Aortic stiffness is associated with atherosclerosis of the coronary arteries in older adults: the Rotterdam Study

OBJECTIVE: Aortic stiffness can lead to low diastolic blood pressure, thereby possibly limiting coronary perfusion. Therefore, the simultaneous occurrence of both aortic stiffness and coronary atherosclerosis can lead to an increased risk of subendocardial ischaemia. The aim of the present study was to investigate the association between aortic stiffness and coronary atherosclerosis. METHODS: The study was performed in 1757 subjects of the Rotterdam Study, a population-based study of elderly individuals. Aortic stiffness was assessed by measuring carotid-femoral pulse wave velocity (PWV). Coronary atherosclerosis was assessed by measuring coronary calcification using electron beam tomography and expressed as a total calcium score. The total calcium score was log-transformed because of its skewed distribution. The association between PWV and coronary calcification was first evaluated after adjustment for age, sex, mean arterial blood pressure and heart rate. RESULTS: Linear regression analyses showed that increased PWV was associated with a higher log total coronary calcium score [beta-regression coefficient 0.11, 95% confidence interval (CI) 0.07-0.15]. Compared with the lowest quartile of PWV, multivariate odds ratios and corresponding 95% CI for advanced coronary calcification in the second, third and fourth highest quartiles were 1.17 (0.79-1.74), 1.58 (1.07-2.34) and 2.12 (1.40-3.20), respectively. CONCLUSIONS: In this large population-based study performed in elderly subjects aortic stiffness was strongly and independently associated with coronary atherosclerosis.     

A comparative study of atherosclerosis and osteopenia in elderly and young hemodialysis patients

The effects of aging on atherosclerosis and osteopenia in hemodialysis patients were investigated. Eighty patients on maintenance hemodialysis were subdivided according to age into old (greater than or equal to 65 years old, N = 40) and young (less than 65 years old, N = 40). Biochemical, radiologic, and biophysical studies were performed in each patient to assess the degree of atherosclerosis and osteopenia. Compared to age-matched controls, patients in the old group exhibited a significantly higher aortic pulse wave velocity (PWV), and old female patients had a significantly lower bone mineral content/bone width (BMC/W). Elderly patients also had a significantly higher aortic PWV and higher grade of aortic calcification as assessed radiologically; in contrast, the BMC/W was lower. Concerning sex differences, elderly male patients had the highest average grade of aortic calcification, the lowest serum Pi, [Ca] x [Pi], and immunoreactive parathyroid hormone concentrations, while elderly female patients had the lowest BMC/W and highest incidence of osteopenia. These observations suggest that elderly male hemodialysis patients are more prone to develop atherosclerosis and elderly female hemodialysis patients to develop advanced osteopenia.     

Effect of upper gastrointestinal endoscopy on circulation in the elderly.

BACKGROUND: Upper gastrointestinal endoscopy in the elderly is increasingly becoming more common, despite the possibility that a minimal load on the circulation can cause serious complications such as shock and cardiac arrest. OBJECTIVE: The effects of endoscopy on the heart and the possibility of predicting circulatory accidents were studied using natriuretic peptide levels. METHODS: The patients were randomly chosen according to their age and divided into an elderly group (over 60 years of age, 64 patients) and a young group (under 30 years of age, 20 patients). The patients in the elderly group were further subdivided into two groups based on the presence or absence of circulatory complications (46 patients with circulatory complications and 18 without complications). The load on the heart was evaluated by measuring human atrial natriuretic peptide (hANP) and human brain natriuretic peptide (hBNP) which are secreted by the myocardial cells in response to cardiac load. Specimens were obtained before and after endoscopy. RESULTS: The hANP level was significantly higher after endoscopy in the elderly group, regardless of the presence or absence of circulatory complications. No significant difference was observed in the hBNP level. No significant increase in hANP or hBNP levels was observed after endoscopy in the young group. CONCLUSIONS: These observations suggest an increased atrial load during endoscopy in the elderly. The increase in pulse rate during endoscopy is one possible cause of atrial load. Therefore, the risk of circulatory system damage must be recognized when endoscopy is performed in the elderly. The measurement of plasma hANP and hBNP levels may provide effective indices for evaluating cardiac load during endoscopy.     

Prediction of cognitive function by arterial stiffness in the very elderly.

BACKGROUND: Cognitive function is impaired in elderly subjects, so the aim of the present study was to determine the role of arterial stiffness on cognitive function. METHODS AND RESULTS: Cognitive function and arterial stiffness were assessed by the Mini-Mental State Examination (MMSE) and measurement of the brachial-ankle pulse wave velocity (PWV), respectively. The cross-sectional association of the MMSE score and PWV was studied in 203 subjects (87 men, 116 women), all of whom were 85 years old. Sex distribution, systolic and diastolic blood pressures did not differ between the normal (MMSE score >or=24, n=128) and impaired MMSE groups (MMSE score <24, n=75). In contrast, the PWV was significantly increased in the impaired MMSE group than in the normal MMSE group (25.0+/-0.8 vs 22.9+/-0.5 m/s, p<0.05). In multiple regression analysis, the PWV was also independently and significantly associated with the MMSE score. CONCLUSIONS: These results suggest that cognitive function could be predicted by arterial stiffness, as assessed by the PWV, in the very old. Preventing atherosclerosis may play an important role in preserving normal cognitive function until very old age.     

Dispersion of ventricular repolarization is determined by the presence of myocardial viability in patients with old myocardial infarction. A dobutamine stress echocardiography study.

AIMS: The study sought to investigate the relationship of myocardial viability detected by dobutamine stress echocardiography to changes of QT dispersion and to the presence of arrhythmias during dobutamine infusion in patients with old myocardial infarction. We also examined whether patency of the infarct-related artery is associated with the presence of myocardial viability and QT dispersion. BACKGROUND: QT dispersion and myocardial variability have been associated with the presence of arrhythmias during late post infarction but not during dobutamine stress. Restoration of anterograde coronary flow has beneficial effects on ventricular systolic function and repolarization, suggesting that the extent of viable myocardium may determine ventricular repolarization. METHODS: Seventy five patients with previous myocardial infarction were studied in a low dose (up to 20 microg(-1) x kg(-1) x min(-1)) dobutamine stress echocardiography study. ECGs were obtained at rest and peak stress for measurement of QT intervals. The presence of ventricular arrhythmias (Lown grade >lb) during stress was noted. A reduction in the total wall motion score of the left ventricle at peak stress confirmed the presence of myocardial viability. RESULTS: Dobutamine infusion increased QT dispersion in all patients (P<0.01). Patients with myocardial viability had a lower resting QT dispersion (P<0.05) and a greater increase in QT dispersion% (P<0.01) than patients without. The combination of a resting QT dispersion <65 ms or an increase in QT dispersion >30% predicted viability with a sensitivity of 67%, a specificity of 96%, and an accuracy of 78%. A patent infarct-related artery, as well as ventricular arrhythmias, were more commonly observed in patients with evidence of viable myocardium (P<0.05). Patients with arrhythmias had a higher QT dispersion than patients without (P<0.05). CONCLUSION: The combination of a resting QT dispersion +/-65 ms or an increase in QT dispersion >30% predicts the presence of viable myocardium and thus, may represent a simple index for the assessment of viability in everyday clinical practice. Myocardial viability is related to a patent coronary artery and to a high incidence of arrhythmias accompanied by a greater increase in QT dispersion at peak dobutamine infusion.     

Brachial-ankle pulse wave velocity is an independent predictor of carotid artery atherosclerosis in the elderly

Objective Brachial-ankle pulse wave velocity （baPWV） is widely used as a simple noninvasive measure of arterial softness. The aim of this study was to evaluate the usefulness of baPWV as a predictor of the carotid artery atherosclerosis in the elderly. Methods A total of 721 elderly participants （mean ~ SD age, 70.3 -4- 5.6years） were enrolled in the current study. All participant underwent both baPWV measurement and B-mode ultrasound for the intima-media thickness. Carotid atherosclerosis （CAS） was defined as the present of carotid plaque or and/or intima media thickness for at least 1.1 mm. Results A multivariate logistic regression analysis reveals that age, sex, brachial-ankle pulse wave velocity, smoking and LDL-C level showed a significant correlation with the presence of CAS. The odds ratios of CAS associated with a 500cm/s increase of brachial-ankle pulse wave velocity were 2.378 [95% confidence interval, 1.36 to 4.00, P〈0.05], 3.733 [95% confidence interval, 1.729 to 8.058, P〈0.01], 4.438 [95% confidence interval, 1.659 to 11.803, P〈0.01]. The baPWV significantly correlated with IMT by bivariate correlation analysis （r=-0.39; p=0.001）. After adjusting for factors influencing, baPWV all the same correlated with IMT （r=-0.35; p=0.001）.Conclusion These results indicate that brachial-ankle PWV is an independent predictor of CAS in the elderly.It also means that the direct measurement of arterial stiffness by this simple method may be of great help for the evaluation of carotid artherosclerosis, at least in the elderly     

QT interval dispersion in hospital patients admitted with cardiac insufficiency. Determinants and prognostic value]

INTRODUCTION AND OBJECTIVES: The determinants and the prognostic value of the QT interval dispersion are analysed in a group of consecutive patients admitted to hospital with heart failure. METHODS: One hundred twenty-two consecutive patients admitted because of heart failure in whom a reliable measurement of QT dispersion in the first electrocardiogram was obtained (maximum QT-minimum QT) were studied. The main clinical, analytic and echocardiographic data were recorded. A control group (n = 35) matched in age and sex with the study group was also analysed. RESULTS: The study group showed a greater QT dispersion than the control group (62 +/- 30 vs 40 +/- 21 ms; p = 0.01). Those cases with a QT dispersion > 80 ms (n = 50; 41%) exhibited a lower natremia (138 +/- 6 vs 141 +/- 4 mEq/l; p = 0.01), a higher probability of ischemic aetiology (52 vs 33%; RR = 2.2; IC95% 1.05-4.7; p = 0.04), an increased mortality during the first year (20 vs 6%; RR = 4.7; IC95% 1.3-16; p = 0.01) and during the whole follow-up (38 vs 19%; RR = 3.4; IC95% 1.3 a 8.6; p = 0.01) than those patients with a QT dispersion < 80 (n = 72; 59%). There were no significant differences between both groups with regard to the clinical, analytic or echocardiographic data. In the multivariate analysis only the ischemic etiology (p = 0.002) and the NYHA grade (p = 0.02) were related to a greater mortality. CONCLUSIONS: Patients with heart failure show an increased QT interval dispersion. This parameter is a simple tool that suggests an ischemic etiology and can help in prognosis stratification.     

代谢综合征对老年糖尿病患者动脉僵硬度的影响

目的探讨老年糖尿病患者合并代谢综合征(MS)动脉僵硬度的变化及影响因素。方法选择老年糖尿病患者305例,根据是否合并MS分为MS组143例、非MS组162例;另选老年葡萄糖耐量试验正常者65例为对照组。检测颈-股脉搏波传导速度(PWV)、体重指数、腰围、血压、高敏C反应蛋白、血脂、空腹血糖、胰岛素及胰岛素抵抗指数,进行比较分析。结果 MS组和非MS组患者PWV明显高于对照组(P<0.05);随着MS组分增加,PWV呈阶梯样增加(P<0.05)。多元回归分析显示,PWV与年龄、血压、MS组分、高敏C反应蛋白、胰岛素抵抗指数及空腹血糖呈正相关(P<0.05)。结论老年糖尿病患者动脉僵硬度明显增加,合并MS加重动脉僵硬。     

QT dispersion as a predictor of long-term mortality in patients with acute myocardial infarction and clinical evidence of heart failure.

BACKGROUND: QT interval dispersion is a marker of inhomogeneous ventricular repolarization, and therefore has the potential to predict re-entry arrhythmias. Following acute myocardial infarction, increased QT dispersion has been associated with a higher risk of ventricular arrhythmias. However, whether or not QT dispersion predicts prognosis post-acute myocardial infarction is not clear. We addressed this issue by analysing the AIREX study registry. METHODS: AIREX was a follow-up study of 603 post-acute myocardial infarction patients who exhibited clinical signs of heart failure and were randomly allocated to ramipril or placebo. An interpretable 12-lead ECG obtained between day 0 and day 9 after the index infarction (median time 2 days) was available in 501 patients. We examined whether QT dispersion was a predictor of all-cause mortality in the AIREX study registry (mean follow-up 6 years). RESULTS: QT dispersion measurements were significantly increased in patients who subsequently died (QT dispersion: 92.0 +/- 38.5 ms vs 82.7 +/- 34.3 ins. P=0.005; rate corrected QT dispersion: 105.7 +/- 42.7 ms vs 93.1 +/- 35.9 ms, P<0.001). Univariate analysis showed that QT dispersion as a predictor of all-cause mortality risk (QT dispersion: hazard ratio per l0 ms 1.05, [95% CI 1.02 to 1.09]. P= 0.004; rate corrected QT dispersion: 1-07 [1.03 to 1.10], P<0.001): an increase of 10 ms added a 5-7%, relative risk of death. QT dispersion remained an independent predictor of all-cause mortality risk on multivariate analysis (QT dispersion: 1.05 [1.01 to 1.09], P=0.027; rate corrected QT dispersion: 1.05 [1.01 to 1.09]. P=0.022). CONCLUSION: QT dispersion. measured from Li routine 12-lead ECG following acute myocardial infarction complicated by heart failure provides independent information regarding the probability of long-term survival. However. the low sensitivity of this electrocardiographic marker limits its usefulness for risk stratification if used in isolation.     

An Evaluation of the Impact of Gender and Age on QT Dispersion in Healthy Subjects

Objectives: To determine if gender, age, and gender per age category, have an impact on QT and QTc dispersion in healthy volunteers. Methods: This study was undertaken in 150 patients (50 per age group, 75 males, 75 females). The age groups included young (20–40 years), middle‐aged (41–69 years) and elderly (> 70 years) subjects. The QT intervals on a 12 lead ECG were determined and Bazett's formula was used to derive the QTc intervals. The QT and QTc dispersion were determined by subtracting the shortest QTc interval from the longest on each 12‐lead recording. Results: Males had higher QT dispersion than females (50 ± 22 vs 42 ± 18 ms, P = 0.017) but QTc dispersion was not significantly changed. No significant differences were seen among the different age categories for QT or QTc dispersion. In elderly subjects, males had higher QT and QTc dispersion than females (54 ± 23 vs 42 ±15 ms, P = 0.039 and 63 ± 23.7 vs 48 ± 21 ms, P = 0.032, respectively). Conclusions: When evaluating the effect of gender in different age categories, elderly males have significantly greater QT and QTc dispersion than elderly female subjects. No other gender differences were noted for QT or QTc dispersion in the other two age categories. When evaluating a population of healthy volunteers, regardless of age, gender has an impact on QT dispersion but no significant interaction with QTc dispersion. Evaluating age without dividing the data by gender yields no significant differences in QT or QTc dispersion. A.N.E. 2001;6(2):129–133     

Determinants of arterial stiffness in an apparently healthy population over 60 years

Arterial stiffness assessed by the pulse wave velocity (PWV), a non-invasive and reproducible method, predicts cardiovascular morbidity and mortality. The main determinants of arterial stiffness are well established in younger and middle-aged populations, but much less in the elderly. The aim of this study was to describe the determinants of arterial stiffness in elderly apparently healthy subjects. The study included 221 voluntary subjects born before 1944 (mean age 67.4+/-5.0 years), who had a standard health check-up at the 'Centre de Médecine Préventive' of Nancy. Arterial stiffness was evaluated by measuring the carotid-femoral PWV with the PulsePen automatic device. Clinical and biological parameters were evaluated at the same day. Measurements were valid and analysed in 207 subjects (94 women). Mean PWV was 9.39+/-2.64 m/s. Men showed higher PWV values than women (9.99+/-2.56 vs 8.66+/-2.56, P<0.001). In univariate analysis, PWV was correlated with age (r=0.26, P<0.001) and mean arterial pressure (MAP) (r=0.40, P<0.001), and these relationships were similar in men and women. Subjects with hypertension (P<0.001), diabetes mellitus (P<0.001) and obesity (P<0.01) had higher values of PWV. In multiple regression analysis, PWV correlated positively and independently with age, male gender, MAP and diabetes mellitus. In conclusion, in an apparently healthy elderly population, the main determinants of arterial stiffness are the age, MAP, diabetes and gender. Our study also shows that the gender-related differences in arterial stiffness observed in middle-aged subjects are maintained in the elderly.     

QT dispersion in nonischemic dilated cardiomyopathy. A long-term evaluation

BACKGROUND: In idiopathic dilated cardiomyopathy (IDC), the predictive value of QT dispersion is still under debate. AIMS: This study assessed the role of QT dispersion for the long-term risk of cardiac death and of major arrhythmic events in IDC. METHODS AND RESULTS: In 162 patients with IDC (age 52+/-12 years), the QT interval on a 12-lead ECG was measured manually. QT dispersion was evaluated with QT range and QT standard deviation, for both QT and QTc (Bazett formula). With a follow-up of 53+/-41 months, QT dispersion was not a predictor of cardiac death in univariate or in multivariate analysis, and was of similar value for patients with or without bundle branch block. Using multivariate analysis, increased pulmonary capillary wedge pressure (p=0.003), decreased heart rate variability (Standard deviation of all NN intervals, p=0.01) and non-sustained ventricular tachycardia (NSVT) (p=0.03) were predictors of cardiac death. Sudden death and/or major arrhythmic events were independently predicted by NSVT (p=0.005), decreased heart rate variability (p=0.01) and late ventricular potentials on signal averaged ECG (p=0.02). CONCLUSION: This study confirms the poor prognostic value of QT dispersion in patients with IDC. Other methods to assess repolarization abnormalities need to be evaluated in such patients.     

Carotid plaques, but not common carotid intima-media thickness, are independently associated with aortic stiffness.

OBJECTIVE: It has been suggested that non-invasive aortic stiffness measurements can be used as an indicator of atherosclerosis. The relationships of arterial stiffness with arterial wall hypertrophy and atherosclerosis however, have rarely been investigated in large-scale studies. The present study reports the associations of carotid arterial structure assessed by B-mode ultrasound with carotid-femoral pulse-wave velocity in hypertensive and non-hypertensive subjects. DESIGN AND METHODS: Free health examinations were performed on 564 subjects (age 58.2 +/- 10.8 years, 31.9% of women, 53.2% of all were hypertensive). Carotid-femoral pulse-wave velocity (PWV) was used to assess aortic stiffness. Carotid ultrasound examination included measurements (at sites free of plaques) of intima-media thickness (IMT) at the common carotid arteries (CCA), CCA-lumen diameter, and assessment of atherosclerotic plaques in the extracranial carotid arteries. RESULTS: Subjects with carotid plaques had significantly higher mean sex-adjusted values of PWV than those without carotid plaques (12.7 +/- 0.2 versus 11.1 +/- 0.1 m/s, P < 0.001). Multivariate analyses showed that this association was independent of sex, age, height, body mass index, mean blood pressure, pulse pressure, diabetes, hypercholesterolaemia and smoking habits (P < 0.009). PWV was positively associated with CCA-IMT and CCA-lumen diameter in sex-adjusted analysis (partial correlation coefficients (r ) were respectively 0.39 and 0.42, P < 0.001 for each). However, the association of PWV with CCA-IMT, but not that with CCA-lumen diameter, disappeared after further adjustment for age and blood pressure measurements (mean blood pressure and/or pulse pressure). CONCLUSION: This study shows that there is a differential association of PWV with CCA-IMT and carotid plaques. The nature of the independent positive association between atherosclerosis and arterial stiffness should be thoroughly investigated.     

Confounding effects of heart rate on pulse wave velocity in paced patients with a low degree of atherosclerosis

BACKGROUND: Pulse wave velocity (PWV), an index of arterial wall stiffness, is modulated by blood pressure (BP). Whether heart rate (HR) is also a modulator of PWV is controversial. Recent research involving mainly patients with high aortic PWV have found either no change or a positive correlation between the two. Given that PWV is increasingly being measured in cardiovascular studies, the relationship between HR and PWV should be known in patients with preserved arterial wall elasticity. OBJECTIVE: The aim of this study was to evaluate the importance of HR as a determinant of the variability in PWV in patients with a low degree of atherosclerosis. DESIGN AND METHODS: Fourteen patients (five female, nine male; aged 68 +/- 8 years) were evaluated post pacemaker implantation due to sick sinus or carotid hypersensitivity syndromes. Carotid-femoral PWV was measured at rest and during atrial pacing at 80, 90 and 100 bpm (paced HR). Arterial femoral blood flow (AFBF) was measured by echodoppler. RESULTS: PWV increased from 6.2 +/- 1.5 m/s (mean +/- SD) during resting sinus rhythm (HR 62 +/- 8 bpm; mean +/- SD) to 6.8 +/- 1.0, 7.0 +/- 0.9, and 7.6 +/- 1.1 m/s at pacing rates of 80, 90 and 100 bpm, respectively (P < 0.0001). Systolic (SBP) and mean blood pressure (MBP) remained constant at all HR levels, whereas AFBF increased in a linear fashion. CONCLUSIONS: These results demonstrate that even in patients with a low degree of atherosclerosis, HR is a potential modulator of carotid-femoral PWV.     

Does healthy obesity exist in the elderly? Findings from the Northern Shanghai Study

Background and aimsMetabolic unhealthiness and obesity are both associated with an increased risk of cardiovascular disease. We aimed to investigate the significance of metabolic unhealthiness and obesity in organ damages in a community-based elderly cohort.Methods and resultsA total of 3325 elderly participants (>65 years old) were recruited in northern Shanghai. Associations of metabolic status and obesity with organ damages were investigated. In all, 1317 (39.6%) participants were metabolically unhealthy and 481 (14.5%) were obese. Compared with metabolically healthy nonobese (MH-nonobese) individuals, metabolically healthy obese subjects had a greater left ventricular mass index (LVMI) and pulse wave velocity (PWV). Metabolically unhealthy subjects, regardless of their obesity status, had greater organ damage parameters including E/Ea, LVMI, PWV, and urine albumin-creatinine ratio (UACR) than MH-nonobese subjects (all P < 0.05). After multivariate adjustments, both metabolic unhealthiness and obesity increased the risk of left ventricular hypertrophy (LVH) (OR 1.31, 95% CI 1.10–1.57 and OR 1.63, 95% CI 1.30–2.04), diastolic dysfunction (OR 1.33, 95% CI 1.06–1.67 and OR 1.51, 95% CI 1.14–1.99), and lower extremity atherosclerosis (OR 1.44, 95% CI 1.11–1.85 and OR 2.01, 95% CI 1.49–2.70). Metabolic unhealthiness was also associated with arterial stiffness, microalbuminuria and chronic kidney disease (all P < 0.05). In a subgroup analysis, metabolic unhealthiness was associated with more organ damages in nonobese subjects, and obesity was associated with LVH and lower extremity atherosclerosis regardless of metabolic status.ConclusionBoth obesity and metabolic unhealthiness were associated with organ damages. Metabolic unhealthiness was associated with more organ damages, especially in nonobese individuals. Even healthy obesity was significantly associated with cardiac and vascular impairment.Registration number for clinical trialsNCT02368938.     

老年患者认知功能障碍与动脉僵硬度关系

目的 探讨老年患者认知功能障碍与动脉僵硬度的关系.方法 选择142例老年患者,以肢体动脉搏动波(PWV)作为评价动脉僵硬度指标,以简易精神状态量表(MMSE)作为认知功能评价指标,MMSE评分总分30分,评分<24分为认知功能障碍.对所有入选病例进行PWV检查及MMSE评分,根据MMSE评分将所有患者分为两组:认知功能正常组93例,认知功能障碍组49例.结果 认知功能障碍组较认知功能正常组PWV明显增高[(13.3±2.4)m/s与(11.8±2.2)m/s,t=3.775,P-0.000].经Logistic回归分析,MMSE评分与PWV呈显著相关.结论 动脉僵硬度增加是老年患者认知功能障碍重要危险因素.     

Association between serum homocysteine and arterial stiffness in elderly: a community-based study

Background Arterial stiffness and homocysteine are both powerful predictors of cardiovascular disease, especially in older popula tions. Previous studies have investigated the association of homocysteine with arterial stiffness in human subjects, while the relationship between homocysteine and arterial stiffness in the elderly is still indefinite. The current study examined the association of homocysteine with arterial stiffness in Chinese community-based elderly persons. Methods We related serum levels of homocysteine to two measures of arte- rial stiffness （carotid-femoral pulse wave velocity （PWV） and carotid-radial PWV） in 780 participants （46.3% men, mean age 71.9 years （ranging 65-96 years old）） from two communities of Beijing, China. Arterial stiffness were measured within two days of the time of bio- marker measurement. Results In multiple-adjusted models, homocysteine levels was strongly associated with the carotid-femoral PWV （standardized 13 = 0.13, P 〈 0.001）, even after adjustment for classical risk factors of cardiovascular disease. The association is also stronger when the carotid-femoral PWV is elevated above normal, whereas no significant association with homocysteine was observed for ca-rotid-radial PWV. Conclusions In Chinese elderly persons, serum homocysteine levels are associated with alterations of aortic stiffness.     

Relation of arterial stiffness to left ventricular diastolic function and cardiovascular risk prediction in patients > or =65 years of age

There is a paucity of data regarding the relation between the various noninvasive indexes of arterial stiffness and left ventricular diastolic function. In 188 subjects aged > or =65 years (mean 75 +/- 5; 71% men), the concordance and strength of the association between measures of arterial stiffness and left ventricular diastolic function were evaluated. Indexes of arterial stiffness (brachial and aortic pulse pressure [PP], carotid-femoral pulse-wave velocity [PWV], and augmentation pressure [AP]) were measured using applanation tonometry. Diastolic function was classified in terms of instantaneous diastolic function grade and quantitated as left atrial volume, a measure of chronic diastolic burden. Risk for new cardiovascular events was estimated using a validated clinical echocardiographic risk algorithm. Aortic and brachial PP, PWV, and AP were correlated positively with left atrial volume and diastolic function grade. After adjusting for age, gender, and clinical and echocardiographic covariates, 1-SD increases in aortic PP, brachial PP, PWV, and AP were associated with 6%, 6%, 4%, and 4% increases in indexed left atrial volume, respectively. Similarly, 1-SD increases in aortic PP, brachial PP, and AP were associated with 84%, 81%, and 83% increased risk for diastolic dysfunction, respectively (all p <0.04). PWV and aortic and brachial PP were superior to AP in discriminating subjects with the highest risk of having new cardiovascular events (5-year risk >50%; area under receiver-operating characteristic curve 0.67, 0.67, 0.70, and 0.56, respectively; p <0.05). In conclusion, increased arterial stiffness was associated with more severe left ventricular diastolic dysfunction, although the strength of the association varied according to the specific measure used. Aortic PP, brachial PP, and PWV appeared superior to AP in risk discrimination in this elderly cohort.     

Insulin sensitivity independently influences brachial-ankle pulse-wave velocity in non-diabetic subjects.

AIMS: Measurement of pulse-wave velocity (PWV) is a non-invasive technique for assessing arterial stiffness. Although insulin resistance is associated with intimal-medial thickness of the carotid artery evaluated by B-mode ultrasonography, it is not known whether it is related to PWV. The aim of this study was to determine the relationship between homeostasis model assessment insulin sensitivity index (HOMA-%S) and PWV in non-diabetic subjects. We also examined the effects of oral glucose tolerance test (OGTT) 2-h glucose and plasma high-sensitivity C-reactive protein (CRP) on PWV, as these two parameters are associated with atherosclerosis. METHODS: A 75-g oral glucose tolerance test was performed in 1934 Japanese subjects who were undergoing health examinations. Of these subjects, we recruited 1541 non-diabetic subjects without chronic or acute inflammation, malignant diseases, autoimmune disorders, elevated serum creatinine levels, and abnormal hepatic function tests. Subjects who had an abnormal ankle/brachial blood pressure index of less than 0.9 were also excluded. Brachial-ankle PWV and plasma high-sensitivity CRP were measured on 1541 subjects who satisfied the admission criteria. RESULTS: PWV was 12.55+/-1.61 (mean+/-sd) m/s and plasma CRP concentration was 0.4 mg/l (median, range, 0.1-5.8 mg/l) in the study subjects. By multivariate regression analysis, HOMA-%S was found to be an independent negative risk factor for PWV, while systolic blood pressure, age and triglycerides were positively associated with PWV. OGTT 2-h glucose was weakly and independently related to PWV in male subjects. Plasma CRP was not independently associated with PWV. CONCLUSIONS: Insulin resistance is independently associated with PWV in non-diabetic subjects.     

Determinants of arterial stiffness in Greek and French hypertensive men

The aim of the present study was to assess the main determinants of arterial stiffness in Greek and French middle-aged, hypertensive men, by using pulse wave velocity (PWV) measurements, which is an established method of quantification of arterial stiffness. The study was performed in 83 consecutive Greek and 79 consecutive French untreated male hypertensive outpatients aged 45-65 years. French subjects were examined in Paris at the "Centre d'Investigations Préventives et Cliniques" (the IPC Center). Greek patients were examined in Athens at the hypertension outpatient clinic in Sotiria Hospital (University of Athens). In both Greek and French hypertensive subjects, aortic stiffness was determined by the same parameters: age, blood pressure and heart rate (HR) explained approximately 40% of the aortic PWV variations, whereas lipids, triglycerides and tobacco smoking were not significant associated with aortic stiffness. After multivariate adjustments, Greek hypertensives had higher aortic stiffness as compared to the French patients by 1.2 m/s (approximately 10%); p < 0.001. Greek hypertensive subjects had also a higher body weight, waist, HR and prevalence of smoking. However, among all these factors only HR had a significant effect on PWV. Also after adjustment for HR, the difference in PWV between the two populations persisted. In conclusion, in two different populations, stiffness seems to be regulated by the same major factors. The higher aortic stiffness found in Greek hypertensives may be explained by the presence of other non-evaluated risk factors and/or patient selection differences.