Vascular Aging and Arterial Stiffness

Research Trends in Vascular Aging in the Last Decade: A Comprehensive Bibliometric Analysis

Background

In recent years, vascular aging has emerged as a hot topic in become an important direction of aging research, but a comprehensive bibliometric analysis has not been conducted.

Methods

The Web of Science database was searched for articles and reviews on vascular aging from January 1, 2014, to August 20, 2024, and the literature was analyzed and knowledge maps were constructed using CiteSpace, VOSviewer, pajek and Scimago Graphica software for econometric analysis and knowledge graph construction of the literature.

Results

A total of 38,910 authors from 7622 institutions in 111 countries published 7277 papers in 1344 academic journals, with a significant increase in publication volume. The United States is the country with the highest productivity and citation rates, and Mayo Clinic is the most active institution. Tarantini S published the most papers, while Csiszar A received the most citations. Retina-The Journal of Retinal and Vitreous Diseases journal published the most papers, and Circulation journal received the most citations. The main research aspects include age-related macular degeneration, arteriosclerosis, and oxidative stress, which are the main keywords in this field. In the last decade, the term c reactive protein has attracted great attention with its strongest citation explosion.

Conclusion

In the past decade, the research focus on vascular aging has been increasing year by year. Age-related macular degeneration, arteriosclerosis, oxidative stress and vascular endothelial cells are the emerging research directions in this field.

Aerobic Exercise Practiced Over Time Mitigates the Structural Effects on the Vascular System Caused by the Deleterious Effects of Aging

Background

Aerobic training has been considered beneficial for determining the detrimental alterations in blood vessels caused by aging.

Objective

Evaluate the relationship between the preventive effects of aerobic exercise and time of practice on cardiovascular health, in aged Wistar rats.

Methods

Wistar rats (16 months) were divided into 3 groups: (1) sedentary (AGED); (2) long-term trained\61 weeks (LTT); and (3) short-term trained\final 8 weeks of life (STT). Body weight, maximum physical capacity, systolic blood pressure (SBP), pulse wave velocity (PWV), plasma nitrite (NO), oxidative stress (TBARS), wall thickness, the wall-to-lumen ratio, and collagen of the thoracic aorta, carotid, and femoral arteries were measured.

Results

Both trained groups showed an increase in physical capacity when compared to the AGED group (p=<0.001 for LTT and p=0.011 for STT), and the LTT group demonstrated higher values when compared to the STT group (p= 0.004). The LTT group presented attenuation of PWV (p= 0.002) and a reduction in the wall thickness and wall-to-lumen ratio of the thoracic aorta (p=0.032 and 0.008, respectively) and carotid arteries (p=0.019 and 0.012, respectively) when compared to the AGED group. The STT group presented a reduction in TBARS compared to the AGED group (p=0.046). Additionally, both trained groups (LTT and STT) presented a reduction in the percentage of arterial collagen compared to the AGED group in the thoracic aorta (p=<0.001 and p=0.001 respectively) and carotid arteries (p= <0.008 and p= 0.041 respectively).

Conclusion

This study demonstrated that long-term training decreased the level of collagen, PWV values, wall thickness, and the wall-to-lumen ratio of the aorta and carotid arteries compared to the AGED group. Moreover, short-term training reduced TBARS and collagen percentage in the aorta and carotid arteries compared to the AGED group.

Functions and application of circRNAs in vascular aging and aging-related vascular diseases

Circular RNAs (circRNAs), constituting a novel class of endogenous non-coding RNAs generated through the reverse splicing of mRNA precursors, possess the capacity to regulate gene transcription and translation. Recently, the pivotal role of circRNAs in controlling vascular aging, as well as the pathogenesis and progression of aging-related vascular diseases, has garnered substantial attention. Vascular aging plays a crucial role in the increased morbidity and mortality of the elderly. Endothelial cells (ECs) and vascular smooth muscle cells (VSMCs) are crucial components of the intima and media layers of the vascular wall, respectively, and are closely involved in the mechanisms underlying vascular aging and aging-related vascular diseases. The review aims to provide a comprehensive exploration of the connection between circRNAs and vascular aging, as well as aging-related vascular diseases. Besides, circRNAs, as potential diagnostic markers or therapeutic targets for vascular aging and aging-related vascular diseases, will be discussed thoroughly, along with the challenges and limitations of their clinical application. Investigating the role and molecular mechanisms of circRNAs in vascular aging and aging-related vascular diseases will provide a novel insight into early diagnosis and therapy, and even effective prognosis assessment of these conditions.

Dynamic Arterial Elastance as a Predictor of Intraoperative Fluid Responsiveness in Elderly Patient over 70 Years of Age Undergoing Spine Surgery in the Prone Position Under General Anesthesia: A Validation Study

Background: Optimizing fluid therapy is critical for maintaining hemodynamic stability in elderly patients undergoing major surgeries. Dynamic arterial elastance (Eadyn), defined as the ratio of pulse pressure variation (PPV) to stroke volume variation (SVV), has been proposed as a predictor of fluid responsiveness, especially in challenging conditions like prone-positioned spine surgery under general anesthesia. Methods: Hemodynamic parameters were measured before and after fluid loading with 500 mL of crystalloid solution. Patients were classified as responders or non-responders based on a ≥15% increase in mean arterial pressure (MAP) post-fluid administration. Predictive performance of these parameters was assessed using receiver operating characteristic (ROC) analysis. Results: Of the 37 patients, 15 were classified as responders and 22 as non-responders. Eadyn demonstrated poor predictive performance (AUC = 0.508). In contrast, SVV (AUC = 0.808), PPV (AUC = 0.738), and C (AUC = 0.741) exhibited moderate to high predictive ability. Responders exhibited significantly higher baseline SVV, PPV, and net arterial compliance compared to non-responders. Conclusions: Dynamic arterial elastance (Eadyn) showed limited predictive ability for fluid responsiveness in elderly patients undergoing spine surgery in the prone position. In contrast, stroke volume variation (SVV), pulse pressure variation (PPV), and net arterial compliance (C) demonstrated superior reliability, with SVV emerging as the most accurate predictor.

The unique association between estimated pulse wave velocity and the prevalence of diabetic kidney disease: a cross-sectional study

OBJECTIVE

Arteriosclerosis plays a significant role as one of the key pathological mechanisms underlying Diabetic Kidney Disease (DKD). The estimated Pulse Wave Velocity (ePWV) is used to assess arteriosclerosis, and is considered a potential clinical surrogate for pulse wave velocity. There are no studies on ePWV in relation to DKD. Our research represents the first embark to explore the relationship between ePWV and DKD.

METHODS

In this cross-sectional analysis, we collected ePWV data from a cohort of 4,296 hospitalized Chinese patients. Multivariable-adjusted logistic regression models and restricted cubic spline (RCS) analysis were employed to examine the relationship between eGDR and the prevalence of DKD, UACR ≥ 30 mg/g, and eGFR < 60 mL/min per 1.73 m².

RESULTS

After adjusting for confounding factors, each unit increase in ePWV was associated with a 23%, 21% and 25% increase in the prevalence of DKD, UACR ≥ 30 mg/g, and eGFR < 60 mL/min per 1.73 m² in T2DM participants, respectively. A J-shaped relationship was observed between ePWV and the prevalence of DKD and eGFR < 60 mL/min per 1.73 m², and a linear association between ePWV and the prevalence of UACR ≥ 30 mg/g.

CONCLUSION

ePWV is independently positively correlated with the prevalence of DKD. Integrating ePWV into routine clinical evaluations enable timely interventions and personalized management approaches.

The crosstalks between vascular endothelial cells, vascular smooth muscle cells, and adventitial fibroblasts in vascular remodeling

Pathological vascular remodeling (VR) is characterized by structural and functional alterations in the vascular wall resulting from injury, which significantly contribute to the development of cardiovascular diseases (CVDs). The vascular wall consists primarily of endothelial cells (ECs), vascular smooth muscle cells (VSMCs), and adventitial fibroblasts (AFs), whose interactions are crucial for both the formation of the vascular system and the maintenance of mature blood vessels. Disruptions in the communication between these cell types have been implicated in the progression of VR. This review examines the complex interactions between ECs, VSMCs, and AFs in the context of CVD development, emphasizing a relatively underexplored yet potentially critical mechanism. This interaction framework likely extends to the broader cellular dialogue in the pathogenesis of CVDs, suggesting novel therapeutic strategies for intervention.

Association between estimated pulse wave velocity and in-hospital mortality of patients with acute kidney injury: a retrospective cohort analysis of the MIMIC-IV database

BACKGROUND

Estimated pulse wave velocity (ePWV) has been found to be an independent predictor of cardiovascular mortality and kidney injury, which can be estimated noninvasively. This study aimed to investigate the association between ePWV and in-hospital mortality in critically ill patients with acute kidney injury (AKI).

METHODS

This study included 5960 patients with AKI from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. The low and high ePWV groups were compared using a Kaplan-Meier survival curve to evaluate the differences in survival status. Cox proportional hazards models were used to explore the association between ePWV and in-hospital mortality in critically ill patients with AKI. To further examine the dose-response relationship, we used a restricted cubic spline (RCS) model. Stratification analyses were conducted to investigate the effect of ePWV on hospital mortality across various subgroups.

RESULTS

Survival analysis indicated that patients with high ePWV had a lower survival rate than those with low ePWV. Following adjustment, high ePWV demonstrated a statistically significant association with an increased risk of in-hospital mortality among AKI patients (HR = 1.53, 95% CI = 1.36-1.71, p < 0.001). Analysis using the RCS model confirmed a linear increase in the risk of hospital mortality as the ePWV values increased (P for nonlinearity = 0.602).

CONCLUSIONS

A high ePWV was significantly associated with an increased risk of in-hospital mortality among patients with AKI. Furthermore, ePWV was an independent predictor of in-hospital mortality in critically ill patients with AKI.

The Importance of Orthostatic Increase in Pulse Wave Velocity in the Diagnosis of Early Vascular Aging

Background/Objectives: Vascular aging can be assessed by arterial stiffness measured through pulse wave velocity (PWV). Increased PWV predicts arterial hypertension, cardiovascular events and all-cause mortality. Detection of early signs of vascular aging remains an unmet problem. To search for the most sensitive markers for the early increase in vascular stiffness in a healthy population. Methods: One-hundred and twenty healthy subjects were divided in three equal age groups: <30 years, 30-45 years and >45 years. Head-up tilt test (HUTT) protocol was applied, providing a standardized hydrostatic column height. PWV at the brachial-ankle artery site (baPWV) was measured using a multichannel sphygmomanometer ABI System 100 PWV in three positions: in the baseline horizontal (supine) position-baPWVb; during the head tilt-up with an individual angle of inclination-baPWVt; and when returning to supine. Results: The most sensitive marker of early stiffness increase in a healthy population is the relative orthostatic increase in baPWV, ΔbaPWV/baPWVb, where ΔbaPWV = baPWVt - baPWVb. The significance of differences in this parameter between the young and elderly groups reached p = 0.000075 and p = 0.000006, respectively. Conclusions: The proposed index ΔbaPWV/baPWVb can be considered as a promising sensitive early biomarker of vascular aging and as a potential effective indicator in cardiovascular prevention. A longitudinal cohort study is needed to confirm this assumption.

Age-Specific Approach to Arterial Stiffness Prediction in Apparently Healthy Patients

Background

The high prevalence of traditional cardiovascular risk factors among the patients without cardiovascular disease (CVD) allows us to predict an increase in cardiovascular morbidity rate in the future. Arterial stiffness is one of the most important predictors and pathogenetic mechanisms of CVD development. The aim of our study was to evaluate the predictive differences of age-related and age-independent (universal) cardio-ankle vascular index (CAVI) reference values for detecting increased arterial stiffness in individuals without CVD.

Methods

The study included 600 patients (43% men and 57% women, mean age 36.0 ± 18.3 years). All the patients underwent anthropometric measurements with obesity markers evaluation, assessment of arterial stiffness by sphygmomanometry. To create predictive models, we used universal and age-related CAVI thresholds: ≥ 9.0 (CAVI≥ 9) and CAVIAge according to the "Consensus of Russian experts on the evaluation of arterial stiffness in clinical practice".

Results

In the < 50 years group, both the CAVIAge and CAVI≥ 9 models were significant (CAVIAge: b = 4.8, standard error b (st.err.b) = 0.27, P < 0.001; CAVI≥ 9: b = 3.2, st.err.b = 1.6, P < 0.001). The CAVIAge model demonstrated high sensitivity and specificity (> 70%) compared to the CAVI≥ 9 model (sensitivity 62%, specificity 58%). In the receiver operating characteristic (ROC) curve analysis, the CAVIAge model had a significantly higher area under the ROC curve (AUC) = 0.802 than the CAVI≥ 9 model: AUC = 0.674. In the ≥ 50 years group, both models were significant: CAVIAge (b = 2.6, st.err.b = 1.13, P < 0.001) and CAVI≥ 9 (b = 5.3, st.err.b = 0.94, P < 0.001). Both models demonstrated high sensitivity and specificity (> 70%). When ROC curves were analyzed for the CAVIAge model, the AUC value of 0.675 was significantly lower when compared to the CAVI≥ 9 model (AUC = 0.787, P = 0.031).

Conclusions

In the < 50 years group, the model based on age-specific CAVI thresholds has the higher predictive value, sensitivity, and specificity for identifying individuals with increased arterial stiffness. In contrast, in the ≥ 50 years group, a predictive model using a universal threshold value of CAVI≥ 9 has advantages.

Aging in Ocular Blood Vessels: Molecular Insights and the Role of Oxidative Stress

Acknowledged as a significant pathogenetic driver for numerous diseases, aging has become a focal point in addressing the profound changes associated with increasing human life expectancy, posing a critical concern for global public health. Emerging evidence suggests that factors influencing vascular aging extend their impact to choroidal and retinal blood vessels. The objective of this work is to provide a comprehensive overview of the impact of vascular aging on ocular blood vessels and related diseases. Additionally, this study aims to illuminate molecular insights contributing to vascular cell aging, with a particular emphasis on the choroid and retina. Moreover, innovative molecular targets operating within the domain of ocular vascular aging are presented and discussed.

Copper homeostasis and copper-induced cell death： Novel targeting for intervention in the pathogenesis of vascular aging

Copper-induced cell death, also known as cuproptosis, is distinct from other types of cell death such as apoptosis, necrosis, and ferroptosis. It can trigger the accumulation of lethal reactive oxygen species, leading to the onset and progression of aging. The significant increases in copper ion levels in the aging populations confirm a close relationship between copper homeostasis and vascular aging. On the other hand, vascular aging is also closely related to the occurrence of various cardiovascular diseases throughout the aging process. However, the specific causes of vascular aging are not clear, and different living environments and stress patterns can lead to individualized vascular aging. By exploring the correlations between copper-induced cell death and vascular aging, we can gain a novel perspective on the pathogenesis of vascular aging and enhance the prognosis of atherosclerosis. This article aims to provide a comprehensive review of the impacts of copper homeostasis on vascular aging, including their effects on endothelial cells, smooth muscle cells, oxidative stress, ferroptosis, intestinal flora, and other related factors. Furthermore, we intend to discuss potential strategies involving cuproptosis and provide new insights for copper-related vascular aging.

The Impact of COVID-19 on Carotid-Femoral Pulse Wave Velocity: A Systematic Review and Meta-Analysis

COVID-19 is a complex multisystemic disease that can result in long-term complications and, in severe cases, death. This study investigated the effect of COVID-19 on carotid-femoral pulse wave velocity (cfPWV) as a measurement to evaluate its impact on arterial stiffness and might help predict COVID-19-related cardiovascular (CV) complications. PubMed, Web of Science, Embase, and the Cochrane Library were searched for relevant studies, and meta-analysis was performed. The study protocol was registered in PROSPERO (nr. CRD42023434326). The Newcastle-Ottawa Quality Scale was used to evaluate the quality of the included studies. Nine studies reported cfPWV among COVID-19 patients and control groups. The pooled analysis showed that cfPWV in COVID-19 patients was 9.5 ± 3.7, compared to 8.2 ± 2.2 in control groups (MD = 1.32; 95% CI: 0.38-2.26; p = 0.006). A strong association between COVID-19 infection and increased cfPWV suggests a potential link between the virus and increased arterial stiffness. A marked increase in arterial stiffness, a known indicator of CV risk, clearly illustrates the cardiovascular implications of COVID-19 infection. However, further research is required to provide a clearer understanding of the connection between COVID-19 infection, arterial compliance, and subsequent CV events.

Aberrant hyper-expression of the RNA binding protein GIGYF2 in endothelial cells modulates vascular aging and function

Vascular endothelial cells (ECs) senescence plays a crucial role in vascular aging that promotes the initiation and progression of cardiovascular disease. The mutation of Grb10-interacting GYF protein 2 (GIGYF2) is strongly associated with the pathogenesis of aging-related diseases, whereas its role in regulating ECs senescence and dysfunction still remains elusive. In this study, we found aberrant hyperexpression of GIGYF2 in senescent human ECs and aortas of old mice. Silencing GIGYF2 in senescent ECs suppressed eNOS-uncoupling, senescence, and endothelial dysfunction. Conversely, in nonsenescent cells, overexpressing GIGYF2 promoted eNOS-uncoupling, cellular senescence, endothelial dysfunction, and activation of the mTORC1-SK61 pathway, which were ablated by rapamycin or antioxidant N-Acetyl-l-cysteine (NAC). Transcriptome analysis revealed that staufen double-stranded RNA binding protein 1 (STAU1) is remarkably downregulated in the GIGYF2-depleted ECs. STAU1 depletion significantly attenuated GIGYF2-induced cellular senescence, dysfunction, and inflammation in young ECs. Furthermore, we disclosed that GIGYF2 acting as an RNA binding protein (RBP) enhances STAU1 mRNA stability, and that the intron region of the late endosomal/lysosomal adaptor MAPK and mTOR activator 4 (LAMTOR4) could bind to STAU1 protein to upregulate LAMTOR4 expression. Immunofluorescence staining showed that GIGYF2 overexpression promoted the translocation of mTORC1 to lysosome. In the mice model, GIGYF2flox/flox Cdh-Cre+ mice protected aged mice from aging-associated vascular endothelium-dependent relaxation and arterial stiffness. Our work discloses that GIGYF2 serving as an RBP enhances the mRNA stability of STAU1 that upregulates LAMTOR4 expression through binding with its intron region, which activates the mTORC1-S6K1 signaling via recruitment of mTORC1 to the lysosomal membrane, ultimately leading to ECs senescence, dysfunction, and vascular aging. Disrupting the GIGYF2-STAU1-mTORC1 signaling cascade may represent a promising therapeutic approach against vascular aging and aging-related cardiovascular diseases.

Serum cystatin C is associated with peripheral artery stiffness in patients with type 2 diabetes mellitus combined with chronic kidney disease

OBJECTIVE

Cystatin C (CysC) is associated with arterial stiffness. However, its suitability for evaluating patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) remains unclear. We aimed to investigate the relationship between CysC levels and peripheral arterial stiffness (PAS) in patients with T2DM combined with CKD.

METHODS

Participants' arterial stiffness was assessed using brachial-ankle pulse wave velocity (baPWV), and those with a baPWV ≥ 1800 cm/s were included in the PAS group. Additionally, patients were divided into young (18-44 years old), middle-aged (45-59 years old), and older (≥60 years old) groups.

RESULTS

Of 200 patients, 94 (47%) were diagnosed with PAS. Multivariate logistic regression revealed that age, pulse pressure, and CysC levels (odds ratio = 1.525, 95% confidence interval: 1.072-2.168, P = 0.019) were independently correlated with PAS in patients with T2DM combined with CKD. The levels of CysC in different age groups were positively correlated with baPWV, and the correlation was significantly higher in the young group (r = 0.739, P < 0.001) than in the middle-aged (r = 0.329, P < 0.001) and older (r = 0.496, P < 0.001) groups. The multifactor linear regression analysis revealed that CysC was significantly correlated with baPWV in the young group (β = 0.455, P = 0.002).

CONCLUSION

CysC was an independent predictor of PAS in patients with T2DM combined with CKD and was more significantly associated with baPWV in young patients than in middle-aged and older patients. CysC may may be an early predictor of peripheral arteriosclerosis in patients with T2DM combined with CKD.

Association of Early Sports Practice with Cardiovascular Risk Factors in Community-Dwelling Adults: A Retrospective Epidemiological Study

BACKGROUND

Sports practice in childhood and adolescence has been inversely related to the chances of developing cardiovascular risk factors (CRFs). However, it is not clear whether sports practice in childhood and adolescence could be inversely related to CRF in adult life.

OBJECTIVES

This study aimed to analyze the association between early sports practice and cardiovascular risk factors in a randomized sample of community-dwelling adults.

METHODS

For this, 265 adults aged ≥ 18 years composed the sample. Cardiovascular risk factors of obesity, central obesity, diabetes, dyslipidemia, and hypertension were collected. Early sports practice was retrospectively self-reported using an appropriate instrument. Total physical activity level was assessed by accelerometry. The association between early sports practice and cardiovascular risk factors in adulthood was analyzed by binary logistic regression, adjusted for sex, age, socioeconomic status, and moderate-to-vigorous physical activity.

RESULTS

Early sports practice was observed in 56.2% of the sample. The prevalence of central obesity (31.5 vs. 50.0%; p = 0.003), diabetes (4.7% vs. 13.7%; p = 0.014), dyslipidemia (10.7% vs. 24.1%; p = 0.005), and hypertension (14.1% vs. 34.5%; p = 0.001) was lower in participants who reported early sports practice. Participants who reported early sports practice in childhood and adolescence were, respectively, 60% (OR = 0.40; 95% CI 0.19-0.82) and 59% (OR = 0.41; 95% CI 0.21-0.82) less likely to have hypertension in adult life when compared to those with no early sports practice, independently of sex, age, socioeconomic status, and habitual physical activity level in adulthood.

CONCLUSION

Early sports practice in childhood and adolescence was a protective factor for hypertension in adulthood.