Microvascular function is impaired in ankylosing spondylitis and improves after tumour necrosis factor a blockade

Objectives: Ankylosing spondylitis (AS) is associated with increased cardiovascular morbidity and mortality. Microvascular function has been linked to several risk factors for cardiovascular disease. Inflammation in AS may cause microvascular dysfunction. To test this, we assessed microvascular function in (a) patients with AS compared to healthy controls and (b) patients with AS before and after 1 month of anti-tumour necrosis factor (TNF)alpha treatment with etanercept. Methods: A total of 15 consecutive patients with AS, who were scheduled for etanercept treatment according to the Assessment in Ankylosing Spondylitis (ASAS) group guidelines, and 12 healthy controls matched for age and sex, were recruited. Endothelium-dependent and independent vasodilatation in skin were evaluated with laser Doppler fluxmetry after iontophoresis of acetylcholine and sodium nitroprusside, respectively. Videomicroscopy was used to measure recruitment of skin capillaries after arterial occlusion. Results: Compared to healthy controls, patients with AS had impaired endothelium-dependent vasodilatation and capillary recruitment. Following anti-TNF alpha treatment, microvascular function improved significantly for endothelium-dependent vasodilatation (p = 0.03) and capillary recruitment (p = 0.006). A significant correlation was observed between changes in endothelium-dependent vasodilatation and changes in erythrocyte sedimentation rate (ESR) (r = -0.56; p = 0.03). Conclusion: Microvascular dysfunction is present in patients with AS with active disease, but improves as inflammation regresses after TNF alpha blockad

Het fenomeen van Raynaud: diagnostiek en behandeling

Primary Raynaud's phenomenon (RP) is a relatively common disorder. Most patients with primary RP have only mild symptoms and do not develop complications. Distinguishing primary from secondary RP is important with respect to complications, and for prognosis and treatment. Secondary RP mainly manifests as part of systemic connective tissue disease. About 13% of patients diagnosed initially as having primary RP develop a systemic disorder within the following few years. Both auto-immune serology including antinuclear antibodies (ANA), and capillaroscopy are important diagnostic tools if one suspects the existence or development of a systemic disorder. Calcium antagonists are the cornerstone of RP pharmacotherap

Postprandial microvascular function deteriorates in parallel with gradual worsening of insulin sensitivity and glucose tolerance in men with the metabolic syndrome or type 2 diabetes

Aims/hypothesis: Hyperinsulinaemia-induced whole-body glucose uptake during a euglycaemic-hyperinsulinaemic clamp is partly mediated by increased capillary density. We hypothesised that physiological insulinaemia in response to a mixed meal may also enhance microvascular function, and that this may be impaired in insulin-resistant individuals and patients with type 2 diabetes. Methods: Twelve men with uncomplicated type 2 diabetes, 13 with metabolic syndrome and 12 age-matched healthy normoglycaemic controls, mean age 57 ± 6 years, underwent skin capillary video microscopy before and 60 and 120 min following a standardised mixed meal to measure baseline capillary density (BCD) and capillary density during post-occlusive peak reactive hyperaemia (PRH), also termed capillary recruitment. Oral glucose insulin sensitivity (Matsuda index) and postprandial hyperglycaemia (2 h AU

The relationship between 30- year developmental patterns of body fat and body fat distributioon and its vascular properties: the Amsterdam Growth and health Longitudinal Study

INTRODUCTION: Although body fat and body fat distribution are known to be related to cardiovascular diseases (CVDs), it is unknown whether specific 30-year developmental patterns of body fat are associated with CVDs. This study examines the existence of distinct developmental patterns of total fat measured by the sum of four skinfolds (S4SFs) and body fat distribution measured by the skinfold thickness ratio (SFratio), and relates these patterns to micro- and macrovascular functions. METHODS: In 2006, 259 apparently healthy subjects were examined on micro- and macrovascular functions, using video microscopy and carotid ultrasound sonography. Body fat, using both S4SFs and SFratio, was measured for 10 times over 30 years, from 13 years onwards. Latent class growth analyses (LCGA) were used to obtain distinct developmental patterns of S4SFs and SFratio. This is a data-drive hypothesis-generating approach and could possibly give a new perspective on body fatness over time. In addition, a mixed-method approach is used to obtain individual growth parameters. Linear regression analyses were used to examine the relationship of these patterns and individual growth parameters with micro- and macrovascular functions. RESULTS: LCGA identified normal and unfavourable developmental patterns in S4SFs and SFratio. Both men and women with an unfavourable developmental pattern of S4SFs showed impaired carotid compliance (β= -0.216, P=0.004 and β= -0.109, P=0.039, respectively), carotid distensibility (β= -5.078, P=0.001 and β= -5.118, P<0.001, respectively) and Young's elastic modulus (β=0.066, P=0.065 and β=0.107, P<0.001, respectively). In contrast, no relationship for microvascular function with developmental patterns of S4SFs was found. Developmental patterns of the SFratio were associated with neither measures of micro- nor macrovascular functions. No associations were using the individual growth parameters. CONCLUSIONS: For macrovascular function, there is a relationship of 30-year developmental patterns of S4SFs, whereas no such relationship was found for the 30-year developmental patterns of S4SFs or SFratio with microvascular function. © 2013 Macmillan Publishers Limited All rights reserved

Microvascular dysfunction: causative role in the association between hypertension, insulin resistance and the metabolic syndrome?

The metabolic syndrome defines a clustering of metabolic risk factors that confers an increased risk for type 2 diabetes and cardiovascular disease. The metabolic syndrome seems to have multiple etiological factors and microvascular dysfunction may be one potential factor explaining the clustering of multiple metabolic risk factors including hypertension, obesity, insulin resistance and glucose intolerance. Microvascular dysfunction may increase not only peripheral vascular resistance and blood pressure, but may also decrease insulin-mediated glucose uptake in muscle. The present article summarizes some of the data concerning the role of microvascular dysfunction in the metabolic syndrome

Sleep quality and duration are related to microvascular function: the Amsterdam Growth and Health Longitudinal Study

Sleep and sleep disorders are related to cardiovascular disease, and microvascular function is an early cardiovascular disease marker. Therefore, the relationship of sleep (measured in sleep quality and duration) with microvascular function was examined in healthy adults. Sleep quality was assessed with the validated Sleep Wake Experience List (SWEL) questionnaire. Duration of sleep was self-reported in an additional question. Microvascular function was measured using nailfold capillaroscopy. Linear regression analyses were used to examine the relationship between sleep and microvascular function. Potential confounders included physical activity, smoking, blood pressure, body mass index and several biochemical parameters. Analyses were performed in 259 participants (116 men). For women reporting insufficient (<7 h) sleep duration, microvascular function (post-ischaemic capillary recruitment) was significantly lower (b = -11.17; P = 0.04) compared to women reporting sufficient sleep duration. There was no relationship between sleep quality and microvascular function in females. In males, a trend towards lower capillary recruitment was found in those reporting a combination of poor sleep quality and insufficient duration (b = -7.54; P = 0.09), compared to those reporting good sleep quality as well as sufficient duration. This study suggests an association between sleep and microvascular function. Which aspects of sleep exactly affect microvascular function, and if indeed the association is different between males and females in other samples, needs further research. Copyrigh