Carotid Intima Research Articles

Identification of metabolic components of carotid plaque in high-risk patients utilizing liquid chromatography-tandem mass spectrometry.

Carotid atherosclerosis is a chronic progressive vascular disease that can be complicated by stroke in severe cases. Prompt diagnosis and treatment of high-risk patients are quite difficult due to the lack of reliable clinical biomarkers. This study aimed to explore potential plaque metabolic markers of stroke-prone risk and relevant targets for pharmacological intervention. Carotid intima and plaque sample tissues were obtained from 20 patients with cerebrovascular symptoms of carotid origin. An untargeted metabolomics approach based on liquid chromatography-tandem mass spectrometry was utilized to characterize the metabolic profiles of the tissues. Multivariate and univariate analysis tools were used. A total of 154 metabolites were significantly altered in carotid plaque when compared with thickened intima. Of these, 62 metabolites were upregulated, whereas 92 metabolites were downregulated. Support vector machines identified the 15 most important metabolites, such as N-(cyclopropylmethyl)-N'-phenylurea, 9(S)-HOTrE, ACar 12:2, quinoxaline-2,3-dithiol, and l-thyroxine, as biomarkers for high-risk plaques. Metabolic pathway analysis showed that abnormal purine and nucleotide metabolism, amino acid metabolism, glutathione metabolism, and vitamin metabolism may contribute to the occurrence and progression of carotid atherosclerotic plaque. Our study identifies the biomarkers and related metabolic mechanisms of carotid plaque, which is stroke-prone, and provides insights and ideas for the precise prevention and targeted intervention of the disease.

Klotho inversely relates with carotid intima- media thickness in atherosclerotic patients with normal renal function (eGFR ≥60 mL/min/1.73m2): a proof-of-concept study.

Klotho protein is predominantly expressed in the kidneys and has also been detected in vascular tissue and peripheral blood circulating cells to a lesser extent. Carotid artery intima-media thickness (CIMT) burden, a marker of subclinical atherosclerosis, has been associated with reductions in circulating Klotho levels in chronic kidney disease patients, who show reduced levels of this protein at all stages of the disease. However, the contribution of serum Klotho and its expression levels in peripheral blood circulating cells and in the carotid artery wall on the CIMT in the absence of kidney impairment has not yet been evaluated. We conducted a single-center study in 35 atherosclerotic patients with preserved kidney function (eGFR≥60 mL/min/1.73m2) subjected to elective carotid surgery. Serum levels of Klotho and cytokines TNFa, IL6 and IL10 were determined by ELISA and transcripts encoding for Klotho (KL), TNF, IL6 and IL10 from vascular segments were measured by qRT-PCR. Klotho protein expression in the intima-media and adventitia areas was analyzed using immunohistochemistry. APatients with higher values of CIMT showed reduced Klotho levels in serum (430.8 [357.7-592.9] vs. 667.8 [632.5-712.9] pg/mL; p<0.001), mRNA expression in blood circulating cells and carotid artery wall (2.92 [2.06-4.8] vs. 3.69 [2.42-7.13] log.a.u., p=0.015; 0.41 [0.16-0.59] vs. 0.79 [0.37-1.4] log.a.u., p=0.013, respectively) and immunoreactivity in the intimal-medial area of the carotids (4.23 [4.15-4.27] vs. 4.49 [4.28-4.63] log µm2 p=0.008). CIMT was inversely related with Klotho levels in serum (r= -0.717, p<0.001), blood mRNA expression (r=-0.426, p=0.011), and with carotid artery mRNA and immunoreactivity levels (r= -0.45, p=0.07; r= -0.455, p= 0.006, respectively). Multivariate analysis showed that serum Klotho, together with the gene expression levels of tumor necrosis factor TNFa in blood circulating cells, were independent determinants of CIMT values (adjusted R2 = 0.593, p<0.001). The results of this study in subjects with eGFR≥60mL/min/1.73m2 show that patients with carotid artery atherosclerosis and higher values of CIMT present reduced soluble Klotho levels, as well as decreased KL mRNA expression in peripheral blood circulating cells and Klotho protein levels in the intima-media of the carotid artery wall.

ATHEROSCLEROSIS AND INCIPIENT NEPHROPATHY IN DIABETIC PATIENTS

Objective: The association between nephropathy, particularly microalbuminuria, and cardiovascular disease, is becoming increasingly apparent. Atherosclerotic process is a combination of fatty degeneration (atherosis) and of vessel stiffening (sclerosis) of the arterial wall. The aim of the study was to assess relationship between diabetic nephropathy and structural changes in arteries, such as carotid intima – media thickness (IMT). Design and method: We selected 80 adults with type 2 diabetes. 47 were women and 33 were men, mean age 51 ± 14. They were divided into three groups based on albuminuria status: Group I = no albuminuria (&lt;30 mg albumin/g creatinine), numbers of patients 27; Group II = microalbuminuria (30 to 300 mg/g) numbers of patients 26; and Group III = macroalbuminuria (&gt;300 mg/g) numbers of patients 27. Albuminuria was measured by collection of fasting random urine specimen on arrival to the clinic, usually in the morning. The IMT was measured by a B-mode ultrasound, 10 MHz transducer. Each group was evaluated for body mass index (BMI), glycosylated hemoglobin (HbA1C), lipid profile, blood pressure. Results: Systolic blood pressure in the II-group was 143.3 ± 15.2mmHg and significantly higher (p &lt; 0.01) than in the I-group (132.5 ± 18.1mmHg) and III-group (139.8 ± 18.9mmHg). No significant differences in age, smoking and kind of antihypertensive agent used were found between three groups. IMT level in the II-group was 1.28 ± 0.35 mm and significantly higher than in the I and III group (1.09 ± 0.28 mm; 1.19 ± 0.44 mm, respectively). There were no significant differences in HbA1C, lipid or serum creatinine between three groups Conclusions: The carotid IMT was significantly higher in the patients with microalbuminuria and so, the last one is associated with structural changes in arteries.

Carotid artery hemodynamics among diabetic and hypertensive patients

Diabetic and hypertensive patients are at increased risk of vascular complications. Carotid Doppler ultrasonography serves as a non-invasive gold standard technique/tool to access and monitor carotids hemodynamics and morphology. There is a need to predict difference in carotid artery hemodynamics among hypertensive and diabetic patients.Aim: Aim of this study is to find out the hemodynamics of carotid artery in diabetic and hypertensive patients. Method: Cross sectional study conducted at University Ultrasound Clinic Green Town. All patients were investigated with Toshiba Xario XG with 5-7.5MHz linear probe. Study included diabetic and hypertensive individuals, whereas patients with history of carotid endarterectomy, carotid stenting and co-morbidity were excluded. Total 200 participants were recruited, 41 were diabetic and hypertensive, while 159 were normal subjects. Statistical analysis was performed using SPSS version 21. Results: From 200 participants were recruited, out of them 41 patients with 20.5% were positive with diabetes and hypertension and 159 patients with 79.5% were negative with diabetes and hypertension. Right common carotid artery intima media thickness (IMT) mean ± S.D was 0.659±0.114mm with p-value (0.022). Left common carotid end diastolic velocity mean ± S.D was 16.719±6.303cm/s with p-value (0.002). Conclusion: The study highlighted that common carotid artery intima media thickness (IMT) and common carotid artery end diastolic velocity were significantly correlated with hypertension and diabetes. Our findings revealed that common carotid artery IMT and EDV were significant in hypertensive and diabetic patients. Indeed, hypertension and diabetes are mainly associated with vascular complications.

Carotid Intima Media Thickness and Comorbid Cardiometabolic Dysfunction in Women: The SWAN Study

Metabolic syndrome (MetS) and obesity are risk factors for atherosclerosis but their combined impact is unknown. The aim of this study was to quantify the added risk of obesity on carotid artery intima media thickness (cIMT), an early indicator for atherosclerosis, beyond MetS alone. The Study of Women’s Health Across the Nation (SWAN) is a multi-center, multi-ethnic cohort of women traversing the midlife into early late adulthood. cIMT was assessed between 2005-2007 and MetS, obesity and covariates were measured at the same time. This cross-sectional analysis is restricted to 1,433 women with a body mass index ≥18.5 kg/m2 and free of cardiovascular disease (CVD) when cIMT was measured. Mean maximum cIMT was related to obesity, MetS and their interaction using multivariable linear regression models. The average age was 60 years (standard deviation 2.7) and the prevalence of obesity and MetS were 44% and 35%, respectively. Both conditions occurred in 24% of women. After adjustment for age, race, smoking, family history of heart disease, and antilipemic medications, obese women had a 0.051mm (95% confidence interval (CI): 0.033,0.070; p<0.001) larger maximum cIMT versus women not obese and women with MetS had a 0.066mm (95%CI: 0.042,0.090; p<0.001) larger maximum cIMT versus women without MetS. There was a statistically significant antagonistic interaction between obesity and MetS; women with both had a mean cIMT of 0.972mm (95%CI: 0.955,0.989) and MetS alone a cIMT of 0.961mm (95%CI:0.938,0.983). This suggests that there is only a small risk of obesity on augmenting cIMT beyond MetS alone.

Index of Reflectivity of Ultrasound Radio Frequency Signal from the Carotid Artery Wall Increases in Astronauts after a 6 mo Spaceflight

The objective was to quantify the index of reflectivity of the common carotid artery and surrounding structures, before and after 6 mo of microgravity. Our hypothesis was that structural changes in the insonated target would increase its index of reflectivity. The neck anterior muscle and common carotid artery (walls and lumen) were visualized by echography (17 MHz linear probe), and the radiofrequency signal along each vertical line was displayed. The limits of the radiofrequency data corresponding to each target (muscle, vessel wall) were determined from the B-mode image and radiofrequency trace. Each target's index of reflectivity was calculated as the proportion of backscattered energy to the whole backscattered energy along the line. After 6 mo in flight, the index of reflectivity increased significantly for both common carotid walls, while it remained unchanged for the neck muscle, carotid intima and lumen. The index of reflectivity provided additional information beyond traditional B-mode imaging.

Assessment of carotid artery intima media thickness in prehypertension

Introduction and Aim: Increased carotid artery intima media thickness (CIMT) has been linked to the development of cardiovascular disease (CVD). CVD is a major cause of mortality and morbidity in India. Increased CIMT has been documented in Hypertension (HT), thus putting them at a higher risk of CVD. Early identification and awareness of risk factors leading to increased morbidity and mortality could help in reducing its incidence. The aim of the study was to measure CIMTin prehypertensive Indian population.&#x0D; &#x0D; Materials and Methods:In this analytical observational study, common carotid artery IMT was measured using B mode ultrasonography in 46 individuals having blood pressure in the prehypertensive range and 46 individuals with normal blood pressure. Cardiovascular risk factors like body mass index(BMI),fasting blood glucose (FBS), and lipid profile, which are known to influence CIMT,were also assessed and compared between the two groups.&#x0D; &#x0D; Results:CIMT was significantly higher in prehypertensives as compared to subjects having normal blood pressure. BMI, FBS, and lipid profile was found to be comparable between the two groups.&#x0D; &#x0D; Conclusions:The presence of increased CIMT in prehypertensives as compared to controls indicates an increased risk of adverse cardiovascular events.

Association of SYNTAX Score with PATIMA Index, Carotid Intima- and Extra- Media Thicknesses

Objectives: Several risk scoring systems have been validated for cardiovascular risk prediction and prognosis. PATIMA index combining Carotid intima media thickness (CIMT), carotid extra media thickness (CEMT), cardiac epicardial fat thickness (EFT) and body mass index (BMI)), are related to coronary artery disease (CAD). Materials and Methods: One-hudered-twenty-four patients were categorized as low SYNTAX (

Circulating calcification inhibitors are associated with arterial damage in pediatric patients with primary hypertension

BackgroundCirculating calcification inhibitors: fetuin A (FA) and osteoprotegerin (OPG) together with soluble ligand of receptor activator of nuclear factor kappa-B (sRANKL) have been linked to vascular calcifications and arterial damage. This study aimed to evaluate relationships between FA, OPG, sRANKL, and arterial damage in children with primary hypertension (PH).MethodsIn this cross-sectional single-center study, calcification inhibitors (FA, OPG, sRANKL) levels were measured in blood samples of 60 children with PH (median age 15.8, IQR: [14.5–16.8] years) and 20 age-matched healthy volunteers. In each participant, peripheral and central blood pressure evaluation (BP) and ambulatory BP monitoring (ABPM) were performed. Arterial damage was measured using common carotid artery intima media thickness (cIMT), pulse wave velocity (PWV), augmentation index (AIx75HR), and local arterial stiffness (ECHO-tracking—ET) analysis.ResultsChildren with PH had significantly higher peripheral and central BP, BP in ABPM, thicker cIMT, higher PWV, and AIx75HR. FA was significantly lower in patients with PH compared to healthy peers without differences in OPG, sRANKL, and OPG/sRANKL and OPG/FA ratios. In children with PH, FA level correlated negatively with cIMT Z-score and ET AIx; sRANKL level correlated negatively with ABPM systolic blood pressure (SBP), SBP load, diastolic BP load, and AIx75HR; OPG/sRANKL ratio correlated positively with SBP load, while OPG/FA ratio correlated positively with ET AIx. In multivariate analysis, FA was a significant determinant of cIMT (mm) and cIMT Z-score.ConclusionsThis study reveals that in children with primary hypertension, arterial damage is related to lower fetuin A concentrations.Graphical abstract

Cardiovascular Risk and Quality of Life in Autosomal Dominant Polycystic Kidney Disease Patients on Therapy With Tolvaptan: A Pilot Study.

Cardiovascular (CV) complications are the most frequent cause of morbidity and mortality in autosomal dominant polycystic kidney disease (ADPKD) patients. In 2017, the Italian Medicines Agency authorised tolvaptan, a vasopressin V2 receptor antagonist, for the treatment of ADPKD, based on the Tolvaptan Phase 3 Efficacy and Safety Study in ADPKD (TEMPO 3: 4), TEMPO 4: 4 and Replicating Evidence of Preserved Renal Function: An Investigation of Tolvaptan Safety and Efficacy (REPRISE) studies. The aim of the study was to assess the impact of tolvaptan on CV risk and quality of life, evaluated by nutritional, inflammatory, metabolic, instrumental parameters and psychocognitive tests on ADPKD patients. We evaluated 36 patients with ADPKD; 10 patients (7 males, mean age 42.5±7.0 years) treated with tolvaptan and 26 controls (11 males, mean age 36.7±9.1 years). They underwent, at T0, monthly, and at T1 (1 year) clinical, laboratory and instrumental evaluation, in addition to psychocognitive tests. In ADPKD patients treated with tolvaptan, we found at T1, a decrease in carotid intima-- media thickness (p=0.048), epicardial adipose tissue thickness (p=0.002), C-reactive protein (p=0.026), sympathovagal balance during night (p=0.045) and increased flow-mediated dilation (p=0.023) with a reduction in depression (Hamilton and Beck tests, p=0.008 and p=0.002, respectively) compared with controls. These preliminary results suggest that treatment with tolvaptan could improve early atherosclerosis and endothelial dysfunction markers and improve mood in ADPKD patients (probably by acting on endothelial cell and adipocyte V2 receptors).

Carotid Intima and Media Thickness Correlation with Central Blood Pressure Measurements by Tonometric and Oscillometric Methods: A Proof of Concept

Background The early detection of vascular damage in subclinical stages of hypertensive disease may be the key point in the prevention of cardiovascular outcomes. Objectives to correlate parameters of structural vascular damage (measurement of the carotid intima-media thickness) with parameters of functional vascular damage (central hemodynamic measurements) in pre-hypertensive and hypertensive patients taking up to two classes of anti-hypertensive drugs. Methods This was a cross-sectional descriptive study conducted with a convenience sample of patients attending the Liga de Hipertensão Arterial , a multidisciplinary program for the diagnosis and treatment of systemic hypertension, of the Federal university of Goias. Patients with arrythmia, diabetes, previous cardiovascular or cerebrovascular diseases, and end-stage diseases were excluded. Carotid Doppler test, measurements of peripheral and central blood pressure by applanation tonometry (Sphygmocor®) and oscillometry (Mobil-O-Graph®) were performed. The t-test was used for comparisons and the Pearson correlation test for correlations, considering a p<0.05 statistically significant. Results twenty patients (12 women) were evaluated, mean age 53.8 ± 14.3 years. Higher values of central pulse pressure (42.9±13.9 vs. 34.7±9.6, p=0.01) and pulse wave velocity (PWV) (9.0±1.9 vs. 7.9±1.5, p=0.01) were obtained by applanation tonometry compared with oscillometry. No difference between the methods was observed for the other measures. A significant correlation was found between carotid artery intima-media thickness (CA-IMT) and PWV (r=0.659; p=0.002) by the oscillometric test, but not with applanation tonometry. No correlation was found between central hemodynamic variables and the presence of carotid artery plaques. Conclusion PWV, estimated by oscillometry, was the only central hemodynamic parameter that correlated significantly with CA-IMT in pre-hypertensive and hypertensive patients at low cardiovascular risk. International Journal of Cardiovascular Sciences. 2020; [online].ahead print, PP.0-0

Home device-monitored sleep blood pressure reflects large artery stiffness: the Nagahama study.

High sleep blood pressure (BP) has been suggested to be an independent risk factor for cardiovascular outcomes. To assess the applicability of sleep BP measured using a timer-equipped home device, we investigated the association between home device-measured sleep BP and large artery stiffness. We performed a cross-sectional analysis of a dataset from the Nagahama study (N = 5916), a general population-based cohort study. Home morning BP and sleep BP were measured using a timer-equipped cuff-oscillometric device (HEM-7080IC). Office BP, carotid intima--media thickness (IMT), and brachial--ankle pulse wave velocity (baPWV) were measured at the follow-up investigation of the Nagahama study. Sleep hypertension (SBP ≥120 mmHg and/or DBP ≥70 mmHg) was associated with the arterial parameters (IMT: β = 0.051, baPWV: β = 0.141, both P < 0.001) independently of morning hypertension (IMT: β = 0.093, baPWV: β = 0.216, both P < 0.001) irrespective of antihypertensive medication status. Individuals exhibiting isolated sleep hypertension (N = 801) had thicker IMT (0.69 ± 0.14 vs. 0.64 ± 0.13 mm, P = 0.017) and faster baPWV (1,299 ± 197 vs. 1,183 ± 178 cm/s, P < 0.001) than normotensives. A sleep SBP at least 110 mmHg and a sleep DBP at least 65 mmHg were identified as the lower threshold BP values for the association with arterial parameters. Sleep BP measurement using a home device may be a simple way to assess cardiovascular risks overlooked by office and home morning BP measurements.

Positive relationship of hypertensive retinopathy with carotid intima--media thickness in hypertensive patients.

We aimed to explore the relationship of hypertensive retinopathy with carotid intima--media thickness (CIMT), and to examine the possible effect modifiers in Chinese adults with hypertension. We conducted a cross-sectional study of 12 342 hypertensive patients with complete exit site visit data from the China Stroke Primary Prevention Trial. CIMT was measured by carotid ultrasonography. Hypertensive retinopathy was diagnosed according to the Keith--Wagener--Barker classification. The mean (SD) CIMT among study participants was 739.9 (111.4) μm. Compared with patients with grade 1 hypertensive retinopathy or without hypertensive retinopathy, a significantly higher CIMT level (β, 7.63, 95% CI: 2.54--12.73) was observed in patients with grade 2-4 hypertensive retinopathy. Moreover, the association between hypertensive retinopathy (grade 2-4 versus grade 1 or normal) and CIMT was stronger in participants of younger age (<60 years; β, 13.70, 95% CI: 5.65--21.75; versus ≥60 years; β, 1.03, 95% CI: -5.58 to 7.63; P interaction = 0.006); or with lower total homocysteine levels [<12.1 μmol/l (median); β, 12.70, 95% CI: 5.98--19.42; versus ≥12.1 μmol/l; β, 2.07, 95% CI: -5.63 to 9.78; P interaction = 0.030). None of the other variables, including sex, BMI, study centers, treatment group, SBP, triglycerides, total cholesterol, fasting blood glucose, folate, serum creatinine, current smoking and alcohol drinking, significantly modified the relation of hypertensive retinopathy with CIMT levels. Hypertensive retinopathy (grade 2 and higher) was significantly associated with increased CIMT in hypertensive patients. The association was stronger in those of younger age or with lower total homocysteine levels.

Lipid profile, random blood glucose and carotid arteries thickness in human male subjects with different ages and body mass indexes

Objective This article investigated the effect of age and body mass index of male humans on the carotid arteries intima media thickness (IMT) and the blood concentration of glucose, triglycerides, total cholesterol and HDL cholesterol. Methods Thirty seven normal male human subjects participated in this study. The participants were classified to three groups depending on their age; 20–29 (11), 30–39 (14) and 40–49 (12). Also, the study subjects were divided to three groups according to their body mass index; normal (13), overweight (13) and obese (11). The Anova test was used for the statistical analysis of the obtained results. Results The body mass index significantly affected the blood glucose concentration while its effect on all the other parameters was insignificant. The age significantly affected all the studied parameters except the blood glucose, triglycerides and HDL cholesterol. The total cholesterol/HDL ratio was significantly affected by the age and insignificantly by the body mass index. Conclusions The age was more effective on the studied parameters than the body mass index. Worsening of the lipid profile was seen in the overweight participants rather than the obese ones.

Thickness of carotid artery intima is an independent risk factor for psoriasis.

Psoriasis (PsO) has been associated with lipoprotein abnormalities, visceral adiposity, atherosclerosis, and coronary artery disease (CAD) in several studies; however, data concerning the risk of psoriasis relevant to these parameters is not well established. We aimed to evaluate the relation between PsO and small dense low-density lipoprotein cholesterol (sd-LDL-C), serum lipid profile (SLP), blood pressures, anthropometric measurements, intima media thickness of the common carotid artery (CIMT), distribution of visceral adipose tissue (VAT; evaluated at 3 different measurement sites including VATa, VATb, VATc) along with subcutaneous (Sc-d1) and preperitoneal (Pre-d2) adipose tissue, and disease characteristics, so as to define relevant risk factors for PsO. In this cross-sectional and observational study, 62 patients with plaque-type PsO and 31 age- and sex-matched controls were enrolled. Data about metabolic profile, CIMT and VAT were obtained. There was a significant association between PsO and hypertension, smoking, diastolic blood pressure, sd-LDL-C/LDL-C ratio, CIMT, VATc, and Pre-d2. Following adjustments for hypertension and smoking, sd-LDL-C/LDL-C ratio, CIMT, and Pre-d2 still remained different between patients and controls (P = 0.03, P = 0.043, and P = 0.05, respectively). Each 0.1 unit increase in the CIMT increased the risk of PsO 1.51-fold (95%CI: 1.08 - 2.12, P = 0.016). PsO associates with a predisposition to develop thick preperitoneal fat tissue and thick intima of carotid arteries, all of which contribute to the increased risk of atherosclerosis and subsequent CAD. CIMT was considered as an independent risk factor for PsO.

MON-LB108 Measurement Of Carotid Intima,hepatic Steatosis And Inflammatory Markers In Obese Children

Measurement of carotid intima,hepatic steatosis and inflammatory markers in obese children. Elevated levels of inflammatory factors and increased mean intimal carotid thickness (IMT) would increase the risk of atherothrombotic events and contribute to the progression of cardiovascular disease in obese children. Objectives: Evaluate inflammatory factors, metabolic syndrome and non-alcoholic liver steatosis and carotid IMT as an early cardiovascular risk marker. Patients and methods: Descriptive cross-sectional exploratory study. Consider 41 obese children both sexes between 6- 12 years old. Evaluated: anthropometry and determinations of lipid and liver profile, blood glucose, insulin, HOMA, ultrasensitive CRP, fibrinogen. Hepatic ultrasound and measurement of carotid IMT with ESAOTE Mylab 50 Exdicion equipment. . Results: From 41 studied patients, 57% were female. 51% presented MS and 68% elevated triglycerides. CRP> 1 was found in 71% of cases. Hepatic steatosis was observed in 60%, which only 10% had altered transaminases. 12% presented high fibrinogen. Patients with MS had a significant positive difference in the IMTCC (X = 0.41 ± 0.12; p 0.024), HDL (X 37.89 ± 1.72; p 0.004) triglycerides (X 149.42 ± 10.69; p 0.002) in relation to patients without MS. Conclusion: CRP is an inflammatory risk factor associated with elevated BMI and MS. There was a higher prevalence of MS in our study. The increase in the average intimal thickness is significantly related to the presence of MS and RCP>1. The determination of marker molecules of an inflammatory state and measurement of carotid IMT would contribute to the implementation of strategies to prevent cardiovascular, hepatic and metabolic risk since childhood.

Study on Correlation of Carotid Artery Intima–Media Thickness and Dyslipidemia in Chronic Kidney Disease in a Bangladeshi Population

Background: In chronic kidney disease (CKD) patients,measuring carotid artery intima– media thickness (CIMT) canpredict coronary heart disease and stroke, resulting from systemic atherosclerosis.Objective: To find out correlation of carotid artery intima–media thickness and dyslipidemia in chronic kidney disease in a Bangladesh population.Methods: A cross-sectional analytic study was conducted in the Department of Nephrology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladeshi, between July 2014 and June 2015, on 80 CKD patients. Standard laboratory techniques were followed to estimate all biochemical parameters. CIMT measurement was done by duplex study of carotid vessels through high resolution B-mode ultrasound technique.Results: Among 80 patients, 29 (36%) were in 18-30 age group, 18 were (23%) 31-40 age group and 33 (41%) were between 41-50 age group; mean age was 36.1±9.5 years. 51 (64%) patients were male and 29 (36%) were female. Though mean CIMT was found markedly increased in all CKD patients, the differences among stage 3, 4 and 5 was not significant. Mean CIMT was found more in dyslipidemic patients in comparison those with normal lipid profile, which was statistically significant (p&lt;0.05). Positive correlations were found between total cholesterol (TC) and CIMT (r=+0.295; p=0.008), triglyceride (TG) and CIMT (r=+0.238; p=0.034), and lowdensity lipoprotein (LDL) and CIMT (r=+0.231; p=0.039). However, there was negative correlation between high-density lipoprotein (HDL) and CIMT (r=–0.242; p=0.030).Conclusion: Our data suggest that the mean carotid intima-media thickness was markedly high in patients with CKD in comparison to normal expected value; however, there was no significant difference in thickness among CKD stages 3, 4 and 5. It was also observed that carotid artery intima-media thickness showed significant positive correlation with total cholesterol, triglyceride and LDL, but negative correlation with HDL.International Journal of Human and Health Sciences Vol. 04 No. 04 October’20 Page : 271-276

Circulating heat shock protein 27 as a novel marker of subclinical atherosclerosis in type 2 diabetes: a cross-sectional community-based study

BackgroundHeat shock protein 27 (HSP27) has been proposed as a vital protective factor in atherosclerosis. The objective of the present study was to evaluate the association between circulating HSP27 and carotid intima–media thickness (IMT) in individuals with type 2 diabetes and to determine whether HSP27 represents an independent marker of subclinical atherosclerosis in this patient population.MethodsWe performed a cross-sectional community-based study in 186 Chinese subjects with a median duration of type 2 diabetes of 8.2 years who underwent ultrasound carotid IMT measurement. Serum HSP27 levels were assessed by ELISA.ResultsSerum HSP27 levels were significantly higher in the IMT (+, > 1.0 mm) group than in the IMT (−, ≤1.0 mm) group, with the median values of 8.80 ng/mL (5.62–12.25) and 6.93 ng/mL (4.23–9.60), respectively (P = 0.006). The discriminative value of HSP27 to evaluate IMT was 7.16 ng/mL and the area under the curve was 0.72 (95%CI = 0.64–0.80, P = 0.0065). Spearman’s rank correlation analysis demonstrated that the concentrations of circulating HSP27 were positively associated with carotid IMT (r = 0.198, P = 0.007) and blood urea nitrogen (r = 0.170, P < 0.05). Furthermore, in the logistic model, serum HSP27 levels were found to be independent predictors for carotid IMT in type 2 diabetic patients after adjustment for onset age of diabetes, blood pressure, total cholesterol and C-reactive protein (OR = 1.085, P = 0.022).ConclusionsCirculating HSP27, positively correlates with carotid IMT, is an independent predictor for early atherosclerotic changes in diabetes, and may represent a novel marker of subclinical atherosclerosis in type 2 diabetes.

The use of cIMT as a predictor of postoperative stroke in patients undergoing surgical repair of acute type a aortic dissection

BackgroundAcute type A aortic dissection (ATAAD) is a life-threatening condition that requires surgical intervention. Stroke remains an extremely serious adverse outcome that can occur in ATAAD patients undergoing aortic arch repair, leading to higher rates of patient mortality and decreased postoperative quality of life. In the present study, we sought to determine whether carotid intima–media thickness (cIMT) is a reliable predictor of postoperative stroke risk.Materials and methodsThis was a prospective study of 76 patients with ATAAD undergoing aortic arch repair. For all patients, cIMT was determined preoperatively through a Doppler-based method. Incidence of different forms of neurological dysfunction, including temporary neurological dysfunction (TND) and stroke, was monitored in these patients, and the relationship between cIMT and stroke incidence was assessed using a receiver-operating characteristic (ROC) curve. Prognostic variables associated with stroke risk were further identified through univariate and multivariate analyses.ResultsA total of 26/76 (34.2%) patients in the present study suffered from neurological dysfunction, of whom 16 (21.0%) suffered from TND and 10 (13.2%) suffered a stroke. The remaining 50 patients (65.8%) did not suffer from neurological dysfunction. The cIMT values in the stroke, TND, and neurological dysfunction-free patients in this study were 1.12 ± 0.19 (mm), 0.99 ± 0.13 (mm), and 0.87 ± 0.13 (mm), respectively. A total of 4 patients in this cohort died during the study, including 1 in the TND group and 3 in the stroke group. An ROC curve analysis indicated that cIMT could predict stroke with an area under the curve value of 0.844 (95% CI, 0.719–0.969; p < 0.001). A multivariate analysis revealed that cIMT > 0.9 mm was independently associated with stroke risk (p = 0.018).ConclusionWe found that cIMT can be used to predict postoperative stroke risk in ATAAD patients undergoing aortic arch repair, with a cIMT > 0.9 mm coinciding with increased stroke risk in these patients.Trial registrationChiCTR1900022289. Date of registration 4 April 2019 retrospectively registered.

Increasing incidence of macular edema in excessive morning blood pressure surge in patients with retinal vein occlusion

Morning blood pressure surge (MBPS) had been known to be associated with hypertensive target organ injury and vascular events. Retinal vein occlusion (RVO) is also known to be related with underlying cardiovascular risk factors. This study investigated the effect of MBPS on patients with RVO. In total, 76 patients with RVO who had undergone systemic cardiovascular examination including a 24-hour ambulatory blood pressure monitoring, carotid artery intima media thickness, and pulse wave velocity were evaluated between January 2015 and February 2019. The MBPS was calculated as follows: mean systolic blood pressure measured over two hours after awakening minus mean systolic blood pressure measured during the one hour that included the lowest sleep blood pressure. Macular edema was significantly more prevalent in the MBPS group compared with the non-MBPS group. After adjusting for confounding factors, multivariate regression analyses revealed that MBPS independently predicted macular edema in patients with RVO [Odds ratio 4.75, 95% confidence interval 1.136–16.6, p = 0.015]. In conclusion, evaluating blood pressure patterns, especially MBPS, using 24-hour ambulatory blood pressure monitoring may be useful for assessing and predicting ophthalmologic outcome and may facilitate better blood pressure control in patients with RVO.