I. The Impact of Arterial Aging on the heart, brain, and health outcomes To elaborate on our, and others', previous findings of a strong role of arterial stiffness parameter, namely PWV, as a predictor of morbidity and mortality, we analyzed data of normotensive and untreated hypertensive community-dwelling subjects showing an early contribution of arterial wave reflection on myocardial diastolic dysfunction before the progression of hypertension (Canepa, AlGhatrif, et al., 2013). Projects aimed at examining the longitudinal impact of wave reflection on myocardial function and structure. At the other end, data from the BLSA have shown that individuals in the upper quintile of carotid intimal medial thickness, another age-associated trait, or bilateral carotid plaque were at greatest risk for dementia. These findings underscore the possibility that early intervention to retard arterial aging may help delay or prevent onset of dementia and AD (Wendell et al., 2012). We have also found that PWV is associated with increased inter-arm blood pressure difference, an independent risk factor for mortality (Canepa, Milaneschi, et al., 2013). II. A. Patterns and Determinants of the Longitudinal Changes in Arterial stiffness Analysis of the longitudinal data from the Baltimore Longitudinal Study on Aging (BLSA) revealed a non-linear, longitudinal increase in pulse wave velocity (PWV) with aging that is more pronounced in men (AlGhatrif et al., 2013). Analysis of longitudinal data from SardiNIA project showed similar results, but in addition it showed an interesting separation between the longitudinal trajectories of PWV and SBP in men with advancing age;this suggests that other age-related process, such as aortic dilatation, might blunt the effect of wall stiffening and cause the separation of PWV and SBP. To test the hypothesis that aortic dilatation contributes to the separation between PWV and SBP in men, preliminary analysis of data from BLSA confirmed the separation between SBP and PWV in older men, and showed greater rates of longitudinal aortic dilatation among men, which supports our hypothesis;the abstract was accepted for an oral presentation at the American Heart Association Scientific Sessions, 2013, Dallas, TX. To examine the underlying causes of the more pronounced aortic dilatation in older men, we performed an analysis of data from Taiwan project;interestingly, we have observed that the magnitude of pressure wave reflection was associated with larger aortic diameter in men but not in women, which might contribute to the greater aortic dilatation in men with aging;this manuscript is in preparation for submission and the abstract was accepted for an oral presentation at the North American Artery Society meeting, 2013. These interesting findings support our working hypothesis of major role of age-associated process that is independent from other traditional cardiovascular risk factors. B. Genetic and Environmental Underpinnings of Accelerated Cardiovascular Aging -Genetic determinates: Earlier results from the SardiNIA study have revealed a potential role of the Col4A1 gene (Tarasov 2009) and a second genetic element located in a desert region of the genome (Mitchell 2012), findings which have been confirmed in replication studies and larger Consortia-based analysis. Work is in progress to examine genetic determinants of the longitudinal change in PWV. -Environmental determinants: Except for blood pressure, we found a minimal role of traditional cardiovascular risk factors in the progression of arterial stiffness(AlGhatrif et al., 2013). We have previously shown a role of non-traditional CV risk factors such as Vitamin D deficiency in arterial stiffness (Giallauria 2011). Projects examining the role of low-grade inflammation in arterial stiffness using data from the BLSA and the SardiNIA projects are in progress. As far as cardiac funciton, Results from the BLSA have shown that visceral, rather than subcutaneous fat, is associated with worse myocardial diastolic dysfunction (M Canepa, Strait, et al., 2013. In addition, the VALIDATE study, which will assess the factors leading to unhealthy vascular aging as measured by PWV, intimal medial thickness, coronary calcium scoring, among other tests, is currently in final stages of completing the follow-up visit. Another project has been started aiming to assess age-associated changes in regional adiposity and novel cardiovascular risk factors such as coronary endothelial function and myocardial triglyceride content using magnetic resonance imaging. C. Interventions to Retard Arterial Aging Resveratrol, a natural compound in grapes and red wine with antioxidant and anti-inflammatory properties, has been associated with improved health and prolonged lifespan in mice. There is evidence that acute and chronic use of resveratrol is associated with improved endothelial dysfunction. A Phase 1 and 2 double-blind randomized study is in progress aiming to examine the effect of resveratrol on PWV in 90 overweight /obese subjects beyond the age of 50.

National Institute of Health (NIH)
National Institute on Aging (NIA)
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Scuteri, Angelo; Morrell, Christopher H; Orru', Marco et al. (2016) Gender specific profiles of white coat and masked hypertension impacts on arterial structure and function in the SardiNIA study. Int J Cardiol 217:92-8
AlGhatrif, Majd; Lakatta, Edward G (2015) The conundrum of arterial stiffness, elevated blood pressure, and aging. Curr Hypertens Rep 17:12
Canepa, Marco; AlGhatrif, Majd (2015) From Arterial Stiffness to Heart Failure: Still a Long Way to Go. J Am Heart Assoc 4:
Canepa, Marco; Malti, Omar; David, Melissa et al. (2014) Prevalence, clinical correlates, and functional impact of subaortic ventricular septal bulge (from the Baltimore Longitudinal Study of Aging). Am J Cardiol 114:796-802
Scuteri, Angelo; Morrell, Christopher H; Orrù, Marco et al. (2014) Longitudinal perspective on the conundrum of central arterial stiffness, blood pressure, and aging. Hypertension 64:1219-27
Canepa, Marco; Ameri, Pietro; AlGhatrif, Majd et al. (2014) Role of bone mineral density in the inverse relationship between body size and aortic calcification: results from the Baltimore Longitudinal Study of Aging. Atherosclerosis 235:169-75
Canepa, Marco; AlGhatrif, Majd; Pestelli, Gabriele et al. (2014) Impact of central obesity on the estimation of carotid-femoral pulse wave velocity. Am J Hypertens 27:1209-17
Cheng, Hao-Min; Chuang, Shao-Yuan; Sung, Shih-Hsien et al. (2013) Derivation and validation of diagnostic thresholds for central blood pressure measurements based on long-term cardiovascular risks. J Am Coll Cardiol 62:1780-7
Marine, Joseph E; Shetty, Veena; Chow, Grant V et al. (2013) Prevalence and prognostic significance of exercise-induced nonsustained ventricular tachycardia in asymptomatic volunteers: BLSA (Baltimore Longitudinal Study of Aging). J Am Coll Cardiol 62:595-600
Canepa, M; Strait, J B; Milaneschi, Y et al. (2013) The relationship between visceral adiposity and left ventricular diastolic function: Results from the Baltimore Longitudinal Study of Aging. Nutr Metab Cardiovasc Dis :

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