Thickness Of Intima-media Complex Research Articles

THE ESTIMATE OF ADIPOKINES, CYTOKINES, MARKERS OF ENDOTHELIAL DYSFUNCTION AND HEMOSTASIS CORRELATION WITH THE STATE OF TARGET ORGANS IN YOUNG PATIENTS WITH HYPERTENSION COMBINED WITH ABDOMINAL OBESITY

Background. To estimate the correlation of adipokines, cytokines, endothelial dysfunction markers and hemostasis with state of target organs in young patients with hypertension and abdominal obesity. Materials and methods. The blood content of adipokines, cytokines, endothelial dysfunction markers and hemostasis in patients with hypertension, abdominal obesity and their combination was determined. Standard 12-lead ECG, two-dimensional echocardiography and duplex scanning of the brachiocephalic arteries were performed in all patients. Results. In young patients with combination of hypertension and abdominal obesity were determined the increased levels of leptin, interleukin-6, monocyte chemoattractant protein type 1, endothelin, angiotensin II and prothrombotic changes in hemostasis. Among this patients were revealed hypertrophy of the left ventricle myocardium and increased intima-media complex thickness compared to those in groups with isolated hypertension, isolated abdominal obesity and the control group. The greatest diagnostic significance for predicting myocardial hypertrophy of the left ventricle according to the ROC-analysis were endothelin level >3,49 pg/ml and interleukin-6 level >5,67 pg/ml.

Association of vessel stiffness parameters and subclinical atherosclerosis and mass of bone tissue in postmenopausal women

Aim. To study relation of vessel wall stiffness parameters and subclinical atherosclerosis with mineral density of bone (MDB) in postmenopausal women. Material and methods. Into a simultaneous study were included 107 patients at the age 45-82 y.o., being monitored in outpatient circumstances and signed informed consent. We did not include patients with any clinical sign of atherosclerosis, malignancies, secondary osteoporosis causing diseases, as those who had been taking drugs influencing calcium metabolism or vessel wall stiffness parameters. The intima-media complex (IMC), presence of absence of atherosclerotic lesions (AL) were studied via duplex scanning. Pulse wave velocity (PWV), augmentation index (AI) were measured by application tonometry (SphygmoCor). MDB of the spine and of proximal femur was measured via double energetic x-ray absorptiometry. Statistics done with the software by Statistical Analysis System (USA). Results. With the increase of menopause duration, there was gradual increase of PWV, AI, IMC and decrease of MDB. Maximal values of vessel stiffness and the highest MDB were found in 10 years after menopause. Osteoporosis was diagnosed in 27 (25%) of patients, osteopenia in 38 (36%), normal MDB in 42 (39%). The risk of bone mass decrease and of osteoporosis development increased 3 times in higher values of PWV (≥10 m/s) (р 9 mm (р=0,02) and in 2,45 times if AL in carotid arteries were found (p=0,03). During multifactor regression analysis, negative relation of AI, IMC thickness and MDB remained, though association with PWV and AL was not proven. Conclusion. With the increase of menopause duration there was increase of vessel rigidity parameters PWV, AL, IMC thickness and bone mass loss. Decrease of MDB in postmenopausal women is associated with high values of PWV, IA, IMC thickness and AL amount, but as independent predictors of low bone mass were only AI and IMC.

Factors associated with pathological cardio-ankle vascular indices in patients with acute ischemic stroke: gender differences

Background. Currently, risk factors of ischemic stroke remain the relevant research object, including gender-dependent arterial stiffness. Objective. To study the gender-related differences in factors associated with pathological cardio-ankle vascular index (CAVI) in subjects with acute cerebrovascular accidents (CVA). Design and methods. The presence of cardiovascular disease, previous cardiovascular events, types and subtypes of stroke were assessed in all subjects. Color-flow duplex scanning of brachiocephalic arteries and laboratory studies (lipid profile) were performed to assess the presence of atherosclerosis. Results. There were no significant differences in intermediate and pathological CAVI valuesin men and women (р = 0,59 and р = 0,48, respectively). The factors associated with pathological CAVI differ depending on the gender. The independent predictors of pathological CAVI in men include obesity (р = 0,04), intima-media complex thickening (р = 0,03); while in women they include obesity (р = 0,03), atherogenic index (p = 0,02), history of acute cerebrovascular accident (р = 0,03), and coronary artery disease (p = 0,02). Conclusions. Thus, the assessment of CAVI is recommended in patients with ischemic stroke in order to identify increased arterial wall stiffness and to apply preventive approaches in accordance with the gender-related differences.

Is plasma-soluble CD36 associated with density of atheromatous plaque and ankle–brachial index in early-onset coronary artery disease patients?

CD36 is a major macrophage scavenger receptor for oxidised low-density lipoprotein particles. Soluble CD36 (sCD36) is circulating as a ligand-bound complex and may be present in microparticles shed from cells such as platelets, monocytes/macrophages, or adipocytes. Positive association of plasma sCD36 with insulin resistance has been reported, and it has been proposed that sCD36 might represent a marker of macrophage activation and inflammation leading to atherosclerosis. Recently we have identified an association between CD36 polymorphism and low thickness of atheromatous plaque, suggesting its protective effect against atherosclerosis development. To obtain insight into the relationship between plasma concentration of sCD36 and radiological parameters of atherosclerosis in patients with early-onset coronary artery disease (CAD). The study group comprised 70 clinically stable patients (18 women and 52 men) with early CAD (aged no more than 50 years for men and 55 years for women). Fasting blood sample was taken for serum glucose, lipid profile, ApoA1, ApoB, Lp(a), and plasma sCD36 protein measurements. Each subject's weight, height, waist and hip circumference, and systolic and diastolic blood pressure were measured, and the body mass index, waist-to-hip ratio, and mean arterial pressure were calculated. Doppler ultrasound examinations of carotid and peripheral arteries were performed in all patients. Thickness of intima-media complex (IMC) of common carotid (CCA) and brachial arteries, as well as density and thickness of atheromatous plaque at CCA bifurcation, were measured with M'Ath programme. Plasma concentrations of CD36 antigen were measured by ELISA. Correlations between quantitative variables and sCD36 plasma concentration were assessed with the Spearman rank correlation coefficient (Rs). Associations between qualitative variables and sCD36 plasma concentration were tested with the Mann-Whitney U test. We observed no significant correlations between sCD36 concentration and radiological parameters of atherosclerosis. We found only borderline significant negative correlation of sCD36 concentration with thickness of IMC of left brachial artery. We also observed a significantly negative correlation with CCA plaque density, but only in the female subgroup and on the right side. Borderline higher sCD36 plasma concentrations were observed in patients with lower ankle-brachial index value (< 0.9). The results of the study show no strong associations and do not prove either detrimental or beneficial influence of sCD36 on radiological parameters of atherosclerosis. Further research is necessary to assess the association of high plasma sCD36 concentrations with the risk of plaque instability in patients with early-onset CAD.

The special features of cardiovascular pathology diagnostics in patients with epilepsy

Aim. The researchers noticed the changes of parameters of cardiovascular system functioning in patients with epilepsy during epileptic attacks and in interictal period. The aim of research was the study of informativity of the different methods of study of cardiovascular system functioning for detection and evaluation of risk of cardiac pathology development in patients with epilepsy.Materials and methods. We examined 50 patients with epilepsy and CVP and 50 patients with epilepsy without CVP. All patients underwent clinical and neurological examination, electrocardiography, echocardioscopy, examination of heart rhythm variability, dopplerography of carotid arteries, analysis of lipid blood spectrum, brain evaluation on indications on SCORE, МРТ.Results. There was revealed that the use of valproates and carbamazepine is associated with dyslipidemia development; valproates – with increase of intima-media complex thickness, cambamazepine – with increased risk of development of heart rhythm and conduction disorder; lamotrigine and levetiracetam – with increase of heart rate. The combined use of levetiracetam and carbamazepine is associated with extension of QT interval. The most significant increase of risk of CVP development during the next 10 years on SCORE was noticed in patients who take carbamazepine.Conclusions. The definition of intima-media complex thickness at dopplerography of carotid arteries, patients evaluation on SCORE, lipidograms, heart rhythm variability, definition of myocardial work index at echocardioscopy along with the standard ECG are effective for determination of risk factors and early detection of CVP in patients with epilepsy

ASSOCIATION OF THE METABOLIC SYNDROME CONSTITUENTS WITH MARKERS OF SUBCLINICAL TARGET ORGAN DAMAGE DURING FOLLOW-UP OF INTELLECTUAL LABORERS

Aim. To evaluate the relation of metabolic syndrome (MS) and its constituents with markers of subclinical damage of target organs (TOD) in follow-up of almost healthy intellectual laborers. Material and methods. From the selection of 1600 employees of a bank we randomly selected 383 with at least one component of MS without cardiovascular disorders, of those by the end of 2 years period 331 came to final visit (response 86%). Mean age 46,6±9,0 y., mostly women (214 (64,6%)). All patients underwent anthropometry, blood pressure measurement (BP), lipids investigation, creatinine and fasting glucose, echocardiography with the assessment of the left ventricle hypertrophy (LVH), ultrasound study of carotid arteries (intima-media complex thickness — CIM, and atherosclerotic plaques), vascular rigidity assessment, anklebrachial index, albumin concentration in single portion of urine at both stages of observation. Results. While performing multiple logistic regression, presence of arterial hypertension (AH) associated with increased probability of LVH, thickening of CIM and higher vessel rigidity in standardization by gender and age. Relation of MS with the markers of TOD has not been found. In 2 years of follow-up there was a significant increase of patients with thickening of CIM (from 81 (24,5%) to 146 (44,1%), p<0,001) and decrease of LVH prevalence (from 154 (46,7%) to 109 (32,9%), p=0,003) together with significant decrease of BP and total cholesterol. Conclusion. Presence of AH is associated with higher probability of LVH and increased vessel rigidity, as atherosclerotic changes in carotid arteries. MS was not related with an increased prevalence of TOD, and the main predetermining factors for structural heart abnormalities, the vessels and kidneys, were gender and age. In 2 years of observation there was markedly decreased number of patients with LVH and kidney dysfunction at the background of BP pattern improvement, and increase of the number of patients with thicker CIM, regardless of a decrease of the hypercholesterolemia patients. In MS patients there was more common to use antihypertension treatments, that led to more prominent LVH regression.

GENE POLYMORPHISM IN ASSOCIATION WITH ATHEROSCLEROSIS DEVELOPMENT AND COGNITION DISORDERS IN PATIENTS WITH ISCHEMIC CHRONIC HEART FAILURE

Aim. To study the interrelation of polymorphic gene variants playing role in atherosclerosis development, with cognition disorders, central nervous system condition and chronic heart failure (CHF) course specifics in patients with ischemic heart disease. Material and methods. 40 patients with CHF I-IV functional class (NYHA) of ischemic origin underwent cognition testing, nuclear-magnetic resonance tomography of the brain, duplex brachiocephalic arteries scanning, gene APOC3, ABCA1 и PON1 polymorphism assessment, and lipid, homocystein, brain natriuretic peptide measurement (BNP). Results. The interrelations of polymorphic gene variants APOC3, ABCA1 и PON1 were found with morphological changes in the brain and cognition tests results. T allele at PON1 (polymorphism L55M A&gt;T) and allele A at PON1 (polymorphism Q192R A&gt;G) associated with the worsening of Burdone correction test, and T allele of APOC3 gene (polymorphism -482C&gt;T) was linked to the decrease of diffusion coefficients in gray as in white matters. There are statistically significant relations of the polymorphisms studied with the levels of plasma lipids, homocysteine and carotid arteries diameter and intima-media complex thickness. While studying relations of polymorphic genes ABCA1 и APOC3 variants (C3238G) and CHF duration, BNP level and end- systolic size of the left atrium it was found that the allele A of gene ABCA1 and allele G of gene APOC3 ^3238G) are associated with longer duration of CHF. The increase of the left atrium size and higher BNP levels were shown in patients — carriers of C allele gene APOC3 (polymorphism -428 C&gt;T). Conclusion. There is interrelation of gene polymorphism that are associated with lipid metabolism disorders, CHF course and cognition functioning and morphological changes in central nervous system in CHD patients.

Abstract 16197: Pedicled Vein Grafts in Coronary Surgery Exhibit Reduced Intimal Hyperplasia at 6 Months

Introduction: Less-than-optimal long-term patency of the saphenous vein is one of the main obstacles for the success of CABG. Harvesting saphenous veins including a pedicle of perivascular tissue has been proposed to improve graft patency rates and endothelial function. Hypothesis: We hypothesized that pedicled vein grafts would show less intimal hyperplasia at 6-month angiographic follow-up. Method: Sixty patients scheduled for first time elective on-pump CABG were randomized to conventional or pedicled vein harvesting. Exclusion criteria were insulin dependent diabetes mellitus, recent smoking or renal failure. Pedicled veins were harvested with perivascular tissue and conventional veins were skeletonized. All veins were distended manually to check for leakage and stored in heparinized blood and saline. At 6 months vein grafts were examined with Intravascular Ultrasound (IVUS) and Optical Coherence Tomography (OCT). Imaging analysis was performed by an external blinded Core-lab. Results: Fifty-four patients were available for follow-up. There were no significant differences in occlusion rates between the two groups. IVUS showed no significant difference in intima-media complex thickness (pedicled: n=28, mean 0.229 mm, SEM 0.011; conventional: n = 26, mean 0.235 mm, SEM 0.017). However, using OCT pedicled veins showed significantly less intimal thickness than conventional veins (pedicled: mean 0.270 mm, SEM 0.012; conventional: mean 0.358 mm, SEM 0.021; p&lt;0.001). In conventional veins higher perioperative flow was positively correlated to increased intimal thickness. Such a correlation was not found in pedicled grafts. The difference in response to flow was significant using a general linear model including an interaction term (adjusted R squared = 0.254, p&lt;0.018). Conclusion: Performing CABG using saphenous vein grafts harvested with a pedicle of perivascular tissue provides significantly less vein graft intimal hyperplasia at 6 months.

Can normal findings in non-invasive examinations (duplex carotid sonography and ankle brachial pressure index) predict a normal result of coronarography?

IntroductionAnkle-brachial pressure index (ABI) and duplex carotid sonography (DCS) are simple non-invasive investigations that can be used for detection of atherosclerosis and, consequently, for prediction of risk of cardiovascular diseases in patients. Numerous studies proved a positive correlation between pathological findings in ABI or DCS and the presence of ischemic heart disease (IHD). We are however not aware of any study dealing with a question whether and how reliably can physiological findings in DCS and/or ABI predict a physiological coronarography result. Methods219 patients admitted to our cardiology department for elective coronarography with no prior IHD diagnosis were investigated using ABI and DCS prior to performing coronarography. ABI results between 0.9 and 1.4 were considered physiological as well as DCS result showing no atherosclerotic plaque and thickness of intima-media complex under 1.0mm. Absence of stenosis over 50% in coronary arteries was considered normal coronarography finding. ResultsA physiological ABI was revealed in 112 patients with a normal and 49 patients with a pathological coronarography result while an abnormal ABI was associated with 29 patients with and 29 patients without IHD confirmed by coronarography. A normal DCS result was obtained in 38 patients with normal coronarography result and 10 patients with IHD, while a pathological DCS finding was associated with 103 patients with a normal coronarography result and 68 patients with IHD. Physiological values in a combination of both ABI and DCS correctly predicted a normal coronarography result in 32 patients but provided false negative results in 9 patients.The negative predictive value of ABI was 69.6%, the negative predictive value of DCS was 79.2% and the negative predictive value of the combination of both examinations was 78.0%. ConclusionsA physiological finding of ABI and particularly DCS investigations can predict a normal coronarography finding. Both methods are cheap and non-invasive and as such, they can help in decision making whether or not to refer patients with intermediate risk of IHD for invasive coronarography investigation.

Short telomere length is associated with arterial aging in patients with type 2 diabetes mellitus

It is known that glucose disturbances contribute to micro- and macrovascular complications and vascular aging. Telomere length is considered to be a cellular aging biomarker. It is important to determine the telomere length role in vascular structural and functional changes in patients with diabetes mellitus. We conducted a cross-sectional observational study in a high-risk population from Moscow, Russia. The study included 50 patients with diabetes and without clinical cardiovascular disease and 49 control group participants. Glucose metabolism assessment tests, measuring intima–media complex thickness and determining the presence of atherosclerotic plaques, pulse wave velocity measurement, and telomere length measurement were administered to all participants. Vascular changes were more dramatic in patients with diabetes than in the control group, and the telomeres were shorter in patients with diabetes. Significant differences were found in the vascular wall condition among diabetes patients, and there were no substantial differences in the arterial structure between patients with ‘long’ telomeres; however, there were statistically significant differences in the vascular wall condition between patients with ‘short’ telomeres. Vascular ageing signs were more prominent in patients with diabetes. However, despite diabetes, vascular changes in patients with long telomeres were very modest and were similar to the vascular walls in healthy individuals. Thus, long lymphocyte telomeres may have a protective effect on the vascular wall and may prevent vascular wall deterioration caused by glucose metabolism disorders.

Intima-media complex thickness: preliminary workup of comparative evaluation of abdominal aorta and carotid artery of small-for-gestation-age term newborns and normal size term newborns

Background Increased intima-media thickness (IMT) has shown to be a good predictor of increased incidence of cardiovascular disease. The use of noninvasive measurement of abdominal aortic intima-media thickness (aIMT) and carotid artery intima-media thickness (cIMT) is an attractive modality to further explore and defi ne possible intrauterine factors that may be associated with increased risk of atherosclerosis.Purpose The aim of this study was to compare intima-media thickness of abdominal aorta and carotid artery in small-for-gestation-age (SGA) term newborns with appropriate for gestation age (AGA or normal sized) term newborns.Material and methods We measured the intima-media thickness of the abdominal aorta (aIMT) and carotid artery (cIMT) by high resolution ultrasonography of 50 SGA and 50 AGA term newborns.Results Mean aIMT and cIMT were significantly greater in the SGA term newborns group as compared to AGA term newborns (0.54 0.06 mm and 0.44 ) 0.04 mm in SGA term newborns vs 0.50 0.04 mm and 0.40 0.04 mm in AGA term newborns; P< 0.008 and P< 0.001, respectively). The signifi cance was even more apparent after adjustment for birthweight. A negative correlation of aIMT and cIMT was seen with birthweight, Ponderal index, length and head circumference.Conclusion SGA term newborns have signifi cantly increased aortic and carotid intima-media thickness as compared to AGA term newborns. This might be associated with higher risk for atherosclerosis. Longitudinal studies are required to further enhance the possible correlation between birthweight and intima-media thickness in SGA babies.

Effects of levothyroxine replacement therapy on parameters of metabolic syndrome and atherosclerosis in hypothyroid patients: a prospective pilot study.

The aim of this study was to investigate the effect of levothyroxine (LT4) replacement therapy during three months on some parameters of metabolic syndrome and atherosclerosis in patients with increased thyroid-stimulating hormone (TSH) level. This study included a group of 30 female patients with TSH level >4 mIU/L and 15 matched healthy controls. Intima media complex thickness (IMCT) and peak systolic flow velocity (PSFV) of superficial femoral artery were determined by Color Doppler scan. In hypothyroid subjects, BMI, SBP, DBP, and TSH were significantly increased versus controls and decreased after LT4 administration. FT4 was significantly lower in hypothyroid subjects compared with controls and significantly higher by treatment. TC, Tg, HDL-C, and LDL-C were similar to controls at baseline but TC and LDL-C were significantly decreased by LH4 treatment. IMCT was significantly increased versus controls at baseline and significantly reduced by treatment. PSFV was similar to controls at baseline and significantly decreased on treatment. In this study, we have demonstrated the effects of LT4 replacement therapy during three months of treatment on correction of risk factors of metabolic syndrome and atherosclerosis.

Cognitive impairment in predialysis stages of chronic kidney disease

To study the development and progression of cognitive impairment (CI), its risk factors and relationship with vascular-wall remodeling in patients with chronic kidney disease (CKD), stages I-IV. Fifty-one patients, aged 53±10 years, including 20 with CKD, stages I-II, 20 with CKD, stage III, and 11 with CKD, stage IV, were enrolled. Frequency, severity and character of CI were studied using neuropsychological tests for assessment of global mental status, short-term and delayed memory, frontal lobe functions. Standard laboratory examinations, echocardiographic study, 24h arterial blood pressure monitoring, measurement of the thickness of carotid intima-media complex, pulse-wave velocity and augmentation index, brain MRI study were carried out. CI was found in 68% of patients, including 35% with CKD, stages I-II, and 90.3% with CKD, stage IV. The severity of CI was higher in patients with CKD, stages III-IV, compared to those with stages I-II (p<0.001). CKD predicted the development of CI (OR 27.32, 95% CI 4.3-72.9, р<0.001). MRI revealed the focal lesions of the white matter in 30% of patients, leukoaraiosis in 23.3%, lateral ventricular dilatation in 50%, expressed dilatation in the sulci of brain hemispheres in 10%. There was a relationship between CI and male sex, hyperhomocysteinemia, anemia, abdominal obesity, left ventricular myocardial hypertrophy and age. The frequency and severity of CI was associated with the signs of atherosclerotic lesions of common carotid arteries and indices of arterial rigidity. The more increased the CKD severity, the higher the severity of CI. The dysfunction of frontal lobes plays a key role in the development of CI in patients with CKD, stages III-IV. CKD, stages III-IV, is an independent predictor of CI in people in predialysis stages.

Structural and functional changes of extra- and intracranial arteries in patients with ischemic heart disease of different ethnic groups

Objective . The structural and functional changes in extraand intracranial arteries in patients from different ethnic groups with coronary artery disease (CAD) before coronary arteriography and operative intervention were studied. Design and methods. We examined 120 patients with CAD including 50 patients of Korean nationality aged 54–73 years (average age 62,5 ± 1,03 years) and 70 patients of Slavic ethnicity aged 53–74 years (mean age 63,2 ± 1,1 years), residents of the Sakhalin Region. All patients received standard antihypertensive, lipid-lowering and antiplatelet therapy. Duplex scanning of extracranial arteries was performed using B-mode, power and color Doppler-mode with spectral analysis of the blood flow. In case of severe stenosis of carotid arteries and in patients with a history of transient ischemic attacks transcranial duplex scanning was performed. Results. Hypertension stage III was diagnosed in 89 % patients of South Asian ethnicity and in 81 % Slavs, and type 2 diabetes mellitus — in 29 and 22 %, respectively. There were no significant differences in mean systolic blood pressure and fasting blood glucose level between the groups. Patients of South Asian ethnicity had higher triglyceride levels and lower values of high-density lipoprotein cholesterol. Conclusions. Ethnicity should be considered when multifocal atherosclerosis structural and functional changes in extra-and intracranial arteries are assessed in patients with CAD. Patients of South Asian ethnicity with CAD show reduced thickness of intima-media complex (1,02 ± 0,01 and 1,07 ± 0,02 mm in the right and left CCA, respectively) compared with the Slavs (1,13 ± 0,02 and 1,23 ± 0,01 mm), although they had more pronounced atherogenic lipid changes inherent to metabolic syndrome. Patients of South Asian ethnicity had 2-fold higher risk of stenotic lesions (> 70 %) and 1,7–2,0-fold risk of pathological deformations of the carotid arteries, which could explain higher rate cerebral circulation disorders in this population compared to those in Caucasians (14 vs. 9 %).

Is hyperlipidemia a risk factor of Parkinson's disease?

To assess the relationship of the lipid spectrum, smoking, coffee drinking and brachiocephalic artery intima-media thickness with clinical characteristics of Parkinson's disease (PD). Authors examined 46 patients with PD, I-IV stages according to the Hoehn and Yahr scale, and 30 people without extrapyramidal pathology or cardiovascular diseases (controls). Patients with PD had lower levels of triglycerides and lower intima-media complex thickness compared to the controls. There was a trend towards the lower levels of total blood cholesterol, the differences were most marked in the late stage of PD. It can be suggested that the factors studied do not play a significant role in the development of degenerative process in PD. The marked differences may be related to a possible influence of antiparkinsonian treatment on the indicators of lipid metabolism.

ВПЛИВ КОМПЛЕКСНОГО ЛІКУВАННЯ З ВКЛЮЧЕННЯМ ПРЕПАРАТУ ОМЕГА-3 ПОЛІНЕНАСИЧЕНИХ ЖИРНИХ КИСЛОТ НА СТАН СУДИН ХВОРИХ НА ЮВЕНІЛЬНИЙ РЕВМАТОЇДНИЙ АРТРИТ.

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Echogenicity of Medium-to-Large Carotid Plaques Predicts Future Vascular Events

Background: Although the echolucent plaque in carotid stenosis is associated with future ischemic stroke, the predictive value of echogenicity in small and medium size carotid plaques on vascular events has not been thoroughly examined. Thus, we prospectively tested the hypothesis that plaque echogenicity of carotid atheroma can predict the future total cardiovascular events in patients with vascular risk factors. Methods: Ultrasound assessment of carotid intima-media complex thickness (IMT) and plaque echogenicity using integrated backscatter (IBS) analysis was performed in 596 patients aged 40 or more, with any history of vascular events or with at least 1 risk factor, who were enrolled between 2001 and 2006 in the Osaka Follow-up Study for Carotid Atherosclerosis, part 2 (OSACA2). We followed the incidence of total cardiovascular events including cerebrovascular events, coronary heart disease (CHD), and peripheral artery disease (PAD) for 6.4 years. We divided the patients into two groups according to the IBS index above (echorich plaques) and under (echolucent plaque) the median value, and calculated the hazard ratios (HR) of the echolucent group compared with the echogenic group in the risk of cardiovascular events. Results: Among 596 patients, carotid stenosis was found only in 87 patients. During the follow-up period, we observed 121 cardiovascular events including 63 cerebrovascular events, 45 CHD cases, and 13 PAD cases. The patients with incident cardiovascular events had larger plaque thickness and lower IBS index than those without incident vascular events. The relative risk of vascular events for echolucent versus echorich plaques was 1.45 (95% confidence interval [CI] 0.99-2.13, p = 0.058) after adjustment for risk factors and plaque thickness. In patients with plaque size above the median value (>2.1 mm), the relative risk of vascular events for echolucent plaques was 1.72 (95% CI 1.06-2.85, p = 0.029), but this association was not observed in patients with plaque size <2.0 mm. Conclusions: The association between echogenicity of carotid plaque and incident vascular events is dependent on the plaque size. Echolucent medium-to-large plaques, but not small plaques, are associated with the risk of future total cardiovascular events. This finding suggests that measurement of echolucency in medium-to-large carotid plaques may improve selection of patients at high risk for total vascular events.

Diabetic symmetric polyneuropathy is associated with increased aortal stiffening but not cerebral angiopathy in type 1 diabetes

IntroductionDiabetic symmetric polyneuropathy (DSP) and cerebral microangiopathy are common complications of type 1 diabetes (T1DM). However, little is known about associations between DSP, cerebral microcirculation and macrovascular injury in T1DM. We aimed to assess relationships between those complications. Material and methodsWe examined 42 patients (25 females; mean age 37.1±5.6years) with T1DM (mean disease duration 20.6±6.1years). DSP was diagnosed with the use of quantitative vibration sensory testing (QVST) and Michigan Neuropathy Screening Instrument (MNSI). Cerebral microvasculature was evaluated with measurements of vasomotor reactivity reserve (VMR) and pulsatility index (PI) of middle cerebral artery, macroangiopathic injury by measuring intima–media complex thickness (IMT) in the common carotid artery and carotid–femoral pulse-wave velocity (PWV). ResultsPatients with DSP (33.3%) showed higher PWV than those without DPS (10.5 vs 9.1m/s; P=0.03); no differences concerning VMR, PI or IMT existed. There were correlations between PWV and vibration perception thresholds (VPT) (r=0.44; P=0.004) and MNSI score (r=0.43; P=0.003); VPT showed impact on PWV (beta 0.34; P<0.03). ConclusionsDSP is associated with systemic macroangiopathy, reflected by increased carotid–femoral PWV, but not with the cerebral macro- and microangiopathy.

Telomere length and vascular wall in patients with Type 2 Diabetes Mellitus

Aim. To study the relationship between changes in the artery structure and function and peripheral lymphocyte telomere length in patients with type 2 diabetes mellitus (DM2). Materials and methods. A total of 50 patients with T2DM and without clinical manifestations of cardiovascular disease (CVD) were included in the study; the control group consisted of 49 people. The following tests were conducted for all study participants: carbohydrate metabolism evaluation, carotid artery duplex scan to measure intima?media complex thickness (IMT) and to determine the presence of atherosclerotic plaques, carotid?femoral pulse wave velocity (PWV) measurement and lymphocyte telomere length measurement. Results. The vascular changes were more pronounced in patients with T2DM than in controls. The telomeres were shorter in patients with T2DM than in those without diabetes (9.53?0.1 vs 9.86?0.1, p=0.033). The participants were divided according to the telomere length. Among patients with T2DM, there were significant differences in the condition of the vascular wall [PWV: 10.58?0.1 m/s in patients with ?long? telomeres and 15.08?1.3 m/s in patients with ?short? telomeres; IMT: 0.80?0.09 mm in patients with ?long? telomeres and 0.87?0.05 mm in patients with ?short? telomeres (p=0.024)]. There were no significant differences in the arterial structure between the patient and control groups with ?long? telomeres [PWV: 10.58?0.1 m/s vs 10.5?0.5 m/s (p=0.913); IMT: 0.080?0.09 mm vs 0.73?0.03 mm (p=0.12). However, there were significant differences in the vascular wall condition between the patient and control groups with ?short? telomeres [PWV: 15.08?1.3 m/s vs, 10.7?0.5 m/s (p=0.015); IMT: 0.87?0.1 vs 0.78?0.1 (p=0.03)]. Conclusions. The signs of vascular ageing were more pronounced in patients with T2DM than in controls. However, despite diabetes, vascular changes were minimal in patients with ?long? lymphocyte telomeres, comparable with the state of the vascular walls in healthy individuals. Thus, enhanced lymphocyte telomere length may have a protective effect on the vascular wall and may prevent damage from carbohydrate metabolism disorders.

Association of the thickness of carotid intima-media complex and ancle brachial index with coronary disease severity

Abstract