Guillermo Adrián Alanis Sánchez

Vieillissement vasculaire et santé cardiovasculaire dans la population : atteinte myocardique subclinique, hypertension et réponse tensionnelle à l'effort: Le vieillissement vasculaire (VA) est un phénomène multidimensionnel reflétant des altérations structurelles et fonctionnelles de la paroi artérielle, reconnu comme prédicteur des maladies cardiovasculaires (MCV). Les études antérieures se sont concentrées sur des marqueurs isolés. L'objectif de cette thèse était d'examiner l'association entre différents profils de VA et trois issues liées aux MCV : la troponine I cardiaque ultrasensible (cTnI), l'hypertension artérielle, et la réponse tensionnelle à l'exercice sous-maximal. À partir de dix biomarqueurs carotidiens mesurés dans l'étude prospective parisienne PPS3 (n=10 157 ; âge moyen 59 ans ; 39% de femmes), un clustering a identifié trois profils : vieillissement vasculaire sain (HVA ; 43,6%), artériosclérose (ART ; 25,1%) et athérosclérose (ATH ; 27,3 %) Dans l'étude 1, ART et ATH étaient liés à des concentrations plus élevées de cTnI, particulièrement marquées pour ATH (OR 2,66 ; IC 95% 2,18-3,23 pour le 5e vs le 1er quintile). Dans l'étude 2, comparés à HVA, ART (aOR 3,94 ; IC 95% 3,50-4,45) et ATH (aOR 2,69 ; IC 95% 2,38-3,04) étaient fortement associés à l'hypertension prévalente. Parmi 5,310 sujets normotensifs, ART (OR 1,34 ; IC 95% 1,08-1,65) et ATH (OR 1,70 ; IC 95% 1,40-2,07) prédisaient l'incidence de l'hypertension après dix ans de suivi. Dans l'étude 3, ART et ATH étaient associés à des réponses tensionnelles anormales (exagérées ou hypotensives) à un effort submaximal. Leur combinaison avec une réponse anormale doublait le risque d'événements cardiovasculaires majeurs après douze ans. Ces résultats confirment le rôle du VA dans l'atteinte myocardique subclinique, l'hypertension, et la réponse tensionnelle à l'effort, et soulignent son intérêt potentiel pour la détection précoce et la prévention cardiovasculaire.

The present study provides the first demonstration that VAC is impaired in humans with SCI, which may further contribute to the poor exercise tolerance often observed in this population. Our findings in the SCI-A group imply that chronic exposure to exercise increases VAC, suggesting that adherence to a long-term exercise program may optimize ventricular-vascular interaction postinjury.

Loss to follow-up (LTFU) remains a major challenge in achieving sustained HIV care. Understanding individual and structural factors influencing disengagement is essential to improve retention, particularly in low- and middle-income settings. This study aimed to identify predictors of LTFU among adults receiving antiretroviral therapy (ART) in western Mexico. A case-control study was conducted among adults with HIV treated at a tertiary hospital. Cases met the national definition of LTFU (≥ 90 days beyond the expected clinic visit or pharmacy refill), while controls were retained patients during the same period. A total of 919 participants were included (148 LTFU, 771 retained). Multivariable logistic regression identified factors associated with LTFU. Median age was 42 years (IQR 34, 51) and 88% were male. The multivariable analysis identified that age was associated with lower risk of LTFU (adjusted odds ratio [aOR] per year, 0.94; 95% CI, 0.91-0.96). Secondary ART resistance (aOR, 4.03; 95% CI, 1.59-9.99), hard-drug use (aOR, 2.57; 95% CI, 1.68-3.93), psychiatric disorders (aOR, 3.58; 95% CI, 2.23-5.72), lower educational level (≥ upper secondary vs. no formal education/primary: aOR, 2.30; 95% CI, 1.34-3.94), emergency department visits (aOR, 2.63; 95% CI, 1.72-4.04), and years living with HIV (aOR per year, 1.06; 95% CI, 1.02-1.10) were associated with higher odds of LTFU. These findings highlight the role of psychosocial and structural determinants of LTFU, underscoring the need for integrated interventions addressing education, mental health, and substance use to improve retention in HIV care in Mexico.

Background: We examined the association between clusters of vascular aging manifestations and ultrasensitivity cardiac troponin I in individuals without cardiovascular disease. Methods and Results: A cross‐sectional analysis was conducted using baseline data from PPS‐3 (Paris Prospective Study III), a French cohort of 10 157 participants. Cardiac troponin I was measured with an ultrasensitive immunoassay with a limit of detection of 0.013 pg/mL. Vascular aging manifestations were assessed via echotracking of the right common carotid artery to measure structural and functional parameters. Hierarchical clustering was used to identify clusters of vascular aging. Multinomial regression assessed the association between vascular aging clusters and cardiac troponin I quintiles. The study included 8722 cardiovascular disease–free participants (mean±SD age, 59.5±6.3 years; 39% women). Three vascular aging clusters were identified. Cluster 1 (n=4158; 47.4%) was characterized as healthy vascular aging with the lowest arteriosclerosis and atherosclerosis indices; cluster 2 (n=2237; 25.5%) was characterized by the highest arteriosclerosis indices, including increased pulse wave velocity, β index, and Young elastic modulus and lowest distensibility coefficient; and cluster 3 (n=2377; 27.0%) was characterized by the highest atherosclerosis indices, including more frequent plaque prevalence and greater intima‐media thickness. Compared with healthy vascular aging, arteriosclerosis and atherosclerosis clusters showed a graded positive association with cardiac troponin I quintiles, independent of traditional risk factors. The adjusted odds ratio for belonging to the highest quintile (quintile 5 versus quintile 1) was 1.55 (95% CI, 1.31–1.92) for arteriosclerosis and 2.66 (95% CI, 2.18–3.23) for atherosclerosis clusters. Conclusions: Vascular aging manifestations of arteriosclerosis and atherosclerosis may partly explain the release of troponin I into the bloodstream in adults without clinical cardiovascular disease. Registration: URL: https://clinicaltrials.gov ; Unique identifier: NCT00741728.

Background: Human immunodeficiency virus (HIV) infection is associated with a greater risk of cardiovascular disease (CVD). HIV infection causes a chronic inflammatory state and increases oxidative stress which can cause endothelial dysfunction and arterial stiffness. Aortic stiffness measured by carotid femoral-pulse wave velocity (cfPWV) and central hemodynamics are independent cardiovascular risk factors and have the prognostic ability for CVD. We assessed cfPWV and central hemodynamics in young individuals with recent HIV infection diagnosis and without antiretroviral therapy. We hypothesized that individuals living with HIV would present greater cfPWV and central hemodynamics (central systolic blood pressure and pulse pressure) compared to uninfected controls. Methods: We recruited 51 treatment-naïve individuals living with HIV (HIV(+)) without previous CVD and 51 age- and sex-matched controls (HIV negative (−)). We evaluated traditional CVD risk factors including metabolic profile, blood pressure (BP), smoking, HIV viral load, and CD4⁺ T-cells count. Arterial stiffness and central hemodynamics were evaluated by cfPWV, central systolic BP, and central pulse pressure (cPP) via applanation tonometry. Results: HIV(+) individuals presented a greater prevalence of smoking, reduced high-density lipoprotein cholesterol, and body mass index. 65.9% of HIV(+) individuals exhibited lymphocyte CD4⁺ T-cells count < 500 cells/μL. There was no difference in brachial or central BP between groups; however, HIV(+) individuals showed significantly lower cPP. We observed a greater cfPWV (mean difference = 0.5 m/s; p < 0.01) in HIV(+) compared to controls, even after adjusting for heart rate, mean arterial pressure and smoking. Conclusion: In the early stages of infection, non-treated HIV individuals present a greater prevalence of traditional CVD risk factors, arterial stiffness, and normal or in some cases central hemodynamics.

Background: Human immunodeficiency virus (HIV) infection is associated with a greater risk of cardiovascular disease (CVD). HIV infection causes a chronic inflammatory state and increases oxidative stress which can cause endothelial dysfunction and arterial stiffness. Aortic stiffness measured by carotid femoral-pulse wave velocity (cfPWV) and central hemodynamics are independent cardiovascular risk factors and have the prognostic ability for CVD. We assessed cfPWV and central hemodynamics in young individuals with recent HIV infection diagnosis and without antiretroviral therapy. We hypothesized that individuals living with HIV would present greater cfPWV and central hemodynamics (central systolic blood pressure and pulse pressure) compared to uninfected controls.Methods. We recruited 51 treatment-naïve individuals living with HIV (HIV(+)) without previous CVD and 51 age- and sex-matched controls (HIV negative (-)). We evaluated traditional CVD risk factors including metabolic profile, blood pressure (BP), smoking, HIV viral load, and CD4⁺ T-cells count. Arterial stiffness and central hemodynamics were evaluated by cfPWV, central systolic BP, and central pulse pressure (cPP) via applanation tonometry.Results. HIV(+) individuals presented a greater prevalence of smoking, reduced high-density lipoprotein cholesterol, and body mass index. 65.9% of HIV(+) individuals exhibited lymphocyte CD4⁺ T-cells count greater cfPWV (mean difference= 0.5 m/s; pConclusion: In the early stages of infection, non-treated HIV individuals present a greater prevalence of traditional CVD risk factors, arterial stiffness, and normal or in some cases central hemodynamics.

The aim of this study was to determine the accuracy of the Omron HEM-7320-LA with Intelli Wrap technology cuff HEM-FL1 for self-measurement and clinic blood pressure (BP) measurement according to the European Society of Hypertension International Protocol revision 2010. The evaluation was performed in 39 individuals. The mean age of the participants was 47.9±14 years; systolic BP was 145.2±24.3 mmHg (range: 97–190), diastolic BP was 90.9±12.9 mmHg (range: 68–120), and arm circumference was 30.8±4 cm (range: 25–38.5). The device successfully fulfilled the established criteria of the validation protocol. The device overestimated systolic BP by 0.6±5.7 mmHg and diastolic BP by 2.2±5.1 mmHg. The specially designed cuff HEM-FL1 to cover a broad range of arm circumferences and self-placement fulfilled the requirements of the International Protocol.

To evaluate the relationship between carotid stiffness parameters and the pulmonary function test in patients with Systemic Sclerosis (SSc) and pulmonary hypertension (PH). We evaluated carotid arterial stiffness by carotid pulse wave velocity (PWV), intima-media thickness, carotid distensibility coefficient and carotid distension by echotracking (MyLabOne Esaote, NH). Distensibility was calibrated with central pulse pressure obtained by carotid tonometry. We assessed pulmonary function by forced vital capacity (FVC), forced expiratory volume in one second (FEV1), diffusing capacity for carbon monoxide (DLCO) and total lung capacity (TLC). Distribution of data was evaluated, and Spearman's correlation coefficient was used as the measure of association. We evaluated forty-nine patients with SSc. 93.9% were females, 12% were ex-smokers and 8.2% hypertensive. Pulmonary hypertension was present in 25 patients (51%) and Raynaud's phenomenon in 36 (73.5%). The mean time of evolution was 3.3 ± 3.5 years. Among the arterial stiffness parameters carotid PWV correlated with FVC (rho = −.606, p= 0.04), distension with FVC (rho= .699, p= 0.01) and DLCO (rho= .721, p = 0.01). As well as, IMT with FVC (rho = −.520, p = < 0.01) and DLCO (rho = −.447, p = 0.02). In Table 1 we show the correlation with the remaining parameters of pulmonary function. Carotid PWV and IMT were negatively associated with only FVC and DLCO in patients with PH and SSC. On the other hand, distension was positively correlated. These parameters reflect the arterial involvement in the interstitial lung disease and pulmonary vascular disease commonly seen in these patients.

Objective: The aim of this study is to evaluate the central blood pressure values in a healthy Mexican sample.Design and method: We included 617 healthy individuals without risks factors of 1047 gathered in our centre. Ages ranged from 18 to 78 years. We used the HEM9000AI non-invasive tonometric device on radial artery to obtain central and peripheral parameters in the same assessment. Due to important age and sex interaction, we divided the groups by decades and gender. We report medians, 95% confidence intervals (CI),Pearson's correlation coefficient and Student's T test. Results: The average height, weight and body mass index (BMI) in males were 175 cm; 77.3 kg and 25.1 and for women was 161.6 cm, 63.5 kg and 24.2, respectively. cSBP values in females and males were the following: < 30 years (94, 96 mmHg); 30–39 years (104, 107 mmHg); 40–49 years (107, 112 mmHg); 50–59 years (114, 115 mmHg); > 60 years (113, 117 mmHg). Similarly to cSBP, central pulse pressure (cPP) values (not shown) had a constant increase correlating with age (r = 0.559, p < 0.001). We found similar mean cSBP values between women and men 103.32 vs 103.36 mmHg respectively (p = 0.973). (Table 1) Conclusions: Assessing reference values in healthy population sample is the first step to establishing normal values for a particular population. Central hemodynamic values have been assessed mostly in European and Asian populations. Due to the high prevalence of cardiovascular mortality in Mexico, it is very important to stablish these cut-off values. We need a larger sample to generalize this to the general Mexican population.