Gender differences in wall shear–mediated brachial artery vasoconstriction and vasodilation

Levenson, Jaime; Pessana, Franco; Gariepy, Jérôme; Armentano, Ricardo L.; Simon, Alain

doi:10.1016/s0735-1097(01)01604-7

Cited by 97 publications

(87 citation statements)

References 25 publications

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“…The timing of the revascularisation procedure may, at least in part, explain why diabetic women derived such a major benefit from the management strategy applied in our study compared with the management strategy applied in OASIS. Although several pathophysiological distinctions [20,21,22,23,24] have been reported between women and men, the fact that women seem to form fewer coronary collaterals than men [24] may be of great importance. Due to this lack of collaterals, women may benefit particularly from a rapid correction of the epicardial obstruction during UA/NSTEMI [25].…”

Section: Discussionmentioning

confidence: 97%

Impact of diabetes mellitus on long-term outcome after unstable angina and non-ST-segment elevation myocardial infarction treated with a very early invasive strategy

et al. 2004

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Aims/hypothesis. We sought to evaluate the impact of diabetes mellitus on long-term outcome in patients with unstable angina and non-ST-segment elevation myocardial infarction treated with a very early invasive strategy. Methods. We carried out a prospective cohort study in 270 diabetic and 1163 non-diabetic patients with unstable angina and non-ST-segment elevation myocardial infarction. All patients underwent coronary angiography and, if appropriate, subsequent revascularisation within 24 hours of admission. The primary endpoint was allcause mortality during follow-up for up to 60 months. Results. Diabetic patients had less favourable baseline characteristics including more advanced coronary artery disease and more severe unstable angina and non-ST-segment elevation myocardial infarction. Percutaneous coronary intervention was performed in 53% of diabetic patients and 56% of non-diabetic patients. Coronary artery bypass grafting was done in 21% of diabetic patients and 12% of non-diabetic patients. In-hospital mortality (4.1% vs 1.3%; hazard ratio 3.47; 95% CI: 1.57 to 7.64; p=0.002) and long-term mortality (9.7% vs 4.9%; hazard ratio 2.11; 95% CI: 1.33 to 3.36; p=0.002) were significantly higher in diabetic patients. After adjustment for differences in baseline characteristics, diabetes mellitus was no longer an independent predictor of long-term mortality (hazard ratio 1.43; 95% CI: 0.74 to 2.78; p=0.292). Conclusions/interpretation. Diabetic patients treated with a very early invasive strategy for unstable angina and non-ST-segment elevation myocardial infarction have a higher in-hospital and long-term mortality that is largely explained by their less favourable baseline characteristics including more advanced coronary artery disease and more severe unstable angina and non-ST-segment elevation myocardial infarction.

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Section: Discussionmentioning

confidence: 97%

Impact of diabetes mellitus on long-term outcome after unstable angina and non-ST-segment elevation myocardial infarction treated with a very early invasive strategy

et al. 2004

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“…The absolute responses in FMD, however, were not different between the groups. Because our groups have significantly different baseline diameters, a possible better way to compare the FMD response is to express the diameter change relative to the trigger (i.e., the difference between maximal hyperemic flow velocity and resting flow velocity) (31,44). When the FMD/ ⌬shear rate as an index for endothelial function is considered, no significant differences between SCI and controls were found in the femoral artery.…”

Section: Discussionmentioning

confidence: 99%

Preserved flow-mediated dilation in the inactive legs of spinal cord-injured individuals

Groot¹,

Poelkens²,

Kooijman³

et al. 2004

American Journal of Physiology-Heart and Circulatory Physiology

103

109

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.-The aim of the study was to assess endothelial function, measured by flow-mediated dilation (FMD), in an inactive extremity (leg) and chronically active extremity (arm) within one subject. Eleven male spinal cord-injured (SCI) individuals and eleven male controls (C) were included. Echo Doppler measurements were performed to measure FMD responses after 10 and 5 min of arterial occlusion of the leg (superficial femoral artery, SFA) and the arm (brachial artery, BA), respectively. A nitroglycerine spray was administered to determine the endothelium independent vasodilatation in the SFA. In the SFA, relative changes in FMD were significantly enhanced in SCI compared with C (SCI: 14.1 Ϯ 1.3%; C: 9.2 Ϯ 2.3%), whereas no differences were found in the BA (SCI: 12.5 Ϯ 2.9%; C: 14.2 Ϯ 3.3%). Because the FMD response is directly proportional to the magnitude of the stimulus, the FMD response was also expressed relative to the shear rate. No differences between the groups were found for the FMD-to-shear rate ratio in the SFA (SCI:0.061 Ϯ 0.023%/s Ϫ1 ; C: 0.049 Ϯ 0.024%/s Ϫ1 ), whereas the FMD-to-shear rate ratio was significantly decreased in the BA of SCI individuals (SCI: 0.037 Ϯ 0.01%/s Ϫ1 ; C: 0.061 Ϯ 0.027%/s Ϫ1 ). The relative dilatory response to nitroglycerine did not differ between the groups. (SCI: 15.6 Ϯ 2.0%; C: 13.4 Ϯ 2.3%). In conclusion, our results indicate that SCI individuals have a preserved endothelial function in the inactive legs and possibly an attenuated endothelial function in the active arms compared with controls. vascular endothelial function; deconditioning; ultrasound THE ENDOTHELIUM plays an essential role in vascular homeostasis and is able to respond to physical and chemical stimuli by the synthesis and release of vasoactive, thromboregulatory, and growth factor substances (37). Impaired endothelial function has been suggested as a key early event in the development of atherosclerosis, and a high correlation between endothelial dysfunction and risk factors for cardiovascular diseases, including hypertension, hypercholesterolemia, cigarette smoking, diabetes, and aging, has been reported (6 -8, 12, 29, 33, 47, 48). Besides the above-mentioned traditional risk factors, it is well known that physical inactivity is associated with an increased risk of developing cardiovascular diseases (32). However, at present, the relationship between inactivity and endothelial dysfunction is not clear. In individuals with paraplegia, the part of the body below the lesion level is paralyzed and thus extremely inactive (20,39). In contrast, the upper limbs are often relatively active because the arms are used for ambulation due to their wheelchair-bound life-style (43). A spinal cord injury (SCI), therefore, offers a unique "human model of nature" to assess peripheral vascular adaptations to inactivity (legs) and activity (arms) on endothelial function within one subject.Healthy vessels are capable of accommodating to an increase in blood flow by dilating the internal vessel diameter, a phenomenon called fl...

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“…Previous studies examining the impact of artery size on the shear-FMD relationship have variably reported the percent change (27) or the absolute change (22,61) in diameter to characterize FMD. Consensus has not yet been reached regarding the best index for expression of FMD, and current guidelines recommend reporting both percent and absolute changes (51).…”

Section: Between-artery Differences: Stimulus-response Relationshipmentioning

confidence: 99%

The impact of baseline artery diameter on flow-mediated vasodilation: a comparison of brachial and radial artery responses to matched levels of shear stress

Jazuli

Pyke

2011

American Journal of Physiology-Heart and Circulatory Physiology

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Jazuli F, Pyke KE. The impact of baseline artery diameter on flow-mediated vasodilation: a comparison of brachial and radial artery responses to matched levels of shear stress. Am J Physiol Heart Circ Physiol 301: H1667-H1677, 2011. First published July 22, 2011; doi:10.1152/ajpheart.00487.2011.-An inverse relationship between baseline artery diameter (BAD) and flow-mediated vasodilation (FMD) has been identified using reactive hyperemia (RH) to create a shear stress (SS) stimulus in human conduit arteries. However, RH creates a SS stimulus that is inversely related to BAD. The purpose of this study was to compare FMD in response to matched levels of SS in two differently sized upper limb arteries [brachial (BA) and radial (RA) artery]. With the use of exercise, three distinct, shear rate (SR) stimuli were created (SR ϭ blood velocity/vessel diameter; estimate of SS) in the RA and BA. Artery diameter and mean blood velocity were assessed with echo and Doppler ultrasound in 15 healthy male subjects (19 -25 yr). Data are means Ϯ SE. Subjects performed 6 min of adductor pollicis and handgrip exercise to increase SR in the RA and BA, respectively. Exercise intensity was modulated to achieve uniformity in SR between arteries. The three distinct SR levels were as follows: steady-state exercise 39.8 Ϯ 0.6, 57.3 Ϯ 0.7, and 72.4 Ϯ 1.2 s Ϫ1 (P Ͻ 0.001). %FMD and AbsFMD (mm) at the end of exercise were greater in the RA vs. the BA at each shear level [at the highest level: RA ϭ 15.7 Ϯ 1.5%, BA ϭ 5.4 Ϯ 0.8% (P Ͻ 0.001)]. The mean slope of the within-subject SR-%FMD regression line was greater in the RA (RA ϭ 0.33 Ϯ 0.04, BA ϭ 0.13 Ϯ 0.02, P Ͻ 0.001), and a strong within-subjects relationship between %FMD and SR was observed in both arteries (RA: r 2 ϭ 0.92 Ϯ 0.02; BA: r 2 ϭ 0.90 Ϯ 0.03). Within the RA, there was a significant relationship between baseline diameter and %FMD; however, this relationship was not present in the BA (RA: r 2 ϭ 0.76, P Ͻ 0.001; BA: r 2 ϭ 0.03, P ϭ 0.541). These findings suggest that the response to SS is not uniform across differently sized vessels, which is in agreement with previous studies. endothelial function; doppler ultrasound; shear stress; handgrip exercise; baseline diameter THE ENDOTHELIAL CELLS THAT line the arteries are critically involved in the maintenance of vascular homeostasis. In healthy arteries, increases in blood flow-associated shear stress lead to the release of vasodilators [e.g., nitric oxide (NO), endothelial-derived hyperpolarizing factor (EDHF), and prostacyclin] by the endothelium, resulting in an endotheliumdependent vasodilation [flow-mediated vasodilation (FMD)] (1, 3, 28, 35). An inverse relationship between baseline vessel diameter and the magnitude of the conduit artery FMD response in the arm has been reported by several studies (19,42,49,52). As a result, it can be difficult to use FMD to compare endothelial function in groups with varying baseline artery sizes (for example, the young vs. the elderly and men vs. women) because it may be unclear whether a small...

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Gender differences in wall shear–mediated brachial artery vasoconstriction and vasodilation

Abstract: Shear-mediated arterial vasodilation and vasoconstriction were more pronounced in women than in men, suggesting different gender-related sensitivity in the regulation of large-artery vascular tone.

Cited by 97 publications

References 25 publications

Impact of diabetes mellitus on long-term outcome after unstable angina and non-ST-segment elevation myocardial infarction treated with a very early invasive strategy

Impact of diabetes mellitus on long-term outcome after unstable angina and non-ST-segment elevation myocardial infarction treated with a very early invasive strategy

Preserved flow-mediated dilation in the inactive legs of spinal cord-injured individuals

The impact of baseline artery diameter on flow-mediated vasodilation: a comparison of brachial and radial artery responses to matched levels of shear stress

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