Carotid Artery Intima-media Thickness Research Articles

Hydrogen Sulfide-to-Thiosulfate Ratio Associated with Blood Pressure Abnormalities in Pediatric CKD.

Identifying children with chronic kidney disease (CKD) at high risk of cardiovascular disease (CVD) and ensuring they receive appropriate treatment can prevent CVD events and mortality later in life. Hydrogen sulfide (H2S) is a gaseous signaling molecule participating in CVD and CKD. Thiosulfate is not only an oxidation product of H2S but is also a H2S donor. We examined whether H2S, thiosulfate, and their combined ratio have differential associations with CVD risk markers in 56 children and adolescents aged 6–18 years with CKD stages G1–G4. Up to two-thirds of CKD children showed higher BP load on 24 h ambulatory blood pressure monitoring (ABPM), even in the early stage. CKD children with ABPM abnormalities had a higher H2S-to-thiosulfate ratio, while H2S-related parameters were not affected by the severity of CKD. The H2S-to-thiosulfate ratio was positively correlated with 24 h systolic BP (SBP), nighttime SBP, and carotid artery intima-media thickness (cIMT). After adjusting for confounders, H2S was negatively associated with LV mass, thiosulfate was positively associated with 24-DBP, and the H2S-to-thiosulfate ratio was positively correlated with nighttime SBP and cIMT. Our data demonstrate differential associations in circulating H2S, thiosulfate, and their combined ratio with CVD risk in childhood CKD. Further studies are required to determine whether targeting the H2S signaling pathway can develop novel therapeutic strategies against CVD in this high-risk population.

Menopausal Hormone Therapy and Subclinical Cardiovascular Disease in Women With and Without Human Immunodeficiency Virus.

Estrogen-based hormone therapy (HT) may have beneficial cardiovascular effects when initiated in early menopause. This has not been examined in women with human immunodeficiency virus (HIV), who have heightened immune activation and cardiovascular risks. Among 609 postmenopausal women (1234 person-visits) in the Women's Interagency HIV Study, we examined the relationship of ever HT use (oral, patch, or vaginal) with subclinical atherosclerosis: carotid artery intima-media thickness (CIMT), distensibility, and plaque assessed via repeated B-mode ultrasound imaging (2004-2013). We also examined associations of HT with cross-sectional biomarkers of immune activation and D-dimer. Statistical models were adjusted for sociodemographic, behavioral, and cardiometabolic factors. Women (mean age, 51 years; 80% HIV positive) who ever used HT at baseline were older, and more likely to be non-Hispanic White and report higher income, than never-users. Women who ever used HT had 43% lower prevalence of plaque (prevalence ratio, 0.57 [95% confidence interval {CI}, .40-.80]; P < .01), 2.51 µm less progression of CIMT per year (95% CI, -4.60, to -.41; P = .02), and marginally lower incidence of plaque over approximately 7 years (risk ratio, 0.38 [95% CI, .14-1.03; P = .06), compared with never-users, adjusting for covariates; ever HT use was not associated with distensibility. These findings were similar for women with and without HIV. Ever HT use was associated with lower serum D-dimer, but not with biomarkers of immune activation after covariate adjustment. HT may confer a subclinical cardiovascular benefit in women with HIV. These results begin to fill a knowledge gap in menopausal care for women with HIV, in whom uptake of HT is very low.

A Comparative Study of the Right and Left Carotid Arteries in Relation to Age for Patients With Diabetes and Hypertension

Introduction: Age, hypertension, and diabetes can cause significant alterations in arterial structure and function, including changes in lumen diameter (LD), intimal-medial thickness (IMT), flow velocities, and arterial compliance. These are also considered risk markers of atherosclerosis and cerebrovascular disease. A difference between right and left carotid artery blood flow and IMT has been reported by some researchers, and a difference in the incidence of nonlacunar stroke has been reported between the right and left brain hemispheres. The aim of this study was to determine whether there are differences between the right and left common carotid arteries and internal carotid arteries in patients with hypertension and diabetes for 2 age groups. Methods: We studied 250 patients with both diabetes and hypertension. Patients were divided into 2 age groups with the old age group being 56 to 75 years and the young age group 35 to 55 years. The bilateral common carotid and internal carotid arteries were evaluated with B-mode ultrasound and Doppler examinations. The LD and IMT were measured for both common carotid arteries, and spectral waveform parameters and indices were recorded for both internal carotid arteries. Results: The difference in LD between the left and right common carotid arteries for the old age group was 11.64% and for the young age group was 6.42%, with significant P values of &lt;.05 for both age groups. The difference in IMT between the left and right common carotid arteries was 18.27% in the old age group compared with 15.38% in the young age group, with significant P values of &lt;.05. There was a difference in peak systolic velocity between the left and right internal carotid arteries of 4.85% in the old age group which was not significant, compared with 14.28% in the young age group with a significant P value &lt;.05, whereas the difference in end-diastolic velocity between the left and right internal carotid arteries was not significant for both age groups. Differences between the right and left internal carotid arteries for resistive index, pulsatility index, and pressure gradient were significant only in the young age group. Conclusion: We found significant differences between the right and left common carotid and internal carotid arteries in patients with diabetes and hypertension which were more prominent in the young age group. Values for common carotid IMT and LD were significantly higher in the left common carotid artery versus the right common carotid artery in both age groups. Differences between the 2 carotid sides may be attributed to anatomic variations in the common carotid artery origins which lead to differences in stress between the 2 sides.

Autoimmune thyroiditis and celiac disease do not worsen endothelial function in subjects with type 1 diabetes: an observational study

BackgroundType 1 diabetes (T1D) is frequently associated with autoimmune thyroiditis (AT) and coeliac disease (CD). Whether the coexistence of multiple autoimmune diseases increases cardiovascular risk is uncertain. We evaluated the effects of AT and CD on arterial wall thickening and endothelial function in patients with T1D.MethodsThis observational study analyzed data from T1D patients regularly followed by the Diabetes Care Centre. Clinical and biochemical characteristics and micro and macrovascular complications were collected from the electronic medical records. All subjects performed Echo-Doppler to evaluate Intima-Media Thickness (IMT) of the common carotid artery (CCA) and endothelial function by the flow-mediated dilation (FMD) technique. The statistical analyses were performed by SPSS for Macintosh. Comparison between means was performed using the t-test for unpaired data and the Mann–Whitney U test. The ANalysis Of VAriance and the Tukey posthoc test were applied to compare patients with and without other autoimmune diseases, and control subjects. The p-value for statistical significance was set at p < 0.05.ResultsA total of 110 patients were enrolled. Among these, 69 had T1D and 41 T1D and AT and or CD, of whom 33 AT, 7 CD, and 1 both AT and CD. The mean age was 35 years, mean HbA1c was 7.6%, and mean diabetes duration 18 years. The IMT of the CCA was not significantly different between T1D patients with and without concomitant autoimmune diseases (with AT and CD: right CCA 603 ± 186 µ, left 635 ± 175 µ; without AT and CD: right CCA 611 ± 176 µ, left CCA 631 ± 200 µ). FMD was also comparable between T1D groups, with AT and CD 7.9 ± 4.2%; without AT and CD 8.8 ± 4.4%.ConclusionPatients with T1D and concomitant AT and or CD show no worse morphological or functional vascular damage, evaluated by CCA IMT and brachial artery flow-mediated dilation, than patients with T1D alone.

Evidence of subclinical atherosclerosis in eosinophilic granulomatosis with polyangiitis.

Patients affected by eosinophilic granulomatosis with polyangiitis (EGPA) display an increased risk of atherothrombotic events compared with the general population. An increased frequency of subclinical markers of atherosclerosis has been observed in other ANCA-associated vasculitis, but no specific study focused on EGPA. We therefore evaluated subclinical atherosclerosis in EGPA patients and in a control population. Forty EGPA patients and 80 controls matched by age, sex and traditional cardiovascular risk factors underwent sonographic assessment of common carotid artery (CCA) intima-media thickness (IMT). The presence of plaques of the CCA was also investigated. The correlation between CCA-IMT and clinical and laboratory features was also assessed. Median CCA-IMT was significantly higher in EGPA patients compared with controls (P = 0.002). Also, the proportion of subjects with increased CCA-IMT and with presence of plaques was significantly higher among EGPA patients (P < 0.001 for both). Moreover, within the EGPA cohort, CCA-IMT tended to increase with disease duration (P = 0.034) and corticosteroid cumulative dose (P = 0.004). No significant associations were found between CCA-IMT, ANCA status, other clinical features and therapeutic regimens. Notably, the prevalence of traditional cardiovascular risk factors was comparable in patients with vs without an increased CCA-IMT. Ultrasound markers of subclinical atherosclerosis are increased in EGPA patients as compared with controls, independently of traditional cardiovascular risk factors.

Correlation of fasting and postprandial triglyceride levels and carotid artery intimal medial thickness in type 2 diabetic patients

Background: Although the prevalence of both type 1 and type 2 diabetes mellitus is increasing worldwide, the prevalence of type 2 DM is rising more rapidly, because of sedentary lifestyle, increasing obesity and increased life expectancy. Objectives: To study correlation between fasting and postprandial triglyceride levels and Carotid artery intimal medial thickness (CIMT) in Type 2 Diabetic Patients. Material and Methods: This cross sectional observation study was done in Department of General Medicine, Mysore Medical College and Research Institute, Mysore, Karnataka, India during January 2019 to June 2020. Sample size was 50 and Simple Random sampling method was used. Results: The mean carotid IMT of subjects with postprandial triglycerides &lt; 200 with normal fasting triglyceride was 0.92±0.33. The mean carotid IMT of subjects with postprandial triglyceride 200-299 with normal fasting triglyceride was 1.52±0.57. The mean carotid IMT of subjects with postprandial triglycerides ≥300 with normal fasting triglycerides was 1.66±0.45. Conclusion: postprandial hypertriglyceridemia, despite normal fasting triglyceride levels, may be an independent risk factor for early atherosclerosis in type 2 diabetes. Hence evaluating not only for FTG but also PPTG level during clinical assessment of patients with type 2 diabetes is important.

Effect of menopausal hormone therapy on methylation levels in early and late postmenopausal women

BackgroundCardiovascular disease (CVD) remains the leading cause of death among postmenopausal women but standard primary prevention strategies in women are not as effective as in men. By comparison, the Early versus Late Intervention Trial with Estradiol (ELITE) study demonstrated that hormone therapy (HT) was associated with significant reduction in atherosclerosis progression in women who were within six years of menopause compared to those who were 10 or more years from menopause. These findings are consistent with other studies showing significant reductions in all-cause mortality and CVD with HT, particularly when initiated in women younger than 60 years of age or within 10 years since menopause. To explore the biological mechanisms underlying the age-related atheroprotective effects of HT, we investigated changes in methylation of blood cells of postmenopausal women who participated in ELITE.ResultsWe first validated the epigenetic data generated from blood leukocytes of ELITE participants by replicating previously known associations between smoking and methylation levels at previously identified CpG sites, such as cg05575921 at the AHRR locus. An epigenome-wide association study (EWAS) evaluating changes in methylation through interactions with time-since-menopause and HT revealed two significantly associated CpG sites on chromosomes 12 (cg19552895; p = 1.1 × 10–9) and 19 (cg18515510; p = 2.4 × 10–8). Specifically, HT resulted in modest, but significant, increases in methylation levels at both CpGs but only in women who were 10 or more years since menopause and randomized to HT. Changes in carotid artery intima-media thickness (CIMT) from baseline to 36 months after HT were not significantly correlated with changes in methylation levels at either cg19552895 or cg18515510. Evaluation of other previously identified CpG sites at which methylation levels in either blood or vascular tissue were associated with atherosclerosis also did not reveal any differences in methylation as a function of HT and time-since-menopause or with changes in CIMT.ConclusionsWe identified specific methylation differences in blood in response to HT among women who were 10 or more years since menopause. The functional consequence of these change with respect to atherosclerosis progression and protective effects of HT remains to be determined and will require additional studies.

Implications of Ezetimibe in Combination with Low- to Moderate-Intensity Atorvastatin Adjuvant Aspirin Therapy for Cerebrovascular Disease.

Objective To analyze the significance of ezetimibe in combination with low- to moderate-intensity atorvastatin adjuvant aspirin therapy for cerebrovascular disease. Methods 110 patients with cerebrovascular disease treated in our hospital from June 2020 to June 2021 were selected and divided into 55 patients in the control group and 55 patients in the study group according to the lottery method. After a comprehensive examination, patients in the two groups should be given aspirin for treatment; the control group was treated with conventional dose of atorvastatin on top of the above, and the study group was given ezetimibe and medium-low-dose atorvastatin on top of aspirin treatment, activities of daily living (ADL) score, carotid artery intima-media thickness, lipid level, coagulation level, clinical effect, and adverse rate of the two groups which were tested and compared. Results After treatment, ADL score, high-density leptin cholesterol (HDL-C), and ATIII levels increased, while carotid artery media thickness, triglyceride (TG), total cholesterol (TC), low-density leptin cholesterol (LDL-C), DD, PC, and hs-CRP levels decreased (P < 0.05). After treatment, ADL score, HDL-C, and ATIII levels were higher in the study group. The levels of carotid media thickness, TG, TC, LDL-C, DD, PC, and hs-CRP were significantly lower (P < 0.05). The clinical effect of the study group was outstanding (P < 0.05). The defect rate of the study group was lower than that of the control group, but there was no difference (P < 0.05). Conclusion Ezetimibe combined with medium- and low-intensity atorvastatin with aspirin in the treatment of cerebrovascular diseases can effectively improve the coagulation function of patients, reduce the level of inflammatory factors in patients, and improve the level of blood lipids in patients, with high safety and worthy of clinical application.

Uterine arcuate artery calcification as a potential marker of cardiovascular risk-a preliminary study.

Atherosclerotic cardiovascular disease is the most common cause of death in postmenopausal women. As this is a progressive disease, it is important to identify markers at an early stage during the subclinical period. Arterial calcifications are an indicator of overall atherosclerotic disease and therefore may be used as a marker for the estimation of future atherosclerotic cardiovascular events. The aims of this study are to investigate the relationship between uterine myometrial calcification (UMC) and carotid artery intima-media thickness (CIMT) and to evaluate whether UMC can be a predictive marker for the estimation of future atherosclerotic cardiovascular risk in asymptomatic postmenopausal women. In this cross-sectional study, we assessed 81 postmenopausal women without gynecological complaints for cardiovascular risk factors, UMC, and CIMT. Participants were divided into two risk groups according to their cardiovascular risk factors. The level of UMC was determined using a new scoring system, which was based on transvaginal ultrasonography. Demographic, clinical, and laboratory parameters, UMC scores, and measurements of CIMT were evaluated. A moderately positive correlation was detected between CIMT and UMC scores ( r = 0.62). There was a significant relationship between UMC scores and atherosclerotic cardiovascular risk; the risk of atherosclerosis was 15.4 times higher (OR: 15.4, 95% CI: 5.1-46.8; P = 0.001) in participants with a high UMC score (≥2). According to the multivariable logistic regression model adjusted by age and duration of menopause, the risk of cardiovascular atherosclerosis increased 27.8 fold for those with CIMT of 0.075 or greater (OR: 27.8, 95% CI: 5.3-147.1; P = 0.001) and 9.2 fold for those with a UMC score of 2 or greater (OR: 9.2, CI: 1.22-69.3; P = 0.032). The presence of UMC has been identified as an independent predictive factor for atherosclerotic risk. Accordingly, considering UMC as an atherosclerotic cardiovascular risk factor may provide an opportunity to identify cardiovascular disease in asymptomatic postmenopausal women. When UMC is detected, women should be assessed for cardiovascular risk.

Preliminary study of carotid variables under ultrasound analysis as predictors for the risk of coronary arterial atherosclerosis.

BackgroundCarotid atherosclerosis by ultrasound scanning can be considered as an ideal window to reflect systemic artery atherosclerosis, which has aroused wide concern for predicting the severity of coronary artery atherosclerosis clinically. Ultrasound radio frequency (RF) data technology has enabled us to evaluate the carotid structure and elastic function precisely, for predicting the severity of coronary artery atherosclerosis.MethodsPatients with suspected coronary artery disease (CAD) underwent coronary angiography and were assigned to four groups according to whether atherosclerotic plaque was found or not and it caused stenosis. Carotid artery intima‐media thickness (IMT) and arterial stiffness were investigated by quality intima‐media thickness (QIMT) and quality arterial stiffness (QAS) techniques during ultrasound scanning. Univariable and multivariable modeling were used to investigate correlations of carotid parameters to coronary artery atherosclerosis. Receive operating characteristic (ROC) curves were used to evaluate diagnostic performance of these ultrasound variables.ResultsCarotid IMT and stiffness variables pulse wave velocity (PWV), α, β and compliance coefficient (CC) were statistically different between every two‐group's comparisons. IMT correlated with stiffness variables significantly with r = 0.70, 0.77, 0.63, and −0.39, respectively. All variables correlated with the severity of coronary atherosclerosis with the odd ratio (OR) of 1.73, 1.67, 1.19, 1.23, and 0.56 accordingly as IMT, PWV, α, β and CC were concerned. The AUC of IMT, PWV, α, β and CC were 0.9257, 0.8910, 0.8016, 0.9383, 0.8581 with correctly classified rate of 88.16%, 83.77%, 78.07%, 86.84%, and 81.58%, respectively.ConclusionsCarotid artery IMT and stiffness variable PWV, α, β and CC presented favorable predicting and differentiating values for patients with coronary atherosclerosis of different severity.

Separate and Joint Associations of Cardiorespiratory Fitness and Healthy Vascular Aging With Subclinical Atherosclerosis in Men.

Achieving healthy vascular aging (HVA) is important for decelerating age-related cardiovascular disease risk. We evaluated the interplay between HVA, cardiorespiratory fitness (CRF), and subclinical atherosclerosis. We analyzed data on 3722 men who underwent cardiopulmonary exercise testing in a health examination program. HVA was defined as blood pressure <140/90 mm Hg without hypertension and brachial-ankle pulse wave velocity <1266 cm/s. CRF was directly measured by peak oxygen uptake. Subclinical atherosclerosis was defined as coronary artery calcification scores of >0 and ≥100 and a mean carotid artery intima-media thickness (CIMT) >75th percentile for each age group as well as >0.8 mm of CIMT. Separate and joint associations of HVA and CRF with subclinical atherosclerosis were evaluated. Each 1 metabolic equivalent increment in CRF was associated with 23% higher odds for having HVA. HVA was associated with lower odds of coronary artery calcification but not CIMT. CRF modified the association between HVA and CIMT>0.8 mm (interaction: P=0.01); HVA was associated with lower odds of CIMT>0.8 mm in fit men with no significant association between HVA and CIMT>0.8 mm in unfit men. Compared with no HVA and being unfit, HVA and being fit was associated with lower odds of subclinical atherosclerosis, but there was no significant association between HVA and being unfit with subclinical atherosclerosis. HVA and higher CRF are each associated with a lower risk of subclinical atherosclerosis in men. Higher CRF is associated with a higher prevalence of HVA and may modify the association between HVA and subclinical atherosclerosis.

Normal Doppler Ultrasonography Indices of Bilateral Common and Internal Carotid Arteries”. A Cross Sectional Study

Carotid Arterial Intima Media Thickness (CA-IMT) is taken as an important indicator of atherosclerosis with increasing age and long-term exposure to particulate air pollution associated diseases like hypertension, diabetes, obesity, cigarette smoking, alcohol usage, drugs, deranged lipid profile and high cholesterol, high salt and fatty diet Objective: To evaluate the Doppler ultrasonography indices of common and internal carotid arteries on both sides in normal individuals. Methods: A prospective comparative cross sectional study was conducted at Imperial Diagnostic and Research Centre, Imperial College of Business Studies, Lahore, Pakistan for a period of four months after the approval of synopsis. Convenient sampling technique was used and all patients visiting us during study interval of and fulfilling the inclusion criteria were included. A total of 50 participants age range from15 to 68 years, were included. Aloka Prosound α 5 SV, equipped with linear array probe with frequency of 6-9MHz, was used. All the participants, who were normal volunteers, were subjected to B-mode imaging and color-coded Doppler ultrasonography of their common carotid arteries and internal carotid artery in supine position. Baseline investigation was taken for blood pressure (BP) during resting phase. Participant’s age, weight and height were also assessed and recorded on questionnaire forms. MedCalc was then used to apply relevant tests for statistical analysis. Repeated Measures ANOVA was performed to see the difference between the values taken during supine and standing position on each side. Results: The IMT showed significant positive correlation with the age in both right and left CCA and ICAs. EDV values of right CCA showed significant positive correlation and RI and PI showed significant negative correlation with age. PSV and SD values of left CCA and PSV of right ICA showed significant negative correlation with age. Left ICA diameter and PSV showed the significant positive correlation with age. Conclusion: The study provides the information about normal Doppler indices which might be useful in the evaluation of cases of carotid artery diseases. These figures can be used to gain a better understanding of the aetiology of ischemic strokes in the brain.

Association between Endocan, PAI-1 and intima media thickness in patients with high diabetes risk

There is no information in the literature on the ratio of the concentrations of Endocan, PAI-1, and intima media thickness (IMT) in patients with high diabetes risk. This study aims to investigate the relationships between endothelial dysfunction biomarkers: Endocan, Plasminogen Activator Inhibitor-1(PAI-1), insulin resistance (IR) indicators, and IMT of the common carotid artery (CCA) in patients with risk of type 2 diabetes mellitus (T2DM). A case-control study was held, including 184 individuals, aged from 18 to 65 years. According to FINDRISC scale, patients were divided into 2 groups: Group 1 (n = 138) — low risk of T2DM (&lt;12 points) and Group 2 (n = 46) high risk of T2DM (&gt;12 points). IMT more than 0.9 mm on ultrasound considered as an atherosclerosis. Significant differences were found when studying the level of Endocan, PAI-1 biomarkers with their predominance in the group of patients with a high risk of T2DM; concentrations of Endocan comprised (mean±SD) 1698.2±576.2 pg/ml; p=0.01; PAI-1–32307.15±19947.12 pg/ml; p=0.05 to compare with low risk of T2DM. In addition to, mean values of IMT prevailed in patients in the group with a high diabetes risk and comprised right IMT CCA-0.90±0.15 mm; p = 0.05, left IMT CCA0.91±0.14 mm; p=0.02. Interrelations between Endocan, PAI-1, and IMT CCA have been determined by correlation analysis. These findings indicate that in patients with high diabetes risk the elevations of the Endocan, PAI-1 is associated with a subclinical atherosclerosis. Furthermore, both biomarkers Endocan and PAI-1 has been demonstrating significant correlation with insulin, IR-HOMA index, С-peptide, HbA1c, and fasting glucose in patients with high risk of T2DM. We found significant relationships between the ED biomarkers with IMT and IR in patients with high risk of T2DM. We suggest that rising of IR leads to Endocan and PAI-1 elevation, subclinical atherosclerosis and thereby increase ED and cardiovascular risk in these patients.

Evaluation of extracranial carotid flow velocities in patients presenting with acute ischemic stroke: A clinical study conducted in Turkey

Objective. The mechanism underlying the relationship between carotid flow velocities and stroke events remains unclear. This study aimed to reveal the relationship of flow velocity measurements with risk factors in patients with acute ischemic stroke. Material and methods. A group of patients between the ages of 41-90 who applied to Mengücek Training and Research Hospital in the Eastern Anatolia Region of Turkey between 2014-2015 due to acute ischemic stroke were included. Groups with large artery atherosclerosis and small-vessel occlusion according to the Toast classification were included in the study. Brain tomography and magnetic resonance imaging, echocardiography, high-resolution color Doppler Ultrasonography examinations were performed. Internal carotid artery peak-systolic and end-diastolic flow velocity, common carotid artery peak-systolic and end-diastolic flow velocity, internal carotid artery peak systolic-common carotid artery peak-systolic velocity ratio and common carotid artery intima-media thickness were measured with Doppler Ultrasonography. The relationship between carotid flow velocities and brain infarction volume, comorbid factors, biochemical variables, left ventricular systolic-diastolic dysfunction was defined by using Statistical Package for Social Sciences version 21.0. Outcomes. In acute ischemic stroke groups, a significant negative correlation between common carotid artery end-diastolic flow velocity and brain infarction volume, a significant positive relationship between common carotid artery peak-systolic velocity and smoking, a significant positive correlation between common carotid artery intima-media thickness and blood glucose and hba1c, a significant negative correlation between common carotid artery end-diastolic flow velocity and hypertension, a significant relationship between common carotid artery end-diastolic flow velocity and ischemic heart disease, an increase in cerebral infarction in patients with left ventricular systolic dysfunction and a decrease in Internal carotid artery peak-systolic flow velocity in patients with left ventricular diastolic dysfunction were detected. Conclusions. In clinical practice, Doppler ultrasound is currently the main diagnostic tool for evaluating the diagnosis of carotid stenosis. In stenosis in the carotid artery system, it should be known as a basic rule that the flow velocity in the stenosis area increases, except for in severe stenosis and four basic measurements should be made to determine the degree of stenosis clearly. These measurements are peak systolic flow velocity (PSV), end-diastolic flow velocity (EDV), peak-systolic flow velocity ratio (ICA/CCA PSV). The purpose of sonographic evaluation of the extracranial cerebral arteries is to prevent bad sequelae and permanent deficits together with cerebral infarction.

Risk Factors of Asymptomatic Carotid Artery Disease in Geriatric Evaluated Using Carotid Intima-Media Thickness (IMT) Measurement, the First Indonesian Population Study.

Carotid artery disease in geriatric is one of the important etiologies of stroke, which topped the cause of mortality in Indonesia. Specific prevention should be done as early as asymptomatic disease occurred. Initial assessment can be performed using ultrasound by measuring the intima-media thickness (IMT) of carotid artery, which can evaluate earlier progression of the atherosclerosis process. Unfortunately, we do not have risk factors categorization that show us which geriatric population fall under high-risk stratification to be screened. Study was done to Indonesian geriatric population. Asymptomatic carotid disease was tested positive if IMT was > 0.9 mm without any previous neurological symptoms. Correlation of the result was statistically tested with risk factors of atherosclerotic process, such as sex, body mass index, presence of hypertension, diabetes mellitus, and hypercholesterolemia. Study obtained 104 subjects and showed the prevalence of asymptomatic carotid disease was 37.5%. Two risk factors: diabetes mellitus and hypercholesterolemia were statistically significant ( p = 0.01) with odds ratio (OR) 3.56 (1.31-9.64, 95% confidence interval [CI]) and OR 2.85 (1.25-6.51, CI 95%), respectively. Logistic regression showed the risk was 69.2% by having two of these comorbidities, 47.2 or 42.5% if diabetes mellitus or hypercholesterolemia was present. As diabetes mellitus and hypercholesterolemia were proved to be significant risk factors for asymptomatic carotid artery disease, we recommend performing ultrasound screening to measure carotid artery IMT for geriatric population who had diabetes mellitus and/or hypercholesterolemia for asymptomatic carotid artery disease to be diagnosed and further treated.

Cardiovascular complications of Cushings syndrome: Impact on morbidity and mortality.

Cardiovascular complications of Cushings syndrome: Impact on morbidity and mortality.

Brachial flow—mediated dilation and carotid intima—media thickness in glaucoma patients

BackgroundThe purpose of the study was to assess the ultrasound measurements of the brachial artery flow-mediated dilation (FMD) and carotid artery intima-media thickness (IMT) and their relationship in glaucoma patients.MethodsThirty-seven patients with glaucoma and thirty-one healthy controls were included in the study. All glaucoma patients and controls underwent ultrasound measurement of FMD of the brachial artery and ultrasound measurement of IMT of the carotid artery.ResultsThe mean values of brachial FMD were significantly lower among the glaucoma compared with controls (16.4 ± 10.6% vs 20.3 ± 8.5%, p = 0.034). No significant difference was found in carotid IMT (1.2 ± 0.4 vs. 1.1 ± 0.4, p = 0.3), and brachial artery diameter at rest (4.7 ± 0.6 vs. 4.9 ± 0.3, p = 0.2) between the glaucoma patients and controls. The significant difference in brachial artery diameter in hyperemia between the glaucoma patients and controls (5.5 ± 0.6 vs. 5.9 ± 0.4 p = 0.002) was found. A negative correlation among brachial FMD and carotid IMT as well as among brachial FMD and brachial artery diameter at rest was found.ConclusionsImpaired brachial FMD indicates presence of systemic vascular endothelial dysfunction in glaucoma; glaucoma patients with lower values of the brachial FMD are at increased risk of having thickened carotid IMT.

Preoperative Vascular Function Assessment and Perioperative Vascular Events in Patients Posted for Elective Non-cardiac Surgeries.

BackgroundCoronary atherosclerosis is usually asymptomatic until a major cardiac event occurs. Surgery is one of the major stress factors that play a role in hastening vascular deterioration in susceptible patients. Non-invasive tests to detect atherosclerosis and endothelial dysfunction have started gaining popularity nowadays, and of the several options, carotid artery intima-media thickness (IMT) and radial artery flow-mediated dilation (FMD) are two promising tests for detecting cardiovascular impairment.MethodsThis was a pilot study that was undertaken on 100 patients in a tertiary care medical center (Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry) between June 2015 and August 2016 with the aim of studying the prevalence of endothelial dysfunction and early atherosclerosis in the given population, and to find out the predictive power of preoperative vascular functional assessment in the prediction of perioperative cardiovascular events in the same population. We had selected patients who had at least two risk factors for endothelial dysfunction and were posted for elective non-cardiac surgical procedures via convenience sampling. Flow-mediated vasodilatation of the radial artery (FMD) and carotid intima-media thickness (CIMT) were measured on the previous day of surgery, while a fasting lipid profile was collected from the patients on the morning of the surgery. Endothelial dysfunction was defined as FMD<4.5%, while atherosclerosis was defined as CIMT>0.07 cm. Demographic details and baseline hemodynamic parameters of the patients were also noted preoperatively as well as intra-operatively, and patients were followed up for any major clinical adverse cardiovascular event post-operatively till they were discharged from the hospital.ResultsIt was found that the prevalence of endothelial dysfunction was 23%, while the prevalence of early atherosclerosis was 33% in our study population. However, it was found that FMD and CIMT did not correlate with each other significantly, nor did they correlate significantly with perioperative cardiovascular events. The risk factors of the patients also did not correlate with the FMD and CIMT values of the patients in which they were impaired. Moreover, they did not have any significant correlation with the perioperative events that occurred.ConclusionThe prevalence of endothelial dysfunction in our tertiary center was found to be 23%, and the prevalence of atherosclerosis was 33% in patients posted for elective non-cardiac surgery who had multiple risk factors. It was also found that non-invasive preoperative vascular assessment was not quite effective as hypothesized in predicting perioperative cardiovascular events.

GENETIC DETERMINATION OF ENDOTHELIAL FUNCTION AND «INTIMA-MEDIA» THICKNESS OF CAROTID ARTERIES IN PATIENTS WITH ARTERIAL HYPERTENSION

Endothelial regulation of vascular tone is an important component of the infl uence onblood pressure (BP).Objective – to study the changes in endothelial function and the «intima- media» thickness(IMT) of the carotid arteries depending on the genes polymorphism GNB3 (rs5443) andNOS3 (rs2070744) in essential arterial hypertension (EAH).Materials and methods. 100 patients with EAH 2nd stage and 48 practically healthypersons (control group) participated in the study. Soluble Vascular Cell AdhesionMolecule (sVCAM-1), total NO metabolites (NO2–+NO3–), transcriptional activity ofNOS3 gene, Endothelium- Dependent Flow- Mediated Dilation of the Brachial Artery(FMD BA) and carotid IMT were studied. NOS3 (rs2070744) and GNB3 (rs5443) geneswere investigated by Real- Time PCR.Results. Severe EAH is accompanied by an IMT increase 50.0-57.14% (p&lt;0.01), NOS3gene expression after mRNA level decrease 34.54% (p=0.003), more often atheroscleroticplaques on the carotid arteries 24.77-27.62% (p&lt;0.05). The polymorphic site of theNOS3 gene (rs2070744) is associated with a total NO metabolites value decrease,transcriptional activity of the NOS3 gene decrease (F=71.11 and F=8.71; p&lt;0.001)and sVCAM-1 level elevation (F=6.96; p=0.002), especially in minor C-allele carriers(more severe in CC-genotype). ANOVA has not shown an association of the GNB3 gene(rs5443) with endothelial function and carotid artery IMT in EAH patients.Conclusions. The polymorphic site of the NOS3 gene (rs2070744) is associated withendothelial function changes and does not aff ect the IMT of the carotid arteries.

Subclinical Atherosclerosis and Oxidized LDL Levels in Familial Mediterranean Fever

Objective: To investigate markers of carotid atherosclerosis and oxidized low density lipoprotein (OxLDL) levels in patients with Familial Mediterranean Fever (FMF) who have no risk factors for cardiovascular disease.&#x0D; Method: It was included 44 patients (25 F/19 M; mean age: 33.5±7.5) with FMF in attack free period and gender and age matched 44 healthy subjects (25 F/19 M; mean age: 33.4±7.0). The patients with clinical coronary artery disease, chronic renal disease, diabetes mellitus, hypertension, history of myocardial infarction, angina pectoris, cerebrovascular disease, dyslipidemia, metabolic syndrome, active infection, those in postmenopausal period, and those using anti-lipid drugs were excluded. Carotid artery intima-media thickness (C-IMT) was measured and investigated atherosclerotic plaques in the carotids by using doppler ultrasound. Serum lipid and OxLDL levels were also assessed. Data were analyzed with the SPSS program and p