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      Is Open Access

      Association between different risk factors and vascular accelerated ageing (EVA study): study protocol for a cross-sectional, descriptive observational study

      protocol
      1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 1 , 2 , 12 , 13
      (Collab), (Collab), (Collab), (Collab), (Collab), (Collab), (Collab), (Collab), (Collab), (Collab), (Collab), (Collab), (Collab), (Collab), (Collab)
      BMJ Open
      BMJ Publishing Group
      Arterial stiffness, Aging, Physical activity, Psychological factors, Diet, Inflammatory markers

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          Abstract

          Introduction

          The process of population ageing that is occurring in developed societies represents a major challenge for the health system. The aim of this study is to analyse factors that have an influence on early vascular ageing (EVA), estimated by carotid-femoral pulse wave velocity (cf-PWV) and Cardio Ankle Vascular Index (CAVI), and to determine differences by gender in a Spanish population.

          Methods and analysis

          An observational, descriptive, cross-sectional study.

          Study population

          From the population assigned to the participating healthcare centres, a cluster random sampling stratified by age and gender will be performed to obtain 500 participants aged between 35 and 75. Those who meet the inclusion criteria and give written informed consent will be included in the study.

          Measurements

          Main dependent variables: cf-PWV determined using the SphygmoCor System and CAVI estimated using VASERA. Secondary dependent variables: telomere length, carotid intima-media thickness, central and peripheral augmentation index, ankle-brachial pulse wave velocity, ankle-brachial index, retinal arteriovenous index, and renal and cardiac organ damage. Independent variables: lifestyles (physical activity, adherence to the Mediterranean diet, alcohol and tobacco consumption); psychological factors (depression, anxiety and chronic stress); inflammatory factors and oxidative stress.

          Ethics and dissemination

          The study has been approved by the clinical research ethics committee of the healthcare area of Salamanca. All study participants will sign an informed consent form agreeing to participate in the study in compliance with the Declaration of Helsinki and the WHO standards for observational studies. The results of this study will allow the understanding of the relationship of the different influencing factors and their relative weight in the development of EVA. At least 5 publications in first-quartile scientific journals are planned.

          Trial registration number

          NCT02623894; Pre-results.

          Related collections

          Most cited references54

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          Calibration of the Computer Science and Applications, Inc. accelerometer.

          We established accelerometer count ranges for the Computer Science and Applications, Inc. (CSA) activity monitor corresponding to commonly employed MET categories. Data were obtained from 50 adults (25 males, 25 females) during treadmill exercise at three different speeds (4.8, 6.4, and 9.7 km x h(-1)). Activity counts and steady-state oxygen consumption were highly correlated (r = 0.88), and count ranges corresponding to light, moderate, hard, and very hard intensity levels were or = 9499 cnts x min(-1), respectively. A model to predict energy expenditure from activity counts and body mass was developed using data from a random sample of 35 subjects (r2 = 0.82, SEE = 1.40 kcal x min(-1)). Cross validation with data from the remaining 15 subjects revealed no significant differences between actual and predicted energy expenditure at any treadmill speed (SEE = 0.50-1.40 kcal x min(-1)). These data provide a template on which patterns of activity can be classified into intensity levels using the CSA accelerometer.
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            Validity, reproducibility, and clinical significance of noninvasive brachial-ankle pulse wave velocity measurement.

            The present study was conducted to evaluate the validity and reproducibility of noninvasive brachial-ankle pulse wave velocity (baPWV) measurements and to examine the alteration of baPWV in patients with coronary artery disease (CAD). Simultaneous recordings of baPWV by a simple, noninvasive method and aortic pulse wave velosity (PWV) using a catheter tip with pressure manometer were performed in 41 patients with CAD, vasospastic angina, or cardiomyopathy. In 32 subjects (15 controls and 17 patients with CAD), baPWV was recorded independently by two observers in a random manner. In 55 subjects (14 controls and 41 patients with CAD), baPWV was recorded twice by a single observer on different days. baPWV were compared among 172 patients with CAD (aged 62 +/- 8 years); 655 age-matched patients without CAD but with hypertension, diabetes mellitus, or dyslipidemia; and 595 age-matched healthy subjects without these risk factors. baPWV correlated well with aortic PWV (r=0.87, p<0.01). Pearson's correlation coefficients of interobserver and intraobserver reproducibility were r=0.98 and r=0.87, respectively. The corresponding coefficients of variation were 8.4% and 10.0%. baPWV were significantly higher in CAD patients than in non-CAD patients with risk factors, for both genders (p<0.01). In addition, baPWV were higher in non-CAD patients with risk factors than in healthy subjects without risk factors. Thus, the validity and reproducibility of baPWV measurements are considerably high, and this method seems to be an acceptable marker reflecting vascular damages. baPWV measured by this simple, noninvasive method is suitable for screening vascular damages in a large population.
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              Depression as an aetiologic and prognostic factor in coronary heart disease: a meta-analysis of 6362 events among 146 538 participants in 54 observational studies.

              With negative treatment trials, the role of depression as an aetiological or prognostic factor in coronary heart disease (CHD) remains controversial. We quantified the effect of depression on CHD, assessing the extent of confounding by coronary risk factors and disease severity. Meta-analysis of cohort studies measuring depression with follow-up for fatal CHD/incident myocardial infarction (aetiological) or all-cause mortality/fatal CHD (prognostic). We searched MEDLINE and Science Citation Index until December 2003. In 21 aetiological studies, the pooled relative risk of future CHD associated with depression was 1.81 (95% CI 1.53-2.15). Adjusted results were included for 11 studies, with adjustment reducing the crude effect marginally from 2.08 (1.69-2.55) to 1.90 (1.49-2.42). In 34 prognostic studies, the pooled relative risk was 1.80 (1.50-2.15). Results adjusted for left ventricular function result were available in only eight studies; and this attenuated the relative risk from 2.18 to 1.53 (1.11-2.10), a 48% reduction. Both aetiological and prognostic studies without adjusted results had lower unadjusted effect sizes than studies from which adjusted results were included (P<0.01). Depression has yet to be established as an independent risk factor for CHD because of incomplete and biased availability of adjustment for conventional risk factors and severity of coronary disease.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2016
                7 June 2016
                : 6
                : 6
                : e011031
                Affiliations
                [1 ]Primary Care Research Unit, Instituto of Investigación Biomédica of Salamanca (IBSAL), The Alamedilla Health Center, Castilla and León Health Service–SACYL , Salamanca, Castile and León, Spain
                [2 ]Department of Medicine, REDIAPP, University of Salamanca , Salamanca, Castile and León, Spain
                [3 ]Unit Renal Physiology and Pathophysiology Cardiovascular Unit, Department of Physiology and Pharmacology, IBSAL, Queen Sofia Institute of Nephrology Research, University of Salamanca , Salamanca, Castile and León, Spain
                [4 ]IBSAL and Instituto of Biología Molecular and Celular of Cáncer (IBMCC), University of Salamanca–SACYL , Salamanca, Castile and León, Spain
                [5 ]Department of Medicine, University of Salamanca , Castile and León, Spain
                [6 ]IBSAL, IBMCC, Cancer Research Center, University of Salamanca, CSIC, University Hospital of Salamanca , Salamanca, Castile and León, Spain
                [7 ]Department of Hematology, University of Salamanca , Salamanca, Castile and León, Spain
                [8 ]Department of Medicine, University of Salamanca , Salamanca, Castile and León, Spain
                [9 ]IBSAL, University Hospital of Salamanca , Salamanca, Castile and León, Spain
                [10 ]Cardiology Department, University of Salamanca , Salamanca, Castile and León, Spain
                [11 ]Primary Care Research Unit, IBSAL, The Alamedilla Health Center, Castilla and León Health Service–SACYL, REDIAPP , Salamanca, Castile and León, Spain
                [12 ]Primary Care Research Unit, BSAL, The Alamedilla Health Center, Castilla and León Health Service–SACYL , Salamanca, Castile and León, Spain
                [13 ]Biomedical and Diagnostic Sciences Department, REDIAPP, University of Salamanca , Salamanca, Castile and León, Spain
                Author notes
                [Correspondence to ] Dr Manuel A Gomez-Marcos; magomez@ 123456usal.es
                Article
                bmjopen-2016-011031
                10.1136/bmjopen-2016-011031
                4908886
                27267107
                214cd444-ba5e-4a27-8d08-a53486a3b819
                Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

                This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

                History
                : 2 January 2016
                : 19 April 2016
                : 13 May 2016
                Categories
                Cardiovascular Medicine
                Protocol
                1506
                1683
                1696
                1689

                Medicine
                arterial stiffness,aging,physical activity,psychological factors,diet,inflammatory markers
                Medicine
                arterial stiffness, aging, physical activity, psychological factors, diet, inflammatory markers

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