Measure Of Central Arterial Stiffness Research Articles

Number of prior live births is associated with higher arterial stiffness but not its change in older women: the atherosclerosis risk in communities study.

Although studies have demonstrated a J-shaped association between parity and cardiovascular disease (CVD), the association with arterial stiffness is not fully understood. We examined the association between parity and carotid-femoral pulse wave velocity (cfPWV), a measure of central arterial stiffness. We conducted a longitudinal analysis of 1220 women (mean age 73.7 years) who attended the Atherosclerosis Risk in Communities Study visit 5 (2011-2013). At visit 2 (1990-1992), women self-reported parity (number of prior live births), which we categorized as: 0 (never pregnant or pregnant with no live births); 1-2 (referent); 3-4; and 5+ live births. Technicians measured cfPWV at visit 5 (2011-2013) and visit 6 or 7 (2016-2019). Multivariable linear regression modeled the associations of parity with visit 5 cfPWV and cfPWV change between visit 5 and 6/7 adjusted for demographics and potential confounding factors. Participants reported 0 (7.7%), 1-2 (38.7%), 3-4 (40.0%), or 5+ (13.6%) prior live births. In adjusted analyses, women with 5+ live births had a higher visit 5 cfPWV (β=50.6 cm/s, 95% confidence interval: 3.6, 97.7 cm/s) than those with 1-2 live births. No statistically significant associations were observed for other parity groups with visit 5 cfPWV or with cfPWV change. In later life, women with 5+ live births had higher arterial stiffness than those with 1-2 live births, but cfPWV change did not differ by parity, suggesting women with 5+ live births should be targeted for early primary prevention of CVD given their higher arterial stiffness at later-life.

Central arterial stiffness, brain white matter hyperintensity and total brain volume across the adult lifespan.

Mounting evidence suggests that central arterial stiffening is associated with brain ageing in older adults. The purpose of this study was to determine the associations of age with carotid arterial stiffness and carotid-femoral pulse wave velocity (cfPWV), both measurements of central arterial stiffness, the relationship between age-related arterial stiffness, brain white matter hyperintensity (WMH) and total brain volume (TBV), and whether effects of central arterial stiffness on WMH volume and TBV are mediated by pulsatile cerebral blood flow (CBF). One hundred and seventy-eight healthy adults (21-80 years) underwent measurements of central arterial stiffness using tonometry and ultrasonography, WMH and TBV via MRI, and pulsatile CBF at the middle cerebral artery via transcranial Doppler. Advanced age was associated with increases in both carotid arterial stiffness and cfPWV, increases in WMH volume and decreases in TBV (all P < 0.01). Multiple linear regression analysis showed that carotid β-stiffness was positively associated with WMH volume (B = 0.015, P = 0.017) and cfPWV negatively with TBV (B = -0.558, P < 0.001) after adjustment for age, sex and arterial pressure. Pulsatile CBF mediates the associations between carotid β-stiffness and WMH (95% confidence interval: 0.0001-0.0079). These findings suggest that age-related central arterial stiffness is associated with increased WMH volume and decreased TBV, which is likely mediated by increased arterial pulsation.

The Association between Exposure to Residential Indoor Volatile Organic Compounds and Measures of Central Arterial Stiffness in Healthy Middle-Aged Men and Women.

It is well reported that individuals spend up to 90% of their daily time indoors, with between 60% to 90% of this time being spent in the home. Using a cross-sectional study design in a population of 111 healthy adults (mean age: 52.3 ± 9.9 years; 65% women), we investigated the association between exposure to total volatile organic compounds (VOCs) in indoor residential environments and measures of central arterial stiffness, known to be related to cardiovascular risk. Indoor VOC concentrations were measured along with ambulatory measures of pulse pressure (cPP), augmentation index (cAIx) and cAIx normalized for heart rate (cAIx75), over a continuous 24-h period. Pulse wave velocity (cfPWV) was determined during clinical assessment. Multiple regression analysis was performed to examine the relationship between measures of arterial stiffness and VOCs after adjusting for covariates. Higher 24-h, daytime and night-time cAIx was associated with an interquartile range increase in VOCs. Similar effects were shown with cAIx75. No significant effects were observed between exposure to VOCs and cPP or cfPWV. After stratifying for sex and age (≤50 years; >50 years), effect estimates were observed to be greater and significant for 24-h and daytime cAIx in men, when compared to women. No significant effect differences were seen between age groups with any measure of arterial stiffness. In this study, we demonstrated that residential indoor VOCs exposure was adversely associated with some measures of central arterial stiffness, and effects were different between men and women. Although mechanistic pathways remain unclear, these findings provide a possible link between domestic VOCs exposure and unfavourable impacts on individual-level cardiovascular disease risk.

Determination of aortic pulse transit time based on waveform decomposition of radial pressure wave

Carotid-femoral pulse transit time (cfPTT) is a widely accepted measure of central arterial stiffness. The cfPTT is commonly calculated from two synchronized pressure waves. However, measurement of synchronized pressure waves is technically challenging. In this paper, a method of decomposing the radial pressure wave is proposed for estimating cfPTT. From the radial pressure wave alone, the pressure wave can be decomposed into forward and backward waves by fitting a double triangular flow wave. The first zero point of the second derivative of the radial pressure wave and the peak of the dicrotic segment of radial pressure wave are used as the peaks of the fitted double triangular flow wave. The correlation coefficient between the measured wave and the estimated forward and backward waves based on the decomposition of the radial pressure wave was 0.98 and 0.75, respectively. Then from the backward wave, cfPTT can be estimated. Because it has been verified that the time lag estimation based on of backward wave has strong correlation with the measured cfPTT. The corresponding regression function between the time lag estimation of backward wave and measured cfPTT is y = 0.96x + 5.50 (r = 0.77; p < 0.001). The estimated cfPTT using radial pressure wave decomposition based on the proposed double triangular flow wave is more accurate and convenient than the decomposition of the aortic pressure wave based on the triangular flow wave. The significance of this study is that arterial stiffness can be directly estimated from a noninvasively measured radial pressure wave.

Association of arterial stiffness with incident atrial fibrillation: a cohort study

BackgroundStiff arteries increase left ventricular (LV) end-systolic workload, leading over time to left atrial and ventricular remodeling, and providing the substrate for atrial fibrillation (AF) development. We investigated if carotid femoral pulse wave velocity (cfPWV), a measure of central arterial stiffness, is associated with incident AF.MethodsIn 2011–2013, cfPWV was measured in 3882 participants of the Atherosclerosis Risk in Communities Cohort Study (ARIC) without prevalent AF. Participants were followed through 2017 for the incidence of AF. Individuals were categorized in cfPWV quartiles based on visit measurements. Multivariable Cox regression models were used to evaluate the association of cfPWV with incident AF.ResultsMean age was 75 years (SD 5), 60% were female and 20% were African American. Over a median follow-up of 5.5 years we identified 331 incident cases of AF. cfPWV demonstrated U-shaped associations with AF risk. In models adjusted for age, race, center, sex, education levels, and hemodynamic and clinical factors, hazard ratios (HR) of AF for participants in the first, third and fourth quartiles were 1.49 (95% CI 1.06, 2.10), 1.59 (1.14, 2.10), and 1.56(1.10, 2.19), respectively, compared to those in the second quartile.ConclusionAmong community-dwelling older adults, low and high central arterial stiffness is associated with AF risk.

Regular resistance training favorably affects central artery stiffness response following transient resistance exercise

High-intensity regular resistance training increases central arterial stiffness. In contrast, resistance-trained individuals experience a protective effect on vascular function response after transient resistance exercise. Central arterial stiffening with regular resistance training might be offset with each transient resistance exercise performed. The aim of the present study was to determine the effects of regular resistance training on the response of central arterial stiffness following a single bout of resistance exercise. All subjects were assigned to control (n = 8) and training (n = 14) groups. The training group underwent four weeks of regular resistance training. Before and after the regular training, they performed a transient resistance exercise consisting of unilateral resistance exercise using arm curls (5 sets of 10 repetitions at 75% of 1 repetition maximum). Beta stiffness index as a measure of central arterial stiffness was evaluated at baseline and 30 min and 60 min following transient resistance exercise. The training group showed that transient resistance exercise did not change the beta stiffness index before regular training. Nevertheless, regular training markedly decreased beta stiffness index after transient resistance exercise (following 30 min: change = − 3.8 ± 2.1 AU, p < 0.05), although it significantly increased beta stiffness index at rest (change = 1.5 ± 1.6 AU). The present findings suggest that regular resistance training remedies central arterial stiffness response following transient resistance exercise. Regular resistance training experience has a favorable effect on elastic properties of central arteries following transient resistance exercise (day-to-day practice in resistance-trained individuals).

ASSOCIATION BETWEEN CARDIOVASCULAR RISK ESTIMATION BY THE ASCVD RISK ESTIMATOR AND CAROTID-FEMORAL PULSE WAVE VELOCITY IN OLDER INDIVIDUALS

Abstract Objective: Carotid-femoral pulse wave velocity (c-fPWV) is a noninvasive indirect measure of central arterial stiffness, considered a predictor of cardiovascular events. However, it is not included in any cardiovascular risk calculator, such as the pooled risk equation for atherosclerotic cardiovascular disease (ASCVD) risk estimation. The study aimed to evaluate the association between c-fPWV and CVR in older individuals as determined by ASCVD Risk Estimator. Design and method: EVOPIU is a longitudinal study where c-fPWV and ASCVD risk were evaluated in 927 patients aged 60 or older. We measured c-fPWV with the SphygmoCor XCEL model EM4C device (AtCor Medical, Sydney, NSW, Australia). We calculated 10-year ASCVD risk using the pooled equation risk calculator that integrates information on age, gender, systolic BP (and treatment), total and HDL cholesterol, and history of DM. The total area under the ROC curve between ASCVD risk estimator and c-fPWV was identified. Results: Average age was 67.8 ± 5.2 years, 38% male, 13% diabetic; 56% hypertensive; total cholesterol 202 ± 37 mg/dl; HDL-cholesterol 52 ± 14 mg/dl, and LDL 119 ± 33 mg /dl. Baseline c-fPWV was 9,3 ± 0,9 m/s. The average ASCVD risk was 21.9%. There was a direct correlation between c-fPWV and ASCVD risk (Spearman's = 0.74 p &lt; 0,0001. Survival analysis showed that CVR or c-fPWV detected higher number of deaths in the largest tertiles (chi2: 8.3; p = 0.002). The area under the curve was 0.86 with 77.4% sensitivity and 77.3% specificity with c-fPWV cutoff = 9.6 m / s. Conclusions: There is a positive association between c-fPWV and ASCVD risk estimator. The c-fPWV measurement could complement ASCVD risk estimator in older individuals.

Acute Changes in Carotid-Femoral Pulse-Wave Velocity Are Tracked by Heart-Femoral Pulse-Wave Velocity.

Background: Carotid-femoral pulse-wave velocity (cfPWV) is the reference standard measure of central arterial stiffness. However, it requires assessment of the carotid artery, which is technically challenging, and subject-level factors, including carotid artery plaque, may confound measurements. A promising alternative that overcomes these limitations is heart-femoral PWV (hfPWV), but it is not known to what extent changes in cfPWV and hfPWV are associated.Objectives: To determine, (1) the strength of the association between hfPWV and cfPWV; and (2) whether change in hfPWV is associated with change in cfPWV when central arterial stiffness is perturbed.Methods: Twenty young, healthy adults [24.0 (SD: 3.1) years, 45% female] were recruited. hfPWV and cfPWV were determined using Doppler ultrasound at baseline and following a mechanical perturbation in arterial stiffness (120 mmHg thigh occlusion). Agreement between the two measurements was determined using mixed-effects regression models and Bland-Altman analysis.Results: There was, (1) strong (ICC > 0.7) agreement between hfPWV and cfPWV (ICC = 0.82, 95%CI: 0.69, 0.90), and, (2) very strong (ICC > 0.9) agreement between change in hfPWV and cfPWV (ICC = 0.92, 95%CI: 0.86, 0.96). cfPWV was significantly greater than hfPWV at baseline and during thigh occlusion (both P < 0.001). Inspection of the Bland-Altman plot, comparing cfPWV and corrected hfPWV, revealed no measurement magnitude bias.Discussion: The current findings indicate that hfPWV and cfPWV are strongly associated, and that change in cfPWV is very strongly associated with change in hfPWV. hfPWV may be a simple alternative to cfPWV in the identification of cardiovascular risk in clinical and epidemiological settings.

Associations between carotid-femoral and heart-femoral pulse wave velocity in older adults: the Atherosclerosis Risk In Communities study.

Carotid-femoral pulse wave velocity (cfPWV) is widely used in epidemiological studies to assess central arterial stiffness. However, despite being superior to traditional risk factors in predicting cardiovascular outcomes, cfPWV is not routinely used in clinical practice. cfPWV assessments require applanation of the carotid artery, which can be cumbersome, and individual-level factors, including carotid artery plaque, may confound the measurements. Heart-femoral PWV (hfPWV) may be a suitable alternative measure of central arterial stiffness. The aim of this study was to estimate the strength of the agreement between hfPWV and cfPWV. We evaluated 4133 older-aged [75.2 (5.0) years] African-American and white adults in the community-based Atherosclerosis Risk in Communities (ARIC) Study. cfPWV and hfPWV were measured using an automated cardiovascular screening device. Agreement between the two measurements was determined using Pearson's correlation coefficient (r), standard error of estimate (SEE) and Bland-Altman analysis. There was a strong (r > 0.7) agreement between hfPWV and cfPWV (r = 0.83, 95% CI: 0.82-0.84). Although the mean cfPWV [11.5 m/s (SD: 3.0)] and hfPWV [11.5 m/s (SD: 2.3)] were comparable, the SEE was 1.7 m/s. Inspection of the Bland-Altman plot revealed greater variability and bias for higher PWV values, with higher PWV further away from the regression line. Findings suggest good agreement between hfPWV and cfPWV. hfPWV is a simpler alternative to cfPWV that is less likely to be confounded by individual-level factors. Considering the greater variability for higher PWV values, further work is warranted to determine the importance of local artery mechanics to both measures.

RNA-sequencing analysis of differential gene expression associated with arterial stiffness.

Arterial stiffness is recognized as an important predictor of cardiovascular disease morbidity and mortality, independent of traditional cardiovascular disease risk factors. Given that arterial tissue is not easily accessible, most gene expression studies on arterial stiffness have been conducted on animals or on patients who have undergone by-pass surgeries. In order to obtain a deeper understanding of early changes of arterial stiffness, this study compared transcriptome profiles between healthy adults with higher and lower arterial stiffness. The sample included 20 healthy female adults without cardiovascular disease. Arterial stiffness was measured by carotid-femoral pulse wave velocity, the "gold-standard" measure of central arterial stiffness. Peripheral blood samples collected to PAXgene™ RNA tubes were used for RNA sequencing (RNA-seq). The potential confounding effects of age, body mass index, and mean arterial pressure were controlled for in RNA-seq analysis. To validate RNA-seq results, quantitative real-time PCR (qRT-PCR) was performed for six selected genes. The findings demonstrated that genes including CAPN9, IL32, ERAP2, RAB6B, MYBPH, and miRNA626 were down-regulated, and that MOCS1 gene was up-regulated among the people with higher arterial stiffness. Real-time PCR showed that the changes of CAPN9, IL32, ERAP2, and RAB6B were in concordance with RNA-seq data, and confirmed the validity of the gene expression profiles obtained by RNA-seq analysis. Previous studies have suggested the potential roles of CAPN9, IL32, and ERAP2 in structural changes of the arterial wall through up-regulation of metalloproteinases. However, the current study showed that CAPN9, IL32, and ERAP2 were down-regulated in the individuals with higher arterial stiffness, compared with those with lower arterial stiffness. The unexpected directions of expression of these genes may indicate an effort to maintain vascular homeostasis during increased arterial stiffness among healthy individuals. Further studies are guaranteed to investigate the roles of CAPN9, IL32, and ERAP2 in regulating arterial stiffness in people with and without cardiovascular disease.

The Effects of an ACE Inhibitor Lisinopril on Cardiovascular and Cognitive Function in Old Hypertensive Dahl Salt‐Sensitive Rats

The Effects of an ACE Inhibitor Lisinopril on Cardiovascular and Cognitive Function in Old Hypertensive Dahl Salt‐Sensitive Rats

The effect of acute aerobic exercise on central arterial stiffness, wave reflections, and hemodynamics in adults with diabetes: A randomized cross-over design

BackgroundIndividuals with diabetes have greater central arterial stiffness, wave reflections, and hemodynamics, all of which promote the accelerated cardiovascular pathology seen in this population. Acute aerobic exercise has been shown to be an effective strategy for reducing central arterial stiffness, wave reflections, and hemodynamics in healthy individuals; however, the effects of acute aerobic exercise in reducing these outcomes is not well established in people with diabetes. Recently, implementation of high-intensity interval exercise (HIIE) has shown superior improvements in cardiovascular health outcomes when compared to traditional aerobic exercise. Yet, the effect of HIIE on the aforementioned outcomes in people with diabetes is not known. The purpose of this study was to (i) describe the central arterial stiffness, wave reflections, and hemodynamic responses to a bout of HIIE and moderate-intensity continuous exercise (MICE) in adults with diabetes; and (ii) compare the effects of HIIE and MICE on the aforementioned outcomes. MethodsA total of 24 adult men and women (aged 29–59 years old) with type 1 (n = 12) and type 2 (n = 12) diabetes participated in a randomized cross-over study. All participants completed the following protocols: (i) HIIE: cycling for 4 × 4 min at 85%–95% of heart rate peak (HRpeak), interspersed with 3 min of active recovery at 60%–70%HRpeak; (ii) MICE: 33 min of continuous cycling at 60%–70%HRpeak; and (iii) control (CON): lying quietly in a supine position for 30 min. ResultsA significant group × time effect was found for changes in central systolic blood pressure (F = 3.20, p = 0.01) with a transient reduction for the HIIE group but not for the MICE or CON groups. There was a significant group × time effect for changes in augmentation index at a heart rate of 75 beats/min (F = 2.32, p = 0.04) with a decrease following for HIIE and MICE but not for CON. For all other measures of central arterial stiffness and hemodynamics, no significant changes were observed (p > 0.05). ConclusionA bout of HIIE appears to lead to a greater transient reduction in central systolic blood pressure than the reduction observed following MICE; however, both HIIE and MICE improved augmentation index at a heart rate of 75 beats/min in people with diabetes. There was no significant difference in response to HIIE and MICE in all outcomes. This provides preliminary evidence on the role of HIIE on such outcomes in people with diabetes.

Abstract P347: Associations Between Carotid-femoral and Heart-femoral Pulse Wave Velocity in Older Adults: The Atherosclerosis Risk in Communities (ARIC) Study

Introduction: Carotid-femoral pulse wave velocity (cfPWV) is widely used in clinical and epidemiological studies to assess central arterial stiffness and predict cardiovascular outcomes. However, cfPWV assessments require applanation of the carotid artery, which may be challenging in some patients, and assessments may be confounded in the presence of carotid artery plaque. Further, since cfPWV is not consistent with the path of blood flow, the measure is adjusted according to an assumed timing of the pressure wave traveling in the opposite direction. Therefore, we hypothesize that heart-femoral PWV (hfPWV) could be a simpler measure of central arterial stiffness that is consistent with the path of blood flow. Objective: To estimate the strength of the association between hfPWV and cfPWV. Methods: We evaluated 4,476 older-aged (75.2 y [SD: 5.0]) adults in the community-based Atherosclerosis Risk in Communities (ARIC) Study. cfPWV and hfPWV were measured using an automated cardiovascular screening device (Omron VP-1000plus) equipped with an electrocardiogram, a phonocardiogram, and 2 applanation tonometry sensors attached to carotid and femoral arteries. Agreement between the two measurements was determined by calculating the intraclass correlation coefficient (ICC) and the standard error of estimate (SEE). We considered ICC value estimates of &lt;0.5, 0.5-0.75, 0.75-0.9, and &gt;0.9 as, respectively, poor, moderate, good, and excellent agreement. The SEE represents the average distance that the observed values fall from the regression line. Smaller values indicate that the observations are closer to the fitted line. The uniformity of error was assessed by visual analysis of regression plot. Results: There was ‘good’ agreement between hfPWV and cfPWV (ICC = 0.83, 95%CI: 0.82, 0.84). While the mean cfPWV (11.6 m/s [SD: 3.0]) and hfPWV (11.5 m/s [SD: 2.3]) were comparable, the SEE was 1.3 (95%CI: 1.27, 1.33) m/s. Inspection of the regression plot revealed bias, with higher PWV further away from the regression line. Conclusions: The current findings suggest good agreement between cfPWV and hfPWV, indicating that hfPWV may be a suitable alternative to cfPWV. Since hfPWV does not require applanation of the carotid artery, the measurement is easier to conduct and may be particularly suited for use in individuals for whom applanation of the carotid artery is challenging.

Habitual physical activity and central artery stiffening in older adults: the Atherosclerosis Risk in Communities study.

Regular physical activity appears to attenuate or even reverse age-related arterial stiffening. Yet, it is not clear if the reduced stiffening associated with habitual physical activity is also observed in community-dwelling older adults. Among 3893 older adults in a prospective cohort study, we associated physical activity with measures of central arterial stiffness (via carotid-femoral pulse wave velocity or cfPWV) and pressure pulsatility (via central pulse pressure or cPP). We also examined the association of long-term habitual physical activity, measured as persistence in physical activity levels from mid-life to late-life, with cfPWV and cPP among 1747 participants. The adjusted mean difference in cfPWV was lower, reflecting less arterial stiffness, for those with moderate (ß = -0.30 m/s) or high (ß = -0.38 m/s) physical activity compared with no physical activity. The adjusted mean difference in cPP was also lower for those with high (ß = -2.49 mmHg) physical activity, relative to no physical activity. Stronger effect estimates were observed among those with persistent physical activity from mid-life to late-life. Higher physical activity in late-life, and habitual physical activity from mid-life to late-life, is associated with lower central arterial stiffness and pressure pulsatility in a large population-based sample of community-dwelling older adults.

Associations Between Kidney Disease Measures and Regional Pulse Wave Velocity in a Large Community-Based Cohort: The Atherosclerosis Risk in Communities (ARIC) Study

Arterial stiffness is suggested as a mediator of cardiorenal interaction. However, previous studies reported inconsistent associations between chronic kidney disease (CKD) and arterial stiffness and were limited byusing either estimated glomerular filtration rate(eGFR) or albumin-creatinine ratio (ACR) and examining arterial stiffness at limited segments. Cross-sectional. 3,424 Atherosclerosis in Communities (ARIC) Study participants aged 66 to 90 years during 2011 to2013. eGFR and ACR. Pulse wave velocity (PWV) at 6 segments: carotid-femoral (cfPWV), heart-carotid (hcPWV), and heart-femoral (hfPWV), reflecting central stiffness; heart-ankle (haPWV) and brachial-ankle (baPWV), representing both central and peripheral stiffness; and femoral-ankle (faPWV), indicating peripheral stiffness. Multiple linear and logistic regression models to quantify the associations ofeGFR and ACR with continuous PWV andelevated PWV (in the highest quartile), respectively. After adjusting for age, sex, and race, higher cfPWV and hfPWV were consistently associated with lower eGFR and higher ACR. Higher haPWV and baPWV were also observed with higher ACR. The independent association of both CKD measures with elevated cfPWV remained consistent after adjusting for additional confounders (ORs of elevated cfPWV were 1.09 [95% CI, 1.01-1.18] per 15-mL/min/1.73m2 lower eGFR and 1.20 [95% CI, 1.07-1.33] per 4-fold higher ACR). Higher ACR was also associated with elevated hfPWV and haPWV (ORs per 4-fold higher ACR were 1.25 [95% CI, 1.12-1.39] for elevated hfPWV and 1.19 [95% CI, 1.06-1.33] for elevated haPWV). Lower eGFR was associated with lower odds of elevated baPWV and faPWV (ORs per 15-mL/min/1.73m2 lower eGFR were 0.92 [95% CI, 0.84-0.99] and 0.91 [95% CI, 0.85-0.99], respectively). Unable to address temporality betweenCKD measures and arterial stiffness. Both lower eGFR and higher ACR are independently associated with measures of central arterial stiffness, with stronger associations for ACR over eGFR. Our findings suggest that central arterial stiffness may be an important pathophysiologic phenotype of vascular disease in CKD.

DIPPING PROFILE, NIGHTTIME SYSTOLIC BLOOD PRESSURE AND VASCULAR DAMAGE IN PATIENTS WITH RHEUMATOID ARTHRITIS

Objective: Both increased nighttime systolic blood pressure (SBP) and a non-dipping pattern are predictors of adverse cardiovascular outcomes. We investigated dipping profile and nighttime SBP in relationship with subclinical vascular damage in patients with rheumatoid arthritis (RA), a disease characterized by excess cardiovascular risk. Design and method: Patients with RA and non-RA individuals underwent 24-hour ambulatory blood pressure monitoring. Carotid-femoral pulse wave velocity (PWV) was assessed with applanation tonometry as a measure of central arterial stiffness. Carotid atherosclerosis was evaluated from carotid ultrasound by measurement of carotid intima-media thickness (cIMT). Peripheral vascular resistance was estimated from impedance cardiography. Disease-related characteristics were addressed, including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), disease duration and activity, and pain. Results: RA patients (n = 91) exhibited a higher prevalence of non-dipping pattern (64.8 vs 28.0 %, p < 0.001), elevated nighttime SBP (112.6 ± 12.8 vs 105.8 ± 9.7 mmHg, p = 0.001) and a lower degree of dipping (6.5 ± 7.4 vs 13.0 ± 5.6 %, p < 0.001), compared to non-RA individuals (n = 50), whereas both office and daytime SBP did not differ. In the RA group, dipping (%) was inversely associated with PWV (r = –0.218, p = 0.045). Nighttime SBP strongly correlated with all vascular indices, including PWV (r = 0.493, p < 0.001), cIMT (r = 0.407, p < 0.001) and systemic vascular resistance index (r = 0.383, p < 0.001). In addition, nighttime SBP increased with increasing ESR (r = 0.213, p = 0.046), CRP (r = 0.245, p = 0.022), intensity of pain over the past 24-hour hours (r = 0.255, p = 0.042) and disease duration (r = 0.246, p = 0.027). The combination of a non-dipping profile with high nighttime SBP was accompanied by the highest (p = 0.019) PWV (10.0 ± 2.5 m/s), compared to both non-dippers with normal nighttime SBP (7.8 ± 2.1 m/s, p = 0.003) and dippers (8.1 ± 1.9 m/s). In the multivariate analysis for dipping, ESR was identified as an independent predictor (beta = –0.234, p = 0.037), and the same was observed in the multivariate analysis for nighttime SBP (beta = 0.201, p = 0.019). Conclusions: Patients with RA exhibit high prevalence of blunted dipping due to elevated nighttime SBP. Inflammation appears to mediate the observed associations of nighttime SBP and dipping with markers of central and peripheral vascular damage. The combination of a non-dipping profile with abnormal nighttime SBP is accompanied by pronounced subclinical vascular impairment.

ARTERIAL STIFFNESS IS ASSOCIATED WITH LOWER CEREBRAL BLOOD PERFUSION IN OLDER ADULTS

Arterial stiffness is an emerging risk factor for Alzheimer's disease and related dementias, partly through its novel associations with both cerebrovascular disease and β-amyloid deposition. Initial reports suggest that greater aortic stiffness may be related to lower cerebral perfusion in the brain. This study included participants from a randomized controlled clinical trial of exercise who received brain MRIs and cognitive testing before and after 6 months of aerobic training or stretching exercise. MRI included multi-phase pseudo-continuous arterial spin labeling to define cerebral blood flow in the whole brain gray matter (CBFgm). A subset of participants received baseline (n=17) and/or post-intervention (n=22) measures of central arterial stiffness using the AtCor SphygmoCor XCEL to obtain carotid-femoral pulse wave velocity (cfPWV). General linear models were used to assess associations between cfPWV and (global and voxel wise) cerebral blood flow with and without adjustment for age, gender, education, intracranial volume and APOE-4 status. Participants in this sample had a mean(SD) age of 67(9) years [range 51–89], 60% women, 19% were APOE-ε4 positive and all had at least an 12th grade education. Baseline cfPWV was negatively correlated with CBFgm (figure), showed regional specificity, and remained significant adjustment for covariates (beta = -4.3(1.8), p=0.04). Baseline and post intervention measures of cfPWV were highly correlated (rho=0.62, P<0.01) and showed similar negative associations with global CBFgm; however, change in cfPWV was not associated with changes global CBFgm (p=0.35). Correlations between global CBF and arterial stiffness by gender.

Arterial Path Length for Arterial Stiffness: Methodological Consideration.

Carotid-femoral pulse wave velocity (cfPWV) is the most established measure of central arterial stiffness and is calculated by dividing the distance travelled by the pulse wave by the pulse transit time. However, there is no universally accepted standardized measurement of pulse travel distance for cfPWV. This study sought to assess validity and convertibility of 2 most frequently used travel distance estimations, and create the simple and useful conversion equation to unify cfPWV values obtained with different methodologies for pulse travel distance. In a total of 227 adults, cfPWV was calculated using 2 different pulse travel distances: suprasternum-femoral distance minus suprasternum-carotid distance (the subtraction method) and carotid-femoral straight distance × 0.8 (the 80% method). They were compared against 3D arterial tracing via magnetic resonance imaging (MRI). The subtraction method underestimated travel distance and cfPWV by 8.7% although correlations with the MRI reference values were significant. The 80% method provided more reliable cfPWV, showing a stronger linearity (r = 0.96, P < 0.0001) and a better agreement with the MRI-based reference value (+0.02±0.54 m/s). Values of cfPWV were influenced primarily by pulse transit time, explaining ~80% of the variation in cfPWV, and the contribution of pulse travel distance was relatively small irrespective of how the travel distance was measured. After the application of the conversion factor (the 80% method = the subtraction method × 1.1), cfPWV values obtained with both methods were strongly correlated and estimation errors were comparable (+0.03±0.75 m/s). Our findings indicate that the subtraction method and the 80% method can provide equivalent cfPWV values by the application of a simple conversion factor.

Correlates of Segmental Pulse Wave Velocity in Older Adults: The Atherosclerosis Risk in Communities (ARIC) Study.

Carotid-femoral PWV (cfPWV) is a well-established measure of central arterial stiffness, while brachial-ankle PWV (baPWV) is being used more frequently in East Asian countries. Few studies have simultaneously characterized the distributions and correlates of segment-specific PWV measures and their associations with cardiovascular risk factors. We evaluated segment-specific PWV (cfPWV, baPWV, and femoral-ankle (faPWV)) in 4,974 older-aged African American and Caucasian adults in the community-based Atherosclerosis Risk in Communities (ARIC) Study using a standardized protocol and the OMRON VP-1000 Plus system. We examined the distribution and multivariable-adjusted correlates of PWV measures by race and sex. Mean age ranged from 74 ± 5 to 76 ± 5 years across race-sex groups. In all race-sex groups, cfPWV correlated with baPWV but not with faPWV, and cfPWV and baPWV were higher with age, whereas faPWV was not. Heart rate and systolic blood pressure (SBP) were positively associated and weight was negatively associated with all PWV measures; however, the associations with age, glycated hemoglobin, triglycerides, and high-density lipoprotein (HDL) cholesterol varied by segment and race-sex group. Our findings indicate that cfPWV and faPWV reflect distinct aspects of segment-specific vascular stiffness and their associated profile of cardiovascular risk factors. Even among older adults, age is associated with higher cfPWV and baPWV, but not with faPWV. Understanding factors that ostensibly play a role in increasing arterial stiffness in different arterial territories can inform opportunities for cardiovascular disease (CVD) prevention and risk management.

Effect of omega-3 polyunsaturated fatty acid supplementation on central arterial stiffness and arterial wave reflections in young and older healthy adults.

Increased central arterial stiffness and enhanced arterial wave reflections may contribute to increased risk of cardiovascular disease development with advancing age. Omega-3 polyunsaturated fatty acid (n-3) ingestion may reduce cardiovascular risk via favorable effects exerted on arterial structure and function. We determined the effects of n-3 supplementation (4 g/day for 12 weeks) on important measures of central arterial stiffness (carotid-femoral pulse wave velocity; PWV) and arterial wave reflection (central augmentation index) in young (n = 12; 25 ± 1-year-old, mean ± SE) and older (n = 12; 66 ± 2) healthy adults. We hypothesized that n-3 supplementation would decrease carotid-femoral PWV and central augmentation index in older adults. Our results indicate that carotid-femoral PWV and central augmentation index were greater in older (988 ± 65 cm/sec and 33 ± 2%) than in young adults (656 ± 16 cm/sec and 3 ± 4%: both P < 0.05 compared to older) before the intervention (Pre). N-3 supplementation decreased carotid-femoral PWV in older (Δ-9 ± 2% Precompared to Post; P < 0.05), but not young adults (Δ2 ± 3%). Central augmentation index was unchanged by n-3 supplementation in young (3 ± 4 vs. 0 ± 4% for Pre and Post, respectively) and older adults (33 ± 2 vs. 35 ± 3%). Arterial blood pressure at rest, although increased with age, was not altered by n-3 supplementation in young or older adults. Collectively, these data indicate that 12 weeks of daily n-3 supplementation decreases an important measure of central arterial stiffness (carotid-femoral PWV) in older, but not young healthy adults. The mechanism underlying decreased central arterial stiffness with n-3 supplementation is unknown, but appears to be independent of effects on arterial blood pressure or arterial wave reflections.