Circadian and sex differences in carotid-femoral pulse wave velocity in young individuals and elderly with and without type 2 diabetes

Abstract

The incidence of cardiovascular events is higher in the morning than in the evening and differs between sexes. We tested the hypothesis that aortic stiffness, a compelling cardiovascular risk factor, increases in the morning than in the evening in young, healthy individuals between 18 and 30 years (H18–30) or in older individuals between 50 and 80 years, either healthy (H50–80) or with type 2 diabetes (T2DM50–80). Sex differences were also investigated. Carotid-femoral pulse wave velocity (cf-PWV) recorded via Doppler Ultrasound, blood pressure and heart rate were checked at 6 a.m. and 9 p.m., at rest and during acute sympathetic activation triggered by handgrip exercise. Cf-PWV values were lower in the morning compared to the evening in all groups (p < 0.01) at rest and lower (p = 0.008) in H18–30 but similar (p > 0.267) in the older groups during sympathetic activation. At rest, cf-PWV values were lower in young women compared to young men (p = 0.001); however, this trend was reversed in the older groups (p < 0.04). During sympathetic activation, the cf-PWV was lower in women in H18–30 (p = 0.001), similar between sexes in H50–80 (p = 0.122), and higher in women in T2DM50–80 (p = 0.004). These data do not support the hypothesis that aortic stiffness increases in the morning compared to the evening within any of the considered groups in both rest and sympathetic activation conditions. There are differences between the sexes, which vary according to age and diabetes status. In particular, aortic stiffness is higher in older women than in men with diabetes during acute stress.

Circadian and sex differences in post‐ischemic vasodilation and reactive hyperemia in young individuals and elderly with and without type 2 diabetes

“…Despite the circadian changes in VC and BF in the older groups were found, peak systolic velocity scored similar in the morning compared to the evening, suggesting that changes in BF may be independent of the velocity of ventricular ejection or viscoelastic properties of the arterial wall 20,21 . In support of this notion, we have previously shown that carotid‐femoral pulse wave velocity, an index related to central artery stiffness, is similar at 6 a.m. compared to 9 p.m. in elderly individuals with and without T2DM of similar age to those recruited in the present study 36 …”

“…The change-scores confirm that there are sex differences in vascular regulation at a young age that are independent of different baseline values between men and women, and that these differences are abolished with aging. 36,39 The study of sex differences in vascular and microvascular regulation has led to new insights into cardiovascular medicine and prevention. The documentation of potential causes affecting vascular health in one sex has led to translational research and development of therapeutics to apply to the opposite sex, as well as to different treatments between sexes in targeting cardiovascular diseases.…”

Cardiovascular prevention in women: an update by the Italian Society of Cardiology working group on ‘Prevention, hypertension and peripheral disease’

“…It is increasingly accepted that several genetic variations and biological differences influence cardiovascular risk and the pathogenesis of CVD in women 10,11 . Specific sex differences in physiology and pathophysiology could be related to both endogenous and exogenous reproductive hormones, although contemporary data question the protective role of synthetic estrogens 12 .…”

“…9 Traditional cardiovascular risk factors in women: the central role of obesity It is increasingly accepted that several genetic variations and biological differences influence cardiovascular risk and the pathogenesis of CVD in women. 10,11 Specific sex differences in physiology and pathophysiology could be related to both endogenous and exogenous reproductive hormones, although contemporary data question the protective role of synthetic estrogens. 12 It is controversial whether exogenous oestrogen therapy used for contraception and menopause lowers the CVD burden.…”

Estimated pulse wave velocity is associated with all-cause mortality and cardiovascular mortality among adults with diabetes

“…Diabetes is an important cause of arterial stiffness, and it is very necessary to pay attention to ePWV of patients with diabetes. Clinical studies have shown that patients with diabetes are more likely to develop arterial stiffness and had a higher cf-PWV than people without diabetes (43)(44)(45). The molecular mechanism of arterial stiffness caused by diabetes has also been widely investigated.…”