Should we calculate arterial stiffness gradient in middle-aged women with increased cardiovascular risk?

Different Measures of Hyperglycemia Are Negatively Associated With Skin Microvascular Flowmotion: The Maastricht Study

OBJECTIVE

Diabetes can lead to microvascular complications such as diabetic neuropathy, nephropathy, and retinopathy. Hyperglycemia may initiate microvascular function impairment early in the course of diabetes, even prior to its clinical establishment during the pre-diabetes stage. Microvascular vasomotion, that is, the rhythmic arteriolar constriction and dilation, is an important function that regulates oxygen and nutrient delivery within the tissue and regulates peripheral resistance. Using laser Doppler flowmetry (LDF), vasomotion in skin microcirculation can be measured as flowmotion. Changes in flowmotion have been shown in individuals with obesity, and type 1 or type 2 diabetes mellitus. However, no data are available on associations between hyperglycemia and flowmotion in the general population. Our aim was to study whether measures of hyperglycemia were associated with different components of skin microvascular flowmotion (SMF) in a population-based cohort (The Maastricht Study).

METHODS

Data from 7293 participants of The Maastricht Study were used. SMF was measured using LDF. Endothelial, neurogenic and myogenic component SMF power were used as dependent variables. We investigated the associations of glucose metabolism status (normal glucose metabolism, prediabetes, and type 2 diabetes mellitus), measures of hyperglycemia (fasting plasma glucose [FPG], 2-h post-load glucose [2 h-PG], HbA1c, advanced glycation end-products [AGEs] assessed as skin autofluorescence [SAF]), and indices of glucose variability (incremental glucose peak [IGP] and continuous glucose monitoring [CGM] -assessed as standard deviation [SD]) with each component of SMF power. We used linear regression analyses with adjustments for confounders, and trend analyses.

RESULTS

We observed consistent negative associations between HbA1c levels and all three (endothelial, neurogenic, and myogenic) skin microvascular flowmotion (SMF) powers in the additionally adjusted model. Similarly, in the conservative model, we found that multiple hyperglycemia metrics such as GMS trend, PreD, T2DM, FPG, 2 h-PG, and HbA1c were consistently negatively associated with all three SMF powers.

CONCLUSIONS

We showed that skin microvascular flowmotion is reduced in individuals with (pre)diabetes. In addition, different measures of hyperglycemia are negatively associated with skin microvascular flowmotion.

Association between serum uric acid to high density lipoprotein-cholesterol ratio and arterial stiffness in a Japanese population

Uric acid (UA) and HDL-cholesterol (HDL-C) level are closely associated to the cardiovascular disease (CVD) morbidity. The UA/HDL-C ratio (UHR), a new parameter combination of serum UA and HDL-C, attracts attention for its association with metabolic and inflammatory conditions. There may exists the association between UHR and arterial stiffness. This study aims to explore the association between the UHR and brachial-ankle PWV (baPWV) and to determine whether or not UHR has effect on arterial stiffness. The present study included a total of 912 Japanese (592 men and 320 women), aged from 24 to 84, received a health medical checkup programme with an automatic waveform analyzer to measure baPWV and various standardized questionnaires in a medical center of Japan. Non-linear regression and threshold effect analysis were conducted to explore the association between UHR and baPWV. It was found that UHR was positively correlated with baPWV after adjusting for multiple confounders. A non-linear relationship (with a inflection point was 14.25) was found between UHR and baPWV. Subgroup analyses showed that the significant association between UHR and baPWV only existed in females group, no fatty liver group and normal BMI groups. This study revealed the nonlinear relationship between UHR and baPWV. A significant correlation between UHR and baPWV existed in females but not in males. Fatty liver status, BMI, and menopausal status may affect the above association.

Modulation of Arterial Stiffness Gradient by Acute Administration of Nitroglycerin

Background: Physiologically, the aorta is less stiff than peripheral conductive arteries, creating an arterial stiffness gradient, protecting microcirculation from high pulsatile pressure. However, the pharmacological manipulation of arterial stiffness gradient has not been thoroughly investigated. We hypothesized that acute administration of nitroglycerin (NTG) may alter the arterial stiffness gradient through a more significant effect on the regional stiffness of medium-sized muscular arteries, as measured by pulse wave velocity (PWV). The aim of this study was to examine the differential impact of NTG on regional stiffness, and arterial stiffness gradient as measured by the aortic-brachial PWV ratio (AB-PWV ratio) and aortic-femoral PWV ratio (AF-PWV ratio).

Methods: In 93 subjects (age: 61 years, men: 67%, chronic kidney disease [CKD]: 41%), aortic, brachial, and femoral stiffnesses were determined by cf-PWV, carotid-radial (cr-PWV), and femoral-dorsalis pedis artery (fp-PWV) PWVs, respectively. The measurements were repeated 5 min after the sublingual administration of NTG (0.4 mg). The AB-PWV and AF-PWV ratios were obtained by dividing cf-PWV by cr-PWV or fp-PWV, respectively. The central pulse wave profile was determined by radial artery tonometry through the generalized transfer function.

Results: At baseline, cf-PWV, cr-PWV, and fp-PWV were 12.12 ± 3.36, 9.51 ± 1.81, and 9.71 ± 1.89 m/s, respectively. After the administration of NTG, there was a significant reduction in cr-PWV of 0.86 ± 1.27 m/s (p < 0.001) and fp-PWV of 1.12 ± 1.74 m/s (p < 0.001), without any significant changes in cf-PWV (p = 0.928), leading to a significant increase in the AB-PWV ratio (1.30 ± 0.39 vs. 1.42 ± 0.46; p = 0.001) and AF-PWV ratio (1.38 ± 0.47 vs. 1.56 ± 0.53; p = 0.001). There was a significant correlation between changes in the AF-PWV ratio and changes in the timing of wave reflection (r = 0.289; p = 0.042) and the amplitude of the heart rate-adjusted augmented pressure (r = − 0.467; p < 0.001).

Conclusion: This study shows that acute administration of NTG reduces PWV of muscular arteries (brachial and femoral) without modifying aortic PWV. This results in an unfavorable profile of AB-PWV and AF-PWV ratios, which could lead to higher pulse pressure transmission into the microcirculation.

Sex-dependent correlates of arterial stiffness in Tanzanian adults

OBJECTIVE

Arterial stiffness is a known indicator for cardiovascular disease. However, the factors that lead to arterial stiffening have primarily been studied in participants from high-income countries. Here, we examine clinical and lifestyle metrics in relation to arterial stiffness in Tanzanian adults.

METHODS

We performed pulse wave velocity (PWV), the gold standard measure of arterial stiffness, on 808 Tanzanian adults (ages 18-65) enrolled in a longitudinal cohort studying trends in blood pressure.

RESULTS

As expected, PWV was strongly associated with age, blood pressure and sex. We controlled for these factors in our statistical analysis. Lifestyle metrics were compared across multiple PWV quantiles. We found that determinants of PWV varied by sex: in female participants, PWV was associated with common obesity metrics and menopause, while in male participants, PWV was associated with HIV status and duration of anti-retroviral therapy (ART). Further clinical and lifestyle factors such as marriage status and type of occupation were also significantly associated with PWV and moderated by sex.

CONCLUSION

Together, our data demonstrate the importance of studying sex-specific causal pathways for arterial stiffness and of including under-represented populations in these studies.

Effect of Menopause on Arterial Stiffness and Central Hemodynamics: A Pulse Wave Analysis-Based Cross-sectional Study from Gujarat, India

Background:

Menopause, a cardiovascular risk in mid-life women, is studied in terms of blood pressure mostly. Arterial stiffness (AS) and central hemodynamics (CH) are direct surrogates measured by pulse wave analysis (PWA) with no study from our region.

Objective:

We studied AS, CH in relation to menopause using PWA.

Materials and Methods:

A cross-sectional study was performed in 134 middle-aged females divided into groups with or without menopause. Oscillometric PWA done by Mobil-o-Graph (IEM, Germany) gave – AS like augmentation pressure, augmentation index at heart rate (HR) 75, aortic pulse wave velocity (aPWV), and total AS pulse pressure amplification; CH like aortic blood pressure, cardiac output and related parameters, peripheral resistance, stroke work, prevalent brachial/central hypertension, and raised central pulse pressure. They were further compared between groups, in relation to body mass index (BMI) and by multiple regressions with P < 0.05 as statistical significance.

Results:

Postmenopausal women were significantly elder, physically inactive with comparable BMI and showed higher AS (only aPWV was significantly different) and CH. BMI was unrelated to AS or CH in postmenopausal group. Age (except for aPWV), BMI, and HR (except for AIx@75) were insignificant predictors, while systolic blood pressure (SBP) in premenopausal and diastolic blood pressure (DBP) in postmenopausal group was major AS predictors. Age, HR, and BMI were insignificant predictors, while SBP more than DBP was significant predictors of CH.

Conclusions:

In obese, predominantly sedentary midlife Gujarati women, menopause negatively affects AS and hemodynamics, central more than peripheral. Menopause accelerates cardiovascular aging, independent of BMI, and age that calls for further studies.

Prevalence of obesity in women of different ages and its relationship with arterial stiffness

Background. General and abdominal obesity is widespread among women in the Russian population. The relationship between obesity and arterial stiffness, as a predictor of the development of cardiovascular diseases, in women of different ages remains unclear. Aims: to study the relationship between obesity and arterial stiffness and dynamics of central aortic pressure in women of different ages with preserved and lost reproductive function. Methods. 161 women were examined and divided into 3 groups. Two groups included women with preserved reproductive function: group 1 consisted of 52 young women aged from 18 to 30 years (23.8 5.3 years); group 2 included 54 women aged from 31 years to the menopause (41 5.9 years). Group 3 included 55 postmenopausal women (55.4 5.8 years). All the women underwent a clinical examination with anthropometry; questioning; 24-hour monitoring of the dynamics of blood pressure with measuring the indicators of arterial stiffness and daily aortic central pressure; determination of the carotid-femoral pulse wave velocity (cfPWV); study of vascular stiffness by volume sphygmography. Results. The anthropometric data in groups 2 and 3 were comparable in terms of the prevalence of general obesity (GO). Abdominal obesity (AO) was detected in 19.2% of the 1st group; 51.9% of the 2nd and 76.4% of the 3rd group. In the 1st group AO had the strongest correlation with the aortic pulse wave velocity PWVao (R = 0.41, p = 0.002) and the corrected to HR75 augmentation index Aixao (R = 0.38, p = 0.005). In the 2nd group AO correlates with cfPWV (R = 0.4, p = 0.003); GO with PWVao (R = 0.38, p = 0.005) and aortic cardio-ankle vascular index CAVIao (R = 0.48, p = 0.001). In the 2nd group AO and GO are also interconnected with the central and peripheral pressure. In the 3rd group AO correlates with PWVao (R = 0.33, p = 0.01), cfPWV (R = 0.32, p = 0.02); GO with the index of the double product IDP (R = 0.36, p = 0.01). Conclusions. Obesity, especially its abdominal type, is an important factor determining the development of vascular wall stiffness in women of the reproductive age. It is necessary to conduct a comprehensive assessment of arterial stiffness and daily dynamics of central aortic pressure in women of all ages, suffering from obesity and, first of all, its abdominal type, in order to early diagnose subclinical changes in the vascular wall and central hemodynamic disorders.