Impacts of mid- to later childhood body build, social circumstance and blood pressure on early-adult arterial stiffness in different ethnic groups

OBJECTIVE: Arterial stiffness, measured as aortic pulse wave velocity [PWV], is a powerful prognostic indicator for cardiovascular events, displacing blood pressure (BP). Little is known of its determinants. We tested how factors measured twice previously in childhood in the MRC ‘DASH’ study, particularly body mass (BMI) components and BP, affected PWV in young adults. DESIGN AND METHODS: Of 6643 London children, aged 11-13y, from 51 schools in samples of about 1000 in 6 ethnic groups, 4785 (72% of the cohort), were seen again at 14-16y. In 2013, 666 (97% of invited) took part in a young-adult pilot (21-23y). With psychosocial, anthropometric and BP measures, PWV was recorded via an upper arm cuff on the calibrated Arteriograph device. RESULTS: PWV reproducibility was excellent, with mean differences across 3 x 6-8 cardiac cycles each of -0.06, 0.03 and 0.06 m/sec. Unadjusted PWVs in Caribbean-origin and White UK young men were similar (mean+SD 7.9+0.3 vs 7.6 +0.4 m/sec) and lower in other groups at similar SBPs (120mmHg), BMIs (24.6kg/m2) and waists (84.3cm). In full regression models, while Caribbean (higher BMIs and waists), African and Indian young women had lower PWV (by 0.5-0.8, 95%CI 0.1-1.1,m/sec) than did white UK women (6.9+0.2), values were still increased by age, BP, a powerful impact from waist/height, with a racism effect (+0.4m/sec) in women. Childhood effects of waist/hip were also detectable. CONCLUSION: Even by young adulthood, increased waist/height ratios, BP and psychosocial variables such as perceived racism were independent determinants of arterial stiffness, likely to increase with age.

Peripheral occlusive arterial disease in diabetic clinic attendees

Peripheral occlusive arterial disease occurs with a greater frequency in the diabetic population than in the general population. It can have debilitating effects and so early detection and intervention are important. The aim of this study was to investigate the prevalence of peripheral occlusive arterial disease (POAD) among a sample of diabetic patients attending the out-patient clinic at the University Hospital of the West Indies (UHWI), Mona. A sphygmomanometer was used to measure arm and ankle blood pressures in 80 diabetic patients, and the ankle-brachial systolic pressure index (ABI) was determined. The presence or absence of peripheral pulses was detected with the Multi-dopplex (model 1). POAD was defined by the absence of one or more peripheral pulses and/or an ABI < 0.09. Of the 80 diabetic patients examined, 18 (22.5 percent) were found to have POAD. Seventy-eight percent of diabetics with POAD had the disease in both legs. Intermittent claudication was diagnosed in 27.7 percent of patients with POAD. A significantly larger proportion of diabetics with POAD were hypertensive and/or neuropathic (p < 0.05). The results suggest that serious attention should be given to the quantitative screening for POAD in the diabetic patients attending the clinic at the UHWI (AU)

The effect of glycaemic control on peripheral blood flow in diabetics -Poster presentation

Many studies have shown that persistent uncontrolled blood glucose predisposes to several diabetic complications. The aim of this study was to determine the influence of blood glycated haemoglobin levels on plasma fibrinogen concentration - (PFC), relative plasma viscosity (RPV) and ankle blood flow (Qak) in a group of diabetic patients with vascular complications compared with non-diabetic control (C). Qak was measured by the technique of venous occlusion plethysmography. PFC was determined by a clot-weight method. RPV was determined by capillary viscometry. Glycaemic control was determined by measuring glycated haemoglobin levels (GHb). Patients were divided into three categories of glycaemic control, namely good (GHb 4 - 8 percent), moderate (GHb > 8 - 12 percent) and poor (GHb > 12 percent). Qak, PFC and RPV were compared among diabetics with and without peripheral occlusive arterial disease (POAD) and/or neuropathy of various categories of glycaemic control. Qak in diabetics without peripheral occlusive arterial disease (POAD) with good glycaemic control was significantly higher (p <0.05) than that of non-diabetic (C). Qak differed significantly (p < 0.05) between non-neuropathic diabetics (without POAD) (D) with good and poor or good and moderate glycaemic control. PFC was significantly higher (p < 0.05) in all diabetics with POAD, in D with moderate glycaemic control and in neuropathic diabetes (without POAD) (ND) with poor control than in C. RPV was significantly higher (p < 0.05) in D with moderate control and poorly controlled neuropathic diabetics with POAD than in C. RPV differed significantly (p < 0.05) between D with moderate and poor control. The results suggest that in the absence of POAD, an initial vasodilatation occurs in diabetics. The decrease in arterial flow as metabolic control worsens, may be a consequence of the simultaneous increase in plasma viscosity.(AU)

Doppler assessment of peripheral arterial disease - abstract

Gangrene and sepsis in the feet are the commonest problems met within the general surgical wards of the Queen Elizabeth Hospital. The outcome is a high rate of amputation and prolonged hospital stay; there are about 150 amputations per year of which 60 percent are in diabetic patients. Early and accurate assessment of the peripheral vascular circulation is vital if limbs are to be saved, particularly by surgical intervention. This study looks at the assessment of 130 patients with peripheral vascular disease by Doppler assessment. The pattern of disease has been studied in diabetics (77) and non-diabetics (53). In both groups, distal (tibio-peroneal and popliteal) disease was found in 66 percent of patients; superficial femoral disease was present in 20.25 percent. The only significant difference between diabetics and non-diabetics was the greater percentage of iliac and aorto-iliac disease in the non-diabetics - 30 percent and 50 percent respectively. An analysis of patients with ankle: brachial indices below 0.6, who may benefit from vascular operations, shows that 30-45 percent would require distal (tibio-peroneal) operations and 30-50 percent would require aorto-iliac surgery. Only 12 percent of diabetics and 5 percent of non-diabetics would require femoral-popliteal bypass (AU)

Central retinal artery occlusion without retrobulbar hemorrhage after retrobulbar anaesthesia

Four patients had central retinal artery occlusions after retrobulbar anaesthesia with lidocaine HCl was administered before photocoagulation. One of these four had two separate episodes of closure. Only one had permanent visual loss and none had evidence of retrobulbar hemorrhage. Each patient had a severe hematologic or vascular disorder. We think that direct trauma to the central retinal artery behind the globe, the pharmacologic or compressive effects of the injected solution,or both caused the occlusions in these patients. (AU)

Salmon-patch hemorrhages after central retinal artery occlusion in sickle cell disease

In two patients with sickle cell disease (one hemoglobin SC and one hemoglobin SS), central retinal artery occlusion developed. In one case, the occlusion followed a retrobular injection of lidocaine hydrochloride. Although the central retinal artery reperfused in each patient, many secondary peripheral retinal ateriolar occlusions remained. During the subsequent days, multiple salmon-patch hemorrhages developed in the distribution of these occluded arterioles. In one patient, the salmon-patch hemorrhages evolved into atrophic schisis cavities. These unusual cases allowed us to document the origin of salmon-patch hemorrhages after peripheral retinal arteriolar occlusions. The development of the hemorrhages was a delayed phenomenon that occurred hours to days after the initial vascular occlusion. Reperfusion of the damaged ischemic vessels with a blowout of the walls of the vessels seems the most likely explanation for this phenomenon. (Au)

Sensori-neural hearing loss in Jamaicans with SS disease

The pure-tone hearing levels in 83 Jamaican patients aged from 10-39 with homozygous sickle cell disease were compared with appropriate controls. A sensori-neural hearing loss, defined as a deficit of at least 25 dB in one or more frequencies, was found in 18/83 (22 percent) patients and in 3/83 (4 percent) controls. Both sexes and ears were equally affected, but the extremes of the tested range, especially the high tones, were involved most frequently. The hearing loss was of slow onset. The relative contributions of thrombosis, anaemia, atherosclerosis and Jamaican neuropathy are discussed. It is felt that the most likely aetiology is a thrombotic process. (AU)