Mean cIMT Research Articles

Markers of subclinical atherosclerosis in schoolchildren with obesity and metabolic syndrome.

Although increased carotid intima-media thickness (cIMT), soluble adhesion molecules and proinflammatory biomarkers are strongly implicated in the development of atherosclerotic lesions, the role of obesity and metabolic syndrome (MetS) in atherogenicity and inflammation among schoolchildren is not well investigated. To determine the levels of cIMT, endothelial dysfunction and inflammatory biomarkers in a group of schoolchildren with obesity and MetS. Eighty-seven schoolchildren (age 10-15 years) were categorised into three groups: normal bodyweight group, obese group and severely obese with MetS group (17 boys and 12 girls in each group). Levels of cIMT were measured with high-resolution B-mode ultrasound. Serum proinflammatory cytokines interleukin-6 (IL-6), tumour necrosis factor-alpha (TNF-α) and interleukin-1 beta (IL-1β), and soluble adhesion molecules E-selectin, vascular cell adhesion molecule-1 (VCAM-1), and intercellular adhesion molecule-1(ICAM-1) were measured. Mean cIMT levels were significantly higher (p 0.05) among severely obese schoolchildren with MetS (0.49 ± 0.02 mm) compared with both the obese (0.43 ± 0.03 mm) and the normal bodyweight counterparts (0.36 ± 0.03 mm). Serum levels of IL-6, TNF-α, IL-1β, E-selectin, VCAM-1 and ICAM-1 were significantly higher (p 0.05) in severely obese with MetS and obese children compared with the normal bodyweight group. However, no significant differences (p >0.05) were found between the severely obese schoolchildren with MetS and the obese without MetS. Severely obese schoolchildren having MetS exhibited higher cIMT levels than obese and normal bodyweight counterparts. Biomarkers of inflammation and endothelial dysfunction were higher in obese schoolchildren, but biomarkers were not increased any further by the degree of obesity nor the MetS cluster.

Sonographic evaluation of Intima-Media thickness of carotid artery in healthy, hypertensive and diabetic Nepalese population

Introduction: Hypertension and Diabetes are two major risk factors for atherosclerotic disease. Carotid artery intima media thickness(cIMT) is considered a reliable surrogate measure for diagnosing subclinical atherosclerosis, its progression and regression. Paucity of available data regarding mean value of cIMT highlights the importance of defining the cut off value of cIMT in a specified population. Very limited studies have been done on sonographic evaluation of mean cIMT and carotid artery injury in hypertension and diabetes in Nepalese population. This study, therefore aims to determine mean cIMT in Nepalese population and to analyze effect of Hypertension and diabetes on cIMT.
 Methods: Cross-sectional hospital based study was conducted within the period of 18 months. B-mode ultrasound was used to measure cIMT in bilateral common carotid arteries. Comparison of mean cIMT was done amongst healthy, hypertensive and diabetes with hypertensive patients. Duration of disease was also considered. Data analysis was done with “R” analytical study. Results were expressed as mean ± standard deviation.
 Results: Total1005 (508 female and 497 male) adult patients with age range of 30 to 85 years were assessed. Among these 329(32.74%) were healthy adults, 341(33.93%) were hypertensive and 335(33.33%) were diabetes with hypertensive patients. The mean cIMT in cases was more than controls (P < 0.001) bilaterally with diabetes having an additive effect. There was also positive correlation of measured value with duration of disease and age of patients.
 Conclusion: The present study found that mean cIMT in cases was more than controls. There is an additional effect of Diabetes on cIMT in hypertensive patient. Age and duration of disease can accelerate atherosclerosis.

Association between trunk fat index and carotid intima-media thickness among children aged 6-8 years old in Beijing

Objective: The study is to explore the association between trunk fat index (TFI) and carotid intima-media thickness (cIMT) among children aged 6-8 years old in Shunyi District, Beijing. Methods: The participants were enrolled from the child cohort on sensitization, puberty, obesity and cardiovascular risk (PROC) conducted in Shunyi District, Beijing from October 2018 to June 2019. The PROC used a community-based census-like design, and all eligible first-grade children from six public non-boarding primary schools in urban area were approached. Finally, a total of 1 503 children with written informed consent from parents and had complete data of TFI and cIMT were included for the present study. Sequential baseline surveys including anthropometric measurements, laboratory testing and ultrasonography measurement were conducted to collect the data on height, weight, body composition, blood pressure, serum lipids and cIMT. Linear regression was used to determine the predictors of cIMT, receiver operating characteristic (ROC) curve analysis was used to determine the cut-off value of TFI to identify children with high cIMT, and analysis of covariance was used to evaluate the post-consistency classification of cIMT by TFI. Results: The age of 1 503 participants was (6.7±0.3) years, and 752 boys accounted for 50.0%. The average cIMT was (0.358±0.024) and (0.355±0.023) mm, and the M (P25, P75) of TFI was 0.70 (0.22, 1.78) and 0.74 (0.23, 1.52) kg/m2 for boys and girls, respectively. The detection rates for boys and girls of high cIMT were 2.1% and 3.3%, respectively. Linear regression analysis showed that height, systolic blood pressure (SBP), diastolic blood pressure (DBP), TFI were positively correlated with cIMT in boys (P values<0.05). And height, SBP, triglyceride (TG), TFI were positively correlated with cIMT, and high-density lipoprotein cholesterol (HDL-C) was negatively correlated with cIMT in girls (P values<0.05). ROC curve analysis indicated that the best cut-off values for TFI to identify children with high cIMT were 1.78 and 1.14 kg/m2, at P75 and P66 for boys and girls, respectively. After grouped with the cut-off value of TFI and adjusted for age, height, SBP, DBP, TG, HDL-C, multivariable covariance analysis showed a consistent cut-off of inter-group cIMT mean by TFI groups (P values<0.005). Conclusion: TFI is associated with cIMT, which underscore its application potential in identifying early vascular structural damage.

Carotid Intima-Media Thickness in Healthy Children and Adolescents: Normative Data and Systematic Literature Review.

Objectives: Early identification of children at risk of atherosclerosis is of paramount importance for implementing primary preventive measures addressing vascular health. Carotid intima-media thickness (cIMT) is a non-invasive biomarker of atherosclerosis. Semiautomatic radiofrequency-based software-guided technique quality intima-media thickness (RF-QIMT) was used to determine cIMT normative values in a healthy cohort of Caucasian children aged 6 to 18 years.Study design: In a cross-sectional study, data on age, chronic illness, medication use, and pubertal status was acquired by a questioner. Anthropometric and blood pressure measurements were performed by standardized methods and trained medical personnel. cIMT of the right common carotid artery far wall (1 centimeter proximal to bifurcation) was determined using a multifrequency (3–13 MHz) electronic linear array transducer SL1543, a portable ultrasound device (MyLab Gamma Esaote, Genoa, Italy), and RF-QIMT software. A systematic review of the published normal cIMT in children was done using PRISMA methodology, and identified normative values were compared to those obtained in the presented study.Results: 1137 non-obese normotensive children (males: n = 512; mean age 12.04 ± 3.52 years, females: n = 625, mean age 12.98 ± 3.83 years) were included. Gender-, age-, and height-specific mean cIMT percentile tables, percentile charts, and LMS tables for the RF-QIMT method were provided. They were comparable to the previously published data on mean cIMT gained by other validated ultrasound imaging techniques. cIMT increased with age, height, hip circumference, and BMI and was higher in males.Conclusions: Gender-, age-, and height-specific normative cIMT values, using the semiautomatic software-guided RF-QIMT technique, in children aged 6 to 18 years were developed and validated in respect to the previously published pediatric normative cIMT data. It is suggested that the investigated method could be used for the estimation of atherosclerotic risk in children, especially in epidemiological studies.

Markers of Inflammation and Endothelial Dysfunction in Young Survivors from Acute Lymphoblastic Leukemia.

Purpose: To assess subclinical markers of endothelial inflammation in young survivors from acute lymphoblastic leukemia (ALL) treated with chemotherapy without cranial irradiation. Methods: Anthropometric parameters [height (H), body mass index (BMI), waist circumference (WC), hip circumference (HC), WC/H, and WC/HC ratio], blood pressure, lipid profile, serum markers of inflammation and endothelial dysfunction [Interleukin 6 (IL-6), vascular cell adhesion molecule, intercellular adhesion molecule, tumor necrosis factor-alfa (TNF-α), Endogenous secretory Receptor for Advanced Glycation Endproducts (Es-RAGE)], and carotid intima-media thickness (c-IMT) were assessed in a group of young ALL survivors and in matched controls. Local Ethics Committee approved the study (code 56/13) on June 24, 2013. Results: 28 ALL survivors (71% male, 18% prepubertal, aged 15.98 ± 4.41 years, mean follow-up 8.57 ± 3.14 years) exhibited lower levels of Es-RAGE than controls (0.18 ± 0.07 vs. 0.27 ± 0.08 ng/mL, p < 0.001). Among survivors, Es-RAGE values significantly correlated with BMI-SD off-therapy (R2 -0.42), WC/H ratio (R2 -0.41), WC/HC ratio (R2 -0.38), and low-density-lipoprotein cholesterol (LDL-C; R2 -0.43). Most of the ALL survivors (78%) presented c-IMT above the 95th centile if compared with gender and age standard. Mean c-IMT value correlated with blood pressure (R2 0.56) and with LDL-C levels (R2 0.56). Metabolic syndrome (MetS) was fully detected only in one ALL survivor. Nevertheless, 18% ALL survivors presented more than one MetS diagnostic criteria: 14% insulin resistance, 25% dyslipidemia, and 17.8% hypertension. Conclusion: We demonstrated an initial functional vascular alteration in young ALL survivors even when treated with standard risk protocols. Our data already support the activation at endothelial level of glycosylation and oxidation processes that are persistent long after the end of the treatment.

Increased exposure to air pollutants leads to greater atherosclerotic burden mediated by systemic inflammation

Abstract Introduction Air pollution has been a well-described environmental factor contributing significantly to the global disease burden. Purpose To examine the association of gaseous air pollutants with atherosclerosis, especially in subjects with coronary artery disease (CAD). Methods 2053 individuals enrolled in the Corinthia study underwent clinical and biochemical assessment followed by carotid ultrasonography to evaluate carotid intima-media thickness (cIMT) and plaque burden. Inflammation was estimated via measurement of C-Reactive protein (CRP). Air pollutants concentration analysis was performed in prespecified regions with respect to their proximity to heavy industries, highways and shipyards. Results A higher concentration of gaseous air pollutants was observed in Region 4 when compared to other regions (Table). Mean cIMT, maximum cIMT and carotid plaque burden were significantly increased in individuals of Region 4 (Table, Figure A and B), a result which remained unaffected after adjustment for cardiovascular confounders (Figure C). In parallel, inhabitants of Region 4 had higher levels of CRP (Region 1: 4.60±5.01mg/l; Region 2: 3.08±3.26mg/l; Region 3: 4.37±4.70mg/l, Region 4: 6.78±9.77mg/l, p&amp;lt;0.001). To examine the effect of air pollution on atherosclerosis in CAD, propensity scores were applied to match healthy controls with CAD subjects in terms of atherosclerosis risk factors resulting in two matched groups; one in regions 1, 2 and 3 -low air pollution areas (LAPA)- and another in region 4 -high air pollution area (HAPA). Interestingly, we noted substantially higher inter-area differences in mean cIMT of CAD individuals (Figure D). Conclusion Air pollution may significantly contribute to atherosclerosis progression, potentially via the induction of inflammation. A more pronounced effect was noted in CAD individuals exposed to high air pollution. Funding Acknowledgement Type of funding source: None

Depression in young adults is associated with increased carotid atherosclerotic burden: insights from the Corinthia study

Abstract Introduction Depression appears to have a detrimental effect not only on mental health but also in the progression of various diseases. Purpose The examination of a potential association between depression and atherosclerosis progression in a rural population. Methods In the context of the cross-sectional Corinthia study, volunteers fulfilled a questionnaire concerning emotional health. The Geriatric Depression Scale was used for individuals aged 60 or more while the Zung self-rating depression score was preferred in younger adults. Carotid ultrasonography examination was performed to evaluate the mean carotid intima-media thickness (cIMT). Thickness of cIMT&amp;gt;1.5 mm or protrusion &amp;gt;50% compared to adjacent segments was considered as atherosclerotic plaque. Results Young adults with significant depression were usually female and did not differ significantly on other risk factors of atherosclerosis compared to those with mild or no depressive disorder. Importantly, those with moderate-severe depression appeared to have increased mean cIMT (Mild-No depression: 0.85±0.30mm, Moderate-severe depression: 0.91±0.42mm, p=0.04) and a higher carotid plaque burden (Mild-No depression: 12.8%, Moderate-severe depression: 20.3%, p=0.04). With regards to the elderly, those with moderate-severe depression were usually smokers (Mild-No depression: 13.9%, Moderate-severe depression: 24.2%, p=0.01). However, mean cIMT (Mild-No depression: 1.11±0.47mm, Moderate-severe depression: 1.09±0.39mm, p=0.69) and carotid plaques (Mild-No depression: 31.1%, Moderate-severe depression: 36.1%, p=0.36) did not differ according to depression status in this subgroup. Conclusion Significant depressive disorder is associated with accelerated carotid atherosclerosis in young individuals. Funding Acknowledgement Type of funding source: None

Combined effect of cigarette smoking and prediabetes on structural and functional changes of large arteries

Abstract Purpose Smoking is a major risk factor for cardiovascular disease and prediabetes is associated with excess risks for adverse cardiovascular outcomes and death. Aim of this study was to explore whether smoking and prediabetes exert a synergistic unfavourable effect on functional and structural parameters of large arteries. Methods We measured carotid-femoral pulse wave velocity (cfPWV), augmentation index (AIx) and carotid intima media thickness (cIMT) in 407 individuals without known atherosclerotic disease (mean age: 52±8 years) categorized into four age-matched groups according to glucose metabolic and smoking status: Smokers with diabetes (n=68), Smokers with prediabetes (n=87), Non-smokers with prediabetes (n=98) and Non- smokers with normal fasting blood glucose (FBG) (n=154). Prediabetes was defined as impaired fasting glucose (100–125 mg/dL), impaired glucose tolerance (2-hour glucose level of 140–199 mg/dL during an oral glucose tolerance test), or glycosylated hemoglobin (HbA1c) level of 5.7% to 6.4%. High sensitivity C-reactive protein (hsCRP) was measured in all patients. Results Systolic pressure, pulse pressure were increased and hsCRP levels were higher in smokers with diabetes compared to the three other groups (overall P&amp;lt;0.05, P&amp;lt;0.01 and P&amp;lt;0.05, respectively, ANOVA). The cumulative tobacco exposure (measured in pack-years) was similar between smokers with diabetes and smokers with prediabetes (45 pack-years). Figure 1 shows cfPWV, AIx and cIMT of the four groups. Interestingly, smokers with diabetes and smokers with prediabetes have similar mean cfPWV and cIMT and significantly higher values compared to non-smokers with prediabetes and non-smokers with normal FBG. The associations remained statistically significant even after adjusting for systolic pressure and hsCRP level. AIx was not different between the four study groups. Conclusion The combination of prediabetes and smoking is associated with higher cfPWV and cIMT values compared to prediabetes alone. The smokers with impaired glucose regulation have functional and structural alterations of large arteries similar to that of smokers with established diabetes. Considering the risk for developing prediabetes in relation to smoking status and the number of cigarettes smoked daily and the independent predictive value of assessing vascular changes in large arteries, the present findings may have important clinical and prognostic implications. Figure 1. Smoking, prediabetes and vascular changes Funding Acknowledgement Type of funding source: None

Exploring functional and structural vascular changes in obesity: are metabolically healthy obese individuals really healthy?

Abstract Purpose Aim of the study is to compare vascular function and structure parameters among middle-aged men with differences in body mass index (BMI) and metabolic status and to investigate whether obese individuals with a normal metabolic profile have a unhealthy vascular profile. Methods We measured carotid-femoral pulse wave velocity (cfPWV), carotid intima media thickness (cIMT) and brachial flow-mediated dilation (bFMD) in 141 obese (BMI≥30 kg/m2) and in 176 aged-matched men with normal BMI (&amp;lt;25 kg/m2) individuals. All participants had no clinical manifestations or a history of atherosclerotic disease. High sensitivity C-reactive protein (hsCRP) and total testosterone (TT) were measured in all patients. Results The two BMI groups were subdivided into subgroups according to presence/absence of abnormal metabolic profile (presence of major cardiovascular risk factors): Metabolically unhealthy obese (MeUO, n=114), metabolically healthy obese (MeHO, n=27), metabolically unhealthy with normal BMI (MeUN, n=122) and metabolically healthy with normal BMI individuals (MeHN, n=54). The four subgroups had similar age. Figure 1 shows the mean cIMT (left plot), cfPWV (middle plot) and bFMD (right plot) of the four subgroups. Carotid IMT and cfPWV is higher and bFMD is lower in metabolically unhealthy compared to individuals with a normal metabolic profile in both patients with obesity and subjects with normal BMI. Interestingly, the MeNO patients had significantly lower cIMT (P&amp;lt;0.05) and cfPWV (P&amp;lt;0.01) and higher bFMD (P&amp;lt;0.01) level compared to MeUN individuals. However, as figure shows all measured vascular parameters were significantly impaired in MeNO patients compared to those of MeHN individuals. MeHO patients had comparable hsCRP and TT levels to those of MeUO and MeUN individuals denoting increased inflammatory activation and endogenous androgen deficiency. Conclusions MeHO which is a obesity phenotype that has created lot of debate is associated with a better vascular profile compared to MeUN status, however patients with MeHO have more impaired vascular function and structure parameters than MeHN individuals. This finding implies that even in the absence of overt metabolic aberrations, the MeHO profile may be associated with endothelial dysfunction, increased aortic stiffness and thickness of the carotid arterial wall. Figure 1. BMI, metabolic status and vascular changes Funding Acknowledgement Type of funding source: None

The relationship between circulating vitamin D3 and subclinical atherosclerosis in an elderly Asian population

The current evidence regarding the association between vitamin D deficiency and cardiovascular diseases/metabolic disorders is contradictory and inconclusive. In this large-scale observational study, we investigated the relationship between the serum 25-hydroxy vitamin D3 [25(OH)D] concentration and subclinical atherosclerosis in an elderly Asian population. In the I-Lan longitudinal study (ILAS), 1798 elderly, aged 50 and older, were enrolled. For each subject, serum 25-hydroxy vitamin D3 [25(OH)D] concentration and demographic data were recorded. The participants were divided into two groups according to their serum 25(OH)D level (sufficient, > 20 ng/mL and deficient, ≤ 20 ng/mL). Carotid intima-media thickness (cIMT) was measured at bilateral common carotid arteries. Subclinical atherosclerosis was defined as a mean cIMT > 0.81 mm. The mean subject age was 64 ± 9 years old, and 604 (33.6%) were identified as having serum 25(OH)D level ≤ 20 ng/mL. Subjects with serum 25(OH)D level ≤ 20 ng/mL were younger, more likely to be female and smoker, and had a higher incidence of hypertension, dyslipidemia, and metabolic syndrome, compared to those with serum 25(OH)D level > 20 ng/mL. Additionally, patients with serum 25(OH)D level ≤ 20 ng/mL were associated with a lower risk of subclinical atherosclerosis (crude OR: 0.63, 95% CI 0.50–0.81, p < 0.001), according to univariate analysis. However, after adjusting for gender and age, serum 25(OH)D level ≤ 20 ng/mL was not a significant risk factor for subclinical atherosclerosis. Serum 25(OH)D level ≤ 20 ng/mL was not an independent risk factor for subclinical atherosclerosis in this large elderly Asian population. Association observed in the univariate analysis may be confounded by gender or comorbidities.

Restless Leg Syndrome and Objectively-Measured Atherosclerosis in the Canadian Longitudinal Study on Aging.

Previous studies suggest associations between restless leg syndrome (RLS) and atherosclerosis, but these have primarily been based upon subjective atherosclerotic measures. We evaluated associations between RLS and an objective indicator of atherosclerosis, namely carotid intima-media thickness (cIMT). In this cross-sectional study among 30,097 Canadian Longitudinal Study on Aging (CLSA) participants, we used a four-item questionnaire to screen for probable-RLS. cIMT was measured at the bifurcation of the common carotid artery. Associations were tested with linear regression adjusting for age, sex, ferritin, pulmonary disease, smoking, alcohol, physical activity, anxiety, depression, and other sleep diagnoses. Among 26,304 included participants, 2047 (7.8%) had probable-RLS. Mean cIMT was higher (0.755 ± 0.17 vs 0.736 ± 0.17, P < 0.001) in those with RLS, even after excluding those without prior atherosclerotic diseases (0.740 ± 0.17 vs 0.723 ± 0.16, P = 0.016). RLS is associated with objective measures of atherosclerosis. © 2020 International Parkinson and Movement Disorder Society.

Comparison of carotid artery ultrasound and Framingham risk score for discriminating coronary artery disease in patients with psoriatic arthritis

ObjectivesThis study aimed to assess the performance of carotid ultrasound (US) parameters alone or in combination with Framingham Risk Score (FRS) in discriminating patients with psoriatic arthritis (PsA) with and without coronary artery disease (CAD).MethodsNinety-one patients with PsA (56 males; age: 50±11 years, disease duration: 9.4±9.2 years) without overt cardiovascular (CV) diseases were recruited. Carotid intima-media thickness (cIMT), the presence of plaque and total plaque area (TPA) was determined by high-resolution US. CAD was defined as the presence of any coronary plaque on coronary CT angiography (CCTA). Obstructive-CAD (O-CAD) was defined as >50% stenosis of the lumen.ResultsThirty-five (38%) patients had carotid plaque. Fifty-four (59%) patients had CAD (CAD+) and 9 (10%) patients had O-CAD (O-CAD+). No significant associations between the presence of carotid plaque and CAD were found. However, cIMT and TPA were higher in both the CAD+ and O-CAD+ group compared with the CAD− or O-CAD− groups, respectively. Multivariate logistic regression analysis revealed that mean cIMT was an independent explanatory variable associated with CAD and O-CAD, while maximum cIMT and TPA were independent explanatory variables associated with O-CAD after adjusting for covariates. The optimal cut-offs for detecting the presence of CAD were FRS >5% and mean cIMT at 0.62 mm (AUC: 0.71; sensitivity: 67%; specificity: 76%), while the optimal cut-offs for detecting the presence of O-CAD were FRS >10% in combination with mean cIMT at 0.73 mm (AUC: 0.71; sensitivity: 56%; specificity: 85%).ConclusionUS parameters including cIMT and TPA may be considered in addition to FRS for CV risk stratification in patients with PsA.

Impact of Mitochondrial DNA Mutations on Carotid Intima-Media Thickness in the Novosibirsk Region.

The search for markers of predisposition to atherosclerosis development is very important for early identification of individuals with a high risk of cardiovascular disease. The aim of the present study was to investigate the association of mitochondrial DNA mutations with carotid intima-media thickness and to determine the impact of mitochondrial heteroplasmy measurements in the prognosis of atherosclerosis development. This cross-sectional, population-based study was conducted in 468 subjects from the Novosibirsk region. It was shown that the mean (carotid intima-media thickness) cIMT correlated with the following mtDNA mutations: m.15059G>A (r = 0.159, p = 0.001), m.12315G>A (r = 0.119; p = 0.011), m.5178C>A (r = 0.114, p = 0.014), and m.3256C>T (r = 0.130, p = 0.011); a negative correlation with mtDNA mutations m.14846G>A (r = −0.111, p = 0.042) and m.13513G>A (r = −0.133, p = 0.004) was observed. In the linear regression analysis, the addition of the set of mtDNA mutations to the conventional cardiovascular risk factors increased the ability to predict the cIMT variability from 17 to 27%. Multi-step linear regression analysis revealed the most important predictors of mean cIMT variability: age, systolic blood pressure, blood levels of total cholesterol, LDL and triglycerides, as well as the mtDNA mutations m.13513G>A, m.15059G>A, m.12315G>A, and m.3256C>T. Thus, a high predictive value of mtDNA mutations for cIMT variability was demonstrated. The association of mutation m.13513G>A and m.14846G>A with a low value of cIMT, demonstrated in several studies, represents a potential for the development of anti-atherosclerotic gene therapy.

Cardiovascular Risk Factors are Inversely Associated With Omega-3 Polyunsaturated Fatty Acid Plasma Levels in Pediatric Kidney Transplant Recipients

High plasma levels of the omega-3 fatty acids eicosapentaenoic acid (EPA), docosahexaenoic acid, and docosapentaenoic acid associates with positive outcomes in adult renal transplant recipients. However, data from pediatric populations are scarce. The aim of the study was to assess the fatty acid profile in a pediatric renal transplantation cohort and to examine the associations between plasma omega-3 fatty acids and cardiovascular disease (CVD) risk factors. In this cross-sectional study comprising 53 children (median age, 12.2years; 32 boys) with a renal transplant, we assessed the prevalence of CVD risk factors as well as markers of end organ damage: carotid intima-media thickness (cIMT) and left ventricular mass index. The associations between plasma omega-3 fatty acids and CVD risk factors were assessed. Twenty-five (47%) patients were preemptively transplanted. Seventy-six percent had dyslipidemia and 51% had hypertension. The mean left ventricular mass index was 40.4±14.3g/m2.7, and 14% had left ventricular hypertrophy. The mean cIMT was 0.41±0.04mm. In a multivariate linear regression, EPA levels were inversely associated to blood pressure (β coeff.=-0.37, P=.007), triglycerides (β coeff.=-0.44, P=.01), and high-density lipoprotein cholesterol (β coeff.=-0.41, P=.01). EPA levels are inversely associated with components of the metabolic syndrome, which may provide support for specific dietary advice or supplementation in this patient population. cIMT is less pronounced in our cohort than in comparable cohorts with lower rate of preemptive transplantations. Our results need replication in prospective cohorts.

Carotid intima-media thickness and metabolic syndrome in a rural population: Results from the Baependi Heart Study

Background and aimsCarotid intima-media thickness (cIMT) is a strong predictor of cardiovascular events and associated with metabolic syndrome (MetS). MetS is a cluster of cardiovascular risk factors, but the association structure between specific factors and disease development is not well-established in rural populations. We described the association structure between MetS factors and cIMT in a sample from rural Brazil. MethodsWe studied 1937 participants from the Baependi Heart Study who underwent carotid ultrasound exam. We used ATP–III–2001 for MetS definition and linear mixed-effects models, adjusting by the family structure, to assess independent associations between the cardiovascular risk factors which define MetS and cIMT. ResultsThe sample's mean age was 46 ± 16y, 61% female, 73% white, mean body-mass-index 26±5 kg/m2, mean cIMT 0.53 ± 0.16 mm, with 35% of the sample classified with MetS. As expected, cIMT demonstrated a linear relationship with increasing age, and cIMT higher values were observed for MetS (0.58 ± 0.16 mm) compared to non-MetS (0.49 ± 0.14 mm). Considering models for cIMT with MetS and all of its factors, we found that blood pressure, glucose and obesity were independently associated with cIMT, but not HDL or triglycerides. ConclusionscIMT showed a linear relationship with increasing age. Blood pressure, obesity, and glucose were independently associated with cIMT, but not HDL-cholesterol or triglycerides. In a rural population, hypertension, diabetes and obesity play a more important role than lipids in determining cIMT interindividual variability.

Prediabetes Is Independently Associated with Subclinical Carotid Atherosclerosis: An Observational Study in a Non-Urban Mediterranean Population.

This was a prospective, observational study to compare the burden of subclinical atherosclerosis as measured by carotid ultrasonography in a cohort of subjects with prediabetes vs. subjects with normal glucose tolerance (NGT) from a non-urban Mediterranean population. Atherosclerosis was assessed through carotid intima-media thickness (c-IMT), the presence/absence of carotid plaques, and plaque number. Among 550 subjects included, 224 (40.7%) had prediabetes. The mean c-IMT and the prevalence of carotid plaque were significantly higher in the prediabetes group compared to the NGT group (0.72 vs. 0.67 mm, p < 0.001; and 37.9% vs. 19.6%; p < 0.001, respectively). Older age, male gender, and increased systolic blood pressure were positively correlated with c-IMT and were independent predictors of the presence of plaques. In contrast, prediabetes and low-density lipoprotein (LDL)-c were predictors of the presence of plaque (odds ratio [OR] = 1.64; 95% confidence interval [CI] = 1.05–2.57; p = 0.03 and OR = 1.01; 95% CI = 1.00–1.02; p = 0.006, respectively) together with tobacco exposure and the leukocyte count (OR = 1.77; 95% CI = 1.08–2.89; p = 0.023 and OR = 1.20; 95% CI = 1.05–1.38; p = 0.008, respectively). In a non-urban Mediterranean population, prediabetes was associated with established subclinical carotid atherosclerosis. These findings could have implications for the prevention and treatment of CV risk in these subjects before the first symptoms of cardiovascular disease appear.

Effect of Yoga in Post-Myocardial Infarction Cases

Introduction: The prevalence of coronary artery disease (CAD) has progressively -increased in India and is the major cause of morbidity and mortality burden in the world. Several strategies are available to reduce morbidity and mortality, including the interventional approach (eg, early revascularization with PCI and stenting) and the pharmacologic approach (eg, thrombolytic and anticoagulant therapies) and yoga 1,2 The various psychological responses to experiencing myocardial infarction are anxiety reactions, depression , agoraphobia , exhaustion, hostility , sadness , anger , disgust and social withdrawal. 3 Yoga has reported to decrease these incidences. Methodology: The study included 200 patients diagnosed as MI who were divided into two groups 100 cases of control group subjected to conventional treatment and lifestyle counseling while 100 cases in test group were treated with yoga in addition to conventional treatment and lifestyle modification. The primary outcome included change in risk factors from baseline to end of study. Secondary outcome included change in Depression score and MACE at the end of the study. Result -After 24 weeks of intervention, the difference among yoga and control group was found to be significant for following parameters- weight, BMI, waist circumference, post prandial blood sugar, HBA1c, HDL cholesterol, triglyceride, total cholesterol and depression score. A significant difference was not seen for mean CIMT. Conclusion: Yoga may be a cost-effective technique to target multiple risk factors of myocardial infarction. It can be recommended along with conventional treatment for prevention and improvement of outcome in MI patients

Arterial structure and function during and after long-duration spaceflight.

Spaceflight missions expose astronauts to increased risk of oxidative stress and inflammatory damage that might accelerate the development of asymptomatic cardiovascular disease. The purpose of this investigation was to determine whether long-duration spaceflight (>4 mo) results in structural and functional changes in the carotid and brachial arteries. Common carotid artery (CCA) intima-media thickness (cIMT), CCA distensibility and stiffness, and brachial artery endothelium-dependent and -independent vasodilation were measured in 13 astronauts (10 men, 3 women) ~180 and 60 days before launch, during the mission on ~15, 60, and 160 days of spaceflight, and within 1 wk after landing. Biomarkers of oxidative stress and inflammation were measured at corresponding times in fasting blood samples and urine samples from 24- or 48-h pools. Biomarkers of oxidative stress and inflammation increased during spaceflight, but most returned to preflight levels within 1 wk of landing. Mean cIMT, CCA stiffness, and distensibility were not significantly different from preflight at any time. As a group, neither mean endothelium-dependent nor -independent vasodilation changed from preflight to postflight, but changes within individuals in endothelial function related to some biomarkers of oxidative stress. Whereas biomarkers of oxidative stress and inflammation are elevated during spaceflight, CCA and brachial artery structure and function were not changed by spaceflight. It is unclear whether future exploration missions, with an extended duration in altered gravity fields and higher radiation exposure, may be problematic.NEW & NOTEWORTHY Carotid artery structure and stiffness did not change on average in astronauts during long-duration spaceflight (<12 mo), despite increased oxidative stress and inflammation. Most oxidative stress and inflammation biomarkers returned to preflight levels soon after landing. Brachial artery structure and function also were unchanged by spaceflight. In this group of healthy middle-aged male and female astronauts, spaceflight in low Earth orbit does not appear to increase long-term cardiovascular health risk.

P0195THE RELATIONSHIP BETWEEN CALCIFICATION INHIBITOR LEVELS IN CHRONIC KIDNEY DISEASE AND THE DEVELOPMENT OF ATHEROSCLEROSIS

Abstract Background and Aims Atherosclerosis and its associated cardiovascular diseases starting from the early stages of chronic kidney disease (CKD) are the most important cause of increased morbi-mortality in the CKD process. In studies performed in patients with end-stage renal disease (ESRD), it is observed that the calcification occured in the vascular structures was an important component of the atero-arteriolosclerosis process. The number of studies investigating the relationship between vascular calcification and the development of atherosclerosis and increased morbi-mortality in the process of CKD are quite small and limited to patients undergoing hemodialysis (HD) treatment for ESRD. We aimed to investigate the factors affecting the development of atherosclerosis and the role of calcification inhibitors fetuin-A, matrix-Gla protein (MGP), osteoprotegerin (OPG) in atherosclerosis progress. Method Our study was planned to investigate the relationship of serum OPG, MGP and fetuin-A levels with the development of atherosclerosis in the stage 2-3-4-5 chronic kidney patients who did not require dialysis treatment. Thirty-two (17 female, 15 male) healthy individuals and 92 (49 females, 43 males) CKD cases were included. The healthy control group did not have a history of regular use of medication for any reason, known acute or chronic disease. Chronic kidney disease group, with no acute disease, no history of known malignancy and cerebrovascular disease. The patients' GFR was also calculated with CKD-EPI Formula. The mean carotid artery intima media thickness was calculated by dividing the sum of right and left carotid artery intima media thickness. Statistical analysis was performed with IBM SPSS Statistics 20.0.0. Results The laboratory data of the healthy control group, stage 2 CKD group, stage 3 CKD group, stage 4 CKD group and stage 5 CKD groups were statistically compared with the healthy control group, between themselves and the whole CKD group, the results were given in Table-1. Chronic kidney disease group divided into two groups; carotid artery intima media thickness less than 0.750 millimeters (without subclinical atherosclerosis) and those above 0.750 millimeters (with subclinical atherosclerosis). The mean C-IMT, CRP, FETUIN-A, OPG and MGP of the two groups were compared statistically and the results are shown in Table-2. In chronic kidney patients, age (r = 0.493, p &amp;lt;0.001), BMI (r = 0.337, p = 0.001), CRP (r = 0.301, p = 0.004), TG (r = 0.245, p = 0.019 ), urea (r = 0.228, p = 0.029), SBP (r = 0.212, p = 0.043), fasting blood sugar (r = 0.212, p = 0.043) have positive linear relationship, fetuin-A (r = -0.409, P = 0.001), OPG (r = -0.235, p = 0.024), GFR (r = -0.209, p = 0.046) have a negative linear relationship with CIMT. The multiple relationships between CIMT and other variables are given in Table-3. The mean CIMT (r =-0.417, p = 0.001), right CIMT (r = -0.412, p = 0.001), left CIMT (r = -0.410, p = 0.001), urea (r = -353, p = 0.007), CRP (r = -0.322, p = 0.014), UPE (r = -0.301, p = 0.022), creatinine (r = -0.277, p = 0.035), age (r = -0.262, p = 0.047) show a negative linear relationship with Fetuin-A. Multiple relationships between fetuin-A and other variables are given in Table-4. Conclusion Our study shows that; In particular, fetuin-A levels, which is a vascular calcification inhibitor, begin to decline from the early stages of CKD and is significantly lower in patients with atherosclerosis. This suggests that fetuin-A may be used as an early marker in CKD with increased cardiovascular mortality. On the other hand, contradictions related to the levels of OPG and MGP in CKD and its role in the development of atherosclerosis continue. The results in our study also support this situation. Reducing mortality and morbidity in CKD primarily depends on reducing the risk of cardiovascular events. Pre-recognition of these risks is important, so large-scale studies on vascular calcification inhibitors are needed.

To fast or not to fast: Lipid measurement and cardiovascular disease risk estimation in rural sub-Saharan Africa.

BackgroundCardiovascular disease (CVD) morbidity and mortality are increasing in sub-Saharan Africa (sSA), highlighting the need for tools to enable CVD risk stratification in the region. Although non-HDL-cholesterol (nHDL-C) has been promoted as a method to measure lipids without a requirement for fasting in the USA, its diagnostic validity has not been assessed in sSA. We sought to estimate: 1) the association between LDL-cholesterol (LDL-C) and nHDL-C, 2) the impact of fasting on their measurement, and 3) their correlation with carotid atherosclerosis, within a rural Ugandan population with high HIV prevalence.MethodsWe collected traditional CVD risk factors, blood for serum lipid levels, self-reported fasting status, and performed carotid ultrasonography in 301 participants in rural Uganda. We fit regression models, stratified by fasting status, to estimate associations between carotid intima media thickness (cIMT), LDL-C, and nHDL-C.ResultsMedian age was 50 years (interquartile range = 46-54), 49% were female, 51% were HIV-positive, and at the time of blood collection, 70% had fasted overnight. Mean LDL-C, nHDL-C, and triglycerides in the non-fasting and fasting groups were 85 vs 88 mg/dL (P = 0.39), 114 vs 114 mg/dL (P = 0.98), and 130 vs 114 mg/dL (P = 0.05) mg/dL, respectively. In unadjusted models, mean cIMT (mm) was associated with both increased LDL-C (β = 0.0078 per 10mg/dL, P < 0.01) and nHDL-C (β = 0.0075, P < 0.01), and these relationships were similar irrespective of fasting status. After adjustment for traditional CVD risk factors, we observed similar associations, albeit with muted effect sizes within the fasting group.ConclusionsWe found a high correlation between LDL-C and nHDL-C, and both were correlated with cIMT, irrespective of fasting or HIV serostatus in rural Uganda. Our findings support use of either fasting or non-fasting serum lipids for CVD risk estimation in rural sSA.