Mean Intima-media Thickness Research Articles

Abstract P112: Peripheral Arterial Disease and Carotid Atherosclerosis among Middle-aged Women Living in Chiapas, Mexico: Preliminary Results

Background: Mexico is undergoing a fast-paced epidemiological and nutritional transition. Evaluating the presence of early cardiovascular disease and understanding risk factors leading to it in this context may provide insight on prevention strategies for the growing burden of this disease in developing countries. Methods and Results: We evaluated subclinical cardiovascular disease in 443 women aged ≥40 years in an urban and a rural site in Chiapas, Mexico. All women were participants in the ongoing ESMaestras cohort, a prospective study of 116,683 Mexican female teachers, which started in 2006-2008. In September 2012, an evaluation of subclinical cardiovascular disease was undertaken in a sub-cohort of 2,000 ESMaestras participants. We present preliminary results from this initial effort. Women were invited to a clinical site where ankle-brachial index (ABI) were measured by previously standardized personnel using the automated VaSera VS-1000 sphyngmomanometer. Carotid intima-media thickness (IMT) was assessed by a neurologist. In 52 participants IMT measurements were repeated to assess the reproducibility of the measurements. Mean age was 48.1 (SD 4.2) and mean body mass index (BMI) was 28.7 kg/m2 (SD 4.7). Mean ABI was 1.06 (SD 0.09) and peripheral artery disease (ABI of <0.90), was present in 4.1% of participants. Mean IMT was 0.68 mm (SD 0.08) and the prevalence of carotid atherosclerosis (IMT ≥1.2 mm) was 1.9%. The intraclass correlation to assess reproducibility of IMT measurements was 0.89 (95% confidence interval 0.82-0.94). Pearson’s correlation coefficients for IMT and BMI (n=312) and ABI and BMI (n=443) were 0.25 (p<0.001) and -0.17 (p<0.001), respectively. No differences were observed between the urban and rural site. Conclusions: In an initial effort to characterize subclinical cardiovascular disease we found a relatively high prevalence of peripheral arterial disease in a middle-aged population of Mexican women, underlining the increasing burden cardiovascular disease in this population.

Control of Home Blood Pressure with an Amlodipine- or Losartan-Based Regimen and Progression of Carotid Artery Intima-media Thickness in Hypertensive Patients: The HOSP Substudy

Carotid artery intima-media thickness (IMT) has emerged as a predictor of cardiovascular events. Home blood pressure (BP) is more closely associated with cardiovascular prognosis than clinic BP. The aim of this study was to compare the progression of carotid IMT with respect to strict and mild control of morning home systolic BP (SBP) and amlodipine- and losartan-based antihypertensive therapy in hypertensive patients. Subjects included 80 hypertensive outpatients who participated in the Hypertension Control Based on Home Systolic Pressure (HOSP) pilot study. After a 1-month drug-free period, the patients were randomly assigned to either the strict control group (target SBP <130 mm Hg) or the mild control group (130–139 mm Hg) and to either the amlodipine group or the losartan group. Additional antihypertensive drugs were added if target BP was not achieved with monotherapy. Morning SBP achieved target levels during 5 years in the strict control group and in the mild control group, while it was comparable between amlodipine and losartan groups. In all patients, mean and maximum carotid IMT increased significantly. Changes in carotid IMT did not differ between strict and mild control groups. Changes in mean carotid IMT in amlodipine group were smaller than those in losartan group at year 1, but were not different between the two groups at year 5. In conclusion, carotid IMT increased over time in hypertensive patients in spite of the strict control of home BP. Amlodipine may slow the progression of IMT more than losartan, although a difference was not obvious after 5 years.

Lack of association between carotid intima-media thickness and apolipoprotein (a) isoforms in a sample of Spanish general population

ObjectivesThe purpose of this study was to examine the relationship between apolipoprotein (a) isoforms and early atherosclerosis, assessed by carotid artery intima-media thickness in a sample of adults of the general population of Burgos, a city in the north of Spain. Design and methodsLipids, lipoprotein (a), number of carotid atherosclerotic plaques, if any, and the intima-media thickness in the far wall of both common carotid arteries by B-mode ultrasound were determined in a group of 171 adults from the general population of Burgos, Spain. Apolipoprotein (a) isoforms were determined in a random subset of 119 subjects. ResultsIncreasing age, male sex, and past personal cardiovascular history were significantly associated with increased left, right, or average intima-media thickness of both carotid arteries in multivariate analysis.No statistically significant association was found between apolipoprotein (a) isoforms and mean carotid intima-media thickness by bivariate or multivariate regression analysis. ConclusionsIn this sample of the general Spanish population, no association was found between apolipoprotein (a) isoforms and carotid artery intima-media thickness.

Preterm Birth and Future Maternal Blood Pressure, Inflammation, and Intimal-medial Thickness

Preterm birth (PTB, &lt;37 weeks) may be a marker of endothelial dysfunction and a proinflammatory phenotype; both are risk factors for cardiovascular disease. We studied 916 women (46% black) with 1181 live births between enrollment in the Coronary Artery Risk Development in Young Adults study (age 18–30 years) and 20 years later. C-reactive protein was measured at years 7, 15, and 20. Interleukin-6 and carotid intima-media thickness, which incorporated the common carotid arteries, bifurcations, and internal carotid arteries, were measured at year 20. Blood pressure, lipids, anthropometrics, and pregnancy events were assessed at all visits. Change in risk factors and differences in inflammatory markers and intima-media thickness according to PTB were evaluated. Women with PTBs (n=226) had higher mean systolic blood pressures before pregnancy (106 versus 105 mm Hg, respectively; P =0.03). Systolic and diastolic blood pressure increased more rapidly over 20 years compared with women with term births ( P &lt;0.01 time interaction), even after removing women with self-reported hypertension in pregnancy. Women with PTB versus term births had similar mean intima-media thickness adjusted for age, body mass index, race, lifestyle, and cardiovascular risk factors. C-reactive protein and interleukin-6 did not differ according to PTB. Women with PTB, regardless of hypertension during pregnancy, had higher blood pressure after pregnancy compared with women with term births. In the United States, where rates of PTB are high and race disparities persist, PTB may identify women with higher blood pressure in the years after pregnancy.

Relationship Between Uric Acid and Vascular Structure and Function in Hypertensive Patients and Sex-Related Differences

We sought to analyze the relationship between uric acid (UA) and vascular structure and function based on the carotid intima-media thickness, the pulse-wave velocity (PWV), the central arterial pressure, and the augmentation index in hypertensive patients and to evaluate the sex-related differences. A cross-sectional study was performed with 366 hypertensive individuals aged 34-75 years (men = 61.74%). The vascular structure was assessed based on the carotid intima-media thickness, the arterial stiffness was assessed by PWV, and the vascular function was assessed using hemodynamic parameters such as the central and peripheral augmentation index and the ambulatory arterial stiffness index (AASI). In the bivariable analysis, the PWV (r = 0.28; P < 0.01) and AASI (r = 0.25; P < 0.01) were positively correlated with UA in women. The central augmentation index (r = -0.16; P < 0.05) and peripheral augmentation index (r = -0.18; P < 0.05) were negatively correlated with UA, whereas the maximum carotid intima-media thickness (r = 0.11; P < 0.05) was positively correlated with UA in the global analysis. In the multiple linear regression analysis, a positive association between PWV and UA was observed after adjusting for classical risk factors (β = 0.27; P = 0.01) in women only. In turn, a negative association was observed between the AASI and UA after adjusting for confounders in men (β = -0.06; P = 0.04), with a positive association in women (β = 0.11; P = 0.03). Serum UA showed a positive correlation with the mean maximum intima-media thickness and PWV, and this parameter showed a negative correlation with the central and peripheral augmentation indices, although this relationship was lost after adjusting for confounding factors. AASI showed a positive association in women and a negative association in men after adjusting for confounding factors. Clinical Trials.gov Identifier: NCT01325064.

The Relationship of Atherosclerosis to the 10-Year Cumulative Incidence of Age-related Macular Degeneration: The Beaver Dam Studies

To describe the relationships of intima-media thickness (IMT), plaque in the carotid artery, angina, myocardial infarction (MI), and stroke to the 10-year cumulative incidence of early and late age-related macular degeneration (AMD) and progression of AMD. Cohort study. A total of 1700 persons aged 53 to 96 years who participated in both the Epidemiology of Hearing Loss Study and the Beaver Dam Eye Study in 1998-2000, with photographs gradable for AMD at 5-year (2003-2005) and 10-year (2008-2010) follow-up examinations. The IMT and presence of plaque were assessed using B-mode ultrasonography of the carotid artery. Presence of angina, MI, and stroke were defined on the basis of a self-reported history of physician diagnosis. The presence and severity of AMD were determined by systematic grading of stereoscopic color fundus photographs. Age-related macular degeneration. The 10-year cumulative incidence of early AMD was 15.7%, and the 10-year cumulative incidence of late AMD was 4.0%. After adjusting for age, sex, body mass index, smoking status, age-related maculopathy susceptibility 2 (ARMS2) and complement factor H (CFH) genotypes, and other factors, mean IMT was associated with the 10-year incidence of early AMD (odds ratio [OR] per 0.1 mm IMT, 1.11; 95% confidence interval [CI], 1.00-1.21; P = 0.03) and late AMD (OR per 0.1 mm IMT, 1.27; CI, 1.10-1.47; P = 0.001). Mean IMT was associated with the 10-year incidence of pure geographic atrophy (OR per 0.1 mm IMT, 1.31; CI, 1.05-1.64; P = 0.02) but not exudative AMD (OR per 0.1 mm IMT, 1.14; CI, 0.97-1.34; P = 0.11). Similar associations were found for maximum IMT. The number of sites with plaque was related to the incidence of late AMD (OR per 0.1 mm IMT, 2.79 for 4-6 sites vs. none; CI, 1.06-7.37; P = 0.04) but not to early AMD. A history of angina, MI, or stroke was not related to any incident AMD outcome. In these population-based data, carotid artery IMT and carotid plaques had a weak relationship to the incidence of late AMD that was independent of systemic and genetic risk factors. Angina, MI, and stroke were not related to AMD. It is unclear whether the carotid IMT is a risk indicator of processes affecting Bruch's membrane and the retinal pigment epithelium, or a measure of atherosclerosis affecting susceptibility to AMD. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Abstract WP182: Relationship Between Carotid Intima-Media Thickness and Periodontal Disease in an Urban Japanese Population: The Suita Study

Background and Purpose: The association between periodontal disease and carotid intima-medial thickness (IMT) has been controversial. There are few population-based studies on the association. We assessed the hypothesis that periodontal disease was a risk factor for carotid atherosclerosis in a general urban Japanese population. Research design and methods: We studied 1,484 Japanese individuals (mean age 66.9 years) who underwent medical check-up, dental examinations, and carotid ultrasonography with atherosclerotic indexes of IMT in the common carotid artery (CCA), carotid artery bulb, and internal and external carotid arteries. Mean IMT was defined as the mean of the proximal and distal walls IMT for both sides of the CCA at a point 10 mm proximal to the beginning of each bulb. Subjects were divided into two groups: plaque (-) (maximum IMT less than 1.1 mm, n=235) and plaque (+) groups (maximum IMT equal or more than 1.1 mm, n=1249). Periodontal status was examined by Community Periodontal Index (CPI, code 0-4) by which subjects with CPI code equal or more than 3 (periodontal pocket [PP] group, n=758) and those with CPI code 4 (severe periodontitis [SP] group, n=244). We examined the relationship between plaque (+/-) and periodontal status by using age- and sex-adjusted chi-square test. Logistic regression model was used to analysis of mean and maximum IMT according to the periodontal status adjusted by cardiovascular risk factors. Results: Plaque (+) group tended to have periodontal pocket in both men and women (odd ratio [OR] =1.84, P&lt;0.000). Women with plaque (+) tended to have periodontal pocket (OR=1.19, P=0.001) and severe periodontitis (OR=3.14, P=0.002). Mean IMT was significantly higher in both PP and SP groups (adjusted mean IMT= 0.82 mm (CPI code 0-2) and 0.847 mm (PP group), P=0.001; adjusted mean IMT=0.815 mm (CPI code 0-3) and 0.834 mm (SP group), P=0.002). Conclusions: In our population based study, periodontitis may be a risk factor for carotid atherosclerosis, especially in women.

Abstract WP184: Prediction of All-cause and Stroke Mortality by Carotid Intima-Media Thickness in Japanese Urban Cohort: The Suita Study

INTRODUCTION: Carotid intima-media thickness (IMT) has been increasingly a subclinical marker for cardiovascular disease (CVD). However, few studies have examined the association between IMT and mortality. We assessed the hypothesis that carotid IMT was a predictor for mortality in a general urban Japanese population. Methods: We studied 5,605 Japanese individuals (mean age 60.1 years, without CVD) who completed a baseline survey and carotid atherosclerosis in the Suita Study, and were then followed for 11.7 years on average. Carotid IMT was evaluated by high-resolution ultrasonography with atherosclerotic indexes of IMT in the common carotid artery (CCA), carotid artery bulb, and internal and external carotid arteries. Mean IMT was defined as the mean of the IMT of the proximal and distal walls for both sides of the CCA at a point 10 mm proximal to the beginning of the dilation of each carotid artery bulb. Max-IMT was defined as the maximum IMT in the entire scanned area. The risks of all-cause mortality across carotid IMT were compared by the use of adjusted Cox proportional-hazards models. Results: In 65,897 person-years of follow-up, we documented 829 all-cause mortality (including 59 strokes, 92 ischemic heart diseases [IHD], and 370 cancers). The adjusted hazard ratios (HRs; 95% confidence intervals, 95% CIs) in the 3rd and 4th quartiles (0.85-0.925 mm and &gt;0.925 mm) of the mean IMT for all-cause mortality were 1.63 (1.02-2.62) and 1.66 (1.03-2.68), respectively, and that in the 4th quartile for CVD mortality was 1.41 (1.01-1.98), compared with the 1st quartile (&lt;0.75 mm). The HR (95% CIs) in the 4th quartile (&gt;1.70 mm) of Max-IMT for all-cause mortality was 1.41 (1.01-1.98) compared with the 1st quartile (&lt;1.0 mm). The adjusted HRs (95% CIs) for all-cause mortality were 2.06 (1.19-3.56) with 0.1 mm increases in mean IMT, and 1.27 (1.16-1.39) in men and 1.27 (1.09-1.47) in women with 0.1 mm increases in Max-IMT. Those for stroke, cerebral infarction, IHD, and cancer mortalities were 1.38 (1.05-1.80), 1.69 (1.18-2.43), 1.49 (1.20-1.86), 1.31 (1.17-1.46) with 0.1 mm increases in Max-IMT, respectively. Conclusions: Carotid IMT, especially Max-IMT is a strong predictor for all-cause, stroke, cerebral infarction, and IHD mortalities in general population.

Abstract TP199: Association between Metabolic Syndrome and Carotid Atherosclerosis: a Community-based Study in Hong Kong

Background and Purpose— Carotid atherosclerosis is not neglectable as a cause for stroke in China, despite of low prevalence. This study was performed to evaluate the association between its ultrasonographic markers with metabolic syndrome (MetS). Methods— This was a community-based cross-sectional study. Demographics, common vascular risk factors, and results of fasting blood analysis were collected at baseline. MetS was defined as ≥3 following conditions or receiving specific treatment: abdominal obesity, elevated triglycerides, low high-density lipoprotein cholesterol, hypertension and impaired fasting blood glucose. All subjects underwent carotid duplex ultrasonography. Mean carotid intima-media thickness (CIMT) of bilateral common carotid arteries was used as the CIMT value for a single subject. CIMT within the 4th quartile was regarded as increased CIMT. Carotid plaque was defined as a focal CIMT of &gt;1.5 mm. Results— A total of 653 subjects (mean age 55.1±10.4; 47.2% male) were recruited. MetS was found in 188 (28.8%) subjects (30.8% in male and 27.0% in female). Mean CIMT was 0.74±0.12 mm. Increased CIMT and carotid plaques were detected in 163 (25.0%) and 95 (14.5%) subjects, respectively. In multivariate linear regression, CIMT significantly increased with increasing numbers of MetS components (P&lt;0.001). In multivariate logistic regression, MetS was independently associated with increased CIMT (OR 1.17; 95% CI 1.11-2.64; P=0.014) but not presence of carotid plaque (OR 1.50; 95% CI 0.92-2.46; P=0.108). Conclusion— MetS may be independently associated with early stage but not later and advanced stages of carotid atherosclerosis in community residents in China.

Abstract WP420: Plasma Interleukin-6 Predicts the Progression of Carotid Intima-Media Thickness in High-Risk Patients Under Intensive Medical Therapy: 10-year Follow-up Study

Purpose: Although carotid intima-media thickness (IMT) is widely used as a surrogate marker for atherosclerosis, the relationship between long-term IMT progression and plasma inflammatory cytokine levels is only partially clarified. We prospectively investigated the association of 10-year IMT progression and mean circulating levels of inflammatory cytokine during follow-up in atherosclerotic high-risk patients with intensive management of conventional risk factors. Methods: We prospectively evaluated 207 atherosclerotic high-risk patients who continued to attend our ambulatory care center and underwent carotid ultrasound in 2001-2003 and in 2010-2012. Participants had to have a previous diagnosis of cardiovascular disease, diabetes, hypertension, dyslipidemia, or current smoking. All participants consecutively received intensive medical treatment and the management of risk factors was evaluated by mean values of annual physical examination and blood tests, including high-sensitive C-reactive protein (hsCRP), interleukin (IL)-6, and IL-18. Results: The mean baseline age was 64±8 years, and the mean follow-up period was 9.0±1.0 years. Conventional risk factors were generally well-controlled during follow-up period; mean blood pressure was 134±9/76±7mmHg, mean total cholesterol level was 204±23 mg/dl, and mean HbA1c (JDS) was 5.6%±0.7%. IMT increased 0.28±0.24 mm throughout the observation period. IMT progressions was positively correlated with baseline IMT, age, male sex, mean plasma glucose, HbA1c, hsCRP, IL-6, and IL-18 levels during follow-up, and negatively correlated with mean diastolic blood pressure levels. In multiple regression analyses adjusted for age, sex, conventional risk factors and statin use, mean plasma IL-6 (β=0.39, p=0.047) together with baseline IMT (β=0.45, p=0.044) and mean HbA1c (β=0.21, p=0.0038) were independently associated with IMT progression. Conclusion: In atherosclerotic high-risk patients under intensive medical therapy, mean plasma IL-6 level during follow-up period was an independent predictor of IMT progression.

Relationship between catalase haplotype and arterial aging

BackgroundAlthough many conventional factors have been associated with the development of arterial aging, cardiovascular diseases remain the first cause of death in old age. Therefore, identification of new risk factors may prove promising for monitoring this serious health problem. Oxidative stress and particularly catalase (CAT), an antioxidant enzyme, play an important role in endothelial cell pathophysiology, in shear stress response and ultimately in arterial aging. ObjectiveExamine the relationships between CAT haplotypes and phenotypes of arterial aging (mean internal diameter, mean intima–media thickness of the common carotid arteries (CCA), presence of atheromatous plaques) in two French cohorts. Methods and results564 middle-aged French individuals (mean age 53 ± 12 years) from two cohorts (ERA and STANISLAS cohorts) were included in the study. Blood pressure, CCA intima–media thickness, CCA internal diameter and number of atheromatous plaques were measured. Catalase rs769214 SNP genotyping was performed. We identified a CAT haplotype that influences arterial aging. Individuals carrying the CAT2 haplotype had a higher mean internal diameter of CCA with aging and/or with an SBP ≥140 mmHg and were associated with a greater number of atheromatous plaques than CAT1 haplotypes carriers. This CAT2 haplotype appeared as an independent risk factor of arterial aging, similarly to previously identified factors such as age, systolic blood pressure, male, sex, tobacco use, hs-CRP, BMI and diabetes. ConclusionThe present study highlights the roles of CAT haplotypes in arterial aging and underlines the beneficial impact of the CAT1 haplotype on mean internal diameter of the CCA and atheromatous plaque number as well as on potential associated diseases.

Carotid Intima-Media Thickness in Patients with Non-Alcoholic Fatty Liver Disease

Objective: To measure the thickness of Carotid Intima Media (CIMT) in patients with Non-Alcoholic Fatty Liver Disease (NAFLD) and compare it with Controls, to establish the strong association of NAFLD with increased CIMT.Method/Setting: Fifty four patients with sonographically proven NAFLD and 50 controls were examined for CIMT. Carotid scanning was performed on Aloka 3500 Doppler Unit.Results: The mean Intima Media Thickness in NAFLD group was 0.80±0.12 and in controls 0.58±0.15 (p=

Carotid intima-media thickness and plaque in apparently healthy Japanese individuals with an estimated 10-year absolute risk of CAD death according to the Japan Atherosclerosis Society (JAS) guidelines 2012: the Shiga Epidemiological Study of Subclinical Atherosclerosis (SESSA).

To examine whether subclinical atherosclerosis of the carotid arteries is concordant with the categories in the 2012 atherosclerosis prevention guidelines proposed by the Japan Atherosclerosis Society (JAS guidelines 2012), which adopted the estimated 10-year absolute risk of coronary artery disease (CAD) death in the NIPPON DATA80 Risk Assessment Chart. Between 2006 and 2008, 868 Japanese men 40 to 74 years of age without a history of cardiovascular disease were randomly selected from Kusatsu City, Japan. The intima media thickness (IMT) and plaque number from the common to internal carotid arteries were investigated using ultrasonography. The absolute risk of CAD death was estimated based on the individual risk factor data, and the mean IMT and plaque number in Categories Ⅰ, Ⅱ and Ⅲ of the guidelines were examined. The estimated 10-year absolute risk of CAD was directly related to the IMT (mean IMT (mean ± SD) (mm) for a 10-year absolute risk of ≥ 2.0% and ≥ 5.0%: 0.88 ± 0.18 and 0.95 ± 0.19, respectively) and the plaque number. These results are compatible with the categories described by the guidelines (mean IMT (mean ± SD) (mm) for Categories Ⅰ, Ⅱ, and Ⅲ: 0.70 ± 0.11, 0.81 ± 0.16 and 0.88 ± 0.18, respectively; mean plaque number: 0.9, 2.1 and 3, respectively). These findings were similar for Category Ⅲ participants with or without DM and CKD. Subclinical atherosclerosis of the carotid arteries is concordant with the 10-year absolute risk of CAD and the categories in the JAS guidelines 2012.

Association of Carotid Artery Parameters of Atherosclerosis in Coronary Artery Disease

BackgroundAlthough carotid intima-media thickness (IMT) is the most commonly used ultrasonic measurement of atherosclerosis, plaque burden can be also assessed by ultrasound (US). We investigated the relationship between IMT, total plaque area (TPA) and total plaque volume (TPV) in patients with coronary artery disease (CAD).MethodsOne hundred and seven patients with suspected CAD and carotid plaques identified by duplex ultrasound underwent 3-dimensional US and coronary angiography. The mean IMT, TPA, and TPV were analyzed for patients with CAD according to the severity of CAD.ResultsIn the 107 participants, IMT, TPA and TPV averaged 0.90 ± 0.26 mm, 0.42 ± 0.39 cm2 and 237.0 ± 301.2 mm3, respectively. We found significant correlations for mean IMT : TPA, mean IMT : TPV and TPA : TPV of 0.448, 0.587 and 0.873, respectively (all p < 0.005). Although there was no significant association of IMT and the severity of CAD, TPA and TPV showed significant positive correlation with CAD severity (r = 0.340, p = 0.0003 for TPA and r = 0.465, p < 0.0001 for TPV). Multivariate linear regression analysis showed age was the only significant attributor to IMT, TPA, and TPV. Mean IMT was significantly associated only with hypertension. TPA was significantly associated with male sex, hypertension, and low density lipoprotein-cholesterol (LDL-C). TPV was significantly associated with male sex, C-reactive protein, and LDL-C.ConclusionAlthough there were significant correlations among the various US measures of carotid artery morphology, there seemed to be different biological determinants of IMT, TPA, and TPV. We might need to be selective about the particular measurements for specific applications.

Effect of Long-Term Intensive Lipid-Lowering Therapy With Rosuvastatin on Progression of Carotid Intima-Media Thickness

Recently, it was reported from the Justification for Atherosclerosis Regression Treatment (JART) Study that intensive therapy with rosuvastatin significantly slowed progression of carotid intima-media thickness (IMT) compared with conventional therapy with pravastatin at 12 months. To assess the long-term efficacy of intensive therapy, the present extension study was conducted. Subjects in the intensive therapy group of the JART Study were asked to participate in the extension study and to continue rosuvastatin treatment. A total of 113 subjects were enrolled into the extension study and were included in the analysis. At 24 months, the mean daily dose of rosuvastatin (±SD) was 7.9±2.9 mg. Mean change in mean IMT was -0.005 mm (range, -0.024 to 0.015 mm) at 24 months (P=0.633, compared with baseline). Rosuvastatin lowered low-density lipoprotein cholesterol (mean±SD) by 46.4±13.8% and elevated high-density lipoprotein cholesterol (mean±SD) by 8.9±24.0% at 24 months compared with baseline. Gray scale median was measured in 25 subjects. It increased by 16.93±33.12 (mean±SD) % at 12 months and by 22.50±52.83% at 24 months from baseline (P=0.017, P=0.044, respectively). Two-year treatment with rosuvastatin inhibited progression of carotid IMT. Rosuvastatin also improved the plaque composition, and this qualitative change occurred relatively early after starting therapy.

Correction: The metabolic syndrome and progression of carotid atherosclerosis over 13 years: the Tromsø study

After publication of our work, we have noticed some inadvertent errors in the article [1]. We deeply regret that these occurred and are hereby presenting corrections. In the 'Subjects’ section (page 2), the second paragraph should read as follows from the fifth sentence and onwards: “During follow-up, 1515 persons died and 468 moved from Tromso. Of the remaining 4744 subjects who were still alive and living in Tromso, 2974 subjects (62.6%) attended the carotid ultrasound examination in the 6th survey in 2007–2008, and were included in the present study.” In the 'Statistical analysis’ section (page 4), the sixth and seventh sentences should read: “Linear regression models were fitted with IMT and TPA as dependent variables and MetS, age, LDL cholesterol and smoking as independent variables. Similarly, stepwise linear multivariable models with forward selection and significance level 0.05 for entry into the model were fitted with each component of the metabolic syndrome entered as separate independent variables, together with age, LDL cholesterol and smoking.” In Table 2, the correct value for the ΔIMT value in participants with metabolic syndrome in the age group 50–59 years was 0.160 mm. The corresponding value for participants in the same age group without metabolic syndrome was 0.169 mm. Errors had also occurred during preparation of Figures 1 and ​and2,2, and corrected figures are presented here. Figure 1 Follow-up levels of mean intima-media thickness (IMT) and total plaque area (TPA). The Tromso Study. a: Mean IMT (mm) at follow-up in subjects with and without metabolic syndrome (MetS), by age group. b: Mean TPA (mm2) at follow-up in subjects ... Figure 2 Change in intima-media thickness (IMT) and total plaque area (TPA) from baseline to follow-up. The Tromso Study. a: Change in IMT (mm) in subjects with and without metabolic syndrome (MetS), by age group. b: Change in TPA (mm2) in subjects with ... The errors had no effect on the scientific content and conclusions.

Impact of Peritoneal Dialysis Treatment on Arterial Stiffness and Vascular Changes in Diabetic Type 2 and Nondiabetic Patients with End-Stage Renal Disease

Diabetes mellitus (DM) is the leading cause of the end-stage renal disease (ESRD). Vascular diseases are the most common cause of morbidity and mortality in the chronic kidney disease. The aim of this study was to analyze the impact of peritoneal dialysis (PD) treatment on morphologic and hemodynamic vascular parameters of carotid arteries in diabetic type 2 and nondiabetic patients with ESRD during the period of one year after the start of PD treatment using ultrasonography of carotid arteries and their relation on uremia and PD inherent factors. Mean intima-media thickness, plaque score, peak systolic velocity, end-diastolic velocity, and carotid diameter significantly decreased 12 months after PD treatment start in both groups. Significant reduction in median serum endothelin-1 concentration after 12 months on PD treatment was observed in the group of patients with DM (7.6–5.9 pg/mL) and also in group of patients without DM (3.6–3.3 pg/mL). Also median nitric oxide concentration significantly increased after 12 months on PD compared to baseline levels both in patients with DM (25.0–34.3 μmol/L) as was observed in patients without DM (49.6–56.5 μmol/L). PD treatment, with the regulation of these vasoactive molecules and other vascular risk factors, significantly contributes to vascular remodeling, especially in DM patients.

Rationale, Design, and Baseline Characteristics of a Trial for the Prevention of Diabetic Atherosclerosis Using a DPP-4 Inhibitor: The Study of Preventive Effects of Alogliptin on Diabetic Atherosclerosis (SPEAD-A)

Alogliptin, an efficacious inhibitor of DPP-4 that improves glycemic control, as well as the pancreatic beta-cell function, is now increasingly used to accomplish glycemic targets in type 2 diabetic patients. Interestingly, recent experimental studies have shown that alogliptin exerts anti-atherosclerotic effects in GLP-1-dependent and -independent manners. The aim of the present ongoing study is to investigate the preventive effects of alogliptin on the progression of atherosclerosis in type 2 diabetic subjects using the carotid intima-media thickness (IMT), an established marker of cardiovascular disease. The Study of Preventive Effects of Alogliptin on Diabetic Atherosclerosis (SPEAD-A) is a prospective, randomized, open-label, blinded-endpoint, multicenter, parallel-group, comparative study. Between March 2011 and March 2012, 341 participants were recruited at 11 clinical sites, and were randomly allocated either to an alogliptin treatment group (172 patients) or a conventional treatment group (169 patients). The primary outcomes are the changes in the maximum and mean IMT of the common carotid artery during a 24-month treatment period, as measured by carotid arterial echography. The secondary outcomes include the changes in glycemic control, parameters related to beta-cell function and diabetic nephropathy, the occurrence of cardiovascular events and adverse events and biochemical measurements reflecting vascular function. This is the first study to address the effects of DPP-4 inhibitors on the progression of changes in the carotid IMT, with the patients without DPP-4 inhibitor treatment serving as a control group. The results will be available soon, and these findings are expected to provide clinical data that will be helpful in the prevention of diabetic atherosclerosis and subsequent cardiovascular disease.

ALK7 Gene Polymorphism is Associated with Metabolic Syndrome Risk and Cardiovascular Remodeling

BackgroundActivin receptor-like kinase 7 (ALK7) is a type I receptor for the TGF-β superfamily and has recently been demonstrated to play an important role in the maintenance of metabolic homeostasis. ObjectiveTo investigate the association of the ALK7 gene polymorphism with metabolic syndrome (MetS) and cardiovascular remodeling in MetS patients. MethodsThe single nucleotide polymorphism rs13010956 in the ALK7 gene was genotyped in 351 Chinese subjects undergoing carotid and cardiac ultrasonography. The associations of the ALK7 gene polymorphism with the MetS phenotype, MetS parameters, and cardiovascular ultrasonic features were analyzed. ResultsThe rs13010956 polymorphism in the ALK7 gene was found to be significantly associated with the MetS phenotype in females (p < 0.05) and was also significantly associated with blood pressure in the total (p < 0.05) and female populations (p < 0.01). Further analysis revealed that rs13010956 was associated with mean intima-media thickness of the carotid arteries in females (p < 0.05). After control for body mass index, blood pressure, fasting blood glucose, and triglycerides, rs13010956 was also found to be significantly associated with left ventricular mass index in the total (p < 0.05) and female populations (p < 0.05). ConclusionOur findings suggested that the ALK7 gene polymorphism rs13010956 was significantly associated with MetS risk in females and may be involved in cardiovascular remodeling in MetS patients.

Arterial Wall Elasticity Measured Using the Phased Tracking Method and Atherosclerotic Risk Factors in Patients with Type 2 Diabetes

The aim of this study was to investigate the relationship between atherosclerotic manifestations and brachial and radial arterial wall elasticity (AWE) measured using the phased tracking method in patients with type 2 diabetes mellitus (T2DM). This study included T2DM patients (n= 220, mean age 59 years) without a history of stroke or coronary artery disease. The brachial AWE, radial AWE, carotid mean intima-media thickness (IMT), max-IMT and flow-mediated vasodilation (FMD) were measured. The patients were classified according to the number of atherosclerotic risk factors, including obesity, dyslipidemia and hypertension. Group 1 included T2DM patients only, group 2 included patients with two risk factors, group 3 included patients with three risk factors and group 4 included patients with four risk factors. The patients were also divided into two groups according to microangiopathic complications, including retinopathy and nephropathy. The between-group differences were analyzed. The brachial AWE (548, 697, 755 and 771 kPa for groups 1, 2, 3 and 4, respectively) and radial AWE (532, 637, 717 and 782 kPa for groups 1, 2, 3 and 4, respectively) significantly increased in association with an increasing number of risk factors. The brachial AWE and radial AWE were significantly higher in the patients with microangiopathic complications than in those without microangiopathic complications (brachial AWE 797 and 694 kPa and radial AWE 780 and 660 kPa, respectively). Receiver operating characteristic curve analyses revealed that, for brachial AWE and radial AWE, the area under the curve was equal to the max-IMT and higher than the mean-IMT and FMD. Upper limb AWE measurement can reflect the degree of atherosclerosis risk overload and may be useful for evaluating vascular complications in T2DM patients.