Background: Although sodium glucose co-transporter 2 (SGLT2) inhibition has been proven to have preventive and therapeutic effects on heart failure, its clinical effect on arterial stiffness remains controversial. Herein, we sought to assess the effect of add-on empagliflozin treatment on arterial stiffness, assessed as brachial-ankle pulse wave velocity (baPWV), in patients with type 2 diabetes (T2D) and cardiovascular disease (CVD).

Methods and Results: This was a prespecified secondary analysis of the effect of empagliflozin on endothelial function in cardiovascular high risk diabetes mellitus: multi-center placebo-controlled double-blind randomized (EMBLEM) trial (UMIN000024502), which was designed primarily to evaluate the effect of empagliflozin, relative to placebo, on endothelial function in patients with T2D and CVD. The present analysis compared the changes in baPWV from baseline to week 24 between empagliflozin (10 mg once daily, n = 13) and placebo (n = 13) groups. Absolute change from baseline to week 24 in baPWV was 54.9 ± 123.9 cm/s in the empagliflozin group and 43.7 ± 166.4 cm/s in the placebo group (mean group difference, 11.2 cm/s [95% confidence interval, -108.1 to 130.5], P = 0.848).

Conclusions: Add-on empagliflozin treatment did not affect baPWV in EMBLEM trial participants.

Trial registration: University Medical Information Network Clinical Trial Registry, number 000024502

Background: Perivascular adipose tissue (PVAT) releases factors that regulate vascular tone (adipocyte-derived factors (ADFs) ). Mitogen-activated protein kinases (MAPKs) in blood vessels have been implicated in the development of hypertension. This study aimed to determine whether MAPKs are involved in impaired ADF-induced relaxation in hypertension.

Methods and Results: Aortic rings of Wistar Kyoto (WKY) rats and spontaneously hypertensive rats (SHRs) with or without PVAT (+PVAT rings and −PVAT rings, respectively) were placed in an organ bath filled with 5 ml of physiological salt solution (PSS). In the aortic rings of SHRs, 5-hydroxytryptamine (5-HT) -induced contraction of the −PVAT ring was increased compared with that in WKY rats. The 5-HT-induced contraction decreased in WKY rats and SHRs when PVAT was retained (+PVAT ring). After contraction with 5-HT (10^−6.5−10^−5.5 M), PSS (2 ml) was removed from the other chambers. The PSS from the +PVAT rings of WKY rats slowly relaxed the −PVAT rings; however, the PSS from the −PVAT rings of WKY rats did not. The PSS collected from the chamber with the +PVAT ring failed to relax the pre-constructed −PVAT rings of the SHR. After pretreatment of the −PVAT rings of SHR with PD98052 (20 μM: MAPK/ERK Kinase (MEK) inhibitor), the PSS from the +PVAT rings relaxed to similar degrees as in WKY rats (WKY 44%±4%, SHR −15%±8%; P<0.001 vs WKY, SHR+PD98052 45%±7%).

Conclusion: PVAT releases ADFs; however, the aorta from SHR resists relaxation with ADFs. The impairment of ADF-induced relaxation and hyperconstriction by 5-HT can be mediated by MAPKs, potentially contributing to the pathogenesis of hypertension.

Background: Sleep apnea is an independent risk factor for motor vehicle accidents. We investigated the prevalence of sleep-disordered breathing (SDB) among commercial motor vehicle drivers in a transport company.

Methods: Among 355 drivers in a transport company, 345 commercial motor vehicle drivers (mean age: 47.0±8.8 years, range: 21-71 years) underwent unattended out-of-center sleep testing using a type IV portable sleep monitor between September 2019 and November 2019.

Results: The prevalence of oxygen desaturation index 3% (ODI3) score ≥15 was 17.7%. The prevalence of moderate-to-severe SDB, defined as respiratory event index (REI) score ≥15, was 31.9%. The prevalence of Epworth Sleepiness Scale (ESS) score ≥11 was 15.3%. There was no significant correlation between the ESS score and ODI3 (ρ=−0.05, P=0.40) or REI (ρ=−0.03, P=0.65) score. Multivariate analysis revealed that age (odds ratio [OR]: 1.05, 95% confidence interval [CI]: 1.02-1.09, P=0.002), body mass index (OR: 1.14, 95% CI: 1.05-1.23, P<0.001), and daily alcohol intake (OR: 1.98, 95% CI: 1.10-3.55, P=0.02) were significantly associated with moderate-to-severe SDB in drivers. The ESS score was not significantly associated with moderate-to-severe SDB (OR: 0.98, 95% CI: 0.93-1.05, P=0.70).

Conclusions: Objective screening tests for sleep apnea such as unattended out-of-center sleep testing may be necessary to improve the health and safety of commercial motor vehicle drivers, especially middle-aged obese male drivers having daily alcohol intake.

Background: Venous thromboembolism (VTE) is a general term used to describe deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE). Since VTE is known to occur frequently in hospitalized patients, this study aimed to clarify the incidence and risk of VTE during hospitalization. Subjects and Methods: We calculated the incidence of VTE among adult patients admitted to Shimane University Hospital within 1 year. The inclusion criteria were cases where VTE was diagnosed after admission, and clinical treatment was considered necessary. Results: The number of patients with hospitalization-related VTE was 55 (0.41%) out of 13534, including eight (0.06%) patients with PTE. VTE occurred in patients older than 40 years, and 42 (76.4%) of the included patients were ≥ 65 years old. The incidence rate in women (0.53%) was higher than that in men (0.29%). According to the clinical department, the incidence rates were 2.53% in orthopedics, 1.55% in the department for collagen disease, and 1.39% in advanced trauma centers. When classified by disease, arthritis/arthropathy accounted for 6.40%, followed by 2.01% of traumatic fractures, and the number of affected patients with cancer was 18 (32.7%). Twenty-eight (50.9%) patients developed VTE within 10 days of admission. However, the aggravation risk factors could not be determined. Conclusion: The incidence of hospitalization-related VTE cases in the elderly is higher. In the present study, one-third of the observed VTE cases occurred in patients with cancer, while arthritis/arthropathy or traumatic fractures were often observed in other cases. Therefore, there is a need to continually assess VTE risks to prevent or treat VTE at an early stage.