1.
Relations of digital vascular function, cardiovascular risk factors, and arterial stiffness: the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort study.
Brant, LC, Hamburg, NM, Barreto, SM, Benjamin, EJ, Ribeiro, AL
Journal of the American Heart Association. 2014;(6):e001279
Abstract
BACKGROUND Vascular dysfunction is an early expression of atherosclerosis and predicts cardiovascular (CV) events. Peripheral arterial tonometry (PAT) evaluates basal pulse amplitude (BPA), endothelial function (PAT ratio), and wave reflection (PAT-AIx) in the digital microvessels. In Brazilian adults, we investigated the correlations of PAT responses to CV risk factors and to carotid-femoral pulse wave velocity (PWV), a measure of arterial stiffness. METHODS AND RESULTS In a cross-sectional study, 1535 participants of the ELSA-Brasil cohort underwent PAT testing (52±9 years; 44% women). In multivariable analyses, more-impaired BPA and PAT ratios were associated with male sex, higher body mass index (BMI), and total cholesterol/high-density lipoprotein. Higher age and triglycerides were related to higher BPA, whereas lower systolic blood pressure, hypertension (HTN) treatment, and prevalent CV disease (CVD) were associated with lower PAT ratio. PAT-AIx correlated positively with female sex, advancing age, systolic and diastolic blood pressures, and smoking and inversely to heart rate, height, BMI, and prevalent CVD. Black race was associated with lower BPA, higher PAT ratio, and PAT-AIx. Microvessel vasodilator function was not associated with PWV. Higher PAT-AIx was modestly correlated to higher PWV and PAT ratio and inversely correlated to BPA. CONCLUSION Metabolic risk factors are related to impaired microvessel vasodilator function in Brazil. However, in contrast to studies from the United States, black race was not associated with an impaired microvessel vasodilator response, implying that vascular function may vary by race across populations. PAT-AIx relates to HTN, may be a valid measure of wave reflection, and provides distinct information from arterial stiffness.
2.
Head-to-head comparison of udenafil vs amlodipine in the treatment of secondary Raynaud's phenomenon: a double-blind, randomized, cross-over study.
Lee, EY, Park, JK, Lee, W, Kim, YK, Park, CS, Giles, JT, Park, JW, Shin, K, Lee, JS, Song, YW, et al
Rheumatology (Oxford, England). 2014;(4):658-64
Abstract
OBJECTIVE RP is a reversible vasoconstriction of digital arteries that causes pain and skin discoloration. This study compared the efficacy of the new phosphodiesterase type 5 inhibitor udenafil with that of the calcium channel blocker amlodipine in the treatment of secondary RP. METHODS A total of 29 patients with secondary RP associated with connective tissue diseases were enrolled in this double-blind, randomized, cross-over study. The patients were randomized to receive udenafil 100 mg/day or amlodipine 10 mg/day for 4 weeks. After a washout period they were crossed over to the other drug for another 4 weeks. The primary outcome was RP frequency before and after treatment. The secondary outcomes were RP condition scores, RP duration, number of digital ulcers, HAQ, physician global assessment and digital artery flow before and after treatment. RESULTS Amlodipine and udenafil both decreased the rate of RP attack significantly. The drugs did not differ in terms of RP frequency or any of the secondary outcomes except for digital blood flow; udenafil improved it significantly better than amlodipine (P = 0.021). Udenafil was well tolerated without serious adverse effects. CONCLUSION Udenafil and amlodipine have comparable efficacy in improving RP attacks. In addition, udenafil improves the blood flow in digital arteries compared with amlodipine. TRIAL REGISTRATION www.clinicaltrials.gov, protocol number NCT01280266.
3.
Nonoperative treatment of digital ischemia in systemic sclerosis.
Wall, LB, Stern, PJ
The Journal of hand surgery. 2012;(9):1907-9
4.
Alternate site glucose testing: a crossover design.
Bennion, N, Christensen, NK, McGarraugh, G
Diabetes technology & therapeutics. 2002;(1):25-33; discussion 45-7
Abstract
A crossover design study was conducted to determine if reducing pain, by using alternative sites off the finger tip, would increase testing frequency and improve clinical outcome as measured by hemoglobin A1c (HbA1c). Subjects with type 1 and type 2 diabetes tested with the FreeStyle meter (group 1) or tested with their original meter (group 2). After three months the subjects used the alternate meter. Testing frequency and blood glucose concentrations were recorded for the month before the study began and monthly thereafter. HbA1c was tested initially, at the crossover point, and at study conclusion. Insulin users increased testing frequency from 2.4 to 3.0 tests/day. Testing frequency for non-insulin users remained the same at 1.5 tests/day. Testing frequency was the same with the FreeStyle and the original meters. The average HbA1c was 7.4% (SD 1.5%) initially, 7.3% (SD 1.5%) at the crossover point, and 6.9% (SD 1.1%) at study conclusion. There was no significant difference in HbA1c measurements between meter types. Preference rankings were 76% for FreeStyle, 20% for their original meter, and 4% preferred both meters equally. This population tended to be in good glycemic control with 70% having HbA1c at < or = 8.0 at study initiation. Subjects preferred testing with the FreeStyle meter (76%), but did not increase testing frequency. Study participants tended to be in good testing compliance and glycemic control with little room for improvement. A population in poor glucose control might show differences in outcome with off site monitoring.