Oral magnesium supplementation improves endothelial function and attenuates subclinical atherosclerosis in thiazide-treated hypertensive women

Background: Epidemiological studies demonstrate an inverse association between serum magnesium and incidence of cardiovascular disease. Diuretics commonly cause hypomagneseamia. Method: We evaluated effects of magnesium supplementation on blood pressure (BP) and vascular function in thiazide-treated hypertensive women in a randomized, double-blind, clinical trial. Hypertensive women (40–65 years) on hydrochlorothiazide and mean 24-h BP at least 130/80 mmHg were divided into placebo and supplementation (magnesium chelate 600 mg/day) groups. Patients were evaluated for nutritional and biochemical parameters, office and ambulatory blood pressure monitoring, brachial flow-mediated dilatation (FMD), peripheral arterial tonometry, assessment of carotid intima–media thickness, central hemodynamic parameters and pulse wave velocity at inclusion and after 6-month follow-up. Results: The magnesium group had a significant reduction in SBP (144 ± 17 vs. 134 ± 14 mmHg, P = 0.036) and DBP (88 ± 9 vs. 81 ± 8 mmHg, P = 0.005) at 6 months, without effect on plasma glucose, lipids, or arterial stiffness parameters. The placebo group showed a significant increase in carotid intima-media thickness (0.78 ± 0.13 vs. 0.89 ± 0.14 mm, P = 0.033) without change in the magnesium group (0.79 ± 0.16 vs. 0.79 ± 0.19 mm, P = 0.716) after 6 months. The magnesium group demonstrated a significant increase in variation of FMD vs. the placebo group (+3.7 ± 2.1 vs. 2.4 ± 1.2%, P = 0.015). There was a significant correlation between the intracellular magnesium variation and FMD (r = 0.44, P = 0.011). Conclusion: Magnesium supplementation was associated with better BP control, improved endothelial function and amelioration of subclinical atherosclerosis in these thiazide-treated hypertensive women

Sprint interval and sprint continuous training increases circulating CD34+ cells and cardio-respiratory fitness in young healthy women

The improvement of vascular health in the exercising limb can be attained by sprint interval training (SIT). However, the effects on systemic vascular function and on circulating angiogenic cells (CACs) which may contribute to endothelial repair have not been investigated. Additionally, a comparison between SIT and sprint continuous training (SCT) which is less time committing has not been made

Progression of endothelial dysfunction, atherosclerosis, and arterial stiffness in stable kidney transplant patients: a pilot study.

BACKGROUND: Kidney transplant patients suffer from vascular abnormalities and high cardiovascular event rates, despite initial improvements post-transplantation. The nature of the progression of vascular abnormalities in the longer term is unknown. This pilot study investigated changes in vascular abnormalities over time in stable kidney transplant patients long after transplantation. METHODS: Brachial artery flow-mediated dilation (FMD), nitroglycerin-mediated dilation, carotid-femoral pulse wave velocity (cf-PWV), ankle-brachial pressure index, and common carotid artery intima-media thickness (CCA-IMT) were assessed in 18 kidney transplant patients and 17 controls at baseline and 3-6 months after. RESULTS: There was no difference in age (51 ± 13 vs. 46 ± 11; P = 0.19), body mass index (26 ± 5 vs. 25 ± 3; P = 0.49), serum cholesterol (4.54 ± 0.96 vs. 5.14 ± 1.13; P = 0.10), systolic blood pressure (BP) (132 ± 12 vs. 126 ± 12; P = 0.13), diastolic BP (82 ± 9 vs. 77 ± 8; P = 0.10), or diabetes status (3 vs. 0; P = 0.08) between transplant patients and controls. No difference existed in vascular markers between patients and controls at baseline. In transplant patients, FMD decreased (- 1.52 ± 2.74; P = 0.03), cf-PWV increased (0.62 ± 1.06; P = 0.03), and CCA-IMT increased (0.35 ± 0.53; P = 0.02). No changes were observed in controls. CONCLUSION: Markers of vascular structure and function worsen in the post-transplant period on long-term follow-up, which may explain the continued high cardiovascular event rates in this population

Estimation of Arterial Viscosity Based on an Oscillometric Method and Its Application in Evaluating the Vascular Endothelial Function

This paper proposes an algorithm for estimating the arterial viscosity using cuff pressures and pulse waves measured by an automatic oscillometric sphygmomanometer. A change in the arterial viscosity during the enclosed-zone flow-mediated dilation test is calculated as an index for evaluating the vascular endothelial function %η. In all, 43 individuals participated in this study. After the index %η was calculated, the accuracy of the index %η in distinguishing healthy subjects and subjects at a high risk of arteriosclerosis was tested via a receiving operating characteristic (ROC) analysis. The calculated %η for the healthy participants and those at a high risk of arteriosclerosis was 13.4 ± 55.1% and −32.7 ± 34.0% (mean ± S.D.), respectively. The area under the ROC curve was 0.77. Thus, it was concluded that the proposed method can be used to evaluate the vascular endothelial function.This research was partly supported by the Transportation Technology Development Promotion Competitive Funding Program from Ministry of Land, Infrastructure, Transport and Tourism, and the Center of Innovation Program from Japan Science and Technology Agency

Endothelial function assessment in atherosclerosis: Comparison of brachial artery flow‑mediated vasodilation and peripheral arterial tonometry

INTRODUCTION Endothelial dysfunction, characterized by the loss of nitric oxide bioavailability, is a key element in the pathogenesis of atherosclerosis and an important prognostic factor in cardiovascular diseases. Therefore, the development of reliable, safe, and noninvasive methods of endothelial function assessment is important for their use in cardiovascular risk stratification. Brachial artery flow‑mediated dilation (FMD) is widely used in research but technical difficulties and problems with calibration between laboratories limit its clinical use. Reactive hyperemia–peripheral artery tonometry (RH‑PAT, EndoPAT) has been developed as a simpler, cheaper, and potentially more reproducible method. OBJECTIVES We aimed to investigate associations between RH‑PAT and FMD in relation to atherosclerotic risk factor profile. PATIENTS AND METHODS The study involved 80 subjects (52 men, 28 women) aged 43.6 ±14.8 years, with moderate‑to‑low cardiovascular risk (mean SCORE, 2.2% ±2%), in whom FMD, RH‑PAT, and intima–media thickness (IMT) were determined. RESULTS The reactive hyperemia index (RHI) measured by RH‑PAT correlated with FMD (r = 0.35, P <0.01). However, no significant correlation was observed between RHI and IMT, SCORE, or the number of classical atherosclerotic risk factors (hypertension, smoking, diabetes, hypercholesterolemia), while FMD was significantly correlated with IMT (r = –0.53, P <0.001), risk factors (r = –0.55, P <0.05), and SCORE (r = –0.4, P <0.05). CONCLUSIONS Despite its technical requirements, FMD is a more sensitive method than RH‑PAT in evaluating the effect of classical atherosclerotic risk factors on vascular endothelial function. Microvasculature response during RH‑PAT needs to be further studied, including the assessment of nonendothelial factors that may affect the measurements, before RH‑PAT becomes the universal tool for the evaluation of the endothelial cells

Relationship of arterial tonometry and exercise in patients with chronic heart failure: a systematic review with meta-analysis and trial sequential analysis

Background: Arterial stiffness is a common characteristic in patients with chronic heart failure (CHF), and arterial tonometric technologies related to arterial stiffness are novel and effective methods and have an important value in the diagnosis and prognosis of CHF. In terms of ameliorating arterial stiffness in patients with CHF, exercise training is considered an adjuvant treatment and also an effective means in the diagnosis and judgment of prognosis. However, there are huge controversies and inconsistencies in these aspects. The objective of this meta-analysis was to systematically test the connection of arterial tonometry and exercise in patients with CHF. Methods: Databases, including MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, were accessed from inception to 7 March 2022. The meta-analysis was then conducted, and trial sequential analysis (TSA) was performed jointly to further verify our tests and reach more convincing conclusions by using RevMan version 5.4 software, STATA version 16.0 software, and TSA version 0.9.5.10 Beta software. Results: Eighteen articles were included, with a total of 876 participants satisfying the inclusion criteria. The pooling revealed that flow-mediated dilation (FMD) was lower in basal condition [standardized mean difference (SMD): - 2.28%, 95% confidence interval (CI) - 3.47 to - 1.08, P < 0.001] and improved significantly after exercise (SMD: 5.96%, 95% CI 2.81 to 9.05, P < 0.001) in patients with heart failure with reduced ejection fraction (HFrEF) compared with healthy participants. The high-intensity training exercise was more beneficial (SMD: 2.88%, 95% CI 1.78 to 3.97, P < 0.001) than the moderate-intensity training exercise to improve FMD in patients with CHF. For augmentation index (AIx), our study indicated no significant differences (SMD: 0.50%, 95% CI - 0.05 to 1.05, P = 0.074) in patients with heart failure with preserved ejection fraction (HFpEF) compared with healthy participants. However, other outcomes of our study were not identified after further verification using TSA, and more high-quality studies are needed to reach definitive conclusions in the future. Conclusions: This review shows that FMD is lower in basal condition and improves significantly after exercise in patients with HFrEF compared with healthy population; high-intensity training exercise is more beneficial than moderate-intensity training exercise to improve FMD in patients with CHF; besides, there are no significant differences in AIx in patients with HFpEF compared with the healthy population. More high-quality studies on this topic are warranted

Effectiveness of cognitive and physical training in slowing progression to dementia: a clinical and experimental study. Focus on relationship with cardiovascular fitness

Physical activity is beneficial to vascular health; on the other hand, vascular damage is associated with cognitive impairment. Both physical activity and a cognitively stimulating environment are known to delay the onset of dementia. The Train The Brain study evaluated the effectiveness of a comprehensive program of physical training and mental activity in delaying cognitive decline in elderly people with initial cognitive impairment, at the same time investigating the relationship between physical, vascular, neurological, and cognitive fitness. Elders age 65-89 with were recruited with the help of family physicians and territorial services. All participants underwent a neurological and cardiologic evaluation. Carotid-femoral pulse wave velocity and carotid pressure were measured with the SphygmoCor system (AtCor, Australia). Longitudinal ultrasound scans of the common carotid were performed and 10-second video clips were recorded to be analysed offline through the Cardiovascular Suite software (Quipu srl, Italy), with the computation of diameter, intima-media thickness, wall cross-sectional area, distensibility coefficient, and elastic modulus. The latter software was used also to measure endothelial function through flow mediated dilation (FMD) of the brachial artery. Subjects classified as mild cognitive impairment at the neurological examination were randomized either to standard care, or a 7-month program of physical training and environmental stimulation (lectures, games, music, social activities) three hours a week. The evaluation was then repeated. Data were obtained for 54 patients who underwent training and 36 controls. The intervention was successful in improving cognitive function as measured through the ADAS-Cog score: 11.95 (3.86) to 13.00 (4.73) for no training, 14.32 (4.27) to 12.85 (4.03) for training, time x treatment p<0.001. Pulse wave velocity showed no significant effect (p=0.5). FMD improved with intervention (no training: 3.20 (2.03) to 2.50 (1.77) %; training: from 2.82 (2.19) to 3.42 (1.82); p=0.014). All selected carotid parameters were influenced by the combination of time and treatment, in a diverging trend, at a statistically significant level, with intervention determining less dilated, less thick and less stiff vessels. None of the parameters measured analysing the vessels showed a correlation The proposed 7-months program improved cognitive function in elders with initial cognitive impairment. There was a significant difference in behaviour in time of the two groups as for endothelial function and carotid enlargement, wall thickening and arterial stiffening. The intervention seems to oppose the typical harmful effects of aging on vessels; at the same time, the positive effects on cognition and vascular health do not appear as directly correlated

Effectiveness of cognitive and physical training in slowing progression to dementia: a clinical and experimental study. Focus on relationship with cardiovascular fitness

Physical activity is beneficial to vascular health; on the other hand, vascular damage is associated with cognitive impairment. Both physical activity and a cognitively stimulating environment are known to delay the onset of dementia. The Train The Brain study evaluated the effectiveness of a comprehensive program of physical training and mental activity in delaying cognitive decline in elderly people with initial cognitive impairment, at the same time investigating the relationship between physical, vascular, neurological, and cognitive fitness. Elders age 65-89 with were recruited with the help of family physicians and territorial services. All participants underwent a neurological and cardiologic evaluation. Carotid-femoral pulse wave velocity and carotid pressure were measured with the SphygmoCor system (AtCor, Australia). Longitudinal ultrasound scans of the common carotid were performed and 10-second video clips were recorded to be analysed offline through the Cardiovascular Suite software (Quipu srl, Italy), with the computation of diameter, intima-media thickness, wall cross-sectional area, distensibility coefficient, and elastic modulus. The latter software was used also to measure endothelial function through flow mediated dilation (FMD) of the brachial artery. Subjects classified as mild cognitive impairment at the neurological examination were randomized either to standard care, or a 7-month program of physical training and environmental stimulation (lectures, games, music, social activities) three hours a week. The evaluation was then repeated. Data were obtained for 54 patients who underwent training and 36 controls. The intervention was successful in improving cognitive function as measured through the ADAS-Cog score: 11.95 (3.86) to 13.00 (4.73) for no training, 14.32 (4.27) to 12.85 (4.03) for training, time x treatment p<0.001. Pulse wave velocity showed no significant effect (p=0.5). FMD improved with intervention (no training: 3.20 (2.03) to 2.50 (1.77) %; training: from 2.82 (2.19) to 3.42 (1.82); p=0.014). All selected carotid parameters were influenced by the combination of time and treatment, in a diverging trend, at a statistically significant level, with intervention determining less dilated, less thick and less stiff vessels. None of the parameters measured analysing the vessels showed a correlation The proposed 7-months program improved cognitive function in elders with initial cognitive impairment. There was a significant difference in behaviour in time of the two groups as for endothelial function and carotid enlargement, wall thickening and arterial stiffening. The intervention seems to oppose the typical harmful effects of aging on vessels; at the same time, the positive effects on cognition and vascular health do not appear as directly correlated

Acute mitochondrial antioxidant intake improves endothelial function, antioxidant enzyme activity, and exercise tolerance in patients with peripheral artery disease

Peripheral artery disease (PAD) is a manifestation of atherosclerosis in the leg arteries, which causes claudication. This may be in part due to vascular mitochondrial dysfunction and excessive reactive oxygen species (ROS) production. A mitochondrial-targeted antioxidant (MitoQ) has been shown to improve vascular mitochondrial function that, in turn, led to improved vascular function in older adults and animal models. However, the roles of vascular mitochondria in vascular function including endothelial function and arterial stiffness in patients with PAD are unknown; therefore, with the use of acute MitoQ intake, this study examined the roles of vascular mitochondria in endothelial function, arterial stiffness, exercise tolerance, and skeletal muscle function in patients with PAD. Eleven patients with PAD received either MitoQ or placebo in a randomized crossover design. At each visit, blood samples, brachial and popliteal artery flow-mediated dilation (FMD), peripheral and central pulse-wave velocity (PWV), blood pressure (BP), maximal walking capacity, time to claudication (COT), and oxygen utility capacity were measured pre- and-post-MitoQ and placebo. There were significant group by time interactions (P \u3c 0.05) for brachial and popliteal FMD that both increased by Δ2.6 and Δ3.3%, respectively, and increases superoxide dismutase (Δ0.03 U/mL), maximal walking time (Δ73.8 s), maximal walking distance (Δ49.3 m), and COT (Δ44.2 s). There were no changes in resting heart rate, BP, malondialdehyde, total antioxidant capacity, PWV, or oxygen utility capacity (P \u3e 0.05). MitoQ intake may be an effective strategy for targeting the vascular mitochondrial environment, which may be useful for restoring endothelial function, leg pain, and walking time in patients with PAD

Reproducibility and physiological factors pertinent to the study of the acute effects of exercise on traditional and alternative measures of vascular and autonomic function in young and older adults

Measuring age-related endothelial dysfunction may provide a prognostic marker of cardiovascular diseases beyond traditional cardiovascular risk factors. Flow-mediated slowing (FMS) may address flow-mediated dilation (FMD) major caveats including larger measurement and biological variability, still, applanation tonometry FMS reproducibility is unknown. The acute model permits investigating the mechanisms underlying aerobic exercise anti-atherogenic and sympatholytic effects which preserve neurovascular homeostasis through aging. Thus, this dissertation aimed to investigate the reproducibility and physiological factors relevant to the study of exercise acute effects on traditional and alternative measures of vascular and autonomic function in young and older adults. Reproducibility assessments of applanation tonometry FMS and FMD were conducted on twenty-four males (aged 23-75 years) healthy and active male adults. Participants also performed walking or running randomized acute bouts of high-intensity interval training (HIIT), moderate-intensity continuous training, or a non-exercise condition. FMS was not a reproducible method with poorer reproducibility (CV: 141%) than FMD (CV: 23%). We found no age-associated response patterns on FMD, and heart-rate variability indexes to exercise in active young and older adults. FMD remained unchanged following exercise, whilst only HIIT reduced cardiovagal modulation, likely representing the initial trigger for vagal adaptations, returning to baseline 60-min into recovery.A disfunção endotelial inerente ao envelhecimento pode ser preditiva de doenças cardiovasculares independentemente dos factores de risco tradicionais, assim a sua avaliação é crucial. A desaceleração fluxo-mediada (DFM) pretende colmatar as lacunas da vasodilatação fluxo-mediada (VFM): a elevada variabilidade biológica e de medição. Contudo, a reprodutibilidade da DFM medida por tonometria de aplanação é desconhecida. O modelo agudo possibilita investigar os mecanismos subjacentes aos efeitos ateroscleróticos e simpatolíticos do exercício aeróbio preservando a homeostasia neurovascular durante o envelhecimento. O objetivo desta dissertação consistiu em examinar a reprodutibilidade e os factores relevantes para o estudo dos efeitos agudos do exercício em medidas tradicionais e alternativas de função endotelial e autonómica em homens jovens e idosos. A reprodutibilidade da DFM e da VFM foi avaliada em 24 homens (23-75 anos), saudáveis e fisicamente ativos. Adicionalmente, duas sessões de treino aeróbio (contínuo vs intervalado) e uma de controlo foram ainda realizadas aleatoriamente. A DFM apresentou uma reprodutibilidade inferior (CV: 141%) à da VDM (CV: 23%). As respostas ao exercício da VFM e da variabilidade da frequência cardíaca não diferiram entre jovens e idosos. A VFM permaneceu inalterada no pós-exercício, já a modulação cardiovagal diminui apenas no pós-treino intervalado de alta intensidade retornando a níveis basais após 60-min de recuperação