Whole-body Electric Bioimpedance Measurement in the Evaluation of Vascular Function

Background: Two pathologies affecting the arterial wall, atherosclerosis and arterial stiffening, are strong predictors of cardiovascular diseases and mortality. The identification of these at the sub-clinical, asymptomatic stages is potentially useful for the prevention of cardiovascular risk. Arterial stiffness can be evaluated locally by measuring carotid artery elasticity or segmentally by measuring pulse wave velocity (PWV), and of these two methods, PWV is considered the gold standard for assessing arterial stiffness. Whole-body impedance cardiography (ICGWB) has previously been shown to be a fast and operator-independent method to measure PWV, but the lack of reference values has limited its use in clinical practice. Moreover, the applicability of the ICGWB method in measuring PWV in large-scale epidemiological studies has not been tested previously.Carotid artery intima-media thickness (IMT) and brachial artery flowmediated dilation (FMD) are well-known non-invasive markers of early atherosclerosis. Although the pathophysiology of atherosclerosis involves many features similar to arterial stiffness, whether IMT and FMD reflect similar or different aspects of vascular damage in comparison to PWV is not known. In addition, PWV and indices of carotid artery elasticity are often used interchangeably, but the relationship between these has received little interest to date.Aims: The objective of the present study was to establish reference values for PWV as measured by ICGWB and gain more insight into the association of PWV with the markers of sub-clinical atherosclerosis (IMT, FMD) and local arterial elasticity. In addition, the aim of the current study was to study the applicability of the ICGWB method for measuring PWV in an epidemiological study. Furthermore, the objective of the present study was to develop a new integrated cardiovascular parameter reflecting several aspects of the cardiovascular system – i.e. arterial stiffness, arterial wall structure and cardiac pump function.Subjects and Methods: The study population was combined from three distinct studies: 455 subjects from the Health 2000 Survey (supplemental study), 1872 subjects from the Cardiovascular Risk in Young Finns Study and 87 subjects from the Tampere Ambulatory Blood Pressure Study. Pulse wave velocity, stroke volume and systemic vascular resistance were measured from all subjects using the commercially available ICGWB monitor (CircMon™). Indices of carotid artery elasticity and carotid artery IMT were measured by ultrasound in the Health 2000 Survey (supplemental study) and the Cardiovascular Risk in Young Finns Study. Moreover, brachial FMD was measured by ultrasound in the Cardiovascular Risk in Young Finns Study.Results: In subjects aged 46–76 years, IMT was directly and independently associated with PWV, but in younger subjects, IMT and PWV were not independently correlated. Carotid artery distensibility was inversely and independently associated with PWV, whereas FMD and PWV were not independently related. Metabolic syndrome and several other cardiovascular risk factors were found to associate with increased PWV, a finding which is in line with previous epidemiological studies using different methods to measure PWV. The present thesis introduces and evaluates a new ICGWB-based hemodynamic parameter known as arterial tension time (ATT), which is defined as the time difference between the stroke-volume-introduced arterial distension and maximal integrated arterial distension. Decreased ATT was associated with increased arterial stiffness, increased subclinical atherosclerosis and decreased stroke volume. The current study also reports reference values for PWV measured by ICGWB for males and females in different age groups with no evidence of cardiovascular disease and a low burden of risk factors.Conclusion: The present study has four main findings. Firstly, the current study establishes reference values for ICGWB-based PWV in an adult Finnish population. Reference values can be useful in the clinical management of patients in future studies. Secondly, PWV was not found to associate with IMT or FMD in young adults, but in older individuals, PWV and IMT were directly and independently correlated. Therefore, the current findings suggest that PWV may reflect a different aspect of vascular damage than FMD or IMT in young adults, whereas in older adults, the information provided by PWV and IMT may be, to some extent, similar. The present findings encourage the use of a combination of complementary non-invasive methods to evaluate arterial wall alterations, particularly in young adults. Thirdly, ICGWB provides a convenient and reliable tool for evaluating arterial stiffness in epidemiological studies. Fourthly, ATT developed in this study could potentially include information on several aspects of cardiovascular structure and function, and possibly serve as a new integrated parameter of cardiovascular health

Early Warning Software for Emergency Department Crowding

Emergency department (ED) crowding is a well-recognized threat to patient safety and it has been repeatedly associated with increased mortality. Accurate forecasts of future service demand could lead to better resource management and has the potential to improve treatment outcomes. This logic has motivated an increasing number of research articles but there has been little to no effort to move these findings from theory to practice. In this article, we present first results of a prospective crowding early warning software, that was integrated to hospital databases to create real-time predictions every hour over the course of 5 months in a Nordic combined ED using Holt-Winters' seasonal methods. We showed that the software could predict next hour crowding with a nominal AUC of 0.98 and 24 hour crowding with an AUC of 0.79 using simple statistical models. Moreover, we suggest that afternoon crowding can be predicted at 1 p.m. with an AUC of 0.84.Comment: 15 pages, 6 figure

Emergency department crowding increases 10-day mortality for non-critical patients : a retrospective observational study

The current evidence suggests that higher levels of crowding in the Emergency Department (ED) have a negative impact on patient outcomes, including mortality. However, only limited data are available about the association between crowding and mortality, especially for patients discharged from the ED. The primary objective of this study was to establish the association between ED crowding and overall 10-day mortality for non-critical patients. The secondary objective was to perform a subgroup analysis of mortality risk separately for both admitted and discharged patients. An observational single-centre retrospective study was conducted in the Tampere University Hospital ED from January 2018 to February 2020. The ED Occupancy Ratio (EDOR) was used to describe the level of crowding and it was calculated both at patient’s arrival and at the maximum point during the stay in the ED. Age, gender, Emergency Medical Service transport, triage acuity, and shift were considered as confounding factors in the analyses. A total of 103,196 ED visits were included. The overall 10-day mortality rate was 1.0% (n = 1022). After controlling for confounding factors, the highest quartile of crowding was identified as an independent risk factor for 10-day mortality. The results were essentially similar whether using the EDOR at arrival (OR 1.31, 95% CI 1.07–1.61, p = 0.009) or the maximum EDOR (OR 1.27, 95% CI 1.04–1.56, p = 0.020). A more precise, mortality-associated threshold of crowding was identified at EDOR 0.9. The subgroup analysis did not yield any statistically significant findings. The risk for 10-day mortality increased among non-critical ED patients treated during the highest EDOR quartile.Peer reviewe

The outcome of “non-urgent'' patients diverted by triage at an emergency department

No universal definitions have been proposed for non-urgent emergency department (ED) patients. Robust evidence on safety issues and the subsequent utilisation of health care services among diverted patients is insufficient. The aim of this study was to establish the revisit rate within 7 days, as well as the 30-day mortality and outcome of patients diverted by triage. An observational single-centre retrospective study was conducted at the Tampere University Hospital ED for the full calendar year of 2019. The primary outcomes were a revisit within 7 days and 30-day mortality. A total of 92,406 ED visits were registered. Of these patients, 7.8% (7216 visits) were diverted by triage. Among the diverted patients, the hospital revisit rate within 7 days was 10.1%, and a diagnostic or therapeutic intervention was performed on 81.4% of the readmitted patients. The all-cause 30-day mortality, hospitalisation and intensive care unit admission rates of diverted patients were 0.07%, 1.7% and 0.1%, respectively. Diverting non-urgent patients reduces ED visits. The current study showed a revisit rate of 10.1% and a 30-day mortality rate of 0.07% for diverted patients. There were more unanticipated adverse outcomes than reported previously, and the strategy may thus be suitable only for some groups of patients without increasing risks. Therefore, further investigation is needed to determine the factors associated with readmissions and adverse outcomes to enhance the performance of triage in the future.Peer reviewe

Systemic vascular resistance predicts the development of hypertension: the cardiovascular risk in young Finns study

Purpose: To study whether systemic hemodynamics, especially systemic vascular resistance, predicts the development of hypertension and improves the risk prediction of incident hypertension beyond common risk factors in the risk models in young adults. Materials and methods: Typical risk factors for hypertension in the risk prediction models (systolic and diastolic blood pressure, parental history of hypertension, age, sex, body-mass index, smoking), laboratory values (high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, glucose, insulin, C-reactive protein), heart rate (HR), stroke index (SI), and systemic vascular resistance index (SVRI) calculated by whole-body impedance cardiography were evaluated in 2007 and blood pressure in 2011 in 1293 Finnish adults (aged 30-45 years; females 56%;n = 1058 normotensive in 2007). Results: Of hemodynamic variables, SVRI and HR evaluated in 2007 were independently associated with systolic blood pressure (p Conclusions: These findings suggest that systemic vascular resistance index predicts the incidence of hypertension in young adults and that the evaluation of systemic hemodynamics could provide an additional tool for hypertension risk prediction.</div

Impedance plethysmography-based method in the assessment of subclinical atherosclerosis

Background and aimsThe aim of this study was to examine an association of individual and combined pulse waveform parameters derived from bioimpedance measurements, that is pulse waves from a distal impedance plethysmographic (IPG), a whole-body impedance cardiographic (ICG) and transformed distal impedance plethysmographic (tIPG) signals, with markers of subclinical atherosclerosis, i.e. carotid intima-media thickness (cIMT), brachial artery flow-mediated dilation (FMD) and carotid artery distensibility (Cdist). The level of the association was also compared for arterial pulse wave velocity (PWV) and cIMT, FMD, and Cdist.MethodsIPG, ICG, tIPG signals were measured from 1741 Finnish adults aged 30-45 years. The association between pulse wave parameters and cIMT, FMD and Cdist was studied using bootstrapped stepwise Akaike's Information Criterion method resulting in selection of parameters other than PWV, i.e. parameters having stronger association with cIMT, FMD and Cdist than PWV, in the model. Then risk scores were calculated from the selected pulse wave parameters and their association between cIMT, FMD and Cdist was studied with multivariable linear regression analysis.Results The risk score was found to be the third strongest predictor of subclinical atherosclerosis as indicated by cIMT measurement, the second strongest predictor of FMD and the strongest predictor of Cdist. These findings show that several individual pulse wave parameters were associated more strongly with cIMT, FMD, and Cdist than PWV when adjusted with clinical risk factors.ConclusionsImpedance based pulse waveform analysis provides a useful tool for assessing cardiovascular risk and estimating presence of structural changes in the vasculature.</div

Kotisivuprojekti Juho Ojala Tmi

Opinnäytetyön aiheena on kotisivuprojektin toteuttaminen Juho Ojala Tmi:lle. Juho Ojala Tmi on pieni monialainen yritys, joka koki tarpeekseen esiintyä myös internetissä, sillä nykypäivänä kotisivujen olemassaolo on lähes elinehto yritykselle. Kotisivujen tarkoituksena on tarjota tiivis, mutta informatiivinen kuvaus yrityksestä ja sen tarjoa- mista palveluista. Kotisivujen sisällön ja ulkoasun suunnittelijoina sekä tuottajina toimimme me, Teemu Koivistoinen ja Jarmo Hyyryläinen. Toimimme myös projektin projektipäällikköinä. Toimeksiantajan toiveesta kotisivuille hankittiin ulkopuolinen tekninen toteuttaja, Lap- peenrannan teknillisen yliopiston opiskelija, Tatu Huttunen. Tavoitteena oli viedä pro- jekti läpi sujuvasti, aikataulussa pysyen ja julkaista yrityksestä hyvän kuvan antavat kotisivut 8.4.2014 annettujen resurssien puitteissa toimien. Opinnäytetyö koostuu kotisivumarkkinoinnin teoriasta, projektisuunnitelmasta, projek- tin läpiviennistä ja pohdinnasta. Kotisivumarkkinoinnin teoriaa on käytetty hyväksi ko- tisivujen sisällön suunnitteluvaiheessa. Projektisuunnitelma on melko laaja, koska pro- jektin onnistumisen kannalta huolellinen suunnittelu oli tärkeää. Projektin läpiviennissä käydään läpi projektin käytännön toteutus vaihe vaiheelta ja lopuksi pohditaan millai- nen projektin lopputulos oli, missä onnistuttiin ja mitä oltaisiin voitu parantaa. Projektista erilaisen verrattuna keskivertoprojektiin teki budjetin pienuus ja tiukka aika- taulu. Myös projektipäälliköille tarjottu suuri vastuu ja toimeksiantajan luottamus loivat omat haasteensa projektille, mutta toisaalta tekivät siitä myös mielenkiintoisemman, sillä saimme melko vapaat kädet kotisivujen suunnittelun suhteen.The aim of this thesis was to carry out a project to design a website for Juho Ojala Company. Juho Ojala Company is a small multi-industry sole tradership which needed an online presence, because nowadays having a website is almost a necessity for any company. The main goal of the website is to provide a compact but informative descrip- tion of the company and the services it provides. The designers and the producers of the contents and the appearance of the website are the authors of this report: Teemu Koivistoinen and Jarmo Hyyryläinen. We acted as the project managers also. The client’s wish was to commission a student to take care of the technical implementation. We acquired a student from Lappeenranta University of Technology, Tatu Huttunen. Our goal was, by using the resources provided, to carry out the project smoothly, stay on schedule, and on the 8th of April 2014 to publish a website that gives a good impression of the company. The thesis consists of a presentation of website marketing theory, the project plan, a description of the project, and the conclusion. Planning of the website contents was based on the website marketing theory. The project plan is quite extensive because care- ful planning was important for the success of the project. The description of the project covers the practical implementation of the project, step by step. The conclusion contains a deliberation on how successful the outcome of the project was, what was done well and what could have been done better. The project was a little bit different from an average project because of the small budget and tight schedule. Also, the client gave a great amount of responsibility to us project managers and placed a great deal of trust in us, which were two factors that made the project more challenging, but at the same time made it more interesting for us since we were given rather free hands to plan and design the website independently

Sydän- ja verisuonisairauksien riskitekijöiden vaikutukset valtimoiden jäykkyyteen sekä hemodynaamisiin muuttujiin

Sydän- ja verisuonisairauksien riskitekijöiden vaikutukset valtimoiden jäykkyyteen sekä sydämen ja verenkiertoelimistön toimintaan Väitöskirjassa tutkittiin sydän- ja verisuonisairauksien riskitekijöiden (metabolinen oireyhtymä, sokeri- ja rasva-aineenvaihdunnan häiriöt) vaikutuksia valtimoiden jäykkyyteen sekä sydämen ja verenkiertoelimistön toimintaan. Valtimoiden jäykkyyttä arvioitiin mittaamalla pulssiaallon etenemisnopeus, jonka kohoaminen viittaa valtimoiden jäykistymiseen. Sydämen ja verenkiertoelimistön toimintaa kuvaavina suureina käytettiin sydämen iskutilavuutta sekä ääreisverenkierron vastusta. Metabolinen oireyhtymä sekä glukoosinsiedon heikkeneminen olivat yhteydessä alentuneeseen sydämen iskutilavuuteen sekä kohonneeseen pulssiaallon etenemisnopeuteen ja suurempaan ääreisverenkierron vastukseen. Henkilöillä, jotka parantuivat metabolisesta oireyhtymästä kuuden vuoden seuranta-aikana, oli matalampi pulssiaallon etenemisnopeus sekä suurempi sydämen iskutilavuus verrattuna koehenkilöihin, jotka sairastivat metabolista oireyhtymää seuranta-ajan. Lapsuudessa metabolista oireyhtymää sairastaneilla oli korkeampi pulssiaallon etenemisnopeus aikuisena verrattuna niihin henkilöihin, jotka olivat lapsuudessa terveitä. Myös niillä henkilöillä, jotka sairastivat metabolista oireyhtymää sekä lapsuudessa että aikuisena, oli korkeampi pulssiaallon etenemisnopeus verrattuna henkilöihin, jotka parantuivat oireyhtymästä 21 vuoden seuranta-aikana. Lisäksi tutkimuksessa todettiin, että apolipoproteiini B:n (veren “haitallisten rasvojen” määrää kuvaava suure) suurentuminen oli yhteydessä kohonneeseen pulssiaallon etenemisnopeuteen. Tutkimuksen johtopäätöksinä voidaan todeta, että tutkituilla sydän- ja verisuonisairauksien riskitekijöillä on useita haitallisia vaikutuksia valtimoiden jäykkyyteen sekä sydämen ja verenkiertoelimistön toimintaan. Lisäksi tulokset viittaavat siihen, että parantuminen metabolisesta oireyhtymästä voi aikaansaada suotuisia vaikutuksia valtimoiden jäykkyyteen sekä sydämen toimintaan. Tutkimuksen tulokset painottavat osaltaan sydän- ja verisuonisairauksien riskitekijöiden tunnistamisen, ehkäisyn ja hoidon tärkeyttä.Backround: Metabolic syndrome is a constellation of metabolic abnormalities including hypertension, dyslipidemia, glucose intolerance (impaired fasting glucose, impaired glucose tolerance, or type 2 diabetes), insulin resistance, and obesity, all well known risk factors for cardiovascular disease. In adult populations, the simultaneous accumulation of these factors carries an increased risk of subclinical atherosclerosis and cardiovascular disease, in addition to increasing mortality. Growing attention has also been directed at metabolic syndrome in children and adolescents as a diagnosis of paediatric metabolic syndrome may predict an increased risk of cardiovascular disease in adulthood. Parallel with the obesity epidemic, the incidence of type 2 diabetes and metabolic syndrome have increased alarmingly. Moreover, the high prevalence of dyslipidemia has become a worldwide public health problem. Although there has been intensive research in the last decades, the effects of these metabolic abnormalities on cardiovascular function have not been fully elaborated. Aims: The current study investigated the associations of impaired glucose metabolism, childhood and adulthood metabolic syndrome, and apolipoproteins B and A-1 with arterial stiffness. In addition, the present study examined the relationship between metabolic syndrome, impaired glucose metabolism and systemic hemodynamic parameters. Subjects and methods: The study population consisted of 1872 participants (aged 30–45 years, 46% males) participating in the Cardiovascular Risk in Young Finns Study, and 455 participants (aged 46–76 years, 44% males) enrolled in the Health 2000 Survey. A whole-body impedance cardiography device was used to measure arterial pulse wave velocity, a commonly used marker of arterial stiffness, and systemic hemodynamic parameters including stroke index and systemic vascular resistance index. Results: Metabolic syndrome, an increasing number of metabolic sydrome components and a worsening of glucose tolerance were associated with lower stroke index as well as higher systemic vascular resistance index and pulse wave velocity. Participants with persistent metabolic syndrome had a lower stroke index and higher pulse wave velocity when compared to participants who recovered from metabolic syndrome over 6 years’ follow up. Participants suffering from metabolic syndrome in childhood had a higher pulse wave velocity after 21-year follow-up when compared with those not afflicted with the syndrome in childhood. Moreover, participants who recovered from metabolic syndrome during the 21-year follow-up period had a lower pulse wave velocity than those with persistent metabolic syndrome. Apolipoprotein B was directly and independently associated with pulse wave velocity, and apolipoprotein B measured in young adulthood was predictive of pulse wave velocity measured 6 years later. Conclusions: Deteriorating glucose tolerance and metabolic syndrome have adverse effects on arterial stiffness and systemic hemodynamics, and recovery from metabolic syndrome may improve cardiovascular function. The present study also suggests that increased apolipoprotein B is associated with increased arterial stiffness. The current study brings new insight into the relationships between cardiovascular risk factors and cardiovascular function, and our findings underline the importance of the prevention and control of cardiovascular risk factors in both childhood and adulthood

Sydän- ja verisuonisairauksien riskitekijöiden vaikutukset valtimoiden jäykkyyteen sekä hemodynaamisiin muuttujiin

Sydän- ja verisuonisairauksien riskitekijöiden vaikutukset valtimoiden jäykkyyteen sekä sydämen ja verenkiertoelimistön toimintaan Väitöskirjassa tutkittiin sydän- ja verisuonisairauksien riskitekijöiden (metabolinen oireyhtymä, sokeri- ja rasva-aineenvaihdunnan häiriöt) vaikutuksia valtimoiden jäykkyyteen sekä sydämen ja verenkiertoelimistön toimintaan. Valtimoiden jäykkyyttä arvioitiin mittaamalla pulssiaallon etenemisnopeus, jonka kohoaminen viittaa valtimoiden jäykistymiseen. Sydämen ja verenkiertoelimistön toimintaa kuvaavina suureina käytettiin sydämen iskutilavuutta sekä ääreisverenkierron vastusta. Metabolinen oireyhtymä sekä glukoosinsiedon heikkeneminen olivat yhteydessä alentuneeseen sydämen iskutilavuuteen sekä kohonneeseen pulssiaallon etenemisnopeuteen ja suurempaan ääreisverenkierron vastukseen. Henkilöillä, jotka parantuivat metabolisesta oireyhtymästä kuuden vuoden seuranta-aikana, oli matalampi pulssiaallon etenemisnopeus sekä suurempi sydämen iskutilavuus verrattuna koehenkilöihin, jotka sairastivat metabolista oireyhtymää seuranta-ajan. Lapsuudessa metabolista oireyhtymää sairastaneilla oli korkeampi pulssiaallon etenemisnopeus aikuisena verrattuna niihin henkilöihin, jotka olivat lapsuudessa terveitä. Myös niillä henkilöillä, jotka sairastivat metabolista oireyhtymää sekä lapsuudessa että aikuisena, oli korkeampi pulssiaallon etenemisnopeus verrattuna henkilöihin, jotka parantuivat oireyhtymästä 21 vuoden seuranta-aikana. Lisäksi tutkimuksessa todettiin, että apolipoproteiini B:n (veren “haitallisten rasvojen” määrää kuvaava suure) suurentuminen oli yhteydessä kohonneeseen pulssiaallon etenemisnopeuteen. Tutkimuksen johtopäätöksinä voidaan todeta, että tutkituilla sydän- ja verisuonisairauksien riskitekijöillä on useita haitallisia vaikutuksia valtimoiden jäykkyyteen sekä sydämen ja verenkiertoelimistön toimintaan. Lisäksi tulokset viittaavat siihen, että parantuminen metabolisesta oireyhtymästä voi aikaansaada suotuisia vaikutuksia valtimoiden jäykkyyteen sekä sydämen toimintaan. Tutkimuksen tulokset painottavat osaltaan sydän- ja verisuonisairauksien riskitekijöiden tunnistamisen, ehkäisyn ja hoidon tärkeyttä.Backround: Metabolic syndrome is a constellation of metabolic abnormalities including hypertension, dyslipidemia, glucose intolerance (impaired fasting glucose, impaired glucose tolerance, or type 2 diabetes), insulin resistance, and obesity, all well known risk factors for cardiovascular disease. In adult populations, the simultaneous accumulation of these factors carries an increased risk of subclinical atherosclerosis and cardiovascular disease, in addition to increasing mortality. Growing attention has also been directed at metabolic syndrome in children and adolescents as a diagnosis of paediatric metabolic syndrome may predict an increased risk of cardiovascular disease in adulthood. Parallel with the obesity epidemic, the incidence of type 2 diabetes and metabolic syndrome have increased alarmingly. Moreover, the high prevalence of dyslipidemia has become a worldwide public health problem. Although there has been intensive research in the last decades, the effects of these metabolic abnormalities on cardiovascular function have not been fully elaborated. Aims: The current study investigated the associations of impaired glucose metabolism, childhood and adulthood metabolic syndrome, and apolipoproteins B and A-1 with arterial stiffness. In addition, the present study examined the relationship between metabolic syndrome, impaired glucose metabolism and systemic hemodynamic parameters. Subjects and methods: The study population consisted of 1872 participants (aged 30–45 years, 46% males) participating in the Cardiovascular Risk in Young Finns Study, and 455 participants (aged 46–76 years, 44% males) enrolled in the Health 2000 Survey. A whole-body impedance cardiography device was used to measure arterial pulse wave velocity, a commonly used marker of arterial stiffness, and systemic hemodynamic parameters including stroke index and systemic vascular resistance index. Results: Metabolic syndrome, an increasing number of metabolic sydrome components and a worsening of glucose tolerance were associated with lower stroke index as well as higher systemic vascular resistance index and pulse wave velocity. Participants with persistent metabolic syndrome had a lower stroke index and higher pulse wave velocity when compared to participants who recovered from metabolic syndrome over 6 years’ follow up. Participants suffering from metabolic syndrome in childhood had a higher pulse wave velocity after 21-year follow-up when compared with those not afflicted with the syndrome in childhood. Moreover, participants who recovered from metabolic syndrome during the 21-year follow-up period had a lower pulse wave velocity than those with persistent metabolic syndrome. Apolipoprotein B was directly and independently associated with pulse wave velocity, and apolipoprotein B measured in young adulthood was predictive of pulse wave velocity measured 6 years later. Conclusions: Deteriorating glucose tolerance and metabolic syndrome have adverse effects on arterial stiffness and systemic hemodynamics, and recovery from metabolic syndrome may improve cardiovascular function. The present study also suggests that increased apolipoprotein B is associated with increased arterial stiffness. The current study brings new insight into the relationships between cardiovascular risk factors and cardiovascular function, and our findings underline the importance of the prevention and control of cardiovascular risk factors in both childhood and adulthood