Presence Of Carotid Artery Plaque Research Articles

Hypertension-Mediated Organ Damage in Relation to Severity of Chronic Low Back Pain in Hypertensive Patients.

Chronic pain triggers a stress response, which results in increased blood pressure (BP). We investigated whether chronic low back pain (cLBP) in hypertensive patients is associated with an increased risk of hypertension-related organ damage. We studied 85 consecutive hypertensive patients with a median age of 62 years (55-67), who suffered from cLBP, the severity of which was evaluated according to the Oswestry Disability Index (ODI). Patients underwent transthoracic echocardiography, arterial ultrasonography and vascular tonometry. We assessed carotid artery atherosclerotic plaques, along with carotid-femoral pulse wave velocity (cf-PWV) and left ventricular mass index (LVMI). An equal to or higher than median (16 points) ODI score in 48 subjects (56.5%) was associated with the presence of carotid artery plaques (p = 0.014). In multivariate analysis, after adjusting for covariates, the presence of carotid artery plaques remained independently associated with an ODI score equal to or higher than the median (OR, 3.71; 95% CI, 1.04-13.25; p = 0.044). None of the other analyzed parameters of hypertension-related organ damage demonstrated a significant relationship with the ODI score. We observed that more severe cLBP is associated with a higher prevalence of carotid artery atherosclerotic plaques among hypertensive patients.

Deep Learning-Based Artificial Intelligence Model for Automatic Carotid Plaque Identification

This study aims at developing a dataset for determining the presence of carotid artery plaques in ultrasound images, composed of 1761 ultrasound images from 1165 participants. A deep learning architecture that combines bilinear convolutional neural networks with residual neural networks, known as the single-input BCNN-ResNet model, was utilized to aid clinical doctors in diagnosing plaques using carotid ultrasound images. Following training, internal validation, and external validation, the model yielded an ROC AUC of 0.99 (95% confidence interval: 0.91 to 0.84) in internal validation and 0.95 (95% confidence interval: 0.96 to 0.94) in external validation, surpassing the ResNet-34 network model, which achieved an AUC of 0.98 (95% confidence interval: 0.99 to 0.95) in internal validation and 0.94 (95% confidence interval: 0.95 to 0.92) in external validation. Consequently, the single-input BCNN-ResNet network model has shown remarkable diagnostic capabilities and offers an innovative solution for the automatic detection of carotid artery plaques.

Risk factors and characteristics analysis of cognitive impairment in patients with cerebral infarction during recovery period

Objective To analyze the risk factors and characteristics of cognitive impairment in patients with cerebral infarction during the recovery period. Methods This retrospective case-control study included 183 patients with cerebral infarction in the recovery period. According to the MMSE score, they were divided into a cognitive impairment group of 79 cases and a cognitive normal group of 104 cases. Collect clinical data from all patients, including age, gender, body mass index, laboratory test results, past medical history, National Institute of Health Stroke Scale (NIHSS) score, modified Barthel index, Oxfordshire Community Stroke Project (OCSP) classification, and number of infarcted lesions. Multiple logistic regression analysis was used to identify risk factors related to cognitive impairment in patients with cerebral infarction. Result There were significant differences (p < 0.05) between the cognitive impairment group and the cognitive normal group in terms of age, body mass index, low-density lipoprotein level, NIHSS score, modified Barthel index, and number of infarcted lesions. Multivariate logistic regression analysis showed that age ≥ 65 years, stroke, carotid artery plaques, NIHSS score ≥ 5, anterior circulation infarction type, and multiple infarcted lesions were important risk factors for cognitive impairment. Conclusion Elderly age, presence of carotid artery plaques, high NIHSS score, multiple infarct lesions, and specific infarct types are important risk factors for cognitive dysfunction in patients during the recovery period of cerebral infarction.

Sex Hormones, the Stool Microbiome, and Subclinical Atherosclerosis in Women With and Without HIV.

Cardioprotective roles of endogenous estrogens may be particularly important in women with HIV, who have reduced estrogen exposure and elevated cardiovascular disease risk. The gut microbiome metabolically interacts with sex hormones, but little is known regarding possible impact on cardiovascular risk. To analyze potential interplay of sex hormones and gut microbiome in cardiovascular risk. Among 197 postmenopausal women in the Women's Interagency HIV Study, we measured 15 sex hormones in serum and assessed the gut microbiome in stool. Presence of carotid artery plaque was determined (B-mode ultrasound) in a subset (n = 134). We examined associations of (i) sex hormones and stool microbiome, (ii) sex hormones and plaque, and (iii) sex hormone-related stool microbiota and plaque, adjusting for potential confounders. Participant median age was 58 years and the majority were living with HIV (81%). Sex hormones (estrogens, androgens, and adrenal precursors) were associated with stool microbiome diversity and specific species, similarly in women with and without HIV. Estrogens were associated with higher diversity, higher abundance of species from Alistipes, Collinsella, Erysipelotrichia, and Clostridia, and higher abundance of microbial β-glucuronidase and aryl-sulfatase orthologs, which are involved in hormone metabolism. Several hormones were associated with lower odds of carotid artery plaque, including dihydrotestosterone, 3α-diol-17G, estradiol, and estrone. Exploratory mediation analysis suggested that estrone-related species, particularly from Collinsella, may mediate the protective association of estrone with plaque. Serum sex hormones are significant predictors of stool microbiome diversity and composition. The gut microbiome may play a role in estrogen-related cardiovascular protection.

CAROTID PLAQUE OFFSETS THE SEX DIFFERENCE IN CARDIOVASCULAR RISK IN YOUNG TO MIDDLE AGE HYPERTENSIVE PATIENTS: THE CAMPANIA SALUTE NETWORK

Objective: The aim of the present study is to assess whether presence of carotid artery plaque (CP) has a similar impact on the sex difference in risk for future cardiovascular events. Design and method: we studied 5209 women and men &lt;65 years old with hypertension and free from prevalent cardiovascular disease enrolled in the prospective Campania Salute Network registry were followed over a mean of 5.9 years. Subjects were grouped according to the absence or the presence of CP identified by Doppler ultrasound (intima-media thickness&gt;15mm). Main outcome was major cardiovascular events (MACE; combined acute coronary syndromes, stroke, hospitalization for heart failure and incident atrial fibrillation). Results: Among patients without CP (n = 3139), women were older, with higher systolic BP, cholesterol level and prevalent LVH but lower triglycerides and eGFR, compared to men (all p&lt;0.001). Among patients with CP (n = 2070), women were older, taking higher number of antihypertensive drug, with higher cholesterol level and prevalent LVH but lower triglycerides and eGFR compared to men (all p&lt;0.001). In Cox regression analysis adjusting for cardiovascular risk factors, LVH and antihypertensive treatment during follow up women without CP had lower hazard rate (HR = 0.41) for MACE (n = 107) than men (95% confidence interval [CI] 0.39–0.89, p = 0.01). In contrast, among patients with CP, women had similar HR for MACE (n = 132) as men (HR 0.79 [95% CI 0.54–1.14], p = 0.203). Conclusions: This study demonstrates that presence of carotid organ damage in hypertension contributes to offset the female sex-protection in cardiovascular risk. Thus, expanding previous finding, young to middle-age women and men with hypertension and carotid organ damage have comparable cardiovascular risk.

Obesity is associated with coronary artery stenosis independently of metabolic risk factors: The population-based SCAPIS study

Background and aimsPrevious studies reported divergent results on whether metabolically healthy obesity is associated with increased coronary artery calcium and carotid plaques. We investigated this in a cross-sectional fashion in a large, well-defined, middle-aged population using coronary CT angiography (CCTA) and carotid ultrasound. MethodsIn the SCAPIS study (50–65 years, 51% female), CCTA and carotid artery ultrasound were performed in 23,674 individuals without clinical atherosclerotic disease. These subjects were divided into six groups according to BMI (normal weight, overweight, obese) and the presence of metabolic syndrome (MetS) according to the NCEP consensus criteria. ResultsThe severity of coronary artery stenosis was increased in individuals with obesity without MetS compared to normal-weight individuals without MetS (OR 1.47, 95%CI 1.34–1.62; p < 0.0001), even after adjusting for non-HDL-cholesterol and several lifestyle factors. Such difference was not observed for the presence of carotid artery plaques (OR 0.94, 95%CI 0.87–1.02; p = 0.11). Obese or overweight individuals without any MetS criteria (except the waist criterion) showed significantly more pronounced stenosis in the coronary arteries as compared to the normal-weight individuals, while one criterion was needed to show increased plaque prevalence in the carotid arteries. High blood pressure was the most important single criterion for increased atherosclerosis in this respect. ConclusionsIndividuals with obesity without MetS showed increased severity of coronary artery stenosis, but no increased occurrence of carotid artery plaques compared to normal-weight individuals without MetS, further emphasizing that obesity is not a benign condition even in the absence of MetS.

Long-term exposure to air pollution, coronary artery calcification, and carotid artery plaques in the population-based Swedish SCAPIS Gothenburg cohort

Long-term exposure to air pollution is associated with cardiovascular events. A main suggested mechanism is that air pollution accelerates the progression of atherosclerosis, yet current evidence is inconsistent regarding the association between air pollution and coronary artery and carotid artery atherosclerosis, which are well-established causes of myocardial infarction and stroke. We studied associations between low levels of long-term air pollution, coronary artery calcium (CAC) score, and the prevalence and area of carotid artery plaques, in a middle-aged population-based cohort.The Swedish CArdioPulmonary bioImage Study (SCAPIS) Gothenburg cohort was recruited during 2013–2017 and thoroughly examined for cardiovascular risk factors, including computed tomography of the heart and ultrasonography of the carotid arteries. In 5070 participants (age 50–64 years), yearly residential exposures to air pollution (PM2.5, PM10, PMcoarse, NOx, and exhaust-specific PM2.5 1990–2015) were estimated using high-resolution dispersion models. We used Poisson regression to examine associations between long-term (26 years’ mean) exposure to air pollutants and CAC score, and prevalence of carotid artery plaques, adjusted for potential confounders. Among participants with carotid artery plaques, we also examined the association with plaque area using linear regression.Mean exposure to PM2.5 was low by international standards (8.5 μg/m3). There were no consistent associations between long-term total PM2.5 exposure and CAC score or presence of carotid artery plaques, but an association between total PM2.5 and larger plaque area in participants with carotid plaques. Associations with traffic-related air pollutants were consistently positive for both a high CAC score and bilateral carotid artery plaques. These associations were independent of road traffic noise. We found stronger associations among men and participants with cardiovascular risk factors. The results lend some support to atherosclerosis as a main modifiable pathway between low levels of traffic-related ambient air pollution and cardiovascular disease, especially in vulnerable individuals.

Association between vascular lesion and penile erection hardness in Japanese patients with erectile dysfunction

ABSTRACT Introduction It is generally recognized that erectile dysfunction (ED) is largely attributable to vascular endothelial dysfunction which develops secondary to atherosclerotic changes and blood flow disorder. It is suggested that many patients with ED usually have advanced atherosclerosis because both ED and atherosclerosis share common risk factors. 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. Materials and Methods The study was 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%). Conclusions 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. Disclosure Work supported by industry: no.

Long-term exposure to particulate air pollution and presence and progression of carotid artery plaques - A northern Sweden VIPVIZA cohort study

AimsTo estimate the association between long-term exposure to particulate air pollution and sub-clinical atherosclerosis based on the existence of plaque and the carotid intima-media thickness (cIMT). MethodsVisualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention (VIPVIZA) is a randomised controlled trial integrated within the Västerbotten Intervention Programme, an ongoing population-based cardiovascular disease (CVD) prevention programme in northern Sweden. Individuals aged 40, 50, or 60 years with one or more conventional CVD risk factors in Umeå municipality were eligible to participate. The 1425 participants underwent an ultrasound assessment of cIMT and plaque formation during the period 2013–2016 and at 3-year follow-up. Source-specific annual mean concentrations of particulate matter with aerodynamic diameter ≤10 μm (PM10) and ≤2.5 μm (PM2.5), and black carbon (BC) at the individual's residential address were modelled for the calendar years 1990, 2001 and 2011. Poisson regression was used to estimate prevalence ratios for presence of carotid artery plaques, and linear regression for cIMT. ResultsThe plaque prevalence was 43% at baseline and 47% at follow-up. An interquartile range (IQR) increase in PM10 (range in year 2011: 7.1–13.5 μg/m3) was associated with a prevalence ratio at baseline ultrasound of 1.11 (95% CI 0.99–1.25), 1.08 (95% CI 0.99–1.17), and 1.00 (95% CI 0.93–1.08) for lag 23, 12 and 2 years, and at follow-up 1.04 (95% CI 0.95–1.14), 1.08 (95% CI 1.00–1.16), and 1.01 (95% CI 0.95–1.08). Similar prevalence ratios per IQR were found for PM2.5 and BC, but with somewhat lower precision for the later. Particle concentrations were however not associated with the progression of plaque. No cross-sectional or longitudinal associations of change were found for cIMT. ConclusionsThis study of individuals with low/moderate risk for CVD give some additional support for an effect of long-term air pollution in early subclinical atherosclerosis.

Tree nut consumption and prevalence of carotid artery plaques: The National Heart, Lung, and Blood Institute Family Heart Study.

While tree nut consumption has been shown to be cardioprotective, a few studies have examined the relationship between tree nut consumption and carotid atherosclerosis. We tested the hypothesis that tree nut consumption would be inversely related with carotid atherosclerosis in adults. We cross-sectionally analyzed data from 4536 participants of the National Heart, Lung, and Blood Institute (NHLBI) Family Heart Study conducted in the United States. Dietary patterns among participants were variable, tree nut consumption was self-reported using the Food Frequency Questionnaire (FFQ), and B-mode ultrasound of the carotid arteries was used to assess for the presence of carotid artery plaques (primary outcome) and carotid intima media thickness (cIMT). Multivariable logistic regression was used to estimate odds ratio (95% confidence interval) of prevalent carotid artery plaques and linear regression was used to estimate adjusted mean cIMT across categories of nut consumption. The mean age was 52.3years (SD = 13.6), 95.6% of the participants were white, and 54% were female. The median tree nut intake was 1-3 servings/month. Odds ratios (95% CI) for prevalent carotid artery plaques were 1.0 (reference), 1.03 [0.86, 1.4], 0.89 [0.70, 1.13], and 0.96 [0.73, 1.26] for tree nut consumption of almost never, 1-3 times/month, 1/week, and 2+/week, respectively, adjusting for age, sex, race, field center, BMI, smoking status, alcohol consumption, creatinine, energy intake, fruit and vegetable consumption, exercise, and education. In secondary analysis, there was a suggestive inverse association of tree nut consumption with cIMT in the internal carotid artery, but not the common carotid or bifurcation. Our data showed no association between tree nut consumption and prevalence of carotid artery plaques in adults.

Carotid Intima and Media Thickness Correlation with Central Blood Pressure Measurements by Tonometric and Oscillometric Methods: A Proof of Concept

Background The early detection of vascular damage in subclinical stages of hypertensive disease may be the key point in the prevention of cardiovascular outcomes. Objectives to correlate parameters of structural vascular damage (measurement of the carotid intima-media thickness) with parameters of functional vascular damage (central hemodynamic measurements) in pre-hypertensive and hypertensive patients taking up to two classes of anti-hypertensive drugs. Methods This was a cross-sectional descriptive study conducted with a convenience sample of patients attending the Liga de Hipertensão Arterial , a multidisciplinary program for the diagnosis and treatment of systemic hypertension, of the Federal university of Goias. Patients with arrythmia, diabetes, previous cardiovascular or cerebrovascular diseases, and end-stage diseases were excluded. Carotid Doppler test, measurements of peripheral and central blood pressure by applanation tonometry (Sphygmocor®) and oscillometry (Mobil-O-Graph®) were performed. The t-test was used for comparisons and the Pearson correlation test for correlations, considering a p<0.05 statistically significant. Results twenty patients (12 women) were evaluated, mean age 53.8 ± 14.3 years. Higher values of central pulse pressure (42.9±13.9 vs. 34.7±9.6, p=0.01) and pulse wave velocity (PWV) (9.0±1.9 vs. 7.9±1.5, p=0.01) were obtained by applanation tonometry compared with oscillometry. No difference between the methods was observed for the other measures. A significant correlation was found between carotid artery intima-media thickness (CA-IMT) and PWV (r=0.659; p=0.002) by the oscillometric test, but not with applanation tonometry. No correlation was found between central hemodynamic variables and the presence of carotid artery plaques. Conclusion PWV, estimated by oscillometry, was the only central hemodynamic parameter that correlated significantly with CA-IMT in pre-hypertensive and hypertensive patients at low cardiovascular risk. International Journal of Cardiovascular Sciences. 2020; [online].ahead print, PP.0-0

Abstract P347: Associations Between Carotid-femoral and Heart-femoral Pulse Wave Velocity in Older Adults: The Atherosclerosis Risk in Communities (ARIC) Study

Introduction: Carotid-femoral pulse wave velocity (cfPWV) is widely used in clinical and epidemiological studies to assess central arterial stiffness and predict cardiovascular outcomes. However, cfPWV assessments require applanation of the carotid artery, which may be challenging in some patients, and assessments may be confounded in the presence of carotid artery plaque. Further, since cfPWV is not consistent with the path of blood flow, the measure is adjusted according to an assumed timing of the pressure wave traveling in the opposite direction. Therefore, we hypothesize that heart-femoral PWV (hfPWV) could be a simpler measure of central arterial stiffness that is consistent with the path of blood flow. Objective: To estimate the strength of the association between hfPWV and cfPWV. Methods: We evaluated 4,476 older-aged (75.2 y [SD: 5.0]) adults in the community-based Atherosclerosis Risk in Communities (ARIC) Study. cfPWV and hfPWV were measured using an automated cardiovascular screening device (Omron VP-1000plus) equipped with an electrocardiogram, a phonocardiogram, and 2 applanation tonometry sensors attached to carotid and femoral arteries. Agreement between the two measurements was determined by calculating the intraclass correlation coefficient (ICC) and the standard error of estimate (SEE). We considered ICC value estimates of &lt;0.5, 0.5-0.75, 0.75-0.9, and &gt;0.9 as, respectively, poor, moderate, good, and excellent agreement. The SEE represents the average distance that the observed values fall from the regression line. Smaller values indicate that the observations are closer to the fitted line. The uniformity of error was assessed by visual analysis of regression plot. Results: There was ‘good’ agreement between hfPWV and cfPWV (ICC = 0.83, 95%CI: 0.82, 0.84). While the mean cfPWV (11.6 m/s [SD: 3.0]) and hfPWV (11.5 m/s [SD: 2.3]) were comparable, the SEE was 1.3 (95%CI: 1.27, 1.33) m/s. Inspection of the regression plot revealed bias, with higher PWV further away from the regression line. Conclusions: The current findings suggest good agreement between cfPWV and hfPWV, indicating that hfPWV may be a suitable alternative to cfPWV. Since hfPWV does not require applanation of the carotid artery, the measurement is easier to conduct and may be particularly suited for use in individuals for whom applanation of the carotid artery is challenging.

P2785Persons with dilated aorta ascendens - who are they?

Abstract Background Dilation of the ascending aorta (AscA) may result in life-threatening events. However, it often remains asymptomatic and undiagnosed until the catastrophic complication occurs. The prevalence of dilated AscA in the general population is largely unknown. It is also unclear whether traditional cardiovascular risk factors are associated with dilated AscA. Purpose The aim was to study the prevalence of dilated AscA and its determinants with focus on cardiovascular risk factors in a middle-aged population. Methods Five thousand subjects from the Swedish CardioPulmonary BioImage Study (SCAPIS), aged 50–65 years, underwent transthoracic echocardiography (echo) and coronary CT angiography. Subjects with dilated AscA (diameter ≥40 mm) were identified. Two age- and gender-matched controls with normal AscA diameter were selected per case. Presence of carotid artery plaques was determined by duplex ultrasound. Results Seventy one cases (16 women, 55 men) and 142 controls were included. In cases, echo and CT measurements were 42 (41–43) and 42 (41–45) mm, respectively. Body surface area-adjusted AscA diameters were higher in female than in male cases, 22,7 (21,9–23,6) vs 20,2 (19,0–20,8) mm/m2 (p&lt;0,001), see Figure. Bicuspid aortic valves and mild aortic regurditation were more common in cases than in controls (12% vs 0% and 30% vs 11%). The use of antihypertensive drugs was higher among cases, 47% vs 32%, p=0.035. There were no differences in body size, smoking status, diabetes, history of cardiovascular disease or presence of carotid plaques between cases and controls. Conclusions The prevalence of dilated AscA was 1.4% in a Swedish middle-aged population. Dilated AscA was associated with male sex, aortic valve pathology and antihypertensive medication. Whether dilated AscA is associated with impaired regulation of blood pressure and vascular function deserves further investigation. Also, data raise the intriguing question that a 40 mm cut-off value may not be appropriate for the diagnosis in women.

447-P: Low Muscle Mass Is Associated with Carotid Atherosclerosis in Korean Men with Type 2 Diabetes

Background: Sarcopenia, an age-related decline in skeletal muscle mass, leads to metabolic and vascular abnormalities. However, little is known regarding the independent relationship between skeletal muscle mass and atherosclerosis in patients with type 2 diabetes mellitus (T2DM). The purpose of this study was to evaluate the association of skeletal muscle mass with markers of carotid atherosclerosis, carotid intima-media thickness (CIMT) and carotid artery plaque, in men and women with T2DM. Methods: In this cross-sectional study, a total of 8,918 patients (4,520 men and 4,398 women) with T2DM were recruited from the outpatient clinic of Huh’s Diabetes Center from 2003 to 2016. Skeletal muscle mass was estimated from bioimpedance analysis measurements and skeletal muscle mass index (SMI, %) was defined as skeletal muscle mass (kg)/total body weight (kg) × 100. Carotid ultrasonography was performed to measure mean CIMT of both common carotid arteries. Carotid artery plaque was defined as a focal structure protruding into the lumen of the vessel of ≥50% than the surrounding area. Results: In both men and women, the presence of carotid artery plaque was higher with decreasing SMI quartiles. In men, this association remained significant after adjustment for additional risk factors (ptrend &amp;lt;0.001). Odds ratio for having carotid artery plaque was 1.76 (95% confidence interval [CI] 1.34-2.33; p &amp;lt;0.001) in men with lowest SMI quartile compared with highest quartile. However, in women, the association was attenuated after adjustment for additional risk factors. There was no significant association between SMI quartiles and CIMT in both men and women. Conclusion: Low muscle mass is associated with the presence of carotid artery plaque in men with T2DM. Disclosure M. Nam: None. D. Seo: None. M. Jung: None. S. Ahn: None. S. Hong: None. Y. Lee: None. Y. Choi: None. B. Huh: None. K. Huh: None. S. Kim: None. Funding National Research Foundation of Korea (2017R1D-1A1B03034581)

436-P: Comparison of the ASCVD and UK Prospective Diabetes Study Risk Engine with Carotid Intima Media Thickness and Brachial-Ankle Pulse Wave Velocity

Object: We explored and compare the efficacy of ACC-AHA-atherosclerotic cardiovascular disease (ASCVD) risk score and UK Prospective Diabetes Study (UKPDS) risk engine with the presence of subclinical carotid and peripheral atherosclerosis in patients with type 2 diabetes(T2DM) patients. Methods: We studied 746 T2DM patients aged 20 years and older, who visited Hallym University Dongtan Sacred Heart Hospital from Noember 2012 to June 2014. Carotid atherosclerosis was defined as carotid intima-media thickness (IMT) &amp;gt; 1mm or the presence of carotid artery plaque. Peripheral atherosclerosis was defined as over than 1750 cm/s of brachial-ankle pulse wave velocity (baPWV). Ten-year coronary heart disease (CHD) risk was determined using the ASCVD and UKPDS risk engine. Results: The mean 10-year CHD risks of UKPDS and ASCVD were 13.9±13.0% and 12.7±13.3%, respectively. The prevalence of carotid atherosclerosis and peripheral atherosclerosis were 13.3% and 22.9%. The risk for carotid atherosclerosis and peripheral atherosclerosis increased 6.12 (95% CI 3.3-11.4) times and 10.0 (95% CI 5.9-17.1) times in high risk group (≥20% 10-year UKPDS risk) than low-risk group, respectively. The risk for carotid atherosclerosis and peripheral atherosclerosis increased 7.891 (95% CI 4.4-14.0) times and 15.6 (95% CI 9.2-26.2) times in high risk group (≥20% 10-year ASCVD-predicted coronary heart disease risk) than low-risk group, respectively. In multiple regression analysis with ASCVD and UKPDS risk for carotid atherosclerosis and peripheral atherosclerosis, only ASCVD risk were statically significant (all p&amp;lt;0.001). Conclusion: Carotid atherosclerosis and peripheral atherosclerosis were prevalent in patients with T2DM and positively correlate d with 10-year CHD risk. In comparison of ASCVD and UKPDS risk engine, ASCVD risk engine was more proper in patients with T2DM. Disclosure S. Hong: None. Y. Choi: None. E. Hong: None.

Elevated Microparticle Tissue Factor Activity Is Associated With Carotid Artery Plaque in HIV-Infected Women.

Expression of tissue factor (TF) on the surface of activated monocytes may trigger thrombosis, leading to clotting risk, inflammation, and atherosclerosis. TF-positive microparticles (MP-TF) represent a functionally active form of TF that may be promulgated by long-term HIV infection. We hypothesized that greater MP-TF activity is associated with carotid artery plaque in HIV+ women. In a case-control study nested within the Women's Interagency HIV Study (WIHS), eligible HIV+ participants underwent B-mode carotid artery ultrasound at 2 study visits occurring 7 years apart. Cases were defined by the presence of at least 1 carotid artery plaque assessed at either visit. Cases were matched 1:2 to controls who were found not to have carotid artery plaques. Conditional logistic regression estimated the association of MP-TF activity with the presence of carotid artery plaque, adjusting for demographic and behavioral characteristics, HIV-related factors, cardiometabolic risk factors, and serum inflammation biomarkers (high-sensitivity C-reactive protein, IL-6, sCD14, sCD163, Gal-3, and Gal-3BP). Elevated MP-TF activity (>0.537 pg/mL) was found to be significantly associated with greater odds of plaque (adjusted odds ratio 3.86, 95% confidence interval: 1.06 to 14.07, P = 0.04). The association was attenuated after further adjustment for IL-6 but was unaffected by adjustment for other biomarkers including those denoting monocyte activation. Our findings suggest a link among HIV infection, innate immune system perturbation, coagulation, and atherosclerosis.

Presence of Carotid Artery Plaque Is Associated with Rapid Renal Function Decline in Patients with Type 2 Diabetes and Normal Baseline Renal Function

Background: Recent clinical evidences indicate that early rapid renal function decline is closely associated with the development of diabetic kidney disease. We have investigated the incidence and baseline clinical predictors of rapid renal function decline in patients with type 2 diabetes and normal baseline renal function. Methods: A total of 967 type 2 diabetic patients from the Korean National Diabetes Program (KNDP), a prospective, multicenter, observational cohort study, with serial GFR measurement for 5 years and normal renal function were included for the analysis. Rapid renal function decline was defined as an eGFR decline &amp;gt;3.3% per year. Carotid ultrasonography was used to assess carotid intima-media thickness (IMT) and the presence of plaque. Results: The mean age was 53.7 years with body mass index of 25.4 kg/m2. Rapid renal function decline developed in 158 participants (16.3%) and average GFR decline was -5.2 ± 1.9% /year in rapid decliners and -0.4 ± 1.9% /year in non-decliners. There were no differences in the presence of albuminuria or retinopathy between the rapid decliners and non-decliners at baseline. Multivariable logistic regression analyses revealed that female sex (odds ratio (OR) 4.80 [95% CI 2.69-8.56], p&amp;lt;0.0001), higher urine albumin/creatinine ratio (OR 1.26 [1.03-1.55], p=0.024), presence of carotid artery plaque (OR 2.58 [1.47-4.53], p=0.001), and previous history of hypertension (OR 1.93 [1.09-3.44], p=0.025) and CVD (OR 2.53 [1.24-5.15], p=0.011) were the independent clinical predictors for rapid renal function decline. Conclusions: Our study suggests the need for close monitoring of renal function and early intensive management in patients with type 2 diabetes and carotid atherosclerosis. Disclosure D. Seo: None. S. Kim: None. S. Ahn: None. S. Hong: None. M. Nam: None. J. Woo: None. S. Baik: None. K. Lee: None. Y. Kim: None. Y. Park: None.

Serum Adipocyte Fatty Acid-Binding Protein Levels Are Linked to Rapid Renal Function Decline in Patients with Type 2 Diabetes and Normal Renal Function

Background: Rapid renal function decline has been recognized as an important predictor for diabetic nephropathy (DN). Adipocyte fatty acid-binding protein (A-FABP) is a major cytoplasmic protein in adipocytes and is closely associated with metabolic syndrome and type 2 diabetes. We aim to investigate the role of adipokines including A-FABP and inflammatory cytokines in the development of rapid renal function decline in type 2 diabetes and normal renal function. Methods: A total of 456 subjects with type 2 diabetes with normal renal function were recruited from an outpatient clinic at the Diabetes Center of Inha University Hospital and were followed up for 6 years with serial glomerular filtration rate (GFR) measurements. The serum levels of tumor necrosis factor (TNF)-a, and interleukin (IL)-6, high molecular weight (HMW) adiponectin, endogenous secretory receptor for advanced glycation end products (esRAGE), A-FABP and pentraxin-related protein (PTX3) were measured at baseline. Rapid renal function decline was defined as an eGFR decline &amp;gt;3.3% per year. Results: During follow-up, 120 participants (26.3%) developed rapid renal function decline and mean annual eGFR decline was -5.4 ± 2.7% and -0.6 ± 2.4% in decliners and non-decliners, respectively. Median A-FABP levels were significantly higher in patients with rapid decliners than in non-decliners (19.1 vs. 16.8 ng/ml, p=0.011). No significant difference of three cytokines levels were observed between groups. Each log unit increase of A-FABP was independently associated with greater risk of rapid renal function decline (odds ratio [OR] = 3.60; 95% confidence interval [CI] 1.95-6.66; p &amp;lt; 0.001) after adjustments for sex, BMI, A1C, GFR, hypertension, presence of carotid artery plaque and urine albumin creatinine ratio. Conclusions: High plasma A-FABP was an independent risk factor for rapid renal function decline in type 2 diabetes and normal renal function. Disclosure D. Seo: None. S. Kim: None. S. Ahn: None. S. Hong: None. M. Nam: None.

Lipoprotein(a) and apolipoprotein(a) isoform size: Associations with angiographic extent and severity of coronary artery disease, and carotid artery plaque

Background and aimsLipoprotein(a) [Lp(a)] is an emerging genetic risk factor for cardiovascular disease (CVD). We examined whether plasma Lp(a) concentration and apolipoprotein(a) [apo(a)] isoform size are associated with extent and severity of coronary artery disease (CAD), and the presence of carotid artery plaque. MethodsWe included in our study male participants (n = 263) from a cohort with angiographically defined premature CAD (Carotid Ultrasound in Patients with Ischemic Heart Disease). The angiographic extent and severity of CAD were determined by the modified Gensini and Coronary Artery Stenosis≥20% (CAGE) scores. Carotid artery plaque was assessed by bilateral carotid B-mode ultrasound. Apo(a) isoform size was determined by LPA Kringle IV-2 copy number (KIV-2 CN). ResultsLp(a) concentration, but not KIV-2 CN, was positively associated with the Gensini score. The association remained significant following adjustment for conventional CVD risk factors (all p < 0.05). Lp(a) concentration and elevated Lp(a) [≥50 mg/dL] were positively associated with the CAGE≥20 score, independent of conventional CVD risk factors. KIV-2 C N Q1 (lowest KIV-2 CN quartile) was associated with CAGE≥20 score and KIV-2 CN, with the CAGE≥20 score in those without diabetes. In multivariate models that included phenotypic familial hypercholesterolemia or low-density lipoprotein cholesterol, Lp(a) concentration, but not KIV-2 CN, was independently associated with the Gensini and CAGE≥20 scores. No significant associations between Lp(a) concentration and KIV-2 CN with carotid artery plaque were observed. ConclusionsLp(a) concentration, but not apo(a) isoform size, is independently associated with angiographic extent and severity of CAD. Neither Lp(a) nor apo(a) isoform size is associated with carotid artery plaque.

Small and large vessel disease in persons with unrecognized compared to recognized myocardial infarction: The Tromsø Study 2007–2008

BackgroundUnrecognized myocardial infarction (MI) is a frequent condition with unknown underlying reason. We hypothesized the lack of recognition of MI is related to pathophysiology, specifically differences in underlying small and large vessel disease. Methods6128 participants were examined with retinal photography, ultrasound of the carotid artery and a 12‑lead electrocardiography (ECG). Small vessel disease was defined as narrower retinal arterioles and/or wider retinal venules measured on retinal photographs. Large vessel disease was defined as carotid artery pathology. We defined unrecognized MI as ECG-evidence of MI without a clinically recognized event. We analyzed the cross-sectional relationship between MI recognition and markers of small and large vessel disease, adjusted for age and sex. ResultsUnrecognized MI was present in 502 (8.2%) and recognized MI in 326 (5.3%) of the 6128 participants. Compared to recognized MI, unrecognized MI was associated with small vessel disease indicated by narrower retinal arterioles (OR 1.66, 95% CI 1.05–2.62, highest vs. lowest quartile). Unrecognized MI was less associated with wider retinal venules (OR 0.55, 95% CI 0.35–0.87, lowest vs. highest quartile). Compared to recognized MI, unrecognized MI was less associated with large vessel disease indicated by presence of plaque in the carotid artery (OR for presence of carotid artery plaque in unrecognized MI 0.51, 95% CI 0.37–0.69). No significant sex interaction was present. ConclusionsUnrecognized MI was more associated with small vessel disease and less associated with large vessel disease compared to recognized MI. These findings suggest that the pathophysiology behind unrecognized and recognized MI may differ.