Media Thickness Of Carotid Artery Research Articles

Study of role of serum magnesium in preventing carotid atherosclerosis in chronic kidney diseases patients

Background: Cardiovascular diseases are the most important causes of mortality and morbidity in CKD mainly due to accelerated atherosclerosis. Mg2+ possesses an anti-atherosclerotic effect, because of its anti-inflammatory and antioxidant properties, by inhibiting endothelial proliferation and inhibiting the upregulation of PAI 1 and VCAM 1. Mg2+ deficiency promotes hydroxyapatite formation and calcification of VSMC thus leading to accelerated plaque formation. Aim and objectives of current study were to evaluate relationship between serum Mg2+ level and atherosclerotic changes in patients with CKD. Methods: This hospital based observational cross-sectional study has been carried out in department of KPS institute of medicine, GSVM Medical College, Kanpur. 58 subjects were recruited and underwent routine tests including Serum urea, creatinine, calcium, phosphorus, iPTH, Magnesium and intima media thickness (IMT) of carotid artery via Doppler study. Results: In our study the mean value of Mg2+ was 2.25 mg/dl±0.81 17 out of 58 patients (29.3%) had hypomagnesemia. Intima Media thickness of carotid artery had an observed mean value of 1.0 cm±0.24, with mostly increased in those who had hypomagnesemia. Serum Mg2+ was negatively correlated (Pearson correlation coefficient was -0.677 and -0.704) with CIMT with statistical significance as p<0.001. Also, our study revealed no significant correlation between serum Mg2+ and other laboratory data (Ca2+, P, iPTH, urea and creatinine. Conclusions: We concluded that serum Mg2+ may be considered as a modifiable risk factor of atherosclerosis (thus, cardiovascular mortality) in CKD patients.

The Correlation Between Serum Glucagon Peptide-1 Levels with Intima Media Thickness of Carotid Artery in Type 2 Diabetes Mellitus

Type 2 Diabetes Mellitus is a group of metabolic disorders characterized by clinical hyperglycemia due to defects in insulin secretion, insulin action or both. This study was to determine the correlation between serum fasting Glucagon Like Peptide-1 (fGLP-1) levels and serum 1 hour post prandial Glucagon Like Peptide-1 (1hGLP-1) levels with IMT of carotid artery in patients with Type 2 DM. This study used a correlative analytic with a cross-sectional approach in population of Type 2 DM patients who were treated at the Interna Polyclinic at Dr. Mohammad Hoesin Palembang the IMT of carotid artery was measured with a high-resolution carotid doppler ultrasound B-mode ultrasound machine. The GLP-1 level was measured by the ELISA method. There were 40 subjects with a median age of 52 (40-59) years. A strong negative correlation was found between fGLP-1 serum levels and IMT of carotid artery with r= -0.748; p = 0.000; n=40. This study also found a strong negative correlation between serum levels of 1hGLP-1 and carotid IMT with r = -0.600; p = 0.000; n=40. There is a strong correlation between serum fGLP-1 levels and serum 1hGLP-1 levels with IMT of carotid artery in Type 2 DM patients. Measurement of serum levels of fGLP-1 and 1hGLP-1 may be an important indicator in evaluating cardiovascular risk in Type 2 DM patients. It may also provide guidance in the development of therapies for Type 2 DM patients to reduce the risk of cardiovascular disease.

PS-C04-5: ASSOCIATIONS BETWEEN INTERARM SYSTOLIC BLOOD PRESSURE DIFFERENCE AND HYPERTENSIVE ORGAN DAMAGES IN PATIENTS WITH ESSENTIAL HYPERTENSION

Objective: Several studies and meta-analyses have reported that interarm systolic blood pressure difference (IAD) in the upper limbs is associated with risks such as all-cause mortality and cardiovascular diseases. However, few results have examined the usefulness of IAD as an index of arteriosclerosis in patients with essential hypertension (EHT). We investigated the relationship between IAD and vascular structures and evaluated the usefulness of IAD as an index of hypertensive organ damages in EHT patients. Design and method: In 71 untreated EHT patients (48 males, average age 56 ± 13 years) without chronic kidney disease (urinary albumin excretion less than 300 mg / g of creatinine and estimated glomerular filtration rate 60 mL / min / 1.73m2 or more), blood sampling, 24-hour urine collection, and 24-hour blood pressure monitoring were performed. Next, as cardiovascular structural indices, Next, as indicators of vascular structure, the intima media thickness of carotid artery (IMT) was measured by ultrasonography, and the cardio ankle vascular index (CAVI) and ankle brachial index (ABI) were measured by using the Vascular Screening System VaSera VS-1000 (Fukuda Denshi, Tokyo, Japan) device. The absolute value of the difference between the left and right blood pressure measured at the same time was defined as IAD. Results: IAD was not associated with age, BMI, or systolic and diastolic blood pressure in 24-hour blood pressure monitoring. IAD increased accompanying with a decrease in creatinine clearance (r = -0.25, p < 0.05). IAD correlated positively with IMT (r = 0.24, p < 0.05) and negatively with ABI (r = -0.45, p < 0.01), whereas it did not associate with CAVI. Furthermore, in multiple regression analysis using any of IMT, ABI and creatinine clearance as objective variables, and conventional risk factors for atherosclerosis and IAD as explanatory variables, IAD became an independent determinant factor for IMT, ABI and creatinine clearance. Conclusions: In EHT patients, IAD was associated with decreased renal function and vascular abnormalities. IAD was considered to be a useful index as an initial screening for latent hypertensive organ damages in EHT patients.

Implications of Ezetimibe in Combination with Low- to Moderate-Intensity Atorvastatin Adjuvant Aspirin Therapy for Cerebrovascular Disease.

Objective To analyze the significance of ezetimibe in combination with low- to moderate-intensity atorvastatin adjuvant aspirin therapy for cerebrovascular disease. Methods 110 patients with cerebrovascular disease treated in our hospital from June 2020 to June 2021 were selected and divided into 55 patients in the control group and 55 patients in the study group according to the lottery method. After a comprehensive examination, patients in the two groups should be given aspirin for treatment; the control group was treated with conventional dose of atorvastatin on top of the above, and the study group was given ezetimibe and medium-low-dose atorvastatin on top of aspirin treatment, activities of daily living (ADL) score, carotid artery intima-media thickness, lipid level, coagulation level, clinical effect, and adverse rate of the two groups which were tested and compared. Results After treatment, ADL score, high-density leptin cholesterol (HDL-C), and ATIII levels increased, while carotid artery media thickness, triglyceride (TG), total cholesterol (TC), low-density leptin cholesterol (LDL-C), DD, PC, and hs-CRP levels decreased (P < 0.05). After treatment, ADL score, HDL-C, and ATIII levels were higher in the study group. The levels of carotid media thickness, TG, TC, LDL-C, DD, PC, and hs-CRP were significantly lower (P < 0.05). The clinical effect of the study group was outstanding (P < 0.05). The defect rate of the study group was lower than that of the control group, but there was no difference (P < 0.05). Conclusion Ezetimibe combined with medium- and low-intensity atorvastatin with aspirin in the treatment of cerebrovascular diseases can effectively improve the coagulation function of patients, reduce the level of inflammatory factors in patients, and improve the level of blood lipids in patients, with high safety and worthy of clinical application.

FLOW MEDIATED DILATATION, CAROTID INTIMA MEDIA THICKNESS, ANKLE BRACHIAL PRESSURE INDEX AND PULSE PRESSURE IN YOUNG MALE POST MYOCARDIAL INFARCTION PATIENTS

Introduction:Due to increase in Coronary Artery Disease (CAD) at a younger age, we should try to diagnose atherosclerotic process and population at risk, at the earliest. Flow Mediated Dilatation (FMD), Carotid Intima-Media Thickness (CIMT) and Ankle-Brachial Pressure Index (ABI) are probable markers for early atherosclerosis and may be useful in coronary risk stratification Objectives: To compare and correlate the FMD, CIMT, ABI and Pulse Pressure (PP) in young male patients of Myocardial Infarction (MI) with age and sex matched healthy controls Method50 patients of MI aged ≤45 years, who presented to iccu of Department of Medicine Indira Gandhi medical college Nagpur India, were recruited consecutively for this case control study and same number of age and sex matched healthy controls were also analyzed. 3 days after Myocardial infarction FMD of the brachial artery, intima media thickness of carotid artery, ABPI and PP were measured in the cases and compared with healthy control Results: The FMD was lower among young patients of MI than controls . CIMT was higher among cases than controls . ABI was lower among cases than controls . Compared to controls, PP was higher among cases . In all subjects, a negative correlation between FMD and CIMT and a positive correlation between FMD and ABPI was found. A statistically significant negative correlation was found between endothelial dependent FMD and PP among cases and control groups Conclusion: Biophysical parameters were deranged in young post MI patients. Majority of our young male patients fell in low risk Framingham risk score but still they manifested with CAD. Despite 3 days of treatment among young male patients of MI, various biophysical parameters were stillderanged.

Predictive value of C-reactive protein and carotid intimal medial thickness in acute ischemic stroke

BackgroundElevated CRP and increased CCA-IMT are both associated with the occurrence of stroke. CRP and IMT are closely associated; the higher the CRP, the greater the carotid atherosclerosis as measured by carotid IMT.ObjectivesTo study the relationship between elevated C-reactive protein as a blood biomarker and increased intimal media thickness of carotid artery, and its relation to infarct size and its impact on prognosis.Materials and methodsThis study is an analytical observational study, in which 73 patients who have recently suffered first-ever acute ischemic stroke in the anterior circulation within 72 h were recruited. Only 64 of them were able to continue the study with follow-up during the 1 month and 3 months durations. Magnetic resonance imaging for the brain was done and the infarct volume was measured. All patients had quantitative Serum CRP level within 72 h from stroke onset and carotid duplex with assessment of carotid intimal media thickness (IMT).ResultsThe results showed there is a significant positive correlation between highly sensitive C-reactive protein (hs-CRP) and MRS after 1 month yet no significant correlation was found between hs-CRP and IMT.ConclusionHighly sensitive C-reactive protein (hs-CRP) could serve as prognostic blood biomarker in long-term follow-up of stroke patients. Non-significant correlation was found in our study between increased hs-CRP and increased intima-media thickness (CCA-IMT).

Serum sclerostin level and its relation to subclinical atherosclerosis in subjects with type 2 diabetes

BackgroundSclerostin, a Wnt-signalling inhibitor, is an established negative regulator of bone formation. However, data regarding its potential importance in vascular disease are less clear. Common carotid artery media thickness (CIMT) assessment and plaque identification using ultrasound imaging are well-recognized tools for identifying and monitoring atherosclerosis. The aim of the present study is to examine the relationship between serum sclerostin and subclinical atherosclerosis (as evidenced by CIMT). MethodsThis cross-sectional study included 50 subjects with T2DM and 20 subjects as a control group. Multivariable linear regression models were used to assess the association of sclerostin with subclinical atherosclerosis. ResultsSerum sclerostin levels in T2DM patients were significantly higher compared to the control group (167.16 ± 63.60 versus 85.98 ± 23.74 pg/ml, P < 0.0001). A concentration of ≥162.5 pg/ml showed a sensitivity of 90% and a specificity of 86.67% to detect an increased risk of subclinical atherosclerosis. Univariate analysis revealed a significant positive correlation between serum sclerostin and CIMT (r = 0.635, P < 0.001). Sclerostin concentrations remained independently associated with CIMT (β = 63.188 [6.919–119.456], P = 0.017) after adjusting for age and gender. ConclusionOur data suggest a positive correlation between serum sclerostin level and subclinical atherosclerosis in subjects with type 2 diabetes mellitus.

Role of Osteopontin in Systemic Lupus Erythematosus

Background: Systemic lupus erythematosus (SLE) is a multisystemic disease, caused by a variety of factors, which lead to immunological abnormalities. Osteopontin (OPN) is a pleiotropic protein, important in bone remodeling and immune system signaling. It produced by various cells, including immune cells, and played a key role in regulating T-helper 1/T-helper 2 balances, stimulating B lymphocytes to produce antibodies, regulating macrophages, neutrophils and inducing dendritic cells. Over expression of OPN has been associated with the pathogenesis of immune-mediated diseases. Objectives: To investigate the role of osteopontin in SLE and to assess its relation to disease activity and subclinical atherosclerosis. Subjects and Methods: This cross sectional case control study was conducted on 30 SLE patients fulfilling SLICCA /ACR criteria for SLE classification and 30 subjects sex- and age-matched apparently healthy as control group. All patients were assessed for SLE disease activity by the systemic lupus activity Index (SLEDAI). Serum OSP and Doppler ultrasound for carotid artery media thickness (CIMT) were measured in all patients and control. Results: Plasma OPN levels were significantly higher in SLE patients than in control group (P<0.001) and had significant positive correlation with disease activity (r 0,595, P<0.05) and CIMT (r = 0.400, P <0.001), but there was no significant correlation between CIMT and disease activity. Conclusion: serum level of OPN was higher in SLE patients and correlated with disease activity and CIMT, and can be used as a marker of subclinical atherosclerosis.

A study on intima- media thickness of carotid artery in children with nephrotic syndrome: a cross sectional study

Introduction: Atherosclerosis is one of the complications of Nephrotic syndrome. It is due to frequent exposure to hyperlipidemia, hypertension, and hypoproteinemia, steroid and immunosuppressive therapy may also contribute to the risk for cardiovascular diseases. Objective: To evaluate intima- media thickness of carotid artery in children with nephrotic syndrome. Design: A cross sectional study. Setting: The study was done in Nehru hospital of B.R.D Medical College Gorakhpur (U.P.) from June 2014- March 2015. Material & Methods: Total 150 children divided in to study group (n1=50) and control group II (n2=100). (n1=50) children with history of nephrotic syndrome enrolled in this study. The Inclusion criteria were nephrotic syndrome with normal serum complement, being on therapy for nephrotic syndrome (continuous or interrupted) for at least one year, glomerular filtration rate more than 90 ml/ min/ 1.73 m2 and age above two years at the time of study. (N2=100) healthy age, sex weight, height and RBS matched children considered as control group. The cIMT was evaluated in nephrotic children. Chi square test was used to test difference among study and control groups. A P value less than 0.05 was considered statistically significant. Result: In the study group (n1=50) steroid resistant, steroid dependent, steroid sensitive and infrequent relapse nephrotic syndrome included one-fourth each. The mean cIMT (mm) in nephrotic children was 0.42(±0.14) while mean cIMT in control was 0.34 (±0.06) and (p <0.0014). Subsequently, the factor that influenced on thickness of cIMT were BMI, SBP, DBP, Total cholesterol, VLDL, LDL, TGs, serum protein ((p<0.05) and duration of disease (r=0.83). Conclusion: cIMT was thicker in nephrotic children, were influenced by the factor that increases thickness of cIMT were hyperlipidemia, hypertension, hypoproteinemia and duration of disease.

The relationship between mean platelet volume and flow mediated dilatation and intima media thickness of carotid artery in patients with essantial hypertension

Aim: Hypertension is an important risk factor in the development of atherosclerosis . Our aim in this study was to determine the relationship between mean platelet volume (MPV) which is a risk factor of atherosclerosis and intima media thickness (IMT) of carotid artery and flow-mediated dilatation (FMD), markers of atherosclerosis, in patients with essential hypertension. Materials-Methods: 50 adults, applying to Kirikkale University Medical Faculty department of internal medicine, (outpatient) clinics, diagnosed as hypertensive for the first time Were included in the study. Their ages ranaed between 18 to 80 nd. We included 50 healthy participants to the study as control group. Carotid Artery Doppler ultrasonography and flow-mediated dilatation (FMD) with the brachial artery ultrasonographic measurment technique was performed by using Ecography (General Electric Vivid S5) and 12 L probe for each patient. Results: In this study statistically significant relationship was found between IMT and age. In the hypertensive group, IMT of carotid artery was found to be higher in comparison with the control group. However this result wasÂ’nt statistically significant. There were no statistically significant difference in MPV, FMD or IMT hypertensive and control groups. Small number of the participants and relatively younger mean age of the groups may lead to this result and can be considered as a limitation of this study. Conclusion: Determining atherosclerosis earlier in patients with essential hypertension may provide development of new treatment modalities. In order to conclude more confidentIy extended studies with larger patient groups are needed.

Frequency of Abnormal Intima Media Thickness of Carotid Artery in Obese Individuals by Colour Doppler Ultrasonography

Objectives: To determine the frequency of abnormal Intima media thickness of Carotid artery in obese individuals by using color Doppler ultrasonography. Design: Descriptive cross-sectional study. Setting: Department of Radiology Allied Hospital, Faisalabad. Period: From August 2011 to june 2012, Methodology: A total of 96 patients were enrolled in this study. LOGIC 5 Doppler ultrasound machine was used. B-mode ultrasonography of common carotid arteries was performed on both sides with a 7.5 MHz linear array transducer. Intima media thickness was accessed in the distal wall of common carotid artery of both sides 1.0 cm proximal to carotid bulb. Results: Mean age of the patients was observed 50.1±5.9 years. Abnormal intima media thickness in right common carotid artery (RCCA) was found to be in 46 (47.9%) patients and in 45 (46.8%) patients in left common carotid artery (LCCA). Mean values of intima-media thickness (IMTs), luminal diameters (LD) and flow velocity (FV) systolic and diastolic of right common carotid artery (RCCA) as follows, 0.74±0.17, 6.90±0.93, 78.91±17.03 and 21.50±5.67, respectively. Mean values of intima-media thickness (IMTs), luminal diameters (LD) and flow velocity (FV) systolic and diastolic of left common carotid artery (LCCA) as follows, 0.74±0.15, 6.85±0.72, 76.58±12.49 and 20.41±5.14, respectively. Conclusion: Carotid intima-media thickness testing by using Colour Doppler Ultrasonography is a powerful and noninvasive tool in the early detection of atherosclerotic plaques and carotid artery wall thickening and is an independent predictor of strokes and heart attacks.

Flow Mediated Dilatation, Carotid Intima Media Thickness, Ankle Brachial Pressure Index and Pulse Pressure in Young Male Post Myocardial Infarction Patients in India.

Due to increase in Coronary Artery Disease (CAD) at a younger age, we should try to diagnose atherosclerotic process and population at risk, at the earliest. Flow Mediated Dilatation (FMD), Carotid Intima-Media Thickness (CIMT) and Ankle-Brachial Pressure Index (ABI) are probable markers for early atherosclerosis and may be useful in coronary risk stratification. To compare and correlate the FMD, CIMT, ABI and Pulse Pressure (PP) in young male patients of Myocardial Infarction (MI) with age and sex matched healthy controls. Eighty male patients of MI aged ≤45 years, who presented to the Cardiac Care Unit and Department of Medicine of Guru Teg Bahadur Hospital, Delhi, India, from November 2010 to April 2012 were recruited consecutively for this case control study and same number of age and sex matched healthy controls were also analyzed. Six weeks after MI, FMD of the brachial artery, intima media thickness of carotid artery, ABPI and PP were measured in the cases and compared with healthy controls. The FMD was lower among young patients of MI than controls (p<0.001). CIMT was higher among cases than controls (p=0.001). ABI was lower among cases than controls (p<0.001). Compared to controls, PP was higher among cases (p=0.001). In all subjects, a negative correlation between FMD and CIMT (r=-0.220, p=0.005) and a positive correlation between FMD and ABPI (r=0.304, p<0.001) was found. A statistically significant negative correlation was found between endothelial dependent FMD and PP among cases and control groups (r=-0.209, p=0.007). Biophysical parameters were deranged in young post MI patients. Majority of our young male patients fell in low risk Framingham risk score but still they manifested with CAD. Despite six weeks of treatment among young male patients of MI, various biophysical parameters were still deranged.

GW26-e0758 Relationship between Vascular Overload Index and Cardiovascular Structure and Function in Hypertensives

To investigate the relationship between vascular overload index (VOI) and cardiovascular structure and function, which were evaluated by endothelium-dependent vasodilatation (FMD) of brachial artery, intima media thickness of carotid artery (CA-IMT), left ventricular mass index (LVMI). A total of

Retinol binding protein 4 correlates with and is an early predictor of carotid atherosclerosis in type 2 diabetes mellitus patients.

The association of retinol binding protein 4 (RBP4) with atherosclerosis of the carotid artery in type 2 diabetes mellitus (T2DM) remains undefined. We aimed to investigate the correlation of RBP4 expression with atherosclerosis of the carotid artery in T2DM. A total of 1,076 subjects were investigated for intima-media thickness of the bilateral common carotid arteries, and they were divided into three groups: in group I, patients had normal neck vascular ultrasound, in group II, intimal carotid artery media thickness was equal to or more than 1 mm, and in group III, carotid artery plaque was present. Height, weight, blood pressure (BP), fasting plasma glucose (FPG), hemoglobin A1c (HbA1c), total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), apolipoprotein A-1 (apoA-1), apolipoprotein B (apoB) and lipoprotein (a) [Lp(a)] were determined by routine laboratory methods. RBP4 and high sensitivity C reactive protein (HsCRP) were measured by an enzyme-linked immuno-sorbent assay, and insulin concentration was measured by an electrochemiluminescence sandwich immunoassay. Duration of diabetes, waist and BP, FPG, HbA1c, TG, TC, LDL-C, APOB, Lp(a), HsCRP, RBP4 and homeostasis model assessment insulin resistance index (HOMA-IR) were significantly lower in group I than in the other two groups (P<0.01, P<0.01). Plasma levels of HbA1c, RBP4, LDL-C, TC, HOMA-IR, HsCRP and Lp(a), waist and BP were significantly increased in group III than in group II (P<0.01). Multivariate logistic regression analysis showed that there were seven factors associated with the occurrence of carotid artery atherosclerosis and its risks in descending order were: high LDL-C, high waist, high HsCRP, duration of diabetes, high HOMA-IR, HbA1c and high RBP4. Our finding supported that RBP4 was positively correlated with carotid atherosclerosis in patients with T2DM and could be used as an early predictor of cardiovascular disease.

Migraine a marker of vascular health?

Strong interrelationships between migraine and the vascular system have been known for decades (1). While there is an ongoing discussion on the primary role of the vascular system in triggering migraine attacks (2,3), there is increasing evidence that migraine, particularly migraine with aura, is a risk factor for stroke and potentially for other cardiovascular disease events (4). The reasons for this increased risk remain unclear, however. One potential explanation is related to vascular risk factors among patients with migraine, as migraine has been associated with higher prevalence of an unfavorable vascular risk profile (5,6). Continuing this hypothesis, one would expect that patients with migraine have a higher atherosclerotic load than individuals without migraine. In this issue of Cephalalgia, Stam and colleagues investigate the association between migraine and the grade of prevalent atherosclerosis among 360 patients with migraine and 617 individuals without relevant headache disorders who participated in the population-based Erasmus Rucphen Family study (7). Atherosclerosis was quantified by intima media thickness, pulse wave velocity, and ankle-brachial index. Patients with migraine were more likely to be current smokers, to have a history of diabetes, to have lower high-density lipoprotein cholesterol, and to drink less alcohol. However, there was no association between migraine and any of the measures of atherosclerosis. There was also no difference between patients with migraine with aura and patients with migraine without aura. The study adds important aspects to the current evidence on the association between migraine and vascular health. In particular the study shows that, although migraineurs have increased frequency of some individual vascular risk factors, this does not necessarily translate to a higher load of atherosclerosis. The association between migraine and individual vascular risk factors confirms many previous reports. For example, it has been reported in several population-based studies that migraine is associated with increased prevalence of individual vascular risk factors, such as smoking (5), diabetes (8), unfavorable cholesterol profile (9), and others. The lack of association between migraine and measures of atherosclerosis is in line with the results of the Women’s Ischemia Syndrome Evaluation study in which the coronaries of patients with migraine and controls were investigated by angiography among women presenting with symptoms suggestive of myocardial ischemia (10). In this study patients with migraine had even a lower load of atherosclerotic changes. However, contrary to the findings by Stam and colleagues, other studies have shown an association between migraine and impaired endothelial vasoreactivity or increased carotid artery media thickness (6,11), suggesting that migraine could well be a triggering factor for vascular pathologies that may eventually result in increased risk of cardiovascular disease events. How can this apparent conflict between the studies be explained? Are the differences in findings of the various studies simply explained by study design and different target populations or by migraine assessments? There is one important aspect that is currently not considered when evaluating the interplay between migraine, vascular risk factors, and cardiovascular disease events: time. Migraine is an intermittent disorder with fluctuating frequencies during the lifespan and this change results in challenges to the classification of migraine in population-based settings (12). Repeated assessments of migraine and the vascular health status are necessary to definitely assess whether migraine leads to vascular pathologies during the lifespan that eventually increase the risk of cardiovascular disease events. It is possible that active migraine is not associated with atherosclerosis in the beginning, but that over time migraineurs have a faster development of vascular pathologies. It would be of particular interest to study the vascular health of individuals in whom the migraine has ‘stopped’.

Measurement of intima media thickness of carotid artery by B-mode ultrasound in healthy people of India and Bangladesh, and relation of age and sex with carotid artery intima media thickness: An observational study

Background:Carotid artery intima media is a surrogate marker of atherosclerosis and related with ethnicity, age, sex, traditional and non-traditional risk factors. Black ethnicity is related to greater mean and maximum carotid artery intima media thickness when compared to South Asians. Our study was done to find out the mean carotid artery intima media thickness (CAIMT) of normal healthy people of India and Bangladesh, and the relationship of non-modifiable risk factors such as age and sex with CAIMT.Materials and Methods:In this observational study, CAIMT of 93 people were examined by B-mode ultrasonography. All subjects underwent a careful interview and clinical, radiological, biochemical examination. Data was analyzed by software statistical package for social sciences (SPSS) (17th version for window).Results:In our study, the mean CAIMT of healthy subjects including all age group was (754.94 ± 11.96 micron.). Mean CAIMT was higher in age group of 61-80 years (908.75 ± 39.02 micron) than age group of 20-40 years (713.62 ± 16.59 micron) and 41-60 years (745.55 ± 13.05 micron). CAIMT was positively correlated with age (P value <0.001) and sex (P value=0.001).Conclusion:An aggregated analysis based on this study in different age groups of healthy people may be useful for assessing carotid artery abnormalities as an aid to defining abnormalities and predicting risk of atherosclerosis in individual healthy people living in India and Bangladesh.

Addition of aliskiren to angiotensin II receptor blockers ameliorates renal tubular injury and reduces intima media thickness of carotid artery in patients with diabetic nephropathy

ofmetachronous presentation the onset of either event urges immediate diagnosis and therapy without any delay. In both presented cases the primary manifestation was myocardial infarction and thus urgent coronary angiography was required as a first diagnostic step. The optimal therapeutic approach for subsequent basilar artery occlusion is less clear. Traditionally, patients have been treated with local intraarterial thrombolysis [2]. Nonetheless, its superiority to the technically simple intravenous thrombolysis has not been proven so far and both strategies seem to be equally effective [3]. We highlight that intravenous thrombolysis bears a significant risk of bleeding complications, notably in the setting of concomitant anticoagulation (Acetaylsalicylic acid, Clopidogrel, Heparin, Glycoprotein IIb/IIIA antagonists). In contrast, the endovasal procedure as performed in our patient allows detailed localization of the occluded vessel, assessment of collateral perfusion and efficient local thrombolysis with reduced risk of devastating bleeding complications.

Comparison of effects of amlodipine and angiotensin receptor blockers on the intima–media thickness of carotid arterial wall (AAA study: Amlodipine vs. ARB in atherosclerosis study)

Although there have been increasing reports, which suggest that angiotensin receptor blockers (ARBs) may have anti-atherogenic actions, most of them are performed in vitro and there are a few reports about anti-atherogenic action in vivo. Especially, in humans, there have been no reports about effect of ARBs on atheroslocerosis. On the other hand, there have been several reports, including ours, which indicate that amlodipine, a calcium channel blocker, has a unique property to cause a reduction in the intima–media thickness (IMT) of common carotid artery, which is established to be an indicator of early atherosclerotic lesion, in humans. The present study investigated which of amlodipine and/or ARBs might have more profound effect on IMT progression. The study included 104 hypertensive patients with type 2 diabetes. They were divided into the two groups: the amlodipine group ( n = 58), who received amlodipine (2.5–5 mg/day) and the ARB group ( n = 46), who received losartan (25–50 mg/day), candesartan (4–8 mg/day), valsaratan (40–80 mg/day) or telmisartan (20–40 mg/day). IMT changes were examined during an average of 56.9 weeks. The amlodipine group showed a significant decrease in IMT compared to the ARB group (−0.046 [S.E. 0.161] mm vs. 0.080 [S.E. 0.255] mm, P < 0.05). These results suggest that amlodipine has an inhibitory effect on early atherosclerotic process, and that ARBs do not have any effect on it in hypertensive patients with type 2 diabetes.

Insulin Sensitivity as a Risk Factor for Common Carotid Intima Media Thickness (IMT): Its Relation to Atherosclerosis

Introduction. The relationship between insulin resistance and atherosclerosis (ATH) in non-diabetic hypertensive patients from the Asian Indian population remains poorly understood. To resolve this issue, the present study was designed to analyze whether insulin sensitivity in a non-diabetic individual is related to the development of ATH.(by using IMT as an index) and whether this relationship is dependent on the presence of other cardiovascular disease (CVD) risk factors such as dyslipidemia and hypertension. Methodology. This study included 68 healthy controls with no diabetes and hypertension and 41 hypertensive patients who underwent four-point oral glucose tolerance test (OGTT) and intravenous glucose tolerance test (IVGTT). A biochemical profile, β mode ultrasonography for intima media thickness of carotid artery, and ECG determination was carried out. Results. Hypertensive patients in our study exhibited significantly increased abdominal obesity. Blood pressure, fasting and 2 hr plasma glucose (4.62 ± 0.08 and 5.55 ± 0.17 mmol/l), and triglyceride (1.47 ± 0.067 mmol/l) levels were compared to those of control subjects (p < 0.05). The fasting insulin levels and HOMA-IR were also significantly increased and Composite Insulin Sensitivity Index (CISI) reduced compared to controls with p < 0.01. Intima media thickness of the left (0.08 ± 0.01) and right (0.069 ± 0.008) CA were both significantly increased in hypertensives (p < 0.01). Correlation analysis showed that IMT of the left carotid artery was significantly associated with triglyceride levels (r = 0.813, p < 0.05) but not with insulin measures such as HOMA-IR and CISI. Conclusion. Hyperinsulinemia was observed in our non-diabetic hypertensive patients, but no association was found between IMT and insulin resistance. That IMT of hypertensives was associated with triglyceride levels suggests that high levels of insulin may be related to the development of ATH indirectly through its effects on lipid metabolism in our population.

The Effect of Pravastatin on Intima Media Thickness of the Carotid Artery in Patients with Normal Cholesterol

Objective Carotid intima media thickness (IMT) is a good indicator of the severity of atherosclerotic disease. Statins have been found to reduce carotid IMT in patients with hypercholesterolaemia. The aim of this study was to investigate if pravastatin is effective in reducing IMT in normocholesterolaemic patients with carotid artery disease. Methods Patients with carotid artery stenosis and normal cholesterol levels who were not on a statin, were recruited. Patients were randomised to receive pravastatin or placebo daily. Serum concentration of cholesterol and IMT of common carotid arteries were measured before randomisation and at 3 monthly intervals thereafter, for 9 months. IMT was analysed to give the mean of a standardised 2 cm of the common carotid artery (CCA). Results are expressed as median (IQR) and comparison made using the Wilcoxon signed ranks test. Results Fifty-four patients were examined. Twenty-eight patients were randomised to active treatment. There was no difference in demographic details and co-morbid states between the two groups. A significant reduction in cholesterol concentration was observed from 3 months in patients randomised to the pravastatin group [5.14(4.72–5.88) vs. 4.11(3.44–5.33), p<0.05], while there was also a significant decrease in combined IMT form 6 months [1.53(1.36–1.87) vs. 1.41 (1.33–1.78), p<0.05]. Conclusions The results demonstrate that pravastatin reduces intima media thickness of the common carotid artery in normocholesterolaemic patients with moderate carotid stenosis.