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Sipahioglu NT, Ilerigelen B, Gungor ZB, Ayaz G, Ekmekci H, Gurel CB, Can G, Sonmez H, Ulutin T, Sipahioglu F. Relation of Biochemical Parameters with Flow-mediated Dilatation in Patients with Metabolic Syndrome. Chin Med J (Engl) 2018. [PMID: 28639572 PMCID: PMC5494920 DOI: 10.4103/0366-6999.208231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Metabolic syndrome (MetS) is one of the high cardiovascular (CV) situations. Endothelial dysfunction, which is a common finding in patients with MetS, is related with increased CV risk. In patients with MetS, the effect of the major CV risk factors, not included in the MetS definition, on endothelial dysfunction is not well known. The aim of this study was to determine the effect of major CV risk factors such as gender, smoking, family history, and biochemical parameters on endothelial dysfunction in patients with MetS. METHODS The study was performed between December 2010 and August 2014. A total of 55 patients (15 females and 40 males) with MetS and 81 healthy controls (37 females and 44 males) with a body mass index <25 kg/m2 were enrolled in the study. Endothelial dysfunction was measured by flow-mediated dilatation (FMD), oxidative stress parameters; high-sensitivity C-reactive protein (hs-CRP), oxidized low-density lipoprotein (ox-LDL), endothelial nitric oxide synthase (e-NOS), nitric oxide, and cell adhesion markers; von Willebrand factor, and e-selectin. Platelet aggregation (endothelial adenosine diphosphate), total platelet count, and mean platelet volume were additionally analyzed and demographic parameters were explored. Student's t- test, Mann-Whitney U-test, and Chi-square test were used to analyze the results. RESULTS The fasting blood glucose (z= 3.52, P= 0.001), hs-CRP (z = 3.23, P= 0.004), ox-LDL (z = 2.62, P= 0.013), and e-NOS (z = 2.22, P= 0.026) levels and cardiac risk score (z = 5.23, P< 0.001) were significantly higher in patients with MetS compared with the control group. Smoking was correlated with decreased FMD (χ2 = 9.26, P= 0.002) in MetS patients but not in the control group. CONCLUSIONS Increased ox-LDL, hs-CRP, and e-NOS are likely to be a result of oxidative stress, a condition in which an imbalance occurs between the production and inactivation of reactive nitrogen and oxygen species. In addition, in patients with MetS, smoking is independently related to endothelial dysfunction.
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Affiliation(s)
| | - Barıs Ilerigelen
- Department of Cardiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul 34303, Turkey
| | - Zeynep B Gungor
- Department of Biochemistry, Cerrahpasa Medical Faculty, Istanbul University, Istanbul 34303, Turkey
| | - Gulsel Ayaz
- Department of Medical Biology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul 34303, Turkey
| | - Hakan Ekmekci
- Department of Biochemistry, Cerrahpasa Medical Faculty, Istanbul University, Istanbul 34303, Turkey
| | - Cigdem Bayram Gurel
- Department of Medical Biology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul 34303, Turkey
| | - Gunay Can
- Department of Public Health, Cerrahpasa Medical Faculty, Istanbul University, Istanbul 34303, Turkey
| | - Huseyin Sonmez
- Department of Biochemistry, Cerrahpasa Medical Faculty, Istanbul University, Istanbul 34303, Turkey
| | - Turgut Ulutin
- Department of Medical Biology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul 34303, Turkey
| | - Fikret Sipahioglu
- Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Istanbul 34303, Turkey
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Owei I, Umekwe N, Mohamed H, Ebenibo S, Wan J, Dagogo-Jack S. Ethnic Disparities in Endothelial Function and Its Cardiometabolic Correlates: The Pathobiology of Prediabetes in A Biracial Cohort Study. Front Endocrinol (Lausanne) 2018; 9:94. [PMID: 29593654 PMCID: PMC5859032 DOI: 10.3389/fendo.2018.00094] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 02/27/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Endothelial function (EF) reflects the balance between vasodilatory and vasoconstrictive factors produced by (or acting on) the innermost lining of blood vessels. Endothelial dysfunction, an imbalance between these factors that favors vasoconstriction, has been associated with increased risk for cardiovascular disease. However, the influence of race/ethnicity and glycemic status on association between EF and cardiovascular risk factors remain to be clarified. SUBJECTS AND METHODS We assessed EF in relation to glycemia and cardiometabolic profile in African-American (AA) and European-American (EA) offspring of parents with type 2 diabetes (T2D), who are participants in the prospective pathobiology and reversibility of prediabetes in a biracial cohort (PROP-ABC) study. Assessments at enrollment included a 75 g oral glucose tolerance test (OGTT), blood pressure, anthropometry, body composition (DEXA), and lipid profile. Other assessments were insulin sensitivity and resting energy expenditure. EF was measured using flow-mediated vasodilation (EndoPAT 2000) and expressed as reactive hyperemia index (RHI). RESULTS We studied 190 subjects (100 AA, 90 C), mean age (±SD) 53.1 ± 9.1 years, and body mass index 30.6 ± 6.8 kg/m2. Based on OGTT data, 96 subjects (52 AA, 44 EA) had prediabetes and 94 subjects were normoglycemic (48 AA and 46 EA). The RHI was lower in AA than EA (2.17 ± 0.55 vs. 2.36 ± 0.72, P = 0.05) and in prediabetic than normoglycemic subjects (2.14 ± 0.62 vs. 2.38 ± 0.65, P = 0.013). Using RHI ≤ 1.68 as diagnostic cut-off, 19% of participants with prediabetes and 10% of normoglycemic participants had endothelial dysfunction (P = 0.04). In univariate models, RHI was positively associated with age and HDL cholesterol levels, and inversely associated with adiposity, diastolic blood pressure, and 2hr plasma glucose. The association between RHI and adiposity was stronger in men than women. The association between RHI and age, glucose and HDL cholesterol displayed marked ethnic disparities. CONCLUSION In our biracial cohort comprising offspring of parents with T2D, prediabetes increased the risk of endothelial dysfunction. However, the association between EF and cardiometabolic risk factors was significantly modified by ethnicity and gender. Our findings support current understanding of endothelial dysfunction as an early sensitive indicator of cardiometabolic risk.
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Affiliation(s)
- Ibiye Owei
- Division of Endocrinology, Diabetes, and Metabolism, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Nkiru Umekwe
- Division of Endocrinology, Diabetes, and Metabolism, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Hanan Mohamed
- Division of Endocrinology, Diabetes, and Metabolism, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Sotonte Ebenibo
- Division of Endocrinology, Diabetes, and Metabolism, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Jim Wan
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Sam Dagogo-Jack
- Division of Endocrinology, Diabetes, and Metabolism, University of Tennessee Health Science Center, Memphis, TN, United States
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Ramos JS, Dalleck LC, Tjonna AE, Beetham KS, Coombes JS. The Impact of High-Intensity Interval Training Versus Moderate-Intensity Continuous Training on Vascular Function: a Systematic Review and Meta-Analysis. Sports Med 2015; 45:679-92. [DOI: 10.1007/s40279-015-0321-z] [Citation(s) in RCA: 290] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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4
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Lind L. Endothelium-dependent vasodilation predicts the development of the metabolic syndrome. Clin Physiol Funct Imaging 2014; 35:411-7. [PMID: 24890287 DOI: 10.1111/cpf.12177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 05/09/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND Different techniques to evaluate endothelium-dependent vasodilation (EDV) in resistance and conduit arteries have been described and have been associated with the occurrence of the metabolic syndrome (MetS) in cross-sectional studies. This study aimed to evaluate whether EDV in resistance and conduit arteries could predict future development of the MetS in the Prospective Study of the Vasculature in Uppsala Seniors (PIVUS) study. METHODS In the population-based PIVUS study (1016 subjects all aged 70 at baseline), the invasive forearm technique with acetylcholine given in the brachial artery (resistance arteries, EDV) and the brachial artery ultrasound technique with the measurement of flow-mediated dilatation (conduit artery, FMD) were evaluated. Six hundred and twenty-four subjects free of the MetS (NCEP/ATPIII criteria) at the age of 70 were reinvestigated at the age of 75. RESULTS During the 5-year follow-up, 109 new subjects developed the MetS. EDV, but not FMD, predicted the development of the MetS (OR 0.78 for a 1 SD increase in EDV, 95%CI 0.62-0.97, P = 0.033). Of the five components of the MetS, EDV could significantly predict the development of the glucose (P = 0.02), waist circumference (P = 0.01) and the triglyceride components (P = 0.002), but not significantly so the HDL (P = 0.09) and blood pressure components (P = 0.92). CONCLUSIONS EDV in resistance arteries, but not in the brachial conduit artery (FMD), was a predictor of future development of the MetS, mainly by prediction of future impairments in fasting glucose, serum triglycerides and waist circumference in an elderly cohort.
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Affiliation(s)
- Lars Lind
- Department of Medical Sciences, University Hospital, Uppsala University, Uppsala, Sweden
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Abstract
To test prospectively in hypertensives whether moderate and vigorous exercise produces equivalent reductions in mortality, Cox-proportional hazard analyses were applied to energy expenditure (metabolic equivalents hours/d [METh/d]) in 6973 walkers and 3907 runners who used hypertensive medications at baseline. A total of 1121 died during 10.2-year follow-up: 695 cardiovascular disease (International Classification of Diseases, Tenth Revision [ICD10] I00-99; 465 underlying cause and 230 contributing cause), 124 cerebrovascular disease, 353 ischemic heart disease (ICD10 I20-25; 257 underlying and 96 contributing), 122 heart failure (ICD10 I50; 24 underlying and 98 contributing), and 260 dysrhythmias (ICD10 I46-49; 24 underlying and 236 contributing). Relative to <1.07 METh/d, running or walking 1.8 to 3.6 METh/d produced significantly lower all-cause (29% reduction; 95% confidence interval [CI], 17%-39%; P=0.0001), cardiovascular disease (34% reduction; 95% CI, 20%-46%; P=0.0001), cerebrovascular disease (55% reduction; 95% CI, 27%-73%; P=0.001), dysrhythmia (47% reduction; 95% CI, 27%-62%; P=0.0001), and heart failure mortality (51% reduction; 95% CI, 21%-70%; P=0.003), as did ≥ 3.6 METh/d with all-cause (22% reduction; 95% CI, 6%-35%; P=0.005), cardiovascular disease (36% reduction; 95% CI, 19%-50%; P=0.0002), cerebrovascular disease (47% reduction; 95% CI, 6%-71%; P=0.03), and dysrhythmia mortality (43% reduction; 95% CI, 16%-62%; P=0.004). Diabetes mellitus and chronic kidney disease mortality also decreased significantly with METh/d. All results remained significant when body mass index adjusted. Merely meeting guideline levels (1.07-1.8 METh/d) did not significantly reduced mortality. The dose-response was significantly nonlinear for all end points except diabetes mellitus, and cerebrovascular and chronic kidney disease. Results did not differ between running and walking. Thus, walking and running produce similar reductions in mortality in hypertensives.
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Affiliation(s)
- Paul T Williams
- Berkeley National Laboratory, Donner 464, 1 Cycloton Road, Berkeley, CA 94720, USA.
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Abstract
Insulin resistance is frequently associated with endothelial dysfunction and has been proposed to play a major role in cardiovascular diseases. Insulin exerts pro- and anti-atherogenic actions on the vasculature. The balance between nitric oxide (NO)-dependent vasodilator actions and endothelin-1- dependent vasoconstrictor actions of insulin is regulated by phosphatidylinositol 3-kinase-dependent (PI3K) - and mitogen-activated protein kinase (MAPK)-dependent signaling in vascular endothelium, respectively. During insulin-resistant conditions, pathway-specific impairment in PI3K-dependent signaling may cause imbalance between production of NO and secretion of endothelin-1 and lead to endothelial dysfunction. Insulin sensitizers that target pathway-selective impairment in insulin signaling are known to improve endothelial dysfunction. In this review, we discuss the cellular mechanisms in the endothelium underlying vascular actions of insulin, the role of insulin resistance in mediating endothelial dysfunction, and the effect of insulin sensitizers in restoring the balance in pro- and anti-atherogenic actions of insulin.
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Affiliation(s)
- Ranganath Muniyappa
- Clinical Endocrine Section, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - James R. Sowers
- Departments of Internal Medicine and Medical Pharmacology and Physiology, University of Missouri School of Medicine, Columbia, Missouri; and Harry S. Truman Memorial Veterans' Hospital, Columbia, Missouri
- Corresponding author for proof and reprints: James R. Sowers, MD, Department of Internal Medicine, University of Missouri School of Medicine, One Hospital Drive, Columbia, Missouri, MO 65212,
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Lilitkarntakul P, Dhaun N, Melville V, Kerr D, Webb DJ, Goddard J. Risk factors for metabolic syndrome independently predict arterial stiffness and endothelial dysfunction in patients with chronic kidney disease and minimal comorbidity. Diabetes Care 2012; 35:1774-80. [PMID: 22648437 PMCID: PMC3402254 DOI: 10.2337/dc11-2345] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Accepted: 03/14/2012] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Metabolic syndrome (MS) is common in patients with chronic kidney disease (CKD), but its contribution to arterial stiffness and endothelial dysfunction in CKD is not well defined. We hypothesized that risk factors for MS would independently predict arterial stiffness and endothelial dysfunction in CKD patients. RESEARCH DESIGN AND METHODS Risk factors for MS, carotid-femoral pulse wave velocity (CF-PWV) and flow-mediated dilation (FMD) as measures of arterial stiffness and endothelial dysfunction, respectively, were assessed in 113 minimally comorbid CKD patients and in 23 matched control subjects. RESULTS CF-PWV correlated with systolic blood pressure (SBP), waist circumference, and plasma glucose (r(2) = 0.25, 0.09, and 0.09; P < 0.01 for all). FMD correlated with SBP (r(2) = 0.09; P < 0.01) and waist circumference (r(2) = 0.03; P < 0.05). CF-PWV increased progressively (r(2) = 0.07; P < 0.01) with increasing number of risk factors for MS. In multiple linear regression, SBP and waist circumference were independent determinants of CF-PWV, whereas only SBP predicted FMD. CONCLUSIONS The number of MS risk factors is an important determinant of arterial stiffness in CKD patients irrespective of the degree of renal impairment. Although BP remains the major determinant of arterial stiffness and endothelial dysfunction, waist circumference independently predicts arterial stiffness. MS risk factors, particularly abdominal girth, are potential targets for future interventional studies in patients with CKD.
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Affiliation(s)
- Pajaree Lilitkarntakul
- Clinical Pharmacology Unit, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, U.K
| | - Neeraj Dhaun
- Clinical Pharmacology Unit, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, U.K
- Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, U.K
| | - Vanessa Melville
- Clinical Pharmacology Unit, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, U.K
| | - Debbie Kerr
- Clinical Pharmacology Unit, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, U.K
| | - David J. Webb
- Clinical Pharmacology Unit, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, U.K
| | - Jane Goddard
- Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, U.K
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Siervo M, Bluck LJC. In vivo nitric oxide synthesis, insulin sensitivity, and asymmetric dimethylarginine in obese subjects without and with metabolic syndrome. Metabolism 2012; 61:680-8. [PMID: 22146092 DOI: 10.1016/j.metabol.2011.10.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Revised: 09/23/2011] [Accepted: 10/08/2011] [Indexed: 10/14/2022]
Abstract
Metabolic syndrome (MetSyn) is associated with impaired endothelial function. Here the association between nitric oxide (NO) production and insulin sensitivity (Si) in obese subjects with and without MetSyn was evaluated. The relationship between NO production and asymmetric dimethylarginine (ADMA) was also explored. Seven healthy normal-weight subjects (male/female [M/F], 3/4; age, 27.4 ± 10.9 years; body mass index [BMI], 21.9 ± 2.2 kg/m(2)), 7 obese subjects without MetSyn (M/F, 1/6; age, 48.0 ± 8.0 years; BMI, 34.5 ± 2.3 kg/m(2)), and 7 with MetSyn (M/F, 3/4; age, 48.0 ± 10.7 years; BMI, 33.4 ± 2.9 kg/m(2)) were recruited. Body composition and cardiometabolic functions (blood pressure, glucose, insulin, triglycerides, total cholesterol, high-density lipoprotein, ADMA) were measured. A frequent sampling intravenous glucose tolerance test was performed to measure Si. A novel stable isotopic method was used to measure in vivo rates of NO production. The NO production was lower in obese subjects with MetSyn compared with normal-weight subjects and obese subjects without MetSyn. Similarly, Si was significantly lower in obesity, both without and with MetSyn, compared with the control group. A significant direct association was found between NO synthesis and Si (ρ = 0.47, P = .03). Circulating levels of ADMA were significantly higher in the obese group with MetSyn. A nonsignificant negative trend between ADMA and NO synthesis was observed. The association between Si and NO production suggests a close mechanistic link between endothelial function and insulin signaling. The results may be highly informative for the development of controlled longitudinal interventions to improve endothelial and metabolic regulation.
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Affiliation(s)
- Mario Siervo
- MRC Human Nutrition Research, Elsie Widdowson, Laboratory, Fulbourn Rd, Cambridge CB1 9NL, United Kingdom
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de Matthaeis A, Greco A, Serviddio G, Stramaglia G, Vendemiale G. Endothelial dysfunction evaluated by flow mediated dilation is strongly associated to metabolic syndrome in the elderly. Aging Clin Exp Res 2010; 22:303-7. [PMID: 19966538 DOI: 10.1007/bf03337727] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
This study was carried out to assess whether endothelial dysfunction, evaluated by flow-mediated dilation (FMD), is related to the occurrence of the Metabolic Syndrome (MetS) in old age. Eighty patients (25 men and 55 women), mean age 74.1±7.4 years (range 65-99 yrs) were studied. Information on all subjects, medical history and regular medications was obtained. Subjects underwent a clinical examination and laboratory tests. The presence of MetS was evaluated according to the revised NCEP-ATP III criteria. An ultrasound vascular examination (US) of the carotid and brachial arteries was performed in all patients. Intima-media thickness (IMT), presence of plaques (PL), endothelium-dependent (EDV) and -independent vasodilation (EIDV) were also evaluated. Patients were divided into two groups according to the presence/absence of MetS. Significant differences were found between MetS and non MetS patients in: EDV (p<0.01), EIDV (p<0.05) and Homeostatic model assessment index (HOMA) (p<0.02), but not in IMT or PL. MetS was significantly associated with FMD reduction (R 0.4, p<0.005) independently of all possible confounding factors other than EIDV, IMT and PL.
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Affiliation(s)
- Angela de Matthaeis
- Internal Medicine Department, Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
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Chen YL, Liu YF, Huang CY, Lee SD, Chan YS, Chen CC, Harris B, Kuo CH. Normalization effect of sports training on blood pressure in hypertensives. J Sports Sci 2010; 28:361-7. [DOI: 10.1080/02640410903508862] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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11
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Does the DASH diet lower blood pressure by altering peripheral vascular function? J Hum Hypertens 2009; 24:312-9. [PMID: 19657359 DOI: 10.1038/jhh.2009.65] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We tested whether lowering of blood pressure (BP) on the dietary approaches to stop hypertension (DASH) diet was associated with changes in peripheral vascular function: endothelial function, assessed by flow-mediated vasodilatation (FMD) of the brachial artery, and subcutaneous adipose tissue blood flow (ATBF). We also assessed effects on heart rate variability (HRV) as a measure of autonomic control of the heart. We allocated 27 men and women to DASH diet and control groups. We measured FMD, ATBF and HRV on fasting and after ingestion of 75 g glucose, before and after 30 days on dietary intervention, aiming for weight maintenance. The control group did not change their diet. The DASH-diet group complied with the diet as shown by significant reductions in systolic (P<0.001) and diastolic (P=0.005) BP, and in plasma C-reactive protein (P<0.01), LDL-cholesterol (P<0.01) and apolipoprotein B (P=0.001), a novel finding. Body weight changed by <1 kg. There were no changes in the control group. We found no changes in FMD, or in ATBF, in the DASH-diet group, although heart rate fell (P<0.05). Glucose and insulin concentrations did not change. In this small-scale study, the DASH diet lowered BP independently of peripheral mechanisms.
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Aizawa K, Shoemaker JK, Overend TJ, Petrella RJ. Metabolic syndrome, endothelial function and lifestyle modification. Diab Vasc Dis Res 2009; 6:181-9. [PMID: 20368209 DOI: 10.1177/1479164109336375] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
We evaluated (1) endothelial function (FMD, ICAM-1 and VCAM-1) cross-sectionally in subjects with (MS+) and without (MS-) metabolic syndrome who were at increased risk for cardiovascular disease due to either HNBP and/or IGR, and (2) examined in a subgroup of subjects the effects of 24-week lifestyle modification on endothelial function. MS components, FMD by Doppler ultrasound, ICAM-1 and VCAM-1 by fasting blood samples were assessed. All of the endothelial functions were similar between MS- and MS+. Although waist circumference, blood pressure, and fasting glucose showed improvements, endothelial function remained unchanged following the intervention. The results showed that in our subject population, MS does not reduce endothelial function, and our 24-week lifestyle modification programme did not result in an improvement in endothelial function in MS+ despite the improvements in some MS components.
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Lind L, Wallentin L, Kempf T, Tapken H, Quint A, Lindahl B, Olofsson S, Venge P, Larsson A, Hulthe J, Elmgren A, Wollert KC. Growth-differentiation factor-15 is an independent marker of cardiovascular dysfunction and disease in the elderly: results from the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) Study. Eur Heart J 2009; 30:2346-53. [PMID: 19561023 DOI: 10.1093/eurheartj/ehp261] [Citation(s) in RCA: 178] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIMS Growth-differentiation factor-15 (GDF-15) is emerging as an independent prognostic biomarker in patients with cardiovascular (CV) disease. Little is known about the pathophysiological basis for the close association of GDF-15 to future CV events. We hypothesized that GDF-15 is related to underlying CV pathologies. METHODS AND RESULTS To relate the levels of GDF-15 to indices of CV dysfunction and disease in elderly individuals, serum levels of GDF-15 were measured in 1004 subjects aged 70 years from the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study. Carotid intima-media thickness and plaque burden, and left ventricular (LV) geometry and function were assessed by ultrasound. Endothelial function was evaluated in forearm resistance vessels and in the brachial artery by venous occlusion plethysmography and ultrasound imaging, respectively. Elevated levels of GDF-15 were related to several CV risk factors (male gender, current smoking, body mass index, waist circumference, diabetes, fasting glucose, triglycerides, and low HDL cholesterol). After adjustment for CV risk factors, increased levels of GDF-15 were associated with reduced endothelium-dependent vasodilation in resistance vessels, plaque burden, LV mass and concentric LV hypertrophy, reduced LV ejection fraction, and clinical manifestations of coronary artery disease and heart failure. CONCLUSION GDF-15 carries information on CV dysfunction and disease that is not captured by traditional CV risk factors in elderly individuals.
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Affiliation(s)
- Lars Lind
- Department of Medicine (Cardiology and Clinical Chemistry), University of Uppsala, 75185 Uppsala, Sweden
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Title LM, Lonn E, Charbonneau F, Fung M, Mather KJ, Verma S, Anderson TJ. Relationship between brachial artery flow-mediated dilatation, hyperemic shear stress, and the metabolic syndrome. Vasc Med 2008; 13:263-70. [DOI: 10.1177/1358863x08095154] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract Metabolic syndrome (MetSyn) may predispose to cardiovascular disease (CVD) by causing vascular dysfunction. This study aimed to determine the association of MetSyn with vascular function, as assessed by brachial artery flow-mediated dilatation (FMD) and hyperemic shear stress (HSS). A total of 1,417 male firefighters without established diabetes and CVD were classified for MetSyn, according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP) definition. MetSyn was present in 267 individuals (19%). Although FMD was lower in those with versus without MetSyn (8.1 ± 4.1 vs 8.7 ± 4.0%; p = 0.02), this was not significant after adjusting for baseline differences (age, smoking, and brachial artery diameter) ( p = 0.2). However, HSS was significantly lower in those with versus without MetSyn (72.0 ± 27.8 vs 80.9 ± 24.8 dyne/cm2; p < 0.001), and there was a significant inverse graded relationship with the number of NCEP criteria present (mean HSS for those with 0, 1, 2, 3, 4, and 5 criteria: 83.2 ± 22.5, 82.2 ± 24.7, 76.5 ± 27.2, 74.3 ± 27.4, 66.5 ± 28.4, 67.1 ± 27.6 dyne/cm2; p < 0.001 for trend). The individual NCEP criteria of abdominal obesity, systolic hypertension, and impaired fasting glucose were independent predictors for HSS. In conclusion, MetSyn was not associated with impaired FMD. Alternatively, HSS, a measure of microvascular function, was significantly lower in those with MetSyn. Thus, MetSyn may contribute to CVD by causing microvascular dysfunction.
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Affiliation(s)
- Lawrence M Title
- Division of Cardiology at Dalhousie University, Halifax, Nova Scotia, Canada
| | - Evan Lonn
- Division of Cardiology at McMaster University, Hamilton, Ontario, Canada
| | | | - Marinda Fung
- Division of Cardiology at University of Calgary, Calgary, Alberta, Canada
| | - Kieren J Mather
- Division of Endocrinology at Indiana University, Indianapolis, Indiana, USA
| | - Subodh Verma
- Division of Cardiovascular Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Todd J Anderson
- Division of Cardiology at University of Calgary, Calgary, Alberta, Canada
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Lind L, Siegbahn A, Hulthe J, Elmgren A. C-reactive protein and e-selectin levels are related to vasodilation in resistance, but not conductance arteries in the elderly. Atherosclerosis 2008; 199:129-37. [DOI: 10.1016/j.atherosclerosis.2007.09.038] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2007] [Revised: 09/26/2007] [Accepted: 09/27/2007] [Indexed: 12/20/2022]
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Polymorphisms in the estrogen receptor alpha gene and endothelial function in resistance and conduit arteries in the elderly. Atherosclerosis 2008; 199:162-71. [DOI: 10.1016/j.atherosclerosis.2007.10.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2007] [Revised: 10/17/2007] [Accepted: 10/24/2007] [Indexed: 11/21/2022]
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Left ventricular mass is related to endothelium-dependent vasodilation in the forearm, but not in the brachial artery, in elderly subjects: the Prospective Investigation of the Vasculature in Uppsala Seniors study. J Hum Hypertens 2008; 22:767-73. [DOI: 10.1038/jhh.2008.61] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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18
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Peripheral wave reflection and endothelial function in untreated essential hypertensive patients with and without the metabolic syndrome. J Hypertens 2008; 26:1216-22. [DOI: 10.1097/hjh.0b013e3282fa7158] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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19
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Chan YH, Lau KK, Yiu KH, Li SW, Chan HT, Fong DYT, Tam S, Lau CP, Tse HF. Reduction of C-reactive protein with isoflavone supplement reverses endothelial dysfunction in patients with ischaemic stroke. Eur Heart J 2008; 29:2800-7. [DOI: 10.1093/eurheartj/ehn409] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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20
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Endothelium-dependent vasodilation in conduit and resistance vessels in relation to the endothelial nitric oxide synthase gene. J Hum Hypertens 2008; 22:569-78. [DOI: 10.1038/jhh.2008.37] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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21
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Järhult SJ, Hall J, Lind L. Hyperaemic blood-flow velocities in systole and diastole relate to coronary risk in divergent ways. Clin Physiol Funct Imaging 2008; 28:189-95. [DOI: 10.1111/j.1475-097x.2008.00797.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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22
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Lind L. Endothelium-dependent vasodilation, insulin resistance and the metabolic syndrome in an elderly cohort. Atherosclerosis 2008; 196:795-802. [PMID: 17335830 DOI: 10.1016/j.atherosclerosis.2007.01.014] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2006] [Revised: 01/03/2007] [Accepted: 01/16/2007] [Indexed: 11/23/2022]
Abstract
BACKGROUND Only a few previous studies have investigated endothelium-dependent vasodilation in the metabolic syndrome (MetS). In the Prospective Study of the Vasculature in Uppsala Seniors (PIVUS) study, different techniques to assess vasodilation in conduit and resistance arteries were evaluated in relation to the MetS and insulin resistance. METHODS In this population-based study, 1016 subjects aged 70 were evaluated by the invasive forearm technique with acetylcholine (EDV), brachial artery ultrasound to assess flow-mediated vasodilation (FMD) and pulse wave analysis with a beta-2 receptor agonist challenge, terbutaline. RESULTS EDV was lower in subjects with the MetS (NECP/ATP III-criteria, prevalence 23%) compared to those without (p<0.0001), and declined with increasing number of MetS criteria (p<0.0001), after adjustment for coronary heart disease, stroke and cardiovascular medication. Also a reduced pulse wave response (p=0.015), but not FMD (p=0.64), was seen in those with the MetS. EDV and the pulse wave response, but not FMD, were inversely related to insulin resistance evaluated by the HOMA index. Also endothelium-independent vasodilation (EIDV) induced by intra-brachial infusion of sodium nitroprusside was impaired in subjects with MetS and in insulin resistance. CONCLUSIONS Vasodilation evaluated with the invasive forearm technique and pulse wave analysis with a beta-2 agonist, but not FMD, was reduced in elderly subjects with the MetS and was related to insulin resistance. Also EIDV showed the same pattern, suggesting a general deterioration in vasoreactivity mainly in resistance arteries in elderly subjects with the MetS.
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Affiliation(s)
- Lars Lind
- Department of Medicine, Uppsala University Hospital, 751 85 Uppsala, Sweden.
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Ghiadoni L, Penno G, Giannarelli C, Plantinga Y, Bernardini M, Pucci L, Miccoli R, Taddei S, Salvetti A, Del Prato S. Metabolic Syndrome and Vascular Alterations in Normotensive Subjects at Risk of Diabetes Mellitus. Hypertension 2008; 51:440-5. [DOI: 10.1161/hypertensionaha.107.103093] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We evaluated the possible association between early vascular abnormalities and the metabolic syndrome (MS) in 77 normotensive subjects (mean age: 50 years) at risk of developing diabetes for family history of diabetes, obesity, or impaired fasting glucose. Fifty healthy subjects were recruited as controls. MS was defined according to the ATP III criteria. Brachial artery endothelium-dependent and -independent vasodilation were assessed as flow-mediated dilation (FMD) and response to glyceryl trinitrate (GTN, 25 μg sublingual), respectively, by automatic computerized edge detection system. Carotid-femoral pulse wave velocity (PWV) and radial augmentation index (AIx) were assessed by applanation tonometry. PWV was significantly (
P
<0.01) higher in subjects with MS (n=29, 9.0±1.9 m/s) as compared with those without MS (n=48, 7.7±1.2 m/s) and controls (7.2±1.5 m/s). FMD was significantly (
P
<0.05) reduced in both subjects with (5.8±2.7%) and without MS (6.1±3.7%) as compared with controls (6.9±2.5%). No significant differences were found for response to GTN and AIx. PWV and FMD were significantly (
P
<0.05) affected by increasing number of MS components. Among the components of the MS, only blood pressure significantly affected PWV, whereas blood pressure and fasting glucose influenced FMD. Logistic regression analysis showed that MS was associated with increased risk of altered PVW (odd ratio: 7.95, confidence limits: 1.06 to 69.11), whereas only blood pressure component was significantly related with increased risk of impaired FMD (odd ratio: 3.60, confidence limits: 1.01 to 12.78). In conclusion, in normotensive subjects at risk of developing diabetes mellitus, the presence of MS is associated with a selective alteration of central PWV.
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Affiliation(s)
- Lorenzo Ghiadoni
- From the Department of Internal Medicine (L.G., C.G., Y.P., M.B., S.T., A.S.) and the Department of Endocrinology & Metabolism (G.P., L.P., R.M., S.D.P.), University of Pisa, Italy
| | - Giuseppe Penno
- From the Department of Internal Medicine (L.G., C.G., Y.P., M.B., S.T., A.S.) and the Department of Endocrinology & Metabolism (G.P., L.P., R.M., S.D.P.), University of Pisa, Italy
| | - Chiara Giannarelli
- From the Department of Internal Medicine (L.G., C.G., Y.P., M.B., S.T., A.S.) and the Department of Endocrinology & Metabolism (G.P., L.P., R.M., S.D.P.), University of Pisa, Italy
| | - Yvonne Plantinga
- From the Department of Internal Medicine (L.G., C.G., Y.P., M.B., S.T., A.S.) and the Department of Endocrinology & Metabolism (G.P., L.P., R.M., S.D.P.), University of Pisa, Italy
| | - Melania Bernardini
- From the Department of Internal Medicine (L.G., C.G., Y.P., M.B., S.T., A.S.) and the Department of Endocrinology & Metabolism (G.P., L.P., R.M., S.D.P.), University of Pisa, Italy
| | - Laura Pucci
- From the Department of Internal Medicine (L.G., C.G., Y.P., M.B., S.T., A.S.) and the Department of Endocrinology & Metabolism (G.P., L.P., R.M., S.D.P.), University of Pisa, Italy
| | - Roberto Miccoli
- From the Department of Internal Medicine (L.G., C.G., Y.P., M.B., S.T., A.S.) and the Department of Endocrinology & Metabolism (G.P., L.P., R.M., S.D.P.), University of Pisa, Italy
| | - Stefano Taddei
- From the Department of Internal Medicine (L.G., C.G., Y.P., M.B., S.T., A.S.) and the Department of Endocrinology & Metabolism (G.P., L.P., R.M., S.D.P.), University of Pisa, Italy
| | - Antonio Salvetti
- From the Department of Internal Medicine (L.G., C.G., Y.P., M.B., S.T., A.S.) and the Department of Endocrinology & Metabolism (G.P., L.P., R.M., S.D.P.), University of Pisa, Italy
| | - Stefano Del Prato
- From the Department of Internal Medicine (L.G., C.G., Y.P., M.B., S.T., A.S.) and the Department of Endocrinology & Metabolism (G.P., L.P., R.M., S.D.P.), University of Pisa, Italy
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24
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Cangemi R, Angelico F, Loffredo L, Del Ben M, Pignatelli P, Martini A, Violi F. Oxidative stress-mediated arterial dysfunction in patients with metabolic syndrome: Effect of ascorbic acid. Free Radic Biol Med 2007; 43:853-9. [PMID: 17664149 DOI: 10.1016/j.freeradbiomed.2007.06.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2007] [Revised: 06/01/2007] [Accepted: 06/05/2007] [Indexed: 11/18/2022]
Abstract
Arterial dysfunction is a hallmark of early atherosclerosis; however, its behavior in patients with metabolic syndrome (MS) is still unclear. We investigated the role of oxidative stress on ischemia-induced flow-mediated dilatation (FMD) in patients with MS. FMD and oxidative stress, as assessed by serum levels of 8-hydroxy-2-deoxy-2-deoxyguanosine (8-OHdG), were studied in 18 MS and 30 control subjects. Thereafter, in the 18 MS patients, FMD was assessed after iv infusion of 1 g vitamin C or placebo in a randomized, double-blind, crossover design; serial blood samples were taken in peripheral circulation before and after FMD to analyze 8-OHdG. Compared to controls, MS patients had higher 8-OHdG (p<0.001) and lower FMD (p<0.001); 8-OHdG and FMD were inversely correlated (R=-0.74; p<0.01). In MS patients, placebo administration did not change FMD, whereas vitamin C significantly enhanced it (p<0.001). After placebo, ischemia-induced FMD was associated with a significant increase in 8-OHdG (p<0.001), an effect that was counteracted by vitamin C. Vitamin C infusion was associated with an inverse correlation between the changes in FMD and oxidative stress (R=-0.67; p<0.01). The present study shows that arterial dilatation is impaired and that enhanced oxidative stress may play a key role in patients with MS.
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Affiliation(s)
- Roberto Cangemi
- Department of Experimental Medicine and Pathology, University of Rome La Sapienza, Rome 00161, Italy
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25
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Abstract
Macrovascular disease is the number one killer in type 2 diabetes patients. The cluster of risk factors in the insulin resistance syndrome (IRS) partly explains this notion. Insulin action in muscle, liver or adipose tissue has been thoroughly described in the literature, whilst this has been less described for the endothelium. Insulin stimulates nitric oxide (NO) production in the endothelium and reduced bioavailability of NO is usually defined as endothelial dysfunction. This impairment might be related to defective insulin signalling in the endothelial cell. Therefore, insulin resistance mechanisms in the endothelial cell will be emphasized in this review. Imbalance between the vasodilating agent NO and the vasoconstrictor endothelin-1 (ET-1) contributes to endothelial dysfunction. Different methods and circulating markers to assess endothelial function will be outlined. Circulating markers of an activated endothelium appear long before type 2 diabetes develops suggesting a unique role of the endothelium in the pathophysiology of the disease. Hampered blood flow in nutritive capillaries due to endothelial dysfunction is coupled with decreased glucose uptake and hyperglycemia. The forearm model combined with muscle microdialysis enables us to measure interstitial glucose and an index for capillary recruitment, the permeability surface area (PS). Available data from this method suggest that capillary recruitment in response of insulin is impaired in insulin resistant human subjects.
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Affiliation(s)
- P-A Jansson
- Lundberg Laboratory for Diabetes Research, Department of Molecular and Clinical Medicine/Diabetes, The Sahlgrenska Academy at Göteborg University, Sahlgrenska University Hospital, Sahlgrenska S-413 45, Göteborg, Sweden.
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Melikian N, Chowienczyk P, MacCarthy PA, Williams IL, Wheatcroft SB, Sherwood R, Gale C, Shah AM, Kearney MT. Determinants of endothelial function in asymptomatic subjects with and without the metabolic syndrome. Atherosclerosis 2007; 197:375-82. [PMID: 17651741 DOI: 10.1016/j.atherosclerosis.2007.06.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2006] [Revised: 05/31/2007] [Accepted: 06/19/2007] [Indexed: 11/26/2022]
Abstract
We investigated the determinants of endothelial function in 100 asymptomatic, non-diabetic, non-smokers with and without the metabolic syndrome ((MS)--defined by ATP-III criteria). Subjects with MS (n=24) had greater endothelial dysfunction (ED, P<0.001) than subjects without MS. One-way analysis of variance demonstrated a significant negative linear trend between level of ED (F=21.89; P<0.001) and number of ATP-III metabolic diagnostic criteria present in each subject. In a stepwise multivariate logistic regression model presence/absence of MS was the only independent determinant of ED (P=0.01). Age, gender, LDL cholesterol, C-reactive protein, interleukin-6 and tumour necrosis factor-alpha receptor 2 had no independent influence on endothelial function. In the absence of MS as variable there was no independent association between the remaining variables and endothelial function. Receiver operating characteristic (ROC) curves demonstrated that a combination of age, LDL cholesterol and CRP levels and presence/absence of MS can be used to predict ED (area under curve 0.81+/-0.06) and thus potentially may be used as a simple screening test to identify subjects with the greatest level of ED (sensitivity=0.82, specificity=0.72). Our study demonstrated that subjects with MS had greater ED. The extent of ED increased with presence of each additional ATP-III diagnostic criteria. Presence/absence of MS was the only independent predictor of ED and in conjunction with age, LDL cholesterol and CRP levels could be used as a potential simple clinical screening test for ED.
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Affiliation(s)
- Narbeh Melikian
- Cardiovascular Division, King's College London School of Medicine at Guy's, King's College and St Thomas' Hospitals, London, United Kingdom
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27
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Lind L. Vasodilation in resistance arteries is related to the apolipoprotein B/A1 ratio in the elderly – The Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study. Atherosclerosis 2007; 190:378-84. [PMID: 16545386 DOI: 10.1016/j.atherosclerosis.2006.02.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2005] [Revised: 01/30/2006] [Accepted: 02/02/2006] [Indexed: 11/28/2022]
Abstract
BACKGROUND Recent studies have shown the apolipoprotein B to apolipoprotein A1 ratio (apoB/A1) to be superior to LDL-cholesterol measurements to predict cardiovascular events. The present study aims to relate apoB/A1 to endothelium-dependent vasodilation, an early marker of atherosclerosis, in the Prospective Study of the Vasculature in Uppsala Seniors (PIVUS) study. METHODS AND RESULTS In this population-based study, 1016 subjects aged 70 years were evaluated by the invasive forearm technique with acetylcholine (EDV), brachial artery ultrasound to assess flow-mediated vasodilation (FMD) and pulse wave analysis with a beta-2 receptor agonist challenge, terbutaline. EDV and the pulse wave response, but not FMD, were related to apoB/A1 levels (r=-0.11, p=0.0038 for EDV, r=-0.16, p<0.0001 for the pulse wave analysis and r=0.01, p=0.65 for FMD). Neither LDL-cholesterol, nor non-HDL-cholesterol, was significantly related to the measurements of endothelium-dependent vasodilation. Also endothelium-independent vasodilation (EIDV) evaluated by the invasive forearm technique with sodium nitroprusside was related to apoB/A1 levels (r=-0.12, p<0.0016). CONCLUSION The apoB/A1 levels, but not LDL-cholesterol, were inversely related to endothelium-dependent vasodilation evaluated by EDV and pulse wave analysis, but not by FMD. Also EIDV showed the same pattern, suggesting a general deterioration in vasoreactivity mainly in resistance arteries in elderly subjects with high apoB/A1 levels.
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Affiliation(s)
- Lars Lind
- Department of Medicine, Uppsala University Hospital, AstraZeneca R&D Mölndal, 751 85 Uppsala, Sweden.
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28
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Lind L. Arterial compliance influences the measurement of flow-mediated vasodilation, but not acetylcholine-mediated forearm blood flow. Atherosclerosis 2007; 190:212-5. [PMID: 16530773 DOI: 10.1016/j.atherosclerosis.2006.01.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2005] [Revised: 01/27/2006] [Accepted: 01/30/2006] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Flow-mediated vasodilation (FMD) is low even in healthy elderly and therefore relations between FMD and cardiovascular risk factors might be hard to evaluate in the elderly. Using data from the Prospective Study of the Vasculature in Uppsala Seniors (PIVUS) study, we investigated if a reduced arterial distensibility could influence FMD measurements. METHODS In the population-based PIVUS study (1016 subjects aged 70), assessments of arterial distensibility by ultrasound in the carotid artery (CCA) and FMD were performed. Endothelium-dependent vasodilation was also evaluated with the invasive forearm technique with acetylcholine (EDV) and by pulse wave analysis following terbutaline injection. A poor CCA distensibility was defined as <25th percentile in the healthy part of the population (n=131). RESULTS FMD was significantly related to the Framingham risk score only in those with a good CCA distensibility (r=-0.16, p=0.0081 versus r=-0.06, p=0.17 in those with a poor CCA distensibility, p=0.0001 for difference). In contrast, the relationship between EDV and coronary risk was not affected by CCA distensibility (r=-0.11, p=0.018 versus r=-0.13, p=0.027). CONCLUSIONS A reduced CCA distensibility could in part explain the low FMD values in the elderly. FMD correlated to the Framingham risk score only in those with a good CCA distensibility, exemplifying a limitation of the use of FMD in elderly populations. On the contrary, EDV was not affected by arterial stiffness.
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Affiliation(s)
- Lars Lind
- Department of Medicine, Uppsala University Hospital and AstraZeneca R&D Mölndal, 751 85 Uppsala, Sweden.
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29
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Lind L, Johansson L, Hulthe J, von Below C, Ahlström H. Vasodilation and visceral fat in elderly subjects: the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study. Atherosclerosis 2006; 194:e64-71. [PMID: 17157860 DOI: 10.1016/j.atherosclerosis.2006.09.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2006] [Revised: 09/07/2006] [Accepted: 09/12/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Although obesity has long been recognised as a cardiovascular risk factor, only in recent years has the role of visceral adipose tissue (VAT) been evaluated. In the Prospective Study of the Vasculature in Uppsala Seniors (PIVUS) study, we related VAT and other obesity indices to endothelium-dependent vasodilation in both capacitance and resistance arteries. METHODS AND RESULTS In this population-based study, 1016 subjects aged 70 were evaluated by the invasive forearm technique with acetylcholine (EDV) and brachial artery ultrasound to assess flow-mediated vasodilation (FMD). Intra-abdominal visceral (VAT) and subcutaneous adipose tissue (SAT) were determined by magnetic resonance imaging in a random sample of 287 subjects. EDV, but not FMD, was inversely related to VAT, SAT, BMI and the waist/hip ratio (r=-0.23, -0.16, -0.21 and -0.11, respectively, p=0.05-0.001 after adjustment for gender). In multiple regression analysis however, only VAT was an independent predictor of EDV. Similar results were obtained for endothelium-independent vasodilation (EIDV, infusion of sodium nitroprusside in the brachial artery). CONCLUSIONS Both endothelium-dependent and independent vasodilation in the forearm resistance arteries, but not FMD in the brachial artery, was reduced in elderly subjects with increased intra-abdominal adipose tissue mass. This finding suggests deterioration in general vasoreactivity mainly in resistance arteries in elderly subjects with intra-abdominal obesity.
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Affiliation(s)
- Lars Lind
- Department of Medicine, Uppsala University Hospital, Uppsala, Sweden.
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Esposito K, Ciotola M, Schisano B, Misso L, Giannetti G, Ceriello A, Giugliano D. Oxidative stress in the metabolic syndrome. J Endocrinol Invest 2006; 29:791-5. [PMID: 17114909 DOI: 10.1007/bf03347372] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The metabolic syndrome represents a cluster of several risk factors for atherosclerosis that increases the risk of future cardiovascular events. In this study, we evaluated whether oxidative stress is increased in subjects with the metabolic syndrome. We studied 100 subjects (50 men and 50 women) with the metabolic syndrome, as defined by the Adult Treatment Panel III, and 50 (25 men and 25 women) matched subjects without the syndrome. Insulin sensitivity was assessed with the homeostasis model assessment (HOMA) methods; endothelium-dependent flow-mediated vasodilation (FMD) was evaluated in the right brachial artery with a high-resolution ultrasound machine; oxidative stress was assessed by measuring the circulating levels of nitrotyrosine (NT), considered a good marker for the formation of endogenous peroxynitrite. Compared with control subjects, patients with the metabolic syndrome had greater waist circumference, higher HOMA and systolic pressure values, higher triglyceride and lower HDL-cholesterol levels. NT levels were higher (0.44+/-0.12 micromol/l, mean+/-SD) while FMD was lower [7.3 (4.4/9.6), median and interquartile range] in subjects with the metabolic syndrome as compared with control subjects [0.27+/-0.08 and 11.8 (8.6/14.9), respectively, p<0.001]. There was an increase in NT levels and HOMA score as the number of components of the metabolic syndrome increased. NT levels were associated with waist circumference (r=0.38, p=0.01), triglycerides (r=0.32, p<0.02), systolic blood pressure (r=0.21, p<0.05) and fasting glucose (r=0.24, p<0.05). The oxidative stress that accompanies the metabolic syndrome is associated with both insulin resistance and endothelial dysfunction, providing a connection which is highly deleterious for vascular functions.
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Affiliation(s)
- K Esposito
- Division of Metabolic Diseases, Department of Geriatrics and Metabolic Diseases, University of Naples SUN, Naples, Italy
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31
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Nyström T, Nygren A, Sjöholm A. Increased levels of tumour necrosis factor-alpha (TNF-alpha) in patients with Type II diabetes mellitus after myocardial infarction are related to endothelial dysfunction. Clin Sci (Lond) 2006; 110:673-81. [PMID: 16466346 DOI: 10.1042/cs20050353] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The pathophysiology of insulin resistance and atherosclerosis may share a common inflammatory basis, maintaining endothelial dysfunction, suggesting why patients with T2DM (Type II diabetes mellitus) have an impaired prognosis after an MI (myocardial infarction), but it remains unclear how these parameters are inter-related. Forty patients with an MI (20 patients with and 20 patients without T2DM) took part in this cross-sectional study. Endothelium-dependent [FMD (flow-mediated dilation)] and -independent [NTG (nitroglycerine)] vasodilatation (determined by ultrasound), S(I) (insulin sensitivity index; determined by isoglycaemic-hyperinsulinaemic clamp) and serum levels of CRP (C-reactive protein), TNF-alpha (tumour necrosis factor-alpha), IL-6 (interleukin 6), resistin and adiponectin (determined by ELISA) were measured. Associations between FMD/NTG and S(I), and CRP, TNF-alpha, IL-6, adiponectin, resistin, lipids, blood pressure, BMI (body mass index) and brachial artery diameter were then assessed. FMD (2.1 compared with 4.7%; P<0.05), NTG (14.9 compared with 21.2%; P<0.05) and S(I) [4.3 compared with 6.6 10(-4) dl.kg(-1) of body weight.min(-1).(mu-units/ml)(-1); P<0.05], and adiponectin levels (3.1 compared with 6.4 microg/ml; P<0.01) were all lower in patients with T2DM. TNF-alpha (6.9 compared with 1.8 pg/ml; P<0.01) and IL-6 (2.3 compared with 1.2 pg/ml; P<0.01) levels were higher in patients with T2DM, whereas differences in CRP and resistin levels did not attain statistical significance between the two groups. TNF-alpha concentrations and brachial artery diameter were negatively, whereas S(I) was positively, correlated with FMD. Adjustment for age weakened the association for S(I), whereas TNF-alpha and brachial artery diameter remained significantly associated with FMD after adjustment for group, age and BMI. Endothelial dysfunction and low-grade inflammation co-exist in T2DM after MI. These results suggest that the endothelium is negatively impacted in multiple ways by the diabetic state after an MI.
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Affiliation(s)
- Thomas Nyström
- Department of Internal Medicine, Karolinska Institute, Stockholm South Hospital, SE-118 83 Stockholm, Sweden.
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32
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Abstract
The cardiometabolic syndrome is a prevalent metabolic disorder. Epidemiologic studies correlate the cardiometabolic syndrome with an increased risk of coronary heart disease, ischemic stroke, cardiovascular mortality, and total mortality. There is also evidence that the cardiometabolic syndrome is a risk factor for abnormalities in myocardial metabolism, cardiac dysfunction, and arrhythmias such as atrial fibrillation. Multiple imaging modalities, both invasive and noninvasive, may help physicians better define the presence or risk of cardiovascular disease in their patients with the cardiometabolic syndrome.
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Affiliation(s)
- Rachel Ash-Bernal
- School of Medicine, Washington University in St. Louis, St. Louis, MO 63110, USA
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33
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Frisbee JC. Vascular adrenergic tone and structural narrowing constrain reactive hyperemia in skeletal muscle of obese Zucker rats. Am J Physiol Heart Circ Physiol 2005; 290:H2066-74. [PMID: 16373580 DOI: 10.1152/ajpheart.01251.2005] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Previous studies have demonstrated that skeletal muscle perfusion is impaired in obese Zucker rats (OZR) under control conditions and with elevated metabolic demand versus responses in lean Zucker rats (LZR). To further our understanding of processes contributing to impaired perfusion, we determined whether hyperemic responses following periods of occlusion were altered in skeletal muscle of OZR versus LZR. In isolated hindlimbs, basal blood flow in OZR was less than in LZR, and total perfusion responses after 30, 90, and 180 s of occlusion were reduced. Treatment of animals with an antioxidant (polythethylene glycol-superoxide dismutase) had no effect on reactive hyperemia, although blockade of alpha-adrenoreceptors (alpha1 > alpha2) improved responses to 30 and 90 s of occlusion; responses to 180 s of occlusion were unaltered. Pump perfusion of a dilated distal hindlimb demonstrated that increased volume flow elicited a greater increase in perfusion pressure in OZR versus LZR, suggesting structural contributions to an increased vascular resistance. Responses were comparable for in situ cremaster muscle because reactive hyperemia following serial arteriolar occlusion was attenuated in OZR versus LZR, treatment with polythethylene glycol-superoxide dismutase was ineffective, and hyperemic responses were improved following inhibition of alpha-adrenoreceptors (alpha1 > alpha2). Treatment of cremaster muscle with adenosine (10(-3) M) caused flow to increase to a level comparable to that following 180 s of occlusion in both strains, although this level was reduced in OZR versus LZR. These results suggest that increased adrenergic tone may constrain reactive hyperemia in OZR with brief occlusion, although structural increases in vascular resistance can contribute to constrained perfusion after longer periods of occlusion.
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Affiliation(s)
- Jefferson C Frisbee
- Center for Interdisciplinary Research in Cardiovascular Science, Department of Physiology and Pharmacology, West Virginia University School of Medicine, Morgantown, WV 26505, USA.
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Lind L, Fors N, Hall J, Marttala K, Stenborg A. A Comparison of Three Different Methods to Evaluate Endothelium-Dependent Vasodilation in the Elderly. Arterioscler Thromb Vasc Biol 2005; 25:2368-75. [PMID: 16141402 DOI: 10.1161/01.atv.0000184769.22061.da] [Citation(s) in RCA: 306] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Three different techniques to evaluate endothelium-dependent vasodilation in the peripheral circulation have been described but not simultaneously tested in a large-scale population-based setting. This study aimed to evaluate the feasibility and usefulness of these techniques in the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study.
Methods and Results—
In the population-based PIVUS study (1016 subjects aged 70 years), the invasive forearm technique with acetylcholine given in the brachial artery (EDV), the brachial artery ultrasound technique with measurement of flow-mediated dilatation (FMD), and the pulse wave analysis method with β-2-agonist (terbutaline) provocation were successfully used in 87%, 97%, and 86% of the sample, respectively. The results of EDV and pulse wave analysis were interrelated (
r
=0.12,
P
=0.0013), but no relationships were found with FMD measurements. All 3 techniques were correlated to the Framingham risk score (
r
=0.10 to 0.12,
P
=0.0007 to 0.001). In multiple regression analysis, however, only EDV and FMD were independently associated with the Framingham score.
Conclusions—
All 3 evaluated techniques were feasible to perform in a general elderly population. Both the invasive forearm technique and FMD were independently associated with increased coronary risk, suggesting that information on conduit artery and resistance artery endothelial function carry different, but important, information in the elderly. If the invasive technique cannot be used, the pulse wave based technique is an alternative.
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Affiliation(s)
- Lars Lind
- Department of Medicine, Uppsala University Hospital, Mölndal, Sweden.
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Clifton PM, Keogh JB, Foster PR, Noakes M. Effect of weight loss on inflammatory and endothelial markers and FMD using two low-fat diets. Int J Obes (Lond) 2005; 29:1445-51. [PMID: 16172619 DOI: 10.1038/sj.ijo.0803039] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Cardiovascular disease is strongly associated with obesity and there is evidence that weight loss has positive effects on cardiovascular disease risk. The aims of this study were to compare meal replacements (MR) with a conventional low-fat diet as weight loss strategies and to examine the effect of weight loss on flow-mediated dilatation (FMD) and other markers of endothelial function in overweight Australians with raised triglycerides (TG) (> 2 mmol/l). RESEARCH METHODS Subjects matched for age, gender, fasting plasma TG and body mass index were randomized to two low- fat high- carbohydrate weight loss strategies (both < 6000 kJ), one using MR and the other a structured eating plan, control (C). Subjects followed both diets for 3 months. In total, 55 subjects completed the study. FMD, pulse wave velocity and blood pressure (BP) were measured at baseline and at 3 months, as were fasting blood samples for lipids, glucose, insulin, C reactive protein (CRP) and endothelium-derived factors. RESULTS Mean weight loss was 6.3 +/- 3.7 kg (6.0 +/- 4.2 vs 6.63 +/- 3.35 kg, MR vs C) with no difference between diet groups. TG, insulin, CRP, plasminogen activator inhibitor 1 (PAI-1) and soluble intracellular adhesion molecule-1 (sICAM1) fell after weight loss, but FMD did not change. Systolic BP fell by 8 mmHg and pulse wave velocity improved. DISCUSSION In subjects with elevated TG, weight loss resulted in significant improvements in cardiovascular risk markers, particularly endothelium-derived factors (PAI-1 and sICAM1). However, FMD did not improve with weight loss.
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Affiliation(s)
- P M Clifton
- CSIRO Health Sciences and Nutrition, Adelaide, South Australia, Australia.
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Villanova N, Moscatiello S, Ramilli S, Bugianesi E, Magalotti D, Vanni E, Zoli M, Marchesini G. Endothelial dysfunction and cardiovascular risk profile in nonalcoholic fatty liver disease. Hepatology 2005; 42:473-80. [PMID: 15981216 DOI: 10.1002/hep.20781] [Citation(s) in RCA: 452] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is consistently associated with features of the metabolic syndrome, a condition carrying a high risk of cardiovascular events. We measured the vasodilatory response of the brachial artery in response to ischemia (a test of endothelial function) (FMV) as well as cardiovascular risk profile in 52 NAFLD cases and 28 age- and sex-matched controls. The 10-year risk of coronary events was calculated according to the Framingham equation and the scores derived from the PROCAM study and NCEP-ATPIII proposals. FMV was 6.33% +/- 5.93% in NAFLD versus 12.22% +/- 5.05% in controls (P < .0001), and higher in pure fatty liver (9.93%) compared with nonalcoholic steatohepatitis (4.94%) (P = .010). No differences were observed in flow-independent vasodilation (response to sublingual nitroglycerin). Percent FMV was negatively associated with insulin resistance (homeostasis model assessment) in the whole population (r = -0.243; P = .030). In logistic regression analysis, NAFLD was associated with a percent FMV in the lower tertile (OR, 6.7; 95% CI, 1.26-36.1), after adjustment for age, sex, body mass index, and insulin resistance. Among NAFLD patients, low FMV was associated with nonalcoholic steatohepatitis (adjusted OR, 6.8; 95% CI, 1.2-40.2). The 10-year probability of cardiovascular events was moderately increased in NAFLD, and particularly in nonalcoholic steatohepatitis. In conclusion, our study provides evidence of endothelial dysfunction and increased risk of cardiovascular events in NAFLD. The risk of advanced liver disease is well recognized in NAFLD patients, but the large majority of cases might experience cardiovascular disease in the long term, indirectly limiting the burden of liver failure.
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Affiliation(s)
- Nicola Villanova
- Unit of Metabolic Diseases, Alma Mater Studiorum University of Bologna, Policlinico S. Orsola-Malpighi, Via Massarenti 9, I-40138 Bologna, Italy
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Miranda PJ, DeFronzo RA, Califf RM, Guyton JR. Metabolic syndrome: evaluation of pathological and therapeutic outcomes. Am Heart J 2005; 149:20-32. [PMID: 15660031 DOI: 10.1016/j.ahj.2004.07.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Phillippa J Miranda
- Diabetes Division, University of Texas Health Science Center, San Antonio, Tex, USA
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Henry RMA, Ferreira I, Kostense PJ, Dekker JM, Nijpels G, Heine RJ, Kamp O, Bouter LM, Stehouwer CDA. Type 2 diabetes is associated with impaired endothelium-dependent, flow-mediated dilation, but impaired glucose metabolism is not; The Hoorn Study. Atherosclerosis 2004; 174:49-56. [PMID: 15135250 DOI: 10.1016/j.atherosclerosis.2004.01.002] [Citation(s) in RCA: 133] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2003] [Revised: 12/09/2003] [Accepted: 01/05/2004] [Indexed: 11/26/2022]
Abstract
BACKGROUND Type 2 diabetes (DM2) and impaired glucose metabolism (IGM) are associated with an increased cardiovascular disease risk. Impaired endothelial synthesis of nitric oxide (NO) is an important feature of atherothrombosis and can be estimated from endothelium-dependent flow-mediated dilation (FMD). It is controversial whether or not FMD is impaired in DM2 and IGM. We investigated this issue in a population-based setting. METHODS AND RESULTS In the study population (n = 650; 246 with normal glucose metabolism (NGM), 135 with IGM and 269 with DM2; mean age: 67.6 years), FMD and endothelium-independent nitroglycerine-mediated dilation (NMD) were ultrasonically estimated from the brachial artery and expressed as the absolute change in diameter in mm. The increase in diameter (mean +/- standard deviation) in NGM, IGM and DM2 was 0.19 +/- 0.15, 0.19 +/- 0.18 and 0.13 +/- 0.17 MD and 0.45 +/- 0.21, 0.43 +/- 0.24 and 0.45 +/- 0.25 for NMD. After adjustment for age, sex, baseline diameter and percentage increase in peak systolic velocity, DM2, as compared to NGM, remained associated with impaired FMD (regression coefficient beta (95%CI)) as compared to NGM, -0.06 mm (-0.09 to -0.03). IGM was not associated with impaired FMD (beta, 0.01 mm (-0.02 to 0.04)). Additional adjustment for conventional cardiovascular risk factors did not alter these associations. Hyperglycemia or hyperinsulinemia explained 2% of the association between DM2 and FMD. NMD was not associated with glucose tolerance. CONCLUSIONS This study shows that DM2 is independently associated with impaired FMD. Hyperglycemia and hyperinsulinemia contribute minimally to this association. Impaired FMD may therefore, in part, explain the increased cardiovascular disease risk in DM2, whereas the normal FMD in IGM suggests that other forms of endothelial dysfunction are important in explaining the increased cardiovascular disease risk in IGM.
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Affiliation(s)
- Ronald M A Henry
- Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, The Netherlands
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Yokoyama H, Emoto M, Fujiwara S, Motoyama K, Morioka T, Koyama H, Shoji T, Inaba M, Nishizawa Y. Short-term aerobic exercise improves arterial stiffness in type 2 diabetes. Diabetes Res Clin Pract 2004; 65:85-93. [PMID: 15223220 DOI: 10.1016/j.diabres.2003.12.005] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2003] [Accepted: 12/26/2003] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To investigate whether: (1) aerobic exercise decreases arterial stiffness and (2) reduction in arterial stiffness is associated with improvement in insulin resistance in type 2 diabetes. METHODS Common carotid and femoral arterial stiffness was ultrasonographically evaluated using stiffness index beta in 23 type 2 diabetic subjects before and after a 3-week exercise protocol including ergometer and walking. Insulin sensitivity (Clamp-IR) was assessed using euglycemic-hyperinsulinemic clamp before and after the protocol. Arterial stiffness was also examined in steady hyperinsulinemic state during clamp. RESULTS Anthropometrical factors did not change following exercise. Clamp-IR tended to increase after exercise protocol (P = 0.061). Stiffness index beta decreased following exercise in both common carotid and femoral arteries (P = 0.020 and P < 0.001, respectively). DeltaClamp-IR was significantly correlated with the changes in stiffness index beta of both common carotid (P = 0.040) and femoral artery (P = 0.016). Divided into tertiles according to DeltaClamp-IR, decreases in stiffness index beta for both common carotid (P = 0.009) and femoral (P = 0.037) arteries was greater in tertile group with a higher DeltaClamp-IR. Hyperinsulinemia during clamp decreased stiffness index beta in both common carotid (P = 0.031) and femoral (P = 0.025) arteries before exercise, but these effects disappeared after the exercise protocol. CONCLUSIONS Short-term aerobic exercise significantly decreased arterial stiffness in both common carotid and femoral arteries, and the reduction of stiffness was associated with improvement of insulin resistance in type 2 diabetes.
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Affiliation(s)
- Hisayo Yokoyama
- Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan.
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