Determining factors for carotid mean/max intima-media thickness and brachial flow-mediated dilation in healthy young women

Background: Many factors can contribute to atherosclerotic-type vascular changes in older individuals or men. Thus, confining the investigation to young women with no clinical evidence of the condition could enhance understanding of the early stages of cardiovascular disease. The aim of this study was to determine whether carotid mean/max intima-media thickness (IMT) and brachial flow-mediated dilation (FMD) values, which are well-known event-related indices, are associated with laboratory data and the other vascular indices of atherosclerosis in healthy young women. Methods: Carotid mean/max IMT and brachial FMD were measured in young women with no clinical evidence of atherosclerosis (n = 110;mean age, 39 years) who were instructed not to eat, drink or smoke after 9 PM the evening before testing. All participants also underwent laboratory assessment, including simultaneous measurements of arterial stiffness such as augmentation index (AI), cardioankle vascular index (CAVI) and brachial-ankle pulse wave velocity (baPWV). Results: Mean IMT was signifi-cantly and positively associated with age (p = 0.002), CAVI (p = 0.044), low-density lipoprotein-cholesterol (LDL-C, p = 0.047) and high-sensitive C-reactive protein (hs-CRP, p = 0.002) values but was not related to FMD, AI, baPWV or triglycerides (TG) in the multivariate regression analysis. Similarly, max IMT was positively associated with age (p p = 0.003) and hs-CRP (p = 0.005) values but was not related to FMD, AI, CAVI, baPWV, TG or blood pressure level in the multivariate regression analysis. The association between LDL-C and max IMT was much stronger than that between LDL-C and mean IMT. Brachial FMD was positively associated only with heart rate in the multivariate regression analysis. Conclusions: These results suggest that mean IMT more closely represents the sclerotic aspect of vascular change, whereas max IMT represents the atherotic aspect in healthy young women. Although the relationship between the autonomic nervous system and heart rate is well-known, there may be a complex interaction between the autonomic nervous system and endothelial function.

The effect of aerobic training on endothelium-dependent vasodilatation in patients with coronary artery disease who were revascularized and young men

Aim: The aim of this study was to determine the effect of training on endothelium-dependent vasodilatation in patients with coronary artery disease (CAD) after revascularization and healthy young men. Background: Impaired endothelial function has been observed in patients with CAD and those with CAD risk factors. Studies have shown that exercise can enhance endothelial function. Methods: This experimental cross-sectional study was conducted on patients with CAD (3 months after CABG and PCI) and students of medical school in 2011. Endothelium dependent dilation of the brachial artery was determined by using high-resolution vascular ultrasonography through flow-mediated vasodilatation (FMD) after induction of ischemia, and the data were analyzed using SPSS, dependent t-test and ANCOVA. Findings: The findings showed that at baseline, FMD was reduced in revascularized patients, when compared with healthy young men, after 8 weeks, and exercise training significantly improved FMD in patients underwent training group [from 4.31 ± 1.45 (SD)% to 6.15 ± 0.773 (SD)%, p p ed unchanged, and even after aerobic training, it did not significantly modify the brachial artery diameter in these groups. Conclusion: Our study demonstrates that endothelial dysfunction persisting in CAD patients after revascularization and aerobic training can improve endothelial function in different vascular beds in CAD patients and healthy young men. This may contribute to the benefit of regular exercise in preventing and restricting cardiovascular disease.

Impaired brachial artery flow-mediated dilation and increased carotid intima-media thickness in rheumatoid arthritis patients

Background Carotid artery intima-media thickness （CIMT） and brachial artery flow-mediated dilation percentage （FMD%） are common parameters used for detecting subclinical atherosclerosis. This study compared subclinical atherosclerosis of the carotid and brachial arteries in rheumatoid arthritis （RA） patients and healthy controls using high resolution ultrasonography. We also investigated their correlation with clinical factors and the association between FMD% and CIMT.

Is reversal of endothelial dysfunction still an attractive target in modern cardiology?

Although the endothelium has a number of important functions, the term endothelial dysfunction is commonly used to describe impairment in its vasodilatory capacity. There have been numerous studies evaluating the relationship between endothelial dysfunction and cardiovascular disease, however assessment of endothelial function is perhaps still primarily thought of as a research tool and has not reached widespread clinical acceptance. In this review we explore the relationship between endothelial dysfunction and cardiovascular disease, its prognostic significance, methods of pharmacological reversal of endothelial dysfunction, and ask the question, is reversal of endothelial dysfunction still an attractive target in modern cardiology?

血管内皮功能检测研究进展及临床应用

目前认为,内皮细胞功能有维持血管结构及张力,调节血管细胞生长,调节抗凝及纤溶系统,介导炎症与免疫,调节白细胞与血小板在血管内皮粘附,调节脂质氧化,调节血管通透等作用。现诸多证据已表明内皮功能的变化发生在动脉粥样硬化形态学改变发生发展之前,且参与了损伤的进展及随后的临床并发症,与心血管疾病关系密切,是急性冠脉综合症等严重后果的直接推手。当下已逐步开始成为心血管疾病诊疗的新靶点,准确评价这一器官功能很有临床价值。目前已有一些检测方法已应用于临床。现就内皮功能检测方法及临床应用做一综述。

Exercise-mediated adaptations in vascular function and structure:Beneficial effects in coronary artery disease

Exercise exerts direct effects on the vasculature via the impact of hemodynamic forces on the endothelium,thereby leading to functional and structural adaptations that lower cardiovascular risk.The patterns of blood flow and endothelial shear stress during exercise lead to atheroprotective hemodynamic stimuli on the endothelium and contribute to adaptations in vascular function and structure.The structural adaptations observed in arterial lumen dimensions after prolonged exercise supplant the need for acute functional vasodilatation in case of an increase in endothelial shear stress due to repeated exercise bouts.In contrast,wall thickness is affected by rather systemic factors,such as transmural pressure modulated during exercise by generalized changes in blood pressure.Several mechanisms have been proposed to explain the exercise-induced benefits in patients with coronary artery disease(CAD).They include decreased progression of coronary plaques in CAD,recruitment of collaterals,enhanced blood rheological properties,improvement of vascular smooth muscle cell and endothelial function,and coronary blood flow.This review describes how exercise via alterations in hemodynamic factors influences vascular function and structure which contributes to cardiovascular risk reduction,and highlights which mechanisms are involved in the positive effects of exercise on CAD.

Effect of plant-based functional foods for the protection against salt induced endothelial dysfunction

This study aimed to compare the efficacy of four formulations of plant-based functional foods on the protection against salt-induced endothelial dysfunction.A randomized crossover design was employed.Ten healthy subjects were recruited,and on five separate occasions they received,in random sequence one of the following 5 treatments:250 mL of plain water(control)alone,and with beetroot powder,celery powder,green tea extract or beetroot powder with green tea extract prior to consuming 150 mL of high-salt chicken broth.Flow-mediated dilation(FMD),blood pressure(BP),heart rate(HR)and pulse-wave velocity(PWV)were measured at fasting and at 30,60,90 and 120 min postprandial.Comparing with control,beetroot supplementation led to a significantly increased HR at 30,60 and 90 min postprandially(P=0.025,0.004,<0.001,respectively).No significant difference was observed for FMD,BP and PWV between control and any of the treatments.Salt reduction may still be the most effective strategy to improve vascular health.

Effects of Statin Therapy on Endothelial Function in Asymptomatic Metabolic Syndrome

Context: Endothelial dysfunction is an early predictor of adverse cardiovascular events. The present study evaluated asymptomatic metabolic syndrome (MS) patients with brachial artery endothelial dysfunction to determine whether a reversal of endothelial dysfunction occurs with statin treatment. Aim: To evaluate the short term effects of statins on endothelial function in asymptomatic metabolic syndrome patients. Methodology: This was a prospective, single centre, case-control study. We evaluated 50 recently diagnosed newly detected asymptomatic MS patients who underwent an assessment of endothelial function by brachial artery flow-mediated dilation (FMD) before and after treatment with 40 mg atorvastatin for one week. Results: A total of 50 MS patients, including 36 (62%) females and 14 (38%) males, were included in the study. The mean age of the patients was 49.70 ± 8.84 y. We identified a significant difference between cases and age- and sex-matched controls regarding baseline brachial artery FMD% (6.73 ± 2.55 vs. 11.03 ± 1.85, respectively;p < 0.001). Significant negative correlations were detected between FMD% and HDL-cholesterol (r = -0.34, p = 0.01), fasting blood sugar (r = -0.40, p = 0.004), and systolic blood pressure (r = -0.34, p = 0.015). Multiple linear regression analysis indicated that HDL-cholesterol was an independently associated factor for FMD. MS patients treated with 40 mg atorvastatin for one week showed a significant improvement in brachial artery FMD% (6.73 ± 2.55 before treatment vs. 10.19 ± 3.01 after treatment, p < 0.001). Conclusions: MS is associated with endothelial dysfunction and decreased brachial artery FMD compared with controls. Statin treatment for one week significantly improved brachial artery endothelial function in MS patients.

Sitagliptin improves vascular endothelial function in Japanese type 2 diabetes patients without cardiovascular disease

We evaluated the effect of sitagliptin on vascular endothelial function in Japanese type 2 diabetes patients without cardiovascular disease. Subjects included 24 Japanese type 2 diabetes patients without cardiovascular disease. This study was a prospective, open-label, randomized clinical trial. We divided the study subjects into 2 groups: subjects who received sitagliptin 50 mg daily (sitagliptin group, n = 12) and subjects who did not receive sitagliptin (control group, n = 12). Brachial artery flow-mediated dilation (FMD) was measured after overnight fasting. Sitagliptin administration was initiated at 1 month after enrollment in study (baseline). FMD and level of biochemical variables in the sitagliptin and control groups were measured at baseline and 3 months from baseline (3 months). We evaluated the effect of sitagliptin on vascular endothelial function by measuring FMD. FMD at 3 months was significantly higher in the sitagliptin group than in the control group (5.36% ± 2.18% vs 3.41% ± 2.29%, P = 0.040), while FMD at baseline was not significantly different between the 2 groups. In addition, FMD of the sitagliptin group at 3 months was significantly higher than that at baseline (5.36% ± 2.18% vs 3.67% ± 2.30%, P = 0.004), while no significant differences were observed in the FMD of the control group during the study period. The change in the adiponectin from baseline to 3 months was significantly higher in the sitagliptin group than that in the control group (0.82 ± 2.18 μg/mL vs 0.01 ± 0.55 μg/mL, P = 0.039). Sitagliptin improves vascular endothelial function of the brachial artery in Japanese type 2 diabetes patients without cardiovascular disease. Furthermore, elevation of adiponectin may induce reduction of endothelial dysfunction in type 2 diabetes patients treated with sitagliptin.