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Published in: Osteoporosis International 1/2008

01-01-2008 | Original Article

Increased augmentation index and central aortic blood pressure in osteoporotic postmenopausal women

Authors: R. A. Mangiafico, C. Alagona, P. Pennisi, N. Parisi, M. Mangiafico, F. Purrello, C. E. Fiore

Published in: Osteoporosis International | Issue 1/2008

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Abstract

Summary

Osteoporosis has been associated with cardiovascular disease. We found increased augmentation index, a measure of wave reflections and arterial stiffness, and central pressures in osteoporotic postmenopausal women. They also showed a higher estimated aortic pulse wave velocity, indicating a stiffer aorta. These changes may increase cardiovascular risk in postmenopausal osteoporosis.

Introduction

Evidence suggests a link between osteoporosis and cardiovascular disease. We investigated whether augmentation index (AIx), a measure of pulse wave reflections and arterial stiffness, is increased and related to the osteoprotegerin (OPG)/receptor activator of nuclear factor-kappa B ligand (RANKL) system in postmenopausal osteoporosis.

Methods

AIx and central aortic haemodynamics were assessed using pulse wave analysis in 182 cardiovascular disease-free osteoporotic postmenopausal women and in 160 controls. Statistical analysis was performed by unpaired t test, Mann-Whitney test, Spearman‘s correlation coefficient, and multivariate linear regression analysis.

Results

AIx (37.2 ± 7.0 vs. 29.6 ± 9.2 %, P < 0.0001) and central aortic systolic (117.5 ± 12.1 vs. 111.4 ± 12.2 mmHg, P < 0.0001) and pulse (40.5 ± 10.3 vs. 36.4 ± 8.1 mmHg, P = 0.0007) pressures were significantly higher in osteoporotic patients than in controls. The estimated aortic pulse wave velocity (PWV) was also significantly higher in the osteoporotic group. In multivariate analysis for osteoporotic patients, femoral neck and lumbar spine bone mineral density T scores were independent negative predictors of AIx (P < 0.0001). AIx was not correlated with serum levels of OPG and RANKL.

Conclusions

Osteoporotic postmenopausal women show increased AIx and central aortic pressures, and a higher estimated aortic PWV, indicating a stiffer aorta. Such alterations may increase cardiovascular risk in postmenopausal osteoporosis.
Literature
1.
go back to reference Tanko LB, Christiansen C, Cox DA et al (2005) Relationship between osteoporosis and cardiovascular disease in postmenopausal women. J Bone Miner Res 20:1912–1920PubMedCrossRef Tanko LB, Christiansen C, Cox DA et al (2005) Relationship between osteoporosis and cardiovascular disease in postmenopausal women. J Bone Miner Res 20:1912–1920PubMedCrossRef
2.
go back to reference von der Recke P, Hansen MA, Hassager C (1999) The association between low bone mass at the menopause and cardiovascular mortality.Am J Med 106:273–278PubMedCrossRef von der Recke P, Hansen MA, Hassager C (1999) The association between low bone mass at the menopause and cardiovascular mortality.Am J Med 106:273–278PubMedCrossRef
3.
go back to reference Mangiafico RA, Russo E, Riccobene S et al (2006) Increased prevalence of peripheral arterial disease in osteoporotic postmenopausal women. J Bone Miner Metab 24:125–131PubMedCrossRef Mangiafico RA, Russo E, Riccobene S et al (2006) Increased prevalence of peripheral arterial disease in osteoporotic postmenopausal women. J Bone Miner Metab 24:125–131PubMedCrossRef
4.
go back to reference Pennisi P, Signorelli SS, Riccobene S et al (2004) Low bone density and abnormal bone turnover in patients with atherosclerosis of peripheral vessels. Osteoporos Int 15:389–395PubMedCrossRef Pennisi P, Signorelli SS, Riccobene S et al (2004) Low bone density and abnormal bone turnover in patients with atherosclerosis of peripheral vessels. Osteoporos Int 15:389–395PubMedCrossRef
5.
go back to reference Farhat GN, Strotmeyer ES, Newman AB et al (2006) Volumetric and areal bone mineral density measures are associated with cardiovascular disease in older men and women: the health, aging, and body composition study. Calcif Tissue Int 79:102–111PubMedCrossRef Farhat GN, Strotmeyer ES, Newman AB et al (2006) Volumetric and areal bone mineral density measures are associated with cardiovascular disease in older men and women: the health, aging, and body composition study. Calcif Tissue Int 79:102–111PubMedCrossRef
7.
go back to reference Laurent S, Cockcroft J, Van Bortel L, European Network for Non-invasive Investigation of Large Arteries et al (2006) Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J 27:2588–2605PubMedCrossRef Laurent S, Cockcroft J, Van Bortel L, European Network for Non-invasive Investigation of Large Arteries et al (2006) Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J 27:2588–2605PubMedCrossRef
8.
go back to reference Hirose K, Tomiyama H, Okazaki R et al (2003) Increased pulse wave velocity associated with reduced calcaneal quantitative osteo-sono index: possible relationship between atherosclerosis and osteopenia. J Clin Endocrinol Metab 88:2573–2578PubMedCrossRef Hirose K, Tomiyama H, Okazaki R et al (2003) Increased pulse wave velocity associated with reduced calcaneal quantitative osteo-sono index: possible relationship between atherosclerosis and osteopenia. J Clin Endocrinol Metab 88:2573–2578PubMedCrossRef
9.
go back to reference Sumino H, Ichikawa S, Kasama S et al (2006) Elevated arterial stiffness in postmenopausal women with osteoporosis. Maturitas 55:212–218PubMedCrossRef Sumino H, Ichikawa S, Kasama S et al (2006) Elevated arterial stiffness in postmenopausal women with osteoporosis. Maturitas 55:212–218PubMedCrossRef
10.
go back to reference Yamada S, Inaba M, Goto H et al (2006) Associations between physical activity, peripheral atherosclerosis and bone status in healthy Japanese women. Atherosclerosis 188:196–202PubMedCrossRef Yamada S, Inaba M, Goto H et al (2006) Associations between physical activity, peripheral atherosclerosis and bone status in healthy Japanese women. Atherosclerosis 188:196–202PubMedCrossRef
11.
12.
go back to reference Nichols WW, O’Rourke MF (1998) McDonald’s blood flow in arteries: Theoretical, experimental and clinical principles. Arnold, London Nichols WW, O’Rourke MF (1998) McDonald’s blood flow in arteries: Theoretical, experimental and clinical principles. Arnold, London
13.
go back to reference Pauca AL, O’Rourke MF, Kon ND (2001) Prospective evaluation of a method for estimating ascending aortic pressure from the radial artery pressure waveform. Hypertension 38:932–937PubMedCrossRef Pauca AL, O’Rourke MF, Kon ND (2001) Prospective evaluation of a method for estimating ascending aortic pressure from the radial artery pressure waveform. Hypertension 38:932–937PubMedCrossRef
14.
go back to reference Nurnberger J, Keflioglu-Scheiber A, Opazo Saez AM et al (2002) Augmentation index is associated with cardiovascular risk.J Hypertens 20:2407–2414PubMedCrossRef Nurnberger J, Keflioglu-Scheiber A, Opazo Saez AM et al (2002) Augmentation index is associated with cardiovascular risk.J Hypertens 20:2407–2414PubMedCrossRef
15.
go back to reference Wilkinson IB, Prasad K, Hall IR et al (2002) Increased central pulse pressure and augmentation index in subjects with hypercholesterolemia. J Am Coll Cardiol 39:1005–1011PubMedCrossRef Wilkinson IB, Prasad K, Hall IR et al (2002) Increased central pulse pressure and augmentation index in subjects with hypercholesterolemia. J Am Coll Cardiol 39:1005–1011PubMedCrossRef
16.
go back to reference Wilkinson IB, MacCallum H, Rooijmans DF et al (2000) Increased augmentation index and systolic stress in type 1 diabetes mellitus. QJM 93:441–448PubMedCrossRef Wilkinson IB, MacCallum H, Rooijmans DF et al (2000) Increased augmentation index and systolic stress in type 1 diabetes mellitus. QJM 93:441–448PubMedCrossRef
17.
go back to reference London GM, Blacher J, Pannier B et al (2001) Arterial wave reflections and survival in end-stage renal failure. Hypertension 38:434–438PubMed London GM, Blacher J, Pannier B et al (2001) Arterial wave reflections and survival in end-stage renal failure. Hypertension 38:434–438PubMed
18.
go back to reference Weber T, Auer J, O’Rourke MF et al (2004) Arterial stiffness, wave reflections, and the risk of coronary artery disease.Circulation 109:184–189PubMedCrossRef Weber T, Auer J, O’Rourke MF et al (2004) Arterial stiffness, wave reflections, and the risk of coronary artery disease.Circulation 109:184–189PubMedCrossRef
19.
go back to reference Bucay N, Sarosi I, Dunstan CR et al (1998) Osteoprotegerin-deficient mice develop early onset osteoporosis and arterial calcification. Genes Dev 12:1260–1268PubMed Bucay N, Sarosi I, Dunstan CR et al (1998) Osteoprotegerin-deficient mice develop early onset osteoporosis and arterial calcification. Genes Dev 12:1260–1268PubMed
20.
go back to reference Min H, Morony S, Sarosi I et al (2000) Osteoprotegerin reverses osteoporosis by inhibiting endosteal osteoclasts and prevents vascular calcification by blocking a process resembling osteoclastogenesis. J Exp Med 192:463–474PubMedCrossRef Min H, Morony S, Sarosi I et al (2000) Osteoprotegerin reverses osteoporosis by inhibiting endosteal osteoclasts and prevents vascular calcification by blocking a process resembling osteoclastogenesis. J Exp Med 192:463–474PubMedCrossRef
21.
go back to reference Jono S, Ikari Y, Shioi A et al (2002) Serum osteoprotegerin levels are associated with the presence and severity of coronary artery disease.Circulation 106:1192–1194PubMedCrossRef Jono S, Ikari Y, Shioi A et al (2002) Serum osteoprotegerin levels are associated with the presence and severity of coronary artery disease.Circulation 106:1192–1194PubMedCrossRef
22.
go back to reference Ueland T, Jemtland R, Godang K et al (2004) Prognostic value of osteoprotegerin in heart failure after acute myocardial infarction.J Am Coll Cardiol 44:1970–1976PubMedCrossRef Ueland T, Jemtland R, Godang K et al (2004) Prognostic value of osteoprotegerin in heart failure after acute myocardial infarction.J Am Coll Cardiol 44:1970–1976PubMedCrossRef
23.
go back to reference Kiechl S, Schett G, Wenning G et al (2004) Osteoprotegerin is a risk factor for progressive atherosclerosis and cardiovascular disease. Circulation 109:2175–2180PubMedCrossRef Kiechl S, Schett G, Wenning G et al (2004) Osteoprotegerin is a risk factor for progressive atherosclerosis and cardiovascular disease. Circulation 109:2175–2180PubMedCrossRef
24.
go back to reference Schoppet M, Schaefer JR, Hofbauer LC (2003) Low serum levels of soluble RANK ligand are associated with the presence of coronary artery disease in men. Circulation 107:e76PubMedCrossRef Schoppet M, Schaefer JR, Hofbauer LC (2003) Low serum levels of soluble RANK ligand are associated with the presence of coronary artery disease in men. Circulation 107:e76PubMedCrossRef
25.
go back to reference Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group (1994) World Health Organ Tech Rep Ser 843:1–129 Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group (1994) World Health Organ Tech Rep Ser 843:1–129
26.
go back to reference Paffenbarger RS Jr, Wing AL, Hyde RT (1978) Physical activity as an index of heart attack risk in college alumni. Am J Epidemiol 108:161–175PubMed Paffenbarger RS Jr, Wing AL, Hyde RT (1978) Physical activity as an index of heart attack risk in college alumni. Am J Epidemiol 108:161–175PubMed
27.
go back to reference Alagona C, Soro A, Westerbacka J et al (2003) Low HDL cholesterol concentration is associated with increased intima-media thickness independent of arterial stiffness in healthy subjects from families with low HDL cholesterol. Eur J Clin Invest 33:457–463PubMedCrossRef Alagona C, Soro A, Westerbacka J et al (2003) Low HDL cholesterol concentration is associated with increased intima-media thickness independent of arterial stiffness in healthy subjects from families with low HDL cholesterol. Eur J Clin Invest 33:457–463PubMedCrossRef
28.
go back to reference Kelly R, Hayward C, Avolio A et al (1989) Noninvasive determination of age-related changes in the human arterial pulse. Circulation 80:1652–1659PubMed Kelly R, Hayward C, Avolio A et al (1989) Noninvasive determination of age-related changes in the human arterial pulse. Circulation 80:1652–1659PubMed
29.
go back to reference Cameron JD, McGrath BP, Dart AM (1998) Use of radial artery applanation tonometry and a generalized transfer function to determine aortic pressure augmentation in subjects with treated hypertension. J Am Coll Cardiol 32:1214–1220PubMedCrossRef Cameron JD, McGrath BP, Dart AM (1998) Use of radial artery applanation tonometry and a generalized transfer function to determine aortic pressure augmentation in subjects with treated hypertension. J Am Coll Cardiol 32:1214–1220PubMedCrossRef
30.
go back to reference Ravikumar R, Deepa R, Shanthirani C et al (2002) Comparison of carotid intima-media thickness, arterial stiffness, and brachial artery flow mediated dilatation in diabetic and nondiabetic subjects (The Chennai Urban Population Study [CUPS-9]). Am J Cardiol 90:702–707PubMedCrossRef Ravikumar R, Deepa R, Shanthirani C et al (2002) Comparison of carotid intima-media thickness, arterial stiffness, and brachial artery flow mediated dilatation in diabetic and nondiabetic subjects (The Chennai Urban Population Study [CUPS-9]). Am J Cardiol 90:702–707PubMedCrossRef
31.
go back to reference Tanaka H, DeSouza CA, Seals DR (1998) Absence of age-related increase in central arterial stiffness in physically active women. Arterioscler Thromb Vasc Biol 18:127–132PubMed Tanaka H, DeSouza CA, Seals DR (1998) Absence of age-related increase in central arterial stiffness in physically active women. Arterioscler Thromb Vasc Biol 18:127–132PubMed
32.
go back to reference Lebrun CE,van der Schouw YT, Bak AA et al (2002) Arterial stiffness in postmenopausal women: determinants of pulse wave velocity. J Hypertens 20:2165–2172PubMedCrossRef Lebrun CE,van der Schouw YT, Bak AA et al (2002) Arterial stiffness in postmenopausal women: determinants of pulse wave velocity. J Hypertens 20:2165–2172PubMedCrossRef
33.
go back to reference Williams B, Lacy PS, Thom SM, CAFE Investigators, Anglo-Scandinavian Cardiac Outcomes Trial Investigators, CAFE Steering Committee, Writing Committee et al (2006) Differential impact of blood pressure-lowering drugs on central aortic pressure and clinical outcomes: principal results of the Conduit Artery Function Evaluation (CAFE) study. Circulation 113:1213–1225PubMedCrossRef Williams B, Lacy PS, Thom SM, CAFE Investigators, Anglo-Scandinavian Cardiac Outcomes Trial Investigators, CAFE Steering Committee, Writing Committee et al (2006) Differential impact of blood pressure-lowering drugs on central aortic pressure and clinical outcomes: principal results of the Conduit Artery Function Evaluation (CAFE) study. Circulation 113:1213–1225PubMedCrossRef
34.
go back to reference O’Rourke MF, Safar ME (2005) Relationship between aortic stiffening and microvascular disease in brain and kidney: cause and logic of therapy. Hypertension 46:200–204PubMedCrossRef O’Rourke MF, Safar ME (2005) Relationship between aortic stiffening and microvascular disease in brain and kidney: cause and logic of therapy. Hypertension 46:200–204PubMedCrossRef
35.
go back to reference Danchin N, Benetos A, Lopez-Sublet M, ESCAPP Investigators et al (2004) Aortic pulse pressure is related to the presence and extent of coronary artery disease in men undergoing diagnostic coronary angiography: a multicentre study. Am J Hypertens 17:129–133PubMedCrossRef Danchin N, Benetos A, Lopez-Sublet M, ESCAPP Investigators et al (2004) Aortic pulse pressure is related to the presence and extent of coronary artery disease in men undergoing diagnostic coronary angiography: a multicentre study. Am J Hypertens 17:129–133PubMedCrossRef
36.
go back to reference Hofbauer LC, Khosla S, Dunstan CR et al (2000) The roles of osteoprotegerin and osteoprotegerin ligand in the paracrine regulation of bone resorption. J Bone Miner Res 15:2–12PubMedCrossRef Hofbauer LC, Khosla S, Dunstan CR et al (2000) The roles of osteoprotegerin and osteoprotegerin ligand in the paracrine regulation of bone resorption. J Bone Miner Res 15:2–12PubMedCrossRef
37.
go back to reference Uemura H, Yasui T, Miyatani Y et al (2007) Circulating osteoprotegerin is associated with age and systolic blood pressure, but not with lipid profile or fasting glucose, in postmenopausal women. Menopause DOI 10.1097/gme.0b013e318046369b Uemura H, Yasui T, Miyatani Y et al (2007) Circulating osteoprotegerin is associated with age and systolic blood pressure, but not with lipid profile or fasting glucose, in postmenopausal women. Menopause DOI 10.​1097/​gme.​0b013e318046369b​
38.
go back to reference Wilkinson IB, MacCallum H, Cockcroft JR et al (2002) Inhibition of basal nitric oxide synthesis increases aortic augmentation index and pulse wave velocity in vivo.Br J Clin Pharmacol 53:189–192PubMedCrossRef Wilkinson IB, MacCallum H, Cockcroft JR et al (2002) Inhibition of basal nitric oxide synthesis increases aortic augmentation index and pulse wave velocity in vivo.Br J Clin Pharmacol 53:189–192PubMedCrossRef
39.
go back to reference McEniery CM, Wallace S, Mackenzie IS et al (2006) Endothelial function is associated with pulse pressure, pulse wave velocity, and augmentation index in healthy humans. Hypertension 48:602–608PubMedCrossRef McEniery CM, Wallace S, Mackenzie IS et al (2006) Endothelial function is associated with pulse pressure, pulse wave velocity, and augmentation index in healthy humans. Hypertension 48:602–608PubMedCrossRef
40.
go back to reference Sanada M,Taguchi A,Higashi Y et al (2004) Forearm endothelial function and bone mineral loss in postmenopausal women. Atherosclerosis 176:387–392PubMedCrossRef Sanada M,Taguchi A,Higashi Y et al (2004) Forearm endothelial function and bone mineral loss in postmenopausal women. Atherosclerosis 176:387–392PubMedCrossRef
41.
go back to reference Zaydun G, Tomiyama H, Hashimoto H et al (2006) Menopause is an independent factor augmenting the age-related increase in arterial stiffness in the early postmenopausal phase. Atherosclerosis 184:137–142PubMedCrossRef Zaydun G, Tomiyama H, Hashimoto H et al (2006) Menopause is an independent factor augmenting the age-related increase in arterial stiffness in the early postmenopausal phase. Atherosclerosis 184:137–142PubMedCrossRef
42.
go back to reference Rajkumar C, Kingwell BA, Cameron JD et al (1997) Hormonal therapy increases arterial compliance in postmenopausal women. J Am Coll Cardiol 30:350–356PubMedCrossRef Rajkumar C, Kingwell BA, Cameron JD et al (1997) Hormonal therapy increases arterial compliance in postmenopausal women. J Am Coll Cardiol 30:350–356PubMedCrossRef
43.
go back to reference Grant SF, Reid DM, Blake G et al (1996) Reduced bone density and osteoporosis associated with a polymorphic Sp1 binding site in the collagen type I alpha 1 gene. Nat Genet 14:203–205PubMedCrossRef Grant SF, Reid DM, Blake G et al (1996) Reduced bone density and osteoporosis associated with a polymorphic Sp1 binding site in the collagen type I alpha 1 gene. Nat Genet 14:203–205PubMedCrossRef
44.
go back to reference Brull DJ, Murray LJ, Boreham CA et al (2001) Effect of a COL1A1 Sp1 binding site polymorphism on arterial pulse wave velocity: an index of compliance. Hypertension 38:444–448PubMed Brull DJ, Murray LJ, Boreham CA et al (2001) Effect of a COL1A1 Sp1 binding site polymorphism on arterial pulse wave velocity: an index of compliance. Hypertension 38:444–448PubMed
45.
go back to reference Levy D, Garrison R, Savage DD et al (1990) Prognostic implications of echocardiographically determined left ventricular mass in the Framingham heart study. N Engl J Med 332:1561–1566CrossRef Levy D, Garrison R, Savage DD et al (1990) Prognostic implications of echocardiographically determined left ventricular mass in the Framingham heart study. N Engl J Med 332:1561–1566CrossRef
46.
go back to reference Saba PS, Roman MJ, Pinni R et al (1993) Relation of arterial pressure waveform to left ventricular and carotid anatomy in normotensive subjects. J Am Coll Cardiol 22:1873–1880PubMedCrossRef Saba PS, Roman MJ, Pinni R et al (1993) Relation of arterial pressure waveform to left ventricular and carotid anatomy in normotensive subjects. J Am Coll Cardiol 22:1873–1880PubMedCrossRef
Metadata
Title
Increased augmentation index and central aortic blood pressure in osteoporotic postmenopausal women
Authors
R. A. Mangiafico
C. Alagona
P. Pennisi
N. Parisi
M. Mangiafico
F. Purrello
C. E. Fiore
Publication date
01-01-2008
Publisher
Springer-Verlag
Published in
Osteoporosis International / Issue 1/2008
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-007-0438-5

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