Case Report: Supernormal Vascular Aging in Leningrad Siege Survivors

Age-related changes in the vascular system play an important role in the biological age and lifespan of a person and maybe affected from an early age onward. One of the indicators of changes in the vascular system is arterial wall stiffness and its main measure, i.e., carotid-femoral pulse wave velocity (cfPWV). We examined arterial wall stiffness in a sample of 305 Leningrad Siege survivors to assess how hunger and stressful conditions during fetal development and early childhood affected the state of the cardiovascular system at a later age and what factors may neutralize the negative impact sustained in early childhood. Here, we presented an evaluation of two unique patients with supernormal vascular aging (SUPERNOVA) phenotype from this cohort and described the details of congruence between hereditary resistance and practiced lifestyle yielding slower biological aging rate.


Phenotyping information
Anthropometry was performed on both visits: measurement of height and body weight with the calculation of body mass index (BMI) according to the Quetelet formula, measurement of waist circumference. Blood pressure (BP) and pulse rate were measured using the OMRON device (Japan) on the right hand after 5 minutes of rest in a sitting position three times with the calculation of the average value of the last two measurements. After obtaining the mean values of systolic and diastolic blood pressure (SBP and DBP), pulse pressure (PP) was calculated as the difference between SBP and DBP.
A fasting blood sample was taken with the determination of the lipid profile (total cholesterol, high density lipoproteins, low density lipoproteins, triglycerides), glucose level. At the second visit the creatinine level was additionally determined with the calculation of the glomerular filtration rate (GFR) according to the CKD-EPI formula. The morning urine sample was collected to determine the concentration of albumin and creatinine, followed by the calculation of the albumin-creatinine ratio. The analysis of blood and urine parameters was performed on an Abbot Architect c8000 biochemical analyzer (USA).
At both visits electrocardiogram (ECG) was registered using PADSY computerized complex ("Medset Medizintechnik GmbH", Germany), interpretation was carried out according to a standard protocol. At the first visit the following was performed: -carotid ultrasonography: assessment of the morphology of the carotid arteries, detection of signs of atherosclerotic damage and calculation of TIM (thickness of intimamedia). We used a Vivid 7 (Samsung, Korea (General Electric, USA), 7 MHz highresolution transducer.
-echocardiography. The study was carried out on a Vivid 7 (GE, USA), a 3.25 MHz transducer in M-modal, two-dimensional and Doppler modes in standard echocardiographic positions along the short and long axes.At the second visit, the cardioankle vascular index (CAVI) and ankle-brachial index (ABI) were determined on the right and left using the VaSera VS-1500 device (FukudaDenshi, Japan).
At both visits, the carotid-femoral pulse wave velocity (PWV) was assessed using a SphygmoCor device (AtCor, Australia) by applanation tonometry. Reference PWV values by age group were taken from the paper "The Reference Values for Arterial Stiffness Collaboration", based on data from a large European study 1 . For people over 60 years of age, the following PWV indicators (median, 10th and 90th percentiles): 60-69 years -9.7 (7.9-13.1) and -70 years -10.6 (8.0-14.6). Based on these values, we conditionally isolated the phenotype (or phenomenon) of supernormal vascular aging (SUPERNOVA) -the PWV value less than the 10th percentile for this age group.
Cognitive functioning was assessed by the Mini Mental State Examination (MMSE) -a brief (11 tasks) quantitative screening measure of cognitive status in adults 2,3 . The cut-off point for cognitive impairment was 26 points and lower.
Anxiety and depression were assessed using a Russian validated version of the Hospital Anxiety and Depression Scale (HADS) 4 . Cut-offs for increased level of anxiety and depression were 8 points and higher.
Two general instruments for assessing health-related quality of life were used: EQ-5D (3-level version) and 36-Item Short Form Survey (SF-36). The sense of meaningfulness and purpose in life was assessed by the Purpose in Life Orientation Test (PLO) 5 . The short version (K-22) of the Social Support Questionnaire F-SozU (Fragebogen zur Sozialen Unterstützung) was used to assess perceived functional social support.