Aims To investigate the prevalence of diastolic dysfunction and associated risk factors in pre-diabetes and diabetes in the general population. Methods Diastolic function was assessed by transthoracic echocardiography in a cross-sectional sample of 3840 men and women aged 50-64 years from the Swedish CArdioPulmonary bioImage Study. Anthropometry, medical history, blood pressure, biochemistry and coronary atherosclerosis assessed by CT were recorded. Population-specific reference ranges were applied. Diastolic function was compared across glycaemic groups and analysed in relation to risk factors. Results Normoglycaemia was present in 82%, pre-diabetes in 12% and diabetes in 6%. Diastolic function was impaired (p<0.001) in pre-diabetes and diabetes, with higher prevalence of abnormal diastolic variables in pre-diabetes (30%) and diabetes (33%) than in normoglycaemia (21%). Among participants with pre-diabetes/diabetes, diastolic dysfunction was associated with hypertension and more severe coronary atherosclerosis (p<0.001). In multivariable analyses, waist circumference (OR 1.034, 95% CI 1.013 to 1.054) and high Coronary Artery Calcium Score (OR 2.897, 95% CI 1.373 to 6.113) were independently associated with diastolic dysfunction, also after exclusion of subjects with ischaemic heart disease. In those without coronary atherosclerosis and hypertension, systolic blood pressure was the only independent risk factor (OR 1.027, 95% CI 1.002 to 1.053). Conclusions Diastolic dysfunction was as common in pre-diabetes as in diabetes and was mainly associated with central adiposity, hypertension and coronary atherosclerosis. In individuals without coronary atherosclerosis or hypertension, systolic blood pressure was still the only independent predictor. These findings challenge the concept of a clinically relevant isolated diabetic cardiomyopathy and highlight the importance of early and comprehensive cardiometabolic risk factor control to prevent heart failure with preserved ejection fraction.

Background

Post-systolic shortening (PSS) has emerged as a method for evaluating left ventricular dysfunction. We aimed to determine whether pathological PSS, alone or in combination with global longitudinal strain (GLS), is a prognostic factor for major adverse cardiovascular events (MACEs) in patients with type 2 diabetes. We prospectively investigated 364 patients with type 2 diabetes aged 55-65 years in the CARDIPP study. All patients underwent echocardiography between 2005 and 2009. PSS, measured by speckle tracking echocardiography, was defined as myocardial contraction after aortic valve closure. Pathological PSS was defined as a post-systolic index > 5% and was calculated as follows: [(maximum longitudinal strain - peak systolic longitudinal strain)/(maximum longitudinal strain)]. The endpoint was any MACE, defined as hospitalization or death due to heart failure, myocardial infarction, or stroke. Cox proportional hazard ratios (HR) with 95% confidence intervals (CI) were calculated and adjusted for sex, age, body mass index, hypertension, smoking, previous cardiovascular events, and HbA1c level. The mean follow-up time was 11.2 +/- 2.3 years.

Results

Pathological PSS was associated with an increased risk of MACEs after adjustment for other cardiovascular risk factors (HR 2.20, 95% CI 1.11-4.37). Subjects with reduced GLS, PSS and GLS combined in a risk prediction model, had an adjusted HR for MACEs of 2.94 (95% CI 1.33-6.52).

Conclusions

Our results suggest that PSS may provide additional prognostic information for patients with T2D when used alone or in combination with GLS.

Background: The Oral and Vascular Health study investigates abdominal aortic aneurysm (AAA) diameter progression overtime. Participants are followed longitudinally for at least two years after identification through the Swedish national AAA screening program, which includes an ultrasound exam at age 65.

Methods: Screened individuals were invited to additional assessments. Pulse wave velocity (PWV) was measured using the SC device, and physical activity was objectively recorded using accelerometry (Actigraph GTX3+). Time spent indifferent activity intensities was categorized using age-relevant cutoffs. Body Mass Index (BMI) was calculated from measured height and weight.

Results: This analysis includes 79 participants with completedata (20 with AAA, 59 controls). Mean age was higher in theAAA group (72.1 vs. 67.5 years, p0.05). In univariate linearregression, physical activity was inversely associated withPWV (standardized β = -0.278, p = 0.013). This associationremained significant after adjustment for age and BMI (β = - 0.222, p = 0.047).

Conclusion: In this preliminary analysis of the Oral andVascular Health study, total physical activity was inverselyassociated with pulse wave velocity, even after adjusting forage and BMI. These findings suggest a potential protectiverole of physical activity on arterial stiffness in elderly men,including those with abdominal aortic aneurysm. Furtherlongitudinal data will clarify whether physical activityinfluences AAA progression over time. 

Background Cardiovascular autonomic neuropathy (CAN), a serious complication of type 1 diabetes mellitus (T1DM), requires early detection for timely prevention of disease progression. Although traditional autonomic function tests effectively identify advanced neuropathic abnormalities, they lack sensitivity for early-stage CAN in young individuals. Heart rate recovery (HRRec) and heart rate variability (HRV) following exercise are potential early markers of autonomic dysfunction in this group.Methods HRRec and HRV from Holter-ECG recordings after a standardized exercise test were compared between 43 individuals with T1DM, aged 10-30 years, subject to modern treatment with advanced technology and with moderate to good metabolic control (mean HbA1c 57 mmol/mol), and 43 healthy controls, matched for age and sex. HRV was additionally assessed on a reference Holter-ECG recording without prior exertion.Results Twice as many participants with T1DM (33%) compared to controls (16%) maintained a heart rate > 100 beats/min beyond two hours after the exercise test. HRV did not differ between groups on reference Holter-ECG without prior exertion, but nocturnal HRV was significantly lower in the T1DM group compared to controls after the standardized exercise test (p < 0.05), primarily among individuals with a lower physical capacity. Long-term HbA1c correlated negatively with nocturnal high-frequency HRV in T1DM participants (p < 0.05).Conclusion Heart rate variability post-exercise may be a pertinent tool for the assessment of early autonomic cardiac dysfunction in young individuals with T1DM with moderate to good metabolic control.

Background Physical activity reduces the risk of cardiovascular diseases in general, but for abdominal aortic aneurysm (AAA) specifically, its potentially beneficial role is not clearly understood. To contribute to the knowledge on vascular changes over time, development and growth rate of AAA, we have initiated a prospective study on oral and vascular health, with special regard to oral status and microbiota, vascular structure and function, and behavioral physical activity (PA) – The Oral and Vascular Health study (OVH).

Methods Participants were recruited from the Swedish national AAA screening program (males, age 65 years), geographically narrowed down to the Jönköping region. The first thirty consecutive subjects in the OVH study were included in these preliminary analyses. Pulse wave velocity (PWV) was measured by applanation tonometry (SphygmoCor, AtCor Medical Pty Ltd) and habitual PA was objectively assessed by accelerometry (Actigraph GT3-X, Actigraph Corp.). Multiple regression analysis was performed, controlling for age.

Results The relations between PWV (mean value 8.4 m/s) and measures of PA were all negative, but only average steps per day remained significant after controlling for age.  Average steps per day:  Approx. 7000 steps per day; beta-coefficient -0.542; p = 0.003; R2Adj (model steps+age) = 0.29. Average time per day spent in Moderate or Vigorous Physical Activity (MVPA): Approx. 29 minutes per day; beta-coefficient -0.367; p = 0.051; R2Adj (model MVPA+age) = 0.15.

Conclusions In this initial cross-sectional analysis, PWV is negatively associated with objectively measured PA. 

Exercise is often cited as a major factor contributing to improved cognitive functioning. As a result, the relationship between exercise and cognition has received much attention in scholarly literature. Systematic reviews and meta-analyses present varying and sometimes conflicting results about the extent to which exercise can influence cognition. The aim of this umbrella review was to summarize the effects of physical exercise on cognitive functions (global cognition, executive function, memory, attention, or processing speed) in healthy adults & GE; 55 years of age.Methods An umbrella review of systematic reviews with meta-analyses investigating the effect of exercise on cognition was performed. Databases (CINAHL, Cochrane Library, MEDLINE, PsycInfo, Scopus, and Web of Science) were searched from inception until June 2023 for reviews of randomized or non-randomised controlled trials. Full-text articles meeting the inclusion criteria were reviewed and methodological quality assessed. Overlap within included reviews was assessed using the corrected covered area method (CCA). A random effects model was used to calculate overall pooled effect size with sub-analyses for specific cognitive domains, exercise type and timing of exercise.Results Database searches identified 9227 reviews. A total of 20 met the inclusion criteria. They were based on 332 original primary studies. Overall quality of the reviews was considered moderate with most meeting 8 or more of the 16 AMSTAR 2 categories. Overall pooled effects indicated that exercise in general has a small positive effect on cognition (d = 0.22; SE = 0.04; p < 0.01). Mind-body exercise had the greatest effect with a pooled effect size of (d = 0.48; SE = 0.06; p < 0.001). Exercise had a moderate positive effect on global cognition (d = 0.43; SE = 0,11; p < 0,001) and a small positive effect on executive function, memory, attention, and processing speed. Chronic exercise was more effective than acute exercise. Variation across studies due to heterogeneity was considered very high.Conclusions Mind-body exercise has moderate positive effects on the cognitive function of people aged 55 or older. To promote healthy aging, mind-body exercise should be used over a prolonged period to complement other types of exercise. Results of this review should be used to inform the development of guidelines to promote healthy aging.

Background: Abdominal aortic aneurysm (AAA) is an aortic enlargement in which the transverse diameter reaches at least 30 mm. Certain risk factors, such as age, male gender, and smoking, are well known; however, less is known about the genetic factors involved. Fibrillin-1 (FBN1) is a protein that coordinates the deposition of elastin fibres in the extracellular matrix and is therefore likely to affect the elastic properties in the aortic wall. Previously studies have found associations between the FBN1-2/3 genotype and arterial stiffness, but how different FBN1 genotypes, AAA, and arterial stiffness are related has been less frequently investigated. Aim: This study aimed to investigate whether there is a difference in FBN1 genotype between men with and without AAA. A further aim was to study whether the FBN1 genotype affects arterial wall stiffness differently in men with and without AAA. Methods: Pulse wave velocity and FBN1 genotyping were performed in 229 men (159 with AAA, 70 without AAA). Participants were recruited from ultrasound AAA surveillance programs or ongoing ultrasound screening programs from 2011 to 2016. Results: The distribution of the FBN1 genotype in the AAA and control groups were as follows: FBN1-2/2: 62% vs. 64%; FBN1-2/3: 8% vs. 14%; and FBN1-2/4: 30% vs. 21%, respectively. Men with AAA and FBN1-2/2 had increased central pulse wave velocity (p < 0.005) compared to the control group (those without AAA) with the FBN1-2/2 genotype. Conclusion: No differences were found with respect to FBN1 genotypes between men with and without AAA. The development of AAA in men does not appear to be linked to a specific FBN1 genotype. Nevertheless, men with FBN1-2/2 and AAA have increased central arterial stiffness compared to men with the same FBN1 genotype but without AAA.

Background: Markers of inflammation and arterial stiffness are predictors of cardiovascular morbidity and events, but their roles in the mechanisms and progression of abdominal aortic aneurysm (AAA) in males have not been fully investigated. This study explored possible associations between inflammatory marker levels and arterial stiffness in males with AAA. Methods: A total of 270 males (191 AAA and 79 controls) were included in the study. Arterial stiffness was assessed using non-invasive applanation tonometry to measure the regional pulse wave velocity between the carotid and femoral arteries and the carotid and radial arteries. Blood samples were obtained, and interleukin-10 (IL-10) and CRP levels were analysed. Results: Subjects with an AAA had higher levels of IL-10 (21.5 ± 14.0 ng/mL versus 16.6 ± 9.3 ng/mL) compared to controls (p = 0.007). In the AAA cohort, subjects with T2DM showed higher levels of IL-10 (26.4 ± 17.3 versus 20.4 ± 13.0, p = 0.036). We observed a positive correlation between PWVcf and CRP in the control group (r = 0.332) but not the AAA group. PWVcf and CRP were negatively correlated (r = 0.571) in the T2DM subjects treated with metformin in the AAA group. Conclusion: Arterial stiffness is related to the degree of inflammation reflected by CRP and IL-10 levels in males with an AAA. IL-10 is negatively correlated with arterial stiffness in these subjects. This finding suggests that IL-10 may decrease arterial stiffness in males with AAA. The negative correlation between CRP and PWVcf in males with T2DM treated with metformin may indicate that metformin influences the arterial wall to decrease stiffness in subjects with AAA.

Numerous studies have shown that lifestyle factors, such as regular physical activity and vitamin D intake, may remarkably improve overall health and mental wellbeing. This is especially important in older adults whose vitamin D deficiency occurs with a high prevalence. This study aimed to examine the influence of lifestyle and vitamin D on global DNA methylation patterns in an elderly cohort in Southwest of Sweden. We also sought to examine the methylation levels of specific genes involved in vitamin D's molecular and metabolic activated pathways. We performed a genome wide methylation analysis, using Illumina Infinium DNA Methylation EPIC 850kBeadChip array, on 277 healthy individuals from Southwest Sweden at the age of 70–95. The study participants also answered queries on lifestyle, vitamin intake, heart medication, and estimated health. Vitamin D intake did not in general affect methylation patterns, which is in concert with other studies. However, when comparing the group of individuals taking vitamin supplements, including vitamin D, with those not taking supplements, a difference in methylation in the solute carrier family 25 (SCL25A24) gene was found. This confirms a previous finding, where changes in expression of SLC25A24 were associated with vitamin D treatment in human monocytes. The combination of vitamin D intake and high physical activity increased methylation of genes linked to regulation of vitamin D receptor pathway, the Wnt pathway and general cancer processes. To our knowledge, this is the first study detecting epigenetic markers associated with the combined effects of vitamin D supplementation and high physical activity. These results deserve to be further investigated in an extended, interventional study cohort, where also the levels of 25(OH)D3 can be monitored.

BACKGROUND: Abdominal aortic aneurysm (AAA) increases the risk of chronic heart failure and other major cardiovascular events. Knowledge about left ventricular function in patients with AAA is lacking. This echocardiographic study aimed to investigate whether AAA is associated with left ventricular systolic and diastolic dysfunction.

METHODS: Echocardiography was performed in 307 males (199 AAA and 108 controls) recruited from a regional ultrasound surveillance programme of known AAA, or from an ongoing ultrasound screening programme, during 2011-2016.

RESULTS: Subjects with AAA had thicker septal and posterior walls and a reduced left ventricular function compared to controls. Left ventricular ejection fraction (AAA 55 ± 8%, controls 57 ± 7%) and global longitudinal strain (AAA 19 ± 3%, controls 20 ± 3%) were lower in the group with AAA (both p < 0·05). Moreover, decreased mitral annular plane systolic excursion (12 ± 2 mm versus 13 ± 2 mm) and higher E/e' (13 ± 5 versus 11 ± 4) were observed in subjects with AAA (both p < 0·05). The aortic sinus (38 ± 4 mm versus 35 ± 2 mm) and ascending aorta (36 ± 4 mm versus 34 ± 5 mm) were also wider in the AAA group compared to controls (both p < 0·01).

CONCLUSION: AAAs are associated with reduced left ventricular systolic and diastolic function in males. The larger diameter of the aortic sinus and ascending aorta among AAA patients suggests that AAA is a general aortic disease.