Common Carotid Artery Intima-media Thickness Research Articles

Abstract P672: Association of Intima-Media Thickness Measured at the Common-Carotid Artery With Incident Carotid Plaque

Background: The association between common-carotid artery intima-media thickness (CCA-IMT) and incident carotid plaque has not been characterised fully. We therefore aimed to precisely quantify the relationship between CCA-IMT and carotid plaque development. Methods: We undertook an individual-participant-data meta-analysis of prospective studies from the Proof-ATHERO consortium that recorded baseline CCA-IMT and incident carotid plaque. We excluded participants with a history of cardiovascular disease or pre-existing carotid plaque at baseline. Incident carotid plaque was defined as the development of first-ever plaque during follow-up in any segment of the carotid artery. We calculated study-specific odds ratios for incident carotid plaque using logistic regression and then combined study-specific estimates using random-effects meta-analysis. Results: We analysed data from 21,494 individuals in 20 studies. Mean baseline age was 56 years (SD 9), 55% were female, and mean baseline CCA-IMT was 0.71 mm (SD 0.17). Over a median follow-up of 5.9 years (5 th -95 th percentile 1.9-19.0), 8,278 individuals developed first-ever carotid plaque. Baseline CCA-IMT was approximately log-linearly associated with the odds of developing carotid plaque. In an analysis adjusted for age, sex, and trial arm, the odds ratio for incident carotid plaque per SD higher baseline CCA-IMT was 1.40 (95% confidence interval 1.31-1.50; I 2 =63.9%). In an analysis further adjusted for ethnicity, smoking, diabetes, body mass index, systolic blood pressure, low-density and high-density lipoprotein cholesterol, and lipid-lowering and antihypertensive medication, the corresponding odds ratio was 1.34 (1.24-1.45; I 2 =59.4%; 14 studies; 16,297 participants; 6,381 incident plaques). We observed no significant effect modification across clinically relevant subgroups including age, sex, lipid-lowering medication, low-density lipoprotein cholesterol, development of cardiovascular disease during follow-up, type of study, and type of CCA-IMT measure. In a sensitivity analysis restricted to studies defining carotid plaque as focal thickening, the odds ratio was similar as in the primary analysis (1.38; 1.29-1.47; I 2 =57.1%; 14 studies; 17,352 participants; 6,991 incident plaques). Conclusions: In this large-scale meta-analysis based on participant-level data, CCA-IMT was associated with the long-term risk of developing first-ever carotid plaque, independent of traditional cardiovascular risk factors. The association was robust across sensitivity analyses and similarly strong for women and men and for individuals at different ages.

Remnant Cholesterol and Common Carotid Artery Intima-Media Thickness in Community Population with Normal Low-Density Lipoprotein Cholesterol

Introduction: Remnant cholesterol is a risk factor for cardiovascular disease, especially when low-density lipoprotein cholesterol (LDL-C) levels are normal. However, there are few studies on the relationship between remnant cholesterol and subclinical atherosclerosis. Common carotid artery intima-media thickness (cIMT) is an imaging marker of subclinical atherosclerosis. This study aimed to investigate the relationship between remnant cholesterol and cIMT in a community population with normal LDL-C. Methods: This study is a retrospective analysis; 1,101 community population with available carotid artery imaging and fasting lipid data with LDL-C <4.1 mmol/L were included in this analysis. Remnant cholesterol was calculated as total cholesterol minus LDL-C minus high-density lipoprotein cholesterol. Abnormal cIMT was defined as maximum cIMT value ≥1 mm. Logistic regression was used to assess the relationships between remnant cholesterol levels and abnormal cIMT. Results: As the remnant cholesterol level increased from the lowest to the highest quartile, the rate of abnormal cIMT increased from 24.5% to 38.6% (p trend <0.001) in the community population with normal LDL-C level. In the unadjusted model, the odds ratios (ORs, 95% confidence intervals) in the highest quartile group were 1.937 (1.338–2.803) for abnormal cIMT compared with the lowest quartile. The multivariable-adjusted ORs (95% confidence intervals) for the highest versus lowest quartile of remnant cholesterol were 2.132 (1.420–3.202) for abnormal cIMT. Conclusion: Elevated fasting remnant cholesterol levels were positively associated with abnormal cIMT in community population with normal LDL-C levels. Remnant cholesterol may be an important indicator of risk stratification in community population with normal LDL-C level.

Effect of lifestyle interventions on carotid arterial structure – The DR's EXTRA study

No lifestyle-based interventions with medium-term duration on carotid atherosclerotic have been performed so far. We aimed to investigate whether guideline-based dietary and physical activity interventions slow the progression of atherosclerotic changes in the general elderly population.1410 Finnish men and women from a representative population sample were randomly assigned to one of six groups in the four-year intervention study: 1) reference, 2) aerobic training, 3) resistance training, 4) Nordic Diet, 5) aerobic training + Nordic Diet, 6) resistance training + Nordic Diet. The primary outcome was mean common carotid artery intima-media thickness (cIMT). The lumen diameter of the common carotid artery (cLD) was also analyzed.567 men and 565 women aged 57 to 78 years were included. None of the intervention groups significantly slowed cIMT progression compared to the reference group. A subgroup analysis showed that men in the diet group had significantly smaller cIMT progression than in the reference group (−0.078 mm, 95% CI: −0.146 to −0.009, p = 0.02) and no significant increase in cIMT (p = 0.23). No other group showed a slowed cIMT progression.Among guideline-based lifestyle interventions, only diet leads to a significantly smaller progression of cIMT in older men of a representative population sample. No other lifestyle intervention contributed to a slowing of the progression of structural carotid markers. It must be questioned whether the guideline-based recommendations for a lifestyle change that were in place until recently are adequate to decelerate the atherosclerotic process.

Evaluation of carotid intima-media thickness of female fibromyalgia patients and determination of their relationship with disease activity, severity of fibromyalgia, anxiety and depression levels

Aim: Carotid artery intima-media thickness is thought strong predictor of cardiovascular diseases. To evaluate the common carotid artery intima-media thickness (CCIMT) in female patients with fibromiyalgia (FM) and determine its relationship with disease activity, severity of fibromyalgia, anxiety and depression levels.Material and Method: Thirty nine patients who had fibromyalgia syndrome according to 2016 American College of Rheumatology (ACR) classification criteria and 41 healthy controls were included. Pain level and disease activities were assessed with Numerical Rating Scale (NRS) and Fibromyalgia Impact Questionnairre (FIQ) respectively. According to ACR 2016 classification criteria, Widespread Pain Index (WPI), Symptom Severity Score and Hospital Anxiety and Depression Scale (HADS) were performed. The LDL , HDL and Triglyceride levels were evaluated. Bilateral common carotid artery intima-media thicknesses (CCIMT) were performed by a blind radiologist to the groups of participants. Results: Age, weight and height were similar between groups (p&amp;gt;0.05). Triglyceride level was significant higher in patients with FM (p=0.001). HDL and LDL levels were similar between groups (p=0.297, p=0.061). Bilateral CCIMT was significantly higher in patients with FM (p&amp;lt;0.001). Bilateral CCIMT were found positively correlated with age in FM group (r=0.390, p=0.014, r=0.404, p=0.011 respectively). There were found no correlations between bilateral CCIMT, height, weight, triglyseride level, LDL level, FIQ, NRS, WPI, Symptom Severity Score, HADS scores. . Conclusion: In FM patients, bilateral CCIMTs were found increased compared to healthy controls. No associations were found between CCIMT, LDL, triglyceride levels, disease activity and pain level, anxiety and depression level in patients with FM.

A preliminary study of changes in carotid artery elasticity in type 2 diabetes mellitus.

Carotid stiffening is found to be present in patients with type 2 diabetes mellitus (T2DM) together with endothelial dysfunction and it remains unclear about the role of carotid elasticity in the development of diabetic vascular damage. The aim of the study was to investigate changes and significance of carotid artery elasticity in diabetic patients with or without microvascular complications using velocity vector imaging (VVI) analysis. Fifty participants were enrolled and divided into health Control group, the uncomplicated DM (uDM) group and the complicated DM (cDM) group. All of them underwent carotid ultrasound examinations. VVI was used to evaluate the common carotid artery (CCA) elasticity and intima-media thickness (IMT) was also measured. Flow-mediated dilation (FMD) was performed to detect the vascular endothelial function. Then differences and correlations of variables between three groups were compared and analyzed. CCA elasticity measured by VVI decreased significantly between three groups (p < 0.05), while FMD decreased significantly only in cDM group (p < 0.01) and only IMT in cDM group was significantly thicker than that of Control group (p < 0.05). Representative VVI variables were independently, negatively related to the known duration and microalbuminuria (p < 0.05). All VVI variables were significantly correlated with FMD (0.5 ≤ |r | <0.8, p < 0.001), and just a small part of VVI variables were significantly correlated with IMT (0.3 ≤ |r | <0.5, p < 0.05). Compared with FMD, CCA elasticity measured by VVI showed more obvious changes in diabetic patients with different levels of vascular damage and may be considered as an alternative indicator in evaluating arterial status of T2DM.

Intima-Media Thickness and Pulsatility Index of Common Carotid Arteries in Acute Ischaemic Stroke Patients with Diabetes Mellitus.

Ultrasonographic parameters such as the common carotid artery (CCA) pulsatility index (PI) and CCA intima-media thickness (IMT) have been associated with an increased mortality and risk of recurrent stroke, respectively. We hypothesized that these ultrasonographic parameters may be useful for monitoring diabetic patients after an acute stroke. We analysed retrospective data of consecutive acute ischaemic stroke patients from the ASTRAL registry who underwent pre-cerebral ultrasonographic evaluation within 7 days of symptom onset. We compared clinical, demographic, radiological and ultrasonographic parameters in diabetic versus non-diabetic patients (univariable and multivariable analyses) and the association of these parameters with CCA PI and CCA IMT. We analysed 1507 carotid duplex ultrasound examinations from patients with a median age of 74 years. Cardiovascular co-morbidities, including hypertension, hypercholesterolemia, obstructive sleep apnoea syndrome, higher body-mass index (BMI) and peripheral artery disease, were associated with diabetes mellitus (DM). Diabetics were more often under antiplatelet therapy and had atrial fibrillation at admission. Diabetic patients showed an increased CCA PI and IMT in line with more atherosclerotic changes on acute CTA compared to non-diabetic patients. Taking IMT as the dependent variable in a second analysis, DM, higher age, hypertension, smoking and CCA PI were associated with higher IMT. Taking CCA PI as the dependent variable in a third analysis, DM, higher age and higher NIHSS at admission were associated with higher CCA PI values. Increased IMT was also associated with higher PI. We show that CCA PI and IMT are higher in diabetic patients in the first week after an initial stroke.

Handheld versus conventional ultrasound for assessing carotid artery in routine volunteers.

Carotid ultrasound is a key tool for the diagnosis and evaluation of cardio disease, and the measurement of carotid intima-media thickness (CIMT) and hemodynamic parameters is of paramount importance for the imaging method. The aim of this study was to evaluate the feasibility and accuracy of handheld ultrasound devices for measuring carotid parameters. We performed a carotid ultrasound on 25 participants using a handheld ultrasound device and a conventional ultrasound machine. For each participant, max and mean CIMT of common carotid artery (CCA) and peak systolic velocity (PSV), end diastolic velocity (EDV) and resistive index (RI) of CCA, bilateral external carotid artery (ECA), internal carotid artery (ICA) and the vertebral artery were measured. Agreement and repeatability were evaluated by linear regression and Bland-Altman analysis. We found a good repeatability and consistent of handheld ultrasound device in measuring mean CIMT (r = 0.68, P < 0.01). Furthermore, there was a moderate to good agreement between handheld and conventional ultrasound systems in measuring max IMT, mean IMT, PSV, EDV and RI of CCA (0.73, 0.79, 0.52, 0.58 and 0.84, respectively). Handheld ultrasound devices were able to provide carotid IMT and hemodynamic parameters measurements similar to those of conventional ultrasound. Such capabilities of handheld ultrasound devices might be useful for the primary assessment of carotid in clinical work.

Carotid intima media thickening is associated with higher future amyloid‐ß burden

AbstractBackgroundCarotid atherosclerosis is associated with cognitive impairment and dementia, though there is limited evidence of a direct link between carotid disease and amyloid‐ß (Aß) burden. We studied the association of baseline and progressive carotid intima media thickness (CIMT) with Aß on 11C‐Pittsburgh Compound B (PiB) to determine if those with carotid atherosclerosis would have higher Aß burden.MethodWe studied 47 participants from the Framingham Offspring cohort with carotid ultrasounds measuring CIMT at their 6th clinic examination (aged 49.5± 5.7 years) and an average of 9.6 years later at exam 8, and PiB imaging measuring Aß on average 22.1 years post baseline. We used multivariate linear regression analyses to relate baseline, follow‐up, mean, and progression of internal carotid artery (ICA) and common carotid artery (CCA) CIMT to Aß in brain regions associated with Alzheimer’s disease (AD) and related dementias (ADRD), adjusting for age, sex, and other vascular risk factors.ResultParticipants with higher mean ICA IMT had more Aß in the precuneus (beta ± standard error [SE]: 0.264 ± 0.12, p = 0.034) and the FLR regions (SE: 0.155 ± 0.071, p = 0.034), after adjusting for age, sex, and vascular risk factors. We did not find an association between any CCA IMT measures and Aß or progression of ICA or CCA IMT and Aß.ConclusionCarotid atherosclerosis, as measured by ICA IMT, is associated with increased Aß burden later in life. These findings support a link between vascular disease and AD/ADRD.

Autonomous Aldosterone Secretion in Patients with Adrenal Incidentaloma.

In recent years, research has emphasized the significance of mild clinical and biochemical presentations of primary aldosteronism (PA) that do not meet current diagnostic criteria of the syndrome. In this study, we assessed the prevalence of autonomous aldosterone (Ald) secretion (AAS), defined as a positive (&gt;1.2 ng/dL/mIU/L) Ald-to-renin ratio (ADRR) combined with unsuppressed Ald (&gt;4 ng/dL), and its associations with blood pressure (BP), cardiac function, and common carotid artery (CCA) intima-media thickness (IMT) in patients with incidentally discovered adrenal adenomas (AI), who were either normo- or hypertensive but had no other cardiovascular disease. Among 332 AI patients hospitalized between November 2018 and December 2019, 63 study participants were recruited (26 normo- and 37 hypertensive), who underwent hormonal examinations, 24 h ambulatory BP measurement, transthoracic echocardiography, and CCA IMT assessment without altering chronic medications. AAS was found in approximately 25% of subjects (seven normo- and nine hypertensive); urinary aldosterone excretion (UAldE) exceeded 10 ug/day in none of the subjects. The left ventricular mass index correlated positively with UAldE in non-diabetic patients (n = 50), and negatively with renin in those without beta blocker therapy (n = 38). The study shows that a pragmatic approach to hormonal assessment (no chronic therapy modification) may reveal patients with AAS. Screening for this subclinical PA presentation is probably more effective with a permissive ADRR than UAldE in such a setting.

The Relationship between Atherosclerosis and Gut Microbiome in Patients with Obstructive Sleep Apnoea

Background: Obstructive sleep apnoea (OSA) and gut dysbiosis are known risk factors for atherosclerosis. However, only very few studies have been focused on the relationship between OSA, atherosclerosis, and the intestinal microbiome, all in animal models. Methods: Twenty-two patients with OSA, 16 with and 6 without carotid atherosclerosis were involved in the study. After a diagnostic sleep examination, the intima media thickness (IMT) was measured and plaques were found using carotid ultrasound. Blood was also drawn for metabolic profile, and a stool sample was provided for 16S ribosomal RNA microbiome investigation. Results: An increased maximal common carotid artery (CCA) IMT was significantly associated with decreased phylum-level diversity. The level of Peptostreptococcaceae was significantly lower in atherosclerotic subjects. Some other candidate microbes appeared in the two groups at the genus level as well: Bilophila, Romboutsia, Slackia, and Veillonella in the non-atherosclerotic group; and Escherichia-Shigella, Prevotella, and Ruminococcaceae in the atherosclerotic group. Conclusions: This is the first pilot research to analyze the association between the gut microbiome and atherosclerosis in adult patients with OSA with and without carotid atherosclerosis. Dysbiosis and individual bacteria may contribute to the development of carotid atherosclerosis in patients with OSA. Further investigations are necessary to reveal a more precise background in a larger sample.

Abstract 12632: Relationships Between Circadian Ambulatory Systolic Blood Pressure Variability With Subclinical Atherosclerosis in Healthy Middle-Aged Individuals

Background: Short-term fluctuations in blood pressure (BP) as measured by 24-hr ambulatory BP monitoring (ABPM) is associated with subclinical atherosclerosis in the general population. However, whether short-term blood pressure variability (BPV) in the day versus night-time has differential effects on the development of subclinical atherosclerosis is uncertain. Methods and Results: We investigated the relationship between mean 24-hr BP and BPV parameters with common carotid artery intima-media thickness (CIMT) in 305 middle-aged Chinese (mean age 54±7years, 45% male) free from hypertension, hyperlipidaemia, diabetes or cardiovascular diseases. Subclinical atherosclerosis with elevated CIMT was defined as &gt;75th percentile of CIMT of the overall study cohort. Linear regression models adjusted for age, sex, body mass index and smoking status revealed significant associations between office, day- and night-time mean SBP, day-time SBP standard deviation (SD) and coefficient of variation (CV) with elevated CIMT (all p&lt;0.05). As shown in the Table , logistic regression analysis demonstrated that only ABPM day-time mean SBP (odds ratio [OR]:2.54, 95% confidence interval [95%CI]:1.29-5.00), night-time mean SBP (OR:3.23, 95%CI:1.67-6.22), night-time mean DBP (OR:2.27, 95%CI:1.16-4.42), day-time SBP CV (OR:0.47, 95%CI:0.26-0.86) and night-time SBP SD (OR1.94, 1.05-3.58) predicted the occurrence of subclinical atherosclerosis (all p&lt;0.05). Conclusions: In healthy middle-age individuals without known hypertension, mean day and night-time SBP as measured using ABPM provided the strongest positive predictive value for elevated CIMT. Interestingly, increase day-time SBP CV versus night-time SBP SD have opposite effects on CIMT, suggesting circadian changes in SBP might have distinct contributions to the development of subclinical atherosclerosis.

SONOGRAPHIC ASSESSMENT OF INTIMA-MEDIA THICKNESS OF CAROTID ARTERIES - A REVIEW OF LITERATURE

We conducted a systematic review of the literature that has examined carotid arteries using ultrasonography in order to better explain the association between diabetes, hypertension, and intima-media thickness (IMT). The goal of this study was also to get a precise evaluation of increasing intima-media thickness predictive value for clinical cardiovascular outcomes. From 2000 through 2021, we searched the Google Scholar, NCBI, PubMed, and Medscape databases. The following essential keywords were looked up: ultrasound of carotid arteries, ultrasound of common carotid arteries intima-media thickness, and carotid IMT in diabetes and hypertension. Of the 135 retained studies the percentage of detection was used to calculate the diseases that affect intima–media thickness. As a result following were the causes that alter intima–media thickness: diabetes and hypertension at 81.4 % and 80 % respectively. Coronary artery disease at 21.4%, dyslipidemia and stroke at 14.8% and 5.2% respectively. Microalbuminuria at 3%. However, non-alcoholic fatty liver disease, peripheral arterial disease (PAD) and chronic kidney disease (CKD) at an equal effect of 2.2%, MI at 1.5%. Breast arterial calcification, polycystic kidneys and glomerulonephritis at an equal effect of 0.7%. In conclusion, patients with hypertension and diabetes are most at risk of developing coronary artery disease.

Long-term vascular dysfunction in Kawasaki disease: systematic review and meta-analyses.

Long-term physiological dysfunction in coronary/systemic vasculature may persist in individuals with Kawasaki disease even in the absence of coronary artery abnormalities. We perform a systematic review and meta-analyses of studies assessing long-term vascular function in Kawasaki disease. PubMed, Embase, and Web of Science databases were searched for relevant literature published till May 2021. Patients with Kawasaki disease were included as cases and healthy age/sex-matched individuals as controls. Newcastle Ottawa Scale was used to assess the study quality. Outcome measures were differences in markers of vascular function 1 year after diagnosis of Kawasaki disease. Data were analysed using Review Manager software. Comprehensive meta-analysis software was used for meta-regression. To assess the certainty of evidence, GRADE Profiler software was utilised. Of 2280 citations, 49 case-control studies (comprising 2714 cases and 2118 controls) were included for data synthesis. Decreased flow-mediated dilatation [3.83, 95%CI 0.94-6.72] and increased pulse-wave velocity [39.34 cm/sec, 95%CI 20.86-57.83], arterial stiffness [0.35, 95%CI 0.11-0.59], and common carotid artery intima-media thickness were noted in patients with Kawasaki disease. No significant difference was observed for nitroglycerine-mediated dilatation and endothelial peripheral artery tonometry (endo-PAT). Significant inter-study heterogeneity was observed for flow-mediated dilatation, arterial stiffness, carotid artery intima-media thickness, and endo-PAT. The GRADE evidence was of 'very low quality' for all outcome measures except 'moderate quality' for pulse-wave velocity. Evidence suggests the presence of long-term endothelial dysfunction in patients with Kawasaki disease even in the absence of coronary artery abnormalities. Avoidance of development of other cardiovascular risk factors seems prudent in patients with Kawasaki disease.

Uric Acid is Independently Associated with Atherosclerosis among Healthy Chinese in Taiwan

&lt;p&gt;Objective: This study investigated the association between uric acid and atherosclerosis in a community population. Methods: We enrolled 2,790 subjects aged &amp;ge; 30 years from the CardioVascular Disease FACTor Two-Township Study. The common carotid artery intima-media thickness (IMT) and atherosclerotic plaque were used as indices of atherosclerosis. Pearson&amp;rsquo;s correlation coefficient, the general linear model, and a logistic model were used to assess the association between uric acid and atherosclerosis. Results: Elevated uric acid was moderately associated with obesity, dyslipidemia, elevated blood pressure, impaired glucose, insulin resistance (all correlation coefficients &lt; 0.05) and IMT (r: 0.12, p &lt; 0.05). Subjects were classified into four groups according to uric acid levels: group 1 (&lt;5.0 mg/dl), group 2 (5.0&amp;ndash;6.9 mg/dl), group 3 (7.0&amp;ndash;8.9 mg/dl) and group 4 (&amp;ge;9.0 mg/dl). The age and sex-adjusted mean of IMT was 0.54 in group 1, was 0.55 in both groups 2 and 3, and the mean of IMT (0.59 mm) in group 4 (&amp;ge;9.0 mg/dl) was significantly higher. Uric acid (&amp;ge;9.0 mg/dl) was significantly and positively associated with higher IMT (multivariate adjusted mean: 0.58 mm), independent of other risk factors, and atherosclerosis (&amp;ge;75th IMT value in the population) with an odds ratio of 2.67 (95% confidence intervals = 1.55&amp;ndash;4.59). This association remained significant in a healthy subgroup (without metabolic syndrome, hypertension, or diabetes; OR = 2.91; CI = 1.16&amp;ndash;7.25). Conclusion: Uric acid of 9 mg/dL and/or above was independently associated with atherosclerosis in terms of IMT measures in the general population and those without metabolic syndrome. Further study is warranted.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Association of Carotid Intima Media Thickening with Future Brain Region Specific Amyloid-β Burden.

Carotid atherosclerosis is associated with cognitive impairment and dementia, though there is limited evidence of a direct link between carotid disease and amyloid-β (Aβ) burden. We studied the association of baseline and progressive carotid intima media thickness (CIMT) with Aβ on 11C-Pittsburgh Compound B (PiB) to determine if those with carotid atherosclerosis would have higher Aβ burden. We studied 47 participants from the Framingham Offspring cohort with carotid ultrasounds measuring CIMT at their 6th clinic examination (aged 49.5±5.7 years) and an average of 9.6 years later, and PiB imaging measuring Aβ on average 22.1 years post baseline. We used multivariate linear regression analyses to relate baseline, follow-up, mean, and progression of internal carotid artery (ICA) and common carotid artery (CCA) CIMT to Aβ in brain regions associated with Alzheimer's disease (AD) and related dementias (ADRD), adjusting for age, sex, and other vascular risk factors. Participants with higher mean ICA IMT had more Aβ in the precuneus (beta±standard error [β±SE]: 0.466±0.171 mm, p = 0.01) and the frontal, lateral, and retrosplenial regions (β±SE: 0.392±0.164 mm, p = 0.022) after adjusting for age, sex, vascular risk factors, and medication use. We did not find an association between any CCA IMT measures and Aβ or progression of ICA or CCA IMT and Aβ. Carotid atherosclerosis, as measured by ICA IMT, is associated with increased Aβ burden later in life. These findings support a link between vascular disease and AD/ADRD pathophysiology.

Autoimmune thyroiditis and celiac disease do not worsen endothelial function in subjects with type 1 diabetes: an observational study

BackgroundType 1 diabetes (T1D) is frequently associated with autoimmune thyroiditis (AT) and coeliac disease (CD). Whether the coexistence of multiple autoimmune diseases increases cardiovascular risk is uncertain. We evaluated the effects of AT and CD on arterial wall thickening and endothelial function in patients with T1D.MethodsThis observational study analyzed data from T1D patients regularly followed by the Diabetes Care Centre. Clinical and biochemical characteristics and micro and macrovascular complications were collected from the electronic medical records. All subjects performed Echo-Doppler to evaluate Intima-Media Thickness (IMT) of the common carotid artery (CCA) and endothelial function by the flow-mediated dilation (FMD) technique. The statistical analyses were performed by SPSS for Macintosh. Comparison between means was performed using the t-test for unpaired data and the Mann–Whitney U test. The ANalysis Of VAriance and the Tukey posthoc test were applied to compare patients with and without other autoimmune diseases, and control subjects. The p-value for statistical significance was set at p < 0.05.ResultsA total of 110 patients were enrolled. Among these, 69 had T1D and 41 T1D and AT and or CD, of whom 33 AT, 7 CD, and 1 both AT and CD. The mean age was 35 years, mean HbA1c was 7.6%, and mean diabetes duration 18 years. The IMT of the CCA was not significantly different between T1D patients with and without concomitant autoimmune diseases (with AT and CD: right CCA 603 ± 186 µ, left 635 ± 175 µ; without AT and CD: right CCA 611 ± 176 µ, left CCA 631 ± 200 µ). FMD was also comparable between T1D groups, with AT and CD 7.9 ± 4.2%; without AT and CD 8.8 ± 4.4%.ConclusionPatients with T1D and concomitant AT and or CD show no worse morphological or functional vascular damage, evaluated by CCA IMT and brachial artery flow-mediated dilation, than patients with T1D alone.

Evidence of subclinical atherosclerosis in eosinophilic granulomatosis with polyangiitis.

Patients affected by eosinophilic granulomatosis with polyangiitis (EGPA) display an increased risk of atherothrombotic events compared with the general population. An increased frequency of subclinical markers of atherosclerosis has been observed in other ANCA-associated vasculitis, but no specific study focused on EGPA. We therefore evaluated subclinical atherosclerosis in EGPA patients and in a control population. Forty EGPA patients and 80 controls matched by age, sex and traditional cardiovascular risk factors underwent sonographic assessment of common carotid artery (CCA) intima-media thickness (IMT). The presence of plaques of the CCA was also investigated. The correlation between CCA-IMT and clinical and laboratory features was also assessed. Median CCA-IMT was significantly higher in EGPA patients compared with controls (P = 0.002). Also, the proportion of subjects with increased CCA-IMT and with presence of plaques was significantly higher among EGPA patients (P < 0.001 for both). Moreover, within the EGPA cohort, CCA-IMT tended to increase with disease duration (P = 0.034) and corticosteroid cumulative dose (P = 0.004). No significant associations were found between CCA-IMT, ANCA status, other clinical features and therapeutic regimens. Notably, the prevalence of traditional cardiovascular risk factors was comparable in patients with vs without an increased CCA-IMT. Ultrasound markers of subclinical atherosclerosis are increased in EGPA patients as compared with controls, independently of traditional cardiovascular risk factors.

Evaluation of extracranial carotid flow velocities in patients presenting with acute ischemic stroke: A clinical study conducted in Turkey

Objective. The mechanism underlying the relationship between carotid flow velocities and stroke events remains unclear. This study aimed to reveal the relationship of flow velocity measurements with risk factors in patients with acute ischemic stroke. Material and methods. A group of patients between the ages of 41-90 who applied to Mengücek Training and Research Hospital in the Eastern Anatolia Region of Turkey between 2014-2015 due to acute ischemic stroke were included. Groups with large artery atherosclerosis and small-vessel occlusion according to the Toast classification were included in the study. Brain tomography and magnetic resonance imaging, echocardiography, high-resolution color Doppler Ultrasonography examinations were performed. Internal carotid artery peak-systolic and end-diastolic flow velocity, common carotid artery peak-systolic and end-diastolic flow velocity, internal carotid artery peak systolic-common carotid artery peak-systolic velocity ratio and common carotid artery intima-media thickness were measured with Doppler Ultrasonography. The relationship between carotid flow velocities and brain infarction volume, comorbid factors, biochemical variables, left ventricular systolic-diastolic dysfunction was defined by using Statistical Package for Social Sciences version 21.0. Outcomes. In acute ischemic stroke groups, a significant negative correlation between common carotid artery end-diastolic flow velocity and brain infarction volume, a significant positive relationship between common carotid artery peak-systolic velocity and smoking, a significant positive correlation between common carotid artery intima-media thickness and blood glucose and hba1c, a significant negative correlation between common carotid artery end-diastolic flow velocity and hypertension, a significant relationship between common carotid artery end-diastolic flow velocity and ischemic heart disease, an increase in cerebral infarction in patients with left ventricular systolic dysfunction and a decrease in Internal carotid artery peak-systolic flow velocity in patients with left ventricular diastolic dysfunction were detected. Conclusions. In clinical practice, Doppler ultrasound is currently the main diagnostic tool for evaluating the diagnosis of carotid stenosis. In stenosis in the carotid artery system, it should be known as a basic rule that the flow velocity in the stenosis area increases, except for in severe stenosis and four basic measurements should be made to determine the degree of stenosis clearly. These measurements are peak systolic flow velocity (PSV), end-diastolic flow velocity (EDV), peak-systolic flow velocity ratio (ICA/CCA PSV). The purpose of sonographic evaluation of the extracranial cerebral arteries is to prevent bad sequelae and permanent deficits together with cerebral infarction.

Association between Endocan, PAI-1 and intima media thickness in patients with high diabetes risk

There is no information in the literature on the ratio of the concentrations of Endocan, PAI-1, and intima media thickness (IMT) in patients with high diabetes risk. This study aims to investigate the relationships between endothelial dysfunction biomarkers: Endocan, Plasminogen Activator Inhibitor-1(PAI-1), insulin resistance (IR) indicators, and IMT of the common carotid artery (CCA) in patients with risk of type 2 diabetes mellitus (T2DM). A case-control study was held, including 184 individuals, aged from 18 to 65 years. According to FINDRISC scale, patients were divided into 2 groups: Group 1 (n = 138) — low risk of T2DM (&lt;12 points) and Group 2 (n = 46) high risk of T2DM (&gt;12 points). IMT more than 0.9 mm on ultrasound considered as an atherosclerosis. Significant differences were found when studying the level of Endocan, PAI-1 biomarkers with their predominance in the group of patients with a high risk of T2DM; concentrations of Endocan comprised (mean±SD) 1698.2±576.2 pg/ml; p=0.01; PAI-1–32307.15±19947.12 pg/ml; p=0.05 to compare with low risk of T2DM. In addition to, mean values of IMT prevailed in patients in the group with a high diabetes risk and comprised right IMT CCA-0.90±0.15 mm; p = 0.05, left IMT CCA0.91±0.14 mm; p=0.02. Interrelations between Endocan, PAI-1, and IMT CCA have been determined by correlation analysis. These findings indicate that in patients with high diabetes risk the elevations of the Endocan, PAI-1 is associated with a subclinical atherosclerosis. Furthermore, both biomarkers Endocan and PAI-1 has been demonstrating significant correlation with insulin, IR-HOMA index, С-peptide, HbA1c, and fasting glucose in patients with high risk of T2DM. We found significant relationships between the ED biomarkers with IMT and IR in patients with high risk of T2DM. We suggest that rising of IR leads to Endocan and PAI-1 elevation, subclinical atherosclerosis and thereby increase ED and cardiovascular risk in these patients.

COMMON CAROTID ARTERY ELASTICITY, INTIMA-DIAMETER RATIO, AND TENSILE STRESS IN PEDIATRIC PATIENTS WITH PRIMARY HYPERTENSION

Objective: Elevated blood pressure (BP) lead to increased thickness of arterial wall and increased diameter of arteries, are risk factors of cardiovascular sequelae in adult populations. Intima-diameter ratio (IDR) and tensile stress (TS) may reflect arterial wall-remodeling to elevated BP. The aim was to evaluate common carotid artery elasticity, IDR, and TS in children with primary hypertension (PH). Design and method: 50 untreated patients with PH and we evaluated: common carotid artery(CCA) intima-media thickness (cIMT) and elasticity(E-tracking - ET), central BP and aortic elasticity (aPWV,AIx75HR), office BP and ABPM, and clinical, and biochemical data. IDR (cIMT/minimal diameter of CCA[D]) and TS (MAP∗D/cIMT) were calculated in all the subjects. Results: Patients with PH compared to CG were characterized by significantly higher peripheral, central office and ambulatory BP, BMI Z-score, uric acid, triglycerides, lower HDL-cholesterol and higher aPWV. PH patients had thicker cIMT and larger CCA D. The groups did not differ in parameters of CCA elasticity: beta stiffness index, CCA pulse wave velocity(PWVbeta) and pressure-strain elasticity modulus(Ep) and in IDR(0.08 ± 0.01vs.0.08 ± 0.02,p = 0.479) and TS(584.9 ± 135.5mmHg vs.529.7 ± 84.2,p = 0.095). We found correlations between cIMT(Z-score) and triglycerides, peripheral SBP Z-score, and ABPM MAP 24 h Z-score. CCA D correlated with BMI Z-score, uric acid and HDL-cholesterol, 24 h systolic blood pressure load(SBPL), Central systolic blood pressure(AoSBP) and peripheral diastolic BP Z-score. We found significant correlations between TS and uric acid, 24 h diastolic blood pressure load, and peripheral systolic and diastolic blood pressure Z-scores. There was no association between IDR and BP except for a weak correlation between IDR and SBPL. In PH patients, there was a strong correlation between cIMT and CCA D(r = 0.790,p &lt; 0.001). Conclusions: In children with PH, structural changes and decreased elasticity primarily affect the aorta and to a lesser extent the muscular arteries. In children with PH, both CCA wall thickness and internal diameter are associated with BP, and are significantly higher in children with PH. The changes observed in the carotid artery are probably adaptive in nature, not associated with impaired arterial function, thus intima-diameter ratio or tensile stress measurement does not appear to contribute additional information in this group of patients.