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The impact of age on endothelial dysfunction measured by peripheral arterial tonometry in a healthy population-based cohort – The Malmö Offspring Study

Jujic, Amra LU ; Kennbäck, Cecilia LU ; Johansson, Madeleine LU orcid ; Nilsson, P. M. LU and Holm, H. LU (2023) In Blood Pressure 32(1). p.1-7
Abstract
Background/Aims

The reactive hyperaemia index (RHI) assesses endothelial function, with a proposed cut-off of <1.67 for prevalent endothelial dysfunction (ED). However, uncertainties remain about whether this cut-off is age-dependent and applicable in healthy individuals. We aimed to explore ED in relation to age within a large population-based cohort of young to middle-aged, healthy individuals.

Methods

Within the Malmö Offspring Study, a total of 1812 subjects (50.9% women, mean age 48 ± 11 years) were included. Post-occlusion/pre-occlusion ratio of the pulsatile signal amplitudes... (More)

Background/Aims

The reactive hyperaemia index (RHI) assesses endothelial function, with a proposed cut-off of <1.67 for prevalent endothelial dysfunction (ED). However, uncertainties remain about whether this cut-off is age-dependent and applicable in healthy individuals. We aimed to explore ED in relation to age within a large population-based cohort of young to middle-aged, healthy individuals.

Methods

Within the Malmö Offspring Study, a total of 1812 subjects (50.9% women, mean age 48 ± 11 years) were included. Post-occlusion/pre-occlusion ratio of the pulsatile signal amplitudes in the non-dominant upper arm was used to calculate RHI by EndoPat®. ED was defined as RHI < 1.67. Multivariable regression models were used to explore associations between ED and age.

Results

Prevalent ED was found in 534 (29.5%) participants. In subjects aged ≤30 years, ED was present in 47.4% compared to 27.6% in subjects ≥30 years (p < 0.001). In multivariable logistic regression analyses, ED was associated with younger age (p < 0.001), higher BMI (p < 0.001) and current smoking (p < 0.001). No sex differences were observed.

Conclusion

In a large healthy population, RHI < 1.67, an early marker of endothelial dysfunction, was more prevalent in younger individuals, implying that RHI might not be a suitable measure of endothelial function in individuals under 30 years of age. Our findings suggest that low RHI in young, healthy individuals may not necessarily indicate true ED but rather an artefact of the limited ability of young and healthy arteries to dilate post-occlusion. Therefore, the term "pseudo-ED" may be applicable to young individuals with low RHI values.

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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Endothelial dysfunction, Reactive hyperemia, population studies
in
Blood Pressure
volume
32
issue
1
pages
1 - 7
publisher
Taylor & Francis
external identifiers
  • pmid:37438962
  • scopus:85164542190
ISSN
0803-7051
DOI
10.1080/08037051.2023.2234059
language
English
LU publication?
yes
id
337cd66b-d193-49c3-8151-3664c3d2d1fb
date added to LUP
2023-07-13 10:49:17
date last changed
2023-07-27 04:05:32
@article{337cd66b-d193-49c3-8151-3664c3d2d1fb,
  abstract     = {{Background/Aims<p style="box-sizing: border-box; margin: 0.5em 0px; word-break: break-word;">The reactive hyperaemia index (RHI) assesses endothelial function, with a proposed cut-off of &lt;1.67 for prevalent endothelial dysfunction (ED). However, uncertainties remain about whether this cut-off is age-dependent and applicable in healthy individuals. We aimed to explore ED in relation to age within a large population-based cohort of young to middle-aged, healthy individuals.</p>Methods<p style="box-sizing: border-box; margin: 0.5em 0px; word-break: break-word;">Within the Malmö Offspring Study, a total of 1812 subjects (50.9% women, mean age 48 ± 11 years) were included. Post-occlusion/pre-occlusion ratio of the pulsatile signal amplitudes in the non-dominant upper arm was used to calculate RHI by EndoPat®. ED was defined as RHI &lt; 1.67. Multivariable regression models were used to explore associations between ED and age.</p>Results<p style="box-sizing: border-box; margin: 0.5em 0px; word-break: break-word;">Prevalent ED was found in 534 (29.5%) participants. In subjects aged ≤30 years, ED was present in 47.4% compared to 27.6% in subjects ≥30 years (<i style="box-sizing: border-box;">p</i> &lt; 0.001). In multivariable logistic regression analyses, ED was associated with younger age (<i style="box-sizing: border-box;">p</i> &lt; 0.001), higher BMI (<i style="box-sizing: border-box;">p</i> &lt; 0.001) and current smoking (<i style="box-sizing: border-box;">p</i> &lt; 0.001). No sex differences were observed.</p>Conclusion<p style="box-sizing: border-box; margin: 0.5em 0px; word-break: break-word;">In a large healthy population, RHI &lt; 1.67, an early marker of endothelial dysfunction, was more prevalent in younger individuals, implying that RHI might not be a suitable measure of endothelial function in individuals under 30 years of age. Our findings suggest that low RHI in young, healthy individuals may not necessarily indicate true ED but rather an artefact of the limited ability of young and healthy arteries to dilate post-occlusion. Therefore, the term "pseudo-ED" may be applicable to young individuals with low RHI values.</p>}},
  author       = {{Jujic, Amra and Kennbäck, Cecilia and Johansson, Madeleine and Nilsson, P. M. and Holm, H.}},
  issn         = {{0803-7051}},
  keywords     = {{Endothelial dysfunction; Reactive hyperemia; population studies}},
  language     = {{eng}},
  number       = {{1}},
  pages        = {{1--7}},
  publisher    = {{Taylor & Francis}},
  series       = {{Blood Pressure}},
  title        = {{The impact of age on endothelial dysfunction measured by peripheral arterial tonometry in a healthy population-based cohort – The Malmö Offspring Study}},
  url          = {{http://dx.doi.org/10.1080/08037051.2023.2234059}},
  doi          = {{10.1080/08037051.2023.2234059}},
  volume       = {{32}},
  year         = {{2023}},
}