Early Atherosclerosis In Patients Research Articles

Evaluation of epicardial adipose tissue thickness and carotid intima-media thickness in children with Behçet's disease.

Behçet's disease (BD) is a systemic vasculitis affecting all sizes of arteries and veins. Approximately 5-10% of patients with BD are present during childhood. The chronic nature of the disease may lead to serious cardiovascular complications over time including early atherosclerosis. Increased levels of epicardial adipose tissue (EAT) and carotid intima-media thickness (CIMT) are considered early signs of subclinical atherosclerosis. Ongoing chronic inflammation may cause to increase in both EAT and CIMT. In this study, we aimed to evaluate CIMT and EAT in children with BD and determine their relationship with the clinical manifestations and course of the disease. This cross-sectional study evaluated 30 patients with juvenile-onset BD and age-sex-matched 20 healthy controls. The CIMT and EAT thickness were measured by the same paediatric cardiologist. The association between clinical features, baseline disease activity, disease duration, EAT thickness and CIMT was also evaluated. Thirty children with BD and 20 age-sex-matched healthy volunteers enrolled in the study. The most common BD-related feature was oral aphthous (n=30), followed by mucocutaneous findings (n=22). Uveitis was observed in 5 patients, vascular involvement in 4, neurological involvement in 4, and gastrointestinal involvement in 2. All patients were inactive at the time of evaluation. The EAT thickness was significantly higher in patients while CIMT levels revealed no significant differences. However, there was no correlation between disease duration, baseline disease activity, and EAT thickness. Increased EAT thickness may be a risk factor for early atherosclerosis in patients with BD. The EAT thickness was found to be significantly higher in paediatric BD patients. Confirmation of results in larger series may provide better insight into early screening for risk factors in these patients.

Evaluation of Novel Biomarker of Early Atherosclerosis in Patients With Chronic Kidney Disease in Wasit Governorate

The aim of the study was to evaluate some Biomarkers in patients with athreoscelerosis in Wasit Province. Atherosclerosis is a chronic arterial disease and a major cause of vascular death. Fatty streaks in arterial walls gradually develop into atheroma and characteristic plaques. The acute rupture of these atheromatous plaques causes local thrombosis, leading to partial or total occlusion of the affected artery. The clinical consequences of these plaques depend on their site and the degree and speed of vessel occlusion . Its major clinical manifestations include ischemic heart disease (IHD), ischemic stroke, and peripheral arterial disease. The study took place in the a hemodialysis unit Al-Zahraa Teaching Hospital in Wasit Governorate during the period from November 2023 to April 2024. This study aimed to examine risk factors (age, gender, high blood pressure, smoking, left ventricular hypertrophy, diabetes mellitus, dyslipidemia, physical inactivity) for atherosclerosis in the general population and patients with chronic kidney disease. Also studying the effect of some novel biomarkers (Homocysteine, Fibrinogen, myeloperoxidase, lipoprotein-associated phospholipase A2, pentraxin 3). The study include (90) samples: (60) patients suffering from early atherosclerosis and chronic kidney disease (dialysis stage) and 30 samples of healthy people (control group), their ages ranged from (40 to 70 years). The samples were divided into two age groups, where the first group had an average age of 40-55 years and the second group was 56-70 years old , the categories were divided equally into males and females Samples were collected based on the incidence of kidney disease first, and then the main risk factors of early atherosclerosis were relied upon, which are (smoking, age, sex, dyslipidemia, hypertension, diabetes, left ventricle valve, physical inactivity). The results of our study regarding diagnostic markers of atherosclerosis showed a significant increase in biomarkers (MPO, PTX3, HCy, FG and LpPLA2)of infected people at p ≥ 0.5. In patients with atherosclerosis the level of new biomarkers showed a significant increase in serum of infected people compared to healthy people at p<0.5. This is an important indication of the importance of these biomarkers in detecting the disease.

T-cell senescence was correlated with early atherosclerosis inpatients with systemic lupus erythematosus.

To investigate the correlation between T-cell senescence with the atherosclerosis markers in patients with systemic lupus erythematosus (SLE). The study participants were 40 female SLE patients aged 18-45 years who met the 2019 EULAR/ACR criteria and 40 healthy individuals. The atherosclerosis markers were investigated using the Doppler ultrasonography examinations to measure the cIMT (carotid intima-media thickness) and flow-mediated dilation (FMD) and serological markers using soluble ICAM-1 and VCAM-1. Flow cytometry of CD4+CD57+, CD8+CD57+, CD4+CD28null, and CD8+CD28null T cells were used to assess the immunosenescence markers. The cIMT (p < .001), sICAM-1 (p < .001), and sVCAM-1 (p < .001) were significantly higher in SLE patients compared with control, while FMD was significantly lower in SLE patients (p < .001). The percentages of all T-cell senescence markers are also significantly higher in SLE patients than in healthy individuals. Positive correlations were shown between cIMT with the CD4+CD57+ (R = .301, p = .005), CD4+CD28null (R = .448, p < .001), and CD8+CD28null (R = .422, p < .001). Conversely, negative correlations were demonstrated between the FMD with CD4+CD57+ (R = -.236, p = .023), CD8+CD57+ (R = -.409, p < .001), CD4+CD28null (R = -.422, p < .001), and CD8+CD28null (R = -.318, p = .003). The soluble markers of sICAM-1 and sVCAM-1 were also positively correlated with the T-cell senescence markers. Early sign of atherosclerosis was demonstrated in patients with SLE in this study. T-cell senescence markers had significant correlations with the atherosclerosis markers, including the cIMT, FMD, and soluble adhesion molecules levels. Understanding the link between immunosenescence and atherosclerosis might help to identify a new method for early detection and treatment of atherosclerosis in SLE.

Evaluation of Some Hematological and Biochemical Parameters of Early Atherosclerosis in Patients with Chronic Kidney Disease in Wasit Governorate

The aim of the study was to evaluate some Hematological and Biochemical Parameters in patients with early atherosclerosis in Wasit Governorate. atherosclerosis is one of the leading causes of death among the aged. The localized deposition of fat in the arteries, along with the development of smooth muscle cells and a fibrous matrix, is the primary issue with atherosclerosis. The study took place in a hemodialysis unit Al-Zahraa Teaching Hospital in Wasit Governorate during the period from November 2023 to April 2024. This study aimed to studying the effect of biochemical and blood indicators of atherosclerosis in patients with chronic kidney disease for the purpose of predicting early cases of atherosclerosis in patients with chronic kidney disease and finding solutions to reduce them. Study includes (90) samples: (60) patients suffering from early atherosclerosis and chronic kidney disease (dialysis stage) and 30 samples of healthy people (control group), their ages ranged from (40 to 70 years). The samples were divided into two age groups, where the first group had an average age of 40-55 years and the second group was 56-70 years old, the categories were divided equally into males and females Samples were collected based on the incidence of kidney disease first, and then the main risk factors of early atherosclerosis were relied upon, which are (smoking, age, sex, dyslipidemia, hypertension, diabetes, left ventricle valve, physical inactivity). The results of our study regarding diagnostic markers of atherosclerosis showed a significant increase cholesterol, HDL and LDL at p ≤ 0.5, while a significant decrease in triglycerides at p ≥ 0.5, and Biochemical indicators (albumin and globulin) showed a decrease in significance at p ≥ 0.5, while significance was high for C-reactive protein. The result of the sedimentation rate test (ESR) and the platelet result showed a significant increase at p ≤ 0.5. While differential white blood cell results did not appear significant in the study at p ≥ 0.5. Conclusions: In patients with early atherosclerosis the level of cholesterol, HDL and LDL and ESR, Platelet showed a significant increase at p ≤ 0.5 for infected people, while a significant decrease in triglycerides at p ≥ 0.5. also, the (albumin and globulin) showed a decrease in significance at p ≥ 0.5, while significance was high for C-reactive protein. This is an important indication of the importance of these parameters to detecting the disease.

Carotid Intima-Media Thickness in Surgically or Conservatively Managed Patients With Primary Hyperparathyroidism.

Current evidence of cardiovascular (CV) risk in primary hyperparathyroidism (PHPT) is still inconsistent. To prospectively investigate changes of early atherosclerosis in patients with PHPT undergoing parathyroidectomy (PTx) or conservative management, according to consensus criteria. Biochemical parameters of PHPT, CV risk factors (systolic and diastolic blood pressure, cholesterol [total, high-density, and low-density], triglyceride, HbA1c, HOMA-IR), and carotid intima-media thickness (IMT) and plaque were assessed in 52 consecutive postmenopausal PHPT patients both at baseline and ≥ 24 months after surgery (PTx, n = 22) or conservative management (non-PTx, n = 30). At baseline, PTx and non-PTx showed comparable age, BMI, renal function, and 25(OH)D levels, and did not differ for CV risk factors, IMT and plaques, or for prevalence of smoking, diabetes mellitus, or antihypertensive or statin therapy, while all parameters characterizing PHPT differed. Follow-up duration in PTx was longer than in non-PTx (P = .004). Parameters characterizing PHPT significantly improved ≥ 24 months after surgery, whereas in non-PTx serum phosphate slightly decreased and parathyroid hormone increased. Systolic and diastolic blood pressure increased at follow-up in both groups, while other CV risk factors did not significantly vary. In PTx, IMT did not significantly vary after surgery (0.85 ± 0.14 to 0.89 ± 0.22 mm, P = .366), whereas it significantly increased in non-PTx (0.80 ± 0.18 to 0.93 ± 0.23 mm, P = .008), even adjusting for blood pressure. Plaque prevalence and incidence did not significantly differ in the 2 groups. Our results suggest that in postmenopausal patients with PHPT, subclinical atherosclerosis could be halted by PTx, whereas it worsens over time in nonoperated patients with milder disease.

Abstract 151: Age‐Related Increases in Carotid Artery Calcification: Insights from NaF PET/CT Imaging

Introduction Atherosclerosis, the hardening and narrowing of the arteries, occurs due to the buildup of plaque on the inner walls of the arteries which can result in reduced blood flow to the organs and tissues. Risk factors such as smoking, chronic kidney disease, and aging can contribute to plaque formation. The gradual loss of elasticity in arterial walls and the presence of other risk factors, such as high blood pressure and diabetes, contribute to the increased risk of cardiovascular disease (CVD) observed in aging populations. Early detection through sensitive and specific imaging methods is important for the detection and treatment of CVD. 18F‐Sodium Fluoride positron emission tomography/computerized tomography (NaF‐PET/CT) can be utilized to detect and quantify molecular calcification and therefore early atherosclerosis in patients with CVD. Research has shown a positive correlation between NaF uptake in the common carotid arteries/thoracic aorta and cardiovascular/thromboembolic risk. This study aims to assess the effect of aging on NaF uptake in the left common carotid artery (LCC) in subjects with known cardiovascular risk factors. Methods In total, 36 subjects (mean age 55.4 ± 12.3 years, 50% males) with known cardiovascular risk factors underwent FDG‐PET/CT. Participants were recruited from a group of patients with chest pain syndromes who were referred for coronary CT angiography. Individuals who were not taking any blood pressure medications and who had a greater than 1% increased risk of fatal CVD, estimated by the systematic coronary risk evaluation tool, were eligible for inclusion into the at‐risk for CVD group. NaF PET/CT was performed 90 min after the intravenous injection of 2.2 MBq of NaF/kg. NaF uptake in the LCC was quantitatively assessed by measuring the blood‐pool‐corrected maximum standardized uptake value (SUVmean) on each axial slice. Pearson’s R was calculated and evaluated for significance in all variables. The threshold for significance was set at P &lt; 0.05. Results A significant association between age in patients with cardiovascular risk factors and NaF uptake in the LCC artery was found. Age positively correlated with NaF uptake (r=0.472, p= 0.004) across all 36 patients. Conclusion Our results demonstrate that NaF uptake increases in the LCC with age in subjects with known cardiovascular risk factors. The strong association between age and calcification of the carotid arteries within a population of individuals with unfavorable cardiovascular and thromboembolic risk profiles demonstrates the potential of NaF PET/CT. NaF PET/CT may allow physicians to evaluate effectiveness of treatment and determine a patient's risk for CVD. However, additional trials are needed to further evaluate the associations found in this study and determine relevance in a clinical setting.

Reduced Diversities and Clonally Expanded Sequences of T-Cell Receptors in Patients With Essential Hypertension and Subclinical Carotid Atherosclerosis.

It has long been hypothesized that the abnormal immune responses contribute to the essential hypertension (EH) and its subclinical target organ damage (STOD). However, the mechanism is unclear. This study aimed at exploring the potential association with abnormal T-cell responses and EH, STOD, and early atherosclerosis in patients with EH. This cross-sectional study included 146 patients with EH and 73 age-matched normotensive individuals. The expressed peripheral TCR (T-cell receptor) β repertoire was analyzed by high through-put sequencing. The TCRβ repertoires of the patients with EH were significantly different, with significantly elevated certain TCR beta variable (TRBV) and joint (TRBJ) gene usages, significantly reduced TCRβ diversity indexes (diversity 50s) and numbers of total TCRβ clonal types, significantly elevated percentages of the biggest TCRβ clones and numbers of clones accounting >0.1% sequences, compared with those in the normotensive controls. Decreased diversity 50s and increased biggest TCRβ clone percentages were independently correlated with carotid intima-media thickness and subclinical carotid atherosclerosis (SCA) in the patients with EH. Moreover, the diversity 50s were further significantly reduced and the biggest TCRβ clone percentages were significantly increased in the patients with EH with SCA (n=89) comparing to the patients with EH/patients without SCA (n=57), and in patients with EH/SCA with carotid plaque (n=22) comparing to patients with EH/SCA/patients without carotid plaque (n=67). Importantly, specific TCRβ clones were identified in different subgroups of the patients with EH. These results reveal that abnormal T-cell responses may play important roles in the progression of EH and its SCA, especially the formation of carotid plaque. URL: https://www.chictr.org.cn; Unique identifier: ChiCTR2100054414.

Carotid Intimomedial Thickness (CIMT) in Patients with Rheumatoid Arthritis; the Need for More Aggressive Cardiovascular Screening in RA.

To use carotid intimal medial thickness as a marker of early atherosclerosis in patients with rheumatoid arthritis. Cross-sectional descriptive study. Place and Duration of the Study: Rheumatology Unit of Federal Government Polyclinic Hospital, Islamabad, from 1st June 2019 till 30th January 2022. The study included 190 patients divided equally into cases of rheumatoid arthritis and healthy control groups. Carotid intimal medial thickness was measured using the carotid doppler ultrasound. The mean values of both the study groups were evaluated using the independent sample t-tests. Different statistical tests for correlation were also used where appropriate. This study included a total of 190 patients, 95 each in case and control groups. There were 15 (15.8%) males and 80 (84.2%) females with mean age of 43.5±12.8 years among cases, while 27 (28.4%) males and 68 (71.6%) females with mean age of 43.1±10.1 years in the control group. A significantly higher number of cases had a carotid intima-media thickness of more than 0.6 mm as compared to controls (43.2% vs. 25.3%, p=0.009). Cases with seropositive status were 1.98 times more likely to have higher carotid intima-medial thickness compared with controls. Carotid intima-media thickness measurement is important as a surrogate marker of atherosclerotic process in patients with rheumatoid arthritis. Rheumatoid arthritis (RA), Carotid intimal medial thickness (CIMT), Atherosclerosis, Cardiovascular disease (CVD).

Positive correlation between lipid accumulation product index and arterial stiffness in Chinese patients with type 2 diabetes.

Many studies have confirmed that lipid accumulation products (LAP) predict arterial stiffness (AS) in hypertensive patients. But there is little research on the use of LAP in identifying early atherosclerosis in patients with type 2 diabetes mellitus (T2DM). The aim of this study was to determine the relationship between the LAP index and brachial-ankle pulse wave velocity (baPWV) in Chinese patients with T2DM. A total of 1471 Chinese participants with T2DM, ranging in age from 18 to 80, were included in this cross-sectional study. BaPWV measurements were used to calculate the AS. A baPWV greater than the 75th percentile (1700 cm/s) was defined as indicating increased AS. The LAP index was calculated from the combination of waist circumference (WC) and triglycerides (TG). According to the quartiles of the LAP index, baPWV tended to increase after adjusting for sex and age. Multiple linear regression analysis showed that the beta coefficient (β) of baPWV increased by 31.0 cm/s for each unit of lnLAP that was increased, and the 95% confidence interval (CI) was (6.5, 55.5) cm/s. In multivariate logistic regression analyses, after fully adjusting for confounders, the risk of elevated baPWV increased with each unit increase in lnLAP, with an odds ratio (OR) of 1.3 (95% CI: 1.0, 1.8). According to the generalized additive model (GAM), we found that lnLAP was positively correlated with baPWV and baPWV elevation. The results were the same for males and females. Subgroup analyses showed that the positive correlation between lnLAP and elevated baPWV did not interact across all subgroups. In Chinese patients with T2DM, LAP was strongly and positively correlated with baPWV and elevated baPWV.

1099-P: Truncal Fat–to–Leg Fat Ratio and Carotid Plaque Score in Patients with Type 2 Diabetes

High truncal fat is known to be a risk factor for cardiovascular disease (CVD) , but high leg fat has a protective effect on CVD. We investigated the association between truncal fat-to-leg fat ratio (TLR) and carotid plaque score PS) in patients with type 2 diabetes (T2D) . A total of 1966 participants aged over 30 years and having T2D were recruited. Truncal fat, leg fat, and appendicular muscle mass (ASM) were measured using dual-energy X-ray absorptiometry and Carotid intima-media thickness (CIMT) and PS were assessed using high-resolution B-mode ultrasonography. High PS was defined as PS ≥ 3. The prevalence of plaque and high PS were 72.0% and 40.0%, respectively. Patients with high PS were more likely to be old, male, and hypertensive and had higher systplic blood pressure (SBP) , diabetic duration (DD) , serum creatinine (Cr) , and TLR, but lower values of diastolic BP, truncal and leg fat, HDL, and estimated glomerular filtration rate (eGFR) than those without high PS. Participants in the highest TLR tertile group were older and more hypertensive and had higher DD, SBP, waist circumference (WC) , body mass index (BMI) , HOMA-IR, glycated A1c (HbA1c) , triglycerides (TG) , serum Cr, CIMT, and PS, but lower ASM/BMI, HDL, and eGFR than those in the lowest TLR tertile group. The prevalence of high PS progressively increased with increasing TLR tertiles (Lowest vs. Middle vs. Highest = 33.4 vs. 41.0 vs. 45.7%, respectively, p &amp;lt; 0.001) . After adjusting age and sex, the odd ratios (ORs) and 95% confidence intervals (CIs) for high PS were 1.39 (1.- 1.79, p = 0.01) in the middle and 1.65 (1.28 - 2.11, p = &amp;lt; 0.001) in the highest tertile groups. After further adjusting for hypertesnsion, WC, BMI, SBP, DD, HbA1c, HOMA-IR, HDL cholesterol, TG, and eGFR, the ORs and 95% CIs in the middle and highest tertile groups remained significant. In conclusion, higher TLR was independently associated with carotid PS in patients with T2D. Therefore, we suggest that high TLR may be a risk factor for early atherosclerosis in patients with T2D. Disclosure J.Shin: n/a.

Relation between Red cell distribution width and Early Atherosclerosis in patients with Beta Thalassemia

Relation between Red cell distribution width and Early Atherosclerosis in patients with Beta Thalassemia

Effect of obstructive sleep apnea syndrome on glycolipid metabolism and early atherosclerosis in diabetics

ObjectiveTo study the changes in glucose and lipid metabolism indexes and the condition of early atherosclerosis in patients with diabetes with and without obstructive sleep apnea syndrome (OSAS). MethodsPatients with type 2 diabetes mellitus (DM) aged 32–50 years who did not have significant complications were included. A total of 42 patients with DM with OSAS and 46 patients with DM without OSAS were chosen according to their sleep monitoring indexes. Height and weight were measured, and fasting blood glucose, postprandial blood glucose, endothelin (ET), nitric oxide (NO) and lipid profile were tested. Then, all the subjects were subjected to the pulse wave velocity (PWV) test. ResultsThe levels of glycated haemoglobin and triglycerides were significantly higher in patients with DM with OSAS than those in patients with DM without OSAS. ET, NO and PWV changed significantly. ConclusionPatients with diabetes with OSAS are more likely to have complications related to arteriosclerosis and aggravation of glycolipid metabolism disorder. Early intervention is recommended.

Metabolic Profile and the Risk of Early Atherosclerosis in Patients with Obesity and Overweight

Obesity and Overweight have the highest rate of incidence and prevalence in the past 3 decades, as global pathologies. The purpose of this study was to evaluate cardiovascular, classic and modern risk factors in overweight and obese patients by studying lipid metabolism (total cholesterol, HDL-cholesterol, non-HDL-cholesterol, LDL-cholesterol, serum triglycerides), glucose metabolism, insulin resistance and insulin sensitivity, the prevalence of hypertension (HBP) and the prevalence of metabolic syndrome (MS). This analytical study was performed on 111 subjects divided as follows: Group I consisting of 27 normal weight subjects - NW; Group II consisting of 84 overweight and obese subjects - OW + O: 36 overweight patients - OW; 33 patients with grade I obesity - O-I; 13 patients with grade II obesity - O-II; 2 patients with grade III obesity - O-III. The overweight and obese, although unknown with heart disease, have significant metabolic changes, such as atherogenic dyslipidemia, dysglycemia, high insulin resistance and low insulin sensitivity, metabolic syndrome, these being the first steps towards endothelial dysfunction and early atherosclerosis.

Metabolic Profile and the Risk of Early Atherosclerosis in Patients with Obesity and Overweight

Obesity and Overweight have the highest rate of incidence and prevalence in the past 3 decades, as global pathologies. The purpose of this study was to evaluate cardiovascular, classic and modern risk factors in overweight and obese patients by studying lipid metabolism (total cholesterol, HDL-cholesterol, non-HDL-cholesterol, LDL-cholesterol, serum triglycerides), glucose metabolism, insulin resistance and insulin sensitivity, the prevalence of hypertension (HBP) and the prevalence of metabolic syndrome (MS). This analytical study was performed on 111 subjects divided as follows: Group I consisting of 27 normal weight subjects - NW; Group II consisting of 84 overweight and obese subjects - OW + O: 36 overweight patients - OW; 33 patients with grade I obesity - O-I; 13 patients with grade II obesity - O-II; 2 patients with grade III obesity - O-III. The overweight and obese, although unknown with heart disease, have significant metabolic changes, such as atherogenic dyslipidemia, dysglycemia, high insulin resistance and low insulin sensitivity, metabolic syndrome, these being the first steps towards endothelial dysfunction and early atherosclerosis. Keywords: obesity, metabolism changes, insulinoresistance, overweight

Assessment of Subclinical Atherosclerosis in Vitamin D Deficiency.

Patients with vitamin D deficiency (VDD) have potential to have increased cardiovascular morbidity and mortality. In this study, we aimed to discover the findings of early atherosclerosis in patients with VDD by measuring carotid intima-media thickness (CIMT) and epicardial fat thickness (EFT). The study population includes 52 patients with VDD (n = 30 [57% female], mean ± SD age 54.28 ± 8.77 years, mean ± SD serum 25-hydroxyvitamin D (25 [OH] D) 11 ± 2.4 ng/mL) and 82 participants for control group (n = 52 [63.4% female], mean ± SD age 56.40 ± 7.90 years, mean ± SD serum (25 [OH] D) 53 ± 4.2 ng/mL) who have no cardiovascular disease. Carotid intima-media thickness was assessed by using ultrasonography, and EFT was measured on the free wall of the right ventricle at end diastole from the parasternal long-axis views by standard transthoracic 2-dimensional echocardiography. Both CIMT and EFT were significantly higher in patients with VDD compared with controls (0.75 ± 0.16 mm vs 0.68 ± 0.21 mm, P < 0.05, and 0.66 ± 0.15 cm vs 0.56 ± 0.15 cm, P < 0.001). Patients with VDD seem to have increased CIMT and EFT, which are predictors of atherosclerotic process. Further studies are needed to confirm these results.

Unusual CD4+CD28− T lymphocyte subset is implicated in the pathogenesis of early atherosclerosis in patients with rheumatoid arthritis

BackgroundRheumatoid arthritis (RA) is associated with accelerated atherosclerosis which is not fully explained by traditional risk factors. Such excess risk appears to be driven by systemic inflammation. Aim of the workAim of the work was to compare between RA patients with and without CD4+CD28− T-cell expansion regarding carotid intima-media thickness (IMT) and brachial artery flow-mediated endothelium-dependent dilatation (FMEDD), as markers of early atherosclerosis. Patients and methodsThe study was conducted on 39 female patients with no overt cardiovascular disease or risk factor and 28 age matched females as controls. Atherosclerotic changes were assessed through measurement of carotid IMT and FMEDD. CD4+CD28− T-cells were assessed by flow cytometry. ResultsThe mean age of the patients was 34.9 ± 5 years and the disease duration of 6.1 ± 2.1 years. Traditional risk factors were comparable between patients and controls. Serum homocysteine level tended to be higher in the patients (11 ± 4.21 μmol/L) compared to the control (9.91 ± 3.61 μmol/L). Patients had significantly higher carotid IMT (0.83 ± 0.24 mm vs 0.6 ± 0.15 mm, p = 0.008) and lower FMEDD (3.27 ± 1.49% vs 6.01 ± 1.79%, p = 0.002). Similarly, patients with CD4+CD28− expansion (n = 12) had significantly higher IMT (1 ± 0.23 mm) and lower FMEDD (2.25 ± 1.06%) compared to those without (n = 27) (0.76 ± 0.21 mm and 3.67 ± 1.47%); p = 0.01, p = 0.01 respectively; but not affected by receiving methotrexate or not. Laboratory investigations were comparable in patients with and without expansion. ConclusionCD4+CD28− cells may contribute to the development of premature atherosclerosis in RA patients. Further studies are recommended to evaluate the benefit of CD4+CD28− T-cell modulation on the future development of atherosclerosis in these patients.

Correlation between neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, mean platelet volume and early atherosclerosis in newly diagnosed type 2 diabetes mellitus

Objective To investigate the possibility of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and mean platelet volume (MPV) as biomarker for early atherosclerosis in patients with newly diagnosed type 2 diabetes. Methods 420 newly diagnosed type 2 diabetes were enrolled in the study. They were divided into three groups: patients with normal carotid artery were group A (n=152), patients with unilateral carotid plaque were group B (n=138), patients with bilateral carotid plaque were group C (n=130). Their neutrophil, lymphocyte, mean platelet volume, lipid and glucose, carotid intimal medial thickness (CIMT), ankle brachial index (ABI) were all performed in these individuals. Results Compared with group A, the age, systolic pressure, neutrophil count (NC), platelet count (PLT), NLR, PLR, low density lipoprotein-cholesterol (LDL-C), total cholesterol (TC), fasting blood glucose (FBG), hemoglobin A1c (HbA1c) and CIMT were higher while ABI were lower in group B and group C; Compared with group B, the age, systolic pressure, NC, PLT, NLR, PLR, LDL-C, TC, CIMT and were higher while ABI was lower in group C (P<0.05). CIMT was positively correlated to age, systolic pressure, NLR, PLR, LDL-C, TC, FBG and HbA1c (P<0.05) while ABI was negtively correlated to age, NLR, PLR, LDL-C, FBG and HbA1c (P<0.05). In multiple linear regression analyses, after adjustment for age, lipid, glucose and so on, NLR and PLR were also significantly correlated to CIMT and ABI. Conclusions NLR and PLR were significantly correlated with CIMT and ABI in newly diagnosed type 2 diabetes. Therefore, NLR and PLR may have the potential to serve as biomarkers for early arteriosclerosis in type 2 diabetic patients. Key words: Diabetes mellitus, type 2/CO/ME; Atherosclerosis/CO/ME; Neutrophils/ME; Lymphocytes/ME; Blood platelets/ME

The predictive value of plasma visfatin and adiponectin in early atherosclerosis in patients with type 2 diabetes

Objective To evaluate the association between plasma levels of visfatin and adiponectin with carotid arterial intima-media thickness in patients with type 2 diabetes. Methods A total of 100 elderly patients with type 2 diabetes and 30 healthy elderly controls were recruited from August 2015 to August 2016 at our hospital.Based on carotid arterial intima-media thickness(IMT)assessed via color Doppler ultrasonography, patients with diabetes were further divided into a thickened IMT group(40 cases)and a non-thickened IMT group(60 cases). Plasma levels of visfatin and adiponectin were analyzed and compared, and their associations with carotid arterial IMT were evaluated. Results Compared with the control group, patients in both the thickened IMT group and the non-thickened IMT group had significantly higher serum levels of visfatin(19.1±2.8)μg/L vs.(40.6±3.9)μg/L, (28.9±3.6)μg/L, which was markedly higher in the thickened IMT group than in the non-thickened IMT group(P<0.05). In addition, compared with the control group, patients in the thickened IMT group and the non-thickened IMT group had significantly lower serum levels of adiponectin(1 590±330)mg/L, (610±170)mg/L, (930±210)mg/L, which was markedly lower in the thickened IMT group than in the non-thickened IMT group(P<0.05). Furthermore, Pearson's analysis showed that the plasma level of visfatin was positively correlated with carotid arterial IMT(r=0.721, P<0.05), and the plasma level of adiponectin was negatively correlated with carotid arterial IMT(r=-0.688, P<0.05). Conclusions Plasma levels of visfatin and adiponectin are closely related to carotid arterial IMT in patients with type 2 diabetes, andmay be used as plasma markers for the prediction of early atherosclerosis. Key words: Nicotinamide phosphoribosyltransferase; Adiponectin; Diabetes mellitus, type 2; Carotid arterial

Evaluation of Endothelial Function by Flow-Mediated Dilation: a Comprehensive Review in Rheumatic Disease.

Flow-mediated dilation (FMD) represents a non-invasive marker of endothelial function to evaluate vascular homeostasis, which reflects the effects of several mechanisms, including vessel tone regulation, cell proliferation, and inflammatory responses. Beyond classical atherosclerotic risk factors such as arterial hypertension, diabetes mellitus, smoking, obesity, and dyslipidemia, chronic inflammation contributes to the endothelial dysfunction causing plaque formation and there is growing evidence of a significantly higher cardiovascular morbidity associated with autoimmune diseases. The endothelium reacts to several endogenous and exogenous stimuli, through surface receptors and intracellular signalling, and releases numerous vasoactive substances, including endothelins, prostacyclins, and nitric oxide (NO). Chronic inflammatory rheumatic diseases are commonly associated with decreased endothelial NO production, vascular damage, and premature atherosclerosis. Despite partially eclipsed by pulse wave velocity measure in the modern scientific literature, we provide a comprehensive overview and critically discuss the available data supporting FMD as a surrogate marker of endothelial function and, therefore, its potential role in predicting early atherosclerosis in patients with rheumatic diseases.

Augmentation index is increased in patients with inflammatory bowel disease, a meta-analysis

In a work published in a recent issue of the European Journal of Internal Medicine [ [1] Cappello M. Licata A. Calvaruso V. et al. Increased expression of markers of early atherosclerosis in patients with inflammatory bowel disease. Eur J Intern Med. 2017; 37: 83-89 Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar ], Cappello et al. found that, despite the lower prevalence of dyslipidemia, carotid-femoral pulse wave velocity, a measure of arterial stiffness, and augmentation index, a measure of wave reflection, were significantly increased in patients with inflammatory bowel disease (IBD), a disease characterized by chronic inflammation. This finding confirms the results of our previous works [ 2 Zanoli L. Cannavò M. Rastelli S. et al. Arterial stiffness is increased in patients with inflammatory bowel disease. J Hypertens. 2012; 30: 1775-1781https://doi.org/10.1097/HJH.0b013e3283568abd Crossref PubMed Scopus (72) Google Scholar , 3 Zanoli L. Rastelli S. Inserra G. et al. Increased arterial stiffness in inflammatory bowel diseases is dependent upon inflammation and reduced by immunomodulatory drugs. Atherosclerosis. 2014; 234: 346-351https://doi.org/10.1016/j.atherosclerosis.2014.03.023 Abstract Full Text Full Text PDF PubMed Scopus (55) Google Scholar ] and is of clinical interest because it helps explain why IBD patients have an increased cardiovascular risk despite the low prevalence of traditional cardiovascular risk factors [ [4] Zanoli L. Inserra G. Castellino P. Increased cardiovascular risk in subjects with a low prevalence of classic cardiovascular risk factors: the inflammatory bowel disease paradox. Trends Cardiovasc Med. 2015 Nov; 25: 705-706https://doi.org/10.1016/j.tcm.2015.04.001 Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar ]. In this regard, the significantly higher augmentation index reported by Cappello et al. in IBD patients treated with salicylates are consistent with current evidences showing that chronic inflammation could play a role in the arterial stiffening of patients with IBD [ 2 Zanoli L. Cannavò M. Rastelli S. et al. Arterial stiffness is increased in patients with inflammatory bowel disease. J Hypertens. 2012; 30: 1775-1781https://doi.org/10.1097/HJH.0b013e3283568abd Crossref PubMed Scopus (72) Google Scholar , 3 Zanoli L. Rastelli S. Inserra G. et al. Increased arterial stiffness in inflammatory bowel diseases is dependent upon inflammation and reduced by immunomodulatory drugs. Atherosclerosis. 2014; 234: 346-351https://doi.org/10.1016/j.atherosclerosis.2014.03.023 Abstract Full Text Full Text PDF PubMed Scopus (55) Google Scholar , 4 Zanoli L. Inserra G. Castellino P. Increased cardiovascular risk in subjects with a low prevalence of classic cardiovascular risk factors: the inflammatory bowel disease paradox. Trends Cardiovasc Med. 2015 Nov; 25: 705-706https://doi.org/10.1016/j.tcm.2015.04.001 Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar , 5 Zanoli L. Rastelli S. Granata A. et al. Arterial stiffness in inflammatory bowel disease: a systematic review and meta-analysis. J Hypertens. 2016; 34: 822-829https://doi.org/10.1097/HJH.0000000000000867 Crossref PubMed Scopus (39) Google Scholar , 6 Zanoli L. Rastelli S. Inserra G. Castellino P. Arterial structure and function in inflammatory bowel disease. World J Gastroenterol. 2015; 21: 11304-11311https://doi.org/10.3748/wjg.v21.i40.11304 Crossref PubMed Scopus (39) Google Scholar ]. This finding is also in accordance with the results of two recent meta-regression analyses that has suggested a lack of efficacy of salicylates in protecting IBD patients from arterial stiffening [ [7] Zanoli L, Boutouyrie P, Lentini P, et al. Maintenance therapy with salicylates is associated with aortic stiffening in patients with inflammatory bowel disease. J Hypertens [in press]. http://dx.doi.org/10.1097/HJH.0000000000001235. Google Scholar ] and the destiffening effect of anti-tumor necrosis factor α (anti-TNFα) therapy [ [5] Zanoli L. Rastelli S. Granata A. et al. Arterial stiffness in inflammatory bowel disease: a systematic review and meta-analysis. J Hypertens. 2016; 34: 822-829https://doi.org/10.1097/HJH.0000000000000867 Crossref PubMed Scopus (39) Google Scholar ].