title: Abnormal stress-related measures of arterial stiffness in middle-aged and elderly men and women with impaired fasting glucose at risk for a first episode of symptomatic heart failure.
abstract: BACKGROUND
  Abnormal resting arterial stiffness is present in middle-aged and elderly persons with abnormalities of fasting glucose (diabetes or impaired fasting glucose) and is associated with exercise intolerance. We sought to determine whether these same persons exhibited stress-related abnormalities of arterial stiffness.
  
  
  RESULTS
  We analyzed dobutamine magnetic resonance stress imaging results from 373 consecutively recruited persons aged 55 to 85 years with normal fasting glucose, impaired fasting glucose, or diabetes who were at risk for but without symptomatic heart failure. Personnel blinded to participant identifiers measured arterial stiffness (brachial pulse pressure/left ventricular stroke volume indexed to body surface area, the aortic elastance index [brachial end-systolic pressure/left ventricular stroke volume indexed to body surface area], and thoracic aortic distensibility) at 80% of the maximum predicted heart rate response for age. Participants averaged 69±8 years of age; 79% were white, 92% were hypertensive, and 66% were women. After accounting for hypertension, sex, coronary artery disease, smoking, medications, hypercholesterolemia, and visceral fat, we observed an effect of glycemic status for stress measures of arterial stiffness in those with diabetes and impaired fasting glucose relative to those with normal fasting glucose (P=0.002, P=0.02, and P=0.003, respectively).
  
  
  CONCLUSIONS
  Middle- and older-aged individuals with diabetes or impaired fasting glucose have higher stress measures of arterial stiffness than those with normal fasting glucose. These data emphasize the need for future studies with larger sample sizes to determine whether stress-related elevations in arterial stiffness are related to exercise intolerance and future episodes of heart failure experienced by those with abnormalities of fasting glucose.
  
  
  BACKGROUND
  http://clinicaltrials.gov/. Unique identifier: NCT00542503.
authors.affiliation: Section of Cardiology, Department of Internal Medicine, Wake Forest School Health Sciences, Winston-Salem, NC (S.V., D.W.K., A.B., R.B.S., V.T., G.H.).
authors.forename: Sujethra
authors.initials: S
authors.lastname: Vasu
authors.affiliation: Department of Biostatistical Sciences, Wake Forest School Health Sciences, Winston-Salem, NC (T.M.M.).
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Morgan
authors.affiliation: Section of Cardiology, Department of Internal Medicine, Wake Forest School Health Sciences, Winston-Salem, NC (S.V., D.W.K., A.B., R.B.S., V.T., G.H.).
authors.forename: Dalane W
authors.initials: DW
authors.lastname: Kitzman
authors.affiliation: Section of Cardiology, Department of Internal Medicine, Wake Forest School Health Sciences, Winston-Salem, NC (S.V., D.W.K., A.B., R.B.S., V.T., G.H.).
authors.forename: Alain
authors.initials: A
authors.lastname: Bertoni
authors.affiliation: Section of Cardiology, Department of Internal Medicine, Wake Forest School Health Sciences, Winston-Salem, NC (S.V., D.W.K., A.B., R.B.S., V.T., G.H.).
authors.forename: Richard B
authors.initials: RB
authors.lastname: Stacey
authors.affiliation: Department of Biomedical Engineering, Wake Forest School Health Sciences, Winston-Salem, NC (C.H.).
authors.forename: Craig
authors.initials: C
authors.lastname: Hamilton
authors.affiliation: Department of Radiology, Wake Forest School Health Sciences, Winston-Salem, NC (C.C., G.H.).
authors.forename: Caroline
authors.initials: C
authors.lastname: Chiles
authors.affiliation: Section of Cardiology, Department of Internal Medicine, Wake Forest School Health Sciences, Winston-Salem, NC (S.V., D.W.K., A.B., R.B.S., V.T., G.H.).
authors.forename: Vinay
authors.initials: V
authors.lastname: Thohan
authors.affiliation: Section of Cardiology, Department of Internal Medicine, Wake Forest School Health Sciences, Winston-Salem, NC (S.V., D.W.K., A.B., R.B.S., V.T., G.H.) Department of Radiology, Wake Forest School Health Sciences, Winston-Salem, NC (C.C., G.H.).
authors.forename: W Gregory
authors.initials: WG
authors.lastname: Hundley
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001786:Blood Glucose / Q000032:analysis; D025401:Echocardiography, Stress / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011236:Prediabetic State / Q000175:diagnosis*; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D059289:Vascular Stiffness
chemical_list: D001786:Blood Glucose
keywords: arterial stiffness; diabetes; dobutamine; elderly