Pilot study on the effect of flavonoids on arterial stiffness and oxidative stress in chronic kidney disease

BACKGROUND Flavonoids,the main class of polyphenols,exhibit antioxidant and antihypertensive properties.AIM To prospectively investigate the impact of flavonoids on arterial stiffness in patients with chronic kidney disease(CKD)stagesⅠ-Ⅳ.METHODS In this prospective,single-arm study,CKD patients with arterial hypertension and diabetes mellitus were enrolled.Baseline demographic,clinical,and laboratory variables were recorded.Patients received daily treatment with a phenol-rich dietary supplement for 3 months.Blood pressure,arterial stiffness(carotidfemoral pulse wave velocity,central pulse pressure),and oxidative stress markers(protein carbonyls,total phenolic compound,total antioxidant capacity)were measured at baseline and at study end.RESULTS Sixteen patients(mean age:62.5 years,87.5%male)completed the study.Following intervention,peripheral systolic blood pressure decreased significantly by 14 mmHg(P<0.001).Carotid-femoral pulse wave velocity decreased from 8.9 m/s(baseline)to 8.2 m/s(study end)(P<0.001),and central pulse pressure improved from 59 mmHg to 48 mmHg(P=0.003).Flavonoids also reduced oxidative stress markers including protein carbonyls(P<0.001),total phenolic compound(P=0.001),and total antioxidant capacity(P=0.013).CONCLUSION Flavonoid supplementation in CKD patients shows promise in improving blood pressure,arterial stiffness,and oxidative stress markers.

Association between Fruit and Vegetable Intake and Arterial Stiffness: The China-PAR Project

Objective This study aimed to investigate the association between fruit and vegetable intake and arterial stiffness.Methods We conducted a cohort-based study comprising 6,628 participants with arterial stiffness information in the Prediction for Atherosclerotic Cardiovascular Disease Risk in China(China-PAR)project. A semi-quantitative food-frequency questionnaire was used to assess baseline(2007–2008) and recent(2018–2021) fruit and vegetable intake. We assessed changes in fruit and vegetable intake from2007–2008 to 2018–2021 in 6,481 participants. Arterial stiffness was measured using the arterial velocity–pulse index(AVI) and arterial pressure-volume index(API). Elevated AVI and API values were defined according to diverse age reference ranges.Results Multivariable-adjusted linear regression models revealed that every 100 g/d increment in fruit and vegetable intake was associated with a 0.11 decrease in AVI(B =-0.11;95% confidence interval [CI]:-0.20,-0.02) on average, rather than API(B = 0.02;95% CI:-0.09, 0.13). The risk of elevated AVI(odds ratio [OR] = 0.82;95% CI: 0.70, 0.97) is 18% lower in individuals with high intake(≥ 500 g/d) than in those with low intake(< 500 g/d). Furthermore, maintaining a high intake in the past median of 11.5years of follow-up was associated with an even lower risk of elevated AVI compared with a low intake at both baseline and follow-up(OR = 0.64;95% CI: 0.49, 0.83).Conclusion Fruit and vegetable intake was negatively associated with arterial stiffness, emphasizing recommendations for adherence to fruit and vegetable intake for the prevention of arterial stiffness.

Increased Risk of Arterial Stiffness in Rhumatoid Arthritis Patients in a Sub-Saharan African Setting

Background: Analysis of arterial stiffness (AS) is a good marker of early arterial disease and an important determinant of cardiovascular risk, independent of other traditional cardiovascular risk factors. Carotid-femoral pulse wave velocity (CfPWV) is the gold standard to evaluate arterial stiffness. There is evidence that patients with rheumatoid arthritis (RA) have a higher arterial stiffness than their age-matched healthy counterparts and thus have higher cardiovascular (CV) risk. However, data on arterial stiffness in African rheumatoid arthritis patients is scarce. Objectives: To determine the patterns of arterial stiffness in rheumatoid arthritis patients in a sub-Saharan African setting, using CfPWV and Augmentation index (AIx). Method: We conducted a case-control study, at the Douala general hospital over four months (February to May 2018) on 63 subjects among which 31 RA patients matched for age and sex with 32 healthy subjects. AIx and CfPWV were determined non-invasively by radial pulse wave analysis and carotid femoral wave analysis respectively, using a sphygmocor Atcor device (SphygmoCor, PWV Medical, Sydney, Australia). Results: The mean age of RA patients was 47 ± 14 years with most of them being females (n = 26, 83.9%). CfPWV was significantly higher in RA patients compared to the control group (mean: 8.85 ± 2.1 vs 7.45 ± 1.38;p ≤ 0.01) as well as was AIx (Median: 33 [26 - 43] vs 26 [20 - 31];p = 0.01). RA (OR: 6.105;95% CI: 1.52 - 24.54;p 1.34;95% CI: 1.14 - 5.17;p = 0.05), elevated CRP levels (OR: 4.01;95% CI: 1.16 - 13.68;p = 0.03) and Hypertension (OR: 5.75;95% CI: 1.24 -11.60;p Conclusion: Arterial stiffness, a well-recognized marker of cardiovascular risk is increased among patients suffering from rheumatoid arthritis when compared to a healthy control group.

Association between serum homocysteine and arterial stiffness in elderly： a community-based study

Background Arterial stiffness and homocysteine are both powerful predictors of cardiovascular disease, especially in older popula tions. Previous studies have investigated the association of homocysteine with arterial stiffness in human subjects, while the relationship between homocysteine and arterial stiffness in the elderly is still indefinite. The current study examined the association of homocysteine with arterial stiffness in Chinese community-based elderly persons. Methods We related serum levels of homocysteine to two measures of arte- rial stiffness （carotid-femoral pulse wave velocity （PWV） and carotid-radial PWV） in 780 participants （46.3% men, mean age 71.9 years （ranging 65-96 years old）） from two communities of Beijing, China. Arterial stiffness were measured within two days of the time of bio- marker measurement. Results In multiple-adjusted models, homocysteine levels was strongly associated with the carotid-femoral PWV （standardized 13 = 0.13, P 〈 0.001）, even after adjustment for classical risk factors of cardiovascular disease. The association is also stronger when the carotid-femoral PWV is elevated above normal, whereas no significant association with homocysteine was observed for ca-rotid-radial PWV. Conclusions In Chinese elderly persons, serum homocysteine levels are associated with alterations of aortic stiffness.

Association between serum homocysteine and arterial stiffness：role of anti-hypertensive drugs

To the Editor I read the article of Zhang, et al. with great interest. They investigated the association of homocysteine with arterial stiffness in Chinese community-based elderly persons. The carotid-femoral pulse wave velocity （PWV） was significantly higher in the high homocyteine group than in the normal one, however, there was no differences in carotid-radial PWV between the high homocyteine group and the normal one. Homocysteine levels were strongly associated with the carotidfemoral PWV even after adjustment for classical risk factors of cardiovascular disease. I congratulate the authors for this important study. However, I want to make minor criticism for this study from the methodological aspect.

Increased Arterial Stiffness in Subjects with Pre-diabetes among Middle Aged Population in Beijing,China

Objective To investigate the relationship between arterial stiffness and pre-diabetes when assessed by the new glycosylated hemoglobin Ale （HbAlc） 5.7%-6.4% criterion or by impaired fasting glucose in middle aged Chinese. Methods 1122 adults aged 55 years or younger in the health examination centers for physical check-ups were enrolled in the two large-sized Tertiary Comprehensive Hospitals in Beijing from June 2011 to June 2012 after excluding those who previously had been diagnosed or treated as diabetes or cardiovascular disease. Subjects with a diagnosis of pre-diabetes according to impaired fasting glucose （IFG） （fasting plasma glucose （FPG） levels at 5.6-6.9 mmol/L）, HbA^c levels at 5.7%-6.4%, or both, were classified into four groups for observation： （1） Normoglycaemia （HbA^c〈5.7% and FPG 〈5.6 mmol/L）; （2） IFG alone （FPG levels at 5.6-6.9 mmol/L and HbA1c〈5.7% ）; （3） HbAI~ 5.7%-6.4% alone （HbA^c levels at 5.7%-6.4% and FPG 〈5.6 mmol/L）; and （4） both HbA1c 5.7%-6.4% and IFG （l-lbA1~ levels at 5.7%-6.4% and FPG levels at 5.6-6.9 mmol/L）. All subjects were measured for weight, height, waist circumference, blood pressure, fasting plasma glucose, HbA1c, lipid profile and brachial-ankle pulse wave velocity （baPWV）. Results The mean values of baPWV were 1282±8, 1311±10, 1398±30, and 1418_±27 cm/s （Mean_±SE） in Normoglycaemia, HbA~ 5.7%-6.4% alone, IFG alone and the both HbAlc 5.7%-6.4% and IFG groups, respectively. After adjusting for age, gender, blood pressure, BMI and triglyceride, baPWV was significantly higher in subjects with both HbAlc5.7%-6.4% and iFG compared among the subjects with Normoglycaemia （1350±14 vs. 1301±6 cm/s, P=0.002） and HbA1c 5.7%-6.4% alone （1350±14 vs. 1309±8 cm/s, P=0.013）.Conclusion Subjects with pre-diabetes exhibited a greater arterial stiffness.

Association of glomerular filtration rate with arterial stiffness in Chinese women with normal to mildly impaired renal function

Objective Both decreased glomemlar 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. PWVef 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 AJx-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.

Albuminuria as a marker of arterial stiffness in chronic kidney disease patients

AIM： To access the association between albuminuria levels and arterial stiffness in non-diabetic patients with hypertension and chronic kidney disease （CKD） stages 1-2, treated with renin angiotensin blockade agents plus other hypertensive drugs when needed.METHODS： One hundred fifteen patients [median age 52 years （68% males）] were consequently enrolled in the study. For each patient, we recorded gender, age, body mass index （BMI）, peripheral systolic blood pressure （pSBP）, peripheral diastolic blood pressure, peripheral pulse pressure, central systolic blood pressure （cSBP）, central diastolic blood pressure （cDBP）, central pulse pressure （cPP）, hematocrit, hemoglobin, hsCRP, total cholesterol triglycerides, high-density lipoprotein-C, low-density lipoprotein-C, calcium, phosphorus, parathormone, and albumin, as well as 24 h urine albumin excretion. According to 24-h urine albumin collection, patients were then classified as those with moderately increased albuminuria （formerly called macroalbuminuria） （≤ 300 mg/d） and those with severely increased albuminuria （formerly called macroaluminuria （〉 300 mg/d）. We considered aortic stiffness （AS） indices [carotid femoral pulse wave velocity （PWVc-f） and augmentation index （AIx）] as primary outcomes of the study. We explored potential correlations between severely increased albuminuria and AS indices using a multiple linear regression model. RESULTS： Fifty-eight patients were included in the moderately increased albuminuria group and 57 in the severely increased albuminuria. Blood pressure measurements of the study population were 138 ± 14/82 ± 1.3 mmHg （systolic/diastolic）. There were no significant differences in age, sex, and BP measurements between the two groups. Patients with severely increased albuminuria had higher PWV and AIx than patients with moderately increased albuminuria （P 〈 0.02, P 〈 0.004, respectively）. In addition these patients exhibited higher BMI （P 〈 0.03）, hsCRP （P 〈 0.001）, and fibrinogen levels （P 〈 0.02） compared to patients with moderately increased albuminuria. In multivariate linear regression analysis, severely increased albuminuria （β = 1.038, P 〈 0.010） pSBP （β = 0.028, P 〈 0.034） and Ht （β = 0.171, P = 0.001） remained independent determinants of the increased PWVc-f. Similarly, severely increased albuminuria （β = 4.385, P 〈 0.012）, cSBP （β = 0.242, P 〈 0.001）, cPP （β = 0.147, P 〈 0.01） and Ht levels （β = 0.591, P 〈 0.013） remained independent determinants of increased AIx.CONCLUSION： These fndings demonstrate an independent association between AS indices and severely increased albuminuria in non-diabetic, hypertensive patients with CKD stages 1-2 treated with renin angiotensin aldosterone system blockers.

Arterial stiffness, vascular calcification and bone metabolism in chronic kidney disease

Patients with chronic kidney disease （CKD） have an extremely poor cardiovascular outcome. Arterial stiff-ness, a strong independent predictor of survival in CKD, is connected to arterial media calcification. A huge number of different factors contribute to the increased arterial calcification and stiffening in CKD, a process which is in parallel with impaired bone metabolism. This coincidence was demonstrated to be part of the direct inhibition of calcifcation in the vessels, which is a counterbalancing effect but also leads to low bone turnover. Due to the growing evidence, the defnition of “CKD mineral bone disorder” was created recently, un-derlining the strong connection of the two phenomena. In this review, we aim to demonstrate the mechanisms leading to increased arterial stiffness and the up-to date data of the bone-vascular axis in CKD. We over-view a list of the different factors, including inhibitors of bone metabolism like osteoprotegerin, fetuin-A, pyro-phosphates, matrix Gla protein, osteopontin, fbroblast growth factor 23 and bone morphogenic protein, which seem to play role in the progression of vascular calcif-cation and we evaluate their connection to impaired ar-terial stiffness in the mirror of recent scientifc results.

Effect of eicosapentaenoic acid on regional arterial stiffness:Assessment by tissue Doppler imaging

AIM: To evaluate the effects of eicosapentaenoic acid (EPA) on regional arterial stiffness assessed by strain rate using tissue Doppler imaging. METHODS: Nineteen eligible patients were prospectively studied (mean age 62 ± 8 years, 68% men). Subjects with large vessel complications and/or diabetes mellitus were excluded. The strain rate of the ascending aorta was measured by tissue Doppler imaging as an index of regional arterial stiffness, and brachial-ankle pulse wave velocity (baPWV) was measured as an index of degree of systemic arteriosclerosis. These indices were compared before and after administration of EPA at 1800 mg/d for one year. RESULTS: The plasma concentration of EPA increased significantly after EPA administration (3.0% ± 1.1% to 8.5% ± 2.9%, P < 0.001). There were no significant changes in baPWV (1765 ± 335 cm/s to 1745 ± 374 cm/s), low-density lipoprotein cholesterol levels (114 ± 29 mg/dL to 108 ± 28 mg/dL), or systolic blood pressure (131 ± 16 mmHg to 130 ± 13 mmHg) before and after EPA administration. In contrast, the strain rate was significantly increased by administration of EPA (19.2 ± 5.6 s-1, 23.0 ± 6.6 s-1, P < 0.05). CONCLUSION: One year of administration of EPA resulted in an improvement in regional arterial stiffness which was independent of blood pressure or serum cholesterol levels.

Radial Applanation Tonometry as an Adjuvant Tool in the Noninvasive Arterial Stiffness and Blood Pressure Assessment

Since antiquity, the human arterial pulse represents an important parameter in the clinical assessment. Besides being routinely assessed in the medical practice, such pulse is not observed in its completeness yet, once many of the data obtained through it cannot be evaluated using conventional methods. Taking into account such methods, the measurement of arterial blood pressure using sphygmomanometry, although broadly widespread in the assessment and follow-up of patients who require accompaniment of their cardiovascular status, is not able to properly guide about parameters related to the central hemodynamic status, the latter most strongly associated with cardiovascular risk. Such incapability is due to the centrifugal augmentation of the pressures taken at different points of the arterial bed, based on the properties of the closed arterial system through which the blood flow travels. In this context, methodologies capable of assessing central parameters estimated using the pulse wave analysis, such as applanation tonometry, represent a promising adjuvant for evaluating patients with cardiovascular diseases, by providing detailed information concerning hemodynamic parameters otherwise inaccessible. In this scenario, the present review focuses on the applanation tonometry and its assessment on the radial artery, highlighting the importance of this method in the cardiovascular assessment, as well as its relevance in the clinical practice, when determining parameters peripherally obtained capable of estimating the central hemodynamic status.

Intensive blood pressure control on arterial stiffness among older patients with hypertension

Background:Arterial stiffening increases with age and blood pressure and is associated with cardiovascular disease(CVD),but the relationship between blood pressure lowering and arterial stiffening is still uncertain,especially in older people.This study aimed to evaluate the effect of intensive blood pressure treatment on the progression of arterial stiffness and risk of CVD in older patients with hypertension.Methods:The Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients(STEP)trial was a multicenter,randomized,controlled trial performed at 42 clinical centers throughout China,and 8511 patients aged 60-80 years with essential hypertension were enrolled and randomly assigned to systolic blood pressure(SBP)target of 110 mmHg to<130 mmHg(intensive treatment)or 130 mmHg to<150 mmHg(standard treatment).Patients underwent repeated examinations of the brachial-ankle pulse wave velocity(baPWV)and ankle-brachial index(ABI)at baseline,and the arterial stiffness was evaluated at the 3-year follow-up.A total of 5339 patients who had twice repeated measurements were included in this study.Changes in arterial stiffness between the intensive and standard treatment groups were analyzed using a multivariate linear regression model.The Cox proportional hazard regression model was used to evaluate the effect of intensive treatment on primary CVD outcomes.Results:The changes in baPWV were 61.5 cm/s(95%confidence interval[CI]:49.8-73.2 cm/s)in the intensive treatment group and 98.4 cm/s(95%CI:86.7-110.1 cm/s)in the standard treatment group(P<0.001).Intensive treatment significantly delayed the progression of arterial stiffness,with an annual change of 23.1 cm·s^(-1)·year-1 vs.36.7 cm·s^(-1)·year^(-1)of baPWV in the intensive and standard treatment groups,respectively.During a median follow-up period of 3.36 years,primary CVD outcomes occurred in 77(2.9%)patients in the intensive treatment group compared with 93(3.5%)in the standard treatment group.Intensive treatment resulted in a significantly lower CVD risk in patients aged 70-80 years or with SBP<140 mmHg.Conclusion:Intensive blood pressure control with an SBP target of 110 mmHg to<130 mmHg could delay the progression of arterial stiffness and reduce the risk of CVD in older patients with hypertension.Clinical trial registration:http://www.clinicaltrials.gov;No.NCT03015311.

Reference values of carotid intima-media thickness and arterial stiffness in Chinese adults based on ultrasound radio frequency signal:A nationwide,multicenter study

Background:Carotid intima-media thickness(IMT)and diameter,stiffness,and wave reflections,are independent and important clinical biomarkers and risk predictors for cardiovascular diseases.The purpose of the present study was to establish nationwide reference values of carotid properties for healthy Chinese adults and to explore potential clinical determinants.Methods:A total of 3053 healthy Han Chinese adults(1922 women)aged 18-79 years were enrolled at 28 collaborating tertiary centers throughout China between April 2021 and July 2022.The real-time tracking of common carotid artery walls was achieved by the radio frequency(RF)ultrasound system.The IMT,diameter,compliance coefficient,βstiffness,local pulse wave velocity(PWV),local systolic blood pressure,augmented pressure(AP),and augmentation index(AIx)were then automatically measured and reported.Data were stratified by age groups and sex.The relationships between age and carotid property parameters were analyzed by Jonckheere-Terpstra test and simple linear regressions.The major clinical determinants of carotid properties were identified by Pearson’s correlation,multiple linear regression,and analyses of covariance.Results:All the parameters of carotid properties demonstrated significantly age-related trajectories.Women showed thinner IMT,smaller carotid diameter,larger AP,and AIx than men.Theβstiffness and PWV were significantly higher in men than women before forties,but the differences reversed after that.The increase rate of carotid IMT(5.5µm/year in women and 5.8µm/year in men)and diameter(0.03 mm/year in both men and women)were similar between men and women.For the stiffness and wave reflections,women showed significantly larger age-related variations than men as demonstrated by steeper regression slopes(all P for age by sex interaction<0.05).The blood pressures,body mass index(BMI),and triglyceride levels were identified as major clinical determinants of carotid properties with adjustment of age and sex.Conclusions:The age-and sex-specific reference values of carotid properties measured by RF ultrasound for healthy Chinese adults were established.The blood pressures,BMI,and triglyceride levels should be considered for clinical application of corresponding reference values.

Composition and Functional Capacity of Gut Microbes are Associated with Arterial Stiffness:A Prospective Study

Objective:Arterial stiffness is an important predictor of cardiovascular disease.Microbial diversity in the gut has been shown to be associated inversely with arterial stiffness in Caucasian populations.However,due to the different profiles of the gut microbiota among ethnicities,the relationship between gut-microbiota dysbiosis and the progression of arterial stiffness merits further investigation.This study aimed to investigate the association between the composition and functional capacity of the gut microbiota and the progression of arterial stiffness.Methods:“Shotgun”metagenomics sequencing were undertaken in 96 individuals from a hypertension-associated gut-microbiota study in the Kailuan cohort,who measured brachial-ankle pulse wave velocity(baPWV)and provided fecal samples between September 2014 and February 2015 at Kailuan General Hospital and 11 affiliated hospitals.The different composition and functional capacity of the gut microbiota were compared between individuals without arterial stiffness(normal arterial stiffness group,baPWV<1,400 cm/s,n=27)and participants with arterial stiffness(increased arterial stiffness group,baPWV≥1,400 cm/s,n=69)at baseline.These participants were followed up prospectively for a mean duration of 2.6 years,and 50 underwent a repeat baPWV measurement.Associations between the gut microbiota and severity and progression of arterial stiffness were assessed using MaAsLin2 software after adjustment for age,sex,and mean arterial blood pressure and correction for multiple testing.Gene“catalogs”were aligned to the Kyoto Encyclopedia of Genes and Genomes(KEGG)database to obtain information for potential functional capacities of the gut microbiota.Results:In this study,14 genera and 50 species of bacteria were identified to be abundant in participants with normal arterial stiffness compared with those with increased arterial stiffness.Of 14 genera,the prevalence of beneficial bacteria of the genera Leadbetterella and Cytophaga was correlated inversely with baPWV(P<0.05).Analyses of functional capacity revealed gut-microbial dysfunctions in the synthetic processes of“threonine dehydratase”“hypothetical protein”“mannosyl transferase”and“type-IV secretion-system proteins”in individuals suffering from arterial stiffness.During follow-up,bacteria of the proinflammatory genera Escherichia,Shigella,and Ruegeria were enriched in individuals with increased baPWV.Functional analyses showed that 26 KEGG orthologs of gut microbes were associated with an increase in baPWV and involved in“carbohydrate metabolism”“amino acid metabolism”and“protein families related to genetic information processing.”Conclusions:The composition and functional capacity of the microbial community in the gut of people suffering from arterial stiffness differed from those in individuals not suffering from arterial stiffness.Our data provide a new direction for the causality of the host-gut microbiota in arterial stiffness.

The Impact of Finerenone on Changes in Pulse Wave Velocity, Arterial Pressure and Heart Related Deaths in Hemodialysis Patients—Study Perspective

The description in the abstract lacks clear logic and a comprehensive summary of this study, so please revise and improve it according to the design theme and main content of this study, and describe it in the order of (research background), purpose/aim, method, results and conclusions. The introduction of the abstract and preface is rather lengthy, but the summary of the whole study and the presentation of the research background are not perfect (mainly because the logic of the context is not clear and orderly), so it will appear a bit messy. Hope to be able to modify (this has been mentioned in the preliminary opinion). Cardiovascular events (CVE) pose a significant threat to individuals with end-stage renal disease (ESRD), yet these patients are often excluded from cardiovascular clinical trials, leaving prognostic factors associated with CVE in ESRD patients largely unexplored. Recent human studies have demonstrated elevated circulating aldosterone levels in ESRD patients, correlating with left ventricular hypertrophy. Additionally, animal models have shown improvements in uremic cardiomyopathy with spironolactone therapy, prompting interest in assessing the efficacy of spironolactone or eplerenone in reducing mortality and improving cardiovascular function in dialysis patients. Clinicians have historically been cautious about prescribing mineralocorticoid receptor antagonists (MRAs) to congestive heart failure patients with chronic kidney disease (CKD) due to hyperkalemia risk. However, the emergence of finerenone, a novel MR antagonist with a favorable safety profile and lower hyperkalemia risk, has renewed interest in MRA therapy in this population. Heart disease, including coronary artery disease, hypertension, and left ventricular failure, is alarmingly prevalent in dialysis patients, contributing significantly to elevated mortality rates compared to the general population. Arterial stiffness, as indicated by pulse wave velocity (PWV), progressively worsens with advancing CKD stages, peaking in severity among ESRD patients undergoing dialysis. High PWV serves as a crucial risk stratification tool in ESRD. Elevated NT-proBNP and BNP levels in ESRD patients are well-documented, with significant associations observed between baseline peptide concentrations and cardiovascular morbidity and mortality. By incorporating finerenone into our study, we aim to investigate its potential benefits in reducing arterial stiffness, lowering blood pressure, and ultimately mitigating heart-related mortality among hemodialysis patients. This study holds substantial implications for hypertension and cardiovascular risk management in this vulnerable patient population. Eligible participants must have been on chronic hemodialysis for at least three months, with ACE inhibitors or angiotensin receptor blockers included in their therapy at maximum tolerable doses. Serum potassium levels 5.7 mmol/L, left ventricular ejection fraction 50%, and PWV higher than age-estimated values are also prerequisites for study entry. Randomized allocation will be conducted using a permuted block design, stratified by center, with allocation communicated via signed study forms during initial examinations. All steps of this research will be conducted in accordance with the principles of the Helsinki Declaration.

Relationships between use of statins and arterial stiffness in normotensive and hypertensive patients with coronary artery disease

Background Statins improve arterial stiffness in patients with coronary artery disease （CAD）.Hypertension is a predominant contributor of arterial stiffening.However,the influence of hypertension on the effect of statins for improving arterial stiffness in CAD patients has seldom been investigated.Therefore,in this study,we investigated the relationships between statin use and arterial stiffness in normotensive and hypertensive CAD patients.Methods Brachial-ankle pulse wave velocity （ba-PWV） was measured in 437 patients,including 220 hypertensive CAD patients （121 used statins,99 did not） and 217 normotensive CAD patients （105 used statins,112 did not）.The normotensive and hypertensive CAD patients were matched according to age,sex,and body mass index （BMI）.Results In the normotensive and hypertensive CAD patients,lipid profiles were significantly improved in the statin group compared with the non-statin group.No significant differences in the administered statins （i.e.,atorvastatin,simvastatin,rosuvastatin,and pravastatin） and statin therapy duration were found between normotensive and hypertensive CAD patients （all P＞0.05）.No significant correlation of ba-PWV and statin therapy duration was found in all CAD patients,normotensive CAD patients,or hypertensive CAD patients （all P＞0.05）.ba-PWV in the statin group was significantly lower than that in the non-statin group in normotensive CAD patients （（1331.68±167.52） cm/s vs.（1468.61±244.54） cm/s,P=0.002） but not in hypertensive CAD patients （P＞0.05）.In multiple linear regression analyses,statin therapy was significantly associated with ba-PWV after adjusting for confounding variables in normotensive CAD patients （P=0.018） but not in hypertensive CAD patients （P＞0.05）.Conclusions Statins may significantly improve arterial stiffness in CAD patients,and hypertension may probably influence the effectiveness of statin therapy in improving arterial stiffness in this population.Further studies are required to investigate the effect of statins on arterial stiffness in normotensive and hypertensive CAD patients.

Associations of plasma homocysteine and high-sensitivity C-reactive protein levels with arterial stiffness in Chinese population： a community-based study

Background Arterial stiffness increases with age and is also associated with traditional cardiovascular risk factors. Little is known about the relations of homocysteine and high-sensitivity C-reactive protein （hs-CRP） to arterial stiffness in the Chinese community. The aim of the present study was to investigate the association of plasma homocysteine and hs-CRP levels with arterial stiffness in a community-based cohort. Methods We related levels of homocysteine and hs-CRP to four measures of arterial stiffness （carotid-femoral pulse wave velocity （PWV）, carotid-radial PWV, carotid-ankle PWV and heart rate corrected augmentation index） in 1680 participants from two communities of Beijing, China. Arterial stiffness was measured within two days of the time of biomarker measurement. Results In univariate analysis, homocysteine was positively associated with the carotid-femoral PWV （r=0.211, P 〈0.0001）, carotid-radial PWV （r=0.120, P 〈0.0001） and carotid-ankle PWV （r=0.148, P 〈0.0001）, whereas it was inversely related to the augmentation index （r= -0.052, P=0.016）. Hs-CRP was positively associated with the carotid-femoral PWV （r=0.074, P=0.001） and carotid-ankle PWV （r=0.050, P=0.02）. In multiple-adjusted models （R2=0.57）, homocysteine levels remained a significant determinant of the carotid-femoral PWV （standardized 13=0.065, P=0.007）, whereas the association of hs-CRP with measurements of arterial stiffness was not present. Conclusions In the Chinese population, plasma homocysteine levels are associated with alterations of aortic stiffness, whereas plasma levels of hs-CRP are not independently related to artery stiffening.

Effect of aliskiren on arterial stiffness, compared with ramipril in patients with mild to moderate essential hypertension

Background Aliskiren is a novel blood pressure-lowering agent acting as an oral direct renin inhibitor. The aim of this study was to assess the effect of aliskiren on arterial stiffness, compared with that of ramipril in mild to moderate essential hypertensive patients. Methods Following a two week placebo run-in period, patients with a mean sitting diastolic blood pressure （ms-DBP） 〉95 and 〈110 mmHg （1 mmHg=0.133 kPa）, and a mean sitting systolic blood pressure （ms-SBP） 〈180 mmHg were randomly allocated to treatment with aliskiren （150 mg/d, n=20） or ramipril （5 mg/d, n=20） for eight weeks. Blood pressure, plasma renin activity, and the brachial-ankle pulse wave velocity （ba-PWV） were measured before and after eight weeks of treatment. Results Eight weeks of treatment significantly decreased systolic blood pressure and diastolic blood pressure in both the aliskiren group and ramipril group. The hypotensJve effect did not differ between the two groups. Plasma renin activity decreased after aliskiren treatment and increased after ramipril treatment. There was no significant difference in baseline ba-PWV between the aliskiren and ramipril groups （P=-0.892）. The ba-PWV was significantly reduced in both the aliskiren group （1535 （1405-1666） vs. 1464 （1360-1506） cm/s） （P 〈0.01） and the ramipril group （1544 （1433-1673） vs. 1447 （1327-1549） cm/s） （P 〈0.01）. No statistically significant difference was found in the decline of ba-PWV between the two groups （P=0.766）. Conclusions The current study revealed that aliskiren （150 mg/d） could ameliorate arterial stiffness and its effect was similar to ramipril （5 mg/d） in mild to moderate hypertensive patients, indicating that in addition to lowering blood pressure, aliskiren had beneficial effect on vascular protection.

Association between non-alcoholic fatty liver disease and arterial stiffness in the non-obese, non-hypertensive, and non-diabetic young and middle-aged Chinese population

Background and objective： Non-alcoholic fatty liver disease（NAFLD） is associated with arterial stiffness in the general population. Age, obesity, hypertension, and diabetics are risk factors for arterial stiffness. In this study, we aimed to investigate the association between NAFLD and arterial stiffness as measured by brachial-ankle pulse wave velocity（baPWV） in the non-obese, non-hypertensive, and non-diabetic young and middle-aged Chinese population. Methods： A cross-sectional study with 1296 non-obese, non-hypertensive, and non-diabetic young and middle-aged（20–65 years） subjects undergoing routine medical check-ups in the International Health Care Center of the Second Affiliated Hospital of School of Medicine of Zhejiang University was carried out. Fatty liver was diagnosed by ultrasonography, and baPWV was measured using an automatic waveform analyzer. The subjects were classified into two groups according to the presence of NAFLD, and divided into a further two groups according to their baPWV. Results： The overall incidence of NAFLD was 19.0%, and NAFLD patients had a significantly higher level of baPWV than the controls（（1321±158） cm/s vs.（1244±154） cm/s; P〈0.001）. The incidence of NAFLD was clearly higher in the increased baPWV group than in the normal baPWV group（29.3% vs. 16.9%; P〈0.001）, and the incidence increased in line with the increase of baPWV quartiles in the normal range as well as with the severity of arterial stiffness（both P for trend 〈0.001）. Multiple linear logistic regression analysis showed that the presence of NAFLD was positively and independently associated with baPWV. Conclusions： Our results suggest that the presence of NAFLD is associated with arterial stiffness as measured by baPWV in the non-obese, non-hypertensive, and non-diabetic young and middle-aged Chinese population.

Association between arterial stiffness and risk of coronary artery disease in a community-based population

Background Arterial stiffness is well known as an important risk factor for coronary artery disease.In this study,we aimed to investigate the association between carotid-ankle pulse wave velocity （caPWV） and risk of coronary artery disease （CAD）,and the interaction between pulse wave velocity （PWV） and other potential risk factors of CAD.Methods A community-based cross-sectional study was conducted for subjects living in Beijing,China.We collected 213 subjects with coronary artery disease and 1 266 subjects without CAD between September 2007 and January 2009 in a community center of Beijing.A multivariate Logistic regression analysis was carried out to assess the odds ratios of factors related to CAD.Results We found CAD subjects were more likely to have a higher body massindex （BMI）,fasting glucose,uric acid,low-density lipoprotein （LDL） cholesterol,high-sensitivity Creactive protein （hs-CRP）,carotic-femoral pulse wave velocity （cfPWV） and caPWV （P ＜0.05）,and CAD subjects had a significantly lower HDL cholesterol levels （P ＜0.05）.Moreover,the proportion of hypertension in CAD subjects was significantly higher than non-CAD subjects.The multiple Logistic regression analysis showed that hypertension,higher uric acid,hs-CRP,cfPWV and caPWV levels significantly increased the risk of CAD,with ORs （Cl） of 1.47 （1.25-1.74）,1.17 （1.01-1.26）,1.35 （1.10-1.67）,1.15 （1.09-1.19） and 1.07 （1.01-1.15）,respectively.Higher HDL cholesterol was significantly associated with reduced risk of CAD,with ORs （CI） of 0.58 （0.40-0.83）.In addition,cfPWV had significant association with age,hypertension,LDL cholesterol,with Pearson＇s coefficients of 0.166,0.074,and 0.030,respectively.Conclusions cfPWV and caPWV are independently associated with significant CAD,and cfPWV has significant correlation with age and hypertension.cfPWV and caPWV may be used as a practical tool for predicting the risk of CAD.