Carotid Intima-media Thickness Values Research Articles

Factors Affecting Carotid Artery Stenosis in the Elderly Living at High Altitudes.

Factors affecting carotid artery stenosis have been generally investigated. However, considering the protective effect of altitude, studies on elderly individuals at high altitudes are few. Our aim is to investigate the systematic adaptive changes caused by high-altitude exposure through the causes of carotid artery stenosis. Carotid Doppler ultrasound was performed on 250 patients over the age of 50 years. The patients' age, gender, height, weight, smoking history, place of residence, and presence of comorbidities were questioned. Those with diabetes, hypertension, hyperlipidemia, and coronary disease were excluded from the study. Those who did not reside at high altitudes were excluded from the study. One hundred and thirty-five patients were included in the study. Carotid artery Doppler findings and biochemical parameters were recorded. Factors affecting stenosis in the carotid arteries were compared. In our study, the factors affecting carotid stenosis were determined to be age, gender, presence of plaque, plaque type, and mean carotid intima-media thickness (CIMT). The mean CIMT of the patients was calculated as 0.71±0.14 mm. The mean CIMT measurement level was significantly higher in patients with plaque in the carotid artery (p<0.05). According to receiver operating characteristic curves, CIMT values higher than 0.72 mm increase plaque and stenosis formation in the common carotid artery (CCA) and internal carotid artery (ICA) in elderly people living at high altitudes (p<0.05, area under the curve [AUC]: 0.71-0.83). The most important factors affecting carotid stenosis in individuals living at high altitudes are age, gender, CIMT, plaque, and plaque type. When soft plaques were detected, the risk of stenosis was found to be higher than in calcific plaques. Additionally, the number of factors affecting stenosis was greater on the left (ICA). This suggests that the left carotid system is more vulnerable. It can be said that in elderly individuals living at high altitudes, a CIMT higher than 0.72 mm is a cutoff value in the presence of plaque and stenosis in the carotid arteries.

β cell function and insulin resistance have gender-specific correlations with carotid intima-media thickness in type 2 diabetes

ObjectiveThe relationships between carotid intima-media thickness (C-IMT) and β cell function and insulin resistance in patients with type 2 diabetes (T2D) have not been fully elucidated. This study is to investigate whether impaired glucose metabolism is etiologically associated with C-IMT in patients with T2D.MethodsThe study group consisted of 490 (284 men, 206 women) participants. Venous blood specimens were obtained from all subjects for biochemical profiles after an >8-h overnight fast. C-IMT was measured as the distance between the luminal-intimal leading edge (I-line) and the medial-adventitial leading edge (M-line) on the far wall. Insulin resistance was estimated with the homeostasis model assessment of insulin resistance (HOMA-IR). The acute insulin response to arginine was calculated as the mean of the three plasma insulin levels obtained within 2, 4, and 6 min after the arginine bolus minus the pre-stimulus plasma insulin levels.ResultsThere was a graded increase in C-IMT values according to tertiles of HOMA-IR in men; the values of C-IMT were significantly decreased across the tertiles of acute insulin and C-peptide responses in women. Multivariate analysis revealed that HOMA-IR and age were positively associated with C-IMT among men participants, and acute insulin response and current smoking were the independent determinants of C-IMT in women.ConclusionEarly insulin response stimulated by arginine is independently associated with C-IMT in women T2D individuals, whereas insulin resistance is positively correlated with C-IMT in men T2D subjects.

Correlation of Carotid Intima-Media Thickness with One-hour Postload Plasma Glucose (1h-PPG) in Overweight and Obese North Indian Adults

Background: Cardiovascular morbidities like arterial stiffness and atherosclerosis have a negative association with insulin resistance, which can be identified by carotid intima media thickness (CIMT) measurement. One-hour postload plasma glucose (1 h-PPG) is a novel marker for early identification of insulin resistance, but very few studies are available on its relationship with CIMT. Objective: To identify the correlation of CIMT with 1 h-PPG in overweight and obese adults without diabetes. Methods: Individuals not having known diabetes or other chronic illnesses were identified and subjected to the initial anthropometric analysis for body mass index (BMI) calculation. A standard oral glucose tolerance test was performed on individuals with a BMI of ≥25 kg/m2 for 1 h-PPG values, and a B-mode ultrasound scan of the neck was used for CIMT measurement. A Pearson’s correlation statistical test was applied for correlation identification. Results: A total of 94 nondiabetic individuals participated, of whom 55 (58.5%) were women. Mean age, BMI, and CIMT values of the study population were 38.8 (±8.09) years, 29.6 (±3.22) kg/m2, and 0.72 (±0.10) mm, respectively. Average 1 h-PPG levels were 150.7 (±21.11) mg/dl, and the Pearson’s coefficient ( r) value with CIMT was 0.5792 ( P &lt; 0.05). Further, correlation analysis demonstrated an r-value of −0.0029 for BMI, −0.1293 for waist-hip ratio, −0.0047 for waist-height ratio, 0.3862 for glycated hemoglobin (HbA1c), and −0.2930 for 2 h-PPG. Conclusion: In euglycemic adults, the early insulin resistance defining parameter, i.e., 1 h-PPG levels had a consistent positive correlation with CIMT, which is a marker of the initial stages of atherosclerosis.

The risk of cardiovascular comorbidity in children with Behçet's disease.

Patients with Behçet's disease (BD) may experience long-term morbidity caused by various forms of cardiovascular disease. This study aimed to assess the risk for cardiovascular comorbidity in paediatric BD patients with and without vascular involvement, independent of the contribution of traditional risk factors. Paediatric patients classified as having BD according to the 2015 Peadiatric BD (PEDBD) criteria were included in the study. Twenty-four-hour ambulatory blood pressure monitoring (ABPM), transthoracic echocardiography, and carotid intima-media thickness (cIMT) measurements were performed. Patients with an active disease or those who have other known risk factors for cardiovascular disease were not included in the study. Thirty-one children and adolescents with paediatric BD (16 female, 51.6%; F/M: 1.06) were enrolled in the study. Among the BD patients, 10 patients (34.4%) had abnormal ABPM. Carotid IMT values, mean arterial pressure, systolic and diastolic blood pressure by ABPM and the prevalence of abnormal ABPM, non-dipping, and ambulatory hypertension were similar between patients with and without vascular involvement. The echocardiography measurements showed that BD patients with vascular involvement had a significantly higher velocity and velocity time integral of the left ventricle outflow tract, which may indicate increased stiffness of the aorta. Paediatric BD patients with vascular involvement may tend to have more cardiovascular risk factors. However, cardiovascular assessment should be considered in all BD patients, regardless of the involved systems. We suggest that ABPM may accurately define hypertension and cardiovascular risk in BD.

The impact of insulin induced lipohypertrophy on carotid intima-media thickness in patients with type 2 diabetes mellitus.

Lipohypertrophy (LH) is a major localized complication of insulin therapy. We aimed to investigate the association between insulin-induced LH and carotid intima-media thickness (CIMT) in patients with type 2 diabetes mellitus (DM). A total of 75 patients with DM treated with insulin were included in this study. The insulin injection sites of the patients were evaluated by inspection and palpation and then radiologically with ultrasound. The CIMT of the patients was evaluated using ultrasonography. According to the guideline recommendation, the CIMT cutoff value was taken as 0.9 mm, and the patients were categorized into 2 groups according to the CIMT value and evaluated statistically. The presence of LH (CI: 1.379-30.000; OR = 6.432; P < .05), age (CI: 1.036-1.149; OR = 1091; P < .05), BMI (CI: 1.003-1.262; OR = 1.125; P < .05) and duration of DM (CI: 1.001-1.300; OR = 1.141; P < .05) were independent risk factors for high-CIMT in patients with DM. The most interesting result of this study was that the presence of LH was an independent risk factor for increased CIMT. According to this result, we think that LH may increase the risk of cardiovascular disease as well as being a complication that disrupts the blood glucose regulation of patients with DM and increases the cost of treatment.

Carotid intima-media thickness and incident hypertension: the Brazilian Longitudinal Study of Adult Health.

High blood pressure (BP) increases carotid intima-media thickness (CIMT). On the other hand, it is not clear whether the vascular abnormalities reflected in high CIMT may predict incident hypertension. The present study aims to investigate the association between CIMT and incident hypertension after 4 years of follow-up in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), a multiethnic sample of middle-aged adults from six Brazilian cities. We analyzed data from 6682 ELSA-Brasil participants (aged 35-74) without hypertension and with complete CIMT data at baseline. After 4 years of follow-up, we describe hypertension incidence, stratifying the sample according to age, sex, and race-specific CIMT quartiles. We also built crude and adjusted Poisson regression models to analyze the association between mean and maximal CIMT values and incident hypertension. We found incident hypertension in 987 (14.8%) participants. According to mean CIMT quartile groups, hypertension incidence varied from 10.2% (first quartile group) to 22.4% (fourth quartile group; P for trend <0.001). In fully adjusted models, 0.1 mm increments in mean CIMT values were associated with a 16% [relative risk (RR):1.16; 95% confidence interval (95% CI) 1.10-1.21; P < 0.001] higher risk of incident hypertension, respectively. Results were similar when maximal CIMT values were considered instead of mean CIMT values. CIMT values at baseline strongly predicted incident hypertension after 4 years of follow-up in this large multiethnic cohort. This highlights the relationship between CIMT and BP and may provide important insights into the significance of this ultrasound measurement.

Carotid Intima-media Thickness through the Continuum of Dysglycemia in North Indian Population

Background: The carotid intima-media thickness (CIMT) is uniformly regarded as a consistent noninvasive marker for subclinical atherosclerosis and is widely accepted for assessment of cardiovascular risk in high-risk individuals including diabetes. Objectives: The present study was conducted to estimate the CIMT in prediabetes, new-onset type 2 diabetes mellitus (T2DM), and those with disease of at least 5-year duration to analyze its relationship to this common metabolic disorder and other risk factors. Materials and Methods: This was a cross-sectional hospital-based study conducted on 75 patients, 25 in each Group A (with T2DM of more than 5-year duration), Group B (new-onset T2DM), and Group C (prediabetes). IMT was measured in common carotid artery (CCA) bilaterally using high-resolution B-mode ultrasound. Continuous variables in the three groups were evaluated by analysis of variance, and CIMT was correlated with glycosylated hemoglobin (HbA1c) and lipid profile by Pearson’s correlation. Results: The mean CIMT in the right CCA was 0.67 + 0.12 mm, 0.58 + 0.07 mm, and 0.53 + 0.07 mm and in the left CCA was 0.65 + 0.10 mm, 0.58 + 0.06 mm, and 0.54 + 0.07 mm in Groups A, B, and C, respectively. A statistically significant difference was observed between Group A and Group B as well as between Group A and Group C (P &lt; 0.05). Patients with diabetes (DM) who had disease of over 5-year duration and relatively poor control of blood glucose (high HbA1c), and dyslipidemia, had significantly higher CIMT values than those with new-onset DM as well as prediabetes. Conclusion: All the three subgroups of dysglycemic individuals had higher CIMT as compared to historical data from healthy Asian Indian population. The CIMT values increased along the temporal continuum of hyperglycemia, being the lowest in individuals with prediabetes to the highest values in DM of at least 5-year duration. This indicates that subclinical atherosclerosis has an onset early in DM and CIMT has a linear relationship with the progression of hyperglycemia.

A Case-Control Study of the Carotid Intima Media Thickness as a Good Predictor of Subclinical Atherosclerosis in South Indian Women Diagnosed With Polycystic Ovarian Syndrome in a Tertiary Care Hospital

Background and Objective: Polycystic ovarian syndrome (PCOS) is a diverse condition whose likelihood of heightened cardiovascular disease (CVD) risk in the future is often disregarded. We need to predict the risk sooner due to the intrinsic propensity for CVD in Indians, increased prevalence in South Indians, and PCOS patients. The objectives are: 1. To elicit the presence of CVD risk factor in pcos patients 2. Considering CIMT (Carotid Intima Media Thickness) as a good predictor for CVD risk Methods: A total of 50 cases and 50 age and weight (+/-2 kg) matched controls were included in this study. We assessed the CIMT by the Doppler system with electrical linear transducer midfrequency of 10 MHz. Results: Women with PCOS had a greater CIMT (0.05 ± 0.01 cm in cases vs. 0.03 ± 0 cm in controls; p &lt; 0.001). The CIMT of the cases is increased over their controls by 42.4% (014mm), P ≤0.001. The r value of age and CIMT is more when compared to the r value of weight and CIMT in both cases and controls (Age and CIMT: cases: r= 0.431 &amp; controls: r =0.312) (Weight and CIMT: cases: r = 0.164 &amp; controls: r =0.233). Conclusion: In PCOS , CIMT is a good indicator of CVD risk. When opposed to an individual's weight, age shows a stronger positive correlation with CIMT. Hence, PCOS patients must get an early CIMT scan. CIMT must be a crucial component of PCOS management and CVD risk alleviation.

The Interconnection between Carotid Intima-Media Thickness and Obesity: Anthropometric, Clinical and Biochemical Correlations.

Background and Objectives: Carotid intima-media thickness (CIMT) and obesity are considered independent determinants of cardio- and cerebrovascular events. The aim of our study was to investigate the effect of obesity on CIMT and to define which traditional cardiovascular risk factors correlate the most with CIMT values in patients with obesity. Materials and Methods: Anthropometric measurements were collected for the whole study group, as well as body composition and blood pressure data, and biochemical blood analyses were also performed. Results: Although our study group was significantly older according to vascular compared with chronological age, the mean CIMT values were lower when compared with the reference values. We found a statistically significant correlation of CIMT with chronological and vascular age, systolic blood pressure, fasting glucose, total cholesterol and triglyceride levels, waist-to-hip ratio, waist circumference, body muscle mass and skeletal muscle mass index. Atherosclerotic Cardiovascular Disease (ASCVD) risk assessment and SCORE (Systematic COronary Risk Evaluation) showed significant positive correlations, but there was only a weak correlation of ASCVD with CIMT. Conclusions: To deduce, since no diagnostic tool currently includes body weight as an individual risk factor, further trials are highly needed to determine if SCORE, SCORE2, ASCVD risk assessment or CIMT would be the most accurate and relevant diagnostic tool for prediction of risk for future CV events in patients with obesity.

Fish and Polyunsaturated Fatty Acid Intake and Carotid Intima-Media Thickness in Japan: the Aidai Cohort Study in Yawatahama, Uchiko, Seiyo, and Ainan.

Epidemiological evidence regarding the relationship between fish and fatty acid intake and carotid intima-media thickness (CIMT) has been limited and inconsistent. The current cross-sectional study investigated this issue using baseline data from the Aidai Cohort Study. Study subjects were 2024 Japanese men and women aged 34-88 years. Right and left CIMT were measured at the common carotid artery using an automated carotid ultrasonography device. Maximum CIMT was defined as the largest CIMT value in either the left or right common carotid artery. Carotid wall thickening was defined as a maximum CIMT value ＞1.0 mm. The prevalence of carotid wall thickening was 13.0%. In men, intake of n-3 polyunsaturated fatty acids (PUFA) was independently positively related to the prevalence of carotid wall thickening, while no associations were found between intake of fish and the other fatty acids and carotid wall thickening or maximum CIMT. In women, intake levels of fish, n-3 PUFA, eicosapentaenoic acid, docosahexaenoic acid, and arachidonic acid were independently inversely associated with carotid wall thickening and intake levels of fish, n-3 PUFA, α-linolenic acid, n-6 PUFA, and linoleic acid were independently inversely associated with the maximum CIMT. No significant relationships were found between intake of total fat, saturated fatty acids, or monounsaturated fatty acids and carotid wall thickening or maximum CIMT regardless of sex. In women, higher intake of fish and n-3 and n-6 PUFA may be associated with a lower prevalence of carotid wall thickening and a decrease in maximum CIMT.

Association of Selected Cardiovascular Markers With Tuberculosis: Community-Based Exploratory Cross-Sectional Analytical Study in Puducherry.

Introduction India accounts for one-fourth of the global tuberculosis (TB) burden and also faces a rising burden of non-communicable diseases. Only a few have studied the association between the infective pathogenesis of TB and cardiovascular diseases (CVD). Methods A cross-sectional exploratory analytical design was used to compare CVD risk factors and immunological and radiological parameters. This was a pilot study conducted in two primary health centers in urban Puducherry between February 2020 and March 2021. Household contacts (HHC) were either spouses or siblings of the newly diagnosedpulmonary tuberculosis (PTB) patients selected for comparison as their exposure to infection would be similar to those who were diseased yet did not develop illness. Assuming a difference of 5% in CVD risk between the general population and TB patients, with a 95% confidence interval, the sample size calculated was 153 in each group by nMaster v2.0. Considering the feasibility and resource constrain, we recruited 50 newly diagnosed PTBpatients, their age- and gender-matched 50 HHCand 50 PTB patients who completed treatment a year before.CVD risk factors were compared using chi-square or Fisher exact test. Interleukins-6 (IL-6), interferon-gamma (INF-γ), highly specific - C reactive protein (hs-CRP), and carotid intima-media thickness (CIMT) were compared using ANOVA or Kruskal-Wallis test. Results Most participants from each group belonged to lower socio-economic strata and were males (40/50). Alcohol intake was higher among newly diagnosed and treatment-completed PTB patients (82.5% vs 72.5%). Excess salt intake (58%) was present more in newly diagnosed PTB patients. General and abdominal obesity were seen more among HHC (64% and 84%) and treatment-completed PTBpatients (50% and 74%). IL-6 was higher in newly diagnosed PTB patients, whereas INF-γ and hs-CRP were higher in treatment-completed PTB patients. The largest proportion of those having high CIMT values was also in the treatment-completed PTB patients. Conclusion Levels of immune markers hint at the role of inflammation due to TB disease being related to the high CIMT values among the newly diagnosed and treatment-completed PTB patients. CVD risk was higher among TB patients even if they had completed treatment and were declared cured.

Reference values for carotid artery intima-media thickness among community adult dwellers in Shenzhen City

Objective: To establish reference values for carotid intima-media thickness (CIMT) of adult dwellers in Shenzhen City. Methods: The study was conducted based on the Shenzhen heart failure epidemiological survey from 2021 to 2022. In this survey, residents aged 18 years and above in Shenzhen were selected by using a multi-stage stratified random sampling method. General information, cardiovascular disease (CVD) related behavior and carotid ultrasound examination and etc. were collected from the participants. People with CVD factors, a history of atherosclerotic cardiovascular disease, carotid plaque or having no carotid ultrasound examination results were excluded. The parameter regression model based on fractional polynomial was used to establish the reference values of CIMT by age and sex. Results: A total of 2 163 healthy individuals were enrolled in the final analysis, including 576 males (26.6%) and 1 587 females (73.4%). The fractional polynomial regression of the CIMT mean and standard deviation was obtained. For men, the regression was meanCIMT=0.324 7+0.006 9×age and SDCIMT=0.076 9+0.001 2×age. For women, the regression was meanCIMT=0.354 9+0.005 4×age and SDCIMT=0.041 6+0.002 0×age. Conclusion: The age and sex reference values for CIMT of adult people in Shenzhen established in this study could provide the latest reference standards for early screening of subclinical CVD.

Unveiling the Silent Danger of Childhood Obesity: Non-Invasive Biomarkers Such as Carotid Intima-Media Thickness, Arterial Stiffness Surrogate Markers, and Blood Pressure Are Useful in Detecting Early Vascular Alterations in Obese Children.

Obese children present a higher cardio-metabolic risk. Measuring vascular biomarkers that assess the evolution of arterial stiffness, subclinical atherosclerosis, and hypertension in such patients could be helpful in the long term. We studied 84 children, aged from 6 to 18 years: 50 obese subjects, versus 34 of normal weight. Clinical examination involved: BMI, waist circumference, waist-to-height ratio, and detection of the presence of acanthosis nigricans and irregular menstrual cycles (the latter in adolescent girls). The carotid intima-media thickness (CIMT) was measured with the Aixplorer MACH 30 echography device. The pulse wave velocity (PWV), augmentation index (AIx), and peripheral and central blood pressures (i.e., SBP, DBP, cSBP, cDBP, and cPP) were acquired through a Mobil-O-Graph device. Obese subjects underwent body composition analysis with a Tanita BC-418. Blood tests were: HOMA-IR, lipid panel, uric acid, and 25-OH vitamin D. All vascular biomarkers presented increased values in obese subjects versus controls. The following cut-off values were significant in detecting obesity: for PWV > 4.6 m/s, cSBP > 106 mmHg for the <12-year-olds, PWV > 4.5 m/s and cSBP > 115 mmHg for the 12-15-year-olds, and PWV > 5 m/s, cSBP > 123 mmHg for the >15-year-olds. AIx is higher in obese children, regardless of their insulin resistance status. Waist circumference and waist-to-height ratio correlate to all vascular parameters. HOMA-IR is an independent predictor for all vascular parameters except CIMT. Cut-off values for PWV of >4.8 m/s, SBP > 125 mmHg, and a cSBP > 117 mmHg predicted the presence of acanthosis nigricans. Obese girls with irregular menses displayed significantly higher PWV, SBP, and DPB. Elevated levels of uric acid, LDL-c, non-LDL-c, triglycerides, and transaminases, and low levels of HDL-c and 25-OH vitamin D correlated with higher arterial stiffness and CIMT values. We conclude that CIMT and the markers of arterial stiffness are useful in the early detection of vascular damage in obese children.

Age-Related Trends in the Predictive Value of Carotid Intima-Media Thickness for Cardiovascular Death: A Prospective Population-Based Cohort Study.

Background The age-related trends in the predictive ability of carotid intima-media thickness (CIMT) for cardiovascular risk remain unclear. We aimed to identify the age-related trends in the predictive value of CIMT for cardiovascular death. Methods and Results In a prospective cohort of adults aged 35 to 75 years without history of cardiovascular disease who were enrolled between 2014 and 2020, we measured CIMT at baseline and collected the vital status and cause of death. We divided the study population into 4 age groups (35-44, 45-54, 55-64, and 65-75 years). Competing risk models were fitted to estimate the associations between CIMT and cardiovascular death. The added values of CIMT in prediction were assessed by the differences of the Harrell's concordance index and the net reclassification improvement index. We included 369 478 adults and followed them for a median of 4.7 years. A total of 4723 (1.28%) cardiovascular deaths occurred. After adjusting for the traditional risk factors, the hazard ratios for CIMTmean per SD decreased with age, from 1.27 (95% CI, 1.17-1.37) in the 35 to 44 years age group to 1.14 (95% CI, 1.10-1.19) in the 65 to 75 years age group (P for interaction <0.01). Meanwhile, the net reclassification improvement indexes for CIMTmean were attenuated with age, from 22.60% (95% CI, 15.56%-29.64%) in the 35 to 44 years age group to 7.00% (95% CI, -6.82% to 20.83%) in the 65 to 75 years age group. Similar results were found for maximum CIMT in all age groups. Conclusions CIMT may improve cardiovascular risk prediction in the young and middle-aged populations, rather than those aged ≥55 years.

Diagnostic value of carotid intima-media thickness and clinical risk scores in determining etiology of ischemic stroke.

In the general population, carotid intima-media thickness (CIMT) is associated with atherosclerosis as well as atrial fibrillation (AF). However, the extent to which CIMT might be of diagnostic value in clarifying stroke etiology is currently unclear. In this retrospective cohort study, we included 800 consecutive patients with acute ischemic stroke. We compared CIMT-values between stroke etiologies. The association between CIMT and cardioembolic stroke was investigated via logistic regression analysis adjusting for vascular risk factors. Receiver operating characteristic analyses were conducted to investigate the diagnostic value of CIMT in comparison to vascular risk factors and clinical AF risk scores (CHA2DS2VASc, HAVOC, and AS5F). CIMT-values were highest in patients with cardioembolic or atherosclerotic stroke origin. CIMT was associated with newly diagnosed AF compared against cryptogenic strokes (crude odds ratio (OR) per 0.1 mm-increase of CIMT: 1.26 (95% confidence interval (CI): 1.13-1.41)). After adjustment for vascular risk factors, the effect of CIMT on AF-diagnosis, however, was weakened (adjusted OR: 1.10 (95% CI: 0.97-1.25)). The diagnostic value of CIMT for detection of AF (AUC: 0.60, 95% CI: 0.54-0.65) was outperformed by AF risk scores. Among the scores investigated, the AS5F-score yielded best accuracy and calibration to predict newly diagnosed AF (AUC: 0.71, 95% CI: 0.65-0.78). CIMT may help in the diagnosis of stroke etiology. However, compared with vascular risk factors or clinical AF risk scores, CIMT does not provide substantial additional information on the risk of newly detected AF. Thus, stratification of AF risk based on scores, such as the AS5F, is advisable.

Repurposing the Incidental Detection of Internal Hemorrhoids as an Independent Predictor of Coronary Artery Disease Risk

The relationship between anal canal hemorrhoids and cardiovascular diseases has been demonstrated in retrospective population-based studies. Despite the etiological similarities, the real-time correlation between hemorrhoids and cardiovascular risk is not known yet. We aimed to investigate the importance of incidentally detected internal hemorrhoids in predicting cardiovascular risk as determined by Carotid Intima-Media Thickness (CIMT) and Epicardial Fat Thickness (EFT) measurements. Totally, 269 patients who underwent colonoscopy for benign reasons were enrolled in this single-center cross-sectional study. The groups with and without hemorrhoids were compared for CIMT, EFT, and other risk factors. Independent predictors for increased CIMT and EFT values were evaluated by regression analysis. The mean age of the patients was 43.5±13.9 years and 34.6% were female. The prevalence of internal hemorrhoids was 30.5% (n=82). The presence of hemorrhoids was one of the independent predictors for increased CIMT along with hypertension and smoking (OR: 4.29, 2.63, and 2.36, respectively). The independent predictors of increased EFT were female gender, high body mass indexes, and high platelet levels (OR: 2.27, 1.47, and 1.01 respectively). Incidentally diagnosed internal anal canal hemorrhoids, albeit for other reasons, can be a useful predictor for the risk of atherosclerosis and cardiovascular diseases.

Significance of Determining Inflammatory Markers and Carotid Artery Intima Media Thickness values in the Detection of Coronary Heart Disease in Asymptomatic Patients with Type 2 Diabetes

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Sex differences in cardiovascular and disease-related features in axial spondyloarthritis. A multicenter study of 912 patients

ObjectivesTo determine the potential impact of sex-specific disease-related characteristics on cardiovascular (CV) disease in axial spondyloarthritis (axSpA). MethodsCross-sectional study of the Spanish AtheSpAin cohort to study CV disease in axSpA. Data on carotid ultrasound and CV disease and disease-related features were collected. Results611 men and 301 women were recruited. Classic CV risk factors were significantly less prevalent in women, who also showed a lower frequency of carotid plaques (p = 0.001), lower carotid intima-media thickness (IMT) values ​​(p<0.001) and CV events (p = 0.008). However, after adjustment for classic CV risk factors, only the differences with respect to carotid IMT remained statistically significant. Women showed higher ESR at diagnosis (p = 0.038), and more active disease (ASDAS, p = 0.012, and BASDAI, p<0.001). They had shorter disease duration (p<0.001), lower prevalence of psoriasis (p = 0.008), less structural damage (mSASSS, p<0.001), and less mobility limitation (BASMI, p = 0.033). To establish whether these findings could lead to sex differences in CV disease burden, we compared the prevalence of carotid plaques in men and women with the same level of CV risk stratified according to the Systematic Coronary Risk Evaluation (SCORE). Men included in the low-moderate CV risk SCORE category had more carotid plaques (p = 0.050), along with longer disease duration (p = 0.004), higher mSASSS (p = 0.001) and psoriasis (p = 0.023). In contrast, in the high-very high-risk SCORE category, carotid plaques were observed more frequently in women (p = 0.028), who were characterized as having worse BASFI (p = 0.011), BASDAI (p<0.001) and ASDAS (p = 0.027). ConclusionDisease-related features may influence the expression of atherosclerosis in patients with axSpA. This may be especially applicable to women at high CV risk, characterized by greater disease severity and more severe subclinical atherosclerosis than men, suggesting a stronger interaction between disease activity and atherosclerosis in women with axSpA.

Subclinical atherosclerosis in patients with hidradenitis suppurativa treated with TNF inhibitors.

Hidradenitis suppurativa (HS) is an independent risk factor for the development of subclinical atherosclerosis. Tumour necrosis factor (TNF) inhibitors are effective for the treatment of recalcitrant moderate-to-severe HS. However, the effect of treatment with TNF inhibitors on subclinical atherosclerosis in HS patients has not been previously investigated. In this study, we aimed to assess changes in biochemical parameters (fasting blood glucose and lipid levels) and carotid intima-media thickness (CIMT) values in Hurley stage II and III HS patients undergoing treatment with TNF inhibitors. This was a single center prospective study including 30 patients with Hurley stage II and III HS and 30 healthy controls (HCs). Baseline values of biochemical parameters and CIMT were compared to the values recorded after at least 6 months of TNF inhibitor therapy. CIMT values of the HS patients significantly exceeded those of HCs (for right p=0.011 and for left p=0.017). After at least 6 months of TNF inhibitor therapy, there was a statistically significant decrease in fasting blood glucose (p=0.001), whereas total cholesterol levels significantly increased (p=0.001). CIMT values also significantly increased (for right p=0.02 and for left p=0.01). Small sample size is limitation of the current study. Our study shows that patients with Hurley stage II and III HS undergoing TNF inhibitor therapy are under risk for progression of subclinical atherosclerosis.

Association of Urinary Lead and Cadmium Levels, and Serum Lipids with Subclinical Arteriosclerosis: Evidence from Taiwan.

Exposure to lead and cadmium has been linked to changes in lipid metabolism and the development of arteriosclerosis, but the role of lipoprotein profiles in this relationship is not well understood, including the potential role of novel lipid biomarkers. In this study, we enrolled 736 young Taiwanese subjects aged 12 to 30 years to assess the correlation between urine levels of lead and cadmium, lipoprotein profiles, and carotid intima-media thickness (CIMT). Higher levels of lead and cadmium were significantly associated with higher levels of low-density lipoprotein cholesterol (LDL-C), small dense LDL-C (sdLDL-C), LDL-triglyceride (LDL-TG), and CIMT. Participants with higher levels of lead and cadmium had the highest mean values of CIMT, LDL-C, sdLDL-C, and LDL-TG. In a structural equation model, lead had a direct and indirect association with CIMT through LDL-C and sdLDL-C, whereas cadmium had a direct association with CIMT and an indirect association through LDL-C. Our results suggest higher levels of lead and cadmium are associated with abnormal lipid profiles and increased CIMT. These heavy metals could have additive effects on lipids and CIMT, and the relationship between them may be mediated by lipoprotein levels. Further research is needed to determine the causal relationship.