{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T17:22:11Z","timestamp":1790788931096,"version":"4.1.0"},"reference-count":45,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2021,2,2]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">An artificial intelligence algorithm that detects age using the 12\u2010lead ECG has been suggested to signal \u201cphysiologic age.\u201d This study aimed to investigate the association of peripheral microvascular endothelial function (PMEF) as an index of vascular aging, with accelerated physiologic aging gauged by ECG\u2010derived artificial intelligence\u2013estimated age.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              This study included 531 patients who underwent ECG and a noninvasive PMEF assessment using reactive hyperemia peripheral arterial tonometry. Abnormal PMEF was defined as reactive hyperemia peripheral arterial tonometry index \u22642.0. Accelerated or delayed physiologic aging was calculated by the \u0394 age (ECG\u2010derived artificial intelligence\u2013estimated age minus chronological age), and the association between \u0394 age and PMEF as well as its impact on composite major adverse cardiovascular events were investigated. \u0394 age was higher in patients with abnormal PMEF than in patients with normal PMEF (2.3\u00b17.8 versus 0.5\u00b17.7\u00a0years;\n              <jats:italic>P<\/jats:italic>\n              =0.01). Reactive hyperemia peripheral arterial tonometry index was negatively associated with \u0394 age after adjustment for cardiovascular risk factors (standardized \u03b2 coefficient, \u20130.08;\n              <jats:italic>P<\/jats:italic>\n              =0.048). The highest quartile of \u0394 age was associated with an increased risk of major adverse cardiovascular events compared with the first quartile of \u0394 age in patients with abnormal PMEF, even after adjustment for cardiovascular risk factors (hazard ratio, 4.72; 95% CI, 1.24\u201317.91;\n              <jats:italic>P<\/jats:italic>\n              =0.02).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Vascular aging detected by endothelial function is associated with accelerated physiologic aging, as assessed by the artificial intelligence\u2013ECG \u0394 age. Patients with endothelial dysfunction and the highest quartile of accelerated physiologic aging have a marked increase in risk for cardiovascular events.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.120.018656","type":"journal-article","created":{"date-parts":[[2021,1,17]],"date-time":"2021-01-17T10:02:03Z","timestamp":1610877723000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":56,"title":["Vascular Aging Detected by Peripheral Endothelial Dysfunction Is Associated With ECG\u2010Derived Physiological Aging"],"prefix":"10.1161","volume":"10","author":[{"given":"Takumi","family":"Toya","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine Mayo Clinic Rochester MN"},{"name":"Division of Cardiology National Defense Medical College Tokorozawa Saitama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Ahmad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9706-7900","authenticated-orcid":false,"given":"Zachi","family":"Attia","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Mayo Clinic Rochester MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michal","family":"Cohen\u2010Shelly","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Mayo Clinic Rochester MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilke","family":"Ozcan","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Mayo Clinic Rochester MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4308-0456","authenticated-orcid":false,"given":"Peter A","family":"Noseworthy","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Mayo Clinic Rochester MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5788-9734","authenticated-orcid":false,"given":"Francisco","family":"Lopez\u2010Jimenez","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Mayo Clinic Rochester MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2283-4340","authenticated-orcid":false,"given":"Suraj","family":"Kapa","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Mayo Clinic Rochester MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3271-3887","authenticated-orcid":false,"given":"Lilach O","family":"Lerman","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension Mayo Clinic Rochester MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul A","family":"Friedman","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Mayo Clinic Rochester MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9446-5313","authenticated-orcid":false,"given":"Amir","family":"Lerman","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Mayo Clinic Rochester MN"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/glq113"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.14336\/AD.2018.1030"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmet.2017.08.020"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arr.2016.09.002"},{"key":"e_1_3_1_6_2","first-page":"112","article-title":"The importance of resistance exercise training to combat neuromuscular aging","volume":"34","author":"Lavin KM","year":"2019","unstructured":"Lavin KM, Roberts BM, Fry CS, Moro T, Rasmussen BB, Bamman MM. 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