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Effects of Oral Magnesium Supplementation on Vascular Function: A Systematic Review and Meta-analysis of Randomized Controlled Trials.
Marques, BCAA, Klein, MRST, da Cunha, MR, de Souza Mattos, S, de Paula Nogueira, L, de Paula, T, Corrêa, FM, Oigman, W, Neves, MF
High blood pressure & cardiovascular prevention : the official journal of the Italian Society of Hypertension. 2020;(1):19-28
Abstract
INTRODUCTION The effects of magnesium (Mg) supplementation on vascular function have been evaluated in some randomized controlled trials (RCT) but their results are conflicting. AIM: A systematic review and meta-analysis were conducted to summarize the effects of oral Mg supplementation on vascular function in RCT. METHODS The databases MEDLINE (PubMed), Embase, Web of Science and Cochrane Library were accessed from inception to May 27, 2019. Intergroup differences (treatment vs. control group) related to changes in flow-mediated dilation (FMD) and pulse wave velocity (PWV), expressed as mean and standard deviation, were used to evaluate the effect of Mg supplementation on these outcomes. The results of the meta-analysis were expressed using a random-effects model. The heterogeneity between studies was evaluated using the I2 statistic. RESULTS The oral supplementation of Mg had no significant effect on FMD (mean difference 2.13; 95% CI - 0.56, 4.82; p = 0.12) and PWV (mean difference - 0.54, 95% CI - 1.45, 0.36, p = 0.24). Heterogeneity for both outcomes (FMD and PWV) was high (I2 = 99%, p < 0.001). However, in subgroup analyses, oral Mg significantly improved FMD in studies longer than 6 months, in unhealthy subjects, in individuals older than 50 years, or in those with body mass index (BMI) ≥ 25 kg/m2. The reduced number of RCT and the heterogeneity among them were the main limitations. CONCLUSIONS This meta-analysis suggest that oral Mg supplementation may improve endothelial function when conducted at least for 6 months and in unhealthy, overweight or older individuals. Registration number: PROSPERO CRD42019111462.
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The effects of correction of vitamin D deficiency on arterial stiffness: A systematic review and updated meta-analysis of randomized controlled trials.
Chen, NC, Hsu, CY, Mao, PC, Dreyer, G, Wu, FZ, Chen, CL
The Journal of steroid biochemistry and molecular biology. 2020;:105561
Abstract
It is unclear whether nutritional vitamin D supplementation in vitamin d-deficient persons improves arterial stiffness. To conduct a meta-analysis of the effects of the nutritional vitamin D therapy on arterial stiffness in adults with vitamin D deficiency, the Scopus, PUBMED, EMBASE, and Cochrane databases were searched for systematic reviews conducted up to October 5, 2018. Randomized clinical trials that compared nutritional vitamin D therapy with placebo in adults with vitamin D deficiency were eligible. Two reviewers independently evaluated eligibility of all retrieved studies based on titles and abstracts. Meta-analysis was performed using random effect or fixed effects model and inverse variance method was used to calculate the effect using standardized mean difference (SMD) and weighted mean difference. A leave-one-out method was used for sensitivity analysis. The main outcome was arterial stiffness, indicated by the carotid-femoral pulse wave velocity (PWV). We identified 237 records, of which 9 satisfied the inclusion criteria of the study. Our meta-analysis included relatively high-quality placebo-controlled randomized trials. In a random-effects model, nutritional vitamin D was associated with significant reductions in the pooled difference of PWV [(SMD: -0.29; 95 % CI: -0.51 to -0.06), p = 0.01; Cochran's Q test: chi2 = 21.85; df = 9; p = 0.009; I2 = 59 %; n = 909 from 9 studies]. All sensitivity analyses yielded similar results. Nutritional vitamin D supplementation significantly improved arterial stiffness (PWV) in several subgroups by correcting vitamin D deficiency, for a study duration of ≥4 months and a daily dose of vitamin D3 ≥ 2000 IU. The study indicated that the correction of vitamin D deficiency by nutritional vitamin D supplementation may improve arterial stiffness in vitamin d-deficient persons, especially by the correction of vitamin D deficiency with a daily dose of vitamin D3 ≥ 2000 IU. However, further studies are required to confirm this.
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Repeated administration of inorganic nitrate on blood pressure and arterial stiffness: a systematic review and meta-analysis of randomized controlled trials.
Li, D, Nishi, SK, Jovanovski, E, Zurbau, A, Komishon, A, Mejia, SB, Khan, TA, Sievenpiper, JL, Milicic, D, Jenkins, A, et al
Journal of hypertension. 2020;(11):2122-2140
Abstract
OBJECTIVE We aim to synthesize effects of repeated administration (≥3 days) of inorganic nitrate on blood pressure and arterial stiffness measures. METHODS We conducted a systematic review and meta-analysis of randomized controlled trials with at least 3 days treatment of inorganic nitrate on blood pressure and arterial stiffness in individuals with or without elevated cardiovascular disease risk. MEDLINE, EMBASE and the Cochrane Library were searched through 2 July 2019. Two independent reviewers extracted relevant study data. Data were pooled using the generic inverse variance method with random-effects model, and expressed as mean differences with 95% confidence intervals. Certainty in the evidence was assessed using GRADE. RESULTS Forty-seven trials were included (n = 1101). Administration of inorganic nitrate significantly lowered SBP [mean difference: -2.91 mmHg, 95% confidence interval (95% CI): -3.92 to -1.89, I = 76%], DBP (mean difference: -1.45 mmHg, 95% CI: -2.22 to -0.68, I = 78%], central SBP (mean difference: -1.56 mmHg, 95% CI: -2.62 to -0.50, I = 30%) and central DBP (mean difference: -1.99 mmHg, 95% CI: -2.37 to -1.60, I = 0%). There was no effect on 24-h blood pressure, augmentation index or pulse wave velocity. Certainty in the evidence was graded moderate for central blood pressure, pulse wave velocity and low for peripheral blood pressure, 24-h blood pressure and augmentation index. CONCLUSION Repeated administration (≥3 days) of inorganic nitrate lower peripheral and central blood pressure. Results appear to be driven by beneficial effects in healthy and hypertensive individuals. More studies are required to increase certainty in the evidence.
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The effect of high Intensity interval training versus moderate intensity continuous training on arterial stiffness and 24h blood pressure responses: A systematic review and meta-analysis.
Way, KL, Sultana, RN, Sabag, A, Baker, MK, Johnson, NA
Journal of science and medicine in sport. 2019;(4):385-391
Abstract
OBJECTIVES Greater arterial stiffness and poor 24h blood pressure (BP) are recognized as indicators of poor cardiovascular health. Evidence has shown that high intensity interval training (HIIT) may be a superior alternative to moderate intensity continuous training (MICT) for improving cardiovascular disease risk factors such as cardiorespiratory fitness and vascular function. However, there are limited data comparing the effect of HIIT to MICT on central arterial stiffness and/or 24h BP response. The purpose of this study was to compare HIIT versus MICT on central arterial stiffness and 24h BP outcomes by systematic review and meta-analysis. DESIGN A systematic review and meta-analysis was conducted. METHODS Eligible studies were exercise training interventions (≥4weeks) that included both HIIT and MICT and reported central arterial stiffness, as measured by pulse wave velocity and augmentation index and/or 24h BP outcome measures. RESULTS HIIT was found to be superior to MICT for reducing night-time diastolic BP (ES: -0.456, 95% CI: -0.826 to -0.086mmHg; P=0.016). A near-significant greater reduction in daytime systolic (ES: -0.349, 95% CI: -0.740 to 0.041mmHg; p=0.079) and diastolic BP was observed with HIIT compared to MICT (ES: -0.349, 95% CI: -0.717 to 0.020mmHg; p=0.063). No significant difference was found for other BP responses or arterial stiffness outcomes. CONCLUSIONS HIIT leads to a superior reduction in night-time diastolic BP compared to MICT. Furthermore, a near-significant greater reduction in daytime BP was found with HIIT compared to MICT. No significant difference was observed for changes to central arterial stiffness between HIIT and MICT.
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Effect of Vitamin D Supplementation on Markers of Vascular Function: A Systematic Review and Individual Participant Meta-Analysis.
Beveridge, LA, Khan, F, Struthers, AD, Armitage, J, Barchetta, I, Bressendorff, I, Cavallo, MG, Clarke, R, Dalan, R, Dreyer, G, et al
Journal of the American Heart Association. 2018;(11)
Abstract
BACKGROUND Low 25-hydroxyvitamin D levels are associated with an increased risk of cardiovascular events, but the effect of vitamin D supplementation on markers of vascular function associated with major adverse cardiovascular events is unclear. METHODS AND RESULTS We conducted a systematic review and individual participant meta-analysis to examine the effect of vitamin D supplementation on flow-mediated dilatation of the brachial artery, pulse wave velocity, augmentation index, central blood pressure, microvascular function, and reactive hyperemia index. MEDLINE, CINAHL, EMBASE, Cochrane Central Register of Controlled Trials, and http://www.ClinicalTrials.gov were searched until the end of 2016 without language restrictions. Placebo-controlled randomized trials of at least 4 weeks duration were included. Individual participant data were sought from investigators on included trials. Trial-level meta-analysis was performed using random-effects models; individual participant meta-analyses used a 2-stage analytic strategy, examining effects in prespecified subgroups. 31 trials (2751 participants) were included; 29 trials (2641 participants) contributed data to trial-level meta-analysis, and 24 trials (2051 participants) contributed to individual-participant analyses. Vitamin D3 daily dose equivalents ranged from 900 to 5000 IU; duration was 4 weeks to 12 months. Trial-level meta-analysis showed no significant effect of supplementation on macrovascular measures (flow-mediated dilatation, 0.37% [95% confidence interval, -0.23 to 0.97]; carotid-femoral pulse wave velocity, 0.00 m/s [95% confidence interval, -0.36 to 0.37]); similar results were obtained from individual participant data. Microvascular function showed a modest improvement in trial-level data only. No consistent benefit was observed in subgroup analyses or between different vitamin D analogues. CONCLUSIONS Vitamin D supplementation had no significant effect on most markers of vascular function in this analysis.