Publications by authors named "Ioanna Dima"

23 Publications

  • Page 1 of 1

Angiography-based estimation of coronary physiology: A frame is worth a thousand words.

Trends Cardiovasc Med 2021 Jul 28. Epub 2021 Jul 28.

First Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokration Hospital, Athens, Greece.

Cumulative evidence has shown that coronary revascularization should be guided by functional significance of coronary lesions. Fractional flow reserve (FFR) is the gold standard for assessment of hemodynamic significance of coronary stenosis and FFR-guided percutaneous coronary intervention has improved clinical outcomes in patients with coronary artery disease. However, limitations of FFR such as increased operational time and cost, requirement of pressure wire and adenosine and technical difficulties have led to significant underutilization of the method in clinical practice. In the last few years, several methods of FFR estimation based on coronary angiography images have emerged to overcome invasive FFR limitations. The common elements of the novel indices include a 3D anatomical reconstruction of coronary vessels by angiographic projections and various approaches to fluid dynamics computation. Angiography-derived FFR methods have shown high diagnostic accuracy compared to invasive FFR. Although there are promising results regarding their prognostic role, large randomized trials evaluating clinical outcomes are lacking. The aim of this review is to present currently available angiography-derived FFR indices and highlight their differences, advantages, disadvantages and potential clinical implications.
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http://dx.doi.org/10.1016/j.tcm.2021.07.004DOI Listing
July 2021

Eligibility for PCSK-9 inhibitors treatment in acute coronary syndrome, chronic coronary artery disease and outpatient dyslipidemic patients.

Atherosclerosis 2020 06 15;303:29-35. Epub 2020 May 15.

1st Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece.

Background And Aims: We aimed to investigate potential eligibility for proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors in patients with coronary artery disease and dyslipidaemia according to patient characteristics and variable criteria.

Methods: We prospectively enrolled 2000 patients (acute coronary syndrome = 407, chronic coronary artery disease inpatients = 1087, outpatient Lipid's clinic = 506). To calculate PCSK-9 inhibitors real-world eligibility, a proprietary adjustable software was developed, which stores data and patient characteristics and can determine eligibility depending on different criteria. We tested four scenarios with different LDL thresholds according to ESC/EAS 2016 and 2019 Guidelines, 2017 American College of Cardiology Expert Consensus, and National criteria.

Results: The eligible percentage was 18.85%, 9.75%, 8.55% and 2.15%, in the total population for the four classifications, respectively, and it varied according to clinical status. The increase toward more recent guidelines was mostly attributed to the increasing number of coronary patients who become eligible as our criteria become stricter.

Conclusions: For the first time, a realistic estimation of PCSK-9 eligibility is provided via an adjustable predictive model in a population of 2000 patients with acute coronary syndrome, chronic coronary artery disease and dyslipidaemia. This can be a valuable tool for the incorporation of PCSK-9 inhibitors in health care systems.
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http://dx.doi.org/10.1016/j.atherosclerosis.2020.04.024DOI Listing
June 2020

Acute effect of heat-not-burn versus standard cigarette smoking on arterial stiffness and wave reflections in young smokers.

Eur J Prev Cardiol 2020 Apr 27:2047487320918365. Epub 2020 Apr 27.

Hypertension and Cardiometabolic Syndrome Unit and Smoking Cessation Unit, 1st Cardiology Department, Athens Medical School, Hippokration Hospital, Greece.

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http://dx.doi.org/10.1177/2047487320918365DOI Listing
April 2020

The interplay between aortic arch calcifications and anticoagulation on prognosis of in-hospital complications in acute coronary syndromes.

Hellenic J Cardiol 2020 Nov-Dec;61(6):444-446. Epub 2020 Feb 29.

Hypertension and Cardiometabolic Unit, First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.

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http://dx.doi.org/10.1016/j.hjc.2020.02.005DOI Listing
August 2021

Right heart dilatation: a rare vascular cause.

Heart 2016 08 21;102(15):1199. Epub 2016 Mar 21.

Department of Radiology, Glenfield Hospital, University Hospitals of Leicester, Leicester, UK.

Clinical Introduction: A 17-year-old boy with primary cardiac diagnosis of cor triatriatum, atrial septal defect (ASD) and patent ductus arteriosus (PDA) was referred for a cardiac MRI. He was operated on at 3 months of age with correction of the above-mentioned defects. During follow-up, on echocardiogram, he gradually developed moderate right ventricular dilation with preserved systolic function and a trace of tricuspid regurgitation. The interatrial septum was intact and the left chambers looked normal in size (see online supplementary video 1). Clinically, he was active and asymptomatic with saturations of 99% on air. Consequently, he was referred for an MRI scan to look for possible causes. The images are seen in figure 1.

Question: What diagnosis would you suspect from figure 1?Arteriovenous malformationLeft superior vena cavaLevoatriocardinal veinMeandering pulmonary vein.
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http://dx.doi.org/10.1136/heartjnl-2015-309172DOI Listing
August 2016

Arterial stiffening and systemic endothelial activation induced by smoking: The role of COX-1 and COX-2.

Int J Cardiol 2015 6;189:293-8. Epub 2015 Apr 6.

Peripheral Vessels and Hypertension Units, 1st Department of Cardiology, Athens Medical School, Hippokration Hospital, Athens, Greece.

Background: Arterial stiffness is an established predictor of cardiovascular risk. We explored the effects of acute smoking on arterial stiffness, systemic inflammation and endothelial activation in chronic smokers and the contribution of cyclooxygenases-1 and 2 (COX-1 and COX-2).

Methods And Results: In a randomized, double-blind, cross-over study, we investigated in 28 young smokers the vascular and systemic effects of smoking one cigarette, 3h after receiving 1000 mg of aspirin (a non-selective COX-1 and COX-2 inhibitor) or placebo (aspirin substudy), or 200 mg of celecoxib (a selective COX-2 inhibitor) or placebo (celecoxib substudy). Smoking increased carotid-femoral pulse wave velocity (PWV, a marker of aortic stiffness), indicating an adverse effect on arterial elastic properties. Similarly, circulating levels of asymmetric dimethylarginine (ADMA) were increased after smoking. Aspirin fully prevented the smoking-induced increase of PWV after smoking. In contrast, celecoxib only partially prevented the smoking-induced increase of PWV. Both aspirin and celecoxib prevented to a similar extent the increase of ADMA levels after smoking.

Conclusions: Smoking one cigarette is associated with a deterioration of arterial stiffness and with systemic endothelial activation in chronic smokers. Both COX-1 and COX-2, but primarily COX-1, mediate these unfavorable effects of smoking.
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http://dx.doi.org/10.1016/j.ijcard.2015.04.029DOI Listing
April 2016

A hypertensive response to exercise is prominent in patients with obstructive sleep apnea and hypertension: a controlled study.

J Clin Hypertens (Greenwich) 2013 Jul 29;15(7):497-502. Epub 2013 Apr 29.

First Cardiology Clinic, University of Athens Medical School, Hippokration Hospital, Athens, Greece.

Blood pressure (BP) behavior during exercise is not clear in hypertensive patients with obstructive sleep apnea (OSA). The authors studied 57 men with newly diagnosed essential hypertension and untreated OSA (apnea-hypopnea index [AHI] ≥5) but without daytime sleepiness (Epworth Sleepiness Scale score ≤10), and an equal number of hypertensive controls without OSA matched for age, body mass index, and office systolic BP. All patients underwent ambulatory BP measurements, transthoracic echocardiography, and exercise treadmill testing according to the Bruce protocol. A hypertensive response to exercise (HRE) was defined as peak systolic BP ≥210 mm Hg. Patients with OSA and control patients had similar ambulatory and resting BP, ejection fraction, and left ventricular mass. Peak systolic BP was significantly higher in patients with OSA (197.6±25.6 mm Hg vs 187.8±23.6 mm Hg; P=.03), while peak diastolic BP and heart rate did not differ between groups. Furthermore, an HRE was more prevalent in patients with OSA (44% vs 19%; P=.009). Multiple logistic regression revealed that an HRE is independently predicted by both the logAHI and minimum oxygen saturation during sleep (odds ratio, 3.94; confidence interval, 1.69-9.18; P=.001 and odds ratio, 0.94; confidence interval, 0.89-0.99; P=.02, respectively). Exaggerated BP response is more prevalent in nonsleepy hypertensives with OSA compared with their nonapneic counterparts. This finding may have distinct diagnostic and prognostic implications.
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http://dx.doi.org/10.1111/jch.12111DOI Listing
July 2013

Common single nucleotide polymorphisms of the p22phox NADPH oxidase subunit do not influence aortic stiffness in young, healthy adults.

Hellenic J Cardiol 2012 Sep-Oct;53(5):352-6

Peripheral Vessels Unit, 1st Cardiology Department, Athens Medical School, Hippokration Hospital, Athens, Greece.

Introduction: Aortic stiffness is a valuable biomarker for stratifying cardiovascular risk. NADPH oxidase regulates oxidative status in vessels; its single nucleotide polymorphisms (SNPs) modify the redox state of carriers and may lead to noxious structural alterations and affect the vasomotor properties of arteries. We hypothesized that genetic variability of NADPH oxidase would be accompanied by differences in aortic stiffness; to this end, we explored the interplay of pulse wave velocity (PWV), a measure of aortic stiffness, with common SNPs of the CYBA gene that encodes the p22phox subunit of NADPH oxidase.

Methods: 289 young, healthy adults were studied. The -930A/G, A640G and C242T CYBA SNPs were genotyped and PWV was measured. Differences in PWV across genotypes were examined in unadjusted models and after adjustment for confounders.

Results: Genetic variability of the examined SNPs did not result in changes of aortic stiffness. In unadjusted models, PWV did not differ across genotypes for the -930A/G (p=0.20), A640G (p=0.65) or C242T SNP (p=0.50). In stepwise multiple linear regression analysis only sex, age and systolic blood pressure emerged as independent predictors of PWV.

Conclusions: Common genetic variants of NADPH oxidase do not influence aortic stiffness in young, healthy adults.
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March 2013

Association of serum uric acid level with aortic stiffness and arterial wave reflections in newly diagnosed, never-treated hypertension.

Am J Hypertens 2011 Jan 27;24(1):33-9. Epub 2010 May 27.

Cardiology Department, Athens Medical School, Hippokration Hospital, Greece.

Background: Serum uric acid (UA) plays a key role in the development and progression of hypertension. We investigated the association of UA levels and indices of arterial function in a cohort of newly diagnosed, never-treated hypertensive subjects.

Methods: One thousand two hundred and twenty-five patients with a new diagnosis of mild to moderate arterial hypertension for which they had never received treatment were enrolled in the study (mean age 52.9 years, 728 men). Serum UA, carotid-femoral pulse-wave velocity (cfPWV), an index of aortic stiffness and augmentation index (AIx), a composite marker of wave reflections and arterial stiffness were measured.

Results: In univariable analysis, UA levels correlated with cfPWV (r = 0.23, P < 0.001) and AIx (r = -0.24, P < 0.001). In multiple linear regression analysis, an independent positive association of cfPWV with UA levels was observed after adjusting for confounders (standardized regression coefficient β = 0.169, P < 0.001, adjusted R² = 0.402), indicating an increase in aortic stiffness with higher values of UA. In contrast, an independent negative association of AIx with UA levels was observed after adjusting for confounders (standardized regression coefficient β = -0.064, P = 0.011, adjusted R² = 0.557), indicating a decrease in wave reflections with higher values of UA. In gender-specific analyses, UA positively correlated with cfPWV in both genders, whereas a negative correlation with AIx existed only in females.

Conclusions: Serum UA levels are independently associated with aortic stiffening and wave reflections in never-treated hypertensives. Future studies are warranted in order to explore its exact role on arterial function in the hypertensive setting.
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http://dx.doi.org/10.1038/ajh.2010.111DOI Listing
January 2011

The effect of p22(phox) -930A/G, A640G and C242T polymorphisms of NADPH oxidase on peripheral and central pressures in healthy, normotensive individuals.

Hypertens Res 2010 Aug 27;33(8):814-8. Epub 2010 May 27.

1st Cardiology Department, Athens Medical School, Hippokration Hospital, Athens, Greece.

The nicotinamide adenine dinucleotide phosphate (NADPH) oxidase produces superoxide, thus regulating redox state in the vessel wall. Three single-nucleotide polymorphisms (SNPs; -930A/G, A640G and C242T) of the p22(phox) subunit have been associated with hypertension; however, their role in peripheral and central pressures in normotensive individuals has not been addressed. A total of 210 healthy, normotensive individuals were studied. Genotypes for the -930A/G, A640G and C242T polymorphisms were determined by polymerase chain reaction. Peripheral pressures were measured by mercury sphygmomanometer and aortic pressures by a validated device using applanation tonometry. Both peripheral and central pressures differed across -930A/G genotypes. G allele carriers showed higher levels of peripheral systolic blood pressure (PSBP; AA: 113+/-12, GG/AG: 119+/-12 mm Hg; P<0.01) and peripheral diastolic blood pressure (AA: 70+/-9, GG/AG: 73+/-10 mm Hg; P<0.05). Regarding central pressures, AA homozygotes had lower central systolic blood pressure (CSBP; AA: 103+/-12, GG/AG: 108+/-12 mm Hg; P<0.01) and central diastolic blood pressure (AA: 71+/-9, GG/AG: 74+/-10 mm Hg; P<0.05). In multiple linear regression analysis, presence of the G allele (AG or GG) independently predicted CSBP. Blood pressure levels did not differ across A640G and C242T genotypes. The -930A/G polymorphism of p22(phox) is a determinant of peripheral and central pressures in normotensive individuals. The G allele is associated with higher blood pressure in the brachial artery, as well as in the aorta. These findings further elucidate the role of this polymorphism in the regulation of blood pressure. In contrast, the A640G and C242T SNPs do not influence peripheral and central pressures in normotensives.
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http://dx.doi.org/10.1038/hr.2010.78DOI Listing
August 2010

Association of arterial stiffness with the angiotensin-converting enzyme gene polymorphism in healthy individuals.

Am J Hypertens 2008 Dec 2;21(12):1354-8. Epub 2008 Oct 2.

Peripheral Vessels Unit, 1st Cardiology Department, Athens Medical School, Hippokration Hospital, Athens, Greece.

Background: Arterial stiffness is an important determinant of cardiovascular morbidity and mortality. The I/D polymorphism of angiotensin-converting enzyme (ACE) gene is associated with cardiovascular disease. However, the relationship between ACE polymorphism, arterial stiffness, and wave reflections in healthy, low-risk population has not been defined yet.

Methods: The study included 282 apparently healthy, low-risk individuals (mean age 39.7 +/- 8.9 years, 178 males). Carotid-femoral pulse wave velocity (PWV) was measured as an index of aortic stiffness, while wave reflections were assessed by augmentation index (AIx) of the central pressure waveform. I/D polymorphism of the ACE gene was determined in all subjects for the prevalence of the DD, ID, and II genotype (39, 44, and 17%, respectively). C-reactive protein (CRP) levels were determined as a marker of chronic, subclinical inflammation.

Results: After adjustment for potential confounding factors, presence of D allele was associated with lower values of PWV compared to II genotype (P < 0.05), implying lower aortic stiffness for D allele carriers. There was no association between ACE genotype and wave reflections or peripheral and central systolic pressures.

Conclusions: In apparently healthy individuals, D allele is associated with lower aortic stiffness, whereas there is no association of the ACE polymorphism with wave reflections. This finding provides new insights into the possible links between ACE gene, regulation of large artery stiffness, and has implications for cardiovascular risk.
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http://dx.doi.org/10.1038/ajh.2008.295DOI Listing
December 2008

The effect of heart rate on wave reflections may be determined by the level of aortic stiffness: clinical and technical implications.

Am J Hypertens 2008 Mar 24;21(3):334-40. Epub 2008 Jan 24.

First Department of Cardiology, Unit of Biomedical Engineering and Hypertension Unit, Hippokration Hospital, Medical School, National & Kapodistrian University of Athens, Greece.

Background: Augmentation Index (AIx) is related to cardiovascular diseases, risk, and mortality. AIx is associated with heart rate but the effect of aortic stiffness on this relationship has not been studied. The purpose of our study was to investigate the relationship between AIx and heart rate at different aortic stiffness levels.

Methods: The study consisted of 425 normotensive and untreated hypertensive subjects. Wave reflections and pulse-wave velocity (PWV) were determined by the Sphygmocor and the Complior systems, respectively.

Results: AIx was independently associated with heart rate, age, gender, height, mean blood pressure (BP) and the effective reflection site distance (ERD). The population was divided into three groups of those with different PWV levels (tertiles). The regression lines for AIx with heart rate differed significantly between the 3rd and the other two tertiles of PWV (P = 0.039 for slopes and P = 0.002 for intercepts). This difference remained significant even after adjustment for age, gender, height, mean BP, and distance of wave reflections.

Conclusions: A significantly stronger correlation of AIx with heart rate was observed in subjects with higher levels of aortic stiffness as compared to those with lower levels; namely, the same increase in the heart rate between subjects, induced a greater decrease in the AIx at higher compared to lower PWV levels. The correction of AIx for heart rate should be reconsidered based on the aortic stiffness level. This finding has implications for interventional studies that aim to improve central hemodynamics but simultaneously affect heart rate. Further studies that show acute modifications of heart rate at different arterial stiffness levels are required to support these findings.
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http://dx.doi.org/10.1038/ajh.2007.52DOI Listing
March 2008

Relation of habitual cocoa consumption to aortic stiffness and wave reflections, and to central hemodynamics in healthy individuals.

Am J Cardiol 2007 May 5;99(10):1473-5. Epub 2007 Apr 5.

Peripheral Vessels Unit, 1st Cardiology Department, Athens Medical School, Hippokration Hospital, Athens, Greece.

The effect of habitual cocoa consumption on arterial stiffness and wave reflection indexes, as well as on peripheral and central blood pressure, was assessed in 198 healthy subjects. In conclusion, higher cocoa intake was an independent determinant of low arterial stiffness and wave reflection indexes and was also independently associated with significantly lower central (aortic) pulse pressure.
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http://dx.doi.org/10.1016/j.amjcard.2006.12.081DOI Listing
May 2007

Triglyceride level is associated with wave reflections and arterial stiffness in apparently healthy middle-aged men.

Heart 2007 May;93(5):613-4

Peripheral Vessels Unit, 1st Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Athens, Greece.

Objective: To investigate the relationship of arterial stiffness and wave reflections, which are predictors of cardiovascular risk, with serum triglyceride level in healthy adults.

Design: Cross-sectional study at the University Department of Cardiology. 213 healthy individuals (141 men and 72 premenopausal women) not taking any medication and without known cardiovascular disease and risk factors, except for smoking.

Main Outcome Measures: Central (aortic) augmentation index (AIx, a composite measure of arterial stiffness and wave reflections), fasting lipid profile (including triglycerides) and 10-year Framingham Risk Score (FRS).

Results: Compared with women, men had higher serum triglyceride level (median (interquartile range) (89 (67-117) vs 73 (54-96) mg/dl, p<0.01) and lower AIx (17.7 (1.0) vs 26.3 (1.4), p<0.001). In both genders, serum triglyceride levels were significantly associated with FRS (men: r = 0.43, p<0.001; women: r = 0.37, p<0.01) and AIx (men: r = 0.21, p<0.05; women: r = 0.26, p<0.05). In men, multivariate linear regression analysis showed an association between triglyceride level and AIx (standardised beta coefficient = 0.19, p = 0.009), independent of age, blood pressure, heart rate, height, weight, smoking habits, total cholesterol and HDL-cholesterol levels. On the other hand, in women, the unadjusted correlation between triglyceride level and AIx was largely explained when the above mentioned confounders were taken into account (beta = -0.016, p = 0.86).

Conclusion: In healthy men, serum triglyceride levels are associated with indices of arterial stiffness and wave reflections, which are important determinants of cardiovascular function and risk. The role of triglycerides in the vascular function of women warrants further investigation.
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http://dx.doi.org/10.1136/hrt.2006.095554DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1955540PMC
May 2007

Negative association between serum levels of matrix metalloproteinases-2 and -9 and aortic stiffness in healthy adults.

Int J Cardiol 2007 Nov 7;122(3):232-8. Epub 2007 Feb 7.

1st Department of Cardiology, Athens Medical School, Hippokration Hospital, Athens, Greece.

Background: Arterial stiffness is a marker of cardiovascular disease and independent predictor of cardiovascular risk. Matrix metalloproteinases (MMPs) are zinc-dependent endopeptidases that degrade components of the extracellular matrix, which is an important determinant of the arterial elastic properties. This study sought to investigate the association between MMP-2 and MMP-9 (gelatinase A and B respectively) and arterial stiffness in healthy human subjects.

Methods: A total of 213 apparently healthy subjects (mean age 41 years, range 18 to 60, 141 males and 72 females) were studied. Carotid-femoral pulse wave velocity (PWV) and aortic augmentation index (AIx) were measured as indices of aortic stiffness and wave reflections respectively. Associations with serum levels of total MMP-2, total MMP-9 and high-sensitivity C-reactive protein (hsCRP) were evaluated with multiple regression models.

Results: In these models, PWV exhibited a significant negative association with both MMP-2 (standardized b=-0.177, P=0.003) and MMP-9 (b=-0.122, P=0.032), after controlling for potential confounding factors such as age, gender, blood pressure, heart rate, body-mass index, smoking habits (pack-years), blood glucose, total cholesterol, and level of subclinical inflammation expressed by hsCRP (adjusted R2 of models 0.352 and 0.338 respectively). On the other hand, no relationship between MMP-2 or MMP-9 and AIx was found.

Conclusions: Circulating MMP-2 and MMP-9 are inversely associated with large artery stiffness but not with wave reflections in healthy persons. This finding implies that these gelatinases may have a possible role in the determination of arterial function and has potential implications for their involvement in the pathophysiology of cardiovascular diseases.
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http://dx.doi.org/10.1016/j.ijcard.2006.11.099DOI Listing
November 2007

Acute effect of black and green tea on aortic stiffness and wave reflections.

J Am Coll Nutr 2006 Jun;25(3):216-23

Ist Department of Cardiology, Athens Medical School, Hippokration Hospital, Athens, Greece.

Objective: While most studies have shown an inverse relation between tea consumption and cardiovascular risk, other studies have shown opposite results. Aortic stiffness and wave reflections are markers of cardiovascular disease and prognosticators of cardiovascular risk.

Methods: The acute effect of black and green tea on aortic stiffness and wave reflections was assessed in 29 healthy volunteers in a randomized, single-blind, sham-procedure controlled, cross-over design. In the black tea sub-study, 16 subjects received 6 gm of tea, caffeine (175 mg), or hot water in 3 different sessions. In the green tea sub-study, 13 subjects received 6 gm of tea, caffeine (125 mg), or hot water. Carotid-femoral pulse wave velocity and wave reflection indices were measured at baseline and for 3 hours after consumption.

Results: Black tea increased pulse wave velocity during the first 90 min (increase by 0.49 m/sec, P < 0.05), showing a rapid return towards baseline values thereafter (P = 0.07 for the whole study period); in contrast, green tea had no effect. Both black and green tea increased augmentation index (by 5.0% and by 6.6%, P < 0.01 and P < 0.001, respectively) throughout the study. These changes were less than the respective changes produced by caffeine. Both black and green tea had a significant pressor effect. No change in oxidant status was found with both types of tea.

Conclusions: Both black and green tea increases acutely wave reflections and only black tea increases aortic stiffness. Tea flavonoids may play a role in the attenuation of the effects of caffeine contained in tea.
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http://dx.doi.org/10.1080/07315724.2006.10719535DOI Listing
June 2006

Acute systemic inflammation increases arterial stiffness and decreases wave reflections in healthy individuals.

Circulation 2005 Oct 26;112(14):2193-200. Epub 2005 Sep 26.

First Department of Cardiology, Athens Medical School, Hippokration Hospital, Athens, Greece.

Background: Aortic stiffness is a marker of cardiovascular disease and an independent predictor of cardiovascular risk. Although an association between inflammatory markers and increased arterial stiffness has been suggested, the causative relationship between inflammation and arterial stiffness has not been investigated.

Methods And Results: One hundred healthy individuals were studied according to a randomized, double-blind, sham procedure-controlled design. Each substudy consisted of 2 treatment arms, 1 with Salmonella typhi vaccination and 1 with sham vaccination. Vaccination produced a significant (P<0.01) increase in pulse wave velocity (at 8 hours by 0.43 m/s), denoting an increase in aortic stiffness. Wave reflections were reduced significantly (P<0.01) by vaccination (decrease in augmentation index of 5.0% at 8 hours and 2.5% at 32 hours) as a result of peripheral vasodilatation. These effects were associated with significant increases in inflammatory markers such as high-sensitivity C-reactive protein (P<0.001), high-sensitivity interleukin-6 (P<0.001), and matrix metalloproteinase-9 (P<0.01). With aspirin pretreatment (1200 mg PO), neither pulse wave velocity nor augmentation index changed significantly after vaccination (increase of 0.11 m/s and 0.4%, respectively; P=NS for both).

Conclusions: This is the first study to show through a cause-and-effect relationship that acute systemic inflammation leads to deterioration of large-artery stiffness and to a decrease in wave reflections. These findings have important implications, given the importance of aortic stiffness for cardiovascular function and risk and the potential of therapeutic interventions with antiinflammatory properties.
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http://dx.doi.org/10.1161/CIRCULATIONAHA.105.535435DOI Listing
October 2005

Chronic coffee consumption has a detrimental effect on aortic stiffness and wave reflections.

Am J Clin Nutr 2005 Jun;81(6):1307-12

1st Department of Cardiology, Hippokration Hospital, School of Medicine, University of Athens, Athens, Greece.

Background: The effect of coffee consumption on the cardiovascular system is still an unresolved issue. Aortic stiffness and wave reflections are important prognosticators of cardiovascular disease risk. We have shown that caffeine acutely increases aortic stiffness and wave reflections.

Objective: The objective was to investigate the effect of chronic coffee consumption on aortic stiffness and wave reflections.

Design: This was a cross-sectional study of 228 healthy subjects: 141 men (x +/- SD: 41 +/- 8 y old) and 87 women (41 +/- 9 y old). Aortic stiffness was evaluated with carotid-femoral pulse wave velocity (PWV). Wave reflections were evaluated with augmentation index (AIx) and augmented pressure (AP) of the aortic pressure waveform with the use of high-fidelity pulse wave analysis. Coffee consumption was ascertained over 1 y with a food-frequency questionnaire.

Results: A linear relation between coffee consumption and PWV, AIx, and AP was observed (P for trend < 0.05). Compared with the nonconsumption group, PWV was on average 13% higher, AIx was 2-fold higher, and AP was 2.4-fold higher (P < 0.01 for all) in the high-consumption group (>450 mL/d). The findings remained significant after control for confounders such as age, sex, smoking habits, body mass index, total and LDL cholesterol, triacylglycerols, blood glucose, mean blood pressure, and heart rate. The linear relation (P for trend < 0.05) observed between coffee consumption and arterial pressures was largely explained when the covariates were entered in the model.

Conclusions: Chronic coffee consumption exerts a detrimental effect on aortic stiffness and wave reflections, which may increase the risk of cardiovascular disease.
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http://dx.doi.org/10.1093/ajcn/81.6.1307DOI Listing
June 2005
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