P4.57 Stiffness of the Large Arteries in Individuals With and Without Down Syndrome

Abstract

Background: Down syndrome is known to cause premature aging in several organ systems. However, it remains unclear whether this aging effect also affects the structure and function of the large arterial trunks. In this controlled study, the possibility of changes in the large arteries due to aging was evaluated in patients with Down syndrome. Methods: Eighty-two subjects of both genders were selected. The Down syndrome group had 41 active subjects consisting of 19 males and 22 females (mean age 21 ± 1, range 13-42 years) without cardiovascular complications and who did not use vasoactive drugs. The control group consisted of 41 healthy individuals without trisomy 21 of the same gender and age as the Down syndrome group and who did not use vasoactive medication. Carotid-femoral pulse wave velocity was obtained as an index of aortic stiffness using an automatic noninvasive method. Results: Individuals with Down syndrome had significantly lower blood pressure than those in the control group. Systolic blood pressure for the Down syndrome group and control group was 106 ± 2 mmHg vs 117 ± 2 mmHg (P , 0.001), respectively; diastolic blood pressure was 66 ± 2 mmHg vs 77 ± 2 mmHg (P , 0.001); and mean arterial pressure was 80 ± 1 mmHg vs 90 ± 1 mmHg (P , 0.001). Only age and systolic blood pressure were shown to correlate significantly with pulse wave velocity, but the slopes of the linear regression curves of these two variables showed no significant difference between the two study groups. Pulse wave velocity, which was initially significantly lower in the Down syndrome group (7.51 ± 0.14 m/s vs 7.84 ± 0.12 m/s; P , 0.05), was similar between the groups after systolic blood pressure adjustment (7.62 ± 0.13 m/s vs 7.73 ± 0.13 m/s). Conclusion: Despite evidence in the literature that patients with Down syndrome undergo early aging, this process does not seem to affect the large arterial trunks, given that values of carotid-femoral pulse wave velocity were similar in individuals with or without trisomy 21. Considering that Down syndrome presents with chronic hypotension, it is reasonable to propose that the prolonged reduction of arterial distending pressure may contribute to functional preservation of the arteries in patients with Down syndrome.

Atherosclerotic Surrogate Markers in Adults With Down Syndrome: A Case‐Control Study

“…These findings are in accordance with the only two previous studies assessing subclinical atherosclerosis in individuals with DS based on cIMT and PWV. Consistent with Rodrigues and colleagues, we found that chronic low BP values could play a key role in reducing arterial stiffness in adults with DS. These findings confirm the importance of BP as the main determinant of arterial stiffness, both in adults with DS and in adults without DS, although genetic differences in arterial wall architecture and function, which affect endothelial function and elasticity, are also important.…”

“…Information on subclinical vascular damage in individuals with DS is scarce, and only two studies have attempted to demonstrate a lower frequency of atherosclerosis in this population. Draheim and colleagues found lower cIMT values in 52 individuals with DS compared with 52 controls matched for sex and age, while Rodrigues and colleagues failed to find any difference in PWV values in adults with DS compared with nontrisomic adults.…”

Atypical aging in down syndrome

“…These include: (a) the integumentary system (i.e., the skin and its appendages), reflected by skin wrinkling and alopecia [Lott, ; Martin, ; Brugge et al, ]; (b) the endocrine system; reflected by earlier menopause in women [Patel et al, ; Schupf et al, , ; Hawli et al, ]; (c) the sensory system [Krinsky‐McHale et al, ]; (d) the musculoskeletal system [van Allen et al, ; Barnhart and Connolly, ]; (e) the immunological system [Lima et al, ], and (f) the neurological system (i.e., seizures, AD) [Lott et al, ]. (In contrast, conditions such as atherosclerosis, ischemic cardiac problems, hypertension, and adult‐onset solid cancers are uncommonly found in people with DS [Lott and Head, ; Rodrigues et al, ]). One of the most troublesome aspects of premature aging in people with DS is the early development of the neuropathology of AD [Mann et al, ; Lott and Head, ; Zigman and Lott, ] and the potential progression to the clinical signs of AD some years or decades later [Schupf, ; Beacher et al, ; Lott et al, ; Lott, ].…”

“…A body of research has indicated that hypertension and the development of ischemic cardiac disease are not common in adults with DS [Lott and Lai, ; Morrison et al, ; Kapell et al, ; Rodrigues et al, ], with one conspicuous exception, 25.5% of adults with DS over 50 were found to have hypertension in a study conducted in Findland [de Winter et al, ]. Subsequent to the surgical correction of congenital heart defects through childhood and adulthood, people with DS are at low risk for cardiac disease.…”

“…In an age‐ and sex‐matched study, Rodrigues found that individuals with DS had significantly lower blood pressure than age‐ and sex‐match typically developing individuals had. Since adults with DS typically present with chronic hypotension, it is reasonable to propose that the prolonged reduction of arterial distending pressure may be contributing to functional preservation of their arteries [Rodrigues et al, ].…”