Association between lipid profile and endothelial dysfunction as assessed by the reactive hyperemia index

Abstract Purpose of the study. Was to identify the features of blood lipid spectrum and endothelium functional state in patients with rheumatoid arthritis (RA) and arterial hypertension (AH). Materials and methods. 83 patients were examined (40 with RA combined with AH, 23 with RA and 20 with AH). The blood lipid spectrum and endothelial function were studied in all patients. Results. The analysis of blood serum lipid parameters demonstrated that in patients with RA, regardless of the presence of AH, there was a significant increase of proatherogenic lipid profile parameters in comparison with those in healthy subjects. It was shown, that lower concentrations of high-density lipoproteins and higher atherogenic coefficient indices was a characteristic feature of the lipid profile in RA patients both with and without AH - in contrast to the same parameters of the lipid spectrum in patients with AH without RA. In the groups of patients with RA a significant increase of the brachial artery diameter at rest and decreased indices of endothelium-dependent vasodilation and endothelium-independent vasodilation were revealed. Subjects with RA in combination with AH had significantly lower indices according to the tests with both reactive hyperemia and nitroglycerin, while in patients with RA without AH, only NG-test was significantly lower. Conclusion. Dyslipidemia of atherogenic type and endothelial dysfunction develops at the initial stages of rheumatoid process and depends on the activity of the inflammatory process, the presence of extra-articular manifestations and rheumatoid factor seropositivity. Keywords: rheumatoid arthritis, arterial hypertension, dyslipidemia, endothelial dysfunction.

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A Pilot Study of External Counterpulsation on Reactive Hyperemia, Levels of Glycemia and Metabolic Parameters in Type 2 Diabetes Mellitus

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.948 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A464-A465

Author(s):

Caroline Wei Shan Hoong ◽

Maudrene Tan ◽

Shih Ling Kao ◽

Eric Yin Hao Khoo

Keyword(s):

Insulin Resistance ◽

Blood Pressure ◽

Endothelial Dysfunction ◽

Endothelial Function ◽

Lipid Profile ◽

Fasting Glucose ◽

Reactive Hyperemia ◽

Metabolic Parameters ◽

Vibration Sense ◽

Duration Of Diabetes

Abstract Introduction: External counter-pulsation (ECP) involves cuff inflation over the lower extremities to generate sheer stress, thereby improving endothelial function and anginal symptoms in coronary artery disease. Endothelial dysfunction is also involved in the pathogenesis of T2DM. We hypothesized that 1) ECP will be associated with an improvement in endothelial function in T2DM as measured by peripheral artery tonometry, and 2) explored whether this would vary with different dose and frequency regimens. A shorter or less intensive regimen could potentially reduce cost and improve patient compliance if a similar therapeutic response is achieved. Methods: This single-center prospective study in a tertiary institute in Singapore involving 46 adults with T2DM of HbA1c between 7 to 10%, who were randomly assigned to receive 35 sessions of ECP at different regimens and duration. Subjects in arm 1 received 1-hour daily sessions 5x per week for 7 consecutive weeks, subjects in arm 2 received 0.5-hour sessions 5x per week for 7 consecutive weeks, and subjects in arm 3 received 1-hour sessions 3x per week for 12 consecutive weeks. Endothelial function was evaluated by reactive hyperemia index (RHI) via peripheral arterial tonometry measured at the start, midpoint and end of study. Other secondary outcomes included fasting glucose, homeostatic model assessment of insulin resistance (HOMA-IR), HbA1c, blood pressure, lipid profile, weight and vibration sense. Results: 42 subjects completed the 35-session course of ECP. Mean age was 56.1±9.3 years, duration of diabetes 8.8±4.7 years, baseline RHI 2.0 (1.3–3.7) and baseline HOMA-IR was 3.1 (0.5–18.7). All regimes of ECP were well-tolerated. There was no change in RHI across all 3 regimens of ECP individually or collectively at the end of the study (ΔRHI +0.01%, p=0.458). Glycaemic markers of fasting glucose, HbA1c and HOMA-IR, as well as blood pressure, lipid profile, weight and vibration sense also remained unchanged at endpoint. Subgroup analysis showed a significant improvement in RHI (ΔRHI +20.6%, p=0.0178) in 7 subjects with more severe endothelial dysfunction (defined by RHI<1.67) at baseline who had a trend to having a longer duration of diabetes, however there was no improvement in fasting glucose, HbA1c, HOMA-IR or metabolic parameters in this group. Conclusion: ECP did not show a beneficial effect on endothelial function, glycemic control or metabolic parameters in this South-East Asian population with T2DM at any of the three regimens. This may partly be explained by less severe endothelial dysfunction and less insulin resistance in our population at baseline. Future studies of ECP may investigate its potential benefits in a larger population of T2DM with more severe endothelial dysfunction, higher insulin resistance and/or longer duration of diabetes at baseline.

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Endothelial Dysfunction Is Associated with Cerebrovascular Events in Pre-Dialysis CKD Patients: A Prospective Study

Life ◽

10.3390/life11020128 ◽

2021 ◽

Vol 11 (2) ◽

pp. 128

Author(s):

Ana Cerqueira ◽

Janete Quelhas-Santos ◽

Susana Sampaio ◽

Inês Ferreira ◽

Miguel Relvas ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Endothelial Dysfunction ◽

Cardiovascular Risk Factors ◽

Reactive Hyperemia ◽

Control Group ◽

Traditional Cardiovascular Risk Factor ◽

Reactive Hyperemia Index ◽

Cerebrovascular Events ◽

The Mean

Background: Patients with chronic kidney disease (CKD) have markedly increased rates of end stage renal disease, major adverse cardiovascular/cerebrovascular events (MACCEs), and mortality. Endothelial dysfunction (ED) is an early marker of atherosclerosis that is emerging as an increasingly important non-traditional cardiovascular risk factor in CKD. There is a lack of clinical studies examining the association between ED and both cardiovascular and renal endpoints in patients with CKD. Aims: We examined the association between reactive hyperemia index (RHI), a validated measure of endothelial function measured by peripheral arterial tonometry (PAT), with traditional cardiovascular risk factors in pre-dialysis CKD patients and prospectively evaluated the role of RHI as predictor of renal and cardiovascular outcomes in this population. Methods: One hundred and twenty pre-dialysis patients with CKD stages 1 to 5 (CKD group) and 18 healthy kidney donor candidates (control group) were recruited and had a successful RHI measurement by PAT. General demographic and clinical information including traditional cardiovascular risk factors were registered from all participants. Thereafter, patients were prospectively followed-up for a median time of 47 (IQR 19–66) months to determine associations of RHI with renal outcomes, MACCEs, hospitalizations or mortality. Results: In the CKD patient population, the mean age was 57.7 ± 15.5 years, the mean eGFR was 54.9 ± 36.7 mL/min/1.73 m2 (CKD-EPI) and 57 were males (47.5%). At baseline, in univariate analysis, RHI in the CKD group correlated positively with eGFR (r = 0.332, p < 0.0001) and correlated negatively with age (r = −0.469, p < 0.0001), Charlson index (r = −0.399, p < 0.0001), systolic blood pressure (r = −0.256, p = 0.005), and proteinuria (r = 0.211, p = 0.027). Reactive hyperemia index in the control group did not significantly differ from RHI observed in patients with CKD stages 1 to 5 (2.09 ± 0.40 vs. 2.01 ± 0.06, p = 0.493). In adjusted analysis, only age (β = −0.014, p = 0.003) remained independently associated with RHI at baseline. During follow-up, 8 patients suffered a MACCEs, 33 patients experienced renal function deterioration, 17 patients were hospitalized for medical reasons and 6 patients died. RHI at baseline was not significantly associated with CKD progression (1.94 vs. 2.02, p = 0.584), hospitalizations (1.90 vs. 2.04, p = 0.334), and all-cause mortality (1.65 vs. 2.01, p = 0.208) or MACCEs (1.77 vs. 2.01, p = 0.356), but was significantly associated with cerebrovascular events (1.27 vs. 2.02, p = 0.004) and with a composite cardiovascular outcome (MACCEs, hospital admissions and death; 1.73 vs. 2.07, p = 0.035). Conclusion: Our results suggest that RHI may be a predictor for the development of cerebrovascular events in pre-dialysis CKD patients who may benefit from more aggressive preventive measures.

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P5.05 REACTIVE HYPEREMIA INDEX AND DETECTION OF ENDOTHELIAL DYSFUNCTION IN CHILDREN

Artery Research ◽

10.1016/j.artres.2010.10.067 ◽

2010 ◽

Vol 4 (4) ◽

pp. 164

Author(s):

P. Jehlicka ◽

M. Huml ◽

T. Votava ◽

J. Kobr

Keyword(s):

Endothelial Dysfunction ◽

Reactive Hyperemia ◽

Reactive Hyperemia Index

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P8.05 REACTIVE HYPEREMIA INDEX AND DETECTION OF ENDOTHELIAL DYSFUNCTION IN PAEDIATRIC HEMATO/ONCOLOGY PATIENTS

Artery Research ◽

10.1016/j.artres.2011.10.127 ◽

2011 ◽

Vol 5 (4) ◽

pp. 184

Author(s):

P. Jehlicka ◽

M. Huml ◽

T. Votava ◽

J. Kobr

Keyword(s):

Endothelial Dysfunction ◽

Reactive Hyperemia ◽

Oncology Patients ◽

Reactive Hyperemia Index

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Reactive Hyperemia Index and Detection of Endothelial Dysfunction in High Risk Children

Pediatric Research ◽

10.1038/pr.2011.472 ◽

2011 ◽

Vol 70 ◽

pp. 247-247

Author(s):

P Jehlicka ◽

M Huml ◽

T Votava ◽

R Pomahacova ◽

L Trefil ◽

...

Keyword(s):

High Risk ◽

Endothelial Dysfunction ◽

Reactive Hyperemia ◽

Reactive Hyperemia Index ◽

High Risk Children

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Identification of gestosis (preeclampsia) risk and evaluation of efficiency of its prevention by means of noninvasive measurement of endothelial function

Journal of obstetrics and women s diseases ◽

10.17816/jowd64358-68 ◽

2015 ◽

Vol 64 (3) ◽

pp. 58-68

Author(s):

Elena Vital’yevna Mozgovaya ◽

Tat’yana Borisovna Postnikova ◽

Ol’ga Nikolaevna Arzhanova ◽

Ekaterina Andreevna Repinskaya ◽

Sergey Viktorovich Serdyukov ◽

...

Keyword(s):

Endothelial Dysfunction ◽

Endothelial Function ◽

Reactive Hyperemia ◽

Preventive Therapy ◽

State Assessment ◽

Omega 3 ◽

Polyunsaturated Fat ◽

Mild Degree ◽

Reactive Hyperemia Index ◽

Pregnancy And Delivery

Research included 64 pregnants in the I trimester with adverse anamnesis and/or clinical risk factors of preeclampsia and with revealed endothelial dysfunction by means of the device EndoPat-2000, on the basis of the reactive hyperemia index (RHI) less than 1.67, which is automatically measured by the device. Before detection of endothelial dysfunction all pregnants received basic prevention of preeclampsia with preparations of multivitamins, magnesium and progesterone. At identification of decrease in RHI to 1.3 preparation Norvesol containing omega-3 polyunsaturated fat acids (1 group, n = 32) was added. And at RHI value less than 1,3 a preparation of Angiofllux - capsular sulodexide, containing fraction of heparin 7000 Da was added. At pregnants accepting Norvesol, RHI grew in the II trimester to 1.85 ± 0.28 (р > 0.05), and in the III trimester to 1.95 ± 0.19 (р < 0,05 in comparison with the first research). At pregnants accepting Angioflux in the II trimester RHI increased to 1.77 ± 0.25 (р < 0.05) and in III to 1.88 ± 0.20 (р ˂ 0.01 in comparison with the first research). No significant changes of indicators of system of hemostasis in dynamics were revealed in both groups. At all examined patients the delivery occurred at the full-term pregnancy. Frequency of preeclampsia development was low (21.9 and 37.5 % respectively in 1 and 2 groups), and except 1 case of middle severity in 1 group, preeclampsia didn’t exceed mild degree and didn’t influence a way of delivery and perinatal indicators. Thus, the method of functional endothelial state assessment by means of the device EndoPat-2000, allowed to specify risk degree of preeclampsia and to control efficiency of preventive therapy. At moderate violations of endothelial functional state Norvesol’s application led to correction of endothelial dysfunction and achievement of favorable outcomes of pregnancy and delivery for mother and fetus. At the cases with expressed endothelial dysfunction addition of Angioflux (sulodexide) promoted considerable improvement of endothelial function that allowed to avoid development of middle and severe preeclampsia even at pregnants with the highest risk of its development.

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Endothelial Dysfunction is Associated With Early‐Onset Cryptogenic Ischemic Stroke in Men and With Increasing Age

Journal of the American Heart Association ◽

10.1161/jaha.121.020838 ◽

2021 ◽

Author(s):

Nicolas Martinez‐Majander ◽

Daniel Gordin ◽

Lotta Joutsi‐Korhonen ◽

Titta Salopuro ◽

Krishna Adeshara ◽

...

Keyword(s):

Ischemic Stroke ◽

Endothelial Dysfunction ◽

Endothelial Function ◽

High Density Lipoprotein ◽

Early Onset ◽

Reactive Hyperemia ◽

Density Lipoprotein ◽

Natural Logarithm ◽

Reactive Hyperemia Index ◽

Diet Score

Background The aim of this study was to assess the association between endothelial function and early‐onset cryptogenic ischemic stroke (CIS), with subgroup analyses stratified by sex and age groups. Methods and Results We prospectively enrolled 136 consecutive patients aged 18 to 49 years (median age, 41 years; 44% women) with a recent CIS and 136 age‐ and sex‐matched (±5 years) stroke‐free controls. Endothelial function was measured with an EndoPAT 2000 device and analyzed as tertiles of natural logarithm of reactive hyperemia index with lower values reflecting dysfunction. We used conditional logistic regression adjusting for age, education, hypertension, diabetes mellitus, dyslipidemia, current smoking, heavy drinking, obesity, and diet score to assess the independent association between endothelial function and CIS. Patients in the lowest tertile of natural logarithm of reactive hyperemia index were more often men and they more frequently had a history of dyslipidemia; they were also more often obese, had a lower diet score, and lower high‐density lipoprotein cholesterol. In the entire cohort, we found no association in patients with endothelial function and CIS compared with stroke‐free controls. In sex‐ and age‐specific analyses, endothelial dysfunction was associated with CIS in men (adjusted odds ratio [OR], 3.50 for lowest versus highest natural logarithm of reactive hyperemia index tertile; 95% CI, 1.22–10.07) and in patients ≥41 years (OR, 5.78; 95% CI, 1.52–21.95). These associations remained significant when dyslipidemia was replaced with the ratio of total to high‐density lipoprotein cholesterol. Conclusions Endothelial dysfunction appears to be an independent player in early‐onset CIS in men and patients approaching middle age.

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