Peripheral Arterial Stiffness Research Articles

P.25 Radial-Digital Pulse Wave Velocity: A Non-Invasive Method for Assessing Stiffness of Peripheral Small Arteries

Pulse wave velocity (PWV) has been used to evaluate arterial stiffness of large arteries. Here, we examine the feasibility of radialdigital PWV (RD-PWV) as a measure of stiffness of smaller arteries, and its response to changes in local mean arterial pressure. In 29 healthy subjects, we used Complior probes to record arterial pulse wave at radial artery and tip of the index. To determine transit time, we used both second derivative and intersecting tangents of the entire recordings using the device-embedded algorithms, in house Matlab analyses of only reliable waves, and by numerical simulation using arterial tree model. In 15 subjects, we examine the response of RD-PWV to changes in local MAP by vertical displacement of the hand above and below the mid-axillary line. Using second derivative, RD-PWV were 4.68 ± 1.18, 4.69 ± 1.21, 4.32 ± 1.19 m/s respectively for deviceembedded, Matlab-based and numerical simulation analyses, respectively. Using intersecting tangents RD-PWV were 4.73 ± 1.20, 4.45 ± 1.08, 4.50 ± 0.84 m/s, respectively for device-embedded, Matlab-based and numerical simulation analyses, respectively. The strongest correlation (r = 0.92) was seen between device-embedded and Matlab-based second derivatives. The intersession coefficients of variation were 7.0 ± 4.9% and 3.2 ± 1.9% (p = 0.04) for device-embedded and Matlab-based second derivative algorithms. We estimated that each increase of 10 mm Hg in local MAP by vertical displacement of the hand resulted in an increase in RD-PWV of 0.28 m/s. This study shows that RD-PWV can be used for the non-invasive assessment of stiffness of small-sized arteries.

Cognitive impairment related to arterial stiffness in cardiovascular disease patients with severe periodontitis

Severe periodontal disease (SPD) associated with systemic peripheral inflammation, cognitive impairment (CI) and arterial stiffness (AS) has been recognized. The aim of this study was to investigate whether CI and arterial stiffness (AS) occur in cardiovascular disease (CVD) patients with SPD. A crosssectional case-control study included hospitalized patients with CVD. Demographic characteristics, CVD and atherogenic risk factors were recorded. SPD was diagnosed by clinical and radiographic dental examinations. Dental clinical attachment level (CAL) and CAL % were recorded. A Mini-Mental State Examination test (MMSE) assessed cognition, a MMSE score of < 27 was set as the cut-off point of CI; a score ≥ 27 was considered as no CI. Patients were categorized into: MMSE< 27 in the three models. The risk of having MMSE < 27 increased an average of 2.404-fold for each 1-unit increase in PWV. SPD and AS had significant and independent associations on the risk for development CI. MMSE negatively correlated with CAL% (r=0.69) and PWV (r=0.70). PWV positively correlated with CAL% (r=0.67). Serum VCAM-1 levels were higher in SPD with lower MMSE scores. In conclusion, SPD increases the risk of development of cognitive decline in CVD patients. PWV was directly associated with the risk of cognitive decline. These findings denote a significant opportunity to improve periodontal health in order to avert CI in CVD patients.

Progression of Vasculopathy in Young Individuals with Turner Syndrome.

Vasculopathy has been identified in young individuals with Turner syndrome (TS). No studies in young individuals with TS have investigated whether this vasculopathy progresses over time. The objective of this study is to describe the changes in vasculopathy over time in a cohort of young individuals with TS. Repeat ultrasound and SphygmoCor CPV® (AtCor Medical) measurements of carotid thickness and peripheral arterial stiffness were performed. Vascular measurements were compared at baseline and follow-up. Follow-up measurements were also compared to historical lean (L) and obese (O) age-, race-, and sex-matched non-TS controls. Thirty-five individuals with TS were studied at a mean age of 19.4years (range, 13.9-27.5). Mean time to follow-up was 7.2years (range, 7.1-7.8). Carotid intima media thickness increased by 0.03 ± 0.07mm (p < 0.01) over time, but was less than L and O controls at follow-up. Pulse wave velocity carotid-femoral increased by 0.51 ± 0.86m/s (p < 0.01) over time, but was similar to L and less than O controls at follow-up. Augmentation index (AIx) remained unchanged (p = 0.09) over time, but was significantly higher at follow-up than both control groups (p < 0.01 for both). There were no identified differences between 45,X and other TS genotypes. We demonstrate evidence of vascular thickening and stiffening over 7years in a cohort of young individuals with TS, as well as a persistently increased augmentation index compared to L and O non-TS controls. It is unclear whether the increase in vascular structure and function are related to normal aging or if TS is a risk factor. Higher body mass index seems to be a risk factor. Early estrogen replacement and longer exposure to growth hormone therapy need to be further explored as potential protective factors.

Familial tendency for hypertension is associated with increased vascular stiffness.

Hypertension is the leading cause of cardiovascular disease and premature death. New methods for early detection of hypertension and its consequences can reduce complications arising from uncontrolled hypertension. Pulse-wave velocity (PWV), a measure of arterial stiffness, has been recognized as a valuable tool in assessing risk for cardiovascular complications, although its use in clinical practice is currently limited. Here we examine whether brachial--ankle PWV (baPWV) and femoral--ankle PWV (faPWV) are elevated in nonhypertensive volunteers, with and without a history of familial hypertension. Volunteers were recruited and questioned as to their medical background and family history. Participants were divided into two groups based on history of familial hypertension and were measured for baPWV and faPWV. Carotid--femoral PWV was computed from these measurements. A total of 82 healthy nonhypertensive volunteers (mean age 31.4 ± 9.6) were recruited. Among the study cohort, 43.7% had a history of familial hypertension. There were no between-group differences in any other clinical or demographic characteristics. Both baPWV and faPWV were significantly elevated in volunteers with a history of familial hypertension (10.86 ± 1.69 vs. 9.68 ± 1.52 m/s, P < 0.004, and 7.01 ± 1.65 vs. 6.28 ± 1.26 m/s, P < 0.028, respectively). Volunteers with a history of familial hypertension present with elevated baPWV and faPWV. This is suggestive of increased central and peripheral arterial stiffness in susceptible individuals before the onset of hypertension. Routine measurement of these parameters may allow for early intervention and risk stratification, especially in persons with a history of familial hypertension.

복합운동프로그램이 비만 여성노인의 근력과 말초혈관기능에 미치는 영향

Purpose: Physical activity is associated with lower cardiovascular disease and all-cause mortality. However, the effects of combined exercise on arterial stiffness are currently unclear in the peripheral arteries of the elderly. Our objectives are to investigate the effect of a combined exercise program for 12 weeks on muscle strength and peripheral arterial stiffness in obese elderly women.BR Method: Obese elderly women were divided into two groups: Con (control group), Ex (Exercise group). The exercise group performed a combined exercise program of 60 mins/day, 3 days/week for 12 weeks. Body composition and blood pressure were measured. Muscle strength was measured by grip strength dynamometer. Arterial stiffness was measured by heart-finger pulse wave velocity (hfPWV), heart-ankle pulse wave velocity (haPWV), and brachial-finger pulse wave velocity (bfPWV) before and after 12 weeks.BR Results: Combined exercise did not affect body composition and blood pressure. However, muscle strength in the combined exercise group significantly improved compared to the control group (p.05). hf-PWV and haPWV did not change, but bfPWV significantly improved compared to the control group (p.05).BR Conclusion: These results suggest that a combined exercise program may improve vascular function through the reduction of bfPWV and enhancement of muscle strength in obese elderly women.

Associations of Ultra-Processed and Unprocessed/Minimally Processed Food Consumption with Peripheral and Central Hemodynamics and Arterial Stiffness in Young Healthy Adults

Consumption of ultra-processed food (UPF) replaces the intake of freshly prepared unprocessed/minimally processed food (MPF) and is positively associated with hypertension and cardiovascular disease (CVD). The objective of this observational study was to investigate the relation between (1) UPF and (2) MPF with peripheral and central blood pressure (BP), wave reflection, and arterial stiffness. Habitual dietary intake, ambulatory BP, augmentation index (AIx), and pulse wave velocity (PWV) were assessed in 40 normotensive young adults (15 M/25 W; 27 ± 1 y; body mass index 23.6 ± 0.5 kg/m2). UPF consumption was positively associated with overall and daytime peripheral systolic BP (B = 0.25, 95% confidence interval (CI) 0.03, 0.46, p = 0.029; B = 0.32, 95% CI 0.09, 0.56, p = 0.008, respectively), daytime diastolic BP (B = 0.18, 95% CI 0.01, 0.36, p = 0.049) and daytime peripheral pulse pressure (PP; B = 0.22, 95% CI 0.03, 0.41, p = 0.027). MPF consumption was inversely associated with daytime peripheral PP (B = −0.27, 95% CI −0.47, −0.07, p = 0.011), overall and daytime central systolic BP (B = −0.27, 95% CI −0.51, −0.02, p = 0.035; B = −0.31, 95% CI −0.58, −0.04, p = 0.024, respectively), and nighttime central PP (B = −0.10, 95% CI −0.19, −0.01, p = 0.042). Both UPF and MPF were not associated with AIx nor PWV. These data suggest avoidance of UPF and consumption of more MPF may reduce CVD risk factors.

Peripheral Arterial Stiffness Increases the Risk of Progression of Renal Disease in Type 2 Diabetic Patients.

Aims: Our aim was to investigate the effects of peripheral arterial stiffness on the risk of progression of renal disease in patients with type 2 diabetes (T2D).Methods: This was a single center, retrospective cohort study. Brachial-ankle pulse wave velocity (baPWV) tests were performed on T2D patients in 2015. Increased arterial stiffness was defined as baPWV of ≥ 1800 cm/s. We applied criteria for progression of renal disease according to EMPA-REG OUTCOME trial.Results: In total, 186 patients were enrolled in the final study. The mean age was 59.1 years and male:female ratio was 1.73:1. Thirteen (7%) patients progressed to renal disease during the average follow-up time of 35.3 months. In particular, the risk of progression to macroalbuminuria was significantly higher in the baPWV ≥ 1800 cm/s group (HR 6.216, p = 0.020). Individuals with a baPWV of ≥ 1800 cm/s (when comparisons were adjusted for age, sex, blood pressure, diabetes duration, eGFR, and use of renin-angiotensin system inhibitors) had a significantly higher risk of the progression of renal disease (HR = 8.480, p = 0.014).Conclusion: These results suggest that peripheral arterial stiffness (baPWV ≥ 1800 cm/s) may be a risk factor for the progression of renal disease in T2D patients.

New indices of arterial stiffness correlate with disease severity and mid-term prognosis in acute decompensated heart failure.

Arterial stiffness has been implicated in pathophysiology of heart failure (HF) since it is involved in the ventricular-vascular coupling. Recently, new indices obtained by a cuff oscillometric technique, the arterial velocity pulse index (AVI) for the stiffness of central arteries and the arterial pressure volume index (API) for the stiffness of peripheral arteries have been developed and validated. However, the AVI and API measurement has not been attempted in HF population. This study aimed to investigate the relationship between the AVI, API and clinical parameters and outcomes in HF patients. A prospective cohort of patients with acute decompensated HF were enrolled within 6months, who were admitted to a tertiary referral hospital in China. Measurement of the AVI and API (AVE-1500, Shisei Datum, Tokyo, Japan) was performed on the day of admission and discharge. Patients were followed up to 6months for the composite endpoint of all-cause death and rehospitalization for HF. A total of 127 patients were recruited for analysis (60 ± 15years, 70% male). 80% of the patients were in New York Heart Association (NYHA) Class III or IV at admission with mean left ventricular ejection fraction (LVEF) of 34 ± 9%. During hospitalization, all patients received guideline-directed medical therapy if not contraindicated. The AVI (27.3 ± 5.0 vs. 28.6 ± 6.7, P = 0.002) and API (24.9 ± 4.9 vs. 26.0 ± 6.5, P = 0.05) were lower at discharge than at admission. By dividing the patients into mild to severe group based on systolic blood pressure (SBP) and LVEF or into tertiles according to the amino-terminal pro-brain natriuretic peptide (NT-proBNP), transmitral E velocity over mitral annular e' velocity (E/e' ratio), it was observed that the AVI increased with a higher level of NT-proBNP (P for trend < 0.001), a larger E/e' (P for trend < 0.001) and a lower LVEF (P for trend = 0.0183), while the API increased as the E/e' and systolic blood pressure became higher (both P for trend < 0.05). The improvement in AVI at discharge was correlated with LVEF (R = -0.3024, P < 0.05) and NT-proBNP improvement (R = 0.3118, P < 0.05), while the change in API was positively correlated with SBP change (R = 0.3897, P < 0.001). In 6months after discharge, there were 52 predefined events including 15 deaths and 44 rehospitalization for HF. Apart from the level of NT-proBNP, the AVI at discharge of ≥ 26 showed a trend of being associated with the composite outcome (HR 2.747, 95% CI 1.411-5.349, P < 0.001 for univariate analysis; HR 1.864, 95% CI 0.892-3.893, P = 0.09761 for multivariate analysis). New noninvasive arterial stiffness indices as the AVI and API reflected severity of illness and midterm prognosis in admitted HF patients. Further studies are warranted for understanding its mechanisms and developing clinical applications.

Relation of Helicobacter pylori infection to peripheral arterial stiffness and 10-year cardiovascular risk in subjects with diabetes mellitus.

Purpose:This study was conducted to investigate the relation of HP infection to peripheral arterial stiffness and 10-year cardiovascular risk in diabetes mellitus (DM).Methods:DM subjects who underwent the C13-breath test were enrolled and divided into DMHP+ and DMHP− groups. Peripheral arterial stiffness was measured using brachial to ankle pulse wave velocity (baPWV). Framingham score (FRS) and Chinese evaluation method of ischemic cardiovascular diseases (ICVD) were used to clarify 10-year cardiovascular risk.Results:A total of 6767 subjects were included, baPWV and proportion of subjects with severe peripheral arterial stiffness were lower in DMHP− group than DMHP+ group (1556.68 ± 227.54 vs 2031.61 ± 525.48 cm/s, p < 0.01; 21.9% vs 62.7%, p < 0.01). Multivariate logistic regression analysis demonstrated that HP infection was independently associated with baPWV. Furthermore, cardiovascular risk score and the proportion of subjects with high risk were lower in DMHP− group than DMHP+ group (FRS: 12.09 ± 3.77 vs 13.91 ± 3.77, 17.2% vs 38.8%; ICVD: 8.56 ± 2.99 vs 10.22 ± 3.16, 43.9% vs 65.4%, with all p < 0.05).Conclusion:DM subjects with HP infection had more severe peripheral arterial stiffness compared those without HP infection, a higher cardiovascular risk score and 10-year cardiovascular risk stratification were observed in those subjects.

Effects Of Boxing Training On Peripheral And Central Blood Pressure And Arterial Stiffness In Prehypertension

PURPOSE: Early stages of high blood pressure, such as elevated blood pressure or stage 1 hypertension, have shown to increase cardiovascular mortality. Exercise is recommended for the prevention and treatment of high blood pressure; however, most clinical evidence is based on lower-body modalities of exercise. Therefore, the purpose of this study is to evaluate the effects of boxing training, a predominant upper-body exercise modality, on peripheral and central blood pressure and arterial stiffness in prehypertensive individuals. METHODS: A total of 14 young prehypertensive individuals were randomly allocated to a boxing training group or to a control group for 6 weeks. The boxing group underwent 42 minutes of boxing training three times per week while the control group performed flexibility and balance exercises. At the beginning and at the end of the intervention, brachial blood pressure was evaluated with an automatic cuff, central blood pressure by pulse wave analysis, and arterial stiffness by pulse wave velocity. A 2x2 repeated measures ANOVA design was employed to compare differences within and in between groups. Significance was established at p ≤ 0.05. RESULTS: After the intervention, only the boxing group showed a significant reduction on systolic blood pressure (p=0.027), diastolic blood pressure (p<0.001), central systolic blood pressure (p=0.011), augmentation index (p=0.021), and augmentation index at 75 beats per minute (p=0.008). No difference could be observed on pulse wave velocity in the boxing group (p=0.323), although a significant increment was seen in the control group (p=0.02). CONCLUSIONS: Boxing training is an effective treatment alternative to reduce peripheral and central blood pressure in prehypertensive individuals. To reduce arterial stiffness in prehypertensive individuals, longer boxing training protocols might be required.

Evidence for improved systemic and local vascular function after long-term passive static stretching training of the musculoskeletal system.

Vascular function and arterial stiffness are important markers of cardiovascular health and cardiovascular co-morbidity. Transitional phases of hypoemia and hypermia, with consequent fluctuations in shear rate, occuring during repetitive passive stretching adminstration (passive stretching training) may constitute an effective stimulus to induce an amelioration in vascular function, arterial stiffness and vascular remodelling by improving central and local blood flow control mechanisms. Vascular function, arterial stiffness and vascular remodelling were evaluated before and after 12weeks of passive stretching training and after 6weeks from training cessation, in the femoral, popliteal (treated with stretching), and brachial arteries (untreated) of both sides. After passive stretching training, vascular function and arterial remodelling improved, and arterial stiffness decreased in all the arteries, suggesting modifications of both central and local blood flow control mechanisms. Passive stretching-induced improvements related to central mechanisms seemed to have a short duration, as they returned to pre-training baseline within 6weeks from training cessation, whereas those more related to a local mechanism persisted in the follow-up. Acute passive stretching (PS) effects on blood flow ( ), shear rate ( ), and vascular function in the feeding arteries of the stretched muscle have been extensively investigated; however, few data are available on vascular adjustments induced by long-term PS training. We investigated the effects of PS training on vascular function and stiffness of the involved (femoral and popliteal) and uninvolved (brachial) arteries. Our hypothesis was that PS-induced changes in and would improve central and local mechanisms of control. Thirty-nine participants were randomly assigned to bilateral PS (n=14), monolateral PS (n=13) or no PS training (n=12). Vascular function was measured before and after 12weeks of knee extensor and plantar flexor muscles' PS training by single passive limb movement and flow-mediated dilatation (FMD). Central (carotid-femoral artery PWV, PWVCF ) and peripheral (carotid-radial artery PWV, PWVCR ) arterial stiffness was measured by pulse-wave velocity (PWV), together with systolic (SBP) and diastolic (DBP) blood pressure. After PS training, increases of 30%, 25% and 8% (P<0.05) in femoral Δ , popliteal and brachial artery FMD%, respectively, occurred in both PS training groups. A decrease in PWVCF , PWVCR , SBP and DBP (-25%, -17%, -4% and -8%, respectively; P<0.05) was noted. No changes occurred in controls. Vascular function improved and arterial stiffness reduced in the arteries involved and uninvolved with PS training, suggesting modifications in both central and local control mechanisms. PS-induced improvements had a short duration in some of vascular function parameters, as they returned to baseline within 6weeks of PS training cessation.

High pulse wave velocity is associated with the severity of diabetic retinopathy in patients with type 2 diabetes

Pulse wave velocity (PWV) is a non-invasive test for assessing arterial stiffness, and brachial-ankle PWV has been used as an index of peripheral arterial stiffness. This study aimed to investigate...

Does insulin resistance alter pulse transit time in the cerebral circulation?

Approximately 80 million adults in the United States suffer from an insulin resistant state known as metabolic syndrome (MetSyn), associated with increased risk for strokes, cerebral infarcts and neurologic disease. Adults with MetSyn also exhibit increased peripheral arterial stiffness, but whether arterial stiffness occurs in the cerebral circulation remains unclear. We hypothesized adults with MetSyn would exhibit increased cerebrovascular stiffness, demonstrated as faster pulse transit time (PTT) compared to healthy adults. Participants were 32±7 years old, sedentary, non‐smoking, free of cardiovascular disease and unmedicated. Healthy normal‐weight adults (Control; n=11; weight=70±8 kg; BMI = 23±2 kg/m2) were normotensive and normolipidemic. Adults with MetSyn (n=6; BMI=38±8 kg/m2) met three or more of the five criteria according to American Diabetes Association (MAP=107±5 mmHg; glucose=82±17 mg/dL; triglycerides 167±123 mg/dL; HDL 39±9 mg/dL; waist circumference 119±16 cm). Subjects were instrumented to continuously monitor heart rate, blood pressure, and end‐tidal CO2. A 3T MRI using 4‐dimensional flow phase contrast vastly under‐sampled isotropic projection reconstruction (PC VIPR; ~6 minutes) was used to capture cerebral blood flow (CBF = blood velocity • vessel cross sectional area) in the internal carotid arteries (ICA) and superior sagittal sinus (SSS). Cerebral blood flow across 20 equal segments of the average cardiac cycle was used to determine the time to peak flow in the ICAs and SSS. Pulse transit time (PTT) was calculated as the difference in time to peak in the SSS from the time to peak in the ICAs. Data are presented as mean ± SD. Significance was determined using independent t‐tests and was set at p≤0.05. MAP, HR, SpO2, and end tidal CO2 were not different in magnet bore (p&gt;0.05). ICA to SSS PTT was not different between Control and MetSyn (141±109 vs. 144±91 ms; p=0.743).ConclusionPulse transit time was similar between healthy adults and those with MetSyn. Perhaps greater disease severity, aging, or their combination are required to negatively change PTT in MetSyn. Alternatively, the cerebral circulation may be resistant to vascular stiffening.Support or Funding InformationADA 1‐12‐IN‐39

Central and peripheral blood pressures and arterial stiffness increase in hypoparathyroidism.

Objective The aim of the present study was to evaluate whether arterial stiffness is affected in the patients with hypoparathyroidism through pulse wave analysis (PWA). Subjects and methods Sixty-three patients diagnosed with hypoparathyroidism and sixty volunteers were evaluated for the study. When 21 patients were excluded in the hypoparathyroidism group due to exclusion criteria, the research continued with 42 patients and 60 volunteers who are similar to the patients in terms of age, gender and body mass index (BMI). Fasting plasma glucose after 10 hours of fasting, creatinine, thyroid stimulating hormone (TSH), free thyroxine (fT4), albumin, calcium, phosphorus, magnesium, 25-OH vitamin D, parathormone (PTH) and urine calcium results in 24-hour urine for the patients in the hypoparathyroidism group were recorded. Evaluation of arterial stiffness was performed by Mobil-O-Graph 24h PWA device. Results Systolic blood pressure (SBP) (p = 0.01), diastolic blood pressure (DBP) (p = 0.005), mean blood pressure (p = 0.009), central SBP (p = 0.004), central DBP (p = 0.01) and pulse wave velocity (PWV) (p = 0.02) were found higher in the hypoparathyroidism group. A positive correlation was detected between phosphorus level and SBP [(p = 0.03. r = 0.327)], central SBP [(p = 0.04, r = 0.324)] and PWV [(p = 0.003, r = 0.449)]. We detected that age and serum phosphorus levels were independent predictor variables for PWV (B = 0.014, p < 0.001 and B = 0.035, p < 0.001, respectively). Conclusion We detected that hypoparathyroidism causes an increase in blood pressure and arterial stiffness. The most significant determinant factors were detected as advanced age and hyperphosphatemia. The patients diagnosed with hypoparathyroidism should be closely monitored and treatment planning should include to prevent the patients from hyperphosphatemia.

Arterial Stiffness as a Measure of Vascular Dysfunction in Hypertensive Women

Abstract Hypertension, affecting a third of the world’s population is associated with many vascular changes in blood vessels, which include rise of peripheral resistance and arterial stiffness. As there are very few studies done on Indian hypertensive women, this project was taken up to determine the prevalence of arterial stiffness in them. In this study, arterial stiffness is determined by assessing the carotid–femoral pulse wave velocity (C-F PWV). Fifty hypertensive female subjects between the ages 25 and 75 years were selected as subjects after informing the procedure and taking their consent. PWV was obtained from blood (BP) and electrocardiogram (ECG) recordings. They showed that subjects belonged to 3 categories depending on the level of their blood pressure—normal, grade I, and grade II hypertensives. PWV increased progressively with level of hypertension (p values = 0.0171 and &lt;0.0001, which are significant for hypertensives having current BP equal to grade I and II hypertension, respectively). Vascular remodeling leading to loss of elasticity and impaired relaxation is believed to play a key role in development of arterial stiffness and subsequent rise of PWV in hypertensives. Arterial stiffness causes vascular dysfunction and is known to be an independent risk factor for many cardiovascular diseases like ventricular remodeling, diastolic dysfunction, myocardial infarction, and so forth. Control of Blood Pressure and its sequelae by dietary interventions and regular exercise is advisable.

Predictive value of the combination of brachial-ankle pulse wave velocity and ankle-brachial index for cardiovascular outcomes in patients with acute myocardial infarction.

Although ankle-brachial index and brachial-ankle pulse wave velocity measurement are well-established modalities for assessing peripheral artery disease and arterial stiffness and predicting cardiovascular events, it is unclear which one is more important or if a combination of the two is more effective for determining prognosis among patients with acute myocardial infarction. Patients with acute myocardial infarction (n = 889) were stratified into four groups according to a brachial-ankle pulse wave velocity (cut-off value: 1684 cm/s) and ankle-brachial index (cut-off value: 0.98): group I (high ankle-brachial index and low brachial-ankle pulse wave velocity, n = 389), group II (high ankle-brachial index and high brachial-ankle pulse wave velocity, n = 281), group III (low ankle-brachial index and low brachial-ankle pulse wave velocity, n = 103), group IV (low ankle-brachial index and high brachial-ankle pulse wave velocity, n = 116). The mean follow-up duration was 348 days. Major adverse cardiovascular events or cardiac death occurred in 64 (7.2%) and 26 patients (2.9%), respectively. In multivariable analysis, group III and IV had a significant high hazard ratio for major adverse cardiovascular events (5.93, 5.43) and cardiac death (13.51, 19.06). Additionally, ankle-brachial index had a higher hazard ratio than brachial-ankle pulse wave velocity for major adverse cardiovascular events (3.38 vs. 1.40) and cardiac death (6.21 vs. 2.40). When comparing receiver operating characteristic curves of the combined models of risk factors, brachial-ankle pulse wave velocity, and ankle-brachial index, pulse wave velocity plus ankle-brachial index or pulse wave velocity plus ankle-brachial index plus risk factors were significantly more predictive of major adverse cardiovascular events than risk factors. Our findings indicate that ankle-brachial index is a strong independent prognostic factor and adding a brachial-ankle pulse wave velocity measurement to ankle-brachial index increases the prognostic power for cardiac events in patients with acute myocardial infarction, while ankle-brachial index and pulse wave velocity showed additive value to risk factors.

Positive correlation of serum fibroblast growth factor 23 with peripheral arterial stiffness in kidney transplantation patients

BackgroundFibroblast growth factor 23 (FGF-23) has a role in arterial stiffness (AS) apart from regulating mineral metabolism. We investigated the association between FGF-23 concentration and peripheral AS in renal transplantation (RT) recipients. MethodsThe fasting blood samples of RT recipients (n = 66) were collected and analyzed. ResultsA total of 29 (43.9%) RT recipients were classified under the peripheral AS group. The RT recipients in this group had a higher prevalence of diabetes (P < 0.001), hypertension (P = 0.001), and metabolic syndrome (P = 0.023); longer post-RT duration (P = 0.006); higher systolic blood pressure (P < 0.001) and diastolic blood pressure (P = 0.024); and higher fasting glucose (P = 0.002), total cholesterol (P = 0.049), blood urea nitrogen (P = 0.027), phosphorus (P = 0.047), and FGF-23 concentrations (P = 0.003) and FGF-23/α-klotho ratio (P < 0.001) but lower klotho concentrations (P = 0.025) than those in the control group. Moreover, FGF-23 concentration (adjusted odds ratio: 1.057, 95% confidence interval: 1.011–1.105, P = 0.015) was found to be an independent predictor of peripheral AS in RT recipients. ConclusionsSerum FGF-23 concentration was a significant predictor of peripheral AS in RT recipients.

Relationship between plasma levels of 25-hydroxyvitamin D and arterial stiffness in elderly Chinese with non-dipper hypertension: An observational study.

Elderly individuals with non-dipper hypertension are at high risk of cardiovascular disease because of increased stiffness of peripheral arteries. Since, vitamin D deficiency is prevalent in elderly Chinese. We examined whether reduced plasma levels of 25-hydroxyvitamin D [25(OH)D] may help promote this stiffness.Hypertensive patients at least 60 years old without history of peripheral arterial disease at our hospital were retrospectively divided into dipper and non-dipper groups according to the results of 24-hour ambulatory blood pressure monitoring. Plasma levels of 25(OH)D were measured by enzyme immunoassay. Peripheral arterial stiffness was measured based on the cardio-ankle vascular index (CAVI).Of the 155 patients enrolled, 95 (61.3%) were diagnosed with non-dipper hypertension and these patients had significantly lower plasma levels of 25(OH)D than the 60 patients with dipper hypertension (19.58 ± 5.97 vs 24.36 ± 6.95 nmol/L, P < .01) as well as significantly higher CAVI (8.46 ± 1.65 vs 7.56 ± 1.08 m/s, P < .01). Vitamin D deficiency was significantly more common among non-dipper patients (57.9% vs 31.7%, P < .01). Multivariate regression showed that age and 25(OH)D were independently related to CAVI, with each 1-ng/ml decrease in 25(OH)D associated with a CAVI increase of +0.04 m/s.Non-dipper hypertension is associated with vitamin D deficiency and reduced plasma levels of 25(OH)D. The latter may contribute to stiffening of peripheral arteries, increasing the risk of cardiovascular disease.

Metformin use in obese mothers is associated with improved cardiovascular profile in the offspring

Maternal obesity increases the risk for pregnancy complications and adverse neonatal outcome and has been associated with long-lasting adverse effects in the offspring, including increased body fat mass, insulin resistance, and increased risk for premature cardiovascular disease. Lifestyle interventions in pregnancy have produced no or modest effects in the reduction of adverse pregnancy outcomes in obese mothers. The Metformin in Obese Pregnant Women trial was associated with reduced adverse pregnancy outcomes and had no effect on birthweight. However, the long-term implications of metformin on the health of offspring remain unknown. The purpose of this study was to assess whether prenatal exposure to metformin can improve the cardiovascular profile and body composition in the offspring of obese mothers. In 151 children from the Metformin in Obese Pregnant Women trial, body composition, peripheral blood pressure, and arterial pulse wave velocity were measured. Central hemodynamics (central blood pressure and augmentation index) were estimated with the use of an oscillometric device. Left ventricular cardiac function and structure were assessed by echocardiography. Children were 3.9±1.0 years old, and 77 of them had been exposed to metformin prenatally. There was no significant difference in peripheral blood pressure, arterial stiffness, and body composition apart from gluteal and tricep circumferences, which were lower in the metformin group (P<.05). The metformin group, compared with the placebo group,had lower central hemodynamics (mean adjusted decrease, -0.707mmHg for aortic systolic blood pressure, -1.65 mm Hg for aortic pulse pressure, and -2.68% for augmentation index; P<.05 for all) and lower left ventricular diastolic function (adjusted difference in left atrial area, -0.525 cm2, in isovolumic relaxation time, -0.324 msec, and in pulmonary venous systolic wave, 2.97 cm/s; P<.05 for all). There were no significant differences in metabolic profile between the groups. Children of obese mothers who were exposed prenatally to metformin, compared with those who were exposed to placebo, had lower central hemodynamic and cardiac diastolic indices. These results suggest that the administration of metformin in obese pregnant women potentially may have a beneficial cardiovascular effect for their offspring.

Endothelial dysfunction and arterial stiffness in patients with systemic lupus erythematosus: A systematic review and meta-analysis

Background and aimsNon-invasive surrogates of cardiovascular (CV) disease such as endothelial dysfunction (ED) and peripheral arterial stiffness (AS) have been evaluated in systemic lupus erythematosus (SLE) patients. The aim of this study was to systematically review and meta-analyze reports of cardiovascular disease (CVD) in SLE patients, as measured by ED and AS. MethodsStudies analyzing the relationship of SLE with ED (flow-mediated dilatation [FMD], nitroglycerin-mediated dilatation [NMD] and peripheral arterial tonometry [PAT]) and AS (augmentation index [AIx], pulse wave velocity [PWV]) were systematically searched for in PubMed, Cochrane library, EMBASE, VHL, SciELO and Web of Science databases. Inclusion criteria included peer-review and English language. Mean differences (MD) and 95% confidence intervals (CIs) were estimated using the random effect model. The study was registered with PROSPERO, number CRD42019121068. ResultsThe meta-analysis included 49 studies. FMD data from 18 studies including 943 SLE subjects (mean age = 38.71 [95%CI 36.21, 41.21] years) and 644 unaffected controls (mean age = 38.63 [95%CI 36.11, 41.15] years) were included. When compared with unaffected controls, FMD in SLE subjects was decreased by 4.3% (95%CI: −6.13%, −2.47%): p < 0.001). However, NMD did not significantly differ between SLE patients and controls (MD = − 2.68%; 95% CI -6.00, 0.62; p = 0.11). A significantly increased AS between SLE patients and controls according to overall PWV (MD = 1.12 m/s; 95% CI 0.72–1.52; p < 0.001) was observed, but not for the brachial-ankle PWV. AIx was also increased in SLE patients compared with healthy controls (MD = 4.55%; 95% CI 1.48–7.63; p = 0.003). ConclusionsOverall, SLE patients showed impaired FMD, an independent predictor of CV events. There was a higher degree of AS in SLE patients compared with controls. ED and AS in SLE should be considered when planning preventive strategies and therapies.