Presence Of Atheromatous Plaques Research Articles

Association of carotid atheroma plaque with IL-18 levels and with polymorphisms in the IL-18 receptor gene in a Mediterranean population

BackgroundAtherosclerosis is an inflammatory disease. Interleukin 18 (IL-18) is an inflammatory molecule that has been linked to the development of atherosclerosis and cardiovascular disease. ObjectiveTo evaluate the possible relationship between plasma levels of IL-18 and the presence of atherosclerosis evaluated at the carotid level, as well as to analyze the possible modulation by different polymorphisms in a Mediterranean population. Material and methods746 individuals from the metropolitan area of ​​Valencia were included, recruited over a period of 2 years. Hydrocarbon and lipid metabolism parameters were determined using standard methodology and IL-18 using ELISA. In addition, carotid ultrasound was performed and the genotype of 4 SNPs related to the IL-18 signaling pathway was analyzed. ResultsPatients with higher plasma levels of IL-18 had other associated cardiovascular risk factors. Elevated IL-18 levels were significantly associated with higher carotid IMT and the presence of atheromatous plaques. The genotype with the A allele of the SNP rs2287037 was associated with a higher prevalence of carotid atheromatous plaque. On the contrary, the genotype with the C allele of the SNP rs2293224 was associated with a lower prevalence of atheromatous plaque. ConclusionsHigh levels of IL-18 were significantly associated with a higher carotid IMT and the presence of atheromatous plaques, which appear to be influenced by genetic factors, as evidenced by associations between SNPs in the IL-18 receptor gene and the presence of atheroma plaque.

Asociación de la placa de ateroma carotídea con los niveles plasmáticos de IL-18 y con polimorfismos en el gen del receptor de la IL-18 en la población mediterránea

BackgroundAtherosclerosis is an inflammatory disease. Interleukin 18 (IL-18) is an inflammatory molecule that has been linked to the development of atherosclerosis and cardiovascular disease. ObjectiveTo evaluate the possible relationship between plasma levels of IL-18 and the presence of atherosclerosis evaluated at the carotid level, as well as to analyze the possible modulation by different polymorphisms in a Mediterranean population. Material and methodsSeven hundred and forty-six individuals from the metropolitan area of Valencia were included, recruited over a period of 2 years. Hydrocarbon and lipid metabolism parameters were determined using standard methodology and IL-18 using ELISA. In addition, carotid ultrasound was performed and the genotype of four SNPs related to the IL-18 signaling pathway was analyzed. ResultsPatients with higher plasma levels of IL-18 had other associated cardiovascular risk factors. Elevated IL-18 levels were significantly associated with higher carotid IMT and the presence of atheromatous plaques. The genotype with the A allele of the SNP rs2287037 was associated with a higher prevalence of carotid atheromatous plaque. On the contrary, the genotype with the C allele of the SNP rs2293224 was associated with a lower prevalence of atheromatous plaque. ConclusionsHigh levels of IL-18 were significantly associated with a higher carotid IMT and the presence of atheromatous plaques, which appear to be influenced by genetic factors, as evidenced by associations between SNPs in the IL-18 receptor gene and the presence of atheroma plaque.

Vascular risk factors and carotid atheromatous disease in patients over 65 years of age

Introduction: Vascular risk factors are decisive in the evolution of atherosclerotic disease and the carotid and vertebral Doppler ultrasound allows monitoring its onset and progress. The measurement of arterial wall thickening allows the early diagnosis of the disease enhancing its treatment and control of vascular risk factors. Aim: Analysing the presence of atheromatous disease in individuals aged > 65 years and understanding its correlation with vascular risk factors. Materials and methods: This is a cross-sectional observational study, in individuals aged > 65 years and underwent carotid echoDoppler between January 1, 2012, and December 31, 2021. The intimal-media index was calculated, as was the presence of atheromatous plaques, their hemodynamic repercussion and vascular risk factors were recorded. Results: A sample of 5885 individuals was obtained with 41.8% female and 58.2% male. The mean age was 76.59 (± 6.69), with a range between 65 and 98 years. Arterial hypertension was the most prevalent 81.3%. There was a significant positive relationship between the intima-media index and age (p = 0.001). In the presence of plaques, male gender, arterial hypertension, diabetes, dyslipidemia, and smoking it presents a positive correlation. Conclusion: In this sample, non-modifiable vascular risk factors seem to be determinants in the presence of increased arterial wall thickness. In the presence of signs of a more advanced stage of atherosclerotic disease, modifiable vascular risk factors are decisive, corroborating the already-known importance of strict control over them for their treatment.

Independent risk factors affecting hemorrhage in percutaneous nephrolithotomy: Retrospective study

IntroductionThe perioperative and postoperative concern in percutaneous nephrolithotomy (PNL) is bleeding. Disease-related conditions (such as stone size, stone HU, tract number, and diameter) affecting this situation were determined. To determine independent risk factors that may affect the amount of hemorrhage in PNL. Material and methodA total of 308 adult patients (211 men, 97 women) undergoing the PNL procedure were included in the study. Renal anatomy and stone size were evaluated using non-contrast thin-section computed tomography (NCCT). NCCT was used to assess Hounsfield unit (HU) values of kidney stones, presence of atheroma plaque and obesity. The difference between preoperative hemoglobin (Hgb) values and postoperative 1st day Hgb values was recorded. This variation was evaluated for the effect of gender, age, atherosclerotic vein disease, urine pH and density, leukocyte count, lymphocyte count, neutrophil count (NEU), platelet count, mean platelet volume (MPV), neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), stone volume, HU, and obesity. ResultsThe mean Hgb variation was identified as 2.1 (standard deviation: 1.6). There were positive, significant, and weak correlations between the Hgb variation with NEU (P=0.019), MPV (P=0.000), NLR (P=0.005), stone volume (P=0.041) and HU (P=0.024) values. There was a negative significant and weak correlation between Hgb variation and PLT (P=0.022). No effects at significant levels were identified for gender (P=0.078), presence of atheroma plaque (P=0.949), obesity (P=0.869), age (P=0.686), urine pH (P=0.746), urine density (P=0.421), and PLR (P=0.855) on Hgb variations. ConclusionIn addition to HU and stone volume, NEU count, MPV, NLR and PLT count may be used as independent risk factors to predict blood loss during PNL.

Factores de riesgo independientes asociados al sangrado en la nefrolitotomía percutánea: estudio retrospectivo

IntroductionThe perioperative and postoperative concern in percutaneous nephrolithotomy (PNL) is bleeding. Disease-related conditions (such as stone size, stone HU, tract number, and diameter) affecting this situation were determined. To determine independent risk factors that may affect the amount of hemorrhage in PNL. Material and methodA total of 308 adult patients (211 men, 97 women) undergoing the PNL procedure were included in the study. Renal anatomy and stone size were evaluated using non-contrast thin-section computed tomography (NCCT). NCCT was used to assess Hounsfield unit (HU) values of kidney stones, presence of atheroma plaque and obesity. The difference between preoperative hemoglobin (Hgb) values and postoperative 1st day Hgb values was recorded. This variation was evaluated for the effect of gender, age, atherosclerotic vein disease, urine pH and density, leukocyte count, lymphocyte count, neutrophil count (NEU), platelet count, mean platelet volume (MPV), neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), stone volume, HU, and obesity. ResultsThe mean Hgb variation was identified as 2.1 (standard deviation: 1.6). There were positive, significant, and weak correlations between the Hgb variation with NEU (P=.019), MPV (P=.000), NLR (P=.005), stone volume (P=.041) and HU (P=.024) values. There was a negative significant and weak correlation between Hgb variation and PLT (P=.022). No effects at significant levels were identified for gender (P=.078), presence of atheroma plaque (P=.949), obesity (P=.869), age (P=.686), urine pH (P=.746), urine density (P=.421), and PLR (P=.855) on Hgb variations. ConclusionIn addition to HU and stone volume, NEU count, MPV, NLR and PLT count may be used as independent risk factors to predict blood loss during PNL.

Early atherosclerosis and acute vascular events in ulcerative colitis patients-a case series

Introduction: In inflammatory bowel disease uncontrolled inflammation may play a role in the early progression of systemic atheromatosis with increased cardiovascular risk. Endothelial dysfunction is mediated by pro-inflammatory cytokines but also by an increased level of CRP which is involved in the expression of adhesion molecules and atheroma plaque rupture. Tailored treatment with better control of the ulcerative colitis and endoscopic healing might result in decrease risk of atherothrombotic events. Aim: We decided to use a well-established method (vascular Doppler ultrasound with media-intimate index measurement) to detect an increased incidence of endothelial lesions as predictors of early atheromatosis in patients with ulcerative colitis treated with biological or conventional therapy. Material and methods: We prospectively analyzed 25 patients with RCUH with a mean age of 40 years, 16 with biological treatment. The Student t test, the Mann Whitney U test and the ANOVA test were used to compare continuous variables. Results: A discriminant analysis was performed with the presence of atheroma plaque as a dependent variable and several predictor variables, such as age, triglycerides, cholesterol of patients with ulcerative colitis. Univariate ANOVA analyzes revealed that the presence or absence of atheroma plaque differs in the variables predicting the age, INR and ecoIMT of patients with ulcerative colitis (in the age of patients (F = 8.511, degrees of freedom = 11, p = 0.014) Patients ‚INR (F = 50,437, degrees of freedom = 11, p = 0.001) and Patients’ ecoIMT (F = 7,398, degrees of freedom = 11, p = 0.020) In another analysis of discriminatory function s -introduced the predictor variables specific to measuring the evolution of ulcerative colitis, respectively Mayo and Mayo E (age (F = 0.8511, degrees of freedom = 11, p = 0.014), INR (F = 50.437, degrees of freedom = 11, p = 0.001), ecoIMT (F = 7.398, df = 11, p = 0.020) and Mayo (F = 14.885, degrees of freedom = 11, p = 0.003). Conclusions: Age, endoscopic activity, and INR were correlated with predictive ultrasound changes for atheromatosis. Strengths are the prospective nature of the study and weaknesses are the limited number of patients and the fact that most patients were in remission and treated with biologicals, which could create bias in the sense of reducing the atherosclerotic risk directly correlated with active inflammation.

VASCULAR RISK FACTORS IMPACT IN CAROTID INTIMA-MEDIA INDEX: PATIENTS OVER 65 YEARS

Objective: Analyze the carotid intima-media index in individuals over 65 years and verify its correlation with modifiable and non-modifiable vascular risk factors. Design and method: A cross-sectional observational study was conducted with a sample of 5885 patients over 65 years who underwent cervical Doppler echo-examination, between January 2012 and December 2021, with measurement of the intima-media index and recording of vascular risk factors. Results: The sample consisted of 5885 individuals, 41.8% female and 58.2% male. The mean age was 76.59, aged between 65 and 98 years (+/- 6.69). Hypertensive individuals are 81.3% of the sample. There is a significant relationship between the intima-media index, age and personal history of cardio and cerebrovascular diseases (p = 0.001). Other risk factors such as male sex, hypertension, dyslipidemia, smoking and personal history of cardio and cerebrovascular diseases have a positive correlation with the presence of atheroma plaques. Conclusions: In this sample of individuals over 65 years, non-modifiable risk factors are important in increasing the intima-media index and modifiable risk factors for atherosclerotic disease in more advanced stages.

Frequency and factors associated with arterial remodeling in persons living with human immunodeficiency virus in Parakou in 2019.

The side effects of antiretroviral drugs and the chronic inflammation induced by human immunodeficiency virus (HIV) infection contribute to the development of atherosclerotic arterial remodeling in people living with HIV (PLWH). To determine the frequency and factors associated with arterial remodeling in PLWH treated at the university hospital of Parakou. It was a cross-sectional, descriptive, and analytic study. Data were collected from March to August 2019 at the university hospital of Parakou in Benin. PLWH aged at least 18years and consenting were included. The diagnosis of arterial remodeling was retained in the presence of at least one of the following criteria: carotid intima-media thickness≥1mm, anteroposterior diameter of the abdominal aorta≥25mm, ankle brachial index<0.9, presence of atheromatous plaque. Data were recorded and analyzed with R 3.5.1 software, and the threshold of significance was 5%. A total of 114 patients have undergone arterial Doppler ultrasound. The majority were women (71.9%). The patients' mean age was 43.2±10.2years with extremes of 18 and 67years. The frequency of arterial remodeling was 24.6%. The most common atherosclerotic lesion found was atheromatous overload (IMT≥1mm). Age≥50y (p=0.003; ORa=4.9[1.5-15.6]), male sex (p=0.037; ORa=4.1[1.3-13.4]), and a family history of hypertension and/or diabetes (p=0.027; ORa=3.6[1.1-12.8]) were significantly associated with atherosclerosis in PLWH. Arterial remodeling was frequent among PLWH in Parakou in 2019. The associated factors were the classic cardiovascular risk factors that should be systematically taken into account in the follow-up of these patients.

Association between Carotid Intima-Media Thickness and the Use of Biological or Small Molecule Therapies in Patients with Rheumatoid Arthritis.

Objective: The objective of this study was to assess the association of carotid intima-media thickness (CIMT), and also the presence of atheromatous plaque, with biological and targeted synthetic disease-modifying antirheumatic drugs, in an established cohort of patients with rheumatoid arthritis (RA). Patients and Methods: We conducted a cross-sectional observational study based on a cohort of patients with RA and a registry of healthy controls, in whom the CIMT and presence of atheromatous plaque were assessed by ultrasound. Data were collected on disease activity, lab results and treatments. Descriptive and bivariate analyses were performed and two multivariate linear regression models (with CIMT as the dependent variable) were constructed to identify variables independently associated with CIMT in our sample of patients with RA. Results: A total of 176 individuals (146 patients with RA and 30 controls) were included. A higher percentage of patients than controls had atheromatous plaque (33.8% vs. 12.5%, p = 0.036), but no differences were found in terms of CIMT (0.64 vs. 0.61, p = 0.444). Compared to values in patients on other therapies, the CIMT was smaller among patients on tumour necrosis factor alpha (TNFα) inhibitors (mean [SD]: 0.58 [0.10] vs. 0.65 [0.19]; p = 0.013) and among those on Janus kinase inhibitors (mean [SD]: 0.52 [0.02] vs. 0.64 [0.18]; p < 0.001), while no differences were found as a function of the use of the other therapies considered. The multivariate linear regression analysis to identify factors associated with CIMT in our patients, adjusting for traditional cardiovascular risk factors such as hypertension, high levels of low-density lipoproteins, diabetes mellitus and smoking, showed that male sex, older age and having a greater cumulative erythrocyte sedimentation rate were independently associated with a larger CIMT, while patients on TNFα inhibitors had a CIMT 0.075 mm smaller than those on other treatments. Conclusions: The use of TNFα inhibitors may protect against subclinical atherosclerosis in patients with RA, patients on this biologic having smaller CIMTs than patients on other disease-modifying antirheumatic drugs. Nonetheless, these results should be confirmed in prospective studies with larger sample sizes.

The detection rate of non-invasive markers of subclinical atherosclerosis of brachyocephalic and coronary arteries with an assessment of their relationship in patients with arterial hypertension

Abstract Introduction Atherosclerosis is a chronic, progressive, inflammatory disease, which is characterized by an undulating course and multifocal nature of the lesion. Arterial hypertension (AH) is widespread in the population, and also contributes to the development and progression of atherosclerosis. Non-invasive imaging techniques make it possible to diagnose atherosclerosis, also at its subclinical stage. The detection of coronary calcification, atheromatous plaques in the brachiocephalic arteries (BCA), and the detection of the ankle-brachial index (ABI) are referred to as non-invasive markers of atherosclerosis. Estimation of the strength of the relationship between the detection rate of non-invasive markers of atherosclerosis in AH is on the front burner. Purpose To estimate the presence and degree of relationship between non-invasive markers of subclinical atherosclerosis in patients with AH. Methods 99 patients were studied with an proven diagnosis of AH, without anamnesis of symptomatic diseases of atherosclerotic genesis. Median age is 58 years, of them 37 are men. To detect subclinical atherosclerotic lesions of the coronary arteries (CA), all persons included in the study, after obtaining informed consent, were performed the multispiral computed tomography of CA on a 64-slice computed tomography Optima CT 660 (General Electric Co, USA) with the calculation of the cardiac calcium score (CCS) according to the Agatston score. Duplex ultrasound of BCA and determination of ABI value was performed using a supersonic diagnostic apparatus Vivid E9 (General Electric Co, USA) according to the standard procedure. Statistical data processing was performed using the Statistica for Windows ver 10.0 software (StatSoft, Inc., USA). To describe the relationship between the parameters under study, the Kendall's rank correlation coefficient was used (at a statistical significance p&amp;lt;0.05). Results Subclinical atherosclerotic lesions of CA (CCS &amp;gt;0) was detected in 53 persons (53.5%), and BCA (presence of atheromatous plaque) – in 52 persons (52.5%). In 13 patients (13.1%), a decrease in ABI &amp;lt;0.9 was recorded. Correlation analysis revealed the presence of a direct correlation of average strength between subclinical lesions of the BCA (presence of atheromatous plaque) and CA (CCS &amp;gt;0), τb=0.33 (95% CI: 0.14; 0.49), p&amp;lt;0.001). Besides, atherosclerotic lesions of BCA had a negative correlation weak strength with subclinical peripheral arterial lesion (ABI &amp;lt;0.9) τb=−0.19 (95% CI: −0.37; 0.01), p=0.005. We have not detected a correlation between the ABI decrease and the presence of coronary calcification. Conclusion Subclinical lesions of CA and BCA were more often detected in persons with AH (in 53.5% and 52.5%, respectively). Correlation analysis showed that in persons with AH, subclinical BCA lesion is positively associated with the presence of coronary calcification and has a weak negative relationship with a decrease value of ABI. Funding Acknowledgement Type of funding sources: None.

The Value of Carotid Intima-Media Thickness in the Detection of Atherosclerosis in HIV (+) Patients Subclinical Atherosclerosis in HIV (+).

To evaluate the role of the traditional risk scoring system (TRSS) in detecting subclinical atherosclerosis in HIV (+) patients. Cohort study. Infectious Diseases Clinic, Izmir Katip Çelebi University, Atatürk Training and Research Hospital, from March 2017 to January 2018. The patient group was formed with 52 HIV (+) patients, aged 18-60 years, and a control group was formed with 52 HIV (-) healthy volunteers. For all groups, there was no comorbid diseases or family history. Diabetes mellitus, hypertension, chronic kidney disease and cardiovascular disease were excluded from the two groups. Carotid intima-media thickness (CIMT) measurements were performed with high resolution B mode Doppler USG and patients with subclinical atherosclerosis were identified by the presence of atheroma plaque. The median right CIMT measurement was 0.91 (0.73-0.97) mm and the median left CIMT was 0.90 (0.73-0.98) mm in HIV (+) patients. The median values of CIMT on right and left sides in the control group were 0.77 (0.67-0.81) mm and 0.76 (0.70-0.81) mm. Atheroma plaque was detected in 13.5% of the HIV (+) patients and in none of the control group. Subclinical atherosclerosis was found in 51.9% of HIV (+) patients and this rate was 7.7% in the HIV (-) group (p<0.001). There was a weak correlation between CIMT and TRSS. In this study, the scoring systems (Framingham, ACC/AHA CVHRS) that determine the risk of cardiovascular disease recommended in current practice and the results of CIMT measurements were not found to be compatible. The development of new scoring systems including CIMT testing for the determination of this risk will open important new horizons. Key Words: AIDS, Cardiovascular disease, Subclinical atherosclerosis, CIMT.

ROLE OF GRAY-SCALE AND DOPPLER ULTRASOUND OF CAROTID ARTERY IN RISK STRATIFICATION OF STABLE ISCHEMIC HEART DISEASE AND ITS CORRELATION WITH CORONARY ANGIOGRAPHY

Introduction: Coronary heart disease (CHD) is a major cause of mortality and morbidity all over the world. According to a report of World Health Organization (WHO) in 2005, cardiovascular disease (CVD) caused 17.5 million (30%) of the 58 million deaths that occurred worldwide. While the prevalence and mortality due to CHD is declining in the developed nations the same cannot be held true for developing countries. Aims And Objective: This study aimed to establish the role of Gray Scale USG and carotid artery Doppler study as a leading investigation in general population presenting with Stable Ischemic Heart Disease. It intended to evaluate the frequency and degree of carotid artery stenosis in these patients &amp; also assess the morphology of atherosclerotic plaque and IMT which are clearly related to pathogenesis and aid in planning and management. Materials And Methods: Adult persons attending to Nilratan Sircar Medical College &amp; Hospital, Kolkata both at OPD and Ward, with Stable Ischemic Heart disease that has undergone coronary angiography were chosen as the Study population. Result And Analysis: Our study showed that 62 % of the patients were above 60 years of age. 84 % of our patients were male.74% of our patients had history of smoking. 70 % of our patients had type 2 diabetes mellitus. 72 % of our patients were dyslipidemic. 78% of the patients were hypertensive. 80 % of patients had increased carotid artery tunica intima media thickening. 66 % of patients had presence of atheromatous plaque in carotid arteries. Summary And Conclusion: However, our study did corroborate with the other available studies except for few deviations like increased number of modiable risk factors in our group. Our study clearly demonstrated Metabolic syndrome –X as a strong risk factor for ischemic heart disease and also suggested early medical treatment can prevent future recurrence. Larger multicentric trials may be necessary in future, for further validation

Association of recurrent common infections and subclinical cardiovascular disease in Mexican women.

BackgroundAcute and agent-specific chronic infections have been associated with increased cardiovascular risk, however data on the burden of common recurrent infections on cardiovascular disease is limited. We hypothesized women with greater exposure to uncomplicated common infectious events had an increased risk of subclinical cardiovascular disease (sCVD).MethodsIn a cross-sectional study, we assessed the relation of recurrent infections and carotid artery intima-media thickness (IMT) in 1946 disease-free women from the Mexican Teachers’ Cohort. Through 2012–2016, participants answered structured questions on respiratory, urinary and vaginal infections during the previous year and their IMT was measured using ultrasound by standardized neurologists. We defined sCVD as mean right and left IMT ≥0.8 mm or the presence of atheromatous plaque. Multivariable linear and logistic regression analyses were used to evaluate the association of infectious events with IMT and sCVD adjusting for age, sociodemographic, and cardiovascular risk factors.ResultsAmong participants (50±5 years) 13% reported no infections, 20% one infection and 67% three or more episodes. Overall prevalence of sCVD was 12%(n = 240). Adjusted models for logistic regression showed that women with 2 or more infections had 91% higher odds of sCVD (OR 1.91; 95%CI 1.16, 3.13) compared to women without infections (p-trend:0.015). Sub-analyses by type of infection resulted not significant. Linear regression analysis did not show a significant association between mean IMT and recurrent infections.ConclusionsRecurrent infectious events in young adult women are associated with greater sCVD, which supports the hypothesis of low-grade chronic inflammation in the pathophysiology of cardiovascular disease.

Predictors of Functional Outcome After Treatment of Acute Ischemic Stroke

Background: Acute ischemic stroke (AIS) is a common condition with significant consequences. Advances in treatment modified outcome and prognosis. Aim: The present study aimed to discuss the predictors of functional outcome of AIS after the first three months. Patients and Methods: All the studied 131 patients had careful history taking, thorough clinical examination, and non-contrast brain CT scans. The initial severity of the stroke and evolution after thrombolysis was evaluated using the National Instituted of Health Stroke Scale (NIHSS). Patients were treated with low molecular weight heparin (LMWH) or rt-PA. Functional status at three months was evaluated using the modified Rankin Scale. Results: The present study included 131 patients with AIS. Favorable functional outcome was achieved in 52 patients (39.7 %) while the remainder 79 patients had a poor outcome. Using logistic regression analysis, significant predictors of poor outcome on univariate analysis included age ≥ 60 years (OR:3.2, CI: 1.3-7.9,p=0.014), presence of atheromatous plaques (OR: 16.8, CI: 4.8-58.3, p < 0.001), late initiation of treatment (OR: 10.6, CI: 3.4-32.1,p < 0.001) and persistent occlusion (OR: 7.8, CI: 3.2-18.8, p < 0.001). However, on multivariate analysis, variable predictive of poor outcome included age ≥ 60 years (OR: 32.5, CI: 5.4-196.5, p < 0.001), presence of atheromatous plaques (OR: 9.4, CI: 1.7-51.2, p= 0.01), late initiation of treatment (OR: 10.0, CI: 1.5-67.1,p= 0.018) and persistent occlusion (OR:25.7, CI: 6.9-95.8,p < 0.001). Conclusions: Independent predictors of poor outcome in AIS patients include age ≥ 60 years, presence of atheromatous plaques, late initiation of treatment, and persistent occlusion.

ASSOCIATION BETWEEN PERIODONTAL DISEASE, ATEROSCLEROSIS, AND THICKNESS OF THE INTIMA-MEDIA OF THE CAROTID ARTERY LAYER

Objective: Evaluate the association between periodontal disease, atherosclerosis, and carotid artery intima-media thickness. Study design: Cross-sectional observational study, which was performed through patient anamnesis and periodontal evaluation through plaque index, bleeding index, probing depth, and gingival recession. Thickness of carotid artery intima-media (cIMT) was obtained by ultrasonography. Results: The sample consisted of 92 patients aged 19 to 82 years. The prevalence of periodontal disease index was 74.2%, and the prevalence of gingivitis was 11.8%. The bivariate analysis showed a statistically significant correlation between periodontal disease and the presence of atheromatous plaque, but this relationship was not maintained in the multivariate analysis. The presence of atheromatous plaques was higher in patients with moderate to severe periodontal disease. Conclusions: Unlike some recent studies, there was a statistically significant correlation between periodontal disease and the presence of atheromatous plaque and increase in cIMT, but this relationship was not maintained in the multivariate analysis. The probing depth was significantly associated with a thickness of the intima-media greater than 1 mm and when depth was greater than 3 mm increased by 11 times the chance of having a cIMT> 1 mm.

Effect of bariatric surgery on inflammation and endothelial dysfunction as processes underlying subclinical atherosclerosis in morbid obesity.

Inflammation and endothelial dysfunction are associated with morbid obesity (MO) and atherosclerosis. To evaluate inflammation and endothelial function as the initial mechanisms underlying subclinical atherosclerosis in patients with MO, with and without atheromas, and their evolution after bariatric surgery (BS). Arnau de Vilanova University Hospital and University of Barcelona. Plasma samples from 66 patients with MO were obtained before BS and 6 and 12 months after BS. Patients were divided into 2 groups based on the presence of atheromatous plaques (detected by ultrasound imaging). Inflammation was increased as demonstrated by changes in the levels of fibroblast growth factor 21, adiponectin, leptin, interleukin 6, tumor growth factor α, nonesterified free fatty acids, lipoprotein(a) and C-reactive protein (CRP). Endothelial dysfunction was characterized by impaired angiogenesis (measured through angiopoietin 1 and 2 and brain-derived neurotrophic factor), vascular function (changes in endothelin 1 and thrombomodulin levels), and diapedesis (changes in intercellular and vascular cell adhesion molecules, and E- and P-selectins). Both mechanisms occurred regardless of the presence of atheromas. BS ameliorated both processes even in patients who already had subclinical atherosclerosis. However, CRP, thrombomodulin, and P-selectin levels were higher in patients with atheromas. Endothelial dysfunction and inflammation were detected before the appearance of structural changes in vessel walls on ultrasonography images. BS might prevent or slow atherogenesis in the early stages by breaking the vicious circle between inflammation and endothelial dysfunction. CRP, thrombomodulin, and P-selectin may have a critical role in plaque development and, together with the study of endothelial dysfunction, might be useful in assessing early atherosclerosis and its evolution after BS.

Impact of bariatric surgery on subclinical atherosclerosis in patients with morbid obesity.

The main cause of death in obese individuals is cardiovascular disease precipitated by atherosclerosis. Endothelial dysfunction and inflammation are considered early events in the development of the disease. The aim of this study was to identify biomarkers of subclinical atherosclerosis in patients with morbid obesity by comparing clinical, vascular, and biochemical parameters indicative of endothelial dysfunction in patients with and without atheromatous plaque and monitoring changes after bariatric surgery. Multicenter collaboration between Biochemistry and Biomedicine Department in Barcelona University and University Hospital Arnau de Vilanova in Lleida. Plasma samples from 66 patients with morbid obesity were obtained before bariatric surgery and at 6 and 12 months after. Patients were divided into 2 groups based on the presence of atheromatous plaque. We used contrast-enhanced carotid ultrasound, enzyme-linked immunosorbent assay, Griess, and EndoPAT-2000 methods. Patients with plaque showed the worst profile of cardiovascular risk factors. Carotid intima-media thickness and plasminogen activator inhibitor-1 were higher in plaque group (P < .0001). After bariatric surgery, vasa vasorum, oxidized low-density lipoprotein, and plasminogen activator inhibitor-1 decreased (P < .0001 in all cases). Obesity promotes atherogenesis, leading to vascular endothelial damage. Bariatric surgery reduces cardiovascular risk and the prognosis is better for patients without plaque. The increase in plasminogen activator inhibitor-1, carotid intima-media thickness, and vasa vasorum proliferation might be the first alterations in the atheromatous process in obesity and could serve as good biomarkers of subclinical atherosclerosis.

2143-PUB: Beneficial Impact of a Routine Clinical Practice Multifactorial Approach on the Progression of Subclinical Arterial Disease in Type 2 Diabetes: 3.2 Years Follow-Up Study

Diabetes is associated with higher incidence of cardiovascular (CV) disease complications due to accelerated arterial damage. The beneficial effect of multi-factorial treatment of CV risk factors in type 2 diabetes is well established from randomized clinical trials. We prospectively examined the impact of such a treatment in a real-world setting, on the development of subclinical arterial damage (SAD), as determined by structural and functional non-invasive biomarkers of vascular pathology (atheromatosis [presence of atheromatous plaques in carotid/femoral arteries, ankle-brachial index], arteriosclerosis [carotid-femoral pulse wave velocity, carotid distensibility], carotid hypertrophy [intima-media thickness, cross-sectional wall artery area]). We prospectively studied 116 persons with type 2 diabetes, treated with a multi-factorial approach of CV risk factors in routine clinical practice at a tertiary medical center, and 324 individuals without diabetes, for 3.2 years. The primary outcome was changes in vascular biomarkers related to SAD. At baseline, participants in the diabetes group had higher prevalence of subclinical arterial disease. At study end, changes in clinical, biochemical and lifestyle characteristics, as well as antihypertensive and lipid-lowering treatments, were comparable between the two groups. During follow-up, classical CV risk factors (smoking, blood pressure, LDL-cholesterol, triglycerides), and behavioral features were significantly improved in both groups. Multivariate analysis, after adjusting for all classical CV risk factors and use of anti-hypertensive/lipid-lowering therapies, demonstrated that all evaluated SAD biomarkers were similarly changed between the two groups. Implementation of a multi-modality approach of type 2 diabetes treatment is feasible and effective in decelerating progression rates of SAD in routine clinical practice. Disclosure K. Makrilakis: None. G. Konstantonis: None. A. Arida: None. E. Aissopou: None. A. Argyris: None. A. Protogerou: None. P.P. Sfikakis: None. N. Tentolouris: None.

Galectin-3 as the Prognostic Factor of Adverse Cardiovascular Events in Long-Term Follow up in Patients after Myocardial Infarction-A Pilot Study.

Galectin-3 (Gal-3) is a new independent risk factor in the development and severity of coronary artery disease (CAD). The aim of the study was to evaluate whether Gal-3 concentration has prognostic value and if it reflects the progression of atherosclerosis in carotid arteries in patients with CAD after acute myocardial infarction (AMI). The analysis included 110 patients who were hospitalized due to AMI, treated with primary coronary intervention (PCI) and further attended a follow-up visit, and 100 healthy volunteers. The Gal-3 concentration and carotid ultrasound were evaluated at baseline and on a follow-up visit. We found that the Gal-3 concentration in the group with hyperlipidemia decreased during the observation (10.7 vs. 7.9 ng/mL, p = 0.00003). Patients rehospitalized during follow up had higher concentration of Gal-3 in the acute phase of myocardial infarction (MI) (10.7 vs. 7.2 ng/mL, p = 0.02; 10.1 vs. 8.0 ng/mL, p = 0.002, respectively). In the group of patients who had none of the following endpoints: subsequent MI, PCI, coronary artery bypass grafting (CABG) or stroke, there was a decrease in Gal-3 concentration at the follow-up visit. Parameters affecting the frequency of a composite endpoint occurrence are: the presence of atheromatous plaque in the carotid artery (p = 0.017), Gal-3 (p = 0.004) and haemoglobin (p = 0.03) concentration. In multivariate analysis, only Gal-3 concentration higher than 9.2 ng/mL at discharge was associated with a nine-fold increase of risk of composite endpoint occurrence (p = 0.0005, OR = 9.47, 95% CI 2.60–34.45). A significant decrease in Gal-3 concentration was observed in the group of patients after AMI without the endpoint occurrence during observation.

Effect of bariatric surgery in the evolution of oxidative stress depending on the presence of atheroma in patients with morbid obesity.

Morbid obesity is associated with accelerated atherosclerosis, a chronic vascular disease related to oxidative stress (OS) and endothelial dysfunction. We aimed to evaluate the effect of bariatric surgery (BS) on oxidative stress as a cardiovascular risk factor in patients with and without atheromatous plaques. Arnau de Vilanova University Hospital and University of Barcelona. Plasma samples from 66 patients with morbid obesity were obtained before BS and 6 and 12 months after. Patients were divided into 2 groups based on the presence of atheromatous plaques (detected by ultrasonography). OS parameters were measured by enzyme-linked immunosorbent assay. Patients with morbid obesity had OS independently of the presence of an atheroma, but oxidized low-density lipoprotein levels were higher in patients with plaques throughout the study (P = .0430). After surgery, oxidized low-density lipoprotein and malondialdehyde levels decreased significantly (P < .0001 in both cases). At the beginning of the study, antioxidant enzyme levels were the same between the groups. After surgery, paraoxonase 1 levels were increased (P < .0001) in the group without plaque, being significantly higher (P = .0147). Superoxide dismutase 2 levels were only decreased in patients without plaque (P < .0010), while catalase activity was higher in patients with plaque. Morbid obesity may lead to chronic OS, which increases predisposition to atherogenesis. BS improves the antioxidant profile and reduces OS and co-morbidities in both groups. However, the benefits are greater for patients without plaque. Therefore, BS may prevent atheroma formation and also could prevent plaque rupture by decreasing OS.