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Previous studies have shown that arterial stiffness (AS) was a risk factor for heart failure (HF) in nondiabetic patients. We aimed to analyze this impact in a community-based diabetic population. Our study excluded those who had HF before brachial-ankle pulse wave velocity (baPWV) measurement and included 9041 participants finally. Subjects were divided into the normal (<14 m/s), intermediate (14–18 m/s), and elevated baPWV groups (>18 m/s) based on baPWV values. Multivariate Cox proportional hazard model was used to analyze the effect of AS on HF risk. During the median follow-up of 4.19 years, 213 patients had HF. The results of Cox model showed that HF risk in the elevated baPWV group was 2.25 times higher than that in the normal baPWV group (95% confidence interval [CI]: 1.24–4.11). HF risk increased by 18% (95% CI:1.03–1.35) for every 1 additional standard deviation(SD)of baPWV. Restricted cubic spline results showed statistically significant overall and non-linear associations between AS and HF risk (P < 0.05). The subgroup analysis and sensitivity analysis were consistent with that of total population. AS is an independent risk factor for developing HF in the diabetic population, and AS exhibits a dose-response relationship with HF risk. • AS was an independent risk factor for developing HF in the diabetic population. • AS exhibits a dose-response relationship with HF risk. [ABSTRACT FROM AUTHOR]

Visceral fat (VF) influences left ventricular (LV) structure and diastolic function in type 2 diabetes (T2DM). However, there are limited data on the association among them based on different BMI levels as well as accounting for arterial stiffness. This study investigated the association of fat distribution, arterial stiffness, left ventricular (LV) structure and diastolic function in T2DM patients. This cross-sectional study comprised 905 patients. VF area (VFA) and subcutaneous fat area (SFA) were assessed by a dual bioelectrical impedance analyzer. Brachial-ankle pulse wave velocity (baPWV) was measured by a volume-plethysmographic apparatus and LV structure and diastolic function were echocardiography. Patients were divided into three groups based on BMI levels. Linear and logistic regression analysis were used to investigate the association. In multivariate linear regression, relative wall thickness (RWT) was negatively correlated with E/A in obese patients (β = −0.203, p = 0.004). LV mass/height2.7 was positively correlated with E/E' in normal weight (β = 0.232, p = 0.002) and obese patients (β = 0.232, p = 0.008). In multivariate logistic regression, baPWV was an independent determinant of LV remodeling (LVRM) in normal weight (OR = 1.001; 95% CI, 1.000, 1.002; P = 0.006), overweight (OR = 1.001; 95% CI, 1.000, 1.002; P = 0.008) and obese groups (OR = 1.003; 95% CI, 1.001, 1.004; P = 0.001), while VFA was correlated with arterial stiffness in normal weight (OR = 1.032; 95% CI, 1.017, 1.047; P < 0.001) and overweight groups (OR = 1.011; 95% CI, 1.002, 1.021; P = 0.015). VF might impact LVRM through changes in baPWV in T2DM patients, thus influencing diastolic function. • Visceral fat area (VFA), but not subcutaneous fat area or BMI, was positively correlated with baPWV. • Both VFA and baPWV were associated with left ventricular structure. • BaPWV has a stronger correlation with left ventricular remodeling (LVRM) than VFA. • VFA might impact LVRM through changes in baPWV. [ABSTRACT FROM AUTHOR]

Low levels of the Klotho protein are associated with accelerated tissue aging, including arterial stiffness, in patients with cardiovascular and renal diseases. However, this association has not been examined in a diverse cohort. We aimed to investigate the association between serum Klotho protein levels and pulse pressure, as an indicator of arterial stiffness, in a cohort representative of the US population. We used the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2016. Association between pulse pressure and Klotho levels as a continuous variable and in quartiles were examined using survey weight-adjusted linear regression models. Multivariable models were adjusted for age, gender, race, BMI, hypertension, diabetes, smoking, alcohol use, total cholesterol, and estimated GFR. Of the 13,362 participants, 3954(29.6%) were > 65 years, 5792(43%) were Caucasian, and 6773(50.7%) had hypertension. Mean(SD) Klotho was 0.85(0.31) ng/mL and pulse pressure was 55.8(18.5) mmHg. In unadjusted and adjusted models, each ng/mL increase in Klotho was associated with a 3.88 mmHg (95%CI = −5.19,−2.57; P < 0.001) and 1.63 mmHg (95%CI = −3.01,−0.24; P = 0.02) decrease in pulse pressure, respectively. Similarly, participants in the highest quartile of Klotho had lower pulse pressure than those in the lowest quartile (−3.05 mmHg; 95%CI = −4.05,−2.05; P < 0.001), and this difference remained significant in adjusted models (−1.10 mmHg; 95%CI = −2.20,−0.01; P = 0.05). In this large diverse cohort, we found an inverse and independent association between serum Klotho levels and pulse pressure suggesting that Klotho is associated with arterial stiffness. The mechanisms underlying this association need further study. • Low levels of serum Klotho protein are associated with accelerated aging of several tissues. • We examined the association between the serum soluble Klotho protein levels and pulse pressure. • An inverse relationship between soluble serum Klotho levels and pulse pressure was observed independent of confounders. [ABSTRACT FROM AUTHOR]

We aimed to provide a comprehensive aortic stiffness description using magnetic resonance imaging (MRI) in patients with ascending thoracic aorta aneurysm and tricuspid (TAV-ATAA) or bicuspid (BAV) aortic valve. This case-control study included 18 TAV-ATAA and 19 BAV patients, with no aortic valve stenosis/severe regurgitation, who were 1:1 age-, gender- and central blood pressures (BP)-matched to healthy volunteers. Each underwent simultaneous aortic MRI and BP measurements. 3D anatomical MRI provided aortic diameters. Stiffness indices included: regional ascending (AA) and descending (DA) aorta pulse wave velocity (PWV) from 4D flow MRI; local AA and DA strain, distensibility and theoretical Bramwell-Hill (BH) model-based PWV, as well as regional arch PWV from 2D flow MRI. Patient groups had significantly higher maximal AA diameter (median[interquartile range], TAV-ATAA: 47.5[42.0–51.3]mm, BAV: 45.0[41.0–47.0]mm) than their respective controls (29.1[26.8–31.8] and 28.1[26.0–32.0]mm, p < 0.0001), while BP were similar (p ≥ 0.25). Stiffness indices were significantly associated with age (ρ ≥ 0.33), mean BP (arch PWV: ρ = 0.25, p = 0.05; DA distensibility: ρ = −0.30, p = 0.02) or AA diameter (arch PWV: ρ = 0.28, p = 0.03; DA PWV: ρ = 0.32, p = 0.009). None of them, however, was significantly different between TAV-ATAA or BAV patients and their matched controls. Finally, while direct PWV measures were significantly correlated to BH-PWV estimates in controls (ρ ≥ 0.40), associations were non-significant in TAV-ATAA and BAV groups (p ≥ 0.18). The overlap of MRI-derived aortic stiffness indices between patients with TAV or BAV aortopathy and matched controls highlights another heterogeneous feature of aortopathy, and suggests the urgent need for more sensitive indices which might help better discriminate such diseases. • Ascending aorta aneurysm with tricuspid or bicuspid aortic valve. • 1:1 age-, gender- and blood pressure-matching with healthy volunteers. • Noninvasive, quantitative, comprehensive MRI description of aortic stiffness. • Central instead of peripheral brachial blood pressures. • Simultaneous blood pressure and MRI acquisition. [ABSTRACT FROM AUTHOR]

Postmenopausal women are more likely to have uncontrolled hypertension and are at higher risk of cardiovascular disease compared with age-matched men. Blood pressure variability is emerging as a predictor of adverse cardiovascular outcomes and may be implicated in the relationship between menopause and worsened vascular health in women. We conducted an observational study, BRAVE (Blood pRessure And Vascular hEalth around menopause) to study this relationship. Normotensive perimenopausal women were recruited. Blood pressure variability was measured through 24-h blood pressure monitoring. Vascular health was assessed through arterial stiffness (carotid-femoral pulse wave velocity), carotid intima-media thickness and endothelial function (reactive hyperemic index). Multivariate models were performed to identify factors associated with blood pressure variability and arterial stiffness in perimenopausal women. Forty-nine healthy women (mean age 52.9 ± 4.0, 63% postmenopausal) were recruited. There was a high prevalence (40%) of night non-dipping, a measure of an abnormal pattern of blood pressure variability. Aside from night dipping, other measures of blood pressure variability were similar between premenopausal and postmenopausal women. In the multivariate analysis, body mass index was the only factor associated independently with different measures of blood pressure variability, including the maximum overnight blood pressure (ß = 1.95, p < 0.01). The latter was also significantly associated with arterial stiffness (ß = 0.035, p = 0.048). Finally, poor sleep was independently associated with an increase in arterial stiffness. Abnormal blood pressure variability, particularly night non-dipping, is common in normotensive perimenopausal women. Maximum overnight blood pressure is independently associated with arterial stiffness and may identify women at higher cardiovascular risk. [ABSTRACT FROM AUTHOR]

Low-volume high-intensity interval training (HIIT) may be a time-efficient strategy that leads to similar or superior improvements in cardiorespiratory fitness (CRF) and cardiovascular disease (CVD) risk factors when compared with moderate-intensity continuous training (MICT). Our study investigated the effect of low-volume HIIT or MICT versus sham placebo-control (PLA) on central arterial stiffness, hemodynamic responses, and CVD risk factors in adults with obesity and type 2 diabetes (T2D). Eligible participants were previously inactive adults with obesity and T2D. Individuals were randomly allocated to: i) HIIT (1 × 4 min cycling at 90% peak oxygen consumption [V̇O 2peak); ii) MICT (45 min of cycling at 60% VO 2peak); or PLA. Training groups exercised thrice weekly for 12 weeks. Central arterial stiffness, hemodynamics and CVD risk factors were assessed at baseline and post-intervention. Analysis of covariance (ANCOVA) was used to examine changes following HIIT, MICT and PLA. Thirty-five participants (age: 55.1 ± 1.4 years, BMI: 36.1 ± 0.8 kg/m2) completed the study. A significant intervention effect was found for changes in pulse wave velocity (PWV) (p =.03), which reduced with HIIT (−0.3 ± 0.9 m/s) and MICT (−0.1 ± 1.1 m/s) but increased with PLA (0.8 ± 1.6 m/s). There was a significant intervention effect for changes in V̇O 2peak (p <.01), glycosylated hemoglobin (p =.03), systolic blood pressure (p <.01), and waist circumference (p =.03), which all improved following MICT or HIIT but not PLA; there was no difference between MICT and HIIT. Twelve minutes of low-volume HIIT per week leads to improvements in central arterial stiffness and cardiovascular health in inactive individuals with obesity and T2D. • Cardiovascular disease is the leading cause of mortality in people with type 2 diabetes. • "Lack of time" is a commonly cited as a barrier to participating in exercise in such individuals. • Just 12 min of low-volume HIIT per week can significantly reduce central arterial stiffness and improve cardiovascular health outcomes in adults with type 2 diabetes. • Low-volume HIIT provides a time-efficient exercise approach for reducing the cardiovascular burden in this population. [ABSTRACT FROM AUTHOR]

Arterial stiffness may affect antihypertensive response to antihypertensive treatment. However, sufficient clinical evidence is lacking. This longitudinal study aimed to evaluate the effect of baseline arterial stiffness measured by the brachial-ankle pulse wave velocity (baPWV) on response to short-term and long-term enalapril-based treatment in 3310 hypertensive adults from the China Stroke Primary Prevention Trial (CSPPT). Blood pressure (BP) measured at three months (short-term) in 2780 subjects, and the time-average on-treatment BP in 3310 subjects during a median of 4.5-year follow-ups (long-term) were analyzed in the study. After short-term antihypertensive treatment, every 1 m/s increase in baPWV denoted a 7% and 6% decreased chance of achieving systolic BP (SBP) control (odds ratio (OR), 0.93; 95% CI 0.90, 0.96; P < 0.001) and BP control (OR, 0.94; 95% CI 0.91, 0.97; P < 0.001), respectively, after adjustment for age, gender and other variables. After long-term treatment, every 1 m/s increase in baPWV posed an 7% and 6% greater risk of failing to attain SBP control (OR, 0.93; 95% CI 0.90, 0.95; P < 0.001) and BP control (OR, 0.94; 95% CI, 0.92, 0.96; P < 0.001), respectively, not regarding for DBP control after both short- and long-term treatment. Higher baseline baPWV significantly decreased SBP reduction both after three months and the median 4.5-year treatment, while increased DBP reduction after the median 4.5-year treatment. Elevated baseline baPWV significantly decreased BP response to short-and long-term treatment in adults with primary hypertensive. Arterial stiffness improvement may be an essential target to achieve adequate BP control. • The baseline baPWV is an independent predictor of adequate SBP and BP control. • Higher baseline baPWV predicts less SBP reduction in a dose response manner. • There was no significant association between baseline baPWV and DBP control. [ABSTRACT FROM AUTHOR]

A stiffened, dilated ascending aorta may represent an important predictor of cardiovascular mortality, and has been reported in patients with congenital heart disease, including single ventricle. However, the serial conformational changes and determinants of reduced distensibility in ascending aorta have not been clarified. This retrospective study investigated 115 postoperative Fontan survivors (median age at Fontan: 3.7 years). All patients underwent cardiac catheterization before and 1, 5, 10, and 15 years after the Fontan operation. We measured Z-scores for diameters and stiffness indexes (β) of the ascending aorta and descending aorta from angiograms. We also reviewed the clinical profiles, hemodynamic parameters, and exercise capacities of patients and compared them with results from 47 control subjects. Fontan survivors displayed significantly larger Z-score and β of the ascending aorta from before to 15 years after surgery than controls, whereas values for the descending aorta were comparable. Z-score for the ascending aorta was decreased, but β was elevated significantly according to the trend test. In multivariable analysis, β of the ascending aorta at 15 years after Fontan operation and its increasing trend were associated with older age at Fontan operation and elevated ventricular end-diastolic pressure. Reduced exercise capacity also correlated with stiffening of the ascending aorta. Fontan survivors showed progressive stiffening and relatively slow growth of the dilated ascending aorta. Progressive stiffening of the ascending aorta may be coupled to diastolic dysfunction and reduced exercise capacity, suggesting the importance of lifelong management of subclinical Fontan pathophysiology. Unlabelled Image • A stiffened, dilated ascending aorta represents aortopathy in single ventricle. • Ascending aorta grew relatively slowly and its dilation gradually attenuated. • In contrast, stiffness of ascending aorta was elevated in 15-year Fontan survivors. • This stiffening was associated with diastolic dysfunction and exercise intolerance. • Our findings emphasize importance of lifelong management in Fontan survivors. [ABSTRACT FROM AUTHOR]

Abstract Aims The present network meta-analysis was performed to comprehensively compare the ability of different types of antihypertensive agents to ameliorate arterial stiffness in hypertensive patients. Methods and results To conduct this network meta-analysis , we searched PubMed, the Embase database, and the https://clinicaltrials.gov / website for all relevant articles concerning clinical trials on hypertension therapy. The last search date was 10 August 2017. As a result, 28 eligible articles were enrolled in our meta-analysis. According to the included studies, there was no significant difference in pulse wave velocity (PWV) between these treatments. The eight types of antihypertension agents outperformed placebo in controlling systolic blood pressure (SBP). Angiotensin-converting enzyme inhibitor (ACEI) outperformed angiotensin II receptor blocker (ARB) in SBP; and angiotensin receptor-neprilysin inhibitor (ARNI) outperformed diuretic (D) in SBP. Conclusions This study found that the eight antihypertensive agents show obvious effect on reducing SBP other than arterial stiffness. Highlights Highlights should consist of 3–5 bullet points. However, only 2 points were provided. Kindly modify the provided Highlights to conform with the requirement. For more information, please see the Guide for Authors. --> • It is the first network meta-analysis to assess the antihypertensive drugs on arterial stiffness. • The eight antihypertensive agents show no effect on reducing arterial stiffness. [ABSTRACT FROM AUTHOR]

Background CV risk exponentially increases as the number of damaged organs increases The Systemic Hemodynamic Atherosclerotic Syndrome (SHATS) represents a novel conceptualization of the CV continuum focusing on simultaneous multi-organ alteration. This is the first study operationally defining SHATS and aimed at identifying its determinants. Methods Left Ventricular Hypertrophy (echocardiography), Common Carotid Artery plaque and increased thickness (ultrasound), and Chronic Kidney Disease (estimated Glomerular Filtration Rate) indexed selective target organ damage. SHATS was operationally defined as their simultaneous presence in a patient. PWV was measured by Sphygmocor® and BP variability by 24 h ABPM. Results SHATS affected 19.9% of the 367 studied subjects. Subjects with SHATS had a similar prevalence in diabetes mellitus, but a greater prevalence of very stiff artery (84.9 vs 64.3%, p < 0.01) and use of antihypertensive medications. In the presence of similar office BP, SHATS was associated with higher 24 h SBP and lower 24 h DBP (a greater pulsatile pressure!), reduced nighttime SBP fall, and a twofold greater prevalence of reverse dipper status (48.2 vs 20.2%, p < 0.001). BMI (positive correlation) and DBP (negative correlation) were the only traditional CV risk factors significantly associated with the odds of having SHATS. Very stiff artery and BP variability were significant independent determinants of SHATS, with highly predictive accuracy. Conclusion SHATS, the simultaneous damage of multiple target organs, may easily operationally defined. Very stiff artery and BP variability represent key factors for SHATS. The present results support the hypothesis of SHATS as a systemic condition, needing further characterization. [ABSTRACT FROM AUTHOR]

Background Serum uric acid (SUA) and oxidized LDL (oxLDL) may be associated with arterial aging. The aim of our study was to evaluate the relationship between SUA, oxLDL and arterial stiffness in subjects with normal renal function and in patients with mild or moderate renal impairment. Methods From the database of the 2012 Brisighella Heart Study, we compared age-matched adult, non-smoker subjects without cardiovascular disease and with normal renal function ( n  = 205), subjects with stage II chronic kidney disease (CKD) ( n  = 118) and subjects with stage III CKD ( n  = 94). All subjects underwent a determination of the LDL oxidative susceptibility, oxLDL levels, SUA and Pulse Wave Velocity (PWV). Results By univariate analysis, PWV correlated with a large number of clinical, haemodynamic and metabolic parameters, including estimated glomerular filtration rate (eGFR) in subjects with normal renal function and in those with stage II or III CKD. Stepwise multiple regression analyses showed that in the presence of normal renal function or stage II CKD, the main predictors of PWV were age, systolic blood pressure (SBP), ox-LDL, apolipoprotein B and SUA ( p  < 0.05), while in the presence of stage III CKD only age, SBP and apolipoprotein B remained significant (p < 0.05). Conclusion Both ox-LDL and SUA independently predicts PWV only in subjects with normal or mildly reduced renal function, but not in the subjects with more compromised eGFR. This study confirms the complex relationship of SUA with cardiovascular and metabolic disease in the patient with established renal disease. [ABSTRACT FROM AUTHOR]

Background Pulse wave velocity (PWV) is considered a major indicator of arterial stiffness, which can be quickly modulated by therapeutic interventions. We sought to assess the short-term effect of rosuvastatin therapy on carotid-femoral PWV in statin-naïve individuals with heterozygous familial hypercholesterolemia (He-FH). Methods In this prospective single-center open-label study, statin-naïve individuals with a probable or definite diagnosis of He-FH (Dutch Lipid Clinic Network score ≥ 6 including LDL-C ≥ 190 mg/dL), without clinical history of diabetes mellitus, coronary artery disease or chronic inflammatory diseases, underwent a clinical, biochemical and instrumental evaluation including carotid-femoral PWV assessment at baseline and after a 3-month treatment with rosuvastatin. Results Among > 500 individuals screened for suspect He-FH in a 1.5-year period, 22 fulfilled our inclusion and exclusion criteria and were enrolled in the study. Twenty of them completed the 3-month treatment period and evaluations, including 7 men and 13 women, with a mean age of 45 ± 14 years. At 3-month follow-up there was a significant 46% reduction in LDL cholesterol (from 255.8 ± 42.1 to 138.6 ± 41.2, p < 0.0001). Concomitantly, we observed a significant 14% reduction in PWV (from 8.30 ± 1.4 to 7.13 ± 0.97 m/s, p < 0.0001), which persisted after adjusting for mean blood pressure and heart rate at the time of PWV assessment. There was no significant relationship between the change in PWV and in LDL cholesterol levels. Conclusions Our preliminary results suggest that in individuals with He-FH, a 3-month treatment period with rosuvastatin determines a significant reduction in arterial stiffness, possibly through its pleiotropic vascular effect beyond lowering of plasma cholesterol. [ABSTRACT FROM AUTHOR]

Objectives To examine the longitudinal mutual association between endothelial dysfunction and arterial stiffness, and also to determine which of the two variables was more closely associated with the progression of subclinical organ damage. Methods The brachial-ankle pulse wave velocity (baPWV), carotid intima-media thickness (CIMT), estimated glomerular filtration rate, microalbuminuria and flow-mediated vasodilatation of the brachial artery (FMD) were measured three times at 1.5-year intervals in 674 Japanese patients receiving antihypertensive treatment. Results The change of the baPWV during the study period was larger in the subjects with baseline FMD values in the lowest tertile as compared to those with baseline FMD values in the highest tertile. The change of the CIMT was smaller in the subjects with baseline baPWV values in the lowest tertile than in those with baseline baPWV values in the highest tertile. After the adjustment, the FMD value at the baseline was inversely associated with the baPWV at the end of the study period (beta = − 0.07, p = 0.01), although, the reverse association was not significant. The baPWV, but not the FMD value, at the baseline was associated with the CIMT (beta = 0.06, p = 0.04) measured at the end of the study period. Conclusions In hypertension, endothelial dysfunction was associated with the progression of arterial stiffness, although the reverse association was not confirmed. The increased arterial stiffness rather than endothelial dysfunction may be more closely associated with the progression of atherosclerotic vascular damage, and the endothelial dysfunction-arterial stiffness-atherosclerosis continuum may be important in hypertension. [ABSTRACT FROM AUTHOR]

Background Aging declines essential physiological functions, and the vascular system is strongly affected by artery stiffening. We intended to define the age- and sex-specific reference values for carotid-to-femoral pulse wave velocity (cf-PWV) in a sample free of major risk factors. Methods and results The ELSA-Brasil study enrolled 15,105 participants aged 35–74 years. The healthy sample was achieved by excluding diabetics, those over the optimal and normal blood pressure levels, body mass index ≤ 18.5 or ≥ 25 kg/m 2 , current and former smokers, and those with self-report of previous cardiovascular disease. After exclusions, the sample consisted of 2158 healthy adults (1412 women). Although cf-PWV predictors were similar between sex (age, mean arterial pressure (MAP) and heart rate), cf-PWV was higher in men (8.74 ± 1.15 vs. 8.31 ± 1.13 m/s; adjusted for age and MAP, P < 0.001) for all age intervals. When divided by MAP categories, cf-PWV was significantly higher in those which MAP ≥ 85 mm Hg, regardless of sex, and for all age intervals. Risk factors for arterial stiffening in the entire ELSA-Brasil population ( n = 15,105) increased by twice the age-related slope of cf-PWV growth, regardless of sex (0.0919 ± 0.182 vs. 0.0504 ± 0.153 m/s per year for men, 0.0960 ± 0.173 vs. 0.0606 ± 0.139 m/s per year for women). Conclusions cf-PWV is different between men and women and even in an optimal and normal range of MAP and free of other classical risk factors for arterial stiffness, reference values for cf-PWV should take into account MAP levels. Also, the presence of major risk factors in the general population doubles the age-related rise in cf-PWV. [ABSTRACT FROM AUTHOR]

Background Pulse pressure amplification (PPA), i.e. the amplification from central arteries to the periphery, is inversely related to arterial stiffness, organ damage and mortality. It is known that arterial stiffness is higher in black than white populations, but it is unclear if this is due to early vascular aging. We therefore investigated whether PPA declines earlier in young normotensive black South Africans, when compared to their white counterparts. Methods We included 875 black and white men and women from the African-PREDICT study (55% black, 41% men), aged 20–30 years, with no prior diagnosis of chronic disease, screened for normotensive clinic blood pressure (BP). We determined supine central PP (cPP), and supine brachial systolic– and diastolic BP, from which brachial PP (bPP) was calculated. PPA was defined as the ratio of the amplitude of the PP between these distal and proximal locations (bPP/cPP). Results We found the mean PPA to be lower in black compared to white participants (1.43 vs. 1.46; P = 0.013). In black adults PPA declined earlier with increasing age (P–trend < 0.001), with a weak trend in whites (P = 0.069) after adjustment for sex, socio-economic status, height, heart rate and mean arterial pressure. In multivariable-adjusted regression, we found an independent inverse association between PPA and age only in the black group (β = − 0.18, P = 0.002). Conclusion PPA declines earlier with age in normotensive black adults younger than 30 years, exemplifying early vascular aging which may predispose black individuals to future cardiovascular outcomes. [ABSTRACT FROM AUTHOR]

Background Arterial stiffness (AS) and baroreflex sensitivity (BRS) are subclinical markers of vascular diseases in type 2 diabetes (T2D). We evaluated the effects of aerobic interval training (AIT), with loads prescribed according to individual heart rate and lactate profiling obtained during a baseline treadmill test (TRIMPi method), on AS and BRS in patients with early-onset T2D without cardiovascular complications. Population study and methods Twenty-two sedentary overweight T2D patients (aged 57 ± 7 years) were randomized to 12-weeks open-label of supervised AIT by TRIMPi ( n = 8) or unsupervised physical activity as per usual care (SOC) ( n = 11). Following parameters were evaluated (pre- and post-): anthropometrics; six-minute walking test (6MWT); fasting glucose, insulin, HbA1c; Pulse Wave Velocity (PWV) and Augmentation Index (AIxHR75) using radial approach (SphigmoCor System); BRS using Finapress method. Results Both interventions significantly improved distance walked during 6MWT (AIT 52 ± 21 m; SOC 39 ± 24 m, p < 0.001 for both). PWV significantly improved with AIT ( p < 0.001) whereas did not vary with SOC ( p = 0.47). Similar trend was observed for AIxHR75. Resulting percent changes from baseline were significantly better for AIT vs SOC, in both PWV (− 15.8 ± 2.1 vs + 1.50 ± 3.4%, p < 0.001) and AIxHR75 (− 28.9 ± 3.2% vs + 12.7 ± 2.4%, p < 0.001). BRS similarly improved in both groups ( p < 0.001 for both), as well as body weight, HbA1c and blood pressure. Conclusion In sedentary T2D patients, 12-weeks AIT individualized by TRIMPi method improved AS to a greater extent than usual recommendation on physical activity, whilst exerting comparable effects on exercise capacity, glycemic control and body weight. Further researches are needed to ascertain durability of these effects. [ABSTRACT FROM AUTHOR]

Aims Mental stress-induced myocardial ischemia (MSIMI) in patients with coronary artery disease (CAD) is associated with adverse cardiovascular outcomes. We aim to assess hemodynamic, neuro-hormonal, endothelial, vasomotor and vascular predictors of MSIMI. Methods and results We subjected 660 patients with stable CAD to 99mTc sestamibi myocardial perfusion imaging at rest, with mental (speech task) and with conventional (exercise/pharmacological) stress. Endothelium-dependent flow-mediated dilation (FMD), microvascular reactivity [reactive hyperemia index (RHI)] and arterial stiffness [pulse wave velocity (PWV)] were measured at rest and 30-min after mental stress. The digital microvascular vasomotor response during mental stress was assessed using peripheral arterial tonometry (PAT). A total of 106(16.1%) patients had MSIMI. Mental stress was accompanied by significant increases in rate-pressure-product (heart rate x systolic blood pressure; RPP), epinephrine levels and PWV, and significant decreases in FMD and PAT ratio denoting microvascular constriction. In comparison to those with no MSIMI, patients with MSIMI had higher hemodynamic and digital vasoconstrictive responses (p < 0.05 for both), but did not differ in epinephrine, endothelial or macrovascular responses. Only presence of ischemia during conventional stress (OR of 7.1, 95%CI of 4.2, 11.9), high hemodynamic response (OR for RPP response ≥ vs < ROC cutoff of 1.8, 95%CI of 1.1, 2.8), and high digital vasoconstriction (OR for PAT ratio < vs ≥ ROC cutoff of 2.1, 95%CI of 1.3, 3.3) were independent predictors of MSIMI. Conclusion Ischemia during conventional stress testing and hemodynamic and vasoconstrictive responses to mental stress can help predict subjects with CAD at greater risk of developing MSIMI. [ABSTRACT FROM AUTHOR]

Background Hemorrhagic transformation (HT) is a multifactorial phenomenon and represents a possible complication of ischemic stroke, especially after thrombolytic treatment. Increased arterial stiffness has been associated with intracranial hemorrhage, but there is no evidence of association with HT after thrombolytic therapy. The aim of our study is to investigate a possible link between arterial stiffness and HT occurrence after thrombolytic therapy in patients with ischemic stroke. Methods We enrolled 258 patients (135 males, 123 females; mean age: 73 ± 12 years) with acute ischemic stroke undergoing intravenous thrombolysis or/and mechanical thrombectomy. All stroke patients underwent neuroimaging examination, 24-h heart rate and blood pressure monitoring and brain CT-scan after 24–72 h to evaluate HT occurrence. The linear regression slope of diastolic on systolic blood pressure was obtained and assumed as a global measure of arterial compliance, and its complement (1 minus the slope), named arterial stiffness index (ASI), has been taken as a measure of arterial stiffness. Results Out of 258, HT occurred in 55 patients. ASI was significantly higher in patients with HT than in patients without HT (0.70 ± 0.12 vs 0.62 ± 0.14, p < 0.001). Logistic regression model showed ASI as independent predictors of HT (OR: 1.9, 95% CI: 1.09–3.02, for every 0.2 increase of ASI): in particular, OR was 5.2 (CI: 2.22–12.24) when ASI was > 0.71, in comparison with ASI lower than 0.57. Conclusions Our results point to arterial stiffness as a novel independent risk factor for HT after ischemic stroke treated with thrombolysis, suggesting a particularly high bleeding risk when ASI is > 0.71. [ABSTRACT FROM AUTHOR]

Background Increased arterial stiffness and sympathetic nervous system activity, independent markers of cardiovascular risk, are common in patients with severe obstructive sleep apnoea, who have excessive daytime sleepiness. Among patients with mild-to-moderate obstructive sleep apnoea, however, it remains unknown whether arterial stiffness and/or increased sympathetic nervous system activity correlate with excessive daytime sleepiness. Methods We measured heart rate variability, as an index of autonomic nervous system activity, and arterial stiffness index, as a marker of vascular damage and cardiovascular risk, in 56 men aged 18 to 75 years, with mild-to-moderate obstructive sleep apnoea, and matched into two groups, “sleepy” (Epworth Sleepiness Scale ≥ 10) and “non-sleepy” (Epworth Sleepiness Scale < 10). Results We found no association of excessive daytime sleepiness with sympathetic nervous system activation (very low frequency power 18,947 ± 11,207 ms 2 vs 15,893 ± 8,272 ms 2 , p = 0.28; low frequency (LH) power 17,753 ± 8,441 ms 2 vs 15,414 ± 5,666 ms 2 , p = 0.26; high frequency (HF) power 7,527 ± 1,979 ms 2 vs 8,257 ± 3,416 ms 2 , p = 0.36; LF/HF ratio 3.04 ± 1.37 vs 2.55 ± 1.01, p = 0.15) and mean arterial stiffness index (6.97 ± 0.83 vs 7.26 ± 0.66, p = 0.18) in mild-to-moderate obstructive sleep apnoea patients. Conclusions Symptoms of excessive daytime sleepiness are not associated with sympathetic nervous system activation and arterial stiffness in male subjects with mild-to-moderate obstructive sleep apnoea. [ABSTRACT FROM AUTHOR]

Background Effects of potassium supplementation on vascular function remain conflicting. This meta-analysis aimed to summarized current literature to fill the gaps in knowledge. Methods A literature search was performed on PubMed database through April, 2016. The measurements of vascular function included pulse wave velocity (PWV), augmentation index (AI), pulse pressure (PP), flow mediated dilatation (FMD), glycerol trinitrate responses (GTN), and intercellular cell adhesion molecule-1 (ICAM-1). Data were pooled as standardized mean difference (SMD) with 95% confidence intervals. Results Seven randomized controlled trials examining 409 participants were included, with dosage of potassium ranging from 40 to 150 mmol/day, and duration of intervention from 6 days to 12 months. Pooling results revealed a significant improvement in PP (SMD − 0.280, 95% CI − 0.493 to − 0.067, p = 0.010), but no improvement in PWV (SMD − 0.342, 95% CI − 1.123 to 0·440, p = 0.391), AI (SMD − 0.114, 95% CI − 0.282 to 0.054, p = 0.184), FMD (SMD 0·278, 95% CI − 0.321 to 0.877, p = 0.363), GTN (SMD − 0.009, 95% CI − 0.949 to 0.930, p = 0.984), and ICAM-1 (SMD − 0.238, 95% CI − 0.720 to 0.244, p = 0.333). Conclusions Potassium supplementation was associated with significant improvement of PP, rather than other measurements of vascular function. However, the small number of researches and wide variation of evidences make it difficult to make a definitive conclusion. [ABSTRACT FROM AUTHOR]

Background Arterial stiffness has been observed to be an independent predictor for cardiovascular events. Effects of cholesterol lowering agents (statins) on arterial stiffness are inconsistent. We conducted a systematic review with a meta-analysis of all RCTs investigating the impact of statin therapy on arterial properties. Methods We comprehensively searched the databases of MEDLINE, EMBASE, and Cochrane from their dates of inception through April 2016. The inclusion criteria were published RCTs comparing change in arterial stiffness between statin administration and active control or placebo groups. Arterial stiffness is determined by aortic pulse wave velocity (PWV). We used a random-effects model and calculated pooled standardized mean difference (SMD) with 95% confidence intervals (CI) comparing change in PWV between the statin and control groups. Results Six studies were included in the meta-analysis. Statin therapy includes simvastatin, rosuvastatin, lovastatin, fluvastatin, and atorvastatin. Compared with the active control or placebo group, the statin therapy group had lower aPWV (SMD = 2.31, 95% CI: 1.15–3.45, P heterogeneity = 0.07, I 2 = 93%). Conclusion Our meta-analysis demonstrates that statin therapy has a beneficial effect on aortic arterial stiffness. Further studies should be conducted to assess the effects of this therapy on arterial stiffness at various sites and conditions. [ABSTRACT FROM AUTHOR]

Background We tested the hypothesis that arteriosclerosis-augmented aortic pulse wave velocity (PWV) and -impaired vasorelaxation were attenuated by rosuvastatin (Rosu) and propylthiouracil (PTU) therapy. Methods and results Thirty-two New Zealand rabbits were equally divided into group 1 (sham-control), group 2 [high-cholesterol-diet (HCD) for 8 weeks], group 3 [HCD-Rosu (20 mg/kg/day administration after 4-week HFD for 4 weeks)], and group 4 [HCD-PTU (0.1% PTU in drinking water), the treatment course as group 3]. KCl-induced vasoconstriction of carotid artery (CA) was significantly higher in group 2 than in other groups (all p < 0.01), but showed no differences among groups 1, 3 and 4, whereas acetylcholine-induced vasorelaxation exhibited an opposite pattern of KCl-induced vasoconstriction among the four groups ( p < 0.001). Basic nitric-oxide release from endothelial cells of CA was highest in group 1, lowest in group 2, but showed no difference between groups 3 and 4 (all p < 0.001). PWV value was highest in group 2, lowest in group 1, and significantly higher in group 4 than in group 3 (all p < 0.001). Serum levels of total-cholesterol, LDL and TG showed an identical pattern to PWV (all p < 0.001), whereas the levels of free T4, sugar, and body weight did not differ among the four groups (all p > 0.4). Aortic inflammatory biomarkers in cellular (CD68 +/IL-1β +/CD14 +) and protein (TNF-α/NF-κB/IL-1β/MMP-9/MCP-1/ICAM-1/PDGF) levels, and aortic oxidative-stress biomarkers in cellular (8-OHdG) and protein (NOX-1/NOX-2/oxidized protein) levels showed an identical pattern to PWV among the four groups (all p < 0.001). Conclusion Rosu-PTU therapy ameliorated aortic stiffness and inflammation/oxidative-stress, and improved endothelial-cell function after HCD challenge in rabbit. [ABSTRACT FROM AUTHOR]

Objective Growing evidence suggested an association between aortic valve sclerosis (AVSc) and cardiovascular (CV) events. However, little is known about the association of AVSc with major markers of subclinical atherosclerosis. We performed a meta-analysis of literature studies to address this issue. Methods Studies on the relationship between AVSc and common carotid artery intima-media thickness (IMT), prevalence of carotid plaques (CPs), flow-mediated dilation (FMD), aortic pulse wave velocity (PWV) and augmentation index (AIx) were systematically searched in electronic databases. Thirteen studies enrolling 1086 AVSc patients and 2124 controls were included. Results Compared to controls, AVSc patients showed higher IMT (MD: 0.32 mm; 95%CI: 0.07, 0.58; p = 0.014), and higher prevalence of CPs (OR: 4.06; 95%CI: 2.38, 6.93; p < 0.001). Moreover, lower FMD (MD: − 4.48%; 95%CI: − 7.23, − 1.74; p = 0.001) and higher PWV (MD: 0.96%; 95%CI: 0.11, 1.81; p = 0.027) were found in AVSc subjects than in controls, with no differences in AIx (MD: 0.76%; 95%CI: − 0.97, 2.49; p = 0.389). In meta-regression analyses, body mass index and triglyceride levels have an impact on the difference in IMT between cases and controls, while male gender and smoking habit were associated with the difference in the prevalence of CPs between the two groups. Conclusions AVSc is significantly associated with altered markers of subclinical atherosclerosis, thus supporting the concept that AVSc and atherosclerosis share common etiopathological mechanism and/or risk factors. [ABSTRACT FROM AUTHOR]

Background Insulin resistance (IR), constitutes an important cardiovascular risk factor and can cause ischemic heart disease. It can lead to left ventricular dysfunction with a mechanism independent of ischemic heart disease and it is closely associated with impaired vascular function. The aim of our study was to explore the impact of IR on cardiac and vascular function, in patients with cardiovascular risk factors but angiographically undamaged coronary arteries. Methods We studied 32 patients (62.06 ± 11.19 years) with cardiovascular risk factors. All patients underwent coronary angiography, echocardiography, Doppler ultrasound of carotid arteries and laboratory tests. Exclusion criteria were coronary artery disease detected by coronary angiography, diabetes mellitus, creatinine above 1.5 mg/dl, atrial fibrillation or malignant arrhythmias, left-ventricular hypertrophy, valvular heart disease, ejection fraction below 50%. The presence of insulin resistance was assessed using the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR). Each patient underwent a complete echocardiographic examination including Global Longitudinal Strain assessment and carotid artery ultrasound scan including measurement of arterial stiffness. Results The patients were divided into two groups based on the median value of HOMA-IR, the first group for values < 4.14 and, the second, for values ≥ 4.14. Ejection fraction and diastolic function did not significantly differ between the two groups, whether in patients with higher levels of HOMA-IR (≥ 4.14) we observed a Global Longitudinal Strain (GLS) that was significantly reduced (− 16.50 ± 1.37% vs. − 20.73 ± 1.84%, p = 0.0015) vascular stiffness, measured in the carotid arteries as pulse wave velocity (PWV) (9.70 ± 1.75 m/s vs. 7.40 ± 1.89 m/s, p = 0.00148) that was increased. At multivariate analysis HOMA-IR was an independent predictor of myocardial dysfunction (GLS: coefficient 0.1156, p < 0.0001). Conclusion Insulin resistance is associated with subclinical myocardial and vascular alterations in patients without significant coronary artery disease, measured as a reduction of Global Longitudinal Strain, and increased arterial stiffness. Our results underscore the importance of studying the interaction between ventricular function and vessels, in the perspective of more effective preventive and therapeutic interventions. [ABSTRACT FROM AUTHOR]

Background Erythropoiesis is partly regulated through classic feedback pathways that govern blood volume (BV) as sensed by veno-atrial but also arterial stretch receptors. Hence, the total volume of red blood cells (RBCV) could be associated with arterial stiffness (AS), although such hypothesis has not yet been tested. Therefore, we sought to investigate the association of AS with hematological variables including RBCV. Methods Fourteen healthy physically active individuals volunteered for the study (age = 23 ± 2). RBCV, plasma volume (PV), and BV were calculated from measures of hematocrit and total hemoglobin mass (Hb mass ) determined by CO-rebreathing. Carotid compliance with ultrasonography and carotid-ankle pulse wave velocity (PWV) were determined at rest and immediately after a maximal exercise test. The rationale for assessment of AS after exercise derives from the potential marked role of AS in the regulation of erythropoiesis in the setting of reduced central venous pressure. Results At rest, carotid compliance was positively associated with Hb mass , RBCV, BV, but not PV, with coefficients of determination ( R 2 ) ranging from 0.39 to 0.57. Following exercise, closer positive associations were observed between carotid compliance and Hb mass , RBCV, or BV. Moreover, carotid-ankle PWV was negatively associated with all hematological variables after exercise except for PV, with R 2 ranging from 0.49 to 0.75. Similar results were observed when adjusted by body weight. Conclusions AS is strongly and inversely associated with RBCV in healthy individuals. These findings suggest that AS may adversely intercede in the regulation of erythropoiesis through the alteration of mechanisms that control BV. [ABSTRACT FROM AUTHOR]

Background Comparing the relationships of antihypertensive medications with brachial blood pressure (BP) and aortic waveform parameters may help clinicians to predict the effect on the latter in brachial BP-based antihypertensive therapy. We aimed to make such comparisons with new waveform measures and a wider range of antihypertensive regimens than examined previously. Methods Cross-sectional analysis of 2933 adults (61% male; aged 50–84 years): 1637 on antihypertensive treatment and 1296 untreated hypertensives. Sixteen medicine regimens of up to 4 combinations of drugs from 6 antihypertensive classes were analysed. Aortic systolic BP, augmentation index (AIx), excess pressure integral (EPI), backward pressure amplitude (Pb), reflection index (RI) and pulse wave velocity (PWV) were calculated from aortic pressure waveforms derived from suprasystolic brachial measurement. Results Forest plots of single-drug class comparisons across regimens with the same number of drugs (for between 1- and 3-drug regimens) revealed that AIx, Pb, RI and/or log e (EPI) were higher (maximum difference = 5.6%, 2.2 mm Hg, 0.0192 and 0.13 log e (mm Hg ⋅ s), respectively) with the use of a beta-blocker compared with vasodilators and diuretics, despite no brachial systolic and diastolic BP differences. These differences were reduced (by 34–57%) or eliminated after adjustment for heart rate, and similar effects occurred when controlling for systolic ejection period or diastolic duration. Conclusions Beta-blocker effects on brachial BP may overestimate effects on aortic waveform parameters. Compared to other antihypertensives, beta-blockers have weaker associations with wave reflection measures and EPI; this is predominantly due to influences on heart rate. [ABSTRACT FROM AUTHOR]

Background The recognition of beta-blockers as a preferred initial therapy for hypertension has been a hot topic of debate recently. This meta-analysis was aimed to assess the impact of different beta-blockers on arterial stiffness as indexed by pulse wave velocity (PWV), peripheral blood pressure (BP) and heart rate, relative to the placebo, angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs). Methods Two authors independently searched articles, appraised eligibility and abstracted information, and the data were analyzed using STATA. Results Twenty-four articles involving 27 independent trials were eligible. Relative to the placebo, treatment with beta-blockers led to remarkable improvement in PWV (WMD, 95% CI, P : − 1.115 m/s, − 1.561 to − 0.669, < 0.001), systolic BP (− 12.355 mmHg, − 14.330 to − 10.380, < 0.001), diastolic BP (− 8.619 mmHg, − 10.357 to − 6.880, < 0.001), mean BP (− 9.683 mmHg, − 11.172 to − 8.194, < 0.001), pulse pressure (− 4.448 mmHg, − 7.386 to − 1.510, 0.003) and heart rate (− 12.335, − 22.739 to − 1.932, 0.020). Beta-blockers were remarkably superior to ACEIs in DBP (− 2.540 mmHg, − 4.463 to − 0.617, 0.010) and heart rate (− 9.859 bpm, − 11.752 to − 7.969, < 0.001). In contrast to ARBs, beta-blocker treatment increased systolic BP (2.042 mmHg, 0.639 to 3.444, 0.004) but reduced heart rate (− 8.814 bpm, − 9.756 to − 7.873, < 0.001) significantly. No publication bias was observed. Conclusions Beta-blockers exerted more favorable impact than the placebo on arterial stiffness, peripheral BP and heart rate, but less favorable impact than ACEIs or ARBs on all, except heart rate, characters, especially in trials with longer duration of treatment and higher baseline PWV. [ABSTRACT FROM AUTHOR]

Background Pulse wave velocity (PWV) is a noninvasive technique to evaluate arterial stiffness, a dynamic property of the vessels, reflecting their structure and function. Childhood obesity is associated with several cardiovascular comorbidities and to the progression of atherosclerosis. We aimed to compare carotid-femoral PWV between normal weight and overweight/obese prepubertal children and to quantify its association with other cardiovascular risk factors. Methods Cross-sectional study of 315 children aged 8–9 years. Anthropometrics, 24-h ambulatory blood pressure (BP) and carotid-femoral PWV were measured. Classification of obesity was according to World Health Organization (WHO) body mass index (BMI)-for-age reference values. Results Compared to normal weight children, overweight and obese children presented significantly higher levels of PWV (4.95 (P25–P75: 4.61–5.23), 5.00 (4.71–5.33), 5.10 (4.82–5.50) m/s, respectively; p trend < 0.001). Significant positive correlations were found between PWV and total cholesterol, LDL cholesterol, triglycerides, fasting insulin and insulin resistance levels (HOMA-IR) and with high-sensitivity C-reactive protein (hs-CRP). In a multivariate linear regression model adjusted for sex, age, height and 24-h systolic blood pressure z-score, the independent determinants of PWV were BMI, HOMA-IR and the absence of dipping. Conclusions The association between PWV and the loss of dipping and insulin resistance levels, independently of the BMI, reinforces the contribution of these comorbidities to vascular injury in early life. [ABSTRACT FROM AUTHOR]

Background There is no definite consensus on the CV burden associated to Masked hypertension (MH) or White Coat Hypertension (WCH) — conditions that can be detected by out-of-office blood pressure measurements (24 hour Ambulatory Blood Pressure Monitoring, 24 h ABPM). Methods We investigated the association of WCH and MH with arterial aging, indexed by a range of parameters of large artery structure and function in 2962 subjects, taking no antihypertensive medications, who are participating in a large community-based population of both men and women over a broad age range (14–102 years). Results The overall prevalence of WCH was 9.5% and was 5.0% for MH, with 54.9% of subjects classified as true normotensive and 30.6% as true hypertensive. Both WCH and MH were associated with a stiffer aorta, a less distensible and thicker common carotid artery, and greater central BP than true normotensive subjects. Notably, the profile of arterial alterations in WCH and MH did not significantly differ from what was observed in true hypertensive subjects. The arterial changes accompanying WCH and MH differed in men and women, with women showing a greater tendency towards concentric remodeling, greater parietal wall stress, and PWV than men. Conclusion Both WCH, and MH are associated with early arterial aging, and therefore, neither can be regarded as innocent conditions. Future studies are required to establish whether measurement of arterial aging parameters in subjects with WCH or MH will identify subjects at higher risk of CV events and cognitive impairment, who may require more clinical attention and pharmacological intervention. [ABSTRACT FROM AUTHOR]

Background/objectives Several studies reported an increased cardiovascular (CV) morbidity and mortality in patients with primary aldosteronism (PA). We performed a meta-analysis on the impact of PA on major markers of CV risk. Methods Studies on the relationship between PA and common carotid artery intima-media thickness (CCA-IMT), prevalence of carotid plaques, flow-mediated dilation (FMD), nitrate-mediated dilation (NMD), pulse-wave velocity (PWV), augmentation index (AIx), and ankle-brachial index (ABI) were systematically searched in the PubMed, Web of Science, Scopus and EMBASE databases. Results 12 case–control studies (445 cases, 472 controls) were included. Compared to subjects with essential hypertension (EH), PA patients showed a higher CCA-IMT (MD: 0.12 mm; 95% CI: 0.09, 0.16; P < 0.00001), and a higher aortic-PWV (272 cases and 240 controls, MD: 1.39 m/s; 95% CI: 0.90, 1.87; P < 0.00001). In contrast, non-significant differences were found in AIx and AIx normalized to a heart rate of 75 beats per minute (AIx@75). When compared to normotensive subjects, PA patients showed significantly higher CCA-IMT (MD: 0.16 mm; 95% CI: 0.05, 0.27; P = 0.004), aortic-PWV (MD: 3.74 m/s; 95% CI: 3.43, 4.05; P < 0.00001), AIx@75 (MD: 8.59%; 95% CI: 0.69, 16.50; P = 0.03), and a significantly lower FMD (MD: − 2.52%; 95% CI: − 3.64, − 1.40; P < 0.0001). Sensitivity and subgroup analyses substantially confirmed our results. Metaregression models showed that male gender, diabetes, and smoking habit impact on the observed results. Conclusions PA appears significantly associated with markers of subclinical atherosclerosis and CV risk. These findings could help establish more specific CV prevention strategies in this clinical setting. [ABSTRACT FROM AUTHOR]

Background A low testosterone level in men is associated with increased adiposity, insulin resistance, and dyslipidemia. Whether low testosterone level is associated with arterial stiffness and endothelial and microvascular dysfunction remains unknown and was investigated in this study. Methods Serum testosterone was measured in 237 healthy men aged 50 years (SD 12). Endothelial and microvascular function were assessed as brachial artery flow-mediated dilation (FMD) and digital reactive hyperemia index (RHI), respectively. Arterial stiffness was evaluated by tonometry-derived pulse wave velocity (PWV) and central augmentation index (AIX). Results Mean total testosterone level was 16.3 nmol/L (SD 6.11) and 25% of subjects had low levels (< 12.0 nmol/L). Testosterone level correlated positively with RHI (r = 0.24, p < 0.001) and inversely with AIX (r = - 0.14, p = 0.033) but not with FMD or PWV, indicating impaired microvascular hyperemia and arterial elasticity with lower testosterone levels. After multivariate adjustment for the Framingham Risk Score and weight, testosterone level remained an independent predictor of RHI and AIX (β = 0.23, - 0.13; p = 0.001, 0.04, respectively). Conclusion In men with few co-morbidities, lower serum testosterone level is associated with microvascular dysfunction and increased pulse wave reflections, mechanisms by which lower testosterone levels may confer increased cardiovascular risk. Whether normalization of low testosterone level improves vascular function needs further investigation. [ABSTRACT FROM AUTHOR]

Objective Well-known ethnic differences in cardiovascular risk exist, which may be explained by ethnic differences in arterial stiffness. Our aim was to assess ethnic differences in arterial stiffness, to explore whether these differences are accounted for by conventional cardiovascular risk factors, and study whether they differ across age. Methods Cross-sectional data of 1797 Dutch, 1846 South-Asian Surinamese, 1840 African Surinamese, and 1673 Ghanaian participants of the observational HELIUS study (aged 18-70 years) were used. Arterial stiffness was assessed by duplicate pulse wave velocity (PWV) measurements using the Arteriograph system. Results Linear regression showed that South-Asian Surinamese had higher PWVs as compared with Dutch (age-adjusted mean difference (95% CI) was 0.55 (0.39-0.70) m/s in men and 0.82 (0.63-1.01) m/s in women). These differences were largely, but not completely, explained by conventional risk factors (particularly age and MAP). These ethnic differences were not found at young age (< 35 years). African Surinamese and Ghanaians had higher PWVs as compared with Dutch across the entire age range (ranging from 0.22 (0.06-0.39) m/s in African Surinamese men to 1.07 (0.89-1.26) m/s in Ghanaian women), but these differences disappeared or reversed after adjustment for risk factors. Conclusions PWV levels paralleled the well-known ethnic differences in cardiovascular risk. After adjustment for cardiovascular risk factors, however, these ethnic differences in PWV largely disappear. Together with the absence of ethnic differences in PWV at young age, our results support the hypothesis that higher PWV in South-Asian and African ethnic groups develops due to higher exposure to cardiovascular risk factors. [ABSTRACT FROM AUTHOR]

Background Arterial stiffness is an established predictor of cardiovascular risk. We explored the effects of acute smoking on arterial stiffness, systemic inflammation and endothelial activation in chronic smokers and the contribution of cyclooxygenases-1 and 2 (COX-1 and COX-2). Methods and results In a randomized, double-blind, cross-over study, we investigated in 28 young smokers the vascular and systemic effects of smoking one cigarette, 3 h after receiving 1000 mg of aspirin (a non-selective COX-1 and COX-2 inhibitor) or placebo (aspirin substudy), or 200 mg of celecoxib (a selective COX-2 inhibitor) or placebo (celecoxib substudy). Smoking increased carotid-femoral pulse wave velocity (PWV, a marker of aortic stiffness), indicating an adverse effect on arterial elastic properties. Similarly, circulating levels of asymmetric dimethylarginine (ADMA) were increased after smoking. Aspirin fully prevented the smoking-induced increase of PWV after smoking. In contrast, celecoxib only partially prevented the smoking-induced increase of PWV. Both aspirin and celecoxib prevented to a similar extent the increase of ADMA levels after smoking. Conclusions Smoking one cigarette is associated with a deterioration of arterial stiffness and with systemic endothelial activation in chronic smokers. Both COX-1 and COX-2, but primarily COX-1, mediate these unfavorable effects of smoking. [ABSTRACT FROM AUTHOR]

Objective Multiple studies have demonstrated the predictive value of arterial stiffness parameters like augmentation index (AIx) for cardiovascular events, the onset of hypertension, and the progression of heart failure. There is evidence that arterial stiffness is increased in some diagnostic subgroups of patients with congenital heart defects (CHD). This study aims to investigate AIx in a large cross-sectional cohort of patients with CHD. Patients and methods We prospectively examined 1125 consecutive patients with various congenital heart defects (27.3 ± 12.1 years, 464 female) referred for routine cardiopulmonary exercise testing (CPET) in our institution, and 322 healthy volunteers (29.4 ± 18.4 years, 165 female). AIx was estimated in supine position using the oscillometric Vicorder device (SMT medical, Würzburg, Germany). Afterward patients performed a CPET. Results In multivariable regression, presence of a CHD emerged as independent risk factor for higher AIx (p < .001). AIx was also higher in older (p < .001), smaller (p < .001) and heavier (p < .001) patients and in females (p = .008). Patients with aortic stenosis (p < .001), Tetralogy of Fallot (p < .001), transposition of the great arteries after atrial switch (p < .001) or Rastelli procedure (p = .013) and after Fontan procedure (p = .002) had higher AIx. Higher peak oxygen uptake (p < .001) and an ACE-inhibitor (p = .088) were associated with a lower AIx. Conclusions AIx is increased in patients with CHD. Several diagnostic subgroups are at risk. A better understanding of pathophysiologic mechanisms, genetic predisposition, the role of surgical aortic scars or implanted conduits/patches and medication is needed to define the value of AIx for further cardiovascular risk assessment in this cohort. [ABSTRACT FROM AUTHOR]

Objectives Recent data indicate that hypertension is not well controlled in many populations throughout the world. The factors that influence individual response to anti-hypertensive treatment need to be clarified. Pulse wave velocity (PWV), as a marker of arterial stiffness, has been demonstrated to have important relationships with BP progression; however, little information is available on the role of PWV in blood pressure (BP) control. We aimed to assess BP control during the run-in treatment period in the China Stroke Primary Prevention Trial (CSPPT). Methods and results These analyses included a total of 3056 treated hypertensive subjects (age: 59.6 ± 7.5 years, male/female 1339/1717) with PWV measured at baseline. The average BP at enrollment was 166/95 mm Hg, and declined to 141/85 mm Hg after short-term antihypertensive treatment (a median follow-up of 20 days). There was an inverse relationship between PWV level and BP reduction during the treatment, most notably for systolic BP (with estimated coefficients of - 9.01 (P < 0.001) for the top quartile, as compared to the bottom quartile). The association did not differ significantly by gender or types of antihypertensive drugs. Factors related to smaller BP decline were low baseline BP, high baseline PWV, high body mass index, high creatinine, use of fewer types of antihypertensive drug, high heart rate (only for SBP), high homocysteine and low age (only for DBP). Conclusion PWV appears to be an independent determinant of individual response to anti-hypertensive treatment. [ABSTRACT FROM AUTHOR]

Background While aerobic exercise training may decrease arterial stiffness, the impact of combined aerobic and resistance training is unclear. Therefore, the aim of this study was to systematically review and quantify the effect of combined aerobic and resistance training on arterial stiffness, as determined by arterial pulse wave velocity (PWV), and compare it with aerobic training. Methods MEDLINE, EMBASE and Web of Science were searched through November 2013 for randomized controlled trials evaluating the effect of aerobic or combined aerobic and resistance training on PWV. A meta-analysis was performed to determine the standardized mean difference (SMD) in PWV between exercise and control groups. Subgroup analyses were used to study potential moderating factors. Results Twenty-one randomized controlled trials comparing exercise and control groups (overall n = 752), met the inclusion criteria. After data pooling, PWV was decreased in aerobic trained groups compared with controls (10 trials, SMD = - 0.52, 95% CI = - 0.76, - 0.27; P < 0.0001) but did not reach statistical significance in combined trained groups compared with controls (11 trials, SMD = - 0.23, 95% CI = - 0.50, 0.04; P = 0.10). The effect in aerobic trained groups did not differ compared with combined trained groups (P = 0.12). In addition, aerobic training resulted in significantly lower SMD in PWV compared with combined training in interventions including a higher volume of aerobic training or assessing carotid-femoral PWV. Conclusions These data suggest that combined aerobic and resistance training interventions may have reduced beneficial effects on arterial stiffness compared with control interventions, but do not appear to differ significantly with aerobic training alone. [ABSTRACT FROM AUTHOR]

Background: We compared the results of laboratory examinations, echocardiography, arterial stiffness, central blood pressure (BP) and ambulatory BP monitoring (ABPM) between treatment-naïve patients with low normal thyroid-stimulating hormone (TSH) and those with high normal TSH levels. Methods: A total of 285 consecutively-eligible patients with both treatment-naïve hypertension and euthyroid were divided into two groups: those with low-normal TSH (0.40–1.99 μIU/mL, group 1) and high-normal TSH (2.00–4.50 μIU/mL, group 2) and compared according to group and gender. Results: Males were divided into group 1 (n = 113, 68.9%) and group 2 (n = 51, 31.1%) and females were divided into group 1 (n = 71, 58.7%) and group 2 (n = 50, 41.3%). Multivariate analyses revealed that the augmentation index (71.0 [adjusted mean] ± 1.7 [standard error] vs. 78.8 ± 2.5%, P = 0.045), central systolic BP (SBP) (143.3 ± 2.1 vs. 153.0 ± 3.2 mm Hg, P = 0.013), systemic vascular resistance (SVR, 21.4 ± 0.6 vs. 23.9 ± 0.9 mm Hg/L/min, P = 0.027), SBP during daytime (144.1 ± 1.4 vs. 151.6 ± 2.1 mm Hg, P = 0.004) and nighttime (130.4 ± 1.6 vs. 138.5 ± 2.5 mm Hg, P = 0.008), and nighttime pulse pressure (PP, 47.2 ± 0.9 vs. 51.7 ± 1.4 mm Hg, P = 0.010) were significantly higher while cardiac output (5.4 ± 0.1 vs. 4.8 ± 0.2 L/min, P = 0.043) and PP amplification (1.02 ± 0.02 vs. 0.94 ± 0.03, P = 0.039) were significantly lower in the male group 2 than in the male group 1. However, there were no significant differences between the two groups in females. Conclusions: Treatment-naïve hypertensive males with high normal TSH and euthyroid showed higher arterial stiffness, central SBP, SVR, and SBP in ABPM and lower cardiac output and PP amplification as compared to the the low normal TSH group, but not females. [ABSTRACT FROM AUTHOR]

Abstract: Background: Debate concerning aerobic exercise decreasing arterial stiffness in pre- and hypertensive individuals still exists. We sought to systematically review and quantify the effect of aerobic exercise training on arterial stiffness in pre- and hypertensive subjects. Methods: MEDLINE, Cochrane, Scopus and Web of Science were searched up until August 2013 for trials assessing the effect of aerobic exercise interventions lasting 4 or more weeks on arterial stiffness in (pre)hypertensive subjects. Standardized mean difference (SMD) in arterial stiffness parameters (PWV, B-stiffness, Compliance, AIx) was calculated using a random-effects model. Subgroup and meta-regression analyses were used to study potential moderating factors. Results: Fourteen trials comprising a total of 472 (pre)hypertensive subjects met the inclusion criteria. Arterial stiffness was not significantly reduced by aerobic training in (pre)hypertensive subjects (14 trials, SMD=−0.19; P =.06). Likewise, post-intervention arterial stiffness was similar between the aerobic exercise-trained and control (pre)hypertensive subjects (8 trials, SMD=−0.10; P =.43). Neither heterogeneity nor publication bias was detected in either of these analyses. In the subgroup analyses, arterial stiffness was significantly reduced in aerobic exercise-trained (pre)hypertensive subgroups below the median value in post minus pre-intervention systolic blood pressure (SBP) (SMD=−0.38, P =.04) and in subgroups above the median value in the duration of the intervention (SMD=−0.28, P =.03). Similar results were obtained in the meta-regression analysis. Conclusions: Arterial stiffness is not reduced in (pre)hypertensive subjects in response to aerobic training unless associated with a substantial reduction in SBP and/or prolonged duration. [Copyright &y& Elsevier]

Abstract: Background: Analysis of the arterial pressure curve plays an increasing role in cardiovascular risk stratification. Measures of wave reflection and aortic stiffness have been identified as independent predictors of risk. Their determination is usually based on wave propagation models of the circulation. Another modeling approach relies on modified Windkessel models, where pressure curves can be divided into reservoir and excess pressure. Little is known of their prognostic value. Methods and results: The aim of this study is to evaluate the predictive value of parameters gained from reservoir theory applied to aortic pressure curves in a cohort of high-risk patients. Furthermore the relation of these parameters to those from wave separation analysis is investigated. Central pressure curves from 674 patients with preserved ejection fraction, measured by radial tonometry and a validated transfer function, were analyzed. A high correlation between the amplitudes of backward traveling pressure waves and reservoir pressures was found (R=0.97). Various parameters calculated from the reservoir and excess pressure waveforms predicted cardiovascular events in univariate Cox proportional hazards modeling. In a multivariate model including several other risk factors such as brachial blood pressure, the amplitude of reservoir pressure remained a significant predictor (HR=1.37 per SD, p=0.016). Conclusions: Based on very different models, parameters from reservoir theory and wave separation analysis are closely related and can predict cardiovascular events to a similar extent. Although Windkessel models cannot describe all of the physiological properties of the arterial system, they can be useful to analyze its behavior and to predict cardiovascular events. [Copyright &y& Elsevier]