Small Artery Elasticity Research Articles

OS 17-02 NONINVASIVE LARGE ARTERIAL STIFFNESS AS CARDIOVASCULAR RISK MARKERS IN A CHINESE POPULATION.

Objective: To validate the potential predictor role of noninvasive large arterial stiffness as cardiovascular risk markers in a Chinese population. Design and Method: 850 patients with essential hypertension (EH) were recruited in the baseline (ChiCTR-TRC-10000888), which 675 (79.4%) patients were enrolled in the second follow-up. mean age was 61 years, 64% men. Arterial stiffness indices were measured in essential hypertension, including the carotid –femoral pulse wave velocity (c-f PWV), pulse wave analysis (PWA) and large and small artery elasticity (C1, C2), inter-media thickness (IMT) obtained by the carotid arterial ultrasonography. To explore the relationship between arterial stiffness and cardiovascular events in 675 with EH by using the multivariable Cox models. Results: During median follow-up of 24 months, 90 of 675 subjects (13.3%) had a total event; moreover, 32 of 675 subjects (4.7%) had a major cardiovascular event, including non-fatal myocardial infarctions, non-fatal stroke and cardiovascular death. In multivariate Cox proportional hazard regression analysis, after adjusting for confounding factors, brachial pulse pressure was more strongly predictive of cardiovascular events than was central pulse pressure (RR = 1.409 per 10 mmHg, P < 0.001 versus RR = 1.365, P = 0.002). Additional adjustment for the MAP and all of arterial stiffness indices, each SD increased in c-f PWV (3 m/s) and IMT (0.16 mm) was associated with 47.7% and 48.7% increase in major cardiovascular events. Each SD increased in IMT (0.16 mm) was associated with 32.6% increase in the total events. For male, each SD (10.9%) increased in [email protected] was associated with 26.0% and 41.1% increase in total events and major cardiovascular events. For age ≥ 60 years, each SD (7.6 mmHg) increased in CAP was associated with 49.6% increase in major cardiovascular events. Conclusions: c-f PWV and carotid IMT is independent predictor for major cardiovascular events and could be surrogate endpoints for cardiovascular events. But for the prospective values of CAP and [email protected] are limited by age or gender.

Effect of omega-3 fatty acid supplementation on arterial elasticity in patients with familial hypercholesterolaemia on statin therapy

Background and aimsIncreased arterial stiffness is closely linked with raised blood pressure that contributes substantially to enhanced risk of coronary heart disease in high risk individuals with familial hypercholesterolaemia (FH). Omega-3 fatty acid (ω3-FA) supplementation has been demonstrated to lower blood pressure in subjects with a high cardiovascular disease risk. Whether ω3-FA supplementation improves arterial stiffness in FH subjects, on background statin therapy, has yet to be investigated. Method and resultsWe carried out an 8-week randomized, crossover intervention trial to test the effect of 4 g/d ω3-FA supplementation (46% eicosapentaenoic acid and 38% docosahexaenoic acid) on arterial elasticity in 20 adults with FH on optimal cholesterol-lowering therapy. Large and small artery elasticity were measured by pulse contour analysis of the radial artery. ω3-FA supplementation significantly (P < 0.05 in all) increased large artery elasticity (+9%) and reduced systolic blood pressure (−6%) and diastolic blood pressure (−6%), plasma triglycerides (−20%), apoB concentration (−8%). In contrast, ω3-FAs had no significant effect on small artery elasticity. The change in large artery elasticity was not significantly associated with changes in systolic blood pressure or plasma triglyceride concentration. Conclusionsω3-FA supplementation improves large arterial elasticity and arterial blood pressure independent of statin therapy in adults with FH.Clinical Trial Registration: https://www.clinicaltrials.com/NCT01577056.

Cerebrovascular and cognitive benefits of high-oleic peanut consumption in healthy overweight middle-aged adults

Objective: Peanuts contain bioactive nutrients beneficial for vascular function. This study investigated whether consumption of unsalted peanuts (with skins) would enhance cerebrovascular perfusion and cognitive performance.Method: In a randomized crossover trial, 61 volunteers (29 males/32 females, 65 ± 7 years, BMI 31 ± 4 kg/m2) consumed their habitual diet ± high-oleic peanuts (56–84 g/day), each for 12 weeks. Nutrient intakes, vascular and cognitive function were assessed at baseline and at the end of each 12-week phase. Differences between the ends of each phase were compared by general linear repeated measures ANOVA controlling for baseline. Pearson's correlation analyses determined relationships between differences in cerebrovascular reactivity (CVR) and cognitive function.Results: Intakes of bioactive nutrients increased during the peanut phase. CVR was 5% greater in the left middle cerebral artery (MCA) and 7% greater in the right MCA. Small artery elasticity was 10% greater after peanut consumption; large artery elasticity and blood pressure did not differ between phases. Measures of short-term memory, verbal fluency, and processing speed were also higher following the peanut phase; other cognitive measures did not change. Differences in CVR in the left MCA correlated with differences in delayed memory and recognition.Discussion: Regular peanut consumption improved cerebrovascular and cognitive function; increased intakes of bioactive nutrients may have mediated these improvements.This clinical trial was registered with the Australian Clinical Trials Registry (ACTRN 12612000192886).

Exaggerated Systolic Blood Pressure Response after Unaccustomed High‐intensity Interval Exercise is independently related to Decreased Small Arterial Elasticity in Normotensive African American Women

PurposeAerobic exercise is known to transiently lower blood pressure and improve arterial function. However, limited research has evaluated blood pressure and small arterial elasticity (SAE), an index of endothelial function, among African American (AA) and European American (EA) women the morning after (≈22 hours later) acute bouts of moderate‐intensity continuous (MIC) and high‐intensity interval (HII) exercise matched for total work. Since hypertension is more prevalent among AAs compared to EAs, it is of clinical relevance to determine optimal exercise strategies for cardiovascular health. Due to potential greater gradients of shear stress, it was hypothesized that HII exercise would elicit a greater reduction in resting systolic blood pressure (SBP) compared to MIC exercise independent of race.MethodsTwenty‐two, premenopausal AA (n = 11) and EA (n = 11) women had their resting blood pressure and SAE measured by local pulse contour analysis at 4 time points following overnight stays in a room calorimeter: 1) at baseline, 2) after 16 weeks of aerobic training [3x/wk for 40 min at 70% peak VO2], as well as, 3) ≈22 hours after MIC exercise at 50% peak VO2, and 4) ≈22 hours following HII exercise at 84% peak VO2. During the room calorimeter stay, energy intake was adjusted to insure energy balance and to isolate the exercise‐mediated effects on cardiovascular variables. The acute exercise bouts (MIC and HII) were performed on a cycle ergometer at random to reduce an ordering effect. Bivariate correlation analyses were performed to examine relationships in the trained state and the changes (Δ) following acute MIC and HII exercise. Multiple linear regression was used to evaluate the independent effects of race and ΔSAE on ΔSBP.ResultsAfter 16 weeks of aerobic training (TR), resting mean arterial pressure and SAE were not different among races (p &gt; 0.05). However, ≈22 hours after HII exercise a significant increase in SBP (mm Hg) (TR, 121 ± 14 vs. HII, 128 ± 14; p = 0.01) emerged among AAs whereas responses (TR, 116 ± 12 vs. HII, 113 ± 9; p = 0.34) did not differ in EAs. After adjusting for race, ΔSBP after HII exercise was negatively associated (partial r = −0.533; p &lt; 0.01) with ΔSAE. Conversely, among AAs but not EAs, SAE (mL/mmHg ×100) was increased (TR, 7.0 ± 2.3 vs. MIC, 8.3 ± 3.0; p = 0.04) ≈22 hours after an acute bout of MIC exercise.ConclusionsTo our knowledge this is the first study to show that unaccustomed HII exercise results in a prolonged (≈22 hours) elevation in resting SBP among trained AA women. Since participants were not naïve to exercise (having trained for 16 weeks), a possible interpretation is that the AAs may have been overstressed during the HII exercise as the elevated SBP may be indicative of delayed recovery. On the other hand, acute MIC exercise appears to have a favorable effect on SAE among AA women. Future work should consider the mechanistic‐link of the observed outcomes including measures of sympathetic activity.Support or Funding InformationNIH support from the following grants: R01DK049779, P30DK056336, P60DK079626, and UL1RR025777.

Temporal Relationship Between Elevated Blood Pressure and Arterial Stiffening Among Middle-Aged Black and White Adults: The Bogalusa Heart Study.

This study assessed the temporal relationship between elevated blood pressure (BP) and arterial stiffness in a biracial (black-white) cohort of middle-aged adults aged 32-51 years from the semirural community of Bogalusa, Louisiana. Measurements of aortic-femoral pulse wave velocity (afPWV; n = 446) and large- and small-arterial compliance (n = 381) were obtained at 2 time points between 2000 and 2010, with an average follow-up period of 7 years. A cross-lagged path analysis model was used to examine the temporal relationship of elevated BP to arterial stiffness and elasticity. The cross-lagged path coefficients did not differ significantly between blacks and whites. The path coefficient (ρ2) from baseline BP to follow-up afPWV was significantly greater than the path coefficient (ρ1) from baseline afPWV to follow-up BP (ρ2 = 0.20 vs. ρ1 = 0.07 (P = 0.048) for systolic BP; ρ2 = 0.19 vs. ρ1 = 0.05 (P = 0.034) for diastolic BP). The results for this 1-directional path from baseline BP to follow-up afPWV were confirmed, although marginally significant, by using large- and small-artery elasticity measurements. These findings provide strong evidence that elevated BP precedes large-artery stiffening in middle-aged adults. Unlike the case in older adults, the large-arterial wall is not stiff enough in youth to alter BP levels during young adulthood.

Abstract P191: Measurements of Large and Small Artery Elasticity Indexes in a Swedish Population: Are Repeated Measurements Needed?

Aim: The aim of this study was to investigate whether the repeated measurement of the pulse wave from the radial artery improve the precision of the estimated elasticity. Method: Between 2002 and 2005 a total of 2816 individuals (Men 1400) 35-74 years old, in the Skaraborg County in southern Sweden, were randomly selected for a health survey within the Skaraborg Project (the Vara-Skövde Cohort). All participants were examined with an oral glucose tolerance test (OGTT), blood pressure and anthropometric data. Pulse wave measurements were performed by two trained study nurses using the HDI/Pulse wave CR-2000 (Eagan, MN). Three repetitive measurements were performed within 5 minutes. Large and small artery elasticity indexes (LAEI and SAEI) from each measurement, as well as the mean value of the first two measurements and all three measurements were evaluated with intraclass correlation (ICC) and Pearsons correlation to investigate the precision of the test. Coefficient of variation (CV) was calculated for each measurement and for the variable of the mean of two first measurements and the mean of three measurements. Results: The measurements were successful in 2733 subjects (97%). The mean LAEI in 1st, 2nd and 3rd measurements were respectively 16.2±5.6ml/mmHg, 16.3±5.4 ml/mmHg and 16.5± 5.4 ml/mmHg and for SAEI the corresponding results were 7.4±3.6 ml/mmHg, 7.5±3.6 ml/mmHg and 7.4±3.5 ml/mmHg. A significant successive increase was observed in both the LAEI and the SAEI; comparing the third to the first examination LAEI-diff by 0.28 ml/mmHg CI 0.14-0.43 0 p&lt;0.001, and SAEI by 0.17 ml/mmHg CI 0.1-0.24 p&lt;0.001). The between measurement correlations for the LAEI were 0.73 and 0.76, and for the SAEI 0.85 and 0.88, respectively. The intraclass correlations were high both for LAEI (0.90 and 0.89) and for SAEI (0.95 and 0.96). The CV decreased from 33-35 in the single measurement to 30 using three measurements for LAEI and from 47-49 to 47 for SAEI. Conclusion: Considering the high CV in both LAEI and SAEI repeated measurements are recommended. However, the high correlation between the mean of two and three measurements suggests only slight improvement in the precision is achieved with three examinations. As commonly recommended for blood pressure control we suggest using the mean of two measurements also for these indices of arterial elasticity.

Systolic blood pressure response after high-intensity interval exercise is independently related to decreased small arterial elasticity in normotensive African American women.

Aerobic exercise transiently lowers blood pressure. However, limited research has concurrently evaluated blood pressure and small arterial elasticity (SAE), an index of endothelial function, among African American (AA) and European American (EA) women the morning after (i.e., ≈22 h later) acute bouts of moderate-intensity continuous (MIC) and high-intensity interval (HII) exercise matched for total work. Because of greater gradients of shear stress, it was hypothesized that HII exercise would elicit a greater reduction in systolic blood pressure (SBP) compared to MIC exercise. After baseline, 22 AA and EA women initiated aerobic exercise training 3 times/week. Beginning at week 8, three follow-up assessments were conducted over the next 8 weeks at random to measure resting blood pressure and SAE. In total all participants completed 16 weeks of training. Follow-up evaluations were made: (i) in the trained state (TS; 8-16 weeks of aerobic training); (ii) ≈22 h after an acute bout of MIC exercise; and (iii) ≈22 h after an acute bout of HII exercise. Among AAs, the acute bout of HII exercise incited a significant increase in SBP (mm Hg) (TS, 121 ± 14 versus HII, 128 ± 14; p = 0.01) whereas responses (TS, 116 ± 12 versus HII, 113 ± 9; p = 0.34) did not differ in EAs. After adjusting for race, changes in SAE were associated (partial r = -0.533; p = 0.01) with changes in SBP following HII exercise. These data demonstrate an acute, unaccustomed bout of HII exercise produces physiological perturbations resulting in a significant increase in SBP that are independently associated with decreased SAE among AA women, but not EA women.

Women with a history of gestational diabetes on long-term follow up have normal vascular function despite more dysglycemia, dyslipidemia and adiposity

AimsPrevious gestational diabetes (GDM) is a risk factor for type 2 diabetes and increased metabolic risk, but the link with vascular dysfunction is not clear. This study examined vascular function in women 4–10 years after a diagnosis of GDM who had a normal oral glucose tolerance test (OGTT) in the first postpartum year. MethodsWe studied 90 women with a history of GDM and 59 age-matched controls, examining differences in insulin resistance as measured by the Homeostatic Model Assessment (HOMA-IR) and glucose responses during an OGTT, adiposity, lipid profile and C-reactive protein (CRP). Using pulse wave analysis, we also measured cardiac function, vascular compliance, and systemic vascular resistance. ResultsWomen with a history of GDM had higher measures of adiposity (body mass index 28.9±6.5 vs. 26.6±6.9kg/m2, P=0.04, waist–hip ratio 0.85±0.06 vs. 0.79±0.07, P<0.001), dyslipidemia (LDL cholesterol 2.78±0.64 vs. 2.41±0.56mmol/L, P<0.001, total cholesterol: HDL cholesterol 3.93±1.2 vs. 3.21±0.82mmol/L, P<0.001) and abnormal glucose metabolism (50% vs. 12%, P<0.001). However, there was no difference in CRP, HOMA-IR, or measures of cardiovascular function including pulse rate, pulse pressure, mean arterial pressure, cardiac output, systemic vascular resistance, small and large artery elasticity index. After controlling for adiposity, blood pressure, lipids and CRP, glycemic status did not contribute to vascular function. ConclusionDespite a higher incidence of adiposity, dyslipidemia, and impaired glycemia, women with a history of GDM who had a normal postpartum OGTT did not have impaired vascular function 4–10 years postpartum, when compared to healthy controls.

Acute Cocoa Supplementation Increases Postprandial HDL Cholesterol and Insulin in Obese Adults with Type 2 Diabetes after Consumption of a High-Fat Breakfast1–3

Background: Dietary cocoa is an important source of flavonoids and is associated with favorable cardiovascular disease effects, such as improvements in vascular function and lipid profiles, in nondiabetic adults. Type 2 diabetes (T2D) is associated with adverse effects on postprandial serum glucose, lipids, inflammation, and vascular function.Objective: We examined the hypothesis that cocoa reduces metabolic stress in obese T2D adults after a high-fat fast-food–style meal.Methods: Adults with T2D [n = 18; age (mean ± SE): 56 ± 3 y; BMI (in kg/m2): 35.3 ± 2.0; 14 women; 4 men] were randomly assigned to receive cocoa beverage (960 mg total polyphenols; 480 mg flavanols) or flavanol-free placebo (110 mg total polyphenols; <0.1 mg flavanols) with a high-fat fast-food–style breakfast [766 kcal, 50 g fat (59% energy)] in a crossover trial. After an overnight fast (10–12 h), participants consumed the breakfast with cocoa or placebo, and blood sample collection [glucose, insulin, lipids, and high-sensitivity C-reactive protein (hsCRP)] and vascular measurements were conducted at 0.5, 1, 2, 4, and 6 h postprandially on each study day. Insulin resistance was evaluated by homeostasis model assessment.Results: Over the 6-h study, and specifically at 1 and 4 h, cocoa increased HDL cholesterol vs. placebo (overall Δ: 1.5 ± 0.8 mg/dL; P ≤ 0.01) but had no effect on total and LDL cholesterol, triglycerides, glucose, and hsCRP. Cocoa increased serum insulin concentrations overall (Δ: 5.2 ± 3.2 mU/L; P < 0.05) and specifically at 4 h but had no overall effects on insulin resistance (except at 4 h, P < 0.05), systolic or diastolic blood pressure, or small artery elasticity. However, large artery elasticity was overall lower after cocoa vs. placebo (Δ: −1.6 ± 0.7 mL/mm Hg; P < 0.05), with the difference significant only at 2 h.Conclusion: Acute cocoa supplementation showed no clear overall benefit in T2D patients after a high-fat fast-food–style meal challenge. Although HDL cholesterol and insulin remained higher throughout the 6-h postprandial period, an overall decrease in large artery elasticity was found after cocoa consumption. This trial was registered at clinicaltrials.gov as NCT01886989.

Associations of body composition measures and C2, a marker for small artery elasticity: The MESA.

ObjectiveLower C2, a continuous blood pressure waveform characteristic asserted to represent small artery elasticity, predicts future cardiovascular disease (CVD) events. We hypothesized that the paradoxical positive association between body mass index (BMI) and C2 may reflect muscle instead of excess fat.MethodsIn a multi-ethnic, community living cohort of 1,960 participants, we used computed tomography (CT) scans of the abdomen to measure visceral adipose tissue (VAT) and total abdominal muscle tissue (TAMT), and used applanation tonometry of the radial arteries to assess C2. We then ascertained the period cross-sectional associations between BMI, TAMT, and VAT with C2.ResultsThe mean age was 62 ± 9 years and 50% male. After adjustments for age, gender, ethnicity, pack years smoking cigarettes, diabetes, hypertension, total and HDL cholesterol, higher BMI (standardized beta = 0.09, p-value < 0.01) and more TAMT (standardized beta = 0.12, p-value < .01), were significantly associated with higher C2. In contrast, more VAT (standardized beta = -0.09, p-value < .01) was associated with lower C2.ConclusionIn multivariable analysis, VAT, in contrast to TAMT and BMI was associated with less compliant small arteries. Visceral fat may be a better marker for detrimental excess body fat than BMI.

Correlation between arterial stiffness and inflammatory markers in autosomal dominant polycystic kidney disease patients with preserved renal function.

To evaluate the association between arterial stiffness and inflammatory markers including C-reactive protein (CRP), pentraxin 3 (PTX3) and neutrophil-to-lymphocyte ratio (NLR) in autosomal dominant polycystic kidney disease (ADPKD) patients with preserved renal function. A total of 52 ADPKD patients [mean (SD) age 38.2 (12.8) years, 69.2 % were females] with preserved renal function and 25 healthy volunteers [mean (SD) age 35.5 (6.5) years, 48.0 % were females] were included. Data on patient characteristics, blood biochemistry, inflammatory markers [PTX3 (pg/mL), CRP (mg/dL) and NLR] and arterial stiffness [large artery elasticity index (LAEI) (mL/mmHg × 10) and small artery elasticity index (SAEI) (mL/mmHg × 100)] were recorded in patient and control groups. Correlation between inflammatory markers and arterial stiffness parameters was analysed in patients. Overall, 42.3 % of ADPKD patients were hypertensive and 44.4 % were receiving renin-angiotensin-aldosterone system (RAAS) blockade therapy. Median levels for PTX3 [442.0 (20.0-4140.0) pg/mL vs. 220.5 (14.7-393.0) pg/mL, p < 0.001] and SAEI [4.90 (1.60-11.80) mL/mmHg × 100 vs. 6.45 (2.80-15.70) mL/mmHg × 10, p = 0.013] were significantly higher in ADPKD patients than in controls. PTX3 and CRP were not correlated with arterial elasticity, while NLR was significantly correlated with LAEI negatively (Rho = -0.278, p = 0.042). In conclusion, our findings revealed increased PTX3 levels and reduced SAEI in patients as compared with controls, while no correlation between inflammatory markers studied and the small artery elasticity.

Acute Effects of a Combination of Vibration and Blood Flow Restriction on Arterial Stiffness

PURPOSE: The goal of the study was to investigate the effect of dynamic lower body vibration exercise with BFR on arterial elasticity and hemodynamic variables. METHODS: Nine male subjects (age= 22±2.9) performed dynamic squat exercise on a vibration platform set at 30 Hz with and without BFR. During BFR sessions, BFR cuffs were inflated to a pressure determined by multiplying the arm systolic blood pressure by 1.44. Exercises consisted of ten 1-min sets of squat exercise with one min rest between sets. Heart rate and ratings of perceived exertion (RPE) were measured after each set during exercise and arterial elasticity and hemodynamic variables were assessed by non-invasive methods using the radial artery tonometer before, at 10 min, 20 min, and 40 min post-exercise. RESULTS: There were condition (p<0.05) and time (p<0.01) main effects for cardiac ejection time; time main effects for stroke volume (p<0.01) and cardiac output (p=0.03); condition*time interaction (p<0.01) for small arterial elasticity following exercise. There were also significant time main effects for heart rate during and following exercise (p<0.01) and condition (p<0.02) and time (p<0.01) main effects for RPE. However, there were no condition*time interaction and main effects for systolic and diastolic blood pressure, pulse pressure, large arterial elasticity, total vascular resistance, and vascular impedance. CONCLUSION: Combining dynamic vibration exercise with BFR changed the pattern and the level of changes in small arterial elasticity. Even though the changes in several hemodynamic variables with BFR did not reach the level of significance, subjective measure of exercise intensity was greater during BFR session. Future studies should investigate acute and chronic effects of different duration and intensity of BFR exercises with vibration.

Abstract 622: Inflammation and Arterial Compliance: A Paradox? The Bogalusa Heart Study

Introduction: Systemic inflammation -as measured by high-sensitivity C-reactive protein (hs-CRP)- is adversely associated with arterial compliance. However, information is scant on whether this association in consistent throughout the different non-invasive measurements of arterial compliance. Hypothesis: We assessed the hypothesis that divergences exist in the association between hs-CRP and measurements of arterial compliance, and that this association differs among race (white/black) groups in relatively young adults. Methods: Measurements of hsCRP and non-invasive arterial compliance --large-artery elasticity index (C1), small-artery elasticity index (C2), brachial-ankle pulse-wave velocity (ba-PWV) and augmentation index (AI@75)-- were assessed in 702 non-institutionalized participants with a mean age of 43.5 years (29.4-51.1 years); 70.8% whites and 43.7% males, as a part of the Bogalusa Heart Study. Race-specific independent associations were tested through multivariable-adjusted linear regression analyses. Results: Black vs white participants had higher hs-CRP, baPWV and AI@75 (p&lt;0.01); whereas C1 and C2 were higher in whites (p&lt;0.01). In multivariable-adjusted linear regression analyses, controlling for: age, sex, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), body mass index (BMI), smoking status and other traditional cardiovascular risk factors, hs-CRP was significantly and independently associated with AI@75 (β=0.11, p&lt;0.01) and C1 (β=-0.08, p=0.04), in whites only. In contrast, black participants did not show any significant associations among these parameters. C2 and baPWV did not exhibit association with either race group. Conclusion: In conclusion, these findings help enhance the concept that the association of inflammation and arterial compliance is seemingly relative, as it is dependent on the measurement used to assess the latter; with its impact varying by race (black-white). Further, these observations may aid in revising existing methodologies used in the diagnosis of inflammation-mediated structural and functional damage, in addition to enhance race-specific approaches for screening and prevention of cardio-metabolic risk factors.

Impact of the Dash Diet on Endothelial Function, Exercise Capacity, and Quality of Life in Patients with Heart Failure

Endothelial dysfunction has been recognized as a pathophysiologic mechanism in the progression of heart failure (HF). However, little attention has been given to the ability of dietary approaches to improve endothelial function. This study examined the effects of the Dietary Approaches to Stop Hypertension (DASH) diet on endothelial function, exercise capacity, and quality of life in patients with chronic symptomatic (stage C) HF. Forty-eight patients were randomized to follow the DASH diet (n = 24) or the general HF dietary recommendations (n = 24). Endothelial function was assessed by measuring large and small arterial elasticity (LAE and SAE) at rest. Exercise capacity (measured with the 6-minute walk test) and quality of life (measured with the Minnesota Living with Heart Failure Questionnaire) at baseline and 3 months were also evaluated. Patients were older adults with an average HF duration of 5 years. LAE at 1 month improved significantly in the DASH diet group (P < 0.01). Overall LAE and SAE scores at 3 months also improved; however, the net changes were not statistically significant. The DASH group had better exercise capacity (292 m vs 197 m; P = 0.018) and quality of life scores (21 vs 39; P = 0.006) over time, while sodium intake levels at 1, 2, and 3 months were comparable between the groups. Adhering to the DASH diet improved arterial compliance initially and improved exercise capacity and quality of life scores at 3 months. The DASH diet may be an important adjunctive therapy for patients with symptomatic H F.

Cranberries Modulate Postprandial Metabolism in Obese Participants with Type 2 Diabetes

BackgroundCranberries have been shown to lower risks of type 2 diabetes, and improve features of the metabolic syndrome, and lower postprandial glucose in a few clinical studies. Purpose: We investigated the postprandial effects of dried cranberries vs. control (bananas) in obese participants with type 2 diabetes (T2DM), in a randomized crossover trial. Methods: Blood draws and vascular measurements were conducted at fasting, 1, 2, 3 and 4 hours (h), following consumption of a fast‐food style high‐fat breakfast (50g fat, 766 kcal). Results: Analyses of our study data (n=25; BMI (kg/m2) (mean±SD) =39.5±6.5; Age (years) =56±6) revealed that postprandial changes in HDL‐cholesterol tended to be lower in the cranberry vs. control up to 4h (p&lt;0.1), while postprandial changes in glucose were significantly lower in the cranberry vs. control at 1 &amp; 2h (p&lt;0.05). Among vascular parameters, no significant differences were noted in mean arterial blood pressure and systolic and diastolic blood pressure, as well as in small and large artery elasticity indices.ConclusionsOverall, cranberries were shown to exert modest but notable effects in high‐fat breakfast induced postprandial glucose and lipid levels in participants with T2DM. These findings define the role of whole cranberries in postprandial blood glucose management and need further investigation.

Adiponectin may be a biomarker of early atherosclerosis of smokers and decreased by nicotine through KATP channel in adipocytes

ObjectivePlasm adiponectin is decreased in smokers. Adiponectin is emerging as a potential key molecular marker in atherosclerosis and other cardiovascular diseases. The aim of this study was to investigate the association between serum adiponectin levels and early atherosclerosis in smokers. Furthermore, the role of the KATP channel in the down-regulation of adiponectin by smoking was preliminarily explored. MethodsWe consecutively enrolled 96 men, including 50 smokers with atherosclerosis and 46 nonsmokers. Serum adiponectin was detected with enzyme-linked immunosorbent assay - in all participants. Large (C1) and small (C2) artery elasticity indices and carotid intima-media thickness (IMT) were measured as evaluation indexes of early atherosclerosis in smokers. Finally, the effect of nicotine via ATP-dependent potassium (KATP) channels on adiponectin secretion by 3T3-L1 preadipocytes was examined in vitro. ResultsAdiponectin levels of smokers were statistically negatively correlated to IMT (r = −.440; P < 0.001) and positively correlated to C1 (r = 0.448; P < 0.001) as well as C2 (r = 0.426; P = 0.002). In 3-T3-L1 preadipocytes, nicotine treatment significantly decreased adiponectin levels (P = 0.003), whereas the adiponectin level was rescued by the inhibition of KATP channel (P < 0.001). ConclusionSerum adiponectin level was an independent predictor of early atherosclerosis in smokers. Nicotine might decrease adiponectin in part through altering KATP channels in adipocytes.

Assessment of arterial elasticity among HIV-positive participants with high CD4 cell counts: a substudy of the INSIGHT Strategic Timing of AntiRetroviral Treatment (START) trial.

Both HIV infection and antiretroviral therapy (ART) may increase cardiovascular disease (CVD) risk. Assessments of vascular function and structure can be used to study the pathogenesis and progression of CVD, including the effects of ART and other interventions. The objective of this report is to understand methods to assess vascular (dys)function and report our experience in the Arterial Elasticity Substudy in the Strategic Timing of AntiRetroviral Treatment (START) trial. We review literature and analyze baseline data from the Arterial Elasticity Substudy, which estimated vascular (dys)function through analysis of the diastolic blood pressure (BP) waveform. Linear regression was used to study cross-sectional associations between baseline clinical factors and small or large arterial elasticity. Arterial elasticity measurement was chosen for its improved measurement reproducibility over other methodologies and the potential of small arterial elasticity to predict clinical risk. Analysis of baseline data demonstrates that small artery elasticity is impaired (lower) with older age and differs by race and between geographical regions. No HIV-specific factors studied remained significantly associated with arterial elasticity in multivariate models. Longitudinal analyses in this substudy will provide essential randomized data with which to study the effects of early ART initiation on the progression of vascular disease among a diverse global population. When combined with future biomarker analyses and clinical outcomes in START, these findings will expand our understanding of the pathogenesis of HIV-related CVD.

Arterial wall function is associated with cognitive performance primarily in elderly with type 2 diabetes.

Regression analyses compared 41 type 2 diabetes (T2D) and 131 non-T2D cognitively normal elderly males on the associations of arterial wall function measures [large artery elasticity index (LAEI), small artery elasticity index (SAEI), systemic vascular resistance (SVR), and total vascular impedance (TVI)] with cognitive performance (memory, language, and executive functions), controlling for socio-demographic and cardiovascular factors. Higher LAEI and lower TVI were significantly associated with better executive functions performance in T2D but not in non-T2D subjects. Lower TVI was more associated with better language performance in T2D. Results suggest that arterial wall function is associated with cognition in T2D.

Does reduction of disease activity improve early markers of cardiovascular disease in newly diagnosed rheumatoid arthritis patients?

The incidence of cardiovascular disease (CVD) is increased in RA. This study was designed to evaluate whether a reduction in disease activity influences early markers of CVD. In a prospective longitudinal study, 58 newly diagnosed RA patients and 58 age- and sex-matched healthy controls (HCs) were included. Endothelial dysfunction was measured by small artery elasticity (SAE) and endothelial cell activation was assessed by measuring soluble vascular cellular activation molecule 1(sVCAM-1) and von Willebrand factor (vWF). Advanced glycation end products (AGEs) were quantified by skin autofluorescence. After 1 year, measurements were repeated in all RA patients. At entry, SAE was decreased in RA vs HCs [median 3.4 ml/mmHg100 (range 1.2-9.0) vs 6.1 (range 5.0-15.3), P < 0.0001] and sVCAM-1 and vWF were increased: 391 ng/ml (range 256-680) vs 341 (range 223-691) (P = 0.0015) and 120 ng/ml (range 26.5-342) vs 99 (range 22-298) (P = 0.02), respectively. SAE was inversely correlated with the 28-joint DAS (DAS28; r = -0.31, P = 0.016). AGEs were increased by 2.55 arbitrary units (range 1.29-4.65) vs 2.12 (range 1.32-3.82) in HCs (P = 0.003). In multivariate analysis, the presence of RA, age and systolic blood pressure were independently and inversely related to SAE. After 1 year, SAE had significantly improved in RA, from 3.4 (range 1.2-9.0) to 3.8 (range 1.5-10.3) (P = 0.03). Endothelial dysfunction is present in newly diagnosed RA patients, independently of traditional risk factors and is inversely correlated with disease activity. By reducing disease activity, endothelial dysfunction improves, although not to normal values. Also, a reduction in disease activity targeting traditional risk factors remains important in preventing CVD in RA.

0108: Large and small artery elasticity in peripheral arterial occlusive disease. Effect of a rehabilitation training program

Objectives In peripheral arterial occlusive disease (PAOD), arterial compliance of central and peripheral arteries has been reported to be reduced. The aim of this prospective study was to determine the effect of a 6-week rehabilitation training program on artery elasticity in 16 patients with PAOD (mean age 61±11 years, 14 men, 2 women). Methods Large (C1) and small artery (C2) elasticity indices were measured using a tonometer of the type HDI/Pulse wave CR-2000. Maximal walking distance (MWD) on the treadmill, ankle brachial index on the limiting leg (ABI), peak oxygen consumption (VO2) and artery elasticity indices were recorded before and after the 6 week. Patients performed a supervised aerobic training intervention five days per week. Results After the 6 week, exercise rehabilitation increased significantly: MWD (684±578 versus 247±232 m- p Conclusion Our study shows that a 6-week exercise-training program improves significantly small artery elasticity in patients with PAOD.