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ABSTRACT: BACKGROUND AND PURPOSE:: Heart rate variability (HRV) as a measure of autonomic function might provide prognostic information in ischemic stroke. However, numerous difficulties are associated with HRV parameters assessment and interpretation, especially in short-term ECG recordings. For better understanding of derived HRV data and to avoid methodological bias we simultaneously recorded and analyzed heart rate, blood pressure and respiratory rate. METHODS:: Seventy-five ischemic stroke patients underwent short-term ECG recordings. Linear and nonlinear parameters of HRV as well as beat-to-beat blood pressure and respiratory rate were assessed and compared in patients with different functional neurological outcomes at 7th and 90th days. RESULTS:: Values of Approximate, Sample and Fuzzy Entropy were significantly lower in patients with poor early neurological outcome. Patients with poor 90-day outcome had higher percentage of high frequency spectrum and normalized high frequency power, lower normalized low frequency power and lower low frequency/high frequency ratio. Low frequency/high frequency ratio correlated negatively with scores in the National Institutes of Health Stroke Scale and modified Rankin Scale (mRS) at the 7th and mRS at the 90th days. Mean RR interval, values of blood pressure as well as blood pressure variability did not differ between groups with good and poor outcomes. Respiratory frequency was significantly correlated with the functional neurological outcome at 7th and 90th days. CONCLUSION:: While HRV assessed by linear methods seems to have long-term prognostic value, complexity measures of HRV reflect the impact of the neurological state on distinct, temporary properties of heart rate dynamic. Respiratory rate during the first days of the stroke is associated with early and long-term neurological outcome and should be further investigated as a potential risk factor.
Journal of hypertension 06/2013; · 4.02 Impact Factor
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ABSTRACT: The ageing of the vascular tree is a fundamental reflection of biological ageing in general and a determinant of organ function. In the arterial wall this is characterized by a reduction in the elastin content, as well as by an increased content of collagen and its cross-linkages, leading to increased arterial stiffness and elevated central as well as brachial blood pressure, accompanied by increased SBP variability. In recent years a better understanding of these processes have led to the proposal of a condition named early vascular ageing (EVA) in patients with increased arterial stiffness for their age and sex. This is a condition that could increase cardiovascular risk and is associated with various degrees of cognitive dysfunction, as well as other features of biological ageing. This brief review aims to give an update on EVA and how the concept can be used in clinical practice.
Journal of hypertension 06/2013; · 4.02 Impact Factor
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Hypertension 05/2013; · 6.21 Impact Factor
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Journal of hypertension 01/2013; 31(1):211-212. · 4.02 Impact Factor
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ABSTRACT: Carotid-femoral pulse wave velocity, a predictor of cardiovascular outcome, is conventionally measured using a tonometer sequentially placed upon the carotid and femoral arteries, gated using an electrocardiogram. Leg cuff detection of the femoral pulse removes the need for signal gating, reduces the time required for a single measurement, but gives different pulse wave velocity values to tonometric analysis. A novel algorithm to correct for the transit time and distance related to the additional femoral segment was applied to the cuff-based approach in this study. Eighty-eight subjects were recruited across four centers and carotid-femoral pulse wave velocity measured in triplicate using two operators with both a tonometer-based device, and a device using an inflated thigh cuff with and without the use of the novel algorithm. Comparison was made by Bland-Altman and regression analysis. The unadjusted cuff-based approach gave lower pulse wave velocity values than the tonometer-based approach (6.11±1.27 and 7.02±1.88 m/s, p<0.001). With application of the algorithm, the cuff-based device gave similar pulse wave velocity values (7.04±1.72 m/s) as the tonometer-based approach (p=0.86). Analysis of covariance with age showed a difference between the tonometer and cuff-based methods (p<0.001), with a dependence upon age (p=0.004). The adjusted cuff-based method gave similar results to the tonometer-based method (p=0.94), with no dependence upon age (p=0.46). This study provided validation of a cuff-based assessment of carotid-femoral pulse wave velocity against the universally accepted tonometric method. Adjusting the cuff-based method for the additional femoral segment measured gives results comparable to the tonometer-based method, for which the majority of population data exists to date.
Journal of Hypertension 01/2013; IN PRESS. · 4.02 Impact Factor
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Alexandre Karras,
Jean-Philippe Haymann,
Erwan Bozec,
Marie Metzger,
Christian Jacquot,
Gerard Maruani,
Pascal Houillier,
Marc Froissart,
Bénédicte Stengel,
Philippe Guardiola,
Stéphane Laurent, Pierre Boutouyrie,
Marie Briet
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ABSTRACT: Chronic kidney disease, even at moderate stages, is characterized by a high incidence of cardiovascular events. Subclinical damage to large arteries, such as increased arterial stiffness and outward remodeling, is a classical hallmark of patients with chronic kidney disease. Whether large artery stiffness and remodeling influence the occurrence of cardiovascular events and the mortality of patients with chronic kidney disease (stages 2-5) is still debated. This prospective study included 439 patients with chronic kidney disease (mean age, 59.8±14.5 years) with a mean measured glomerular filtration rate of 37 mL/min per 1.73 m(2). Baseline aortic stiffness was estimated through carotid-femoral pulse wave velocity measurements; carotid stiffness, diameter, and intima-media thickness were measured with a high-resolution echotracking system. For the overall group of patients, the 5-year estimated survival and cumulative incidence of cardiovascular events were 87% and 16%, respectively. In regression analyses adjusted on classical cardiovascular and renal risk factors, aortic stiffness remained significantly associated with all-cause mortality (for 1 SD, Cox model-derived relative risk [95% CI], 1.48 [1.09-2.02]) and with fatal and nonfatal cardiovascular events (for 1 SD, Fine and Gray competing risks model-derived relative risk [95% CI], 1.35 [1.05-1.75]). Net reclassification improvement index was significant (29.0% [2.3-42.0%]). Carotid internal diameter was also independently associated with all-cause mortality. This study shows that increased aortic stiffness and carotid internal diameter are independent predictors of mortality in patients with stages 2 to 5 chronic kidney disease and that aortic stiffness improves the prediction of the risk.
Hypertension 10/2012; · 6.21 Impact Factor
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Giuseppe Schillaci,
Grzegorz Bilo,
Giacomo Pucci,
Stéphane Laurent,
Isabelle Macquin-Mavier, Pierre Boutouyrie,
Francesca Battista,
Laura Settimi,
Gaëlle Desamericq,
Guillaume Dolbeau,
Andrea Faini,
Paolo Salvi,
Elmo Mannarino,
Gianfranco Parati
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ABSTRACT: Short-term blood pressure (BP) variability predicts cardiovascular complications in hypertension, but its association with large-artery stiffness is poorly understood and confounded by methodologic issues related to the assessment of BP variations over 24 hours. Carotid-femoral pulse wave velocity (cfPWV) and 24-hour ambulatory BP were measured in 911 untreated, nondiabetic patients with uncomplicated hypertension (learning population) and in 2089 mostly treated hypertensive patients (83% treated, 25% diabetics; test population). Short-term systolic BP (SBP) variability was calculated as the following: (1) SD of 24-hour, daytime, or nighttime SBP; (2) weighted SD of 24-hour SBP; and (3) average real variability (ARV), that is, the average of the absolute differences between consecutive SBP measurements over 24 hours. In the learning population, all of the measures of SBP variability showed a direct correlation with cfPWV (SD of 24-hour, daytime, and nighttime SBP, r=0.17/0.19/0.13; weighted SD of 24-hour SBP, r=0.21; ARV, r=0.26; all P<0.001). The relationship between cfPWV and ARV was stronger than that with 24-hour, daytime, or nighttime SBP (all P<0.05) and similar to that with weighted SD of 24-hour SBP. In the test population, ARV and weighted SD of 24-hour SBP had stronger relationships with cfPWV than SD of 24-hour, daytime, or nighttime SBP. In both populations, SBP variability indices independently predicted cfPWV along with age, 24-hour SBP, and other factors. We conclude that short-term variability of 24-hour SBP shows an independent, although moderate, relation to aortic stiffness in hypertension. This relationship is stronger with measures of BP variability focusing on short-term changes, such as ARV and weighted 24-hour SD.
Hypertension 07/2012; 60(2):369-77. · 6.21 Impact Factor
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Hypertension 06/2012; 60(2):518-22. · 6.21 Impact Factor
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ABSTRACT: To compare two drug regimens to treat resistant hypertension.
In a prospective, randomized, open blinded endpoint study, 167 patients with mean baseline daytime ambulatory blood pressure 135 mmHg or more and/or 85 mmHg or more, despite 4 weeks' treatment with irbesartan 300 mg/day, hydrochlorothiazide 12.5 mg/day and amlodipine 5 mg/day, were randomized to sequential nephron blockade (group 1, n = 85) or sequential renin-angiotensin system blockade (group 2, n = 82). First, spironolactone 25 mg/day in group 1 or ramipril 5 mg/day in group 2 were added for 4 weeks. Treatment was increased at weeks 4, 8 or 10 if home blood pressure was 135 mmHg or more and/or 85 mmHg or more by sequentially administering furosemide 20 mg/day, furosemide 40 mg/day and amiloride 5 mg/day in group 1, or ramipril 10 mg/day, bisoprolol 5 mg/day and bisoprolol 10 mg/day in group 2. The primary endpoint was change in systolic daytime ambulatory blood pressure at week 12.
At week 12, the mean between-group difference in daytime ambulatory blood pressure was 10/4 mmHg (95% confidence interval: 7-14/2-7; P < 0.001/P = 0.0014) in favour of the group 1. The blood pressure goal (daytime ambulatory blood pressure <135/85 mmHg) was achieved in 58% in the group 1 and 20% in the group 2 (P < 0.0001). Discontinuation for drug-related adverse events was low (group 1, n = 7; group 2, n = 6).
In patients with resistant hypertension, sequential nephron blockade induces a large and well tolerated reduction in blood pressure via a progressive increase in sodium depletion, and is more effective than sequential renin-angiotensin system blockade.
Journal of hypertension 06/2012; 30(8):1656-64. · 4.02 Impact Factor
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ABSTRACT: Classical risk scores may underestimate the risk of cardiovascular events in specific risk groups suitable for early prevention, such as asymptomatic hypertensive subjects. Arterial stiffness and wave reflection are now well accepted as the most important determinants of increasing systolic and pulse pressures in aging societies, thus affording a major contribution to stroke and myocardial infarction. A major reason for measuring arterial stiffness in hypertensive patients comes from the demonstration that arterial stiffness has a predictive value for cardiovascular events, beyond classical cardiovascular risk factors. Aortic stiffening also gives direct evidence of target organ damage, and improves the determination of the overall cardiovascular risk of asymptomatic hypertensive subjects. In clinical practice, the measurement of aortic stiffness may avoid patients being mistakenly classified as at low or moderate risk, when they actually have an abnormally high aortic stiffness placing them within a higher-risk group. The present mini-review successively addresses the concept of 'tissue' biomarker, applies it to arterial stiffness, describes the methodology of measurement, gives some pathophysiological links in order to explain the occurrence of stroke and myocardial infarction in patients with high arterial stiffness, and raises the issue of whether arterial stiffness is a surrogate marker.
Annals of medicine 06/2012; 44 Suppl 1:S93-7. · 3.52 Impact Factor
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Kim-Thanh Ong,
Henri Plauchu,
Simone Peyrol,
Elisabeth Roux,
Elisabeth Errazuriz,
Philippe Khau Van Kien,
Brigitte Arbeille,
Alain Gaulier,
Gabriela Georgescou,
Patrick Collignon,
Dominique P Germain,
Marie-Noëlle Gaveau,
Jérôme Perdu,
Stéphane Laurent,
Patrick Bruneval, Pierre Boutouyrie
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ABSTRACT: Vascular Ehlers-Danlos syndrome (vEDS) results from a mutation in the gene encoding alpha-1, type III pro-collagen (COL3A1) and confers fragility to skin, ligament and vascular tissue. We tested the value of skin biopsy for diagnosis of vEDS through an ultrastructure scoring procedure. Study design was a multicentric, case-control, blinded trial consisting of two phases: phase 1 was to identify an ultra-structure score providing the best discriminative value for vEDS and phase 2 was to replicate this result in a different population. We enrolled 103 patients, 66 cases defined through the revised nosology for Ehlers-Danlos syndromes and 37 control subjects selected from patients referred for other pathologies. Ultrastructure of extracellular matrix was read by three to five experienced pathologists blinded for diagnosis. We used the receiver operating curves and logistic regression analysis for ranking ultrastructure scores. We created a detailed description of lesions observed in vEDS patients with 27 items (coded 0 or 1). In the phase 1 (17 cases and 20 controls), abnormal fibroblast shape, presence of lysosomes in the fibroblast and abnormal basal lamina were found to be independent discriminative items. Addition of these three items (defining an ultrastructure score) had the best diagnosis value (area under the curve (AUC) = 0.96). In the phase 2 (49 cases, 17 controls), ultrastructure score provided odds ratio of 9.76 (95 % CI 2.91-32.78), and AUC of 0.90. The ultrastructure score of skin biopsy has predictive value for the diagnosis of vEDS. Presence of two or more signs (either abnormal fibroblast, presence of lysosomes in the fibroblast or abnormal basal lamina) is very evocative of vEDS.
Archiv für Pathologische Anatomie und Physiologie und für Klinische Medicin 05/2012; 460(6):637-49. · 2.49 Impact Factor
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ABSTRACT: Resting heart rate has been related to the risk of cardiovascular disease and sudden death in several large prospective studies.
To investigate prospectively the association of novel heart rate parameters and of carotid artery stiffness with sudden death
and other cardiovascular disease. The Paris Prospective Study III (PPS3) is a new, ongoing French prospective study. From
June 2008 to December 2011, 10,000 men and women aged 50–75years who will have a preventive medical check-up at the Centre
d’Investigations Préventives et Cliniques in Paris (France), will be enrolled in the study, after signing an informed consent.
In addition to the general health examination, each subject’s heart rhythm will be recorded during the course of the health
check-up (approximately 21/2h) and an echo-tracking of the right carotid bulb will be performed by trained technicians. A bio bank and DNA bank will
be established for further biomarker and genetic analyses. The occurrence of cardiovascular disease including acute coronary
syndrome, stroke, peripheral artery disease and sudden death, and of mortality, of the participants will be followed up during
20years. With an estimated mean annual rate of sudden death of 0.1% and its increasing incidence rate with age, between 250
and 300 sudden deaths are expected. This unique study should provide new insights into the regulation of heart rate and blood
pressure and should enable to identify novel heart rate parameters that are associated with sudden death.
KeywordsEpidemiology–Sudden death–Risk factors–Heart rate–Arterial stiffness
European Journal of Epidemiology 04/2012; 26(11):887-892. · 4.71 Impact Factor
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ABSTRACT: We recognize that increased systolic pressure is the most challenging form of hypertension today and that pulse pressure as an independent cardiovascular risk factor has focused attention on arterial stiffness and wave reflections as the most important factors determining these pressures. In recent years, many studies emphasized the role of arterial rigidity in the development of cardiovascular diseases, and it was shown that stiffening of arteries is associated with increased cardiovascular mortality and morbidity. Moreover,arterial stiffening is linked to decreased glomerular filtration rate, and is predictive of kidney disease progression and the patient’s cardiovascular outcome. Premature vascular aging and arterial stiffening are observed with progression of chronic kidney disease (CKD) and in end-stage renal disease(ESRD). This accelerated aging is associated with outward remodeling of large vessels, characterized by increased arterial radius not totally compensated for by artery wall hypertrophy. Arterial stiffening in CKD and ESRD patients is of multifactorial origin with extensive arterial calcifications representing a major covariate. With aging, the rigidity is more pronounced in the aorta than in peripheral conduit arteries, leading to the disappearance or inversion of the arterial stiffness gradient and less protection of the microcirculation from high-pressure transmission. Various non-pharmacological or pharmacological interventions can modestly slow the progression of arterial stiffness,but arterial stiffness is, in part, pressure dependent and treatments able to stop the process mainly include antihypertensive drugs.
Kidney International 04/2012; 82(4):388-400. · 6.61 Impact Factor
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ABSTRACT: The ambulatory arterial stiffness index (AASI), derived from ambulatory blood pressure monitoring (ABPM) recordings, has been proposed as a surrogate marker of arterial stiffness. However, there is controversy to what extent it reflects stiffness or is affected by other parameters. Using a previously validated one-dimensional computer model of the arterial circulation, the relative importance of the different determinants of the AASI was explored.
Arterial distensibility (inverse of stiffness), peripheral resistance, heart rate, maximal cardiac elastance and venous filling pressure were varied from 80 to 120% of their initial value in steps of 10% to generate 3125 BP values, mimicking the daily fluctuations in one theoretical patient. From this dataset, we assessed the confidence with which AASI can be derived in this patient, as well as the influence of different individual parameters on AASI. To assess the ability of AASI to detect large changes in arterial stiffness, two additional patients were simulated with a distensibility of 50 and 25% of the default distensibility, respectively.
The distribution of AASI values, obtained from 10 000 ABPM simulations (each using 72 BP values randomly selected among 3125) was normal [AASI = 0.43 ± 0.04 (SD)]. An increase in heart rate, distensibility or resistance from 80 to 120% of its default value caused the AASI to decrease by 37, 21 or 9%, respectively. Whereas there was no overlap in the distensibility ranges for the three theoretical patients, the amount of overlap between the AASI distributions was substantial.
The confounding effects of vascular resistance and heart rate seriously limit the use of AASI as a marker of stiffness.
Journal of hypertension 03/2012; 30(3):574-80. · 4.02 Impact Factor
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Luc M Van Bortel,
Stephane Laurent, Pierre Boutouyrie,
Phil Chowienczyk,
J K Cruickshank,
Tine De Backer,
Jan Filipovsky,
Sofie Huybrechts,
Francesco U S Mattace-Raso,
Athanase D Protogerou,
Giuseppe Schillaci,
Patrick Segers,
Sebastian Vermeersch,
Thomas Weber
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ABSTRACT: Stiffness of elastic arteries like the aorta predicts cardiovascular risk. By directly reflecting arterial stiffness, having the best predictive value for cardiovascular outcome and the ease of its measurement, carotid-femoral pulse wave velocity is now considered the gold standard for arterial stiffness assessment in daily practice. Many different measurement procedures have been proposed. Therefore, standardization of its measurement is urgently needed, particularly regarding the distance measurement. This consensus document advises on the measurement procedures in general and provides arguments for the use of 80% of the direct carotid-femoral distance as the most accurate distance estimate. It also advises the use of 10 m/s as new cut-off value for carotid-femoral pulse wave velocity.
Journal of hypertension 03/2012; 30(3):445-8. · 4.02 Impact Factor
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Luc M. Van Bortel,
Stephane Laurent, Pierre Boutouyrie,
Phil Chowienczyk,
J.K. Cruickshank,
Tine De Backer,
Jan Filipovsky,
Sofie Huybrechts,
Francesco U.S. Mattace-Raso,
Athanase D. Protogerou,
Giuseppe Schillaci,
Patrick Segers,
Sebastian Vermeersch,
Thomas Weber
[show abstract]
[hide abstract]
ABSTRACT: Stiffness of elastic arteries like the aorta predicts cardiovascular risk. By directly reflecting arterial stiffness, having the best predictive value for cardiovascular outcome and the ease of its measurement, carotid-femoral pulse wave velocity is now considered the gold standard for arterial stiffness assessment in daily practice. Many different measurement procedures have been proposed. Therefore, standardization of its measurement is urgently needed, particularly regarding the distance measurement. This consensus document advises on the measurement procedures in general and provides arguments for the use of 80% of the direct carotid-femoral distance as the most accurate distance estimate. It also advises the use of 10 m/s as new cut-off value for carotid-femoral pulse wave velocity.
Journal of Hypertension 02/2012; 30(3):445–448. · 4.02 Impact Factor
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Anne Gompel, Pierre Boutouyrie,
Robinson Joannides,
Sophie Christin-Maitre,
Anna Kearny-Schwartz,
Kristian Kunz,
Stéphane Laurent,
Jean-Marc Boivin,
Bruno Pannier,
Bernard Pornel,
Harry A J Struijker-Boudier,
Christian Thuillez,
Luc Van Bortel,
Faied Zannad,
Isabelle Pithois-Merli,
Patrice Jaillon,
Tabassome Simon
[show abstract]
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ABSTRACT: To evaluate the remodeling of large arteries according to age at menopause, duration of menopause, and use of hormone therapy (HT).
A cross-sectional study consisting of baseline measurements of a multicentric randomized trial were used to evaluate arterial parameters.
The study was conducted in France, Belgium, and the Netherlands in academic hospitals and private clinics.
Postmenopausal women (n = 538) with mild hypercholesterolemia.
None.
Common carotid artery intima-media thickness (CCA-IMT), central pulse pressure, and aortic stiffness (carotid-femoral pulse wave velocity) were measured and centrally controlled for quality. Multivariate regression analysis was used to assess the possible covariates associated with arterial parameters.
Women were 58 ± 6 (mean ± SD) years of age with an age of 50 ± 5 at menopause and a mean duration of menopause of 8 ± 7 years. Lower age at menopause, time since menopause, and absence of HT use were independently associated with worsening of the arterial parameters. After multivariate analysis, HT was associated with a lower CCA-IMT (-40 μm [range -64 to -1]), whereas lower age at menopause and menopause duration were respectively associated with a CCA-IMT increase (25 μm/5 y and 27 μm/5 y). Similarly, values of central pulse pressure and pulse wave velocity were lower in HT users (-3.1 mm Hg [-5.1 to -0.9] and -0.31 m/s [-0.63 to -0.02], respectively) but worsened with age at menopause and menopause duration.
The age at menopause, the time since menopause, and the use of HT are independently associated with the thickening and stiffening of the large arteries.
NCT00163163.
Fertility and sterility 12/2011; 96(6):1445-50. · 3.97 Impact Factor
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Marie-Olivia Chandesris,
Arshid Azarine,
Kim-Thanh Ong,
Soraya Taleb, Pierre Boutouyrie,
Elie Mousseaux,
Mélissa Romain,
Erwan Bozec,
Stéphane Laurent,
Nathalie Boddaert, [......],
Marine Munzer,
Roland Jaussaud,
Felipe Suarez,
Olivier Clément,
Olivier Hermine,
Alain Tedgui,
Olivier Lortholary,
Capucine Picard,
Ziad Mallat,
Alain Fischer
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ABSTRACT: Signal transducer and activator of transcription 3 (STAT3) deficiency is responsible for autosomal dominant hyperimmunoglobulin E syndrome, characterized by recurrent bacterial and fungal infections, connective tissue abnormalities, hyperimmunoglobulin E, and Th17 lymphopenia. Although vascular abnormalities have been reported in some patients, the prevalence, characteristics, and etiology of these features have yet to be described.
We prospectively screened 21 adult STAT3-deficient patients [corrected] (median age, 26 years; range, 17-44 years) [corrected] for vascular abnormalities. We explored the entire arterial vasculature with whole-body magnetic resonance imaging angiography, coronary multislice computed tomography, and echo-tracking-based imaging specifically for the [corrected] carotid arteries. We also assayed for serum biomarkers of inflammation and endothelial dysfunction. Finally, we studied murine models of aortic aneurysm in the presence and absence of inhibitors of STAT3-dependent signaling. Ninety-five percent of patients showed brain abnormalities (white matter hyperintensities, lacunar lesions suggestive of ischemic infarcts, and atrophy). We reported peripheral and brain artery abnormalities in 84% of the patients and detected coronary artery abnormalities in 50% of the patients. The most frequent vascular abnormalities were ectasia and aneurysm. The carotid intima-media thickness was markedly decreased, with a substantial increase in circumferential wall stress, indicating the occurrence of hypotrophic arterial remodeling in this STAT3-deficient population. Systemic inflammatory biomarker levels correlated poorly with the vascular phenotype. In vivo inhibition of STAT3 signaling or blockade of IL-17A resulted in a marked increase in aneurysm severity and fatal rupture in mouse models.
Vascular abnormalities are highly prevalent in patients with STAT3 deficiency. This feature is consistent with the greater susceptibility to vascular aneurysm observed after inhibition of STAT3-dependent signaling in mouse models.
Circulation Cardiovascular Genetics 11/2011; 5(1):25-34. · 6.11 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: Resting heart rate has been related to the risk of cardiovascular disease and sudden death in several large prospective studies. To investigate prospectively the association of novel heart rate parameters and of carotid artery stiffness with sudden death and other cardiovascular disease. The Paris Prospective Study III (PPS3) is a new, ongoing French prospective study. From June 2008 to December 2011, 10,000 men and women aged 50-75 years who will have a preventive medical check-up at the Centre d'Investigations Préventives et Cliniques in Paris (France), will be enrolled in the study, after signing an informed consent. In addition to the general health examination, each subject's heart rhythm will be recorded during the course of the health check-up (approximately 2(1/2) h) and an echo-tracking of the right carotid bulb will be performed by trained technicians. A bio bank and DNA bank will be established for further biomarker and genetic analyses. The occurrence of cardiovascular disease including acute coronary syndrome, stroke, peripheral artery disease and sudden death, and of mortality, of the participants will be followed up during 20 years. With an estimated mean annual rate of sudden death of 0.1% and its increasing incidence rate with age, between 250 and 300 sudden deaths are expected. This unique study should provide new insights into the regulation of heart rate and blood pressure and should enable to identify novel heart rate parameters that are associated with sudden death.
European Journal of Epidemiology 10/2011; 26(11):887-92. · 4.71 Impact Factor
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[hide abstract]
ABSTRACT: Arterial stiffness has emerged as an important marker of cardiovascular risk in various populations and reflects the cumulative effect of cardiovascular risk factors on large arteries, which in turn is modulated by genetic background. Arterial stiffness is determined by the composition of the arterial wall and the arrangement of these components, and can be studied in humans non-invasively. Age and distending pressure are two major factors influencing large artery stiffness. Change in arterial stiffness with drugs is an important endpoint in clinical trials, although evidence for arterial stiffness as a therapeutic target still needs to be confirmed. Drugs that independently affect arterial stiffness include antihypertensive drugs, mostly blockers of the renin-angiotensin-aldosterone system, hormone replacement therapy and some antidiabetic drugs such as glitazones. While the quest continues for 'de-stiffening drugs', so far only advanced glycation endproduct cross-link breakers have shown promise.
Drugs 09/2011; 71(13):1689-701. · 4.23 Impact Factor
