Change In Common Carotid Intima-media Thickness Research Articles

O3.01 * PROGRESSION OF CAROTID INTIMA MEDIA THICKNESS AFTER RADIOTHERAPY: A PROSPECTIVE COHORT STUDY

INTRODUCTION: Carotid artery vasculopathy is a long-term complication of radiotherapy (RT) of the neck with an increased risk of cerebrovascular events. We investigated the change in carotid Intima Media Thickness (IMT) and the incidence of ischemic stroke in the first 7 years after RT. METHODS: We conducted a multicentre prospective cohort study among patients treated for Head and Neck Cancer (HNC). We assessed carotid Intima Media Thickness at baseline before and after RT with a median follow-up of 7 years. We also assessed cerebrovascular risk factors and incident vascular events. RESULTS: 48 HNC patients underwent IMT measurement at baseline and follow-up (median age 61 years, range 29-87). Mean IMT of the irradiated common carotid arteries was 0.64 mm at baseline and 0.74mm at follow-up (p = 0.002 for change). Mean delta IMT in the irradiated versus non-irradiated common carotid arteries was 0.11 and 0.02 mm (p = 0.03 for difference), respectively. In a subgroup of unilaterally irradiated patients mean change in common carotid IMT from baseline to follow-up was 0.06 mm in the irradiated artery and 0.02 mm in the non-irradiated artery (p = 0.18 for difference). Within a mean follow-up of 3 years after radiotherapy 10 patients had an ischemic event. In these patients mean common carotid IMT increase was 0.08 mm. CONCLUSION: Our study showed an increase in IMT in irradiated carotid arteries in the first 7 years after treatment of HNC, which was significantly larger than in non-irradiated arteries. Patients treated with RT for HNC have a high risk of future stroke. This knowledge needs to be used to improve diagnostic and preventive strategies.

Abstract P445: A Randomized Controlled Trial Of A Cardiovascular Fixed-dose Combination Pill (polypill) Treatment Strategy Compared With Usual Care On Carotid Intima Media Thickness Progression In Individuals At High Risk Of Cardiovascular Disease

Aim: The use of fixed-dose combination (FDC) pills, frequently called polypills, containing aspirin, a statin and blood pressure (BP) lowering medication may improve medication adherence and consequently reduce cardiovascular risk. Carotid intima-media thickness (CIMT) and CIMT progression have been used as surrogate measures of cardiovascular risk. This study evaluated the effect of a polypill-based treatment strategy compared to usual care on CIMT progression. Methods: A study nested within the UMPIRE trial was performed to assess whether a polypill-based treatment strategy reduces CIMT progression compared to usual care. The study was a randomized, open label, blinded endpoint clinical trial in participants with established cardiovascular disease or at equivalent high risk (estimated five year cardiovascular risk of ≥15%). Two versions of the polypill were available. These contained aspirin 75 mg, simvastatin 40 mg, lisinopril 10 mg and either atenolol 50 mg or hydrochlorothiazide. The choices of polypill version and the components of usual care were made at the discretion of the physician. (http://clinicaltrials.gov/show/NCT01326676). Results: In total 296 participants in the polypill group and 290 participants in the usual care group had both a baseline and follow-up CIMT scan. Allocation to a polypill compared to usual care resulted in similar levels of low-density lipoprotein (LDL)-cholesterol (mean difference: 0.0 mmol/L; 95%-confidence interval (CI): -0.1 to 0.1; p=0.41) and systolic BP (mean difference -1.7 mmHg; 95%-CI:-4.5 to 1.1; p=0.23) after a median follow-up duration of 1.00 year [IQR: 0.93 to 1.04 year]. The annualized rate of change in common CIMT in the polypill-based treatment strategy group (6.56 μm/year; standard error (SE): 4.76 μm/year) did not differ significantly from the rate of change in the usual care group (10.72 μm/year; SE: 4.76 μm/year; mean difference: -4.2 μm/year; 95%-CI: -17.0 to 8.7; p=0.53). Conclusion: This study demonstrated that a polypill-based cardiovascular treatment strategy compared to usual care did not reduce the rate of progression of common CIMT during a one year follow-up interval in a well-treated population with cardiovascular disease. Importantly, CIMT progression was not adversely effected by the polypill-based treatment strategy.

Whole soy, but not purified daidzein, had a favorable effect on improvement of cardiovascular risks: A 6‐month randomized, double‐blind, and placebo‐controlled trial in equol‐producing postmenopausal women

Equol is produced by the intestinal bacteria from isoflavone daidzein. Studies have reported the health benefits of soy can only present or more pronounced in equol producers. This 6-month randomized controlled trial examined the effect of whole soy (soy flour) and purified daidzein on cardiovascular biomarkers and carotid intima-media thickness (CIMT) in prehypertensive postmenopausal women who were equol producers. Two hundred seventy eligible women were randomized to either one of the three treatments: 40 g soy flour (whole soy group), 40 g low-fat milk powder + 63mg daidzein (daidzein group), or 40 g low-fat milk powder (placebo group) daily each for 6 months. Fasting venous samples were obtained at baseline and end of trial for testing glucose, lipids, high sensitivity C-reactive protein (hs-CRP), and free fatty acid. Changes in common CIMT were also assessed. Serum LDL-C decreased by 7.95% (95% CI: -15.09∼-0.81%) and 6.32% (95% CI: -13.45∼0.08%), and serum hs-CRP decreased by 0.164 (95% CI: -0.309∼-0.019) and 0.054 (95% CI: -0.199∼0.012) in the whole soy group compared with daidzein and milk placebo groups, respectively. No significant change in CIMT was found. Whole soy, but not purified daidzein, had a beneficial effect on reduction of LDL-C and hs-CRP among prehypertensive equol-producing postmenopausal women.

Manual or semi‐automated edge detection of the maximal far wall common carotid intima–media thickness: a direct comparison

Automated edge detection is thought to be superior to manual edge detection in quantification of the far wall common carotid intima-media thickness (CIMT), yet published evidence making a direct comparison is not available. Data were used from the METEOR study, a randomized placebo-controlled trial among 984 individuals showing that rosuvastatin attenuated the rate of change of 2 year change in CIMT among low-risk individuals with subclinical atherosclerosis. For this post hoc analysis, CIMT images of the far wall of the common carotid artery were evaluated using manual and semi-automated edge detection and reproducibility, relation to cardiovascular risk factors, rates of change over time and effects of lipid-lowering therapy were assessed. Reproducibility was high for both reading methods. Direction, magnitude and statistical significance of risk factor relations were similar across methods. Rate of change in CIMT in participants assigned to placebo was 0.0066 mm per year (SE: 0.0027) for manually and 0.0072 mm per year (SE: 0.0029) for semi-automatically read images. The effect of lipid-lowering therapy on CIMT changes was -0.0103 mm per year (SE: 0.0032) for manual reading and -0.0111 mm per year (SE: 0.0034) for semi-automated reading. Manual and semi-automated readings of the maximal far wall of the common CIMT images both result in high reproducibility, show similar risk factor relations, rates of change and treatment effects. Hence, choices between semi-automated and manual reading software for CIMT studies likely should be based on logistical and cost considerations rather than differences in expected data quality when the choice is made to use far wall common CIMT measurements.

Effect of 3 y of folic acid supplementation on the progression of carotid intima-media thickness and carotid arterial stiffness in older adults

Observational studies have shown that low folate and elevated homocysteine concentrations are risk factors for vascular disease in the general population. Randomized controlled trials in vascular patients have failed to show that folic acid reduces the risk of recurrent vascular disease, whereas such trials are lacking in the general population. The objective was to determine whether folic acid supplementation reduces the progression of atherosclerosis as measured by common carotid intima-media thickness (CIMT)-a validated marker of atherosclerosis and predictor of vascular disease risk. A randomized, double-blind, placebo-controlled study in 819 men and postmenopausal women aged 50-70 y, free-living in the Netherlands, and with a total homocysteine concentration ≥13 μmol/L at screening was conducted. Participants received either 800 μg folic acid or placebo daily for 3 y. Rate of change in CIMT and arterial distensibility were the primary and secondary outcomes, respectively. Compared with placebo, serum folate increased by 577% and plasma total homocysteine concentrations decreased by 26% after 3 y of folic acid supplementation. The mean (±SE) rate of change in CIMT was 1.9 ± 0.9 μm/y in the folic acid arm and 1.3 ± 0.8 μm/y in the placebo arm (mean difference: 0.7 μm/y; 95% CI: -1.8, 3.1 μm/y; P = 0.59). No difference was observed (P = 0.23) between the rates of change in distensibility in the folic acid arm (-0.53 ± 0.06 × 10(-3) kPa(-1)) and in the placebo arm (-0.62 ± 0.06 × 10(-3) kPa(-1)). Despite a considerable increase in folate concentrations and a reduction in total homocysteine concentrations, 3-y folic acid supplementation did not slow down atherosclerotic progression or arterial stiffening. This trial was registered at clinicaltrials.gov as NCT00110604.

Subclinical impairment of coronary flow velocity reserve assessed by transthoracic echocardiography in young renal transplant recipients

Background In renal transplant recipients (RTR) an increased risk to develop cardiovascular injury is present. Transthoracic Doppler echocardiographic assessment of coronary flow velocity reserve (CFVR), a sensitive and minimally invasive technique, was recently employed to detect both macrovascular and microvascular coronary artery disease (CAD) in different clinical settings. The prevalence of coronary involvement in young adult RTR is still unknown. The aim of the study was to investigate the presence of early cardiovascular damage in asymptomatic young adult RTR. Methods Transthoracic Doppler echocardiographic-derived CFVR and common carotid intima-media thickness (IMT) were assessed in 25 asymptomatic young adult RTR (mean age 25.7 ± 7.0 years; range 17.3–43.9) without CAD and 25 healthy controls. Results CFVR was lower in young adult RTR compared to controls (2.8 ± 0.6 vs. 3.5 ± 0.8; P < 0.001), meanwhile left ventricular wall motion and common carotid IMT were comparable in both groups. We found a negative correlation between CFVR and age ( r = −0.50; P = 0.018) and months on dialysis ( r = −0.54; P < 0.01). Conclusions Young adult RTR showed a reduced CFVR reflecting an impaired coronary microcirculation, which is significantly related to the age and duration of dialysis; coronary microvascular damage is detectable in the absence of changes in common carotid IMT. Non-invasive evaluation of CFVR by transthoracic stress echocardiography could be a reliable method for identification of early coronary microvascular involvement in young adult RTR.

Metformin attenuates progression of carotid arterial wall thickness in patients with type 2 diabetes

To investigate the anti-atherogenic effect of metformin, we prospectively evaluated the effect of metformin treatment on common carotid intima-media thickness (CCA-IMT) in patients with type 2 diabetes. A 2-year open prospective study was performed. Thirty-six patients were treated with metformin (500–750mg per day). CCA-IMT was measured after 1- and 2-year treatment. Changes in CCA-IMT were compared with control patients.After 2-year metformin therapy, the progression of CCA-IMT was significantly less than 56 control patients (0.02±0.08mm versus 0.07±0.08mm, P<0.01). Metformin therapy did not alter body weight, blood pressure, HbA1c, and serum lipids relative to the control.Thus, metformin attenuates the progression of CCA-IMT. This anti-atherogenic effect is not mediated through changes in classical cardiovascular risk factors.

Correlations between measures of atherosclerosis change using carotid ultrasonography and coronary angiography

Few studies have examined the correlation between change in carotid artery intima-media thickness (IMT) and change in coronary artery disease. In the Cholesterol Lowering Atherosclerosis Study, current nonsmoking men with coronary artery disease were randomized to colestipol-niacin or placebo. Among 133 subjects with baseline and on-trial coronary angiography and carotid ultrasonography, colestipol-niacin treatment significantly reduced progression of atherosclerosis by both end point measures (2-year average change in percent diameter stenosis by coronary angiography and rate of change in carotid IMT). Significant correlations between change in common carotid artery IMT and quantitative coronary angiographic measures of change were evident over all coronary artery lesions, and in mild/moderate (<50% diameter stenosis), but not severe (≥50% diameter stenosis) coronary artery lesions. In mild/moderate lesions, correlations with change in common carotid IMT were: percent diameter stenosis ( r=0.28, P=0.002), minimum lumen diameter ( r=−0.28, P=0.002), and vessel edge roughness ( r=0.25, P=0.003). While measures obtained by carotid ultrasonography and coronary angiography are correlated, they each assess different aspects of atherosclerosis change.