Subclinical Atherosclerosis In Patients Research Articles

Primary Sjögren's syndrome as independent risk factor for subclinical atherosclerosis.

To assess the prevalence of subclinical atherosclerosis in patients with primary Sjögren's syndrome (pSS) and its possible association with clinical and analytical parameters of the disease. In this cross-sectional study, 38 consecutive patients with pSS were compared with 38 age and sex healthy controls. Demographic variables and classic cardiovascular risk factors (CVRFs): Hypertension, dyslipidemia, diabetes mellitus, obesity, and smoking habit were assessed in both groups, and also disease-related features were collected in pSS group. The presence of subclinical atherosclerosis was assessed by carotid ultrasound, with carotid intima-media thickness (CIMT) measurement and determination of the presence of atheromatous plaques. Subclinical atherosclerosis presence was remarkably greater in patients with pSS than in healthy controls (OR = 4.17, 95%CI [1.27-16.54]), as well as CIMT values (0.79 ± 0.43mm vs. 0.66 ± 0.27mm; P = .02). No differences for classic CVRFs were found between both groups. An association of subclinical atherosclerosis with erythrocyte sedimentation rate (ESR) and rheumatoid factor (RF) was observed in patients with pSS. This cohort showed a greater prevalence of subclinical atherosclerosis in patients with pSS, indicating this disease as an independent risk factor for presence of early vascular damage.

The evaluation of epicardial adipose tissue and carotid intima-media thickness in patients with Behçet’s disease

Background/Aim. Epidemiological studies indicate that cardiovascular disease (CVD) is common in almost all patients diagnosed with autoimmune disease. This study aimed to examine whether epicardial adipose tissue (EAT) thickness (EATT) and carotid intima-media (CIM) thickness (CIMT) differ between patients with Beh?et?s disease (BD) and healthy individuals. Methods. A total of 40 healthy subjects as controls and 40 BD patients with musculoskeletal complaints were enrolled in this cross-sectional prospective study. Socio-demographic, clinical, and laboratory data were obtained and compared between groups. The Beh?et?s Disease Current Activity Form was used to assess disease activity. Both groups underwent echocardiography in order to measure EATT and CIMT. Results. The mean thickness of EAT (5.70 ? 1.05 mm; 2.50 ? 0.61 mm, respectively, p < 0.001) and CIM (0.68 ? 0.05 mm; 0.63 ? 0.06 mm, respectively, p = 0.002) were significantly in-creased in BD patients compared to the control group. A positive correlation was observed between EATT and age (r = 0.500, p = 0.001), the duration of the disease (r = 0.330, p < 0.001), waist circumference (r = 0.316, p = 0.013), and disease activity (r = 0.31, p < 0.001) in the patient group. CIMT was positively correlated with age (r = 0.594, p = 0.001) and the duration of the disease (r = 0.585, p = 0.001). The use of glucocorticoids or clinical manifestations (joint involvements, genital ulcer, skin lesions, inflammatory back pain, and major organ involvement) of the patients were not found to be associated with EATT or CIMT. Conclusion. EATT and CIMT are in-creased in patients with BD and are associated with dis-ease activity. Echocardiographic measurement of EATT and CIMT is an objective, noninvasive, and available method that can evaluate the risk of subclinical atherosclerosis in patients with BD.

A Cross-Sectional Study to Assess Sub-clinical Atherosclerosis in Patients of Psoriasis Independent of Metabolic Syndrome.

A sustained inflammatory state of psoriasis causes comorbidities such as psoriatic arthritis, metabolic syndrome (MetS), and cardiovascular disease. To note the duration and severity of psoriasis, assess prevalence of MetS, and correlate these with indicators of sub-clinical atherosclerosis. Thirty-two patients of chronic plaque psoriasis were enrolled in the study. Their demographic particulars, clinical details, results of investigations to assess MetS, and indicators of sub-clinical atherosclerosis, namely, carotid intimal media thickness (CIMT) measured using B-mode USG and epicardial fat thickness (EFT) using 2-D ECHO, were recorded. The study participants were predominantly male (2.5:1); their mean age was 40.45 ± 12.42 years, the median disease duration (DD) was 2 years, and the mean psoriatic area severity index (PASI) score was 8.62 ± 7.49. Mild disease (PASI <5) was present in 12 participants (37.5%), and shorter DD (<5 years) was present in 16 (50%) participants. MetS, detected in 11 (37.5%) study participants, was not significantly associated with CIMT, EFT, DD, and PASI. CIMT and EFT too did not correlate significantly with DD, PASI, or measures of MetS. Neither did there exist any significant correlation between CIMT and EFT. Sub-clinical atherosclerosis in our study participants was not significantly associated with either measures of MetS or duration/severity of psoriasis.

Evaluation of subclinical atherosclerosis by ultrasound radiofrequency data technology in patients with psoriatic arthritis.

This study aimed to assess the presence of subclinical atherosclerosis in patients with psoriatic arthritis using ultrasound radiofrequency data technology. In all, 29 psoriatic arthritis patients and 42 age- and sex-matched healthy controls were included in this cross-sectional study. Arterial stiffness and carotid intima-media thickness measurements were performed in bilateral common carotid arteries using ultrasound radiofrequency data technology in all participants. In psoriatic arthritis patients, the mean carotid intima-media thickness, α and β stiffness indices, and pulsed wave velocity value were significantly higher than those in the control group (542.3 (81.3) vs. 487.9 (64.1), 9.3 (6.3) vs. 3.9 (0.1), 18.7 (17.7) vs. 8.04 (4.2), and 10.2 (3.8) vs. 6.4 (1.5), p<0.05). The mean distensibility coefficient and compliance coefficient values of the patient group were significantly lower than those of the control group (0.014 (0.01) vs. 0.03 (0.01) and 0.57 (0.33) vs. 1.02 (0.4), p<0.05). No significant correlation was found between carotid artery hemodynamic parameters and symptom duration, duration of diagnosis and treatment, disease activity ındex for psoriatic arthritis scores, erythrocyte sedimentation rate, and C-reactive protein levels (p>0.05). In the results of our study, evidence of subclinical atherosclerosis has been detected in psoriatic arthritis patients without clinically evident cardiovascular disease or traditional cardiovascular risk factors.

The Relationship with Serum Heart Type Fatty Acid Binding Protein and Subclinical Atherosclerosis in Patients with Hypothyroidism

Aim: To investigate the variability of Carotid intima-media thickness (CIMT) and the relationship between CIMT and serum Hearttype fatty acid binding protein (H-FABP) levels in patients with overt and subclinical hypothyroidism. We also aimed to evaluate the effect of levothyroxine treatment on these markers. Material and Methods: 40 patients with overt hypothyroidism (OH), 40 patients with subclinical hypothyroidism (SH) and 30 healthy individuals as control group were evaluated according to serum lipid and thyroid hormone panels, serum H-FABP levels and CIMT measurements. Serum H-FABP levels and CIMT of the patients in group OH were also evaluated following 6-months levothyroxine replacement treatment. Results: The levels of serum total cholesterol, LDL cholesterol and H-FABP in group OH were significantly higher (p<0.05). CIMT in group OH was also significantly higher than other groups (p<0.05). There was an insignificant slight positive correlation between serum H-FABP and CIMT. The values of serum H-FABP levels and CIMT measurements after levothyroxine treatment significantly decreased in comparison with pre-treatment period (p<0.05). Conclusion: The increased CIMT and H-FABP levels in overt hypothyroidism might be used as an indicator in determining subclinical atherosclerosis. Levothyroxine treatment might protect the patients with overt hypothyroidism in terms of cardiovascular risk by decreasing CIMT and serum H-FABP levels.

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

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

“Subclinical atherosclerosis in acromegaly: Possible association with cardiovascular risk factors rather than disease activity”

ObjectiveCardiovascular (CV) disease is still a major cause of excessive morbidity and mortality in patients with active acromegaly, which may be attributed to a high prevalence of associated pro-atherosclerotic risk factors. However, a direct effect of GH/IGF-1 excess on the vasculature has been previously suggested, warranting further investigation. The present study was designed to investigate whether chronic GH/IGF-1 excess is associated with an increased prevalence of subclinical atherosclerosis in patients with acromegaly. DesignWe measured carotid intima-media thickness (cIMT) and assessed carotid plaques by ultrasonography along with classical CV risk factors in 54 acromegaly patients (34 females, 50 ± 12 years and compared those with 62 (42 females, 53 ± 13 years) age-, sex- and CV risk factors- matched controls. In order to compare cIMT measurements between patients and controls we analyzed common carotid artery far wall data as well as a combined measurement result, which consisted of the mean value of the six different measurements, three at each side. Resultsmean ± SD serum GH and IGF-1 levels were 2.76 ± 4.65 ng/mL and 1.7 ± 1.25 x ULN, respectively, in all acromegaly patients. Age, body mass index, blood pressure, lipid levels, fasting glucose and Framingham's global cardiovascular risk score classification were similar comparing patients and controls. Combined median [IQR] cIMT measurements were similar in acromegaly patients and matched controls (0.59 [0.52–0.66] mm vs. 0.59 [0.52–0.69] mm; P = 0.872) as well as in acromegaly patients with active and controlled disease (0.59 [0.51–0.68] mm vs. 0.60 [0.54–0.68] mm; P = 0.385). No significant correlations were observed between cIMT measurements and GH (Spearman r = 0.1, P = 0.49) or IGF-1 (Spearman r = 0.13, P = 0.37) levels in patients with acromegaly. Carotid atherosclerotic plaques prevalence was similar in patients and controls (26% vs. 32%; P = 0.54) as well as in patients with active and controlled acromegaly (22% vs. 30%; P = 0.537). ConclusionsOur data suggest that GH/IGF-1 excess itself is not one of the main drivers of subclinical morphological atherosclerosis changes in patients with acromegaly and that optimal control of acromegaly-associated CV risk factors may preserve vasculature structure even when strict biochemical control is not achieved.

Fetuin-A to adiponectin ratio is an independent indicator of subclinical atherosclerosis in patients with newly diagnosed type 2 diabetes mellitus

AimsThe purpose of this research was to explore the associations of fetuin-A, adiponectin, and fetuin-A/adiponectin ratio (F/A ratio) with subclinical atherosclerosis as evaluated by carotid intima-media thickness (CIMT) in cases with newly diagnosed type 2 diabetes mellitus (T2DM). MethodsA total of 283 newly diagnosed T2DM patients were enrolled in this study. Serum fetuin-A and adiponectin levels were determined with an ELISA method. Other clinical and biochemical parameters were also collected. ResultsSignificant linear increases in waist-to-hip ratio (WHR), systolic blood pressure (SBP), diastolic blood pressure, homoeostasis model assessment of insulin resistance, C-reactive protein (CRP) and F/A ratio, and a significant linear decrease in adiponectin with increasing tertiles of CIMT were observed (P for trends <0.05). However, no significant correlation between fetuin-A and CIMT was detected (P > 0.05). In multivariate logistic regression models, WHR, SBP and F/A ratio were independently correlated with higher CIMT. Receiver operating characteristic curve analysis indicated that F/A ratio had a better predictive power for higher CIMT than adiponectin and fetuin-A, with an area under the curve of 0.802, 0.713 and 0.646, respectively. ConclusionF/A ratio is an independent indicator of subclinical atherosclerosis in patients with newly diagnosed T2DM.

Carotid intima-media thickness in patients with psoriasis with and without metabolic syndrome.

Introduction:Patients with psoriasis have an increased prevalence of cardiovascular risk factors as well as cardiovascular disease.Objective:To determine if patients with psoriasis and metabolic syndrome (MS) have a higher frequency of subclinical atherosclerosis compared with those with psoriasis without MS.Materials and Methods:A cross-sectional study was conducted in patients with psoriasis; MS was defined according to ATP III criteria. Demographic, clinical, and anthropometric data were obtained. Blood chemistry, high sensitive C-reactive protein (hs-CRP), and insulin were measure. Subclinical atherosclerosis was defined as high carotid intima-media thickness (CIMT) by Mode B ultrasound.Results:92 patients with psoriasis were included, 67 (72.8%) with MS and 25 (27.2%) without MS. Subjects with psoriasis and MS had significantly higher weight, body mass index, waist circumference, systolic blood pressure, glucose, insulin, triglycerides, insulin resistance, hs-CRP, and lower level of high-density lipoprotein cholesterol, compared with subjects without MS. High CIMT was greater in patients with psoriasis and MS than in those without MS. Age and MS were independent predictors of increased CIMT after multiple linear regression analysis.Conclusions:MS is associated with greater inflammation and subclinical atherosclerosis in patients with psoriasis.

Effect of glycemic control on markers of subclinical atherosclerosis in patients with type 2 diabetes mellitus: A review.

Cardiovascular disease is the predominant cause of death in type 2 diabetes mellitus (T2DM). Evidence suggests a strong association between duration and degree of hyperglycemia and vascular disease. However, large trials failed to show cardiovascular benefit after intensive glycemic control, especially in patients with longer diabetes duration. Atherosclerosis is a chronic and progressive disease, with a long asymptomatic phase. Subclinical atherosclerosis, which is impaired in T2DM, includes impaired vasodilation, increased coronary artery calcification (CAC), carotid intima media thickness, arterial stiffness, and reduced arterial elasticity. Each of these alterations is represented by a marker of subclinical atherosclerosis, offering a cost-effective alternative compared to classic cardiac imaging. Their additional use on top of traditional risk assessment strengthens the predictive risk for developing coronary artery disease (CAD). We, herein, review the existing literature on the effect of glycemic control on each of these markers separately. Effective glycemic control, especially in earlier stages of the disease, attenuates progression of structural markers like intima-media thickness and CAC. Functional markers are improved after use of newer anti-diabetic agents, such as incretin-based treatments or sodium-glucose co-transporter-2 inhibitors, especially in T2DM patients with shorter disease duration. Larger prospective trials are needed to enhance causal inferences of glycemic control on clinical endpoints of CAD.

Biomarkers of subclinical atherosclerosis in patients with psoriasis

Psoriasis is linked with increased risk of cardiovascular disease (CVD) that is underestimated by traditional risk stratification. We conducted a large-scale plasma proteomic analysis by use of a proximity extension assay in 85 patients with a history of moderate-to-severe psoriasis with or without established atherosclerotic CVD. Differentially expressed proteins associated with CVD were correlated with subclinical atherosclerotic markers including vascular inflammation determined by 18F-fluorodeoxyglucose positron emission tomography/computed tomography, carotid intima-media thickness (CIMT), carotid artery plaques, and coronary artery calcium score (CCS) in the patients without CVD and statin treatment. We also examined the association between the neutrophil-to-lymphocyte ratio (NLR) and subclinical atherosclerosis. In unadjusted analyses, growth differentiation factor-15 (GDF-15) levels and NLR were increased, while tumor necrosis factor (TNF)-related activation-inducing ligand (TRANCE) and TNF-related apoptosis-induced ligand (TRAIL) levels were decreased in patients with established CVD compared to those without CVD. Among patients with psoriasis without CVD and statin treatment, GDF-15 levels were negatively associated with vascular inflammation in the ascending aorta and entire aorta, and positively associated with CIMT and CCS. NLR was positively associated with vascular inflammation in the carotid arteries. Our data suggest that circulating GDF-15 levels and NLR might serve as biomarkers of subclinical atherosclerosis in patients with psoriasis.

Moderate and High Disease Activity Predicts the Development of Carotid Plaque in Rheumatoid Arthritis Patients without Classic Cardiovascular Risk Factors: Six Years Follow-Up Study.

Patients with rheumatoid arthritis (RA) have a higher incidence of subclinical atherosclerosis and cardiovascular (CV) disease. It is postulated that the appearance of accelerated atherosclerosis in these patients is a consequence of the inflammation present in the disease. In this study, we aim to determine if baseline disease activity in patients with RA predicts the future development of carotid plaque. A set of consecutive RA patients without a history of CV events, cancer or chronic kidney disease, who did not show carotid plaque in a carotid ultrasound assessment, were prospectively followed up for at least 5 years. At the time of recruitment, CV risk factors and disease-related data, including disease activity scores, were assessed. At the end of the follow-up, a carotid ultrasound was repeated and patients were divided into two groups; those who developed carotid plaque, and those who did not. A multivariable regression analysis was performed to define the predictors for the development of carotid plaque. One hundred and sixty patients with RA were followed up for an average of 6 ± 1 years. After this time, 66 (41%) of the patients had developed carotid plaque, and 94 (59%) did not. Patients with carotid plaque were significantly older (47 ± 13 vs. 55 ± 9 years, p < 0.001) at baseline, were more frequently diabetic (0% vs. 6%, p = 0.028), and had higher total cholesterol (197 ± 36 vs. 214 ± 40 mg/dL, p = 0.004) and LDL cholesterol (114 ± 35 vs. 126 ± 35 mg/dL, p = 0.037) at the beginning of the study. After multivariable adjustment, patients who were in the moderate and high disease activity (DAS28-CRP) categories displayed a higher odds ratio for the appearance of carotid plaque (OR 2.26 [95% CI 1.02–5.00], p = 0.044) compared to those in the DAS-28-CRP remission category. Remarkably, when patients were divided in patients within the low-risk SCORE category, and patients included in the remaining SCORE categories (moderate, high and very high), the relation between DAS28-CRP and the development of carotid plaque was only significant in the low-risk SCORE category. In conclusion, disease activity predicts the future development of subclinical atherosclerosis in patients with RA.

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

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

Evaluation of endothelial function and subclinical atherosclerosis in patients with HIV infection

The aim of this study was to analyse the association between human immunodeficiency virus (HIV) related clinical and analytical parameters and the presence of subclinical atherosclerosis as well as endothelial dysfunction. This was a prospective cohort study of HIV-positive patients who underwent intima media thickness (IMT) determination and coronary artery calcium scoring to determine subclinical atherosclerosis. To detect endothelial dysfunction, the breath holding index, flow-mediated dilation and the concentration of endothelial progenitor cells (EPCs) were measured. Patients with an IMT ≥ 0.9 mm had an average of 559.3 ± 283.34 CD4/μl, and those with an IMT < 0.9 mm had an average of 715.4 ± 389.92 CD4/μl (p = 0.04). Patients with a low calcium score had a significantly higher average CD4 cell value and lower zenith viral load (VL) than those with a higher score (707.7 ± 377.5 CD4/μl vs 477.23 ± 235.7 CD4/μl (p = 0.01) and 7 × 104 ± 5 × 104 copies/ml vs 23.4 × 104 ± 19 × 104 copies/ml (p = 0.02)). The number of early EPCs in patients with a CD4 nadir < 350/µl was lower than that in those with a CD4 nadir ≥ 350 (p = 0.03). In HIV-positive patients, low CD4 cell levels and high VL were associated with risk of developing subclinical atherosclerosis. HIV patients with CD4 cell nadir < 350/µl may have fewer early EPCs.

Intima-Media Thickness Measurements of the Common Carotid Artery in Patients with Central Serous Chorioretinopathy: A Case-Control Study.

Purpose To evaluate the intima-media thickness (IMT) of the left and right common carotid arteries (CCA) as an indicator of subclinical atherosclerosis in patients with central serous chorioretinopathy (CSCR). Methods This was a case-control study involving patients with CSCR and a matched healthy control group. The mean and difference of the left and right CCA IMT were determined and compared between the two groups using carotid duplex high-resolution B-mode ultrasound equipment. Results The study enrolled 32 CSCR patients (68.8% female, mean age 38.22 ± 5.42 years) and 32 controls (65.6% female, mean age 39.56 ± 5.33 years). The difference in common carotid IMT between the right and left sides was significantly greater in the CSCR group than in the control group (p < 0.001). Additionally, according to logistic regression analysis, patients with CSCR had a greater chance of having differences in IMT between the two sides when compared to the control group (OR: 1.29, 95% CI: 1.09–1.52). Conclusion Our findings indicated that in the CSCR group, the difference between the right and left sides of CCA IMT was significantly greater than in the control group.

The relationship of serum visfatin levels with clinical parameters, flow-mediated dilation, and carotid intima-media thickness in patients with ankylosing spondylitis

Background/aimAtherosclerotic heart diseases can occur at an early age in patients with ankylosing spondylitis (AS). Flow-mediated dilation (FMD) and carotid intima-media thickness (cIMT) values are reliable markers for early detection of subclinical atherosclerosis in patients with AS. We aimed to investigate the relationship between visfatin levels and indirect markers of subclinical atherosclerosis and endothelial dysfunction in patients with AS.Materials and methodsForty-two patients diagnosed with AS and 42 age, sex, and body mass index (BMI)-matched controls were included in the study. Visfatin levels, FMD, and cIMT were measured using appropriate methods.ResultsVisfatin levels of the patients were significantly higher than controls (p < 0.001). FMD values in patients with AS were significantly lower (p = 0.007) whereas cIMT were significantly higher than the controls (p = 0.003). There was a negative relationship between FMD with visfatin levels (p = 0.004), BASDAI (p = 0.010), and BASFI (p = 0.007). There was a positive relationship between cIMT with visfatin (p = 0.005), BASDAI (p < 0.001), and BASFI (p < 0.001). There was a positive relationship between visfatin with BASDAI (p < 0.001), and BASFI (p < 0.001). ConclusionVisfatin levels are increased and associated with impaired FMD and increased cIMT in patients with AS. Increased visfatin levels may be associated with subclinical atherosclerosis in AS.

Anemia in Patients with Axial Spondyloarthritis is Not Associated with an Increase of Arterial Stiffness and Intima-Media Thickness (Results of a Single-Center Cross-Sectional Study)

Aim: to study parameters of arterial stiffness and subclinical atherosclerosis in patients with axial spondyloarthritis (axSpA) without clinically manifest cardiovascular pathology depending on the presence of anemia.Material and methods. 102 patients with axSpA (mean age – 37.7±9.8 years, axSpA duration – 13.5±8.7 years, 66 (64.7%) men) were included. The BASDAI index and C-reactive protein (CRP)-based ASDAS score were measured, the hemogram, the erythrocyte sedimentation rate (ESR), and the level of CRP were studied. Parameters of arterial stiffness were studied by oscillography and photoplethysmography, intima-media thickness (IMT) was evaluated by B-mode ultrasound according to standard protocols.Results. During analysis of pulse wave properties, no statistically significant differences in parameters of vascular wall stiffness were found in axSpA patients with and without anemia. Aortic pulse wave velocity (PWVao) in patients with anemia was 7.4±1.5 m/sec, aortic augmentation index (Aix-ao) was 19.1±13.7%, stiffness index (SI) was 8.2±1.7 m/sec; in patients without anemia – 7.4±1.4 m/sec, 17.3±10.6% and 8.8±2.0 m/sec, respectively (p &gt;0.05 for all). IMT in patients with anemia was 0.70±0.13 cm, in patients without anemia – 0.73±0.16 cm (p &gt;0.05). Correlation analysis was performed and significant correlations were noted between Aix-ao, PWVao, SI, IMT and age (r=0.488, r=0.516, r=0.289, r=0.461, respectively, p &lt;0.05); Aix-ao, PWVao and the BASDAI index (r=0.243, r=0.253, respectively, p &lt;0.05). Significant correlations between PWVao and Aix-ao (r=0.442, p &lt;0.001), SI (r=0.273, p=0.011) and IMT (r=0.236, p=0.034) were found.Conclusion. The present study did not confirm the negative effect of anemia on vascular wall stiffness parameters and IMT in patients with axSpA. We consider that potential protective effect of anemia, due to well-known pathophysiological patterns — a decrease in blood viscosity and the induction of nitric oxide synthesis, plays an important role. Further studies are required to assess relationship between hemoglobin levels and markers of endothelial dysfunction in patients with axSpA.

Klotho as a biomarker of subclinical atherosclerosis in patients with moderate to severe chronic kidney disease

Chronic kidney disease (CKD) has been associated with a higher risk of cardiovascular disease (CVD). CKD patients present a decrease in the levels of the protein Klotho that accompanies the decrease in kidney function. This protein has been related to protective effects against CVD. However, it is unclear whether circulating Klotho, and its expression in peripheral blood cells (PBCs) are also associated with subclinical atherosclerosis in CKD. The present study aimed to study the relationship between Klotho and subclinical atherosclerosis in a population of patients with moderate to severe CKD. We determined the serum levels and gene expression in PBCs levels of Klotho and three inflammatory cytokines in 103 patients with CKD and investigated their relationship with two surrogate markers of subclinical atherosclerotis: ankle-brachial index (ABI) and carotid intima-media thickness (CIMT). Patients with subclinical atherosclerosis presented lower serum and PBCs expression levels of Klotho. Both variables were associated with the presence of subclinical atherosclerosis, being directly related with ABI and inversely with CIMT (P < 0.0001 for both). Multiple regression analysis demonstrated that both variables were significant determinants for ABI (adjusted R2 = 0.511, P < 0.0001) and CIMT (adjusted R2 = 0.445, P < 0.0001), independently of traditional and emergent cardiovascular risk factors. Moreover, both constituted protective factors against subclinical atherosclerosis [OR: 0.993 (P = 0.002) and 0.231 (P = 0.025), respectively]. Receiver operating characteristic analysis pointed to the utility of serum Klotho (area under the curve [AUC]: 0.817, 95% CI: 0.736–0.898, P < 0.001) and its gene expression in PBCs (AUC: 0.742, 95% CI: 0.647–0.836, P < 0.001) to distinguish subclinical atherosclerosis. The reductions in serum and PBCs expression levels of Klotho in CKD patients are independently associated with the presence of for subclinical atherosclerosis. Further research exploring whether therapeutic approaches to maintain or elevate Klotho could reduce the impact of CVD in CKD patients is warranted.

A Nomogram for Identifying Subclinical Atherosclerosis in Chronic Kidney Disease.

PurposeAtherosclerosis contributes substantially to cardiovascular mortality in patients with chronic kidney disease (CKD). But precise risk model for subclinical atherosclerosis in the CKD population is still lacking. The study aimed to develop and validate a nomogram for screening subclinical atherosclerosis among CKD patients without dialysis.Patients and MethodsA total of 1452 CKD stage 1‒5 has been recruited in this cross-sectional study. Subclinical atherosclerosis was diagnosed with carotid ultrasonography. Patients were divided into the training set and validation set. The risk factors of atherosclerosis were identified by the training set and confirmed by the validation set. The receiver operating characteristic (ROC) curves and decision curve analyses (DCA) were executed to evaluate the accuracy of fitted logistic models in training and validation sets. Finally, a nomogram based on constructed logistic regression model in all participants was plotted.ResultsA total of 669 (46.1%) patients were diagnosed with subclinical carotid atherosclerosis. Binary logistic regression analysis showed that males, age, hypertension, diabetes, CKD stages, calcium, platelet, and albumin were risk factors for atherosclerosis. The accuracy of fitted logistic models was evaluated by the area under the ROC curve (AUC), which showed good predictive accuracy in the training set (AUC=0.764 (95% Confidence interval (CI): 0.733–0.794) and validation set (AUC=0.808 (95% CI: 0.765–0.852). A high net benefit was also proven by the DCA. Finally, these predictors were all included to generate the nomogram.ConclusionThis proposed nomogram shows excellent predictive ability and might have a significant clinical implication for detecting subclinical atherosclerosis in patients with CKD.

Clinical significance of subclinical atherosclerosis in retinal vein occlusion

Retinal vein occlusion (RVO) is associated with atherosclerotic cardiovascular risk factors; however, its association with the specific markers of subclinical atherosclerosis has not yet been established. To investigate this association, we compared 70 patients with RVO to 70 age- and sex-matched patients without RVO. Low-density lipoprotein cholesterol (LDL-C) levels and brachial-ankle pulse wave velocity (baPWV) were significantly higher in the RVO group than in the control group. Carotid plaques (54.3% vs. 28.6%, p = 0.004) were more frequent in the RVO group. Multivariate logistic regression analysis showed that the presence of carotid plaques (odds ratio [OR]: 3.15, 95% confidence interval [CI] 1.38–7.16, p = 0.006), as well as smoking, LDL-C level, and baPWV were associated with RVO. Additionally, a multinomial logistic regression model showed that the presence of carotid plaques (OR: 3.94, 95% CI 1.65–9.41, p = 0.002) and LDL-C level were associated with branch RVO, whereas smoking and baPWV were associated with central RVO. In conclusion, RVO was associated with subclinical atherosclerosis markers, including carotid plaques and baPWV. These results support the hypothesis that atherosclerosis contributes to the etiology of RVO and suggest the evaluation of subclinical atherosclerosis in patients with RVO.