Atherosclerosis In Middle-aged Men Research Articles

Circulating Oxidized Low-Density Lipoprotein and Common Carotid Artery Intima-Media Thickness in a Random Sample of Middle-Aged Men

Circulating oxidized low-density lipoprotein (oxLDL) has been suggested to play an important role in atherosclerosis development. According to previous observations, oxLDL correlates with clinically manifest coronary and carotid artery disease. We investigated the association between the oxLDL concentration measured directly in plasma and common carotid artery intima-media thickness (IMT) in a population-based, case-control study in middle-aged men from Southern Finland. oxLDL was determined in 214 men by a commercially available sandwich ELISA test (Mercodia). Carotid artery IMT was measured at 12 standardized segments by B-mode ultrasonography (at the near and far wall of the left and right common carotid arteries, bifurcations and internal carotid arteries), and the overall mean maximum IMT (MMaxIMT) was calculated. The MMaxIMT of the carotid arteries was significantly associated with circulating oxLDL (r_s = 0.16, p = 0.018). In a stepwise multiple regression model with MMaxIMT as dependent variable and systolic blood pressure, smoking, oxLDL, HDL cholesterol and apolipoprotein B as covariates, systolic blood pressure (β = 0.22, p < 0.001), oxLDL (β = 0.15, p = 0.022) and smoking (β = 0.17, p = 0.014) showed an independent association with IMT (R² = 0.10, p < 0.001). Our results show that oxLDL measured directly from plasma is independently associated with subclinical carotid artery atherosclerosis in middle-aged men.

Cardiorespiratory fitness and the progression of carotid atherosclerosis in middle-aged men

Cardiorespiratory fitness and the progression of carotid atherosclerosis in middle-aged men

Oxidized LDL and thickness of carotid intima-media are associated with coronary atherosclerosis in middle-aged men: lower levels of oxidized LDL with statin therapy

We investigated the relation between serum lipids including oxidized LDL and the severity of coronary atherosclerosis. Serum lipids and oxidized LDL was measured in 62 men (33–66 years), who underwent diagnostic coronary angiography and sonography to measure the carotid intima-media thickness. LDL oxidation was found in chemical analyses to be due to conjugated fatty acids in cholesteryl esters and triglycerides. Regression analysis indicated that the carotid intima-media thickness and the ratio of LDL diene conjugation to LDL cholesterol (the ox-LDL:LDL ratio) were the only factors associated independently with the severity of coronary atherosclerosis. The patients with multi-vessel disease who did not use lipid lowering therapy had a 50% thicker carotid intima media ( P=0.030) and a 41% higher ox-LDL:LDL ratio ( P=0.020) than patients with normal vessels. Further, patients with multi-vessel disease on statin therapy had a 24% lower ox-LDL:LDL ratio than the subjects with multi-vessel disease who did not use lipid lowering drugs ( P=0.027), although the concentration of LDL cholesterol did not differ between the groups. This study supports the hypothesis that lipid oxidation plays a role in the development of atherosclerosis.

Cardiorespiratory fitness and the progression of carotid atherosclerosis in middle-aged men. Ann Intern Med 134:12–20, 2001

Background Good cardiorespiratory fitness has been associated with reduced risk for clinical events of atherosclerotic vascular diseases, but whether it is related to slower progression of early atherosclerosis is unclear. Objective: To study the association between cardiorespiratory fitness and the progression of early carotid atherosclerosis. Design: 4-year follow-up study. Setting: Eastern Finland. Participants: Population-based sample of 854 men 42 to 60 years of age. Measurements: Maximal oxygen uptake (VO2max [L/kg per minute]) was measured directly by using respiratory gas exchange in a cycle ergometer exercise test. Carotid atherosclerosis was assessed by using B-mode ultrasonography. Results: After adjustments for age, technical covariates, and cigarette smoking, VO2max had strong, inverse, and graded associations with 4-year increases i maximal intima-media thickness (IMT) (standard regression coefficient β = 0.120; P = 0.002); plaque height (β = 0.140; P &lt; 0.001), surface roughness, and mean IMT (β = 0.080; P = 0.035). These associations weakened but remained statistically significant after additional adjustment for systole blood pressure, serum levels of apolipoprotein B, diabetes, and plasma fibrinogen levels. The increases in maximal IMT, surface roughness, and mean 26.1 mL/kg per IMT (23%, 32% and 100%, respectively) were larger among men in the lowest quartile of VO2max (&lt; minute) than among those in the highest quartile (&gt; 36.2 ML/kg per minute). Conclusions: Good cardiorespiratory fitness is associated with slower progression of early atherosclerosis in middle-aged men. These findings are important because they emphasize that middle-aged men can be evaluated for cardiorespiratory fitness to estimate their future risk for atherosclerotic vascular disease. Additional research is warranted to investigate a possible causal relationship between cardiorespiratory fitness and atherosclerosis.

Cardiorespiratory fitness and the progression of carotid atherosclerosis in middle-aged men.

Good cardiorespiratory fitness has been associated with reduced risk for clinical events of atherosclerotic vascular diseases, but whether it is related to slower progression of early atherosclerosis is unclear. To study the association between cardiorespiratory fitness and the progression of early carotid atherosclerosis. 4-year follow-up study. Eastem Finland. Population-based sample of 854 men 42 to 60 years of age. Maximal oxygen uptake (VO2max [mL/kg per minute]) was measured directly by using respiratory gas exchange in a cycle ergometer exercise test. Carotid atherosclerosis was assessed by using B-mode ultrasonography. After adjustments for age, technical covariates, and cigarette smoking, VO2max had strong, inverse, and graded associations with 4-year increases in maximal intima-media thickness (IMT) (standardized regression coefficient beta = -0.120; P = 0.002), plaque height (beta = -0.140; P < 0.001), surface roughness (beta = -0.147; P < 0.001), and mean IMT (beta = -0.080; P = 0.035). These associations weakened but remained statistically significant after additional adjustment for systolic blood pressure, serum levels of apolipoprotein B, diabetes, and plasma fibrinogen levels. The increases in maximal IMT, surface roughness, and mean IMT (23%, 31%, and 100%, respectively) were larger among men in the lowest quartile of VO2max (<26.1 mL/kg per minute) than among those in the highest quartile (>36.2 mL/kg per minute). Good cardiorespiratory fitness is associated with slower progression of early atherosclerosis in middle-aged men. These findings are important because they emphasize that middle-aged men can be evaluated for cardiorespiratory fitness to estimate their future risk for atherosclerotic vascular diseases. Additional research is warranted to investigate a possible causal relationship between cardiorespiratory fitness and atherosclerosis.

Physical Fitness and Carotid Atherosclerosis in Middle-Aged Men

Physical Fitness and Carotid Atherosclerosis in Middle-Aged Men

Age-dependent association of apolipoprotein E genotype with coronary and aortic atherosclerosis in middle-aged men: an autopsy study.

Apolipoprotein E (apoE) polymorphism is one of the genetic determinants of serum cholesterol values. The apoE epsilon4 allele has been associated with advanced coronary heart disease (CHD) diagnosed by angiography, but the role of the apoE genotype in atherosclerosis has not been confirmed at vessel-wall level, nor is any age-dependent effect of the apoE genotype on the development of CHD known. The right and left anterior descending coronary arteries (RCA and LAD) and the aorta from 700 male autopsy cases (Helsinki Sudden Death Study) in 1981-1982 and 1991-1992 (average age 53 years, range 33 to 70 years) were stained for fat, and all areas covered with fatty streaks, fibrotic plaques, and complicated lesions were measured. In the RCA and LAD, the apoE genotype was significantly associated with the area of total atherosclerotic lesions in men <53 years old but not with that in older men (P=0.0085 and P=0.041, respectively, for age-by-genotype interaction). Men <53 years old with the epsilon4/3 genotype showed 61% larger total atherosclerotic lesion area in the RCA (P=0.0027) and 26% larger area in the LAD (P=0.12) than did men with the epsilon3/3. The apoE epsilon4/3 was also associated with atherosclerotic lesions in the abdominal (P=0.014) and thoracic (P=0.12) aorta, but this effect, unlike that of the coronary arteries, was not age-related. In men, the apoE epsilon4 allele is a significant genetic risk factor for coronary atherosclerosis in early middle age. This suggests that at older age, other known risk factors of CHD play a more important role in the atherosclerotic process than apoE polymorphisms.

Blood pressure and the progression of carotid atherosclerosis in middle-aged men.

Elevated blood pressure has consistently been associated with increased prevalence of preclinical atherosclerosis and with increased risk of clinical atherosclerotic cardiovascular disease (CVD). However, there is no prospective evidence of the association between blood pressure and the progression of preclinical atherosclerosis. We therefore investigated the relationships of systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure to the 4-year increase in the measures of early carotid atherosclerosis, the mean and maximal common carotid intima-media thickness (IMT), assessed by B-mode ultrasonography, in 1026 men aged 42 to 60 years. Men with the SBP of <120, 120 to 126, 127 to 134, 135 to 143, and >143 mm Hg (fifths) had an increase in the mean IMT of 0.074, 0.090, 0.110, 0.136, and 0.158 mm per 4 years (P<0.001 for difference between groups, P<0.001 for linear trend) and in the maximal IMT of 0.212, 0.221, 0.279, 0.286, and 0.315 mm per 4 years, (P<0.001, P<0.001), respectively, adjusting for other atherosclerotic risk factors, including DBP. Also, pulse pressure, when adjusted for other risk factors including mean arterial pressure, was directly associated with the IMT increase. DBP was not independently related to the IMT increase. This is the first documentation to show that mildly elevated SBP and pulse pressure accelerate the progression of preclinical atherosclerosis. This study provides further evidence for the finding that systolic hypertension is a more important risk factor for atherosclerosis and consequent CVD than diastolic hypertension. Therefore, more attention should be paid to the level of SBP in the evaluation of CVD risk and in the treatment of hypertension.

Behavioral correlates of plasma sex hormones and their relationships with plasma lipids and lipoproteins in Japanese men

In contrast to the hypothesis that endogenous testosterone decreases plasma high-density lipoprotein (HDL) cholesterol levels, many, but not all, studies have reported a positive correlation between plasma total testosterone and HDL cholesterol. We examined behavioral correlates of plasma testosterone and estradiol and the relationships between these sex hormones and plasma lipoproteins, in middle-aged Japanese men. Plasma, lipids, including HDL subfractions, total and free testosterone, and total estradiol were determined with 313 men aged 50–54 years who received a preretirement health examination at the Self-Defence Forces Fukuoka Hospital from January to June in 1992. Body mass index and waist-hip ratio were also measured. Smoking habit, alcohol use, and physical activity were ascertained by a self-administered questionnaire. Obesity, especially waist-hip ratio, was a strong correlate of both total and free testosterone, but not of estradiol. Smoking was associated with elevated levels of testosterone without a dose-effect relation. Neither alcohol use nor physical activity was associated with total or free testosterone, but plasma estradiol levels were higher among current alcohol drinkers. HDL and HDL 2 cholesterol were unrelated to either total or free testosterone in the univariate analysis, but negatively associated with free, not total, testosterone after adjustment for obesity. HDL and HDL 2 cholesterol also were positively associated with estradiol regardless of adjustment for obesity and other covariates. These findings add to evidence for a hypothesis that high levels of endogenous testosterone and low estradiol levels may cause a decrease in plasma HDL cholesterol, thereby being linked with atherosclerosis in middle aged men.

Carotid atherosclerosis in middle-aged men. Relation to conjugal circumstances and social support

The purpose of this study was to examine the association of conjugal circumstances and social support with carotid atherosclerosis. The subjects were 212 men randomly selected from those (N = 4,853) aged 50-60 years, living in Kuopio and a nearby residental area in eastern Finland. Social network and support levels were assessed with a structured 34-item questionnaire. Conjugal circumstances were constituted by cohabition or otherwise. Intima media thickness of the carotid artery (IMT) was chosen to designate atherosclerosis, and determined by quantitative B-mode ultrasonography. The analyses showed that the men living alone had greater common carotid (p = 0.008) and carotid bifurcation (p = 0.011) IMT values than their cohabiting counterparts. The differences remained significant even when the confounding factors (age, health status and education level) and potential intervening factors (saturated fat consumption and smoking) were allowed for. Of the social support subindices, strong adequacy of emotional support (p < 0.001) and of the social network subindices, strong social anchorage (p = 0.031) were correlated to increased common carotid IMT. The present data suggest that conjugal circumstances are an independent social factor predicting carotid atherosclerosis.

Inverse relationship between cardiorespiratory fitness and carotid atherosclerosis

The association between cardiorespiratory fitness (V̇O 2max) and carotid atherosclerosis was analyzed in 163 men, aged 50 to 60 years. V̇O 2max was assessed using breath-by-breath respiratory gas analyses during maximal exercise stress test. Atherosclerosis was evaluated quantitatively as intima-media thickness (IMT) of the right and left carotid arteries by high-resolution B-mode ultrasonography. Mean V̇O 2max was 29.6 ml/kg per min (95%CI 28.7;30.5), common carotid IMT 1.04 mm (95%CI 1.01;1.07) and carotid bifurcation IMT 1.73 mm (95%CI 1.66;1.81). V̇O 2max correlated inversely with carotid bifurcation IMT ( r = −0.31, P < 0.001), but not with common carotid IMT ( r = −0.13, P = 0.102). Men in the highest quartile of V̇O 2max had lower ( P < 0.001) bifurcation IMT 1.51 mm (95%CI 1.41;1.61) than men in the lowest (1.95 mm (95%CI 1.75;2.16)) and in the second lowest V̇O 2max quartile (1.79 mm (1.63; 1.95)). The difference persisted ( P = 0.014) after controlling for age, LDL-cholesterol, systolic blood pressure, saturated fat intake, current health status and exercise-induced ST-segment depression. These data suggest that cardiorespiratory fitness is an important independent predictor of carotid atherosclerosis in middle-aged men.

Apolipoprotein (a), fibrinopeptide A and carotid atherosclerosis in middle-aged men

Apolipoprotein (a), fibrinopeptide A and carotid atherosclerosis in middle-aged men

Apolipoprotein(a), Fibrinopeptide A and Carotid Atherosclerosis in Middle-Aged Men

The association between apolipoprotein(a) [apo(a)], fibrinogen, fibrinopeptide A (FPA) and carotid intima-media thickness (IMT) was analyzed in Eastern Finnish men aged 50 to 60 years. Apo(a) correlated directly with carotid bifurcation (r = 0.26, p = 0.001), but not with common carotid IMT. Men in the lowest quartile of apo(a) had thinner (p = 0.013) IMT in bifurcation [1.59 mm (95% CI 1.49; 1.68)] compared to the men in the highest [1.91 mm (95% CI 1.73; 2.09)] apo(a) quartile. The difference remained (p = 0.038) after adjusting for confounders. Plasma fibrinogen was not related to carotid IMT, whereas FPA correlated with common carotid (r = 0.21, p = 0.016) and carotid bifurcation (r = 0.21, p = 0.018) IMT. These associations abolished after adjusting for the confounders. The data suggest that apo(a) associate with carotid atherosclerosis independent of other risk factors for ischemic cardiovascular diseases.