English Polski
Vol 16, No 6 (2021)
Review paper
Published online: 2021-12-31

open access

Page views 6153
Article views/downloads 238
Get Citation

Connect on Social Media

Connect on Social Media

Arterial stiffness in metabolic syndrome: sex-specific differences, clinical consequences, how to prevent?

Ewa Kruszyńska1, Maria Łoboz-Rudnicka1, Bogusława Ołpińska1, Krystyna Łoboz-Grudzień1, Joanna Jaroch2
Folia Cardiologica 2021;16(6):381-388.

Abstract

Non-invasively assessed arterial stiffness has been recently growing interest as a novel marker of cardiovascular (CV) risk. The effects of risk factors on the progression of arterial changes and the development of CV diseases seem to be different in women and men. Arterial stiffness was shown to be primarily determined by age and mean arterial pressure (MAP). Hyperglycaemia and resistance to insulin were identified as contributors to increased arterial stiffness. Metabolic syndrome (MS) accelerates age-related arterial stiffening, leading to the so-called early vascular ageing. Arterial stiffness was also shown to increase with the number of MS components. The effects of MS and its components on arterial stiffness are stronger in women than in men. The sex-specific differences in age-related changes within the cardiovascular system might explain why heart failure with preserved ejection fraction  occurs more often in older women than in men. Published evidence suggests that arterial stiffness may be associated with left ventricular diastolic dysfunction in MS patients. Hence, a question arises whether a therapy aimed at optimal control of glycaemia and reduction of arterial stiffness could slow down the development of diastolic heart failure? Lifestyle modifications and pharmacological interventions (de-stiffening) may exert a beneficial effect on arterial stiffness independently from the reduction of blood pressure.

Article available in PDF format

View PDF Download PDF file

References

  1. Townsend RR, Wilkinson IB, Schiffrin EL, et al. American Heart Association Council on Hypertension. Recommendations for improving and standardizing vascular research on arterial stiffness: a scientific statement from the American Heart Association. Hypertension. 2015; 66(3): 698–722.
  2. Vlachopoulos C, Aznaouridis K, Stefanadis C. Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis. J Am Coll Cardiol. 2010; 55(13): 1318–1327.
  3. DuPont JJ, Kenney RM, Patel AR, et al. Sex differences in mechanisms of arterial stiffness. Br J Pharmacol. 2019; 176(21): 4208–4225.
  4. Laurent S, Cockcroft J, Van Bortel L, et al. European Network for Non-invasive Investigation of Large Arteries. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J. 2006; 27(21): 2588–2605.
  5. 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(11): 924–938.
  6. Jaroch J, Łoboz-Grudzień K, Kowalska A, et al. Echo tracking i wave intensity — nowe, nieinwazyjne metody w ocenie funkcji naczyń. Pol Prz Kardiol. 2008; 10(2): 137–143.
  7. Uejima T, Dunstan FD, Arbustini E, et al. E-Tracking International Collaboration Group (ETIC), E-Tracking International Collaboration Group (ETIC). Age-specific reference values for carotid arterial stiffness estimated by ultrasonic wall tracking. J Hum Hypertens. 2020; 34(3): 214–222.
  8. Coutinho T, Borlaug BA, Pellikka PA, et al. Sex differences in arterial stiffness and ventricular-arterial interactions. J Am Coll Cardiol. 2013; 61(1): 96–103.
  9. Mosca L. The role of hormone replacement therapy in the prevention of postmenopausal heart disease. Arch Intern Med. 2000; 160(15): 2263–2272.
  10. Narkiewicz K, Kjeldsen SE, Hedner T. Hypertension and cardiovascular disease in women: progress towards better understanding of gender-specific differences? Blood Press. 2006; 15(2): 68–70.
  11. Schram MT, Henry RMA, van Dijk RA, et al. Increased central artery stiffness in impaired glucose metabolism and type 2 diabetes: the Hoorn Study. Hypertension. 2004; 43(2): 176–181.
  12. Cruickshank K, Riste L, Anderson SG, et al. Aortic pulse-wave velocity and its relationship to mortality in diabetes and glucose intolerance: an integrated index of vascular function? Circulation. 2002; 106(16): 2085–2090.
  13. Bociąga Z, Jaroch J, Wilczyńska M, et al. Sztywność tętnic szyjnych u pacjentów z cukrzycą typu 2. Folia Cardiol. 2020; 15(5): 333–342.
  14. Prenner SB, Chirinos JA. Arterial stiffness in diabetes mellitus. Atherosclerosis. 2015; 238(2): 370–379.
  15. De Angelis L, Millasseau SC, Smith A, et al. Sex differences in age-related stiffening of the aorta in subjects with type 2 diabetes. Hypertension. 2004; 44(1): 67–71.
  16. Li S, Chen W, Srinivasan SR, et al. Influence of metabolic syndrome on arterial stiffness and its age-related change in young adults: the Bogalusa Heart Study. Atherosclerosis. 2005; 180(2): 349–354.
  17. Olszanecka A, Dragan A, Kawecka-Jaszcz K, et al. Influence of metabolic syndrome and its components on subclinical organ damage in hypertensive perimenopausal women. Adv Med Sci. 2014; 59(2): 232–239.
  18. Lin HF, Liu CK, Liao YC, et al. The risk of the metabolic syndrome on carotid thickness and stiffness: sex and age specific effects. Atherosclerosis. 2010; 210(1): 155–159.
  19. Kim HL, Lee JM, Seo JB, et al. The effects of metabolic syndrome and its components on arterial stiffness in relation to gender. J Cardiol. 2015; 65(3): 243–249.
  20. Protogerou AD, Blacher J, Aslangul E, et al. Gender influence on metabolic syndrome's effects on arterial stiffness and pressure wave reflections in treated hypertensive subjects. Atherosclerosis. 2007; 193(1): 151–158.
  21. Weng C, Yuan H, Tang X, et al. Age- and gender dependent association between components of metabolic syndrome and subclinical arterial stiffness in a Chinese population. Int J Med Sci. 2012; 9(8): 730–737.
  22. Scuteri A, Cunha PG, Agabiti Rosei E, et al. MARE Consortium. Arterial stiffness and influences of the metabolic syndrome: a cross-countries study. Atherosclerosis. 2014; 233(2): 654–660.
  23. Gomez-Sanchez L, Garcia-Ortiz L, Patino-Alonso MC, et al. MARK Group. Association of metabolic syndrome and its components with arterial stiffness in Caucasian subjects of the MARK study: a cross-sectional trial. Cardiovasc Diabetol. 2016; 15(1): 148.
  24. Della-Morte D, Gardener H, Denaro F, et al. Metabolic syndrome increases carotid artery stiffness: the Northern Manhattan Study. Int J Stroke. 2010; 5(3): 138–144.
  25. Topouchian J, Labat C, Gautier S, et al. Effects of metabolic syndrome on arterial function in different age groups: the Advanced Approach to Arterial Stiffness study. J Hypertens. 2018; 36(4): 824–833.
  26. Kruszyńska E, Łoboz-Rudnicka M, Palombo C, et al. Carotid artery stiffness in metabolic syndrome: sex differences. Diabetes Metab Syndr Obes. 2020; 13: 3359–3369.
  27. Mitchell GF. Arterial stiffness and hypertension: chicken or egg? Hypertension. 2014; 64(2): 210–214.
  28. Safar ME, Blacher J, Jankowski P. Arterial stiffness, pulse pressure, and cardiovascular disease — is it possible to break the vicious circle? Atherosclerosis. 2011; 218(2): 263–271.
  29. Łoboz-Rudnicka M, Jaroch J, Kruszyńska E, et al. Relationship between vascular age and classic cardiovascular risk factors and arterial stiffness. Cardiol J. 2013; 20(4): 394–401.
  30. Tolezani EC, Costa-Hong V, Correia G, et al. Determinants of functional and structural properties of large arteries in healthy individuals. Arq Bras Cardiol. 2014; 103(5): 426–432.
  31. Caviezel S, Dratva J, Schaffner E, et al. Sex-specific associations of cardiovascular risk factors with carotid stiffness--results from the SAPALDIA cohort study. Atherosclerosis. 2014; 235(2): 576–584.
  32. Mizia-Stec K, Gasior Z, Zahorska-Markiewicz B, et al. The indexes of arterial structure and function in women with simple obesity: a preliminary study. Heart Vessels. 2008; 23(4): 224–229.
  33. Kawaguchi M, Hay I, Fetics B, et al. Combined ventricular systolic and arterial stiffening in patients with heart failure and preserved ejection fraction: implications for systolic and diastolic reserve limitations. Circulation. 2003; 107(5): 714–720.
  34. Kim HL, Lim WH, Seo JB, et al. Association between arterial stiffness and left ventricular diastolic function in relation to gender and age. Medicine (Baltimore). 2017; 96(1): e5783.
  35. Zito C, Mohammed M, Todaro MC, et al. Interplay between arterial stiffness and diastolic function: a marker of ventricular-vascular coupling. J Cardiovasc Med (Hagerstown). 2014; 15(11): 788–796.
  36. Jaroch J, Rzyczkowska B, Bociąga Z, et al. The relationship of carotid arterial stiffness to left ventricular diastolic dysfunction in untreated hypertension. Kardiol Pol. 2012; 70(3): 223–231.
  37. Solovjova S, Ryliškytė L, Čelutkienė J, et al. Aortic stiffness is an independent determinant of left ventricular diastolic dysfunction in metabolic syndrome patients. Blood Press. 2016; 25(1): 11–20.
  38. Kruszynska E, Kozakova M, Rudnicka M, et al. Predictors of left ventricular diastolic dysfunction in metabolic syndrome: gender differences. J Metabolic Synd. 2018; 07(02).
  39. Kozakova M, Morizzo C, Fraser AG, et al. Impact of glycemic control on aortic stiffness, left ventricular mass and diastolic longitudinal function in type 2 diabetes mellitus. Cardiovasc Diabetol. 2017; 16(1): 78.