Carotid Atherosclerotic Lesions Research Articles

Impact des antiviraux à action directe sur l'athérosclérose subclinique chez les patients atteints d’une hépatite C chronique

The impact of direct antiviral drugs (DAAs) on extrahepatic manifestations in chronic hepatitis C (CHC) has been poorly studied. To assess the prevalence of subclinical atherosclerosis in patients with CHC and the impact of DAAs on atherosclerotic lesions. Methods A 5-year prospective evaluative study, including patients followed for CHC at hepato-gastroenterology department. The subclinical atherosclerosis was assessed by ultrasound measurement of carotid intima-media thickness (IMTc) and the highest IMTc measurements from the left and right side defined the IMTc maximum (IMTc max). IMTc>75th percentile (IMTc75) define subclinical atherosclerosis with high cardiovascular risk. Patients were evaluated before (T0) and one year after DAAs therapy achievement (T1). At time T0, forty patients (median age: 55 y.; sex ratio M / F = 0.48), were included. Average value of IMTc max was 0.68 ± 0.16 mm. Subclinical atherosclerosis was noted in 82.5 %. At time T1, 28 patients were evaluated, all of whom completed sustained virological response (SVR). Compared to time T0, there was a significant increase in cholesterol (p = 0.001) and triglyceride (p = 0.009) levels. IMTc max was significantly higher at time T1 compared to T0 (0.75 Vs 0.67 mm, p = 0.04). Prevalence of IMTc75 was 82.1% at time T0 and 75% at time T1 (p=0.5). SVR, in CHC patients treated with DAA, was associated with worsening of carotid atherosclerotic lesions.

Arterial Adventitial Vasa Vasorum Density Reflects The Progression Of Unstable Plaques: A Retrospective Clinical Study

Arterial adventitial vasa vasorum (AVV) plays an important role in the occurrence and development of atherosclerotic (AS) disease. AS is a systemic disease, and plaque is not only a local vascular event, but also occurs at multiple sites throughout the vascular bed. Currently, effective anti-AVV therapies are lacking. Therefore, we posed the following scientific questions: "does human carotid adventitial vasa vasorum density reflect plaque neovascularization and intimal-media hyperplasia in carotid?"; and "is it possible to reduce human AVV density by sonodynamic therapy (SDT)?" A retrospective study was conducted on 160 patients with carotid atherosclerosis. Duplex ultrasound scanning (DUS), contrast-enhanced ultrasound (CEUS), coronary angiography, and coronary CT angiography (CTA) were used for diagnosis and screening. Pearson correlation tests and Receiver operating characteristic (ROC) curve were used to analyze the relationships between AVV hyperplasia, vasa vasorum (VV) hyperplasia and the intima-media thickness (IMT). SDT was developed for the treatment of arterial AVV hyperplasia and AS plaques. The presence of local AVV in carotid unstable plaques correlated with the echogenic properties of the carotid plaque and the extent of plaque progression; Furthermore local AVV hyperplasia in patients with carotid atherosclerotic plaques was associated with acute coronary syndrome (ACS) events; Local AVV hyperplasia in patients with carotid atherosclerotic plaques was associated with coronary artery stenosis. Notably, SDT reduced local AVV hyperplasia and shrank the plaques in human femoral and carotid atherosclerotic lesions. The presence of AVV in human carotid arteries reflects the severity of carotid and coronary artery AS. Further, SDT can reduce the hyperplasia of local AVV in human femoral and carotid plaques.

On the Impact of Residual Strains in the Stress Analysis of Patient-Specific Atherosclerotic Carotid Vessels: Predictions Based on the Homogenous Stress Hypothesis

The identification of carotid atherosclerotic lesion at risk for plaque rupture, eventually resulting in cerebral embolism and stroke, is of paramount clinical importance. High stress in the fibrous plaque cap has been proposed as risk factor. However, among others, residual strains influence said stress predictions, but quantitative and qualitative implications of residual strains in this context are not well explored. We therefore propose a multiplicative kinematics-based Growth and Remodeling (G&R) framework to predict residual strains from homogenizing tissue stress and then investigate its implication on plaque stress. Carotid vessel morphology of four patients was reconstructed from clinical Computed Tomography-Angiography (CT-A) images and equipped with heterogeneous tissue constitutive properties assigned through a histology-based artificial intelligence image segmentation tool. As compared to a purely elastic analysis and depending on patient-specific morphology and tissue distributions, the incorporation of residual strains reduced the maximum wall stress by up to 30%\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$30\\%$$\\end{document} and resulted in a fundamentally different distribution of stress across the atherosclerotic wall. Regardless residual strains homogenized tissue stresses, the fibrous plaque cap may persistently be exposed to spots of high stress. In conclusion, the incorporation of residual strains in biomechanical studies of atherosclerotic carotids may be important for a reliable assessment of fibrous plaque cap stress.

European Carotid Surgical Trial-based diameter measurement using B-mode ultrasound imaging to quantify low-grade carotid artery stenosis: the QUAMUS study

BackgroundIdentification of carotid atherosclerotic lesions with no hemodynamic effect on Doppler ultrasound examination is a common situation. Although the use of B-mode ultrasound examination has been recommended to assess this type of lesion, there is no validated examination procedure to date for quantifying low-grade carotid stenosis. MethodsWe conducted a single-center prospective study (QUAntification Morphologique en UltraSonographie [QUAMUS] study) to assess the reproducibility of B-mode ultrasound quantification of low-grade internal carotid artery stenosis using the European Carotid Surgical Trial (ECST) measurement method. We included consecutive patients with <50% North American Symptomatic Carotid Endarterectomy Trial carotid stenosis identified by the University of Washington duplex criteria (ie, maximum systolic velocity of <125 cm/second at a Doppler angle of 50°-60°). The examination was carried out and interpreted independently, blindly, and successively by two operators according to a precise methodology based on the measurement of cross-sectional diameter in B-mode and calculation of the stenosis percentage according to the ECST method. The primary objective was to assess the measurement concordance of the stenosis percentage for a difference not exceeding 10% between the two operators. The secondary objective was to assess concordance in relation to examination quality. ResultsAmong the 86 patients included, 159 atherosclerotic carotid arteries were eligible and 157 could be explored (feasibility of 98.74%). The conditions were considered as good by the two operators in 69.43% of cases and poor in 2.55%. The concordance of the stenosis percentage measurement for a maximum difference of 10% between the two operators was 89.17% (95% confidence interval, 83.23-93.56) with a Lin concordance correlation coefficient of 0.87 (95% confidence interval, 0.82-0.90). Under examination conditions estimated as good, average, and poor, the concordance was 95.37%, 78.95%, and 60.00%, respectively. ConclusionsOur study shows that ECST-based B-mode ultrasound measurement of low-grade carotid stenosis is reliable and can be performed in routine practice in most patients with a measurement variation of <10% using a simple standardized examination procedure.

Transcriptomics Analysis Revealed Key Genes Associated with Macrophage Autophagolysosome in Male ApoE-/- Mice Aortic Atherosclerosis.

Atherosclerosis (AS) is the most common cause of cardiovascular and cerebrovascular diseases. However, the mechanisms underlying atherosclerotic plaque progression remain unclear. This study aimed to investigate the genes associated with the development of atherosclerosis in the aorta of ApoE-/- male mice, which could serve as novel biomarkers and therapeutic targets in interventions to halt plaque progression. Eight-week-old ApoE-/- mice were fed a normal purified laboratory diet or a Western Diet (WD) for 6 or 22 weeks. High-throughput sequencing technology was used to analyze the transcriptomes of the aortas of four groups of mice that were exposed to different dietary conditions. We retrieved and downloaded the human Arteriosclerosis Disease Chip dataset GSE100927 from the Gene Expression Omnibus (GEO) database and selected 29 cases of carotid atherosclerotic lesions and 12 cases of normal carotid tissues as the experimental and control groups, respectively, to further verify our dataset. In addition, we used quantitative reverse transcription polymerase chain reaction (QT-PCR) to verify the expression levels of the core genes in an atherosclerosis mouse model. There were 265 differentially expressed genes (DEGs) between the ApoE-/- Male mice AS22W group and Sham22W group. In addition to the well-known activation of inflammation and immune response, t the autophagy-lysosome system is also an important factor that affects the development of atherosclerosis. We identified five core genes (Atp6ap2, Atp6v0b, Atp6v0d2, Atp6v1a, and Atp6v1d) in the protein-protein interaction (PPI) network that were closely related to autophagosomes. Hub genes were highly expressed in the carotid atherosclerosis group in the GSE100927 dataset (P < 0.001). QT-PCR showed that the RNA level of Atp6v0d2 increased significantly during the development of atherosclerotic plaque in ApoE-/- male mice. Five core genes which affect the development of aortic atherosclerosis through the autophagy-lysosome system, especially Atp6v0d2, were screened and identified using bioinformatic techniques.

Contrast-Enhanced Ultrasound Feasibility in Assessing Carotid Plaque Vulnerability-Narrative Review.

The risk assessment for carotid atherosclerotic lesions involves not only determining the degree of stenosis but also plaque morphology and its composition. Recently, carotid contrast-enhanced ultrasound (CEUS) has gained importance for evaluating vulnerable plaques. This review explores CEUS's utility in detecting carotid plaque surface irregularities and ulcerations as well as intraplaque neovascularization and its alignment with histology. Initial indications suggest that CEUS might have the potential to anticipate cerebrovascular incidents. Nevertheless, there is a need for extensive, multicenter prospective studies that explore the relationships between CEUS observations and patient clinical outcomes in cases of carotid atherosclerotic disease.

X chromosome inactivation skewing is common in advanced carotid atherosclerotic lesions in females and predicts secondary peripheral artery events

Background and aimSex differences in atherosclerosis have been described with female plaques being mostly perceived as stable and fibrous. Sex-specific mechanisms such as mosaic loss of the Y chromosome in men have been linked to cardiovascular health. In women, X-linked mechanisms such as X chromosome inactivation (XCI) skewing is common in several tissues. Yet, information on the role of XCI in female atherosclerotic plaques is lacking. Here, we investigated the presence of XCI skewing in advanced atherosclerotic lesions and its association with cardiovascular risk factors, histological plaque data, and clinical data.MethodsXCI skewing was quantified in 154 atherosclerotic plaque and 55 blood DNA samples of women included in the Athero-Express study. The skewing status was determined performing the HUMARA assay. Then, we studied the relationship of XCI skewing in female plaque and cardiovascular risk factors using regression models. In addition, we studied if plaque XCI predicted plaque composition, and adverse events during 3-years follow-up using Cox proportional hazard models.ResultsXCI skewing was detected in 76 of 154 (49.4%) plaques and in 27 of 55 (67%) blood samples. None of the clinical risk factors were associated with plaque skewing. Plaque skewing was more often detected in plaques with a plaque hemorrhage (OR [95% CI]: 1.44 [1.06–1.98], P = 0.02). Moreover, skewed plaques were not associated with a higher incidence of composite and major events but were specifically associated with peripheral artery events during a 3-year follow-up period in a multivariate model (HR [95%CI]: 1.46 [1.09–1.97]; P = 0.007).ConclusionsXCI skewing is common in carotid plaques of females and is predictive for the occurrence of peripheral artery events within 3 years after carotid endarterectomy.

High Contrast Detection of Carotid Neothrombus with Strong Near-Infrared Absorption Selenium Nanosphere Enhanced Photoacoustic Imaging.

Carotid artery thrombosis is the leading cause of stroke. Since there are no apparent symptoms in the early stages of carotid atherosclerosis onset, it causes a more significant clinical diagnosis. Photoacoustic (PA) imaging provides high contrast and good depth information, which has been used for the early detection and diagnosis of many diseases. We investigated thrombus formation by using 20% ferric chloride (FeCl3) in the carotid arteries of KM mice for the thrombosis model. The near-infrared selenium/polypyrrole (Se@PPy) nanomaterials are easy to synthesize and have excellent optical absorption in vivo, which can be used as PA contrast agents to obtain thrombosis information. In vitro experiments showed that Se@PPy nanocomposites have fulfilling PA ability in the 700 nm to 900 nm wavelength range. In the carotid atherosclerosis model, maximum PA signal enhancement up to 3.44, 4.04, and 5.07 times was observed by injection of Se@PPy nanomaterials, which helped to diagnose the severity of carotid atherosclerosis. The superior PA signal of Se@PPy nanomaterials can identify the extent of atherosclerotic carotid lesions, demonstrating the feasibility of PA imaging technology in diagnosing carotid thrombosis lesion formation. This study demonstrates nanocomposites and PA techniques for imaging and diagnosing carotid thrombosis in vivo.

Role of lipoprotein(a) in plaque progression

Identified by Berg in 1963, lipoprotein(a) represents a key contemporary residual risk pathway in atherosclerotic cardiovascular disease (ASCVD) secondary prevention. Indeed, epidemiological and genetic studies have undoubtedly demonstrated that lipoprotein(a) is one of the strongest causal risk factors of ASCVD. Although a risk threshold has been set between 30 and 50 mg/dL, depending on the ethnicity, a linear risk gradient across the distribution has been demonstrated. In the context of the atherosclerotic process, hyperlipoproteinaemia(a) contributes to the atherosclerotic plaque formation by deposition of cholesterol in the same manner as low-density lipoprotein (LDL) cholesterol, due to the LDL particle component of lipoprotein(a). Lipoprotein(a) accumulates in human coronary and carotid atherosclerotic lesions. High concentrations of lipoprotein(a) are associated with accelerated progression of the necrotic core, but not with coronary calcium score (CAC), although in the latter case, the evaluation of lipoprotein(a) can overcome the potential limitation of CAC to capture the totality of ASCVD risk in asymptomatic individuals. Finally, in the absence of a pharmacological approach to lower lipoprotein(a) to the extent required to achieve a cardiovascular benefit, implementation strategies that increase awareness among the population, patients, and healthcare providers on the importance of lipoprotein(a) in the development of ASCVD are eagerly needed.

Abstract 14630: Cigarette Smoking and Risk of Carotid Atherosclerotic Lesions Among Chinese Adults With or Without Cardiometabolic Disorders: A Longitudinal Study

Backgroud: Cigarette smoking is closely associated with the presence of carotid atherosclerotic lesions (CAL); however, whether such association differs in participants with or without cardiometabolic disorders (CD) is largely unknown. Methods: A dynamic retrospective cohort study of health checkup data was used from the Beijing MJ Health Screening Centers. A total of 14 410 participants were included among those who took both routine tests and carotid ultrasonography (CU) at least twice from 2008 to 2018 and had no CAL at the first time. Information on smoking status was collected from self-reported questionnaires. CAL was defined as increased carotid intima-media thickness, carotid plaques, or carotid stenosis. CD was defined with the presence of hypertension, diabetes, and/or dyslipidemia. The associations of smoking with CAL among participants with or without CD and the joint effect of smoking and CD were estimated by logistic regression. Results: Among 5810 and 8600 participants with and without CD at baseline, 2016 and 1386 developed CAL during follow-up, respectively. We found the status of CD significantly modified the associations between smoking and CAL ( P interaction &lt; 0.01). Among participants without CD, non-current smoking was independently associated with a decreased risk of CAL (odds ratio [OR] and 95% confidence interval [CI]: 0.80 [0.68-0.94]). Whereas, such association was not observed among CD patients. In joint analyses, compared with current smokers with CD (CD + &amp;smoking + ), the ORs (95% CIs) were 0.72 (0.61-0.84), 0.94 (0.82-1.07), and 0.56 (0.49-0.64) for participants in the CD - &amp;smoking + , CD + &amp;smoking - , and CD - &amp;smoking - group, respectively. Conclusion: Never and former smokers without CD might have a lower risk of CAL, but not the ones prevalent with CD, highlighting the carotid atherosclerotic benefits of early smoking cessation.

Low-normal serum unconjugated bilirubin levels are associated with late but not early carotid atherosclerotic lesions in T2DM subjects.

We aimed to examine the association of serum unconjugated bilirubin (UCB) within normal limits with carotid atherosclerosis in Chinese patients with type 2 diabetes mellitus (T2DM). This cross-sectional, real-world study was performed in 8,006 hospitalized T2DM patients including 4,153 men and 3,853 women with normal UCB. The subjects were stratified into quintiles based on serum UCB levels (<6.2, 6.2-7.9, 8.0-8.9, 9.0-10.9, and >10.9 μmol/l, respectively). Carotid atherosclerotic lesions detected by ultrasonography, including carotid intima-media thickness (CIMT), carotid plaque, and stenosis, were compared among the five groups. The associations of serum UCB levels and quintiles with carotid atherosclerotic lesions were also determined by multiple logistic regression. The prevalence of carotid plaque (55.3%, 49.5%, 47.4%, 43.8%, and 37.5%, respectively; p < 0.001 for trend) and stenosis (15.2%, 12.2%, 9.1%, 7.7%, and 5.4%, respectively; p < 0.001 for trend) was progressively lower across the UCB quintiles even after adjusting for age, sex, and duration of diabetes. Results of a fully adjusted multiple logistic regression analysis revealed that serum UCB levels and quintiles were significantly associated with carotid plaque and stenosis. Compared with the subjects in the lowest UCB quintile, the risk of carotid plaque decreased by 25.5%, 28.7%, 33.5%, and 42.8%, and that of carotid stenosis by 24.6%, 37.4%, 44.9%, and 47.3%, respectively, in those from the second to highest UCB quintiles. High serum UCB within the normal range was a protective factor against carotid plaque [odds ratio (OR) 0.810, 95% confidence interval (CI) 0.747-0.878; p < 0.001] and stenosis [OR 0.722, 95% CI 0.647-0.805; p < 0.001]. However, no significant association was observed between serum UCB and CIMT in T2DM patients. Furthermore, C-reactive protein (CRP) levels were significantly higher in the subjects with carotid atherosclerosis than in those without carotid atherosclerosis and clearly decreased across the UCB quintiles. Serum UCB within normal limits is inversely associated with late carotid atherosclerotic lesions including carotid plaque and stenosis but not CIMT, an early carotid atherosclerotic lesion in T2DM patients. High-normal UCB may be protective against carotid atherosclerosis by its anti-inflammation effect, which was indicated by significantly decreased CRP levels from the lowest to highest UCB quintiles.

Vascular Imaging Follow‐Up in Carotid Webs: Is There Vascular Remodeling?

Vascular Imaging Follow‐Up in Carotid Webs: Is There Vascular Remodeling?

Association Between Retinal Microvascular Metrics Using Optical Coherence Tomography Angiography and Carotid Artery Stenosis in a Chinese Cohort.

Objectives: The main aim was to investigate the association between retinal microvascular metrics using optical coherence tomography angiography (OCTA) and carotid artery stenosis (CAS) in an aging Chinese cohort. Methods: In this cross-sectional and observational study, 138 eyes of 138 participants were examined. Indices of the microcirculation measured by OCTA included mean vessel density (VD), skeleton density (SD), vessel diameter index (VDI), fractal dimension (FD) and foveal avascular zone (FAZ) of the superficial retinal layer (SRL) and deep retinal layer (DRL), and peripapillary vessel caliber. The correlation of these indices with the carotid atherosclerotic lesions including carotid intima media thickness (CIMT) and common carotid artery (CCA) plaque was assessed. Results: A total of 72 of 138 eyes demonstrated an increased (≥1 mm) CIMT, and 32 of the eyes presented common carotid plaques. Macular VD, SD, and FD were decreased with the increasing CCA caliber diameter (p < 0.05, respectively). Superficial and deep macular FDs were negatively associated with CIMT as well as the existence of CCA plaques (p < 0.05, respectively). Conclusion: Changes in retinal microvasculature accessed by OCTA may be used as one of the non-invasive early indicators to monitor asymptomatic CAS.

One-Year Outcomes of Transcarotid Artery Revascularization Versus Transfemoral Carotid Artery Stenting in a Medicare Database

Transfemoral carotid artery stenting (TFCAS) was introduced as a minimally invasive option for high-risk patients not eligible for carotid endarterectomy. However, TFCAS was found to be associated with higher rates of perioperative stroke. This was attributed to the unprotected manipulation of the aortic arch and carotid atherosclerotic lesion. Therefore, transcarotid artery revascularization (TCAR) was introduced as a hybrid alternative to TFCAS. Prior studies have shown a significantly lower risk of perioperative stroke and death compared with TFCAS.

Increased Risk to Develop Hypertension and Carotid Plaques in Patients with Long-Lasting Helicobacter pylori Gastritis.

Helicobacter pylori infection has been reported to be positively associated with hypertension, although with conflicting results. In this study, the relationship between H. pylori infection and hypertension, as well as atherosclerotic carotid lesions, was analyzed. Methods. Clinical records of patients referred to undergo upper endoscopy and gastric biopsy were retrieved. Information regarding the presence of H. pylori infection with atrophy/metaplasia/dysplasia (interpreted as a long-lasting infection), and current or past H. pylori infection was collected, as well as demographic variables, smoking habits, body mass index (BMI), dyslipidemia, diabetes, hypertension, presence of carotid lesions, and current treatment, and analyzed by multivariable regression models. Results. A total of 7152 clinical records from patients older than 30 years (63.4% women) were available for the study. Hypertension was present in 2039 (28.5%) patients and the risk was significantly increased in those with long-lasting H. pylori infection after adjusting for age decades, sex, BMI, cigarette smoking, diabetes, and dyslipidemia (OR 1.17, 95% CI 1.02–1.35). In addition, the long-lasting H. pylori infection was an independent risk for carotid plaques (OR 2.15, 95% CI 1.14–4.09). Conclusions. Our retrospective study demonstrated that long-lasting H. pylori infection is an independent risk factor for hypertension and the presence of carotid lesions after adjusting for potential confounders, although further validation our findings is needed from prospective studies.

Nur77 Deficiency Exacerbates Macrophage NLRP3 Inflammasome-Mediated Inflammation and Accelerates Atherosclerosis.

Purpose Activation of NLR (nucleotide-binding and leucine-rich repeat immune receptor) family pyrin domain containing 3 (NLRP3) inflammasome mediating interleukin- (IL-) 1β secretion has emerged as an important component of inflammatory processes in atherogenesis. The nuclear receptor Nur77 is highly expressed in human atherosclerotic lesions; however, its functional role in macrophage NLRP3 inflammasome activation has not yet been clarified. Methods, Materials, and Results. Eight-week-old apolipoprotein E (ApoE)−/− and ApoE−/− Nur77−/− mice that were fed a Western diet underwent partial ligation of the left common carotid artery (LCCA) and left renal artery (LRA) to induce atherogenesis. Four weeks later, severe plaque burden associated with increased lipid deposition, reduced smooth muscle cells, macrophage infiltration, and decreased collagen expression was identified in ApoE−/− Nur77−/− mice compared with those in ApoE−/− mice. ApoE−/− Nur77−/− mice showed increased macrophage inflammatory responses in carotid atherosclerotic lesions. In vitro studies demonstrated that oxidized low-density lipoprotein cholesterol (ox-LDL) increased the release of lactate dehydrogenase (LDH) and upregulated the expressions of cleaved caspase-1, cleaved IL-1β and gasdermin D (GSMD) in WT peritoneal macrophages (PMs) in a NLRP3-dependent manner. Nur77−/− PMs exhibited a further increased level of NLRP3 inflammasome-mediated inflammation under ox-LDL treatment compared with WT PMs. Mechanistically, Nur77 could bind to the promoter of NLRP3 and inhibit its transcriptional activity. Conclusions This study demonstrated that Nur77 deletion promotes atherogenesis by exacerbating NLRP3 inflammasome-mediated inflammation.

Albuminuria but not low eGFR is closely associated with atherosclerosis in patients with type 2 diabetes: an observational study

BackgroundThere is still controversy regarding the associations of urinary albumin excretion (UAE) and estimated glomerular filtration rate (eGFR) with atherosclerosis in patients with type 2 diabetes mellitus (T2DM). Therefore, it is necessary to explore the correlation between them in T2DM patients.MethodsWe conducted a survey involving 2565 T2DM patients from a single center. The study cohort was classified into three groups based on the levels of albuminuria: normal UAE (UAE < 30 mg/24 h), moderate UAE (UAE between 30 and 299 mg/24 h) and high UAE (UAE ≥ 300 mg/24 h). Additionally, the patients were divided into three separate groups according to eGFR levels, including low eGFR (eGFR < 60 ml/min/1.73 m2), intermediate eGFR (eGFR 60–89 ml/min/1.73 m2) and normal eGFR (eGFR ≥ 90 ml/min/1.73 m2) groups. Atherosclerotic lesions were compared among the three UAE and eGFR groups. Regression analyses were used to assess the associations of atherosclerotic lesions with UAE and eGFR in T2DM.ResultsAfter controlling for age, sex and diabetes duration, the prevalence of atherosclerotic plaque and stenosis were significantly increased from the normal to high UAE groups (plaque: 72.2%, 78.6% and 87.3%, respectively, p = 0.016 for trend; stenosis: 14.0%, 25.5% and 37.3%, respectively, p < 0.001 for trend). Likewise, the values of carotid intima-media thickness (CIMT) and femoral intima-media thickness (FIMT) were also obviously increased from the normal to high UAE groups (CIMT: p < 0.001 for trend; FIMT: p = 0.001 for trend). Conversely, only the FIMT value was clearly increased from the low to normal eGFR groups (p = 0.001 for trend). Fully adjusted regression analyses revealed that UAE was closely associated with the presence of atherosclerotic plaque (OR 1.20, 95% CI 1.03–1.40, p = 0.020) and stenosis (OR 1.17, 95% CI 1.01–1.35, p = 0.036), and with the values of CIMT (β 0.05, 95% CI 0.01–0.10, p = 0.029) and FIMT (β 0.07, 95% CI 0.03–0.11, p = 0.001) in T2DM patients. However, there was no significant association between eGFR levels and atherosclerotic lesions in T2DM after adjustment for multiple confounding factors.ConclusionsOverall, albuminuria rather than low eGFR is closely associated with atherosclerotic lesions in T2DM patients. Albuminuria is an independent risk factor for carotid and femoral atherosclerotic lesions in T2DM. Therefore, albuminuria may be a potential early marker to predict the development of atherosclerosis in patients with T2DM.

PM2.5 induce the defective efferocytosis and promote atherosclerosis via HIF-1α activation in macrophage

Epidemiological studies demonstrate that fine particulate matter (PM2.5) promotes the development of atherosclerosis. However, the mechanism insight of PM2.5-induced atherosclerosis is still lacking. The aim of this study was to explore the biological effects of hypoxia-inducible factor 1α (HIF-1α) on PM2.5-triggered atherosclerosis. The vascular stiffness, carotid intima-media thickness (CIMT), lipid and atherosclerotic lesion were increased when von Hippel-Lindau (VHL)-null mice were exposed to PM2.5. Yet, knockout of HIF-1α markedly decreased the PM2.5-triggered atherosclerotic lesion. We firstly performed microarray analysis in PM2.5-treated bone morrow-derived macrophages (BMDMs), which showed that PM2.5 significantly changed the genes expression patterns and affected biological processes such as phagocytosis, apoptotic cell clearance, cellular response to hypoxia, apoptotic process and inflammatory response. Moreover, the data showed knockout of HIF-1α remarkably relieved PM2.5-induced defective efferocytosis. Mechanistically, PM2.5 inhibited the level of genes and proteins of efferocytosis receptor c-Mer tyrosine kinase (MerTK), especially in VHL-null BMDMs. In addition, PM2.5 increased the genes and proteins of a disintegrin and metallopeptidase domain 17 (ADAM17), which caused the MerTK cleavage to form soluble MerTK (sMer) in plasma and cellular supernatant. The sMer was significantly up-regulated in plasma of VHL-null PM2.5-exposed mice. Moreover, PM2.5 could induce defective efferocytosis and activate inflammatory response through MerTK/IFNAR1/STAT1 signaling pathway in macrophages. Our results demonstrate that PM2.5 could induce defective efferocytosis and inflammation by activating HIF-1α in macrophages, ultimately resulting in accelerating atherosclerotic lesion formation and development. Our data suggest HIF-1α in macrophages might be a potential target for PM2.5-related atherosclerosis.

Ассоциация саркопении и атеросклероза сонных артерий у больных мужского пола пожилого возраста с остеоартритом коленного сустава

Aim: to evaluate the association of sarcopenia and carotid atherosclerosis in elderly male patients with knee osteoarthritis (OA). Materials and Methods: the study included 36 patients (mean age — 68.9 (66; 71) years) with an established diagnosis of grade II–III knee OA according to the Kellgren-Lawrence scale. Diagnosis of sarcopenia was conducted on the basis of the European Working Group on Sarcopenia in Older People (EWGSOP, 2010) recommendations with the determination of three parameters: muscle strength, muscle mass and muscle function. The severity of carotid atherosclerotic lesions was assessed by duplex color scanning with examination of the intima-media thickness (IMT), the presence of atherosclerotic plaques and the degree of aortic stenosis. Comparative analysis was performed in 3 groups: group 1 — 10 patients without sarcopenia, group 2— 12 patients with presarcopenia, and group 3 — 14 patients with sarcopenia. Results: IMT in group 3 with sarcopenia was statistically significantly (p=0.005) higher versus the same indicator in men without sarcopenia. The majority (23 (63.9%)) of the patients included in the study had carotid atherosclerotic lesions. The most severe carotid lesion with multiple atherosclerotic plaques and stenosis not less than 50% was significantly more commonly detected in patients with sarcopenia: 35.7% versus group 2 with presarcopenia (8.3%, p=0.015) and without sarcopenia (10.0%, p=0.013). According to the correlation analysis, a significant negative association was established between the severity of carotid atherosclerosis and the musculoskeletal index (r=-0.227, p=0.047). Conclusion: the association between carotid atherosclerosis and body composition disorders in men with knee OA allows discussing atherosclerosis and sarcopenia as two conditions with common pathogenetic mechanisms that potentially increase the risk of adverse outcomes. KEYWORDS: sarcopenia, presarcopenia, carotid atherosclerosis, osteoarthritis, elderly, male. FOR CITATION: Alekseeva L.I., Taskina E.A., Raskina T.A. et al. Association of sarcopenia and carotid atherosclerosis in elderly male patients with knee osteoarthritis. Russian Medical Inquiry. 2022;6(3):120–125 (in Russ.). DOI: 10.32364/2587-6821-2022-6-3-120-125.

Stroke risk stratification in elderly patients with comorbid sarcopenia and atherosclerosis

The study was to investigate the features of carotid arteries atherosclerosis as the leading risk factor for atherothrombotic stroke in elderly patients depending on the presence of sarcopenia. 2 groups of patients above the working age were examined: 110 patients with normal muscle mass and 24 suffering sarcopenia. Ultrasound examination of carotid and vertebral arteries extracranial segments was performed with an assessment of atherosclerotic changes severity, atherosclerotic plaques instability, 10-year risk of stroke (according to Framingham risk score) and a 10-year risk of fatal cardiovascular disease (SCORE risk scale). 10-year risk of fatal cardiovascular disease was 3 [2; 5] points for patients without sarcopenia, 3 [2; 3] points for patients with sarcopenia (p=0.81). The 10-year risk of stroke was 16 [12; 18] for patients without sarcopenia, 18 [15; 22] points for patients with sarcopenia (p=0.1). Due to the ultrasound examination data the incidence of carotid arteries atherosclerotic lesions in patients without sarcopenia was 50 (46.3%), in patients with sarcopenia - 18 (75.0%) (p=0.01). Statistically significant (p<0.05) increase in the atherosclerotic plaques instability signs was revealed in patients suffering sarcopenia compared to those without it: heterogeneous echotexture - 66.7% cases versus 38.2% (p=0.01), presence of hypoechoic masses - 41.7% patients vs 12.7% (p=0.02). It is important to take into account not only traditional risk factors in the overall assessment of cardiovascular risk as well as therapeutic and preventive measures planning in elderly patients, but also pay attention to body composition since modern diagnostic systems may be not sensitive enough to identify high-risk patients with comorbid atherosclerosis and sarcopenia.