Arterial Stiffness and Peripheral Arterial Disease

The Diagnosis Center, Hotel-Dieu Hospital, Paris, France Of the atherosclerotic diseases, peripheral arterial disease is the most characterized by its association with systolic hypertension, increased arterial stiffness and disturbed wave reflection. This disease raises the question to which extent sclerosis in 'atherosclerosis' is necessary per se to cause an increase in systolic blood pressure. Copyright 2007 S. Karger AG, Basel Arteriosclerosis obliterans or peripheral arterial disease (PAD)...

Calcifications Arterial Stiffness and Atherosclerosis

Mackey Lakshmi Venkitachalam Kim Sutton-Tyrrell Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pa., USA Vascular calcification can occur in either the intimal or medial layers of the arterial wall. Intimal calcification is associated with atherosclerosis, which is characterized by lipid accumulation, inflammation, fibrosis and development of focal plaques. Medial calcification is associated with arteriosclerosis, i.e. age- and...

Target Trials Showing Selective SBP Reduction

Any antihypertensive drug reducing arteriolar tone, and therefore mean arterial pressure, may decrease SBP through a passive reduction of arterial stiffness and change in the timing of wave reflections (see chapter by Safar, pp 1-18) 24, 25 . However, in the case of subjects with a disproportionate increase of SBP over DBP, the target mechanisms are rather a decrease of ventricular ejection, an active decrease of arterial stiffness or a change in wave reflections. Regarding ventricular...

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Inverse correlation with triglycerides and non-HDL cholesterol Some of the published studies relating lipids to arterial stiffness. SAC Systemic arterial compliance CHD coronary artery disease PWV pulse wave velocity CRP C-reactive protein. Taquet et al. 24 were amongst the first to assess the relationship between cholesterol and aortic pulse wave velocity in 429 healthy middle-aged women. Although they found weak associations between some lipid fractions and pulse wave velocity, they were...

Small Arteries and Arterioles

Aging and disease modify vascular structure and function. Hypertension is associated with vasoconstriction, VSM hypertrophy and rarefaction in the microcirculation. Pulse volume, pressure, and velocity are important physiological variables that may function as biologic signals to the endothelium and VSM of the microcirculation. The capillary pulse volume modifies and in turn is modified by microcirculatory structure and function. For example, both MAP and PP affect glomerular filtration rate...

Mechanistic Basis of the Efficacy of Statins in Atherothrombosis

In addition to their well-documented effects on serum lipid levels, there are several other postulated mechanisms by which statins exert a variety of beneficial effects on the determinants of atherothrombosis. These effects are summarized in table 1. Most of these effects have been attributed to the modification of the altered biology of endothelial cells and vascular SMCs as well as coagulation and platelet activation pathways. In particular, statins enhance the activity of endothelial nitric...

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SMCs transformation from a contractile to a synthetic proliferative phe-notype is, in part, modulated by integrin a5p1 69 . Interestingly, integrins a1p1, a2p1, and a are upregulated during the phenotypic transformation 70-72 . As mentioned before, contact with the surrounding collagen matrix may control ECM production in phenotypically modified SMCs. In this regard, cell adhesion studies in SMCs indicate that the a1p1 and a2p1 integrins may be the dominant receptors for triple helical domains...

Atherosclerosis Arterial Stiffness and Antihypertensive Therapy

As shown earlier in this book, the links between atherosclerosis, arterial stiffness, age and high BP are often difficult to establish, particularly according to age. Many atherosclerotic alterations (AA) are subclinical and difficult to define in routine clinical investigations. On the other hand, many markers have been proposed, such as defects in vascular relaxation, alterations in endotheli-um-dependent flow dilatation and or presence of atherosclerotic plaques (see chapter by Baldewsing et...

Mechanical Stress and Arterial Remodeling

An arterial wall is a complex tissue composed of different cell populations capable of structural and functional changes, in response to direct injury and atherogenic factors, or to modifications of long-term hemodynamic conditions. The principal geometric modifications induced by hemodynamic alterations are changes of arterial lumen and or arterial wall thickness due to activation, proliferation and migration of VSM cells, and rearrangements of cellular elements and ECM 12-18 . The mechanical...

Amplification and Reflection Central vs Peripheral BP

The morphology of a pulse contour at any point along the vascular tree represents the sum of the forward and reflected pressure waves at that point. Pulse wave morphology is unique in each artery because of differences in time of arrival of the forward and reflected pressure waves. Unlike diastolic or mean BP, systolic BP is thus not constant throughout the arterial tree. In the arm, the amplitude of the forward wave is generally much greater than the amplitude of the reflected wave, so...

Relationship between Atherosclerosis and Hyperhomocysteinemia

Homocysteine is a sulfur-containing amino acid, which in humans can only be derived from the demethylation of the essential amino acid methio-nine. S-adenosylmethionine and S-adenosylhomocysteine are intermediates in this important biochemical pathway, called transmethylation, in which S-adenosylmethionine donates its methyl group to a variety of acceptors, such as guanidinoacetic acid, phosphatidylethanolamine, norepinephrine, DNA, RNA and protein amino acid residues. This reaction is driven...

Carotid Atherosclerosis Arterial Stiffness and Stroke Events

Enrico Agabiti-Rosei Maria Lorenza Muiesan Internal Medicine, Department of Medical and Surgical Sciences, University of Brescia, Brescia, Italy Assessment of intima-media thickness or of measures of large arteries compliance may identify patients at increased risk for stroke. In fact, carotid atherosclerosis and arterial stiffness are both related to risk factors associated with the occurrence of stroke. In addition, several cross-sectional studies have shown that risk factors associated with...

Effects of Statins on Vascular Elasticity

Determinant of Vascular Elasticity and Compliance Vascular elasticity or compliance or stiffness is a major determinant of vascular resistance. The elasticity is determined by all components of the vessel wall, including the endothelium, SMCs, and the interstitium composed primarily of fibroblasts. Table 2. Evidence for blood pressure-lowering effect of statins Table 2. Evidence for blood pressure-lowering effect of statins Fluvastatin lowered blood pressure by 8-16 mm Hg Patients with...

Statins and Blood Pressure

Interaction of Dyslipidemia and Renin-Angiotensin System RAS Interactions between dyslipidemia and activation of neurohumoral systems, such as RAS, may not only explain the frequent coexistence of hypertension and dyslipidemia, but also play an important role in the pathogenesis of atherosclerosis. Experimental data suggest that the effects of Ang II and lipo-proteins on atherogenic risk are not independent and that the pathways by which Ang II and dyslipidemia lead to vascular disease may...

Pulse Transmission in Conduit Arteries

There has been a long tradition of assuming that changes in brachial cuff BP are similar to those at the heart or in peripheral target organs. As discussed, this is simply not the case due to intra- and interindividual differences in forward wave transmission and wave reflection 45, 46 . Differences in systolic BP from one site to another can be traced to alterations in the timing and amplitude of the forward and reflected pressure waves fig. 3 . Unlike diastolic or mean BP, systolic BP is thus...