Arterial stiffness is a potential mechanism and promising indicator of orthostatic hypotension in the general population

VASA ◽  
2014 ◽  
Vol 43 (6) ◽  
pp. 423-432 ◽  
Author(s):  
Qingtao Meng ◽  
Si Wang ◽  
Yong Wang ◽  
Shixi Wan ◽  
Kai Liu ◽  
...  
Keyword(s):  
General Population ◽  
Arterial Stiffness ◽  
Orthostatic Hypotension ◽  
Operating Characteristic ◽  
Pulse Wave ◽  
Augmentation Index ◽  
Multiple Logistic Regression Analysis ◽  
The Elderly ◽  
Baroreceptor Sensitivity ◽  
Roc Curve Analysis

Background: Orthostatic hypotension (OH) is a disease prevalent among middle-aged men and the elderly. The association between arterial stiffness and OH is unclear. This study evaluates whether arterial stiffness is correlated with OH and tests the usefulness of brachial-ankle pulse wave velocity (baPWV), an arterial stiffness marker, with regard to identifying OH. Patients and methods: A sample of 1,010 participants was recruited from the general population (64.8 ± 7.7 years; 426 men) who attended health check-ups. BaPWV and the radial augmentation index (rAI) were both assessed as the arterial stiffness markers, and OH was determined using blood pressure (BP) measured in the supine position, as well as 30 seconds and 2 minutes after standing. Results: The prevalence of OH in this population was 4.9 %. Compared with the non-OH group, both baPWV (20.5 ± 4.5 vs 17.3 ± 3.7, p < 0.001) and rAI (88.1 ± 10.8 vs 84.2 ± 10.7, p < 0.05) were significantly higher in the OH group. In the multiple logistic regression analysis, baPWV (OR, 1.3; 95 % CI, 1.106–1.528; p < 0.05) remained associated with OH. Moreover, the degree of orthostatic BP reduction was related to arterial stiffness. In addition, increases in arterial stiffness predicted decreases in the degree of heart rate (HR) elevation. Finally, a receiver operating characteristic (ROC) curve analysis showed that baPWV was useful in discriminating OH (AUC, 0.721; p < 0.001), with the cut-off value of 18.58 m/s (sensitivity, 0.714; specificity, 0.686). Conclusions: Arterial stiffness determined via baPWV, rather than rAI, was significantly correlated with the attenuation of the orthostatic hemodynamic response and the resultant OH. The impaired baroreceptor sensitivity might be the mechanism. In addition, baPWV appears to be a relatively sensitive and reliable indicator of OH in routine clinical practice.

Abstract 10245: Arterial Stiffness, Central Pulsatile Hemodynamic Load and Orthostatic Hypotension: A Cross-sectional Survey of Community Residents in Chengdu

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Kai Liu ◽  
Xiaoping Chen ◽  
Si Wang ◽  
Shixi Wan ◽  
Yufei Zhou ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Arterial Stiffness ◽  
Systolic Blood Pressure ◽  
Orthostatic Hypotension ◽  
Multiple Logistic Regression Analysis ◽  
The Elderly ◽  
Discriminatory Power ◽  
Receiver Operating Curve ◽  
Cross Sectional Survey ◽  
Central Systolic Blood Pressure

Introduction: Orthostatic hypotension (OH) is an independent risk factor for cardiovascular morbidity and often unrecognized in the elderly. The association between measures of central pulsatile hemodynamic load or arterial stiffness with OH is unclear. This study evaluated the usefulness of these indexes to identify OH. Hypothesis: We hypothesize that direct measures of central pulsatile hemodynamic load (e.g. central systolic blood pressure) and arterial stiffness (pulse wave velocity) both associated with OH. And Measures of central pulsatile hemodynamic load may represent a better indicator of OH. Methods: A sample of 1099 participants was recruited from the general population who attended health check-ups. Questionnaire, physical examination and laboratory tests were performance by a standard protocol. To assess the correlation between central hemodynamic indexes and the probability of OH, multiple logistic regression analysis was used to estimate the odds ratio in different models, and the discriminatory power of hemodynamic indexes for OH was assessed by the area under the receiver operating curve (ROC). Results: The prevalence of OH in this population was 5.6 %. Compared with those without OH, OH subjects had a higher age, SBP in sitting position, BP in supine position, brachial-ankle PWV (BaPWV) and central systolic blood pressure (CSBP) (all P<0.05). After adjusting for potential confounders, both CSBP (OR=1.039, 95%CI: 1.016-1.062, P=0.001) and BaPWV (OR=1.259, 95%CI: 1.130-1.402, P< 0.001) were significantly positive correlated with OH. However, in subgroup analysis, CSBP (OR=1.017, 95%CI: 0.985-1.050, P=0.310) was insignificantly associated with OH in non hypertension subgroup. In addition, BaPWV seemed to be a better discriminatory power than CSBP in both two subgroups (BaPWVAUC-CSBPAUC =0.127, 95%CI: 0.020-0.233, P=0.02 in non hypertension group; BaPWVAUC-CSBPAUC =0.118, 95%CI: -0.030-0.267, P=0.117 in hypertension group). Conclusion: BaPWV appears to be a better indicator of OH in the elderly. If a patient’s BaPWV is greater than 18m/s, Clinicians should better to carry out supine to standing blood pressures measurement in routine clinical practice.

Markers of arterial stiffness in peripheral arterial disease

VASA ◽  
2015 ◽  
Vol 44 (5) ◽  
pp. 341-348 ◽  
Author(s):  
Marc Husmann ◽  
Vincenzo Jacomella ◽  
Christoph Thalhammer ◽  
Beatrice R. Amann-Vesti
Keyword(s):  
Arterial Stiffness ◽  
Peripheral Arterial Disease ◽  
Pulse Wave ◽  
Augmentation Index ◽  
Arterial Disease ◽  
Care Physician ◽  
Additional Information ◽  
Non Invasive ◽  
Assessment Techniques ◽  
Peripheral Arterial

Abstract. Increased arterial stiffness results from reduced elasticity of the arterial wall and is an independent predictor for cardiovascular risk. The gold standard for assessment of arterial stiffness is the carotid-femoral pulse wave velocity. Other parameters such as central aortic pulse pressure and aortic augmentation index are indirect, surrogate markers of arterial stiffness, but provide additional information on the characteristics of wave reflection. Peripheral arterial disease (PAD) is characterised by its association with systolic hypertension, increased arterial stiffness, disturbed wave reflexion and prognosis depending on ankle-brachial pressure index. This review summarises the physiology of pulse wave propagation and reflection and its changes due to aging and atherosclerosis. We discuss different non-invasive assessment techniques and highlight the importance of the understanding of arterial pulse wave analysis for each vascular specialist and primary care physician alike in the context of PAD.

scholarly journals Association of changes of pulse wave velocity and augmentation index after isometric handgrip exercise with coronary lesion extent and revascularization

2021 ◽  
Vol 27 (1) ◽  
Author(s):  
Seong Taeg Kim ◽  
Yeekyoung Ko ◽  
Jong-Wook Beom ◽  
Ki Yung Boo ◽  
Jae-Geun Lee ◽  
...  
Keyword(s):  
Arterial Stiffness ◽  
Pulse Wave Velocity ◽  
Iliac Artery ◽  
Pulse Wave ◽  
Augmentation Index ◽  
Coronary Revascularization ◽  
External Iliac Artery ◽  
Handgrip Exercise ◽  
Isometric Handgrip ◽  
Isometric Handgrip Exercise

Abstract Background Arterial stiffness is associated with myocardial ischemia and incident coronary artery disease (CAD), and indexes of arterial stiffness are usually increased in patients with CAD. However, these indexes are often increased in elderly without CAD. Arterial stiffness in patients with CAD may become more evident after isometric handgrip exercise which increases systolic pressure and ventricular afterload. We investigated the association of the change of stiffness indexes after isometric handgrip exercise with the lesion extent of CAD and the necessity for coronary revascularization. Methods Patients who were scheduled a routine coronary angiography via a femoral artery were enrolled. Arterial waveforms were traced at aortic root and external iliac artery using coronary catheters at baseline and 3 min after handgrip exercise. Augmentation index (AIx) was measured on the recorded aortic pressure waveform, and pulse wave velocity (PWV) was calculated using the ECG-gated time difference of the upstroke of arterial waveforms and distance between aortic root and external iliac artery. Results Total 37 patients were evaluated. Both PWV and AIx increased after handgrip exercise. ΔPWV was significantly correlated with ΔAIx (r = 0.344, P = 0.037). Patients were divided into higher and lower ΔPWV or ΔAIx groups based on the median values of 0.4 m/sec and 3.3%, respectively. Patients with higher PWV had more 2- or 3-vessel CAD (69% vs. 27%, P = 0.034), and underwent percutaneous coronary intervention (PCI) more frequently (84% vs. 50%, P = 0.038), but higher ΔAIx was not associated with either the lesion extent or PCI. Area under curve (AUC) of ΔPWV in association with PCI by C-statistics was 0.70 (95% confidence interval [CI] 0.51–0.88; P = 0.056). In multiple logistic regression analysis, ΔPWV was significantly associated with PCI (odds ratio 7.78; 95% CI 1.26–48.02; P = 0.027). Conclusions Higher ΔPWV after isometric handgrip exercise was associated with the lesion extent of CAD and the necessity for coronary revascularization, but higher ΔAIx was not.

scholarly journals Prognostic Value of Aortic Pulse Wave Velocity as Index of Arterial Stiffness in the General Population

Circulation ◽  
2006 ◽  
Vol 113 (5) ◽  
pp. 664-670 ◽  
Author(s):  
Tine Willum Hansen ◽  
Jan A. Staessen ◽  
Christian Torp-Pedersen ◽  
Susanne Rasmussen ◽  
Lutgarde Thijs ◽  
...  
Keyword(s):  
General Population ◽  
Arterial Stiffness ◽  
Pulse Wave Velocity ◽  
Wave Velocity ◽  
Prognostic Value ◽  
Pulse Wave ◽  
Aortic Pulse Wave Velocity

Arterial stiffness could reflect increased cardiac load and reduced pulmonary function in the general population

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Murai ◽  
T Sugiura ◽  
Y Dohi ◽  
H Takase ◽  
T Mizoguchi ◽  
...  
Keyword(s):  
Regression Analysis ◽  
General Population ◽  
Arterial Stiffness ◽  
Pulmonary Function ◽  
Multivariate Regression ◽  
Troponin I ◽  
Augmentation Index ◽  
Smoking Status ◽  
Multivariate Regression Analysis ◽  
The Other

Abstract Background Pulmonary function is known to decrease with age and reduced pulmonary function has been reported to be associated with all-cause mortality and cardiovascular death. The association between pulmonary impairment and atherosclerosis was reported previously but has not been investigated sufficiently in the general population. Purpose We hypothesized that arterial stiffness could reflect increase of cardiac load and reduced pulmonary function. The present study aimed to investigate whether increased cardiac load and reduced pulmonary function could affect arterial stiffness in the general population. Methods Subjects undergoing their health check-up were enrolled. Plasma B-type natriuretic peptide (BNP) levels and serum high-sensitivity cardiac troponin I (hs-cTnI) levels were measured to evaluate cardiac load and myocardial damage. Radial augmentation index (rAI) was measured to investigate arterial stiffness using HEM-9000AI device. Subjects with an ST-T segment abnormality on the electrocardiogram, renal insufficiency, cancer, active inflammatory disease, or a history of cardiovascular events and pulmonary disease were excluded. Pulmonary function was assessed using spirometry by calculating forced vital capacity (FVC) as a percentage of predicted value (FVC%-predicted), forced expiratory volume in 1 second (FEV1) as a percentage of predicted value (FEV1%-predicted), and the ratio of FEV1 to FVC (FEV1/FVC). Results A total of 1100 subjects aged 57 years were enrolled and their median values of BNP and hs-cTnI were 15.5 and 2.3 pg/ml. The levels of rAI were significantly associated with the levels of BNP after adjustment for possible confounders in multivariate regression analysis, but were not with the levels of hs-TnI. While the parameters of pulmonary function were inversely associated with the levels of rAI and hs-cTnI after adjustment for possible confounders in the multivariate regression analysis, but not with the levels of BNP. The other multivariate regression analyses where BNP, hs-cTnI, parameters of pulmonary function, and the other possible factors were simultaneously included as independent variables revealed that the BNP levels and the FVC%-predicted or FEV1%-predicted, besides age, gender, smoking status, body mass index, blood pressure, heart rate, creatinine, fasting plasma glucose, and triglyceride, were significantly associated with the levels of rAI. Conclusions The significant associations of rAI with BNP and pulmonary function were revealed in the general population. These findings support that arterial stiffness could reflect increased cardiac load and reduced pulmonary function, in apparently healthy individuals. Funding Acknowledgement Type of funding source: None

scholarly journals Evaluation of Arterial Stiffness Using Pulse Wave Velocity and Augmentation Index in Patients with Chronic Venous Insufficiency

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Mustafa Dogdus ◽  
Onur Akhan ◽  
Mehmet Ozyasar ◽  
Ahmet Yilmaz ◽  
Mehmet Sait Altintas
Keyword(s):  
Arterial Stiffness ◽  
Pulse Wave Velocity ◽  
Wave Velocity ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Pulse Wave ◽  
Augmentation Index ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
High Morbidity

Background and Objectives. Chronic venous insufficiency (CVI) is a common pathology of the circulatory system and is associated with a high morbidity for the patients and causes high costs for the healthcare systems. Arterial stiffness has been shown to be a predictor of cardiovascular events and mortality. The relationship between CVI and arterial stiffness using pulse wave velocity (PWV) and augmentation index (Aix) was evaluated in this study. Methods. Sixty-two patients with the stage of C3-C5 chronic venous disease (CVD) and 48 healthy subjects were enrolled in the study. To assess arterial stiffness, all cases were evaluated with I.E.M. Mobil-O-Graph brand ambulatory blood pressure monitor device. PWV and Aix were used to assess arterial stiffness in this study. Results. The mean age was 61.9±11.05 years and 54 % of the patient population was females. PWV and Aix were significantly higher in CVI patients than controls (8.92±1.65 vs. 8.03±1.43, p=0.001; 25.51±8.14 vs. 20.15±9.49, p=0.003, respectively) and also positive linear correlation was observed between CVI and all measured arterial stiffness parameters (r=0.675 for CVI and PWV, r=0.659 for CVI and Aix, respectively). A PWV value of > 9.2 has 88.9 % sensitivity and 71.4 % specificity to predict the presence of CVI. Conclusions. PWV and Aix are the most commonly used, easy, reproducible, reliable methods in the clinic to assess arterial stiffness. Logistic regression analysis showed that PWV and Aix were the independent predictors of CVI. PWV has the sensitivity of 88.9 % and specificity of 71.4 % to detect the presence of CVI.

scholarly journals Effects of pacing modality on noninvasive assessment of heart rate dependency of indices of large artery function

2016 ◽  
Vol 121 (3) ◽  
pp. 771-780 ◽  
Author(s):  
Isabella Tan ◽  
Hosen Kiat ◽  
Edward Barin ◽  
Mark Butlin ◽  
Alberto P. Avolio
Keyword(s):  
Heart Rate ◽  
Arterial Stiffness ◽  
Pulse Pressure ◽  
Wave Reflection ◽  
Pulse Wave ◽  
Augmentation Index ◽  
Large Artery ◽  
Rate Dependency ◽  
Wave Reflections

Studies investigating the relationship between heart rate (HR) and arterial stiffness or wave reflections have commonly induced HR changes through in situ cardiac pacing. Although pacing produces consistent HR changes, hemodynamics can be different with different pacing modalities. Whether the differences affect the HR relationship with arterial stiffness or wave reflections is unknown. In the present study, 48 subjects [mean age, 78 ± 10 (SD), 9 women] with in situ cardiac pacemakers were paced at 60, 70, 80, 90, and 100 beats per min under atrial, atrioventricular, or ventricular pacing. At each paced HR, brachial cuff-based pulse wave analysis was used to determine central hemodynamic parameters, including ejection duration (ED) and augmentation index (AIx). Wave separation analysis was used to determine wave reflection magnitude (RM) and reflection index (RI). Arterial stiffness was assessed by carotid-femoral pulse wave velocity (cfPWV). Pacing modality was found to have significant effects on the HR relationship with ED ( P = 0.01), central aortic pulse pressure ( P = 0.01), augmentation pressure ( P < 0.0001), and magnitudes of both forward and reflected waves ( P = 0.05 and P = 0.003, respectively), but not cfPWV ( P = 0.57) or AIx ( P = 0.38). However, at a fixed HR, significant differences in pulse pressure amplification ( P < 0.001), AIx ( P < 0.0001), RM ( P = 0.03), and RI ( P = 0.03) were observed with different pacing modalities. These results demonstrate that although the HR relationships with arterial stiffness and systolic loading as measured by cfPWV and AIx were unaffected by pacing modality, it should still be taken into account for studies in which mixed pacing modalities are present, in particular, for wave reflection studies.

Volume status and arterial blood pressures are associated with arterial stiffness in hemodialysis patients

2018 ◽  
Vol 41 (7) ◽  
pp. 378-384 ◽  
Author(s):  
Alper Erdan ◽  
Abdullah Ozkok ◽  
Nadir Alpay ◽  
Vakur Akkaya ◽  
Alaattin Yildiz
Keyword(s):  
Blood Pressure ◽  
Arterial Stiffness ◽  
Pulse Wave Velocity ◽  
Wave Velocity ◽  
Pulse Pressure ◽  
Pulse Wave ◽  
Augmentation Index ◽  
Mean Blood Pressure ◽  
Aortic Blood ◽  
Aortic Blood Pressure

Background: Arterial stiffness is a strong predictor of mortality in hemodialysis patients. In this study, we aimed to investigate possible relations of arterial stiffness with volume status determined by bioimpedance analysis and aortic blood pressure parameters. Also, effects of a single hemodialysis session on these parameters were studied. Methods: A total of 75 hemodialysis patients (M/F: 43/32; mean age: 53 ± 17) were enrolled. Carotid-femoral pulse wave velocity, augmentation index, and aortic pulse pressure were measured by applanation tonometry before and after hemodialysis. Extracellular fluid and total body fluid volumes were determined by bioimpedance analysis. Results: Carotid-femoral pulse wave velocity (9.30 ± 3.30 vs 7.59 ± 2.66 m/s, p < 0.001), augmentation index (24.52 ± 9.42 vs 20.28 ± 10.19, p < 0.001), and aortic pulse pressure (38 ± 14 vs 29 ± 8 mmHg, p < 0.001) significantly decreased after hemodialysis. Pre-dialysis carotid-femoral pulse wave velocity was associated with age (r2 = 0.15, p = 0.01), total cholesterol (r2 = 0.06, p = 0.02), peripheral mean blood pressure (r2 = 0.10, p = 0.005), aortic-mean blood pressure (r2 = 0.06, p = 0.02), aortic pulse pressure (r2 = 0.14, p = 0.001), and extracellular fluid/total body fluid (r2 = 0.30, p < 0.0001). Pre-dialysis augmentation index was associated with total cholesterol (r2 = 0.06, p = 0,02), aortic-mean blood pressure (r2 = 0.16, p < 0.001), and aortic pulse pressure (r2 = 0.22, p < 0.001). Δcarotid-femoral pulse wave velocity was associated with Δaortic-mean blood pressure (r2 = 0.06, p = 0.02) and inversely correlated with baseline carotid-femoral pulse wave velocity (r2 = 0.29, p < 0.001). Pre-dialysis Δaugmentation index was significantly associated with Δaortic-mean blood pressure (r2 = 0.09, p = 0.009) and Δaortic pulse pressure (r2 = 0.06, p = 0.03) and inversely associated with baseline augmentation index (r2 = 0.14, p = 0.001). In multiple linear regression analysis (adjusted R2 = 0.46, p < 0.001) to determine the factors predicting Log carotid-femoral pulse wave velocity, extracellular fluid/total body fluid and peripheral mean blood pressure significantly predicted Log carotid-femoral pulse wave velocity (p = 0.001 and p = 0.006, respectively). Conclusion: Carotid-femoral pulse wave velocity, augmentation index, and aortic pulse pressure significantly decreased after hemodialysis. Arterial stiffness was associated with both peripheral and aortic blood pressure. Furthermore, reduction in arterial stiffness parameters was related to reduction in aortic blood pressure. Pre-dialysis carotid-femoral pulse wave velocity was associated with volume status determined by bioimpedance analysis. Volume control may improve not only the aortic blood pressure measurements but also arterial stiffness in hemodialysis patients.

Abstract 17389: The Role of Arterial Stiffness in Mediating the Association Between Grip Strength and Cardiovascular Events: The Korean Genome and Epidemiology Study

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Cheol Ung Choi ◽  
Woohyeun Kim ◽  
Chol Shin ◽  
Jong-il Choi ◽  
Seong Hwan Kim ◽  
...  
Keyword(s):  
Arterial Stiffness ◽  
Pulse Wave Velocity ◽  
Grip Strength ◽  
Wave Velocity ◽  
Cardiovascular Events ◽  
Pulse Wave ◽  
Augmentation Index ◽  
Epidemiology Study ◽  
Intima Medial Thickness ◽  
Carotid Intima Medial Thickness

Introduction: Grip strength has been associated with cardiovascular events. However, there have been no exact mechanisms explaining the association between grip strength and cardiovascular events. Hypothesis: The aim of this study was to assess whether arterial stiffness or endothelial function could mediate the association between grip strength and cardiovascular events. Methods: We studied 1508 participants (Age; 60 ± 7, Men; 47.5 %) from the Ansan cohort of the Korean Genome Epidemiology Study. Participants were assessed for grip strength, measured using a Jamar dynamometer. The central blood pressure, the augmentation index, and the pulse wave velocity were evaluated by using an applanation tonometer. Intima medial thickness was measured by B-mode ultrasonogram with a 7.5 MHz linear array transducer. Results: With increasing the grip strength, augmentation index decreased (r= -0.445, p<0.001). Pulse wave velocity (r= -0.044, p=0.109) and carotid intima medial thickness (r= -0.004, p=0.881) had no significant correlation with grip strength. Conclusions: Grip strength was inversely correlated with augmentation index. This result suggests that systemic arterial stiffness could mediate the association between grip strength and cardiovascular events.

scholarly journals Effect of Second hand Smoke on Arterial Stiffness among Healthy Women

2019 ◽  
Vol 18 (2) ◽  
pp. 340-346
Author(s):  
Suriyati Sariban ◽  
Siti Suhaila Mohd Yusoff ◽  
Juwita Shaaban ◽  
Norhayati Mohd Noor ◽  
Harmy Mohamed Yusoff
Keyword(s):  
Arterial Stiffness ◽  
Pulse Wave Velocity ◽  
Cigarette Smoke ◽  
Wave Velocity ◽  
Pulse Wave ◽  
Augmentation Index ◽  
Pulse Wave Analysis ◽  
Second Hand Smoke ◽  
Wave Analysis ◽  
The Mean

Introduction: Arterial stiffness is recognised as a significant cardiovascular risk factor and an independent predictor of all causes of cardiovascular death. Women are the largest population exposed to cigarette smoke either at work or from their partner. The objectives of this study are to compare the arterial stiffness (augmentation index and pulse wave velocity) between second hand smoke (SHS) and non second hand smoke (non-SHS). Designs and method: Comparative cross-sectional study was conducted among 118 healthy female subjects (64 SHS and 54 non- SHS). The women were in the SHS group if their spouse is a smoker and they had an exposure to cigarette smoke for at least three years, minimum of15 minutes two days a week. Pulse wave analysis and pulse wave velocity was used to study the arterial stiffness. Pulse wave analysis reported as percentage of augmentation index. Pulse wave velocity equal to carotid femoral distance (meter) divided by time (second) Results: The mean augmentation index (AIx) for SHS groups was 17.9 (SD7.06) and for non SHS groups was 20.7(SD6.11). The mean of Pulse wave velocity was 8.94 (SD1.36) in SHS groups and 9.02 (SD8.68) in non SHS groups. ANOVA and ANCOVA shown significance difference in crude mean (p = 0.047) and estimated marginal mean (p = 0.028) of augmentation index between SHS and non - SHS after controlling for age and BMI. However, there was no significant difference in crude mean (p = 0.795) and estimated marginal mean (p = 0.716) pulse wave velocity between SHS and non - SHS after controlling for age and BMI. Conclusion: An increase in augmentation index amongst non SHS in this study most probably due to exposure to environmental tobacco at work compared to exposure to spouse’s smoke Bangladesh Journal of Medical Science Vol.18(2) 2019 p.340-346

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