Carotid Artery Atherosclerosis Research Articles

Segment-specific progression of carotid artery atherosclerosis: a magnetic resonance vessel wall imaging study.

This study aimed to investigate the segment-specific progression of atherosclerotic carotid plaques using serial multi-contrast magnetic resonance (MR) imaging. Symptomatic patients with carotid 30-70% stenosis were recruited and underwent carotid MR vessel wall imaging at baseline and follow-up time point (≥ 6months after baseline). The location of plaques was determined according to the maximum wall thickness located above or below carotid bifurcation. The baseline and changing characteristics of carotid plaques were compared between plaques above and below carotid bifurcation, and the risk factors for segment-specific plaque progression were analyzed with logistic regression. Ninety-six carotid plaques from 73 patients (mean age 66.5 ± 11.4years old) were eligible for statistical analysis. Compared with plaques located below carotid bifurcation, those above bifurcation had significantly greater stenosis at baseline (57.2 ± 13.0% vs. 50.4 ± 13.5%, p = 0.016, adjusted p = 0.005) and greater progression rate of carotid wall volume (35.2 ± 68.8mm3/year vs. 4.2 ± 65.0mm3/year, p = 0.026, adjusted p = 0.005) before and after adjusting for all clinical risk factors and baseline stenosis and wall volume of carotid arteries. Logistic regression showed that the related risk factors were age, hypertension, and smoke for the progression of plaques located above the bifurcation and age for plaques below the bifurcation, respectively. Plaques located above the bifurcation of carotid arteries had greater annual progression and correlated with more cardiovascular risk factors compared with those located below the bifurcation.

Sarcopenia and myokines profile as risk factors in cardiovascular diseases?

Skeletal muscles and substances released during physical activity (myokines) have a beneficial influence on the functioning of the organism. Myokines (released also by myocardium) together with hepatokines and adipokines play an important role not only in energetic metabolism, but they also influence, among others, the function of the circulatory and nervous systems, modulation of inflammatory state and atherogenesis. Under pathological conditions connected with the presence of chronic diseases, chronic inflammatory state, low physical activity, long-term immobility the following consequences are observed: reduction of muscle mass and strength (sarcopenia) and changed profile of released myokines. The incidence of sarcopenia is connected with an unfavorable course of the aging process, often leading to disability and multiple morbidities. Sarcopenia can also lead to frailty syndrome, which not only worsens the prognosis of various diseases, but it can also increase the risk of medical procedures. Sarcopenia and adverse przymyokine profile are modifiable risk factors of cardiovascular diseases and affecting them may improve functional status and prognosis. An important intervention to improve muscles function and myokine profile, apart from nutritional treatment and pharmacotherapy, is regular physical activity as a component of cardiac rehabilitation. In our paper we focused on a review of the newest research regarding the association of sarcopenia and the profile of released myokines with incidence and course of cardiovascular diseases such as chronic heart failure, coronary artery disease, carotid artery atherosclerosis or ischemic cerebral stroke.

Atherosclerotic calcification in major vessel beds in chronic obstructive pulmonary disease: The Rotterdam Study

Background and aimsCOPD is associated with an increased risk of cardiovascular morbidity and mortality, potentially by mechanisms of atherosclerosis. Insight into location-specific vulnerability to atherosclerosis in COPD, including intracranial arteries, is lacking. We aimed to investigate the relation between COPD and atherosclerosis in multiple vessel beds within a large population-based cohort study. MethodsFrom 2003 to 2006, a random sample of 2187 elderly participants (mean age, 69.6 ± 6.8 years; 50.9% female; 11.7% COPD) from the population-based Rotterdam Study underwent computed tomography to quantify atherosclerotic coronary artery calcification (CAC), aortic arch calcification (AAC), extracranial carotid artery calcification (ECAC), and intracranial carotid artery calcification (ICAC). We investigated the association of COPD [ratio of forced expiratory volume in the first second to forced vital capacity (FEV1/FVC) < 70%] with the presence of calcification and with calcification volumes in each vessel bed using logistic and linear regression, with adjustments for cardiovascular risk factors including smoking. ResultsThe prevalence of CAC, AAC and ECAC was significantly higher in subjects with COPD compared to those without. After adjusting for age and smoking, COPD remained associated with the presence of ECAC (odds ratio 1.46 [95% confidence interval, 1.02–2.07, p = 0.037]). COPD was significantly associated with larger calcification volumes in all four vessel beds in people in whom calcification was present. ConclusionsThe results of this study suggest that COPD plays a role in extracranial carotid artery atherosclerosis initiation and systemic atherosclerosis aggravation.

Association of Lipidomic Profiles With Progression of Carotid Artery Atherosclerosis in HIV Infection

Lipid metabolism disruption and excess risk of cardiovascular disease (CVD) have been observed in HIV-infected individuals, but the associations among HIV infection, plasma lipidome, and CVD risk have not been well understood. To evaluate plasma lipidomic profiles and their associations with carotid artery atherosclerosis in individuals with HIV and individuals without HIV. Prospective analysis in the Women's Interagency HIV Study and Multicenter AIDS Cohort Study during a 7-year follow-up (from 2004-2006 to 2011-2013) at multicenter HIV cohorts in the United States. The study included 737 participants aged 35 to 55 years (520 with HIV and 217 without HIV) without CVD or carotid artery plaque at baseline. Data were analyzed between April 2017 and July 2019. Two hundred eleven plasma lipid species. Poisson regression was used to examine the associations of baseline lipid species with risk of plaque measured by repeated B-mode carotid artery ultrasonography imaging. Of the 737 included participants, 398 (54%) were women, 351 (48%) were African American (non-Hispanic), 156 of 737 (21%) were nonwhite Hispanic, and the mean (SD) age was 45 (6) years. After adjusting for demographic and behavioral factors, we identified 12 lipid species, representing independent signals for 10 lipid classes, associated with risk of plaque. Nine lipid species remained significant after further adjusting for conventional CVD risk factors, although many of them showed moderate to high association with conventional blood lipids (eg, total and low-density lipoprotein cholesterols and triglycerides). Cholesteryl ester (16:1) (risk ratio [RR] per standard deviation, 1.28; 95% CI, 1.08-1.52), ceramide (16:0) (RR, 1.29; 95% CI, 1.02-1.63), lysophosphatidylcholine (20:4) (RR, 1.28; 95% CI, 1.05-1.58), lysophosphatidylethanolamine (16:0) (RR, 1.28; 95% CI, 1.05-1.57), phosphatidylethanolamine (38:6) (RR, 1.33; 95% CI, 1.08-1.64), phosphatidylethanolamine-plasmalogen (36:2) (RR, 1.25; 95% CI, 1.04-1.52), phosphatidylserine-plasmalogen (36:3) (RR, 1.19; 95% CI, 1.00-1.43), and triacylglycerol (54:6) (RR, 1.26; 95% CI, 1.04-1.54) were associated with increased risk of plaque, while phosphatidylcholine (36:4) (RR, 0.65; 95% CI, 0.54-0.77) was associated with decreased risk of plaque. Most of these plaque-increased lipid species showed higher levels in individuals with HIV, particularly among individuals with HIV using antiretroviral therapy compared with individuals without HIV. Network analysis identified 9 lipid modules, and 2 modules composed of triacylglycerols and phosphatidylcholines with long and unsaturated acyl chains, respectively, showed the strongest associations with increased risk of plaque. This study identified multiple plasma lipid species associated with carotid artery atherosclerosis, and alterations in these lipid species might be associated with HIV infection and antiretroviral therapy. Our data suggest unfavorable associations of long-chain and unsaturated triacylglycerols and phosphatidylcholines with carotid artery plaque formation.

Geniposide against atherosclerosis by inhibiting the formation of foam cell and lowering reverse lipid transport via p38/MAPK signaling pathways

Geniposide, the main medicinal ingredient of Gardenia jasminoides Ellis, is known to be a resistant agent to atherosclerosis. Some reports its mechanism against atherosclerosis remains completely unclear. Herein, we have investigated the protective effect of geniposide against atherosclerosis as well as clarified the mechanisms related with inhibiting the formation of foam cells and lowering reverse lipid transport via p38/MAPK signaling pathways. Macrophage Raw264.7 was induced by lysophosphatidic acid (LPA) to form foam cell as a cell model. ApoE−/- mice were fed with a high-fat diet for 16 weeks to cause atherosclerosis in carotid artery. After treatment with geniposide, CCK-8, oil red O stain, qRT-PCR and western blot were carried out to explore the effect of geniposide. Morphological changes, histological analyses were used to evaluate atherosclerosis in ApoE–/– mice. Geniposide significantly reduced serum total cholesterol (TC), triglyceride (TG) and LDL cholesterol levels in ApoE−/- mice compared with vehicle control. Meanwhile, geniposide dose dependently inhibited the development of atherosclerosis in ApoE−/- mice. Furthermore, geniposide observably inhibited the formation of foam cells induced by LPA, down-regulated the mRNA and protein levels of SR-A and up-regulated the mRNA and protein levels of ABCA1 or SR-B1 in vitro via inhibition of the p38MAPK and AKT signaling pathways. Our study shows that geniposide protected against atherosclerosis and inhibited the formation of foam cells by regulating the equilibrium on expression of diverse lipid transporters in cytomembrane which related with p38MAPK and AKT signaling pathways. Geniposide is a potential therapeutic drug for atherosclerosis.

P4389Effect of cigarette smoking on carotid artery atherosclerosis: a community-based cohort study

Abstract Background Cigarette smoking is closely associated with the development of cardiovascular diseases (CVD), and the European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) guidelines recommend smoking bans.On the other hand, the relationship between cigarette smoking and subclinical atherosclerosis has not been fully studied. Carotid intima-media thickness (cIMT) is commonly used as a subclinical atherosclerosis marker, and a carotid plaque feature is also known to be an important predictor of cardiovascular diseases. Purpose We sought to clarify the association between cigarette smoking and subclinical atherosclerosis by evaluating carotid plaque including cIMT and carotid plaque features in general population. Methods and results Among 1,209 participants with no prior coronary artery disease who received a medical check-up with cardiovascular examination at our institution, 450 participants (37.2%) were smokers (including both past and current smokers). We defined carotid plaque as cIMT ≥1.1 mm and high-risk plaque as carotid plaque with hypoechoic dominant and/or plaque ulceration. The value of cIMT and the rate of carotid plaque were not different between smokers and never smokers (Figure A &amp; B). However, the rate of carotid high-risk plaque was significantly higher in participants with smokers than those with never smokers (29.7%, vs 23.5%, p=0.011) (Figure C). Even after adjustment with covariates including age, gender and traditional cardiovascular risk factors, cigarette smoking was independently associated with high-risk plaque formation (odds ratio 1.384, 95% CI 1.020–1.877; p=0.037). According to the subgroup analysis classified by age, cigarette smoking was associated with not only the development of high-risk plaque but also the increased value of cIMT in the subgroup over 60 years old, whereas only the rate of high-risk plaque was higher in smokers than never smokers in the subgroup under 60 years old. Carotid plaque and smoking Conclusion The development of high-risk carotid artery plaque may precede thickening of cIMT in cigarette smokers, suggesting that the novel insight for the pathological mechanism underlying cardiovascular events and cigarette smoking.

Sub-clinical atherosclerosis in the common carotid artery in women with/without previous pre-eclampsia: A seven years follow-up

Sub-clinical atherosclerosis in the common carotid artery in women with/without previous pre-eclampsia: A seven years follow-up

P604Clinical feasibility assessment of a novel Quantitative Multi-contrast Atherosclerosis Characterization (qMATCH) sequence for carotid plaque quantification

Abstract Background Conventional protocol contrast MRI (cMRI) for evaluating carotid artery atherosclerosis is clinically under-utilized due to complex scanning procedures and long scan time. Recently, the Quantitative Multi-contrast Atherosclerosis Characterization (qMATCH) has been proposed, which allows comprehensive and quantitative assessment of atherosclerosis including MRA, dark-blood vessel wall morphology, and T1/T2 mapping with an 8-minute single scan (Figure1). However, the diagnostic accuracy and feasibility of qMATCH has not been validated in clinical circumstances. Purpose To evaluate the diagnostic accuracy of quantitative plaque analysis of qMATCH compared with cMRI Method We prospectively enrolled 43 patients who have carotid plaques diagnosed by carotid ultrasound. cMRI was performed along with qMATCH scan. All imaging data were acquired with a clinical 3T scanner using a 64-channel head &amp; neck coil. In the current analysis, we evaluated the diagnostic accuracy of qMATCH in the quantitative assessment of carotid plaque. Plaque area measurements using dark-blood wall images with qMATCH were compared with corresponding cross-sectional T1/T2-weighted images with cMRI as references values (Figure 2). These inter-technique comparisons included linear regression with Pearson correlation and Bland-Altman analyses to assess the mean inter-technique differences (biases) and limits of agreements. Result Among 90 segments, mean plaque areas measured by cMRI and qMATCH were 43.83±21.21 mm2 and 42.47±19.23mm2, respectively (mean differences, −1.36±8.12mm2; p for a paired t-test, 0.073). Correlation coefficient showed excellent correlation between plaque areas measured by cMRI and qMATCH (r=0.943, p&lt;0.001) (Figure 3). Bland-Altman plot showed excellent agreement in plaque areas between the two methods (Figure 4). Conclusion Quantitative carotid plaque burden analysis by a novel sequence with qMATCH is feasible and accurate compared with conventional MRI. Given that qMATCH can reduce scan time and allow quantitative relaxometry mapping, fast and accurate carotid plaque analysis would be feasible. Further studies to evaluate the accuracy of qualitative plaque analysis should be performed to confirm the “all-in-one” assessment of carotid atherosclerosis using qMATCH.

ASSOTIATION OF THE GENETIC POLYMORPHISM E670G OF THE PCSK-9 AND THE SEVERITY OF THE CAROTID ATHEROSCLEROSIS IN PATIENTS WITH HETEROZYGOUS FAMILIAL HYPERCHOLESTEROLEMIA IN UZBEK POPULATION

Objective: to study the severity of carotid artery atherosclerosis in patients with heterozygous familial hypercholesterolemia in the Uzbek population, depending on the level of PCSK-9 and the genetic polymorphism E670G of the PCSK-9 gene.Material and methods. The study included 57 patients with chronic stable coronary artery disease (SCAD) and familial heterozygous hypercholesterolemia (HeFH, group I). The comparison group consisted of 144 patients with SCAD without HeFH divided into two subgroups: A - statin free before the research (n=63) and B (n=81) who took it as outpatients; control group consisted of 17 healthy people. The level of proprotein convertase subtilisin-kexin type 9 (PCSK-9) was measured with Human Proprotein Convertase 9/PCSK9 ELISA Kit (MULTI SCIENCE, China). The genetic typing of PCSK9 E670G (rs505151) polymorphism was performed by means of the PCR-RFLP method.Results. A comparison of the results of duplex scanning of carotid arteries in patients with HeFH showed that the carotid intima-media thickness (CIMT) on the left (1.14±0.18 mm, P&lt;0.01) and on the right (1.15±0.16 mm, P&lt;0.01) was higher, than in the comparison group: 1.05±0.17 mm and 1.04±0.18 mm, respectively. The studies revealed a positive correlation between the incidence of Myocardial infarction (MI) in the history in patients with HeFH and the (r=0.38, P&lt;0.05). The CIMT also correlated with an increase in the concentration of PCSK9 (r = 0.31, P &lt;0.05) in the blood and the carriage of the G allele of polymorphism E670G (r = 0.39, P &lt;0.05) of the PCSK9 gene.Conclusion. Inpatientswithheterozygousfamilialhypercholesterolemia in the Uzbek population a direct correlation was established between Myocardial infarction in the history, the carotid intima-media thickness, an increase in the concentration of PCSK-9 in the blood and the carriage of the G allele of E670G polymorphism of the PCSK9 gene, that allows them to be used as prognostic markers for the risk of development of cardiovascular complications.

Carotid Artery Doppler Ultrasound and Coronary Calcium Score in Assessment of Atherosclerosis in Patients with Suspected Coronary Artery Disease

AbstractBackground: Cardiovascular Disease (CVD) is the leading cause of morbidity and mortality in both industrialized and low income to middle-income countries. As atherosclerosis is the underlying cause for most of CAD, so identification of subclinical disease in the asymptomatic phase has emerged as a public health and economic imperative.Aim of Study: The aim of the study was to evaluate the ability of carotid artery Doppler ultrasound and coronary artery calcium score as screening tools for atherosclerosis in patients who underwent CT coronary angiography for suspect-ed coronary artery disease.Patients and Methods: This study was conducted on 30 patients (17 males and 13 females) with mean age of 58 years with atypical chest pain underwent Cardiac CT (CCT) and carotid Ultrasound (US) on the same day. Carotid artery atherosclerosis was evaluated by detection of Carotid Intimal Thickness (CIMT) & Carotid Plaque Score (CPS) then coro-nary arteries were evaluated by CCT. Coronary artery calcium score was obtained from axial non contrast cardiac CT and finally Coronary Artery Disease (CAD) was evaluated by Gensini score. The relation between both carotid artery Doppler findings & CACS and severity of coronary artery disease were detected.Results: There were significant association between carotid artery disease that was estimated by CIMT, CPS and Gensini score (p=0.045 & 0.004). There was also a significant associ-ation between CACS and Gensini score (p=0.039).Conclusion: Subclinical atherosclerosis as defined by CIMT, CPS and CACs can be simple, non-invasive yet sensi-tive risk-prediction tools to promptly identify those individuals at risk of CVD.

Carotid artery stenosis and ultrasound vascular indexes predict the coronary revascularization in patients with high cardiovascular risk scheduled for coronary angiography.

Carotid artery atherosclerosis is a complex and multifactorial chronic disease. We aimed to assess the predictive value of cardiovascular (CV) risk factors, carotid artery stenosis (CAS), and ultrasound vascular indices for coronary revascularization in patients referred for coronary angiography. Patients scheduled for elective coronary angiography were enrolled. The following ultrasound indices were obtained: CAS, carotid intima‑media thickness (IMT), extra‑media thickness (EMT), intra‑abdominal thickness (IAT), and the combined PATIMA index. The study included 322 patients (118 women, 204 men) with CV risk factors (mean [SD] number, 5.4 [1.5]) and coronary artery disease (n = 228; 71%) with equal rates of 1-, 2-, and 3-vessel disease (35%, 33%, and 32%, respectively). Indications for percutaneous or surgical coronary revascularization were reported for 158 patients (49%). Patients with and without revascularization had a similar total number of CV risk factors (mean [SD], 5.4 [1.3] vs 5.3 [1.1]; P = 0.9) and IAT (mean [SD], 74 [24] mm vs 77 [28] mm; P = 0.4). The receiver operating characteristic (ROC) curve analysis showed that baseline CAS, carotid IMT, EMT adjusted for body mass index, and PATIMA index have a similar significant predictive value for coronary revascularization (mean [SD] area under the ROC curve, 610 [31] u, 590 [31] u, 610 [32] u, and 630 [30] u, respectively). The severity of CAS and carotid vascular indices (IMT, EMT, and PATIMA index) may predict coronary revascularization in patients with high or very high CV risk. Clinical assessment and the presence of CV risk factors do not add predictive value in these patients.

TanshinoneⅡA attenuates carotid artery atherosclerosis by deactivating mast cells in adventitia

Objective: To investigate the effects of tanshinone ⅡA on atherosclerosis plaque formation and adventitial mast cells activation in high-fat-diet induced Apo E(-/-) mice model. Methods: Sixteen 8-week-old Apo E(-/-)male mice and eight 8-week-old C57BL/6 male mice were randomly allocated into following group: the control group (C57BL/6 + carboxymethyl cellulose per gavage), the atherogenic group (Apo E(-/-)+carboxymethyl cellulose per gavage) and the tanshinoneⅡA intervention group (Apo E(-/-)+30 mg/kg tanshinone ⅡA per gavage). All three groups were fed with high-fat-diet for 26 weeks. Tanshinone ⅡA/carboxymethyl cellulose was applied by the method of gavage administration 6 weeks before execution. After 26 weeks, tumor necrosis factor-α (TNF-α) andinterleukin (IL)-6 levels in serum were assessed by ELISA. Carotid artery was removed, fixed with paraformaldehyde, embedded with paraffin and sectioned. Percentage of stenosis was evaluated on HE stained sections. Plaque progression was assessed by Movat staining. Toluidine blue staining was used to evaluate mast cells infiltration and activation. Immunochemistry staining was used to assess 5-HT, TNF-α and IL-6 expression. mRNA expression of mast cell marker Fcer1a in adventitial tissue was detected by real time-PCR. Results: After high-fat-diet for 26 weeks, the mice in the atherogenic group showed advanced atherosclerosis, tanshinoneⅡA intervention reduced the percentage of carotid artery stenosis caused by atherosclerotic plaque formation ((58.48±8.07)% vs. (80.31±4.08)%, P<0.05). Compared with the atherogenic group, tanshinone ⅡA intervention group had lower level of TNF-α ((12.39±1.62)pg/ml vs. (17.44±1.42)pg/ml) and IL-6 ((116.24±12.16)pg/ml vs. (166.05±19.09)pg/ml) in serum, lower TNF-α ((20 145±1 556) vs. (25 288±1 671)) and IL-6 ((25 688±1 604) vs. (35 286±4 198)) expression in adventitia (all P<0.05). TanshinoneⅡA intervention also decreased the number of mast cells infiltration and activation, reduced 5-HT expression and mast cell marker Fcer1a mRNA relative expression in adventitia (all P<0.05). Conclusions: Tanshinone ⅡA could attenuate induced by high-fat-diet carotid artery atherosclerosis in Apo E(-/-) mice. The protective effect of tanshinoneⅡA is probably mediated through reducing the number and activation percentage of mast cells, decreasing the release of inflammatory cytokines and inflammation of carotid artery in adventitia.

Evaluation Of Atherosclerosis Severity Based On Carotid Artery Intima-Media Thickness Changes: A New Diagnostic Criterion

This study aimed to identify instant intima-media thickness changes (ΔIMT) in the common carotid artery (CCA) during cardiac cycle in order to assess atherosclerosis progression. Using a computerized semi-automated method, instant IMT changes were extracted in the two walls of the left CCA (240 consecutive patients) using B-mode ultrasound images. We found that CCA ΔIMT increased from 8 ± 4% of IMTmax in the controls to 15 ± 6% of IMTmax in the severe stenosis group. According to the multiple ordinal regression analysis, ΔIMT was associated with the severity of carotid artery stenosis (odds ratio [OR], 4.95; p < 0.001), independent of sex (OR, 1.11; p = 0.04), age (OR, 1.14; p < 0.001), body mass index; OR, 1.13; p = 0.036), hypertension (OR, 2.04; p < 0.001), diabetes (OR, 1.38; p = 0.045) and hyperlipidemia (OR, 1.54; p = 0.002). We concluded that increment of CCA ΔIMT during the cardiac cycle was strongly and independently associated with severity of carotid artery stenosis or atherosclerosis progression.

Inhibition Of Microrna-494 Halts Atherosclerotic Plaque Progression And Stabilizes Advanced Atherosclerotic Lesions

Inhibition of miR-494 reduces early carotid artery atherosclerosis. However, patients generally present with advanced atherosclerosis. Therefore, we investigated the effect of miR-494 inhibition on advanced atherosclerotic plaques. LDLr-/- mice were placed on a Western Type Diet (WTD). After four weeks, semi-constrictive collars were placed around both carotid arteries to induce local plaque formation. After 10 weeks of WTD, a subset of mice (n 10) was sacrificed as baseline. Remaining mice were placed on normal chow and 3rd Generation Antisense Oli- gonucleotides (3GAs) against miR-494 (3GA-494; n¼10) or negative control (3GA-ctrl; n¼10) were administered (i.v., 1 mg/mouse) imme- diately and at two and four weeks after diet switch. After 5 weeks, all mice were sacrificed. 3GA-ctrl mice showed increased carotid artery plaque size compared to baseline, even though plasma cholesterol levels were reduced upon diet-replacement (before: 863±115 mg/dL vs. after: 214±13 mg/dL). 3GA-494 treatment resulted in a further cholesterol reduction (3GA-494: 154±6 mg/dL, P decreased compared to control and 3GA-494 mice had similar plaque sizes to baseline mice (baseline: 30±8*103 mm2, 3GA-ctrl: 56±16*103 mm2 vs. 3GA-494: 23±9*103 mm2, P plaque size remained similar between groups, however, increased intra-plaque collagen (3GA- ctrl: 37±3% vs. 3GA-494: 55±3%, P 3GA-494: 12±1%, P¼0.1) was reduced after miR-494 inhibition. Our results show that treatment with 3GA-494 halts plaque progression in the carotid artery and increases plaque stability in aortic root plaques. Furthermore, 3GA-494 treatment reduces plasma cholesterol els.

Ambulatory Blood Pressure Reactivity as a Moderator in the Association Between Daily Life Psychosocial Stress and Carotid Artery Atherosclerosis: Erratum.

Ambulatory Blood Pressure Reactivity as a Moderator in the Association Between Daily Life Psychosocial Stress and Carotid Artery Atherosclerosis: Erratum.

Anti-atherosclerotic effects between a combined treatment with simvastatin plus hirudin and single simvastatin therapy in patients with early type 2 diabetes mellitus

This study aimed to investigate the efficacy and safety of simvastatin plus hirudin in preventing atherosclerosis in the patients with early type 2 diabetes mellitus (T2DM). This was a 24-week, randomized, open-label and controlled study in which 150 outpatients initially diagnosed with T2DM were randomly assigned into either simvastatin (40 mg daily at night) plus hirudin (3 g thrice daily) group [combined group (CG) n=75] or simvastatin (40 mg once daily) group [monotherapy group (MG) n=75]. The therapeutic efficacy was evaluated by the score of carotid artery atherosclerosis, plaque size, peak systolic velocity (PSV) and end-diastolic velocity (EDV) on carotid ultrasonography at three and six months after treatment. Logistic regression analysis was used to investigate the correlation between treatment and carotid atherosclerosis. One hundred and thirty-one patients completed this study, and there were no significant differences in the dropout rate in the CG (14.67%) and the MG (10.67%). Significant difference was found in the incidence of adverse events in the CG compared with the MG (37.50% vs. 17.91%, P<0.05) due to the higher risk of hemorrhage (12.50% vs. 1.49%, P<0.05), which did not affect the treatment compliance. The efficacy of combined treatment was better than monotherapy in the enhancement of carotid artery atherosclerosis scores (P<0.01), the plaque thickness (P<0.05) and the change of PSV (P<0.05) and EDV (P<0.05) since three months after treatment, which maintained to the end of observation. In addition, hirudin treatment was able to independently predict the carotid artery atherosclerosis scores (β=2.37, P<0.05), the plaque thickening (β=3.51, P<0.01) and the change of PSV (β=1.69, P<0.05) and EDV (β=1.79, P<0.05). Combined use of simvastatin and hirudin is well tolerated and possesses better anti-atherosclerotic effects than simvastatin alone in patients with early T2DM.

Correlation of abdominal fat area and distribution with carotid atherosclerosis progress in middle aged and elderly people

Objective To analyze the relationship between the abdominal fat and the progress of carotid atherosclerosis in the subject ageing 51-100 years. Methods 140 subjects receiving health examination in the department of health of Peking Union Medical College Hospital from 2015 to 2016 were included in the research. The abdominal fat area and distribution were calculated according to abdominal CT, and the progress of atherosclerosis in carotid artery was determined by ultrasound. Results In the population of 51-100 years old, there were no statistically significant difference in abdominal fat area and distribution among carotid artery plaque thickening group, arteriosclerosis non-progressing group and plaque reducing group; In the population of 51-80 years old, the total abdominal fat was significantly higher in carotid artery plaque thickening group than in arteriosclerosis non-progressing group and plaque reducing group (P=0.05, P=0.03), abdominal visceral fat area also increased, but no significant difference was found (P>0.05), and no significant differences in abdominal fat distribution was found (P>0.05. Conclusion The less total area of abdominal fat is, the slower the progress of atherosclerosis in carotid artery is in the population of 51-80 years old. Key words: Carotid atherosclerosis; Visceral fat; Subcutaneous fat; Obesity

Ischemic stroke: Observations and analysis of stroke patients admitted in a tertiary hospital of Kathmandu

Background: Stroke is a disabling condition that has physical and mental impact on a patient’s life. Stroke is an important morbidity for low and middle income countries like Nepal. Hypertension, diabetes, smoking, and dyslipidemia are common risk factors in this regard and are inadequately controlled; mainly because of poor public awareness, inadequate infrastructure, lack of service and qualified manpower.Objectives: This study aims to provide insight into the epidemiology and risk factors in ischemic stroke patients.Methodology: A descriptive cross sectional study was conducted in 92 ischemic stroke patients at a tertiary care hospital Kathmandu Medical College and Teaching Hospital (KMCTH), Sinamangal, Nepal from December 2017 to June 2018. Consecutive sampling technique was used and data was collected from ischemic stroke patients above 14 years of age who were admitted in the Department of Neurology. Information regarding pre-morbid and morbid conditions, imaging findings as well as results was obtained from biochemical analysis of blood after taking consent from the patient or patient’s relative. Statistical Package for the Social Sciences Version 20 was used as a tool for statistical analysis.Results: Their mean age was 63.25 years with standard deviation of 16.45. Dyslipidemia was the most commonly found risk factor which was present in 77.2% of the subjects, followed by smoking (59.8%), presence of carotid artery atherosclerosis (59.8%), hypertension (50%), atrial fibrillation (26.1%) and diabetes mellitus(15.2%). Smoking was significant in males and heart disease was mostly seen in females.Conclusion: Dyslipidemia and smoking were the most common risk factors followed by carotid artery atherosclerosis. Patients with hypertension and dyslipidemia had higher incidence of stroke in both young and elderly group.

Automatic identification of atherosclerosis subjects in a heterogeneous MR brain imaging data set

Carotid-artery atherosclerosis (CA) contributes significantly to overall morbidity and mortality in ischemic stroke. We propose a machine learning technique to automatically identify subjects with CA from a heterogeneous cohort of magnetic resonance brain images. The cohort includes 190 subjects with CA, white mater hyperintensites of presumed vascular origin or multiple sclerosis, as well as 211 presumed healthy subjects. We determined a set of handcrafted and convolutional discriminant features to perform this task. A support vector machine (SVM) was used to perform this four-class classification task. Our approach had an accuracy rate of 97.5% (higher than chance accuracy of 52.6% for guessing majority class), sensitivity of 96.4% and specificity of 97.9% in identifying subjects with CA, suggesting that the proposed combination of features may be used as an imaging biomarker for characterizing atherosclerotic disease on brain imaging.

Carotid artery atherosclerosis is not associated with hyoid proximity: Results from a cross-sectional and longitudinal cohort study

IntroductionCervical internal carotid artery (ICA) atherosclerotic plaque and stenosis is often asymmetric. We hypothesized that hyoid bone proximity to the ICA also may be asymmetric and may increase the risk of traumatic endothelial injury and accelerate atherosclerotic stenosis. MethodsA retrospective cross-sectional and longitudinal cohort design evaluated consecutive adult patients at 3 hospitals who underwent repeat computed tomography angiography (CTA) of the neck 2 calendar years apart (01/2000–07/2017). ICA plaque thickness, luminal stenosis, and their progression over time were compared between side with the nearer hyoid wing (proximal side) to the further side (distal side). ResultsSixty-six patients were included with a median age of 64y (IQR 53–73), 37 (56.1%) female, had a median hyoid-ICA distance of 3.06 mm (IQR 1.27–6.20 mm) and median difference between sides of 2.11 mm (IQR 0.70–3.97 mm). The median plaque thickness was 3.5 mm (IQR 2–4) and median stenosis was 10% (IQR 0–33%). Comparing the proximal to distal side, there was no difference in ICA plaque thickness (median 2.5 mm [IQR 1–4] vs. 3.0 mm [IQR 2–4], p = 0.366) or stenosis (7% [IQR 0–31%] vs. 12% [IQR 0–39%], p = 0.21). After a median follow-up of 1002 days (range 392–3397 days), there was no difference in the change in plaque thickness (0.5 cm [IQR 0–1] vs. 0.0 cm [IQR −0.5–0.5], p = 0.21) or stenosis (0% [IQR −2.5–13%] vs. 0% [IQR −6–5%], p = 0.34) between proximal and distal ICAs. ConclusionsThe presence and progression of atherosclerotic plaque and stenosis were unrelated to hyoid-ICA distance in this cross-sectional and longitudinal cohort study.