Measure Of Arterial Wave Reflection Research Articles

Sex differences in arterial wave reflection and the role of exogenous and endogenous sex hormones: results of the Berlin Aging Study II.

Arterial stiffness is tightly linked to hypertension. Sex differences in hypertension and arterial stiffness have already been established, yet the role of sex hormones is not precisely defined. This study examined age and sex differences of arterial wave reflection and associations with endogenous and exogenous sex hormones in women. Pulse wave analysis was performed with an oscillometric device in 590 male and 400 female participants of the Berlin Aging Study II. Participants have been recruited from two age-strata, 22-35 years and 60-82 years. Data on exposures and potential confounders, including medication, have been collected at baseline visit. Aumentation index (AIx) and pulse wave velocity increased with age. Mean AIx was higher in women than in men. Multivariable regression analysis showed a positive association between use of oral contraceptive pills (OCPs) and AIx controlling for confounders (age, BMI, current smoking, central blood pressure), with a significantly higher mean AIx in OCP-users compared with nonusers (mean group difference: 4.41; 95% confidence interval 1.61-7.22). Per quartile decrease in estradiol level AIx increased by 1.72 (95% confidence interval 0.43-3.00). In OCP users endogenous estradiol was largely suppressed. The findings suggest important sex differences in measures of arterial wave reflection, with a higher mean AIx observed in women compared with men. OCPs may promote the development of hypertension by increasing AIx. Suppressed endogenous estradiol levels may be responsible for this increased wave reflection due to increased vasotonus of the small and medium arteries.

P6506Circulating microparticles preceding endothelial dysfunction and inflammatory process in patients with pseudoexfoliative glaucoma

Abstract Background Pseudoexfoliative glaucoma (PEX) is a type of glaucoma characterized by the secretion of a grey-white, fibrogranular material in several tissues. Microparticles are shed membrane vesicles released from a variety of cell types in response to cellular activation or apoptosis and correlate with the pathogenesis of cardiovascular diseases. Endothelial MPs may be used as biomarkers of endothelial function. Purpose To evaluated the role of endothelial dysfunction, arterial stiffness and systemic inflammation in patients with PEX compared to patients with Primary open angle glaucoma (POAG) and control subjects as well as the possible pathophysiologic role of a specific microparticle profile associated with endothelial damage. Methods We enrolled 29 subjects with PEX, 57 subjects with POAG and 44 control subjects. Endothelial function was evaluated by flow-mediated dilation (FMD). Pulse wave velocity (PWV) was measured as an index of aortic stiffness and augmentation index (AIx) as a measure of arterial wave reflections. Growth differentiation factor-15 (GDF-15) and intercellular adhesion molecule1 (ICAM1) were measured to evaluate systemic inflammatory status. Total circulating MPs and EMPs were isolated and analysed by flow cytometry, utilizing specific labels for EMPs (CD 144+) and Annexin V staining for phospatidylserine bearing-MPs (AnnexinV + MPs). Results There was a linear impairment in FMD (p=0.005), PWV (p=0.007) and Aix (p=0.02) and a stepwise increase in GDF-15 (p=0.001) and sICAM-1 levels (p=0.08) between the three study groups (control, POAG, PEX). Interestingly, the PEX subjects expressed greater levels of total circulating MPs (Annexin V+) [1698 (1199–5894) MPs/μL vs. 1641 (1470–2705) MPs/μL. vs 493 (417–1512) MPs/μL, p=0.004] and EMPs (CD144+)[1412 (645–1760) MPs/μL3 vs 1380 (498–2496) MPs/μL vs 34 (184–870) MPs/μL, p<0.001] compared to POAG and control subjects. Conclusion Pseudoexfoliative glaucoma is associated with impaired endothelial function, arterial wall properties and vascular inflammation with a parallel increase in EMPs. Our findings indicate the significant role of endothelial damage in the progress of glaucomatous disease especially in subjects with pseudoexfoliative glaucoma.

Vascular function and ocular involvement in sarcoidosis

Ocular involvement occurs in sarcoidosis (Sar) patients mainly in the form of uveitis. This study was designed to determine if uveitis in Sar patients is associated with vascular impairment. We enrolled 82 Sar patients and 77, age and sex matched, control subjects (Cl). Sar patients were divided into those with ocular sarcoidosis (OS) and those without ocular sarcoidosis (WOS). Endothelial function was evaluated by flow-mediated dilation (FMD). Pulse wave velocity (PWV) was measured as an index of aortic stiffness and augmentation index (AIx) as a measure of arterial wave reflections. Although there was no significant difference in sex, age and mean arterial pressure, patients with OS compared to WOS patients and Cl subjects had impaired FMD (p<0.001), increased AIx (p=0.02) and increased PWV (p=0.001). Interestingly, impaired FMD in Sar patients was independently, from possible covariates (age, sex, smoking habits, arterial hypertension, dyslipidemia), associated with increased odds of ocular involvement (odds ratio=1.69, p=0.001). More precisely ROC curve analysis revealed that FMD had a significant diagnostic ability for the detection of OS (AUC=0.77, p<0.001) with a sensitivity of 79% and a specificity of 68% for an FMD value below 6.00%. To conclude in the present study we have shown that ocular involvement in Sar patients is associated with impaired endothelial function and increased arterial stiffness. These results strengthen the vascular theory which considers uveitis a consequence of vascular dysfunction in Sar patients and reveals a possible clinical importance of the use of endothelial function tests.

Abstract 380: Favorable Effects of Flavonoids on Endothelial Function and Arterial Stiffness in Healthy Smokers

Background: Smoking is associated with impaired vascular function. Consumption of concord grape juice (CGJ), a rich source of flavonoids, has previously been shown to have antithrombotic and antioxidant effects and moreover can modify cardiovascular risk factors. In the present study we assessed the hypothesis that CGJ can improve endothelial function and arterial stiffness in healthy smokers. Methods: We studied the effect of a 2 weeks oral treatment with 7cc/Kg/day of CGJ (Welch’s 100% Concord Grape) in 20 healthy smokers (aged 26±5y) on two occasions (day 0: baseline and day 14). The study was carried out on two separate arms, one with CGJ and one with placebo, according to a randomized, placebo-controlled, double-blind, cross-over design. Measurements were carried out before (pSm) and immediately after (Sm0) cigarette smoking. Endothelial function was evaluated by flow-mediated dilation (FMD) of the brachial artery. Carotid-femoral pulse wave velocity (PWV) was measured as an index of aortic stiffness and augmentation index (AIx) as a measure of arterial wave reflections. Results: At baseline measurements, compared to pSm, cigarette smoking decreased FMD values (8.58±3.17% vs.5.65±1.98%, p&lt;0.001) and moreover caused an increase in AIx (4.19±9.13% vs. 6.26±9.81%, p=0.013) and PWV (6.02±0.67m/sec vs. 6.21±0.68m/sec, p&lt;0.046). Treatment with CGJ, improved pSm values of: FMD (7.87±2.79% vs. 9.43±2.62%, p=0.024), PWV (6.11±0.58m/sec vs. 5.70±0.6m/sec, p=0.013) and AIx (3.03±7.70% vs. -0.59±8.56%, p=0.016), while there was no statistically significant difference with placebo administration. Finally, compared with placebo, at day 14, treatment with CGJ, blunted the acute smoking-induced increase in PWV (placebo: from 5.67±0.64m/sec Psm to 6.00±0.78m/sec Sm0), (CGJ: from 6.00±0.73m/sec Psm to 6.23±0.66m/sec Sm0) (p=0.012). Conclusion: Concord grape juice contains specific flavonoids that may improve endothelium-dependent vasodilation and vascular elastic properties of the arterial tree in healthy smokers. Improved endothelial function and decreased arterial stiffness is a potential mechanism by which flavonoids may prevent cardiovascular events.

Abstract 17432: Influence of Smoking on Arterial Stiffness - A Racial Comparison

BACKGROUND: Although an association between smoking and arterial stiffness has been well established, whether this varies by ethnicity remains a subject of controversy. We hypothesized that the association between smoking and increased arterial stiffness is race-specific. METHODS: White (n=285, 36 smokers) and black (n=317, 91 smokers) participants (mean age 50±9, 57% female) from the Morehouse-Emory Partnership to Eliminate Cardiovascular Health Disparities (META-Health) study underwent measurement of central augmentation index (CAIx), a composite measure of arterial wave reflections and stiffness using applanation tonometry (SphygmoCor, AtCor). Mixed statistical models were used to determine whether race, age, gender, glucose, lipid parameters, systolic blood pressure (SBP), triglycerides and waist circumference (WC) were predictors of change in CAIx caused by smoking. RESULTS: Age, gender, race, SBP, WC and smoking were found to be independent predictors of CAIx (all P&lt;0.05). The two-way interaction (adjusted for all risk factors) between race and smoking on CAIx was statistically significant. Moreover, CAIx (corrected for heart rate at 75 beats per minute) were similar in white and black non-smokers (20.3 and 21.0, respectively), but significantly higher in black compared to white smokers (21.3 vs.26.4, p=0.027, respectively). CONCLUSIONS: Race is a strong predictor of the degree of change in arterial stiffness in conjunction with smoking, with black smokers having higher CAIx. There were no racial differences in non-smokers. The mechanisms by which smoking predisposes blacks to developing arterial stiffness need to be investigated.

Effects of omega-3 fatty acids on endothelial function, arterial wall properties, inflammatory and fibrinolytic status in smokers: A cross over study

BackgroundSmoking is associated with endothelial dysfunction and arterial stiffness. Supplementation of omega-3 PUFAs is associated with better prognosis. Aim of this study was to evaluate the effects of omega-3 polyunsaturated fatty acids (PUFAs) supplementation on smoking-induced impairment of arterial function. MethodsWe studied the effect of a 12weeks oral treatment with 2gr/day of omega-3 PUFAs in 20 healthy smokers on three occasions (day0:baseline, day28 and day84). The study was carried out on two separate arms (omega-3 fatty acids and placebo), according to a randomized, placebo-controlled, double-blind, cross-over design. Measurements were carried out before (pSm), immediately and 20min after cigarette smoking. Endothelial function was evaluated by flow-mediated dilation (FMD) of the brachial artery. Carotid-femoral pulse wave velocity (PWV) was measured as an index of aortic stiffness and augmentation index (AIx) as a measure of arterial wave reflections. Circulating levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and plasminogen activator inhibitor-1 (PAI-1) were measured. ResultsCompared with placebo, omega-3 PUFAs treatment resulted in a significant improvement in pSm values of FMD (p<0.05), AIx (p<0.001) and PWV (p<0.01). Although, acute cigarette smoking decreased FMD and caused an increase in AIx and PWV, omega-3 PUFAs treatment blunted the acute smoking-induced impairment of FMD (p<0.001), AIx (p<0.05) and PWV (p<0.05) and significantly decreased levels of TNFα (p<0.05) and IL-6 (p=0.01) and increased levels of PAI-1 (p=0.05). ConclusionsOmega-3 PUFAs improved endothelial function and the elastic properties of the arterial tree in healthy smokers, with a parallel anti-inflammatory effect.

The association between aortic regurgitation and increased arterial wave reflection

BackgroundChronic Aortic Regurgitation (AR) increases left ventricular preload and afterload, which may enhance arterial wave reflection. The effects of AR on noninvasive measures of arterial wave reflection and central aortic pressure are unknown. MethodsTo determine the relation between AR and wave reflection, we prospectively studied 86 subjects with AR and 50 controls referred for echocardiography. Peripheral (P) blood pressures (BP) were measured using an automated sphygmomanometer. Central aortic systolic (CS) BP, central pulse pressure (CPP), central augmented pressure (AP), heart rate corrected augmentation index (AI75), AI, reflected wave systolic duration (∆Tr) and round trip travel time (Tr) were derived from the radial artery waveform obtained by applanation tonometry (Sphygmocor®, Atcor Medical). Pulse pressure amplification (PPA) was calculated as peripheral PP/central PP. There were 50 controls, 50 with mild, 25 with moderate, and 11 subjects with severe AR. Clinical characteristics were similar among the groups. ResultsAP, AI75, and CPP increased in a stepwise manner with increasing AR severity. On analysis of variance adjusted for age, gender, height, weight, mean peripheral BP, ejection fraction, and medication classes, AR severity was independently associated with increased AI75 (p<0.001), AP (p<0.001), CSBP (p=0.04). PPA decreased in a stepwise manner with increasing AR severity (p=0.001). Tr decreased and ∆Tr increased. ConclusionsAR is associated with increased amplitude and duration and earlier onset of the reflected pressure wave, which suggests arterial wave reflection to be a potentially important consideration in patients with AR.

ARTERIAL STIFFNESS IS ASSOCIATED WITH THE DEGREE OF PULMONARY IMPAIRMENT IN SARCOIDOSIS PATIENTS

Abstract Category: 11. Peripheral Arterial/Carotid Disease/Aortic DiseaseSession-Poster Board Number: 1010-131Authors: Elias Gialafos, Gerasimos Siasos, Dimitris Tousoulis, Evangelos Oikonomou, Marina Zaromitidou, Athanasios Verveniotis, Thodoris Paraskevopoulos, Konstantinos Maniatis, Christos Kostopoulos, Aggeliki Rapti, Georgios Marinos, Athanasios G. Papavassiliou, Christodoulos Stefanadis, Athens University Medical School, 1st Cardiology Dept, Hippokration Hospital, Athens, Greece Introduction: Sarcoidoisis (Sar) is a multisystemic granulomatous disease characterized by extensive local inflammation and affects multiple organs mainly lungs and lymph nodes. However, the relationship of pulmonary dysfunction with the vascular function remains unknown. In the present study we assessed the hypothesis that pulmonary impairment is associated with arterial stiffness in Sar patients.Methods: Ninety five patients with Sar and eighty seven matched healthy subjects (Cl) were included in the study. Sar patients were subdivided in 3 groups according to the pulmonary function test. Group “A was consisted from patients with normal pulmonary function-total lung capacity (TLC)>75% and diffusion lung capacity for carbon monoxide (DLCO)>75%- group “B” from patients with restrictive pulmonary Physiology - TLC>75%, DLCO 75% -. Carotid-femoral pulse wave velocity (PWV) was measured as an index of aortic stiffness and augmentation index (AIx) as a measure of arterial wave reflections. Serum levels of soluble intercellular cells adhesion molecule 1(sICAM-1) were measured by ELISA.Results: Compare to Cl, Sar patients had significantly higher values of AIx (16.56 ± 13.96 % vs 24.2 ± 9 %, p<0.001) and PWV (7.09 ± 1.49 m/sec vs 7.7 ± 1.83 m/sec, p< 0.05). Bivariate correlation showed that AIx in the Sar group was significantly correlated with age (p<0.001, r=0.412), TLC (p<0.05 r=- 0.25), DLCO (p<0.05, r=-0.276), and s-ICAM-1 (p<0.01, r=-0.36). PWV was significantly associated with the age of the patient (p<0.001, r=0.423) and TLC (p<0.05, r=-0.265). Moreover there was a significance difference between Sar groups “A” and “C” in values of PWV (7.28 ± 1.74 m/sec vs 8.39 ± 1.56 m/sec, p<0.05) and sICAM-1(287.77 ± 147.60 ng/ml vs 664.86 ± 652.46 ng/ml, p<0.05).Conclusion: Arterial stiffness is associated with pulmonary impairment and increased inflammatory status in Sarcoidosis patients. These findings indicate that inflammation is probably the common pathogenetic mechanism causing arterial wall impairment and pulmonary dysfunction in this specific population.

Association of Sarcoidosis With Endothelial Function, Arterial Wall Properties, and Biomarkers of Inflammation

Sarcoidosis is an inflammatory disease, which may affect vascular function. The study was designed to assess the impact of sarcoidosis on endothelial function and arterial stiffness. Eighty-seven sarcoidosis patients and eighty-seven matched healthy subjects (Cl) were included in the study. Sarcoidosis patients were divided into two groups. Group 1 included patients never treated and group 2 included patients receiving cortisone treatment. Endothelial function was evaluated by flow-mediated dilatation (FMD). Carotid-femoral pulse wave velocity (PWV) was measured as an index of aortic stiffness and augmentation index (AI75) as a measure of arterial wave reflections. Serum levels of soluble intercellular adhesion molecule-1 and tumor necrosis factor-α (TNF-α), were measured. In the totality of the population, sarcoidosis patients had significantly lower FMD (P < 0.01) and significantly higher AI75 (P < 0.05). There was also a significant difference, between group 1, and Cl in FMD and AI75, but there was no difference between group 2 and Cl in FMD and AI75. AI75 values were significantly correlated with serum levels of intercellular adhesion molecule-1 (ICAM-1) (r = 0.370, P < 0.01) and TNF-α (r = 0.219, P = 0.049). In the present study, we have shown that sarcoidosis patients have impaired endothelial function and increased arterial stiffness. Sarcoidosis patients on cortisone treatment had no differences compared to controls on the vascular parameters. Moreover, there was a significant correlation between inflammatory process and vascular function impairment. These findings indicate that sarcoidosis patients have impaired vascular function and increased inflammatory status, which may improve with cortisone treatment.

Maternal arterial stiffness in pregnancies complicated by gestational and type 2 diabetes mellitus

We sought to investigate whether maternal arterial stiffness is altered in pregnant women with gestational diabetes mellitus (GDM) and type 2 diabetes compared to normoglycemic women. We conducted a cross-sectional study involving 34 women with GDM and their controls (n = 34), and 34 women with type 2 diabetes and their controls (n = 34). Maternal arterial stiffness was assessed using applanation tonometry. In patients with GDM, compared to their controls, augmentation index (a measure of arterial wave reflection) was higher (13.1 +/- 8.9% vs 0.7 +/- 11.4%; P < .001) and pulse wave velocity (PWV) (arterial stiffness of the carotid-femoral) was marginally increased (6 +/- 1.5 vs 5.4 +/- 0.6 m/s; P = .07). In type 2 diabetics, compared to their controls, both augmentation index and PWV were increased (11.5 +/- 11.4% vs 3.3 +/- 12.5%; P = .006, and 6.8 +/- 1.2 vs 5.6 +/- 1 m/s; P < .001). When all groups were considered together, there was a significant trend of increasing augmentation index (P = .001) and PWV (P < .001) from controls to those with GDM to type 2 diabetes. Pregnancies complicated by GDM and type 2 diabetes are associated with increased maternal arterial stiffness.

The Impact of Oral L-Arginine Supplementation on Acute Smoking-Induced Endothelial Injury and Arterial Performance

Smoking is associated with endothelial dysfunction and increased inflammatory status. The amino acid L-arginine, improves endothelial function in patients with cardiovascular risk factors. We investigated the effect of L-arginine on vascular function and inflammatory process in healthy smokers at rest and after acute smoking. We studied the effect of L-arginine and/or placebo in 12 healthy young smokers on three occasions (day 0, day 1, and day 3). The study was carried out on two separate arms, one with L-arginine (3 x 7 g/day) and one with placebo, according to a randomized, placebo-controlled, double-blind, cross-over design. Measurements were carried out before, immediately after, and 20 min after cigarette smoking. Endothelial function was evaluated by flow-mediated dilation (FMD). Carotid-femoral pulse wave velocity (PWV) was measured as an index of aortic stiffness and augmentation index (AIx) and as a measure of arterial wave reflections. Serum soluble intercellular adhesion molecule-1 (sICAM-1) was measured. Compared to placebo, L-arginine improved FMD (P < 0.01 at day 1 and P < 0.05 at day 3). L-Arginine reduced PWV and AIx at both days 1 and 3 (P < 0.05 vs. baseline). L-Arginine blunted the acute smoking-induced increase of AIx at both day 1 (P < 0.05) and day 3 (P < 0.01), and prevented the smoking-induced elevation of PWV at day 3 (P < 0.05). Importantly, L-arginine reduced sICAM-1 at days 1 and 3 (P < 0.05 for both vs. baseline). Oral L-arginine improves endothelial function and vascular elastic properties of the arterial tree during the acute phase of smoking, an effect accompanied by reduced sICAM-1 levels in these subjects.

Short-term treatment with L-arginine prevents the smoking-induced impairment of endothelial function and vascular elastic properties in young individuals

Background l-arginine, the substrate for endothelial nitric oxide synthase, is essential for normal endothelial function. Aim of the present study was to investigate in healthy smokers the effect of a short-term daily l-arginine administration on vascular function. Methods We studied the effect of a 3-day oral administration of l-arginine in 10 healthy smokers (24.3 ± 0.73 years old) on 3 occasions (day0, day1 and day3). The study was carried out on two separate arms, one with l-arginine (7 gr/d) and one with placebo according to a randomized, placebo-controlled, double-blind, cross-over design. Measurements were carried out before, immediately after (Sm0) and 20 min after (Sm20) cigarette smoking. Endothelial function was evaluated by flow-mediated dilatation (FMD) of the brachial artery. Carotid-femoral pulse wave velocity (PWV) was measured as an index of aortic stiffness and augmentation index (AIx) as a measure of arterial wave reflections. Results Compared to placebo, l-arginine led to an increase of FMD ( p < 0.05 at day 2), indicating a favorable effect on endothelial function, which however lost significance at day 3. l-arginine induced a progressive decrease of PWV and AIx at both day 2 and day 3 ( p < 0.01 vs baseline for all). l-arginine blunted the acute smoking-induced increase of AIx at both day 1 ( p < 0.05) and day 3 ( p < 0.01), and there was a trend to protect the smoking-induced change of PWV at day 3 ( p < 0.1). Conclusions Short-term daily administration of l-arginine improves arterial performance in healthy smokers and abrogates the smoking-induced increase in arterial stiffness and wave reflections in these individuals.

Arterial Wave Reflections and Determinants of Endothelial Function: A Hypothesis Based on Peripheral Mode of Action

Pulse waveform analysis (PWA) for determination of augmentation index (AIx), a measure of arterial wave reflections, has been used to assess endothelial function, but only in combination with provocative pharmacologic testing. We hypothesized that AIx under basal conditions would be related to endothelial function as well. We quantified arterial wave reflections as aortic AIx, using applanation tonometry of the radial artery, and PWA in 424 patients (mean age 64.6 years) undergoing coronary angiography. Plasma levels of asymmetric dimethylarginine (ADMA), an endogenous inhibitor of endothelial nitric oxide (NO) synthase, were determined with a validated ELISA assay. In a group of the patients (n = 160), pulse wave velocity (PWV) was measured invasively during catheter pullback. Statistics were Spearman's correlation coefficient and multiple linear regression models. We observed a positive, statistically significant correlation between AIx and ADMA (R = 0.11, P = .03), that was closer in 134 patients up to 60 years of age (R = 0.28, P = .001). In the latter group, the correlation was independent of age, gender, smoking, lipids, heart rate, diastolic blood pressure (BP), the presence of hypertension or diabetes, and the extent of coronary artery disease. In contrast, we observed a significant (R = 0.19, P = .02) correlation between PWV and ADMA that disappeared after correction for age and BP. Our cross-sectional data indicate that ADMA levels are associated with increased arterial wave reflections, most likely due to decreased NO activity in small arteries and arterioles. This relationship is more pronounced in patients up to 60 years of age.

Aortic Augmentation Index Is Inversely Associated With Cardiorespiratory Fitness in Men Without Known Coronary Heart Disease

We investigated whether the aortic augmentation index (AIx), a measure of arterial wave reflection and stiffness, is associated with cardiorespiratory fitness in men without known coronary heart disease (CHD). Asymptomatic men (n = 201, mean age 51 +/- 9.2 years) referred for a screening exercise electrocardiogram (ECG) underwent applanation tonometry to obtain radial artery pulse waveforms, and an ascending aortic pressure waveform was derived by a transfer function. The AIx is the difference between the first and second systolic peak of the ascending aortic pressure waveform, expressed as a percentage of the pulse pressure. Cardiorespiratory fitness was assessed by maximal oxygen consumption (VO2max mL/min/kg) during a symptom-limited graded exercise test. Multivariable regression analyses were used to identify significant independent determinants of AIx and of VO2 max. Diabetes was present in 2.5% of subjects, 34.8% had history of smoking, and 29% were hypertensive. Mean (+/- SD) AIx was 19.9% +/- 9.0% and mean VO(2 max) was 33.9 +/- 6.4 mL/min/kg. In a multivariable linear regression model, AIx was positively associated with age, hypertension, and history of smoking and inversely with heart rate, height, and body mass index (BMI). The VO2 max was significantly inversely related to AIx after adjustment for age, heart rate, height, and BMI (r = -0.22, P = .002), after further adjustment for CHD risk factors (total cholesterol, HDL-cholesterol, history of smoking, diabetes, hypertension) (P = .006), and after additional adjustment for behavioral factors (physical activity score, alcohol intake, and percent body fat) (P = .022). These findings indicate that AIx, a measure of arterial wave reflection and stiffness, is inversely associated with cardiorespiratory fitness in men without CHD.

Alcohol and arterial wave reflections in middle aged and elderly men

Augmentation index (AIx) is a measure of arterial wave reflection, providing information on the workload of the heart. and is a possible marker for cardiovascular disease risk. The relation of alcohol consumption with cardiovascular disease (CVD) risk is U-shaped with a protective effect of moderate alcohol consumption. The relation of alcohol consumption level with AIx has not been widely investigated, which prompted this study of the relation of alcohol consumption with AIx in a population-based cohort of men aged 40-80 years. Three hundred and seventy-four men (mean age 60.5 years) participated in this cross-sectional study. Alcohol consumption and smoking habits were determined through a validated questionnaire. Fasting blood samples were drawn and analyzed for glucose and lipid levels and AIx was estimated by radial applanation tonometry using the SphygmoCor Device. The resultant data were analyzed using linear regression models. Age, height, heart rate, blood pressure, packyears, current smoking, presence of CVD and hypertension were independently related to AIx. The relation of alcohol consumption with AIx was U-shaped, with a significantly lower AIx in the group drinking 4-8 glasses/week (difference = -2.91%, 95% CI [-5.65; -0.18]) relative to those drinking 0-3 glasses/week. Additional adjustment for current smoking did not change this relationship, but adjustment for pulse wave velocity attenuated the relation. In a population-based cohort of men aged 40-80 years the relation of alcohol consumption level with AIx was U-shaped, further expanding the evidence for vascular protective effects of moderate alcohol intake.

C-Reactive Protein Is Related to Arterial Wave Reflection and Stiffness in Asymptomatic Subjects From the Community

Emerging data suggest that C-reactive protein (CRP), a marker of inflammation, is associated with functional properties of arteries. We investigated the relationship of CRP to measures of arterial wave reflection and stiffness (aortic augmentation index [AIX], carotid-femoral pulse wave velocity [PWV], and pulse pressure) in asymptomatic individuals from the community. Subjects (n = 214) had a mean age of 59 years and 53% were men. CRP was measured by a high-sensitivity assay and values were log-transformed to reduce skewness. Radial artery waveforms were obtained by applanation tonometry, a validated transfer function was used to derive an ascending aortic pressure waveform, and AIX calculated. PWV was calculated from electrocardiogram-gated waveforms of the right carotid and right femoral artery obtained by applanation tonometry. Log CRP was correlated with AIX (r = 0.24, P = .0005), PWV (r = 0.25, P = .0002), and pulse pressure (r = 0.29, P < or = .0001). In separate backward elimination multiple regression analyses, log CRP was significantly associated with AIX (P = .038) and pulse pressure (P = .036), and marginally significantly associated with PWV (P = .054), after adjustment for heart rate, height, and coronary heart disease (CHD) risk factors (age, sex, body mass index, mean arterial pressure, total cholesterol, HDL cholesterol, diabetes, hypertension, and history of smoking). These results suggest that CRP, a marker of systemic inflammation, is related to measures of arterial wave reflection and stiffness in asymptomatic subjects from the community. Further studies are needed to understand the mechanisms underlying this association and the implications for assessment and management of CHD risk.

Effects of High Intensity Resistance Training on Arterial Stiffness and Wave Reflection in Women

Cross-sectional studies reported that chronic resistance training is associated with arterial stiffening in men. These findings are in marked contrast to those found with aerobic exercise and may have important clinical relevance with regard to cardiovascular disease risk. However, the effect of resistance training on arterial stiffness has not been confirmed by interventional studies nor has this relation been investigated in women. To determine whether a strength training program increases regional and central arterial stiffness in women, 23 healthy young women (29+/-1 years; mean+/-SD) participated in a high-intensity strength and power training program for 11 weeks. Ten other women (27+/-2 years) served as time controls. In the intervention group, one repetition maximal strength increased 12% to 17% (P<.0001), and leg fat-free mass (via DEXA) increased significantly. Brachial blood pressure (BP) and fasting plasma lipid and lipoprotein concentrations did not change across the 11 weeks. Carotid augmentation index, a measure of arterial wave reflection and arterial stiffness, increased from -8%+/-13% to 1%+/-18% (P<.05), and carotid-femoral pulse wave velocity increased (791+/-88 v 833+/-96 cm/sec; P<.05). There were no changes in femoral-ankle pulse wave velocity, a segmental measure of peripheral arterial stiffness. We concluded that a high-intensity resistance training program increases arterial stiffness and wave reflection in young healthy women. Our present interventional results are consistent with the previous cross-sectional studies in men in which high-intensity strength training is associated with arterial stiffening.

Alcohol Consumption and Augmentation Index in Healthy Young Men: The ARYA Study

Light-to-moderate alcohol consumption is associated with a decreased risk of ischemic cardiovascular disease, whereas increased alcohol intake is related to hypertension and intracerebral hemorrhage. We studied the effect of alcohol consumption on the augmentation index (AIx), a measure of arterial wave reflection in a population of healthy young men. Three hundred twenty-nine men (mean age 28 years) from the Atherosclerosis Risk in Young Adults study (ARYA-study) were studied. The level of alcohol consumption and risk factors for cardiovascular disease were determined. The AIx was estimated by radial applanation tonometry using a Sphygmocor device. The relation between alcohol intake level and AIx was determined using linear regression models. There was a positive graded relation between alcohol intake and AIx. Subjects who did not drink, who drank 1 to 2 glasses/d, or who drank > or =3 glasses of alcohol/d had, respectively, a -0.6% (95% confidence interval [CI] -4.2, 3.0), 0.2% (95% CI -2.6, 2.9), and 3.4% (95% CI 0.2, 6.7) difference in AIx compared with very light drinkers (<1 glass/d). After adjustment for current smoking, body mass index and HDL-cholesterol, those consuming >3 glasses/d had a 3.29% (95% confidence interval CI 0.01, 6.7) higher AIx compared with those consuming <1 glass/d. In a population of healthy young men, the heaviest drinkers had a significantly higher AIx. This finding supports the evidence that increased alcohol consumption is related to vascular damage at young age.

Altered Aortic Properties in Elderly Orthostatic Hypertension

To investigate the impact of arterial properties on orthostatic blood pressure (BP) dysregulation in older hypertensives, orthostatic BP dysregulation, a common phenomenon in elderly hypertensives, is associated with target organ damage and falls. However, the mechanism of orthostatic BP dysregulation remains unclear. The pulse wave velocity (PWV), related arterial stiffness, and the augmentation index (AI), a measure of arterial wave reflection, were measured in 365 older hypertensives. We classified the study patients into an orthostatic hypertension (OHT) group with orthostatic increase of systolic BP (SBP) of > or = 220 mmHg (n = 27) and an orthostatic normotension (ONT) group with an orthostatic increase of SBP of < 20 mmHg and orthostatic SBP decrease of < 20 mmHg (n = 338). Orthostatic AI was significantly greater in the OHT group than in the ONT group (OHT: 6.5 +/- 12% vs. ONT: -5.6 +/- 12%, p < 0.001), while supine AI and supine and orthostatic pulse rate were comparable between the two groups. There was no significant difference in the PWV between the OHT and ONT groups. Orthostatic hypertension was affected by altered aortic properties and associated with augmented wave reflection of arterial pressure.

The Effects of Strength Training on Arterial Stiffness in Women

0377 Cross-sectional studies reported that chronic resistance training is associated with arterial stiffening in men. These findings are in marked contrast to those found with aerobic exercise and may have important clinical relevance with regard to cardiovascular disease risk. However, the effect of resistance training on arterial stiffness has not been confirmed by interventional studies nor has this relation been investigated in women. PURPOSE: To determine if a short-term, high-intensity, progressive strength training program increases regional and central arterial stiffness in women. METHODS: Twenty-four healthy young women (30 ± 1 yrs) participated in a high intensity strength and power training program 90 min/day, 4 days/wk for 128 wks. Two days of the week were devoted to leg/trunk exercises and two days to upper body exercises. Heavy (85% 1 repetition maximum (RM), 8–10 reps × 3 sets) and light (65% 1 RM, 10 reps × 3 sets) exercises were performed each day. Ten other women (27 ± 2 yrs) served as time controls. Blood pressure and measures of arterial stiffness were obtained using a recently-validated automatic device (Colin VP-2000; Colin Medical, San Antonio, TX). RESULTS: One RMrepetition maximal strength increased between 12 and 17% (p < 0.0001)., L and leg fat-free mass (via DEXA) also increased significantly. Brachial blood pressure and fasting plasma lipid and lipoprotein concentrations did not change across the 128 wks. Carotid augmentation index, a measure of arterial wave reflection and arterial stiffness, increased from −8.3 ± 2.6 to 0.5 ± 3.5% (p < 0.05). There were no changes in carotid-femoral or femoralankle pulse wave velocity which are, segmental measures of central and peripheral arterial stiffness, respectively. There were no significant changes in any of the variables in the control group. CONCLUSIONS: A high intensity resistance training program increases amplification of arterial wave reflection that is associated with arterial stiffness in women. Our present interventional results are consistent with the previous cross-sectional studies indicating that high intensity strength training is associated with arterial stiffening. Supported by the Austin Fire Department, GSSI, and NIH grant AG20966