Increased Carotid Intima-media Thickness Research Articles

Clinical and Genetic Features of Uncontrolled, Complicated Arterial Hypertension in Hypertensive Patients of the Aral Sea Region

The purpose of this study was to assess the clinical and genetic features of the course of hypertension, complicated by a hypertensive crisis in the inhabitants of the Aral Sea region. Methods and Results: The study included 132 patients (52 men and 80 women) with AH who applied at least 5 times (4.9±2.4) during 1 year to the Nukus Emergency Medical Care Center with a diagnosis of “Uncomplicated hypertensive crisis.” The mean age of the patients was 57.2±11.6 years, the mean duration of AH ‒ 8.85±3.4 years. The control group consisted of 50 healthy people (mean age of 52.7±6.4 years), women and men in equal proportions. A cardio Hypertension Panel of multiplex RT-PCR assay was used to detect 4 SNP [ADD1 rs4961 (G460T), GNB3 rs5443 (C825T), AGT rs4762 (C521T), and AGT rs699 (T704C)]. To assess the strength of the association between a genetic marker and AH, measured by the OR, we used multiplicative and additive models. According to the results of office BP measurement, the average SBP corresponded to AH Grade 3 (200.8±22.6 mmHg), and DBP corresponded to AH Grade 2 (105.4±7.62 mmHg). All AH patients, regardless of gender, were diagnosed with left ventricular hypertrophy and increased carotid intima-media thickness. Microalbuminuria was detected in 89 (67.4%) patients, proteinuria in 39 (29.6%) patients. Among AH patients, 88% had a high salt taste sensitivity threshold (STST) and 12% had a medium STST (χ²=269.455, P=0.0001). Analysis of the multiplicative and additive models for the AGT rs699 (Т704С) SNP showed a significant risk of AH with the carriage of the T allele (OR=3.70, 95% CI: 1.88-7.26, P=0.000) and the homozygous TT genotype and heterozygous CT genotype (OR=12.55, 95% CI: 0.72-218.80, P=0.000, and OR=2.67, 95% CI: 1.24-5.74, P=0.000, respectively). At the same time, the carriage of the C allele and CC genotype may be protective against the development of AH in individuals of the Aral Sea region. Analyzing the additive models, we also found a significant risk of AH with the carriage of the homozygous CC genotype of the AGT rs4762 (C521T) SNP (OR=5.92, 95% CI: 2.78-12.63, P=0.000). For the ADD1 rs4961 (G460Т) SNP and the GNB3 rs5443 (C825T) SNP, we did not find associations with the risk of AH. The presence of ethnic differences in the prevalence and associative links of AH candidate genes with the development of the salt-sensitivity phenotype require further extended searches in this direction, especially in the Aral Sea region.

Ultrasound Evaluation of Carotid Artery Intima-Media Thickness: Effective Early Marker of Carotid Artery Disease in Adult Head and Neck Cancer Patients After Neck Radiation?

Radiation is a recommended front-line treatment for many adult head and neck cancer (HNC) patients. Early identification of radiation-associated carotid artery disease (CAD), a well-known phenomenon, can minimize long-term sequelae. This integrative literature review assesses the use of ultrasound measured carotid artery intima-media thickness (IMT) as an early marker of CAD in adult HNC patients after neck radiation. A search of PubMed and Scopus databases in December 2020 yielded 475 unique articles published between January 2011 and December 2020, of which eight met inclusion criteria. Carotid IMT, measured by ultrasound, was significantly increased after neck radiation in all reviewed publications. Ultrasound was able to detect IMT measurements exceeding or at risk of exceeding pathologic IMT, indicating higher risk for future cardiovascular events. Findings suggest that radiation-associated carotid IMT increase occurs early and persists for years. Ultrasound adequately detects post-radiation carotid IMT changes and is a reliable early marker for radiation-associated CAD. Initiation of ultrasound screening should be considered prior to neck radiation for a baseline and at 1 year post treatment to optimize medical management.

Predictors of increased carotid intima-media thickness in patients with diabetes type 2 and chronic kidney disease

Predictors of increased carotid intima-media thickness in patients with diabetes type 2 and chronic kidney disease

Endothelial dysfunction and increased carotid intima–media thickness in patients with spondyloarthritis without traditional cardiovascular risk factors

BackgroundThe aim of our study was to assess subclinical atherosclerosis in spondyloarthritis (SpA) by combining three ultrasound methods (flow-mediated dilation (FMD), carotid intima–media thickness (cIMT) and Ankle Brachial Index (ABI))...

Gestational diabetes mellitus and offspring’s carotid intima–media thickness at birth: MySweetHeart Cohort study

ObjectiveHyperglycaemia during pregnancy is associated with cardiometabolic risks for the mother and the offspring. Mothers with gestational diabetes mellitus (GDM) have signs of subclinical atherosclerosis, including increased carotid intima–media thickness...

P-772 Cardiovascular autonomic nervous function in singletons conceived after ART with frozen and fresh embryo transfer compared to naturally conceived children

Abstract Study question Do children conceived after assisted reproductive technologies (ART) with frozen or fresh embryo transfer have altered cardiovascular autonomic nervous function compared to naturally conceived children? Summary answer Cardiovascular autonomic nervous function was comparable in singletons conceived after ART with frozen or fresh embryo transfer, and naturally conceived children. What is known already Cardiovascular autonomic nervous function (CANF) exert important homeostatic mechanisms to prevent major arterial blood pressure fluctuations by adjusting heart rate, cardiac contractility, and peripheral vascular tone. CANF is impaired in children with obesity and diabetes mellitus, and conductance artery stiffness is documented to influence CANF. Previous studies have reported that children conceived after ART are at risk of increased carotid intima-media thickness; insulin resistance; arterial stiffness; and hypertension. This is the first study to investigate CANF in children conceived after ART. Study design, size, duration CANF was studied in 110 singletons aged 7-12 years conceived after frozen embryo transfer (FET, N = 35), fresh embryo transfer (fresh-ET, N = 39) or natural conception (NC, N = 36). Children were born between 2009 and 2013. This study was conducted between June 2019 and October 2021. Participants/materials, setting, methods Participants were identified through the Danish IVF and Medical Birth Registries. CANF was evaluated by heart rate (HR) changes (ratio to rest) during deep breathing; Valsalva; and active stand test with continuous non-invasive hemodynamic measurements. Anthropometric measures, fasting blood samples, and maternal questionnaires were collected. Neonatal and maternal pregnancy data were collected from the Medical Birth Registry. Children with a history of congenital heart disease or mothers with gestational diabetes or diabetes mellitus were excluded. Main results and the role of chance A total of 110 singletons with a median age of 9.0 years were included in this study. We found no significant associations between conception method and our measures of CANF. For FET, fresh-ET, and NC, respectively, the HR-ratio for deep breathing was 1.62 (0.2 SD), 1.62 (0.16) and 1.63 (0.17) (ANOVA-P = 0.97). For Valsalva, the HR-ratio was 1.97 (0.4), 1.88 (0.41) and 1.63 (0.17), respectively (ANOVA-P = 0.24). For the active stand test, the HR-ratio was 1.43 (0.17), 1.41 (0.2) and 1.43 (0.19), respectively (ANOVA-P = 0.91). Associations remained non-significant after adjustment for age, sex, body surface area, body mass index, and mean arterial pressure. In the multivariate analysis, several other factors were significantly associated with HR-ratio for deep breathing: age (β = -0.06, P = 0.03), body surface area (β = 0.79, P = 0.01), body mass index (β = -0.03, P = 0.04), and mean arterial pressure (β =-0.01, P = 0.03), but not with other measures of CANF. All data for CANF were within reference limits. Also, mothers in the ART groups were older at childbirth than NC group as expected. No significant differences were observed in clinical characteristics, including neonatal and other maternal data. Limitations, reasons for caution This study is limited by its observational design to draw any firm conclusion on causality. Also, it is a limitation that the pubertal status was not systematically assessed as pubertal hormones may play a role in CANF. Wider implications of the findings This study contributes to the current knowledge about cardiovascular health risks in ART children. Reassuringly, this study found that children conceived after ART (frozen or fresh-ET) did not exhibit impaired cardiovascular autonomic nervous function compared to naturally conceived children. Trial registration number NCT03719703

Metabolically obese phenotype and its dynamic change are associated with increased carotid intima-media thickness: Results from a cohort study

Background and aimsTo examine associations between metabolically obese phenotypes or their changes and increased carotid intima-media thickness (CIMT). Methods and resultsThis prospective cohort included 13,681 Chinese adults aged 20–80 years who completed follow-up health examination with carotid ultrasound and were divided according to metabolic and weight status: metabolically healthy and normal weight (MHNW); metabolically obese but normal weight (MONW); metabolically healthy but obese (MHO); metabolically abnormal and obese (MAO). Cox and logistic regression were used to evaluate the associations of the phenotypes or their changes with increased CIMT.During a mean follow-up of 33 months, 1927 participants developed increased CIMT. After adjusting for age, sex and potential biochemical confounders, MAO was significantly associated with increased CIMT (HR 1.22, 95% CI [1.07, 1.4]); the association remained significant in those 40 years or older. Compared with stable MHNW, increased CIMT risk was higher for stable MAO (OR 1.35 [1.16, 1.57]), transitional MAO from MONW (OR 1.44 [1.04, 1.97]), and transitional MHO from MHNW (OR 1.59 [1.10, 2.26]) in demographic adjusted models; only stable MAO remained significant in the multivariate adjusted model (OR 1.23 [1.05, 1.45]). ConclusionMAO significantly elevated the risk of increased CIMT. Stable MAO and obese transitions also promoted CIMT progression.

Effect of Lipoprotein Apheresis on Progression of Carotid Intima-Media Thickness in Patients with Severe Hypercholesterolemia

The extent of intervention effects on carotid intima-media thickness (CIMT) can predict the degree of atherosclerotic cardiovascular risk-reduction. We hypothesized that regular lipoprotein apheresis over the course of 10 years might slow down progression of CIMT in patients with severe hypercholesterolemia. This case series describes 10 Caucasian patients (mean age 60 ± 9 years, 70% female, 80% statin intolerant) with a severe hypercholesterolemia phenotype treated with lipoprotein apheresis between 2005 and 2020 (mean duration, 10 ± 4 years). The median pretreatment low-density lipoprotein cholesterol (LDL-C) level was 214 mg/100 ml (95% confidence interval, 145 to 248), lipoprotein(a) (Lp[a]), 26 mg/100 ml (15 to 109; 40% with Lp(a)>60 mg/100 ml). Three patients were diagnosed with a monogenic cause. The baseline mean CIMT was 850 ± 170 µm, and maximum CIMT was 1,040 ± 220 µm across the age range of 46 to 70 years. Acute effects of lipoprotein apheresis determined as a difference before and immediately after the procedure were estimated as a median of 72 ± 8% and 75 ± 7% reduction in the LDL-C and Lp(a) levels, respectively. Using the imputed trajectories, period-specific on-treatment time-weighted averages for LDL-C and Lp(a) were 141 mg/100 ml (interquartile range, 89 to 152; 38% reduction from the baseline) and 24 mg/100 ml (interquartile range, 12 to 119; 19% reduction from baseline), respectively. The number of patients with CIMT above their "vascular age" decreased from 80% to 30% over the treatment course. In conclusion, an increase in CIMT seen with advanced age and severe hypercholesterolemia was halted with lipoprotein apheresis with an estimated annual rate of change in mean common CIMT of -4 µm/y and maximum CIMT of -3 µm/y.

The Relationship between Arterial Elasticity Parameters of Ascending Aorta, Abdominal Aorta and Carotid Arteries with Carotid Intima Media Thickness in Children with Bicuspid Aortic Valve.

Background:Bicuspid aortic valve is a congenital cardiac malformation that affects not only the valve and ascending aorta but also the abdominal aorta and large central arteries like carotid arteries by damaging the elasticity of the vessel resulting in increased stiffness and reduced distensibility. Deterioration of aortic compliance disturbs functions of the left ventricle and triggers atherosclerosis determined with carotid intima-media thickness. The aim of this study was to assess the effect of the bicuspid aortic valve on the elastic properties of these parts of the arterial system in children.Methods:Thirty-four children with bicuspid aortic valves with normal valvular functions or mild valvular dysfunction and a control group of 34 individuals with tricuspid aortic valves were included in the study. Echocardiographic measurements of the left ventricle, ascending aorta, and ultrasonographic measurements of the abdominal aorta and carotid arteries were performed, and elasticity indexes were calculated.Results:The bicuspid aortic valve group had higher stiffness and lower distensibility in ascending aorta, abdominal aorta, and carotid arteries with higher carotid intima-media thickness values than the tricuspid aortic valve group. Aortic valvular z scores and ascending aorta and abdominal aorta stiffness were higher in patients with bicuspid aortic valves irrespective of valvular functions than in controls. Valvular dysfunction affected stiffness in carotid arteries. Dilatation of ascending aorta increased stiffness in the abdominal aorta. Distensibility was lower in ascending aorta and left carotid artery, with increased carotid intima-media thickness independent from ascending aorta dilatation. Stiffness of abdominal aorta revealed a positive correlation with the stiffness of the ascending aorta and the carotid arteries (P < .05, for all).Conclusions:Elasticity indexes of children with bicuspid aortic valves were impaired in ascending aorta, abdominal aorta, and carotid arteries with an increase in carotid intima-media thickness.

ENDOTHELIUM DYSFUNCTION PATHWAY AND CAROTID INTIMA-MEDIA THICKNESS IN HYPERTENSIVE PATIENTS: ROLE OF NOS3 (RS2070744) AND GNB3 (RS5443) GENES’ POLYMORPHISMS

Objective: The crucial function of endothelium’s regulatory mechanisms is to maintain the balance between Monoxide Nitrogen (NO) release and endothelium-derived contracting factors production. Therefore, it is prognostically important to clarify the endothelial function (EF) deterioration pathway through the early biomarkers of EF and carotid intima media thickness (IMT) changes depending on GNB3 (rs5443) and NOS3 (rs2070744) genes’ polymorphism in essential arterial hypertension (EAH). Design and method: One-hundred EAH patients with hypertensive-mediated organ damage (moderate-very high cardiovascular risks, aged 45–65 years) and 48 practically healthy (control) participated in the cohort case-control study. Soluble Vascular Cell Adhesion Molecule (sVCAM-1), total NO metabolites (NO2-/NO3-), transcriptional activity of NOS3 gene, Endothelium-Dependent Flow-Mediated Dilation of the Brachial Artery (FMD BA) and carotid IMT were studied. GNB3 (rs5443) and NOS3 (rs2070744) genotyping performed by TaqMan probes (CFx96ÔReal-Time PCR). Results: The connections of NOS3 (rs2070744) with decreased total NO metabolites (F = 71.11; p &lt; 0.001), reduced NOS3 gene’s transcription activity (F = 8.71; p &lt; 0.001) and sVCAM-1 increase (F = 6.96; p = 0.002) were found, especially in the C-allele carriers (particularly in CC-genotype patients with lower total NO metabolites value – by 16.46% and 40.88% (p &lt; 0.001), lower transcription activity of NOS3 gene – 46.03% and 7 times (p &lt; 0.001), higher sVCAM-1 – 35.48% and 89.48% (p &lt; 0.001), respectively). ANOVA analysis didn’t confirm association of GNB3 (rs5443) gene with EF and carotid IMT. Severe EAH is associated with increased carotid IMT – 50.0% (p &lt; 0.001) and 57.14% (p &lt; 0.007), dilated carotid arteries – 17.36% (p = 0.012) and 21.79% (p = 0.004), decreased NOS3 gene’s transcription activity – 34.54% (p = 0.003). Severe structural carotid IMT changes in EAH patients (IMT &gt; 0.9 mm) is followed by higher blood pressure values (p &lt; 0.001), deterioration of EF: FMD BA decrease – 11.80% with compensatory increase of carotid arteries diameters – 17.38% and 21.99% (p &lt; 0.001) and serum sVCAM-1 concentration – by 20.49% (p = 0.005). Conclusions: NOS3 (rs2070744), but not GNB3 (rs5443) gene associate with endothelial function impairment and carotid IMT in EAH patients.

ASSOCIATION OF CEREBRAL OXYGENATION DURING EXERCISE WITH TARGET ORGAN DAMAGE IN HYPERTENSIVE AND NORMOTENSIVE INDIVIDUALS

Objective: To investigate whether indices of cerebral oxygenation during exercise correlate with subclinical markers of target organ damage (TOD), namely carotid intima-media thickness (cIMT), arterial stiffness, and retinal vessel diameter in newly diagnosed hypertensives and healthy individuals. Design and method: Hypertension was diagnosed using 24-hour ambulatory blood pressure (BP) monitoring. Patients with white coat or masked hypertension were excluded. Cerebral oxygenation was measured continuously during a three-minute isometric hand grip exercise at 30% of maximal voluntary contraction using near infrared spectroscopy. The average response during exercise in oxygenated-hemoglobin (O2Hb), deoxygenated-hemoglobin (HHb), and total-hemoglobin (tHb, reflecting changes in regional blood volume) were examined. CIMT was measured using ultrasound, arterial stiffness was estimated with augmentation index and pulse wave velocity, and retinal vessel diameters were estimated by the central retinal arteriolar (CRAE) and vein (CRVE) equivalent and retinal arteriovenous ratio (AVR). Univariate analyses were performed and partial correlation was used to account for traditional cardiovascular risk factors to identify independent associations between cerebral oxygenation indices and TOD. Results: Fifty-two newly-diagnosed, never treated hypertensives and 41 healthy normotensive individuals with no known medical history of any other disease were included in our study. There were no differences in anthropometric and laboratory variables between groups except for their BP levels, as expected by study design. Mean cIMT was negatively correlated with the average exercise response in cerebral oxygenation (rhoO2Hb = -0.348, pO2Hb = 0.001; rhotHb = -0.253, ptHb = 0.02). Augmentation index was negatively correlated with cerebral-oxygenation during exercise (rhoO2Hb = -0.374, p &lt; 0.001; rhotHb = -0.332, p = 0.02), whereas no significant correlation was observed between pulse wave velocity and cerebral oxygenation indices. In the adjusted analysis, cerebral oxygenation was correlated with central retinal arteriolar diameter (CRAE rO2Hb = 0.233, pO2Hb = 0.043). Conclusions: Our novel findings suggest that indices of cerebral oxygenation during a submaximal physical task are associated with markers of early, subclinical target organ damage, namely increased carotid intima-media thickness, arterial stiffness and retinal arteriolar narrowing in a population of newly diagnosed hypertensive individuals.

Association Between Serum Uric Acid and Carotid Intima-Media Thickness in Different Fasting Blood Glucose Patterns: A Case-Control Study.

Our objective was to analyze the correlation between serum uric acid (SUA) levels and carotid intima-media thickness (CIMT) and explore the relationship between SUA and carotid atherosclerosis in different glucose metabolism patterns. A total of 614 patients were enrolled in this case-control study, including 406 in the normouricemia group and 208 in the hyperuricemia group. The two groups were each divided into three groups according to fasting blood glucose (FBG) level: normal, impaired fasting glucose (IFG), and diabetes mellitus (DM). CIMT and the CIMT thickening rate in the hyperuricemia group were significantly higher than those in the normouricemia group: 0.17 (0.11–0.24) cm vs. 0.12 (0.08–0.15) cm and 73.56% vs. 51.97% (p < 0.001). Pearson’s correlation analysis showed that age, systolic blood pressure (SBP), diastolic blood pressure, FBG, triglyceride, SUA, creatinine, and blood urea nitrogen were positively correlated with CIMT, whereas high-density lipoprotein cholesterol and total cholesterol were negatively correlated with CIMT. Multiple linear regression analysis showed that age, SUA, FBG, and SBP were independent factors that affected CIMT. Furthermore, age and SBP were independent factors in the normouricemia group, and FBG was an independent factor that affected CIMT in the hyperuricemia group (p < 0.05). In the hyperuricemia group, CIMT in the DM group was significantly higher than that in the normal group [0.20 (0.14–0.25)cm vs. 0.15 (0.1–0.25); p < 0.05], and the CIMT thickening rate in the DM group was significantly higher than those in the IFG and normal groups (90.38% vs. 78.38%, 90.38% vs. 65.81%; p < 0.05). The ROC curve analysis showed that uric acid combined with age, SBP, and FBG had the highest area under the curve (AUC) for predicting CIMT thickening [0.855 (95% confidence interval (CI): 0.804–0.906)], followed by uric acid combined with FBG [AUC: 0.767 (95% CI: 0.726–0.808)]. In conclusion, SUA was closely associated with an increase in CIMT in patients with specific FBG metabolic patterns and may be an independent risk factor for carotid atherosclerosis. SUA, especially in combination with other factors (such as age, SBP, FBG), may serve as a specific model to help predict the incidence of CIMT thickening. Clinical Trial Registration: http://www.chictr.org.cn, identifier ChiCTR2000039124.

The Role of Physical Activity Status in the Relationship between Obesity and Carotid Intima-Media Thickness (CIMT) in Urban South African Teachers: The SABPA Study.

Globally, the prevalence of physical inactivity and obesity are on the rise, which may increase carotid intima-media thickness (CIMT) as a marker of subclinical atherosclerosis. This study assessed the association between physical activity (PA), obesity, and CIMT. A cross-sectional study design was used, including a sub-sample (n = 216) of teachers who participated in the Sympathetic Activity and Ambulatory Blood Pressure in Africans (SAPBA) study. Measurements included the following: physical activity status (measured with ActiHeart devices over 7 consecutive days), body mass index (BMI), waist circumference (WC), waist-to-height ratio (WtHR), CIMT (measured by SonoSite Micromax ultrasound), blood pressure (BP), fasting C-reactive protein (CRP), and cholesterol and glucose levels. Data were analysed using the Statistical Package for Social Science. One-third of the teachers were physically inactive (33%) and had low-grade inflammation CRP ≥ 3 mg/L (41%). Males were more sedentary and had higher BP and CIMT (p < 0.05). Independent of age and sex, WC or central obesity was 2.63 times more likely (p = 0.02) to contribute to atherosclerosis, especially in females (OR: 4.23, p = 0.04). PA levels were insignificantly and negatively (β −0.034; 0.888; 0.240) related to subclinical atherosclerosis. The cardiovascular disease risk profiles and limited PA status may have curbed the beneficial impact of PA on the obesity and atherosclerosis.

Vascular aging in the young: New carotid stiffness centiles and association with general and abdominal obesity – The KIGGS cohort

Background and aimsThe evidence for an association between obesity and increased carotid intima-media thickness (CIMT) and carotid stiffness (CS) in the young has been limited by methodological challenges related to study populations, measurements, methods of percentile derivation and comprehensiveness of obesity markers investigated. This nationwide general population study developed new CS and CIMT centiles in the young and used them to study associations with body mass index, waist circumference, waist-to-height-ratio, bioimpedance-derived absolute and relative fat mass, fat-free mass, subscapular skinfold thickness and blood pressure. MethodsIn its 11-year follow-up, the KiGGS cohort, which is based on a nationally representative sample, included semi-automated state-of-the-art sonographic CIMT and CS measurements in 4,709 participants aged 14 to 28. Distensibility coefficient (DC), stiffness index β, Young's elastic modulus (YEM) and Peterson's elastic modulus (Ep) centiles were modelled by sex, age and height simultaneously. ResultsCS increased with age in both sexes, and young men had stiffer arteries than young women at all ages. All obesity measures at baseline and at follow-up, except for subscapular skinfold thickness, were positively associated with several CS parameters with moderate relative risks (RR), e.g. cross-sectional RR 2.23 (95% CI 1.26–3.93) for DC ≥ 90th percentile when waist circumference ≥90th percentile; RR 5.98 (3.38–10.56) for elevated DC associated with simultaneously elevated waist circumference and BP. ConclusionsThese new state-of-the-art CS percentiles show consistent associations of obesity with CS in the young and support primary prevention efforts starting at a young age.

Increased carotid intima-media thickness and reduced health-related physical fitness in children and adolescents with coarctation of the aorta

BackgroundCoarctation of the Aorta (CoA) was assumed to be one of the congenital heart defects not associated with major long-term sequels. Meanwhile, it is known that there are long-term cardiovascular consequences. This study investigates the functional outcome measures in children with CoA. Methods77 children (40.3% girls, 13.1 ± 3.3 years) with CoA were examined for their functional outcome measures and compared to healthy controls (CG). Carotid Intima-Media wall thickness (cIMT) was measured by ultrasound of the common carotid artery. In addition, Health-related Physical Fitness (HrPF) was assessed by five tasks of the FITNESSGRAM® and health-related quality of life (HrQoL) was analyzed with a self-report questionnaire (KINDL-R). ResultsAfter adjustment for age and sex and in comparison to the CG, the CoA patients showed structural changes in cIMT (CoA: 0.480 ± 0.043 mm vs CG: 0.465 ± 0.033 mm; p = 0.002) and significantly lower HrPF (z-score −0.46 ± 0.7; p < 0.001; 32nd percentile). HrQoL in children with CoA was significantly better in comparison to CG (p = 0.020). ConclusionEarly onset of structural changes of the cIMT in children with CoA could be shown. These structural changes in combination with hypertension, which often is associated with CoA, should be the focus of structured follow-up during childhood. The children with CoA showed impaired HrPF in comparison, where the promotion of physical activity should be the key factor for improvement. Encouragingly they showed better HrQoL.

10 A NOVEL PEPTIDE ELABELA IS ASSOCIATED WITH HYPERTENSION-RELATED SUBCLINICAL ATHEROSCLEROSIS

Background: Elabela is a newly identified peptide which, alongside apelin, acts as an endogenous ligand that activates the angiotensin receptor-like 1 receptor (APJ). Previous clinical studies have shown the association of elabela with hypertension, but information about the role of elabela in hypertension-related atherosclerosis is scarce. Objectives: To determine the association between plasma elabela peptide levels and subclinical atherosclerosis in the hypertensive population. Methods: A total of 104 subjects with hypertension were included in a cross-sectional study. Plasma elabela levels were measured using enzyme-linked immunosorbent assay (ELISA) by extracting the peptide following the manufacturer's instructions. The subclinical atherosclerosis parameter was assessed by measuring the carotid intima-media thickness (IMT) using ultrasound. Results: Compared to stage 1, elabela levels decreased in stage 2 of the hypertension group (0.14 [0.09, 0.23] ng/ml vs. 0.23 [0.13, 0.45] ng/ml; P = 0.000), and in the group with increased carotid IMT compared to normal IMT (0.15 [0.10, 0.23] ng/ml vs. 0.24 [0.13, 0.38] ng/ml; P = 0.005). Additionally, a linear correlation analysis showed that elabela had a significant negative correlation with systolic blood pressure (r = -0.340, P = 0.000) and carotid IMT (r = -0.213; P = 0.030). In multivariate analysis, decreased elabela levels (cut-off 0.155 ng/ml) were associated with the higher cardiovascular risk group in this study (OR 5.0, 95% CI 1.8-13.5, P &lt; 0.001). Conclusion: This study is the first to demonstrate the association of circulating elabela with carotid IMT in hypertensive patients, implicating that elabela is involved in the pathogenesis of hypertension-related subclinical atherosclerosis. Reduced elabela levels were also associated with increased cardiovascular risk.

Is thyroid autoimmunity associated with subclinical atherosclerosis in young women with type 1 diabetes mellitus?

It has been hypothesized that autoimmunity may contribute to cardiovascular complications and may be an important trigger for processes leading to atherosclerosis, especially in type 1 diabetes mellitus (T1DM). This pilot study aimed to answer the question of whether markers of thyroid autoimmunity are associated with increased carotid intima-media thickness (cIMT) in young, asymptomatic T1DM women. The study population consisted of 102 women, including 72 with T1DM and 30 healthy controls. All patients had thyroid hormones within the normal range. According to the antiperoxidase antibodies (aTPO) titre, the T1DM women were divided into an aTPO-positive (T1DM aTPO+) (n = 41) and an aTPO-negative (T1DM aTPO-) (n = 31) group. In all patients, aTPO, thyroglobulin antibody (aTG) titres, thyroid-stimulating hormone (TSH), free thyroxine (FT3), free triiodothyronine (FT4), lipid parameters, glycated haemoglobin, thyroid ultrasonography, and cIMT assessment were evaluated. The association of cIMT with different risk factors related to thyroid autoimmunity was determined. Carotid intima-media thickness was significantly greater in T1DM aTPO+ females (0.66 ± 0.10 mm) than in T1DM aTPO- (0.59 ± 0.11 mm) and healthy controls (0.58 ± 0.10 mm) (p = 0.007, p = 0.001, respectively). In all women cIMT was significantly, positively correlated with aTPO (p = 0.005, r = 0.273), Hashimoto's thyroiditis (HT) duration (p = 0.00015, r = 0.367), levothyroxine dose per week (p = 0.006, r = 0.269), and ultrasound features of HT (p = 0.004, r = 0.281) and inversely with fT3 concentration (p = 0.014, r = -0.243) and FT3/FT4 ratio (p = 0.042, r = -0.201). A logistic regression analysis showed that HT duration (OR: 1.102, 95% CI: 1.008-1.206, p = 0.032) and a positive history family of HT (OR: 3.909, 95%CI: 1.014-15.071, p = 0.045) were risk factors for increased cIMT. However, multivariate regression analysis showed that the studied parameters related to thyroid autoimmunity are not independent risk factors for increased cIMT. We expanded the data on cIMT in young women with T1DM and showed that thyroid autoimmunity, and in particular the duration of exposure to anti-thyroid antibodies, despite adequate levothyroxine substitution, is associated with subclinical atherosclerosis in young women with T1DM. However, thyroid-related parameters are not independent risk factors for increased cIMT in euthyroid women.

Endothelium function biomarkers and carotid intima-media thickness changes in relation to NOS3 (rs2070744) and GNB3 (rs5443) genes polymorphism in the essential arterial hypertension.

Objective. The aim of the present study was to clarify the endothelial function biomarkers and carotid "intima media" thickness (IMT) changes in relation to GNB3 (rs5443) and NOS3 (rs2070744) genes polymorphism in the essential arterial hypertension (EAH). Methods. One-hundred EAH patients (48 - control) participated in the case-control study. Soluble vascular cell adhesion molecule (sVCAM-1), total NO metabolites (NO2 -+NO3 -), transcriptional activity of NOS3 gene, endothelium-dependent flow-mediated dilation of the brachial artery (FMD BA), and carotid IMT were studied. GNB3 (rs5443) and NOS3 (rs2070744) genotyping was performed by TaqMan probes (CFX96™Real-Time PCR). Results. The connection of NOS3 (rs2070744) with decreased total NO metabolites (F=71.11; p<0.001), reduced NOS3 genes transcription activity (F=8.71; p<0.001) and increased sVCAM-1 (F=6.96; p=0.002), especially in the C-allele carriers (particularly in CC-genotype patients with lower NO - 16.46% and 40.88%; p<0.001), lowered the transcription activity of NOS3 gene - 46.03% 7 times (p<0.001), and become higher sVCAM-1 - 35.48% and 89.48% (p<0.001), respectively. ANOVA did not confirm the association of GNB3 (rs5443) gene with endothelial function and carotid IMT. Severe EAH was associated with increased carotid IMT - 50.0% (p<0.001) and 57.14% (p=0.007), wider carotid arteries - 17.36% (p=0.012) and 21.79% (p=0.004), and decreased NOS3 genes transcription activity - 34.54% (p=0.003). Atherosclerotic plaques were unilateral - 24.77% (χ2=5.35; p=0.021) or bilateral - 27.62% (χ2=5.79; p=0.016). IMT---gt---0.9 mm was followed by a higher BP (p<0.001), FMD BA 11.80% decrease with compensatory increase in carotid arteries diameters - 17.38% and 21.99% (p<0.001) and sVCAM-1 by 20.49% (p=0.005). Conclusion. NOS3 (rs2070744), but not GNB3 (rs5443), gene associated with the essential arterial hypertension severity relying upon the endothelial function impairment and NOS3 genes reduced transcription activity.

IDF21-0083 Standard deviation

Background: Increased standard deviation (SD) has been previously reported to be associated with increased carotid intima-media thickness. It is well unknown how to simplify standard deviation (SD) and achieve target SD. Aim: We studied how to simplify SD. We also studied regarding the useful metrics for achieving target SD. Method: In a cross-sectional study, we analyzed 24-h glucose levels measured using continuous glucose monitoring (CGM) [Medtronic iPro2; Medtronic MiniMed, Northridge, CA, USA] in 150 patients with type 2 diabetes. We analyzed 51 time in range (TIR) (reference ranges: mean glucose level (M) ± 20, M ± 21 … M ± 69, M ± 70 mg/dL [we referred to the underlined numbers as “Margin”]). We analyzed optimal cutoff values of TIR to predict SD below target, corresponding to 51 TIR × 26 target SD (25, 26 … 49, 50 mg/dL), using receiver operating characteristic analysis. Of the 51 reference ranges, the reference range for which TIR had the largest AUC for each target SD was referred to as “optimal reference range 1”. We arranged the patients in ascending order of SD, ranking from 1 to 150. Consecutive 110 patients were selected 41 times while shifting one by one (from “1–110” to “41–150”: 41 groups). Of the 51 reference ranges, the reference range for which TIR most correlated to SD for each group was referred to as “optimal reference range 2”. Results: Mean absolute deviation (MAD) correlated to SD (r = 0.995, p < 0.001; MAD = 0.87 × SD - 1.22) (n = 150). “Margin” of “optimal reference range 1” (M1, mg/dL) tended to increase with increased target SD (mg/dL), from 42 for “target SD of 25” to 66 for “target SD of 50”. Target SD correlated to M1 (r = 0.92, p < 0.001; M1 = 1.31 × target SD + 5.56) (n = 26). The optimal cutoff values of TIR for “optimal reference range 1” was 86.8 ± 4.6 % in 26 target SD. “Margin” of “optimal reference range 2” (M2) tended to increase with increased mean of SD, from 35 for “mean of SD of 30.6” to 64 for “mean of SD of 47.7”. Mean of SD correlated to M2 (r = 0.96, p < 0.001) (n = 41). Discussion: SD means difference from M. If “optimal reference range 1” is used as an alarm threshold in a personal CGM and TIR for “optimal reference range 1” > 80–90 % is achieved, SD below the target may be achieved. The mean of SD in study participants may affect the M2.

Increased carotid intima-media thickness is independently associated with the occurrence of depressive disorders in patients with obstructive sleep apnea without cardiocerebrovascular disease

Study objectivesThis study aimed to explore the relationship between carotid intima-media thickness (cIMT) and depression in patients with obstructive sleep apnea (OSA) without cardiocerebrovascular diseases. MethodsThis study evaluated self-rating depression scale (SDS) scores, night sleep, and cIMT in 114 patients with OSA without cardiocerebrovascular diseases. ResultsAmong the 114 patients, 79.8% were male (mean age: 46.7 ± 11.58 years; range: 22–72 years). Moreover, 46.5%, 44.7%, and 7.89% of the patients presented with depressive disorders (8, 24, and 21 with severe, moderate, and mild degrees of depression, respectively), cIMT increase, and carotid plaques, respectively. Logistic regression with adjustment for age, sex, and other confounding factors revealed that, compared with patients with OSA without depressive disorders, those with depressive disorders had higher cIMT (odds ratio [OR] = 1.839; 95% confidence interval [CI]: 1.210–2.795), D-value (the difference between nocturnal mean blood oxygen saturation and the lowest blood oxygen saturation; OR = 1.434; 95% CI: 1.259–1.633]), and time spent at O2 saturation below 90% (OR = 1.060; 95% CI: 1.001–1.123). ConclusionscIMT and D-value are independently associated with depression in patients with OSA, which provides clinical evidence regarding the involvement of vascular damage in OSA-induced depression.