Mean Intima-media Thickness Research Articles

Correlation between Microalbuminuria and Ultrasonographically Measured Carotid Intima Media Thickness in Type 2 Diabetic Subjects

Background: Microalbuminuria is associated with increased cardiovascular mortality in type 2 Diabetes mellitus. Carotid intima media thickness reflects index of cardiovascular disease. There is increased prevalence of microalbuminuria found in type 2 diabetes. So there is a positive correlation between microalbuminuria and carotid intima media thickness in type 2 diabetic subjects. Objective: This study was performed to find out correlation between microalbuminuria and ultrasonographically measured carotid intima media thickness in type 2 diabetic subjects. Materials and methods: The cross-sectional study was carried out in the Department of Radiology & Imaging, BIRDEM from 1st june 2011 to 31st may 2012. A total number of 90 type 2 diabetic patients with microalbuminuria were included. All the subjects underwent B mode sonographic imaging of the extracranial carotid arteries. The intima media thickness of both left and right side was recorded. Urinary albumin and creatinine were measured in random urine samples. The urinary albumin concentration was determined by turbidimetric immuneassay (TIA) with the use of superior microalbumin kit and creatinine was measured by Jaffe’s reaction. Albumin-to-Creatinine Ratio (ACR) was calculated. Results: The total number of patient was 90,male were 68 and female were 22 (Male female ratio was 3.09:1). Mean age was 55.6 years with standard deviation(SD) ± 6.06 years (Range 45-65 years).The mean ACR was 78.9 mg/g with standard deviation(SD) ± 21.8 mg/g (Range 33 to 111 mg/g). The mean intima-media thickness of carotid arteries was 1.04 mm with standard deviation (SD) ±0.19 mm. Significant positive correlation was found between albumin-to-creatinine ratio (ACR) and intima-media thickness of carotid arteries (CIMT) in type 2 diabetic subjects. The value of Pearson’s correlation was r= 0.583, which is significant (p<0.01). Therefore, there was a linear positive correlation between albumin-tocreatinine ratio (ACR) and intima-media thickness of carotid arteries (CIMT) in type 2 diabetic subjects. Conclusion:From this cross-sectional study it can be concluded that there is a significant positive correlation between microalbuminuria and ultrasonographically measured carotid intima media thickness in type 2 diabetic subjects. Birdem Med J 2013; 3(2): 85-89 DOI: http://dx.doi.org/10.3329/birdem.v3i2.17211

Association of high-sensitivity assayed troponin I with cardiovascular phenotypes in the general population: the population-based Gutenberg health study

Aim of the study was to analyze the correlation of high-sensitivity assayed troponin I with cardiac and vascular structure and function in a large population-based cohort. In a sample of 4,139 subjects (2,099 men, 2,040 women, age 35-74 years) from the population-based Gutenberg Health Study, troponin I was measured with a high-sensitivity assay that had a limit of detection of 1.9 pg/mL. In the study cohort, 3,405 subjects had detectable troponin I concentrations [82.3% overall, 89.9% men (N = 1,888), 74.4% women (N = 1,517)]. All analyses were adjusted for age. The strongest correlate between detectable troponin I and measures of cardiac phenotypes was observed for left ventricular mass (p < 0.001) and left ventricular end-diastolic diameter (p < 0.001) for both, women and men. Left ventricular ejection fraction was inversely correlated with troponin I (p value <0.001 in men and 0.0013 in women), also measures of diastolic dysfunction as represented by Tei index and E/E' correlated with detectable troponin I concentrations (p < 0.001 for both gender). With respect to vascular structure and function, troponin I correlated with mean intima-media thickness of the carotid artery (p < 0.001 in men and p = 0.013 in women) but showed only borderline correlation with measures of vascular function represented by flow-mediated dilation (p = 0.05 in women and p = 0.018 in men) and arterial stiffness. Troponin I assessed by a high-sensitivity assay correlated with measures of left ventricular hypertrophy and systolic and diastolic function, whereas its correlation with vascular phenotypes was only of weak magnitude.

Reduced carotid intima–media thickness in systemic lupus erythematosus patients treated with cyclosporine A

Background Patients with systemic lupus erythematosus (SLE) are at risk of atherosclerosis. An increased carotid intima–media thickness (IMT) is considered to be a marker of early atherosclerosis.Objective To determine influential factors for increased carotid IMT in SLE patients.Methods We evaluated the impact of conventional risk factors for atherosclerosis on carotid IMT in 427 healthy controls and of clinical factors on carotid IMT in 94 SLE patients. Carotid IMT was measured by using a newly developed computer-automated system. Unconditional logistic regression was used to assess the adjusted odds ratios (ORs) and 95 % confidence intervals (95 % CI).Results Multivariate-adjusted mean carotid IMT (mm) was significantly reduced in SLE patients (0.51, 95 % CI = 0.36–0.66) compared to healthy controls (0.55, 95 % CI = 0.40–0.70) (P = 0.003). The SLE Disease Activity Index (SLEDAI) was associated with carotid IMT in a dose-dependent manner (Ptrend = 0.041). The current use of cyclosporine A (adjusted OR = 0.02, 95 % CI = 0.01–0.40, P = 0.011) and a history of steroid pulse therapy (adjusted OR = 0.01, 95 % CI = 0.01–0.25, P = 0.006) were significantly associated with a decreased risk of increased carotid IMT.Conclusions Our findings suggest that the current use of cyclosporine A can protect against increased carotid IMT, leading to a decreased risk of arteriosclerosis. Future studies with a larger sample size need to confirm that this association holds longitudinally.

Relationship Between Carotid Disease on Ultrasound and Coronary Disease on CT Angiography

The purpose of this study was to assess the relationship between carotid artery disease by ultrasound and coronary artery disease by coronary computed tomography angiography (CTA) and to identify carotid ultrasound parameters predictive of coronary artery disease. Carotid ultrasound and CTA are noninvasive modalities used to image atherosclerosis. Studies examining the relationship between the 2 tests, however, are lacking. We performed carotid ultrasound on predominantly nondiabetic subjects referred for CTA. Carotid intima media thickness (IMT) and plaque were assessed and compared with coronary artery calcification and the number of coronary arteries with any evidence of atherosclerosis on CTA. A total of 150 subjects underwent both CTA and carotid ultrasound on the same day. Carotid plaque was present in 71.3% (n = 107), whereas the presence of at least 1 coronary artery with disease on CTA was present in 57.1% (n = 84). Carotid plaque was present in 47.6% (30 of 63) of subjects with a calcium score of 0 and 88.5% (77 of 87) of subjects with a calcium score >0 (p = 0.0001). Similarly carotid plaque was present in 52.4% (33 of 63) of subjects with no CTA evidence of atherosclerosis versus 85.7% (72 of 84) of subjects with any CTA evidence of atherosclerosis (p < 0.0001). Carotid plaque, IMT ≥ 1.5 mm, or averaged mean IMT >0.75 mm were associated with a calcium score >0 (odds ratio: 5.4, p < 0.0001, 2.7, p < 0.001; 2.9, p = 0.011, respectively) and disease in at least 1 vessel on CTA (odds ratio: 2.8, p = 0.03, 2.19, p = 0.073; 2.22, p = 0.058, respectively) independent of age and sex. Carotid plaque and increased carotid IMT are associated with the presence and severity of coronary calcification and disease on CTA in ambulatory subjects.

Carotid Intima-Media Thickness – A Potential Predictor for Rupture Risk of Intracranial Aneurysms

Individual assessment of rupture risk of cerebral aneurysms is challenging, and increased knowledge of predictors for aneurysm rupture is needed. Smoking and hypertension are shared risk factors for atherosclerotic disease and cerebral aneurysms, and patients with atherosclerosis have an increased prevalence of intracranial aneurysms. Carotid ultrasound with evaluation of intima-media thickness (IMT) is a non-invasive, safe, rapid, well-validated and reproducible technique for quantification of subclinical atherosclerosis and assessment of cardio- and cerebrovascular risk. Increased IMT is associated with elevated risk for ischemic stroke and myocardial infarction, but sparse data exist on carotid ultrasound findings in patients with intracranial aneurysms. The purpose of this study was to investigate carotid IMT in patients with unruptured intracranial aneurysms (UIA) and aneurysmal subarachnoid hemorrhage (aSAH), and to assess if IMT might be associated with aneurysm rupture risk. Patients treated for saccular aneurysms (UIA and aSAH) from February 2011 to August 2012 were included. Standardized high resolution B-mode ultrasound assessment of carotid arteries was done after aneurysm treatment, and traditional vascular risk factors were recorded. Healthy partners of young patients with ischemic stroke were used as controls. 69 patients treated for UIA (n=28) and aSAH (n=41) were compared with 80 controls. Mean IMT was higher in patients with aSAH (0·79 mm) than patients with UIA (0·65 mm) and controls (0·63 mm). Multiple multinomial regression analysis comparing aSAH, UIA and control groups demonstrated that IMT was the only variable predicative of aSAH compared to UIA. According to the multiple regression model, the probability of having aSAH compared to non-rupture increased by 62% for each 0·10 mm increment of mean IMT (RRR=1·62, P=0·017). Taking into account only patients harboring intracranial aneurysms, simple binary logistic regression was then applied to the UIA and aSAH groups. According to this model the risk of belonging to the aSAH group increased with higher mean IMT values (OR=1·40 per 0·10 mm increase of mean IMT, P=0·024). There is an association between IMT and intracranial aneurysm rupture status at the time of aneurysm treatment. Carotid IMT can be a potential predictor of aneurysm rupture. IMT may thus be a possible adjunct in the risk assessment of aneurysm rupture, and a helpful tool in patient risk stratification and counseling.

IQ in childhood and atherosclerosis in middle-age: 40 Year follow-up of the Newcastle Thousand Families Cohort Study

ObjectiveCarotid intima-media thickness (IMT) is a known precursor to coronary heart disease (CHD) and other relevant health outcomes such as stroke and cognitive impairment. In addition, higher childhood intelligence has been associated with lower risk of coronary heart disease events in later life, although the mechanisms of effect are unclear. We therefore examined the association between childhood intelligence and atherosclerosis using carotid IMT as a marker of the atherosclerotic process. ApproachParticipants were 412 members of the Newcastle Thousand Families Study, a prospective cohort study of all 1142 births in the city of Newcastle in May and June 1947, who took an IQ test and English and arithmetic tests at age 11 years. Study members participated in a medical examination and lifestyle assessment at age 49–51 years during which IMT was measured using ultrasound techniques. ResultsIndividuals with higher childhood IQ score had a lower mean IMT in middle-age. A standard deviation higher score in childhood overall IQ was associated with a 0.053 mm (95% CI −0.102, −0.004) lower IMT in men and a 0.039 mm (95% CI −0.080, −0.002) lower IMT in women. Similar levels of association were found for the English and arithmetic tests. After adjustment for a range of covariates including education, the size of effect was undiminished in men but increased in women. ConclusionsIn the present study, higher childhood IQ scores were associated with a lower degree of atherosclerosis by middle-age.

Predictive value and relationship between intima-media thickness/carotid artery plaque score and severity of coronary artery disease

Cardiologia CROATICA Objectives: The aim of this article is to investigate the relationship between the degree of the common carotid artery (CCA) atherosclerosis and the degree of complexity of the coronary artery disease (CAD) expressed with SYNTAX score. It is known that the existence of the CCA disease indicates with high probability the existence of CAD, but few studies have examined the relationship between CCA ultrasound findings and complexity, not just the presence of CAD. Patients and Methods: We included a total of 106 consecutive patients referred to the BH Heart Center for elective coronary angiography. In order to measure and calculate the mean intima-media thickness (IMT) we performed three measurements in predefined segments of CAA for both carotid arteries, the values are converged, and divided by the number of measurements. Plaque score (PS) was measured on the basis of maximum thickness of plaque in four clearly defined segments of both CCA. The final value of PS score is obtained by adding the thickness of plaques found in all segments of CCA. The complexity of coronary artery lesions is evaluated by using the SYNTAX score. The middle and high SYNTAX scores are associated with an increased risk of cardiac death and major cardiac events. Results: Data collection and statistical analysis is in progress and preliminary results indicate that IMT values and PS score significantly correlate with SYNTAX score >18 (r=.0,64, p 27 (r=.0,79, p<0,01). It is expected that final results will show that there is a significant correlation between the degree of CCA atherosclerosis measured by two methods — IMT and PS, and the degree of complexity of coronary artery lesions. Conclusion: Preliminary results show that carotid ultrasound examination has sufficient sensitivity and specificity in the detection of patients with high risk of significant CAD and it is an argument for broader use of CCA ultrasound for the evaluation of patients who are considered for coronary angiography. Besides, we are going to improve algorithm of patients selection for coronary angiography, so, our limited material and human resources and efforts will be directed towards the treatment of patients i.e. net clinical benefit will be improved.

Plasma Klotho Levels Were Inversely Associated with Subclinical Carotid Atherosclerosis in HIV-Infected Patients Receiving Combined Antiretroviral Therapy

Combined antiretroviral therapy (cART) has significantly improved the survival rate in HIV-infected individuals, but it contributes to the development of various metabolic complications. Klotho is a novel antiaging gene that encodes a protein with pleiotropic functions, including an emerging role in cardiovascular disease (CVD). The protective effect of higher plasma klotho levels against CVD was recently observed in non-HIV-infected adults. We aimed to assess whether plasma-secreted α-klotho is associated with subclinical carotid atherosclerosis in HIV-infected patients receiving cART. We prospectively examined the association of circulating plasma α-klotho in 120 HIV-infected patients who had received cART for ≥6 months with intima-media thickness (IMT) in the carotid artery and other metabolic variables. The subclinical carotid atherosclerosis was defined as an increased mean IMT level of ≥75th percentile for the matched age, sex, and race and/or the presence of carotid plaque. Thirty-four (28.3%) of 120 had subclinical carotid atherosclerosis. The higher plasma levels of α-klotho had protective effect against subclinical carotid atherosclerosis (OR 0.006, p=0.034) in multivariate regression analysis. Plasma α-klotho levels had a significantly negative correlation with fasting glucose levels (r=-0.216, p=0.018) and mean IMT (r=-0.258, p=0.004) in multiple stepwise regression analyses. The optimal cutoff values of plasma α-klotho levels for the greatest sensitivity and specificity were calculated as 2.83 log10 [pg/ml] (sensitivity, 48.7%; specificity, 90.5%). These results show that plasma klotho levels were inversely associated with subclinical carotid atherosclerosis in HIV-infected patients receiving cART.

Progression of Carotid Intima-Media Thickness as Predictor of Vascular Events

Objective— To investigate whether several different measures of carotid intima-media thickness (IMT) progression are associated with subsequent vascular events and whether such associations are independent of baseline carotid atherosclerotic profile and Framingham risk factors. Approach and Results— A longitudinal cohort study (the Carotid Intima Media Thickness [IMT] and IMT-Progression as Predictors of Vascular Events in a High Risk European Population study) was performed in 7 centers in 5 European countries (Finland, France, Italy, the Netherlands, and Sweden). Three thousand four hundred eighty-two subjects (median age 64.1 years; 47.8% men) with ≥3 vascular risk factors were recruited and monitored for a postprogression median follow-up of 21.5 months, during which time 129 subjects experienced a first vascular event (incidence of 20.4 per 1000 person-years). The 15th month progression of mean and maximum carotid IMT of the left and right common carotids, bifurcations, internal carotid arteries, and their composite measures, as well as the fastest IMT max progression (Fastest-IMT max-progr ) detected in the whole carotid tree regardless of location, were used in statistical analyses. All carotid IMT measures showed significant progression during the first 15 months ( P &lt;0.001), but only the Fastest-IMT max-progr was significantly associated with the risk of subsequent vascular events. The Fastest-IMT max-progr association persisted after Bonferroni correction for multiple comparisons and after adjustments for Framingham risk factors and pharmacological treatments (all P &lt;0.005). The use of Framingham Risk Score in place of Framingham risk factors provided almost identical results ( P =0.003). Conclusions— The Fastest-IMT max-progr , a novel approach to assess carotid IMT progression, identifies focal increases of carotid IMT and, in contrast to other progression variables, is associated with cardiovascular risk.

Associations of objectively measured and self‐reported sleep duration with carotid artery intima media thickness among police officers

We aimed to examine the association of objectively measured and self-reported sleep duration with carotid artery intima media thickness (IMT) among 257 police officers, a group at high risk for cardiovascular disease (CVD). Sleep duration was estimated using actigraphic data and through self-reports. The mean maximum IMT was the average of the largest 12 values scanned bilaterally from three angles of the near and far wall of the common carotid, bulb, and internal carotid artery. Linear and quadratic regression models were used to assess the association of sleep duration with IMT. Officers who had fewer than 5 or 8 hr or more of objectively measured sleep duration had significantly higher maximum IMT values, independent of age. Self-reported sleep duration was not associated with either IMT measure. Attainment of sufficient sleep duration may be considered as a possible strategy for atherosclerosis prevention among police officers.

Does the ratio of eicosapentaenoic acid to arachidonic acid predict carotid intima-media thickness in the general population?

Purpose: A decrease in the ratio of eicosapentaenoic acid (EPA) to arachidonic acid (AA) (EPA/AA) has been reported to be closely associated with increased incidence of cardiovascular diseases including coronary artery disease and stroke in subjects with high risk of atherothrombotic diseases. Similarly, an increase in the intima-media thickness (IMT) of the common carotid artery is a marker of early stage atherosclerosis and considered to be a predictor of cardiovascular disease. The present study was designed to investigate a possible relationship between the EPA/AA ratio and carotid IMT in the Japanese general population. Methods: A total of 401 participants (men=178, mean age=61.0 years), who visited our hospital for a yearly physical checkup from May 2010 to December 2010, were enrolled. In addition to a routine physical checkup program (routine physical examination, chest X-ray, electrocardiogram [ECG], and laboratory assessment of cardiovascular risk factors), EPA and AA were measured. Participants under medication with EPA were excluded from the study. An image of the common carotid artery was obtained by an ultrasound system and the mean IMT was calculated according to the guideline of Carotid Ultrasound Examination (Neurosonology 2006: 19(2):49-69). Cross-sectional analyses were performed to investigate a relationship between the EPA/AA ratio and carotid IMT. Results: Although the mean value of AA was not different in men and women, the EPA value and the EPA/AA ratio were significantly higher in men than in women (69.6±37.2 vs. 62.4±31.9 μg/ml, and 0.46±0.24 vs. 0.40±0.21, respectively). Strikingly, there was a positive correlation between the mean IMT value and the EPA/AA ratio in univariable regression analysis. However, in multivariable regression analysis, the mean IMT value was correlated with age, male gender, systolic blood pressure and ECG voltage, but not with the EPA/AA ratio. Both the EPA/AA ratio and the mean IMT value were greater in subjects with hypertension as compared to normotensive subjects. In contrast, the mean IMT, but not the EPA/AA ratio, was greater in subjects with than without diabetes mellitus. Conclusions: A decrease in the EPA/AA ratio does not predict increased carotid IMT in the Japanese general population. Significance of the EPA/AA ratio as a maker of clinical atherosclerosis should be further investigated in future by interventional studies.

Bilateral inflammatory activation in human carotid arteries in patients with coronary artery disease: insights from microwave radiometry

Purpose: The development of atherosclerosis is partially controlled by systemic factors. Local factors, including local inflammation and shear stress, may also affect the progression of carotid plaques. The aim of this study was to evaluate in patients with coronary artery disease whether intra-subject left and right carotid arteries, have similar local inflammatory activation as determined non-invasively by microwave radiometry (MR). Methods: We examined 400 carotids from 200 consecutive patients with significant coronary artery disease, as documented by coronary angiography (stenosis ≥ 50%). All patients underwent carotid artery examination by basic ultrasound imaging and MR. Carotid artery disease was defined as intima-media thickness (IMT) ≥1.2 mm. During ultrasound study, plaque texture, surface and echogenicity were analyzed. Plaques were characterized as fatty, mixed and calcified according to previous classifications. Plaque surface was classified as regular and irregular. Thermal heterogeneity (ΔT) by MR was assigned as maximal temperature along the carotid artery minus minimum. Results: Mean IMT of all carotid arteries (n=400) was 2.04±1.09 mm. Mean ΔT of all carotid arteries was 0.80±0.49°C. In carotid arteries with carotid artery disease (n=313), fatty plaques (n=52) had higher ΔT compared to mixed (n=181) and calcified (n=80) (1.23±0.55°C versus 0.87±0.44°C versus 0.67±0.49°C respectively, p<0.01). Plaques with irregular surface (n=81) had higher ΔT compared to plaques with regular (n=232) (1.20±0.45°C versus 0.76±0.48°C, p<0.01). Heterogeneous plaques (n=71) had higher ΔT compared to homogenous (n=242) (1.22±0.56°C versus 0.77±0.44°C, p<0.01). Mean ΔT was similar between left and right carotid arteries (0.78±0.48°C versus 0.84±0.52°C, p=0.12). In all carotids, there was a correlation between left and right carotid plaque ΔT (p<0.001, R=0.38). In all lesions, there was a correlation between ΔT and IMT (p<0.001, R=0.25). Conclusions: Patients with coronary artery disease have similar inflammatory activation in the carotid plaques as detected by microwave radiometry. Thus, the systemic factors producing this diffuse inflammatory activation in patients with atherosclerosis need to be further investigated.

Depression symptoms and the progression of carotid intima-media thickness: a 5-year follow-up study

Background: Only a few studies have investigated the changes in carotid intima-media thickness (IMT) over time, and uncertainties remain on the underlying mechanisms linking depression and subclinical atherosclerosis. We carried out a prospective cohort study to evaluate whether depression is associated with changes in carotid IMT in subjects with cardiac risk factors but free from coronary heart disease (CHD), and to what extent the atherogenicity of depression can be explained by inflammatory markers and autonomic nervous system dysfunction. Methods and results: During baseline and follow-up visits: all participants were asked to provide blood samples and compile a structured questionnaire; trained physicians assessed depression symptoms using Beck Depression Inventory (BDI); altered cardiac autonomic tone was measured using time-domain components of heart rate variability in 24h Holter recordings; measurements of carotid IMT were carried out using B-mode ultrasound image acquisition. Logistic and linear regression analyses were used to adjust for potential confounders and explore potential mediators. A total of 381 subjects completed the 5-year follow-up. The mean carotid IMT significantly increased in all subjects but the amount of increase was significantly larger among subjects with depression symptoms: mean IMT increased by 0.16±0.14 mm; 0.31±0.28 mm and 0.61±0.54 mm among the subjects with no, mild and moderate/severe depression, respectively (all p<0.01). The association between moderate/severe depression and IMT increase remained highly significant even after controlling for all the variables considered, however when both IL-6 and CRP were included in multivariate models the regression coefficient decreased by 42.3%. Some of the inflammation markers and autonomic nervous system dysfunction were also independently correlated with carotid IMT increase. Conclusion: Depression symptoms are independently associated with an accelerated progression of carotid IMT in subjects with CHD risk factors, and inflammation may substantially modulate the association between depression and carotid IMT progression.

GW24-e2303 Relationship between asymmetric dimethylarginine and carotid atherosclerosis in patients with essential hypertension

ObjectivesCirculating levels of asymmetric dimethylarginine (ADMA), an endogenous nitric oxide synthase inhibitor, are increased in hypertensive patients. This study was to assess the relationship between plasma ADMA level and carotid...

Intima media thickness measurement as a marker of subclinical atherosclerosis in SLE patient

Accelerated atherosclerosis in systemic lupus erythematosus (SLE) is an important cause of morbidity and mortality. The pathophysiology of accelerated atherosclerosis in SLE is mediated by factors such as inflammatory processes in the vascular wall, specific antibodies, dyslipoproteinemia, endothelial dysfunction and the high prevalence of traditional risk factors for cardiovascular diseases. In this context, we evaluated the clinical significance of ultrasound examination of the carotic arteries in the early diagnosis of atherosclerosis. The study included 63 patients with SLE (female: male 53:10, mean age 38.4±12.7 years, mean disease duration 143.0±82.6 months), 24 patients had lupus nephritis. The control group consisted of 24 volunteers (female: male 20:4 mean age 31.04±8.59). Intima media thickness (IMT) was measured by ultrasound on both sides. The results were correlated with markers of lipid spectrum, anti-dsDNA, antinucleosomal and anticardiolipin antibodies, lupus anticoagulant and complement components. Clinical disease activity and damage were evaluated by SLEDAI and SLICC indices. Lifestyle and other important factors were examined per protocol and by questionnaire. A significant difference of IMT (P≤0.03) was found between the lupus patients and sex-age adjusted healthy controls with an in mean IMT in SLE patients of 0.569±0.11 mm, in control group 0.495±0.05 mm. A significant correlation between IMT and disease duration, age, positivity of lupus anticoagulant, use of ACE inhibitors, glomerular filtration and serum creatinine were found. No difference in IMT was found between patients with or without lupus nephritis. IMT measurement could be used as a clinical predictor of risk of accelerated atherosclerosis in lupus patients.

Rapid Screening for Subclinical Atherosclerosis by Carotid Ultrasound Examination: The HAPPY (Heart Attack Prevention Program for You) Substudy

BackgroundCardiovascular disease (CVD)-related death rates have been escalating in emerging economies such as India. A strategy to initiate prophylactic medical intervention by direct identification of subclinical atherosclerotic burden may be appropriate in rural populations where assessment based on traditional risk factors is not available. ObjectivesThis study sought to investigate the feasibility of performing rapid automated carotid ultrasound studies in a rural setting and to measure the prevalence of carotid plaques and age-specific distribution of carotid intima-media thickness (IMT) as an index of subclinical atherosclerosis. MethodsScreening of the extracranial carotid system with automated B-mode ultrasound was performed along with health questionnaire assessments in 771 asymptomatic volunteers (ages 40 ± 14 years; 626 men and 145 women) with no known CVD. Measurements of IMT were recorded as the mean of 24 spatial measurements performed over a 1-cm region in the far wall of the common carotid artery at end diastole; the prevalence of the plaque (focal IMT >1.5 mm) was determined. ResultsA total of 69 (8.9%) subjects had atherosclerotic plaques. Of these, 16 (2.1%) exhibited bilateral plaques, 28 (3.6%) left carotid plaque only, and 25 (3.2%) had right carotid plaques. Patients even under 50 years showed a high prevalence of carotid plaques (7%), which increased with age (25% and 35% for 51 to 70 and >70 years, respectively). Only 3 (4.3%) participants with plaques were former smokers. Global mean IMT was 0.55 ± 0.13 mm and correlated with age for both left and right carotid arteries (r = 0.61 and 0.60, p < 0.001 for both) in male as well as female subjects (r = 0.70 and 0.67, p < 0.001 for both), respectively. ConclusionsRapid community screening for subclinical atherosclerosis is feasible with automated carotid ultrasound examination and may be beneficial in rural communities of industrializing nations where traditional CVD risk factor data are not yet readily available.

Serum omentin-1, inflammation and carotid atherosclerosis in patients with non-diabetic chronic kidney disease

Background and aim: Omentin-1 is suggested to affect inversely atherosclerosis (AS). Data about omentin-1 is limited to chronic kidney disease (CKD). Our aim was to examine omentin-1 in non-diabetic CKD patients who are not dialyzed and investigate its relationships with inflammation and carotid AS. Materials and Methods: We performed a cross-sectional study in 55 non-diabetic CKD patients and 30 healthy controls. Baseline clinical and laboratory data were obtained for all participants. Serum omentin-1 and interleukin-6 (IL-6) levels were measured according to the manufacturer’s instructions. Carotic plaque and intima-media thickness (IMT) were assessed by carotid ultrasonography. The homeostasis model assessment of insulin resistance index (HOMA-IR) was used to assess IR. Results: Omentin-1 and IL-6 levels in the patient group were found to be higher than the control group; the differences were statistically significant (p = 0.01 and p = 0.04, respectively). Carotid IMT(mean) was significantly higher in the patient group (p = 0.01). Omentin-1 did not correlate with IL-6 and IMT in the patient group (p = 0.51 and p = 0.76, respectively). In subgroup analysis, omentin-1 levels in patients with carotid plaque were lower than those without carotid plaque (179.5 ± 88.1 ng/ml and 185.9 ± 67.8 ng/ml, respectively). However, the difference was not statistically significant (p = 0.47). Conclusion: We conclude that omentin-1 is higher in not dialyzed non-diabetic CKD and there is no correlation between omentin-1 and IL-6 or carotid IMT(mean).

Abdominal Aortic Intima-Media Thickness in Preschool Children Born Preterm

Recently aortic intima-media thickness (IMT) has been used as an earlier marker of preclinical atherosclerosis in high-risk children, such as those with type 1 diabetes mellitus and hypercholesterolemia. Children who were born preterm have an early elevation in insulin resistance, which may be a risk factor for metabolic syndrome in adulthood. However, there is no optimal marker of subsequent cardiovascular disease for children born preterm. In this study, we aimed to evaluate the effect of preterm birth on aortic IMT during the preschool period. Mean aortic IMT was measured by ultrasound in 26 subjects born preterm (gestational age<37weeks [preterm group]) and 11 control subjects born at term (term group). The mean aortic IMT of the preterm group was significantly thicker than that of the term group (preterm group: median 577μm, interquartile range (524-599) versus term group: 517μm (442-544); p=0.003). Mean aortic IMT may be one of the earlier markers of subclinical vasculopathy in preschool children who were born preterm.

Impact of hypertension on vascular remodeling in patients with psoriatic arthritis

We studied the impact of hypertension along with traditional and new cardiovascular risk factors on the structural and functional properties of arteries in psoriatic arthritis (PsA) patients. We examined 42 PsA subjects (aged 51±9 years) stratified according to hypertensive status (19 normotensive, PsA-NT and 23 hypertensives, PsA-HT). Thirty-eight normotensive subjects (C-NT) and 23 hypertensives (C-HT) comparable by age and sex served as controls. Mean carotid intima-media thickness (mean-IMT) and mean of the maximum IMT (M-Max) were evaluated by ultrasound in carotid artery segment bilaterally. Post-occlusion flow-mediated dilation (FMD) of the brachial artery was evaluated by ultrasonography. These parameters were correlated with risk factors, markers of inflammation and disease activity. Values of mean-IMT were higher in both groups of PsA patients compared with C-NT (0.68 mm in PsA-NT and 0.75 mm in PsA-HT versus 0.61 mm in C-NT). PsA-HT displayed higher M-Max (0.95 mm) versus both C-HT (0.71 mm) and PsA-NT (0.79 mm). FMD was impaired in PsA subjects compared with C-NT (5.7% in PsA-NT and 6.0% PsA-HT versus 9.3% in C-NT), whereas there was no difference among PsA-HT, PsA-NT, and C-HT groups. Values of carotid IMT were directly related to tumor necrosis factor (TNF)-α, osteoprotegerin (OPG), blood pressure and lipid profile levels. FMD showed an inverse relationship with TNF-α and blood pressure, but no correlation with lipids. In conclusion, PsA per se implies a pro-atherogenic remodeling, which is enhanced by the hypertensive status. TNF-α and OPG may have an independent role in the development of such vascular damage.

Circulating Vitamin D Metabolites and Subclinical Atherosclerosis in Type 1 Diabetes

OBJECTIVEPeople with type 1 diabetes are at high risk of premature atherosclerosis. Existing evidence suggests that impaired vitamin D metabolism may contribute to the development of atherosclerosis. We tested associations of circulating vitamin D metabolite concentrations with subclinical atherosclerosis among 1,193 participants with type 1 diabetes in the DCCT/EDIC study.RESEARCH DESIGN AND METHODSWe measured plasma concentrations of 25-hydroxyvitamin D [25(OH)D], 1,25-dihydroxyvitamin D, and 24,25-dihydroxyvitamin D by mass spectrometry at the end of the DCCT. In a staggered cross-sectional design, we tested associations with coronary artery calcium (CAC), measured by computed tomography a median of 10 years later, and with common and internal carotid intima-media thickness (IMT), measured by B-mode ultrasonography on two occasions a median of 4 years later and a median of 10 years later. We hypothesized that lower concentrations of each vitamin D metabolite would be associated with increased risk of CAC and greater carotid IMT.RESULTSAt the time metabolites were measured, mean age was 32.4 years and mean duration of diabetes was 7.5 years. The prevalence and severity of CAC tended to be lower—not higher—with lower concentrations of each vitamin D metabolite. For instance, in a fully adjusted multinomial logistic model, a 25 nmol/L lower 25-hydroxyvitamin D was associated with a 0.8-fold decrease in the odds of having higher CAC (95% CI 0.68–0.96, P = 0.01). No vitamin D metabolite was associated with either common or internal mean IMT.CONCLUSIONSWe did not find evidence linking impaired vitamin D metabolism with increased subclinical atherosclerosis in type 1 diabetes.