Mechanisms, pathophysiology, and therapy of arterial stiffness

Association Between Cardiovascular Biological Age and Cardiovascular Disease - A Prospective Cohort Study

BACKGROUND

Biological age serves as a common starting point for various age-related diseases and can be associated with a wide range of cardiovascular outcomes. However, associations between cardiovascular biological age (CBA) and various types of cardiovascular disease (CVD) remain unclear.

METHODS AND RESULTS

Analyzing 262,343 UK Biobank participants, we constructed CBA based on composite biomarkers using the Klemera-Doubal method (denoted as KDM-CBA). We measured KDM-CBA acceleration as the difference between KDM-CBA and chronological age. We then examined the associations between KDM-CBA and 17 CVD types using Cox proportional hazard models. We used restricted cubic spline models to assess potential nonlinear associations of KDM-CBA and KDM-CBA acceleration with different types of CVDs. We observed that KDM-CBA (per 1SD increase) was associated with various CVD types, but with different extent (hypertension: hazard ratio (HR)=2.115, 95% confidence interval (CI): 2.083-2.148; coronary atherosclerosis: HR=1.711, 95% CI: 1.545-1.896). We observed similar results for KDM-CBA acceleration and KDM-CBA. KDM-CBA and KDM-CBA acceleration showed J-type nonlinear associations with nearly all CVD types (cutoff values of ≈55 and -1.7 years for KDM-CBA and KDM-CBA acceleration, respectively).

CONCLUSIONS

Our study showed that CBA is associated with increased incidence of CVD, which further validates aging as a common starting point for different CVD types as well as highlighting CBA's role as an early CVD indicator, providing valuable insights for CVD interventions.

Advancements in Bio-Integrated Flexible Electronics for Hemodynamic Monitoring in Cardiovascular Healthcare

Cardiovascular diseases (CVDs) remain the leading cause of global mortality, highlighting the urgent need for effective monitoring and prevention strategies. The rapid advancement of flexible sensing technology and the development of conformal sensors have attracted significant attention due to their potential for continuous, real-time assessment of cardiovascular health over extended periods. This review outlines recent advancements in bio-integrated flexible electronics designed for hemodynamic monitoring and broader CVD healthcare applications. It introduces key physiological indicators relevant to hemodynamics, including heart rate, blood pressure, blood flow velocity, and cardiac output. Next, it discusses flexible bio-integrated electronics engineering strategies, such as working principles and configuration designs. Various non-invasive and invasive bio-integrated devices for monitoring these hemodynamic indicators are then presented. Additionally, the review highlights the role of artificial intelligence algorithms and their practical applications in bio-integrated electronics for hemodynamic detection. Finally, it proposes future directions and addresses potential challenges in the field.

Central vs. Brachial Blood Pressure and Pulse Pressure Amplification for Mortality Risk Prediction in Patients Undergoing Coronary Angiography

BACKGROUND

Arterial hypertension is a significant risk factor for cardiovascular (CV) morbidity and mortality. Although central blood pressure (BP) evaluation is considered the gold standard, the reliability of non-invasive measurements remains unclear. Therefore, we compared the predictive value of invasively measured central BP with non-invasively measured brachial BP and analyzed pulse pressure (PP) amplification (delta-PP; the difference between central and peripheral PP) as an independent predictor of mortality.

METHODS

We analyzed systolic BP (SBP), diastolic BP (DBP), mean arterial BP (MAP), PP, and delta-PP as predictors of CV and all-cause mortality in the Ludwigshafen Risk and Cardiovascular Health (LURIC) study, involving 3,316 patients referred for coronary angiography.

RESULTS

All brachial BP parameters, except DBP, were significantly linked to all-cause and CV mortality in a univariate analysis. A 10 mm Hg increase in SBP, MAP, and PP corresponded to increased risks of all-cause (11%, 10%, and 19%) and CV mortality (11%, 11%, and 18%). Central SBP and PP showed similar, but numerically weaker, associations with increased risks of all-cause (5% and 10%) and CV mortality (4% and 8%). After adjusting for age, sex, body mass index, diabetes mellitus, and eGFR, only delta-PP independently predicted mortality with a 10 mm Hg increase linked to a 4% reduction in all causes and a 6% reduction in CV mortality.

CONCLUSIONS

Neither brachial nor centrally measured BP parameters were independent mortality predictors in contrast to PP amplification, which remained an independent predictor of mortality in multivariate analysis, in a cohort with a medium to high CV risk profile. As PP amplification decreased, mortality increased.

Kyolic aged garlic extract improves aerobic fitness in middle‑aged recreational endurance athletes: A randomized double‑blind placebo‑controlled 3 month trial

Arterial stiffness is a cardiovascular risk factor that increases with age. Kyolic aged garlic extract has been shown to reduce arterial stiffness, while normalizing blood pressure, cholesterol and blood thickness. The present study hypothesized that increased flexibility of arteries could lead to slower blood flow and increased oxygen uptake and overall aerobic fitness. The present 12 week trial aimed to assess the effect of Kyolic aged garlic extract (AGE) on arterial stiffness, aerobic fitness, lactate threshold, recovery from muscle soreness and cardiovascular proteomic biomarkers in middle-aged (40-65 years) endurance athletes with elevated arterial stiffness. A total of 75 middle-aged recreational endurance athletes completed the trial, after being randomly allocated for 12 weeks to either the placebo or Kyolic aged garlic extract groups: low-dose cohort 1 (n=37), 2 capsules/day containing 1.2 g AGE powder and 1.2 mg S-allylcysteine (SAC); and the high-dose cohort 2 (n=38), 4 capsules/day of 2.4 g AGE powder and 2.4 mg SAC. Arterial stiffness was assessed through pulse wave velocity measurements and aerobic fitness was measured by volume-maximal-oxygen-consumption (VO2max) and lactate thresholds during high-intensity exercise using a cycle-ergometer-test-station, as well as measuring the levels of muscle fatigue and recovery time at 12 weeks compared with the baseline results. Urinary proteomic analysis was performed in a subgroup of participants and measured the levels of certain relevant proteins used as biomarkers for risk of cardiovascular events, at 12 weeks compared with baseline results. The Kyolic aged garlic extract group significantly improved their aerobic fitness, as was evidenced by increased VO2max, increased aerobic power, higher lactate threshold-to-oxygen uptake, higher lactate threshold-to-power output and quicker recovery times compared with the placebo group. Pulse wave velocity, a measure for arterial flexibility, was improved in the Kyolic aged garlic extract group compared with the placebo. The proteomics analysis demonstrated that a subset of polypeptides associated with cardiovascular risk, such as heart attacks and stroke, decreased in the Kyolic aged garlic extract group at 12 weeks compared with the baseline, which was contrary to the effects observed in the placebo group. Therefore, the results of the present study suggested that Kyolic aged garlic extract significantly improved aerobic fitness, lactate threshold, recovery and cardiovascular proteomic biomarkers in middle-aged endurance athletes within 12 weeks. The present clinical trial was registered on 11/03/2020 at the Australian New Zealand Clinical Trial Registry (trial registration no. ACTRN12620000340932).

Association between body shape index and arterial stiffness: results of the EVasCu study and a meta-analysis

OBJECTIVE

The aim of this study was to analyse the association between body shape index (ABSI) and arterial stiffness in healthy subjects using data from the EVasCu study. In addition, a meta-analysis was performed to compare the association between ABSI and central, peripheral and systemic arterial stiffness in the general population.

METHODS

The EVasCu study included 390 healthy subjects. ABSI was calculated from waist circumference, body mass index and height, and arterial stiffness was assessed with aortic pulse wave velocity (a-PWv) and cardio-ankle vascular index (CAVI). A meta-analysis of previous studies, including data from the EVasCu study, was performed to obtain pooled estimates of correlation coefficients (r) and their respective 95% confidence intervals (95% CIs) for the association between ABSI and central, peripheral and systemic arterial stiffness. In addition, pooled OR estimates and their 95% CIs were calculated.

RESULTS

In the EVasCu study, the correlation coefficient estimate was 0.458 (p < 0.01) for the association of a-PWv and ABSI and 0.408 (p < 0.01) for the association of CAVI and ABSI. In the meta-analysis, the pooled correlation coefficient estimate was 0.22 (95% CIs: 0.16, 0.28) for central arterial stiffness and ABSI, 0.21 (95% CIs: 0.14, 0.28) for peripheral arterial stiffness and ABSI, and 0.28 (95% CI: 0.21, 0.3) for systemic arterial stiffness and ABSI. When pooled ORs were calculated, the pooled OR estimate was 2.12 (95% CIs: 1.68, 2.56) for central arterial stiffness and ABSI, 2.21 (95% CIs: 1.81, 2.60) for peripheral arterial stiffness and ABSI, and 2.99 (95% CIs: 2.14, 3.85) for systemic arterial stiffness and ABSI.

CONCLUSION

Based on both the results obtained in the EVasCu study and the meta-analysis, there is a positive association between ABSI and arterial stiffness, both in healthy subjects and in participants with comorbidities. For each unit of cm/kg/m²/m increase in ABSI, the risk of arterial stiffness increased by 112% for central arterial stiffness, 121% for peripheral arterial stiffness, and 199% for systemic arterial stiffness. However, further research is needed in this field of knowledge.

The relative associations of aortic and carotid artery stiffness with CeVD and cognition

We examined the relative associations of aortic and carotid artery stiffness with cerebrovascular disease (CeVD), cognition, and dementia subtypes in a memory clinic cohort of 272 participants (mean age = 75.4, SD = 6.8). We hypothesized that carotid artery stiffness would have greater effects on outcomes, given its proximate relationship to the brain. Aortic and carotid artery stiffness were assessed with applanation tonometry and carotid ultrasonography, respectively. CeVD markers included white matter hyperintensities (WMH), lacunes, cerebral microbleeds, cortical infarcts, and intracranial stenosis. Cognition was assessed by the Mini Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and a neuropsychological battery. Multivariable linear regression was conducted to determine associations of arterial stiffness with WMH and cognition, while logistic regression analysed associations with CeVD markers and dementia subtypes. Carotid artery stiffness z-score was associated with WMH, cortical infarcts, vascular cognitive impairment, and MMSE, independent of age, sex, education, vascular risk factors, and aortic stiffness z-score. Although aortic stiffness z-score was independently associated with cortical infarcts, this became non-significant after further adjusting for carotid artery stiffness z-score. We found that carotid artery stiffness had greater effects on CeVD, cognitive function and impairment in memory clinic patients compared to aortic stiffness.

Systolic and diastolic dysfunction is exacerbated by age and spinal cord injury in male and female mice with central nervous system serotonin deficiency

The present study was designed to explore whether the depletion of serotonin (5-HT) in the central nervous system (CNS5-HT) leads to systolic and diastolic dysfunction and whether this dysfunction is exacerbated by sex, age and spinal cord injury. Echocardiographic assessment of systolic and diastolic function was completed in young and old male and female tryptophan hydroxylase 2 knockout (TPH2-/-) and wild-type (TPH2+/+) mice with intact spinal cords, as well as in C2  spinal cord hemisected young TPH2-/- and TPH2+/+ mice. In addition, lumbar sympathetic nervous system activity was recorded in elderly male and female intact TPH2-/- and TPH2+/+ mice. Systolic and diastolic dysfunction was evident in young TPH2-/- mice, including a higher left ventricular mass (P < 0.001), left ventricular outflow parameters (e.g. peak velocity) and E/A (P < 0.001). Reductions in ejection fraction and fractional shortening were also evident (P < 0.001), although stroke volume and cardiac output were maintained. The assessed dysfunction was exacerbated by age and spinal cord injury, resulting in reductions in cardiac output (P ≤ 0.01). The dysfunction was accompanied by increases in sympathetic burst height (P = 0.038) and incidence (P = 0.001). Reductions in CNS5-HT are coupled to systolic and diastolic dysfunction, which is exacerbated by age and spinal cord injury. This dysfunction is coupled to increases in sympathetic nervous system activity in elderly mice. Our findings are an initial step toward determining whether reductions in CNS5-HT are a unifying mechanism that links central sleep apnoea, sympathoexcitation and heart failure in intact and spinal cord injured individuals. KEY POINTS: Reductions in central nervous system serotonin (CNS5-HT) may contribute to systolic and diastolic dysfunction. This dysfunction may be linked to increases in sympathetic nervous system activity and exacerbated by sex, age and spinal cord injury. Echocardiographic assessment of systolic and diastolic function was completed in young and old male and female intact TPH2+/+ and TPH2-/- mice, as well as in C2 spinal cord hemisected young mice. Lumbar sympathetic nervous system activity was also recorded in elderly male and female intact TPH2+/+ and TPH2-/- mice. Systolic and diastolic dysfunction was evident in young TPH2-/- mice. This dysfunction was exacerbated by age and spinal cord injury. The cardiac dysfunction was accompanied by increases in lumbar sympathetic nervous system activity. Our findings are an initial step toward determining whether reductions in CNS5-HT is a unifying mechanism that links central sleep apnoea, sympathoexcitation and heart failure in intact and spinal cord injured individuals.

Effects of Exercise on Arterial Stiffness: Mechanistic Insights into Peripheral, Central, and Systemic Vascular Health in Young Men

BACKGROUND/OBJECTIVES

Arterial stiffness, a critical predictor of cardiovascular events, varies regionally across peripheral, central, and systemic arteries, necessitating targeted exercise interventions for young men. However, research on the effects of exercise on arterial stiffness in these regions among young men remains limited. This review aims to (i) examine the effects of exercise on arterial stiffness in young men across these regions, and (ii) investigate the underlying mechanisms involved.

METHODS

Database searches on PubMed, ScienceDirect, Web of Science, and Scopus were conducted up to July 2024. The keywords were: exercise, men/male, and arterial stiffness. Inclusion criteria were studies involving young men, supervised exercise, and arterial stiffness measures. Thirty-five papers were categorized into groups based on peripheral, central and systemic arterial stiffness.

RESULTS

Peripheral arterial stiffness: continuous aerobic cycling (light to high intensity), interval aerobic cycling (moderate to high intensity), and 30-s stretching exercises demonstrated positive effects, likely due to short-term changes in sympathetic nervous system activity, nitric oxide availability, and vascular tone. Central arterial stiffness: chronic high-intensity continuous and interval aerobic cycling exercises promoted vascular remodeling, including elastin preservation and collagen regulation. For systemic arterial stiffness, continuous and interval aerobic cycling and light-intensity squats with whole-body vibration exercises improve endothelial function, smooth muscle relaxation, and vascular remodeling.

CONCLUSIONS

Tailored exercise intervention can effectively reduce arterial stiffness across peripheral, central and systemic regions in young men. Improvements in peripheral stiffness are linked to short-term metabolic shifts, central stiffness responds to long-term remodeling, while systemic arterial stiffness involves both short- and long-term metabolic adaptations.

The Role of the Glymphatic System in Cervical Spondylotic Myelopathy: Insights From Advanced Imaging

STUDY DESIGN

Prospective cohort study.

OBJECTIVE

To provide a primer of the glymphatic system, discuss its potential relevance in evaluating spinal diseases like cervical spondylotic myelopathy (CSM), and describe possible imaging markers of the glymphatic system derived from advanced diffusion-weighted imaging (dMRI), namely diffusion tensor imaging (DTI) and diffusion basis spectrum imaging (DBSI).

SUMMARY OF BACKGROUND DATA

The glymphatic system is a recently described physiological process that plays an integral role in macroscopic waste clearance in the CNS through cerebrospinal fluid (CSF)-interstitial fluid (ISF) exchange. Chronic spinal cord compression in CSM leads to pathophysiological consequences that theoretically affect the glymphatic system, and advanced dMRI may be well positioned to characterize these changes.

METHODS

This single-center study enrolled participants (control and CSM) from 2018 through 2020. All participants underwent clinical assessments and dMRI, followed by DTI and DBSI analyses, preoperatively and 2 years postoperatively. CSF flow was characterized by DTI-derived apparent diffusion coefficient (ADC) and ISF flow by DBSI-derived extra-axonal axial diffusivity (EA-AD) and radial diffusivity (EA-RD). Imaging parameters were compared among participants.

RESULTS

Forty-two patients with CSM [23 (55%) mild, 9 (24%) moderate, 10 (21%) severe] and 20 control patients were included. Preoperatively, ADC was significantly lower in CSM (2.59±0.4 µm2/ms) than control (3.08±0.34 µm2/ms) patients (P<0.01). Conversely, EA-AD and EA-RD were significantly higher in CSM (2.53±0.33; 0.48±0.13 µm2/ms) compared with control (2.27±0.2; 0.40±0.04 µm2/ms) patients (both P<0.01). Two years postoperatively, only EA-RD significantly decreased for CSM patients (Δ-0.04±0.12 µm2/ms, P<0.01). More severe CSM preoperatively was associated with lower baseline ADC (ρ=0.49, P<0.001) and higher baseline EA-RD (ρ=-0.35, P=0.005).

CONCLUSIONS

The pathophysiology of CSM may affect the glymphatic system because of chronic spinal cord compression that decreases CSF bulk flow, leading to compensatory increases in ISF flow. Although research in this topic remains nascent, greater glymphatic system function observed on dMRI may correspond with greater disease burden. Future studies examining the role of the glymphatic system in spinal cord pathology are critical to better understanding how these noninvasive imaging biomarkers can improve patient outcomes in CSM.

LEVEL OF EVIDENCE

Level II.

Coronary Artery Calcium Is Independently Associated with Arterial Stiffness and LDL Cholesterol Burden in Patients with Familial Hypercholesterolemia

Background: Familial hypercholesterolemia (FH) is a genetic disorder characterized by high plasma levels of low-density lipoprotein cholesterol (LDL-C) and exposing patients to higher risk of early cardiovascular (CV) atherosclerotic diseases. Though the estimated prevalence of heterozygous FH (HeFH) is about 1 in 200, FH is still underdiagnosed and undertreated. Coronary artery calcification (CAC) assessment and arterial stiffness measured as pulse wave velocity (PWV) have demonstrated their accuracy in CV risk assessment, but data on HeFH are lacking. This study aims to evaluate CAC and PWV in a population of HeFH patients to improve risk stratification and therapy timing and setting. Methods: One hundred genetically characterized HeFH patients, regularly followed up since diagnosis, were recruited at our outpatient clinic. In all patients, CAC, PWV measurement, and LDL-C burden calculation were assessed. Results: The mean age was 45 ± 16 years. A total of 25% of patients had hypertension, and 15% were in secondary prevention. Through univariate analysis, we found strong positive correlations between CAC and both PWV (r = 0.52 p > 0.0001) and total LDL-C burden (r = 0.52 p < 0.0001). No other associations with lipid parameters were found. Multivariate analysis showed that CAC was independently associated with PWV adjusted for sex, total LDL-C burden, systolic blood pressure, smoking, LDL-C, HDL-C, and statin treatment. Conclusions: Arterial stiffness is strongly associated with CAC in HeFH patients with similar total LDL-C burden and CV risk profiles. Personalized risk assessment based on arterial stiffness and CAC evaluation enhances the stratification and management of cardiovascular risk in FH patients, supporting individualized therapeutic approaches.

Association between serum uric acid levels and arterial stiffness in patients with psoriasis

This study examined the association between serum uric acid levels (SUA) and arterial stiffness in patients with psoriasis vulgaris. A cross-sectional study was conducted on 205 consecutive patients with psoriasis vulgaris who visited the Dermatology Clinic of China-Japan Friendship Hospital between March 2022 and July 2024. Arterial stiffness was assessed by measuring brachial-ankle pulse wave velocity (baPWV). The patients were divided into four groups (Q1, Q2, Q3, and Q4) according to the quartiles of SUA levels. The clinical data of each group were analysed and compared. Multivariate linear regression was employed to investigate the linear correlation between SUA levels and baPWV, and subgroup analyses were performed. There were differences in sex ratio, body mass index (BMI), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), homocysteine (HCY), and baPWV levels between the four groups. After adjustment for confounders, a significant linear correlation between SUA and baPWV remained, with baPWV increasing by 0.519 cm/s for every 1 mmol/L increase in SUA (β=0.519, 95%CI: 0.176-0.862, P = 0.003). BaPWV was significantly higher in the Q4 group compared with the lowest Q1 group (β=137.043, 95%CI: 43.574-230.511, P = 0.004). Subgroup analysis showed that the positive correlation between SUA and baPWV was more significant in the subgroups of males, moderate-to-severe psoriasis, no history of hypertension, no history of hyperlipidaemia, non-smokers and BMI ≥ 24 kg/m2. In patients with psoriasis, high SUA is associated with increased baPWV. Early screening and intervention of cardiovascular risk should be emphasised. Further studies are needed to establish a causal relationship and to guide treatment.

Association between carotid artery hemodynamics and neurovascular coupling in cerebral small vessel disease: an exploratory study

Background

Recent studies have linked disrupted cerebral hemodynamics, including pulsatility index (PI) and wall shear stress (WSS), with neuroimaging features of cerebral small vessel disease (CSVD). Cerebral neurovascular coupling (NVC) dysfunction is an important pathophysiological mechanism of CSVD. However, evidence linking the features of carotid artery hemodynamics to cerebral NVC is still lacking.

Objective

This study is aimed to explore the impact of PI and WSS on NVC and cognitive performance in CSVD patients using neuroimaging.

Methods

This study included 52 CSVD patients and 41 healthy controls. Carotid artery PI and WSS were measured using 4D flow magnetic resonance imaging (MRI). NVC was assessed through voxel-wise correlations between cerebral blood flow and the amplitude of low-frequency fluctuations. Multiple linear regression was used to investigate correlations between them.

Results

CSVD patients showed elevated PI in the C2 and C4 segments of the internal carotid artery and reduced WSS in the common carotid artery compared to controls. NVC measurements were significantly diminished in CSVD patients. Multiple linear regression analysis indicated significant correlations between reduced WSS and impaired NVC as well as between reduced PI and impaired NVC, but not between PI, WSS, and cognitive scores.

Conclusion

Reduced WSS and PI in CSVD patients are associated with impaired NVC. These findings provide insights into the mechanisms underlying CSVD and suggest that hemodynamic abnormalities may serve as indicators of neurovascular dysfunction in early-stage CSVD.

Hyperglycemia inhibits AAA expansion: examining the role of lysyl oxidase

Abdominal aortic aneurysm (AAA) is a common, progressive, and potentially fatal dilation of the most distal aortic segment. Multiple studies with longitudinal follow-up of AAA have identified markedly slower progression among patients affected with diabetes. Understanding the molecular pathway responsible for the growth inhibition could have implications for therapy in nondiabetic patients with AAA. Toward this end, we investigated the effects of hyperglycemia in a murine model of AAA and a carefully monitored cohort of patients with AAA from the Noninvasive Treatment of AAA-Clinical Trial (NTA3CT). In mice with hyperglycemia, AAA growth was inhibited to a similar degree (∼30%) as seen in patients with diabetes. AAA growth correlated inversely to levels of hyperglycemia in mice and patients with AAA. Inhibiting lysyl oxidase (LOX) activity increases aneurysm growth and matrix degradation in this model. Hyperglycemia increased LOX concentration in aortic smooth muscle cells (SMCs) but not in murine AAA tissue. Inhibiting LOX activity completely blocked the growth-inhibitory effect of hyperglycemia. Lysyl oxidase-like 2 (LOXL2), the primary arterial isoform of LOX, is expressed in the same area as type IV collagen along the outer media in murine AAA tissue. There is a significant inverse correlation between LOXL2 and AAA growth rates in patients. Taken together, these studies suggest a role for LOXL2-mediated type IV collagen crosslinking in slowing AAA growth in the setting of hyperglycemia.NEW & NOTEWORTHY AAA grows slower in patients affected by diabetes. This growth inhibition is lost when the enzyme lysyl oxidase (LOX) is blocked in diabetic mice. The predominant arterial isoform of LOX, LOX-like 2 (LOXL2), overlaps with type IV collagen in the outer media of murine aneurysm tissue. Circulating LOXL2 correlates inversely with AAA growth in patients. Type IV collagen cross-linking by LOXL2 may play a role in the AAA growth inhibition associated with diabetes.

Cadmium promotes hyaluronan synthesis by inducing hyaluronan synthase 3 expression in cultured vascular endothelial cells via the c-Jun N-terminal kinase-c-Jun pathway

Cadmium is a heavy metal risk factor for various cardiovascular diseases, such as atherosclerosis. In atherosclerotic lesions, hyaluronan, a glycosaminoglycan consisting of β4-glucuronic acid-β3-N-acetylglucosamine disaccharides repeats, is highly accumulated, regulating signal transduction, cell migration, and angiogenesis. Hyaluronan is synthesized by hyaluronan synthase (HAS)1-3 in the plasma membrane and secreted into the extracellular space. Hyaluronan derived from HAS3 promotes inflammatory responses. Recently, we found that cadmium elongates chondroitin/dermatan sulfate chains in vascular endothelial cells and that glycosaminoglycan sugar chains are potential targets for the vascular toxicity of cadmium. Therefore, hyaluronan, a glycosaminoglycan sugar chain, may also affected by cadmium; however, this has not yet been clarified. In this study, we aimed to analyze the effect of cadmium on hyaluronan synthesis using cultured aortic endothelial cells. Cadmium at a concentration of 2 µM upregulated hyaluronan synthesis in the medium and specifically induced HAS3 mRNA and protein expression. However, cadmium-mediated HAS3 induction was abolished by the inhibition of the c-Jun N-terminal kinase (JNK)-c-Jun pathway. Moreover, JNK inhibition prevented the increase in hyaluronan levels in the medium. These results revealed that the JNK-c-Jun pathway was involved in HAS3-mediated hyaluronan synthesis by cadmium in vascular endothelial cells, suggesting that endothelial HAS3 induction contributes to atherosclerotic lesion formation by promoting inflammatory responses.

Vascular adaptations following an eight-week sprint interval training intervention in healthy men

BACKGROUND

Sprint interval training (SIT) has been shown to improve many indices of cardiovascular risk. The effect of SIT on emerging indicators of cardiovascular health, including arterial stiffness and carotid intima media thickness, remains unclear. Thus, the purpose of this study was to assess changes in augmentation index at 75 beats per minute (AIx@75), pulse wave velocity (cfPWV), and carotid intima media thickness (CIMT) at three time points of an 8-week SIT intervention.

METHODS

Eighteen sedentary men (age: 24.7±5.1 years, BMI: 26.7±5.8 kg/m2) participated in the study. Subjects trained 3 times a week for 8 weeks. Training consisted of 3-6 consecutive 30-second bouts of maximal intensity cycling, with 4.5 minutes of active recovery between bouts. Baseline, 4-week, and 8-week vascular assessments were performed. Training effects were analyzed using repeated measures ANOVA. Pearson correlations were used to determine the relationship between baseline values and the change scores (baseline to 8 weeks) of each vascular measure.

RESULTS

AIx@75 (BL: -3.6±10.9%, 4W: -5.6±8.3%, 8W: -3.2±9.5%), cfPWV (BL: 5.6±1.0 m/s, 4W: 5.8±0.9 m/s, 8W: 5.6±0.7 m/s), and CIMT (BL: 0.51±0.08 mm, 4W: 0.52±0.08 mm, 8W: 0.51±0.08 mm) did not significantly change (all P>0.05). Baseline cfPWV and AIx@75 were negatively correlated to their change from baseline to 8 weeks (P<0.05).

CONCLUSIONS

These findings demonstrate that 8 weeks of SIT is an insufficient stimulus to reduce cfPWV, AIx@75, or CIMT in a group of young, healthy men. Baseline arterial stiffness may modulate vascular adaptations to SIT.

BRISC-Mediated PPM1B-K63 Deubiquitination and Subsequent TGF-β Pathway Activation Promote High-Fat/High-Sucrose Diet-Induced Arterial Stiffness

BACKGROUND

Metabolic syndrome heightens cardiovascular disease risk primarily through increased arterial stiffness. We previously demonstrated the involvement of YAP (Yes-associated protein) in high-fat/high-sucrose diet (HFHSD)-induced arterial stiffness via modulation of PPM1B (protein phosphatase Mg2+/Mn2+-dependent 1B)-lysine 63(K63) deubiquitination. In this study, we aimed to elucidate the role and mechanisms underlying PPM1B deubiquitination in HFHSD-induced arterial stiffness.

METHODS

Enzymes governing PPM1B deubiquitination were identified through small interfering RNA (siRNA) screening and mass spectrometry. Glutathione S-transferase pull-down, coimmunoprecipitation, protein purification, and immunofluorescence were used to explore the mechanism underlying PPM1B deubiquitination. Doppler ultrasound was used to evaluate HFHSD-induced arterial stiffness in mice, and telemetry was used to record pulsatile (systolic and diastolic) blood pressure.

RESULTS

Smooth muscle cell-specific PPM1B overexpression attenuated HFHSD-induced arterial stiffness in mice in a PPM1B-K326-K63-linked polyubiquitination-dependent manner. Mechanistically, ABRO1 (Abraxas brother 1; a core BRCC36 [BRCA1/BRCA2 (breast cancer type 1/2)-containing complex subunit 36] isopeptidase complex component) directly bound YAP and underwent liquid-liquid phase separation with YAP and PPM1B in a YAP-dependent manner, which in turn promoted PPM1B deubiquitination. Furthermore, smooth muscle cell-specific Abro1-knockout mice and Brcc3-knockout mice showed attenuated HFHSD-induced arterial stiffness and activation of transforming growth factor-β-Smad (mothers against decapentaplegic homolog) signaling.

CONCLUSIONS

We elucidated the PPM1B deubiquitination mechanisms and highlighted a potential therapeutic target for metabolic syndrome-related arterial stiffness.

Intramyocellular lipid use is altered with exercise in males with childhood-onset obesity despite no differences in substrate oxidation

OBJECTIVE

Compared to adulthood-onset obesity (AO), those with childhood-onset obesity (CO) are at greater risk of metabolic disease. However, the differences between these two obesity phenotypes are not clear. The aim of this study is to investigate how the age of obesity onset (CO vs. AO) affects the use of intramyocellular (IMCL) and extramyocellular (EMCL) lipids in response to exercise.

METHODS

Males with CO (n = 5) and AO (n = 5) were recruited. At the first study visit, body composition was measured via dual-energy x-ray absorptiometry (DEXA). Energy expenditure and substrate oxidation were measured via indirect calorimetry. Participants were provided with standardized meals for 3 days prior to the exercise study visit. At the exercise study visit, IMCL and EMCL were measured via magnetic resonance spectroscopy (MRS) before and after 90-minutes of moderate intensity cycling with indirect calorimetry.

RESULTS

Substrate oxidation at rest and during exercise was not different between groups. Post-exercise, a decrease in IMCL was observed in the AO group that was not demonstrated in the CO group. There were no changes in EMCL post-exercise in either group.

CONCLUSIONS

This was the first study to compare the effects of exercise on IMCL and EMCL use in males with CO and AO. The decreases in IMCL of the AO group is similar with those observed in the literature in lean individuals. We made the novel observation that with moderate intensity cycling, males with CO do not appear to use IMCL as effectively as those with AO, suggesting perturbations in IMCL metabolism.

Soluble guanylyl cyclase stimulators and activators: Promising drugs for the treatment of hypertension?

Nitric oxide (NO)-stimulated cyclic guanosine monophosphate (cGMP) is a key regulator of cardiovascular health, as NO-cGMP signalling is impaired in diseases like pulmonary hypertension, heart failure and chronic kidney disease. The development of NO-independent sGC stimulators and activators provide a novel therapeutic option to restore altered NO signalling. sGC stimulators have been already approved for the treatment of pulmonary arterial hypertension (PAH), chronic thromboembolic pulmonary hypertension (CTEPH), and chronic heart failure (HFrEF), while sGC activators are currently in phase-2 clinical trials for CKD. The best characterized effect of increased cGMP via the NO-sGC-cGMP pathway is vasodilation. However, to date, none of the sGC agonists are in development for hypertension (HTN). According to WHO, the global prevalence of uncontrolled HTN continues to rise, contributing significantly to cardiovascular mortality. While there are effective antihypertensive treatments, many patients require multiple drugs, and some remain resistant to all therapies. Thus, in addition to improved diagnosis and lifestyle changes, new pharmacological strategies remain in high demand. In this review we explore the potential of sGC stimulators and activators as novel antihypertensive agents, starting with the overview of NO-sGC-cGMP signalling, followed by potential mechanisms by which the increase in cGMP may regulate vascular tone and BP. These effects may encompass not only acute vasodilation, but also mid-term and chronic effects, such as the regulation of salt and water balance, as well as mitigation of vascular ageing and remodelling. The main section summarizes the preclinical and clinical evidence supporting the BP-lowering efficacy of sGC agonists.

Effects of continuous positive airway pressure treatment on arterial stiffness and inflammatory factors in patients with coronary heart disease complicated with obstructive sleep apnea

BACKGROUND

Continuous Positive Airway Pressure (CPAP) treatment brings more benefits than risks to most coronary heart disease (CHD) patients with obstructive sleep apnea (OSA). However, the pathophysiological mechanism by which CPAP treatment improves the prognosis of patients with CHD and OSA remains unclear. The purpose of this study was to clarify whether CPAP can improve arterial stiffness and inflammatory factor levels in CHD patients with OSA, and to further improve prognosis.

METHOD

59 patients with coronary heart disease complicated by moderate to severe sleep apnea were divided into a CPAP treatment group (CPAP + coronary heart disease standard treatment) and a control group (only coronary heart disease standard treatment). Peripheral blood test reports were collected and pulse wave velocity (PWV) measurements were performed for each patient at the beginning, 3 months, and 6 months of treatment.

RESULTS

After 6 months of treatment, the CPAP group showed more significant improvement in the levels of inflammatory factors such as white blood cell (WBC), neutrophil (N), C-reactive protein (CRP), interleukin-6 (IL-6), procalcitonin (PCT), and PWV than the control group.

CONCLUSION

After active treatment with CPAP, arterial stiffness and inflammatory cytokine levels in patients with coronary heart disease and OSA improved. This association should be given more attention in clinical practice, and sleep apnea should be actively treated.

Changes in Cerebral Hemodynamics and Progression of Subclinical Vascular Brain Disease: A Population-Based Cohort Study

BACKGROUND

Cerebral hypoperfusion is associated with vascular brain injury and neurodegeneration, but their longitudinal relationship is largely unknown, especially in healthy older adults.

METHODS

We investigated the longitudinal relationship between cerebral hemodynamics and subclinical vascular brain disease in community-dwelling older adults without stroke or dementia at baseline. Participants underwent brain magnetic resonance imaging scans every 3 to 4 years between 2005 and 2016. Cerebral blood flow (CBF) was measured through 2-dimensional phase-contrast magnetic resonance imaging; the cerebrovascular resistance index (CVRi) was defined as the ratio of mean arterial blood pressure to total CBF. Simultaneous progression in subclinical brain disease was evaluated through repeated magnetic resonance imaging assessment of white matter hyperintensities (WMH), cerebral microbleeds, lacune, and brain atrophy. The longitudinal relationship was estimated using generalized estimating equations, with adjustment for age, sex, smoking habits, body mass index, systolic blood pressure (for CBF measures), lipid level, history of diabetes and cardiovascular disease, and the baseline burden of magnetic resonance imaging markers.

RESULTS

Among 3623 older adults (mean age, 61.4±9.3 years; 54.6% women), large decreases and increases in CBF and increases in CVRi over time were associated with white matter hyperintensity progression. The risk ratios for white matter hyperintensity progression were 1.36 (95% CI, 1.19-1.55) for large decreases in total CBF (lowest quartile), 1.02 (95% CI, 0.91-1.14) for moderate decreases (second quartile), and 1.28 (95% CI, 1.14-1.45) for large increases (highest quartile), compared with stable CBF (third quartile). The corresponding risk ratios for changes in CVRi were 1.13 (95% CI, 1.00-1.30), 1.25 (95% CI, 1.09-1.43), and 1.33 (95% CI, 1.16-1.52) for the second to fourth (versus lowest) quartiles, respectively, showing a dose-response relationship. The changes in CBF also demonstrate a similar U-shaped association with the progression of brain atrophy and incident microbleeds, whereas increases in CVRi were associated with lower microbleed risk.

CONCLUSIONS

Longitudinal changes in CBF and CVRi may capture distinct pathophysiologies linking cerebral hemodynamics to subclinical brain disease, extending beyond single-time point measurements.

Angiotensin-converting enzyme inhibitors: a therapeutic option for controlling blood pressure associated with delayed cognitive processing speed

Antihypertensive treatment (AT) is essential for preventing hypertension-related cognitive decline. The goals of this observational study were to compare cognitive performance (CP) between non-hypertensive (NH) volunteers and hypertensive patients and to evaluate the correlation between CP and antihypertensive drugs (AHD). Three groups were constituted: NH (n = 30) [group 1], hypertensive with systolic blood pressure (SBP) < 140 mmHg and diastolic blood pressure (DBP) < 90 mmHg (n = 54) [group 2] and hypertensive with SBP ≥ 140 or DBP ≥ 90 (n = 31) [group 3]. To analyze the cognitive domains, a neuropsychological battery was applied and the raw performance values in these tests were transformed into z-scores. The domain was considered impaired if it presented a z-score below -1.5 SD. Compared to group 1, both groups of hypertensive were older (51 [ ± 12] years) and showed a worse CP in episodic memory (p = 0.014), language (p = 0.003) and processing speed (PS) [p = 0.05]. Angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) were the most used AHD (46.3%, p = 0.01 [group 2] and 64.5%, p = 0.005 [group 3]) and showed correlations with PS. Linear regression models revealed a negative association of PS with the use of ACEi (β = -0.230, p = 0.004), but not with the use of ARB (β = 0.208, p = 0.008). The effect of AT on cognition appears to go beyond the search for lower blood pressure targets and also includes the mechanism of action of AHD on the brain, so that additional benefits may possibly be achieved with simple adaptations in the treatment regimen, particularly in patients without clinically manifest cognitive impairment.

Macrophage NLRP3-dependent IL-1β production contributes to aortic fibrosis in heart failure with preserved ejection fraction

Fibrosis is the main pathological feature of aortic stiffness, which is a common extracardiac comorbidity of heart failure with preserved ejection fraction (HFpEF) and a contributor to left ventricular (LV) diastolic dysfunction. Systemic low-grade inflammation plays a crucial role in the pathogenesis of HFpEF and the development of vascular fibrosis. In this study, we investigate the inflammatory mechanism of aortic fibrosis in HFpEF using a novel mouse model. LV diastolic dysfunction with preserved ejection fraction and aortic fibrosis induced by a high-fat diet (HFD) combined with subcutaneous aldosterone infusion are utilized. The constructed model exhibits augmented macrophage recruitment and NLR family pyrin domain containing 3 (NLRP3)-dependent interleukin (IL)-1β production in fibrotic aortas. In addition, a bone marrow transplant is employed to induce macrophage-specific NLRP3 deficiency in the HFpEF mouse model. These mice show almost completely suppressed cleaved-caspase-1 and mature IL-1β protein expression in the aortas, indicating that macrophage NLRP3 inflammasome activation enhances the IL-1β overproduction in fibrotic aortas. Furthermore, we show that macrophage NLRP3 inflammasome inhibition improves aortic fibrosis and LV diastolic dysfunction. In conclusion, this study demonstrates the pivotal effect of macrophage NLRP3-dependent IL-1β production on aortic fibrosis and cardiac function in HFpEF, suggesting a potential target for HFpEF therapy.

Evaluation of Arterial Stiffness Parameters Measurement With Noninvasive Methods-A Systematic Review

Objective: Arterial stiffness, as determined by pulse wave velocity (PWV), is a recognized marker of cardiovascular risk. Noninvasive technologies have enabled easier and more accessible assessments of PWV. The current gold standard for measuring carotid-femoral PWV (cfPWV)-a reliable indicator of arterial stiffness-utilizes applanation tonometry devices, as recommended by the Artery Society Guidelines. The objective of this study was to compare the performance of various noninvasive arterial stiffness measurement methods, specifically the Mobil-O-Graph and SphygmoCor/SphygmoCor XCEL, and evaluate their alignment with the Artery Society Guidelines for accuracy and reliability. Methods: A comprehensive search was conducted in the PubMed and Scopus databases to identify studies that compared and validated noninvasive PWV measurements, focusing on their repeatability. The search covered studies from inception through March 31, 2024. A total of 2092 papers were identified. Following the selection process, 21 studies met the inclusion criteria. Additionally, 2 more studies, not retrieved by the initial search but deemed relevant from other databases, were included. The included studies focused on populations with chronic diseases who were hemodynamically stable. Studies involving participants in specific conditions, such as pregnancy, hemodynamic shock, or undergoing stress tests, were excluded from the analysis. Results: Several devices have been developed and validated for the noninvasive measurement of arterial stiffness, utilizing applanation tonometry (e.g., SphygmoCor, SphygmoCor XCEL) and cuff-based oscillometry (e.g., Arteriograph, Mobil-O-Graph). The analyses reviewed included studies using both invasive and noninvasive devices. A notable finding was the relative heterogeneity of study populations across different research, with variations in sample size, BMI, sex proportions, and age groups often falling short of guideline recommendations. In most of the included validation studies, the sample sizes were smaller than the minimum recommended by guidelines. Moreover, factors such as BMI, sex distribution, and age group sizes were inconsistent with established standards. Despite these limitations, validation studies comparing invasive and noninvasive methods consistently highlighted the superiority of cfPWV assessment devices. Applanation tonometry devices demonstrated smaller discrepancies in PWV measurements and better overall agreement with invasive methods than oscillometry-based devices. Three studies comparing the SphygmoCor XCEL with the standard SphygmoCor showed an excellent level of agreement, with one study confirming the SphygmoCor XCEL's superior adherence to validation criteria. Oscillometric devices showed a stronger reliance on algorithmic adjustments based on factors such as age and systolic blood pressure. This dependence likely contributes to the underestimation of PWV, particularly in populations with chronic diseases or other conditions promoting arterial stiffness. Despite this, oscillometric devices demonstrated lower PWV variability in short-term repeatability assessments. Conclusions: More research on a larger population should be performed in order to introduce noninvasive devices into daily medical practice.

The Association Between Serum Trimethylamine N-Oxide and Arterial Stiffness in Chronic Peritoneal Dialysis Patients: A Cross-Sectional Study

Trimethylamine N-oxide (TMAO), a gut microbiome-derived metabolite, participates in the atherogenesis and vascular stiffening that is closely linked with cardiovascular (CV) complications and related deaths in individuals with kidney failure undergoing peritoneal dialysis (PD) therapy. In these patients, arterial stiffness (AS) is also an indicator of adverse CV outcomes. This study assessed the correlation between serum TMAO concentration quantified with high-performance liquid chromatography and mass spectrometry and central AS measured by carotid-femoral pulse wave velocity (cfPWV) in patients with chronic PD. Of the 160 participants included, 23.8% had a cfPWV of ≥10 m/s, which fulfilled the AS criteria. Multivariable logistic regression analysis revealed that TMAO, age, and waist circumference were positively associated with AS. Multivariable stepwise linear regression showed that underlying diabetes, advanced age, waist circumference, systolic blood pressure, and logarithmic-transformed TMAO were independently correlated with cfPWV. The area under the receiver operating characteristic curve for TMAO in differentiating AS from non-AS was 0.737. In conclusion, serum TMAO level was significantly independently correlated with central AS among participants undergoing PD for end-stage kidney failure.

Soluble P-Selectin as an Indicator of Cutaneous Microangiopathy in Uncomplicated Young Patients with Type 1 Diabetes

This study aimed to analyze the relationship between cutaneous microcirculation reactivity, retinal circulation, macrocirculation function, and specific adhesion molecules in young patients with uncomplicated type 1 diabetes. Fifty-five patients with type 1 diabetes mellitus (T1DM), aged 8 to 18 years, were divided into subgroups based on skin microcirculation reactivity. The cutaneous microcirculatory vessels were considered reactive if post-test PORH coverage increased compared to pre-test coverage. Optical coherence tomography (OCT) was conducted to detect early retinopathic changes. Macrocirculation was described using pulsatility indices (PIs) determined for common carotid (CCA) and peripheral arteries of the upper and lower limbs. The ankle-brachial index was also assessed. There were no significant differences in retinal circulation and macrocirculation between the studied subgroups. However, there were significant differences between the various subgroups concerning the age at onset of diabetes and the sP-selectin levels but not ICAM-1 and sVCAM-1. The sP-selectin differences remained true after adjusting for age at onset. The sP-selectin level was significantly higher in the subgroup of patients with non-reactive cutaneous microcirculation. The results of our study indicate that sP-selectin may be considered as an immunological marker for cutaneous abnormalities, which serve as an early indicator of endothelial dysfunction in young patients with type 1 diabetes in the absence of classical complication.

Elevated Aortic Stiffness after Pediatric Heart Transplantation

In adults, arterial stiffness has been linked to the development of target end-organ damage, thought to be related to abnormal transmission of pulse pressure. Increased arterial stiffness and endothelial dysfunction have been hypothesized to contribute to the development of microvascular dysfunction and coronary allograft vasculopathy (CAV), an important comorbidity after heart transplantation. However, little data exists regarding arterial stiffness in pediatric heart transplantation and its influence on development of coronary allograft vasculopathy is not well understood. We sought to assess aortic stiffness and distensibility in pediatric post-heart transplant patients. A prospective, observational study analyzing the ascending (donor tissue) and descending aorta (recipient tissue) using transthoracic echocardiographic M-mode measurements in patients aged < 21 years was conducted. Descending and ascending aorta M-modes were obtained from the subcostal long axis view, and the parasternal long axis view 3-5mm above the sinotubular junction, respectively. Two independent reviewers averaged measurements over 2-3 cardiac cycles, and Aortic Distensibility (AD) and Aortic Stiffness Index (ASI) were calculated using previously validated methods. We recruited 39 heart transplant (HT) patients and 47 healthy controls. Median end diastolic dimension of the ascending aorta (donor tissue) was significantly larger in the transplant group than the control group (1.92 cm vs. 1.74 cm, p = 0.01). Ascending aortic distensibility in post-transplant patients was significantly lower than in the control group (4.87 vs. 10.53, p < 0.001). Ascending aortic stiffness index was higher in the transplant patients compared to the controls (4.63 vs. 2.21, p < 0.001). There is evidence of altered ascending aortic distensibility and stiffness parameters in post-heart transplant patients. Further studies are required to assess its influence on complications like development of coronary artery vasculopathy.

A noninvasive measurement technique for the initial stiffness of the radial artery

Arterial stiffness carries significant implications for cardiovascular disease. Monitoring changes in arterial stiffness is integral to proactive health management, however, current noninvasive methods of quantifying stiffness in vivo rely primarily on linear tangent stiffness, making the measurements vulnerable to the variability of blood pressure and thereby affecting the accuracy in portraying the health status of the arteries. This study proposed a novel methodology for evaluating arterial stiffness that is unaffected by changes in blood pressure. Ultrasound detection techniques are applied to accurately chronicle changes in radial artery diameters across varied blood pressures. Incorporating blood pressure measurements, the initial diameter at cuff blockade, and vessel diameters at systolic and diastolic pressures enables inverse determination of the unstressed initial radial artery stiffness. This method accurately mirrors the results of in vitro experiments employing porcine blood vessels at physiological pressures. The results underscore the technique's ability to quantify arterial mechanical properties precisely. This study offers a groundbreaking strategy for fostering the early detection of atherosclerosis, and aiding artery health regulation.

Cerebral Small Vessel Disease: a Review of the Pathophysiological Mechanisms

Cerebral small vessel disease (cSVD) refers to the age-dependent pathological processes involving the brain small vessels and leading to vascular cognitive impairment, intracerebral hemorrhage, and acute lacunar ischemic stroke. Despite the significant public health burden of cSVD, disease-specific therapeutics remain unavailable due to the incomplete understanding of the underlying pathophysiological mechanisms. Recent advances in neuroimaging acquisition and processing capabilities as well as findings from cSVD animal models have revealed critical roles of several age-dependent processes in cSVD pathogenesis including arterial stiffness, vascular oxidative stress, low-grade systemic inflammation, gut dysbiosis, and increased salt intake. These factors interact to cause a state of endothelial cell dysfunction impairing cerebral blood flow regulation and breaking the blood brain barrier. Neuroinflammation follows resulting in neuronal injury and cSVD clinical manifestations. Impairment of the cerebral waste clearance through the glymphatic system is another potential process that has been recently highlighted contributing to the cognitive decline. This review details these mechanisms and attempts to explain their complex interactions. In addition, the relevant knowledge gaps in cSVD mechanistic understanding are identified and a systematic approach to future translational and early phase clinical research is proposed in order to reveal new cSVD mechanisms and develop disease-specific therapeutics.

The role and mechanism of Aβ clearance dysfunction in the glymphatic system in Alzheimer's disease comorbidity

Alzheimer's disease (AD) is the leading type of dementia globally, characterized by a complex pathogenesis that involves various comorbidities. An imbalance in the production and clearance of amyloid β-protein (Aβ) peptides in the brain is a key pathological mechanism of AD, with the glymphatic system playing a crucial role in Aβ clearance. Comorbidities associated with AD, such as diabetes, depression, and hypertension, not only affect Aβ production but also impair the brain's lymphatic system. Abnormalities in the structure and function of this system further weaken Aβ clearance capabilities, and the presence of comorbidities may exacerbate this process. This paper aims to review the role and specific mechanisms of impaired Aβ clearance via the glymphatic system in the context of AD comorbidities, providing new insights for the prevention and treatment of AD. Overall, the damage to the glymphatic system primarily focuses on aquaporin-4 (AQP4) and perivascular spaces (PVS), suggesting that maintaining the health of the glymphatic system may help slow the progression of AD and its comorbidities. Additionally, given the ongoing controversies regarding the structure of the glymphatic system, this paper revisits this structure and discusses the principles and characteristics of current detection methods for the glymphatic system.

Sex-specific age-related differences in cerebrospinal fluid clearance assessed by resting-state functional magnetic resonance imaging

Cerebrospinal fluid (CSF) flow may assist the clearance of brain wastes, such as amyloid-β (Aβ) and tau, and thus play an important role in aging and dementias. However, a lack of non-invasive tools to assess the CSF dynamics-related clearance in humans hindered the understanding of the relevant changes in healthy aging. The global infra-slow (<0.1 Hz) brain activity measured by the global mean resting-state fMRI signal (gBOLD) was recently found to be coupled by large CSF movements. This coupling has been found to correlate with various pathologies of Alzheimer's disease (AD), particularly Aβ pathology, linking it to waste clearance. Using resting-state fMRI data from a group of 719 healthy aging participants, we examined the sex-specific differences of the gBOLD-CSF coupling over a wide age range between 36-100 years of age. We found that this coupling index remains stable before around age 55 and then starts to decline afterward, particularly in females. Menopause may contribute to the accelerated decline in females.

Cardiovascular, perceptual, and performance responses to single- vs. multi-chambered blood flow restriction cuffs

Introduction

This study aimed to investigate the impact of the blood flow restriction bladder type (single- [SC-BFR] vs. multi-chambered [MC-BFR]) on exercise performance, cardiovascular responses, and perceptual experiences with exercise sessions incorporating multiple sets to volitional failure in a randomized, crossover experimental design.

Methods

Twenty-seven healthy, physically active participants (age: 22.6 ± 5.7; weight: 74.3 ± 15.8 kg; height: 171.7 ± 7.7 cm; BMI: 25.0 ± 4.1 kg/m2; ∼93% reported regular resistance training within 6 months; 11 females) randomly performed exercise to failure (4× sets to failure, 20% 1RM, 1 min rest between sets) in each of three conditions: SC-BFR (using the Delfi Personalized Tourniquet Device inflated to 60% limb occlusion pressure), MC-BFR (using the B Strong Cuffs inflated to 300 mmHg according to manufacturer recommendations), and N-BFR (no BFR control).

Results

SC-BFR blunted post-exercise increases in carotid-femoral pulse wave velocity (p = 0.328) (+3.3%) whereas the other conditions showed elevations (MC-BFR +11.8% [p = 0.041], N-BFR +9.3% [p = 0.012]). Discomfort was lower in N-BFR compared to SC-BFR (p < 0.001) and MC-BFR (p = 0.035) but all displayed similar exertion (p = 0.176). Median total repetitions achieved were significantly less in SC-BFR (57 [25-75th percentile: 47-65) than MC-BFR (76 [63-91] (p = 0.043) and N-BFR [106 (97-148)] p = 0.005). Per set repetition volumes were similar on set 1 between SC-BFR (p < 0.001) and MC-BFR (p = 0.001) and were lower than N-BFR (p ≤ 0.001) whereas in sets 2-4, MC-BFR performed similar number of repetitions as N-BFR (p = 0.984-1.000).

Conclusion

Bladder design of a BFR cuff has an impact on the acute responses to exercise if applied according to recommended application guidelines, as SC-BFR impacts performance to a greater degree and mitigates post-exercise arterial stiffness responses compared to MC-BFR and N-BFR while both BFR conditions display greater levels of discomfort compared to N-BFR.

Clinical Trial Registration

NCT06276673.

Arterial Stiffness as a New Predictor of Clinical Outcome in Patients with Polycythemia Vera

Background: Thrombotic adverse events and disease progression are crucial in Polycythemia Vera (PV), as it stands as the leading cause of mortality. The pulse wave velocity (PWV) is a valuable indicator of arterial aging and often plays a significant independent role in contributing to cardiovascular adverse events (CV-AEs). The aim of this study was to examine the relationship between PWV and critical vascular function parameters, with the goal of identifying new predictive factors of vascular damage and exploring a potential connection with disease progression. Methods: Non-invasive aortic stiffness was assessed through carotid-femoral PWV measurement. PWV was measured using the SphygmoCor device. History of arterial or venous thrombosis (TAEs) or other CV-AEs was collected at baseline. PWV measurements were repeated at baseline, at 6 and at 12 months. Results: The study involved 28 PV patients aged 27 to 77 years, with 57.1% being male. Fourteen patients (50%) reported a high-risk thrombotic score at diagnosis, and 60.7% had at least one comorbidity. Multivariable regression models showed that hemoglobin levels were independently associated with PWV (β: 0.68, SE 0.24, p < 0.01). During the follow-up period (median duration 21.3 months, range 6-33), a total of 13 events were documented. Specifically, two patients exhibited a loss of response to treatment, four patients presented an increase in spleen diameters, three patients displayed an escalation of systemic symptoms, and three patients had a clear progression to secondary myelofibrosis. PWV (per 1 m/s: OR 1.70, 95% CI 1.00-2.91, p = 0.047) and leukocyte count (per 1 × 103/μL: OR 1.47, 95% CI: 1.04-2.09, p = 0.043) were significant predictors of events, independently of waist circumference, blood pressure, treatment, and hematocrit. Conclusions: PWV has demonstrated its potential as an effective tool for monitoring PV patients. It stands as a clinical parameter that can predict the risk of progression in PV patients. Further investigation is essential to fully explore this potential. If successful, it could offer clinicians a valuable resource for effectively managing PV patients.

Evaluation of the Glymphatic System in Schizophrenia Spectrum Disorder Using Proton Magnetic Resonance Spectroscopy Measurement of Brain Macromolecule and Diffusion Tensor Image Analysis Along the Perivascular Space Index

BACKGROUND AND HYPOTHESIS

The glymphatic system (GS), a brain waste clearance pathway, is disrupted in various neurodegenerative and vascular diseases. As schizophrenia shares clinical characteristics with these conditions, we hypothesized GS disruptions in patients with schizophrenia spectrum disorder (SCZ-SD), reflected in increased brain macromolecule (MM) and decreased diffusion-tensor-image-analysis along the perivascular space (DTI-ALPS) index.

STUDY DESIGN

Forty-seven healthy controls (HCs) and 103 patients with SCZ-SD were studied. Data included 135 proton magnetic resonance spectroscopy (1H-MRS) sets, 96 DTI sets, with 79 participants contributing both. MM levels were quantified in the dorsal-anterior cingulate cortex (dACC), dorsolateral prefrontal cortex, and dorsal caudate (point resolved spectroscopy, echo-time = 35ms). Diffusivities in the projection and association fibers near the lateral ventricle were measured to calculate DTI-ALPS indices. General linear models were performed, adjusting for age, sex, and smoking. Correlation analyses examined relationships with age, illness duration, and symptoms severity.

STUDY RESULTS

MM levels were not different between patients and HCs. However, left, right, and bilateral DTI-ALPS indices were lower in patients compared with HCs (P < .001). In HCs, age was positively correlated with dACC MM and negatively correlated with left, right, and bilateral DTI-ALPS indices (P < .001). In patients, illness duration was positively correlated with dACC MM and negatively correlated with the right DTI-ALPS index (P < .05). In the entire population, dACC MM and DTI-ALPS indices showed an inverse correlation (P < .01).

CONCLUSIONS

Our results suggest potential disruptions in the GS of patients with SCZ-SD. Improving brain's waste clearance may offer a potential therapeutic approach for patients with SCZ-SD.

Associations Between Atherosclerosis and Subsequent Cognitive Decline: A Prospective Cohort Study

BACKGROUND

This study aimed to examine whether baseline atherosclerosis was associated with subsequent short-term domain-specific cognitive decline.

METHODS AND RESULTS

This research was based on the BRAVE (Beijing Research on Aging and Vessel) study, a population-based prospective cohort study of adults aged 40 to 80 years, free of dementia. At baseline (wave 1, 2019), cognitive assessments and atherosclerosis measures, including carotid intima-media thickness, carotid plaques, coronary artery calcification, and brachial-ankle pulse wave velocity were conducted. Cognitive function was reassessed in wave 2 (2022-2023) using linear mixed models for analysis. A total of 932 participants (63.7% women; mean age, 60.0±6.9 years) were included. Compared with the lowest tertile of carotid intima-media thickness, carotid plaques, and brachial-ankle pulse wave velocity, or a coronary artery calcification score=0, the highest tertile of carotid intima-media thickness (β=-0.065 SD/y [95% CI, -0.112 to -0.017]; P=0.008), carotid plaques (β=-0.070 SD/y [95% CI, -0.130 to -0.011]; P=0.021), and brachial-ankle pulse wave velocity (β=-0.057 SD/y [95% CI, -0.105 to -0.010]; P=0.018), and a coronary artery calcification score≥400 (β=-0.081 SD/y [95% CI, -0.153 to -0.008]; P=0.029) were significantly associated with a faster decline in semantic fluency after multivariable adjustment. Moreover, greater carotid intima-media thickness, coronary artery calcification, and brachial-ankle pulse wave velocity were significantly associated with a faster decline in global cognition.

CONCLUSIONS

More significant atherosclerosis was associated with faster semantic fluency and global cognition declines.

Space Travel: The Radiation and Microgravity Effects on the Cardiovascular System

Space flight modulates the functions of the cardiovascular system. The exposure to space conditions can alter the cerebral blood flow, as well as the venous return. Anemia, cardiac output changes, and increased activity of the sympathetic nervous system can also be seen. Understanding cardiac changes prepares astronauts for both better in-flight adaptations and long-term protection against cardiovascular diseases. The heart could undergo radio-degenerative effects when exposed to space radiation, increasing the risk of cardiovascular diseases in the long run. A high frequency of arrhythmias, such as ventricular/atrial premature complexes, have been reported during the Gemini and Apollo missions. Additionally, microgravity can lead to progressive degeneration of the myocytes and muscle atrophy with altered gene expression and calcium handling, along with impaired contractility. This review summarizes the potential cardiovascular effects of spaceflight and prevention measures.

The Role of Obesity as a Cardiac Disease Risk Factor in Patients with Type 2 Diabetes

PURPOSE OF REVIEW

Cardiovascular disease (CVD) is the leading cause of death globally and is closely associated with obesity and type 2 diabetes mellitus (T2DM). This review examines the interplay between obesity, T2DM, and CVD, highlighting the increasing prevalence and economic burden of these conditions.

RECENT FINDINGS

Pharmacologic therapies, particularly glucagon-like peptide-1 receptor agonists, show promise in substantial weight loss and subsequent reduction of adverse cardiovascular events in obese individuals with and without diabetes. Obesity significantly contributes to the development of insulin resistance and T2DM, further escalating CVD risk. The common co-occurrence of these three conditions may involve several other pathophysiological mechanisms, such as chronic inflammation, increased visceral adiposity, and endothelial dysfunction. Until recently, lifestyle modifications and bariatric surgery had been the primary methods for weight loss and mitigating obesity-associated cardiovascular risk. Newer pharmacological options have led to a paradigm shift in our approach to obesity management as they provide substantial benefits in weight loss, glycemic control, and cardiovascular risk reduction.

Association between pulse wave velocity and white matter hyperintensities among older adults: A meta-analysis of cross-sectional and longitudinal studies

BACKGROUND

Higher levels of pulse wave velocity (PWV) have been related with the presence of small vessel disease that could damage the brain, in which white matter hyperintensities (WMH) could be presented as consequence. This meta-analysis aims to examine the cross-sectional and longitudinal associations between PWV and the presence of WMH among older adults.

METHODS

We searched PubMed, Scopus, and WOS until June 2024. Pooled Odds Ratio (p-OR) were estimated for the cross-sectional and longitudinal associations between PWV and WMH. In addition, we explored whether this associations could be modified by type of PWV measurement and study and sample characteristics.

RESULTS

The p-OR between PWV and WMH was 1.16 (95 % CI, 1.10-1.22) for the cross-sectional and 1.07 (95 %, 1.00-1.15) for the longitudinal association. Similar figures were found by type of PWV measurement and no one of the explored characteristics modified this associations.

CONCLUSIONS

This meta-analysis revealed that the presence in and the long-term development of WMHs among older adults are more likely among those with elevated PWV.

Heart Failure with Preserved Ejection Fraction and Cardiac Amyloidosis in the Aging Heart

Heart Failure with Preserved Ejection Fraction (HFpEF) is one of the most frequent causes of heart failure in the world's population (about 19-55%), and is commonly associated with a high rate of hospitalization (almost 70-80%) and with increased mortality (40-50% in a 5-year timeframe). The elderly are more often affected, with higher rates of hospitalizations than young people, and currently almost 70% of the population aged 65 years old has HFpEF. An increase in cardiomyocyte stiffness, thus resulting in diastolic dysfunction, increased filling pressures and heart failure with preserved ejection fraction are characteristics features of the disease. In addition, among the various causes of HFpEF, cardiac amyloidosis (CA) can provoke diastolic dysfunction and increased wall stiffness directly from intercellular deposition of insoluble proteic substances and their toxic activity. Totally, almost 30 different proteins are able to form deposits, but the most frequently involved are transthyretin and misfolded monoclonal immunoglobulin light chains, which bring to two clinical conditions called transthyretin amyloidosis (ATTR) and light-chain amyloidosis (AL). Although there has been increasing attention on ATTR-CA in recent years, the actual prevalence remains underestimated, especially in people of advanced age, as well as its real impact as a cause of HFpEF, and only data derived from autoptic exams are currently available. Moreover, CA itself often mimics HFpEF, and some conflicting data on the use of predictive scores are described in the literature. The close relationship between HFpEF and CA, especially in older population and the main pathophysiological mechanisms which bond these two conditions are described in this focused review. The need to screen red flags for ATTR-CA in elderly patients with HFpEF is urgently advised, because a prompt recognition of the disease can optimize the approach to the disease with an early therapeutic, life-saving choice.

Physiological characteristics of blood pressure responses after combined exercise in elderly hypertensive patients: a systematic review and meta-analysis

Objective

The aim of this investigation is to explore the efficacy of combined exercise in elderly patients with hypertension. Moreover, we aim to delve into the underlying mechanisms governing blood pressure regulation, with the objective of promoting the adoption of this exercise regimen among elderly hypertensive individuals.

Methods

In our study, we conducted a thorough search across multiple databases, including PubMed, Web of Science, Cochrane Library, Embase, and Scopus. This extensive search resulted in the preliminary screening of 2,347 articles. Among these, 9 studies were carefully selected for an in-depth analysis. For our meta-analysis, we employed Review Manager 5.3 and Stata 15.0, enabling us to perform detailed subgroup analyses and assess the possibility of publication bias.

Results

In comparison to the control group (n = 194), individuals enrolled in the combined exercise group (n = 200) exhibited a notable decrease in both resting systolic blood pressure (SBP) [weighted mean difference (WMD) = -11.17 mm Hg, 95% confidence interval (CI) (-17.13, -5.22), Z = 3.68, P < 0.05] and diastolic blood pressure (DBP) [WMD = -5.93 mm Hg, 95% CI (-9.24, -2.61), Z = 3.51, P < 0.05]. Nonetheless, no statistically significant alteration was observed in pulse pressure (PP) [WMD = -9.05 mm Hg, 95% CI (-22.65, 4.55), Z = 1.3, P = 0.192]. Further subgroup analyses elucidated that combined exercise regimens, characterized by aerobic training intensities below 85% of HRmax, durations of up to 12 weeks, weekly frequencies of either ≥3 or <3 sessions, total session times under 60 min, and a sequence of aerobic exercise followed by resistance training (AE-RT), were particularly effective in enhancing SBP and DBP among elderly patients with hypertension. Additionally, regular engagement in combined exercise led to significant improvements in SBP and DBP across individuals aged 60-70, those older than 70 years, and regardless of whether participants were using antihypertensive medications or not.

Conclusion

Combined exercise serves as an efficacious adjunctive therapy for reducing blood pressure among elderly individuals with hypertension, exerting beneficial influences on multiple physiological mechanisms pertinent to blood pressure regulation. Moreover, the integration of aerobic exercise with resistance training presents a more varied training program, thereby eliciting wider-ranging positive effects on both the physical and mental well-being of elderly patients afflicted with hypertension.

Choroid plexus volumes in patients with transient global amnesia: A retrospective study

Increased choroid plexus (ChP) volume is well known to be associated with glymphatic system dysfunction. This study aimed to investigate glymphatic system function in patients with transient global amnesia (TGA) compared to healthy controls through ChP volumes measurements. We retrospectively enrolled patients with TGA from our hospital, as well as healthy controls. This was retrospectively observational study followed STROBE guideline. All participants underwent brain magnetic resonance imaging, including three-dimensional T1-weighted imaging. We analyzed and compared ChP volumes between patients with TGA and healthy controls and investigated the relationship between ChP volumes and clinical characteristics in patients with TGA. We enrolled 44 patients with TGA and 47 healthy controls. Among the 44 patients with TGA, 38 experienced a single TGA event, while 6 had recurrent TGA events. ChP volumes did not significantly differ between patients with TGA and healthy controls (2.140% vs 2.089%, P = .568). However, ChP volumes were higher in patients with a single TGA event compared to those with recurrent events (2.204% vs 1.740%, P < .013). We observed a significant positive correlation between ChP volumes and age in patients with TGA (R = 0.282, P = .007). ChP volumes were not associated with the duration of amnesia in patients with TGA (R = 0.187, P = .274). We find no differences in the glymphatic system function, as demonstrated by ChP volume for the first time. This study also found a significant correlation between ChP volume and age in patients with TGA, indicating that aging influences glymphatic system function.

Different Glymphatic Kinetics in Spontaneous Intracranial Hypotension

BACKGROUND AND PURPOSE

The glymphatic (glia-lymphatic) system is a paravascular pathway for the clearance of waste metabolites including amyloid β from the brain. Serial T1 relaxation time measurements after the intrathecal injection of gadolinium-based contrast agents facilitate the analysis of the temporal dynamics that may be different in patients with spontaneous intracranial hypotension (SIH) and those without SIH.

MATERIALS AND METHODS

3D T1-weighted magnetization-prepared 2 rapid gradient echo sequences were acquired in 4 patients with SIH with proved CSF leaks and 12 patients without SIH before, 2-4, 6-8, and 24-48 hours after intrathecal gadobutrol injection. MR scans were warped to the Montreal Neurological Institute space and serial scans were coregistered. T1 relaxation times were measured in predefined ROIs including the subarachnoid space, cortex, white matter, and cervical lymph nodes.

RESULTS

In the subarachnoid space and cortex, T1 relaxation times decreased after 2-4 and 6-8 hours before they increased again. In contrast, in the white matter of the temporal lobe T1 relaxation time still decreased after 24-48 hours. There was a striking difference in patients with SIH who did not show a clear contrast distribution within the brain parenchyma.

CONCLUSIONS

T1 relaxation time curves are compatible with a convective flow driven by arterial pulsations via paravascular spaces surrounding penetrating arteries into the brain's interstitial fluid in the deep white matter. Different curves in patients with SIH and those without SIH indicate that the CSF pressure also impacts the temporal kinetics of the glymphatic system.

AOP report: Development of an adverse outcome pathway for deposition of energy leading to abnormal vascular remodeling

Cardiovascular diseases (CVDs) are complex, encompassing many types of heart pathophysiologies and associated etiologies. Radiotherapy studies have shown that fractionated radiation exposure at high doses (3-17 Gy) to the heart increases the incidence of CVD. However, the effects of low doses of radiation on the cardiovascular system or the effects from space travel, where radiation and microgravity are important contributors to damage, are not clearly understood. Herein, the adverse outcome pathway (AOP) framework was applied to develop an AOP to abnormal vascular remodeling from the deposition of energy. Following the creation of a preliminary pathway with the guidance of field experts and authoritative reviews, a scoping review was conducted that informed final key event (KE) selection and evaluation of the Bradford Hill criteria for the KE relationships (KERs). The AOP begins with a molecular initiating event of deposition of energy; ionization events increase oxidative stress, which when persistent concurrently causes the release of pro-inflammatory mediators, suppresses anti-inflammatory mechanisms and alters stress response signaling pathways. These KEs alter nitric oxide levels leading to endothelial dysfunction, and subsequent abnormal vascular remodeling (the adverse outcome). The work identifies evidence needed to strengthen understanding of the causal associations for the KERs, emphasizing where there are knowledge gaps and uncertainties in both qualitative and quantitative understanding. The AOP is anticipated to direct future research to better understand the effects of space on the human body and potentially develop countermeasures to better protect future space travelers.

Moyamoya disease manifesting with bilateral involvement of the proximal vertebral arteries: A case report

Moyamoya disease (MMD) is a cerebrovascular disorder characterized by progressive occlusion of intracranial arteries, often leading to stroke and intracerebral hemorrhage. While MMD classically affects the intracranial vasculature, we present an unusual case of bilateral vertebral steno-occlusion, resulting in vertebrobasilar insufficiency in a 37-year-old man with MMD and treated with angioplasty and stenting of the dominant vertebral artery. Review of the literature demonstrates proximal vertebral artery involvement to be a rare manifestation of moyamoya disease. This report contributes to the understanding of the clinical spectrum of MMD and emphasizes the need for vigilance and awareness of the possibility of extracranial vascular complications in affected individuals.

Effect of adding PCSK9 inhibitors to lipid-lowering interventions on arterial stiffness: A systematic review and meta-analysis

BACKGROUND

Atherosclerosis, a leading cause of mortality, necessitates effective management of hypercholesterolemia, specifically elevated low-density lipoprotein cholesterol (LDL-C). The emergence of proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) has revolutionised lipid-lowering. PCSK9i demonstrates substantial LDL-C reduction and cardiovascular benefits, particularly in statin-intolerant or nonresponsive individuals. However, the potential pleiotropic effects of PCSK9i, especially on arterial stiffness, remain a subject of investigation. This systematic review and meta-analysis seek to provide a nuanced understanding of the potential pleiotropic effects of PCSK9i, specifically on arterial health. The primary objective was to analyse the influence of PCSK9i on arterial stiffness, extending beyond traditional lipid-lowering metrics and contributing to a more comprehensive approach to cardiovascular risk reduction.

METHODS

A systematic search was conducted across major databases, clinical trial registries and grey literature. Inclusion criteria comprised adults in prospective cohort studies undergoing PCSK9i augmentation in lipid-lowering therapy, with a focus on arterial stiffness measured by pulse wave velocity (PWv). Random-effects meta-analyses, sensitivity analyses and meta-regression models were employed to assess the pooled effect of adding PCSK9i to lipid-lowering interventions on arterial stiffness.

RESULTS

Five studies (158 participants) met the inclusion criteria, demonstrating a significant reduction in PWv (mean difference: -2.61 m/s [95% CI: -3.70, -1.52]; ES: -1.62 [95% CI: -2.53, -.71]) upon adding PCSK9i to lipid-lowering interventions. Subgroup analysis and meta-regression models suggested potential sex-based and baseline PWv-dependent variations, emphasising patient-specific characteristics.

CONCLUSION

The meta-analysis provides robust evidence that adding PCSK9i to lipid-lowering interventions significantly improves arterial stiffness, indicating broader vascular benefits beyond LDL-C reduction.

Cyclic stretch enhances neutrophil extracellular trap formation

BACKGROUND

Neutrophils, the most abundant leukocytes circulating in blood, contribute to host defense and play a significant role in chronic inflammatory disorders. They can release their DNA in the form of extracellular traps (NETs), which serve as scaffolds for capturing bacteria and various blood cells. However, uncontrolled formation of NETs (NETosis) can lead to excessive activation of coagulation pathways and thrombosis. Once neutrophils are migrated to infected or injured tissues, they become exposed to mechanical forces from their surrounding environment. However, the impact of transient changes in tissue mechanics due to the natural process of aging, infection, tissue injury, and cancer on neutrophils remains unknown. To address this gap, we explored the interactive effects of changes in substrate stiffness and cyclic stretch on NETosis. Primary neutrophils were cultured on a silicon-based substrate with stiffness levels of 30 and 300 kPa for at least 3 h under static conditions or cyclic stretch levels of 5% and 10%, mirroring the biomechanics of aged and young arteries.

RESULTS

Using this approach, we found that neutrophils are sensitive to cyclic stretch and that increases in stretch intensity and substrate stiffness enhance nuclei decondensation and histone H3 citrullination (CitH3). In addition, stretch intensity and substrate stiffness promote the response of neutrophils to the NET-inducing agents phorbol 12-myristate 13-acetate (PMA), adenosine triphosphate (ATP), and lipopolysaccharides (LPS). Stretch-induced activation of neutrophils was dependent on calpain activity, the phosphatidylinositol 3-kinase (PI3K)/focal adhesion kinase (FAK) signalling and actin polymerization.

CONCLUSIONS

In summary, these results demonstrate that the mechanical forces originating from the surrounding tissue influence NETosis, an important neutrophil function, and thus identify a potential novel therapeutic target.

Association between Mixed Heavy Metal Exposure and Arterial Stiffness, with Alkaline Phosphatase Identified as a Mediator

Elevated arterial stiffness has been associated with exposure to heavy metals such as lead (Pb) and cadmium (Cd). However, the collective impact of multiple metals and the underlying mechanisms are not fully elucidated. The purpose of this study was to assess the combined effects of exposure to nine heavy metals on arterial stiffness and explore whether serum alkaline phosphatase (ALP) acts as a mediator in this relationship. In the retrospective analysis, data from 8,700 participants were retrieved from the National Health and Nutrition Examination Survey (NHANES) spanning from 1999 to 2018. Arterial stiffness was measured by estimated pulse wave velocity (ePWV). The cumulative impact of exposure to multiple metals was examined using adaptive elastic-net, environmental risk score, weighted quantile sum regression, and quantile g-computation. Additionally, mediation analysis was conducted to explore the potential mediating role of serum ALP. We found that combined exposure to multiple metals was consistently associated with elevated ePWV, with Ba, Pb, and Sb exhibiting the greatest contributions. Notably, serum ALP partially mediated the associations between individual (Pb, Sb) and mixed metal exposure with ePWV, with mediation proportions at 10.76% for Pb, 18.22% for Sb, and 11.07% for mixed metal exposure. In conclusion, this study demonstrates a clear association between exposure to heavy metals, either individually or in combination, and heightened arterial stiffness. Furthermore, the findings suggest that serum ALP activity may act as a mediator in these relationships.

Influence of heart failure (HF) comorbidity in chronic obstructive pulmonary disease (COPD) and isolated forms of HF and COPD on cardiovascular function during hospitalization

INTRODUCTION

Coexistence of chronic obstructive pulmonary disease(COPD) and heart failure(HF) is associated with systemic inflammation, myocardial injury, and arterial stiffening, impacting cardiovascular risk and prognosis in patients. Arterial stiffness, reduced nitric oxide synthesis, and altered cardiac autonomic control further link COPD and HF pathophysiology, emphasizing the need for comprehensive cardiovascular assessment.

OBJECTIVE

To investigate a cardiovascular profile in patients hospitalized with exacerbation COPD(ECOPD) in coexistence with HF compared with isolated diseases.

METHODS

A cross-sectional study including patients diagnosed with ECOPD and decompensated HF, approached between 24 and 48 h after hospital admission. Assessments included: endothelial function by brachial artery flow-mediated vasodilation(FMD); hemodynamic through analysis of pulse wave and arterial stiffness by carotid-femoral pulse wave velocity(cfPWV) and cardiac autonomic modulation(CAM) by heart rate variability(HRV).

RESULTS

The mean FMD was 4.45 %, indicating endothelial dysfunction in all patients. Date is present in mean(confidence interval) sequency COPD(n = 12), COPD-HF(n = 21) and HF(n = 21). FMD: 5.47(3.96-6.91); 2.66(0.09-3.48); 4.60(2.30-6.43) p < 0.01. However, COPD-HF had worse FMD. Arterial stiffens (AIx: 29.0(19.0-42.6); 34.6(24.3-43.2); 14.5(8.0-24.0)p < 0.01; cfPWV: (6.5(5.4-7.2); 7.7(7.0-8.5); 6.0(5.0-6.5)); COPD-HF also showed greater activation of the sympathetic nervous system compared to patients with isolated diseases (PNS: 1.32(-2.53 to -0.62); -2.33(-2.60 to -2.12); -1.32(-1.42 to -1.01) p < 0.01; SNS: 3.50(1.40-8.55); 7.11(5.70-8.29); 2.32(1.78-5.01) p < 0.01). In addition, rMSSD, NN50, pNN50, and TINN also indicate worse CAM in the COPD-HF group compared to isolated diseases.

CONCLUSION

During hospitalization, the worst impairment in vascular function and cardiac autonomic modulation were found in patients with COPD and HF comorbidity compared to the isolated diseases(HF or COPD).

Arterial stiffness in adults with Long COVID in sub-Saharan Africa

Severe acute coronavirus-2 (SARS-CoV-2) infection has been associated with endothelial damage, and impaired nitric oxide production, which results in arterial stiffness and increased risk of cardiovascular disease. Long COVID is a term used to describe the persistence or the development of new symptoms that can occur after an acute infection. Little is known about the association between arterial stiffness and Long COVID. An observational, cross-sectional study in which arterial stiffness was measured with pulse wave velocity (PWV) was carried out in 74 participants between 19 and 40 years old (53 with Long COVID, 21 age and gender-matched controls). Data was collected from participants between 1 and 9 months after acute COVID-19 infection using the Complior analyze unit protocol. The Long COVID group had higher carotid-radial-PWV (crPWV) than controls (10 m/s interquartile range [IQR] 8.5-11.2 m/s) versus 8.8 m/s (IQR 7.7-9.2 m/s) as was their carotid-radial-arterial stiffness index (crASI) (2.26 cm/ms (IQR 1.9-2.56 cm/ms) vs. 2.01 cm/ms (IQR 1.82-2.27 cm/ms); p < 0.05) in both. They also had more type-A waveforms, indicating increased arterial stiffening. Peripheral arterial stiffness was higher in adults with Long COVID than in controls who were never infected with SARS-CoV-2 as noted by the elevated levels of crPWV and crASI among adults with Long COVID.