Carotid Arteriosclerosis Research Articles

Phenotype of haptoglobin and presence of subclinical vascular disease: Population study

Introduction and objectivesHaptoglobin is a protein involved in the protection against oxidative damage caused by iron in haemoglobin. This protein is polymorphic, with 3 isomorphs prevalent in the population. The carriers of the Hp2-2 isoform have a lower antioxidant capacity and, in the population with diabetes, an increased risk of subclinical vascular disease and cardiovascular complications. The objective of this study was to evaluate whether this isomorphy is associated with an increased risk of carotid arteriosclerosis in subjects with and without diabetes, and free of cardiovascular disease. Patients and methodsA study was conducted in a population between 45 and 74 years of age, randomly selected from the northwest area of Madrid. The participants were characterised in terms of their glycaemic status by oral glucose overload and the determination of the concentration of Hb1Ac. The haptoglobin phenotypes in all of them were determined by means of an immunoenzymatic assay, and the presence of carotid arteriosclerosis by ultrasound. ResultsOf the 1256 participants included in the present analysis (mean age 61.6 ± 6 years, 41.8% males), the distribution of the isoforms of haptoglobin was as follows: Hp1-1: 13.3%, Hp1-2: 48.5%, and Hp2-2: 38.2%. In comparison with subjects Hp1-1 and Hp1-2, those with the Hp2-2 phenotype had a higher prevalence of dyslipidaemia (53.3% vs 43%; p < .0001) and arterial hypertension (39.2% vs. 32.2%, p = .012), and they more frequently received treatment with statins (31.5% vs 21.6%, p < .0001), and with antihypertensive agents (38.4% vs 30.8%, p = .006). The carriers of the Hp2-2 isoform had a higher prevalence of carotid plaques (OR: 1.35, 95% CI: 1.07–1.69, p = .011), with no differences in that prevalence as regards the glycaemic status. There were no differences in the intima-media thickness between the different phenotypes. The relationship of the Hp2-2 phenotype with the presence of plaques in the carotid was independent of age, gender, presence of risk factors (dyslipidaemia, hypertension and diabetes), the concentration of LDL-cholesterol, C-reactive protein and uric acid, blood pressure, and treatment with statins, and hypertensive drugs (OR: 1.31, 95% CI 1.01–1.70, p = .044). ConclusionSubjects with the Hp2-2 phenotype of haptoglobin have a higher prevalence of carotid arteriosclerosis, which is independent of the presence of other cardiovascular risk factors and their glycaemic status.

Features of the pathomorphological structure of the aterosclerotic plaques of carotid aterosclerosis

Carotid arteriosclerosis is a recognized leader among causes of ischemic disorders of the cerebral circulation. It is known that brain infarction occurs with atherosclerotic stenosis and thrombosis of the carotid arteries in approximately 40 % of cases. The peculiar geometry of carotid bifurcation creates conditions for the development of atherosclerotic plaques. The aim of the work is determination of pathomorphological features of the structure of atherosclerotic plaques in carotid atherosclerosis. Materials and methods . Histological, histochemical and immunohistochemical studies of surgical material in 680 patients were performed. Results . On the basis of pathomorphological analysis of the plaque in carotid AS they can be divided into complicated and uncomplicated. The first type is atheromatous unstable plaques with the prevalence of foci of atheromatosis, lympho-macrophage infiltration, intraplaque hemorrhage, necrosis of fibrous elements and edema. Immunohistochemically they are characterized by high expression of MMP-9 in macrophages and lymphocytes with degradation of type I collagen in the surface and deep layers of the plaque coating and its replacement by type III collagen (P < 0.05). The second type of plaque is stable uncomplicated with the advantage of fibrosis, hyalinosis and petrification. Immunohistochemical structure of plaques was collagen type I, expression of collagen type III was low, expression of MMP-9 was moderate (P < 0.05). Conclusions . High expression of MMP-9 in carotid atherosclerosis in macrophage-lymphocytic infiltrates in atheromatosis and neovascularization sites was found to result in degradation of type I collagen with its replacement by type III collagen. Such pathomorphological changes underlie plaque instability – the development of intraplaque hemorrhages, ulcers with embolic complications. Synthesis of collagen type I with low expression of type III collagen and MMP-9 has been found to determine the basis of the structure of fibro-muscular plaques. This ensures their hemodynamic stability and stable vascular stenosis.

Fenotipo de la haptoglobina y presencia de enfermedad vascular subclínica: estudio poblacional

Introduction and objectivesHaptoglobin is a protein involved in the protection against oxidative damage caused by iron in haemoglobin. This protein is polymorphic, with 3 isomorphs prevalent in the population. The carriers of the Hp2-2 isoform have a lower antioxidant capacity and, in the population with diabetes, an increased risk of subclinical vascular disease and cardiovascular complications. The objective of this study was to evaluate whether this isomorphy is associated with an increased risk of carotid arteriosclerosis in subjects with and without diabetes, and free of cardiovascular disease. Patients and methodsA study was conducted in a population between 45 and 74years of age, randomly selected from the northwest area of Madrid. The participants were characterised in terms of their glycaemic status by oral glucose overload and the determination of the concentration of Hb1Ac. The haptoglobin phenotypes in all of them were determined by means of an immunoenzymatic assay, and the presence of carotid arteriosclerosis by ultrasound. ResultsOf the 1,256 participants included in the present analysis (mean age 61.6±6years, 41.8% males), the distribution of the isoforms of haptoglobin was as follows: Hp1-1: 13.3%, Hp1-2: 48.5%, and Hp2-2: 38.2%. In comparison with subjects Hp1-1 and Hp1-2, those with the Hp2-2 phenotype had a higher prevalence of dyslipidaemia (53.3% vs 43%; P<.0001) and arterial hypertension (39.2% vs. 32.2%, P=.012), and they more frequently received treatment with statins (31.5% vs 21.6%, P<.0001), and with antihypertensive agents (38.4% vs 30.8%, P=.006). The carriers of the Hp2-2 isoform had a higher prevalence of carotid plaques (OR: 1.35, 95%CI: 1.07-1.69, P=.011), with no differences in that prevalence as regards the glycaemic status. There were no differences in the intima-media thickness between the different phenotypes. The relationship of the Hp2-2 phenotype with the presence of plaques in the carotid was independent of age, gender, presence of risk factors (dyslipidaemia, hypertension and diabetes), the concentration of LDL-cholesterol, C-reactive protein and uric acid, blood pressure, and treatment with statins, and hypertensive drugs (OR: 1.31, 95%CI 1.01-1.70, P=.044). ConclusionSubjects with the Hp2-2 phenotype of haptoglobin have a higher prevalence of carotid arteriosclerosis, which is independent of the presence of other cardiovascular risk factors and their glycaemic status.

Association Between Systemic Inflammation, Carotid Arteriosclerosis, and Autonomic Dysfunction.

Systemic inflammation is associated with arteriosclerotic disease progression and worse stroke outcome in patients with carotid arteriosclerotic disease. We hypothesize that systemic inflammation is mediated by impaired carotid baroreceptor and chemoreceptor function induced by carotid arteriosclerosis rather than by the generalized inflammatory arteriosclerotic process.Heart rate variability (HRV), serum levels of inflammatory markers, demographic and life style factors, and concomitant diseases with potential impact on systemic inflammation were determined in 105 patients with asymptomatic carotid stenosis of varying degree. Multivariate linear regression analyses were performed to ascertain independent determinants of carotid stenosis severity, autonomic function, and inflammation.Systemic inflammation (C-reactive protein, beta = .255; P= .014), age (beta = .232; P< .008), and arterial hypertension (beta = .206; P= .032) were associated with carotid stenosis severity. Only carotid stenosis severity and not generalized arteriosclerotic disease, concomitant diseases (arterial hypertension, diabetes mellitus, dyslipidemia, hypothyroidism), life style factors (smoking, obesity), or age was associated with a reduction in vagal tone (HRV HF band power beta = - .193; P< 0.049). Systemic inflammation was related to a reduction in vagal tone (HRV HF band power, beta = - .214; P= .031), and not to generalized arteriosclerotic disease, concomitant diseases (arterial hypertension, diabetes mellitus, dyslipidemia), life style factors (smoking, obesity), and age.In conclusion, systemic inflammation is associated with carotid rather than with generalized arteriosclerotic disease. The association between systemic inflammation and carotid arteriosclerosis is mediated by a reduction in vagal tone which indicates a major role of carotid arteriosclerosis-mediated autonomic dysfunction in the pathogenesis of systemic inflammation in arteriosclerotic disease.

A7763 Relationship between serum lipid profiles and carotid arteriosclerosis in community dwelling old population

A7763 Relationship between serum lipid profiles and carotid arteriosclerosis in community dwelling old population

ACE2 polymorphisms associated with cardiovascular risk in Uygurs with type 2 diabetes mellitus

BackgroundType 2 diabetes mellitus (T2D), rapidly increasing to epidemic proportions, globally escalates cardiovascular disease risk. Although intensive interventions and comprehensive management of environmental risks factors for T2D are associated with reduced cardiovascular disease, such approaches are limited for individuals with high genetic T2D risk. In this study we investigated possible associations of ACE2 polymorphisms and cardiovascular risks in Uygur patients with T2D.Methods275 Uygur T2D patients and 272 non-diabetic Uygur individuals were enrolled as study participants. 14 ACE2 polymorphisms were genotyped by Matrix-assisted laser desorption ionization time-of-flight mass spectrometry.ResultsACE2 SNP rs1978124, rs2048683, rs2074192, rs233575, rs4240157, rs4646156, rs4646188 and rs879922 were associated with T2D (all P < 0.05). The 8 diabetic risk related ACE2 SNPs were further associated with diabetic related cardiovascular complications or events but exhibited heterogeneity as fellows: firstly, almost all diabetic risk related ACE2 SNPs (all P < 0.05) were associated with increased SBP except rs1978124 and rs2074192, while rs2074192, rs4646188 and rs879922 were associated elevated DBP (all P < 0.05). Secondly, SNP rs4646188 was not correlated with any type of dyslipidemia (TRIG, HDL-C, LDL-C or CHOL), and the other 7 diabetic risk related loci were at least correlated with one type of dyslipidemia (all P < 0.05). In particular, rs879922 were simultaneously correlated with four type of dyslipidemia (all P < 0.05). Thirdly, ACE2 SNP rs2074192 and rs879922 were associated with carotid arteriosclerosis stenosis (CAS) ≥ 50% (both P < 0.05). Fourthly, ACE2 SNP rs2074192, rs4240157, rs4646188 and 879922 were associated with increased MAU (all P < 0.05). In addition, ACE2 SNP rs2048683, rs4240157, rs4646156, rs4646188 and rs879922 were linked to heavier LVMI (all P < 0.05), but only rs4240157, rs4646156 and rs4646188 were associated with lower LVEF (all P < 0.05).ConclusionACE2 SNP rs879922 may be a common genetic loci and optimal genetic susceptibility marker for T2D and T2D related cardiovascular risks in Uygurs.

Childhood pulse pressure predicts subclinical vascular damage in adulthood: the Beijing Blood Pressure Cohort Study.

We aimed to investigate associations of childhood pulse pressure (PP) and change in PP status with adult subclinical vascular damage. Data were obtained from a population-based cohort of children aged 6-18 years started in 1987. The study constituted 1254 participants who were followed up in 2010-2011 (aged 28-42 years). Carotid arteriosclerosis and aortic stiffness were assessed by carotid intima-media thickness (IMT) and brachial-ankle pulse wave velocity (PWV), respectively. Both childhood PP and mean arterial pressure (MAP) were independently associated with adult carotid IMT and PWV adjusted for sex, childhood age, follow-up duration, and other traditional cardiovascular risk factors. After further adjustment for adult values of PP and MAP, childhood PP was still associated with adult carotid IMT but not with PWV, whereas childhood MAP was associated with adult PWV but not with carotid IMT. In addition, compared with participants who had normal PP in both childhood and adulthood, participants who had high PP in adulthood, irrespective of their childhood PP status, had higher levels of carotid IMT and PWV (all P < 0.05). Participants who had high PP in childhood and normal PP in adulthood also had higher levels of adult carotid IMT but similar levels of PWV compared with participants who had consistently normal PP. Large PP in childhood plays an important role in the development of subclinical vascular damage in adulthood. These findings underscore the importance of early prevention of large PP to reduce future risk of cardiovascular disease.

Analysis of carotid atherosclerosis and related risk factors in a university physical examination population in Beijing

Objective: To explore the incidence of carotid atherosclerosis in staffs of Tsinghua university according to the different age groups, the possible risk factors and conduct a follow-up survey. Methods: Detailed information about physical examination and carotid ultrasound from 832 staffs of Tsinghua University between 2014 to 2016 were reviewed to observe the occurrence and development of atherosclerosis according to different age groups; the correlation between conventional risk factors and carotid arteriosclerosis was studied by multivariate Logistic regression analysis.The process of different degrees of arteriosclerosis in the population was observed one year later. Results: In the past three years, there were 2 024 cases of carotid examination. Among them, there were 832 staffs who had been followed up for more than 6 months. There were 517 cases of carotid atherosclerosis, with 289 males (55.9%) and 228 females (44.1%), and the incidence of atherosclerosis in male was higher than that in female (P<0.05). The 50 to 59 years old, 60 to 69 years old, 70 to79 years old were the age group with high incidence of pure carotid intima-media thickening, atherosclerosis plaque formation and stenosis or occlusion, respectively. After multivariate Logistic regression analysis, hypertension, diabetes and hyperlipidemia were found the independent risk factors for carotid intimal thickening. The follow-up of 832 staffs with ultrasound showed that there was no significant difference in intima-media thickening, plaque formation, stenosis or occlusion after one year (P>0.05). Conclusions: This research suggests that the incidence of atherosclerosis in male is higher than that in female, and hypertension, diabetes and hyperlipidemia are important influencing factors of arteriosclerosis for staffs of Tsinghua University. Early screening, identification of high-risk patients and comprehensive treatment should be done to delay the process of atherosclerosis.In addition, long-term follow-up is necessary in the context of no significant changes within the short-term.

Percutaneous Angioplasty of Severe Concomitant Carotid, Coronary, and Peripheral Arteriosclerosis: A Case Report and Literature Review

Introduction: Severe presentation of concomitant carotid, coronary, and peripheral arteriosclerosis is not a common finding. However, some studies have reported surgical and noninvasive interventions for this condition. Case Presentation: Herein, we present a patient with concomitant carotid, coronary, and peripheral arteriosclerosis, who underwent angioplasty in Tehran, Iran in November 2015. Some studies have been carried out on surgical and percutaneous coronary, carotid and peripheral intervention for concomitant lesions; however, reports about percutaneous coronary, carotid and peripheral intervention, similar to the present case, are not available. Conclusions: Due to lack of evidence on the prevalence and management of concomitant multifocal coronary, carotid, and limb arteriosclerosis, it is necessary to perform well-designed studies on such groups of patients to define proper management (surgical versus endovascular interventions), periprocedural complications, as well as short- and long-term outcomes.

Relationship between carotid artery sclerosis and blood pressure variability in essential hypertension patients

ObjectivesThis study aimed to investigate the relationship between the presence of carotid arteriosclerosis (CAS) and blood pressure variability (BPV) in patients with essential hypertension. MethodsOne hundred and forty four essential hypertension patients underwent ambulatory BP monitoring for 24h after hospitalization. Common BPV metrics were calculated. General clinical parameters, including age, gender, height, weight, history of coronary heart disease, stroke, diabetes, hypertension, smoking and drink, were recorded. Biochemical indices were obtained from a blood test. Carotid intima-media thickness (IMT) and carotid plaques were assessed to separate patients into a non-CAS group (IMT≤0.9mm; n=82) and a CAS group (IMT>0.9mm; n=62). BPV metrics and clinical parameters were analyzed and compared between the two groups. Multivariate logistic regression analysis was performed to determine the associated risk factors of CAS. ResultsMultivariate logistic regression analysis revealed that two BPV metrics, the standard deviation of daytime systolic blood pressure (SSD) (OR: 1.587, 95%CI: 1.242–2.028), the difference between average daytime SBP and nighttime SBP (OR: 0.914, 95%CI: 0.855–0.977), as well as three clinical parameters (age, OR: 1.098, 95%CI: 1.034–1.167; smoking, OR: 4.072, 95%CI: 1.466–11.310, and fasting blood glucose, OR: 2.029, 95%CI: 1.407–2.928), were significant factors of CAS in essential hypertension patients. ConclusionSSD, in combination with the ageing, smoking and FBG, has been identified as risk factors for CAS in patients with essential hypertension.

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.

P-Cresyl sulfate is associated with carotid arteriosclerosis in hemodialysis patients and promotes atherogenesis in apoE-/- mice.

p-Cresyl sulfate (PCS) is a risk factor of cardiovascular disease in patients with chronic kidney disease. Here we tested whether serum PCS levels were related to the rate and evolution of carotid atherosclerosis in hemodialysis patients and identified a potential mechanism. A total of 200 hemodialysis patients were categorized as with or without carotid atherosclerotic plaque and followed for 5 years. Serum PCS levels were found to be higher in patients with than without carotid atherosclerotic plaque and positively correlated with increased total plaque area during follow-up. Multiple logistic regression and mixed effects model analyses showed that serum PCS levels were independently associated with the incidence and progression of carotid atherosclerotic plaque. PCS induced inflammatory factor and adhesion molecule expression in endothelial cells and macrophages. In addition, PCS triggered monocyte-endothelial cell interaction in vitro and in vivo through increased production of reactive oxygen species. Compared with controls, increase of PCS levels produced by gavage promoted atherogenesis in 5/6-nephrectomized apoE-/- mice; a process attenuated by NADPH oxidase inhibitors. Thus, increased serum PCS levels are associated with the occurrence and progression of carotid atherosclerosis in hemodialysis patients and promote atherogenesis through increased reactive oxygen species production.

The influence of chronic Helicobacter pylori infection in serum lipoprotein associated phospholipase A2 level and stability of atherosclerotic plaques in patients with carotid atherosclerosis

Objective To explore the influence of Helicobacter pylori (Hp) infection in serum lipoprotein associated phospholipase A2 (Lp-PLA2), carotid intima-media thickness and stability of atherosclerotic plaques in atherosclerosis patients. Methods A total of 393 cases of patients with carotid artery arteriosclerosis confirmed by carotid color ultrasonography, who are informed consent, was selected as objects. The14C urea breath test was used to determine the infection situation of selected objects of helicobacter pylori. Meanwhile, enzyme-linked immunosorbent assay (ELISA) was used to determine the level of serum lipoprotein associated phospholipase A2 (Lp-PLA2). Results Serum Lp-PLA2 levels and carotid intima-media thickness (IMT) of patients with carotid artery atherosclerosis in Hp infection group were higher than that of Hp non-infection group, and with the degree of Hp infection aggravating in the patients of carotid artery atherosclerosis, their serum Lp-PLA2 levels and carotid IMT were also increased accordingly. F test showed that the differences of serum Lp-PLA2 levels and carotid IMT in different degree of carotid artery atherosclerosis group were statistically significant (P<0.01). The incidence of unstable plaque of Hp infection group was obviously higher than that of the Hp non-infection group in the carotid atherosclerosis with plaques with statistical significance (chi square value=4.744, P=0.029). Multivariate linear regression analysis showed that the possibility of complication of unstable plaques in Hp infection group of carotid artery atherosclerosis was 1.82 times than that of non-infection group. With serum Lp-PLA2 every increasing 1 μg/L, the possibility of instability plaque increased by 2%. Conclusions Hp infection may promote the occurrence and development of carotid artery atherosclerosis by increasing serum level of Lp-PLA2 and changing the stability of atherosclerotic plaques. Key words: Helicobacter infections; Helicobacter pylori; Carotid artery diseases/ME; Atherosclerosis/ME; Phospholipases A2/ME; Carotid arteries/PP

Sleep Apnea and Asymptomatic Carotid Stenosis: A Complex Interaction

BACKGROUND: Carotid arteriosclerosis and sleep apnea are considered as independent risk factors for stroke. Whether sleep apnea mediates severity of carotid stenosis remains unclear. Sleep apnea comprises two pathophysiologic conditions: OSA and central sleep apnea (CSA). Although OSA results from upper airway occlusion, CSA reflects enhanced ventilatory drive mainly due to carotid chemoreceptor dysfunction.METHODS: Ninety-six patients with asymptomatic extracranial carotid stenosis of ≥ 50% underwent polysomnography to (1) determine prevalence and severity of sleep apnea for different degrees of carotid stenosis and (2) analyze associations between OSA and CSA, carotid stenosis severity, and other arteriosclerotic risk factors.RESULTS: Sleep apnea was present in 68.8% of patients with carotid stenosis. Prevalence and severity of sleep apnea increased with degree of stenosis (P≤ .05) because of a rise in CSA (P≤ .01) but not in OSA. Sleep apnea (OR, 3.8;P≤ .03) and arterial hypertension (OR, 4.1;P≤ .05) were associated with stenosis severity, whereas diabetes, smoking, dyslipidemia, BMI, age, and sex were not. Stenosis severity was related to CSA (P≤ .06) but not to OSA. In addition, CSA but not OSA showed a strong association with arterial hypertension (OR, 12.5;P≤ .02) and diabetes (OR, 4.5;P≤ .04).CONCLUSIONS: Sleep apnea is highly prevalent in asymptomatic carotid stenosis. Further, it is associated with arteriosclerotic disease severity as well as presence of hypertension and diabetes. This vascular risk constellation seems to be more strongly connected with CSA than with OSA, possibly attributable to carotid chemoreceptor dysfunction. Because sleep apnea is well treatable, screening should be embedded in stroke prevention strategies.

Expression of Vasohibin-1 in Human Carotid Atherosclerotic Plaque.

In patients with carotid plaque, intraplaque hemorrhage arising from ruptured neovascular vessels within the neointima is an important cause of stroke. The expression of Vasohibin-1 (VASH1), a negative feedback regulator of angiogenesis, occurs in the microvessel endothelial cells of various solid tumors and the arterial wall. However, the roles of VASH1 in the pathogenesis of atherosclerotic diseases remain unclear. The present study aimed to clarify the relevance of the VASH1 expression and plaque instability in human carotid plaques. We used quantitative real-time PCR and immunostaining to examine 12 atheromatous plaque specimens obtained via carotid endarterectomy. The distal areas of specimens lacking macroscopic atherosclerotic lesions served as controls. Compared with that observed in the controls, the VASH1 gene expression increased significantly in the atheromatous plaque (p=0.018). Moreover, the VASH1 mRNA levels correlated positively with those of VEGFA, CD31 and VCAM1 (r=0.788, p=0.004; r=0.99, p ＜ 0.001; r=0.94, p ＜ 0.001, respectively). Finally, the immunohistochemical analyses revealed the VASH1 expression in the neointimal microvessel endothelial cells of carotid plaque. The VASH1 expression levels in atheroma reflect both enhanced neovascularization and the inflammatory burden. Therefore, the VASH1 level may be a novel biomarker for evaluating plaque instability in patients with carotid arteriosclerosis and predicting ischemic stroke.

Advice on Lifestyle Changes (Diet, Red Wine and Physical Activity) Does Not Affect Internal Carotid and Middle Cerebral Artery Blood Flow Velocity in Patients with Carotid Arteriosclerosis in a Randomized Controlled Trial

Background: A Mediterranean diet, with and without small daily amounts of red wine, and physical activity reduce the risk of cerebrovascular disease and improve cognition. An increase in cerebral blood flow may be the underlying mechanism. Under normal conditions, cerebral blood flow velocity changes in the internal carotid arteries and in large basal cerebral arteries correlate closely with cerebral blood flow changes, as the diameter of these vessels hardly changes and only the smaller vessels downstream change their diameter. Methods: A prospective randomized controlled trial was performed in 108 patients with carotid atherosclerosis (mean age 64 years, 67% men, 66% on statin therapy). Half of them were advised to follow a polyphenol-rich modified Mediterranean diet including 1-2 tomatoes, 3-5 walnuts and a bar of dark chocolate (25 g) a day and to perform moderate physical exercise for 30 min/day (lifestyle changes). Within these two groups, half of the patients were randomized either to avoid any alcohol or to drink 100 ml of red wine (women) or 200 ml of red wine (men) daily. Bilateral middle cerebral and internal carotid blood flow velocity (peak systolic, peak end-diastolic and mean) was measured at baseline and after 4 and 20 weeks using colour-coded duplex ultrasound. Insonation depth and insonation angle were used to identically place the sample volume during follow-up investigations. A general linear model with Tukey-Kramer adjustment for multiple comparisons was used to assess the primary end points. For the analysis we used the mean values of the right and left artery. Results: Neither lifestyle changes nor red wine had an effect on peak systolic, peak end-diastolic or mean cerebral blood flow velocity. Conclusions: Advice on lifestyle changes, including a modified polyphenol-rich Mediterranean diet, a glass of red wine daily and physical exercise, did not affect middle cerebral and internal carotid blood flow velocity in our patient group with carotid atherosclerosis. An increase in cerebral blood flow is thus unlikely to be the cause of the reduced risk of cerebrovascular disease and improved cognitive functioning described in the literature. One possible explanation for the fact that blood flow velocity was not affected by red wine, diet and physical activity advice is that two thirds of our patients were already on statin therapy. Statins increase cerebral blood flow and vasomotor reactivity via nitric oxide.

Abstract T P162: Cardio-Ankle Vascular Index (CAVI) predicts Cardioembolic Stroke in Patients with Atrial Fibrillation

Arteriosclerosis has shown to be a definite risk factor of atrial fibrillation, which is an important cause of cardioembolic stroke. The cardio-ankle vascular index (CAVI) has been reported as a novel parameter for arterial stiffness, and high CAVI implies progression of carotid and coronary arteriosclerosis. However, it remains to be determined whether CAVI is associated with cardioembolic stroke. We performed CAVI and transesophageal echocardiography in 219 patients with paroxysmal or chronic atrial fibrillation (165 males, 64 ± 12 years), including 53 patients with the history of cardioembolic stroke. CAVI was higher in patients with hypertension, diabetes mellitus, chronic atrial fibrillation and the history of heart failure compared with those without them. CAVI showed a good correlation with age, systolic blood pressure, pulse pressure, fasting blood glucose, high-sensitivity CRP, fibrinogen and von Willebrand factor. CAVI was also associated with left atrial dimension, left atrial volume index, left atrial emptying fraction, left ventricular diastolic function and left atrial appendage emptying flow velocity. CAVI was significantly increased with advancing grade of spontaneous echo contrast and increasing CHADS 2 score and CHA 2 DS 2 VASc score. Furthermore, CAVI was significantly different between patients with score 0 and score 1 in CHADS 2 and CHA 2 DS 2 VASc. CAVI was significantly higher in patients with left atrial appendage thrombus than in those without (10.3 ± 2.4 vs. 8.5 ± 1.6, P&lt;0.0001). CAVI was also significantly higher in patients with cardioembolic stroke than in those without (10.6 ± 2.2 vs. 8.3 ± 1.2, P&lt;0.0001). Logistic regression analysis revealed that CAVI was an important risk factor for cardioembolic stroke after adjustment of age and heart rhythm (odds ratio 2.16, 95% confidence interval 1.55-3.01). The patients with CAVI ≥ 9 had 12 times higher risk for cardioembolic stroke compared with those with CAVI &lt; 9 after adjustment of age and heart rhythm. In conclusion, CAVI is a novel parameter to predict cardioembolic stroke in patients with atrial fibrillation.

A daily glass of red wine associated with lifestyle changes independently improves blood lipids in patients with carotid arteriosclerosis: results from a randomized controlled trial.

BackgroundPhysical exercise and a Mediterranean diet improve serum lipid profile. The present work studied whether red wine has an effect on top of a lipid-lowering lifestyle in patients with carotid atherosclerosis.MethodsA prospective randomised unblinded trial was performed from 2009 to 2011 in 108 patients with carotid atherosclerosis, 65% of whom were already on statin therapy with a low mean LDL of 104.9 mg/dl. Half of them were advised to follow a modified Mediterranean diet and to perform moderate physical exercise during 30 min/day (lifestyle changes) for 20 weeks. Within these two groups half of the patients were randomised either to avoid any alcohol or to drink 100 ml of red wine (women) or 200 ml of red wine (men) daily.ResultsLDL was significantly lowered by 7% in the lifestyle-changes group compared to the no-lifestyle-changes group (p = 0.0296) after 20 weeks. Lifestyle changes lowered the LDL/HDL ratio after 20 weeks by 8% (p = 0.0242) and red wine independently by 13% (p = 0.0049). The effect on LDL/HDL ratio after 20 weeks was, however, more pronounced in the non-LC group. Total cholesterol (−6%; p = 0.0238) and triglycerides (−13%; p = 0.0361) were lowered significantly by lifestyle changes after 20 weeks compared to the no-lifestyle-changes group. Lipoprotein (a) was not significantly affected by any intervention. The given results are per ITT analysis.ConclusionsLifestyle changes including a modified Mediterranean diet and physical exercise as well as a glass of red wine daily improve independently the LDL/HDL ratio in patients with carotid arteriosclerosis even though the vast majority of them was already on statin therapy.Trial registrationhttp://www.clinicaltrials.gov, NCT01146132

A Daily Glass of Red Wine and Lifestyle Changes Do Not Affect Arterial Blood Pressure and Heart Rate in Patients with Carotid Arteriosclerosis after 4 and 20 Weeks

Background: Regular consumption of small amounts of red wine improves blood lipids. However, there is concern whether this beneficial effect might be counterbalanced by an increase in blood pressure (BP) and heart rate (HR), which are risk factors for cerebro-cardiovascular disease. In particular, we studied whether regular consumption of red wine with and without lifestyle changes (LC; healthy diet and physical activity advice) results in an increase in BP and HR. Methods: A prospective, unblinded randomized trial was performed in 108 patients (67% men) with carotid atherosclerosis documented by ultrasound, a mean BP of 122/79 mm Hg and a mean HR of 71 bpm at inclusion in the study. Sixty-eight percent were known and treated hypertensives. The mean 24-hour BP at baseline was 122/79 mm Hg. Half of the study participants, the control group, was seen by a nurse at baseline, after 4 and after 20 weeks, and was instructed not to change their eating and physical activity habits. In the other half, a dietician performed five sessions of 30 min each (at baseline, after 1 week and after 2, 3 and 4 weeks) giving advice on healthy eating based on a Mediterranean diet and physical exercise. The recommendations given were the following: 5 portions of fruit/vegetables per day, a diet low in absolute fat, a preference of vegetable oil (olive or rapeseed oil), whole-grain products, poultry, low-fat dairy products, 1 fat and 1 lean fish meal per week, reduced consumption of red meat, and avoidance of pork, ready-made meals, sugar and excessive salt intake. In addition, regular consumption of 1 bar of dark chocolate (25 g, >70% of cacao), 1-2 tomatoes, and 3-5 walnuts as well as at least 30 min of moderate daily physical activity were recommended. Within these two groups, half of the patients were randomized either to avoid alcohol completely or to drink 100 ml (women) or 200 ml of red wine (men) daily. Results: Neither LC nor red wine had an effect on the mean systolic and diastolic 24-hour BP and HR after 4 and 20 weeks, as analyzed by general linear modeling. No difference was found for diurnal and nocturnal values. Conclusions: The possible beneficial effect of regular consumption of small amounts of red wine is not counterbalanced in the long term by an increase in the mean BP or HR in mainly normotensive and well-treated hypertensive patients with carotid atherosclerosis, neither in the patients given healthy lifestyle advice nor in those with a standard lifestyle. Yet, we remain cautious about actively advice patients to drink alcohol regularly given the well-known risks.

Research on early carotid arteriosclerosis in impaired glucose tolerance patients by ultrasonic e-tracking imaging technology

Objective To explore the change of the early carotid arteriosclerosis in impaired glucose tolerance patients by ultrasonic e-tracking imaging technology.Methods All 100 cases were divided into abnormal glucose tolerance group and normal glucose tolerance group,50 cases in each group,aged 40-65 years.Quantitative analysis of carotid artery blood flow velocity was used by e-tracking technology to assess carotid artery stiffness indexes,including stiffness parameter (β),pressure-strain elastic modulus (Ep),arterial compliance (AC),augmentation index (AI) and pulse wave velocity (PW-Vβ).Results β,Ep and PWV β of abnormal glucose tolerance group were significantly higher than those of the normal control group,AC significantly reduced compared with that of normal control group,the difference was statistically significant (P＜0.05),and AI had no difference between two groups.Conclusion The hardness,elasticity,vascular compliance of artery are reduced in patients with impaired glucose tolerance,showing vascular endothelial dysfunction.The application of e-tracking can better assess vascular endothelial function. Key words: E-tracking; Impaired glucose tolerance; Early carotid arteriosclerosis