Clinical determinants of the macrovascular reactivity response as assessed by flow mediated slowing in people at risk for cardiovascular disease Article Swipe
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· 2024
· Open Access
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· DOI: https://doi.org/10.1093/eurjpc/zwae175.310
· OA: W4399678685
Background Non-invasive methods that assess endothelial function may improve the evaluation of cardiovascular risk in primary care. Previous research showed that flow-mediated slowing (FMS) of the brachial-radial pulse wave velocity reflects cardiovascular risk, but larger studies on the FMS response in at-risk populations are required to further unravel its clinical and added value for cardiovascular risk stratification. Purpose We investigated the clinical determinants of the full FMS response in people at risk for cardiovascular disease. Methods We collected baseline FMS data from a subsample of 157 participants enrolled in the PRIORITY trial (Personalized remotely guided preventive exercise therapy for a healthy heart). Participants had at least one of following risk factors at baseline: systolic blood pressure (BP) / diastolic BP between 130/80 – 159/99 mmHg and/or on antihypertensive treatment, prediabetes with either fasting plasma glucose 100-125mg/dL or HbA1c 5.7%-6.4%, diabetes mellitus, obesity (BMI >30 kg/m2), or evidence of subclinical diastolic dysfunction. We continuously recorded the brachial-radial PWV using a Vicorder device in supine position at rest and after 5-minutes of supra-systolic occlusion of the upper arm (Figure 1). Stepwise linear regression analyses were performed to assess clinical determinants of the FMS response. We illustrated the effect of important determinants on the FMS response by plotting the estimated marginal means of the final models for each FMS post-occlusion interval by the mean and one standard deviation changes of each determinant. Results The study sample was on average 60.2 +/- 11.23 years old and included 74 women (47.1%). Until 180 seconds post-occlusion, a lower FMS response was significantly associated with higher diastolic BP and higher triglycerides levels (P<0.05 for all 0-180s intervals). Higher age only correlated with less decline in brachial-radial PWV in the 60 to 90 seconds post-occlusion interval (P=0.050). Participants with elevated triglycerides or elevated DBP or both exhibited significantly less decline in brachial-radial PWV as compared to those with average or below average levels (Figure 2, panels A to C). Conclusion In individuals at increased risk for cardiovascular disease, worse macrovascular reactivity was associated with hypertriglyceridemia and high diastolic BP. Our findings suggest that the use of FMS may have clinical value for cardiovascular risk evaluation and highlight the importance of an optimal control of triglycerides and diastolic BP for adequate cardiovascular risk management. More studies are needed for assessing the additive value of such testing for cardiovascular disease prediction and management beyond current strategies.
