Maximum cIMT Research Articles

Time-related trends in variability of cIMT changes in statin trials.

This brief article provides complementary data supporting the results reported in “Changing Characteristics of Statin-related cIMT Trials from 1988 to 2006” [1]. That article described time-related trends in baseline factors and study characteristics that may have influenced the variability of carotid intima media thickness (cIMT) endpoints (mean of mean and maximum common carotid artery [CCA]/cIMT) in published statin trials. In this brief report, additional details for the studies included in the analysis, and further supporting data, including mean of the maximum CCA/cIMT changes and subgroup data (mean and maximum CCA/cIMT) are provided. For the analysis, study-level data was extracted from 17 statin cIMT trials conducted during 1988–2006, selected on the basis of having at least one statin monotherapy arm in the absence of mixed therapy, and baseline- and study-end values for mean mean and mean maximum CCA/cIMT endpoints. The baseline mean CCA/cIMT, maximum mean CCA/cIMT and LDL-C levels, and annualized cIMT changes were estimated for the overall studies, those conducted before/after 2000, and in risk-based subgroups. Interestingly, all 8 studies conducted before 2000 were significant for cIMT change in which patients did not receive prior LLT; whereas after 2000, the results were more variable and in 4 of 6 trials that did not show a significant cIMT change, patients had received prior treatment. Baseline mean maximum cIMT and LDL-C levels, and annualized changes in studies conducted before 2000 were higher than those conducted after 2000, similar to the results reported in the original article for the mean mean cIMT endpoint. These findings were consistent across study populations of patients with CHD risk versus those without, and in studies with greater LDL-C reductions and with thickened baseline cIMT at study entry for both mean and maximum cIMT changes. Taken together, these results are consistent with trends in recent years toward greater use of lipid-lowering therapy and control of LDL-C that may have impacted the variability in the results of cIMT studies.

Changing characteristics of statin-related cIMT trials from 1988 to 2006

ObjectivesChanges in cIMT have not been consistently correlated with cardiovascular risk reduction in clinical studies. The variability of carotid intima media thickness (cIMT) changes in published statin LDL-C-lowering studies in relation to various baseline and study characteristics was assessed. MethodsThis was an exploratory analysis of study-level data pooled from statin-treatment arms of 13 studies conducted during 1988–2006. Baseline mean common carotid artery (CCA)/cIMT, maximum mean CCA/cIMT and LDL-C levels, and annualized cIMT changes were estimated for the overall studies, those conducted before/after 2000, and in risk-based subgroups. Potential relationships between prespecified covariates and cIMT changes were assessed. ResultsBaseline mean CCA/cIMT and LDL-C levels were higher in the combined studies conducted before year 2000 (0.8521 mm) than after 2000 (0.7458 mm), and somewhat higher in study populations of patients with coronary heart disease risk and those with greater LDL-C reductions. Mean CCA/cIMT changes were also larger for the studies conducted before 2000 (−0.0119 mm/year) than after 2000 (−0.0013 mm/year). Notably, studies conducted before 2000 were of longer duration (≥2 years) than after 2000 (<2 years). Heterogeneity in cIMT change was attributed to baseline and study-design characteristics. Longer study duration and greater LDL-C reductions were significantly related to larger annualized cIMT changes. Maximum cIMT results were similar. ConclusionBaseline cIMT and LDL-C levels were lower, and cIMT changes were smaller in statin cIMT trials conducted after 2000 than those before 2000. These trends are consistent with increased treatment and control of high LDL-C levels over recent years in clinical practice, and may influence the results of cIMT studies.

Peripheral Endothelial (Dys)Function, Arterial Stiffness and Carotid Intima-Media Thickness in Patients after Kawasaki Disease: A Systematic Review and Meta-Analyses.

BackgroundKawasaki disease (KD) is a systemic pediatric vasculitis. Its main complication is the development of coronary arterial aneurysms (CAA), causing an increased risk for ischemia and myocardial infarction. It is unclear whether KD patients, apart from the presence of CAA, have an increased cardiovascular disease (CVD) risk due to the previous systemic vasculitis. The aim of this study was to systematically review and meta-analyse the literature regarding surrogate markers for CVD risk in KD patients.MethodsMedline and Embase were searched for articles comparing endothelial dysfunction (flow-mediated dilation, nitroglycerin-mediated dilation and peripheral arterial tonometry), vascular stiffness (stiffness index, pulse wave velocity) and carotid intima-media thickness (cIMT) between patients and controls. Two investigators assessed the articles for eligibility and evaluated quality.ResultsThirty studies were included. For all outcomes, moderate to high heterogeneity between studies was found. Most studies reported a decreased flow-mediated dilation in the whole KD- and CAA-positive group compared to controls, while data on CAA-negative patients were conflicting. The stiffness index was increased in the majority of studies evaluating the whole KD- and CAA-positive group, but not in most studies on CAA-negative patients. Mean cIMT was neither significantly increased in the whole KD-group nor in the CAA-positive group nor in most studies studying CAA-negative patients. Studies measuring maximum cIMT were conflicting.ConclusionLiterature suggests that surrogate markers for CVD risk in KD patients are increased in CAA-positive but not in CAA-negative patients. This may indicate that CAA-positive patients should be monitored for CVD in later life. The results of this review have to be interpreted with care due to substantial heterogeneity between studies and methodological limitations, as well as the lack of long-term follow-up studies.

Insulin-like growth factor-1 in early-onset coronary artery disease: Insights into the pathophysiology of atherosclerosis

percutaneous coronary intervention. Patients with acute coronary syndromes or coronary interventions in the previous 6 months were not considered eligible for the study. Controls were nondiabetic adults ≤45 years without cardiac symptoms or known CAD. Blood was collected after a 12-hour fast for glucose, total cholesterol, LDL and HDLcholesterol, triglycerides, IGF-1 and insulin measurements. IGF-1 was measured by chemiluminescent enzyme-labeled immunometric assays (Immulite 2000, Diagnostic Products Corporation, USA), and serum insulin was measured by radioimmunoassay (ImmuChemTM Coated Tube, MP Biomedicals, USA). CIMT measurement was performed with a 7.5-MHz ultrasound system (GE Healthcare, Wisconsin, USA) by 2 trained sonographers. Scans of the right and left last distal centimeter of common carotid arteries and bifurcation and of the first proximal centimeter of internal carotid arteries in 3 different projections (anterior, lateral, and posterior) were performed. Measurements were made on longitudinal scans by using the machine's electronic caliper. Values for the 3 different projections and for right and left carotid arteries were averaged to obtain the mean maximum CIMT. For the analysis of agreement between observers, a Bland–Altman analysis was employed. There was good concordance between observers (0.73–0.91). The study complied with the Declaration of Helsinki. All participants gave informed written consent and study approval was obtained from the local ethics committee. Categorical variables were expressed as number and percentage and compared with a chi-square test. Continuous variables were expressed as mean ± SD or median and interquartile range and compared with the Student's t test or Mann-Whitney's test according to their distribution (normal or skewed). Correlations between CIMT and candidate variables of interest were studied with the Pearson's test. Linear regression analysis was employed to evaluate variables independently associated with CIMT in the entire population; traditional risk factors were entered into the model, and IGF-1 and insulin were then separately entered to assess their contribution over and above the other risk factors. A value of p b 0.05 was considered statistically significant. Nineteen patients (84.2% with prior myocardial infarction, 26.3% with prior coronary artery bypass surgery and 68.4% with prior percutaneous coronary intervention) and 17 controls were studied. Table 1 depicts their characteristics. There was a small, statistically significant difference in age, which was not considered biologically important since patients remained at the “young for coronary artery disease” age range and very close to controls. Early-onset CAD patients had higher body mass index, fasting glucose and triglycerides and lower HDL-cholesterol. Of note, total cholesterol and LDL-cholesterol were not significantly

Abstract P191: Carotid Intima-Media Thickness is Associated with Systolic Blood Pressure, Body-Mass Index and LDL Cholesterol in Low-Risk Individuals. A Cross-Sectional Analysis of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

Introduction: Carotid intima-media thickness (cIMT) is a noninvasive measurement of early atherosclerosis by ultrasound. Determinants of cIMT in individuals without classical cardiovascular (CV) risk factors are poorly studied. Hypothesis: We assessed the hypothesis that systolic blood pressure (SBP), body-mass index (BMI), serum glucose and LDL cholesterol (LDL-c) are associated with maximal cIMT values in low-risk individuals (no hypertension, diabetes, dyslipidemia or prior CV disease, no CV medications, no current or past smoking and a BMI &lt; 30 kg/m 2 ). Methods: We used data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline. ELSA-Brasil is a multicenter cohort of 15,105 civil servants aged 35-74 years in six Brazilian cities. Baseline assessment included cIMT measurements in both common carotid arteries. SBP, BMI, serum glucose and LDL-c values were standardized. We used multiple linear regression models to study the association of SBP, BMI, serum glucose and LDL-c with maximal cIMT (in mm). Results: We analyzed 1,569 ELSA-Brasil low-risk participants with complete cIMT data. There were 1,024 (65.3%) women and 924 (58.9%) of White race. Mean ± standard deviation (SD) for continuous variables were: age 46.1 ± 7.7 years; SBP 111.2 ± 10.8 mmHg; BMI 24.0 ± 2.9 kg/m 2 ; serum glucose 99.7 ± 7.8 mg/dl; LDL-c 105.6 ± 17.1 mg/dl and maximal cIMT 0.700 ± 0.136 mm. The table shows the beta-coefficients associated to one standard deviation increase in SBP, BMI, serum glucose and LDL-c. Conclusions: Even in a low-risk subsample, excluding individuals with hypertension, dyslipidemia or obesity, SBP, BMI and LDL-c were positively associated with higher maximal cIMT. This probably reflects a continuum of risk for atherosclerotic disease mediated by these measurements that do not evanesce with the exclusion of subjects who fulfill current diagnostic criteria for these conditions.

Lack of evidence for progression of atherosclerosis during puberty in type 1 diabetes.

Children with type 1 diabetes have early changes in vascular structure with increased aortic intima-media thickness (aIMT) or carotid IMT (cIMT). aIMT may be an earlier, more sensitive marker; however, longitudinal data in type 1 diabetes are lacking. This study will aim to evaluate changes in vascular structure (aIMT and cIMT) over 2 yr during puberty in children with type 1 diabetes and compare them with those in healthy children. A total of 110 children (aged 10-18 yr, 55 males) participated in a prospective cohort study, including 77 children with type 1 diabetes and 33 age- and sex-matched healthy children. Ultrasound assessments of aIMT and cIMT; and clinical and biochemical data were collected at baseline and 2 yr later. Mean and maximal aIMT or cIMT did not worsen over time in children with type 1 diabetes compared with healthy children. Longer duration of diabetes related to an increase in aIMT. Improvement in HDL cholesterol and leptin related to a decrease in aIMT. Higher baseline IMT related to an improvement in IMT in children with type 1 diabetes (mean and maximal aIMT: β = -0.52, p < 0.001; β = -0.49, p = 0.001, and mean and maximal cIMT: β = -0.36, p = 0.003; β = -0.40, p = 0.001), independent of cardiovascular risk factors. Aortic and carotid IMT does not deteriorate during puberty in children with type 1 diabetes. This has implications for the design of interventional studies in this important age group.

Abstract 17913: Inhibition of CETP by Dalcetrapib Results in a Modest Increase in Cholesterol Efflux Capacity Associated With an Increase in Large HDL Particles, but Does Not Impact Carotid Intima-Media Thickness in a dal-PLAQUE-2 Substudy

Inhibition of cholesteryl ester transfer protein (CETP) is an approach aiming at raising HDL-cholesterol levels and reducing cardiovascular risk. The dal-PLAQUE-2 phase III study recruited 988 subjects with stable coronary artery disease. Its primary objective was to evaluate the effect of dalcetrapib on the progression of carotid atherosclerotic disease measured by intima-media thickness after one year of therapy. As dalcetrapib showed a neutral effect on cardiovascular risk in the dal-OUTCOMES study, our objective was to evaluate its effect on cIMT and markers of HDL mass, lipoprotein subclass distribution and HDL function. All subjects from dal-PLAQUE-2 who had provided serum samples at baseline and one year were included in our substudy of 193 subjects on placebo and 186 subjects on dalcetrapib. Comparisons between groups at one year were made by ANCOVA after adjustment for baseline levels. No significant differences between groups for all variables considered were observed at baseline. Dalcetrapib reduced CETP activity as measured by a fluorescent method by 30% after 1 year (p&lt;0.001), which resulted in increases in HDL-cholesterol and apoA-I levels by 32% and 11%, respectively (both p&lt;0.001). Dalcetrapib markedly increased the concentration of large HDL particles measured by NMR profiling (+59%, p&lt;0.001), at the expense of small HDL particles (-9.5%, p&lt;0.001). Cholesterol efflux capacity of serum was measured from J774 macrophages under basal conditions and after cAMP stimulation. Dalcetrapib increased basal and stimulated efflux by 7.1% and 5.5% (both p&lt;0.001), but was without effect on the ABCA1-dependent component (p=0.26). Despite these effects, dalcetrapib had no impact on mean and maximal cIMT (p=0.98 and p=0.85). While the change in cIMT was inversely correlated with basal cholesterol efflux in the placebo group (Spearman r=-0.163, p&lt;0.05), such a relationship was not found in the dalcetrapib group. Moreover, the change in total HDL particles concentration was inversely correlated with change in cIMT (r=0.181, p&lt;0.05) in the placebo arm only. In conclusion, dalcetrapib raised HDL-C and larger HDL, but this had minimal effects on cholesterol efflux capacity of patients’ serum and had a neutral effect on carotid artery plaque burden.

Common genetic determinants of lung function, subclinical atherosclerosis and risk of coronary artery disease.

Chronic obstructive pulmonary disease (COPD) independently associates with an increased risk of coronary artery disease (CAD), but it has not been fully investigated whether this co-morbidity involves shared pathophysiological mechanisms. To identify potential common pathways across the two diseases, we tested all recently published single nucleotide polymorphisms (SNPs) associated with human lung function (spirometry) for association with carotid intima-media thickness (cIMT) in 3,378 subjects with multiple CAD risk factors, and for association with CAD in a case-control study of 5,775 CAD cases and 7,265 controls. SNPs rs2865531, located in the CFDP1 gene, and rs9978142, located in the KCNE2 gene, were significantly associated with CAD. In addition, SNP rs9978142 and SNP rs3995090 located in the HTR4 gene, were associated with average and maximal cIMT measures. Genetic risk scores combining the most robustly spirometry–associated SNPs from the literature were modestly associated with CAD, (odds ratio (OR) (95% confidence interval (CI95) = 1.06 (1.03, 1.09); P-value = 1.5×10−4, per allele). In conclusion, our study suggests that some genetic loci implicated in determining human lung function also influence cIMT and susceptibility to CAD. The present results should help elucidate the molecular underpinnings of the co-morbidity observed across COPD and CAD.

Association of Carotid Intima–media Thickness and Atherosclerotic Plaque with Periodontal Status

Studies have suggested an association between clinical/subclinical atherosclerosis and periodontal status. The purpose of this study was to investigate the association among maximal carotid intima–media thickness (cIMT), atherosclerotic plaque, and periodontal status in Chinese elderly patients. A cross-sectional study was conducted of 847 participants (age, 70.64 ± 9.03 yr) with ≥10 teeth. A questionnaire survey, routine biochemical tests, a periodontal examination, and maximal cIMT measurement were performed for each. Traditional risk factors for atherogenesis were considered in the statistical analysis. Mean plaque index, which reflects oral hygiene, was correlated with maximal cIMT and atherosclerotic plaque in the study sample overall (β = 0.068, p < .001; OR = 2.051, p < .001) and in euglycemic participants (β = 0.066, p = .008; odds ratio = 2.122, p = .009). In hyperglycemic participants, multiple linear regression analysis (p = .006) and multivariate logistic regression analysis (p = .025) revealed a linear and dose-dependent association between mean clinical attachment loss and maximal cIMT after adjustment for traditional risk factors. Each 1-mm increase in mean clinical attachment loss corresponded to a 0.018-mm increase in maximal cIMT. The risk of atherosclerotic plaque increased by 18.3% with each 1-mm increase in mean clinical attachment loss. Other indicators of periodontal exposure, including percentage of sites with attachment loss ≥ 3 to 5 mm (3%-5%), were also correlated with cIMT and atherosclerotic plaque in hyperglycemic patients. In this elderly population, a linear and dose-dependent association among mean clinical attachment loss, attachment loss 3% to 5%, maximal cIMT, and atherosclerotic plaque was verified in those with hyperglycemia. Poor oral hygiene was correlated with maximal cIMT and atherosclerotic plaque in all participants, including those with normal blood glucose.

Carotid intima-media thickness and calcification in relation to bone mineral density in postmenopausal women—The OSTPRE-BBA study

ObjectivesAtherosclerosis (AS) and osteoporosis are common diseases in elderly people and may be metabolically related. The aim of this cross-sectional population-based study was to explore the association between common carotid artery intima-media thickness (cIMT), carotid artery calcification (CAC), and BMD in postmenopausal women. In addition, the association of postmenopausal hormone therapy (HT) and selected diseases with cIMT and carotid calcification was studied. Study designThe 290 women (mean age 73.6 years) included in this Bone Brain Atherosclerosis study (OSTPRE-BBA) were randomly selected from the population-based Kuopio Osteoporosis Risk Factor and Prevention (OSTPRE) study cohort, Finland. Main outcome measuresFor this cross-sectional study, cIMT was measured with B-mode ultrasound; femoral neck and total body BMD were measured with dual-energy X-ray absorptiometry. ResultsThere were no statistically significant associations between mean cIMT and femoral neck T-score (p>0.05). However, an increased maximum cIMT was significantly associated with low femoral neck T-score. In the osteoporotic group (T-score <−2.5, n=20), the maximum cIMT was 2.51±0.88mm (mean±SD); in the normal BMD group (T-score >−1, n=122), it was 1.93±0.64mm (p=0.001). The odds of having CAC were approximately four-fold higher in the osteoporotic group compared with the group with a normal femoral neck T-score (odds ratio [OR]=4.2, p=0.038). The maximum cIMT was smaller in HT users (1.98±0.56mm, n=190) than in non-users (2.16±0.74mm, n=156, p=0.036). ConclusionsThe results of our population-based study suggest that BMD is related to AS, at least in carotid arteries. They indirectly support the hypothesis of partially shared pathophysiological mechanisms between these two disorders.

Early atherogenesis and visceral fat in obese adolescents

Little information is available as to the cause of increased thickening of the intima-media of the carotid artery (cIMT) in the pediatric population. Therefore, cIMT was compared in obese adolescents and normal-weight controls, and associations between cIMT and lipid and non-lipid cardiovascular risk factors were assessed. Subjects included 61 obese non-diabetic male and female volunteers aged 12-18 years inclusive with a body mass index (BMI) >95th percentile for age and 2-h blood glucose <200 mg dl(-1) matched to 25 normal-weight control volunteers with normal glucose levels. Each subject underwent a 2-h glucose tolerance test and measurement of hemoglobin A1c, ultrasensitive C-reactive protein, fasting insulin, blood lipids, visceral, subcutaneous abdominal and hepatic fat, and cIMT. Maximum cIMT was 0.647±0.075 mm in the obese subjects versus 0.579±0.027 mm in normal-weight controls (P<0.001). There was no difference in maximum cIMT between male and female subjects. There were significant correlations between maximum cIMT and BMI z-score, 2-h glucose, fasting insulin, homeostasis model assessment (HOMA), total low-density lipoprotein (LDL) cholesterol, very LDL cholesterol, high-density lipoprotein (HDL) cholesterol, HDL2 cholesterol, HDL3 cholesterol, triglycerides, remnant lipoprotein cholesterol, intermediate-density lipoprotein cholesterol, lipoprotein(a), apoprotein B100, abdominal subcutaneous fat volume, visceral fat volume and hepatic phase difference. On multiple regression analysis, visceral fat was the most significant predictor of maximum cIMT. Two-hour blood glucose, HOMA and systolic blood pressure were also significant predictors of maximum cIMT. cIMT was increased in the obese adolescents compared with the normal-weight-matched controls. Visceral fat was a key predictor of arterial wall thickening in these subjects. The results suggest that the focus of cardiovascular disease prevention in the adolescent obese should be visceral obesity, and not blood lipids or lipid subclasses.

PP123-MON THE ASSOCIATION BETWEEN DIETARY INTAKE OF SODIUM AND CARDIOVASCULAR RISK FACTORS IN PEOPLE WITH TYPE 1 AND TYPE 2 DIABETES

Rationale: Sodium intake is positively associated with cardiovascular disease risk. The aim was to investigate the correlation between predicted 24 hour urinary sodium excretion and carotid intima media thickness (cIMT), central blood pressure, augmentation index and pulse wave velocity in people with type 1 and type 2 diabetes. Methods: Participants (age 55.5±17.1years) were 62 adults with type 1 (n = 16) or type 2 (n = 46) diabetes recruited from the community. Common cIMT was measured using B-mode ultrasound. Predicted 24 hour urinary sodium excretion was calculated from a random spot urine sample using the formula: spot urine sodium concentration/spot urine creatinine concentration × predicted 24 hour creatinine ( 2.04·age + 14.89·weight + 16.14·height [cm] 2244.45). In a sub-sample of the cohort (n = 19; type 1 diabetes n = 3; type 2 diabetes n = 16) a SphygmoCor® XCELwas used to measure central blood pressure, augmentation index and pulse wave velocity. Results: Mean predicted 24 hour urinary sodium excretion was 202±150mmol/24hrs. Twenty four hour predicted sodium excretion was positively correlated with mean and maximum left cIMT (r = 0.295 and 0.286; both p 0.05). Predicted urinary sodium excretion was positively correlated with central systolic blood pressure (r = 0.549), central diastolic blood pressure (r = 0.462) and mean arterial pressure (r = 0.469) after adjustment for age (n = 19; p < 0.05). Augmentation index and pulse wave velocity were not associated with predicted sodium excretion. Conclusion: In this relatively small cohort of people with type 1 and type 2 diabetes dietary sodium intake was positively associated with central blood pressure. However, no relationship was found between sodium and cIMT. These relationships will be explored in a larger cohort of people with diabetes.

Carotid intima-media thickness, carotid distensibility, and incident atrial fibrillation: the Multi-Ethnic Study of Atherosclerosis (MESA)

Purpose: Increased carotid intima-media thickness (cIMT) and decreased carotid distensibility are associated with an increased risk of myocardial infarction and stroke. It is unclear whether these carotid indices are associated with atrial fibrillation (AF) risk. In MESA, a multiethnic community-based cohort in the USA, we assessed whether carotid indices are associated with an increased risk and improve risk prediction of AF. Methods: We included 6,162 (mean age, 62.0±10.2 yrs; 48% male) subjects who were followed from 2000-02 through 2010. Maximal cIMT, distensibility coefficient, and Young's elastic modulus were measured using carotid ultrasound in 2000-02. Incident AF cases were identified from hospitalisation discharge codes. We used Cox proportional hazards model to assess association between carotid indices and AF. Using the Atherosclerosis Risk in Communities AF score as the benchmark, we assessed improvement in model discrimination with inclusion of carotid indices by estimating the C statistic and the net reclassification improvement (NRI). Results: During follow-up (median 7.6 yrs), there were 207 incident AF cases. Higher cIMT, but not lower carotid distensibility, was associated with an increased risk of AF (Table). The addition of cIMT improved model discrimination marginally: C statistic (95% CI) improved from 0.800 (0.766-0.833) to 0.807 (0.774-0.841). NRI was 3% (P=0.21). View this table: Hazard ratio of AF by carotid indices Conclusions: Greater cIMT is associated with an increased risk of AF and modestly improves risk prediction of AF. This finding reinforces an emerging viewpoint on AF pathogenesis: AF is not purely an electrical disease, but is also a vascular disease.

Determination of site-specific carotid-intima media thickness: common –carotid artery and carotid bifurcation in hypercholesterolemia patients

To determine site specific carotid intima-media thickness: common-carotid artery and carotid bifurcation in hypercholesterolemia patients as a marker for atherosclerosis. Fifty patients with hypercholesterolemia and twenty controls were selected after getting informed consent regarding the investigation of carotid- intima media thickness by B-mode ultrasound. All the patients of hypercholesterolemia with LDL-C > 160mg/dL had family history of coronary artery diseases. This procedure was carried out in the Radiology Department of Dr. Ziauddin Hospitals. Measurement of carotid -intima media thickness, B-mode ultrasonography of common carotid artery, carotid bifurcation and internal carotid artery (left and right carotid arteries) was performed with Toshiba (M# SSA-580A/E2) ultrasound scanner with linear probe. The posterior or far wall of the carotid artery is, the distance between the leading edge first bright line (lumen -intima interface) and the leading edge of the second bright line (media-adventitia interface) of far wall was recorded as intima -media thickness. The average mean of six segments of intima-media thickness was taken as mean CIMT of right and left common carotid, bifurcation and internal carotid arteries. Maximal CIMT was significantly increased at sites common carotid, carotid bifurcation and internal carotid arteries in fifty patients with hypercholesterolemia as compared to controls. At carotid bifurcation mean of maximal CIMT was (0.9+ 0.3mm). Range of maximum CIMT in hypercholesterolemia patients was (0.8- 3.3mm) and in controls (0.4- 0.8 mm). The thickness was more frequently increased at site of bifurcation. Carotid intima- media thickness in hypercholesterolemia patients was increased and carotid bifurcation was site that has shown greater increase in intima-media thickness and plaques in these patients predict high risk for atherosclerosis.

AB0359 Strong impact of anti-rheumatic drugs on intima media thickness in high-risk patients

BackgroundAtherosclerosis is accelerated in rheumatoid arthritis (RA). Cardiovascular disease has become a major cause of morbidity and mortality in RA. Carotid intima media thickness (IMT) is considered as a noninvasive...

Association of periodontitis with carotid artery intima–media thickness and arterial stiffness in community-dwelling people in Japan: The Nagasaki Islands study

ObjectiveRecent studies have suggested an association between periodontitis and atherosclerosis; however, the relationship between periodontal status and arterial alterations should be clarified. The purpose of this study was to examine associations between periodontal status and carotid intima–media thickness (cIMT) and arterial stiffness using the cardio-ankle vascular index (CAVI) in community dwellers. MethodsA community-based cross-sectional study of 1053 subjects ≥40 years with 10 teeth or more was conducted in Goto, Japan from 2008 to 2010. ResultsIn a multiple linear regression analysis adjusted for age, sex, number of present teeth, and other confounders, each 1-mm increase in mean periodontal pocket depth corresponded to a 0.02-mm increase in maximal cIMT (β = 0.018; P = 0.049) and also to a 0.1 increase in mean CAVI (β = 0.133; P = 0.040). In addition, each 1-mm increase in the mean periodontal attachment loss corresponded to a 0.01-mm increase in maximal cIMT (β = 0.013; P = 0.040). A multiple logistic regression analysis revealed that each 1-mm increase in mean periodontal pocket depth was associated with an increased risk of a maximal cIMT >1 mm (adjusted odds ratio [OR], 1.430; 95% confidence interval [CI], 1.067–1.918; P = 0.017) and mean CAVI of ≥8 (OR, 1.323; 95% CI, 1.003–1.743; P = 0.047). Furthermore, each 1-mm increase in mean periodontal attachment loss was associated with an increased risk of a maximal cIMT >1 mm (OR, 1.251; 95% CI, 1.032–1.516; P = 0.022). ConclusionA linear, dose-dependent relationship was found between periodontal pocket depth, cIMT, and arterial stiffness.

ASSA13-10-11 Nonalcoholic Fatty Liver Disease is Associated with Subclinical Atherosclerosis

<h3>Objective</h3> Nonalcoholic fatty liver disease (NAFLD) is a very frequent disease in whole world, it become a heavy medical burden in China. The aim of this study is to investigate the association between NAFLD and subclinical atherosclerosis using carotid intima media thickness (c-IMT) in check-up population in China. <h3>Methods</h3> The study population consisted of 987 participants (372 women), aged between 18 and 70 years who undertake check up in our hospital. There were 486 subjects with NAFLD and 501 apparently healthy controls without NAFLD. The age, gender and body mass index were similar. Subclinical atherosclerosis was detected by c-IMT measurement through ultrasound. <h3>Results</h3> Subjects with NAFLD had higher average and maximum CIMT (0.5 ± 0.12 and 0.58 ± 0.17mm, respectively, vs 0.39 ± 0.11 and 0.42 ± 0.12mm, respectively; p &lt; 0.05), and had higher prevalence of atherosclerotic plaques (18.7% vs 5.9%, p &lt; 0.05) than controls. The presence of NAFLD was observed to be the independent predictor of having high average CIMT (OR 4.2; 95% CI: 1.7–11.2) and high maximum CIMT (OR 4.7; 95% CI: 2.0–12.1) even after adjusting for obesity, blood pressure, glucose and lipid parameters. <h3>Conclusions</h3> This study has shown a possible independent role of NAFLD in determining subclinical atherosclerosis.

Quantitative Ultrasound Measurement of Intima–Media Thickness of Abdominal Aorta and Common Carotid Arteries in Normal Term Newborns

The objective of this study was to measure intima-media thickness (IMT) of the abdominal aortic (aIMT) and common carotid (cIMT) arteries in normal term newborns. We measured aIMT and cIMT using high-resolution ultrasonography in 100 normal term newborns during the first 4 days of life. Mean abdominal aIMT and cIMT values of term newborns were 0.51 ± 0.041 mm (n = 100) and 0.37 ± 0.054 mm (n = 100), respectively. Maximum and minimum aIMT and cIMT values of term newborns were 0.58 and 0.42 mm and 0.47 and 0.32 mm, respectively. The intraobserver intrasubject correlation coefficients for aIMT, right cIMT, and left cIMT were 0.89, 0.91, and 0.92, respectively (coefficient of variation = 5 %). The study provides data for normal aIMT and cIMT values in normal term newborns. By establishing normal values, we can further study the aetiopathogenesis of various possible intrauterine risk factors in premature atherosclerosis in normal or intrauterine growth-retarded newborns.

The Relationship Between Carotid Intima-Media Thickness and the Activity of Rheumatoid Arthritis

Cardiovascular (CV) disease, the most common cause of mortality in patients with rheumatoid arthritis (RA), is largely attributable to accelerated atherosclerosis. Carotid intima-media thickness (cIMT) has been approved as a surrogate marker of early atherosclerosis. The aim of the study was to assess cIMT in RA patients lacking concomitant comorbidities potentially influencing cIMT value. The study group consisted of 74 RA patients, without diagnosed heart or kidney disease, hypertension, diabetes, obesity, or current smoking (mean age, 46.4 [SD, 10.6] years; range, 19-70 years). Assessment of cIMT was determined by high-resolution B-mode ultrasonography in RA patients and 31 control subjects (mean age, 42.6 [SD, 8.0] years; range, 27-59 years). The mean maximum cIMT value was significantly greater in RA patients than in control subjects (0.73 [SD, 0.14] vs 0.59 [SD, 0.12] mm; P < 0.0001). In RA patients, cIMT correlated positively with a number of immunological and inflammatory parameters and also with amino-terminal pro-brain natriuretic peptide (NT-proBNP), age, metabolic variables (serum cholesterol, creatinine, cystatin C). In multiple linear regression analysis, significant association was found between cIMT and NT-proBNP and age. Patients without atherosclerosis (cIMT <0.6 mm) were younger and had significantly lower concentrations of NT-proBNP and total cholesterol, as well as higher estimated glomerular filtration rate. The course of RA in patients without atherosclerosis was characterized by shorter disease duration, lower tender joint count, and C-reactive protein. Values of cIMT were significantly greater in RA compared with control subjects. Features of RA, such as extra-articular manifestations, erosions, high inflammatory parameters, and long disease duration, even in the absence of traditional clinical CV risk factors, were associated with greater cIMT, suggesting an unfavorable CV risk profile.

Association of VKORC1 −1639 G > A polymorphism with carotid intima–media thickness in type 2 diabetes mellitus

Aims Media calcification is a predictor of cardiovascular mortality in type 2 diabetes mellitus (T2DM). Undercarboxylation of some vitamin K-dependent proteins, due to genetic polymorphisms of VKORC1, can lead to calcification. We examined a potential association between VKORC1 −1639 G > A polymorphism and T2DM and, also, the association of this polymorphism with carotid intima–media thickness (cIMT). Methods VKORC1 −1639 G > A polymorphism was determined in 299 T2DM patients and 328 controls of Caucasian origin using PCR–RFLP. cIMT was measured in a subgroup of 118 T2DM patients. Results The frequency of VKORC1 genotypes between diabetic and nondiabetic subjects differed significantly ( p = 0.01). VKORC1 genotype was associated with T2DM in an adjusted model (OR 1.36, p = 0.009). A statistically significant difference was observed in the maximum value of cIMT among different genotypes. VKORC1 −1639 G > A polymorphism was an independent predictor of cIMT ( p = 0.029) after adjusting for established risk factors. Conclusions The association between VKORC1 −1639 G > A polymorphism and risk of T2DM could be due to the higher prevalence of calcification in T2DM patients. This is supported by the independent association between VKORC1 −1639 G > A polymorphism and maximum cIMT in T2DM patients which is likely due to atherosclerosis characterized by increased calcification.