Small Artery Elasticity Research Articles

ASSOCIATION BETWEEN PERCEIVED STRESS AND VASCULAR ELASTICITY: AN OBSERVATIONAL STUDY FROM SOUTH-WESTERN SWEDEN

Objective: The association between perceived stress and arterial stiffness has yet to be fully explored. This study aims to determine the associations between perceived mental stress and arterial elasticity. Design and method: Our observational study was based on the Vara- Skövde Cohort. Between 2012 and 2014, a total of 1327 individuals were examined for risk factors for the development of cardiovascular disease. Known hypertension, missing information on mental stress and artery elasticity were exclusion criteria. In total, 785 individuals (men=379) were included. Body height, weight, heart rate, and blood pressure were measured, while data on medical history and lifestyle factors such as alcohol consumption, smoking, and physical activity were collected through validated questionnaires. Perceived stress was evaluated with the PSS-10 (Perceived Stress Scale), which contains ten questions with 0 - 4 points per item and focuses on the perceived stress in the last month. Small artery elasticity (C2) was estimated using an applanations tonometer (Pulsewave CR-2000, Hypertension Diagnostics Inc.) over the arteria radialis. Logistic regression was used in our analyses. In model 1, we adjusted for age, sex, systolic blood pressure and heart rate. In model 2, we adjusted for the variables in model 1 plus waist-hip ratio, LDL-cholesterol, and C-reactive protein. In model 3, we included model 2 plus lifestyle factors such as smoking, alcohol consumption, and physical activity. Results: The mean age was 54.5 (±10) years. There were no significant sex differences in the association between stress and vascular elasticity (interaction test p=0.371). In the fully adjusted model in logistic regression, a one-point rise in PSS-10 correlated with having an elasticity index in the lowest quartile of C2 by 5% in the entire study population (OR=1.05, CI: 1.009- 1.093, p= 0.015). Correspondingly, one quartile higher PSS-10 was associated with a 25% elevated risk of having a cardiovascular elasticity in the lowest quartile of C2 (OR=1.25, CI: 1.03- 1.52, p= 0.021). Conclusions: Increased perceived stress was associated with decreased vascular elasticity in this cohort.

The association between inflammation, arterial stiffness, oxidized LDL and cardiovascular disease in Finnish men with metabolic syndrome – a 15-year follow-up study

BackgroundAll-cause mortality and cardiovascular disease are increased in subjects with metabolic syndrome (MetS). Risk scores are used to predict individual risk of heart disease. We performed a long-term follow-up study to investigate whether risk scores and cardiovascular risk factors such as arterial stiffness, high-sensitive C-reactive protein (hs-CRP) and oxidized LDL (OxLDL) can be used to predict cardiovascular events in Finnish men with MetS.MethodsAfter baseline measurements we followed 105 Finnish men aged 30 to 65 years with MetS for a mean period of 16.4 years. The primary outcome of the study was a composite of myocardial infarction, stroke, symptomatic vascular disease diagnosed with invasive angiography, coronary or peripheral revascularization, amputation due to peripheral vascular disease, cardiovascular death and non-cardiovascular death. The endpoints were retrieved from electronic medical records.ResultsThe number of acute myocardial infarctions and strokes during the first 10 years was lower than estimated by FINRISK score but SCORE predicted cardiovascular death correctly. During the whole follow-up period, 27 of 105 participants (25.8%) had 30 endpoint events. The incidence of the primary composite outcome was significantly lower in subjects with hs-CRP < 1.0 mg/L than in subjects with hs-CRP ≥ 1.0 mg/L (6 of 41 subjects [14.6%] vs. 21 of 64 subjects [32.8%]; p = 0.036). The incidence of the primary composite outcome was higher among subjects with large artery elasticity classified as borderline compared to subjects with normal large artery elasticity (5 of 10 subjects [50%] vs. 22 of 93 subjects [24%]; p = 0.05). There was no difference in the incidence of primary composite outcome in groups with different degrees of small artery elasticity or different level of oxLDL.ConclusionsMen with MetS who had hs-CRP ≥ 1.0 mg/L had higher risk for CVD and all-cause mortality than those with hs-CRP of < 1.0 mg/L. This also applies to subjects with borderline decreased large artery elasticity. The amount of OxLDL had no predictive value on the incidence of CVD and all-cause mortality. Men with MetS participating in the Hämeenlinna Metabolic Syndrome Research Program without lifestyle or drug intervention had better outcome for myocardial infarction or stroke than estimated by the FINRISK score.Trial registrationClinicalTrials.gov NCT01119404 retrospectively registered 07/05/2010.

Abstract 13719: Minimal and Delayed Age-Related Increase of Arterial Stiffness Among Tsimane Forager-Horticulturalists

Background: Tsimane forager-farmers of the Bolivian Amazon exhibit a distinct trajectory of vascular aging, characterized by low age-related increases in BP, the lowest levels of coronary calcification ever reported, and robust VO 2 max. However, the prevalence of arterial stiffness (ArSt) in this population and its association with age and other cardiovascular risk factors are unknown. Methods: Large artery elasticity (LAE) and small artery elasticity (SAE) were measured among 491 Tsimane adults (mean age 55.3±13.0 y, 55% female) using HDI CR-2000 (Eagan, MN). Carotid-femoral pulse wave velocity (cfPWV) was assessed among 89 Tsimane (mean age 53.1±15.7 y, 54% female) using the foot-to-foot method with ECG and carotid/femoral pulse wave data. Results: Compared to previous studies from diverse urban populations, Tsimane show lower indices of ArSt: higher LAE (mean 22.79±12.21 ml/mmHg·10) and SAE (mean 7.57±4.04 ml/mmHg·100), and lower cfPWV (mean 6.34±2.1 m/s). LAE and SAE are 73% and 57% higher for Tsimane men, and 70% and 86% higher for Tsimane women, compared to age-matched US MESA adults. Tsimane demonstrate lower LAE and SAE with age, while higher cfPWV was only evident among Tsimane over 70 years (β=2.26±0.71, P =0.001; reference &lt;40 y). Hypertension is rare in this population, but was associated with having higher ArSt. Conclusion: Tsimane forager-farmers have substantially lower levels of ArSt and fewer age-related differences in ArSt compared to more urbanized and sedentary populations. The minimal and delayed age-related increase of arterial stiffness might contribute to the very low observed levels of coronary atherosclerosis and dementia in the Tsimane.

Impaired artery elasticity predicts cardiovascular morbidity and mortality- A longitudinal study in the Vara-Skövde Cohort

It is still debated whether arterial elasticity provides prognostic information for cardiovascular risk beyond blood pressure measurements in a healthy population. To investigate the association between arterial elasticity obtained by radial artery pulse wave analysis and risk for cardiovascular diseases (CVD) in men and women. In 2002–2005, 2362 individuals (men=1186, 50.2%) not taking antihypertensive medication were included. C2 (small artery elasticity) was measured using the HDI/Pulse Wave CR2000. Data on acute myocardial infarction or stroke, fatal or non-fatal, was obtained between 2002–2019. Cox- regression was used to investigate associations between C2 and future CVD, adjusting for confounding factors such as age, sex, systolic blood pressure, heart rate, HOMA-IR (Homeostatic Model Assessment for Insulin Resistance), LDL- cholesterol, CRP (C-Reactive Protein), alcohol consumption, smoking and physical activity. At baseline, the mean age of 46 ± 10.6 years and over the follow-up period, we observed 108 events 70 events in men [event rate: 5.9%], 38 in women [event rate: 3.2%]. In the fully adjusted model, and for each quartile decrease in C2, there was a significant increase in the risk for incident CVD by 36%. (HR = 1.36, 95% CI: 1.01–1.82, p = 0.041). The results were accentuated for all men (HR = 1.74, 95% CI: 1.21–2.50, p = 0.003) and women over the age of 50 years (HR = 1.70, 95% CI: 0.69–4.20). We showed a strong and independent association between C2 and CVD in men. In women after menopause, similar tendencies and effect sizes were observed.

Neurocognitive impairment associated with chronic morbidity in long-term survivors of Hodgkin Lymphoma

AbstractThoracic radiation is associated with significant cardiopulmonary morbidities in survivors of long-term Hodgkin lymphoma and may affect neurocognitive outcomes. Survivors (N = 204; 52.5% female; mean [standard deviation] age, 36.6 [8.01] years) treated with thoracic radiation and age-, sex-, and race/ethnicity-matched community controls (N = 205; 51.7% female; age, 36.7 [9.17] years) completed standardized neurocognitive testing, echocardiography, pulmonary function tests, and vascular studies during the same visit. Treatments were abstracted from medical records. Cardiac (ie, left ventricular ejection fraction [LVEF], global longitudinal strain [GLS]), vascular (ie, large and small artery elasticity [SAE]), pulmonary (ie, diffusing capacity of the lungs for carbon monoxide [DLCO] and forced expiratory volume [FEV1]), and chronic health conditions were evaluated for associations with age-adjusted neurocognitive performance using multivariable linear regression. Compared with controls, survivors had lower performance (P < 0.05) in visuomotor (0.11 vs 0.41), visual processing speed (0.25 vs 0.64), short-term recall (−0.24 vs 0.12), and flexibility (−0.04 vs 0.28). Survivors had lower pulmonary (FEV1, DLCOcorr), cardiac (LVEF, GLS), and vascular function (SAE) than controls (all P < 0.001). FEV1 was associated with visuomotor (P = .008) and visual processing speed (P = .05), and flexibility (P = .05). GLS was associated with short-term recall (P = .03). SAE was associated with flexibility (P = .007). Neurocognitive outcomes were also associated with moderate-to-severe neurologic chronic conditions (P < .05). Findings suggest a link between subclinical cardiopulmonary and vascular findings, neurologic morbidity, and neurocognitive impairments. Prevention of health morbidity may benefit neurocognitive outcomes.

Effect of omega-3 fatty acid ethyl esters on postprandial arterial elasticity in patients with familial hypercholesterolemia

Impaired arterial elasticity reflects increased risk of atherosclerotic cardiovascular disease in patients with familial hypercholesterolemia (FH). Treatment with omega-3 fatty acid ethyl esters (ω-3FAEEs) in FH patients has been shown to improve postprandial triglyceride-rich lipoprotein (TRL) metabolism, including TRL-apolipoprotein(a) [TRL-apo(a)]. Whether ω-3FAEE intervention also improves postprandial arterial elasticity in FH has not been demonstrated. We carried out an 8-week open-label, randomized, crossover trial to test the effect of ω-3FAEEs (4g/day) on postprandial arterial elasticity in 20FH subjects following ingestion of an oral fat load. Fasting and postprandial large (C1) and small (C2) artery elasticity at 4 and 6h were measured by pulse contour analysis of the radial artery. The area under-the-curves (AUCs) (0-6h) for C1, C2, plasma triglycerides and TRL-apo(a) were determined using the trapezium rule. Compared with no treatment, ω-3FAEEs significantly increased fasting (+9%, P<0.05) and postprandial C1 at 4h (+13%, P<0.05) and at 6h (+10%, P<0.05), with improvement in the postprandial C1 AUC (+10%, P<0.01). ω-3FAEEs also decreased postprandial triglyceride and TRL-apo(a) AUCs (-17% and-19%, respectively, P<0.05). ω-3FAEEs had no significant effect on fasting and postprandial C2. The change in C1 AUC was inversely associated with the changes in the AUC of triglycerides (r=-0.609, P<0.01) and TRL-apo(a) (r=-0.490, P<0.05). High-dose ω-3FAEEs improves postprandial large artery elasticity in adults with FH. Reduction in postprandial TRL-apo(a) with ω-3FAEEs may contribute to the improvement in large artery elasticity. However, our findings need to be confirmed in a larger population. https://www. com/NCT01577056.

PS-P15-5: EFFECT OF SODIUM RESTRICTION ON LARGE ARTERY STIFFNESS AND DISTENSIBILITY OF SMALL ARTERIES IN HYPERTENSIVE PATIENTS: A RANDOMIZED TRIAL

Objective: Arterial stiffness is characterized by a decrease in arterial distensibility, resulting from the interaction between the extracellular matrix and cellular elements. Large and small arteries can be differently influenced by extrinsic factors, such as excessive sodium intake. This study aim to evaluate the impact of sodium restriction on large artery stiffness and distensibility of small arteries in young adults diagnosed with arterial hypertension. Methods: Randomized controlled clinical trial, including 20 hypertensive patients, aged between 30 and 59 years, followed up at the hypertension outpatient clinic of a tertiary hospital. Subjects were randomized into two groups: group 1 - low-sodium diet (2 g sodium/day); group 2 - usual diet. To analyze the stiffness and distensibility of the arteries, it was measured aortic pulse wave velocity by Complior®, elasticity of small arteries and vascular resistance by HDI®, and also through the measurement of metalloproteinase-9. For nutritional assessment it were considered blood glucose levels, 24-h urinary sodium, body mass index (BMI) and other anthropometric measurements. For nutritional intake we analized the 24-hour dietary recall. Results and Discussion: In comparison with group 2, it was observed a significant (p &lt; 0.05) reduction in office blood pressure (p = 0,037) and pulse wave velocity (p = 0,010) in group 1 subjects. Also, in group 1 it occurred reduction in blood glucose levels, BMI, waist and neck circumference. Sodium intake was significantly reduced in group 1, taking into account 24 hs urinary sodium and evaluated by dietary recall. It is worth mentioning that excessive sodium intake linked to arterial hypertension causes a remodeling process, increased oxidative stress, inflammation and fibrosis of the arteries, contributing to arterial stiffness. Regarding the distensibility of small arteries, no significant differences were found between the two groups, but the intervention period and the number of individuals in the study should be taken into account, since these factors may have influenced the results. Conclusion: Sodium restriction for a short period of time promoted reduction of arterial stiffness, in parallel to reduction in obesity parameters and blood pressure in adults diagnosed with systemic arterial hypertension.

Postexercise Arterial Compliance and Hemodynamic Responses to Various Durations and Intensities of Aerobic Exercise.

Karabulut, M, Bitting, M, and Bejar, J. Postexercise arterial compliance and hemodynamic responses to various durations and intensities of aerobic exercise. J Strength Cond Res 37(3): 589-596, 2023-The purpose of this study was to determine the effects of various aerobic training protocols using different intensities and durations on arterial compliance and hemodynamic responses. Seventeen male subjects (age = 23.1 ± 2.8 years) performed a maximal oxygen consumption (V̇ o2 max) test, followed by 3 randomly assigned exercise test sessions, each on a separate day. At the beginning of each test session, pre-exercise baseline assessments of arterial elasticity, hemodynamic variables, and pulse wave velocity (PWV) were performed after a 10-minute rest. After baseline measurements, participants performed either a bout of aerobic exercise on a treadmill for 60 minutes at 65% of V̇ o2 max (60min); 20 minutes at 40% of V̇ o2 max (20min); or for 20 minutes at 40% of V̇ o2 max with blood flow restriction (BFR; 20min-BFR). All baseline measurements were repeated at the completion of each testing session. Significance for this study was set at p ≤ 0.05. The 60min session resulted in significant increases in small artery elasticity (SAE) compared with the 20min-BFR session ( p < 0.03) and decreases in both systemic vascular resistance (SVR) and total vascular impedance (TVI) compared with both 20min sessions ( p < 0.01). The carotid to radial PWV was significantly lower after both the 60min and the 20min-BFR sessions compared with the 20min session ( p < 0.02). The findings indicate that the duration and the intensity of exercise are important factors for improving SAE, SVR, and TVI. In addition, 20min-BFR at 40% V̇ o2 max may result in site-specific modifications in PWV that is comparable with those seen after 60 minutes of exercise at 65% V̇ o2 max.

Associations of plasma omega-3 and omega-6 pufa levels with arterial elasticity: the multi-ethnic study of atherosclerosis.

Literature examining the relationship of circulating omega-3 and omega-6 polyunsaturated fatty acids [n-3(ω-3) and n-6 (ω-6) PUFAs] and arterial elasticity in large cohort-based populations are lacking. We investigated the association of circulating ω-3and ω-6 PUFAs with large artery elasticity (LAE) and small artery elasticity (SAE) in participants from the Multi-Ethnic Study of Atherosclerosis (MESA). A total of 6124 participants (mean age 61.9; 52% female; 38% White, 27% Black, 22% Hispanic, and 13% Chinese-American) with plasma phospholipid PUFAs and arterial elasticity measured at baseline were included. LAE and SAE were derived from pulse contour analysis of the radial artery in all subjects in a supine position using tonometry. Linear regression models were used to determine associations for levels of (1) each circulating fatty acid, (2) total ω-3PUFAs, and (3) total ω-6 PUFAs with log-transformed LAE and SAE. Each standard deviation (SD) increment in circulating levels of total ω-3 PUFAs, eicosapentaenoic acid, and docosahexaenoic acid were associated with a 0.017 ml/mmHg, 0.017 ml/mmHg, and 0.015 ml/mmHg higher LAE respectively (p values all <0.01). No significant trends were observed for ω-3 PUFAs levels with SAE.22 Similarly, no significant trends were observed for ω-6 PUFA levels with either LAE or SAE. In a multi-ethnic cohort of individuals free of baseline cardiovascular disease, higher plasma levels of total and individual ω-3 PUFAs were associated with an increased LAE. Further understanding into differential associations of ω-6 PUFAs with LAE and SAE is needed.

ARTERIAL ELASTICITY PREDICTS CARDIOVASCULAR MORBIDITY AND MORTALITY- A LONGITUDINAL STUDY IN THE VARA-SKÖVDE COHORT

Objective: Background: Measures of arterial elasticity are used for early detection of vascular disease and identification of individuals at high risk for cardiovascular disease morbidity (CVD). Aim: To investigate the association between arterial elasticity and risk for CVD in men and women. Design and method: A total of 2816 randomly selected individuals were examined (Men = 1400) between 2002 and 2005. The average follow-up time was 14.8 ± 2.4 years. After excluding participants with known cardiovascular disease, hypertension and diabetes mellitus, 2362 individuals (Men = 1186) were included in this study. Small Arterial Elasticity Index (SAEI) was measured using the HDI/Pulse Wave™ CR2000. Diagnoses of CVD were defined as acute myocardial infarction or stroke and based on Swedish Cause of Death Register and Swedish National Inpatient Register for period 2002–2019. Kaplan – Meijer and Cox- regression analyses were used to investigate the differences between SAEI quartiles and future CVD, adjusting for age, sex, heart rate, systolic blood pressure, LDL- cholesterol, HOMA-IR, C- reactive protein, smoking, alcohol consumption and physical activity. Of note, higher values of SAEI indicate more compliant arteries. Results: Mean age at baseline was 46 ± 10.6 years. Overall, 108 events were observed, 38 in women with 11 under 50 years. In the fully adjusted model, a one quartile higher SAEI score was associated with a 26% lower risk of incident CVD among men and women combined; (HR = 0.74, 95% CI: 0.55- 0.99, p = 0.041). Similar results were observed in men in the fully adjusted model (HR = 0.65, 95% CI: 0.45- 0.95, p = 0.024). Analogous, however nonsignificant, results were observed in women older than 50 years (HR = 0.59, 95% CI: 0.24- 1.45). The effect size was significantly lower in women younger than 50 years (HR = 0.93, 95% CI: 0.58- 1.45). However, the number of events in this group was low. Conclusions: We showed a strong and independent association between SAEI and CVD in men. Similar tendencies and effect size were observed in postmenopausal women. The diastolic pulse wave appears to provide additional information for cardiovascular risk assessments.

Vascular hemodynamics and blood pressure differences between young and older women

BackgroundCardiovascular disease is one of the main causes of death in the United States, and hypertension is a primary risk factor. Therefore, the primary causes of hypertension need to be identified so they may be addressed for treatment. The purpose of this study was to compare blood pressure with hemodynamic values and identify factors that may explain blood pressure differences between a cohort of healthy normotensive younger and older women.MethodsParticipants were 49 young (age: 33.8 ± 5.9) and 103 old (age: 65.8 ± 4) who were non-hypertensive, had no previous history of heart disease or type 2 diabetes, body mass index less than 30 kg/m2, normal electrocardiography response at rest and during exercise, nonsmokers, and no use of medications known to affect cardiovascular or metabolic function. Body composition measured by dual-energy X-ray absorptiometry. Hemodynamic values measured by non-invasive pulse wave velocity through radial artery tonometry. Markers of inflammation measured through blood sample analysis.ResultsSignificant differences exist between young and old groups in %fat (P < 0.001), systolic blood pressure (SBP) (P = 0.001), large artery elasticity (P = 0.005), small artery elasticity (P < 0.001), systemic vascular resistance (P = 0.004), total vascular impedance (P < 0.001), estimated cardiac output (P < 0.001), and tumor necrosis factor-⍺ (TNF-⍺) (P < 0.001). Using ANCOVA the difference in SBP between age groups was no longer significant after adjusting for small artery elasticity (P < 0.001) and TNF-⍺ (P = 0.041).ConclusionsThese data demonstrate that blood pressure and vascular hemodynamic measures differ significantly between young and old women independent of body composition. Furthermore, these differences may be explained by the inflammation marker TNF-⍺ and/or small artery elasticity.

INTERDEPENDENCE BETWEEN LEFT VENTRICULAR DIASTOLIC DYSFUNCTION AND ARTERIAL ELASTICITY ALTERATION

Objective: In HT, both arterial elasticity of the central arteries (C1) and of the distal circulation (C2) has been reported to be reduced and this condition favours the development of other cardiovascular diseases. Diastolic dysfunction (DD) identifies hypertensives with high cardiovascular risk independent of LV mass and BP level. Several studies have shown that the extent of diastolic function's impairment could be interdependent on the level of arterial elasticities’ alteration. PURPOSE: To evaluate the correlation between the elasticity of large and small arteries and DD Design and method: Arterial elasticity indices (C1, C2) were derived from pulse wave analysis based on a modified Windkessel model in 101 hypertensive subjects, (mean age 51.08 ± 0.79 yrs; 48.51% of men, SBP/DBP: 202.49 ± 7.41/106.7 ± 5.54 mmHg, BMI- 29.38 ± 0.22 kg/m2), without other co-morbidities. Ambulatory blood pressure monitoring (ABPM), transthoracic echocardiography (TE)were performed at baseline and after 6, 12- months period of treatment. DD patterns were appreciated according to ASE/EACVI 2016 guidelines. Altered arterial elasticity was considered for C1 &lt; 10 ml/mm Hg × 10, C2 &lt; 6 ml/mm Hg × 1. Correlation analysis was performed using Pearson's test. The correlation coefficient was considered weak at &lt; 0.3, medium-0.3–0.7 and strong &gt; 0.7–1.0. Statistical significance was appreciated at a P-value &lt; 0.05 and highly significant at a P-value &lt; 0.001 Results: Diastolic dysfunction and C1 and C2 indices demonstrated a statistically significant correlation (p &lt; 0.001). More advanced patterns of diastolic dysfunction were associated with higher C1 and C2 abnormalities (Tab. 1,). Conclusions: Diastolic dysfunction is associated with arterial elasticity's alteration, and this association appears to have a particularly strong relationship with the extent of diastolic function's impairment. The more advanced patterns of diastolic dysfunction occurred, the stronger is the interdependence with arterial elasticity abnormalities.

Longitudinal association between leisure-time physical activity and vascular elasticity indices

AimWe investigated the association between levels of leisure-time physical activity and vascular stiffness in a longitudinal observational study from a representative Swedish population.MethodA total of 2816 randomly selected individuals were examined at visit 1 (2002–2005, Men = 1400). After a mean follow-up of 9.7 ± 1.4 years, a representative sample of 1327 of the original participants were re-examined at visit 2. After excluding subjects with hypertension at baseline, 761 participants were included in the longitudinal analyses. Leisure-time physical (LTPA) activity was self-reported and dichotomized as high or low (level 3, 4 and level 1, 2, respectively). Large Arterial Elasticity Index (LAEI) and Small Arterial Elasticity Index (SAEI) were measured using the HDI/Pulse Wave™ CR2000. Multivariable general linear models were used to investigate the differences in changes SAEI and LAEI based on LTPA levels.ResultsAt visit 1, and after adjustment for possible confounders, participants in the high LTPA group had better small artery elasticity (SAEI) (SAEI in low-level LTPA: 7.89 ± 0.11, SAEI in high-level LTPA: 8.32 ± 0.15, ΔSAEI: 0.42, CI: 0.07–0.78; p = 0.020). SAEI decreased between the two assessments (Visit 1: SAEI 8.01 ± 3.37 ml/mmHg; Δ SAEI: 1.4, CI 1.2–1.6, p < 0.001). Participants with a higher LTPA at visit 1 had significantly better SAEI at visit 2 (ΔSAEI: 0.44, CI 0.03–0.85, p = 0.037). No significant associations were observed between LAEI and LTPA after adjustments.ConclusionsHigh LTPA predicted higher small arterial compliance at visit 2 suggesting that positive effects of LTPA on arterial elasticity persists over time.

Association of APOL1 Genotypes With Measures of Microvascular and Endothelial Function, and Blood Pressure in MESA.

Background APOL1 high‐risk genotypes are associated with increased risk for hypertension‐attributed kidney disease among Black adults in the United States. Biopsy studies show differences in kidney vasculature by APOL1 status; less is known about the variants' associations with systemic vascular and endothelial function. Whether APOL1 risk variants are associated with blood pressure (BP) is also uncertain.Methods and ResultsUsing linear regression, we examined cross‐sectional associations of APOL1 risk genotypes (high=2 risk alleles, low=0 or 1 risk allele) with subclinical measures of vascular function (small arterial elasticity, n=1586; large arterial elasticity, n=1586; ascending aortic distensibility, n=985) and endothelial function (flow‐mediated dilation, n=777). Using linear mixed‐effects models, we studied longitudinal associations of APOL1 risk genotypes with BP (n=1619), adjusting for age, sex, and African ancestry. Among 1619 (12% APOL1 high‐risk) Black participants in MESA (Multi‐Ethnic Study of Atherosclerosis), mean age was 62 years old, 58% had hypertension, and mean systolic BP was 131 mm Hg at baseline. At examination 1 (2000–2002), there was no significant difference in small arterial elasticity, large arterial elasticity, ascending aortic distensibility, or flow‐mediated dilation in participants with APOL1 high‐ versus low‐risk genotypes (P>0.05 for all). Over a mean follow‐up of 7.8 years, relative annual changes in systolic and diastolic BP and pulse pressure did not differ significantly by APOL1 risk status (between‐group differences of −0.20, −0.14, and −0.25, respectively; P>0.05 for all).ConclusionsAmong Black participants in MESA, APOL1 high‐risk genotypes were not associated with subclinical vascular and endothelial function or BP trajectories. The relationship of APOL1 with kidney disease may be intrinsic to the kidney rather than through peripheral effects on systemic vasculature or BP.

Fish oil supplementation reduces osteoarthritis-specific pain in older adults with overweight/obesity

ObjectivesOA is a leading cause of chronic pain and disability. Next to inflammation, vascular pathology has been hypothesized to play a role in its aetiology and progression. Owing to side effects and the low efficacy of pharmacological treatments, dietary supplements are popular as alternative treatments, but evidence of efficacy is limited. We tested whether fish oil and curcumin supplementation can reduce chronic pain and OA burden in older adults.MethodsA 16-week randomized, double-blind, placebo-controlled, 2 × 2 factorial design supplementation trial with fish oil (2000 mg/day docosahexaenoic acid + 400 mg/day eicosapentaenoic acid), curcumin (160 mg/day) or a combination of both was undertaken in sedentary overweight/obese older adults. Secondary outcomes included treatment-induced changes in self-reported chronic pain and OA burden and whether changes were related to changes in small artery elasticity (surrogate marker for microvascular function), CRP (inflammatory marker) and well-being.ResultsThe majority of participants (131 of 152) reported chronic pain, which was predominantly OA specific. Fish oil significantly reduced OA-specific pain (P = 0.002, Cohen’s d = 0.56) and burden (P = 0.015, Cohen’s d = 0.45) compared with no fish oil treatment; reductions were correlated with improvements in microvascular function and well-being. Curcumin, alone or in combination with fish oil, did not reduce pain measures.ConclusionOur findings indicate potential for fish oil to alleviate OA pain and burden in overweight/obese older adults. Further investigations should be undertaken in patients with clinically diagnosed OA to evaluate fish oil alone and as an adjunct to conventional pharmacotherapy and to investigate underlying mechanisms.Trial registrationAustralian and New Zealand Clinical Trials Register, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370788, ACTRN12616000732482p.

Association of obesity with arterial stiffness: The Multi-Ethnic Study of Atherosclerosis (MESA).

Arterial stiffness (AS) and obesity are recognized as important risk factors of cardiovascular disease (CVD). The purpose of this study was to investigate the relationship between AS and obesity. AS was defined as high augmentation index (AIx) and low elasticity (C1, large artery elasticity; C2, small artery elasticity) in participants enrolled in the Multi-Ethnic Study of Atherosclerosis at baseline. We compared AIx, C1, and C2 by body mass index (BMI) (< 25, 25-29.9, 30-39.9, ⩾ 40 kg/m2) and waist-hip ratio (WHR) (< 0.85, 0.85-0.99, ⩾ 1). The obesity-AS association was tested across 10-year age intervals. Among 6177 participants (62 ± 10 years old, 52% female), a significant inverse relationship was observed between obesity and AS. After adjustments for CVD risk factors, participants with a BMI > 40 kg/m2 had 5.4% lower AIx (mean difference [Δ] = -0.82%; 95% CI: -1.10, -0.53), 15.4% higher C1 (Δ = 1.66 mL/mmHg ×10; 95% CI: 1.00, 2.33), and 40.2% higher C2 (Δ = 1.49 mL/mmHg ×100; 95% CI: 1.15, 1.83) compared to those with a BMI < 25 kg/m2 (all p for trend < 0.001). Participants with a WHR ⩾ 1 had 5.6% higher C1 (∆ = 0.92 mL/mmHg ×10; 95% CI: 0.47, 1.37) compared to those with a WHR < 0.85. The WHR had a significant interaction with age on AIx and C2, but not with BMI; the inverse relationships of the WHR with AIx and C2 were observed only in participants < 55 years between the normal (WHR < 0.85) and the overweight (0.85 ⩽ WHR < 0.99) groups. Different associations of WHR and BMI with arterial stiffness among older adults should be further investigated.

A prospective controlled study of metabolic and physiologic effects of kidney donation suggests that donors retain stable kidney function over the first nine years

While there have been numerous studies of living kidney donors, most have been retrospective without suitable controls and have yielded conflicting results. To clarify this we studied 205 living donor candidates and 203 controls having no medical conditions precluding donation. Before and at six months, one, two, three, six, and nine years after donation we measured iohexol glomerular filtration rate, clinic blood pressure, urine protein excretion and metabolic parameters reported to be affected by kidney function. We measured 24 hour ambulatory blood pressure at three, six, and nine years and at six and nine years blood pressure after treadmill exercise, carotid-femoral pulse wave velocity and arterial elasticity. Between six months and nine years, the mean (95% confidence interval) change in glomerular filtration rate was significantly different among 133 donors 0·02 (-0·16-0·20) mL/min/1·73m2/year versus -1·26 (-1·52--1·00) mL/min/1·73m2/year in 113 healthy controls. Blood pressure, urine protein, urine albumin, glucose, hemoglobin A1c, insulin, and lipoproteins were not different in controls versus donors; but parathyroid hormone, homocysteine and uric acid remained higher at nine years. At six and nine years carotid-femoral pulse wave velocity was not different, but the mean small artery elasticity was significantly lower in 141 donors 6·1 mL/mmHg x100, versus 113 controls 7·1 mL/mmHg x100, and 6·1 mL/mmHg x100 in 137 donors versus 7·6 mL/mmHg x100 in 112 controls at six and nine years, respectively [significant adjusted difference of 1·1 mL/mmHg x100]. Thus, donors remain healthy with stable kidney function for the first nine years, but differences in metabolic and vascular parameters could be harbingers of adverse outcomes requiring future interventions.

Abstract 47: Using Ultrasound and Inflammation to Improve Prediction of Ischemic Stroke: A Secondary Analysis of MESA

Background: The Multi-Ethnic Study of Atherosclerosis (MESA) is a large prospective epidemiologic study of the clinical factors that can predict transition from asymptomatic to symptomatic cardiovascular disease. Although prior studies have looked at ischemic stroke, they have not systematically examined the relationship between baseline ultrasound and inflammation measurements and subsequent primary stroke risk. Methods: The primary outcome is incident ischemic stroke during follow-up. The predictors are 9 ultrasound-derived measurements and 5 serum measurements related to inflammation. We fit Cox models to ischemic stroke and adjusted for patient age, hypertension, diabetes, total cholesterol, and smoking. Using DeLong’s method, we compared the AUC of the baseline adjusted model to the AUC of the model with predictor variables that were significant in the Cox models, to determine if they improved stroke prediction. Results: We included 6,095 patients with an average age of 61.9 years. The primary outcome of ischemic stroke was seen in 107 patients (1.8%) and the mean follow-up time was 7.7 years. In the Cox models, we found that small artery elasticity (SAE), carotid distensibility (CD), carotid stenosis (CS), and interleukin-6 (IL6) were associated with incident stroke. The AUC of the baseline model to predict stroke, which included patient age, hypertension, diabetes, total cholesterol, and smoking, was 0.745. When we added tertiles of SAE, CD, IL6 and categories of CS, the AUC improved to 0.765 (p=0.021 for difference). Conclusions: In a multiethnic cohort of patients without CVD at baseline, we found several ultrasound measurements and a serum marker of inflammation which predicted the occurrence of a primary ischemic stroke. Adding these basic ultrasound and serum measurements significantly improved the prediction of stroke, which could have implications for primary prevention efforts.

Relationship between arterial stiffness and chronic kidney disease in patients with primary hypertension.

To investigate the association of noninvasive indices of arterial stiffness with chronic kidney disease (CKD) in patients with primary hypertension, 547 (mean age 60 years, 63% males) hypertensive hospital inpatients were recruited, comprising 337 hypertensives without CKD and 210 hypertensives with CKD. Noninvasive arterial stiffness indices were obtained, including central arterial haemodynamics derived from the radial artery waveform using SphygmoCor V8.0 system, carotid-femoral pulse wave velocity (cfPWV), large and small artery elasticity indices (C1, C2 respectively). Intima-media thickness (IMT) was evaluated by ultrasonography. The diagnosis of CKD was assessed by the estimated glomerular filtration rate (eGFR) or urinary albumin creatinine ratio (ACR). Compared with hypertension without CKD, hypertensive patients with CKD were older, had higher central systolic blood pressure, cfPWV, and IMT (all P < 0.01). With decreasing eGFR, cfPWV and augmentation index adjusted to heart rate of 75 bpm increased progressively whereas C2 decreased (P < 0.05) in subjects with CKD. In the overall population, cfPWV showed a significant trend of a negative association with eGFR (P = 0.04) after adjusting for age, gender, and brachial systolic blood pressure. Multiple logistic analysis showed that 1 SD (3 m/s) increase in cfPWV entailed a 1.35 (95% Cl: 1.018-1.790) times higher likelihood of the presence of CKD even after adjustment for confounding factors. The association of arterial stiffness and CKD suggests that cfPWV may be a potential hemodynamic index to evaluate cardiovascular risk in CKD patients with primary hypertension.

Aerobic training session length affects arterial elasticity.

The purpose of this study was to examine haemodynamic and arterial elasticity responses to aerobic exercise of varying durations. Eighteen male subjects (age=23·4±2·0) performed a maximal aerobic fitness (VO2max ) test. Participants met in the laboratory following an overnight fast for three randomly assigned sessions. Assessments for large and small arterial elasticity (SAE), systemic vascular resistance (SVR), total vascular impedance (TVI), systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), stroke volume (SV), cardiac output (CO), pulse pressure (PP) and cardiac ejection time (CET) were performed using applanation tonometry at the radial artery. Following baseline measurements, participants executed aerobic exercise on a treadmill at 65% of their respective VO2max for 30, 45 or 60min on three different occasions. Postexercise measurements were performed immediately, 10, 20 and 40min postexercise cessation. The 60-min exercise bout resulted in significantly increased SAE values (P<0·04) and decreased SVR values (P<0·02) when compared with the 30-min exercise bout. The 60-min session also caused significantly higher HR values and significantly lower values for SV and DBP values following exercise (P<0·04). The results of this study emphasize that varying the length of moderate-intensity aerobic exercise bouts affects arterial elasticity response and total vascular resistance.