RESUMEN
OBJECTIVE: To investigate the prevalence and determinants of spurious systolic hypertension (SSH) in a population-based sample of young adults and estimate their 20-year risk of coronary heart disease. POPULATION AND METHODS: Seven hundred and fifty young adults (352 men and 398 women), aged 26-31 years, from the Atherosclerosis Risk in Young Adults study were studied. Blood pressure levels were measured twice and central (aortic) pressures were derived by applanation tonometry on the radial artery using a generalized transfer function. SSH was defined as brachial systolic blood pressure (SBP) > or = 140 mmHg, brachial diastolic blood pressure (DBP) < 90 mmHg, and central SBP < 124 mmHg for men and < 120 mmHg for women. The Framingham risk score was calculated. Analysis of variance models were used to compare SSH individuals with normotensive and hypertensive males for cardiovascular risk factors. RESULTS: SSH was diagnosed in 57 men (16.1%; 95% confidence interval, 12.3-20.0) versus only three women (8%; 95% confidence interval, 0-1.6). The female population was excluded from further analysis. Compared with normotensive males, SSH individuals were heavier (88.7 versus 81.8 kg, P < 0.05) had a higher body mass index (25.8 versus 24.2 kg/m, P < 0.01) and significantly higher brachial and central SBP, DBP, pulse pressure, and mean arterial pressure. They had significantly higher pulse pressure amplification. Twenty-year Framingham risk scores based on DBP did not differ significantly between SSH subjects and normotensive individuals (2.72 versus 2.10%, respectively). CONCLUSION: SSH is predominantly found among young adult men. Apart from weight and body mass index, no other cardiovascular risk factors differed significantly between subjects with SSH and normotension or hypertension. When calculating the 20-year risk of coronary heart disease based on brachial DBP, SSH individuals were at intermediate risk between normotensive and hypertensive participants, but differences were not statistically significant.
Asunto(s)
Aorta/fisiología , Presión Sanguínea/fisiología , Arteria Braquial/fisiología , Hipertensión/epidemiología , Adulto , Factores de Edad , Enfermedad Coronaria/etiología , Femenino , Humanos , Hipertensión/etiología , Hipertensión/fisiopatología , Masculino , Prevalencia , Medición de Riesgo , Factores de Riesgo , Factores SexualesRESUMEN
PURPOSE: There is an increasing interest in noninvasive measurements of early structural or functional changes in large arteries such as pulse wave velocity (PWV), carotid intima-media thickness (CIMT), and augmentation index (AIx). These measurements may be applied in etiologic or prognostic research. The role of the AIx as a marker of cardiovascular risk has not fully been established. Our aim was to study whether AIx is related to coronary heart disease (CHD) risk and to compare the strength of the relations of AIx, PWV, and CIMT with cardiovascular risk in healthy young adults. METHODS: Our study included 224 men and 273 women (mean age 28 years, range 27-30 years) from the Atherosclerosis Risk in Young Adults (ARYA) study. Cardiovascular risk profile was determined and CHD risk was estimated using the Framingham risk score. AIx, PWV and CIMT were measured using standard methods. Data were analyzed in strata of gender using linear regression models. RESULTS: In men, PWV and CIMT were most strongly related to CHD risk. The increase in CHD risk per standard deviation increase in measurement was 0.24%/m/s, 95% CI (0.01;0.33) and 0.32%/mm, 95% CI (0.08;0.55), whereas the AIx was not significantly related to CHD risk (0.09 %/% 95% CI [-0.15;0.33]). In women, AIx, PWV, and CIMT were weakly but significantly related to CHD risk; there was no clear difference between the measurements. CONCLUSION: In young men, PWV and CIMT are better measures of CHD risk than AIx. In women, AIx, PWV and CIMT estimate CHD risk equally well.
Asunto(s)
Arteriosclerosis/etiología , Arterias Carótidas/patología , Enfermedad Coronaria/etiología , Adiposidad , Adulto , Envejecimiento/patología , Envejecimiento/fisiología , Arteriosclerosis/epidemiología , Glucemia/análisis , Determinación de la Presión Sanguínea , Arterias Carótidas/fisiopatología , Estudios de Cohortes , Enfermedad Coronaria/epidemiología , Estudios Transversales , Femenino , Arteria Femoral/fisiopatología , Humanos , Lípidos/sangre , Masculino , Flujo Pulsátil , Análisis de Regresión , Factores de Riesgo , Túnica Íntima/patología , Túnica Media/patologíaRESUMEN
OBJECTIVE: To study the relationship between intrauterine growth and the metabolic syndrome, particularly fasting serum lipids in young adulthood. METHODS: Seven hundred and forty-four young adults aged 26-31 years participated in the ARYA birth cohort. Birth characteristics were available from charts kept by the Municipal Health Service, Utrecht, The Netherlands. Adult medical history and lifestyle information were assessed by questionnaires. Adult anthropometry, blood pressure, fasting plasma glucose, total cholesterol, HDL-cholesterol, triglycerides were measured, and LDL-cholesterol was calculated. RESULTS: Subjects in the lower tertiles of birth weight (1250-3209 and 3210-3649 g) had higher risks for metabolic syndrome than those in the highest birth weight tertile (3650-5500 g): odds ratio, 1.8; 95% confidence interval (CI) 1.0-3.5 and 1.4; 0.7-2.7, respectively; p for trend = 0.064, adjusted for gender, cardiovascular disease family history and current education. Birth weight was inversely related to systolic blood pressure (linear regression coefficient, -1.9 mmHg/kg birth weight; 95% CI -3.4 to -0.3) and to (log) triglycerides in mmol/L (-0.03/kg birth weight; 95% CI -0.06 to -0.01), adjusted for gender, current body mass index and current education. Birth weight showed inverse relations to diastolic blood pressure, serum glucose, total and LDL cholesterol and positive relations to waist circumference and HDL cholesterol levels, although not statistically significant. Birth length and ponderal index were not related to the metabolic syndrome or lipid profiles. CONCLUSION: Lower birth weight indicates a higher risk for metabolic syndrome in young adults, particularly through higher serum triglycerides and higher systolic blood pressure.
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Aterosclerosis/etiología , Recién Nacido de Bajo Peso , Síndrome Metabólico/etiología , Adolescente , Adulto , Aterosclerosis/sangre , Aterosclerosis/epidemiología , Biomarcadores/sangre , Glucemia/metabolismo , Índice de Masa Corporal , Preescolar , HDL-Colesterol/sangre , LDL-Colesterol/sangre , Estudios de Cohortes , Femenino , Humanos , Incidencia , Recién Nacido , Masculino , Síndrome Metabólico/sangre , Síndrome Metabólico/epidemiología , Países Bajos/epidemiología , Pronóstico , Factores de Riesgo , Triglicéridos/sangreRESUMEN
BACKGROUND: Moderate alcohol consumption has been shown to protect against cardiovascular disease. Aortic stiffness can be regarded as a marker of cardiovascular disease risk. Previously we have shown an inverse to J-shaped association between alcohol intake and aortic stiffness in middle-aged and elderly men and postmenopausal women. OBJECTIVE: In the present study we examined whether a relation between alcohol intake and aortic stiffness is already present at a younger age. DESIGN: Cross-sectional data of a cohort study in men and women aged 28 years were analysed stratified by gender (240 men and 283 women). MEASUREMENTS: Alcohol intake was derived from a questionnaire and aortic stiffness was assessed by pulse-wave velocity measurement. RESULTS: In women an alcoholic beverage intake of >/=1 glass/day is associated with a 0.36 m/s (95% confidence interval, -0.58 to -0.14) lower pulse-wave velocity compared with non-drinkers. In men alcohol intake is also inversely related to pulse-wave velocity, but this was not significant. These findings were independent of age, blood pressure and heart rate. CONCLUSIONS: These findings suggest that moderate intake of alcohol may affect vascular stiffness at an early age, notably in women. These findings may be viewed as compatible with a vascular protective effect of alcohol that expresses well before the occurrence of symptomatic cardiovascular disease.
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Consumo de Bebidas Alcohólicas/epidemiología , Enfermedades de la Aorta/epidemiología , Enfermedades de la Aorta/prevención & control , Hipertensión/epidemiología , Hipertensión/prevención & control , Adulto , Distribución por Edad , Enfermedades de la Aorta/fisiopatología , Velocidad del Flujo Sanguíneo , Estudios de Cohortes , Estudios Transversales , Femenino , Humanos , Hipertensión/fisiopatología , Masculino , Flujo Pulsátil , Factores de Riesgo , Distribución por SexoRESUMEN
PURPOSE: Although intrauterine growth retardation (IUGR) is associated with increased risk of cardiovascular disease (CVD) in adult life, it is unclear whether the relationship is present at younger ages. Furthermore, current debate suggests that postnatal factors might be at least as important as prenatal conditions. The authors investigated whether low birth weight leads to an increased risk of subclinical atherosclerosis in a population-based sample of 750 Dutch men and women, aged 27 to 30 years. METHODS: Information about birth characteristics was available from the original charts of the Municipal Health Service, Utrecht, The Netherlands. Cardiovascular risk factors were evaluated by a questionnaire. The extent of atherosclerosis, assessed by carotid intima-media thickness (CIMT), was measured in both common carotid arteries. RESULTS: Overall, birth weight was not related to common CIMT. However, in the lowest tertile of birth length an inverse association between birth weight and common CIMT was observed. Moreover, low birth weight was significantly associated with increased common CIMT in those who showed exaggerated postnatal growth. CONCLUSIONS: These findings suggest that low birth weight is only associated with increased common CIMT in young adulthood in those who experienced severe IUGR and in those who showed exaggerated postnatal growth.
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Arteriosclerosis/etiología , Peso al Nacer/fisiología , Arterias Carótidas/patología , Retardo del Crecimiento Fetal/complicaciones , Recién Nacido de Bajo Peso/fisiología , Adulto , Arteriosclerosis/patología , Arterias Carótidas/diagnóstico por imagen , Estudios de Cohortes , Femenino , Humanos , Lactante , Recién Nacido de Bajo Peso/crecimiento & desarrollo , Recién Nacido , Modelos Lineales , Masculino , Países Bajos , Factores de Riesgo , Encuestas y Cuestionarios , UltrasonografíaRESUMEN
BACKGROUND: It is insufficiently known if routine blood pressure (BP) measurement by school doctors has added predictive value for later hypertension and cardiovascular risk. OBJECTIVE: To assess whether screening of BP in adolescence has additional predictive value to already routinely collected indicators of later hypertension and cardiovascular risk. METHODS: In the Dutch city of Utrecht, routine BPs and anthropometry were collected from school health records of 750 adolescents. In The Hague, standardized repeated BP measurements and anthropometry were available for 262 adolescents. Of both cohorts, 998 now young adults were recently re-examined. Predictors of adult hypertension, systolic blood pressure (SBP) > or = 140 mmHg and/or diastolic blood pressure (DBP) > or = 90 mmHg) and 10-year cardiovascular risk were analysed by logistic regression and area under receiver operator characteristics curve (AUC). RESULTS: A total of 167 young adults had hypertension. Single adolescent SBP and DBP predicted hypertension: odds ratio (OR) 1.04 per mmHg [95% confidence interval (CI): 1.03-1.06], OR 1.02 (1.00-1.04), respectively, but with little discriminative power. Gender, adolescent body mass index (BMI) and age combined predicted hypertension: AUC 0.71 (0.67-0.75), which slightly improved by adding SBP: AUC 0.74 (0.70-0.77); difference in AUC 0.03 (0.002-0.06). SBP exclusively predicted hypertension within men: OR 1.03 (1.01-1.04), AUC: 0.59 (0.53-0.65), and within women: OR 1.08 (1.05-1.11), AUC 0.74 (0.67-0.82). However, an adolescent BP of > or = 120 mmHg did not efficiently detect hypertensive men, while it detected 57.9% of hypertensive women. Only young adult men had meaningful 10-year cardiovascular risks, which only SBP predicted: OR risk score > 95th percentile 1.04 (1.02-1.07), AUC 0.67 (0.60-0.75). CONCLUSION: A single routine BP measurement in adolescent girls efficiently predicts young adult hypertension. In adolescent boys, BP predicts young adult 10-year cardiovascular risk.
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Determinación de la Presión Sanguínea , Enfermedades Cardiovasculares/etiología , Hipertensión/etiología , Adolescente , Adulto , Envejecimiento , Área Bajo la Curva , Índice de Masa Corporal , Pruebas Diagnósticas de Rutina , Femenino , Humanos , Modelos Logísticos , Masculino , Oportunidad Relativa , Valor Predictivo de las Pruebas , Medición de Riesgo , Caracteres SexualesRESUMEN
BACKGROUND: The relation between cardiovascular risk factors and extent of atherosclerosis in middle-aged and elderly populations is well established. Autopsy studies have suggested that similar associations may be present at a young age. We evaluated the relationship between conventional risk factors and increased carotid intima-media thickness (CIMT) in 750 healthy young adults, aged 27 to 30 years. METHODS: All participants completed a questionnaire on cardiovascular risk factors, had a fasting blood sample drawn, and underwent an ultrasonographic examination of both common carotid arteries to assess common CIMT (CCIMT). RESULTS: Age (11.2 micro m/SD), body mass index (10.3 micro m/SD), pulse pressure (5.0 micro m/SD), sex (4.8 micro m/SD), and low-density lipoprotein cholesterol level (4.3 micro m/SD) were independent determinants of increased CCIMT in young adults (R2 = 0.36). Total pack-years of smoking, adjusted for age and sex, showed a linear trend with increased CCIMT (P =.02), which attenuated after further adjustment for body mass index. Common CIMT increased gradually and significantly with the number of cardiovascular risk factors present. The estimated absolute risk, based on the Framingham risk function, for development of coronary heart disease within 20 years was 2.5 times higher in individuals with mean CCIMT in the highest quartile compared with those in the lowest quartile of the distribution. CONCLUSIONS: An unfavorable cardiovascular risk profile is associated with a marked increase in CCIMT in young adulthood. Efforts to change modifiable risk factors early in life may retard atherosclerosis development and hence delay the onset of clinical cardiovascular disease later in life.
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Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/patología , Arterias Carótidas/patología , Túnica Íntima/patología , Túnica Media/patología , Adulto , Enfermedades Cardiovasculares/diagnóstico por imagen , Arterias Carótidas/diagnóstico por imagen , Femenino , Humanos , Masculino , Factores de Riesgo , Túnica Íntima/diagnóstico por imagen , Túnica Media/diagnóstico por imagen , UltrasonografíaRESUMEN
BACKGROUND: Increased blood pressure (BP) in young adulthood is associated with cardiovascular morbidity and mortality. Longitudinal studies of patients at young ages are, however, limited. Our aim was to study the relationships of adolescent BP and tracking of BP into young adulthood with subclinical atherosclerosis, as assessed by carotid intima-media thickness (CIMT), at the age of 28 years. METHODS: The Atherosclerosis Risk in Young Adults (ARYA) study comprises of a community-based sample of 750 subjects aged 27 to 30 years. In the 352 men and 398 women, at least one BP measurement was recorded at a mean age of 13 years in school health records. Recently, all participants completed a questionnaire on cardiovascular risk factors, had a fasting blood sample drawn, and underwent an ultrasound examination of both common carotid arteries to assess CIMT. RESULTS: Linear regression showed that adolescent systolic BP was associated with thickening of the intima-media (an increase of 7.5 microm in CIMT per standard deviation increase in systolic BP; 95% CI 4.3 to 10.6). Similar relations were found for pulse pressure and mean arterial pressure. When sex, age, and body mass index at adolescence and young adulthood and adult BP were taken into account, the relations attenuated, but for pulse pressure they remained statistically significant. Furthermore, subjects who tracked in the highest systolic BP and pulse pressure levels from adolescence into young adulthood showed the thickest CIMT. CONCLUSION: Our findings strengthen the notion that elevated BP at adolescence and a relative increase in BP from adolescence to adulthood unfavorably affect cardiovascular risk, as indicated by increased CIMT.
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Arteriosclerosis/diagnóstico por imagen , Arteriosclerosis/fisiopatología , Presión Sanguínea/fisiología , Adolescente , Adulto , Factores de Edad , Enfermedades Cardiovasculares/epidemiología , Arterias Carótidas/diagnóstico por imagen , Estudios de Cohortes , Femenino , Humanos , Masculino , Valor Predictivo de las Pruebas , Riesgo , UltrasonografíaRESUMEN
BACKGROUND: Increased arterial stiffness has been shown to be a good predictor of cardiovascular morbidity and mortality and to be associated with an adverse cardiovascular risk profile. OBJECTIVE: To evaluate the relationship between adolescent blood pressure and aortic stiffness in 524 healthy young adults aged 27-30 years, as a means of investigating early determinants of arterial stiffness. SETTING: General community. PARTICIPANTS: We studied 524 healthy young adults, aged 27-30 years, who attended secondary school in Utrecht, The Netherlands. MEASUREMENTS: Data on adolescent weight, height, blood pressure and stage of puberty were available from the original school health records of the Municipal Health Service. At young adulthood, a questionnaire on cardiovascular risk factors was completed and a fasting blood sample was drawn. MAIN OUTCOME MEASURE: Arterial stiffness, assessed by carotid-femoral pulse wave velocity (PWV). RESULTS: Adolescent blood pressure did not predict aortic PWV at young adulthood (linear regression coefficient 0.03 m/s per 10 mmHg increase in systolic blood pressure; 95% confidence interval 0.09 to 0.14). Repeated analysis in a subgroup (n = 199) for whom two adolescent blood pressure measurements were averaged showed stronger (2-19x) associations with adult PWV, although these were not significant. CONCLUSION: Adolescent blood pressure did not predict arterial stiffness in healthy young adults. Measurement error in the baseline blood readings (regression to the mean phenomenon) may partly explain the lack of association in our study. Further studies should confirm our results in order to enable better understanding of the role of adolescent blood pressure in the aetiology of vascular damage.
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Adolescente , Envejecimiento/fisiología , Aorta/fisiología , Velocidad del Flujo Sanguíneo , Presión Sanguínea , Flujo Pulsátil , Adulto , Elasticidad , Femenino , Humanos , Masculino , Valores de ReferenciaRESUMEN
BACKGROUND: Impaired vascular development due to intrauterine growth retardation and postnatal-induced vascular damage by an unfavorable cardiovascular risk profile may both cause stiffer arteries in later decades. METHODS: Of 524 young adults, participating in the Atherosclerosis Risk in Young Adults (ARYA) study, data on birth characteristics were obtained from the original medical records of the Municipal Health Service and the extent of aortic stiffness was assessed using carotid-femoral pulse wave velocity (PWV). RESULTS: The PWV showed an inverse trend with gestational age (linear regression coefficient (beta) = -0.07 m/sec per 1 week; P =.064) whereas it was positively related to birth weight (beta = 0.33 m/sec per 1 kg; P =.020), adjusted for blood pressure (BP), gender, age, and each other. After exclusion of the 26 prematurely born infants, the association with gestational age was attenuated (beta = -0.03 m/sec per 1 week; P =.582), whereas the relation with birth weight hardly changed (beta = 0.30 m/sec per 1 kg; P =.041). In an analysis in which we excluded the 26 subjects with diabetic mothers the birth weight-PWV relation was attenuated (beta = 0.21 m/sec per 1 kg; P =.169). CONCLUSIONS: Our findings suggest that prematurity drives the relation of gestational age and PWV, whereas risk of impaired glucose tolerance drives the relation of birth weight and PWV. We hypothesized that two separate mechanisms might be involved in the development of arterial stiffness in healthy young adults.
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Aorta/patología , Arteriosclerosis/epidemiología , Arteriosclerosis/patología , Peso al Nacer , Adulto , Diabetes Gestacional/epidemiología , Femenino , Edad Gestacional , Humanos , Recién Nacido , Modelos Lineales , Masculino , Embarazo , Factores de RiesgoRESUMEN
AIMS: Over recent decades the interest in cardiovascular epidemiology has broadened from studies on causes and consequences of elevated cardiovascular risk factors to include research on causes and consequences of atherosclerosis and associated arterial wall abnormalities. One of the underlying reasons was that established cardiovascular risk factors were insufficiently accurate in identifying those individuals who will suffer from cardiovascular disease in the future and measures of subclinical atherosclerosis may enhance the precision of these predictions and thus enable better-tailored medical care to be provided. The usefulness of measuring subclinical atherosclerosis is conditional on evidence that presence of subclinical atherosclerosis confers an increased risk of cardiovascular disease and that favourable changes in subclinical atherosclerosis parallel reductions in risk. We aimed at providing an overview of epidemiological data on carotid intima-media thickness (CIMT) and arterial stiffness measurements and their relation to risk of cardiovascular disease. METHODS: We reviewed the published epidemiological data. RESULTS AND CONCLUSION: CIMT is a good indicator of cardiovascular risk and provides a graded measure of vascular damage: no clear CIMT level above which the cardiovascular risk appears to increase considerably The evidence for arterial stiffness, assessed as carotid distensibility or aortic pulse wave velocity, as an indicator for risk of cardiovascular disease is restricted to subjects with either hypertension or end-stage renal disease or based on small studies in renal transplant patients and elderly. Evidence to indicate that information on carotid intima-media thickness or arterial stiffness, additional to established cardiovascular risk factors, helps to distinguish subjects into those with a high and those with a low absolute risk of cardiovascular disease is limited, but needed. Also, information on the direct comparison of both arterial stiffness measures in their ability to predict cardiovascular disease is needed.