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Background and Aim: Several reports show a significant association between metabolic dysfunction‐associated steatotic liver disease (MASLD) and arterial stiffness (estimated pulse wave velocity [ePWV]) as a surrogate marker of vascular age. We investigate whether ePWV as arterial stiffness in MASLD is associated with all‐cause/cause‐specific mortality. Methods: This cohort study was based on the third National Health and Nutrition Examination Survey (NHANES, 1988–1994) and NHANES 2007–2014 and linked mortality datasets through 2019. Cox regression models assessed the association between ePWV categorized by quartile and all‐cause/cause‐specific mortality among individuals with MASLD. Results: During the follow‐up of a median of 26.3 years (interquartile range: 19.9–27.9), higher levels of ePWV among individuals with MASLD were associated with increased all‐cause mortality, which remained significant after adjusting for demographic, lifestyle, clinical, and metabolic risk factors. Furthermore, higher ePWV in MASLD was associated with higher cardiovascular mortality. There was a 44% (hazard ratio: 1.44, 95% confidence interval: 1.32–1.58) increase in all‐cause mortality and a 53% (hazard ratio: 1.53, 95% confidence interval: 1.32–1.77) increase in cardiovascular mortality for every 1 m/s increase in ePWV in MASLD. However, there was no significant association between ePWV and cancer‐related mortality. Sensitivity analyses using the NHANES 2007–2014 dataset showed results identical to the original analysis. Conclusion: Higher ePWV in MASLD was associated with a higher risk of all‐cause and cardiovascular mortality beyond traditional cardiovascular risk factors. Screening for ePWV in individuals with MASLD may be an effective and beneficial approach to reducing all‐cause and cardiovascular mortality. [ABSTRACT FROM AUTHOR]

Background: As the pulmonary system and cardiovascular system are intimately linked, patients with chronic obstructive pulmonary disease (COPD) and asthma have high risk for developing cardiovascular diseases (CVDs) and altered central hemodynamic. Objective: We aim to assess the central aortic blood pressure (CABP) indices, pulse wave velocity (PWV) and other indicators of arterial stiffness in Indian patients with COPD and bronchial asthma. Methods: This is a single‐center, cross‐sectional study conducted in outpatients diagnosed with either chronic stable phase of COPD or bronchial asthma. CABP indices, vascular age, arterial stiffness and central hemodynamics were measured in patients. Results: Of 193 patients with obstructive airway disease who were enrolled, (n = 81 had COPD and n = 112 had partially‐controlled bronchial asthma) the proportion of male patients was higher in both groups. The PWV, augmentation index (AI) and vascular age (VA) were significantly higher in patients with COPD compared to those with bronchial asthma (all, p < 0.05). Conclusion: The study showed that PWV, AI and VA were higher in patients with stable COPD without any cardiac comorbidities compared to bronchial asthma. [ABSTRACT FROM AUTHOR]

Introduction: Immune dysregulation persists in people with HIV (PWH) on antiretroviral therapy (ART) and may lead to accelerated vascular ageing and cardiovascular disease (CVD). While delayed time to initiation of ART has been linked to worse cardiovascular outcomes, the effect of ART initiation during acute infection on these outcomes is not well understood. Methods: Participants were enrolled from the SEARCH010/RV254 acute HIV (AHI) and HIV‐NAT chronic HIV (CHI) cohorts in Thailand. Participants with 6‐year follow‐up and viral suppression (viral load < 50 copies/μL) at follow‐up were included. Both unmatched cohorts and age and gender‐matched cohorts were analysed. Demographics, HIV laboratories, and cardiovascular risk factors from enrolment and 6‐year follow‐up were obtained from electronic records. Framingham Risk Score (FRS), vascular age (VA), vascular age deviation (VAD), and 10‐year atherosclerotic cardiovascular disease (ASCVD) risk were calculated from previously published equations. Vascular outcomes in AHI and CHI cohorts were compared, and univariable and multivariable linear regression analyses were used to investigate risk factors associated with worse vascular scores. Results: In all, 373 AHI participants and 608 CHI participants were identified. AHI participants were of younger age, had a higher prevalence of syphilis and a lower prevalence of prior hepatitis B, tuberculosis, diabetes, and hypertension. Higher CD4 T‐cell and lower CD8 T‐cell counts were seen in the AHI cohort at enrolment and 6‐year follow‐up. In all participants, the AHI cohort had a lower median FRS (p < 0.001) and VA (p < 0.001), but higher VAD (p < 0.001). However, in matched cohorts, no differences were found in FRS‐based outcomes. In all participants, higher VAD after 6 years of ART was associated with higher body mass index (p < 0.001) and higher CD4 count (p < 0.001), which persisted in multivariable analysis. When FRS components were analysed individually, CD4 count was associated only with male sex and cholesterol. Conclusions: We did not identify differences in FRS‐based vascular outcomes at 6 years in matched cohorts of participants who started ART during AHI versus CHI. We identified a correlation between higher CD4 count and worse FRS‐based vascular outcomes, which may be driven by underlying metabolic risk factors. Further study is needed to confirm these findings and evaluate underlying mechanisms. [ABSTRACT FROM AUTHOR]

Abstract Background As the pulmonary system and cardiovascular system are intimately linked, patients with chronic obstructive pulmonary disease (COPD) and asthma have high risk for developing cardiovascular diseases (CVDs) and altered central hemodynamic. Objective We aim to assess the central aortic blood pressure (CABP) indices, pulse wave velocity (PWV) and other indicators of arterial stiffness in Indian patients with COPD and bronchial asthma. Methods This is a single‐center, cross‐sectional study conducted in outpatients diagnosed with either chronic stable phase of COPD or bronchial asthma. CABP indices, vascular age, arterial stiffness and central hemodynamics were measured in patients. Results Of 193 patients with obstructive airway disease who were enrolled, (n = 81 had COPD and n = 112 had partially‐controlled bronchial asthma) the proportion of male patients was higher in both groups. The PWV, augmentation index (AI) and vascular age (VA) were significantly higher in patients with COPD compared to those with bronchial asthma (all, p

Abstract Central aortic diastolic pressure decay time constant ( $${\uptau }$$ τ ) is according to the two-element Windkessel model equal to the product of total peripheral resistance ( $$R$$ R ) times total arterial compliance ( $$C$$ C ). As such, it is related to arterial stiffness, which has considerable pathophysiological relevance in the assessment of vascular health. This study aimed to investigate the relationship of the constant $${\uptau }$$ τ with the product $$T\frac{MBP}{{cPP}}$$ T MBP cPP , given by heart period ( $$T$$ T ) times the ratio of mean blood pressure (MBP) to central pulse pressure ( $$cPP$$ cPP ). The relationship was derived by performing linear fitting on an in silico population of n1 = 3818 virtual subjects, and was subsequently evaluated on in vivo data (n2 = 2263) from the large Asklepios study. The resulted expression was found to be $${\uptau } = k^{\prime}T\frac{MBP}{{cPP}},$$ τ = k ′ T MBP cPP , with $$k^{\prime} = 0.7$$ k ′ = 0.7 (R2 = 0.9). The evaluation of the equation on the in vivo human data reported high agreement between the estimated and reference $${\uptau }$$ τ values, with a correlation coefficient equal to 0.94 and a normalized RMSE equal to 5.5%. Moreover, the analysis provided evidence that the coefficient $$k^{\prime}$$ k ′ is age- and gender-independent. The proposed formula provides novel theoretical insights in the relationship between $${\uptau }$$ τ and central blood pressure features. In addition, it may allow for the evaluation of $${\uptau }$$ τ without the need for acquiring the entire central blood pressure wave, especially when an approximation of the $$cPP$$ cPP is feasible. This study adds to the current literature by contributing to the accessibility of an additional biomarker, such as the central diastolic pressure decay time constant, for the improved assessment of vascular ageing.

Background. Visceral obesity is a risk factor in the development of metabolic and endocrine disorders leading to arterial hypertension and cardiovascular complications. Their early predictors include increased vascular stiffness and early vascular aging. The current literature lacks studies into the effects of changes in testosterone, cortisol, and aldosterone levels in serum on vascular stiffness and the development of early vascular aging in patients with visceral obesity. Objective. To determine the relationship between hypercortisolemia, hyperaldosteronemia, and hypotestosteronemia and vascular stiffness and the presence of early vascular aging in male patients with visceral obesity. Methods. An observational cohort study of 78 males aged 35–45 years (mean age 38.1 ± 6.5 years) diagnosed with abdominal obesity and grade 1 arterial hypertension was conducted. The mean waist circumference ranged 105.5 ± 6.9 cm; systolic and diastolic blood pressure ranged 152.5 ± 5.0 and 92.5 ± 5.0 mm Hg, respectively. The vascular age of the studied patients (n = 78) comprised 44.1 ± 6.2 years, which was statistically higher than their passport age (р < 0.001). The studied patients were divided into subgroups according to both total testosterone (< 12.1 nmol/l in subgroup 1A (n = 49) and ≥ 12.1 nmol/L in subgroup 1B (n = 29)) and cortisol in the evening saliva portion (> 4.5 nmol/L in subgroup 2A (n = 24) and ≤ 4.5 nmol/L in subgroup 2B (n = 24)). All the patients completed the study. To assess the hormonal status, the total testosterone sex steroid-binding globulin (SSBP) and insulin in morning serum samples were investigated. Insulin resistance was assessed based on the NOMA-IR index. The concentration of total testosterone was determined by enhanced chemiluminescence (Ortho-Clinical Diagnostics, J&J); the SSBP and insulin levels were determined by delayed fluorescence. Aldosterone content was determined by radioimmunoassay; free cortisol and testosterone were measured by luminescent LIA. Free and bioavailable testosterone concentrations in serum were calculated using an online calculator (issam.ch/freetesto.htm). The cardio-ankle vascular index (CAVI) was determined using a VaSera VS-15000N device, which automatically calculated the vascular age. Statistical analysis was performed using the Statistica 10.0 Windows package (StatSoft, Inc., USA). Results. The vascular age of patients with hypogonadism was statistically significantly ( р < 0.001) higher than their passport age and the vascular age in males without hypogonadism. The CAVI and vascular age were also statistically significantly higher in males with functional hypercorticism (р < 0.001) compared with a subgroup of patients without hypercorticism. The vascular age and CAVI increased with an increase in the salivary cortisol concentration 2200 (r = 0.5; р < 0.05) and decreased with an increase in the salivary cortisol level 900 (r = –0.5; р < 0.05). These parameters decreased with an increase in serum aldosterone obtained in the morning (r = –0.4; p < 0.05) and increased with an increase in serum aldosterone in the evening (r = 0.4; p < 0.05). In 23% (n = 18), an inversion of the daily rhythm of cortisol production was observed; in these patients, salivary cortisol levels of 2200 exceeded salivary cortisol levels of 900. The vascular age of patients with the inversion of cortisol production (49.4 ± 4.4 years) was statistically significantly ( р < 0.001) different from that of patients with normal changes in salivary cortisol concentrations (41.9 ± 4.9 years). CAVI was also higher (р < 0.001) in males with inverted fluctuations in salivary cortisol levels (7.51 ± 0.62) compared to those with normal diurnal rhythm (6.45 ± 0.69). The results of aldosterone evaluation revealed that 17% of the patients (n = 13) had higher aldosterone levels in the evening serum portion compared to the morning serum portion. In these patients, the vascular age (45.8 ± 5.1 years) was higher ( р < 0.001) than that in males with normal physiologic changes in aldosterone levels (41.6 ± 5.7 years). A similar pattern was observed when comparing vascular stiffness indices. Thus, the CAVI in men with inverted changes in aldosterone concentration (6.9 ± 0.8) was significantly higher ( р < 0.001), compared to that in men with physiological changes in blood aldosterone levels (6.4 ± 0.8). Conclusion. Endocrinologic disorders in male patients with visceral obesity and concomitant arterial hypertension (functional hypogonadism, functional hypercorticism, inverted daily rhythms of cortisol and aldosterone production) contribute to the development of early vascular aging by increasing vascular stiffness.

A Mediterranean-style eating pattern (MED-EP) may include moderate red meat intake. However, it is unknown if the pro-atherogenic metabolite trimethylamine N-oxide (TMAO) is affected by the amount of red meat consumed with a MED-EP. The results presented are from a secondary, retrospective objective of an investigator-blinded, randomized, crossover, controlled feeding trial (two 5-wk interventions separated by a 4-wk washout) to determine if a MED-EP with 200g unprocessed lean red meat/wk (MED-CONTROL) reduces circulating TMAO concentrations compared to a MED-EP with 500g unprocessed lean red meat/wk (MED-RED). Participants were 27 women and 12 men (n=39 total) who were either overweight or obese (BMI: 30.5 ± 0.3 kg/m2 mean ± SEM). Serum samples were obtained following an overnight fast both before (pre) and after (post) each intervention. Fasting serum TMAO, choline, carnitine, and betaine concentrations were measured using a targeted Liquid chromatography-mass spectrometry. Data were analyzed to assess if (a) TMAO and related metabolites differed by intervention, and (b) if changes in TMAO were associated with changes in Framingham 10-year risk score. Serum TMAO was lower post-intervention following MED-CONTROL compared to MED-RED intervention (post-MED-CONTROL 3.1 ± 0.2 µM vs. post-MED-RED 5.0 ± 0.5 µM, p

Early vascular ageing contributes to cardiovascular (CV) morbidity and mortality. There are different possibilities to calculate vascular age including methods based on CV risk scores, but different methods might identify different subjects with early vascular ageing. We aimed to compare SCORE and Framingham Risk Score (FRS)-based vascular age calculation methods on subjects that were involved in a national screening program in Hungary. We also aimed to compare the distribution of subjects identified with early vascular ageing based on estimated pulse wave velocity (ePWV). The Three Generations for Health program focuses on the development of primary health care in Hungary. One of the key elements of the program is the identification of risk factors of CV diseases. Vascular ages based on the SCORE and FRS were calculated based on previous publications and were compared with chronological age and with each other in the total population and in patients with hypertension or diabetes. ePWV was calculated based on a method published previously. Supernormal, normal, and early vascular ageing were defined as <10%, 10–90%, and >90% ePWV values for the participants. In total, 99,231 subjects were involved in the study, and among them, 49,191 patients had hypertension (HT) and 15,921 patients had diabetes (DM). The chronological age of the total population was 54.0 (48.0–60.0) years, while the SCORE and FRS vascular ages were 59.0 (51.0–66.0) and 64.0 (51–80) years, respectively. In the HT patients, the chronological, SCORE, and FRS vascular ages were 57.0 (51.0–62.0), 63.0 (56.0–68.0), and 79.0 (64.0–80.0) years, respectively. In the DM patients, the chronological, SCORE, and FRS vascular ages were 58.0 (52.0–62.0), 63.0 (56.0–68.0), and 80.0 (76.0–80.0) years, respectively. Based on ePWV, the FRS identified patients with an elevated vascular age with high sensitivity (97.3%), while in the case of the SCORE, the sensitivity was much lower (13.3%). In conclusion, different vascular age calculation methods can provide different vascular age results in a population-based cohort. The importance of this finding for the implementation in CV preventive strategies requires further studies. [ABSTRACT FROM AUTHOR]

Vascular age is an emerging field in cardiovascular risk assessment. This concept includes multifactorial changes in the arterial wall, with arterial stiffness as its most relevant manifestation, leading to increased arterial pressure and pulsatile flow in the organs. Today, the approved test for measuring vascular age is pulse wave velocity, which has been proven to predict cardiovascular events. Furthermore, vascular phenotypes, such as early vascular aging and “SUPERNOVA,” representing phenotypic extremes of vascular aging, have been found. The identification of these phenotypes opens a new field of study in cardiovascular physiology. Lifestyle interventions and pharmacological therapy have positively affected vascular health, reducing arterial stiffness. This review aims to define the concepts related to vascular age, pathophysiology, measurement methods, clinical signs and symptoms, and treatment.

With aging being a major non-reversible risk factor for cardiovascular disease, the concept of Vascular Age (VA) emerges as a promising alternate measure to assess an individual's cardiovascular risk and overall health. This study investigated the use of frequency features and Supervised Learning (SL) models for estimating a VA Age-Group (VAAG), as a surrogate of Chronological Age (CHA). Frequency features offer an accessible alternative to temporal and amplitude features, reducing reliance on high sampling frequencies and complex algorithms. Simulated subjects from One-dimensional models were employed to train SL algorithms, complemented with healthy in vivo subjects. Validation with real-world subject data was emphasized to ensure model applicability, using well-known risk factors as a form of cardiovascular health analysis and verification. Random Forest (RF) proved to be the best-performing model, achieving an accuracy/AUC score of 66.5%/0.59 for the in vivo test dataset, and 97.5%/0.99 for the in silico one. This research contributed to preventive medicine strategies, supporting early detection and personalized risk assessment for improved cardiovascular health outcomes across diverse populations. [ABSTRACT FROM AUTHOR]

Background/Aim: Vascular age (VA) is an emerging metric in preventive cardiovascular (CV) medicine. VA can be derived from morphological parameters such as carotid intimamedia thickness (CIMT), or functional parameters such as pulse wave analysis (PWA), which celebrates its 100th birthday. This study aimed to investigate whether the results of both approaches are comparable. Patients and Methods: On the occasion of the double 100th anniversary of PWA and the Mannheim Clinic, 100 volunteers underwent a) bilateral CIMT assessment using high-resolution ultrasound and b) oscillometric PWA at the brachial forearm site. The respective VAs were calculated using previously published equations. Results: Median age of the participants was 53.6 years (range=39.8-62.6 years), and 56% were female. Median CIMT was 632.5 μm (range=548.8-730.0 μm). Median PWA-derived VA was 55.3 years (36.5-70.5 years). Different values were obtained for CIMT-derived VA, depending on the reference cohort used as calculation basis, ranging from median 43.7 (26.2-59.5 years) to median 64.0 years (43.5-82.1 years). In 46% of the participants divergent VAs were found, that is, the calculated age was higher according to one method and lower according to the other. Correlation analysis revealed a strong dependence of VA (both PWA- and CIMT-derived) and chronological age, as well as an increase in CV risk factors and the detection of plaques with age. Conclusion: Different approaches for estimating VA are not comparable and often produce contradictory results. The current methods and their validity must be critically assessed if they are not standardized. [ABSTRACT FROM AUTHOR]

Background and Objectives: Carotid intima–media thickness (CIMT) and obesity are considered independent determinants of cardio- and cerebrovascular events. The aim of our study was to investigate the effect of obesity on CIMT and to define which traditional cardiovascular risk factors correlate the most with CIMT values in patients with obesity. Materials and Methods: Anthropometric measurements were collected for the whole study group, as well as body composition and blood pressure data, and biochemical blood analyses were also performed. Results: Although our study group was significantly older according to vascular compared with chronological age, the mean CIMT values were lower when compared with the reference values. We found a statistically significant correlation of CIMT with chronological and vascular age, systolic blood pressure, fasting glucose, total cholesterol and triglyceride levels, waist-to-hip ratio, waist circumference, body muscle mass and skeletal muscle mass index. Atherosclerotic Cardiovascular Disease (ASCVD) risk assessment and SCORE (Systematic COronary Risk Evaluation) showed significant positive correlations, but there was only a weak correlation of ASCVD with CIMT. Conclusions: To deduce, since no diagnostic tool currently includes body weight as an individual risk factor, further trials are highly needed to determine if SCORE, SCORE2, ASCVD risk assessment or CIMT would be the most accurate and relevant diagnostic tool for prediction of risk for future CV events in patients with obesity. [ABSTRACT FROM AUTHOR]

BackgroundIn younger individuals, low absolute risk of cardiovascular disease (CVD) may conceal an increased risk age and relative risk of CVD. Calculation of risk age is proposed as an adjuvant to absolute CVD risk estimation in European guidelines. We aimed to compare the discriminative ability of available risk age models in prediction of CVD in rheumatoid arthritis (RA). Secondly, we also evaluated the performance of risk age models in subgroups based on RA disease characteristics.MethodsRA patients aged 30-70 years were included from an international consortium named A Trans-Atlantic Cardiovascular Consortium for Rheumatoid Arthritis (ATACC-RA). Prior CVD and diabetes mellitus were exclusion criteria. The discriminatory ability of specific risk age models was evaluated using c-statistics and their standard errors after calculating time until fatal or non-fatal CVD or last follow-up.ResultsA total of 1974 patients were included in the main analyses, and 144 events were observed during follow-up, the median follow-up being 5.0 years. The risk age models gave highly correlated results, demonstrating R2 values ranging from 0.87 to 0.97. However, risk age estimations differed > 5 years in 15-32% of patients. C-statistics ranged 0.68-0.72 with standard errors of approximately 0.03. Despite certain RA characteristics being associated with low c-indices, standard errors were high. Restricting analysis to European RA patients yielded similar results.ConclusionsThe cardiovascular risk age and vascular age models have comparable performance in predicting CVD in RA patients. The influence of RA disease characteristics on the predictive ability of these prediction models remains inconclusive.

Background: Cardiac output is essential for patient management in critically ill patients. The state-of-the-art for cardiac output monitoring bears limitations that pertain to the invasive nature of the method, high costs, and associated complications. Hence, the determination of cardiac output in a non-invasive, accurate, and reliable way remains an unmet need. The advent of wearable technologies has directed research towards the exploitation of wearable-sensed data to improve hemodynamical monitoring.Methods: We developed an artificial neural networks (ANN)-enabled modelling approach to estimate cardiac output from radial blood pressure waveform. In silico data including a variety of arterial pulse waves and cardiovascular parameters from 3,818 virtual subjects were used for the analysis. Of particular interest was to investigate whether the uncalibrated, namely, normalized between 0 and 1, radial blood pressure waveform contains sufficient information to derive cardiac output accurately in an in silico population. Specifically, a training/testing pipeline was adopted for the development of two artificial neural networks models using as input: the calibrated radial blood pressure waveform (ANNcalradBP), or the uncalibrated radial blood pressure waveform (ANNuncalradBP).Results: Artificial neural networks models provided precise cardiac output estimations across the extensive range of cardiovascular profiles, with accuracy being higher for the ANNcalradBP. Pearson’s correlation coefficient and limits of agreement were found to be equal to [0.98 and (−0.44, 0.53) L/min] and [0.95 and (−0.84, 0.73) L/min] for ANNcalradBP and ANNuncalradBP, respectively. The method’s sensitivity to major cardiovascular parameters, such as heart rate, aortic blood pressure, and total arterial compliance was evaluated.Discussion: The study findings indicate that the uncalibrated radial blood pressure waveform provides sample information for accurately deriving cardiac output in an in silico population of virtual subjects. Validation of our results using in vivo human data will verify the clinical utility of the proposed model, while it will enable research applications for the integration of the model in wearable sensing systems, such as smartwatches or other consumer devices.

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With aging being a major non-reversible risk factor for cardiovascular disease, the concept of Vascular Age (VA) emerges as a promising alternate measure to assess an individual’s cardiovascular risk and overall health. This study investigated the use of frequency features and Supervised Learning (SL) models for estimating a VA Age-Group (VAAG), as a surrogate of Chronological Age (CHA). Frequency features offer an accessible alternative to temporal and amplitude features, reducing reliance on high sampling frequencies and complex algorithms. Simulated subjects from One-dimensional models were employed to train SL algorithms, complemented with healthy in vivo subjects. Validation with real-world subject data was emphasized to ensure model applicability, using well-known risk factors as a form of cardiovascular health analysis and verification. Random Forest (RF) proved to be the best-performing model, achieving an accuracy/AUC score of 66.5%/0.59 for the in vivo test dataset, and 97.5%/0.99 for the in silico one. This research contributed to preventive medicine strategies, supporting early detection and personalized risk assessment for improved cardiovascular health outcomes across diverse populations.

Background and Objectives: Carotid intima–media thickness (CIMT) and obesity are considered independent determinants of cardio- and cerebrovascular events. The aim of our study was to investigate the effect of obesity on CIMT and to define which traditional cardiovascular risk factors correlate the most with CIMT values in patients with obesity. Materials and Methods: Anthropometric measurements were collected for the whole study group, as well as body composition and blood pressure data, and biochemical blood analyses were also performed. Results: Although our study group was significantly older according to vascular compared with chronological age, the mean CIMT values were lower when compared with the reference values. We found a statistically significant correlation of CIMT with chronological and vascular age, systolic blood pressure, fasting glucose, total cholesterol and triglyceride levels, waist-to-hip ratio, waist circumference, body muscle mass and skeletal muscle mass index. Atherosclerotic Cardiovascular Disease (ASCVD) risk assessment and SCORE (Systematic COronary Risk Evaluation) showed significant positive correlations, but there was only a weak correlation of ASCVD with CIMT. Conclusions: To deduce, since no diagnostic tool currently includes body weight as an individual risk factor, further trials are highly needed to determine if SCORE, SCORE2, ASCVD risk assessment or CIMT would be the most accurate and relevant diagnostic tool for prediction of risk for future CV events in patients with obesity.

Copyright of Lege Artis Medicine (LAM) is the property of LifeTime Media Kft. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The concept of vascular age (VA) was proposed to provide patients with an understandable explanation of cardiovascular (CV) risk and to improve the performance of prediction models. The present study compared risk-based VA derived from Framingham Risk Score (FRS) and Systematic Coronary Risk Estimation (SCORE) models with value-based VA derived from the measurement of the common carotid artery (CCA) distensibility coefficient (DC), and it assessed the impact of DC-based VA on risk reclassification. In 528 middle-aged individuals apparently free of CV disease, DC was measured by radiofrequency-based arterial wall tracking that was previously utilised to establish sex- and age-specific reference values in a healthy population. DC-based VA represented the median value (50th percentile) for given sex in the reference population. FRS-based and SCORE-based VA was calculated as recommended. We observed a good agreement between DC-based and FRS-based VA, with a mean difference of 0.46 ± 12.2 years (p = 0.29), while the mean difference between DC-based and SCORE-based VA was higher (3.07 ± 12.7 years, p < 0.0001). When only nondiabetic individuals free of antihypertensive therapy were considered (n = 341), the mean difference dropped to 0.70 ± 12.8 years (p = 0.24). Substitution of chronological age with DC-based VA in FRS and SCORE models led to a reclassification of 28% and 49% of individuals, respectively, to the higher risk category. Our data suggest that the SCORE prediction model, in which diabetes and antihypertensive treatment are not considered, should be used as a screening tool only in healthy individuals. The use of VA derived from CCA distensibility measurements could improve the performance of risk prediction models, even that of the FRS model, as it might integrate risk prediction with additional risk factors participating in vascular ageing, unique to each individual. Prospective studies are needed to validate the role of DC-based VA in risk prediction. [ABSTRACT FROM AUTHOR]

Background: Depression is a significant global health concern, projected to become the leading disease burden. Vascular burden has been implicated in the pathogenesis of depression. Conversely, whether depression independently influences the process of vascular aging is unknown. This study aims to investigate the mutual relationship between vascular age and depression., Methods: Utilizing data from the National Health and Nutrition Examination Survey (NHANES), the study included 27,764 participants after exclusions. Depression was assessed using the Patient Health Questionnaire (PHQ-9). Vascular aging was assessed by estimated pulse wave velocity (ePWV) and the heart age/vascular age (HVA) based on Framingham Risk Score (FRS). The study employed weighted logistic regression and Cox proportional hazards models to analyze the association between vascular age and depression as well as its mortality risk. Mendelian randomization was utilized to explore the causal associations., Results: Individuals with depression exhibited a higher risk of an advanced vascular age over their chronological age. Mendelian randomization analysis indicated a causal relationship between depression and arterial stiffness. A significant association was found between vascular age and depression incidence with odds ratios ranging from 1.10 to 1.38. As vascular age increased, the risk of mortality in individuals with depression increased by 22 % and 46 %, respectively., Limitations: The study design limits the exploration of the dynamic relationship between changes in vascular age and depression due to the single timepoint measurement., Conclusion: This study highlights the bidirectional relationship between depression and vascular age. Vascular age is a significant biomarker for the risk and prognosis of depression, while depression may contribute to vascular aging, which underscores the importance of integrated strategies for managing both vascular health and depression., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

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IntroductionThe risk of cardiovascular disease (CVD) in patients with rheumatoid arthritis (RA) is 1.5–2 times higher than the general population. The fundamental risk factor for CVD is age, related to alterations at the arterial level. The aim of the study was to compare vascular age (VA) in RA patients under a strict treat-to-target (T2T) strategy with Osteoarthritis (OA) patients without strict follow up and to assess the influence of inflammaging (chronic, sterile, low-grade inflammation related to aging) and metabolic markers on VA.Materials and MethodsThis was an analytical cross-sectional study. Patients with RA (under a strict a T2T strategy) and OA patients without strict clinical follow-up were included. Patients with a history of uncontrolled hypertension, CVD, and/or current smoking were excluded. Sociodemographic, physical activity, and toxic exposure data were obtained. Waist-hip ratio and body mass index (BMI) were measured. DAS-28 (RA) and inflammatory markers, lipid profile, and glycaemia were analyzed. Pulse wave velocity (PWV) was measured (oscillometric method, Arteriograph-TensioMed®). VA was calculated based on PWV. Eleven components of inflammaging [six interleukins, three metalloproteinases (MMP), and two tissue inhibitors of metalloproteinases (TIMP)] were evaluated (Luminex® system). Univariate and bivariate analyzes (Mann Whitney U and chi-square) and correlations (Spearmans Rho) were done to compare the two groups.ResultsA total of 106 patients (74% women) were included, 52/RA and 54/OA. The mean age was 57 (Interquartile range - IQR 9 years). The BMI, waist circumference, and weight were higher in patients with OA (p < 0.001). RA patients had low disease activity (DAS-28-CRP). There were no differences in VA, inflammaging nor in PWV between the two groups. VA had a positive, but weak correlation, with age and LDL. In group of RA, VA was higher in those who did not receive methotrexate (p = 0.013). LDL levels correlated with MMP1, TIMP1, and TIMP2.ConclusionsWhen comparing RA patients with low levels of disease activity with OA patients with poor metabolic control, there are no differences in VA. Furthermore, methotrexate also influences VA in RA patients. This shows that implemented therapies may have an impact on not only the inflammatory state of the joint but also CVD risk.

Aim. To study the relationship of modifiable risk factors (RF) with indicators of arterial stiffness and vascular age based on the contour analysis of the pulse wave velocity in hypertensive patients.Material and methods. The material of the study was the data from a survey of patients undergoing clinical observation at the polyclinic of MMC SOGAZ. A total of 107 patients were examined, in which 70 were men and 37 were women. The average age was 52.3±18.29. Photoplethysmography was used as a special research method, performed using the AngioScan-01 diagnostic complex. The main indicators used to evaluate the stiffness of large vessels were: stiffness index (SI), reflection index (RI), augmentation index (Alp75), age index (AGI), pulse wave types (PV) and vascular age (VA).Results. The mean values of arterial stiffness indices in patients with essential arterial hypertension (AH) and healthy individuals (control) had significant differences. The mean SI, Alp75, and VA values in the group of patients with AH were 7.8±1.03, 7.0±14.44 and 50.8±15.93 versus 7.2±1.73, 0.5±18.02 and 43.8±16.94, respectively (p< 0.05). In both groups, a strong inverse correlation of passport age with C-type PV was revealed (r=0.74, p< 0.01), which reflected the dynamics of a gradual age-dependent decrease in vascular compliance. The average VA value in the control group was 63.1±16.99 years with an average passport age of 59.5±8.79 years, which significantly differed from VA in hypertensive patients (p< 0,05). Overweight, hypercholesterolemia, elevated low-density lipoprotein levels, lack of adequate antihypertensive control, and left ventricular diastolic dysfunction were significantly associated with early vascular (arterial) aging.Conclusion. Patients with hypertension, in addition to high blood pressure, significantly differ from normotensive control in terms of arterial stiffness. The lack of control over modifiable RF of patients with hypertension is associated with early vascular aging.

Background. Peripheral artery disease (PAD) is a distinct atherosclerotic syndrome marked by stenosis or occlusion of the arteries, particularly of the lower extremities. The major risk factors for PAD are similar to those for coronary and cerebrovascular disease, comprising smoking, hypertension, hypercholesterolemia and diabetes. The factors involved in the progression of PAD are less well defined. Vascular age (VA) is represented by the apparent age of the vascular system derived from the associated cardiovascular risk factors. This concept has been used so far mainly in primary prevention, being usefull for communication with the patient. Aim. The purpose of the study was to investigate the factors involved in the progression of arterial stenosis in patients already having PAD. Moreover, we tried to determine the utility of VA in increasing patient compliance with therapeutic decisions. Methods. Between 1st February 2015 - 31st December 2015, 270 consecutive patients (pts) referred for vascular echo-Doppler assessment were enrolled in the study. 106 pts with nonsignificant arterial stenosis were prospectively evaluated. All pts underwent complete clinical examination, carotid, femoral ultrasound, echocardiography and laboratory evaluation. Presence of atherosclerotic plaques in the carotid arteries were recorded. Medical history, drug use, smoking behavior, blood pressure, duration of diabetes, presence of premature atherosclerotic PAD in relatives, characterized by disease diagnosis before the age of 50 years, were evaluated. Serum total cholesterol (TC), HDL cholesterol (HDL-C), serum glucose, A1c hemoglobine (HbA1c), serum creatinine, estimated glomerular filtration rate (eGFR) were determined. VA was estimated using Framingham score and intima-media thickness (IMT). The primary end-point was the occurrence of significant peripheral artery stenosis (PAS), defined as a two-fold increase Doppler velocity across the stenosis. Results. At baseline, median age of enrolled pts was 57 years, with male predominance (69,8%). Less than 40% had high blood pressure (39.3%), 36.4% had treated hypertension. The median left ventricular mass index (LVMI) was 108.5 g/m² and concentric hypertrophy was 2 present in 29.9% of patients. Patients with hypertension had LVMI of 113.12 g/m² and those 2 without hypertension, had 105.6 g/m². Diabetes mellitus (DM) was present in 20.6% of 2 patients, majority treated (88%). Among them, 10.3% had more than 10 years duration of DM. Median HbA1c was 5.8%. The majority of the patients are smokers (75.5%). Mean pack-years of smoking was 29.8. During the 4.5 years follow-up, 31.25% quit smoking. The median ejection fraction (EF) was 51.6%. The median TC concentration was 191.6 mg/dl and median HDL-c level was 62.9 mg/dl. 45.8% of the patients received treatment with statins. Premature atherosclerotic PAD in relatives was present in 25.2 % of the patients, and carotid atheromas (CA) in 35.5%. Aortic calcifications (AC) were found in 37.4% of the patients. Median arterial elastance (Ea) was 2.07 mmHg/ml. Median serum creatinine was 1.03 mg/dl and eGFR was 75.6 ml/ml/1.73m. Median value of the 2 VA calculated by IMT (VA-IMT) was 65.5 years and the median VA calculated by cardiovascular risk factors (VA-RF) was 62.9 years. After 4.5 years of follow-up, 35 (32.7%) patients developed significant PAS. 22 patients had popliteal artey stenosis (62.85%) and 13 patients had superficial femoral artery stenosis (37.15%). During the 4.5 years follow-up, 25 patients (31.25%) quit smoking. Median age of population who developed significant PAS at follow-up was 62.6 years and 39.2% were males. Individuals who developed stenosis tended to be smokers, older, receiving hypertensive and statin therapy, having diabetes, especially more than 10 years duration, having dyslipidemias and CA. They all had higher VA-IMT and VA-RF values compared to patients that did not develop PAS. Median value of VA-IMT was 72.6 years and VA-RF was 74.2 years (p<0,001 for both parameters). They also had significantly higher values of Ea, with median value of 2.16 mmHg/ml. There were no statistically significant differences between the two groups in cardiac performance, LV mass, percentage of LV concentric hypertrophy, presence of AC, premature PAD in relatives, renal function and blood pressure values. In logistic regression analysis, pack-years of smoking, HbA1c %, presence of CA and HDL-C were independently associated with significant PAS progression. From the 25 patients which quit smoking, only 6 developed significant PAS (24%), as compared to 29 (52.7%) from the 55 patients which remained active smokers (p =0.016). Conclusion. We demonstrated that some of the classical cardiovascular risk factors were involved in PAD progression: smoking, dyslipidemia, diabetes, carotid atherosclerosis. At multivariate analysis the independent variables associated with PAD progression were packyears of smoking, glycosilated hemoglobin and HDL-cholesterol values and presence of CA. VA assessed by cardiovascular risk scales and by directly measured IMT both predict the progression of PAD, as did Ea, but without independent predictive value for the outcome. Nevertheless, VA was usefull in communicating with the patients, influencing their perception of disease progression and adherence to therapy, improving shared decision making, mainly quitting smoking. We have shown that even after 4.5 years of smoking cessation there was a measurable effect on PAD progression. [ABSTRACT FROM AUTHOR]

Copyright of Medicina Pro Praxi is the property of SOLEN sro and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Coronary artery disease has higher prevalence in India than the West. Studies suggest that vascular age of Asian Indians is older to their chronological age, making them more susceptible for the disease. Association between various factors involved in patients having coronary artery disease and their lipid profiles in rural India is not clear. Objectives: The study focuses on the prevalence and comparative analysis of dyslipidemia in the patient group with respect to demographic data and comorbid conditions. Patients and Methods: This was a retrospective study which analysed 957 patients' hospital record in whom angiography was done for their coronary artery disease in a rural south India. Results: Statistically significant data (P < 0.005) were found in case of total cholesterol levels, with a mean being elevated in age below 45 years (178 ± 46 mg/dl) as compared to age above 45 years (167 ± 48 mg/dl). The mean total cholesterol levels were greater (177 ± 49 mg/dl) in women as compared to men (166 ± 48 mg/dl) with P < 0.005. Hypertensive patients showed elevated levels of total cholesterol and triglycerides. Patients with diabetes had elevated triglyceride levels in general. Conclusion: Triglyceride levels might be playing an important role than total cholesterol in the pathophysiology of CAD and for atherogenesis, it is the presence of hypertension with a deranged lipid profile, more so with total cholesterol and triglycerides.

In the development of renocardial relationships in chronic kidney disease, an important role is given to the activation of the renin-angiotensin-aldosterone system (RAAS), as the main component of the progression and development of cardiovascular complications..The presented review is devoted to the analysis of modern scientific data on the effect of high RAAS activity in chronic kidney disease on the course and prognosis of cardiovascular complications, as well as the protective capabilities of angiotensin-converting enzyme inhibitors, in particular perindopril. The results of scientific research on the role of the RAAS in the progression of chronic kidney disease are summarized. Data on chronic kidney disease as a risk factor for cardiovascular and cerebral complications are presented. Attention is focused on the possibilities of prolonging the pre-dialysis period of chronic kidney disease when using angiotensin-converting enzyme inhibitors. The role of perindopril as a lipophilic angiotensin-converting enzyme inhibitor with a high affinity for tissue RAAS was emphasized in reducing cardiovascular and cerebral risk in chronic kidney disease.

Background: Vascular aging (VA) increases the risk of Cardiovascular Disease (CVD) and premature deaths. Increased VA is attributed to the extent of the Arterial stiffness index (ASI), which is evident in smokers, diabetics, hypertensives, etc. The authors of this paper have discussed the usage of a smartphonebased healthcare instrument, called Lyfas that works with the principle of arterial photoplethysmography (APPG) and estimates the Pulse rate variability (PRV), which surrogates for the Heart rate variability (HRV) and its correlated digital cardiovascular biomarkers (CVb). PRV reflects cardiovascular autonomic modulation, which helps obtain the ASI by Lyfas. Objective: To establish the inter-relationships of the CVb and ASI using Lyfas. Methods: (i) Lyfas assess the ASI from the 2nd derivative of the photoplethysmography (SDPPG) waveform of the capillary arteriole at the tip of index fingers using the camera sensor. From SDPPG, ASI is computed. (ii) Lyfas simultaneously captures the CVb such as SDNN, RMSSD, HR, HRV score, pNN50, SD1/SD2, and LF/HF. (iii) Linear regressions (LR) and One-way ANOVA, and Pearson’s interclass correlations (‘r’) are applied to check the interrelationships of (a) ASI with that of (b) CVb in 116 adults (58 females and males, each) within the age group of 30-60 years and above. Hypersensitivity of Lyfas has been tested by taking the test thrice a day at a gap of 8 hours. The variance and the ranges are measured for hypersensitivity analysis. Results: The study found that the ranges and variances fall within the normal limits. For female hypertensives, SDNN and LF/HF are statistically significant to predict for ASI with correlation (r) values of 0.79 in the age group >60 years and -0.98 in the age group 41-50 years and 0.99 in the age group 41-50 years, respectively. In the case of smokers, SD1/SD2 is negatively correlated (-0.77) with ASI and is statistically significant. male smokers, RMSSD, and HRV are statistically significant to predict for ASI with correlation (r) values of 0.59 in the age group 30-40 years and 0.96 in the age group 41-50 years and for HRV 0.96 in the age group 41-50 years, respectively. In the case of hypertensives, SDNN is negatively correlated (-0.89) with ASI in the age group of 41-50 years and is statistically significant. No biomarker showed a significant correlation in diabetics in this sample. Conclusions: Lyfas is a robust clinical-grade instrument and the CVb captured by it can predict the ASI and the vascular age in a personalized manner. [ABSTRACT FROM AUTHOR]

Purpose: To identify the features of early vascular ageing (EVA) in patients with metabolic syndrome (MetS), to assess the accuracy of existing methods for determining vascular age in MetS, and to derive a new score (VAmets) for the calculation of vascular age and predicting EVA in patients with MetS.Methods: Prospective open cohort study using routinely collected data from general practice. A total of 750 patients (age, 35-80 yrs old) with MetS were examined. EVA syndrome was detected in 484 patients with MetS and carotid-femoral pulse wave velocity (cfPWV) values exceeding average expected for age values by 2 or more standard deviations (SD).Results: The presence of type 2 diabetes and insulin resistance (IR) were associated with greater risk of EVA in MetS patients; the odds ratios were 2.75 (95% confidence interval (CI): 2.34, 3.35) and 1.57 (95% CI: 1.16, 2.00), respectively. In addition, the risk of EVA increased by 76% with an increase in homeostatic model assessment ofinsulin resistance (HOMA-IR) by 1 unit, by 17% with an increase in high-sensitivity C-reactive protein (hs-CRP) by 1 mg/L, by 4% with an increase in diastolic blood pressure (DBP) by 1 mmHg, and by 1% with each (1) μmol/L increase in the level of uric acid (UA). The area under the curve (AUC) for predicting EVA in patients with MetS was 0.949 (95% CI: 0.936,-0.963), 0.630 (95% CI: 0.589,-0.671), 0.697 (95% CI: 0.659,-0.736) and 0.686 (95% CI: 0.647,-0.726), for vascular age calculated from carotid-femoral pulse wave velocity (cfPWV), Systematic COronary Risk Evaluation (SCORE) scale, QRESEARCH cardiovascular risk algorithm (QRISK-3) scale, and Framingham scale, respectively. Diabetes mellitus and clinical markers of IR (yes/no), HOMA-IR and UA level were used to develop a new VAmets score for EVA prediction providing a total accuracy of 0.830 (95% CI: 0.799,-0.860). Based on the results of the study, a VAmets calculator was developed for diagnosing EVA in patients with MetS. (The calculator is available online at https://apps.medhub.pro/evams/) CONCLUSION: Carotid-femoral pulse wave velocity is at present the most widely studied index of arterial stiffness and fulfils most of the stringent criteria for a clinically useful biomarker of EVA in patients with MetS. There are Parallel efforts for the effective identification and integration of a simple clinical score into clinical practice. Our score (VAmets) may accurately identify patients with MetS and EVA on the basis of widely available clinical variables and classic cardiovascular risk factors, and may assist in prioritising the calculation and use of vascular age in routine care. [ABSTRACT FROM AUTHOR]

Background: The calculation of vascular age can help patients understand the importance of adherence to healthy lifestyle and medications. However, multiple methods are available to calculate vascular age and no comparison data is available yet. Our aim was to evaluate vascular age based on the Framingham Risk Score (FRS), the Systematic COronary Risk Evaluation (SCORE) and carotid-femoral pulse wave velocity (PWV).Methods: Consecutive subjects between the age of 40-65 years, who took part in a screening program in three general practitioner practices were involved. PWV was measured by tonometry and was compared with normal values. Vascular age was defined based on FRS and SCORE according to literature data.Results: One hundred and seventy-two (172) patients were involved. The median chronological age was 55.5 (48.8-61.2) years. The median vascular age based on FRS and SCORE were 64 (54-79) years and 55 (44.2-60.7) years, respectively (p<0.05). Based on PWV, FRS and SCORE, 40.1%, 78.5% and 32% of the subjects had increased vascular age compared with chronological age, respectively (PWV+, FRS+, SCORE+, p<0.05). Fifty-eight (58) (84%) of the PWV+ subjects were also FRS+, and this proportion was high in case of SCORE+ patients as well (n=47, 85.4%). However, only moderate overlap was found between PWV+ and SCORE+ subjects as 17 (30.9%) of SCORE+ patients were also PWV+.Conclusion: The differences found between the calculated vascular ages and the proportion of subjects with elevated vascular age warrants further detailed comparison of different vascular age calculation methods. [ABSTRACT FROM AUTHOR]

Background: Lack of blood pressure control leads to a higher incidence of hypertension-mediated target organ damage (HMOD). One of the markers of HMOD is an increased arterial stiffness, an independent predictor of cardiovascular complications. However, abstract numbers showing the level of arterial stiffness do not give patients a clear understanding of the risk of their condition. In order to increase patient compliance, the term "vascular age" (VA) was introduced. Arteriosclerosis plays the main role in increasing VA. The greatest interest, according to the literature, in the study of this issue is in arteriosclerosis caused by transforming growth factor β1 (TGF-β1)-the effect of TGF-β1 on the culture of smooth muscle cells leads to their proliferation and growth; also, TGF-β1 increases the amount of collagen and accelerates the degradation of elastin.Methods: We included 140 people in the study: 80 patients with controlled arterial hypertension (CAH), 30 with uncontrolled arterial hypertension (UAH), and 30 patients who formed the control group. All patients underwent a determination of arterial stiffness and VA using the cardio-ankle vascular index (CAVI), a corrected (blood-pressure independent) cardio-ankle vascular index (CAVI0) and the concentration of TGF-β1 was measured.Results: The TGF-β1 value in the UAH group was 22.6 (25th percentile=20.6; 75th percentile=25.6) ng/mL, and in the control group it was 17.4 (25th percentile=11.8; 75th percentile=19.3) ng/mL. In the CAH group, an intermediate value was noted-19.2 (25th percentile=17.2; 75th percentile=24.7) ng/mL. The CAVI in the UAH group was 9.2 (25th percentile=8.5; 75th percentile=9.9), in the control group-7 (25th percentile=6.5; 75th percentile=7.5). In the CAH group, the average CAVI was 7.8 (25th percentile=7.0; 75th percentile=8.5). The CAVI 0 in the UAH group was 14.8 (25th percentile=12.0; 75th percentile=15.6), in the control group - 9.7 (25th percentile=8.8; 75th percentile=9.7). In the CAH group, the average CAVI was 11.1 (25th percentile=10.1; 75th percentile=13.6). Vascular age in the UAH group was 71.5 (25th percentile=64; 75th percentile=74) years, in the CAH group 59 (25th percentile=49; 75th percentile=69) years, and in both groups (UAH, CAH), VA was significantly higher than the chronological age (p<0.05). In the control group, the VA did not significantly differ from the chronological age (p>0.05) and it was 54 (25th percentile=44; 75th percentile=59) years. A significant relationship was found between the TGF-β1 level and CAVI (CAH r=0.777; UAH r=0.753; p<0.05), CAVI 0 (CAH r=0.625; UAH r=0.502; p<0.05) and VA in patients with AH (CAH r=0.649; UAH r=0.753; p<0.05).Conclusion: In patients in the UAH group, there was an increase in the concentration of TGF-β1, an increase in the arterial stiffness and in VA in comparison with patients in the CAH group and the control group. The relationship between TGF-β1 and the arterial stiffness and VA was revealed in patients with hypertension. [ABSTRACT FROM AUTHOR]

Cátia Cristina Silva Sousa Vergara Palma,1 Pablo Moura Lopes,2 Eliete Leão Clemente Silva,1 Maria de Fátima da Matta Bevilaqua,1 Alfredo de Souza Bomfim,2 Marilia Brito Gomes1 1Department of Internal Medicine, Diabetes Unit, State University Hospital of Rio de Janeiro, Rio de Janeiro, Brasil; 2Department of Internal Medicine, Cardiology Unit, State University Hospital of Rio de Janeiro, Rio de Janeiro, BrasilCorrespondence: Cátia Cristina Silva Sousa Vergara PalmaDepartment of Internal Medicine,Diabetes Unit, Rio de Janeiro State University (UERJ), Boulevard 28 de Setembro, 77- 3º Andar - Vila Isabel, Rio de Janeiro, RJ 20551-030, BrazilTel +55 212 868 8224Email catiasousapalma@gmail.comAim: There is a wide variety of cardiovascular outcomes in patients with type 2 diabetes (T2DM), even in asymptomatic individuals. Carotid intima-media thickness (CIMT) is a marker of subclinical atherosclerosis and can be considered as a predictor of cardiovascular risk (CVR). The aim of this study was to evaluate the relationship between CIMT-determined vascular age (VA), CVR scores, and thyroid function in asymptomatic patients with T2DM.Patients and Methods: Clinical laboratory and CIMT parameters were measured in 154 asymptomatic patients with T2DM. The Framingham risk score (FRS) was performed with chronological age (CA) and with VA. A multinomial logistic regression model was used to analyze variables related to CVR reclassification.Results: The use of CIMT-determined VA led to the reclassification of 54 (35.52%) out of 152 asymptomatic T2DM patients, being 20 (37.03%) to a lower categorical risk and 34 (62.96%) to a higher categorical risk according to FRS. The variables that were associated to reclassification to a higher categorical risk were positive family history (FH) of premature coronary artery disease (p=0.046), FH of thyroid disease (p=0.010), use of statins (p=0.027), and free T4 levels (p=0.009).Conclusion: VA determined from CIMT allowed the reclassification of the CVR in asymptomatic T2DM patients. FH of premature CAD, FH of known thyroid disease, use of statins, and free T4 levels were associated to a reclassification into a higher risk category. The use of doppler to perform CIMT measure is currently more accessible, especially in a low-middle income country like Brazil. However, further prospective studies must be performed to establish the predictive values of CIMT on atherosclerosis and how thyroid function acts like cardiovascular risk marker on CVR scores.Keywords: vascular age, type 2 diabetes, cardiovascular risk, CIMT

Aim. To study the possibilities of photoplethysmography (PPG) in evaluation of arterial stiffness, arterial age and early vascular aging (EVA) in healthy individuals and patients with cardiovascular risk factors.Material and methods. The material of the study was the data from a survey of large teams undergoing medical examination in a group of clinics of Medical Center “SOGAZ”. A total of 783 men aged from 20 to 92 years were examined. The mean age was 48.2±10.32 years. PPG was used as a special research method, performed using the AngioScan-01 diagnostic complex. The following indicators were evaluated: stiffness index (SI), reflection index (RI), augmentation index (Alp75), age index (AGI) and pulse wave types (PV-type). For determining the vascular age (VA), correlation field of the dependence of AGI on the age of the subject was built, and then the VA was calculated by the value of the AGI.Results. The greatest correlation with passport age was revealed for the AGI indicator (r=0.54) at the first stage of the study. EVA-syndrome criteria were considered as values of the AGI, beyond the 90th percentile (n=65), and the criteria for “young vascular age” (n=87) were AGI values below 10 percentile with age correction. Comparison of these two alternative subgroups (in men aged from 40 to 59) in terms of arterial stiffness showed significant differences in SI (8.2±0.99 vs 7.6±0.89, respectively, p=0.001), Alp75 (-0.2±14.54 vs 20.5±10.31, respectively, p=0.0001), PV-type. The frequency of detection of multiple risk factors according to the results of questionnaires and laboratory diagnostics in patients with EVA-syndrome was also significantly higher. Assessment of the contribution of vascular risk factors to vascular aging showed that the leading positions are occupied by hypertension, hypertriglyceridemia, abdominal obesity, hyperglycemia, and smoking.Conclusion. PPG is a simple, fast, and informative method that allows to evaluate the parameters of the vascular wall stiffness. It can be assumed that its use in screening examinations of middle-aged men can help in identifying patients requiring observation and intensive prevention.

Abstract Background In younger individuals, low absolute risk of cardiovascular disease (CVD) may conceal an increased risk age and relative risk of CVD. Calculation of risk age is proposed as an adjuvant to absolute CVD risk estimation in European guidelines. We aimed to compare the discriminative ability of available risk age models in prediction of CVD in rheumatoid arthritis (RA). Secondly, we also evaluated the performance of risk age models in subgroups based on RA disease characteristics. Methods RA patients aged 30–70 years were included from an international consortium named A Trans-Atlantic Cardiovascular Consortium for Rheumatoid Arthritis (ATACC-RA). Prior CVD and diabetes mellitus were exclusion criteria. The discriminatory ability of specific risk age models was evaluated using c-statistics and their standard errors after calculating time until fatal or non-fatal CVD or last follow-up. Results A total of 1974 patients were included in the main analyses, and 144 events were observed during follow-up, the median follow-up being 5.0 years. The risk age models gave highly correlated results, demonstrating R 2 values ranging from 0.87 to 0.97. However, risk age estimations differed > 5 years in 15–32% of patients. C-statistics ranged 0.68–0.72 with standard errors of approximately 0.03. Despite certain RA characteristics being associated with low c-indices, standard errors were high. Restricting analysis to European RA patients yielded similar results. Conclusions The cardiovascular risk age and vascular age models have comparable performance in predicting CVD in RA patients. The influence of RA disease characteristics on the predictive ability of these prediction models remains inconclusive.

The article discusses the vascular age concept and modern approaches to assessing vascular age. It describes modern methods for measuring arterial stiffness (applanation tonometry or ultrasonic Doppler examination) as the most frequently used index of vascular age. The authors discuss the role of antihypertensive therapy and statins in preventing early vascular aging, and the relationship between the role of achieving lower blood pressure levels and the choice of certain antihypertensive agents to reduce arterial stiffness and ensure optimal vascular age. Increased arterial stiffness has been reported to be a marker of risk for developing severe complications of cardiovascular diseases, in particular, a meta-analysis showed that after taking into account the known risk factors for developing cardiovascular complications, higher carotid stiffness was associated with an increased risk of stroke. It is stated that in addition to biological age, vascular age may increase due to the cumulative effect of such risk factors as high blood pressure, impaired glucose homeostasis, obesity and hypercholesterolemia. Modern approaches to the preservation and maintenance of vascular age are discussed. The key role of achieving lower blood pressure levels is considered. It is emphasized that the role of combination drugs in preventing complications of cardiovascular diseases is strengthened, and approaches to choosing the optimal components of such combination drugs are also considered. The relationship between increased arterial stiffness and the development of cognitive disorders is discussed. The article describes the role of statins and effectiveness of the concomitant use of statins and combination antihypertensive therapy in reducing the pulse wave velocity.

Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim. To determine the relationship between vascular age (VA) and atherosclerosis-related cardiovascular diseases in patients with hypertension and hyperlipidemia.Material and methods. The study involved 241 residents of Baku. The mean age was 58,7±10,9 years. There were 119 women (49,4%) and 122 (50,6%) men. The mean body mass index was 27,77±4,19 kg/m2. Data on family history, smoking, obesity, diabetes, chronic kidney disease, revascularization, peripheral arterial disease, angina pectoris, drug intake, lipid profile, systolic and diastolic blood pressure were analyzed. Patient VA was estimated using an online calculator.Results. The patient VA was on average 78,0±15,1 years. Pearson's correlation analysis showed a positive correlation between biological age (BA) and estimated VA (0,719; 95% confidence interval: 0,651-0,775; p80 years (13,3%). MI+stroke+revascularization in the group defined by BA was more common in age subgroups of 50-59 (12,0%) and 60-69 (14,5%) years, and in the group defined by VA, MI+stroke+revascularization was more common in age subgroups of 70-79 (11,6%) and >80 years (19,9%).Conclusion. A significant positive correlation was found between BA and VA. In case of VA >70 years, the incidence of MI+stroke+revascularization increases approximately 3-5 times. Thus, the assessment of VA is an effective clinical tool that allows to inform the patient about possible cardiovascular events and to develop preventive measures.

Aim. To assess the effect of visceral obesity on main artery elasticity and vascular age in patients with hypertension (HTN), obesity, and type 2 diabetes (T2D).Material and methods. A total of 320 patients with stage II-III HTN aged 4570 years were divided into 4 groups: isolated HTN (group 1), HTN and obesity (group 2), HTN, obesity and T2D (group 3), HTN and T2D without obesity (group 4). We assessed the clinical status, parameters of visceral obesity, main artery elasticity, and vascular age. We used nonparametric statistics, Spearman correlation analysis.Results. At least 50% of all patients had visceral obesity, despite no BMI-estimated obesity in groups 1 and 4: 57,5 vs 100,0 vs 100,0 vs 50,0% in groups 1, 2, 3 and 4, respectively (p10 m/s was consistently more common among patients of group 3 compared with patients in groups 1 and 2 (77,0 vs 57,9 and 55,3%, respectively, p1-3=0,004, p2-3=0,006).Vascular age was significantly lower in group 1 compared with groups 3 and 4 (64,0 [57,8; 71,0] vs 69,0 [62,0; 73,0] and 69,5 [66,0; 74,3] years, respectively), as well as in group 2 compared with group 4 (64,0 [56,5; 70,5] vs 69,5 [66,0; 74,3] years). The 5-year risk of cardiovascular events was significantly higher among patients with hypertension, obesity and T2D and those with HTN and T2D without obesity, compared with patients with isolated HTN, and with those with HTN and obesity (5,9 [3,9; 7,9] and 6,5 [4,7; 8,7] vs 4,4 [2,7; 6,8] and 3,6 [2,4; 5,8], respectively). Correlation analysis revealed the relationship between the visceral obesity parameters, main artery elasticity, vascular age and the 5-year risk of cardiovascular events, demonstrating the special aspects of HTN course in each of the studied groups.Conclusion. The paper showed peculiarities of the effect of visceral obesity on main artery elasticity and vascular age in patients with HTN in combination with obesity and T2D.

To calculate the vascular age of hypertensive patients and assess the risk at 10 years of occurrence of an absolute cardiovascular event in outpatient consultation of the Abidjan Heart Institute. Patients and methodology: Cross-sectional study with descriptive and analytical purposes from June 2021 to September 2021, i.e. 4 months in patients at least 30 years of age followed in the outpatient department for arterial hypertension without cardiovascular complications. Data were collected using a questionnaire. We considered the parameters established in the D'Agostino chart for the calculation of vascular age. Each parameter was weighted and the total points obtained corresponded to the vascular age. The cardiovascular risk at 10 years was also obtained from another abacus established by D'Agostino by cross-referencing the total points of each patient with pre-established data. Three hundred hypertensive people were included in this study. The calendar average age was 62.0 ± 10 years with extremes of 30 and 95 years. The gender distribution showed female predominance and there was no significant difference in vascular age by sex. The mean vascular age of all patients was 73.4 ± 9.9 years. The mean difference between actual and vascular age was 11.4 years. Dyslipidemia (p = 0.0002), diabetes (p = 0.0004) and unstandardized BP (p = 0.0000) significantly influenced vascular age. There was no significant difference between smokers and non-smokers (p = 0.1349). All men had a greater than 30% risk of having a cardiovascular accident while women before the age of 35 had no risk. Over the age of 60, almost all patients (both men and women) had a greater than 30% risk of having a cardiovascular accident at 10 years. The calculation of vascular age made it possible to assess arterial aging and calculate the probability at 10 years of occurrence of a cardiovascular event. This study also highlights the importance of cardiovascular risk and vascular age assessment for management adaptation and therapeutic education. [ABSTRACT FROM AUTHOR]

Aim. To study the state of the main arteries and vascular age in conjunction with the level of leptin and adiponectin in patients with arterial hypertension (AH) and obesity.Material and methods. One hundred and twenty patients with AH stage II aged from 45 to 65 years were divided into 3 groups depending on body mass index (BMI). Group 1 was represented by patients with AH and normal BMI, the 2 group was represented by patients with AH and excessive BMI, the 3 group was represented by patients with AH in combination with obesity. A standard clinical examination was performed, the stiffness of the vascular wall was measured by measuring the pulse wave velocity (PWV) of the muscle and elastic vessels (PWVe), vascular age was calculated, and the laboratory markers of obesity were determined.Results. High percentage of visceral obesity was observed: 20,0% among people with normal BMI, 64,4% among overweight people and 100% among people with obesity (differences between 1 and 2, 1 and 3, 2 and 3 groups are reliable). A statistically significant increase in PWVe was detected in patients with AH and obesity in comparison with patients with AH and normal body weight (9,8 [8,5; 11,3] vs 8,0 [79; 8,1] m/s). Vascular age was higher in patients with AH and overweight or obesity compared with patients with AH and normal weight (670 [60,0; 76,0], 68,0 [60,0; 72,0] vs 58,0 [57,0; 60,0] years, respectively). A statistically significant increase in the concentration of leptin (6,9 [4,5; 15,1] vs 19,0 [74; 42,7] vs 53,8 [38,4; 75,8] ng/ml) was detected, as well as a decrease in adiponectin concentration from the 1 to the 3 group (44,9 [36,6; 55,8] vs 16,5 [12,5; 24,7] vs 18,6 [15,3; 22,4] ng/ml, respectively).Correlation analysis revealed the presence of highly reliable relationships between the parameters of rigidity of the main arteries and laboratory markers of obesity.Conclusion. The results indicated a negative effect of hyperleptinemia and hypoadiponectinemia on the elasticity of the vascular wall of the main arteries and the vascular age in hypertensive patients with its combination with overweight or obesity.

Background An artificial intelligence algorithm that detects age using the 12‐lead ECG has been suggested to signal “physiologic age.” This study aimed to investigate the association of peripheral microvascular endothelial function (PMEF) as an index of vascular aging, with accelerated physiologic aging gauged by ECG‐derived artificial intelligence–estimated age. Methods and Results This study included 531 patients who underwent ECG and a noninvasive PMEF assessment using reactive hyperemia peripheral arterial tonometry. Abnormal PMEF was defined as reactive hyperemia peripheral arterial tonometry index ≤2.0. Accelerated or delayed physiologic aging was calculated by the Δ age (ECG‐derived artificial intelligence–estimated age minus chronological age), and the association between Δ age and PMEF as well as its impact on composite major adverse cardiovascular events were investigated. Δ age was higher in patients with abnormal PMEF than in patients with normal PMEF (2.3±7.8 versus 0.5±7.7 years; P=0.01). Reactive hyperemia peripheral arterial tonometry index was negatively associated with Δ age after adjustment for cardiovascular risk factors (standardized β coefficient, –0.08; P=0.048). The highest quartile of Δ age was associated with an increased risk of major adverse cardiovascular events compared with the first quartile of Δ age in patients with abnormal PMEF, even after adjustment for cardiovascular risk factors (hazard ratio, 4.72; 95% CI, 1.24–17.91; P=0.02). Conclusions Vascular aging detected by endothelial function is associated with accelerated physiologic aging, as assessed by the artificial intelligence–ECG Δ age. Patients with endothelial dysfunction and the highest quartile of accelerated physiologic aging have a marked increase in risk for cardiovascular events.

Background: Coronary artery disease has higher prevalence in India than the West. Studies suggest that vascular age of Asian Indians is older to their chronological age, making them more susceptible for the disease. Association between various factors involved in patients having coronary artery disease and their lipid profiles in rural India is not clear. Objectives: The study focuses on the prevalence and comparative analysis of dyslipidemia in the patient group with respect to demographic data and comorbid conditions. Patients and Methods: This was a retrospective study which analysed 957 patients’ hospital record in whom angiography was done for their coronary artery disease in a rural south India. Results: Statistically significant data (P < 0.005) were found in case of total cholesterol levels, with a mean being elevated in age below 45 years (178 ± 46 mg/dl) as compared to age above 45 years (167 ± 48 mg/dl). The mean total cholesterol levels were greater (177 ± 49 mg/dl) in women as compared to men (166 ± 48 mg/dl) with P < 0.005. Hypertensive patients showed elevated levels of total cholesterol and triglycerides. Patients with diabetes had elevated triglyceride levels in general. Conclusion: Triglyceride levels might be playing an important role than total cholesterol in the pathophysiology of CAD and for atherogenesis, it is the presence of hypertension with a deranged lipid profile, more so with total cholesterol and triglycerides. [ABSTRACT FROM AUTHOR]

Objectives: Affective temperaments (depressive, anxious, irritable, hyperthymic, cyclothymic) are regarded as the biologically stable core of personality, and accumulating data implies their relationship with cardiovascular diseases. There are currently limited data on the association of affective temperaments and early vascular aging. The aim of our study was to assess the potential relationship of affective temperaments and vascular age, as assessed by coronary CT. Methods: In our current cross-sectional study, 209 patients referred to coronary computed tomography angiography (CCTA) due to suspected coronary artery disease (CAD), were included. After the evaluation of medical history and demographic parameters, all patients completed the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A) and the Beck Depression Inventory (BDI). Vascular age was estimated using coronary artery calcium (CAC) score and we calculated its difference from chronological age for each patient. Linear regression analysis was applied to identify predictors of early vascular aging in the entire cohort and in male and female sub-populations, separately. Results: The independent predictors of early vascular aging were female sex (B = −10.82 [95% CI: −15.30 – −6.33]), diabetes mellitus (B = 7.16 [95% CI: 1.20 – 13.12]) and dyslipidemia (B = −8.28 [95% CI: 3.94 – 12.62]). Further assessing gender differences, cyclothymic temperament score proved to be an independent predictor of early vascular aging in women (B = 0.89 [95% CI: 0.04 – 1.75]), while this association was absent in men. Conclusions: Our results suggest that cyclothymic affective temperament contribute to early vascular aging in women.

This study presents a database of central blood pressure waveforms according to cardiovascular health conditions, to supplement the lack of clinical data in cardiovascular health research, constructed by a cardiovascular simulator. Blood pressure (BP) is the most frequently measured biomarker, and in addition to systolic and diastolic pressure, its waveform represents the various conditions of cardiovascular health. A BP waveform is formed by overlapping the forward and reflected waves, which are affected by the pulse wave velocity (PWV). The increase in vascular stiffness with aging increases PWV, and the PWV-age distribution curve is called vascular age. For cardiovascular health research, extensive data of central BP waveform is essential, but the clinical data published so far are insufficient and imbalanced in quantity and quality. This study reproduces the central BP waveform using a cardiovascular hardware simulator and artificial aortas, which mimic the physiological structure and properties of the human. The simulator can adjust cardiovascular health conditions to the same level as humans, such as heart rate of 40-100 BPM, stroke volume of 40-100 mL, and peripheral resistance of 12 steps. Also, 6 artificial aortas with vascular ages in the 20-70 were fabricated to reproduce the increase in vascular stiffness due to aging. Vascular age calculated from measured stiffness of artificial aorta and central BP waveform showed an error of less than 3 years from the clinical value. Through this, a total of 636 waveforms were created to construct a central BP waveform database according to controlled various cardiovascular health conditions., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: The current models of estimating vascular age (VA) primarily rely on the regression label expressed with chronological age (CA), which does not account individual differences in vascular aging (IDVA) that are difficult to describe by CA. This may lead to inaccuracies in assessing the risk of cardiovascular disease based on VA. To address this limitation, this work aims to develop a new method for estimating VA by considering IDVA. This method will provide a more accurate assessment of cardiovascular disease risk., Methods: Relative risk difference in vascular aging (RRDVA) is proposed to replace IDVA, which is represented as the numerical difference between individual predicted age (PA) and the corresponding mean PA of healthy population. RRDVA and CA are regard as the influence factors to acquire VA. In order to acquire PA of all samples, this work takes CA as the dependent variable, and mines the two most representative indicators from arteriosclerosis data as the independent variables, to establish a regression model for obtaining PA., Results: The proposed VA based on RRDVA is significantly correlated with 27 indirect indicators for vascular aging evaluation. Moreover, VA is better than CA by comparing the correlation coefficients between VA, CA and 27 indirect indicators, and RRDVA greater than zero presents a higher risk of disease., Conclusion: The proposed VA overcomes the limitation of CA in characterizing IDVA, which may help young groups with high disease risk to promote healthy behaviors., Competing Interests: Declaration of competing interest The authors declare no competing interests., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: To calculate the vascular age of hypertensive patients and assess the risk at 10 years of occurrence of an absolute cardiovascular event in outpatient consultation of the Abidjan Heart Institute., Patients and Methodology: Cross-sectional study with descriptive and analytical purposes from June 2021 to September 2021, i.e. 4 months in patients at least 30 years of age followed in the outpatient department for arterial hypertension without cardiovascular complications. Data were collected using a questionnaire. We considered the parameters established in the D'Agostino chart for the calculation of vascular age. Each parameter was weighted and the total points obtained corresponded to the vascular age. The cardiovascular risk at 10 years was also obtained from another abacus established by D'Agostino by cross-referencing the total points of each patient with pre-established data., Results: Three hundred hypertensive people were included in this study. The calendar average age was 62.0 ± 10 years with extremes of 30 and 95 years. The gender distribution showed female predominance and there was no significant difference in vascular age by sex. The mean vascular age of all patients was 73.4 ± 9.9 years. The mean difference between actual and vascular age was 11.4 years. Dyslipidemia (p = 0.0002), diabetes (p = 0.0004) and unstandardized BP (p = 0.0000) significantly influenced vascular age. There was no significant difference between smokers and non-smokers (p = 0.1349). All men had a greater than 30% risk of having a cardiovascular accident while women before the age of 35 had no risk. Over the age of 60, almost all patients (both men and women) had a greater than 30% risk of having a cardiovascular accident at 10 years., Conclusion: The calculation of vascular age made it possible to assess arterial aging and calculate the probability at 10 years of occurrence of a cardiovascular event. This study also highlights the importance of cardiovascular risk and vascular age assessment for management adaptation and therapeutic education., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Aim. To study the efficacy, safety and effect on vascular age of free-equivalent and fixed-dose combinations of amlodipine, a renin-angiotensin-aldosterone system blockers and rosuvastatin in patients with high and very high cardiovascular risk with uncontrolled hypertension and concomitant dyslipidemia.Material and methods. This open-label case series study included 148 men and women (mean age 60,63±8,16 years). The patients were randomly divided into 2 groups: group 1 (n=76) received a triple fixed-dose combination of amlodipine, lisinopril, rosuvastatin; group 2 (n=72) received a dual free-equivalent antihypertensive combination (amlodipine/losartan) and rosuvastatin. The doses were selected by the attending physician and were not regulated by the researchers. The study included an assessment of blood pressure, lipid profile (total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol, triglycerides), biochemical profile, ASCORE value, medication adherence, changes in the augmentation index (AI) at baseline and after 6 months of therapy (first and second visits, respectively). The results were considered significant at p