Mean Intima-media Thickness Research Articles

Assessment of influence of traditional cardiovascular risk factors and inflammation on arterial wall structural characteristics in psoriatic arthritis

Система комплексной поддержки и сопровождения научного журнала Elpub позволяет запустить двуязычный сайт журнала со встроенной системой электронной редакции в соответствии с лучшими издательскими практиками, а так же предусматривает техническую и методическую поддержку со стороны специалистов НЭИКОН.

Impact of low-density lipoprotein receptor mutational class on carotid atherosclerosis in patients with familial hypercholesterolemia

Background and objectivesDefects in the low-density lipoprotein receptor (LDLR) gene cause familial hypercholesterolemia (FH), a highly atherogenic condition. The effect of different LDLR mutations on coronary heart disease (CHD) risk is insufficiently defined. We assessed carotid intima-media thickness (IMT), a surrogate marker of CHD, in relation to LDLR mutational class in FH. MethodsIn 436 Spanish FH patients (223 men and 213 women, age 44±14 years) with known LDLR mutations, alleles were classified by standard criteria as null (n=269), defective (n=162), or undetermined (n=5). LDLR defects were detected using a microarray (Lipochip®) designed to uncover prevalent mutations in Spain and gene sequencing when no mutations were detected. Carotid IMT and plaque were assessed in FH patients and 268 healthy subjects. ResultsAll carotid measurements were increased in FH patients versus controls (p<0.05), irrespective of genotype. After adjustment for gender and age, patients with null alleles compared with defective alleles had similar mean and maximum common carotid artery (CCA) IMT, but higher maximum IMT at any carotid segment, with median values (95% confidence interval) of 1.25mm (1.19–1.31) and 1.11mm (1.05–1.18), respectively. Multivariate analysis showed that null alleles were independently associated with maximum CCA-IMT (β=0.09, p=0.033) with an impact similar to that of gender (β=0.10, p=0.035). ConclusionsFH patients show advanced carotid atherosclerosis in relation to LDLR mutational class. The findings support the utility of genetic testing in FH beyond providing a secure diagnosis.

Elevation of serum aminotransferase activity increases risk of carotid atherosclerosis in patients with non‐alcoholic fatty liver disease

Patients with non-alcoholic fatty liver disease (NAFLD) have an increased risk of atherosclerosis and alanine aminotransferase (ALT) is associated with insulin resistance independently of metabolic factors. The aim of the present study was to investigate whether NAFLD patients with ALT elevation had a higher risk of carotid atherosclerosis. A total of 190 individuals were enrolled from the health management center. Among them, 20 subjects were excluded due to the presence of hepatitis B surface antigen (HbsAg), anti-hepatitis C virus (HCV) and cardiovascular disease. NAFLD was diagnosed by ultrasound examination. Carotid ultrasonography was used to measure maximal intima-media thickness (IMT) of the common carotid artery (CCA) and IMT (mean) > 1.0 mm was defined as the presence of carotid atherosclerosis. NAFLD patients with ALT elevation had increased risk of carotid atherosclerosis than those with normal ALT by Fisher's exact test (P < 0.05). Multivariate analyses showed that serum ALT levels were positively associated with carotid atherosclerosis after adjustment for age, sex, number of metabolic syndrome components or status of metabolic syndrome (OR, 1.44; 95% CI 1.09-1.89; OR, 1.45; 95% CI 1.11-1.91). In addition, the higher the serum ALT levels with every 10 IU/L increment, the greater the risk of carotid atherosclerosis. Serum ALT levels are positively associated with the risk of carotid atherosclerosis in patients with NAFLD, suggesting that serum ALT levels could serve as a surrogate marker of cardiovascular risk in this special clinical setting.

Association between central systolic blood pressure, white matter lesions in cerebral MRI and carotid atherosclerosis

White matter hyperintensities (WMHs) observed on cerebral magnetic resonance images (MRIs) are associated with age and hypertension, suggesting a vascular mechanism of pathogenesis. Central systolic blood pressure (cSBP) correlates more closely with measures of cardiovascular disease risk than brachial pressure. We sought to determine whether cSBP correlates with WMHs and if cSBP is predictive of cerebrovascular disease. Radial applanation tonometric measurements for cSBP and augmentation index (AI) were carried out in unselected individuals undergoing carotid ultrasound. WMHs were assessed retrospectively using fluid-attenuated inversion recovery (FLAIR)-MRIs as periventricular (PVH) and deep white matter hyperintensities (DWMH), and they were rated using the Fazekas scale. A total of 179 patients, 94 (53%) men and 85 (47%) women, with a mean age of 66+/-13 years were included in the study. On MRI, 17, 74, 67 and 21 patients had PVH grades 0, 1, 2 and 3, respectively. Forty-eight, 69, 49 and 13 had DWMH grades 0, 1, 2 and 3, respectively. In our study population, PVH correlated with age, brachial SBP, cSBP and AI (r=0.49, 0.28, 0.23; P<0.002 and r=0.13; P<0.05, respectively). DWMH also correlated with age, brachial SBP and cSBP (r=0.41, 0.30, 0.22; P<0.003, respectively), but not with AI. cSBP values were associated with PVH/DWMH grades 2 and 3, but brachial SBP correlated only with grade 3. Mean carotid intima-media thickness (common carotid arteries (CCA)-IMT) was 0.68+/-0.13 mm. CCA-IMT and plaque score (PS) correlated with PVH/DWMH. Multivariate regression analysis showed cSBP, age and PS to be independently associated with PVH and DWMH. Correlation of cSBP with PVH and DWMH was independent of PS. Central SBP correlated with PVH and DWMH in FLAIR-MRIs and can better predict WMHs than brachial SBP in earlier stages.

Cardiovascular risk factors and non-invasive assessment of subclinical atherosclerosis in youth

Our understanding of the natural history of atherosclerosis in childhood and its response to cardiovascular (CV) risk factor reduction have been hampered by the lack of a reliable, non-invasive measure of atherosclerosis. Carotid intima media thickness (IMT), a surrogate marker of atherosclerosis in adults, is increased in youth heterozygous for familial hypercholesterolemia (FH) and declines with lipid lowering pharmacotherapy. The age at which vascular changes can be reliably identified using IMT and the influence of CV risk factors beyond FH on IMT remains unclear. ObjectiveTo examine the influence of demographic, family history, anthropometric characteristics and traditional CV risk factors on IMT in children 5–16 years of age (mean age 11 year). MethodsIn a cross-sectional study, we assessed IMT in 148 children (51 with elevated low density lipoprotein (LDL)-cholesterol, 44 with overweight and 53 controls). Measures included: family history of premature coronary heart disease (CHD), physical activity, pubertal stage, smoking history, fasting glucose, insulin, lipid profile, apolipoproteins A1 and B, anthropometry, blood pressure and IMT. ResultsThe groups were similar for age and family history of premature CHD. Compared to controls, average maximum IMT (0.403±0.04 vs 0.387±0.029) and average mean IMT were elevated in the hyperlipidemia group (p<0.05), but not in the overweight group (max IMT 0.393±0.034; p vs control=0.17). Using multiple regression modelling, age, family history of premature CHD and apoliprotein A1 and B predicted 17% of the variability in IMT. No measure of adiposity predicted IMT. ConclusionAge is an important predictor of IMT in youth. Among traditional CV risk factors, dyslipidemia and family history of premature CHD are independent predictors of IMT.

Cholesteryl Ester Transfer Protein, Coronary Calcium, and Intima-Media Thickness of the Carotid Artery in Middle-Age Japanese Men

The relation between cholesteryl ester transfer protein (CETP) levels and atherosclerosis is controversial. We examined whether the serum CETP levels were associated with subclinical atherosclerosis, independent of its most common gene variant, in a sample of Japanese men. A population-based cross-sectional study of 250 Japanese men aged 40 to 49 years was conducted to assess the intima-media thickness of the carotid artery, coronary artery calcium, serum CETP levels, and the CETP D442G gene variant. Compared with the lowest CETP quartile, the multivariate adjusted odds ratio for coronary artery calcium was 0.77 (95% confidence interval 0.18 to 3.36), 0.96 (95% confidence interval 0.27 to 3.40), and 3.49 (95% confidence interval 1.05 to 11.6) with increasing CETP quartiles. The serum CETP quartiles were also positively associated with the intima-media thickness of the carotid artery (adjusted mean 602, 616, 615, and 646 mum for the lowest to top quartile, respectively). The findings remained unchanged after additional adjustment for the CETP D442G gene variant. No significant difference was found in the prevalence of coronary artery calcium or in the mean intima-media thickness of the carotid artery between participants with and without the CETP D442G gene variant.

Diabetic state as a crucial factor for impaired arterial elastic properties in patients with peripheral arterial disease

Background Increased arterial stiffness is associated with greater risk of cardiovascular events and mortality. However, in patients with peripheral arterial disease (PAD) who have severe atherosclerotic disorder or risk clustering, the major determinants of increased stiffness have been not clarified. Methods This study investigated the associations between elastic properties of the carotid artery as measured by ultrasonography and atherosclerotic risk factors, with particular focus on diabetes mellitus (DM), in PAD patients ( n = 481; mean age, 69.6 years). DM was defined as hemoglobin A1c ≥6.5%, administration of anti-diabetic agents, or DM pattern on 75-g oral glucose tolerance test. Stiffness β index was calculated from luminal diameter changes measured by the M-mode method using a linear array imaging probe. Results Stiffness parameter β was significantly increased in diabetic patients compared with non-diabetic patients (9.56 ± 0.35 vs. 8.31 ± 0.32; p = 0.009) in an age- and gender-adjusted model. This significant difference was maintained in a multivariate-adjusted model including age, gender, hypertension, hyperlipidemia, obesity and smoking history (9.43 ± 0.36 vs. 8.39 ± 0.33; p = 0.037). No significant differences in mean intima-media complex thickness or plaque score of the carotid artery were seen between diabetic and non-diabetic patients. Conclusion Diabetic condition impairs the elastic properties of arteries, independent of other known atherosclerotic risk factors or excessive intimal diseases in PAD patients. This may support the notion that diabetic condition can worsen prognosis for PAD patients.

Dyslipidaemia and Intima-Media Thickness of Carotid Arteries in Thirty-Five HIV/AIDS Patients Receiving Highly Active Antiretroviral Therapy

Objectives: Highly active antiretroviral therapy (HAART) has being impacted significantly therapies for natural human immunodeficiency virus (HIV) infection, which leads to a remarkable decrease in its morbidity and mortality but it is frequently associated with metabolic complications such as dyslipidaemia and cardiovascular complications. HIV reverse transcriptase (RT) inhibitors can be classified into nucleoside and non-nucleoside types. Mitochondrial dysfunction due to the depletion of mt-DNA is partly responsible for various nucleoside RT inhibitors-associated adverse effects including dyslipidaemia. Efavirenz (EFV) is metabolized primarily by cytochrome P450 2B6 (CYP2B6) and the metabolic effects of EFV have been described previously. All patients in this study received the same HAART treatment regime (Stavudine (d4T) + Lamivudine (3TC) + Efavirenz (EFV)). This study aims to assess incidences for dyslipidaemia and atherosclerosis. Methods: This retrospective study was conducted within outpatients of Shanghai Public Health Center. We selected thirty-five HIV-1 infected patients who receiving highly active antiretroviral therapy. Their mean CD4 cell count was 69.5 (±34.6) copies per micro liter before therapy. Fasting total cholesterol, triglyceride, high-density lipoprotein (HDL) cholesterol and low-density lipoprotein (LDL) cholesterol values were respectively compared among patients at present and before therapy. Then the data was statistically analyzed. Twenty-two patients had the intima-media thickness (IMT) of their carotid arteries measured by Philips 5000 Color-Doppler ultrasound tests. Results: After therapy, patients achieved significant changes in levels of triglycerides (1.44 ± 0.35mmol/L Vs. 2.07 ± 0.54mmol/L) (P&lt;0.001), total cholesterol (4.96 ± 0.46 mmol/L Vs. 6.15 ± 0.83mmol/L) (P&lt;0.001) and LDL cholesterol (2.29 ± 0.33 Vs. 3.11 ± 0.29 mmol/L) (P&lt;0.001). In contrast, the level of HDL cholesterol did not significantly change (1.06 ± 0.01 mmol/L Vs. 1.04 ± 0.01 mmol/L) (P&gt;0.5). The mean IMT of twenty-two patients was (0.86 ± 0.14) mm after HAART, which is higher than the norm age-matched value of (0.7 ± 0.2) mm (P&lt;0.05). Conclusion: These data suggest that HAART is potentially dangerous for hyperlipidaemia and maybe an increase in atherosclerosis.

Associations of coronary artery calcification and carotid intima-media thickness with plasma concentrations of vascular calcification inhibitors in type 2 diabetic patients

Vascular calcification is frequently accompanied by intima-media thickening, but the associations among these atherosclerotic features and bone-related peptides in diabetic patients are unclear. We enrolled 168 type 2 diabetic patients and 40 non-diabetic subjects consecutively admitted to our hospital. Mean intima-media thickness (mean-IMT) in common carotid arteries was measured by B-mode ultrasonography. Agatston coronary artery calcium score (CACS) was obtained using multidetector-row computed tomography (MDCT). Plasma bone-related peptides osteopontin and osteoprotegerin levels were measured. Diabetic patients had higher mean-IMT ( p = 0.0002) and log(CACS + 1) ( p < 0.0001) and similar bone-related peptides compared to non-diabetic subjects. In diabetic patients classified into tertiles according to their CACS levels, those with the highest scores showed the highest mean-IMT ( p = 0.0004) and bone-related peptides ( p < 0.05) among the groups. log(CACS + 1) and mean-IMT were associated ( p < 0.0001) and were positively correlated with osteopontin ( p < 0.01) and osteoprotegerin ( p < 0.01) in diabetic patients. Multivariate analyses revealed that the significant independent determinants of log(CACS + 1) were age, duration of diabetes and osteopontin ( p < 0.0001) and those of mean-IMT were age, hypertension, osteopontin and osteoprotegerin ( p < 0.0001), respectively. We have demonstrated that vascular calcification in type 2 diabetic patients is frequently accompanied by intima-media thickening, and osteopontin may act as a vascular calcification inhibitor by increasing intima-media thickness.

Police Work and Subclinical Atherosclerosis

Employment as an urban police officer was hypothesized to be associated with increased structural subclinical cardiovascular disease (CVD), measured by carotid artery intima-media thickness (IMT). The sample of men and women consisted of police officers (n = 312) and the general population (n = 318), free of clinical CVD. Officers had elevated levels of age-adjusted CVD risk factors (blood pressure, total cholesterol, smoking prevalence) compared with the population sample. In age-, gender-, and traditional risk factor-adjusted models, police officers exhibited increased mean common carotid IMT (police = 0.67 mm, population = 0.64 mm; P = 0.03) and mean maximum carotid IMT (police = 0.99 mm, population = 0.95 mm; P = 0.13). Police officers have increased levels of atherosclerosis compared with a general population sample, which was not fully explained by elevated CVD risk factors; thereby potentially implicating other mechanisms whereby law enforcement work may increase CVD risk.

Carotid atherosclerosis and the risk factors in early postmenopausal Chinese women

Objectives To describe the distribution of intima-media thickness (IMT) and the prevalence of plaque by carotid segments, walls and sides, and to examine their associated risk factors in asymptomatic, early postmenopausal Chinese women in Hong Kong. Methods Between 2002 and 2004, the study recruited 518 postmenopausal women aged 50–64 years. They were examined by B-mode ultrasound to measure the IMT and the prevalence of plaque at the near and far walls of common carotid (CCA), bifurcation (bulb), and internal carotid (ICA) of both the left and right carotid arteries. Blood pressures, obesity indices, lipids and glucose levels, sociodemographic, medical and lifestyle factors were also obtained. Results The mean IMT was 0.76 ± 0.12 mm (range: 0.53–1.33 mm). IMT was significantly thicker on the far wall than on the near wall and differed among segments (being thickest at the bulb and the narrowest at the ICA). 21.8% had at least one plaque in the carotid artery with most of the plaque found at the bulb area. Systolic blood pressure had statistically significant relationship with IMT that were fairly homogeneous among different segments. Lipids were associated with the CCA and bulb IMT, but not the ICA IMT. Diabetes predicted only CCA IMT. Older age, higher waist–hip-ratio and low-density lipoprotein cholesterol were significant predictors of plaques at all sites combined. Conclusions We described the distribution of IMT and the prevalence of plaque in asymptomatic, early postmenopausal Chinese women. Associations of risk factors with IMT of different arterial segments were also observed.

Visceral adiposity and leptin are independently associated with C-reactive protein in Korean type 2 diabetic patients

The inflammatory marker, C-reactive protein (CRP) is associated with long-term cardiovascular events. The aim of the study was to investigate the factors contributing to serum CRP, assess the relationship between CRP level and the parameters of visceral obesity, and examine the association between leptin and CRP level in type 2 diabetic patients. 150 patients with type 2 diabetes were enrolled. These patients were recently diagnosed (< or =3 years) with type 2 diabetes and were drug naive or taking sulfonylureas only. BMI, WC, and serum concentration of CRP, glycosylated hemoglobin (HbA1c), glucose, lipids, plasminogen activator-1 (PAI-1) and leptin were measured. Insulin resistance was estimated by the insulin resistance index of homeostasis model assessment (HOMA-IR). We measured the carotid intima-media thickness (IMT). Fat mass assessed by dual-energy X-ray absorptionmetry and abdominal fat distribution was determined by CT scan. Serum concentration of CRP was significantly correlated with BMI (gamma = 0.257, P < 0.01), WC (gamma = 0.293, P < 0.01), fat mass (gamma = 0.213, P < 0.01), total adipose tissue (gamma = 0.263, P < 0.01), visceral adipose tissue (gamma = 0.296, P < 0.01), insulin (gamma = 0.189, P = 0.047), PAI-1 (gamma = 0.206, P < 0.01), leptin (gamma = 0.322, P < 0.01), mean IMT (gamma = 0.132, P = 0.042), and HOMA-IR (gamma = 0.172, P = 0.045). After adjustment for age and gender, multiple regression analysis showed that serum CRP was significantly associated with leptin (beta = 0.326, P = 0.01) and visceral adipose tissue (beta = 0.265, P = 0.035). In conclusion, serum CRP level is significantly associated with obesity, especially the visceral adipose tissue, and serum leptin is another important independent factor associated with CRP in Korean type 2 diabetic patients.

Association Between Wall Shear Stress and Carotid Atherosclerosis in Patients With Never Treated Essential Hypertension

Wall shear stress (WSS) has been shown to be a critical determinant of vessel diameter implicated in vascular remodeling and atherogenesis. Carotid intima-media thickness (IMT), resistive index (RI), and pulsatility index (PI) have been used as relevant indictors for carotid atherosclerosis. The study aimed to investigate the relationship between hemodynamic parameters in the common carotid artery (CCA) and the severity of carotid atherosclerosis in untreated hypertensive patients. Duplex ultrasound was performed in 64 untreated hypertensive patients and 16 age-matched normotensive control subjects. Morphologic and hemodynamic parameters of CCA, including peak and mean WSS, RI, PI, and IMT were calculated after measuring internal diameter (ID) and flow velocity of CCA. Subjects with hypertension had lower peak and mean WSS than did normotensive control subjects (P < 0.05). Both carotid RI and PI were found to correlate inversely with mean WSS in hypertensive subjects. There was no correlation between carotid IMT and WSS. Stepwise multiple regression analysis for carotid RI and PI after adjustment for age, carotid IMT, and high sensitivity C-reactive protein (hsCRP) showed that mean WSS was an independent determinant of RI and PI. High carotid atherosclerotic indexes as expressed by both RI and PI are associated with low WSS in CCA. These findings indicate that local shear stress is associated with altered vascular pulsatility and resistance. Consequent alteration in local vascular dynamics could be an underlying mechanism for the progression of atherosclerosis.

Proteomic study of macrophages exposed to oxLDL identifies a CAPG polymorphism associated with carotid atherosclerosis

Objective Macrophages play a key role in the development of atherosclerosis. The objective of this observational study was to characterize the proteome of macrophages to identify proteins implicated in atherosclerosis. Methods The proteome of macrophage exposed to oxidized low-density lipoprotein (LDL) was studied in a sample of 12 subjects with autosomal dominant hypercholesterolemia and analyzed according to carotid atherosclerosis. Carotid intima-media thickness (IMT), genotyping of the polymorphisms responsible for the amino acid change present in the identified proteins, and an association study was performed in a sample of 320 subjects with autosomal dominant hypercholesterolemia and 145 normolipemic controls. Results Mass spectroscopy identified two proteins, gelsolin like capping protein (CapG) and glutathione-S-transferase omega 1 (GSTO1), with large variability among subjects which corresponded with two common genetic variants. The rs6886 polymorphism in CAPG was significantly associated with carotid IMT. Carriers of the minor allele in CAPG polymorphism presented less carotid IMT than noncarriers in the hypercholesterolemia group (mean and maximum internal carotid IMT p = 0.016 and p = 0.032, respectively). This effect was more important in subjects below 50 years old (mean and maximum internal carotid IMT p < 0.001). Conclusions Association analysis revealed rs6886 polymorphism in CAPG to be associated with carotid IMT, suggesting that this polymorphism could modulate macrophages’ response to oxidized LDL in subjects with hypercholesterolemia.

Relation of Carotid Intima-Media Thickness and Aortic Valve Sclerosis (from the ISMIR Study [“Ispessimento Medio Intimale e Rischio Cardiovascolare”] of the Italian Society of Cardiovascular Echography)

Carotid intima-media thickness (IMT) and aortic valve sclerosis (AVS) have recently emerged as important predictive factors for cardiovascular (CV) events. However, few data are available on their association and the respective roles of major CV risk factors in determining either condition. In this study, 479 asymptomatic subjects (mean age 58 +/- 13 years, 62% men) were assessed, without histories of CV disease, consecutively referred for comprehensive evaluations by echocardiography and carotid ultrasonography because of the presence of > or = 1 risk factor. Common carotid artery IMT and aortic valve morphology and function were analyzed. The mean IMT was 0.82 +/- 0.19 mm. The prevalence of increased carotid IMT (>0.80 mm) and AVS was 60.8% and 18.4%, respectively. The prevalence of increased IMT was 79.6% in subjects with AVS and 56.5% in those without AVS (relative risk 2.99, 95% confidence interval 1.72 to 5.21, p <0.001). On multivariate analysis, increased IMT was significantly and independently associated with hypertension, dyslipidemia, obesity, family history of CV disease, and age. Only age emerged as an independent predictor of AVS. The presence of both markers was independently associated only with hypertension and age. In conclusion, increased carotid IMT was strongly associated with AVS in a population of asymptomatic patients. IMT and AVS were differently related to individual CV risk factors, and their association seems to be correlated mainly with age and hypertension.

Evaluación del grosor del complejo íntima-media de la carótida en la hipercolesterolemia familiar durante la infancia

Introduction Familial hypercholesterolemia (FH) is characterized by exposure to severely elevated LDL-cholesterol from birth, which produces lipid deposits, which can be measured by means of intima-media thickness (IMT). Subjects and methods The IMT and concentrations of cholesterol and its fractions, triglycerides, alipoproteins Apo-A1, Apo-B and endothelial risk factors (homocysteine and high sensitivity protein C ) were determined in 89 patients (44 males) from 2 to 19 years (9.54±3.91 years). IMT was measured by ultrasound using a 12 MHz linear array transducer in both carotids to 1 cm of the bulb. The IMT mean was compared with age, sex and analytical parameters using multiple regression analysis. Results The mean values were: IMT 0.334±0.088 mm, total cholesterol 273.62±91.93 mg/dl, LDL-cholesterol 204.21±86.16 mg/dl, LDL/HDL 3.83±1.45, apoprotein A1 134.61±26.49 mg/dl, apoprotein B 130.59±40.59 mg/dl, homocysteine (median) 7.16 mmol/dl, Protein C (median) 0.3 mg/l. Using multiple regression analysis, only age was associated with IMT ( P=0.049), a mean 0.005 mm (95% CI: 0.000–0.010) being the annual increase: up to 12 years the increase in IMT was 0.002 mm/year on (95% CI: −0.007–0,010) and then from that age it was 0.013 mm/year (95% CI: −0.023–0.049). Conclusions The measurement of the carotid IMT could become an objective parameter in the evaluation of the FH in childhood. In our study, it is only associated with age, the increase being most marked from 12 years onwards.

Can beta stiffness index be proposed as risk factor for dementia

Background and aim Changes of arterial stiffness indicate alteration in arterial mechanics predisposing to the evolution of stroke or vascular dementia. The aim of this pilot study was to investigate whether ultrasound parameters, particularly beta stiffness index (BSI), should be further explored as independent markers or risk factors for dementia. Patients and methods There were 38 demented patients included in this study (72.53 ± 7.87 yrs) and 33 clinically healthy controls (68.85 ± 3.52 yrs). Risk factors were noted and ultrasound measurements performed on common carotid artery (CCA) using eTracking software on Aloka ProSound ALPHA 10 with 13 MHz linear probe. Level of significance was p < 0.05. Results Arterial hypertension was present in 24 patients, atrial fibrillation in 9, diabetes in 3, and hypercholesterolemia in 18. Hypertension was present as a single risk factor in 15 controls with average diastolic blood pressure significantly lower in patients. Significantly higher in patients were mean intima-media thickness, systolic and diastolic CCA diameters (CD), and mean BSI in CCA bilaterally. Linear regression analysis for groups of Alzheimer's dementia and vascular dementia proved that MMSE of the two groups relates to CCA diameter change (CDc) and BSI change explaining up to 5% of variability. Conclusions CD, CDc and BSI should be monitored in patients with cognitive decline and further explored as possible independent markers or risk factors; in future studies groups of demented and non-demented patients should be age, sex and risk factor matched.

Measurement of the Intimal Thickness of the Carotid Artery: Comparison Between 40 MHz Ultrasound and Histology in Rats

Common carotid artery intimal thickness (IT) has been shown to be as useful as a measurement of the whole layer of intima-media thickness (IMT) for evaluating the early phase of atherosclerosis. The aim of this study was to elucidate the relationship between high echogenic intimal thickening (HEIT), which was measured using a 40 MHz ultrasound biomicroscope (UBM), and the histologically determined IT in rat carotid arteries. HEIT was estimated in 10 Wistar-Kyoto rats (group I), 15 spontaneous hypertensive rats (SHR) fed a standard diet (group II) and 10 SHR fed a high-fat diet (group III). IT and IMT measurements were determined in Masson trichrome-stained tissues and were compared with the HEIT and IMT evaluated using the UBM. In group I, the HEIT and the IT were 33 ± 4 μm and 12 ± 1 μm, respectively. In group II, the HEIT and the IT were 68 ± 8 μm and 16 ± 2 μm, respectively. In group III, the HEIT and the IT were 65 ± 26 μm and 33 ± 14 μm, respectively. In SHR, the HEIT and the mean IMT measured with echography were significantly correlated with the IT and the IMT that were determined by histologic measurement ( r = 0.60, p = 0.003 and r = 0.53, p = 0.01, respectively). Moreover, HEIT may be associated with the intimal pathology and atherosclerotic burden. The HEIT measurement is a noninvasive method that may be used to assess atherosclerosis in humans. (E-mail: younhj@catholic.ac.kr)

A cross-sectional study of intima-media thickness, ethnicity, metabolic syndrome, and cardiovascular risk in 2268 study participants.

To describe the association between intima-media thickness (IMT) and metabolic syndrome (MetS) and to examine if the addition of IMT to a traditional MetS definition adds value to the assessment of predicted cardiovascular disease (CVD) risk in a large multiethnic population. In this cross-sectional study, carotid IMT was measured in 2268 men and women as part of a wellness physical examination between August 1, 2000, and October 1, 2001. The wellness examination included a fasting lipid panel, physical examination, and medical history. Mean IMT was described by sex, ethnicity, and the MetS. Predicted risk for CVD was determined with IMT as a component of the diagnostic criteria for MetS. Intima-media thickness increased with each additional component of the MetS, increasing from 0.516 mm for 0 components to 0.688 mm for 4 or more components (P<.001). In each ethnic group (non-Hispanic whites, blacks, Hispanics, and Asians), those with the MetS had higher mean IMT (increased by 0.084 mm to 0.134 mm) than those without MetS. The addition of IMT as a "new" component in the diagnosis of MetS allowed us to identify 78 (3.4%) participants who were not previously diagnosed as having MetS but who had a high 10-year estimated risk of MetS as measured by the Framingham risk score (11.67%). The addition of IMT to the traditional criteria for the diagnosis of the MetS may help identify individuals who otherwise would not have been identified to be at high risk of CVD.

Stiffness parameters, intima-media thickness and early atherosclerosis in systemic lupus erythematosus patients

Detection of early carotid vascular disease in patients with systemic lupus erythematosus (SLE) is considered mandatory for evaluation of subclinical atherosclerosis (ATS), and various ultrasonographic (US) parameters have been proposed. In the present investigation, 33 SLE and 33 healthy age-matched females have been studied by colour-coded sonography of the common carotid artery, assessing intima-media thickness (IMT), vascular strain (VS), vascular distensibility (VD), vascular stiffness (VSf) and pressure-strain elastic modulus (PSEM) as possible markers of early ATS. Patients with SLE, despite equivalent exposure to "traditional" cardiovascular risk factors, presented a higher mean IMT of the common carotid artery than healthy subjects (0.7 +/- 0.2 mm vs 0.5 +/- 0.1 mm - P < 0.0001). Of the stiffness parameters, patients with lupus showed a mean VSf of 0.72 +/- 0.38 vs 0.54 +/- 0.14 in controls (P < 0.0001) and a mean PSEM of 6.0 +/- 2.8 Pa vs 3.0 +/- 1.4 Pa in controls (P < 0.0001). Mean VS and VD were significantly lower in patients with SLE than in healthy subjects (P < 0.0001). Among individuals with IMT < 0.6 mm, patients with SLE presented more compromised stiffness parameters. IMT was shown to be a useful parameter in the evaluation of vascular damage, even in a "sub-clinical" phase, while stiffness parameters provide additional details regarding endothelial and vessel functional state. Combined evaluation may allow ATS to be detected in the early stages in patients with SLE.