Circulating homocysteine and large arterial stiffness and thickness in a population-based sample of middle-aged and elderly men

Elevated plasma homocysteine (tHcy) is considered as a risk factor for cardiovascular events, and has been associated with arterial stiffness and subclinical atherosclerosis in subjects with classical cardiovascular risk factors. The aim of this study is to investigate the association of plasma tHcy with functional and structural changes in the large arteries by measuring aortic pulse-wave velocity (PWV) and carotid artery intima-media thickness (CIMT). In a population-based sample of 376 middle-aged and elderly men, tHcy levels were measured by using fluorescence polarization immunoassay. Aortic stiffness was assessed non-invasively by measuring carotid-femoral PWV with the use of applanation tonometry. CIMT was measured by ultrasonography. We used multivariate linear regression analysis with the log-transformed value of tHcy as the determinant, and aortic PWV and CIMT as outcomes. In the univariate model, PWV increased with increasing tHcy concentration; PWV increased by 2.64 m/s (95% confidence interval (CI) 1.74; 3.54) per unit change in log tHcy. After adjustment for confounders, no statistically significant association remained; PWV increased by 0.42 m/s (95% CI -0.27; 1.11) per unit change in log tHcy. Furthermore, in the univariate model, CIMT increased significantly with increasing tHcy concentration; CIMT increased by 0.19 mm (95% CI 0.11; 0.26) per unit increase log tHcy. This association was attenuated and did not remain significant after additional adjustment for age and cardiovascular confounders (beta=0.06 (95% CI -0.01; 0.13)). The results of this study do not support the presence of an independent relationship between circulating tHcy levels and large artery stiffness and thickness.     

Increased arterial stiffness as the marker of vascular involvement in systemic sclerosis

OBJECTIVE: Endothelial dysfunction and vasculopathy of the small and large vessels are crucial pathogenic factors in systemic sclerosis (SSc). Accelerated atherosclerosis and impaired flow-mediated vasodilation have been described in SSc. We evaluated arterial stiffness in patients with SSc compared to healthy controls. METHODS: Augmentation index (AI) and pulse wave velocity (PWV) of the brachial artery were measured in 40 patients with SSc and 35 age and sex matched healthy controls using an arteriograph system. RESULTS: AI was significantly higher in SSc patients (9.02) compared to controls (-41.15) (p < 0.0001). PWV was similarly higher in patients with SSc (9.67 m/s) than in controls (8.00 m/s) (p = 0.0017). PWV was significantly higher in patients with localized SSc (10.04 +/- 2.01 m/s) compared to those with diffuse SSc (8.39 +/- 1.87 m/s) (p = 0.034). There was a significant, positive linear correlation between AI and PWV (r = 0.32, p = 0.045). We also observed significant correlations between AI and age (r = 0.31, p = 0.048), PWV and age (r = 0.36, p = 0.021), and PWV and disease duration (r = 0.40, p = 0.011) in SSc patients. CONCLUSION: Increased AI and PWV of the aorta in comparison to age and sex matched healthy controls indicate increased large-vessel stiffness in patients with SSc. PWV and AI are reproducible indicators of the presence and degree of arterial stiffening. Because arterial stiffness may correlate with disease duration and age in patients with SSc, it may be a useful diagnostic test in the assessment of arterial function. Increased vascular stiffness may be therapeutically targeted by statins and other vasoprotective agents during the management of SSc.     

Metabolic syndrome and arterial stiffness: the Health 2000 Survey

Metabolic syndrome and its components have been associated with arterial stiffness and cardiovascular disease. The objective of this study was to examine the independent influences of metabolic syndrome, its components, and other cardiovascular risk factors on arterial stiffness as well as to compare 2 definitions for metabolic syndrome (National Cholesterol Education Program [NCEP] and International Diabetes Federation [IDF]) in their ability to identify subjects with arterial stiffness. The study population consisted of 401 Finnish men and women aged 45 years and older who participated in a substudy of the Finnish population-based Health 2000 Survey. Pulse wave velocity (PWV) measured by whole-body impedance cardiography was used as a marker of elevated arterial stiffness. In multivariate models, systolic blood pressure, age, waist circumference, and fasting blood glucose (P ≤ .001 for all) were independent determinants for PWV. In the models including metabolic syndrome instead of its components, the NCEP and IDF definitions were similarly associated with PWV (P ≤ .01 for both), the other independent determinants being age, sex (P < .001 for both) and plasma C-reactive protein concentration (P = .016 and P = .005 in models containing the NCEP and IDF definitions, respectively). Systolic blood pressure, age, waist circumference, and fasting blood glucose level were independently associated with increased arterial stiffness. Metabolic syndrome determined increased arterial stiffness independently of other known cardiovascular risk factors. The NCEP and IDF definitions did not differ in their ability to identify subjects with increased arterial stiffness.     

Arterial stiffening as a possible risk factor for both atherosclerosis and diastolic heart failure.

While arterial stiffness is known to be related to atherosclerosis, the association between arterial stiffness and cardiac systolic and diastolic function in hypertension has not been fully evaluated. The present study was conducted to simultaneously evaluate the relationship of brachial-ankle pulse wave velocity (PWV) to parameters reflecting atherosclerosis and to those reflecting the risk of congestive heart failure in patients with hypertension. In 147 patients with hypertension, the left ventricular ejection fraction, the ratio of the peak velocity of early rapid filling and the peak velocity of atrial filling (E/A ratio), and left ventricular mass index were obtained from echocardiographs, the intima-media thickness of the common carotid artery was obtained by ultrasonography, the plasma B-type natriuretic peptide (BNP) level was measured by radioimmunoassay, and the brachial-ankle PWV was measured by the volume rendering method. Brachial-ankle PWV correlated positively with the intima-media thickness of the carotid artery, E/A ratio and BNP. Multiple linear regression analysis demonstrated that the relationship between the brachial-ankle PWV and the E/A ratio was significantly independent from other clinical variables. The receiver operator characteristic curve demonstrated that a brachial-ankle PWV of 1,600 cm/s was useful to discriminate mild cardiac diastolic dysfunction (E/A ratio of < or =0.75) (sensitivity=78% and specificity=58%). The present study demonstrated that increased brachial-ankle PWV relates not only to the parameters reflecting atherosclerosis but also to those reflecting cardiac diastolic dysfunction. Therefore, increased arterial stiffness is a possible simultaneous risk for atherosclerotic cardiovascular disease and diastolic heart failure in patients with hypertension.     

Higher plasma homocysteine concentration is associated with more advanced systemic arterial stiffness and greater blood pressure response to stress in hypertensive patients.

Hyperhomocysteinemia has been reported to be associated with both vascular structure alteration and increased cardiovascular risk. This study examined whether hyperhomocysteinemia causes increased systemic arterial stiffness, thereby enhancing blood pressure response to stress in hypertensive patients. In 50 treated hypertensive patients, we studied brachial-ankle pulse wave velocity (PWV), a new measure for arterial stiffness, blood pressure response to stress, and blood pressure recovery after stress. Autonomic nervous activities were examined by spectral analysis of blood pressure and RR interval variabilities. Total plasma homocysteine and neurohumoral parameters were determined from fasting blood. Brachial-ankle PWV correlated with age (r=0.64, p<0.001), plasma homocysteine concentration (r=0.35, p<0.05), and systolic blood pressure (SBP) (r=0.62, p<0.001). Higher plasma homocysteine concentration was independently associated with greater brachial-ankle PWV (beta=0.388, p=0.01). We classified the subjects into high homocysteine (7.3 nmol/ml or over) and low homocysteine (7.2 nmol/ml or below) groups. Baseline SBP, plasma renin activity, aldosterone, and norepinephrine concentrations were similar between the two groups. However, the SBP values during stress and the recovery periods were higher in the high homocysteine group than the low homocysteine group even after adjusting for sex and age. The behavior of sympathetic vasomotor activity did not differ between the two groups. These data suggest that higher plasma homocysteine concentration is associated with increased systemic arterial stiffness, which may enhance blood pressure reactivity to stress in hypertensive patients.     

Central pulse wave velocity is responsible for increased brachial-ankle pulse wave velocity in subclinical hypothyroidism

Objective Subclinical hypothyroidism affects 5–15% of the general population, and is associated with increased morbidity from cardiovascular disease. We recently reported a significant increase in brachial‐ankle pulse wave velocity (baPWV), a parameter of arterial stiffening and an independent predictor for the presence of cardiovascular disease, in subclinical hypothyroidism. The current study was performed to assess which arterial segment is responsible for enhanced baPWV in subclinical hypothyroidism. Patients and methods Central PWV (PWV in heart‐femoral segments), peripheral PWV (PWV in femoral‐ankle segments), and baPWV were measured in subclinical hypothyroid patients and normal subjects. Results Central PWV, baPWV, and peripheral PWV were significantly higher in subclinical hypothyroid patients than in normal subjects. BaPWV was significantly and positively correlated with central and peripheral PWV in both groups. However, a significant and positive correlation between central and peripheral PWV in normal subjects was not found in subclinical hypothyroid patients. Moreover, stepwise regression analysis showed that the association of central PWV with baPWV was stronger than that of peripheral PWV, whereas in normal subjects central PWV was not associated with baPWV. Conclusions Our results demonstrate that central and peripheral PWV are significantly higher in subclinical hypothyroid patients, and that the increase in baPWV depends more strongly on central PWV than on peripheral PWV in these patients. This suggests that increased elastic arterial stiffening of the aorta, rather than of peripheral muscular arteries, might be more responsible for increased general arterial stiffening in subclinical hypothyroid patients.     

Effects of fluvastatin on the carotid arterial media as assessed by integrated backscatter ultrasound compared with pulse-wave velocity.

OBJECTIVES: Our goal is to show the effectiveness of fluvastatin in reducing arterial sclerosis using integrated backscatter (IB) values rather than depending on the pulse-wave velocity (PWV) and stiffness beta. BACKGROUND: Atherosclerotic changes consist of two components: atherosis as a structural change and sclerosis as a functional change; IB ultrasound of carotid media was useful for assessment of arterial sclerosis. METHODS: We measured IB values in the media of 40 segments of carotid arteries in 40 patients with hyperlipidemia before and after statin therapy or diet for 12 months (fluvastatin [F group] 40 mg/day, n = 20; control [C group]: diet, n = 20). Pulse-wave velocity, intima-media thickness, and stiffness beta were measured at the same time. RESULTS: At baseline, IB values correlated with PWV (r = 0.71, p < 0.001) and stiffness beta (r = 0.47, p = 0.002) in 40 patients with hyperlipidemia. Integrated backscatter values did not change in the C group but decreased in the F group (from 12.3 +/- 2.1 dB to 11.3 +/- 2.1 dB, p = 0.002). Also, PWV increased in the C group (from 1,728 +/- 687 cm/s to 1,771 +/- 716 cm/s, p = 0.021) but decreased in the F group (from 1,848 +/- 582 cm/s to 1,768 +/- 549 cm/s, p = 0.012). Stiffness beta decreased in the F group (from 14.0 +/- 3.9 to 12.1 +/- 3.5, p = 0.002). CONCLUSIONS: Statin therapy with fluvastatin improved arterial sclerosis as assessed by IB values.     

Early identification of vascular damage in patients with systemic sclerosis

Vascular involvement in systemic sclerosis (SSc) plays a key role in the pathogenesis of fibrosis. We assessed arterial stiffness using a new echo-tracking technique in patients with SSc asymptomatic for cardiovascular diseases. We enrolled 22 patients (21 female, 63 ± 14 years) and 20 controls (12 female, 62 ± 3 years). Carotid intima-media thickness (IMT) was comparable between the 2 groups (1.1 ± 0.3 vs 1.0 ± 0.4 mm, P = ns), whereas the stiffness parameters were significantly increased in patients (β: 9.5 ± 4.2 vs 5.8 ± 1.1, P = .001; pulse wave velocity [PWV]: 6.5 ± 1.5 vs 5.2 ± 0.6 m/sec, P = .003). A correlation between stiffness parameters, anti-Scl-70 antibodies (β: r = .46, P = .03; PWV: r = .50, P = .02), and anticentromere antibodies (β: r = -.54, P = .020; PWV: r = -.53, P = .023) was found. Echo-tracking technique may be valuable in early identification of vascular involvement in patients with SSc.     

B-type natriuretic peptide and arterial stiffness in healthy Japanese men

BACKGROUND: Recent evidence suggests that even a slight increase in the plasma level of B-type natriuretic peptide (BNP) may be a marker of cardiovascular risk; however, the mechanisms underlying the association are currently unclear. Because increased arterial stiffness, as reflected by an increase of the pulse wave velocity (PWV) or pulse pressure (PP), may contribute to increasing plasma BNP levels, in the present study we investigated the relationships between the plasma BNP level and the PWV and PP, all of which are known markers of cardiovascular risk, in a healthy male Japanese cohort. METHODS: This was a cross-sectional study of 725 healthy Japanese men (age, 54 +/- 4 years). The PWV was assessed by the volume-rendering method. Plasma BNP levels were determined with a high-sensitivity noncompetitive immunoradiometric assay. RESULTS: A univariate linear regression analysis demonstrated that the plasma BNP level was significantly correlated with age (r = 0.20, P < .01), PWV (r = 0.12, P < .01), and PP (r = 0.17, P < .01). A stepwise multivariate linear regression analysis demonstrated that both the PWV and PP were significantly associated with the plasma BNP level, independent of age. CONCLUSION: In healthy Japanese men, stiffening of large arteries, as evidenced by an increase of the PWV or PP, may account at least in part for elevated plasma BNP levels, even within the so-called normal range.     

Pulse wave velocity is increased in patients with transient myocardial ischemia

OBJECTIVE: We have recently shown that mean pulse pressure is higher in patients with transient myocardial ischemia. Pulse pressure elevation might be an important consequence of increased arterial stiffness. The aim of this study was to prove if arterial stiffness is changed in patients with transient myocardial ischemia who bear a high cardiovascular risk. Additionally we investigated whether arterial stiffness or wave reflection is the best indicator for transient myocardial ischemia. Aortic pulse wave velocity (PWV) is a measure of arterial stiffness, and augmentation index (AIx) an indication of arterial wave reflection. Both are indicators for cardiovascular risk. METHODS: PWV (carotid-femoral) and AIx (SphygmoCor) were assessed in 74 hypertensive patients. Transient myocardial ischemia was detected using an ST-triggered 24-h ambulatory blood pressure monitoring device. RESULTS: ST-segment depressions were recorded in 30 of 74 patients. There were no significant differences with regard to age, mean arterial pressure, systolic blood pressure, diastolic blood pressure or heart rate. PWV was seen to be higher in patients with transient myocardial ischemia (10.6 versus 9.5 m/s, P = 0.036). There was no significant difference in AIx between the two groups. PWV (r = 0.36, P = 0.002) but not AIx correlated with pulse pressure. CONCLUSIONS: PWV is higher in hypertensive individuals (age > 60 years) with transient myocardial ischemia, suggesting that PWV is an indicator of increased cardiovascular risk. Although AIx is known to be associated with several cardiovascular diseases, it was not seen to be associated with silent myocardial ischemia. Our results suggest that the clinical significance of parameters of arterial stiffness and arterial wave reflection change with age, with a higher clinical importance of PWV indicated in patients over the age of 60.     

Aortic stiffness in untreated adult patients with human immunodeficiency virus infection

HIV infection is associated with chronic immune activation, subclinical inflammation, and an atherogenic metabolic profile. It remains controversial whether HIV infection is a risk factor for accelerated arteriosclerosis independent from the effects of antiretroviral drugs. We investigated whether aortic stiffness, an early marker of arteriosclerosis, is increased in HIV patients who were not under antiretroviral treatment. In 39 untreated HIV-infected patients and 78 individually matched age-, sex-, and blood pressure-matched HIV-uninfected control subjects, we determined aortic pulse wave velocity (PWV), a direct noninvasive measure of aortic stiffness, by tonometric method. Subjects with overt cardiovascular disease or major cardiovascular risk factors were excluded from the study. Prevalence of the metabolic syndrome was higher in HIV patients (18% versus 5%; P=0.025). HIV patients had a higher aortic PWV (7.5+/-1.4 versus 6.7+/-1.1 m.s(-1); P=0.001) than control subjects. Age, mean arterial pressure as a measure of distending pressure, and HIV infection (all P<0.05) independently predicted aortic PWV when a consistent number of cardiovascular risk factors was simultaneously controlled for. Among HIV-infected subjects, serum gamma-glutamyl transpeptidase concentration (beta=0.46; P=0.003) and mean arterial pressure (beta=0.32; P=0.03) were independent determinants of aortic PWV. In conclusion, aortic stiffness is increased in HIV-infected individuals who have never received antiretroviral therapy. PWV increases with increasing serum gamma-glutamyl transpeptidase concentration. Our data support the hypothesis that HIV infection is a risk factor for arteriosclerosis.     

Arterial distensibility in Wegener's granulomatosis: a carotid-femoral pulse wave velocity study.

OBJECTIVE: The purpose of this study was to test the hypothesis; that chronic inflammation may impair vascular function and lead to an increase of arterial pulse wave velocity (PWV) in patients with Wegener's granulomatosis (WG). METHODS: We recruited 5 patients with WG and 5 healthy age and sex matched controls in this cross-sectional case-controlled study. Aortic PWV was determined by using an automatic device (Complior Colson, France), which allowed on-line pulse wave recording and automatic calculation of PWV. RESULTS: The carotid-femoral (aortic) PWV was increased in patients with WG as compared with control group (p=0.04). Although we found positive correlation between PWV and heart rate (r=0.75, p=0.01), we did not find any significant correlation between PWV and anthropometric and other hemodynamic parameters (p>0.05). In addition, we found positive correlation between PWV and erythrocyte sedimentation rate in patients with WG (r=0.90, p=0.03). CONCLUSION: Pulse wave velocity is increased and arterial distensibility decreased in patients with WG. Measurements of carotid-femoral (aortic) PWV may provide an easy and noninvasive technique to identify patients at increased risk of arterial disease.     

Acute effect of DDD versus VVI pacing on arterial distensibility

Pulse wave velocity (PWV) is a new technique and frequently used today to determine the elastic distensibility of great arteries. Increased arterial stiffness and PWV have been proposed as possible mechanisms in the initiation and/or progression and/or complications of atherosclerosis and cardiovascular disease. We evaluated the acute effect of two frequently used pacing modes (DDD vs. VVI) on arterial distensibility using PWV. METHODS: Seventeen patients (age, 56 +/- 14 years) implanted with DDD pacemakers were included in the study. All patients were pacemaker dependent and continuously paced at the programmed rate. PWV was measured first in DDD mode, and then the mode was switched to VVI, and PWV was measured again at the same programmed heart rate as in the DDD mode. RESULTs: Although systolic blood pressure significantly decreased from 129 +/- 18 to 119 +/- 16 mm Hg (p = 0.001) after switching the mode from DDD to VVI, diastolic blood pressure (81 +/- 12 vs. 80 +/- 13 mm Hg; p = 0.38) did not change. In addition, PWV significantly increased from 11 +/- 2.46 m/s in DDD mode to 11.29 +/- 2.43 m/s (p = 0.01) after having been programmed to VVI mode. CONCLUSIONS: Our results suggest that VVI pacing increases PWV, and therefore decreases arterial distensibility, and thus may contribute to the development and progression of atherosclerosis.     

Relationship between low serum endogenous androgen concentrations and arterial stiffness in men with type 2 diabetes mellitus

The aim of this study was to evaluate the relationship between arterial stiffness determined by pulse wave velocity (PWV) and serum endogenous androgen concentrations as well as major cardiovascular risk factors in men with type 2 diabetes mellitus. Serum free testosterone and dehydroepiandrosterone sulfate (DHEA-S) concentrations were measured in 268 men with type 2 diabetes mellitus. Relationships between PWV and serum endogenous androgen concentrations as well as major cardiovascular risk factors, including age, blood pressure, serum lipid concentration, glycemic control (hemoglobin A(1c)), body mass index, and degree of albuminuria, were evaluated. Positive correlations were found between PWV and age (r = 0.491, P < .0001), duration of diabetes (r = 0.320, P < .0001), systolic blood pressure (r = 0.292, P < .0001), and log (urinary albumin excretion) (r = 0.269, P < .0001). Inverse correlations were found between serum free testosterone concentration and PWV (r = -0.228, P = .0003) and between serum DHEA-S concentration and PWV (r = -0.252, P = .0002) in men with type 2 diabetes mellitus. Pulse wave velocity was significantly greater in patients with lower concentrations of free testosterone (<10 pg/mL) than in patients with higher concentrations of free testosterone (1864 +/- 359 vs 1736 +/- 327 cm/s; P = .0053). Pulse wave velocity also was significantly greater in patients with lower concentrations of DHEA-S (<1000 ng/mL) than in patients with higher concentrations of DHEA-S (1843 +/- 371 vs 1686 +/- 298 cm/s; P = .0008). Multiple regression analysis identified both serum free testosterone concentration (beta = -.151, P = .0150) and serum DHEA-S concentration (beta = -.200, P = .0017) as independent determinants of PWV. In conclusion, serum endogenous androgen concentrations are inversely associated with arterial stiffness determined by PWV in men with type 2 diabetes mellitus, which is true for men in general based on other works.     

Does the serum uric acid level have any relation to arterial stiffness or blood pressure in adults with congenital renal agenesis and/or hypoplasia?

Background: The relationship between serum uric acid and arterial stiffness or blood pressure is not clear. The serum uric acid level and its association with cardiovascular risk is not well known in patients with reduced renal mass. We aimed to investigate the relation between serum uric acid levels and arterial stiffness and also blood pressure in patients with congenital renal agenesis and/or hypoplasia. Material and Methods: In this single center, cross-sectional study, a total of 55 patients (39 (% 70.9) with unilateral small kidney and 16 (%29.1) with renal agenesis) were included. The median age was 35 (21–50) years. The study population was divided into tertiles of serum uric acid (according to 2.40–3.96, 3.97–5.10, and 5.11–9.80 mg/dl cut-off values of serum uric acid levels). Official and 24-h ambulatory non-invasive blood pressures of all patients were measured. The arterial stiffness was assessed by pulse wave velocity (PWV). Results: PWV values were increased from first to third tertile (5.5 ± 0.6, 5.7 ± 0.8, 6.1 ± 0.7, respectively), but this gradual increase between tertiles did not reach significance. Linear regression analyses showed a positive correlation between serum uric acid levels and PWV (β = 0.40, p = 0.010), but no correlation was found between uric acid and daytime systolic blood pressure (β = 0.24, p = 0.345). Conclusion: In congenital renal agenesis/hypoplasia, the serum uric acid level was positively correlated with arterial stiffness, but there was no correlation with blood pressure.     

Impact of serum parathyroid hormone concentration and its regulatory factors on arterial stiffness in patients undergoing maintenance hemodialysis

BACKGROUND: Cardiovascular mortality is extremely high in patients on hemodialysis. Among a variety of pathophysiological conditions, deranged calcium homeostasis including secondary hyperparathyroidism may be one of the factors contributing to cardiovascular disease in patients on hemodialysis. This study was designed to evaluate the role of the serum parathyroid hormone (PTH) concentration and its regulatory factors in serum on arterial stiffness in patients on maintenance hemodialysis. METHODS: Arterial stiffness was assessed by pulse wave velocity (PWV) in 73 non-diabetic patients undergoing maintenance hemodialysis. At the same time, serum concentrations of calcium, phosphate, and intact PTH were measured. RESULTS: Single regression analyses revealed that arterial PWV was positively correlated with age (r = 0.505, p < 0.0001), systolic blood pressure (r = 0.250, p = 0.043), and pulse pressure (r = 0.306, p = 0.012). It was inversely correlated with the serum phosphate concentration (r = -0.240, p = 0.041) and the duration of hemodialysis treatment (r = -0.343, p = 0.003), but not with serum concentrations of calcium and intact PTH or the calcium x phosphate product in serum. By multiple regression analysis age was found to be the most significant variable affecting arterial PWV, and the duration of hemodialysis treatment negatively influenced arterial PWV. CONCLUSION: Age is an independent risk factor for arterial stiffness in patients on maintenance hemodialysis, and the serum PTH concentration and its regulatory factors in the serum are not.     

Effects of atorvastatin on aortic pulse wave velocity in patients with hypertension and hypercholesterolaemia: a preliminary study

As statins may contribute to plaque stabilisation, it is important to evaluate whether these drugs may modify arterial stiffness. In 23 patients, aged 32-70 years, with hypertension and hypercholesterolaemia, a double-blind randomised study vs placebo was performed to evaluate whether atorvastatin was able to modify aortic stiffness, measured from aortic pulse wave velocity (PWV), after a 12-week treatment. The results revealed that atorvastatin did not change blood pressure, significantly lowered (P<0.003; <0.002) plasma total and LDL cholesterol, and increased aortic PWV by +8% (vs -2% under placebo) (P相似文献   

Takayasu's arteritis: a cause of prolonged arterial stiffness

OBJECTIVES: Cardiovascular disease is a major cause of mortality and morbidity in patients with Takayasu's arteritis (TA). Increased arterial stiffness is an independent risk factor and predictor of cardiovascular mortality in a variety of diseases. Pulse wave velocity (PWV) and the augmentation index (AI) are used as clinical measurements of arterial stiffness. METHODS: Data are presented from 10 patients with TA and 11 normal controls obtained between 2000 and 2004. Arterial compliance was assessed non-invasively by measurement of PWV, using the Complior system, and calculation of the aortic AI. RESULTS: TA patients (mean age 40.8+/-13.2 yr) were compared with a control group of healthy women from a parallel study (mean age 32.3+/-5.5 yr). The mean carotid-femoral PWV (PWV-CF) was higher in TA patients (P = 0.03). In addition, both aortic AI derived from the radial artery (P = 0.002) and carotid AI (P = 0.03) were higher in TA patients compared with controls. PWV-CF did not correlate with CRP (r = - 0.23, P = 0.23) or ESR (r = - 0.19, P = 0.27). Similar results were obtained for the correlation of carotid-radial PWV with CRP (r = 0.15, P = 0.32) and ESR (r = 0.33, P = 0.14). CONCLUSIONS: Our data show that TA is associated with elevated arterial stiffness in the central aorta, which may persist when the disease is quiescent. These data suggest that PWV represents a means by which cardiovascular risk can be detected and monitored in TA, and highlights the importance of effective management of cardiovascular risk factors in these patients.     

桡动脉增强指数与心血管病危险及动脉僵硬度相关分析

目的 探讨桡动脉增强指数(rAI)与心血管病危险及动脉僵硬度相关性。方法 北京地区4985例(男2417例,女2568例),年龄18 ～96(50.9±14.7)岁,测量左侧rAI;应用脉搏波传播速度(PWV)自动测量系统测定颈-股动脉PWV(CFPWV)和颈-桡动脉PWV(CRPWV)。并对其中没有心血管病的人群应用Framingham危险评分和中国缺血性心血管病危险评分分别计算个体心血管病风险。结果 女性的rAI显著高于男性[(83.18±12.36)％比(71.93±15.22)％,P＜0.01]。相关分析rAI无论与两种心血管评分还是与CFPWV、CRPWV均有显著相关性;当校正了年龄、舒张压、吸烟、心率、身高、腰围及空腹血糖后rAI仍与Framingham评分及中国心血管评分有相关性,其中男、女性相关系数r分别为0.17、0.09和0.12、0.08(P值均＜0.05),rAI仅与CFPWV有相关性(男女分别为r=0.14、0.10,P＜0.01),而与CRPWV无相关性。在相对年老的人群中(＞50岁)rAI与心血管病危险评分及PWV的相关性减弱。结论 rAI可能是一种预测心血管病风险及评估动脉僵硬度的有价值工具;作为危险分层的工具,rAI可能更适用于相对年轻的人群。     

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.