Global endothelial function assessment using pulse wave analysis in hypercholesterolemia

To compare global endothelial function assessed by pulse wave analysis (PWA) using the ratio of endothelium dependent vasodilatation (EDV) to endothelium independent vasodilatation (EIV) in patients with hypercholesterolemia and controls. 92 subjects [46 hypercholesterolemics, 46 controls] were studied at standardized conditions. Baseline augmentation index (AIx) was assessed followed by the administration of 0.5 mg sublingual nitroglycerine, an endothelium independent vasodilator. AIx was assessed and the maximum change in AIx after nitroglycerine was recorded as EIV. After a washout period of 30 minutes, 400 µg of inhaled salbutamol, an endothelium dependent vasodilator was administered. AIx was assessed again and the maximum change in AIx after salbutamol was recorded as EDV. Global endothelial function was calculated as EDV:EIV ratio. EDV and EIV in patients with hypercholesterolemia compared to controls were 2.97 ± 3.95 and 6.65 ± 3.80 (p<0.001); and 13.41 ± 4.57 and 15.88 ± 4.78 (p=0.01) respectively. EDV:EIV ratio was significantly reduced in patients with hypercholesterolemia compared to controls; 0.21 ± 0.38 and 0.44 ± 0.24 (p<0.001) respectively. EDV:EIV ratio was significantly reduced in patients with hypercholesterolemia compared to controls. PWA is a potential clinical tool to assess global endothelial function in patients with hypercholesterole

Correlation between Three Methods of Blood Pressure Measurement (Impedance Cardiography, Sphygmomanometry, and Invasive Methods)

Aims and Objectives: The aims of the study were to find out the correlation between three methods of blood pressure (BP) measurement with impedance cardiography (ICG) device, conventional non-invasive sphygmomanometer, and cath lab-based invasive arterial pressure (AP) study. Patients Materials and Methods: Patients who had definite indications for coronary angiography (CAG) or coronary intervention due to cardiac reasons were selected for the measurement of BP by three methods, namely, by transducer-based invasive central aortic pressure study, by ICG, and by conventional sphygmomanometry. One hundred patients of acute myocardial infarction having chest pain, ST elevation in two or more contiguous leads of electrocardiogram (ECG), biomarker positivity, and echocardiographic evidence of regional wall motion abnormality were selected. Transfemoral or radial access of the ascending aorta allowed the measurement of central aortic pressure during invasive procedure. CAG was done in the cath lab having “Siemens™ Axiom Artis Zee (floor)” equipment. The subjects who were unwilling to participate, who were moribund, critically ill subjects, and patients with concomitant heart failure, arrhythmia, and valvular lesions were excluded from the study. GE™ Vivid 7 Dimension machine was used for ECG-gated echo-Doppler studies. ICG-derived BP values (systolic BP [SBP], diastolic BP [DBP], mean AP [MAP], and pulse pressure) were recorded for comparison with similar pressure data obtained from two other methods. Results and Analysis: Analysis of results show a comparison of data on SBP, DBP, and MAP measured by three methods by sphygmomanometry, invasive, and ICG methods. The analysis also shows the values of correlation coefficients – all of which are significantly positive correlations. ICG has been found to have positive correlation with both sphygmomanometric and invasive methods of BP measurement. It also shows a graphical presentation of the correlation between SBP, DBP, and MAP measured by three methods by sphygmomanometry, invasive, and ICG methods. Conclusion: There is a significant correlation between three methods of BP measurement with ICG device, conventional noninvasive sphygmomanometer-based method, and cath lab-based invasive AP study

Correlation between Coronary Angiography and Impedance Cardiography

Aims and Objectives: The aims of the study were to find out the correlation between coronary angiographic findings and hemodynamic parameters derived from impedance cardiography (ICG) and echo-Doppler study. Patients, Materials and Methods: A total of 200 patients of acute myocardial infarction having chest pain, ST elevation in two or more contiguous leads of electrocardiogram (ECG), biomarker positivity, echocardiographic evidence of regional wall motion abnormality (RWMA), and coronary angiographic evidence of coronary lesions were recruited. Subjects unwilling to participate, moribund, critically ill subjects, and patients with concomitant heart failure, arrhythmia, and valvular lesions were excluded from the study. GE™ Vivid 7 Dimension machine was used for ECG-gated echo-Doppler studies. The left ventricular ejection fraction (LVEF), stroke volume (SV), RWMA, diastolic function, etc., were observed. ICG measured LVEDV, LVESV, LVEF, and other parameters particularly amplitudes of the different waves. Coronary angiography (CAG) was done in the Cath Lab having “Siemens™ Axiom Artis Zee (floor)” equipment. Results and Analysis: Results-analysis revealed there is negative correlation (Pearson’s correlation coefficient, r = −0.8) between augmentation pressure and coronary angiographic stenosis percentage and P value is also significant (P = 0.034). Pulse pressure (PP) also is positively correlated (r = −0.78) with coronary angiographic stenosis percentage and P value is also significant (P = 0.027). There is a negative correlation (r = −0.259) between augmentation index (AIx) and coronary angiographic lesions and that is statistically significant (P = 0.03). Conclusion: There is a positive correlation between ICG -derived hemodynamic parameters and the percentage stenosis of coronary arteries. Rise of augmentation pressure and PP in the ICG waveform is associated with coronary artery disease severity. AIx is negatively correlated with severity of coronary arterial stenosis

Arterial stiffness in hyperthyroid patients is deteriorated due to thyroid hormones

ABSTRACT Objective The aim of this study is to evaluate and compare arterial stiffness, which is an independent risk indicator for cardiovascular diseases (CVDs), between patients with overt hyperthyroidism, subclinical hyperthyroidism, euthyroidism by antithyroid therapy and healthy volunteers with pulse wave analysis (PWA). Subjects and methods A total of 102 volunteers were included in the study (30 in the overt hyperthyroid group, 28 in the subclinical hyperthyroid group and 14 with euthyroidism by antithyroid therapy and 30 healthy). The arterial stiffness measurements of the participants in the study were performed with the Mobil-O-Graph PWA device (I.E.M. GmBH, Stolberg, Germany), which makes cuff based oscillometric measurement from the brachial artery. Results Systolic blood pressure, pulse rate, central systolic blood pressure, cardiac output, heart rate-corrected augmentation index (Aix@75) and pulse wave velocity (PWV) measurements were significantly higher in the hyperthyroid group than in the control group. The heart rate and PWV in the subclinical hyperthyroid group were significantly higher than the control group. In the euthyroid group, systolic blood pressure, central systolic blood pressure, cardiac output, cardiac index and PWV were found significantly higher than the control group. There was also a negative correlation between Aix@75 and thyroid-stimulating hormone (TSH), and a positive correlation between Aix@75 and free thyroid hormones. Conclusion In our study, we observed that the arterial stiffness was adversely affected by an overt or subclinical increase in thyroid hormones and this correlated with thyroid hormone levels. We recommend that PWV measurement, which is a simple method for detecting CVD risk, can be used in these patients.

Assessment of variations in arterial tone during different phases of menstrual cycle

Background: Arterial tone parameters in young African women during the different phases of menstrual cycle were assessed in the present study.Methods: Out of the 30 student volunteers who participated in the study, only 15 completed the study. Anthropometric data using stadiometer, blood pressure using automated oscillometric pressure gauge were measured. Arterial stiffness parameters at the radial and ECG gated carotid and femoral arteries using sphygmocor tonometry was mesured in two consecutive menstrual cycles at early follicular, ovulation and luteal phase. Estrogen and progesterone concentrations were analyzed using Elisa kits in all three phases.Results: Estrogen level in ovulation phase and progesterone in luteal phase were higher. Peripheral augmentation index in ovulation phase was higher compared to luteal phase. Pulse pressure amplification value at follicular and luteal phases was higher than in ovulation phase. Pulse wave velocity and pulse pressure amplification was negatively correlated to progesterone in follicular phase. The arterial stiffness increased at ovulation and decreased in follicular and luteal phases of menstrual cycle.Conclusions: No significant correlation between arterial stiffness parameters and ovarian hormones was found.

Relationship between body mass index and central haemodynamic indices / 上海交通大学学报（医学版）

Objective • To investigate the relationship between body mass index (BMI) and central haemodynamic indices in physical examination population. Methods • From December 2017 to June 2018, a total of 287 subjects undergoing health examination (164 males, accounting for 57.1%) in the Physical Examination Center, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine were included. According to BMI, the subjects were divided into normal BMI group (BMI<24 kg/m2), overweight group (24 kg/m2 ≤ BMI<28 kg/m2), and obesity group (BMI ≥ 28 kg/m2). The peripheral systolic blood pressure (PSP), the peripheral diastolic blood pressure (PDP), the peripheral pulse pressure (PPP), and the mean arterial pressure (P-MAP) were measured, respectively. The central arterial pressures were measured by pulse wave analysis, including central systolic blood pressure (CSP), central diastolic blood pressure (CDP), central pulse pressure (CPP), central augmentation pressure (AP), and central augmentation index (AIx). The amplification index of pulse pressure was PPP/CPP. Results • ① The differences of PDP, CDP, P-MAP, AP, AIx and PPP/CPP among the three groups were statistically significant (P<0.05). ② Pearson correlation analysis showed that BMI was negatively correlated with AP and AIx (r=-0.140, r=-0.149, P<0.05), but positively correlated with PDP, CDP and PPP/CPP (r=0.151, r=0.155, r=0.124, P<0.05). ③ Multiple linear regression analysis showed that BMI was not an independent related factor for CSP. Conclusion • With the increase of BMI, AP and AIx show a downward trend, but PDP, CDP, and PPP/ CPP show an upward trend; BMI and CSP have no significant correlation.

Impact of coronary artery disease on augmentation index as measured by estimated central blood pressure: A case control study in Asian Indians

Aims We compared various components of blood pressure and arterial stiffness of healthy control with those of coronary artery disease (CAD) patients using BP+ machine™. Methods In this prospective, case-control study, total 585 individuals of both the genders were enrolled. The study population consisted of 277 controls (healthy siblings of diseased subjects not having CAD – group A) and 308 CAD patients (group B). Age and sex adjusted regression and receiver operative curve (ROC) analysis was performed to assess the strength of association of these parameters. Results We found that mean systolic blood pressure (SBP) (137.14 ± 22.49 vs. 129.26 ± 19.86), central systolic blood pressure (CSBP) (130.78 ± 21.89 vs. 117.53 ± 17.98), augmentation index (AI) (108.55 ± 44.98 vs. 49.38 ± 21.03) and pulse rate variability (98.82 ± 231.09 vs. 82.86 ± 208.77) were significantly (p < 0.05) higher in CAD population as compared to healthy counterparts. Left ventricular contractibility as measured by dP/dt was significantly lower in CAD patients. All these parameters were significantly abnormal in CAD as compared to healthy control population irrespective of the gender of the patient except for SBP in females. Both – odds ratio (1.108; 95% CI: 1.081–1.135; p < 0.0001) and ROC analysis (AUC: 0.937; 95% CI: 0.919–0.956; p < 0.0001) showed AI as the strongest predictor of CAD, closely followed by CSBP. Conclusion Central aortic blood pressure parameters such as AI and CSBP measured noninvasively with BP+ machine could be the effective predictors of CAD in Asian Indians.

A Comparative Study of Central Hemodynamics in Parkinson's Disease

OBJECTIVE: To explore the central aortic pressure in patients with Parkinson's disease (PD). METHODS: We investigated central arterial stiffness by measurement of the augmentation index (AIx) in PD patients. Patients were eligible for the study if they were de novo PD and 45 years of age or older. The patients’ demographics, vascular risk factors, and neurologic examinations were collected at baseline. The AIx was measured by applanation tonometry. RESULTS: A total of 147 subjects (77 in control and 70 in PD groups) were enrolled in the study. While there was no significant difference in peripheral systolic blood pressure (SBP), diastolic blood pressure (DBP), or mean arterial pressure between groups, peripheral pulse pressure (PP) was significantly lower in the PD group than in the control group (p = 0.012). Regarding central pressure, aortic DBP was significantly higher and PP was significantly lower in the PD group (p = 0.001, < 0.0001). Although there was no significant difference in the AIx between the groups, a trend toward a lower AIx was observed in the PD group (31.2% vs. 28.1%, p = 0.074). CONCLUSION: This study showed that peripheral and central PP was significantly lower in the PD group than in the control group. Our study suggests that PD patients may have a low risk of a cardiovascular event by reason of a lower PP.

The influence and clinical significance of different pacing modes on central aortic pressure and augmentation index in non-smoking individuals / 天津医药

Objective To investigate the influence and clinical significance of single and dual-chamber pacing on central aortic pressure (CAP) and augmentation index (AI) in non-smoking individuals. Methods Totally, 83 non-smokers with pacemaker-implanted were consecutively enrolled in this study, and they were divided into three groups:dual-chamber pacemaker group (DDD, n=35), single-chamber pacemaker group (VVI, n=33) and control group (n=15). Heart rate (HR), CAP, AI, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured in three groups of patients. Finally, DDD pacing mode was turned into VVI pacing mode in patients of DDD group and the indexes were measured again. All of the indexes were recorded and analyzed. Results There were no significant changes in baseline characteristics and laboratory data between three groups (P>0.05). Left atrial diameters were significantly higher in VVI group than those of control group (P0.05). All of these indexes (CAP, AI and brachial BP) were significantly reduced after the pacing mode was changed (P<0.05). Conclusion In non-smokers, dual-chamber pacing mode can increase CAP and AI.

Urinary Albumin Excretion and Vascular Function in Rheumatoid Arthritis

Rheumatoid arthritis (RA) is associated with significant cardiovascular (CV) morbidity and mortality. Increased urinary albumin excretion is a marker of CV risk. There are only few data on urinary albumin excretion in RA patients. Aim of the present study was to investigate urinary albumin excretion in RA patients and analyze, whether there is an association between urinary albumin excretion and vascular function as measured by the augmentation index (AIx). In a total of 341 participants (215 with RA, 126 without RA) urinary albumin-creatinine ratio (ACR) was determined and the AIx was measured. The Kolmogorov-Smirnov-test was used to cluster patient groups whose distributions of ACR can be considered to be equal. A crude analysis showed a median ACR of 6.6 mg/g in the RA group and 5.7 mg/g in patients without RA (P > 0.05). In order to account for diabetes (DM) we formed 4 distinct patient groups. Group 1: RA-/DM- (n = 74); group 2: RA+/DM- (n = 195); group 3: RA-/DM+ (n = 52); group 4: RA+/DM+ (n = 20). Clustering of these groups revealed two distinct patient groups: those without RA and DM, and those with either RA or DM or both. The latter group showed statistically significant higher ACR (median 8.1 mg/g) as the former (median 4.5 mg/g). We found no significant correlation between AIx and ACR. Urinary albumin excretion in patients with RA or DM or both is higher than in subjects without RA and DM. This can be seen as a sign of vascular alteration and increased CV risk in these patients.

Black Raspberry Improved Lipid Profiles and Vascular Endothelial Function in Patients with Metabolic Syndrome: A Subgroup Analysis of Statin Naïve Participants

OBJECTIVE: Black raspberry (Rubus occidentalis) has been known for its anti-inflammatory and anti-oxidant effects and for improving vascular endothelial function in patients at high-risk for cardiovascular disease. We investigated short-term effects of black raspberry on lipid profiles, vascular endothelial function and circulating endothelial progenitor cells in statin naïve participants with metabolic syndrome. METHODS: Patients with metabolic syndrome (n=51) without lipid lowering medications were prospectively randomized into the black raspberry group (n=26, 750 mg/day) and placebo group (n=25) during the 12-week follow-up. Lipid profiles, brachial artery flow-mediated dilatation (baFMD) and inflammatory cytokines such as IL-6, TNF-α, C-reactive protein, adiponectin, sICAM-1, sVCAM-1 were measured at baseline and at 12-week follow-up. Central blood pressure and augmentation index were also measured at baseline and at 12-week follow-up. RESULTS: Decreases from baseline in total cholesterol levels (-22.7±34.3 mg/dL vs. 0.0±34.7mg/dL, p<0.05, respectively) and total cholesterol/HDL ratio (-0.34±0.68 vs. 0.17±0.56, p<0.05, respectively) were significantly greater in the black raspberry group when compared to the placebo group. Decreases from baseline in IL-6 (-0.5±1.4 pg/mL vs. -0.1±1.1 pg/mL, p<0.05, respectively) and TNF-α levels (-5.4±4.5 pg/mL vs. -0.8±4.0 pg/mL, p<0.05, respectively) were significantly greater in the black raspberry group. Increases from the baseline in adiponectin levels (2.9±2.1 µg/mL vs. -0.2±2.5 µg/mL, p<.05) were significant in the black raspberry group. Increases in baFMD at 12-week follow-up were significantly greater in the black raspberry group when compared to the placebo group (2.9±3.6 mm vs. 1.0±3.9 mm, p<0.05, respectively). Radial augmentation indexes were significantly decreased in the black raspberry group when compared to the placebo group (-2±10% vs. 4±13%, p<0.05). CONCLUSION: The use of black raspberry significantly decreased serum total cholesterol levels, inflammatory cytokines, and augmentation index, thereby improving vascular endothelial function in statin naïve participants with metabolic syndrome during the 12-week follow-up.

Carotid-radial Pulse Wave form and Velocity in Normotensive and Hypertensive Pregnant Women at University Teaching Hospital (UTH), Lusaka, Zambia.

Background: Hypertensive disease in pregnancy continues to be one of the leading causes of maternal death. Pregnancy induced hypertension (PIH) is said to be accompanied by several cardiovascular pathophysiological changes including increases in arterial stiffness. Pulse wave velocity (PWV) is a method for measuring arterial stiffness. Both the pulse wave form and the velocity are said to change in PIH. However, studies documenting these characteristics of the pulse wave have mainly been in the Caucasian population. Aims and Objectives: To establish the characteristics of the carotid-radial (cr) pulse wave in normotensive (NTN) and hypertensive (HTN) pregnant black African women at the UTH in Lusaka, Zambia. Methodology: This cross-sectional study comprised of 26 systemically selected pregnant women between the ages 18-45 years old who met the criteria. A structured interview was used to collect socio demographic data. Anthropometric measurements were taken. After a 15 minute rest, peripheral systolic and diastolic blood pressures (BP) were measured. The PWV measurement involved applying non-invasive piezoelectric sensors on the skin over the carotid artery in the neck and the radial artery on the wrist (carotid-radial segment crPWV). Using IBM® SPSS® version 20.0 analyses were made using mann - whitney and spearman correlation tests. A 95% confidence interval (CI) and P-value of <0.05 were set. Quality recordings were obtained from the crPWV recording processes showing the wave forms and specific measurements were made. Results: The anthropometric measurements were comparable between the 2 groups. There were significant changes in the pulse wave forms. While the normotensive participants had the type C wave form, the type A wave form was recorded from hypertensive participants. The augmentation pressure (AP) in NTN was 4±5 mmHg while it was 9±8 mmHg in HTN, indicating an increase in pressure difference from the systolic shoulder to the peak of the pulse wave (p <0.05). There was also a significant increase in the augmentation index (Aix) (1±22% vs 16±23%) (p<0.05). The hypertensive pregnant women also had a significantly higher PWV (9±4 m/s vs 13±7 m/s) (p<0.05). Conclusion: Distinct differences were seen in the cr pulse wave forms and velocity between normotensive and hypertensive individuals with PIH indicating an increase in arterial stiffness. These findings suggest the presence of significant peripheral vascular changes that may underly the pathophysiology of PIH.

The Effect of Brief Thyroid Functional Changes on Arterial Stiffness in Patients Who Preparing Radioactive Iodine Administration

BACKGROUND AND OBJECTIVES: Abnormal thyroid function influences the cardiovascular system. In particular, brief thyroid functional change due to levothyroxine (LT4) suppression therapy and withdrawal in papillary thyroid cancer (PTC) patients can affect cardiovascular system and other biochemical markers. However, the effect of brief thyroid functional change on arterial stiffness has not been evaluated. Therefore, we evaluated the changes in arterial stiffness according to short-term thyroid hormone levels in patients who underwent total thyroidectomy and radioactive iodine (RAI) therapy for PTC. MATERIALS AND METHODS: Patients with PTC (n=17; 15 females, mean age 52 years) who underwent total thyroidectomy and RAI therapy were enrolled in this study. The arterial stiffness was evaluated using the corrected augmentation index for heart rate (AI@75) and brachial-ankle pulse wave velocity (BaPWV). Serum thyroid hormone levels and arterial stiffness parameters were checked three times consecutively: the day before thyroidectomy (Visit 1; baseline euthyroid state), after LT4 withdrawal (Visit 2; pre-RAI hypothyroid state) and 4 weeks after RAI (Visit 3; post-RAI thyrotoxic state). Biochemical markers, which can influence the arterial stiffness, were also measured. RESULTS: The heart rate, AI@75 and serum thyroid hormone levels changed significantly at each visit. BaPWV was not significantly changed. Changes in AI@75 correlated with systolic blood pressure (SBP), serum thyroid hormone levels, total cholesterol and high density lipoprotein cholesterol in univariate analysis. In multivariate analysis, SBP was the independent factor for AI@75 changes. CONCLUSION: These results suggest that brief thyroid functional changes can influence AI@75. And SBP was important factor for AI@75 change.

Effect of Spinach, a High Dietary Nitrate Source, on Arterial Stiffness and Related Hemodynamic Measures: A Randomized, Controlled Trial in Healthy Adults

Diets rich in fruits and vegetables reduce risk of adverse cardiovascular events. However, the constituents responsible for this effect have not been well established. Lately, the attention has been brought to vegetables with high nitrate content with evidence that this might represent a source of vasoprotective nitric oxide. We hypothesized that short-term consumption of spinach, a vegetable having high dietary nitrate content, can affect the arterial waveform indicative of arterial stiffness, as well as central and peripheral blood pressure (BP). Using a placebo-controlled, crossover design, 27 healthy participants were randomly assigned to receive either a high-nitrate (spinach; 845 mg nitrate/day) or low-nitrate soup (asparagus; 0.6 mg nitrate/day) for 7 days with a 1-week washout period. On days 1 and 7, profiles of augmentation index, central, and brachial BP were obtained over 180 min post-consumption in 4 fasted visits. A postprandial reduction in augmentation index was observed at 180 min on high-nitrate compared to low-nitrate intervention (-6.54 +/- 9.7% vs. -0.82 +/- 8.0%, p = 0.01) on Day 1, and from baseline on Day 7 (-6.93 +/- 8.7%, p < 0.001; high vs. low: -2.28 +/- 12.5%, p = 0.35), suggesting that the nitrate intervention is not associated with the development of tolerance for at least 7 days of continued supplementation. High vs. low-nitrate intervention also reduced central systolic (-3.39 +/- 5.6 mmHg, p = 0.004) and diastolic BP (-2.60 +/- 5.8 mmHg, p = 0.028) and brachial systolic BP (-3.48 +/- 7.4 mmHg, p = 0.022) at 180 min following 7-day supplementation only. These findings suggest that dietary nitrate from spinach may contribute to beneficial hemodynamic effects of vegetable-rich diets and highlights the potential of developing a targeted dietary approach in the management of elevated BP.

The Effect of Cilostazol on Arterial Stiffness in Patients Undergoing Percutaneous Coronary Intervention / 대한내과학회지

BACKGROUND/AIMS: Increased arterial stiffness is a well-known risk factor for cardiovascular disease. Cilostazol, a phosphodiesterase type 3 inhibitor, is a unique antiplatelet agent with vasodilatory and vasoprotective effects. Therefore, we hypothesized that cilostazol may affect arterial stiffness. METHODS: We enrolled 161 patients (112 males; mean age, 63 years) who had undergone percutaneous coronary intervention (PCI) for ischemic heart disease. The brachial-ankle pulse wave velocity (baPWV), radial augmentation index (rAI), rAI adjusted for a heart rate of 75 beats/min (rAI75), central systolic blood pressure (cSBP), and central pulse pressure (cPP), were measured at baseline and at the 30-day follow-up. Parameter changes were compared between the cilostazol group (n = 51) and the control group (n = 110). RESULTS: In the cilostazol group, the values for rAI, cSBP, and cPP all improved after 30 days, while the control group displayed no significant interval changes in these parameters. The changes in rAI75 and baPWV did not differ significantly between the two groups. The changes in rAI, cSBP, and cPP were related to brachial systolic blood pressure, brachial diastolic blood pressure, heart rate, and the use of cilostazol and beta-blockers. In a multivariate analysis, the use of cilostazol was identified an independent factor associated with changes in rAI, cSBP, and cPP. CONCLUSIONS: The addition of cilostazol to conventional antiplatelet therapy in patients undergoing PCI may be associated with improvements in rAI, cSBP, and cPP, but not in rAI75 or baPWV. Therefore, the effects of cilostazol might be related to an increased heart rate.

Effects of Korean White Ginseng (Panax Ginseng C.A. Meyer) on Vascular and Glycemic Health in Type 2 Diabetes: Results of a Randomized, Double Blind, Placebo-controlled, Multiple-crossover, Acute Dose Escalation Trial

Korean red ginseng (steam treated Panax ginseng C.A. Meyer), among most prized traditional herbal remedies, has been clinically shown to improve cardiovascular disease (CVD) risk factors. Whether this holds true for the dried non-steamed variety, known as Korean white ginseng (KWG) is unclear. This study therefore, investigated the efficacy and safety of escalating doses of KWG on vascular and glycemic parameters in type 2 diabetes (T2DM). Using an acute, randomized, placebo-controlled, double-blind, crossover design, 25 participants with well-controlled T2DM (12-males: 13-females, age: 63 +/- 9 years, A1c: 6.9 +/- 0.7%, BMI: 29.3 +/- 4.3 kg/m2) underwent five visits during which they received 1 g, 3 g, or 6 g KWG or 3 g wheat-bran control (twice) together with 50 g-glucose load. For the duration of 240 minutes, augmentation index (AI), and central blood pressure were measured at baseline and at 60 min-intervals, and ambulatory blood pressure was assessed at baseline and at 10 min-intervals. Additionally, capillary blood was collected at time zero and at 15, 30, 45, 60, 90, 120, and 180 minutes post-treatment. A symptoms questionnaire was used to assess safety and adverse events. Two-way ANOVA demonstrated a significant time-treatment interaction effect on AI (p = 0.01) with one-way ANOVA showing significant reductions in AI with 3 g KWG relative to control (p = 0.04). Compared to control, acute administration of KWG appeared to be safe, but did not affect any other postprandial, vascular or glycemic parameters. KWG might have a beneficial effect on AI, a cumulative indicator of arterial health. However, these results are preliminary and highlight the need for long-term investigation with a focus on its accountable components. Clinical Trial Registration: NCT01699074

Arterial Stiffness by Aerobic Exercise Is Related with Aerobic Capacity, Physical Activity Energy Expenditure and Total Fat but not with Insulin Sensitivity in Obese Female Patients with Type 2 Diabetes

BACKGROUND: Arterial stiffness is an important factor in atherosclerosis. Thus we examined whether aerobic exercise could reduce arterial stiffness in obese women with type 2 diabetes without diabetic complication. METHODS: A total of 35 women with type 2 diabetes (body mass index, 26.6+/-2.8 kg/m2; age, 56.4+/-1.9 years; duration of diabetes, 4.7+/-4.8 years) were assigned to aerobic exercise group (AEG) or control group (CG). AEG completed a 12-week exercise program (3.6 to 5.2 metabolic equivalents, 3 day/week, 60 min/day), with their exercise activities monitored by accelerometers. We measured abdominal total fat area (TFA), visceral fat area (VFA), and subcutaneous fat area (SFA) by computed tomography, insulin sensitivity by insulin tolerance test (K(ITT)), and augmentation index (AIx) by SphygmoCor at baseline and at the end of the 12-week program. RESULTS: The AIx was improved in the AEG compared with the CG (P<0.001). The percent change of AIx had significant correlation with the improvement of physical activity energy expenditure (PAEE), aerobic capacity, TFA, and SFA (r=-0.416, P=0.013; r=0.560, P<0.001; r=0.489, P=0.003; r=0.531, P=0.001, respectively), but not with insulin sensitivity, energy intake, or VFA. CONCLUSION: Improvement in aortic stiffness by aerobic exercise is related with the improvement of aerobic capacity, PAEE, and total fat but not with insulin sensitivity or energy intake in obese women with type 2 diabetes.

Arterial Stiffness and its Association with Dyslipidemia

Cardiovascular diseases (CVD) are the leading cause of mortality in Malaysia as well as in other countries. It is associated with many risk factors, such as increasing age, hypertension, diabetes, dyslipidemia, oxidative stress and autonomic dysfunction and arterial stiffness. The objectives of this study were to measure the prevalence of arterial stiffness and to assess its association with dyslipidemia. Methods: A cross sectional study was conducted in a rural community in Malaysia involving 146 subjects. Data were collected using an interviewer administered questionnaire which included three sections – sociodemographic characteristics, personal profile, and past medical history. In addition, Seca Body Meter (Seca 220) was used to measure height and weight. Sphygmomanometer (OMRON Automatic Blood Pressure Monitor HEM 907) and SphygmoCor-AtCor MM3 SERIAL/RS-232 were used for blood pressure and augmentation index (AIx) measurement. Data were analysed using the SPSS for Windows, Version 18.0. Results: The mean age of respondents was 49.5 years, SD±15.6. The prevalence of arterial stiffness was 23.3% (95% Confidence Interval (CI): 16.44 – 30.16). The prevalence of dyslipidemia was 82.9% (95% CI: 76.79 – 89.01). Multivariate logistic regression revealed that total cholesterol was significantly associated with arterial stiffness (OR=4.56, CI 1.10-18.90). Conclusion: The prevalence of dyslipidemia was high. Despite an insignificant association between dyslipidemia and AIx, there is a significant association between TC level and AIx.

Increased Arterial Stiffness Correlates with the Severity of Coronary Artery Disease in Patients with acute ST Elevation MI.

Background: The aim of this study was to evaluate the association between arterial stiffness determined noninvasively by pulse wave analysis (PWA) and the severity of coronary artery disease in patients with acute ST elevation myocardial infarction (STEMI). Methods: This cross sectional study was conducted in the National Institute of Cardiovascular Disease, Dhaka over a period of ten months starting from July 2011 to April 2012. Patients were purposively selected from those who were admitted in NICVD with acute STEMI myocardial infarction agreed to do coronary angiography. Total 99 patients (male: 81, female: 18) were included in this study. Assessment of arterial stiffness was performed noninvasively with the commercially available SphygmoCor system using applanation tonometry with a high-fidelity micromanometer. Augmentation index (AIx), Augmentation pressure (AP) and Augmentation index corrected for heart rate 75beats/min (AIx@75) were derived from this with the technique of PWA. Coronary angiography was performed in those patients during the same hospital stay and severity was assessed by vessel score, Friesinger score and Leaman score. Results: It was found that 9 (9.1%) patients had score 0, 42 (42.4%) had score 1, 23 (23.2%) had score 2 and 25 (25.3%) had score 3. However higher the number of vessels is involved, the greater is the AIx @75. Mean score in single, double and triple vessel disease was 24.50, 33.57 and 34.60 respectively. The mean level of AIx @75 was observed 23.97±11.47 and 31.76±11.26 in insignificant and significant CAD respectively using Friesinger score. The difference was statistically significant (p<0.05). Spearman correlation analysis demonstrated a positive correlation between the AIx@75 and the severity of coronary artery disease (p= <0.05, r=0.40). Conclusion: In conclusion, the results presented herein indicate that augmentation pressure (AP), augmentation index (AIx), and augmentation index corrected for heart rate 75/minute (AIx@75), measures closely related to wave reflections and arterial stiffness, are predictors of severity of CAD. It may be considered as a recommended test for the evaluation of CV risk in addition to other routine investigations.

Association of glomerular filtration rate with arterial stiffness in Chinese women with normal to mildly impaired renal function / 老年心脏病学杂志（英文版）

Objective Both decreased glomerular filtration rate (GFR) and arterial stiffness were considered as risk factors for atherosclerosis. Previous studies have suggested the association between central arterial stiffness and the degree of GFR loss. Whether decreased GFR contributes to peripheral artery stiffness remains controversial. Moreover, data analyzed from a cohort of Chinese women are rare. Our aim was to explore the relationship between GFR and regional arterial stiffness in Chinese women. Methods In this cross-sectional study, we randomly recruited 1131 adult women residents with GFR ≥ 60 mL/min per 1.73 m2 estimated by the Chinese Modification of Diet in Renal Disease equation from three large communities. Central and peripheral arterial stiffness were estimated simultaneously by measuring carotid-femoral pulse wave velocity (PWVcf) and carotid-radial PWV (PWVcr) using a validated automatic device. Augmentation Index at heart rate 75 beats/minutes (AIx-75) was measured by pulse wave analysis as a composite parameter reflecting both large and distal arterial properties. Results The mean estimated GFR (eGFR) of the study group was 100.05 ± 23.26 mL/minute per 1.73 m2. Subjects were grouped by tertiles of eGFR level. PWVcf and AIx-75 increased ongoing from the top to the bottom eGFR tertile, while the values of PWVcr were comparable. Both univariate Pearson correlations and multiple stepwise regression analyses showed that eGFR significantly correlated to PWVcf, but not to PWVcr and AIx-75. Conclusions In Chinese women with normal to mildly impaired renal function, decreased eGFR affected carotid-to-femoral rather than carotid-to-radial stiffening. This provides rational to conduct future prospective studies to investigate predictors of atherosclerosis in this population.