Carotid Artery Intima-media Thickness Research Articles

Iron Metabolism Dysregulation and Atherosclerotic Changes in Obstructive Sleep Apnoea

The Syndrome of obstructive sleep apnoea (OSA) is associated with an increased risk of arterial hypertension, metabolic syndrome, diabetes mellitus type 2, brain-vascular damages and atherosclerosis. The aim of this study is to assess the connection between iron metabolism dysregulation in OSA and atherosclerotic changes of carotid arteries. Thirty-five OSA patients with brain-vascular atherosclerotic evidences were included in this study; changes were evaluated by carotid artery intima-media thickness (IMT) and flow-mediated dilatation (FMD). Their results were compared to an equal number of healthy volunteers. Haematological and biochemical assays were performed in all participants in the study. Serum hepcidin levels are statistically significantly increased in OSA patients with atherosclerotic a. carotis changes (101.9±10.1 µg/L) compared to the control group (18.5±2.5 µg/L); $$P<0.001$$. Serum homocysteine levels are significantly higher in OSA than in healthy people. Average IMT (1.22±0.19) and ABI (1.71±0.14) values in OSA patients with atherosclerotic a. carotis changes are increased in comparison to the control group (0.34±0.07, 1.11±0.06, resp.); $$P<0.001$$. Serum vitamin B12 levels were lower in OSA patients with atherosclerotic changes in carotid arteries (71.7±9.9 pmol/L) compared to the controls (449.7±21.4 pmol/L); $$P<0.001$$. A connection between iron homeostasis and atherosclerotic changes was established during this study. Increased hepcidin and homocysteine concentrations might be connected to an elevated risk of cardio- and brain-vascular diseases in OSA. The use of these markers in the routine practice may be very useful for early atherosclerosis assessment in OSA.

Adiposity, fat depots and the prediction of stroke.

Despite the progress in research, the utility of clinical assessment for the prediction of stroke is limited. The aim herein, was to evaluate the predictive values of major ultrasound indexes of carotid artery and fat depots for stroke in patients with high and very high cardiovascular (CV) risk. The study group included 364 patients (age: 61.3 ± 7.2 years old) with typical CV risk factors scheduled for elective coronary angiography (2012-2013). A comprehensive baseline assessment included the following ultrasound indexes: carotid artery intima-media thickness (IMT), extra-media thickness (EMT), epicardial (EFT) and pericardial fat thickness (PFT), abdominal subcutaneous (ASF) and visceral fat (AVF) and combined periarterial adipose tissue intima-media adventitia (PATIMA) index. Afterwards, all patients were followed for 80.9 ± 7.1 months. There were 23 strokes and 25 cases with new-onset atrial fibrillation during follow-up. Receiver operating characteristics (ROC) analysis showed, that selected clinical parameters (age, waist circumference [WC], waist-hip ratio [WHR]) and ultrasound indexes (EFT: area under curve [AUC] 0.672, p < 0.01 and PATIMA index: AUC 0.658, p < 0.01) were predictive for stroke. However, their predictive values showed no significant differences (p = NS). The baseline body mass index (BMI) was the only parameter, which showed a prediction for new-onset atrial fibrillation (BMI > 33 kg/m2: sensitivity 65%, specificity 76%). It was found that age, WC and echocardiographic EFT revealed significant predictive values for stroke. Both WC and EFT showed a very high NPV suggesting that they should be implemented into the clinical practice as a tool affirming a very low risk of stroke.

Evaluation of Arterial Stiffness in Depression Patients.

It has been known that there is a significant correlation between depression and cardiovascular diseases. However, the reasons behind this correlation that could affect mortality and morbidity were not fully identified. The present study aimed to analyze arterial stiffness diagnosed with ultrasonography, which could be associated with cardiovascular disease risks in depression patients, and to compare the findings with those of healthy controls. The study was conducted with 35 depression patients and 35 healthy individuals. Routine complete blood and biochemistry tests were requested for all patients, and their weight and height, waist circumference, and diastolic and systolic arterial blood pressure were measured. Femoral and carotid artery intima-media thickness and other arterial stiffness parameters were determined with Doppler ultrasonography. It was determined that the systolic pressure (P = .028) was higher in the patient group (P = .028). Also, the carotid elastic modulus (P = .048) was significantly higher in the patient group. A negative and significant correlation was determined between femoral compliance and chlorpromazine equivalent dose (P = .021, r = -0.389). It was determined that the systolic blood pressure and carotid elastic modulus arterial stiffness parameters were significantly higher in depression patients. Measurable arterial stiffness parameters should be investigated in depression patients as cardiovascular risk markers. Furthermore, the determination of the effects of psychotropic drugs employed in arterial stiffness treatment could play an important role in the determination of cardiovascular disease risk in these patients.

Prevalence and influencing factors of abnormal carotid artery intima-media thickness in Henan Province in China.

Carotid intima-media thickness (CIMT) has been shown to be a valuable predictor of cardiovascular diseases (CVDs). The aim of this study was to investigate the influencing factors of CIMT among adults in Central China. A total of 2,578 participants who underwent physical examination in Henan Provincial People's Hospital between January 2018 and July 2018 were enrolled. The respondents were divided into two subgroups according to their CIMT value (CIMT ≥1.0 mm group and CIMT <1.0 mm group). Variables considered were age, gender, total cholesterol, triglycerides, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) triglycerides, fasting blood glucose, and uric acid levels, as well as hypertension, diabetes, body mass index (BMI), waist-to-hip ratio, body fat percentage, and visceral fat area (VFA). Logistic regression analysis was performed to explore the potential factors influencing CIMT. The proportion of CIMT ≥1.0 mm among the physical examination population was 27.42% (707/2 578). The analysis of the two groups revealed significant differences in age, sex, hypertension, diabetes, total cholesterol, and HDL cholesterol. In the logistic regression analysis, age (OR=1.071, 95%CI=1.062-1.080), male sex (OR=2.012, 95%CI=1.251-2.238), hypertension (OR=1.337, 95%CI=1.031-1.735), diabetes (OR=1.535, 95%CI=1.045-2.255), HDL cholesterol (OR=0.540, 95%CI=0.366-0.796), and LDL cholesterol (OR=1.336, 95%CI=1.154-1.544) were significantly associated with abnormal CIMT. Early screening should be carried out among men, the older adults, and those with hypertension, diabetes, and dyslipidemia.

Sonographic evaluation of common carotid artery intima-media thickness in adults with coexisting type two (2) diabetes and hypertension: A case-controlled study

Diabetes mellitus (DM) and hypertension (HTN) are the two leading risk factors for atherosclerosis. Carotid intima-media thickness (CIMT) is considered a reliable surrogate measure for detecting subclinical atherosclerosis including its progression and regression. The study aim at evaluating the intima-media thickness of the common carotid artery in adults with coexisting diabetes mellitus and hypertension (DM+HTN) and compare with healthy controls.. A prospective case control study involving 115 adult subjects with coexisting DM+HTN and 144 healthy adult controls was carried out. Common carotid intima-media thickness (CCIMT) was measured at point approximately 1 cm distal to the right and left carotid bulb using the 7-12 MHz, multi-frequency linear array transducer of high resolution, touch Venue 50 ultrasound machine equipped with electronic callipers. The overall mean CCIMT was 1.13±0.40 mm and 0.82±0.23 mm for subjects with coexisting DM and HTN; and healthy controls, respectively. There was a statistically significant difference in CIMT of subjects with DM+HTN compared to healthy controls (p=0.000 each for both males and females, respectively). There were positive correlations between CCIMT and age in subjects with DM+HTN (r=0.260 and r=0.424 for males and females respectively); with healthy controls (r=0.619 and 0.626 for males and females, respectively). There was a statistically significant difference in CCIMT between subjects with DM+HTN and healthy controls. This implies that the increase in CCIMT is associated with both DM and HTN. In addition, age has a significant positive relationship with CCIMT in both subjects with DM+HTN and healthy controls.

Adipokines in rheumatoid arthritis patients suffering glomerulonephritis

Background: Beside their eminent role in metabolic syndrome, white adipose tissue (WAT) derived adipokines might have a distinguished role in autoimmune and rheumatic diseases. In addition, increased level of many adipokines is observed in patients suffering glomerulonephritis. The status of adipokines was not studied in rheumatoid arthritis patients (RA) suffering glomerulonephritis (GN). Objective: To study serum level of adiponectin, leptin, and Visfatin in RA patients suffering GN in a trial to elucidate if they play a role on metabolic or endothelial function. Cases and methods: In this cross-sectional case control observational study, we compared serum level of adiponectin, leptin, and Visfatin in fifty RA patients (group I) in coparison to fifty RA cases suffering chronic GN (group II) and fifty normal control subjects. In addition, we looked for kidney function tests and 24 urine protein (UP), serum calcium, phosphorus, alkaline phosphatase (AP), 25 hydroxy vitamin D (25 OH vit. D), parathyroid hormone (PTH), C-reactive protein (CRP), interleukin 6(IL6), lipid profile, and Homa insulin resistanc (Homa IR). RA cases were further investigated for rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP) carotid arteries intima media thickness (IMT), brachial artery flow mediated Dilation (BA-FMD), health assessment questionnaire (HAQ), disease activity score calculator (DASC), simple disease activity index (SDAI), and clinical disease activity index (CDAI). Percutaneous kidney biopsies were obtained in group II patients. Results: Serum adiponectin and Visfatin are significantly higher and serum leptin is significantly lower in Group II compared to group I and the control group (20.3 vs. 18.6 and 12.3, 24,5 vs. 20.9 and 9.8, and 3.6 vs. 4.6 and 7.8 ng/mL for median serum adiponectin, visfatin, and leptin in group II vs group I and control group respectively, P&lt;0.001 in all). Serum level of 25 (OH) vit D is significantly lower, while serum AP, PTH and Homa IR are significantly higher in group I compared to control subjects (18 vs. 37 ng/mL, 140.5 vs, 57 u/L, 63 vs 47.8 ng/mL, and 13.2 vs 4 respectively, P&lt;0.001 in all) whilst there is no significant difference in these parameters between the RA groups. BA-FMD is significantly lower in group II vs group I (3% vs 4%, P=0.02) but there are no significant differences between these two groups in IMT of carotid arteries, HAQ, DASC, SDAI or CDAI. Moreover, there is no difference in any of the studied parameters within patients of group II according to renal histopathology. Conclusion: Studied adipokines have no relation to metabolic or vascular complications of RA. Changes of serum adipokines in GN patients are unrelated to inflammation. This pilot study would stimulate further research looking for the possible role of different adipokines in GN complicating RA.

Determinants of vascular structure and function in at-risk children born to mothers managed for pre-eclampsia (FINNCARE study).

Pre-eclampsia (PE) is related to elevated blood pressure (BP) in children. The study aims to investigate if elevated BP is reflected in child arterial health and how anthropometrics, body composition, and gestational and perinatal factors influenced this. In this prospective cohort study, we assessed the arteries of 182 children exposed (46 had an early onset, with a diagnosis before 34 gestational weeks, and 136 had a late onset) and 85 children unexposed (non-PE) to PE at 8-12 years from delivery using ultra-high-frequency ultrasound in addition to ambulatory and central BPs, body composition and anthropometrics, and tonometry-derived pulse wave velocity (PWV). No differences were found in intima-media thickness (IMT), adventitia thickness (AT), lumen diameter (LD), local carotid artery stiffness, distensibility, or wall stress between PE-exposed and non-PE-exposed children. All children's brachial, radial, and femoral artery IMTs were associated with 24-h systolic BP (SBP) and pulse pressure, carotid-femoral PWV, and anthropometric measures. The 24-h SBP and anthropometrics, notably lean body mass, were independent predictors of peripheral artery IMTs (brachial R2 = 0.217, radial R2 = 0.208, femoral R2 = 0.214; p < 0.001). Head circumference predicted carotid artery IMT and LD (β = 0.163, p = 0.009; β = 0.417, p < 0.001, respectively), but carotid artery IMT was not associated with BP. No independent associations were found for peripheral artery ATs. Local carotid artery stiffness, distensibility, and wall stress were independently associated with adiposity. No significant associations were found between gestational or perinatal factors and child vascular health parameters. The peripheral artery IMT of PE-exposed children is identical to that of non-PE-exposed children, but associated with BP. Adiposity is related to local carotid artery stiffness. These adverse associations in arterial health may reflect the early progression of cardiovascular disease in PE-exposed children.

Genotype-by-socioeconomic status interaction influences heart disease risk scores and carotid artery thickness in Mexican Americans: the predominant role of education in comparison to household income and socioeconomic index.

Background: Socioeconomic status (SES) is a potent environmental determinant of health. To our knowledge, no assessment of genotype-environment interaction has been conducted to consider the joint effects of socioeconomic status and genetics on risk for cardiovascular disease (CVD). We analyzed Mexican American Family Studies (MAFS) data to evaluate the hypothesis that genotype-by-environment interaction (GxE) is an important determinant of variation in CVD risk factors. Methods: We employed a linear mixed model to investigate GxE in Mexican American extended families. We studied two proxies for CVD [Pooled Cohort Equation Risk Scores/Framingham Risk Scores (FRS/PCRS) and carotid artery intima-media thickness (CA-IMT)] in relation to socioeconomic status as determined by Duncan's Socioeconomic Index (SEI), years of education, and household income. Results: We calculated heritability for FRS/PCRS and carotid artery intima-media thickness. There was evidence of GxE due to additive genetic variance heterogeneity and genetic correlation for FRS, PCRS, and CA-IMT measures for education (environment) but not for household income or SEI. Conclusion: The genetic effects underlying CVD are dynamically modulated at the lower end of the SES spectrum. There is a significant change in the genetic architecture underlying the major components of CVD in response to changes in education.

B-mode ultrasound characteristics of carotid plaques in symptomatic and asymptomatic patients with low-grade stenosis.

Carotid plaque features assessed using B-mode ultrasound can be useful for the prediction of cerebrovascular symptoms. Therefore, the aim of this retrospective study was to determine the ability of ultrasound B-mode imaging to differentiate between carotid plaques causing less than 50% stenosis in symptomatic and asymptomatic patients. A dataset of 1,593 patients with carotid disease who underwent carotid ultrasound between 2016 and 2021 was evaluated retrospectively between January and April of 2022. A total of 107 carotid plaques from 35 symptomatic and 52 asymptomatic patients causing low-grade stenosis on B-mode images were included in the analysis. Chi-square, independent t-test and Mann-Whitney U test were used to compare the variables. There was a significant association between hypertension and the presence of cerebrovascular symptoms (p = 0.01). Predominantly hypoechoic and hyperechoic carotid plaque were significantly associated with the presence and absence of cerebrovascular symptoms, respectively (predominantly hypoechoic: p = 0.01; predominantly hyperechoic: p = 0.02). Surface irregularity was significantly associated with the presence of cerebrovascular symptoms (p = 0.02). There is was a significant difference in the carotid plaque length and area between the symptomatic and asymptomatic patients (plaque length: symptomatic median 9 mm, interquartile range [IQR] 6 mm; asymptomatic median 6 mm, IQR 4.5 mm, p = 0.01; plaque area: symptomatic median 24 mm, IQR 30 mm; asymptomatic median 14 mm, IQR 17 mm, p = 0.01); however, this difference was not significant for plaque thickness (p = 0.55), or common carotid artery intima-media thickness (p = 0.7). Our findings indicate that hypertension patients with predominantly hypoechoic carotid plaques and plaques with an irregular surface are associated with the presence of cerebrovascular symptoms. In addition, the carotid plaques in symptomatic patients were longer and larger compared to asymptomatic patients.

O.2.3-11 Light standing work and high intensity occupational physical activities predict baseline and 8-year progression of carotid atherosclerosis among women

Abstract Purpose Recent reviews link higher levels of occupational physical activity (OPA) to cardiovascular disease (CVD). However, the evidence for women is inconsistent and studies of activity-limiting symptomatic CVD are prone to healthy worker selection effect. To address these limitations, this study investigated OPA effects on asymptomatic carotid artery intima-media thickness (IMT), a proxy for atherosclerosis, among women. Methods Participants include 905 women from the population-based Kuopio Ischemic Heart Disease Risk Factor Study with baseline (1998-2001) data on self-reported OPA and sonographic measurement of IMT. Linear mixed models with adjustment for 15 potential confounders estimated and compared mean baseline IMT and 8-year IMT progression for five levels of self-reported OPA. Analyses stratified by cardiovascular health and retirement status were planned because strong interactions between pre-existing CVD and OPA intensity have previously been reported. Results Light standing work, moderately heavy active work, and heavy or very heavy physical work were all consistently associated with greater baseline IMT and 8-year IMT progression than light sitting work, being hazardous for cardiovascular health. The greatest baseline IMT was observed for heavy or very heavy physical work (1.21 mm), and the greatest 8-year IMT progression for light standing work and moderately heavy active work (both 0.13 mm), 30% above sitting work (0.10 mm). Stratified analyses showed that these differences were driven by much stronger OPA effects among women with baseline carotid artery stenosis. Retired women experienced slower IMT progression than those still working at baseline. Conclusions Light standing work and higher levels of OPA intensity predict higher baseline IMT and 8-year IMT progression, especially among women with baseline stenosis. This study suggests that inconsistent findings regarding the effects of OPA on cardiovascular diseaes and mortality outcomes may be due to healthy worker selection and exposure misclassification biases including the failure to distinguish between standing and sitting work postures in many cohort studies. Funding Source This project is funded by the Danish taxpayers, via the Danish Work Environment Research Foundation, grant number 20195100247.

Sonographic Association of Common Carotid Artery Intima-Media Thickness With Age, Obesity, and Hypertension

Objective: The intima-media thickness (IMT) of the common carotid artery (CCA) can indicate cardiovascular and cerebrovascular disease risk, which could aid in early disease identification and prevention. This study was designed to correlate carotid artery IMT with age, obesity, diabetes, and hypertension using sonography. Materials and Methods: This cross-sectional cohort study included 300 individuals of all ages selected through convenient sampling at a university clinic in Lahore from November 2022 to February 2023. An Xario XG ultrasound equipment system (Toshiba, Tokyo, Japan) and a 7.5- to 10-MHz linear transducer was used to examine the patients. Results: The CCA-IMT was evaluated in 300 individuals (mean age 36.83 years). Significant statistical differences were observed between hypertensive/non-hypertensive and diabetic/non-diabetic individuals ( P &lt; .05). CCA-IMT was positively correlated with age and higher in obese/overweight individuals. Conclusion: This large cohort study found a significant difference in CCA-IMT between hypertensive/diabetic and normal individuals. CCA-IMT was positively correlated with age and body mass index.

Association of nonalcoholic fatty liver disease and carotid media-intima thickness: A systematic review and a meta-analysis.

The relationship between cardiovascular disorders and nonalcoholic fatty liver disease (NAFLD) has been extensively studied. To better pool this data and make a more definite conclusion, we performed a meta-analysis to evaluate the association between NAFLD and the thickness of media and intima of carotid artery (CIMT) and cardiovascular disorders. We searched PubMed, Ovid, Scopus, ProQuest, Web of Science, and the Cochrane Library, and analyzed the pooled data using R studio and the "metafor" package. The final analysis included a total of 59 studies with 16,179 cases and 26,120 control individuals. NAFLD was shown to be associated with an increase of 0.1231 mm (20.6%) in carotid artery intima-media thickness (CIMT) (p = 0.002, 95% confidence interval [CI]: 0.0462-0.2000) in individuals with NAFLD. The prevalence of atherosclerotic plaques in the carotid arteries and the occurrence of NAFLD are significantly correlated, according to a meta-analysis based on 17 distinct studies (p = 0.001, 1.28-1.43, 95% CI, odds ratio = 1.356). Patients with increased CIMT are considerably more likely to have NAFLD. Large prospective investigations are required to corroborate these findings and their prognostic significance, along with the effectiveness of the available interventions.

Relation of forward and backward traveling pressure waves with subclinical carotid artery wall remodeling and central pulse pressure.

Central pulse pressure (PP) is the sum of forward and backward traveling pressure waves that have been associated with cardiovascular disease (CVD) risk. However, previous studies have reported differential findings regarding the importance of the forward versus the backward wave for CVD risk. Therefore, we sought to determine the degree to which the forward and backward pressure waves are associated with subclinical carotid artery wall remodeling and central PP in healthy adults. Using applanation tonometry, carotid pressure waveforms were acquired in 308 healthy individuals (aged 45 ± 17 years, range 19-80 years, 61% women), from which the time integral of the forward (PfTI) and backward (PbTI) pressure waves were derived via pressure-only wave separation analysis. Common carotid artery intima-media thickness (cIMT), a biomarker of subclinical CVD risk, was derived via B-mode ultrasonography measured ∼2 cm from the carotid bulb. Both PfTI (r = 0.31, P < 0.001) and PbTI (r = 0.40, P < 0.001) were correlated with cIMT. However, further analysis revealed that PbTI mediated the relation between PfTI and cIMT (proportion mediated = 156%, P < 0.001). The association between PbTI and cIMT remained after adjusting for age, sex, body mass index, blood glucose, low-density lipoprotein cholesterol, heart rate, brachial systolic pressure, and aortic stiffness (B = 0.02, 95% confidence interval = 0.01, 2.77, P < 0.001). Both PfTI (r = -0.58, P < 0.001) and PbTI (r = -0.50, P < 0.001) were correlated with central PP, however, PfTI fully mediated the association between PbTI and central PP (proportion mediated = 124%, P < 0.001). Although PfTI is correlated with higher central PP, it is PbTI that is directly associated with carotid artery wall remodeling.NEW & NOTEWORTHY The present study contributes to the growing body of evidence highlighting the physiological and clinical insight provided by the pulsatile hemodynamic components of central artery pulse pressure. The notable findings of this study are: 1) The reflected (backward) pressure wave is associated with carotid intima-media thickness independent of traditional cardiovascular risk factors, including systolic blood pressure and aortic stiffness. 2) The incident (forward) pressure wave, and not the reflected pressure wave, is associated with greater central pulse pressure.

Ambulatory and successive home-based heart rate targeted aerobic training improves arterial parameters: a follow-up study in people with metabolic syndrome

Background Studies demonstrated that outpatient aerobic exercise programs (aEP) can significantly decrease aortic stiffness in people with metabolic syndrome (MetS). There is some limited data that remotely supervised home-based aEP can also improve arterial stiffness in this population. We aimed to evaluate the changes in the arterial wall parameters after the 2-month ambulatory supervised aEP followed by the 6-month home-based aEP with and without targeting of heart rate (HR) by electrocardiogram (ECG) in people with MetS. Methods In this prospective study (ClinicalTrials.gov identifier: NCT05592704) 132 MetS subjects (mean age 52.44 ± 6.26 years, 54.55% female) were evaluated. At first, all subjects participated in the 2-month ambulatory supervised aEP, which consisted of 40 individual aerobic training sessions on a cycle ergometer 5 times/week for 40 min and received the recommendations for home-based training. Then the study (n = 66) and the control (n = 66) groups participated in the 6-month home-based aEP, but only the study group subjects targeted their HR using ECG monitor connected to the smartphone during workouts. Arterial stiffness parameters and carotid artery intima-media thickness (cIMT) were evaluated in all participants at baseline and after 8 months. Results After 8 months, carotid-femoral pulse wave velocity (c-f PWV) significantly reduced in both groups (−12.22% in the study group vs. −7.85% in the control group, all p < .001) without a significant between-group difference (p = 0.144). A significant improvement of carotid-radial pulse wave velocity (c-r PWV) was observed only in the study group (-11.37%, p < .001, d = −0.671) with significant between-group difference (p < .001). The reduction of c-r PWV after 8 months of aEP occurred when c-r PWV at baseline was in the 2nd quartile (>7.90 m/s). A significant decrease of 3.32% in cIMT was present only in the study group (p = .032, d = −0.288). Conclusions The combination of 2-month ambulatory supervised aEP and successive 6-month home-based aEP targeted by HR monitoring using ECG improved arterial properties in MetS subjects more than the same combination without HR targeting, leading to the greater reduction of c-r PWV and cIMT.

Fibroblast Gross Factor-23 and Carotid Artery Stiffness in Hemodialysis Patient

Abstract Background FGF23 is a free circulating hormone secreted by osteocytes affecting mainly phosphate metabolism as it inhibits its renal tubular reabsorption by suppressing the expression of luminal sodium-phosphate co –transporters (Na Pi). Aim of the Work Aim of study is to verify the usefulness of FGF23 as a marker for diagnosis of arterial stiffness in CKD patients on regular hemodialysis (3 sessions per week, 4 hours each). Patients and Methods The present study enrolled 30 living end stage renal disease patients on regular hemodialysis randomly selected from hemodialysis unit at Ain Shams University hospitals after exclusion of patients of known cardiovascular disease or ischemic heart disease, also patients of age below 18 years and above 50 years were excluded as well as patients having arterio venous fistulas on both arms. All patients were subjected to complete medical history taking, including (Age, Sex, Etiology of chronic kidney disease, drugs and duration of dialysis), and detailed clinical examination was done. Results In this study patients have elevated serum levels of FGF-23 ranging from 100 up to 700 pg/ml. when the normal reference range is 18-108 pg/ml. Also our study result revealed a statistical significance of negative correlation between FGF-23 and diabetes mellitus duration, serum phosphorous, corrected calcium and estimated glomerular filtration rate as well. The current study shows statistical correlation of positive significance between FGF-23 and hypertension duration where, common carotid artery intima media thickness as well as present plaques in common carotid artery. Moreover there is no statistical significant correlation between FGF-23 and pulse pressure. Conclusion FGF23 serum levels are markedly elevated in chronic kidney disease CKD and among patients on regular hemodialysis causing arterial stiffness.

Ultrasound-Based Image Analysis for Predicting Carotid Artery Stenosis Risk: A Comprehensive Review of the Problem, Techniques, Datasets, and Future Directions.

The carotid artery is a major blood vessel that supplies blood to the brain. Plaque buildup in the arteries can lead to cardiovascular diseases such as atherosclerosis, stroke, ruptured arteries, and even death. Both invasive and non-invasive methods are used to detect plaque buildup in the arteries, with ultrasound imaging being the first line of diagnosis. This paper presents a comprehensive review of the existing literature on ultrasound image analysis methods for detecting and characterizing plaque buildup in the carotid artery. The review includes an in-depth analysis of datasets; image segmentation techniques for the carotid artery plaque area, lumen area, and intima-media thickness (IMT); and plaque measurement, characterization, classification, and stenosis grading using deep learning and machine learning. Additionally, the paper provides an overview of the performance of these methods, including challenges in analysis, and future directions for research.

Frailty in relation to the risk of carotid atherosclerosis and cardiovascular events in Chinese community-dwelling older adults: A five-year prospective cohort study

ObjectiveTo investigate the frailty, as estimated by accumulated health deficits, in association with the symptomatic carotid atherosclerosis and in relation to five-year cardiovascular (CVD) outcomes. MethodsThis is a five-year prospective cohort study. Secondary analysis of data from the Beijing Longitudinal Study on Aging. Community-dwelling people aged 55+ years (n = 1257) have been followed between 2009 and 2014, and having carotid ultrasonography examinations with no CVD events at baseline. Frailty was quantified using the deficit accumulation-based frailty index (FI), constructed from 37 health deficits assessed at baseline. The association between the degree of frailty and carotid atherosclerosis was examined using odds ratios (OR) with multivariate logistic regression analyses. Effects of frailty on the probability of five-year cardiovascular events and mortality were evaluated using Cox proportional hazard ratios (HR). The analyses were adjusted for demographics, baseline carotid atherosclerosis status, and CVD risk factors. ResultsThe FI showed characteristic properties and was independently associated with the major carotid atherosclerosis symptoms, including carotid artery intima-media thickening (the most frail vs. the least frail: OR = 4.39: 1.98–7.82), carotid plaque (OR = 3.41: 1.28–6.54), and carotid plaque stability (OR = 1.19, 95 % CI: 1.01–3.59). Compared with the least frail, the most frail individuals were more likely to develop a cardiovascular event in five years, including myocardial infarction (HR = 3.38, 95 % CI = 1.84–6.19), stroke (HR = 1.26, 95 % CI = 1.00–5.87), CVD death (HR = 6.33, 95 % CI = 1.69–11.02), and all-cause death (HR = 5.95, 95 % CI = 2.74–8.95). ConclusionDeficit accumulation was closely associated with carotid atherosclerosis risks and strongly predicted five-year CVD events. The frailty index can be used to help identify older adults at high risks of CVD for improved preventive healthcare.

Investigation of flow-mediated dilatation, carotid artery intima-media thickness and arterial stiffness in systemic lupus erythematosus patients

Investigation of flow-mediated dilatation, carotid artery intima-media thickness and arterial stiffness in systemic lupus erythematosus patients

Implications of homocysteine levels and carotid intima-media thickness in Indian stroke patients

Background The study aimed to evaluate the role of homocysteine (HCY) in modulating various stroke parameters. The primary objective was to study the correlation of HCY levels with carotid intima-media thickness (IMT) in stroke patients and investigate if HCY levels had any predictive value for the National Institutes of Health Stroke Scale (NIHSS) score. Material and Methods Seventy-eight patients of magnetic resonance imaging or computed tomography scans-confirmed acute ischaemic stroke were recruited for this study, and the NIHSS score was evaluated upon admission. Fasting blood samples were tested for serum HCY, fasting blood glucose (FBG) and lipid profile. Ultrasonography of the neck ascertained IMT of common carotid artery (CCA) and internal carotid artery (ICA). Results The mean age of male and female subjects was 57.88±13.97 and 59.16±13.62 years, respectively. 71.93% of stroke patients were hyperhomocysteinemic (HHcyc), and 24.36% were hyperlipidemic. Patients with NIHSS ≥5 had higher LDL cholesterol than those with NIHSS &amp;lt;5. Positive correlations were found between FBG and CCA IMT and triglyceride and NIHSS. HCY cut off of ≥15 μmol/L had 91.7% sensitivity and 66.7% specificity for predicting NIHSS ≥15. HHcyc state was associated with increased ICA IMT. HHcyc state was best predicted by ICA IMT and HCY positively correlated with ICA IMT. Conclusions HHcyc state holds a good predictive value for the severity of stroke. We also concluded that ICA IMT measurement may reduce the need for a HCY test as it predicts higher HCY levels, reducing the burden on resources. We suggest that evaluating HCY and ICA IMT should be part of the standard cerebrovascular accident management protocol.

Son dönem renal yetmezlikli hastalarda vasküler kalsifikasyon, ateroskleroz ve inflamasyon ilişkisi

Introduction: This study aims to determine the relationship between vascular calcification, carotid artery intima-media thickness (CIMT) and malnutrition with inflammatory parameters in dialysis patients.&#x0D; Materials and Methods: 140 CKD patients and 44 healthy controls were included in the study. CIMT was measured by ultrasonography. Valvular calcification was assessed by echocardiography and vascular calcification scores (VCS) were done based on the radiograms. Biochemical parameters were assessed using routine laboratory methods. Subjective global assessment (SGA) was used to evaluate malnutrition.&#x0D; Results: In the study, VCS showed no differences between hemodialysis (HD) and peritoneal dialysis (PD) patients (1.84±2.35 for HD, 1.77±1.64 for PD; p:0.83). CIMT, Osteopontin (OPN), interleukin-6 (IL-6) and homocysteine were significantly different in both dialysis groups compared to healthy controls. The Mean carotid intima-media thickness (m-CIMT) was higher in HD patients compared to PD group. CIMT, vascular calcification and SGA scores showed positive correlation with age, dialysis duration and valvular calcification grades, and negative correlation with albumin levels. A positive correlation between SGA scores and high-sensitive C-reactive protein (hs-CRP) levels was also noted. On multiple regression analysis, m-CIMT was independently associated with age, VCS and albumin levels. VCS was found to be independently associated with only albumin levels.&#x0D; Conclusion: Vascular and valvular calcification, an indicator of cardiovascular mortality and morbidity in dialysis patients, was found to be significantly associated with malnutrition. We found higher rates of valvular calcification in patients with vascular calcification. Malnutrition was more prominent in these patients.