The predictive value of estimated pulse wave velocity (ePWV) combined with BMI for newly diagnosed diabetes.

PURPOSE: Estimated pulse wave velocity (ePWV) and body mass index (BMI) are significant predictors of new-onset diabetes. This study aims to evaluate the impact and predictive value of combining ePWV and BMI on the incidence of new-onset diabetes. METHODS: A secondary analysis was conducted on a cohort study by Rich Healthcare (China), involving 211,833 eligible participants. Logistic regression analysis identified factors influencing diabetes occurrence, while ROC curve analysis assessed the predictive value of ePWV, BMI, and their combination for new-onset diabetes. RESULTS: Over a mean follow-up period of 3.12 years, 3,000 men (1.41%) and 1,174 women (0.55%) were diagnosed with diabetes. Logistic regression revealed that BMI, triglycerides, alanine aminotransferase, blood urea nitrogen, creatinine clearance rate, ePWV, and family history of diabetes are high-risk factors for new-onset diabetes. The combination of ePWV and BMI provided a higher area under the ROC curve (0.822) compared to ePWV or BMI alone. CONCLUSION: Elevated levels of ePWV and BMI are independent risk factors for new-onset diabetes. Combining these measures enhances predictive accuracy compared to using either indicator alone.

Maior Rigidez Arterial Prediz Doença Renal Crônica no Estudo de Coorte ELSA-Brasil / Higher Arterial Stiffness Predicts Chronic Kidney Disease in Adults: The ELSA-Brasil Cohort Study

Resumo Fundamento A rigidez arterial pode afetar diretamente os rins, que são perfundidos passivamente por alto fluxo. No entanto, determinar se a relação entre rigidez arterial e função renal depende das condições de diabetes e hipertensão é uma questão controversa. Objetivo Investigar a relação entre a rigidez arterial, por velocidade da onda de pulso carotídea-femoral (VOPcf), e a incidência de doença renal crônica (DRC) em indivíduos e verificar se essa associação está presente em indivíduos sem hipertensão e diabetes. Métodos Estudo longitudinal com 11.647 participantes do ELSA-Brasil acompanhados por quatro anos (2008/10-2012/14). A VOPcf basal foi agrupada por quartil, de acordo com pontos de corte específicos com relação a sexo. A presença de DRC foi verificada pela taxa de filtração glomerular (TFGe-CKD-EPI) < 60 ml/min/1,73 m2 e/ou relação albumina/creatinina ≥ 30 mg/g. Modelos de regressão logística foram executados para toda a coorte e uma subamostra livre de hipertensão e diabetes no início do estudo, após ajuste para idade, sexo, raça, escolaridade, tabagismo, relação colesterol/HDL, índice de massa corporal, diabetes, uso de anti-hipertensivos, pressão arterial sistólica, frequência cardíaca e doenças cardiovasculares. A significância estatística foi fixada em 5%. Resultados A chance de DRC foi de 42% (IC de 95%: 1,05;1,92) maior entre indivíduos no quartil superior da VOPcf. Entre os participantes normotensos e não diabéticos, os indivíduos do 2º, 3º e 4º quartis da VOPcf apresentaram maiores chances de desenvolver DRC, quando comparados aos do quartil inferior, sendo a magnitude dessa associação maior para aqueles do quartil superior (OR: 1,81 IC de 95%: 1,14;2,86). Conclusão A maior VOPcf aumentou as chances de DRC, e sugere que esse efeito é ainda maior em indivíduos sem diabetes e hipertensão.

Abstract Background Arterial stiffening can directly affect the kidneys, which are passively perfused by a high flow. However, whether the relation between arterial stiffness and renal function depends on diabetes and hypertension conditions, is a matter of debate. Objective To investigate the relationship between arterial stiffening by carotid-to-femoral pulse wave velocity (cfPWV) and chronic kidney disease (CKD) incidence in individuals and verify whether this association is present in individuals without hypertension and diabetes. Methods A longitudinal study of 11,647 participants of the ELSA-Brasil followed up for four years (2008/10-2012/14). Baseline cfPWV was grouped per quartile, according to sex-specific cut-offs. Presence of CKD was ascertained by glomerular filtration rate (eGFR-CKD-EPI) < 60 ml/min/1.73 m2 and/or albumin-to-creatinine ratio ≥ 30 mg/g. Logistic regression models were run for the whole cohort and a subsample free from hypertension and diabetes at baseline, after adjustment for age, sex, race, schooling, smoking, cholesterol/HDL ratio, body mass index, diabetes, use of antihypertensive, systolic blood pressure, heart rate, and cardiovascular disease. Statistical significance was set at 5%. Results The chance of CKD was 42% (CI 95%: 1.05;1.92) greater among individuals in the upper quartile of cfPWV. Among normotensive, non-diabetic participants, individuals in the 2nd, 3rd, and 4th quartiles of cfPWV presented greater chances of developing CKD, as compared to those in the lower quartile, and the magnitude of this association was the greatest for those in the upper quartile (OR: 1.81 CI 95%: 1.14;2.86). Conclusion Higher cfPWV increased the chances of CKD and suggests that this effect is even greater in individuals without diabetes and hypertension.

Value of estimating pulse wave velocity compared to SCORE in cardiovascular risk stratification in community pharmacies / Valor de la estimación de la velocidad de onda de pulso en comparación con SCORE en la estratificación del riesgo cardiovascular en farmacias comunitarias

Objectives Arterial stiffness is considered to be an intermediate marker with independent prognostic value. The objective of this study is to assess whether the estimation of arterial stiffness can improve CV risk stratification compared to SCORE in patients at community pharmacies. Methods Observational prospective epidemiological study in which consecutive individuals entering a participating Community Pharmacy are offered a voluntary measurement of blood pressure and estimation of pulse wave velocity by oscillometry (AGEDIO, IEM®) to stratify their CV risk according to SCORE compared to the use of arterial stiffness. Results After nine months of recruitment, data from 923 patients (570 women, 353 men) were collected. 16/122 (13.1%) patients under 40 years and 72/364 (19.8%) over 65 years of age presented pathological stiffness and could be classified as high-risk, even though being out of the age-range of SCORE. Of the 437 (47.3%) patients who were susceptible to calculating SCORE, 42/437 patients (9.6%) presented pathological arterial stiffness. Cholesterol values were available in 281 patients (64.3%). Among them, according to SCORE, only 6 (2.1%) fell into the high-risk category. Conclusions More than half of the subjects who randomly enter a community pharmacy had ages that make it impossible to calculate the CV risk by SCORE. Among them, arterial damage was detected in 18.1%. Of the other half, 9.6% presented arterial damage and, therefore, high CV risk, when SCORE only detected it in 2.1%. Therefore, estimating arterial stiffness in community pharmacies markedly improves detection of high CV risk compared to SCORE (AU)

Objetivos La rigidez arterial es un marcador intermedio con valor pronóstico independiente. Nuestro objetivo es valorar si la estimación de la rigidez arterial puede mejorar la estratificación del riesgo cardiovascular (CV) en comparación con SCORE. Métodos Estudio epidemiológico observacional prospectivo en el que se ofrece a pacientes consecutivos que entran en una farmacia participante la medición voluntaria de la presión arterial y de la velocidad de onda de pulso estimada por oscilometría (AGEDIO, IEM®) para estratificar su riesgo CV según SCORE o según la presencia de rigidez arterial. Resultados Tras 9 meses de reclutamiento, presentamos datos de 923 pacientes (570 mujeres, 353 hombres). Dieciséis/122 (13,1%) pacientes <40años y 72/364 (19,8%) >65años presentaron rigidez arterial patológica y fueron clasificados de alto riesgo, aun hallándose fuera del rango de edad de SCORE. De los 437 (47,3%) pacientes evaluables por SCORE, 42/437 pacientes (9,6%) mostraron rigidez elevada. Los valores de colesterol estaban disponibles en 281 de estos pacientes (64,3%). Entre ellos, según SCORE, solo 6 (2,1%) eran de la categoría de alto riesgo. Conclusiones Más de la mitad de sujetos que entran aleatoriamente en una farmacia comunitaria tenían edades situadas fuera de los rangos de SCORE, imposibilitando el cálculo del riesgo CV con SCORE. En este grupo se constató daño arterial en el 18,1%. En la otra mitad, el 9,6% presentaron daño vascular y, consecuentemente, riesgo elevado, mientras que SCORE solo detectó riesgo elevado en el 2,1%. Por tanto, la estimación de la rigidez arterial en farmacias comunitarias mejora claramente la detección de riesgo CV elevado en comparación con SCORE (AU)

Asociación de preeclampsia grave y daño vascular valorado por marcadores no invasivos de rigidez arterial / Association of severe preeclampsia and vascular damage assessed by noninvasive markers of arterial stiffness

Antecedentes La preeclampsia (PE) es un trastorno hipertensivo del embarazo asociado a una elevada morbimortalidad materna y fetal, y un mayor riesgo futuro de complicaciones cardiovasculares. Objetivo Analizar si las mujeres que han tenido PE grave en su embarazo presentan parámetros de rigidez arterial (RA) superiores a las de aquellas cuya PE cursó sin signos de gravedad. Métodos Se evaluaron 65 mujeres que habían desarrollado PE durante su gestación, divididas en 2 grupos: grupo de PE sin criterios de gravedad o PE no grave (n=30) y grupo de PE con criterios de gravedad o PE grave (n=35). Se determinó la velocidad de onda de pulso carótida-femoral (VOPcf), el índice de aumento central normalizado a 75 latidos por minuto (IAc75) y presión de aumento central (PAc) al mes y a los 6 meses posparto. La comparación de proporciones se llevó a cabo mediante la prueba de Chi-cuadrado, la comparación de medias entre grupos se utilizaron la prueba t de Student o la prueba de Mann-Whitney, y la comparación de medias de un mismo grupo en momentos evolutivos diferentes, la prueba t para o el test de Wilcoxon. La correlación, con y entre parámetros hemodinámicos, se llevó a cabo con el coeficiente de correlación de Spearman y la asociación entre variables demográficas, antecedentes personales y parámetros hemodinámicos, y valores alterados de RA se llevó a cabo mediante modelos de regresión lineal y logística. Resultados Las mujeres con PE grave presentaban, al mes y a los 6 meses posparto, valores de presión arterial, tanto central como periférica, así como parámetros de RA y amplificación de pulso, superiores a aquellas mujeres cuya PE no revistió gravedad. Los valores del índice de aumento central (IAc) al mes y a los 6 meses posparto fueron superiores, aunque no de forma significativa, en el grupo de PE grave respecto al grupo de PE no grave (24,0 [16,5-34,3] vs. 19,0% [14-29] y 24,0 [14,0-30,0] vs. 20,0% [12,3-26,8], respectivamente)(AU)

Background Preeclampsia (PE) is a hypertensive disorder of pregnancy associated with high maternal and fetal morbidity and mortality and increased future risk of cardiovascular complications. Objective To analyze whether women who have had PE with severe features in their pregnancy have higher arterial stiffness (AS) parameters than those whose PE course was without signs of severity. Methods Sixty-five women who developed PE during their gestation were evaluated, divided into two groups: PE group without severe features or non-severe PE (n=30) and PE group with severe features or severe PE (n=35). Carotid-femoral pulse wave velocity (cfPWV), central augmentation index corrected to a heart rate of 75 beats per minute (AIxc75) and central augmentation pressure (cAP) were determined one month and six months postpartum. Comparison of proportions was carried out using the chi-square test, comparison of means between groups using the Student's t-test or the Mann-Whitney test, and comparison of means of the same group at different evolutionary moments, using the t-test or the Wilcoxon test. Correlation, with and between hemodynamic parameters, was carried out with Spearman's correlation coefficient and the association between demographic variables, personal history and hemodynamic parameters, and altered arterial stiffness parameters was carried out using linear and logistic regression models. Results Women with severe PE presented, both at 1 and 6 months postpartum, higher values of blood pressure, both central and peripheral, as well as AR and pulse amplification parameters, than those women whose PE was not severe. Central augmentation index (cAIx) values at 1 month and 6 months postpartum were higher, although not significantly, in the severe PE group compared to the non-severe PE group (24.0 (16.5-34.3) vs. 19.0% (14-29) and 24.0 (14.0-30.0) vs. 20.0% (12.3-26.8), respectively) (AU)

Effect of low-sodium salt applied to Chinese modified DASH diet on arterial stiffness in older patients with hypertension and type 2 diabetes / Efecto de una sal baja en sodio aplicada a la dieta china DASH modificada sobre la rigidez arterial en pacientes mayores con hipertensión y diabetes tipo 2

Background and purpose: the Dietary Approaches to Stop Hypertension (DASH) diet has multifunctional health benefits. We evaluated theeffects of low-sodium salt applied to Chinese modified DASH diet on arterial stiffness in older patients with hypertension and type 2 diabetes.Methods: sixty-one older adults with hypertension and type 2 diabetes were randomly allocated to low sodium salt group (n = 31) or normalsodium salt group (n = 30). They were given the Chinese modified DASH diet plus low-sodium salt (52 % sodium chloride) or same diet plusregular salt (99 % sodium chloride) for eight weeks, respectively. Brachial and ankle pulse wave conduction velocity, ankle brachial index andatherosclerosis-related indices were measured at baseline and week 8. In addition, 24-hour urine and blood samples were measured at baseline,the 4th week and the end of the intervention.Results: as compared with the baseline, the low sodium salt group significantly decreased in ankle brachial index (-0.09 ± 0.11, p < 0.001)and brachial and ankle pulse wave conduction velocity (-133.07 ± 265.99 cm/s, p = 0.010) at week 8 while the normal sodium salt group onlydecreased significantly in ankle brachial index (-0.06 ± 0.12, p = 0.010) at week 8.Conclusion: the low-sodium salt applied to Chinese modified DASH diet may improve arterial stiffness in patients with hypertension and type 2diabetes. Further research with an extended follow-up is needed. (AU)

Antecedentes y propósito: la dieta DASH (del inglés Dietary Approaches to Stop Hypertension) tiene beneficios multifuncionales para la salud.Evaluamos los efectos de una sal baja en sodio aplicada a la versión modificada china de la dieta DASH sobre la rigidez arterial en pacientesmayores con hipertensión y diabetes tipo 2.Métodos: sesenta y un adultos mayores con hipertensión arterial y diabetes tipo 2 fueron asignados al azar al grupo de sal baja en sodio (n= 31) o al grupo de sal con contenido normal de sodio (n = 30). Se les administró la versión china modificada de la dieta DASH más sal bajaen sodio (52 % de cloruro de sodio) o la misma dieta más sal con la cantidad normal de sodio (99 % cloruro de sodio) durante ocho semanas,respectivamente. Se midieron la velocidad de onda de pulso brazo-tobillo, el índice brazo-tobillo y los índices relacionados con la aterosclerosis alinicio del estudio y a la semana 8. Se recogieron muestras de orina y sangre de 24 horas al inicio, a la cuarta semana y al final de la intervención.Resultados: en comparación con el estado inicial, el grupo de sal baja en sodio disminuyó significativamente el índice brazo-tobillo (-0,09 ±0,11, p < 0,001) y la velocidad de onda de pulso brazo-tobillo (-133,07 ± 265,99 cm/s, p = 0,010) en la semana 8, mientras que el grupode sal con contenido normal de sodio solo disminuyó significativamente en el índice brazo-tobillo (-0,06 ± 0,12, p = 0,010) en la semana 8.Conclusión: la sal baja en sodio aplicada a la versión china modificada de la dieta DASH puede mejorar la rigidez arterial en pacientes conhipertensión y diabetes tipo 2. Se necesitan más investigaciones con un seguimiento prolongado. (AU)

Value of estimating pulse wave velocity compared to SCORE in cardiovascular risk stratification in community pharmacies.

OBJECTIVES: Arterial stiffness is considered to be an intermediate marker with independent prognostic value. The objective of this study is to assess whether the estimation of arterial stiffness can improve CV risk stratification compared to SCORE in patients at community pharmacies. METHODS: Observational prospective epidemiological study in which consecutive individuals entering a participating Community Pharmacy are offered a voluntary measurement of blood pressure and estimation of pulse wave velocity by oscillometry (AGEDIO, IEM®) to stratify their CV risk according to SCORE compared to the use of arterial stiffness. RESULTS: After nine months of recruitment, data from 923 patients (570 women, 353 men) were collected. 16/122 (13.1%) patients under 40 years and 72/364 (19.8%) over 65 years of age presented pathological stiffness and could be classified as high-risk, even though being out of the age-range of SCORE. Of the 437 (47.3%) patients who were susceptible to calculating SCORE, 42/437 patients (9.6%) presented pathological arterial stiffness. Cholesterol values were available in 281 patients (64.3%). Among them, according to SCORE, only 6 (2.1%) fell into the high-risk category. CONCLUSIONS: More than half of the subjects who randomly enter a community pharmacy had ages that make it impossible to calculate the CV risk by SCORE. Among them, arterial damage was detected in 18.1%. Of the other half, 9.6% presented arterial damage and, therefore, high CV risk, when SCORE only detected it in 2.1%. Therefore, estimating arterial stiffness in community pharmacies markedly improves detection of high CV risk compared to SCORE.

Effect of low-sodium salt applied to Chinese modified DASH diet on arterial stiffness in older patients with hypertension and type 2 diabetes.

Introduction: Background and purpose: the Dietary Approaches to Stop Hypertension (DASH) diet has multifunctional health benefits. We evaluated the effects of low-sodium salt applied to Chinese modified DASH diet on arterial stiffness in older patients with hypertension and type 2 diabetes. Methods: sixty-one older adults with hypertension and type 2 diabetes were randomly allocated to low sodium salt group (n = 31) or normal sodium salt group (n = 30). They were given the Chinese modified DASH diet plus low-sodium salt (52 % sodium chloride) or same diet plus regular salt (99 % sodium chloride) for eight weeks, respectively. Brachial and ankle pulse wave conduction velocity, ankle brachial index and atherosclerosis-related indices were measured at baseline and week 8. In addition, 24-hour urine and blood samples were measured at baseline, the 4th week and the end of the intervention. Results: as compared with the baseline, the low sodium salt group significantly decreased in ankle brachial index (-0.09 ± 0.11, p < 0.001) and brachial and ankle pulse wave conduction velocity (-133.07 ± 265.99 cm/s, p = 0.010) at week 8 while the normal sodium salt group only decreased significantly in ankle brachial index (-0.06 ± 0.12, p = 0.010) at week 8. Conclusion: the low-sodium salt applied to Chinese modified DASH diet may improve arterial stiffness in patients with hypertension and type 2 diabetes. Further research with an extended follow-up is needed.

Introducción: Antecedentes y propósito: la dieta DASH (del inglés Dietary Approaches to Stop Hypertension) tiene beneficios multifuncionales para la salud. Evaluamos los efectos de una sal baja en sodio aplicada a la versión modificada china de la dieta DASH sobre la rigidez arterial en pacientes mayores con hipertensión y diabetes tipo 2. Métodos: sesenta y un adultos mayores con hipertensión arterial y diabetes tipo 2 fueron asignados al azar al grupo de sal baja en sodio (n = 31) o al grupo de sal con contenido normal de sodio (n = 30). Se les administró la versión china modificada de la dieta DASH más sal baja en sodio (52 % de cloruro de sodio) o la misma dieta más sal con la cantidad normal de sodio (99 % cloruro de sodio) durante ocho semanas, respectivamente. Se midieron la velocidad de onda de pulso brazo-tobillo, el índice brazo-tobillo y los índices relacionados con la aterosclerosis al inicio del estudio y a la semana 8. Se recogieron muestras de orina y sangre de 24 horas al inicio, a la cuarta semana y al final de la intervención. Resultados: en comparación con el estado inicial, el grupo de sal baja en sodio disminuyó significativamente el índice brazo-tobillo (-0,09 ± 0,11, p < 0,001) y la velocidad de onda de pulso brazo-tobillo (-133,07 ± 265,99 cm/s, p = 0,010) en la semana 8, mientras que el grupo de sal con contenido normal de sodio solo disminuyó significativamente en el índice brazo-tobillo (-0,06 ± 0,12, p = 0,010) en la semana 8. Conclusión: la sal baja en sodio aplicada a la versión china modificada de la dieta DASH puede mejorar la rigidez arterial en pacientes con hipertensión y diabetes tipo 2. Se necesitan más investigaciones con un seguimiento prolongado.

Utilidad pronóstica de la presión de pulso en pacientes con insuficiencia cardiaca con fracción de eyección preservada: Registro RICA / Prognostic utility of pulse pressure in patients with heart failure with preserved ejection fraction: The RICA Registry

Background and aims The prognostic role of pulse pressure (PP) in heart failure (HF) patients with preserved left ventricular ejection fraction (LVEF) is not well understood. Our aim was to evaluate it in acute and stable HF. Material and methods This work is a retrospective observational study of patients included in the RICA registry between 2008 and 2021. Blood pressure was collected on admission (decompensation) and 3 months later on an outpatient basis (stability). Patients were categorized according to whether the PP was greater or less than 50mmHg. All-cause mortality was assessed at 1year after admission. Results A total of 2291 patients were included, with mean age 80.1±7.7 years. 62.9% were women and 16.7% had a history of coronary heart disease. In the acute phase, there was no difference in mortality according to PP values, but in the stable phase PP<50mmHg was independently associated with all-cause mortality at 1-year follow-up (HR 1.57, 95% CI 1.21−2.05, p=0.001), after adjusting for age, sex, New York Heart Association functional class, previous HF, chronic kidney disease, valvular heart disease, cerebrovascular disease, score on the Barthel and Pfeiffer scales, hemoglobin and sodium levels. Conclusion Low stable-phase PP was associated with increased all-cause mortality in HF patients with preserved LVEF. However, PP was not useful as a prognostic marker of mortality in acute HF. Further studies are needed to assess the relationship of this variable with mortality in HF patients (AU)

Antecedentes y objetivo El papel pronóstico de la presión de pulso (PP) en pacientes con insuficiencia cardiaca (IC) con fracción de eyección de ventrículo izquierdo (FEVI) preservada no es bien conocido. Nuestro objetivo fue evaluarlo en fases de descompensación y de estabilidad. Material y métodos Estudio observacional retrospectivo de pacientes incluidos en registro RICA entre 2008 y 2021. La presión arterial se recogió al ingreso (descompensación) y a los 3 meses (estabilidad). Se calculó la PP y los pacientes se categorizaron según PP mayor/igual vs menor de 50mmHg. Se evaluó la mortalidad por todas las causas al año del ingreso. Resultados Se incluyeron 2.291 pacientes, con edad media 80,1±7,7 años. El 62,9% eran mujeres y un 16,7% tenían antecedentes de cardiopatía isquémica. En fase aguda, no hubo diferencias en la mortalidad según los valores de PP, pero en fase estable una PP<50mmHg se asoció de forma independiente con mortalidad por todas las causas al año de seguimiento (HR 1,57, IC 95% 1,21-2,05; p=0,001), una vez controlado por edad, sexo, NYHA, IC previa, enfermedad renal crónica, valvulopatía, enfermedad cerebrovascular, Barthel, Pfeiffer, hemoglobina y sodio. Conclusione Una PP baja en fase estable se asoció con mayor mortalidad por todas las causas en pacientes con IC con FEVI preservada. Sin embargo, la PP no demostró ser un factor pronóstico en fase de descompensación. Se necesitan más estudios que valoren la relación de esta variable con la mortalidad en los pacientes con IC (AU)

Prognostic utility of pulse pressure in patients with heart failure with preserved ejection fraction: The RICA Registry.

BACKGROUND AND AIMS: The prognostic role of pulse pressure (PP) in heart failure (HF) patients with preserved left ventricular ejection fraction (LVEF) is not well understood. Our aim was to evaluate it in acute and stable HF. MATERIAL AND METHODS: This work is a retrospective observational study of patients included in the RICA registry between 2008 and 2021. Blood pressure was collected on admission (decompensation) and 3 months later on an outpatient basis (stability). Patients were categorized according to whether the PP was greater or less than 50mmHg. All-cause mortality was assessed at 1year after admission. RESULTS: A total of 2291 patients were included, with mean age 80.1±7.7 years. 62.9% were women and 16.7% had a history of coronary heart disease. In the acute phase, there was no difference in mortality according to PP values, but in the stable phase PP<50mmHg was independently associated with all-cause mortality at 1-year follow-up (HR 1.57, 95% CI 1.21-2.05, p=0.001), after adjusting for age, sex, New York Heart Association functional class, previous HF, chronic kidney disease, valvular heart disease, cerebrovascular disease, score on the Barthel and Pfeiffer scales, hemoglobin and sodium levels. CONCLUSIONS: Low stable-phase PP was associated with increased all-cause mortality in HF patients with preserved LVEF. However, PP was not useful as a prognostic marker of mortality in acute HF. Further studies are needed to assess the relationship of this variable with mortality in HF patients.

Asociación entre rigidez arterial y masa grasa en pacientes con obesidad / Association between arterial stiffness and fat mass in patients with obesity

Objetivo Comprobar si la composición corporal en los pacientes con obesidad de riesgo alto (índice de masa corporal>35 o entre 30 y 34,9kg/m2 con un perímetro abdominal mayor de 102cm en varones o mayor de 88cm en mujeres) se relaciona con la enfermedad vascular. Métodos Estudio transversal de pacientes con obesidad de riesgo alto. Se mide su masa grasa mediante bioimpedancia y la rigidez arterial mediante la velocidad de la onda de pulso (VOP). Se analizan los terciles de pacientes según la distribución de la VOP. Resultados Se ha estudiado a 59 pacientes. Con incrementos de la VOP, aumentan el IMC (p=0,02) y el contenido de masa grasa (p<0,00). Existe, además, un incremento significativo de los indicadores de inflamación. Conclusiones En pacientes con obesidad de riesgo alto existen diferencias relativas a su composición corporal que se asocian a modificaciones de su rigidez arterial y de su carga inflamatoria (AU)

Objective The aim is to observe whether body composition in patients with high-risk obesity (body mass index>35 or between 30 and 34.9kg/m2 with a waist circumference greater than 102cm in men or greater than 88cm in women) is related with vascular disease. Methods This is a cross-sectional study of patients with high-risk obesity. Their fat mass was measured through bioimpedance and arterial stiffness through pulse wave velocity (PWV). Tertiles of patients were analyzed according to PWV distribution. Results A total of 59 patients were analyzed. As PWV increased, BMI (p=0.02) and fat mass content (p<0.00) increased. There was also a significant increase in inflammation indicators. Conclusions In patients with high-risk obesity, there were differences in their body composition which were associated with changes in arterial stiffness and inflammatory burden (AU)

Eating frequency has an inverse correlation with adiposity measures and non-invasive arterial stiffness parameters in healthy adult people / La frecuencia de alimentación tiene una correlación inversa con las medidas de adiposidad y los parámetros de rigidez arterial no invasivos en personas adultas sanas

Background: Lifestyle modifications have been recommended as an essential treatment approach for cardiovascular diseases. Recent studies have shown that eating frequency (EF) correlates with hypertension and related risk of organ damage. This study aimed to examine critical clinical implications to evaluate the association of EF with arterial stiffness parameters as an early marker of atherosclerosis manifestations. Methods: A cross-sectional descriptive study was performed on 658 participants of the PERSIAN Organizational Cohort study in Mashhad, aged 30–70 years. Arterial stiffness was assessed by measurement markers of arteriosclerosis, including arterial age, augmentation index (AIx), augmentation pressure (AP), carotid-femoral pulse wave velocity (Cf-PWV), and central blood pressure. Differences in anthropometric indices, blood indices, and arterial stiffness parameters were evaluated across EF groups. Results: Our data demonstrate that EF was positively correlated with total daily energy intake, and favourable profiles of adiposity and blood lipids. Subjects with an increased EF, had significantly lower AIx, AP, Arterial Age and Central blood pressure (P for trend<0.001) as compared to Lowest EF and not significant with PWV (P for trend, 0.19). Arterial stiffness was also significantly lower in those with increased EF compared with subjects with low EF. By Linear regression analysis, after adjustment for Confounding factors, except PWV, EF showed the associations with all of the non-invasive arterial stiffness parameters. Conclusion: Increased EF is associated with a lower wave reflection and blood pressure in the central arteries.(AU)

Introducción: Las modificaciones del estilo de vida se han recomendado como un enfoque de tratamiento esencial para las enfermedades cardiovasculares. Estudios recientes han demostrado que la frecuencia de las comidas (EF) se correlaciona con la hipertensión y el riesgo relacionado de daño orgánico. Este estudio tenía como objetivo examinar las implicaciones clínicas críticas para evaluar la asociación de la EF con los parámetros de rigidez arterial como un marcador temprano de las manifestaciones de la aterosclerosis. Métodos: Se realizó un estudio descriptivo transversal en 658 participantes del estudio de cohorte organizativo PERSIAN en Mashhad, de entre 30 y 70 años de edad. La rigidez arterial se evaluó mediante la medición de marcadores de arteriosclerosis, incluyendo la edad arterial, el índice de aumento (AIx), la presión de aumento (AP), la velocidad de la onda del pulso carótido-femoral (Cf-PWV) y la presión arterial central. Se evaluaron las diferencias en los índices antropométricos, los índices sanguíneos y los parámetros de rigidez arterial en los grupos de EF. Resultados: Nuestros datos demuestran que la EF se correlacionó positivamente con la ingesta energética diaria total, los perfiles favorables de adiposidad y los lípidos sanguíneos. Los sujetos con una EF aumentada, tenían un AIx, una AP, una edad arterial y una presión arterial central significativamente menores (p de tendencia <0,001) en comparación con la EF más baja y no significativa con la PWV (p de tendencia, 0,19). La rigidez arterial también fue significativamente menor en los sujetos con una mayor FE en comparación con los sujetos con una FE baja. Mediante un análisis de regresión lineal, después de ajustar los factores de confusión, excepto la VOP, la frecuencia de las comidas se asoció con todos los parámetros de rigidez arterial no invasivos. Conclusiones: El aumento de la FE se asocia a una menor reflexión de la onda y a una menor presión arterial en las arterias...(AU)

Association between arterial stiffness and fat mass in patients with obesity.

OBJECTIVE: The aim is to observe whether body composition in patients with high-risk obesity (body mass index >35 or between 30 and 34.9kg/m2 with a waist circumference greater than 102cm in men or greater than 88cm in women) is related with vascular disease. METHODS: This is a cross-sectional study of patients with high-risk obesity. Their fat mass was measured through bioimpedance and arterial stiffness through pulse wave velocity (PWV). Tertiles of patients were analyzed according to PWV distribution. RESULTS: A total of 59 patients were analyzed. As PWV increased, BMI (p=0.02) and fat mass content (p<0.00) increased. There was also a significant increase in inflammation indicators. CONCLUSIONS: In patients with high-risk obesity, there were differences in their body composition which were associated with changes in arterial stiffness and inflammatory burden.

Eating frequency has an inverse correlation with adiposity measures and non-invasive arterial stiffness parameters in healthy adult people.

BACKGROUND: Lifestyle modifications have been recommended as an essential treatment approach for cardiovascular diseases. Recent studies have shown that eating frequency (EF) correlates with hypertension and related risk of organ damage. This study aimed to examine critical clinical implications to evaluate the association of EF with arterial stiffness parameters as an early marker of atherosclerosis manifestations. METHODS: A cross-sectional descriptive study was performed on 658 participants of the PERSIAN Organizational Cohort study in Mashhad, aged 30-70 years. Arterial stiffness was assessed by measurement markers of arteriosclerosis, including arterial age, augmentation index (AIx), augmentation pressure (AP), carotid-femoral pulse wave velocity (Cf-PWV), and central blood pressure. Differences in anthropometric indices, blood indices, and arterial stiffness parameters were evaluated across EF groups. RESULTS: Our data demonstrate that EF was positively correlated with total daily energy intake, and favourable profiles of adiposity and blood lipids. Subjects with an increased EF, had significantly lower AIx, AP, Arterial Age and Central blood pressure (P for trend<0.001) as compared to Lowest EF and not significant with PWV (P for trend, 0.19). Arterial stiffness was also significantly lower in those with increased EF compared with subjects with low EF. By Linear regression analysis, after adjustment for Confounding factors, except PWV, EF showed the associations with all of the non-invasive arterial stiffness parameters. CONCLUSION: Increased EF is associated with a lower wave reflection and blood pressure in the central arteries.

Discriminative value of pulse wave velocity for arterial stiffness and cardiac injury in prediabetic patients / Valor discriminativo da velocidade da onda de pulso para rigidez arterial e lesão cardíaca em pacientes pré-diabéticos

Abstract Background Prediabetes (PD) is defined as impaired fasting glucose and/or impaired glucose tolerance (IGT) and may be associated with high risk of cardiovascular injury. It is recommended that PD patients be screened for signs of arterial stiffness and cardiovascular injury to reinforce therapeutic strategies. Objectives To identify pulse wave velocity values discriminative for arterial stiffness and cardiovascular injury in PD patients. Methods A cross-sectional study was conducted with PD (N=43) and normoglycemic (N=37) patients who underwent clinical evaluation, arterial stiffness assessment by carotid-femoral pulse wave velocity (cfPWV) using SphygmoCor, laboratory blood analysis, investigation of morphological and functional cardiac variables by transthoracic echocardiogram, and assessment of carotid intima-media-thickness (CIMT) by carotid ultrasonography. A statistical analysis was performed using SPSS software and values of p<0.05 were considered significant. Results A cfPWV cut-off value of 6.9 m/s was identified for IGT (Sensitivity [SE]: 74% and Specificity [SP]: 51%). Comparison of general data and risk factors between subsets with values above and below this cutoff value revealed higher rates of fasting glucose (p=0.02), obesity (p=0.03), dyslipidemia (p=0.004), early signs of left ventricle (p=0.017) and right ventricle (p=0.03) impaired diastolic function, and elevated CIMT in subjects with cfPWV ≥ 6.9m/s (p=0.04). Conclusions In PD patients, a cfPWV cutoff of 6.9 m/s was considered a discriminative value for arterial stiffness. These findings highlight the value of early investigation of cardiovascular injury and aggressive therapy strategies with good control of risk factors in PD.

Resumo Contexto O pré-diabetes (PD) é definido como glicemia de jejum alterada e/ou tolerância à glicose alterada (TGA) e pode estar associado a alto risco de lesão cardiovascular. Recomenda-se discriminar quais pacientes com PD podem apresentar sinais de rigidez arterial e lesão cardiovascular para reforçar as estratégias terapêuticas. Objetivos Identificar os valores discriminativos da velocidade de onda de pulso determinantes de rigidez arterial e lesão cardiovascular em pacientes com PD. Métodos Estudo transversal em pacientes com PD (N=43) e normoglicêmicos (N=37) submetidos a avaliação clínica, avaliação da rigidez arterial pela velocidade da onda de pulso carótido-femoral (cfPWV) utilizando SphygmoCor, análise laboratorial de sangue, investigação de alterações morfológicas e variáveis cardíacas funcionais por ecocardiograma transtorácico e avaliação da espessura íntima-média carotídea (EIMC) pela ultrassonografia da carótida. A análise estatística foi realizada no software SPSS, e valores de p<0,05 foram considerados significativos. Resultados Foi identificado um valor de corte cfPWV de 6,9 m/s para TGA (sensibilidade 74% e especificidade 51%). A comparação dos dados e fatores de risco entre valores acima e abaixo do valor de corte estabelecido revelou glicemia de jejum elevada (p=0,02), obesidade (p=0,03), dislipidemia (p=0,004), sinais precoces de função diastólica prejudicada do ventrículo esquerdo (p=0,017) e ventrículo direito (p=0,03) e maior EIMC em cfPWV ≥6,9m/s (p=0,04). Conclusões Em pacientes com PD, o cfPWV de 6,9 m/s foi considerado um valor discriminativo de rigidez arterial. Esses achados reforçam que a investigação precoce da lesão cardiovascular e uma estratégia com terapia agressiva são valiosas no controle dos fatores de risco na PD.

Association of severe preeclampsia and vascular damage assessed by noninvasive markers of arterial stiffness.

BACKGROUND: Preeclampsia (PE) is a hypertensive disorder of pregnancy associated with high maternal and fetal morbidity and mortality and increased future risk of cardiovascular complications. OBJECTIVE: To analyze whether women who have had PE with severe features in their pregnancy have higher arterial stiffness (AS) parameters than those whose PE course was without signs of severity. METHODS: Sixty-five women who developed PE during their gestation were evaluated, divided into two groups: PE group without severe features or non-severe PE (n=30) and PE group with severe features or severe PE (n=35). Carotid-femoral pulse wave velocity (cfPWV), central augmentation index corrected to a heart rate of 75 beats per minute (AIxc75) and central augmentation pressure (cAP) were determined one month and six months postpartum. Comparison of proportions was carried out using the chi-square test, comparison of means between groups using the Student's t-test or the Mann-Whitney test, and comparison of means of the same group at different evolutionary moments, using the t-test or the Wilcoxon test. Correlation, with and between hemodynamic parameters, was carried out with Spearman's correlation coefficient and the association between demographic variables, personal history and hemodynamic parameters, and altered arterial stiffness parameters was carried out using linear and logistic regression models. RESULTS: Women with severe PE presented, both at 1 and 6 months postpartum, higher values of blood pressure, both central and peripheral, as well as AR and pulse amplification parameters, than those women whose PE was not severe. Central augmentation index (cAIx) values at 1 month and 6 months postpartum were higher, although not significantly, in the severe PE group compared to the non-severe PE group (24.0 (16.5-34.3) vs. 19.0% (14-29) and 24.0 (14.0-30.0) vs. 20.0% (12.3-26.8), respectively). Carotid-femoral pulse wave velocity (cfPWV) was significantly higher at both 1 and 6 months postpartum in the severe PE group compared to the non-severe PE group (10.2 (8.8-10.7) vs. 8.8m/s (8.3-9.6) and 10.0 (8.8-10.6) vs. 8.8m/s (8.3-9.3), respectively). Central systolic pressure and central pulse pressure amplification were also higher, although not significantly, in the severe PE group in comparison with the non-severe PE group. CONCLUSIONS: Women who have had severe PE have more pronounced arterial stiffness parameters than those in whom PE was not particularly severe. The determination of cAIx and cfPWV, as a strategy for the assessment of cardiovascular risk, should be evaluated among women who have had PE.

Efeitos do Treinamento Intervalado de Alta Intensidade sobre a Pressão Arterial Central: Uma Revisão Sistemática e Metanálise / Effects of High-Intensity Interval Training on Central Blood Pressure: A Systematic Review and Meta-Analysis

Resumo A pressão arterial central (PAc) é considerada um preditor independente de lesão de órgão, eventos cardiovasculares e mortalidade por todas as causas. Evidências mostram que o treino intervalado de alta intensidade (HIIT) é superior ao treino contínuo de intensidade moderada (MICT) na melhoria da aptidão cardiorrespiratória e da função vascular. No entanto, os efeitos dessas modalidades de treino aeróbico sobre a PAc não foram propriamente revisados. Esta metanálise tem como objetivo investigar os efeitos do HIIT versus MICT sobre a PAc.Conduzimos uma metanálise de ensaios controlados randomizados que compararam HIIT versus MICT sobre a PAc. Os desfechos primários foram Pressão Arterial Sistólica (PAS) central (PASc) e Pressão Arterial Diastólica central (PADc). A PAS periférica (PASp), a PAD periférica (PADp), a Velocidade de Onda de Pulso (VOP) e a captação máxima de oxigênio (VO2max) foram analisadas como desfechos secundários. A metanálise das diferenças médias (DM) foi conduzida usando modelos de efeitos aleatórios.Nosso estudo incluiu 163 pacientes recrutados em seis ensaios. Encontramos que HIIT foi superior ao MICT em reduzir PASc (DM = -3,12 mmHg, IC95% -4,75 - 1,50, p = 0,0002) e PAS (DM = -2,67 mmHg, IC95% -5,18 - -0,16, p = 0,04) e aumentar VO2max (DM = 2,49 mL/Kg/min, IC95% 1,25 - 3,73, p = 0,001). No entanto, não foram relatadas diferenças quanto à PADc, PAD ou VOP. O HIIT foi superior ao MICT em reduzir PASc, sugerindo seu potencial papel como uma terapia não farmacológica para a pressão arterial elevada.

Abstract Central blood pressure (cBP) is considered an independent predictor of organ damage, cardiovascular events and all-cause mortality. Evidence has shown that high intensity interval training (HIIT) is superior to moderate-intensity continuous training (MICT) for improving cardiorespiratory fitness and vascular function. However, the effects of these aerobic training modalities on cBP have not yet been properly reviewed.This meta-analysis aims to investigate to effects of HIIT versus MICT on cBP.We conducted a meta-analysis of randomized controlled trials that compared HIIT versus MICT on cBP. Primary outcomes were measures of central systolic blood pressure (cSBP) and central diastolic blood pressure (cDBP). Peripheral systolic blood pressure (pSBP) and diastolic blood pressure (pDBP), pulse wave velocity (PWV) and maximal oxygen uptake (VO2max) were analyzed as second outcomes. Meta-analysis of mean differences (MD) was conducted using the random effects model.Our study included 163 patients enrolled in six trials. We found that HIIT was superior to MICT in reducing the cSBP (MD = -3.12 mmHg, 95% CI: -4.75 to -1.50, p = 0.0002) and SBP (MD = -2.67 mmHg, 95% CI: -5.18 to -0.16, p = 0.04), and increasing VO2max(MD = 2.49 mL/kg/min, 95% CI: 1.25 to 3.73, p = 0.001). However, no significant differences were reported for cDBP, DBP and PWV.HIIT was superior to MICT in reducing the cSBP, which suggests its potential role as a non-pharmacological therapy for high blood pressure.

Efecto de la administración de diferentes formas de vitamina D en la presión arterial y rigidez aórticas, y su implicación en la reducción de la albuminuria en la enfermedad renal crónica / Effect of the administration of different forms of vitamin D on central blood pressure and aortic stiffness, and its implication in the reduction of albuminuria in chronic kidney disease

Antecedentes y objetivos: La vitamina D (vitD) ejerce efectos pleiotrópicos como son las modificaciones de la función arterial y descenso de la albuminuria. Existe 1-alfa-hidroxilasa tisular que convierte el 25-hidroxicolecalciferol (25[OH]D) en calcitriol que ejerce acciones autocrinas y paracrinas que intervienen en los efectos pleiotrópicos. El déficit de 25(OH)D podría limitar estos efectos tisulares de la vitD. La administración de vitD nutricional (colecalciferol) y de paricalcitol puede promover beneficios en la función vascular y renal. El objetivo fue estudiar el efecto que tiene, en la enfermedad renal crónica (ERC), la administración de diferentes formas de vitD sobre la rigidez aórtica y sobre la albuminuria, y la relación fisiopatológica entre las modificaciones de estas variables.Pacientes y métodos: Estudiamos, en 97 enfermos con ERC estadios 3-4 y con albuminuria residual, el efecto de la administración de colecalciferol (grupo 2) y paricalcitol (grupo 3) sobre la rigidez aórtica estudiada mediante la velocidad de pulso carótida-femoral (Vpc-f), sobre la presión arterial braquial y aórtica (central) y sobre la albuminuria. Un grupo de enfermos con ERC estadios 3-4 que no recibió terapia con vitD sirvió como grupo control (grupo 1). Todos los parámetros se estudiaron basalmente y tras un periodo de seguimiento de 7 ± 2 meses. Resultados: No hubo diferencias entre los grupos en la rigidez aórtica que estaba aumentada en todos ellos con un valor basal de la Vpc-f de 10,5 (9,2-12,1) m/s. Los valores basales de presión arterial sistólica braquial (PASb), presión arterial sistólica central (PASc), presión de pulso braquial (PPb) y presión de pulso central (PPc) fueron similares en todos los grupos. El valor de albuminuria basal fue 198 (46-832) mg/g, sin diferencias entre los grupos.(AU)

Background and objectives: Vitamin D(vitD) participates in phospho-calcium metabolism and exerts multiple pleiotropic effects. There is tissue 1-α (OH)ase that converts 25-OH cholecalciferol (25 (OH) D) in calcitriol that exerts autocrine and paracrine effects. 25 (OH)D deficiency could limit these tissue effects of vitD. The administration of nutritional vitD and the activator of the vitD receptor, paricalcitol, may promote beneficial effects on vascular and renal function. The objective of this work was to study in subjects with chronic kidney disease (CKD) the effect that the administration of different forms of vitD has on arterial function and albuminuria, and the possible relationship between the modifications of these variables. Patients and methods: We studied in 97 patients with CKD stages 3-4 the effect of the administration of cholecalciferol (group 2; n: 35) and paricalcitol (n: 31; group 3) on parameters derived from brachial blood pressure, aortic blood pressure and on aortic stiffness studied using carotid-femoral pulse velocity (Vpc-f), and on albuminuria. A group of patients with stages 3-4 CKD who did not receive vitD therapy served as a control group (n: 31; group 1). All parameters were studied at baseline and after the follow-up period which was 7 ± 2 months. Results: In the baseline phase, no differences were observed between the groups in brachial systolic blood pressure (bSBP), central systolic blood pressure (SBP), brachial pulse pressure (bPP), and central pulse pressure (pCP) or in aortic stiffness that was increased in all groups with a baseline Vpc-f value of 10.5 (9.2-12.1) m/sec. The baseline albuminuria value in the grouped patients was 229 (43-876) mg / g (median (interquartile range)), with no differences between the groups.(AU)

Effect of the administration of different forms of vitamin D on central blood pressure and aortic stiffness, and its implication in the reduction of albuminuria in chronic kidney disease. / Efecto de la administración de diferentes formas de vitamina D en la presión arterial y rigidez aórticas, y su implicación en la reducción de la albuminuria en la enfermedad renal crónica.

BACKGROUND AND OBJECTIVES: Vitamin D(vitD) participates in phospho-calcium metabolism and exerts multiple pleiotropic effects. There is tissue 1-α (OH)ase that converts 25-OH cholecalciferol (25 (OH) D) in calcitriol that exerts autocrine and paracrine effects. 25 (OH)D deficiency could limit these tissue effects of vitD. The administration of nutritional vitD and the activator of the vitD receptor, paricalcitol, may promote beneficial effects on vascular and renal function. The objective of this work was to study in subjects with chronic kidney disease (CKD) the effect that the administration of different forms of vitD has on arterial function and albuminuria, and the possible relationship between the modifications of these variables. PATIENTS AND METHODS: We studied in 97 patients with CKD stages 3-4 the effect of the administration of cholecalciferol (group 2; n: 35) and paricalcitol (n: 31; group 3) on parameters derived from brachial blood pressure, aortic blood pressure and on aortic stiffness studied using carotid-femoral pulse velocity (Vpc-f), and on albuminuria. A group of patients with stages 3-4 CKD who did not receive vitD therapy served as a control group (n: 31; group 1). All parameters were studied at baseline and after the follow-up period which was 7 ± 2 months. RESULTS: In the baseline phase, no differences were observed between the groups in brachial systolic blood pressure (bSBP), central systolic blood pressure (SBP), brachial pulse pressure (bPP), and central pulse pressure (pCP) or in aortic stiffness that was increased in all groups with a baseline Vpc-f value of 10.5 (9.2-12.1) m/sec. The baseline albuminuria value in the grouped patients was 229 (43-876) mg / g (median (interquartile range)), with no differences between the groups. Serum calcium and phosphorus increased significantly in those treated with cholecal-ciferol (native vitD) and paricalcitol (active vitD). Parathormone (PTH) values decreased in those treated with paricalcitol.bPP and cPP decreased in all groups treated with native and active vitD. No significant changes in bPP and cPP were observed in the control group. Vpc-f did not change significantly in any of the groups, although the variation was quantitatively greater in group 3 (11.2±2 vs. 10.7±1.6 (P=.06)). No differences were observed in the changes in Vpc-f between the groups when adjusted to the baseline values of estimated glomerular filtration rate (eGFR), albuminuria, PTH, vitD, brachial and central blood pressure parameters, and their changes with treatment.Those who received treatment with native and active vitD presented a significant decrease in albuminuria of 17% (group 2) and 21% (group 3) compared to a 16% increase in the untreated group (group 1) (P=.01). A decrease in albuminuria ≥30% was observed more frequently in the groups treated with some form of vitD (group 2: 23%; group 3: 45%) than in the control group (13%) (P=.03). The decrease in albuminuria observed in the groups treated with any of the forms of vitD did not vary when the baseline values of the biochemical parameters of phosphorus-calcium metabolism, those of arterial function (PPb, PPc, Vpc-f) or its modifications were introduced as covariates. There was no significant correlation between changes in Vpc-f and albuminuria. In logistic regression, changes in arterial function parameters were also not explanatory for the ≥30% decrease in albuminuria. CONCLUSIONS: In patients with CKD stages 3-4, treated with RAS blockers and with residual albuminuria, the administration of or paricalcitol reduces brachial and aortic pulse pressures, and albuminuria. The decrease in albuminuria does not seem to be mediated, at least not decisively, by changes in central hemodynamics or aortic stiffness.