Mean Carotid Intima-media Thickness Research Articles

Association between Non-HDL-C/HDL-C Ratio and Carotid Intima-Media Thickness in Post-Menopausal Women.

Atherogenic lipoproteins (particularly, very low-density lipoproteins, VLDL) are associated with subclinical atherosclerosis. The present study aims at evaluating whether routinely analysed lipid parameters are associated with carotid intima–media thickness, a proxy for subclinical atherosclerosis. Lipid parameters from 220 post-menopausal women undergoing ultrasound investigation of the carotid arteries were analysed. Forty-five percent of women showed subclinical atherosclerosis on carotid ultrasound. The mean carotid intima–media thickness was 1.26 ± 0.38 mm. The mean value of the non-HDL-C/HDL-C ratio was 3.1 ± 1.2. Univariate analysis showed a significant association between non-HDL-C/HDL-C ratio and intima–media thickness (r = 0.21, p = 0.001). After adjusting for cardiovascular risk factors (age, systolic blood pressure, smoking, body mass index Homeostasis model assessment: insulin resistance and high-sensitivity C-Reactive-Protein), multivariate analysis showed a significant association between non-HDL-C/HDL-C ratio and intima–media thickness (β = 0.039, p = 0.04). Logistic regression analysis showed that the highest tertile of the non-HDL-C/HDL-C ratio was associated with the presence of carotid plaques (OR = 3.47, p = 0.003). Finally, a strong correlation between non-HDL-C/HDL-C ratio and cholesterol bound to VLDL (r = 0.77, p < 0.001) has been found. Non-HDL-C/HDL-C ratio is associated with the presence of carotid atherosclerosis in post-menopausal women and is strongly correlated to VLDL-C levels.

Vasomotor symptoms and carotid artery intima-media thickness among Korean midlife women

ObjectivesTo evaluate the association between vasomotor symptoms (VMS) and carotid intima-media thickness (CIMT) in Korean midlife women. Study designThis cross-sectional study included 918 Korean women aged 45–65 years who attended their routine health checkup at a single institution between 2013 and 2016. Main outcome measuresAll participants’ results on the Menopause Rating Scale were used to assess the VMS. Severe and very severe VMS were combined into severe VMS. CIMT and blood flow velocities were measured on the common carotid arteries using duplex ultrasound. ResultsAll participants’ mean age was 54.73 ± 5.37 years, and 627 (68.3%) were postmenopausal. A total of 401 (43.7%) women reported VMS: 217 (23.6%), mild; 109 (11.9%), moderate; and 75 (8.2%), severe. The mean CIMT was 0.062 ± 0.017 mm and 0.064 ± 0.019 mm in premenopausal and menopausal women, respectively. In the multivariate linear regression analysis, the CIMT of women with moderate VMS was 0.102 mm (95% confidence interval [CI] = 0.002–0.009) more than that of women with no VMA, and the CIMT of women with severe VMS was 0.246 mm (95% CI = 0.012–0.021) more than that of women with no VMS, after adjusting for several confounders, including age, body mass index, and lifestyle factors. Severe VMS were associated with the risk of thickened CIMT (≥0.075 mm) and/or plaques (odds ratio = 2.90, 95% CI = 1.74–4.84) in the logistic regression analysis after adjusting for the same variables. ConclusionsModerate and severe VMS are independently associated with increased CIMT in otherwise healthy Korean midlife women. Clinicians managing midlife women with bothersome VMS should consider screening for subclinical cardiovascular diseases.

Evaluation of atherosclerosis in patients with chronic kidney disease by measuring carotid intima media thickness: An observational study from a tertiary care center in India

Background: Chronic kidney disease (CKD) is associated with a substantial cardiovascular mortality and morbidity. Besides other factors, accelerated atherosclerosis plays a significant role in this. Carotid intima media thickness (CIMT) is an index of systemic atherosclerosis. By measuring the CIMT with the help of B mode ultrasound at common carotid artery, the overall atherosclerotic burden in CKD patients can be estimated. Accordingly patients at increased risk of premature mortality can be identified so that timely intervention can be taken. Aims and Objectives: The aim of the study was to measure the CIMT at the level of common carotid artery by B mode ultrasound for estimation of atherosclerotic burden in patients with CKD. Materials and Methods: It is a hospital based observational cross-sectional study involving 70 patients carried out in the department of General Medicine of Medical College and Hospital, Kolkata for a period of 1 year. Patients were selected on the basis of certain inclusion and exclusion criteria. They were evaluated based on clinical history, disease duration, physical examination findings and certain investigation parameters such as complete hemogram, renal function tests, serum potassium, lipid profile, urinalysis, urine for albumin-creatinine ratio, ultrasonography of kidney-ureter-bladder, and CIMT value as measured by B mode ultrasound of carotid artery. The data collected were analyzed with a suitable statistical analysis software package. Range, frequencies, percentage, mean, standard deviation, and P value were calculated. P&lt;0.05 was taken as significant. Results: The study showed a strong correlation between CIMT and BMI (r=0.533, P&lt;0.001). CIMT for serum triglyceride levels (≥150 mg/dl) were significantly (P&lt;0.001) high in patients (mean±SD=1.45±0.559) mg/dl in comparison with serum triglyceride levels (&lt;150 mg/dl) (0.98 ± 0.380 mg/d). Patients with high cholesterol of ≥200 mg/dl have a higher CIMT of 1.56±0.574 with P&lt;0.001. There is statistically significant relation of LDL with respect to mean CIMT as P&lt;0.001 at 1% level of significance. Hence, mean CIMT is more in LDL (≥130) than in LDL (&lt;130). CIMT for HDL levels (&lt;40 mg/dl) were high in CKD (mean=1.53±0.518 mg/dl) patients compared to HDL levels (≥40 mg/dl) (mean=10.88±0.291). It was found that mean CIMT was higher in the later stages of kidney disease (Stage 3B, 4 and Stage 5) as compared to early stages (Stages 1, 2, and 3). We also found that the Mean CIMT (1.214±0.531 was higher in patients with CKD compared to sonographically defined normal value (&lt;0.9 mm). Hence, CKD patients who have traditional risk factors for atherosclerosis such as higher BMI, higher serum total cholesterol level, higher serum triglyceride level, higher serum LDL level, and lower serum HDL level have a higher value of CIMT. Conclusion: B-mode ultrasound is a non-invasive sensitive tool for assessment of CIMT. Since CKD is associated with accelerated atherosclerosis and subsequent increased cardiovascular mortality, this modality may help us to identify patients with atherosclerotic burden so that timely intervention can be taken to reduce future cardiovascular complications in CKD patients.

Mean Carotid Intima-Media Thickness in Patients with Type 2 Diabetes Mellitus Attending Tertiary Care Center: A Descriptive Cross-sectional Study.

Sonographic carotid intima media thickness measurement in diabetic patients is an important tool for estimating the risk of cardiovascular and cerebrovascular events. It is a simple, noninvasive and widely available tool which can give idea of further treatment needed. The objective of this study was to determine the mean intima media complex thickness in patients with type II diabetes mellitus attending a tertiary care center. This was a descriptive cross-sectional study done in 64 patients with the type II diabetes mellitus patients visiting diabetic clinic of Tribhuvan University Teaching Hospital, sent for carotid Doppler examination in the department of radiology and imaging. Ethical approval was taken from the Instituitonal Review Board. Convenient sampling method was used. Carotid intima media thickness was measured on both sides and mean intima media thickness was calculated. Mean intima media thickness for male and female diabetic patients was also calculated separately. Statistical Package for Social Sciences version 25 was used for data analysis. The mean carotid intima media thickness was 0.86±0.13mm with range from 0.7mm to 1.3mm. Mean intima media thickness in male was 0.832±0.094mm and in female it was 0.904±0.144mm. Among 64 patients, 30 (46.8%) were female and 34 (53.3%) were male. Age of the patients ranged from 35 years to 68 years with mean age of 52.4±6.54 years. Carotid intima media thickness in patients with type II diabetes mellitus showed higher values than that of mean value from study done in similar study. Female had higher mean intima media thickness than male.

Association between non-alcoholic fatty liver disease and subclinical atherosclerosis in Western and Asian cohorts: an updated meta-analysis

BackgroundNon-alcoholic fatty liver disease (NAFLD) is a well-established risk factor for cardiovascular disease, with ethnic and regional differences noted. With the recent surge of research within this field, we re-examine...

OR6. Ankle-brachial index is associated with carotid intima-media thickness in type 2 diabetes mellitus patients

Abstract Background and Aims Atherosclerosis and its complications occur more rapidly in diabetes mellitus. Early detection remains a challenge. Carotid intima-media thickness (CIMT) has been used widely and validated marker for detecting subclinical atherosclerosis. The limitation of this examination is operator dependence. Meanwhile, ankle-brachial index (ABI) examination is easier and widely available. This study is aimed to evaluate correlation ABI and CIMT in type 2 diabetes mellitus patients. Method and Results We conducted cross-sectional study in vascular outpatient clinic of Dr. Sardjito Hospital. Fifty-one patients were taken by purposive sampling. An interview, hematological parameters, lipid profiles, anthropometric, ABI, and CIMT measurement were performed. ABI was measured by doppler ultrasound, meanwhile an ultrasound examination of both common carotid artery was done to obtain the CIMT. Subjects were 49.02% females and 50.98% males, with mean age 59.22 ± 8.8 years old. The percentages of hypertension, dyslipidemia, smoking, obesity, metabolic syndrome, coronary artery disease, congestive heart failure, and chronic kidney disease were 60.8%, 51%, 27.5%, 52.9%, 72.5%, 31.4%, 9.8%, and 9.8%, respectively. Bivariate analysis showed mean ABI in the presence of mean CIMT ≥1mm and/or carotid plaque were lower (1.05±0.17 vs 1.16±0.08, p = 0.016). Proportions mean and maximum CIMT ≥1mm were 15.7% and 33.3%, respectively. Pearson’s correlation showed ABI was negatively correlated with mean CIMT and maximum CIMT (r=-0.334, p = 0.017; r=-0.299, p = 0.033). Conclusion Ankle-brachial index is negatively correlated with carotid intima-media thickness. Therefore, in limited facility, ABI examination might be performed for predicting subclinical atherosclerosis.

OR54. Relationship Between Degree of Smoking Based on the Brinkman Index and Mean Tunica Intima-Media Thickness of the Carotid Artery (CIMT) in Young Adult Patients in H. Badaruddin Kasim Tabalong Regional Hospital, South Kalimantan

Abstract Background and Aims This study is to analyse the relationship between the degree of smoking based on the Brinkman Index and mean carotid intima-media thickness (CIMT) in young adult patients in H Badaruddin Kasim Tabalong Hospital. Method and Results This cross-sectional study included 38 patients undergoing medical check-up. The smoking degree was measured at the time of the medical checkup in H Badruddin Kasim Tabalong Hospital between February April March 2019. The subjects were categorised into three groups based on the Brinkman Index, mild smokers (n = 19), moderate smokers (n = 19), and there was no patient in the heavy smoker group (n = 0), according to their responses to a questionnaire. We compared the CIMT in the three groups after adjusting for age. CIMT was measured using doppler ultrasound. The analysis used by Pearson correlation and independent samples test (t-test). Multivariate analysis performed using linear regression. In both right and left carotid artery assessment, carotid intima-media thickness was significantly increased in moderate smoker group (p = 0.008 and p = 0.013, respectively). There was a significant positive correlation between Brinkman Index and carotid intima-media thickness (p = 0.08, r = 0.425). The smoking period was significantly associated with carotid intima-media thickness in both right and left carotid artery (p = 0.001, p = 0.013, respectively). There was no significant association between the number of cigarettes consumed and carotid intima-media thickness. Conclusion The Brinkman Index is positively correlated with mean carotid intima-media thickness.

Association of Carotid Intima Media Thickness With Metabolic Syndrome Among Low-Income Middle-Aged and Elderly Chinese: A Population-Based Cross-Sectional Study.

Background: We aimed to evaluate the relationship between metabolic syndrome (MetS) including its components and carotid intima media thickness (CIMT) in a low-income Chinese population aged ≥45 years.Methods: The participants underwent a general health screening and B-mode carotid ultrasonography that measured CIMT. The diagnosis of MetS and its components was based on the modified International Diabetes Federation Criteria for the Asian Population. The univariate and multivariable linear regression analyses were used to evaluate the relationship between MetS and CIMT.Results: A total of 3,583 participants (mean age, 60 years) was included in the analyses (41.4% male and 58.6% female); more than 50% of the participants were diagnosed with MetS. In the multivariable linear regression analysis, the mean CIMT was 0.009 mm greater in the participants with MetS than in those without MetS (β = 0.009; 95% CI, 0.003–0.014; P < 0.05). Moreover, a high number of MetS components was associated with greater CIMT values; for example, CIMT increased by 0.007 and 0.015 mm for the individuals diagnosed with 3–4 and 5 MetS components, respectively. Among the MetS components, elevated blood pressure (β = 0.022; 95% CI, 0.015–0.029; P < 0.001) and abdominal obesity (β = 0.008; 95% CI, 0.001–0.015; P < 0.001) were positively correlated with CIMT. However, the increased triglyceride levels were negatively associated with CIMT (β = −0.008; 95% CI: −0.015 to −0.002; P = 0.012), especially among the elderly population.Conclusions: The risk of carotid atherosclerosis increased in the presence of multiple MetS components in a low-income, middle-aged, and elderly population. Accordingly, more detailed management strategies are essential for the early prevention and intervention of atherosclerosis in this low-income population with MetS, in China.

Abstract 9055: Vascular Age in Patients With Familial Hypercholesterolemia and/or Elevated Lipoprotein(a) Treated With Lipoprotein Apheresis

Introduction: The 2020 ASE guidelines indicate that an average mean carotid intima-media thickness (CIMT) ≥75th percentile for the patient’s age, sex, race/ethnicity is indicative of increased risk of atherosclerotic cardiovascular disease (ASCVD). With each 10 μm/year reduction of CIMT progression there is a relative risk reduction in the ASCVD event rate by 9% (95% confidence interval, 0.87-0.94). Published nomograms of CIMT percentiles determine “vascular age,” defined as the age at which the composite CIMT value for an individual would represent the median value. Hypothesis: Lipid-modifying treatment with lipoprotein apheresis (LA) over the course of 10 years will affect vascular age in patients with baseline elevated CIMT due to severe hypercholesterolemia. Methods: Ten individuals (mean age 60±9 years, 70% female) with familial hypercholesterolemia and/or elevated lipoprotein(a) [Lp(a)] were treated every two weeks with LA (Liposorber, Kaneka, Japan) between 2005 and 2020 (median duration, 12 years). Results: Acute effects of LA included reduction in LDL-C and Lp(a) levels by a median of 72±8% and 75±7%, respectively. The proportion of patients with average mean CIMT ≥75th percentile was 8/10 at the time of apheresis initiation. LA resulted in mean CIMT reduction of –40μm (IQR, –50 to 20). This translated into 70% (7/10) of cases demonstrating composite mean CIMT below their expected vascular age. The follow-up mean CIMT strongly correlated only with the baseline Lp(a) levels. The number of patients with CIMT above their “vascular age” decreased from 80% to 30% over treatment course. The rate of ASCVD was 37.5 per 1000 person-years while on LA. Conclusions: While annual CIMT progression rates average 15 μm/y, an increase in CIMT seen with advanced age and severe hypercholesterolemia was halted with LA with an estimated annual rate of change in mean common CIMT of –4 μm/y and maximum CIMT of –3μm /y. This analysis demonstrates positive impact of LA on vascular age.

Abstract 9982: World Health Organization Cardiovascular Risk Score Correlates with Carotid Intima-Media Thickness, but Fails to Identify High Risk Black Patients Unlike the Framingham and Atherosclerotic Cardiovascular Risk Score Models

Introduction: Correlation between various cardiovascular risk models and carotid intima-media thickness (CIMT) in the black population is not well described. To risk stratify patients in Ethiopia, three scores are used: Non-laboratory World Health Organization (nWHO) score, used for Sub-Saharan countries, ACC/AHA atherosclerotic cardiovascular risk score (ASCVD), and Framingham risk score (FRS). We compared these three scores and determined their relationship with a marker of subclinical atherosclerosis such as CIMT. Methodology: 336 patients (ages 40-79) with no atherosclerotic cardiovascular disease were randomly selected in Ethiopia’s largest tertiary hospital and underwent CIMT measurement read by blinded readers. Participants were stratified into low, intermediate, and high-risk groups based on the three scores. Pearson correlations and Freedman’s comparisons were used. Results: The three risk scores and mean CIMT were moderately correlated (Figure 1). There were strong positive correlations between ASCVD and FRS (n=284, r=0.71, CI: 0.65-0.77, p&lt;.0001), ASCVD and nWHO (n=279, r =0.73, CI: 0.67-0.78, p&lt;.0001), as well as FRS and nWHO risk scores (n=331, r=0.76, CI: 0.71-0.78, p&lt;.0001). However, there was significant disagreement in their risk categorization (Figure 2). Conclusion: Non-laboratory WHO risk score fails to identify high-risk patients stratified by ASCVD or FRS despite having similar correlations with CIMT. The use of nWHO score may underestimate risk in the Ethiopian population, compared to ASCVD and FRS scores. These findings have therapeutic implications for primary prevention.

Cumulative Inflammation and HbA1c Levels Correlate with Increased Intima-Media Thickness in Patients with Severe Hidradenitis Suppurativa.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease that has been associated with a greater risk of metabolic and cardiovascular comorbidities. The aim of this study is to assess cardiovascular risk by means of intima-media thickness (IMT), metabolic syndrome, and other potential biomarkers in patients with severe hidradenitis suppurativa who are candidates for biologic therapy and to explore potentially associated factors. A cross-sectional study was performed. Body mass index (BMI), carotid intima-media thickness (IMT), and blood tests, including glycemic and lipid profile, insulin, vitamin D, and inflammation markers were performed. Fifty patients were included in the study; the male/female ratio was 3:2. The mean age was 38 years, and the mean disease duration was 21.8 years. The mean carotid IMT was 651.39 μm. A positive association of IMT with disease duration, tobacco consumption, and HbA1c levels was observed. HbA1c correlated with the age of onset, hypertension, metabolic syndrome, and glucose levels. Vitamin D levels inversely correlated with the number of areas affected. In conclusion, patients with severe HS present a higher cardiovascular risk, but it is not distributed equally within the patients: Tobacco consumption, inadequate glycemic control, and disease duration could be useful clinical and biochemical markers to identify patients at higher risk.

Relationship between Adipokines and Cardiovascular Ultrasound Parameters in Metabolic-Dysfunction-Associated Fatty Liver Disease

(1) Background: The role of adipokines such as adiponectin and visfatin in metabolic-dysfunction-associated fatty liver disease (MAFLD) and cardiovascular disease remains unclear. Therefore, we aim to assess serum adiponectin and visfatin levels in MAFLD patients and associated cardiovascular parameters. (2) Methods: A cross-sectional study involving 80 participants (40 MAFLD patients, 40 controls), recruited between January and September 2020, was conducted, using both hepatic ultrasonography and SteatoTestTM to evaluate hepatic steatosis. Echocardiographic and Doppler parameters were assessed. Serum adipokines were measured using ELISA kits. (3) Results: Adiponectin and visfatin levels were not significantly different in MAFLD vs. controls. Visfatin was associated with mean carotid intima-media thickness (p-value = 0.047), while adiponectin was associated with left ventricular ejection fraction (LVEF) (p-value = 0.039) and E/A ratio (p-value = 0.002) in controls. The association between adiponectin and E/A ratio was significant in the univariate analysis at 95% CI (0.0049–0.1331, p-value = 0.035), but lost significance after the multivariate analysis. Although LVEF was not associated with adiponectin in the univariate analysis, significant values were observed after the multivariate analysis (95% CI (−1.83–−0.22, p-value = 0.015)). (4) Conclusions: No significant difference in serum adiponectin and visfatin levels in MAFLD patients vs. controls was found. Interestingly, although adiponectin levels were not associated with LVEF in the univariate analysis, a significant inversely proportional association was observed after the multivariate analysis.

Gender difference in the association between TyG index and subclinical atherosclerosis: results from the I-Lan Longitudinal Aging Study

BackgroundInsulin resistance (IR) is a known risk factor for cardiovascular disease (CVD) in non-diabetic patients through the association of hyperglycemia or associated metabolic factors. The triglyceride glucose (TyG) index, which was defined by incorporating serum glucose and insulin concentrations, was developed as a surrogate marker of insulin resistance. We aimed to investigate the association between the TyG index and the early phase of subclinical atherosclerosis (SA) between the sexes.MethodsThe I-Lan Longitudinal Aging Study (ILAS) enrolled 1457 subjects aged 50–80 years. For each subject, demographic data and the TyG index {ln[fasting triglyceride (mg/dL) × fasting plasma glucose (mg/dL)]/2} were obtained. Patients were further stratified according to sex and the 50th percentile of the TyG index (≥ 8.55 or < 8.55). SA was defined as the mean carotid intima-media thickness (cIMT) at the 75th percentile of the entire cohort. Demographic characteristics and the presence of SA were compared between the groups. Logistic regression analysis was performed to assess the relationship between TyG index and SA.ResultsPatients with a higher TyG index (≥ 8.55) had a higher body mass index (BMI), hypertension (HTN) and diabetes mellitus (DM). They had higher lipid profiles, including total cholesterol (T-Chol) and low-density lipoprotein (LDL), compared to those with a lower TyG index (< 8.55). Gender disparity was observed in non-diabetic women who had a significantly higher prevalence of SA in the high TyG index group than in the low TyG index group. In multivariate logistic regression analysis, a high TyG index was independently associated with SA in non-diabetic women after adjusting for traditional risk factors [adjusted odds ratio (OR): 1.510, 95% CI 1.010–2.257, p = 0.045] but not in non-diabetic men. The TyG index was not associated with the presence of SA in diabetic patients, irrespective of sex.ConclusionA high TyG index was significantly associated with SA and gender disparity in non-diabetic patients. This result may highlight the need for a sex-specific risk management strategy to prevent atherosclerosis.

Progression of carotid intima-media thickness in patients treated with lipoprotein apheresis: real-world evidence over 12 years

Abstract Background The extent of intervention effects on carotid intima-media thickness (CIMT) can predict the degree of atherosclerotic cardiovascular disease (ASCVD) risk reduction. There is limited evidence of long-term effects of lipoprotein apheresis on the CIMT progression. Purpose We hypothesized that regular lipoprotein apheresis over the course of 10 years may slow down progression of CIMT in patients with severe hypercholesterolemia. Methods This case series describes ten Caucasian patients (mean age 60±9 years, 70% female, 80% statin intolerant) with familial hypercholesterolemia and/or hyperlipoproteinemia(a) treated with lipoprotein apheresis at a single academic center between 2005 and 2020. The mean and maximum diastolic CIMT of the distal 1 cm of the far wall of the right and left common carotid arteries was measured by the same, trained sonographer utilizing an automated border-detection algorithm. Results The median pre-treatment low-density lipoprotein cholesterol (LDL-C) level was 214 mg/dL (95% confidence interval, 145 to 248), lipoprotein(a), 26 mg/dL (15 to 109; 40% with lipoprotein(a) &amp;gt;60 mg/dL). Using the imputed trajectories, period-specific on-treatment time-weighted averages for LDL-C and lipoprotein(a) were 141 mg/dL (IQR, 89 to 152) and 24 mg/dL (IQR, 12 to 119), respectively. The baseline mean CIMT was 850±170μm and maximum CIMT was 1040±220μm across the age range of 46 to 70 years. Over a median duration of 12 years, regular treatment with lipoprotein apheresis resulted in an average reduction in the mean CIMT of −40μm (IQR, −50 to 20) and maximum CIMT −30μm (IQR, −60 to −10). Among tested lipid and lipoprotein fractions in this sample, the follow-up mean CIMT values strongly correlated only with the baseline lipoprotein(a) levels. Median CIMT progression rates were as follows: mean common carotid, −4μm/y (IQR, −9 to 1), mean common carotid, −12μm/3y (IQR, −26 to 4), maximal common carotid, −3μm/y (IQR, −8 to −1). This translated into 70% (7/10) of cases demonstrating composite mean CIMT below their expected chronologic age, gender and race-stratified vascular age. There was a strong direct correlation between the mean CIMT value at the end of the treatment period and the age of treatment initiation. In this cohort of primary and secondary prevention of patients with severe hypercholesterolemia, the overall rate of ASCVD was 37.5 per 1000 person-years while on lipoprotein apheresis. Conclusions Our observation performed in the clinical setting, demonstrated a real-world effectiveness of lipoprotein apheresis. This analysis supports implementation of aggressive lipid-modifying strategies across all ages. Surveillance with CIMT allows for continued monitoring of atherosclerosis progression and increases compliance with the lipid-modifying therapies in the high-risk patients with poor statin tolerance in the clinical setting. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): KUMC

Relationship between endothelium-dependent vasodilation, carotid intima-media thickness and atherosclerotic plaques: is it preserved in the elderly?

Abstract Introduction Vascular ageing refers to the age-related deterioration in vascular structure and function. Endothelial dysfunction (ED), carotid intima-media thickness (CIMT) and atherosclerotic plaques are key-players in this process, but also are indicators of chronological age. As established, they are jointly associated in young and middle age populations but this pattern could be changed over the lifetime. Purpose We aimed to assess the association between endothelium-dependent vasodilation, CIMT, atherosclerotic plaques and cardiovascular risk factors in elder and senile population sample. Methods The study was carried out in the population sample of men and women aged 58–82 years (n=788/424 women). The intima-media thickness and presence of carotid plaques were assessed by high-resolution ultrasound. The ED was detected with ultrasound reactive hyperemia test (Celermajer) by measurement of flow-mediated dilation (FMD) of brachial artery; ED was identified if FMD lower than 10%. Medical history of cardiovascular diseases and risk factors were assessed by standard methods. Results The mean FMD was 2.7% in men (SD 7.32), and 3.2% in women (SD 7.19) and did not differ by sex. The frequency of ED was 88.2% in men and 85.8% in women. The mean CIMT was higher in men than in women (0.95 mm (SD 0.18) vs. 0.88 mm (SD 0.17), p&amp;lt;0.001). Men with ED had significantly higher triglycerides level (125.1 mg/dl (SD 71.2) vs. 102.7 mg/dl (SD 45.7), p=0.033) and ratio “waist circumference/hip circumference” (0.94 (SD 0.05) vs. 0.92 (SD 0.076), p=0.009) than men without ED. Moreover, men with ED had higher body-mass index, but the difference did not reach statistical significance. There was borderline association between smoking and ED found in women (p=0.067) and poor association in men (p=0.106). No linear association was found between CIMT and FMD in men (β=−1.76, SD 2.25; p=0,436) and in women (β=−2.19, SD 2.15; p=0.309); however, the regression coefficients in age-adjusted models were of negative direction as expected. In addition, there was no difference in the mean CIMT and frequency of atherosclerotic plaques in groups with and without ED either in men or in women. There was a tendency of greater CIMT in those men with ED in the youngest of the studied group (58–62 years) vs. the same age men without ED (p=0.242). In women, we encountered significant increase of CIMT among those with ED in age group 63–77 years against women without ED (p=0.047), which faded out in older group. Conclusions In our population sample we did not observe the associations of frequency of ED or FMD% neither with CIMT nor presence of atherosclerotic plaques. Only in women below 78 years, the presence of ED was associated with increased CIMT. The subclinical markers of atherosclerosis – synergistically expressed in younger populations – lose their associations in elderly. We should take this into account in development of novel therapies for elderly and senile population. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Wellcome Trust No. 081081AIA,Russian Academy of Sciences No. AAAA-A-17-117112850280-2

Rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone therapy increases carotid intima-media thickness and plaque score with von Willebrand factor activity elevation in patients with malignant lymphoma

An increased risk for atherosclerosis has been noted in cancer survivors; however, studies that focus on the risk of atherosclerosis in patients treated with chemotherapy are scarce. Therefore, we evaluated 32 patients who received rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone (R-CHOP) therapy for B-cell malignant lymphoma by analysing the changes in atherosclerosis. Just before each treatment course, plasma levels of von Willebrand Factor (vWF) activity were evaluated, and carotid ultrasonography was performed at baseline and after the final treatment. Throughout the follow-up period, plasma vWF levels showed significantly transient increased by approximately 20%–40%. Both mean carotid intima-media thickness (IMT) and plaque score (PS) significantly increased during the 36.6 ± 26.0 weeks of observation (mean IMT: 0.724 ± 0.118 to 0.767 ± 0.129 mm; PS: 4.31 ± 3.53 to 4.87 ± 3.88, P < 0.001). Our study suggests that R-CHOP therapy promotes atherosclerosis.

Subclinical Atherosclerosis in Psoriatic Patients: Relation with Vitamin D

Abstract Background Psoriasis is a chronic, inflammatory disease that mainly affects skin and nails. Approximately 13%-25% of Psoriasis patients develop Psoriatic arthritis (PsA). Psoriasis and PsA are strongly associated with numerous comorbid diseases and among them, cardiovascular diseases are of particular importance. Low levels of serum vitamin D are associated with increasing risk of metabolic diseases and cardiovascular diseases. Vitamin D deficiency is observed in numerous chronic systemic inflammatory diseases including psoriasis. Carotid intima-media thickness (CIMT) is a marker of arterial vascular disease used to predict a future vascular event. It can serve as a surrogate marker for subclinical atherosclerosis and cardiovascular diseases. Coronary artery calcification score (CACS) is a non-invasive and highly reliable method to measure coronary atherosclerosis through non-contrast cardiac CT. Objective To detect subclinical atherosclerosis and study its relation with serum levels of 25hydroxyvitamin D in psoriatic patients with and without arthritis. Patients and Methods This study was carried out on 25 Egyptian psoriatic patients and 25 healthy individuals matched as regarding age, sex and BMI as a control group. Patients were classified into 2 groups; Group I: 13 patients with PsA and Group II: 12 patients with psoriatic skin lesion without any arthritic manifestations. All patients were subjected to full medical history taking, thorough clinical examination. Basic laboratory investigations in addition to assessment of serum levels of 25-OH vitamin D were done to all patients and control. carotid duplex for measurement of CIMT in addition to measurement of CACS using coronary CT. Results Patients with PsA had lower values of vitamin D than psoriatic patients and controls despite being statistically insignificant (median; 5, 5.5 &amp; 11). CIMT and CACS were statistically higher among PsA patients (CIMT mean; 0.57, 0.52 &amp; 0.44) and (CACS median; 53, 1.5 &amp; 0) respectively. Vitamin D was found to be negatively well correlated with PASI, ALT, AST, serum creatinine and CACS in psoriatic patients. A significant relation between higher PASI and low vitamin D levels in psoriatic patients. CIMT was significantly positively correlated with age, BMI, LEI, ALT, AST, SUA, cholesterol and CACS in psoriatic patients, while CACS was positively correlated with age, ALT, SUA and cholesterol. Conclusion Psoriatic patients especially those with PsA had lower values of vitamin D than controls despite being statistically insignificant. They also suffered from increased risk of CVDs and subclinical atherosclerosis due to increased burden of inflammation and lack of physical activity. Vitamin D was negatively correlated with CACS in psoriatic patients in addition to a strong positive correlation between CIMT and CACS among them.

Serum sclerostin level and its relation to subclinical atherosclerosis in the polycystic ovary syndrome phenotypes: A prospective controlled study

Objective:We aim to study the relationship between atherosclerosis and serum sclerostin levels in different phenotypes of polycystic ovary syndrome (PCOS).Materials and Methods:A total of 134 women with PCOS and 33 age-matched controls participated in this study. Women with PCOS were further divided into subgroups based on their PCOS phenotypes: phenotype A (n=35), phenotype B (n=33), phenotype C (n=31), and phenotype D (n=35). Metabolic parameters, hormonal parameters, carotid intima-media thickness (CIMT), and sclerostin levels were compared among the PCOS phenotypes.Results:Statistically significant differences occurred among groups regarding follicle-stimulating hormone, luteinizing hormone, estradiol, total cholesterol, low-density lipoprotein, Ferriman-Gallwey score, total testosterone, and free androgen index. The mean CIMT was statistically higher in all PCOS phenotypes than in controls. In subgroup comparison, phenotypes A and B had a higher body mass index (BMI) adjusted CIMT than other phenotypes, respectively (p=0.005). Serum sclerostin levels were higher in PCOS patients than in controls. A concentration of ≥6.297 ng/mL showed a sensitivity of 56% and a specificity of 69.7% to predict PCOS. The BMI-adjusted sclerostin level was significantly higher in phenotype C (20.3±0.7 ng/mL) than in other phenotypes.Conclusion:Patients with phenotypes A and B seem to have an increased risk for atherosclerosis. Although sclerostin was higher in PCOS patients, we could not demonstrate the relation between sclerostin and atherosclerosis in different PCOS phenotypes.

Prevalence of Microalbuminuria and Its Association with Subclinical Carotid Atherosclerosis in Middle Aged, Nondiabetic, Low to Moderate Cardiovascular Risk Individuals with or without Hypertension.

Microalbuminuria is closely associated with the risk of cardiovascular disease and all-cause mortality in the general population. Less is known about its relationship with subclinical atherosclerosis. We aimed to assess the prevalence of microalbuminuria and its relationship with subclinical atherosclerosis in middle-aged, nondiabetic, apparently healthy individuals (N = 187; 40.1% men, 59.9% women; aged 35–55 years) as well as to evaluate its potential associations with established risk modifiers, especially with the presence of carotid plaque. Clinical and laboratory parameters, the estimated 10-year fatal cardiovascular risk (SCORE), as well as circulating, functional (flow mediated vasodilation, ankle-brachial index, augmentation index, and pulse wave velocity), and morphological markers (mean carotid intima–media thickness, and carotid plaque) of subclinical atherosclerosis were analysed in group with vs. without microalbuminuria. Microalbuminuria was present in 3.8% of individuals with SCORE risk 0.43 ± 0.79%. Functional markers predominated in both groups. Carotid intima–media thickness (mean ± SD) in both groups was in range: 0.5–0.55 ± 0.09–0.14 mm. Carotid plaque was more frequent in group with (14.3%) vs. without (4.4%) microalbuminuria. Microalbuminuria had no statistically significant effect on most markers of subclinical atherosclerosis, but the increasing value of microalbuminuria was significantly associated with the occurrence of carotid plaque (p = 0.035; OR = 1.035; 95% CI = 1.002–1.07). Additional multiple logistic regression analysis, where variables belonged to microalbuminuria, number of risk factors, and family history, finally showed only two variables: microalbuminuria (p = 0.034; OR = 1.04; 95%CI = 1.003–1.09) and the number of risk factors (p = 0.006; OR = 2.15; 95% CI = 1.24–3.73) with independent and significant impact on the occurrence of carotid plaque. Our results may indicate an association of microalbuminuria with the presence of carotid atherosclerotic plaque; in addition, microalbuminuria and the number of risk factors appear to be possible predictors of the carotid plaque occurrence. Monitoring microalbuminuria may improve the personalized cardiovascular risk assessment in nondiabetic, low-to-moderate cardiovascular risk individuals with or without hypertension.

Effect of age stratification on the association between carotid intima-media thickness and cognitive impairment in Chinese hypertensive patients: new insight from the secondary analysis of the China Stroke Primary Prevention Trial (CSPPT).

The current study aimed to explore the association between carotid intima-media thickness (CIMT) and cognitive function assessed by the Mini-Mental State Examination (MMSE) and to examine possible effect modifiers in hypertensive patients. A total of 14,322 hypertensive participants (mean age 64.2 ± 7.4 years; 40.9% male) from the China Stroke Primary Prevention Trial (CSPPT) were included in the final analysis. CIMT was measured by ultrasound, and data were collected at the last follow-up visit; MMSE was used to evaluate cognitive function. Nonparametric smoothing plots, multivariate linear regression analysis, subgroup analyses and interaction testing were performed to examine the relationship between the CIMI and cognitive function and effect modification. The mean CIMT was 0.74 ± 0.11 mm, and the mean MMSE score was 23.5 ± 4.8. There was a significant interaction (P interaction < 0.05) in both male and female populations stratified by age (<60 vs. ≥60 years), and higher CIMT was significantly associated with decreased MMSE scores only in participants aged ≥60 years (male: β = -2.29, 95% CI -3.23 to -1.36; female: β = -1.96, 95% CI -2.97 to -0.95). Males with abnormal HDL-C showed a stronger negative association (β = -3.16, 95% CI -4.85 to -1.47) than those with normal HDL-C (normal vs. abnormal, P for interaction = 0.004). We observed that increased CIMT was significantly associated with cognitive impairment in the hypertensive population, especially among individuals with an age greater than 60 years and HDL-C deficiency. Overall, upon diagnosis of hypertension, treatment should start at the earliest opportunity to prevent end-organ damage and cognitive decline.