Impact of mean arterial blood pressure on higher arterial stiffness indices in South Asians compared to white Europeans

Abstract-We studied aortic pulse wave velocity (aPWV), a predictor of cardiovascular events independent of blood pressure, in a multiethnic sample of British men, to investigate the roles for blood levels of vitamin D and aldosterone in total and regional aortic stiffness. Total aPWV was estimated noninvasively by the Arteriograph device (aPWV AG ) in 198 men, with its length measure calibrated by magnetic resonance. PWVs over the aortic arch and descending aorta were measured by magnetic resonance in a subsample (nϭ47). Mean (SE) aPWV AG in South Asians (nϭ68; age 55Ϯ10 years), at known higher coronary disease risk than other groups, was 0.5 m/s (0.2 m/s) higher than in African Caribbeans (nϭ67; 55Ϯ10 years), at lowest coronary disease risk here, and Europeans (nϭ63; 57Ϯ8 years), adjusted for age, systolic blood pressure, and diabetes mellitus (Pϭ0.01). By magnetic resonance, PWV over the descending aorta in South Asians was 0.7 m/s (0.3 m/s) and 0.8 m/s (0.3 m/s) higher than in African Caribbeans and Europeans, respectively; PWV over the aortic arch was not different. South Asians and African Caribbeans had 21 nmol/L (3 nmol/L) and 14 nmol/L (3 nmol/L) lower mean (SE) 25(OH)D than Europeans (PϽ0.001). Unlike aldosterone, 25(OH)D was negatively correlated with aPWV AG adjusted for age and systolic blood pressure, as well as weakened or removed ethnic differences in aPWV AG in regression models. These data suggest that aortic stiffness as aPWV parallels coronary disease risk in ethnic groups, descending aortic but not arch PWV has this feature, and serum 25(OH)D is an independent negative correlate of aPWV and may partly account for ethnicity-related differences in aPWV and coronary disease risk.

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“…healthy 20 and poststroke 21 SA subjects compared with their European counterparts. Neither measured aPWV.…”

Section: Discussionmentioning

confidence: 99%

Ethnic Differences in Aortic Pulse Wave Velocity Occur in the Descending Aorta and May Be Related to Vitamin D

et al. 2011

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“…78 Diabetes among South Asian patients with stroke explains poorer survival in this group 38 and a greater incidence of CVD outcomes among South Asian patients with hypertension. 65 Although the presence of diabetes calls for more stringent management of blood pressure, the underlying pathophysiology that accelerates the risk of stroke is not clear. Moreover, the magnitude of cerebrovascular risk from diabetes may differ between migrant and nonmigrant populations of South Asians, especially those living in the United Kingdom.…”

Section: Diabetes Mellitusmentioning

confidence: 99%

“…65 It appears that there is an adverse and disproportional impact of the mean arterial pressure on the vascular system in South Asians. The reasons for this adverse impact on the vascular system appear to be multifactorial and include genetic susceptibility and the simultaneous presence of other metabolic, inflammatory, and oxidative stress-related abnormalities, 66 which cause a synchronized impact on the vascular system.…”

Section: Hypertensionmentioning

confidence: 99%

Ischemic Stroke in South Asians

Gunarathne

Patel

Gammon

et al. 2009

Stroke

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Background and Purpose-Within the United Kingdom, mortality from stroke is higher among South Asians compared to European whites. The reasons for this excess cerebrovascular risk in South Asians remain unclear. The aim of this review is to present a comprehensive and systematic overview of the available literature relating to ischemic stroke among South Asian populations identifying distinct features of stroke epidemiology in this group. Summary of Review-A high frequency of lacunar strokes is a familiar pattern among South Asians, which suggests a greater prevalence of small-vessel disease in South Asians. This may be a consequence of abnormal metabolic and glycemic processes. In addition, stroke mortality among South Asians appears to be explained by glycemic status, which is an independent predictor of long-term stroke mortality. Within India, there is a perceptible rural-urban gradient in stroke prevalence, underlying the dangers of the rapid transition in socioeconomic circumstances seen across the Indian subcontinent. Conclusions-This

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“…The DVP analysis method is a noninvasive technique of measuring pulse wave reflections to determine the arterial stiffness peripherally. 24 Arterial stiffness using this has been proven to be a validated, reproducible technique 25 with minimal intraobserver variation. 29 The stiffness index derived from this method has been demonstrated to have a good correlation to pulse wave velocity, 26 whereas the sensitivity and specificity of this technique are comparable to the pulse wave velocity method in the identification of patients with latent cardiovascular disease.…”

Section: Measurements Of Arterial Stiffnessmentioning

confidence: 99%

Glycemic Status Underlies Increased Arterial Stiffness and Impaired Endothelial Function in Migrant South Asian Stroke Survivors Compared to European Caucasians

Gunarathne

Patel

Kausar

et al. 2009

Stroke

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Background-The pathophysiology of an increased risk of cerebrovascular disease mortality among South Asians (SA) remains unclear. Indices of arterial stiffness and endothelial dysfunction are independent markers of vascular disease, having both prognostic and diagnostic implications. We hypothesized that there are ethnic variations in indices of arterial stiffness and endothelial dysfunction between SA and European Caucasian (EC) stroke patients, which may underline a poorer prognosis in the former, and further investigated promoters of vessel wall abnormalities. Methods-Using a cross-sectional approach, a total of 100 SA stroke survivors were prospectively recruited from the ongoing West Birmingham Stroke Project. Indices of vessel wall characteristics (arterial stiffness and endothelial function [change in reflective index]) were measured noninvasively using the digital volume pulse analysis technique in a temperature-controlled environment, using a direct standardized approach. SA stroke subjects were compared to 60 EC stroke survivors, 60 SA with risk factors, and 73 healthy controls. Results-Among stroke patients, both ethnic groups were comparable for cardiovascular risk profile, except for more diabetes mellitus in SA (Pϭ0.007) subjects and a higher prevalence of atrial fibrillation in EC (Pϭ0.04) subjects. According to the TOAST and Bamford classifications, SA subjects had more small vessel (Pϭ0.04) and lacunar infarctions (Pϭ0.01). SA subjects had higher measurements of arterial stiffness (PϽ0.001) and impaired endothelialdependent vascular function (change in reflective index %; PϽ0.001). On univariate analysis, endothelial function was negatively correlated with fasting plasma glucose (rϭϪ0.4; PϽ0.001) and total cholesterol level (rϭϪ0.2; PϽ0.001).On multivariate analysis, glycemic status was independently associated with impaired endothelial function (Pϭ0.008) and increased arterial stiffness (PϽ0.001) among SA subjects. Conclusion-SA stroke survivors had more small vessel disease-related cerebrovascular events compared to EC subjects.Underlying glycemic status in SA subjects had an adverse impact on the vascular system, leading to abnormal vessel wall characteristics. (Stroke. 2009;40:2298-2306.)

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Impact of mean arterial blood pressure on higher arterial stiffness indices in South Asians compared to white Europeans

Cited by 24 publications

References 37 publications

Ethnic Differences in Aortic Pulse Wave Velocity Occur in the Descending Aorta and May Be Related to Vitamin D

Ethnic Differences in Aortic Pulse Wave Velocity Occur in the Descending Aorta and May Be Related to Vitamin D

Ischemic Stroke in South Asians

Glycemic Status Underlies Increased Arterial Stiffness and Impaired Endothelial Function in Migrant South Asian Stroke Survivors Compared to European Caucasians

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