Higher Risk Of Subclinical Atherosclerosis Research Articles

The ratio of systolic and diastolic pressure is associated with carotid and femoral atherosclerosis.

Although the impact of hypertension on carotid intima-media thickness (IMT) and plaques has been well established, its association with femoral IMT and plaques has not been extensively examined. In addition, the role of the ratio of systolic and diastolic pressure (SDR) in the subclinical atherosclerosis (AS) risk remains unknown. We assessed the relationship between SDR and carotid and femoral AS in a general population. A total of 7,263 participants aged 35-74 years enrolled from January 2019 to June 2021 in a southeast region of China were included in a cross-sectional study. Systolic and diastolic blood pressure (SBP and DBP) were used to define SDR. Ultrasonography was applied to assess the AS, including thickened IMT (TIMT) and plaque in the carotid and femoral arteries. Logistic regression and restricted cubic spline (RCS) models were the main approaches. The prevalence of TIMT, plaque, and AS were 17.3%, 12.4%, and 22.7% in the carotid artery; 15.2%, 10.7%, and 19.5% in the femoral artery; and 23.8%, 17.9% and 30.0% in either the carotid or femoral artery, respectively. Multivariable logistic regression analysis found a significant positive association between high-tertile SDR and the higher risk of overall TIMT (OR = 1.28, 95% CI = 1.10-1.49), plaques (OR = 1.36, 95%CI = 1.16-1.61), or AS (OR = 1.36, 95% CI = 1.17-1.57), especially in the carotid artery. RCS analysis further revealed the observed positive associations were linear. Further analyses showed that as compared to the low-tertile SDR and non-hypertension group, high-tertile SDR was associated with increased risks of overall and carotid TIMT, plaques, or AS in both groups with or without hypertension. SDR is related to a higher risk of subclinical AS, regardless of hypertension or not, suggesting that as a readily obtainable index, SDR can contribute to providing additional predictive value for AS.

Clinical and Serological Associations of Subclinical Atherosclerosis in Spondyloarthropathy

Background: Patients with spondyloarthropathy (SpA) have a higher risk of subclinical atherosclerosis (SCA). We assessed clinical and serological determinants of SCA in Indian SpA patients. Methods: Patients with SpA (fulfilling ASAS 2010 criteria; n = 104) attending our hospital were recruited; mean carotid intima-media thickness (CIMT) was performed by carotid ultrasonography, along with clinical assessment and traditional risk factor evaluation. Microparticles were extracted from plasma and total, as well as endothelial microparticles (EMP), platelet microparticles, T lymphocyte microparticles and B lymphocyte microparticles, were analysed by flow cytometry. Serum samples were analysed for inflammatory cytokines previously implicated in atherosclerosis, namely interleukin 1β (IL-1β), IL-6, IL-17, IL-27, IL-33 and tumour necrosis factor-alpha. Thirty-eight healthy controls were used for comparison. Subgroup analyses compared parameters between SpA with SCA (i.e., with carotid plaque or more than 75th percentile of CIMT for that age and sex in the Indian population) versus those without SCA. Ethical approval and written, informed consent were obtained. Results: Despite significantly younger age, lower body mass index and higher total cholesterol in controls compared to SpA, those with SpA had higher CIMT. Traditional cardiovascular risk factors (older age, higher waist-hip ratio) and novel markers of inflammation (serum IL-1β, IL-6) were associated with SCA. While total microparticles, EMP, T lymphocyte and B lymphocyte microparticles were increased in SpA than in healthy controls, they were not associated with SCA. Conclusions: Traditional risk factors and serum inflammatory cytokines IL-1β and IL-6 are associated with higher SCA in Indian SpA patients.

Clinical and Serological Associations of Subclinical Atherosclerosis in Systemic Sclerosis

Background: While patients with systemic sclerosis (SSc) are predisposed to cardiovascular events, data regarding this from India is sparse. We analysed correlates of subclinical atherosclerosis in Indian patients with SSc. Methods: Patients with SSc fulfilling the 2013 classification criteria ( n = 61) were recruited after obtaining written informed consent. Clinical risk factors for cardiovascular disease (CVD) were assessed. A carotid ultrasound was performed to assess the mean carotid intima-media thickness (CIMT). Total and endothelial microparticles (EMP, positive for CD31 and CD146) were estimated from plasma. Serum cytokines known to play a role in atherosclerosis (interleukin-1β [IL-1β], tumour necrosis factor-alpha, IL-6 and IL-17) were assessed. Forty-one age- and sex-similar healthy controls were recruited for comparison. Clinical and serological risk factors for CVD were compared between SSc with and without carotid plaque. Linear regression analyses were conducted to identify predictors of CIMT and carotid plaque in SSc. Results: Patients with SSc had lower body-mass index than healthy controls, however, had higher CIMT, higher serum IL-1β, IL-6, total microparticles and EMP than control subjects. SSc with carotid plaque ( n = 13) were older, and more likely to be male, but demonstrated no differences in serological markers of CVD. On multivariable-adjusted regression analyses, age was the only significant predictor of CIMT in SSc and male sex was the only significant predictor of carotid plaque in SSc. Conclusions: Carotid plaques were present in one-fifth of young patients with SSc. Older age and male sex predicted a higher risk of subclinical atherosclerosis in SSc.

Metabolic-associated fatty liver disease in relation to site-specific and multiple-site subclinical atherosclerosis.

Non-alcoholic fatty liver disease (NAFLD) and the newly proposed metabolic-associated fatty liver disease (MAFLD) were each associated with subclinical atherosclerosis. However, there is limited evidence on risk of atherosclerosis in individuals who meet the criteria for one but not the other. We aimed to investigate the associations of MAFLD or NAFLD status with site-specific and multiple-site atherosclerosis. This is a prospective cohort study involving 4524 adults within the MJ health check-up cohort. Logistic regression model was used to estimate odds ratios (ORs) and confidence intervals (CIs) for subclinical atherosclerosis (elevated carotid intima-media thickness [CIMT], carotid plaque [CP], coronary artery calcification [CAC] and retinal atherosclerosis [RA]) associated with MAFLD or NAFLD status, MAFLD subtypes and fibrosis status. MAFLD was associated with higher risks of elevated CIMT, CP, CAC and RA (OR: 1.41 [95% CI 1.18-1.68], 1.23 [1.02-1.48], 1.60 [1.24-2.08], and 1.79 [1.28-2.52], respectively), whereas NAFLD per se did not increase risk of atherosclerosis except for elevated CIMT. Individuals who met both definitions or the definition for MAFLD but not NAFLD had higher risk of subclinical atherosclerosis. Among MAFLD subtypes, MAFLD with diabetes had the highest risk of subclinical atherosclerosis, but the associations did not differ by fibrosis status. Stronger positive associations were observed of MAFLD with multiple-site than single-site atherosclerosis. In Chinese adults, MAFLD was associated with subclinical atherosclerosis, with stronger associations for multiple-site atherosclerosis. More attention should be paid to MAFLD with diabetes, and MAFLD might be a better predictor for atherosclerotic disease than NAFLD.

Glycated Hemoglobin and Subclinical Atherosclerosis in People Without Diabetes

BackgroundThe metabolic injury caused by protein glycation, monitored as the level of glycated hemoglobin (HbA1c), is not represented in most risk scores (i.e., Systematic Coronary Risk Estimation or atherosclerotic cardiovascular disease risk scale). ObjectivesThe purpose of this study was to assess the association between HbA1c and the extent of subclinical atherosclerosis (SA) and to better identify individuals at higher risk of extensive SA using HbA1c on top of key cardiovascular risk factors (CVRFs). MethodsA cohort of 3,973 middle-aged individuals from the PESA (Progression of Early Subclinical Atherosclerosis) study, with no history of cardiovascular disease and with HbA1c in the nondiabetic range, were assessed for the presence and extent of SA by 2-dimensional vascular ultrasound and noncontrast cardiac computed tomography. ResultsAfter adjusting for established CVRFs, HbA1c showed an association with the multiterritorial extent of SA (odds ratio: 1.05, 1.27, 1.27, 1.36, 1.80, 1.87, and 2.47 for HbA1c 4.9% to 5.0%, 5.1% to 5.2%, 5.3% to 5.4%, 5.5% to 5.6%, 5.7% to 5.8%, 5.9% to 6.0%, and 6.1% to 6.4%, respectively; reference HbA1c ≤4.8%; p < 0.001). The association was significant in all pre-diabetes groups and even below the pre-diabetes cut-off (HbA1c 5.5% to 5.6% odds ratio: 1.36 [95% confidence interval: 1.03 to 1.80]; p = 0.033). High HbA1c was associated with an increased risk of SA in low-risk individuals (p < 0.001), but not in moderate-risk individuals (p = 0.335). Relative risk estimations using Systematic Coronary Risk Estimation or atherosclerotic cardiovascular disease predictors confirmed that inclusion of HbA1c modified the risk of multiterritorial SA in most risk categories. ConclusionsRoutine use of HbA1c can identify asymptomatic individuals at higher risk of SA on top of traditional CVRFs. Lifestyle interventions and novel antidiabetic medications might be considered to reduce both HbA1c levels and SA in individuals without diabetes.

High-sensitivity C-reactive protein as a biomarker in detecting subclinical atherosclerosis in psoriasis.

Psoriasis is known to be associated with increased risk of cardiovascular diseases. High-sensitivity C-reactive protein (hs-CRP) is a marker of inflammation and an independent risk factor for atherosclerosis. We aimed to assess the correlation between hs-CRP and subclinical atherosclerosis in psoriatic patients. In 60 patients with moderate to severe psoriasis and 60 age- and gender matched healthy controls, we evaluated the serum hs-CRP level and mean intima-media thickness of the common carotid artery (MIMT-CCA). Psoriatic patients had higher levels of hs-CRP (median, 2.25 mg/L; IQR, 0.98-3.80; and range, 0.29-11.60) than did those in the control group (median, 1.03 mg/L; IQR, 0.36-2.15; and range, 0.10-3.35). Psoriatic patients also had higher mean MIMT (0.74 ± 0.19 and 0.54 ± 0.12, respectively, and P < .0001) compared with healthy subjects. The serum level of hs-CRP was significantly correlated with MIMT (P < .0001). Our results indicate that psoriatic patients have a higher risk of subclinical atherosclerosis and hs-CRP may be a useful marker for future risk of cardiovascular diseases in these patients. So, not only does anti-inflammatory drugs play a key role in the treatment of psoriasis, but also they may reduce the risk of cardiovascular diseases by decreasing level of inflammatory markers including hs-CRP.

Subclinical and clinical atherosclerosis in rheumatoid arthritis: results from the 3-year, multicentre, prospective, observational GIRRCS (Gruppo Italiano di Ricerca in Reumatologia Clinica e Sperimentale) study

BackgroundRheumatoid arthritis (RA) is associated with an increased risk of morbidity and mortality, when compared with general population, largely due to enhanced atherosclerotic disease. In this work, we aimed at assessing both occurrence and predictive factors of subclinical and clinical atherosclerosis in RA.MethodsFrom January 1, 2015, to December 31, 2015, consecutive participants with RA, admitted to Italian Rheumatology Units, were assessed in the GIRRCS (Gruppo Italiano di Ricerca in Reumatologia Clinica e Sperimentale) cohort. After that, those participants were followed up in a 3-year, prospective, observational study, assessing the occurrence of subclinical and clinical atherosclerosis and possible predictive factors. McNemar test was employed to assess the changes in subclinical and clinical atherosclerosis, and regression analyses exploited the ORs for the occurrence of those comorbidities.ResultsWe analysed 841 participants, mostly female (82.2%) and with median age of 60 years (range 21–90). The remission was achieved and maintained by 41.8% of participants during the follow-up. We observed an increased rate of subclinical atherosclerosis at the end of follow-up (139 vs 203 participants, p < 0.0001), particularly in participants with a disease duration less than 5 years at baseline (70 participants vs 133 participants, p < 0.0001). Type 2 diabetes (T2D) (OR 4.50, 95%CI 1.74–11.62, p = 0.002), high blood pressure (OR 2.03, 95%CI 1.04–4.14, p = 0.042), ACPA (OR 2.36, 95%CI 1.19–4.69, p = 0.014) and mean values of CRP during the follow-up (OR 1.07, 95%CI 1.03–1.14, p = 0.040) were significantly associated with higher risk of subclinical atherosclerosis. We observed an increased rate of clinical atherosclerosis at the end of follow-up (48 vs 76 participants, p < 0.0001). T2D (OR 6.21, 95%CI 2.19–17.71, p = 0.001) was associated with a significant risk of clinical atherosclerosis. The achievement and the maintenance of remission reduced the risk of subclinical (OR 0.25, 95%CI 0.11–0.56, p = 0.001) and clinical atherosclerosis (OR 0.20, 95%CI 0.09–0.95, p = 0.041).ConclusionsWe reported an increased prevalence and incidence of both subclinical and clinical atherosclerosis in 3-year prospectively followed participants, mainly in the subset with a duration of disease less than 5 years. The achievement and the maintenance of remission are associated with a reduction of the risk of subclinical and clinical atherosclerosis. Among “traditional” cardiovascular risk factors, participants with T2D showed a higher risk of clinical and subclinical atherosclerosis.

Plasma Sphingolipids and Subclinical Atherosclerosis – Novel Associations Uncovered by a Large-scale Lipidomic Analysis (P18-129-19)

ObjectivesSphingolipids (SP) are a diverse class of heterogenous lipids that includes ceramides, sphingomyelins, and glycosphingolipids. Many SPs have diverse roles in cell functions including cell growth, inflammation and angiogenesis, and previous studies suggest that SPs may also be involved in the pathogenesis of cardiovascular diseases. We aimed to identify plasma SPs and subsequently evaluate associations between plasma SPs and subclinical atherosclerosis in a subset of the Multiethnic Cohort of Singapore with the goal of uncovering novel biomarkers predictive of heart disease. MethodsWe conducted a lipidomics evaluation of 103 molecularly-distinct SPs in the plasma of 559 Singaporeans aged 50 years and above using electrospray ionization mass spectrometry coupled with liquid chromatography. All participants did not have a history of diabetes, heart disease, stroke or cancer at baseline, and completed a detailed health screening that evaluated risk factors for cardiovascular disease including computed tomography scans of the abdomen and coronary arteries. Multivariable logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations between SPs and subclinical atherosclerosis (defined as coronary artery calcium score ≥ 100). ResultsCeramides (Cer), particularly those with a d16:1 or d18:1 backbone, were directly associated with higher risk of subclinical atherosclerosis whereas a small number of monohexosylceramides (MHCer), dihexosylceramides (DHCer) and sphingomyelins (SM) with a d18:2 sphingoid backbone were inversely associated. However most associations were attenuated after adjusting for conventional cardiovascular risk factors, including blood lipid (low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides) concentrations and glycemic markers, suggesting that the associations may be mediated by these risk factors. ConclusionsHigh-throughput lipidomics may uncover novel sphingolipids predictive of heart disease. Characterization of these lipid species could provide insights into disease etiology. Funding SourcesThis work was supported by the National University Health System and the National Research Foundation Investigatorship grant. Supporting Tables, Images and/or Graphs▪▪

T cell senescence predicts subclinical atherosclerosis in HIV-infected patients similarly to traditional cardiovascular risk factors

The main objective of this study is to evaluate the predictive capacity of T cell activation/senescence in subclinical atherosclerosis (SCA) in a group of HIV-infected patients. So, a cross-sectional analysis was performed on 91 long-term triple-ART therapy HIV-infected patients from an observational and prospective cohort. Carotid Intima Media Thickness (cIMT) was measured. Binary logistic regression was used to evaluate independent variables associated with SCA. Compared to patients without SCA, patients with SCA (60.4%) were older (41.33 ± 9.04 vs. 51.73 ± 8.44 years old, p < 0.001) and showed Framingham risk score (2.63 ± 3.127 vs. 7.66 ± 5.84, p = 0.008), as well as higher numbers of CD4+CD8+ double positive T cells (0.50 ± 0.42% vs. 0.81 ± 0.79%, p = 0.037), CD8+CD28− T cells (41.70 ± 16.96% vs. 50.22 ± 16.15%, p = 0.018), higher expression of CD28 on CD8+CD28+ T cells (1865 ± 789 vs. 2243 ± 917 MFI, P = 0.046). In contrast, they showed lower expression of CD38 on CD19+ B cells (65.38 ± 27.47% vs. 42.67 ± 30.26%, P < 0.001). Logistic multivariable analysis showed that Framingham risk score >10% (OR = 14.84, CI95% 1.63–125; p = 0.016) and numbers of CD8+CD28− T cells (OR = 1.032, CI 95% 1–1.065; p = 0.045) were independent factors associated with SCA. Patients with CD8+CD28− T cells ≥59% compared to those <59% had higher risk of SCA (OR = 4, CI95% 1.19–13.3, p = 0.024). Interestingly, 27.4% of patients with low Framingham risk score had elevated levels of CD8+CD28− T cells. In conclusion, immune senescence represented by accumulation of CD8+CD28− T cells may contribute to improve the predictive capacity of the Framingham risk score, especially when the scores are low and can explain, at least in part, the higher prevalence of SCA observed in long-term ART-treated stable HIV infected patients.

The Relationship of Ankylosing Spondylitis and Subclinical Atherosclerosis: A Systemic Review and Meta-Analysis.

Cardiovascular disease has become the first cause of death for patients with ankylosing spondylitis (AS). However, the relevant data is limited and the relationship between AS and subclinical atherosclerosis remains questionable. Therefore, we assessed the relationship between subclinical atherosclerosis and AS in this meta-analysis. We synthesized the primary data on flow-mediated vasodilation (FMD), carotid intima media thickness (cIMT), or pulse wave velocity (PWV)-related studies involving AS and using searched electronic databases. Not only were heterogeneity tests, publication bias, and sensitivity analysis performed overall, but also subgroup analysis and meta-regression grouped by measuring site, region, age, sex, and sample size were also carried out. A total of 35 articles involving 1535 patients with AS and 1347 normal controls were included. Significantly increased cIMT (weighted mean difference [WMD]; 95% confidence interval [CI]) = 0.071 [0.048-0.094]), PWV (WMD [95%CI] = 0.910 [0.464-1.356]), and decreased FMD (WMD [95%CI] = -4.459 [-8.389 to -0.529]) were observed in patients with AS compared to controls. The funnel plots or Egger test or Begg test showed no significant publication bias (all P > .05). Sensitivity analysis did not show statistical significance. We conclude that patients with AS have a higher risk of subclinical atherosclerosis. Early screening and intervention deserves consideration.

The synergistic impact of nonalcoholic fatty liver disease and metabolic syndrome on subclinical atherosclerosis.

Nonalcoholic fatty liver disease (NAFLD) is a well-known contributor for the development of cardiovascular disease (CVD). We examined the influence of NAFLD and metabolic syndrome (MetS) on markers of subclinical atherosclerosis, including carotid intima-media thickness (CIMT), brachial-ankle pulse wave velocity (baPWV) and ankle-brachial pressure index (ABI), after adjusting for cardiometabolic risk factors. A cross-sectional study. The association between NAFLD, MetS and markers of subclinical atherosclerosis was assessed in 955 participants without CVD using multiple logistic regression analysis after adjusting for multiple cardiometabolic risk variables. After adjusting for age and sex, CIMT and baPWV were found to be significantly correlated with multiple cardiometabolic risk variables, whereas ABI was only associated with obesity parameters. The prevalence of NAFLD differed significantly according to the presence of subclinical atherosclerosis as defined by both CIMT and baPWV (P = 0·004 and P = 0·007, respectively). After adjusting for potential confounding factors, NAFLD or MetS was not associated with subclinical atherosclerosis as defined by CIMT and baPWV. However, individuals with both NAFLD and MetS had a significantly higher risk of subclinical atherosclerosis as defined by CIMT (OR = 2·06, 95% CI = 1·13-3·74) or baPWV (OR = 2·64, 95% CI = 1·46-4·76) compared to normal subjects, even after adjusting for potential confounders. The results show that NAFLD and MetS have a synergistic impact on the subclinical atherosclerosis, which suggests that individuals with both NAFLD and MetS should be strongly advised to engage in CVD prevention strategies.

SAT0397 Serum Apolipoprotein B is Associated with Increased Risk of the Presence and Progression of Carotid Atherosclerosis in Patients with Psoriatic Arthritis

BackgroundRisk factors that are associated with a higher risk of subclinical atherosclerosis (SCA) in psoriatic arthritis (PsA) have never been examined in longitudinal studies.ObjectivesThe aim of this study is to...

Assessment of subclinical carotid atherosclerosis in patients with primary osteoarthritis: Correlation with disease severity and insulin resistance

Aim of the workTo assess the carotid artery intima–media thickness (IMT) as an index of subclinical atherosclerosis in patients with primary osteoarthritis (OA) and its correlation to severity and insulin resistance (IR). Patients and methodsThis study included 40 primary OA patients (28 with predominant knee OA and 12 with hip OA) and 15 age and sex matched controls. They were subjected to full medical history, thorough clinical examination and radiological assessment by plain X-rays of knee and hip joints scored according to the Kellgren–Lawrence grading. In patients and control, the IR was calculated by the homeostasis model assessment (HOMA) and carotid IMT measured by ultrasonography. ResultsThere was significant increased carotid IMT in OA patients (0.82±0.12mm) compared to controls (0.61±0.02mm) (p<0.001) with cut-off value of 0.65mm. There was significant higher HOMA in OA patients (2.55±0.8) compared to controls (1.79±0.44) (p<0.001). OA patients with IMT>0.65mm (n=34) had longer duration (9±2.56y), higher Kellgren–Lawrence score (2.89±0.45) and higher HOMA (3.8±0.53) compared to those patients with IMT<0.65mm (n=6) (3.41±2.09y, 2.01±0.26 and 2.23±0.32 respectively). Multi-regression analysis showed that disease duration, Kellgren–Lawrence Grading and HOMA are the best sensitive discriminators for patients having carotid intima >0.65mm. (F ratio 36.54, p<0.001). ConclusionOsteoarthritis patients have higher risk of subclinical atherosclerosis independent of traditional risk factors. The severity of OA may contribute to the progression of atherosclerotic disease. Measurement of insulin resistance in OA patients can identify those with higher risk of subclinical atherosclerosis and may help in their follow up and early intervention.

Lower Zinc Bioavailability May Be Related to Higher Risk of Subclinical Atherosclerosis in Korean Adults

BackgroundThere is a proposed link between dietary zinc intake and atherosclerosis, but this relationship remains unclear. Phytate may contribute to this relationship by influencing zinc bioavailability.ObjectiveThe aim of this study is to examine the relationship between zinc bioavailability and subclinical atherosclerosis in healthy Korean adults.Materials and MethodsThe present cross-sectional analysis used baseline data from the Korean multi-Rural Communities Cohort Study (MRCohort), which is a part of The Korean Genome Epidemiology Study (KoGES). A total of 5,532 subjects (2,116 men and 3,416 women) aged 40 years and older were recruited from rural communities in South Korea between 2005 and 2010. Phytate:zinc molar ratio, estimated from a food-based food frequency questionnaire (FFQ) of 106 food items, was used to determine zinc bioavailability, and carotid intima media thickness (cIMT) and pulse wave velocity (PWV) were measured to calculate the subclinical atherosclerotic index.ResultsWe found that phytate:zinc molar ratio is positively related to cIMT in men. A higher phytate:zinc molar ratio was significantly related to an increased risk of atherosclerosis in men, defined as the 80th percentile value of cIMT (5th vs. 1st quintile, OR = 2.11, 95% CI 1.42-3.15, P for trend = 0.0009), and especially in elderly men (5th vs. 1st quintile, OR = 2.58, 95% CI 1.52-4.37, P for trend = 0.0021). We found a positive relationship between phytate:zinc molar ratio and atherosclerosis risk among women aged 65 years or younger. Phytate:zinc molar ratio was not found to be related to PWV.ConclusionsLower zinc bioavailability may be related to higher atherosclerosis risk.

Main findings from the prospective Cardiovascular Risk in Young Finns Study

To provide a comprehensive overview on the main findings from the Cardiovascular Risk in Young Finns Study. This prospective multicenter study initiated in 1980 (N = 3596, baseline age 3-18 years) has followed up study participants over 30 years to investigate childhood risk factors for cardiometabolic outcomes in adulthood. Childhood BMI, socioeconomic status, parental risk factor status, as well as genetic polymorphisms are independent predictors of adult obesity, hypertension, and dyslipidemia. Results from the Young Finns Study and other follow-up studies have shown that conventional childhood risk factors, such as dyslipidemia, obesity, elevated blood pressure and smoking, are predictive of subclinical atherosclerosis in young adults. Recent findings suggest that childhood lifestyle (diet, physical activity) is associated with subclinical atherosclerosis and its progression in adulthood. Concerning the timing of risk factor measurements, they seem to be predictive of adult atherosclerosis from the age of 9 onwards. From a clinical point of view, a recent observation suggesting that the adverse cardiometabolic effects of childhood overweight/obesity are reversed among those who become nonobese adults, provides optimism during the days of obesity epidemic. Current data suggest that childhood risk factors are associated with higher risk of subclinical atherosclerosis in adulthood. Future studies among aging cohorts followed since childhood will provide data on their influence on clinical cardiovascular outcomes.

PP103. Arterial stiffness in women with previous GDM – A follow up of Chinese HAPO study cohort

It is well known that women with history of gestational diabetes (GDM) are at risk of future DM. Whether they are at a higher risk of hypertension and cardiovascular risk remained to be determined. To determine whether Chinese women who have been diagnosed GDM according to the new IADPSG criteria have a higher risk of hypertension & arterial stiffness than women with normal glucose tolerance (NGT) during pregnancy. Chinese women who had participated in the HAPO study between 2001 and 2006 in Hong Kong were followed up at a median of 6years postpartum. All underwent anthropometric & BP measurements. Central systolic and diastolic blood pressures (SBP & DBP), augmentation index (AI) and pulse wave velocity (PWV) were assessed by using SphygmoCor(®) PVx.A total of 608 women (494 NGT, 114 GDM) were followed up till early 2012. Although there was no significant difference in the rate of hypertension, the central SBP (106±12 vs 102±13mmHg, p=0.03), AI (22.1±8.3 vs 18.9±8.5%, p<0.001) and PWV (6.8±1.0 vs 6.6±0.8, p=0.03) were all higher in women with history of GDM. The findings suggest a higher risk of subclinical atherosclerosis amongst women with GDM despite the blood pressure may appear normal at the time of follow up.

Abstract P298: Progression Of Subclinical Atherosclerosis And Its Determinants In Early Postmenopausal Chinese Women - A Five-year Followup Study Of A Population-based Cohort

Introduction: Subclinical atherosclerosis (SA) progresses silently over a period of time before the clinical manifestations of cardiovascular disease. Hypothesis: We hypothesize that early postmenopausal women with adverse cardiovascular risk factors or their progression to abnormal values have a higher risk of SA. This study aimed to investigate the progression of SA and its determinants in early postmenopausal Chinese women. Methods: This is a community-based 5-year followup study on a cohort of 518 women aged 50–64, within 10 years menopause, and recruited through random telephone dialing. Clinical assessments, fasting blood samples, lifestyle and dietary variables based on validated and structured questionnaires, as well as intima-media thickness (IMT) were obtained at baseline and at followup. IMT was measured using a 12.5-MHz linear probe of the HDI 5000 ultrasound scanner at the near and far walls of three 10-mm segments: distal common carotid, bifurcation, proximal internal carotid of both the left and right carotid arteries. Plaque was defined as a focal wall thickening of at least 1.5mm and graded as: grade 0, 1 and 2. Plaque progression was the difference of the plaque index at baseline and followup, and classified into 3 categories. Results: This study of Chinese early postmenopausal women (followup mean age 61.5 years at followup) has revealed a progression of IMT of 2.1% per year (standard deviation = 1.7). 17% were found to have a moderate and 8% severe plaque progression. Stepwise multiple regression analyses showed that baseline IMT, age, low density lipoprotein cholesterol (LDL-C), systolic and diastolic blood pressure were significant predictors of higher followup IMT, while vegetable and fruit intake were inversely related. Women with values belonging to the “normal” ranges of blood pressure, waist circumference, lipid and fasting blood glucose levels had lower IMT at followup compared to those with abnormal baseline values and those with progression from “normal” to the “abnormal” ranges. Women with high soy-vegetable-fruit intake at both baseline and followup had lower IMT than those with low intakes at both time points. Increasing age, waist circumference ≥80 cm, cholesterol ≥200 mg/L, having diabetes, regular drinking were significant predictors of plaque progression (adjusted odds ratios from 1.10 to 2.81), while higher vegetable and fruit intake lowered the risk. Conclusion: Age, central obesity, diabetes, dislipidaemia, high blood pressure, regular drinking were significant predictors for an increased risk of SA. Maintenance of these CVD factors within normal ranges through early menopausal years with adequate fruit and vegetable intake is important to reduce the progression of SA.

Enfermedad arterial periférica asintomática estimada mediante el índice tobillo-brazo en pacientes con infección por el VIH: prevalencia y factores de riesgo asociados

Human immunodeficiency virus (HIV) infection has been associated with a higher risk of subclinical atherosclerosis and cardiovascular events. Peripheral arterial disease (PAD) is a good marker of systemic atherosclerosis and a powerful predictor of cardiovascular morbidity and mortality. The objective of this study was to determine the prevalence of asymptomatic PAD and associated risk factors in HIV-infected people. Cross-sectional study was conducted on all consecutive HIV-positive patients older than 20 years without symptoms of intermittent claudication who attended our clinic between November 2008 and December 2009. PAD was assessed by measuring the ankle-brachial index (ABI) at rest. To define PAD, an ABI ≤ 0.90 was used. Main epidemiological and clinical characteristics of the HIV infection and cardiovascular risk factors (CVRF) were recorded. Two hundred and five patients were evaluated (66.8% male), with a mean age of 41 years and there was a median of 2 CVRF (63.9% smokers). Prevalence of asymptomatic PAD (ABI ≤ 0.90) was 6.3% (n=13). There was only 1 patient with a high ABI (>1.40). In the multivariate analysis, factors significantly associated with PAD were overweight (adjusted odds ratio [ORadj] 4.21; 95% confidence interval [CI] 1.00-18.78), obesity (ORadj 5.76; 95% CI 1.17-28.37) and clinical stage C of HIV infection (ORadj 2.95; 95% CI 1.00-9.83). Prevalence of asymptomatic PAD in a relatively young HIV-infected cohort is similar to that observed in the uninfected middle-aged adult population. Overweight, obesity and advanced clinical stage of HIV infection (AIDS-defining conditions) were identified as independent risk factors for PAD.