Carotid Artery Intima Media Research Articles

Evaluation of subclinical cardiovascular risk in drug-naive pediatric patients with anxiety disorders.

This study examined subclinical atherosclerosis in drug-naïve children with anxiety disorders using non-invasive measures to investigate the clinical features associated with subclinical atherosclerosis. A total of 37 drug-naive children and adolescents with anxiety disorders and 37 healthy controls were included in the study. The Children's Depression Inventory (CDI) and the State-Trait Anxiety Inventory (STAI-T and STAI-S) were used to assess children's depression and anxiety levels. Carotid artery intima-media (cIMT), epicardial adipose tissue (EAT), and periaortic adipose tissue (PAT) thicknesses, which are indicators of subclinical atherosclerosis, were obtained by echocardiographic measurements. Multivariate analysis of covariance (MANCOVA) revealed a significant main effect on cIMT, EAT thickness, and PAT thickness, independent of confounding factors such as age, sex, body mass index, mean blood pressure, and family income (Pillai's Trace V = .76, F (1, 72) = 35.60, P < .001, ηp2 = .76). Analysis of covariance (ANCOVA) showed that cIMT, EAT thickness, and PAT thickness values were significantly higher in the anxiety disorder group compared to the the control group (P < .001). In partial correlation analysis, a positive correlation was observed between STAI-T and cIMT and EAT thickness. In linear regression analyses, age and STAI-T were significantly correlated with cIMT and EAT thickness levels. These results suggest that subclinical cardiovascular risk is significantly increased in children and adolescents with anxiety disorders.

FDADE: Flow direction algorithm with differential evolution for measurement of intima-media thickness of the carotid artery in ultrasound images

The third leading cause of death globally is cardiovascular disease. Atherosclerosis, the build-up of plaque on the arterial wall, is the earliest sign of cardiovascular disease. The common carotid artery's Intima-Media Thickness (IMT) is primarily used as an early indicator of cardiovascular disease. This paper proposes a new method called FDADE by integrating the Flow Direction Algorithm (FDA) with Differential Evolution (DE) to segment images using multilevel thresholding. Otsu's interclass variance function is used in FDADE to establish optimal threshold values for measuring IMT in Carotid Artery Ultrasound Images. Carotid ultrasound images are subjected to a quantitative evaluation, and the results are compared to those obtained using other, more recent techniques. This method is reliable in measuring the IMT in carotid ultrasound pictures by the experimental investigation. Also, the proposed FDADE's performance is tested using a variety of benchmark issues of varying levels of complexity. Various tests are undertaken, such as the Wilcoxon rank-sum test for statistical implication, convergence curvatures, and the detachment amid the resolution earlier and later applying alteration approaches. The data are then compared and analyzed to demonstrate the superiority of the proposed FDADE over alternative algorithms.

Development and validation of dietary atherogenic index using common carotid artery-intima-media thickness: A food frequency questionnaire-based longitudinal study in Korean adults

Dietary patterns based on pathways of diseases such as subclinical atherosclerosis can predict diet-disease associations better than dietary quality indices or data-driven indices. We aimed to develop and validate a novel dietary atherogenic index (DAI) in adults using the common carotid artery-intima media thickness (c-IMT) in Korean adults. Participants aged ≥40 years from the Yangpyeong cohort were enrolled in the development set (n = 1373). Two DAIs were developed using 38 predefined food groups as predictors and c-IMT as response variable, using stepwise linear regression (SLR) and reduced rank regression (RRR) models. Based on the associations between DAI and c-IMT, DAIs were then validated in the total, men, and women, internally in 1000 bootstrap sets, and externally in a set combined with 2 other populations (n = 2476). The DAI-S by SLR and the DAI-R by RRR included 7 anti- and 10 pro-inflammatory food groups and 2 anti- and 6 pro-inflammatory food groups, respectively. Total rice and white root kimchi were pro-inflammatory, and mushrooms, other beverages (mostly traditional beverages), poultry, processed seafood, and pizza/hamburger were anti-inflammatory in both the DAI-S and DAI-R. They were internally valid in the multivariable-adjusted models, showing a significant linear trend in all 3 sets; they were also valid in the bootstrap at 95% confidence interval. In the external validation, only the DAI-S was significantly associated with the c-IMT (P trend = .0004, .0133, and .0212 in total, men, and women, respectively). This study indicated that DAIs, particularly DAI-S, may be useful for assessing the atherogenic potential of food-based total diets.

THE ROLE OF NEUROHORMONAL FACTORS - GALECTIN-3 AND ALDOSTERONE IN THE FORMATION OF THE CLINICAL PROFILE OF THE PATIENT AND THE INFLUENCE ON THE STRUCTURAL REMODELING OF THE HEART AND VESSELS IN PATIENTS WITH HYPERTONIC DISEASE

The article is devoted to the study of the urgent problem of modern cardiology with regard to improving the prediction of the course of Essential arterial hypertension (AH), stage II, in patients of young and middle age based on the study of the role of age-related and neurohumoral factors - galectin-3 and aldosterone in the formation of the clinical profile and structural remodeling of the heart and vessels.&#x0D; The study was conducted according to the protocol of the current clinical and performed at the Department of Therapeutic Disciplines and Family Medicine of the Faculty of Postgraduate Education, Vinnytsya National Pirogov Memorial Medical University. The material was collected on the basis of the Khmelnytsky Regional Cardiovascular Center of the Khmelnytsky Regional Council in the period from January 2016 to April 2017.&#x0D; Patients with hypertension, who participated in the study, were divided into 4 groups depending on age: groups of young and middle age. The group of young patients included men and women (40 people), aged 18 to 44 years. The middle-aged groups included men and women (40 people), aged 45 to 60 years. The total number of the examined patients which we surveyed and were included in the study was 160 persons. The control group included 27 relatively healthy persons (male and female). The average age and the percentage of young and middle-aged patients did not differ significantly. Verification of the diagnosis of hypertension was carried out on the basis of the existing criteria and recommendations.&#x0D; In the course of study, all the patients have undergone laboratory tests (determination of the level of galectin-3 and aldosterone, glucose, creatinine, electrolytes (Na 2+, K +), total cholesterol, triglycerides, high, low and ultra-low density lipoprotein cholesterol), instrumental tests (electrocardiography (ECG ) in 12 leads, 24-hour ambulatory blood pressure monitoring (ABPM), echocardiographic (Echo CG) in M, B-, D modes, the structural state of the carotid arteries (CA) based on the assessment of the thickness of the intima-media (TIM) and statistical studies.&#x0D; Aldosterone level was determined by the enzyme-linked immunosorbent assay ELISA using reagents of IBL International GmbH (Canada). Aldosterone level of 40-160 pg/ml was considered as the reference values.&#x0D; The level of galectin-3 in serum was determined by the solid-phase enzyme linked immunosorbent assay using a set of reagents of Human Galectin-3 Platinum Elisa (Bender MedSystems GmbH, Austria).&#x0D; Scores reflect the prognostic value of indicators. The most valuable for predicting relatively high levels of galectin-3 are obesity, carotid artery Intima Media &gt; 0.91 mm and left atrial volume index &gt; 34 ml/m2 (echocardiography), while aldosterone is obesity, the presence of a non-dipper profile according to аverage blood pressure (24 hour blood pressure monitoring) &gt; 32 ml/m2 (еchocardiography) and nightly average heart rate &gt; 62 (24 hour blood pressure monitoring).&#x0D; When determining the IV level of galectin-3 and/or aldosterone, a more severe course of hypertension should be envisaged, and the patient should be referred to the group of high risk of complications from the heart and blood vessels and, possibly, an earlier indication of mineralocorticoids should be considered.

Evaluation of subclinical cardiovascular risk and cardiac function in children with vesicoureteral reflux: a prospective study.

Vesicoureteral reflux is a prominent congenital anomaly of the kidney and the urinary tract. Further, renal scarring is known to be related to chronic inflammation. However, there have been limited studies to date regarding the cardiovascular consequences of vesicoureteral reflux. The aim of this study is to evaluate the possible subclinical atherosclerosis and cardiovascular complications in children with vesicoureteral reflux. Patients with vesicoureteral reflux and age matched healthy controls were prospectively included in this case-control study. Patients were divided into two groups concerning renal scarring status. To assess cardiac functions, carotid artery intima media, epicardial adipose tissue, and periaortic adipose tissue thicknesses were evaluated. There were 50 patients with vesicoureteral reflux; 26 patients without renal scarring and 24 patients with renal scarring, as well as 40 healthy controls. Myocardial performance indexes (Tei indexes) measured by tissue Doppler echocardiography from septum and left ventricle were significantly increased in study group (for all, p < 0.001). Also, intima media, epicardial adipose tissue, and periaortic adipose tissue thicknesses of the study groups were significantly higher than the control group (for all, p < 0.001). However, no statistical difference was observed between renal scarring (-) and renal scarring (+) groups. Results of our study showed early deterioration of cardiac systolic and diastolic functions in children with vesicoureteral reflux regardless of renal scarring. Also, diagnosis of vesicoureteral reflux is an important risk factor for subclinical atherosclerosis, independent of renal scarring, which should be considered in the follow-up of these patients.

Features of cerebral blood flow in patients with chronic obstructive pulmonary disease associated with hypertension

Objective. The aim of the work was to study the features of cerebral blood flow in patients with chronic obstructive pulmonary disease (COPD) associated with hypertension (HTN). Design and methods. A crosssectional study was conducted, which included 90 males 40–60 years old. Of these, 30 patients with chronic COPD associated with HTN (COPD + HTN) were included in the study group, 30 individuals with isolated COPD were in the comparison group, 30 healthy volunteers were included in the control group. All participants underwent physical examination, spirography, 24-hour blood pressure monitoring and ultrasound examination of cerebral vessels. Results. Patients with COPD + HTN in comparison with the control showed an increase in the diameter (p = 0,018) and complex of the intima-media of the common carotid artery (p = 0,003) while the velocities, resistance index (RI) and pulsation index (PI) did not change. In the basin of the internal carotid artery an increase in RI values was noted (p = 0,018). At the intracranial level there was a decrease in the end-diastolic velocity (p = 0,03) and the time-averaged average blood flow velocity (TAV) (p = 0,033) without due changes RI and PI. At the same time no changes in speed indicators and indices were noted in the vertebral artery basin. Among the indicators of cerebral perfusion in patients with COPD + HTN, hydrodynamic resistance (p = 0,0015), intracranial pressure (ICP) (p = 0,0048) significantly increased, and the cerebral blood flow index was comparable with the control. Assessment of venous cerebral blood flow showed an increase in the diameter of the internal jugular vein (p = 0,021) with unchanged TAV together with an increase in ICP indicating the formation of venous dysfunction. It was shown that the body mass index, forced expiratory volume at the first second, systolic and diastolic blood pressure together determine the peak systolic blood flow velocity from the midbrain artery. Conclusions. The cerebral blood flow in patients with COPD + HTN is characterized by a change in arterial blood flow at the level of both intra- and extracranial vessels, while maintaining a normal cerebral blood flow index, as well as the formation of arteriovenous dyshemia against the background of remodeling of the cerebral vascular bed.

Association between C-reactive protein and carotid plaque in mild-to-moderate idiopathic pulmonary fibrosis.

An association between C-reactive protein (CRP) levels and carotid plaque has never been investigated in idiopathic pulmonary fibrosis (IPF). The aim of this study was to evaluate the extent of carotid atherosclerosis in mild-to-moderate IPF and to assess its relationship to serum CRP. This observational retrospective case-control study included 60 consecutive IPF patients (73.8 ± 6.6years, 45 males) and 60 matched controls, examined between Sep 2017 and Jan 2019. All patients underwent CRP assessment and a carotid Doppler ultrasonography. CRP levels were significantly higher in IPF patients than controls (0.2 ± 0.09mg/dl vs 0.09 ± 0.04mg/dl, p < 0.0001). A total of 46 plaques were detected, with higher prevalence in IPF patients than controls (38 vs 8, p < 0.0001). On univariate logistic regression the main variables independently associated with carotid plaque were: age (HR 1.09, 95% CI 1.03-1.16, p = 0.006), hypertension duration (HR 1.05, 95% CI 1.01-1.09, p = 0.01), diabetes duration (HR 1.09, 95% CI 1.01-1.18, p = 0.03), LDL-cholesterol (HR 1.07, 95% CI 1.04-1.10, p < 0.0001) and finally CRP levels (HR 1.73, 95% CI 0.59-5.00, p < 0.0001). Multivariate logistic regression analysis revealed that LDL-cholesterol (HR 1.05, 95% CI 1.01-1.08, p = 0.009) and CRP levels (HR 1.43, 95% CI 0.39-5.19, p < 0.0001) retained statistical significance. Common carotid artery-intima media thickness was significantly correlated with CRP levels in IPF patients (r = 0.86). SerumCRP might represent both an early marker and a potential therapeutic target for carotid atherosclerosis in mild-to-moderate IPF.

Abstract TP472: The Interplay Between Subclinical Micro- and Macro-Vascular Disease in Asymptomatic Individuals

Introduction: Pathophysiological changes within large arteries, among many other factors, are considered to contribute to cerebral small vessel disease. Craniocervical sonography is a valuable tool in this regard to evaluate various physiological metrics of extra- and intra-cranial large arteries. Herein, we tried to evaluate the interplay between markers of small vessel disease, and internal carotid (ICA) and middle cerebral artery (MCA) pulsatility, carotid distensibility and intima media thickness (IMT). Methods: We prospectively evaluated a total of 278 subjects without any prior history of stroke using transcranial and cervical Doppler ultrasound, and magnetic resonance imaging. Pulsatility index was determined by Gosling’s index from bilateral MCA’s and ICA’s. We also measured carotid distensibility and IMT (by AutoIMT TM ) from both carotids and calculated their mean values. The relationship of all these sonographic metrics with imaging markers of chronic small vessel disease [lacunes, microbleeds, perivascular spaces (PVS), white matter hyperintensities (WMH)] were evaluated in multivariate models where age and cardiovascular risk factors were included as additional covariates. Results: The study population consisted of 108 males and 170 females with a mean±SD age of 64±9 years. In bivariate analyses, higher carotid IMT, higher MCA and ICA pulsatility indices, and lower carotid distensibility were significantly associated with high burden of WMH (Fazekas score of ≥2), basal ganglia PVS (PVS score ≥2) and presence of lacunes, but not with microbleeds or centrum semiovale PVS. In multivariate models, each 0.1 mm change in IMT increased the odds of severe WHM by 1.4 (95%CI 1.0-1.9), severe basal ganglia PVS by 1.4 (1.0-1.8) and lacunes by 1.6 (1.0-2.6), while no significant association remained for pulsatility index or distensibility. Conclusion: Our analyses highlight that IMT, is not only a subclinical marker of atherosclerosis, but also emerges as a factor intimately related with cerebral small vessel disease. These findings raise the possibility that IMT and cerebral small vessel disease might together reflect downstream events that culminate in vascular disease involving the large and small vessels of the brain.

Correlation of Plasma Klotho Levels and Carotid Intima- Media Thickness in CKD Patients on Regular Hemodialysis

Background: The incidence of heart death is 5-10 times more in patients with chronic kidney disease (CKD) with regular hemodialysis compared to the general population. Vascular calcification is a risk factor. In CKD patients there is a decrease in the distal renal cell cells which are the main producer of Klotho in the body. The functions of Klotho are maintaining integrity, endothelial permeability and endogenous inhibitors of vascular calcification. Previous studies reported an association between vascular calcification and Klotho plasma levels. Vascular calcification for heart disease can be determined by the thickness Intima Media (TIM) Carotid Artery. Objective: To determine the correlation of plasma Klotho levels with the Intima Media thickness of the Carotid Artery in CKD patients with regular hemodialysis. Methode: This cross-sectional study was conducted at the Rasyida Kidney General Hospital in Medan from April to July 2018. Patients with CKD who have undergone routine hemodialysis are examined for plasma levels of Klotho and real time ultrasound examinations to determine the thickness of arterial intima media carotid. Data are analyzed with Mann Whitney test, binominal logistic regression and Pearson correlation. Results: Seventy patients with CKD showed an average plasma Klotho level of 281.43 + 298.63 pg / ml with an average TIM of the carotid artery of 0.22 + 0.09 cm. Patients were divided into 2 groups, namely the calcification group (n = 39) and the noncalcified group (n = 31). Mann-Whitney test was performed with the results that there were differences in plasma Klotho levels between the calcification group and the noncalcified carotid artery group which were statistically significant (p = 0.001). The binominal logistic regression analysis test was performed on risk factors associated with the incidence of vascular calcification and the results of Klotho serum levels, Diabetes Mellitus and Hypertension were found to be significant risk factors for calcification (p &lt;0.05). With the Pearson correlation test, the negative correlation of plasma Klotho levels with the thickening of Intima Carotid Arterial Media was statistically significant with moderate correlation strength (p = 0.002; r = -0.368). Conclusion: Patients with chronic kidney disease with low plasma Klotho levels have thickening of the intima media of carotid artery.

ATHEROPROTECTIVE EFFECT OF SOLANUM BETACEUM ON RAT EXPOSED TO CIGARETTE SMOKE

Objective: The objective of this research was to determine the atheroprotective effect of Solanum betaceum ethanol extract toward carotid arteryintima-media thickness (cIMT) and the level of malondialdehyde (MDA) on rats exposed to cigarette smoke.Methods: Thirty adult Rattus norvegicus strain Wistar were divided into five groups and exposed to cigarette smoke, 3 pc cigarette/day andsimultaneously administered with S. betaceum in Group K2, K3, and K4 (100 mg/kg b.w/day; 200 mg/kg b.w/day; and 400 mg/kg b.w/day),respectively. The duration of treatment for all groups was 28 days. Blood was withdrawn from the cardiac to determine the MDA level. Histologicalslide from carotid artery intima-media was collected to determine cIMT.Results: S. betaceum ethanol extract administration could significantly prevent the development of atherosclerosis due to oxidative stress bydecreasing the level of MDA (p&lt;0.05) and reducing the degree of cIMT changes (p&lt;0.05).Conclusion: The present study found that S. betaceum ethanol extract could prevent the development of atherosclerosis due to smoke exposurethrough the reduction of the MDA level, i.e., the marker of oxidative stress, which is associated with the reduced of cIMT changes. However, furtherstudies on other bioactivity of S. betaceum as an antioxidant are warranted.

The association of fibroblast growth factor 23 with atherosclerosis and arterial stiffness in peritoneal dialysis patients

Aim: Increased serum fibroblast growth factor-23 (FGF-23) levels are associated with adverse cardiovascular events in chronic kidney disease patients. The aim of our study was to investigate the association of FGF-23 with atherosclerosis and arterial stiffness in patients with peritoneal dialysis (PD). Material and Methods: This cross-sectional study was performed in 55 (34 (61.8%) male/21 (38.2%) female) PD patients with a mean age of 53.1±11.4 years. The presence of atherosclerosis was determined by carotid artery-intima media thickness (CA-IMT) and the presence of arterial stiffness was determined by brachial-ankle pulse wave velocity (baPWV). Residual renal function was determined by residual glomerular filtration rate (rGFR), renal creatinine clearance (CCr), and residual urine output. FGF-23 and soluble klotho (s-KL) levels were determined by enzyme-linked immunosorbent assay. Results: CA-IMT (p 2.16. In multiple regression analysis there was an inverse relationship between log10 FGF-23 and rGFR (p = 0.032), residual diuresis (p = 0.048), renal CCr (p = 0.045). There was no relationship with log10 FGF-23 and CA-IMT, baPWV (p > 0.05). Conclusion: Increased atherosclerosis and arterial stiffness were detected in PD patients compared to healthy subjects. There was no relationship between FGF-23 and atherosclerosis and arterial stiffness in PD patients.

Daily variability of arterial stiffness of patients with arterial hypertension depending on the category of cardiovascular risk

The study of the daily variability of arterial stiffness indicators, depending on the category of cardiovascular risk.Materials and methods.The study consistently included patients with essential hypertension who were admitted to the cardiology department of the Volga district medical center from November 1, 2015 to October 1, 2017. The study involved 134 patients with an average age of 52±1 years. Depending on the category of total cardiovascular risk, the patients were divided into 3 groups from I (lowest risk) to III (highest risk). The analysis was carried out on ABPM for 12-14 days (BPLab system of "Peter Telegin" firm). Determined: glomerular filtration rate (GFR), the thickness of the intima-media of the common carotid arteries, analysis of the lipid spectrum. For statistical analysis of clinical and instrumental data, a T-criterion for independent samples was used and an ANOVA analysis was performed. A correlation analysis was performed.Results.Patients of group III had the highest level of av. SBP (рI-III =0.010; pII-III =0.020) and mean pulse BP (PBP) (рI-III =0.002; pII-III =0.002), also more unfavorable the indicators cALALx (pI-II=0.025; рI-III =0.004), varAlx (рI-III =0.004) and av. ASI (рI-III =0.034). When comparing the data of patients of groups II and III, adjusted for gender and age, it was found that statistically significant differences between the groups of varPAD (pII-III =0.008), AASI (рI-III =0.043), varAlx (pII-III=0.049), as well as a pronounced tendency for varASI (pII-III=0.050). Markers of target organ damage (TIM, LVML, GFR) were more pronounced in the high-risk group. As the risk group increased, the level of HDL decreased (рI-III =0.002; pII-III I=0.0001), the level of TG increased (рI-III =0.007; pII-III =0.009) and the CA (рI-III =0.015). The total cholesterol level was lower in patients of group III compared to group II (pII-III=0.004). Statistically signifi nt relationships of arterial wall stiffness indicators with age were found: crAlx (0.467, p&lt;0.001), varAlx (0.272, p&lt;0.01), cpASI (0.227, p&lt;0.01), varASI (0.407, p&lt;0.001). In addition, women showed significant correlations of medium and high strength between age and mean values of mean SPD (r = 0.490, p&lt;0.05), varPAD (r=0.540, p&lt;0.05), avAS (r=0.460, p&lt;0.05) and varASI (r=0.620, p&lt;0.05). VarASI and WedSASI were most closely associated with the level of SRSAD and SRPAD. Only cASI was associated with GFR, and only varASI was associated with the parameters of the lipid spectrum (HSLPVP, TG, KA and LVMI.Conclusion.The most statistically significant dynamics was observed when evaluating varASI, which varied in the sequence I gr. &lt;II gr. &lt; III gr. Corrected by sex and age, the analysis showed a greater variability in arterial stiffness in high-risk patients.

Effect of aldosterone antagonists on common carotid artery's intima-media thickness, stiffness indices and flow mediated vasodilatation of brachial artery in CAD patients

Effect of aldosterone antagonists on common carotid artery's intima-media thickness, stiffness indices and flow mediated vasodilatation of brachial artery in CAD patients

The relationship between insulin resistance and endothelial dysfunction in obese adolescents.

Insulin resistance and endothelial dysfunction share a reciprocal relationship that links the metabolic and cardiovascular sequelae of obesity. We characterized the brachial artery reactivity testing (BART) and carotid artery-intima media thickness (CIMT) in adolescents categorized as obese insulin resistant (OIR) and obese not insulin resistant (ONIR). Lipoprotein particle (p) analysis and inflammatory cytokines in OIR and ONIR groups were also analyzed. Obese adolescents (n=40; mean body mass index [BMI] 35.6) were categorized as ONIR and OIR based on their homeostatic model assessment of insulin resistance (HOMA-IR) calculation (≤or> than 3.4). Ultrasound measured conduit arterial function BART, microvascular function (post-ischemic hyperemia) and conduit artery structure CIMT. BART did not differ according to IR status (mean±SD: 7.0±4.3% vs. 5.9±3.4% in ONIR and OIR, respectively, p=0.3, but post-ischemic hyperemia was significantly greater in the ONIR group (4.5±2.2 vs. 3.5±3, p=0.04). Atherogenic lipoprotein particles; large VLDL particles and small LDL particles were higher in the OIR compared to ONIR group. OIR adolescents demonstrate an inflamed atherogenic milieu compared to the ONIR adolescents. Microvascular function, but not conduit vessel structure or function, was impaired in association with IR.

English

English

Changes over the last decade in carotid atherosclerosis in patients with end-stage kidney disease

ObjectiveTherapies for chronic kidney disease have changed greatly over the last decade. The aim of this study was to examine the changes in the clinical characteristics and carotid atherosclerosis of patients with end-stage kidney disease (ESKD) over the last 9 years. MethodsA cross-sectional study of 150 consecutive patients with ESKD who had initiated maintenance dialysis between January 2005 and December 2013 was conducted. The patients' mean age was 68 ± 13 years. The group comprised 73% men, and 63% of the patients had diabetic nephropathy. The carotid artery-intima media thicknesses and the plaque scores (PS) were measured using carotid artery ultrasonography within 3 months of dialysis initiation. Changes in the patients' carotid atherosclerosis and clinical characteristics over the years were examined by categorizing the patients into 3 groups representing 3-year intervals based on when dialysis was initiated. ResultsThe PS declined from 12.8 to 5.4 (P = 0.001). Low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol levels declined over the 9-year period (P = 0.005 and P = 0.006, respectively), and the ratio of statin users increased markedly from 24% to 54% (P = 0.001). Univariate regression analysis identified a positive correlation between the PS and LDL-C (r = 0.281; P = 0.01), and a strong positive correlation was found between the PS and LDL-C after adjusting for various risk factors for atherosclerosis. ConclusionCarotid atherosclerosis in patients with ESKD has decreased over the past 9 years, which may be a consequence of improvements in dyslipidemia management.

Metabolic and cardiovascular adjustments during psychological stress and carotid artery intima-media thickness in youth

ObjectiveCardiovascular reactivity is associated with carotid artery intima-media thickness as early as childhood. Excess cardiovascular responses relative to the metabolic demand during psychological stress have been proposed as a mechanism for this association. However, it is not known whether excess cardiovascular responses in relation to the metabolic demand correlate with carotid artery intima-media thickness as strongly as traditionally measured cardiovascular reactivity. MethodsFifty-four adolescents, ages 13–16years completed a graded exercise test in 1day and measures of psychological stress reactivity (star tracing, speech) on another day. Heart rate, systolic blood pressure, and oxygen consumption were measured on both days. On a third visit adolescents completed an ultrasound scan to measure carotid artery intima-media thickness. ResultsTraditionally measured systolic blood pressure reactivity (β=0.30, p=0.02, R2 increase=0.09) and excess systolic blood pressure (β=0.30, p=0.02, R2 increase=0.08) while preparing a speech were associated with greater carotid artery intima-media thickness when controlling for demographic characteristics, fitness, and baseline systolic blood pressure. ConclusionsThis study adds to the growing body of literature showing a link between systolic blood pressure reactivity to acute psychological stress and carotid artery intima-media thickness in youth. This was the first study to demonstrate that systolic blood pressure in excess of the metabolic demand during psychological stress was also associated with carotid artery-intima media thickness.

Associations of Triiodothyronine Levels with Carotid Atherosclerosis and Arterial Stiffness in Hemodialysis Patients

End-stage renal disease is linked to alterations in thyroid hormone levels and/or metabolism, resulting in a high prevalence of subclinical hypothyroidism and low triiodothyronine (T3) levels. These alterations are involved in endothelial damage, cardiac abnormalities, and inflammation, but the exact mechanisms are unclear. In this study, we investigated the relationship between serum free-T3 (fT3) and carotid artery atherosclerosis, arterial stiffness, and vascular calcification in prevalent patients on conventional hemodialysis. 137 patients were included. Thyroid-hormone levels were determined by chemiluminescent immunoassay, carotid artery-intima media thickness (CA-IMT) by Doppler ultrasonography, carotid-femoral pulse wave velocity (c-f PWV), and augmentation index by Sphygmocor device, and coronary artery calcification (CAC) scores by multi-slice computerized tomography. Mean fT3 level was 3.70 ± 1.23 pmol/L. Across decreasing fT3 tertiles, c-f PWV and CA-IMT values were incrementally higher, whereas CACs were not different. In adjusted ordinal logistic regression analysis, fT3 level (odds ratio, 0.81; 95% confidence interval, 0.68 to 0.97), age, and interdialytic weight gain were significantly associated with CA-IMT. fT3 level was associated with c-f PWV in nondiabetics but not in diabetics. In nondiabetics (n = 113), c-f PWV was positively associated with age and systolic BP but negatively with fT3 levels (odds ratio = 0.57, 95% confidence interval 0.39 to 0.83). fT3 levels are inversely associated with carotid atherosclerosis but not with CAC in hemodialysis patients. Also, fT3 levels are inversely associated with surrogates of arterial stiffness in nondiabetics.

Regression of the Increased Common Carotid Artery-intima Media Thickness in Subclinical Hypothyroidism after Thyroid Hormone Replacement

The association between subclinical hypothyroidism and cardiovascular disease and the beneficial effect of levothyroxine replacement in subclinical hypothyroidism are still under debate. The present study was designed to determine whether subclinical hypothyroidism is associated with an increase in the intima-media thickness of the common carotid artery (C-IMT) and whether thyroid hormone replacement can reverse this change in the C-IMT. Patients with newly-diagnosed subclinical (n=36) and overt (n=40) hypothyroidism and healthy euthyroid individuals (n=32) participated in this study. All the patients were examined for clinical characteristics, and the serum lipid levels and the C-IMT were measured. Patients with subclinical hypothyroidism had a C-IMT measurement after 18 months of levothyroxine replacement. There were meaningful differences in total cholesterol and LDL-cholesterol levels between patients with subclinical hypothyroidism and euthyroidism. The subjects with subclinical and overt hypothyroidism had a greater C-IMT compared with euthyroid controls (0.66+/- 0.10 and 0.70+/- 0.11 vs. 0.57+/- 0.08 mm, respectively; P < 0.05). After 12 months of euthyroidism, 28 of 36 patients with subclinical hypothyroidism completed the follow-up study. Thyroid hormone replacement significantly decreased the C-IMT (0.67+/- 0.11 to 0.60+/- 0.10 mm; P = 0.021) and improved the lipid profile. Based on multiple regression analysis, the decrement in LDL-cholesterol was independently associated with the regression of the C-IMT. Subclinical hypothyroidism was closely related to an increased C-IMT. Thyroid hormone replacement resulted in regression of the increased C-IMT, which was attributed to the improvement in the lipid profile.

Circulating Retinol-Binding Protein 4 and Subclinical Cardiovascular Disease in the Elderly

OBJECTIVEWe evaluated associations of serum retinol-binding protein 4 (RBP4) with subclinical cardiovascular disease (CVD).RESEARCH DESIGN AND METHODSSubclinical CVD was measured with echocardiography, carotid artery ultrasound, brachial artery ultrasound, and invasive forearm endothelial vasoreactivity in 1,008 70-year-old participants (50% women) of the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study.RESULTSIn analyses adjusted for multiple CVD risk factors, we observed inverse associations of RBP4 with carotid artery intima-media (β −0.39, 95% CI −0.55 to −0.22) and plaque (β −0.33, 95% CI −0.60 to −0.05) echogenicity (gray scale median).CONCLUSIONSCirculating RBP4 concentrations were inversely associated with intima-media and plaque echogenicity in carotid arteries. These findings imply that RBP4 could be involved in the development of atherosclerosis.