Atsuhito Saiki

Circulating angiotensin II is associated with body fat accumulation and insulin resistance in obese subjects with type 2 diabetes mellitus

Adipocytes express all components of the renin-angiotensin system, and the renin-angiotensin system is involved in obesity and insulin resistance. Circulating angiotensin II (Ang II) is detectable in blood, but its significance in human obesity remains unknown. The aim of this study was to investigate plasma Ang II in obese patients with type 2 diabetes mellitus (T2D) and the change during weight loss. Fifty Japanese obese subjects with T2D (body weight, 75.0 +/- 14.1 kg; body mass index, 29.1 +/- 3.7 kg/m(2); visceral fat area [VFA], 169.3 +/- 54.3 cm(2); hemoglobin A(1c), 7.6% +/- 1.5%) were enrolled. The subjects were prescribed a diet of daily caloric intake of 20 kcal/kg for 24 weeks. Plasma Ang II was measured by radioimmunoassay. Leptin, adiponectin, and lipoprotein lipase mass in preheparin serum were also measured as adipocyte-derived factors. After 24 weeks of weight reduction diet, the mean body weight, VFA, and hemoglobin A(1c) decreased significantly by 2.3%, 7.0%, and 8.3%, respectively. The mean plasma Ang II decreased by 24% (P < .0001) and correlated with body weight both at baseline (r = 0.425, P = .0018) and at 24 weeks (r = 0.332, P = .0181). The change in Ang II correlated with changes in body weight (r = 0.335, P = .0167) and VFA (r = 0.329, P = .0191). The change in Ang II also correlated positively with change in leptin (r = 0.348, P = .0127) and tended to correlate negatively with change in lipoprotein lipase mass in preheparin serum (r = -0.260, P = .0683), which is a marker of insulin sensitivity. Plasma Ang II is associated with body weight, decreases during weight loss, and is associated with markers of insulin resistance in obese subjects with T2D.

Improvement of cardio‐ankle vascular index by glimepiride in type 2 diabetic patients

Aims:  Glimepiride, a third generation sulfonylurea (SU), is known to have extrapancreatic effects, but its vascular effect is unclear. We investigated the efficacy of glimepiride in improving arterial stiffness assessed by cardio‐ankle vascular index (CAVI) in type 2 diabetic patients, compared with glibenclamide, a conventional SU.

Effects of body weight reduction on cardio-ankle vascular index (CAVI)

OBJECTIVE Obesity is associated with type 2 diabetes, dyslipidemia and hypertension, contributing to atherogenesis. Weight reduction is the fundamental therapy for obesity. Recently, a novel arterial stiffness parameter called cardio-ankle vascular index (CAVI) has been developed. We hypothesized that CAVI may be a candidate marker of increased vascular stiffness in obese patients. The aim of this study is to investigate the effect of weight reduction on CAVI. SUBJECTS AND METHODS Using CAVI as an indicator, we assessed the changes in arterial stiffness in 47 obese Japanese subjects (aged 46 ± 13 years) who underwent a 12-week weight reduction program consisting of a calorie restriction diet (20-25 kcal/day) and exercise therapy. Visceral fat area (VFA) was evaluated by CT. RESULTS At baseline, CAVI correlated positively with age (r = 0.70), blood pressure (r = 0.23), VFA (r = 0.26) and HbA1c (r = 0.39). After 12 weeks of weight reduction, mean BMI decreased from 33.3 ± 7.5 to 30.7 ± 6.4 kg/m(2) (p < 0.0001), and mean CAVI decreased from 8.3 to 7.9 (p < 0.01). The change in VFA correlated positively with change in CAVI in subjects with decrease in CAVI (r = 0.47). Furthermore, change in VFA was a significant independent predictor for change in CAVI. No significant correlation was observed between change in CAVI and clinical variables such as BMI, HbA1c and lipids. CONCLUSION This study demonstrated that CAVI decreased after weight reduction, and was associated with a decrease in VFA. CAVI reduction maybe a marker of improved vascular stiffness after weight reduction in subjects with visceral adiposity.

Improvement of postprandial hyperglycemia and arterial stiffness upon switching from premixed human insulin 30/70 to biphasic insulin aspart 30/70

Postprandial hyperglycemia is known to be associated with increasing cardiovascular mortality in type 2 diabetes mellitus patients. Cardio-ankle vascular index (CAVI) reflects arterial stiffness and is more useful for predicting coronary atherosclerosis than intima-media thickness. Premixed human insulin 30/70 (BHI30) containing rapid-acting insulin has been used conventionally as a biphasic insulin. Recently, a biphasic insulin analogue preparation, biphasic insulin aspart 30/70 (BIAsp30), containing ultrarapid-acting insulin has been approved and expected to improve postprandial hyperglycemia. The aim of this study was to clarify the effects of switching the biphasic insulin from BHI30 to BIAsp30 on arterial stiffness in type 2 diabetes mellitus patients. Twenty-six type 2 diabetes mellitus patients (glycosylated hemoglobin >6.5%) who were already receiving biphasic insulin therapy with BHI30 twice daily were observed for 3 months. Afterward, BHI30 was switched to BIAsp30. At 3 months after switching, relative mobility of the peak of LDL fraction decreased significantly (from 0.3462 ± 0.041 to 0.3356 ± 0.035, P < .01); and CAVI also decreased significantly (from 9.77 ± 1.11 to 9.35 ± 1.17 m/s, P < .005). A significant negative correlation was observed between the change in CAVI and change in 1,5-anhydroglucitol (1,5-AG) (r = -0.3929, P < .05). A stronger correlation between change in CAVI and change in 1,5-AG was observed in the subgroup of patients whose 1,5-AG levels were elevated after switching (r = -0.6261, P < .05) compared with all subjects. These results suggest that switching biphasic insulin from BHI30 to BIAsp30 improves arterial stiffness, and the improvement of arterial stiffness may be associated with improvement of postprandial hyperglycemia.

Evaluation of Blood Pressure Control using a New Arterial Stiffness Parameter, Cardio-ankle Vascular Index (CAVI)

Arterial stiffness has been known to be a surrogate marker of arteriosclerosis, and also of vascular function. Pulse wave velocity (PWV) had been the most popular index and was known to be a predictor of cardiovascular events. But, it depends on blood pressure at measuring time. To overcome this problem, cardio-ankle vascular index (CAVI) is developed. CAVI is derived from stiffness parameter β by Hayashi, and the equation of Bramwell-Hill, and is independent from blood pressure at a measuring time. Then, CAVI might reflect the proper change of arterial wall by antihypertensive agents. CAVI shows high value with aging and in many arteriosclerotic diseases and is also high in persons with main coronary risk factors. Furthermore, CAVI is decreased by an administration of α1 blocker, doxazosin for 2-4 hours, Those results suggested that CAVI reflected the arterial stiffness composed of organic components and of smooth muscle cell contracture. Angiotensin II receptor blocker, olmesartan decreased CAVI much more than that of calcium channel antagonist, amlodipine, even though the rates of decreased blood pressure were almost same. CAVI might differentiate the blood pressure-lowering agents from the point of the effects on proper arterial stiffness. This paper reviewed the principle and rationale of CAVI, and the possibilities of clinical applications, especially in the studies of hypertension.

Determination of serum 7-ketocholesterol concentrations and their relationships with coronary multiple risks in diabetes mellitus

Oxysterols have cytotoxic effects and contribute to the development of atherosclerosis. To examine association between 7-ketocholesterol and diabetes mellitus, and other coronary risk factors, we developed a reliable quantitative method to measure serum 7-ketocholesterol (s-7KCHO) and studied s-7KCHO in patients with type 2 diabetes mellitus (T2DM). The s-7KCHO was detected by gas chromatography-mass spectrometry assay. The s-7KCHO was significantly higher in patients with T2DM (n=137, 33.8 ng/ml) compared to non-diabetic healthy subjects (n=89, 16.1 ng/ml). Patients with T2DM were divided into two groups with two or more than two risk factors (defined as multiple risk factors group) and with zero or one risk factor (non-multiple risk factors group). The s-7KCHO was significantly higher in multiple risk factors group (39.5 ng/ml) compared to non-multiple risk factors (30.1 ng/ml). Among patients with multiple risk factors group, s-7KCHO was significantly higher in patients with high low-density lipoprotein cholesterol (LDL-C) levels (45.1+/-5.9 ng/ml) compared to those with normal LDL-C levels (35.3+/-7.0 ng/ml). Furthermore, s-7KCHO increased according to the number of concurrent coronary risk factors. These results suggest that serum 7-ketocholesterol levels may depend on the multiple risk factors and serum LDL-C levels.

Suppression of lipoprotein lipase expression in 3T3-L1 cells by inhibition of adipogenic differentiation through activation of the renin-angiotensin system

The renin-angiotensin system (RAS) may inhibit adipogenic differentiation by down-regulating peroxisome proliferator-activated receptor gamma gene expression in adipocytes, and adipocytes express all components of the RAS, including angiotensinogen. Expression of lipoprotein lipase (LPL), which is expressed mainly in adipocytes, is considered to be affected by adipogenic differentiation. We studied whether LPL expression in mouse 3T3-L1 cells is suppressed by inhibition of adipogenic differentiation through activation of RAS by the cells. The mean 3T3-L1 cell size increased and peroxisome proliferator-activated receptor gamma messenger RNA (mRNA) expression in the cells measured by reverse transcriptase polymerase chain reaction (RT-PCR) was enhanced with increase in incubation time. The LPL activity, LPL protein expression (Western blot), and mRNA expression (RT-PCR) in 3T3-L1 cells increased transiently followed by a decline during long-term incubation. Angiotensin II suppressed adipogenic differentiation, LPL activity, protein expression, and mRNA expression in 3T3-L1 cells. On the other hand, the selective angiotensin type 1 receptor blocker valsartan enhanced adipogenic differentiation and LPL activity in 3T3-L1 cells. Angiotensinogen mRNA expression in 3T3-L1 cells measured by RT-PCR was enhanced with increase in incubation time. These results suggest that LPL expression may be suppressed by inhibition of adipogenic differentiation through activation of endogenous RAS in 3T3-L1 cells angiotensin type 1 receptor.

Cardio-Ankle Vascular Index is Independently Associated with Future Cardiovascular Events in Outpatients with Metabolic Disorders

AIM We investigated whether cardio-ankle vascular index (CAVI), an arterial stiffness marker, independently predicts future cardiovascular events in subjects with metabolic disorders. METHODS 1562 outpatients underwent CAVI between April 2004 and March 2006 at Toho University, Sakura Medical Center in Chiba, Japan. Patients who already had cardiovascular events at baseline, patients with low ankle brachial index (＜0.9), and patients with atrial fibrillation were excluded. After exclusion, 1080 subjects with metabolic disorders including diabetes mellitus, hypertension and dyslipidemia were screened and followed prospectively. RESULTS Eventually, 1003 subjects (92.9% of 1,080 subjects) followed until March 2012 (follow-up duration 6.7±1.6 years) were analyzed. During the observation period, 90 subjects had new-onset myocardial infarction or angina pectoris confirmed by angiography. All subjects were stratified into quartiles by baseline CAVI (Q1: CAVI ≤8.27, Q2: CAVI 8.28-9.19, Q3: CAVI 9.20-10.08, Q4: CAVI ≥10.09). Age, male ratio and future cardiovascular events increased as CAVI quartile became higher. In Cox proportional hazards regression analysis, the factors independently associated with higher risk of future cardiovascular events were every 1.0 increment of CAVI [hazard ratio (HR) 1.126, p= 0.039], male gender (HR 2.276, p=0.001), smoking (HR 1.846, p=0.007), diabetes mellitus (HR 1.702,p=0.020), and hypertension (HR 1.682, p=0.023). CONCLUSION In individuals with metabolic disorders, CAVI was a predictor of future cardiovascular events, independent of traditional coronary risk factors. CAVI is a potentially valuable tool to identify persons likely to benefit from more intensive therapeutic approaches.

High serum uric acid is associated with increased cardio-ankle vascular index (CAVI) in healthy Japanese subjects: A cross-sectional study

OBJECTIVE To investigate the association of serum uric acid (SUA) with arterial stiffness assessed by cardio-ankle vascular index (CAVI). METHODS We analyzed the cross-sectional data from 27,360 healthy Japanese subjects (12,910 males and 14,450 females) aged between 20 and 74 years without a past history of heart disease, stroke, hypertension, diabetes, nephritis or gout. We investigated whether SUA was independently associated with CAVI in a gender-specific manner. RESULTS BMI, CAVI, systolic/diastolic BP, GOT, GPT, γ-GTP, triglyceride (TG), creatinine and SUA were higher and HDL-C was lower in males than in females. Next, they were stratified by SUA into 3 groups: lower tertile (T1), middle tertile (T2) and upper tertile (T3) and by gender. CAVI increased progressive with increasing SUA tertile, after adjusting for age, BMI and systolic BP (sBP) identified in multiple regression analysis for CAVI. Multivariate analysis showed that the odds ratios (95% CI) relative to T1 for high CAVI (≥90(th) percentile) were 1.233 (0.928-1.638) in T2 and 1.352 (1.031-1.773) in T3 for males, and 1.133 (0.984-1.303) in T2 and 1.361 (1.098-1.687) in T3 for females, after adjusting for confounders. Furthermore, increase in adjusted CAVI was observed in a lower SUA range in females compared to that observed in males. CONCLUSION We demonstrated an independent correlation between SUA and CAVI, and observed gender difference in the SUA range for increase in CAVI. These results may suggest the need to set different target SUA levels for men and women in anti-hyperuricemic treatment for atherosclerosis prevention.

Cardio-ankle vascular index may reflect endothelial function in type 2 diabetes

To the Editor: A non-invasive arterial stiffness parameter called cardio-ankle vascular index (CAVI) has been developed recently as a marker of arteriosclerosis (1). However, factors that regulate CAVI are not fully elucidated. Endothelial dysfunction is considered to be one of the most important factors in the development of atherosclerosis. In this study, we examined whether CAVI reflects endothelial dysfunction by measuring flow mediated dilatation (FMD) and serum thrombomodulin level. A total of 206 patients with type 2 diabetes were included in this study. This study was approved by the Ethics Committee of the Toho University. All patients provided written informed consent. Cardio-ankle vascular index was measured with a VaSera CAVI instrument (Fukuda Denshi Co Ltd, Tokyo, Japan) as described previously (1). FMD is a non-invasive technique to assess endothelial function. We measured FMD according to the reported guidelines (2). Body weight and blood pressure were measured in the morning after 12 h of fasting. Blood samples were collected in the morning after 12 h of fasting, and were used for measuring glycosylated haemoglobin, total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol and serum thrombomodulin. Data were analysed using spss 11.01.1 (Chicago, IL, USA.) statistical package for Microsoft Windows. Table 1 shows the correlation between CAVI and several clinical parameters. CAVI correlated strongly with age (R = 0.564, p < 0.01), correlated weakly with systolic blood pressure (R = 0.314, p < 0.01), correlated with serum thrombomodulin (R = 0.332, p < 0.01) and correlated with FMD (R = )0.388, p < 0.01). Multiple regression analysis was conducted to identify clinical parameters related to CAVI (Table 2). Absolute t values for age, FMD and serum thrombomodulin were greater than 2 (age; 6.350, FMD; )5.087, serum thrombomodulin; 3.212) and were therefore identified as independent factors related to CAVI. Shirai et al. (1), Nakamura et al. (3) and Kim et al. (4) reported that CAVI may be able to detect the presence of vascular disease. On the other hand, we reported that CAVI was improved by statin, ARB and glimepiride treatment (5–7). Our studies also indicated that the improvement of CAVI correlated with the reduction of malondialdehyde-modified low-density lipoprotein or 8-hydroxy-2¢deoxyguanosimne. Oxidative stress has been reported to be a cause of endothelial dysfunction (8–10). FMD were previously described as a non-invasive technique to assess endothelial function (11). Serum thrombomodulin is considered to be a biochemical marker of endothelial dysfunction (12,13). Simple linear regression analysis showed that CAVI correlated with both FMD and serum thrombomodulin. In addition, multiple regression analysis identified FMD and serum thrombomodulin as independently related to CAVI. These results indicate that CAVI may reflect endothelial function. Endothelial dysfunction is an important abnormality for atherosclerosis (14–16), especially in the early phase of the atherosclerotic process. Perticone et al. (17) concluded that endothelial dysfunction was a marker of future cardiovascular events. Therefore, if CAVI would be validated as a marker of endothelial function, it may also be a useful predictor of future cardiovascular events. Our study had several limitations. First, the sample size was relatively small. Second, endothelial function is known to be affected by many factors, especially by dietary condition. Therefore, the effects of these factors on CAVI should be studied in the future. Moreover, prospective studies are required to validate whether CAVI predicts the progression of endothelial dysfunction and systemic atherosclerosis.