Chloe May Park

• BSc PhD
• UKRI Policy Fellow at University College London

Translating vascular aging research from bench to bedside presents both significant opportunities and challenges. This paper summarizes insights from a roundtable discussion at the Artery 23 conference, featuring perspectives from basic science, clinical trials, regulation, and industry. The main conclusions of the discussion are as follows: basic...

Vascular ageing is the deterioration of arterial structure and function which occurs naturally with age, and which can be accelerated with disease. Measurements of vascular ageing are emerging as markers of cardiovascular risk, with potential applications in disease diagnosis and prognosis, and for guiding treatments. However, vascular ageing is no...

Objectives Blood pressure (BP) is the leading global cause of mortality, and its prevalence is increasing in children and adolescents. Aortic BP is lower than brachial BP in adults. We aimed to assess the extent of this difference and its impact on the diagnosis of hypertension among adolescents. Methods We used data from 3850 participants from a...

Background: Regulation has a key role for medical devices throughout their lifecycle aiming to guarantee effectiveness and safety for users. Requirements of Regulation (EU) 2017/745 (MDR) have an impact on novel and previously approved systems. Identification of key stakeholders' needs can support effective implementation of MDR improving the tran...

Objectives In general, a terminology shared and agreed by different stakeholders is important to facilitate communication and cooperation. This holds true in the field of vascular ageing for the benefit of global cardiovascular health. The need to promote a common language and understanding across this area was recognised by VascAgeNet, a collabora...

Introduction: Although coronary artery disease (CAD) is associated with worse brain health in observational studies, whether this is causal remains elusive. Aim: To examine observational associations between CAD and brain health, and use Mendelian randomisation (MR) to test for causal relationships. Methods: 472,120 UK Biobank participants were inc...

Background Blood pressure is the leading global cause of mortality and its prevalence is rising in children and adolescents. Aortic blood pressure (BP) is known to be lower than brachial BP but the extent of this difference and its impact on the diagnosis of hypertension in adolescents is not known. Methods We used data from 3850 participants from...

Background: Left ventricular mass (LVM) is an important predictor of cardiovascular risk. In adolescence, LVM is commonly indexed to height2.7, although some evidence suggests that this may not fully account for sex differences. Methods: We investigated appropriate allometric scaling of LVM to height, total lean mass, and body surface area, in a...

This review critiques the literature supporting clinical assessment and management of cardiovascular disease and cardiovascular disease risk stratification with brachial-ankle pulse wave velocity (baPWV). First, we outline what baPWV actually measures-arterial stiffness of both large central elastic arteries and medium-sized muscular peripheral art...

Background: The COVID-19 pandemic disrupted healthcare and may have impacted ethnic inequalities in healthcare. We aimed to describe the impact of pandemic-related disruption on ethnic differences in clinical monitoring and hospital admissions for non-COVID conditions in England. Methods: In this population-based, observational cohort study we u...

3D-speckle tracking echocardiography(3D-STE) allows simultaneous assessment of ejection fraction(EF) and multidirectional strains, but its prognostic utility in the general population is unknown. We investigated if 3D-STE strains predicted a composite of major cardiac endpoints(MACE) beyond cardiovascular risk factors(CVDRF), and whether they were...

Background Three-dimensional echocardiography (3DE) measures of the left ventricle (LV) predict outcomes in high risk individuals, but their prognostic value in the general population is unknown. We aimed to establish whether 3DE was associated with mortality and morbidity in a multi-ethnic community-based sample, if associations differed by sex, a...

Blood pressure and vascular ageing trajectories differ between men and women. These differences develop due to sex-related factors, attributable to sex chromosomes or sex hormones, and due to gender-related factors, mainly related to different sociocultural behaviors. The present review summarizes the relevant facts regarding gender-related differe...

Background: Vascular age (VA) is independent and chronological age for assessing cardiovascular disease (CVD) risk. However, tools for the implementation of VA are currently lacking. We aimed to develop a questionnaire to assess the current knowledge gaps related to VA and barriers to its implementation in routine practice. Methods: Using a stepwis...

Prevention of cardiovascular disease (CVD) remains one of the largest public health challenges of our time. Identifying individuals at increased cardiovascular risk at an asymptomatic, subclinical stage is of paramount importance for minimizing disease progression as well as the substantial health and economic burden associated with overt CVD. Vasc...

Background: An exaggerated blood pressure (BP) response to exercise and low exercise capacity are risk factors for cardiovascular disease (CVD). The effect of pharmacological antihypertensive treatment on exercise BP in older adults is largely unknown. This study investigates these effects accounting for differences in exercise capacity. Methods:...

Children with obesity typically have larger left ventricular heart dimensions during adulthood. However, whether this is due to a persistent effect of adiposity extending into adulthood is challenging to disentangle due to confounding factors throughout the lifecourse. We conducted a multivariable mendelian randomization (MR) study to separate the...

Objective: Despite current evidence demonstrating the important role of Vascular ageing (VA) in cardiovascular risk assessment, its awareness and mostly implementation in everyday practice still lags significantly. To effectively assess the need for future target strategies for health providers, a qualitative questionnaire was developed. The aim o...

Background Image‐quality (IQ) compromises left ventricle assessment by 3‐dimensional echocardiography (3DE). Sicker/frailer patients often have suboptimal IQ, and therefore observed associations may be biased by IQ. We investigated its effect in an observational study of older people and when IQ was modified experimentally in healthy volunteers. M...

Background Low‐grade inflammation in the young may contribute to the early development of cardiovascular disease. We assessed whether circulating levels of glycoprotein acetyls (GlycA) were better able to predict the development of adverse cardiovascular disease risk profiles compared with the more commonly used biomarker high‐sensitivity CRP (C‐re...

[This corrects the article DOI: 10.3389/fcvm.2020.591946.].

Background Smoking tobacco and drinking alcohol are associated with increased arterial stiffness, a critical intermediate endpoint for cardiovascular disease, in adults and in teenagers. The relationship between these risky behaviours and changes in arterial stiffness from late adolescence to early adulthood is not known. Purpose To investigate as...

Background Both left ventricular (LV) ejection fraction (EF) and Global Longitudinal Strain (GLS) by 2D-echocardiography predict mortality and cardiac events, and GLS may be superior to EF. 3D-speckle tracking echocardiography (3D-STE), a recently validated method, allows simultaneous assessment of EF, GLS and principal tangential strain (PTS), but...

Sex and gender are important modifiers of cardiovascular system physiology, pathophysiology, and disease development. The atherosclerosis process, together with the progressive loss of arterial elasticity with age, is a major factor influencing the development of overt cardiovascular, renal, and cerebrovascular disease. While differences between wo...

Background In the last two decades, the global prevalence of paediatric hypertension increased by approximately 75%. Nearly 25% of children are now classified as obese or overweight. Substantial evidence suggests that risk factors for cardiovascular disease (CVD) begin to develop in childhood, thus warranting the need for tools to better screen for...

Extensive evidence shows that risk factors for cardiovascular disease (CVD) begin to develop early in life. Childhood obesity and elevated blood pressure (BP) have become overwhelmingly challenging, with 57% of today's children predicted to be obese by the age of 35 years, and global rates of hypertension in children and adolescents increasing by 7...

Objective Exaggerated exercise blood pressure (BP) is associated with cardiovascular risk factors in adolescence. Cardiorespiratory fitness and adiposity (fatness) are independent contributors to cardiovascular risk, but their interrelated associations with exercise BP are unknown. This study aimed to determine the relationships between fitness, fa...

Objective 17–24 years is a distinct period of lifestyle change. However little is known regarding changes in cardiovascular (CV) health during this time. We explored changes in Left ventricle (LV) structure and function, arterial stiffness, compliance and resistance in a large population-based birth cohort and investigated associations with body co...

Background Whether earlier onset of puberty is associated with higher cardiovascular risk in early adulthood is not well understood. Our objective was to examine the association between puberty timing and markers of cardiovascular structure and function at age 25 years. Methods We conducted a prospective birth cohort study using data from the Avon...

Having the physical function to undertake activities of daily living (ADLs) is essential in order to maintain independence. The aim of this study is to investigate factors associated with physical function in older adults and determine if these associations differ in men versus women. In total, 726 participants (57% men; 73±7 years old) from a popu...

Background: We hypothesized that cardiovascular physiology differs in reflex syncope patients compared with the general population, predisposing such individuals to vasovagal reflex. Methods: In this multicohort cross-sectional study, we compared aggregate data of resting SBP, DBP, pulse pressure (PP) and heart rate (HR), collected from six comm...

Purpose: To define and compare cardiovascular (CV) health scores (CHS) from adolescence (17 yrs) to emerging adulthood (24 yrs) using longitudinal data from a large British birth cohort. Methods: 3142 participants from the Avon Longitudinal Study of Parents and Children (ALSPAC) study attended clinical investigations at 17.8 ± 0.4 yrs and 24.0 ± 0....

BACKGROUND We hypothesized that cardiovascular physiology differs in reflex syncope patients compared with general population, predisposing such subjects to vasovagal reflex. METHODS In this multicohort cross-sectional study, we compared resting systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP) and heart rate (HR),...

Importance Whether earlier onset of puberty is associated with higher cardiovascular risk in early adulthood is not well understood. Objective To examine the association between puberty timing and markers of cardiovascular structure and function at age 25 years. Design Prospective birth cohort study. Setting The Southwest region of England. Par...

Background: People of South Asian and African Caribbean ethnicities living in UK have a high risk of cardiometabolic disease. Limited data exist regarding detailed cardiometabolic phenotyping in this population. Methods enabling this are widely available, but the practical aspects of undertaking such studies in large and diverse samples are seldom...

Increased wave reflection is an independent predictor of cardiovascular events, possibly due to effects on left ventricular (LV) function. We investigated the relationship between reflected waves in early systole, the forward decompression wave in mid-late systole and LV mechanical behavior. Invasively acquired ascending aortic velocity, pressure,...

Objective: Low-grade inflammation in the young may contribute to the early development of adverse cardiometabolic risk profiles. We assessed whether measures of glycoprotein acetylation (GlycA) were better able to detect the development of these changes compared to the more commonly used biomarker high-sensitivity C-reactive protein (CRP), and inve...

Background and aims: Mechanisms underlying the association between cardiovascular disease (CVD) and depression are unknown, and sex differences understudied. We investigated associations between a comprehensive set of measures of macro and microvascular disease and depressive symptoms in older men and women. Methods: We performed cross-sectional...

Background: People of South Asian and African Caribbean ethnicities living in UK have a high risk of cardiometabolic disease. Limited data exist regarding detailed cardiometabolic phenotyping in this population. Methods enabling this are widely available, but the practical aspects of undertaking such studies in large and diverse samples are seldom...

Background Wave intensity analysis provides valuable information on ventriculo-arterial function, hemodynamics, and energy transfer in the arterial circulation. Widespread use of wave intensity analysis is limited by the need for concurrent measurement of pressure and flow waveforms. We describe a method that can estimate wave intensity patterns us...

Purpose: Exaggerated exercise blood pressure (BP) is associated with altered cardiac structure and increased cardiovascular risk. Fitness modifies these associations, but the effect in healthy adolescents is unknown. We performed an observational study to determine the influence of fitness on post-exercise BP, and on its relationship with cardiac...

Adult obesity is associated with greater arterial stiffness however in youth the relationship is unclear. We investigated associations between arterial stiffness and adiposity and explored the contribution of blood pressure from adolescence to emerging adulthood (17–24 yrs). 3885 individuals (2152 female) had measurements of carotid-femoral pulse w...

Introduction: In adults, aging is associated with a rise in blood pressure (BP) and a disproportionate increase in central systolic blood pressure (cSBP) relative to brachial SBP (bSBP) (i.e. reduced aortic to radial pulse pressure amplification (PPamp)). But changes in brachial and central BP have not been studied in the transition from adolescenc...

Objective: Exaggerated exercise blood pressure (BP) is associated with cardiovascular risk factors in adolescence. Aerobic fitness and adiposity (fat mass or ‘fatness’) are important independent contributors to cardiovascular risk in adolescence, but their interrelated associations with exercise BP are unknown. The aim of this study was to determin...

Introduction: Adult obesity is associated with greater arterial stiffness however in youth the relationship is unclear. We investigated associations between arterial stiffness and adiposity and explored the contribution of blood pressure from adolescence to emerging adulthood (17–24 yrs). Methods: 3885 individuals (2152 female) had measurements of...

Introduction: Left ventricular mass (LVM) predicts cardiovascular risk. In early life, LVM is conventionally indexed to height 2.7 [1], although this may not account for sex differences in growth. We investigated allometric scaling of LVM to height, lean mass (LM) and body surface area (BSA) in a UK birth cohort. Methods: 861 individuals underwent...

Background: We have previously shown that 3D echocardiography-derived (3DE) indices of left ventricular (LV) structure predict all-cause mortality differently in men and women [1]. However, the mechanism behind these sex differences remains unknown. We therefore examined the role of macro- and micro-vascular disease in explaining these sex differen...

Background: Measurement of wave intensity (WI) requires simultaneous or quasi-simultaneous measurement of pressure and flow limiting its use. Previous work in dogs [1] and humans [2] has shown that the excess pressure waveforms calculated using reservoir analysis correspond closely with aortic flow waveforms. This offers a potential method to estim...

Background: Wave intensity analysis provides valuable information on ventriculo-arterial function, hemodynamics and energy transfer in the arterial circulation. Widespread use of wave intensity analysis is limited by the need for concurrent measurement of pressure and flow waveforms. We describe a method that can estimate wave intensity patterns us...

Background: 3D speckle-tracking echocardiography (3D-STE) is a novel method to quantify left ventricular (LV) mechanical dyssynchrony. 3D-STE is influenced by image quality, but studies on the magnitude of its effect on 3D-STE derived LV systolic dyssynchrony indices (SDIs) and their test-retest reproducibility are limited. Methods: 3D-STE was perf...

Background Three-dimensional echocardiography (3DE) may have advantages over two-dimensional echocardiography (2DE) for the assessment of left ventricular (LV) function and structure. However, studies comparing 3DE and 2DE-derived indices in relation to mortality are limited, particularly in the general population. Purpose We examined associations...

Background In our rapidly ageing society, dementia and neurocognitive decline are significant global public health problems. Blood pressure (BP), an established cardiovascular risk factor, has been extensively studied with respect to brain structure and function; however, findings across the literature differ depending on the BP component in consid...

Introduction Body mass index (BMI) is independently associated with increased left ventricle mass (LVM) and remodeling in children. However associations from adolescence to emerging adulthood are unknown. Purpose To investigate associations between the change (Δ) in BMI to Δ in cardiac structure from 17 to 25 yrs using a large population-based sam...

Purpose: Masked hypertension is associated with increased cardiovascular risk but is undetectable by clinic blood pressure (BP). Elevated systolic BP responses to submaximal exercise reveal the presence of masked hypertension in adults, but it is unknown whether this is the case during adolescence. We aimed to determine if exercise BP was raised i...

Purpose Left ventricular (LV) mechanics by speckle-tracking echocardiography (STE) is prognostic in patients with cardiovascular diseases, but evidence related to community-dwelling individuals is uncertain. We therefore performed a systematic review and meta-analysis of STE as a predictor of adverse outcomes in the general population. Methods PRI...

Background: Three-dimensional echocardiography (3DE)-derived indices of left ventricular (LV) structure and function predict mortality in various patient groups, although studies are limited. However, whether these indices equally predict mortality in the general population is unknown. Further, whether known sex-differences in cardiac structure and...

Cardiovascular structure by sex.

Pre-exercise and delta systolic BP and cardiovascular structure (sex-pooled analyses).

BACKGROUND: Three-dimensional speckle-tracking echocardiography (3D-STE) is increasingly used to assess left ventricular (LV) mechanics but the quantitative effect of image quality on measurements is not known. OBJECTIVES: To assess the impact of image quality on 3D-STE derived LV indices. METHODS: Echocardiography was performed in two groups of 18...

http://www.arterysociety.org/wp-content/uploads/2018/12/HannahTaylor.pdf

Objective: Exaggerated exercise blood pressure (BP) is associated with higher left-ventricular mass index (LVMI). Paradoxically, exercise BP and LVMI may be higher with greater fitness, but underlying factors are poorly understood. This study aimed to determine the influence of fitness on exercise BP and its relationship with LVMI in adolescents. M...

Unlike in older people, it has been suggested that elevated blood pressure (BP) in young people is because of high cardiac output accompanied by normal total peripheral resistance (TPR)-a hyperkinetic/hyperdynamic circulation. We investigated this in a large, United Kingdom-based birth cohort of adolescents. The study was conducted on 2091 17-year-...

Blood pressure mediates very little of the association between fat mass and left ventricular mass. Other biomarkers associated with cardiovascular risk individually make only very minor or negligible contributions. Most of the association between body composition and LV mass appears to be a direct effect.

Purpose Dynamic exercise results in increased systolic blood pressure (BP). Irrespective of resting BP, some individuals may experience exaggerated rise in systolic BP with exercise, which in adulthood is associated with risk of hypertension, and cardiovascular (CV) disease. It is unknown if exercise BP is associated with markers of CV structure du...

Introduction Left ventricular (LV) strain by speckle-tracking echocardiography (STE) is a comparatively new prognostic marker. Meta-analyses relating LV strain by STE to outcomes have been conducted in selected patient-based populations with established or suspected cardiovascular (CV) diseases. However, the evidence related to population-based stu...

Causal effects of body mass index on cardiac structure and function in young adults using Mendelian randomisation. https://www.nature.com/articles/jhh201763

Table S1. Associations Between All Left Ventricular Function Variables and Brain Volumes and Cognitive Function