Early Vascular aging & Arterial Stiffness Normal vascular aging Nilsson PM1.Early vascular aging (EVA): consequences and prevention. Vasc Health Risk.
Post on 27-Dec-2015
235 Views
Preview:
Transcript
Normal vascular aging
Nilsson PM1.Early vascular aging (EVA): consequences and prevention. Vasc Health Risk Manag. 2008;4(3):547-52.
A gradual change of the vascular structure and function
Decreased arterial Increased arterial compliance stiffening
Features of normal vascular aging.
Influenced by age dependent structural and biochemical changes, eg, in the content of elastin and collagen in the vessel wall.
Subtle increased intima media thickening (IMT) in the vessel wall followed by atherosclerosis with characteristic lesions and plaque.
Impairment of endothelial-mediated vasodilatation and decrease in fibrinolysis.
When vascular aging takes a rapid course
Nilsson PM1.Early vascular aging (EVA): consequences and prevention. Vasc Health Risk Manag. 2008;4(3):547-52.
Premature CVD manifestations : Coronary heart disease (CHD), Myocardial infarction, StrokeSymptoms from peripheral arterial disease (PAD).
Progressing vascular dementia :Impaired cognitive function, DepressionDisturbed central regulation of physiological processes, eg, blood pressure regulation.
Features of early vascular ageing (EVA)
Nilsson PM1.Early vascular aging (EVA): consequences and prevention. Vasc Health Risk Manag. 2008;4(3):547-52.
Increased arterial stiffness and pulse wave velocity
Impaired endothelial function and vasodilatation
Chronic vascular inflammation
Intima media thickness and early atherosclerosis
Hemorheological disturbances of blood flow
Capillary rarefaction and dysfunctional regulation
Shorter telomere length/lower telomerase activity
Impaired glucose and lipid metabolis
Insulin resistance
Oxidative stress
Arterial calcification
Increased deposition of matrix substances
Small vessel degeneration in brain and kidney
Increased left ventricular heart (LVH) load with hypertrophy
Structural changes in arterial wall
Nilsson PM1. Hemodynamic Aging as the Consequence of Structural Changes Associated with Early Vascular Aging (EVA) Aging Dis. 2014 Apr; 5(2): 109–113.
Increased stiffening caused by:
A decrease in the elastin content of the arterial media
Dominance of collagen content
Increased non-enzymatic cross-linkages between collagen structures.
Arterial stiffness – hemodynamic effects
Nilsson PM1. Hemodynamic Aging as the Consequence of Structural Changes Associated with Early Vascular Aging (EVA) Aging Dis. 2014 Apr; 5(2): 109–113.
Changes in brachial BP
Isolated systolic hypertension (ISH)
Elevated pulse pressure (PP)
Changes in central BP
Increased central systolic BP and PP
Increased BP variability
Decreased heart rate variability
Impaired endothelial function - Less vasodilation
Impaired baroreceptor function, orthostatic hypotension
Arterial stiffness – a nexus between cardiac and renal disease
.Huveneers S1, Daemen MJ2, Hordijk PL2 Between Rho(k) and a Hard Place: The Relation Between Vessel Wall Stiffness,
Endothelial Contractility, and Cardiovascular Disease Circ Res. 2015 Feb 27;116(5):895-908.Jia G1, Aroor AR1, Sowers JR2Arterial Stiffness: A Nexus between Cardiac and Renal Disease. Cardiorenal Med.
2014 Apr;4(1):60-71.
A key driver of (chronic) human disorders
Pulmonary arterial hypertension,
Kidney disease, and
Atherosclerosis.
Low serum 25-hydroxyvitamin D levels is associated with both arterial and ventricular stiffness
Seker T1, Gür M2, Kuloğlu O2, Serum 25-hydroxyvitamin D is associated with both arterial and ventricular stiffness in healthy subjects. J Cardiol. 2013 Dec;62(6):361-5.
Vitamin D and arterial stiffness:
Regulates the renin–angiotensin system
Suppresses proliferation of vascular smooth muscle
Improves endothelial cell dependent vasodilatation.
These mechanisms may play a role in pathogenesis of arterial and left ventricular stiffness.
Low serum 25-hydroxyvitamin D levels is associated with both arterial and ventricular stiffness
Şeker T1, Gür M2, Kuloğlu O2, Serum 25-hydroxyvitamin D is associated with both arterial and ventricular stiffness in healthy subjects. J Cardiol. 2013 Dec;62(6):361-5.
Vitamin D deficient group have
Higher
Pulse wave velocity (PWV)Serum calcium Left ventricular filling index Systolic blood pressure values
Lower
Mitral peak early/peak late flow velocities valuescompared with patients with vitamin D sufficient group
Vitamin D status and vascular effects
LVID, left ventricular inner dimension; LAD, left atrium dimension; LVMI, left ventricular mass index; PWV, pulse wave velocity.
Low serum 25-hydroxyvitamin D levels is associated with both arterial and ventricular stiffness
Şeker T1, Gür M2, Kuloğlu O2, Serum 25-hydroxyvitamin D is associated with both arterial and ventricular stiffness in healthy subjects. J Cardiol. 2013 Dec;62(6):361-5.
Conclusions
Low 25-hydroxyvitamin D levels are associated with increased ventricular and arterial stiffness as well as systolic blood pressure in healthy subjects.
Arterial stiffness plays a role in pathogenesis of hypertension.
Ventricular stiffness plays a role in pathogenesis of heart failure.
Therefore, vitamin D may play a role in pathogenesis of both hypertension and heart failure.
Vitamin D insufficiency associated with increased endothelial dysfunction irrespective of traditional risk burden.
Al Mheid I1, Patel R, Murrow J, Vitamin D status is associated with arterial stiffness and vascular dysfunction in healthy humans. J Am Coll Cardiol. 2011 Jul 5;58(2):186-92.
25-OH D levels independently associated with:
Flow-mediated vasodilation (β = 0.1, p = 0.03),
Reactive hyperemia index (β = 0.23, p < 0.001),
Pulse wave velocity (β = -0.09, p = 0.04),
Augmentation index (β = -0.11, p = 0.03),
Subendocardial viability ratio (β = 0.18, p = 0.001).
Vitamin D insufficiency associated with increased endothelial dysfunction irrespective of traditional risk burden.
Al Mheid I1, Patel R, Murrow J, Vitamin D status is associated with arterial stiffness and vascular dysfunction in healthy humans. J Am Coll Cardiol. 2011 Jul 5;58(2):186-92.
Normalization of 25-OH D at 6 months was associated with :
Increase in reactive hyperemia index (0.38 ± 0.14, p = 0.009)
Subendocardial viability ratio (7.7 ± 3.1, p = 0.04),
Decrease in mean arterial pressure (4.6 ± 2.3 mm Hg, p = 0.02).
Vitamin D insufficiency associated with increased endothelial dysfunction irrespective of traditional risk burden.
Al Mheid I1, Patel R, Murrow J, Vitamin D status is associated with arterial stiffness and vascular dysfunction in healthy humans. J Am Coll Cardiol. 2011 Jul 5;58(2):186-92.
Conclusions
Vitamin D insufficiency associated with :
Increased arterial stiffness and endothelial dysfunction in the conductance and resistance blood vessels in humans, irrespective of traditional risk factor burden.
Normalization of vitamin D status in insufficient individuals is associated with improvements in several parameters of vascular function
Arterial stiffness, Vitamin D, CVD and CKD
Andrade J1, Er L, Ignaszewski A, Levin AExploration of association of 1,25-(OH)2D3 with augmentation index, a composite measure of arterial stiffness. Clin J Am Soc Nephrol. 2008 Nov;3(6):1800-6.
Abnormalities in mineral metabolism [calcium, phosphate, and immunoreactive parathyroid hormone (PTH)] and vitamin D have been linked to increase in central arterial stiffness.
There is a significant association between augmentation index - AIx (a composite measure of central arterial stiffness) and 1,25-(OH)2D3 in a diverse group of individuals with CVD, CKD, or both.
Vitamin D, Arterial stiffness and Diabetes
.Kuloğlu O1, Gür M, Şeker T Serum 25-hydroxyvitamin D level is associated with aortic distensibility and left
ventricle hypertrophy in newly diagnosed type 2 diabetes mellitus. Diab Vasc Dis Res. 2013 Nov;10(6):546-9. ,
Type 2 diabetes mellitus (DM) is an established major independent risk factor for cardiovascular disease.
Serum 25-hydroxyvitamin D (vitamin D) is a prevalent condition in patients with type 2
Macrovascular complications of DM are associated with stiffening of the aorta, which is a major contributing factor to the target organ damage
Short Term Vitamin D Supplementation on the Inflammatory and Oxidative Mediators of Arterial Stiffness
Authors conclude :
Vitamin D has been postulated to mediate its cardiovascular effect by modulating the mediators of inflammation and oxidative stress
Cardiovascular benefit of vitamin D :
•May require near maximum serum 25(OH)D levels of vitamin D sufficiency •May be more apparent in a subset of the population with an excess burden of oxidative stress
Martins D1, Meng YX2, Tareen N1The Effect of Short Term Vitamin D Supplementation on the Inflammatory and Oxidative Mediators of Arterial Stiffness. Health (Irvine Calif). 2014 Jun;6(12):1503-1511
Vitamin D, Arterial stiffness and Diabetes
Patients with vitamin D deficiency group have :
Higher Left ventricle mass index (LVMI )and
Lower aortic distensibility (AD ) values
Compared with patients with vitamin D sufficient group
Kuloğlu O1, Gür M, Şeker T Serum 25-hydroxyvitamin D level is associated with aortic distensibility and left ventricle hypertrophy in newly diagnosed type 2 diabetes mellitus. Diab Vasc Dis Res. 2013 Nov;10(6):546-9.
Short Term Vitamin D Supplementation on the Inflammatory and Oxidative Mediators of Arterial Stiffness
Monthly dose of 100,000IU of vitamin D3 for three months
Significant increase in the serum 25(OH)D levels to a mean level of 34.5 ng/ml (SD = 7.1) (p < 0.001).
The increase in 25(OH)D levels was associated with
a significant decrease in the serum level of intact PTH (p = 0.02),
mean urinary isoprostane (p = 0.02) and
adipocyte cytokine expression.
significant decrease in the augmentation index among the participants with the highest tertile of urinary isoprostane (p = 0.007).
Martins D1, Meng YX2, Tareen N1The Effect of Short Term Vitamin D Supplementation on the Inflammatory and Oxidative Mediators of Arterial Stiffness. Health (Irvine Calif). 2014 Jun;6(12):1503-1511
Short Term Vitamin D Supplementation on the Inflammatory and Oxidative Mediators of Arterial Stiffness
Authors conclude :
Vitamin D has been postulated to mediate its cardiovascular effect by modulating the mediators of inflammation and oxidative stress
Cardiovascular benefit of vitamin D :
May require near maximum serum 25(OH)D levels of vitamin D sufficiency May be more apparent in a subset of the population with an excess burden of oxidative stress
Martins D1, Meng YX2, Tareen N1The Effect of Short Term Vitamin D Supplementation on the Inflammatory and Oxidative Mediators of Arterial Stiffness. Health (Irvine Calif). 2014 Jun;6(12):1503-1511
Summary
Arterial stiffness is a feature of early vascular aging
Low vitamin D levels are associated with both arterial and ventricular stiffness
Vitamin D plays a major role in pathogenesis of heart failure and hypertension
Supplementation of Vitamin D modulates cardiovascular inflammatory mediators and oxidative stress.
top related