Mean Intima-media Thickness Research Articles

Adiponectin and vascular properties in obese patients: is it a novel biomarker of early atherosclerosis?

Adiponectin is an adipocyte-derived collagen-like protein, highly specific to adipose tissue and may represent an important link between obesity and atherosclerosis. The present study was designed to investigate a possible association between serum adiponectin levels and early vascular changes in obese patients as determined by intima media thickness (IMT) and arterial pulse-wave contour analysis. Obese subjects (n=47) were evaluated for arterial structure and function, metabolic parameters and serum adiponectin levels. IMT was measured by ultrasound. Arterial elasticity was evaluated using pulse-wave contour analysis. Insulin resistance was assessed by homeostasis model assessment (HOMA-IR). diponectin was significantly, inversely associated with mean IMT (r=-0.369, P=0.011) and significantly positively associated with large artery elasticity index (LAEI) (r=0.467, P=0.001) as well as small artery elasticity index (SAEI) (r=0.462, P=0.001). In separate multivariate models, adiponectin remained significantly associated with mean IMT, LAEI and SAEI even after adjustment for cardiovascular confounders. Among metabolic parameters, adiponectin was significantly positively associated with HDL cholesterol and inversely associated with triglycerides. Adiponectin was significantly inversely associated with fasting insulin and HOMA-IR. In addition, a marginally inverse association between adiponectin and ALT was observed. In this study, serum adiponectin levels were significantly associated with indices of subclinical atherosclerosis, such as IMT and arterial compliance in obese patients. This association was independent of traditional cardiovascular risk factors.

The C609T variant of NQO1 is associated with carotid artery plaques in patients with type 2 diabetes

Objective Atherosclerosis in patients with type 2 diabetes has been linked to oxidative stress. NADP[1]:quinone oxidoreductase 1 (NQO1) plays a key role in cellular antioxidant defense. Recent reports suggest that highly expressed and inducible endogenous NQO1 from cardiovascular cells may act as a potential superoxide scavenger. We examined the relationship between the risk of NQO1 C609T polymorphism and carotid artery atherosclerosis in patients with type 2 diabetes. Methods We recruited 601 (Seoul set) and 233 (Koyang set) unrelated patients with type 2 diabetes from independent groups. The C609T variant of NQO1 was genotyped by Taqman RT-PCR. Mean and maximum carotid intima-media thickness (IMT) and carotid artery plaques were measured by high-resolution ultrasonography. Results Patients with the T allele exhibited a higher prevalence of atherosclerotic plaques than non-T allele carriers in both sets (Seoul set vs. Koyang set, p = 0.021, p = 0.023, respectively). After adjusting for age, sex, duration of diabetes, systolic blood pressure, body mass index, current smoking, HDL-cholesterol, LDL-cholesterol and HbA1c, subjects with the T allele had a significantly higher risk of carotid artery plaques (Seoul set vs. Koyang set, OR = 1.65, p = 0.015; OR = 2.00, p = 0.037, respectively) than subjects with the CC genotype. Conclusion These results suggest that the C609T polymorphism of NQO1 is associated with carotid artery plaques in type 2 diabetic patients.

Relation of stiffness parameter β to carotid arteriosclerosis and silent cerebral infarction in patients on chronic hemodialysis

Aortic stiffness measured by pulse wave velocity (PWV) predicts all-cause and cardiovascular mortality in hemodialysis (HD) patients. However, there is a lack of information on stiffness parameter beta, another index of arterial stiffness, in HD patients. The aim of the present study was to investigate the clinical usefulness of stiffness parameter beta in HD patients. We compared the relation of stiffness parameter beta to carotid intima-media thickness (IMT) and plaque score estimated by carotid ultrasound and investigated the relationship between stiffness parameter beta and silent cerebral infarction (SCI) in 64 HD patients. Stiffness parameter beta was positively correlated with mean IMT (r = 0.318, P = 0.0113) and plaque score (r = 0.672, P < 0.0001). Stepwise regression analysis revealed that pulse pressure and age were found to be independent determinants of stiffness parameter beta (partial correlation coefficients: beta = 0.501 and P < 0.0001 for pulse pressure, beta = 0.488 and P < 0.0001 for age). In addition, stiffness parameter beta in patients with SCI (12.2 +/- 3.9) was significantly higher than those (8.0 +/- 2.4) in patients without SCI. However, there was no significant difference in mean IMT and plaque score in both groups. These results suggest that arteriosclerosis assessed by stiffness parameter beta is associated with atherosclerotic changes of carotid arteries and with the presence of SCI in HD patients.

A study of the development of macrovascular complications and factors related to these complications in young adults with childhood/adolescence-onset type 1 diabetes mellitus

Purpose : Macrovascular complications are the main cause of mortality in type 1 diabetes mellitus (T1DM). The purpose of this study was to clarify the presence of early vascular changes and to assess the risk factors of macrovascular complications in young adults with T1DM diagnosed in childhood and adolescence. Methods : Seventy-two patients (23.92.4 years) with T1DM diagnosed before 18 years of age and twenty normal controls were included. The incidence of hypertension, dyslipidemia, and other risk factors of macrovascular complication were reviewed. Flow-mediated vasodilation (FMD) and mean intima-media thickness (IMT) measured by ultrasound were compared between patients and control subjects, and their correlations with macrovascular risk factors were analyzed. Results : Of the 72 patients, 32 (44.4%) had hypertension. The proportions of maleness (P=0.03) and mean body mass index (P=0.04) were higher in the hypertensive patients than in normotensive patients. Thirty-one (N=69, 44.9%) patients had dyslipidemia and LDL-cholesterol was positively correlated with mean HbA1c (r=0.32, P=0.008) and total daily insulin dose (r=0.27, P=0.02). The mean IMT was significantly higher in patients than in control subjects (0.430.06 mm vs 0.390.06 mm, P=0.03). There was no difference in the value of FMD between patients and controls, but the duration of the disease after pubertal onset was negatively correlated with FMD (r=-0.34, P=0.01). Conclusion : Hypertension, dyslipidemia and atherosclerotic vascular change were observed in young adults with T1DM diagnosed during childhood and adolescence; this strongly suggests that meticulous screening of macrovascular complications and control of their risk factors should be conducted.

Evaluation of Plaque Stabilization by Fluvastatin with Carotid Intima- Medial Elasticity Measured by a Transcutaneous Ultrasonic-Based Tissue Characterization System

As an approach to tissue characterization, we attempted to classify in vivo carotid plaque tissues in terms of arterial wall elasticity instead of echogenicity on B-mode scanning and investigated whether the effect of fluvastatin on carotid elasticity can be detected in hypercholesterolemic patients. In 170 subjects, simultaneous measurements of intima-media thickness (IMT) and elastic modulus in the circumferential direction (E(theta)) were performed using a new transcutaneous high-resolution Doppler technique. From the observation of various tissues, an elasticity library was obtained as follows: lipid core, 22+/-15 kPa; calcification, 674+/-384 kPa; lipid core- and calcification-free plaques, 173+/-69 kPa; smooth muscle, 104+/-32 kPa; blood clot, 85+/-68 kPa; fibrosis, 273+/-173 kPa.The effect of fluvastatin (30 mg/day, n=62) was assessed over 12 months using the elasticity distribution and serum markers. The statin reduced low-density lipoprotein cholesterol, high-sensitivity CRP, mean IMT and mean E(theta), and increased nitrite/nitrate. In the max IMT > or =1.1 mm group, both E(theta) and IMT decreased significantly. On the other hand, in the max IMT <1.1 mm group, E(theta) but not IMT decreased significantly. The histogram of the subgroups showing increased E(theta) with max IMT> or =1.1 mm revealed a decrease in areas corresponding to E(theta) of 20200 kPa (lipid/smooth muscle-rich tissue) and an increase in relatively hardened areas of <250 kPa (collagen fibers). Non-invasive echographic carotid arterial elasticity measurement is useful for the classification of atherosclerotic plaques and evaluation of chronological and histopathological changes.

Albuminuria within the normal range and ultrasound‐assessed atherosclerosis in the AIR study: a 9‐year follow‐up of 58‐year‐old clinically healthy men

Background:Microalbuminuria, traditionally defined as 30–300 mg urinary albumin/24 h, predicts renal impairment and cardiovascular disease. Studies suggest that also a far lower urinary albumin excretion (UAE) can predict clinical outcome. Intima media thickness (IMT) is an established estimate of atherosclerosis. In this study, we investigated the predictive value of UAE within the normal rate (UAE–n) for the progression of IMT in the carotid and femoral arteries. Methods: We included 325 clinically healthy men with normoalbuminuria. Anthropometrics, urine and blood samples were taken and IMT in the carotid and femoral arteries were assessed by B–mode ultrasound at baseline and after 3 and 9 years. The annual progression rate of IMT (r–IMT) was calculated. Results: UAE–n correlated with carotid IMT at baseline and after 3 and 9 years, but not with r–IMT. In a regression analysis, only HDL and baseline IMT remained as statistically significant co–variates to mean IMT at 9 years. IMT in the femoral artery and r–IMT at any time–point did not correlate to baseline UAE. Conclusion: UAE–n was associated with carotid IMT after 3 and 9 years but not r–IMT or with femoral artery IMT. Carotid IMT after 9 years' follow–up was independently related to baseline IMT and HDL cholesterol. In this cohort of 58–year–old men, our interpretation is that UAE–n is not associated with the increase in carotid and femoral artery IMT observed after 9 years.

Pitavastatin Improves Plasma Pentraxin 3 and Arterial Stiffness in Atherosclerotic Patients with Hypercholesterolemia

To investigate the effect of pitavastatin on asymptomatic atherosclerosis in patients with hypercholesterolemia. Thirty-five outpatients with hypercholesterolemia (61.5+/-12.8 yr) were administered 2 mg oral pitavastatin daily for 6 months. Plasma pentraxin 3 (PTX3), a novel inflammatory marker of atherosclerosis, was measured together with the serum hsCRP and carotid-artery intima-media thickness (IMT). Significant improvement of the LDL-C/HDL-C and log (TG/HDL-C) ratios began to be observed from 1 month after using pitavastatin. Significant correlation of the initial PTX3 value was observed with the initial plaque score (PS) (p=0.038, r=0.246), but not between the hsCRP and plasma PTX3 or PS. When patients were divided into 3 groups based on the initial PTX3 values, a significant decrease of the plasma PTX3 was obtained in the highest PTX3 group alone (p=0.034). The change in the plasma PTX3 value (DeltaPTX3) was significantly correlated with the Delta mean IMT during the study period (p=0.008, r=0.456). Pitavastatin significantly reduced the elevated plasma levels of PTX3 in patients with hypercholesterolemia by its pleiotropic effect against atherosclerotic inflammation. This study showed for the first time that the plasma PTX3 might be a useful blood parameter for direct detection of active atherosclerotic change.

Relationship between carotid intima-media thickness and hemodynamic changes during anesthetic induction.

The carotid intima-media thickness (IMT) have been known to be related to the degree of atherosclerosis and cardiovascular risk factors. The aim of this study was to elucidate the relationship of IMT and the hemodynamic changes during anesthetic induction. Two hundred fourteen patients scheduled for general anesthesia were studied. The blood pressures and heart rates during anesthetic induction and endotracheal intubation were measured. IMT was measured at right common carotid artery using M-mode ultrasonography after anesthesia, RESULTS: Mean IMT of the patients was 0.611 +/- 0.146 (0.34-0.96) mm. IMT was significantly related with age, systolic blood pressure, the changes of blood pressure after induction, and the changes of blood pressure after intubation. IMT was not related for basal heart rate and the changes of heart rate during anesthetic induction and intubation. IMT is related with the magnitude of blood pressure decreasing during anesthetic induction and increasing during intubation. The further study is needed to evaluate the relationship of IMT and hemodynamic changes during other anesthetic practice.

Carotid Atherosclerosis in Ischemic Cerebrovascular Patients

BackgroundCerebral emboli resulting from atherosclerosis at the carotid bifurcation is a major cause of ischemic stroke. A convenient and prompt evaluation is necessary for secondary prevention and treatment.MethodsIn this study, one hundred and thirty eight patients with cerebral ischemic events were enrolled; 100 patients with nonischemic cerebral diseases were enrolled as controls. Noninvasive ultrasound was used to measure the atherosclerotic plaques and intima-media thickness (IMT) of carotid and femoral artery.ResultsOur results showed that patients in study group had higher incidence and severity of carotid and femoral plaques, and higher mean intima-media thickness (IMT) at both the carotid and femoral sites compared with that of controls (p < 0.01). Carotid atherosclerosis were highly prone to have instability plaques in study group(p < 0.001).ConclusionsThis cross-sectional study showed that, the prevalence of carotid atherosclerosis and the unstable plaques were higher in cerebral ischemic patients.KeywordsCarotid artery; Atherosclerosis; Intima-media thickness; Cerebral ischemic stroke

Vascular Dysfunction in Glycogen Storage Disease Type I

To determine cardiovascular disease risk in a larger cohort of patients with glycogen storage disease (GSD) I through the use of noninvasive measures of arterial function and anatomy. Carotid intima media thickness (IMT), radial artery tonometry, and brachial artery reactivity were performed in 28 patients with GSD I (13F/15M, mean age 23 years) and 23 control subjects (19F/4M, mean age 23 years). The primary outcome measure, mean left distal IMT was greater in the GSD cohort (0.500+/-0.055 mm) than in the control group (0.457+/-0.039 mm) (P= .002, adjusted for age, sex, and body mass index). Mean augmentation index measured by radial artery tonometry was higher in the GSD cohort (16.4%+/-14.0%) than in the control group (2.4%+/-8.7%) (P< .001). No significant difference was observed between mean brachial artery reactivity in the GSD cohort (6.3%+/-4.9% change) versus control subjects (6.6%+/-5.1% change) (P= .46). GSD I is associated with arterial dysfunction evident by increased IMT and augmentation index. Patients with GSD I may be at increased risk for cardiovascular disease.

Inter-relationship between low-density lipoprotein phenotype and carotid intima-media thickness in North Indian type 2 diabetic subjects

Aims Diabetic dyslipidemia is characterized by a preponderance of small dense LDL which is highly atherogenic. The aim of this study was to examine the interrelationship between LDL Phenotype and atherosclerosis; to determine the factors determining LDL phenotype; and evaluate LDLc:apo-B ratio as a surrogate for the assessment of LDL phenotype in a group of North Indian Type 2 diabetic subjects. Methods 285 diabetic subjects attending the outpatient Endocrine Clinic were subjected to detailed anthropometry and fasting serum lipid and apo-B was measured. The carotid intima-media thickness (IMT) was determined using a high resolution B-mode Ultrasonography. LDLc:apo-B ratio was taken as a surrogate index for LDL size. Results 29.5% patients with normal triglyceride levels and 52.1% patients with normal LDLc levels showed the presence of small dense LDL or Phenotype B as estimated by the LDL cholesterol/apo-B ratio. The mean IMT in Phenotype B group was higher (0.88 mm vs. 0.68 mm). Triglycerides was the most important predictor variable predicting carotid IMT ( R 2 = 0.15, β = 0.376) as well as LDL phenotype B ( R 2 = 0.28, β = 0.561). Conclusions Triglycerides and HDLc contribute independently to the variability in LDL particle size, and LDL particle size was associated with preclinical atherosclerosis as determined by carotid IMT in North Indian Type 2 diabetic subjects. LDL cholesterol/apo-B ratio serves as an easy clinical tool to determine the elevated small dense LDL.

The Association Between Cigarette Smoking and Carotid Intima-Media Thickness Is Influenced by the -930A/G CYBA Gene Polymorphism: The Cardiovascular Risk in Young Finns Study

Smoking-induced damage to the cardiovascular system has been shown in many studies; however, the degree of damage varies from individual to individual. We hypothesized that the -930A/G CYBA gene polymorphism in the NADPH oxidase influences the association between cigarette smoking and carotid intima-media thickness (IMT) in young healthy adults. Cross-sectional data obtained in 2001 for the Cardiovascular Risk in Young Finns Study were used. IMT was measured with ultrasound. The genotyping was performed using a 5'-nuclease assay. A linear regression model was used to test whether the interaction between smoking and the genotypes was associated with IMT. The magnitude of the interaction effect was further examined by performing a stratified analysis according to smoking habits. In the entire population, the mean and maxima IMT were higher in smokers than nonsmokers (P = 0.005 and 0.008, respectively). The differences were most significant in subjects with the GG genotype, borderline significant for the GA genotype, and nonsignificant for the AA genotype. The interaction of genotypes with smoking was associated with mean and maximal IMT (P = 0.042 and 0.022). Among smokers, subjects with the GG genotype had a higher mean and maximal IMT compared with carriers of the A allele (P = 0.021 and 0.012). In contrast, the mean and maximal IMT were lower for G allele carriers than subjects with the AA genotype among nonsmokers (P = 0.022 and 0.026). All results had been adjusted for potential risk factors related to IMT. The -930A/G polymorphism modifies the association between cigarette smoking and IMT in young healthy adults.

Age-Related Acceleration of Endothelial Dysfunction and Subclinical Atherosclerosis in Subjects with Coronary Artery Lesions After Kawasaki Disease

The objective of this study was to test the hypothesis that accelerated endothelial dysfunction and the development of premature atherosclerosis are associated with age in subjects with coronary artery lesions after Kawasaki disease (KD). A case-control study was performed at a university hospital that included 35 post-KD subjects across a wide age range (range, 8-42 years) without traditional cardiovascular risk factors and 35 age- and sex-matched healthy control subjects (Cont). Flow-mediated dilatation (FMD) of the brachial artery-induced by reactive hyperemia, intima media thickness (IMT), and elastic modulus (Ep) of the common carotid artery were compared between KD and Cont subjects assessed against age. KD subjects had slightly higher levels of body mass index, lipid profile, and HbA1c than Cont subjects, but the differences were not significant. The mean IMT (p < 0.001), age-adjusted percentage normal IMT (%N IMT; p < 0.0001), and Ep (p < 0.001) were significantly higher in KD than Cont subjects, and the peak FMD% (p < 0.01) was significantly lower in KD than Cont subjects. There were significant correlations between FMD% and age (r = -0.51 p < 0.0001), IMT and age (r = 0.68, p < 0.001), and Ep and age (r = 0.58, p < 0.01) in KD but not Cont subjects. When the difference in FMD% between KD and matched Cont subjects (DeltaFMD%) was plotted against age, no significant relationship was found, although significant correlations between DeltaIMT and age (r = 0.52, p < 0.01) as well as between DeltaEp and age (r = 0.46, p < 0.05) were observed. When we defined values that were +2.0 SD over the mean control values (i.e., %N IMT >or= 120% and/or Ep >or= 50 kPa) as markers of subclinical atherosclerosis, 15 subjects met the criteria. Subjects over the age of 22 years were more likely to have (OR = 16.54, p = 0.0001) subclinical atherosclerosis in this cohort. Our results suggest that endothelial dysfunction and the development of premature atherosclerosis were accelerated in adult post-KD compared to Cont subjects.

Binge drinking and the progression of atherosclerosis in middle-aged men: An 11-year follow-up

ObjectiveThere is limited knowledge on drinking patterns and the progression of atherosclerosis. Previous studies have shown conflicting results between alcohol consumption and atherosclerotic progression. We investigated the association between the pattern of binge drinking and the 11-year progression of carotid atherosclerosis in a population-based sample of middle-aged men. Methods and resultsThis study is a part of the FinDrink Study, based on the Kuopio Ischemic Heart Disease Risk Factor Study. We investigated the effect of drinking patterns on the changes in maximum and mean intima-media thickness, including changes in maximum plaque height in 751 participants as measured by carotid ultrasound. The increased atherosclerosis progression was statistically significant among those men with binge drinking of ≥6 drinks per session (22.4% of total number of participants) using different covariates in different models according to the mean increase in maximum intima-media thickness (Model 1, p=0.008; Model 2, p=0.031, Model 3, p=0.037) and the mean increase in maximum plaque height (Model 1, p=0.002; Model 2, p=0.012, Model 3, p=0.017). ConclusionOur study shows that binge drinking was associated with an increased atherosclerosis progression during an 11-year follow-up in middle-aged men, independent of the total alcohol consumption.

Correlations between plasma homocysteine and folate concentrations and carotid atherosclerosis in high-risk individuals: baseline data from the Homocysteine and Atherosclerosis Reduction Trial (HART)

Homocysteine has been proposed as a risk factor for atherosclerosis. The association between plasma total homocysteine (tHcy) concentration and carotid atherosclerosis has not been thoroughly studied in high-risk populations with vascular disease. For this study, carotid atherosclerosis was assessed by measurements of carotid intima-media thickness (IMT) and plaque calcification in 923 patients with vascular disease or diabetes. Associations with tHcy and plasma folate concentrations were examined. The mean and single maximum carotid IMT were 1.27 +/- 0.34 mm and 2.41 +/- 0.83 mm, respectively. The mean segment plaque calcification score was 27.8%. tHcy correlated with mean (r = 0.13; p < 0.001) and single maximum (r = 0.12; p < 0.001) carotid IMT. There was a progressive increase in mean and single maximum carotid IMT across quartiles of tHcy (p < 0.0001 for trend). These associations were no longer significant after adjusting for other CV risk factors. A trend towards an inverse association between plasma folate and mean max carotid IMT was found in both univariate and multivariable analyses. However, the plaque calcification score increased across quartiles of tHcy (p < 0.01) and decreased across quartiles of plasma folate concentrations (p < 0.05) after multiple adjustments. In conclusion, in high-risk individuals, tHcy and low folate concentrations were only weakly associated with carotid IMT. In contrast, we found an independent association with the plaque calcification score, a measure of more advanced atherosclerosis. The effect of tHcy lowering on carotid atherosclerosis and stroke prevention warrants further investigation.

Ecografía femoral en la evaluación de la aterosclerosis preclínica. Distribución de valores del grosor íntima-media y frecuencia de placas de ateroma en una cohorte comunitaria española

High-resolution B-mode ultrasound measurements of intima-media thickness (IMT) and plaque presence are useful to assess preclinical atherosclerosis. Normal carotid IMT values, but not normal femoral IMT values, have been reported in Spanish subjects. Our aim was to define the normality data of femoral ultrasound by sex and age. We studied 192 healthy subjects from a community cohort, 85 men and 107 women (mean age: 49 years; range: 20-81 years). We sonographically determined mean and maximum IMT in the far wall of the common femoral artery, plaque occurrence, and maximum plaque height. Reference values for femoral IMT, expressed as 25th, 50th, and 75th percentiles by sex and 5 age groups, were obtained. The 50th percentiles of mean IMT ranged from 0.50 to 1.04 mm in men in the age groups < or = 35 years and > or = 65 years, respectively. For women, corresponding IMT values ranged from 0.40 to 0.53 mm. IMT was positively related to age in both men (r = 0.44; p < 0.001) and women (r = 0.23; p = 0.019). From the regression equations of IMT versus age, the estimated yearly increase in IMT was 0.016 mm in men and 0.008 mm in women. More than 50% of men aged > or = 55 years and women aged > or = 65 years had plaques. Both IMT and plaque frequency are associated with age in men and women. Femoral IMT values in a Spanish community cohort are lower than those reported for geographical areas with higher cardiovascular risk, such as the Northern European countries and the US.

Human immunodeficiency virus per se exerts atherogenic effects

Objective Premature atherosclerosis in HIV-infected patients has been attributed to highly active antiretroviral therapy (HAART) and the associated metabolic complications. Whether HIV per se plays a role is an unresolved issue. The purpose of this study was to evaluate whether HIV per se exerts atherogenic effects. Methods We measured carotid intima–media thickness (IMT) and brachial endothelial-dependent (FMD) and endothelial-independent (NMD) vasodilation in 38 naïve untreated HIV-infected patients and 41 healthy control subjects. Results Control subjects were selected as to match the HIV patients for metabolic risk factors. Mean carotid IMT was higher in HIV patients (0.85 ± 0.2 mm; p < 0.001) than in controls (0.63 ± 0.1 mm). In a stepwise multiple regression model, the changes in carotid IMT were predicted by the duration of HIV infection ( p < 0.001) and CD4 T-cells ( p = 0.035). Brachial FMD was impaired in HIV patients (8.8 ± 3% versus 12.2 ± 3% in controls; p < 0.001). In contrast, NMD values practically overlapped in the HIV patients and controls. Analysis of the data in relation to viral load showed that FMD was significantly more impaired in the subgroup of patients with viral load values above the median ( p < 0.001). In addition, there was a highly significant, inverse correlation between FMD and the HIV-RNA copies ( p < 0.001). Conclusion HIV infection causes functional and structural vascular alterations in a very early stage of the infection independent of HAART and metabolic factors. The data lend support to the viral infectious theory of atherosclerosis. Early assessment of the vascular status in HIV-infected patients is suggested.

Abstract 950: Should We Measure Intima Media Thickness In Patients With Peripheral Arterial Disease?

Background: Carotid intima-media thickness (IMT) is a marker of early atherosclerosis. Patients with peripheral arterial disease (PAD) have advanced atherosclerosis and a high cardiovascular event rate. The aim of this study was to evaluate, whether measurement of carotid IMT adds prognostic information in PAD patients. Methods: We included 165 patients (mean age 64.5 ± 9 years, 71.5% men) with PAD. In all patients IMT was measured at both common carotid arteries and the mean IMT was used for further evaluation. Carotid IMT of more than 0.9 mm was defined as thickened. After a median follow-up of 6.5 years in total 33 patients (20%) died from cardiovascular causes. Results: Mean IMT was 0.75 ± 0.19 mm and in 30 patients (18.2%) an IMT ≥ 0.9 mm could be detected. Cardiovascular mortality was significantly higher in patients with PAD and IMT ≥ 0.9 mm than in patients with IMT ≥ 0.9 mm (IMT ≥ 0.9 mm = 40.0 % versus IMT &lt; 0.9 mm = 15.6 %; P=0.002, figure ). In a fully adjusted Cox regression analysis (adjusted for age, sex, diabetes, hypertension, high density lipoprotein cholesterol, smoking, body mass index and acute coronary syndrome) a carotid IMT ≥ 0.9 mm could not be identified as an independent predictor for cardiovascular death (Hazard Ratio (95% Confidence Interval) = 2.0 (0.9 – 4.2), P=0.09). Conclusion: Patients with PAD and a carotid IMT ≥ 0.9 mm had a higher cardiovascular mortality than patients with normal IMT. But an increased carotid IMT could not be identified as independent predictor for cardiovascular mortality. Therefore it should be discussed whether IMT measurement adds prognostic impact in patients with PAD. Survival in Accordance to Carotid IMT

Abstract 3707: The Multiplier Effect of Telmisartan and Fenofibrate in Patients with Metabolic Syndrome

Background: Telmisartan, a partial agonist of PPARγ, improve insulin resistance with increase adiponectin and especially high molecular weight adiponectin (HMW adipo) in patients with metabolic syndrome. Fenofibrate, an antihyperlipidemic drug, can function as an agonist of PPARα and is increased adiponectin receptors. In this study, we examined that telmisartan with fenofibrate influences multiplier effect of insulin resistance and anti-arteriosclerosis action in patients with metabolic syndrome. Methods: 25 patients with metabolic syndrome took telmisartan (40mg/day) for 6 months (stage 1), and they were measured HOMA-R, high sensitive CRP (hsCRP), adiponectin, HMW adipo, TNFα, both visceral fat (VF) area and subcutaneous fat (SF) area by CT scan and mean intima-media thickness (M-IMT) of common carotid artery. After stage 1 they took telmisartan (40mg/day) together with fenofibrate (100mg/day) for 6 months (stage 2), and they were measured them again. Results: We compared these parameters of stage 1 and stage 2. HOMA-R, hsCRP, and TNFα were decreased for both stage 1 and stage 2. HOMA-R especially was significant (from 3.97 to 3.09; p&lt;0.05) for stage 2. Both adiponectin and HMW adipo were increased for stage 1, but they were decreased for stage 2. Both VF area and SF area were decreased between stage1 and stage2. SF area especially was significant (from 194.9 to 184.3 cm2; p&lt;0.05) for stage 2. M-IMT of common carotid artery significantly was decreased (from 0.97 to 0.84 mm; p&lt;0.01) between stage 1 and stage 2. Conclusion: Our findings indicate that although telmisartan with fenofibrate are decreased both fat area (especially SF area) and secretion of adiponectin, they influences multiplier effect of insulin resistance and anti-arteriosclerosis action through the improvement of adiponectin sensitivity.

Effects of aging and sex on progression of carotid intima‐media thickness: A retrospective 6‐year follow‐up study

We retrospectively examined the relationship of aging, sex and risk factors to increased carotid intima-media thickness (IMT) over a follow-up period of 6 years in patients with multiple risk factors. Subjects were comprised of 463 patients (287 men, 176 women) with a mean age of 64 +/- 0.4 years who had undergone carotid ultrasonography twice or more at intervals of 5 years or older. The mean follow-up period was 6.0 +/- 0.1 years. Mean baseline IMT for all subjects was 1.40 +/- 0.02 mm, and no significant difference was seen between sexes. Mean IMT after 6 years for all subjects was 1.84 +/- 0.03 mm, and was significantly greater in men than in women. Mean annual increase in IMT (Delta IMT) for all subjects was 0.073 +/- 0.005 mm/year, with a significant positive correlation between baseline age and Delta IMT (r = 0.11, P < 0.05), and Delta IMT was significantly greater in men than in women (0.087 +/- 0.007 mm vs 0.050 +/- 0.007 mm, P < 0.001). IMT increased with age in both men and women, but Delta IMT increased with age only in men. Multivariate analysis showed baseline age and diabetes mellitus as significant risk factors with baseline IMT as the objective variable. Age and sex represented significant risk factors with DeltaIMT as the objective variable. Sex differences exist in the relationship between increases in IMT and age. Age, sex and diabetes mellitus represented the main risk factors.