Laser Doppler flowmetry evaluation of skin microvascular endothelial function in patients with metabolic syndrome.

BACKGROUND: Metabolic syndrome (MetS) is associated with high cardiovascular morbidity and mortality, and endothelial dysfunction is an early pathogenetic event in the MetS. Lifestyle changes and pharmacological intervention might partly restore endothelial function in MetS. Whereas an optimal non-invasive test for endothelial dysfunction is still being sought, the aim of this study was to assess the relationship between changes in skin microvascular endothelial function, detected by Laser Doppler flowmetry, and cardiovascular risk factors (CVRFs) of patients with MetS. DESIGN AND METHODS: 3081 patients (1865 women and 1216 men, mean age 53 ± 6 years) with MetS were enrolled in the study, which was conducted during the period of 2010-2014 at Vilnius University Hospital Santaros Klinikos. Skin microvascular endothelial function was evaluated using the Laser Doppler flowmetry in combination with the post-occlusive reactive hyperaemia test. The percentage change of flow from peak to the rest flow (PF-RF) was calculated and used as the main measure of endothelial function. RESULTS: The study showed that decrease in flow-mediated dilatation reflected by PF-RF was associated with increased triglycerides (p = 0.002), male sex (p < 0.001), and diabetes (p = 0.002). Patients with quite a few CVRFs (body mass index ≥25 kg/m2, smoking, diabetes, arterial hypertension, a positive history of dyslipidaemia) had significantly lower PF-RF score than patients only with one of these risk factors (p < 0.001). CONCLUSIONS: Changes in skin microvascular endothelial function are significantly associated with most CVRFs and depend on the number of CVRFs.

Hypertriglyceridemia impact on arterial parameters in patients with metabolic syndrome.

BACKGROUND: The development of metabolic syndrome (MS) augments risk for atherosclerotic cardiovascular disease (CVD), but pathophysiological mechanisms of this relation are still under discussion. Overlapping CVD risk factors make it difficult to assess the importance of individual elements. This study aimed to analyze subclinical atherosclerosis based on arterial structure and function parameters in patients with MS and different triglycerides levels. METHODS: Patients (aged 40-65 years) were divided into two groups: patients with MS and with or without hypertriglyceridemia (hTG). Noninvasive assessment of vascular parameters-aortic augmentation index adjusted for heart rate 75 bpm (AIxHR75), pulse wave velocity (PWV), and common carotid artery intima-media thickness (cIMT) were performed. RESULTS: Carotid-femoral PWV (cfPWV) and carotid-radial PWV (crPWV) were significantly higher in patients with hTG. After adjusting for age, gender, waist circumference, fasting glucose, smoking status, cardiovascular family history and mean arterial pressure, crPWV (OR 1.150; CI 95% 1.04-1.28), cfPWV (OR 1.283; CI 95% 1.14-1.42) and cIMT (OR 1.13; CI 95% 1.02-1.25) were significantly associated with hTG (p < 0.05), while AIxHR75 did not show significant association. CONCLUSION: Increased triglycerides are independently associated with a cfPWV, crPWV, and cIMT and may modify CVD risk in patients with MS.

Mir-1, miR-122, miR-132, and miR-133 Are Related to Subclinical Aortic Atherosclerosis Associated with Metabolic Syndrome.

Previously, miR-1, miR-122, miR-126, miR-132, miR-133, and miR-370 were found to be related to coronary artery disease (CAD) progression. However, their relationship with subclinical atherosclerosis, especially in subjects with metabolic syndrome, is unknown. Therefore, our aim was to determine their relationship with arterial markers of subclinical atherosclerosis. Metabolic syndrome subjects (n = 182) with high cardiovascular risk but without overt cardiovascular disease (CVD) were recruited from the Lithuanian High Cardiovascular Risk (LitHiR) primary prevention program. The ardio-ankle vascular index (CAVI), augmentation index normalized to a heart rate of 75 bpm (AIxHR75), aortic pulse wave velocity (AoPWV), and carotid artery stiffness were assessed. MicroRNAs (miRs) were analyzed in serum. Pearson correlation and a univariate linear regression t-test showed that miR-1, miR-133b, and miR-133a were negatively associated with CAVI mean, whereas miR-122 was positively associated. MiR-1, miR-133b and miR-133a, and miR-145 were negatively associated with AIxHR75. MiR-122 correlated negatively with AoPWV. In multivariate linear regression models, miR-133b and miR-122 predicted CAVImean, miR-133 predicted AIxHR75, and miR-122 predicted AoPWV. MiR-132 predicted right carotid artery stiffness, and miR-1 predicted left carotid artery stiffness. The addition of smoking to miR-133b and miR-122 enhanced the prediction of CAVI. Age and triglycerides enhanced the prediction of AoPWV by miR-122. A cluster of four miRs are related to subclinical atherosclerosis in subjects with metabolic syndrome. Combined, they may have a more substantial diagnostic or prognostic value than any single miR. Future follow-up studies are needed to establish their clinical relevance.

Trends in cardiovascular risk factor prevalence among Lithuanian middle-aged adults between 2009 and 2018.

BACKGROUND AND AIMS: The aim of the study was to estimate trends and differences in cardiovascular disease (CVD) risk factor prevalence among middle-aged men and women based on the data from the Lithuanian High Cardiovascular Risk (LitHiR) primary prevention program between 2009 and 2018. METHODS: A community-based cross-sectional study included men aged 40-54 years and women aged 50-64 years without overt CVD. Nationally representative data comprised 110,370 Lithuanian adults (42.4% men and 57.6% women) examined in the period 2009-2018. Prevalences of major CVD risk factors, such as dyslipidaemia, arterial hypertension, diabetes mellitus, obesity, metabolic syndrome and smoking, were assessed. RESULTS: The study showed a significant drop in the prevalence of dyslipidaemia and TC levels among men (p = 0.030 and p < 0.001) and no significant change among women (p = 0.594 and p = 0.799). The prevalence of AH significantly decreased in both gender groups (p < 0.001 in women and p < 0.001 in men). Obesity rates declined among women while it remained constant among men (p < 0.001 and p = 0.100 respectively). There was a significant decline among women and a significant increase among men in the prevalence of metabolic syndrome (p < 0.001 and p = 0.016 respectively). The prevalence of diabetes increased until 2013, after which it started decreasing in the whole group (p = 0.005). The study showed a significant increase in the percentage of smoking women (p < 0.001), although the number of smoking men remained much higher (about 40%) (p < 0.001). CONCLUSIONS: In our observational study, we have documented a high prevalence of all CVD risk factors in 2009 with a slight decrease during the period in most prevalence rates, except in dyslipidaemia and smoking levels.

The relationship between the metabolic syndrome and arterial wall thickness: A mosaic still to be interpreted.

BACKGROUND AND AIMS: We aimed to identify clusters of metabolic syndrome (MetS) components, risky for extremely high intima-media thickness. METHODS: We studied 41,513 volunteers (men and women) from eleven cohorts worldwide, participating in the MARE (Metabolic syndrome and Artery REsearch) Consortium. RESULTS: Specific clusters of MetS components - high triglycerides-high blood pressure-abdominal obesity (TBW), low HDL cholesterol-high blood pressure-abdominal obesity (HBW), high glucose-high blood pressure-abdominal obesity (GBW) - were accompanied by a 50-90% significantly greater likelihood of presenting extremely high intima-media thickness (via ultrasound of carotid artery, CCA IMT), after controlling for age, sex, smoking, non-HDL cholesterol, and presence of diabetes mellitus. This likelihood is comparable to the effect of being 7-8 years older or of being a cigarette smoker or of having non-HDL cholesterol 50 mg/dl higher. CONCLUSIONS: The consistent association of specific clusters of MetS components with extremely thick (older) large artery cross-culturally suggests that identification of those clusters in clinical practice will facilitate a personalized health care and a better - i.e. more healthy and cost-effective - prevention of major cardiovascular (CV) events.

Prevalence of cardiovascular risk factors in Lithuanian middle-aged subjects participating in the primary prevention program, analysis of the period 2009-2012.

BACKGROUND: The aim of this study was to assess the prevalence and changes of cardiovascular risk factors in the middle-aged Lithuanian subjects after conducting the primary prevention program. DESIGN AND METHODS: Four cross-sectional investigations of cardiovascular risk factors were conducted in 2009 (n = 9625), 2010 (n = 7716), 2011 (n = 5018) and 2012 (n = 4348). The program recruited men aged 40-54 and women aged 50-64 without overt cardiovascular disease. RESULTS: During the period 2009-2012, the mean number of risk factors significantly increased (from 3.95 to 4.03, p < 0.001), while the numbers of people having metabolic syndrome (from 34.1% to 28.7%; p < 0.001), arterial hypertension (from 60.2% to 54.5%; p < 0.001), the average body mass index (BMI) value (from 29.17 to 28.92 kg/m(2); p = 0.001) and abdominal obesity (from 48.4% to 45.3%; p < 0.001) significantly decreased. The percentage of subjects with dyslipidemia, as well as the average values of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and triglycerides, remained unchanged. The percentage of smoking subjects have significantly increased (from 19.3% to 22.7%; p < 0.001). CONCLUSIONS: The analysis showed that the prevalence of arterial hypertension, metabolic syndrome and obesity in Lithuania is slowly decreasing while conducting the primary prevention program; however, dyslipidemia, diabetes mellitus and smoking are still hard to manage for both genders.

Arterial stiffness and influences of the metabolic syndrome: a cross-countries study.

Specific clusters of metabolic syndrome (MetS) components impact differentially on arterial stiffness, indexed as pulse wave velocity (PWV). Of note, in several population-based studies participating in the MARE (Metabolic syndrome and Arteries REsearch) Consortium the occurrence of specific clusters of MetS differed markedly across Europe and the US. The aim of the present study was to investigate whether specific clusters of MetS are consistently associated with stiffer arteries in different populations. We studied 20,570 subjects from 9 cohorts representing 8 different European countries and the US participating in the MARE Consortium. MetS was defined in accordance with NCEP ATPIII criteria as the simultaneous alteration in ≥3 of the 5 components: abdominal obesity (W), high triglycerides (T), low HDL cholesterol (H), elevated blood pressure (B), and elevated fasting glucose (G). PWV measured in each cohort was "normalized" to account for different acquisition methods. MetS had an overall prevalence of 24.2% (4985 subjects). MetS accelerated the age-associated increase in PWV levels at any age, and similarly in men and women. MetS clusters TBW, GBW, and GTBW are consistently associated with significantly stiffer arteries to an extent similar or greater than observed in subjects with alteration in all the five MetS components--even after controlling for age, sex, smoking, cholesterol levels, and diabetes mellitus--in all the MARE cohorts. In conclusion, different component clusters of MetS showed varying associations with arterial stiffness (PWV).

[Relationship of arterial wall parameters to cardiovascular risk factors and cardiovascular risk assessed by SCORE system]. / Arteriju sieneles rodikliu rysys su sirdies ir kraujagysliu ligu rizikos veiksniais bei sirdies ir kraujagysliu ligu rizika remiantis SCORE vertinimo sistema.

OBJECTIVE: To investigate the relationship of arterial wall parameters (flow-mediated dilatation of the brachial artery, augmentation index, pulse wave velocity, stiffness index, carotid intima-media thickness) to conventional cardiovascular risk factors and cardiovascular risk assessed by SCORE system. MATERIAL AND METHODS: A total of 209 subjects aged 40-65 years without clinically overt cardiovascular disease were examined. Parameters of arterial stiffness were obtained by two methods: augmentation index and carotid-radial pulse wave velocity by applanation tonometry and stiffness index by the means of finger photoplethysmography. Flow-mediated dilatation of the brachial artery, reflecting endothelial function, and carotid intima-media thickness was determined using a high-resolution B-mode ultrasonography. RESULTS: Age and the presence of diabetes strongly influenced all parameters of the arterial wall (diabetes was not independent predictor when evaluating augmentation index). Mean arterial pressure and gender were independent predictors for arterial stiffness parameters--carotid-radial pulse wave velocity and augmentation index. Flow-mediated dilatation was strongly dependent on the diameter of the brachial artery, age, and body mass index. Using logistic regression, it was found that pulse wave velocity (P=0.014), intima-media thickness (P=0.004), and flow-mediated dilatation (P=0.020) were important parameters dividing subjects to the groups of increased (> or =5%) and low (<5%) cardiovascular risk assessed by SCORE system. The cutoff values for intima-media thickness and pulse wave velocity were 0.078 cm and 8.95 m/s, respectively. CONCLUSIONS: Arterial wall parameters are closely associated with conventional risk factors; they are influenced by age and the presence of diabetes. Arterial stiffness parameters are also influenced by mean arterial pressure; high-density lipoprotein cholesterol has influence on carotid intima-media thickness. Cutoff values for carotid intima-media thickness and carotid-radial pulse wave velocity could help to discriminate patients with increased cardiovascular risk.

Non-invasive assessment of arterial stiffness indices by applanation tonometry and pulse wave analysis in patients with rheumatoid arthritis treated with TNF-alpha blocker remicade (infliximab).

Rheumatoid arthritis (RA) is accompanied by long lasting inflammation, which may lead to arterial dysfunction and premature aging of the arteries. The purpose of this clinical work was to determine the modification of carotid-radial pulse wave velocity (PWV) and aortic augmentation index (AIx) in young-aged RA patients and the influence of treatment with anti-TNF-alpha (infliximab) on these measures. We examined 68 RA patients (mean age 40.68 yrs) with moderate or high disease activity (DAS28 5.37 +/- 0.94) and 87 controls (mean age 38.10 yrs). PWV and AIx were assessed non-invasively by applanation tonometry. A blood test included serum lipid profile, and high-sensitivity CRP measurements. We found that in RA patients, AIx (p < 0.001) was significantly higher while PWV (p = 0.315) did not differ as compared to control. Multiple regression analysis revealed the presence of RA is an independent predictor for AIx (R2 = 0.718, adjusted R2 = 0.707; p < 0.001). Analysis (Mann-Whitney test) in 15 RA patients revealed lowering of PWV (p = 0.004) under infliximab therapy with no change in AIx (p = 0.573), suggesting the improvement of arterial wall function by anti-TNF-alpha therapy. We conclude that increased AIx is more prominent in RA patients as compared to the controls. PWV appears to be a less sensitive marker for the detection of enhanced development of arterial stiffness in relatively young-aged RA patients. However, PWV may serve as a good marker to discern effects of infliximab on artery elasticity.