Higher Carotid Intima-media Thickness Research Articles

Elevated Blood Pressure in Childhood or Adolescence and Cardiovascular Outcomes in Adulthood: A Systematic Review.

There remains some uncertainty about the magnitude of the associations between elevated blood pressure (BP) in childhood or adolescence and cardiovascular morbidity and mortality in adulthood. We summarized evidence on the long-term impact of elevated BP in childhood or adolescence on cardiovascular morbidity and mortality in adulthood. PubMed and Embase databases were searched up to August 1, 2019, and retrieved studies were reviewed manually. Our systematic review included all eligible prospective cohort studies on the associations between BP status in childhood or adolescence and intermediate markers or hard outcomes of cardiovascular disease in adults, including high pulse wave velocity, high carotid intima-media thickness, left ventricular hypertrophy, and cardiovascular disease (fatal and nonfatal) and total mortality. A total of 19 articles were finally included, and 12 could be synthesized by meta-analysis. Elevated BP in childhood or adolescence was significantly associated, in adulthood, with high pulse wave velocity (3 articles, N=3725; pooled odds ratio [OR], 1.83 [95% CI, 1.39-2.40]); high carotid intima-media thickness (2 articles, N=4152; OR, 1.60 [95% CI, 1.29-2.00]); and left ventricular hypertrophy (2 articles, N=3019; OR, 1.40 [95% CI, 1.20-1.64]). Additionally, our systematic review also shows evidence of associations of elevated BP in youth with cardiovascular disease and mortality in adulthood. In conclusion, our systematic review and meta-analysis confirms that elevated BP in childhood or adolescence is associated with several intermediate markers and hard outcomes of cardiovascular disease in adulthood. These findings emphasize the importance for children and adolescents to have their BP within normal values.

Impact of carotid atherosclerosis in CHA2DS2-VASc-based risk score on predicting ischemic stroke in patients with atrial fibrillation.

Background/AimsVascular disease is an established risk factor for stroke in patients with atrial fibrillation (AF), which is included in CHA2DS2-VASc score. However, the role of carotid atherosclerosis remains to be determined.MethodsThree hundred-ten patients with AF who underwent carotid sonography were enrolled.ResultsDuring a median follow-up of 31 months, 18 events (5.8%) of stroke were identified. Patients with stroke had higher carotid intima-media thickness (CIMT) (1.16 ± 0.33 mm vs. 0.98 ± 0.25 mm, p = 0.017). CIMT was significantly increased according to the CHA2DS2-VASc score (p < 0.001) and it was correlated with left ventricular mass index and early diastolic mitral annular velocity (e’), a ratio of early transmitral flow velocity to e’ (E/e’) and pulmonary artery systolic pressure (all p < 0.05). Cox regression using multivariate models showed that carotid plaque was associated with the risk of stroke (hazard ratio, 3.748; 95% confidence interval [CI], 1.107 to 12.688; p = 0.034). C-statistics increased from 0.648 (95% CI, 0.538 to 0.757) to 0.716 (95% CI, 0.628 to 0.804) in the CHA2DS2-VASc score model after the addition of CIMT and carotid plaque as a vascular component (p = 0.013).ConclusionsIncreased CIMT and presence of carotid plaque are associated with a high risk of ischemic stroke, and CIMT is related to myocardial remodeling and diastolic dysfunction, suggesting that carotid atherosclerosis can improve risk prediction of stroke in patients with AF, when included under vascular disease in the CHA2DS2-VASc scoring system.

Abstract TP472: The Interplay Between Subclinical Micro- and Macro-Vascular Disease in Asymptomatic Individuals

Introduction: Pathophysiological changes within large arteries, among many other factors, are considered to contribute to cerebral small vessel disease. Craniocervical sonography is a valuable tool in this regard to evaluate various physiological metrics of extra- and intra-cranial large arteries. Herein, we tried to evaluate the interplay between markers of small vessel disease, and internal carotid (ICA) and middle cerebral artery (MCA) pulsatility, carotid distensibility and intima media thickness (IMT). Methods: We prospectively evaluated a total of 278 subjects without any prior history of stroke using transcranial and cervical Doppler ultrasound, and magnetic resonance imaging. Pulsatility index was determined by Gosling’s index from bilateral MCA’s and ICA’s. We also measured carotid distensibility and IMT (by AutoIMT TM ) from both carotids and calculated their mean values. The relationship of all these sonographic metrics with imaging markers of chronic small vessel disease [lacunes, microbleeds, perivascular spaces (PVS), white matter hyperintensities (WMH)] were evaluated in multivariate models where age and cardiovascular risk factors were included as additional covariates. Results: The study population consisted of 108 males and 170 females with a mean±SD age of 64±9 years. In bivariate analyses, higher carotid IMT, higher MCA and ICA pulsatility indices, and lower carotid distensibility were significantly associated with high burden of WMH (Fazekas score of ≥2), basal ganglia PVS (PVS score ≥2) and presence of lacunes, but not with microbleeds or centrum semiovale PVS. In multivariate models, each 0.1 mm change in IMT increased the odds of severe WHM by 1.4 (95%CI 1.0-1.9), severe basal ganglia PVS by 1.4 (1.0-1.8) and lacunes by 1.6 (1.0-2.6), while no significant association remained for pulsatility index or distensibility. Conclusion: Our analyses highlight that IMT, is not only a subclinical marker of atherosclerosis, but also emerges as a factor intimately related with cerebral small vessel disease. These findings raise the possibility that IMT and cerebral small vessel disease might together reflect downstream events that culminate in vascular disease involving the large and small vessels of the brain.

Association Between Waist Circumference and Carotid Intima-Media Thickness in the General Population.

Waist circumference (WC) is measured for the assessment of abdominal obesity, whereas carotid intima-media thickness (IMT) is a marker of preclinical atherosclerosis. The relationship between WC and carotid IMT in the general population is not fully understood. In this study, we examined 1,182 subjects (658 men and 524 women, 62.3 ± 11.7 years on average) who underwent voluntary health check-ups and sought to determine the optimal cut-off value of WC for predicting carotid IMT thickness. Receiver operating characteristic curve analysis of WC was utilized to predict high carotid IMT (defined as carotid IMT ≥ 1.1 mm). We determined that the appropriate WC cut-off value was a WC ≥ 79 cm for men and women. There was a statistically significant difference in the prevalence of high carotid IMT between WC ≥ 79 cm and WC < 79 cm in both men and women. However, multivariable logistic regression analysis demonstrated that the WC category was independently associated with high carotid IMT in men, but not in women. Our study indicates that the optimal cut-off value of WC to identify preclinical atherosclerosis may be lower than the current Japanese diagnostic criteria for metabolic syndrome (MetS) in both men and women. Compared to women, the association between WC and preclinical atherosclerosis may be more pronounced in men.

ENERGI, MAKRONUTRIEN, DAN CAROTID INTIMA-MEDIA THICKNESS (CIMT) PADA REMAJA OBESITAS [Energy, Macronutrients, and Carotid Intima-Media Thickness (CIMT) in Obese Adolescents]

Obesity prevalence is increasing in adolescents. Subclinical chronic infl ammation in obesity causes complication, such as atherosclerosis. Cardiovascular disease is one of the complications of obesity that causes premature death. Carotid intima-media thickness (CIMT) is a subclinical marker of atherosclerosis which easily performed and noninvasive. Early detection of atherosclerosis can improved outcome. Healthy diet have a negative correlation with CIMT meanwhile high calori diet increase CIMT. This study aimed to examine the eff ect of energy and macronutrients intake on CIMT in obese adolescents. A cross sectional study was conducted on 59 adolescents aged 13-16 years old with obesity in pediatric clinic of Dr. Soetomo General Hospital using consecutive sampling method. Dietary intake was obtained through 1 x 24 hours food recall. Anthropometric measurements include body height and weight. Body Mass Index (BMI) was calculated. Obesity is defi ned as BMI higher than 95th percentile based on age and gender (CDC 2000 curve). CIMT examination was performed using B mode ultrasonography on the neck. Statistical analysis was perfomed using mutiple linear regression to analyze the eff ect of total energy, fat, and carbohydrate on CIMT. There were 59 obese adolescents included in this study, consist of 27 (45.8%) female adolescents and 32 (54.2%) male adolescents. No eff ects of total energy, carbohydrate, and fat on CIMT was found in obese adolescents (p&gt;0.05). Further research with more subjects and at least 2x24 hours food recall are needed to assess the eff ect of calories and macronutrients on CIMT in obese adolescents.

Hypertension in children in sub-Saharan Africa: primordial prevention is crucial

Hypertension in children in sub-Saharan Africa: primordial prevention is crucial

Relationship between Brachial pulse pressure index and subclinical atherosclerosis among susceptible individuals

Background: Atherosclerosis develops gradually with a subclinical change in arterial elasticity. Pulse pressure index (PPI) (i.e. pulse pressure/systolic blood pressure) could be a predictive parameter of decreased arterial compliance. Objective: This study aimed to evaluate whether brachial PPI (BPPI) is an independent predictor for increased Carotid intima-media thickness (CIMT), and additionally, whether BPPI is superior to brachial pulse pressure (BPP) in the prediction of subclinical atherosclerosis. Methods: In this cross-sectional study, 115 patients, aged 40-60 years, who attended Minia University Hospital Medical units, were recruited. Subjects who had a history of coronary heart disease or stroke or were prescribed to drugs that could affect blood pressure on the day of the study were excluded. CIMT at a cut-off value of > 0.9 mm was used as a reference measure. Results: The mean values of BPPI and BPP were 0.37±0.06 and 49.17±12.59, respectively. Subjects with BPPI ≥ 0.36 (median value) had higher CIMT (0.81±0.15 versus 0.72±0.14) compared to those with BPPI 0.9 mm were 0.702 (p <0.001) and 0.598 (p =0.001), respectively. Conclusion: BPPI is a valuable predictive tool for subclinical atherosclerosis with higher predictive accuracy compared to BPP.

Cardiovascular disease risk in an urban African population: a cross-sectional analysis on the role of HIV and antiretroviral treatment

BackgroundLife expectancy is increasing in the HIV-positive population and age-related non-communicable diseases, such as cardiovascular disease, (CVD) are seen more frequently. This study investigated to what extent HIV and antiretroviral therapy (ART) is associated with CVD risk in an urban African population.MethodsA cross-sectional study was performed in Johannesburg, South Africa, between July 2016 and November 2017. Both HIV-positive adults (ART-naïve, or on first- or second-line ART), as well as age and sex matched HIV-negative controls who were family or friends of the HIV-positive participants were included. Data were collected on demographics, cardiovascular risk factors, HIV-related characteristics, carotid intima-media thickness (CIMT) and carotid distensibility. The association between HIV, ART and CIMT and distensibility was analysed with linear regression models, adjusting for age, gender and CVD risk factors.ResultsThe study included 548 participants, 337 (62%) females, age 38.3 ± 9.5 years of whom 104 (19.0%) were HIV-positive, ART-naïve; 94 (17.2%) were on first-line ART; 197 (35.9%) were on second-line ART; and 153 (27.9%) were HIV-negative. Participants on second-line ART had higher CIMT and lower distensibility compared to the other groups (p < 0.001). After adjustment for age, these outcomes were similar between groups. Further adjustment for CVD and HIV-related factors did not alter the findings.ConclusionNeither HIV nor ART was associated with CIMT or carotid distensibility in this urban African population. Longitudinal studies are needed to fully understand the relationship between HIV and CVD across different populations.

A study on carotid artery intima-media thickness and metabolic risk factors in overweight and obese Indian children.

Carotid intima-media thickness (CIMT) serves as an early marker of atherosclerosis. Data on obesity-related risk factors and their association with carotid intima-media thickness among overweight and obese children are lacking. To compare CIMT of overweight and obese children with CIMT of normal BMI children. To compare various anthropometric and metabolic risk factors associated with increased CIMT among overweight and obese children. A descriptive study in a paediatric department of a tertiary care hospital including 50 age-matched normal BMI children and 50 overweight and obese children. Anthropometric data, blood pressure, CIMT (by B-mode ultrasonography), fasting blood sugar, fasting Insulin, fasting lipid profile, TSH, and FT4 were collected. HOMA-IR and fasting glucose-insulin ratio (FGIR) were calculated for insulin resistance. Cutoff for high CIMT was derived using ROC curve analysis. Overweight and obese children had higher mean CIMT than normal BMI children (0.5 ± 0.1mm vs 0.34 ± 0.05mm, respectively, P < 0.001). ROC analysis revealed 0.45mm as the cutoff for high CIMT. Among overweight and obese children, 31 children (62%) had high CIMT. Among metabolic risk factors for increased CIMT, only FGIR was observed to be significant. Compared to overweight and obese children with normal CIMT, those with higher CIMT had low FGIR value (5.2 ± 2.2mm vs 6.9 ± 2.6mm, respectively, P < 0.05). Overweight and obese children had significantly higher CIMT than controls. Even among overweight and obese children, those with increased CIMT had low FGIR (implying insulin resistance) compared to those with normal CIMT.

Classical Cardiovascular Risk Factors and HIV are Associated With Carotid Intima-Media Thickness in Adults From Sub-Saharan Africa: Findings From H3Africa AWI-Gen Study.

BackgroundStudies on the determinants of carotid intima‐media thickness (CIMT), a marker of sub‐clinical atherosclerosis, mostly come from white, Asian, and diasporan black populations. We present CIMT data from sub‐Saharan Africa, which is experiencing a rising burden of cardiovascular diseases and infectious diseases.Methods and ResultsThe H3 (Human Hereditary and Health) in Africa’s AWI‐Gen (African‐Wits‐INDEPTH partnership for Genomic) study is a cross‐sectional study conducted in adults aged 40 to 60 years from Burkina Faso, Kenya, Ghana, and South Africa. Cardiovascular disease risk and ultrasonography of the CIMT of right and left common carotids were measured. Multivariable linear and mixed‐effect multilevel regression modeling was applied to determine factors related to CIMT. Data included 8872 adults (50.8% men), mean age of 50±6 years with age‐ and sex‐adjusted mean (±SE) CIMT of 640±123μm. Participants from Ghana and Burkina Faso had higher CIMT compared with other sites. Age (β = 6.77, 95%CI [6.34–7.19]), body mass index (17.6[12.5–22.8]), systolic blood pressure (7.52[6.21–8.83]), low‐density lipoprotein cholesterol (5.08[2.10–8.06]) and men (10.3[4.75– 15.9]) were associated with higher CIMT. Smoking was associated with higher CIMT in men. High‐density lipoprotein cholesterol (−12.2 [−17.9– −6.41]), alcohol consumption (–13.5 [−19.1–−7.91]) and HIV (−8.86 [−15.7–−2.03]) were inversely associated with CIMT.ConclusionsGiven the rising prevalence of cardiovascular diseases risk factors in sub‐Saharan Africa, atherosclerotic diseases may become a major pan‐African epidemic unless preventive measures are taken particularly for prevention of hypertension, obesity, and smoking. HIV‐specific studies are needed to fully understand the association between HIV and CIMT in sub‐Saharan Africa.

Echocardiographic association of epicardial fat with carotid intima-media thickness in patients with type 2 diabetes.

Epicardial fat is recognized as active endocrine organ and as emerging risk factor for cardio-metabolic diseases. The aim of this study was to explore the relationship between epicardial fat and carotid intima-media thickness in type 2 diabetes patients. Epicardial fat thickness was measured in 76 type 2 diabetes patients without clinical atherosclerotic cardiovascular disease and 30 age- and sex-matched controls. In addition to laboratory tests, all patients underwent transthoracic echocardiography for epicardial fat thickness and ultrasonographic examination of carotid intima-media thickness. Patients with diabetes had higher epicardial fat thickness and carotid intima-media thickness than those of the controls (6.23 ± 1.27 mm vs 4.6 ± 1.03 mm, p < 0.001 and 0.77 ± 0.150 mm vs 0.58 ± 0.08 mm, p < 0.001, respectively). Epicardial fat thickness was correlated significantly with age, duration of type 2 diabetes, body mass index, waist circumference, HbA1c, carotid intima-media thickness, Homeostasis Model Assessment Index for insulin resistance and lipid profile in the type 2 diabetic patients. Stepwise regression analysis showed that carotid intima-media thickness, duration of diabetes, triglyceride and body mass index were the independent predictors of epicardial fat thickness, with carotid intima-media thickness the most important predictor (β = 3.078, t = 4.058, p < 0.001). Receiver operating characteristic curve analysis was done and cut-off high-risk epicardial fat thickness value of 6.1 mm was determined with a sensitivity and specificity of 71.4% and 72%, respectively. Patients with type 2 diabetes have higher carotid intima-media thickness and epicardial fat thickness. Epicardial fat thickness was found to be a strong predictor of subclinical atherosclerosis.

The relationship between hypoxia, inflammation, and airway obstruction with carotid intima-media thickness in Chronic Obstructive Pulmonary Disease (COPD)

The present study aimed to determine whether there is a relationship between intima-media thickness (IMT) changes in peripheral vessels (carotid and vertebral artery) and inflammatory mediators (C-reactive protein (CRP), leucocytes, etc.), artery blood gas changes and airway obstruction in COPD patients. This study included 60 patients with COPD and 40 healthy control subjects. We used the GOLD criteria for COPD diagnosis. The patient group differentiated according to arterial blood gas values and the presence or absence of pulmonary failure, and its type if any was present. In all patients and control group members, blood leucocytes and CRP values were measured. The carotid, vertebral artery thickness, and total cerebral blood flow were measured using a Doppler USG device and standardized 7 MHz linear transducer. There was no significant relationship between age, sex, body mase index (BMI) and intima-media thickness between the two groups. In the present study, we found out that the CRP levels were higher in COPD patients than in the control group. In progressive COPD patients, CRP levels were the highest. Furthermore, we found out the CIMT was higher in COPD patients compared to the control group. In conclusion, the CIMT and atherosclerosis risk increased in COPD patients. Systemic inflammation causes a higher carotid intima-media thickness in COPD patients. This finding was used as an early risk factor for cardiovascular disease. Doppler USG was used to identify a carotid artery pathology early. Systematic inflammation continuing during a stable period causes increased carotid artery intima-media thickness. This entity plays a role in atherosclerosis etiology.

Relationship of fibroblast growth factor 21 with subclinical atherosclerosis and cardiovascular events: Multi-Ethnic Study of Atherosclerosis

Background and aimsFibroblast growth factor 21 (FGF21) has been suggested as a novel biomarker for cardiovascular disease (CVD), especially in people with high CVD risk. However, it is not known whether FGF21 is a CVD biomarker in an initially healthy cohort. We therefore investigated the relationship of plasma FGF21 levels with measures of subclinical atherosclerosis and cardiovascular events in Multi-Ethnic Study of Atherosclerosis participants without known CVD at baseline. MethodsA total of 5788 participants had plasma FGF21 levels measured at the baseline exam (2000–2002). Carotid intima-media thickness (IMT), ankle-brachial index (ABI) and coronary artery calcification (CAC) were measured at baseline. Participants were followed up for incident CVD events over a median period of 14 years. ResultsIn cross-sectional analyses adjusting for socio-demographic variables, participants with higher FGF21 levels had higher carotid IMT, lower ABI, and higher prevalence of CAC (p < 0.001). However, these associations were not significant after simultaneously adjusting for demographic, socioeconomic and lifestyle factors, traditional CVD risk factors, and biomarkers of inflammation and hemostasis. Among 5768 patients with follow-up data, 820 developed incident CVD endpoints. Higher baseline FGF21 levels were not associated with the risk for incident CVD endpoints after adjusting for multiple confounding factors (odds ratio 1.03; 95% confidence interval, 0.94–1.12, per SD increase in ln-transformed FGF21 levels). ConclusionsAlthough FGF21 has been suggested as a CVD biomarker for people with high CVD risk, our findings do not support a role of FGF21 as a CVD biomarker in those without a history of CVD.

Large vessel disease in children with chronic kidney disease

Objectives : To assess early atherosclerotic changes using echocardiography and to correlate with the clinical and biochemical parameters associated with chronic kidney disease (CKD). Method A cross sectional study was carried out in a tertiary care hospital over a period of 2 years. All 45 children with CKD registered with the nephrology unit were assessed and 43 without congenital cardiac disease were included. Data regarding onset of CKD, stage of CKD, biochemical profile and carotid intima-media thickness (CIMT) measured by B-mode echocardiography were analysed in these children. Correlation of CIMT with the stage of CKD, biochemical and clinical parameters associated with CKD was the main outcome measured. Results : Ninety percent of the patients had high CIMT. The mean CIMT was more in children with end stage renal disease (ESRD) (0.139±0.009cm vs 0.112±0.007cm; p = 0.003). There was a significant difference between the mean CIMT in normotensive patients (0.104±0.008cm) and well controlled systolic and diastolic hypertension [(0.134±0.009cm) and (0.132±0.009cm) respectively]. Mean CIMT in children with uncontrolled systolic and diastolic hypertension group (0.152±0.009cm) was higher as compared to the mean CIMT in patients well controlled hypertension and normotensive patients (0.116±0.006cm; p =0.0214). Conclusions: CIMT is an echocardiographic marker for cardiovascular disease in CKD. Hypertension is the single most important risk factor associated with large vessel disease. Sri Lanka Journal of Child Health, 2019; 48 (2): 127-133

Nonalcoholic Fatty Liver Disease Is Associated With Arterial Distensibility and Carotid Intima-Media Thickness: (from the Multi-Ethnic Study of Atherosclerosis)

Nonalcoholic fatty liver disease (NAFLD) is considered a potential independent risk factor for cardiovascular disease (CVD). The Multi-Ethnic Study of Atherosclerosis cohort enrolled 6,814 adults without previous CVD. We excluded 2,692 participants who had missing variables, were heavy drinkers, or history of steroid use and/or chronic liver disease. NAFLD was defined using noncontrast cardiac CT and a liver/spleen Hounsfield Unit attenuation ratio <1. Ultrasound-measured carotid arterial compliance and stiffness, was expressed as distensibility coefficient and Young's modulus. Common and internal carotid intima-media thickness (CIMT) and coronary artery calcium (CAC) >0 were used as markers of subclinical CVD. A multivariate robust linear regression and logistic regression analysis were done to evaluate the association of NAFLD and this subclinical CVD markers. Our analysis of 4,123 participants showed 55% were female with a mean age of 63 (±10) years, 39% white, 10% Chinese, 28% black, and 23% were Hispanic. The prevalence of NAFLD was 17% (n = 729). Patients with NAFLD had higher distensibility coefficient and higher CIMT. Multivariate linear regression analysis showed the presence of NAFLD was associated with both the common carotid and internal carotid IMT and logCAC. Logistic analysis showed an independent association with CAC > 0 (odds ratio [OR] 1.44 95% confidence interval [CI] 1.18, 1.75) and CIMT > 1 mm (OR 1.30 95% 1.08, 1.56). When stratified by race the association with CIMT > 1 mm was significant in whites (OR 1.37 95% 1.00, 1.90) and Hispanic (OR 1.53 95% 1.08, 2. 17) and CAC > 0 was significant in Hispanics (OR 1.52 95% 1.06, 2.19). In conclusion, NAFLD is modestly associated with carotid IMT and coronary artery calcification in a multiethnic population.

Post-trauma cardiovascular risk factors and subclinical atherosclerosis in young adults following the war in Bosnia and Herzegovina

ABSTRACT Background: Risk of cardiovascular disease (CVD) has been associated with stress from serving in a war, but it has not been established whether children who experience war-related stress are at increased CVD risk. Objective: This study aimed to compare CVD risk factors in young adults according to whether they experienced traumatic events as children during the 1990–1995 war in Bosnia and Herzegovina, and whether those exposed to trauma have evidence of subclinical atherosclerosis. Method: We examined 372 first-year medical students who were preschool children during the war (1990–1995) (average age 19.5 ± 1.7 years, 67% female) in 2007–2010. They completed the Semi-Structured Interview for Survivors of War. CVD risk factors and carotid intima–media thickness (CIMT) measurements were obtained and compared in individuals with and without trauma. We also examined whether increased CIMT was independently associated with trauma after adjustment for other risk factors. Results: From multiple logistic regression, only elevated triglycerides (> 1.7 mmol/l) were associated with a 5.2 greater odds of having experienced trauma. The mean CIMT of subjects with trauma was greater than that of non-trauma-exposed subjects (0.53 mm vs 0.50 mm, p = 0.07). Moreover, trauma was independently associated with higher CIMT (difference = 0.036 mm, p = 0.024) after adjustment for CVD risk factors. Conclusions: We show that most CVD risk factors are associated with post-war trauma in young adults, and, if present, such trauma is associated with higher triglycerides and higher levels of CIMT in multivariable analysis.

The relationship between monocyte to HDL cholesterol ratio, carotid intima-media thickness and type 2 diabetes mellitus

Aim: Diyabetes mellitus (DM) is a majör risk factor for atheroscleros. Circulating monocyte count plays an important role for new atherosclerotic plaque development. Also, there is a strong inverse relationship between high density lipoprotein cholesterol (HDL) and atherosclerosis. monocyte count/HDL ratio (MHR) is a novel inflammatory marker for atheroscleros. Carotid intima-media thickness (CIMT) can predict the presence or absence of coronary artery disease (CAD). I aimed to investigate relationship between CIMT, MHR and type 2 DM Methods: A total of 120 patients were divided into two groups (with type2 DM group = 60, control group: 60). Baseline characteristics, laboratory parameters, MHR and CIMT were recorded and compared between groups. Results: The Diabetes group had considerable higher CIMT, MHR levels compared to the control (p&amp;lt;0.001,p&amp;lt;0,001 respectively ). Also, CIMT levels showed significant correlation with blood glucose level (r=0.474, p&amp;lt;0.001). On the contrary, HDL levels were higher in the control group (p=0.010).Conclusion: In conclusion, I found significantly higher MHR and CIMT in the diabetic group and thus I think MHR, which is an easily calculated index, can be used in the daily clinical practice as an indicator of atherosclerosis in Type 2 DM patients.

Childhood health motivation and adult cardiometabolic health in the Childhood Determinants of Adult Health (CDAH) study.

This research examined if childhood health motivation was associated with adult health behaviors and objectively measured health outcomes. Data were from the Childhood Determinants of Adult Health study. Children aged 9 to 15 years in 1985 completed a questionnaire with health motivation items. In 2004-2006, when aged 26 to 36, participants completed assessments of health behaviors (smoking, diet, alcohol consumption, and physical activity) and cardiometabolic outcomes (body mass index, carotid intima-media thickness from ultrasound, and HOMA insulin resistance from fasting blood samples). Structural path regression analyses examined pathways from health motivation in childhood to adult cardiometabolic outcomes, mediated via adult health behaviors measured concurrently, controlling for age, sex and socioeconomic position. There were 6,230 (49% female) children with data on health motivation. There were two latent constructs: health motivation (4 items: visiting a dentist, visiting a doctor, knowing about your body, and eating a good diet) and risk motivation (3 items: not being a smoker, not being fat, and not drinking alcohol). Greater health motivation was directly associated with nonsmoking, lower carotid intima-media thickness, and lower body mass index in adulthood. Greater risk motivation was directly associated with smoking, higher alcohol consumption, and poorer diets in adulthood. It was also indirectly associated with higher carotid intima-media thickness and higher HOMA insulin resistance via poorer health behaviors. Health motivation during childhood appears important to maintain health across the life course. It could be a target for interventions to improve cardiovascular health in children and adults. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Risk of cardiovascular involvement in pediatric patients with X-linked hypophosphatemia.

To find out if cardiovascular alterations are present in pediatric patients with X-linked hypophosphatemia (XLH). Multicentre prospective clinical study on pediatric patients included in the RenalTube database ( www.renaltube.com ) with genetically confirmed diagnosis of XLH by mutations in the PHEX gene. The study's protocol consisted of biochemical work-up, 24-h ambulatory blood pressure monitoring (ABPM), carotid ultrasonography, and echocardiogram. All patients were on chronic treatment with phosphate supplements and 1-hydroxy vitamin D metabolites. Twenty-four patients (17 females, from 1 to 17years of age) were studied. Serum concentrations (X ± SD) of phosphate and intact parathyroid hormone were 2.66 ± 0.60mg/dl and 58.3 ± 26.8pg/ml, respectively. Serum fibroblast growth factor 23 (FGF23) concentration was 278.18 ± 294.45pg/ml (normal < 60pg/ml). Abnormally high carotid intima media thickness was found in one patient, who was obese and hypertensive as revealed by ABPM, which disclosed arterial hypertension in two other patients. Z scores for echocardiographic interventricular septum end diastole and left ventricular posterior wall end diastole were + 0.77 ± 0.77 and + 0.94 ± 0.86, respectively. Left ventricular mass index (LVMI) was 44.93 ± 19.18g/m2.7, and four patients, in addition to the obese one, had values greater than 51g/m2.7, indicative of left ventricular hypertrophy. There was no correlation between these echocardiographic parameters and serum FGF23 concentrations. XLH pediatric patients receiving conventional treatment have echocardiographic measurements of ventricular mass within normal reference values, but above the mean, and 18% have LVMI suggestive of left ventricular hypertrophy without correlation with serum FGF23 concentrations. This might indicate an increased risk of cardiovascular involvement in XLH.

Accelerated atherosclerosis, hyperlipoproteinemia and insulin resistance in long-term survivors of Hodgkin lymphoma during childhood and adolescence.

Long-term survivors of Hodgkin lymphoma during childhood or adolescence (HL survivors) are at high risk of developing treatment-related late cardiovascular sequelae. In our study we evaluated the presence of modifiable cardiovascular risk factors (hypertension, hyperlipoproteinemia, hyperinsulinemia, obesity), endothelial and inflammatory markers (E-selectin, PAI-1, hs-CRP) and atherosclerotic changes in the common carotid arteries. Assessment was performed in 80 young adult Hodgkin lymphoma long-term survivors at more than 10 years after the potentially cardiovascular toxic anticancer treatment (median age at evaluation 34.7 years; range 24.1-40.9 years). The HL survivors were compared with 83 age- and gender-matched healthy volunteers. The HL survivors showed unfavorable lipid profiles compared to those of healthy controls: triglycerides (p=0.01), total cholesterol (p=0.0004), low density lipoprotein cholesterol (p=0.005). In HL survivors, we found a higher prevalence of hypertension (p=0.004) and insulin resistance - HOMA-IR (p=0.0002). Ultrasonographic examination of both common carotid arteries revealed a higher prevalence of atherosclerotic plaques (p=0.0009) and higher carotid intima-media thickness (p<0.0001) in HL survivors. Markers of oxidative stress (advanced oxidation protein products, oxidized low-density lipoprotein), inflammation (hs-CRP) and endothelial dysfunction (E-selectin, PAI-1) were also higher in HL survivors (p<0.0001, p=0.0002, p=0.0031, p=0.0087, p=0.004, respectively). Adult survivors of Hodgkin lymphoma during childhood and adolescence need closer follow-up with screening of metabolic syndrome components, unfavorable lifestyle factors and early management of these risk factors.