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Journal ArticleDOI

Brachial-ankle pulse wave velocity as an index of central arterial stiffness.

30 Jun 2010-Journal of Atherosclerosis and Thrombosis (Japan Atherosclerosis Society)-Vol. 17, Iss: 6, pp 658-665
TL;DR: In this paper, an automated device for brachial-ankle pulse wave velocity (baPWV) is used, although information is limited whether it reflects the stiffness of central or peripheral arteries.
Abstract: Aim: Stiffness of the central arteries plays an important role in the pathophysiology of cardiovascular disease, and pulse wave velocity (PWV) of the aorta has been used as the standard measure of central arterial stiffness. An automated device for brachial-ankle (ba) PWV is available, although information is limited whether baPWV reflects the stiffness of central or peripheral arteries. We therefore addressed this question in the present study.Methods: The subjects were 2,806 consecutive participants in our non-invasive vascular laboratory, excluding those with an ankle-brachial index (ABI) lower than 0.95. PWV measurements were simultaneously performed using an automated device for the ba, heart-femoral (hf, aorta), heart-carotid (hc), heart-brachial (hb), and femoral-ankle (fa) segments. Correlational analyses were performed (1) among these PWV values, (2) between PWV and individual risk factors, and (3) between PWV and the Framingham risk score (FRS), a surrogate index for integrated cardiovascular risk.Results: The correlation of baPWV was the highest with hfPWV (r=0.796) and the lowest with hcPWV (r=0.541). Among the known factors preferentially affecting central arterial stiffness, higher age, diabetes mellitus, and chronic kidney disease (CKD) were also closely associated with increased baPWV. Finally, FRS was more closely correlated with hfPWV (r=0.613) and baPWV (r=0.609) than with hbPWV (r=0.523), hcPWV (r=0.509), and faPWV (r=0.393).Conclusion: These results indicate that baPWV is an index of arterial stiffness showing similar characteristics to those of aortic PWV.
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TL;DR: Vascular aging is an independent risk factor for cardiovascular disease, from atherosclerosis to target organ damage, including coronary artery disease, stroke and heart failure, and various strategies, especially controlling hypertension, show benefit in preventing, delaying or attenuating vascular aging.
Abstract: Arterial walls stiffen with age. The most consistent and well-reported changes are luminal enlargement with wall thickening and a reduction of elastic properties at the level of large elastic arteries. Longstanding arterial pulsation in the central artery causes elastin fiber fatigue and fracture. Increased vascular calcification and endothelial dysfunction are also characteristic of arterial aging. These changes lead to increased pulse wave velocity, especially along central elastic arteries, and increases in systolic blood pressure and pulse pressure. Vascular aging is accelerated by coexisting cardiovascular risk factors, such as hypertension, metabolic syndrome and diabetes. Vascular aging is an independent risk factor for cardiovascular disease, from atherosclerosis to target organ damage, including coronary artery disease, stroke and heart failure. Various strategies, especially controlling hypertension, show benefit in preventing, delaying or attenuating vascular aging.

512 citations

Journal ArticleDOI
TL;DR: It is indicated that cfPWV and baPWVs are indices of arterial stiffness that exhibit similar extent of associations with cardiovascular disease risk factors and clinical events.
Abstract: BackgroundArterial stiffness is an important risk factor for cardiovascular disease. Carotid-femoral pulse wave velocity (cfPWV) is the most recognized and established index of arterial stiffness. An emerging automatic measure of PWV primarily used in the Asian countries is brachial-ankle PWV (baPWV

484 citations

Journal ArticleDOI
TL;DR: Arterial stiffness was highest in individuals with both high Aβ deposition and WMH, which has been suggested to be a “double hit” contributing to the development of symptomatic dementia.
Abstract: Objective: To determine arterial stiffness and β-amyloid (Aβ) deposition in the brain of dementia-free older adults. Methods: We studied a cohort of 91 dementia-free participants aged 83–96 years. In 2009, participants completed brain MRI and PET imaging using Pittsburgh compound B (PiB; a marker of amyloid plaques in human brain). In 2011, we measured resting blood pressure (BP), mean arterial pressure (MAP), and arterial stiffness by pulse wave velocity (PWV) in the central, peripheral, and mixed (e.g., brachial ankle PWV [baPWV]) vascular beds, using a noninvasive and automated waveform analyzer. Results: A total of 44/91 subjects were Aβ-positive on PET scan. Aβ deposition was associated with mixed PWV, systolic BP, and MAP. One SD increase in baPWV resulted in a 2-fold increase in the odds of being Aβ-positive ( p = 0.007). High white matter hyperintensity (WMH) burden was associated with increased central PWV, systolic BP, and MAP. Compared to Aβ-negative individuals with low WMH burden, each SD increase in PWV was associated with a 2-fold to 4-fold increase in the odds of being Aβ-positive and having high WMH. Conclusions: Arterial stiffness was associated with Aβ plaque deposition in the brain, independent of BP and APOE e4 allele. The associations differed by type of brain abnormality and vascular bed measured (e.g., WMH with central stiffness and Aβ deposition and mixed stiffness). Arterial stiffness was highest in individuals with both high Aβ deposition and WMH, which has been suggested to be a “double hit” contributing to the development of symptomatic dementia.

164 citations


Cites background from "Brachial-ankle pulse wave velocity ..."

  • ..., with cfPWV and hfPWV) than with peripheral arterial stiffness measured by faPWV.(26) Accordingly, baPWV and cfPWV are correlated similarly with cardiovascular disease risk factors and clinical events....

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Journal ArticleDOI
TL;DR: The findings indicate that a 12-week moderate-intensity combined circuit RE and EE training improves arterial stiffness, hemodynamics, and muscle strength in previously sedentary postmenopausal women.
Abstract: Objective: Menopause is associated with increased arterial stiffness and reduced muscle strength. Combined resistance (RE) and endurance (EE) exercise training can decrease brachial-ankle pulse wave velocity (baPWV), an index of arterial stiffness, in young men. We tested the hypothesis that combined circuit RE and EE training would improve baPWV, blood pressure (BP), and muscle strength in postmenopausal women. Methods: Twenty-four postmenopausal women (age 47-68 y) were randomly assigned to a Bno exercise[ control (n = 12) or to combined exercise training (EX; n = 12) group. The EX group performed concurrent circuit RE training followed by EE training at 60% of the predicted maximal heart rate (HR) 3 days per week. Brachial systolic BP, diastolic BP, mean arterial pressure, baPWV, HR, and dynamic and isometric muscle strength were measured before and after the 12-week study. Results: Mean T SE baPWV (j0.8 T 0.2 meters/s), systolic BP (j6.0 T 1.9 mm Hg), diastolic BP (j4.8 T 1.7 mm Hg), HR (j4.0 T 1.0 beats/min), and mean arterial pressure (j5.1 T 1.6 mm Hg) decreased (P G 0.05), whereas dynamic leg strength (5.1 T 1.0 vs 0.6 T 1.0 kg for the EX and control groups, respectively) and isometric handgrip strength (2.8 T 0.7 vs j0.6 T 1.2 kg) increased (P G 0.05) in the EX group but not in the control group. Conclusions: Our findings indicate that a 12-week moderate-intensity combined circuit RE and EE training improves arterial stiffness, hemodynamics, and muscle strength in previously sedentary postmenopausal women. This study provides evidence that combined training may have important health implications for the prevention of hypertension and frailty in postmenopausal women.

151 citations


Cites background from "Brachial-ankle pulse wave velocity ..."

  • ...A recent study demonstrated that when performed in separate groups, moderate-intensity endurance training decreases but resistance training increases aortic PWV and leg PWV,(16) the main components of baPWV.(23) However, when endurance and resistance training are concurrently performed, 30 minutes of moderate-intensity exercise followed by resistance exercise can counteract the increase in arterial stiffness observed after separate resistance training in young healthy adults....

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Journal ArticleDOI
TL;DR: The present model features excellent descriptive and predictive capabilities in both patient-generic and patient-specific cases, presenting a new step toward integrating an unprecedented anatomical description, morphometric, and simulations data to help in understanding complex arterial blood flow phenomena and related cardiovascular diseases.
Abstract: Simulation platforms are increasingly becoming complementary tools for cutting-edge cardiovascular research. The interplay among structural properties of the arterial wall, morphometry, anatomy, wave propagation phenomena, and ultimately, cardiovascular diseases continues to be poorly understood. Accurate models are powerful tools to shed light on these open problems. We developed an anatomically detailed computational model of the arterial vasculature to conduct 1-D blood flow simulations to serve as simulation infrastructure to aid cardiovascular research. An average arterial vasculature of a man was outlined in 3-D space to serve as geometrical substrate for the mathematical model. The architecture of this model comprises almost every arterial vessel acknowledged in the medical/anatomical literature, with a resolution down to the luminal area of perforator arteries. Over 2000 arterial vessels compose the model. Anatomical, physiological, and mechanical considerations were employed for the set up of model parameters and to determine criteria for blood flow distribution. Computational fluid dynamics was used to simulate blood flow and wave propagation phenomena in such arterial network. A sensitivity analysis was developed to unveil the contributions of model parameters to the conformation of the pressure waveforms. In addition, parameters were modified to target model to a patient-specific scenario. On the light of the knowledge domain, we conclude that the present model features excellent descriptive and predictive capabilities in both patient-generic and patient-specific cases, presenting a new step toward integrating an unprecedented anatomical description, morphometric, and simulations data to help in understanding complex arterial blood flow phenomena and related cardiovascular diseases.

136 citations

References
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Journal Article
TL;DR: In the early 1990s, the National Kidney Foundation (K/DOQI) developed a set of clinical practice guidelines to define chronic kidney disease and to classify stages in the progression of kidney disease.

10,265 citations

Journal ArticleDOI
TL;DR: In this paper, the authors used the modified isotope dilution mass spectrometry (IDMS)-traceable 4-variable modified modification of Diet in Renal Disease (MDRD) study equation to estimate the glomerular filtration rate (GFR) for Japanese patients.

4,862 citations

Journal ArticleDOI
TL;DR: This study provides the first direct evidence that aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in patients with essential hypertension.
Abstract: Although various studies reported that pulse pressure, an indirect index of arterial stiffening, was an independent risk factor for mortality, a direct relationship between arterial stiffness and all-cause and cardiovascular mortality remained to be established in patients with essential hypertension. A cohort of 1980 essential hypertensive patients who attended the outpatient hypertension clinic of Broussais Hospital between 1980 and 1996 and who had a measurement of arterial stiffness was studied. At entry, aortic stiffness was assessed from the measurement of carotid-femoral pulse-wave velocity (PWV). A logistic regression model was used to estimate the relative risk of all-cause and cardiovascular deaths. Selection of classic risk factors for adjustment of PWV was based on their influence on mortality in this cohort in univariate analysis. Mean age at entry was 50+/-13 years (mean+/-SD). During an average follow-up of 112+/-53 months, 107 fatal events occurred. Among them, 46 were of cardiovascular origin. PWV was significantly associated with all-cause and cardiovascular mortality in a univariate model of logistic regression analysis (odds ratio for 5 m/s PWV was 2.14 [95% confidence interval, 1.71 to 2.67, P<0.0001] and 2.35 [95% confidence interval, 1.76 to 3.14, P<0.0001], respectively). In multivariate models of logistic regression analysis, PWV was significantly associated with all-cause and cardiovascular mortality, independent of previous cardiovascular diseases, age, and diabetes. By contrast, pulse pressure was not significantly and independently associated to mortality. This study provides the first direct evidence that aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in patients with essential hypertension.

3,685 citations

Journal ArticleDOI
TL;DR: These results provide the first direct evidence that in patients with ESRD, increased aortic stiffness determined by measurement of aorta pulse-wave velocity is a strong independent predictor of all-cause and mainly cardiovascular mortality.
Abstract: Background—Damage to large arteries is a major factor in the high cardiovascular morbidity and mortality of patients with end-stage renal disease (ESRD). Increased arterial stiffness and intima-med...

2,158 citations

Journal ArticleDOI
TL;DR: Aortic PWV is a powerful independent predictor of mortality in both type 2 diabetes and glucose-tolerance–tested population samples and may represent a useful integrated index of vascular status and hence cardiovascular risk.
Abstract: Background— Arterial distensibility measures, generally from pulse-wave velocity (PWV), are widely used with little knowledge of relationships to patient outcome. We tested whether aortic PWV predicts cardiovascular and all-cause mortality in type 2 diabetes and glucose-tolerance–tested (GTT) multiethnic population samples. Methods and Results— Participants were randomly sampled from (1) a type 2 diabetes outpatient clinic and (2) primary care population registers, from which nondiabetic control subjects were given a GTT. Brachial blood pressures and Doppler-derived aortic PWV were measured. Mortality data over 10 years’ follow-up were obtained. At any level of systolic blood pressure (SBP), aortic PWV was greater in subjects with diabetes than in controls. Mortality risk doubled in subjects with diabetes (hazard ratio 2.34, 95% CI 1.5 to 3.74) and in those with glucose intolerance (2.12, 95% CI 1.11 to 4.0) compared with controls. For all groups combined, age, sex, and SBP predicted mortality; the additi...

1,540 citations

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