Vascular function correlates with risk factors for cardiovascular disease in a healthy population of 35-year-old subjects

OBJECTIVE: To investigate whether, in a healthy, randomly selected population of 35-year-old men and women, there is a relation between vascular function and conventional risk factors for cardiovascular disease such as gender, smoking, elevated blood-lipids, high blood pressure and heredity for cardiovascular disease, and to blood glucose. DESIGN: Basal brachial artery diameter was measured. Endothelial function was measured as flow mediated dilation (FMD) in response to reactive hyperaemia. The nonendothelial dependent dilation was measured after sublingual nitro-glycerine (NTG). SETTING: A research centre of general medicine and a university hospital. SUBJECTS: One hundred men and 100 women all 35 years old, were invited by letter. Sixty-six of the 92 men (72%) living in the community and 74 of the 88 women (84%) participated. RESULTS: Gender had the largest influence on FMD and NTG induced arterial dilation, probably reflecting the larger vessel diameters in the men as FMD and NTG induced dilation is inversely related to basal vessel size (r = -0.55, P < 0.001 and r = -0.40, P < 0.001). In women basal vessel diameter was positively correlated to blood glucose (r = 0.35, P = 0.009) and BMI (r = 0.34, P = 0.012) and negatively correlated to HDL cholesterol (r = -0.43, P = 0.001). FMD and NTG induced arterial dilation correlated with a combined risk factor score (r = -0.32, P = 0.019 and r = -0.31, P = 0.024). The men with the highest risk factor scores had larger vessel size and higher blood flow at rest compared to men without risk factors (4.8 +/- 0.6 mm, 240 +/- 84 mL min-1 and 4.0 +/- 0.8 mm, 139 +/- 72 mL min-1, respectively, P = 0.014 and P = 0.016). FMD or NTG induced dilation did not correlate to any of the risk factors in men. CONCLUSIONS: There are correlations between vascular reactivity and risk factors for IHD in women and correlations between vessel diameter and risk factors for IHD in both men and women already in a healthy population 35-year-old subjects. Further studies are needed to determine if the vessel diameter in itself, in a healthy population, is a sign of attenuated endothelial function.     

老年冠心病患者冠状动脉病变程度与血管内皮功能的关系

目的探讨老年冠心病患者冠状动脉病变程度与血管内皮功能的关系。方法应用高分辨率彩色多普勒超声诊断仪对176例健康老年人(健康对照组)及161例老年冠心病患者(冠心病组)进行肱动脉血管内皮功能的超声检测,并对老年冠心病组患者冠状动脉病变支数与肱动脉血管内皮功能进行分析。结果反应性充血(reactive hyperemia,RH)后血管内径的变化率(flow-mediated diameter,FMD)及RH在老年冠心病组分别为6.05%及56.29%,而在健康对照组则分别为16.12%及127.23%,差异有显著性意义(P<0.001)。FMD在1支冠状动脉病变时为6.37%,在2支冠状动脉病变时下降为5.69%,而在3支冠状动脉病变时仅为3.94%;RH在1支冠状动脉病变时为62.19%,在2支冠状动脉病变时下降为53.45%,而在3支冠状动脉病变时仅为40.13%,差异有显著性意义(P<0.01)。结论老年冠心病组血管内皮功能较健康对照组明显减退。随着冠心病患者冠状动脉血管病变程度的增加,血管内皮功能进一步减退。血管内皮功能的减退在一定程度上可能反映了冠状动脉血管病变的严重程度。     

阿卡波糖对餐后高血糖患者血管内皮功能的影响

目的研究阿卡波糖对餐后高血糖患者血管内皮功能的影响。方法选择新诊断为2型糖尿病、行口服葡萄糖耐量试验餐后高血糖患者58例,分为常规组26例和治疗组32例。检测患者治疗前后体重指数、TC、TG、LDL-C、HDL-C、空腹血糖、空腹胰岛素、糖化血红蛋白(HbA1c)、高敏C反应蛋白(hs-CRP)、血管性血友病因子(vWF)、葡萄糖耐量试验2 h血糖、2 h胰岛素及肱动脉内皮依赖性舒张功能(EDD)。结果与治疗前比较,治疗后2组患者体重指数、2 h血糖、2 h胰岛素、HbA1c、vWF明显降低,EDD明显增大(P0.05,P0.01);与常规组比较,治疗组患者2 h血糖、2 h胰岛素、HbA1c、hs CRP、vWF明显降低,EDD增大更明显(P0.05,P0.01)。多因素逐步回归分析显示,EDD与2 h血糖、2 h胰岛素、HbA1c、hs-CRP呈负相关。结论阿卡波糖可能通过降低餐后高血糖,改善机体胰岛素抵抗,使血管内皮功能得到改善,延缓动脉粥样硬化的发生、发展。     

空腹血糖受损与糖耐量受损患者血管内皮功能的对比研究

目的:应用多普勒超声技术检测空腹血糖受损(IFG)与糖耐量受损(IGT)患者的血管内皮功能,探讨其对动脉粥样硬化的影响。方法:根据口服葡萄糖耐量试验(OGTT)结果,选择血糖正常(NGT)组25例,IFG组24例,IGT组22例,检测TC、TG、LDL-C、HDL-C、空腹血糖(FPG)、空腹胰岛素(FINS)、糖化血红蛋白(HbA1C)、高敏C反应蛋白(hs-CRP)及血管性血友病因子(vWF),OGTT后2h血糖(2hPG)及2h胰岛素(2hINS),以及肱动脉内皮依赖性舒张功能(EDD)。结果:IGT组vWF较IFG组、NGT组明显升高[(170.25±21.76)%∶(155.16±17.19)%、(135.46±15.52)%,P<0.05～0.01],肱动脉EDD较IFG组、NGT组明显降低[(4.86±0.94)%∶(5.47±0.90)%、(6.24±0.97)%,P<0.05～0.01];IFG组vWF较NGT组明显升高[(155.16±17.19)%∶(135.46±15.52)%,P<0.05],肱动脉EDD较NGT组明显降低[(5.47±0.90)%∶(6.24±0.97)%,P<0.05]。多因素逐步回归分析显示,EDD与2hPG、LDL-C明显负相关(r分别为-0.73、-0.59,P<0.05)。结论:IGT较IFG对血管内皮功能危害更大,加强IGT防治对延缓动脉粥样硬化更为重要。     

Obesity, weight loss, and vascular function

Obesity promotes the development of several major cardiovascular risk factors. Moreover, excess adiposity may play a direct role in initiating atherosclerosis as fat cells are capable of affecting the systemic vasculature through a variety of mechanisms. Recent studies demonstrate that obesity per se may impair vascular endothelial function. This is important as endothelial dysfunction is a key factor in the pathogenesis of atherosclerosis and in triggering acute ischemic events. At present, few studies have determined the beneficial impact of weight loss on cardiovascular outcomes and mortality. However, several experiments have demonstrated that weight loss can lead to improvements in endothelial function, a validated surrogate marker of cardiovascular risk. The mechanisms whereby weight loss restores vascular health are likely multifactorial. However, the relative importance of reduced adiposity versus the specific dietary regimens prescribed, the role of concomitant exercise, and the direct effect of medications remain unclear. Several other unresolved issues such as the longevity of improvement, the amount of weight loss required, and whether the improvement in endothelial function actually translates into a reduction in cardiovascular events also remain to be determined. Nevertheless, lifestyle changes that lead to weight reduction are able to improve vascular function in over-weight adults.     

心-踝血管指数—— 动脉粥样硬化无创检测指标: 845例分析

目的用无创方法检测青年和老年人心．踝血管指数（CAVI）,分析动脉粥样硬化（AS）和血管硬度的影响因素。方法845例住院、门诊及正常体检者（男594例、女251例,年龄35-85岁）测定CAVI,并进行诊室血压、血脂、血糖、肾功能、心电图及胸部X线检查,记录既往史。结果845例中54．2％CAVI异常（458例）;CAVI增加与年龄、血压、脉压差等因素密切相关;随年龄增长,并存疾病如高血压、糖尿病、冠心病、脑卒中及血脂异常,特别是冠心病、高血脂检出率升高;吸烟对CAVI影响显著,吸烟并存疾病可使CAVI进一步升高。结论CAVI是新的AS评估指标,与多种因素有关,吸烟及吸烟并存疾病对CAVI均有明显影响。结果提示,AS应根据患者各自不同的影响因素进行个性化综合防治。     

Relationships between perioperative vascular endothelial function and cardiovascular changes

Background Perioperative cardiovascular complications occurred frequently,especially coronary heart disease,as atherosclerosis risk factors in patients.To explore the perioperative arterial vascular endothelial function and carotid intima-media thickness(IMT) as atherosclerosis early pathological changes of alternative indicators forecast the possibility of cardiovascular complications.Methods We selected surgery patients 150 cases:including atherosclerosis risk factors group(ASF group):73 cases,among them,22 cases had carotid artery atherosclerosis plaque(ASF:IMT Plaque) and 51 cases had no plaque(ASF:NO-IMT Plaque);and non-risk factors group(NO-ASF group):77 cases,among them,18 cases had carotid artery atherosclerosis plaque(NO-ASF:IMT Plaque) and 59 cases had no plaque(NO-ASF:NO-IMT Plaque).Arterial vascular endothelial function was measured as flow-mediated dilation(FMD) of the brachial artery using high-resolution B-mode ultrasonic device,for one day before operation(the baseline of value),on two hours from recovery after general anesthesia,the first day after operation,the fifth days after operation.Results FMD of two groups on two hours was reduced,compared with the baseline,but FMD of ASF group was decreased significantly(P = 0.032);FMD of ones further was increased on Day 1 and Day 5,but NO-ASF group was increased significantly(P < 0.05);FMD of the baseline and atherosclerosis risk factors was negatively correlated(R =-0.216,P = 0.023).FMD of ASF:IMTP group was decreased significantly respectively in four times,compared with the ASF:NO-IMTP group(P = 0.034,P = 0.009,P = 0.001 and P = 0.017).FMD of NO-ASF:IMTP group was decreased significantly respectively in four times,compared with the NO-ASF:NO-IMTP group(P = 0.006,P = 0.005,P = 0.000 and P = 0.000).Pulse pressure(PP) was not different on Day 1(P = 0.26),and was different between the two groups in the remaining three periods(P = 0.035,P = 0.040 and P = 0.014);SBP was not different between the basic value(P > 0.05),there were differences in the other three times(P < 0.05).While Nitroglycerin-induced dilation(NTG) was stable throughout.Conclusions Arterial endothelial function was correlative with atherosclerosis risk factors,and that EDD and IMT as atherosclerosis alternative indicators forecast cardiovascular and cerebrovascular events after surgery is feasible.     

Cardiovascular events and all-cause mortality by albuminuria and decreased glomerular filtration rate in patients with vascular disease

Objectives. Albuminuria and decreased estimated glomerular filtration rate (eGFR) are associated with increased cardiovascular risk, but do not necessarily coexist and have different pathophysiological mechanisms. This study aims to evaluate separate and combined effects of decreased eGFR and albuminuria on the occurrence of vascular diseases and mortality in patients with vascular disease. Design. Prospective cohort study. Setting. University Medical Center Utrecht, the Netherlands. Subjects and main outcome measures. 2600 patients with vascular disease were followed for vascular events, vascular and all‐cause mortality. Cox regression analysis was used to calculate hazard ratios (HRs) according to eGFR (MDRD) and albuminuria (albumin‐to‐creatinine ratio >3 mg mmol⁻¹). Results. In this population, 14.0% had albuminuria, 15.6% had eGFR <60 ml min⁻¹ 1.73 m⁻² and 5.2% had both. Nonalbuminuric decreased eGFR and albuminuria with normal eGFR generated moderately increased risks on all outcomes. eGFR <60 ml min⁻¹ 1.73 m⁻² without albuminuria mainly influenced the risk of vascular events (HR 1.50; 1.05–2.15) whilst albuminuria with eGFR ≥60 ml min⁻¹ 1.73 m⁻² principally affected all‐cause mortality (HR 1.53; 1.04–2.26). The combination of eGFR <60 ml min⁻¹ 1.73 m⁻² and albuminuria was associated with an increased risk for vascular events (HR 2.27; 1.54–3.34), vascular mortality (HR 2.22; 1.40–3.52) and all‐cause mortality (HR 1.84; 1.25–2.69). Comparable results were found in additional analyses amongst 759 diabetic patients. Conclusions. The combination of decreased eGFR with albuminuria is associated with the highest risks of vascular events, vascular and all‐cause mortality in patients with vascular diseases. To adequately estimate vascular risk associated with impaired renal function, both eGFR and urinary albumin should be considered.     

外周血管内皮功能、炎症因子与冠状动脉粥样硬化性心脏病的关系

目的研讨外周血管内皮功能、炎症因子与冠状动脉粥样硬化性心脏病(冠心病)的相关性。方法纳入疑似冠心病受试者95例,经冠状动脉造影(coronary angiography,CAG)分为冠心病组(n=51)即CAG阳性及对照组(n=44)即CAG阴性,对入选患者进行肱动脉血流介导的血管舒张功能(flow-mediated dilatation,FMD)及硝酸甘油依赖的血管扩张(nitroglycerin-mediated dilatation,NMD)检测。并检测血液中炎症因子指标:超敏C-反应蛋白、白细胞介素-2、白细胞介素-4、白细胞介素-6、白细胞介素-10及肿瘤坏死因子-α、干扰素-γ。结果 (1)冠心病组FMD明显低于对照组,差异有统计学意义(4.13%±3.67%vs.6.52%±4.58%,P=0.006);两组NMD比较,差异无统计学意义(17.7%±0.76%vs.16.9%±6.61%,P=0.59)。(2)两变量关联性分析示FMD与吸烟(r=-0.2860,P=0.002)、原发性高血压(r=-0.177,P=0.043)、尿酸(r=-2.2,P=0.016)、冠状动脉病变(r=-0.31,P=0.001)呈负相关性;与性别(r=0.193,P=0.03)、高密度脂蛋白(r=0.175,P=0.045)呈正相关性。(3)多重线性回归分析示冠状动脉病变与FMD呈负相关性(β=-1.011,P=0.001,t=-3.277)。冠心病组白细胞介素-2浓度高于对照组,差异有统计学意义[(4.15±0.34)pg/m L vs.(3.98±0.42)pg/m L,P=0.03]。结论肱动脉FMD在冠心病预测、诊断上有一定临床应用价值,在反映冠状动脉病变上有一定的参考价值。     

The relationship of renal function to segmental vascular stiffness,ankle‐brachial index,and peripheral artery disease

The authors consecutively assessed various arterial pulse‐wave velocity (PWV) indices and ankle‐brachial index (ABI) by an automatic device (VP2000, OMRON Health Care Co. Ltd., Kyota, Japan) in outpatients with ≥ 1 cardiovascular risk. PAD was defined as ABI ≤ 0.9. Among 2309 outpatients (mean age 62.4 years), worse renal function was associated with higher brachial‐ankle PWV, heart‐carotid PWV, heart‐femoral PWV (hf‐PWV), and lower ABI (all P < .001). Multivariate regression models showed independent associations between lower eGFR, lower ABI (Coef: 0.42 & 0.41 for right and left), higher hf‐PWV (Coef: −11.4 [95% CI: −15.4, −7.3]) and greater PAD risk (adjusted OR: 0.83 [95% CI: 0.76, 0.91], all P < .05). eGFR set at 77 mL/min/1.73m² was observed to be useful clinical cutoff (c‐statistics: 0.67) for identifying PAD (P for ΔAUROC: .009; likelihood X ²: 93.82 to 137.43, P < .001) when superimposed on clinical risks. This study suggested early renal insufficiency is tightly linked to region‐specific vascular stiffness and PAD.     

Age‐related difference of the association of cardiovascular risk factors with the cardio‐ankle vascular index in the Cardiovascular Prognostic Coupling Study in Japan (the Coupling Registry)

The value of the cardio‐ankle vascular index (CAVI) increases with age. All large‐scale studies of the CAVI have investigated patients <80 years old. Thus, the clinical characteristics of high CAVI in patients aged 80 or more remain unclear. Therefore, we investigated (1) the CAVI in very elderly patients and (2) the determinants of a high CAVI in high‐risk patients, including very elderly patients. The Cardiovascular Prognostic Coupling Study in Japan (Coupling Registry) is a prospective observational study of Japanese outpatients with any cardiovascular risk factors. We enrolled 5109 patients from 30 institutions (average age 68.7 ± 11.4 years, 52.4% males). We investigated the determinants of the CAVI by separating the patients into three groups: 970 middle‐aged (<60 years), 3252 elderly (60‐79 years), and 887 very elderly (≥80 years) patients. The CAVI values of the males were significantly higher those of the females in all age groups (<60 years: 7.81 ± 1.11 vs. 7.38 ± 0.99, P < .001; 60‐79 years: 9.20 ± 1.29 vs. 8.66 ± 1.07, P < .001; ≥80 years: 10.26 ± 1.39 vs. 9.51 ± 1.12, P < .001). In all age groups, the CAVI of the patients with diabetes/glucose tolerance disorder was higher than that of the patients without diabetes/glucose tolerance disorder (<60 years: 7.82 ± 1.22 vs 7.58 ± 1.03, P = .002; 60‐79 years: 9.23 ± 1.20 vs 8.78 ± 1.19, P < .001; ≥80 years: 10.04 ± 1.24 vs 9.75 ± 1.32, P = .002). The determinants of the CAVI in these very elderly patients were age, male sex, low BMI, and mean blood pressure. Diabetes/glucose tolerance disorder and glucose were independently associated with the CAVI in the patients aged <60 years and 60‐79 years, but not in those aged ≥80 years after adjusting for other covariates.     

通心络对急性冠状动脉综合征患者介入术后血小板活化及血管内皮功能的影响

目的评价通心络胶囊对急性冠状动脉综合征(ACS)介入治疗术后血小板活化状态及血管内皮功能的影响。方法90例ACS患者(ACS组)随机分为通心络胶囊治疗组(45例)和常规治疗组(45例),另选健康对照组45例,分别检测血小板表面活性标记蛋白CD62P、CD63和膜糖蛋白(GP)Ⅱb/Ⅲa,测定血浆血管性假血友病因子(vWF),并测量内皮依赖性血管舒张功能(FMD)。服用通心络胶囊治疗8周后复查上述指标并进行治疗前后比较及两组间比较。结果与健康对照组比较,ACS组患者血小板活化指标CD62P、CD63及GPⅡb/Ⅲa受体复合物显著升高(P<0.01),vWF显著升高(P<0.01),FMD显著降低(P<0.01)。冠状动脉介入术后vWF升高(P<0.05),FMD降低(P<0.05)。与常规治疗组比较,通心络胶囊治疗组更明显降低CD62P、CD63、vWF(P<0.05)及GPⅡb/Ⅲa复合物(P<0.01),增加FMD的水平(P<0.05)。结论通心络胶囊可用于冠状动脉介入术前后预防和治疗冠状动脉内血栓及保护血管内皮功能。     

老年冠心病合并糖尿病患者血管内皮功能的变化

目的探讨老年冠心病患者以及冠心病合并糖尿病患者肱动脉内皮依赖性舒张功能(EDD)、非内皮依赖性舒张功能(EID)、血浆一氧化氮(NO)、内皮素(ET)的水平,为临床防治提供依据。方法采用高分辨率超声诊断系统分别检测35例老年冠心病患者(冠心病组,年龄62~91岁)以及32例老年冠心病合并糖尿病患者(冠心病合并糖尿病组,年龄65~89岁)肱动脉的EDD及EID;同时采用还原、比色法测定NO水平;采用放射免疫法检测ET水平,并分别与40例健康老年人(健康对照组,年龄61~86岁)进行对比。结果老年冠心病合并糖尿病组肱动脉的EDD、EID以及血浆NO水平均显著低于老年冠心病组和健康对照组(P<0.05),而老年冠心病组的EDD、EID以及血浆NO水平亦显著低于健康对照组(P<0.05);老年冠心病合并糖尿病组的ET却显著高于老年冠心病组和健康对照组(P<0.05),老年冠心病组ET水平显著高于健康对照组(P<0.05)。结论(1)老年冠心病及冠心病合并糖尿病组肱动脉EDD及EID均受损;(2)老年冠心病及冠心病合并糖尿病组均存在血管内皮功能失调,且冠心病合并糖尿病组内皮功能紊乱更严重;(3)改善血管内皮功能、控制血糖是减少心血管事件的重要措施之一。     

高动物蛋白饮食对高血压患者血管功能及心血管危险因素的影响

目的 调查高血压患者的生活方式,了解高动物蛋白饮食对血管功能和颈动脉内膜中层厚度等心血管危险因素的影响。方法 在我院心血管门诊选取符合纳入标准的高血压患者88例,通过问卷调查方式获取参与者的一般生活方式,检测肱动脉血流介导的血管舒张功能（FMD）和肱踝脉搏波传导速度,同时收集患者颈动脉内膜中层厚度（IMT）等一般临床资料,分析高动物蛋白饮食与血管功能及颈动脉内膜中层厚度等心血管危险因素的相关性。结果 男性52例,女性36例,年龄中位数42 (38, 53)岁。平均动脉压中位数106 (97, 112) mmHg,最高平均动脉压中位数123 (116, 132) mmHg。FMD中位数5.1 (3.8, 7.3)%,IMT中位数0.9 (0.8, 1.2) mm。在日常饮食中,偏向于高动物蛋白饮食的39例,比较均衡的36例;高动物蛋白饮食与FMD显著负相关,与IMT显著正相关;而且,动物蛋白摄入量较大的受试者倾向于存在更大的心血管风险。结论 高血压患者在接受有效降压治疗的同时,应采取健康的生活方式,均衡饮食,避免过高的动物蛋白摄入量,可能有助于降低心血管疾病风险。     

Correlations between brachial endothelial function and cardiovascular risk factors: a survey of 2,511 Chinese subjects

Objective

We examined the relationship of several cardiovascular risk factors (CVRF) to brachial artery flow-mediated dilatation (FMD) in Chinese subjects.

Methods

This was a cross-sectional study. In 2,511 Chinese adults (age 46.86±9.52 years, 1,891 men and 620 women) recruited from people who underwent health screening at The Third Xiangya Hospital, patients’ CVRF [age, body mass index (BMI), waist circumference (WC), blood pressure (BP), cholesterol parameters, creatinine (Cr), uric acid (UA), glucose level and smoking] and prevalence of present disease (hypertension, diabetes mellitus, coronary heart disease and hyperlipidemia) were investigated.

Results

Multivariate analysis revealed that FMD negative correlated with age (β=–0.29, P<0.001), gender (β=–0.12, P<0.001), BMI (β=–0.12, P=0.001), WC (β=–0.10, P=0.011), systolic BP (SBP) (β=–0.12, P<0.001), fasting glucose (β=–0.04, P=0.009), total cholesterol (TC) (β=–0.04, P=0.014), smoking (β=–0.05, P=0.003), and baseline brachial artery diameter (β=–0.35, P<0.001). FMD decreased with increasing age in both genders. In women, FMD was higher than men and age-related decline in FMD was steepest after age 40; FMD was similar in men above 55 years old.

Conclusions

In Chinese subjects, FMD may be a usefully marker of CVRF. Age, gender, BMI, WC, SBP, fasting glucose, TC, smoking, and baseline brachial artery diameter were independent variables related to the impairment of FMD. The influence of CVRF on endothelial function is more in women than men.     

冠心病患者血管内皮细胞功能的变化

目的　探讨血管内皮细胞功能障碍与冠心病 (CHD)的关系。方法　采用二维超声检测 70例CHD患者肱动脉血管内径 (内皮依赖性和内皮非依赖性舒缩功能 ) ,同时采用生化比色法测定CHD患者血浆一氧化氮 (NO) ,用放射免疫法测定血浆内皮素 (ET)、前列腺素 (PGI2 )、血栓素A2 (TXA2 )、肿瘤坏死因子 (TNF)、心钠素 (ANP)及降钙素基因相关肽 (CGRP)浓度 ,并以 2 0例健康人为对照组。结果　CHD组内皮依赖性血管舒缩功能与对照组比较明显降低 ,内皮非依赖性血管舒缩功能与对照组比较差异无显著性意义 ;CHD组与对照组比较 ,血浆平均ET、TXA2 、TNF显著升高 ,而血浆NO、PGI2 、ANP、CGRP水平显著降低。结论　内皮细胞功能障碍及其内皮源性血管活性物质和影响内皮功能的血管活性物质的失衡 ,在CHD的发病机制中起重要作用