Mean Intima-media Thickness Research Articles

Genetic and epigenetic factors affecting carotid intima-media thickness in monozygotic twins.

The intima-media thickness (IMT) of the carotid artery, an indicator of subclinical atherosclerosis, varies in close association with various factors such as diabetes and immune response. The extent of changes in IMT varies among individuals owing to both genetic and epigenetic factors. In this study, we aimed to identify single nucleotide polymorphisms (SNPs) and DNA methylation patterns that affect carotid IMT in monozygotic (MZ) twins. We measured the maximum IMT (IMT-Cmax) and the mean IMT in the common carotid artery wall using ultrasonography in 107 pairs of MZ twins recruited from the Osaka University Twin Registry. The genotyping of SNPs and the measurement of methylation levels were performed using a beads array, and the expression of each gene was determined by RNA sequencing. Linear regression analysis was performed on each of the two groups: one group consisted of twins randomly selected from each pair, and the other group consisted of co-twins. We identified a CpG site (cg02432467) on HS3ST6 as a significant epigenetic factor in both IMT-Cmax and mean IMT analyses. The methylation level at another site (cg07927379) was negatively correlated with LINC01006 expression and IMT-Cmax. Furthermore, there were significant differences in AP2A2 expression and mean IMT among individuals with each genotype of the rs10902263 polymorphism. We identified genetic and epigenetic factors associated with carotid IMT that may be useful for individualized assessments.

Plasma levels of sCASP3 predicts carotid intima media thickness progression

Abstract Background Studies on human atherosclerotic plaques have shown that apoptosis is associated with rupture prone plaques and that apoptosis is a key process for fast plaque progression. In line with this, we showed that circulating levels of soluble Caspase-3 (sCaspase-3) predict atherosclerotic events. However, the relationship between circulating levels of apoptosis markers and plaque progression remains to be explored. Purpose Here we aimed to investigate if circulating levels of apoptosis markers could predict mean intima-media thickness in the common carotid artery (IMT-CCA) progression among individuals with atherosclerotic carotid plaques. Methods The Malmö Diet and Cancer (MDC) cardiovascular cohort was used. MDC is a prospective population-based cohort study. Baseline variables (blood, clinical information and carotid ultrasound measurements) were collected between 1991-1994 and the right carotid ultrasound re-examinations were performed between 1994-2001. IMT was measured at by ultrasound at baseline as well as at the re-examinations. The Olink Proximity Extension Assay (SciLifeLab, Uppsala, Sweden) was used to analyze plasma levels of sCaspase-3, sFADD, sCaspase-8, sTRAIL-R2 and sTNFR1 at baseline. Correlation and multiple linear regression analyses, adjusted for age, sex, and cardiovascular risk factors, were employed to evaluate the relationships between apoptosis biomarkers and IMT-CCA as well as average annual change in IMT-CCA. Results In total, 1929 participants (median age 60 years) with an ultrasound confirmed carotid plaque (focal IMT >1.2mm) at baseline were included. Subjects who underwent ultrasound IMT re-examination over a period of >4.5 years were divided into a discovery (n=406) and a validation (n=355) cohort. sCaspase-3 was identified as the marker with the strongest correlation to IMT-CCA at baseline (p=0.02) and upon re-examination (p=0.04), among the five apoptosis markers examined, in both the discovery and validation cohorts. sCaspase-3 also showed a correlation with the average annual change of IMT-CCA (r=0.12, p=8×10-4) in both cohorts. Furthermore, when diving the cohort into tertiles based on plasma levels of sCapase-3, subjects with high levels of sCaspase-3 (3rd tertile) had greater annual changes in IMT-CCA compared to the 1st tertile (p=0.03). Multiple linear regression analyses confirmed that sCapase-3 was associated with the average annual IMT-CCA change in both the discovery (beta=0.14, 95% confidence interval (CI) 0.04–0.24) cohort and the validation cohort (beta=0.11, 95%CI 0.01–0.21). Conclusion Using a large, population-based study with repeated IMT measurements, we demonstrated that circulating levels of sCapase-3 were associated with increasing IMT in the CCA. While further studies are warranted, these results suggest that sCapase-3 levels could serve as potential screening marker to identify individuals at higher risk for plaque progression.

Hand Osteoarthritis and Subclinical Cardiovascular Disease in Middle-Aged Women.

Objective: To determine subclinical cardiovascular disease (sCVD) in middle-aged women with clinically manifested hand osteoarthritis (HOA) and to improve the characterization of cardiovascular risk in this population. Design: We cross-sectionally evaluated the relationship between HOA and sCVD in 1,803 volunteers from the Mexican Teachers' Cohort. From 2012 to 2016, a subsample from Mexico City, the Northern state Nuevo León, and the Southern states Chiapas and Yucatán was invited for clinical evaluations, during which neurologists examined carotid arteries using ultrasound, and a standardized HOA questionnaire was also administered. HOA was defined as age ≥45 years, hand joint pain, and morning stiffness that lasted no longer than 30 minutes. sCVD was assessed using the intima-media thickness (IMT) and atherosclerotic plaques. Results: Among participants with a mean age of 51 years (±4), 18.4% met the criteria for HOA, and the prevalence of carotid atherosclerosis was 23.1%. After multivariable adjustment, women diagnosed with HOA had a 1.8% (95% confidence interval [CI] 0.3, 3.3) greater mean IMT than those without this joint disease. Similarly, women with HOA had 36% (95% CI 1.01, 1.84) higher odds of carotid atherosclerosis. Conclusions: HOA is associated with sCVD in middle-aged women. This relationship might be due to low-grade chronic inflammation; however, further research is required to clarify the underlying mechanisms.

Subclinical Atherosclerosis Progression in Low-Risk, Middle-Aged Adults: Carotid Leads Femoral in IMT Increase but Not in Plaque Formation.

Clinical data, risk factors, carotid/femoral intima-media thickness (IMT), and plaque presence were analyzed. Cardiovascular risk factors and scores increased significantly at follow-up. Both carotid and femoral mean IMT increased (p < 0.001). While plaque prevalence rose and was similar in both arteries (carotid: 4.8% to 17.9%, femoral: 3.6% to 17.7%, p < 0.001 for both), the progression of plaque burden was greater in femorals. Notably, the carotid mean IMT demonstrated a faster yearly progression rate compared to the mean femoral IMT. The prevalence of pathological nomogram-based mean IMT right or left was higher in the carotids (52.9% to 78.8%, p < 0.001) compared to femorals (23.2% to 44.7%, p < 0.001), with a significant increase at the end of follow-up in both territories. This study demonstrates significant subclinical atherosclerosis progression in low-risk, middle-aged adults over 5 years. Carotid arteries showed a faster progression rate of mean IMT and a higher prevalence of pathological nomogram-based mean IMT compared to the femoral arteries. However, plaque burden was similar in both territories, with greater progression in femorals. Identifying carotid and femoral atherosclerosis burden may be a valuable tool for risk stratification in this population.

The Impact of Kidney/Pancreas Transplantation on Peripheral Arterial Disease.

It is unclear whether kidney/pancreas (KP) transplantation will prevent the progression of peripheral arterial disease (PAD) in patients with insulin dependent diabetes (IDDM) and end-stage renal disease. We sought to determine the pre- and posttransplant prevalence of symptomatic PAD and changes in carotid artery intima-media thickness (IMT) in KP recipients. In this single center study, outcomes were compared between KP recipients with and without a history of PAD. A subset of recipients underwent pre- and posttransplant IMT measurements. Among the study group (N = 107), 18 (17%) recipients admitted to a pretransplant history of symptomatic PAD, comprised 11 foot infections and 7 amputations (5 minor and 2 major). Baseline characteristics of age, gender, race, years of diabetes, dialysis history, smoking history, years of hypertension, and history of coronary artery disease (CAD) were equivalent between PAD and non-PAD cohorts. At a median follow-up of 60 months (IQR: 28, 110), 16 (15%) KP recipients had suffered a PAD event. In multivariate analysis, a pretransplant history of PAD (hazard ratio [HR] 9.66, p < 0.001) and CAD (HR 3.33, p = 0.04) were independent predictors of posttransplant PAD events. Among a subset of 20 recipients (3 with PAD), mean IMT measurements pretransplant and at a median of 24 (range 18-24) months posttransplant, showed no evidence of disease progression. Based on IMT measurements and clinical results, KP transplantation stabilized PAD in most patients, but did not alter outcomes of symptomatic PAD recipients. A pretransplant history of PAD and CAD was an independent predictor of posttransplant PAD events.

Ultrasound Findings of Carotid Arteries in Patients with Type-2 Diabetes Mellitus

Background and objectives: Type 2 diabetes mellitus is common public health problem nationally and globally. Early detection of the vascular changes with inexpensive and non-invasive techniques is important in the process of management of type 2 diabetes mellitus. The aim of this study was to determine the frequency and grading of carotid artery atherosclerosis using color doppler ultrasound in type 2 diabetes mellitus. Methods: A cross-sectional study was implemented in Radiology Department of Rizgari Teaching Hospital in Hawler city-Kurdistan Region during the period of six months from 1st of March to 1st of September, 2022. Sixty cases of type 2 diabetic patients included in the study and referred from Layla Qasim diabetic center and Rizgari Hospital Outpatient. Left and right carotid arteries (common, internal and bulb) were examined by ultrasound and intima-media thickness were measured, plaque, stenosis and occlusion were looked for. Patients more than 18 years old with type 2 diabetes mellitus included in the study and patients with recent stroke, type 1 diabetes and history of neck surgery were excluded. Results: The mean intima-media thickness of type 2 diabetic patients were higher in both right and left carotid artery bulb (65% and 73.3%) than common (6.7% and 21.7%) and internal carotid arteries (16.7% and 21.7%). The stenosis was observed in 21.7% in each right and left carotid bulb with less proportion of stenosis in common (0% and 1.7%) and internal carotid arteries (8.3% and 3.3%). There was a significant association between smoker and elderly age type 2 diabetic patients and carotid artery stenosis (p=0.03 and p=0.001 respectively). Conclusions: Diabetes mellitus is a common cause of atherosclerotic changes in carotid arteries mainly in the bulb and more on left side. Smoking and elderly age are the common associated factors.

PHENOTYPIC CHARACTERISTICS OF PATIENTS WITH INCREASED ARTERIAL STIFFNESS IN A HYPERTENSION UNIT

Objective: Arterial stiffness is related to the increase in morbidity and mortality of patients with arterial hypertension (HTN). The characteristics of a sample of patients where PWV was performed. Our goal was to look for differential characteristics among those with increased PVW. Design and method: Retrospective study of patients assessed in the hypertension unit of a tertiary hospital during 2019. Patients were assessed through ABPM by Space labs(R), Ankle brachial index by ABI Huntleigh (R) and PWV measured by Sphygmocor®. Characteristics of patients with High PWV are presented. Results: A total of 22 patients were included, mean age was 60 (± 18.1), average abdominal circumference was 99.3 cm (± 18) and average BMI was 28.55 kg/m2 (± 6.4). Office Blood pressure (BP): Mean systolic BP of 156mmHg (± 22), a mean diastolic BP of 76.58mmHg (± 10.89), a mean heart rate (HR) of 69bpm (± 10), mean central systolic BP of 135.66mmHg (± 10.76) and mean central diastolic BP of 81mmHg (± 12.4). An ankle-brachial index (ABI) was performed on 9 patients, with a mean right ABI of 120 (± 11.87) with a mean intima media thickness (IMG) of 626 (± 206.1) and a mean left ABI of 118 (± 14.61) with an IMT of 631.7 (± 143.83). Ambulatory blood pressure monitoring (ABPM) was performed in 11 of the patients, which showed a mean systolic BP of 138mmHg (± 17.57), mean diastolic BP of 75mmHg (± 11.65), and mean HR of 68bpm (± 11.94). Regarding the correlation with the laboratory findings, a mean glucose value of 108 g/dL (± 29.9), mean triglycerides of 146.9mg/dL (± 54), mean cholesterol of 191.27mg/dL (± 40.94), mean LDL of 114mg/dL (± 36.57) and mean HDL of 48.7mg/dL (± 11.37), and a mean glomerular filtration rate of 64ml/min (± 14.25). This sample was compared with patients with non-pathological PWV, with no significant differences between the groups. Conclusions: We did not find statistically significant associations, in our data, that would allow us to differentiate patients who had pathological OPV during the first visit. More studies are needed

Carotid intima-medial thickness in patients with severe hypertriglyceridemia

Background and aimsSevere hypertriglyceridemia (HTG), defined as plasma triglyceride (TG) concentration > 10 mmol/L, is relatively uncommon, and its implications for atherosclerotic cardiovascular disease (ASCVD) risk remain somewhat unclear. We evaluated the association between severe HTG and carotid intima-media thickness (IMT), a marker for ASCVD. MethodsWe studied three clinical cohorts: 88 patients with severe HTG (mean TG level 20.6 mmol/L), 271 patients with familial hypercholesterolemia (FH) as a contrast group, and 70 normolipidemic controls. Carotid IMT was measured using standardized ultrasound imaging. Statistical analysis was conducted using one-way analysis of variance (ANOVA) to compare mean IMT values, analysis of covariance (ANCOVA) to adjust for confounding variables, specifically age and sex, as well as Spearman pairwise correlation analysis between variables. ResultsUnadjusted mean carotid IMT was greater in severe HTG and FH groups compared to controls, however, this was no longer significant for severe HTG after adjustment for age and sex. In contrast, adjusted carotid IMT remained significantly different between the FH and control groups. ConclusionsOur findings suggest that extreme TG elevations in severe HTG patients are not significantly associated with carotid IMT, in contrast to the increased IMT seen in FH patients. These findings add perspective to the complex relationship between severe HTG and ASCVD risk.

Long-term effects of abatacept on atherosclerosis and arthritis in older vs. younger patients with rheumatoid arthritis: 3-year results of a prospective, multicenter, observational study

BackgroundWe aimed to reveal the effect of abatacept (ABT) on atherosclerosis in rheumatoid arthritis (RA) patients, 3-year efficacy for arthritis, and safety in a population of older vs. younger patients.MethodsIn this open-label, prospective, observational study, patients were stratified into four groups: younger (20–64 years old) and older (≥ 65 years) patients taking ABT (AY and AO) and conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) (CY and CO). Primary endpoints were change from baseline in mean intima-media thickness (IMT) of the common carotid artery, IMT max (bulbus, bifurcation, and internal and common carotid artery), and plaque score at Week 156. Disease activity, retention rate, and adverse effects were also evaluated.ResultsThe ABT group (AY + AO) tended to have smaller increases in mean IMT, max IMT, and plaque score than the csDMARD group (CY + CO) at Week 156, although the differences between groups were not statistically significant. Multivariate analysis showed significantly lower increases in plaque score with ABT than with csDMARDs, only when considering disease activity at 156 weeks (p = 0.0303). Proportions of patients with good or good/moderate European League Against Rheumatism response were higher in the ABT group, without significant difference between older and younger patients. No significant differences were observed in ABT retention rates between older and younger patients. Serious adverse effects, especially infection, tended to be more frequent with ABT than with csDMARDs, although no significant differences were found.ConclusionsABT may decelerate atherosclerosis progression and may be useful for patients with high risk of cardiovascular disease, such as older patients.Trial registration number:UMIN000014913.

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.

Exercise-induced Hypertension and Carotid Intima-media Thickness in Male Marathon Runners.

This study aimed to identify the relationship between exercise-induced hypertension and carotid artery intima-media thickness in long-distance runners. Sixty healthy male runners aged 40 to 60 years were assigned to the following three groups based on resting blood pressure and maximal systolic blood pressure during a maximal exercise test: normal blood pressure response, exercise-induced hypertension, and complex hypertension. An exaggerated systolic blood pressure response was defined as a maximal systolic blood pressure+≥+210 mmHg during the maximal exercise test, while carotid intima-media thickness was measured using B-mode ultrasonography. The carotid intima-media thickness mean values were the highest in the complex hypertension group (0.72±0.11 mm), followed by exercise-induced hypertension (0.62±0.12 mm) and normal blood pressure groups (0.55±0.13 mm), with a significant difference between the groups (p+<+0.002). In linear regression analysis, the mean intima-media thickness was independently associated with age (p=0.015) and maximal systolic blood pressure (p=0.046) but not with resting systolic blood pressure. These results suggest that exercise-induced hypertension is associated with carotid intima-media thickness, a surrogate marker of cardiovascular disease, in long-distance runners. Therefore, evaluating the blood pressure response during exercise is important for the early detection of potential cardiovascular disease risks in long-distance runners.

Abstract P179: Association Between Serum Metabolites and Carotid Atherosclerosis Among Japanese Men

Background: Complex metabolic pathways may exist for atherosclerosis. We examined metabolomic signatures that reflect mechanistic pathways associated with carotid atherosclerosis in apparently healthy men. Methods: A cross-sectional study was conducted in 675 Japanese men (46-83 years) from the SESSA Study (2010-2014). A total of 468 serum metabolites were quantified by liquid chromatography mass spectrometry. The mean intima-media thickness (IMT) and total number of plaques from carotid arteries were measured using B-mode ultrasound. All metabolites were standardized prior to the analysis. We used partial least square regression and variable importance projection (VIP) method to extract the principal metabolites most associated with the mean IMT and total number of plaques. We used a multivariable linear model for the log-mean IMT and a multivariable Poisson model for the total number of plaques to assess the association between individual extracted serum metabolites and carotid measures. Each metabolite multivariable model adjusted for age, body mass index, smoking and drinking status, medications for hypertension, diabetes and dyslipidemia, and systolic blood pressure, high- and low-density lipoprotein cholesterols and hemoglobin A1c. We used false discovery rate adjusted p-values to control for multiple testing. Results: The average mean IMT and total number of plaques were 0.80 mm (SD: 0.16) and 2.06 (range: 0-14), respectively. There were 191 metabolites with a VIP value of one or higher for mean IMT. None of these metabolites was significantly associated with the log-mean IMT. On the other hand, there were 209 metabolites with a VIP value of one or higher for the total number of plaques. Among them, SulfoHexCer(d18:2/24:0(OH)) and SulfoHexCer(d18:2/16:0(OH)) had an inverse association with the total number of plaques (Figure 1). Conclusion: We identified distinct metabolites associated with the total number of plaques. The results suggest an important role of sphingolipids in carotid plaque formation.

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.

Early Atherosclerosis in Familial Hypercholesterolemia Patients: Significance of Vascular Markers for Risk Stratification.

Familial hypercholesterolemia (FH) is a genetic disorder that manifests as impaired low-density lipoprotein cholesterol (LDL-C) metabolism, resulting in lifelong exposure to high cholesterol levels and increased risk of cardiovascular disease (CVD). There is heterogeneity in cardiovascular risk for FH patients, so risk stratification is of utmost importance. The aim of this study was to evaluate the impact of increases in LDL-C and the impact of other CVD risk factors on vascular markers in the FH patient population. A total of 428 patients were included in this study and divided into two groups according to age: ≤40 years in the first group and ≥41 years in the second group. Vascular markers of atherosclerosis included the common carotid artery (CCA) intima-media thickness (IMT), pulse wave velocity (PWV), flow-mediated dilation (FMD), ankle-brachial index (ABI), and cardio-vascular index (CAVI). The influence of traditional CVD risk factors on atherosclerotic changes in vascular markers was analyzed. A statistically significant difference in IMT was detected between the same sex and different age groups (p < 0.001), whereas no significant difference was detected between the sexes within each age group. In the ≤40-year-old group, the mean IMT among males was 612.5 μm (±88.2) and that among females was 580.6 μm (±77.7) (p > 0.05); in the ≥41-year-old group, the mean IMT was 697.4 μm (±138.4) for males and 700.3 μm (±114.4) for females (p > 0.05). Higher LDL-C was associated with greater IMT (r = 0.405; p = 0.009) in the younger age group (≤40 years); however, in the older age group (≥41 years), this correlation was not evident (r = -0.07; p = 0.596). Carotid plaque formation was more common among males (OR = 2.2; 95% CI: 1.2-4.0) and hypertensive patients (OR = 2.7; 95% CI: 1.6-4.7). Age was a mildly significant risk factor for increased ABI (β = 0.13, p < 0.05). FMD was found to be impaired for all patients, and no risk factors were shown to have further influence. Age was a significant risk factor for increased arterial stiffness, as measured by both the CAVI and PWV. Although vascular markers of atherosclerosis may provide a unique and valuable way to evaluate cardiovascular risk, the results of this study show that only increased IM thickness could be beneficial for risk stratification in young FH patients, whereas other vascular markers of atherosclerosis would be excessive, as they do not provide merit in risk evaluation in this population.

Follow-up ultrasound examination in patients with newly diagnosed giant cell arteritis.

Ultrasound is a standard tool to diagnose giant cell arteritis (GCA). Until now, only few studies investigated the role of ultrasound in the follow-up of GCA. The aim of this study was to assess the changes in the intima media thickness (IMT), total number of affected arteries and provisional OMERACT GCA ultrasonography score (OGUS) in a 12-months follow-up period. Patients with newly diagnosed GCA were prospectively enrolled. Ultrasound examinations of facial, temporal, carotid, vertebral and axillary arteries were performed at baseline, after three, six, nine and 12 months. Changes of IMT, total number of affected arteries, and OGUS values were evaluated. In a subgroup of patients, exams were conducted weekly in the first 100 days. Fifty patients were enrolled, 36 completed the follow-up. Significant reductions in IMT, total number of affected arteries and OGUS were observed. Eighteen patients presented to weekly exams. The mean IMT of the axillary artery normalized after seven days, while IMT of the common temporal artery normalized after 50 days. The mean OGUS values were below one after six months. There were no differences in IMT changes between GCA patients with or without PMR or between those with and without additional tocilizumab treatment. A relapse occurred in 4 patients. At relapse, mean IMT and OGUS were higher as compared with the preceding assessment. No predictive values indicating a relapse were identified. Vascular ultrasound is sensitive to change in GCA. The presence of PMR or treatment with tocilizumab did not affect IMT decrease.

Peri-Carotid Adipose Tissue and Atherosclerosis at Carotid Bifurcation.

Vulnerable carotid plaques are responsible for 20% of the ischemic strokes. The identification of these asymptomatic carotid plaques that will become symptomatic is essential but remains unclear. Our main goal was to investigate whether the amount of the peri-carotid adipose tissue, estimated by the extra-media thickness (EMT), is associated with the atherosclerotic characteristics at the carotid bifurcation in patients with PAD. An observational, prospective, single-center, longitudinal study was conducted. Overall, 177 patients were subjected to carotid Doppler ultrasound at the study admission. The following data were collected: EMT, intima-media thickness (IMT), the presence of carotid plaques, the area of the highest plaque, the presence of "acute culprit" carotid stenosis, and the grade of internal carotid stenosis. "Acute culprit" carotid stenosis was defined as a significant atherosclerotic plaque that leads to a neurologic event within 15 days. From each carotid bifurcation, a right and a left EMT were determined. We analyzed both the mean EMTs (calculated as the mean between the right and the left EMT) and the EMT ipsilateral to the carotid bifurcation. The presence of carotid plaques was associated with a higher mean EMT [Median = 1.14; IQR = 0.66 versus Median = 0.97; IQR = 0.40; p = 0.001]. A positive correlation was found between the mean EMT and IMT (right: ρ = 0.20; p = 0.010; left: ρ = 0.21; p = 0.007) and between the mean EMT and the area of the largest carotid plaque (right: ρ = 0.17; p = 0.036; left: ρ = 0.22; p = 0.004). Left carotid stenosis ≥ 70% was associated with higher ipsilateral EMT [Median = 1.56; IQR = 0.70 versus Median = 0.94; IQR = 0.42; p = 0.009]. Patients with "acute culprit" carotid stenosis had a higher ipsilateral EMT [left ipsilateral EMT: Median = 1.46; IQR = 0.63; "non-acute": Median = 0.94; IQR = 0.43; p = 0.009; right ipsilateral EMT: Median = 2.25; IQR = 0.62; "non-acute": Median = 1.00; IQR = 0.51; p = 0.015]. This difference was not found in the contra-lateral EMT. Six months after the neurologic event, EMT ipsilateral to an "acute culprit" carotid stenosis decreased (p = 0.036). The amount of peri-carotid adipose tissue, estimated with EMT, was associated with atherosclerosis at the carotid arteries. The mean EMT was associated with the features of chronic atherosclerosis lesions: the presence of carotid plaques, IMT, and the area of the highest plaque. Ipsilateral EMT was linked with "acute culprit" atherosclerotic plaque.

Effects of Smoking on Intima-Media Thickness of the Common Carotid Artery Using Ultrasonography

BackgroundCigarette smoking is a causative factor in premature atherosclerosis, but the exact mechanism of smoking-induced damage to the arterial wall and its relationship to the atherosclerotic process are still largely unknown. Carotid ultrasound may help target treatment. The aim of this study was to measure carotid intima-media thickness (IMT) and carotid Doppler parameters in Sudanese smokers compared to non-smokers using ultrasound.MethodsThis was a retrospective, case–control, community-based study conducted between June 2021 and September 2021. The study was conducted on 100 Sudanese subjects (50 smokers as the case group and 50 non-smokers as the control group). The practical part was conducted in Khartoum State at Al Raqi University Hospital using the E-CUBE 8-ALPINION and at Yastbshroon Hospital using the Fukuda Denshi Sefius UF890AG with a high-frequency linear transducer (7–10 MHz). Scanning was performed in the supine position with the neck extended. Pulsed-wave (PW) Doppler spectral and IMT measurements were obtained.ResultsThe mean age was 29.8 ± 4.5 years (range 24–40 years), and the mean IMT in smokers was 0.6 ± 0.06 mm, which was greater than the mean in non-smokers (0.462 ± 0.09 mm) (p = 0.000). Peak systolic velocity (PSV) was increased in smokers (40.0 ± 5.67 cm/s) compared to non-smokers (26.5 ± 5.6 cm/s) (p = 0.000), and end-diastolic velocity (EDV) was decreased in smokers (6.0 ± 1.2 cm/s) compared to non-smokers (9.8 ± 2.2 cm/s) (p = 0.000). In addition, the resistive index (RI) and the systolic-diastolic ratio (S/D) were not significantly different between smokers and non-smokers. The study showed that there was a significant positive correlation between IMT and the number of cigarettes per day in chronic smokers (p < 0.05), whereas peak systolic velocity (PSV) and end-diastolic velocity (EDV) were not affected in chronic smokers.ConclusionsThere was a statistically insignificant difference between the case (smokers) and control (non-smokers) groups in terms of age, body mass index (BMI), resistance index (RI), and systolic–diastolic ratio (S/D). While there were statistically significant differences in intima-media thickness (IMT), peak systolic velocity (PSV), and end-diastolic velocity (EDV), regular follow-up of individuals with a history of smoking is recommended to detect carotid intimal changes earlier.

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.

Vascular Effects of Achieving Low Disease Activity in Axial Spondyloarthritis - A 2-Year Prospective Cohort Study

Background: Axial spondyloarthritis (axSpA) is associated with accelerated atherosclerosis driven by chronic inflammation. Achieving LDA may result in significant benefits in articular disease, little is known about its effect on extra-articular disease, including CVD risk in axSpA. To investigate the effect of achieving Ankylosing Spondylitis Disease Activity Score (ASDAS) low disease activity (LDA) using a protocolized treatment strategy on the progression of subclinical atherosclerosis and arterial stiffness in axial spondyloarthritis (axSpA) patients. Methods: One hundred consecutive AxSpA patients will participate in this 2-year prospective, hospital-based, cohort study. All participants will receive 2 years of tight-control treatment. Treatment will be adjusted according to a standardized protocol every 3-6 monthly aiming at ASDAS LDA (ASDAS &lt;2.1). Carotid intima-media thickness (IMT) and total plaque area (TPA) will be measured using high-resolution ultrasound. Arterial stiffness is measured by pulse wave velocity (PWV) and augmentation index (AIx). The main outcome measure is the change in subclinical atherosclerosis over a period of 2 years comparing between patients who achieve sustained LDA at year 2 (sLDA group: achieved LDA at both year 1 and year 2) to those who cannot achieve LDA (non-sLDA group). Secondary outcomes include differences in the changes in AIx and PWV over 2 years between the 2 groups. Results: In this interim analysis, a total of 56 axSpA patients (age: 38± 10 years, 43 (76.8%) male) who completed 2 year of follow-up were included. A significant improvement in disease activity was observed after 2 years of treatment (ASDAS-CRP at baseline: 2.9± 0.6 vs 1.9± 0.7 at year 2, p&lt;0.001). Forty-one patients achieved LDA at year 1 and 31 patients achieved sustained LDA (sLDA) at year 2. The baseline traditional CV risk factors were comparable between the sLDA and non-sLDA groups. The multivariate analysis demonstrated that the sLDA group exhibited a smaller increase in mean IMT ([Formula: see text]: -0.04, 95%CI -0.07 to -0.01, P=0.025) and max IMT ([Formula: see text]: -0.06, 95%CI -0.12 to -0.004, P=0.038) after adjustment for covariates compared to the non-sLDA group. However, there were no significant differences in the progression of carotid plaque and arterial stiffness markers between the two groups in the multivariate analysis. Conclusion: Patients with AxSpA who are able to achieve sLDA through a protocolized treatment algorithm experience reduced progression of subclinical atherosclerosis compared to patients who cannot achieve sLDA. This indicates that effective suppression of inflammation in AxSpA patients who reach sLDA may potentially lower CV risk.

Abstract 15748: Association of Clonal Hematopoiesis in the Setting of Human Immunodeficiency Virus Infection With Subclinical Atherosclerosis and Vascular Inflammation

Background: Clonal hematopoiesis of indeterminate potential (CHIP) is associated with cardiovascular disease (CVD) and common in HIV, but whether CHIP contributes to atherosclerosis in HIV is unknown. We hypothesized CHIP is associated with atherosclerosis and arterial inflammation among people with HIV (PWH). Methods: We studied treated, suppressed PWH ages 35-70 years old with ≥1 CVD risk factor. CHIP mutations were detected with a validated targeted sequencing assay. We measured carotid intima-media thickness (IMT) longitudinally with ultrasound and aortic inflammation and lymph node activity using cross-sectional 18 F-FDG-PET. Inflammatory biomarkers were measured with a multiplex electrochemiluminescence assay. We used linear regression with adjustment for age, sex, nadir CD4 count, smoking, hypertension, diabetes, and hyperlipidemia. Results: We included 231 PWH (52±9 years, 7% female). 32 (14%) had CHIP with median variant allele fraction of 3.1%. Common mutations were in DNM3TA (n=21) and TET2 (n=6). Only age was associated with CHIP (OR 2.3 per decade older, 95%CI 1.2-3.9; p=0.003). Among N=165 (CHIP=22), mean IMT was 1.0 mm with and without CHIP (p=0.63), unchanged after adjustment (Figure). CHIP was not associated with prevalent or incident plaque. Over 3.2 years, IMT progression was faster among those with CHIP (0.033 mm/year; p=0.10), attenuated after adjustment (0.022 mm/year; p=0.27). Among 80 with FDG-PET, CHIP (n=12) was associated with higher lymph node activity (SUV p=0.04) that was attenuated in reference to background activity and adjusted for risk factors. CHIP was not associated with arterial inflammation (p=0.83), inflammatory markers, or viral persistence markers. Conclusions: Among PWH, CHIP mutations were not associated with subclinical atherosclerosis or arterial inflammation, proposed mechanisms of how CHIP could cause CVD. Clinical outcomes studies are needed to ascertain the impact of CHIP on CVD in HIV.