Arterial stiffness and blood pressure (BP) both increase with aging synchronously. Whether elevated BP results from thickening of arterial wall or vice versa is controversial in previous studies. This study included 17 862 participants without history of myocardial infarction, stroke, atrial fibrillation or flutter, or cancer and with brachial-ankle pulse wave velocity (baPWV) and BP measurements during 2010 to 2016. Age was calculated from the self-reported birthdate to the first date of baPWV examination. Mediation analyses were applied to assess the mediation effect by baPWV in the association between age and BP. Temporal relation between baPWV and BP was assessed by cross-lagged analyses among 1508 participants with repeated assessment of baPWV. We found that systolic BP increased 0.47 (95% CI, 0.45–0.49) mm Hg per 1 year older by the mediation effect of baPWV and that the direct effect of aging on systolic BP was −0.07 (95% CI, −0.09 to −0.05) mm Hg per 1 year older. The standard regression coefficient from baseline baPWV to follow-up systolic BP was 0.09 (95% CI, 0.04–0.15), which was greater than the standard regression coefficient from baseline systolic BP to follow-up baPWV (0.01; 95% CI, −0.04 to 0.06). Arterial stiffness mediated the positive association between aging and BP, and arterial stiffness might precede elevated BP. Clinical Trial Registration— URL: http://www.chictr.org.cn . Unique identifier: ChiCTR-TNRC-11001489.

Rationale: Previous studies on the relationship between diabetes and arterial stiffness were mostly cross-sectional. A few longitudinal studies focused on one single direction. Whether the association between arterial stiffness and diabetes is bidirectional remains unclear to date. Objective: To explore the temporal relationship between arterial stiffness and fasting blood glucose (FBG) status. Methods and Results: Included were 14,159 participants of the Kailuan study with assessment of brachial-ankle pulse wave velocity (baPWV) from 2010 to 2015, and free of diabetes, cardiovascular and cerebrovascular diseases and chronic kidney disease at baseline. FBG and baPWV were repeatedly measured at baseline and follow-ups. Cox proportional hazard regression model was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of incident diabetes across baseline baPWV groups: <1,400 cm/s (ref), 1,400 {less than or equal to} baPWV < 1,800 cm/s, and {greater than or equal to}1,800cm/s. Path analysis was used to analyze the possible temporal causal relationship between baPWV and FBG, among 8,956 participants with repeated assessment of baPWV and FBG twice in 2010-2017. The mean baseline age of the observed population was 48.3{plus minus}12.0 years. During mean 3.72 years of follow-up, 979 incident diabetes cases were identified. After adjusting for potential confounders, the HR (95% CI) for risk of diabetes was 1.59 (1.34, 1.88) for the borderline arterial stiffness group and 2.11 (1.71, 2.61) for the elevated arterial stiffness group, compared with the normal ideal arterial stiffness group. In the path analysis, baseline baPWV was associated with follow-up FBG (the standard regression coefficient was 0.09; 95% CI: 0.05 to 0.10). In contrast, the standard regression coefficient of baseline FBG for follow-up baPWV (β = 0.00, 95% CI: -0.02 to 0.02) was not significant. Conclusions: Arterial stiffness, as measured by baPWV, was associated with risk of developing diabetes. Arterial stiffness appeared to precede the increase in FBG.

Background and ObjectivesAlthough flavonoids have the potential to exert neuroprotective benefits, evidence of their role in improving survival rates among individuals with Parkinson disease (PD) remains lacking. We aimed to prospectively study the association between pre- and post-diagnosis flavonoid intakes and risk of mortality among individuals with PD identified from two large ongoing cohorts of US men and women.MethodsIncluded in the current analysis were 599 women from the Nurses’ Health Study and 652 men from the Health Professionals Follow-up Study who were newly diagnosed with PD during follow-up. Dietary intakes of total flavonoid and its subclasses together with major flavonoid-rich foods (tea, apples, berries, orange and orange juice, and red wine) were repeatedly assessed based on a validated food frequency questionnaire every 4 years. Mortality was ascertained via the National Death Index and state vital statistics records.ResultsWe documented 944 deaths during 32–34 years of follow-up. A higher total flavonoid intake before PD diagnosis was associated with a lower future risk for all-cause mortality in men (hazard ratio [HR] comparing two extreme quartiles=0.53, 95% CI: 0.39, 0.71; p-trend<0.001) but not in women (HR=0.93, 95% CI: 0.68, 1.28; p-trend=0.69), after adjusting for age, smoking status, total energy intake, and other covariates. The pooled HR comparing the extreme quartiles was 0.70 (95% CI: 0.40, 1.22; p-trend=0.25) with significant heterogeneity (p=0.01). For flavonoid subclasses, the highest quartile of anthocyanins, flavones, and flavan-3-ols intakes before diagnosis had a lower mortality risk compared to the lowest quartile (pooled HR=0.66, 0.78, and 0.69, respectively, p<0.05 for all); for berries and red wine, participants consuming >=3 servings/week had a lower risk (pooled HR=0.77 (95%CI: 0.58, 1.02) and 0.68 (95%CI: 0.51, 0.91), respectively), compared to <1 serving/month. After PD diagnosis, greater consumptions of total flavonoid, subclasses including flavonols, anthocyanins, flavan-3-ols, and polymers, and berries and red wine, were associated with lower mortality risk (p<0.05 for all).DiscussionAmong individuals with PD, higher consumption of flavonoids, especially anthocyanins and flavan-3-ols, and flavonoid-rich food such as berries and red wine, was likely to be associated with a lower risk of mortality.