Carotid Atherosclerosis In Patients Research Articles

Circulating microRNAs in Carotid Atherosclerosis: Complex Interplay and Possible Associations with Atherothrombotic Stroke.

Atherosclerosis is a chronic inflammatory disorder which remains the main cause of cardiovascular morbidity and mortality, with carotid atherosclerosis (CA) being a major cause of ischemic stroke. Epigenetic regulation plays a significant role in CA progression and stroke, yet the impact of circulating microRNA expression, associated with atherogenesis, has not been clearly defined. We included 81 patients with moderate-severe CA (mean age 67 ± 7 years, 53% male), 42% of whom had prior ipsilateral ischemic stroke (i.e., were symptomatic). A total of 24 miRs were identified and their plasma expression levels were measured. We observed that several microRNAs were up-regulated in stroke survivors, namely miR-200c-3p (30.6 vs. 29.7, p = 0.047), miR-106b-3p (31.01 vs. 30.25, p = 0.004), and miR-494-5p (39 vs. 33, p < 0.001), while others (miR183-3p [25.5 vs. 28.6, p < 0.001], miR-126-5p [35.6 vs. 37.1, p = 0.03], and miR-216-3p [12.34 vs. 16.2, p < 0.001]) had lower plasma levels in symptomatic patients. In a multivariable logistic regression model for symptomatic CA, the only miRs showing statistical significance were miR-106b-5p, miR-183-3p, miR-216-3p, and miR-494-5p. Cluster analysis demonstrated differential miR expression in CA patients depending on their stroke status. Epigenetic modulation, represented as complex interplay between circulating miRs of different atherogenic potential, may play a significant role in CA development and progression. In our study, we show possible candidates for future research regarding CA and stroke.

The visceral fat area/subcutaneous fat area ratio is positively associated with carotid atherosclerosis in patients with type 2 diabetes mellitus.

Evidence has demonstrated that visceral fat area (VFA) and subcutaneous fat area (SFA) had different influences on cardiovascular disease (CVD) risk in patients with type 2 diabetes mellitus (T2DM). We aimed to investigate the relationship between the visceral fat area (VFA) to subcutaneous fat area (SFA) ratio (V/S) and carotid atherosclerosis (CAS) in patients with T2DM. From January 2018 to May 2023, 1,838 patients with T2DM admitted to the National Metabolic Management Centre in our hospital were assigned to two groups based on comorbid CAS. Dual bioelectrical impedance analysis was used to measure the VAF and SFA, and the V/S was calculated. Patient characteristics and serum biochemical indices were compared between groups. Factors influencing comorbid CAS were determined, and correlations between V/S and other clinical indices were analyzed. The group with comorbid CAS included 858 individuals and 980 without comorbid CAS. Those with comorbid CAS were older and had a longer disease duration, more significant systolic blood pressure, and greater V/S. The proportions of patients with comorbid hypertension increased significantly with the V/S ratio. The V/S ratio positively correlated with triglyceride (TG), low-density lipoprotein cholesterol levels, and waist circumference. According to binary logistic regression analysis, V/S was an independent risk factor for CAS. Elevated V/S is an independent risk factor for CAS in patients with T2DM.

Unraveling the role of collateral circulation and serum ELAVL1 in carotid atherosclerosis and ischemic stroke: Insights from clinical observations.

The (embryonic lethal, abnormal vision, drosophila)-like protein 1 (ELAVL1) is a newly discovered protein associated with cerebral ischemic/reperfusion (I/R) injury. However, little is known of ELAVL1 in ischemic stroke patients. To investigate the clinical significance of collateral circulation and serum ELAVL1 in patients with carotid atherosclerosis (CAS) and ischemic stroke. The present prospective cohort investigation included 317 ischemic stroke patients and 300 CAS patients admitted between March 2020 and March 2022. Collateral circulation was measured using digital subtraction angiography (DSA) and graded using the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) grading system. Enzyme-linked immunosorbent assays (ELISAs) were used to measure serum ELAVL1, C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor alpha (TNF-α). The serum levels of total cholesterol (TC), triglyceride (TG), high-density leptin cholesterol (HDL-C), and low-density leptin cholesterol (LDL-C) were also measured. The serum levels of ELAVL1, CRP, IL-6, TNF-α, and LDL-C were all markedly higher, while HDL-C was significantly lower in ischemic stroke patients compared to the CAS patients. Serum ELAVL1 was markedly higher in ASITN/SIR grade 0-1 patients compared to grade 2-4 patients. Also, ELAVL1 correlated positively with serum CRP, IL-6, TNF-α, TC, and LDL-C, and negatively with HDL-C. Receiver operating characteristic (ROC) curves showed that ELAVL1 and collateral circulation have the potential to be used as biomarkers for the diagnosis of ischemic stroke. Meanwhile, CRP, IL-6, TNF-α, HDL-C, ASITN/SIR grading, and ELAVL1 were independent risk factors for ischemic stroke. We found that serum ELAVL1 was associated with clinical outcomes of ischemic stroke patients, while the combination of ELAVL1 and collateral circulation could be used as a potential biomarker for ischemic stroke diagnosis.

Carotid Plaque Types and Their Correlations with Risk Factors for Myocardial Infarction

Objective: The aim of this study was to investigate different carotid plaque types and their correlations with the risk factors for myocardial infarction (MI) in patients with carotid atherosclerosis (CA). Methods: A total of 557 CA patients were enrolled, and information on general data, carotid artery plaque types, and their combinations, risk factors, and disease diagnoses were retrospectively analyzed. Univariate and multivariate logistic regression analyses were employed to identify the risk factors. Results: Hard plaque was closely related to B-type natriuretic peptide (BNP) and triiodothyronine 3 (FT3); soft plaque to prothrombin time (PT) and PT ratio (PTR); mixed plaque to blood urea nitrogen (BUN), FT3, and cardiac troponin T (cTnT); two coexisting types of plaque (hard plaque and soft plaque, hard plaque and mixed plaque, and soft plaque and mixed plaque) to FT3 and C-reactive protein (CRP); and three coexisting types of plaque (hard plaque, soft plaque, and mixed plaque) to BUN, FT3, BNP, cTnT, D-dimer (D-D), neutrophil count (NEUT), monocyte count (MONO), PT, and PTR. Logistic regression analysis revealed that male sex, soft plaque, and three coexisting types of plaque were possible risk factors for MI. Conclusion: Various risk factors increase when plaque types become complicated. The three coexisting types of plaque were associated with various risk factors (increased BUN, PT, PTR, NEUT, MONO, BNP, cTnT, and D-D, and decreased FT3) for MI. Male sex, soft plaque, and three coexisting types of plaque were possible risk factors for MI, which may be beneficial for early risk stratification and MI prediction.

The Relationship between the complement system and subclinical carotid atherosclerosis in patients with rheumatoid arthritis

BackgroundPatients with rheumatoid arthritis (RA) have an increased risk of cardiovascular (CV) events and CV mortality. Subclinical carotid atherosclerosis is independently associated with rates of incident CV events among patients with RA. The complement system has been related to both the etiopathogenesis of RA and CV disease. In this study, we aimed to evaluate the association between a comprehensive assessment of the complement system and carotid intima media thickness and carotid plaque in patients with RA.Methods430 patients with RA were recruited. Functional assays of the three pathways of the complement system, utilizing new-generation techniques, were assessed. Additionally, serum levels of individual components of the complement system belonging to the three pathways were measured: C1q (classical), lectin (lectin), C2, C4, and C4b (classical and lectin), factor D and properdin (alternative), C3 and C3a (common), C5, C5a, and C9 (terminal), as well as regulators factor I and C1-inhibitor. Subclinical carotid atherosclerosis was evaluated by ultrasonography. Multivariable linear regression analysis was conducted to investigate the association between the complement system and carotid intima media thickness and carotid plaque.ResultsAfter multivariable adjustment, which included traditional CV risk factors and disease-related data, C3a and C5a exhibited significant positive correlations with carotid intima media thickness. Additionally, higher values of C1-inhibitor, properdin, C3, C5, and C5a were independently associated with the presence of carotid plaque.ConclusionThe complement system and subclinical carotid atherosclerosis are linked in patients with RA.

The association between the remnant cholesterol and non-HDL-C with subclinical carotid atherosclerosis in patients with metabolic syndrome

The association between the remnant cholesterol and non-HDL-C with subclinical carotid atherosclerosis in patients with metabolic syndrome

The predictive value of plasma uridine for type 2 diabetes and its atherosclerotic complications.

Uridine might be a common link between pathological pathways in diabetes and cardiovascular diseases. This study aimed to investigate the predictive value of plasma uridine for type 2 diabetes (T2D) and T2D with atherosclerosis. Individuals with T2D and healthy controls (n = 218) were randomly enrolled in a cross-sectional study. Patients with T2D were divided into two groups based on carotid ultrasound: patients with carotid atherosclerosis (CA) (group DCA) and patients without CA (group D). Plasma uridine was determined using HPLC-MS/MS. Correlation and logistic regression analyses were used to analyze the results. Fasting and postprandial uridine were significantly increased in patients with T2D compared with healthy individuals. Logistic regression suggested that fasting and postprandial uridine were independent risk factors for T2D. The receiver operating characteristic (ROC) curve showed that fasting uridine had a predictive value on T2D (95% CI, 0.686-0.863, sensitivity 74.3%, specificity 71.8%). Fasting uridine was positively correlated with LDL-c, FBG, and PBG and negatively correlated with fasting C-peptide (CP-0h) and HOMA-IS. The change in postprandial uridine from fasting baseline (Δuridine) was smaller in T2D patients with CA compared with those without (0.80 (0.04-2.46) vs 2.01 (0.49-3.15), P = 0.010). Δuridine was also associated with T2D with CA and negatively correlated with BMI, CP-0h, and HOMA-IR. Fasting uridine has potential as a predictor of diabetes. Δuridine is closely associated with carotid atherosclerosis in patients with T2D.

Association Between Triglyceride-glucose Index and Carotid Atherosclerosis in Patients with Systemic Lupus Erythematosus: A Cohort-based Study

Background: Individuals with systemic lupus erythematosus (SLE) patients confer substantial increased risks of cardiovascular complications that have become the primary cause of premature mortality worldwide. We aimed to investigate the association between triglyceride-glucose (TyG) index and carotid atherosclerosis in patients with systemic lupus erythematosus (SLE). Methods: This cross-sectional study in a tertiary hospital included 333 consecutive SLE patients receiving carotid ultrasonography with integrated TyG index, calculated as ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. The subjects were categorized into three groups according to the TyG index tertiles. Logistic regression models were used to assess the association of TyG index with carotid atherosclerosis and carotid artery plaque. Fully adjusted model included age, gender, body mass index, comorbidities, low-density lipoprotein cholesterol and SLE-related variables. Results: There were 10.5% (35/333) of participants identified as having carotid atherosclerosis. Patients with carotid atherosclerosis had significantly higher TyG index as compared with those without (8.77 ± 0.45 vs. 8.45 ± 0.49, p [Formula: see text] 0.001). The frequency of carotid atherosclerosis was increased with increases in TyG index tertiles (3.6% for tertile 1, 10.0% for tertile 2, 17.7% for tertile 3; p = 0.003). Multivariate logistic analyses showed that each 1-unit increase in TyG index was significantly associated with prevalent carotid atherosclerosis (unadjusted OR 4.07 (1.87-8.87); fully-adjusted OR 4.88 (1.74-13.69)). The unadjusted and fully-adjusted OR for occurrence of carotid atherosclerosis were 5.70 (1.88-17.28) and 5.88 (1.66-20.74) in patients with tertile 3 compared to patients with tertile 1 of TyG index (P for trend 0.006 and 0.019, respectively). Similar findings were noticeable for the outcome of carotid artery plaque. Conclusions: The present study suggested that an elevated TyG index was associated with a higher risk of carotid atherosclerosis, independent of traditional cardiovascular risk factors and SLE-related factors. TyG index may be a promising and accessible atherosclerotic indictor for SLE population.

Circulating miR-423-5p levels are associated with carotid atherosclerosis in patients with chronic kidney disease

Background and aimsCarotid atherosclerosis is associated with an elevated risk of stroke in patients with chronic kidney disease. However, the molecular basis for the incidence of carotid atherosclerosis in patients with CKD is poorly understood. Here, we investigated whether circulating miR-423-5p is a crucial link between CKD and carotid atherosclerosis. Methods and resultsWe recruited 375 participants for a cross-sectional study to examine the occurrence of carotid plaque and plaque thicknesses. Levels of miR-423-5p were determined by qPCR analysis. We found that non-dialysis CKD patients had higher circulating exosomal and plasma miR-423-5p levels, and dialysis-dependent patients had lower miR-423-5p levels than non-dialysis CKD patients. After excluding for the influence of dialysis patients, linear regression analysis indicated that levels of circulating miR-423-5p are negatively correlated with eGFR (P < 0.001). Higher plasma miR-423-5p levels were associated with the incidence and severity of carotid plaques. In parallel, we constructed a murine model of CKD with a 5/6 nephrectomy protocol and performed RNA sequencing studies of aortic tissues. Consistent with these findings in CKD patients, circulating exosomal miR-423-5p levels in CKD mice were elevated. Furthermore, our RNA-seq studies indicated that the putative target genes of miR-423-5p were related to oxidative stress functions for aorta of CKD mice. ConclusionLevels of miR-423-5p are associated with the presence and severity of carotid plaque in CKD. Data from our mouse model suggests that miR-423-5p likely influences gene expression programs related to oxidative stress in aorta of CKD mice.

Albumin-Globulin Ratio and Common Carotid Artery Intima-Media Thickness in Patients with Ischemic Stroke

Background: The relationships between serum albumin, albumin-globulin (A/G) ratio, globulin and atherosclerosis in acute ischemic stroke (AIS) remain uncertain. We investigated the associations between serum albumin, A/G ratio, globulin levels and carotid atherosclerosis in patients with AIS. background: The relationships between serum albumin, albumin-globulin (A/G) ratio, globulin and atherosclerosis in the setting of ischemic stroke are unclear. Methods: A total of 1,339 AIS patients were enrolled. Admission A/G ratio was divided into quartiles, and serum albumin and globulin levels were also categorized. Carotid atherosclerosis was detected through the assessment of common carotid artery intima-media thickness (cIMT), and abnormal cIMT was characterized by mean and maximum cIMT values of ≥1 mm. We evaluated the relationships between A/G ratio, albumin, globulin and abnormal cIMT, using multivariable logistic regression models. objective: We aimed to evaluate the associations between serum albumin, A/G ratio, globulin levels and carotid atherosclerosis in patients with ischemic stroke. Results: In the multivariable-adjusted analysis, the highest A/G ratio quartile (Q4) was linked to a 59% decreased risk of abnormal mean cIMT (OR 0.41; 95% CI 0.29-0.60) and a 58% decreased risk of abnormal maximum cIMT (OR 0.42; 95% CI 0.30-0.60) when compared to the lowest quartile (Q1), respectively. Moreover, decreased albumin and elevated globulin levels were also associated with abnormal mean cIMT and maximum cIMT. In addition, the A/G ratio provided supplementary predictive capability beyond the already established risk factors, and the C-statistic of the A/G ratio for abnormal cIMT is larger than globulin (P &lt;0.01). Conclusion: Decreased serum A/G ratio, albumin and elevated serum globulin were independently associated with abnormal cIMT in AIS patients. Moreover, the A/G ratio appeared to be a better predictor of abnormal cIMT. result: In the multivariable-adjusted analysis, the highest A/G ratio quartile (Q4) was associated with a 59% (OR 0.41; 95% CI 0.29-0.60) decreased risk of having abnormal mean cIMT and 58% (OR 0.42; 95% CI 0.30-0.60) decreased risk of having abnormal maximum cIMT in comparison to Q1, respectively. Moreover, decreased albumin and increased globulin levels were associated with abnormal mean cIMT and maximum cIMT. In addition, the A/G ratio provided incremental predictive capacity beyond established risk factors, and the C-statistic of A/G ratio for abnormal cIMT is larger than globulin (P&lt;0.01). conclusion: Decreased serum A/G ratio, albumin and elevated serum globulin were independently associated with abnormal cIMT in patients with ischemic stroke. Moreover, the A/G ratio appeared to be a better predictor of abnormal cIMT. other: No

Qualitative and quantitative ultrasound parameters of carotid atherosclerotic plaques in patients with moderate cardiovascular risk according to the SCORE scale: 7-year prospective follow-up study

Aim. To assess asymptomatic carotid atherosclerosis in patients with moderate cardiovascular risk over a 7-year prospective follow-up using non-invasive ultrasound markers.Material and methods. Eighty patients (47 men and 33 women) aged 53,1±5,9 years with moderate Systematic Coronary Risk Evaluation (SCORE) level, low-density lipoprotein cholesterol (LDL-C) of 2,7-4,8 mmol/l and asymptomatic hemodynamically insignificant (stenosis &lt;50%) carotid atherosclerosis (CA). Patients underwent CA ultrasound (PHILIPS IU22) at baseline and after 7 years. Plaque number, maximum plaque height, total plaque height, total CA stenosis, visual plaque morphology, gray-scale median (GSM), and intima- media thickness of the right and left common CAs were assessed. All patients were prescribed atorvastatin therapy at a dose of 10-40 mg until a target LDL-С level &lt;2,6 mmol/l was achieved.Results. During the follow-up period, a significant increase was noted in the number of plaques, the maximum and total plaque height, total CA stenosis, and intima- media thickness of the right and left common CAs. An increase in GSM was detected in 79% of plaques on statin therapy. Plaque echoicity increased by 4,90 [0,51; 17,41] (p &lt;0,001) or 7,2% [0,7%; 29%] (p&lt;0,001) over seven years. Regression analysis adjusted for sex and age showed the dependence of GSM changes (ΔGSM) on changes in the LDL-C level (ΔLDL-C) (p=0,049). With a decrease in LDL-C by 1 mmol/l, an increase in average GSM was noted by 5,9 (0,03-11,78). The maximum plaque height increased significantly after 7-year follow-up from 1,80 [1,50; 2,20] to 2,00 [1,63; 2,68] mm (p=0,044). In patients who reached a LDL-C level of 1,8 mmol/l, the maximum plaque height decreased more than in patients who did not reach this level (-0,07 [-0,45; 0,14] mm and 0,20 [-0,05; 0,40] mm, respectively (p=0,028)). Regression analysis adjusted for sex and age did not reveal a relationship between the change of maximum plaque height with ΔLDL-C and Δhigh-density lipoprotein cholesterol, but with LDL-C level after 7 years.Conclusion. Statin therapy in patients with CA stenosis &lt;50% stabilizes the plaques due to echogenicity increase. LDL-C &lt;1,8 mmol/l can lead to a decrease in maximum plaque height.

The triglyceride-glucose index is associated with atherosclerosis in patients with symptomatic coronary artery disease, regardless of diabetes mellitus and hyperlipidaemia

BackgroundDiabetes and hyperlipidaemia are both risk factors for coronary artery disease, and both are associated with a high triglyceride-glucose index (TyG index). The TyG index has been presented as a marker of insulin resistance (IR). Its utility in predicting and detecting cardiovascular disease has been reported. However, few studies have found it to be a helpful marker of atherosclerosis in patients with symptomatic coronary artery disease (CAD). The purpose of this study was to demonstrate that the TyG index can serve as a valuable marker for predicting coronary and carotid atherosclerosis in symptomatic CAD patients, regardless of diabetes mellitus and hyperlipidaemia.MethodsThis study included 1516 patients with symptomatic CAD who underwent both coronary artery angiography and carotid Doppler ultrasound in the Department of Cardiology at Tianjin Union Medical Center from January 2016 to December 2022. The TyG index was determined using the Ln formula. The population was further grouped and analysed according to the presence or absence of diabetes and hyperlipidaemia. The Gensini score and carotid intima-media thickness were calculated or measured, and the patients were divided into four groups according to TyG index quartile to examine the relationship between the TyG index and coronary or carotid artery lesions in symptomatic CAD patients.ResultsIn symptomatic CAD patients, the TyG index showed a significant positive correlation with both coronary lesions and carotid plaques. After adjusting for sex, age, smoking, BMI, hypertension, diabetes, and the use of antilipemic and antidiabetic agents, the risk of developing coronary lesions and carotid plaques increased across the baseline TyG index. Compared with the lowest quartile of the TyG index, the highest quartile (quartile 4) was associated with a greater incidence of coronary heart disease [OR = 2.55 (95% CI 1.61, 4.03)] and carotid atherosclerotic plaque [OR = 2.31 (95% CI 1.27, 4.20)] (P < 0.05). Furthermore, when compared to the fasting blood glucose (FBG) or triglyceride (TG) level, the TyG index had a greater area under the ROC curve for predicting coronary lesions and carotid plaques. The subgroup analysis demonstrated the TyG index to be an equally effective predictor of coronary and carotid artery disease, regardless of diabetes and hyperlipidaemia.ConclusionThe TyG index is a useful marker for predicting coronary and carotid atherosclerosis in patients with symptomatic CAD, regardless of diabetes mellitus and hyperlipidaemia. The TyG index is of higher value for the identification of both coronary and carotid atherosclerotic plaques than the FBG or TG level alone.

Long-term observation of estimated fluid volume reduction after the initiation of ipragliflozin in patients with type 2 diabetes mellitus: a sub-analysis from a randomized controlled trial (PROTECT)

Backgrounds/AimRecent studies have shown that the addition of sodium-glucose co-transporter 2 (SGLT2) inhibitors gradually reduces the estimated fluid volume parameters in a broad range of patient populations, suggesting that this mediates the clinical benefits of SGLT2 inhibitors in preventing heart failure. Here, we sought to examine the long-term (24 months) effect of the SGLT2 inhibitor ipragliflozin on the estimated fluid volume parameters in patients with type 2 diabetes mellitus (T2DM).MethodsIn this prespecified sub-analysis of the PROTECT (Prevention of Atherosclerosis by SGLT2 Inhibitor: Multicenter, Randomized Controlled Study) trial, which was an investigator-initiated, multicenter, prospective, randomized, open-label, clinical trial primarily designed to evaluate the effect of ipragliflozin treatment administered for 24 months on carotid atherosclerosis in patients with T2DM, we evaluated serial changes in estimated plasma volume (ePV, %) calculated using the Straus formula and estimated extracellular volume (eEV, mL) calculated by the body surface area by 24 months following the initiation of 50-mg ipragliflozin once daily and compared them with those following standard care for T2DM (non-SGLT2 inhibitor use).ResultsThis sub-analysis included 464 patients (ipragliflozin, n = 232; control, n = 232), a full analysis set of the PROTECT trial. In an analysis using mixed-effects models for repeated measures, relative to the control group, ipragliflozin significantly reduced ePV by − 10.29% (95% confidence interval [CI] − 12.47% to − 8.11%; P < 0.001) at 12 months and − 10.76% (95% CI − 12.86% to − 8.67%; P < 0.001) at 24 months. Additionally, ipragliflozin significantly reduced eEV by − 190.44 mL (95% CI − 249.09 to − 131.79 mL; P < 0.001) at 12 months and − 176.90 mL (95% CI − 233.36 to − 120.44 mL; P < 0.001) at 24 months. The effects of ipragliflozin on these parameters over 24 months were mostly consistent across various patient clinical characteristics.ConclusionsThis prespecified sub-analysis from the PROTECT trial demonstrated that ipragliflozin treatment, compared with the standard care for T2DM, reduced two types of estimated fluid volume parameters in patients with T2DM, and the effect was maintained for 24 months. Our findings suggest that SGLT2 inhibitor treatment regulates clinical parameters incorporated into the calculating formulas analyzed and consequently fluid volume status for the long-term, and this may be at least partly associated with clinical benefits from chronic use of SGLT2 inhibitors.Trial registration Japan Registry of Clinical Trials, ID jRCT1071220089

Association between remnant cholesterol and subclinical carotid atherosclerosis among Chinese general population in health examination

ObjectiveRemnant cholesterol (RC) was associated with carotid atherosclerosis in patients with clinical settings. But the value of RC as a risk management indicator for subclinical carotid atherosclerosis in health examination has not been fully determined. MethodsThis was a real-world, cross-sectional study including 12317 Chinese general population. Carotid intima-media thickness (CIMT) and carotid atherosclerotic plaque (CAP) were assessed by ultrasound. RC was calculated by total cholesterol minus low density lipoprotein-cholesterol (LDL-C) minus high density lipoprotein-cholesterol (HDL-C).Carotid atherosclerosis (CAS) was defined as a composite of increased CIMT and CAP. Multivariable logistic regression models were used to investigate the association of RC and CAS, increased CIMT and CAP. ResultsAmong 12317 participants (mean age: 51.21±13.76 years; 8303 men and 4014 women), the prevalence of CAS and increased CIMT was higher in participants with higher RC levels (P for trend<0.01). After multivariable adjustment, the highest quartile of RC was significantly associated with higher risk of CAS (OR: 1.45 95%CI: 1.26-1.67) and increased CIMT (OR: 1.48 95%CI: 1.29-1.71) with the lowest quartile of RC as reference. And the relationships remained significant even after adjustment of LDL-C and HDL-C. Every 1-SD increase of RC level was positively associated with 17% risk increment for CAS (6-30%) and 20% risk increment for increased CIMT (8-34%). ConclusionElevated serum RC levels were significantly associated with CAS and increased CIMT among Chinese general population, independent of LDL-C and HDL-C. RC evaluation could be applied for the risk management of early stage of subclinical carotid atherosclerosis in health examination.

473-P: Differences in Carotid Arteriosclerosis according to Waist Circumference and Thigh Circumference Appear Differently in Diabetic Patients and Prediabetic Patients

This study investigated the relationships of thigh and waist circumference with the glycemic variability and carotid atherosclerosis in patients with type 2 diabetes mellitus (T2DM) and prediabetes. This observational study included 3,453 Korean patients with T2DM and prediabetes, in whom anthropometric measurements and carotid ultrasonography were conducted. Carotid plaque was defined as focal structures encroaching the arterial lumen by ≥ 0.5 mm or 50% of the surrounding IMT value or a thickness ≥1.5 mm. In men with T2DM, it was found that the larger the thigh circumference, the lower the risk of carotid plaque after adjustment for potential confounding variables. In women with T2DM, a similar tendency was observed before adjustment, but no statistically significant relationship was seen after adjustment. In women with T2DM, the presence of carotid plaque was higher in the thickest waist group compared to the reference group, but there is no statistical significance after adjustment. However, no difference in carotid arteriosclerosis according to waist and thigh circumference was found in both men and women in prediabetic patients. It suggests that the risk of cardiovascular disease according to the difference in body type such as waist circumference and thigh thickness may appear differently depending on the glucose status. However, further longitudinal studies are warranted. Disclosure C.Kim: None. S.A.Jang: None. K.Kim: None. S.Park: None.

Transforming growth factor beta 1 is associated with subclinical carotid atherosclerosis in patients with systemic lupus erythematosus

BackgroundTransforming growth factor beta (TGF-β1) is a multifunctional cytokine that has anti-inflammatory and immunosuppressive effects. TGF-β1 has been linked to cardiovascular disease in the general population. The immunosuppressive effect of TGF-β1 is believed to be dysregulated in patients with systemic lupus erythematosus (SLE). In the present work, we aimed to study the relationship of serum levels of TGF-β1 with subclinical carotid atherosclerosis in patients with SLE.MethodsThe study included 284 patients with SLE. Serum levels of TGF-β1 and subclinical carotid atherosclerosis (by carotid ultrasonography) were evaluated. In addition, the complete lipid profile and insulin resistance were analyzed. Multivariable linear and logistic regression analysis was performed to establish the relationship of TGF-β1 with carotid subclinical atherosclerosis adjusting for traditional cardiovascular risk factors that included lipid profile and insulin resistance.ResultsCirculating TGF-β1 was positively and significantly associated with higher levels of LDL:HDL cholesterol ratio and atherogenic index. TGF-β1 was also associated with significantly lower levels of HDL cholesterol and apolipoprotein A1. Remarkably, TGF-β1 was associated with the presence of carotid plaque not only after adjustment for demographics (age, sex, body mass index, diabetes, hypertension, and aspirin use) but also after adjustment for relationships of TGF-β1 with lipid profile molecules, insulin resistance, and SLEDAI disease score (odds ratio 1.14 [95% confidence interval 1.003–1.30], p = 0.045).ConclusionTGF-β1 serum levels are positively and independently associated with the presence of subclinical atherosclerosis disease in patients with SLE.

Subclinical Carotid Atherosclerosis in Patients with Rheumatoid Arthritis at Low Cardiovascular Risk.

To evaluate the rate of subclinical carotid atherosclerosis and clinical significance of immunoinflammatory markers in patients with rheumatoid arthritis (RA) at low cardiovascular risk. The study included 275 RA patients and a control group of 100 participants without autoimmune diseases. All study participants were at low cardiovascular risk, calculated by the QRISK3 scale (<20%), and free of cardiovascular disease. Ultrasound examination of carotid arteries was performed to measure cIMT and to detect atherosclerotic plaques (ASP) in carotid arteries. sIСАМ-1, sVСАМ, and sCD40L levels were determined by enzyme immunoassay. Carotid ASP was observed more frequently in RA patients (27%) than in the control group (17%), p = 0.03. The frequency of ASP in RA patients did not depend on the disease's stage or activity. There was a significant correlation between cIMT and age, cardiovascular risk determined by QRISK3, level of total cholesterol, LDL, and blood pressure in RA patients, p < 0.05 in all cases. No correlation between cIMT and blood levels of sCD40L, sVCAM, and sICAM was found. In RA patients, a higher concentration of sVCAM was detected in the carotid ASP group compared to the non-atherosclerotic group. sCD40L was associated with cIMT and total cholesterol in the ASP group and with total cholesterol and blood pressure in non-atherosclerotic patients. Subclinical atherosclerotic lesions of the carotid arteries were observed significantly more frequently in RA patients with low cardiovascular risk than in the control group. The results of the study demonstrate the association between cIMT, traditional cardiovascular risk factors, and immunoinflammatory markers in RA patients.

Association between triglyceride‑glucose index and carotid atherosclerosis in patients with psoriatic arthritis.

To investigate the association of triglyceride-glucose (TyG) index with atherosclerotic risk among patients with psoriatic arthritis (PsA). This cross-sectional study included 165 consecutive PsA patients receiving carotid ultrasonography with integrated TyG index, calculated as ln [fasting triglycerides (mg/dl)×fasting glucose (mg/dl)/2]. Logistic regression models were applied to analyze the association of TyG index as continuous variables and tertiles with carotid atherosclerosis and carotid artery plaque. Fully adjusted model included sex, age, smoking, body mass index, comorbidities, and psoriatic related variables. Overall, PsA patients with carotid atherosclerosis had substantially higher TyG index than those without (8.82 ± 0.50 vs 8.54 ± 0.55, p= 0.002). The frequency of carotid atherosclerosis was increased with increases in TyG index tertiles, showing 14.8%, 34.5%, 44.6% for tertile 1, 2 and 3, respectively (p= 0.003). Multivariate logistic analyses showed that each 1-unit increase in TyG index was significantly associated with prevalent carotid atherosclerosis (unadjusted OR 2.65 [1.39-5.05]; fully-adjusted OR 2.69 [1.02-7.11]). Compared with patients with tertile 1 of TyG index, the unadjusted and fully-adjusted OR for occurrence of carotid atherosclerosis were 4.64 (1.85-11.60) and 5.10 (1.54-16.93) in patients with tertile 3. Similarly, higher prevalent carotid artery plaque was observed with increasing TyG index (unadjusted OR 3.11 [1.54-6.26]; fully-adjusted OR 3.61 [1.15-11.38]) or with tertile 3 vs. tertile 1 (unadjusted OR 10.20 [2.83-36.82]; fully-adjusted OR 17.89 [2.88-111.11]). Additionally, TyG index provided incremental predictive capacity beyond established risk factors, shown by an increase in discrimination ability (all P < 0.001). TyG index was positively correlated with the burden of atherosclerosis in PsA patients, independent of traditional cardiovascular risk factors and psoriatic-related factors. These findings suggest that TyG index may be a promising atherosclerotic marker for PsA population.

Development and validation of a nomogram for evaluating the incident risk of carotid atherosclerosis in patients with type 2 diabetes.

The purpose of this study was to evaluate the clinical characteristics of carotid atherosclerotic disease in patients with type 2 diabetes mellitus, investigate its risk factors, and develop and validate an easy-to-use nomogram. 1049 patients diagnosed with type 2 diabetes were enrolled and randomly assigned to the training and validation cohorts. Multivariate logistic regression analysis identified independent risk factors. A method combining least absolute shrinkage and selection operator with 10-fold cross-validation was used to screen for characteristic variables associated with carotid atherosclerosis. A nomogram was used to visually display the risk prediction model. Nomogram performance was evaluated using the C index, the area under the receiver operating characteristic curve, and calibration curves. Clinical utility was assessed by decision curve analysis. Age, nonalcoholic fatty liver disease, and OGTT3H were independent risk factors associated with carotid atherosclerosis in patients with diabetes. Age, nonalcoholic fatty liver disease, smoke, HDL-C, and LDL-C were characteristic variables used to develop the nomogram. The area under the curve for the discriminative power of the nomogram was 0.763 for the training cohort and 0.717 for the validation cohort. The calibration curves showed that the predicted probability matched the actual likelihood. The results of the decision curve analysis indicated that the nomograms were clinically useful. A new nomogram was developed and validated for assessing the incident risk of carotid atherosclerotic in patients with diabetes; this nomogram may act as a clinical tool to assist clinicians in making treatment recommendations.

Non-Alcoholic Fatty Liver Disease with Sarcopenia and Carotid Plaque Progression Risk in Patients with Type 2 Diabetes Mellitus.

We aimed to evaluate whether non-alcoholic fatty liver disease (NAFLD) with or without sarcopenia is associated with progression of carotid atherosclerosis in patients with type 2 diabetes mellitus (T2DM). We investigated 852 T2DM patients who underwent abdominal ultrasonography, bioelectrical impedance analysis, and carotid artery ultrasonography at baseline and repeated carotid ultrasonography after 6 to 8 years. NAFLD was confirmed by abdominal ultrasonography, and sarcopenia was defined as a sex-specific skeletal muscle mass index (SMI) value <2 standard deviations below the mean for healthy young adults. SMI was calculated by dividing the sum of appendicular skeletal mass by body weight. We investigated the association between NAFLD with or without sarcopenia and the progression of carotid atherosclerosis. Of the 852 patients, 333 (39.1%) were classified as NAFLD without sarcopenia, 66 (7.7%) were classified as sarcopenia without NAFLD, and 123 (14.4%) had NAFLD with sarcopenia at baseline. After 6 to 8 years, patients with both NAFLD and sarcopenia had a higher risk of atherosclerosis progression (adjusted odds ratio, 2.20; P<0.009) than controls without NAFLD and sarcopenia. When a subgroup analysis was performed on only patients with NAFLD, female sex, absence of central obesity, and non-obesity were significant factors related to increased risk of plaque progression risk in sarcopenic patients. NAFLD with sarcopenia was significantly associated with the progression of carotid atherosclerosis in T2DM patients.