Trajectories of Age-Related Arterial Stiffness in Chinese Men and Women

Multi-scale modelling of the effects of ageing, hypertension and exercise on the cerebral vasculature

Ageing and hypertension both have substantial, well-documented effects on the cerebral vasculature. The effects of aerobic exercise on cerebrovascular function and development, although less well understood, have also recently received significantly increased attention. There is now clear evidence that aerobic exercise yields both short- and long-term changes to cerebrovascular health, with significant potential to improve population brain health. However, there has as yet been no mathematical model of this, making it challenging to quantify the effects of aerobic exercise. One reason for this is the very different time scales between exercise (minutes/hours) and cerebrovascular development (years/decades). Here, a new mathematical model is proposed, one that incorporates short-term changes within a longer time scale. The model is calibrated against various experimental data sources and used to quantify the effects of ageing, hypertension, and exercise interventions on lifetime cerebrovascular health. The model predicts that high-intensity exercise has a significant positive effect on cerebral health; that antihypertensive treatment has a significant positive effect even after prolonged periods of hypertension; and that different interventions can strongly interact with each other. This model provides the foundation for future quantitative investigations into the critical role of aerobic exercise and other interventions in cerebrovascular health. KEY POINTS: Exercise has a significant and lifetime positive effect on the cerebral vasculature, which can counterbalance the negative effects of ageing and hypertension. A new model is presented that incorporates the effects of all three effects on the cerebral vasculature, using multiple time scales to include both short- and long-term effects. The model is calibrated against a range of experimental data and used to quantify the effects of different exercise regimes on cerebrovascular health for the first time. This model can be used in future to explore the lifetime effects of different lifestyles and interventions on population brain health.

Longitudinal dynamics of pulse wave velocity in the days after acute ischaemic stroke: prospective cohort study

OBJECTIVES

Arterial stiffness as assessed by pulse wave velocity (PWV) improves the prediction of first-ever and recurring stroke and of stroke outcomes when measured in the days after stroke. Here, we investigated the longitudinal dynamics of PWV in the days after acute ischaemic stroke.

DESIGN

Monocentric, prospective cohort study nested within a clinical trial registry with repeated measurement assessment of PWV.

SETTING

Comprehensive middle European stroke centre.

PARTICIPANTS

20 men and women that suffered stroke from November 2022 through August 2023.

PRIMARY AND SECONDARY OUTCOME MEASURES

Change in carotid-femoral PWV was investigated by recording PWV four times between 1.2 and 9.9 days after stroke using a Vicorder device. Haemodynamic and patient-, stroke- and care-related variables were investigated as potential modifiers of PWV trajectories.

RESULTS

Twenty patients aged 61.3±16.9 years (14 males) were included. There was a daily decline in PWV of -0.19 m/s (95% CI: -0.29 to -0.09; p<0.001) until approximately 8 days after stroke, corresponding to a total relative decline of -15.5% (95% CI: -22.3 to -8.1; p<0.001). Whereas higher anxiety predicted 0.11 m/s (95% CI: 0.01 to 0.20; p=0.044) slower daily decline, decline was not significantly related to baseline PWV, blood pressures, stroke severity or location, or functional status (all p>0.05). Rank-order correlation between the earliest and latest PWV measurements was 0.87 (95% CI: 0.69 to 0.95; p<0.001).

CONCLUSIONS

A marked decline in PWV during the first week after acute ischaemic stroke should be accounted for when interpreting PWV after recent stroke.

TRIAL REGISTRATION NUMBER

The STROKE-CARD Registry was registered at ClinicalTrials.gov (NCT04582825).

Structural and load-dependent arterial stiffness across the adult life span

BACKGROUND

The arterial stiffening is attributed to the intrinsic structural stiffening and/or load-dependent stiffening by increased blood pressure (BP). The respective lifetime alterations and major determinants of the two components with normal aging are not clear.

METHODS

A total of 3053 healthy adults (1922 women) aged 18-79 years were enrolled. The carotid intima-media thickness, diameter, and local BPs were automatically determined by the radio frequency ultrasound system. The Peterson and Young elastic moduli were then calculated to represent total arterial stiffness. Structural stiffness was recalculated at a reference BP of 120/80 mmHg with established models. Load-dependent stiffness was the difference between total and structural stiffness.

RESULTS

Both structural and load-dependent stiffness increased with aging, with much larger changes in the structural components. The age-related increasing rates were higher in women for the structural stiffness than men ( P  < 0.05), but similar for the load-dependent stiffness. The clinical characteristics and arterial stiffness were widely correlated, but most correlations were quite weak ( r  < 0.3) other than BPs. Multiple regression analyses adjusted for sex, age and other clinical correlates showed that structural stiffness increased with pulse pressure (PP) and load-dependent stiffness increased with mean arterial pressure (MAP), respectively.

CONCLUSION

The age-related arterial stiffening is mainly caused by the intrinsic structural stiffening, which demonstrated significant age-sex interaction. BPs were the major clinical determinants of arterial stiffness, with PP and MAP associated with different arterial stiffness components. The differentiation of the structural and load-dependent arterial stiffness should be highlighted for the optimal vascular health management.

Prevalence of Lipoprotein(a) Measurement and its Association with Arteriosclerosis in Asymptomatic Individuals in China

AIMS

Lipoprotein(a) [Lp(a)] is an independent risk factor for atherosclerotic cardiovascular disease (ASCVD), and its level is genetically determined. Although guidelines and consensuses in various cardiovascular fields have emphasized the importance of Lp(a), screening for Lp(a) in China has not been well studied.

METHODS

A cross-sectional study was conducted using a random sample of 30,000 medical examiners from each of the five health check-up centres. The distribution of Lp(a) was described for those who completed Lp(a) testing, and logistic regression modelling was used to evaluate the relationship between Lp(a) levels and vascular structure and function in the population who underwent carotid ultrasound and brachial‒ankle pulse wave velocity (baPWV) measurements.

RESULTS

Lp(a) was measured in only 4400 (3.02%) of the 150,000 participants. Among those tested for Lp(a), the median concentration was 15.85 mg/dL. The proportion of participants with Lp(a) levels ≥ 30 mg/dL was 15.00%. Multiple logistic regression analysis revealed a significant correlation between Lp(a) and cIMT ≥ 1.0 mm (OR: 1.008, 95% CI: 1.001-1.014, P=0.020) and carotid artery plaques (OR: 1.010, 95% CI: 1.004-1.016, P=0.001) but no correlation with baPWV ≥ 1400 (OR: 0.999, 95% CI: 0.993-1.005, P=0.788) or baPWV ≥ 1800 (OR: 1.002, 95% CI: 0.993-1.011, P=0.634).

CONCLUSIONS

The detection rate of Lp(a) at health checkups is low, and Lp(a) is positively associated with cervical vascular sclerosis and plaque but not with baPWV. Therefore, the testing rate of Lp(a) and the awareness of the risk of vascular structural changes due to Lp(a) should be further improved.

Association Between Arterial Stiffness, High Blood Pressure, and Hypertensive Phenotypes: Insights from the PAMELA Study

Hypertension is a clinical condition associated with structural alterations in small, medium, and large arteries, also affecting target organs due to the mechanical effects of high blood pressure and shear stress. However, these vascular changes are also influenced by various inflammatory and neurohumoral mediators originating from the endothelium, the renin-angiotensin-aldosterone system, the neuroadrenergic system, and the perivascular fat. Specifically, chronic hypertension leads to vascular stretching, which triggers complex signaling pathways that promote vascular remodeling. The endothelium plays a crucial role in this process, as its function is impaired in hypertensive patients, leading to reduced nitric oxide-mediated vasodilation, increased vascular tone, and a proinflammatory and prothrombotic state. Along with structural changes, hypertension also triggers dynamic alterations in arterial distensibility and arterial wall properties, leading to increased arterial stiffness, which is strongly linked to cardiovascular outcomes and associated disability, as well as subsequent rehabilitation needs. Several non-invasive and highly reproducible methods are currently used to assess arterial stiffness, one of which is the cardio-ankle vascular index (CAVI). This article examines the association between arterial stiffness and high blood pressure, with a particular focus on the results of the Pressioni Arteriose Monitorate e Loro Associazioni (PAMELA) study. This study analyzes the determinants of arterial stiffness in the general population, the different hypertensive phenotypes affecting diurnal and nocturnal blood pressure profiles, and the impact of blood pressure control through antihypertensive treatment on arterial stiffness.

Menopause-related changes in vascular signaling by sex hormones

Cardiovascular disease (CVD), such as hypertension and coronary artery disease, involves pathological changes in vascular signaling, function, and structure. Vascular signaling is regulated by multiple intrinsic and extrinsic factors that influence endothelial cells, vascular smooth muscle, and extracellular matrix. Vascular function is also influenced by environmental factors including diet, exercise, and stress, as well as genetic background, sex differences, and age. CVD is more common in adult men and postmenopausal women than in premenopausal women. Specifically, women during menopausal transition, with declining ovarian function and production of estrogen (E2) and progesterone, show marked increase in the incidence of CVD and associated vascular dysfunction. Mechanistic research suggests that E2 and E2 receptor signaling have beneficial effects on vascular function including vasodilation, decreased blood pressure, and cardiovascular protection. Also, the tangible benefits of E2 supplementation in improving menopausal symptoms have prompted clinical trials of menopausal hormone therapy (MHT) in CVD, but the results have been inconsistent. The inadequate benefits of MHT in CVD could be attributed to the E2 type, dose, formulation, route, timing, and duration as well as menopausal changes in E2/E2 receptor vascular signaling. Other factors that could affect the responsiveness to MHT are the integrated hormonal milieu including gonadotropins, progesterone, and testosterone, vascular health status, preexisting cardiovascular conditions, and menopause-related dysfunction in the renal, gastrointestinal, endocrine, immune, and nervous systems. Further analysis of these factors should enhance our understanding of menopause-related changes in vascular signaling by sex hormones and provide better guidance for management of CVD in postmenopausal women. SIGNIFICANCE STATEMENT: Cardiovascular disease is more common in adult men and postmenopausal women than premenopausal women. Earlier observations of vascular benefits of menopausal hormone therapy did not materialize in randomized clinical trials. Further examination of the cardiovascular effects of sex hormones in different formulations and regimens, and the menopausal changes in vascular signaling would help to adjust the menopausal hormone therapy protocols in order to enhance their effectiveness in reducing the risk and the management of cardiovascular disease in postmenopausal women.

Association between brachial-ankle pulse wave velocity, obesity-related indices, and the 10-year incident risk score of atherosclerotic cardiovascular disease: The rural Chinese cohort study

BACKGROUND AND AIMS

Although existing evidence suggests that arterial stiffness and obesity impact cardiovascular health, limited studies have been conducted to explore the association between brachial-ankle pulse wave velocity (baPWV), obesity-related indices, and the risk of atherosclerotic cardiovascular disease (ASCVD).

METHODS AND RESULTS

The study participants were among those who completed the baPWV measurement at the second follow-up examination (during 2018-2020) of the Rural Chinese Cohort Study. Logistic regression models were employed to calculate odds ratios (ORs) and 95 % confidence intervals (CIs) of the 10-year incident risk score of ASCVD associated with baPWV and obesity-related indices. Mediation analysis was applied to investigate the role of baPWV in the obesity-induced 10-year incident risk score of ASCVD. A total of 1589 individuals, including 573 men and 1016 women, were included in the study. In logistic regression analyses, the highest quartile levels of baPWV and obesity-related indices all significantly increased the 10-year incident risk score of ASCVD compared to their corresponding lowest quartiles. The ORs (95%CIs) of ASCVD 10-year incident risk score risk were 4.21(2.55-6.94) for baPWV, 4.43(2.69-7.29) for METS-VF, 7.20(4.09-12.66) for CVAI, 3.38(2.12-5.38) for CI, and 2.40(1.54-3.75) for ABSI. The indirect effect of baPWV accounted for 5.85 %, 7.92 %, 14.56 %, and 5.08 % of the total effects for METS-VF, CVAI, CI, and ABSI, respectively.

CONCLUSION

This study found that elevated levels of both baPWV and obesity-related indices were associated with a higher 10-year incident risk score of ASCVD. Additionally, baPWV partially mediated the obesity-related increase in 10-year incident risk score of ASCVD.

Joint exposure to multiple air pollutants and residual cardiovascular risk in hypertension

BACKGROUND

Despite the widespread availability of antihypertensive medications, residual cardiovascular risk of hypertension remained high. Limited studies have investigated the link between air pollution, particularly joint exposure to multiple air pollutants, with residual cardiovascular risk of hypertension.

METHODS

1981 hypertensive patients (≥ 18 years) from an ongoing longitudinal cohort in China, were enrolled between 2013 and 2019. Using high-quality datasets from China, the ground-level air pollutants concentrations, including PM2.5, PM2.5-10, SO2, O3, CO and NO2, at each participant's residence were calculated. The relationships between individual and multiple air pollutants with the residual cardiovascular risk were assessed by Cox proportional hazards models, air pollution score analyses and Bayesian Kernel Machine Regression model.

RESULTS

Over an average follow-up period of 2.24 years (SD, 1.25), 706 hypertensive patients developed cardiovascular disease. In the single-pollutant analysis, higher concentrations of PM2.5, PM2.5-10, SO2 and CO were linked to increased residual cardiovascular risk. The air pollution score analyses and Bayesian kernel machine regression suggested that combined exposure to multiple air pollutants had a positive association with the residual cardiovascular risk, and NO2 played a dominant role. With higher NO2 concentrations, the hazard ratio of individual pollutants to residual cardiovascular risk increased.

CONCLUSIONS

Prolonged exposure to a mixture of various air pollutants is linked to elevated residual cardiovascular risk in individuals with hypertension. Apart from taking antihypertensive medication and adopting healthy lifestyle behaviors, hypertensive patients should lower air pollutant exposure to decrease residual cardiovascular risk.

Aberrant STING activation promotes macrophage senescence by suppressing autophagy in vascular aging from diabetes

Diabetic vascular aging is driven by macrophage senescence, which propagates senescence-associated secretory phenotypes (SASP), exacerbating vascular dysfunction. This study utilized a type 2 diabetes mellitus (T2DM) mouse model induced by streptozotocin injection and a high-fat diet to investigate the role of STING in macrophage senescence. Vascular aging markers and senescent macrophages were assessed in vivo, while in vitro, high glucose treatment induced macrophage senescence, enhancing senescence in co-cultured vascular smooth muscle cells. Mechanistic studies revealed that STING activation inhibits autophagy by phosphorylating ULK1 at S757, accelerating senescence. Pharmacological modulation showed that the STING inhibitor H-151 alleviates, while the agonist DMXAA enhances, senescence. These findings highlight the STING-autophagy axis as a critical driver of macrophage senescence, offering insights into the molecular mechanisms of diabetic vascular aging and identifying potential therapeutic targets to mitigate vascular complications in diabetes.

Role of Advanced Glycation End Products in Mediating Glycated Haemoglobin and Pulse Wave Velocity in Healthy Adults

Background/Objectives: Poor metabolic control is associated with increased levels of advanced glycation end products (AGEs), which in turn may lead to increased arterial stiffness. The aim of this study was to estimate the association between glycated haemoglobin A1c (HbA1c) and aortic pulse wave velocity (a-PWV) in healthy subjects and to analyse the mediating effect of AGEs measured by skin autofluorescence (SAF) on this association. Methods: HbA1c, a-PWV and SAF were analysed in 390 healthy Spanish subjects from the EVasCu study (42.02 ± 13.14 years, 63.08% females). A directed acyclic graph (DAG) was generated to define the covariates to be included, and the model was confirmed via multiple linear regression analysis. Descriptive and exploratory analyses were performed to investigate the associations between variables. Finally, adjusted and unadjusted mediation analyses were performed to verify the influence of SAF on the main association between HbA1c and a-PWV. Results: Multiple linear regression analyses for a-PWV supported the validity of the structure in the DAG. Descriptive and exploratory analyses revealed that when the models were adjusted to include all covariates, the statistical significance of the main association disappeared. Mediation analysis revealed that SAF mediated 35.77% of the effect of HbA1c on a-PWV in the unadjusted model and 42.18% after adjusting for covariates. Conclusions: Our study suggests that increases in HbA1c levels are associated with increases in a-PWV and that this relationship is mediated by the SAF score in healthy adults.

Association of Cumulative Remnant Cholesterol with Kidney Function Decline in Chinese Population: A Prospective Cohort Study

Introduction

There were limited data regarding the association between remnant cholesterol (RC), an emerging novel lipid marker, and chronic kidney disease (CKD). This study aimed to investigate the association of baseline and cumulative exposure of RC (cumRC) with kidney function decline (KFD) risk in the general population of China.

Methods

Using data from the physical examination database in the Third Xiangya Hospital of Central South University (Changsha, China), 22,702 participants (age ≥18 years) without KFD, who underwent 3 consecutive annual health examinations between 2012 and 2015, were included. KFD was recorded during the interval between the third examination and the end of follow-up through 2020.

Results

The cumRC was classified into 4 groups according to these cutoff values: 0.92, 1.33, and 1.99 (mmol/L). During a median follow-up of 3.17 years, 1,085 new KFD events were confirmed. Participants in the highest quartile of cumRC had 43% higher risk of KFD (hazard ratio, 1.43 [95% confidence interval, 1.16-1.77]), compared with the lowest quartile. Similarly, restricted cubic spline analysis showed a significant dose-response relationship between cumRC and the risk of KFD (P nonlinearity = 0.0314). However, baseline RC did not show any typical dose-dependent positive relationship with KFD development. In the discordance analysis, high baseline RC/low baseline low-density lipoprotein cholesterol (LDL-C) or high cumRC/low cumLDL-C were all associated with KFD in adjusted models.

Conclusion

These data suggest a significant association between cumRC and risk of KFD independent of traditional CVD risk factors as well as the LDL-C level. Therefore, consistent RC monitoring should be given to individuals for early KFD prevention, especially in population with normal LDL-C levels who are often overlooked.

Resting Heart Rate Mediates the Association Between Circulating Neutrophil Count and Arterial Stiffness Progression: The Kailuan Study

Objective

This study aimed to longitudinally investigate the association between circulating neutrophil count and the progression of arterial stiffness and to ascertain whether resting heart rate (RHR) mediates this association.

Methods

The current study included 56,760 participants with brachial-ankle pulse wave velocity (baPWV) measurements from a real-life, prospective cohort in China. The associations of circulating neutrophil (exposure) with baseline baPWV, baPWV progression, and arterial stiffness (outcomes), as well as RHR (mediator) were assessed using multivariable linear and Cox regression models and mediation analysis.

Results

After adjusting for cardiometabolic risk factors, for each 1-SD increase in neutrophil count, the corresponding increase was 13.5 cm/s (95% CI, 11.1 to 15.9 cm/s, P<0.001) for the baseline baPWV and 3.10 cm/s (95% CI, 1.51 to 4.69, P<0.001) for the annual change in baPWV. Over a median follow-up period of 4.08 (IQR: 2.37 to 6.21) years, there were 3,376 incident cases of arterial stiffness among the 23,263 participants. Each 1-SD increase in neutrophil count was associated with a 7% increase in the risk of developing arterial stiffness (HR: 1.07; 95% CI: 1.04 to 1.10, P<0.001) in the multivariable-adjusted model. In the mediation analyses, 20.0% (95% CI: 16.8% to 24.2%), 12.6% (95% CI: 8.16% to 26.4%), and 16.7% (95% CI: 9.94% to 51.0%) of the observed associations of neutrophil counts with baPWV at baseline, baPWV progression and developing arterial stiffness, respectively, were mediated by RHR.

Conclusion

The present study underlines that circulating neutrophil count is significantly associated with arterial stiffness progression and that the RHR is, in part, a mediator of this association.

Association Between Cardiorespiratory Fitness and Trend of Age-Related Rise in Arterial Stiffness in Individuals With and Without Hypertension or Diabetes

BACKGROUND

This study aimed to investigate whether higher cardiorespiratory fitness (CRF) can modify the trend of age-related rise in arterial stiffness in individuals with and without hypertension (HTN) or diabetes.

METHODS

The study included 4,935 participants who underwent maximal cardiopulmonary exercise testing with respiratory gas analysis in a health screening program. CRF was directly measured using peak oxygen uptake during the cardiopulmonary exercise test, while arterial stiffness was evaluated using brachial-ankle pulse wave velocity (baPWV).

RESULTS

Participants with high CRF levels had significantly lower baPWV compared with those with low CRF levels, regardless of HTN or diabetes status (P < 0.05). The trend of baPWV increased with age, but the rate of age-related increase in baPWV was lower in individuals with moderate-to-high CRF levels compared with those with low CRF levels, regardless of HTN or diabetes status. Joint association analysis indicated that the trend of age-related increase in baPWV was the lowest in fit individuals without HTN or diabetes compared with unfit individuals with HTN or diabetes (P < 0.01). However, the trend of age-related increase in baPWV was not attenuated in fit with HTN or diabetes compared with unfit with HTN or diabetes.

CONCLUSIONS

These findings suggest that higher CRF levels may mitigate the trend of age-related rise in arterial stiffness in individuals with and without HTN or diabetes. However, this attenuating trend appears more pronounced in individuals without HTN or diabetes.

Sex differences in the impact of ventricular-arterial coupling on left ventricular function in patients with hypertension

Increased arterial stiffness elevates aortic load, which can have adverse impacts on left ventricular (LV) function and contribute to the onset of heart failure. This impact is known to be more pronounced in women. Optimal coordination between ventricular contraction and the arterial system is required to maintain efficient cardiac function. This study aimed to investigate sex differences in the impact of ventricular-arterial coupling (VAC) on LV function in patients with hypertension at rest and after handgrip exercise. Echocardiographic indexes of LV volumes, systolic function, and diastolic function were obtained in the usual way. Effective arterial elastance (EA) and index (EAI) were calculated from stroke volume measured using LV outflow waveform. Effective LV end-systolic elastance (ELV) and index (ELVI) were obtained using the single-beat method. Central aortic pressure waveform was recorded using the applanation tonometry. Characteristic impedance (Zc) of aortic root and reflection magnitude (RM) was calculated after Fourier transformation of both aortic pressure and flow waveforms. Sixty-four patients (31 women and 33 men) with hypertension were enrolled. Women showed higher ELVI (1.33±0.34 vs. 1.10±0.29 mmHg/ml∙m2, P = 0.004) and EAI (1.14±0.25 vs. 0.93±0.26 mmHg/ml∙m2, P = 0.001), but VAC was not different (women: 0.88±0.17 vs. men: 0.85±0.11, P = 0.431). Zc and RM were not different between women and men. After handgrip exercise, an increase in ELVI (P = 0.021) and a decrease in VAC (P = 0.035) were observed specifically in men, with no corresponding changes noted in women. In women, VAC was significantly associated with E' velocity (beta -0.344, P = 0.029) and left ventricular global longitudinal strain (beta 0.470, P = 0.012) after adjustment, but in men, no association was found. Hypertensive women demonstrated greater stiffness in both the left ventricle and arterial systems, along with impaired LV contractile reserve in response to handgrip exercise, as compared to men. The ventricular-arterial mismatch had a notable impact on LV diastolic and systolic dysfunction only in women, but not in men.

Associations of triglyceride-glucose index cumulative exposure and variability with the transitions from normoglycaemia to prediabetes and prediabetes to diabetes: Insights from a cohort study

AIM

This study aimed to investigate the separate and joint associations of triglyceride-glucose (TyG) index accumulation and variability with prediabetes and diabetes risk.

METHODS

Health check-up participants who underwent 3 sequential health examinations during 2012-2016 and were followed up from 2017 to 2021 were enrolled and categorized into two subcohorts: (a) progression from normoglycaemia to prediabetes subcohort (n = 9373) and (b) progression from prediabetes to diabetes subcohort (n = 4563). Cumulative TyG (cumTyG) and TyG variability from Exams 1-3 were the exposures of interest in our study. The outcomes were newly incident prediabetes or diabetes.

RESULTS

In the prediabetes development subcohort, 2,074 participants developed prediabetes over a 2.42-year follow-up. Higher cumTyG (HR, 2.02; 95 % CI, 1.70-2.41), but not greater TyG variability alone, was significantly associated with increased prediabetes risk. In the diabetes development subcohort, 379 participants developed diabetes over a 3.0-year follow-up. Higher cumTyG (HR, 3.54; 95 % CI, 2.29-5.46), but not greater TyG variability alone, was significantly associated with increased diabetes risk. The "cumTyG+variability" combination had the highest predictive value for prediabetes and diabetes beyond a single baseline TyG measurement.

CONCLUSION

Higher cumTyG exposure independently predicts prediabetes and diabetes incidence. Coexisting cumTyG and variability could further yield incrementally greater risks.

Advanced vascular aging and outcomes after acute ischemic stroke: a systematic review and meta-analysis

Pulse wave velocity (PWV) is as a reliable marker of arterial stiffness and vascular aging, surpassing traditional risk factors in predicting detrimental cardiovascular events. The present meta-analysis aims to investigate PWV thresholds and assess its prognostic value in outcomes of acute ischemic stroke (AIS). A search was conducted in PubMed, Cochrane, Web of Science, and Scopus for studies published up to January 2024, focusing on patients admitted with AIS, wherein arterial stiffness was assessed through PWV measurements during hospitalization. Identified studies reported PWV values in individuals with both favorable and unfavorable outcomes at the end of follow-up. Initially, 35 eligible studies provided data for weighted mean baPWV (11,953 AIS patients) and cfPWV (2,197 AIS patients) calculations. The average age was 67 years, with approximately 60% male, 67% hypertensive, 30% diabetic and 30% smoker participants. The weighted mean systolic blood pressure was approximately 150 mmHg. In AIS patients, the mean PWV was 10 m/s for standard cfPWV and 20 m/s for baPWV. Nine cohort studies (6,006 AIS patients) were included in the quantitative analysis of clinical outcomes. Higher PWV levels were associated with poorer functional outcomes (2.3 m/s higher, 95%CI:1.2-3.4, p < 0.001; I2 = 87.4%). AIS patients with arterial stiffness/vascular aging (higher PWV) had approximately 46.2% increased risk of poor functional outcome, 12.7% higher risk of mortality, 13.9% greater risk of major adverse cardiovascular events, and 13.9% greater risk of stroke recurrence over the long term compared to those without arterial stiffness. Advanced vascular aging, as indicated by PWV, significantly predicts adverse outcomes in AIS patients. Integrating the assessment of vascular aging into clinical practice can improve risk perception in these patients.

Age-Related Changes in Blood Volume Pulse Wave at Fingers and Ears

OBJECTIVE

The decline in vascular elasticity with aging can be manifested in the shape of pulse wave. The study investigated the pulse wave features that are sensitive to age and the pattern of these features change with increasing age were examined.

METHODS

Five features were proposed and extracted from the photoplethysmography (PPG)-based pulse wave or its first derivative wave. The correlation between these PPG features and ages was studied in 100 healthy subjects with a wide range of ages (20-71 years). Piecewise regression coefficients were calculated to examine the rates of change of the PPG features with age at different age stages.

RESULTS

The proposed PPG features obtained from the finger showed a strong and significant correlation with age (with r = 0.76 - 0.77, p < 0.01), indicating higher sensitivity to age changes compared to the PPG features reported in previous studies (with r = 0.66 - 0.75). The correlation remained significant even after correcting for other clinical variables. The rate of change of the PPG feature values was found to be significantly faster in subjects aged ≥40 years compared to those aged < 40 years in the healthy population. This rate of change was similar to the age-related progression of arterial stiffness evaluated by pulse wave velocity (PWV), which is considered a gold standard for evaluating vascular stiffness.

CONCLUSIONS

The proposed PPG features showed a high correlation with chronological age in healthy subjects and exhibited a similar age-related change trend as PWV.

SIGNIFICANCE

With the convenience of PPG measures, the proposed age-related features have the potential to be used as biomarkers for vascular aging and estimating the risk of cardiovascular disease.

Hippocampal volume mediates the association of arterial stiffness with cognitive impairment in adult population

OBJECTIVES

To investigate the association of arterial stiffness with brain perfusion, brain tissue volume and cognitive impairment in the general adult population.

MATERIALS AND METHODS

This prospective study included 1488 adult participants (age range: 22.8-83.9 years) from the Kailuan study. All participants underwent brachial-ankle pulse wave velocity (PWV) measurement, brain MRI, and Montreal Cognitive Assessment (MoCA). The association of PWV with cerebral blood flow (CBF), brain tissue volume and MoCA score was investigated. Mediation analysis was used to determine whether CBF and brain tissue volume changes mediated the associations between PWV and MoCA score.

RESULTS

A 1 standard deviation (SD) increase in PWV was associated with lower total brain CBF [ β (95% CI) -0.67 (-1.2 to -0.14)], total gray matter CBF [β (95% CI) -0.7 [-1.27 to -0.13)], frontal lobe CBF [ β (95% CI) -0.59 (-1.17 to -0.01)], parietal lobe CBF [ β (95% CI) -0.8 (-1.43 to -0.18)], and temporal lobe CBF [ β (95% CI) -0.68 (-1.24 to -0.12)]. Negative associations were found for PWV and total brain volume [ β (95% CI) -4.8 (-7.61 to -1.99)] and hippocampus volume [ β (95% CI) -0.08 (-0.13 to -0.04)]. A 1 SD increase PWV was significantly associated with elevated odds of developing cognitive impairment [odds ratio (95% CI) 1.21 (1.01-1.45)]. Mediation analysis showed that hippocampal volume partially mediated the negative association between PWV and MoCA scores (proportion: 14.173%).

CONCLUSION

High arterial stiffness was associated with decreased total and regional CBF, brain tissue volume, and cognitive impairment. Hippocampal volume partially mediated the effects of arterial stiffness on cognitive impairment.

Development of a comprehensive risk prediction model for arterial stiffness assessment in individuals with obesity

Introduction

Obesity in adults is a known risk factor for cardiovascular events and is associated with a decline in arterial elasticity. This study aims to evaluate the utility of pulse wave analysis (PWA) parameters in routine clinical practice for the primary prevention of cardiovascular events by developing a prediction model for arterial stiffness among obese and overweight individuals.

Methods

The study enrolled 84 adult patients, aged 18 to 85 years, with varying degrees of weight status, including optimal weight, overweight, and obesity. The lifestyle habits, the personal and family history of cardiometabolic diseases, as well the clinical evaluation that included BMI (body mass index), WHR (waist-to-hip ratio), WC (waist circumferance) were performed. PWA evaluation was conducted using the Mobil-O-Graph device, assessing the following parameters: pulse wave velocity (PWV), augmentation index (AIx), heart rate (HR), central pulse pressure (cPP), peripheral and central blood pressure (SBP, DBP, cSBP, cDBP). Body composition analysis was performed using the TANITA BC-418 body analyzer. Laboratory results from the past 3 months were also collected during initial nutritional consultations for each patient.

Results

Family history of cardiovascular events showed positive correlations with all PWA parameters, while diabetes history only with PWV and family history of obesity with PWV, DBP, and cSBP. Insufficient sleep duration showed positive associations with all arterial stiffness parameters except cDBP. Smoking status correlated with significantly elevated PWV and Aix values, while insufficient physical activity was associated solely with PWV. Positive correlations were showed between current weight and PWV, while WC demonstrated positive associations with PWV, SBP, and cSBP. Body composition analysis revealed significant associations between trunk adipose tissue mass (%) and PWV, SBP, and cSBP. Hydration status (%) emerged as an independent predictor for PWV, exhibiting an inverse relationship. HOMA-IR (Homeostatic Model Assessment for Insulin Resistance) showed a strong positive correlation with PWV. Negative associations were observed with HDL-c and vitamin D. Threshold values for age, cDBP and Cardiac Index providing positive diagnostic for vascular impairment.

Conclusion

The assessment of arterial stiffness can be considered a reliable approach to prevent obesity-related cardiovascular events and facilitate the comprehensive management of such pathologies.

Discrepancies between general and central obesity in arterial stiffness: observational studies and Mendelian randomization study

BACKGROUND

Obesity has been linked to arterial stiffness, while no consensus was reached on the association. We aimed to clarify the association of general and central obesity with arterial stiffness by combining observational studies and Mendelian randomization (MR) study.

METHODS

Two cross-sectional studies were performed in UK Biobank and Fuqing Cohort, respectively. Two-sample MR study was conducted using summary data of GWASs from GIANT consortium and UK Biobank. General obesity and central obesity were measured using body mass index (BMI) and waist circumference (WC), respectively. Arterial stiffness was measured by arterial stiffness index (ASI) in UK Biobank or branchial-ankle pulse wave velocity (baPWV) in Fuqing Cohort.

RESULTS

Two observational studies found a consistent positive association of BMI and WC with arterial stiffness when adjusting for age, sex, education, smoking, alcohol drinking, physical activity, and LDL cholesterol. However, when additionally adjusting for metabolic traits (i.e., systolic blood pressure, diastolic blood pressure, blood glucose, triglycerides, high-density lipoprotein cholesterol, and WC or BMI), the association with BMI changed to be inverse. As compared to the lowest quintile group, the adjusted ORs across groups of second to fifth quintile were 0.93, 0.90, 0.83, and 0.72 in UK Biobank and 0.88, 0.65, 0.63, and 0.50 in Fuqing Cohort. In contrast, the positive relationship with WC remained stable with the adjusted ORs of 1.23, 1.46, 1.60, and 1.56 in UK Biobank and 1.35, 1.44, 1.77, and 1.64 in Fuqing Cohort. MR analyses provided supportive evidence of the negative association with BMI (OR = 0.97, 95%CI = 0.94-1.00) and the positive association with WC (OR = 1.14, 95%CI = 1.08-1.20).

CONCLUSIONS

Observational and genetic analyses provide concordant results that central obesity is independently related to arterial stiffness, while the role of general obesity depends on metabolic status.

Arterial stiffness progression in metabolic dysfunction-associated fatty liver disease subtypes: A prospective cohort study

BACKGROUND AND AIMS

We aimed to investigate the correlation and to explore which MAFLD subtypes have the greatest influence on progression of arterial stiffness risk.

METHODS AND RESULTS

Using data from a health examination-based cohort, a total of 12,129 participants who underwent two repeated health examinations that included brachial-ankle pulse wave velocity (baPWV) from 2012 to 2020 were enrolled. Participants were separated into non-MAFLD, overweight/obese (OW-MAFLD), lean/normal weight (lean-MAFLD) and diabetes (DM-MAFLD) groups. Among the participants with a median follow-up of 2.17 years, 4511 (37.2%) participants had MAFLD at baseline, among which 3954 (87.7%), 123 (2.7%), and 434 (9.6%) were OW-, lean- and DM-MAFLD, respectively. Analyses using linear regression models confirmed that compared with the non-MAFLD group, the elevated baPWV change rates (cm/s/year) were 12.87 (8.81-16.94), 25.33 (7.84-42.83) and 38.49 (27.88-49.10) in OW, lean and DM-MAFLD, respectively, while the increased change proportions (%) were 1.53 (1.10-1.95), 3.56 (1.72-5.40) and 3.94 (2.82-5.05), respectively. Similar patterns were observed when these two baPWV parameters were transformed in the form of the greatest increase using Cox proportional hazards model analyses. Furthermore, the risk of arterial stiffness progression across MAFLD subtypes presented a significant, gradient, inverse relationship in the order of DM-, lean-, OW with metabolic abnormalities (MA)-, and OW without MA-MAFLD.

CONCLUSION

MAFLD, especially DM-MAFLD and lean-MAFLD, was significantly associated with arterial stiffness progression, providing evidence that stratification screening and surveillance strategies for CVD risk have important clinical implications.

Early vascular aging in acute ischemic stroke: A systematic review and meta-analysis

BACKGROUND

While arterial stiffening is a known risk factor for cardiovascular diseases, it remains unclear whether there is an early vascular aging (EVA) in patients who have experienced acute ischemic stroke (AIS). This systematic review and meta-analysis aims to investigate whether patients with AIS exhibit EVA through pulse wave velocity (PWV) measurements shortly after the stroke onset, shedding light on the relationship between arterial stiffness, hypertension, and stroke.

METHODS

Thirteen case-control studies were included, comparing PWV measurements between AIS patients and non-AIS individuals. A meta-analysis was performed to compare PWV levels, age, blood pressure, and the prevalence of different cardiovascular risk factors among 1711 AIS patients and 1551 controls.

RESULTS

Despite AIS patients showing higher PWV compared to controls (mean difference: 1.72 m/s, 95 % CI: 1.05-2.38, p < 0.001; I2 = 88.3 %), their age did not significantly differ (95 % CI: -0.47-0.94, p = 0.519; I2 = 0 %), suggesting EVA in AIS patients. Moreover, AIS patients exhibited elevated systolic and diastolic blood pressure and had higher odds of smoking, hypertension, diabetes, and male gender compared to controls.

CONCLUSIONS

This study's findings underscore the presence of EVA in AIS patients, evident through increased PWV measurements shortly after stroke onset. Notably, smoking, hypertension, and diabetes mellitus emerge as substantial factors contributing to accelerated arterial stiffness within this population.

Investigating the Association of Aortic Stiffness and Phase Angle with the Clinical Course of Rheumatoid Arthritis

Background

Aortic stiffness is an independent predictor of cardiovascular events which is increased in rheumatoid arthritis (RA). It can be measured by carotid-femoral pulse wave velocity (cfPWV). Phase angle (PhA) is lower in patients with cardiovascular disease and may be informative in assessing the clinical course of RA.

Materials and Methods

In this observational and cross-sectional study, all RA patients referred to the Imam Khomeini Hospital rheumatology clinic between September 2022 and March 2023 were included in the study. RA activity was assessed using the DAS28 criteria. In the patients, PhA and cfPWV were measured using Inbody-s10 and PulsePen tonometer instruments. The relationships between PhA, cfPWV, clinical course of RA, and CRP were evaluated using regression analysis.

Results

53 patients were included in the study (83% female, mean age 46.5 years). Significant inverse relationships existed between PhA, CRP, and age (P value = 0.003, 0.0001, R: 0.69, respectively). People with aortic stiffness had a lower mean PhA (P value = 0.05). In patients with RA duration of less than 10 years, the cfPWV percentile and the prevalence of rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) positive cases were higher than in patients with RA duration >10 years (P values = 0.02, 0.01, respectively).

Conclusions

With increasing duration of RA, aortic stiffness and positive serology cases decreased. PhA and cfPWV may be useful in assessing the clinical course of RA to prevent cardiovascular events.

Predicting Arterial Stiffness From Single-Channel Photoplethysmography Signal: A Feature Interaction-Based Approach

Arterial stiffness (AS) serves as a crucial indicator of arterial elasticity and function, typically requiring expensive equipment for detection. Given the strong correlation between AS and various photoplethysmography (PPG) features, PPG emerges as a convenient method for assessing AS. However, the limitations of independent PPG features hinder detection accuracy. This study introduces a feature selection method leveraging the interactive relationships between features to enhance the accuracy of predicting AS from a single-channel PPG signal. Initially, an adaptive signal interception method was employed to capture high-quality signal fragments from PPG sequences. 58 PPG features, deemed to have potential contributions to AS estimation, were extracted and analyzed. Subsequently, the interaction factor (IF) was introduced to redefine the interaction and redundancy between features. A feature selection algorithm (IFFS) based on the IF was then proposed, resulting in a combination of interactive features. Finally, the Xgboost model is utilized to estimate AS from the selected features set. The proposed approach is evaluated on datasets of 268 male and 124 female subjects, respectively. The results of AS estimation indicate that IFFS yields interacting features from numerous sources, rejects redundant ones, and enhances the association. The interaction features combined with the Xgboost model resulted in an MAE of 122.42 and 142.12 cm/sec, an SDE of 88.16 and 102.56 cm/sec, and a PCC of 0.88 and 0.85 for the male and female groups, respectively. The findings of this study suggest that the stated method improves the accuracy of predicting AS from single-channel PPG, which can be used as a non-invasive and cost-effective screening tool for atherosclerosis.

Cumulative exposure to AHA Life's Essential 8 is associated with nonalcoholic fatty liver disease: a large cohort study

BACKGROUND AND AIM

We aimed to explore the associations of baseline and cumulative cardiovascular health with nonalcoholic fatty liver disease (NAFLD) development and regression using the new Life's Essential 8 score.

METHODS

From a health screening database, participants who underwent at least 4 health examinations between 2012 and 2022 were recruited and categorized into two cohorts: (a) the NAFLD development cohort with no history of NAFLD prior to Exam 4 and (b) the NAFLD regression cohort with diagnosed NAFLD prior to Exam 4. The LE8 score was calculated from each component. The outcomes were defined as newly incident NAFLD or regression of existing NAFLD from Exam 4 to the end of follow-up.

RESULTS

In the NAFLD development cohort, of 21,844 participants, 3,510 experienced incident NAFLD over a median follow-up of 2.3 years. Compared with the lowest quartile of cumulative LE8, individuals in the highest quartile conferred statistically significant 76% lower odds (hazard ratio [HR] 0.24, 95% confidence interval [CI], 0.21-0.28) of NAFLD incidence, and corresponding values for baseline LE8 were 42% (HR 0.58, 95% CI 0.53-0.65). In the NAFLD regression cohort, of 6,566 participants, 469 experienced NAFLD regression over a median follow-up of 2.4 years. Subjects with the highest quartile of cumulative LE8 had 2.03-fold (95% CI, 1.51-2.74) higher odds of NAFLD regression, and corresponding values for baseline LE8 were 1.61-fold (95% CI, 1.24-2.10).

CONCLUSION

Cumulative ideal cardiovascular health exposure is associated with reduced NAFLD development and increased NAFLD regression. Improving and preserving health behaviors and factors should be emphasized as an important part of NAFLD prevention and intervention strategies.

Plasma metabolomics identifies S-adenosylmethionine as a biomarker and potential therapeutic target for vascular aging in older adult males

Brachial-ankle pulse wave velocity (baPWV) is a noninvasive index of vascular aging. However, the metabolic profile underlying vascular aging has not yet been fully elucidated. The current study aimed to identify circulating markers of vascular aging as assessed by baPWV and to elucidate its mechanism from a metabolomic perspective in older adults. A total of 60 and 61 Chinese male participants aged ≥80 years were recruited to the metabolome and validation cohorts, respectively. The baPWV of participants was measured using an automatic waveform analyzer. Plasma metabolic profile was investigated using ultra-performance liquid chromatography coupled with triple quadrupole linear ion trap tandem mass spectrometry. Orthogonal partial least squares (OPLS) regression modeling established the association between metabolic profile and baPWV to determine important metabolites predictive of vascular aging. Additionally, an enzyme-linked immunosorbent assay was employed to validate the metabolites in plasma and culture media of vascular smooth muscle cells in vitro. OPLS modeling identified 14 and 22 metabolites inversely and positively associated with baPWV, respectively. These 36 biomarkers were significantly enriched in seven metabolite sets, especially in cysteine and methionine metabolism (p <0.05). Notably, among metabolites involved in cysteine and methionine metabolism, S-adenosylmethionine (SAM) level was inversely related to baPWV, with a significant correlation coefficient in the OPLS model (p <0.05). Furthermore, the relationship between SAM and vascular aging was reconfirmed in an independent cohort and at the cellular level in vitro. SAM was independently associated with baPWV after adjustments for clinical covariates (β = -0.448, p <0.001) in the validation cohort. In summary, plasma metabolomics identified an inverse correlation between SAM and baPWV in older males. SAM has the potential to be a novel biomarker and therapeutic target for vascular aging.

The relationship between HbA1c control pattern and atherosclerosis progression of diabetes: a prospective study of Chinese population

BACKGROUND

This study aims to comprehensively explain of glycosylated Hemoglobin (HbA1c) control patterns and help determine the causal relationship between glycemic control patterns and atherosclerosis progression, thereby contributing to the effective management of diabetes complications.

METHOD

All participants registered at the National Metabolic Management Center (MMC) of Beijing Luhe Hospital. The HbA1c pattern was described by HbA1c variability and trajectory groups of HbA1c. Then we examined the associations between the HbA1c pattern and the changes of intima-media thickness (ΔIMT) using covariate-adjusted means (SE) of ΔIMT, which were calculated by multiple linear regression analyses adjusted for the covariates. Finally, a cross-lagged panel model (CLPM) was performed to further verify the bidirectional relationship between IMT and HbA1c.

RESULTS

After data cleaning, a total of 1041 type 2 diabetes patients aged 20-80 years were included in this study. Except for average real variability (ARV), the other variation variables of HbA1c were associated with ΔIMT% (P < 0.05). Four discrete trajectories of HbA1c were identified in trajectory analysis. Comparing with the low-stable trajectory group of HbA1c, the covariate-adjusted means (SE) of ΔIMT% were significantly higher in Moderate-increase, U-shape and relative high trajectory groups, the mean (SE) were 7.03 (0.031), 15.49 (0.185), 14.15 (0.029), respectively. Meanwhile, there were significant bidirectional cross-lagged associations between HbA1c and IMT after adjusting for covariates.

CONCLUSION

We found four discrete trajectory groups of HbA1c during the long-term follow-up of diabetes. There was a positive association between HbA1c variability and the progression of atherosclerosis. Our study suggested that patients with diabetes should avoid roller coaster changes in glucose over a long period when controlling blood glucose.

Visceral fat area is more strongly associated with arterial stiffness than abdominal subcutaneous fat area in Chinese patients with type 2 diabetes

BACKGROUND

Few studies have compared the correlation between visceral fat area (VFA) and abdominal subcutaneous fat area (SFA) with arterial stiffness (AS) in patients with type 2 diabetes (T2D). In addition, there is currently controversy regarding the correlation between VFA and SFA with AS. We aimed to investigate the relationship between VFA and SFA with AS in patients with T2D.

METHODS

In this cross-sectional study, 1475 Chinese T2D patients with an average age of 52.32 ± 10.96 years were included. VFA and SFA were determined by a dual bioelectrical impedance analyzer, and AS was determined by measurement of brachial-ankle pulse wave conduction velocity (baPWV). Atherosclerosis was deemed present in study participants with baPWV values higher than 75th percentile (1781 cm/s). Independent correlations of logVFA and logSFA with AS were assessed using multiple linear regression and multivariate logistic regression.

RESULTS

The baPWV was linked with VFA, waist circumference, and women's SFA in a general linear correlation study (P < 0.05), but not with body mass index (P = 0.3783) or men's SFA (P = 0.1899). In both men and women, VFA and SFA were positively correlated with AS, according to the generalized additive model (GAM). After fully adjusting for confounders, multiple linear regression analyses showed that for every 1-unit increase in logVFA, the beta coefficient of baPWV increased by 63.1 cm/s (95% CI: 18.4, 107.8) (P < 0.05). logSFA did not correlate significantly with baPWV (P = 0.125). In the multiple logistic regression analysis, the odds ratio (OR) of elevated baPWV was 1.8 (95% CI: 1.1, 3.1) (P = 0.019) per 1-unit increase in logVFA. logSFA did not correlate significantly with AS (P = 0.091). In the subgroup analysis, the correlation between logVFA and baPWV did not interact across subgroups (P-interaction > 0.05).

CONCLUSIONS

Compared with SFA, VFA had a stronger independent positive correlation with AS in Chinese T2D patients. Patients with T2D should pay more attention to monitoring VFA and lowering it to minimize cardiovascular events.

Correlation between novel inflammatory markers and carotid atherosclerosis: A retrospective case-control study

OBJECTIVE

Carotid atherosclerosis is a chronic inflammatory disease, which is a major cause of ischemic stroke. The purpose of this study was to analyze the relationship between carotid atherosclerosis and novel inflammatory markers, including platelet to lymphocyte ratio (PLR), neutrophil to lymphocyte ratio (NLR), lymphocyte to monocyte ratio (LMR), platelet to neutrophil ratio (PNR), neutrophil to lymphocyte platelet ratio (NLPR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and aggregate index of systemic inflammation (AISI), in order to find the best inflammatory predictor of carotid atherosclerosis.

METHOD

We included 10015 patients who underwent routine physical examinations at the physical examination center of our hospital from January 2016 to December 2019, among whom 1910 were diagnosed with carotid atherosclerosis. The relationship between novel inflammatory markers and carotid atherosclerosis was analyzed by logistic regression, and the effectiveness of each factor in predicting carotid atherosclerosis was evaluated by receiver operating characteristic (ROC) curve and area under the curve (AUC).

RESULT

The level of PLR, LMR and PNR in the carotid atherosclerosis group were lower than those in the non-carotid atherosclerosis group, while NLR, NLPR, SII, SIRI and AISI in the carotid atherosclerosis group were significantly higher than those in the non-carotid atherosclerosis group. Logistic regression analysis showed that PLR, NLR, LMR, PNR, NLPR, SII, SIRI, AISI were all correlated with carotid atherosclerosis. The AUC value of NLPR was the highest, which was 0.67, the cut-off value was 0.78, the sensitivity was 65.8%, and the specificity was 57.3%. The prevalence rate of carotid atherosclerosis was 12.4% below the cut-off, 26.6% higher than the cut-off, and the prevalence rate increased by 114.5%.

CONCLUSION

New inflammatory markers were significantly correlated with carotid atherosclerosis, among which NLPR was the optimum inflammatory marker to predict the risk of carotid atherosclerosis.

The difference in diameter between radial artery and cephalic vein correlates with primary patency of radio-cephalic arteriovenous fistula

INTRODUCTION

Autogenous radio-cephalic arteriovenous fistula (RCAVF) is preferred for chronic hemodialysis access. However, RCAVF still suffers from disappointing survival due to fistula dysfunction, with intimal hyperplasia (IH) as an underlying cause of this condition. The inconsistency of radial artery diameter (DRA) and cephalic vein diameter (DCV) is one of the factors affecting the shear disturbance, which is believed to trigger the onset of IH. However, there are no reports correlating the difference in DRA and DCV with RCAVF outcomes.

METHODS

This was a retrospective cohort study. Consecutive patients (n = 233) with a new RCAVF created were included if they underwent duplex ultrasound examination to evaluate preoperatively the radial artery diameter (DRA) and cephalic venous diameter (DCV). We then calculated radial artery-cephalic vein diameter difference (DCV minus DRA, termed DCV-DRA hereafter) and evaluated the association of the preoperative DCV-DRA with primary patency of RCAVF at 12 months. Subgroup analysis was also performed to explore effect modification by age, gender, radial artery diameter, and cephalic vein diameter with DCV-DRA.

RESULTS

After adjusting for age, gender, weight, and mean arterial pressure, the preoperative DCV-DRA was associated with primary patency of RCAVF at 12 months (adjusted Odds ratio [aOR], 1.524 per 1-mm increase; 95% confidence interval [95% CI], 1.048-2.218). The primary patency of RCAVF at 12 months was achieved in 69.4%, 71.8%,and 87.3% of patients with a preoperative DCV-DRA of ⩽-0.6 mm, (-0.5)-0.5 mm, and ⩾0.6 mm, respectively. P for trend was 0.029. Patients with DCV-DRA of ⩾0.6 mm had a much higher chance of 12-month patency than patients with DCV-DRA of ⩽-0.6 mm (aOR, 3.574; 95% CI, 1.276-10.010). Age, gender, radial artery diameter, and cephalic vein diameter did not modify the association of DCV-DRA with primary patency of RCAVF at 12 months.

CONCLUSIONS

Preoperative DCV-DRA may be an under-recognized predictor of RCAVF patency.

Long-term simulated microgravity fosters carotid aging-like changes via Piezo1

AIMS

Elucidating the impacts of long-term spaceflight on cardiovascular health is urgently needed in face of the rapid development of human space exploration. Recent reports including the NASA Twins Study on vascular deconditioning and aging of astronauts in spaceflight are controversial. The aims of this study were to elucidate whether long-term microgravity promotes vascular aging and the underlying mechanisms.

METHODS AND RESULTS

Hindlimb unloading (HU) by tail suspension was used to simulate microgravity in rats and mice. The dynamic changes of carotid stiffness in rats during 8 weeks of HU were determined. Simulated microgravity led to carotid artery aging-like changes as evidenced by increased stiffness, thickness, fibrosis, and elevated senescence biomarkers in the HU rats. Specific deletion of the mechanotransducer Piezo1 in vascular smooth muscles significantly blunted these aging-like changes in mice. Mechanistically, mechanical stretch-induced activation of Piezo1 elevated microRNA-582-5p in vascular smooth muscle cells, with resultant enhanced synthetic cell phenotype and increased collagen deposition via PTEN/PI3K/Akt signalling. Importantly, inhibition of miRNA-582-5p alleviated carotid fibrosis and stiffness not only in HU rats but also in aged rats.

CONCLUSIONS

Long-term simulated microgravity induces carotid aging-like changes via the mechanotransducer Piezo1-initiated and miRNA-mediated mechanism.

Dose-response associations of triglyceride to high-density lipoprotein cholesterol ratio and triglyceride-glucose index with arterial stiffness risk

BACKGROUND

The triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio and triglyceride-glucose (TyG) index are novel indexes for insulin resistance (IR). We aimed to evaluate associations of TG/HDL-C and TyG with arterial stiffness risk.

METHODS

We enrolled 1979 participants from the Rural Chinese Cohort Study, examining arterial stiffness by brachial-ankle pulse wave velocity (baPWV). Logistic and linear regression models were employed to calculate effect estimates. For meta-analysis, we searched relevant articles from PubMed, Embase and Web of Science up to August 26, 2023. The fixed-effects or random-effects models were used to calculate the pooled estimates. We evaluated dose-response associations using restricted cubic splines.

RESULTS

For cross-sectional studies, the adjusted ORs (95%CIs) for arterial stiffness were 1.12 (1.01-1.23) and 1.78 (1.38-2.30) for per 1 unit increment in TG/HDL-C and TyG. In the meta-analysis, the pooled ORs (95% CIs) were 1.26 (1.14-1.39) and 1.57 (1.36-1.82) for per 1 unit increment of TG/HDL-C and TyG. Additionally, both TG/HDL-C and TyG were positively related to PWV, with β of 0.09 (95% CI 0.04-0.14) and 0.57 (95% CI 0.35-0.78) m/s. We also found linear associations of TG/HDL-C and TyG with arterial stiffness risk.

CONCLUSIONS

High TG/HDL-C and TyG were related to increased arterial stiffness risk, indicating TG/HDL-C and TyG may be convincing predictors of arterial stiffness.

Remnant cholesterol trajectory and subclinical arteriosclerosis: a 10-year longitudinal study of Chinese adults

We aimed to identify different trajectories of remnant cholesterol (RC) and investigate the association of RC trajectories with vascular endothelial function and atherosclerosis progression in a longitudinal cohort of the Chinese population. A total of 521 participants were included in the flow-mediated vasodilation (FMD) subcohort study, and 7775 participants were included in the brachial-ankle pulse wave velocity (baPWV) subcohort study. All participants had ≥ 3 medical examinations during the 10-year follow-up period. In the FMD subcohort study, three distinct RC trajectories were identified according to the RC range and changing pattern over time: "low" (57.58%), "moderate" (30.90%) and "high" (11.52%). The proportion of the three groups with vascular endothelial dysfunction (FMD < 7.0%) was 20.00%, 39.75% and 60.00% respectively. Taking the low group as a reference, participants in the moderate and high groups had over 1.88 and 2.94 times the odds of vascular endothelial dysfunction (P = 0.048). In the baPWV subcohort study, three distinct RC trajectories were also identified: "low" (54.29%), "moderate" (38.97%) and "high" (6.74%). The proportion of the three groups with atherosclerosis (baPWV > 1400 cm/s) was 38.79%, 51.26% and 59.01% respectively. Taking the low group as a reference, participants in the moderate and high groups had over 1.46 and 2.16 times the odds of atherosclerosis (P < 0.001). The findings indicated that distinct RC trajectories are significantly associated with vascular endothelial function and atherosclerosis. Regular monitoring to identify persistent increases in RC may be more helpful in identifying individuals with a high risk of cardiovascular disease.

Evaluation of reducing the south and reinforcing the north method on postmenopausal atherosclerosis disease based on 4 diagnostic objectifications: A prospective observational study

Reducing the south and reinforcing the north method (RSRN) has a positive effect on atherosclerosis disease. However, there is a lack of objective standards based on the quantification of 4 diagnostic methods in evaluating the improvement or effectiveness of the treatment. This study aimed to explore the quantitative evaluation of the therapeutic effect of RSRN on postmenopausal atherosclerosis based on the 4 diagnostic methods. The observational prospective cohort study was conducted at Longhua hospital Shanghai University of traditional Chinese medicine. According to the inclusion criteria, 96 patients (disease group) and 38 healthy cases (control group) were selected, the pulse parameters were compared between the 2 groups to demonstrate the reliability and success of the disease model. Then 4 diagnostic information before and after RSRN treatment were collected and statistical analyzed by 1-way analysis of variance (ANOVA) (with Bonferroni correction). Furthermore, social network analysis was used to analyze the changes of symptoms, tongue, pulse, and complexion characteristics before and after treatment. There was a significant difference in pulse parameters between the disease group and the control group. The pulse parameters t1, h3, h3/h1, h4/h1, S, As, and w values in disease group were higher than those in control group, while the h5, h5/h1, and Ad values were lower than those in control group (P < .05). After the treatment of RSRN, the clinical symptoms of patients were greatly improved. The facial color indexes L, a, b values of the disease group at week 6 were different from those at week 0 (P < .05). The overall brightness and chroma of the patient's facial color were significantly improved. The patients had virtual string pulse at week 0, and mainly string I and string II at week 7. The pulse parameters t1, t5, w, w/t, h1, h5, h3/h1, and h5/h1 values at week 7 were different from those at weeks 0, 1, 2 (P < .05); the tongue image was mainly red and crimson, peeling or greasy fur at week 0, while at weeks 6, 7, mainly light red, or thin white tongue. The RSRN method can regulate the complexion, tongue and pulse condition, clinical symptoms of postmenopausal atherosclerosis.

Efficacy and classification of Sesamum indicum linn seeds with Rosa damascena mill oil in uncomplicated pelvic inflammatory disease using machine learning

Background and objectives: As microbes are developing resistance to antibiotics, natural, botanical drugs or traditional herbal medicine are presently being studied with an eye of great curiosity and hope. Hence, complementary and alternative treatments for uncomplicated pelvic inflammatory disease (uPID) are explored for their efficacy. Therefore, this study determined the therapeutic efficacy and safety of Sesamum indicum Linn seeds with Rosa damascena Mill Oil in uPID with standard control. Additionally, we analyzed the data with machine learning. Materials and methods: We included 60 participants in a double-blind, double-dummy, randomized standard-controlled study. Participants in the Sesame and Rose oil group (SR group) (n = 30) received 14 days course of black sesame powder (5 gm) mixed with rose oil (10 mL) per vaginum at bedtime once daily plus placebo capsules orally. The standard group (SC), received doxycycline 100 mg twice and metronidazole 400 mg thrice orally plus placebo per vaginum for the same duration. The primary outcome was a clinical cure at post-intervention for visual analogue scale (VAS) for lower abdominal pain (LAP), and McCormack pain scale (McPS) for abdominal-pelvic tenderness. The secondary outcome included white blood cells (WBC) cells in the vaginal wet mount test, safety profile, and health-related quality of life assessed by SF-12. In addition, we used AdaBoost (AB), Naïve Bayes (NB), and Decision Tree (DT) classifiers in this study to analyze the experimental data. Results: The clinical cure for LAP and McPS in the SR vs SC group was 82.85% vs 81.48% and 83.85% vs 81.60% on Day 15 respectively. On Day 15, pus cells less than 10 in the SR vs SC group were 86.6% vs 76.6% respectively. No adverse effects were reported in both groups. The improvement in total SF-12 score on Day 30 for the SR vs SC group was 82.79% vs 80.04% respectively. In addition, our Naive Bayes classifier based on the leave-one-out model achieved the maximum accuracy (68.30%) for the classification of both groups of uPID. Conclusion: We concluded that the SR group is cost-effective, safer, and efficacious for curing uPID. Proposed alternative treatment (test drug) could be a substitute of standard drug used for Female genital tract infections.

Hypertension combined with atherosclerosis increases the risk of heart failure in patients with diabetes

The increase in heart failure risk in the diabetic population when hypertension and atherosclerosis are both present is still inconclusive. The aim of this study was to explore the effects of hypertension combined with atherosclerosis in diabetic population on the risk of heart failure. We selected 10,711 patients with diabetes who participated in the Kailuan study and completed brachial-ankle pulse wave velocity (baPWV) testing for statistical analysis. The subjects were divided into the non-hypertensive non-atherosclerotic, hypertensive, atherosclerotic, and hypertensive atherosclerotic groups based on their history of hypertension and atherosclerosis. At a median follow-up of 4.15 years, 227 cases of heart failure occurred. Compared with the non-hypertensive non-atherosclerotic group, the multifactorial Cox proportional risk regression model showed that the hazard ratio (HR) for heart failure in the hypertensive atherosclerotic group was 3.08 (95% confidence interval [CI]: 1.32-7.16), whereas the HR decreased to 2.38 (95% CI: 1.01-5.63) after gradual correction of lipid-lowering, glucose-lowering, and antihypertensive drugs. The subgroup analysis and sensitivity analysis were consistent with that of total population. In conclusion, patients with diabetes exposed to both hypertension and atherosclerosis had an increased heart failure risk, which was attenuated by the use of lipid-lowering, glucose-lowering, and antihypertensive drugs.

Long-term exposure to reduced specific-size ambient particulate matter and progression of arterial stiffness among Chinese adults

To assess the associations of ambient specific-size PM with brachial-ankle pulse wave velocity (baPWV) and the progression of arterial stiffness. Participants were included from the Kailuan study, the cross-sectional study involved 36,486 participants, while the longitudinal study enrolled 16,871 participants. PM exposures was assessed through satellite-based random forest approaches at a 1 km resolution. Initial observations indicated a link between baseline baPWV and heightened levels of PM1, PM2.5, and PM10 exposure, and greater effects were observed for PM1 (β: 22.52, 95% CI: 18.14-26.89), followed by PM2.5 (β: 9.76, 95% CI: 7.52-12.00), and PM10 (β: 8.88, 95% CI: 7.32-10.45). Furthermore, the growth rate of baPWV was higher in participants exposed to high levels of PM1 exposure (β: 2.77, 95% CI: 1.19-4.35), succeeded by PM2.5 and PM10. Throughout a median follow-up period of 4.04 years, arterial stiffness was diagnosed in 1709 subjects. Long-term exposure to PM was linked with an increased risk of incident arterial stiffness, estimated HR for fixed 10 µg/m3 increments in annual average PM1 was 2.20 (95% CI: 2.01-2.42), PM2.5 was 1.48 (95% CI: 1.41-1.55), and PM10 1.32 (95% CI: 1.27-1.36). PM had a greater impact on men and older individuals (P for interaction <0.001). Long-term exposures to ambient PM1, PM2.5, and PM10 were positively associated with baPWV and an increased risk of arterial stiffness. Higher estimated effects were observed for PM1 than PM2.5 and PM10.

Impact of arterial stiffness on cerebrovascular function: a review of evidence from humans and preclincal models

With advancing age, the cerebral vasculature becomes dysfunctional, and this dysfunction is associated with cognitive decline. However, the initiating cause of these age-related cerebrovascular impairments remains incompletely understood. A characteristic feature of the aging vasculature is the increase in stiffness of the large elastic arteries. This increase in arterial stiffness is associated with elevated pulse pressure and blood flow pulsatility in the cerebral vasculature. Evidence from both humans and rodents supports that increases in large elastic artery stiffness are associated with cerebrovascular impairments. These impacts on cerebrovascular function are wide-ranging and include reductions in global and regional cerebral blood flow, cerebral small vessel disease, endothelial cell dysfunction, and impaired perivascular clearance. Furthermore, recent findings suggest that the relationship between arterial stiffness and cerebrovascular function may be influenced by genetics, specifically APOE and NOTCH genotypes. Given the strength of the evidence that age-related increases in arterial stiffness have deleterious impacts on the brain, interventions that target arterial stiffness are needed. The purpose of this review is to summarize the evidence from human and rodent studies, supporting the role of increased arterial stiffness in age-related cerebrovascular impairments.

Estimated pulse wave velocity added additional prognostic information in general population: Evidence from National Health and Nutrition Examination Survey (NHANES) 1999-2018

Background

As an indicator of arterial stiffness, there is controversy over whether estimated pulse wave velocity (ePWV) add additional prognostic information other than cardiovascular risk factors or traditional risk estimation model in general population.

Methods

Data from National Health and Nutrition Examination Survey in 1999-2018 was analyzed. Cardiovascular risk factors were collected and Framingham Risk Score (FRS) was calculated. Using all-cause and cardiovascular mortality as outcomes, Cox and restricted cubic spline (RCS) analysis was performed. Receiver operator characteristic (ROC) curves, Harrell's C-statistic and net reclassification index (NRI) analysis were used to assess whether ePWV adds additional predictive value.

Results

The association between ePWV and outcomes was independent of cardiovascular risk factors (HR = 1.23 [95%CI 1.23-1.50] per m/s for all-cause mortality, and 1.52 [1.30-1.78] for cardiovascular mortality) and FRS (1.22 [1.12-1.32] for all-cause mortality, and 1.32 [1.10-1.59] for cardiovascular mortality). Except for ePWV and all-cause mortality adjusted by FRS, a liner association was found between ePWV and outcomes. For predictive value, the area under ROC and C-index of the model added with ePWV was higher than the one with FRS or risk factors alone (P < 0.01). The elevated ePWV upgraded 1338456 subjects from high-intermediate to high FRS category, and NRI was 3.61 % and 2.62 % for all-cause and cardiovascular deaths, respectively (all P < 0.001).

Conclusions

In general population, the present study demonstrated the association between ePWV and all-cause, cardiovascular mortality is independent of cardiovascular risk factors and traditional risk estimated model. ePWV also added additional information to them in predicting clinical outcomes.

Association of High-Sensitivity C-Reactive Protein and Lipoprotein-Associated Phospholipase A2 with Metabolically Unhealthy Phenotype: A Cross Sectional Study

Objective

Whether the combination of high-sensitivity C-reactive protein (hs-CRP) and Lipoprotein-associated Phospholipase A2 (Lp-PLA2) was an independent risk factor for metabolic unhealthy is unknown. This study aimed to evaluate the association between combining hs-CRP and Lp-PLA2 and metabolic unhealthy.

Methods

A total of 3198 participants who underwent routine health check-up examinations. The participants completed inflammation indicators (hs-CRP and Lp-PLA2) examination and physical assessments. Four phenotypes were determined according to obesity and metabolic health status. Meanwhile, the participants were divided into four groups according to the level of hs-CRP and Lp-PLA2. The cross-sectional association between hs-CRP, Lp-PLA2 and metabolic unhealthy was tested by logistic regression analysis.

Results

About 30.48%, 17.35%, 17.32% and 34.83% had MHNO, MUNO, MHO, and MUO, respectively. The combination of the hs-CRP and Lp-PLA2 levels was significantly correlated with metabolic unhealthy in non-obese subjects. However, in obese subjects, only hs-CRP level was significantly correlated with metabolic unhealthy.

Conclusion

The hs-CRP and Lp-PLA2 together were significantly associated with metabolic unhealthy in non-obese subjects. hs-CRP level was significantly correlated with metabolic unhealthy in obese subjects.

Characteristics and correlation of body fat distribution and brachial-ankle pulse wave velocity in adults aged 20-59 years: a cross-sectional study

BACKGROUND

Fat distribution is closely related to vascular stiffness. This study aimed to investigate age and sex differences in fat distribution and brachial-ankle pulse wave velocity (baPWV), and the association between fat parameters and baPWV.

METHODS

A total of 10,811 participants aged 20-59 years were recruited. Measures included waist and hip circumference, waist-to-hip ratio (WHR), body mass index (BMI), percentage body fat (PBF), subcutaneous fat area (SFA), visceral fat area (VFA), and baPWV.

RESULTS

The results confirm that fat accumulates with age and that men tend to carry more abdominal fat than women in the same age group. The findings also indicate that baPWV increases with age and is significantly higher in men than in women in the same age group. In addition, WHR, VFA, and baPWV were more strongly correlated than baPWV and BMI, SFA, and PBF. Finally, the effects of age, PBF, WHR, and VFA on baPWV were greater for the higher quantiles.

CONCLUSIONS

There are age and sex differences in fat distribution and baPWV. Abdominal obesity is more closely linked to arterial stiffness than overall obesity, and people with higher baPWV are more affected by obesity parameters.

Not only baseline but cumulative exposure of remnant cholesterol predicts the development of nonalcoholic fatty liver disease: a cohort study

BACKGROUND AND AIM

Remnant cholesterol (remnant-C) mediates the progression of major adverse cardiovascular events. It is unclear whether remnant-C, and particularly cumulative exposure to remnant-C, is associated with nonalcoholic fatty liver disease (NAFLD). This study aimed to explore whether remnant-C, not only baseline but cumulative exposure, can be used to independently evaluate the risk of NAFLD.

METHODS

This study included 1 cohort totaling 21,958 subjects without NAFLD at baseline who underwent at least 2 repeated health checkups and 1 sub-cohort totaling 2,649 subjects restricted to those individuals with at least 4 examinations and no history of NAFLD until Exam 3. Cumulative remnant-C was calculated as a timeweighted model for each examination multiplied by the time between the 2 examinations divided the whole duration. Cox regression models were performed to estimate the association between baseline and cumulative exposure to remnant-C and incident NAFLD.

RESULTS

After multivariable adjustment, compared with the quintile 1 of baseline remnant-C, individuals with higher quintiles demonstrated significantly higher risks for NAFLD (hazard ratio [HR] 1.48, 95%CI 1.31-1.67 for quintile 2; HR 2.07, 95%CI 1.85-2.33 for quintile 3; HR 2.55, 95%CI 2.27-2.88 for quintile 4). Similarly, high cumulative remnant-C quintiles were significantly associated with higher risks for NAFLD (HR 3.43, 95%CI 1.95-6.05 for quintile 2; HR 4.25, 95%CI 2.44-7.40 for quintile 3; HR 6.29, 95%CI 3.59-10.99 for quintile 4), compared with the quintile 1.

CONCLUSION

Elevated levels of baseline and cumulative remnant-C were independently associated with incident NAFLD. Monitoring immediate levels and longitudinal trends of remnant-C may need to be emphasized in adults as part of NAFLD prevention strategy.

Association of carotid wall shear stress measured by vector flow mapping technique with ba-PWV: a pilot study

Objective

Arterial stiffness is an important tissue biomarker of the progression of atherosclerotic diseases. Brachial-ankle pulse wave velocity (ba-PWV) is a gold standard of arterial stiffness measurement widely used in Asia. Changes in vascular wall shear stress (WSS) lead to artery wall remodeling, which could give rise to an increase in arterial stiffness. The study aimed to explore the association between ba-PWV and common carotid artery (CCA) WSS measured by a newly invented vascular vector flow mapping (VFM) technique.

Methods

We included 94 subjects free of apparent cardiovascular disease (CVD) and divided them into a subclinical atherosclerosis (SA) group (N = 47) and non subclinical atherosclerosis (NSA) group (N = 47). CCA WSS was measured using the VFM technique. Bivariate correlations between CCA WSS and other factors were assessed with Pearson's, Spearman's, or Kendall's coefficient of correlation, as appropriate. Partial correlation analysis was conducted to examine the influence of age and sex. Multiple linear stepwise regression was used for the analysis of independent determinants of CCA WSS. Receiver operating characteristic (ROC) analysis was performed to find the association between CCA WSS and 10-year CVD risk.

Results

The overall subjects had a mean age of 47.9 ± 11.2 years, and males accounted for 52.1%. Average systolic CCA WSS was significantly correlated with ba-PWV (r = -0.618, p < 0.001) in the SA group. Multiple linear stepwise regression analysis confirmed that ba-PWV was an independent determinant of average systolic CCA WSS (β = -0.361, p = 0.003). The area under the curve (AUC) of average systolic CCA WSS for 10-year CVD risk ≥10% was 0.848 (p < 0.001) in the SA group.

Conclusions

Average systolic CCA WSS was significantly correlated with ba-PWV and was associated with 10-year CVD risk ≥10% in the SA group. Therefore, CCA WSS measured by the VFM technique could be used for monitoring and screening subjects with potential CVD risks.

Noninvasive hemodynamic indices of vascular aging: an in silico assessment

Vascular aging (VA) involves structural and functional changes in blood vessels that contribute to cardiovascular disease. Several noninvasive pulse wave (PW) indices have been proposed to assess the arterial stiffness component of VA in the clinic and daily life. This study investigated 19 of these indices, identified in recent review articles on VA, by using a database comprising 3,837 virtual healthy subjects aged 25-75 yr, each with unique PW signals simulated under various levels of artificial noise to mimic real measurement errors. For each subject, VA indices were calculated from filtered PW signals and compared with the precise theoretical value of aortic Young's modulus (EAo). In silico PW indices showed age-related changes that align with in vivo population studies. The cardio-ankle vascular index (CAVI) and all pulse wave velocity (PWV) indices showed strong linear correlations with EAo (Pearson's rp > 0.95). Carotid distensibility showed a strong negative nonlinear correlation (Spearman's rs < -0.99). CAVI and distensibility exhibited greater resilience to noise compared with PWV indices. Blood pressure-related indices and photoplethysmography (PPG)-based indices showed weaker correlations with EAo (rp and rs < 0.89, |rp| and |rs| < 0.84, respectively). Overall, blood pressure-related indices were confounded by more cardiovascular properties (heart rate, stroke volume, duration of systole, large artery diameter, and/or peripheral vascular resistance) compared with other studied indices, and PPG-based indices were most affected by noise. In conclusion, carotid-femoral PWV, CAVI and carotid distensibility emerged as the superior clinical VA indicators, with a strong EAo correlation and noise resilience. PPG-based indices showed potential for daily VA monitoring under minimized noise disturbances.NEW & NOTEWORTHY For the first time, 19 noninvasive pulse wave indices for assessing vascular aging were examined together in a single database of nearly 4,000 subjects aged 25-75 yr. The dataset contained precise values of the aortic Young's modulus and other hemodynamic measures for each subject, which enabled us to test each index's ability to measure changes in aortic stiffness while accounting for confounding factors and measurement errors. The study provides freely available tools for analyzing these and additional indices.

Pharmacological modulation of vascular ageing: A review from VascAgeNet

Vascular ageing, characterized by structural and functional changes in blood vessels of which arterial stiffness and endothelial dysfunction are key components, is associated with increased risk of cardiovascular and other age-related diseases. As the global population continues to age, understanding the underlying mechanisms and developing effective therapeutic interventions to mitigate vascular ageing becomes crucial for improving cardiovascular health outcomes. Therefore, this review provides an overview of the current knowledge on pharmacological modulation of vascular ageing, highlighting key strategies and promising therapeutic targets. Several molecular pathways have been identified as central players in vascular ageing, including oxidative stress and inflammation, the renin-angiotensin-aldosterone system, cellular senescence, macroautophagy, extracellular matrix remodelling, calcification, and gasotransmitter-related signalling. Pharmacological and dietary interventions targeting these pathways have shown potential in ameliorating age-related vascular changes. Nevertheless, the development and application of drugs targeting vascular ageing is complicated by various inherent challenges and limitations, such as certain preclinical methodological considerations, interactions with exercise training and sex/gender-related differences, which should be taken into account. Overall, pharmacological modulation of endothelial dysfunction and arterial stiffness as hallmarks of vascular ageing, holds great promise for improving cardiovascular health in the ageing population. Nonetheless, further research is needed to fully elucidate the underlying mechanisms and optimize the efficacy and safety of these interventions for clinical translation.

Gender and age disparities in small-to-medium arterial stiffness among the Chinese population

BACKGROUND AND AIMS

Arterial pressure-volume index (API) is a non-invasive tool for assessing small-to-medium-sized arterial stiffness. This study aimed to investigate the potential age- and sex-related differences in the API and explore the practical implications of such differences.

METHODS AND RESULTS

The study analysed 7620 subjects for whom API measurements were available. Linear regression and restrictive cubic spline models were used to investigate the associations between potential risk conditions and the API. Additionally, this study employed a backward stepwise regression method to identify the independent factors associated with a high API. Middle-aged to older women had higher API values and a higher prevalence of high API than men in the same age group. However, the opposite was observed among younger individuals, with women having lower API values than men. This study also identified a J-shaped relationship between API and age, where API values began to increase at a certain age and rapidly increased after that. In women, the API started to increase at 31 years of age and rapidly increased after 54 years of age. In men, the API started to increase at 38 years of age, followed by a rapid increase after 53 years of age.

CONCLUSION

This study's observation of a significant age-sex interaction in small-to-medium-sized arterial stiffening offers a valuable explanation for cardiovascular disease risk and provides important parameters for using API measurements to evaluate such risk.

Positive correlation between lipid accumulation product index and arterial stiffness in Chinese patients with type 2 diabetes

Background

Many studies have confirmed that lipid accumulation products (LAP) predict arterial stiffness (AS) in hypertensive patients. But there is little research on the use of LAP in identifying early atherosclerosis in patients with type 2 diabetes mellitus (T2DM). The aim of this study was to determine the relationship between the LAP index and brachial-ankle pulse wave velocity (baPWV) in Chinese patients with T2DM.

Methods

A total of 1471 Chinese participants with T2DM, ranging in age from 18 to 80, were included in this cross-sectional study. BaPWV measurements were used to calculate the AS. A baPWV greater than the 75th percentile (1700 cm/s) was defined as indicating increased AS. The LAP index was calculated from the combination of waist circumference (WC) and triglycerides (TG).

Results

According to the quartiles of the LAP index, baPWV tended to increase after adjusting for sex and age. Multiple linear regression analysis showed that the beta coefficient (β) of baPWV increased by 31.0 cm/s for each unit of lnLAP that was increased, and the 95% confidence interval (CI) was (6.5, 55.5) cm/s. In multivariate logistic regression analyses, after fully adjusting for confounders, the risk of elevated baPWV increased with each unit increase in lnLAP, with an odds ratio (OR) of 1.3 (95% CI: 1.0, 1.8). According to the generalized additive model (GAM), we found that lnLAP was positively correlated with baPWV and baPWV elevation. The results were the same for males and females. Subgroup analyses showed that the positive correlation between lnLAP and elevated baPWV did not interact across all subgroups.

Conclusions

In Chinese patients with T2DM, LAP was strongly and positively correlated with baPWV and elevated baPWV.

Assessment of aortic to peripheral vascular stiffness and gradient by segmented upper limb PWV in healthy and hypertensive individuals

Theoretically pulse wave velocity (PWV) is obtained by calculating the distance between two waveform probes divided by the time difference, and PWV ratio is used to assess the arterial stiffness gradient (SG) from proximal to distal. The aim was to investigate segmental upper-limb PWV (ulPWV) differences and the effects of hypertension and or aging on each ulPWV and SG. The study collected multi-waveform signals and conduction distances from 167 healthy individuals and 92 hypertensive patients. The results showed significant differences between ulPWVs (P < 0.001), with increased and then decreased vascular stiffness along the proximal transmission to the distal peripheral artery and then to the finger. Adjusted for age and sex, ulPWVs in hypertension exceeded that of healthy individuals, with significant differences between groups aged ≥ 50 years (P < 0.05). The hrPWV/rfPWV (heart-radial/radial-finger) was reduced in hypertension and differed significantly between the aged ≥ 50 years (P = 0.015); the ratio of baPWV (brachial-ankle) to ulPWV differed significantly between groups (P < 0.05). Hypertension affected the consistency of rfPWV with hfPWV (heart-finger). The findings suggest that segmented ulPWV is instrumental in providing stiffness corresponding to the physiological structure of the vessel. The superimposition of hypertension and or aging exacerbates peripheral arterial stiffness, as well as alteration in stiffness gradient.