Maximum Intima-media Thickness Research Articles

Correlation between blood inflammatory indices and carotid intima-media thickness in the middle-aged and elderly adults

ObjectivesThis study aimed to investigate the correlations between carotid intima-media thickness (IMT) and systemic immune inflammation index (SII), platelet-to-lymphocyte ratio (PLR), and neutrophil-to-lymphocyte (NLR) ratio. Materials and methodsThis was a cross-sectional study enrolling a total of 582 middle-aged and elderly patients. The correlations between SII, PLR, and NLR with IMT were assessed using logistic regression models, which were subsequently incorporated into the underlying models with traditional risk factors and their predictive values for IMT. ResultsNLR exhibited a significant correlation with IMT in the simple regression analysis (β = 0.01, 95 %CI= 0.00-0.02, p < 0.05). After controlling for potential confounding variables in the multivariate analysis, the association between NLR and both Maximum IMT [β = 0.04, 95 %CI = 0.02-0.07, p = 0.0006] and Mean IMT [β = 0.05, 95 %CI = 0.02-0.07, p = 0.0001] remained statistically significant. Additionally, PLR was found to be a significant independent predictor of Maximum IMT [β = 0.04, 95 % CI =0.00-0.07, p = 0.0242] and Mean IMT [β = 0.04, 95 % CI = 0.01-0.07, p = 0.0061]. Similarly, SII was identified as an independent predictor of Maximum IMT [β = 1.87, 95 % CI =1.24, p = 0.0003]. The study found a significant positive correlation between Maximum IMT and the levels NLR, PLR, and SII. Specifically, in the Maximum IMT group, higher quartiles of NLR, PLR, and SII were associated with increased odds ratios (OR) for elevated IMT levels, with statistically significant results for NLR (Q4vsQ1: OR 3.87, 95 % CI 1.81-8.29), PLR (Q4vsQ1: OR 2.84, 95 % CI 1.36-5.95), and SII (Q4vsQ1: OR 2.64, 95 % CI 1.30-5.37). Finally, the inclusion of NLR, PLR, and NLR+PLR+SII in the initial model with traditional risk factors resulted in a marginal improvement in the predictive ability for Maximum IMT, as evidenced by the net reclassification index (p < 0.05). ConclusionsThis study discovered a positive correlation between SII, PLR, NLR, and IMT, which are likely to emerge as new predictors for IMT thickening. These findings lay a theoretical reference for future predictive research and pathophysiological research on carotid intima-media thickening.

Effect of fasting glucose levels on carotid intima-media thickness in premenopausal versus postmenopausal women.

To investigate the relationship between fasting blood glucose (FBG) and carotid intimamedia thickness (IMT) in premenopausal and postmenopausal women. The study enrolled 2,959 women seen at the Maanshan People's Hospital of Anhui Province from December 2013 to December 2018. Carotid IMT was measured using Doppler ultrasound. Linear regression and R smoothing curves were used to analyze the relationship between blood glucose level and carotid IMT in the premenopausal and postmenopausal groups. Postmenopausal compared with premenopausal women had higher mean IMT (mIMT; 0.81 ± 0.23 mm versus 0.70 ± 0.14 mm, respectively, p < 0.001) and maximum IMT (maxIMT; 0.86 ± 0.35 mm versus 0.74 ± 0.16 mm, respectively, p < 0.001) values. On linear regression analysis, mIMT values increased with increasing FBG values when FBG level was ≤ 7 mmol/L, but no significance was found between FBG and maxIMT. After stratification by menopausal status, mIMT and maxIMT increased with increasing FBG when FBG was ≤ 7 mmol/L in the premenopausal group. In the postmenopausal group, mIMT and maxIMT increased with increasing FBG. After adjustment for covariate factors, the relationship between FBG and mIMT remained the same as before the adjustment, but when FBG was ≤ 11 mmol/L, the maxIMT increased with increasing FBG. In the stratification analysis, maxIMT increased with increasing FBG when FBG was ≤ 7 mmol/L in the premenopausal group, while both mIMT and maxIMT increased with increasing FBG when FBG was > 10 mmol/L in the postmenopausal group. Levels of FBG contributed more to increased IMT in postmenopausal than premenopausal women. The influence of FBG was greater on maxIMT than mIMT. Additionally, FBG was helpful in assessing focal thickening of the carotid intima.

Local and systemic factors associated with quantitative stiffness of carotid plaque.

Plaque stiffness in carotid artery stenosis is a clinically important factor involved in the development of stroke and surgical complications. The purpose of this study was to clarify which local and systemic factors are associated with the quantitatively measured stiffness of plaque. The subjects were 104 consecutive patients who underwent carotid endarterectomy at our institution. To measure quantitative stiffness of plaque, we used an industrial hard meter in the operating room within 1h after removal of plaque. Local factors related to carotid plaque hardness were evaluated, including maximum intima-media thickness (max IMT), degree of stenosis using the European Carotid Surgery Trial (ECST), presence of ulceration or calcification, and echo brightness on preoperative carotid ultrasound. The degree of stenosis was also evaluated using the North American Symptomatic Carotid Endarterectomy Trial method in digital subtraction angiography. Age, sex, and presence or absence of hypertension, diabetes, and dyslipidemia (low-density lipoprotein cholesterol and triglyceride [TG] levels) served as systemic factors and were compared with the quantitative stiffness of carotid plaque. In multivariate analysis, ECST stenosis degree, calcification, and IMT max as local factors affected plaque stiffness. As a systemic factor, plaque stiffness was statistically significantly negatively correlated with TG values in multivariate analysis (p < 0.05). The quantitative stiffness of the plaque was negatively correlated with TG levels as a systemic factor in addition to local factors. This might suggest that reducing high TG levels is associated with plaque stabilization.

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.

Intima-Media Thickness in the Carotid Bifurcation is Related to Silent Brain Infarction: A Cross-Sectional Study.

Carotid intima-media thickness (IMT) measurement is used to assess subclinical atherosclerosis. We aimed to examine the association between the maximum IMT by location and the occurrence of silent brain infarction (SBI). Overall, 280 Japanese individuals (92 females, 52.6±5 years old) underwent a medical check-up at our hospital in Tokyo in 2015. Carotid IMT was measured at each site on ultrasound images (common carotid artery [CCA], internal carotid artery, or bifurcation). The risk factors for arterial dysfunction were evaluated. SBI was assessed using magnetic resonance imaging (MRI). The cross-sectional relationship between carotid maximum IMT and SBI was evaluated. Of the 280 individuals, 18 (6.4%) were diagnosed with SBI on MRI. The mean age of the SBI(-) and SBI(+) groups was 51.9±10.6 and 63.6±18.6 years, respectively. The correlation coefficients between the carotid maximum IMT at each location were very weak (correlation coefficient range: 0.180-0.253). The percentage of participants with SBI increased significantly with increasing maximum CCA and bIMT values. After adjusting for confounders, SBI was found to be significantly associated with the maximum bIMT (per 0.1-mm increase) (adjusted odds ratio [aOR], 1.10; 95% confidence interval [CI]: 1.03-1.17). When bIMT was categorized according to three groups (＜1.0 mm, 1.0-＜2.0 mm, and ≥ 2.0 mm), a significant SBI risk was also observed with an increase by each category of bIMT (aOR: 3.96, 95% CI: 1.63-9.52, P=0.002). The maximum bIMT was found to be the main determinant of SBI. A significant SBI risk was associated with an increase in each category of the maximum bIMT. Therefore, the maximum bIMT might be a useful predictor of future stroke in Japanese stroke-free medical check-up participants.

Moderate and high disease activity levels increase the risk of subclinical atherosclerosis progression in early rheumatoid arthritis: a 5-year prospective study

ObjectivesTo elucidate the association between different disease activity levels over time on long-term vascular outcomes in patients with early rheumatoid arthritis (ERA).MethodsThis was a 5-year prospective study. Patients with consecutive...

Maximum carotid intima-media thickness and NT-pro BNP in association with retinal vein occlusion

The purpose is to clarify the relationship between patients with retinal vein occlusion (RVO), maximal intima-media complex thickness (Max IMT), and N-terminal pro-brain natriuretic peptide (NT-proBNP), which is useful in assessing atherosclerosis. This was a retrospective observation, single center study. The patients were 86 RVO patients (male: female = 43:43, mean age 63.3 years), 25 with central retinal vein occlusion (CRVO) and 61 with branch retinal vein occlusion (BRVO), classified as ≧50 years old and &lt;50 years old, Max IMT≧1.1 and less, NT-pro BNP≧55 and less. Results showed that Max IMT ≧1.1 was significantly more common in both the CRVO and BRVO groups at ≧50 years, and NT-pro BNP ≧55 was significantly more common in the CRVO group. Max IMT≧1.1 was seen in 80% of the BRVO group and in 85% of patients aged ≧50 years. Sixty-eight percent of patients in the CRVO group had Max IMT≧1.1, but none of those &lt; 50 years had Max IMT≧1.1. Forty-eight percent of RVO patients had NT-pro BNP≧55, and significantly more patients had Max IMT≧1.1 than those who did not have NT-pro BNP more than 55 (p = 0.02). Multiple regression analysis with Max IMT as the dependent variable showed that age and NT-pro BNP were significantly associated with RVO (p = 0.015, 0.022). RVO patients were more likely to have a Max IMT≧1.1, which was associated with atherosclerosis. Max IMT and NT-pro BNP were also associated with RVO patients, so NT-pro BNP may be a marker of RVO.

Associations Among Tooth Loss, Periodontitis, and Carotid Intima-Media Thickness: the Nagahama Study.

This study aimed to clarify the relationships among tooth loss, periodontal condition, and subclinical atherosclerosis from the aspect of intensity, extent, and duration of inflammation. This cross-sectional study included 9,778 people from the Nagahama Study, a large-scale, general population-based study conducted in Japan. The number of teeth and periodontal status, including the attachment level (AL) and pocket depth (PD) of representative teeth from six regions, were evaluated by dentists. The maximum intima-media thickness (IMT) of the common carotid artery was used as an index of atherosclerosis. In the multivariate analysis adjusted for conventional risk factors, a large number of missing teeth (＜9 remaining teeth), which related to long-lasting inflammation indicative of the highest stage of periodontitis, was identified as an independent determinant of IMT in a general population (coefficient: 0.042; 95% confidence interval [CI]: 0.016 to 0.068). The presence of two or more regions with an AL ≥4 mm, which is indicative of the progressing, long-lasting stages of periodontal inflammation, was also independently associated with IMT (coefficient: 0.016; 95% CI: 0.004 to 0.028). On the contrary, PD, a measure of the early and reversible phases of periodontal inflammation, and loss of AL in the group without tooth loss were not significantly associated with IMT, because of the limited degree of accumulated periodontitis. The present results suggest that the association between periodontitis and atherosclerosis depends on the inflammation intensity, extent, and duration.

Factors associated with carotid intima-media thickness progression in patients with asymptomatic hyperuricemia: insights from the PRIZE study

Hyperuricemia is reportedly associated with the progression of carotid intima-media thickness (IMT), a surrogate of cardiovascular risks and events. However, factors associated with carotid IMT progression in patients with asymptomatic hyperuricemia are largely unknown. In this post-hoc analysis of the multicenter, randomized PRIZE study, we analyzed data from a total of 326 patients who underwent carotid ultrasonography in a blind manner at baseline and 24 months to evaluate carotid IMT. Mean and maximum IMT at the common carotid artery (CCA) were measured at a central core laboratory. Factors related to the absolute change in mean and maximum IMT from baseline to 24 months were explored. Overall, the adjusted mean [0.0032 (− 0.0214 to 0.0278) mm] and maximum [0.0011 (− 0.0327 to 0.0351) mm] CCA-IMT increased numerically from baseline to 24 months. Multivariable analysis identified higher body mass index, history of atherosclerotic cardiovascular disease (ASCVD), and lower mean CCA-IMT at baseline as significant factors associated with the increase in mean CCA-IMT. In addition, older age and lower mean CCA-IMT at baseline were significant factors for an increased absolute change in the maximum CCA-IMT at 24 months. The present sub-analysis of the PRIZE study showed higher body mass index, history of ASCVD, and older age as significant factors associated with CCA-IMT progression in patients with asymptomatic hyperuricemia. These factors may be considered when identifying the possible risk of atherosclerotic progression in this specific patient population of hyperuricemia.Trial registration: UMIN000012911 and UMIN000041322.

VASCULAR REMODELING AND FIBROSIS INDEXES IN NAFLD SUBJECTS

Objective: Non-alcoholic fatty liver disease (NAFLD) is a growing public health problem and is related to an increased burden of cardiovascular disease. Aim of the study: to assess the relation between non-invasive scoring systems for liver fibrosis (Fibrosis-4 Index and NAFLD Fibrosis Score) and structural and functional vascular properties in NAFLD patients. Design and method: The study enrolled 30 consecutive patients (mean age 64±13, BMI 29.3±6.1 kg/m2, male 60%) who underwent hepatological evaluation in our department. Atherosclerotic burden was evaluated by B-mode ultrasound in each carotid artery segment (common, bulb, internal), bilaterally, and expressed as mean of carotid intima-media thickness (mean-IMT) and mean of maximum IMT (M-MAX), right common carotid artery distensibility and stiffness (CardioVascular Suite 4, Quipu, Italy). Aortic stiffness was measured by applanation tonometry (PulsePen DiaTecne, Italy) and was expressed as carotid-femoral pulse wave velocity (PWV). Results: In our cohort vascular properties were: carotid mean-IMT 0.83±0.15 mm, M-MAX 0.98±0.17 mm, carotid distensibility 18.8±8.3 10-3/kPa, and carotid compliance CC 0.88±0.40 mm2/kPa. We found a significant correlation between NAFLD Fibrosis Score and PWV (mean PWV = 10.9±2.9m/s; Fibrosis Score = -0.97±1.80; R = 0.422, p = 0.020), which remained significant after adjustment for mean arterial blood pressure and sex (p = 0.017). No correlation was found between carotid ultrasound parameters and fibrosis scores. Conclusions: In NAFLD patients, our preliminary observation shows a correlation between a liver fibrosis score and PWV, an established marker of aortic stiffness, while no correlation was observed with carotid atherosclerosis markers. This vascular remodeling phenotype needs to be confirmed in a larger population.

A CROSS-SECTIONAL STUDY ON CORRELATION BETWEEN SERUM URIC ACID LEVEL AND CAROTID ATHEROSCLEROSIS IN PATIENTS OF TYPE 2 DIABETES

Objective: The objective of the study was to assess correlation between uric acid (UA) level and carotid intima media thickness (CIMT) in type 2 diabetes mellitus (DM) patients. Methods: The study was conducted in the Department of Medicine, SMS Medical College and Attached Hospital, among adults with type 2 DM. It was cross-sectional study conducted from April 1, 2019, to December 31, 2020. Sample size is calculated 60 patients of Type 2 DM. As per previous study show correlation coefficient between serum UA (SUA) level and CIMT (r=0.779)52 (For 90% power and 1% α error). CIMT and carotid artery plaques were measured through Doppler ultrasound. The thickness was measured at 1 cm proximal to the dilatation of the carotid bulb. The mean of maximum IMT of both the common carotid artery is taken as the average CIMT. Results: Most patients (60%) were diabetics since 5 years and nearly 30% had diabetes since 5–15 years while only 10% had diabetes since more than 15 years. Mean duration of diabetes was 6.91±5.88 years. Two thirds of diabetic individuals (67%) had HDL cholesterol level above 40 mg/dL. About 42% of diabetic individuals had triglyceride level &lt;150 mg/dL and 5% of diabetic individuals had LDL cholesterol level &lt;100 mg/dL. Mean HDL cholesterol, Triglycerides, and LDL cholesterol were 47.4±15.49 mg/dL, 153.78±81.56 mg/dL, and 92.33±57.28 mg/dL, respectively. Mean bilirubin and serum creatinine in study population were 0.65±0.48 mg/dL and 0.96±0.18 mg/dL, respectively. Mean CRP was 3.95±2.40 mg/L. Mean SUA level in study population was 5.78±2.18 mg/dL. Mean of average CIMT was found to be 8.0±1.16 mm. Glycated hemoglobin (HbA1c) and UA had negative weak linear correlation which was statistically significant. HbA1c and average CIMT had no or week negative correlation which was not statistically significant and SUA and average CIMT showed positive moderate linear correlation which was statistically significant. Conclusion: Carotid atherosclerosis as measured by IMT is associated with SUA levels in patients with type 2 DM. In type 2 DM patients, HbA1C is negatively correlated with UA while HbA1C has no correlation with CIMT.

Associations of Arterial Stiffness and Bone Mineral Density in Postmenopausal Women

Aim. To study associations between arterial stiffness and bone mineral density in postmenopausal women.Material and methods. The intima-media thickness (IMT), the presence and number of atherosclerotic plaques (AP) were studied using duplex scanning. Pulse wave velocity (PWV), augmentation index (AI) were measured by applanation. The Bone mineral density (BMD) of the spine, hip neck (HN) and proximal hip (PH) was measured using double energy x-ray absorptiometry.Results. A significant correlation of PWV with age, duration of menopause was revealed, a more pronounced correlation was noted with blood pressure (BP), maximum IMT thickness. There was no significant correlation between PWV and BMD. AI showed a statistically significant but weak negative correlation with the HN (rs=0.12, p&lt;0.05); a more pronounced negative correlation was obtained for BMD (rs=0.16, p&lt;0.01). For indicators characterizing the degree of bone mass increased, there is a significant correlation with age (rs=-0.4, p&lt;0.01), weight (rs=0.4, p&lt;0.01), Quetelet index (rs=0.3, p&lt;0.01) and the presence of AP (rs=-0.12, p&lt;0.05). According to the results of multivariate regression analysis, the most significant predictors of arterial stiffness were indicators reflecting obesity and diastolic BP. The relationship between BMD and age-adjusted vascular stiffness was not statistically significant.Conclusion. In our study, postmenopausal women have increased arterial stiffness, suggesting a higher risk of cardiovascular disease. The relationship between bone mineral density and vascular wall stiffness was insignificant. To a greater extent, arterial stiffness depended on age, increased blood pressure, and the presence of atherosclerotic changes.

Abstract TP164: Impact Of Baseline Carotid Intima-media Thickness On All Causes And Cardiovascular Disease Mortalities In A General Urban Population: The Suita Study

Purpose: This study aimed to explore the association between carotid intima-media thickness (IMT) and the Suita Risk Score for cardiovascular events and all-cause and cause-specific death. Methods: We studied 4,870 Japanese individuals (mean age 55.0±12.2 years, without CVD at the baseline; women 53.9%) who completed a baseline survey and carotid atherosclerosis in the Suita and were then followed for 14.8 years of the median. Carotid IMT was evaluated by high-resolution ultrasonography with atherosclerotic indexes of IMT in the common carotid artery (CCA) and carotid artery bulb (Bulb). We defined Mean CIMT as the mean of the IMT of the proximal and distal walls for both sides of the CCA on a longitudinal scan at a point 10 mm proximal from the beginning of the dilation of each carotid artery bifurcation. The maximum IMT in the CCA (max-CIMT) and the entire area (max-IMT) were defined as the maximum measurable IMT in the scanned CCA and the entire scanned carotid artery areas for both sides. The risks of all-cause mortality across carotid IMT were compared using Cox proportional-hazards models adjusting for the Suita risk score. The 95% CIs of the C-statistic was estimated using 200 bootstrap samples. Similarly, the standard error for the difference in C-statistic between each model was estimated from the bootstrap samples and used to calculate a P value for the difference. Results: We observed 923 deaths during 14.8 years as a median. The fourth quartiles of mean CIMT observed increased risks of all causes of mortalities and CVD mortality (hazard ratio (HR)=2.65, 95%CIs,1.93-3.63; HR=4.89, 95%CIs,1.88-12.72), max-CIMT (HR=1.99, 95%CIs,1.47-2.70; HR=2.92, 95%CIs, 1.21-7.06), and max-IMT (HR=2.13, 95%CIs,1.63-2.78; HR=2.69, 95%CIs, 1.30-5.58), respectively, compared to the first quartiles of then. C-statistic significantly improved by adding the fourth quartiles of mean CIMT and max-IMT to the Suita risk score for all-cause death (+0.003, 95%CIs, 0.0002-0.005, P=0.03 and +0.006, 95%CIs, 0.002-0.010, P&lt;0.01; respectively), although not significantly improved for CVD mortalities. Conclusion: Additional assessment of carotid IMT to the Suita risk score may be helpful to improve the predictive ability for all causes of mortalities, not for CVD mortalities.

PS-BPC08-7: ORAL SALT LOADING TEST REFLECTS NOCTURNAL HYPERTENSION AND HIGH URINARY ALBUMIN EXCRETION IN PATIENTS WITH PRIMARY ALDOSTERONISM

Objective: In the present study, which confirmatory test was most useful for reflecting the severity of primary aldosteronism (PA) was determined by evaluating 24-h blood pressure (BP), urine albumin, left ventricular mass (LVM), and intima media thickness (IMT). Design and method: This study included 113 patients (80 PA and 33 non-PA hypertensive patients) who were admitted to Oita University Hospital and evaluated using ambulatory blood pressure monitoring (ABPM). First, casual blood pressure (BP) and ABPM parameters were compared between PA and non-PA patients. Second, patients were divided into PA-positive and PA-negative groups based on confirmatory tests including the saline infusion test (SIT), captopril challenge test (CCT), and oral salt loading test (OSLT), and casual BP and ABPM parameters were compared between the two groups. In addition, urine albumin excretion, LVM, and maximum IMT as markers of organ damage were compared between the two groups. Results: The ABPM parameters but not casual BP, were higher in PA patients than in non-PA patients (nocturnal SBP: 118.3 ± 1.6 mmHg, 107.6 ± 2.7 mmHg, p &lt; 0.001; 24-h SBP: 123.4 ± 1.6 mmHg, 113.2 ± 2.6 mmHg, p &lt; 0.001, respectively). Nocturnal and 24-h systolic BP (SBP) in OSLT-positive patients were significantly higher than in OSLT-negative patients (nocturnal SBP: 124.3 ± 3.2 mmHg, 114.4 ± 3.2 mmHg, p = 0.036; 24-h SBP: 129.2 ± 3.3 mmHg, 119.9 ± 3.0 mmHg, p = 0.044, respectively). ABPM parameters in other confirmatory tests were not different between the PA-positive and PA-negative groups. Urine albumin excretion in OSLT-positive patients was significantly higher than in the OSLT-negative patients (51.6 ± 22.5 mg/day and 3.0 ± 0.3 mg/day, p = 0.043). However, in other confirmatory tests, organ damage markers (such as LVM and IMT) were not different between the two groups. Conclusions: The OSLT is potentially useful not only for the diagnosis of PA but also for assessment of 24-h SBP and organ damage, as indicated by urine albumin excretion.

PS-C05-4: EFFECT OF EVOLOCUMAB ON CAROTID MAXIMUM INTIMA-MEDIA THICKNESS IN PATIENTS UNDERGOING STATIN THERAPY

Background: This study investigated the effect of evolocumab, a fully human monoclonal antibody targeting proprotein convertase subtilisin/kexin type 9, on carotid maximum intima media thickness (IMT), an established surrogate marker of atherosclerosis, in patients taking statins with and without renal impairment (estimated glomerular filtration rate (eGFR) &lt; 60 ml/min/1.73 m2). Methods: The annual change in carotid maximum IMT before and after administration of evolocumab was retrospectively analyzed in 229 statin treated patients (148 men and 81 women; mean age: 72.6 ± 8.6 years). The annual change in carotid maximum IMT was compared between patients with and without renal impairment (n = 73; mean eGFR 48.8 ± 8.3 ml/min/1.73 m2 vs. n = 156; mean eGFR 77.1 ± 11.9 ml/min/1.73 m2). The changes in lipid parameters were also evaluated. Results: Evolocumab significantly reduced the progression rate of carotid maximum IMT in whole patients (0.17 ± 0.38 mm/year to 0.08 ± 0.47 mm/year, p &lt; 0.005). Evolocumab significantly reduced the progression rate of carotid maximum IMT in patients without renal impairment (0.18 ± 0.39 mm/year to 0.08 ± 0.46 mm/year, p &lt; 0.05) but did not in patients with renal impairment (0.15 ± 0.36 mm/year to 0.06 ± 0.50 mm/year, p = 0.12). However, it significantly reduced total cholesterol, low density lipoprotein cholesterol, triglyceride, and lipoprotein (a), and increased high density lipoprotein cholesterol in both patients with and without renal impairment. Conclusion: Evolocumab attenuated the progression of carotid maximum IMT in patients undergoing statin therapy without renal impairment but not in patients with renal impairment. However, it improved lipid parameters in both patients with and without renal impairment. These results suggest that evolocumab protects against carotid atherosclerosis in only patients undergoing statin therapy without renal impairment.

Relationship between carotid intima-media thickness and periodontal disease in a Japanese urban population with and without hypertension: The Suita Study.

To investigate the association between periodontal disease and atherosclerosis and to examine whether the association is modified by hypertension status. In this cross-sectional study, 1472 Japanese individuals aged 50-79 years who underwent a medical check-up, dental examination, and carotid ultrasonography were studied. Carotid atherosclerosis was expressed as the maximum and mean carotid intima-media thickness (max-IMT, mean-IMT) and the presence of stenosis (≥75%). Periodontal status was examined by the Community Periodontal Index (CPI, codes 0-4). The participants were divided into three groups according to the periodontal status (CPI0-2, CPI3, CPI4). A positive correlation was found between mean-IMT and periodontal disease after adjustment for cardiovascular risk factors in the entire cohort (mean-IMT in hypertensives: CPI0-2: 0.848 mm, CPI3: 0.857 mm, CPI4: 0.877 mm; normotensives: 0.782, 0.802, 0.826). In the entire cohort, the multivariable-adjusted odds ratio of stenosis based on mean-IMT significantly increased according to periodontal status in normotensives (odds ratio; CPI0-2: 1, CPI3: 1.39, CPI4: 2.53; p-value for trend=.004) but showed only marginal significant increase in hypertensives (1, 1.15, 1.55; p-value for trend=.063). No significant relationships were observed for max-IMT in all analyses. We observed an association between periodontal disease and atherosclerosis in normotensive and hypertensive participants.

Sex-Related Differences in Sitagliptin Treatment in Type 2 Diabetes: Results from the PROLOGUE Trial.

BACKGROUND At present, whether sitagliptin has sex-related differences in effect on atherosclerosis in type 2 diabetes mellitus (T2DM) patients is unknown. The purpose of this study was to investigate whether there is sex-related difference in the effect of sitagliptin on atherosclerosis in T2DM patients. MATERIAL AND METHODS In the PROLOGUE trial, 222 patients were allocated to the sitagliptin group and 220 patients were allocated to the conventional group. Carotid artery intima-media thickness (IMT) was assessed at baseline, 12 months, and 24 months. RESULTS In male patients, sitagliptin significantly reduced the mean IMT (0.84±0.41 mm vs 1.02±0.67 mm, P=0.013) and the maximum IMT (1.14±0.59 mm vs 1.39±0.88 mm, P=0.016) in the right internal carotid arteries (ICA) compared to the conventional group at 12 months. Similarly, sitagliptin significantly reduced the maximum IMT (1.09±0.52 mm vs 1.28±0.77 mm, P=0.049) in the right ICA compared to the conventional group at 24 months, but no difference was found in the mean IMT in the right ICA between groups at 24 months. In female patients, sitagliptin significantly reduced the mean IMT (1.01±0.47 mm vs 1.23±0.51 mm, P=0.049) and the maximum IMT (1.39±0.65 mm vs 1.71±0.77 mm, P=0.042) in the right bulb compared to the conventional group at 12 months. However, the group differences were not observed in mean IMT and maximum IMT at 24 months. CONCLUSIONS Our results suggest that sitagliptin slows the progression of right carotid IMT in male patients. However, more research is needed to validate this finding in female patients.

Biomechanical changes of the common carotid artery and internal jugular vein in patients with multiple sclerosis.

Investigations of the hemodynamic changes of the venous system in patients with multiple sclerosis (MS) have shown contradictory results. Herein, the biomechanical parameters of the internal jugular vein (IJV) and common carotid artery (CCA) of MS patients were extracted and compared to healthy individuals. B-mode and Doppler sequential ultrasound images of 64 IJVs and CCAs of women including 22 healthy individuals, 22 relapsing-remitting multiple sclerosis (RRMS) patients, and 20 primary-progressive multiple sclerosis (PPMS) patients were recorded and processed. The biomechanical parameters of the IJV and the CCA walls during three cardiac cycles were calculated. The IJV maximum and minimum pressures were higher in the MS patients than in the healthy subjects, by 31% and 19% in RRMS patients and 39% and 24% in PPMS patients. The venous wall thicknesses in RRMS and PPMS patients were 51% and 60% higher than in healthy subjects, respectively. IJV distensibility in RRMS and PPMS patients was 70% and 75% lower, and compliance was 40% and 59% lower than in healthy subjects. The maximum intima-media thicknesses of the CCAs were 38% and 24%, and the minimum intima-media thicknesses were 27% and 23% higher in RRMS and PPMS patients than in healthy individuals, respectively. The shear modulus of CCA walls in RRMS and PPMS patients was 17% and 31%, and the radial elastic moduli were 47% and 9% higher than in healthy individuals. Some physical and biomechanical parameters of the CCA and IJV showed significant differences between MS patients and healthy individuals.

HSPA8 Single-Nucleotide Polymorphism Is Associated with Serum HSC70 Concentration and Carotid Artery Atherosclerosis in Nonalcoholic Fatty Liver Disease.

There is an association between nonalcoholic fatty liver disease (NAFLD) and atherosclerosis, but the genetic risk of atherosclerosis in NAFLD remains unclear. Here, a single-nucleotide polymorphism (SNP) of the heat shock 70 kDa protein 8 (HSPA8) gene was analyzed in 123 NAFLD patients who had been diagnosed using a liver biopsy, and the NAFLD phenotype including the maximum intima–media thickness (Max-IMT) of the carotid artery was investigated. Patients with the minor allele (A/G or G/G) of rs2236659 showed a lower serum heat shock cognate 71 kDa protein concentration than those with the major A/A allele. Compared with the patients with the major allele, those with the minor allele showed a higher prevalence of hypertension and higher Max-IMT in men. No significant associations between the HSPA8 genotype and hepatic pathological findings were identified. In decision-tree analysis, age, sex, liver fibrosis, and HSPA8 genotype were individually associated with severe carotid artery atherosclerosis (Max-IMT ≥ 1.5 mm). Noncirrhotic men aged ≥ 65 years were most significantly affected by the minor allele of HSPA8. To predict the risk of atherosclerosis and cardiovascular disease, HSPA8 SNP genotyping might be useful, particularly for older male NAFLD patients.

Arterial Ultrasound Testing to Predict Atherosclerotic Cardiovascular Events

BackgroundStudies have indicated that the presence and size of subclinical atherosclerotic plaques improve the prediction of atherosclerotic cardiovascular events (ASCVE) over and above that provided by conventional risk factors alone. However, the relative contribution of different ultrasonographic measurements and sites of measurements on the 10-year ASCVD risk is largely unknown. ObjectivesOur aims were to determine the relative performance of carotid intima-media thickness, plaque thickness, and plaque area in 10-year ASCVD prediction when added to conventional risk factors as well as whether the vascular territory of these measurements, carotid or common femoral bifurcation, and the number of bifurcations with plaque (NBP) influence prediction. MethodsWe enrolled 985 adults (mean age: 58.1 ± 10.2 years) free of atherosclerotic cardiovascular disease. Conventional risk factors were recorded, and both carotid and common femoral bifurcations were scanned with ultrasonography. The primary endpoint was a composite of first-time fatal or nonfatal ASCVE. ResultsOver a mean ± SD follow-up of 13.2 ± 3.7 years, ASCVE occurred in 154 (15.6%) participants. By adding different plaque measurements to conventional risk factors in a Cox model, net reclassification improvement was 10.4% with maximum intima-media thickness, 9.5% with carotid plaque thickness, and 14.2% with carotid plaque area. It increased to 16.1%, 16.6%, and 16.6% (P < 0.0001) by adding measurements from 4 bifurcations: NBP, total plaque thickness, and total plaque area, respectively. ConclusionsNBP, total plaque thickness, or total plaque area from both the carotid and common femoral bifurcations provides a better prediction of future ASCVE than measurements from a single site. The results need to be validated in an independent cohort.