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

Manuel A Gomez-Marcos, Carlos Martinez-Salgado, Rogelio Gonzalez-Sarmiento, Jesus Ma Hernandez-Rivas, Pedro L Sanchez-Fernandez, Jose I Recio-Rodriguez, Emiliano Rodriguez-Sanchez, Luis García-Ortiz, Manuel A Gomez-Marcos, Carlos Martinez-Salgado, Rogelio Gonzalez-Sarmiento, Jesus Ma Hernandez-Rivas, Pedro L Sanchez-Fernandez, Jose I Recio-Rodriguez, Emiliano Rodriguez-Sanchez, Luis García-Ortiz

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.

Keywords: Aging; Arterial stiffness; Diet; Inflammatory markers; Physical activity; Psychological factors.

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/

References

    1. Villella E, Cho JS. Effect of aging on the vascular system plus monitoring and support. Surg Clin North Am 2015;95:37–51. 10.1016/j.suc.2014.09.007
    1. Gragasin FS, Bourque SL, Davidge ST. Vascular aging and hemodynamic stability in the intraoperative period. Front Physiol 2012;3:74 10.3389/fphys.2012.00074
    1. Nilsson PM. Hemodynamic aging as the consequence of structural changes associated with Early Vascular Aging (EVA). Aging Dis 2014;5:109–13. 10.14336/AD.2014.0500109
    1. Oakley R, Tharakan B. Vascular hyperpermeability and aging. Aging Dis 2014;5:114–25. 10.14336/AD.2014.0500114
    1. Mitchell GF. Effects of central arterial aging on the structure and function of the peripheral vasculature: implications for end-organ damage. J Appl Physiol 2008;105:1652–60. 10.1152/japplphysiol.90549.2008
    1. Henry-Feugeas MC, Koskas P. Cerebral vascular aging: extending the concept of pulse wave encephalopathy through capillaries to the cerebral veins. Curr Aging Sci 2012;5:157–67. 10.2174/1874609811205020157
    1. Lee HY, Oh BH. Aging and arterial stiffness. Circ J 2010;74:2257–62. 10.1253/circj.CJ-10-0910
    1. Hashimoto J, Ito S. Some mechanical aspects of arterial aging: physiological overview based on pulse wave analysis. Ther Adv Cardiovasc Dis 2009;3:367–78. 10.1177/1753944709338942
    1. O'Rourke MF, Hashimoto J. Mechanical factors in arterial aging: a clinical perspective. J Am Coll Cardiol 2007;50:1–13. 10.1016/j.jacc.2006.12.050
    1. Maruyama Y. Aging and arterial-cardiac interactions in the elderly. Int J Cardiol 2012;155:14–19. 10.1016/j.ijcard.2011.01.087
    1. Safar ME. Arterial aging—hemodynamic changes and therapeutic options. Nat Rev Cardiol 2010;7:442–9. 10.1038/nrcardio.2010.96
    1. Najjar SS, Scuteri A, Lakatta EG. Arterial aging: is it an immutable cardiovascular risk factor? Hypertension 2005;46:454–62. 10.1161/01.HYP.0000177474.06749.98
    1. Artandi SE. Telomeres, telomerase, and human disease. N Engl J Med 2006;355:1195–7. 10.1056/NEJMp068187
    1. Marín C, Yubero-Serrano EM, López-Miranda J. Endothelial aging associated with oxidative stress can be modulated by a healthy Mediterranean diet. Int J Mol Sci 2013;14:8869–89. 10.3390/ijms14058869
    1. Rode L, Nordestgaard BG, Bojesen SE. Peripheral blood leukocyte telomere length and mortality among 64,637 individuals from the general population. J Natl Cancer Inst 2015;107:djv074 10.1093/jnci/djv074
    1. Carty CL, Kooperberg C, Liu J et al. . Leukocyte telomere length and risks of incident coronary heart disease and mortality in a racially diverse population of postmenopausal women. Arterioscler Thromb Vasc Biol 2015;35:2225–31. 10.1161/ATVBAHA.115.305838
    1. Simpson K, Jones RE, Grimstead JW et al. . Telomere fusion threshold identifies a poor prognostic subset of breast cancer patients. Mol Oncol 2015;9:1186–93. 10.1016/j.molonc.2015.02.003
    1. Needham BL, Rehkopf D, Adler N et al. . Leukocyte telomere length and mortality in The National Health and Nutrition Examination Survey, 1999–2002. Epidemiology 2015;26:528–35. 10.1097/EDE.0000000000000299
    1. Haycock PC, Heydon EE, Kaptoge S et al. . Leucocyte telomere length and risk of cardiovascular disease: systematic review and meta-analysis. BMJ 2014;349:g4227 10.1136/bmj.g4227
    1. Gomez-Marcos MA, Recio-Rodríguez JI, Patino-Alonso MC et al. . Relationship between physical activity and plasma fibrinogen concentrations in adults without chronic diseases. PLoS ONE 2014;9:e87954 10.1371/journal.pone.0087954
    1. Schmidt-Trucksass A, Weisser B. [Vascular aging, arterial hypertension and physical activity]. Dtsch Med Wochenschr 2011;136:2367–71. 10.1055/s-0031-1292053
    1. Seals DR, Desouza CA, Donato AJ et al. . Habitual exercise and arterial aging. J Appl Physiol 2008;105:1323–32. 10.1152/japplphysiol.90553.2008
    1. Jørgensen AB, Frikke-Schmidt R, Nordestgaard BG. Loss-of-function mutations in APOC3 and risk of ischemic vascular disease. N Engl J Med 2014;371:32–41. 10.1056/NEJMoa1308027
    1. García-Ortiz L, Recio-Rodríguez JI, Schmidt-Trucksäss A et al. . Relationship between objectively measured physical activity and cardiovascular aging in the general population—the EVIDENT trial. Atherosclerosis 2014;233:434–40. 10.1016/j.atherosclerosis.2014.01.021
    1. Corbi G, Conti V, Russomanno G et al. . Is physical activity able to modify oxidative damage in cardiovascular aging? Oxid Med Cell Longev 2012;2012:728547 10.1155/2012/728547
    1. Seals DR, Jablonski KL, Donato AJ. Aging and vascular endothelial function in humans. Clin Sci 2011;120:357–75. 10.1042/CS20100476
    1. Strazhesko ID, Akasheva DU, Dudinskaia EN. [The renin-angiotensin-aldosterone system and vascular aging]. Kardiologiia 2013;53:78–84.
    1. Patino-Alonso MC, Recio-Rodríguez JI, Belio JF et al. . Factors associated with adherence to the Mediterranean diet in the adult population. J Acad Nutr Diet 2014;114:583–9. 10.1016/j.jand.2013.07.038
    1. Scuteri A, Cunha PG. Decreasing arterial aging by controlling blood pressure levels and hypertension: a step forward. Curr Vasc Pharmacol 2012;10:702–4. 10.2174/157016112803520954
    1. Vlachopoulos C. Progress towards identifying biomarkers of vascular aging for total cardiovascular risk prediction. J Hypertens 2012;30(Suppl):S19–26. 10.1097/HJH.0b013e328353e534
    1. Khurana S, Venkataraman K, Hollingsworth A et al. . Polyphenols: benefits to the cardiovascular system in health and in aging. Nutrients 2013;5:3779–827. 10.3390/nu5103779
    1. Estruch R, Ros E, Salas-Salvadó J et al. , PREDIMED Study Investigators. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med 2013;368:1279–90. 10.1056/NEJMoa1200303
    1. Lespérance F, Frasure-Smith N, Talajic M et al. . Five-year risk of cardiac mortality in relation to initial severity and one-year changes in depression symptoms after myocardial infarction. Circulation 2002;105:1049–53. 10.1161/hc0902.104707
    1. Blumenthal JA, Lett HS Babyak MA et al. . Depression as a risk factor for mortality after coronary artery bypass surgery. Lancet 2003;362:604–9. 10.1016/S0140-6736(03)14190-6
    1. Nicholson A, Kuper H, Hemingway H. 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. Eur Heart J 2006;27:2763–74. 10.1093/eurheartj/ehl338
    1. Van der Kooy K, van Hout H, Marwijk H et al. . Depression and the risk for cardiovascular diseases: systematic review and meta analysis. Int J Geriatr Psychiatry 2007;22:613–26. 10.1002/gps.1723
    1. Sherwood A, Blumenthal JA, Trivedi R et al. . Relationship of depression to death or hospitalization in patients with heart failure. Arch Intern Med 2007;167:367–73. 10.1001/archinte.167.4.367
    1. Lesman-Leegte I, van Veldhuisen DJ, Hillege HL et al. . Depressive symptoms and outcomes in patients with heart failure: data from the COACH study. Eur J Heart Fail 2009;11:1202–7. 10.1093/eurjhf/hfp155
    1. Janszky I, Ahnve S, Lundberg I et al. . Early-onset depression, anxiety, and risk of subsequent coronary heart disease: 37-year follow-up of 49,321 young Swedish men. J Am Coll Cardiol 2010;56:31–7. 10.1016/j.jacc.2010.03.033
    1. Rosengren A, Hawken S, Ounpuu S et al. . Association of psychosocial risk factors with risk of acute myocardial infarction in 11119 cases and 13648 controls from 52 countries (the INTERHEART study): case-control study. Lancet 2004;364:953–62. 10.1016/S0140-6736(04)17019-0
    1. Csiszar A, Podlutsky A, Wolin MS et al. . Oxidative stress and accelerated vascular aging: implications for cigarette smoking. Front Biosci (Landmark Ed) 2009;14:3128–44.
    1. Pietri P, Vlachopoulos C, Chrysohoou C et al. . Deceleration of age-related aortic stiffening in a population with high longevity rates: the IKARIA study. J Am Coll Cardiol 2015;66:1842–3. 10.1016/j.jacc.2015.07.070
    1. Babizhayev MA, Yegorov YE. Smoking and health: association between telomere length and factors impacting on human disease, quality of life and life span in a large population-based cohort under the effect of smoking duration. Fundam Clin Pharmacol 2011;25:425–42. 10.1111/j.1472-8206.2010.00866.x
    1. Babizhayev MA, Savel'yeva EL, Moskvina SN et al. . Telomere length is a biomarker of cumulative oxidative stress, biologic age, and an independent predictor of survival and therapeutic treatment requirement associated with smoking behavior. Am J Ther 2011;18:e209–26. 10.1097/MJT.0b013e3181cf8ebb
    1. Karimi L, Mattace-Raso FU, van Rosmalen J et al. . Effects of combined healthy lifestyle factors on functional vascular aging: the Rotterdam Study. J Hypertens 2016;34:853–9. 10.1097/HJH.0000000000000861
    1. Tyrovolas S, Haro JM, Polychronopoulos E et al. . Factors associated with components of arterial pressure among older individuals (the multinational MEDIS study): the role of the Mediterranean diet and alcohol consumption. J Clin Hypertens (Greenwich) 2014;16:645–51. 10.1111/jch.12370
    1. Mattace-Raso FU, van der Cammen TJ, van den Elzen AP et al. . Moderate alcohol consumption is associated with reduced arterial stiffness in older adults: the Rotterdam study. J Gerontol A Biol Sci Med Sci 2005;60:1479–83.
    1. Lakatta EG, Wang M, Najjar SS. Arterial aging and subclinical arterial disease are fundamentally intertwined at macroscopic and molecular levels. Med Clin North Am 2009;93:583–604, Table of Contents 10.1016/j.mcna.2009.02.008
    1. Sun Z. Aging, arterial stiffness, and hypertension. Hypertension 2015;65:252–6. 10.1161/HYPERTENSIONAHA.114.03617
    1. Kim JY, Kim OY, Paik JK et al. . Association of age-related changes in circulating intermediary lipid metabolites, inflammatory and oxidative stress markers, and arterial stiffness in middle-aged men. Age (Dordr) 2013;35:1507–19. 10.1007/s11357-012-9454-2
    1. Bachschmid MM, Schildknecht S, Matsui R et al. . Vascular aging: chronic oxidative stress and impairment of redox signaling-consequences for vascular homeostasis and disease. Ann Med 2013;45:17–36. 10.3109/07853890.2011.645498
    1. Menghini R, Stohr R, Federici M. MicroRNAs in vascular aging and atherosclerosis. Ageing Res Rev 2014;17:68–78. 10.1016/j.arr.2014.03.005
    1. Nyholm AM, Lerche CM, Manfé V et al. . miR-125b induces cellular senescence in malignant melanoma. BMC Dermatol 2014;14:1471–5945. 10.1186/1471-5945-14-8
    1. van Balkom BW, de Jong OG, Smits M et al. . Endothelial cells require miR-214 to secrete exosomes that suppress senescence and induce angiogenesis in human and mouse endothelial cells. Blood 2013;121:3997–4006, S1–15 10.1182/blood-2013-02-478925
    1. Fenn AM, Smith KM, Lovett-Racke AE et al. . Increased micro-RNA 29b in the aged brain correlates with the reduction of insulin-like growth factor-1 and fractalkine ligand. Neurobiol Aging 2013;34:2748–58. 10.1016/j.neurobiolaging.2013.06.007
    1. Xu C, Yamamoto-Ibusuki M, Yamamoto Y et al. . High survivin mRNA expression is a predictor of poor prognosis in breast cancer: a comparative study at the mRNA and protein level. Breast Cancer 2014;21:482–90. 10.1007/s12282-012-0403-9
    1. Mattace-Raso FU, van der Cammen TJ, Hofman A et al. . Arterial stiffness and risk of coronary heart disease and stroke: the Rotterdam Study. Circulation 2006;113:657–63. 10.1161/CIRCULATIONAHA.105.555235
    1. Williams B, Lacy PS, Thom SM et al. . Differential impact of blood pressure-lowering drugs on central aortic pressure and clinical outcomes: principal results of the Conduit Artery Function Evaluation (CAFE) study. Circulation 2006;113:1213–25. 10.1161/CIRCULATIONAHA.105.595496
    1. Laurent S. Defining vascular aging and cardiovascular risk. J Hypertens 2012;30(Suppl):S3–8. 10.1097/HJH.0b013e328353e501
    1. Shirai K, Utino J, Saiki A et al. . Evaluation of blood pressure control using a new arterial stiffness parameter, cardio-ankle vascular index (CAVI). Curr Hypertens Rev 2013;9:66–75. 10.2174/1573402111309010010
    1. INE. Clasificación Nacional de Ocupaciones 2011 (CNO-11) URL 2011. ,.
    1. Mancia G, Fagard R, Narkiewicz K et al. . 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2013;31:1281–357. 10.1097/
    1. Schroder H, Fito M, Estruch R et al. . A short screener is valid for assessing Mediterranean diet adherence among older Spanish men and women. J Nutr 2011;141:1140–5. 10.3945/jn.110.135566
    1. Melanson EL Jr, Freedson PS. Validity of the Computer Science and Applications, Inc. (CSA) activity monitor. Med Sci Sports Exerc 1995;27:934–40.
    1. Freedson PS, Melanson E, Sirard J. Calibration of the Computer Science and Applications, Inc. accelerometer. Med Sci Sports Exerc 1998;30:777–81. 10.1097/00005768-199805000-00021
    1. Craig CL, Marshall AL, Sjöström M et al. . International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 2003;35:1381–95. 10.1249/01.MSS.0000078924.61453.FB
    1. Marshall AL, Miller YD, Burton NW et al. . Measuring total and domain-specific sitting: a study of reliability and validity. Med Sci Sports Exerc 2010;42:1094–102. 10.1249/MSS.0b013e3181c5ec18
    1. Nowak Z, Plewa M, Skowron M et al. . Paffenbarger Physical Activity Questionnaire as an additional tool in clinical assessment of patients with coronary artery disease treated with angioplasty. Kardiol Pol 2010;68:32–9.
    1. Simpson K, Parker B, Capizzi J et al. . Validity and reliability question 8 of the Paffenbarger Physical Activity Questionnaire among healthy adults. J Phys Act Health 2015;12:116–23. 10.1123/jpah.2013-0013
    1. Paffenbarger RS Jr, Blair SN, Lee IM et al. . Measurement of physical activity to assess health effects in free-living populations. Med Sci Sports Exerc 1993;25:60–70. 10.1249/00005768-199301000-00010
    1. Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatr 1960;23:56–62. 10.1136/jnnp.23.1.56
    1. Ramos-Brieva JA, Cordero Villafafila A. [Validation of the Castillian version of the Hamilton Rating Scale for Depression]. Actas Luso Esp Neurol Psiquiatr Cienc Afines 1986;14:324–34.
    1. Montgomery SA, Asberg M. A new depression scale designed to be sensitive to change. Br J Psychiatry 1979;134:382–9. 10.1192/bjp.134.4.382
    1. Hamilton M. The assessment of anxiety states by rating. Br J Med Psychol 1959;32:50–5. 10.1111/j.2044-8341.1959.tb00467.x
    1. Lobo A, Chamorro L, Luque A et al. . [Validation of the Spanish versions of the Montgomery-Asberg depression and Hamilton anxiety rating scales]. Med Clin (Barc) 2002;118:493–9. 10.1016/S0025-7753(02)72429-9
    1. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav 1983;24:385–96. 10.2307/2136404
    1. Van Bortel LM, Laurent S, Boutouyrie P et al. . Expert consensus document on the measurement of aortic stiffness in daily practice using carotid-femoral pulse wave velocity. J Hypertens 2012; 30:445–8. 10.1097/HJH.0b013e32834fa8b0
    1. Shirai K, Hiruta N, Song M et al. . Cardio-ankle vascular index (CAVI) as a novel indicator of arterial stiffness: theory, evidence and perspectives. J Atheroscler Thromb 2011;18:924–38. 10.5551/jat.7716
    1. Shirai K, Utino J, Otsuka K et al. . A novel blood pressure-independent arterial wall stiffness parameter; cardio-ankle vascular index (CAVI). J Atheroscler Thromb 2006;13:101–7. 10.5551/jat.13.101
    1. Yamashina A, Tomiyama H, Takeda K et al. . Validity, reproducibility, and clinical significance of noninvasive brachial-ankle pulse wave velocity measurement. Hypertens Res 2002;25:359–64. 10.1291/hypres.25.359
    1. Kawai T, Ohishi M, Onishi M et al. . Cut-off value of brachial-ankle pulse wave velocity to predict cardiovascular disease in hypertensive patients: a cohort study. J Atheroscler Thromb 2013;20:391–400. 10.5551/jat.15040
    1. Korkmaz L, Erkan H, Korkmaz AA et al. . Relationship of aortic knob width with cardio-ankle vascular stiffness index and its value in diagnosis of subclinical atherosclerosis in hypertensive patients: a study on diagnostic accuracy. Anadolu Kardiyol Derg 2012;12:102–6. 10.5152/akd.2012.034
    1. Gómez-Marcos MA, Recio-Rodríguez JI, Patino-Alonso MC et al. . Protocol for measuring carotid intima-media thickness that best correlates with cardiovascular risk and target organ damage. Am J Hypertens 2012;25:955–61. 10.1038/ajh.2012.72
    1. Agatston AS, Janowitz WR, Hildner FJ et al. . Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 1990;15:827–32. 10.1016/0735-1097(90)90282-T
    1. Levey AS, Stevens LA, Schmid CH et al. . A new equation to estimate glomerular filtration rate. Ann Intern Med 2009;150:604–12. 10.7326/0003-4819-150-9-200905050-00006
    1. Okin PM, Roman MJ, Devereux RB et al. . Electrocardiographic identification of increased left ventricular mass by simple voltage-duration products. J Am Coll Cardiol 1995;25:417–23. 10.1016/0735-1097(94)00371-V
    1. van Buuren S, Boshuizen HC, Knook DL. Multiple imputation of missing blood pressure covariates in survival analysis. Stat Med 1999;18:681–94.
    1. Li KH, Raghunathan TE, Rubin DB. Large-sample significance levels from multiply imputed data using moment-based statistics and an F reference distribution. J Am Stat Assoc 1991;86:1063–73.
    1. World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA 2013;310:2191–4. 10.1001/jama.2013.281053

Source: PubMed

3
Subskrybuj