Higher Carotid Intima-media Thickness Values Research Articles

Relationship Between Carotid Intima-Media Thickness and Osteoporosis in Type 2 Diabetic Patients: Cross-Sectional Study in the Third-Level Center.

Aim: Although atherosclerosis and osteoporosis (OP) are seen in elderly patients, it is still a matter of research whether there is an age-independent relationship between them. In our study, we planned to investigate the relationship between carotid intima-media thickness (CIMT), OP, and bone turnover parameters in patients with type 2 diabetes mellitus (DM2) of both sexes. Materials and Methods: A total of 69 patients and 40 healthy volunteers with chronic diseases such as DM2, hypertension, hyperlipidemia, and OP. Group 1 had 27 patients with DM2 and OP, group 2 had 42 patients with DM2 and no OP, and group 3 had 40 healthy volunteers without DM2 and OP. Results: In the control group, CIMT was measured lower than the patients with DM2 (0.8 + 0.1 and 1.1 + 0.3, P < 0.001, respectively). Femur T score and lumbar T score values of patients with DM2 were lower than the control group (-0.48 + 1.1 and 0.7 + 0.6, P < 0.001, and -1.3 + 1.5 and 0.6 + 0.5, P < 0.001, respectively). Bone turnover markers in DM2 compared to the control group (C-terminal telopeptide of type 1 collagen: 240.9 ± 211.1 and 606.5 ± 200.8, P < 0.001; bone-specific alkaline phosphatase: 47.9 ± 15.5 and 431.5 ± 140, P < 0.001; and osteocalcin: 13.2 ± 5.0 and 19.7 ± 9.2, P < 0.001, respectively) were lower. Patients with femoral region (TSF) T score and lumbar region (TSL) T score below -2.5 were found to have higher CIMT values than those without (1.2 ± 0.23 mm and 0.9 ± 0.23 mm, P = 0.006, and 1.1 ± 0.28 mm and 0.95 ± 0.21 mm, P = 0.003, respectively). In linear regression analysis, age (β = 0.01, P < 0.001), OP (β = 0.166, P = 0.001), and DDM2 (β = 0.222, P = 0.04) were found to be effective on CIMT, while DM2 (β) = -0.754, P < 0.001), CIMT (β = -0.258, P = 0.021), body mass index (β = 0.355, P = 0.028), and age (β = -0.229, P = 0.029) were found to be independent factors on TSF. Conclusion: Bone turnover and bone mineral density are decreased in DM2 patients. In addition, subclinical atherosclerosis is more common in DM2 patients. Findings suggest that there is a relationship between subclinical atherosclerosis and OP due to metabolic factors other than age.

Premature Atherosclerosis in Children With Transfusion-Dependent Thalassemia: A Twin-Center Cross-Sectional Study

Objective To analyze the risk of premature atherosclerosis in children with transfusion-dependent thalassemia (TDT) compared to controls by measuring carotid intima-media thickness (CIMT) and correlating it with clinical and biochemical parameters. Case-control study among children aged 2 to 15 years. Significantly higher CIMT values were observed across all age groups. Mean (SD) CIMT in controls were 0.27(0.07) mm, 0.39 (0.03) mm, and 0.46 (0.05) mm in 2 to 5 years, 6 to 10 years, and 11 to 15 years age groups respectively, as against 0.43 (0.08) mm, 0.55 (0.07) mm and 0.63 (0.08) mm in cases in similar age groups (P<0.001). Mean triglycerides and liver enzymes were significantly elevated in cases. Logistic regression analysis demonstrated that older age group and higher serum ferritin levels, but not dyslipidemia, were significantly associated with high CIMT. Children with TDT are at increased risk for premature atherosclerosis.

Urine transferrin as an early endothelial dysfunction marker in type 2 diabetic patients without nephropathy: a case control study

BackgroundAlbumin, along with other proteins, is abnormally eliminated via the urine during early stages of diabetic nephropathy. Moreover, endothelial dysfunction (ED) accompanying early diabetic nephropathy may develop even before microalbuminuria is detectable. Transferrin has a molecular weight comparable to albumin, whereas transferrinuria and microalbuminuria in a 24-h urine sample may comparably reflect early diabetic nephropathy. Whereas transferrin metabolism is related with ED during very early diabetic nephropathy has not been elucidated yet. This case–control study aimed to evaluate the relation between ED and urine transferrin, even before early diabetic nephropathy is present.MethodsPatients were enrolled from two study sites in Mexico City: Ticomán General Hospital (healthy controls); and a Specialized Clinic for the Management of the Diabetic Patient (cases). All patients provided written informed consent. The primary endpoint was the correlation between urinary transferrin concentration and ED measured in type 2 diabetic patients without albuminuria. ED was evaluated by ultrasonographic validated measurements, which included carotid intima-media thickness (CIMT) and flow mediated dilation (FMD). Plasma biomarkers included glycated hemoglobin, creatinine, cholesterol and triglycerides, as well as urine albumin, transferrin and evidence of urinary tract infection.ResultsSixty patients with type 2 Diabetes Mellitus (t2DM; n = 30) or without t2DM (n = 30), both negative for microalbuminuria, were recruited. The group with t2DM were older, with higher values of HbA1c and higher ED. This group also showed significant differences in urine transferrin and urine/plasma transferrin ratio, as compared with healthy controls (14.4 vs. 18.7 mg/mL, p = 0.04, and 74.2 vs. 49.5; p = 0.01; respectively). Moreover, urine transferrin correlated with higher CIMT values (r = 0.37, p = 0.04), being particularly significant for t2DM population. CIMT also correlated with time from t2DM diagnosis (r = 0.48, p < 0.001) and HbA1c (r = 0.48; p < 0.001).ConclusionUrine transferrin correlated with subclinical atherogenesis in patients with t2DM without renal failure, suggesting its potential to identify cardiovascular risk in patients at very early nephropathy stage without microalbuminuria.

Evaluation of the aortic velocity propagation, epicardial fat thickness, and carotid intima-media thickness in patients with subclinical hypothyroidism.

Subclinical hypothyroidism (SH) is associated with hemodynamic and metabolic abnormalities that cause endothelial dysfunction and atherosclerotic cardiovascular diseases. Aortic velocity propagation (AVP), epicardial fat thickness (EFT), and carotid intima-media thickness (CIMT) may provide additional information in SH patients. This study aimed to evaluate thyroid stimulating hormone (TSH), AVP, EFT, and CIMT in SH patients, and determine the associations among these parameters. Eighty patients with SH and 43 euthyroid (EU) individuals were enrolled. Blood samples were collected to measure laboratory parameters. Patients were divided into two groups based on their TSH values (TSH ≥10 or TSH <10 mIU/L). AVP, EFT, and CIMT were measured and compared between the study groups. A multivariate linear regression model was used for analysis of the independent predictors of AVP (beta = -0.298; 95% confidence interval = -0.946 to -0.287; p < 0.001). AVP was significantly lower in SH patients than the control group (43.7 ± 12.5 and 62.6 ± 13.8, respectively; p < 0.001). EFT values were similar between the SH and control groups (0.7 ± 0.3 and 0.6 ± 0.2, respectively; p = 0.10). SH patients had higher CIMT values than the control group (0.8 ± 0.3 and 0.5 ± 0.2, respectively; p < 0.001). In the multivariate linear analysis, TSH was an independent predictor of AVP. AVP was lower and CIMT was higher in SH patients compared to EU individuals. The increased CIMT and decreased AVP levels were significantly associated with TSH levels in SH patients.

Increased serum leptin levels are associated with metabolic syndrome and carotid intima media thickness in premenopausal systemic lupus erythematosus patients without clinical atherosclerotic vascular events

Aim To assess subclinical atherosclerosis and the role of inflammatory mediators, vascular endothelial cell activation markers and adipocytokines in systemic lupus erythematosus (SLE) in the presence or absence of metabolic syndrome (MetS). Methods We studied 66 premenopausal female SLE patients (20 with MetS) and 28 female healthy controls (HCs) without history of cardiovascular disease (CVD). Subclinical atherosclerosis was screened by measuring carotid intima media thickness (CIMT). Serum levels of high sensitivity C-reactive protein (hs-CRP), tumour necrosis factor α (TNFα), interleukin 6 (IL-6), soluble intercellular adhesion molecule 1 (sICAM-1), soluble E-selectin, leptin and visfatin were measured. Results The mean age of MetS+SLE, MetS- and HC were 38.3 ± 6.7, 32.7 ± 9.3 and 29.9 ± 5.6 years, respectively. The mean disease duration, SLICC (Systemic Lupus International Collaborating Clinics damage index) and Systemic Lupus Erythematosus Disease Activity Index scores were 74.8 ± 54.9 months, 0.16 ± 0.48 and 1.18 ± 1.5, respectively, and were similar between MetS+and MetS- SLE patients. CIMT values were higher in both MetS+ and MetS- SLE patients than HCs ( p < 0.001). sICAM-1 and erythrocyte sedimentation rate levels were higher in both MetS+ and MetS- SLE patients than HCs ( p < 0.001; p = 0.002, p = 0.001). The SLE MetS+ group had higher CIMT values than SLE MetS- (right: p = 0.003; left: p = 0.025). Leptin levels and homeostatic model assessment (HOMA) scores were significantly higher in SLE MetS+ than SLE MetS- ( p = 0.018; p = 0.04). Leptin and CRP levels and body mass index, SLICC and HOMA scores were correlated with CIMT values (right: p = 0.03, p < 0.001, p < 0.001, p = 0.026 and p < 0.001, and left: p = 0.028, p = 0.03, p = 0.003, p = 0.002 and p = 0.025). Conclusions In premenopausal women with SLE without a history of CVD, CIMT values were increased and related to MetS. Leptin was increased in patients with MetS and correlated with CIMT values.

Assessment of Carotid Intima-Media Thickness as an Early Marker Of Vascular Damage In Hypertensive Children.

BackgroundThe increased carotid intima-media thickness (CIMT) correlates with the presence of atherosclerosis in adults and describes vascular abnormalities in both hypertensive children and adolescents.ObjectiveTo assess CIMT as an early marker of atherosclerosis and vascular damage in hypertensive children and adolescents compared with non-hypertensive controls and to evaluate the influence of gender, age, and body mass index (BMI) on CIMT on each group.MethodsObservational cohort study. A total of 133 hypertensive subjects (male, n = 69; mean age, 10.5 ± 4 years) underwent carotid ultrasound exam for assessment of CIMT. One hundred and twenty-one non-hypertensive subjects (male, n = 64; mean age, 9.8 ± 4.1 years) were selected as controls for gender, age (± 1 year), and BMI (± 10%).ResultsThere were no significant difference regarding gender (p = 0.954) and age (p = 0.067) between groups. Hypertensive subjects had higher BMI when compared to control group (p = 0.004), although within the established range of 10%. Subjects in the hypertensive group had higher CIMT values when compared to control group (0.46 ± 0.05 versus 0.42 ± 0.05 mm, respectively, p < 0.001; one-way ANOVA). Carotid IMT values were not significantly influenced by gender, age, and BMI when analyzed in both groups separately (Student's t-test for independent samples). According to the adjusted determination coefficient (R²) only 11.7% of CIMT variations were accounted for by group variations, including age, gender, and BMI.ConclusionsCarotid intima-media thickness was higher in hypertensive children and adolescents when compared to the control group. The presence of hypertension increased CIMT regardless of age, gender, and BMI.

Sonographic normative values of carotid intima-media thickness in an adult Nigerian population

Background: The thickness of the intima-media complex of the Common carotid artery (CCA) has been advanced as a reliable measurement of the degree of atherosclerosis in the CCA and the coronary artery. We set out to determine the baseline values of this complex in a Nigerian population so as to determine standards for abnormalities.Method: This prospective study was conducted on 100 normal patients aged 21years and above. The CCAs were scanned using GE Logic 5 color Doppler scanner (2007) with 7.5MHz linear probe. Two measurements of the carotid intima-media thickness (CIMT) were obtained at 1cm proximal to the right and left carotid bulbs and the mean value of the two measurements was recorded. The mean values were then analyzed with Statistical Package for Social Sciences (SPSS) version 20.0.Results: The age range of participants was 21-70 years with a mean age of 45.26 ±12.95 years. We observed the mean CIMT of 0.61±0.12mm with the overall right and left mean CIMT of 0.61±0.12mm and 0.61±0.13mm respectively. No significant difference was seen between the two sides. CIMT in the study population increased with age, with a maximal value of 0.82±0.05mm recorded among the 61-70 year age group. Male subjects had higher CIMT values than females. CIMT values were higher in overweight, compared to underweight, subjects.Conclusion: This study showed different values of CIMT according to age and gender variations. However, the values obtained were slightly different from previous values from other African and Caucasian populations.

Atherosclerotic coronary artery disease: The accuracy of measures to diagnose preclinical atherosclerosis.

Different methods can be used to diagnose early pre-clinical stage atherosclerosis. The present study was carried out to evaluate the efficiency of these methods. Measures including carotid intima-media thickness (CIMT), pulse wave velocity (PWV), and coronary calcium score (CCS) were evalutated for the detection of coronary artery disease (CAD). We studied the clinical and biochemical profiles of individuals with non-CAD and CAD to assess measures of pre-clinical atherosclerosis. The association between CIMT, PWV and CCS on the one hand, and the coronary atherosclerosis on the other, was studied. In total, 150 cases of cardiovascular disease (CVD) participated in the present study and were subjected to computed tomographic (CT) coronary angiography to divide them into non-CAD (n=100) and CAD (n=50) groups. The patients were also subjected to pre-clinical atherosclerosis tests (CIMT, PWV and CCS). CAD patients had higher CIMT values on both sides (right side, 0.74±0.09 vs. 0.62±0.12 mm; left side, 0.78±0.16 vs. 0.64±0.19 mm; and average, 0.76±0.12 vs. 0.63±0.14 mm; all P-values <0.01). These patients also had significantly higher brachial-ankle PWV (baPWV) on left side (1638.8±372.9 vs. 1498.6±339.8 cm/sec, P<0.001). The overall CCS was significantly increased in CAD patients as compared to the patients without CAD (117.8±118.6 vs. 8.6±18.3, P<0.001). In conclusion, the present study showed that among different measures of preclinical atherosclerosis, CCS had the best diagnostic accuracy. However, the combination of CIMT and baPWV had an excellent negative predictive value for atherosclerotic coronary vascular disease.

1 Cardiovascular risk factors in women with preeclampsia history and their association with myocardial hypertrophy and intima-media thickening of the carotids

Background A history of preeclampsia (PE) has been associated with cardiovascular disease in women. There is substantial evidence that cardiovascular alterations resulting from PE can persist even after termination of pregnancy. Objectives 1-evaluate the frequency of cardiovascular risk factors in women with 12-month history of PE and their association with myocardial hypertrophy and carotid intima-media thickness (CIMT); 2-evaluate the effect of myocardial hypertrophy on left ventricular function and functional capacity. Methods Transversal prospective study including 118 consecutive patients with 12-month PE history. Clinical and laboratory evaluations, echocardiogram, ergometric and carotid ultrasound were performed. Myocardial hypertrophy (LVH) was defined as indexed myocardial mass ⩾45 g/m 2,7. CMIT was considered elevated when the measures were above the 75th percentile for the age range. The classical risk factors for cardiovascular disease were considered, and the 30-year global cardiovascular risk score was calculated (GCVR_30). The data were analyzed by linear or logistic regression and Spearman’s correlation coefficient. Significance level p Results Systemic arterial hypertension (SAH) was identified in 52 patients (44%), overweight/obesity (OOB) in 82 (69%), dyslipidemia in 68 (57%) and metabolic syndrome in 47 patients (40%). A total of 48 women (41%) presented GCVR_30 greater than or equal to 10%, with these patients aged 34 ± 5.4 years. LVH was present in 35 cases (29%) and associated with the presence of OOB (OR = 4.51; CI95%:1.18 – 17.17, p Conclusions Twelve months after the PE event there is a high prevalence of cardiovascular risk factors. Furthermore, elevated LVH frequency was observed, which was associated with alterations of diastolic function indices and with harm to functional capacity. Among the risk factors, overweight and increased abdominal circumference play a prominent role in elevating the risk of myocardial hypertrophy 12 months after a PE episode. The GCVR_30 was associated with higher CIMT values. Data obtained in a simple manner, via anamnesis and physical exam, can be utilized to stratify myocardial hypertrophy risk, helping to identify patients of greater cardiovascular risk in this population.

A Study to derive distribution of carotid intima media thickness and to determine its COrrelation with cardiovascular Risk factors in asymptomatic nationwidE Indian population (SCORE-India)

BackgroundThere is presently no data to describe normal distribution of carotid intima-media thickness (CIMT), an established measure of subclinical atherosclerosis, in Indian subjects. MethodsIn this multi-centric study, 1229 subjects with age ≥30 years and no previous cardiovascular disease (CVD) underwent CVD risk factor assessment and CIMT measurement. Mean far wall common carotid artery IMT was measured on both sides and averaged. ResultsMean age of the subjects was 48.0±12.0 years and 54.2% were men. CIMT measurement was feasible in 1157 subjects. Mean, median and 75th percentile values of CIMT for different age-groups were derived for men and women separately. There was a progressive increase in CIMT with increasing age (P<0.001) and men had higher CIMT values than women (0.608±0.12mm vs. 0.579±0.11mm, P<0.001). The CIMT values were also higher in diabetics (0.635±0.10mm) and hypertensives (0.624±0.10mm) as compared to non-diabetics (0.589±0.12mm, P<0.001) and non-hypertensives (0.592±0.12, P 0.02) respectively. Among continuous variables, age, systolic blood pressure and fasting blood glucose had strong to modest correlation with CIMT (Pearson's r 0.524, 0.282 and 0.192 respectively, all P values <0.001), whereas body mass index, diastolic blood pressure and serum triglycerides exhibited weak but still statistically significant relationship (Pearson's r 0.069, P 0.019; Pearson's r 0.065, P 0.026; and Pearson's r 0.094, P 0.001, respectively). ConclusionsThis is the first study to provide age- and gender-specific distribution of CIMT in Indian subjects free from CVD. This information should help facilitate further research and clinical work involving CIMT in India.

Anxiety and depressive symptoms are associated with higher carotid intima-media thickness. Cross-sectional analysis from ELSA-Brasil baseline data

BackgroundStudies focusing on the association between anxiety/depressive symptoms and accelerated subclinical atherosclerosis have yielded mixed results. Our aim is to examine associations between anxiety/depressive symptoms, common mental disorder (CMD), major depression disorder (MDD) or generalized anxiety disorder (GAD) and carotid intima-media thickness (CIMT) in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort baseline. MethodsThe ELSA-Brasil baseline assessment included CIMT measurements and the Clinical Interview Schedule – Revised (CIS-R), a validated questionnaire for anxiety/depressive symptoms/diagnoses. We analyzed participants without previous coronary heart disease or stroke, and with high-quality CIMT images. We built regression models to determine whether the CIS-R score, CMD, MDD or GAD were associated with maximal CIMT levels. ResultsThe study sample comprised 9744 participants. We found that individuals with higher CIS-R scores (Odds ratio for one standard deviation increase [OR]:1.12; 95% confidence interval [95%CI]:1.06–1.19), CMD (OR:1.22; 95%CI:1.07–1.38) and GAD (OR:1.19; 95%CI:1.01–1.41) had significantly higher odds of being classified in the highest age, sex and race-specific CIMT quartile. In the linear models, after adjustment for traditional cardiovascular risk factors, higher CIS-R scores (β:0.005; P = 0.010) and GAD (β:0.010; P = 0.049) were independently associated with CIMT values. ConclusionIndividuals with more symptoms of anxiety and/or depression, or diagnoses of CMD or GAD, had higher CIMT values, compared to peers of same age, sex and race. CIS-R scores and GAD were independently associated with higher CIMT values. These results suggest an association between anxiety/depressive symptoms (and, most notably, GAD) and accelerated subclinical atherosclerosis.

Neutrophil‐to‐Lymphocyte Ratio May Predict Subclinical Atherosclerosis in Patients with Psoriasis

Systemic inflammation beyond the skin may provide an explanation of the increased cardiovascular risk observed in psoriasis. It was hypothesized that neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are potential predictors of subclinical atherosclerosis measured by aortic velocity propagation (AVP) and carotid intima-media thickness (CIMT) in psoriasis. Fifty-one patients with psoriasis taking no antipsoriatic therapy and 37 age- and sex-matched healthy controls were prospectively enrolled. The Psoriasis Area and Severity Index (PASI) was calculated. Complete blood counts were obtained. Measurements of AVP and CIMT were performed. The baseline clinical and demographic features, and white blood cell, platelet, neutrophil, lymphocyte, monocyte, and PLR were similar in both groups. NLR and high-sensitivity C-reactive protein (hs-CRP) were higher in the psoriasis group than the control group (P=0.001, P<0.001; respectively). The psoriasis group had lower AVP and higher CIMT values than those of controls (AVP: 48.9±18.1 vs. 64.3±14.5 cm/sec; P<0.001, CIMT: 0.84±0.29 vs. 0.63±0.27 mm; P=0.001, respectively). PASI was positively correlated with NLR and hs-CRP (r=0.423, P=0.002; r=0.315, P=0.024, respectively). There was an inverse association between AVP and CIMT (r=-0.749, P<0.001). Binary logistic regression analysis demonstrated that NLR was the only variable able to predict lower AVP (≤41cm/sec) and higher CIMT (>0.9mm) values (P=0.024 and 0.023; respectively). NLR is potentially an unrecognized predictor of subclinical atherosclerosis in patients with psoriasis. Future studies assessing the prognostic significance of NLR on cardiovascular event rates in psoriasis patients would be of great interest.

Elevated serum gamma-glutamyl transferase activity in patients with cardiac syndrome X and its relationship with carotid intima media thickness

Objectives —We aimed to evaluate serum gamma-glutamyl transferase (GGT) activity and its relationship with carotid intima media thickness (CIMT) in patients with cardiac syndrome X (CSX).Methods — The study population consisted of 40 patients with CSX, 35 controls and 40 patients with coronary artery disease (CAD). All patients underwent a noninvasive stress test and conventional coronary angiography. Serum GGT and C-reactive protein (CRP) levels were measured and CIMT was assessed in all subjects.Results — Serum GGT activity was higher in the CSX and the CAD groups than in the control group (32.6 ± 16.0 and 30.4 ± 15.3 U/L, respectively, vs. 17.9 ± 4.2 U/L; P < 0.001). There was no statistically significant difference in serum GGT activity between the CSX and the CAD groups. When compared to the control group, serum CRP levels were significantly increased in both the CSX and the CAD groups (4.1 ± 2.0 and 4.7 ± 2.6 mg/L, respectively, vs. 2.2 ± 1.8 mg/L; P < 0.001). Patients with CSX and CAD had significantly higher CIMT values than the controls (0.74 ± 0.17 and 0.94 ± 0.12 mm, respectively, vs. 0.62 ± 0.08 mm; P < 0.001). A significant correlation was found between GGT activity and CIMT measurements (r = 0.640, P < 0.001), but serum GGT activity did not correlate with serum CRP levels in patients with CSX (r = 0.277, P > 0.05).Conclusions — The present study showed that serum GGT activity in patients with CSX was as high as those in patients with CAD. Increased GGT levels may play a role in the pathogenesis of the microvascular atherosclerotic process of CSX.

Hemochromatosis (HFE) genotype and atherosclerosis: Increased susceptibility to iron-induced vascular damage in C282Y carriers?

Background The C282Y mutation of the hemochromatosis (HFE)-gene increases body iron status. Among Caucasians, the carrier frequency of this mutation is 8–9%. C282Y carriers may be more susceptible to iron-induced atherosclerosis due to higher iron levels. It has also been postulated that the C282Y mutation could alter aspects of iron metabolism. We examined the relationship between the C282Y mutation, iron status, and carotid intima-media thickness (IMT) as a marker of atherosclerosis. Methods and results The present study comprised 764 Dutch men and post-menopausal women aged 50–70 years. Mean and maximum carotid IMT were assessed by B-mode ultrasonography. Blood was sampled for assessment of the C282Y mutation and body iron status. Parameters of iron status (e.g. ferritin and non-transferrin bound iron) were significantly higher in C282Y carriers ( n = 80; 10%) compared to non-carriers ( P-values <0.001), however, there was no difference in the carotid IMT measures. Among non-smokers ( n = 222), carotid IMT was 0.051 mm (95% CI: 0.005; 0.096) lower in carriers compared to non-carriers ( P = 0.03), which remained after adjustment for iron parameters. Within the subgroup of carriers, higher carotid IMT values were observed across sex-specific quartiles of ferritin (mean IMT: 0.789, 0.787, 0.814, and 0.865 mm; P-trend = 0.08), whereas this association was absent in non-carriers. Conclusion Overall, we found no association of HFE genotype with carotid IMT, despite higher iron status. Interestingly, C282Y carriers may be hyper responsive to vascular damage which needs to be confirmed in prospective cohort studies.

Increased risk of premature atherosclerosis at initiation of chronic hemodialysis: A possible link with hypertriglyceridemia?

Background Patients with end-stage renal failure have high rates of cardiovascular morbidity and mortality. It is not clear yet whether it is the hemodialysis procedure or the uremia itself that is the major determinant of this increased risk. We set out to determine whether atherosclerosis was more accelerated in patients with uremia at the initiation of chronic hemodialysis therapy compared with that in a control group of those without uremia who had a similar cardiovascular risk profile. Also, risk factors related to premature atherosclerosis were investigated. Patients and Methods High-resolution B-mode ultrasonography was used to determine the intima-media thickness (IMT) of the carotid arteries in 30 patients with uremia just before the initiation of chronic hemodialysis therapy and in 26 controls without uremia. Results The 2 groups were similar in age, sex, presence of hypertension, presence of dyslipidemia, and smoking habits. Serum levels of total cholesterol, triglycerides, total HDL, fibrinogen, inorganic phosphorus, and total calcium were evaluated. The IMT values of the patients with uremia were significantly higher than were those of the control group. The patients with uremia had higher levels of serum fibrinogen, inorganic phosphorus, and triglycerides. The IMT values significantly correlated with age, male sex, and triglyceride level in the patients with uremia. In the control group, only age showed a significant correlation with IMT values. Conclusion These results indicate that patients with uremia at the initiation of chronic hemodialysis therapy had higher carotid IMT values than did a control group of those without uremia who have a similar cardiovascular risk profile. Thus, uremic status per se may be responsible for the increased risk of premature atherosclerosis. Identification of a positive correlation between carotid IMT and triglyceride levels may indicate that therapeutic interventions are necessary to reduce this risk.

Correlation of parents’ longevity with carotid intima–media thickness in patients attending a Lipid Clinic

The relationship between carotid intima–media thickness (IMT) and the subject's parents’ longevity has been investigated. The association between parents’ age at death and IMT was estimated in 593 consecutive patients attending a Lipid Clinic by survival-analysis methods. Average maximum IMT (Avg-IMT), maximum IMT (Max-IMT), clinical and laboratory variables and parental age at death, were assessed. Kaplan–Meier analyses showed significant differences in survival curves, low IMTs being associated with long-lived parents ( p = 0.0003 and 0.001 by log-rank test for fathers and mothers, respectively). A Cox proportional hazards regression model showed that higher carotid IMT values were associated with father's and mother's deaths at an early age, even after adjusting for conventional cardiovascular risk factors. These data were confirmed after the stratification of patients into younger (<65 y) and older (≥65 y) or into subjects with and without a family history of dyslipidemia or vascular diseases. In addition, by stratifying subjects into those with no, one or two long-lived parents, we observed a significant trend for the combination of father's and mother's longevity on their offspring's IMTs ( p < 0.01 and 0.05 for Avg-IMT and Max-IMT, respectively). These data highlight a significant relationship between carotid artery IMT and a familial predisposition to be long-lived that is independent of the individual's vascular risk profile.

LDL oxidative modifications in well- or moderately controlled type 2 diabetes.

The aim of the study was to examine, by measurement of specific indicators of free radical-mediated oxidation of LDL, whether there is evidence of increased in vivo oxidation of LDL in type 2 diabetic patients, and to investigate their associations with carotid intima media thickness (IMT). In native LDL, we quantified five different products of LDL oxidation reflecting various stages of LDL oxidative modification in 38 individuals with well- or moderately controlled type 2 diabetes (HbA(1c) </= 8.5%) and 38 gender-matched subjects with normal glucose metabolism. Baseline conjugated dienes (BCD), 7-OH-glycero-phosphocholine (7-OH-GPC), lyso-phosphatidylcholine (lyso-PC), and ketocholesterol were determined in LDL, and circulating in vivo oxidized apolipoprotein B100 (Ox-apoB) was measured in plasma. The IMT of the carotid artery was measured by ultrasound. Borderline higher carotid IMT values were observed in individuals with diabetes (0.88 +/- 0.14 vs 0.83 +/- 0.11 mm, p = 0.06). LDL-ketocholesterol (45.5 +/- 19.4 vs 37.1 +/- 13.8 nmol/mmol LDL-cholesterol, p < 0.05) and Ox-apoB (25.3 +/- 5.5 vs 22.2 +/- 5.8 U/mmol LDL-cholesterol, p < 0.05) were significantly increased in diabetic patients. The concentration of BCD, 7-OH-GPC and lyso-PC in LDL did not differ between diabetic patients and control subjects. No significant correlations were demonstrated between the measured indicators of LDL oxidation and carotid IMT. Levels of BCD, 7-OH-GPC and lyso-PC, that is, intermediary products of LDL oxidation, were not significantly elevated, but ketocholesterol and Ox-apoB, that is, stable end products of the oxidation process, were increased in diabetic patients. We conclude that in vivo oxidation of LDL is increased, even in subjects with well- or moderately controlled type 2 diabetes.