Lifestyle and large arterial properties – insights from a Finnish and a Swiss Cohort Study

Nève, Gilles. Lifestyle and large arterial properties – insights from a Finnish and a Swiss Cohort Study. 2022, Doctoral Thesis, University of Basel, Faculty of Medicine.

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Official URL: https://edoc.unibas.ch/94293/

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In the last centuries, life expectancy in industrialized nations has doubled. Many people reach an advanced age, but the period of life in which a manifest cardiovascular disease has to be treated, is continuously lengthening. Vascular biomarkers and risk scores are used to determine cardiovascular risk. In recent years, however, there has been a shift toward measures of healthy lifestyle, which are more focused on determining health potential. However, the relationship between lifestyle, especially nutrition and physical activity, and the traditionally used biomarkers is still poorly understood.
This PhD project had several aims. The first one was to validate a visually aided dietary assessment tool (DAT). Second, this project aimed at comparing various lifestyle metrics, calculated as a cardiovascular health score, and their influence on the structure and function of large human arteries in both a healthy Swiss (aged 50+ years old) and Finnish (aged 55-74 years old) population. Third, the effects of a 4-year lifestyle-based intervention on carotid structure in the same Finnish population were analyzed, to determine if atherosclerotic progression could be slowed.
The DAT was validated against a weighed seven-day food record (7d-FR). Young (20-40 years old) and older (50-70 years old) adults were recruited. The DAT was compared to the 7d-FR for total energy intake, macronutrients, sugar, water, and portions of fruits and vegetables. The Finnish Dose-Responses to Exercise Training (DR’s EXTRA) study was a randomized-controlled trial lasting four years that consisted of six groups: aerobic exercise, resistance exercise, diet, aerobic exercise + diet, resistance exercise + diet, and reference. Carotid intima-media thickness (cIMT), and lumen diameter (cLD) were used as vascular biomarkers to quantify atherosclerotic progression during the intervention and were measured by transcutaneous ultrasound using state-of-the-art wall contour detection techniques.
In a cross-sectional approach of the DR’s EXTRA study, adherence to the American Heart Association’s “Life’s Simple 7” cardiovascular health score, consisting solely of modifiable lifestyle metrics, was compared with cIMT and cLD, as well as carotid distensibility. The Life’s Simple 7 score was divided into poor, intermediate, and ideal cardiovascular health.
The Swiss cross-sectional Cardiopulmonary Exercise Testing (COmPLETE) study included a healthy sample of the Swiss population. For this PhD project, only a sub-sample aged 50-91 years old was considered. The Life’s Simple 7 were also used to determine cardiovascular health and were compared to arterial properties, namely cIMT, cLD, carotid distensibility coefficient (DC), flow-mediated dilation (FMD), and brachial-ankle pulse wave velocity (baPWV).
DAT: 51 participants were included. Correlations between the DAT and the 7d-FR ranged from 0.288 (sugar, p<0.05) to 0.729 (water, p<0.01). The older group had higher correlations for all macronutrients, the highest correlation being for total energy intake at 0.799 (p<0.01). Both groups overestimated total calories in kcal (+14.0%), protein (+44.6%), fats (+36.3%), and portions of fruits and vegetables (+16.0%) but strongly underestimated sugar intake (-50.9%).
DR’s EXTRA intervention: 1132 participants had valid measurements at baseline and follow-up. Over all groups, we found no significant slowing of atherosclerotic progression (p<0.01). A sub-group analysis showed that only men who were given dietary goals did not show a significant cIMT increase during the intervention (p=0.23). Men in the diet group had significantly smaller cIMT progression than in the reference group (-0.078 mm, 95% CI: -0.146 to -0.009, p=0.02). No other group showed a slowed cIMT progression. None of the intervention groups significantly slowed cLD progression when compared to the reference group.
DR’s EXTRA cross-sectional: 1400 participants were included in the analyses. Those with an ideal cardiovascular health score had lower cLD than those with intermediate (-0.21 mm, 95% CI: -0.37 to -0.05 mm, p<0.01) and a poor score (-0.39 mm, 95% CI: -0.65 to -0.12 mm, p<0.01). Those with an ideal score also had higher carotid distensibility than those with an intermediate (0.0032 kPa-1, 95% CI: 0.009 to 0.0055 kPa-1, p<0.01) and a poor score (0.0018 1/kPa, 95% CI: 0.0005 to 0.0032 kPa-1, p<0.01). No differences were found for cIMT.
COmPLETE: The analyses comprised 280 healthy participants. None had a low Life’s Simple 7 cardiovascular health score. Those with an ideal score had lower cIMT (-0.038 mm, 95% CI: -0.069 mm to -0.007 mm, p<0.05, lower cLD (-0.28 mm, 95% CI: -0.46 mm to -0.11 mm, p<0.01), and lower baPWV (-0.05 m/s, 95% CI: -0.08 m/s to -0.02 m/s, p<0.01) than those with an intermediate health score.
The DAT is an adequate method for screening selected dietary habits and may be particularly useful in older populations.
In middle-aged to older Finns, the Life's Simple 7 was negatively associated with cLD and positively associated with carotid artery distensibility but not with cIMT. A healthy lifestyle, probably pursued decades before the study, seems to protect carotid artery structure and function in the general Finnish population.
A four-year lifestyle intervention did not slow atherosclerosis progression, except in a subgroup of men who were given dietary goals. Physical activity interventions based on international guidelines that were in effect during the study must therefore be questioned.
In a healthy sample of the Swiss population, those with a higher Life's Simple 7 score had better arterial properties. This shows that even in the healthiest individuals, a more favorable lifestyle is associated with better vascular health.
The Life's Simple 7 health score appears to be a practical method for assessing cardiovascular health, for which we were able to show that it is associated with traditional vascular biomarkers. In the middle-aged to older Finnish population studied, lifestyle-based interventions are not sufficient to slow the progression of atherosclerosis; other or more intensified approaches may be needed.
Advisors:Schmidt-Trucksäss, Arno
Committee Members:Hanssen, Henner and Tegtbr, Uwe
Faculties and Departments:03 Faculty of Medicine > Departement Sport, Bewegung und Gesundheit > Bereich Sport- und Bewegungsmedizin > Sportmedizin (Schmidt-Trucksäss)
UniBasel Contributors:Schmidt-Trucksäss, Arno and Hanssen, Henner
Item Type:Thesis
Thesis Subtype:Doctoral Thesis
Thesis no:14986
Thesis status:Complete
Number of Pages:xii, 112
Identification Number:
  • urn: urn:nbn:ch:bel-bau-diss149869
edoc DOI:
Last Modified:29 Apr 2023 04:30
Deposited On:28 Apr 2023 13:34

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