Comparison of Brachial-Ankle Pulse Wave Velocity in Japanese and Russians

Article (PDF Available)inThe Tohoku Journal of Experimental Medicine 207(4):263-70 · January 2006with35 Reads
DOI: 10.1620/tjem.207.263 · Source: PubMed
Abstract
Pulse wave velocity (PWV) is a well-known indicator of arterial stiffness and a marker of the presence of vascular lesions. Cardiovascular mortality in Russia has become the highest in the world. The Japanese are enjoying long lives, and the mortality caused by cardiovascular diseases has thus far remained at lower levels than that in Russia. In this study, we focused on brachial-ankle pulse wave velocity (baPWV) obtained from normal human subjects in Russia as well as in Japan, and compared their respective cardiovascular risks. We evaluated baPWV in 337 Japanese and 138 Russian healthy subjects. The baPWV was recorded using a PWV diagnosis device. BaPWV was measured between 2 locations of the arterial tree. The baPWV in the Russian group was significantly higher than that obtained in the Japanese of two groups categorized by age (40-59 years and 60- years). Further, body mass index (BMI), systolic blood pressure (SBP) and diastolic blood pressure in the Russian group were significantly higher than those obtained in Japanese in three age groups (under 39 years, 40-59 years, and 60- years). Moreover, the baPWV indicated a positive correlation with age, BMI and SBP in both Japanese and Russians, although the increasing trend of the baPWV against age of the Russian group had a larger value than that of the Japanese. Therefore, we suggest that arterial stiffness might be promoted earlier in the Russian group, which might be the main cause of the increased cardiovascular risk in Russia.
Comparison of baPWV between Japanese and Russians 263
263
Tohoku J. Exp. Med., 2005,
207
, 263-270
Received June 3, 2005; revision accepted for publication September 13, 2005.
Correspondence: Hongjian Liu, Ph.D., Department of Medical Engineering and Cardiology, Institute of
Development, Aging and Cancer, Tohoku University, 4-1 Seiryomachi, Aoba-ku, Sendai 980-8575, Japan.
e-mail: hongjianliu63@yahoo.co.jp
Comparison of Brachial-Ankle Pulse Wave Velocity in
Japanese and Russians
HONGJIAN LIU, TOMOYUKI YAMBE, XIUMIN ZHANG,
1
YOSHIFUMI SAIJO,
YASUYUKI SHIRAISHI, KAZUMITSU SEKINE, MITSUYA MARUYAMA,
2
YURI A. KOVALEV,
3
IRINA A. MILYAGINA,
3
VIKTOR A. MILYAGIN
3
and
SHINICHI NITTA
2
Department of Medical Engineering and Cardiology, Institute of Development,
Aging and Cancer, Tohoku University, Sendai, Japan,
1
Department of Medicine and Science in Sports and Exercise, Tohoku University
Graduate School of Medicine, Sendai, Japan,
2
Division of Medical Engineering and Clinical Investigation, Institute of Devel-
opment, Aging and Cancer, Tohoku University, Sendai, Japan, and
3
Department of Therapy, Smolensk State Medical Academy, Smolensk, Russia
LIU, H., YAMBE, T., ZHANG, X., SAIJO, Y., SHIRAISHI, Y., SEKINE, K., MARUYAMA, M.,
KOVALEV, Y.A., MILYAGINA, I.A., MILYAGIN, V.A. and NITTA, S.
Comparison of Brachial-
Ankle Pulse Wave Velocity in Japanese and Russians.
Tohoku J. Exp. Med., 2005,
207
(4),
263-270
Pulse wave velocity (PWV) is a well-known indicator of arterial stiffness
and a marker of the presence of vascular lesions. Cardiovascular mortality in Russia has
become the highest in the world. The Japanese are enjoying long lives, and the mortality
caused by cardiovascular diseases has thus far remained at lower levels than that in Russia.
In this study, we focused on brachial-ankle pulse wave velocity (baPWV) obtained from
normal human subjects in Russia as well as in Japan, and compared their respective car-
diovascular risks. We evaluated baPWV in 337 Japanese and 138 Russian healthy sub-
jects. The baPWV was recorded using a PWV diagnosis device. BaPWV was measured
between 2 locations of the arterial tree. The baPWV in the Russian group was signicantly
higher than that obtained in the Japanese of two groups categorized by age (40-59 years
and 60- years). Further, body mass index (BMI), systolic blood pressure (SBP) and dia-
stolic blood pressure in the Russian group were signicantly higher than those obtained in
Japanese in three age groups (under 39 years, 40-59 years, and 60- years). Moreover, the
baPWV indicated a positive correlation with age, BMI and SBP in both Japanese and Rus-
sians, although the increasing trend of the baPWV against age of the Russian group had a
larger value than that of the Japanese. Therefore, we suggest that arterial stiffness might
be promoted earlier in the Russian group, which might be the main cause of the
increased cardiovascular risk in Russia.
brachial-ankle pulse wave velocity;
atherosclerosis; Japanese; Russians
© 2005 Tohoku University Medical Press
H. Liu et al.264
Comparison of baPWV between Japanese and Russians 265
Arterial stiffness can occur in the absence of
atherosclerosis and plays important roles in the
development of atherosclerosis. Pulse wave
velocity (PWV) is known to be an indicator of
arterial stiffness and a marker of vascular damage.
There have been many reports about the relation-
ship between PWV and the development of ath-
erosclerotic disease. Recent studies have demon-
strated that PWV is not only a risk marker of
cardiovascular disease, but also its prognostic
predictor (Tomiyama et al. 2003; Altun et al.
2004; Choi et al. 2004; Fujiwara et al. 2004;
Mitchell et al. 2004; Schmitt et al. 2004; Stewart
et al. 2004; Woodside et al. 2004).
PWV is the velocity of a pulse wave travel-
ing a given distance between 2 sites in the arterial
system. Recently, a new, simple device to mea-
sure brachial-ankle pulse wave velocity (baPWV)
has been developed using pressure cuffs wrapped
on the brachium and ankle. BaPWV has potential
as a new marker of cardiovascular risk; compared
to conventional markers, it is easy to obtain and
serves as an indicator of either atherosclerotic
cardiovascular risk or severity of atherosclerotic
vascular damage. Thus, it is useful for screening
the general population (Ogawa et al. 2003;
Yamashina et al. 2003; Yokoyama et al. 2003).
During recent years a rapid increase in car-
diovascular mortality in Russia has been reported.
Mortality from cardiovascular diseases in Russia
is the highest in the world. In recent years the
average lifespan of Russians has decreased more
and more, and at least 55% of Russians die from
cardiovascular events. The age-standardized male
and female mortality rates from cardiovascular
diseases in Russia are 751 and 453 per 100,000
(Malyutina et al. 2004).
On the other hand, in Japan, cardiovascular
mortality declined markedly between the 1960s
and 1970s, mainly
as a result of the improvement
of hypertension management. Since the 1980s,
presumably as the inuence of an increasingly
westernized lifestyle, the risk factors of athero-
sclerosis and preclinical atherosclerosis have been
increasing. Still, the Japanese population has one
of the longest life expectancies
in the world and
low levels of cardiovascular mortality have been
achieved (Martikainen et al. 2001).
Therefore, we established the hypothesis that
Russians, having a higher cardiovascular risk,
would show higher PWV values than Japanese.
In this study, we focused on the baPWV obtained
from normal (healthy) subjects in Russia and in
Japan, and compared their cardiovascular risks.
MATERIALS AND METHODS
Subjects
Three hundreds thirty seven normal Japanese sub-
jects and 138 normal Russian subjects participated in this
study. The data on the Japanese were collected at
Tohoku University, Sendai. The data on the Russians
were collected at the Smolensk State Medical Academy,
Smolensk. To generate a healthy sample, participants
were excluded for the following reasons: hypertension
(dened as systolic blood pressure [SBP]
140 mmHg,
diastolic blood pressure [DBP]
90 mmHg, or drug
treatment for hypertension), endocrine disease, signi-
cant renal or hepatic disease,
coronary artery disease,
arrhythmias, cerebrovascular disease, or use of medica-
tion for diabetes mellitus or hyperlipidemia. Written
informed consent was obtained from all participants, and
the study protocol was approved by the Ethics Committee
of Tohoku University, Graduate of Medicine and School
of Medicine, Japan.
Measurement of PWV
The subjects were examined while resting in the
supine position. After at least a 5-min bed rest,
baPWV was recorded using an automated device
(VaSeraVS-1000, Fukuda Denshi, Tokyo) (Watanabe et
al. 2005). The device recorded baPWV, blood pressure
(BP), electrocardiogram and heart sounds simultaneous-
ly. Electrocardiogram electrodes were placed on both
wrists, and a heart sound microphone was placed on the
left sternal border. Cuffs to measure baPWV were
wrapped around both upper arms and ankles, and
connected to a plethysmographic sensor that determines
volume pulse form. Volume waveforms were stored for
a sampling time of 10 s with automatic gain analysis and
quality adjustment. This instrument simultaneously
records the baPWV on the left and right sides. The high-
est baPWV on both sides were determined, and subse-
quent statistical analyses were performed using these
values (Tomiyama et al. 2005).
H. Liu et al.264
Comparison of baPWV between Japanese and Russians 265
Statistical Analysis
Data are expressed as means ± S.D. All statistical
analyses were performed with StatView-5 software (SAS
Institute Inc., Cary, NC, USA). Student’s
t-
test was used
to examine statistical difference of baPWV or body mass
index (BMI) between Russian subjects and Japanese sub-
jects. Multiple linear regression analysis was performed
to evaluate the association between baPWV and age,
BMI, SBP or DBP in Japanese and Russian subjects.
Pearsons correlation coefcient analysis was used to
assess the relation between PWV and other variables in
Japanese and Russian subjects.
P
< 0.05 was regarded as
statistically signicant.
RESULTS
Comparison of baPWV, BMI, SBP and DBP
between Japanese and Russians
The characteristics of subjects are classied
according to three age groups in Table 1. BaPWV
in Japanese subjects showed signicantly lower
values than those in Russian subjects of two age
groups (40-59 years and 60- years). BMI in
Japanese subjects were signicantly lower than
those in Russian subjects of three age groups (-39
years, 40-59 years, and 60- years). SBP or DBP
were also signicantly lower in Japanese subjects
in all three age groups.
Correlation of baPWV with age, BMI, SBP and
DBP in Japanese and Russians
Table 2 shows the results of multiple regres-
sion analysis including baPWV and age, BMI,
SBP or DBP. Age, BMI and SBP were signi-
cantly associated with baPWV, whereas DBP
showed no signicant association.
BaPWV showed a signicant positive corre-
TABLE 1. Characteristics of subjects
Age -39 Age 40-59 Age 60-
n
Japanese 224 83 30
Russians 72 54 12
Age (years)
Japanese 25.8 ± 6.7 48.7 ± 5.3 67.0 ± 5.7
Russians 26.8 ± 6.4 48.3 ± 4.3 66.3 ± 5.3
BMI (kg/m
2
)
Japanese 20.9 ± 2.2
*
22.4 ± 2.3
*
23.3 ± 2.5
*
Russians 22.9 ± 4.2 27.4 ± 4.9 26.8 ± 2.3
BaPWV (m/sec)
Japanese 11.04 ± 1.26 12.32 ± 1.25
*
15.24 ± 1.97
*
Russians 11.23 ± 1.31 13.05 ± 1.34 16.65 ± 1.36
SBP (mmHg)
Japanese 118.75 ± 10.51
*
121.13 ± 8.77
*
126.93 ± 8.57
*
Russians 123.98 ± 10.64 126.39 ± 8.65 135.68 ± 6.09
DBP (mmHg)
Japanese 73.18 ± 8.33
*
78.05 ± 6.97
*
78.2 ± 7.46
*
Russians 77.01 ± 7.32 83.37 ± 5.3 85.58 ± 4.5
Data represent mean ± S.D.
*
p < 0.05 (Student’s t-test).
TABLE 2. Multiple regression analysis of the
factors associated with baPWV
Variables ß
p
value
Japanese
Age 0.29 0.001
BMI 0.18 0.01
SBP 0.17 0.004
DBP 0.1 0.1
Russians
Age 0.65 0.001
BMI 0.15 0.027
SBP 0.23 0.014
DBP 0.07 0.44
BMI, body mass index; SBP, systolic blood
pressure; DBP, diastolic blood pressure.
H. Liu et al.266
Comparison of baPWV between Japanese and Russians 267
lation with age in Japanese subjects (
r
= 0.75,
p
<
0.05) (Fig. 1A) and Russian subjects (
r
= 0.42,
p
< 0.05) (Fig. 1B). However, the straight-line
slopes of regression of baPWV vs age in Russian
subjects (Y = 8.607 + 0.098X) were obviously
larger than those in Japanese subjects (Y = 10.096
+ 0.043X).
BaPWV also showed a mild, but signicant
positive correlation with BMI in Japanese sub-
jects (
r
= 0.46,
p
< 0.05) (Fig. 2A) and Russian
subjects (
r
= 0.26,
p
< 0.05) (Fig. 2B).
BaPWV showed a signicant positive corre-
lation with SBP in Japanese subjects (
r
= 0.32,
p
< 0.05) (Fig. 3A) and Russian subjects (
r
= 0.46,
p
< 0.05) (Fig. 3B).
The straight-line slopes of regression of
baPWV vs SBP in Russian subjects (Y = 1.565 +
0.088X) were obviously larger than those in
Japanese subjects (Y = 6.206+ 0.045X).
Correlation of BP with age in Japanese and
Russians
BP showed a signicant positive correlation
with age in Japanese subjects (
r
= 0.27,
p
< 0.05)
(Fig. 4A) and Russian subjects (
r
= 0.46,
p
< 0.05)
(Fig. 4B). The straight-line slope of regression of
BP versus age in Russian subjects (Y = 84.853 +
0.249X) was obviously larger than that in
Japanese subjects (Y = 85.258 + 0.135X).
DISCUSSION
The synergistic effect of hypertension and
arterial stiffness may appear as a higher PWV
value. Increased arterial stiffness, as reected by
an increased PWV, results in aggravation of ath-
erosclerosis via an increased stress on the arterial
Fig. 1. Relations between baPWV and age in 337
Japanese subjects (A) and 138 Russian subjects
(B).
Fig. 2. Relations between baPWV and BMI in 337
Japanese subjects (A) and 138 Russian subjects
(B).
H. Liu et al.266
Comparison of baPWV between Japanese and Russians 267
wall. The degree of elevation of PWV may corre-
spond to the degree of atherosclerotic change: a
very high PWV may indicate that the atheroscle-
rotic process is already well established (Ogawa
et al. 2003; Yokoyama et al. 2003). Thus, an
increased PWV was associated with atheroscle-
rotic risk factors (Altun et al. 2004; Fujiwara et al.
2004; Tomiyama et al. 2004).
In this study, we compared the baPWV of
Japanese and Russians for the rst time. Our
major nding in this study is that baPWV of
Russians has higher values than those of Japanese.
Therefore, our results suggest that Russians have
a higher risk for atherosclerotic diseases than
Japanese.
We also examined the correlation between
baPWV and age. BaPWV showed signicantly
positive correlation with age in both Japanese and
Russians. This is consistent with previous inves-
tigations (Fujiwara et al. 2004; Mitchell et al.
2004). The signicant positive correlation found
between PWV and age indicates that arteries be-
come less elastic with age, and arterial stiffening
was observed with increasing age (Oren et al.
2003). Aging induces structural and functional
abnormalities such as arterial wall hypertrophy
and degeneration or disorganization of the medial
layer. These changes increase PWV because of
increased arterial stiffness (Tomiyama et al.
2003).
Russian subjects were found to have higher
values of baPWV compared with Japanese sub-
jects matched for age groups. The straight-line
slopes of regression of baPWV vs age were obvi-
ously larger in Russian subjects than in Japanese
subjects. These results suggest that the increase
Fig. 4. Relations between BP and Age in 337 Japa-
nese subjects (A) and 138 Russian subjects (B).
Fig. 3. Relations between baPWV and SBP in 337
Japanese subjects (A) and 138 Russian subjects
(B).
H. Liu et al.268
Comparison of baPWV between Japanese and Russians 269
of baPWV with age occurred earlier, the develop-
ment of atherosclerosis was faster, and an overall
higher cardiovascular risk was shown in Russians
than in Japanese. This trend may be associated
with the differences in their lifestyles.
Obesity might adversely affect cardiovascu-
lar health through association with dyslipidemia,
hypertension, and inammation. Obesity is one
of the factors that dene the metabolic syndrome,
and it might also exert adverse affects on the vas-
cular system by increasing arterial stiffness
(Anuurad et al. 2003). In this study, we found a
mild but signicant correlation between baPWV
and BMI both in Russians and Japanese. This
signicant correlation found between baPWV and
BMI showed that arteries become less elastic with
BMI and arterial stiffening is observed with
increasing BMI. Excess body weight has both
short- and long-term effects on the vascular sys-
tem. The association between excess body weight
and increased vascular stiffness is present in
adults, and the vascular effects of obesity occur at
a very early stage of vascular aging (Anuurad et
al. 2003).
Russian subjects were found to have a larger
increase in BMI compared with Japanese subjects
matched by age. Previous reports have shown
that Japanese also
have lower levels of obesity
and total cholesterol than many
Western European
countries (Martikainen et al. 2001). As for obesi-
ty in Japanese, the population of the morbidly
obese is much smaller than among Europeans and
Americans (Ogura et al. 2004). However, recent-
ly the Japanese lifestyle, especially regarding
dietary habits, has changed drastically, with
changes resembling those that have occurred in
Western countries. These changes in the Japanese
lifestyle have caused an increase in the rate of
obesity in Japan in the past half century. The
inuence of Western culture is greater in Japan
than in other parts of Asia (Notzon et al. 1998).
In this study, we found a signicant correla-
tion between baPWV and SBP both in Russians
and Japanese. These ndings showed that arterial
stiffening was observed with increasing SBP. The
straight-line slopes of regression of baPWV vs
SBP in Russian subjects are obviously larger than
in Japanese subjects, and SBP in Japanese sub-
jects are signicantly lower than that in Russian
subjects in three age groups. These results sug-
gest that the increase of BP with age was earlier
and a higher cardiovascular risk was shown in
Russians than in Japanese.
The higher baPWV values in Russians may
be caused by their unhealthy lifestyles. In
Russians, heavy alcohol consumption and
binge
drinking are common, and very high total choles-
terol levels and high rates of smoking have been
shown (Men et al. 2003; Perlman et al. 2003; Cai
et al. 2004). Total cholesterol was positively
related to arterial stiffness (Kontopoulos et al.
2003), and smoking caused short-time increases
in arterial wall stiffness for smokers in habitual
(Eguchi et al. 2004). Therefore, Russians have a
higher overall risk for cardiovascular diseases
than Japanese. These factors are also consistent
with their high mortality from cardiovascular dis-
eases in Russia. Designing interventions to
change health behaviors in Russia will be impor-
tant for combating these diseases. In Japan, risk
factors of atherosclerosis and preclinical athero-
sclerosis are increasing as the inuence of a west-
ernized lifestyle increases. The PWV values of
Japanese-Americans in Hawaii were greater than
those of the Japanese living in Japan. A western-
ized lifestyle may play an important role in
increased PWV (Shokawa et al. 2005). A healthy
lifestyle is thus also considered to be important
for Japanese to decrease the risk of cardiovascular
diseases.
On the other hand, it is known that smoking
and lack of exercise are atherosclerotic risk fac-
tors (Boreham et al. 2004; Eguchi et al. 2004).
We have no information about smoking rate or
exercise frequency of subjects in this study.
However, we will examine them in our future
studies.
In summary, our data suggest that the
increase of baPWV with age was earlier, the
development of atherosclerosis was faster, and a
cardiovascular risk was higher in Russians than in
Japanese. This may be associated with the differ-
ences in their lifestyles.
H. Liu et al.268
Comparison of baPWV between Japanese and Russians 269
Acknowledgments
This work was partly supported by a Grant-in-
aid for Scientic Research (11480253), a Research
Grant for Cardiovascular Diseases from the Ministry
of Health and Welfare and Program for Promotion
of Fundamental Studies in Health Science of Orga-
nizing for Drug ADR Relief, R & D Promotion and
Product Review of Japan, and Health and Labour
Sciences Research Grants for Research on Advanced
Medical Technology.
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    • "This instrument simultaneously records the baPWV on the left and right sides. The highest baPWV on both sides was determined , and subsequent statistical analyses were performed using these values (Liu et al. 2005; Tomiyama et al. 2005). "
    [Show abstract] [Hide abstract] ABSTRACT: Pulse wave velocity (PWV) is the velocity of a pulse wave traveling a given distance between 2 sites in the arterial system, and is a well-known indicator of arteriosclerosis. Brachial-ankle PWV (baPWV) is a parameter more simple to obtain, compared with the conventional PWV, and is an easy and effective means of evaluating arteriosclerosis. BaPWV can be obtained by only wrapping the four extremities with blood pressure cuffs, and it can be easily used to screen a large number of subjects. Type A behavior has been confirmed as an independent risk factor for the development of coronary heart disease. To examine the relationship between Type A behavior and arteriosclerosis, 307 normal Japanese subjects were classified into either a Type A group (n = 90) or a non-Type A group (n = 217) by using Maeda's Type A Scale. BaPWV was evaluated using a PWV diagnosis device. The baPWV in the Type A group was significantly higher than that obtained in the non-Type A group. The baPWV showed a positive correlation with age both in the Type A group and in the non-Type A group; however, the straight-line regression slope of baPWV versus age in the Type A group was significantly larger than that in the non-Type A group. Therefore, our results suggest that arteriosclerosis might be promoted earlier in subjects expressing the Type A behavior pattern. Type A behavior pattern is confirmed as a risk factor for arteriosclerosis, and may increase the risk of the cardiovascular disease related to arteriosclerosis.
    Full-text · Article · Jun 2006
  • [Show abstract] [Hide abstract] ABSTRACT: Cardiovascular mortality in Russia has become the highest in the world. The Japanese are enjoying long lives, and the mortality caused by cardiovascular diseases has thus far remained at lower levels than that in Russia. Cardio-ankle vascular index (CAVI) is a new index of arteriosclerosis, a known independent risk factor for cardiovascular disease. In this study, we focused on CAVI obtained from Japanese and Russians, and compared their respective cardiovascular risks. We evaluated CAVI in 221 Japanese and 231 Russian healthy subjects. The CAVI was measured by using a CAVI device (CAVI-Vasera VS-1000; Fukuda Denshi, Tokyo, Japan). The CAVI showed a positive correlation with age in both Japanese and Russians. The CAVI in Russians was significantly higher than that obtained in Japanese in all three groups categorized by age (under 39 year-old, 40-59 year-old, and 60-year-old). Body mass index and mean blood pressure in Russians also showed higher values than those of Japanese in all three groups. Our results suggest that arteriosclerosis might be promoted earlier and faster in Russians, and Russians have a higher risk of cardiovascular disease related to arteriosclerosis than Japanese. This might be associated with the differences in their lifestyles.
    Conference Paper · Nov 2006 · The Tohoku Journal of Experimental Medicine
  • [Show abstract] [Hide abstract] ABSTRACT: We have developed a novel assisted-circulation apparatus through the integration of nanotechnology, including nano-optical sensor, nano-DLC sensor, nano-control integrated circuit, nano-particle percutaneous energy transfer and nano-actuator. This new device is completely different from the artificial hearts or the ventricular assist devices currently used. Researches have already established the elemental technology, and we are now entering into the integrated experiment phase. Animal experiments have confirmed the cardioassist effect of the new device. According to the timetable, a chronic experiment on the integrated system, with a view to determining the cardioassist effect of the apparatus, and a durability test will be conducted, before we proceed with a preclinical test.
    Conference Paper · Nov 2006 · The Tohoku Journal of Experimental Medicine
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