Is arterial stiffness a surrogate end-point for cardiovascular complications? A tentative answer given by the SPARTE Study

The aim of this study was to evaluate Cardio-Ankle Vascular Index (CAVI) and increased arterial stiffness predictors in patients with carbohydrate metabolism disorders (CMD) in the population sample of Russian Federation. Methods: 1617 patients (age 25–64 years) were enrolled in an observational cross-sectional study Epidemiology of Cardiovascular Diseases and Their Risk Factors in the Regions of the Russian Federation (ESSE-RF). The standard ESSE-RF protocol has been extended to measure the cardio-ankle vascular index (CAVI), a marker of arterial stiffness. Patients were divided into three groups: patients with type 2 diabetes mellitus (n = 272), patients with prediabetes (n = 44), and persons without CMD (n = 1301). Results: Median CAVI was higher in diabetes and prediabetes groups compared with group without CMD (p = 0.009 and p < 0.001, respectively). Elevated CAVI (≥9.0) was detected in 16.8% of diabetes patients, in 15.9% of those with prediabetes, and in 9.0% of those without CMD (p < 0.001). The factors affecting on CAVI did not differ in CVD groups. In logistic regression the visceral obesity, increasing systolic blood pressure (SBP) and decreasing glomerular filtration rate (GFR) were associated with a pathological CAVI in CMD patients, and age, diastolic blood pressure (DBP), and cholesterol in persons without CMD. Conclusions: the CAVI index values in the prediabetes and diabetes patients were higher than in normoglycemic persons in a population sample of the Russian Federation. Since the identified disorders of arterial stiffness in prediabetes are similar to those in diabetes, their identification is important to prevent further cardiovascular complications.

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Arterial Stiffness and Type 1 Diabetes: The Current State of Knowledge

Current Diabetes Reviews ◽

10.2174/1573399817666210614113827 ◽

2021 ◽

Vol 17 ◽

Author(s):

Michal Kulecki ◽

Aleksandra Uruska ◽

Dariusz Naskret ◽

Dorota Zozulinska-Ziolkiewicz

Keyword(s):

Type 1 Diabetes ◽

Arterial Stiffness ◽

Estimated Glomerular Filtration Rate ◽

Healthy Lifestyle ◽

Density Lipoprotein ◽

Positive Association ◽

Cardiovascular Complications ◽

Current State ◽

All Cause Mortality

: The most common cause of mortality among people with type 1 diabetes is cardiovascular diseases. Arterial stiffness allows predicting cardiovascular complications, cardiovascular mortality, and all-cause mortality. There are different ways to measure arterial stiffness; the gold standard is pulse wave velocity. Arterial stiffness is increased in people with type 1 diabetes compared to healthy controls. It increases with age and duration of type 1 diabetes. Arterial stiffness among people with type 1 diabetes has a positive association with systolic blood pressure, obesity, glycated hemoglobin, waist circumference, and waist to hip ratio. It has a negative correlation with estimated glomerular filtration rate, high-density lipoprotein, and the absence of carotid plaques. The increased arterial stiffness could be the result of insulin resistance, collagen increase due to inadequate enzymatic glycation, endothelial and autonomic dysfunction. The insulin-induced decrease in arterial stiffness is impaired in type 1 diabetes. There are not enough proofs to use pharmacotherapy in the prevention of arterial stiffness, but some of the medicaments have obtained promising results in single studies, for example, renin-angiotensin-aldosterone system inhibitors, statins, and SGLT2 inhibitors. The main form of prevention of arterial stiffness progression remains glycemic control and a healthy lifestyle.

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Mechanisms of Arterial Stiffening

Arteriosclerosis Thrombosis and Vascular Biology ◽

10.1161/atvbaha.119.313129 ◽

2020 ◽

Vol 40 (5) ◽

pp. 1055-1062 ◽

Cited By ~ 5

Author(s):

Patrick Lacolley ◽

Véronique Regnault ◽

Stéphane Laurent

Keyword(s):

Risk Factor ◽

Cardiovascular Risk ◽

Arterial Stiffness ◽

Cardiovascular Complications ◽

Cell Stiffness ◽

Biological Mechanisms ◽

Mitochondrial Oxidative Stress ◽

Arterial Stiffening ◽

Novel Approach ◽

Target Organs

Arterial stiffness is a major independent risk factor for cardiovascular complications causing isolated systolic hypertension and increased pulse pressure in the microvasculature of target organs. Stiffening of the arterial wall is determined by common mechanisms including reduced elastin/collagen ratio, production of elastin cross-linking, reactive oxygen species–induced inflammation, calcification, vascular smooth muscle cell stiffness, and endothelial dysfunction. This brief review will discuss current biological mechanisms by which other cardiovascular risk factors (eg, aging, hypertension, diabetes mellitus, and chronic kidney disease) cause arterial stiffness, with a particular focus on recent advances regarding nuclear mechanotransduction, mitochondrial oxidative stress, metabolism and dyslipidemia, genome mutations, and epigenetics. Targeting these different molecular pathways at different time of cardiovascular risk factor exposure may be a novel approach for discovering drugs to reduce arterial stiffening without affecting artery strength and normal remodeling.

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P808Characteristics of patients with reproducible masked hypertension

European Heart Journal ◽

10.1093/eurheartj/ehz747.0407 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M I Smirnova ◽

V M Gorbunov ◽

D A Volkov ◽

Y N Koshelyaevskaya ◽

A D Deev ◽

...

Keyword(s):

Arterial Stiffness ◽

Aortic Pressure ◽

Cardiovascular Complications ◽

Masked Hypertension ◽

Ambulatory Bp Monitoring ◽

Oscillometric Device ◽

The Family ◽

Ambulatory Patients ◽

History Of ◽

Family History Of Hypertension

Abstract Background Masked hypertension (MH) is associated with cardiovascular complications and poor prognosis. Characteristics of untreated patients with reproducible MH are studied insufficiently. Purpose The aim of our study was to assess characteristics of ambulatory patients with reproducible MH in comparison to patients with non-reproducible MH in two visits. Methods The patients from the ambulatory BP monitoring (ABPM) database (>2000 patients) were selected according to the following criteria: absence of any antihypertensive treatment (AHT), availability of clinical BP (CBP) and ABPM records at two visits with the 6 months interval, CBP<140 and 90 mmHg at both visits, availability of clinical, anthropometric data and history. MH criteria in each patients should be present at least at one of the visits. ABPM was performed by the oscillometric device equipped with software for arterial stiffness calculation. The standard statistical methods and analysis of variance (ANOVA) were used. Results We selected 295 patients (men 43%, mean age 49.0±7.6 years, CBP 128.4±9.4/80.5±7.2 mm Hg, body mass index 27.6±4.3 kg/m2, 24h pulse wave velocity in aorta [PWV] 10.7±1.7 m/s). MH only at one visit was found in 168 patients (56.9%). Respectively, MH at both visits was in 127 patients (43.1%). The patients with reproducible MH were characterized by the presence of: mother's (p=0.011) or father's hypertension (p=0.025), mother's ischemic heart disease (p=0.015), mother's myocardial infarction (p=0.020), father's stroke (p=0.030), higher arterial stiffness (PWV 11.0±1.7 m/s vs. 10.5±1.8 m/s, p=0.022), and systolic BP in aorta (120.0±7.5 mmHg vs. 117.8±9.4 mm Hg). Conclusions The patients with reproducible MH (without AHT) are characterized most of all by the family history of hypertension and its complications. The correlation of stable MH with arterial stiffness confirms the importance of PWV and central aortic pressure measurement in patients with CBP<140 and 90 mmHg.

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A Randomised Multicentre Open Label Blinded End Point Trial to Compare the Effects of Spironolactone to Chlortalidone on Left Ventricular Mass and Arterial Stiffness in Stage 3 Chronic Kidney Disease

http://isrctn.org/> ◽

10.1186/isrctn94696478 ◽

2014 ◽

Author(s):

Gemma Slinn

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Arterial Stiffness ◽

Left Ventricular Mass ◽

Left Ventricular ◽

Open Label ◽

End Point ◽

Ventricular Mass

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Vascular stiffness in patients with arterial hypertension: possible antihypertensive therapy

Systemic Hypertension ◽

10.26442/sg29126 ◽

2016 ◽

Vol 13 (2) ◽

pp. 17-23

Author(s):

O D Ostroumova ◽

A I Kochetkov ◽

M V Lopukhina

Keyword(s):

Blood Pressure ◽

Arterial Stiffness ◽

Pulse Wave Velocity ◽

Pulse Wave ◽

Antihypertensive Drugs ◽

Vascular Wall ◽

Cardiovascular Complications ◽

Increased Risk ◽

Pharmacokinetic Properties ◽

Complications And Mortality

The article discusses the factors that increase the arterial stiffness: the blood pressure, atherosclerosis, smoking, diabetes, age. Given evidence that pulse wave velocity and a number of other indicators that reflect the state of the vascular wall, are markers for increased risk of cardiovascular complications and mortality. The influence of antihypertensive drugs of different groups on the stiffness of the vascular wall, with particular attention paid to the effects of drugs from group of diuretics. We discuss possible mechanisms of the influence of indapamide retard on the elastic properties of vessels. It is emphasized that the influence on the stiffness of the arteries of different antigipertenzivny medicines, even belong to the same class, is different, due to differences in pharmacokinetic properties.

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Pulse Pressure, Prognosis, and Influence of Sacubitril/Valsartan in Heart Failure With Preserved Ejection Fraction

Hypertension ◽

10.1161/hypertensionaha.120.16277 ◽

2020 ◽

Author(s):

Kota Suzuki ◽

Brian Claggett ◽

Masatoshi Minamisawa ◽

Kotaro Nochioka ◽

Gary F. Mitchell ◽

...

Keyword(s):

Heart Failure ◽

Arterial Stiffness ◽

Ejection Fraction ◽

Pulse Pressure ◽

Cox Proportional Hazards ◽

Hazard Ratio ◽

Adjusted Hazard Ratio ◽

Preserved Ejection Fraction ◽

End Point ◽

Valsartan Group

Arterial stiffness is increased with increasing age, and pulse pressure (PP), a marker of arterial stiffness, is a predictor of incident cardiovascular disease and mortality. However, the prognostic relevance of PP in heart failure (HF) with preserved ejection fraction has not been fully understood. We studied 4796 patients with HF with preserved ejection fraction from the PARAGON-HF trial. All patients underwent sequential run-in phases of valsartan and sacubitril/valsartan before randomization. We categorized patients by PP quartile and evaluated the influence of baseline PP on the PARAGON-HF primary end point (total HF hospitalizations and cardiovascular death). At screening, the median PP was 58 mm Hg (interquartile range, 50–69 mm Hg). There was a nonlinear, J-shaped association between PP and outcomes. Multivariable Cox proportional hazards models showed that patients in the highest PP quartile had a higher risk of the primary end point (adjusted hazard ratio, 1.39 [95% CI, 1.14–1.69]; P =0.001), total HF hospitalizations (adjusted hazard ratio, 1.43 [95% CI, 1.15–1.79]; P =0.001), and myocardial infarction (adjusted hazard ratio, 1.54 [95% CI, 1.06–2.23]; P =0.022) compared with those in the second (lowest risk) PP quartile. Reductions in PP during sacubitril/valsartan run-in were associated with a decreased risk of the primary end point and total HF hospitalizations. One year after randomization, PP was significantly lower in the sacubitril/valsartan group compared with the valsartan group (3.0 mm Hg decrease [95% CI, 2.4–3.5]; P <0.001). In conclusion, PP was an independent predictor of cardiovascular events in patients with HF with preserved ejection fraction enrolled in PARAGON-HF. Sacubitril/valsartan lowered PP compared with valsartan.

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Korrektsiya arterial'noy gipertonii u bol'nykh sakharnym diabetom 2 tipa: fokus na zhestkost' arteriy

Obesity and metabolism ◽

10.14341/2071-8713-4948 ◽

2011 ◽

Vol 8 (2) ◽

pp. 19-25

Author(s):

Olga Konstantinovna Vikulova

Keyword(s):

Metabolic Syndrome ◽

Arterial Stiffness ◽

Ace Inhibitor ◽

Antihypertensive Effect ◽

Cardiovascular Complications ◽

Organ Protection ◽

Factors Associated ◽

Pathogenic Factors ◽

Patients With Diabetes ◽

Complications And Mortality

Elevation of the arterial stiffness is one of the important pathogenic factors associated with a high risk of cardiovascular complications and mortality rate in patients with diabetes and metabolic syndrome. Correction of the arterial stiffness has a great value for decrease of the risk of atherosclerosis progress and organ protection. Therapy with ACE inhibitor ramipril provides not only high antihypertensive effect but also significant improvement of parameters of the arterial stiffness which indicates an additional vasoprotective effect of the drug.

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The Effects of Cabergoline on Vascular Indices in Overweight and Obese Type 2 Diabetes Patients

Asian Journal of Medicine and Biomedicine ◽

10.37231/ajmb.2021.5.1.369 ◽

2021 ◽

Vol 5 (1) ◽

pp. 10-18

Author(s):

Miza Hiryanti Zakaria ◽

Wan Mohamad Wan Bebakar ◽

Aida Hanum Ghulam Rasool ◽

Zulkefli Sanip ◽

Wan Mohd Izani Wan Mohamed

Keyword(s):

Type 2 Diabetes ◽

Arterial Stiffness ◽

Lipid Profile ◽

Augmentation Index ◽

Fasting Blood Glucose ◽

Cardiovascular Complications ◽

Control Groups ◽

Profile Changes ◽

And Control

Introduction: Type 2 diabetes (T2D) and obesity often coexist and are associated with increased cardiovascular complications. Objective: This study aims to determine the effects of cabergoline, a dopamine agonist on fasting blood glucose (FBG), glycated hemoglobin (HbA1c), lipid profile, blood pressure (BP) and arterial stiffness in overweight and obese T2D patients. Methods: Fifty-eight T2D patients were randomized to cabergoline 0.5 mg biweekly or control groups for 12 weeks. BP and arterial stiffness were recorded at baseline before starting study medication and repeated after 12 weeks. Pulse wave velocity (PWV) and central augmentation index (AIx) were used to assess arterial stiffness. Other parameters measured were anthropometric measurements, FBG, HbA1c and lipid profile. Changes in these parameters after 12 weeks compared to baseline were calculated for each group, and compared between the two groups. Results: Twenty-eight and twenty-six patients from cabergoline and control groups completed the treatment respectively. After 12 weeks, weight and diastolic BP were increased for both groups while body mass index (BMI) and waist circumference (WC) were increased in cabergoline group. PWV and AIx were not significantly different either within or between group comparisons. There were no significant differences in mean changes in all parameters between the two groups. Conclusion: Weight and diastolic BP were elevated in both groups while BMI and WC were increased in cabergoline group. Compared to control, cabergoline treatment at 0.5 mg biweekly in overweight and obese T2D patients for 12 weeks did not improve BP and arterial stiffness.

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The COSEVAST Study: Unravelling the role of Arterial Stiffness in COVID-19 Disease severity

10.1101/2020.12.18.20248317 ◽

2020 ◽

Author(s):

Sanjeev Kumar ◽

Neeraj Kumar ◽

Abhyuday Kumar ◽

Divendu Bhushan ◽

Amarjeet Kumar ◽

...

Keyword(s):

Arterial Stiffness ◽

Disease Severity ◽

Pulse Wave ◽

Cardiovascular Complications ◽

Endothelial Damage ◽

Specific Marker ◽

Non Invasive ◽

Independent Marker ◽

Invasive Measurement

AbstractBackgroundBased on the detailed review of available research and case studies reported in reputed international journals, it can be concluded that endothelial damage (En-dotheliitis) both in small and large arteries may be an important factor of morbidity and mortality in COVID-19 patients. Arterial stiffness due to Endothelial Dysfunction has been established as an independent and specific marker of various chronic cardiovascular diseases.ObjectiveOur objective was to examine functional impairment of the arteries in COVID-19 disease and establish the non-invasive measurement of Arterial Stiffness as an independent marker of disease severity.MethodsWe recorded the Arterial Stiffness of 23 Mild, 21 Moderate and 20 Severe COVID-19 patients grouped on latest NIH severity criteria. We observed Arterial Stiffness of COVID-19 patients with standard parameters like non-invasive Carotid-Femoral Pulse Wave velocity (cfPWV), Age-Normalized increase in cfPWV (ANI_cfPWV).ResultsModerate and Severe COVID-19 patients have extremely elevated arterial stiffness than Mild patients. In Mild patients, cfPWV (829.1 ± 139.2 cm/s) was extremely significantly lower than both Moderate (1067 ± 152.5 cm/s, P< 0.0001) and Severe (1416 ± 253.9 cm/s, P < 0.0001) patients. ANI_cfPWV in Moderate and Severe patients was significantly higher than Mild patients. (Mild: 101.2 ± 126.1 cm/s; Moderate: 279 ± 114.4 cm/s; Severe: 580.1 ± 216.4 cm/s; intergroup P <0.0001). Conclusion: Our findings strongly suggest that arterial stiffness can be an independent and accurate marker for objective risk stratification and therapeutic alleviation of the acute cardiovascular complications like MODS in COVID-19.

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