Normal Carotid Intima-media Thickness Research Articles

Carotid intima medial thickness and its association with cardiometabolic risk factors in children with overweight and obesity: A hospital based cross-sectional study.

A hospital based cross sectional study involving children aged 2-15 years attending the obesity clinic of a tertiary care hospital from January 2016 to March 2018 was carried out to study carotid intima media thickness (cIMT) and its association with cardiometabolic risk factors in children with overweight and obesity. Secondary objective was to compare children with elevated (EcIMT) and normal cIMT (NcIMT). Out of 223 patients enrolled for the study, 102 (45.7%) had elevated cIMT. Mean cIMT of the study participants was 0.41 ± 0.13 mm. Median alanine transaminase levels (27 vs. 24, p=0.006) and proportion of patients with fatty liver (63.7% vs 48.8%, p=0.025) and ≥ 3 risk factors (80.4% vs. 66.1%, p=0.003) were higher in the EcIMT group compared to NcIMT group. Proportion of patients with hypercholesterolemia (36.4% vs. 16%, p=0.024), elevated LDL-C (38.6% vs. 16%, p=0.013), low HDL-C (40.9% vs. 20%, p= 0.027) and dyslipidemia (84.1% vs. 58%, p=0.006) were higher in the pubertal EcIMT group and those with fatty liver (63.8% vs. 45.1%, p=0.034) was higher in the prepubertal EcIMT group compared to pubertal and prepubertal NcIMT groups respectively. No significant correlations were observed between cIMT and various cardiometabolic parameters. Our finding of elevated cIMT in nearly half of the study participants including young children is very concerning as these children are at increased risk of atherosclerotic cardiovascular disease in adulthood. Interventions starting at a young age are important when trajectories are likely to be more malleable and adverse cardiometabolic phenotypes and subclinical atherosclerosis are reversible.

Can lung function be used as a predictor of cerebral stroke?

Background and objectivesLimited research has looked into the precise connection between lung function, arterial blood gases, and cerebral stroke. This study was focused on examining the correlation between pulmonary function and carotid intima-media thickness (CIMT) in patients with and without cerebral stroke who do not have chronic pulmonary disease.MethodsA case–control study included 125 cerebral stroke patients and 125 non-stroke controls selected from the outpatient clinics of the Neurology and Rheumatology & Rehabilitation departments at Zagazig University Hospital, Sharkia Governorate, Egypt. The assessment of lung function passed through measuring forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), the ratio of forced expiratory volume in the first second to forced vital capacity (FEV1/FVC) ratio, and maximum voluntary ventilation (MVV). Arterial blood gases were measured, and CIMT was evaluated using high-resolution ultrasonography by the radiology author.ResultsThe research findings suggested that patients exhibiting elevated carotid intima-media thickness (CIMT) faced a heightened risk of suffering from a cerebral stroke in comparison to those with normal CIMT levels. Additionally, the study revealed a negative relationship between lung function, as measured by FEV1, FVC, the ratio (FEV1/FVC), and MVV, and arterial blood gases, as indicated by the partial pressure of oxygen (PaO2), in relation to CIMT. Reduced FEV1, FVC, FEV1/FVC, MVV, and PaO2 were found to be associated with elevated CIMT. The stepwise multivariable regression model further showed that CIMT was positively correlated with age, while it displayed negative correlations with FEV1, FVC, FEV1/FVC, MVV, and PaO2.ConclusionPatients who have an elevated carotid intima-media thickness (CIMT) are at a greater risk of experiencing a cerebral stroke. In addition, reduced forced expiratory volume in one second (FEV1), forced vital capacity (FVC), FEV1/FVC ratio, maximal voluntary ventilation (MVV), and arterial partial pressure of oxygen (PaO2) are all linked with increased CIMT levels. Patients with elevated CIMT have a higher risk of cerebral stroke. These findings suggest that lung function tests in individuals without respiratory conditions could be beneficial for identifying those who may be at a heightened risk for experiencing a cerebrovascular stroke.

Quantitative Analysis on Vessel Stiffness and Vector Flow Imaging in the Assessment of Carotid Artery Structural and Functional Changes in Patients With Type 2 Diabetes

ObjectiveTo explore the value of RF-data-based quantitative analysis on vessel stiffness (R-QVS) combined with dynamic vector flow imaging (VFI) in evaluating structural and functional changes in the carotid arteries of patients with type 2 diabetes mellitus (T2DM). MethodsA prospective study was conducted between October 2022 and April 2024, including 275 consecutive subjects (50 volunteers as controls, 108 patients with T2DM and normal carotid intima-media thickness (CIMT), and 117 patients with T2DM and thickened CIMT). Carotid intima-media thickness (IMT) was measured using real-time intima-media thickness (RIMT) technology, while R-QVS was employed to measure the systolic diameter (Diam), displacement (Dist), hardness coefficient (HC), and pulse wave velocity (PWV) of the distal segment of the carotid artery. VFI was used to measure the maximum wall shear stress (WSSmax), mean wall shear stress (WSSmean), and maximum instantaneous velocity (Vmax) of the vessel wall. Differences in ultrasound parameters among the three groups were compared, and receiver operating characteristic (ROC) curves were plotted to calculate the area under the curve (AUC), evaluating the efficacy of these parameters in assessing structural and functional changes in the carotid arteries of patients with T2DM. ResultsThere were statistically significant differences in carotid IMT, Diam, Dist, HC, PWV, WSSmax, and Vmax among the three groups (all p < 0.01). The AUCs for evaluating structural and functional changes in the carotid arteries of patients with T2DM using carotid ultrasound parameters Diam, Dist, HC, PWV, WSSmax, and Vmax were 0.64, 0.68, 0.83, 0.88, 0.86, and 0.82, respectively. Multiple linear regression analysis identified Dist., HC, PWV, WSSmax, and WSSmean as influencing factors for CIMT in T2DM patients (with β values of -0.406, 0.515, 0.564, -0.472, and -0.438, respectively; all p < 0.05). ConclusionR-QVS and VFI techniques contribute to the early assessment of structural and functional changes in the carotid arteries of patients with type 2 diabetes mellitus. Compared with controls, T2DM patients exhibit more advanced functional changes than morphological changes despite normal CIMT. The enhanced sensitivity, reproducibility, and detailed assessment capabilities of these methods make them valuable tools in the early detection and intervention of cardiovascular risk in T2DM.

A Siamese ResNeXt network for predicting carotid intimal thickness of patients with T2DM from fundus images.

To develop and validate an artificial intelligence diagnostic model based on fundus images for predicting Carotid Intima-Media Thickness (CIMT) in individuals with Type 2 Diabetes Mellitus (T2DM). In total, 1236 patients with T2DM who had both retinal fundus images and CIMT ultrasound records within a single hospital stay were enrolled. Data were divided into normal and thickened groups and sent to eight deep learning models: convolutional neural networks of the eight models were all based on ResNet or ResNeXt. Their encoder and decoder modes are different, including the standard mode, the Parallel learning mode, and the Siamese mode. Except for the six unimodal networks, two multimodal networks based on ResNeXt under the Parallel learning mode or the Siamese mode were embedded with ages. Performance of eight models were compared via the confusion matrix, precision, recall, specificity, F1 value, and ROC curve, and recall was regarded as the main indicator. Besides, Grad-CAM was used to visualize the decisions made by Siamese ResNeXt network, which is the best performance. Performance of various models demonstrated the following points: 1) the RexNeXt showed a notable improvement over the ResNet; 2) the structural Siamese networks, which extracted features parallelly and independently, exhibited slight performance enhancements compared to the traditional networks. Notably, the Siamese networks resulted in significant improvements; 3) the performance of classification declined if the age factor was embedded in the network. Taken together, the Siamese ResNeXt unimodal model performed best for its superior efficacy and robustness. This model achieved a recall rate of 88.0% and an AUC value of 90.88% in the validation subset. Additionally, heatmaps calculated by the Grad-CAM algorithm presented concentrated and orderly mappings around the optic disc vascular area in normal CIMT groups and dispersed, irregular patterns in thickened CIMT groups. We provided a Siamese ResNeXt neural network for predicting the carotid intimal thickness of patients with T2DM from fundus images and confirmed the correlation between fundus microvascular lesions and CIMT.

(141) Can a Nocturnal Penile Tumescence and Rigidity Test Detect Organic Aetiology of Erectile Dysfunction? A Peripheral and Penile Vascular Study

Abstract Introduction In the diagnostic workup of erectile dysfunction (ED) the Nocturnal Penile Tumescence and Rigidity test (NPTR) is being used less and less because of its inconvenience but also in part because of the intrinsic limits of this test. In particular, the NPTR has been considered very useful to diagnose psychogenic ED when it is positive (normal) but less informative when it is negative (pathological) because of the high incidence of false negatives. Other tests have been suggested to better diagnose an organic ED, especially the dynamic Penile Colour-Doppler Ultrasound (PCDU) to study the penile vascular response and detect a vasculogenic ED. Objective The purpose of the study was to explore the value of a pathological NPTR by investigating relationship between the NPTR result and the peripheral vascular health at the carotid, brachial and cavernous arteries. Methods We conducted an observational study involving patients with ED who had undergone a NPTR as part of their ED diagnostic workup. We assessed their peripheral vascular health through (1) the measurement of the intima-media thickness at the carotid arteries (cIMT), (2) the measurement of the flow-mediated dilation at the brachial artery (FMD), and (3) performing a PCDU. Results Globally, our patients presented with a normal cIMT, FMD and Peak Systolic Value (PSV) in the PCDU. The group with pathological NPTR were significantly older than patients with normal NPTR (55.6 vs 44.1 years, p=0.002), had a higher prevalence of hypertension (50.0 vs 6.8%, p=0.001), longer hypertension duration (8.0 vs 1.3 years, p=0.035), a higher prevalence of diabetes mellitus (42.9 vs 6.8%, p= 0.004), higher blood glucose (111 vs 92 mg/dl, p=0.004) and higher blood triglycerides levels (188 vs 96 mg/dl, p=0.002). Furthermore, they showed lower PSV (46.2 vs 71.0 cm/s, p=0.002) while we did not find significant differences as regards cIMT and FMD between the two groups. Interestingly, the prevalence of patients with pathological PSV (&amp;lt;35 cm/s) was higher among patients with a pathological NPTR but without reaching the statistical significance. However, when adopted an age-dependant cut-off described in the literature (PSV &amp;lt; age x 0.7 + 6.73) the difference between the two groups became significant (50.0 vs 11.4%, p=0.005). Finally, the correlation analysis showed a significant correlation between PSV and the cIMT (-0.352, ρ=0.009), the maximum number of events in the RPTR record (+0.344, ρ=0.012), and the mean tip tumescence (+0.303, ρ=0.036). When corrected for age, these associations lost their statistical significance. Conclusions This study demonstrates the diagnostic value of a pathological NPTR which suggests an organic aetiology of the ED and associates with pathological findings in the PCDU. Age appears to be one of the most important risk factors for ED, even when other risk factors are present. Finally, when using a PCDU to diagnose vasculogenic ED, a cut-off of 35 cm/s might be less sensitive than an age-dependent cut-off to detect early impairments of penile endothelial function. Disclosure No.

Reference intervals for carotid artery intima-media thickness measurements in the multi-ethnic Asian population: relationship with cardiometabolic risk factors

Abstract Background Carotid artery intima-media thickness (cIMT) is an intermediate surrogate marker for cardiovascular disease (CVD). It has been reported that although the distribution of cIMT values is very heterogeneous and values vary widely between different ethnicity, geographic location, and ultrasound protocol, the prediction of vascular events with study-specific cIMT values is consistent across all ethnicities and regions (1). Hence, Consensus Statement from the American Society of Echocardiography suggests that cIMT greater than or equal to 75th percentile for the patient’s age, sex, and ethnicity is indicative of increased CVD risk (2). Aims We aimed to establish age, sex, and ethnic-specific reference intervals in the multi-ethnic Asian population comprising Chinese, Malays, and Indians. Methods We analysed data from 8762 healthy individuals who had a 3D carotid ultrasonography done as part of the Health for Life in Singapore study. Carotid ultrasonography measurements were taken from the distal common carotid artery (CCA) at both the lateral and posterior angles bilaterally during the end-diastolic phase. The mean of all 4 measurements were taken as average cIMT (avgcIMT). For this analysis, we excluded individuals on treatment for diabetes, hypertension, hyperlipidemia, and ischemic heart disease to derive a healthy population subset comprising of 6522 individuals (Chinese: 69%, Malays: 14%, Indians: 17%). We then assessed the 75th percentile as a marker of cardiovascular risk in all individuals, by testing associations with Framingham risk scores (locally adapted) and with cardiometabolic risk factors (3). Results Ethnic- and sex-specific 75th percentiles (95% CI) of CIMT for our Asian populations are summarised in Table 1. Compared to reference intervals reported in European and African American populations, the 75th centiles are lower in all Asian ethnic subgroups (p&amp;lt;0.05). Framingham risk score, BMI, LDL-C, HbA1c and systolic blood pressure were higher in Asians with cIMT more than 75th percentile (p&amp;lt;0.001), compared to Asians with normal cIMT. Conclusions We estimated race- and sex-specific 75th percentiles of avgcIMT across age in the multi-ethnic Asian population. The thresholds for Asian populations are substantially lower than reported in European and African populations. The 75th centiles identify people with raised cardiovascular risk factors, supporting the validity of cIMT as marker of vascular risk in the population. The 75th centiles will be useful in interpretation of cIMT measures obtained both in research and clinical settings in different ethnic populations in Asia. Longitudinal evaluation is needed to determine the prediction of our Asian specific thresholds for predicting hard cardiovascular outcomes.

Carotid Intima-Media Thickness and Its Correlation With Echocardiographic Left Ventricular Function and Geometry in Hypertensive Individuals: A Cross-Sectional Study.

Background It is important to consider left ventricular hypertrophy (LVH) and carotid intima-media thickness (CIMT) in assessing hypertensive patients' global cardiovascular risk profile, as LVH and arterial wall changes occur concurrently. This study aimed to assess the relationship between CIMT and left ventricular geometry and function in hypertensive patients. Methodology This cross-sectional study included 200 hypertensive individuals and sought to correlate their CIMT with left ventricular geometry and function in Lagos University Teaching Hospital. Hypertension was defined as blood pressure ≥140/90 mmHg or on treatment for hypertension presenting at the outpatient clinics. Patients who satisfied the inclusion criteria were recruited. Abnormal CIMT was defined as >0.9 mm. Patients' demographic data were obtained in addition to general characteristics, physical examination, transthoracic echocardiography, and CIMT. The statistical relationship between CIMT and left ventricular geometry and function was obtained and analyzed. Results Normal geometry and LVH were observed in 50.5% and 15.5%, respectively. Left ventricular geometry was associated with abnormal CIMT (χ2 = 31.688, p < 0.001). Furthermore, the mean left ventricular mass index was statistically different between abnormal and normal CIMT (97.84 ± 30.5 vs. 80.75 ± 15.6; p < 0.001). Regardingleft ventricular function, there was no significant difference in E-point septal separation, left ventricular fractional shortening, and left ventricular ejection fraction in abnormal versus normal CIMT groups. However, there was a significant association of CIMT with grades of diastolic dysfunction (χ2 = 7.069, p = 0.029). Additionally, individual parameters of diastolic dysfunction such as left atrial volume index and septal mitral were significantly different (p < 0.001). Conclusions There was an association between age, left ventricular geometry, diastolic function, and CIMT in hypertensive individuals. Therefore, it is beneficial to evaluate CIMT and for these patients to receive more targeted blood pressure control which may reduce the risk of cardiovascular diseases.

Study of the Relation between Atherosclerosis and Serum Level of 25(OH) Vitamin D among Maintenance Hemodialysis Patients

Abstract Background Cardiovascular (CV) disease is considered the main cause of exceedingly high overall mortality observed in hemodialysis patients. A number of studies have shown variable results on the relationship between 25 (OH) D deficiency and subclinical atherosclerosis. Aim and objectives To measure the relationship of serum 25(OH) D with Carotid intima-media thickness (cIMT) as a surrogate marker for the presence of atherosclerosis in hemodialysis patients, Subjects and methods This was a cross sectional study, was conducted on 90 patients (ESRD) undergoing hemodialysis in The National Institute of Nephrology and Urology divided into two groups: (Group A); included 45 ESRD patients on maintenance hemodialysis with normal carotid intima media thickness, (Group B): included 45 ESRD patients on maintenance hemodialysis with increased carotid intima media thickness during a period of 6 months. Result There were highly significant difference between both groups as regard 1, 25(OH) 2D, ng/ml. Conclusion Our findings suggested that vitamin D deficiency is not an independent predictor of subclinical atherosclerosis in elderly patients after adjusting confounding factors. Future studies to address the association between serum 25(OH) D and the cIMT need to be explored carefully. Finally we came to the conclusion that in patients on HD, the deficiency of vitamin D is related to rising of ESR asan inflammatory marke,

Associations between physical activity and cardiorespiratory fitness with vascular health phenotypes in older adults: a cross-sectional study.

Objective: We investigated the associations between physical activity (PA) and cardiorespiratory fitness (CRF) with vascular health phenotypes in community-dwelling older adults. Methods: This cross-sectional study included 82 participants (66.8 ± 5.2years; 81% females). Moderate-to-vigorous physical activity (MVPA) was assessed using accelerometers, and CRF was measured using the distance covered in the 6-min walk test (6MWT). The vascular health markers were as follows: i) arterial function measured as aortic pulse wave velocity (aPWV) estimated using an automatic blood pressure device; and ii) arterial structure measured as the common carotid intima-media thickness (cIMT). Using a combination of normal cIMT and aPWV values, four groups of vascular health phenotypes were created: normal aPWV and cIMT, abnormal aPWV only, abnormal cIMT only, and abnormal aPWV and cIMT. Multiple linear regression was used to estimate the beta coefficients (β) and their respective 95% confidence intervals (95% CI) adjusting for BMI, and medication for diabetes, lipid, and hypertension, sex, age, and blood pressure. Results: Participants with abnormal aPWV and normal cIMT (β = -53.76; 95% CI = -97.73--9.78m; p = 0.017), and participants with both abnormal aPWV and cIMT (β = -71.89; 95% CI = -125.46--18.31m; p = 0.009) covered less distance in the 6MWT, although adjusting for age, sex and blood pressure decreased the strength of the association with only groups of abnormal aPWV and cIMT covering a lower 6MWT distance compared to participants with both normal aPWV and cIMT (β = -55.68 95% CI = -111.95-0.59; p = 0.052). No associations were observed between MVPA and the vascular health phenotypes. Conslusion: In summary, poor CRF, but not MVPA, is associated with the unhealthiest vascular health phenotype (abnormal aPWV/cIMT) in older adults.

Correlation of neutrophil–lymphocyte ratio with carotid intima–media thickness in diabetes-an analytical cross-sectional study

Background: Atherosclerosis, the growth of fibrofatty lesions in the arterial wall, is a major cause of illness and mortality across the world. Cardiovascular disease, stroke, and coronary heart disease risk are increased in diabetics compared to nondiabetics. Carotid intima–media thickness (CIMT), performed by radiologists has been widely regarded as a marker of atherosclerosis. Neutrophil–lymphocyte ratio (NLR) is an easily available and reproducible test and is said to be a marker of inflammation. In this study, our aim was to assess the correlation of NLR with CIMT in diabetes patients. Methods: A total of 25 Type 2 diabetic patients (F:M = 7:18, mean age: 71.56 ± 9.63) were included. Complete blood count (CBC) was done and CIMT was measured. Depending on CIMT, the patients were divided into the following two groups: High CIMT group (&gt;1 mm) and normal CIMT group (&lt; 0.05). There was no difference in mean neutrophil count and mean lymphocyte count between the two groups. Conclusion: In this study, mean NLR was found to be higher in diabetes patients with higher CIMT than normal CIMT. Hence, NLR can be used to predict atherosclerosis in diabetes patients. Being cheaper, it can be used to predict adverse atherosclerotic events such as cerebrovascular accidents and coronary syndromes in diabetes patients, and the progression of these events in the same.

Association between gut microbiota and obesity combined with high carotid intima-media thickness among Chinese children.

Obesity and related target organ damage such as high carotid intima-media thickness (cIMT) in children is associated with cardiovascular disease (CVD) later in life. However, the asso-ciation between gut microbiota and obesity combined with high cIMT among children remains unclear. Therefore, we compared differences in composition, community diversity, and richness of gut microbiota among normal children and obesity combined with or without high cIMT to identify differential microbiota biomarkers. A total of 24 children with obesity combined with high cIMT (OB+high-cIMT), 24 with obesity but normal cIMT (OB+non-high cIMT), and 24 with normal weight and normal cIMT aged 10-11 years matched by age and sex from the "Huantai Childhood Cardiovascular Health Cohort Study" were included. All included fecal samples were tested using 16S rRNA gene sequencing. The community richness and diversity of gut microbiota in OB+high-cIMT children were decreased compared with OB+non-high cIMT children and normal children. At the genus level, the relative abundances of Christensenellaceae_R-7_group, UBA1819, Family_XIII_AD3011_group, and unclassi-fied_o_Bacteroidales were associated with reduced odds of OB+high-cIMT among children. Receiver operating characteristic (ROC) analysis showed that combined Christensenellaceae_R-7_group, UBA1819, Fami-ly_XIII_AD3011_group, and unclassified_o_Bacteroidales performed a high ability in identifying OB+high-cIMT. Phylogenetic Investigation of Communities by Reconstruction of Unobserved States (PICRUSt) showed that several pathways such as biosynthesis of amino acids and aminoacyl-tRNA pathways were lower in the OB+high-cIMT group compared with the normal group. We found that the alteration of gut microbiota was associated with OB+high-cIMT among children, which indicates that the gut microbiota may be a marker for obesity and related cardiovascular damage among children.

Association of Carotid Artery Intima Media Thickness With Ischemic Stroke Patients

Background: Atherosclerotic risk factors frequently lead to ischemic stroke. The thickness of the carotid intima-media thickness (CIMT) is a significant indicator for early atherosclerosis alterations. The aim of the study is to evaluate the association between ischemic stroke patients and CIMT. Methods: A total of 50 patients were recruited in this cross-sectional descriptive study which was carried out in the Department of Neurology, BSMMU, from January 2015 to June 2016. All patients of ischemic stroke were confirmed by history, examination and CT scan of head/MRI of brain. Carotid ultrasound scan was done to detect intima-media thickness (IMT) of both sided carotid bifurcation, common carotid and internal carotid artery and performed by a single sonographer at the Department of Neurology, BSMMU. Results: This population has a total of 27 male and 23 female with mean age 60.7± 13.6 years. Maximum patients (72%) were found to be above 50 year of age. After risk factor stratification among the study population, HTN, dyslipidemia was the most followed by positive family history, smoker, DM, IHD. Among study population 45 cases were anterior circulation stroke and only 5 cases were posterior circulation stroke. Maximum mean IMT=1.2± 0.3, minimum mean IMT=1.0±0.10 mm and least IMT was 0.7mm. (Normal CIMT value is &lt; 0.8mm). The mean IMT was higher at symptomatic side in comparison to the asymptomatic side. Higher IMT was found mostly at the carotid bifurcation and higher IMT at one site was significantly correlated with other sites (r= +0.435, p=0.002), there was also correlation between IMT and risk factor (r=+0.265, p=0.063). Increased IMT was more marked in patients with risk factors in comparison to without risk factor, like smoker &amp; nonsmoker but not statistically significant (ORR=2.00, 95% CI 0.636- 6.286, p=0.233). Conclusion: The present Study found that extra-cranial carotid artery intima media thickness (IMT) was higher than normal level in ischemic stroke patients. Higher CIMT was found at symptomatic side in comparison to the asymptomatic side. Bangladesh J Medicine 2022; 33: 24-30

Association of High Muscle Mass with Carotid Atherosclerosis: A Community-Based Population Cohort Study.

Although low muscle mass may make an under-appreciated contribution to increasing the risk of cardiovascular diseases, no prospective studies have explored the association between low muscle mass and carotid atherosclerosis. We investigated whether muscle mass was related to a higher carotid intima-media thickness (C-IMT) and carotid artery plaque in a community-based population. The study included 1,253 asymptomatic participants without known cardiovascular disease, who underwent carotid ultrasonography at baseline in 2013-2014 and received a re-examination in 2015-2016. The skeletal muscle mass index was estimated using a bioelectrical impedance analyzer. We assessed the relationship between the skeletal muscle mass index and the development of C-IMT and carotid plaque, both, using multivariate-adjusted logistic regression models. During the follow up, 400 (51.0%) subjects with normal C-IMT at baseline developed elevated C-IMT and 215 (17.2%) subjects developed carotid plaque. The risk of elevated C-IMT occurrence linearly decreased with an increase in skeletal muscle mass index quintiles or its continuous data, after multivariate-adjustment in men and women, respectively (both P for trend < 0.05; both P < 0.05). Subgroup analyses showed that this association was BMI-dependent. Besides, there was an inverse association between a high skeletal muscle mass index and carotid artery plaque in women, but the association disappeared after multivariate adjustment. In men, the skeletal muscle mass index was not associated with the incidence of carotid plaque. Skeletal muscle mass was inversely associated with the incidence of carotid atherosclerosis, suggesting muscle mass maintenance may play a role in modifying atherosclerosis.

Increased Carotid Intima-Media Thickness in Asymptomatic Individuals Is Associated with the PCSK9 (rs2149041) Gene Polymorphism in the Mexican Mestizo Population: Results of the GEA Cohort.

The increase in carotid intima-media thickness (CIMT) and coronary artery calcification (CAC) are features of subclinical atherosclerosis that might be determined by the genetic background of patients. Among the multiple risk factors, the proprotein convertase subtilisin kexin type 9 (PCSK9) has a great impact on atheroma development. Then, we focused on the potential association of the PCSK9 gene polymorphism (rs2149041) with the risk of an increased CIMT. We included 881 unrelated, asymptomatic individuals (732 normal CIMT and 149 increased CIMT) who lacked coronary calcification (CAC score = 0). Under the recessive inheritance model and adjusted by several cardiovascular risk factors, the rs2149041 polymorphism, determined by TaqMan genotyping assay, was associated with a high risk of increased CIMT (OR = 2.10, 95% IC = 1.26–3.47, P recessive = 0.004). Our results suggest that the rs2149041 polymorphism could be a risk marker for increased CIMT in asymptomatic individuals without coronary artery disease determined by the absence of a CAC score.

Association of Common Variants in OLA1 Gene with Preclinical Atherosclerosis.

Reactive oxygen species impair the blood vessels, leading to the initiation of atherosclerosis, and migration and proliferation of vascular smooth muscle cells and neovascularization by endothelial cells of vasa vasorum are essential for atherosclerosis development. Obg-like ATPase 1 (OLA1), a negative regulator in cellular responses to oxidative stress, binds to breast cancer susceptibility gene 1 (BRCA1), which protects vascular endothelial and smooth muscle cells against reactive oxygen species. However, it is not known whether OLA1 is genetically correlated with atherosclerosis. Here, we conducted two independent population-based case–control studies to explore the effects of variants in OLA1 genes on preclinical atherosclerosis. A total of 564 and 746 subjects who had thicker and normal carotid intima–media thickness (cIMT), respectively, were enrolled. Among 55 screened SNPs, rs35145102, rs201641962, rs12466587, rs4131583, and rs16862482 in OLA1 showed significant associations with cIMT. SNP rs35145102 is a 3′-utr variant and correlates with the differential expression of OLA1 in immune cells. These five genetic markers form a single closely linked block and H1-ATTGT and H2-GCCTC were the top two most prevalent 5-locus haplotypes. The H1 + H1 genotype negatively and H1 + H2 genotype positively correlated with thicker cIMT. The five identified SNPs in the OLA1 gene showed significant correlations with cIMT. Furthermore, we found that OLA1 was required for migration and proliferation of human aortic endothelial and smooth muscle cells and regulated vascular tube formation by human aortic endothelial cells. Therefore, these genetic variants in the OLA1 gene may serve as markers for risk prediction of atherosclerotic diseases.

Proprotein convertase subtilisin kexin type 9 and main artery atherosclerosis in patients with arterial hypertension.

Aim of our investigation is to study the relationship between the level of proprotein convertase subtilisin kexin type 9 (PCSK9) and atherosclerotic process of coronary and brachiocephalic arteries in patients with arterial hypertension (AH). Our investigation was performed in regional railway hospital. In our investigation we included 161 male train drivers who had AH with achieved target grades 1-2. All patients were performed laboratory tests including cholesterol, LDL-C, triglycerides, glucose, hemostasiograms, PCSK9. Patients were divided into groups up to the PCSK9 level: in group 1 (N.=41) we included patients with PCSK9 level 108-250 ng/mL; group 2 (N.=37) 251-400 ng/mL; group 3 (N.=45) 420-560 ng/mL and group 4 (N.=38) 580-860 ng/mL. All patients were performed coronary angiography, ultrasound Doppler of brachiocephalic arteries, electrocardiography, transthoracic echocardiography. The groups of the patients were identical in age, Body Mass Index, triglycerides, LDL-C, glucose, cholesterol levels. Also, there was no significant difference in the dependence of PCSK9 level on smoking status (χ2=3.1; P=0.3) and the presence of family history of AH (χ2=0.9; P=0.8). It was found that in the 1st group, patients with normal Body Mass Index had normal carotid intima-media thickness ≤1 mm in most of the cases (34.1%). The severity of brachiocephalic and coronary arteries atherosclerosis was more advanced in the 4th group. The atherosclerotic plaques determine the cardiovascular risk in patients with AH. The level of PCSK9 in male patients is an additional cardiovascular risk factor independent from the traditional risk factors. The PCSK9 level is correlated with atherosclerotic severity process of brachiocephalic arteries (P=0.08; r=0.2). The concentration of PCSK9 in the blood serum more than 580 ng/mL in patients with AH determines more severe coronary arteries atherosclerosis. If more the level of PCSK9 than more cardiovascular risk (P=0.002).

Carotid intima-media thickness measurements in patients with multiple sclerosis

ObjectivesThe goal of this study was to evaluate the mean carotid intima-media thickness (CIMT) in patients with Multiple Sclerosis (MS). MethodsIn this cross-sectional study, 100 patients with MS were enrolled. Carotid intima-media thickness was measured by Doppler Ultrasonography. The mean CIMT was then compared between different groups of sex, age, body mass index (BMI), medications, and site of the MS plaques in the brain and cervical MRI. In addition, disease duration, annual relapse rate, and Expanded Disability Status Scale (EDSS) were compared between high and normal CIMT groups. ResultsAmong 100 patients, Sixty-two percent of the patients were female. The mean age was 35.95 ± 9.32 years. Mean CIMT was 0.38 ± 0.2 mm, and 22% of the patients had abnormal CIMT measures. CIMT was significantly associated with higher age (P = 0.01) and prolonged disease duration (P < 0.001). CIMT was not associated with other disease factors or types of the disease-modifying drug (P > 0.05). ConclusionMultiple Sclerosis might be associated with carotid atherosclerotic vascular disease.

Fibroblast growth factor 23 and carotid intima media thickness in non-diabetic chronic kidney disease patients

ObjectivesTo clarify the relationship between fibroblast growth factor-23 (FGF23) and carotid intima-media thickness (CIMT) in nondiabetic chronic kidney disease (CKD) patients on conservative treatment.BackgroundCIMT is a reliable marker of subclinical atherosclerosis, and it has been associated with increased risk of cardiovascular events among CKD. Vascular calcification in CKD patients was independently correlated with FGF23.Patients and methodsThe study included 75 nondiabetic CKD patients on conservative treatment aged from 20 to 65 years as group 1 and 15 healthy individuals aged from 28 to 61 years, who have no medical history as a control group (group 2). Group 1 was subdivided into two groups: patients with increased CMIT and patients with normal CMIT. The study was conducted from October 2018 to May 2019. The patients were excluded if they have any of the following criteria: acute illness, CKD on dialysis, and patients with diabetes mellitus. The study was a case–control study. All patients and healthy individuals were subjected to the following: full history taking, general demographic data, including age, sex, height, weight, drug history, clinical examination, and laboratory investigations in the form of complete blood count, serum creatinine, and fasting and postprandial blood glucose. Estimated glomerular filtration rate (eGFR) was calculated by the Cockcroft–Gault formula as follows: eGFR=[140 − age (years)]×weight (kg)/serum creatinine (mg/dl)×72 [×0.85 if female], liver function tests (alanine transferase, aspartate transferase, serum albumin level), corrected serum calcium, serum phosphorus, lipid profile, carotid ultrasound, and intact FGF23.ResultsFGF23 levels and CIMT were significantly increasing across all the stages of CKD. The CIMT is significantly increasing in nondiabetic CKD patients with FGF23 levels of above 190 pg/ml. FGF23 levels positively correlated with the levels of creatinine, calcium, phosphrous, eGFR, hemoglobin, and albumin in nondiabetic CKD patients.ConclusionNondiabetic CKD patients had higher levels of FGF23 than controls. Nondiabetic CKD patients with increased CIMT had significantly higher phosphorus, creatinine, and FGF23 levels than those with normal CIMT. CIMT and FGF23 were significantly increased across all the stages of CKD. Increasing FGF23 concentrations across the stages of CKD reflect increasing CIMT and progression in CKD nondiabetic patients on conservative treatment.

The Correlation between Carotid Intima-Media Thickness and Neutrophil to Lymphocyte Ratio in Prediabetes Patients.

BackgroundPrediabetes is a metabolic state between normoglycemia and diabetes and is known to carry a higher risk of developing overt diabetes and cardiovascular disease (CVD). The relative and absolute risks of all-cause mortality, CVD, coronary heart disease, and stroke in prediabetes patients, as well as in diabetic patients, is higher than that in patients with normoglycemia. Carotid intima-media thickness (cIMT) is a method used to stratify CVD risk. In this study, we aimed to determine whether the neutrophil-to-lymphocyte ratio (NLR) correlates with cIMT in prediabetes patients.MethodsFrom January 1, 2016, to February 20, 2021, 581 adults their 30s–70s who underwent carotid ultrasonography as part of a comprehensive medical examination at the Dongtan Sacred Heart Hospital were enrolled. Statistical analysis using SPSS presented t-test and chi-square test significance levels into a group with normal cIMT (nIMT; cIMT <1 mm) and a group with thick cIMT (tIMT; cIMT ≥1 mm). Binary logistic regression analysis was performed to confirm the correlation between NLR and cIMT.ResultsIn prediabetic adults, age, hemoglobin A1c (HbA1c), systolic blood pressure, and NLR were significantly higher in the tIMT group than in the nIMT group. In the regression analysis, NLR, age, and HbA1c were significantly correlated with cIMT.ConclusionNLR was significantly higher in the tIMT group than in the nIMT group; therefore, NLR may be used to assess CVD risk in prediabetes patients.

Linking extracellular inhibitors of Wnt/beta-catenin signaling to carotid intima-media thickness in heart failure with reduced ejection fraction

Abstract Background The Wnt/β-catenin signaling pathway plays an important role in endothelial inflammation, vascular calcification, contributing to atherosclerosis development and progression. Sclerostin and Dickkopf-1 (DKK-1) are soluble extracellular canonical Wnt signaling inhibitors frequently associated with atherosclerotic disease. Purpose We investigated the possible association between carotid intima-media thickness (cIMT) and circulating levels of sclerostin and DKK-1 in patients with heart failure with reduced ejection fraction (HFrEF). Methods 65 patients with HFrEF were assigned to one of two groups based on cIMT measurements: 30 patients had normal cIMT, whereas 35 patients showed pathological cIMT. CIMT was assessed by vascular ultrasonography, and values above 0.9 mm were considered abnormal. Serum sclerostin and DKK-1 levels were measured using commercially available ELISA kits. Unpaired t-test and Mann-Whitney test were used for statistical analysis (p&amp;lt;0.05 was considered statistically significant). Results Patients belonging to the group with abnormal cIMT were older (70±9 years vs. 57±12 years, p&amp;lt;0.0001), had higher systolic blood pressure (123±16 mm Hg vs. 112±15 mm Hg, p=0.005), and had more often type 2 diabetes mellitus (40.00% vs. 13.33%, p=0.017). Sclerostin levels were significantly higher in the abnormal cIMT population (537.91±816.69 pg/mL vs. 276.37±173.21 pg/mL, p=0.017), whereas serum DKK-1 concentrations did not differ significantly (398.34±218.73 pg/mL vs. 352.35±188.08 pg/mL, p=0.498). The two groups had similar C-reactive protein levels (1.78±2.77 mg/dL vs. 1.88±2.77 mg/dL, p=0.200), estimated glomerular filtration rates (73.60±22.32 mL/min/1.73m2 vs. 66.25±23.69 mL/min/1.73m2, p=0.254) and body mass index (27.58±4.95 kg/m2 vs. 26.65±5.75 kg/m2, p=0.490). Conclusion Patients with HFrEF and increased cIMT had elevated levels of serum sclerostin. DKK-1 levels did not increase with the progression of cIMT. Further studies with large sample size are needed to establish the involvement of these proteins in vascular calcification and atherosclerosis in the setting of HFrEF. Funding Acknowledgement Type of funding sources: None.