Max Intima-media Thickness Research Articles

Patients with a large ossification of the posterior longitudinal ligament have a higher incidence of arteriosclerosis in the carotid artery.

This study aimed to investigate the impact of the severity of cervical ossification of the posterior longitudinal ligament (OPLL) on the incidence of arteriosclerosis in the carotid artery. Patients with OPLL-induced cervical myelopathy were prospectively enrolled. The study involved analyzing patient characteristics, blood samples, computed tomography scans of the spine, and intima-media thickness (IMT) measurements of the common carotid artery. Patients were divided into two groups based on the size of the cervical OPLL to compare demographic data, comorbidities, and the presence of thickening of the carotid intima-media (max IMT ≥ 1.1mm). The study included 96 patients (mean age: 63.5years; mean body mass index: 26.9kg/m2; 71.8% male; 35.4% with diabetes mellitus). The mean maximum anteroposterior (AP) diameter of the OPLL was 4.9mm, with a mean occupancy ratio of 43%. The mean maximum IMT was 1.23mm. Arteriosclerosis of the carotid artery was diagnosed in 62.5% of the patients. On comparing the two groups based on OPLL size, the group with larger OPLL (≥ 5mm) had a higher BMI and a greater prevalence of carotid intima-media thickening. This significant difference in the prevalence of carotid intima-media thickening persisted even after adjusting for patient backgrounds using propensity score matching. Patients with a larger cervical OPLL showed a higher frequency of intima-media thickening in the carotid artery.

Advanced glycation end products measured by skin autofluorescence and subclinical cardiovascular disease: the Rotterdam Study

BackgroundAdvanced glycation end products (AGEs) have been linked to cardiovascular disease (CVD), especially coronary heart disease (CHD), but their role in CVD pathogenesis remains unclear. Therefore, we investigated cross-sectional associations of skin AGEs with subclinical atherosclerosis, arterial stiffness, and hypertension after confirming their relation with CHD.MethodsIn the population-based Rotterdam Study, skin AGEs were measured as skin autofluorescence (SAF). Prevalent MI was obtained from digital medical records. Carotid plaques, carotid intima-media thickness (IMT), coronary artery calcification (CAC), pulse wave velocity (PWV), and hypertension were assessed. Associations of SAF with endophenotypes were investigated in logistic and linear regression models adjusting for common cardiovascular risk factors. Effect modification by sex, diabetes mellitus, and chronic kidney disease (CKD) was tested.Results3001 participants were included (mean age 73 (SD 9) years, 57% women). One unit higher SAF was associated with the presence of carotid plaques (OR 1.2 (0.92, 1.57)), a higher max IMT (0.08 SD (0.01, 0.15)), higher CAC (OR 2.2 (1.39, 3.48)), and PWV (0.09 SD (0.01, 0.16)), but not with hypertension (OR 0.99 (0.81, 1.21)). The associations with endophenotypes were more pronounced in men and participants with diabetes or CKD with significant interactions.ConclusionsPreviously documented associations between SAF and CVD, also found in our study, may be explained by the endophenotypes atherosclerosis and arterial stiffness, especially in men and individuals with diabetes or CKD, but not by hypertension. Longitudinal studies are needed to replicate these findings and to test if SAF is an independent risk factor or biomarker of CVD.Trial registration: The Rotterdam Study has been entered into the Netherlands National Trial Register (NTR; www.trialregister.nl) and the WHO International Clinical Trials Registry Platform (ICTRP; www.who.int/ictrp/network/primary/en/) under shared catalogue number NTR6831.

Impact of drinking water hardness on carotid atherosclerosis and arterial stiffness: Insights from the “Corinthia” study

BackgroundSeveral investigations have highlighted the role of water quality in cardiovascular health. In the present study, we have investigated the effects of drinking water hardness on atherosclerotic burden in carotid arteries and arterial stiffness. Methods“Corinthia” study was conducted in the homonym region in Greece from 2015 to 2017. Carotid atherosclerosis was assessed by intima-media thickness (IMT). Pulse wave velocity (PWV) was used to evaluate arterial stiffness. Tap-water samples were collected from the study area and analyzed for a variety of elements, as well as pH and total hardness. ResultsIndividuals living in lower drinking water hardness areas (Area 1) versus individuals living in higher water hardness areas (Area 2) had lower max IMT (p = 0.004) and were less susceptible to carotid plaque formation (p = 0.004). Interestingly, individuals over 65 years from Area 1 had lower mean IMT, max IMT, and less plaque formation (p < 0.001 for all). The mean value of PWV in the overall study population was below the 10 m/s cutoff, which defines arterial stiffness (9.15 ± 2.79 m/s). Nevertheless, a marginally higher rate of vascular stiffening was noted in Area 2 vs. Area 1 (16.2% and 12.8%, respectively, p = 0.048). ConclusionsAccording to this cross-sectional study's findings, a positive association between extra hard water and carotid atherosclerotic burden was found. However, the association with arterial stiffness is unclear and should be investigated further.

Abstract WP272: Automatic Detection and Measurement of Atherosclerotic Plaques in Carotid Ultrasound Using Deep Learning

Purpose: B-Mode ultrasound imaging is commonly used for detection and measurement of atherosclerotic carotid plaques, which are an important cause of ischemic stroke. However, accurate interpretation of ultrasound can be difficult and subjective. Artificial Intelligence (AI) models can assist in image interpretation, reducing subjectivity, and speeding up the process of detection and measurement of carotid plaques. We evaluated the accuracy of a deep learning model for automatic detection of carotid plaques in b-mode ultrasound compared against expert interpretation of the images. Methods: We propose an automated method using convolutional neural networks to detect atherosclerotic plaques and measure intima-media thickness (IMT) in B-Mode carotid images. In contrast to most of the existing methods, our goal was to not only measure IMT in healthy subjects (max IMT below 1.2 mm) but also to provide accurate detection of plaques and other vessel wall pathology. Given the B-mode longitudinal image as the input, the neural network first finds a region of interest (ROI) surrounding the artery and then segments both near wall and far wall of the artery. The network was trained and tested on two separate datasets obtained retrospectively from 3 stroke centers and 4 different ultrasound machine manufacturers. The training dataset was comprised of 1021 images. Results: The performance of the method was assessed on an independent dataset not used for model development to prevent bias, consisting of 205 images, where 54% (111 out of 205) of the images had pathology. The ground truth was determined by an expert reader interpreting images, and Pearson coefficient (IMT correlation) and Bland-Altman analysis were used to assess the performance of the method. The obtained correlation coefficient was 0.93 and r-squared was 0.87, showing a strong correlation. There was no significant over or under estimation of IMT (bias = -0.002 mm, lower limit of agreement (LOA) = -0.246 mm, upper LOA = 0.242 mm). Conclusion: The results show that the proposed deep learning method can be used for accurate analysis and interpretation of carotid ultrasound scans in a clinical setting and potentially reduce the reporting time while increasing objectivity of the reports.

Subclinical Vascular Disease in Children With Human Immunodeficiency Virus in Uganda Is Associated With Intestinal Barrier Dysfunction.

The risk of cardiovascular disease (CVD) and its mechanisms in children living with perinatally acquired HIV (PHIV) in sub-Saharan Africa has been understudied. Mean common carotid artery intima-media thickness (IMT) and pulse-wave velocity (PWV) were evaluated in 101 PHIV and 96 HIV-negative (HIV-) children. PHIV were on ART, with HIV-1 RNA levels ≤400 copies/mL. We measured plasma and cellular markers of monocyte activation, T-cell activation, oxidized lipids, and gut integrity. Overall median (interquartile range, Q1-Q3) age was 13 (11-15) years and 52% were females. Groups were similar by age, sex, and BMI. Median ART duration was 10 (8-11) years. PHIV had higher waist-hip ratio, triglycerides, and insulin resistance (P ≤ .03). Median IMT was slightly thicker in PHIVs than HIV- children (1.05 vs 1.02 mm for mean IMT and 1.25 vs 1.21 mm for max IMT; P < .05), while PWV did not differ between groups (P = .06). In univariate analyses, lower BMI and oxidized LDL, and higher waist-hip ratio, hsCRP, and zonulin correlated with thicker IMT in PHIV (P ≤ .05). After adjustment for age, BMI, sex, CD4 cell count, triglycerides, and separately adding sCD163, sCD14, and hsCRP, higher levels of intestinal permeability as measured by zonulin remained associated with IMT (β = 0.03 and 0.02, respectively; P ≤ .03). Our study shows that African PHIV have evidence of CVD risk and structural vascular changes despite viral suppression. Intestinal intestinal barrier dysfunction may be involved in the pathogenesis of subclinical vascular disease in this population.

Malnutrition assessed by controlling nutritional status is correlated to carotid atherosclerosis in patients with type 2 diabetes.

Diabetes and malnutrition sometimes overlap. Little is known about the relationship between malnutrition and subclinical atherosclerosis in patients with type 2 diabetes. This cross-sectional study investigated this relationship in patients with type 2 diabetes. We evaluated the relationships between malnutrition assessed by controlling nutritional status (CONUT) score and subclinical atherosclerosis assessed by carotid intima-media thickness (IMT) and carotid plaque scores in 461 consecutive patients with type 2 diabetes. Nutritional assessment indicated that 38% of patients were malnourished (CONUT ≥3). Carotid IMT and carotid plaque scores were significantly higher in patients with malnutrition. Multivariate linear regression analyses revealed that a high CONUT score (CONUT ≥3) was correlated with mean IMT (β = 0.196, p = 0.043) and max IMT (β = 0.243, p = 0.011) in patients taking statins and was also correlated with mean IMT (β = 0.287, p = 0.004), max IMT (β = 0.308, p = 0.002), and plaque score (β = 0.190, p = 0.044) in patients not taking statins after adjusting for age, sex, duration of diabetes, body mass index, hemoglobin A1c, creatine, smoking, and hypertension. Our results demonstrate a relationship between malnutrition and subclinical atherosclerosis in patients with type 2 diabetes.

Habitual hot water bathing protects cardiovascular function in middle-aged to elderly Japanese subjects

Favorable effects of sauna bathing on cardiovascular disease have been demonstrated. Hot water bathing is an alternative, and could also have similar effects. Information pertaining to hot water bathing frequency and water temperature was obtained from 873 subjects. Carotid mean and max intima-media thickness (IMT) and brachial-ankle pulse wave velocity (baPWV) were measured as indices of atherosclerosis. Central haemodynamics were evaluated using radial pulse waveform analyses. Plasma levels of B-type natriuretic peptide (BNP) were measured as an index for cardiac loading. The mean duration of a single hot bath was 12.4 ± 9.9 min. Subject bathing in hot water ≥5 times per week had significantly lower baPWV, central pulse pressure (PP), and BNP after correcting for possible confounding parameters. Stepwise regression analyses revealed that hot water temperature was negatively associated with baPWV, while bathing frequency was negatively related to central PP and BNP. A longitudinal follow-up in 164 subjects showed that hot water bathing ≥5 times per week was associated with significantly lower increase in BNP over time, while the temperature of the water tended to be related to lower increases in carotid max IMT and baPWV. Hot water bathing showed a favorable effect on atherosclerotic and central haemodynamic parameters.

Effects of periodontal treatment on carotid intima-media thickness in patients with lifestyle-related diseases: Japanese prospective multicentre observational study.

Atherosclerosis, a chronic inflammatory disease in arterial blood vessels, is one of the major causes of death in worldwide. Meanwhile, periodontal disease is a chronic inflammatory disease caused by infection with periodontal pathogens such as P. gingivalis (Porphyromonas gingivalis). Several studies have reported association between periodontal infection and atherosclerosis, but direct investigation about the effects of periodontal treatment on atherosclerosis has not been reported. We have planned Japanese local clinics to determine the relationship between periodontal disease and atherosclerosis under collaborative with medical and dental care. A prospective, multicentre, observational study was conducted including 38 medical patients with lifestyle-related diseases in the stable period under consultation at participating medical clinics and 92 periodontal patients not undergoing medical treatment but who were consulting at participating dental clinics. Systemic and periodontal examinations were performed before and after periodontal treatment. At baseline, LDL-C (low-density lipoprotein cholesterol) levels and percentage (%) of mobile teeth were positively related to plasma IgG (immunoglobulin) antibody titer against P. gingivalis with multivariate analysis. Corresponding to improvements in periodontal clinical parameters after treatment, right and left max IMT (maximum intima-media thickness) levels were decreased significantly after treatment (SPT-S: start of supportive periodontal therapy, SPT-1y: at 1 year under SPT, and SPT-3y: at 3 years under SPT). The present study has clarified our previous univariate analysis results, wherein P. gingivalis infection was positively associated with progression of atherosclerosis. Thus, routine screening using plasma IgG antibody titer against P. gingivalis and periodontal treatment under collaborative with medical and dental care may prevent cardiovascular accidents caused by atherosclerosis.

Impact of glycemic variability on the levels of endothelial progenitor cells in patients with type 1 diabetes.

A reduction in endothelial progenitor cell (EPC) count is considered to correlate with cumulative cardiovascular risk factors including hyperglycemia. This study was conducted to elucidate the influence of glycemic variability on EPC count in patients with diabetes. In study 1, we examined the number of EPCs in 57 patients with type 1 diabetes and 43 patients with type 2 diabetes. The number of EPCs (CD34+, CD34+CD133+, CD34+CD309+, and CD34+CD133+CD309+) was counted as the number of cells per 106 events. In study 2, we examined 37 outpatients with type 1 diabetes without macrovascular complications. We assessed associations between EPC count and seven parameters of glycemic variability (blood glucose standard deviation, mean amplitude of glycemic excursion, J index, M value, mean of daily differences, low blood glucose index, and high blood glucose index), as measured by continuous glucose monitoring. We further analyzed the correlation between EPC count and the carotid intima-media thickness (IMT) in 24 patients. In study 1, the number of circulating CD34+ and CD34+CD133+ cells was significantly decreased in patients with type 1 diabetes relative to that in patients with type 2 diabetes (p=0.020 and 0.036, respectively). In study 2, a univariate analysis showed that the J index was negatively correlated with logCD34+ (r=-0.342, p=0.039). LogCD34+ was significantly negatively associated with the max IMT (r=-0.486, p=0.012) and the mean IMT (r=-0.503, p=0.016). An increase in the J index, which reflects both hyperglycemia and glycemic variability, is associated with a reduction in the EPC count, which might result in the progression of diabetic vascular complications.

Association between Lp (a) and atherosclerosis in menopausal women without metabolic syndrome.

The association between Lipoprotein (a) (Lp [a]) and common carotid intima media thickness (IMT) has been evaluated in 222 menopausal women. Lp (a) and IMT were measured, carotid ultrasound examination (B-Mode imaging) was performed and mean max IMT was calculated. Lp (a) was significantly lower in women with metabolic syndrome (MS). In a multivariate analysis Lp (a) showed the following odds ratio (OR; all p < 0.05) of having common carotid IMT (≥1.30 mm): 1.03, adjusted for age, low-density lipoprotein cholesterol (LDL) and waist circumference; 1.02, adjusted for age LDL, homeostatic assessment model (HOMA). In women without MS, after controlling for age, LDL and waist circumference, we found the following OR for increased IMT (≥1.30; OR: 1.03; for Lp [a]); 1.02 adjusted for age, LDL and HOMA (all p < 0.05). In women with MS these relationships were not statistically significant. Lp (a) gives additional information in the risk assessment for atherosclerotic cardiovascular disease, especially in menopausal women without MS.

Serum carboxy-terminal telopeptide of type I collagen levels are associated with carotid atherosclerosis in patients with cardiovascular risk factors.

Carboxy-terminal telopeptide of type I collagen (ICTP) is generated through matrix metalloproteinase (MMP)-dependent type I collagen digestion, and has been widely utilized as a biomarker for bone turnover. The fact that atherosclerotic lesions are rich in both type I collagen and MMP-producing macrophages led to the hypothesis that serum ICTP concentrations may serve as a non-invasive clinical biomarker for atherosclerosis. Therefore, the association of serum ICTP concentrations with the maximum intima-media thickness (IMT) of carotid arteries, a surrogate index of systemic atherosclerosis, or brachial-ankle pulse wave velocity (baPWV) in patients with atherosclerotic risk factors was evaluated. A total of 52 male and 65 female (mean age: 62.8 yrs) patients without renal failure, malignancies or bone diseases known to affect serum ICTP concentrations were recruited. Patients with max IMTs ≥1.1 mm showed significantly higher serum ICTP concentrations compared with patients with max IMTs <1.1 mm (3.33 ± 0.97 vs 2.82 ± 0.65 ng/mL, p<0.05). Serum ICTP concentration was also positively correlated with max IMT (p<0.001) or baPWV values (p<0.05). Multivariate analyses also revealed that serum ICTP concentrations were correlated with max IMT (p<0.001; 95% CI 0.200 to 0.454). These results suggest that serum ICTP concentrations can be used as a non-invasive biomarker for systemic atherosclerosis.

Abstract 16411: Can the Types of Coronary Artery Disease Severity be Predicted Using Any Parameters of Brachial Ultrasonography and/or Carotid Ultrasonography?

Introduction: It has been reported that the flow-mediated dilatation (FMD) of the brachial artery on brachial ultrasonography and carotid intima-media thickness (IMT) on carotid ultrasonography correlate with the presence of coronary artery disease (CAD). Hypothesis: However, it is not clear whether CAD types can be detected using these techniques. We examined whether CAD types can be detected using brachial and/or carotid ultrasonography. Methods: Four hundred fifteen patients (mean age 68 years, 266 men) who underwent coronary angiography (CAG) during the evaluation of CAD were enrolled. Each patient underwent brachial and carotid ultrasonography before CAG. On brachial ultrasonography, FMD) and nitroglycerine-induce dilation (NID) were measured. On carotid ultrasonography, maximum IMT, the presences of carotid plaque (&gt;1.1 mm) and calcification were measured. On coronary angiography, if organic coronary stenosis was absent, a spasm provocation test was performed to confirm the presence of vasospastic angina (VSA). According to the CAG results, patients were divided into three subgroups: Group I, patients with organic coronary stenosis (n = 244); Group II, patients with VSA without organic coronary stenosis (n = 98); and Group III, patients without organic coronary stenosis or VSA (n = 73). Results: FMD was lower in Groups I (3.2% ± 0.3%) and II (3.2% ± 0.4%) than in Group III (4.5% ± 0.4%, p &lt; 0.05), and NID were lower in Group I (12.1% ± 0.4%) than in Groups II (14.6% ± 0.6%) and III (15.6% ± 0.7%, p &lt; 0.0001). Max IMT was higher in Group I (2.38 ± 0.06 mm) than in Groups II (1.61 ± 0.09 mm) and III (1.56 ± 0.10 mm, p &lt; 0.0001). The presence of both carotid plaque and calcification was higher in Group I (93% and 43%, respectively) than in Group II (74% and 19%, respectively) and III (60% and 19%, respectively, both p &lt; 0.0001). Logistic regression analysis demonstrated that carotid plaque (p = 0.0162), carotid calcification (p = 0.0011) and lower NID (p = 0.0011) were predictors of the presence of Group I, whereas lower max IMT (p = 0.0002) was one of predictors for the presence of Group II. Conclusions: These findings suggest that brachial and/or carotid ultrasonography before CAG may provide important diagnostic information regarding CAD types.

Elevated plasma homocysteine level is possibly associated with skin sclerosis in a series of Japanese patients with systemic sclerosis.

Homocysteine is a sulfhydryl-containing amino acid that is derived from dietary methionine, and there has been increasing evidence that elevated plasma homocysteine levels are associated with increased risk of cardiovascular diseases, including carotid, coronary and peripheral arterial disease (PAD). The association of plasma homocysteine levels with peripheral vascular involvements, such as Raynaud phenomenon (RP), digital ulcers (DU) in systemic sclerosis (SSc) patients has not been well studied. The objective of this study was to examine plasma homocysteine levels and their clinical associations in patients with SSc. Plasma homocysteine levels in 151 Japanese patients with SSc and 20 healthy controls were examined. No significant differences were observed in plasma homocysteine levels between SSc patients and healthy individuals. Demographic and clinical features of the SSc patients revealed that severe skin sclerosis, anti-topoisomerase I antibody positivity, complications of DU, acro-osteolysis (AO) and interstitial lung disease (ILD) were significantly more prevalent among the patients with elevated plasma homocysteine levels. The plasma homocysteine levels were positively correlated with modified Rodnan total skin score. The plasma homocysteine levels in the SSc patients with DU, AO and ILD were significantly higher than those in the SSc without DU, AO and ILD, respectively. Plasma homocysteine levels did not correlate with either the mean or max intima-media thickness (IMT) or plaque score, suggesting that plasma homocysteine levels might not be associated with carotid artery atherosclerosis in SSc patients. The measurement of plasma homocysteine levels in SSc patients might be useful for the risk stratifications of severe skin sclerosis, DU and AO.

Plasma creatinine levels, estimated glomerular filtration rate and carotid intima media thickness in middle-aged women: A population based cohort study

Background and aimThe relationships between high Creatinine (Cr) levels or low estimated Glomerular Filtration Rate (eGFR) and common carotid Intima Media thickness (IMT) have been evaluated in a population-based cohort study in women, aged 30–69 (Progetto ATENA). Methods and resultsSerum Cr and eGFR were measured in 310 women, as a part of 5.062. In this group carotid ultrasound examination (B-Mode imaging) was performed and mean max IMT was calculated. Women were classified by Cr levels >1 mg/dL or eGFR < 56 ml/min.Women with Cr > 1 mg/dL (90th percentile of creatinine distribution) or eGFR less than 56 ml/min (5th percentile of eGFR distribution) had relatively more carotid plaques as compared to the rest of the cohort.Multivariate logistic analysis, after adjustment for age, demonstrated a significant association between Cr (>1 mg/dL) and IMT (≥1.2 mm): OR 4.12 (C.I 1.22–13.86), p = 0.022; or eGFR (<56 ml/min) and IMT (≥1.2 mm): OR 4.31 (C.I 1.27–14.66), p = 0.019. ConclusionsThese findings on an independent relationship between Cr and common carotid plaques in this population of middle aged women, independently of age, suggest the value of screening for early carotid disease in asymptomatic middle aged-women with mild renal insufficiency, in order to predict those at relatively higher risk for future cardiovascular events.

Abstract 9559: Serum Uric Acid and the Vulnerability of Carotid Atherosclerotic Plaque Measured by Magnetic Resonance Imaging

Carotid-wall intima-media thickness (IMT) is a surrogate marker of atherosclerosis associated with cardiovascular risk factors and with cardiovascular outcomes. MR imaging of carotid plaque has been shown to be superior to the diagnostic assessment of plaque vulnerability at high risk of rupture, and to provide information useful to the choice of treatment. Regression of plaque has been reported by intensive statin therapy (IST). The effect of IST on the characteristics of carotid plaques, especially on the instability of plaques was determined using a combination of ultrasonography and MR imaging. In the present investigation, 572 patients having max IMT over 1.5mm were included. Among them, 445 patients (234 males and 211 females, average age was 70 ± 9.9 and 70 ± 10.1, respectively ) had been treated on IST for more than 1 year before the study(IST group). On the other hand, 117 patients (49 males and 68 females) had not been treated on IST before the study(non-IST group). Serum levels of LDL-C, HDL-C, LDL-C/HDL-C and uric acid of IST group and non-IST group are 68 ± 15 vs 133 ± 29, 52 ± 13 vs 53 ± 12, 1.39 ± 0.4 vs 2.6 ± 0.5 and 5.4 ± 1.4 vs 5.1 ± 1.2, respectively. The black-blood method was used, and a horizontal cross-sectional image of plaque was taken with T1- and T2-weighted mode. Finally, the ratio of the lesion and the submandibular gland was determined. Plaques having the ratio of T1 evaluation more than 1.25 were defined as intraplaque hemorrhage (IPH), while those below 1.25 were defined as stable. Plaques having the ratio of T2 evaluation more than 1.25 were defined as lipid core (LC), while those below 1.25 were defined as stable. In IST group, 58% of the patients have stable plaque, 6% have IPH, 24% have LC and 11% have IPH+LC. On the other hand, 50% of the patients of non-IST group have stable plaque, 4% have IPH, 33% have LC and 12% have IPH+LC. In IST group, among various parameters, only serum uric acid has strong and significant correlation with the presence of LC in carotid plaque in male (p=0.0030). Odds ratio of uric acid in the presence of LC in carotid plaque is 1.530. No such correlation was observed in female patients. Thus the present investigation provides a new insight into the role of uric acid in the vulnerability of carotid atherosclerotic plaque.

Association of Systolic Blood Pressure and Pulse Pressure with Carotid Intima Thickness in Elderly Japanese Patients

Many studies have demonstrated that increased carotid intima-media thickness (IMT) is related to future cardiovascular events and is influenced by cardiovascular risk factors such as sex, hypertension, diabetes, and hypercholesterolemia. Although aging is a well-known risk factor for an increase in carotid IMT, few studies have investigated which factors influence carotid IMT in the very elderly. In the present study, we investigated the relationship of pulse pressure (PP), blood pressure (BP), and its variability (six consecutive visits) with carotid IMT among 240 high-risk elderly in whom risk factors were managed clinically (average age was 79 ± 5 years). In the simple correlation, mean systolic BP (SBP) had a positive correlation with IMT and max IMT (P = .012 and P = .045), as did PP (P = .018 and P = .004), but did not diastolic BP or standard deviation of BP and coefficient of variation of BP. In multiple regression analyses, mean SBP and mean PP were each determinants of both IMT and max IMT, when each parameter was added separately to the regression model. We concluded that high SBP and wide PP still have an influence on increased carotid IMT in the very elderly Japanese patients.

Neointimal Hyperplasia after Silverhawk Atherectomy versus Percutaneous Transluminal Angioplasty (PTA) in Femoropopliteal Stent Reobstructions: A Controlled, Randomized Pilot Trial

Due to intimal hyperplasia instent reobstruction in the femoropopliteal arterial segment is still an unsolved problem. Different techniques have been discussed in case of reintervention to guarantee longlasting patency rate. We conducted a randomized, controlled, pilot trial comparing Silverhawk atherectomy with percutaneous transluminal angioplasty (PTA) in patients with a first instent reobstruction in the femoropopliteal arterial segment, to evaluate intima media thickness (IMT) within the treated segment, as a parameter of recurrence of intimal hyperplasia. In a total 19 patients were included: 9 patients in the atherectomy device and 10 patients in the PTA arm. IMT within the treated segment was statistically significantly elevated in all patients treated with the Silverhawk device versus the patients treated with PTA. The obvious differentiation in elevation of IMT in nonfavor for patients treated with the Silverhawk device started at month 2 (max IMT SH 0.178mm vs. IMT PTA 0.1mm, p=0.001) with a spike at month 5 (max IMT SH 0.206mm vs. IMT PTA 0.145mm, p=0.003) and a decline once again at month 6 (max IMT SH 0.177mm vs. IMT PTA 0.121mm, p=0.02). The values for mean IMT performed the same way. Although Silverhawk atherectomy provides good results at first sight, in the midterm follow-up of treatment of first instent restenosis it did not perform better than PTA as it showed elevated reoccurrence of intimal media hyperplasia.

Abstract 2803: Cilostazol Reduces Carotid Atherothrombotic Plaques In Patients With Acute Ischemic Stroke During A 6-month Follow-up

Introduction: We previously reported that patients treated with aspirin plus cilostazol during the acute phase of ischemic stroke had less neurological deterioration than those treated with aspirin alone. However, the mechanisms of this beneficial effect remain unknown. Although cilostazol has been reported to induce regression of carotid atherosclerosis in patients with type 2 diabetes mellitus, no report has focused on patients with acute ischemic stroke. Therefore, we performed carotid ultrasonography in a sub-study of a randomized trial to investigate the effects of aspirin plus cilostazol on the progression of carotid plaques and intima-media thickness (IMT) during the first 6 months after acute ischemic stroke. Patients and Methods: This randomized study compared the effects of oral aspirin alone to aspirin plus cilostazol in patients admitted to our hospital due to non-cardioembolic ischemic stroke within 48 h of stroke onset. Maximum IMT within the internal and common carotid arteries (max IMT) and plaque score (PS) were examined on admission and 6 months after study entry. No other antithrombotic drugs were administered during the follow-up period. For statistical analysis, on-treatment analysis was conducted, and patients who had adverse effects due to aspirin or cilostazol and were treated with other antithrombotics due to neurological deterioration (NIH Stroke Scale score ≥1) were excluded from the analysis. Results: Seventy-six patients were enrolled in the study and randomly allocated to one of the treatment groups. During the 6-month follow-up, 10 patients in the aspirin group and 3 in the aspirin plus cilostazol group experienced neurological deterioration. As a result, 16 patients in the aspirin group and 26 in the aspirin plus cilostazol group completed the 6-month follow-up. Vascular risk factors and use of antihypertensive or lipid-lowering drugs did not significantly differ between the groups. In the aspirin plus cilostazol group, the changes in max IMT had a tendency towards regression when compared with the aspirin group (-0.23 ± 0.60 vs. 0.10 ± 0.53; p = 0.08). The regression in PS was significantly greater in the aspirin plus cilostazol group than in the aspirin group (-1.02 ± 2.20 vs. 1.00 ± 2.27; p = 0.0068). Conclusion: Compared to treatment with aspirin alone, treatment with aspirin plus cilostazol is more effective for preventing progression of carotid plaques for 6 months after stroke onset.

Determining factors for carotid mean/max intima-media thickness and brachial flow-mediated dilation in healthy young women

Background: Many factors can contribute to atherosclerotic-type vascular changes in older individuals or men. Thus, confining the investigation to young women with no clinical evidence of the condition could enhance understanding of the early stages of cardiovascular disease. The aim of this study was to determine whether carotid mean/max intima-media thickness (IMT) and brachial flow-mediated dilation (FMD) values, which are well-known event-related indices, are associated with laboratory data and the other vascular indices of atherosclerosis in healthy young women. Methods: Carotid mean/max IMT and brachial FMD were measured in young women with no clinical evidence of atherosclerosis (n = 110; mean age, 39 years) who were instructed not to eat, drink or smoke after 9 PM the evening before testing. All participants also underwent laboratory assessment, including simultaneous measurements of arterial stiffness such as augmentation index (AI), cardioankle vascular index (CAVI) and brachial-ankle pulse wave velocity (baPWV). Results: Mean IMT was signifi-cantly and positively associated with age (p = 0.002), CAVI (p = 0.044), low-density lipoprotein-cholesterol (LDL-C, p = 0.047) and high-sensitive C-reactive protein (hs-CRP, p = 0.002) values but was not related to FMD, AI, baPWV or triglycerides (TG) in the multivariate regression analysis. Similarly, max IMT was positively associated with age (p p = 0.003) and hs-CRP (p = 0.005) values but was not related to FMD, AI, CAVI, baPWV, TG or blood pressure level in the multivariate regression analysis. The association between LDL-C and max IMT was much stronger than that between LDL-C and mean IMT. Brachial FMD was positively associated only with heart rate in the multivariate regression analysis. Conclusions: These results suggest that mean IMT more closely represents the sclerotic aspect of vascular change, whereas max IMT represents the atherotic aspect in healthy young women. Although the relationship between the autonomic nervous system and heart rate is well-known, there may be a complex interaction between the autonomic nervous system and endothelial function.

Impact of Low-and High-Density Lipoprotein Cholesterol Levels on Carotid Intima-Media Thickness Differs by Smoking Status in Middle-Aged Men

Cigarette smoking is a strong risk factor for atherosclerotic disease; however, it remains unclear whether the impact of other risk factors differs by smoking status. The aim of this study was to investigate this issue, especially with regard to low-density and high-density lipoprotein (LDL/HDL) levels. In total, 448 healthy, middle-aged men (aged 37 to 61) participated in this study. Smoking habits were recorded, carotid intima-media thickness (IMT) was measured by B-mode ultrasound, and serum lipids and other biochemical parameters were determined from fasted blood samples. Among the overall subjects, multivariate regression analyses showed that IMT was significantly associated with age (p < 0.0001 for mean IMT, p= 0.002 for max IMT), body mass index (BMI, mean IMT, p= 0.028), LDL-C levels (mean/max IMT, p= 0.001), HDL-C levels (max IMT, p= 0.022) and current smoking habit (mean IMT, p=0.012). Subgroup analyses according to smoking status revealed that LDL-C levels were significantly associated with mean/max IMT in current smokers (p=0.001) but not in ex- or nonsmokers (never smoked subjects). After adjusting for age, BMI, systolic blood pressure, hemoglobin A1c and serum lipids, mean IMT respectively increased and decreased progressively across LDL-C and HDL-C quartiles (p= 0.004 and 0.045) in the overall subjects. These associations were observed in current smokers (p= 0.01) but not in ex- or nonsmokers for LDL-C, and were observed in ex- and nonsmokers (p= 0.025, 0.017, respectively) but not in current smokers for HDL-C. The impact of LDL-C/HDL-C levels on carotid IMT differs by smoking status. These observations imply that distinct mechanisms are involved in the (anti) atherogenesis of LDL/HDL according to smoking status.