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Cintra RMR, Soares AAS, Breder I, Munhoz DB, Barreto J, Kimura-Medorima ST, Cavalcante P, Zanchetta R, Breder JC, Moreira C, Virginio VW, Bonilha I, Lima-Junior JC, Coelho-Filho OR, Wolf VLW, Guerra-Junior G, Oliveira DC, Haeitmann R, Fernandes VHR, Nadruz W, Chaves FRP, Arieta CEL, Quinaglia T, Sposito AC. Assessment of dapagliflozin effect on diabetic endothelial dysfunction of brachial artery (ADDENDA-BHS2 trial): rationale, design, and baseline characteristics of a randomized controlled trial. Diabetol Metab Syndr 2019; 11:62. [PMID: 31384310 PMCID: PMC6668143 DOI: 10.1186/s13098-019-0457-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 07/22/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Endothelial dysfunction (ED) is a hallmark in type 2 diabetes mellitus (T2DM) that favor both atherogenesis and ischemia and reperfusion injury (IRI). Sodium-glucose-2 co-transporter inhibitors (SGLT2i) may hypothetically improve microvascular and macrovascular functions via a broad spectrum of mechanisms, being superior to traditional antidiabetic therapy such as sulfonylurea, even in subjects under equivalent glycemic control. Hence, the present clinical trial was designed to compare the effect of these two treatments on markers of arterial wall function and inflammation in T2DM patients as well as on the potential mediating parameters. METHOD AND RESULTS ADDENDA-BHS2 is a prospective, single-center, active-controlled, open, randomized trial. Ninety-eight participants (40-70 years old) with HbA1c 7-9% were randomized (1:1, stratified by gender, BMI and HbA1c levels) to either dapagliflozin 10 mg/day or glibenclamide 5 mg/day on top of metformin. The primary endpoint was the change of flow-mediated dilation (FMD) after a 12-week period of treatment evaluated at rest and after IRI between dapagliflozin and glibenclamide arms. Secondary outcomes were defined as the difference between treatments regarding: plasma nitric oxide (NO) change after FMD, plasma isoprostane, plasma levels of vascular inflammatory markers and systemic inflammatory markers, plasma levels of adipokines, anthropometric measures, glucose control parameters, office and ambulatory BP control. Safety endpoints were defined as systolic and diastolic function assessed by echocardiography and retinopathy change. Serious adverse events were recorded. The study protocol was approved by the Independent Scientific Advisory Committee. CONCLUSION The ADDENDA-BHS2 trial is an investigator-initiated clinical trial comparing the effect of dapagliflozin versus glibenclamide on several aspects of vascular function in high cardiovascular risk T2DM patients. Besides, a large clinical and biochemical phenotype assessment will be obtained for exploring potential mediations and associations.Trial registration Clinical trial registration: NCT02919345 (September, 2016).
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Affiliation(s)
- Riobaldo M. R. Cintra
- Cardiology Division, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo 13084-971 Brazil
| | - Alexandre A. S. Soares
- Cardiology Division, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo 13084-971 Brazil
| | - Ikaro Breder
- Cardiology Division, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo 13084-971 Brazil
| | - Daniel B. Munhoz
- Cardiology Division, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo 13084-971 Brazil
| | - Joaquim Barreto
- Cardiology Division, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo 13084-971 Brazil
| | - Sheila T. Kimura-Medorima
- Cardiology Division, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo 13084-971 Brazil
| | - Pamela Cavalcante
- Cardiology Division, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo 13084-971 Brazil
| | - Renata Zanchetta
- Cardiology Division, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo 13084-971 Brazil
| | - Jessica Cunha Breder
- Cardiology Division, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo 13084-971 Brazil
| | - Camila Moreira
- Cardiology Division, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo 13084-971 Brazil
| | - Vitor W. Virginio
- Cardiology Division, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo 13084-971 Brazil
| | - Isabella Bonilha
- Cardiology Division, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo 13084-971 Brazil
| | - Jose Carlos Lima-Junior
- Cardiology Division, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo 13084-971 Brazil
| | - Otavio R. Coelho-Filho
- Cardiology Division, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo 13084-971 Brazil
| | - Vaneza L. W. Wolf
- Cardiology Division, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo 13084-971 Brazil
| | - Gil Guerra-Junior
- Growth and Body Composition Lab, Center for Investigation in Pediatrics, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo Brazil
| | - Daniela C. Oliveira
- Cardiology Division, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo 13084-971 Brazil
| | - Rodrigo Haeitmann
- Cardiology Division, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo 13084-971 Brazil
| | - Vicente H. R. Fernandes
- Growth and Body Composition Lab, Center for Investigation in Pediatrics, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo Brazil
| | - Wilson Nadruz
- Cardiology Division, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo 13084-971 Brazil
| | - Fernando R. P. Chaves
- Department of Ophthalmology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo Brazil
| | - Carlos E. L. Arieta
- Department of Ophthalmology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo Brazil
| | - Thiago Quinaglia
- Cardiology Division, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo 13084-971 Brazil
| | - Andrei C. Sposito
- Cardiology Division, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo 13084-971 Brazil
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Carter SE, Draijer R, Holder SM, Brown L, Thijssen DHJ, Hopkins ND. Regular walking breaks prevent the decline in cerebral blood flow associated with prolonged sitting. J Appl Physiol (1985) 2018; 125:790-798. [DOI: 10.1152/japplphysiol.00310.2018] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Decreased cerebrovascular blood flow and function are associated with lower cognitive functioning and increased risk of neurodegenerative diseases. Prolonged sitting impairs peripheral blood flow and function, but its effects on the cerebrovasculature are unknown. This study explored the effect of uninterrupted sitting and breaking up sitting time on cerebrovascular blood flow and function of healthy desk workers. Fifteen participants (10 male, 35.8 ± 10.2 yr, body mass index: 25.5 ± 3.2 kg/m2) completed, on separate days, three 4-h conditions in a randomized order: 1) uninterrupted sitting (SIT), 2) sitting with 2-min light-intensity walking breaks every 30 min (2WALK), or 3) sitting with 8-min light-intensity walking breaks every 2 h (8WALK). At baseline and 4 h, middle cerebral artery blood flow velocity (MCAv) and CO2 reactivity (CVR) of the MCA and carotid artery were measured using transcranial Doppler (TCD) and duplex ultrasound, respectively. Cerebral autoregulation (CA) was assessed with TCD using a squat-stand protocol and analyzed to generate values of gain and phase in the very low, low, and high frequencies. There was a significant decline in SIT MCAv (−3.2 ± 1.2 cm/s) compared with 2WALK (0.6 ± 1.5 cm/s, P = 0.02) but not between SIT and 8WALK (−1.2 ± 1.0 cm/s, P = 0.14). For CA, the change in 2WALK very low frequency phase (4.47 ± 4.07 degrees) was significantly greater than SIT (−3.38 ± 2.82 degrees, P = 0.02). There was no significant change in MCA or carotid artery CVR ( P > 0.05). Results indicate that prolonged uninterrupted sitting in healthy desk workers reduces cerebral blood flow; however, this is offset when frequent short-duration walking breaks are incorporated. NEW & NOTEWORTHY Prolonged uninterrupted sitting in healthy desk workers reduces cerebral blood flow. However, this reduction in cerebral blood flow is offset when frequent short-duration walking breaks are incorporated into this sitting period. For those who engage in long periods of sedentary behavior, chronically breaking up these sitting periods with frequent active break strategies may have important implications for cerebrovascular health; however, further research should explore this hypothesis.
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Affiliation(s)
- Sophie E. Carter
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Richard Draijer
- Unilever Research and Development, Vlaardingen, The Netherlands
| | - Sophie M. Holder
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Louise Brown
- Unilever Research and Development, Colworth Science Park, Bedfordshire, United Kingdom
| | - Dick H. J. Thijssen
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nicola D. Hopkins
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
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Pigłowska M, Kostka T, Drygas W, Jegier A, Leszczyńska J, Bill-Bielecka M, Kwaśniewska M. Body composition, nutritional status, and endothelial function in physically active men without metabolic syndrome--a 25 year cohort study. Lipids Health Dis 2016; 15:84. [PMID: 27117476 PMCID: PMC4847354 DOI: 10.1186/s12944-016-0249-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 04/14/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The purpose of this analysis was to investigate the relationship between body composition, metabolic parameters and endothelial function among physically active healthy middle-aged and older men. METHODS Out of 101 asymptomatic men prospectively tracked for traditional cardiovascular risk factors (mean observation period 25.1 years), 55 metabolically healthy individuals who maintained stable leisure time physical activity (LTPA) level throughout the observation and agreed to participate in the body composition assessment were recruited (mean age 60.3 ± 9.9 years). Body composition and raw bioelectrical parameters were measured with bioelectrical impedance analysis (BIA). Microvascular endothelial function was evaluated by means of the reactive hyperemia index (RHI) using Endo-PAT2000 system. RESULTS Strong correlations were observed between lifetime physical activity (PA), aerobic fitness and most of analyzed body composition parameters. The strongest inverse correlation was found for fat mass (p < 0.01) while positive relationship for fat-free mass (p < 0.01), total body water (p < 0.05 for current aerobic capacity and p < 0.01 for historical PA), body cell mass (p < 0.001), muscle mass (p < 0.001), calcium and potassium (p < 0.01 and p < 0.001 for current aerobic capacity and p < 0.001 and p < 0.01 for historical PA, respectively) and glycogen mass (p < 0.001). Among metabolic parameters, HDL cholesterol (HDL-C) and uric acid were significantly associated with most body composition indicators. Regarding endothelial function, a negative correlation was found for RHI and body mass (p < 0.05) while positive relationship for RHI and body cell mass (p < 0.05), calcium (p < 0.05) and potassium mass (p < 0.05). Impaired endothelial function was observed among 8 subjects. Among bioelectrical parameters, impedance (Z) and resistance (R) normalized for subjects' height were negatively related with body mass, body mass index (BMI) and waist circumference (p < 0.001); while reactance (Xc) normalized for patients' height was negatively related with body mass (p < 0.05). The mean phase angle value was relatively high (8.83 ± 1.22) what reflects a good level of cellularity and cell function. Phase angle was positively related with body mass and BMI (p < 0.05). CONCLUSIONS Both fat mass and muscle mass components are important predictors of metabolic profile. Maintaining regular high PA level and metabolically healthy status through young and middle adulthood may have beneficial influence on body composition parameters and may prevent age-related decrease of fat-free mass and endothelial dysfunction.
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Affiliation(s)
| | - Tomasz Kostka
- Department of Geriatrics, Medical University of Lodz, Lodz, Poland
| | - Wojciech Drygas
- Department of Preventive Medicine, Medical University of Lodz, Zeligowskiego 7/9, 90-752, Lodz, Poland
- Department of Epidemiology, Cardiovascular Disease Prevention and Health Promotion, Institute of Cardiology, Warsaw, Poland
| | - Anna Jegier
- Department of Sports Medicine, Medical University of Lodz, 92-213, Lodz, Poland
| | - Joanna Leszczyńska
- Department of Sports Medicine, Medical University of Lodz, 92-213, Lodz, Poland
| | | | - Magdalena Kwaśniewska
- Department of Preventive Medicine, Medical University of Lodz, Zeligowskiego 7/9, 90-752, Lodz, Poland.
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Kontos A, van den Heuvel C, Pamula Y, Martin J, Lushington K, Baumert M, Willoughby S, Gent R, Couper J, Kennedy D. Delayed brachial artery dilation response and increased resting blood flow velocity in young children with mild sleep-disordered breathing. Sleep Med 2015; 16:1451-6. [DOI: 10.1016/j.sleep.2015.08.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 08/04/2015] [Accepted: 08/07/2015] [Indexed: 11/30/2022]
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Hopkins ND, Dengel DR, Stratton G, Kelly AS, Steinberger J, Zavala H, Marlatt K, Perry D, Naylor LH, Green DJ. Age and sex relationship with flow-mediated dilation in healthy children and adolescents. J Appl Physiol (1985) 2015; 119:926-33. [PMID: 26251515 DOI: 10.1152/japplphysiol.01113.2014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 07/28/2015] [Indexed: 11/22/2022] Open
Abstract
Flow-mediated dilation (FMD) is a noninvasive technique used to measure conduit artery vascular function. Limited information is available on normative FMD values in healthy children and adolescents. The objective of this study was to assess relationships between age and sex with FMD across childhood and adolescence. Nine hundred and seventy-eight asymptomatic children (12 ± 3 yr, range 6-18 yr, 530 male) underwent ultrasonic brachial artery assessment before and after 5 min of forearm ischemia. Sex differences in FMD and baseline artery diameter were assessed using mixed linear models. Baseline artery diameter was smaller in females than males [2.96 mm (95% CI: 2.92-3.00) vs. 3.24 mm (3.19-3.28), P < 0.001] and increased with age across the cohort (P < 0.001). Diameter increased between ages 6 and 17 yr in males [from 2.81 mm (2.63, 3.00) to 3.91 mm (3.68, 4.14)] but plateaued at age 12 yr in females. Males had a lower FMD [7.62% (7.33-7.91) vs. 8.31% (7.95-8.66), P = 0.024], specifically at ages 17 and 18 yr. There was a significant effect of age on FMD (P = 0.023), with a reduction in FMD apparent postpuberty in males. In conclusion, the brachial artery increases structurally with age in both sexes; however, there are sex differences in the timing and rate of growth, in line with typical sex-specific adolescent growth patterns. Males have a lower FMD than females, and FMD appears to decline with age; however, these findings are driven by reductions in FMD as males near maturity. The use of age- and sex-specific FMD data may therefore not be pertinent in childhood and adolescence.
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Affiliation(s)
- Nicola D Hopkins
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, United Kingdom;
| | - Donald R Dengel
- School of Kinesiology, University of Minnesota, Minneapolis, Minnesota; Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Gareth Stratton
- Applied Sports Technology Exercise and Medicine Research Centre, Swansea University, Swansea, United Kingdom
| | - Aaron S Kelly
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota; Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Julia Steinberger
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Hanan Zavala
- School of Kinesiology, University of Minnesota, Minneapolis, Minnesota
| | - Kara Marlatt
- School of Kinesiology, University of Minnesota, Minneapolis, Minnesota
| | - Daniel Perry
- Institute of Child Health, University of Liverpool, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom; and
| | - Louise H Naylor
- School of Sports Science, Exercise and Health, The University of Western Australia, Crawley, Australia
| | - Daniel J Green
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, United Kingdom; School of Sports Science, Exercise and Health, The University of Western Australia, Crawley, Australia
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Moesgaard S, Klostergaard C, Zois N, Teerlink T, Molin M, Falk T, Rasmussen C, Luis Fuentes V, Jones I, Olsen L. Flow-Mediated Vasodilation Measurements in Cavalier King Charles Spaniels with Increasing Severity of Myxomatous Mitral Valve Disease. J Vet Intern Med 2011; 26:61-8. [DOI: 10.1111/j.1939-1676.2011.00846.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 09/26/2011] [Accepted: 10/28/2011] [Indexed: 11/29/2022] Open
Affiliation(s)
| | | | - N.E. Zois
- Department of Basic Animal and Veterinary Sciences
| | - T. Teerlink
- Department of Clinical Chemistry (Teerlink); VU University Medical Center, Amsterdam; The Netherlands
| | - M. Molin
- Department of Basic Animal and Veterinary Sciences
| | - T. Falk
- Department of Basic Animal and Veterinary Sciences
| | | | - V. Luis Fuentes
- Department of Veterinary Clinical Sciences (Jones, Luis Fuentes); Royal Veterinary College, Hatfield, Hertfordshire; England
| | - I.D. Jones
- Department of Veterinary Clinical Sciences (Jones, Luis Fuentes); Royal Veterinary College, Hatfield, Hertfordshire; England
| | - L.H. Olsen
- Department of Veterinary Disease Biology (Olsen); The Faculty of Life Sciences; University of Copenhagen, Frederiksberg; Denmark
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