Thicker Carotid Intima-media Thickness Research Articles

Association of Central Blood Pressure and Carotid Intima Media Thickness with New-Onset Hypertension in People with High Normal Blood Pressure.

People with high normal blood pressure (BP) have a higher risk of cardiovascular events than those with normal BP; therefore, progression to hypertension (HT) should be prevented. We aimed to assess the HT risk using central BP and carotid intima media thickness (CIMT) in people with high normal BP. This prospective cohort study used the Tohoku Medical Megabank Community-Based Project Cohort Study (conducted from 2013 in Miyagi Prefecture in Japan). The participants had a high normal BP, defined as a systolic BP of 120-139 mmHg and diastolic BP ＜90 mmHg using brachial BP measurement during the baseline survey. The outcome was new-onset HT during the secondary survey, conducted four years after the baseline survey. Overall, 4,021 participants with high normal BP during the baseline survey, with an average age of 58.7 years, were included; 1,030 (26%) were diagnosed with new-onset HT during the secondary survey, 3.5±0.7 years after the baseline survey. The multivariable odds ratio (95% confidence interval) for HT in the highest versus lowest quartile of central BP was 1.7 (1.2-2.4, p=0.0030), and that of CIMT was 1.8 (1.4-2.4, p＜0.001). Subgroup analysis according to age (＜60 and ≥ 60 years) and sex revealed that the central BP was influential in groups with younger age and female individuals; CIMT was influential in all groups. Higher central BP and thicker CIMT at the baseline were correlated with new-onset HT in individuals with high normal BP, independent of brachial systolic BP and other cardiovascular risk factors.

Abstract 15400: Association of Cardiovascular Health With Early Carotid Artery Changes in Young Adults From Disadvantaged Social Backgrounds: The Future of Families and Child Wellbeing Study (FFCWS)

Introduction: Associations of cardiovascular health (CVH), as measured by the AHA’s Life’s Essential 8 (LE8) score, with early markers of arterial injury have not been described in young adults. Methods: The FFCWS enrolled 4898 mother-baby dyads at delivery in 20 US cities in 1998-2000, oversampling mothers who were unmarried, including a disproportionate number of minority and low-income families. In 2021-23, offspring were invited to attend an in-person exam to measure CVH and perform carotid artery ultrasound. Individual CVH metric and overall LE8 scores (except sleep) were calculated for each participant (ppt). Carotid imaging was performed by 2 trained sonographers and images were analyzed by a core lab. We examined cross-sectional associations of LE8 scores with measures of carotid intima-media thickness (IMT), gray scale (a measure of early arterial injury), and distensibility, using linear regression. Results: Among 1211 offspring ppts, mean age was 22y, >50% self-identified as female, and >75% as Black or Hispanic. Black and Hispanic ppts had lower, and ppts from Other racial/ethnic groups had higher, overall LE8 scores compared with White ppts (all P≤0.01; Table 1A). In unadjusted analyses, Black ppts had thicker carotid IMT and lower Young’s elastic modulus measures. Prevalence of diagnostic plaque was low. In analyses adjusted for age, sex, and race/ethnicity (Table 1B), LE8 scores were significantly associated with lower carotid IMT, higher gray scale median, and lower Young’s elastic modulus. For example, for each 10 point higher (better) LE8 score, mean-maximal carotid IMT was lower by 0.008 mm. Conclusions: Among young adults largely from disadvantaged social backgrounds, the LE8 score was associated with early measures of carotid arterial injury. LE8 may be an important surrogate measure for monitoring long-term CVH and may help identify young adults with emerging subclinical disease and higher long-term cardiovascular risk.

Periodontitis is associated with subclinical cerebral and carotid atherosclerosis in hypertensive patients: A cross-sectional study

ObjectiveTo examine the relationship between periodontitis and subclinical intracranial atherosclerosis. The association of periodontitis with preclinical markers of atherosclerosis in other vascular territories was also explored.Material and methodsThis was a cross-sectional study where 97 elderly subjects with a previous history of hypertension received an ultrasonographic evaluation to assess subclinical atherosclerosis in different vascular territories: (1) cerebral [pulsatility (PI) and resistance index (RI) of the middle cerebral artery], (2) carotid [intima-media thickness (IMT)], and (3) peripheral [ankle-brachial index (ABI)]. Additionally, participants underwent a full-mouth periodontal assessment together with blood sample collection to determine levels of inflammatory biomarkers (leukocytes, fibrinogen, and erythrocyte sedimentation rate), lipid fractions (total cholesterol and high- and low-density lipoprotein), and glucose.ResultsSixty-one individuals had periodontitis. Compared to subjects without periodontitis, those with periodontitis showed higher values of PI (1.24 ± 0.29 vs 1.01 ± 0.16), RI (0.70 ± 0.14 vs 0.60 ± 0.06), and IMT (0.94 ± 0.15 vs 0.79 ± 0.15) (all p < 0.001). No statistically significant differences were found neither for ABI or for other clinical and biochemical parameters. An independent association was found between periodontitis and increased intracranial atherosclerosis (ORadjusted = 10.16; 95% CI: 3.14–32.90, p < 0.001) and to a lesser extent with thicker carotid IMT (ORadjusted = 4.10; 95% CI: 1.61–10.48, p = 0.003).ConclusionsPeriodontitis is associated with subclinical atherosclerosis in both intracranial and carotid arteries in elderly subjects with hypertension.Clinical relevanceThe association of periodontitis with intracranial atherosclerosis implies that periodontitis patients might have greater chances to develop ischemic stroke in the future.

Synergistic Effects of Inflammation and Atherogenic Dyslipidemia on Subclinical Carotid Atherosclerosis Assessed by Ultrasound in Patients with Familial Hypercholesterolemia and Their Family Members.

Low-density lipoprotein cholesterol (LDL-C) and total to high-density lipoprotein cholesterol (TC/HDL-C) ratio are both common risk factors for atherosclerotic cardiovascular diseases (ASCVDs). However, whether high-sensitivity C-reactive protein (hsCRP) has synergistic or attenuated effects on atherogenic dyslipidemia remains unclear. We investigated subclinical carotid atherosclerosis in patients with familial hypercholesterolemia (FH) and their family members. A total of 100 families with 761 participants were prospectively studied. Participants were categorized into four groups according to atherogenic dyslipidemia and inflammatory biomarkers. The group with LDL-C ≥ 160 mg/dL (or TC/HDL-C ratio ≥ 5) combined with hsCRP ≥ 2 mg/L have a thicker carotid intima-media thickness (CIMT) in different common carotid artery (CCA) areas and a higher percentage of high plaque scores compared with other subgroups. Multivariate logistic regression analysis revealed a significantly higher adjusted odds ratio (aOR) for thicker CIMT of 3.56 (95% CI: 1.56–8.16) was noted in those with concurrent LDL-C ≥ 160 mg/dL and hsCRP ≥ 2 mg/L compared with the group with concurrent LDL-C < 160 mg/dL and hsCRP < 2 mg/L. Our results demonstrated that systemic inflammation, in terms of higher hsCRP levels ≥ 2 mg/L, synergistically contributed to atherogenic dyslipidemia of higher LDL-C or a higher TC/HDL-C ratio on subclinical atherosclerosis.

Environmental tobacco smoke and carotid intima-media thickness in healthy children and adolescents: a systematic review.

Thicker carotid intima–media thickness (CIMT) has been a valid predictor for atherosclerosis development. A significant association between environmental tobacco smoke (ETS) and thickening of CIMT has been demonstrated in adults, whereas such association has scarcely been reviewed in paediatric population. The dominate electronic databases, including MEDLINE (Ovid), PubMed, Embase, CINAHL, Web of Science, Scopus, were searched from inception. Reference lists of retrieved articles were further scanned as to avoid any missing literatures. Newcastle-Ottawa scale was used to assess the quality of the included studies. Qualitative synthesis analyses were performed on the selected studies. 331 articles were retrieved, and 4 were finally selected. All four studies investigated the association between postnatal ETS and CIMT in children, and three of them reported a statistically significant positive association. Three studies investigated the association between prenatal maternal ETS and CIMT, and one of the three found a positive association. Two studies explored the association between postnatal maternal ETS and CIMT, one reported a positive association. Two studies used serum cotinine measurement to quantify ETS and demonstrated potential dose-response relationship with CIMT. ETS exposure may play an independent role in the development of cardiovascular risks in healthy children and adolescents. In the consideration of the great burden of respiratory and cardiovascular diseases, there is an urgent need of effective surveillance for paediatric population’s ETS exposure to reduce smoke exposure.

Exercise Training Duration and Intensity Are Associated With Thicker Carotid Intima-Media Thickness but Improved Arterial Elasticity in Active Children and Adolescents.

Even though exercise generally has a positive effect on health, intensive exercise can have adverse effects on the vascular system of adults. This study aimed to investigate the association between training duration and intensity and vascular structure and function in 427 physically active children and adolescents (14.0 ± 1.94 years). In this study, we examined carotid intima-media thickness (cIMT), carotid diameter, and cIMT:diameter-ratio as parameters of carotid arterial structure and arterial compliance (AC), stiffness index β (β), elastic modulus (Ep), and carotid pulse wave velocity (PWVβ) as parameters of carotid arterial function with high-resolution ultrasound. We collected central systolic blood pressure (cSBP) and aortic pulse wave velocity (aPWV) as parameters of central arterial stiffness with an oscillometric device. We used the MoMo Physical Activity Questionnaire to record training duration and intensity. Training duration (p = 0.022) and intensity (p = 0.024) were associated with higher cIMT. Further, training duration was associated with lower central arterial stiffness (cSBP: p = 0.001; aPWV: p = 0.033) and improved AC (p < 0.001). Higher training intensity was related to improved AC (p < 0.001) and larger carotid diameter (p = 0.040). Boys presented thicker cIMT (p = 0.010), improved AC (p = 0.006), and lower central arterial stiffness (cSBP: p < 0.001; aPWV: p = 0.016) associated with higher training duration. Girls presented improved AC (p = 0.023) and lower Ep (p = 0.038) but higher β (p = 0.036) associated with higher training duration. Only boys demonstrated thicker cIMT (p = 0.016) and improved AC (p = 0.002) associated with higher training intensity. A quintile analyses of the training duration revealed thicker cIMT of children and adolescents in Q1 and Q5 than that in Q4 and Q5. Besides, Q1 showed lower cSBP compared to Q4 and Q5. Regarding training intensity, Q5 had thicker cIMT than Q2 and Q3. Although a higher training load is associated with thicker cIMT, the common carotid artery is also more elastic. This suggests that a higher training load leads to a functional adaptation of the carotid artery in youth.

The mediating role of inflammation in the association between cigarette smoking and intima-media thickness: The Guangzhou biobank cohort study.

Cigarette smoking is associated with thicker carotid intima-media thickness (IMT), probably partly through inflammatory pathways. However, to what extent does inflammation mediate the smoking-carotid atherosclerosis association is unclear. We investigated the mediating effect of inflammation on the association between cigarette smoking and carotid IMT, and quantified the respective contributions of inflammatory markers to this association.A total of 1752 participants from Guangzhou Biobank Cohort Study-Cardiovascular Disease Sub-cohort (GBCS-CVD) were included. Using causal mediation analysis under the counterfactual framework, we decomposed total effects of cigarette smoking on IMT into indirect effects (through inflammatory response) and direct effects (not through inflammatory response).After adjusting for traditional risk factors, the indirect effects of per 109/L increment in leukocyte and granulocyte, per mg/L increment in high-sensitivity C-reactive protein (hs-CRP), and per mg/dL increment in fibrinogen on carotid IMT was 0.0028 mm (95% confidence interval [CI], 0.0011–0.0047), 0.0019 mm (95% CI, 0.0006–0.0034), 0.0017 mm (95% CI, 0.0006–0.003), and 0.001 mm (95% CI, 0.0001–0.0021), respectively. No evidence for a mediating role of lymphocyte was found. The proportion of the smoking-IMT association mediated by leukocyte, granulocyte, hs-CRP, and fibrinogen was 12.57% (95% CI, 8.50%–22.11%), 8.50% (95% CI, 5.76%–15.09%), 7.64% (95% CI, 5.20%–13.79%), and 4.48% (95% CI, 3.04%–8.03%), respectively. Restricting data analysis to men showed similar results.The effects of cigarette smoking on IMT were partly mediated by leukocyte, hs-CRP, and fibrinogen. The mediating role of leukocyte was likely mainly driven by higher granulocyte.

The influence of insulin resistance in the occurence of non-alcoholic fatty liver disease among first degree relatives of type 2 diabetes

BackgroundFirst degree relatives (FDR) of type 2 diabetes mellitus (T2DM) predisposes individuals to have earlier metabolic and vascular disorders independent of insulin resistance (IR) such as thicker carotid intima media thickness than that of non-FDR. Non-alcoholic fatty liver disease (NAFLD) is the most commonly found chronic liver disease in T2DM which is IR dependent. Studies about NAFLD in FDR of T2DM populations are very limited and inconclusive. It is unclear whether the occurrence of NAFLD in FDR of T2DM is IR dependent or due to genetic vulnerability. AimsThe aim of this study is to determine the association between NAFLD and FDR of T2DM. Method and materialsA total of 118 young adults (19–39 years old) with normal glucose tolerance (59 FDR of T2DM and age-sex matched 59 non-FDR subjects) were included in this cross-sectional study. Anthropometric measurement and routine laboratory analysis (fasting blood glucose/FBG, HbA1c, lipid profile, alanine aminotransferase (ALT), aspartate transaminase (AST)) were examined. Fatty liver was diagnosed by ultrasonography (US) using standard criteria. ResultsTwenty-six (22,03%) subjects with NAFLD were detected by ultrasound with similar proportion for each group. Low HDL-C level and metabolic syndrome were found higher in FDR group (p = 0.004, OR 3.81, CI95 = 1.47–9,91; p = 0.023, OR 4.28, CI95 = 1.13–16.23). Based on logistic regression analysis, central obesity and obesity had statistically significant influence towards NAFLD. ConclusionThe occurrence of NAFLD in FDR of T2DM was influenced by IR (central obesity and obesity).

Abstract P365: Objectively Measured Snoring is Associated with Carotid Vascular Remodeling in Overweight and Obese Adults

Introduction: Snoring is often used as a surrogate measure for obstructive sleep apnea (OSA), a sleep disorder associated with elevated cardiovascular disease (CVD) risk. Although the literature supports a link between snoring and CVD, it is not clear if this association is independent of OSA. The objective of our study was to explore the association between snoring and subclinical CVD in adults with and without OSA. We hypothesized that snorers would have a greater burden of subclinical CVD, including thicker carotid intima media thickness (CIMT) and higher pulse wave velocity (PWV). Methods: Cross-sectional analyses were conducted using 24-month follow up data from the Slow Adverse Vascular Effects (SAVE) study, a randomized controlled trial evaluating the effects of weight loss, increased physical activity, and reduced dietary sodium intake on vascular health. The original population included 349 men and women aged 20-45 years and BMI 25-40 kg/m 2 . Participants (n=122) with objective measures of sleep-disordered breathing from a home-based sleep assessment (ResMed ApneaLink) were grouped into three categories using the snoring index (SI) and oxygen desaturation index (ODI). SI is defined as the number of vibratory snoring events per hour of recording time . ODI is the number of oxyhemoglobin desaturations of ≥ 4% per hour of recording . The snoring categories were: OSA (ODI≥5; n=41), heavy snoring (ODI&lt;5, above-median SI; n=40), and normal snoring (ODI&lt;5, below-median SI; n=41). Vascular measures such as carotid-femoral PWV (cfPWV), femoral-ankle PWV (faPWV), brachial-ankle PWV (baPWV), CIMT, and carotid inter-adventitial diameter were compared across snoring groups. We used multiple linear regression to assess the association between snoring and subclinical CVD independent of age, sex, BMI, mean arterial pressure, and intervention group. Results: Participants were on average 40.1 ± 5.9 years old (BMI of 31.6 ± 4.4 kg/m 2 ; 76.2% women and 82% white). Across snoring severity categories, most CVD risk factors worsened including age, blood pressure, BMI, lipids, and fasting glucose (ANOVA; all p &lt;.05). Similarly, vascular measures including faPWV, baPWV, CIMT, inter-adventitial diameter and bulb IMT differed across snoring categories with differences occurring mainly between the normal snoring and OSA groups. Differences in carotid inter-adventitial diameter and CIMT were noted between normal and heavy snoring groups (6.52 ± 0.49 vs. 6.83 ± 0.49; 0.58 ± 0.06 vs. 0.63 ± 0.07; mm), respectively. Following covariate adjustment, differences in carotid inter-adventitial diameter and IMT persisted between normal and heavy snoring categories (p &lt;.05). Conclusion: Our findings suggest that, in overweight and obese adults, objectively measured snoring is related to indices of local vascular remodeling and aging, even in those without OSA. Snoring severity may be associated with CVD risk.

Impact of different antihypertensives on carotid arterial wall thickness.

Hypertension has been associated with atherosclerosis and cardiovascular disease. Carotid intima media thickness is increased in hypertensive patients. But, the correlation between carotid intima media thickness and antihypertensive agents is still uncertain. Therefore, we investigated carotid intima media thickness based on types of antihypertensive agents. 1809 patients were enrolled in this study and it showed that 1079 hypertensive patients had thicker carotid intima media thickness than non-hypertensive patients, with carotid intima media thicknesses of (0.72±17mm vs 0.64±15mm, P<.001), (0.31±0.07mm vs 0.30±0.06mm, P<.001), and (0.41±0.13mm vs 0.35±0.12mm, P<.001). Additionally, hypertensive patients on beta-blockers also had thicker carotid intima media thickness than the non-beta-blocker group, with carotid intima media thicknesses of (0.74±0.18mm vs 0.71±0.16mm, P=.018), (0.33±0.09mm vs 0.31±0.07mm, P=.029), and (0.43±0.13mm vs 0.40±0.13mm, P=.035). Multivariate analysis showed that carotid intima thickness was only correlated with beta-blockers (odds ratio=2.489, confidence interval=1.183-5.239, P=.016); however, this study showed that beta-blocker could be associated with increased carotid wall thickness as well.

Thicker carotid intima-media thickness and increased plasma VEGF levels suffered by post-acute thrombotic stroke patients.

Background and objectivesAtherosclerosis causes reduction of the oxygen supply to structures in the far arterial wall, provoking the release of factors that drive angiogenesis of vasa vasorum, including VEGF. Other studies have revealed the inflammatory response in atherosclerosis and the role of platelet factor 4 (PF4) as an anti-angiogenic chemokine through the inhibition of VEGF. This cross-sectional study aims at measuring the effect of atherosclerosis assessed through carotid intima-media thickness (CIMT) against plasma VEGF levels in patients with post-acute thrombotic stroke.Materials and methodsCIMT was assessed sonographically using GE Logiq S6 with 13 MHz frequency linear probe. VEGF-A plasma levels were measured using enzyme-linked immunosorbent assay (ELISA) method. Differences among variables were compared statistically. The data were analyzed using Pearson correlation.ResultsA total of 25 patients with post-acute thrombotic stroke were identified in days 7 to 90. CIMT thickening was indicated in 88% of patients (1.202 ± 0.312 mm), while an increase in plasma VEGF was identified in all patients (178.28 ± 93.96 ng/mL). There was no significant correlation between CIMT and plasma VEGF levels in patients with post-acute thrombotic stroke (p=0.741). A significant correlation was recognized between CIMT and total cholesterol (p=0.029) and low-density lipoprotein (p=0.018).ConclusionThere were no significant correlations between CIMT and plasma VEGF levels in patients with post-acute thrombotic stroke. However, plasma VEGF increased in patients with thrombotic stroke. CIMT measurement is a promising noninvasive modality to assess the vascular condition of patients with stroke and diabetes, while plasma VEGF cannot specifically assess vascular condition as it can be triggered by ischemic conditions in tissues of the whole body.

Genetic variations in the osteopontin promoters T-443C and G-156GG increase carotid intima-media thickness.

Carotid intima–media thickness (CIMT) is a clear predictor of atherosclerosis. The increase of CIMT is affected by mutations in the osteopontin (OPN) promoters. The purpose of this study was to examine genetic variations in OPN promoters T-443C and G-156GG, identified in Javanese children with ischemic stroke parents, and to investigate their relationship with the increase of CIMT. A case–control analytic study was performed on 20 case and 12 control samples. Case samples were Javanese children aged between 10 to 21 years with ischemic stroke parents. Control samples were children with healthy parents. Mutations of T-443C and G-156GG were determined by employing polymerase chain reaction. Results of sequencing were analyzed using CLC Main Workbench 6.0. CIMT was defined using ultrasound. Genetic variations of T-443C were identified in six samples. Likewise, genetic variations of G-156GG were identified in six samples. Genetic variations in the OPN promoters T-443C and G-156GG were not potential risk factors in an increase of CIMT (P=0.654 and P=0.654). This study proves that genetic variations could be identified at the points of T-443C and G-156GG in children with ischemic stroke parents. Although statistically insignificant, the tendency to increase CIMT occurs in children with genetic variations. Children with ischemic stroke parents have thicker CIMT than children of healthy parents.

Abstract 12149: Associations of Intima-Media Thickness of Different Segments of Carotid Arteries and Prevalent Cardio-Metabolic Diseases in Middle-age Adults and Elders in Taiwan

Background and Aim: Carotid intima-media thickness (IMT) is a well-studied phenotype of atherosclerosis in developed countries, however, there was only a few studies in developing countries. The aim of the study was to explore the relationships between carotid IMTs and prevalent cardio-metabolic diseases in Chinese. Methods: 1579 residents aged 40-74 years from three communities in northern Taiwan were recruited in 2010-2012. The far-wall intima-media thickness (IMTs) of the right and left common carotid arteries (CCAs), internal carotid arteries (ICA), and carotid bifurcation (BIF) were measured by B mode ultrasound. All participants were assessed for cardio-metabolic profiles and 10-year general cardiovascular risks by the Framingham Risk Score. Results: Correlation analyses showed that there were significant linear trends with age and estimated 10-year general cardiovascular risks for all segmental carotid IMTs. The linear trends were the strongest for CCA IMTs, followed by BIF IMTs, and the least for ICA IMTs, and stronger for the average IMTs of the right and left carotid arteries than one-sided IMTs alone. Male sex, central obesity, high BMI, high LDL-/HLD-C ratio, high blood pressure, and high blood sugar were significantly correlated with thicker carotid IMTs. Subjects affected with hypertension, diabetes mellitus (DM), metabolic syndrome, and cardiovascular diseases (CVDs) had significantly thicker carotid IMTs. After adjustment for traditional cardio-metabolic risk factors, subjects who had mean or maximum CCA or mean BIF IMTs &gt;= the 3rd quartiles had significantly higher likelihoods of having prevalent CVDs. The adjusted ORs were 2.13 (95% CI: 1.30-3.49), 1.73 (95% CI: 1.06-2.82), and 1.59 (95% CI: 1.01-2.51), respectively. The adjusted ORs were not significant for subjects who had elevated mean or maximum ICA or maximum BIF IMTs. Conclusions: Carotid IMTs were significantly correlated with most traditional cardio-metabolic risk factors. Among different segmental carotid IMTs, CCA IMTs demonstrated stronger associations with prevalent CVDs and DM. Carotid IMTs may be used as an intermediate marker of advanced vascular diseases in Chinese.

Carotid intima-media thickness, a marker of subclinical atherosclerosis, and particulate air pollution exposure: the meta-analytical evidence.

IntroductionStudies on the association between atherosclerosis and long-term exposure to ambient air pollution suggest that carotid intima-media thickness (CIMT), a marker of subclinical atherosclerosis, is positively associated with particulate matter (PM) exposure. However, there is heterogeneity between the different studies concerning the magnitude of this association. We performed a meta-analysis to determine the strength of the association between CIMT and particulate air pollution.MethodsWe queried PubMed citation database and Web of Knowledge up to March 2015 in order to identify studies on CIMT and particulate air pollution. Two investigators selected and computerized all relevant information, independently. Eight of the reviewed epidemiological publications provided sufficient details and met our inclusion criteria. Descriptive and quantitative information was extracted from each selected study. The meta-analysis included 18,349 participants from eight cohorts for the cross-sectional association between CIMT and PM and 7,268 participants from three cohorts for the longitudinal analysis on CIMT progression and PM exposure.ResultsThe average exposure to PM2.5 in the different study populations ranged from 4.1 to 20.8 µg/m3 and CIMT averaged (SD) 0.73 (0.14) mm. We computed a pooled estimate from a random-effects model. In the combined cross-sectional studies, an increase of 5 µg/m3 PM2.5 was associated with a 1.66% (95% CI: 0.86 to 2.46; P<0.0001) thicker CIMT, which corresponds to an average increase of 12.1 µm. None of the studies moved the combined estimate outside the confidence interval of the overall estimate. A funnel plot suggested absence of publication bias. The combined longitudinal estimate showed for each 5 µg/m3 higher PM2.5 exposure, a 1.04 µm per year (95% CI: 0.01 to 2.07; P=0.048) greater CIMT progression.ConclusionOur meta-analysis supports the evidence of a positive association between CIMT, a marker of subclinical atherosclerosis, and long-term exposure to particulate air pollution.

Functionally defective high-density lipoproteins are related to heightened T-cell activation in vertically HIV-infected adolescents.

We assessed high-density lipoprotein (HDL) anti-inflammatory properties in a cohort of vertically HIV-infected adolescents. We hypothesized that proatherogenic mechanisms related to inflammation and immune activation during HIV infection may impair HDL functionality and impact on the atherosclerotic burden. Compared with healthy controls, HDL from HIV-infected adolescents presented impaired functionality, as determined by its ability to inhibit monocyte chemotaxis in vitro, which correlated with detectable viral loads (P = 0.044), lower CD4 nadir (P = 0.043), increased levels of CD4 T-cell activation (P = 0.018), higher C-reactive protein (P = 0.009), and a tendency toward thicker carotid intima-media thickness (P = 0.071).

Thicker Carotid Intima Media Thickness in Children with Monocyte Chemoattractant Protein-1: A-2138T and A-2464G Mutation.

Carotid intima media thickness (CIMT) is clearly associated with atherosclerosis. Studies in ischemic stroke patients reveal that there is a significant association between CIMT with monocyte chemoattractant protein-1 (MCP-1) and osteopontin (OPN) promoter polymorphism. This research aims to explain the effect of MCP-1 and OPN promoter polymorphism toward CIMT changes identified in Javanese Indonesian children. Subjects were 54 children: 27 were from parents with ischemic stroke (cases), and 27 were from healthy parents (controlled). The CIMT was examined by utilizing high resolution B-mode ultrasound. Physical examination and genotyping analysis of MCP-1 promoter were conducted by employing PCR method. Research results indicate that two polymorphisms were obtained, that is, A-2138T and G-2464A, respectively. A-2138T polymorphism was found in 5% of case children and in 14.3% of controlled children. G-2464A polymorphism was found in 5% of case children. CIMT of case children was significantly different from that of controlled children (0.61 ± 0.012 mm versus, 0.52 ± 0.015 mm, P = 0.021). Subjects with MCP-1 promoter polymorphism have 1.471 times higher tendency to have thicker CIMT than subjects with no polymorphism in MCP1 promoter. OPN promoter T-66G was also studied but it did not indicate occurrence of polymorphism in samples.

An Overweight or Obese Status in Childhood Predicts Subclinical Atherosclerosis and Prehypertension/Hypertension in Young Adults

The aim of this study, the YOung TAiwanese Cohort (YOTA) Study, was to investigate the relationship between a childhood overweight/obese status and young adult preclinical atherosclerosis, including assessments of the carotid intima-media thickness (CIMT) and prehypertension or hypertension. From among children who participated in the 1992-2000 mass urine screening program in Taiwan, we recruited 303 subjects with an elevated blood pressure (EBP) and 486 subjects with a normal BP in childhood during the period of 2006-2008. These 789 young adults received health check-ups for cardiovascular health, including examinations of blood and urine parameters, anthropometrics, BP and the CIMT, a subclinical cardiovascular risk index. Data analyses were used to evaluate the associated risks in both childhood and young adulthood. The school students with a childhood overweight/obese status had a higher risk of prehypertension or hypertension, with a relative risk of 3.20 (1.40-7.33) for being overweight and 6.51 (3.36-12.63) for being obese in young adulthood at an average age of 21. A childhood overweight/obese status also predicted a higher risk of having a thicker CIMT, with a relative risk of 2.82 (1.26-6.28) and 4.17 (2.21-7.85) for being overweight and obese in adulthood, respectively, after a mean follow-up of 8.5 years. The body mass index exhibited a consistent trend from childhood to adulthood, with an adjusted R square of 0.551. The participants who were not overweight/obese in childhood also demonstrated a higher risk of prehypertension or hypertension if they became overweight or obese in adulthood. This study highlights the importance of preventing and treating an overweight or obese status in childhood for the primary prevention of cardiovascular disease in adulthood.

Commentary: coeliac disease and atherosclerosis - hand in hand?

Most, but not all, large-scale studies have observed a positive association between diagnosed coeliac disease and cardiovascular disease (Table 1). In their interesting paper, De Marchi et al. take this issue further by examining instrumental and biochemical signs of atherosclerosis in coeliac disease, adding to previous studies on cardiovascular risk factors. 4 They conclude that young adults with coeliac disease are at increased risk of higher mean LDL cholesterol, have a thicker carotid intima media thickness (IMT), while their endothelium-dependent dilatation is decreased – all bad for cardiovascular health. Interestingly, the authors also found that dietary treatment influenced C-reactive protein levels, and that both IMT and endothelium-dependent dilatation improved with diet. While the results of the De Marchi study may have been influenced by their study design (it is not clear if the authors used paired statistical tests; they excluded individuals with prior hypertension; and used hospital staff as controls with risk of healthy selection bias), the findings of the current paper nevertheless indicate that the cardiovascular risk profile may be different in coeliac patients. That said, the size of this difference is still a matter of debate. Differences may have been overestimated as patients and controls were matched for two important cardiovascular risk factors (body mass index and smoking) that may be less prevalent in the coeliac population. Of great importance are De Marchi’s findings that a gluten-free diet may improve the cardiovascular risk profile. A recent US-Swedish paper in this journal found no association between mucosal healing and overall mortality, but preliminary data from the same group suggest that mucosal healing influenced the risk of lymphoproliferative malignancy (B. Lebwohl, personal communication). If a gluten-free diet is crucial also for cardiovascular health in coeliac disease, all efforts should

868 AMBULATORY BLOOD PRESSURE VARIABILITY AND CAROTID INTIMA-MEDIA THICKNESS IN TREATED HYPERTENSIVE PATIENT

Background: Blood pressure (BP) variability is estimated as the standard deviation (SD) of 24-h ambulatory BP1-3. The present study was performed to determine the effect of the mean day- and night- ambulatory BP values and standard deviations on carotid intima-media thickness (IMT) in treated hypertensive patients4-5. Methods: Carotid IMT and 24-h ambulatory BP were measured in 107 hypertensive patients with treatment (62.6 ± 14.8 years old; clinical systolic/diastolic BP: 144.0/82.3 mmHg). The mean value and SD of ambulatory BP were calculated for the entire 24-h period and separately for the day-time period and the night-time period. Carotid IMT was defined as the distance between the leading edge of the lumen-intima interface and the leading edge of the media-adventitia interface on the far wall, and the greatest IMT value in the bilateral longitudinal projections was recorded as the maximum IMT. Results: Univariate regression analyses revealed a significant association between carotid IMT values and the SD of ambulatory systolic/diastolic BP during night time (r = 0.296, p = 0.004; r = 0.205, p = 0.048, respectively). However, there were no association between carotid IMT and the 24-h systolic/diastolic BP, day-time systolic/diastolic BP, night-time systolic/diastolic BP, the SD of 24-h systolic/diastolic BP, and the SD of day-time systolic/diastolic BP. Multivariate regression analyses confirmed a significant correlation between carotid IMT and the SD of night-time systolic BP (β=0.232, p = 0.012). Conclusions: In hypertensive patients with treatment, a higher night-time ambulatory systolic BP variability had thicker carotid IMT. Only night-time ambulatory systolic BP variability may be involved in carotid IMT in treated hypertensive patients. References Pickering TG, James GDJ. Ambulatory blood pressure and prognosis. J Hypertens. 1994; 12(Suppl 8): S29–S33. Verdecchia P, Borgioni C, Ciucci A, Gattobigio R, Schillaci G, Sacchi N, et al. Prognostic significance of blood pressure variability in essential hypertension. Blood Press Monit. 1996; 1: 3–11. Kikuya M, Hozawa A, Ohokubo T, Tsuji I, Michimata M, Matsubara M, et al. Prognostic significance of blood pressure and heart rate variabilities: the Ohasama study. Hypertension. 2000; 36: 901–6. Hamada T, Murata T, Narita K, Takahashi T, Wada Y, Kimura H, Yoshida H, et.al. The clinical significance of abnormal diurnal blood pressure variation in healthy late middle-aged and older adults. Blood Press. 2008;17:134-40.

Implications of immunosuppressive agents in cardiovascular risks and carotid intima media thickness among lupus nephritis patients

Patients with systemic lupus erythematosus, particularly with lupus nephritis (LN), are at risk of premature cardiovascular (CV) disease. To determine the association between immunosuppressive medications, traditional CV risk factors and carotid intima media thickness (CIMT) among patients with LN. This was a cross-sectional study in which consecutive LN patients attending the Nephrology/SLE Clinic were evaluated for traditional CV risk factors. Detailed information on their treatment was obtained from their medical records. CIMT, an excellent marker of subclinical atherosclerosis, was measured by B Mode carotid ultrasound. A total of 82 patients with LN with a mean age of 33.9 ± 9.8( )years were recruited. More than half had hypertension (n = 55, 67.1%) and dyslipidemia (n = 43, 52.4%) as traditional CV risks. Longer history and higher cumulative dose of corticosteroids were associated with hypertension, but use of intravenous methylprednisolone was associated with lower systolic and diastolic blood pressure and lower serum total cholesterol and triglyceride levels (p < 0.05 each). Hydroxychloroquine use was associated with lower total serum cholesterol and serum low-density lipoprotein levels (p < 0.05). Although the use of cyclosporine A (CyA) was associated with hypertension (p < 0.05), those who received a lower cumulative dose of CyA had thicker CIMT (r (s) = -0.33, p =0.01) and CyA use remained an independent predictor of CIMT during linear regression analysis. There were no associations between CIMT and cumulative dose and duration of steroids, hydroxychloroquine, azathioprine, mycophenolic acid and cyclophosphamide. Aggressive treatment of severe LN and the use of CyA as a steroid-sparing agent may have protective effects against premature atherosclerosis.