Jorge Conde

Central arterial hemodynamic effects of dark chocolate ingestion in young healthy people: a randomized and controlled trial.

Introduction. The aim of this study was to assess the vascular benefits of dark chocolate in healthy and young individuals. Methods. A randomized and controlled trial was carried out involving 60 healthy volunteers, randomized into two groups: control group (CG; n = 30) and intervention group (IG; n = 30). The IG ingested a daily dosage of 10 g of dark chocolate (>75% cocoa) for a month. Blood pressure (BP), flow-mediated dilation (FMD), arterial stiffness index (ASI), aortic pulse wave velocity (PWV), and pulse wave analysis (PWA) were assessed at baseline and one week after the one-month intervention period. Results. Arterial function improved after intervention in the IG, with PWV decreasing from 6.13 ± 0.41 m/s to 5.83 ± 0.53 m/s (P = 0.02), with no significant differences observed in the CG. A significant decrease in ASI (0.16 ± 0.01 to 0.13 ± 0.01; P < 0.001) and AiX (−15.88 ± 10.75 to −22.57 ± 11.16; P = 0.07) was also depicted for the IG. Endothelial function improved in the IG, with the FMD increasing 9.31% after the 1-month intervention (P < 0.001), with no significant variation in the CG. Conclusion. The daily ingestion of 10 g dark chocolate (>75% cocoa) during a month significantly improves vascular function in young and healthy individuals.

A distensibilidade da aorta prediz o acidente vascular cerebral em pacientes hipertensos

BACKGROUND Cardiovascular disease remains the leading cause of death in developed countries and is not entirely predicted by classic risk factors. Increased arterial stiffness is an important determinant of cardiovascular morbidity and mortality. OBJECTIVE To assess whether Aortic Pulse Wave Velocity (PWV) predicts the occurrence of stroke in hypertensive patients METHODS A cohort, observational and prospective study, including 1133 hypertensive patients (586 men), with a mean age 51.05 ± 12.64 years, was designed. PWV with the Complior method was performed in all patients, as well as a detailed clinical evaluation and blood pressure measurement. RESULTS The cumulative incidence of stroke in hypertensive patients with increased PWV was 3.25% (CI: 1.97% -5.25%), compared with 0.78% (CI: 0.28% -1.87%) in hypertensive patients with normal PWV (Risk Ratio (RR) =4.15; CI:1.53-11.26). In a multivariate analysis, adjusting the model to classical cardiovascular risk factors, PWV was an independent predictor of stroke, with a Hazard Ratio (HR) = 1.40 (CI:1.13-1.73, p<0.001), indicating a 40% increase in the risk of stroke per 1m/s increment in PWV. The addition of PWV to a model consisting of conventional cardiovascular risk factors significantly improved the discriminative capacity for stroke (Harrells C increased from 0.68 to 0.71 after the inclusion of the PWV; p<0.01). CONCLUSION Aortic PWV is a risk factor for stroke in hypertensive patients, and its integration into clinical follow-up programs in patients whose cardiovascular risk is manifest is strongly recommended.

Invasive validation of the Complior Analyse in the assessment of central artery pressure curves: a methodological study.

IntroductionArteries are the target, the place, and the common denominator of cardiovascular diseases; hence, study of arterial function is of greatest importance in clinical practice. The aim of this study was to evaluate the accuracy of carotid pulse wave analysis using the new version of the Complior device – the Complior Analyse. Methods and resultsThis was a cross-sectional study that included 15 patients (seven women), mean age 62.07±10.59 years, referenced for cardiac catheterization. Pressure curves were obtained simultaneously in the ascending aorta (invasively) and in the right common carotid artery (using the Complior Analyse). Mean central arterial pressures, augmentation indexes, and wave morphology obtained using both methods were compared. A good concordance between methods was obtained for all the parameters measured, with intraclass correlation coefficients above 0.9. Bland–Altman analysis also indicated a good accuracy profile of the Complior device, with small mean differences observed for all parameters and most values confined within 2 SD of the mean difference. This was further confirmed by the strong Pearson correlation coefficients, with r2 coefficients above 0.92 for all the variables studied. The correlations observed were independent of sex, age, arterial pressure, and BMI. ConclusionThe results presented and available research clearly indicate that the Complior Analyse device measures carotid pressure waves accurately; therefore, it is a simple and reliable noninvasive alternative for pressure wave analysis.

Reproducibility of aortic pulse wave velocity as assessed with the new Complior Analyse.

IntroductionThe aim of this study was to assess the interobserver and intraobserver reproducibility, as well as the temporal variability of the new Complior Analyse assessing aortic pulse wave velocity (PWV). MethodsEighty-seven participants (60% men), mean age 34.26±16.58 years, were enrolled in a cross-sectional study. All patients were subjected to sequential measures of aortic PWV by two experienced operators. In a group of 27 participants, PWV was also determined 1 month after the first moment evaluation to assess the temporal stability of the PWV estimations with the device. ResultsThe analysis of concordance showed a very good agreement for paired PWV values in terms of both the intraobserver and the interobserver variability and also the temporal variability. The intraclass correlation coefficients were above 0.98 for the three conditions (P<0.0001), indicating an excellent strength of agreement. Further evidences in favor of a good overall performance of the device were determined from the Bland–Altman analysis, with small mean differences for intrareproducibility, interreproducibility, and temporal reproducibility (respectively, 0.02±0.38, 0.10±0.45, and 0.07±0.51 m/s), and with differences mainly between 2 SDs of the mean difference. The correlations observed were independent of sex, age, arterial pressure, heart rate, and BMI. ConclusionThe data showed an excellent reproducibility of the Complior Analyse for the assessment of aortic PWV when used in ideal conditions and by experienced observers. The technical profile presented shows that this device meets the requirements of quality for its inclusion in integrated clinical follow-up programs.

Flow-Mediated Slowing as a Methodological Alternative to the Conventional Echo-Tracking Flow-Mediated Dilation Technique for the Evaluation of Endothelial Function: A Preliminary Report

The Moens-Korteweg equation predicts changes in pulse wave velocity (PWV) after changes in arterial radius; therefore, an increase in arterial radius, as seen in a reactive hyperemia (RH) condition, should slow PWV over a given arterial segment. If this assumption is true, then the deceleration of PWV over the brachial artery (flow-mediated slowing [FMS]) should be an equivalent signal of endothelial function during a conventional RH flow-mediated dilation (FMD) procedure. Our aim was to compare FMS with FMD after RH in healthy individuals as part of a study that seeks to evaluate the clinical usefulness of FMS as a noninvasive approach to characterize endothelial function. This cross-sectional study included 25 healthy participants (18 women [72%]) with a mean ± SD age of 21.12±0.73 years. The FMD and FMS were simultaneously measured. A significant correlation was observed between both measures of FMS (absolute difference and percentage variation) and echo FMD: R=−0.42 (P=.04) and r=0.46 (P=.02), respectively. The FMS was shown to depend on the baseline brachial diameter, with smaller variations depicted for smaller baseline brachial diameters. It seems to be a promising and feasible method for measuring changes after RH, although further studies are needed to evaluate how this correlation holds in different clinical conditions and to demonstrate its clinical usefulness.

Bone tissue, blood lipids and inflammatory profiles in adolescent male athletes from sports contrasting in mechanical load

Exploring the effect of non-impact and impact sports is particular relevant to understand the interaction between skeletal muscle and bone health during growth. The current study aimed to compare total and regional bone and soft-tissue composition, in parallel to measurements of blood lipid and inflammatory profiles between adolescent athletes and non-athletes. Anthropometry, biological maturity, dual energy X-ray absorptiometry (DXA) scans, training load and lipid and inflammatory profiles were assessed in a cross-sectional sample of 53 male adolescents (20 non-athletes, 15 swimmers and 18 basketball players) aged 12–19 years. Multiple comparisons between groups were performed using analysis of variance, covariance and magnitude effects (ES-r and Cohen’s d). The comparisons of controls with other groups were very large for high-sensitivity C-reactive protein (d range: 2.17–2.92). The differences between sports disciplines, regarding tissue outputs obtained from DXA scan were moderate for all variables except fat tissue (d = 0.4). It was possible to determine small differences (ES-r = 0.17) between controls and swimmers for bone area at the lower limbs (13.0%). In parallel, between swimmers and basketball players, the gradient of the differences was small (ES-r range: 0.15–0.23) for bone mineral content (24.6%), bone area (11.3%) and bone mineral density (11.1%) at the lower limbs, favoring the basketball players. These observations highlight that youth male athletes presented better blood and soft tissues profiles with respect to controls. Furthermore, sport-specific differences emerged for the lower limbs, with basketball players presenting higher bone mineral content, area and density than swimmers.

Reproducibility of isokinetic strength assessment of knee muscle actions in adult athletes: Torques and antagonist-agonist ratios derived at the same angle position

The current study aimed to examine the reliability of the conventional and functional ratios derived from peak torques (PTs) and those obtained from the combination of knee flexors torque at the angle of knee extensors PT. Twenty-six male athletes (mean of 24.0±0.7 years) from different sports completed a test-to-test variation in isokinetic strength (Biodex, System 3) within a period of one week. Anthropometry and body composition assessed by Dual Energy X-ray Absorptiometry were also measured. The proposed isokinetic strength ratio measurements appeared to be highly reliable: conventional ratio at PT angle (intra-class correlation, ICC = 0.98; 95% confidence interval; 95%CI: 0.95 to 0.99); functional extension ratio at PT angle (ICC = 0.98; 95%CI: 0.96 to 0.99); and, functional flexion ratio at PT angle (ICC = 0.95; 95%CI: 0.89 to 0.98). Technical error of measurement (TEM) and associated percentage of the coefficient of variation (%CV) were as follows: conventional ratio at PT angle (TEM = 0.02; %CV = 4.1); functional extension ratio at PT angle (TEM = 0.02; %CV = 3.8); and, functional flexion ratio at PT angle (TEM = 0.03; %CV = 3.6). The current study demonstrated that the traditional and new obtained simple and combined isokinetic indicators seem highly reliable to assess muscle strength and function in adult male athletes. A single testing session seems to be sufficiently to obtain these isokinetic strength indicators.

Skeletal maturity and oxygen uptake in youth soccer controlling for concurrent size descriptors

Interrelationships among skeletal maturity status, body size, ventilator thresholds (VT) and peak oxygen uptake (VO2peak) were considered in 47 adolescent male soccer players aged 12.5–15.4 years. Body mass, stature, and the triceps and subscapular skinfolds were measured. The latter were used to estimate fat mass and fat-free mass. Skeletal age was assessed with the Fels method. VO2peak and VO2 at the first (VT1) and second (VT2) ventilatory thresholds were determined during an incremental maximal exercise test on a motorized treadmill. Ratio standards and allometric models were used in the analysis. Scaling exponents suggested linearity for all combinations between size descriptors and physiological variables, except between log-transformed values of VT1 and body mass (mL·kg-0.801·min, 95%CI: 0.649 to 0.952). Early maturing players attained greater values than players classified as “on-time” in skeletal maturity for the three ventilatory parameters expressed in absolute terms (d ranged from 0.65 to 0.71). The differences were attenuated after normalizing for mass descriptors using ratio standards and scaled variables (d ranged from 0.00 to 0.31). The results suggested significant variability between maturity groups when moving from VT1 to maximal metabolic conditions expressed by unit of stature (VT1: t = -2.413, p = 0.02, d = 0.60; VT2: t = -2.488, p = 0.02, d = 0.65; VO2peak: t = -2.475, p = 0.02, d = 0.65). Skeletal maturity status and associated variation in overall body size affects VT1, VT2 and VO2peak. The observed scaling of ventilatory outputs for body size may be related to the better running economy and smaller body size of average maturing athletes.

RANDOMIZED STUDY OF THE ACUTE EFFECTS OF COCOA-RICH CHOCOLATE ON THE VASCULAR FUNCTION AND COGNITIVE PERFORMANCE OF YOUNG AND HEALTHY ADULTS

Objective: To evaluate the acute effects of cocoa-rich chocolate consumption on the vascular function and cognitive performance of healthy young adults. Design and method: A randomized study was conducted in 30 healthy participants aged 18 to 27 years. Half of the participants ingested a 20 g single dose of low cocoa chocolate (LCC:∼55%; 12,61 ± 1,35 mg equivalent of epichatequin/g) and the others ingested a single dose of 20 g of high cocoa chocolate (HCC:∼90%; 18,19 ± 2,64 mg equivalent of epichatequin/g). A baseline evaluation was performed after which the participants ingested the assigned chocolate, and two hours after a post-intervention evaluation was repeated. Each evaluation included heart ultrasonography, carotid-femoral pulse wave velocity (PWV) and carotid pulse wave analysis (PWA) with the Complior Analyse device, flow mediated slowing (FMS), cognitive testing and functional near-infra-red (fNIR) screening of the prefrontal cortex perfusion. Results: The baseline evaluation presented similar values within normal range in both groups. Memory scores were similar in both groups. A positive vascular effect was depicted in both groups, but was more distinct in the HCC group. A statistically significant decrease of brachial and central systolic and pulse pressures were observed, with greatest effect size in the HCC group. A trend for improvement in the AiX and the FMS was observed in the HCC group only. Improvement in the memory scores (speed and accuracy) was observed in both groups, with a larger improvement in the HCC group, and related with an improvement in the pre-frontal cortex perfusion as assessed with the fNIR method. Dilation of the proximal segment of the right and left coronary arteries, assessed with transthoracic echocardiography (Parasternal short axis - aortic valve level) was also found, with greatest effect size in the HCC group. Conclusions: Acute intake of cocoa-rich chocolate improves vascular function and cognitive performance in healthy young adults, by reducing central brachial artery pressures, promoting vascular dilation, and improving brain perfusion over the prefrontal cortex.

RANDOMIZED STUDY OF THE EFFECTS OF COCOA-RICH CHOCOLATE ON THE VASCULAR FUNCTION AND THE VENTRICLE-ARTERIAL COUPLING OF YOUNG AND HEALTHY ADULTS

Objective: The purpose of this study was to evaluate and explore the benefits of long-term dark chocolate intake in young healthy adults by measuring cardiovascular function. Design and method: A randomized study was conducted in 30 healthy participants aged 18 to 27 years. Half of the participants ingested a 20 g dose of low cocoa chocolate (LCC:∼55%; 12,61 ± 1,35 mg equivalent of epichatequin/g) and the others ingested a daily dose of 20 g of high cocoa chocolate (HCC:∼90%; 18,19 ± 2,64 mg equivalent of epichatequin/g). A baseline evaluation was performed before the participants started ingesting the assigned chocolate for a 30 days period, after which a final evaluation was performed. Each evaluation included heart ultrasonography, carotid-femoral pulse wave velocity (PWV) and carotid pulse wave analysis (PWA), flow mediated slowing (FMS) and an analysis of the ventricular-arterial coupling (VAC). Results: The baseline evaluation presented similar values within normal range in both groups. The positive vascular effects were overall more distinct in the group eating chocolate with the highest content in cocoa. No structural modifications on the heart were found after the intervention, notwithstanding cardiac function was improved on certain functional parameters in the HCC group only. A statistically significant improvement was depicted over the brachial and central systolic and pulse pressures in the HCC group, and a trend for improvement in the AiX and the FMS was also observed in the HCC but not in the LCC. The VAC parameters were similar at baseline between groups, but showed a significant improvement in the HCC group after intervention, increasing from 0.674 to 0.719 (p = 0.004), so that the post-intervention VAC was significantly higher in the HCC group compared with the LCC group (p < 0.05). In addition, significant variation was observed in both groups regarding arterial elastance, LV elastance, stroke work and potential energy, with greater mean differences identified in the HCC. Conclusions: This study shows that regular consumption of HCC has beneficial effects over the cardiovascular system in young and healthy adults, improving vascular function by reducing central brachial artery pressures, promoting vascular relaxation, and enhancing VAC.