High Prevalence Of Subclinical Atherosclerosis Research Articles

Subclinical atherosclerosis burden in carotid and femoral territories in HIV subjects: relationships with HIV and non-HIV related factors

BackgroundCardiovascular disease is a major cause of morbidity in an aging HIV population. However, risk estimation with the most frequent equations usually classifies HIV patients as having a low or moderate risk. Several studies have described a very high prevalence of subclinical atherosclerosis in a middle-aged, non-HIV population. There is insufficient body of knowledge to understand if this is the case in people living with HIV (PLWH). We aim to calculate the proportion of patients with subclinical atherosclerosis in a single site cohort of HIV-infected subjects.MethodsWe have analyzed chronically HIV infected adults (≥ 18 years) who were on active follow-up in an HIV unit specialized in the care of cardiovascular health. The most recent clinical visit and vascular ultrasonography were used to assess the objectives of our research. Our primary objective was to describe the proportion of participants with subclinical atherosclerosis (focal protrusion into the lumen > 0.5 mm or > 50% of the surrounding IMT or a diffuse thickness > 1.5 mm) in a single site cohort of PLWH. Carotid and iliofemoral territories were evaluated. As a secondary objective we have run a multivariate analysis to determine which HIV and non-HIV factors might be related with the presence of atherosclerotic plaques.FindingsWe included a total of 463 participants between November 2017 to October 2019. Subjects were predominantly male (84.2%) with a mean age of 48.8 years (SD 10.7). Hypercholesterolemia (36%) was the most prevalent comorbidity followed by Hypertension (18%) and Hypertriglyceridemia (16%). Mean duration of HIV infection is 12.3 years. Overall, participants had been receiving cART for a median of 9.5 years. Subclinical atherosclerosis was found in 197 subjects (42.5%; CI 95% [38.0–47.2]). The disease was found more frequently in the femoral arteries (37.8%) than in the carotid vascular bed (18.6%). Despite some HIV factors correlated with the presence of plaques in a univariate analysis (e.g., time with HIV-1 RNA > 50 copies/mL or time from HIV diagnosis), the only two explanatory factors that remained associated with the presence of atherosclerotic plaques in the multivariate analysis were smoking (OR 5.47, 95% CI 3.36 – 8.90) and age (OR 1.13, 95%CI 1.10 – 1.16).InterpretationWe have found a very high prevalence of subclinical atherosclerosis among our cohort of PLWH. Despite having analyzed several HIV factors, age and smoking have been found to be the only factors associated with the development of atherosclerotic plaques.

Metabolic health phenotype better predicts subclinical atherosclerosis than body mass index-based obesity phenotype in the non-alcoholic fatty liver disease population.

Non-alcoholic fatty liver disease (NAFLD), especially lean NAFLD is associated with an increased risk of atherosclerotic cardiovascular disease (CVD). It is not currently known which clinical phenotypes of NAFLD contribute most to individual subclinical atherosclerosis risk. We examined the relationship between body mass index (BMI), the metabolically healthy status, and subclinical atherosclerosis in the NAFLD population. Data from asymptomatic NAFLD subjects who participated in a routine health check-up examination were collected. Participants were stratified by BMI (cutoff values: 24.0-27.9 kg/m2 for overweight and ≥28.0 kg/m2 for obesity) and metabolic status, which was defined by Adult Treatment Panel III criteria. Subclinical atherosclerosis was evaluated by brachial-ankle pulse wave velocity (baPWV) in 27,738 participants and by carotid plaque in 14,323 participants. Within each BMI strata, metabolically unhealthy subjects had a significantly higher prevalence of subclinical atherosclerosis than metabolically healthy subjects, whereas fewer differences were observed across subjects within the same metabolic category. When BMI and metabolic status were assessed together, a metabolically unhealthy status was the main contributor to the association of clinical phenotypes with the subclinical atherosclerosis burden (all p < 0.001). When BMI and metabolic abnormalities were assessed separately, the incidence of subclinical disease did not increase across BMI categories; however, it increased with an increase in the number of metabolic abnormalities (0, 1, 2 and ≥3). A metabolically healthy status in NAFLD patients was closely correlated with subclinical atherosclerosis, beyond that of the BMI-based obesity phenotype. The application of metabolic phenotyping strategies could enable more precise classification in evaluating cardiovascular risk in NAFLD.

Exploring the Link between Plasma Levels of PCSK9, Immune Dysregulation and Atherosclerosis in Patients with Primary Sjögren's Syndrome.

Proprotein convertase subtilisin/kexin type 9 (PCSK9) regulates lipid metabolism contributing to cardiovascular (CV) risk in the general population. The relationship between PCSK9 and CV risk in systemic autoimmune diseases has been poorly explored. We investigated the association between plasma PCSK9, measures of immune-inflammatory status and markers of atherosclerosis in 52 consecutive patients with primary Sjögren's syndrome (pSS) in comparison to healthy controls (HCs). Median plasma PCSK9 levels were significantly higher in pSS patients versus HCs (162 (79-255) vs. 53 (39-99) ng/mL). Significantly higher prevalence of subclinical atherosclerosis and lower of dyslipidaemia (61% vs. 85%, p = 0.042) characterized pSS patients versus HCs. In pSS, no significant correlation emerged between PCSK9 and disease activity, atherosclerosis and lipid levels. In HCs, PCSK9 significantly correlated with lipid levels and atherosclerosis. Interestingly, significantly higher PCSK9 levels were found in HCs with high-to-very-high as compared to low-to-moderate CV risk (p = 0.018) while a non-significant trend towards higher PCSK9 levels was detected in pSS patients with low-to-moderate as compared to high-to-very-high CV risk (p = 0.060). This is the first demonstration that pSS patients, despite lower prevalence of dyslipidaemia and higher CV risk profile, are characterized by a 3-fold increase in PCSK9 levels in comparison to HCs. As PCSK9 does not correlate with measures of CV risk, its role in CV morbidity in pSS needs further investigation.

Carotid atherosclerosis in the first five years since rheumatoid arthritis diagnosis: a cross sectional study

BackgroundSystemic inflammation, documented before rheumatoid arthritis (RA) diagnosis, is associated with accelerated atherosclerosis. We aimed to compare the prevalence of carotid plaque (CP) in RA patients in the first five years since diagnosis and healthy controls, and to determine disease characteristics associated with the presence of subclinical atherosclerosis in RA patients.MethodsThis was a cross-sectional study. We recruited 60 RA patients in the first five years since diagnosis and 60 matched healthy controls. Carotid ultrasound was performed to detect the presence of CP and measure carotid-intima media thickness (cIMT). Subclinical atherosclerosis was considered as the presence of CP and/or increased cIMT. Distribution was evaluated with the Kolmogorov-Smirnov test. Comparisons were made with Chi-square or Fisher’s exact test for qualitative variables and Student’s t or Mann-Whitney’s U test for quantitative variables. A p-value < 0.05 was considered significant.ResultsThere were no differences in the demographic characteristics between RA patients and controls. The mean disease duration was 2.66 ± 1.39 years. A higher prevalence of CP (30.0% vs. 11.7%, p = 0.013), bilateral CP (18.3% vs. 3.3%, p = 0.008), increased cIMT (30.0% vs. 6.7%, p = 0.001), and subclinical atherosclerosis (53.3% vs. 18.3%, p = < 0.001) was found in RA patients. RA patients with subclinical atherosclerosis were older (56.70 years vs. 50.00 years, p = 0.002), presented a higher prevalence of dyslipidemia (53.1% vs. 14.3%, p = 0.002), and higher prevalence of classification in moderate-high disease activity category measured by DAS28-CRP (68.8% vs. 35.7%, p = 0.010). The latter variable persisted independently associated with subclinical atherosclerosis in the binary logistic regression (OR 6.11, 95% CI 1.51–24.70, p = 0.011).ConclusionsIn the first five years since diagnosis, higher prevalence of subclinical atherosclerosis, including CP was found in RA patients. Carotid ultrasound should be considered part of the systematic CVR evaluation of RA at the time of diagnosis.

SUBCLINICAL TARGET ORGAN DAMAGE IN A SAMPLE OF CHILDREN WITH SOLITARY FUNCTIONING KIDNEY. A PRELIMINARY OBSERVATIONAL STUDY

Objective: Solitary Functioning Kidney (SFK) is a condition characterized by a single-functioning kidney. Children bearing this condition are exposed to an increased risk of subclinical organ damage (SOD) due to the compensatory hyperfiltration in the remaining kidney and increased peripheral blood pressure (pBP) values. The aim of the present study was to assess the impact of traditional (pBP) and novel (central systolic blood pressure, cSBP) cardiovascular risk factors on SOD in children and adolescents with solitary functional kidney. Design and method: Carotid ultrasonography was performed to measure carotid Intima-Media Thickness (cIMT), an index of subclinical atherosclerosis. Arterial stiffness was assessed by measuring carotid Distensibility Coefficient (cDC) and carotid-femoral Pulse Wave Velocity (PWV). Cardiac mass and remodeling were analyzed using transthoracic echocardiography. Central and peripheral (both office and ambulatory) BP measurements, as well as biochemical data from blood and urine samples were collected. Results: Forty-eight SFK children and adolescents were included, of whom 45.5% were hypertensive at the Ambulatory Blood Pressure Monitoring. Twenty-four patients had increased cIMT and RWT while 8.4% and 8.9% demonstrated a reduction of cDC and an increase of PWV. Two patients had a left ventricular mass index (LVMi) above the 95th percentile. cSBP correlated with all vascular indices measured (cIMT r = 0.43; cDC r = -0.33; PWV r = 0.42, p &lt; 0.05) and with LVMi (r = 0.41; p = 0.005). Office pSBP correlated with cDC (r = -0.31; p = 0.03), PWV (r = 0.42 and p = 0.004) and LVMi (r = 0.33; p = 0.02). Regarding ABPM measurements, daytime systolic BP correlated with all vascular indices (cIMT r = 0.34, cDC r = -0.31, PWV r = 0.39 p &lt; 0.005) but not with echocardiographic ones. No correlation was found between cardiovascular parameters and the estimated glomerular filtration rate or the urinary albumin to creatinine ratio. Conclusions: Our data show a high prevalence of subclinical atherosclerosis and cardiac remodeling in children and adolescents with SFK. A lesser proportion of patients presented an increased arterial stiffening. cSBP more than pBP (office or ambulatory) associates with SOD. Children with SFK could bear a greater cardiovascular risk pointing out the importance of early preventive efforts.

A comparative cross-sectional study on evaluation of carotid artery intima-media thickness in patients of psoriasis vulgaris: an early predictor of subclinical atherosclerosis

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Psoriasis is associated with atherosclerosis and increased cardiovascular risk. Carotid artery intima-media thickness (CIMT) is used as a non-invasive marker in the assessment of subclinical atherosclerosis. In this study, by using a doppler ultra-sonogram, subclinical atherosclerosis in patients with psoriasis was evaluated in need of special follow-up to reduce cardiovascular morbidity. It was aimed to evaluate the mean CIMT, determine the prevalence of subclinical atherosclerosis and to evaluate the association between the severity, duration of psoriasis and CIMT.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A hospital-based cross-sectional study was done on 25 patients with psoriasis and age, gender, and body mass index (BMI) matched 25 healthy controls over 2 months. CIMT was measured using a doppler ultra-sonogram.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Compared to the controls, patients had higher CIMT. 24% of patients had subclinical atherosclerosis compared to 12% of controls. Chronic smokers with psoriasis had a significant association with subclinical atherosclerosis. Because of the COVID-19 pandemic, it was unable to determine the severity and prognosis of subclinical atherosclerosis through follow up.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; This study provides an insight into the higher prevalence of subclinical atherosclerosis in psoriasis patients, smokers in particular. CIMT can serve as an important noninvasive marker to assess cardiovascular risk.&lt;/p&gt;

The association of insulin resistance measured through the estimated glucose disposal rate with predictors of micro-and macrovascular complications in patients with type 1 diabetes

Background and aimInsulin resistance (IR) is associated with a higher rate of type 1 diabetes (T1D) complications. We aimed to examine the relationship between estimated glucose disposal rate (eGDR), a readily available marker of IR in clinical practice and early predictor biomarkers of macrovascular and microvascular complications in patients with T1D. DesignA cross-sectional study. MethodsA total of 165 consecutive patients with T1D free of cardiovascular, eye, and renal complications were included in the study from 2016 to 2020. Participants were characterized as insulin resistant if their eGDR value was ≤ 8 mg/kg/min. Pulse wave velocity (PWV) and global longitudinal strain (GLS) were used as surrogates for subclinical atherosclerosis and left ventricular systolic dysfunction (LVSD), respectively. Four previously standardized tests based on the calculation of heart rate variability (HRV) were used to evaluate subclinical cardiac autonomic neuropathy (CAN). Early nephropathy was assessed by assessing urinary albumin to creatinine ratio (ACR). ResultsThe population sample (n = 165) included a majority of female patients (63%) and had a median age of 32 years (24−43), median disease duration of 14 years ( ± 9.5–21.5), a median BMI value of 23.7 kg/m2 (21.4–26.6), an HbA1C of 7.2% (6.7–8.2) and median eGDR (lower values indicate higher insulin resistance) of 9.2 mg/kg/min (8.2–9.9), while 21.8% (n = 36) of the participants were characterized as insulin resistant. After adjustment for age, gender, and the duration of diabetes, the presence of IR was significantly associated with higher prevalence of subclinical atherosclerosis (OR:2.59, 95% CI: 1.06–6.30, p = 0.036), CAN (OR:3.07, 95% CI: 1.02–9.32, p = 0.047) and subclinical LVSD (OR: 4.9, 95% CI: 1.94–12.79, p = 0.001). No association was shown with ACR. ConclusionsIn patients with T1D, insulin resistance, as measured by eGDR, correlates well with early CVD predictors and CAN. These associations appear independent of the effects of gender, aging, and disease duration.

Periodontitis is associated with higher subclinical atherosclerosis in patients with systemic lupus erythematosus.

AimTo determine periodontitis prevalence in patients with systemic lupus erythematosus (SLE) and to assess whether periodontitis in SLE patients is associated with a greater subclinical atherosclerosis.MethodsAn observational case–control study was conducted in SLE (cases) and patients without any rheumatic diseases (controls), matched for sex. Sociodemographic and cardiometabolic variables were gathered, and SLE activity was assessed through several indexes. Periodontal examination registered probing pocket depth, clinical attachment level, bleeding on probing, plaque index, and tooth loss. Subclinical atherosclerosis was assessed by measuring the carotid–femoral pulse wave velocity (PWV) by Doppler velocimetry, homocysteine levels, C‐reactive protein (CRP), and erythrocyte sedimentation rate (ESR). Bivariate analyses and logistic regression were used to assess the association of any of the studied variables with SLE.ResultsSeventy‐one cases and 72 controls were included in the study. Thirty‐nine SLE patients (54.9%) were diagnosed with periodontitis, compared with 16 controls (22.2%). High levels of PWV (≥7.7 m/s, 75th percentile) were shown by 44.3% of the cases vs. 22.4% of the controls (p = .011). Among SLE patients, those with periodontitis showed higher PWV values (8.1 ± 1.52 vs. 7.16 ± 1.11 m/s, p = .006) and higher homeostasis model assessment index (indicative of insulin resistance) (1.7 ± 0.73 vs. 2.92 ± 3.05, p = .028) compared to those with periodontal health. Logistic regression showed that waist circumference (OR 1.06, 95% CI 1.01–1.12, p = .015); ESR (OR 1.09, 95% CI 1.03–1.16, p = .003); and bleeding on probing (OR 1.1, 95% CI 1.01–1.19, p = .018) were associated with the risk of SLE.ConclusionSystemic lupus erythematosus patients showed a higher periodontitis percentage than controls. Higher PWV values were found in SLE patients with periodontitis, indicating a higher prevalence of subclinical atherosclerosis. Patients with higher gingival bleeding showed a higher risk of SLE.

Abstract 9936: Impact of Lipids on Cardiovascular Disease in Healthy Individuals Without Dyslipidemia and with a Low Burden of Risk Factors: MESA (Multi-Ethnic Study of Atherosclerosis)

Introduction: The association between lipids and CVD among healthy persons without dyslipidemia is incompletely defined. Objectives: To determine the cross-sectional associations of lipids with subclinical atherosclerosis and 10-year incident CVD events among healthy participants with a low burden of cardiovascular risk factors. Methods: The analysis included 1,204 participants from the Multi-Ethnic Study of Atherosclerosis, who had no prior CVD events and were without current smoking, hypertension (BP ≥130/80 mmHg or antihypertensive use), diabetes (fasting glucose ≥126 mg/dl or glucose-lowering drug use), and dyslipidemia (LDL-C ≥160 mg/dl, HDL-C &lt;40 mg/dl, TC ≥240 mg/dl, TG ≥150 mg/dl, or lipid-lowering drug use) at baseline. Multivariable relative risk regression and Cox proportional-hazard regression were used in the analyses for subclinical atherosclerosis (presence of carotid plaque and/or coronary artery calcium) and CVD, respectively. Results: At baseline, participants’ median (IQR) age was 54 (49-62) years, mean LDL-C, TC, and HDL-C values were 112.1, 188.0, and 57.9 mg/dl, and median TG was 83.0 mg/dl. Subclinical atherosclerosis was presented in 43% of (n=522) participants. A 1-SD higher LDL-C, TC, non-HDL-C, TC/HDL-C, LDL-C/HDL-C, and TG/HDL-C was associated with a 6-9% higher prevalence of subclinical atherosclerosis (all p&lt;0.05). Over 10 years, 42 CVD events were recorded. For every 1-SD higher LDL-C (23.4 mg/dl), HDL-C (13.5 mg/dl), and non-HDL-C (25.3 mg/dl), HRs (95%CIs) for 10-year incident CVD events were 1.40 (1.01-1.96), 0.63 (0.41-0.96), and 1.44 (1.02-2.02). Similar associations with CVD were also observed for TC/HDL-C, LDL-C/HDL-C, and TG/HDL-C. TG was not associated with any outcome. ( Table 1 ) Conclusions: Except for TG, all lipids were associated with atherosclerosis and/or incident CVD, demonstrating a continuum of risk for lipids with subclinical atherosclerosis and CVD among healthy persons without dyslipidemia.

Subclinical Liver Disease Is Associated with Subclinical Atherosclerosis in Psoriasis: Results from Two Observational Studies

Psoriasis is associated with a higher risk of liver diseases. We investigated the impact of hepatic steatosis (European cohort) and hepatic inflammation (United States cohort) on subclinical atherosclerosis. In the European cohort (n= 76 psoriasis participants and 76 controls), nonalcoholic fatty liver disease, assessed by the sonographic hepatorenal index, was more prevalent in psoriasis than in controls (61% vs. 45%; P= 0.04). Participants with psoriasis with nonalcoholic fatty liver disease had a higher prevalence of subclinical atherosclerosis (ultrasonographic presence of plaque in femoral or carotid arteries) than participants with psoriasis without nonalcoholic fatty liver disease (61% vs. 23%; P= 0.006) and controls with nonalcoholic fatty liver disease (61% vs. 32%; P < 0.05). Sonographic hepatorenal index was a determinant of subclinical atherosclerosis in psoriasis (OR= 3.5; P= 0.01). In the United States cohort (n= 162 participants with psoriasis who underwent positron emission tomography and coronary computed tomography angiography), those with high hepatic 2-[fluorine-18]fluoro-2-deoxy-D-glucose uptake had higher noncalcified (1.3 [0.49 mm2] vs. 1.0 [0.40 mm2]), fibrofatty (0.23 [0.15 mm2] vs. 0.11 [0.087 mm2]), and lipid-rich necrotic core (4.3 [2.3 mm2] vs. 3.0 [1.7 mm2]) coronary burden (all P < 0.001). Hepatic 2-[fluorine-18]fluoro-2-deoxy-D-glucose uptake associated with noncalcified (β= 0.28; P < 0.001), fibrofatty (β= 0.49; P < 0.001), and lipid-rich necrotic core (β= 0.28; P= 0.003) burden. These results show the downstream cardiovascular effects of subclinical liver disease in psoriasis.

P1293 Coronary artery flow velocity alteration by transthoracic echo in a group of young adult males

Abstract Funding Acknowledgements university Grand Background Atherosclerosis is a chronic and progressive disease that causes high mortality primarily in persons over the age of forty. However, a lot of atherosclerosis cases are only discovered after a fatal cardiovascular event. Several techniques can be used to identify atherosclerosis when it is still in its subclinical stages and at ages before the symptoms of atherosclerosis became marked. The SCORE chart and other scores were developed for this purpose. However, the SCORE chart doesn’t cover the people under 40 years old. A significant portion of patients with a high risk of cardiovascular disease have major cardiac events before reaching 40 years of age. The aim of the study was to define subclinical coronary flow alteration in apparently healthy men between the ages of 30-39. Methods This is part of a study intended to facilitate risk estimation in apparently healthy persons between 30 and 39 years old with no documented cardiovascular disease. Seventy-two consecutive men (34 ± 3 years old) who were assumed healthy, were recruited into the study. A standard cardiology exam; analysis of blood lipids; basic transthoracic echocardiography examination with additional scans of the left main, left anterior descending, and circumflex arteries; and carotid ultrasound were performed. Results Among the study population there were eight obese patients (12.5%), twenty-two (22%) smokers, forty-eight (66%) had dyslipidaemias, and six (8%) had a first-degree relative with known premature coronary or vascular events. All of them had a normal ejection fraction (65 ± 4%) and heart chamber sizes. The mean global longitudinal strain (GLS) was -19.3 ± 2%, myocardial mass index was 77 ± 12 g/m2, and intima-media thickness (IMT) was 0.74 ± 0.19 mm. Intima-media thickening at standard site was found in twelve patients (17%, 95% CI 9-26%), atherosclerosis with pronounced plaques in carotid arteries was diagnosed in twenty-one man (29%, 95% CI 19-40%). The group with atherosclerotic plaques had a higher maximal velocity in coronary arteries (44 ± 16 vs. 33 ± 11 cm/s, p &amp;lt; 0.002) compared to other patients. Ejection fraction (65 ± 5 vs. 65 ± 4 %, p = 0.93), myocardial mass index (81 ± 13 vs. 75 ± 12, g/m2 p = 0.053), and GLS (-19 ± 3 vs. -19 ± 2 %, p = 0.55) were similar. There was a significant correlation between IMT and maximal velocity in coronary arteries (r=-0.44, p &amp;lt; 0.0005). Three patients of atherosclerotic group (14%, 95% CI 3-32%) had coronary flow velocity more than 68 cm/s corresponding significant coronary artery lesions. Conclusion There is a high prevalence of subclinical atherosclerosis among men between the ages of 30 and 39 in a population with a high risk of cardiovascular disease by SCORE chart. Coronary flow velocity assessment could be helpful for detection of coronary lesions in young adult patients with carotid plaques.

ULTRASOUND MARKERS OF PREMANIFEST ATHEROSCLEROSIS OF CAROTID AND FEMORAL ARTERIES IN ASSESSMENT OF CARDIOVASCULAR RISK

More than a half of cardiovascular events occur in low to moderate cardiovascular risk patients if assessed based on the traditional risk factors. At the same time, ultrasound examination of arteries makes it possible to reveal atherosclerosis even at early stages of its development. High prevalence of subclinical atherosclerosis in low to moderate risk patients, which is a realization of traditional and “unknown” risk factors, makes ultrasound examination a useful method for risk stratification. The review is focused on ultrasound markers of atherosclerosis with association to traditional risk factors, on the possibility to improve predictive role of current scores and influence on outcomes. Predictive significance of the markers is regarded for primary prevention in general population, in high risk persons and from the perspective of quantitative indicator of atherosclerotic lesion grade or plausibility as a surrogate cardiovascular diseases marker.

Association of non-alcoholic fatty liver disease with cardiovascular disease and subclinical atherosclerosis.

Non-alcoholic fatty liver disease (NAFLD) refers to fatty infiltration of liver in the absence of significant alcohol intake, use of steatogenic medication, or hereditary disorders. It is a common cause of chronic liver disease with a worldwide estimated prevalence ranging from 6.3% to 33%. The NAFLD is considered a hepatic manifestation of the metabolic syndrome. Insulin resistance and increased oxidative stress are central to pathogenesis of NAFLD, and risk factors include metabolic syndrome, diabetes mellitus, obesity, lack of physical activity, smoking, and high fat diet. NAFLD is associated with higher mortality as compared to the general population with cardiovascular disease being the most common cause of death. The NAFLD is associated with a higher prevalence of subclinical atherosclerosis as evidenced by odds of higher coronary artery calcification, higher average and maximum carotid intima-media thickness. It is also associated with stiff arteries as evidenced by higher cardio-ankle vascular index and higher brachial-ankle pulse wave velocity. Increasing evidence has linked NAFLD with atherosclerotic cardiovascular diseases. The NAFLD is associated with a higher prevalence of coronary artery disease (CAD), more severe CAD, poor coronary collateral development, and higher incidence of coronary events. The NAFLD is also associated with ischemic stroke. Studies have shown that the association between NAFLD and atherosclerotic cardiovascular diseases is independent of shared risk factors.

An association between residual vein thrombosis and subclinical atherosclerosis: Cross-sectional study

BackgroundThe association between venous and arterial thrombotic disorders is still unclear. We assessed the association between residual vein thrombosis (RVT) and subclinical atherosclerosis in a cohort of patients with unprovoked (or associated with weak risk factors) proximal deep-vein thrombosis (DVT). MethodsIn a multicenter cross-sectional study, consecutive patients over 40years free from atherosclerotic disorders received the ultrasound assessment of the leg vein system and that of carotid arteries approximately three months after an episode of proximal DVT. In each center the evaluation was done by two independent assessors. The presence of RVT was defined as the incompressibility of at least 4mm in either the popliteal or the common femoral vein, and that of subclinical atherosclerosis as the presence of increased (>0.9mm) intima-media tickness (IMT) and/or carotid plaques. ResultsOut of 252 patients (mean age, 67; males, 53%; unprovoked, 77%), the presence of RVT was found in 139 (55.2%). An increased IMT was shown in 76 (54.7%) patients with and in 35 (31.0%) without RVT (p<0.001). At least one carotid plaque was found in 80 (57.6%) patients with and in 36 (31.9%) without RVT (p<0.001). After adjusting for the baseline characteristics, the odds ratio of subclinical atherosclerosis (increased IMT and/or carotid plaques) was 2.8 (95% CI, 1.6 to 4.7). ConclusionThe ultrasound detection of RVT after an episode of proximal DVT that is either unprovoked or triggered by weak risk factors is associated with a higher prevalence of subclinical atherosclerosis. These findings may have implications for patient prognosis.

Assessment of subclinical atherosclerosis in hidradenitis suppurativa.

Patients with hidradenitis suppurativa (HS) have an increased prevalence of traditional cardiovascular risk factors. Our aim was to investigate the association between subclinical atherosclerosis, detected by carotid ultrasound, and HS. A prospective observation and analytical study assessing subclinical atherosclerosis using carotid ultrasound in patients with HS. A total of 62 HS patients and 62 matched controls were studied. Diabetes mellitus (22.6% vs. 6.5%, P = 0.020), hypertension (41.9% vs. 12.9%, P < 0.001) and metabolic syndrome (MetS) (38.7% vs. 8.1%, P < 0.001) were more common in HS patients. Elevated neutrophil-to-lymphocyte ratio (59.7% vs. 40.3%, P = 0.031), high-sensitivity C-reactive protein (61.1 vs. 29.0%, P < 0.001) and erythrocyte sedimentation rate (46.8% vs. 9.7%, P < 0.001) were more frequent in patients with HS. Subclinical atherosclerosis was present in 30.6% of HS patients and in 16.1% of the controls subjects (P = 0.06). After a logistic regression analysis, elevated age was associated with the presence of subclinical atherosclerosis (P < 0.001), and HS showed a tendency towards this association [adjusted OR (95% CI) 3.8 (0.9-16.0), P = 0.066]. This association was statistically significant between patients 40 years and older [OR (95% CI) 4.9 (1.8-13.1)]. Our clinical results indicate that patients with HS have a higher prevalence of subclinical atherosclerosis than expected when correcting for traditional risk factors. The findings support the conclusions of previous epidemiological studies.

Association of Adiponectin with Subclinical Atherosclerosis in a Mexican-Mestizo Population

Adiponectin (ADPN) is a cardioprotective adipocytokine, and its association with atherosclerosis development is controversial. The aim of the present study was to assess the association of low ADPN plasma levels with the presence of subclinical atherosclerosis in a Mexican-Mestizo population without history of diabetes or coronary artery disease (CAD). In 818 subjects (53.4±9years; 49.9% women) anthropometry, subcutaneous and visceral adipose tissue, lipids, glucose, C-reactive protein (CRP), insulin, and ADPN levels were determined. Carotid artery intima-media thickness (CIMT) was measured with ultrasound in B mode and the sex-age specific value higher than 75th percentile defined the presence of subclinical atherosclerosis. Low ADPN was considered when plasma concentrations were lower than 25th percentile (8.67μg/mL in women, 5.30μg/mL in men). Prevalence of low ADPN was 43.6% (42.9% in women and 44.4% in men; p=0.66) and elevated CIMT (eCIMT) was 23.8% (25.8% in women and 21.9% in men; p=0.184). In addition to their higher prevalence of low ADPN, subjects with eCIMT had higher values of body mass index, blood pressure, total cholesterol, triglycerides, glucose, insulin, and CRP. Multivariate analysis revealed that independent of these factors, low ADPN was associated with eCIMT (OR [95% CI]: 1.505 [1.051-2.153]). In the studied population, low adiponectin concentrations are associated with a higher prevalence of subclinical atherosclerosis, independent of traditional cardiovascular risk factors.

High prevalence of subclinical atherosclerosis in psoriatic arthritis patients: a study based on carotid ultrasound.

Analyse the presence of subclinical atherosclerosis in psoriatic arthritis patients (PsA). A cross-sectional study of 53 patients with PsA and 53 controls matched for age and sex was designed. Carotid intima-media thickness (IMT) and the presence of carotid plaques (CP) were assessed with carotid ultrasound. Data on cardiovascular (CV) risk factors were collected. Patients with PsA had a higher prevalence rate of obesity and tobacco smoking. CP were detected more frequently in patients with PsA than in controls with an OR of 4.15, 95% CI 1.4-12.1, which adjusted for smoking and those with history of CV disease gave an OR of 3.9, 95% CI 1.2-12.7, p=0.026. Carotid IMT was significantly higher in patients with PsA adjusted for age and tobacco smoking. According to ultrasound data, 30.2% of patients with PsA had carotid atherosclerosis (presence of CP and/or carotid IMT>0.90mm) compared with 9.4% of controls. The SCORE index (Systematic Coronary Risk Evaluation) underestimated the CV risk in these patients: most patients with CP had an intermediate CV risk. According to carotid ultrasound data, PsA patients have a high prevalence of subclinical atherosclerosis. These results support the importance of screening for CV risk and to include carotid ultrasound in CV prevention strategies in these patients.

High prevalence of subclinical atherosclerosis in Brazilian postmenopausal women with low and intermediate risk by Framingham score.

Cardiovascular diseases are the leading cause of mortality among women in several countries. Early detection of subclinical atherosclerosis (SA) could enable the adoption of preventive measures to avoid cardiovascular events. This study aimed to determine the prevalence of SA in Brazilian asymptomatic postmenopausal women in Framingham Risk Score (FRS) low and intermediate groups. Computed tomography (CT) and ultrasound (US) scans were performed in 138 asymptomatic postmenopausal women (56.1 ± 4.9 years of age) to survey for coronary artery and aortic calcification (CT scan) and assess carotid intima-media thickness (CIMT) and identify carotid plaques (US). The mean FRS was 2.64 ± 2.13 %. The prevalence of increased CIMT, carotid plaques, increased CIMT and/or plaques, coronary artery calcification (CAC) >0 and aortic calcification (AC) were, respectively, 45.7, 37.7, 62.3, 23.9 and 45.7 %. Normal imaging tests were found in 22.4 %. SA, defined as at least one abnormal imaging test, was associated with age, FRS, waist-to-rip ratio, systolic and diastolic blood pressure, HDL-c and ApoA1 levels, and ApoA1/ApoB ratio. In logistic regression, SA was associated with higher age (OR 1.108, 95 % CI 1.010-1.215, p = 0.029) and lower ApoA1 levels (OR 0.979, 95 % CI 0.960-0.998, p = 0.029). SA was prevalent in Brazilian postmenopausal women with low and intermediate risk groups (FRS) and was associated with higher age and lower levels of ApoA1. Carotid atherosclerosis was the most common presentation of SA in this group.

Subclinical Carotid Atherosclerosis in Asymptomatic Subjects With Type 2 Diabetes Mellitus.

Subjects with type 2 diabetes mellitus are considered to be at high risk for cardiovascular disease. The identification of carotid atherosclerosis is a validated surrogate marker of cardiovascular disease. Nurses are key professionals in the improvement and intensification of cardiovascular preventive strategies. The aim is to study the presence of carotid atherosclerosis in a group of asymptomatic subjects with type 2 diabetes mellitus and no previous clinical cardiovascular disease. A total of 187 patients with type 2 diabetes mellitus and 187 age- and sex-matched subjects without type 2 diabetes mellitus were studied in this cross-sectional, observational, cohort study. Standard operational procedures were applied by the nursing team regarding physical examination and carotid ultrasound assessment. Common, bulb, and internal carotid arteries were explored by measuring intima-media thickness and identifying atherosclerotic plaques. Carotid intima-media thickness (c-IMT) and carotid plaque prevalence were significantly greater in diabetic subjects than in the control group. Carotid plaques and c-IMT were more frequent in men than in women and increased with increasing age. In the multivariate analysis, age, gender, waist circumference, systolic blood pressure, and hypercholesterolemia were positively associated with c-IMT, whereas age, gender, and weight were positively associated with carotid plaque. The current nurse-led study shows that subjects with type 2 diabetes mellitus have a high prevalence of subclinical atherosclerosis that is associated with cardiovascular risk factors.

Prevalence of metabolic syndrome and cardiovascular changes in patients with chronic plaque psoriasis and their correlation with disease severity: A hospital-based cross-sectional study.

Previous epidemiological studies suggest an association between psoriasis and metabolic syndrome and risk of subclinical atherosclerosis. However, there is a paucity of data in the Indian population on these associations. To evaluate the prevalence of metabolic syndrome and subclinical atherosclerosis in patients with chronic plaque psoriasis compared to healthy controls and to correlate the prevalence of metabolic syndrome with severity of psoriasis. A hospital-based cross-sectional study was performed on 140 patients with chronic plaque psoriasis and 140 controls. Psoriasis was categorized as mild, moderate and severe based on psoriasis area and severity index (<10, 10-14 and ≥15, respectively) and as disease of short (<1 year), intermediate (1-3 years) and long duration (>3 years). In all patients and controls, body mass index was calculated, blood pressure and waist circumference were measured and fasting bloaod sugar and lipid profile were estimated. Metabolic syndrome was diagnosed by the presence of 3 or more of the modified National Cholesterol Education Program's Adult Treatment Panel III criteria. A subset of 30 psoriatic patients and 30 healthy controls were selected by the systematic sampling method for cardiac evaluation including electrocardiography, echocardiography and carotid intima-media thickness measurement. The prevalence of metabolic syndrome was significantly more in psoriatic patients than in controls (39.3% vs. 17.1%, odds ratio = 3.13). Psoriatic patients also had a significantly higher prevalence of hypertension, abdominal obesity and diabetes. There was a significant trend to increase in prevalence of metabolic syndrome, hypertension and type 2 diabetes with increased severity and longer duration of the psoriasis. Patients with psoriasis had significantly higher carotid intima-media thickness (mean 0.61 mm ± 0.01 mm vs. 0.37 mm ± 0.01 mm) than controls. This was a hospital-based cross-sectional study with a relatively small sample size. A prospective study with a larger sample would have validated the results further. There is a significantly higher prevalence of metabolic syndrome in psoriasis patients as compared to controls; the prevalence of metabolic syndrome and its components increases with severity and duration of psoriasis. There is a higher prevalence of subclinical atherosclerosis in patients with psoriasis thus increasing the risk of cardiovascular disease. We suggest that patients with moderate to severe psoriasis be screened routinely for metabolic syndrome and cardiovascular disease and encouraged to correct modifiable cardiovascular risk factors.