In the published literature relating to flow-mediated dilatation (FMD), there are substantial differences between centres in terms of normal FMD amongst healthy subjects. This present study attempts to identify the effect of differing methodologies on FMD. High frequency ultrasound was used to measure blood flow and percentage brachial and radial artery dilatation after reactive hyperaemia induced by forearm or upper arm cuff occlusion in 24 healthy subjects, less than 40 years, without known cardiovascular risk factors. FMD of the brachial artery was significantly higher after upper arm occlusion, compared with forearm occlusion, 6.4 (3.3) and 3.9 (2.6)% (P<0.05), respectively. FMD of the radial artery was significantly higher after forearm occlusion, compared with upper arm occlusion, 10.0 (4.6) and 7.9 (3.5)% (P<0.05), respectively. The percentage blood flow increase in the brachial and radial arteries after forearm and upper arm occlusion were similar. After forearm and upper arm occlusion, the radial artery percentage dilatation was greater than the brachial artery. In conclusion dilatation of the brachial artery, after reactive hyperaemia induced by upper arm occlusion, was significantly more pronounced compared with dilatation of the brachial artery after forearm occlusion, despite a similar percentage blood flow increase. The local ischaemia of the brachial artery with a proximal occlusion may explain why the brachial artery dilated more after upper arm occlusion compared with after forearm occlusion. The study has also shown that FMD of the radial artery could be assessed by B-mode ultrasound technique. FMD was greater using the radial artery compared with the brachial artery, suggesting that the radial artery may be a useful way to assess FMD in future clinical studies.
Dietary salt restriction lowers blood pressure and has been advocated as a population-based strategy to reduce the cardiovascular morbidity associated with hypertension. However, the effect of lowering salt intake on metabolic vascular risk factors such as insulin resistance and levels of atherogenic lipids and fasting insulin is uncertain. We have studied the short-term effect of moderate dietary salt restriction on insulin resistance and serum lipids in 34 nonobese (body mass index [mean +/- SD] 23.4 +/- 1.8 kg/m2), normotensive young white men. Subjects were maintained on a low salt diet ( < 80 mmol/day) for the 2-week study period. In a randomized, cross-over, double-blind fashion, each subject also received 120 mmol of sodium chloride per day during one of the study weeks, and a matching placebo during the other. Insulin resistance, serum insulin, lipids, and blood pressure were measured in the fasting state at the end of each study week. Urinary sodium excretion (185 +/- 46 v 52 +/- 25 mmol/day, P < .001), serum sodium (141.2 +/- 1.2 v 140.1 +/- 1.3 mmol/L, P < .001) and body weight (75.4 +/- 9.1 v 75.0 +/- 9.3 kg, P < .05) were higher during the high salt than the low salt period. Serum creatinine was higher during the low salt period (100 +/- 8 v 90 +/- 9 mumols/L, P < .01). There was no difference in blood pressure, insulin resistance, serum insulin, C-peptide, total cholesterol, low density lipoprotein cholesterol, high density lipoprotein cholesterol or its subfractions, triglycerides, apolipoprotein A1, or apolipoprotein B between the high salt and low salt periods. We conclude that short-term, moderate dietary salt restriction does not adversely affect insulin sensitivity or levels of atherogenic lipids in normotensive nonobese men.
AF is a common comorbid condition in the acute general medical ward. Standard investigations were under-utilised. Attention needs to be paid to the recording and control of heart rate at rest and on exercise. Cardioversion is considered infrequently. This patient group had a high risk for thromboembolism and after excluding the large group in whom warfarin was contraindicated, warfarin was still under-utilised.
Short-term reduction of HbA1c levels did not appear to affect endothelial function in patients with type 2 diabetes and previously poorly regulated glycaemic control.
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