scholarly journals A variant of the IGF-I gene is associated with blood pressure but not with left heart dimensions at the age of 2 years: the Generation R Study

2008 ◽  
Vol 159 (3) ◽  
pp. 209-216 ◽  
Author(s):  
Vera A A van Houten ◽  
Dennis O Mook-Kanamori ◽  
Lennie van Osch-Gevers ◽  
Eric A P Steegers ◽  
Albert Hofman ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Promoter Region ◽  
Later Life ◽  
Population Based ◽  
Root Diameter ◽  
Left Ventricular ◽  
Left Heart ◽  
Igf I ◽  
Blood Pressures ◽  
Design And Methods

Background and objectiveA common variant of the IGF-I gene has been shown to be associated with cardiovascular disease in adulthood. The objective of this study was to examine whether this variant of the IGF-I gene is associated with blood pressure and left heart dimensions in early childhood.Research design and methodsThis study was embedded in the Generation R Study, a population-based prospective cohort study from foetal life onwards. IGF-I promoter region was genotyped in DNA obtained from cord blood. Blood pressure (systolic and diastolic) and echocardiography (left ventricular mass, left atrial diameter and aortic root diameter) measurements were performed at the age of 2 years. Analyses were performed in 538 subjects.ResultsEight alleles of the IGF-I promoter region were identified. In total, 43% of the subjects were homozygous for the 192 bp allele (wild type), 46% were heterozygous and 11% were non-carriers. Significantly lower systolic and diastolic blood pressures were found in non-carrier subjects (difference compared with homozygous subjects: −4.4 (95% confidence interval (CI) −7.8 to −1.1) mmHg and −3.5 (95% CI: −6.9 to −0.1) mm respectively). No significant differences were found for left heart dimensions at the age of 2 years. No association was found when we used a previously proposed alternative classification of the IGF-I gene.ConclusionThe variant type of the IGF-I promoter region is associated with lower blood pressure but not with left heart dimensions at the age of 2 years. Follow-up studies are needed to examine whether these differences persist in later life.

scholarly journals Association between Neonatal Intakes and Hyperglycemia, and Left Heart and Aortic Dimensions at 6.5 Years of Age in Children Born Extremely Preterm

2021 ◽  
Vol 10 (12) ◽  
pp. 2554
Author(s):  
Jawwad Hamayun ◽  
Lilly-Ann Mohlkert ◽  
Elisabeth Stoltz Sjöström ◽  
Magnus Domellöf ◽  
Mikael Norman ◽  
...  
Keyword(s):  
Interventricular Septum ◽  
Posterior Wall ◽  
Root Diameter ◽  
Left Ventricular ◽  
Left Heart ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Nutritional Data ◽  
Aortic Dimensions

Survivors of extremely preterm birth (gestational age < 27 weeks) have been reported to exhibit an altered cardiovascular phenotype in childhood. The mechanisms are unknown. We investigated associations between postnatal nutritional intakes and hyperglycemia, and left heart and aortic dimensions in children born extremely preterm. Postnatal nutritional data and echocardiographic dimensions at 6.5 years of age were extracted from a sub-cohort of the Extremely Preterm Infants in Sweden Study (EXPRESS; children born extremely preterm between 2004–2007, n = 171, mean (SD) birth weight = 784 (165) grams). Associations between macronutrient intakes or number of days with hyperglycemia (blood glucose > 8 mmol/L) in the neonatal period (exposure) and left heart and aortic dimensions at follow-up (outcome) were investigated. Neonatal protein intake was not associated with the outcomes, whereas higher lipid intake was significantly associated with larger aortic root diameter (B = 0.040, p = 0.009). Higher neonatal carbohydrate intake was associated with smaller aorta annulus diameter (B = −0.016, p = 0.008). Longer exposure to neonatal hyperglycemia was associated with increased thickness of the left ventricular posterior wall (B = 0.004, p = 0.008) and interventricular septum (B = 0.004, p = 0.010). The findings in this study indicate that postnatal nutrition and hyperglycemia may play a role in some but not all long-lasting developmental adaptations of the cardiovascular system in children born extremely preterm.

scholarly journals No association of the CYP3A5*1 allele with blood pressure and left ventricular mass and geometry: the KORA/MONICA Augsburg echocardiographic substudy

2006 ◽  
Vol 111 (6) ◽  
pp. 365-372 ◽  
Author(s):  
Wolfgang Lieb ◽  
Juliane Bolbrinker ◽  
Angela Döring ◽  
Hans-Werner Hense ◽  
Jeanette Erdmann ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Arterial Hypertension ◽  
Left Ventricular Mass ◽  
Posterior Wall ◽  
Pressure Control ◽  
Population Based ◽  
Left Ventricular ◽  
Genotype Distribution ◽  
Cytochrome P450 3A ◽  
Ventricular Mass

A polymorphism in the cytochrome P450 3A CYP3A5 enzyme has been implicated in BP (blood pressure) control and arterial hypertension. Carriers of the CYP3A5*1 allele had high, whereas homozygous carriers of the CYP3A5*3 allele exhibit low, CYP3A5 expression in the kidney, where CYP3A5 represents the major CYP3A enzyme. The aim of the present study was to investigate the association of the CYP3A5*1 allele with BP, arterial hypertension, LVM [(left ventricular) mass] and LV geometry in a large Caucasian-population-based cohort. We compared BP, LVM and the prevalence of hypertension between carriers (CYP3A5*1/*1 and CYP3A5*1/*3 genotypes) and non-carriers (CYP3A5*3/*3 genotype) of the CYP3A5*1 allele in the echocardiographic substudy of the third MONICA (MONItoring trends and determinants in CArdiovascular disease) Augsburg survey. After exclusion of 269 individuals who were taking antihypertensive medication, 530 women and 554 men were available for analysis, revealing allele frequencies of 5.8 and 94.2% for the CYP3A5*1 and CYP3A5*3 alleles respectively. Overall, the presence of the CYP3A5*1 allele exhibited no effect on systolic or diastolic BP in either gender. One-third of the individuals in this cohort were hypertensive (BP ≥140/90 mmHg), and the genotype distribution between normotensive and hypertensive individuals revealed no association between CYP3A5*1 and hypertension after adjustment for age, BMI and gender (odds ratio, 1.02; P=0.92). Moreover, no effect of CYP3A5*1 on LVM, thickness of the septal and posterior wall and LV end-diastolic diameter was found. We conclude that CYP3A5*1 exhibits no significant effect on BP, LVM and LV geometry in the KORA/MONICA echocardiographic substudy.

Factors affecting left ventricular remodelling and mechanics in the long-term follow-up after successful repair of aortic coarctation

2005 ◽  
Vol 15 (2) ◽  
pp. 160-167 ◽  
Author(s):  
Roberto Crepaz ◽  
Roberto Cemin ◽  
Cristina Romeo ◽  
Edoardo Bonsante ◽  
Lino Gentili ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Aortic Coarctation ◽  
Surgical Repair ◽  
Left Ventricular ◽  
Left Ventricular Geometry ◽  
Ventricular Remodelling ◽  
Left Ventricular Remodelling ◽  
Ventricular Geometry ◽  
Blood Pressures ◽  
Successful Repair

Aims: To identify factors predisposing to abnormal left ventricular geometry and mechanics in 52 patients after successful repair of aortic coarctation. Methods and results: We evaluated left ventricular remodelling, systolic midwall mechanics, and isthmic gradient by echo-Doppler, systemic blood pressure at rest/exercise and by ambulatory blood pressure monitoring, and the aortic arch by magnetic resonance imaging. Echocardiographic findings were compared with those of 142 controls. The patients with aortic coarctation showed an increased indexed left ventricular end-diastolic volume, increased mass index, increased ratio of mass to volume and systolic chamber function. The contractility, estimated at midwall level, was increased in 21 percent of the patients. In 26 (50 percent) of the patients, we found abnormal left ventricular geometry, with 9 percent showing concentric remodelling, 33 percent eccentric hypertrophy, and 8 percent concentric hypertrophy. These patients were found to be older, underwent a later surgical repair, and to have higher systolic blood pressures at rest and exercise as well as during ambulatory monitoring. The relative mural thickness and mass index of the left ventricle showed a significant correlation with different variables on uni- and multivariate analysis. Age and diastolic blood pressure at rest are the only factors associated with abnormal left ventricular remodelling. Conclusions: Patients who have undergone a seemingly successful surgical repair of aortic coarctation may have persistently abnormal geometry with a hyperdynamic state of the left ventricle. This is more frequent in older patients, and in those with higher diastolic blood pressures.

scholarly journals Impact of successful transsphenoidal surgery on cardiovascular risk factors in acromegaly

2003 ◽  
pp. 193-201 ◽  
Author(s):  
ML Jaffrain-Rea ◽  
G Minniti ◽  
C Moroni ◽  
V Esposito ◽  
E Ferretti ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Insulin Sensitivity ◽  
Glucose Tolerance ◽  
Cardiovascular Risk Factors ◽  
Transsphenoidal Surgery ◽  
Left Ventricular ◽  
Diastolic Filling ◽  
Igf I

BACKGROUND: Cardiac abnormalities develop in patients with acromegaly as a consequence of effects of GH/IGF-I on the heart and related cardiovascular risk factors. OBJECTIVE: To evaluate the possible contribution of postoperative variations in blood pressure (BP), glucose tolerance and insulin sensitivity to the cardiac improvement reported in patients who have been cured of acromegaly. DESIGN: Thirty-one patients with acromegaly were studied before and 6 Months after successful transsphenoidal surgery, defined by normal age-related IGF-I concentrations and glucose-suppressed GH concentrations <1 microg/l. METHODS: Cardiovascular parameters were assessed by Doppler echocardiography and 24-h ambulatory blood pressure monitoring. Insulin sensitivity indexes were calculated on the basis of fasting and post-load glycaemia and insulinaemia and referred to as HOMA(ISI) and OGTT(ISI), respectively. RESULTS: Successful surgery was confirmed to improve left ventricular mass index (LVMI) and diastolic filling significantly. Mean 24-h systolic BP values decreased (P=0.009) and BP rhythm was restored in 12 of 15 patients with a blunted preoperative profile. Glucose tolerance normalized in patients with preoperative glucose intolerance (n=7) or diabetes mellitus (n=3). HOMA(ISI) and OGTT(ISI) increased (P=0.0001 for each parameter), indicating a marked improvement in insulin sensitivity. The postoperative reduction in LVMI correlated with increased insulin sensitivity (P<0.001 for both indexes), but not with other parameters. Improved diastolic filling correlated with the reduction in LVMI. CONCLUSIONS: Successful surgery in patients with acromegaly induces a significant improvement in haemodynamic and metabolic risk factors. This study suggests a direct link between insulin resistance and acromegalic cardiomyopathy.

P5360Cardiovascular adaptation characteristics in women with preeclampsia

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
E C Buzdugan ◽  
C Goidescu ◽  
G Nemeti ◽  
I Goidescu ◽  
L M Procopciuc ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Pregnant Women ◽  
Stress Test ◽  
Later Life ◽  
Study Groups ◽  
Left Ventricular ◽  
Stiffness Index ◽  
Lv Function ◽  
Cardiovascular Assessment ◽  
Vascular Age

Abstract Introduction Even in normal pregnancies, physiologic functional and structural cardiovascular adjustments are required for progression of a successful pregnancy. In preeclamptic patients, these pregnancy-induced adaptive processes are intensified. It has been suggested that preeclampsia should be regarded as a failed stress test, a marker for increased later life cardiovascular risk. Purpose To differentiate between cardiovascular remodelling patterns in preeclamptic vs. normal pregnancies, using echocardiography and digital photoplethysmography. Material We conducted a single-center case–control study, performing cardiovascular assessment during last trimester of pregnancy in 56 pregnant women with preeclamsia (PE) and 62 healthy pregnant women, without CV risk factors. Echocardiography was performed to characterize left ventricular (LV) remodelling patterns and to assess LV systolic and dyastolic function. Also, digital photoplethysmography was used to determine stiffness index (SI) and vascular age (VA). Data between groups were compared. Results The two groups were matched by age (30.42±6.37 vs 29.96±5.18 y/o, p=0.74), body mass index (29.84±5.31 vs. 28.53±5.33g, p=0.30), and parity (primiparous 33 vs. 25, p=0.47, multiparous 23 vs. 27, p=0.78). The prevalence of LV hypertrophy, expressed as LV mass (185.75±39.61 vs. 144.85±28.81 g, p=0.0023) and LV relative wall thickness (0.49±0.08 vs. 0.42±0.069), was higher in preeclamptic women, corresponding to higher blood pressure values (systolic blood pressure 164.27±20.09 vs 114±18.04 mmHg, p=0.0014, dyastolic blood pressure 103.22±14.13 vs. 72.83±11.34 mmHg, p=0.0015). The most common remodeling type in preeclamptic group was concentric hypertrophy (28/56, 50%), while in normal pregnancy group, normal geometry (21/62, 34%) and concentric remodeling (21/62, 34%), were more frequently encountered. No significant differences between groups were found in terms of LV ejection fraction, while dyastolic LV function, depicted through transmitral flow parameters, varied only when E/A ratio was measured (1.38±0.34 vs. 1.62±0.46, p=0.03). In preeclamptic women, SI was increased (9.27±1.86 vs. 7.13±1.86 m/s, p=0.0091), with a significantly higher VA also (47.44±21.61 vs. 28.75±7.51y/o, p=0.0001), for a similar maternal age of the study groups. Conclusions We documented a higher prevalence of LV hypertrophy, with the concentric remodelling pattern predominance, as well as a significantly advanced vascular age due to an increased arterial stiffness, among preeclamptic group. Follow-up of these patients may reveal features, or cut-off values, useful to early identify a population that may benefit from early interventions to prevent cardiovascular disease.

scholarly journals Finger photoplethysmography during the Valsalva maneuver reflects left ventricular filling pressure

2012 ◽  
Vol 302 (10) ◽  
pp. H2043-H2047 ◽  
Author(s):  
Harry A. Silber ◽  
Jeffrey C. Trost ◽  
Peter V. Johnston ◽  
W. Lowell Maughan ◽  
Nae-Yuh Wang ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Amplitude Ratio ◽  
Valsalva Maneuver ◽  
Pulse Amplitude ◽  
Left Ventricular ◽  
Filling Pressure ◽  
Left Heart ◽  
Cardiac Filling Pressure ◽  
Cardiac Filling ◽  
Waveform Amplitude

It is often challenging to assess cardiac filling pressure clinically. An improved system for detecting or ruling out elevated cardiac filling pressure may help reduce hospitalizations for heart failure. The blood pressure response to the Valsalva maneuver reflects left heart filling pressure, but its underuse clinically may be due in part to lack of continuous blood pressure recording along with lack of standardization of expiratory effort. In this study, we tested whether Valsalva-induced changes in the pulse amplitude of finger photoplethysmography (PPG), a technology already widely available in medical settings, correlate with invasively measured left ventricular end-diastolic pressure (LVEDP). We tested 33 subjects before clinically scheduled cardiac catheterizations. A finger photoplethysmography waveform was recorded during a Valsalva effort of 20 mmHg expiratory pressure sustained for 10 s, an effort most patients can achieve. Pulse amplitude ratio (PAR) was calculated as the PPG waveform amplitude just before release of expiratory effort divided by the waveform amplitude at baseline. PAR was well correlated with LVEDP ( r = 0.68; P < 0.0001). For identifying LVEDP > 15 mmHG, PAR > 0.4 was 85% sensitive [95% confidence interval (95CI): 54–97%] and 80% specific (95CI: 56–93%). In conclusion, finger PPG, a technology already ubiquitous in medical centers, may be useful for assessing clinically meaningful categories of left heart filling pressure, using simple analysis of the waveform after a Valsalva maneuver effort that most patients can achieve.

scholarly journals Maternal first-trimester dietary intake and childhood blood pressure: the Generation R Study

2013 ◽  
Vol 110 (8) ◽  
pp. 1454-1464 ◽  
Author(s):  
Leontine C. L. van den Hil ◽  
H. Rob Taal ◽  
Layla. L. de Jonge ◽  
Denise H. M. Heppe ◽  
Eric A. P. Steegers ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Dietary Intake ◽  
Diastolic Blood Pressure ◽  
Multiple Testing ◽  
Daily Intake ◽  
Later Life ◽  
First Trimester ◽  
Population Based ◽  
Vitamin B ◽  
Standard Deviation Increase

Suboptimal maternal dietary intake during pregnancy might lead to fetal cardiovascular adaptations and higher blood pressure in the offspring. The aim of the present study was to investigate the associations of maternal first-trimester dietary intake with blood pressure in children at the age of 6 years. We assessed first-trimester maternal daily dietary intake by a FFQ and measured folate, homocysteine and vitamin B12 concentrations in the blood, in a population-based prospective cohort study among 2863 mothers and children. Childhood systolic and diastolic blood pressure was measured using a validated automatic sphygmomanometer. First-trimester maternal daily intake of energy, fat, protein and carbohydrate was not associated with childhood blood pressure. Furthermore, maternal intake of micronutrients was not associated with childhood blood pressure. Also, higher maternal vitamin B12 concentrations were associated with a higher diastolic blood pressure (0·31 mmHg per standard deviation increase in vitamin B12 (95 % CI 0·06, 0·56)). After taking into account multiple testing, none of the associations was statistically significant. Maternal first-trimester folate and homocysteine concentrations were not associated with childhood blood pressure. The results from the present study suggest that maternal Fe intake and vitamin B12 concentrations during the first trimester of pregnancy might affect childhood blood pressure, although the effect estimates were small and were not significant after correction for multiple testing. Further studies are needed to replicate these findings, to elucidate the underlying mechanisms and to assess whether these differences in blood pressure persist in later life.

scholarly journals Hypothetical blood-pressure-lowering interventions and risk of stroke and dementia

2020 ◽  
Author(s):  
Liliana Paloma Rojas-Saunero ◽  
Saima Hilal ◽  
Eleanor J. Murray ◽  
Roger W. Logan ◽  
Mohammad Arfan Ikram ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Risk Ratio ◽  
Stroke Risk ◽  
Smoking Status ◽  
Later Life ◽  
Population Based ◽  
Prior History ◽  
Rotterdam Study ◽  
Dementia Risk ◽  
Quitting Smoking

AbstractWe aimed to study the effects of hypothetical interventions on systolic blood pressure (SBP) and smoking on risk of stroke and dementia using data from 15 years of follow-up in the Rotterdam Study. We used data from 4930 individuals, aged 55–80 years, with no prior history of stroke, dementia or cognitive impairment, followed for 15 years within the Rotterdam Study, a population-based cohort. We defined the following sustained interventions on SBP: (1) maintaining SBP below 120 mmHg, (2) maintaining SBP below 140 mmHg, (3) reducing SBP by 10% if above 140 mmHg, (4) reducing SBP by 20% if above 140 mmHg, and a combined intervention of quitting smoking with each of these SBP-lowering strategies. We considered incident stroke and incident dementia diagnoses as outcomes. We applied the parametric g-formula to adjust for baseline and time-varying confounding. The observed 15-year risk for stroke was 10.7%. Compared to no specified intervention (i.e., the “natural course”), all interventions that involved reducing SBP were associated with a stroke risk reduction of about 10% (e.g., reducing SBP by 20% if above 140 mmHg risk ratio: 0.89; 95% CI 0.76, 1). Jointly intervening on SBP and smoking status further decreased the risk of stroke (e.g., risk ratio: 0.83; 95% CI 0.71, 0.94). None of the specified interventions were associated with a substantive change in dementia risk. Our study suggests that a joint intervention on SBP and smoking cessation during later life may reduce stroke risk, while the potential for reducing dementia risk were not observed.

scholarly journals Aortic Root Remodeling as an Indicator for Diastolic Dysfunction and Normative Ranges in Asians: Comparison and Validation with Multidetector Computed Tomography

Diagnostics ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. 712
Author(s):  
Lawrence Yu-min Liu ◽  
Chun-Ho Yun ◽  
Jen-Yuan Kuo ◽  
Yau-Huei Lai ◽  
Kuo-Tzu Sung ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Diastolic Dysfunction ◽  
Multidetector Computed Tomography ◽  
Aortic Root ◽  
Asian Population ◽  
Population Based ◽  
Root Diameter ◽  
Left Ventricular ◽  
Aortic Diameter ◽  
Reference Ranges

Background: The aortic root diameter (AoD) has been shown to be a marker of cardiovascular risk and heart failure (HF). Data regarding the normal reference ranges in Asians and their correlates with diastolic dysfunction using contemporary guidelines remain largely unexplored. Methods: Among 5343 consecutive population-based asymptomatic Asians with echocardiography evaluations for aortic root diameter (without/with indexing, presented as AoD/AoDi) were related to cardiac structure/function and N-terminal pro-brain B-type natriuretic peptide (Nt-ProBNP), with 245 participants compared with multidetector computed tomography (MDCT)-based aortic root geometry. Results: Advanced age, hypertension, higher diastolic blood pressure, and lower body fat all contributed to greater AoD/AoDi. The highest correlation between echo-based aortic diameter and the MDCT-derived measures was found at the level of the aortic sinuses of Valsalva (r = 0.80, p < 0.001). Age- and sex-stratified normative ranges of AoD/AoDi were provided in 3646 healthy participants. Multivariate linear regressions showed that AoDi was associated with a higher NT-proBNP, more unfavorable left ventricular (LV) remodeling, worsened LV systolic annular velocity (TDI-s′), a higher probability of presenting with LV hypertrophy, and abnormal LV diastolic indices except tricuspid regurgitation velocity by contemporary diastolic dysfunction (DD) criteria (all p < 0.05). AoDi superimposed on key clinical variables significantly expanded C-statistic from 0.71 to 0.84 (p for ∆AUROC: < 0.001). These associations were broadly weaker for AoD. Conclusion: In our large asymptomatic Asian population, echocardiography-defined aortic root dilation was associated with aging and hypertension and were correlated modestly with computed tomography measures. A larger indexed aortic diameter appeared to be a useful indicator in identifying baseline abnormal diastolic dysfunction.

Validity of fluorescent microspheres method for bone blood flow measurement during intentional arterial hypotension

2003 ◽  
Vol 95 (3) ◽  
pp. 1153-1158 ◽  
Author(s):  
H. Anetzberger ◽  
E. Thein ◽  
M. Becker ◽  
A. K. Walli ◽  
K. Messmer
Keyword(s):  
Blood Pressure ◽  
Blood Flow ◽  
Arterial Blood Pressure ◽  
Left Ventricular ◽  
Bone Blood Flow ◽  
Control Mechanisms ◽  
Arterial Blood ◽  
Severe Hypotension ◽  
New Zealand White Rabbits ◽  
Blood Pressures

In this study, we compared bone blood flow values obtained by simultaneously injected fluorescent (FM) and radiolabeled microspheres (RM) at stepwise reduced arterial blood pressure. Ten anesthetized female New Zealand White rabbits received simultaneous left ventricular injections of FM and RM at 90, 70, and 50 mmHg mean arterial blood pressure (MAP). After the experiments, both kidneys and long bones of all four limbs were removed and dissected in a standardized manner. Radioactivity (corrected for decay, background, and spillover) and fluorescence were determined, and blood flow values were calculated. Relative blood flow values estimated for each bone sample by RM and FM were significantly correlated ( r = 0.98, slope = 0.99, and intercept = 0.04 for 90 mmHg; r = 0.98, slope = 0.94, and intercept = 0.09 for 70 mmHg; r = 0.98, slope = 0.96, and intercept = 0.07 for 50 mmHg). Blood flow values (ml · min-1 · 100 g-1) of right and left bone samples determined at the different arterial blood pressures were identical. During moderate hypotension (70 mmHg MAP), blood flow in all bone samples remained unchanged compared with 90 mmHg MAP, whereas a significant decrease of bone blood flow was observed at severe hypotension (50 mmHg MAP). Our results demonstrate that the FM technique is valid for measuring bone blood flow. Differences in bone blood flow during altered hemodynamic conditions can be detected reliably. In addition, changes in bone blood flow during hypotension indicate that vasomotor control mechanisms, as well as cardiac output, play a role in setting bone blood flow.

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