Carotid stiffness is associated with retinal microvascular dysfunction—The Maastricht study

Baan, Frank van de; Zhou, Tan Lai; Henry, Ronald M.A.; Houben, Alfons J.H.M.; Kroon, Abraham A.; Dagnelie, Pieter C.; Dongen, M.C.J.M. van; Eussen, Simone J. P. M.; Berendschot, Tos T. J. M.; Schouten, Jan S.A.G.; Webers, Carroll A.B.; Schram, Miranda T.; Greevenbroek, Marleen M.J. van; Wesselius, Anke; Schalkwijk, Casper G.; Koster, Annemarie; Savelberg, Hans; Schaper, Nicolaas C.; Reesink, Koen D.; Stehouwer, Coen D. A.

doi:10.1111/micc.12702

Cited by 7 publications

(7 citation statements)

References 40 publications

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“…[ 4 6 ] However, few studies did not find any association between central aortic stiffness and T2DM retinopathy. [ 13 14 ] In the present study, baPWV was found to be significantly higher in T2DM patients with retinopathy than in T2DM patients without retinopathy. Moreover, a positive association of baPWV with the T2DM retinopathy group was found.…”

Section: Discussionsupporting

confidence: 52%

Assessment of the relationship of systemic vascular dysfunction and cardiac autonomic neuropathy (CAN) with diabetic retinopathy

Hari Prakash,

Parija,

Kar

2023

Journal of Family Medicine and Primary Care

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Context: Diabetic retinopathy, a form of microvasculopathy, is the leading cause of the visual abnormality. However, there is no conclusive evidence of the relationship of systemic vascular dysfunction with retinal microvasculopathy. In addition, diabetes-associated cardiac autonomic neuropathy may also compromise vascular function. Aims: The present study intends to correlate arterial stiffness, endothelial function, and heart rate variability (HRV) as a standardized measure of cardiac autonomic neuropathy with diabetic retinopathy. Settings and Design: The present cross-sectional, observational study was conducted in the Department of Physiology. Materials and Methods: Twenty subjects were recruited in group 1 (T2DM, type 2 diabetes mellitus patients, without retinopathy) and group 2 (T2DM with retinopathy). The vascular parameters such as heart rate, peripheral and central blood pressure, augmentation index [AIx (%)], brachial -ankle pulse wave velocity (baPWV), and reactive hyperaemia index (RHI) were recorded. Statistical Analysis Used: Independent sample t-test (for parametric data) and Mann–Whitney U test (for non-parametric data) were employed to compare the variables of two groups. Spearman correlation was used to examine the relationship among the parameters. Linear regression analysis was performed to examine the important vascular predictor for diabetic retinopathy. Results: baPWV was significantly higher in group 2 than in group 1 and positively associated with group 2. RHI was significantly less in group 2 than group 1 and negatively associated with group 2. Among HRV metrics, standard deviation of successive differences (SDSD), root mean square of successive differences between normal heartbeats (RMSSD), and high frequency (HF) power were significantly decreased in group 2 than in group 1. SDSD, RMSSD, and HF power were negatively associated with group 2. RHI emerged as a significant predictor of diabetic retinopathy following linear regression. Conclusions: Overall, the result of the present study indicates that metabolic dysregulation of glucose may affect the normal functioning of the autonomic nervous system and vascular function. Therefore, screening of vascular function and cardiac autonomic tone may be advocated in diabetic patients in routine clinics to examine the existence of any comorbid condition, such as diabetic retinopathy, as systemic vascular changes may also affect ophthalmic vasculature.

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Section: Discussionsupporting

confidence: 52%

Assessment of the relationship of systemic vascular dysfunction and cardiac autonomic neuropathy (CAN) with diabetic retinopathy

Hari Prakash,

Parija,

Kar

2023

Journal of Family Medicine and Primary Care

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“…The specific methodology for obtaining vascular health measurements in The Maastricht Study have been described in detail previously 15–17 . In brief, all vascular measures were completed in one or two study visits.…”

Section: Methodsmentioning

confidence: 99%

“…A higher value indicates a better microvascular health. Retinal vessel reactivity was evaluated by retinal dynamic vessel analysis as the arteriolar and venular dilation in response to flicker light stimulation using the Dynamic Vessel Analyzer (DVA, IMEDOS, Jena, Germany). The integrated DVA software (version 4.51, Imedos) automatically calculated baseline diameter, absolute dilation and percentage dilation, as previously described 15,17 . Due to significant associations between baseline retinal venule and arteriole diameter with total step count and time spent faster paced stepping ( p = 0.024 to <0.001) it was deemed more appropriate to use the absolute total response to flicker light stimulation (ΔMU) rather than the percentage increase.…”

Section: Methodsmentioning

confidence: 99%

“…The vascular health measurements completed were as follows: Arterial stiffness was evaluated using carotid–femoral pulse wave velocity (cfPWV), determined according to recent guidelines 18 with the use of applanation tonometry (SphygmoCor; Atcor Medical, Sydney, Australia), as described previously 6,15 . A lower value indicates a better vascular health. Skin microvascular function was evaluated using heat‐induced skin hyperemia, measured with a laser Doppler system (Periflux 5000, Perimed), as the percent increase in skin blood flow on the dorsal side of the wrist of the left hand in response to local heating to 44°C as described previously 8,17 .…”

Section: Methodsmentioning

confidence: 99%

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Associations of between‐ and within‐day patterns of physical activity accumulation with arterial stiffness and indices of microvascular health—Evidence from The Maastricht study

Lear,

Metcalf,

Hillsdon

et al. 2024

Scandinavian Med Sci Sports

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While physical activity (PA) is understood to promote vascular health, little is known about whether the daily and weekly patterns of PA accumulation associate with vascular health. Accelerometer‐derived (activPAL3) 6‐ or 7‐day stepping was analyzed for 6430 participants in The Maastricht Study (50.4% women; 22.4% Type 2 diabetes mellitus (T2DM)). Multivariable regression models examined associations between stepping metrics (average step count, and time spent slower and faster paced stepping) with arterial stiffness (measured as carotid–femoral pulse wave velocity (cfPWV)), and several indices of microvascular health (heat‐induced skin hyperemia, retinal vessel reactivity and diameter), adjusting for confounders and moderators. PA pattern metrics were added to the regression models to identify associations with vascular health beyond that of stepping metrics. Analyses were stratified by T2DM status if an interaction effect was present. Average step count and time spent faster paced stepping was associated with better vascular health, and the association was stronger in those with compared to those without T2DM. In fully adjusted models a higher step count inter‐daily stability was associated with a higher (worse) cfPWV in those without T2DM (std β = 0.04, p = 0.007) and retinal venular diameter in the whole cohort (std β = 0.07, p = 0.002). A higher within‐day variability in faster paced stepping was associated with a lower (worse) heat‐induced skin hyperemia in those with T2DM (std β = −0.31, p = 0.008). Above and beyond PA volume, the daily and weekly patterns in which PA was accumulated were additionally associated with improved macro‐ and microvascular health, which may have implications for the prevention of vascular disease.

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“…45 Carotid stiffness was associated with retinal microvascular dysfunction in the Maastricht study. 46 Aortic stiffness was associated not only with structural but also functional parameters of the retinal microcirculation. 47…”

Section: Hypertension-mediated Organ Damagementioning

confidence: 99%

Microcirculation and Macrocirculation in Hypertension: A Dangerous Cross-Link?

et al. 2022

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Microcirculation and macrocirculation are tightly interconnected into a dangerous cross-link in hypertension. Small artery damage includes functional (vasoconstriction, impaired vasodilatation) and structural abnormalities (mostly inward eutrophic remodeling). These abnormalities are major determinants of the increase in total peripheral resistance and mean blood pressure (BP) in primary hypertension, which in the long term induces large artery stiffening. In turn, large artery stiffening increases central systolic and pulse pressures, which are further augmented by wave reflection in response to the structural alterations in small resistance arteries. Finally, transmission of high BP and flow pulsatility to small resistance arteries further induces functional and structural abnormalities, thus leading to increased total peripheral resistance and mean BP, thus perpetuating the vicious circle. Hyperpulsatility, in addition to higher mean BP, exaggerates cardiac, brain, and kidney damages and leads to cardiovascular, cerebral, and renal complications. The dangerous cross-link between micro and macrocirculation can be reversed into a virtuous one by ACE (angiotensin-converting enzyme) inhibitors, sartans, and calcium channel blockers. These three pharmacological classes are more potent than β-blockers and diuretics for reducing arterial stiffness and small artery remodeling. The same ranking was observed for their effectiveness at reducing left ventricular hypertrophy, preserving glomerular filtration rate, and preventing dementia, suggesting that they can act beyond brachial BP reduction, by breaking the micro/macrocirculation vicious circle.

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Carotid stiffness is associated with retinal microvascular dysfunction—The Maastricht study

Cited by 7 publications

References 40 publications

Assessment of the relationship of systemic vascular dysfunction and cardiac autonomic neuropathy (CAN) with diabetic retinopathy

Assessment of the relationship of systemic vascular dysfunction and cardiac autonomic neuropathy (CAN) with diabetic retinopathy

Associations of between‐ and within‐day patterns of physical activity accumulation with arterial stiffness and indices of microvascular health—Evidence from The Maastricht study

Microcirculation and Macrocirculation in Hypertension: A Dangerous Cross-Link?

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