Femoral Intima-media Thickness Research Articles

Correlations in pravastatin treatment effect between carotid and femoral intima-media thickness, and coronary artery stenosis

Correlations in pravastatin treatment effect between carotid and femoral intima-media thickness, and coronary artery stenosis

Echographic assessment of carotid and femoral arterial structure in men with essential hypertension. Group PCVMETRA.

Extracoronary in vivo structural arterial changes were studied in asymptomatic essential hypertension. Carotid and femoral arteries were examined with B-mode echography for the presence or absence of plaque (the whole vascular segments of each vessel in the both sides) and for automated measurement of the far wall intima-media thickness (the vascular segment of each vessel proximal to the bifurcation in the right side) in 53 never treated hypertensive men and 133 normotensive men similar with regard to age, serum cholesterol levels, and smoking history. In the hypertensive group carotid plaque was more frequent (P < .05) and carotid and femoral intima-media thicknesses were greater (P < .001) than in the normotensive group. In the overall normotensive and hypertensive population intima-media thickness was independently associated with age and systolic pressure in both arteries (P < .001) and with cholesterol in the femoral artery (P < .05) while plaque was associated with systolic pressure (P < .01), and cholesterol (P < .01) in the carotid arteries and with age (P < .01), cholesterol (P < .05), and smoking (P < .001) in the femoral arteries. No significant difference in intima-media thickness in both arteries existed between hypertensive subjects with plaque and those without. Wall thickening and plaque were more frequent in hypertensive patients. Thickening was distributed homogeneously to both arteries, while plaque affected preferentially the femoral bed. The influence of age and pressure was more marked on intima-media thickness than on plaque. The lack of association between wall thickening and plaque suggested that vascular hypertrophy and early atherosis might be two different structural changes.

Intima-media thickness after cholesterol lowering in familial hypercholesterolemia. A three-year ultrasound study of common carotid and femoral arteries

Patients with familial hypercholesterolemia (FH) ( n = 53) were examined with B-mode ultrasound before and after 3 years of cholesterol-lowering therapy with pravastatin, cholestyramine, or a combination. The aim was to measure the progression rate of intima-media thickening during follow-up in the common carotid and common femoral arteries. Since for ethical reasons it was not possible to perform a randomized placebo controlled study in patients with FH, we chose to recruite an untreated control group with lower risk, matched for sex, age, height and weight, and with serum cholesterol below 6.5 mmol/l. At baseline, intima-media thickness was larger in the hypercholesterolemic group than in the control group in both the common carotid and common femoral arteries. The difference between the change over 3 years observed in the control group and the change observed in the hypercholesterolemic group was calculated and defined as ‘net difference’. There was a −32% net difference in low density lipoprotein (LDL) in the hypercholesterolemic group during follow-up. The ultrasound investigation showed a concomitant net difference of −0.06 mm in mean carotid intima-media thickness (95% confidence interval, −0.11 to −0.01 mm) and of −0.09 mm in maximum carotid intima-media thickness ( P < 0.05, 95% confidence interval, −0.16 to −0.01 mm), with no net change in lumen diameter. No decrease was recorded in common femoral intima-media thickness. Seventeen of the patients with FH had a positive history of myocardial infarction (MI) and this subgroup had a significantly larger decrease in mean carotid intima-media thickness during follow-up than the subgroup of patients with a negative history of MI ( P < 0.01). In conclusion, the results showed a reduction in common carotid intima-media thickness after long-term cholesterol-lowering therapy in patients with FH. This finding may indicate a beneficial effect on atherosclerosis development in these patients.

Wall thickening of carotid and femoral arteries in male subjects with isolated hypercholesterolemia

This study was performed to determine whether hypercholesterolemic men had increased large artery intima-media thickness (IMT), a potential surrogate measure of atherosclerosis, compared to normocholesterolemic controls. The measurements were performed in the far walls of common carotid and femoral arteries with non-invasive automatic computerized ultrasonic technique in 101 asymptomatic men (28–60 years) of whom 40 were normocholesterolemic (total cholesterol < 5.2 mmol/l, controls), 25 had borderline hypercholesterolemia (5.2 ≤ total cholesterol < 6.2 mmol/l, group 1) and 36 had hypercholesterolemia (total cholesterol ≥ 6.2 mmol/l, group 2). All the subjects had no other traditional risk factors, except smoking. Carotid and femoral IMT were significantly increased in group 2 ( P < 0.01) but not in group 1 compared to controls. When all subjects were pooled for analysis, carotid and femoral IMT were correlated ( r = 0.47, P < 0.001) and increased with total cholesterol ( r = 0.35, P < 0.001) and LDL cholesterol ( r = 0.33, r = 0.34, respectively; P < 0.001). Carotid and femoral IMT increased with age in each group: controls, r = 0.46, P < 0.01 and r = 0.50, P < 0.001, respectively; group 1, r = 0.42, P < 0.05; group 2, r = 0.48, P < 0.01, and r = 0.59, P < 0.001, respectively. At the carotid and femoral sites, the regression slopes between age and IMT were steeper in group 2 than in controls ( P < 0.01). Thus, hypercholesterolemia was associated with diffuse large artery wall thickening, whose presence might be useful in the identification of those hypercholesterolemic individuals most prone to developing atheromatous changes, in the decision to treat, and in the monitoring of lipid-lowering treatment.

750-6 B-mode Ultrasound Assessment of the Treatment Effect of Pravastatin on the Progression of Carotid and Femoral Intima-Media Thickness in a Population Selected on Coronary Disease

The REgression GRowth Evaluation Statin Study (REGRESS) is a two year double blinded placebo controlled prospective atherosclerosis regression study, primarily investigating pravastatin treatment by means of quantitative coronary analysis in a 885 male population with coronary disease. In the REGRESS ultrasound substudy, 255 patients received five B-mode scans, which were used to do intima-media thickness (IMTI measurements of three carotid and two femoral arterial wall segments. One of the aims was to detect a difference in the change of the combined far wall lMT's between the pravastatin and the placebo group (respective baseline values: age 56.8 (8.1) and 55,2 (7,7); LDL-chol. 4.36 (0.80) and 4.33 (0.79) mmol/l; mean far wall IMT 0.88 (0.34) and 0.91 (0.33)mm, p = 0.41). Pravastatin treatment caused a stable decrease in LDL-chol. of 1.4(0.8) mmol/l (p &lt; 0.001) after two months, Multivariate repeated measurements variance analysis showed a statistically significant effect of pravastatin (p &lt; 0.001) on the mean combined far wall lMT. The largest effect was observed in the common femoral artery: 0.09 mm. (SE0.05) decrease in the pravastatin, and 0 13 mm (SE 0.05) increase in IMT in the placebo group. Pravastatin induced a decrease in far wall IMT.

Determinants of femoral and carotid artery atherosclerosis

The aim of the study was to find the most important determinants of early atherosclerosis in the carotid and femoral arteries. Carotid and femoral maximal intima media thickness (IMT) was measured 19 months after the first of 4 risk factor measurements. Department of Community Health and General Practice, University of Kuopio, and Occupational Health Care in Pyhäsalmi Mine, Finland. The subjects comprised 60 male volunteers aged from 32 to 65 years from amongst 277 workers at the Pyhäsalmi Mine, Finland. Subjects were invited for an ultrasound examination, in order of serum total cholesterol content, until the required figure of 60 cases was achieved. Carotid and femoral maximal intima media thickness. Systolic blood pressure (P < 0.01), serum total cholesterol (P < 0.01), age (P = 0.01) and pack-years smoked (P = 0.02) were independent determinants of maximal carotid artery IMT, and total cholesterol (P = 0.01), age (P = 0.03) and pack-years smoked (P = 0.01) for maximal femoral artery IMT. For the latter, plasma fibrinogen concentration (P = 0.10) was the next factor to enter the multiple regression model. Body mass index, heart rate, serum HDL cholesterol, triglycerides, urate, apolipoprotein A1, antithrombin III, lipid peroxides, vitamin E and plasma vitamin C had no significant association with either maximal carotid or femoral IMT or the mean of the carotid and femoral IMT. Systolic blood pressure, serum total cholesterol, age and pack-years smoked are the most important determinants of early atherosclerosis in the carotid artery and total cholesterol, age and pack-years smoked in the femoral artery. Prevention should take into consideration these findings. The role of plasma fibrinogen and oxidized low density lipoprotein would require re-evaluation in larger populations studied longitudinally.

Evidence for in vivo carotid and femoral wall thickening in human hypertension. Groupe de Prévention Cardio-vasculaire en Médecine du Travail.

Little is known of the in vivo structural changes of large arteries in uncomplicated hypertension. Therefore, we measured the intima-media thickness and lumen diameter of common carotid and femoral arteries by a computerized ultrasonographic technique in 25 normotensive and 25 never treated hypertensive men of similar age (from 25 to 72 years). The intraobserver variability of carotid and femoral wall thicknesses was 4.3% and 5.6%, respectively. Moreover, an in vitro study of 13 human arterial segments removed at autopsy demonstrated a strong correlation (r = .989, P < .001) between computerized ultrasonic and histological intima-media thickness measurements. Compared with control subjects, hypertensive patients had similar arterial diameters but higher carotid and femoral intima-media thicknesses (P < .001) as well as higher ratios of carotid and femoral intima-media thickness to lumen (P < .001, P < .01). The carotid thickness was correlated with age in control subjects (r = .48, P < .05) but not in hypertensive patients. The femoral thickness was correlated with age both in control subjects (r = .55, P < .01) and in hypertensive patients (r = .46, P < .05). Thus, carotid and femoral arterial walls of hypertensive patients were thickened. This thickening was not due to age, although aging also thickened both vessels in control subjects and the femoral artery only in hypertensive patients. Such a wall thickening associated with a normal diameter provides direct evidence of vascular growth and represents a new target to monitor noninvasively in vivo for large artery changes in human hypertension.

MATTERS ARISING: Facco replies:

<h3>Introduction</h3> We studied if motivational interviewing (MI) added to standard educational care (SEC) improves vascular health in adolescents with poorly controlled type 1 diabetes. <h3>Research design and methods</h3> 47 adolescents with type 1 diabetes of at least 2 years duration and hemoglobin A1c &gt;75 mmol/mol (&gt;9.0%) on two visits were randomized to MI+SEC or SEC. We also compared vascular health parameters of patients with type 1 diabetes at trial baseline with a group of healthy historical controls matched for age and body size. <h3>Results</h3> 39 adolescents (20 MI+SEC) completed the vascular health study. At 12 months, parameter changes were not statistically significantly different between MI+SEC and SEC (carotid-femoral pulse wave velocity (cfPWV): mean difference 0.052 m/s (95% CI −0.395 to 0.500, p=0.81); carotid-radial PWV (crPWV): 0.118 m/s (95% to 0.478 to 0.713, p=0.69), carotid intima-media thickness (IMT): 0.002 mm (95% CI −0.37 to 0.40, p=0.93), systolic blood pressure (BP) z-score: 0.495 (95% CI −0.099 to 1.09, p=0.10). At baseline, duration of type 1 diabetes was associated with radial IMT (r=0.430, p=0.007) and cfPWV (r=0.373, p=0.018), and carotid, femoral and brachial IMT were correlated with continuous glucose monitoring (CGM) SD (r=0.440, p=0.017; r=0.377, p=0.048; r=0.387, p=0.038). There was an inverse association between CGM time-in-range (3.9–10.0 mmol/L) and crPWV (r=−0.476, p=0.022) changes. Systolic BP change was associated with body mass index change (r=0.374, p=0.019) and IMT change (r=0.461, p=0.016 for carotid IMT; r=0.498, p=0.010 for femoral IMT). PWVs were higher and common carotid compliance lower among patients with type 1 diabetes at baseline compared with healthy controls, but no other differences were found. <h3>Conclusion</h3> There was no effect of MI added to SEC on vascular health parameters. Although disease duration and glycemic control were associated with vascular health at baseline, there were only limited associations between glycemic control and vascular health parameter changes. Vascular health parameter changes were interrelated suggesting clustering of cardiovascular risk. <h3>Trial registration number</h3> NCT02637154.

Gonorrhoea--a question of tactics.

<h3>Background</h3> Ankle-brachial blood pressure index (ABI) is a noninvasive indicator of peripheral arterial diseases (PAD) in older individuals, but information in this regard in young adults is limited. This study examined the limitation of ABI for diagnosis of PAD in asymptomatic young and middle-age adults. <h3>Methods</h3> ABI was measured by dividing ankle systolic blood pressure by brachial systolic blood pressure obtained from a Collin machine in 867 black and white subjects (aged 24-44 years; 72% white, 44% male) enrolled in the Bogalusa Heart Study. Individuals in the bottom (ABI # 0.99; n = 44) versus top 5th (ABI $ 1.27; n = 50) percentile distribution of ABI were compared for traditional cardiovascular (CV) risk factors profile. Univariate analysis compared the two groups; t-tests and chi-square tests were performed. <h3>Results</h3> There were only 6 (0.7%) individuals having clinically cut point ABI of # 0.9. Females, especially black females, had lower ABI than males (p &lt; .0001). Blacks had lower ABI compared to whites (p &lt; .0001). The bottom versus top 5th percentiles of ABI did not differ significantly with respect to age, body mass index (BMI), waist circumference, systolic and diastolic blood pressure, total cholesterol, LDL cholesterol, non-HDL cholesterol, HDL cholesterol, triglycerides, glucose, insulin, cigarette smoking status, and femoral and carotid intima-media thickness (IMT). In terms of prevalence of clinically defined traditional risk factors, individuals at the bottom vs top 5th percentile of ABI distribution had not had significantly higher prevalence of high LDL cholesterol, non-HDL cholesterol, triglycerides, low HDL cholesterol, high blood sugar, and high blood pressure. Further, these individuals had not had significantly higher prevalence of high BMI, waist circumference, femoral IMT, abnormal ECG, and higher smoking status. Subjects with ABI # 0.99 did not display significantly higher prevalence of multiple risk factors compared to ABI $ 1.27. <h3>Conclusions</h3> The prevalence of abnormal ABI in this population is extremely low because of the relatively younger study population. The lack of association of traditionally cardiovascular risk factors with the lower ABI indicates that using ABI as a screening tool for diagnosis of PAD is not useful and cost-effective in younger and middle-age adults.