Significant Increase In Intima-media Thickness Research Articles

Ремоделювання сонних артерій у жінок з артеріальною гіпертензією та його зв’язок із додатковими факторами ризику

Актуальність. Артеріальна гіпертензія (АГ) разом із дією інших додаткових факторів серцево-судинного ризику обумовлює зміни в стінці артерій, що виражається в потовщенні комплексу інтима-медіа (КІМ), головним чином за рахунок середньої оболонки — медії. Мета дослідження: вивчити особливості ремоделювання загальних сонних артерій у жінок з АГ за допомогою ультразвукової пошарової оцінки інтими і медії та визначити вплив на них додаткових факторів серцево-судинного ризику. Матеріали та методи. Обстежено 98 жінок з АГ I і II стадії 1-го і 2-го ступеня (основна група) та 42 здорові жінки (контрольна група). На апараті LOGIC PRO P5 у В-режимі вимірювали товщину КІМ, інтими, медії та діаметр загальних сонних артерій. Проведено добове моніторування артеріального тиску, допплерехокардіографію, оцінку індексу маси тіла, швидкості клубочкової фільтрації, ліпідограми, рівня креатиніну, глюкози плазми крові. Результати. При пошаровому скануванні стінки загальних сонних артерій у жінок з АГ порівняно з контрольною групою виявлено достовірне збільшення товщини КІМ (0,068 ± 0,009 см проти 0,052 ± 0,009 см, р < 0,001) переважно за рахунок шару медії (0,042 ± 0,008 проти 0,028 ± 0,009 см, р < 0,001). Товщина шару інтими в досліджуваних групах була статистично порівнянна (р > 0,05). Виявлений прямий кореляційний зв’язок товщини КІМ і медії з віком (r = +0,26; р < 0,001 і р = 0,56; р < 0,001), рівнем систолічного артеріального тиску (r = +0,30; р < 0,01 і r = +0,31; р < 0,01), глюкози (r = +0,37; р < 0,001 і r = +0,31, р < 0,01), з індексом маси тіла (r = +0,27; р < 0,01 і r = +0,22; р < 0,05) і обернений — зі швидкістю клубочкової фільтрації (r = –0,36; р < 0,001 і r = –0,41; р < +0001). Висновки. У жінок з АГ товщина КІМ на 30,8 %, а шару медії — на 33,4 % більша, ніж у контрольній групі (р < 0,001). Загальний внесок таких факторів, як рівень систолічного артеріального тиску, індекс маси тіла, швидкість клубочкової фільтрації, концентрація холестерину ліпопротеїнів низької щільності, глюкози, у прогресування потовщення КІМ становив 68 % і збігся з впливом на шар медії — 62 % на відміну від впливу на шар інтими, де їх внесок становив 26 %.

Vascular Calcification in Chronic Kidney Disease PatientsA Cross-sectional Study

Introduction: Vascular Calcification (VC) is considered as a cardiovascular risk marker in Chronic Kidney Disease (CKD) patients. VC is a process characterised by thickening and loss of elasticity of muscular arteries walls. The three pathological forms of cardiovascular disease in CKD are cardiac geometry, atherosclerosis and arteriosclerosis of the large vessels (carotid artery or aorta). Aim: To evaluate VC as a cardiovascular risk marker in CKD patients. Materials and Methods: This cross-sectional study was conducted in the Nephrology Department at Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India, from November 2019 to December 2020. The study included 27 CKD patients who were on maintenance haemodialysis. The participants were 20 to 70 years of age, and of both genders. The Intima Media Thickness (IMT) was assessed by ultrasonography. Peak Systolic Velocity (PSV) measurement was done using doppler ultrasonography. Both the measurements were done on common Carotid Artery (CCA), and Internal Carotid Artery (ICA) on both sides of the neck. Student’s t-test and Chi-square test was used in this study. Data were expressed as mean±SD. The p-value <0.05 was considered as statistically significant. Results: Out of 27 study participants, 20 (74%) were male and females were 7 (26%), with mean age of 48 years. There was significant increase in IMT of the ICA on the right side of the neck compared to left side (p-value=0.01). Also, there was significant increase in PSV of ICA on the right side compared to left side of the neck (p-value=0.04). There were no statistically significant differences in IMT and PSV when CCA on the right side was compared to that of the left side of the neck. Conclusion: The IMT was increased in ICA and CCA. But there was statistically significant difference only in ICA, where it was more prominent on the right side compared to left side. CKD patients on haemodialysis management could have the risk factors in the form of increased IMT predisposing them to early mortality from cardiovascular complications.

Predictors of subclinical cardiovascular affection in Egyptian patients with juvenile idiopathic arthritis subtypes

BackgroundTo assess the subclinical cardiovascular affection in juvenile idiopathic arthritis (JIA) Egyptian patient subtypes using Doppler ultrasonography (US) for carotid and femoral arteries and detecting their predictorsResultsForty percent of the patients were polyarticular type, while 40% were systemic onset and 20% were oligoarticular. There was a statistically significant difference between JIA and controls in all parameters of subclinical atherosclerosis by ultrasonography except right external carotid velocity and (right and left) femoral velocity. There was also a highly significant increase in intima-media thickness (IMT) in systemic onset type of JIA. There was a statistically positive correlation between increased internal carotid velocity (right and left) and high erythrocyte sedimentation rate (ESR), high-sensitivity C-reactive protein (hs-CRP), lipid profile, and disease activity. High disease activity and lipid profile were valid predictors of subclinical atherosclerotic cardiovascular affection in JIA.ConclusionIncreased cardiovascular risks and subclinical atherosclerosis in patients with JIA especially systemic onset type may be due to higher prevalence of multiple risk factors in these patients. Doppler ultrasonography is a simple, non-invasive technique which can be used to detect subclinical atherosclerosis in JIA. Control of disease activity by treat to target strategy and proper diet control should be applied for every patient with JIA especially those with systemic onset type for future prevention of cardiovascular disease.

Obesity and carotid artery remodeling.

Background/Objective:The present study tested the hypothesis that obesity-related changes in carotid intima-media thickness (IMT) might represent not only preclinical atherosclerosis but an adaptive remodeling meant to preserve circumferential wall stress (CWS) in altered hemodynamic conditions characterized by body size-dependent increase in stroke volume (SV) and blood pressure (BP).Subjects/Methods:Common carotid artery (CCA) luminal diameter (LD), IMT and CWS were measured in three different populations in order to study: (A) cross-sectional associations between SV, BP, anthropometric parameters and CCA LD (266 healthy subjects with wide range of body weight (24–159 kg)); (B) longitudinal associations between CCA LD and 3-year IMT progression rate (ΔIMT; 571 healthy non-obese subjects without increased cardiovascular (CV) risk); (C) the impact of obesity on CCA geometry and CWS (88 obese subjects without CV complications and 88 non-obese subjects matched for gender and age).Results:CCA LD was independently associated with SV that was determined by body size. In the longitudinal study, baseline LD was an independent determinant of ΔIMT, and ΔIMT of subjects in the highest LD quartile was significantly higher (28±3 μm) as compared with those in the lower quartiles (8±3, 16±4 and 16±3 μm, P=0.001, P<0.05 and P=0.01, respectively). In addition, CCA CWS decreased during the observational period in the highest LD quartile (from 54.2±8.6 to 51.6±7.4 kPa, P<0.0001). As compared with gender- and age-matched lean individuals, obese subjects had highly increased CCA LD and BP (P<0.0001 for both), but only slightly higher CWS (P=0.05) due to a significant increase in IMT (P=0.005 after adjustment for confounders).Conclusions:Our findings suggest that in obese subjects, the CCA wall thickens to compensate the luminal enlargement caused by body size-induced increase in SV, and therefore, to normalize the wall stress. CCA diameter in obesity could represent an additional biomarker, depicting the impact of altered hemodynamics on arterial wall.

Is an exaggerated blood pressure response to exercise in hypertensive patients a benign phenomenon or a dangerous alarm?

A hypertensive response to exercise is associated with high cardiovascular risk, whereas scarce data are available about its relation to surrogates of subclinical atherosclerosis. Endothelial dysfunction and intima-media thickness (IMT) have been demonstrated in atherosclerotic patients. The purpose of this study was to investigate the relationships between a hypertensive response to exercise and IMT as well as endothelial function as surrogates of subclinical atherosclerosis. A total of 52 untreated males with stage I essential hypertension and a negative treadmill exercise test for exercise-induced myocardial ischemia were divided into two groups: group I which included 21 patients with a hypertensive response to exercise (peak exercise systolic blood pressure ≥210 mm Hg) and group II which included 31 individual with normal blood pressure response. Flow-mediated dilatation (FMD) and dilatation ratio (as markers of endothelial function) and measurements of carotid IMT were done for both groups. Group I patients showed significant reduction in FMD (5.61 ± 5.25 vs 10.52 ± 4.78, p = 0.026) and dilatation ratio (50.28 ± 26.03 vs 94.8 ± 40.06, p < 0.001) compared to group II. Moreover, Group I patients also showed significant increase in IMT compared to group II (0.102 ± 0.033 vs 0.089 ± 0.03, p = 0.047). Hypertensive response to exercise in patients with untreated stage I essential hypertension is associated with endothelial dysfunction and increased carotid IMT. It seems that this phenomenon is not a benign one but rather a dangerous alarm.

The Effect of Radioiodine on the Intima Media Thickness of the Carotid Artery

Aim: The radiation can induce vessel injury. The result of this injury can be severe and life-threatening. There are a few studies demonstrating an increase in intima-media thickness (IMT) of the common carotid artery (CCA) after radiotherapy, especially in head and neck cancers. We evaluated the effect of I-131 to the IMT of the CCA in the patients who were treated for hyperthyroidism.Methods: 38 patients (25M, 13W) referred to our department for radioiodine treatment with the diagnosis of nodular goitre (25 patients) and diffuse hyperplasia (Graves disease (GD), 13 patients) were included to the prospective study. An USG was performed for all the patients before therapy, 3, 6 and 12 months after radioiodine therapy in order to measure IMT of CCA and the femoral artery (FA). The IMT was measured at the level of proximal part of bulbus anteriorly on the left and right side. The IMT of FA was measured just before the bifurcation.Results: There was a statistically significant increase in IMT of both CCA and FA bilaterally in nodular hyperthyroid patients. However, in the patients with Graves disease, there was only statistically significant increase in the left IMT of CCA at 0-3rd, 0-6th month measurements and in the right IMT of FA at 0-3rd month measurements. Conclusion: Though the limitation of the study is the interobserver and intraobserver variability, it was seen that I-131 therapy might affect the IMT of CCA in the patients with NG. I-131 effect on the IMT of CCA in patients with nodular goitre was higher than the IMT of CCA in patients with GD. I-131 effect on the IMT of CCA might be due to administered dose and adjacency. The interesting point of our study was the increased thickness of IMT in FA. We think that the increase in IMT is due to the systemic effect of radioactivity circulating in the blood vessel. I-131 effect on the IMT of FA in patients with nodular goitre was higher than the IMT of FA in the patients with GD due to I-131 uptake of thyroid gland. Because I-131 uptake was lower in patients with nodular goitre, I-131 in systemic circulation was higher.Conflict of interest:None declared.

Intima‐media thickness in an Italian psoriatic population: correlation with lipidic serum levels, PASI and BMI

Recent findings have shown that psoriasis is frequently associated with atherosclerosis. Intima-media thickness (IMT) is a surrogate marker of atherosclerosis damage. Psoriasis patients had impaired endothelial function and thicker IMT of the carotid artery, compared with the healthy control subjects. The aim of our study is to evaluate the prevalence of subclinical atherosclerosis in patients affected by cutaneous psoriasis without arthritis, considering the IMT as a subclinical feature of atherosclerosis. Intima-media thickness of the common carotid artery was measured using High-resolution B-mode ultrasound in 40 psoriasis patients and 40 control patients matched for age and gender. We also measured triglycerides, PASI, total cholesterol, LDL cholesterol and BMI. Pearson's partial correlation test was used to determine the correlation between each variable. Intima-media thickness in subjects with psoriasis was statistically higher than those in the control subjects (1.465 mm, P value < 0.001). A positive strong correlation between IMT and age (r = 0.464 P < 0.01), total cholesterol (r = 0.466 P < 0.01), LDL cholesterol (r = 0.518 P < 0.01), triglycerides (r = 0.285 P = 0.01) and PASI (r = 0.515 P < 0.01) was observed. There was no statistically significant correlation between IMT and BMI (r = 0.132 P = 0.244). Our study showed a significant increase in IMT in cutaneous psoriatic patients with moderate to severe psoriasis compared with a control group. IMT seems to be uncorrelated with BMI value. It can be assumed that the assessment of IMT, through a reliable and non-invasive technique such as ultrasound, appears particularly useful in the clinical evaluation of patients with psoriasis who may benefit from early intervention.

Differential effects of the changes of LDL cholesterol and systolic blood pressure on the risk of carotid artery atherosclerosis

BackgroundThe effects of baseline and changes in blood pressure and low density lipoprotein (LDL) cholesterol on the carotid intima media thickness (IMT) have not been well documented.MethodsA total of 2572 adults (mean age 53.8 years, 54.6% women) in a Taiwanese community undertook three blood pressure and LDL cholesterol examinations over 6 years. Latent growth curve modeling was used to investigate the effects of baseline and change in blood pressure and LDL cholesterol on IMT.ResultsGreater baseline LDL and blood pressure were associated with an increase in IMT (0.005 ± 0.002 mm per 1 mg/dL [p = 0.006] and 0.041 ± 0.004 mm mmHg [p <0.0001], respectively. Change in blood pressure was associated with a significant increase in IMT (0.047±0.016, P = 0.004), whilst the association between change in LDL and change in IMT was not statistically significant (0.008±0.006, P = 0.20).ConclusionsCarotid IMT was associated with baseline blood pressure and LDL cholesterol, yet only changes of blood pressure, not LDL cholesterol, were related to carotid IMT during the 6-year observation.

Carotid artery intima-media thickness is associated with coronary artery disease

Objective — The intima-media thickness (IMT) of the carotid artery is dependent on the risk factor load during life and correlates well with the degree of atherosclerosis, also in other vascular beds.Methods — We reviewed our database of IMT measurements, from-01-2002 to-02-2007. We compared the mean IMT values of patients without a history of coronary artery disease (group 1) with those with a history of coronary artery disease (group 2). For both groups we divided the results of measurements according to age.We compared the IMT between both groups and looked for a correlation with increasing age.The IMT was measured with high-resolution echography at the posterior wall of the common carotid artery, using an automated edge-tracking method.Results — The database contained 598 IMT measurements in group 1 and 672 in group 2. In both groups we observed a significant increase in IMT with increasing age. Within a certain age group, a significant difference in IMT between group 1 and 2 occurred at an age of 40 years or above (age 40-65: IMT 645.54 versus 671.71 μm, respectively, P= 0.04, and age > 65 years: IMT 715.2 versus 772.91 μm, respectively, P= 0.01).Conclusions — IMT increases with age and is higher in patients with a history of vascular disease. This difference is significant in patients of 40 years or older.This finding supports the recommendations of the prevention conference of the American Heart Association, that carefully performed IMT measurement can add incremental information to traditional risk factor assessment in asymptomatic individuals above the age of 45 years.

Carotid and Femoral Atherosclerosis in Chronic Hepatitis C: A 5-Year Follow-Up

The objective of this study was to assess the progression of atherosclerosis in carotid and femoral arteries after a 5-year period using ultrasound in subjects with chronic hepatitis C and in controls matched for classic atherosclerotic risk factors. A total of 40 patients and 40 controls were assessed by echocolor Doppler in 2001 and in 2006 to evaluate plaque and intima-media thickness. The patients showed no changes in plaque and intima-media thickness during the 5-year period in all districts examined, whereas a significant increase in intima-media thickness in the carotid sections was recorded in the controls. Chronic hepatitis C seems to cause delay in the atherosclerotic process.

Imaging of Atherosclerosis in WHHL Rabbits Using High-Resolution Ultrasound

Watanabe heritable hyperlipidemic (WHHL) rabbits provide an animal model of hypercholesterolemia and atherosclerotic progression. However, a large individual variation in plaque progression rate calls for serial investigations, as do treatment studies. In contrast to histopathology, transthoracic ultrasound imaging of the aortic arch is a noninvasive technique suitable for repeated investigations. We studied 34 WHHL rabbits by both techniques. Ultrasound correctly interpreted plaque morphology compared with histopathology of the same spot (location verified by needle puncture). Intima media thickness (IMT) measured by the two methods agreed well. Ultrasonic values were similar to the histopathologic average circumferential values when these were corrected for postmortem shrinkage. Finally, the transthoracic ultrasound technique demonstrated a significant increase in IMT over a 15-week period ( p = 0.0002). We conclude that transthoracic ultrasound of aortic arch IMT in WHHL rabbits is a reliable and feasible technique for studies of plaque progression and the evaluation of interventions. (E-mail: li-ming@hjl.gu.se)

Hyperglycaemia after glucose loading is a major predictor of preclinical atherosclerosis in nondiabetic subjects

Carotid intima-media thickness (IMT) has proved to be an independent marker of preclinical atherosclerosis. The aim of this study was to determine whether carotid IMT is associated with the plasma glucose concentration in the fasting state, after loading with oral glucose, or with the insulin sensitivity index (ISI) in nondiabetic subjects with different levels of glucose intolerance and insulin resistance. Cross-sectional study. A total of 160 nondiabetic subjects (147 from our obesity-overweight clinic and 13 healthy normal subjects) were included in the present study, among them 33 had normal glucose tolerance (NGT), 13 had impaired fasting glucose (IFG), 80 had impaired glucose tolerance (IGT) and 34 had both IFG and IGT. Carotid IMT was assessed in the common carotid artery by a high-resolution B-mode ultrasound system. Plasma glucose was measured after fasting and at 30 min, 1, 2 and 3 h after a standard 75-g load of glucose. The ISI was calculated from the frequent sampling intravenous glucose tolerance test (FSIGT). Results The IMT values in the NGT group were lower than those in the IFG, IGT and IFG + IGT groups (P < 0.03). No statistical difference in IMT values was found among the latter three groups. Univariate correlation analyses showed that the IMT was positively associated with age, plasma glucose concentrations 1 and 2 h after glucose loading, and serum concentration of low density lipoprotein (LDL) cholesterol (r=0.39, 0.22, 0.25 and 0.18, respectively, P<0.05). Multiple regression analysis showed that only age, plasma glucose concentration 2 h after glucose loading, and LDL cholesterol appeared to be significant correlates of the IMT (P<0.0001), whereas the ISI was not. In nondiabetic subjects with various degrees of glucose intolerance, there was a significant increase in IMT in those with IFG and IGT. Significant determinants of IMT, an indicator of preclinical atherosclerosis, include hyperglycaemia 2 h after a glucose load, age and LDL cholesterol, whereas fasting glucose concentration and the ISI were not significantly associated with IMT.

Glucose peaks – the hidden danger in type 2 diabetes

Glucose peaks – the hidden danger in type 2 diabetes

Intima media thickness in patients with vertebrobasilar and carotid stenosis/occlusions

The purpose of this study was to investigate the degree of atherosclerosis in patients with stenoses or occlusions in the vertebrobasilar system (VBS) and the carotid system (CS). The Intima-Media-Thickness (IMT) and the diameter of the common carotid artery (CCA) (as parameters of the proliferative and dilatative form of atherosclerosis) were measured on both sides on areas of vessel wall without stenoses and plaques. We examined of the neck 134 people, including 32 normal healthy counds, 57 patients with stenoses or occlusions in the CS and 16 patients with macroangiopathy exclusively in the VBS (following doppler- and duplex sonographical criteria). In control persons, a IMT of 0.67 +/- 0.2 mm and a CCA-diameter of 5.8 +/- 1.2 mm was found. Patients with CS-macroangiopathy exhibited a statistically significant increase in IMT with 0.97 +/- 0.2 mm (p < 0.001) and dilatation of the CCA (6.6 +/- 1.2 mm, p < 0.01). In comparison to the controls we also found a significant increase in IMT (0.86 +/- 0.2 mm, p < 0.001) and in diameter (6.8 +/- 0.9 mm, p < 0.01) in patients with VBS-macroangiopathy. There was no significant difference between both groups, despite a tendency of less severe changes in patients suffering from VBS-macroangiopathy. Patients with diabetes (1.1 +/- 0.2 mm, p < 0.001), with hypertension (0.99 +/- 0.2 mm, p < 0.05) and with coronary heart disease (0.96 +/- 0.2 mm, p < 0.05) showed a significant increase in IMT. Parameters of generalized atherosclerosis do not significantly differ between patients with stenoses or occlusions in the VBS and patients with changes in the CS and are correlated to the classical risk factors.

Structural changes of large conduit arteries in hypertension.

Structural alterations of large conduit arteries are a common pathway for any complication of hypertensive vascular disease. Whether increased arterial wall thickness occurs at an early phase in uncomplicated hypertension has remained largely ignored until recent years. Sophisticated echo-Doppler techniques with a high degree of resolution and reproducibility have been developed to obtain reliable non-invasive determinations of intima-media thickness of superficial arteries such as the radial and the common carotid arteries. In uncomplicated hypertension, a significant increase in intima-media thickness is observed at the sites both of the radial and of the carotid arteries. The former is known to be constantly undamaged by atheroscierosis and is composed almost exclusively of arterial smooth muscle; operational arterial stiffness is found to be normal. The latter is strongly affected by atheroscierosis and predominantly composed of elastin and collagen fibres; operational arterial stiffness is found to be increased. In old subjects with systolic hypertension, radial artery hypertrophy is significantly reversed by drug therapy involving diuretics, converting enzyme inhibitors or both. This change occurs in parallel with the reduction in blood pressure. In sustained essential hypertension, arterial wall hypertrophy can be demonstrated in the absence of organ damage. Operational arterial elasticity is maintained in peripheral but not in central arteries. Structural changes of the large conduit arteries are substantially reversed by drug therapy together with a reduction in blood pressure.