Carotid Bulb Intima-media Thickness Research Articles

Muscular Strength and Carotid Intima-Media Thickness in Physically Fit Young Adults: The CHIEF Atherosclerosis Study.

Background: Greater muscular strength (MusS) has been found to have an inverse association with subclinical atherosclerosis in children, as well as with mortality from cardiovascular diseases (CVDs) in middle-aged and elderly individuals. However, the association of the degree of MusS with atherosclerosis may differ by sex and has not been clarified in young adults. Methods and Results: A total of 1021 Taiwanese military personnel, aged 18–40 years, participated in annual health examinations in 2018–2020. MusS was separately assessed by 2-min push-up and 2-min sit-up numbers. Subclinical atherosclerosis was measured by the left carotid bulb intima–media thickness (cIMT) using high-resolution ultrasonography. Multiple linear regression with adjustments for age, sex, alcohol intake, cigarette smoking, anthropometric indices, blood pressure, and lipid profiles was utilized to determine the correlation between MusS and cIMT. Both 2-min push-up and 2-min sit-up numbers were inversely correlated with cIMT (standardized β: −0.089 and −0.072, respectively; both p-values < 0.05). In men, both 2-min push-up and 2-min sit-up numbers were inversely correlated with cIMT (standardized β: −0.076 and −0.086, respectively; both p-values < 0.05), while in women, 2-min push-up numbers but not 2-min sit-up numbers were inversely correlated with cIMT (standardized β: −0.204 and −0.01; p = 0.03 and 0.99, respectively). Conclusions: Among young adults, there was an inverse association between MusS and cIMT, emphasizing the beneficial impact of MusS on the regression of atherosclerosis. The study also revealed a sex difference and suggested that training of the upper arm muscles may be an effective preventive measure for young women to reduce the risk of early cardiovascular diseases.

Dietary patterns are associated with arterial stiffness and carotid atherosclerosis in postmenopausal women.

PurposeThe increase in cardiovascular risk after the menopausal transition remains partly explained until today. Further research is needed to identify risk factors potentially modifiable by primary prevention practices. This cross-sectional study, part of a larger prospective project, aims to investigate possible associations between dietary patterns and indices of vascular structure and function among healthy postmenopausal women.MethodsPostmenopausal women (n = 310) without clinically overt cardiovascular disease were recruited consecutively from a University Menopause Clinic over three years. Dietary intake was assessed by a validated food frequency questionnaire and the MedDietScore. In addition, we assessed anthropometric/biochemical parameters, including the Triglyceride-glucose index (TyG-Index), body fat distribution [triceps skinfold (TSF), mid-upper arm circumference (MUAC)] and physical activity. The vascular assessment included carotid-femoral pulse wave velocity (PWV), carotid and femoral-artery intima-media thickness (IMT) and atheromatous plaques presence.ResultsConsumption of non-refined cereals was associated with carotid-bulb IMT (R2 = 5.5% b-coefficient = −0.142; p = 0.011), adjusting for age, physical activity, lipids, systolic blood pressure, smoking, body mass index, insulin resistance, and daily energy intake. PWV was associated with the intake of total dairy products (R2 = 27.3%, b-coefficient = −0.117; p = 0.017). Higher red meat consumption was related to a greater TyG-index (Model 1, R2 = 14.3%, b-coefficient=0.121; p = 0.048), an association mediated by total daily energy intake. Higher consumption of alcohol, as well as the MedDietScore, were inversely associated with TSF measurements, significant after Bonferroni correction.ConclusionDietary patterns are associated with metabolic indices and subclinical atherosclerosis in postmenopausal women independently of traditional cardiovascular risk factors, total energy intake or physical activity.

Carotid atherosclerosis, changes in tissue remodeling and repair in patients with aortic coarctation

Background and aimsAfter aortic coarctation (CoA) repair, patients still suffer from cardiovascular complications. The aim of this study was to measure cardiovascular markers, intima-media thickness (IMT) and plaques in controls and patients with CoA. MethodsSixty-four patients with CoA (66% male, mean age 48 ± 15 years) and controls (54% men, mean age 47 ± 16 years) underwent ultrasound of their arteries. A multiplex platform to analyze circulating blood levels biomarkers reflecting inflammation, tissue remodeling and repair was used. ResultsIn men following CoA repair, a significantly increased carotid bulb IMT was observed in comparison to the control group (1.05 [0.72–1.24] vs. 0.67 [0.59–0.95] mm; p = 0.003). Median common carotid artery (CCA) IMT was increased in men compared to controls (0.82 [0.61–0.97] mm vs. 0.58 [0.53–0.76] mm, p < 0.003) and in women compared to controls (0.83 [0.70–0.92] vs. 0.60 [0.55–0.69], p < 0.004). CoA demonstrated an independent association with IMT in both men and women. Men with CoA were also more likely to have a plaque in their carotid arteries (p = 0.010). In women with CoA, we observed significantly lower levels of stem cell factor (SCF, p = 0.004) while in men with CoA we observed significantly lower levels of matrix metalloproteinase-3 (MMP-3, p = 0.048), tumor necrosis factor receptor 1 (TNF-R1, p = 0.032), tumor necrosis factor receptor superfamily member 10B (TRAIL-R2, p = 0.019) and monocyte chemotactic protein 1 (MCP-1, p = 0.015). ConclusionsThis is the first study to show that despite successful CoA repair, patients have more carotid atherosclerosis than can be explained by changes in tissue remodeling and repair.

ELEVATED EXCESS PRESSURE INTEGRAL IS ASSOCIATED WITH VASCULAR BIOMARKERS OF SUBCLINICAL ATHEROSCLEROSIS IN OLDER ADULTS

Objective: Altered central artery haemodynamics could have an unfavourable influence on the vasculature. A previous study has suggested that elevated excess pressure integral (INTXSP), derived from reservoir-excess pressure analysis, could reflect circulatory dysfunction and predispose to developing atherosclerosis. In this study, we aimed to determine whether an alteration in parameters derived from the reservoir-excess pressure analysis would be associated with vascular biomarkers of subclinical atherosclerosis in older adults. Design and method: The data from 958 older adults (69.0 ± 8.2yrs, 351 female, 456 with known cardiovascular disease) were analysed. Using radial artery tonometry, the parameters derived from the reservoir-excess pressure analysis including reservoir pressure integral, INTXSP, systolic rate constant (SRC) and diastolic rate constant were obtained. Common carotid artery intima-media thickness (CA-IMT), carotid bulb intima-media thickness (BL-IMT), common carotid artery wall-to-lumen ratio (CA-WLR) were also obtained using an ultrasound system. Results: Multivariate regression analysis revealed that INTXSP was directly associated with CA-IMT [B = 0.081 (95%CI: 0.029, 0.133)] and CA-WLR [B = 0.010 (95%CI: 0.002, 0.017)] after accounting for conventional cardiovascular risk factors and renal function. SRC was also inversely associated with CA-IMT [B = -0.056 (95%CI: -0.099, -0.012)] and CA-WLR [B = -0.009 (95%CI: -0.017, 0.000)] after accounting for conventional cardiovascular risk factors and renal function. When both INTXSP and SRC were entered into the same regression model together, only INTXSP was associated with those parameters. The observed association was independent of carotid-femoral pulse wave velocity and aortic systolic pressure. BL-IMT did not show any association with reservoir-excess pressure parameters. Conclusions: INTXSP was significantly associated with vascular biomarkers of subclinical atherosclerosis in older adults, suggesting that an elevated INTXSP is linked to the development of atherosclerosis.

Circulating Amyloid Beta 1-40 Is Associated with Increased Rate of Progression of Atherosclerosis in Menopause: A Prospective Cohort Study.

Accumulating evidence suggests that circulating amyloidβ 1-40 (Αβ1-40), a proatherogenic aging peptide, may serve as a novel biomarker in cardiovascular disease (CVD). We aimed to explore the role of plasma Αβ1-40 and its patterns of change over time in atherosclerosis progression in postmenopausal women, a population with substantial unrecognized CVD risk beyond traditional risk factors (TRFs). In this prospective study, Αβ1-40 was measured in plasma by enzyme-linked immunosorbent assay and atherosclerosis was assessed using carotid high-resolution ultrasonography at baseline and after a median follow-up of 28.2 months in 152 postmenopausal women without history or symptoms of CVD. At baseline, high Αβ1-40 was independently associated with higher carotid bulb intima-media thickness (cbIMT) and the sum of maximal wall thickness in all carotid sites (sumWT) (p < 0.05). Αβ1-40 levels increased over time and were associated with decreasing renal function (p < 0.05 for both). Women with a pattern of increasing or persistently high Αβ1-40 levels presented accelerated progression of cbIMT and maximum carotid wall thickness and sumWT (p < 0.05 for all) after adjustment for baseline Αβ1-40 levels, TRFs, and renal function. In postmenopausal women, a pattern of increasing or persistently high Αβ1-40 was associated with the rate of progression of subclinical atherosclerosis irrespective of its baseline levels. These findings provide novel insights into a link between Αβ1-40 and atherosclerosis progression in menopause and warrant further research to clarify the clinical value of monitoring its circulating levels as an atherosclerosis biomarker in women without clinically overt CVD.

Anti-Mullerian hormone concentrations are inversely associated with subclinical atherosclerosis in premenopausal women

Abstract Background Anti-Müllerian hormone (AMH) constitutes a marker of ovarian reserve and appears to have a predictive role regarding the time of menopause. Moreover, AMH is associated with adverse cardiac events. History of premature menopause and early onset of menopause have been associated with increased risk of cardiovascular (CV) disease. In addition, menopausal transition and duration of menopause have been associated with increased burden of subclinical atherosclerosis. However, the association between AMH as a marker of female reproductive age with atherosclerosis in premenopausal women is currently unknown. Purpose To investigate whether AMH concentrations are associated with markers of early atherosclerosis in healthy, normally menstruating women. Methods In a cross-sectional study, vascular structure and function were assessed by measurement of carotid and femoral intima-media thickness (IMT), lipid profile and serum AMH concentrations were assessed. Exclusion criteria were clinically overt CV disease, abnormal ovulatory cycles, polycystic ovarian syndrome, acute infection or chronic inflammatory disease, risk factors for CV disease and any medication Results Seventy premenopausal women, aged 32.7±6.5 years, were included. Mean AMH levels were lower in smokers than in non-smokers and negatively associated with total cholesterol (TC) levels. An inverse association between mean AMH concentrations and IMT in all segments was observed. No correlation with other markers of subclinical atherosclerosis or traditional CV risk factors was found. After multi-variable adjustment for traditional CV risk factors, the association between AMH concentrations combined IMT and carotid bulb IMT, remained significant. Conclusions In healthy, normally ovulating women, low AMH concentrations are associated with an adverse lipid profile and subclinical atherosclerosis, independently of traditional CV risk factors. This finding suggest a role of decreased follicular reserve with atherosclerotic disease. Funding Acknowledgement Type of funding source: None

Anti-Müllerian Hormone Concentrations Are Inversely Associated With Subclinical Atherosclerosis in Premenopausal Women.

Anti-Müllerian hormone (AMH), which is secreted by granulosa cells of late preantral and small antral follicles, is a marker of ovarian reserve. The association of ovarian reserve with subclinical atherosclerosis in women of reproductive age is currently unknown. We primary investigated whether AMH levels are associated with markers of subclinical atherosclerosis in healthy, normally menstruating women. In this cross-sectional study, vascular structure and function were assessed by measurement of carotid and femoral intima-media thickness (IMT), flow-mediated dilation, carotid-femoral pulse wave velocity and augmentation index. Lipid profile and serum AMH concentrations were also measured. Seventy premenopausal women, aged 32.7 ± 6.5 years, were included. Mean AMH levels were lower in smokers than in non-smokers and negatively associated with total cholesterol (TC) levels. An inverse association between mean AMH concentrations and femoral and carotid IMT in all segments was observed. No correlation with other markers of subclinical atherosclerosis or established cardiovascular (CV) risk factors was found. After multivariable adjustment, the association between AMH concentrations and combined carotid IMT or carotid bulb IMT remained significant. In conclusion, in healthy, normally ovulating women, AMH concentrations are negatively associated with subclinical atherosclerosis indices and TC levels, independently of established CV risk factors.

Non-alcoholic fatty liver disease, bulb carotid intima-media thickness and obesity phenotypes: results of a prospective observational study.

The objective of this prospective study was to assess the correlation between carotid intima-media thickness at thecommon carotid (CIMTc) and carotid bifurcation (CIMTb) level, hepatic fat accumulation, and obesity phenotypes. Two hundred obese adults, in which CIMTc and CIMTb thickness was determined, were included. Accordingto body mass index (BMI) and presence of metabolic syndrome (MetS), patients were classified as metabolically healthy obese(MHO, obesity without MetS) and metabolically unhealthy obese (MUHO, obesity with MetS). MHO patients were furtherclassified as MHO1 (obese with increased waist circumference) and MHO2 (obese with increased waist circumference plusone of the 4 criteria for MetS). Non-alcoholic fatty liver disease (NAFLD) presence was assessed by fatty liver index (FLI).RESULTS: CIMTc and CIMTb increased with obesity phenotypes from 0.74 mm and 1.04 mm in MHO1 to 0.84 mm and 1.23mm in MHO2 and 0.88 mm and 1.74 mm in MUHO. Obesity phenotypes were significantly correlated with CIMTb. NAFLDfrequency increased from 66.0% in the MHO1 to 73.0% in the MHO2 and 84.2% in the MUHO (p<0.05). Independent of age,BMI, total cholesterol, HbA1c, and HOMA-IR, the CIMTc was significantly associated with FLI in all obesity phenotypesand CIMTb only in MHO2 and MUHO. Our results suggest that subclinical atherosclerosis varies according toobesity phenotypes and is correlated with the hepatic fat accumulation.

Arterial stiffness in HIV-infected youth and associations with HIV-related variables

ABSTRACTChildren and young adults infected with HIV are at elevated risk for cardiovascular disease (CVD). However, scarce data exist on the utility of non-invasive methods to diagnose subclinical CVD, such as pulse wave velocity (PWV), a non-invasive measure of arterial stiffness. The objectives of this study were to assess the relationship of carotid-femoral PWV with subclinical atherosclerosis measured by carotid intima-media thickness (IMT), compare measurements to healthy controls, and evaluate variables associated with PWV in HIV-infected youth. One hundred and one 8–25 year-old subjects on stable antiretroviral therapy with low-level viremia or an undetectable HIV-1 RNA were enrolled, along with 86 healthy controls similar in age, sex and race. There was no significant difference in PWV between groups (median (Q1, Q3): 5.7 (5.2, 6.3) vs 5.7 (4.9, 6.5) m/s; P = 0.81). Among the HIV-infected subjects, PWV was positively correlated with both internal carotid artery (R = 0.31, P = 0.02) and carotid bulb IMT (R = 0.29, P = 0.01). In multivariable regression, only current alcohol consumption and systolic blood pressure were independently associated with PWV in the HIV-infected group (where current alcohol consumption and higher systolic blood pressure were associated with higher PWV); whereas, age, body mass index, and current marijuana use were associated with PWV in healthy controls. In this study of PWV in HIV-infected youth, measures of arterial stiffness were not different between subjects and controls. However, in HIV-infected youth, there was a significant association between PWV and carotid IMT, as well as between PWV and current alcohol consumption. Thus, PWV may have potential as a useful, non-invasive method to assess CVD risk in HIV-infected youth, but further investigation is needed.

ISH ADA-06 INTIMA-MEDIA THICKNESS OF THE CAROTID BULB IS ASSOCIATED WITH WORSENING OF ORTHOSTATIC HYPOTENSION IN PATIENTS WITH METABOLIC DISORDER

Abstract Though both carotid bulb and aortic arch are known to play important roles in regulation of blood pressure through modulation in baroreflex function, few studies have investigated the association of carotid bulb atherosclerosis and large arterial stiffness and orthostatic blood pressure change. Patients with metabolic disorder such as hypertension, dyslipidemia and diabetes mellitus underwent measurement of segment-specific carotid intima-media thickness (IMT) (as an index of atherosclerosis of carotid bulb), cardio-ankle vascular index (CAVI) (as an index for large arterial stiffness), heart rate variability (HRV) (as an index of baroreflex function) and sit-to-stand orthostatic blood pressure change (as a simple method for detecting orthostatic hypotension). Of the 129 patients, mean age was 65.7 years and 32.6% were male. Hypertension, dyslipidemia and diabetes mellitus were diagnosed in 64.3%, 87.6% and 7.8% of the patients, respectively. Common carotid artery (CCA) IMT and carotid bulb IMT and internal carotid artery (ICA) IMT had significant positive correlation with CAVI (R = 0.349, P

Influence of blood pressure variability on early carotid atherosclerosis in hypertension with and without diabetes.

Carotid intima-media thickness (IMT) has been one widely used index of early carotid atherosclerosis. We speculated that the influence of blood pressure variability (BPV) on early carotid atherosclerosis may be varied by the location of the carotid artery and diabetes history. Thus, the goal of this study was to evaluate the effects of BPV on early arteriosclerosis progression in different segments of the carotid artery for hypertension with and without diabetes.A total of 148 hypertension patients who underwent 24 hours ambulatory blood pressure (BP) monitoring and carotid ultrasonography were enrolled in this study. Of them, 84 subjects were without diabetes, and 64 subjects were with diabetes. Short-term BPV during daytime, nighttime, and over 24 hours were evaluated through standard deviation (SD) and average real variability (ARV). We measured carotid IMT at left and right common carotid artery (CCA), carotid bulb, and the origin of the internal carotid artery (ICA). The associations between segment-specific measurements of carotid IMT and 24 hours ambulatory BPV were analyzed.We found that IMT at the common carotid artery (CCA-IMT) and IMT at the internal carotid artery (ICA-IMT) were more closely associated with BPV than was carotid bulb IMT. In addition, for all subjects, BPV was clearly associated with left CCA-IMT but not with right CCA-IMT. Furthermore, in diabetes patients, nighttime systolic BPV was independently related to mean CCA-IMT (P < 0.01) and mean bulb IMT (P < 0.01). In contrast, in nondiabetes patients, daytime and 24 hours systolic BPV was positively associated with mean CCA-IMT (P < 0.05), but not independent after adjusting for baseline characteristics such as age and sex.The findings of our study indicate a segment-specific association between carotid IMT and 24 hours ambulatory BPV, and the associations also vary according to the diabetes history. We conclude that BPV plays a distinct role in early carotid arteriosclerosis progression within different segments of the carotid artery, especially for the hypertensions with and without diabetes.

Associations of cortisol/testosterone and cortisol/sex hormone-binding globulin ratios with atherosclerosis in middle-age women

Background and aimsThe cortisol/testosterone (C/T) ratio has been hypothesized to be a better predictor of atherosclerosis than cortisol alone. No study has assessed whether the C/T and C/sex hormone-binding globulin (SHBG) ratios are associated with atherosclerosis in a U.S. population sample. MethodsThis substudy included 367 women who had both cortisol from year 15 and testosterone and SHBG at year 16 of the Coronary Artery Risk Development in Young Adults study, an ongoing observational cohort in the United States. Of these, intima-media thickness (IMT) was available at follow-up year 20 in 339 (n = 332 with measurement at carotid bulb), and 303 were free of prevalent coronary artery calcium (CAC) at year 15. Area under the curve (AUC) of salivary cortisol was available in 302 individuals. Ratios of AUCs of cortisol to total testosterone, free testosterone, and SHBG were categorized into tertiles. Associations with CAC and IMT were assessed by regression models adjusted for age, race, body mass index, systolic blood pressure, menopause, oral contraceptive use, diabetes, alcohol, and smoking. ResultsOnly the highest tertile of the AUC/free testosterone ratio was positively associated with carotid bulb IMT (β = 0.088, P = 0.006). This tertile was also positively associated with new onset CAC between year 15 and 25 (OR 3.45, 95% CI 1.18–10.06). Tertiles of cortisol or testosterone alone were not associated with new onset CAC. ConclusionAUC/Free testosterone ratio may be more associated with atherosclerosis in women than either indicator alone. The ratio may serve as a suitable biomarker of cortisol-linked stress.

Baroreflex sensitivity and carotid intima-media thickness in risk stratification of prehypertensives and hypertensives.

BACKGROUNDː The aim of the study was to evaluate the clinical significance of baroreflex sensitivity (BRS) and carotid intima media thickness (IMT) in risk stratification of hypertensives and subjects with high normal blood pressure (SHNBP). METHODSː A total of 20 patients (61±13 years of age, 10 female/10 male) with essential, treated hypertension and 20 subjects (59±8 years of age, 10 female/10 male) with high normal blood pressure were enrolled. The interrelationship between BRS expressed in ms/mmHg (BRS) and IMT of common carotid artery (CCA) in hypertensives and subjects with high normal blood pressure (SHNBP, prehypertensives) was evaluated. BRS was determined by the sequence and spectral method: a five-minute non-invasive beat-to-beat recording of blood pressure (BP) and R-R interval with use of Collin CBM-7000 monitor, controlled breathing at a frequency of 0.1 Hz. Duplex ultrasonographic examination of the carotid wall and IMT of both CCA and carotid bulb were performed in all patients. RESULTSː Essential hypertension was associated with decreased BRS (r =-0.53, P<0.001). We found out that there was no significant difference between BRS and IMT CCA values in mild treated hypertensives and those in SHNBP. This finding was independent of age-dependent decrease of BRS. SHNBP and hypertensives with critical value BRS≤5 ms/mmHg have significantly increased IMT CCA. CONCLUSIONSː Decreased BRS is an early sign of autonomic dysfunction even in prehypertensive period. SHNBP and hypertensives with BRS≤5ms/mmHg have significantly increased IMT CCA. The principal result of this study showed that BRS and carotid IMT in relatively low-risk hypertensives and SHNBP could identify subjects at higher cardiovascular risk.

Abstract P065: Cross-Sectional and Prospective Associations of the Cortisol/testosterone and Cortisol/ Sex Hormone Binding Globulin Ratios With Atherosclerosis in Women

Introduction: The ability to study chronic stress in humans is complicated due to measurement error of questionnaires and the inability of short-term measures of stress hormones to reflect the chronic state. Therefore considerable controversy remains about whether chronic stress influences atherosclerosis or not. The cortisol/testosterone (C/T) ratio was suggested to be a better predictor of heart disease in men than cortisol alone, as gonadotropin and cortisol are derived from the same biochemical precursor. This ratio has never been studied in a U.S. epidemiologic study, especially in women. Study question: Are C/T and C/sex hormone binding globulin (SHBG) ratio associated with subclinical atherosclerosis in women? Methods: In the Coronary Artery Risk Development in Young Adults (CARDIA) study, 367 women (age range 32 to 51, mean age 40 years old) who had both cortisol from year (Y) 15 and sex hormones from serum specimen Y16 measured are included. Intima-media thickness (IMT) from Y20 was assessed cross-sectionally. Coronary artery calcium (CAC) incidence from Y15-25 was assessed prospectively where available (n=299). Due to the instability and diurnal characteristics of cortisol, area under the curve (AUC) of six samples and slope of 1st (or 3rd) and 6th (or 5th when 6th is not available) sample of salivary cortisol collected over one day were calculated. Ratios of AUC and of slope of cortisol to total testosterone (TT), free testosterone (FT), and sex hormone binding globulin (SHBG) were computed: AUC/TT, AUC/FT, AUC/SHBG, Slope/TT, Slope/FT, and Slope/SHBG. The associations of these variables categorized into tertiles with CAC and IMT were assessed by logistic regression analysis (CAC) and multiple linear regression (IMT). Model I controlled for age and race. Model II controlled for model I variables plus BMI, systolic BP, menopause, oral contraceptive usage, diabetes mellitus, alcohol consumption, and cigarette smoking. Results: The highest tertile of AUC/FT ratio was associated with Y20 carotid bulb IMT max in model I (β=0.07, p=0.031) and model II (β=0.09, p=0.006). This ratio also had moderate OR with incident CAC from Y15 to Y25 in model I (OR 2.22, 95% CI 0.89-5.51) and had significant association in model II (OR 3.45, 95% CI 1.18-10.06). Conclusions: Findings suggest that AUC/FT ratio is cross-sectionally and prospectively associated with subclinical atherosclerosis in women.

Childhood 25-OH Vitamin D Levels and Carotid Intima-Media Thickness in Adulthood: The Cardiovascular Risk in Young Finns Study

Low vitamin D levels in adulthood have been associated with cardiovascular disease. To investigate if low vitamin D levels in childhood are related with increased carotid artery intima-media thickness (IMT) in adulthood. The analyses included 2148 subjects from the Cardiovascular Risk in Young Finns Study, aged 3-18 years at baseline (in 1980). Subjects were re-examined at age 30-45 years (in 2007). Childhood levels of 25-hydroxy-vitamin D were measured from stored serum in 2010. The carotid artery IMT from 2007 was used. When adjusted for age, sex, and childhood risk factors, continuous data of childhood 25-OH vitamin was inversely associated with adulthood carotid IMT levels among females (β ± SE -0.006 ± 0.003, P = 0.03), but not among males (0.001 ± 0.004, P = 0.88). Children with 25-OH vitamin D levels in the lowest quartile (<40 nmol/L) had significantly increased odds of having high-risk IMT (highest decile of common carotid or carotid bulb IMT or carotid plaque) as adults, in analyses adjusted for age, sex and either childhood risk factors (odds ratio 1.70 [95 % CI 1.15-2.31], P = 0.0007) or adult risk factors, including adult vitamin D levels (odds ratio 1.80 [1.30-2.48], P = 0.0004). In sex-specific analyses, these associations were significant both in females and males (P always <0.05). In sensitivity analyses, those with childhood vitamin D levels in the lowest quintile (<37 nmol/L), gave similar results to those using a quartile cut-point. Low 25-OH vitamin D levels in childhood were associated with increased carotid IMT in adulthood.

The effect of hormone therapy on biochemical and ultrasound parameters associated with atherosclerosis in 46,XY DSD individuals with female phenotype

The aim of this study was to evaluate the effect of hormone therapy (HT) in the endothelial function of 46,XY disorders of sexual development (DSD) patients with female phenotype. Biochemical and ultrasound measurements were performed in 20 patients at initiation of oral 2 mg 17β-estradiol/1 mg norethisterone acetate, and after 6 months of therapy. Lipid profile, including total cholesterol (TC), LDL, HDL, triglycerides (TG) and Atherogenic Index of Plasma (AIP), as well as levels of VE-Cadherin, E-Selectin, Thrombomodulin and vWf were determined. Ultrasonographic examinations included evaluation of flow-mediated dilatation (FMD) and measurement of Carotid and Femoral Intima Media Thickness (IMT). HT raised HDL (35.4 mg/dl versus 40.1 mg/dl, p = 0.019) while lowering TG (166 mg/dl versus 109 mg/dl, p = 0.026) and AIP (0.24 versus 0.04, p = 0.007). No changes were noted in TC and LDL (215.7 mg/dl versus 192.25 mg/dl and 87.46 mg/dl versus 76.35 mg/dl, respectively). There was significant reduction of VE-Cadherin (4.05 ng/ml versus 2.20 ng/ml, p = 0.002) and E-selectin (73.98 ng/ml versus 56.73 ng/ml, p = 0.004). No change was observed in Thrombomodulin and vWf (11.76 ng/ml versus 13.90 ng/ml and 80.75% versus 79.55%, respectively). FMD improved significantly (5.4% versus 8.15%, p = 0.003), while only carotid bulb IMT decreased significantly (0.65 mm versus 0.60 mm, p = 0.018). Overall, HT was found to improve biochemical and ultrasound markers of endothelial function in 46,XY DSD patients with female phenotype.

Carotid artery remodelling in relation to body fat distribution, inflammation and sustained weight loss in obesity

Obesity is known to be associated with carotid artery remodelling, but less is known about how body fat distribution, inflammation and weight loss may affect this relation. Ultrasonography, dual-energy X-ray absorptiometry and computed tomography were performed to evaluate carotid artery intima-media thickness (IMT), body composition and fat distribution, respectively. Participants were divided into three matched study groups (n = 44 per group): obese patients with sustained weight loss 10 years after bariatric surgery [surgery group, body mass index (BMI) 31.5 kg m(-2)]; obese patients who maintained stable weight during the same time period (obese group, BMI 42.5 kg m(-2)); and normal weight subjects (lean group, BMI 24.4 kg m(-2)). Patients in the surgery group, compared with those in the obese group, had slightly lower common carotid artery (CCA) IMT (0.75 ± 0.18 vs. 0.78 ± 0.17 mm) and common carotid bulb (CCB) IMT (0.92 ± 0.32 vs. 0.97 ± 0.32 mm); however, these differences were not statistically significant. Lean individuals, compared with those in the surgery group, had significantly lower CCA and CCB IMT values (P < 0.001). In forward stepwise multiple regression analyses including all subjects (n = 132), CCA IMT was predicted mainly by visceral adipose tissue, but was also related to blood pressure and levels of triglycerides and high-sensitivity C-reactive protein. Carotid lumen diameter was primarily influenced by lean body mass. Visceral adiposity was the main determinant of premature carotid artery atherosclerosis, possibly through elevated blood pressure, dyslipidaemia and inflammation. Lean body mass predicted carotid artery lumen diameter. Obese patients with long-term sustained weight loss did not have thinner carotid artery walls compared with their weight-stable obese counterparts.

Normative and mean carotid intima-media thickness values according to metabolic syndrome in Koreans: The Namwon Study

ObjectivesWe determined the gender- and age-specific normative values of carotid intima-media thickness (IMT) in a healthy Korean population. We also present the mean age-specific carotid IMT values according to the presence of metabolic syndrome (MetS) and the number of MetS components. MethodsA total of 9374 subjects from the Namwon Study aged 45–74 years were included in the analysis. Subjects without hypertension, diabetes, dyslipidemia, obesity, and current smoking were classified as the healthy reference population (n = 2595). MetS was identified by the presence of three or more of the following five components: abdominal obesity, high triglycerides, low high-density lipoprotein cholesterol, high blood pressure, and high fasting blood glucose. Common carotid artery IMT (CCA-IMT) and carotid bulb IMT values were determined in a region free of plaque by B-mode carotid ultrasonography. ResultsThe mean normative CCA-IMT values of 45–49, 50–54, 55–59, 60–64, 65–69, and 70–74 year old males were 0.614, 0.671, 0.711, 0.759, 0.783, and 0.787 mm and 0.613, 0.653, 0.689, 0.718, 0.753, and 0.778 mm for females, respectively. An increase in CCA-IMT of 0.007 mm/year was estimated in both genders. The mean CCA-IMT values of subjects with 0, 1, 2, 3, 4, and 5 MetS components were 0.744, 0.753, 0.765, 0.766, 0.771, and 0.798 mm for males and 0.688, 0.705, 0.724, 0.734, 0.757, and 0.762 mm for females, respectively. ConclusionThe gender-specific normative carotid IMT values were determined in a large healthy Korean population. An increasing trend in the CCA-IMT values was observed with an increasing number of MetS components in both genders.

C-Reactive Protein Predicts 96-Week Carotid Intima Media Thickness Progression in HIV-Infected Adults Naive to Antiretroviral Therapy

: This is a 96-week prospective cohort study of antiretroviral therapy (ART)-naive HIV-infected adults and matched healthy controls to assess progression of carotid intima media thickness (CIMT) and its relationship to inflammation. Median common carotid artery (CCA) CIMT increased significantly but similarly in both groups [CCA: 0.02 (interquartile range: 0-0.05); P < 0.01 within HIV-infected adults vs. 0.01 (0-0.05) mm; P < 0.01 within controls; and P = 0.83 between groups]. Change in bulb CIMT yielded similar results. Independent predictors of CCA CIMT progression in HIV-infected adults were higher systolic blood pressure, total cholesterol, and high sensitivity C-reactive protein. Independent predictors of bulb CIMT progression were higher non-high-density lipoprotein cholesterol and high sensitivity C-reactive protein. Other inflammation markers were not associated with CIMT progression.

Rate and Predictors of Carotid Artery Intima Media Thickness Progression in Antiretroviral-Naive HIV-Infected and Uninfected Adults: A 48-Week Matched Prospective Cohort Study

Carotid intima media thickness (CIMT) progresses faster in HIV-infected adults on antiretroviral therapy (ART) than the general population. It is unclear if the rate of progression is similarly faster in ART-naive, HIV-infected adults. This was a 48-week prospective cohort study to compare change in CIMT and inflammation markers in ART-naive, HIV-infected adults in no immediate need of ART (HIV-positive/ART-naive) and age/sex/body mass index (BMI)-matched controls (HIV-negative). A total of 85 HIV-positive/ART-naive and 45 HIV-negative participants were enrolled. In the HIV-positive/ART-naive group, median baseline CD4+ T-cell count and HIV-1 RNA were 535 cells/mm3 and 6,916 copies/ml. Baseline common carotid artery (CCA) and bulb CIMTs were similar between groups. Changes in CIMT to 48 weeks at both sites were not different within- or between-groups (median [IQR] change in HIV-positive/ART-naive versus HIV-negative CCA CIMT -0.0071 mm [-0.0267-0.0233] versus 0.0113 mm [-0.0117-0.0306]; P = 0.19 between-groups; and bulb CIMT 0.0017 mm [-0.0367-0.06167] versus 0.01 mm [-0.0383-0.0625]; P = 0.54). After adjustment for cardiovascular disease (CVD) risk factors, change in CCA CIMT was greater in HIV-negative participants (-0.0046 versus 0.0177 mm for HIV-positive/ART-naive versus HIV-negative; P = 0.01). In HIV-positive/ART-naive, interleukin (IL)-6, soluble tumour necrosis factor-α receptor (sTNFR)-II, vascular cell adhesion molecule-1 and intercellular adhesion molecule (ICAM)-1 were higher at both time points and D-dimer was higher at week 48 (P < 0.01 for all). IL-6, sTNFR-I and D-dimer increased over 48 weeks in HIV-positive/ART-naive participants (P < 0.01 for all). In HIV-positive/ART-naive participants, independent predictors of greater change in CCA CIMT were higher BMI (P = 0.05) and family history of CVD (P < 0.01) and of greater change in bulb CIMT were higher sTNFR-I (P = 0.03) and higher diastolic blood pressure (P < 0.01). In ART-naive HIV-infected adults at low risk of HIV disease progression and low cardiovascular risk, CIMT progression rate was similar to matched controls. In addition to traditional CVD risk factors, higher levels of sTNFR-I predicted greater bulb CIMT changes.