Pulse-Wave Velocity, Flow-Mediated Dilation, and Carotid Intima-Media Thickness to Assess Cardiovascular Risk in Population with Metabolic Syndrome

Summary

Endothelial/vascular aging and atherogenesis are key mechanisms that promote the development of cardiovascular diseases. The present protocol describes methods to evaluate arterial stiffness, endothelial dysfunction, and atherogenesis in patients with related risk factors, which are highly valuable in the cardiovascular research field.

Abstract

Pulse-wave velocity (PWV), flow-mediated dilation (FMD), and carotid intima-media thickness (CIMT) are established methods used in research and clinical settings to assess arterial stiffness, endothelial function, and subclinical atherogenesis. These measurements may reflect vascular disease and atherosclerotic progression, which are major causes of adverse cardiovascular events. These methods are particularly valuable in determining cardiovascular dysfunction among populations with different risk factors, such as diabetes mellitus, hypertension, and other metabolic dysfunction-related conditions. They provide a non-invasive and reliable source of information that complements clinical practice. Early detection, risk assessment, and therapeutic decisions regarding cardiovascular disease can be achieved, ultimately contributing to improved patient outcomes. Traditional tools for evaluating cardiovascular disease do not reveal whether metabolic syndrome affects early subclinical cardiovascular disease in patients with obesity. Recent research has highlighted the importance of including arterial stiffness and endothelial function in a comprehensive cardiovascular assessment. Therefore, the aim of the present study is to describe methods that provide information on early subclinical vascular aging, endothelial dysfunction, and atherogenic disease, enabling vascular-targeted risk stratification among populations with obesity and different metabolic profiles.

Introduction

Obesity is a major health problem worldwide due to its associated complications, such as hypertension, dyslipidemia, liver disease, atherosclerosis, insulin resistance, and type 2 diabetes mellitus (T2DM), as well as an increased risk of cardiovascular diseases (CVD)¹.

The constellation of these conditions, known as Metabolic Syndrome (MS), has been reported to be a major cause of CVD pathogenesis, which is one of the leading causes of death, accounting for up to 30% of all deaths worldwide². Obese individuals have a higher requirement for oxygen and nutrients throughout the body due to an inc....

Protocol

The institutional research ethics committee from the National Medical Center "20 de Noviembre" ISSSTE approved this protocol (ID No. 386.2013). All enrolled patients provided written informed consent. The details of the equipment and software used in this study are listed in the Table of Materials.

Patient inclusion/exclusion criteria:
Eligible patients were older than 18 years and diagnosed with morbid obesity (Body Mass Index [BMI] >40 kg/m² or BMI .......

Discussion

Addressing vascular health and understanding and managing cardiovascular risk are essential for the prevention, early intervention, and reduction of the global burden of cardiovascular diseases. In this regard, the combined use of methods to assess the elasticity and compliance of the arterial wall (including aortic hemodynamic parameters, cfPWV for arterial stiffness, and Augmentation Index), endothelial nitric oxide production, and atherosclerosis provide a more comprehensive evaluation. These methods are highly useful.......

Materials

Name	Company	Catalog Number	Comments
Device for measuring arterial wave reflection and Pulse Wave Analysis	ATCOR	SphygmoCor	Analyzer of pulse wave for central pressure. It contains a brachial cuff and a femoral cuff
Microplate reader for absorbance, Sunrise	Tecan	30190079	Detection Mode: Absorbance; Wavelength Range: 340 nm - 750 nm; Filter Wavelength: 405 nm, 450 nm, 492 nm, 620 nm; Plate Format 96 well plates
Nitric oxide assay kit	Abcam	ab65328	Nitric Oxide Assay Kit, Colorimetric, Abcam Cat. ab65328 for 96-well plates
Portatil ultrasound to measure FMD	Sonolife	MED 36-13	Ultrasonography linear transducer
Software for FMD WirelessUSG	SonoStarMed Technologies	WirelessUSG v. 3.6.52	Software used to measure artery diameter for FMD
Software used to calculate vascular parameters from Waveform Analysis	ATCOR	SphygmoCor XCEL	Software used to integrate patient profile, waveform analysis, calculation of PWA, PWV and other vascular parameters
Sphygmomanometer	Homecare	ANEROIDE 1000	100% cotton self-adjustable bracelet with hook, Adult artery indicator cuff.
Ultrasound to measure CIMT	Philips	EPIQ7L12-3 Broadband Linear Array Transducer	Linear transducer (Broadband Linear Array Transducer)