Atherosclerotic Changes In Carotid Arteries Research Articles

Ultrasound Findings of Carotid Arteries in Patients with Type-2 Diabetes Mellitus

Background and objectives: Type 2 diabetes mellitus is common public health problem nationally and globally. Early detection of the vascular changes with inexpensive and non-invasive techniques is important in the process of management of type 2 diabetes mellitus. The aim of this study was to determine the frequency and grading of carotid artery atherosclerosis using color doppler ultrasound in type 2 diabetes mellitus. Methods: A cross-sectional study was implemented in Radiology Department of Rizgari Teaching Hospital in Hawler city-Kurdistan Region during the period of six months from 1st of March to 1st of September, 2022. Sixty cases of type 2 diabetic patients included in the study and referred from Layla Qasim diabetic center and Rizgari Hospital Outpatient. Left and right carotid arteries (common, internal and bulb) were examined by ultrasound and intima-media thickness were measured, plaque, stenosis and occlusion were looked for. Patients more than 18 years old with type 2 diabetes mellitus included in the study and patients with recent stroke, type 1 diabetes and history of neck surgery were excluded. Results: The mean intima-media thickness of type 2 diabetic patients were higher in both right and left carotid artery bulb (65% and 73.3%) than common (6.7% and 21.7%) and internal carotid arteries (16.7% and 21.7%). The stenosis was observed in 21.7% in each right and left carotid bulb with less proportion of stenosis in common (0% and 1.7%) and internal carotid arteries (8.3% and 3.3%). There was a significant association between smoker and elderly age type 2 diabetic patients and carotid artery stenosis (p=0.03 and p=0.001 respectively). Conclusions: Diabetes mellitus is a common cause of atherosclerotic changes in carotid arteries mainly in the bulb and more on left side. Smoking and elderly age are the common associated factors.

Iron Metabolism Dysregulation and Atherosclerotic Changes in Obstructive Sleep Apnoea

The Syndrome of obstructive sleep apnoea (OSA) is associated with an increased risk of arterial hypertension, metabolic syndrome, diabetes mellitus type 2, brain-vascular damages and atherosclerosis. The aim of this study is to assess the connection between iron metabolism dysregulation in OSA and atherosclerotic changes of carotid arteries. Thirty-five OSA patients with brain-vascular atherosclerotic evidences were included in this study; changes were evaluated by carotid artery intima-media thickness (IMT) and flow-mediated dilatation (FMD). Their results were compared to an equal number of healthy volunteers. Haematological and biochemical assays were performed in all participants in the study. Serum hepcidin levels are statistically significantly increased in OSA patients with atherosclerotic a. carotis changes (101.9±10.1 µg/L) compared to the control group (18.5±2.5 µg/L); $$P<0.001$$. Serum homocysteine levels are significantly higher in OSA than in healthy people. Average IMT (1.22±0.19) and ABI (1.71±0.14) values in OSA patients with atherosclerotic a. carotis changes are increased in comparison to the control group (0.34±0.07, 1.11±0.06, resp.); $$P<0.001$$. Serum vitamin B12 levels were lower in OSA patients with atherosclerotic changes in carotid arteries (71.7±9.9 pmol/L) compared to the controls (449.7±21.4 pmol/L); $$P<0.001$$. A connection between iron homeostasis and atherosclerotic changes was established during this study. Increased hepcidin and homocysteine concentrations might be connected to an elevated risk of cardio- and brain-vascular diseases in OSA. The use of these markers in the routine practice may be very useful for early atherosclerosis assessment in OSA.

Sonographic Comparison of Atherosclerotic Changes in Carotid Arteries of Diabetic and Non-Diabetic Individuals

Objective: To compare the sonographic findings of atherosclerotic changes in carotid arteries of diabetic and non-diabetic individuals. Material & Methods: A cross-sectional study of 62 diabetic and non-diabetic individuals was conducted from 11 November 2021 to 20 March 2022 at the Radiology Department of District Head Quarter Hospital, Faisalabad, Pakistan. The ultrasound of carotid arteries with a TOSHIBA MX Doppler ultrasound machine, using a linear probe with transducer frequency of 5-12.5MHz was performed in both diabetic and non-diabetic participants. Results: The mean value of CIMT in diabetic patients was 0.6839 ± 0.29178mm while the mean value of CIMT in Non- diabetic patients was 0.8000 ± 0.08563mm. The mean value of peak systolic velocity (PSV) of CCA in diabetic patients was 41.4194 ± 6.60189mm and the mean value of PSV of CCA in Non- diabetic patients was 41.7742 ± 6.52538mm. The mean value of PSV of ICA in diabetic patients was 58.4839 ± 12.03293mm and in Non- diabetic patients was 59.0323 ±10.03489mm. Similarly, the mean value of ICA/CCA ratio in diabetic patients was 1.4097 ± 0.39442 while in non-diabetic patients was 1.4323 ± 0.30374. Conclusion: The diagnostic accuracy of ultrasonography of common carotid artery, and internal carotid artery is very high for atherosclerosis. The use of sonography for measurement of IMT and plaque area act as a vital tool for the detection of atherosclerosis changes due to diabetes. Keywords: carotid artery, diabetes mellitus, intima-media thickness

Patterns of the association among ultrasound, hemodynamic and biochemical parameters of atherosclerosis of the carotid and coronary arteries in patients with coronary heart disease

An increase in the proportion of comorbid cardiac patients with primary nosologies such as arterial hypertension and atherosclerosis actualizes the search for optimal approaches to their diagnosis and treatment. The emerging pathogenetic mechanisms of concomitant diseases must be taken into account on an individual basis. Aim of the study was to investigate the patterns of atherosclerotic changes in carotid arteries in patients with coronary heart disease who underwent percutaneous transluminal coronary angioplasty and their correlation with biochemical and hemodynamic markers of atherosclerosis. Material and methods. 53 patients with coronary heart disease (CHD) were examined and treated in the clinic of the Federal Research Center of Fundamental and Translational Medicine. The average age of the patients was 64.73 ± 1.66 years. A comprehensive clinical laboratory examination was conducted, including the blood lipids test to measure content of total cholesterol, low- and high-density lipoprotein cholesterol, triglycerides, as well as serum markers of systemic inflammation (concentration of C-reactive protein (CRP), fibrinogen, erythrocyte sedimentation rate (ESR)) and carotid artery duplex scan. Results. A direct correlation between the severity of atherosclerotic changes in the carotid arteries and indicators of systemic inflammation, i.e. CRP, ESR and fibrinogen was found. The study also revealed greater severity of atherosclerotic stenosis of the carotid arteries in patients with coronary artery disease who underwent percutaneous transluminal coronary angioplasty with coronary artery stenting compared to patients without any intervention. Conclusion. The obtained data indicate the effectiveness of ultrasound scan of the carotid arteries for the early diagnosis of multifocal atherosclerosis for timely treatment and prevention of cardiovascular polymorbidity in patients with a cardiovascular profile.

Increased pulsatility index is associated with adverse outcomes in left ventricular assist device recipients.

AimsRecipients of left ventricular assist devices (LVAD) are exposed to increased risk of adverse clinical events. One of the potential contributing factors is non‐pulsatile flow generated by LVAD. We evaluated the association of flow patterns in carotid arteries and of increased arterial stiffness with death and cerebrovascular events in LVAD recipients.Methods and resultsWe analysed data from 83 patients [mean age 54 ± 15 years; 12 women; HeartMate II (HMII), n = 34; HeartMate 3 (HM3), n = 49]. Pulsatile and resistive indexes, atherosclerotic changes in carotid arteries (measured by duplex ultrasound), and arterial stiffness [measured by Endo‐PAT 2000 as the augmentation index standardized for heart rate (AI@75)] were evaluated 3 and 6 months after LVAD implantation. Sixteen patients died during follow‐up (27.3 months; interquartile range 15.7–44.3). After adjusting for the main variables examined, the pulsatility index measured at 3 months was positively associated with increased hazard ratios (HR) for death and cerebrovascular events [HR 9.8, 95% confidence interval (CI) 1.62–59.42], with HR increasing after adding AI@75 to the model (HR 18.8, 95% CI 2.44–145.50). In HM3 recipients, HR was significantly lower than in HMII recipients (HR 0.31, 95% CI 0.11–0.91), but the significance disappeared after adding AI@75 to the model (HR 0.33, 95% CI 0.09–1.18).ConclusionsThe risk of death and cerebrovascular events in LVAD recipients is associated with increased pulsatility index in carotid arteries and potentiated by increased arterial stiffness. The same risk is attenuated by HM3 LVAD implantation, but this effect is weakened by increased arterial stiffness.

IL-10, Inflammation and Atherosclerosis in Psoriatic Arthritis Patients

It is known that patients with psoriatic disease have increased risk of cardiovascular diseases (CVD) and cardiovascular death but the relationship of those events with influence of traditional risk factors, inflammatory process, anti inflammatory cytokines, and atherosclerosis is not clear.The objective: to investigate surrogate atherosclerosis markers in patients with psoriatic arthritis (PsA), skin psoriasis (PS) and their connection to inflammation activity and serum IL-10 level.Materials and methods. The study was conducted in 2 groups of patients: 42 – with PsA, 20 – with skin psoriasis and 20 healthy subjects. Persons with established CVD, other chronic internal diseases, HIV, diabetes where not included; study groups did not take statins or antihypertensive medications. All included patients and healthy subjects consented to take part in the study and underwent complex of clinical (physical examination, joints and skin examination with DAS28, PASI calculation), laboratory (CRP, hematology, IL-10), ultrasound (examination of the carotid arteries with the surrogate aterosclerosis markers determinations – intima-media thickness (IMT), atherosclerotic plaques (AP)) investigations.Results. PsA patients demonstrated more severe atherosclerotic changes in carotid arteries compared to PS patients and healthy subjects. The severity of the atherosclerotic process was connected with DAS28, CRP level, index PASI. At the same time PsA patients had highest level of IL-10, which might be a sign of upregulation of the anti inflammatory cytokine synthesis in chronic immuno-inflammatory process.Conclusion. Atherosclerosis development is more prominent in PsA then in skin psoriasis patients and healthy subjects, which is connected to the inflammatory process activity. IL-10 is increased in PsA patients which could be explained as a defense reaction to the chronic inflammatory state.

DIAGNOSTIC VALUE OF STRUCTURAL AND FUNCTIONAL CHANGES IN THE CAROTID AND VERTEBRAL ARTERIES IN ARTERIAL HYPERTENSION, ASSOCIATED WITH BENIGN PAROXYSMAL POSITIONAL VERTIGO

Objective of the study was to assess the diagnostic significance of hemodynamic disorders in the area of carotid and vertebral arteries in patients with hypertension combined with benign paroxysmal positional vertigo (DPPG) using ultrasound duplex scanning of neck vessels. Material and methods . Thirty eight patients of the clinic of Federal Research Center for Fundamental and Translational Medicine with hypertension and concomitant dizziness were examined. The state of carotid and vertebral arteries, blood flow in the arteries were assessed by duplex ultrasound scanning using the Vivid E9 apparatus. Results and discussion. The influence of the blood flow at the level of carotid and vertebral arteries on the severity of clinical symptoms of dizziness in patients with hypertension with concomitant DPPG was shown. The clinical significance of atherosclerotic changes in carotid arteries, tortuosity of carotid and vertebral arteries of the effectiveness of treatment and prevention of dizziness in patients with hypertension and DPPG was revealed. It is shown that in patients with hypertension and comorbid DPP, the severity of the relationship of hemodynamically significant changes in the carotid and vertebral arteries with clinical manifestations of dizziness is greater than in patients with hypertension without DPP. The use of ultrasound duplex scanning of brachiocephalic arteries in hypertension with comorbid vertigo allows for differential diagnosis of benign paroxysmal positional vertigo and cerebrovascular dyscirculatory disorders, the degree of their participation in clinical manifestations of dizziness. A new medical technology for the diagnosis of pathogenic mechanisms of dizziness in patients with hypertension, using ultrasound duplex scanning of carotid and vertebral arteries, allows to personalize treatment and prevention in such patients.

Justification of Increasing the Blood Flow Velocity in the Arteries of the Thyroid Gland in Autoimmune Thyroiditis as a Reflection of Endothelial Changes Due to Inflammatory Status.

The aim of the research was to determine the dependence of the blood flow velocity in the thyroid arteries in patients with Autoimmune Thyroiditis (AIT) on the presence of atherosclerotic carotid disease and the level of systemic blood pressure. The research involved 20 patients with AIT in euthyroid state, 30 patients AIT in euthyroid state with stable Coronary Heart Disease (CHD), 30 patients with stable CHD and 30 healthy individuals. Participants of the research were examined using ultrasound of carotid arteries and inferior thyroid arteries. Parameters of blood flow velocity were compared with the level of systemic blood pressure. In AIT peak systolic velocity and resistance index in the inferior thyroid arteries were significantly higher than in healthy individuals and patients with CHD (p<0.05). In patients with CHD velocity parameters in carotid arteries were high, unlike in the healthy individuals and patients with AIT (p<0.05). In patients with AIT without CHD the atherosclerotic changes of carotid arteries were not found. Increased systemic blood pressure was noticed in all patients with CHD without significant differences between groups. The value of peak systolic velocity and resistance index of inferior thyroid arteries in autoimmune thyroiditis are noticed even with euthyroidism and do not depend on systemic blood pressure and atherosclerosis of carotid arteries. Increasing the thyroid arterial blood flow velocity parameters should be considered as sign of an active inflammatory period AIT, where advanced fibrosis is not present.

Ochronne właściwości cholesterolu HDL i zwapnień w blaszce miażdżycowej w zaawansowanej miażdżycy u pacjentów z udarem niedokrwiennym mózgu

STRESZCZENIEWstęp: Zmiany miażdżycowe w tętnicach szyjnych odgrywająistotną rolę w patogenezie udaru niedokrwiennego mózgu.W znacznym procencie przypadków stwierdza się wyraźną asymetrięw rozwoju tych zmian, które zajmują tylko jedną tętnicę.Celem pracy było ustalenie wpływu sercowo‑naczyniowychczynników ryzyka na obecność istotnych hemodynamiczniezmian miażdżycowych lub niedrożności tylko w jednej tętnicyszyjnej w porównaniu do obustronnego ich zajęcia u pacjentówz udarem niedokrwiennym mózgu.Materiały i metody: Pacjenci z rozpoznaniem udaru niedokrwiennegomózgu poddani zostali retrospektywnej oceniew kierunku zwężenia ≥70% lub niedrożności, co najmniej w jednejtętnicy szyjnej wewnętrznej lub wspólnej. Do badania zostałowłączonych 104 pacjentów. Grupę I stanowili chorzy z istotnymhemodynamicznie zwężeniem (≥70%) lub niedrożnością jednejtętnicy (n = 48). Grupę II stanowiły osoby z obustronnymistotnym hemodynamicznie zwężeniem (≥70%) lub niedrożnościątętnic szyjnych (n = 56).Wyniki: Nie stwierdzono różnic w częstości występowanianiemodyfikowalnych czynników ryzyka pomiędzy grupami.W grupie I stwierdzono istotnie wyższy poziom cholesteroluHDL (45,7 vs 38,9 mg/dL, p = 0,038) i istotnie częściej obecnośćzwapnień w blaszkach miażdżycowych tętnic szyjnych(p = 0,03). Nie stwierdzono różnic w częstości występowaniainnych badanych czynników pomiędzy grupami.Wnioski: Ochronne właściwości cholesterolu HDL i wolniejszadynamika powstawania bardziej stabilnych, uwapnionych blaszekmiażdżycowych odgrywają istotną rolę w rozwoju tylkojednostronnych, zaawansowanych zmian miażdżycowych w tętnicachszyjnych. Rola HDL w patomechanizmie powstawaniaudaru mózgu wymaga dalszych badań.

Association between Apolipoproteins AI and B and Ultrasound Indicators of Carotid Atherosclerosis.

Apolipoproteins A-I and B (apoA-I and apoB) may be better indicators of the risk of cardiovascular and cerebrovascular diseases than conventional risk factors (RFs). The onset of ischemic stroke (IS) may be preceded by the development of atherosclerotic changes in carotid arteries, which can be detected by ultrasound. Only a certain % of patients with IS have an (underlying) carotid etiology. The aim of our study was to determine the association between ultrasound indicators of carotid atherosclerosis and the presence of apolipoproteins and other biomarkers in patients with IS. The study included 120 patients with clinically first, non-cardioembolic ischemic stroke in the carotid circulation. For all patients the following data were recorded: risk factors (hypertension, diabetes, hyperlipoproteinemia, smoking, obesity, metabolic syndrome, (MetS) hyperhomocysteinemia and inflammation), and levels of blood pressure, glucose, glycosylated hemoglobin, lipids, apoA-I and apoB apolipoproteins, body mass index, homocysteine, and C-reactive protein (CRP). Carotid duplex ultrasound was used to measure carotid intima media thickness (cIMT) and determine the presence of an unstable (hypoechogenic) plaque. The most significant associations were found between cIMT and older age (β=0.230; p=0.006), lower concentrations of apoA-I (β=-0.244; p=0.008) and a higher apoB/apoA-I ratio (β=0.247; p=0.007). The presence of a hypoechogenic plaque was most significantly associated with increased concentrations of apoB (OR=2.29; 95% CI=4.9-173.5; p<0.0001), the presence of MetS (OR=9.2; 95% CI=2.9-29.2; p<0.0001) and elevated CRP (OR=2.7; 95% CI=1.1-6.9; p = 0.046). Among RFs and their biomarkers, apoA-I, apoB and the apoB/apoA-I ratio showed strong association with ultrasound indicators of carotid atherosclerosis in IS patients.

Role of inflammation versus hypercholesterolemia in the development of atherosclerosis in male albino rats

Background Atherosclerosis (AS) is a chronic condition in which dyslipidemia had been contributed to its development, along with evidence proving an inflammatory cause. Objective The aim was to determine the relation between dietary hypercholesterolemia and AS with a trial to evaluate the role of inflammation in development of AS in male albino rats. Materials and methods A total of 30 adult male albino rats were divided into two main groups: control group (n=6) and high-cholesterol diet (HCD)-fed group (n=24), which was subdivided into four subgroups (n=6): HCD-fed, HCD-fed with methotrexate, HCD-fed with cholestyramine, and HCD-fed with statin groups. Serum total cholesterol (TC), triglycerides, high-density lipoprotein (HDL) cholesterol, non-HDL cholesterol, low-density lipoprotein (LDL)-cholesterol, very LDL-cholesterol, atherogenic index, LDL/HDL ratio, and inflammatory markers such as inerlukin-6, tumor necrotic factor-α, and highly sensitive C-reactive protein were estimated. Carotid artery histopathology was done. Results HCD produced marked disturbance in lipid profile and increased inflammatory markers and atherosclerotic changes in carotid artery. Administration of statin and cholestyramine significantly improved this dyslipidemia. Elevated inflammatory markers were significantly decreased by administration of methotrexate and statin. Atherosclerotic changes in carotid artery decreased significantly in rats pretreated with methotrexate and statin. Conclusion Atherosclerotic condition is closely associated with excessive intake of cholesterol-rich diet; however, inflammation has a central role in the pathogenesis of the atherosclerotic process, as atherosclerotic changes could be reduced despite disturbed lipid profile by anti-inflammatory medication. Further studies are recommended for more evaluation of the role of anti-inflammatory drugs in reduction of clinical outcomes in atherosclerotic conditions.

Association Between Conjunctival and Corneal Calcification and Atherosclerotic Changes in the Carotid Artery in Maintenance Hemodialysis Patients.

We aimed to investigate the association between atherosclerotic changes in the common carotid artery (CA) and conjunctival and corneal calcification (CCC) in maintenance hemodialysis (MHD) patients. Fifty eyes of MHD patients with the highest CCC scores were enrolled. CCCs were scored according to the method described by Tokuyama et al. The eyes with the highest CCC scores were selected for further analysis. According to their CCC scores, the patients were classified into 3 groups: mild (0-2 score), moderate (3-5), and severe (6-10 score). Atherosclerosis of the common CA was evaluated by determination of intima-media thickness (IMT), peak systolic (PSV) and end diastolic (EDV) flow velocities, pulsatility index, and resistive index values by using Doppler ultrasonography. The mean IMT of the CA was 0.61 ± 0.09 mm in the mild group, 0.82 ± 0.16 mm in the moderate group, and 1.21 ± 0.32 mm in the severe group (P < 0.001). The PSV and EDV were significantly higher in the severe group than in the mild and moderate groups (all, P < 0.001). The CCC score was positively correlated with the duration of hemodialysis, ocular surface disease index score, IMT, PSV, EDV, lymphocyte, calcium, and sedimentation rate. In multiple stepwise linear regression analysis, IMT was the best predictive factor for the CCC score (R = 0.812, β = 9.526 ± 1.05, and P < 0.001). Our results suggest that chronic ocular ischemia due to atherosclerotic changes may have a role in the formation or progression of CCC in MHD patients.

CAROTID ATHEROSCLEROSIS

Objectives: To determine the frequency of carotid atherosclerosis in obesepatients having hepatic steatosis and its effect on the development of MI. Design: Crosssectionalstudy. Setting: Department of Radiology Allied Hospital, Faisalabad. Period: FromJanuary 2012 to June 2013, Patients and method: A total of 96 patients were included in thisstudy. LOGIC 5 Doppler ultrasound machine was used. B-mode ultrasonography of commoncarotid arteries was performed on both sides with a 7.5 MHz linear array transducer. Ultrasoundwas done in supine position &amp; elevation of chest by pillow. Patient head will be turned to theopposite side. Intima media thickness was accessed in the distal wall of common carotidartery of both sides 1.0 cm proximal to carotid bulb. Results: Mean age of the patients was46.69±11.86 years. Out of 96 patients, 51 (53.1%) were males while remaining 45 patients(46.9%) were females. Presence of carotid atherosclerosis was noted in 96 patients (100.0%).Out of these patients, myocardial infarction was present in 81 patients (84.4%). Mean BMI was30.67±0.47, mean weight was 91.86±7.57 Kg and intima media thickness was 0.84±0.12 mm.Conclusion Prevalence of atherosclerotic changes in carotid arteries detected by Dopplerultrasound among obese patients having hepatic steatosis and its effect on the developmentof MI is remarkable

Carotid intima-media thickness as a marker of atherosclerosis in hemodialysis patients.

Atherosclerotic changes in carotid arteries of hemodialysis (HD) patients reflect global atherosclerotic changes in vasculature. Carotid intima-media thickness (CIMT) can be used for atherosclerosis prediction and assessment of cardiovascular risks in HD patients, and thus screening high-risk patients. In this cross-sectional study, CIMT was measured using ultrasonography (B-mode with 5-10-MHz multifrequency linear probe) in HD patients in our hospitals. Additionally, we assessed the relationship between their CIMT and some cardiovascular risk factors. A total of 62 HD patients (64.5% male) were included. Age, body mass index, low-density lipoprotein, fasting blood sugar, history of diabetes mellitus and cardiovascular disease, serum albumin, and duration and adequacy of HD in study patients had significant association with their CIMT. There were no significant relationships between CIMT and patient's gender, smoking, serum calcium, phosphate, calcium x phosphate product, hemoglobin, and uric acid level. More diagnostic modalities must be performed for detecting the impact of atherosclerosis on HD patients with high CIMT.

ASSOCIATION OF THE METABOLIC SYNDROME CONSTITUENTS WITH MARKERS OF SUBCLINICAL TARGET ORGAN DAMAGE DURING FOLLOW-UP OF INTELLECTUAL LABORERS

Aim. To evaluate the relation of metabolic syndrome (MS) and its constituents with markers of subclinical damage of target organs (TOD) in follow-up of almost healthy intellectual laborers. Material and methods. From the selection of 1600 employees of a bank we randomly selected 383 with at least one component of MS without cardiovascular disorders, of those by the end of 2 years period 331 came to final visit (response 86%). Mean age 46,6±9,0 y., mostly women (214 (64,6%)). All patients underwent anthropometry, blood pressure measurement (BP), lipids investigation, creatinine and fasting glucose, echocardiography with the assessment of the left ventricle hypertrophy (LVH), ultrasound study of carotid arteries (intima-media complex thickness — CIM, and atherosclerotic plaques), vascular rigidity assessment, anklebrachial index, albumin concentration in single portion of urine at both stages of observation. Results. While performing multiple logistic regression, presence of arterial hypertension (AH) associated with increased probability of LVH, thickening of CIM and higher vessel rigidity in standardization by gender and age. Relation of MS with the markers of TOD has not been found. In 2 years of follow-up there was a significant increase of patients with thickening of CIM (from 81 (24,5%) to 146 (44,1%), p<0,001) and decrease of LVH prevalence (from 154 (46,7%) to 109 (32,9%), p=0,003) together with significant decrease of BP and total cholesterol. Conclusion. Presence of AH is associated with higher probability of LVH and increased vessel rigidity, as atherosclerotic changes in carotid arteries. MS was not related with an increased prevalence of TOD, and the main predetermining factors for structural heart abnormalities, the vessels and kidneys, were gender and age. In 2 years of observation there was markedly decreased number of patients with LVH and kidney dysfunction at the background of BP pattern improvement, and increase of the number of patients with thicker CIM, regardless of a decrease of the hypercholesterolemia patients. In MS patients there was more common to use antihypertension treatments, that led to more prominent LVH regression.

Прогнозирование субклинического атеросклероза сонных артерий на основании параметров отрицательного в отношении ишемии нагрузочного теста

to elucidate relationship between parameters of negative ischemic stress test and subclinical atherosclerosis of carotid arteries.Electrocardiographic stress test on treadmill and ultrasound study of carotid arteries (CA) were carried out in 204 patients (100 women and 104 men, mean age 54.16±8.07 years without verified ischemic heart disease and with ≥ 1 traditional factors of cardiovascular risk). Measurements of intima media thickness (IMT) in three extracranial CA segments and identification of atherosclerotic plaques (AP) were used for detection of subclinical atherosclerosis. CA total atherosclerotic plaque area (TAPA) was calculated when appropriate.Multifactorial regression analysis revealed the following predictors of increased IMT and TAPA: physical working capacity, increment and reserve of heart rate (HR), HR restoration, and increment of systolic arterial pressure (SAP). Presence of atherosclerotic plaque was associated with SAP rise > 42% during exercise test and slow HR restoration (≤42 bpm at 2-nd minute of recovery period).Analysis of nonelectrocardiographic parameters of negative relative to ischemia induction exercise test allows predicting severity of atherosclerotic changes in CA. The information obtained can supplement assessment of traditional factors of cardiovascular risk.

Study of Conventional and Novel Risk Factors of Ischemic Stroke in Eastern India

Background: Stroke accounts as one of the leading cause of morbidity and mortality and third most common cause of death worldwide. In a significant percentage of stroke patients no definite cause can be identified. These group of unknown cause, the so-called ‘cryptogenic strokes’ are associated with some novel risk factors and now a major focus for clinical discussion. Objectives: To find out conventional risk factors behind ischemic stroke and to establish correlation between ischemic stroke with elevated lipoprotein(a), Homocysteinemia, elevated High-sensitivity C-reactive protein (hs CRP),Systemic Lupus Erythematous (SLE) and chronic H.pylori infection and carotid intimo-medial thickness(CIMT). Materials and methods: Thirty (30) admitted ischemic stroke patients based on WHO definition and confirmed by axial CT and or MRI Scan. were included. Thirty (30) controls were recruited from close relatives of the patients attending the Medicine OPD without any prior history of stroke or coronary heart diseases. Risk factors were documented on the basis of biochemical tests performed. Results : Statistically significant association of ischaemic stroke with diabetes,hypertension, smoking, homocysteine, Lp(a), hsCRP, LVH, CIMT,H.pylori infection. No association of valvular heart disease, atrial fibrillation, A.N.A was found with ischaemic stroke. Conclusion: In addition to measures that include blood sugar, blood pressure and lipid control routine estimation of Lp(a), homocysteine level, monitoring of atherosclerotic changes in carotid artery by Doppler study, echocardiographic monitoring of LVH should be done so that appropriate steps can be taken to avert an attack of stroke. Lastly early detection and eradication of H.pylori is always advisable to reduce the incidence of ischemic stroke. DOI: http://dx.doi.org/10.3329/jom.v14i1.13165 J MEDICINE 2013; 14 : 11-17

Clinical determinants of carotid intima-media thickness in patients with diabetes mellitus type 2

Background and purposeEarly atherosclerotic changes in carotid arteries can be detected using ultrasound examination. The aim of this study was to assess correlations between intima-media thickness (IMT) and gender, age and clinical features of diabetes mellitus (DM). Material and methodsThe study group consisted of 73 patients with type 2 DM (mean age: 63.6 ± 7.5 years), and 74 controls without DM (mean age 62.2 ± 7.5 years). Analysed clinical features of diabetes included disease duration, anti-diabetic treatment, glycaemic control (HbA1c level), presence of metabolic syndrome, and complications of macroand microangiopathy. IMT was measured using ultrasonography in the carotid arteries (common – CCA, bifurcation, internal – ICA) bilaterally. ResultsMean and maximum IMT in the CCA was greater in diabetic patients than in controls. Age and male sex, but not vascular risk factors, were independent predictors of increased IMT in all segments. Macroangiopathy correlated with IMT within both CCA in univariate analysis. After adjusting for age and gender, this relationship remained significant in the right CCA in middle-aged patients (59–67 years; p = 0.01 for mean IMT, p = 0.02 for maximum IMT). In patients without metabolic syndrome, IMT in the right CCA bifurcation correlated with HbA1c level (p = 0.05). Patients treated simultaneously with insulin and oral antidiabetic drugs had smaller IMT in the right ICA than those treated with insulin only (0.471 ± 0.105 vs. 0.678 ± 0.209 mm; p = 0.04). ConclusionsIn diabetic patients, ultrasound IMT measurement can be used to assess the cardiovascular risk and to determine indications for intensified anti-diabetic treatment. IMT is a sensitive marker of early carotid atherosclerosis, particularly on the right side.

Relation of stiffness parameter β to carotid arteriosclerosis and silent cerebral infarction in patients on chronic hemodialysis

Aortic stiffness measured by pulse wave velocity (PWV) predicts all-cause and cardiovascular mortality in hemodialysis (HD) patients. However, there is a lack of information on stiffness parameter beta, another index of arterial stiffness, in HD patients. The aim of the present study was to investigate the clinical usefulness of stiffness parameter beta in HD patients. We compared the relation of stiffness parameter beta to carotid intima-media thickness (IMT) and plaque score estimated by carotid ultrasound and investigated the relationship between stiffness parameter beta and silent cerebral infarction (SCI) in 64 HD patients. Stiffness parameter beta was positively correlated with mean IMT (r = 0.318, P = 0.0113) and plaque score (r = 0.672, P < 0.0001). Stepwise regression analysis revealed that pulse pressure and age were found to be independent determinants of stiffness parameter beta (partial correlation coefficients: beta = 0.501 and P < 0.0001 for pulse pressure, beta = 0.488 and P < 0.0001 for age). In addition, stiffness parameter beta in patients with SCI (12.2 +/- 3.9) was significantly higher than those (8.0 +/- 2.4) in patients without SCI. However, there was no significant difference in mean IMT and plaque score in both groups. These results suggest that arteriosclerosis assessed by stiffness parameter beta is associated with atherosclerotic changes of carotid arteries and with the presence of SCI in HD patients.

Diagonal Ear-Lobe Crease is Correlated With Atherosclerotic Changes in Carotid Arteries

The diagonal ear-lobe crease (ELC) is reported to be a marker of cardiovascular disease. Very few reports have assessed the relationship of ELC with atherosclerosis. This relationship is investigated here using a Japanese population. A prospective cross-sectional study included 212 consecutive patients. Bilateral ear lobes were checked for the ELC and this was followed by carotid ultrasonography to measure the far wall common carotid artery intima-media thickness (CCA-IMT), plaque score (PS) and plaque number (PN). Patients with ELC had significantly higher carotid IMT than controls (0.90 +/-0.24 vs 0.77 +/-0.15, respectively, P<0.001). ELC presence correlated significantly with carotid IMT, PS, and PN (r=0.306, P<0.0001; r=0.198, P<0.008 and r=0.221, P<0.0001, respectively), and also with age, male sex and hypertension. ELC presence and absence in mild or no PS and moderate or severe PS subgroups was significant, with a chi-squared value of 7.59 (P<0.006). In multivariate regression analysis, ELC presence correlated with CCA-IMT independently. The odds ratio for the presence of ELC in patients with CCA-IMT of <0.8 mm vs patients with CCA-IMT of >or=0.8 mm (the median value) was 0.41 (95% confidence interval, 0.22-0.76). The present study showed an association between ELC and increased CCA-IMT, PS, and PN.