Abnormal Intima-media Thickness Research Articles

Endoscopically Active Ulcerative Colitis Is Associated With Asymptomatic Atherosclerotic Vascular Disease: A Case-Control Study.

Chronic inflammation in immune-mediated conditions has been associated with an increased risk in atherosclerotic disease. There is paucity of evidence regarding the prevalence of asymptomatic atherosclerosis in patients with ulcerative colitis (UC) and its association with disease activity. We sought to compare the prevalence of asymptomatic atherosclerotic disease between young patients with UC with and without mucosal healing (MH) and healthy control individuals. An observational study was conducted in 2 hospitals in Buenos Aires, Argentina. Patients with UC 18 to 50 years of age with at least 1 previous colonoscopy in the last year were enrolled, along with age- and sex-matched healthy control individuals. Carotid and femoral ultrasound assessments were performed to determine the prevalence of atherosclerotic lesions and abnormal intima-media thickness (IMT). We compared the prevalence of atherosclerotic disease and the prevalence of abnormally increased IMT in at least 1 vascular territory. Sixty patients with UC and 60 healthy control individuals were enrolled. Mean age was 38 years and 53.33% were men. Although the prevalence of atherosclerotic lesions was similar in patients with UC without MH when compared with both patients with UC with MH and control individuals (3.7% vs 0% vs 6.67%; P = .1), we found a significant increase in abnormal IMT in at least 1 vascular territory in UC patients without MH when compared with healthy control individuals (48.15% vs 26.67%; P = .05). Patients with UC with active mucosal inflammation showed a significantly increased odds of asymptomatic femoral or carotid vascular disease when compared with control individuals.

Prospective, simultaneous assessment of joint and vascular inflammation by PET/CT in tofacitinib-treated patients with rheumatoid arthritis: associations with vascular and bone status

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Associations of Renal Augmented Velocity Index with Arterial Stiffness, Carotid Intima–Media Thickness and Blood Pressure, in Comparison with Renal Resistive Index

The augmented velocity index (Avi) is a new Doppler index associated with arterial stiffness. We examined associations of renal Avi with blood pressure (BP), aortic stiffness and carotid intima–media thickness (IMT), and compared its performance with that of resistive index (RI). One hundred forty-seven volunteers were recruited. Renal Avi had significant positive correlations with systolic BP (r = 0.37, p < 0.001), diastolic BP (r = 0.2, p = 0.016), mean arterial pressure (r = 0.29, p < 0.001), pulse pressure (r = 0.31, p < 0.001), carotid–femoral pulse wave velocity (r = 0.49, p < 0.001) and carotid IMT (r = 0.23, p = 0.005). RI correlated positively with pulse pressure (r = 0.3, p < 0.001) only. After adjustments for co-variables, the associations remained similar. Patients with abnormal BP values (≥130/80 mm Hg), IMT and aortic stiffness (≥1 standard deviation of mean value) had higher Avi than those with normal values, but not RI. In conclusion, renal Avi had stronger associations with BP, arterial stiffness and carotid IMT than RI in apparently healthy volunteers, and was significantly increased in abnormal patients.

P694Evaluation of preclinical atherosclerosis in chronic myeloid patients continuously treated with tyrosine kinase inhibitors

Abstract In tyrosine kinase inhibitors (TKIs) era chronic myeloid leukemia (CML) became from fatal to well controlled chronic disease. Meanwhile it seems that some TKIs may have cardiovascular (CV) effects. The aim of the study was to assess signs of preclinical atherosclerosis (PA) on different TKIs in CML patients (pts). Patients and method In our study 126pts with CML obtained TKIs as any line at least 6mos were included. Males were 56 (44,5%). The median age was 52 (20–76)yrs. Pts with previous history of atherosclerotic CV events were excluded. There were 115 (91%), 61 (48%), 48 (38%), 12 (11%) pts ever obtained Imatinib (IMA), Nilotinib (NILO), Dasatinib (DASA) or Bosutinib (BOSU) with median treatment duration 22mos, 14mos, 16mos and 15,5mos, respectively. Median time since the first TKI was 48 mos. There are 79, 46, 12 pts obtained 2, 3 or 4 TKIs. To assess PA ankle-brachial index (ABI) and intima media thickness (IMT) were measured. To evaluate ABI Vascular Screening System VaSera VS-1500 was used. Normal values for ABI and IMT were &gt;0,9 and ≤1,1. Results ABI was abnormally low in 14/108 (13%) evaluable pts. Previous TKIs of IMA, NILO, DASA and BOSU were in 12 (86%) and 87 (93%), 9 (64%) and 41 (43%), 5 (35%) and 29 (31%), 1 (7%) and 9 (10%) pts with or w/t low ABI. All NILO its were pretreated with IMA. Only 2 pts previously obtained other TKIs. Median time on NILO was 23 mos and 15mos in pts with or w/t abnormal ABI, respectively. Median age for pts with or w/t low ABI was 53 and 52 yrs. The proportion of male pts were lower in abnormal vs normal ABI group – 29% and 44%. In NILO group 2 pts were male and median age for all pts was 51yrs. IMT was evaluable in 86 pts. The median value of IMT was 0,8mm for all pts. It was abnormal in 12 (14%) pts with median thickness 1,3mm. All pts previously ever obtained IMA. NILO, DASA and BOSU were exposed in 5 (42%) and 33 (46%), 5 (42%) and 23 (31%), 1 (8%) and 7 (10%) pts with or w/t IMT abnormalities. The proportion of males was 4 (33%) and 34 (46%) among pts with or w/t abnormal IMT. Pts with high vs normal IMT were older with median age 64 vs 44yrs. TKIs2 were ever obtained in 13/14 (93%) and 11/12 (92%)pts with abnormal ABI and IMT&lt; respectively. Both ABI and IMT were abnormal only in 4 pts. Heart SCORE was high and very high only in 18/80 (22,5%) pts. Median age for low vs high risk pts were much lower (40 vs 52yrs). There were no differences between treatment groups according to SCORE distribution. Overall 9/50 (18%) and 3/32 (9%), 5/38 (13%) and 3/28 (11%)pts on NILO and DASA, had abnormal ABI and IMT. Conclusion CML pts heavily pretreated with different TKIs were included In the study. The most pts with abnormal ABI and IMT have ever been obtaining TKIs2. Pts with NILO more frequently experienced low ABI. There were not significant differences among TKIs groups regarding heart SCORE or IMT. It seems that extended PA is low on TKIs including NILO in CML pts w/t previous SVEs. Acknowledgement/Funding Funded from government assignment

Association between Serum Alkaline Phosphatase and Carotid Atherosclerosis in a Chinese Population: A Community-based Cross-sectional Study

ObjectiveThis study aimed to investigate the relationship between alkaline phosphatase (ALP) and common carotid intima media thickness (IMT), carotid plaque, and extracranial carotid artery stenosis (ECAS). MethodsA total of 3,237 participants aged ≥ 40 years were recruited from Jidong community in 2013-2014. Participants were divided into five quintile groups based on their serum ALP levels. Carotid atherosclerosis was assessed using ultrasound. Abnormal IMT, carotid plaque, and ECAS were defined as IMT > 0.9 mm, IMT > 1.5 mm, and ≥ 50% stenosis in at least one extracranial carotid artery, respectively. ResultsCommon carotid IMT values and the prevalence of carotid plaque increased across serum ALP quintiles. Higher ALP quintiles were correlated with an increased risk of abnormal IMT [fourth quintile: odds ratio (OR) 1.78, 95% confidence interval (CI) 1.13-2.82, P = 0.0135; fifth quintile: OR = 1.82, 95% CI: 1.15-2.87, P = 0.0110] and ECAS compared to the lowest quintile (fifth quintile: OR = 1.47, 95% CI: 1.09-1.97, P = 0.0106). The association between ALP and prevalence of carotid plaque became insignificant after adjustment for confounders. ConclusionSerum ALP levels were independently associated with abnormal common carotid IMT and ECAS. These conclusions need to be further corroborated in future prospective cohort studies.

The Role of Circulating Regulatory T Cell Levels on Subclinical Atherosclerosis and Cardiovascular Risk Factors in Women with Systemic Lupus Erythematosus.

The increase in cardiovascular disease (CVD) in patients with systemic lupus erythematosus (SLE) is not fully explained by traditional CVD risk factors. Regulatory T cells (Treg cells) are considered atheroprotective. We investigated the relationship between the absolute number of different phenotypes of Treg cells and abnormal carotid intima-media thickness (IMT) in women with SLE. Sixty-six women with SLE with no history of CV disease were included. Carotid IMT was quantified by ultrasound. Abnormal carotid IMT was defined as ≥0.8 mm and two groups were compared according to this definition. Flow cytometry was used to analyze Foxp3 and Helios expression in peripheral blood CD4 T cells. A significantly higher level of absolute CD4+CD25+FoxP3high T cells was present in patients with abnormal carotid IMT compared with those without (1.795 ± 4.182 cells/μl vs. 0.274 ± 0.784 cells/μl; p = 0.003). However, no correlations were found between any Treg cell phenotypes and carotid IMT. Only the absolute number of CD4+CD45RA+FoxP3low T cells was significantly decreased in SLE patients with low HDL cholesterol compared with those with normal HDL cholesterol (0.609 ± 2.362 cells/μl vs. 1.802 ± 4.647 cells/μl; p = 0.009 and 15.358 ± 11.608 cells/μl vs. 28.274 ± 34.139; p = 0.012, respectively). In conclusion, in SLE women, diminished levels of Treg cells based on flow cytometry were not a good indicator of abnormal carotid IMT.

Investigation of vascular endothelial dysfunction in the patients with age-related macular degeneration

Purpose This study aims to evaluate the association between age-related macular degeneration (AMD) and cardiovascular disease by using the noninvasive flow-mediated dilation (FMD) test to show endothelial dysfunction as an indicator of subclinical atherosclerosis. Method Participants in this study included 30 dry AMD patients, 30 wet AMD patients, and 30 healthy controls without any systemic disease, including AMD. FMD and the intima media thickness (IMT) of the carotid artery were compared between the groups. Results Comparison of FMD between the groups showed a 10.96% brachial artery dilation in the healthy controls, 3.99% in the dry AMD group, and 5.03% in the wet AMD group. While a significant difference was not observed between the wet and dry AMD groups, comparison of the control group to the wet and dry AMD groups yielded a significant difference. When brachial artery dilation below 7% was accepted as an abnormal FMD, 26.7% of the healthy controls, 66.7% of the dry AMD patients and 76.7% of the wet AMD patients were found to be abnormal. Similarly, while no significant difference was observed between the wet and dry AMD groups, comparison of the control group with the wet and dry AMD patients yielded a significant difference. When an IMT below 0.7 mm was accepted as abnormal, 26.7% of the healthy controls, 33.3% of the dry AMD, and 43.3% of the wet AMD were found to have an abnormal IMT. However, differences between the groups did not reach statistical significance. Conclusions In this study, use of the FMD test showed endothelial dysfunction among AMD patients. No significant differences were found between the dry and wet AMD patient groups.

ASSOCIATION BETWEEN SLEEP COMPLAINTS AND CAROTID ATHEROSCLEROTIC LESIONS

Objective: Sleep deprivation is discussed as a cardiovascular risk factor, however, its association with cardiovascular mortality and morbidity is controversial. We assessed the relation between self-reported sleep complaints and carotid atherosclerotic lesions. Design and method: In this analysis, we included 861 (320 males, 37.2%) out of 1600 participants of the St Petersburg population-based sample (within the ESSE-RF study) without previously known cardio/cerebrovascular events. Mean age – 44.9 ± 11.9 years old. Mean body mass index: 26.9 ± 5.3 kg/m2. All participants underwent a structured interview regarding their lifestyle, complaints, medical history, and sleep complaints. In this analysis, we considered the following questions: “How often did you have difficulties in falling asleep for >30 minutes after going to bed in the last month?”, “How often did you have difficulties in falling asleep after midnight awakening in the last month?”. The answers “>1/week” were considered symptomatic. In addition, we measured office blood pressure (BP) and performed a standard duplex ultrasound protocol (My Sono U6, Samsung, Korea) to evaluate carotid intima-media thickness (IMT) (normal: <=0.9 mm, abnormal: 0.91–1.29 mm) and atherosclerotic plaques (local thickening >=1.3 mm). We applied parametric statistics (t-Student, chi-square tests), Spearman correlation analysis. Results: In total, 362 subjects (42%) reported at least one sleep complaint. The atherosclerotic plaques were found in 15 subjects (1.7%). The plaques presence was associated with awakenings (chi-square 9.04, p = 0.005). Abnormal IMT was found in 83 subjects (9.6%). Subjects with sleep-related complaints showed higher IMT values (0.71 ± 0.18 vs. 0.67 ± 0.16 in insomniacs vs. non-insomniacs, p = 0.001). However, there was no association between the rates of sleep complaints and abnormal IMT (p = 0.24). Correlation analysis demonstrated a weak association between mean IMT and sleep complaints (ρ = 0.11, p = 0.001), which disappeared after adjustment for age and BP. Conclusions: In a large epidemiology cohort, we demonstrated an association between sleep complaints and carotid atherosclerosis. However, their role seems to be minor compared to the traditional cardiovascular risk factors, although potential mechanisms and benefits of insomnia treatment deserve further investigation.

Epicardial fat thickness is associated with aortic intima-media thickness in patients without clinical manifestation of atherosclerotic cardiovascular disease.

Although the relationship between epicardial fat thickness (EFTh) and coronary atherosclerosis is well established, this relation in the early periods of atherosclerosis has not been fully demonstrated. On the other hand, thoracic aortic intima-media thickness (IMT) rather than carotid IMT was reported as an earlier marker of preclinical atherosclerosis. We aimed to assess the relationship between thoracic aortic IMT and EFTh in patients undergoing transesophageal echocardiography (TEE) examination for different indications. We included 104 patients (mean age 38±11.4years), who underwent TEE for various indications. The patients were divided into two groups according to the median thoracic aortic IMT values (IMT normal group<10mm and IMT abnormal group≥10mm). EFTh was obtained using two-dimensional transthoracic echocardiography on the right ventricular free wall during systole and diastole. The highest EFTh values (3.3±0.96mm vs. 4.51±0.66mm, P<.001) were observed in the abnormal aortic IMT group. Multivariate linear regression analysis showed that aortic IMT was independently correlate with EFTh (β=0.423, P<.001). Moreover, EFTh was found to be associated with history of transient ischemic attack (r=.403, P<.001) and abnormal IMT (r=.643, P<.001) in bivariate analysis. Epicardial fat thickness is independently related to the extent of subclinical thoracic aortic atherosclerosis. Increase in EFTh may be crucial marker for initial atherosclerosis.

Association of Serum 25-hydroxyvitamin D in Carotid Intima-media Thickness: A Study from South India.

Background:Abnormal carotid intima-media thickness (IMT) is a marker of carotid atherosclerosis which is a risk factor for cerebrovascular and cardiovascular diseases. Recent studies have found an association of 25-hydroxyvitamin D deficiency with abnormal carotid IMT.Purpose:The purpose of the study was to investigate the association of serum 25-hydroxyvitamin D levels with carotid IMT in Indian participants.Materials and Methods:We prospectively recruited 300 participants at Yashoda Hospital, Hyderabad, during the study period between January 2012 and December 2014. All participants were assessed for fasting blood sugar, lipid profile, C-reactive protein (CRP), serum alkaline phosphatase, serum calcium, serum phosphorous, serum 25-hydroxyvitamin D levels, and carotid Doppler examination.Results:Among the 300 participants, men were 190 (63.3%) and mean age was 51.9 ± 7.7 years with a range from 35 to 64 years. On risk factors evaluation, 105 (35%) were hypertensive, 79 (26.3%) diabetics, 63 (21%) smokers, and 56 (18.6%) were alcoholics. On evaluation of biochemical parameters, 81 (27%) had dyslipidemia, 120 (40%) had elevated CRP levels, 119 (39.6%) had 25-hydroxyvitamin D deficiency, mean alkaline phosphatase was 93.9 ± 14.9 IU/L, serum calcium (mg/dL) was 9.2 ± 2.3, and serum phosphorous 4.4 ± 1.2 mg/dL. On carotid imaging, 121 (40.3%) had abnormal IMT. After multivariate analysis, 25-hydroxyvitamin D deficiency (odds ratio [OR]: 2.14; 95% confidence interval [CI]: 1.29–3.55), dyslipidemia (OR: 2.53; 95% CI: 1.46–4.40), elevated CRP (OR: 2.27; 95% CI: 1.37–3.76), smoking (OR: 2.09; 95% CI: 1.16–3.77), and diabetes (OR: 1.84; 95% CI: 1.05–3.21) were independently associated with abnormal IMT.Conclusion:In our study, we established 25-hydroxyvitamin D deficiency as an independently associated with abnormal IMT in Indian participants.

A study of the association of acanthosis nigricans with subclinical atherosclerosis.

Hyperinsulinism is related to the presence of acanthosis nigricans and atherosclerosis; however, we were unable to find any study on the prevalence of atherosclerosis in acanthosis nigricans. To evaluate the prevalence of carotid atherosclerosis and metabolic alterations in Mexican patients with acanthosis nigricans. We carried out a cross-sectional study that included 45 patients with acanthosis nigricans, age- and gender-matched with 45 healthy participants. Volunteers with any comorbidity or taking weight reduction, glucose- and/or lipid-lowering medication or drugs capable of causing acanthosis nigricans were not included in the study. B-mode ultrasound tests were done to measure the carotid intima-media thickness. Body mass index, insulin, glucose and lipid blood serum levels were measured. Chi-square or Fisher's exact test and paired Student t-test were used for statistical analysis. Carotid intima-media thickness was greater in patients with acanthosis nigricans (mean 0.52 mm vs. 0.46 mm, P = 0.002). The prevalence of abnormal intima-media thickness was higher in patients with acanthosis nigricans versus healthy participants (62.2% vs. 35.5%, P = 0.02). The same occurred with hyperinsulinemia (73.3% vs. 13.3%, P< 0.001), insulin resistance (86.6% vs. 33.3%, P< 0.001), obesity (86.6% vs. 13.3%, P< 0.001) and dyslipidemia (95.5% vs. 77.7%, P = 0.01). The sample size is small and serum markers of cardiovascular risk were not measured. Acanthosis nigricans is a skin marker for metabolic disturbances and is also associated with carotid atherosclerosis, a finding which is not well documented. We propose that individuals with acanthosis nigricans should be routinely evaluated for these cardiovascular risks.

Frequency of Abnormal Intima Media Thickness of Carotid Artery in Obese Individuals by Colour Doppler Ultrasonography

Objectives: To determine the frequency of abnormal Intima media thickness of Carotid artery in obese individuals by using color Doppler ultrasonography. Design: Descriptive cross-sectional study. Setting: Department of Radiology Allied Hospital, Faisalabad. Period: From August 2011 to june 2012, Methodology: A total of 96 patients were enrolled in this study. LOGIC 5 Doppler ultrasound machine was used. B-mode ultrasonography of common carotid arteries was performed on both sides with a 7.5 MHz linear array transducer. Intima media thickness was accessed in the distal wall of common carotid artery of both sides 1.0 cm proximal to carotid bulb. Results: Mean age of the patients was observed 50.1±5.9 years. Abnormal intima media thickness in right common carotid artery (RCCA) was found to be in 46 (47.9%) patients and in 45 (46.8%) patients in left common carotid artery (LCCA). Mean values of intima-media thickness (IMTs), luminal diameters (LD) and flow velocity (FV) systolic and diastolic of right common carotid artery (RCCA) as follows, 0.74±0.17, 6.90±0.93, 78.91±17.03 and 21.50±5.67, respectively. Mean values of intima-media thickness (IMTs), luminal diameters (LD) and flow velocity (FV) systolic and diastolic of left common carotid artery (LCCA) as follows, 0.74±0.15, 6.85±0.72, 76.58±12.49 and 20.41±5.14, respectively. Conclusion: Carotid intima-media thickness testing by using Colour Doppler Ultrasonography is a powerful and noninvasive tool in the early detection of atherosclerotic plaques and carotid artery wall thickening and is an independent predictor of strokes and heart attacks.

Relation between visceral fat and carotid intimal media thickness in Mexican postmenopausal women: a preliminary report.

Aim of the studyTo investigate the relationship between visceral fat and carotid IMT (intima media thickness) in Mexican postmenopausal women.Material and methodsIn 71 postmenopausal women divided in two groups: group 1, IMT > 1 mm and group 2, IMT ≤ 1 mm, blood pressure, body mass index (BMI), waist hip ratio (WHR), visceral and subcutaneous fats and carotid IMT were analyzed. Descriptive statistics were used and the comparison among those with abnormal and normal IMT was carried out using Mann-Whitney U test; also Spearman's correlation analysis was done.ResultsWhen comparing group 1 (n = 9, 12.7%) with group 2 (n = 62, 87.3%), it was found that the subcutaneous fat, visceral fat and systolic blood pressure were significantly greater in group 1 (p < 0.018, p < 0.001 and p < 0.006, respectively), and also in this group there was a correlation between BMI and subcutaneous fat (ρ = 0.686, p < 0.041) and between visceral fat and the systolic blood pressure (ρ = 0.712, p < 0.031). In group 2, there was a correlation between IMT and diastolic blood pressure (ρ = 0.251, p < 0.049).ConclusionSubcutaneous and visceral fat have an unfavorable effect in the carotid IMT and in blood pressure.

Subclinical atherosclerosis among Chilean subjects classified as having a low cardiovascular Framingham risk

Framingham risk score (FRS) has limitations and can underestimate risk. Carotid ultrasound to measure intima media thickness or plaques is recommended for cardiovascular risk assessment. To determine the prevalence of subclinical atherosclerosis in asymptomatic subjects classified as low and intermediate risk. Cross-sectional study performed in subjects without cardiovascular disease. Cardiovascular risk was estimated using the Chilean FRS and the General Cardiovascular Disease FRS. Carotid ultrasound was performed in all subjects. We defined subclinical atherosclerosis as the presence of carotid plaque or intima media thickness greater than 75th percentile by gender and age. We studied 203 subjects aged 47.2 ± 9.6 years (54% males). Mean intima media thickness was 0.62 ± 0.1 mm. An abnormal value was detected in 68 subjects (33%) and carotid plaques in 32 subjects (15.7%). Based on Chilean FRS, 96% were considered at low risk, 4% at intermediate, and none at high risk. In the low risk group the prevalence of abnormal intima media thickness and plaques was 40 and 14% respectively. Presence of plaques was more common in women than men (23 and 7% respectively, p < 0.01). According to the General Cardiovascular Disease FRS, 23% were at low, 39% at low intermediate and 28% at high intermediate risk. In the low risk group the prevalence of an abnormal intima media thickness was 34% and no subject had plaques. Carotid plaques were detected in Chilean subjects classified as having a low FRS risk. The underestimation of risk was higher in Chilean women.

The association among peri-aortic root adipose tissue, metabolic derangements and burden of atherosclerosis in asymptomatic population

AimTo describe the relationship between a novel measurement of peri-arotic root fat and ultrasound measures of carotid artery remodeling. Materials and methodsWe studied 1492 consecutive subjects (mean age: 51.04 ± 8.97 years, 27% females) who underwent an annual cardiovascular risk survey in Taiwan. Peri-aortic root fat (PARF) was assessed by cardiac CT using three-dimensional (3D) volume assessment. Carotid artery morphology and remodeling were assessed by ultrasound. We explored the relationships between PARF volumes, cardiometabolic risk profiles and carotid morphology and remodeling. ResultsMean PARF volume in current study was 20.8 ± 10.6 ml. PARF was positively correlated with measures of general adiposity, systemic inflammation, and several traditional cardiometabolic risk profiles (all p < 0.001) and successfully predicted metabolic syndrome (MetS) (AUROC: 0.75, 95%, confidence interval: 0.72–0.77). Higher PARF was independently associated with increased carotid artery intima-media thickness (IMT) (β-coef.: 0.08) and diameter (β-coef.: 0.08, both p < 0.05) after accounting for age, sex, BMI and other cardiovascular risk factors. The addition of PARF beyond metabolic syndrome components significantly provided incremental prediction value for abnormal IMT (ΔAUROC: 0.053, p = 0.0021). ConclusionPeri-aortic root fat is associated with carotid IMT, even after adjustment for cardiometabolic risks, age and coronary atherosclerosis. Further research studies are warranted to identify the mediators of downstream pathophysiologic effects on carotid arteries by PARF and understand the mechanisms related to this correlation.

Role of Chlamydia pneumoniae in pediatric acute ischemic stroke: A hospital based study

Several studies have shown that Chlamydia pneumoniae accelerates atherothrombosis by cytokine-mediated process with increased risk of cerebral ischemia in adults. Such a relationship has not been established in children. We sought to study the role of C. pneumoniae infection in children under the age of 18 years presenting with first ever-ischemic stroke. This study was carried out at a tertiary care hospital, between January 2006 and December 2008. Using a prospective registry, we enrolled all consecutive childhood stroke patients presenting within 72 h of stroke onset. All patients underwent neuroimaging tests as a part of their stroke work up. In addition to routine blood investigations, hypercoagulable panel and fasting lipid profile were estimated for all participants. We measured C. pneumoniae IgG and IgA antibodies, by microimmunofluorescence technique, for all participants. A total of 42 children under the age of 18 years who presented with acute ischemic stroke were studied. The mean age of presentation was 15.2 years and males outnumbered females by 5:2. Stroke risk factors were identified in 33 of 42 (80%) cases. C. pneumoniae seropositivity (IgG) was found in 14 of the 42 stroke patients. After adjustment in C. pneumoniae seropositive strokes, abnormal intima media thickness (odds ratio [OR]: 7.0; 95% confidence interval [CI]: 1.2–37.9), elevated total cholesterol (OR: 9.3; 95% CI: 1.6–53.2) and low-density lipoprotein cholesterol (OR: 27.0; 95% CI: 2.5–291.1) were significantly associated with ischemic stroke in children. C. pneumoniae infection is associated with atherogenic lipid profile in children presenting with acute ischemic stroke.

Prevalence and risk factors of carotid intima-media thickness in asymptomatic individual subjects in a tertiary care center in India

Background:Carotid intima-media thickness (IMT) is increasingly identified as a marker of atherosclerosis and increased risk of cerebrovascular disease.Aim:We aimed to investigate the prevalence of carotid IMT in asymptomatic Indian individuals, more than 40 years of age, and correlate it with other risk factors for cerebrovascular ischemia.Materials and Methods:Individuals attending outpatient services of Nizam's Institute of Medical Sciences, who were asymptomatic for cerebrovascular ischemia underwent detailed history and carotid Doppler examination. IMT on mid common carotid artery (CCA) was measured. All subjects’ blood was taken for biochemical estimation of fasting blood sugar and total cholesterol levels.Results:Out of 1,392 subjects, 571 (41%) had abnormal IMT and 821 (59%) had normal IMT. On comparison of the two groups, the factors significantly associated with abnormal IMT were mean older age (59 vs 50.7 years; P < 0.0001) and higher prevalence of hypertension (257 (45%) vs 236 (28.7%); P < 0.0001), diabetes (159 (27.8%) vs 139 (16.9%); P < 0.0001), and hypercholesterolemia (124 (21.7%) vs113 (13.7%); P = 0.0001). After adjustment with multiple logistic regression, significant predictors were age (odds 3.2; 95% confidence interval (CI) 2.5-4.1), male gender (odds 1.5; 95% CI 1.1-1.9), hypercholesterolemia (odds 1.5; 95% CI 1.1-2.0), hypertension (odds 1.4; 95% CI 1.1-1.8), and diabetes (odds 1.3; 95% CI 1.0-1.7).Conclusion:We found age, sex, hypertension, diabetes, and hypercholesterolemia to be independent risk factor for abnormal IMT in asymptomatic subjects over 40 years of age.

Relationship of Dickkopf1 (DKK1) with cardiovascular disease and bone metabolism in Caucasian type 2 diabetes mellitus.

ObjectivesDickkopf-1 (DKK1) is a potent inhibitor of Wnt signalling, which exerts anabolic effects on bone and also takes part in the regulation of vascular cells. Our aims were to evaluate serum DKK1 in type 2 diabetes (T2DM) patients and to analyze its relationships with cardiovascular disease (CVD). We also evaluated the relationship between DKK1 and bone metabolism.DesignWe conducted a cross-sectional study in which we measured serum DKK1 (ELISA, Biomedica) in 126 subjects: 72 patients with T2DM and 54 non-diabetic subjects. We analysed its relationship with clinical CVD, preclinical CVD expressed as carotid intima media thickness (IMT), and bone metabolism.ResultsT2DM patients with CVD (P = 0,026) and abnormal carotid IMT (P = 0,038) had higher DKK1 concentrations. DKK1 was related to the presence of CVD in T2DM, independently of the presence of risk factors for atherosclerosis. Therefore, for each increase of 28 pg/ml of serum DKK1 there was a 6,2% increase in the risk of CVD in T2DM patients. The ROC curve analysis to evaluate the usefulness of DKK1 as a marker for high risk of CVD showed an area under the curve of 0,667 (95% CI: 0,538–0,795; P = 0,016). In addition, there was a positive correlation between serum DKK1 and spine bone mineral density in the total sample (r = 0,183; P = 0,048).ConclusionIn summary, circulating DKK1 levels are higher in T2DM with CVD and are associated with an abnormal carotid IMT in this cross-sectional study. DKK1 may be involved in vascular disease of T2DM patients.

Association of multiple biomarkers and classical risk factors with early carotid atherosclerosis: results from the Gutenberg Health Study

In the Gutenberg Health Study, a random sample of the population was scanned with vascular ultrasound for early atherosclerosis. A continuous classical risk marker model (waist circumference, HbA1c, LDL/HDL ratio, pack years and pulse pressure) was compared to a model of modern biomarkers (C-reactive protein, troponin I, N-terminal pro B-type natriuretic peptide, copeptin, mid-regional pro-adrenomedullin, and asymmetric dimethylarginine) with regard to the ability of ruling out abnormal intima-media thickness (IMT), respectively, carotid plaques. Data of the first consecutive 5,000 participants (aged 35-74 years; 2,540 men, 2,460 women) were analyzed. IMT was measured at both common carotid arteries using an edge detection system. Plaques were defined as protrusion of ≥1.5 mm in common, internal and external carotid artery. For classical risk factors, in comparison to a model of six modern biomarkers, regarding the variable (a) IMT>0.85 mm negative and positive predictive value (NPV and PPV) were 0.98 and 0.16 for both the classical risk factor model and the biomarker model. The second variable (b) presence of plaque could be ruled out with an NPV of 0.84 and identified with a PPV of 0.61 for classical risk factors, and 0.84 and 0.58 for biomarkers, respectively. Values were calculated using logistic regression analysis. Classical risk factors allow ruling out pathologic IMT and presence of carotid plaques in a population of primary prevention in a reliable way. Modern biomarkers performed almost equally well but did not provide further information.

Computed tomography characteristics of coronary artery atherosclerosis in subjects with lower extremity peripheral artery disease and no cardiac symptoms

Computed tomography coronary angiography (CTCA) enables noninvasive evaluation of coronary artery atherosclerosis. However, its value to assess coronary artery disease (CAD) in subjects with lower‑extremity peripheral artery disease (PAD) and no cardiac symptoms is unknown. Moreover, the relationship between coronary artery plaque characteristics and severity of peripheral atherosclerosis in this group of patients was not sufficiently elucidated. The aim of the study was to determine the value of CTCA to assess coronary artery atherosclerosis and to evaluate the relationship between coronary artery plaque characteristics and severity of peripheral atherosclerosis in subjects with lower‑extremity PAD and no cardiac symptoms. Sixty‑five individuals (45 men, 20 women, mean age, 62.5 ±7.6 years) with lower‑extremity PAD and no cardiac symptoms underwent CTCA. CTCA revealed CAD in 56 subjects. Twenty‑two had obstructive CAD. The mean ankle-brachial index (ABI) was 0.64 ±0.16. Twenty‑six individuals demonstrated abnormal carotid artery intima-media thickness (IMT). ABI lower than median, if compared with ABI equal of higher than median, was associated with a higher proportion of obstructive multivessel to single vessel CAD (8:4 vs. 1:9; P = 0.01) and higher number of coronary artery segments with mixed plaques (2.3 ±2.2 vs. 1.2 ±1.3; P = 0.02). Comparing patients with abnormal and normal IMT, the former demonstrated higher proportion of obstructive multivessel to single-vessel CAD (7:3 vs. 2:10; P = 0.01) and higher number of coronary artery segments with noncalcified (1.9 ±3.2 vs. 0.6 ±1.4; P = 0.04) and mixed plaques (2.3 ±2.1 vs. 1.3 ±1.7; P = 0.049). CTCA may be effective to detect CAD in subjects with lower‑extremity PAD and no cardiac symptoms. The low ABI and abnormal IMT are associated with more extensive CAD and higher burden of high‑risk coronary artery plaques.