N. Ioakeimidis

Hippokration General Hospital, Athens, Athínai, Attica, Greece

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Publications (92)255.21 Total impact

  • Article: PP.20.32
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    ABSTRACT: Objective: Vascular aging, as assessed by structural and functional properties of the arteries, is an independent indicator of cardiovascular risk. We hypothesized that the number presence of hypertension and dyslipidemia determine the progression of arterial stiffening. Design and method: One hundred and forty-two subjects (mean age 51.9 +/- 10.8 years, 94 men) attending the Peripheral Vessels Unit with no established cardiovascular disease were investigated in two examinations over a 2-year period (mean follow-up visit 1.84 years). Subjects had at the beginning and end of the study determinations of carotid-femoral pulse wave velocity (cfPWV), aortic augmentation index corrected for heart rate (AIx75). Based on these measurements the annual absolute changes were calculated. Results: Subjects with hypertension or dyslipidemia had a gradual higher annual progression of cfPWV compared to subjects without hypertension [0.281 m/s/year (95% CI:0.183-0.379) versus 0.102 m/s/year (95% CI:0.020-0.185), P = 0.013] and subjects without dyslipidemia [0.285 m/s/year (95% CI:0.181-0.390) versus 0.130 m/s/year (95% CI:0.060-0.199), P = 0.017]. Annual progression of AIx75 based on presence of hypertension or dyslipidemia was not statistically significant. However, when only subjects < 55 years where considered the progression rate was significantly higher in subjects with dyslipidemia compared to subjects without dyslipidemia [2.98%/year (95% CI:2.05-3.09) versus 1.22%/year (95% CI:0.68-1.75), P = 0.002]. Conclusions: The presence of hypertension and dyslipidemia is associated with accelerated progression of vascular stiffening in the general population. Copyright
    No preview · Article · Jun 2015 · Journal of Hypertension
  • Article: 5B.06
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    ABSTRACT: There is evidence for an inverse association between plasma testosterone and blood pressure. Recently, low plasma testosterone was associated with increased risk of major cardiovascular events in middle-aged hypertensive men. Central (aortic) blood pressures predict cardiovascular mortality with equal ability compared to peripheral (brachial) blood pressures. The aim of the present study was to assess the relationship of plasma total testosterone (TT) with peripheral and central haemodynamics in hypertensive men. We studied 70 non-diabetic, hypertensive men (mean age = 60 years old). Office brachial systolic (bSBP) and diastolic (bDBP) blood pressures were measured according to the ESH guidelines. Pulse pressure (bPP) was calculated as SBP minus DBP. All patients were subject to measurement of aortic systolic (aoSBP), diastolic (aoDBP) and pulse pressures (aoPP) by pulse wave analysis using the Sphygmocor device. Wave reflections were assessed by the measurement of heart-rate corrected augmentation index (AIx75). Plasma TT was measured in all subjects by enzyme immunoassay. The mean value of TT in the whole population was 4.6 ng/ml (hypogonadism was defined as TT < 3.4 ng/ml). Plasma TT was inversely and significantly related to aoSBP (r = -0.26, p = 0.03), aoPP (r = -0.30, p = 0.01) and AIx75 (r = -0.31, p = 0.01) but only marginally related to bSBP (r = -0.22, p = 0.07) and bPP (r = -0.23, p = 0.06). In linear regression analysis, after adjustment for age, smoking, BMI, plasma glucose, total cholesterol and presence of antihypertensive treatment, aoSBP (b = -0.29, p = 0.03), aoPP (b = -0.31, p = 0.02) and AIx75 (b = -0.30, p = 0.03) were independently associated with TT but the relationship of TT with bSBP (b = -0.25, p = 0.06) and bPP (b = -0.23, p = 0.07) remained weak. In hypertensive men, plasma TT is independently and inversely associated with central blood pressures and wave reflections. Considering the adverse prognostic role of central blood pressures on cardiovascular outcomes, the present finding might explain part of the increased cardiovascular risk associated with low testosterone. Whether measurement of central haemodynamics may improve risk stratification in men with low testosterone, warrants further investigation.
    No preview · Article · Jun 2015 · Journal of Hypertension
  • Article: PP.18.10
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    ABSTRACT: Objective: Metabolic syndrome (MS) is associated with increased prothrombotic state. Arterial stiffness and microalbuminuria, markers of target organ damage, predict cardiovascular events and are closely related to MS. However, whether prothrombotic status is associated with arterial stiffness and microalbuminuria in hypertensive patients with MS is not clarified. Design and method: We investigated 524 never-treated hypertensive patients with MS, defined according to ATP III criteria. Arterial stiffness was assessed by measuring carotid-femoral pulse wave velocity (PWV) using the Complior device. Albumin excretion was evaluated after 24 h urine collection by immunonephelometry and albumin-creatinine ratio (ACR) was calculated. Homocysteine and plasminogen activator inhibitor 1 (PAI-1) were measured as prothrombotic indices. Results: In the whole population, both PWV and ACR were associated with age, mean arterial pressure (MAP), glucose, homocysteine and PAI-1 (p < 0.01 for all associations). Moreover, ACR was associated with smoking (p = 0.04) and waist-to-hip (W/H) ratio (p < 0.01). In linear regression analysis, when homocysteine and PAI-1 inserted into the same model, after adjustment for age, gender, smoking, MAP, W/H, glucose, total cholesterol and triglycerides, PWV was independently related to age, MAP, glucose, homocysteine (b = 0.17, p < 0.001) and PAI-1 (b = 0.13, p = 0.002). Similar independent associations were demonstrated between ACR and age, MAP, glucose, smoking and both homocysteine (b = 0.23, p < 0.001) and PAI-1 (b = 0.15, p = 0.001). Conclusions: Target organ damage is independently associated with prothrombotic state in hypertensive patients with MS. Given the prognostic significance of arterial stiffness and microalbuminuria, therapeutic interventions in patients with hypertension and MS should aim, apart from blood pressure reduction and glucose regulation, also towards lowering prothrombotic state. Copyright
    No preview · Article · Jun 2015 · Journal of Hypertension
  • Article: 4D.02
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    ABSTRACT: Objective: Vascular aging, as assessed by structural and functional properties of the arteries, is an independent indicator of cardiovascular risk. We investigated the effect of cardiovascular risk factors (RFs) on the progression of vascular aging. Design and method: One hundred and forty-two subjects (mean age 51.9 +/- 10.8 years, 94 men) attending the Peripheral Vessels Unit with no established cardiovascular disease were investigated in two examinations over a 2-year period (mean follow-up visit 1.84 years). Subjects were classified at baseline according to their number of cardiovascular RFs (from zero to two and more). The RFs were hypertension, dyslipidemia, smoking and diabetes. Subjects had at the beginning and end of the study determinations of carotid-femoral pulse wave velocity (cfPWV), aortic augmentation index corrected for heart rate (AIx75), brachial flow-mediated dilatation (FMD) and carotid intima-media thickness (cIMT). Based on these measurements the annual absolute changes were calculated. Results: Subjects with more RFs had a gradual higher annual progression of cfPWV (0.092 m/s for no RF, 0.153 m/s for 1 RF and 0.316 for more than 2 RFs; p = 0.03) after adjusting for age, gender, baseline waist circumference and annual change of mean blood pressure heart rate and renal function. (Figure) Subjects with more RFs had a trend for a gradual higher annual deterioration of FMD (-0.04% for no RF, -0.14% for 1 RF and -0.51% for more than 2 RFs; p = 0.11) after adjusting for age, gender and baseline FMD. Annual progression of AIx75 between groups was not statistically significant. However, when only subjects <55 years where considered the progression rate was significantly higher in subjects with more RFs (1.04% vs. 1.52% vs. 3.15%, respectively, p = 0.02). Subjects with more RFs did not show an association with a gradual higher annual deterioration of cIMT. There was also a trend for a statistical association between the annual rate of PWV and FMD (P = 0.07). Copyright
    No preview · Article · Jun 2015 · Journal of Hypertension
  • Article: PP.10.04
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    ABSTRACT: Objective: Ikaria, the Greek island of the East Aegean, is among the five places in the world with the highest rates of octagenarians. Aortic stiffness, assessed by aortic pulse wave velocity (PWV), is an independent prognostic factor of cardiovascular and all-cause mortality. However, data on the assessment of aortic stiffness in long-living populations are lacking. The aim of the present study was to evaluate aortic stiffness in the inhabitants of Ikaria island, across a broad spectrum of age. Design and method: We studied a sample of the Ikaria island's inhabitants (N = 153). We divided the population into 4 age groups, each per decade: 1. 40-49 years old (N = 30), 2. 50-59 years old (N = 40), 3. 60-69 years old (N = 35) and 4. over 70 years of age (N = 48). Aortic stiffness was assessed by the measurement of carotid-femoral PWV using the Complior device. Laboratory evaluation was performed in all participants. Results: Systolic blood pressure (SBP) showed a gradual increase proportional to the advanced age group (from 131.1 +/- 11.5 to 136.5 +/- 15.1 to 143.6 +/- 16.4 to 152.4 +/- 21.7 mmHg, p < 0.01). On the contrary, no difference was observed in the levels of diastolic BP among groups (from 81.7 +/- 6.4 to 83.5 +/- 10.1 to 80.8 +/- 7.3 to 81.6 +/- 11.1 mmHg, p = NS). Pulse wave velocity increased gradually across the 4 groups of age (from 7.96 +/- 0.95 to 8.76 +/- 1.25 to 9.89 +/- 1.19 to 12.05 +/- 2.62 m/s, respectively, p < 0.001). In linear regression analysis, PWV was independently related to age group (b = 0.62, p < 0.001), heart rate (b = 0.24, p < 0.001), mean BP (b = 0.20, p < 0.01), creatinine (b = 0.15, p = 0.02) and, inversely, to BMI (b = -0.13, p = 0.03) Conclusions: Age is a powerful determinant of aortic stiffness in the population of Ikaria island. Moreover, haemodynamic parameters, such as arterial pressure and heart rate, as well as kidney function are independently associated with aortic stiffness. Interestingly, obesity is inversely related to PWV, a finding suggesting a possible 'obesity paradox' effect. Future studies in other long-living populations need to confirm the present findings and shed light into the relationship of arterial stiffness with longevity. Copyright
    No preview · Article · Jun 2015 · Journal of Hypertension

  • No preview · Article · May 2015 · Journal of Sexual Medicine

  • No preview · Article · May 2015 · Journal of Sexual Medicine

  • No preview · Article · Dec 2014 · Artery Research

  • No preview · Article · Dec 2014 · Artery Research

  • No preview · Article · May 2014 · European Journal of Heart Failure
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    ABSTRACT: Erectile dysfunction confers an independent risk for cardiovascular events and total mortality. Aortic pulse wave velocity (PWV) is an important predictor of cardiovascular events and all-cause mortality. We investigated whether PWV predicts major adverse cardiovascular events (MACEs) in patients with erectile dysfunction beyond traditional risk factors. MACEs in relation to PWV were analyzed with proportional hazards models in 344 patients (mean age, 56 years) without established cardiovascular disease. During a mean follow-up of 4.7 years (range, 1-8.5 years), 24 of 344 participants (7.0%) experienced a MACE. Subjects in the highest PWV tertile (>8.8 m/s) had a 4-fold higher risk of MACEs compared with those in the lowest PWV tertile (<7.6 m/s; adjusted hazard ratio, 3.97; P=0.035). A PWV value of 7.81 m/s was associated with a negative predictive value (ability to rule out MACE) of 98.1%. Addition of PWV to standard risk factor model yielded correct patient reclassification to higher or lower risk category by 27.6% (P=0.0332) in the whole cohort. Our results show that higher aortic stiffness is associated with increased risk for a MACE in patients with erectile dysfunction without known cardiovascular disease. Aortic PWV improves risk prediction when added to standard risk factors and may represent a valuable biomarker of prediction of cardiovascular disease risk in these patients.
    No preview · Article · Jan 2014 · Hypertension

  • No preview · Article · Sep 2013 · Artery Research
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    ABSTRACT: Purpose: Increased aortic stiffness identify hypertensive patients at high CV risk, independently of systematic coronary risk evaluation (SCORE). Testosterone is associated with aortic stiffness, however whether this association is different in hypertensive patients with low or intermediate SCORE compared to high SCORE subjects is unknown. Methods: Total testosterone (TT) levels were measured in 311 non-diabetic hypertensive men with no evidence of clinical atherosclerosis. Carotid-femoral Pulse Wave Velocity (PWVc-f) was measured as an index of aortic stiffness. Hypogonadism (HypG) was defined when TT levels were below 3.4 ng/ml. Results: The prevalence of hypogonadism in hypertensive patients with low, moderate and high SCORE was 12.5, 15.2 and 28.2%, respectively. PWVc-f was significantly associated with TT in patients with low (r=-0.289, P<0.001) and patients with moderate SCORE (r=-0.274, P<0.001) but not in patients with high SCORE (r=-0.092, P=0.33). Subjects were then categorized by SCORE and further subdivided according to presence/absence of HypG (TT<3.4 ng/ml). PWVc-f values of each SCORE/testosterone category are shown in figure. In low and moderate SCORE categories, patients with HypG had higher PWVc-f (by 0.92 m/s, P<0.01 and 0.55 m/s, P<0.05, respectively) compared to subjects with TT concentration above the cut off level for biochemical definition of HypG. On the contrary, in high SCORE category, PWVc-f between patients with HypG and men with normal levels did not differ. It can be noted also that low and moderate SCORE hypertensive patients with HypG had already elevated PWVc-f as compared to high SCORE men with normal TT.
    Preview · Article · Sep 2013 · Artery Research

  • No preview · Article · Sep 2013 · Artery Research
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    ABSTRACT: Purpose: Music has been correlated to cardiovascular health and used as additional therapy in patients with cardiovascular disease, however, few are known on the impact of music on arterial stiffness and central hemodynamics which are both predictors of cardiovascular risk. We investigated the effect of rock and classical music on arterial stiffness and wave reflections in young healthy people. Methods: We studied 20 healthy individuals (22.5±2.5 years, 10 males), free of cardiovascular risk factors except smoking (10%). Volunteers were studied on three different occasions and listened to a 30-minute music track (classical, rock or no music for the sham procedure). Carotid-femoral pulse-wave velocity (PWV) and pulse wave analysis were used to assess aortic stiffness and central hemodynamics. Measurements were made before, immediately after and 30 minutes after each track. Volunteers were classified as classical or rock music fans, according to their answers to a questionnaire. Results: Augmentation index (AIx) and augmented pressure (AP) were significantly decreased by both music genres compared to sham procedure with a maximum decrease noted immediately post music by 8.3% and 1,56 mmHg, respectively (all p<0.001). Music had no significant effect on PWV. Classical and rock music led to a more potent response in classical and rock fans, respectively (figure).
    Preview · Article · Sep 2013 · Artery Research

  • No preview · Article · Sep 2013 · Artery Research
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    ABSTRACT: Purpose: Aortic stiffness is a marker of subclinical vascular damage in patients with essential hypertension. Low testosterone has been associated with increased aortic stiffness. We investigated whether this association could be mediated or modified by hypertension severity as well as inflammatory status. Methods: Total testosterone (TT) levels were measured in 211 non-diabetic hypertensive men (mean age 58±10 yrs) with no evidence of clinical atherosclerosis. Hypogonadism (HypG) was defined when TT levels were below 3.4 ng/ml. Carotid-femoral Pulse Wave Velocity (PWVc-f) was measured as an index of aortic stiffness. Results: Analysis with and without adjustment for age and mean pressure showed that PWVc-f was inversely and significantly correlated with total TT. This association depended on C-reactive protein (CRP) levels (p for interaction <0.05). Subjects were categorized according to tertiles of hsCRP level [Group 1: first tertile (0.20–0.92 mg/L), Group 2: second tertile (0.94–1.78 mg/L), Group 3: third tertile (1.82–8.15 mg/L)]. Among men in high CRP tertile, patients with HyG had significantly higher PWVc-f compared to subjects with TT concentration above the cut off level for biochemical definition of HypG (9.56 m/s vs 8.74 m/s respectively, p<0.01, figure). The difference remained significant after adjustment for age and mean pressure (F=4.651, P=0.015). By contrast, among men in the low and intermediate tertile, mean PWVc-f was similar between HypG patients and subjects with normal TT (p=NS, Figure 1).
    Preview · Article · Aug 2013 · European Heart Journal
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    ABSTRACT: Purpose: Erectile dysfunction (ED) carries an independent risk for cardiovascular (CV) events. Evidence points towards a grading effect of the severity of ED in the predictive ability of this condition for CV events and all-cause mortality. However, the overall quantitative estimate of this ability has not been fully clarified. We conducted a meta-analysis of all longitudinal studies for investigating the role of severity of ED in predicting risk of clinical events. Methods: A comprehensive search of electronic databases was conducted through January 2013. Longitudinal studies that reported relative risk (RR) estimates with 95% confidence intervals (CI) of severity of ED were included. Of the 5 studies included (101,147 participants, mean follow-up 6.4 years), all reported results on total CV events and 3 on all-cause mortality (98,212 individuals). Participants were grouped according to their severity of ED in 3 different groups. The reference group included participants with no or mild ED, the second group included participants with moderate ED and the third group participants with severe ED. Results: The pooled relative risks (RRs) for total CV events were 1.32 (95% CI: 1.20 to 1.45, p<0.001) for men with moderate ED and 1.92 (95% CI: 1.37 to 2.68, p<0.001) for men with severe ED compared with men with no/mild ED (p=0.036 for comparison between men with moderate ED vs. severe ED). The pooled RRs for all-cause-mortality were 1.29 (95% CI: 1.01 to 1.65, p=0.043) for men with moderate ED and 1.83 (95% CI: 1.26 to 2.66, p=0.002) for men with severe ED compared with men with no/mild ED (p=0.127 for comparison between men with moderate ED vs. severe ED). Conclusions: ED is associated with increased risk of CV events and all-cause mortality. RR for CV events is higher at men with severe ED compared to men with moderate ED, implying a grading effect of the severity of ED and augmenting the pathophysiological link between ED and CV disease. This grading effect of ED severity is less apparent for all-cause mortality.
    Preview · Article · Aug 2013 · European Heart Journal
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    ABSTRACT: Purpose: Studies of the association between arterial stiffness and atherosclerosis are contradictory. We studied arterial stiffness and central pressures in relation to carotid atherosclerosis severity assessed by B-mode ultrasound. Methods: Aortic stiffness and wave reflections were measured in 61 patients with carotid atherosclerotic plaques and no history of coronary heart disease or cerebrovascular disease (age 61±8 years, 12% women, 29% diabetics). Carotid-femoral pulse-wave velocity (PWV) and analysis were used to assess aortic stiffness and wave reflection indices, respectively. Carotid ultrasound examination included assessment of atherosclerotic plaques in the extracranial carotid arteries. Results: According to the degree of stenosis, people affected with carotid occlusive disease were classified into three groups: < 50% (n=25); 50-70% (n=17) and >70% (n=19). Carotid-femoral PWV, augmentation index (AIx), augmented pressure (AP) and aortic pressures (systolic and pulse pressure) were found to have a strong positive association with severity of plaques in the carotid artery (P: for trend <0.001 for all associations). Results were similar after adjustment for age, sex and cardiovascular risk factors and after exclusion of subjects with diabetes (analysis by ANCOVA). On post hoc analysis, PWV and wave reflection indices were significantly higher in patients with >70% carotid stenosis compared with the values of subjects with < 50% and 50-70% carotid stenosis (figure).
    Preview · Article · Aug 2013 · European Heart Journal
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    ABSTRACT: Purpose: The systematic coronary risk evaluation (SCORE) predicts a patient's 10-year risk of developing cardiovascular disease. Many risk factors included in its calculation influence or are influenced by circulating testosterone. Low levels of testosterone are involved in the pathophysiology of erectile dysfunction (ED). To investigate the possible association between testosterone and cardiovascular risk, as defined by SCORE, a database of ED patients was analyzed. Methods: SCORE in relation to total testosterone (TT) were analyzed with proportional hazards models in 415 patients (mean age 56 years). Hypogonadism (HypG) was defined when TT levels were below 3.4 ng/ml. Exclusion criteria included pre-existing coronary artery disease, stroke and diabetes. Results: There was a positive association between TT levels and penile peak systolic velocity (p<0.01) and negative associations between TT levels and body mass index (p<0.01), systolic blood pressure (p<0.01) and blood pressure medication use (p<0.01). SCORE was negatively associated with TT (r= -0.267, p<0.001). Patients with high SCORE (>5%) were more likely to have laboratory HypG as compared to subjects with moderate (1-5%) and low SCORE (<1%) (figure).
    Preview · Article · Aug 2013 · European Heart Journal

Publication Stats

182 Citations
255.21 Total Impact Points

Institutions

  • 2007-2013
    • Hippokration General Hospital, Athens
      Athínai, Attica, Greece
  • 2007-2011
    • Harokopion University of Athens
      Athínai, Attica, Greece
  • 2007-2010
    • Κωνσταντοπούλειο νοσοκομείο Νέας Ιωνίας (Η Αγία Όλγα)
      Athínai, Attica, Greece