RESUMEN
BACKGROUND AND AIMS: The progression of arterial stiffness is accelerated by aging, although the underlying mechanisms have not yet been clarified. This prospective observational study was conducted to clarify whether longitudinal changes in the serum calcium/phosphate levels are associated with the accelerated progression of arterial stiffness with age. METHODS: In a cohort of employees at a construction company (1507 middle-aged Japanese men), the serum calcium/phosphate levels and brachial-ankle pulse wave velocity (baPWV) were measured at the start and at the end of a 3-year study period. RESULTS: A general linear model multivariate analysis revealed a significant interaction of the 2 factors {age and longitudinal changes of the serum calcium levels (delCa) during the follow-up period} on the longitudinal changes of the baPWV during the study period (delPWV). The delCa was significantly correlated with the delPWV even after adjustments for covariates in subjects aged ≥48 years. The delPWV in subjects aged ≥48 years with the delCa in the upper tertile (69 ± 137 cm/s) was significantly larger than that in the other groups even after adjustments for covariates (e.g., del PWV in subjects aged <48 years with the delCa in the lower tertile = 1 ± 94 cm/s) (p < 0.01). CONCLUSIONS: The association between the arterial stiffness and serum calcium levels differed with age. Pathophysiological abnormalities related to increased serum calcium levels appeared to be associated with accelerated progression of arterial stiffness with age.
Asunto(s)
Envejecimiento/sangre , Calcio/sangre , Enfermedades Cardiovasculares/etiología , Rigidez Vascular , Adulto , Factores de Edad , Índice Tobillo Braquial , Biomarcadores/sangre , Enfermedades Cardiovasculares/sangre , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/fisiopatología , Progresión de la Enfermedad , Humanos , Modelos Lineales , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Análisis Multivariante , Valor Predictivo de las Pruebas , Estudios Prospectivos , Análisis de la Onda del Pulso , Factores de Riesgo , Factores de Tiempo , Regulación hacia ArribaRESUMEN
BACKGROUND: Elevated serum levels of cardiac troponin T (cTnT) and N-terminal fragment of B-type natriuretic peptide (NT-proBNP), and also increased arterial stiffness/abnormal central hemodynamics, are well-known risk factors for future cardiovascular events. The present study was conducted to clarify which of the two - the serum level of cTnT or that of NT-proBNP - might be more closely associated with the arterial stiffness/central hemodynamics. METHODS: In 2374 male employees of a company (46±9 years), the following parameters were measured: second peak of the radial systolic pressure waveform (SP2), radial augmentation index (rAI), PP2 (SP2 minus the diastolic blood pressure), brachial-ankle pulse wave velocity (baPWV), and serum levels of cTnT and NT-pro BNP. RESULTS: After adjustments for confounding variables, binary logistic regression analyses demonstrated that baPWV was associated with a significant odds ratio for serum NT-proBNP ≥125pg/mL (1.690; 95% confidence interval=1.136-2.514, p=0.002) and rAI was associated with a significant odds ratio for serum NT-proBNP ≥55pg/mL (1.205; 95% confidence interval=1.012-1.435, p=0.036). The baPWV, rAI, SP2, and PP2 were not associated with significant odds ratios for elevated serum cTnT levels (≥0.014ng/mL and ≥0.010ng/mL). CONCLUSIONS: In the middle-aged male worksite cohort studied, increased arterial stiffness/abnormal central hemodynamics appeared to be associated with elevated serum NT-proBNP levels, rather than with minimally elevated serum cTnT levels. This difference may be one of the plausible explanations for the independency of the predictive values of the two serum markers for future cardiovascular events.
Asunto(s)
Enfermedad de la Arteria Coronaria/fisiopatología , Péptido Natriurético Encefálico/sangre , Fragmentos de Péptidos/sangre , Troponina T/sangre , Rigidez Vascular , Índice Tobillo Braquial , Biomarcadores/sangre , Velocidad del Flujo Sanguíneo , Estudios de Cohortes , Enfermedad de la Arteria Coronaria/sangre , Estudios Transversales , Humanos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Flujo Pulsátil , Factores de Riesgo , Tokio , Lugar de TrabajoRESUMEN
We examined whether the central aortic systolic blood pressure, a marker of the function of the systemic arterial tree, might be a more powerful predictor of the development of hypertension than the brachial-ankle pulse wave velocity, a marker of the stiffness of the large- to middle-sized arteries, independent of the conventional risk factors for the development of hypertension. In 1268 Japanese men without hypertension (43±8 years old), the relationships between three variables (the second peak of the radial pressure waveform (SP2), brachial-ankle pulse wave velocity and conventional risk factors measured at the first examination) with the presence of hypertension at the second examination (after 3 years' follow-up) were examined. Hypertension was detected at the second examination in 154 men. The best cutoff points of the brachial-ankle pulse wave velocity and SP2, for predicting the development of hypertension, were 12.7 m/s and 109 mm Hg, respectively. The results of a logistic regression analysis confirmed that an SP2 of ≥109 mm Hg (odds ratio=8.493, P<0.001) was a more powerful predictor of the development of hypertension than a brachial-ankle pulse wave velocity of ≥12.7 m/s, independent of the conventional risk factors. The net reclassification index of SP2 (at the best cutoff point) to brachial-ankle pulse wave velocity was 0.211 (P<0.001), indicating that SP2 is a better predictor of the development of hypertension than brachial-ankle pulse wave velocity. In middle-aged Japanese men without hypertension, SP2 may be a more powerful predictor of the development of hypertension than the assessment of stiffness in large to middle-sized arteries independent of the conventional risk factors.
Asunto(s)
Índice Tobillo Braquial , Presión Sanguínea/fisiología , Hipertensión , Rigidez Vascular/fisiología , Adulto , Consumo de Bebidas Alcohólicas/epidemiología , Pueblo Asiatico/estadística & datos numéricos , Velocidad del Flujo Sanguíneo/fisiología , Estudios de Seguimiento , Humanos , Hipertensión/diagnóstico , Hipertensión/epidemiología , Hipertensión/fisiopatología , Modelos Logísticos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Prospectivos , Flujo Pulsátil/fisiología , Factores de RiesgoRESUMEN
BACKGROUND: It has not been fully clarified as to which marker related to arterial stiffness or central hemodynamics might be most closely associated with the blood natriuretic peptide levels. The present cross-sectional study was conducted to examine the strength of the relationships of the arterial stiffness and central hemodynamic indices with the serum N-terminal fragment B-type natriuretic peptide (NT-pro BNP) levels. METHODS AND RESULTS: In a total of 2,657 male employees of a company (46±9 years old), the first and second peaks of the radial systolic pressure waveform (SBP1 and SBP2, respectively), the radial augmentation index (rAI), the PP2 (SBP2 minus the diastolic blood pressure), the brachial-ankle pulse wave velocity (baPWV), and the serum NT-pro BNP levels were measured. Even after adjustments for confounding variables, the SBP1, SBP2, PP2, rAI and baPWV showed a significant positive association with the serum NT-pro BNP levels. A stepwise multivariate linear regression analysis demonstrated that among these variables, only PP2 contributed significantly to the serum NT-pro BNP levels (ß=0.176, partial R-square=0.017, P<0.001). CONCLUSIONS: In middle-aged Japanese men, among the parameters related to arterial stiffness and central hemodynamics, PP2 showed the closest relationship with the serum NT-pro BNP levels. Therefore, elevation of the serum NT-pro BNP levels appears to reflect, at least in part, the pathophysiological abnormalities related to increased central pulse pressure.
Asunto(s)
Presión Sanguínea , Péptido Natriurético Encefálico/sangre , Análisis de la Onda del Pulso , Rigidez Vascular , Adulto , Estudios de Cohortes , Humanos , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVE: We examined the relationship among the serum omega-3 and omega-6 fatty acid (O3FA and O6FA) levels, serum C-reactive protein (CRP) levels, and arterial stiffness/wave reflection (AS/WR) in healthy Japanese men. METHODS: In 2206 Japanese healthy men, parameters related to the AS/WR (i.e., brachial-ankle pulse wave velocity and radial arterial pulse wave analysis) were measured. RESULTS: No significant inverse relationships were observed between the serum O3FA levels and the AS/WR-related parameters. Adjusted values of the AS/WR-related parameters and serum CRP levels were higher in the subjects with serum O6FA levels in the highest tertile than in those with serum O6FA levels in the lowest tertile. CONCLUSIONS: In healthy Japanese men with known high dietary intakes of O3FAs, the serum O3FA levels may not reflect the pathophysiological abnormalities related to AS/WR. Increased serum O6FA levels appeared to be independently associated with the unfavorable conditions related to AS/WR and inflammation.
Asunto(s)
Pueblo Asiatico , Arteria Braquial/fisiopatología , Proteína C-Reactiva/análisis , Ácidos Grasos Omega-3/sangre , Ácidos Grasos Omega-6/sangre , Inflamación , Enfermedad Arterial Periférica , Flujo Pulsátil , Arteria Radial/fisiopatología , Adulto , Índice Tobillo Braquial , Pueblo Asiatico/estadística & datos numéricos , Biomarcadores/sangre , Velocidad del Flujo Sanguíneo , Adaptabilidad , Humanos , Inflamación/sangre , Inflamación/etnología , Inflamación/inmunología , Inflamación/fisiopatología , Japón , Masculino , Persona de Mediana Edad , Enfermedad Arterial Periférica/sangre , Enfermedad Arterial Periférica/etnología , Enfermedad Arterial Periférica/inmunología , Enfermedad Arterial Periférica/fisiopatologíaRESUMEN
An age-related association of blood pressure in the non-hypertensive range (non-hypertensive blood pressure) to the cardiovascular mortality has been demonstrated. This prospective study was conducted to examine the effects of age, persistence of pre-hypertension (preHYP) during the study period, and the interaction between these factors on the rate of progression of arterial stiffening. Among 1563 healthy Japanese subjects without hypertension (age range: 29-95 years), the brachial-ankle pulse wave velocity (baPWV) was measured twice (i.e., at baseline and 5-6 years later). The adjusted (including for blood pressure) value of the annual rate of increase of the baPWV during the study period (delPWV) increased in a linear manner along with the age category (categorized into 29-39 years, 40-59 years, and 60 years or older for this study) and the evolutional category of non-hypertensive blood pressure during the study period (categorized into persistence of normal blood pressure, borderline evolution, and persistence of preHYP), and a significant interaction between the two in relation to the delPWV was also noted (non-standardization coefficient=5.08 [95% confidence interval=3.24-6.92], F-value=29.40, P<0.01). In conclusion, the present study suggests that persistence of preHYP is associated with accelerated structural stiffening of the large- to middle-sized arteries, and that age may exert a synergistic effect on this acceleration of arterial stiffening. Thus, persistence of preHYP also appears, like hypertension, to be associated with progressive vascular damage, and this progression may be more pronounced in middle-aged and elderly subjects.
Asunto(s)
Envejecimiento , Arterias/patología , Prehipertensión/fisiopatología , Rigidez Vascular , Adulto , Anciano , Anciano de 80 o más Años , Índice Tobillo Braquial , Presión Sanguínea , Progresión de la Enfermedad , Femenino , Humanos , Japón , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: Interactions among age, arterial stiffness, and pressure wave reflection affect the central blood pressure (CBP). We evaluated our hypothesis that the contribution of the wave reflection to the CBP indexes is reduced at higher levels of arterial stiffness, independent of the effect of age. METHODS: In 2,691 Japanese men aged <60 years old who are not suffering from cardiovascular disease or receiving medications for cardiovascular risk factors, the brachial-ankle pulse wave velocity (PWV), radial augmentation index (AI), and second peak of the radial pressure waveform (SBP2), a marker of CBP, were measured. RESULTS: The increase in the radial AI associated with increase of the brachial-ankle PWV became attenuated at brachial-ankle PWV values of ≥15 m/s. Stepwise multivariate linear regression analysis demonstrated that 33.6% of the total variation in the value of SBP2 and 54.0% of the total variation in the value of the SBP2 minus the diastolic blood pressure, a marker of the central pulse pressure (CPP), were accounted for by the change of the radial AI in the group with brachial-ankle PWV values of <15 m/s, with the corresponding percentages of 16.2 and 38.0% in the group with brachial-ankle PWV values of ≥15 m/s (P < 0.01). CONCLUSIONS: In non-elderly Japanese men, the contribution of the wave reflection to the CBP indexes may be reduced in subjects with higher levels of arterial stiffness, independent of the effect of age. Notwithstanding, the wave reflection may still be the major determinant of the CPP at any given level of arterial stiffness.
Asunto(s)
Índice Tobillo Braquial , Presión Sanguínea/fisiología , Resistencia Vascular , Rigidez Vascular , Adulto , Pueblo Asiatico , Velocidad del Flujo Sanguíneo , Humanos , Masculino , Persona de Mediana Edad , Flujo PulsátilRESUMEN
OBJECTIVE: We evaluated the temporal association between arterial stiffening and the early stage of renal functional decline. METHODS: In 2053 Japanese employees with an estimated glomerular filtration rate (GFR) of > or = 60 ml/min/1.73 m(2) plus no proteinuria (40+/-8 years old) at the start, brachial-ankle pulse wave velocity (baPWV) and serum C-reactive protein (CRP) were measured before and after a 5-6-year follow-up period. RESULTS: After adjusting for confounding variables including serum CRP levels, higher baseline baPWV was associated with lower follow-up GFR (value expressed as per doubling: -16; 95% confidence interval: -24 to -9; P<0.01) and with higher annual rate of decline in GFR (value expressed as per doubling: -3; 95% confidence interval: -4 to -2; P<0.01). Every m/s higher baPWV was associated with a 36% increased odds (95% CI 1.09-1.70; P<0.01) for a development of a GFR <60 ml/min/1.73 m(2) at follow-up. In contrast, baseline GFR was not associated with follow-up baPWV (P=0.08) or the annual rate of change in baPWV (P=0.11). CONCLUSION: In a Japanese occupational cohort with normal renal function/early chronic kidney disease, elevated arterial stiffness was an independent risk factor for the decline in renal function. CRP did not appear to exert any significant influence on this association.
Asunto(s)
Arterias/fisiopatología , Arteriosclerosis/fisiopatología , Tasa de Filtración Glomerular , Enfermedades Renales/fisiopatología , Riñón/fisiopatología , Adulto , Índice Tobillo Braquial , Arteriosclerosis/sangre , Arteriosclerosis/epidemiología , Biomarcadores/sangre , Proteína C-Reactiva/metabolismo , Enfermedad Crónica , Progresión de la Enfermedad , Elasticidad , Femenino , Estudios de Seguimiento , Humanos , Inflamación/sangre , Inflamación/fisiopatología , Japón/epidemiología , Enfermedades Renales/epidemiología , Modelos Lineales , Modelos Logísticos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Medición de Riesgo , Factores de Riesgo , Factores de TiempoRESUMEN
BACKGROUND: This prospective cross-sectional study was conducted to clarify whether serum cystatin C levels might be associated with not only arterial stiffness, but also the pressure wave reflection, in middle-aged Japanese subjects with normal renal function or mild chronic kidney disease (CKD) (stage 1 or 2 CKD) (i.e., creatinine-based estimate of the glomerular filtration rate (eGFRcr) > or =60 ml/min/1.73 m(2) plus a result of the urine dipstick test for proteinuria of <1+). METHODS: In 2,904 Japanese subjects (45 +/- 9 years old), the brachial-ankle pulse wave velocity (baPWV), radial augmentation index adjusted to a heart rate of 75 beats/min (rAI75), and serum cystatin C levels were measured. RESULTS: Multivariate linear regression analysis demonstrated that the serum cystatin C levels were significantly correlated with the baPWV (standardized coefficient = 0.04, P < 0.01) even after adjustments for confounding variables, but not with the AI75 (standardized coefficient = 0.01, P = 0.71). adjusted values of the baPWV, but not those of rAI75, were higher in subjects with serum cystatin C levels in the highest tertile than in those with serum cystatin levels in the intermediate or lowest tertile. CONCLUSION: In middle-aged Japanese subjects with normal renal function or mild CKD (stage 1 or 2 CKD) (eGFRcr >60 ml/min/1.73 m(2) plus a result of the urine dipstick test for proteinuria of <1+), the serum cystatin C levels may reflect facet of cardiovascular risk associated with arterial stiffness, but not that associated with the pressure wave reflection.
Asunto(s)
Cistatina C/sangre , Enfermedades Renales/sangre , Adulto , Índice Tobillo Braquial , Enfermedades Cardiovasculares/sangre , Enfermedades Cardiovasculares/etiología , Enfermedad Crónica , Creatinina/sangre , Estudios Transversales , Femenino , Tasa de Filtración Glomerular/fisiología , Frecuencia Cardíaca/fisiología , Humanos , Enfermedades Renales/complicaciones , Enfermedades Renales/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Flujo Pulsátil/fisiología , Índice de Severidad de la EnfermedadRESUMEN
OBJECTIVES: We prospectively and longitudinally determined the effects of smoking on the progression of arterial stiffening as well as the involvement of inflammation in this process. BACKGROUND: Smoking is an important avoidable risk factor for cardiovascular disease, and arterial stiffness might be involved in the pathophysiology. No prospective study has examined the effect of continuous smoking on the age-associated progression of arterial stiffening. METHODS: In 2,054 Japanese subjects (40 +/- 8 years of age), brachial-ankle pulse wave velocity (baPWV) and serum C-reactive protein (CRP) levels were measured at the baseline and the end of a 5- to 6-year follow-up period. RESULTS: The annual rate of change of the baPWV during the study period was significantly greater in the continuous heavy smokers (11.0 +/- 1.9 cm/s/year, n = 181) than in the never-smokers (5.5 +/- 0.6 cm/s/year, n = 1,018). This difference remained significant even after adjustments for covariates, including age (p < 0.05). In continuous smokers (n = 493), the mean number of cigarettes smoked/day during the study period showed a significant relationship with the changes in baPWV. No significant relationship was found between the change in baPWV and serum CRP levels. CONCLUSIONS: Continuous smoking might accelerate the age-associated progression of structural stiffening of the large- to middle-size arteries. We also found a dose-response relationship between cigarette consumption and accelerated arterial stiffening. However, we failed to confirm any significant association between the rate of arterial stiffening and the serum CRP levels in the smokers.
Asunto(s)
Arterias/fisiopatología , Fumar/fisiopatología , Adulto , Factores de Edad , Índice Tobillo Braquial , Arterias/patología , Proteína C-Reactiva/análisis , Progresión de la Enfermedad , Elasticidad , Femenino , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Fumar/sangreRESUMEN
OBJECTIVES: Temporal associations between rates of increases in pulse wave velocity (PWV), a marker of arterial stiffness, and heart rate (HR) indices (baseline HR and changes in HR) as well as inflammatory markers were examined. METHODS: In 1795 apparently healthy Japanese individuals (mean age 39 +/- 8 years old), brachial-ankle PWV (baPWV) and serum C-reactive protein (CRP) levels were measured at the baseline and at the end of a 5-6-year follow-up period. RESULTS: Heart rate at the baseline examination and changes in HR during the follow-up period were significantly associated with the corresponding changes in baPWV during the study period (nonstandardized co-efficient = 0.14, 95% confidential interval = 8.14 x 10-0.19, P < 0.01) even after the adjustment for atherogenic risk factors. When individuals were divided into four groups categorized by baseline HR (higher or lower than median HR) and increase/decrease in HR during the study period, serum CRP levels and atherogenic risk factors were significantly worse in the individuals with high baseline HR accompanied by increased HR during the study period. There was no significant relationship between the changes in the baPWV and the changes in the serum CRP levels. Even after the adjustment for confounding factors, changes in baPWV were significantly higher in this group than the other three groups (P < 0.01). CONCLUSIONS: The study results suggest a synergistic role of high baseline HR and increase in HR during the study period in accelerating age-associated increases in PWV. Inflammation might not be a major factor for this relationship.
Asunto(s)
Fenómenos Fisiológicos Cardiovasculares , Frecuencia Cardíaca/fisiología , Pulso Arterial , Adulto , Tobillo/irrigación sanguínea , Tobillo/fisiología , Pueblo Asiatico , Biomarcadores/sangre , Velocidad del Flujo Sanguíneo/fisiología , Determinación de la Presión Sanguínea/instrumentación , Arteria Braquial/metabolismo , Arteria Braquial/fisiología , Proteína C-Reactiva/metabolismo , Estudios de Cohortes , Electrocardiografía , Femenino , Humanos , Japón , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de RiesgoRESUMEN
BACKGROUND: This 3-year prospective study in middle-aged Japanese men with prehypertension examined the usefulness of the plasma levels of C-reactive protein (CRP) and the brachial-ankle pulse wave velocity (baPWV) as predictors of the development to hypertension as compared with other previously proposed markers, such as the age, initial blood pressure, heart rate, obesity, smoking, and alcohol intake. METHODS AND RESULTS: Among 777 men with prehypertension (42 +/- 8 years old), hypertension developed in 58 men during the observation period. Significant elevation of blood pressure during this 3-year follow-up was not observed in some, but not all, subjects. Univariate linear regression analysis demonstrated that baPWV, body mass index (BMI), age, and alcohol intake, but not plasma levels of CRP, heart rate, and smoking, on the first examination were significant variables related to the changes in systolic blood pressure from the first examination to the second examination. Multivariate linear regression analysis confirmed that baPWV and BMI were weak but significant independent variables related to the changes in systolic blood pressure (R(2) = 0.03). The logistic regression analysis demonstrated that baPWV >13.5 m/s (adjusted odds ratio = 3.32 (1.79-6.15)) and BMI >25.0 (adjusted odds ratio = 2.27 (1.25 - 4.13)) were significant predictors of future hypertension independent of blood pressure on the first examination. CONCLUSION: This 3-year prospective study suggested that the baPWV and BMI, but not plasma CRP levels, are not powerful but significant independent markers to identify middle-aged Japanese men with prehypertension at high risk for hypertension.
Asunto(s)
Presión Sanguínea/fisiología , Hipertensión/diagnóstico , Adulto , Factores de Edad , Índice de Masa Corporal , Progresión de la Enfermedad , Estudios de Seguimiento , Humanos , Hipertensión/epidemiología , Hipertensión/fisiopatología , Japón/epidemiología , Masculino , Morbilidad/tendencias , Pronóstico , Estudios Prospectivos , Factores de Riesgo , Factores de TiempoRESUMEN
The association of blood pressure levels with the effects of alcohol intake on the vasculature has not been clarified. We evaluated the differential effects of alcohol intake on the vasculature of subjects with optimal or normal blood pressure (ONbp) and those with high normal blood pressure or higher (HNHbp) in a 6-year follow-up study. The pulse wave velocity (PWV) was measured on three occasions at an interval of 3 years in 1185 middle-aged Japanese men (age 41+/-8 years). In subjects with ONbp (n=677), a U-shaped relationship between alcohol intake (non-drinker, and light-to-moderate and heavy alcohol intake groups) and the increase in the adjusted value of PWV was observed at the end of 6 years' observation. On the other hand, in subjects with HNHbp (n=508), a U-shaped relationship was not observed. At the end of 6 years' observation, the increase in PWV was significantly more in the heavy intake group than in the light-to-moderate intake group or the non-drinker group, even after adjustment for changes in blood pressure and prescribed medication (P<0.01). In conclusion, blood pressure levels may modulate the effects of alcohol intake on the vasculature in middle-aged Japanese subjects. In subjects with ONbp, light-to-moderate alcohol intake appeared to have a possible vasculoprotective effect; on the other hand, in subjects with NHNbp, heavy alcohol intake seemed to exert a detrimental effect on the vasculature.
Asunto(s)
Consumo de Bebidas Alcohólicas/fisiopatología , Presión Sanguínea/efectos de los fármacos , Vasos Sanguíneos/efectos de los fármacos , Índice Tobillo Braquial , Estudios Transversales , Relación Dosis-Respuesta a Droga , Humanos , Hipertensión/fisiopatología , Japón , Modelos Lineales , Masculino , Persona de Mediana Edad , Flujo Sanguíneo Regional/efectos de los fármacosRESUMEN
The present study was conducted to clarify whether body mass index (BMI [kg/m(2)]) classifications (i.e., without excess weight, overweight, and obese) modify the rate of progression of arterial stiffening, a cardiovascular risk factor associated with weight gain. A 3-year observational study was conducted in 2,080 healthy middle-aged Japanese men (aged 42+/-10 years). Brachial-ankle pulse wave velocity (baPWV) was measured at the beginning and end of the study period. In overweight subjects (30>BMI>or=25), the estimated annual rate of increase of baPWV (ARbaPWV) in subjects with weight gain (>or=5% weight gain; ARbaPWV, 21.8+/-4.4 cm/s/year) was significantly higher than in those without weight gain (<5% weight gain; ARbaPWV, 12.5+/-1.6 cm/s/year), after adjustments for changes in blood pressure and other variables (p<0.05). This change was not observed in subjects without excess weight (BMI<25) or in obese subjects (BMI>or=30). The increase in the ARbaPWV associated with weight gain in the overweight group was also higher than that in the without excess body weight or obese groups. Our study revealed that the BMI classifications modified the annual rate of increase in arterial stiffening associated with weight gain. Weight gain seemed to accelerate arterial stiffening in overweight subjects, but not in subjects without excess weight. The weight gain in overweight subjects seemed to worsen the cardiovascular risk related to arterial stiffness in middle-aged healthy Japanese men. Thus, the prevention of weight gain should be emphasized in overweight subjects.
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Arterias/fisiología , Índice de Masa Corporal , Sobrepeso/fisiopatología , Aumento de Peso/fisiología , Adulto , Elasticidad , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
PURPOSE: The aim of this retrospective study was to evaluate the clinical value of percutaneous radiofrequency ablation (RFA) for the treatment of renal cell carcinoma (RCC). MATERIALS AND METHODS: In a recent 3 years seven RCCs in six patients were treated by percutaneous RFA. RCC had been diagnosed based on the typical findings by computed tomography and/or magnetic resonance imaging. A cool-tip RF system (Vallylab) was mainly used with a RF2000 generator. The maximum tumor size ranged from 8 to 40 mm in diameter. The follow-up period was 14-36 months after initial RFA treatment. RESULTS: Complete disappearance of contrast enhancement during the early arterial phase was noted immediately after each session of percutaneous RFA. Two RCCs > or = 3 cm in diameter showed tumor recurrence and required re-RFA during the follow-up period. In one patient, retroperitoneal hematoma was observed as a noteworthy complication. CONCLUSION: Despite our limited number of patients, we believe that percutaneous RFA is clinically feasible and can be an alternative treatment of choice for RCC.
Asunto(s)
Carcinoma de Células Renales/cirugía , Ablación por Catéter , Neoplasias Renales/cirugía , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
BACKGROUND AND OBJECTIVES: This study was conducted to clarify whether individuals with mildly impaired renal function show increased arterial stiffness, microinflammation, and oxidative stress as compared with those with normal renal function and also to examine the association of these parameters with the degree of GFR loss in middle-aged Japanese men with a low cardiovascular risk. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The brachial-ankle pulse wave velocity and plasma levels of C-reactive protein and lipid peroxides were measured in 1873 men (42 +/- 9 yr of age). RESULTS: The brachial-ankle pulse wave velocity but not the plasma C-reactive protein or lipid peroxides, was increased in individuals with mildly impaired renal function. The GFR was significantly correlated with the brachial-ankle pulse wave velocity but not with the log-transformed values of C-reactive protein or lipid peroxides. Multivariate linear regression analysis demonstrated a significant relationship between the brachial-ankle pulse wave velocity and the GFR, independent of the conventional atherosclerotic risk factors. This relationship was significant even in individuals with GFR values within the "normal renal function" range. Thus, GFR loss seems to be more closely associated with arterial stiffness than with microinflammation and/or oxidative stress. CONCLUSIONS: A weak but significant relationship was observed between the degree of GFR loss and arterial stiffness, even in individuals with GFR values within the normal renal function range. Therefore, increased arterial stiffness may underlie, at least in part, the elevated cardiovascular risk in individuals with mildly impaired renal function.
Asunto(s)
Arterias/fisiopatología , Tasa de Filtración Glomerular , Inflamación/etiología , Enfermedades Renales/complicaciones , Estrés Oxidativo , Adulto , Proteína C-Reactiva/análisis , Enfermedades Cardiovasculares/etiología , Estudios Transversales , Humanos , Enfermedades Renales/fisiopatología , Peroxidación de Lípido , Masculino , Persona de Mediana EdadRESUMEN
A 51-year-old woman with Cushing's syndrome underwent unilateral adrenalectomy for left adrenal adenoma. After 7 years of prednisolone treatment (with some interruptions), followed by 4 years of total withdrawal from prednisolone treatment, she presented with hypotension, weight loss, general fatigue, nausea, hyponatremia and hypoglycemia. These clinical features together with a low response in the rapid adrenocorticotropic hormone test led to the diagnosis of acute adrenal insufficiency. Relatively low serum adrenocorticotropic hormone levels in the face of increased demand for cortisol during adrenal crisis suggested a disordered hypothalamic-pituitary function, indicating secondary adrenal insufficiency. This patient demonstrated the etiology of acute adrenal insufficiency long after unilateral adrenalectomy in association with subsequent glucocorticoid therapy. A reduction in the reserved secretory capacity of cortisol after prolonged prednisolone treatment was considered to have induced secondary adrenal insufficiency, even after 4 years of total withdrawal from prednisolone.
Asunto(s)
Insuficiencia Suprarrenal/etiología , Adrenalectomía/efectos adversos , Síndrome de Cushing/cirugía , Glucocorticoides/efectos adversos , Hidrocortisona/metabolismo , Prednisolona/efectos adversos , Enfermedad Aguda , Adrenalectomía/métodos , Femenino , Glucocorticoides/uso terapéutico , Humanos , Persona de Mediana Edad , Prednisolona/uso terapéutico , Factores de TiempoRESUMEN
A case of osteosarcoma in pelvic bone following radiation therapy for prostate cancer is reported. A 74-year-old patient was diagnosed with prostate cancer 10 years ago and started on the endocrine therapy with LH-RH agonist. He had no apparent distant metastasis, and received radiation therapy 8 years ago. He has complained of low back pain since several months ago. A high uptake on bone scintigram and osteolytic and osteoblastic damages on CT were noted in pubic bone and sacrum. The PSA level was less than 0.2 ng/ml. Pathohistological diagnosis by biopsy of the pubic bone was chondroblastic type osteosarcoma, showing an atypical cell proliferation with osteoid. Immunostaining for nonepithelial marker vimentin was positive. He underwent heavy ion radiation therapy for osteosarcoma at the National Institute of Radiological Sciences. Osteosarcoma is one of the rare delayed complications after radiation therapy and requires biopsy for correct diagnosis.