Composite Carotid Intima-media Thickness Research Articles

Composite carotid intima-media thickness as a risk predictor of coronary heart disease in a selected population in Sri Lanka.

Segment-specific variations of carotid intima-media thickness (CIMT) have not been assessed in South Asian populations. The purpose of this study was to determine if segment-specific CIMTs or a composite-CIMT score is a better risk predictor of coronary heart disease in South Asian populations. A comparative prospective study was conducted from November 2019 to October 2020 in a hospital in Colombo, Sri Lanka. Based on pre-defined inclusion and exclusion criteria, cases (having a diagnosis of Coronary Heart Disease (CHD), n = 338) and controls (non-CHD group, n = 356) were recruited. Ultrasound examination of the common carotid (CCA), the carotid bulb (CB) and the internal carotid segments (ICA) of the carotid vessels was conducted by a radiologist, and CIMTs were measured. A composite-CIMT score defined as the average value of all six segments of the left and right sides was derived. 694 participants were enrolled (male n = 399, 57.5%). The mean (±SD) age of the study sample was 60.2 (±9.86) years. There were variations in segment-specific values between the left and right vessels. The mean composite-CIMT value of the CHD group was significantly higher than that of the non-CHD group. A composite-CIMT score of 0.758 had a sensitivity of 98.4% and a specificity of 64.6% in distinguishing CHD from non-CHD groups (Area under the curve (AUC): 0.926). Carotid artery segment-specific CIMT variations were present in this population. The composite CIMT score is better than segment-specific CIMTs in predicting CHD and may be used to predict CHD in this population.

Abstract 9055: Vascular Age in Patients With Familial Hypercholesterolemia and/or Elevated Lipoprotein(a) Treated With Lipoprotein Apheresis

Introduction: The 2020 ASE guidelines indicate that an average mean carotid intima-media thickness (CIMT) ≥75th percentile for the patient’s age, sex, race/ethnicity is indicative of increased risk of atherosclerotic cardiovascular disease (ASCVD). With each 10 μm/year reduction of CIMT progression there is a relative risk reduction in the ASCVD event rate by 9% (95% confidence interval, 0.87-0.94). Published nomograms of CIMT percentiles determine “vascular age,” defined as the age at which the composite CIMT value for an individual would represent the median value. Hypothesis: Lipid-modifying treatment with lipoprotein apheresis (LA) over the course of 10 years will affect vascular age in patients with baseline elevated CIMT due to severe hypercholesterolemia. Methods: Ten individuals (mean age 60±9 years, 70% female) with familial hypercholesterolemia and/or elevated lipoprotein(a) [Lp(a)] were treated every two weeks with LA (Liposorber, Kaneka, Japan) between 2005 and 2020 (median duration, 12 years). Results: Acute effects of LA included reduction in LDL-C and Lp(a) levels by a median of 72±8% and 75±7%, respectively. The proportion of patients with average mean CIMT ≥75th percentile was 8/10 at the time of apheresis initiation. LA resulted in mean CIMT reduction of –40μm (IQR, –50 to 20). This translated into 70% (7/10) of cases demonstrating composite mean CIMT below their expected vascular age. The follow-up mean CIMT strongly correlated only with the baseline Lp(a) levels. The number of patients with CIMT above their “vascular age” decreased from 80% to 30% over treatment course. The rate of ASCVD was 37.5 per 1000 person-years while on LA. Conclusions: While annual CIMT progression rates average 15 μm/y, an increase in CIMT seen with advanced age and severe hypercholesterolemia was halted with LA with an estimated annual rate of change in mean common CIMT of –4 μm/y and maximum CIMT of –3μm /y. This analysis demonstrates positive impact of LA on vascular age.

Association between Lumbar Bone Mineral Density and Carotid Intima-Media Thickness in Korean Adults: a Cross-sectional Study of Healthy Twin Study.

Bone mineral density (BMD) has been suggested to be associated with atherosclerosis. In the present study, we evaluated the association between lumbar BMD and the segments of carotid intima-media thickness (CIMT), a surrogate marker of subclinical atherosclerosis, in Korean adults, with consideration of sex and menopause status. Among 1,679 Korean adults who enrolled in a Healthy Twin Study, 723 men, 690 premenopausal women, and 266 postmenopausal women measured the CIMT at the common carotid artery intima-media thickness (CCA-IMT), carotid bifurcation intima-media thickness (BIF-IMT), internal carotid artery intima-media thickness (ICA-IMT) using B-mode ultrasound and lumbar BMD using dual-energy X-ray absorptiometry. The composite CIMT was calculated as the mean value of three CIMTs. The association was evaluated using linear mixed models. In premenopausal women, lumbar BMD was positively associated with composite CIMT and with CCA-IMT (P = 0.008 and 0.002, respectively). However, no association was observed between BMD and CIMT in men or in postmenopausal women. Stratified analysis revealed the effect of body mass index (BMI) on the association between BMD and CIME. The positive association in premenopausal women persisted only in low BMI (< 25 kg/m2) group, whereas a positive association appeared at high BMI (≥ 25 kg/m2) group in men. A high lumbar BMD may indicate an elevated risk of subclinical atherosclerosis in premenopausal women and men with high BMI.

Abstract 495: Body Mass Index is Associated with Progression of Carotid Intima-Media Thickness in Black, but not in White Young Adults: The Bogalusa Heart Study.

Introduction: Increased Carotid intima-media thickness (CIMT) has been shown to be predictive of future cardiovascular events in middle-age and older adults, with this outcome being detrimentally enhanced by increased body adiposity -as measured by Body Mass Index (BMI). Hypothesis: We assessed the hypothesis that the association between BMI and CIMT varies among race (black/white) and gender groups. Methods: B-mode ultrasound images of the far walls for both carotid arteries were obtained from 676 community-based subjects, aged 24 to 43 years, enrolled in the Bogalusa Heart Study (70% white and 43% male). CIMT, BMI and traditional cardio metabolic (CM) risk factors were measured at baseline, and a second set of CIMT imaging was performed at follow-up after an average of 6.9 years. Composite CIMT was considered for the analyses. Progression of IMT was defined as an increase of IMT between examinations, that was greater than the upper endpoint of the 95% confidence interval of the mean difference between the baseline samples and their blind duplicates. Results: BMI was the only significant predictor of progression of CIMT within the general population (Odds Ratio [OR]= 1.062 p=0.0031), after controlling for age, race, sex and traditional CM risk factors. In race-specific analyses, BMI significantly influenced the odds of CIMT progression only in the black subpopulation (OR= 1.092 p&lt;0.0001). Gender-specific analyses showed independent association of these parameters in females only (OR= 1.063 p=0.0179). Conclusions: In conclusion, these findings help support the proposed hypothesis of racial and gender divergences in the association between BMI and progression of CIMT, which suggest that race (black-white) and gender-specific mechanistic differences exist in the impact of increased body adiposity on carotid artery disease. Further, these observations may help strengthen individualized race and gender approaches to cardio-metabolic risk prevention in the community.

Secondhand smoke exposure is associated with increased carotid artery intima-media thickness: The Bogalusa Heart Study

BackgroundSecondhand smoke (SHS) exposure increases cardiovascular disease risk. The objective of this study was to examine the association of SHS exposure in childhood and adulthood with adult arterial thickness. MethodsThe study cohort consisted of 415 nonsmoking adults (301 whites and 114 blacks; ages 26.2–48.0 years) enrolled in 2004–2010. The arterial wall thickness was measured as common, bulb and internal carotid artery intima-media thickness (IMT). SHS exposure data in childhood and adulthood were obtained by a questionnaire survey. ResultsIncreased adult composite carotid IMT was significantly associated with SHS exposure (regression coefficient, β = 53.1 μm, p < 0.001) after adjusting for race, age, gender, education, income, body mass index, systolic blood pressure, LDL cholesterol and triglycerides/HDL cholesterol ratio, with blacks (β = 81.2 μm, p = 0.005) and whites (β = 38.9 μm, p = 0.017) showing the same direction of the association. Furthermore, the SHS exposure in childhood showed a relatively stronger association with increased carotid IMT than the exposure in adulthood based on standardized βs (0.180 vs. 0.106); the same trend in the difference between childhood and adulthood exposure was noted for duration of SHS exposure (0.186 vs. 0.145). The covariates-adjusted composite carotid IMT showed a significant increasing trend by the order of exposure status of none, adulthood only, childhood only and both (p for trend<0.001). ConclusionsIf the relationship is causal, the associations observed in this study suggest that more awareness should be raised on the dangers of SHS exposure during childhood so that its effect may be mitigated and controlled early in the cardiovascular disease process.

Phenotypic and Genetic Relationships between Kidney Function and Carotid Intima-Media Thickness in Koreans: The Healthy Twin Study

Background: The phenotypic and genetic relationships between carotid intima-media thickness (CIMT) and estimated glomerular filtration rate (eGFR) or urinary albumin-creatinine ratio (ACR) were evaluated in Korean twins and families. Methods: We recruited 688 participants (296 individual twins and 392 singletons, age 30–74 years) who were without myocardial infarction and stroke among participants in the Healthy Twin Study. eGFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. CIMT was measured using B-mode carotid ultrasound. Covariates were sex, Framingham risk scores, alcohol use, exercise, BMI, high-sensitivity C-reactive protein and triglycerides. Quantitative genetic and linear mixed analyses were performed. Results: In adjusted models there were associations between kidney function and CIMT with [beta] estimates ranging from –0.022 to –0.032 between eGFR and CIMT, and from 0.042–0.060 between ACR and CIMT. The covariate-adjusted heritabilities for eGFR, ACR and composite CIMT were 0.75, 0.32 and 0.45, respectively (p < 0.001). The adjusted genetic correlation between eGFR and CIMT was from –0.20 to –0.28 (p < 0.05), whereas there was no genetic correlation between ACR and CIMT. Conclusion: Kidney function is a surrogate marker of carotid atherosclerosis and further studies of the pleiotropic relationships between CIMT and eGFR are warranted.

Subclinical Atherosclerotic Changes Related to Chronic Kidney Disease in Asymptomatic Black and White Young Adults: The Bogalusa Heart Study

Chronic kidney disease (CKD) remains asymptomatic until its late stage, and also significantly increases the risk of cardiovascular (CV) disease morbidity and mortality. However, information in scant on the prevalence of CKD, and its association with subclinical atherosclerosis as depicted by carotid intima media thickness (IMT) in younger adults. This cross-sectional study included 1193 participants (43% males, 30% blacks) aged 23 to 43 years, residing in the semi-rural biracial (black-white) community of Bogalusa, Louisiana. The measured variables include estimated glomerular filtration rate (eGFR) to determine functional renal changes and urine album creatinine ratio to diagnose albuminuria, along with CV risk factor variables, and both segmental and composite carotid IMT. Ninety-nine (8.5%) subjects had CKD, with blacks showing higher prevalence than whites (p= .01). Subjects with albuminuria had significantly greater internal carotid IMT (p = .03), common carotid IMT (p = .005), and composite carotid IMT (p = .04) than those without. In the multivariate logistic regression model, albuminuria was associated with black race (odds ratio [OR], 1.92; p = .005), female gender (OR, 2.24; p = .002), diabetes (OR, 6.26; p < .001), hypertension (OR, 2.36; p < .001), obesity (OR, 1.73; p = 0.02), and composite carotid IMT (OR, 1.83; p = .02), after adjusting for age. However, reduction in eGFR did not show significant independent association with carotid IMT. Among asymptomatic young adults, subclinical atherosclerosis and structural renal damage depicted by albuminuria coexist, which has implications for early prevention and control.

Distribution and Cardiovascular Risk Correlates of Plasma Soluble Intercellular Adhesion Molecule-1 Levels in Asymptomatic Young Adults from a Biracial Community: The Bogalusa Heart Study

That circulating soluble form of intercellular adhesion molecule-1 (sICAM-1) is associated with an increased risk for coronary artery disease is well recognized. However, information is scant regarding the distribution and cardiovascular (CV) risk correlates of sICAM-1 in asymptomatic young adults. Plasma sICAM-1 was measured in 1,184 black and white persons in the Bogalusa Heart Study cohort (70% white, 43% male), aged 24 to 44 years. CV risk was assessed in terms of CV risk factors, status of parental CV disease, and composite carotid intima-media thickness (IMT). sICAM-1 levels displayed race difference (whites > blacks, p<0.0001), but no sex difference. In multivariate analysis including age, race, sex, smoking status, waist circumference, mean arterial pressure, low- and high-density lipoprotein (LDL and HDL) cholesterols, triglycerides, insulin resistance index, C-reactive protein (CRP), and adiponectin, the significant predictors of sICAM-1, in order of entry, were race (white > black), smoking, CRP, and waist circumference. Furthermore, there was a smoking by waist circumference interaction in that smoking attenuated the magnitude of correlation between waist circumference and sICAM-1. Levels of sICAM-1 adjusted for age, race, sex, and smoking increased with number of metabolic syndrome components (p for trend<0.01); positive family history of CV disease (p<0.05); and increased in composite carotid IMT specific for age, race, and sex (p for trend<0.05). These findings underscore the potential value of plasma sICAM-1 as an additional biomarker for CV risk among asymptomatic young adults.

Effects of Consumption of Pomegranate Juice on Carotid Intima–Media Thickness in Men and Women at Moderate Risk for Coronary Heart Disease

This randomized, double-blind, parallel trial assessed the influence of pomegranate juice consumption on anterior and posterior carotid intima-media thickness (CIMT) progression rates in subjects at moderate risk for coronary heart disease. Subjects were men (45 to 74 years old) and women (55 to 74 years old) with > or =1 major coronary heart disease risk factor and baseline posterior wall CIMT 0.7 to 2.0 mm, without significant stenosis. Participants consumed 240 ml/day of pomegranate juice (n = 146) or a control beverage (n = 143) for up to 18 months. No significant difference in overall CIMT progression rate was observed between pomegranate juice and control treatments. In exploratory analyses, in subjects in the most adverse tertiles for baseline serum lipid peroxides, triglycerides (TGs), high-density lipoprotein (HDL) cholesterol, TGs/HDL cholesterol, total cholesterol/HDL cholesterol, and apolipoprotein-B100, those in the pomegranate juice group had significantly less anterior wall and/or composite CIMT progression versus control subjects. In conclusion, these results suggest that in subjects at moderate coronary heart disease risk, pomegranate juice consumption had no significant effect on overall CIMT progression rate but may have slowed CIMT progression in subjects with increased oxidative stress and disturbances in the TG-rich lipoprotein/HDL axis.

Differential impact of heart rate on arterial wall stiffness and thickness in young adults: The Bogalusa Heart Study

Heart rate, a hemodynamic parameter, is an important determinant of arterial wall stiffness. However, information on the relationship of heart rate to arterial wall thickness is inconsistent. This study examined the influence of heart rate on arterial stiffness and thickness in Black and White young adults. The study cohort consisted of 255 Black and 659 White adults age 25 to 43 years enrolled in the Bogalusa Heart Study. Carotid artery intima-media thickness (IMT) was measured by B-mode ultrasound and aorta-femoral pulse wave velocity (af-PWV) by echo-Doppler. There was no difference in heart rate between Blacks and Whites. Males vs. females displayed lower heart rate and higher segmental and composite carotid IMT; Blacks vs. Whites had higher composite carotid IMT (0.83 mm vs. 0.80 mm, P < .01) and af-PWV (5.4 m/s vs. 5.2 m/s, P < .01). In a multivariate regression model adjusting for traditional cardiovascular risk variables, heart rate was independently associated with af-PWV (standardized regression coefficient: β = .14, P = .01 for Blacks; β = .06, P = .07 for Whites; β = .09, P = .003 for total sample), but not with carotid IMT. These results indicate that heart rate plays differential roles in the development of arterial stiffness and subclinical atherosclerosis during young adulthood.

Distribution and Predictors of Carotid Intima‐Media Thickness in Young Adults

The authors' aim was to determine reference values and predictors for carotid intima-media thickness (CIMT) in the Bogalusa Heart Study. Carotid ultrasound images from 1203 young adults (mean age 36 years; 30% black, 43% male) were reviewed. Age-, sex-, and race-specific CIMT percentiles were estimated using multivariable regression. Nomograms of CIMT quartiles for persons aged 25 to 40 years are provided in 5-year increments. CIMT was thickest in the carotid bulb and increased linearly with age, most rapidly in the bulb. With age, composite CIMT increased most slowly in white women and more rapidly in white men and black women. Systolic blood pressure (P<.001) was the strongest predictor of composite CIMT. Male sex, total to high-density lipoprotein cholesterol ratio, and age independently predicted CIMT in all segments. This report may be used to help plan epidemiologic investigations and clinical trials investigating atherosclerosis and its changes with interventions.

Predictors of Carotid Intima-Media Thickness Progression in Young Adults

We sought to evaluate the predictors of carotid intima-media thickness (CIMT) progression in young adults and to determine whether they differed between the sexes. Although risk factors for the progression of atherosclerosis in middle-aged and elderly adults are well known, they are less well understood in young adults. CIMT is a validated measure of subclinical atherosclerosis. B-mode ultrasound images of the far walls of both carotid arteries were obtained in 336 young adults in the Bogalusa Heart Study, whose mean+/-SD age was 32.3+/-3.0 years. CIMT and risk factors were measured at baseline (1995-1996) and after 5.8+/-0.6 years. Multivariable regression was used to determine the predictors of CIMT progression. CIMT progression rates in women (0.015+/-0.024 mm/y) and men (0.020+/-0.027 mm/y) were not statistically different after controlling for body mass index (P=0.155). Smoking was a statistically significant predictor of common and composite CIMT progression in both sexes. In men, systolic blood pressure was an independent predictor of internal carotid and composite CIMT progression, fasting glucose predicted common CIMT progression, and family history predicted composite CIMT progression. In young adults, smoking was a consistent predictor of short-term CIMT progression in men and women. Traditional risk factors also predicted CIMT progression in men.

Increased Subclinical Atherosclerosis in Young Adults With Metabolic Syndrome: The Bogalusa Heart Study

The purpose of this study was to investigate the association of metabolic syndrome (MetS) with subclinical atherosclerosis, determined by ultrasound carotid intima-media thickness (CIMT) measurements, in young adults. Metabolic syndrome is associated with subclinical atherosclerosis and increased cardiovascular risk in older and middle-aged adults; however, these associations have not been studied among young adults. Non-diabetic subjects from Bogalusa Heart Study, a longitudinal study of atherosclerosis in young adults, underwent B-mode ultrasonography of the carotid arteries. Metabolic syndrome was defined with the National Cholesterol Education Program Adult Treatment Panel III (MetSNCEP) and World Health Organization (MetSWHO) definitions. CIMT and MetS associations were evaluated with multivariable regression and area under receiver-operator characteristic curve (AUC) analyses. Of 507 subjects (29% black, 39% male, mean [SD] age 32 [3] years), 67 (13%) had MetSNCEP and 65 (13%) had MetSWHO. Common (mean = 0.70 [0.11] mm vs. 0.66 [0.08] mm, p = 0.002) and internal CIMT (0.72 [0.21] mm vs. 0.68 [0.12] mm, p = 0.020) were higher among those with MetS(NCEP) than those without MetS(NCEP). Common (0.69 [0.11] mm vs. 0.66 [0.08] mm, p = 0.020) and internal CIMT (0.73 [0.23] mm vs. 0.68 [0.12] mm, p = 0.012) also were higher among those with MetSWHO than those without MetSWHO. Composite CIMT increased with the number of MetS components present (MetSNCEP r = 0.997, p < 0.001; MetSWHO r = 0.946, p = 0.053). Metabolic syndromeNCEP (AUC = 0.557, 95% confidence interval [CI] 0.513 to 0.601) and MetSWHO (AUC = 0.539, 95% CI 0.495 to 0.584) both predicted composite CIMT > or =75th percentile. In young adults, MetS is associated with increased atherosclerotic burden, and therefore, increased cardiovascular risk. These results support the importance of screening and early intervention in this population.

Distribution and Cross-Sectional Age-Related Increases of Carotid Artery Intima-Media Thickness in Young Adults

Reference values and age-related changes of carotid intima-media thickness (CIMT) have not been described in a community-based sample of young asymptomatic adults. CIMT measurements from the Bogalusa Heart Study, a study of the natural history of atherosclerosis in young adults and children, were used to characterize age-, race-, and sex-specific CIMT distributions and yearly rates of change. Age-, sex-, and race-specific CIMT percentile values and cross-sectional changes with age were estimated using B-mode carotid ultrasound images from 519 young adults (mean age 32 years, 61% female, 29% black). Nomograms of CIMT percentiles between the ages of 25 and 40 years are provided in 5-year increments. CIMT was thickest in the carotid bulb and increased linearly with age, most rapidly in the bulb. With age, composite CIMT increased most slowly in white females and most rapidly in white males. Sample size estimates projected that 268 to 462 subjects are needed to detect CIMT changes > or =0.010 mm/year. These estimated CIMT distributions and percentiles can serve as reference values for assessment of subclinical atherosclerosis in young adults. The observed age-related differences in CIMT can be used to plan epidemiological and clinical trials investigating atherosclerosis and anti-atherosclerotic interventions.

Alcohol consumption and carotid atherosclerosis in older adults: the Cardiovascular Health Study.

The association of alcohol use with atherosclerosis is inconsistent in previous studies. For the Cardiovascular Health Study, 5888 adults aged 65 years and older underwent a standardized interview and examination. They reported beer, wine, and liquor use individually and underwent B-mode ultrasonography to determine internal and common carotid intima-media thickness (IMT). We compared composite carotid IMT values cross-sectionally using linear regression to adjust for demographic and clinical characteristics. Among 4247 participants free of cardiovascular disease, consumers of 1 to 6 drinks per week had 0.07+/-0.04-mm lower composite IMT and consumers of 14 or more drinks per week had 0.07+/-0.05-mm higher IMT than abstainers (P quadratic trend=0.02). We found similar relationships using internal and common carotid thickness measures and among men and women. The higher IMT associated with heavier alcohol use was particularly strong among 1592 participants with confirmed cardiovascular disease (0.24+/-0.09 mm greater than abstainers). Controlling for HDL cholesterol levels reduced the effect on composite IMT among consumers of 1 to 6 drinks per week by 22%. Relative to older adults who abstain from alcohol, consumption of 1 to 6 drinks per week had an inverse association with carotid atherosclerosis whereas consumption of 14 or more drinks had a positive association.