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van Hoogland-van Heerden M, Böhmer LH, Heyneke O, Lechaba T, Scott L, Norton G, Woodiwiss A, Mntla P, Majane OHI. Characteristics of heart failure with a preserved ejection fraction in black South African patients. IJC HEART & VASCULATURE 2024; 52:101408. [PMID: 38638536 PMCID: PMC11024654 DOI: 10.1016/j.ijcha.2024.101408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 03/14/2024] [Accepted: 04/06/2024] [Indexed: 04/20/2024]
Abstract
Background Heart failure with a preserved ejection fraction (HFpEF) is common in the elderly (≥75 years) and associated with arterial stiffness. The mean age of HFpEF presentation is lower (40-55 years) in sub-Saharan Africa. No clinical study has been conducted on HFpEF in identifying and characterising this phenotype at a younger age, moreover in a South African black population where the risk of HFpEF is two times higher than in other ethnic groups. This study investigated the characteristics of HFpEF in a black South African population, the biochemical markers that predict HFpEF and cardiac structural changes in this HF phenotype. Methods Sixty-six participants with HFpEF and 213 controls were enrolled. All participants gave informed consent and completed a standardised questionnaire. Echocardiographic, anthropometric, central haemodynamic measurements, pulse wave velocity (PWV) and biomarker analysis were done. Results The mean age of HFpEF participants was 54.88 ± 13.51 years. Most of the participants (76 %) were between 20 and 64 years, while only 24 % were older. HFpEF participants were hypertensive, and more obese with increased incidence of alcohol consumption. PWV was increased in HFpEF (9.97 ± 2.78 m/s) when compared to participants without HFpEF (6.11 ± 2.18 m/s), p < 0.0001. There were no significant associations between central haemodynamic parameters, N-terminal pro B-type natriuretic peptide (NT-proBNP) (p = 0.9746), and galectin-3 (p = 0.2166). NT-proBNP, but not galectin-3, was associated with left ventricular hypertrophy (p = 0.0002) and left atrial diameter (p = 0.0005). Conclusion HFpEF in South Africa is predominant in obese young to middle-age individuals with arterial stiffness and who consume alcohol regularly. NT-proBNP could be used to diagnose HFpEF, however, should be interpreted with caution in populations with a high prevalence of obesity.
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Affiliation(s)
| | - LH Böhmer
- Sefako Makgatho Health Sciences University, South Africa
| | - O Heyneke
- Sefako Makgatho Health Sciences University, South Africa
| | - T Lechaba
- Sefako Makgatho Health Sciences University, South Africa
| | - L Scott
- Sefako Makgatho Health Sciences University, South Africa
| | - G Norton
- University of the Witwatersrand, South Africa
| | - A Woodiwiss
- University of the Witwatersrand, South Africa
| | - P Mntla
- Sefako Makgatho Health Sciences University, Dr George Mukhari Academic Hospital, South Africa
| | - OHI Majane
- Sefako Makgatho Health Sciences University, South Africa
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2
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Campillo JT, Dupasquier V, Lebredonchel E, Rancé LG, Hemilembolo MC, Pion SDS, Boussinesq M, Missamou F, Perez Martin A, Chesnais CB. Association between arterial stiffness and Loa loa microfilaremia in a rural area of the Republic of Congo: A population-based cross-sectional study (the MorLo project). PLoS Negl Trop Dis 2024; 18:e0011915. [PMID: 38241411 PMCID: PMC10830006 DOI: 10.1371/journal.pntd.0011915] [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: 09/26/2023] [Revised: 01/31/2024] [Accepted: 01/12/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Loa loa filariasis (loiasis) is still considered a relatively benign disease. However, recent epidemiologic data suggest increased mortality and morbidity in L. loa infected individuals. We aimed to examine whether the density of L. loa microfilariae (mfs) in the blood is associated with cardiovascular disease. METHODOLOGY Using a point-of-care device (pOpmètre), we conducted a cross-sectional study to assess arterial stiffness and peripheral arterial disease (PAD) in 991 individuals living in a loiasis-endemic rural area in the Republic of the Congo. Microfilaremic individuals were matched for age, sex and village of residence with 2 amicrofilaremic subjects. We analyzed markers of arterial stiffness (Pulse-Wave Velocity, PWV), PAD (Ankle-Brachial Index, ABI) and cardiovascular health (Pulse Pressure, PP). The analysis considered parasitological results (L. loa microfilarial density [MFD], soil-transmitted helminths infection, asymptomatic malaria and onchocerciasis), sociodemographic characteristics and known cardiovascular risk factors (body mass index, smoking status, creatininemia, blood pressure). PRINCIPAL FINDINGS Among the individuals included in the analysis, 192/982 (19.5%) and 137/976 (14.0%) had a PWV or an ABI considered out of range, respectively. Out of range PWV was associated with younger age, high mean arterial pressure and high L. loa MFD. Compared to amicrofilaremic subjects, those with more than 10,000 mfs/mL were 2.17 times more likely to have an out of range PWV (p = 0.00). Factors significantly associated with PAD were older age, low pulse rate, low body mass index, smoking, and L. loa microfilaremia. Factors significantly associated with an elevation of PP were older age, female sex, high average blood pressure, low pulse rate and L. loa microfilaremia. CONCLUSION A potential link between high L. loa microfilaremia and cardiovascular health deterioration is suggested. Further studies are required to confirm and explore this association.
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Affiliation(s)
- Jérémy T. Campillo
- TransVIHMI, Université de Montpellier, INSERM Unité 1175, Institut de Recherche pour le Développement (IRD), Montpellier, France
| | - Valentin Dupasquier
- Department of Cardiology, Montpellier University Hospital, Montpellier, France
| | - Elodie Lebredonchel
- Département de Biochimie, Hôpitaux Universitaires Paris Nord Val de Seine–site Bichat, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Ludovic G. Rancé
- Department of Anesthesiology and Critical Care Medicine, Montpellier University Hospital, Montpellier, France
| | - Marlhand C. Hemilembolo
- TransVIHMI, Université de Montpellier, INSERM Unité 1175, Institut de Recherche pour le Développement (IRD), Montpellier, France
- Programme National de Lutte contre l’Onchocercose, Direction de l’Épidémiologie et de la Lutte contre la Maladie, Ministère de la Santé et de la Population, Brazzaville, Republic of Congo
| | - Sébastien D. S. Pion
- TransVIHMI, Université de Montpellier, INSERM Unité 1175, Institut de Recherche pour le Développement (IRD), Montpellier, France
| | - Michel Boussinesq
- TransVIHMI, Université de Montpellier, INSERM Unité 1175, Institut de Recherche pour le Développement (IRD), Montpellier, France
| | - François Missamou
- Programme National de Lutte contre l’Onchocercose, Direction de l’Épidémiologie et de la Lutte contre la Maladie, Ministère de la Santé et de la Population, Brazzaville, Republic of Congo
| | - Antonia Perez Martin
- Vascular Medicine Laboratory, Nîmes University Hospital, Nîmes, France
- IDESP, Université de Montpellier, INSERM, Montpellier, France
| | - Cédric B. Chesnais
- TransVIHMI, Université de Montpellier, INSERM Unité 1175, Institut de Recherche pour le Développement (IRD), Montpellier, France
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Grosicki GJ, Flatt AA, Cross BL, Vondrasek JD, Blumenburg WT, Lincoln ZR, Chall A, Bryan A, Patel RP, Ricart K, Linder BA, Sanchez SO, Watso JC, Robinson AT. Acute beetroot juice reduces blood pressure in young Black and White males but not females. Redox Biol 2023; 63:102718. [PMID: 37120928 PMCID: PMC10172749 DOI: 10.1016/j.redox.2023.102718] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/08/2023] [Accepted: 04/24/2023] [Indexed: 05/02/2023] Open
Abstract
A complex interplay of social, lifestyle, and physiological factors contribute to Black Americans having the highest blood pressure (BP) in America. One potential contributor to Black adult's higher BP may be reduced nitric oxide (NO) bioavailability. Therefore, we sought to determine whether augmenting NO bioavailability with acute beetroot juice (BRJ) supplementation would reduce resting BP and cardiovascular reactivity in Black and White adults, but to a greater extent in Black adults. A total of 18 Black and 20 White (∼equal split by biological sex) young adults completed this randomized, placebo-controlled (nitrate (NO3-)-depleted BRJ), crossover design study. We measured heart rate, brachial and central BP, and arterial stiffness (via pulse wave velocity) at rest, during handgrip exercise, and during post-exercise circulatory occlusion. Compared with White adults, Black adults exhibited higher pre-supplementation resting brachial and central BP (Ps ≤0.035; e.g., brachial systolic BP: 116(11) vs. 121(7) mmHg, P = 0.023). Compared with placebo, BRJ (∼12.8 mmol NO3-) reduced resting brachial systolic BP similarly in Black (Δ-4±10 mmHg) and White (Δ-4±7 mmHg) adults (P = 0.029). However, BRJ supplementation reduced BP in males (Ps ≤ 0.020) but not females (Ps ≥ 0.299). Irrespective of race or sex, increases in plasma NO3- were associated with reduced brachial systolic BP (ρ = -0.237, P = 0.042). No other treatment effects were observed for BP or arterial stiffness at rest or during physical stress (i.e., reactivity); Ps ≥ 0.075. Despite young Black adults having higher resting BP, acute BRJ supplementation reduced systolic BP in young Black and White adults by a similar magnitude, an effect that was driven by males.
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Affiliation(s)
- Gregory J. Grosicki
- Biodynamics and Human Performance Center, Georgia Southern University, Armstrong Campus, Savannah, GA, USA
| | - Andrew A. Flatt
- Biodynamics and Human Performance Center, Georgia Southern University, Armstrong Campus, Savannah, GA, USA
| | - Brett L. Cross
- Biodynamics and Human Performance Center, Georgia Southern University, Armstrong Campus, Savannah, GA, USA
| | - Joseph D. Vondrasek
- Biodynamics and Human Performance Center, Georgia Southern University, Armstrong Campus, Savannah, GA, USA
| | - Wesley T. Blumenburg
- Biodynamics and Human Performance Center, Georgia Southern University, Armstrong Campus, Savannah, GA, USA
| | - Zoe R. Lincoln
- Biodynamics and Human Performance Center, Georgia Southern University, Armstrong Campus, Savannah, GA, USA
| | - Amy Chall
- Department of Diagnostic and Therapeutic Services, Georgia Southern University, Armstrong Campus, Savannah, GA, USA
| | - Anna Bryan
- Department of Diagnostic and Therapeutic Services, Georgia Southern University, Armstrong Campus, Savannah, GA, USA
| | - Rakesh P. Patel
- Department for Pathology and Center for Free Radical Biology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Karina Ricart
- Department for Pathology and Center for Free Radical Biology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Braxton A. Linder
- Neurovascular Physiology Laboratory, Auburn University, Auburn, AL, USA
| | - Sofia O. Sanchez
- Neurovascular Physiology Laboratory, Auburn University, Auburn, AL, USA
| | - Joseph C. Watso
- Cardiovascular and Applied Physiology Laboratory, Florida State University, Tallahassee, FL, USA
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Wright A, Stavres J, Galloway R, Donahue P, Sha Z, McCoy S. Aortic stiffness increases during prolonged sitting independent of intermittent standing or prior exercise. Eur J Appl Physiol 2023; 123:533-546. [PMID: 36334128 DOI: 10.1007/s00421-022-05079-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/13/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Adverse vascular responses can occur during prolonged sitting, including stiffening of the aortic artery which may contribute to cardiovascular disease. Few studies have investigated the impact of intermittent standing and/or prior exercise as strategies to attenuate these potentially deleterious vascular changes. PURPOSE To investigate central vascular health responses during prolonged sitting, with and without intermittent standing and/or prior exercise. METHODS Fifteen males aged 18 to 31 years were recruited. Subjects completed a control condition [Sitting Only (SO)], and three randomized strategy conditions [Sitting Plus Standing (SSt), Exercise Plus Sitting (ES), Exercise Plus Sitting Plus Standing (ESSt)]. For all conditions, measurements of carotid-femoral pulse wave velocity (cfPWV) were taken at pre- and post-intervention, and brachial and central blood pressure (BP) at pre-, 1-h, 2-h, and 3-h intervention. RESULTS cfPWV significantly increased from pre- to post-intervention for all conditions (all p ≤ 0.043), as did brachial mean arterial pressure (MAP) and diastolic BP, and central MAP and diastolic BP for the control condition (all p ≤ 0.022). Brachial and central systolic BP were significantly higher during SO compared to ESSt at 1 h, and compared to ES for central systolic BP (all p ≤ 0.036). CONCLUSIONS Strategies of intermittent standing and/or prior exercise may not prevent aortic stiffening during sitting but may attenuate BP elevations in the brachial and aortic arteries. Future research should investigate causal mechanistic links between sitting and aortic stiffening, and other attenuation strategies.
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Affiliation(s)
- Alexander Wright
- School of Kinesiology and Nutrition, College of Education and Human Sciences, University of Southern Mississippi, Hattiesburg, MS, USA.
| | - Jon Stavres
- School of Kinesiology and Nutrition, College of Education and Human Sciences, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Riley Galloway
- School of Kinesiology and Nutrition, College of Education and Human Sciences, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Paul Donahue
- School of Kinesiology and Nutrition, College of Education and Human Sciences, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Zhanxin Sha
- School of Kinesiology and Nutrition, College of Education and Human Sciences, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Stephanie McCoy
- School of Kinesiology and Nutrition, College of Education and Human Sciences, University of Southern Mississippi, Hattiesburg, MS, USA
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Sood MR, Abdelmoneim SS, Dontineni N, Ivanov A, Lee E, Rubin M, Vittoria M, Meykler M, Ramachandran V, Sacchi T, Brener S, Klem I, Heitner JF. Descending Aortic Distensibility and Cardiovascular Outcomes: A Cardiac Magnetic Resonance Imaging Study. Vasc Health Risk Manag 2022; 18:653-665. [PMID: 36065283 PMCID: PMC9440722 DOI: 10.2147/vhrm.s359632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/27/2022] [Indexed: 11/25/2022] Open
Abstract
Background Aortic distensibility (AD) is an important determinant of cardiovascular (CV) morbidity and mortality. There is scant data on the association between AD measured within the descending thoracic aorta and CV outcomes. Objective We evaluated the association of AD at the descending thoracic aorta (AD desc) with the primary outcome of all-cause mortality, myocardial infarction (MI), stroke or coronary revascularization in patients referred for a cardiovascular magnetic resonance (CMR) study. Methods 928 consecutive patients [(mean age 60 ± 17; 33% with prior cardiovascular disease (CVD))] were evaluated. AD desc was measured at the cross-section of the descending thoracic aorta in the 4-chamber view (via steady-state free precession [SSFP] cine sequences) and was grouped into quintiles (with the 1st quintile corresponding to the least AD, i.e., the stiffest aorta). Cox proportional-hazards regression analysis were performed for the primary outcome. Results A total of 315 patients (34%) experienced the primary outcome during a median (25% IQR, 75% IQR) follow-up of 5.0 (0.56, 9.3) years. A decreased AD was significantly associated with hypertension, diabetes, renal disease, and dyslipidemia (p <0.0001). A primary outcome occurred in 43% of patients with AD desc ≤ median compared to 25% with AD desc > median, p <0.0001, and in 44% of patients with AD desc in the 1st quintile compared to 31% with AD desc in the other quintiles (p = 0.0004). Event free survival was incrementally reduced amongst quintiles (p <0.0001). However, AD desc ≤ median was not an independent predictor of the primary endpoint after multivariable adjustment in the overall population [adjusted HR 1.09 (95% CI:0.82–1.45), p = 0.518] or in the subgroup analysis of patients with or without prior CVD. Conclusion In this real-world cohort of 928 patients referred for CMR, AD desc is not an independent predictor of CV outcomes.
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Affiliation(s)
- Michael R Sood
- Division of Cardiology, New York-Presbyterian Hospital, Brooklyn, NY, USA
- Division of Cardiology, Mount Sinai South Nassau, Oceanside, NY, USA
- Correspondence: Michael R Sood, Division of Cardiology, Mount Sinai South Nassau, Oceanside, NY, USA, Email
| | | | - Nripen Dontineni
- Division of Cardiology, New York-Presbyterian Hospital, Brooklyn, NY, USA
| | - Alexander Ivanov
- Division of Cardiology, New York-Presbyterian Hospital, Brooklyn, NY, USA
| | - Ernest Lee
- Division of Cardiology, New York-Presbyterian Hospital, Brooklyn, NY, USA
| | - Michael Rubin
- Division of Cardiology, New York-Presbyterian Hospital, Brooklyn, NY, USA
| | - Michael Vittoria
- Division of Cardiology, New York-Presbyterian Hospital, Brooklyn, NY, USA
| | - Marcella Meykler
- Division of Cardiology, New York-Presbyterian Hospital, Brooklyn, NY, USA
| | | | - Terrence Sacchi
- Division of Cardiology, New York-Presbyterian Hospital, Brooklyn, NY, USA
| | - Sorin Brener
- Division of Cardiology, New York-Presbyterian Hospital, Brooklyn, NY, USA
| | - Igor Klem
- Duke University, Raleigh Durham, NC, USA
| | - John F Heitner
- Division of Cardiology, New York-Presbyterian Hospital, Brooklyn, NY, USA
- Division of Cardiology, New York University-Langone Health, Brooklyn, NY, USA
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Camelo LV, Machado AV, Chor D, Griep RH, Mill JG, Brant LCC, Barreto SM. Racial discrimination is associated with greater arterial stiffness and carotid intima-media thickness: The ELSA-Brasil study. Ann Epidemiol 2022; 72:40-47. [DOI: 10.1016/j.annepidem.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 03/14/2022] [Accepted: 03/18/2022] [Indexed: 11/01/2022]
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Cruz VPD, Gonzaga CWO, da Silva VB, da Cruz AFP, da Silva ABT, Capingana DP, Magalhães P, Zaniqueli DA, Guimarães ALS, Cunha RS, Mill JG, Baldo MP. Arterial stiffness in black adults from Angola and Brazil. J Clin Hypertens (Greenwich) 2020; 22:1469-1475. [PMID: 32750210 DOI: 10.1111/jch.13962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/27/2020] [Accepted: 04/30/2020] [Indexed: 11/30/2022]
Abstract
Ethnicity is an important determinant of blood pressure levels, being black individuals affected more than any other ethnic group. Arterial stiffening, an independent risk factor for hypertension, is also influenced by ethnicity. However, whether black individuals from different continents would have different patterns of arterial stiffening is still unknown. Thus, the authors aimed to compare pulse wave velocity (PWV) in black subjects living in Angola and Brazil. A total of 677 black individuals from two independent cross-sectional studies conducted in Brazil and Angola were included in this analysis. Carotid-to-femoral PWV was measured following the same protocols for both studies, as well as clinical and anthropometric variables. Adjusted PWV was higher in Brazilian blacks than in Angolans, regardless of sex (men from Brazil: 10.7 ± 1.8 vs men from Angola: 9.9 ± 1.8 m/s, P < .001; women from Brazil: 10.3 ± 1.5 vs women from Angola: 9.2 ± 1.3 m/s, P < .001). Although the cf-PWV was higher in Brazilian blacks, the age-related increase in cf-PWV was higher in Angolan men compared to Brazilians, but not in women. SBP showed the strongest association with cf-PWV, regardless of sex and country. However, age was associated with cf-PWV in all groups, except in Brazilian men. Our results clearly show a difference in PWV between two black populations, and highlight for sex differences in the hemodynamic parameters that might affect blood pressure levels in these populations.
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Affiliation(s)
- Vitória P D Cruz
- Postgraduate Program in Health Sciences, Montes Claros State University, Montes Claros, Brazil
| | - Carla W O Gonzaga
- Postgraduate Program in Health Sciences, Montes Claros State University, Montes Claros, Brazil
| | - Victor B da Silva
- Postgraduate Program in Health Sciences, Montes Claros State University, Montes Claros, Brazil
| | - André F P da Cruz
- Postgraduate Program in Health Sciences, Montes Claros State University, Montes Claros, Brazil
| | | | - Daniel P Capingana
- Department of Physiology, Faculty of Medicine, University Agostinho Neto, Luanda, Angola
| | - Pedro Magalhães
- Department of Physiology, Faculty of Medicine, University Agostinho Neto, Luanda, Angola
| | - Divanei A Zaniqueli
- Department of Physiological Sciences, Federal University of Espírito Santo, Vitória, Brazil
| | - André L S Guimarães
- Postgraduate Program in Health Sciences, Montes Claros State University, Montes Claros, Brazil
| | - Roberto Sá Cunha
- Department of Physiological Sciences, Federal University of Espírito Santo, Vitória, Brazil
| | - José Geraldo Mill
- Department of Physiological Sciences, Federal University of Espírito Santo, Vitória, Brazil
| | - Marcelo P Baldo
- Postgraduate Program in Health Sciences, Montes Claros State University, Montes Claros, Brazil.,Department of Medicine, Faculdades Integradas Pitágoras, UniFIPMOC, Montes Claros, Brazil.,Department of Pathophysiology, Montes Claros State University, Montes Claros, Brazil
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Schutte AE, Kruger R, Gafane-Matemane LF, Breet Y, Strauss-Kruger M, Cruickshank JK. Ethnicity and Arterial Stiffness. Arterioscler Thromb Vasc Biol 2020; 40:1044-1054. [PMID: 32237903 DOI: 10.1161/atvbaha.120.313133] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Early vascular aging reflects increased arterial stiffness of central blood vessels at young chronological ages and powerfully predicts cardiovascular events and mortality, independent of routine brachial blood pressure and other risk factors. Since ethnic disparities exist in routine blood pressure, in hypertension and cardiovascular outcomes, this review evaluates major studies comparing arterial stiffness through the life course between different ethnic groups or races (which have no biological definition)-in children, adolescents, young, and middle-aged adults and the very elderly. Most report that compared with white European-origin samples, populations of black African descent have increased central arterial stiffness throughout different life stages, as well as a more rapid increase in arterial stiffness at young ages. Exceptions may include African Caribbean origin people in Europe. Differences in vascular structure and function are clearest, where obesity, socioeconomic, and psychosocial factors are most marked. Few studies evaluate a wider spectrum of ethnic groups or factors contributing to these ethnic disparities. Genetic effects are not obvious; maternal risk and intergenerational studies are scarce. Nevertheless, across all ethnic groups, for given levels of blood pressure and age, some people have stiffer central arteries than others. These individuals are most at risk of vascular events and mortality and, therefore, may benefit from early, as yet untested, preventive action and treatment.
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Affiliation(s)
- Aletta E Schutte
- From the Hypertension in Africa Research Team, South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa (A.E.S., R.K., L.F.G.-M., Y.B., M.S.-K.)
- School of Public Health and Community Medicine, University of New South Wales, The George Institute for Global Health, Sydney, Australia (A.E.S.)
| | - Ruan Kruger
- From the Hypertension in Africa Research Team, South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa (A.E.S., R.K., L.F.G.-M., Y.B., M.S.-K.)
| | - Lebo F Gafane-Matemane
- From the Hypertension in Africa Research Team, South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa (A.E.S., R.K., L.F.G.-M., Y.B., M.S.-K.)
| | - Yolandi Breet
- From the Hypertension in Africa Research Team, South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa (A.E.S., R.K., L.F.G.-M., Y.B., M.S.-K.)
| | - Michél Strauss-Kruger
- From the Hypertension in Africa Research Team, South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa (A.E.S., R.K., L.F.G.-M., Y.B., M.S.-K.)
| | - J Kennedy Cruickshank
- Life-Course and Nutritional Sciences and St Thomas' & Guy's Hospitals, King's College/King's Health Partners, London, United Kingdom (J.K.C.)
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Vera L, De Clercq D, Paulussen E, Van Steenkiste G, Decloedt A, Chiers K, van Loon G. Aortic, common carotid and external iliac artery arterial wall stiffness parameters in horses: Inter-day and inter-observer and intra-observer measurement variability. Equine Vet J 2019; 52:471-476. [PMID: 31648382 DOI: 10.1111/evj.13196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 10/22/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND In human medicine, local and regional arterial wall stiffness (AWS) parameters are routinely used to assess the vascular health. In horses, information regarding reproducibility of ultrasonographically derived AWS parameters is lacking. OBJECTIVES To evaluate the inter-day and inter-observer and intra-observer measurement variability of both local and regional AWS parameters in horses. STUDY DESIGN Experimental study. METHODS In 10 healthy, adult Warmblood horses, B-, M-mode and pulsed-wave Doppler ultrasound images were collected on two different days from aorta, cranial and caudal common carotid arteries and external iliac artery. Heart rate and noninvasive blood pressure were recorded simultaneously. From blinded data, diastolic and systolic vessel lumen areas and diameters were measured from B/M-mode images and the velocity of the pressure wave was determined by pulsed-wave Doppler spectra. From each horse, one examination was measured again by the same observer and by a second, independent observer. Local and regional AWS parameters were calculated and inter-day and inter-observer and intra-observer measurement coefficient of variation (CV) were assessed. RESULTS Low CV was found for both arterial diameter and lumen area measurements. Moderate to high CV was found for local AWS parameters, while regional AWS parameters had low CV. MAIN LIMITATIONS The number of horses investigated was too low to obtain reference values. The inter-operator variability was not evaluated. CONCLUSIONS Our results show good reproducibility of aortic, carotid and external iliac artery diameter and area measurements using both B- and M-mode ultrasonography. Nevertheless, the variability of the derived local AWS parameters was relatively high. Therefore, local AWS parameters might be less suitable for follow-up studies, although they might be useful for population studies. On the other hand, regional AWS parameters showed low CV, making them valuable for both follow-up and population studies.
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Affiliation(s)
- L Vera
- Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Equine Cardioteam Ghent University, Ghent University, Merelbeke, Belgium
| | - D De Clercq
- Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Equine Cardioteam Ghent University, Ghent University, Merelbeke, Belgium
| | - E Paulussen
- Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Equine Cardioteam Ghent University, Ghent University, Merelbeke, Belgium
| | - G Van Steenkiste
- Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Equine Cardioteam Ghent University, Ghent University, Merelbeke, Belgium
| | - A Decloedt
- Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Equine Cardioteam Ghent University, Ghent University, Merelbeke, Belgium
| | - K Chiers
- Department of Pathology, Bacteriology and Poultry Diseases, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - G van Loon
- Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Equine Cardioteam Ghent University, Ghent University, Merelbeke, Belgium
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10
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Racial differences in the association between early socioeconomic position, birth weight, and arterial stiffness in adults from ELSA-Brasil. Ann Epidemiol 2019; 34:45-51. [DOI: 10.1016/j.annepidem.2019.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 02/28/2019] [Accepted: 03/16/2019] [Indexed: 12/12/2022]
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11
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Zilbermint M, Hannah-Shmouni F, Stratakis CA. Genetics of Hypertension in African Americans and Others of African Descent. Int J Mol Sci 2019; 20:ijms20051081. [PMID: 30832344 PMCID: PMC6429313 DOI: 10.3390/ijms20051081] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 02/19/2019] [Accepted: 02/21/2019] [Indexed: 02/07/2023] Open
Abstract
Hypertension is the leading cause of cardiovascular disease in the United States, affecting up to one-third of adults. When compared to other ethnic or racial groups in the United States, African Americans and other people of African descent show a higher incidence of hypertension and its related comorbidities; however, the genetics of hypertension in these populations has not been studied adequately. Several genes have been identified to play a role in the genetics of hypertension. They include genes regulating the renin-aldosterone-angiotensin system (RAAS), such as Sodium Channel Epithelial 1 Beta Subunit (SCNN1B), Armadillo Repeat Containing 5 (ARMC5), G Protein-Coupled Receptor Kinase 4 (GRK4), and Calcium Voltage-Gated Channel Subunit Alpha1 D (CACNA1D). In this review, we focus on recent genetic findings available in the public domain for potential differences between African Americans and other populations. We also cover some recent and relevant discoveries in the field of low-renin hypertension from our laboratory at the National Institutes of Health. Understanding the different genetics of hypertension among various groups is essential for effective precision-guided medical therapy of high blood pressure.
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Affiliation(s)
- Mihail Zilbermint
- Section on Endocrinology and Genetics, The Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, BG 31 RM 2A46, 31 Center Dr, Bethesda, MD 20892, USA.
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
- Johns Hopkins Community Physicians at Suburban Hospital, Bethesda, MD 20814, USA.
- Johns Hopkins University Carey Business School, Baltimore, MD 21202, USA.
| | - Fady Hannah-Shmouni
- Section on Endocrinology and Genetics, The Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, BG 31 RM 2A46, 31 Center Dr, Bethesda, MD 20892, USA.
| | - Constantine A Stratakis
- Section on Endocrinology and Genetics, The Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, BG 31 RM 2A46, 31 Center Dr, Bethesda, MD 20892, USA.
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12
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Lemogoum D, Halle MP, Mboule RD, Van de Borne P, Bika Lele EC, Kamdem F, Doualla MS, Luma H, Hermans MP, Van Bortel L. Arterial stiffness in black African ancestry patients with chronic kidney disease living in Cameroon. Cardiovasc Diagn Ther 2018; 8:450-459. [PMID: 30214860 DOI: 10.21037/cdt.2018.04.04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Increased aortic pulse wave velocity (PWV), a direct measure of arterial stiffness (AS) is an independent predictor of cardiovascular events (CVEs) in chronic kidney disease (CKD) patients. This study assessed the patterns of PWV among Cameroonian patients with CKD in whom that marker of early vascular aging has not been explored so far. Methods We enrolled 150 Black African patients (mean age: 52±15 years, 56.7% males) with CKD in a cross-sectional study conducted at Douala General Hospital, Douala, Cameroon. Sociodemographic, anthropometric and biologic variables, blood pressure (BP) and PWV were recorded in all participants. Estimated aortic PWV was measured using a Mobil-O-Graph automatic brachial oscillometric device. Results PWV increased with aging (P<0.0001), and PWV adjusted for age, sex, body mass index and mean arterial BP (MAP) was higher in non-dialysed (n=90) than in hemodialysed (n=60) patients, even in pre-dialysis: 8.5±2.0 vs. 7.9±1.4 m/s (P=0.026); and in post-dialysis: 8.5±2.0 vs. 7.8±1.5 m/s (P=0.008). The mean PWV of all study participants was 8.2±1.8 m/s, with 61.3% of patients having a PWV ≥8.2 m/s, indicative of subclinical damage to the aorta, which was more pronounced in non-dialysis (67.8%) than in hemodialysis (53.3%) patients (P=0.033). Multivariable analysis performed in all participants revealed that advanced age, MAP and tobacco use were independently associated with PWV (all P<0.05). Conclusions Our findings suggest increased AS in Cameroonian CKD non-dialyzed as compared to dialyzed patients. Slower PWV in patients on maintenance hemodialysis suggests improvement of aortic distensibility following dialysis. However, further large-scale studies are needed to confirm our findings and to improve understanding of the underlying mechanisms of arterial stiffening in black African ancestry patients with CKD.
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Affiliation(s)
- Daniel Lemogoum
- Faculty of medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon.,ULB-Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.,Cameroon Heart Foundation, Douala, Cameroon
| | - Marie Patrice Halle
- Faculty of medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon.,Department of Internal Medicine, Douala General Hospital, Douala, Cameroon
| | - Ruth Dione Mboule
- Faculty of medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon.,Cameroon Heart Foundation, Douala, Cameroon
| | | | | | - Felicité Kamdem
- Faculty of medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon.,Department of Internal Medicine, Douala General Hospital, Douala, Cameroon
| | | | - Henry Luma
- Department of Internal Medicine, Douala General Hospital, Douala, Cameroon
| | - Michel P Hermans
- Endocrinology and Nutrition Unit, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Avenue Hippocrate, Brussels, Belgium
| | - Luc Van Bortel
- Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium
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13
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Ethnicity and arterial stiffness in children and adolescents from a Brazilian population. J Hypertens 2017; 35:2257-2261. [PMID: 28692446 DOI: 10.1097/hjh.0000000000001444] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Increased stiffness of large arteries is an important determinant of cardiovascular disease risk. Higher values of arterial stiffness measured by carotid-femoral pulse wave velocity (cf-PWV) have been measured in adult African-Americans compared with whites. Studies assessing ethnic differences in cf-PWV among children and adolescents are scarce. This study sought to evaluate the association between ethnicity and cf-PWV in Brazilian children and adolescents. METHODS Seven hundred and seventy-one children and adolescents (211 blacks and 560 nonblacks, 11.3 ± 2.7 years) were included. Arterial stiffness was evaluated by cf-PWV. The ethnic classification was obtained by a single interviewer according to general phenotypes such as skin color, hair shape and facial traces. RESULTS Blood pressure was similar in blacks and nonblacks across all pubertal stages. Differently, cf-PWV was higher in blacks than nonblacks pubescent (5.9 ± 0.7 vs. 5.6 ± 0.8 m/s, P = 0.001) and postpubescent (6.1 ± 0.7 vs. 5.7 ± 0.7 m/s, P = 0.042), whereas no difference was detected between blacks and nonblacks prepubescent. These analyses were adjusted for sex, age, height, BMI, SBP and heart rate. CONCLUSION Our study showed that higher cf-PWV values in blacks appear in adolescence and are independent of blood pressure values. Therefore, our data suggest adolescence as the key phase for the appearance of the vascular profile found in adults black individuals.
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14
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Baldo MP, Cunha RS, Ribeiro ALP, Lotufo PA, Chor D, Barreto SM, Bensenor IM, Pereira AC, Mill JG. Racial Differences in Arterial Stiffness are Mainly Determined by Blood Pressure Levels: Results From the ELSA-Brasil Study. J Am Heart Assoc 2017. [PMID: 28637779 PMCID: PMC5669170 DOI: 10.1161/jaha.117.005477] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background Black people have a higher risk of developing hypertension and presenting higher vascular stiffening. Our aim was to investigate whether the association between race and aortic stiffness could be explained by differences in the primary risk factors. Methods and Results We analyzed data from 11 472 adults (mean age, 51.9±8.9; 53.8% female) self‐reported as white (n=6173), brown (n=3364), or black (n=1935). Their carotid‐to‐femoral pulse wave velocity (cf‐PWV) as well as clinical and anthropometric parameters were measured. cf‐PWV was higher in blacks than in whites or browns (men: white, 9.63±1.81; brown, 9.63±1.88; black, 9.98±1.99; women: white, 8.84±1.64; brown, 9.02±1.68; black, 9.34±1.91; P<0.05). However, this difference disappeared after adjustments for age, mean arterial pressure, heart rate, waist circumference, fasting glucose, and glomerular filtration rate (men: white, 9.68±1.54; brown, 9.68±1.50; black, 9.73±1.52; women: white, 8.93±1.32; brown, 8.98±1.29; black, 9.02±1.32; P>0.05). The association between race and arterial stiffness was significant for brown and black women in the highest cf‐PWV quartile, even after controlling for covariates. There were no differences in the age‐related increase in cf‐PWV among the racial groups after adjustment, confirming the strong effect of age and mean arterial pressure on cf‐PWV revealed by the multiple linear regression. Conclusions Racial differences in cf‐PWV were mainly attributed to differences in mean arterial pressure and age, although they cannot fully explain the association between race and cf‐PWV in women in the highest cf‐PWV values. This suggests that therapeutic approaches to overcome the effects of aging on the vascular system should focus on blood pressure control, especially in the black population.
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Affiliation(s)
- Marcelo P Baldo
- Department of Pathophysiology, Montes Claros State University, Montes Claros, MG, Brazil
| | - Roberto S Cunha
- Department of Physiological Sciences, Federal University of Espírito Santo, Vitória, ES, Brazil
| | - Antônio L P Ribeiro
- Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Paulo A Lotufo
- Center for Clinical and Epidemiologic Research, University of São Paulo, São Paulo, Brazil
| | - Dora Chor
- Escola Nacional de Saúde Pública Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Sandhi M Barreto
- Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Isabela M Bensenor
- Center for Clinical and Epidemiologic Research, University of São Paulo, São Paulo, Brazil
| | | | - José Geraldo Mill
- Department of Physiological Sciences, Federal University of Espírito Santo, Vitória, ES, Brazil
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15
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Silva AB, Capingana DP, Magalhães P, Molina MDCB, Baldo MP, Mill JG. Predictors and Reference Values of Pulse Wave Velocity in Prepubertal Angolan Children. J Clin Hypertens (Greenwich) 2016; 18:725-32. [PMID: 26663634 PMCID: PMC8031821 DOI: 10.1111/jch.12739] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 09/17/2015] [Accepted: 09/22/2015] [Indexed: 11/29/2022]
Abstract
Carotid-femoral pulse wave velocity (PWV) has been used as the gold standard method to estimate arterial stiffness. However, its use in clinical practice is still limited because reference values for specific groups, such as black children, remain unknown. The authors aimed to investigate predictors and to propose preliminary reference values of PWV in this population. Prepubertal schoolchildren (N=157; mean age, 9.36±1.41 year) from Luanda (Angola) with normal blood pressure values and without obesity were included. Mean PWV was 5.73±0.68 m/s, with no difference between the sexes. Univariate regression analysis showed a significant (P<.05) positive correlation between PWV and height, age, body weight, lean body weight, and blood pressure. In multivariate analysis, however, only height remained an independent predictor of PWV [PWV=0.018×height (cm)+3.230]. Curves of PWV percentiles as a function of height are proposed, thus identifying normal PWV in black children.
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Affiliation(s)
- Amílcar B.T. Silva
- Department of Physiological SciencesFederal University of Espírito SantoEspírito SantoBrazil
- Department of Physiological SciencesMedical School of the Agostinho Neto UniversityLuandaAngola
| | - Daniel P. Capingana
- Department of Physiological SciencesMedical School of the Agostinho Neto UniversityLuandaAngola
| | - Pedro Magalhães
- Department of Physiological SciencesMedical School of the Agostinho Neto UniversityLuandaAngola
| | | | - Marcelo P. Baldo
- Department of Physiological SciencesFederal University of Espírito SantoEspírito SantoBrazil
| | - José Geraldo Mill
- Department of Physiological SciencesFederal University of Espírito SantoEspírito SantoBrazil
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Integrated multiomics approach identifies calcium and integrin-binding protein-2 as a novel gene for pulse wave velocity. J Hypertens 2016; 34:79-87. [PMID: 26378684 PMCID: PMC4845763 DOI: 10.1097/hjh.0000000000000732] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is available in the text Background: Carotid-femoral pulse wave velocity (PWV) is an important measure of arterial stiffness, which is an independent predictor of cardiovascular morbidity and mortality. In this study, we used an integrated genetic, epigenetic and transcriptomics approach to uncover novel molecular mechanisms contributing to PWV. Methods and results: We measured PWV in 1505 healthy twins of European descendent. A genomewide association analysis was performed using standardized residual of the inverse of PWV. We identified one single-nucleotide polymorphism (rs7164338) in the calcium and integrin-binding protein-2 (CIB2) gene on chromosome 15q25.1 associated with PWV [β = −0.359, standard error (SE) = 0.07, P = 4.8 × 10–8]. The same variant was also associated with increased CIB2 expression in leucocytes (β = 0.034, SE = 0.008, P = 4.95 × 10–5) and skin (β = 0.072, SE = 0.01, P = 2.35 × 10–9) and with hypomethylation of the gene promoter (β = −0.899, SE = 0.098, P = 3.63 × 10–20). Conclusion: Our data indicate that reduced methylation of the CIB2 promoter in individuals carrying rs7164338 may lead to increased CIB2 expression. Given that CIB2 is thought to regulate intracellular calcium levels, an increase in protein levels may prevent the accumulation of serum calcium and phosphate, ultimately slowing down the process of vascular calcification. This study shows the power of integrating multiple omics to discover novel cardiovascular mechanisms.
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17
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Chen W, Li S, Fernandez C, Sun D, Lai CC, Zhang T, Bazzano L, Urbina EM, Deng HW. Temporal Relationship Between Elevated Blood Pressure and Arterial Stiffening Among Middle-Aged Black and White Adults: The Bogalusa Heart Study. Am J Epidemiol 2016; 183:599-608. [PMID: 26960706 DOI: 10.1093/aje/kwv274] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 07/23/2015] [Indexed: 11/12/2022] Open
Abstract
This study assessed the temporal relationship between elevated blood pressure (BP) and arterial stiffness in a biracial (black-white) cohort of middle-aged adults aged 32-51 years from the semirural community of Bogalusa, Louisiana. Measurements of aortic-femoral pulse wave velocity (afPWV; n = 446) and large- and small-arterial compliance (n = 381) were obtained at 2 time points between 2000 and 2010, with an average follow-up period of 7 years. A cross-lagged path analysis model was used to examine the temporal relationship of elevated BP to arterial stiffness and elasticity. The cross-lagged path coefficients did not differ significantly between blacks and whites. The path coefficient (ρ2) from baseline BP to follow-up afPWV was significantly greater than the path coefficient (ρ1) from baseline afPWV to follow-up BP (ρ2 = 0.20 vs. ρ1 = 0.07 (P = 0.048) for systolic BP; ρ2 = 0.19 vs. ρ1 = 0.05 (P = 0.034) for diastolic BP). The results for this 1-directional path from baseline BP to follow-up afPWV were confirmed, although marginally significant, by using large- and small-artery elasticity measurements. These findings provide strong evidence that elevated BP precedes large-artery stiffening in middle-aged adults. Unlike the case in older adults, the large-arterial wall is not stiff enough in youth to alter BP levels during young adulthood.
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18
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Koumaras C, Katsiki N, Athyros VG, Karagiannis A. Metabolic syndrome and arterial stiffness: the past, the present and the future. J Cardiovasc Med (Hagerstown) 2014; 14:687-9. [PMID: 24335882 DOI: 10.2459/jcm.0b013e3283657c96] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Charalambos Koumaras
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
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Magalhães P, Capingana DP, Silva ABT, Ferreira AVL, de Sá Cunha R, Rodrigues SL, Mill JG. Age- and gender-specific reference values of pulse wave velocity for African adults: preliminary results. AGE (DORDRECHT, NETHERLANDS) 2013; 35:2345-2355. [PMID: 23319362 PMCID: PMC3824996 DOI: 10.1007/s11357-012-9504-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 12/27/2012] [Indexed: 06/01/2023]
Abstract
Pulse wave velocity (PWV) is an independent predictor of cardiovascular (CV) risk. Higher PWV values have been observed in Africans; however, there are no established age- and gender-adjusted reference values for this population. Therefore, PWV was measured using a validated device (Complior SP) in 544 subjects recruited from an occupational cohort of employees of a public university in Angola. Since high blood pressure (BP) is an important factor influencing PWV, a subsample of 301 normotensive subjects (aged 22-72 years) was selected for this study. A subset of 131 individuals without CV risk factors was considered the healthy group (HG), while the entire group (n = 301) comprised the less healthy group (LHG). Predictors of PWV were evaluated using multiple regression analyses and age- and gender-specific percentile tables and curves were constructed. Age and PWV means were 36 ± 9.7 years and 6.6 ± 1.0 m/s in the HG, respectively, and 39.9 ± 10.2 years and 7.3 ± 1.3 m/s in the LHG. Age and plasma uric acid (UA) were the only significant PWV predictors in the HG, while age, mean BP (MBP), and gender showed significant prediction of PWV in the multiple regression analysis in the LHG. Age- and gender-adjusted reference values of PWV were provided for healthy and less healthy normotensive Africans. Considering the small sample size of our cohort, these preliminary results should be used cautiously until data on robust sample of the general population can be obtained.
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de Oliveira Alvim R, Santos PCJL, Musso MM, de Sá Cunha R, Krieger JE, Mill JG, Pereira AC. Impact of diabetes mellitus on arterial stiffness in a representative sample of an urban Brazilian population. Diabetol Metab Syndr 2013; 5:45. [PMID: 23965633 PMCID: PMC3765236 DOI: 10.1186/1758-5996-5-45] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 08/19/2013] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Independent of other cardiovascular (CV) risk factors, increased arterial stiffness has been established as a predictor of morbidity and mortality. The main aim of this study was to investigate the impact of diabetes on arterial stiffness in a representative sample of an urban Brazilian population plus Amerindians. METHODS A total of 1,415 individuals from the general population were randomly selected plus 588 Amerindians from a native community in Brazil. In addition, a sub-sample of 380 individuals from the general population had 5-year follow-up data. Pulse wave velocity (PWV) was measured with a non-invasive automatic device (Complior, Colson; Garges les Gonesses, France) and increased arterial stiffness was defined as PWV ≥ 12 m/s. RESULTS In the overall group, diabetic individuals had higher frequencies of increased arterial stiffness and hypertension. They also had higher values of PWV, body mass index, total cholesterol, triglycerides, systolic and diastolic blood pressures compared to non-diabetic individuals (p < 0.01). In an analysis stratified by hypertension, PWV values and increased arterial stiffness frequency were higher in diabetic individuals in both groups (hypertensive and non-hypertensive) (p < 0.05). Furthermore, higher risk for increased arterial stiffness was observed in the diabetic individuals from the overall group (OR = 2.27; CI = 1.47-3.52, p < 0.001) and from the hypertensive group (OR = 2.70; CI = 1.58-4.75, p < 0.001), adjusted for covariates. Regarding the ethnic stratification, diabetic individuals from Amerindian, White, and Mulatto (mixed-race) groups had higher PWV values and a greater frequency of increased arterial stiffness compared to non-diabetic individuals. Both diabetic and non-diabetic individuals had higher PWV values after 5 years. There was no significant difference in the 5-year PWV progression in diabetic compared to non-diabetic individuals. CONCLUSIONS These results confirm, in a sample of Brazilian population, that the presence of diabetes is associated with increased arterial stiffness and it may contribute in part to increased cardiovascular risk in diabetic patients.
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Affiliation(s)
- Rafael de Oliveira Alvim
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 44 Cerqueira César, São Paulo, SP CEP 05403-000, Brazil
| | - Paulo Caleb Junior Lima Santos
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 44 Cerqueira César, São Paulo, SP CEP 05403-000, Brazil
| | - Mariane Manso Musso
- Department of Medicine, Juiz de Fora Federal University, Juiz de Fora, MG, Brazil
| | - Roberto de Sá Cunha
- Department of Physiology, Espirito Santo Federal University, Espirito Santo, ES, Brazil
| | - José Eduardo Krieger
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 44 Cerqueira César, São Paulo, SP CEP 05403-000, Brazil
| | - José Geraldo Mill
- Department of Physiology, Espirito Santo Federal University, Espirito Santo, ES, Brazil
| | - Alexandre Costa Pereira
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 44 Cerqueira César, São Paulo, SP CEP 05403-000, Brazil
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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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Conduit vessel stiffness in British south Asians of Indian descent relates to 25-hydroxyvitamin D status. J Hypertens 2013; 30:1588-96. [PMID: 22688263 DOI: 10.1097/hjh.0b013e328354f385] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND South Asians migrating to Northern latitudes are more susceptible to premature cardiovascular disease (CVD) than expected for given levels of blood pressure. Vitamin D deficiency is common in this group and may play an important role mediating vascular wall senescence in response to central pressure effects. METHODS A cross-sectional association study. South Asian and White European participants were randomly recruited from a population-based diabetes-screening programme. Carotid-femoral pulse wave velocity (cfPWV), biochemistry (25-hydroxyvitamin D, fasting glucose), anthropometrics, resting blood pressure and a physical activity measure (International Physical Activity Questionnaire) were measured under controlled conditions. PARTICIPANTS One hundred and thirty-two and 125 age-matched South Asians and White Europeans not taking vitamin D supplementation with a risk factor for diabetes but no overt CVD. RESULTS Age (mean south Asian: 55.7 vs. White European: 56.0 years), mean arterial pressure (MAP) and calculated CVD risk were similar in both groups. Unadjusted (cf)PWV (m/s) was higher (9.32 vs. 8.68 P = 0.001) and 25-hydroxyvitamin D (nmol/l) lower in (21.29 vs. 52.5 P < 0.001) south Asians. 25-Hydroxyvitamin D independently associated with cfPWV in multivariate modelling adjusted for age, MAP, sex, glucose, heart rate, vasoactive medication and south Asian ethnicity (R = 0.73, P = 0.004). 25-Hydroxyvitamin D but not physical activity was negatively correlated with cfPWV independent of south Asian ethnicity. CONCLUSION Aortic stiffness is increased in British Indo-Asians without vascular disease despite conventional risk profiles, which are comparable to age-matched white Europeans. This effect may be mediated by a greater pressure-dependent increase in stiffness in individuals with vitamin D insufficiency.
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Chen W, Srinivasan SR, Berenson GS. Differential impact of heart rate on arterial wall stiffness and thickness in young adults: The Bogalusa Heart Study. ACTA ACUST UNITED AC 2012; 2:152-7. [PMID: 20409897 DOI: 10.1016/j.jash.2007.10.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2007] [Revised: 10/05/2007] [Accepted: 10/16/2007] [Indexed: 11/29/2022]
Abstract
Heart rate, a hemodynamic parameter, is an important determinant of arterial wall stiffness. However, information on the relationship of heart rate to arterial wall thickness is inconsistent. This study examined the influence of heart rate on arterial stiffness and thickness in Black and White young adults. The study cohort consisted of 255 Black and 659 White adults age 25 to 43 years enrolled in the Bogalusa Heart Study. Carotid artery intima-media thickness (IMT) was measured by B-mode ultrasound and aorta-femoral pulse wave velocity (af-PWV) by echo-Doppler. There was no difference in heart rate between Blacks and Whites. Males vs. females displayed lower heart rate and higher segmental and composite carotid IMT; Blacks vs. Whites had higher composite carotid IMT (0.83 mm vs. 0.80 mm, P < .01) and af-PWV (5.4 m/s vs. 5.2 m/s, P < .01). In a multivariate regression model adjusting for traditional cardiovascular risk variables, heart rate was independently associated with af-PWV (standardized regression coefficient: beta = .14, P = .01 for Blacks; beta = .06, P = .07 for Whites; beta = .09, P = .003 for total sample), but not with carotid IMT. These results indicate that heart rate plays differential roles in the development of arterial stiffness and subclinical atherosclerosis during young adulthood.
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Affiliation(s)
- Wei Chen
- Tulane Center for Cardiovascular Health and Department of Epidemiology, Tulane University Health Sciences Center, New Orleans, Louisiana, USA
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Hall JL, Duprez DA, Barac A, Rich SS. A review of genetics, arterial stiffness, and blood pressure in African Americans. J Cardiovasc Transl Res 2012; 5:302-8. [PMID: 22492025 PMCID: PMC3381797 DOI: 10.1007/s12265-012-9362-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Accepted: 03/20/2012] [Indexed: 01/11/2023]
Abstract
The prevalence of hypertension in African Americans in the USA is among the highest in the world and increasing. The identification of genes and pathways regulating blood pressure in African Americans has been challenging. An early predictor of hypertension is arterial stiffness. The prevalence of arterial stiffness is significantly higher in African Americans compared to Caucasians. Approximately 20 % of the variance in arterial stiffness is estimated to be heritable. Identifying genes and biological pathways regulating arterial stiffness may provide insight into the genetics underlying the increased risk of hypertension in African Americans. This paper reviews the genetic findings to date in the area of arterial stiffness and blood pressure in African Americans with an emphasis on the current limitations and new efforts to move the field forward.
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Affiliation(s)
- Jennifer L Hall
- Division of Cardiology, Department of Medicine, Lillehei Heart Institute, University of Minnesota, 4-106 NHH, 312 Church Street, Minneapolis, MN 55455, USA.
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Lemogoum D, Ngatchou W, Janssen C, Leeman M, Van Bortel L, Boutouyrie P, Degaute JP, Van de Borne P. Effects of hunter-gatherer subsistence mode on arterial distensibility in Cameroonian pygmies. Hypertension 2012; 60:123-8. [PMID: 22615114 DOI: 10.1161/hypertensionaha.111.187757] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We aimed to assess whether arterial distensibility estimated by pulse wave velocity (PWV) and augmentation index (AI) differs between Cameroon traditional pygmies (TPs) on hunter-gather subsistence mode, contemporary pygmies who migrated to semiurban area, and the Bantou farmers (BFs) sharing the same environment. For that purpose, we recorded carotid-femoral PWV (ComplioR) in age and sex carefully matched 20 TPs, 20 contemporary pygmies, and 22 BFs. Aortic AI corrected for heart rate and blood pressures were generated from pressure wave analysis (SphygmoCor). Lipid profile was determined in TP and BF participants. TPs were shorter (P=0.02) with lower body weight (P<0.01) in comparison with contemporary pygmies and BFs. TPs had lower low-density lipoprotein cholesterol but higher high-density lipoprotein cholesterol than BFs (P<0.01). Their PWV (5.81±0.21 m/s) was slower (P=0.006) than that of contemporary pygmies (6.82±0.36 m/s) or BFs (6.93±0.29 m/s); however, after its adjustment for age, mean arterial pressure, and heart rate, the difference was slightly attenuated (P=0.051). PWV adjusted for weight did not differ between groups (P=0.10). In the whole study population but not in TPs taken separately, multivariate regression analysis revealed that PWV was independently associated with mean arterial pressure, age, and TP status (P<0.001), whereas age, mean arterial pressure, and height emerged as independent determinants of aortic AI corrected for heart rate (P<0.001). Aortic AI corrected for heart rate did not differ in the 3 groups. In conclusion, hunter-gather lifestyle is associated with low atherosclerosis risk translated by lower aortic stiffness attributed at least partly to low weight and blunted effects of aging and blood pressures on TP arterial structure and function.
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Affiliation(s)
- Daniel Lemogoum
- Hypertension Clinic, Department of Cardiology, Université Libre de Bruxelles-Erasme Hospital, 808 Lennik Rd 1070, Brussels, Belgium.
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Birru MS, Matthews KA, Thurston RC, Brooks MM, Ibrahim S, Barinas-Mitchell E, Janssen I, Sutton-Tyrrell K. African-American ethnicity and cardiovascular risk factors are related to aortic pulse-wave velocity progression. Am J Hypertens 2011; 24:809-15. [PMID: 21490691 PMCID: PMC3605977 DOI: 10.1038/ajh.2011.57] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Accelerated central arterial stiffening as represented by progression of aortic pulse-wave velocity (PWV) may be influenced by cardiovascular disease (CVD) risk factors. Little is known about the relationships between CVD risk factors and PWV progression among women transitioning through the menopause, or whether these relationships vary by ethnicity. METHODS We conducted a subgroup analysis of 303 African-American and Caucasian participants in the Study of Women's Health Across the Nation (SWAN) Heart Study which received PWV scans at baseline examination and at a follow-up examination at an average of 2.3 years later. CVD risk factors were also assessed at baseline. RESULTS Systolic blood pressure (SBP) and waist circumference were the strongest predictors of PWV progression, after adjustment for age, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol, diastolic blood pressure (DBP), glucose, and triglyceride levels. The magnitude of the influence of SBP, DBP, LDL-C, and glucose on PWV progression varied by ethnicity (difference in slopes: P = 0.02 for SBP, P = 0.0009 for DBP, P = 0.005 for LDL-C, and P = 0.02 for glucose). The positive relationship between SBP and PWV progression was significant among women of both ethnicities. LDL-C, DBP, and, to a lesser extent, glucose levels were positively associated with PWV progression only among African Americans. CONCLUSIONS Blood pressure, LDL-C, glucose, and excess body size may be important targets for improving vascular health and preventing clinical outcomes related to arterial stiffening, particularly among African-American women.
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Affiliation(s)
- Mehret S Birru
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
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Kamran H, Salciccioli L, Bastien C, Castro P, Sharma A, Lazar JM. Effect of beta blockers on central aortic pressure in African-Americans. ACTA ACUST UNITED AC 2011; 5:94-101. [PMID: 21414564 DOI: 10.1016/j.jash.2011.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Revised: 01/11/2011] [Accepted: 01/12/2011] [Indexed: 11/29/2022]
Abstract
The objective of this study was to evaluate the vascular effects of heart rate (HR) reduction with BB therapy in African Americans (AA). Beta-blockers (BB) offer less cardiovascular protection than other hypertensive drugs. Studies of Caucasian subjects suggest this may be due to an adverse effect of HR lowering on arterial wave reflection. We studied 506 subjects (age 63 ± 14 years, 52% were treated with BB). Central systolic (C-SBP) and pulse pressure (C-PP), augmented pressure (AP), and augmentation index (AI) were obtained via applanation tonometry (Sphygmocor). On univariate analysis, HR correlated inversely with BB use, C-SBP, AP, and AI (all P < .001), but not P-SBP. Multivariate analysis showed P-SBP and HR to be major determinants of C-SBP (R(2) = 0.95). Generalized linear model analysis showed higher C-SBP (P < .05) and C-PP (P = .04), but similar P-SBP (P = .24) in the BB group. After HR adjustment, differences in C-SBP, C-PP, AI, and AP were attenuated, suggesting HR to be a determinant of C-SBP. BB use is associated with higher C-SBP and lower PPA in hypertensive AA despite similar P-SBP. C-SBP is HR-dependent. HR reduction with BB accounts for less effective central blood pressure control in AA, similar to that reported in Caucasians.
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Affiliation(s)
- Haroon Kamran
- Division of Cardiovascular Medicine, State University of New York Downstate Medical Center, Brooklyn, New York 11203, USA
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Izzo JL, Zion AS. Combined aliskiren-amlodipine treatment for hypertension in African Americans: clinical science and management issues. Ther Adv Cardiovasc Dis 2011; 5:169-78. [PMID: 21606125 DOI: 10.1177/1753944711409615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
While it may seem at first that antihypertensive drug combinations run counter to the desire to 'personalize' the management of hypertension, the best combinations have predictable efficacy in different individuals and subpopulations. Race is probably not a valid surrogate for clinically meaningful genetic variation or guide to therapy. Most guidelines suggest similar blood pressure goals for different races but drug treatment recommendations have diverged. In the United States, race is not considered to be a major factor in drug choice, but in England and other countries, initial therapy with renin-angiotensin system blocking drugs is not recommended in Blacks. In this review we: (1) examine new trends in race-based research; (2) emphasize the weaknesses of race-based treatment recommendations; and (3) explore the effects of a new combination, renin inhibition (aliskiren) and amlodipine, in African Americans.
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Affiliation(s)
- Joseph L Izzo
- Department of Medicine, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, 462 Grider Street, Buffalo, NY 14215, USA.
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de Lima Santos PCJ, de Oliveira Alvim R, Ferreira NE, de Sa Cunha R, Krieger JE, Mill JG, Pereira AC. Ethnicity and arterial stiffness in Brazil. Am J Hypertens 2011; 24:278-84. [PMID: 21183929 DOI: 10.1038/ajh.2010.244] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The impact of increased central arterial stiffness as a predictor of morbidity and mortality, independently of other cardiovascular (CV) risk factors, has been established. The main aim of the present work was to investigate the association of ethnicity on arterial stiffness in different ethnic groups from the Brazilian population. METHODS A total of 1,427 individuals from the general population were randomly selected from the Vitoria City metropolitan area and 588 Amerindians from a native community in Brazil. The ethnicity of the general population was classified by a standard questionnaire as Caucasian descent, African descent, or Mulattos (considered racially mixed subjects). Pulse wave velocity (PWV) was measured with a noninvasive automatic device (Complior, Colson; Garges les Gonesses, France). RESULTS Hemodynamic data of PWV, systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean blood pressure (MBP) was higher in African descent individuals than in the other groups (P < 0.001). These results were still observed after adjustment for age and mean arterial pressure (P < 0.001). In addition, studying only normotensive individuals, PWV adjusted levels were higher in African descent individuals, and lower in Amerindians when compared with other ethnic groups (P < 0.01), showing, without the possible confounder effects of time and severity of hypertension or medication use, that PWV is associated with ethnicity in our population. CONCLUSION The study of different ethnic groups from a highly admixtured population was able to demonstrate an association between ethnicity and arterial stiffness.
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Ferdinand KC, Pool J, Weitzman R, Purkayastha D, Townsend R. Peripheral and Central Blood Pressure Responses of Combination Aliskiren/Hydrochlorothiazide and Amlodipine Monotherapy in African American Patients With Stage 2 Hypertension: The ATLAAST Trial. J Clin Hypertens (Greenwich) 2011; 13:366-75. [DOI: 10.1111/j.1751-7176.2010.00416.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Ezeala-Adikaibe B, Liu YP, Lemogoum D, Anisiuba BC, Kamdem MK, Kaptue J, Ijoma CK, Thijs L, Odili AN, Asayama K, Staessen JA, M’Buyamba-Kabangu JR, Ulasi II. Central haemodynamics reveal significant potential for prevention in Black hypertensive patients born and living in sub-Saharan Africa. Artery Res 2011. [DOI: 10.1016/j.artres.2011.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Flack JM, Sica DA, Bakris G, Brown AL, Ferdinand KC, Grimm RH, Hall WD, Jones WE, Kountz DS, Lea JP, Nasser S, Nesbitt SD, Saunders E, Scisney-Matlock M, Jamerson KA. Management of high blood pressure in Blacks: an update of the International Society on Hypertension in Blacks consensus statement. Hypertension 2010; 56:780-800. [PMID: 20921433 DOI: 10.1161/hypertensionaha.110.152892] [Citation(s) in RCA: 303] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Since the first International Society on Hypertension in Blacks consensus statement on the "Management of High Blood Pressure in African American" in 2003, data from additional clinical trials have become available. We reviewed hypertension and cardiovascular disease prevention and treatment guidelines, pharmacological hypertension clinical end point trials, and blood pressure-lowering trials in blacks. Selected trials without significant black representation were considered. In this update, blacks with hypertension are divided into 2 risk strata, primary prevention, where elevated blood pressure without target organ damage, preclinical cardiovascular disease, or overt cardiovascular disease for whom blood pressure consistently <135/85 mm Hg is recommended, and secondary prevention, where elevated blood pressure with target organ damage, preclinical cardiovascular disease, and/or a history of cardiovascular disease, for whom blood pressure consistently <130/80 mm Hg is recommended. If blood pressure is ≤10 mm Hg above target levels, monotherapy with a diuretic or calcium channel blocker is preferred. When blood pressure is >15/10 mm Hg above target, 2-drug therapy is recommended, with either a calcium channel blocker plus a renin-angiotensin system blocker or, alternatively, in edematous and/or volume-overload states, with a thiazide diuretic plus a renin-angiotensin system blocker. Effective multidrug therapeutic combinations through 4 drugs are described. Comprehensive lifestyle modifications should be initiated in blacks when blood pressure is ≥115/75 mm Hg. The updated International Society on Hypertension in Blacks consensus statement on hypertension management in blacks lowers the minimum target blood pressure level for the lowest-risk blacks, emphasizes effective multidrug regimens, and de-emphasizes monotherapy.
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Affiliation(s)
- John M Flack
- Department of Internal Medicine, Wayne State University, Detroit, Mich, USA.
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Relative contributions of different cardiovascular risk factors to significant arterial stiffness. Int J Cardiol 2010; 139:263-8. [DOI: 10.1016/j.ijcard.2008.10.032] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2008] [Revised: 07/28/2008] [Accepted: 10/12/2008] [Indexed: 11/23/2022]
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Heffernan KS, Fahs CA, Iwamoto GA, Jae SY, Wilund KR, Woods JA, Fernhall B. Resistance exercise training reduces central blood pressure and improves microvascular function in African American and white men. Atherosclerosis 2009; 207:220-6. [DOI: 10.1016/j.atherosclerosis.2009.03.043] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2009] [Revised: 03/11/2009] [Accepted: 03/30/2009] [Indexed: 11/16/2022]
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Salciccioli L, Kamran H, Qureshi G, Philip C, Jean-Louis G, Zizi F, Ko EH, Lazar JM. Indices of Arterial Stiffness in African American and African Caribbean Subjects. J Natl Med Assoc 2009; 101:992-8. [DOI: 10.1016/s0027-9684(15)31065-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Age-dependent increase in blood pressure in two different Native American communities in Brazil. J Hypertens 2009; 27:1753-60. [DOI: 10.1097/hjh.0b013e32832e0b2b] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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37
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Heffernan KS, Jae SY, Wilund KR, Woods JA, Fernhall B. Racial differences in central blood pressure and vascular function in young men. Am J Physiol Heart Circ Physiol 2008; 295:H2380-7. [DOI: 10.1152/ajpheart.00902.2008] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Young African-American men have altered macrovascular and microvascular function. In this cross-sectional study, we tested the hypothesis that vascular dysfunction in young African-American men would contribute to greater central blood pressure (BP) compared with young white men. Fifty-five young (23 yr), healthy men (25 African-American and 30 white) underwent measures of vascular structure and function, including carotid artery intima-media thickness (IMT) and carotid artery β-stiffness via ultrasonography, aortic pulse wave velocity, aortic augmentation index (AIx), and wave reflection travel time (Tr) via radial artery tonometery and a generalized transfer function, and microvascular vasodilatory capacity of forearm resistance arteries with strain-gauge plethysmography. African-American men had similar brachial systolic BP (SBP) but greater aortic SBP ( P < 0.05) and carotid SBP ( P < 0.05). African-American men also had greater carotid IMT, greater carotid β-stiffness, greater aortic stiffness and AIx, reduced aortic Tr and reduced peak hyperemic, and total hyperemic forearm blood flow compared with white men ( P < 0.05). In conclusion, young African-American men have greater central BP, despite comparable brachial BP, compared with young white men. Diffuse macrovascular and microvascular dysfunction manifesting as carotid hypertrophy, increased stiffness of central elastic arteries, heightened resistance artery constriction/blunted resistance artery dilation, and greater arterial wave reflection are present at a young age in apparently healthy African-American men, and conventional brachial BP measurement does not reflect this vascular burden.
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Malayeri AA, Natori S, Bahrami H, Bertoni AG, Kronmal R, Lima JA, Bluemke DA. Relation of aortic wall thickness and distensibility to cardiovascular risk factors (from the Multi-Ethnic Study of Atherosclerosis [MESA]). Am J Cardiol 2008; 102:491-6. [PMID: 18678312 DOI: 10.1016/j.amjcard.2008.04.010] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2008] [Revised: 04/02/2008] [Accepted: 04/02/2008] [Indexed: 01/05/2023]
Abstract
To determine the relation between aortic wall thickness (WT) and aortic distensibility (AD) with traditional cardiovascular risk factors in the Multi-Ethnic Study of Atherosclerosis (MESA) cohort, 1,053 participants in MESA who underwent cardiac magnetic resonance imaging were consecutively selected for the measurement of aortic WT and AD. Double inversion-recovery fast spin-echo images of the thoracic aorta were obtained to measure average and maximum WT. AD was measured at the same level using a gradient-echo cine sequence. Average and maximum WT were positively correlated with increasing age, and AD was inversely related to age (p <0.01). Compared with normotensive participants, those with hypertension had significantly greater mean average WT (2.45 vs 2.23 mm, p <0.01) and maximum WT (3.61 vs 3.41 mm, p <0.01) and lower AD (0.15 vs 0.2 mm Hg(-1), p <0.01). In multiple regression analysis, older age and hypertension were significantly associated with higher mean average WT, while older age, male gender, and higher blood pressure were associated with higher mean maximum WT. AD was inversely related to older age, hypertension, current smoking, African American ethnicity, and lower high-density lipoprotein cholesterol level. In conclusion, in the MESA cohort, older age and higher blood pressure were associated with higher aortic WT and lower AD. Decreased AD was further associated with current smoking, African American ethnicity, and higher high-density lipoprotein cholesterol level.
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Racial (black-white) divergence in the association between adiponectin and arterial stiffness in asymptomatic young adults: the Bogalusa heart study. Am J Hypertens 2008; 21:553-7. [PMID: 18292758 DOI: 10.1038/ajh.2008.14] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Adiponectin, an adipocytokine with beneficial biological functions relevant to cardiovascular (CV) diseases, and arterial stiffness, an indicator of vascular function, are considered to be important correlates of CV disease risk. Although racial (black-white) divergences in adiponectin and arterial stiffness are known, information is scant regarding the association between these two parameters among asymptomatic young adults within each race. METHODS As part of the Bogalusa Heart Study, arterial stiffness was examined noninvasively in terms of aorta-femoral pulse wave velocity (af-PWV) in 991 black and white nondiabetic subjects (72% white, 43% male) aged 24-44 years. RESULTS In a multivariate regression model by race that included adiponectin, age, sex, waist circumference, mean arterial pressure, heart rate, homeostasis model assessment of insulin resistance, low- and high-density lipoprotein cholesterols, triglycerides, and cigarette smoking, the significant predictors of af-PWV, in the order of entry, were: mean arterial pressure, age, smoking, and heart rate in both races, followed by adiponectin (inverse relation) in blacks. Further, after adjusting for mean arterial pressure, age, smoking, and heart rate, the odds ratio of finding excess af-PWV (top decile vs. the rest) in individuals with low adiponectin levels (bottom quartile vs. the rest) was significantly higher in blacks (OR: 2.5; 95% CI: 1.1-5.5), but not in whites (OR: 0.9; 95% CI: 0.5-1.9). CONCLUSIONS These findings suggest that the status of hypoadiponectinemia is an independent correlate of excess arterial stiffness in asymptomatic young black adults.
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Ge D, Young TW, Wang X, Kapuku GK, Treiber FA, Snieder H. Heritability of arterial stiffness in black and white American youth and young adults. Am J Hypertens 2007; 20:1065-72. [PMID: 17903689 PMCID: PMC3672691 DOI: 10.1016/j.amjhyper.2007.05.013] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2007] [Revised: 02/26/2007] [Accepted: 05/24/2007] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Our objectives were to examine the heritability of arterial stiffness measured as pulse-wave velocity (PWV), and its dependence on ethnicity, gender, and blood pressure (BP). METHODS As part of the Georgia Cardiovascular Twin Study, we measured aorto-radial (radial) and aorto-dorsalis-pedis (foot) PWV in 702 twins (41% black; 49% male) aged 12 to 30 years (mean age, 17.7 +/- 3.3 years), including monozygotic and dizygotic pairs of the same as well as opposite gender. Ethnicity and gender effects on genetic and environmental contributions to PWV were estimated by genetic model fitting. RESULTS Diastolic BP was the most important hemodynamic predictor. The best-fitting models showed no ethnicity or gender differences in estimates of genetic and environmental influence, and indicated substantial heritabilities of 0.43 (95% confidence interval, 0.30 to 0.54) and 0.53 (95% confidence interval, 0.42 to 0.62) for radial and foot PWV, respectively. Over a quarter of these heritabilities (0.19 for radial PWV; 0.14 for foot PWV) could be attributed to genes that also influenced diastolic BP, as based on multivariate models. CONCLUSIONS Individual differences in the arterial stiffness of youth and young adults are substantially heritable, and >25% of this heritability is explained by genes that also influence diastolic BP. Heritability estimates do not show any differences between blacks and whites or males and females.
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Affiliation(s)
- Dongliang Ge
- Georgia Prevention Institute, Department of Pediatrics, Medical College of Georgia, Augusta, GA, USA
| | - Thomas W. Young
- Dept. of Pediatrics, Sections of Pediatric Cardiology and Pediatric Pulmonology; Medical College of Georgia; Augusta, GA, USA
| | - Xiaoling Wang
- Georgia Prevention Institute, Department of Pediatrics, Medical College of Georgia, Augusta, GA, USA
| | - Gaston K. Kapuku
- Georgia Prevention Institute, Department of Pediatrics, Medical College of Georgia, Augusta, GA, USA
| | - Frank A. Treiber
- Georgia Prevention Institute, Department of Pediatrics, Medical College of Georgia, Augusta, GA, USA
| | - Harold Snieder
- Georgia Prevention Institute, Department of Pediatrics, Medical College of Georgia, Augusta, GA, USA
- Twin Research & Genetic Epidemiology Unit, St Thomas’ Campus, King’s College, London, UK
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Bellasi A, Veledar E, Ferramosca E, Ratti C, Block G, Raggi P. Markers of vascular disease do not differ in black and white hemodialysis patients despite a different risk profile. Atherosclerosis 2007; 197:242-9. [PMID: 17524408 DOI: 10.1016/j.atherosclerosis.2007.03.047] [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: 01/04/2007] [Revised: 03/21/2007] [Accepted: 03/30/2007] [Indexed: 11/26/2022]
Abstract
Increased aortic stiffness, as measured by pulse wave velocity (PWV) and augmentation index (Aix), and vascular calcification have been associated with an unfavourable cardiovascular outcome in hemodialysis patients. However, the majority of data have been published in white patients and epidemiological data are discordant on the fate of patients of different races. In this cross sectional study we measured PWV and Aix by applanation tonometry and coronary artery and thoracic aorta calcium score (CAC and AoC) by electron beam tomography (EBT) in 81 Blacks and 61 Whites on maintenance hemodialysis. Vascular stiffness measurements and EBT scans were performed within a week of each other. There was no difference between races in age, systolic blood pressure or gender distribution. Blacks had a more frequent history of hypertension (100% versus 89%; P=0.002), lower prevalence of dyslipidemia (30% versus 66%; P<0.001), higher PTH levels (geometric mean 607 pg/ml versus 245 pg/ml; P=0.039), received calcium based phosphate binders less frequently (37% versus 60%, P=0.007) and calcium antagonists more frequently than Whites (54% versus 28%; P=0.003). Nonetheless, the unadjusted and risk adjusted PWV and Aix, as well as CAC and AoC were not statistically different between races. In this dialysis cohort there was no difference in markers of vasculopathy between black and white patients despite differences in baseline clinical characteristics. Epidemiological data from the general population indicate that Blacks have lower calcium scores and stiffer vessels than Whites. Some studies in the renal populations suggest a better and others a similar survival of Blacks and Whites on hemodialysis. Our findings raise the important question of the prognostic significance of markers of vasculopathy in patients of different races and with different risk profiles.
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Affiliation(s)
- A Bellasi
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
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Koivistoinen T, Kööbi T, Jula A, Hutri-Kähönen N, Raitakari OT, Majahalme S, Kukkonen-Harjula K, Lehtimäki T, Reunanen A, Viikari J, Turjanmaa V, Nieminen T, Kähönen M. Pulse wave velocity reference values in healthy adults aged 26?75�years. Clin Physiol Funct Imaging 2007; 27:191-6. [PMID: 17445071 DOI: 10.1111/j.1475-097x.2007.00734.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The stiffening of arteries is associated with various cardiovascular diseases. Arterial stiffening can be studied utilizing arterial pulse wave velocity (PWV), but the absence of reliable reference values for PWV has limited its use in clinical practice. The aim of this study was to establish a range of reference values for PWV. PWV was examined by measuring the time difference of systolic pulse waves in arteries from the aortic arch to the popliteal artery using whole-body impedance cardiography (ICG). The study population consisted of 799 individuals (age range 25-76 years), 283 of whom had no evidence of cardiovascular disease, and a low burden of risk factors was selected to represent an apparently healthy population. In healthy study population, PWV was higher in males (8 x 9 +/- 1 x 8 m s(-1)) than females (8 x 1 +/- 2 x 0 m s(-1), P<0 x 001). Young males had lower PWV values than old males. Correspondingly, young females also had lower PWV values than old females. PWV was clearly associated with age, and PWV was higher in young and middle-aged males than in females. There was no statistically significant difference between old males and females in PWV. In conclusion, whole-body ICG provides a practical method for PWV measurement. Reference values can be useful in the clinical management of patients, especially in detecting early vascular disease or an increased risk of cardiovascular complications.
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Affiliation(s)
- T Koivistoinen
- Department of Clinical Physiology, Medical School, University of Tampere, and Tampere University Hopsital, Tampere, Finland.
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Li R, Nicklas B, Pahor M, Newman A, Sutton-Tyrrell K, Harris T, Lakatta E, Bauer DC, Ding J, Satterfield S, Kritchevsky SB. Polymorphisms of angiotensinogen and angiotensin-converting enzyme associated with lower extremity arterial disease in the Health, Aging and Body Composition study. J Hum Hypertens 2007; 21:673-82. [PMID: 17429448 DOI: 10.1038/sj.jhh.1002198] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The role of renin-angiotensin system (RAS) genes on the risk of lower extremity arterial disease (LEAD) in elderly people remains unclear. We assessed the relationship of genetic polymorphisms in RAS: G-6A, T174M and M235T of the angiotensinogen (AGT) gene, and the angiotensin-converting enzyme insertion/deletion (ACE_I/D) variant to the risk of LEAD in the Health, Aging and Body Composition (Health ABC) Study. This analysis included 1228 black and 1306 white men and women whose age ranged between 70 and 79 years at the study enrollment. LEAD was defined as ankle-arm index (AAI) <0.9. Genotype-phenotype associations were estimated by regression analyses with and without adjustment for established cardiovascular disease (CVD) risk factors. The proportion of LEAD was significantly higher in black (21.1%) than that in white elderly people (10.1%, P<0.0001). The distribution of AGT polymorphisms was also significantly different between black and white participants. There was no statistically significant association between the selected RAS genetic variants and LEAD after adjustment for age, antihypertensive medications, lipid-lowering medication, pack-year smoking, body mass index, low-density lipoprotein cholesterol, and prevalent diabetes and coronary heart disease. However, A-T haplotype of G-6A and M235T interacting with homozygous ACE_II (beta=-1.07, P=0.006) and with ACE inhibitors (beta=-1.03, P=0.01) significantly decreased the risk of LEAD in white but not in black participants after adjustment for the selected CVD risk factors. In conclusion, the study observed a gene-gene and gene-drug interaction for LEAD in the white elderly.
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Affiliation(s)
- R Li
- Department of Preventive Medicine, Center for Genomics and Bioinformatics, University of Tennessee Health Science Center, Memphis, TN 38163, USA.
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Maple-Brown LJ, Piers LS, O'Rourke MF, Celermajer DS, O'Dea K. Increased arterial stiffness in remote Indigenous Australians with high risk of cardiovascular disease. J Hypertens 2007; 25:585-91. [PMID: 17278975 DOI: 10.1097/hjh.0b013e328011f766] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To assess central and peripheral arterial stiffness in Indigenous and European Australians with and without type 2 diabetes using applanation tonometry to obtain the augmentation index (AI) and pulse wave velocity (PWV). METHODS AI was assessed in 162 Indigenous Australians (60 with type 2 diabetes) participating in a population-based study and 121 Australians of European ancestry (38 with diabetes) of similar age and sex. PWV was assessed in a subgroup: n = 62 indigenous, n = 118 European participants. RESULTS The indigenous group had higher AI than the European group [mean (SD) 32 (12) versus 24 (12)%, P < 0.0001] and carotid-femoral PWV [8.4 (1.8) versus 7.1 (2.2) ms(-1), P < 0.0001]. There were no significant differences between groups regarding blood pressure and total cholesterol; however, indigenous individuals had higher fasting glucose, insulin, haemoglobin A1c, triglycerides, waist circumference (despite lower body mass index), and a higher prevalence of cigarette smoking. Fifty-five per cent of the variance in AI was explained on multiple regression analysis by age, sex, indigenous participant, heart rate, mean arterial pressure, height, triglycerides and waist circumference. Age, indigenous participant, heart rate, mean arterial pressure and antihypertensive medication explained 56% of the variance in PWV. Variables of the metabolic syndrome and smoking, C-reactive protein (CRP), homocysteine and heart rate clustered with indigenous status on factor analysis. CONCLUSIONS Indigenous Australians have higher indices of peripheral and central arterial stiffness than European Australians of similar age and sex. Factor analysis revealed that metabolic syndrome variables, smoking, CRP, homocysteine and heart rate clustered with 'indigenous participant' and may explain increased arterial stiffness in this group.
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Aboyans V, Criqui MH, McClelland RL, Allison MA, McDermott MM, Goff DC, Manolio TA. Intrinsic contribution of gender and ethnicity to normal ankle-brachial index values: The Multi-Ethnic Study of Atherosclerosis (MESA). J Vasc Surg 2007; 45:319-27. [PMID: 17264011 DOI: 10.1016/j.jvs.2006.10.032] [Citation(s) in RCA: 118] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2006] [Accepted: 10/11/2006] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Several studies report a higher prevalence of peripheral arterial disease (PAD) in women and among blacks. These studies based their PAD definition on an ankle-brachial index (ABI) <0.90. We hypothesized that there is an inherent contribution of gender and ethnicity to normal ABI values, independent of biologic and social disparities that exist between gender and ethnic groups. Consequently, an ABI threshold that disregards these fundamental gender-related and ethnicity-related differences could partly contribute to reported prevalence differences. METHODS A cross-sectional study was designed as part of the Multi-Ethnic Study of Atherosclerosis (MESA), a multicenter United States population study. We selected a subgroup of participants with unequivocally normal ABIs (1.00 to 1.30), and additionally excluded participants with any major PAD risk factor (smoking, diabetes, dyslipidemia, hypertension). In a linear model with ABI as the dependent variable, demographic, clinical, biologic, and social variables were introduced as independent factors. RESULTS Among 1775 healthy participants, there was no association between ABI level and subclinical cardiovascular disease (coronary calcium or carotid plaque). Male gender, weight, and high education level were positively correlated with ABI, whereas black race, triglycerides, pack-years (in past smokers), and pulse pressure were negatively correlated. In the fully adjusted model, women had about 0.02 lower ABI values than men, and blacks showed ABI values about 0.02 lower than non-Hispanic whites. CONCLUSION These data suggest intrinsic ethnic and gender differences in ABI. Such differences, although small in magnitude, are highly significant and can distort population estimates of disease burden.
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Affiliation(s)
- Victor Aboyans
- Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA, USA.
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Arena R, Fei DY, Arrowood JA, Kraft KA. Influence on aerobic fitness on aortic stiffness in apparently healthy Caucasian and African-American subjects. Int J Cardiol 2007; 122:202-6. [PMID: 17270294 PMCID: PMC2118057 DOI: 10.1016/j.ijcard.2006.11.078] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2006] [Accepted: 11/02/2006] [Indexed: 02/05/2023]
Abstract
BACKGROUND Previous research suggests that arterial stiffness may be significantly higher in African-Americans compared to Caucasians. However, the influence of aerobic fitness on the putative difference in arterial stiffness between these groups has not been previously investigated. METHODS Two hundred forty-eight subjects (215 Caucasian, 33 African-American) participated in this study. Within one week following enrollment, subjects underwent body mass index (BMI, kg/m2) assessment, cardiopulmonary exercise testing and measurement of aortic wave velocity (AWV, m/s) via magnetic resonance imaging. Initially, 33 Caucasian subjects were randomly age (+/-4 years) and sex-matched (10 male/23 female) to the African-American subjects. 25 Caucasian subjects were then randomly matched for age (+/-4 years), sex (7 male/18 female) and maximal oxygen consumption (VO2Max+/-7 mlO2 kg(-1) min(-1)) to the African-American subjects. Matching based upon VO2Max criteria was not possible for 8 African-American subjects. RESULTS In the age and sex-matched analysis, Caucasian subjects demonstrated a significantly higher VO2Max (38.3+/-9.6 vs. 27.9+/-8.6 mlO2 kg(-1) min(-1), p<0.001) and lower BMI (24.5+/-3.2 vs. 29.3+/-6.2 kg/m2, p<0.001) and AWV (5.8+/-1.7 vs. 6.7+/-1.5 m/s, p=0.03). However, when subjects were matched for age, sex and VO2Max, the differences in both BMI (26.8+/-5.5 vs. 27.9+/-5.6 kg/m2, p=0.45) and AWV (6.1+/-1.8 vs. 6.5+/-1.6 m/s, p=0.77) were insignificant. CONCLUSIONS The results of the present study suggest that previously reported differences in arterial stiffness between Caucasians and African-Americans are at least partially a consequence of a lower level of aerobic fitness in the latter group, a phenomenon that has also been previously demonstrated.
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Affiliation(s)
- Ross Arena
- Department of Physical Therapy, Virginia Commonwealth University, Richmond, VA 23298-0224, USA.
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Khoshdel AR, Thakkinstian A, Carney SL, Attia J. Estimation of an age-specific reference interval for pulse wave velocity: a meta-analysis. J Hypertens 2006; 24:1231-7. [PMID: 16794467 DOI: 10.1097/01.hjh.0000234098.85497.31] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To estimate an age-specific reference interval for carotid-femoral pulse wave velocity (PWV), an index of aortic stiffness, and to determine the predictive values of the reference range for detecting those at moderate and high risk of cardiovascular disease (CVD). DESIGN AND METHODS We searched MEDLINE using PubMed from 1995 to 2005 for all studies in which Carotid-Femoral PWV was measured using a Complior (Colson, Paris, France) apparatus in Caucasian non-pregnant adults. Twenty-five studies were included, covering 30 groups of subjects; these groups were classified a priori into low (normal), moderate, and high CVD risk categories, with 2008, 5979, and 180 (total 8167) subjects, respectively. Individual-level data were simulated for each group, and an age-specific reference interval was calculated by using fractional polynomial functions. RESULTS We plotted an age-adjusted normal curve for PWV with 2.5, 5, 50, 90, 95, and 97.5 centile limits. Applying this reference interval to the moderate- and high-risk groups using simulations yielded sensitivities of 34.3 [95% confidence interval (CI) 33.2-35.3] and 57.2 (95% CI 55.2-59.3), respectively, specificities of 95.3 (95% CI 94.8-95.8) and 95.3 (95% CI 94.4-96.2), respectively, and positive likelihood ratios of 7.3 and 12.2, respectively. CONCLUSION We constructed an age-adjusted reference curve for PWV. Using the 95th centile of this curve as a threshold (e.g. 10.94, 11.86, and 13.18 m/s for 20, 40, and 60 years old) shows construct validity, as it appears to identify medium and high CVD risk groups reasonably accurately. This reference range needs to be tested using other datasets.
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Affiliation(s)
- Ali Reza Khoshdel
- John Hunter Hospital, Faculty of Health, The University of Newcastle, New South Wales, Australia.
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Chen W, Srinivasan SR, Li S, Berenson GS. Different Effects of Atherogenic Lipoproteins and Blood Pressure on Arterial Structure and Function: The Bogalusa Heart Study. J Clin Hypertens (Greenwich) 2006; 8:323-9. [PMID: 16687940 PMCID: PMC8109451 DOI: 10.1111/j.1524-6175.2005.04875.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Differential impact of non-high-density lipoprotein cholesterol (total cholesterol minus high-density lipoprotein cholesterol) and blood pressure on arterial wall thickness and stiffness was examined in 900 black and white adults aged 24-43 years. Blacks compared with whites had greater values of pulse wave velocity (5.4 m/sec vs. 5.2 m/sec; p<0.01) and carotid artery intima-media thickness (0.83 mm vs. 0.80 mm; p<0.01). Non-high-density lipoprotein cholesterol was significantly associated with carotid intima-media thickness (standardized regression coefficient [b]=0.21; p<0.01), but not with pulse wave velocity (b=0.03; p=0.37), after adjusting for race, sex, age, body mass index, insulin, glucose, and smoking. Systolic blood pressure was associated significantly stronger with pulse wave velocity (b=0.36; p<0.01) than with carotid intima-media thickness (b=0.15; p<0.01). No race difference in these relationships was found. The results of this study indicate that atherogenic lipoproteins and blood pressure may play different roles in the development of arterial wall stiffness and atherosclerosis.
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Affiliation(s)
- Wei Chen
- From the Tulane Center for Cardiovascular Health and the Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | - Sathanur R. Srinivasan
- From the Tulane Center for Cardiovascular Health and the Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | - Shengxu Li
- From the Tulane Center for Cardiovascular Health and the Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | - Gerald S. Berenson
- From the Tulane Center for Cardiovascular Health and the Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
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Lemogoum D, Van Bortel L, Van den Abeele W, Ciarka A, Degaute JP, van de Borne P, Leeman M. Effect of beta-adrenergic stimulation on pulse wave velocity in black and white subjects. J Hypertens 2004; 22:2349-53. [PMID: 15614029 DOI: 10.1097/00004872-200412000-00017] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Reduced beta-adrenergic sensitivity has been reported in black subjects. We hypothesized that beta-adrenergic stimulation by isoproterenol would affect pulse wave velocity (PWV), a marker of arterial stiffness, differently in black and white subjects. METHODS Healthy normotensive black subjects (n = 21) matched for age, gender, height and body mass index with healthy normotensive white subjects (n = 20), participated in a randomized, double-blind, placebo-controlled cross-over study. The PWV was determined using an automated device at baseline and after 30 min of an equal volume infusion of isoproterenol (8 mug/kg per min) or placebo (dextrose 5%), separated by a washout period of 25 min. RESULTS At baseline, heart rate (HR), systolic and diastolic blood pressure (SBP, DBP) and PWV were comparable in black and in white subjects. Placebo had no significant effect on haemodynamic variables. Isoproterenol increased HR, SBP and pulse pressure and decreased DBP with a comparable magnitude in both groups. Compared with placebo, isoproterenol decreased carotid-femoral PWV in white (from 5.9 +/- 1.2 to 5.7 +/- 1.1 m/s, means +/- SD, P = 0.05), but not in black subjects (from 6.2 +/- 1.3 to 6.6 +/- 1.7 m/s, P = 0.1). The difference in response between black and white subjects was significant (P = 0.04). Isoproterenol decreased carotid-radial PWV only significantly in white subjects. CONCLUSION These results are compatible with the hypothesis of an altered beta-adrenergic sensitivity, which is expressed by a blunted effect of isoproterenol on arterial stiffness in black subjects.
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Affiliation(s)
- Daniel Lemogoum
- Hypertension Clinic, Department of Cardiology, Erasme University Hospital, Brussels, Belgium
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Lemogoum D, Van Bortel L, Najem B, Dzudie A, Teutcha C, Madu E, Leeman M, Degaute JP, van de Borne P. Arterial stiffness and wave reflections in patients with sickle cell disease. Hypertension 2004; 44:924-9. [PMID: 15534075 DOI: 10.1161/01.hyp.0000148506.73622.ba] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We tested the hypothesis that lower blood pressure and increased vasodilatation reported in sickle cell disease (SCD) patients with hemoglobin SS genotype (SS) are translated by lower arterial stiffness determined by pulse wave velocity (PWV) and wave reflections assessed by augmentation index (AI). We enrolled 20 SS (8 females; 12 male) patients closely matched for age, gender, height, and body mass index to 20 subjects with hemoglobin AA genotype (AA). Carotid-femoral PWV (PWV(CF)) and carotid-radial PWV (PWV(CR)) were recorded with the Complior device. Aortic AI was derived from pressure wave analysis (SphygmocoR). PWV(CF) and PWV(CR) were lower in SS than in AA (4.5+/-0.7 m/s versus 6.9+/-0.9 m/s, P<0.0001 and 6.6+/-1.2 m/s versus 9.5+/-1.4 m/s, P<0.0001, respectively). AI was lower in SS than in AA (2+/-14% versus 11+/-8%, P=0.02). Multivariate analysis revealed that both PWV(CF) and PWV(CR) were negatively associated with hemoglobin SS type and positively related to mean arterial pressure (MAP), whereas AI was positively associated with MAP and total cholesterol (all P<0.0001). Multivariate analysis restricted to SS indicated a positive association between PWV(CF) and PWV(CR) with age but a negative association with MAP (R2=0.57 and 0.51, respectively, both P<0.001), whereas MAP and heart rate were independently associated with AI (R2=0.65, P<0.001). This study provides the first evidence that SCD is associated with both lower arterial stiffness and wave reflections. SS patients have a paradoxical negative association between PWV and MAP, suggesting that low MAP does not protect them against arterial stiffness impairment.
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Affiliation(s)
- Daniel Lemogoum
- Hypertension Clinic, Department of Cardiology, Erasme Hospital, 808 Lennik Road, 1070 Brussels, Belgium.
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