Absence Of Atherosclerotic Plaques Research Articles

P124 CARDIOVASCULAR RISK RE-CLASSIFICATION BY IMPLEMENTING CAROTID ULTRASONOGRAPHY IN PRIMARY CARE

Background and Objective: The accurate assessment of the total cardiovascular risk (CVR) using risk calculation algorithms in individuals with CVR factors in the primary prevention setting is essential for optimal management decisions, including drug treatment initiation and treatment goals. The aim of this study was to evaluate the contribution of ultrasonographic identification of asymptomatic carotid atherosclerosis in the re-classification of the CVR assessed with the reference SCORE2/2-OP algorithm. Methods: In individuals aged ≥40 years without established cardiovascular disease, the 10-year CVR was calculated using the SCORE2/2-OP algorithm (3 risk categories: low/moderate, high, and very high). Carotid ultrasound study was applied using a portable handheld device (Lumify, Philips) to classify CVR as follows: (i) low/moderate (absence of atherosclerotic plaque), (i) high (atherosclerotic plaque with <50% stenosis), (iii) very high (atherosclerotic plaque with ≥50% stenosis). Results: Data from 332 participants were analysed [age 59±7.5 years, men 41%, current smokers 26%, body mass index 28±5 kg/m2, office blood pressure 125±15/77±10 mmHg (systolic/diastolic), LDL-cholesterol 111±33 mg/dl]. Based on SCORE2/2-OP, 49/46/5% participants were categorised as of low/moderate, high, and very high CVR, respectively. Based on carotid ultrasound, the rates were 39/59/2%, respectively. 44% of individuals categorized as of low/moderate CVR based on SCORE2/2-OP were re-classified into a higher CVR category based on carotid ultrasound. The agreement between the 2 methods (ultrasound versus algorithms) in categorizing low/moderate and high CVR was 67% (kappa 0.35, P<0.001) and 61% (kappa 0.23, P<0.001), respectively. Among 204 participants categorized as of high/very high CVR according to carotid ultrasound, only 15 (7%) had LDL-cholesterol levels <70 mg/dl. Conclusions: These findings suggest that carotid ultrasonography using a portable handheld device may significantly contribute to assess CVR more accurately in primary care, especially in individuals classified as of low/moderate CVR using reference algorithms.

Macrophages derived from LPS-stimulated monocytes from individuals with subclinical atherosclerosis were characterized by increased pro-inflammatory activity

ObjectiveAtherosclerosis is characterized by chronic inflammation in the vascular wall. Currently the violation of immune tolerance of innate immune cells is considered as a possible mechanism of chronification of inflammation. The aim of this study is to assess the inflammatory activity and tolerance of monocytes and macrophages in subclinical atherosclerosis. MethodsA total of 55 individuals free from clinical manifestations of atherosclerosis-associated cardiovascular disease with a presence or absence of atherosclerotic plaques in the carotid arteries were included in this study. CD14+ monocytes were isolated from individuals' blood and stimulated with a single dose of lipopolysaccharide (LPS) on day 1 or with double doses of LPS on day 1 and day 6. The secretion of cytokines TNF, IL-1β, IL-6, IL-8, IL-10 and CCL2 were evaluated using ELISA. ResultsOur findings demonstrate that macrophages derived from LPS-stimulated monocytes in individuals with subclinical atherosclerosis exhibited increased secretion of IL-6, IL-10 and CCL2, which was associated with intima-media thickness, body mass index, but not with individuals’ age. Moreover, macrophages from individuals with atherosclerotic plaques exhibited impaired tolerance towards the second LPS stimulation manifested by elevated secretion of the chemoattractant CCL2. ConclusionIncreased secretion of these cytokines by macrophages may contribute to chronic local inflammation in the vascular wall by recruiting other immune cells.

Disparities in the Prevalence and Risk Factors for Carotid and Lower Extremities Atherosclerosis in a General Population—Bialystok PLUS Study

This study was conducted in a representative sample of area residents aged 20-80 years old. The aim of the study was to assess the prevalence of classic risk factors of atherosclerosis in the studied population and to search for new risk factors in these patient subpopulations. A total of 795 people (mean age 48.64 ± 15.24 years, 45.5% male) were included in the study group. Two independent data analyses were performed. In the first analysis, the study group was divided into two subgroups depending on the presence or absence of atherosclerotic plaques in carotid arteries (APCA). APCA were observed in 49.7% of the study group: in the population aged between 41 and 60 years in 49.3%, and those between 61 and 70 years in 86.3%. Patients with APCA were more often diagnosed with arterial hypertension, diabetes, and hypercholesterolemia. In the second analysis, the study group was divided into two subgroups depending on the presence of lower extremities atherosclerotic disease (LEAD). Patients with an ABI (ankle-brachial index) ≤ 0.9 constituted 8.5% of the study group, and they were significantly older, and more often diagnosed with diabetes and APCA. To identify the factors most strongly associated with APCA and an ABI ≤ 0.9, logistic regression was used, with stepwise elimination of variables. The strongest factors associated with APCA were current smoking and diastolic central pressure. We did not note such an association and did not find additional parameters to facilitate the diagnosis of LEAD in asymptomatic patients. The most important observation in our study was the high prevalence of APCA in the study population, especially in the group of young people under the age of 60.

Factors associated with the risk subclinical carotid atherosclerosis in rotational shift workers in the Arctic

Objective.To determine the most unfavorable predictors of atherosclerotic plaque (ASP) in carotid arteries (CA) in rotational shift workers in the Arctic using traditional risk factors, clinical and instrumental methods of research.Design and methods. In 2010–2012, we randomly selected 424 males aged 30–59 years from 1708 rotational shift workers at the medical unit of the gas production company “Gazprom dobycha Yamburg” (Yamburg settlement, 68ºN) and performed preventive medical examination. Subjects were divided into 2 groups according to blood pressure (BP) level. Group 1 included 294 patients with hypertension (HTN) of 1 or 2 stages > 140/90 mmHg and group 2 was comprised of 130 people with BP < 140/90 mmHg. The groups did not differ by age, total work experience in the Arctic and rotational shiftwork duration. Ultrasound examination of CA showed presence or absence of ASP and stenosis by NASCET method. In addition, we assessed traditional risk factors and performed 24-hour BP monitoring and blood tests including lipid spectrum, glucose level, creatinine.Results.ASP was found more often in subjects with HTN (group 1) than in people with normal BP in the same age group, 95 % CI 56–60 % vs 95 % CI 14–20 %, (p < 0,0001). The groups did not differ significantly in the nutritional habits (p = 0,067). At the same time, the rate of smoking (p = 0,039), low physical activity (p = 0,007), overweight (p < 0,0001) was significantly higher in group 1 compared to subjects with normal BP. According to multivariate analysis, three variables with the most significant predictors associated with ASP in CA with sensitivity 75,9 % were selected using step-by-step method: diastolic BP 24 (DBP24) (p < 0,0001), glucose (p = 0,017) and total cholesterol (p = 0,044). The linear function was obtained: F = –7,664 + 0,225 × Chol + 0,366 × Glu + 0,057 × DBP24, where the variable “Chol” is the level of total cholesterol in the blood in mmol/l; “Glu” — the level of blood glucose in mmol/l; “DBP24” — average 24-hour diastolic BP. Based on the model, we concluded that DBP24 increment by 1 mmHg increases the risk for developing ASB in CA by 5,9 %, OR = 1,059 (95 % CI: 1,033; 1,087); the increment in glucose and total cholesterol by 1 mmol/l increases the risk by 44,1 % and 25,2 %, respectively: OR = 1,441 (95 % CI: 1,084; 1,966), OR = 1,252 (95 % CI: 1,010; 1,565).Conclusions.Our data enable to determine the most unfavorable predictors of ASP in CA and can potentially serve as a guideline for early diagnosis and medical management to prevent cardiovascular diseases in rotational shift workers in the Arctic.

Risk prediction for subclinical carotid atherosclerosis in rotational shift workers in the arctic

Abstract Introduction High prevalence of cardiovascular events at northern latitudes determines the necessity of studying mechanisms of formation and early diagnosis of atherosclerotic process. Purpose To determine the most unfavorable prognostic factors that provide the percentage of correct prediction and high accuracy in detection of atherosclerotic plaque (ASP) in common carotid arteries (CCA) in rotational shift workers in the Arctic. Methods Within 2010–2012 a study of 424 males aged 30–59 years at the medical unit “Gazprom dobycha Yamburg” (Yamburg settlement, 68°N) was performed. Patients were randomized into 2 groups according to blood pressure (BP). Gr.I included 294 people with BP more than 140/90 mmHg, arterial hypertension (AH) of 1,2 stage and Gr.II included 130 people with BP less than 140/90 mmHg. Groups did not differ in age (46.9±5.8 years, p=0.435); total work experience in the Arctic: 16.5±6.8 years (p=0.512) and rotational shiftwork duration: 12.5±4.6 years (p=0.597). Office BP was 149.4±13.3/97.1±7.3 mmHg in Gr.I and 123.4±7.5/80.5±5.5 mmHg in Gr.II. Ultrasound examination of carotid arteries with determination of presence or absence of ASP in CCA and estimation of stenosis using NASCET method were performed; ambulatory blood pressure monitoring was conducted; blood glucose levels, total cholesterol, high-density lipoprotein cholesterol, low density lipoprotein cholesterol were determined. Statistical analysis was carried out using R (v. 3.6.1) programming language for statistical data processing of R Studio application package (v. 1.2.1335). Results Signs of CCA atherosclerosis were revealed in 56% of patients with AH and in 25% of those without AH. According to multivariate analysis, three variables with the most significant set of predictors, associated with ASP in CCA with the percentage of correct prediction of 75.9% were selected by step-by-step method: diastolic BP24 (<0.0001), glucose (0.0167) and cholesterol (0.0439). Based on the obtained model, it was concluded that 1 mmHg increase in diastolic BP24 increases the risk for developing ASP by 5.9%, Exp. (Beta) = 1.059, 1 mmol/l increase in glucose and cholesterol escalates the risk by 44.1% and 25.2%, respectively: Exp. (Beta) = 1.441 and Exp. (Beta) = 1.252. Conclusion The data obtained will improve accuracy for the early diagnosis of subclinical atherosclerosis of CCA, allow to prescribe lipid-lowering therapy timely and reduce the risk of adverse cardiovascular events in rotational shift workers in the Arctic. Funding Acknowledgement Type of funding source: None

Correlation between Carotid Intima-media Thickness and Risk Factors for Atherosclerosis

The purpose of this study was to investigate the effect of carotid artery ultrasound Respectively. The carotid intima-media thickness is known to have a significant correlation with cardiovascular disease and cerebrovascular disease. We investigated the relationship between carotid intima - media thickness, body mass index, waist circumference, the blood lipid value, fasting blood glucose, glycated hemoglobin, and blood pressure using carotid artery ultrasound. The carotid artery ultrasound was considered to be abnormality of IMT thickness over 0.8 mm and the presence or absence of atherosclerotic plaque was evaluated. Serological tests were used to compare the geologic value, fasting blood glucose level, and glycated hemoglobin. As a result, waist circumference (=.022), low density cholesterol (=.004), fasting blood glucose level (.019), and glycemic index (.002) were analyzed as predictors of atherosclerosis. In the ROC curve analysis, sensitivity was 87.80% (95% CI: 73.8-95.9), specificity was 41.67% (95% CI: 30.2-53.9), sensitivity was 78.05% (95% CI: 62.4-89.4) in low density lipoprotein, Specificity was 50.00% (95% CI: 38.0-62.0), sensitivity was 73.11% (95% CI: 57.1-85.8), specificity was 61.11 (95% CI: 48.9-72.4) and sensitivity was 82.93%-91.8) and a specificity of 43.06% (31.4-55.3). In logistic regression analysis, the risk of atherosclerosis was 0.248 times at waist circumference (WC)> 76 cm, 3.475 times at low-density lipoprotein (LDL-C) ≥124 mg / dL, 0.618 at HbA1c> 5.4% It appeared as a times. We suggest that prospective study of carotid artery ultrasound should be performed for the effective prevention of cardiovascular diseases.

Recurrent tendosynovitis as a rare manifestation of a lipid disorder

A 33-year-old female had suffered from spontaneously recurrent bursitis and tendosynovitis/enthesitis of the patellar and Achilles tendons for about 10 years. The episodes of immobilization increased. Ultrasound imaging of the swollen and painful tendons showed chronic inflammation with neoangiogenesis within the tendons and hypoechoic lesions. Clinical and laboratory tests did not provide evidence for a rheumatic disease. Low density lipoprotein cholesterol was elevated. Biopsies of skin lesions did not confirm the suspicion of cutaneous xanthomas. Genetic testing for familial hypercholesterolemia was negative. Campesterol and sitosterol were elevated 7- to 12-fold and 20- to 38-fold over the upper limit of normal on two occasions. There was no relevant mutation in ABCG5. In ABCG8, we identified a missense mutation c.1267G>A in exon 9 changing glutamic acid 423 into lysine within the transmembrane domain, and an insertion of adenine (c.1487insA) leading to a frameshift and a premature stop codon (Ile497Aspfs*105). The patient had no clinical evidence of premature atherosclerosis. Therapeutic approaches with nonsteroidal antirheumatic drugs, prednisone, statins, and ezetimibe accompanied by a diet poor in plant sterols led to a relief of symptoms. This case report shows that tendon xanthoma along with tendosynovitis, especially on extensor areas, is suspicious for hypercholesterolemia as the underlying cause. The absence of atherosclerotic plaques in the abdominal aorta and in the carotid arteries on ultrasound may suggest that phytosterolemia is not necessarily accompanied by premature vascular disease.

Association between the Number of Chondrocytes of Lumbar Intervertebral Discs and Age, Abdominal Aorta Atherosclerosis and Lumbar Artery Arteriosclerosis Descriptive Cross Sectional Study

Background: The effect of age, atherosclerotic changes of abdominal aorta and arteriosclerotic changes of lumbar arteries on number of chondrocytes of lumbar intervertebral discs has not been studied. Methods: A descriptive cross sectional post mortem study was carried out in Faculty of Medicine, University of Kelaniya, Sri Lanka to determine the association between the mean number of chondrocytes in the fifth lumbar intervertebral disc and age, the level of atherosclerotic changes of the lumbar abdominal aorta and arteriosclerotic changes of right and left, fourth lumbar arteries. The presence or absence of atherosclerotic plaques in the abdominal aorta lumbar region was studied. To assess arteriosclerotic changes, the Intima Media thickness (IMT) and the total thickness (TT) of lumbar arteries were measured and the ratio IMT/TT was calculated. Bivariant analysis and a multi variant analysis were done. Results: There were 51 samples in total. Their ages ranged from 18 to 96 years. The mean age (SD) was 43 (± 17.1) years. The samples were obtained from 38 males and 13 females. There was a significant negative association (P<0.001; Beta Coefficient=- 0.95) between the age of the subject and the mean number of chondrocytes in the intervertebral disc. There was no significant association between atherosclerotic changes of abdominal aorta and arteriosclerotic changes of lumbar arteries and the mean number of chondrocytes. Conclusion: Only the age had a significant negative association with the mean number of chondrocytes of the intervertebral disc.

Grosor íntima-media en una muestra de mediana-avanzada edad de la población general española

ObjectivesTo ascertain reference values of carotid intima-media thickness (cIMT) in a middle and old-aged sample of the Spanish general population and to establish the 75th percentile above which it is necessary to control more strictly other cardiovascular risk factors. To determine cIMT values and the number of carotid plaques in age and sex subgroups, and whether there are differences between them. Material and methodsLipids, apolipoproteins, number of carotid atherosclerotic plaques if any, and cIMT of both common carotid arteries were determined in 171 individuals, representative of the adult general population of Burgos (Spain). ResultsThe median age of the patients was 63 years (interquartile range=20) and the 75th percentile of carotid IMT was 0,88mm and 0,81mm in men and women, respectively.This study shows that the values of cIMT median increase with age and are higher in men than in women in all age groups, except in individuals over 74 years where cIMT median values are similar. The presence or absence of atherosclerotic plaques was not statistically different between men and women at different ages. ConclusionsThis population study shows the reference values of cIMT in a middle and old-aged sample of the Spanish population and shows that age, male gender, systolic blood pressure (SBP) and personal history of coronary heart disease are the main determinants of increased cIMT.

Atypical Aortic Thrombus: Should Nonoperative Management Be First Line?

Aortic thrombus in the absence of atherosclerotic plaque or aneurysm is rare, and its optimal management remains unclear. Although atypical aortic thrombus (AAT) has been historically managed operatively, successful nonoperative strategies have been recently reported. Here, we report our experience in treating patients with AAT that has evolved from a primarily operative approach to a first-line, nonoperative strategy. Records of patients treated for AAT between 2008 and 2011 at our institution were reviewed. Ten female and three male patients with ages ranging from 27 to 69 were identified. Seven were treated operatively and 6 nonoperatively. Initial presentation was variable and included limb thromboembolic events (n=6), visceral ischemia (n=5), and stroke (n=1). Associated risk factors included hypercoagulability (76%; n=10) and hyperlipidemia (38%, n=5). In the nonoperative group, complete thrombus resolution was obtained via anticoagulation (n=5) or systemic thrombolysis (n=1). Complete thrombus extraction was achieved in all operative patients. There were 11 significant complications in 5 of the 7 patients (71%) in the operative group, including intraoperative lower extremity embolism, pericardial effusion, stroke, and 1 death. There was 1 complication in the patients treated nonoperatively. The median hospital length of stay was 9days (range 3-49) for those treated nonoperatively and 30days (range 4-115) for those undergoing operative thrombectomy. Although AAT has traditionally been treated operatively, nonoperative management of AAT with anticoagulation or thrombolysis is feasible in selected patients and may lessen morbidity and length of hospitalization in those patients for whom it is appropriate.

Structural Changes in the Myocardium and Serum Lipid Spectrum in Experimental Hypercholesterolemia and Hypothyroidism

We studied the peculiarities of lipid spectrum of the blood and structural reorganization of the myocardium in experimental hypercholesterolemia with and without hypothyroidism. It was found that alimentary hypercholesterolemia accompanied by elevated total cholesterol, LDL, HDL, and triglyceride concentrations led to a decrease in body weight, heart weight, number of cardiomyocytes in the heart and induced pronounced lytic changes in cardiomyocytes, circulation disorders (sludge syndrome, echinocytosis of erythrocytes, lymphostasis), diffuse fibrosis of the stroma, and appearance of foam cells among diffuse mononuclear infiltrate cells. The combination of hypercholesterolemia with hypothyroid status caused more pronounced changes in the lipid spectrum and atherogenic index and more pronounced lytic and necrobiotic changes in cardiomyocytes. These findings suggest that elevated cholesterol concentrations in the blood, especially against the background of suppressed thyroid function, can directly induce considerable damage to cardiomyocytes, intramural vessels, and erythrocytes without the development of myocardial ischemia and in the absence of atherosclerotic plaques.

Carotid Artery Atherosclerotic Profile as a Predictor of the Aorta Atherosclerotic Profile in Patients with Cerebrovascular Events

Background: It is well known that the presence of atheroma of the thoracic aorta is a risk factor for cerebrovascular events. We sought to evaluate whether the presence and the morphology of atherosclerotic plaque in the carotid artery detected by duplex ultrasonography is associated with disease in the proximal aorta visualized by transesophageal echocardiogram in patients with a cerebrovascular event. Methods: We carried out a cross-sectional prospective study including 147 consecutive patients with prior stroke or transient ischemic attack (TIA). Neurological evaluations were performed by an expert neurologist using clinical and tomographic diagnostic criteria including the definition of etiology and whether the patient suffered from stroke or TIA. Transthoracic and transesophageal echocardiograms and carotid artery duplex ultrasonography were performed by the same examiner. Patients with and without plaque in the carotid artery were compared using Student's t test or the χ² test. Regression analysis was used to determine whether the presence of plaque in the carotid artery was predictive of the presence of plaque in the proximal aorta and to analyze the relationship between the echogenicity of carotid and aortic plaques. The significance level was set at p < 0.05. Results: All 147 patients (95 men) were included in the analysis. Patients' ages ranged from 23 to 85 years (65 ± 12.4 years). Most of the patients (58.5%) were Caucasian, while 41.5% were African-Brazilian. Arterial hypertension, diabetes and tobacco use were more frequent among patients with atherosclerotic plaque in the aorta. A normal carotid intima-media thickness halved the risk of atherosclerotic plaque in the aorta [odds ratio (OR) 0.46, 95% confidence interval (CI) 0.23-0.91; p = 0.026]. The presence of carotid plaque increased the risk of aortic plaque by 70-fold (OR 73.2, 95% CI 25.6-2,018.6; p < 0.001) in univariate analysis. The absence of atherosclerotic plaque in the carotid artery reduced the risk of plaque in the aorta to almost 0 (OR 0.014, 95% CI 0.004-0.041; p < 0.001). Considering the 86 patients with both aortic and carotid plaques, the presence of hypoechoic plaque in the carotid artery was a predictor of hypoechoic plaque in the aorta (OR 10.1, 95% CI 3.3-31.2; p < 0.001). Conclusions: The carotid artery atherosclerotic profile defined by ultrasonography is a strong predictor of the atherosclerotic profile of the proximal aorta. This should be taken into consideration before referring patients with acute cerebrovascular events for transesophageal echocardiogram.

AB1222 Subclinical atherosclerosis and oxidized LDL levels in familial mediterranean fever

BackgroundTo investigate markers of carotid atherosclerosis and oxidized low density lipoprotein(oxLDL) levels in patients with Familial Mediterranean Fever (FMF) who have no risk factors for cardiovascular disease.MethodsWe studied 44 patients...

Discrimination and stratification tests of cardiovascular disease risk assessment models against ultrasound detection of carotid plaques in type 2 diabetics

Atherosclerosis is the early stage of arterial disease, and underlies development of cardiovascular disease (CVD) and stroke. Although sophisticated models for assessing CVD and stroke risk have been derived based on large-scale prospective studies, their abilities in detecting the presence or absence of atherosclerotic plaque have not been investigated. This study aimed to evaluate and compare discriminatory and risk stratifying abilities of 13 CVD risk assessment models against the ultrasound detection of carotid plaques in type 2 diabetes mellitus (T2DM) patients. Forty-nine T2DM subjects were recruited with informed consent, and major anthropomorphic and biomarker data for these models were collected. The model risk scores were evaluated against the carotid plaques detected by Doppler ultrasound. Only the FHS-Lpts-CHD-10Y model, which is a variant of the Framingham model, revealed an area under the receiver operating curve (AUROC) that was significantly different from a random scoring approach (AUROC: 0.681, p was able to stratify the risk levels of carotid plaque presence (Chi-Square statistic: 5.99, p

Periodontitis and atherosclerosis: an observational study

Poor oral health has been related with cardiovascular diseases. Specifically, periodontitis has been implicated in the pathogenesis of atherosclerosis. Our aim was to evaluate the relationship between the degree of carotid atherosclerosis and severity of periodontitis in a patient cohort. Fifty adult patients receiving carotid duplex scans in a cerebral hemodynamics lab were included in the study. Ultrasound protocol included measurement of carotid intima-media thickness (IMT), which is a marker of atherosclerosis, and characterization of any atherosclerotic plaques in the cervical common and internal carotid arteries. Patients were divided into two main groups: the test group had IMT ≥ 1 mm or the presence of any carotid atherosclerotic plaque, and the control group had IMT < 1 mm and absence of atherosclerotic plaques. Periodontal evaluation was performed in all the teeth and characterized according to the clinical attachment level, which between 1 mm and 2 mm was classified as slight, 3 mm and 4 mm as moderate and ≥5 mm as severe. The control group included 15 (30%), while the test group included 35 (70%) subjects. The most common diagnosis was severe periodontitis (40%); moderate and slight periodontitis were also frequent occurrences (32% and 28%, respectively). In the control group, 53.3% had slight, 33.3% had moderate and 13.3% had severe periodontitis. In the test group, those percentages were respectively 22.2%, 44.4% and 33.3%. Patients with atheroma plaque had the highest percentage of severe periodontitis (70.6%). More severe periodontitis was related to atherosclerosis (P = 0.007). This study showed an association between periodontitis severity and carotid atherosclerosis, suggesting that periodontal disease might be a risk indicator for atherosclerotic disease.

Functional alterations in endothelial NO, PGI2 and EDHF pathways in aorta in ApoE/LDLR−/− mice

Adequate endothelial production of nitric oxide (NO), endothelium-derived hyperpolarizing factor (EDHF), and prostacyclin (PGI2) is critical to the maintenance of vascular homeostasis. However, it is not clear whether alterations in each of these vasodilatory pathways contribute to the impaired endothelial function in murine atherosclerosis. In the present study, we analyze the alterations in NO-, EDHF- and PGI2-dependent endothelial function in the thoracic aorta in relation to the development of atherosclerotic plaques in apoE/LDLR−/− mice. We found that in the aorta of 2-month-old apoE/LDLR−/− mice there was no lipid deposition, subendothelial macrophage accumulation; and matrix metalloproteinase (MMP) activity was low, consistent with the absence of atherosclerotic plaques. Interestingly, at this stage the endothelium was already activated and hypertrophic as evidenced by electron microscopy, while acetylcholine-induced NO-dependent relaxation in the thoracic aorta was impaired, with concomitant upregulation of cyclooxygenase-2 (COX-2)/PGI2 and EDHF (epoxyeicosatrienoic acids, EETs) pathways. In the aorta of 3-6-month-old apoE/LDLR−/− mice, lipid deposition, macrophage accumulation and MMP activity in the intima were gradually increased, while impairment of NO-dependent function and compensatory upregulation of COX-2/PGI2 and EDHF pathways were more accentuated.These results suggest that impairment of NO-dependent relaxation precedes the development of atherosclerosis in the aorta and early upregulation of COX-2/PGI2 and EDHF pathways may compensate for the loss of the biological activity of NO.

Aterosclerosis subclínica, un predictor de limitación funcional al año en ancianos con alto nivel funcional: estudio Albacete

Subclinical atherosclerosis is associated with cardiovascular morbidity and mortality, but its relationship with functional limitation as a precursor of disability has not been determined.A longitudinal cohort study was performed in 171 high-functioning community-dwelling adults aged more than 64 years old (mean age 73.7 years, 110 women). All received a carotid ultrasound examination at the beginning of the study. Subclinical atherosclerosis was determined by the presence or absence of atherosclerotic plaques and the sum of the diameters of all the plaques (SDP) in the carotid bilateral tree. Subjects were followed-up at 12 months. The association between subclinical atherosclerosis and functional limitation was assessed with the Timed Up and Go test (TUG) at entry and at 1 year, adjusted by demographic, functional, affective, cognitive and cardiovascular risk factors as covariables.At 1 year after baseline, 37 subjects (21.6%) performed the TUG 20% more slowly: 30 with plaque (30.7%) and seven without plaque (9.5%) (p=0.001). Those with plaque had an adjusted increased risk of performing the TUG 20% more slowly than those without plaque [OR 5.5, 95% CI 2.2-15.8]. SDP was 1.48 mm greater in subjects with more than 20% slowing on the TUG [3.34 vs 1.85; 95% CI 0.52-2.44]. For each 2-mm increment in the SDP, subjects had a 1.9-fold greater adjusted risk of performing the TUG 20% more slowly at 1 year [95% CI 1.4-2.5].Subclinical atherosclerosis is an independent predictor of functional limitation at 1 year in high-functioning older adults.

Spontaneous coronary artery rupture in a young patient: a rare diagnosis for cardiac tamponade

We report a case of spontaneous coronary artery rupture (SCAR) in a 43-year-old male who presented with symptoms of sudden onset of chest pain and hemodynamic collapse. There were no abnormal electrocardiogram changes and serum troponin was not detected. Acute aortic dissection was suspected but urgent contrast computed tomography (CT) showed a large pericardial effusion with cardiac tamponade. This was later confirmed on trans-oesophageal echocardiogram. The SCAR was seen intra-operatively as an isolated perforation of the posterior descending artery. The patient was successfully managed with direct repair under cardiopulmonary bypass. Postoperative multi-detector dual-source 64-slice CT coronary angiography revealed normal coronary arteries with absence of atherosclerotic plaque in all coronary arterial segments. It is concluded that, though rare, a differential diagnosis of SCAR should be considered in cases of acute chest pain with cardiac tamponade in adult patients of all ages.

Atherosclerosis of radial arterial graft may increase the potential of vessel spasm in coronary bypass surgery

RA samples were collected during the procedure (with preopera- tive patient consent) and shipped to the research laboratory in 0.9% saline solution on ice. Intraoperative visual inspection was used to determine the presence or absence of atherosclerotic plaques, which was then confirmed by light microscopic examination of the endothelium in the laboratory. Photographs of normal and sclerotic vessels were taken with a digital camera with a 1:2 macro lens. The arteries were immediately transferred to oxygenated Krebs solu- tion (4°C), and the connective tissue was removed. The smooth muscle strip was carefully dissected and dissociated in an enzyme tube containing collagenase (type F, 1 mg/mL) and elastase (type IV, 0.12 mg/mL). The tissues were incubated with the enzyme in a 37°C bath for 45 minutes and carefully triturated to liberate free smooth muscle cells. Electrophysiologic responses were tested in cells that were phase dense and appeared relaxed. Cell membrane potential was recorded at room temperature with current-clamp mode after a gigaohm seal was obtained. Potassium and calcium currents were also examined with voltage-clamp for kinetic and phar- macologic characterization (data not presented). Acquisition and analysis of data were accomplished with Axopatch 200B and pCLAMP8 software (Axon Instruments, Inc, Foster City, Calif). Results Three atherosclerotic arteries were found among 38 RA samples in the study. These arteries were obtained from patients with no contraindications to coronary artery bypass grafting. Fat plaques and loss of elasticity of arterial wall were used as the diagnostic criteria. The membrane potentials of normal RA range from 30 to 70 mV, compared with 10 to 35 mV in their sclerotic counterparts. The average membrane potentials of normal and atherosclerotic RA tissues were 50.0 7.8 mV (n 4) and 20.3 6.0 mV (n 3, P.05), respectively. One of the sclerotic tissues also exhibited spontaneous spikelike hyperpolar- izations (indicative of sporadic activation of calcium-dependent potassium ion currents); this type of activity was not seen in any of the normal tissues. The membrane potential recordings of both groups are shown in Figure 1.

Calcification of the Coronary Arteries in the Absence of Atherosclerotic Plaque

Calcification of the Coronary Arteries in the Absence of Atherosclerotic Plaque