Associations among different functional and structural arterial wall properties and their relations to traditional cardiovascular risk factors in healthy subjects: a cross-sectional study

Atherosclerosis in Vietnamese patients with systemic sclerosis and its relation to disease and traditional risk factors

Objective

The aim of this study was to determine the frequency of clinical and subclinical atherosclerosis in Vietnamese patients with SSc and the risk factors for subclinical atherosclerosis.

Methods

A case–control study of 46 patients with SSc who met the ACR criteria for the disease and 42 healthy age- and sex-matched controls of Kinh ethnicity was conducted. Clinical data including cardiovascular disease (CVD) events were collected. Serum levels of blood lipids and high-sensitivity CRP were determined. Carotid artery intima–media thickness (IMT) and carotid plaques were measured by carotid Doppler ultrasonography.

Results

Patients with SSc, of whom 96% had dcSSc, reported a higher number of CVD events compared with the controls (21.7 vs 0%; P = 0.0065). They exhibited low serum levels of high-density lipoprotein cholesterol and high levels of total cholesterol compared with controls (P = 0.01 and P = 0.03, respectively). Common carotid artery IMT was significantly higher in SSc patients compared with controls [mean (s.d.): 0.61 (0.12) vs 0.47 (0.07) mm; P < 0.0001]. Carotid artery IMT in SSc showed significant positive correlations with age, disease duration, total cholesterol and low-density lipoprotein cholesterol (P < 0.05). Thirteen patients with SSc (28.3%) but no controls had carotid atherosclerotic plaques. Patients with plaque had a higher mean modified Rodnan skin score and higher mean IMT compared with patients without plaque.

Conclusion

We confirmed an increased risk of CVD events and signs of subclinical atherosclerosis in patients with SSc of Kinh ethnicity and both traditional and disease-related risk factors for CVD.

Impedance plethysmography-based method in the assessment of subclinical atherosclerosis

BACKGROUND AND AIMS

The aim of this study was to examine an association of individual and combined pulse waveform parameters derived from bioimpedance measurements, that is pulse waves from a distal impedance plethysmographic (IPG), a whole-body impedance cardiographic (ICG) and transformed distal impedance plethysmographic (tIPG) signals, with markers of subclinical atherosclerosis, i.e. carotid intima-media thickness (cIMT), brachial artery flow-mediated dilation (FMD) and carotid artery distensibility (Cdist). The level of the association was also compared for arterial pulse wave velocity (PWV) and cIMT, FMD, and Cdist.

METHODS

IPG, ICG, tIPG signals were measured from 1741 Finnish adults aged 30-45 years. The association between pulse wave parameters and cIMT, FMD and Cdist was studied using bootstrapped stepwise Akaike's Information Criterion method resulting in selection of parameters other than PWV, i.e. parameters having stronger association with cIMT, FMD and Cdist than PWV, in the model. Then risk scores were calculated from the selected pulse wave parameters and their association between cIMT, FMD and Cdist was studied with multivariable linear regression analysis.

RESULTS

The risk score was found to be the third strongest predictor of subclinical atherosclerosis as indicated by cIMT measurement, the second strongest predictor of FMD and the strongest predictor of Cdist. These findings show that several individual pulse wave parameters were associated more strongly with cIMT, FMD, and Cdist than PWV when adjusted with clinical risk factors.

CONCLUSIONS

Impedance based pulse waveform analysis provides a useful tool for assessing cardiovascular risk and estimating presence of structural changes in the vasculature.

An Acute Bout of Aquatic Treadmill Exercise Induces Greater Improvements in Endothelial Function and Postexercise Hypotension Than Land Treadmill Exercise: A Crossover Study

OBJECTIVE

The purpose of the study was to compare acute bouts of aquatic treadmill (ATM) and land treadmill (LTM) exercise on flow-mediated dilation, postexercise blood pressure, plasma nitrate/nitrite, and atrial natriuretic peptide in untrained, prehypertensive men.

DESIGN

In a counterbalanced, crossover design, 19 untrained, prehypertensive men completed bouts of ATM and LTM on separate days. Flow-mediated dilation was measured pre-exercise and 1-hr postexercise. Blood samples were obtained pre-exercise and immediately postexercise and analyzed for plasma nitrate/nitrite and atrial natriuretic peptide. A magnitude-based inference approach to inference was used for statistical analysis.

RESULTS

A possible clinically beneficial increase in flow-mediated dilation (1.2%, 90% confidence interval = -0.07% to 2.5%) was observed 1 hr after ATM. In contrast, a possible clinically harmful decrease in flow-mediated dilation (-1.3%, 90% confidence interval = -2.7% to 0.2%) was observed 1 hr after LTM. The magnitude of the postexercise systolic blood pressure reduction was greater after ATM (-4.9, SD = 2.9 mm Hg) than LTM (-2.6, SD = 2.5 mm Hg). Atrial natriuretic peptide increased 34.3 (SD = 47.0%) after ATM and decreased -9.0 (SD = 40.0%) after LTM.

CONCLUSIONS

An acute bout of ATM induced a more favorable endothelial response and greater postexercise hypotensive response than LTM. These changes were associated with increased atrial natriuretic peptide levels after ATM.

Predictors of candesartan's effect on vascular reactivity in patients with coronary artery disease

Introduction and Aims

Endothelial dysfunction and arterial stiffness have a prognostic value on adverse long‐term outcomes in coronary artery disease (CAD) patients. We evaluated the efficacy on vascular reactivity of candesartan and analyzed predictors to control the candesartan's effect on vascular reactivity in CAD patients.

Method

Patients were prospectively enrolled and prescribed candesartan for 6 months. The effect on vascular reactivity was evaluated by the change in flow‐mediated dilation (FMD) and pulse wave velocity (PWV).

Results

A total of 124 patients completed the study. The better responder in FMD change (≥1.3%) showed significantly lower baseline FMD than the poor responder (P < .001). In receiver operating characteristic analysis, baseline FMD 7.5% showed optimal predictive value (sensitivity 79%, specificity 79%) for predicting better responder. The baseline endothelial dysfunction (FMD <7.5%) was the only significant predictor of the better responder to candesartan. The better responder in PWV change (≤−100 cm/s) showed greater blood pressure lowering and significantly higher baseline PWV than the poor responder (both P < .05). The poor responder in both FMD and PWV showed a higher prevalence of previous myocardial infarction (38.7% vs 17.2%, P = .013).

Conclusion

The candesartan's effect on vascular reactivity is more pronounced in patients with more severe endothelial dysfunction and arterial stiffness. Poor responders on both FMD and PWV showed higher prevalence of previous myocardial infarction.

Comparison of ultrasound-measured properties of the common carotid artery to tobacco smoke exposure in a cohort of Indonesian patients

BACKGROUND

The purpose of this study was to use point-of-care ultrasound (POCUS) to investigate the relationship between tobacco smoke exposure and the characteristics of the common carotid artery (CCA). The effect of both primary and secondary smoking on CCA properties was evaluated.

METHODS

We performed a prospective cross-sectional study across 20 primary care clinics in Bandung, West Java, Indonesia in July 2016. Point of care ultrasound was performed on a convenience sample of Indonesian patients presenting to clinic. The CCA wall stiffness and carotid intima-media thickness (CIMT) were measured during diastole and systole. These measurements were correlated with smoke exposure and cardiovascular disease.

RESULTS

We enrolled 663 patients in the study, with 426 patients enrolled in the smoking category and 237 patients enrolled in the second-hand smoke category. There was an overall positive correlation with the measured lifestyle factors and the ultrasound-measured variables in the group of individuals who smoked. For all variables, age seemed to contribute the most out of all of the lifestyle factors for the positive changes in CIMT and CCA wall stiffness.

CONCLUSION

Our data yielded correlations between CCA properties and cardiovascular risk, as well as between CIMT and arterial stiffness. We were also able to demonstrate an increase in thickness of the CIMT in patients who have been exposed by tobacco through the use of ultrasound. Further large scale studies comparing patients with multiple cardiac risk factors need to be performed to confirm the utility of ultrasound findings of cardiovascular disease and stroke.

Difference in carotid artery elasticity in subjects with different brachial artery kinetic of vasodilatation

Increased carotid stiffness and impaired brachial artery flow-mediated dilatation (FMD) associate with cardiovascular events. We have previously reported three FMD patterns based on the time of maximal dilatation. The aim of the present study was to verify whether different FMD patterns associate with carotid artery stiffness. In all, 133 subjects were enrolled. All participants underwent complete clinical examination, blood sampling and ultrasound study. FMD was used as a measure of endothelial function. Based on the maximal brachial artery FMD, subjects were divided into Early dilators (peak FMD at 50 s), Late dilators (peak FMD over 50 s) and No dilators. Echo-Doppler evaluation of carotid arteries was performed in order to calculate elastic indexes (strain, β-stiffness index and distensibility). In all, 64 subjects were classified as Early FMD, 36 as Late FMD and 33 as No dilators. Age, gender and cardiovascular risk factors were comparable among three groups. Early FMD had higher values of strain compared with both Late and no Dilators (P<0.001). Furthermore, Early dilators showed a significantly lower stiffness and higher distensibility compared with Late and No dilators. No significant differences between Late FMD and No Dilators were detected. Our results demonstrate that common carotid artery elasticity indexes significantly differ among Early, Late and No dilators. Subjects with delayed or absent brachial artery dilatation have stiffer common carotid arteries compared with subjects with early dilatation. In conclusion, our research suggests that the assessment of the kinetics of FMD in a clinical setting might represent a useful screening tool to improve the cardiovascular risk stratification.

Pulse Wave Velocity, Intima Media Thickness, and Flow-mediated Dilatation in Patients with Normotensive Normoglycemic Inflammatory Bowel Disease

BACKGROUND

Patients with inflammatory bowel disease (IBD) have increased risk for atherosclerosis. The cause of increased cardiovascular risk is not fully understood. Chronic inflammatory process may predispose to atherosclerosis. We aimed primarily to investigate subclinical atherosclerosis in patients with IBD, by measuring carotid femoral pulse wave velocity (PWV), carotid intima media thickness, and flow-mediated dilatation compared with matched normal controls.

METHODS

Patients with IBD were recruited among individuals proven to have Crohn's disease (CD) and ulcerative colitis (UC). To exclude any interference of confounding factors for endothelial dysfunction or atherosclerosis, we studied a specifically selected group with no additional cardiovascular risk. PWV, carotid intima media thickness, and flow-mediated dilatation levels were measured in all patients and controls.

RESULTS

The carotid femoral PWV levels were 8.13 ± 1.61 m/sec in the patients with UC, 8.16 ± 1.74 m/sec in the patients with CD, and 6.85 ± 0.95 m/sec in the healthy subjects. The levels of carotid femoral PWV were significantly higher in patients with CD and UC than control group (P < 0.001). Flow-mediated dilatation levels were significantly decreased in patients with UC and CD (9.6% ± 5.1% versus 108% ± 4.4%) when compared with control subjects (15.1% ± 9.7%) (P = 0.004). No significant difference in carotid intima media thickness was detected between UC, CD, and control groups (P = 0.152).

CONCLUSIONS

This study suggests that patients with IBD without traditional cardiovascular risk factors have increased risk of endothelial dysfunction and atherosclerosis.

Nonalcoholic fatty liver disease is an independent risk factor for atherosclerosis in young adult men

INTRODUCTION

The possible cause of accelerated atherosclerosis in NAFLD may be the relationship with the MetS and its components. Our primary goal was to evaluate the relationship between NAFLD and subclinical atherosclerosis in adult male patients between 20 and 40 years of age. Moreover, we aimed to investigate the changes in this association according to the presence or absence of MetS.

METHOD

Sixty-one male patients with biopsy-proven NAFLD and 41 healthy male volunteers were enrolled. In order to exclude any interference of confounding factors, we studied a specifically selected group with no additional cardiovascular risk. PWV, CIMT and FMD levels were measured in all patients and controls.

RESULTS

The levels of cf-PWV were significantly higher in SS and NASH patients compared to the control group (P < 0.001); no significant difference was found between SS and NASH patients (P > 0.05). We found significantly decreased FMD levels in patients with SS and NASH compared with control subjects (P < 0.001). Subjects with NASH had significantly greater CIMT measurements than the SS and controls (P = 0.026, P < 0.001, respectively). Although, NAFLD patients with MetS had increased cf-PWV and CIMT and reduced FMD compared to healthy subjects (P < 0.05), no significant difference existed between NAFLD with Mets and NAFLD without MetS in terms of cf-PWV, CIMT and FMD (P > 0.05) CONCLUSION: The present study showed that the presence of NAFLD leads to increased risk of endothelial dysfunction and atherosclerosis in adult male patients, independent of MetS.

Metabolomic study of carotid-femoral pulse-wave velocity in women

OBJECTIVE

Carotid-femoral pulse-wave velocity (PWV) is a measure of aortic stiffness that is strongly associated with increased risk of cardiovascular morbidity and mortality. The aim of the current study was to identify the molecular markers and the pathways involved in differences in PWV in women, in order to further understand the regulation of arterial stiffening.

METHODS

A total of 280 known metabolites were measured in 1797 female twins (age range: 18-84 years) not on any antihypertensive medication. Metabolites associated with PWV (after adjustment for age, BMI, metabolite batch, and family relatedness) were entered into a backward linear regression. Transcriptomic analyses were further performed on the top compounds identified.

RESULTS

Twelve metabolites were associated with PWV (P < 1.8 × 10). One of the most strongly associated metabolites was uridine, which was not associated with blood pressure (BP) and traditional risk factors but correlated significantly with the gene-expression levels of the purinergic receptor P2RY2 (Beta = -0.010, SE = 0.003, P = 0.007), suggesting that it may play a role in regulating endothelial nitric oxide synthase phosphorylation. On the other hand, phenylacetylglutamine was strongly associated with both PWV and BP.

CONCLUSION

Circulating levels of uridine, phenylacetylglutamine, and serine appear strongly correlated with PWV in women.

Correlations between brachial endothelial function and cardiovascular risk factors: a survey of 2,511 Chinese subjects

OBJECTIVE

We examined the relationship of several cardiovascular risk factors (CVRF) to brachial artery flow-mediated dilatation (FMD) in Chinese subjects.

METHODS

This was a cross-sectional study. In 2,511 Chinese adults (age 46.86±9.52 years, 1,891 men and 620 women) recruited from people who underwent health screening at The Third Xiangya Hospital, patients' CVRF [age, body mass index (BMI), waist circumference (WC), blood pressure (BP), cholesterol parameters, creatinine (Cr), uric acid (UA), glucose level and smoking] and prevalence of present disease (hypertension, diabetes mellitus, coronary heart disease and hyperlipidemia) were investigated.

RESULTS

Multivariate analysis revealed that FMD negative correlated with age (β=-0.29, P<0.001), gender (β=-0.12, P<0.001), BMI (β=-0.12, P=0.001), WC (β=-0.10, P=0.011), systolic BP (SBP) (β=-0.12, P<0.001), fasting glucose (β=-0.04, P=0.009), total cholesterol (TC) (β=-0.04, P=0.014), smoking (β=-0.05, P=0.003), and baseline brachial artery diameter (β=-0.35, P<0.001). FMD decreased with increasing age in both genders. In women, FMD was higher than men and age-related decline in FMD was steepest after age 40; FMD was similar in men above 55 years old.

CONCLUSIONS

In Chinese subjects, FMD may be a usefully marker of CVRF. Age, gender, BMI, WC, SBP, fasting glucose, TC, smoking, and baseline brachial artery diameter were independent variables related to the impairment of FMD. The influence of CVRF on endothelial function is more in women than men.

The association between functional and morphological assessments of endothelial function in patients with rheumatoid arthritis: a cross-sectional study

Introduction

Patients with rheumatoid arthritis (RA) are at an increased risk for cardiovascular disease (CVD). One of the earliest manifestations of CVD is endothelial dysfunction (ED), which can lead to functional and morphological vascular abnormalities. Several non-invasive assessments of vascular function and morphology can be utilised to assess vascular health, but little is known about the association between each of these assessments in patients with RA, and they tend to be used interchangeably in the literature. The objective of the present study was to examine associations between measures of vascular function and morphology in patients with RA.

Methods

A total of 201 RA patients (155 females, median (25^th to 75^th percentile) age: 67 (59 to 73)) underwent assessments of microvascular endothelium-dependent and endothelium-independent function (laser Doppler imaging with iontophoresis of acetylcholine and sodium-nitroprusside respectively), macrovascular endothelium-dependent and endothelium-independent function (flow-mediated dilatation and glyceryl-trinitrate-mediated dilation respectively), and vascular morphology (pulse wave analysis, carotid intima-media thickness (cIMT), and carotid plaque).

Results

Spearman's correlations revealed that from the functional parameters, only macrovascular endothelium-independent function was inversely associated with cIMT (-0.294 (P < 0.001)) after applying the Bonferroni correction for multiple comparisons. For carotid plaque, t tests showed that macrovascular endothelium-independent function was lower in patients with plaque than without (15.5 ± 8.3 vs. 23.1 ± 9.1%, P = 0.002, respectively).

Conclusions

With the exception of macrovascular endothelium-independent function, all other measures of vascular function were not associated with vascular morphology. This suggests that different assessments of vascular function and morphology in patients with RA reflect quite distinct mechanisms and phases of the atherosclerotic process and should not be used interchangeably.