Presence Of Carotid Artery Plaque Research Articles

Association between Vascular Lesion and Penile Erection Hardness in Japanese Patients with Erectile Dysfunction

Objective: Many erectile dysfunction (ED) cases are attributed to vascular endothelial dysfunction and impaired blood flow due to arteriosclerotic changes. In this study, we examined the association among the erection hardness score (EHS), pulse wave velocity (PWV), and the presence of carotid artery plaques. Subjects and Methods: The study enrolled 67 patients who visited our hospital with the chief complaint of ED. Based on the history at the first visit, 28 of the 67 patients were categorized into the EHS 3–4 group and the remaining 39 into the EHS 0–2 group. The two groups were retrospectively analyzed. Results: The PWV points were significantly higher in the EHS 0–2 group than in the EHS 3–4 group (P = 0.047). In consideration for error in age, the modified points (PWV at the first visit – reference PWV by age) were significantly higher in the EHS 0–2 group than in the EHS 3–4 group (P = 0.026). This group also showed a higher detection rate of plaques by carotid ultrasound (66.7%). Conclusion: This study showed that patients with lower points of EHS had higher PWV and were more likely to have carotid artery plaques. While ED has occasionally been considered as an early risk marker for the onset of cardiovascular events; this study suggests that the hardness of the penis can be an easier-to-measure and more sensitive index.

Carotid artery intimal medial thickness and carotid artery plaques in hypertensive patients with non-arteritic anterior ischaemic optic neuropathy.

To assess the correlation of carotid artery intimal medial thickness (C-IMT) and carotid artery plaque score (CPS) of the common carotid artery with non-arteritic anterior ischemic optic neuropathy (NAION) in hypertensive patients. This case-control study recruited 192 subjects. Forty-eight patients had NAION with systemic hypertension, 46 had hypertension without visual complaints, and 98 were normal controls. C-IMT and common carotid arterial plaque were measured by high-resolution vascular ultrasonography. High-density lipoprotein (HDL) in patients with NAION (1.24±0.31) was significantly lower than that of the Hypertensive group (1.39±0.30, P=0.034). The C-IMT in the affected side of patients with NAION (1.00±0.23) was significantly increased compared to the unaffected side (0.83±0.19, P<0.001), the Hypertensive group (0.83±0.17, P<0.001), and the Normal group (0.69±0.16, P<0.001). The presence of carotid artery plaque was more frequent in the patients with NAION, compared to either the Hypertensive group (P=0.001) or the Normal group (P<0.001). By multiple regression analysis, lower high-density lipoprotein (HDL) (P=0.009), thicker C-IMT (P=0.002), CPS Grade=1 (P=0.028), and Grade=2 (P=0.005) were associated with increased NAION risk, when the NAION group compared with the Hypertensive group (OR>1.0). Systolic blood pressure (P=0.001), thicker C-IMT (P<0.001), CPS Grade=1 (P=0.006), Grade=2 (P=0.002), and Grade=3 (P=0.015) were associated with increased NAION risk, when the NAION group compared with the Normal group (OR>1.0). C-IMT and CPS were associated with NAION in hypertensive patients, suggesting that NAION might be associated with carotid artery atherosclerosis. This association may be due to similar pathological changes of the inner vascular walls in the carotid artery and the arteries supplying the optic nerve head.

Association Between the Presence of Carotid Artery Plaque and Cardiovascular Events in Patients With Genetic Hypercholesterolemia

Introduction and objectivesThe equations used in the general population to calculate cardiovascular risk are not useful in genetic hypercholesterolemia (GH). Carotid plaque detection has proved useful in cardiovascular prediction and risk reclassification but there have been no studies of its usefulness in GH. The aim of this study was to determine the association between the presence of carotid artery plaque and the occurrence of cardiovascular events in patients with GH. MethodsThis study included 1778 persons with GH. The mean follow-up until the occurrence of cardiovascular events was 6.26 years. At presentation, the presence of carotid artery plaque was studied by high-resolution ultrasound. ResultsCarotid artery plaque was found in 661 (37.2%) patients: 31.9% with familial hypercholesterolemia, 39.8% with familial combined hyperlipidemia, 45.5% with dysbetalipoproteinemia, and 43.2% with polygenic hypercholesterolemia. During follow-up, 58 patients had a cardiovascular event. Event rates were 6354/100 000 (95%CI, 4432.4-8275.6) in the group with plaque and 1432/100 000 (95%CI, 730.6-2134.3) in the group without plaque, with significant differences between the 2 groups (P < .001). The relative risk of an event was 4.34 (95CI%, 2.44-7.71; P < .001) times higher in patients with plaque and was 2.40 (95%CI, 1.27-4.56; P = .007) times higher after adjustment for major risk factors. The number of carotid artery plaques was positively associated with the risk of cardiovascular events. ConclusionsMost cardiovascular events occur in a subgroup of patients who can be identified by carotid plaque detection. These results support the use of plaque screening in this population and should help in risk stratification and treatment in GH.

Predictors of subclinical atherosclerosis evaluated by carotid intima-media thickness in asymptomatic young women with type 1 diabetes mellitus.

This study aimed to evaluate the occurrence and clinical predictors of subclinical atherosclerosis in asymptomatic, young adult women with type 1 DM. The study included 45 women with type 1 diabetes mellitus (DM) (aged 36 ± 9 years) who underwent carotid Doppler ultrasound evaluation to determine the carotid artery intima-media thickness (CIMT) and to assess the occurrence of carotid artery plaques. Insulin sensitivity was assessed by estimated glucose disposal rate (eGDR), and metabolic syndrome (MS) was defined by the World Health Organization criteria. The cohort had a mean age of 36 ± 9 years, diabetes duration of 18.1 ± 9.5 years, and body mass index (BMI) of 24.6 ± 2.4 kg/m2. MS was present in 44.4% of the participants. The CIMT was 0.25 ± 0.28 mm, and the prevalence of carotid artery plaques was 13%. CIMT correlated positively with hypertension (p = 0.04) and waist-to-hip ratio (r = 0.37, p = 0.012). The presence of carotid artery plaques correlated positively with age (p = 0.018) and hypertension (p = 0.017). eGDR correlated negatively with CIMT (r = -0.39, p = 0.009) and carotid plaques (p = 0.04). Albuminuria showed a correlation trend with CIMT (p = 0.06). Patients with carotid artery plaques were older, had a higher prevalence of hypertension, and lower eGDR. No correlation was found between CIMT and carotid plaques with diabetes duration, MS, BMI, cholesterol profile, glycated hemoglobin, high-sensitivity C-reactive protein, or fibrinogen. Insulin resistance, central obesity, hypertension, and older age were predictors of subclinical atherosclerosis in asymptomatic, young adult women with type 1 DM.

Abstract WP187: Subclinical Macro and Microvascular Disease in Stroke-free Subjects With Nonsustained Atrial Fibrillation

Introduction: Prevalence of nonsustained atrial fibrillation (NSAF), described as irregular atrial runs lasting shorter than 30-seconds, is higher in patients with ischemic stroke compared to stroke-free controls. Nonetheless, its role in causality of stroke and future cerebrovascular risk is still not established. Subclinical atherosclerotic burden and vascular stiffness are more prevalent, and have been shown to modify future risk of vascular events in patients with atrial fibrillation (AF). We aimed to determine the relationship between NSAF and subclinical atherosclerosis, vascular dysfunction and cerebral microvascular disease. Methods: Sonographic carotid distensibility metrics, carotid intima-media thickness (IMT), carotid plaque burden score (Ten Cate’s), middle cerebral artery (MCA) pulsatility index (PI) and cerebral white matter disease burden (Fazekas’ periventricular and subclinical scores) were studied in 263 stroke-free control subjects. 24-hour Holter monitoring documented NSAF in 27% of study population. Abnormality limits were set as mean±standard deviation. Results: Compared to those without NSAF (age 62±8 yr, 43% male), subjects with NSAF (age 67±9 yr, 31% male) had significantly higher total carotid plaque burden score (p=0.009) and significantly lower common carotid artery carotid distensibility (p=0.019). Maximum and averaged IMT, carotid stiffness and elastic modulus, and asymptomatic significant (≥50%) carotid artery stenosis were numerically higher. Patients with NSAF had significantly higher MCA PI (p=0.007) and numerically higher white matter disease scores. Regression analysis models showed that NSAF is one independent predictors of abnormal carotid distensibility (p=0.026) and presence of carotid plaque (p=0.023); but not for carotid plaque burden score (&gt;4), MCA PI (&gt;1.1) and IMT max (&gt;0.966). Conclusions: The presence of a significant relationship between NSAF and presence of carotid artery plaque and decreased cervical artery distensibility raises the possibility that NSAF might be a reflection of subclinical atherosclerotic burden. This crosstalk between surrogate markers might explain the higher prevalence of NSAF in ischemic stroke patients.

The Association between Bone Quality and Atherosclerosis: Results from Two Large Population-Based Studies.

Objective It is highly debated whether associations between osteoporosis and atherosclerosis are independent of cardiovascular risk factors. We aimed to explore the associations between quantitative ultrasound (QUS) parameters at the heel with the carotid artery intima-media thickness (IMT), the presence of carotid artery plaques, and the ankle-brachial index (ABI). Methods The study population comprised 5680 men and women aged 20–93 years from two population-based cohort studies: Study of Health in Pomerania (SHIP) and SHIP-Trend. QUS measurements were performed at the heel. The extracranial carotid arteries were examined with B-mode ultrasonography. ABI was measured in a subgroup of 3853 participants. Analyses of variance and linear and logistic regression models were calculated and adjusted for major cardiovascular risk factors. Results Men but not women had significantly increased odds for carotid artery plaques with decreasing QUS parameters independent of diabetes mellitus, dyslipidemia, and hypertension. Beyond this, the QUS parameters were not significantly associated with IMT or ABI in fully adjusted models. Conclusions Our data argue against an independent role of bone metabolism in atherosclerotic changes in women. Yet, in men, associations with advanced atherosclerosis, exist. Thus, men presenting with clinical signs of osteoporosis may be at increased risk for atherosclerotic disease.

Asociación de la presencia de placa carotídea en la aparición de eventos cardiovasculares en pacientes con hipercolesterolemias genéticas

Introduction and objectivesThe equations used in the general population to calculate cardiovascular risk are not useful in genetic hypercholesterolemia (GH). Carotid plaque detection has proved useful in cardiovascular prediction and risk reclassification but there have been no studies of its usefulness in GH. The aim of this study was to determine the association between the presence of carotid artery plaque and the occurrence of cardiovascular events in patients with GH. MethodsThis study included 1778 persons with GH. The mean follow-up until the occurrence of cardiovascular events was 6.26 years. At presentation, the presence of carotid artery plaque was studied by high-resolution ultrasound. ResultsCarotid artery plaque was found in 661 (37.2%) patients: 31.9% with familial hypercholesterolemia, 39.8% with familial combined hyperlipidemia, 45.5% with dysbetalipoproteinemia, and 43.2% with polygenic hypercholesterolemia. During follow-up, 58 patients had a cardiovascular event. Event rates were 6354/100 000 (95%CI, 4432.4-8275.6) in the group with plaque and 1432/100 000 (95%CI, 730.6-2134.3) in the group without plaque, with significant differences between the 2 groups (P < .001). The relative risk of an event was 4.34 (95CI%, 2.44-7.71; P < .001) times higher in patients with plaque and was 2.40 (95%CI, 1.27-4.56; P = .007) times higher after adjustment for major risk factors. The number of carotid artery plaques was positively associated with the risk of cardiovascular events. ConclusionsMost cardiovascular events occur in a subgroup of patients who can be identified by carotid plaque detection. These results support the use of plaque screening in this population and should help in risk stratification and treatment in GH.Full English text available from:www.revespcardiol.org/en

Ocular Arterial Occlusive Disorders and Carotid Artery Disease

To compare prevalence of carotid artery disease and its various types of lesions in different types of ocular arterial occlusive disorders. Cohort study. 614 consecutive patients (728 eyes) with ocular arterial occlusive disorders. At first visit, all patients had a detailed ophthalmic and medical history, comprehensive ophthalmic evaluation, and carotid artery evaluation (by Doppler/angiography) on the side of ocular arterial occlusion, and echocardiography. The same ophthalmic evaluation was performed at each follow-up visit. Ocular arterial occlusive disorders were divided into central (CRAO) and branch (BRAO) retinal artery occlusion, ocular ischemic syndrome (OIS), non-arteritic anterior ischemic optic neuropathy (NA-AION) and amaurosis fugax (AF). Carotid artery and echocardiographic abnormalities, and incidence of transient ischemic attack (TIA)/stroke and myocardial ischemia. The study consists of a cohort of 266 eyes with NA-AION, 203 with CRAO, 127 with BRAO, 80 with OIS and 52 with AF. Carotid artery stenosis on the involved side was worse in AF and OIS compared to BRAO, CRAO, and NA-AION (p<0.0001). Presence of carotid artery plaques on the involved side was significantly higher in OIS, AF, and CRAO compared to NA-AION (p=0.002, p=0.003, and p=0.0003, respectively). Echocardiography revealed an embolic source in 61% of CRAO and 53% of BRAO compared to only 3% of NA-AION patients (p<0.0001). TIA/stroke before or after onset of ocular condition occurred in 17% of OIS, 11% of AF, 7% of CRAO, 6% of NA-AION, and 3% of BRAO patients. Kaplan-Meier estimate of the incidence of TIA /stroke within 3 months after onset was 6% (95% CI: 2%, 17%) for OIS, 3% (95% CI: 0.4%, 19%) for AF, and 1% (95% CI: 0.3%, 4.1%) for CRAO. Report of myocardial ischemia before or after onset of ocular condition was 52% in AF, 22% in OIS, 22% in BRAO, 21% in CRAO, and 6% in NA-AION patients. The incidence of carotid artery stenosis and plaques, cardiac embolic source, TIA/stroke and myocardial ischemia differ among various ocular arterial occlusive disorders. The role of embolism and hemodynamic disturbances caused by carotid artery disease in these disorders is discussed.

Brachial-ankle pulse wave velocity is associated with composite carotid and coronary atherosclerosis in a middle-aged asymptomatic population

Aim: Although arterial stiffness has been associated with the development of atherosclerosis, the role of brachial-ankle pulse wave velocity (baPWV) for diagnosing composite coronary and carotid atherosclerosis has not been completely elucidated. Method: We enrolled 773 asymptomatic individuals who were referred from 25 public health centers in Seoul and who underwent carotid ultrasonography and coronary computed tomography. Noninvasive hemodynamic parameters, including baPWV, were also measured. Composite coronary and carotid atherosclerosis was defined as follows: 1) coronary artery calcium (CAC) score ≥ 100, 2) coronary artery stenosis (CAS) ≥ 50% of diameter stenosis, 3) carotid intima medial thickness (CIMT) ≥ 0.9 mm, or 4) presence of carotid artery plaque (CAP). Results: The incidence of composite coronary and carotid atherosclerosis was 28.2%. Coronary atherosclerosis (CAC and CAS) was significantly associated with carotid atherosclerosis (CIMT and CAP). Subjects with higher baPWV (highest quartile) had a higher prevalence of composite coronary and carotid atherosclerosis (p < .001). Although multivariate analysis failed to show baPWV as an independent predictor for composite atherosclerosis, baPWV had moderate diagnostic power to detect a subject with more than two positive subclinical atherosclerosis exams [area under the curve (AUC), 0.692]. Conclusion: baPWV was associated with the composite coronary and carotid atherosclerotic burden in a community-based asymptomatic population.

FGF-23 levels are associated with vascular calcification, but not with atherosclerosis, in hemodialysis patients.

High fibroblast growth factor-23 (FGF-23) levels are associated with mortality and cardiovascular events in patients with chronic kidney disease. The aim of this cross-sectional study was to investigate the relationship between plasma FGF-23 levels and coronary artery calcification and carotid artery intima-media thickness (CA-IMT) in hemodialysis (HD) patients. In this cross-sectional study, plasma intact FGF-23 levels were measured in 229 patients who underwent coronary artery calcification scores (CACs) determined by multi-slice computerized tomography and CA-IMT assessed by using high-resolution color Doppler ultrasonography. Median FGF-23 was 53.5 pg/ml (IQR 30.8-249.5). Median CACs was 98 (IQR 0-531), and the frequency of patients with severe calcification (CACs > 400) was 28.8%; 27.5% of cases had no calcification. Mean CA-IMT was 0.78 ± 0.20 mm, and the presence of carotid plaques was 51% with a mean length 2.1 mm. FGF-23 level was positively correlated with serum calcium (r = 0.337, p < 0.001), phosphate (r = 0.397, p < 0.001) and CACs (r = 0.218, p = 0.001). Neither CA-IMT nor the presence of carotid artery plaques correlated with FGF-23 levels. In adjusted ordinal regression analysis, FGF-23 level was an independent predictor for severe CACs together with age, gender, presence of diabetes, time on dialysis and CA-IMT (model r(2) = 0.44, p < 0.001). As a novel finding, the mean CACs was markedly higher in patients with FGF-23 level above median regardless of phosphate levels (p = 0.03). In HD patients, plasma FGF-23 level is superior to phosphate in the prediction of coronary artery calcification. However, FGF-23 is not associated with carotid artery atherosclerosis in HD patients.

No evidence of association between subclinical thyroid disorders and common carotid intima medial thickness or atherosclerotic plaque

Background and aimsIncreased carotid artery intima-media thickness (IMT) and the presence of plaques have been shown to be predictors of cardiovascular disease. The cardiovascular risk in patients with overt thyroid diseases is related to increased risk of atherosclerosis, but there has been no clear evidence about subclinical disorders. We have assessed whether subclinical thyroid dysfunction is associated with arterial thickening and plaque. Methods and resultsThe SardiNIA study is a population-based survey on the Italian island of Sardinia. We reviewed data from 5815 subjects (aged 14–102 years), none of whom had overt hyperthyroidism or hypothyroidism or was taking thyroid medication. Serum thyrotropin (TSH), free thyroxine, together with carotid ultrasound IMT and the presence of common carotid plaques were analysed in all subjects. Possible association of IMT and carotid plaques with thyroid parameters was evaluated by univariate and multivariate analyses. IMT was significantly associated with age, sex, smoking, low density lipoprotein cholesterol (LDL), high density lipoprotein cholesterol, pulse pressure (PP), history of arterial hypertension, diabetes, and previous cardiovascular events (p = 0.001 or lower, R2 = 0.47). Carotid plaques were predicted by age, sex, LDL, PP, history of diabetes, previous cardiovascular events, and the use of statins (p = 0.029 or lower). Thyroid hormone was not predictive of carotid atherosclerosis when adjusted for confounders. ConclusionThyroid hormone is not associated with increased IMT or with the presence of carotid artery plaque. Our data do not support the idea that treating subclinical disorders might help to prevent arterial remodelling or carotid atherosclerosis.

Subclinical atherosclerosis and increased risk of hearing impairment

Objective: The study's purpose was to test if subclinical atherosclerosis was associated with the risk of developing HI in a large cohort of middle-aged participants. Methods: Study subjects were members of the Beaver Dam Offspring Study (BOSS), a longitudinal study of adult children of participants in the population-based Epidemiology of Hearing Loss Study (1993-present). BOSS examinations took place in 2005–2008 (baseline) and 2010–2013 (5-year follow-up). The 5-year incidence of hearing impairment was defined as a pure-tone average (PTA) of thresholds at 0.5, 1, 2 and 4 kHz > 25 dB Hearing Level (dB HL) in either ear at follow-up among participants at risk (baseline PTA in both ears < = 25 dB HL; n = 2436, mean age = 47.7 years). Atherosclerosis was measured as the mean carotid intima-media thickness and the presence of carotid artery plaque. Results: Among the 1984 participants at-risk with a follow-up audiometric examination, the 5-year incidence of hearing impairment was 8.3% (95% Confidence Interval (C.I.) 7.1, 9.5). With multivariable adjustment, carotid intima-media thickness was positively associated with hearing impairment incidence (Relative Risk (RR) = 1.14 per 0.1 mm, 95% C.I. 1.04, 1.24). The number of sites (0–6) with plaque was also positively associated with the incidence of impairment (RR = 1.16 per site, 95% C.I. 1.01, 1.32). Conclusion: Atherosclerosis was associated with the 5-year incidence of hearing impairment in this predominantly middle-aged cohort. Interventions targeting atherosclerosis prevention may help to prevent or delay the onset of hearing impairment.

Coronary artery tortuosity: comparison with retinal arteries and carotid intima-media thickness

We conducted a prospective study to investigate the possible relationship between the tortuosity of coronary arteries (TCA) and carotid intima-media thickness (CIMT), and also compare TCA to retinal artery tortuosity. One hundred and five participants with nonsignificant coronary plaque or normal coronary angiogram were included. To determine subclinical atherosclerosis, maximum CIMT was measured. Retinal tortuosity was evaluated ophthalmically. Among all demographic variables and risk factors, only female gender and height were significantly associated with TCA (p = 0.001, p = 0.01, respectively). Retinal artery tortuosity and retinal artery atherosclerosis were more common inpatients with TCA compared to patients without TCA (p < 0.001, R = 0.6; p = 0.002, R = 0.4, respectively). CIMT was greater in participants with TCA than patients without TCA (p = 0.001), and also the presence of carotid artery plaque was more common in patients with TCA (p < 0.001). There was a significant correlation between the presence of subclinical atherosclerosis and TCA (p = 0.005, R = 0.3). Likewise, a significant correlation was found between subclinical atherosclerosis and retinal artery tortuosity (p = 0.02, R = 0.3). Multivariate analysis identified female gender (p < 0.008), retinal arterytortuosity (p < 0.001), and CIMT (p = 0.02) as independent predictors of TCA. These results indicate that, whatever the mechanism is: 1) TCA is associated with female gender and short stature; 2) TCA is associated with subclinical atherosclerosis even in patients with entirely normal appearing coronary arteries on coronary angiography; 3) Retinal artery tortuosity is correlated with TCA and can be a surrogate for systemic arterial tortuosity.

Carotid ultrasound examination as an aging and disability marker

To explore the usefulness of carotid ultrasound examination as a marker of aging and predictor of disability among older people. Carotid ultrasound, measuring carotid intima media thickness (CIMT) and recording the presence of plaques, was carried out in 152 adults aged 29-59 years (47 women) and in 107 older adults aged 61-88 years (86 women). In all, clinical routine laboratory parameters and lymphocyte telomere length as T/S ratio were measured. Among older adults, 12-min walk, timed up and go, hand grip and quadriceps strength were determined. CIMT was significantly higher among older people and T/S ratio was significantly higher in young women. Carotid plaques were found in one adult and 17 older people. A multiple regression analysis accepted age, systolic blood pressure and T/S ratios as independent predictors of CIMT (R(2) = 0.51). Among older people, a logistic regression accepted age and the presence of carotid plaques as significant predictors of a 12-min walk speed below 1 m/s. An abnormal 12-min walk as an indicator of functional decline among older people is associated with the presence of carotid artery plaques. CIMT is independently associated with age.

Oxidative stress and other risk factors for white matter lesions in chronic hemodialysis patients

Chronic kidney disease (CKD) is a risk factor for cardiovascular disease and promotes oxidative tress (OS), which has been implicated in the pathogenesis of white matter lesions (WML), a form of small-vessel cerebrovascular disease. The relationship between OS and WML in chronic hemodialysis (HD) patients has not yet been studied. We studied 67 chronic HD patients, aged 40 - 65 years (average 54 years) without known cerebrovascular disease. All patients underwent brain magnetic resonance imaging and subcortical and periventricular WML were evaluated using semiquantitative measures. Patients were classified into two groups depending on the presence or absence of WML (Fazekas classification), and the WML were scored. Carotid ultrasonography was also performed to evaluate the presence of carotid artery plaques and/or stenosis. Markers of protein and lipid oxidation (protein carbonyl and oxLDL antibodies), the glutathione system, enzymatic antioxidants (superoxide dismutase, glutathione peroxidase, glutathione reductase and catalase) and total antioxidant capacity (ORAC) were measured. OS markers were compared to those of a group of 36 healthy subjects. WML were present in 54% of the total population. Patients who had WML were older and had lower predialysis diastolic blood pressure than patients without WML. Other potential cardiovascular risk factors for WML, including obesity, hyperlipidemia, diabetes mellitus, presence of carotid artery plaques or stenosis, and duration and adequacy of HD were not related to the presence of WML. Compared to controls, HD patients had increased OS and decreased antioxidant capacity. However, OS did not differ between patients with WML and those without, and we found no association between OS markers and mean WML scores. After adjusting for several factors, only age and low predialysis diastolic blood pressure independently predicted an increased risk of WML. Our results confirm that chronic HD patients have increased OS, but this is not related to the presence or severity of WML.

Patients with Rheumatoid Arthritis Have More Vulnerable Arterial Plaques, But Lowering Disease Activity May Stabilize This Threat

Patients with rheumatoid arthritis (RA) die of cardiovascular disease (CVD)1. Although the inflammatory part of RA is better controlled with conventional and especially modern medicine, CV risk still seems to be double that of people without RA2. The risk of future CVD can be predicted by the presence of carotid artery plaques (CP). If they are present, the risk for future acute coronary syndromes and stroke is increased 2- to 4-fold3,4. Moreover, as shown by Kobayashi and colleagues, CP seem to be more prevalent in RA5. The presence of CP could prove helpful in identifying which RA patients are most at risk for future CV events. Additionally, it is shown that not only the presence of CP but also certain characteristics of these plaques are of great importance. A thin cap and less fibrous tissue inside plaques make them more vulnerable to rupture and more likely to cause CV events. Different types of CP have been identified together with their specific CV risk6. However, how does one reliably identify these vulnerable plaques? Simple eyeballing does not seem good enough. A more objective method could be measuring the gray-scale median (GSM). A lower score means less fibrous tissue and consequently a more vulnerable plaque. The usefulness of this GSM method in identifying vulnerable plaques has been shown by several authors6,7. It is stipulated that the … Address correspondence to Dr. Van Halm; E-mail: vpvanhalm{at}gmail.com.

Carotid Artery Plaque and Progression of Coronary Artery Calcium: The Multi-Ethnic Study of Atherosclerosis

Carotid and coronary atherosclerosis are associated with each other in imaging and autopsy studies. The aim of this study was to evaluate whether carotid artery plaque seen on carotid ultrasound can predict incident coronary artery calcification (CAC). Agatston calcium score measurements were repeated in 5,445 participants of the Multi-Ethnic Study of Atherosclerosis (MESA; mean age, 57.9 years; 62.9% women). Internal carotid artery lesions were graded as 0%, 1% to 24%, or >25% diameter narrowing, and intima-media thickness (IMT) was measured. Plaque was present for any stenosis >0%. CAC progression was evaluated with multivariate relative risk regression for CAC scores of 0 at baseline and with multivariate linear regression for CAC score > 0, adjusting for cardiovascular risk factors, body mass index, ethnicity, and common carotid IMT. CAC was positive at baseline in 2,708 of 5,445 participants (49.7%) and became positive in 458 of 2,837 (16.1%) at a mean interval of 2.4 years between repeat examinations. Plaque and internal carotid artery IMT were both strongly associated with the presence of CAC. After statistical adjustment, the presence of carotid artery plaque significantly predicted incident CAC with a relative risk of 1.37 (95% confidence interval, 1.12-1.67). Incident CAC was associated with internal carotid artery IMT, with a relative risk of 1.13 (95% confidence interval, 1.03-1.25) for each 1-mm increase. Progression of CAC was also significantly associated (P < .001) with plaque and internal carotid artery IMT. In individuals free of cardiovascular disease, subjective and quantitative measures of carotid artery plaques by ultrasound imaging are associated with CAC incidence and progression.

Serum fibroblast growth factor 21 was elevated in subjects with type 2 diabetes mellitus and was associated with the presence of carotid artery plaques

AimsFibroblast growth factor 21 (FGF21) is an important regulator of glucose/lipid metabolism. Although there are studies examining the relationship between serum FGF21 levels and glucose homeostasis, the role of FGF21 remains unclear. The objective of this study was to examine whether serum FGF21 levels are associated with metabolic parameters in subjects with varying degrees of obesity and glucose tolerance and with complications in subjects with type2 diabetes mellitus (T2DM). MethodsThe study consisted of 213 subjects who were lean and had normal glucose tolerance (lean NGT), were overweight with NGT, had impaired glucose tolerance (IGT) or had T2DM. Serum FGF21 levels and their associations with the parameters of adiposity, glucose tolerance and the presence of diabetic complications were examined. ResultsThe serum FGF21 levels in T2DM were higher than in lean NGT. Serum FGF21 levels showed a positive correlation with the urine albumin-to-creatinine ratio (ACR) in all subjects except for the T2DM subjects, who showed a correlation after adjustment of age, gender and body mass index. Moreover, the subjects with carotid artery plaque showed higher serum FGF21 levels than those without complications. ConclusionSerum FGF21 levels were associated with the urine ACR and diabetic complications including carotid artery plaque.

Increased prevalence of diabetic complications in Japanese patients with type 1 diabetes and nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease (NAFLD) is associated with insulin resistance, metabolic syndrome and cardiovascular disease. The purpose of this study was to evaluate the phenotype of Japanese type 1 diabetes with NAFLD. The study population consisted of patients with type 1 diabetes with (n = 25) and without (n = 119) NAFLD who underwent an examination with hepatic ultrasonography. The duration of diabetes, HbA1c, body mass index, basal and bolus insulin doses, urinary albumin excretion, prevalence of carotid artery plaques, and incidence of retinopathy in patients with NAFLD were all significantly higher than in those without NAFLD. Dyslipidemia and hypertension also occurred more frequently in the NAFLD group. Logistic analysis showed that age (P < 0.05), gender (P < 0.05), duration of diabetes (P < 0.05), dyslipidemia (P < 0.05), and the presence of NAFLD (P < 0.05) were independent risk factors for the presence of carotid artery plaque. Multiple regression analysis showed that the rate of urinary albumin excretion was significantly associated with age (P < 0.01), systolic blood pressure (P < 0.05), and the presence of NAFLD (P < 0.01). Our results suggest that the presence of NAFLD in type 1 diabetes may be strongly associated with the progression of diabetic nephropathy and macroangiopathy.

Impaired Brachial Flow-Mediated Dilation Is a Predictor of a New-Onset Vascular Event after Stroke

Background and Objective: Brachial arterial flow-mediated dilation (FMD) is associated with an increased risk of vascular events. Our aim was to investigate the relationship between FMD measured in the acute phase of ischemic stroke and a new major adverse vascular event in a consecutive cohort of patients followed up for 48 months after an acute first-ever stroke. Methods: We measured FMD in 120 consecutive patients with acute ischemic stroke using high-resolution ultrasonography. FMD was calculated as the relationship between the basal diameter of the brachial artery before and after transient vascular occlusion. Intima-media thickness, extracranial carotid atherosclerosis, stroke severity National Institute of Health Stroke Scale, and modified Rankin Scale at 3 months were also evaluated. A vascular event was defined as any of the following: vascular disease (VD) death, nonfatal myocardial infarction (MI), nonfatal recurrent stroke (RS), claudication or peripheral arterial thrombosis (PVD), angioplasty or cardiac bypass graft surgery. Results: There were 34 new major adverse vascular events in 32 of 120 patients (26.7%): 21 (61.8%) RS, 5 (14.7%) VD death, 5 (14.7%) MI, and 3 (8.8%) PVD. The presence of carotid artery plaque (81.3 vs. 46%; p < 0.0001), atrial fibrillation (37.5 vs. 14.8%; p = 0.007) and FMD (5.30 ± 7.48 vs. 10.54 ± 7.02; p = 0.001) were associated with new-onset vascular events. FMD ≤4.5% was an independent predictor of new-onset vascular events (hazards ratio 3.48; 95% confidence interval 1.26–9.63; p = 0.01). Conclusions: FMD is an independent predictor for a new-onset vascular event after first-ever ischemic stroke.