Search

BackgroundThe purpose of this document is to provide clinicians with guidance, using expert consensus, to help summarize evidence and offer practical recommendations.MethodsExpert Consensus Documents are intended to provide guidance for clinicians in areas in which there are no clinical practice guidelines, especially for new and evolving tests such as arterial stiffness measurements, until any formal guidelines are released.ResultsThis expert consensus document is intended as a source of information for decision-making and to guide clinician-patient discussions in various clinical scenarios.ConclusionsThe goal is to help clinicians and patients make a more informed decision together.

Background and aimsThe ankle-brachial index (ABI) is a diagnostic test for screening and detecting peripheral artery disease (PAD), as well as a risk enhancer in the AHA/ACC guidelines on the primary prevention of atherosclerotic cardiovascular disease (ASCVD). However, our understanding of the association between ABI and cardiovascular risk in contemporary older populations is limited. Additionally, the prognostic value of ABI among individuals with prior ASCVD is not well understood.MethodsAmong 5,003 older adults at ARIC visit 5 (2011-2013) (4,160 without prior ASCVD [median age 74 years, 38% male], and 843 with ASCVD [median age 76 years, 65% male]), we quantified the association between ABI and the risk of heart failure (HF), and composite coronary heart disease and stroke (CHD/stroke) using multivariable Cox regression models.ResultsOver a median follow-up of 5.5 years, we observed 400 CHD/stroke events and 338 HF cases (242 and 199 cases in those without prior ASCVD, respectively). In participants without a history of ASCVD, a low ABI ≤0.9 (relative to ABI 1.11-1.20) was associated with both CHD/stroke and HF (adjusted hazard ratios 2.40 [95% CI: 1.55-3.71] and 2.23 [1.40-3.56], respectively). In those with prior ASCVD, low ABI was not significantly associated with CHD/stroke, but was with HF (7.12 [2.47-20.50]). The ABI categories of 0.9-1.2 and > 1.3 were also independently associated with increased HF risk. Beyond traditional risk factors, ABI significantly improved the risk discrimination of CHD/stroke in those without ASCVD and HF, regardless of baseline ASCVD.ConclusionsLow ABI was associated with CHD/stroke in those without prior ASCVD and higher risk of HF regardless of baseline ASCVD status. These results support ABI as a risk enhancer for guiding primary cardiovascular prevention and suggest its potential value in HF risk assessment for older adults.

The cardio-ankle vascular index (CAVI) is a new measure of arterial stiffness that reflects the stiffness from the ascending aorta to the ankle arteries, and demonstrates little dependence on blood pressure during the evaluation. However, a comprehensive assessment of the association of CAVI with cardiovascular disease (CVD) has not been reported. We performed a systematic review to assess the association between CAVI and CVD. We searched for both prospective and cross-sectional studies using MEDLINE, Embase, and Cochrane from inception until April 11, 2017. We pooled the results using random-effects models. Among 1519 records, we identified nine prospective studies (n = 5214) and 17 cross-sectional eligible studies (n = 7309), with most enrolling high CVD risk populations in Asia. All nine prospective studies investigated composite CVD events as an outcome (498 cases including coronary events and stroke) but modeled CAVI inconsistently. The pooled adjusted hazard ratio for CVD events per 1 standard deviation increment of CAVI in four studies was 1.20 (95% CI: 1.05-1.36, P = 0.006). Of the 17 cross-sectional studies, 13 studies compared CAVI values between patients with and without CVD and all reported significantly higher values in those with CVD (pooled mean difference in CAVI values 1.28 [0.86-1.70], P

Aging is associated with vascular endothelial dysfunction observed through a progressive loss of flow-mediated dilation caused partly by a decreased nitric oxide bioavailability. Intermittent hypoxia, consisting of alternating short bouts of breathing hypoxic and normoxic air, was reported to either maintain or improve vascular function in young adults. The aim of this study was to determine the impact of age on the vascular response to intermittent hypoxia. Twelve young adults and 11 older adults visited the laboratory on two occasions. Plasma nitrate concentrations and brachial artery flow-mediated dilation were assessed before and after exposure to either intermittent hypoxia or a sham protocol. Intermittent hypoxia consisted of eight 4-min hypoxic cycles at a targeted oxygen saturation of 80% interspersed with breathing room air to resaturation, and the sham protocol consisted of eight 4-min normoxic cycles interspersed with breathing room air. Vascular responses were assessed during intermittent hypoxia and the sham protocol. Intermittent hypoxia elicited a brachial artery vasodilation but did not change brachial artery shear rate in both young and older adults. Plasma nitrate concentrations were not significantly affected by intermittent hypoxia compared with the sham protocol in both groups. Brachial artery flow-mediated dilation was not acutely affected by intermittent hypoxia or the sham protocol in either young or older adults. In conclusion, the brachial artery vasodilatory response to intermittent hypoxia was not influenced by age. Intermittent hypoxia increased brachial artery diameter but did not acutely affect endothelium-dependent vasodilation in young or older adults. NEW & NOTEWORTHY: The objective of this study was to determine the impact of age on the vascular response to intermittent hypoxia. Eight 4-min bouts of hypoxia at a targeted oxygen saturation of 80% induced a brachial artery vasodilation in both young and older adults, indicating that age does not influence the vasodilatory response to intermittent hypoxia. Intermittent hypoxia did not acutely affect brachial artery flow-mediated dilation in young or older adults. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to clarify the differences in the movement of the superficial microchambers and deep macrochambers of the heel fat pad during loading and unloading movements, and to clarify the influence of height and weight on this movement. Methods: The subjects were 21 healthy adults. The right foot was placed on an evaluation instrument stand made of polymethylpentene (PMP) resin plate, and the left foot was placed on a scale stand used to adjust the amount of load. When measuring, the heel fat pad is divided into the superficial microchamber layer and the deep macrochamber layer, and the thickness due to loading from 0% to 100% of the body weight and unloading from 100% to 0% is measured. Measurement was performed every 20% using an ultrasound imaging device. We also examined the rate of change in the thickness of the superficial and deep layers of the heel fat pad when applying 100% load (end load) from 0% load (unload). Results: No changes were observed in the superficial layer of the heel fat pad during unloading, but significant changes were observed in the deeper layers. Additionally, the thickness of the microchamber and macrochamber layers tended to increase under each loading condition as the height and weight increased. On the other hand, the rate of change in the thickness of the macrochamber layer tended to decrease. Conclusion: The microchamber layer and the macrochamber layer of the heel fat pad may have different functions. As height and weight increase, the thickness of the microchamber and macrochamber layers may increase, and the rate of change in the thickness of the macrochamber layer appears to decrease. Although the thickness increases as the load increases, we found that the related elasticity decreases. Level of Evidence: Level Ⅳ, cross-sectional survey study. [ABSTRACT FROM AUTHOR]