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PYUR Global Why Aortic Pulse Wave velocity Is An Excellent Diagnostic Indicator Dr. Howard W. Fisher Anti-Aging Medicine Researcher

Whether you realize it or not, disease is 90-95% is dependent upon your environment.1 Science has now reached the point where indicators have been developed that will lead us to the point of deciding upon protocols, primarily nutritional based with some moderate activity levels maintained that can allow us to optimize a disease free longer life. There is a science to wellness.

Seventeen million people died from CVD in 2011, which represents approximately 30 % of the global deaths, and approximately 23 million by 2030, to remain the single leading cause of death.2 3

“The great incidence of CVDs in the world spurred the search for new solutions to enable an early detection of pathological processes, to monitor the vital signals continuously, and to provide a more precise diagnosis based in multi-parameters assessment.4 An accurate assessment of the CV system changes and the identification of risk factors is of utmost importance to avoid hospitalization and to reduce CVD morbidity and mortality rates. The early detection based in multi-parameters of pathological condition is the key to the patient survival.”5 6

Cardiovascular (CV) diseases are still the number one cause of death and most people do not realize that there is an early warning system available.7 In most cases,

1Anand P, Kunnumakara A B, Sundaram C, Harikumar K B, Tharakan S T, Lai O S, Sung B, Aggarwal B B. Cancer is a Preventable Disease that Requires Major Lifestyle Changes. Pharm Res. 2008 September; 25(9): p.2097–2116. 2 Alwan A, editor. Global status report on noncommunicable diseases. Geneva: World Health Organization; 2010. 3 Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Medicine. 2006;3:e442. doi: 10.1371/journal.pmed.0030442. 4 Bitton A, Gaziano T. The Framingham heart study’s impact on global risk. Progress in Cardiovascular Diseases. 2010;53:68–78. 5 Pereira T, Correia C, Cardoso J. Novel Methods for Pulse Wave Velocity Measurement. J Med Biol Eng. 2015;35(5):555-565. 6 Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren M, Albus C, Benlian P, Boysen G, Cifkova R, Deaton C, Ebrahim S, Fisher M, Germano G, Hobbs R, Hoes A, Karadeniz S, Mezzani A, Prescott E, Ryden L, Scherer M. European guidelines on cardiovascular disease prevention in clinical practice (version 2012) European Heart Journal. 2012;33:1635–1701 7 Blacher J, Asmar R, Djane S, London GM, Safar ME.. Aortic pulse wave velocity as a marker of cardiovascular risk in hypertensive patients. Hypertension. 1999;33:1111-1117.

nutritional protocols may be instituted to change the risk factors and the onset of these disorders as well. If we are aware of the status of large artery damage by an early evaluation in the general context of CV risk factors, we will be able to take advantage of the situation. “CV risk evaluation systems are based on clinical judgment and traditional vital signals measurement, including heart rate, respiratory rate, blood pressure (BP), temperature and pulse oximetry,8 and clearly these protocols have not been effective enough.

Several methods have been proposed to analyze the structure and function of large arteries.9 One of the most non-invasive methods of evaluating arteries, pulse wave velocity (PWV) measurement, is used as an index of large artery elasticity and stiffness.10 11 This method is easy to use, accurate, and reproducible, and thus can easily be applied for the evaluation of CV risk and to evaluate the status of central arteries. Further, algorithms have been devised to convert these values into an internal age designation because at a given age, aortic PWV is not only the best predictor of cardiovascular mortality, but all mortality and target organ damage.12 13 14 15 In fact the reason that this biofeedback technology is so valuable is because it gives an overview of your inner workings: your internal age and is considered to be the gold standard for arterial risk.16

The relationship between the blood vessels and your physiological function are so tightly linked that this device is mandatory for anyone wanting to have a window on their health and anyone who is involved in treating patients, clients or supplying products to improve health. Now it can be monitored with concrete results and the progress of any

8 Current CV risk evaluation systems are based on clinical judgment and traditional vital signals measurement, including heart rate, respiratory rate, blood pressure (BP), temperature and pulse oximetry. 9 Safar ME, London GM. The arterial system in human hypertension. In: Swales JD, ed. Textbook of Hypertension. London, UK: Blackwell Scientific. 1994:85-102. 10 Asmar RG, Benetos A, Topuchian J, et al. Assessment of arterial compliance by automatic pulse wave velocity measurements. Validation and clinical application studies. Hypertension. 1995;26:485-490. 11 Pereira T, Correia C, Cardoso J. Novel Methods for Pulse Wave Velocity Measurement. J Med Biol Eng. 2015;35(5):555-565. 12 Blacher J, Asmar R, Djane S, London GM, Safar ME.. Aortic pulse wave velocity as a marker of cardiovascular risk in hypertensive patients. Hypertension. 1999;33:1111-1117 13 Vlachopoulos C., Aznaouridis K., Stefanadis C.; Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis. J Am Coll Cardiol. 55 2010:1318-1327. 1414 Leoncini G., Ratto E., Viazzi F.; Increased ambulatory arterial stiffness index is associated with target organ damage in primary hypertension. Hypertension. 48 2006: 15Pereira T, Correia C, Cardoso J. Novel Methods for Pulse Wave Velocity Measurement. J Med Biol Eng. 2015;35(5):555-565 16 Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Böhm M, Christiaens T, Cifkova R, De Backer G, Dominiczak A, Galderisi M, Grobbee DE, Jaarsma T, Kirchhof P, Kjeldsen SE, Laurent S, Manolis AJ, Nilsson PM, Al E. 2013 ESH/ESC guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) European Heart Journal. 2013;34:2159–2219.

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intervention can be compared. The heart pumps blood into the aorta which travels through arteries to the body’s organs and tissues. The aorta runs from the heart, through the chest and abdomen to the pelvis, where is divides into the iliac arteries that provide blood flow to the legs.

 

 

As the heart pumps blood into the arteries (aorta), the contraction of left ventricle ejects blood into the ascending aorta which will dilate the aortic wall and generate a pulse wave. This velocity of this wave is related to the status of the blood vessels, most importantly constitutes an index of arterial elasticity or stiffness: the higher the velocity, the higher the rigidity of the vascular wall and the lower the ability to expand or bend.17

The PYUR Global System records your pulse waves and utilizes the eart app to analyze the data to calculate Aortic Pulse Wave Velocity (AoPWV). This is how quickly the pulse wave, sent out by each heart beat, travels down your aorta to the bottom of your abdomen and back again. AoPWV is related to the wave that travels down the aorta and then is reflected back towards the heart. The reflected wave maintains pressure in the aorta in between the pumping of the heart, in order to allow blood to flow into those arteries that feed the heart, the coronary arteries, supplying the heart muscle with invaluable oxygen and nutrients. When the aorta stiffens with aging or CVD complications, the speed with which the reflected wave travels along the aorta will be increased. The reflected wave returns to the heart earlier and the returning wave crashes into the wave of blood still being ejected from the heart. This leads to hypertension, also known as High Blood Pressure. Early return of the reflected wave also leads to low pressure in the aorta when the heart is in its relaxation phase, reducing flow to the coronary arteries.

 

In a healthy young person, just as the heart completes a contraction and starts to relax. The stiffer the aorta, the faster the

17 Nichols WW, O'Rourke M. McDonald's Blood Flow in the Arteries. Theoretical, Experimental and Clinical Principles. 4th ed. London, UK: Arnold Publishers; 1998:54-113; 201-222;284-292;347-401.

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wave and the less time The calculated AoPWV is then compared to known values of different ages and populations to determine your Internal Age. This technology used by PYUR Global system is the new gold standard for determining pulse wave velocity and has created the opportunity for everyone to be aware of their CV status.. Quantitative information on the large arteries may be easily obtained by determination of PWV. This method enables one to evaluate indirectly arterial distensibility and stiffness.18 19 Simply stated the higher the PWV, the lower blood vessel elasticity and compliance and indication that arterial change has occurred and the likelihood that it is pathological.20 The pressure pulse wave generated by this action is determined by the elastic and geometric properties of the arterial wall and the characteristics (density) of the contained fluid (blood which happens to be incompressible and therefore not a factor). Thus, the properties of the arterial wall, its thickness, and the arterial lumen diameter are the major factors influencing PWV. These relationships between PWV, the pressure, wall tension and distensibility have been used to create an ‘internal age’ parameter. PWV is usually expressed per unit length and then evaluated in terms of changes in diameter or radius. PYUR Heart measures aortic elasticity by measuring the speed with which pulse waves travel down the aorta. As the aorta stiffens, pulse waves will travel more quickly. Previously, the only method to measure aortic pulse wave velocity was to have a trained medical technician place pulse sensor precisely over the Carotid Artery in the neck and the Femoral Artery in the thigh. The PYUR Heart uses the analysis of the fingertip pulse signal to find the wave that travels down the aorta and reflects back towards the heart. Fingertip pulse wave shape is determined by speed with which the Aortic Reflected Wave travels. In 30-seconds PYUR Heart is able to characterize the Aortic Reflected Wave, determine Aortic Pulse Wave Velocity and use this to calculate Internal Age. Internal Age is an indication of whether a person’s Aortic Pulse Wave Velocity is equal to that of a person younger or older than their chronological age, revealing a more appropriate physiological age. The PYUR Heart unit is so easy to use:

• Allow your body to relax for one or two minutes before an PYUR Global recording.

• Sit still, comfortable, and relaxed for entire 30-second recording.

• Do not talk or move during the recording.

18 Avolio AP. Pulse wave velocity and hypertension. In: Safar M, ed. Arterial and Venous Systems in Essential Hypertension. Boston, Mass: Martinus-Nijhoff; 1991:133-152. 19 Avolio AP, Deng FQ, Li DQ, Luo YF, Huang ZD, Xing LF, O’Rourke M. Effects of aging on arterial distensibility in populations with high and low prevalence of hypertension: comparison between urban and rural communities in China.Circulation. 1985;71:202-210 20 Wilmer CV, Nichols W, O’Rourke MF. McDonald’s blood flow in arteries- Theoretical experimental and clinical principles. CRC Press. London. 2005.

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• Slip your first or middle finger fully into the PYUR Global oximeter.

• Ensure the finger used is warm and dry.

• Place the hand used in the recording flat on level surface, like a table top or your leg.

• The PYUR Global oximeter will reveal your Internal Age

• Doctors, Chiropractors, Physiotherapists, Nutritionists all have protocols to improve your score.

• The best validation device for any health intervention.

Reflected wave shown on the PYUR Heart app reading

Aortic Stiffness has been studied in the medical scientific literature for the past twenty years. Scientists have proved that Aortic Stiffness can be used to identify people at high risk for heart disease and Dementia as well as predict risk of death from all causes, an indicator of overall health status. Aortic Stiffness has been found to improve with attention to exercise, diet and stress management. Aortic Index can objectively show how wise lifestyle choices lead to better health and longer life. Some tips to increase aortic elasticity:

• Increased movement/activity*

• Improved diet

• Improved sleep quality

• Improved stress levels

• Dietary supplementation**

• Increased hydration levels

• Stretching

• Relaxation/meditation

When you are aware of a situation, you can take steps to improve that issue. Regular measurement with the PYUR Heart gives you the information to allow you to take the steps needed to improve that status.

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