Vascular age and endothelial dysfunction in individuals living at high altitude
DOI:
https://doi.org/10.24265/horizmed.2019.v19n2.05Keywords:
Risk, Cardiovascular diseases, Endothelium, HypertensionAbstract
Objective: To determine the relationship between vascular age (VA) and endothelial dysfunction (ED) in adults living at more than 3,000 m.a.s.l. Materials and methods: An observational, descriptive, cross-sectional study was performed at the Hospital Regional Docente Clínico Quirúrgico Daniel Alcides Carrión, Huancayo - Peru, from January to December 2015. The VA was calculated using the Framingham Risk Score and the ED was evaluated with the flow-mediated dilation (FMD) test in the brachial artery. A p-value <0.05 was considered significant. Results: The study included 67 individuals (100 %), whose mean age was 55.3 ± 13.4 years (range: 30-74), out of which 41 (61.1 %) were women. The VA and the delta value were 57.9 ± 18.3 and 2.3 ± 9.3 years, respectively. Fifty-three point seven percent (53.7 %) (36 participants) had an increased VA and 22.3 % (15 participants) were older than age 10. Increasing age, hypertension and overweight were associated with higher cardiovascular risk. From age 40, VA progressively increases and is more common in men. Individuals with ED presented high cardiovascular risk (87.5 %) compared to those with normal endothelial function (12.5 %) (p = 0.007; OR: 8.52; 95 % CI: 1.7-41.4). There is an inverse relationship between VA and endothelial function (r = -0.437; p = 0.000). The higher the VA , the higher the ED, which is more frequent in men (Rho = -1.0; p <0.010). Conclusions: There is an inverse relationship between VA and ED. Determining the endothelial function could improve the stratification of cardiovascular risk in individuals living at high altitude and thus prevent cardiovascular events.
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Harvey A, Montezano AC, Touyz RM. Vascular biology of ageing-Implication in hypertension. J Mol Cell Cardiol. 2015 Jun;83:112-21.
Achiong Alemañy M, Achiong Estupiñán F, Achiong Alemañy F, Afonso de León JA, Álvarez Escobar MC, Suárez Merino M. Riesgo cardiovascular global y edad vascular: herramientas claves en la prevención de enfermedades cardiovasculares. Rev Med Electrón. 2016 Mar-Abr;38(2):211-6.
Ruíz Mori E, Segura Vega L, Agusti Campos R. Uso del score de Framingham como indicador de los factores de riesgo de las enfermedades cardiovasculares en la población peruana. Rev Per Card. 2012 Set-Dic;38(3):1-19.
Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren M, et al. Guía Europea sobre prevención de la Enfermedad Cardiovascular en la Práctica Clínica (versión 2012). Rev Esp Cardiol. 2012;65(10):937.e1-e66.
D’Agostino RB, Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM, et al. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation. 2008 Feb 12;117(6):743-53.
Cuende JI, Cuende N, Calaveras-Lagartos J. How to calculate vascular age with the SCORE project scales: a new method of cardiovascular risk evaluation. Eur Heart J. 2010 Oct;31(19): 2351-8.
Masson W, Siniawski D, Toledo G, Vita T, Fernández G, Del Castillo S, et al. Estimación de la "edad vascular" basada en el índice de masa corporal en una población en prevención primaria. Asociación con la aterosclerosis carotídea subclínica. Med Clin. 2013 Mar 16;140(6):255-9.
Leal Herrera U, Espinoza de Leal M. La edad vascular: Un nuevo concepto de fácil compresión. Salus. 2015 May- Ago,19(2):5-6.
Gaziano TA, Young CR, Fitzmaurice G, Atwood S, Gaziano JM. Laboratory-based versus non-laboratory-based method for assessment of cardiovascular disease risk: the NHANES I Follow-up Study cohort. Lancet. 2008 Mar 15; 371(9616):923–31.
Arrebola-Moreno AL, Laclaustra M, Kaski JC. Evaluación no invasiva de la función endotelial en la práctica clínica. Rev Esp Cardiol. 2012; 65(1):80-90.
Celermajer DS, Sorensen KE, Gooch VM, Spiegelhalter DJ, Miller OI, Sullivan ID, et al. Non-invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis. Lancet. 1992 Nov 7;340(8828):1111-5.
Narváez-Guerra O, Herrera-Enríquez K, Medina - Lezama J, Chirinos JA. Systemic Hypertension at high altitude. Hypertension. 2018 Sep;72(3):567-78.
Lewis NC, Bailey DM, Dumanoir GR, Messinger L, Lucas SJ, Cotter JD, et al. Conduit artery structure and function in lowlanders and native highlanders: relationships with oxidative stress and role of sympathoexcitation. J Physiol. 2014 Mar 1;592(5):1009-24.
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003 Dec; 42(6):1206-52.
Lobos Bejarano JM, Brotons Cuixart M. Factores de riesgo cardiovascular y atención primaria: evaluación e intervención. Aten Prim. 2011 Dic;43(12):625-84.
American Diabetes Association. Diagnosis and classification of Diabetes Mellitus. Diabetes Care. 2010 Jan;33(Suppl 1):S62-9.
Berrington de Gonzales A, Hartge P, Cerhan JR, Flint AJ, Hannan L, Maclnnis RJ, et al. Body Mass Index and Mortality among 1.46 million white adults. N Engln J Med. 2010 Dec 2;363 (23). :2211-9.
Pasternak RC. Report of the Adult Treatment Panel III: the 2001 National Cholesterol Education Program guidelines on the detection, evaluation and treatment of elevated cholesterol in adults. Cardiol Clin. 2003 Aug;21(3):393-8.
Moreno Moreno LP. Prevalencia de los principales factores de riesgo de enfermedad cardiovascular y riesgo cardiovascular en pacientes con hipertensión arterial que asisten a una IPS en Bogotá y algunos municipios de Cundinamarca [Tesis]. Bogotá: Pontificia Universidad Javeriana; 2009. pp. 1-92.
Cabrera de León A, Rodríguez-Pérez MC, Rodríguez-Benjumeda LM, Ania-Lafuente B, Brito-Díaz B, Muros de Fuentes M, et al. Sedentary Lifestyle: Physical activity duration versus percentage of energy expenditure. Rev Esp Cardiol. 2007 Mar;60(3):244-50.
Cuende JI. La edad vascular frente al riesgo cardiovascular: aclarando conceptos. Rev Esp Cardiol. 2016 Mar;69(3):243-6.
Todo vertical-Guías de montañas. [modificar por Internet] Disponible en: http://www.todovertical.com/articulo/6/aclimatacion-adaptacion-a-la-altitud-prevencion-del-mal-agudo-de-montana
Cruz Hernández J, Licea Puig ME, Hernández García P, Yanes Quesada M, Salvato Dueñas A. Disfunción endotelial y diabetes mellitus. Rev Cubana Endocrinol. 2012;23(2):166-85.
Mahmood SS, Levy D, Vasan RS, Wang TJ. The Framingham Heart Study and the epidemiology of cardiovascular diseases: a historical perspective. Lancet. 2014 Mar 15;383(9921):999-1008.
Ruíz Mori E. Riesgo y Prevención Cardiovascular. 1a ed. Lima: Unigraph Editores; 2014.
Alcocer LA, Lozada O, Fanghanel G, Sánchez-Reyes L, Campos-Franco E. Estratificación del riesgo cardiovascular global. Comparación de los métodos Framingham y SCORE en población mexicana del estudio PRIT. Circ. 2011;79(2):168-74.
Baena Díez JM, Del Val García JL, Salas Gaetgens LH, Sánchez Pérez R, Altes Vaques E, Deixens Martínez B, et al. Comparación de los modelos SCORE y REGICOR para el cálculo del Riesgo Cardiovascular en sujetos sin enfermedad cardiovascular atendidos en un centro de salud de Barcelona. Rev Esp Salud Publica. 2005 Jul-Ago;79(4):543-64.
Conroy RM, Pyorala K, Fitzgerald AP, Sans S, Menotti A, De Backer G, et al. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE Project. Eur Heart J. 2003 Jun;24(11):987-1003.
Assmann G, Cullen P, Schulte H. Simple scoring scheme for calculating the risk of acute coronary events based on the 10-year follow-up of the prospective cardiovascular Munster (PROCAM) study. Circulation. 2002 Jan 22;105(3):310-5
Cuende JI, Saltijeral A, Estrada V, Pérez de Isla L. Vascular age calculation and equivalent risk factors in HIV-infected patients obtained from the D:A:D risk equation. Eur J Prev Cardiol. 2016 Nov;23(17):1903-8.
Cuende JI. Edad vascular derivada del SCORE y Guía Europea sobre prevención de la enfermedad cardiovascular en la práctica clínica (versión 2012). Rev Esp Cardiol. 2013;66(3): 241.
Herrera Tanaka V, Chavez Ayala C. Relación entre reactividad flujo de arteria braquial y SCORE de riesgo de Framingham como marcador de disfunción endotelial. Rev Per Cardiol. 2006;34(3):152-8.
Mayta Calderón JC, Morales Moreno AM, Cárdenas Rojas AD, Mogollón Lavi JA, Armas Rodríguez V, Neyra Arismendiz L, et al. Determinación de riesgo cardiovascular y edad vascular según SCORE de Framingham en pacientes del Hospital Nacional Arzobispo Loayza. Horiz Med. 2015 Abr-Jun;15(2):27-34.
González Ariztimuño E. Valoración del riesgo cardiovascular y edad vascular en personas con hipertensión primaria [Tesis]. España: Universidad del País Vasco UPV/EHU; 2014/2015. pp. 1-26.
Campuzano R, Moya JL, García-Lledó A, Salido L, Guzmán G, Tomas JP, et al. Asociación de la disfunción endotelial y el grosor mediointimal carotídeo con los factores de riesgo coronario en pacientes sin evidencia clínica de aterosclerosis. Rev Esp Cardiol. 2003;56(6):546-54.
Calderón - Gerstein WS, López-Peña A, Macha-Ramirez R, Bruno-Huamán A, Espejo-Ramos R, Vílchez-Bravo S, et al. Endothelial dysfunction assessment by flow-mediated dilation in a high-altitude population. Vasc Health Risk Manag. 2017 Nov 21;13:421-6.
Díaz A. Factores de riesgo cardiovascular y disfunción endotelial en adultos que viven a gran altura. Acta Méd Peru. 2016 Oct-Dic;33(4):289-95.
Yao F, Liu Y, Liu D, Wu S, Lin H, Fan R, et al. Sex differences between vascular endothelial function and carotid intima- media thickness by Framingham Risk Score. J Ultrasound Med. 2014 Feb;33(2):281-6.
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