Takuo Iizuka

Diagnosis of Macrovascular Complications in Diabetes Mellitus Using Arterial Stiffness Measured by the Cardio-Ankle Vascular Index

Arterial anti-aging treatment is important, but there had not been a good marker of arterial aging. One candidate of the markers was arterial stiffness. But, it has been difficult to measure proper arterial stiffness in vivo, noninvasively. Pulse wave velocity (PWV) which was reflecting arterial stiffness, was used for last 30 years, but was inherently changed at the blood pressure at measuring time. The cardio-ankle vascular index (CAVI) was recently developed marker reflecting arterial stiffness of the arterial tree from the origin of the aorta to the ankle. The conspicuous feature of CAVI is independency from the blood pressure at measuring time. CAVI increased with aging both in males than in females. So, CAVI could be a good marker reflecting arterial aging. Furthermore, CAVI showed high value in most of those with various risks of coronary artery disease, and especially high in those with diabetes mellitus and even with prediabetes condition. Diabetes mellitus is kwon to be a strong factor for arterial aging. Recently, many studies showed that CAVI was improved by some of various diabetic treatments, indicating that CAVI might be an indicator of the treatment for diabetic angiopathy. Those also suggested that CAVI could be an indicator of various strategies especially controlling diabetes mellitus, in preventing, delaying vascular aging.

Frequency of coronary artery stenosis in patients with asymptomatic familial hypercholesterolemia and its association with carotid intimal thickness and cardio-ankle vascular index [Corrigendum]

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PS 02-09 Effect of nicorandil administration on arterial stiffness monitored with the cardio-ankle vascular index (CAVI) after coronary intervention

Objective: Nicorandil improves coronary arterial dysfunction and improves clinical outcome in patients with ischemic heart disease. But, the precise mechanism was not fully clarified. Cardio-ankle vascular index (CAVI) represents arterial stiffness of the aorta, femoral artery and tibial artery as a whole, and its feature is independency from blood pressure at measuring time. Then, the effect of intravenous nicorandil on arterial stiffness monitored with CAVI, were studied after percutaneous coronary intervention (PCI) in patients with stable angina pectoris (SAP). Design and Method: Study subjects were 45 consecutive patients with SAP underwent successful PCI. Patients were randomized to the control (n = 15), or nicorandil group (n = 30). In the nicorandil group, nicorandil was administrated over 12 hours after PCI (2 or 4 mg/h). CAVI was measured just after PCI and after administration of nicorandil (every 10 minutes for first 30 minutes, 60 minutes, and over 12 hours later). At the same time, stroke volume was measured using electrical bio-impedance method (Aesculon), and various circulation factors were calculated. Results: CAVI was significantly decrease in nicorandil group (9.90 ± 1.00 to 8.68 ± 1.10, p < 0.05), whereas there were no significantly change in control group (9.71 ± 1.22 to 9.39 ± 1.37, p = 0.30). Systolic blood pressure (sBP) and systemic vascular resistance index (SVRI) were significantly decrease only in nicorandil group (sBP; 146.8 ± 15.2 to 118.9 ± 13.7 mmHg, p < 0.05, SVRI; 3725.5 ± 1076.7 to 2632.8 ± 765.9 dyne sec cm−5, p < 0.05). Cardiac index (CI) increased in nicorandil, but not significant (2.31 ± 0.63 to 2.55 ± 0.60 l/min/m2, p = 0.13). CAVI during nicorandol administration significantly correlated with each factors (vs SBP, r = 0.37, vs SVRI, r = 0.29, vs CI, r = -0.21, p < 0.05 in each). Conclusions: In this study, intravenous administration of nicorandil decrease the arterial stiffness monitored with CAVI, indicating that nicorandil decreased an afterload after successful PCI. Improvement of clinical outcome in patients with ischemic heart disease by nicorandil might be due to a decrease of afterload in addition to improvement of coronary arterial dysfunction.