Common Carotid Artery Intima-media Thickness Research Articles

Common carotid artery intima media thickness (CIMT) in patients with prediabetes and newly diagnosed type 2 diabetes mellitus

AimTo evaluate the relationship between common carotid artery intima media thickness (CIMT) in patients with prediabetes and new-onset diabetes mellitus without proven cardiovascular disease and some classic cardio-metabolic risk factors. Patients and methodsThe study included 461 obese patients with an average age of 53.2 ± 10.7 years, divided into three groups - group 1 without carbohydrate disturbances (n = 182), group 2 with prediabetes (n = 193) and group 3 with newly diagnosed diabetes mellitus (n = 86). ResultsThe patients with new-onset diabetes had significantly higher mean CIMT values compared to those with prediabetes or without carbohydrate disturbances and a higher frequency of abnormal IMT values. CIMT correlated significantly with age, systolic BP, diastolic BP and fasting blood glucose and showed a high predictive value for the presence of diabetic neuropathy and sudomotor dysfunction. Patients with abnormal CIMT values had a higher incidence of arterial hypertension, dyslipidemia, metabolic syndrome, peripheral neuropathy, and sudomotor dysfunction. Patients who developed type 2 diabetes during follow-up had a significantly higher initial mean CIMT, which showed the highest predictive value for the risk of new-onset diabetes, with CIMT≥0.7 mm having 53 % sensitivity and 83 % specificity for the risk of progression to diabetes mellitus. ConclusionPatients with new-onset diabetes mellitus had significantly greater intima media thickness of the common carotid artery and a greater frequency of abnormal CIMT values compared to those with normoglycemia and prediabetes. CIMT has a high predictive value for the presence of diabetic neuropathy, sudomotor dysfunction and the risk of new onset diabetes.

Risk factors for ischemic stroke in China: a case-control study

Background Stroke is a primary cause of disability and death in adults worldwide. This study aimed to determine whether uric acid (UA), total bilirubin (TBIL), serum creatinine (Scr), homocysteine (Hcy), platelet large cell ratio (P-LCR), mean platelet volume (MPV), red blood cell volume distribution width (RDW), and common carotid artery intima-media thickness (CCA-IMT) were risk factors for ischemic stroke and whether there were sex differences in their associations. Methods This was a case-control study, and all data were collected from the medical records at Fuzhou First People’s Hospital of Jiangxi Province, China. The case group consisted of 400 patients treated for ischemic stroke at the Neurology Department, Fuzhou First People’s Hospital from January 2017 to June 2023. The control group included 200 patients with non-ischemic stroke in the same period and at the same hospital. In this study, clinical history, physical examination, and biochemical indices such as UA, TBIL, Scr, Hcy, P-LCR, MPV, and RDW were obtained from the patients’ medical records. Craniocerebral imaging was performed using magnetic resonance imaging (MRI) or computerized tomography (CT). CCA-IMT was measured using ultrasonography of the carotid arteries. Results In the multivariate binary logistic regression analysis, Hcy, FBS, right CCA-IMT and Hypertension were associated with ischemic stroke (p<0.001). The odds of ischemic stroke increased with Hcy (adjusted OR=1.217, 95% CI=1.129-1.311, p<0.001), fasting blood sugar (FBS) (adjusted OR=1.313, 95%CI=1.169-1.475, p<0.001), and right CCA-IMT (adjusted OR=45.273, 95%CI=6.693-306.232, p<0.001). Hypertensive persons had a higher possibility of ischemic stroke than persons without hypertension (adjusted OR=3.161, 95%CI=2.086-4.790, p<0.001). Conclusions Hcy, FBS, right CCA-IMT, and hypertension are independent risk factors for ischemic stroke in China. There was no association between TBIL, Scr, P-LCR, MPV, RDW, and the incidence of ischemic stroke. There was no sex difference in the association between Hcy, TBIL, Scr, P-LCR, and the incidence of ischemic stroke.

Early Atherosclerosis in Familial Hypercholesterolemia Patients: Significance of Vascular Markers for Risk Stratification.

Familial hypercholesterolemia (FH) is a genetic disorder that manifests as impaired low-density lipoprotein cholesterol (LDL-C) metabolism, resulting in lifelong exposure to high cholesterol levels and increased risk of cardiovascular disease (CVD). There is heterogeneity in cardiovascular risk for FH patients, so risk stratification is of utmost importance. The aim of this study was to evaluate the impact of increases in LDL-C and the impact of other CVD risk factors on vascular markers in the FH patient population. A total of 428 patients were included in this study and divided into two groups according to age: ≤40 years in the first group and ≥41 years in the second group. Vascular markers of atherosclerosis included the common carotid artery (CCA) intima-media thickness (IMT), pulse wave velocity (PWV), flow-mediated dilation (FMD), ankle-brachial index (ABI), and cardio-vascular index (CAVI). The influence of traditional CVD risk factors on atherosclerotic changes in vascular markers was analyzed. A statistically significant difference in IMT was detected between the same sex and different age groups (p < 0.001), whereas no significant difference was detected between the sexes within each age group. In the ≤40-year-old group, the mean IMT among males was 612.5 μm (±88.2) and that among females was 580.6 μm (±77.7) (p > 0.05); in the ≥41-year-old group, the mean IMT was 697.4 μm (±138.4) for males and 700.3 μm (±114.4) for females (p > 0.05). Higher LDL-C was associated with greater IMT (r = 0.405; p = 0.009) in the younger age group (≤40 years); however, in the older age group (≥41 years), this correlation was not evident (r = -0.07; p = 0.596). Carotid plaque formation was more common among males (OR = 2.2; 95% CI: 1.2-4.0) and hypertensive patients (OR = 2.7; 95% CI: 1.6-4.7). Age was a mildly significant risk factor for increased ABI (β = 0.13, p < 0.05). FMD was found to be impaired for all patients, and no risk factors were shown to have further influence. Age was a significant risk factor for increased arterial stiffness, as measured by both the CAVI and PWV. Although vascular markers of atherosclerosis may provide a unique and valuable way to evaluate cardiovascular risk, the results of this study show that only increased IM thickness could be beneficial for risk stratification in young FH patients, whereas other vascular markers of atherosclerosis would be excessive, as they do not provide merit in risk evaluation in this population.

Correlation Between Common Carotid Artery Intima-Media Thickness and Lumbosacral Intervertebral Disc Degeneration

Background: Lumbosacral intervertebral disc degeneration (IDD) is a common cause of low back pain and has recently been attributed to ischemic causes. Magnetic resonance imaging (MRI) can accurately assess the presence and degree of IDD, while the common carotid artery (CCA) intima-media thickness (IMT) measured on ultrasound (US) has been accepted as a reliable imaging marker for the presence of atherosclerosis. Aim of the Study: To assess the association between CCA-IMT with the presence and grade of lumbosacral IVD as evident on MRI in patients with LBP. Patient and Methods: This cross-sectional study was done on 200 patients with LBP (115 females and 85 males) referred for lumbosacral spinal MRI at the MRI unit in AL-Sader Medical City for eight months duration. MRI examination involved L1/L2 ,L2/L3,L3/4 ,L4/L5 \&amp; L5/S1 intervertebral discs levels. Patients with a history of lumbosacral surgery, trauma, or tumor were excluded. CCA-IMT was measured using a B-mode US scan, while the degree of IDD was assessed on MRI using I-V Pfirrmann's grading system. Results: Older age, male gender, higher body mass index, presence of cardiovascular comorbidities, and specific occupations were associated with a higher grade of IDD. However, the mean CCA-IMT was independently associated with the advancing grade of IDD at all levels with a statistically significant difference (P&lt;0.001). A significantly larger mean CCA-IMT was found in relation to grade V (0.946 ±0.28), and the lowest mean was found in those with grade I (0.468 ±0.1). The grading of IDD was fair in the prediction of thicker CCA-IMT. Conclusion: IDD was directly correlated with CCA-IMT, and patients with higher grades of IDC tend to have thicker mean CCA-IMT. IDD may be a manifestation or predictor of atherosclerosis. However, future long-term cohort studies to assess causal association are recommended.

Dependence of local carotid arterial stiffness on the presence of atherosclerotic plaque in the carotid basin in hypertensive patients

Aim. To evaluate the viscoelastic properties of the common carotid arteries (CCA) in patients with stage II hypertension (HTN) and to compare these indicators between groups with and without carotid artery (CA) stenosis &lt;50 %. Materials and methods. The study included 48 patients with stage II HTN, mean age – 55.9 years, 45.8 % men. Basic anthropometric data, laboratory parameters of lipid and carbohydrate metabolism, creatinine, quality intima-media thickness (QIMT), local stiffness indicators: artery diameter, distensibility, distensibility coefficient (DC), compliance coefficient (CC), stiffness indices α, β, local pulse wave velocity (PWV), pressure and augmentation index (using RF-QIMT, RF-QAS technologies) were studied. Statistical analysis was performed, p values of &lt; 0.05 were considered statistically significant. Results. CA atheromas with stenosis up to 50 % were found in 48 % of the examined, they were older with higher parameters of vessel diameter by 4.6 %, QIMT – by 12.5 %, α index – by 28.0 %, β index – by 27.7 %, and PWV – by 14.7 %. A medium-strength positive correlation has been revealed for age, QIMT, HDL, creatinine level and local stiffness parameters (distensibility, CC, PWV, indices α, β). The atherosclerotic plaque (ASP) presence in the CA was associated with the limit levels of the left CCA QIMT over 698 μm (sensitivity 65.2 %, specificity 86.6 %, p &lt; 0.01), of the right – over 598 μm (sensitivity 73.9 %, specificity 66.6 %, p &lt; 0.01). However, a greater dependence on age than on the presence of atheroma has been proven. At the same time, the odds ratio of the ASP presence was 2.99-fold higher (p = 0.0065) with an increase in the CCA diameter of more than 7.94 mm, and in the multivariate model incorporating age – 2.6-fold higher (p = 0.036), while age has not impacted significantly (p = 0.301) the prognosis. Conclusions. In individuals with stage II HTN, the presence of CA atherosclerosis with stenosis up to 50 % is associated with a significant increase in vessel diameter regardless of age. CCA intima media thickness depends more on the age of hypertensive patients.

Evaluation of atherosclerosis as a risk factor in COPD patients by measuring the carotid intima-media thickness

BackgroundThis study aimed to evaluate atherosclerosis as comorbidity by measuring the carotid (bulb and common carotid artery) Carotid intima-media thickness in COPD-diagnosed patients and to evaluate the relationship of atherosclerosis with the prevalence of COPD, hypoxemia and hypercapnia.MethodsThis study was conducted out between January 2019-December 2019 consisting of a total of 140 participants (70 COPD-diagnosed patients-70 healthy individuals). The COPD-diagnosed patients have been planned according to the selection and diagnosis criteria as per the GOLD 2019 guide. It is planned to evaluate as per prospective matching case-control study of the carotid thickness, radial gas analysis, spirometric and demographic characteristics of COPD diagnosed patients and healthy individuals.ResultsThe average Carotid intima-media thickness in COPD patients was 0.8746±0.161 (p<0.05), and the thickness of the carotid bulb was 1.04±0.150 (p<0.05). In the control group, the average CCA intima-media thickness was 0.6650±0.139 (p<0.05), and the thickness of the carotid bulb was 0.8250±0.15(p<0.05) For the carotid thickness that has increased in COPD diagnosed patients a significant relationship is determined between hypoxemia (p<0.05) and hypercapnia(p<0.05). A significant relationship determined between CIMT and severity of COPD (p<0.05) The CIMT was high in COPD patients with hypoxemia and hypercapnia(p<0.05).ConclusionSignificant difference was determined between the severity (grades) of COPD (mild, moderate, severe, very severe) in carotid thickness. Also, CIMT was found to be high in patients who is in the early phases of the prevalence of COPD. In COPD-diagnosed patients, it was determined that severity of COPD, hypoxemia, hypercapnia and age were determining factors of atherosclerosis.Graphical

High-density lipoprotein cholesterol subfraction HDL2 is associated with improved endothelial function in systemic lupus erythematosus.

Patients with systemic lupus erythematosus (SLE) have increased risk of premature atherosclerosis but the exact mechanisms remains unclear. Flow-mediated dilatation (FMD) is an established non-invasive assessment of vascular endothelial function. Lipoprotein subfractions may be better predictors of FMD than conventional cholesterol measurements. We tested the hypothesis that lipoprotein subfractions are independently associated with FMD. Forty-one consecutive adult patients with SLE without known cardiovascular risk factors or disease were recruited in this cross-sectional study. Endothelial function and early atherosclerosis were assessed by brachial FMD and common carotid artery (CCA) intima-media thickness (IMT). High-density lipoprotein (HDL)/low-density lipoprotein (LDL) subfractions were measured. Machine learning models were also constructed to predict FMD and CCA IMT. Median FMD was 4.48% (IQR 5.00%) while median IMT was 0.54 mm (IQR 0.12 mm). Univariate analysis showed lower LDL1 (r=-0.313, p<0.05) and higher HDL2 subfractions (r=0.313, p<0.05) were significantly associated with higher log-transformed FMD. In a multiple linear regression model, HDL2 (β=0.024, SE=0.012, p<0.05) remained an independent predictor of higher FMD after adjusting for age, body mass index, LDL1 and systolic blood pressure. The machine learning model included parameters such as HDL2 (positive association), prednisolone dose, LDL cholesterol and LDL1 for prediction of FMD (r=0.433, p<0.01). Age, LDL cholesterol and systolic blood pressure were independently associated with higher CCA IMT after adjusting for body mass index and HDL2. HDL 2, a large HDL particle, was independently associated with greater FMD and may be a biomarker of vascular health in SLE.

Albumin-Globulin Ratio and Common Carotid Artery Intima-Media Thickness in Patients with Ischemic Stroke

Background: The relationships between serum albumin, albumin-globulin (A/G) ratio, globulin and atherosclerosis in acute ischemic stroke (AIS) remain uncertain. We investigated the associations between serum albumin, A/G ratio, globulin levels and carotid atherosclerosis in patients with AIS. background: The relationships between serum albumin, albumin-globulin (A/G) ratio, globulin and atherosclerosis in the setting of ischemic stroke are unclear. Methods: A total of 1,339 AIS patients were enrolled. Admission A/G ratio was divided into quartiles, and serum albumin and globulin levels were also categorized. Carotid atherosclerosis was detected through the assessment of common carotid artery intima-media thickness (cIMT), and abnormal cIMT was characterized by mean and maximum cIMT values of ≥1 mm. We evaluated the relationships between A/G ratio, albumin, globulin and abnormal cIMT, using multivariable logistic regression models. objective: We aimed to evaluate the associations between serum albumin, A/G ratio, globulin levels and carotid atherosclerosis in patients with ischemic stroke. Results: In the multivariable-adjusted analysis, the highest A/G ratio quartile (Q4) was linked to a 59% decreased risk of abnormal mean cIMT (OR 0.41; 95% CI 0.29-0.60) and a 58% decreased risk of abnormal maximum cIMT (OR 0.42; 95% CI 0.30-0.60) when compared to the lowest quartile (Q1), respectively. Moreover, decreased albumin and elevated globulin levels were also associated with abnormal mean cIMT and maximum cIMT. In addition, the A/G ratio provided supplementary predictive capability beyond the already established risk factors, and the C-statistic of the A/G ratio for abnormal cIMT is larger than globulin (P &lt;0.01). Conclusion: Decreased serum A/G ratio, albumin and elevated serum globulin were independently associated with abnormal cIMT in AIS patients. Moreover, the A/G ratio appeared to be a better predictor of abnormal cIMT. result: In the multivariable-adjusted analysis, the highest A/G ratio quartile (Q4) was associated with a 59% (OR 0.41; 95% CI 0.29-0.60) decreased risk of having abnormal mean cIMT and 58% (OR 0.42; 95% CI 0.30-0.60) decreased risk of having abnormal maximum cIMT in comparison to Q1, respectively. Moreover, decreased albumin and increased globulin levels were associated with abnormal mean cIMT and maximum cIMT. In addition, the A/G ratio provided incremental predictive capacity beyond established risk factors, and the C-statistic of A/G ratio for abnormal cIMT is larger than globulin (P&lt;0.01). conclusion: Decreased serum A/G ratio, albumin and elevated serum globulin were independently associated with abnormal cIMT in patients with ischemic stroke. Moreover, the A/G ratio appeared to be a better predictor of abnormal cIMT. other: No

Association Between Physical Activity and Arterial Stiffness in Patients with Type 2 Diabetes in Ningbo, China: A Cross-Sectional Study.

The study aimed to investigate the association between physical activity and arterial stiffness in patients with type 2 diabetes mellitus (T2DM) in Ningbo, China. A cross-sectional study was conducted using the Metabolic Management Center (MMC) dataset of The First Affiliated Hospital of Ningbo University from 1st March 2018 to 28th February 2023. 4444 adults with T2DM were included in the study. Physical activity was assessed using the International Physical Activity Questionnaire (IPAQ)-Short and was categorized into high, moderate, and low. Arterial stiffness was defined as brachial-ankle pulse wave velocity (baPWV) ≥1800cm/s or common carotid artery intima-media thickness (CCA IMT) ≥1mm. Multiple logistic regression analyses were performed to identify the association between physical activity and arterial stiffness. 6.5%, 47.0%, and 46.5% of patients with T2DM had high, moderate, and low physical activity, respectively. 18.8% and 17.5% of patients had arterial stiffness based on baPWV and CCA IMT, respectively. The odds of arterial stiffness (based on baPWV) were lower in patients having moderate to high physical activity (OR 0.82, 95% CI 0.68 to 0.98 and OR 0.58, 95% CI 0.39 to 0.87, respectively). The odds of arterial stiffness (based on CCA IMT) were found to be lower in patients having high physical activity (OR 0.49, 95% CI 0.33 to 0.74). Higher physical activity was found to be associated with lower arterial stiffness in patients with T2DM in Ningbo, China. This was a cross-sectional study, and there is a need to conduct longitudinal studies on this topic.

Varying Definitions of Carotid Intima-Media Thickness and Future Cardiovascular Disease: A Systematic Review and Meta-Analysis.

Carotid intima-media thickness (cIMT) has been widely used as a predictor of future cardiovascular disease (CVD); however, various definitions of cIMT exist. This study provides a systematic review and meta-analysis of the associations between different cIMT definitions and CVD. A systematic review of the different cIMT definitions used in prospective cohort studies was performed. The relationships between cIMT of different definitions (common carotid artery IMT [CCA-IMT], internal carotid artery IMT [ICA-IMT], combined segments [combined-IMT], mean CCA-IMT, and maximum CCA-IMT) with future stroke, myocardial infarction (MI), and CVD events were analyzed using random effects models. Among 2287 articles, 18 articles (14 studies) with >10 different cIMT definitions were identified and included in our meta-analysis. After adjusting for age and sex, a 1-SD increase in CCA-IMT was associated with future stroke (hazard ratio [HR], 1.32 [95% CI, 1.27-1.38]), MI (HR, 1.27 [95% CI, 1.22-1.33]), and CVD events (HR, 1.28 [95% CI, 1.19-1.37]). A 1-SD increase in ICA-IMT was related to future stroke (HR, 1.25 [95% CI, 1.11-1.42]) and CVD events (HR, 1.25 [95% CI, 1.04-1.50]) but not MI (HR, 1.26 [95% CI, 0.98-1.61]). A 1-SD increase in combined-IMT was associated with future stroke (HR, 1.30 [95% CI, 1.08-1.57]) and CVD events (HR, 1.36 [95% CI, 1.23-1.49]). Maximum CCA-IMT was more strongly related than mean CCA-IMT with risk of MI, and both measures were similarly associated with stroke and CVD events. Combined-IMT is more strongly associated with CVD events compared with single-segment cIMT definitions. Maximum CCA-IMT shows a stronger association with MI than mean CCA-IMT. Further research is warranted to validate our findings and to standardize the cIMT measurement protocol, as well as to explore underlying mechanisms.

Changes in common carotid artery elasticity in solid organ recipients

Background. Cardiovascular diseases are very common among solid organ recipients. They are associated with worsening transplant outcomes. Arterial vascular wall elasticity is an important prognostic indicator and a risk marker for cardiovascular events. Noninvasive measurement of common carotid artery (CCA) elasticity may be useful in assessing cardiovascular risk in solid organ recipients.Objective: To conduct a comparative analysis of indicators of CCA elasticity in solid organ recipients and to study their relationship with factors that potentially have a negative impact on the risk of adverse events.Materials and methods. The study included 154 patients aged 10 to 75 years, including heart (n = 77), liver (n = 9), and kidney (n = 35) recipients, as well as 33 patients with end-stage heart failure waitlisted for heart transplantation (HT). In all participants, carotid artery ultrasound was performed, pulse wave velocity was measured, and CCA elasticity was calculated.Results. CCA elasticity was found to be strongly inversely correlated with age, body mass index, systolic blood pressure, renal tubular filtration rate, CCA intima media thickness, and aortic pulse wave velocity. In heart recipients, CCA elasticity was significantly lower than in liver and kidney recipients (p = 0,002) and it inversely correlated with the length of time elapsed after transplantation, which is probably associated with cardiac denervation.Conclusion. CCA elasticity calculated via noninvasive ultrasound reflects the degree of adverse effects of pathological factors on the main arteries in solid organ recipients.

Sonographic evaluation of common carotid artery intima-media thickness in adults with coexisting type two (2) diabetes and hypertension: A case-controlled study

Diabetes mellitus (DM) and hypertension (HTN) are the two leading risk factors for atherosclerosis. Carotid intima-media thickness (CIMT) is considered a reliable surrogate measure for detecting subclinical atherosclerosis including its progression and regression. The study aim at evaluating the intima-media thickness of the common carotid artery in adults with coexisting diabetes mellitus and hypertension (DM+HTN) and compare with healthy controls.. A prospective case control study involving 115 adult subjects with coexisting DM+HTN and 144 healthy adult controls was carried out. Common carotid intima-media thickness (CCIMT) was measured at point approximately 1 cm distal to the right and left carotid bulb using the 7-12 MHz, multi-frequency linear array transducer of high resolution, touch Venue 50 ultrasound machine equipped with electronic callipers. The overall mean CCIMT was 1.13±0.40 mm and 0.82±0.23 mm for subjects with coexisting DM and HTN; and healthy controls, respectively. There was a statistically significant difference in CIMT of subjects with DM+HTN compared to healthy controls (p=0.000 each for both males and females, respectively). There were positive correlations between CCIMT and age in subjects with DM+HTN (r=0.260 and r=0.424 for males and females respectively); with healthy controls (r=0.619 and 0.626 for males and females, respectively). There was a statistically significant difference in CCIMT between subjects with DM+HTN and healthy controls. This implies that the increase in CCIMT is associated with both DM and HTN. In addition, age has a significant positive relationship with CCIMT in both subjects with DM+HTN and healthy controls.

B-mode ultrasound characteristics of carotid plaques in symptomatic and asymptomatic patients with low-grade stenosis.

Carotid plaque features assessed using B-mode ultrasound can be useful for the prediction of cerebrovascular symptoms. Therefore, the aim of this retrospective study was to determine the ability of ultrasound B-mode imaging to differentiate between carotid plaques causing less than 50% stenosis in symptomatic and asymptomatic patients. A dataset of 1,593 patients with carotid disease who underwent carotid ultrasound between 2016 and 2021 was evaluated retrospectively between January and April of 2022. A total of 107 carotid plaques from 35 symptomatic and 52 asymptomatic patients causing low-grade stenosis on B-mode images were included in the analysis. Chi-square, independent t-test and Mann-Whitney U test were used to compare the variables. There was a significant association between hypertension and the presence of cerebrovascular symptoms (p = 0.01). Predominantly hypoechoic and hyperechoic carotid plaque were significantly associated with the presence and absence of cerebrovascular symptoms, respectively (predominantly hypoechoic: p = 0.01; predominantly hyperechoic: p = 0.02). Surface irregularity was significantly associated with the presence of cerebrovascular symptoms (p = 0.02). There is was a significant difference in the carotid plaque length and area between the symptomatic and asymptomatic patients (plaque length: symptomatic median 9 mm, interquartile range [IQR] 6 mm; asymptomatic median 6 mm, IQR 4.5 mm, p = 0.01; plaque area: symptomatic median 24 mm, IQR 30 mm; asymptomatic median 14 mm, IQR 17 mm, p = 0.01); however, this difference was not significant for plaque thickness (p = 0.55), or common carotid artery intima-media thickness (p = 0.7). Our findings indicate that hypertension patients with predominantly hypoechoic carotid plaques and plaques with an irregular surface are associated with the presence of cerebrovascular symptoms. In addition, the carotid plaques in symptomatic patients were longer and larger compared to asymptomatic patients.

Sonographic Association of Common Carotid Artery Intima-Media Thickness With Age, Obesity, and Hypertension

Objective: The intima-media thickness (IMT) of the common carotid artery (CCA) can indicate cardiovascular and cerebrovascular disease risk, which could aid in early disease identification and prevention. This study was designed to correlate carotid artery IMT with age, obesity, diabetes, and hypertension using sonography. Materials and Methods: This cross-sectional cohort study included 300 individuals of all ages selected through convenient sampling at a university clinic in Lahore from November 2022 to February 2023. An Xario XG ultrasound equipment system (Toshiba, Tokyo, Japan) and a 7.5- to 10-MHz linear transducer was used to examine the patients. Results: The CCA-IMT was evaluated in 300 individuals (mean age 36.83 years). Significant statistical differences were observed between hypertensive/non-hypertensive and diabetic/non-diabetic individuals ( P &lt; .05). CCA-IMT was positively correlated with age and higher in obese/overweight individuals. Conclusion: This large cohort study found a significant difference in CCA-IMT between hypertensive/diabetic and normal individuals. CCA-IMT was positively correlated with age and body mass index.

Detection of Non-Alcoholic Fatty Liver Disease with Non-invasive Tools in Turkish People Living with HIV and with Apparently Normal Liver Function.

Non-alcoholic fatty liver disease (NAFLD) has become a significant cause of mortality and morbidity in people living with HIV. We aimed to investigate NAFLD presence by magnetic resonance imaging (MRI) methods, including MRI-derived proton density fat fraction (MRI-PDFF) and MRE, and ultrasound elastography among Turkish people living with HIV (PLWH), and identify factors correlated with fatty liver. We included 57 PLWH attending outpatient clinics on antiretroviral therapy (ART) for more than six months, without HBV/HCV co-infection, significant alcohol consumption, active opportunistic infection, previously diagnosed hepatobiliary disease, T2DM, and hyperlipidemia. We performed MRI, MRE, and US elastography on all participants. The mean age of the participants (M/F, 47/10) was 41.7± 12 years. The median duration of HIV infection was 3 (0.5-19 years) years. The mean MRI-PDFF was 4.4 ± 3.8 %, and 11 had fatty liver. The mean MRE value was 2.27 ± 0.6 kPa, inflammation was present in 16, and 4 participants had values consistent with fibrosis. The mean US elastography of the study population was 4.1±2.4 kPa. The mean right and left CCA intima-media of the study population was 0.65± 0.23 mm and 0.66± 0.25 mm; 16 had increased intima-media thickness. In patients with fatty liver, a significant positive correlation was present between MRE and CCA intima-media thickness (rs=0.82, p:0.006 for MRE-left CCA; r=0.68, p=0.042 for MRE-right CCA). We demonstrated that even a significant proportion of PLWH individuals with normal transaminase levels have fatty liver. Future prospective trials are warranted to understand and mitigate the risk factors, course of NAFLD, and accurate non-invasive tests, predicting fibrosis in people living with HIV.

Relation of forward and backward traveling pressure waves with subclinical carotid artery wall remodeling and central pulse pressure.

Central pulse pressure (PP) is the sum of forward and backward traveling pressure waves that have been associated with cardiovascular disease (CVD) risk. However, previous studies have reported differential findings regarding the importance of the forward versus the backward wave for CVD risk. Therefore, we sought to determine the degree to which the forward and backward pressure waves are associated with subclinical carotid artery wall remodeling and central PP in healthy adults. Using applanation tonometry, carotid pressure waveforms were acquired in 308 healthy individuals (aged 45 ± 17 years, range 19-80 years, 61% women), from which the time integral of the forward (PfTI) and backward (PbTI) pressure waves were derived via pressure-only wave separation analysis. Common carotid artery intima-media thickness (cIMT), a biomarker of subclinical CVD risk, was derived via B-mode ultrasonography measured ∼2 cm from the carotid bulb. Both PfTI (r = 0.31, P < 0.001) and PbTI (r = 0.40, P < 0.001) were correlated with cIMT. However, further analysis revealed that PbTI mediated the relation between PfTI and cIMT (proportion mediated = 156%, P < 0.001). The association between PbTI and cIMT remained after adjusting for age, sex, body mass index, blood glucose, low-density lipoprotein cholesterol, heart rate, brachial systolic pressure, and aortic stiffness (B = 0.02, 95% confidence interval = 0.01, 2.77, P < 0.001). Both PfTI (r = -0.58, P < 0.001) and PbTI (r = -0.50, P < 0.001) were correlated with central PP, however, PfTI fully mediated the association between PbTI and central PP (proportion mediated = 124%, P < 0.001). Although PfTI is correlated with higher central PP, it is PbTI that is directly associated with carotid artery wall remodeling.NEW & NOTEWORTHY The present study contributes to the growing body of evidence highlighting the physiological and clinical insight provided by the pulsatile hemodynamic components of central artery pulse pressure. The notable findings of this study are: 1) The reflected (backward) pressure wave is associated with carotid intima-media thickness independent of traditional cardiovascular risk factors, including systolic blood pressure and aortic stiffness. 2) The incident (forward) pressure wave, and not the reflected pressure wave, is associated with greater central pulse pressure.

Implications of homocysteine levels and carotid intima-media thickness in Indian stroke patients

Background The study aimed to evaluate the role of homocysteine (HCY) in modulating various stroke parameters. The primary objective was to study the correlation of HCY levels with carotid intima-media thickness (IMT) in stroke patients and investigate if HCY levels had any predictive value for the National Institutes of Health Stroke Scale (NIHSS) score. Material and Methods Seventy-eight patients of magnetic resonance imaging or computed tomography scans-confirmed acute ischaemic stroke were recruited for this study, and the NIHSS score was evaluated upon admission. Fasting blood samples were tested for serum HCY, fasting blood glucose (FBG) and lipid profile. Ultrasonography of the neck ascertained IMT of common carotid artery (CCA) and internal carotid artery (ICA). Results The mean age of male and female subjects was 57.88±13.97 and 59.16±13.62 years, respectively. 71.93% of stroke patients were hyperhomocysteinemic (HHcyc), and 24.36% were hyperlipidemic. Patients with NIHSS ≥5 had higher LDL cholesterol than those with NIHSS &amp;lt;5. Positive correlations were found between FBG and CCA IMT and triglyceride and NIHSS. HCY cut off of ≥15 μmol/L had 91.7% sensitivity and 66.7% specificity for predicting NIHSS ≥15. HHcyc state was associated with increased ICA IMT. HHcyc state was best predicted by ICA IMT and HCY positively correlated with ICA IMT. Conclusions HHcyc state holds a good predictive value for the severity of stroke. We also concluded that ICA IMT measurement may reduce the need for a HCY test as it predicts higher HCY levels, reducing the burden on resources. We suggest that evaluating HCY and ICA IMT should be part of the standard cerebrovascular accident management protocol.

The association between serum phosphorus and common carotid artery intima-media thickness in ischemic stroke patients.

An elevated concentration of phosphorus is associated with an increased risk of atherosclerosis and cardiovascular diseases. Common carotid artery intima-media thickness (cIMT) is an imaging marker of atherosclerosis. However, data on the relationship between phosphorus and cIMT in ischemic stroke are scarce. We aimed to evaluate the association between serum phosphorus levels and cIMT in patients who had experienced ischemic stroke. A total of 1,450 ischemic stroke patients were enrolled. Participants were divided into four groups (quartiles) according to baseline serum phosphorus level. Carotid atherosclerosis was identified by measurement of cIMT; abnormal cIMT was defined as a maximum cIMT or mean cIMT ≥ 1 mm. Multivariable logistic regression models were used to assess the association between serum phosphorus level and the presence of abnormal cIMT. In the multivariable adjusted analysis, falling into the highest quartile for serum phosphorus (Q4) was associated with a 2.00-fold increased risk of having abnormal maximum cIMT [adjusted odds ratio (OR) 2.00; 95% confidence interval (CI) 1.44-2.79] and a 1.76-fold increased risk of having abnormal mean cIMT (adjusted OR 1.76; 95% CI 1.22-2.53) in comparison to Q1. Furthermore, the association between serum phosphorus and abnormal cIMT was confirmed in analyses treating serum phosphorus as a continuous variable and in subgroup analyses. In acute ischemic stroke patients, baseline elevated serum phosphorus level was found to be independently associated with carotid atherosclerosis, as measured by cIMT.

#4655 IMPACT OF MAGNESIUM ASPARTATE AND L-CARNITINE ON INFLAMMATION, INSULIN RESISTANCE AND ATHEROSCLEROSIS PROGRESSION IN DIABETIC HEMODIALYSIS PATIENTS

Abstract Background and Aims The development of new pathogenetic treatment programs to reduce cardiovascular risk in diabetic patients with end-stage kidney disease is an important task of modern nephrology. In these conditions, considering the essential role of magnesium and L-carnitine deficiency in the mechanisms (via endothelial and metabolic disorders) of cardiovascular diseases, we evaluated the effect of the combined use of magnesium aspartate and L-carnitine on inflammation, insulin resistance and the atherosclerosis progression of carotid arteries in type 2 diabetic hemodialysis (HD) patients. Method 42 type 2 diabetic HD patients were included in this prospective cohort study (male, 26; age, 59.5 ± 0.7 years; HD duration, 31.2 ± 4.6 month; diabetes mellitus duration, 174.6 ± 7.8 month). Depending on the treatment programme, patients were divided into two groups: the 1st (main) group (n = 22) in addition to basic treatment (hypoglycemic, antihypertensive therapy, correction of anemia, hyperparathyroidism, hyperphosphatemia) was treated by combination of magnesium aspartate (0.5 g/day orally) and L-carnitine (1 g/day parenterally after each HD session (three times weekly); the 2nd (comparison) group (n = 20) was only on the standard therapy. Complex treatment lasted 12-months; administration of L-carnitine was performed continuously throughout the year, while magnesium aspartate – by three 2-months’ courses per year. Serum content of tumor necrosis factor alpha (TNF-α), C-reactive protein (CRP) and fibrinogen as inflammatory biomarkers were determined. The homoeostasis model of assessment-insulin resistance (HOMA-IR) as an index of insulin resistance was estimated. Common carotid artery intima-media thickness (CСА IMT) as an index of the atherosclerosis severity was measured by ultrasound. Data are expressed as means ± SEM. Wilcoxon T-test was used for comparison of the dependent variables, Mann-Whitney U-test – for independent ones. Results In diabetic HD patients undergoing complex treatment with a combination of magnesium aspartate and L-carnitine after 12 months of observation CCA IMT did not change (0.88 ± 0.05 vs. 0.88 ± 0.05 mm; Z = 0.09, p = 0.925), while a significant increase (by 9.1%) in the CCA IMT was determined in subjects, who were on basic therapy (0.98 ± 0.04 vs. 1.07 ± 0.04 mm; Z = 2.27, p = 0.023). In addition, after 12 months of treatment, the indicated index between 1st and 2nd groups differed (p = 0.006). By the end of follow-up, the TNF-α, CRP and fibrinogen contents in patients who were on modified therapy were 44.7, 56.4 and 78.2% from baseline, a similar indices in patients receiving standard treatment – 70.7, 77.3 and 88.8% respectively, and after one year the main group and the comparison group on the serum concentrations of TNF-α (p = 0.089), CRP (p = 0.030) and fibrinogen (p = 0.026) differed. Magnesium aspartate and L-carnitine supplementation significantly improve HOMA-IR, and after 12 months of observation, the indicated index in the 2nd group exceeded (p = 0.003) that in the 1st one (Table 1). Conclusion (1) The combined use of magnesium aspartate and L-carnitine, in addition to the basic 12-month treatment, prevents the atherosclerosis progression of CCA, provides an effective reduction of the activity of chronic inflammation, improves insulin resistance in type 2 diabetic HD patients. (2) Long-term modified treatment may reduce the cardiovascular risk in these subjects.

Association of Intima-Media Thickness Measured at the Common Carotid Artery With Incident Carotid Plaque: Individual Participant Data Meta-Analysis of 20 Prospective Studies.

Background The association between common carotid artery intima-media thickness (CCA-IMT) and incident carotid plaque has not been characterized fully. We therefore aimed to precisely quantify the relationship between CCA-IMT and carotid plaque development. Methods and Results We undertook an individual participant data meta-analysis of 20 prospective studies from the Proof-ATHERO (Prospective Studies of Atherosclerosis) consortium that recorded baseline CCA-IMT and incident carotid plaque involving 21 494 individuals without a history of cardiovascular disease and without preexisting carotid plaque at baseline. Mean baseline age was 56 years (SD, 9 years), 55% were women, and mean baseline CCA-IMT was 0.71 mm (SD, 0.17 mm). Over a median follow-up of 5.9 years (5th-95th percentile, 1.9-19.0 years), 8278 individuals developed first-ever carotid plaque. We combined study-specific odds ratios (ORs) for incident carotid plaque using random-effects meta-analysis. Baseline CCA-IMT was approximately log-linearly associated with the odds of developing carotid plaque. The age-, sex-, and trial arm-adjusted OR for carotid plaque per SD higher baseline CCA-IMT was 1.40 (95% CI, 1.31-1.50; I2=63.9%). The corresponding OR that was further adjusted for ethnicity, smoking, diabetes, body mass index, systolic blood pressure, low- and high-density lipoprotein cholesterol, and lipid-lowering and antihypertensive medication was 1.34 (95% CI, 1.24-1.45; I2=59.4%; 14 studies; 16 297 participants; 6381 incident plaques). We observed no significant effect modification across clinically relevant subgroups. Sensitivity analysis restricted to studies defining plaque as focal thickening yielded a comparable OR (1.38 [95% CI, 1.29-1.47]; I2=57.1%; 14 studies; 17 352 participants; 6991 incident plaques). Conclusions Our large-scale individual participant data meta-analysis demonstrated that CCA-IMT is associated with the long-term risk of developing first-ever carotid plaque, independent of traditional cardiovascular risk factors.