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      Pulse Wave Velocity Is Associated with Metabolic Syndrome Components in CAPD Patients

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          Abstract

          Background: Overall, the proportion of deaths due to cardiovascular disease (CVD) reached 40–50% in dialysis patients. Pulse wave velocity (PWV) reflects arterial stiffness and may provide an integrated index of vascular status and CVD risk. Individual components of the metabolic syndrome (MetS) are well-established cardiovascular risk factors. Thus we conducted a cross-sectional study in continuous ambulatory peritoneal dialysis (CAPD) patients to explore the association of MetS components with PWV. Methods: Prevalent CAPD patients (n = 148, 63 M/85 F) were categorized according to the number of traits of the MetS into one of three groups (No MetS, Risk of MetS, MetS). Due to the effect of peritoneal dialysis (PD), waist circumference was not assessed. Aortic stiffness was assessed by carotid-femoral PWV (C-F PWV). Results: Patients’ MetS trait numbers were positively associated with C-F PWV (r = 0.301, p < 0.01), pulse pressure (r = 0.256, p < 0.01), systolic blood pressure (r = 0.233, p < 0.01), and serum albumin (r = 0.205, p < 0.05). In a multivariate regression analysis, PWV was independently determined by age (p < 0.01) and MetS score (p = 0.01). Adjusted R<sup>2</sup> of the model was 0.24. Conclusion: MetS traits were closely associated with an increased C-F PWV, even after adjustment for confounders. This suggests that commonly recognized MetS criteria are useful also when predicting CVD in CAPD patients.

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          Clinical epidemiology of cardiovascular disease in chronic renal disease.

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            Prevalence of the Metabolic Syndrome Among US Adults

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              Aortic stiffness is an independent predictor of fatal stroke in essential hypertension.

              Pulse pressure is a stronger predictor of cardiovascular events than systolic or diastolic blood pressure in large cohorts of French and North American patients. However, its influence on stroke is controversial. Large-artery stiffness is the main determinant of pulse pressure. The influence of arterial stiffness on the occurrence of stroke has never been demonstrated. Our aim was to establish the relationship between aortic stiffness and stroke death in hypertensive patients. We included, in a longitudinal study, 1715 essential hypertensive patients who had a measurement of arterial stiffness at entry (ie, between 1980 and 2001) and no overt cardiovascular disease or symptoms. Mean follow-up was 7.9 years. At entry, aortic stiffness was assessed from the carotid-femoral pulse wave velocity. A Cox proportional hazard regression model was used to estimate the relative risk (RR) of stroke and coronary deaths. Mean+/-SD age at entry was 51+/-13 years. Twenty-five fatal strokes and 35 fatal coronary events occurred. Pulse wave velocity significantly predicted the occurrence of stroke death in the whole population. There was a RR increase of 1.72 (95% CI, 1.48 to 1.96; P<0.0001) for each SD increase in pulse wave velocity (4 m/s). The predictive value of pulse wave velocity remained significant (RR=1.39 [95% CI, 1.08 to 1.72]; P=0.02) after full adjustment for classic cardiovascular risk factors, including age, cholesterol, diabetes, smoking, mean blood pressure, and pulse pressure. In this population, pulse pressure significantly predicted stroke in univariate analysis, with a RR increase of 1.33 (95% CI, 1.16 to 1.51) for each 10 mm Hg of pulse pressure (P<0.0001) but not after adjustment for age (RR=1.19 [95% CI, 0.96 to 1.47]; P=0.10). This study provides the first evidence, in a longitudinal study, that aortic stiffness is an independent predictor of fatal stroke in patients with essential hypertension.
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                Author and article information

                Journal
                AJN
                Am J Nephrol
                10.1159/issn.0250-8095
                American Journal of Nephrology
                S. Karger AG
                0250-8095
                1421-9670
                2008
                June 2008
                21 February 2008
                : 28
                : 4
                : 641-646
                Affiliations
                aDivision of Nephrology, Peking University Third Hospital, Beijing, PR China; bDivisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
                Article
                117813 Am J Nephrol 2008;28:641–646
                10.1159/000117813
                18287789
                17fbfaa4-dac7-4aeb-8e28-6181c32fdfac
                © 2008 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                : 04 September 2007
                : 19 December 2007
                Page count
                Tables: 3, References: 45, Pages: 6
                Categories
                Original Report: Patient-Oriented, Translational Research

                Cardiovascular Medicine,Nephrology
                Cardiovascular disease,Arterial stiffness,Chronic kidney disease,Dyslipidemia,Hypertension

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