Pulse Wave Velocity Research Articles

Impact of nonsurgical periodontal treatment on arterial stiffness outcomes related to endothelial dysfunction: A systematic review and meta-analysis.

To assess the available evidence on whether nonsurgical periodontal treatment (NSPT) improves arterial stiffness outcomes in patients with periodontitis (PD). Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and population, intervention, comparison, outcomes, and study design (PICOS) question, electronic databases were screened for clinical interventional studies addressing the impact of NSPT on pulse wave velocity (PWV), carotid intima-media thickness (CIMT), and flow-mediated dilatation (FMD) outcomes in PD patients. Furthermore, the research strategy was implemented using a hand search. Studies were selected, and data were extracted by two independent reviewers. Random effects models were applied to perform a meta-analysis, and methodological index for nonrandomized studies (MINORS) and Cochrane Rob2 tools were used to assess the risk of bias. Fifteen articles were finally included for qualitative synthesis. Among them, eight single-arm cohort studies met the final inclusion criteria for meta-analysis. The Rob2 analysis evidenced that one randomized clinical trial (RCT) had a low risk, three RCTs raised some concerns, and three RCTs had a high risk of bias, while the MINORS scores ranged from 9 to 14. The meta-analysis showed that NSPT significantly impacted FMD (p<0.001) and CIMT (p=0.004), while changes in PWV were not statistically significant. However, there was high heterogeneity among studies (I2=78% for FMD and I2=62% for CIMT). Despite some beneficial effects on FMD and CIMT, due to study limitations, high heterogeneity, and risk of bias, it cannot be concluded that NSPT is effective in improving arterial stiffness. Therefore, further studies are necessary to achieve high-quality evidence on the effect of NSPT on arterial stiffness outcomes in PD patients. PROSPERO ID CRD42024501399. Periodontitis (PD) has been associated with alterations in arterial stiffness outcomes related to early endothelial dysfunction. Based on noninterventional studies, this meta-analysis indicates that nonsurgical periodontal treatment (NSPT) may reduce cardiovascular disease risk in patients with PD. The moderate evidence derived from the studies that were finally included showed that NSPT had beneficial effects on flow-mediated dilatation and carotid intima-media thickness, while this trend was not observed for pulse wave velocity. Moreover, the findings of the present meta-analysis were characterized by high heterogeneity and risk of bias and were derived from uncontrolled clinical trials or randomized clinical trials with limitations. Therefore, more studies with standardized protocols and homogeneous arterial stiffness outcomes are needed to elevate the quality of the present evidence.

Effects of long-term almond consumption on markers for vascular function and cardiometabolic risk in men and women with prediabetes: results of a randomized, controlled cross-over trial.

The aim of this study was to investigate the long-term effects of almond consumption on peripheral vascular function, ambulant blood pressure profiles (ABP), and serum/plasma markers reflecting endothelial dysfunction and inflammation in participants with overweight/obesity and prediabetes. Thirty-four participants completed this single-blinded, randomized, cross-over trial with 5-month intervention and control periods, separated by a 2-month wash-out. During the intervention period, participants consumed 50g of whole almonds daily. At the end of each intervention period, peripheral vascular function was assessed by measuring the carotid-to-femoral and carotid-to-radial pulse wave velocities (PWVc-f and PWVc-r, respectively) and retinal microvascular calibers. Serum/plasma concentrations of soluble intracellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1 (sVCAM-1), interleukin-6 (IL-6), IL-8, tumor necrosis factor-alpha (TNFα), serum amyloid A protein (SAA) and high-sensitivity C-reactive protein (hs-CRP) and 24-hour ABP were also analyzed. Almond consumption did not significantly affect arterial stiffness (PWVc-f and PWVc-r), while central retinal venular equivalent (CRVE) was minimally increased by 2μm (P = 0.019). Central retinal arteriolar equivalent (CRAE), the arteriolar-to-venular ratio (AVR), and endothelial and inflammatory serum/plasma markers showed no significant changes after almond consumption. Almond consumption reduced systolic blood pressure (SBP; -3 mmHg 24-hour P = 0.035, -4 mmHg daytime P = 0.046, and - 4 mmHg during nighttime P = 0.029), SBP variability during 24-hour, daytime, and nighttime (P = 0.005, P = 0.019, and P = 0.003, respectively), and diastolic blood pressure variability during nighttime (P ≤ 0.001). Almond consumption did not affect arterial stiffness, retinal microvasculature calibers, or serum and plasma markers for endothelial dysfunction and inflammation in participants with prediabetics, while BP and BP variability were improved. This clinical trial was registered in February 2018 as NCT03419702.

Arterial Stiffness as a New Predictor of Clinical Outcome in Patients with Polycythemia Vera

Background: Thrombotic adverse events and disease progression are crucial in Polycythemia Vera (PV), as it stands as the leading cause of mortality. The pulse wave velocity (PWV) is a valuable indicator of arterial aging and often plays a significant independent role in contributing to cardiovascular adverse events (CV-AEs). The aim of this study was to examine the relationship between PWV and critical vascular function parameters, with the goal of identifying new predictive factors of vascular damage and exploring a potential connection with disease progression. Methods: Non-invasive aortic stiffness was assessed through carotid–femoral PWV measurement. PWV was measured using the SphygmoCor device. History of arterial or venous thrombosis (TAEs) or other CV-AEs was collected at baseline. PWV measurements were repeated at baseline, at 6 and at 12 months. Results: The study involved 28 PV patients aged 27 to 77 years, with 57.1% being male. Fourteen patients (50%) reported a high-risk thrombotic score at diagnosis, and 60.7% had at least one comorbidity. Multivariable regression models showed that hemoglobin levels were independently associated with PWV (β: 0.68, SE 0.24, p &lt; 0.01). During the follow-up period (median duration 21.3 months, range 6–33), a total of 13 events were documented. Specifically, two patients exhibited a loss of response to treatment, four patients presented an increase in spleen diameters, three patients displayed an escalation of systemic symptoms, and three patients had a clear progression to secondary myelofibrosis. PWV (per 1 m/s: OR 1.70, 95% CI 1.00–2.91, p = 0.047) and leukocyte count (per 1 × 103/μL: OR 1.47, 95% CI: 1.04–2.09, p = 0.043) were significant predictors of events, independently of waist circumference, blood pressure, treatment, and hematocrit. Conclusions: PWV has demonstrated its potential as an effective tool for monitoring PV patients. It stands as a clinical parameter that can predict the risk of progression in PV patients. Further investigation is essential to fully explore this potential. If successful, it could offer clinicians a valuable resource for effectively managing PV patients.

Abstract 4113164: Central Arterial Stiffness in Young Adults with Perinatal HIV Exposure

Intro: Young adults with perinatally acquired HIV (YPHIV) have higher morbidity and mortality than uninfected persons. Antiretroviral therapy (ART) has extended life expectancy making adult CV disease a concern. Perinatal exposure to HIV increases inflammation which is associated with increased arterial stiffness which predicts CV disease. Aims: We compared arterial stiffness between YPHIV and young adults perinatally HIV exposed but uninfected (YPHEU), and evaluated the association of type and duration of ART regimens, HIV disease severity, and cardiac structure and function with arterial stiffness. Methods: In a substudy of the Pediatric HIV/AIDS Cohort Study, 150 participants (95 YPHIV, 55 YPHEU, mean 23.4 yrs, 60% female, 72% Black, 24% Hispanic) had echocardiography and pulse wave velocity (PWV) measured. We compared PWV between YPHIV and YPHEU, adjusting for covariates. Among YPHIV, we fit linear regression models to evaluate the association of current (within 1 year of PWV) and historical measures of HIV disease severity with PWV. We computed correlations between PWV and measures of left ventricular (LV) structure and function, overall and by HIV status. Results: Mean PWV and hemodynamic parameters did not differ between YPHIV and YPHEU (YPHIV 5.63 vs YPHEU 5.39 m/s; p=0.5). HIV control was good (82% with viral load &lt;400 copies/ml), 91% used combination ART: integrase strand inhibitors (INSTIs; median duration 4.6 years), protease inhibitors (PIs 15.1 years), or non-nucleoside reverse transcriptase inhibitors (NNRTIs 5.2 years). Most participants had normal PWV compared to healthy controls but all values above 11.8 m/sec ( Figure , level associated with CV events in adults) were only in YPHIV. Only weak correlations were observed between PWV and echocardiographic measures (&lt;0.20) in both YPHEU and YPHIV. Among YPHIV, HIV severity measures were not associated with PWV using either current or historical measures. Mean PWV was 1.68 (-0.36, 3.72) m/s higher among YPHIV with current PI use than those on INSTIs, and 1.58 (-0.94, 4.11) m/s higher than those on NNRTIs, although these differences were not significant. Conclusions: PWV was within normal ranges in most YPHIV and YPHEU although 5% YPHIV had elevated PWV. PWV may be higher with PI use due to cardiometabolic side effects. Successful HIV treatment and control of traditional CV risk factors may prevent premature vascular aging and subsequent cardiac compromise in YPHIV.

Abstract 4128250: Healthier Lifestyle is Associated with Better Arterial Health in People without Prevalent Cardiovascular Disease

Background: Higher arterial stiffness contributes to atherogenesis and arterial calcification, resulting in cardiovascular morbidity and mortality. Research Question: The relations of lifestyle, measured by the AHA Life’s Essential 8 (LE8), with arterial health (AH) and CVD outcomes are incompletely understood. Aims: To examine the association of LE8 with AH and extent to which carotid-femoral pulse wave velocity (PWV) mediates the association of LE8 with outcomes in a sample free of CVD. Methods: In 3 Framingham Heart Study cohorts, we studied the relations of LE8 (total score and components) with AH, assessed by arterial stiffness (PWV, by tonometry) and coronary calcification score (CAC, by computed tomography) using multivariable-adjusted linear regression (p&lt;0.01 considered significant after Bonferroni correction). We evaluated the extent to which PWV mediates the association of LE8 with outcomes using Cox proportional hazards regression models (p&lt;0.05 considered significant). Results: We studied 5222 participants, aged 50±15 years, 56% women. Characteristics of the sample are presented in Table . Higher LE8 score (better cardiovascular health) was associated with more favorable AH measures (PWV inverse transformed, standardized; CAC log(CAC+1); all β±SE, x10 -3 ): β PWV =-14.4±0.7, β CAC= -51.9±7.8, both p&lt;0.01). Of the LE8 components, BMI (β PWV =-1.53±0.31), BP (β PWV =-9.74±0.36), fasting glucose (β PWV =2.03±0.45), lipids (β PWV =-1.54±0.31, β CAC =-16.14±3.30) and smoking (β CAC =-17.9±2.8) were the greater contributors to AH (all p&lt;0.01). PWV mediated modest degrees of the associations between LE8 and CHD, HF, CVD, and CVD mortality [ Figure ]. Conclusions: In people without prevalent CVD, healthier lifestyle was associated with better AH. Arterial stiffness mediates the association between lifestyle measures and CHD, HF, CVD, and CVD-mortality. Our results support studying lifestyle interventions to improve arterial health and their benefits for CVD outcomes.

Abstract 4144503: Association of Granular Sleep Health Metrics with Arterial Stiffness in the Community

Introduction: Poor sleep is a risk factor for cardiovascular disease and all-cause mortality; however, the mechanisms underlying this relationship remain poorly understood. Since sleep health is a complex construct extending beyond mere sleep duration, we aimed to examine the relationship between granular sleep health indicators and arterial stiffness. Methods: We analyzed Framingham Offspring cohort (Exam 9) and OMNI cohort 1 (Exam 4) participants with sleep study and applanation tonometry data (n= 847, 56.6% females). Participants wore an M1 device to obtain ECG-derived sleep spectrograms to assess sleep quality and the Nonin WristOx device for oximetry data over two consecutive nights. Sleep variables of interest included total sleep time, duration of stable and unstable NREM, duration of elevated low-frequency coupling (e-LFC), and duration and number of nocturnal hypoxia events. Measures of aortic stiffness and pressure pulsatility included carotid-femoral pulse wave velocity (PWV), and central pulse pressure (CPP). Results: Characteristics of the sample are presented in Table 1. Several sleep measures were associated with PWV in univariable analysis, but significance attenuated after age/sex adjustment (Table 2). After adjusting for cardiovascular risk factors and sociodemographics, duration of e-LFCnb remained associated with CPP (β = 0.036, p = 0.02) Conclusion: Sleep measures associated with aortic stiffness are closely tied to age and sex. Longer duration of e-LFCnb, a hallmark of carotid body-driven elevated sympathetic tone and periodic breathing, is associated with greater pressure pulsatility. Longitudinal studies are needed to fully elucidate the role of e-LFCnb in vascular health

Abstract 4126650: Prognostic Value of Femoral-Ankle Pulse Wave Velocity for Cardiovascular Outcomes in Older Adults: The Atherosclerosis Risk in Communities (ARIC) study

Background: Carotid-femoral pulse wave velocity (cfPWV) is a representative measure of central arterial stiffness and an independent predictor of cardiovascular disease (CVD). Femoral-ankle PWV (faPWV) represents peripheral arterial stiffness, but its association with CVD has not been specifically studied. Aim: To compare faPWV and cfPWV regarding their associations with CVD outcomes. Methods: We analyzed 3,402 ARIC participants without prior heart failure (HF), coronary heart disease (CHD), or stroke at visit 5 (2011-13) (mean age 74.8 [SD 4.9] years, 36.1% male, and 78.0% White). faPWV and cfPWV were measured by Omron VP-1000 Plus. The outcomes of interest were composite and individual outcomes of CVD (HF, CHD, and stroke). We ran unadjusted and multivariable Cox proportional hazards models. Results: During a median follow-up of 9.0 years, there were 607 CVD events. Overall, faPWV showed an inverse association with CVD (Table). P-for-trend reached statistical significance in Models 1 and 2 and was borderline significant in Model 3 (p=0.077). In contrast, as anticipated, cfPWV was positively associated with CVD in all Models, although the association was somewhat attenuated in Model 3 (p-for-trend=0.045 and hazard ratio [HR] for top vs. bottom quartile 1.22 [95%CI 0.95-1.56]). Given their opposite patterns, we explored the ratio of cfPWV and faPWV (“cf/fa ratio”) and found that its association with CVD appeared stronger (p-for-trend=0.004 and HR for top vs. bottom quartile 1.37 [1.08-1.74]) than cfPWV. When each CVD subtype was examined separately, HF showed most consistent associations with our stiffness measures, and only the cf/fa ratio remained significant for HF up to Model 3 (p-for-trend=0.010 and HR for top vs. bottom quartile 1.40 [1.03-1.90]). Conclusions: faPWV was inversely associated with CVD, and cf/fa ratio appeared more strongly associated with CVD compared to cfPWV. Our findings indicate distinct prognostic implications of central vs. peripheral arterial stiffness and suggest cf/fa ratio as a new stiffness measure predicting CVD.

Abstract 4139148: Mechanisms of Maternal Cardiovascular Disease Development in a Novel Mouse Model of Pregnancy-Induced Diabetes

Background: Women with gestational diabetes mellitus (GDM) are more likely to develop cardiovascular disease (CVD) within 3 to 10 years following pregnancy. Endothelial dysfunction is a mechanism implicated in both hyperglycemia and CVDs, and it may constitute the missing link in this interaction. One reason for the lack of progress into the cardiovascular complications of GDM is the need for appropriate preclinical models that mimic human GDM. Also, the exact mechanisms mediating increased future cardiovascular risk in maternal with pregnancy-induced diabetes is unclear. Aim: To determine the mechanisms underlying cardiovascular disease in hormonal model of GDM. Methods: Sixteen week-old C57BL/6J female mice were treated with insulin receptor antagonist (S961) or saline (n=4) from the second trimester of pregnancy until delivery to develop a model of GDM. Glucose tolerance test was determined by glucometer and fasting insulin by colorimetry. Cardiac structure and function were measured by echocardiography (VEVO 3100) and pulse wave velocity was measured by Pulse Wave Doppler. Exercise tolerance test was performed on treadmill. Plasma endothelin-1 and nitrite were measured by ELISA and colorimetric assay. Aortic SIRT-1 was determined by western blot and aortic vascular reactivity was determined by wire myograph. Results: S961-induced GDM mice exhibit hyperglycemia (169.2 ± 3.6 vs. 105.5 ± 10.8mg/dL, P&lt;0.004 ) and hyperinsulinemia (1.9 ± 0.2 vs. 0.8 ± 0.1ng/ml , p&lt;0.01 ) which mimics the condition observed in human GDM. Interestingly, S961-induced GDM mice went on to develop systolic and diastolic dysfunction, vascular stiffness (3.7 ± 0.1 vs. 3.1 ± 0.08m/s, p&lt;0.005 ), exercise intolerance and increased thickness of the cardiac wall at 10 weeks post-delivery. Plasma ET-1 was elevated in our model during pregnancy (28.1 ± 1.7 vs. 5.2 ± 0.2pg/ml, p&lt;0.002 ) and at 10 weeks post-delivery (19.9 ± 2.9 vs. 6.7 ± 0.7pg/ml, p&lt;0.05 ). Circulating NO and aortic expression of sirtuin-1 (SIRT 1), that is involved in endothelial longevity is reduced in GDM mice. Additionally, vascular relaxation to acetylcholine was attenuated in S961-induced GDM mice. Conclusion: We have developed a novel mouse model of GDM similar to that observed in pregnant women by treatment with S961. Moreover, S961 treated mice develop cardiac dysfunction and vascular stiffness at 10 weeks post-delivery. Alterations in ET-1, SIRT 1, and NO levels may be responsible for the development of CVD in this model.

Abstract 4141457: Forms of Childhood Maltreatment and Subclinical Cardiovascular Disease Risk in Black men and women

Background: Exposure to specific forms of childhood maltreatment have been associated with cardiovascular disease (CVD) risk factors and CVD events in adulthood. Heterogenous experiences of childhood maltreatment across race and sex exist, yet there is little evidence regarding these relationships and CVD risk in Black populations. Aims: To investigate the association between various forms of childhood maltreatment (emotional, general, physical, and sexual abuse) and surrogate markers of vascular dysfunction and test whether sex modify these associations. Methods: Forms of childhood maltreatment and indices of vascular function were assessed in a cohort of healthy Black adults without known CVD (n=404) from a large metropolitan southeastern city. Childhood maltreatment was assessed using the Early Trauma Inventory short form (ETISR-SF) consisting of physical, sexual, emotional, and general domains. A trauma severity index score was calculated by summing the indexes for each of the four domains. Higher scores are indicative of higher traumatic life events before age 18 years. Outcomes of central augmentation index (cAIx) corrected for a heart rate of 75 bpm and carotid femoral pulse wave velocity (CfPWV) were measured as indices of wave reflections and arterial stiffness using applanation tonometry (Sphygmocor Inc.), and central pulse pressure (CPP) was calculated as the difference between the aortic systolic and diastolic blood pressures. Associations between each domain and outcomes were assessed using multivariate-adjusted and sex-stratified linear regression models. Results: Mean age of the cohort was 53 + 10.3 years, 61% women. Exposure to emotional [ b = -1.5%, 95%CI: -2.7,-0.3] and physical abuse [ b = -1.3%, 95%CI: -2.5,-0.2] was associated with cAIx overall but not CPP or CfPWV after adjusting for sociodemographic, clinical factors, health behaviors, and depressive symptoms. Significant emotional abuseXsex ( P= 0.014) and physical abuseXsex ( P=&lt; 0.001) interactions were identified for cAIx. Among women, physical abuse was associated with higher cAIx [ b =1.5%, 95%CI: 0.6, 2.4] and among men emotional [ b =-1.6%, 95%CI: -3.2, -0.0] and physical [ b =-1.7%, 95%CI: -3.1, -0.3] abuse was associated with lower cAIx. Conclusions: Exposure to emotional and physical abuse as children was associated with vascular dysfunction; moreover, exposure to physical abuse among women and not men have adverse clinical implications for CVD risk and prospects for enhanced preventive care.

Abstract 4136796: The effect of replacing typical snacks with pecans on vascular health and diet quality: a randomized controlled trial

Background: Poor diet quality accounts for approximately half of all deaths from cardiometabolic diseases. Food pattern modelling using nationally representative U.S. data suggests that replacing typical snacks consumed with tree nuts will improve diet quality. However, few clinical trials have assessed the potential for tree nuts to improve diet quality. Pecans are rich in polyphenols, which may improve endothelial and vascular function. This study aimed to examine how substitution of usual snack foods with 2 oz/day of pecans affects flow mediated dilation (FMD), carotid-femoral pulse wave velocity (cf-PWV), blood pressure and diet quality after 12 weeks in individuals at increased risk for cardiometabolic disease. Hypothesis: Intake of 2 oz/day of pecans in place of habitually consumed snacks will improve vascular health and diet quality compared to habitual intake. Methods: In this single-blind RCT, adults (46 ± 13 years, 29.8 ± 3.7 kg/m 2 ) with ≥1 criterion for metabolic syndrome who were free from cardiovascular disease, type 2 diabetes and other chronic diseases were included. The experimental group was provided with 2 oz/day of pre-portioned raw, unsalted pecans (~392 kcal) and instructed to replace the snacks they currently consume with the provided pecans. The control group was instructed to continue their usual diet. FMD (primary outcome), cf-PWV, brachial and central blood pressure were measured at baseline and following the intervention period (~12 weeks). At three timepoints (baseline, week 6, and week 12) during the study, participants completed three 24-hour recalls (total 9 recalls). The Healthy Eating Index-2020 (HEI-2020) was calculated to assess diet quality. Results: A total of 138 (69 per group) participants were randomized. No between-group difference in FMD, cf-PWV, or blood pressure was observed. The HEI-2020 was 11.1 points higher (95% CI 5.1, 17.2) in the pecan group compared to the usual diet group at week 12. The following HEI-2020 components were improved in the pecan group vs. the usual diet group: total protein foods (0.5 points [95% CI 0.1, 1.0]), seafood and plant proteins (2.5 points [95% CI 1.6, 3.4]), fatty acids (4.1 points [ 95% CI 2.6, 5.5]), and sodium (1.8 points [95% CI 0.3, 3.2]). Conclusion: Replacement of usual snacks with 2 oz of pecans improved adherence to the Dietary Guidelines for Americans but did not improve endothelial function, blood pressure, or arterial stiffening.

Association of lower serum sclerostin levels with elevated risk for increased arterial stiffness: The JPOS Cohort Study.

Studies on the relationship between serum sclerostin, a Wnt/β-catenin pathway inhibitor, and atherosclerosis have yielded inconsistent results. We aim to longitudinally investigate the relationship between serum sclerostin levels and the risk of increased arterial stiffness in Japanese community-dwelling women. Of 1044 women aged ≥50 years whose brachial-ankle pulse wave velocity (baPWV) value was available in a baseline survey in 2011-2012, we excluded 374 whose baPWVs were ≥1800 cm/s, set as the cutoff for increased arterial stiffness, and eight with missing data. Of the remaining 662 women, we included in the analysis 556 followed in the 4- to 5-year follow-up study. The coefficient of variation of the sclerostin measurement was 3.45%. We obtained odds ratios (ORs) for sclerostin at baseline categorized by tertiles, with the high tertile as reference for increased arterial stiffness. Ninety-four women showed increased arterial stiffness during a mean follow-up of 4.0 years. The increased arterial stiffness rates in the low, medium, and high tertiles were 22.2%, 16.1%, and 12.4%, respectively (trend test p = 0.013). The ORs for the medium and low tertiles for increased arterial stiffness were 1.58 (p = 0.205) and 2.16 (p = 0.027), respectively, after adjusting for age and baseline baPWV. After further adjustment for baseline BMI, hypertension, hyperlipidemia, diabetes mellitus, eGFR, and BMC at whole body, the ORs for the medium and low tertiles were 1.65 (p = 0.181) and 2.50 (p = 0.014), respectively. Lower serum sclerostin levels were associated with elevated risks for increased arterial stiffness in Japanese community-dwelling women.

THE IMPACT OF EXOGENOUS AND ENDOGENOUS FACTORS ON VASCULAR WALL ELASTICITY AND POTENTIAL CLINICAL EFFECTS (Review Article)

Vascular aging is associated with profound changes in the structural properties of the arterial wall. Arterial hypertension, diabetes mellitus, and chronic kidney disease are the primary determinants of the loss of elasticity and reduced compliance of the vascular wall. Arterial stiffness is a key parameter for assessing the elasticity of the arterial wall and can be easily evaluated using non-invasive methods such as pulse wave velocity. Early assessment of arterial stiffness is critical, as its changes may precede the clinical manifestations of cardiovascular disease. With age, arterial walls become stiffer, leading to an increase in systolic blood pressure and an increased risk of cardiovascular events such as stroke, myocardial infarction, or heart failure. The gradual decrease in vascular elasticity is accompanied by remodeling of their structure, an increase in collagen fibers, and a decrease in elastin, which exacerbates the problem. In addition, the mechanical stress on the vascular wall, which increases with age, worsens its condition, provoking the formation of atherosclerotic plaques. Arterial stiffness, as an important biomarker of vascular aging, is also an indicator of increased cardiovascular risk, independent of other factors such as blood pressure or the presence of comorbidities. Therefore, timely diagnosis of arterial stiffness can help prevent serious complications and adjust treatment for patients at risk. Important are also preventive measures, including a healthy lifestyle, physical activity, and control of the underlying diseases that contribute to the acceleration of vascular aging processes. Moreover, the influence of endogenous and exogenous factors, such as diet, the presence of chronic diseases, and bad habits (in particular, smoking), contribute to the acceleration of these processes. Innovative diagnostic methods, such as magnetic resonance imaging (MRI) or ultrasound, allow detecting these changes at early stages and, accordingly, adapting treatment.

Non-modifiable and Modifiable Risk Factors in Vascular Ageing Extremes: The African-PREDICT Study

Abstract Background Cardiovascular risk factors accelerate vascular ageing beyond chronological age, hence early vascular ageing (EVA). Carotid to femoral pulse wave velocity (cfPWV) is a measure of vascular ageing and is used to identify EVA and supernormal vascular ageing (SUPERNOVA). Vascular ageing is not completely understood in African populations. Therefore, we aimed to phenotype young South African adults stratified by cfPWV extremes in terms of non-modifiable and modifiable risk factors. This study included 1133 young adults (mean age: 24.5 years). We measured cfPWV using applanation tonometry. Body composition measures, self-reported 24-h dietary intake, smoking and alcohol consumption were included. Fasting blood samples were analysed for biochemical risk factors. Three groups based on cfPWV percentiles were compared and included SUPERNOVA (≤ 10th percentile), average vascular ageing (AVA, between 10 to 90th percentile) and EVA (≥ 90th percentile). Results Chronological age, male sex, smoking, alcohol use, and blood pressure were incrementally higher across PWV groups (all p trend ≤ 0.007). Black ethnicity was higher (p = 0.038) in the SUPERNOVA group. In exploratory factor analysis, a factor pattern including mean arterial pressure and fasting glucose showed beneficial odds (OR 0.62, p = 0.002) for SUPERNOVA and higher likelihood (OR 2.10, p &lt; 0.001) for EVA. Another factor pattern of socio-economic status and total dietary fat showed lower odds (OR 0.64, p = 0.003) for EVA. Conclusion Poor lifestyle behavioural risk factors seem detrimental in the EVA group conferring a possible higher risk of future CVD.

Retinal Microvascular Changes in Association with Endothelial Glycocalyx Damage and Arterial Stiffness in Patients with Retinal Vein Occlusion: A Cross-Sectional Study

Background/Objectives: To investigate the potential association between the endothelial dysfunction and arterial stiffness with retinal changes observed through optical coherence tomography (OCT) and OCT-angiography (OCT-A) in patients with retinal vein occlusion (RVO). Methods: Participants in this cross-sectional study were 28 patients with RVO. The demographic and clinical characteristics of all participants were recorded. Comprehensive ophthalmologic examinations were performed, including fundus photography, OCT and OCT-A. Endothelial dysfunction was assessed by measuring the endothelial glycocalyx thickness via the perfused boundary region (PBR5-25). Arterial stiffness was evaluated by measuring the carotid-femoral pulse wave velocity (PWV), the central systolic and diastolic blood pressures (cSBP and cDBP) and the augmentation index (Aix). For each ophthalmological outcome, we generated a saturated linear regression model with demographic and systemic vascular parameters serving as independent variables. Regression coefficients with the corresponding 95% confidence intervals (CIs) were reported. A p value &lt; 0.05 was considered as statistically significant. Results: A 1 m/s increase in PWV was associated with a 0.6% reduction in inferior macular vessel density (VD) (p = 0.050). A 10 mmHg increase in cSBP was associated with a 0.03 mm2 increase in foveal avascular zone (FAZ) area (p = 0.033). A 1% increase in Aix was associated with a 0.005 mm2 increase in FAZ area (p = 0.008). A 1 μm increase in PBR5-25 was associated, on average, with a 4.4% decrease in superior peripapillary VD (p = 0.027). Conclusions: In patients with RVO, structural and microvascular retinal parameters were significantly associated with markers of endothelial dysfunction and arterial stiffness.

Effects of Continuous Positive Airway Pressure Treatment on Vascular Function in a Real-Life Cohort of Elderly Patients with Obstructive Sleep Apnoea Syndrome

Background: Obstructive sleep apnoea syndrome (OSAS) is an independent risk factor for cardiovascular morbidity and mortality and has a detrimental effect on vascular function, in particular on arterial stiffness and endothelial function. Continuous positive airway pressure (CPAP) is the gold-standard therapy for OSAS and its effects on arterial stiffness and endothelial function have been demonstrated in non-elderly patients. Objectives: The objective of this study was to evaluate the effect of one year of CPAP treatment on arterial stiffness, through assessment of carotid–femoral pulse wave velocity (cf-PWV), and on endothelial function, through the reactive hyperaemia index (RHi), in a real-life cohort of elderly patients with moderate-to-severe OSAS and several comorbidities. Methods: In this nonrandomised prospective study, we enrolled 469 consecutive elderly patients affected by moderate-to-severe OSAS distributed in two groups: CPAP-treated (n = 225) and untreated patients (n = 244). Results: At one-year follow-up, in the treated group emerged an important improvement in poligraphics (AHI, ODI, TC90, mean SpO2%), laboratory (HOMA index, eGFR, hs-CRP) and vascular function parameters: cf-PWV. The stepwise multivariate linear regression demonstrated a significant correlation between the delta of the polygraph parameters and the delta of PWV and RHi. Conclusions: Our study confirmed the favourable effects of CPAP therapy in a cohort of elderly patients affected by OSAS and several comorbidities on sleep respiratory parameters and vascular function; early diagnosis and treatment with CPAP might be beneficial to delay or prevent the occurrence of cardiovascular events in these groups of patients.

Sleeping habits and aortic stiffness in middle-aged men and women from the general population: insights from the SCAPIS study

Background The relationship between sleeping habits and aortic stiffness remains inconclusive and is not fully explored in the European general population. Methods We examined cross-sectionally 8659 participants from the Swedish population-based cohort Swedish CArdioPulmonary bioImage Study (SCAPIS), mean age 57.5 years, 52.1% women. A self-administered questionnaire on sleeping habits (duration, quality, insomnia, and daytime sleepiness) was administered. Aortic stiffness was examined by the gold-standard method, carotid-femoral pulse wave velocity (c-f PWV) using Sphygmocor® XCEL, continuously and stratified by cut-off of >10 m/s. Multivariable linear and logistic regression were performed stratified by sex. Results Out of 8659 subjects (mean c-f PWV of 9.4 ± 1.9 m/s), 32.3% had c-f PWV >10 m/s, defined as aortic stiffness. Compared with subjects with c-f PWV ≤10 m/s, individuals with aortic stiffness reported more insomnia (p = 0.01) but less daytime sleepiness (p = 0.008). Men and women with poor sleep quality had 0.2 m/s lower mean c-f PWV compared with subjects with good sleep quality (p = 0.004). No difference in mean PWV was found in men and women with shorter/longer sleep duration (p > 0.05). In the multivariable regression models, no significant association was found between poor sleep quality, shorter (≤6 h) or longer (≥9 h) sleep duration and aortic stiffness in the total population, neither among men nor women (all p > 0.05), independently of cardiovascular risk factors. Conclusions Short and long sleep duration and poor sleep quality are not associated with aortic stiffness, measured with the gold-standard method c-f-PWV, in middle-aged men and women from the Swedish general population, independently of cardiovascular risk factors.

Associations of Cardiovascular Health Metrics in Childhood and Adolescence With Arterial Health Indicators in Adolescence: The PANIC Study.

Our aim was to assess the relationships of cardiovascular health metrics, cardiorespiratory fitness, lean mass, and fat percentage with arterial structure and function from childhood to adolescence. Five hundred four children aged 6 to 9 years were examined in the PANIC (Physical Activity and Nutrition in Children) study at baseline, 2 and 8 years later. The associations of adjusted American Heart Association cardiovascular health metrics (smoking status, body mass index-SD score, moderate-to-vigorous physical activity, diet quality, plasma total cholesterol, systolic blood pressure, plasma glucose categorized into poor, intermediate, and ideal), the American Heart Association cardiovascular health score, cardiorespiratory fitness measured by maximal oxygen uptake in a bicycle exercise test, lean mass and fat percentage with carotid intima-media thickness (cIMT) and pulse wave velocity (PWV) were analyzed cross-sectionally and longitudinally in 277 participants at age 15 to 17 years. Higher American Heart Association cardiovascular health score at baseline was associated with lower PWV at 8-year follow-up (ß, -0.19 [95% CI, -0.32 to -0.05]). Higher body mass index-SD score and systolic blood pressure were associated with higher cIMT (ß, 0.18 [95% CI, 0.05-0.31]); and (ß, 0.13 [95% CI, 0.00-0.25]; respectively) and PWV (ß, 0.20 [95% CI, 0.07-0.34]) and (ß, 0.13 [95% CI, 0.00-0.26]; respectively) at 8-year follow-up. Higher moderate-to-vigorous physical activity was associated with higher cIMT (ß, 0.25 [95% CI, 0.07-0.43]); yet lower PWV (ß, -0.25 [95% CI, -0.44 to -0.06]) at 8-year follow-up. Better cardiorespiratory fitness (ß, 0.29 [95% CI, 0.08-0.51]) and higher lean mass (ß, 0.51 [95% CI, 0.03-0.98]) were associated with higher cIMT after accounting for American Heart Association cardiovascular health score at 8-year follow-up. While our results suggest that higher cardiometabolic risk factors in childhood may exert unfavorable effects on arterial health during adolescence, we demonstrated the complexity of relationships between cardiovascular health metrics and arterial health indicators in childhood and adolescence. We found different associations of cardiovascular health metrics with cIMT and PWV in childhood and adolescence, calling for caution when interpreting the results of various cardiovascular risk factors with measures of arterial health, particularly in youth. URL: https://www.clinicaltrials.gov; Unique identifier: NCT01803776.

Efficacy of Olmesartan/Amlodipine Single-Pill Combination on 24-h Mean Systolic Blood Pressure Measured by Ambulatory Monitoring in Non-Responders to Valsartan or Candesartan Monotherapy.

The aim of this study was to evaluate the efficacy of olmesartan/amlodipine (OLM/AML) single-pill combination (SPC) therapy using ambulatory blood pressure monitoring (ABPM) in non-responders to valsartan or candesartan monotherapy. Isolated systolic hypertension (ISH) is the most prevalent form of hypertension in middle-aged and elderly individuals. Patients aged over 55 years who did not achieve the target systolic blood pressure (SBP < 140mmHg) with valsartan 80mg or candesartan 8mg for at least 4 weeks were included. Doses were escalated from 20/5mg to 40/5mg and finally to 40/10mg of OLM/AML SPC until patients reached the target SBP. Efficacy was assessed via ABPM by comparing baseline values with those in the 12th week. Office blood pressure (OBP) and brachial-ankle pulse wave velocity (baPWV) were assessed at baseline, weeks 4, 8, and 12. Fifty-four patients (average age 64 ± 6 years; 33 males) participated. The 24-h mean BPs decreased significantly from an average of 146.2 ± 12.7/93.3 ± 9.2mmHg to 129.7 ± 14.3/83.4 ± 10.7mmHg (p < 0.001), and pulse pressures (PPs) from ABPM were reduced (p < 0.001). Additionally, significant reductions in night-time SBP standard deviations (SDs) (14.7 ± 4.7vs. 12.5 ± 3.9, p = 0.029) were observed at 12 weeks compared to baseline. OBPs significantly dropped from 151.1 ± 9.7/89.3 ± 8.3mmHg to 125.5 ± 13.8/77.8 ± 8.8mmHg after 12 weeks of SPC therapy (p < 0.001). Reductions in PPs of OBP and baPWVs were also observed. OLM/AML SPC therapy effectively reduced the 24-h mean BP, as measured by ABPM, in hypertensive patients over 55 years old who failed to achieve a target SBP (< 140mmHg) with angiotensin receptor blocker (ARB) monotherapy using valsartan 80mg or candesartan 8mg. Trial Registration: ClinicalTrials.gov identifier: NCT01713920.

Effect of Controlled Expiratory Pressures on Cerebrovascular Changes During Valsalva Maneuver

This study aimed to investigate the effects of Valsalva maneuver (VM) with the controlled expiratory pressures on vascular stiffness of common carotid artery (CCA) and cerebral hemodynamic changes using diagnostic ultrasonography. Twenty-seven healthy participants (mean and standard deviation of age = 22.78 ± 1.89) performed 30 and 40 mmHg VM. The right CCA stiffness index and pulse wave velocity (PWV) were measured before (PRE) and after (POST) VM. The peak systolic velocity (PSV), resistance index (RI), and heart rate (HR) were measured before (PRE) and after (POST1 and POST2 during the first and the second 15 s, respectively) VM. Near-infrared spectroscopy (NIRS) was utilized to measure regional oxygen saturation (rSO2) and oxyhemoglobin (HbO) on the left and right prefrontal cortex. Stiffness index decreased by 1.76 (p &lt; 0.001) from PRE to POST only after 30 mmHg VM. PWV decreased by 0.69 m/s (p &lt; 0.001, 30 mmHg) and 0.34 m/s (p = 0.022, 40 mmHg) in POST. Conversely, PSV increased by 5.36 cm/s (p = 0.031, 30 mmHg) and 4.77 cm/s (p = 0.04, 40 mmHg) in POST2. Increase in RI (p = 0.017) and decrease in HR (p = 0.003) occurred only after the 40 mmHg VM. Right HbO decreased after 30 mmHg VM (p = 0.023) from PRE to POST1, and right rSO2 increased after 40 mmHg VM (p = 0.036) from VM (during) to POST1. Both 30 and 40 mmHg VM showed a significant improvement in PWV and an increase in PSV. However, at 30 mmHg VM, a significant decrease in HbO was observed after VM owing to increased cerebral oxygen exchange, and at 40 mmHg VM, an rSO2 increase was observed after VM owing to high vascular pressure. Additionally, the increased pressure and rSO2 at 40 mmHg may have been caused by increased RI. The results indicated that the 30 mmHg VM was more effective on CCA stiffness than the 40 mmHg VM.

Comparison of high-intensity interval training and moderate-intensity continuous training on cardiopulmonary function, cardiac autonomic function and vascular function in adolescent boys with obesity: A randomized controlled trial.

Adolescent obesity can impair cardiopulmonary function, vascular elasticity, endothelial function, and vago-sympathetic balance. While moderate-intensity continuous training (MICT) benefits cardiovascular health in obese adolescents, the effects of high-intensity interval training (HIIT) are less understood. We hypothesize that HIIT may be more effective than MICT in improving VO2peak, vascular elasticity, endothelial function, and vago-sympathetic balance in obese adolescent boys. Forty four participants were randomly assigned to the HIIT (10×1-min at 85%-95% peak HR, intersperse with 2-min active recovery at 60%-70% peak HR) or MICT (35min at 65%-75% peak HR) for an 8-week program. The primary outcome measured was the change in VO2peak with secondary outcomes including brachial-ankle pulse wave velocity (baPWV), flow-mediated dilation (FMD), and heart rate variability (HRV). Forty four adolescent boys with obesity (age, 14±1years old, body mass index, 31.6±1.3kg/m2) were enrolled and 43 (97.73%) completed the 8-week exercise. No significant difference of VO2peak was found between the HIIT and MICT group (p=0.243). There was no significant difference of baPWV between the groups (p=0.789). Change in FMD% was significantly higher in the HIIT group compared to the MICT group (p<0.001). The Change in HRV-high frequency (HRV-HF; p=0.009) and HRV-low frequency/high frequency (HRV-LF/HF; p=0.035) was significantly higher in the HIIT group compared to the MICT group. Among adolescent boys with obesity, 8-week HIIT and MICT had similar effects on improving VO2peak. HIIT may be superior to MICT to improve endothelial function and vago-sympathetic balance.