Common Carotid Artery Increased Intima-media Thickness Research Articles

Carotid Artery Doppler: A Possible Non-invasive Diagnostic Approach to Assessing the Severity of Coronary Artery Disease.

Carotid artery Doppler ultrasound is being explored for its potential as a non-invasive tool for evaluating coronary artery disease (CAD) severity and cardiovascular risk. This study aimed to investigate the association between carotid Doppler parameters and CAD severity, as determined by the Gensini score (GS) and multi-vessel disease presence. Ninety patients undergoing coronary angiography (CAG) and carotid ultrasound were retrospectively analysed. Carotid Doppler parameters and CAD severity were assessed through bivariate and multivariable analyses. Among the patients studied, 80% were male, with a mean age of 65.24 years (±9.91). Triple vessel disease (68.9%) and dominant vessel disease (73.3%) were prevalent coronary findings, with a mean GS of 139.2 (±76.6). Increased intima-media thickness (IMT) in the common carotid artery (CCA) and internal carotid artery (ICA) showed significant associations (CCA IMT: OR = 0.312, p = 0.037; ICA IMT: OR = 0.354, p = 0.017) with high GS (>125) and multi-vessel disease. Significant carotid stenosis (>50% diameter stenosis) emerged as an independent predictor of CAD severity. Fibrocalcific plaques, detected in 62.2% of cases, correlated significantly with elevated GS. Plaque burden, especially plaques in >3 locations, indicated a higher likelihood of triple vessel disease and a higher GS. Carotid Doppler parameters, particularly IMT and significant stenosis, are robust predictors of CAD severity, including high GS and multi-vessel disease. Integrating carotid artery assessment into clinical protocols can aid in timely interventions and preventive strategies for CAD management.

Assessment of carotid cross-sectional area in hypertensive patients: phenotyping and prognostic validation in The Campania Salute Network

Increased intima-media thickness (IMT) of common carotid artery (CA) is considered the hallmark of vascular hypertension-mediated target organ damage, even if vessel remodeling due to mechanical stress may also induce changes in diameter. We developed a method computing both diameter and IMT of CA, to assess correlates and prognostic impact of carotid cross-sectional area (CCSA) in a large registry of treated hypertensive patients. We selected 6300 hypertensive patients of the Campania Salute Network registry free of overt cardiovascular (CV) disease and with available CA ultrasound (54 ± 11 years; 57% male). CCSA was computed as:[Formula: see text]CCSA was considered high if >90th percentile of the sex-specific distribution (>48 mm2 in men and >41 mm2 in women). Patients with high CCSA were male, with older age, higher pulse pressure (PP), more prevalent obese and diabetic, with higher total and LDL cholesterol (p < 0.01 for all). During a median follow-up of 60 months (IQR 19-87), 206 incident composite major and minor CV events occurred. In Cox regression analysis high CCSA was associated with more than 100% increased risk of incident CV events ((HR 2.11, 95%CI 1.46-3.1, p < 0.0001), independently of the effect of older age, male sex, PP > 60 mmHg, presence of left ventricular hypertrophy (LVH), carotid plaque (CP), and less anti-RAS therapy (p < 0.05 for all). In treated hypertensive patients, increased CCSA is associated with worse metabolic and lipid profile and predict incident CV events, independently of high PP, presence of LVH and CP.

Performance Intima-Media Thickness of Carotid Artery and Flow Mediated Dilation of Brachial Artery for Assessing Atherosclerosis Progression

Material and methods: 90 men were studied with the range of ages of 40-60 years in three groups. Vascular ultrasongraphy was performed to analyze endothelium-dependent vascular dilation in the brachial artery and IMT in the common carotid artery. Results: Our study showed that first, there were significant differences in IMT and flow mediated dilation (FMD) among the three groups (p-value < 0.05). Second, there was significant negative correlation between FMD of the left brachial artery (LBA) and IMT of the left common carotid artery (LCCA) in mild stenosis and severe stenosis groups (R=-0.37; p-value < 0.05, R=-0.55; p-value < 0.05). Conclusions: This study showed that FMD on the LBA with accompaniment of IMT on the LCCA could be useful tools to evaluate atherosclerosis progression. © 2014 American Scientific Publishers All rights reserved. Introduction: Endothelial dysfunction and increased intima-media thickness (IMT) are early findings in the development of atherosclerosis that can be evaluated non-invasively by ultrasonography. The aim of this study was to investigate endothelial function and IMT, and the relation between these processes and atherosclerosis progression in three groups (control, mild stenosis and severe stenosis in the carotid artery).

Common carotid artery thickness in chronic kidney disease.

AIM: Previous studies showed that patients with chronic kidney disease (CKD) > 2 dergee had increased intima-media thickness (IMT). We evaluate the relationship between IMT and parameters for renal function. METHODS: 130 subjects were examined - 66 with CKD, 44 without CKD, as well as 20 healthy volunteers. The first group- patients with CKD were with creatinine clearance (CrCl) over 20 ml/min and below 90 ml/min. The second group included 44 pts. with normal renal function, CrCl > 90 ml/min. All examined patients with and without CKD had hypertension. The two groups were streamed into two subgroups: with and without vascular disease. To evaluate the renal function creatinine clearance was calculated in ml/min. IMT was measured in both common carotid artery (CCA) using high resolution sonography in all examined subjects. RESULTS: CCA IMT increased in pts. with CKD and was > 0.75 ( 0.76 ± 0.14 v.s contols 0.59 ± 0.10) Patients with vascular disease (VD) had higher IMT which increased significant when CKD with GFR < 90 ml/min was included (0.77 ± 0.06/0.81 ± 0.10, p < 0.05). Multiple regression analysis proved that renal function deterioration directly affected CCA IMT (R 2 =0.208, p=0.022). CONCLUSION: Increased IMT is presented in mild renal dysfunction. CKD -GFR< 90 ml/min could be an independent vascular risk factor.

Common Carotid Artery Thickness in Chronic Kidney Disease

AIM: Previous studies showed that patients with chronic kidney disease (CKD) &gt; 2 dergee had increased intima-media thickness (IMT). We evaluate the relationship between IMT and parameters for renal function.METHODS: 130 subjects were examined – 66 with CKD, 44 without CKD, as well as 20 healthy volunteers. The first group- patients with CKD were with creatinine clearance (CrCl) over 20 ml/min and below 90 ml/min. The second group included 44 pts. with normal renal function, CrCl &gt; 90 ml/min. All examined patients with and without CKD had hypertension.  The two groups were streamed into two subgroups: with and without vascular disease. To evaluate the renal function creatinine clearance was calculated in ml/min. IMT was measured in both common carotid artery (CCA) using high resolution sonography in all examined subjects.RESULTS: CCA IMT increased in pts. with CKD and was &gt; 0.75 ( 0.76 ± 0.14 v.s contols 0.59 ± 0.10) Patients with vascular disease (VD) had higher IMT which increased significant when CKD with GFR &lt; 90 ml/min was included (0.77 ± 0.06/0.81 ± 0.10, p &lt; 0.05). Multiple regression analysis proved that renal function deterioration directly affected CCA IMT (R2=0.208, p=0.022).CONCLUSION: Increased IMT is presented in mild renal dysfunction. CKD –GFR&lt; 90 ml/min could be an independent vascular risk factor.

Effects of long‐term antiepileptic drug monotherapy on vascular risk factors and atherosclerosis

Long-term therapy with antiepileptic drugs (AEDs) has been associated with metabolic consequences that lead to an increase in risk of atherosclerosis in patients with epilepsy. We compared the long-term effects of monotherapy using different categories of AEDs on markers of vascular risk and the atherosclerotic process. One hundred sixty adult patients who were receiving AED monotherapy, including two enzyme-inducers (carbamazepine, CBZ; and phenytoin, PHT), an enzyme-inhibitor (valproic acid, VPA), and a noninducer (lamotrigine, LTG) for more than 2 years, and 60 controls were enrolled in this study. All study participants received measurement of common carotid artery (CCA) intima media thickness (IMT) by B-mode ultrasonography to assess the extent of atherosclerosis. Other measurements included body mass index, and serum lipid profile or levels of total homocysteine (tHcy), folate, uric acid, fasting blood sugar, high sensitivity C-reactive protein (hs-CRP), or thiobarbituric acid reactive substances (TBARS). Long-term monotherapy with older-generation AEDs, including CBZ, PHT, and VPA, caused significantly increased CCA IMT in patients with epilepsy. After adjustment for the confounding effects of age and gender, the CCA IMT was found to be positively correlated with the duration of AED therapy. Patients with epilepsy who were taking enzyme-inducing AED monotherapy (CBZ, PHT) manifested disturbances of cholesterol, tHcy or folate metabolism, and elevation of the inflammation marker, hs-CRP. On the other hand, patients on enzyme-inhibiting AED monotherapy (VPA) exhibited an increase in the levels of uric acid and tHcy, and elevation of the oxidative marker, TBARS. However, no significant alterations in the markers of vascular risk or CCA IMT were observed in patients who received long-term LTG monotherapy. Patients with epilepsy who were receiving long-term monotherapy with CBZ, PHT, or VPA exhibited altered circulatory markers of vascular risk that may contribute to the acceleration of the atherosclerotic process, which is significantly associated the duration of AED monotherapy. This information offers a guide for the choice of drug in patients with epilepsy who require long-term AED therapy, particularly in aged and high-risk individuals.

Cardiorenal Risk Prevalence in Sickle Cell Hemoglobinopathy

Introduction: The spectrum of kidney functional and structural alterations in sickle cell hemoglobinopathy (SCH) is broad. Also, morbidity and mortality from end organ dysfunction, especially cardiorenal dysfunction, are substantial. Consequently, screening an SCH population prospectively for surrogate markers of cardiorenal risk such as albuminuria and intima-media thickness (IMT) was the aim of this cross-sectional study. Patients and Methods: We screened 165 patients with SCH over 4 months at the Primary Care Department, King Abdulaziz Armed Forces Hospital, Saudi Arabia. The 133 who fulfilled the inclusion criteria have been referred for further investigations. Anthropometric evaluation of body mass index (BMI) and blood pressure (BP), determination of 24-hour urine albuminuria, fasting lipids, computed atherogenic risk ratio (ARR), estimated glomerular filtration rate (eGFR), common carotid artery (CCA) IMT measurements, and hemoglobin (Hb) electrophoresis were done. Results: Increased urinary albumin excretion (UAE) rate [380 (272.2–489.6) mg/day; mean and 95% confidence interval (95% CI) of mean] was detected in 24% of SCH patients (6 males and 26 females). Microalbuminuria (168.8 ± 59.7 mg/day) was noted in the majority (63.6%) while macroalbuminuria (752.7 ± 205.4 mg/day) was detected in a smaller percentage (36.4%). Patients with sickle cell disease (SCD) contributed about 66.6% of subjects with microalbuminuria and 100% of those with macroalbuminuria, while most individuals with sickle cell trait (89%) were normoalbuminuric (p < 0.0001). Preclinical atherosclerosis (increased CCA IMT and/or atheromatous plaques) was noticed in 68.8% of SCH individuals with increased UAE (ANOVA p = 0.003). The microalbuminuric and macroalbuminuric patients had comparable BMI, BP values and lipid profiles. However, the microalbuminuric sicklers were significantly younger (28.4 ± 6.7 vs. 34.0 ± 7.2 years, p = 0.04), less anemic (Hb: 9.13 ± 2 vs. 7.47 ± 0.8 g/dl, p = 0.015), with lesser atherosclerosis (IMT; 0.68 ± 0.1 vs. 0.78 ± 0.1 mm, p = 0.004) and higher eGFR (83.3 ± 17.2 vs. 61 ± 10.7 ml/min/1.73 m², p = 0.0004) compared to those with macroalbuminuria. UAE correlated positively with age (r = 0.591, p = 0.0001), systolic BP (r = 0.483, p = 0.005), IMT (r = 0.399, p = 0.024) and negatively with Hb (r = –0.409, p = 0.02), and eGFR (r = –0.620, p = 0.0001). By univariate analysis, the significant indicators of UAE in SCH patients were age (p = 0.05), BMI (p = 0.041), IMT (p = 0.018) and eGFR (p = 0.016). Also, increased risk (odds ratio) of albuminuria was noted with SCD, age, anemia, abnormal eGFR, obesity, and ARR. Conclusions: Markers of cardiorenal risk such as albuminuria and IMT are common findings in SCH patients of Arabic descent and could be useful screening tools to identify sicklers at risk for cardiovascular and renal events.

Influence of haemodialysis on early markers of atherosclerosis

End-stage renal disease (ESRD) patients treated by haemodialysis (HD) have impaired endothelium-dependent vasodilatation and increased intima-media thickness (IMT) of the carotid artery The aim of the study was to analyse the relationships between parameters of chronic HD treatment and non-invasive assessments of preclinical atherosclerosis (endothelial dysfunction and carotid IMT) in ESRD patients on HD. Fifty-two (19 females, 33 males) adult patients on chronic maintenance (4.65 +/- 3.29 years) HD aged 59.88 +/- 15.49 years were investigated. Ultrasonographic studies were performed with a 7.5 MHz high-resolution probe. The common carotid artery IMT was measured. Brachial artery diameter was analysed to the rest. In order to assess flow-mediated dilatation (FMD), hyperaemia was induced by a pneumatic cuff, and an analysis of the diameter was performed 1, 2, 3 and 4 min after cuff deflation. Significant differences were found in the average carotid IMT value between subjects with delivered dialysis dose (Kt/V) > or =1.2 and <1.2 (0.89 +/- 0.21 vs 1.04 +/- 0.11, P = 0.0045). A correlation between Kt/V and IMT (r = 0.366, P = 0.004) was demonstrated. FMD values of the brachial artery did not correlate with Kt/V. A correlation between low molecular weight heparin per kg of body mass and maximal percent of FMD was demonstrated (r = -0.242, P = 0.049). The maximal percent of brachial FMD was correlated with absolute difference between pre- and postdialysis pulse pressure values (r = -0.265, P = 0.033). In a partial correlation with haemoglobin as control, a variable significant correlation between total erythropoietin dose and maximal carotid IMT (r = -0.262, P = 0.036) was found. In a multiple linear regression model, Kt/V was independently correlated with carotid IMT values (beta = -0.227, P = 0.0335). This study has demonstrated the association between HD procedure and early atherosclerosis markers. HD treatment has to be considered as potential modifying factor in atherosclerosis development.

Plasma levels of adiponectin and soluble thrombomodulin in hypothyroid patients with normal thyroid function following levothyroxine replacement therapy

Hypothyroidism is associated with increased morbidity from cardiovascular disease, and adiponectin (ApN) is a newly-identified adipocytokine, which is expressed in human adipose cells and may have a protective effect against the development of coronary artery disease. The aim of the study was to evaluate the involvement of ApN secretion in hypothyroid patients with normal thyroid function following levothyroxine (L-T 4) replacement therapy, and to associate plasma ApN levels with intima-media thickness (IMT) in the common carotid artery (CCA), an indicator of early atherosclerosis, and cardiovascular parameters including soluble thrombomodulin (sTM), a plasma endothelial injury marker. The CCA IMT and plasma levels of ApN and sTM were measured in 52 hypothyroid patients and in age-, sex- and body mass index (BMI)-matched normal control subjects. Thirty-six of the hypothyroid patients were further monitored for changes in these markers during 1 year in a euthyroid state induced by L-T 4 replacement therapy. Although the basal CCA IMT was significantly higher in hypothyroid patients [0.633 ± 0.018 mm (mean ± S.E.)] than in control subjects (0.552 ± 0.022 mm, P < 0.005), both groups had similar baseline ApN and sTM levels [10.23 ± 0.76 vs. 10.10 ± 0.93 μg/ml: NS; and 2.58 ± 0.14 vs. 2.68 ± 0.20 ng/ml: NS, respectively]. Simple regression analysis revealed that plasma ApN was significantly correlated in a positive manner with age ( r = 0.339, P = 0.015), HDL-cholesterol ( r = 0.295, P = 0.048), and sTM ( r = 0.490, P = 0.0005), but not with CCA IMT ( r = 0.059, P = 0.742). In multivariate analysis, the plasma ApN level was significantly associated with that of sTM ( r = 0.546, P = 0.0001) and with serum high-density lipoprotein (HDL)-cholesterol levels ( r = 0.291, P = 0.029) in hypothyroid patients. During 1 year of L-T 4 replacement therapy, hypothyroid patients showed a significant decrease in CCA IMT, to 0.553 ± 0.016 mm ( P < 0.0001), a level comparable to normal controls, but no significant change in ApN (from 10.79 ± 1.07 to 10.69 ± 1.14 μg/ml, NS) or sTM (from 2.59 ± 0.15 to 2.74 ± 0.18 ng/ml, NS). Hence, we provide evidence that ApN and sTM might not contribute to enhanced atherosclerosis, as reflected by increased CCA IMT in hypothyroid patients. However, this is the first report to demonstrate a positive and significant association of sTM with ApN. These data support the hypothesis that sTM is one of the determinant of ApN and thus suggest the presence of an sTM-associated regulatory mechanism for ApN secretion in hypothyroid patients.

Carotid atherosclerosis is correlated with extent and severity of coronary artery disease evaluated by myocardial perfusion scintigraphy.

Increased intima-media thickness (IMT) in the common carotid artery (CCA) correlates with conventional risk factors for cardiovascular disease and is an independent predictor of cardiac events. However, correlation between IMT and degree of ischemic heart disease evaluated by coronary angiogram is weak. The purpose of this study was to investigate the relationship between measures of carotid atherosclerosis and the extent and severity of coronary artery disease (CAD) in 111 consecutive patients (60 men and 51 women, mean age 60 years) with known or suspected CAD who were investigated with adenosine-stress myocardial perfusion scintigraphy. Common carotid artery lumen diameter (LD) and IMT of the carotid bulb and distal CCA were measured with ultrasound, and CCA cross-sectional intima-media area (CIMA) was calculated. Seventy-two of 110 patients (65%) had significant perfusion defects. Increasing carotid plaque occurrence (absence, unilateral or bilateral occurrence) correlated with more advanced CAD (p<0.01). The extent and severity of myocardial hypoperfusion correlated significantly with presence of carotid plaque (r=0.23 and 0.24 respectively, p<0.05), CIMA (r=0.23 and 0.22, p<0.05), and LD (r<0.26 and 0.25, p<0.01) but not with IMT. In contrast to CIMA, LD failed to show an independent relation to extent of CAD after adjustment for age, sex, and body mass index. In conclusion, in subjects with intermediate to high risk of ischemic heart disease, occurrence of carotid plaques and increased cross-sectional intimamedia area in the common carotid artery are the best parameters for predicting CAD expressed as myocardial hypoperfusion.

Inflammation and bone resorption as independent factors of accelerated arterial wall thickening in patients with rheumatoid arthritis.

We recently reported that rheumatoid arthritis (RA) patients had increased intima-media thickness (IMT) of the common carotid artery (CCA). The present longitudinal study was performed to determine whether the change in arterial thickness was accelerated in RA patients and to determine which factor was important in the progression of arterial wall changes. We studied 62 female RA patients with stable disease activity and 63 healthy female controls. IMT of the CCA was measured twice by high-resolution B-mode ultrasonography. The second examination was performed 18-36 months after the first, and changes were expressed as millimeters of increase per year. Baseline examinations included blood markers of inflammation and urinary calcium excretion (expressed as the calcium-to-creatinine ratio). RA patients showed a significantly greater increase in IMT of the CCA compared with controls. In univariate analyses of the RA patient data, the C-reactive protein (CRP) level correlated with the increase in CCA IMT. Other markers of inflammation (the erythrocyte sedimentation rate and white blood cell and platelet counts) also showed significant positive associations with the annual increase in CCA IMT in multiple regression models when adjusted for age, smoking status, blood pressure, and serum cholesterol level. The urinary calcium-to-creatinine ratio was also significantly associated with an increase in CCA IMT. Moreover, both the CRP level and the urinary calcium-to-creatinine ratio were significantly and independently associated with the increase in IMT of the CCA. Patients with RA have a higher rate of increase in thickening of the arterial wall. Inflammation and calcium mobilization are factors closely associated with the accelerated arterial wall changes.

Promoter polymorphism in the endotoxin receptor (CD14) is associated with increased carotid atherosclerosis only in smokers: the Carotid Atherosclerosis Progression Study (CAPS).

The risk of atherosclerosis from endotoxemia is increased in smokers. Endotoxin is a potent mediator of inflammation, and smokers have elevated plasma levels of endotoxin. The endotoxin receptor CD14 can enhance the endotoxin-neutralization capacity of plasma. A functional polymorphism in the promoter region of the CD14 gene (CD14 -159C/T) was studied to determine its impact on common carotid artery (CCA) intima-media thickness (IMT) and any interactions with environmental inflammatory stimuli. A community population (n=992; aged 50 to 65 years) underwent genotypic examination for the CD14 -159 polymorphism by restriction fragment length polymorphism analysis. The CC genotype was associated with increased CCA IMT. The age- and sex-adjusted odds ratio for IMT above the 75th percentile was 1.63 (95% CI, 1.19 to 2.24; P=0.002) and 1.70 (95% CI, 1.18 to 2.44; P=0.004) after additional adjustment for conventional risk factors. This gene effect was found only in current smokers and ex-smokers. Multivariate analysis in this group (n=503) increased the odds ratio to 2.02 (95% CI, 1.23 to 3.34; P=0.006). No significant interactions were found in nonsmokers or with alcohol consumption. The CD14 -159 polymorphism is associated with increased CCA IMT in smokers from a general population. CD14 may modulate the inflammatory effects of smoking in atherogenesis.

Microalbuminuria and carotid artery intima-media thickness in nondiabetic and NIDDM subjects. The Insulin Resistance Atherosclerosis Study (IRAS).

Microalbuminuria is associated with cardiovascular mortality in subjects with non-insulin-dependent diabetes mellitus (NIDDM). However, little is known about this association in nondiabetic subjects. Specifically, it is not known whether microalbuminuria is related to an early stage of atherosclerosis manifested as increased intima-media thickness (IMT) of carotid arteries. We investigated the relationship between microalbuminuria and carotid artery IMT in 991 nondiabetic and 450 NIDDM subjects aged 40 to 69 years. Microalbuminuria was defined as albumin-to-creatinine ratio > or = 2 mg/mmol in a morning spot urine sample. B-mode ultrasound was used to assess the IMT of the common and internal carotid arteries. Altogether 13.9% of nondiabetic and 27.6% of NIDDM subjects had microalbuminuria, and 31.1% of nondiabetic and 50.8% of NIDDM subjects had hypertension. Subjects with microalbuminuria had greater common carotid artery (CCA) IMT than those without microalbuminuria (nondiabetic: 0.84 +/- 0.02 versus 0.80 +/- 0.01 mm, P = .010; NIDDM: 0.89 +/- 0.02 versus 0.86 +/- 0.01 mm, P = .152; combined: 0.86 +/- 0.01 versus 0.82 +/- 0.01, P = .005). The association of microalbuminuria and CCA IMT was independent of age, sex, ethnicity, smoking, and lipoprotein levels. Although further adjustment for hypertension in the multivariate linear regression analysis attenuated the difference in CCA IMT between subjects with and without microalbuminuria, this difference continued to be significant (combined: 0.86 +/- 0.01 versus 0.83 +/- 0.01, P = .015). In contrast to CCA IMT, microalbuminuria was not related to ICA IMT. Microalbuminuria was associated with increased CCA IMT. This relationship was only partly mediated by hypertension. Thus, microalbuminuria is related to atherosclerosis at an early stage of the disease process.