Racial Differences in Arterial Stiffness are Mainly Determined by Blood Pressure Levels: Results From the ELSA-Brasil Study

The association between pulse wave velocity and cerebrospinal fluid biomarkers for Alzheimer's disease

We examined the association between arterial stiffness using non-invasive pulse wave velocity (PWV) and cerebrospinal fluid (CSF) Alzheimer's disease (AD) biomarkers. We conducted a cross-sectional multivariate logistic regression analysis using established cut-off values for PWV and CSF biomarkers. Of the 739 participants, 69% were female, 84% were White, 12% were Black, and the mean age was 62. After adjustment for potential confounders, participants with high PWV had 94% (OR = 1.94, 95% CI 1.20-3.20) greater odds of AD biomarker positivity for tTau/Aβ42 and 108% (OR = 2.08, 95% Cl, 1.27-3.46) for pTau181/Aβ42. Our results suggest that higher arterial stiffness is associated with AD CSF biomarker positivity.

Effect of Early Life Trauma Exposure on Vascular Dysfunction in Black Men and Women

BACKGROUND

Psychosocial stressors such as childhood trauma have been associated with an increased risk of hypertension. The impact of childhood trauma on vascular dysfunction in Black adults remains less clear. We examined the association between childhood trauma and vascular function in Black adults.

METHODS AND RESULTS

Childhood trauma exposure and vascular function were assessed in a cohort of healthy Black participants without known cardiovascular disease (n=404) from a large metropolitan city. Childhood trauma was assessed using the Early Trauma Inventory Short Form with higher scores indicative of higher traumatic life events assessed before age 18 years. Outcomes of central augmentation index (CAIx) and carotid femoral pulse wave velocity were measured as indices of wave reflections and arterial stiffness using applanation tonometry (Sphygmocor Inc.), and central pulse pressure (CPP) was calculated as the difference between the central aortic systolic and diastolic blood pressures. Relationships between Early Trauma Inventory Short Form and outcomes were assessed using multivariate-adjusted and sex-stratified linear regression models. The mean age of the cohort was 53 (SD=10.3), 61% women. Cumulative childhood trauma was not associated with CAIx, central pulse pressure, or carotid femoral pulse wave velocity in the minimal or fully adjusted models for sociodemographic, sex, clinical factors, medical history, health behaviors, and depression. Significant trauma × sex interactions were identified for CAIx (P=0.003) and central pulse pressure (P=0.025). Childhood trauma was associated with lower CAIx (β=-0.55% [95% CI, -1.07 to -0.03] in men, but higher CAIx (β=0.35% [95% CI, 0.08-0.63]) and central pulse pressure (β=0.23 mm Hg [95% CI, 0.01-0.43]) in women.

CONCLUSIONS

Childhood trauma is independently associated with impaired arterial compliance in Black women.

Simplified single neuron model for robust local pulse wave velocity sensing using a tetherless bioimpedance device

Pulse arrival time (PAT), Pulse transit time (PTT), and Pulse Wave Velocity (PWV) have all been used as metrics for assessing a number of cardiovascular applications, including arterial stiffness and cuffless blood pressure monitoring. These have been measured using various sensing methods, including electrocardiogram (ECG) with photoplethysmogram (PPG), two PPG sensors, or two Bioimpedance (BioZ) sensors. Our study addresses the mathematical inaccuracies of previous bioimpedance approaches and incorporates PTT weights for the peak-peak (PTTpp), middle-middle (PTTmm), and foot-foot (PTTff) segments of the sensing signal into a single neuron model to determine a more accurate and stable PWV. In addition, we developed a tetherless bioimpedance device and compared our PTT estimation approaches, which yielded PWV across six subjects and two different arteries. Specifically, using our model, we found that the most reliable combination of weights corresponding to PTTpp, PTTmm, and PTTff was (0.260, 0.704, 0.036) for the brachial artery and (0.104, 0.858, 0.038) for radial artery. This model consistently yielded stable values across repetitions, with PWV values of 5.2 m/s, 5.3 m/s, and 5.9 m/s for the brachial artery and values of 5.8 m/s, 6.6 m/s, and 6.5 m/s for the radial artery. This system and model offer the possibility of obtaining higher reliability PTT and PWV values yielding better monitoring of cardiovascular health measures such as blood pressure and arterial stiffness.

Socioeconomic status as a potential mediator of arterial aging in marginalized ethnic and racial groups: current understandings and future directions

Cardiovascular diseases (CVDs) are the leading cause of death in the United States. However, disparities in CVD-related morbidity and mortality exist as marginalized racial and ethnic groups are generally at higher risk for CVDs (Black Americans, Indigenous People, South and Southeast Asians, Native Hawaiians, and Pacific Islanders) and/or development of traditional CVD risk factors (groups above plus Hispanics/Latinos) relative to non-Hispanic Whites (NHW). In this comprehensive review, we outline emerging evidence suggesting these groups experience accelerated arterial dysfunction, including vascular endothelial dysfunction and large elastic artery stiffening, a nontraditional CVD risk factor that may predict risk of CVDs in these groups with advancing age. Adverse exposures to social determinants of health (SDOH), specifically lower socioeconomic status (SES), are exacerbated in most of these groups (except South Asians-higher SES) and may be a potential mediator of accelerated arterial aging. SES negatively influences the ability of marginalized racial and ethnic groups to meet aerobic exercise guidelines, the first-line strategy to improve arterial function, due to increased barriers, such as time and financial constraints, lack of motivation, facility access, and health education, to performing conventional aerobic exercise. Thus, identifying alternative interventions to conventional aerobic exercise that 1) overcome these common barriers and 2) target the biological mechanisms of aging to improve arterial function may be an effective, alternative method to aerobic exercise to ameliorate accelerated arterial aging and reduce CVD risk. Importantly, dedicated efforts are needed to assess these strategies in randomized-controlled clinical trials in these marginalized racial and ethnic groups.

Association Between Triglycerides, High-Density Lipoprotein Cholesterol, and Their Ratio With the Pulse Wave Velocity in Adults From the ELSA-Brasil Study

Atherogenic dyslipidemia is a risk factor for cardiovascular diseases. The present study aimed to evaluate the association between triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and the triglycerides to high-density lipoprotein (TG/HDL-C) ratio with carotid-femoral pulse wave velocity (cf-PWV), a marker of vascular stiffness. Anthropometric, biochemical, and clinical data from 13,732 adults were used to assess this association. Individuals within the third TG/HDL-C tertile presented worse anthropometric, biochemical, and clinical profiles as compared with the participants in the lower TG/HDL-C tertile. There was a linear association between TG, HDL-C, and TG/HDL-C ratio and cf-PWV in both men and women (stronger in women). After adjustment for confounders, lower levels of HDL-C were associated with increased cf-PWV in men (9.63 ± .02 m/s) and women (8.90 ± .03 m/s). However, TG was not significantly associated with cf-PWV after adjustment, regardless of sex. An increased TG/HDL-C ratio is associated with higher cf-PWV only in women (9.01 ± .03 m/s), but after adjustment for HDL-C levels, the association was non-significant (8.99 ± .03 m/s). These results highlight the stronger association of HDL-C with arterial stiffness, and that the association of TG/HDL-C with cf-PWV is dependent on HDL-C.

Hair Cortisol Concentration, Perceived Stress, Mental Well-Being, and Cardiovascular Health in African American Older Adults: A Pilot Study

(1) Background: African Americans experience high rates of psychological stress and hypertension, which increases their risk of cardiovascular disease with age. Easy-to-collect psychological and biological stress data are valuable to investigations of this association. Hair cortisol concentration (HCC), as a proxy biomarker of chronic stress exposure, provides such advantages in contrast to collection of multiple daily samples of saliva. Objective: To examine the relationships among HCC, perceived stress, mental well-being, and cardiovascular health (systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP)). (2) Methods: Cross-sectional secondary data (N = 25) were used from a mind–body intervention study in hypertensive African Americans ages 65 and older. Data included HCC, a four-item perceived stress scale, SF-36 mental components summary, and SBP/DBP. SBP + 2 (DBP)/3 was used to calculate MAP. (3) Results: The relationship between mental well-being and perceived stress (r = −0.497, p ≤ 0.01) and mental well-being and DBP (r = −0.458, p = 0.02) were significant. HCC change was not significant. In a regression model, every unit increase in well-being predicted a 0.42 decrease in DBP (β = −0.42, 95% CI (−0.69–0.15)) and a 1.10 unit decrease in MAP (β = −1.10, 95% CI (−1.99–0.20)). (4) Conclusions: This study contributes to the knowledge of physiologic data regarding the relationship between MAP and well-being. Findings from this study may aid in the development of interventions that address mental well-being and cardiovascular health in African American older adults with hypertension.

Generalizability challenges of mortality risk prediction models: A retrospective analysis on a multi-center database

Modern predictive models require large amounts of data for training and evaluation, absence of which may result in models that are specific to certain locations, populations in them and clinical practices. Yet, best practices for clinical risk prediction models have not yet considered such challenges to generalizability. Here we ask whether population- and group-level performance of mortality prediction models vary significantly when applied to hospitals or geographies different from the ones in which they are developed. Further, what characteristics of the datasets explain the performance variation? In this multi-center cross-sectional study, we analyzed electronic health records from 179 hospitals across the US with 70,126 hospitalizations from 2014 to 2015. Generalization gap, defined as difference between model performance metrics across hospitals, is computed for area under the receiver operating characteristic curve (AUC) and calibration slope. To assess model performance by the race variable, we report differences in false negative rates across groups. Data were also analyzed using a causal discovery algorithm "Fast Causal Inference" that infers paths of causal influence while identifying potential influences associated with unmeasured variables. When transferring models across hospitals, AUC at the test hospital ranged from 0.777 to 0.832 (1st-3rd quartile or IQR; median 0.801); calibration slope from 0.725 to 0.983 (IQR; median 0.853); and disparity in false negative rates from 0.046 to 0.168 (IQR; median 0.092). Distribution of all variable types (demography, vitals, and labs) differed significantly across hospitals and regions. The race variable also mediated differences in the relationship between clinical variables and mortality, by hospital/region. In conclusion, group-level performance should be assessed during generalizability checks to identify potential harms to the groups. Moreover, for developing methods to improve model performance in new environments, a better understanding and documentation of provenance of data and health processes are needed to identify and mitigate sources of variation.

Racial Differences in Blood Pressure Control from Users of Antihypertensive Monotherapy: Results from the ELSA-Brasil Study

BACKGROUND

It seems that the worst response to some classes of antihypertensive drugs, especially angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, on the part of the Black population, would at least partially explain the worse control of hypertension among these individuals. However, most of the evidence comes from American studies.

OBJECTIVES

This study aims to investigate the association between self-reported race/skin color and BP control in participants of the Longitudinal Study of Adult Health (ELSA-Brasil), using different classes of antihypertensive drugs in monotherapy.

METHODS

The study involved a cross-sectional analysis, carried out with participants from the baseline of ELSA-Brasil. Blood pressure control was the response variable, participants with BP values ≥140/90 mmHg were considered out of control in relation to blood pressure levels. Race/skin color was self-reported (White, Brown, Black). All participants were asked about the continuous use of medication. Association between BP control and race/skin color was estimated through logistic regression. The level of significance adopted in this study was of 5%.

RESULTS

Of the total of 1,795 users of antihypertensive drugs in monotherapy at baseline, 55.5% declared themselves White, 27.9% Brown, and 16.7% Black. Even after adjusting for confounding variables, Blacks using angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor blocker (ARB), thiazide diuretics (thiazide DIU), and beta-blockers (BB) in monotherapy had worse blood pressure control compared to Whites.

CONCLUSIONS

Our results suggest that in this sample of Brazilian adults using antihypertensive drugs in monotherapy, the differences in blood pressure control between different racial groups are not explained by the possible lower effectiveness of ACEIs and ARBs in Black individuals.

Racial and ethnic disparities in cardiometabolic disease and COVID-19 outcomes in White, Black/African American, and Latinx populations: Physiological underpinnings

Coronavirus disease 2019 (COVID-19) is a highly contagious respiratory illness caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) that began spreading globally in late 2019. While most cases of COVID-19 present with mild to moderate symptoms, COVID-19 was the third leading cause of mortality in the United States in 2020 and 2021. Though COVID-19 affects individuals of all races and ethnicities, non-Hispanic Black and Hispanic/Latinx populations are facing an inequitable burden of COVID-19 characterized by an increased risk for hospitalization and mortality. Importantly, non-Hispanic Black and Hispanic/Latinx adults have also faced a greater risk of non-COVID-19-related mortality (e.g., from cardiovascular disease/CVD) during the pandemic. Contributors to the racial disparities in morbidity and mortality during the pandemic are multi-factorial as we discuss in our companion article on social determinants of health. However, profound racial variation in the prevalence of CVD and metabolic diseases may serve as a key driver of worse COVID-19-related and non-COVID-19-related health outcomes among racial and ethnic minority groups. Within this review, we provide data emphasizing the inequitable burden of CVD and metabolic diseases among non-Hispanic Black and Hispanic/Latinx populations. We also discuss the pathophysiology of these conditions, with a focus on how aberrant physiological alterations in the context of CVD and metabolic diseases manifest to increase susceptibility to severe COVID-19.

Aortic Stiffness: Epidemiology, Risk Factors, and Relevant Biomarkers

Aortic stiffness (AoS) is a maladaptive response to hemodynamic stress and both modifiable and non-modifiable risk factors, and elevated AoS increases afterload for the heart. AoS is a non-invasive marker of cardiovascular health and metabolic dysfunction. Implementing AoS as a diagnostic tool is challenging as it increases with age and varies amongst races. AoS is associated with lifestyle factors such as alcohol and smoking, as well as hypertension and comorbid conditions including metabolic syndrome and its components. Multiple studies have investigated various biomarkers associated with increased AoS, and this area is of particular interest given that these markers can highlight pathophysiologic pathways and specific therapeutic targets in the future. These biomarkers include those involved in the inflammatory cascade, anti-aging genes, and the renin-angiotensin aldosterone system. In the future, targeting AoS rather than blood pressure itself may be the key to improving vascular health and outcomes. In this review, we will discuss the current understanding of AoS, measurement of AoS and the challenges in interpretation, associated biomarkers, and possible therapeutic avenues for modulation of AoS.

Association of physical activity with arterial stiffness among Black adults

Arterial stiffness is a precursor for the development of hypertension and premature cardiovascular disease (CVD). Physical activity has been associated with lower arterial stiffness among largely White populations, but the types of activity required and whether these findings apply to Black adults remain unknown. We examined whether physical activity levels were associated with arterial stiffness among Black adults in two independent cohorts. In the Morehouse-Emory Cardiovascular (MECA) Center for Health Equity, 378 Black adults (age 52.8 ± 10.3, 39.7% male) without known CVD living in Atlanta, GA were recruited. Arterial stiffness was measured as pulse wave velocity (PWV). Total and domain-specific physical activity were assessed by self-report. Multiple linear regression models were used to investigate differences across physical activity levels after adjusting for age, sex, CVD risk factors, and socioeconomic status. Findings were validated in an independent cohort of Black adults (n = 55, age 50.4 ± 9.2, 23.6% male). After adjustment for covariates, lower arterial stiffness was associated with higher self-reported levels of sport/exercise (6.92 ± 1.13 vs 7.75 ± 1.14, p < 0.001, highest vs lowest quartile) and home/life activities (7.34 ± 1.24 vs 7.73 ± 1.07, p = 0.04, highest vs lowest quartile), but not work, active living, or the overall physical activity scores. These findings were replicated in the independent cohort where higher levels of sport/exercise remained associated with lower arterial stiffness (6.66 ± 0.57 vs 8.21 ± 0.66, p < 0.001, highest vs lowest quartile). Higher levels of sport/exercise and home/life-related physical activities (in comparison to occupational physical activity) are associated with lower arterial stiffness in Black adults.

Phytosterol consumption and markers of subclinical atherosclerosis: Cross-sectional results from ELSA-Brasil

BACKGROUND AND AIMS

Phytosterol (PS) consumption is associated with lower total and LDL-cholesterol (LDL-c) concentrations, but its impact on cardiovascular risk is unclear. This study assessed the effect of usual intake of PS on markers of subclinical atherosclerosis in the Longitudinal Study of Adult Health (ELSA-Brasil).

METHODS AND RESULTS

This cross-sectional study included 2560 participants of ELSA-Brasil, aged 48 (43-54) years, with available food frequency questionnaires (FFQ), coronary artery calcium (CAC) scores, carotid intima media thickness (cIMT), and carotid-femoral pulse wave velocity (cf-PWV), at baseline. Several logistic and linear regression models were used, and significance level was set at a P < 0.05. Mean values (SD) for PS consumption were 256 (198) mg/day, CAC 22.78 (110.54) Agatston Units, cf-PWV 9.07 (1.60) m/s and cIMT 0.57 (0.12) mm. PS consumption in Q4 was associated with lower total- and LDL-c levels, and with higher percentiles of cf-PWV (P < 0.001). Proportion of subjects in Q4 of PS consumption was 1.5 times higher among individuals in cf-PWV Q4, than in Q1 (P = 0.002, for comparisons among quartiles). There was a trend (P = 0.003) for higher cf-PWV with higher PS intake. In crude logistic and linear regressions, PS intake was associated with cf-PWV. In the adjusted models, these associations disappeared. No associations were found between PS and cIMT or CAC.

CONCLUSIONS

In this large and apparently healthy cross-sectional sample from ELSA-Brasil, usual PS consumption was associated with lower total- and LDL-cholesterol, but not with markers of subclinical atherosclerosis.

The association between pulse wave analysis, carotid-femoral pulse wave velocity and peripheral arterial disease in patients with ischemic heart disease

INTRODUCTION

Functional changes in peripheral arterial disease (PAD) could play a role in higher cardiovascular risk in these patients.

METHODS

123 patients who underwent elective coronary angiography were included. Ankle-brachial index (ABI) was measured and arterial stiffness parameters were derived with applanation tonometry.

RESULTS

6 patients (4.9%) had a previously known PAD (Rutherford grade I). Mean ABI was 1.04 ± 0.12, mean subendocardial viability ratio (SEVR) 166.6 ± 32.7% and mean carotid-femoral pulse wave velocity (cfPWV) 10.3 ± 2.4 m/s. Most of the patients (n = 81, 65.9%) had coronary artery disease (CAD). There was no difference in ABI among different degrees of CAD. Patients with zero- and three-vessel CAD had significantly lower values of SEVR, compared to patients with one- and two-vessel CAD (159.5 ± 32.9%/158.1 ± 31.5% vs 181.0 ± 35.2%/166.8 ± 27.8%; p = 0.048). No significant difference was observed in cfPWV values. Spearman's correlation test showed an important correlation between ABI and SEVR (r = 0.196; p = 0.037) and between ABI and cfPWV (r = - 0.320; p ≤ 0.001). Multiple regression analysis confirmed an association between cfPWV and ABI (β = - 0.210; p = 0.003), cfPWV and mean arterial pressure (β = 0.064; p < 0.001), cfPWV and age (β = 0.113; p < 0.001) and between cfPWV and body mass index (BMI (β = - 0.195; p = 0.028), but not with arterial hypertension, dyslipidemia, diabetes mellitus or smoking status. SEVR was not statistically significantly associated with ABI using the same multiple regression model.

CONCLUSION

Reduced ABI was associated with increased cfPWV, but not with advanced CAD or decreased SEVR.

Reference values of office central blood pressure, pulse wave velocity, and augmentation index recorded by means of the Mobil-O-Graph PWA monitor

Assessment of central blood pressure (BP), pulse wave velocity (PWV), and augmentation index (AIx) measurements may improve cardiovascular risk stratification. This study aimed to establish reference office values for central BP, PWV, and AIx by means of a Mobil-O-Graph PWA monitor and to evaluate the impact of cardiovascular risk factors (CVRFs) on these measurements. We cross-sectionally evaluated clinical characteristics, central BP, PWV, AIx, and peripheral BP measurements among 867 apparently healthy individuals (age = 46.0 ± 15.5 years, 39% males) who were free of obesity, hypertension, active smoking, dyslipidemia, and diabetes (CVRF-No) and 5632 individuals (age = 57.0 ± 14.7 years, 44% males) with at least one of these major CVRFs (CVRF-Yes). Reference values for central BP, PWV, and AIx were provided for the CVRF-No and CVRF-Yes groups, stratified by age and sex. PWV and AIx exhibited curvilinear increases with age, and there was an interaction between age and sex for central systolic BP and PWV in both the CVRF-No and CVRF-Yes groups. The results of a multivariable analysis including the whole sample (n = 6499) showed that obesity had a direct association with central BP, while diabetes was directly related to PWV. In addition, alcohol intake was directly associated with central BP, while performance of physical activity was inversely related to AIx. In conclusion, values of office-measured central BP, PWV, and AIx obtained in an apparently healthy population and in a population with CVRFs are now available according to age and sex and may be useful to build thresholds for use in clinical practice.

Arterial stiffness in black adults from Angola and Brazil

Ethnicity is an important determinant of blood pressure levels, being black individuals affected more than any other ethnic group. Arterial stiffening, an independent risk factor for hypertension, is also influenced by ethnicity. However, whether black individuals from different continents would have different patterns of arterial stiffening is still unknown. Thus, the authors aimed to compare pulse wave velocity (PWV) in black subjects living in Angola and Brazil. A total of 677 black individuals from two independent cross-sectional studies conducted in Brazil and Angola were included in this analysis. Carotid-to-femoral PWV was measured following the same protocols for both studies, as well as clinical and anthropometric variables. Adjusted PWV was higher in Brazilian blacks than in Angolans, regardless of sex (men from Brazil: 10.7 ± 1.8 vs men from Angola: 9.9 ± 1.8 m/s, P < .001; women from Brazil: 10.3 ± 1.5 vs women from Angola: 9.2 ± 1.3 m/s, P < .001). Although the cf-PWV was higher in Brazilian blacks, the age-related increase in cf-PWV was higher in Angolan men compared to Brazilians, but not in women. SBP showed the strongest association with cf-PWV, regardless of sex and country. However, age was associated with cf-PWV in all groups, except in Brazilian men. Our results clearly show a difference in PWV between two black populations, and highlight for sex differences in the hemodynamic parameters that might affect blood pressure levels in these populations.

Clinical Characteristics of Resistant vs. Refractory Hypertension in a Population of Hypertensive Afrodescendants

Background Afrodescendants have been associated with a greater severity of arterial hypertension and a higher incidence of cardiovascular complications. Characteristics in the presentation of resistant hypertension (RH) or refractory hypertension (RfH), specifically in this ethnic group, have not been properly studied. Objectives The study compares clinical and epidemiological characteristics and prevalence of cardiovascular events in people of African descent diagnosed with RH or RfH. Methods Cross-sectional study carried out in a referral clinic for patients with severe hypertension. The level of significance was 5%. Results 146 consecutive patients were evaluated, of which 68.7% were female. The average age was 61.8 years, with 88.4% of Afrodescendants (mixed race or black). 51% had RfH. There was a high prevalence of cardiovascular risk factors: 34.2% of subjects had diabetes, 69.4% dyslipidemia, 36.1% obesity, and 38.3% history of smoking. Reduced renal function was seen in 34.2%. Previous cardiovascular events occurred in 21.8% for myocardial infarction and in 19.9% for stroke. The Framingham's risk score was moderate/high at 61%. RfH patients were younger (mean age 59.38±11.69 years versus 64.10±12.23 years, p=0.02), had more dyslipidemia (83.8 versus 66.7%, p=0.021), and stroke (30.4 versus 12.3%, p=0.011) when compared to those with RH. The use of a combination of ACEi/ARB+CCB+Diuretic, chlortalidone and spironolactone was also more frequent in individuals with RfH. Conclusion Africandescendant people with RH had a high cardiovascular risk, a high prevalence of RfH, a higher frequency of dyslipidemia and stroke, compatible with a high incidence of injury to target organs. (Arq Bras Cardiol.2020; 115(1):31-39).

Effect of acute maximal exercise on vasodilatory function and arterial stiffness in African-American and white adults

INTRODUCTION

African-Americans are at increased risk of cardiovascular disease compared with their white counterparts, potentially due to greater arterial stiffness and reduced vasodilatory capacity. Racial differences also exist in arterial stiffness and blood pressure (BP) following maximal aerobic exercise; African-Americans do not exhibit central post exercise BP reductions. Whether impaired vasodilatory function contributes to the lack of BP response is unknown.

PURPOSE

To evaluate vasodilatory function, arterial stiffness, and hemodynamics following a maximal aerobic exercise test in young, healthy African-American and white adults.

METHODS

Twenty-seven African-American and 35 white adults completed measures at baseline, 15 and 30 min after a maximal exercise test. Measures included vasodilatory capacity of forearm resistance arteries, central pulse wave velocity (PWV), and carotid artery stiffness (β).

RESULTS

Forearm reactive hyperemia was greater in white but increased similarly following exercise in both groups (P < 0.05). Carotid β-stiffness increased at 15 and 30 min (P = 0.03) in both groups, but PWV controlled for mean arterial pressure decreased after maximal exercise (P = 0.03). White exhibited reductions in systolic and mean pressure, whereas no changes were seen for African-Americans (interaction effects: P < 0.05).

CONCLUSION

African-American and white adults had similar decreases in PWV, increases in β-stiffness, and increases in vasodilatory function following maximal exercise. African-American adults, however, did not display reductions in BP and had overall lower vasodilatory function in comparison with white adults. Our results suggest African-Americans exhibit similar vasodilatory function changes following aerobic exercise as their white counterparts, and therefore vasodilatory function likely does not explain the lack of BP response in African-Americans.

HIV Infection Is Not Associated With Aortic Stiffness. Traditional Cardiovascular Risk Factors Are the Main Determinants-Cross-sectional Results of INI-ELSA-BRASIL

INTRODUCTION

Aortic stiffness measured by carotid-femoral pulse wave velocity (cf-PWV) is a marker of subclinical atherosclerosis. We propose to assess whether HIV infection is associated with arterial stiffness and their determinants in HIV-infected subjects.

METHODS

We compared data from an HIV cohort (644 patients, HIV+) in Rio de Janeiro with 2 groups: 105 HIV-negative (HIV-) individuals and 14,873 participants of the ELSA-Brasil study. We used multivariable linear regression to investigate factors associated with cf-PWV and whether HIV was independently associated with aortic stiffness and propensity score weighting to control for imbalances between groups.

RESULTS

From 15,860 participants, cf-PWV was obtained in 15,622 (98.5%). Median age was 51 (interquartile range 45-58), 44.41 (35.73, 54.72), and 43.60 (36.01, 50.79) years (P < 0.001), and median cf-PWV (m/s; interquartile range) was 9.0 (8.10, 10.20), 8.70 (7.90, 10.20), and 8.48 (7.66, 9.40) for ELSA-Brasil, HIV- and HIV+, respectively (P < 0.001). In the final weighted multivariable models, HIV group was not associated with cf-PWV when compared either with ELSA-Brasil [β = -0.05; 95% confidence interval (CI) = -0.23; P = 0.12; P = 0.52] or with the HIV- groups (β = 0.10; 95% CI = -0.10; 0, 31; P = 0.32). Traditional risk factors were associated with higher cf-PWV levels in the HIV+ group, particularly waist-to-hip ratio (β = 0.20; 95% CI = 0.10; 0.30; P < 0.001, result per one SD change).

CONCLUSIONS

HIV infection was not associated with higher aortic stiffness according to our study. In HIV-infected subjects, the stiffness of large arteries is mainly associated with traditional risk factors and not to the HIV infection per se.

Non-alcoholic fatty liver disease presence and severity are associated with aortic stiffness beyond abdominal obesity: The ELSA-Brasil

BACKGROUND AND AIMS

It is uncertain whether non-alcoholic fatty liver disease (NAFLD) is associated with aortic stiffness in a racial/ethnically diverse and admixed society. We addressed whether NAFLD presence and severity were associated with carotid-femoral pulse wave velocity (cf-PWV) in individuals free of cardiovascular disease.

METHODS

In 7196 individuals free of cardiovascular disease at the baseline Brazilian longitudinal study of adult health, we classified NAFLD presence and severity (mild, moderate and severe) by ultrasound hepatic attenuation. We measured cf-PWV using a non-invasive validated device (Complior SP, Artech Medicale France). We compared cf-PWV of NAFLD individuals to those without by analysis of covariance adjusted for demographics, life style, waist circumference, and arterial pressure. We also analyzed the cf-PWV trend from no-NAFLD to severe NAFLD.

RESULTS

In unadjusted analysis, from no-NAFLD to severe NAFLD, there were slightly older individuals, lower frequency of smokers, more prevalent diabetes and hypertension. In adjusted analysis, there was slightly higher cf-PWV (m/s) (95%CI) in NAFLD vs. no-NAFLD, respectively 9.32 (9.22, 9.41) and 9.24 (9.15, 9.33) (p = 0.037). Across NAFLD severity spectrum, adjusted cf-PWV increased from 9.24 (9.15, 9.33) in no-NAFLD to 9.69 (9.46, 9.93) in severe NAFLD (p for trend association = 0.001). In sensitivity analysis, diabetes adjustment nullified the association of binary NAFLD with cf-PWV, but not that of increasingly severe NAFLD.

CONCLUSIONS

In racial/ethnically diverse individuals free of cardiovascular disease, NAFLD is associated with aortic stiffness beyond abdominal obesity. The specific NAFLD impact on CVD worldwide is potentially relevant.

Development of a Cardiovascular Simulator for Studying Pulse Diagnosis Mechanisms

This research was undertaken to develop a cardiovascular simulator for use in the study of pulse diagnosis. The physical (i.e., pulse wave transmission and reflection) and physiological (i.e., systolic and diastolic pressure, pulse pressure, and mean pressure) characteristics of the radial pulse wave were reproduced by our simulator. The simulator consisted of an arterial component and a pulse-generating component. Computer simulation was used to simplify the arterial component while maintaining the elastic modulus and artery size. To improve the reflected wave characteristics, a palmar arch was incorporated within the simulator. The simulated radial pulse showed good agreement with clinical data.