Family history of cardiometabolic diseases and its association with arterial stiffness in the Malmö Diet Cancer cohort

Vascular ageing: moving from bench towards bedside

Prevention of cardiovascular disease (CVD) remains one of the largest public health challenges of our time. Identifying individuals at increased cardiovascular risk at an asymptomatic, sub-clinical stage is of paramount importance for minimizing disease progression as well as the substantial health and economic burden associated with overt CVD. Vascular ageing (VA) involves the deterioration in vascular structure and function over time and ultimately leads to damage in the heart, brain, kidney, and other organs. Vascular ageing encompasses the cumulative effect of all cardiovascular risk factors on the arterial wall over the life course and thus may help identify those at elevated cardiovascular risk, early in disease development. Although the concept of VA is gaining interest clinically, it is seldom measured in routine clinical practice due to lack of consensus on how to characterize VA as physiological vs. pathological and various practical issues. In this state-of-the-art review and as a network of scientists, clinicians, engineers, and industry partners with expertise in VA, we address six questions related to VA in an attempt to increase knowledge among the broader medical community and move the routine measurement of VA a little closer from bench towards bedside.

The Malmö Offspring Study (MOS): design, methods and first results

As cardio metabolic disease manifestations tend to cluster in families there is a need to better understand the underlying mechanisms in order to further develop preventive strategies. In fact, genetic markers used in genetic risk scores, important as they are, will not be able alone to explain these family clusters. Therefore, the search goes on for the so called missing heritability to better explain these associations. Shared lifestyle and social conditions in families, but also early life influences may be of importance. Gene-environmental interactions should be explored. In recent years interest has grown for the role of diet-microbiota associations, as microbiota patterns may be shared by family members. In the Malmö Offspring Study that started in 2013, we have so far been able to examine about 4700 subjects (18-71 years) representing children and grandchildren of index subjects from the first generation, examined in the Malmö Diet Cancer Study during 1991 to 1996. This will provide rich data and opportunities to analyse family traits of chronic disease across three generations. We will provide extensive genotyping and phenotyping including cardiovascular and respiratory function, as well as markers of glucose metabolism. In addition, also cognitive function will be assessed. A 4-day online dietary recall will be conducted and gut as well as oral microbiota analysed. The ambition is to provide one of the first large-scale European family studies with individual data across three generations, which could deepen our knowledge about the role of family traits for chronic disease and its underlying mechanisms.

Hyperglycemia and arterial stiffness across two generations

OBJECTIVE

Hyperglycemia and diabetes mellitus associate with arterial stiffness. This observational study aimed to investigate such links in two related generations from a population-based study.

METHODS

Data from 2640 participants in the ongoing Malmö Offspring Study, Sweden, was used. The participants were direct descendants, that is, parents (median age 52.5 years) and children (26.9 years). In linear regressions, arterial stiffness measured through carotid--femoral pulse wave velocity was associated with markers of glucose metabolism (fasting glucose, glycated hemoglobin, skin autoflourescence of Advanced Glycation End products), adjusted for age, sex, smoking, BMI, lipids, SBP and antihypertensive medication. Analysis was first performed in all participants and then separately in each generation. T-tests with diabetes mellitus as the grouping variable were performed for all participants and per generation.

RESULTS

In all participants, pulse wave velocity was significantly associated with glucose (β = 0.007, P = 0.018) and hemoglobin (β = 0.017, P < 0.001), but not with autoflourescence. Stratified by generation, arterial stiffness was associated with glucose (β = 0.013, P = 0.008) and glycated hemoglobin (β = 0.022, P < 0.001) only in parents. Mean pulse speed differed between participants with and without diabetes in the total group (mean difference 1.7 m/s, P < 0.001), as well as within each generation (parents: 1.3 m/s; P < 0.001, and children: 0.7 m/s; P = 0.040).

CONCLUSION

Impaired glucose metabolism and arterial stiffness were significantly associated only in the parental generation, indicating the influence of hyperglycemia on vascular aging. However, carotid--femoral pulse wave velocity differed significantly between participants with or without diabetes mellitus in both generations, suggesting that diabetes might negatively affect arterial stiffness also at a younger age.

Patterns of urinary albumin and IgM associate with markers of vascular ageing in young to middle-aged individuals in the Malmö offspring study

BACKGROUND

Increased urinary excretion of IgM and low-grade albuminuria are associated with increased risk of cardiovascular morbidity and mortality. The objective of this study was to investigate the association between urinary IgM, albuminuria, and vascular parameters reflecting arterial structure and function.

METHODS

Subjects of the present study were from the Malmö Offspring study (MOS) cohort, and included 1531 offspring (children and grand-children) to first-generation subjects that participated in the Malmö Diet Cancer-Cardiovascular Arm study cohort. At baseline, technical measurements of arterial stiffness (carotid-femoral pulse wave velocity; c-f PWV), carotid arterial morphology, 24-h ambulatory blood pressure recordings, ankle-brachial-index (ABI), and evaluation of endothelial function (reactive hyperemia index, RHI) were performed. Urinary (U) IgM, U-albumin, and U-creatinine were measured. Multivariate adjusted logistic regression was used to test whether U-IgM excretion and increasing urinary albumin excretion were related to vascular parameters.

RESULTS

Detectable U-IgM was independently associated with higher systolic blood pressure, odds ratio (OR) 1.021, 95% confidence interval (CI, 1.003-1.039), p = 0.025 and lower ABI; ABI dx: OR 0.026, 95% CI (0.002-0.381), p = 0.008, ABI sin: OR 0.040, 95% CI (0.003-0.496), p = 0.012. Low-grade albuminuria was independently associated with systolic and diastolic blood pressure, aortic blood pressure, the c-f PWV and the number of carotid intima plaques (p < 0.05).

CONCLUSIONS

In young to middle-aged, mostly healthy individuals, increased U-IgM excretion and low-grade albuminuria are associated with adverse vascular parameters. Increased U-IgM excretion may reflect subclinical peripheral atherosclerosis, whereas increased U-albumin excretion is associated with a wide range of cardiovascular abnormalities. This may reflect different pathophysiological mechanisms.

Vascular aging and preclinical target organ damage in community-dwelling elderly: the Northern Shanghai Study

OBJECTIVES

Vascular aging represents a mediating step between risk factors and cardiovascular events, and preclinical target organ damage (TOD) integrates the cumulative effect of cardiovascular risk factors. This study is aimed at the relationships between vascular aging and TOD.

METHODS

Two thousand and ninety-eight participants (45.52% men, aged 71.3 ± 6.1 years) were recruited from June 2014 to June 2017 from the communities in the northern Shanghai area. Preclinical TOD was assessed in all the participants. Other clinical information was obtained by standard questionnaire. Healthy vascular aging (HVA) was defined as absence of hypertension and a relatively normal carotid-femoral PWV based on participants' age and blood pressure. We fitted logistic regression models to assess the probability of non-HVA in association with all the preclinical TOD.

RESULTS

Six hundred and forty-two (30.6%) elderly participants had HVA, and the prevalence of HVA decreased from 30.84% (aged 65-66) to 20.72% (aged ≥75). Increased age, increased SBP, metabolic syndrome, increased BMI and family history of premature cardiovascular disease (CVD) were significantly associated with accelerated vascular aging (P = 0.031 to P < 0.001). After multivariate adjustments, accelerated vascular aging was associated with left ventricular diastolic dysfunction (LVDD; OR (95% CI) 1.83 (1.23, 2.71), P = 0.003), left ventricular hypertrophy (LVH; OR (95% CI) 1.97 (1.54, 2.51), P < 0.001) and micro-albuminuria (MAU; OR (95% CI) 1.66 (1.35, 2.03), P < 0.001).

CONCLUSION

Management of blood pressure and metabolic profile may help to alleviate vascular aging and accelerated vascular aging is associated with LVH, LVDD and MAU, which may serve as a potential target to reverse cardiac and renal TOD.