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Carotid femoral pulse wave velocity in type 2 diabetes and hypertension: capturing arterial health effects of step counts.

ABSTRACT: Optimal medication use obscures the impact of physical activity on traditional cardiometabolic risk factors. We evaluated the relationship between step counts and carotid-femoral pulse wave velocity (cfPWV), a summative risk indicator, in patients with type 2 diabetes and/or hypertension.Three hundred and sixty-nine participants were recruited (outpatient clinics; Montreal, Quebec; 2011-2015). Physical activity (pedometer/accelerometer), cfPWV (applanation tonometry), and risk factors (A1C, Homeostatic Model Assessment-Insulin Resistance, blood pressure, lipid profiles) were evaluated. Linear regression models were constructed to quantify the relationship of steps/day with cfPWV.The study population comprised 191 patients with type 2 diabetes and hypertension, 39 with type 2 diabetes, and 139 with hypertension (mean?±?SD: age 59.6?±?11.2 years; BMI 31.3?±?4.8?kg/m; 54.2% women). Blood pressure (125/77?±?15/9?mmHg), A1C (diabetes: 7.7?±?1.3%; 61?mmol/mol), and low-density lipoprotein cholesterol (diabetes: 2.19?±?0.8?mmol/l; without diabetes: 3.13?±?1.1mmol/l) were close to target. Participants averaged 5125?±?2722?steps/day. Mean cfPWV was 9.8?±?2.2?m/s. Steps correlated with cfPWV, but not with other risk factors. A 1000?steps/day increment was associated with a 0.1?m/s cfPWV decrement across adjusted models and in subgroup analysis by diabetes status. In a model adjusted for age, sex, BMI, ethnicity, immigrant status, employment, education, diabetes, hypertension, medication classes, the mean cfPWV decrement was 0.11?m/s (95% confidence interval -0.2, -0.02).cfPWV is responsive to step counts in patients who are well controlled on cardioprotective medications. This ability to capture the 'added value' of physical activity supports the emerging role of cfPWV in arterial health monitoring.

SUBMITTER: Dasgupta K

PROVIDER: S-EPMC5377988 | biostudies-literature | 2017 May

REPOSITORIES: biostudies-literature

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Carotid femoral pulse wave velocity in type 2 diabetes and hypertension: capturing arterial health effects of step counts.

Dasgupta Kaberi K Rosenberg Ellen E Joseph Lawrence L Trudeau Luc L Garfield Natasha N Chan Deborah D Sherman Mark M Rabasa-Lhoret Rémi R Daskalopoulou Stella S SS

Journal of hypertension 20170501 5

<h4>Objective</h4>Optimal medication use obscures the impact of physical activity on traditional cardiometabolic risk factors. We evaluated the relationship between step counts and carotid-femoral pulse wave velocity (cfPWV), a summative risk indicator, in patients with type 2 diabetes and/or hypertension.<h4>Research design and methods</h4>Three hundred and sixty-nine participants were recruited (outpatient clinics; Montreal, Quebec; 2011-2015). Physical activity (pedometer/accelerometer), cfPW ...[more]

PMID: 28129250

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Project description:The arterial system in diabetic patients is characterized by generalized non-atherosclerotic alterations in the vascular extracellular matrix causing increased arterial stiffness compared with subjects without diabetes. The underlying pathophysiology remains elusive. The elastin-associated extracellular matrix protein, fibulin-1, was recently found in higher concentrations in the arterial wall and in plasma in patients with long duration type 2 diabetes. Furthermore, plasma fibulin-1 independently predicted total mortality and was associated with pulse pressure, an indirect measure of arterial stiffness. Whether plasma fibulin-1 is associated with arterial stiffness at earlier phases of type 2 diabetes has not been determined.In this cross-sectional study, we examined 90 patients with recently diagnosed type 2 diabetes (< 5 years) and 90 gender- and age-matched controls. Plasma fibulin-1 was measured immunochemically. Arterial stiffness was assessed by carotid-femoral Pulse Wave Velocity (PWV). Differences in means were assessed by t-tests. Associations were assessed by multivariate regression analyses.Plasma fibulin-1 levels were lower in the diabetic group compared with the control group, 93?±?28 vs 106?±?30 ?g/mL, p?=?0.005. In unadjusted analysis of the total study sample, plasma fibulin-1 was not associated with PWV, p?=?0.46. However, with adjustment for the confounders age, gender, mean blood pressure, heart rate, body mass index, diabetes and glomerular filtration rate, a 10 ?g/mL increase in plasma fibulin was associated with 0.09?±?0.04 m/s increase in PWV, p?<?0.05. In subgroup analysis, plasma fibulin-1 was associated with PWV in the diabetes group, (0.16?±?0.07 m/s increase in PWV per 10 ?g/mL increase in plasma fibulin-1, p<0.05), but not controls, ??=?0.021?±?0.057 m/s per 10 ?g/mL, p?=?0.70. The association remained significant in the diabetes group after adjustment for covariates, p < 0.05.Plasma fibulin-1 is independently associated with PWV. Yet, as the plasma level of fibulin-1 was lower in patients with recently diagnosed type 2 diabetes than in healthy controls, plasma fibulin-1 levels are not a simple marker of the degree of arterial stiffening. Further studies are needed to determine the exact role of fibulin-1 in arterial stiffness and cardiovascular risk in patients with type 2 diabetes.

Project description:BACKGROUND:In end-stage renal disease (ESRD) patients, increased arterial stiffness detected by carotid-femoral pulse wave velocity (cf-PWV) is associated with fatal cardiovascular events and all-cause mortality. Since cf-PWV is an operator-dependent technique, poor reproducibility may be a source of bias in the estimation of arterial stiffness. OBJECTIVES:We assessed the week-to-week reproducibility of cf-PWV and radial artery pulse wave analysis in healthy subjects and ESRD patients. We also determined the extent of patient eligibility, enrollment, acceptance, and comfort. METHODS:In a cohort study design, independent tonometric examinations of carotid, femoral, and radial arteries were conducted in 20 healthy subjects and 15 ESRD patients attending chronic hemodialysis treatments according to a randomized sequence by two operators on 2 days scheduled 1-week apart. cf-PWV, augmentation index (AIx@HR75) and central pulse pressure (CPP) were the outcome measures. Patients were tested at mid-week and prior to dialysis treatment. The variability on the distance measured between the suprasternal notch and femoral site using two different methods (standard vs direct) was compared. A post-examination survey assessed acceptance and comfort associated with examinations. Reproducibility was evaluated by intra-class correlations (ICCs). RESULTS:The mean age for healthy subjects and ESRD patients was 45?±?12 and 63?±?16 years, respectively. ESRD patients had higher cf-PWV (p?=?0.0002), elevated AIx@HR75 (p?=?0.003), and increased CPP (p?=?0.001) compared to healthy subjects. The mean inter-visit differences for all stiffness indices were non-significant (p?>?0.05), but the mean inter-operator differences for the cf-PWV were significant only in the healthy subject group (-0.7 m/s; p?=?0.02). The ICCs between operators and visits were higher for the ESRD group compared to the healthy subjects (between operators, 0.870 vs 0.461; between visits, 0.830 vs 0.570). Distances were longer (p?<?0.001), but less variable with the standard method compared to the direct method (healthy subjects, p?=?0.036; ESRD, p?=?0.39). There was a high rate of patient acceptance and minimal discomfort. CONCLUSIONS:Week-to-week measurements of cf-PWV and pulse wave analysis are highly reproducible in ESRD patients prior to hemodialysis treatment. The high reproducibility and minimal test-to-test variations encourage use of cf-PWV to monitor changes in arterial stiffness and the efficacy of interventions in ESRD patients. TRIAL REGISTRATION:ClinicalTrials.gov, NCT02196610.

Dataset Information

Carotid femoral pulse wave velocity in type 2 diabetes and hypertension: capturing arterial health effects of step counts.

Publications

Carotid femoral pulse wave velocity in type 2 diabetes and hypertension: capturing arterial health effects of step counts.

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