Pulse Wave Velocity In Subjects Research Articles

PS-C30-2: SHORT STATURE IS ASSOCIATED WITH HIGHER PULSE WAVE VELOCITY IN SUBJECTS WITHOUT OVERT CARDIOVASCULAR DISEASE

Objective: Short stature is reportedly associated with cardiovascular disease (CVD). However, the mechanism underlying this intriguing epidemiological finding is unclear. Pulse wave velocity (PWV), a marker of vascular stiffness, is a predictor of future CVD. Therefore, PWV may be affected by height even before overt CVD occurs. Here, we investigated the association between adult height and PWV in subjects without overt CVD. Design and method: A total of 1019 subjects (48 ± 12 years old; 509 men, 21 with diabetes mellitus, 209 with hypertension) without overt CVD were enrolled, all of whom underwent brachial-ankle PWV (baPWV) measurements. The subjects were divided into 3 groups by height. A multiple regression model was used to estimate baPWV values among heights after the adjustment for confounders. Results: Mean baPWV value was highest in the group with the shortest height for both sexes (both P < .001). Bivariate correlation analysis between height and baPWV showed significant correlations in men (r = -0.131, P = .003) and women (r = -0.180, P < .001). In the multiple regression analysis with adjustment for identified confounders, group height was a predictor of baPWV (P for trend = .003) in younger men (< 50 years old) but not in older men, while group height was correlated with baPWV in older women (50 years old or more, P for trend = .014) but not in younger women. Conclusions: Height is inversely correlated with baPWV in subjects without overt CVD, especially in younger men and older women. This may explain the historical epidemiological observation of an inverse relationship between height and CVD.

Impact of Cardiovascular Risk Factors on Arterial Stiffness in a Countryside Area of Switzerland: Insights from the Swiss Longitudinal Cohort Study.

Cardiovascular disease is the leading cause of morbidity and mortality. Besides traditional cardiovascular risk factors, arterial stiffness is a recognized predictor of cardiovascular risk. We investigated the relationship between traditional cardiovascular risk factors, sex, and aortic pulse wave velocity in subjects living in a countryside area of Southern Switzerland. For this aim, we performed a cross-sectional analysis of data from adult participants of the Swiss Longitudinal Cohort Study, which, initiated in 2015, follows health status and disease risk factors in a Swiss countryside cohort at least 6years of age. A total of 387 people (205 women and 182 men) were included. Hyperlipidemia, overweight, and obesity were more common (p ≤ 0.001) and LDL-cholesterol, triglycerides, and hemoglobin A1c were higher (p < 0.03) in men than women. Systolic and diastolic brachial and aortic blood pressures were higher in men (p < 0.02), whereas aortic pulse wave velocity and aortic pulse pressure were higher in women (p < 0.05). The aortic pulse wave velocity was significantly higher in subjects with hypertension, hyperlipidemia, diabetes, and obesity, and significantly increased with age (p < 0.0001). Multiple linear regression analysis showed a significant correlation between pulse wave velocity and age, female sex, brachial systolic blood pressure, and heart rate (p < 0.005). Also in a countryside area, the aortic pulse wave velocity is higher in subjects with hypertension, hyperlipidemia, diabetes and obesity, and significantly increases with age. Furthermore, with advancing age, aortic pulse wave velocity is higher in women than men. ClinicalTrials.gov identifier, NCT02282748.

Lipoprotein(a) Serum Levels Predict Pulse Wave Velocity in Subjects in Primary Prevention for Cardiovascular Disease with Large Apo(a) Isoforms: Data from the Brisighella Heart Study.

In the last decades, high serum levels of lipoprotein(a) (Lp(a)) have been associated with increased cardiovascular disease (CVD) risk, in particular among individuals with smaller apolipoprotein(a) (apo(a)) isoforms than those with larger sizes. The aim of our analysis was to evaluate whether Lp(a) levels could predict early vascular aging, and whether smaller apo(a) isoforms had a predictive value for vascular aging different than larger apo(a) isoforms in a cohort of subjects free from CVD. We considered the data of a subset of Brisighella Heart Study (BHS) participants free from CVD (462 men and 516 women) who were clinically evaluated during the 2012 BHS population survey. Predictors of arterial stiffness, measured as carotid-femoral pulse wave velocity (cfPWV) were estimated by the application of a step-wise linear regression model. In our cohort, there were 511 subjects with small apo(a) size and 467 subjects with large apo(a) isoforms. Subjects with larger apo(a) isoform sizes had significantly lower serum levels of Lp(a). In the BHS subpopulation sample, cfPWV was predicted by age, systolic blood pressure (SBP), serum levels of high-density lipoprotein cholesterol (HDL-C), triglycerides (TG) and sex, higher HDL-C serum levels and female sex associated with lower values of cfPWV. In subjects with smaller apo(a) isoform sizes, predictors of cfPWV were age, SBP, sex and serum levels of HDL-C, being higher HDL-C serum levels and female sex associated to lower values of cfPWV. In subjects with larger apo(a) isoform sizes, cfPWV was predicted by age, SBP, serum levels of Lp(a) and sex, with female sex associated with lower values of cfPWV. In our subpopulation sample, Lp(a) did not predict cfPWV. However, in subjects with large apo(a) isoform sizes, Lp(a) was a significant predictor of arterial stiffness.

EFFECTS OF EXERCISE TRAINING ON ARTERIAL STIFFNESS IN PATIENTS WITH HYPERTENSION: A SYSTEMATIC REVIEW AND META-ANALYSIS

Objective: This review aims to determine the effects of exercise training on arterial stiffness, namely Pulse Wave Velocity (PWV), in patients with hypertension. The identification of possible moderator variables of the effect of exercise on PWV was defined as a secondary objective. Design and Methods: For this systematic review and meta-analysis (PROSPERO CRD42019138658), MEDLINE, Scopus, Cochrane and Web of Science were searched up until July 2019. Randomized controlled trials assessing the effect of exercise interventions lasting 4 or more weeks on PWV in (pre)hypertensive subjects were included. The standardized mean difference between the pre-post of the intervention group versus the control group was calculated for PWV using the Cohen's d index as the effect size statistic. The type of exercise, PWV assessment site, use of medication, baseline PWV and study quality assessment score were used to perform subgroup analysis. Design and method: Fourteen trials, involving 15 exercise groups (5 aerobic, 2 dynamic resistance, 6 combined, and 2 isometric resistance groups), totaling 694 subjects with pre- and hypertension (374 exercise). Exercise program duration ranged from 4 to 26 weeks, with a mean duration of 13.1 ± 6.1 weeks. The overall effect size showed statistically significant differences in PWV [(d (95% CI) = 1.35 (0.72, 1.98)] in favor of the exercise group. Aerobic exercise [d (95% CI) = 1.93 (0.31, 3.55)], combined exercise [d (95% CI) = 0.79 (0.09, 1.49)] and isometric resistance exercise [d (95% CI) = 2.23 (1.66, 2.81)] reduced PWV for the exercise group when compared to the control group. There was no significant reduction in PWV in subjects undertaking dynamic resistance training [d (95% CI) = 0.69 (-2.32, 3.69)]. Subgroup analysis demonstrated that the positive effects of exercise training on PWV are independent of medication use, PWV assessment site, study quality assessment score and baseline PWV, although higher baseline PWV values presented a more significant reduction with exercise. Results: Aerobic, combined and isometric resistance exercise significantly decreased PWV in (pre)hypertensive patients. Despite the small number of studies, data from the isometric resistance exercise has the potential for the largest reductions in PWV.

Short stature is associated with higher pulse wave velocity in subjects without overt cardiovascular disease.

Short stature is reportedly associated with cardiovascular disease (CVD). However, the mechanism underlying this intriguing epidemiological finding is unclear. Pulse wave velocity (PWV), a marker of vascular stiffness, is a predictor of future CVD. Therefore, PWV may be affected by height even before overt CVD occurs. Here, we investigated the association between adult height and PWV in subjects without overt CVD.A total of 1019 subjects (48 ± 12 years old; 509 men, 21 with diabetes mellitus, 209 with hypertension) without overt CVD were enrolled, all of whom underwent brachial-ankle PWV (baPWV) measurements. The subjects were divided into 3 groups by height. A multiple regression model was used to estimate baPWV values among heights after the adjustment for confounders.Mean baPWV value was highest in the group with the shortest height for both sexes (both P < .001). Bivariate correlation analysis between height and baPWV showed significant correlations in men (r = –0.131, P = .003) and women (r = –0.180, P < .001). In the multiple regression analysis with adjustment for identified confounders, group height was a predictor of baPWV (P for trend = .003) in younger men (<50 years old) but not in older men, while group height was correlated with baPWV in older women (≥50 years old, P for trend = .014) but not in younger women.Height is inversely correlated with baPWV in subjects without overt CVD, especially in younger men and older women. This may explain the historical epidemiological observation of an inverse relationship between height and CVD.

A18499 Evaluation of Central Aortic Blood Pressure and Pulse Wave Velocity in subjects with Ankylosing Spondylitis compared with healthy controls

Objectives: The aim of this study was to evaluate the finger-toe Pulse Wave Velocity (ftPWV) and central blood pressure in patients with AS and controls, paired by age. Methods: Finger-toe pulse wave velocity (ft-PWV) was measured by pOpmetre® device allowed to explore arterial stiffness, pulse wave analysis was performed with pulse pen device which calculate central hemodynamics parameters by tonometry. Results: Twenty-two patients with AS and 24 controls were included in our study, subjects with AS exhibited greater pSBP (p < 0.001), pDBP (p < 0.001), pPP (p < 0.001) and MBP (p < 0.001) compared to controls. Moreover, in the AS group we observed a higher ftPWV with a mean difference of 1.63 (p < 0.006, 95% CI of .50 to 2.7). No significant difference was observed in pPP. Conclusion: Subjects with ankylosing spondylitis showed increased ftPWV, central and peripheral blood pressure, this contributes to explain the higher risk of cardiovascular disease in this pathology. pOpmètre® is a no operator depended, simple and practical device, highlighted an increase in arterial stiffness in patients with AS by measuring the ft-PWV. It could play a role in this disease monitoring and in prediction of cardiovascular complications.

AORTIC VISCOELASTIC PROPERTIES AND ALTERED ELECTROMECHANICAL CARDIO-AORTIC CONNECTION IN PATIENTS WITH CARDIAC AMYLOIDOSIS

Objective: Cardiac amyloidosis (CA) is an infiltrative disorder caused by deposition of amyloid fibrils in the myocardial extracellular matrix. Although there is a wide scientific literature regarding amyloid heart disease, no data about aortic viscoelastic properties in these patients are available. This studio has the aims to start filling this gap.Design and method: 113 outpatients attending the Pavia Amyloid Center either with suspected or already diagnosed amyloidosis were enrolled; 58 of them were affected by cardiac amyloidosis. Arterial applanation tonometry (PulsePen, DiaTecne, Milan, Italy) was performed in carotid and femoral arteries to calculate carotid-to-femoral pulse wave velocity (PWV) as index of aortic stiffness. Carotid pressure wave was calibrated with oscillometric brachial blood pressure (BP) to obtain central BP, pulse pressure amplification (PPA) and augmentation index (AIx). Tonometric data were related to biochemical parameters, clinical data and treatment. Populations with and without cardiac involvement (NCA) were compared. Results: Carotid-femoral PWV was not significantly higher in CA subjects compared to NCA (p = 0.462). PPA was significantly reduced in subjects with CA (26.9 ± 10.6% in NCA, 19.8 ± 12.4% in CA, p = 0.0014). Multivariate Regression Analysis highlighted that the presence of cardiac involvement is the main element in determining a reduction in PPA. CA subjects had lower both peripheral pressure values and central ones. There were no significant differences in central pulse pressure (42.6 ± 12.3 in NCA vs 39.5 ± 12.6 mmHg in CA, p = 0.187), and AIx. The morphological analysis of the central pulse wave in its components (direct and reflected wave) did not show significant differences in the parameters studied, with the exception of Ti, detecting an early wave overlap in CA. Conclusions: Although there were no significant differences in aortic stiffness evaluated by PWV in subjects with CA, a reduced PPA was found. An altered electromechanical cardio-aortic connection, with preserved aortic properties, may be an explanation for this finding. In other words, amyloid cardiopathy strongly impairs cardiac function without significantly alteration in aortic function. Significantly reduced central and peripheral pressure values could be caused by the inability of the diseased heart to develop a post load compared to that of subjects without cardiac involvement.

BP.11.07] LDL-OXIDATION, SERUM URIC ACID AND PULSE-WAVE VELOCITY RELATIONSHIP IN CHRONIC KIDNEY DISEASE

Objective: The aim of our study was to evaluate the relationship between oxidized LDL (oxLDL), elevated Serum Uric Acid (SUA) and arterial stiffness in subjects with normal renal function compared with subjects with mild or moderate chronic kidney disease (CKD).Design and method: We selected from the database of the Brisighella Heart Study 205 adult non-smokers subjects, in primary prevention for cardiovascular disease, with normal renal function (M: 99, F: 106), 118 age-matched subjects with mild CKD (M: 55; F: 63) and 94 with moderate CKD (M: 44; F: 50), all visited during the 2012 population survey. All subjects underwent a medical visit including the determination of LDL oxidative susceptibility, oxLDL levels and arterial stiffness parameters such as Augmentation Index (AI) and Pulse Wave Velocity (PWV). Results: PWV was significantly increasing with the degree of CKD (Figure 1). An univariate analysis revealed a direct correlation of PWV with the main anthropometric, haemodynamic and laboratory values usually associated to higher arterial stiffness and a significant inverse correlation with LDL-C lag phase, HDL-C and apoAI (p < 0.05), either in subjects with normal renal function, or with mild or moderate CKD. In a stepwise multiple regression model we observed that in normal renal function and mild CKD groups the main predictors of PWV were age, Systolic Blood Pressure (SBP), ox-LDL, apoB and SUA (p < 0.05), while in moderate CKD group the main predictors were age, SBP and apoB, only (p < 0.05). Conclusions: In our population sample, SUA and oxLDL are significantly related to PWV in subjects with normal renal functions and with mild CKD, but not in subjects with more advanced CKD.

Pulse wave velocity and cardiac autonomic function in type 2 diabetes mellitus

BackgroundIncreased carotid-femoral pulse wave velocity (PWV) has been associated with incident cardiovascular disease, independently of traditional risk factors. Cardiac autonomic dysfunction is a common complication of diabetes and has been associated with reduced aortic distensibility. However, the association of cardiac autonomic dysfunction with PWV is not known. In this study we examined the association between cardiac autonomic function and PWV in subjects with type 2 diabetes mellitus.MethodsA total of 290 patients with type 2 diabetes were examined. PWV was measured at the carotid-femoral segment with applanation tonometry. Central mean arterial blood pressure (MBP) was determined by the same apparatus. Participants were classified as having normal (n = 193) or abnormal (n = 97) PWV values using age-corrected values. Cardiac autonomic nervous system activity was determined by measurement of parameters of heart rate variability (HRV).ResultsSubjects with abnormal PWV were older, had higher arterial blood pressure and higher heart rate than those with normal PWV. Most of the values of HRV were significantly lower in subjects with abnormal than in those with normal PWV. Multivariate analysis, after controlling for various confounding factors, demonstrated that abnormal PWV was associated independently only with peripheral MBP [odds ratio (OR) 1.049, 95% confidence intervals (CI) 1.015–1.085, P = 0.005], central MBP (OR 1.052, 95% CI 1.016–1.088, P = 0.004), log total power (OR 0.490, 95% CI 0.258–0.932, P = 0.030) and log high frequency power (OR 0.546, 95% CI 0.301–0.991, P = 0.047).ConclusionsIn subjects with type 2 diabetes, arterial blood pressure and impaired cardiac autonomic function is associated independently with abnormal PWV.

Safety Of Resistance Training with Elevated Arterial Stiffness

Arterial stiffness, a strong independent risk factor for cardiovascular (CV) disease, is elevated in patients with metabolic syndrome. Central arterial stiffening can be non‐invasively measured by pulse wave velocity (PWV), were 1 standard deviation change is associated with a 15% increase in CV risk. Therapeutic interventions aimed at decreasing PWV and other CV risk factors are clinically important to reduce the risk of CV disease and events in metabolic syndrome. Resistance training (RT) is under investigation, but to date results have been controversial with some showing increases in PWV. This increase could be detrimental to someone with preexisting arterial stiffness, but none of these studies included subjects with metabolic syndrome. We hypothesize that 8 weeks of progressive RT would not increase PWV in subjects with metabolic syndrome. Following RT there was a non‐significant reduction in triglycerides (12%) and body fat (11%) in the RT MetS group. We found 8 weeks of progressive RT did not cause a rise in PWV in metabolic syndrome patients (Pre 7.7 ± 0.4 Post 7.6 ± 0.3 m/s). Further, we found correlations between high baseline PWV (r=‐0.7, p&lt;0.01), carotid intima media thickness (r=‐0.5, p&lt;0.05), and systolic blood pressure (r=‐0.5, p&lt;0.01) with improvement in PWV pre to post. Backward elimination models showed baseline PWV (β=‐0.7, p&lt;0.01) as the best predictor of a decrease in PWV following RT. In summary progressive RT is a safe exercise modality for individuals with metabolic syndrome to reduce CV risk factors and improve arterial function.

Association between fat amount of dairy products with pulse wave velocity and carotid intima-media thickness in adults.

BackgroundExamine the relation between consumption of low-fat vs. whole-fat dairy products with the carotid intima-media thickness and pulse wave velocity.FindingsMethods: Cross-sectional and multi-center study. A total of 265 subjects were selected by stratified random sampling. Measurements: Information about dairy products was assessed using a semi-quantitative food-frequency questionnaire. Carotid intima-media thickness (IMT) was measured by carotid ultrasonography. Pulse wave velocity (PWV) was measured using the SphygmoCor-System.ResultsSubjects (age 55.8 ± 12.2) had mean values of IMT 0.68 ± 0.10 mm and PWV 7.60 ± 2.0 m/sec. The relationship between PWV and IMT with whole-fat and low-fat dairy intake groups, adjusted for age, sex, energy intake and other confounders revealed lower values of PWV in subjects with a consumption higher than 125 g/day of low-fat dairy and in those who did not intake whole-fat dairy. In a risk-factor adjusted regression model, an increase in PWV of 0.109 m/sec (95% CI: 0.006 –0.213) was estimated for every 100 g/day increase in whole-fat dairy intake. Similarly, a decrease in PWV of 0.101 m/sec (95% CI: −0.178 –0.023) was estimated for every 100 g/day increase in low-fat dairy intake, (p = 0.038 and p = 0.011 respectively). While for every 100 g/day increase in low-fat dairy intake, the estimate decrease of IMT was 0.005 mm (95% CI: −0.010 –0.001), p = 0.011.ConclusionsPWV and IMT showed an inverse association with the intake of low-fat dairy and a positive association with the intake of whole-fat dairy, so the amount of fat in dairy products can play an important role in arterial stiffness and subclinical atherosclerosis.

Relationship between aortic valve sclerosis and different vascular damage markers: an observational study

Although aortic valve sclerosis (AVS) and atherosclerosis may share same atherosclerotic process, there is still a controversy whether AVS may be related to atherosclerotic and nonatherosclerotic processes. The purpose of present study was to investigate this relation. In this cross-sectional and observational study, we enrolled 60 patients diagnosed with AVS and risk factor matched 76 subjects without AVS. Applanation tonometry was applied to assess the augmentation index and aortic pulse-wave velocity (PWV). Control and AVS group were examined by B-mode ultrasound to measure the intima-media thickness (IMT). Continuous variables were compared using unpaired t-test and Mann-Whitney U test. Logistic regression analysis was performed in order to find independent predictors of AVS. PWV and augmentation index did not differ between control and AVS groups (11.2±3.6 vs 12±3.2, p=0.18 and 26±7.6 vs 27±9.8, p=0.2 respectively). But IMT was significantly higher in AVS group than in control one (0.76 mm±0.17 vs 0.6 mm±0.16; p<0.001). There was a significant positive bivariate correlation between the presence of AVS, IMT (r=0.43, p<0.001), male gender(r=0.31, p<0.001), augmentation index (r=0.17, p:0,04), and age (r=0.36, p<0.001). Logistic regression analysis demonstrated that only IMT (OR: 1.46, 95% CI: 1.1-1.9, p=0.009) and age (OR: 1.1, 95% CI: 1.01-1.16, p=0.013) were independent predictors of AVS. Increased IMT but not PWV in subjects with AVS compared to control group may suggest that, AVS is probably a multifactorial disease, related to the both atherosclerotic and nonatherosclerotic processes.

Decreased estimated glomerular filtration rate (eGFR) is not an independent risk factor of arterial stiffness in Chinese women

Recent studies suggest that decreased estimated glomerular filtration rate (eGFR) and uric acid (UA) may be independent risk factors for arterial stiffness (AS). As serum UA level is linked to renal function, we hypothesize that decreased eGFR may be not an independent risk factor of AS, but may be related to UA level. In this study, we aimed to validate this hypothesis in a large community-based Chinese population. A total of 13,899 people were selected from the Cardiovascular Risk Survey (CRS) from October 2007 to March 2010. Pulse wave velocity (PWV) was calculated using the established methods. The relationships between eGFR, fasting blood glucose (FBG), UA and PWV were analyzed with multivariate linear regression. We found that PWV was significantly correlated to FBG (r = 0.173, p < 0.001) and UA (r = 0.177, p < 0.001), and inversely correlated to eGFR (r = − 0.161, p < 0.001). A multivariable regression analysis revealed that FBG (β = 0.056, p < 0.001) and UA (β = 0.039, p < 0.001), but not eGFR (β = − 0.011, p = 0.062) were significantly related to elevation of PWV. In women, eGFR was not an independent risk factor of AS with progressively decreasing renal function (all p > 0.05). However, in men, eGFR was associated with PWV in subjects with eGFR < 60 ml/min/1.73 m2. Our results suggest that decreased eGFR is not independently associated with AS in Chinese women.

Yearly evolution of organ damage markers in diabetes or metabolic syndrome: data from the LOD-DIABETES study

BackgroundCardiovascular disease morbidity-mortality is greater in people with type 2 diabetes mellitus or metabolic syndrome. The purpose of this study was to evaluate the yearly evolution of organ damage markers in diabetes or metabolic syndrome, and to analyze the associated factors.MethodsAn observational prospective study was carried out in the primary care setting, involving 112 patients: 68 diabetics and 44 subjects with metabolic syndrome, subjected to 12 months of follow-up. Measurements: traditional cardiovascular risk factors (blood pressure, blood glucose, lipids, smoking, body mass index (BMI) and) and non-traditional risk factors (waist circumference, hsC Reactive Protein and fibrinogen); subclinical vascular (carotid intima-media thickness, pulse wave velocity and ankle/brachial index), cardiac (Cornell voltage-duration product), renal organ damage (creatinine, glomerular filtration and albumin/creatinine index), and antihypertensive and lipid-lowering drugs.ResultsAt baseline, the diabetics presented a mean age of 59.9 years, versus 55.2 years in the subjects with metabolic syndrome (p = 0.03). Diastolic blood pressure, total cholesterol and HDL-cholesterol were lower among the patients with diabetes, while blood glucose and HbA1c, as well as antihypertensive and lipid-lowering drug use, were greater. At evaluation after one year, the diabetics showed a decrease in BMI (-0.39), diastolic blood pressure (-3.59), and an increase in fibrinogen (30.23 mg/dL), ankle/brachial index (0.07) and the number of patients with ankle/brachial index pathologic decreased in 6. In turn, the patients with metabolic syndrome showed an increase in HDL-cholesterol (1-91 mg/dL), fibrinogen (25.54 mg/dL), Cornell voltage-duration product (184.22 mm/ms), ankle/brachial index (0.05) and the use of antihypertensive and lipid-lowering drugs, and a reduction in serum glucose (3.74 mg/dL), HOMA, systolic (-6.76 mmHg), diastolic blood pressure (-3.29 mmHg), and pulse wave velocity (-0.72 m/s). The variable that best predicted a decrease in pulse wave velocity in subjects with metabolic syndrome was seen to be an increase in antihypertensive drug use.ConclusionsThe annual assessment of cardiovascular risk factors and the decrease in pulse wave velocity was more favorable in the patients with metabolic syndrome, probably influenced by the increased percentage of subjects treated with antihypertensive and lipid lowering drugs in this group.

Aortic Pulse Wave Velocity in Subjects with Aortic Valve Sclerosis

Aortic stiffness is an independent risk factor for cardiovascular events and mortality. The measurement of pulse-wave velocity (PWV) is the most simple, noninvasive, and robust method to determine aortic stiffness. Whether aortic stiffness contributes to aortic valve sclerosis (AVS) remains unknown. The aim of the present study was to examine the relationship between PWV and AVS in subjects free of clinically evident atherosclerotic disease. We enrolled 62 patients (48 men; age 65 +/- 8 years) diagnosed with AVS and an additional 62 age-, hypertension-, diabetes mellitus-, and history of smoking-matched subjects without AVS. Applanation tonometry was applied to assess the augmentation index and aortic PWV. The subjects with symptomatic vascular disease were excluded from the study. AVS was defined by echocardiography as thickening and calcification of the normal trileaflet aortic valve without obstruction to the left ventricular outflow. There was no significant difference between the two groups regarding the aortic PWV and augmentation index (11.7+/-3.3 vs 11.8+/-3.7, P=0.85; 28.0+/-9.4 vs 25.0+/-8.6, P=0. 17, respectively). The presence of AVS was significantly correlated with ejection fraction (r=0.211, P=0.011), male gender (r=0.362, P=0.0001), and age (r=0.200, P=0.026). The lack of an association between the aortic PWV and AVS suggests that AVS is a complex phenomenon consisting of several distinct processes, related to both atherosclerotic and nonatherosclerotic processes.

High blood pressure worsens age‐related increases in arterial stiffness evaluated by pulse wave velocity in subjects with lifestyle‐related diseases

Objective: Arterial stiffness is a risk factor for cardiovascular diseases, and is altered by age and blood pressure. Lifestyle‐related diseases are also major risk factors for cardiovascular events and influence arterial stiffness. The goal of this study was to clarify the clinical influence of aging on pulse wave velocity in patients with hypertension, diabetes and/or dyslipidemia.Methods: Eight hundred and forty‐seven outpatients (480 males, 367 females, mean age 61.5 years) at the Division of Geriatric Medicine and Hypertension in Osaka University Hospital who had lifestyle‐related diseases such as hypertension (n = 720), diabetes (n = 228) and dyslipidemia (n = 613) were enrolled. We evaluated arterial stiffness as measured by carotid‐femoral pulse wave velocity.Results: After age and systolic blood pressure adjustment, pulse wave velocity was higher in hypertensive patients (P = 0.0048), but not in patients with diabetes or dyslipidemia. By single linear regression analysis, pulse wave velocity and age were positively correlated in patients with (r = 0.359, P &lt; 0.0001) and without (r = 0.377, P &lt; 0.0001) hypertension, and the regression coefficients of these two groups were similar. Moreover, these variables were positively correlated with pulse wave velocity in hypertensive patients receiving medication (r = 0.324, P &lt; 0.0001) and without medication (r = 0.425, P &lt; 0.0001), and the regression coefficient with medication (0.033) was lower than that without medication (0.045).Conclusion These data suggest that the presence of hypertension worsened the age‐related increase in arterial stiffness in patients with lifestyle‐related diseases.

Aldosterone synthase gene polymorphism, stroke volume and age-related changes in aortic pulse wave velocity in subjects with hypertension

In rats, chronic aldosterone administration with high diet intake increases aortic stiffness independent of mechanical stress. In hypertensive humans, enhanced plasma aldosterone and arterial stiffness are positively associated. Whether the aldosterone synthase gene polymorphism (ASGP) CYP11B2 influences the age-related changes in blood pressure (BP) and arterial stiffness in hypertensive subjects has never been investigated. In 425 untreated hypertensive men and women, ASGP was evaluated together with aortic pulse wave velocity (PWV). In 191 of these subjects, cardiac haemodynamics were measured using echo-Doppler techniques. In the overall population, independently of sex, the TC and CC genotypes of ASPG had significantly higher heart rate (HR) (P < 0.05) and lower stroke index (P < 0.01) than the TT genotype, but did not affect BP. In men, the adjusted slopes of the curves relating age to PWV and HR were significantly steeper (P = 0.04; P = 0.002) for the TC and CC than for the TT genotype. Such gene-related differences were not observed for the age-systolic BP relationship. In hypertensive subjects, the TC and CC genotypes of ASGP involve, by comparison with the TT genotype, significantly higher HR and reduced stroke index. In men with the C allele, the reduced stroke index (cardiac effect) compensates for the steep increase of PWV with age (arterial effect), thus modulating the cardiovascular phenotype and explaining the lack of increased incidence of systolic hypertension. The results are consistent with a local role of endogenous aldosterone on both heart and vessels.

The age-related increase in arterial stiffness is augmented in phases according to the severity of hypertension.

Although blood pressure and age are major determinants of arterial stiffness, it is still unclear whether age-related changes in arterial stiffness are similar among subjects with different degrees of severity of hypertension. The present study examined the association between age and pulse wave velocity in subjects with different degrees of hypertension stratified according to the JNC-7 classification (Normal, Prehypertensive, and Stage I or II Hypertensive subjects). A number of 5,312 subjects (age range, 30-79 years) with no atherosclerotic risk factors other than high blood pressure were selected from two cohorts who regularly underwent annual health checkups, including the measurement of brachial-ankle pulse wave velocity (baPWV). baPWV was increased according to the severity of hypertension in all age groups. The association between age and baPWV formed a quadratic curve in each stage in both genders. The steepness of the slope of the quadratic curve increased according to the severity of hypertension. In each stage of hypertension, age and the baPWV were divided into tertiles. After adjustment for systolic and diastolic blood pressure, the odds ratio of having an increased baPWV in the 3rd age tertile (the highest-age group) was found to increase according to the severity of hypertension. In conclusion, the age-related increase of baPWV was shown to be augmented in phases according to the severity of hypertension, and this augmentation occurred even between the Normal and Prehypertensive stages. These results support the JNC-7 recommendations for a strict control of blood pressure even in the elderly.

Clustered features of the metabolic syndrome and the risk for increased aortic pulse wave velocity in middle-aged Japanese men.

The association between different features of the metabolic syndrome (MS) (obesity, hypertension, hypercholesterolemia, low high-density lipoprotein cholesterol level, hypertriglyceridemia, high fasting plasma glucose level, and hyperuricemia) and the risk for increased aortic pulse wave velocity (PWV) of > or = 8.0 m/sec was examined in 2431 Japanese men aged 35 to 54 years who were not taking antihypertensive medication. After controlling for age, cigarette smoking, and alcohol intake, the odds ratios for increased aortic PWV in subjects with 1, 2, 3, and > or = 4 features of the MS, compared with those without features of the MS, were 1.35 (95% CI, 0.86 to 2.11), 1.90 (95% CI, 1.18 to 3.06), 1.57 (95% CI, 0.89 to 2.76), and 2.38 (95% CI, 1.26 to 4.49), respectively (p for trend = 0.003). A 9-year longitudinal study was also performed to prospectively examine the association between clustered features of the MS and the development of increased aortic PWV in 2073 men without aortic stiffness with a PWV < 8.0 m/sec and without antihypertensive medication during the follow-up period. The multivariate-adjusted hazard ratios for the incidence of increased aortic PWV in subjects with 1, 2, 3, and > or = 4 features of the MS, compared with those without features of the MS, were 1.39 (95% CI, 1.10 to 1.77), 1.46 (95% CI, 1.1 1 to 1.92), 1.75 (95% CI, 1.27 to 2.40), and 2.22 (95% CI, 1.52 to 3.25), respectively (p for trend < 0.001). These results suggest that clustered features of the MS are closely associated with the risk for increased aortic PWV in middle-aged Japanese men.

Polymorphism in the promoter region of the insulin-like growth factor I gene is related to carotid intima-media thickness and aortic pulse wave velocity in subjects with hypertension.

Low circulating levels of insulin-like growth factor I (IGF-I) have been associated with an increased risk for atherosclerosis. Absence of the 192-bp (wild-type) allele in the promoter region of the IGF-I gene has been associated with low circulating IGF-I levels. We examined the role of this polymorphism in relation to blood pressure and 2 early markers of atherosclerosis: carotid intima-media thickness (IMT) and aortic pulse wave velocity (PWV). A total of 5132 subjects of the Rotterdam Study, aged 55 to 75 years, were included in this study. In 3769 subjects who did not use blood pressure-lowering medication, the association between the IGF-I polymorphism and blood pressure was examined. In the total population, and in 3484 normotensive subjects, 1648 hypertensive and 462 untreated hypertensive subjects, the association between this polymorphism and IMT and PWV was examined. Mean systolic and diastolic blood pressure did not differ between genotypes. In hypertensive subjects IMT was significantly increased in noncarriers of the 192-bp allele (0.83 mm) compared with heterozygous or homozygous carriers (0.80 mm) (P=0.04). PWV was also significantly higher in hypertensive subjects who were noncarriers of the 192-bp allele (14.3 m/s) compared with heterozygous (14.1 m/s) or homozygous carriers (13.7 m/s) (P=0.02). Findings were more pronounced in hypertensive subjects without medication use. In normotensive subjects, no association between this polymorphism, IMT, and PWV was observed. Our study suggests that hypertensive subjects who have low IGF-I levels because of a genetic polymorphism in the IGF-I gene are at increased risk of developing atherosclerosis.