Mean Intima-media Thickness Research Articles

Abstract 374: Does Aortic Stiffness Precede, Follow or Occur Simultaneously with Aortic Atherosclerosis?

Background: Aortic stiffness (AoS) and atherosclerosis (AoA) are common in systemic lupus erythematosus (SLE). Whether AoS precedes, follows, or occurs simultaneously with AoA is unknown. Methods: 75 SLE patients (68 women, age 37±12 years) and 26 age-and-sex matched healthy controls underwent transesophageal echocardiography for assessment of AoS and AoA of the proximal, mid and distal thoracic aorta. Brachial blood pressures were obtained and matched in time with measurement of aortic diameters. AoS was assessed using the Pressure-Strain Elastic Modulus (PSEM) = [k(sBP–dBP)/(SD-dD/dD)] where k = 133.3 is the conversion factor from mmHg to Nm -2 [Pascal units (U)], sBP=systolic blood pressure, dBP=diastolic blood pressure, SD=systolic diameter and dD=diastolic diameter. AoS was defined as the mean PSEM of controls +1.5SD = >9.4U. AoA was assessed using two-dimensional and M-mode images and defined as intima-media thickening (mean intima-media thickness of controls +2SD = >0.96mm) or plaques (>50% focal wall thickening as compared with surrounding walls). Results: Patients had higher PSEM and intima media-thickness than controls (8.14±4.25 U and 0.83±0.29 mm vs 5.97±2.31 U and 0.66±0.15 mm, respectively, both p≤0.002 ). Patients had higher frequency of abnormal AoS (29%) and AoA (35%) than controls (8% for both AoS and AoA) (both p≤0.03). In SLE patients and in relation to age, AoS and AoA occurred at similar rates (p=0.42) ( Figure 1). Conclusion: AoS occurs simultaneously with AoA in SLE patients.

Association between cardiometabolic index and atherosclerotic progression in patients with peripheral arterial disease

BackgroundCardiometabolic index (CMI), calculated as a product of waist-to-height ratio and triglycerides-to-HDL cholesterol ratio, is a new index for discriminating diabetes mellitus. Patients with peripheral arterial disease (PAD) are prone to have other atherosclerotic diseases such as coronary artery disease and stroke. The purpose of this study was to clarify the relationships between CMI and indicators of atherosclerotic progression in patients with PAD. MethodsThe subjects were 63 outpatients with PAD. Relationships of CMI with variables related to atherosclerotic progression were investigated using multivariate linear regression analysis and analysis of covariance with adjustment for age, sex and histories of smoking and alcohol drinking. ResultsLog-transformed CMI was significantly correlated with mean intima-media thickness of the common carotid artery (IMT) (standardized regression coefficient: 0.350, p<0.01) and % decrease in ankle-brachial systolic pressure index (ABI) after treadmill exercise (standardized regression coefficient: 0.365, p<0.01). Mean IMT and % decrease in ABI by treadmill exercise were significantly higher (p<0.01) in the group of the 3rd tertile for CMI than in the group of its 1st tertile (mean±SE: mean IMT (mm), 0.94±0.06 (1st tertile) vs. 0.94±0.06 (2nd tertile) vs. 1.19±0.06 (3rd tertile); % decrease in ABI, 14.1±3.4 [1st tertile] vs. 26.0±3.5 [2nd tertile] vs. 30.0±3.5 [3rd tertile]). ConclusionCMI was shown to be associated with the degrees of atherosclerosis in the common carotid artery and ischemia in leg arteries and is therefore a useful discriminator of atherosclerotic progression in patients with PAD.

Hypohydration and Vascular Atherosclerosis

Background and objectivesIt has been hypothesized that chronic hypohydration may be associated with vascular stiffness and atherosclerosis mainly driven by increased arginine‐vasopressin, aldosterone, and angiotensin II, however, no study has addressed the issue in humans.MethodsDuring 2011‐2012, 433 men and women (age: 54±10 y, 227; 52% men) were voluntarily enrolled from the general population. Socio‐demographic factors, medical history, physical activity (international physical activity questionnaire) and smoking, were recorded through a face‐to‐face interview. Participants also provided first morning urine sample, analyzed for urine osmolality (Uosm) and completed a validated food frequency questionnaire.Carotid artery Intimal‐Medial‐Thickness (IMT) through ultrasound was also measured by trained cardiologists.ResultsMean IMT was found 0.83±0.32 mm, urine osmolality was: 642±230 mmol/kg and total fluid Intake from beverages was 2,544±884 mL.Multivariable linear regression analysis revealed an independent association between urine osmolality and IMT (B‐coef: 0.0009 and p=0.009), after adjusting for several confounding variables such as age, sex, BMI,fluid intake (from beverages), smoking habits and family history of hypertension and hyperlipidemia. The aforementioned model explained 61.6% of IMT's variability while model's significance was p= 0.06.ConclusionsThe data indicated that hydration status is associated with atherosclerosis.

Abstract MP68: Risk of Sleep Apnea and Subclinical Cardiovascular Disease in Young-to-Middle Aged Adults: The Bogalusa Heart Study

Obstructive sleep apnea (OSA) may affect cardiovascular risk. Prior studies examining this issue have often been limited to patients in clinical settings or older adults. Given the high prevalence of obstructive sleep apnea in middle-aged adults and the influence of duration of OSA on cardiovascular risk, examining subclinical cardiovascular in middle aged-adults would further elucidate the direct relationship between OSA and cardiovascular disease. We examined the association between risk of OSA and subclinical cardiovascular disease indicators among 914 young-to-middle aged adults who responded to the Berlin Questionnaire assessment of OSA risk in 2010, and had measures of carotid intima-media thickness (IMT) and left ventricular (LV) geometry. Carotid IMT was measured using standard procedures and categorized into quartiles. Indices of LV geometry were assessed by M-mode echocardiography and classified into normal, concentric remodeling, eccentric hypertrophy, and concentric hypertrophy by integrating gender and race specific relative wall thickness and LV mass index. High-risk for OSA was determined using Berlin Questionnaire score as the primary outcome. Secondary outcomes included habitual snoring and excessive sleepiness. Of those included in the analysis, mean (SD) age was 43.1 (4.5) yrs; 42.1% were male and 31.7% were Black. A total of 235 (25.7%) participants had elevated Berlin scores indicating high-risk for OSA. Mean (SD) of carotid IMT was 0.66 (0.15) mm, and 87 (9.5%) and 161 (17.6%) participants had eccentric and concentric LV hypertrophy, respectively. In log-linear regression models adjusted for age, race, sex, education, current smoking, regular alcohol consumption, total cholesterol, high-density lipoprotein cholesterol, and type-2 diabetes, participants at high-risk of OSA were 1.35 (95% CI: 1.07 - 1.71) times more likely to be in the highest quartile of IMT (≥0.74 mm), were 1.68 (1.09 - 2.58) times as likely to have concentric hypertrophy, and 1.64 (0.95 - 2.82) times as likely to have eccentric hypertrophy, compared to those at low-risk of OSA. Similar positive associations were observed for habitual snoring but not for excessive sleepiness. After further adjusting for current obesity status in the models, the association of OSA risk with IMT remained consistent while the associations with LV hypertrophy was attenuated. There was no significant effect modification by race or sex. In summary, being at high risk OSA was associated with substantially higher risk of subclinical cardiovascular disease in this biracial, semi-rural, community-based population of young-to-middle age adults.

Abstract P056: Emerging Lifestyle Markers Predict Regression of Carotid Intima-Media Thickness Scores

Introduction: CVD remains the number one cause of mortality in the western world. Carotid intima-media thickness (IMT) is a safe &amp; reliable predictor of future CVD risk. This study assesses which lifestyle factors best predict a change in IMT over time. Hypothesis: We assessed the null hypothesis that all lifestyle changes are effective. Methods: A prospective cross-sectional analysis of 289 men &amp; women undergoing health &amp; cardiovascular risk screening every 1-2 years at an outpatient wellness center in Florida. This study reflects the first visit at the clinic, &amp; a second visit that occurred on average 2.8 years later. These subjects ranged in age from 23-65 (mean = 48.2). In addition to testing, subjects received nutrition, fitness, &amp; health coaching. Measurements were made of fitness using VO2max stress testing, diet intake using a 3-day dietary intake survey. Laboratory &amp; anthropometric measures were obtained fasting. Mean IMT scores used high resolution B-mode ultrasonography of the common carotid arteries. Each subject had ≥10 images collected from the far wall of both distal 1 cm of the common carotid arteries at end diastole. The carotid intimal thickness was measured as a continuous variable, using both multivariate &amp; bivariate linear regression, adjusting for age &amp; gender; as our site IMT precision was = 3%, we selected a 4% change as significant. Results: The average decrease in IMT score in this cohort was -0.018 mm over 2.8 years, a 2.04% reduction. The bivariate analyses showing a significant association with a ≥4% reduction in IMT in 62 of 288 subjects; they were a decrease in: Body mass index (BMI) (p=0.047), body fat (p=0.025), total cholesterol (TC) (p=0.031), LDL cholesterol (p=0.028), TC/HDL (0.002), or an increase in dietary intake of: magnesium (p=0.0001), fiber (p=0.017), vitamin D (p=0.016), vitamin K (p=0.001), potassium (p=0.001), &amp; calcium (p=0.024). In a multivariate analysis, starting a statin medication (p=0.0007), a decrease in BMI (p=0.042), baseline IMT, male gender, diastolic BP decrease, &amp; years of follow up were predictive of 4% IMT decline. Prior use of a statin medication was not significant. Conclusions: In conclusion, this study shows that a reduction in IMT score over 2.8 years is associated with a decrease in: BMI, body fat, TC, LDL, TC/HDL ratio, &amp; diastolic BP; or, an increase in intake of: magnesium, fiber, vitamins K &amp; D, potassium, &amp; calcium; or, starting a statin medication.

Genetic association and gene-smoking interaction study of carotid intima-media thickness at five GWAS-indicated genes: The Bogalusa Heart Study

ObjectivesTo examine the associations of five GWAS-identified genes with carotid intima-media thickness (IMT) in a biracial sample from the Bogalusa Heart Study, and evaluate their participation in gene-smoking interactions. MethodsFar wall IMTs of common carotid arteries were measured using high-resolution B-mode ultrasound. Both the gene-smoking interactions and single-marker associations were evaluated by linear models of carotid IMT levels, while the gene-based analyses were assessed through the truncated product method. A Bonferroni multiple testing correction was applied. ResultsMarker rs7840785 (PINX1) was significantly associated with right carotid IMT (p=0.0003) using all participants; mean levels for the CC, TC, and TT genotypes were 0.74 (0.73 to 0.75), 0.76 (0.75 to 0.78), and 0.78 (0.75, 0.81), respectively. Similar trends were observed in blacks (p=0.0031) and whites (p=0.0118). Marker rs7844465 (ZHX2) was significantly associated with left carotid IMT in whites (p=0.0005); mean IMT levels for the GG, TG, and TT genotypes were 0.73 (0.71 to 0.74), 0.75 (0.74 to 0.77) and 0.78 (0.75 to 0.81), respectively. Marker rs6841473 (EDNRA) modified the association between smoking and left carotid IMT in blacks (p=2.79×10−5). In addition, gene-based analysis demonstrated that EDNRA and ZHX2 were associated with left carotid IMT in the white and overall participants, respectively, while PINX1 was associated with right carotid IMT in both blacks and whites. ConclusionWe identified two novel markers that were associated with IMT in both blacks and whites. One gene-smoking interaction was identified in blacks only. Three genes showed gene-based associations with IMT levels. However, genetic markers with small effects may have been missed due to the limited number of black participants.

Emerging Risk Factors as Markers for Carotid Intima Media Thickness Scores

Aims: Cardiovascular disease (CVD) remains the number one cause of mortality in the Western world. This study aims to determine which lifestyle factors are associated with mean carotid intima media thickness (IMT), a safe and reliable predictor of future CVD risk.Methods and Results: A prospective cross-sectional analysis of 592 subjects. Measures were made of body composition, anthropometric measures, fitness, diet (measured with a 3-day food diary), laboratory results, and mean carotid IMT.Multivariate analyses show that higher mean IMT values are associated with increasing age (p < 0.0001), male gender (p = 0.0002), higher systolic blood pressure (BP; p = 0.0008), higher body mass index (BMI; p = 0.0005), and lower intake of zinc (p = 0.0001).Bivariate analyses controlling for age and gender, with and without statin use, showed that higher mean IMT scores were statistically associated with higher diastolic BP (p = 0.007), higher total cholesterol/high-density lipoprotein (HDL) ratio (p < 0.0001), higher triglyceride/HDL ratio (p = 0.0001), lower aerobic capacity measures (p = 0.0007), higher body fat percentage and waist circumference (p < 0.0001), higher fasting glucose level (p = 0.028), and lower intake of magnesium (p = 0.019), fish (p = 0.007), and fiber (p = 0.02).Other factors that were not associated with mean IMT include total cholesterol, low-density lipoprotein cholesterol (LDL-C), and high-sensitivity C-reactive protein (hs-CRP); intake of saturated fat, potassium, calcium, sodium, or vitamin K; percentage of calories from protein, fat, or carbohydrate; measures of strength (assessed with push-up and sit-up testing); and reported exercise.Conclusions: Aerobic fitness and dietary intake of fiber, fish, magnesium, and zinc are inversely associated with carotid IMT scores. Of the traditional CVD risk factors, only systolic BP, fasting glucose, body composition, and total cholesterol/HDL ratio have a direct relationship with mean carotid IMT.

Non-high-density cholesterol level as a predictor of maximum carotid intima-media thickness in Japanese subjects with type 2 diabetes: a comparison with low-density lipoprotein level.

To determine whether non-high-density lipoprotein cholesterol (non-HDL-C) level, in comparison with low-density lipoprotein cholesterol (LDL-C) level, is useful for predicting the values of various surrogate atherosclerosis markers in Japanese subjects with type 2 diabetes (T2DM). Data were retrieved from medical records of 265 subjects with T2DM who underwent laboratory tests to evaluate for atherosclerosis by using the following parameters: brachial-ankle pulse wave velocity, mean and maximum carotid intima-media thickness (mean CIMT and max-CIMT), and ankle-brachial index, with simultaneous fasting blood sampling for routine lipid parameters. In a multiple stepwise regression analysis, non-HDL-C level, but not LDL-C level, positively correlated with max-CIMT (β coefficient=0.14, F=6.84). Stepwise logistic regression analysis revealed that a 0.26mmol/L (10mg/dL) increase in non-HDL-C level, but not LDL-C level, was significantly associated with high risk of max-CIMT (≥1.1mm; odds ratio, 1.096; 95% confidence interval, 1.003-1.202; p=0.046). However, in a receiver operating characteristic curve (ROC) analysis, the addition of non-HDL-C level to the three significant independent variables obtained from the stepwise analyses did not significantly increased the area under the ROC curve (from 0.7789 to 0.7864, p=0.4343). Non-HDL-C levels may be non-inferior to LDL-C level for the prediction of high-risk max-CIMT in Japanese subjects with T2DM.

Clinical and biochemical factors associated with area and metabolic activity in the visceral and subcutaneous adipose tissues by FDG-PET/CT.

Body fat distribution and inflammation may play a role in metabolic derangements and cardiovascular disease in obesity. The aim of this study is to investigate clinical and biochemical factors associated with area and metabolic activity in the visceral and subcutaneous adipose tissues (VAT and SAT). (18)F-fluorodeoxyglucose-positron emission tomography and computed tomography imaging was performed in 251 consecutive subjects (62.6 ± 9.3 y) for risk screening. We examined which clinical, anthropometric, metabolic, and inflammatory variables including advanced glycation end products (AGEs) and pigment epithelium-derived factor (PEDF) were independently associated with area and metabolic activity in VAT and SAT. Adipose tissue area was determined with computed tomography, whereas metabolic activity was assessed by (18)F-fluorodeoxyglucose uptake expressed as a target to background ratio (TBR) of blood-normalized standardized uptake. Serum levels of AGEs and PEDF were 9.81 ± 3.21 U/mL and 14.0 (range 10.8-17.7) μg/mL, respectively. Although the area in VAT and SAT was associated with waist circumference and sex, each adipose tissue area and TBR had different metabolic risk profiles. The TBR value in VAT was higher than that in SAT. In a multiple stepwise regression analysis, AGEs and medication for hypertension were independently associated with VAT TBR (R(2) = 0.102), whereas medication for diabetes, mean intima-media thickness, AGEs, and PEDF were the independent correlates of SAT TBR (R(2) = 0.132). The present study demonstrated that area and metabolic activity in VAT and SAT could be differently regulated, suggesting the involvement of AGEs and PEDF in adipose tissue inflammation.

Investigation of subclinical atherosclerosis in psoriatic arthritis patients with minimal disease activity.

The aim of this study was to investigate the presence of subclinical atherosclerosis among psoriatic arthritis (PsA) patients without any cardiovascular disease (CVD) or traditional cardiovascular risk factors through measurement of endothelial function and carotid intima-media thickness (IMT) and correlated with disease-related risk factors. Twenty patients with PsA according to classification criteria for psoriatic arthritis and 20 age- and sex-matched controls were included. Patients with risk factors for cardiovascular disease were excluded. Carotid IMT was measured using two-dimensional carotid ultrasonography (USG). Endothelial function was determined by measuring flow-mediated endothelial-dependent vasodilatation (FMD%) and nitrate-induced dilatation (NID%) using brachial artery USG. Additionally, serum asymmetric dimethylarginine (ADMA) level was obtained using ELISA methodology. In this cross-sectional study, FMD% was significantly more decreased among PsA patients versus control group [mean 11% (median (range)%10.5 (8-15%)] and mean 13.2% [median (range) 12, 8% (8.1-17.6%), respectively; p=0.01]. There was no significant difference in NID%, ADMA level and mean IMT or maximum IMT results. FMD% did not show a significant correlation with clinical and laboratory data of PsA patients. This study showed that endothelial dysfunction may be present in PsA patients with no CVD and traditional cardiovascular risk factors. The study findings lend support to the previous reports that suggested a potential relationship between PsA and atherosclerotic disorders.

Orthostatic Blood Pressure Changes and Subclinical Markers of Atherosclerosis.

Using a simple standing-up test in normotensive subjects, we evaluated orthostatic upright postural blood pressure (BP) changes and autonomic nervous function, as well as the relationship between orthostatic BP changes and subclinical markers of atherosclerosis. A total of 515 normotensive subjects aged 35-75 years (58.4±10.0 years) were enrolled. We measured body mass index (BMI), systolic BP (SBP) and diastolic BP (DBP), serum lipids, hemoglobin A1c (HbA1c), high-sensitivity C-reactive protein (hs-CRP), and urinary albumin-to-creatinine ratio. Brachial to ankle pulse wave velocity (baPWV) and carotid mean intima-media thickness (IMT) were measured. Participants underwent a simple standing-up test involving sitting then standing for 2 minutes each, followed again by sitting. To evaluate autonomic fluctuations, we calculated the coefficient of variation of the R-R interval, the ratio of low to high frequency heart rate variability (LF/HF), and the coefficient of component variance of high frequency. SBP and DBP decreased when standing, with a reduction of SBP when changing position of -8.0±10.2mm Hg. Orthostatic hypotension (OH) produced a significantly higher SBP than without OH. The baPWV was significantly higher in OH than in without OH. Stepwise regression analysis adjusted for age, sex, BMI, baseline SBP, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, fasting glucose, HbA1c, hs-CRP, IMT, late systolic peak of the pressure wave form (SBP2), and baPWV confirmed that baPWV, SBP2, and triglycerides were independently related to orthostatic BP changes. Multiple regression analyses showed that a decrease in SBP as well as baseline SBP, age, BMI, and fasting glucose were independent determinants of PWV. We have shown that increased arterial stiffness was associated with OH during a standing-up test. Arterial stiffness may contribute to greater BP responses to postural changes from standing.

Evaluation of Carotid Atherosclerosis, Peripheral Arterial Disease, and Chronic Kidney Disease in Patients with Exudative Age-Related Macular Degeneration without Coronary Artery Disease or Stroke

Purpose: To evaluate the risk factors for acute atherothrombotic events in patients with exudative age-related macular degeneration (AMD) without a history of coronary artery disease or stroke. Methods: Two hundred fifty-nine patents with exudative AMD were evaluated for carotid atherosclerosis, peripheral arterial disease, and chronic kidney disease (CKD). Results: A mean intima-media thickness of ≥1.0 mm was found in 28.2% of patients; 8.9% of patients had severe carotid artery stenosis. The prevalence rates of severe atherosclerosis with a plaque score >10, peripheral arterial disease, and CKD were 16.6, 5.4, and 32%, respectively. Diabetes mellitus and AMD affecting eyes bilaterally were identified as risk factors for abnormal carotid artery thickening, and age and body mass index were identified as risk factors for CKD. Conclusion: The current study confirmed that potentially 30% of patients with exudative AMD without a history of coronary artery disease or stroke have a high risk of acute atherothrombotic events.

Relation between birth weight, growth, and subclinical atherosclerosis in adulthood.

Background and Objectives. Adverse conditions in the prenatal environment and in the first years of life are independently associated with increased risk for cardiovascular disease. This paper aims to study the relation between birthweight, growth in the first year of life, and subclinical atherosclerosis in adults. Methods. 88 adults aged between 20 and 31 were submitted to sociodemographic qualities, anthropometric data, blood pressure measurements, metabolic profile, and evaluation of subclinical atherosclerosis. Results. Birthweight <2,500 grams (g) was negatively correlated with (a) increased waist-to-hip ratio (WHR), according to regression coefficient (RC) equal to −0.323, 95% CI [−0.571, −0.075] P < 0.05; (b) diastolic blood pressure (RC = −4.744, 95% CI [−9.017, −0.470] P < 0.05); (c) low HDL-cholesterol (RC = −0.272, 95% CI [−0.516, −0.029] P < 0.05); (d) frequency of intima-media thickness (IMT) of left carotid >75th percentile (RC = −0.242, 95% CI [−0.476, −0.008] P < 0.05). Birthweight >3,500 g was associated with (a) BMI >25.0 kg/m2, (RC = 0.317, 95% CI [0.782, 0.557] P < 0.05); (b) increased waist circumference (RC = 0.284, 95% CI [0.054, 0.513] P < 0.05); (c) elevated WHR (RC = 0.280, 95% CI [0.054, 0.505] P < 0.05); (d) minimum subcutaneous adipose tissue (SAT) (RC = 4.354, 95% CI [0.821, 7.888] P < 0.05); (e) maximum SAT (RC = 7.095, 95% CI [0.608, 13.583] P < 0.05); (f) right lobe of the liver side (RC = 6.896, 95% CI [1.946, 11.847] P < 0.001); (g) frequency's right lobe of the liver >75th percentile (RC = 0.361, 95% CI [0.169, 0.552] P < 0.001). Weight gain in the first year of life was inversely correlated with (a) mean IMT of left carotid (RC = −0.046, 95% CI [−0.086, −0.006] P < 0.05; (b) frequency IMT of left carotid >75th percentile (RC = −0.253, 95% CI [−0.487, −0.018] P < 0.05); (c) mean IMT (RC = −0.038, 95% CI [0.073, −0.002] P < 0.05); (d) the frequency of the mean IMT >75th percentile (RC = −0.241, 95% CI [−0.442, −0.041] P < 0.05). Conclusions. Adults birthweight <2,500 g and >3,500 g and with insufficient weight gain in the first year of life have showed different metabolic phenotypes, but all of them were related to subclinical atherosclerosis.

Endothelial dysfunction state in migraine headache and neutrally mediated syncope in children and young adults.

Background:Recent evidences have supported migraine headache and neurally mediated syncope as the especial types of endotheliopathies. To determine endothelial function in patients with migraine headache or those with neurally mediated syncope, the present study was conducted.Materials and Methods:This cross-sectional study was performed on 93 consecutive patients aged 5-20 years in four groups; neurally mediated syncope, migraine, both neurally mediated syncope and migraine, and control groups. All subjects were tested for basic biophysical and biochemical features including age, gender, body mass index, systolic, and diastolic blood pressures, intima-media thickness (IMT) and flow-mediated dilation (FMD), blood hemoglobin, fasting blood glucose, lipid profile, intercellular adhesion molecule (ICAM), vascular cell adhesion molecule (VCAM), and E-selectin.Results:The mean levels of VCAM and ICAM were significantly higher in all groups when compared to control group (P < 0.05). FMD was significantly higher in syncope, migraine, and syncope and migraine groups than in the control group (P < 0.05). Furthermore, mean IMT was significantly lower in migraine and also in syncope and migraine groups than in syncope group and control group (P < 0.05). Examining the association between IMT and other baseline parameters showed positive association of IMT with systolic and diastolic blood pressures.Conclusion:Endothelial dysfunction is seen in both migraine headache and neurally mediated syncope. Changes in endothelial functional indices are also dependent on the blood pressure.

Coronary artery disease is a significant cause of morbidity and premature death in patients with systemic lupus erythematosus.

Coronary artery disease is a significant cause of morbidity and premature death in patients with systemic lupus erythematosus.

Asymmetric dimethylarginine, a biomarker of cardiovascular complications in diabetes mellitus.

Cardiovascular (CV) complications are an essential causal element of prospect in diabetes mellitus (DM), with carotid atherosclerosis being a common risk factor for prospective crisis of coronary artery diseases and/or cerebral infarction in DM subjects. From another point of view, asymmetric dimethylarginine (ADMA) has been established as an inhibitor of endogenous nitric oxide synthesis and the relationship between ADMA and arteriosclerosis has been reported. In our study with 87 type 2 DM (T2DM) patients, we have examined whether ADMA and other CV risk factors are the useful predictors of DMCV complications. After the measurement of the respective CV risk factors, we have followed the enrolled T2DM patients for 5 years. We have finally analyzed 77 patients. DMCV complications developed in 15 cases newly within 5 years, and 4 cases recurred. The concentrations of ADMA in plasma were markedly more elevated in 19 DM patients with CV complications than in 58 DM patients without CV complications. Urinary albumin (U-Alb), mean intimal-medial thickness (IMT) and ankle brachial index (ABI) were also higher in patients with CV complications. Multiple regression analyses showed that U-Alb had an influence on the high level of ADMA (standardized β = 6.59, P = 0.00014) independently of age, systolic BP, fibrinogen, mean IMT, plaque score, and ABI. The review indicates what is presently known regarding plasma ADMA that might be a new and meaningful biomarker of CV complications in DM subjects.

A Comparison of Ultrasound Intima-Media Thickness Measurements of the Left and Right Common Carotid Artery.

The intima-media thickness (IMT) of the common carotid artery (CCA) is an established indicator of cardiovascular disease (CVD). There have been reports about the difference between the left and the right sides of the CCA IMT and their relation with CVD. In this paper, we propose an automated system based on image normalization, speckle reduction filtering, and snakes segmentation, for segmenting the CCA, perform IMT measurements, and provide the differences between the left and the right sides. The study was performed on 1104 longitudinal-section ultrasound images acquired from 568 men and 536 women out of which 125 had cardiovascular symptoms (CVD). A cardiovascular expert manually delineated the IMT for the normal and the CVD groups. The corresponding (normal versus CVD) IMT mean ± standard deviation values for the left and the right sides were 0.74 ± 0.24 versus 0.87 ± 0.24 mm and 0.70 ± 0.17 versus 0.80 ± 0.18 mm, respectively. The main findings of this paper can be summarized as follows: 1) there was no significant difference between the CCA left side IMT and the right side IMT. These findings suggest that the measurement of the CCA IMT on one side only is needed for the normal group (and this is in agreement with other studies); 2) there were statistical significant differences for the IMT measurements between the normal group and the CVD group for both the left and the right sides; 3) there was an increasing linear relationship of the left and the right IMT measurements with age for the normal group; and to a lesser extend for the CVD group; 4) no statistical significant differences were found between the manual and the automated IMT measurements for both sides; and 5) the best result for classification disease modeling, using support vector machines, to discriminate between the normal and the CVD groups was a 64%±3.5% correct classifications score when using both the left and the right IMT automated measurements. Further research is required for estimating differences and similarities between left and right intima media complex structure and morphology and their variability with texture features for differentiating between the normal and the CVD group.

Effect of vitamin C on endothelial function of children with chronic renal failure: An experimental study.

Background:It is well established that improvement of endothelial dysfunction (ED) could prevent or delay the occurrence of cardiovascular disease (CVD) and its related morbidity and mortality in patients with chronic kidney disease (CKD). In this study we investigated whether administration of vitamin C could be effective by improving brachial artery flow-mediated dilation (FMD) and intima media thickness (IMT), two surrogate markers of ED, in children with CKD or chronic renal failure (CRF).Materials and Methods:In this analytic-experimental study children aged 3-18 years with a diagnosis of CRF and a group of healthy children were enrolled. Vitamin C (250 mg/day) administrated for the two studied groups for 1 month. Endothelial function was evaluated by FMD and IMT measurement using vascular Doppler ultrasonography, before and after trial.Results:In this study 18 patients with CRF and 19 normal children as the control group were studied. At baseline mean of IMT and FMD was not different in the two studied groups (P > 0.05). After vitamin C administration IMT decreased significantly in the two studied groups (P < 0.05). FMD increased in the two studied groups but the difference was significant in the control group (P < 0.05).Conclusion:The findings of this interventional trial have demonstrated that vitamin C could have protective effect on ED of patients with CRF possibly in those with severe form of the disease but for obtaining more conclusive results larger sample size is needed.

The Association Between the Cardio-ankle Vascular Index and Other Parameters of Vascular Structure and Function in Caucasian Adults: MARK Study.

We assessed whether there is an association between the cardio-ankle vascular index (CAVI) score and the carotid intima media thickness (IMT), the pulse wave velocity (PWV) and the central augmentation index (CAIx) that is independent of the subject's cardiovascular risk and pharmacological treatment. The CAVI score was measured in 500 subjects using a VaSera device and the brachial ankle PWV (ba-PWV) was calculated. A carotid ultrasound was used to measure the IMT. A Mobil-O-Graph device was used to measure the carotid femoral PWV (cf-PWV) and the CAIx. The Framingham-D'Agostino and SCORE scales were used to measure the subject's cardiovascular risk. The mean value of the CAVI score was 8.59 ± 1.1. IMT, CAIx and PWV maintained a positive association with the CAVI score (p ＜ 0.01) in a multiple linear regression analysis, after adjusting for the subject's cardiovascular risk, body mass index and pharmacological treatment. The cut-off level that gave the maxima sensitivity and specificity to detect a mean IMT of ＞ 0.90 mm was 8.95 (AUC=0.67) for the CAVI score, 8.85 (AUC=0.66) for cf-PWV and 15.10 (AUC=0.66) for ba-PWV. The cut-off to detect a maxima IMT of ＞ 0.90 mm was 8.60 (AUC=0.62) for the CAVI score, 8.85 (AUC=0.64) for cf-PWV and 15.75 (AUC=0.70) for ba-PWV. There was a positive association of the CAVI score with vascular structure and function parameters that was independent of cardiovascular risk and any medications being used by the subject. The ability of the CAVI score to predict carotid atherosclerosis is similar to that of cf-PWV and ba-PWV in Caucasian adults.

Micromorphology of Skeletonized and Pedicled Internal Thoracic and Radial Arteries

The objective of the study was to estimate the internal thoracic arteries (ITA) and radial arteries (RA) micromorphologic features by light microscopy after harvesting them using the skeletonization and pedicled methods in patients undergoing coronary artery bypass grafting. The micromorphologic characteristics of ITA and RA were studied by luminous microscopy in 61 patients undergoing coronary artery bypass grafting. A total of 122 ITA and RA segments harvested during surgery, fixed in formalin, and stained with hematoxiline and eosin were evaluated. The mean intima-media thickness of ITA was 9.2 and 134.7 µm and that of RA was 9.1 and 334.2 µm, respectively. In the distal segment of ITA the media-intima relation was 1.5 times bigger than in the proximal segment. None of ITA specimens contained atherosclerotic plaques or lipid inclusions. Atherosclerotic plaques were found in 3 (5%) RA specimens. Other degenerative changes were detected in 30%-74.2% of the specimens: splitting of internal elastic lamina, reduced tortuosity of the internal elastic lamina, and thickening and detachment of the intima; their incidence was associated with the skeletonization of the vessels. In conclusion, the incidence of ITA and RA degenerative changes varies from 30%-74.2% and its increase is associated with the skeletonization of the vessels, which is statistically significant. The media of the RA is 2.5 times thicker than that of the ITA (P < 0.01). This fact shows that RA has higher spasmogenic potential than that of ITA. The distal segment of the ITA has 1.5 times bigger media-intima relation than the proximal segment. Therefore, in case of enough graft length, it is recommended to avoid the distal segment and cut it off.