Structural Changes In Large Arteries Research Articles

MP43-16 CAROTID ATHEROSCLEROSIS EXPRESSED BY INCREASED INTIMA MEDIA THICKNESS IS ASSOCIATED WITH LOW ADHERENCE TO MEDITERRANEAN DIET IN ERECTILE DYSFUNCTION PATIENTS

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Basic Research I1 Apr 2014MP43-16 CAROTID ATHEROSCLEROSIS EXPRESSED BY INCREASED INTIMA MEDIA THICKNESS IS ASSOCIATED WITH LOW ADHERENCE TO MEDITERRANEAN DIET IN ERECTILE DYSFUNCTION PATIENTS A. Rempelakos, Ch Vlachopoulos, K. Makarounis, N. Ioakimidis, A. Katevatis, A. Aggelis, D. Karagiannis, and Ch Fasoulakis A. RempelakosA. Rempelakos More articles by this author , Ch VlachopoulosCh Vlachopoulos More articles by this author , K. MakarounisK. Makarounis More articles by this author , N. IoakimidisN. Ioakimidis More articles by this author , A. KatevatisA. Katevatis More articles by this author , A. AggelisA. Aggelis More articles by this author , D. KaragiannisD. Karagiannis More articles by this author , and Ch FasoulakisCh Fasoulakis More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1173AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives The Mediterranean type of diet, rich in fruits, legumes, vegetables and nuts, is a healthy dietary pattern, gaining widely recognition as a non-pharmaceutical mean for cardiovascular disease prevention due to its antioxidant components and anti-inflammatory properties. Endothelial dysfunction and subclinical inflammation are important pathophysiologic mechanisms underlying both vasculogenic erectile dysfunction (ED) and atherosclerosis in other vascular beds. Increased carotid IMT (>0,9mm) relates to traditional risk factors and associates with an unfavorable cardiovascular outcome. Purpose of our study is to investigate the association of Mediterranean type of diet with structural changes in large arteries in ED patients, a relation which has not been defined yet. Methods Forty-five ED patients (aged 56±11 years) underwent carotid ultrasound for evaluation of intima medial thickness (IMT) in the common carotid artery. Overall assessment of dietary habits was evaluated through a special diet score (the Med-DietScore, theoretical range 0–55), which assesses adherence to the Mediterranean dietary pattern. Higher values on the score indicate greater adherence to this pattern and, consequently, healthier dietary habits. Results Med-diet score was significantly associated with age (r=-0.215, P<0.05) systolic and pulse pressure (r=-0.198 and r=-0.277, respectively, all P<0.05). In univariate analysis Med-DietScorewas inversely associated with carotid IMT (r=-0.43, P<0.001, figure). In order to further evaluate the impact of Mediterranean diet on carotid wall thickness, multiple linear regression analysis was applied, which revealed that MedDiet Score was inversely associated with IMT after adjustment for history and treatment of hypertension, hypercholesterolemia, diabetes mellitus, as well as use of statinsand smoking (b = -0.305, p<0.01). Patients with a mean IMT >0.9 mmhad significantly lower Med-Diet Score as compared to subjects with lower IMT values (27±4 vs 33±5, P<0.05). Conclusions The inverse association between Med-Diet Score and carotid IMT indicates an unhealthy dietary life style in ED patients that contributes to an adverse cardiovascular profile and may help in preventing further vascular damage by adapting healthier dietary habits. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e484 Advertisement Copyright & Permissions© 2014MetricsAuthor Information A. Rempelakos More articles by this author Ch Vlachopoulos More articles by this author K. Makarounis More articles by this author N. Ioakimidis More articles by this author A. Katevatis More articles by this author A. Aggelis More articles by this author D. Karagiannis More articles by this author Ch Fasoulakis More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Comprehensive Noninvasive Arterial Vascular Evaluation

Noninvasive evaluation of the health of the vasculature is an increasingly important approach to identifying individuals at risk for cardiovascular morbid events. Vascular health assessment involves functional and structural examination of the large and small arteries. Endothelial dysfunction, which alters small artery function, is a key contributor to progressive structural vascular changes. Ultrasonography of conduit arteries and aortic pulse-wave velocity provide information limited to structural changes in large arteries. Comprehensive assessment of the large and small arteries is best carried out by pulse-contour analysis. This can provide insight into functional and structural abnormalities in the small as well as the large arteries, and may be useful in monitoring response to therapy.

Role of Angiotensin II Type 1 Receptor Antagonists in the Treatment of Hypertension in Patients Aged ≥65 Years

Systolic blood pressure (SBP) increases with age, and hypertension affects approximately two-thirds of adults in the US aged >60 years. Blood pressure (BP) increases as a consequence of age-related structural changes in large arteries, which lead to loss of elasticity and reduced vascular compliance. Increased pulse wave velocity augments SBP, resulting in a high prevalence of isolated systolic hypertension. Because age itself elevates cardiovascular risk, effective treatment of hypertension in an older (aged >or=65 years) patient population prevents many more events per 1000 patients treated than treatment of younger hypertensive patients. Recommendations for treating hypertension are similar in older patients compared with the general population. The Seventh Report of the Joint National Committee on Detection, Prevention, Evaluation, and Treatment of High Blood Pressure recommends target BP goals of <140/90 mmHg for patients with uncomplicated hypertension, and <130/80 mmHg for those with diabetes mellitus or renal disease. Recent guidelines and position papers have extended these aggressive treatment goals to include patients with coronary artery disease, other types of vascular disease and heart failure. Randomized clinical trials have demonstrated the efficacy of calcium channel antagonists (calcium channel blockers [CCBs]), low-dose diuretics, ACE inhibitors and angiotensin II type 1 receptor antagonists (angiotensin receptor blockers [ARBs]) in reducing the risk of stroke and other adverse cardiovascular outcomes in older patients; beta-adrenoceptor antagonists are less effective in terms of endpoint reduction. The majority of older patients require two or more drugs to achieve BP goals. Despite active treatment, half of these patients do not achieve target BP, in part because of the reluctance of physicians to intensify treatment, a phenomenon referred to as 'clinical inertia'. ARBs are effective antihypertensive agents in older patients and have been shown to reduce cardiovascular endpoints in patients with hypertension, diabetic nephropathy, cerebrovascular disease and heart failure. ARBs produce additive BP reduction when combined with diuretics or CCBs. They also have the advantage of placebo-like tolerability, and this contributes favourably to patient compliance with long-term treatment, which is a prerequisite for reducing morbidity and mortality.

The indexes of arterial structure and function in women with simple obesity: a preliminary study

Obesity is associated with an increased risk of cardiovascular disorders. The aim of the present study was to compare the indexes of arterial structure and function in women with simple obesity and healthy individuals. Twenty-two women with simple obesity (body mass index [BMI]: 33.6 +/- 2.9 kg/m(2), age: 29.7 +/- 6.2 years), and 34 healthy women were included in the study. Healthy subjects were divided into two subgroups according to their age (<35 and >45 years): Control A-16 young women (age <35 years, BMI: 24.0 +/- 3.0 kg/m(2)), and Control B-18 older women (age >45 years, BMI: 25.8 +/- 2.9 kg/m(2)). Noninvasive, high-resolution, vascular ultrasound was used to evaluate the endothelial-dependent vasodilatation: flow-mediated dilatation of brachial artery (FMD); the arterial structure: intima-media thickness (IMT) of common carotid artery (CCA); and the compliance parameters corresponding to structural changes in large arteries (PWV: pulse wave velocity; PP: pulse pressure; TAC: total arterial compliance; Ao C: aorta compliance, CCA C: CCA compliance, stiffness indexes). Endothelial-dependent vasodilatation as represented by FMD was comparable in the obese group (16.8% +/- 7.9%; median: 15.5%) and healthy subjects (Control A: 14.1% +/- 4.7%; median: 13.6%; Control B: 13.9% +/- 6.5%; median: 13.0%). The mean value of IMT was significantly increased (P < 0.05) in Control B group (0.67 +/- 0.07 mm) in comparison to both obese patients (0.58 +/- 0.09 mm) and Control A group (0.53 +/- 0.05 mm). The compliance parameters (PWV, AoC, CCA C, stiffness indexes) were impaired in obese patients and Control B patients as compared to Control A individuals. PWV and stiffness indexes were significantly increased, and the AoC, CCA C-diameter, CCA C-area were significantly decreased. Simple obesity constitutes an important risk factor accelerating arterial stiffness in women.

Carotid intima–media thickness in children and young adults with renal transplant: Internal carotid artery vs. common carotid artery

Cardiovascular diseases are the main causes of morbidity and mortality following renal transplantation. Atherosclerotic structural changes, which can be detected by high-resolution B-mode ultrasonography, begin before clinical findings. However, little is known about the extent of these abnormalities in children after renal transplantation. We aimed to determine early structural changes of large arteries in renal transplant recipients without cardiovascular disease and to evaluate the role of clinical and laboratory features on IMT of carotid arteries. IMT and hemoglobin, serum levels of creatinine, acute phase proteins, lipid profile, and homocysteine were examined in 24 asymptomatic renal transplant recipients (median age 16.5 yr; range 8-25), and 20 healthy controls (median age 16 yr; range 9-24). CCA and ICA were evaluated in patients and controls with a high-resolution B-mode ultrasonography in multiple projections to optimize detection of carotid IMT. Measurement of IMT of both CCA [0.36 mm (range 0.16-0.48) vs. 0.28 mm (range 0.21-0.35), p < 0.001] and ICA [0.27 mm (range 0.16-0.48) vs. 0.22 mm (range 0.1-0.26), p < 0.001] were significantly higher in renal recipients than in healthy controls. Among several parameters assessed, only significant correlations were found between duration of CRF, duration of dialysis prior to transplantation and ICA-IMT (p = 0.06 and p = 0.02, respectively) and between mean past serum calcium-phosphorus ion product and CCA-IMT (p = 0.002). In conclusion, our observations indicate that vascular changes begin early in the course of CRF and are directly related to time on CRF and dialysis. These changes can be detected by measuring CCA/ICA-IMT ultrasonographically. We suggest that early renal transplantation can potentially avoid long-term cardiovascular events in children with end stage kidney disease.

Studies on structural changes of the carotid arteries and the heart in asymptomatic renal transplant recipients

The present study was designed to characterize early structural changes of large arteries in renal transplant recipients with no clinical evidence of cardiovascular disease and normal blood pressure values, and to analyse the relationship between arterial alterations and those of the heart. Intima media thickness and atherosclerotic plaques of the carotid arteries as well as left ventricular geometry and function were examined in 35 asymtomatic renal transplant recipients and 29 age- and sex-matched healthy controls by high resolution B-mode ultrasound and by echocardiography. Intima-media thickness of the carotid arteries was significantly higher in renal transplant recipients (1.21+/-0.08 mm) than in healthy controls (0.74+/-0.04 mm) (P<0.001). Atherosclerotic plaques were found in the majority of renal transplant recipients (71% vs 14% in healthy controls, P<0.001). Left ventricular mass index was significantly increased in the group of renal transplant recipients (264+/-13 g, 146+/-7 g/m2) when compared with healthy controls (155+/-8 g, 83+/-4 g/m2) (P<0.001). Multiple regression analysis in renal transplant recipients showed that intima media thickness of the carotid arteries was significantly related to left ventricular mass index (P<0.02), but not to age, blood pressure, body mass index, serum creatinine, cholesterol and lipoprotein (a) levels. In the group of healthy controls, intima-media thickness of the carotid artery was related to age (P<0.002), but not to left ventricular mass index or the other independent variables. The present study documents pronounced intima-media thickening in asymptomatic renal transplant recipients. Atherosclerotic lesions are present in most renal transplant recipients with no clinical evidence of cardiovascular disease. We observed a parallelism between arterial wall thickening and left ventricular hypertrophy, although blood pressure levels were normal during haemodialysis therapy and after renal transplantation.

Effect of neonatal sympathectomy on the development of structural vascular changes in angiotensin II-treated rats.

In a previous study, we found that neonatal sympathectomy prevented the development of angiotensin II (ANG II)-induced hypertension but not the development of structural changes in small mesenteric arteries. To investigate further the dissociation between hypertension and structural vascular changes in sympathectomized ANG II-treated rats by extending morphometric measurements to include all segments of the mesenteric arterial tree. Neonatally sympathectomized and sham-sympathectomized male Sprague-Dawley rats, aged 34 months, were administered 200 ng/kg per min ANG II subcutaneously for 4 weeks. Sham-operated sympathectomized and sham-sympathectomized rats were controls. At the end of the treatment period the mesenteric circulation of rats was perfusion-fixed for morphometric measurements. Tail systolic blood pressure in ANG II-treated sham-sympathectomized rats increased by 47 mmHg (P < 0.001); the increase of systolic blood pressure (11 mmHg) in ANG II-treated sympathectomized rats did not attain statistical significance. Sympathectomy alone increased the lumen and reduced the wall : lumen ratio of first- and second-order branches of the superior mesenteric artery (hypotrophic outward remodeling). ANG II treatment increased the dimensions, wall thickness, and wall area of first- and second-order arteries (hypertrophic outward remodeling) and the wall : lumen ratio of small resistance arteries in sham-sympathectomized rats. Neonatal sympathectomy attenuated the development of structural changes in large arteries but had no effect on the development of structural changes in small arteries of ANG II-treated rats. Hypertension and sympathetic innervation appear to be contributing to the development of structural changes in large arteries of ANG II-treated rats because sympathectomy attenuated these changes. Structural changes in small arteries, on the other hand, appear to be due to a direct trophic effect of ANG II.

Structural versus functional modulation of the arterial baroreflex.

Structural changes in large arteries are often considered the predominant mechanism responsible for decreased baroreflex sensitivity and baroreceptor resetting in hypertension, atherosclerosis, and aging. Recent work has demonstrated that "functional" mechanisms, both at the level of the peripheral sensory endings and within the central nervous system, contribute significantly to altered baroreflex responses. We have conducted both reductive studies of mechanoelectrical transduction in cultured baroreceptor neurons and integrative studies with in vivo recordings of the activity of baroreceptor afferent fibers and efferent sympathetic nerves. Results suggest that the primary mechanism of mechanical activation of baroreceptor neurons involves opening of stretch-activated ion channels susceptible to blockade by gadolinium. Baroreceptor nerve activity is modulated by the activity of potassium channels and the sodium-potassium pump and by paracrine factors, including prostacyclin, oxygen free radicals, and factors released from aggregating platelets. Endothelial dysfunction and altered release of these paracrine factors contribute significantly to the decreased baroreceptor sensitivity in hypertension and atherosclerosis. The central mediation of the baroreflex depends on the pulse phasic pattern of afferent baroreceptor discharge. Baroreflex-mediated inhibition of sympathetic nerve activity is well maintained during pulse phasic afferent activity. Continuous, nonphasic baroreceptor discharge or a rapid (> 1.5 Hz) pulse phasic discharge results in disinhibition of sympathetic activity. This disinhibition during continuous baroreceptor input is exaggerated with aging. Thus, a defect in central mediation of the baroreflex may be a major cause of the impaired baroreflex and sympathoexcitation in the elderly. In summary, functional neural mechanisms, in addition to structural vascular changes, contribute importantly to altered baroreflex responses in normal and pathophysiological states.(ABSTRACT TRUNCATED AT 250 WORDS)

Evidence for in vivo carotid and femoral wall thickening in human hypertension. Groupe de Prévention Cardio-vasculaire en Médecine du Travail.

Little is known of the in vivo structural changes of large arteries in uncomplicated hypertension. Therefore, we measured the intima-media thickness and lumen diameter of common carotid and femoral arteries by a computerized ultrasonographic technique in 25 normotensive and 25 never treated hypertensive men of similar age (from 25 to 72 years). The intraobserver variability of carotid and femoral wall thicknesses was 4.3% and 5.6%, respectively. Moreover, an in vitro study of 13 human arterial segments removed at autopsy demonstrated a strong correlation (r = .989, P < .001) between computerized ultrasonic and histological intima-media thickness measurements. Compared with control subjects, hypertensive patients had similar arterial diameters but higher carotid and femoral intima-media thicknesses (P < .001) as well as higher ratios of carotid and femoral intima-media thickness to lumen (P < .001, P < .01). The carotid thickness was correlated with age in control subjects (r = .48, P < .05) but not in hypertensive patients. The femoral thickness was correlated with age both in control subjects (r = .55, P < .01) and in hypertensive patients (r = .46, P < .05). Thus, carotid and femoral arterial walls of hypertensive patients were thickened. This thickening was not due to age, although aging also thickened both vessels in control subjects and the femoral artery only in hypertensive patients. Such a wall thickening associated with a normal diameter provides direct evidence of vascular growth and represents a new target to monitor noninvasively in vivo for large artery changes in human hypertension.

Structural changes of large arteries in sustained essential hypertension.

The physical properties of intact superficial arteries can be studied in humans by using original pulsed Doppler systems. Measurements of the diameter, blood flow velocity, volumic flow, and compliance of the brachial artery can be obtained in hypertensive humans in comparison with controls of the same age. In sustained essential hypertension, arterial compliance is decreased, in a manner that is not related exclusively to age and to the level of blood pressure. On the basis of pharmacological studies, the predominant role of activation of the autonomic nervous system can be excluded. As observed in isolated systolic hypertension and in arteriosclerosis obliterans of the lower limbs, the reduction in arterial compliance is probably due to structural alterations of the arterial wall, which produce a disproportionate increase in systolic pressure. Nitroglycerine is able to reverse both the decreased compliance and the increased systolic pressure. The conclusion follows that adaptive changes of large arteries participate in the structural autoregulation of blood flow in hypertension and lead to a predominant elevation of systolic pressure in older subjects.