Reduction Of Intima-media Thickness Research Articles

Effects of five types of exercise on vascular function in postmenopausal women: a network meta-analysis and systematic review of 32 randomized controlled trials.

As women age, especially after menopause, cardiovascular disease (CVD) prevalence rises, posing a significant global health concern. Regular exercise can mitigate CVD risks by improving blood pressure and lipid levels in postmenopausal women. Yet, the optimal exercise modality for enhancing vascular structure and function in this demographic remains uncertain. This study aims to compare five exercise forms to discern the most effective interventions for reducing cardiovascular risk in postmenopausal women. The study searched PubMed, Web of Science, Cochrane, EBSCO, and Embase databases. It conducted a network meta-analysis (NMA) of randomized controlled trials (RCTs) on five exercise interventions: continuous endurance training (CET), interval training (INT), resistance training (RT), aerobic combined with resistance training (CT), and hybrid-type training (HYB). Outcome measures included carotid artery intima-media thickness (IMT), nitric oxide (NO), augmentation index (AIx), pulse wave velocity (PWV), and flow-mediated dilatation (FMD) of the brachial artery. Eligible studies were assessed for bias using the Cochrane tool. A frequentist random-effects NMA was employed to rank exercise effects, calculating standardized mean differences (SMDs) with 95% confidence intervals (CIs). The analysis of 32 studies (n = 1,427) indicates significant increases in FMD with CET, INT, RT, and HYB in postmenopausal women. Reductions in PWV were significant with CET, INT, RT, CT, and HYB. AIx decreased significantly with INT and HYB. CET, INT, and CT significantly increased NO levels. However, no significant reduction in IMT was observed. SUCRA probabilities show INT as most effective for increasing FMD, CT for reducing PWV, INT for decreasing AIx, CT for lowering IMT, and INT for increasing NO in postmenopausal women. The study demonstrates that CET, INT, RT, and HYB have a significant positive impact on FMD in postmenopausal women. Furthermore, all five forms of exercise significantly enhance PWV in this population. INT and HYB were found to have a significant positive effect on AIx in postmenopausal women, while CET, INT, and CT were found to significantly improve NO levels. For improving vascular function in postmenopausal women, it is recommended to prioritize INT and CT exercise modalities. On the other hand, as CET and RT were not ranked at the top of the Sucra value ranking in this study and were less effective than INT and CT as exercise interventions to improve vascular function in postmenopausal women, it is not recommended that CET and RT be considered the preferred exercise modality.

Follow-up ultrasound examination in patients with newly diagnosed giant cell arteritis.

Ultrasound is a standard tool to diagnose giant cell arteritis (GCA). Until now, only few studies investigated the role of ultrasound in the follow-up of GCA. The aim of this study was to assess the changes in the intima media thickness (IMT), total number of affected arteries and provisional OMERACT GCA ultrasonography score (OGUS) in a 12-months follow-up period. Patients with newly diagnosed GCA were prospectively enrolled. Ultrasound examinations of facial, temporal, carotid, vertebral and axillary arteries were performed at baseline, after three, six, nine and 12 months. Changes of IMT, total number of affected arteries, and OGUS values were evaluated. In a subgroup of patients, exams were conducted weekly in the first 100 days. Fifty patients were enrolled, 36 completed the follow-up. Significant reductions in IMT, total number of affected arteries and OGUS were observed. Eighteen patients presented to weekly exams. The mean IMT of the axillary artery normalized after seven days, while IMT of the common temporal artery normalized after 50 days. The mean OGUS values were below one after six months. There were no differences in IMT changes between GCA patients with or without PMR or between those with and without additional tocilizumab treatment. A relapse occurred in 4 patients. At relapse, mean IMT and OGUS were higher as compared with the preceding assessment. No predictive values indicating a relapse were identified. Vascular ultrasound is sensitive to change in GCA. The presence of PMR or treatment with tocilizumab did not affect IMT decrease.

Ischemia‒Reperfusion accelerates neointimal hyperplasia via IL-1β-mediated pyroptosis after balloon injury in the rat carotid artery

BackgroundIschemia‒reperfusion (IR) is a pathological process that causes secondary damage to blood vessels. However, whether IR can further worsen neointima formation after balloon injury and the detailed mechanism are unclear. MethodsAn in vivo model of balloon injury to the rat carotid artery was established to study the effect of IR following balloon injury on neointima formation. Smooth muscle cells (SMCs) were isolated from rat aortas and exposed to hypoxia-reoxygenation to mimic the IR process in vitro. The in vitro cell model was used to investigate the mechanism of IR-mediated neointima formation after balloon injury, which was further confirmed in an in vivo rat model. ResultsIR aggravated neointima formation in the rat carotid artery 2 weeks after balloon injury compared with that observed in the absence of balloon injury (P < 0.001). Compared with that of normal SMCs in the rat carotid artery, the expression of IL-1β, a key proinflammatory cytokine associated with pyroptosis, was increased more than 3-fold in the IR-induced neointima (P < 0.0001) and contributed to the proliferation and migration of rat primary aortic SMCs (P < 0.0001). This process was alleviated by the antioxidant acetylcysteine (NAC), suggesting its partial dependence on intracellular ROS. In the rat model of IR following balloon injury in the carotid artery, the carotid artery that was locally transfected with AAV carrying sh-IL-1β or sh-caspase-1, which alleviated neointima formation, as indicated by a reduction in intima-media thickness in the rat carotid artery (P < 0.0001). ConclusionOur results suggested that IR could promote IL-1β production in SMCs in the carotid artery after balloon injury and aggravate neointimal hyperplasia, which was alleviated by silencing caspase-1/IL-1β signaling in SMCs in the carotid artery. These results suggest that IL-1β may be an effective target to combat IR-related neointima formation.

Effect of Bariatric Surgery on Intima Media Thickness: A Systematic Review and Meta-Analysis

Background: Obesity, and in particular extreme obesity, as a global health problem is an important risk factor for many diseases, including atherosclerotic cardiovascular disease (ACVD). Bariatric surgery might stop or slow atherogenesis by decreasing excessive weight in the early stages of atherogenesis, by suppressing low-grade systemic inflammation as well as by inhibiting oxidative stress and endothelial dysfunction. The aim of this meta-analysis was to provide an answer to whether bariatric surgery has a significant effect on intima-media thickness (IMT) which is a surrogate marker of early atherosclerosis and has a good correlation with atherosclerotic coronary heart disease. Methods: A systematic literature search in PubMed, Scopus, Embase, and Web of Science as well as grey literature was performed from inception to 1 July 2022. The meta-analysis was performed using Comprehensive Meta-Analysis (CMA) V3 software. Overall, the estimate of effect size was measured by a random effects meta-analysis. To account for the heterogeneity of studies regarding study design, characteristics of the populations, and treatment duration, a random-effects model (using the DerSimonian–Laird method) and the generic inverse variance weighting approach were used. To assess the existence of publication bias in the meta-analysis, the funnel plot, Begg’s rank correlation, and Egger’s weighted regression tests were used. Results: The meta-analysis of 30 trials, including 1488 subjects, demonstrated a significant decrease in IMT after bariatric surgery. The reduction in IMT was also robust in the leave-one-out sensitivity analysis. It must be stressed that the results of the random-effects meta-regression did not suggest any relationship between the changes in IMT and delta body mass index (BMI) or duration of follow-up after the bariatric surgery. However, the subgroup analyses showed a better IMT reduction after laparoscopic sleeve gastrectomy (LSG) when compared to Roux-en-Y gastric bypass (RYGB). Within a year, the IMT follow-up values showed a further improvement. Conclusions: Bariatric surgery significantly reduced IMT. Significant associations were found between the surgery type and IMT changes, as well as a significant effect of follow-up duration on the changes of IMT after bariatric surgery.

Vitamin D Supplementation on Carotid Remodeling and Stiffness in Obese Adolescents.

Obesity is associated with vitamin D (VD) deficiency and arterial stiffness. This randomized control trial assessed the effects of VD supplementation during a weight-loss program on carotid intima-media thickness (IMT) and carotid compliance in obese adolescents. Participants were randomly assigned to receive either a 12-week lifestyle program with VD supplementation (n = 13), a lifestyle program without VD supplementation (n = 13) or a control group composed of normal-weight adolescents (n = 18). Serum total and free 25-hydroxyvitamin D (25(OH)D), IMT and carotid compliance were measured before and after the trial. Insufficiency in 25(OH)D concentration was found in 73% of obese participants compared to 22% among controls. Obese adolescents had lower free 25(OH)D and displayed higher IMT but lower carotid compliance than controls. Free 25(OH)D and IMT were negatively correlated in adolescents displaying VD insufficiency at baseline. After three months, total and free 25(OH)D increased in both groups. The changes of IMT and carotid compliance were similar between groups. The changes in IMT were correlated with the changes in total 25(OH)D in obese adolescents with VD insufficiency at baseline (r = −0.59, p = 0.03). While the lifestyle program with VD supplementation did not affect carotid compliance, IMT reduction was improved in obese adolescents.

Effects of uric acid-lowering therapy in patients with essential arterial hypertension.

Asymptomatic hyperuricemia (AHU) is elevated serum uric acid (UA) without symptoms. This study aimed to determine the effects of AHU treatment with allopurinol on selected hypertension-mediated organ damage (HMOD) indices in patients with uncomplicated essential arterial hypertension (AH). Patients aged 30-70 years with AHU and AH grade 1-2 with adequate blood pressure (BP) control, without previous urate-lowering therapy (ULT), were divided into two groups: (a) ULT (receiving allopurinol) and (b) control (age- and sex-matched patients without ULT). Both received a UA-lowering diet. BP (office, 24 h and central), echocardiographic parameters, carotid intima-media thickness (IMT) and lab tests [high-sensitivity C-reactive protein (hs-CRP)] were measured at baseline and at 6 months follow-up. Of 100 participants, 87 (44 ULT, 43 controls) completed the study. At 6 months follow-up, there was a greater reduction in serum UA concentration in the ULT group than in the control group. Patients receiving allopurinol had significant reductions in office systolic and diastolic BP, central systolic BP, pulse pressure, IMT (0.773 ± 0.121 vs. 0.752 ± 0.13 mm, P = 0.044) and hs-CRP (3.36 ± 2.73 vs. 2.74 ± 1.91 mg/L, P = 0.028) compared to controls. Multivariate regression analysis revealed the independent relationship between reduction in IMT and UA lowering (P < 0.026). In patients with AH and AHU, treatment with allopurinol leads to improvement in BP control and reduction in HMOD intensity, in particular IMT. The decrease in hs-CRP concentration associated with ULT may have a beneficial effect on a patient's long-term prognosis.

Arterial structure and function in patients with acute coronary syndrome after 1‑year treatment.

INTRODUCTION The modification of arterial stiffness and intima-media thickness (IMT) is controversial in patients with clinically significant atherosclerosis. OBJECTIVES We evaluated the effects of 1‑year pharmacological therapy on arterial stiffness and IMT in survivors of non‑ST‑segment elevation myocardial infarction (NSTEMI) who were treated according to current clinical guidelines. PATIENTS AND METHODS A total of 298 patients with NSTEMI (median age, 64 years; 85 women) were enrolled to this study. Local (carotid) arterial stiffness and IMT were measured noninvasively before discharge and after 12 months of contemporary pharmacological treatment according to current clinical guidelines. The study group was divided into patients with normal systolic blood pressure (BP) (<140 mm Hg) and those with increased systolic BP (≥140 mm Hg) at 12 months. The results were presented as median (25th-75th percentile). RESULTS There were no significant changes in local arterial stiffness between patients with normal and those with increased systolic BP (8.9 m/s [7.9-10.9 m/s] vs 8.7 m/s [7.8-10.1 m/s] at baseline and 9.6 m/s [8.3-11.0 m/s] vs 10.4 m/s [9.1-12.4 m/s] at 12 months, P = 0.67 and P = 0.05, respectively); however, a significant reduction in IMT was found in both groups (777 μm [664-896 μm] vs 715 μm [619-841 μm] at baseline and 818 μm [720-962 μm] vs 760 μm [674-897 μm] at 12 months, P = 0.0003 and P = 0.001, respectively). Arterial stiffness and IMT were affected by age and mean BP; however, adjustment for these variables did not affect the obtained results in multivariate models. CONCLUSIONS The 1‑year pharmacological treatment of patients after NSTEMI was associated with a significant reduction in IMT but had no effect on the properties of the arterial structure.

Weight loss and carotid intima-media thickness-a meta-analysis.

Obesity is a risk factor for clinical cardiovascular disease, putatively via increased burden of atherosclerosis. It remains contentious as to whether weight loss in people with obesity is accompanied by a reduction in intima-media thickness, a noninvasive marker of subclinical atherosclerosis, consistent with a lowering of risk of cardiovascular events. A systematic literature search was performed to identify all surgical and nonsurgical weight loss interventions that reported intima-media thickness. A meta-analysis was undertaken to obtain pooled estimates for change in intima-media thickness. From the 3,197 articles screened, 9 studies were included in the meta-analysis, with a total of 393 participants who lost an average of 16 kg (95% CI 9.4-22.5) of body weight over an average follow-up of 20 months. The pooled mean change in carotid intima-media thickness was -0.03 mm (95% CI -0.05 to -0.01), which was similar between surgical and nonsurgical interventions. In people with obesity, weight loss was associated with a reduction in carotid intima-media thickness, consistent with a lowering in risk of cardiovascular events.

PS 02-81 COMPARISON OF EFFICACY AND TOLERABILITY OF LERCARDIPINE AND AMLODIPINE ON INTIMA–MEDIA THICKNESS IN NEWLY DIAGNOSED HYPERTENSIVE PATIENTS

Objective: We compared the efficacy and tolerability of the lercardipine and amlodpine on intima–media thickness (IMT) in newly diagnosed hypertensive patients. Design and Method: An open label, controlled, randomized, parallel-group study was conducted on 100 newly diagnosed hypertensive patients (blood pressure [BP] > 140/90 mmHg) from Oct 2010 to May 2012 in Eulji University Hospital. Patients were allocated randomly two groups to receive amlodipine 5–10 mg or Lercardipine10–20 mg and followed up for 2 years. The endpoint was the change from baseline of the combined mean maximum far wall IMT of carotid artery, evaluated by repeated measurement analysis of the treatment effect and adverse events after first and second years of treatment. Results: Both lercanidipine and amlodipine were similarly able to significantly reduce mean systolic BP (SBP)/diastolic BP (DBP), mean 24hr day-time and night-time BP monitor. In particular, mean SBP/DBP was reduced from 160 ± 21/94 ± 13 mmHg to 142 ± 21/87 ± 12 mmHg in the lercanidipine group (p < 0.001 for both SBP and DBP) and from 163 ± 18/96 ± 12 mmHg to 141 ± 19/81 ± 14 mmHg in the amlodipine-treated group (p < 0.001 for both SBP and DBP). After 2 years of treatment, amlodipine decreased IMT by 0.089 mm [95% confidence interval (CI) 0.144 - 0.037]. Lecardipine decreased IMT by 0.065 mm (95% CI 0.124 - 0.010). No statistical difference was observed between the two treatments in the reduction of IMT. Both treatments achieved the greatest reduction of IMT after first and year, whereas the reduction in BP was maintained. Lercanidipine showed a better tolerability profile than amlodipine, with fewer adverse events and a lower percentage of patients suffering from peripheral edema. Conclusions: Lercanidipine is as effective as amlodipine reduced IMT to a similar extent in newly diagnosed hypertensive patients and presents tolerablility in the adverse events.

Oral contraceptives versus physical exercise on cardiovascular and metabolic risk factors in women with polycystic ovary syndrome: a randomized controlled trial.

Although oral contraceptives (OCs) are one the most widespread therapy in young polycystic ovary syndrome (PCOS) women and physical exercise represents a crucial first step in the treatment of overweight and obese PCOS, no studies were performed to compare the effects on cardiovascular risk (CVR) of OCs and physical exercise in PCOS. To compare the effects of OCs administration and physical exercise on the CVR, clinical, hormonal and metabolic parameters in PCOS women. One hundred and fifty PCOS women were enrolled and were randomized to OCs (3 mg drospirenone plus 30 μg ethinyloestradiol), structured exercise training programme (SETP) or polyvitamin tablets. The intervention phase study was of 6 months. Primary outcome was intima-media thickness (IMT) and flow-mediated dilation (FMD). Secondary outcomes were clinical, hormonal and metabolic changes. A significant reduction of IMT and a significant increase of FMD were observed in the SETP group after treatment. Compared to baseline, in the SETP group, a significant improvement in anthropometric measures, insulin sensitivity indexes, lipid profile, cardiopulmonary function, inflammatory markers and frequency of menses was observed. Oral contraceptives use was associated with a significant decrease of hyperandrogenism and a significant improvement of frequency of menses. Further, OCs use had a neutral effect on CVR risk factors. OCs effectively treat hyperandrogenism and menstrual disturbances, while SETP is more effective in improving cardiometabolic profile and cardiopulmonary function in PCOS.

Maraviroc Reduces Arterial Stiffness in PI-Treated HIV-infected Patients.

The Δ32-CCR5 deletion of the CCR5 receptor is protective toward coronary artery pathology and myocardial infarction. Maraviroc (MVC), a CCR5 antagonist, was recently introduced in the therapy of HIV infection; we evaluated whether this drug could modulate the atherosclerotic burden in aviremic PI-treated HIV-positive individuals who underwent MVC intensification. Thus, the effect of MVC on intima media thickness, arterial stiffness, metabolic parameters, pro-inflammatory cytokines, endothelial dysfunction, and microbial traslocation markers was analyzed in 6 aviremic PI-treated HIV-positive individuals and were compared to those obtained in 9 additional aviremic PI-treated subjects that were enrolled retrospectively from our outpatients cohort. MVC intensification resulted in a significant reduction in intima media thickness, pulse wave velocity and triglycerides compared to baseline. Notably, MVC was also associated with a significant reduction of IL-6, microbial translocation indexes, sICAM and sVCAM; these changes were maintained throughout the 6 months of MVC intensification. No significant modifications were observed in CD4 counts, HIV viral load, and cholesterolemia. Results herein support a role of CCR5 antagonists in reducing the cardiovascular risk in HIV-infection. The hampering of inflammation, microbial translocation and the improvement of endothelial function could justify the protective role of CCR5 antagonists on atherosclerotic burden.

Effects of bariatric surgery on markers of subclinical atherosclerosis and endothelial function: a meta-analysis of literature studies.

Several studies confirmed a significantly increased carotid intima-media thickness (IMT) and impaired flow-mediated dilation (FMD) and nitrate-mediated dilation (NMD) in obese subjects, but few data are available on the effects of bariatric surgery on these markers of cardiovascular (CV) risk. We performed a meta-analysis of studies evaluating changes in IMT, FMD and NMD in obese patients after bariatric surgery. A systematic search was performed in the PubMed, Web of Science, Scopus and EMBASE databases without any language or publication year restriction. The last search was performed in January 2015. In addition, the reference lists of all retrieved articles were manually reviewed. Prospective studies evaluating the impact of bariatric surgery on the markers of CV risk were included. Changes in IMT, FMD and NMD after bariatric surgery were expressed as mean differences (MD) with pertinent 95% confidence intervals (95% CIs). IMT has been expressed in millimeters (mm); FMD and NMD as percentage (%). Impact of clinical and demographic features on effect size was assessed by meta-regression. Ten articles (314 obese patients) were included in the analysis. Six studies contained data on IMT (7 data sets; 206 patients), 8 studies on FMD (9 data sets; 269 patients) and 4 on NMD (4 data sets; 149 patients). After bariatric surgery, there was a significant reduction of IMT (MD: -0.17 mm; 95% CI: -0.290, -0.049; P=0.006) and a significant improvement in FMD (MD: 5.65%; 95% CI: 2.87, 8.03; P<0.001), whereas NMD did not change (MD: 2.173%; 95% CI: -0.796, 5.142; P=0.151). Interestingly, percentage of changes in the body mass index were associated with changes in IMT (Z=11.52, P<0.001), FMD (Z=-4.26, P<0.001) and NMD (Z=-3.81, P<0.001). Despite heterogeneity among studies, bariatric surgery is associated with improvement of subclinical atherosclerosis and endothelial function. These effects may significantly contribute to the reduction of the CV risk after bariatric surgery.

The effects of aerobic endurance exercise on pulse wave velocity and intima media thickness in adults: A systematic review and meta-analysis.

The aim of this study was to perform a systematic review and meta-analysis of randomized controlled trials (RCTs) or cohort studies that evaluated the effect of aerobic endurance exercise on pulse wave velocity (PWV) and intima media thickness (IMT) in adults. IMT and PWV were the most commonly used parameters for the assessment of arterial stiffness. The MEDLINE, Cochrane, ISI, and Ovid databases were searched between January 2000 and February 2015. A total of 1654 participants in 26 RCTs and two cohort studies were included in the meta-analysis. In studies for which PWV was the outcome, aerobic endurance exercise had a significant effect on reducing PWV [-0.67, 95% CI -0.97, -0.38; I(2) = 89%; heterogeneity, P < 0.0001]. Changes in peripheral arterial PWV were statistically greater than in central arterial PWV. In the RCTs for which IMT was the outcome, changes [-0.04, 95% CI -0.12, 0.04; I(2) = 95%; heterogeneity, P < 0.00001] in IMT did not reach statistical significance. In the two cohort studies, changes [-8.81, 95% CI -9.25, -8.37; I(2) = 22%; heterogeneity, P = 0.26] in IMT were statistically significant. Subgroup analysis indicated a longer duration aerobic exercise and a greater improvement in VO2max were associated with larger reductions in PWV. Reductions in IMT were observed in two cohort studies, but not in four RCTs.

Abstract P056: Emerging Lifestyle Markers Predict Regression of Carotid Intima-Media Thickness Scores

Introduction: CVD remains the number one cause of mortality in the western world. Carotid intima-media thickness (IMT) is a safe &amp; reliable predictor of future CVD risk. This study assesses which lifestyle factors best predict a change in IMT over time. Hypothesis: We assessed the null hypothesis that all lifestyle changes are effective. Methods: A prospective cross-sectional analysis of 289 men &amp; women undergoing health &amp; cardiovascular risk screening every 1-2 years at an outpatient wellness center in Florida. This study reflects the first visit at the clinic, &amp; a second visit that occurred on average 2.8 years later. These subjects ranged in age from 23-65 (mean = 48.2). In addition to testing, subjects received nutrition, fitness, &amp; health coaching. Measurements were made of fitness using VO2max stress testing, diet intake using a 3-day dietary intake survey. Laboratory &amp; anthropometric measures were obtained fasting. Mean IMT scores used high resolution B-mode ultrasonography of the common carotid arteries. Each subject had ≥10 images collected from the far wall of both distal 1 cm of the common carotid arteries at end diastole. The carotid intimal thickness was measured as a continuous variable, using both multivariate &amp; bivariate linear regression, adjusting for age &amp; gender; as our site IMT precision was = 3%, we selected a 4% change as significant. Results: The average decrease in IMT score in this cohort was -0.018 mm over 2.8 years, a 2.04% reduction. The bivariate analyses showing a significant association with a ≥4% reduction in IMT in 62 of 288 subjects; they were a decrease in: Body mass index (BMI) (p=0.047), body fat (p=0.025), total cholesterol (TC) (p=0.031), LDL cholesterol (p=0.028), TC/HDL (0.002), or an increase in dietary intake of: magnesium (p=0.0001), fiber (p=0.017), vitamin D (p=0.016), vitamin K (p=0.001), potassium (p=0.001), &amp; calcium (p=0.024). In a multivariate analysis, starting a statin medication (p=0.0007), a decrease in BMI (p=0.042), baseline IMT, male gender, diastolic BP decrease, &amp; years of follow up were predictive of 4% IMT decline. Prior use of a statin medication was not significant. Conclusions: In conclusion, this study shows that a reduction in IMT score over 2.8 years is associated with a decrease in: BMI, body fat, TC, LDL, TC/HDL ratio, &amp; diastolic BP; or, an increase in intake of: magnesium, fiber, vitamins K &amp; D, potassium, &amp; calcium; or, starting a statin medication.

Effects of Stress Reduction on Cardiovascular Risk Factors in Type 2 Diabetes Patients with Early Kidney Disease – Results of a Randomized Controlled Trial (HEIDIS)

Current guidelines for the treatment of type 2 diabetes focus on pharmacological treatment of glucose and cardio-vascular risk factors. The aim of this prospective randomized controlled intervention study was to examine the effects of a psychosocial intervention on clinical endpoints and risk factors in patients with type 2 diabetes and early diabetic kidney disease.110 patients were randomized to receive an 8-week mindfulness-based stress reduction (MBSR) training (n = 53) compared to standard care (n = 57). The study was carried out open-labelled and randomization was performed computer-generated in a 1:1 ratio. Primary outcome of the study was the change in urinary albumin excretion (albumin-creatinine-ratio, ACR); secondary outcomes were metabolic parameters, intima media thickness (IMT), psychosocial parameters and cardiovascular events.89 patients (42 in control group and 47 in intervention group) were analysed after 3 years of follow-up. After 1 year, the intervention group showed a reduction of ACR from 44 [16/80] to 39 [20/71] mg/g, while controls increased from 47 [16/120] to 59 [19/128] mg/g (p = 0.05). Parallel to the reduction of stress levels after 1 year, the intervention-group additionally showed reduced catecholamine levels (p < 0.05), improved 24 h-mean arterial (p < 0.05) and maximum systolic blood pressure (p < 0.01), as well as a reduction in IMT (p < 0.01). However, these effects were lost after 2 and 3 years of follow-up.This is the first study to show that a psychosocial intervention improves cardiovascular risk factors in high risk type 2 diabetes patients. Trial-Registration: NCT00263419 http://clinicaltrials.gov/ct2/show/NCT00263419 TRIAL REGISTRATION: clinicaltrials.gov-Identifier: NCT00263419.

Abstract 128: Six Months of Lifestyle Intervention Reduces Carotid Intima-media Thickness in African Merican Adults

Background: African Americans tend to have greater carotid intima-media thickness (IMT), and are 60% more likely to have a stroke than Caucasians. Data on the effects of lifestyle intervention on carotid IMT in African Americans does not exist. The aim of our study was to assess the efficacy of 6 months of diet and exercise intervention on carotid IMT in sedentary African American adults. Methods: Nineteen African American subjects (15F/4M, 52 ± 6yrs) who were sedentary, non smoking, non diabetic, free of cardiovascular disease, not on antihypertensive or cholesterol medications underwent 6 weeks of dietary counseling under the supervision of a registered dietician and were required to follow an AHA low fat, low salt diet for the duration of the study. Compliance was assessed by a diet log (3 days/week). Subjects completed 6 months of supervised aerobic exercise training (3 days/week, 40 minutes/session at 65% of their estimated VO 2max ). Common carotid artery IMT was assessed using high resolution ultrasonography. Results: At baseline, IMT significantly correlated with age (r = 0.58, P = 0.003) and total cholesterol (r = 0.41, P = 0.04). At 6 months, there were significant changes in basal metabolic index (ΔBMI, -0.83 kg/m 2 , P = 0.01); Δtriglycerides (-13.7 mg/dL, P = 0.03) and Δfasting glucose (-7.2 mg/dL, P = 0.01). On repeated measures ANCOVA, the mean IMT were statistically significantly different (F (1, 15) = 7.999, P = 0.013) between before vs. after training (Mean ± SD; 0.617 ± 0.092mm vs. 0.572 ± 0.068mm), after adjusting for changed variables (ΔBMI, Δtotal cholesterol and Δmean arterial pressure) as covariates. Conclusion: Our preliminary study showed that 6 months of diet and exercise intervention reduced carotid IMT by ∼7.3% and improved the cardio-metabolic profile in sedentary African Americans. Reduction in IMT from early and effective lifestyle modification strategies may help to improve cerebrovascular health and prevent stroke in this at-risk stroke population.

ACE inhibitor effects of brachial artery structure and function in patients with arterial hypertension

Aim. To investigate the effects of an angiotensin-converting enzyme (ACE) inhibitor fosinopril on the structural and functional parameters of brachial arteries (BA) in patients with essential arterial hypertension (EAH). Material and methods. The study included 32 EAH patients: 15 men and 17 women aged 27-59 years (mean age 45,6±11,7 years). BA ultrasound and echocardiography (EchoCG) were performed with the use of the Vivid 7 Dimension device (USA). The following parameters of BA remodelling were analysed: intima-media thickness (IMT), lumen diameter (D), and wall-to-lumen (W/L) ratio. BA endotheliumdependent vasodilatation (EDVD) was assessed in the reactive hyperemia test. Central hemodynamic parameters were also assessed. Results. In EAH patients, the six-month fosinopril treatment was associated with BA IMT reduction, but not with substantial intraluminal diameter changes, or increased endothelium-dependent vasodilatation. Conclusion. Among EAH patients, an ACE inhibitor fosinopril demonstrated a marked improvement in BA structural and functional parameters.

Intima media thickness-related risk factors in childhood obesity

Macroangiopathy caused by atherosclerosis is one of the major morbidity and mortality factors in obese adults with dyslipidemia, hypertension and disturbed glucose metabolism. However, the onset of these cardiovascular changes is not well established. Measuring the intima- media thickness (IMT) of the common carotid artery, as a non-invasive marker for early atherosclerotic changes, has been reported to be reliable and predictive for later cardiovascular disease. Increased IMT has been reported in children with diabetes mellitus type 1 and 2. IMT was related to both hyperglycaemia and dyslipidemia in these children. Furthermore, children with hypertension demonstrated increased IMT. Moreover, children with familial hypercholesterolemia have higher IMT values as compared to healthy children. Obese children with the features of the metabolic syndrome (MetS) such as hypertension, dyslipidemia, or impaired glucose tolerance also demonstrated increased IMT. A strong association between IMT and parameters of the MetS has been reported for impaired glucose tolerance. Furthermore, increased androgens in girls with polycystic ovarian syndrome (PCOS) are associated with increased IMT measurements. Reduction of overweight and normalization of blood pressure, glucose metabolism and dyslipidemia were associated with a reduction of IMT in children and adolescents. In conclusion, early vascular changes already occur in obese children with MetS suggesting that rather cardiovascular risk factors such as hypertension, dyslipidaemia, or disturbed glucose metabolism are associated to increased IMT than obesity per se. Most importantly, these early changes are reversible if effective therapy of cardiovascular risk factors could be achieved.

Comparative Effects of Benidipine and Amlodipine on Proteinuria, Urinary 8-OHdG, Urinary L-FABP, and Inflammatory and Atherosclerosis Markers in Early-Stage Chronic Kidney Disease

IntroductionWe examined the effects of 2 calcium channel blockers, benidipine (T-, L-, and N-type) and amlodipine (L- and N-type), on renal, inflammatory, oxidative, and atherosclerosis markers in hypertensive patients with mild chronic kidney disease (CKD). MethodsForty hypertensive patients with CKD were assigned randomly to either of the 2 treatments: 8mg benidipine once daily (n=20, group A) or 5mg amlodipine once daily (n=20, group B). Treatment was continued for 12months. Blood pressure, serum creatinine, estimated glomerular filtration rate, urinary protein excretion, urinary liver-type fatty acid-binding protein, interleukin-6, high mobility group box-1 protein, urinary 8-hydroxy-2′- deoxyguanosine, pulse wave velocity, intima-media thickness, and blood asymmetric dimethylarginine were monitored. ResultsBlood pressure decreased equally in both groups (P<0.001, at 6 and 12months versus before treatment). Serum creatinine and estimated glomerular filtration rate changed little during the experimental period in each group. However, urinary protein excretion (P<0.001), urinary liver-type fatty acid-binding protein (P<0.001), urinary 8-hydroxy-2'-deoxyguanosine (P<0.001), blood interleukin-6 (P<0.001), blood high mobility group box-1 (P <0.5), and pulse wave velocity (P<0.01) decreased more in group A than in group B with 12months of treatment. The percent reductions in intima-media thickness and blood asymmetric dimethylarginine were significantly greater in group A than in group B (P<0.001). ConclusionsBenidipine is more effective than amlodipine for protecting renal function and potentially for ameliorating atherosclerosis in hypertensive patients with mild CKD. T-type calcium channel blockers may be effective in patients with CKD.

Carotid Intima—Media Thickness (cIMT): A Useful Clinic Tool or Research Luxury? Another View of the ENHANCE Trial

The ENHANCE trial was the first trial of ezetimibe- simvastatin with a surrogate marker as a primary endpoint. The combination of the 2 drugs is highly effective in reducing total cholesterol and low-density lipoprotein cholesterol levels and with a positive profile on high-density lipoprotein cholesterol. However, there are no data as yet about the clinical effectiveness of the addition of ezetimibe on statin therapy and whether this provides a further reduction of cardiovascular events. The answer to the clinical hard endpoints question will be provided in 2012 by the IMPROVE-IT trial comparing the effectiveness of simvastatin 40 mg plus ezetimibe versus simvastatin 40 mg on 18,000 acute coronary syndrome patients. The ENHANCE study failed in its primary endpoint, carotid intima-media thickness reduction, but has various methodological weaknesses that makes it very difficult to accept the American College of Cardiology statement that ezetimibe should be the last resort after trying all other available treatments.