Age-Dependent Decline in Common Femoral Artery Flow-Mediated Dilation and Wall Shear Stress in Healthy Subjects

Q: What are the key findings of this study?

Age independently predicted a decline in femoral artery FMD of 0.36% per decade, which was lower overall than brachial artery FMD.

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Healthy non-smoking adults evaluated for lower extremity vascular health and age-related endothelial function (n=70). Intervention: Age and common femoral artery flow-mediated dilation (FA-FMD with calf occlusion) vs. Brachial artery flow-mediated dilation (BA-FMD with forearm occlusion). Primary outcome: Common femoral artery flow-mediated dilation (FA-FMD) vs brachial artery flow-mediated dilation (BA-FMD) and age-dependent decline (MD -0.5%, p=0.030).

Q: What does this research mean for the field?

Common femoral artery flow-mediated dilation independently declines with age by approximately 0.36% per decade in healthy adults, exhibiting an age-dependent decline similar to that of the brachial artery. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Mariam Bapir; Gavrielle R. Untracht; Julie Hunt; John H. McVey; Jenny Harris; Simon S. Skene; Paola Campagnolo; Νικόλαος Δικαίος; Ana Rodriguez‐Mateos; David D. Sampson; Danuta M. Sampson; Christian Heiß

doi:10.3390/life12122023

December 4, 2022LifeOpen Access

Age-Dependent Decline in Common Femoral Artery Flow-Mediated Dilation and Wall Shear Stress in Healthy Subjects

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Key result

Aging is linked to an absolute ~0.4% decline in femoral artery FMD per decade.

MD -0.5%
P=0.030
n=70

Figures

Why the study?

Femoral artery endothelial function is a promising biomarker of lower extremity vascular health, but the impact of age on femoral artery endothelial function had not been reported in healthy adults.

Does common femoral artery flow-mediated dilation (FA-FMD) decline with age to a similar degree as brachial artery FMD (BA-FMD) in healthy non-smoking adults?

Key Points

To evaluate the reproducibility and acceptability of femoral artery flow-mediated dilation and determine the effect of aging on femoral endothelial function and wall shear stress in healthy adults.
Assessed protocol reproducibility and participant discomfort during femoral and brachial artery flow-mediated dilation (FMD) with thigh and calf occlusion cuffs (n = 20).
Conducted cross-sectional ultrasound measurements of femoral artery and brachial artery FMD with calf occlusion in 50 healthy non-smokers aged 22−76 years.
Femoral artery FMD with calf occlusion was significantly lower than brachial artery FMD (6.0 ± 1.1% vs 6.4 ± 1.3%, p = 0.030).
Multivariate regression identified age as an independent predictor of femoral artery FMD (−0.4%/decade, R2 = 0.35, p = 0.002), exhibiting an age-dependent decline comparable to the brachial artery (p interaction locationxage = 0.388).
Among participants older than 40 years, 40% showed baseline femoral artery wall shear stress values below 5 dyne/cm2, a threshold recognized as pro-atherogenic.

Study Design

Type

Cross-Sectional (n=70)

Multicenter

No

Structured PICO

Does common femoral artery flow-mediated dilation (FA-FMD) decline with age to a similar degree as brachial artery FMD (BA-FMD) in healthy non-smoking adults?

P

Population

70 healthy non-smoking adults (n=20 across two reproducibility studies and n=50 aged 22-76 years in the main cross-sectional study) with BMI 20-30 kg/m2 and free of cardiovascular disease or diabetes at a single UK center.

E

Exposure

Ageing / Ultrasound-based common femoral artery flow-mediated dilation (FA-FMD) measured using a 5-minute distal occlusion (200 mmHg cuff around the mid-thigh or proximal calf) after an overnight fast

C

Comparator

Brachial artery flow-mediated dilation (BA-FMD) measured in the same participants using a 5-minute distal forearm occlusion (200 mmHg cuff)

O

Outcome

Age-dependent change in common femoral artery flow-mediated dilation (FA-FMD, defined as maximum relative diastolic diameter increase during post-occlusive reactive hyperaemia) and comparison with brachial artery FMD (BA-FMD)surrogate

Main Result

Mean Difference: -0.5

Absolute Event Rate: 6% vs 6.4%

p-value: p=0.030

In healthy adults, femoral artery endothelial function (FA-FMD) can be reproducibly measured with calf occlusion and declines with age at a rate similar to the brachial artery (-0.36%/decade), while age-related femoral enlargement frequently reduces wall shear stress to pro-atherogenic levels (<5 dyne/cm2 in 40% of adults >40 years), helping explain age-related predisposition to PAD.

Limitations

Lipids, glucose, and cardiovascular family history were not determined, so some participants may have had undiagnosed dyslipidaemia, insulin resistance, or familial risk.
The FMD method only captures a single time point and is time-consuming.
FMD requires high-quality ultrasound equipment, specialized analysis software, and trained staff.
The cost-effectiveness of FMD measurements is unknown.
Lipids, glucose, and cardiovascular family history were not measured, leaving the possibility of subclinical dyslipidaemia, insulin resistance, or familial risk
FMD only captures a single time point and is time-consuming
FMD requires high-quality ultrasound equipment, analysis software, and trained staff
Cost-effectiveness of FMD measurements is unknown

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Implication

FA-FMD declines with age similarly to BA-FMD; leaves open its added prognostic value for PAD beyond BA-FMD in prospective cohorts.

Abstract

Femoral artery (FA) endothelial function is a promising biomarker of lower extremity vascular health for peripheral artery disease (PAD) prevention and treatment; however, the impact of age on FA endothelial function has not been reported in healthy adults. Therefore, we evaluated the reproducibility and acceptability of flow-mediated dilation (FMD) in the FA and brachial artery (BA) (n = 20) and performed cross-sectional FA- and BA-FMD measurements in healthy non-smokers aged 22−76 years (n = 50). FMD protocols demonstrated similar good reproducibility. Leg occlusion was deemed more uncomfortable than arm occlusion; thigh occlusion was less tolerated than forearm and calf occlusion. FA-FMD with calf occlusion was lower than BA-FMD (6.0 ± 1.1% vs 6.4 ± 1.3%, p = 0.030). Multivariate linear regression analysis indicated that age (−0.4%/decade) was a significant independent predictor of FA-FMD (R2 = 0.35, p = 0.002). The age-dependent decline in FMD did not significantly differ between FA and BA (pinteraction agexlocation = 0.388). In older participants, 40% of baseline FA wall shear stress (WSS) values were <5 dyne/cm2, which is regarded as pro-atherogenic. In conclusion, endothelial function declines similarly with age in the FA and the BA in healthy adults. The age-dependent FA enlargement results in a critical decrease in WSS that may explain part of the age-dependent predisposition for PAD.

Discussion

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Cite This Study

Bapir et al. (2022) conducted a cross-sectional in Healthy non-smoking adults evaluated for lower extremity vascular health and age-related endothelial function (n=70). Age and common femoral artery flow-mediated dilation (FA-FMD with calf occlusion) vs. Brachial artery flow-mediated dilation (BA-FMD with forearm occlusion) was evaluated on Common femoral artery flow-mediated dilation (FA-FMD) vs brachial artery flow-mediated dilation (BA-FMD) and age-dependent decline (MD -0.5%, p=0.030). Age independently predicted a decline in femoral artery FMD of 0.36% per decade, which was lower overall than brachial artery FMD.

synapsesocial.com/papers/6a8c17ae634d203318b21afc https://doi.org/10.3390/life12122023

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Age-Dependent Decline in Common Femoral Artery Flow-Mediated Dilation and Wall Shear Stress in Healthy Subjects

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Age-Dependent Decline in Common Femoral Artery Flow-Mediated Dilation and Wall Shear Stress in Healthy Subjects

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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