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van der Sluijs KM, Thannhauser J, Visser IM, Nabeel PM, Raj KV, Malik AEF, Reesink KD, Eijsvogels TMH, Bakker EA, Kaur P, Joseph J, Thijssen DHJ. Central and local arterial stiffness in White Europeans compared to age-, sex-, and BMI-matched South Asians. PLoS One 2023; 18:e0290118. [PMID: 37616275 PMCID: PMC10449187 DOI: 10.1371/journal.pone.0290118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/01/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Ethnicity impacts cardiovascular disease (CVD) risk, and South Asians demonstrate a higher risk than White Europeans. Arterial stiffness is known to contribute to CVD, and differences in arterial stiffness between ethnicities could explain the disparity in CVD risk. We compared central and local arterial stiffness between White Europeans and South Asians and investigated which factors are associated with arterial stiffness. METHODS Data were collected from cohorts of White Europeans (the Netherlands) and South Asians (India). We matched cohorts on individual level using age, sex, and body mass index (BMI). Arterial stiffness was measured with ARTSENS® Plus. Central stiffness was expressed as carotid-femoral pulse wave velocity (cf-PWV, m/s), and local carotid stiffness was quantified using the carotid stiffness index (Beta) and pressure-strain elastic modulus (Epsilon, kPa). We compared arterial stiffness between cohorts and used multivariable linear regression to identify factors related to stiffness. RESULTS We included n = 121 participants per cohort (age 53±10 years, 55% male, BMI 24 kg/m2). Cf-PWV was lower in White Europeans compared to South Asians (6.8±1.9 vs. 8.2±1.8 m/s, p<0.001), but no differences were found for local stiffness parameters Beta (5.4±2.4 vs. 5.8±2.3, p = 0.17) and Epsilon (72±35 vs. 70±31 kPa, p = 0.56). Age (standardized β, 95% confidence interval: 0.28, 0.17-0.39), systolic blood pressure (0.32, 0.21-0.43), and South Asian ethnicity (0.46, 0.35-0.57) were associated with cf-PWV; associations were similar between cohorts (p>0.05 for interaction). Systolic blood pressure was associated with carotid stiffness in both cohorts, whereas age was associated to carotid stiffness only in South Asians and BMI only in White Europeans. CONCLUSION Ethnicity is associated with central but not local arterial stiffness. Conversely, ethnicity seems to modify associations between CVD risk factors and local but not central arterial stiffness. This suggests that ethnicity interacts with arterial stiffness measures and the association of these measures with CVD risk factors.
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Affiliation(s)
- Koen M. van der Sluijs
- Department of Medical BioSciences, Radboud University Medical Center, Nijmegen, Gelderland, The Netherlands
| | - Jos Thannhauser
- Department of Medical BioSciences, Radboud University Medical Center, Nijmegen, Gelderland, The Netherlands
- Faculty of Science and Technology, Department of Cardiovascular and Respiratory Physiology, University of Twente, Enschede, Overijssel, The Netherlands
| | - Iris M. Visser
- Department of Medical BioSciences, Radboud University Medical Center, Nijmegen, Gelderland, The Netherlands
- Technical Medicine, University of Twente, Enschede, Overijssel, The Netherlands
| | - P. M. Nabeel
- Healthcare Technology Innovation Centre, Indian Institute of Technology Madras, Chennai, Tamil Nadu, India
| | - Kiran V. Raj
- Department of Electrical Engineering, Indian Institute of Technology Madras, Chennai, Tamil Nadu, India
| | - Afrah E. F. Malik
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, Limburg, The Netherlands
| | - Koen D. Reesink
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, Limburg, The Netherlands
| | - Thijs M. H. Eijsvogels
- Department of Medical BioSciences, Radboud University Medical Center, Nijmegen, Gelderland, The Netherlands
| | - Esmée A. Bakker
- Department of Medical BioSciences, Radboud University Medical Center, Nijmegen, Gelderland, The Netherlands
| | - Prabhdeep Kaur
- National Institute of Epidemiology, Indian Council of Medical Research, Chennai, Tamil Nadu, India
| | - Jayaraj Joseph
- Department of Electrical Engineering, Indian Institute of Technology Madras, Chennai, Tamil Nadu, India
| | - Dick H. J. Thijssen
- Department of Medical BioSciences, Radboud University Medical Center, Nijmegen, Gelderland, The Netherlands
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Gujral UP, Mehta A, Sher S, Uphoff I, Kumar S, Hayek SS, Ko YA, Martin GS, Gibbons GH, Quyyumi AA. Ethnic differences in subclinical vascular function in South Asians, Whites, and African Americans in the United States. IJC HEART & VASCULATURE 2020; 30:100598. [PMID: 32793802 PMCID: PMC7408720 DOI: 10.1016/j.ijcha.2020.100598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/29/2020] [Accepted: 07/20/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND South Asians are a high-risk ethnic group for cardiovascular disease despite having lower levels of conventional cardiovascular risk factors such as obesity and smoking. Ethnic differences in pulse wave reflections, arterial stiffness, and subclinical atherosclerosis as measured using augmentation index (AIX), pulse wave velocity (PWV), and carotid intima-media thickness (CIMT) may reflect some of this excess risk. METHODS We conducted a cross-sectional analysis of pooled data from three community-based sources in Atlanta, Georgia, USA. Data on 530 South Asians collected from local health fairs was compared with data on 507 White and 192 African Americans from the Emory Predictive Health Initiative and 351 White and 382 African Americans from the Morehouse and Emory Team up to Eliminate Health Disparities Study. RESULTS Linear regression models adjusted for age, sex, smoking, MAP, fasting glucose, TC, HDL-C, creatinine, and body mass index were used to assess the relationship between ethnicity and vascular function measures. In fully adjusted models, South Asians had higher heart rate corrected AIX as compared with Whites and African Americans (by 5.47%, p < 0.01 and 3.50%, p < 0.01; respectively), but lower PWV (by 0.51 m/s, p < 0.01 and 0.72 m/s, p < 0.01; respectively) and lower CIMT (by 0.02 mm p = 0.03 and 0.04 mm p < 0.01; respectively). CONCLUSIONS Systemic pulse wave reflections, independent of other risk factors, are higher in South Asians as compared with Whites and African Americans. Future research is needed to determine whether higher AIX explains the increased cardiovascular risk among South Asians.
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Affiliation(s)
- Unjali P. Gujral
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Anurag Mehta
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Salman Sher
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Irina Uphoff
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Saket Kumar
- Ohio State University, Wexner Medical Center, Department of Emergency Medicine, USA
| | - Salim S. Hayek
- Frankel Cardiovascular Center, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Yi-An Ko
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Greg S. Martin
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Gary H. Gibbons
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Arshed A. Quyyumi
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Ethnic Differences in Arterial Wave Reflection Are Mostly Explained by Differences in Body Height - Cross-Sectional Analysis of the HELIUS Study. PLoS One 2016; 11:e0160243. [PMID: 27472397 PMCID: PMC4966932 DOI: 10.1371/journal.pone.0160243] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 07/15/2016] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Differences in arterial wave reflection and central blood pressure (BP) have been associated with cardiovascular disease (CVD) in various populations and may contribute to ethnic differences in CVD. Whether ethnic differences in wave reflection and central BP can be explained by conventional risk factors for CVD or may result from physiological differences remains undetermined. METHODS We examined ethnic differences in augmentation index (AIx) and central systolic BP and their determinants in a large multi-ethnic cohort study in Amsterdam, the Netherlands. A total of 8812 (46% male) participants aged 18-70 years of Dutch, South-Asian Surinamese, African Surinamese and Ghanaian origin were included. AIx and central BP were measured in duplicate using the Arteriograph system. RESULTS AIx and central systolic BP were significantly higher in South-Asian Surinamese (35±17%, 126±22 mmHg), African Surinamese (33±17%, 129±23 mmHg) and Ghanaian (33±16%, 135±24 mmHg) as compared with Dutch (27±17%, 118±20 mmHg, all p<0.001). Correction for cardiovascular risk factors only slightly reduced the difference in AIx, whereas correction for body height attenuated age and gender corrected ethnic differences in AIx the most. Differences in central systolic BP were primarily determined by differences in AIx for South-Asian Surinamese and by differences in peripheral systolic BP for subjects of African origin. CONCLUSIONS Substantial differences in AIx and central BP exist across different ethnic groups that cannot be explained by differences in conventional risk factors for CVD. These findings may explain part of the underestimation of cardiovascular risk observed in populations of African and South-Asian descent.
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Brar I, Robertson AD, Hughson RL. Increased central arterial stiffness and altered cerebrovascular haemodynamic properties in South Asian older adults. J Hum Hypertens 2015; 30:309-14. [PMID: 26178590 DOI: 10.1038/jhh.2015.76] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 05/25/2015] [Accepted: 06/04/2015] [Indexed: 01/22/2023]
Abstract
South Asians (SA) suffer from a higher burden of heart disease and stroke compared with White Caucasians (CA). We hypothesized that increased arterial stiffness in older adults of SA origin would be associated with greater cerebrovascular pulsatile pressure and flow characteristics compared with CA older adults. Forty-four SA and CA older adults, free of known cardiovascular and cerebrovascular diseases, were assessed. Vascular ageing was characterized by brachial-ankle pulse wave velocity, carotid pulse pressure, compliance coefficient (CC) and intima-media thickness (IMT). Duplex ultrasonography of the internal carotid arteries estimated anterior cerebral blood flow (aCBF) and cerebrovascular resistance (aCVR), and transcranial Doppler ultrasound quantified middle cerebral artery blood flow velocity, resistive index (RI) and pulsatility index (PI). Fasting blood samples were collected to assess glycaemic status, lipid profile and C-reactive protein. SA had higher carotid pulse pressure and lower CC indicating stiffer arteries compared with CA. Multiple regression analyses revealed that ethnic differences in arterial stiffness were associated with glycated haemoglobin level in SA. Among SA, an inverse association was observed between carotid CC and aCVR. In turn, aCVR was associated with a steeper reduction in aCBF in SA than in CA. IMT was strongly associated with greater PI and RI (r>0.81, P<0.001) in SA, whereas a weaker relationship for PI (r=0.46, P=0.03) and no significant relationship for RI were found in CA. The study found stronger associations between pulsatile cerebrovascular haemodynamics and structural and functional alterations in central arteries in SA that may underlie the elevated risk for cerebrovascular disease.
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Affiliation(s)
- I Brar
- Faculty of Applied Health Sciences, Schlegel-University of Waterloo Research Institute for Aging, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - A D Robertson
- Faculty of Applied Health Sciences, Schlegel-University of Waterloo Research Institute for Aging, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - R L Hughson
- Faculty of Applied Health Sciences, Schlegel-University of Waterloo Research Institute for Aging, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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Bakker LEH, Sleddering MA, Schoones JW, Meinders AE, Jazet IM. Pathogenesis of type 2 diabetes in South Asians. Eur J Endocrinol 2013; 169:R99-R114. [PMID: 23939919 DOI: 10.1530/eje-13-0307] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The risk of developing type 2 diabetes mellitus (T2DM) is exceptionally high among both native and migrant South Asians. T2DM occurs more often and at a younger age and lower BMI, and the risk of coronary artery and cerebrovascular disease, and renal complications is higher for South Asians compared with people of White Caucasian descent. The high prevalence of T2DM and its related complications in South Asians, which comprise one-fifth of the total world's population, poses a major health and socioeconomic burden. The underlying cause of this excess risk, however, is still not completely understood. Therefore, gaining insight into the pathogenesis of T2DM in South Asians is of great importance. The predominant mechanism, in this ethnicity seems to be insulin resistance (IR) rather than an impaired β-cell function. In this systematic review, we describe several possible mechanisms that may underlie or contribute to the increased IR observed in South Asians.
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Affiliation(s)
- Leontine E H Bakker
- Department of General Internal Medicine and Endocrinology Walaeus Library, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
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Abstract
Arterial stiffness is an important clinical marker of cardiovascular diseases. Although many studies have been conducted on different racial groups, less is known about arterial stiffness in Asian Americans. Korean Americans constitute the fifth largest subgroup in the Asian American population and reportedly have a noticeably high prevalence of hypertension. The aims of this study were to assess arterial stiffness and blood pressure and to examine the effect of age and gender on arterial stiffness and blood pressure in 102 Korean American men and women aged 21 to 60 years. The values of arterial stiffness for Korean Americans in this study were compared to published reference values for other racial and ethnic groups. Arterial stiffness was measured by carotid-femoral pulse wave velocity, which is the gold standard for determining arterial stiffness. Findings indicated that aging was an important determinant of arterial stiffness, which increased linearly with age. Although there was no gender difference observed in arterial stiffness, the effect of age on arterial stiffness was greater in women than in men. After adjusting for covariates including age, body mass index, and smoking, multiple regression models showed that arterial stiffness and gender were significant predictors of systolic and diastolic blood pressure. The comparisons of these findings to those from several other studies that used the same method to measure arterial stiffness showed that Korean Americans may have levels of arterial stiffness that are similar to or slightly higher than those of other racial groups. Considering that arterial stiffness is an independent predictor of future development of hypertension, more studies are required to examine cardiovascular risk of this understudied group.
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Blood pressure and body mass index: a comparison of the associations in the Caucasian and Asian populations. Hypertens Res 2012; 35:523-30. [DOI: 10.1038/hr.2011.219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Rezai MR, Wallace AM, Sattar N, Finn JD, Wu FCW, Cruickshank JK. Ethnic differences in aortic pulse wave velocity occur in the descending aorta and may be related to vitamin D. Hypertension 2011; 58:247-53. [PMID: 21670413 DOI: 10.1161/hypertensionaha.111.174425] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We studied aortic pulse wave velocity (aPWV), a predictor of cardiovascular events independent of blood pressure, in a multiethnic sample of British men, to investigate the roles for blood levels of vitamin D and aldosterone in total and regional aortic stiffness. Total aPWV was estimated noninvasively by the Arteriograph device (aPWV(AG)) in 198 men, with its length measure calibrated by magnetic resonance. PWVs over the aortic arch and descending aorta were measured by magnetic resonance in a subsample (n=47). Mean (SE) aPWV(AG) in South Asians (n=68; age 55±10 years), at known higher coronary disease risk than other groups, was 0.5 m/s (0.2 m/s) higher than in African Caribbeans (n=67; 55±10 years), at lowest coronary disease risk here, and Europeans (n=63; 57±8 years), adjusted for age, systolic blood pressure, and diabetes mellitus (P=0.01). By magnetic resonance, PWV over the descending aorta in South Asians was 0.7 m/s (0.3 m/s) and 0.8 m/s (0.3 m/s) higher than in African Caribbeans and Europeans, respectively; PWV over the aortic arch was not different. South Asians and African Caribbeans had 21 nmol/L (3 nmol/L) and 14 nmol/L (3 nmol/L) lower mean (SE) 25(OH)D than Europeans (P<0.001). Unlike aldosterone, 25(OH)D was negatively correlated with aPWV(AG) adjusted for age and systolic blood pressure, as well as weakened or removed ethnic differences in aPWV(AG) in regression models. These data suggest that aortic stiffness as aPWV parallels coronary disease risk in ethnic groups, descending aortic but not arch PWV has this feature, and serum 25(OH)D is an independent negative correlate of aPWV and may partly account for ethnicity-related differences in aPWV and coronary disease risk.
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Affiliation(s)
- Mohammad-Reza Rezai
- Diabetes, Nutrition & Cardiovascular Medicine Research Group, Franklin-Wilkins Building level 4, King's College University of London & King's Health Partners, 150 Stamford Street, London SE1 9NH, UK
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Gholap N, Davies M, Patel K, Sattar N, Khunti K. Type 2 diabetes and cardiovascular disease in South Asians. Prim Care Diabetes 2011; 5:45-56. [PMID: 20869934 DOI: 10.1016/j.pcd.2010.08.002] [Citation(s) in RCA: 152] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Revised: 07/26/2010] [Accepted: 08/13/2010] [Indexed: 02/07/2023]
Abstract
Type 2 diabetes (T2DM) is growing at a pandemic scale and is associated with a rapid increase in its complications such as cardiovascular diseases (CVD). This problem is even worse in South Asian population with South Asian people having a much higher prevalence of T2DM and CVD, occurring at an earlier age and being associated with premature and high mortality. This review looks in detail at the current knowledge on epidemiology and characteristic pathophysiology of T2DM and CVD (coronary heart disease, heart failure, stroke and peripheral vascular disease) in South Asian migrant population. Specific attention is also drawn to the role of novel risk factors and cultural and socioeconomic factors on occurrence and outcomes of these chronic diseases in this population. Finally the review makes recommendations on various measures including need for further research to tackle this serious health challenge facing the South Asian community.
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Affiliation(s)
- Nitin Gholap
- Department of Diabetes Research, University Hospitals of Leicester NHS Trust, Leicester, UK.
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Brillante DG, O'Sullivan AJ, Howes LG. Arterial stiffness indices in healthy volunteers using non-invasive digital photoplethysmography. Blood Press 2008; 17:116-23. [PMID: 18568701 DOI: 10.1080/08037050802059225] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Increased arterial stiffness is a marker of cardiovascular damage, even in the absence of clinically apparent disease. It is likely to become an important clinical tool in cardiovascular risk assessment. AIMS AND METHODS We studied a group of healthy subjects and measured their arterial stiffness by digital photoplethysmography. We aimed to obtain a range of arterial stiffness values, and investigated the influence of age, gender, race, body mass index, fasting lipids and haemodynamic factors. RESULTS One hundred and fifty-two healthy subjects, aged between 18 and 67 years, on no medications and with no significant medical illnesses were recruited. The population was predominantly Caucasian (n = 112). Two measures of arterial stiffness were obtained: stiffness index (SI), a measure of large arterial stiffness, and reflection index (RI), a measure of small to medium-sized arterial stiffness. SI and RI were significantly correlated with age, total cholesterol, low-density lipoprotein-cholesterol, heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP). Race was a significant independent predictor of SI. CONCLUSION Digital photoplethysmography is a portable, operator-independent, reproducible and simple method of measuring arterial stiffness. Ranges of normality of arterial stiffness will depend on the individual's age, race, lipid levels, HR and blood pressure.
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Affiliation(s)
- Divina G Brillante
- St George Clinical School, University of New South Wales, St George Hospital, Kogarah, NSW, Australia
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Hall LML, Sattar N, Gill JMR. Risk of metabolic and vascular disease in South Asians: potential mechanisms for increased insulin resistance. ACTA ACUST UNITED AC 2008. [DOI: 10.2217/17460875.3.4.411] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Impact of mean arterial blood pressure on higher arterial stiffness indices in South Asians compared to white Europeans. J Hypertens 2008; 26:1420-6. [DOI: 10.1097/hjh.0b013e3282ffb42a] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Jaumdally JR, Varma C, Lip GYH. Statin therapy in South-Asian patients: clinical implications beyond lipid lowering? Expert Opin Pharmacother 2007; 8:1235-43. [PMID: 17563259 DOI: 10.1517/14656566.8.9.1235] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Whether used as primary or secondary prevention, 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors (statins) can lead to a significant reduction in mortality and morbidity from cardiovascular disease. Given the benefit in halting atherosclerotic disease progression in patients with stable and acute coronary syndrome, the potential for use in South-Asians remains largely unreported. As this ethnic group has a high rate of coronary events at a younger age, with more extensive and diffuse atheroma, the authors review the impact of statins in relation to observed lipid profiles, as well as novel markers of vascular disease.
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Affiliation(s)
- J Rumi Jaumdally
- Haemostasis Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham, B18 7QH, UK
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