Thickness Of Common Carotid Artery Research Articles

Neurosonological Examination: A Non-Invasive Approach for the Detection of Cerebrovascular Impairment in AD

There has been a growing interest in vascular impairment associated with Alzheimer’s disease (AD). This interest was stimulated by the findings of higher incidence of vascular risk factors in AD. Signs of vascular impairment were investigated notably in the field of imaging methods. Our aim was to explore ultrasonographic studies of extra- and intracranial vessels in patients with AD and mild cognitive impairment (MCI) and define implications for diagnosis, treatment, and prevention of the disease. The most frequently studied parameters with extracranial ultrasound are intima-media thickness in common carotid artery, carotid atherosclerosis, and total cerebral blood flow. The transcranial ultrasound concentrates mostly on flow velocities, pulsatility indices, cerebrovascular reserve capacity, and cerebral microembolization. Studies suggest that there is morphological and functional impairment of cerebral circulation in AD compared to healthy subjects. Ultrasound as a non-invasive method could be potentially useful in identifying individuals in a higher risk of progression of cognitive decline.

Abstract 9876: Long-Term Treatment With Sitagliptin Provides Multiple Ultrasonic Manifested Antiatherosclerotic Effects Independent of Diabetic Improvement for Type-2 Diabetics

Background: Diabetes mellitus is thought to be highly involved in complex atherothrombogenic processes, but the long-term antiatherosclerotic therapies in patients with type-2 diabetes mellitus have not been established. We previously demonstrated adverse prognostic impacts of endothelial dysfunction and intima-media thickening. Therefore we assessed hypothesis long-term treatment with sitagliptin, a dipeptidyl peptidase-4 inhibitor recently developed antidiabetic agent, chronically inhibits atherosclerotic progression in patients with type-2 diabetes mellitus. Methods: Thirty-four type-2 diabetic patients with stable coronary artery disease were randomized to group-S where they received sitagliptin (50mg/day), or to group-C where they received enhanced antidiabetic therapy without a dipeptidyl peptidase-4 inhibitor for 2 years. We quantified flow-mediated endothelium-dependent dilation of right brachial artery after transient forearm occlusion (FMD), endothelium-independent dilation of brachial artery after sublingual administration of nitroglycerin (TNG), and intima-media thickness of common carotid artery (IMT) using high-resolution ultrasonography. Changes in FMD, TNG, and IMT were compared between the two groups. Results: Group-S (n=17) manifested good compliance to the long-term treatment and improvements in diabetic and lipid variables represented by HbA1c and LDL after long-term medication of sitagliptin, while there were no improvements in group-C. FMD improved after medication in group-S (from 4.0±1.9% to 6.3±2.7%, p<0.01) but not in group-C (from 4.1±2.0% to 4.0±1.9%, p=0.78). Changes of FMD in group-S did not correlate to those of HbA1c (r= 0.14, p=0.57). TNG (%) remained unchanged in both group-S and group-C. IMT did not increase in group-S (from 1.10±0.35mm to 1.08±0.40mm, p=0.17) but increased in group-C (from 1.09±0.47mm to 1.17±0.48mm, p<0.01). Conclusion: This ultrasonic study suggests that long-term treatment of sitagliptin safely improves endothelial function of brachial artery independent of reversal for diabetic status and reduces progression of wall thickness in carotid artery, which may have beneficial potentials for long-term management of atherosclerosis in type-2 diabetics.

Cerebral hemodynamics and endothelial function in patients with Fabry disease

BackgroundCerebral vasculopathy have been described in Fabry disease, in which altered cerebral blood flow, vascular remodelling or impairment of endothelial function could be involved. Our study aims to evaluate these three possibilities in a group of Fabry patients, and compare it to healthy controls.MethodsCerebral hemodynamics, vascular remodelling and systemic endothelial function were investigated in 10 Fabry patients and compared to data from 17 healthy controls. Transcranial Doppler was used to study blood flow velocity of intracranial arteries and cerebral vasomotor reactivity. For the study of vascular remodelling and endothelial function, intima-media thickness of common carotid arteries, flow-mediated dilation in brachial artery and serum levels of soluble VCAM-1, TNF-α, high-sensitive CRP and IL-6 were measured. Differences between groups were evaluated using appropriate tests.ResultsNo relevant differences were observed in cerebral hemodynamic parameters, intima-media thickness or flow-mediated dilation. There was a trend for low serum levels of IL-6 and high serum levels of TNF-α and high-sensitive CRP in Fabry patients; plasma concentrations of soluble VCAM-1 were significantly higher in Fabry disease patients than in healthy volunteers (p = 0.02).ConclusionsIn our sample, we did not find relevant alterations of cerebral hemodynamics in Fabry disease patients. Increased levels of plasmatic endothelial biomarkers seem to be the most important feature indicative of possible vascular dysfunction in Fabry disease patients.

English

Non alcoholic fatty liver disease is associated with increased cardiovascular risk. Intima media thickness of common carotid artery is considered to be an excellent non-invasive measure of generalized atherosclerosis. The present study was conducted to evaluate the cardiovascular risk in asymptomatic non alcoholic fatty liver disease (NAFLD) subjects as demonstrated by increased carotid intima media thickness( CIMT) detected by using B-mode ultrasonography. A total of 50 healthy participants, 18 males and 32 females in the age group of 21-50 years of age with incidental finding of fatty liver on ultrasound abdomen, attending hospital outpatient department of Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar were included. The relationship of carotid intima media thickness was observed with various variables. Mean carotid intimal medial thickness was taken on both sides. The result concluded that serum cholesterol >200mg/dl, serum triglycerides >150mg/dl, serum LDL >130mg/dl and increasing grades of fatty liver from grade I to III were significantly associated with increased CIMT. The present study also depicted no significant relationship of age, gender, body mass index (BMI), waist hip ratio (WHR), serum HDL levels with carotid intima media thickness. Fatty changes in liver had direct correlation with carotid intimal medial thickness thereby stressing that asymptomatic NAFLD is an important component/ risk factor and determinant of atherosclerosis.

Detection of Intima-Media Thickness in Common Carotid Artery on Ultrasound Image

The intima-media thickness (IMT) measurement is an important subject in the cardiovascular disease diagnosis. However, the manual way to measure IMT is not objective and imprecise due to the skill of the operators. In this paper, a new method of automatic IMT measurement is proposed. This algorithm solves the active contour model problem based on the modified dynamic programming to search the most minimize cost path which is the contour of the intima-media. Experimental results demonstrate that this method is not only robust for the impact of speckle noise, but also attain better extraction results than the traditional way with much smaller time-consuming. The clear intima-media could be automatically obtained with a simple and not very select ROI.

Assessment of atherosclerosis in obese adolescents: Positive correlation of mean platelet volume and carotid intima media thickness

This study aims to assess the correlation of mean platelet volume (MPV) and common carotid artery (CCA) thickness in a population of obese adolescents. Sixty-eight patients and 23 controls were enrolled. Anthropometric measurements, triglyceride, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, alanine aminotransferase, aspartate aminotransferase, γ-glutamyl transpeptidase, hemoglobin, white blood cell count, platelet count, MPV and insulin resistance by homeostasis model of assessment of insulin resistance were investigated. Furthermore, CCA thickness was measured by high-resolution ultrasound. MPV and the left CCA thickness were significantly higher in obese adolescents than the healthy controls. The association between MPV and left CCA was checked by linear regression analysis. MPV explained 19% of the variation in left CCA (P < 0.001). At multiple regression analysis, MPV maintained a positive association with the left CCA thickness (P = 0.002) independently of fatty liver grade, relative weight, total cholesterol and homeostasis model of assessment of insulin resistance. MPV is significantly correlated with CCA thickness in obese adolescents.

Anti-atherosclerotic therapy based on botanicals.

Natural products including botanicals for both therapy of clinical manifestations of atherosclerosis and reduction of atherosclerosis risk factors are topics of recent patents. Only a few recent patents are relevant to the direct antiatherosclerotic therapy leading to regression of atherosclerotic lesions. Earlier, using a cellular model we have developed and patented several anti-atherosclerotic drugs. The AMAR (Atherosclerosis Monitoring and Atherogenicity Reduction) study was designed to estimate the effect of two-year treatment with time-released garlic-based drug Allicor on the progression of carotid atherosclerosis in 196 asymptomatic men aged 40-74 in double-blinded placebo-controlled randomized clinical study. The primary outcome was the rate of atherosclerosis progression, measured by high-resolution B-mode ultrasonography as the increase in carotid intima-media thickness (IMT) of the far wall of common carotid arteries. The mean rate of IMT changes in Allicor-treated group (-0.022±0.007 mm per year) was significantly different (P = 0.002) from the placebo group in which there was a moderate progression of 0.015±0.008 mm at the overall mean baseline IMT of 0.931±0.009 mm. A significant correlation was found between the changes in blood serum atherogenicity (the ability of serum to induce cholesterol accumulation in cultured cells) during the study and the changes in intima-media thickness of common carotid arteries (r = 0.144, P = 0.045). Thus, the results of AMAR study demonstrate that long-term treatment with Allicor has a direct anti-atherosclerotic effect on carotid atherosclerosis and this effect is likely to be due to serum atherogenicity inhibition. The beneficial effects of other botanicals including Inflaminat (calendula, elder and violet), phytoestrogen- rich Karinat (garlic powder, extract of grape seeds, green tea leafs, hop cones, β-carotene, α-tocopherol and ascorbic acid) on atherosclerosis have also been revealed in clinical studies which enforces a view that botanicals might represent promising drugs for anti-atherosclerotic therapy.

COGNITIVE DYSFUNCTION IN PATIENTS WITH ATRIAL FIBRILLATION: ASSESSING THE ROLE OF VASCULAR FACTORS

Aim. To study the association between the presence and type of atrial fibrillation (AF), cognitive dysfunction, and brachiocephalic artery pathology.Material and methods. In total, 54 patients with AF and 20 AF-free patients who had Functional Class I–III chronic heart failure (CHF) underwent cognitive assessment tests, echocardiography, cerebral nuclear magnetic resonance imaging, and duplex brachiocephalic ultrasound.Results. In AF patients, deteriorated parameters of memory and attention were registered. Patients with persistent AF demonstrated worse cognitive function parameters. The characteristics of short-term memory and attention, attainment of visual and motoric skills, and attention shift and span were not associated with the intima-media thickness of common carotid artery and its bifurcation.Conclusion. There is an association between the presence of AF, its type, and the severity of cognitive dysfunction, which is independent of the degree of brachiocephalic artery abnormalities.

Cerebral basis of posttraumatic stress disorder following the Chernobyl disaster

Whether posttraumatic stress disorder (PTSD) following radiation emergency has psychopathological, neurocognitive, and neurophysiological peculiarities is at issue. The goal was to explore the features and cerebral basis of "radiation" PTSD in the survivors of the Chernobyl accident. Subjects and Methods The cross-sectional study included 241 people, 219 of whom have been diagnosed with PTSD according to the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) criteria, among them 115 clean-up workers of the Chernobyl accident (34 with acute radiation sickness), 76 evacuees from the Chernobyl exclusion zone, 28 veterans of the war in Afghanistan, and 22 healthy unexposed individuals. Psychometric examinations, neurocognitive assessments, computerized electroencephalography, and cerebral vascular Doppler were used. "Radiation" PTSD includes "flashforward" phenomena and anticipating stress (projection of fear and danger to the future); somatoform disorders (depression, trait and state anxiety); and neurocognitive deficit (impaired memory and attention, auditory-verbal memory and learning, proactive and retroactive interference, cerebellar and stem symptoms, intellectual changes). The intima-media component, thickness of common carotid arteries, and common and left internal carotid arteries stenosis rates are increased in the liquidators. Changes of bioelectrical brain activity as a decrease of beta- and theta-power, together with an increase of alpha-power, were found in the Chernobyl accident survivors with PTSD. PTSD following radiation emergency is characterized by comorbidity of psychopathology, neurocognitive deficit, and cerebrovascular pathology with increased risk of cerebral atherosclerosis and stroke. The cerebral basis of this PTSD is proposed to be an abnormal communication between the pyramidal cells of the neocortex and the hippocampus, and deep brain structures. It is recommended that a system of emergency and long-term psychological and psychiatric care be organized for the survivors in Fukushima Daichi, Japan.

1332 – Radiation post-traumatic stress disorder

Background Whether PTSD following radiation emergency has psychopathological, neurocognitive and neurophysiological peculiarities is at issue. Goal To explore features and cerebral basis of “radiation” PTSD in the Chernobyl accident survivors. Subjects and methods The cross-sectional study included 241 people, 219 of whom have been diagnosed with PTSD according to the DSM-IV criteria, among them 115 clean-up workers [liquidators] of the Chernobyl accident (34 with acute radiation sickness), 76 evacuees from the Chernobyl exclusion zone, 28 veterans of the war in Afghanistan, and 22 healthy unexposed individuals. Psychometric examinations, neurocognitive assessments, computerized electroencephalography, and cerebral vascular Doppler were used. Results “Radiation” PTSD includes: “flashforward” phenomenon and anticipating stress (projection of fear and danger to the future); somatoform disorders, depression, trait and state anxiety; neurocognitive deficit (impaired memory and attention, auditory-verbal memory and learning, proactive and retroactive interference; cerebellar and stem symptoms, intellectual changes). The intima-media component thickness of common carotid arteries, and common and left internal carotid arteries stenosis rates are increased in the liquidators. Changes of bioelectrical brain activity as a decrease of beta- and theta-power together with an increase of alpha-power were found in the Chernobyl accident survivors with PTSD. Conclusions PTSD following radiation emergency is characterized by comorbidity of psychopathology, neurocognitive deficit, and cerebrovascular pathology with increased risk of cerebral atherosclerosis and stroke. Cerebral basis of this PTSD is proposed to be an abnormal communication between the pyramidal cells of neocortex and hippocampus, and deep brain structures.

Hyperlipidemia, oxidative stress, and intima media thickness in children with chronic kidney disease

The roles of dyslipidemia and oxidative stress in the early phases of atherosclerosis were tested in children with chronic kidney disease (CKD). Intima media thickness of common carotid arteries (cIMT) is used as a measure of early atherosclerosis. Fifty-two pediatric CKD patients were enrolled in the study (10 with chronic renal failure [CRF], 22 with a renal transplant [RT], 20 with chronic hemodialysis (cHD) patients, and 36 healthy children (control group, CG). Lipid status, oxidative stress, and paraoxonase 1 (PON1) status were assessed. cIMT was measured by ultrasound, adjusted for age and sex, and presented as standard deviation scores (SDS). Children with CKD had disturbed lipid content, which was most pronounced in cHD children, with higher free cholesterol and triglycerides compared with healthy children. Oxidative stress was markedly increased (malodialdehyde [MDA, μmol/L]: CRF 1.50 ± 0.26, RT 1.55 ± 0.40, cHD 1.77 ± 0.34, CG 0.97 ± 0.33, p < 0.001) and antioxidative defense was compromised (superoxide dismutase [SOD, U/L]: CG 120 ± 21, CRF 84 ± 25, RT 93 ± 12, cHD 119 ± 37, p < 0.001). Multiple linear regression analysis showed that a model that included disease duration, blood pressure, urea, lipid, and oxidative status parameters accounted for more than 90% of the variability of cIMT-SDS. Early atherosclerosis in CKD children is caused, at least in part, by dyslipidemia and oxidative stress. Monitoring of vessel wall changes, along with assessment of oxidative stress status and high density lipoprotein (HDL) functionality is necessary to ensure better therapeutic strategies for delaying atherosclerotic changes in their asymptomatic phase.

Carotid Doppler Study in Patients with Cerebral Infarction

Background: Duplex ultrasound is inexpensive, non-invasive and can provide functional and anatomical information about vessel stenosis and plaque morphology. Color duplex flow ultrasonography has thus become the most widely used noninvasive method of assessing extra cranial cerebrovascular occlusive disease.Objectives:To find the relation of the severity of carotid artery stenosis, intima media thickness, and atheromatous plaque morphology with the size of cerebral infarction.Patients and Methods: A prospective study, conducted from September 2010 to May 2011, in Department of Radiology in Baghdad Teaching Hospital. A total of 62 Patients with clinical &amp; radiological (brain CT) diagnosis of acute stroke, (42 males &amp; 20 females) had been referred from Medical &amp; Neurological units to the Radiology Department / Ultrasound Unit for carotid arteries examination.Results: Thirty out of 62(48.4%) patients had evidence of ipsilateral carotid stenosis distributed as: 18 out of 30 patients (60%) had &lt; 50% stenosis, 8 patients (26.7%) had 50-69% stenosis, and 4 patients (13.3%) had &gt; 70% stenosis. Also in our study we found that homogenous hypoechoic and ulcerated plaques were more frequent in patients with large size infarcts.Conclusion: From this study we concluded that the size of cerebral infarction is related to degree of ipsilateral carotid artery stenosis, especially when the plaque is soft with irregular or ulcerated surface, and that increased intima media thickness of common carotid artery is strongly associated with stroke and its risk factors.

Avaliação da espessura do complexo médio-intimal da artéria carótida como marcador de aterogênese acelerada secundária a dano vascular na esclerose sistêmica progressiva

To evaluate the intima-media thickness of the common carotid artery in patients with and without scleroderma; to verify a possible association with disease severity; to assess the relationship of intima-media thickness with known cardiovascular risk factors. In a case-control study, were selected 30 patients with scleroderma and 30 without the disease and matched according to age, sex and cardiovascular risk factors such as hypertension, diabetes mellitus and hypercholesterolemia. The age ranged from 17 to 79 years (mean 49). All patients underwent carotid artery evaluation by high-resolution vascular Doppler in order to measure the intima-medial thickness of the carotid 2 cm from the bifurcation. In all the analysis was considered the greatest value of intima-media thickness in right and left carotid arteries. The sample consisted of 30 patients, being 29 (96.67%) women and one man (3.3%). In this sample, 11/30 (36.67%) had high blood pressure, 5/30 (16.67%) had diabetes mellitus, 6/30 (20%) had dyslipidemia and 2/30 (6.67%) were smokers. Comparing the measure of the increased risk (maximum intima-media thickness between the left and right side), was obtained an average of 0.77 mm for group scleroderma and a value of 0.70 mm for the control group (p = 0.21). In assessing the association between disease severity and carotid intima-media thickness, was found no significant association (p= 0.925). Was found a slight increase in intima-medial thickness of common carotid artery in patients with scleroderma but without statistical significance. Regarding the severity of the disease and intima-medial thickness of common carotid artery, there was no significant difference.

B-006 DECREASE OF AUTOANTIBODIES AGAINST OXIDIZED LDL IN CYTOMEGALOVIRUS - RELATED CAROTID ATHEROSCLEROSIS

Background Autoantibodies against Oxidized low-density lipoproteins (oxLDL) were found to be protective at an early stage of atherosclerosis in our previous study.[Chen et al. Cardiology 2008;110:252–259.]Howerer, we suspected that latent human cytomegalovirus (HCMV) infection may modulate the protection of immune response in subclinical atherosclerosis. Methods An age-matched case-control study was constructed including 72 HCMV latent infection subjects and 41 non-HCMV latent infection healthy controls recruited from 2009 to 2010. HCMV latent infection is defined as presence of HCMV DNA, detected by nested PCR, in leucocytes but absence in plasma of subjects. Carotid atherosclerosis, lipid profile, oxLDL and autoantibody were also measured. Results Increase of intima-media thickness of common carotid artery (p = 0.018) indicated subclinical atherosclerosis in the HCMV latent infection subjects compared with non-HCMV latent infection healthy controls. Lower autoantibodies against oxLDL (p = 0.018), relatively higher level of oxLDL (p = 0.058), higher triglyceride (p = 0.014) and higher ratio of cholesterol to HDL (p = 0.009) were noted in the HCMV latent infection subjects. Conclusions We concluded HCMV latent infection may play a crucial role in the lessened production of protective autoantibodies against oxLDL. Based on the differences in lipid panel, interference with lipid metabolism may be one possible pathway for HCMV to precipitate the process of carotid atherosclerosis.

Subclinical Atherosclerosis and Endothelial Dysfunction in Patients with Early Rheumatoid Arthritis as Evidenced by Measurement of Carotid Intima-Media Thickness and Flow-Mediated Vasodilatation: An Observational Study

In this study, we aimed to investigate the frequency of endothelial dysfunction and subclinical atherosclerosis in early rheumatoid arthritis (RA) patients by carotid intima-media thickness (cIMT) and endothelial-dependent flow mediated vasodilatation (ED-FMD) as compared with healthy controls. The study included 35 early RA patients (disease duration <12 months) and 35 healthy controls. Intima-media thickness of common carotid artery and ED-FMD of brachial artery were measured by high-resolution ultrasonography. Disease activity of RA was assessed by Disease Activity Score and activities of daily living were determined by Health Assessment Questionnaire-Disability Index Score. RA patients (age 38.3 ± 10.6 years) had average disease duration of 0.46 ± 0.28 years and 22 patients (62.9%) were rheumatoid factor (RF) positive (RF titer >9.56 IU/mL). There were no significant differences between age, sex, and lipid profiles of patient and control group. cIMT was significantly higher in RA patients (0.50 ± 0.16 mm) than in controls (0.44 ± 0.09 mm) (P = 0.007). Similarly, FMD% was significantly lower in RA patients [5.26 (2.9-10.6)] as compared with controls [10.34 (7.4-14.3)] (P = 0.004). Age, systolic blood pressure, tender joint count, and swollen joint count had significant correlations with patient cIMT. RF titer came out to be the major risk factor for increased cIMT of the patients. Compared with controls, early RA patients have higher cIMT and lower FMD%, denoting premature atherosclerosis. Our data suggest that early determination of FMD% and cIMT may be useful tools to assess cardiovascular risk even in early RA patients.

Cerebrovascular disorders: carotid-wall intima-media thickness, stroke recurrence, and β-blocker selectivity

It is always amazing to see how many articles are published in the field of cerebrovascular disorders every month, even in very high-ranking journals. This is most certainly justified because daily clinical practice shows how relevant cerebrovascular disorders are. The three articles discussed in this month’s Journal Club primarily focus on primary or secondary prophylaxis. In the first study published in the New England Journal of Medicine, intima-media thickness of the walls of the common carotid artery and internal carotid artery, as well as the presence of plaque, were identified as a predictor for cardiovascular outcomes. The second article deals with stroke recurrence within the time window recommended for carotid endarterectomy, i.e. within 2 weeks after the first stroke due to a carotid stenosis. The article shows that early recurrent stroke risk was indeed high, particularly within the first 72 h, which has a considerable clinical impact. The final article, a systematic review on the effects of b-blocker selectivity on blood pressure variability and stroke also has clinical implications: non-selective b-blockers should be avoided in neurologic practice. In other words, b1-selective blockers can be used with the exception of atenolol, which has been shown not to be effective for stroke prevention. Carotid-wall intima-media thickness and cardiovascular events Known risk factors for cardiovascular events are increased systolic blood pressure, cholesterol, diabetes, cigarettesmoking, age, male sex, and history of cardiovascular disease. On the other hand, patients clearly benefit from hypertension treatment. In the current study, Polak and co-workers from Boston University examined whether intima-media thicknesses of the walls of the common carotid artery and internal carotid artery are independent risk factors and, further, if they may add to the Framingham risk score for predicting cardiovascular events. In 2,965 members of the Framingham Offspring Study cohort, the mean intima-media thickness of the common carotid artery and the maximum intima-media thickness of the internal carotid artery as well as the presence of plaque (defined as intima-media thickness of the internal carotid artery of more than 1.5 mm) were measured. Of these 2,965 participants a total of 296 had a cardiovascular event. The major findings were as follows: First, in the group of patients with no cardiovascular disease at follow-up the mean common carotid artery thickness was 0.59 ± 0.13 versus 0.66 ± 0.15 mm in the group of patients with cardiovascular disease at follow-up. Second, in those with no cardiovascular disease at follow-up the maximum internal carotid artery thickness was 1.30 ± 0.79 versus 1.9 ± 1.00 mm in those with cardiovascular disease at follow-up. Third, 27.4% of patients with no cardiovascular disease at follow-up had evidence of a plaque versus 59.6% of those with cardiovascular disease at follow-up. Fourth, the above-mentioned risk factors predicted the cardiovascular events with a so-called C statistic of 0.748. Fifth, the mean intima-media thickness of the common carotid artery and the maximum intima-media thickness of the internal

Effects of telmisartan and losartan on cardiovascular protection in Japanese hypertensive patients

The Telmisartan and Losartan Cardiac Evaluation Trial, a multicenter, prospective, randomized, open-labeled, blinded-endpoint trial, was designed to compare the effects of two angiotensin II receptor blockers (ARBs), telmisartan and losartan, on cardiovascular protection in Japanese patients with mild to moderate essential hypertension. We compared the effects of telmisartan and losartan on left ventricular (LV) hypertrophy, cardiac function, atherosclerosis of carotid arteries and surrogate markers related to the actions of peroxisome proliferator-activated receptor-γ. A total of 58 patients were enrolled in the present trial and the follow-up period was 1 year. There were no significant differences in blood pressure (BP) levels between the telmisartan group and the losartan group throughout the trial. The percentage of the patients treated with ARB monotherapy was significantly higher in the telmisartan group compared with the losartan group. In addition, the progression of intima-media thickness of common carotid artery was significantly inhibited in the telmisartan group compared with the losartan group. Neither group experienced significant changes in cardiac function and LV mass index. There were no differences between the groups with respect to changes in surrogate markers such as serum adiponectin, creatinine, homeostasis model assessment index, plasminogen activator inhibitor-1 and high sensitivity C-reactive protein. Although BP levels were equal and well controlled in both groups, telmisartan showed more protective vascular effects than losartan.

INTIMA-MEDIA THICKNESS OF THE COMMON CAROTID ARTERY AND LDL-R DEFECT IN ASYMPTOMATIC SEVERE HYPERCHOLESTEROLEMIA

The data on the examination of early vascular alterations in carriers of molecular defects of the LDL-R in comparison to non-carriers with severe hypercholesterolemia are controversial. Aim: To examine the difference between patients with severe hypercholesterolemia, who are carriers and non-carriers of LDL-R defective gene, with respect to their structural (intima-media thickness of carotid artery) characteristics of arterial wall. A total of 60 hypercholesterolemic patients were enrolled. Biochemistry parameters were examined by routine methods. Determination of intima-media thickness of common carotid artery was performed with Hewlett Packard Sonos 5 500, using automated computer software MedicaSoft. IMT.lab. Results: There was no significant difference between the groups with respect to total cholesterol, LDL, HDL, triglycerides. We were founded a significantly higher carotid IMT in the carriers versus non-carriers. This significant difference was confirmed after adjustment for age and gender. Conclusion: Our data demonstrate that carriers of the LDL-R defective gene have a higher carotid IMT than non-carriers, whereas no difference between the groups was found with respect to the level of lipid parameters.

Increased Intima-Media Thickness in Carriers of the LDL-Receptor Defective Gene versus Noncarriers with Newly Detected Asymptomatic Severe Hypercholesterolemia

The data on the examination of early vascular alterations in carriers of molecular defects of the low-density lipoprotein-receptor (LDL-R) in comparison to noncarriers with severe hypercholesterolemia are controversial. To examine the difference between patients with severe hypercholesterolemia, who are carriers and noncarriers of LDL-R defective gene, with respect to their functional (flow-mediated vasodilation) and structural (intima-media thickness of carotid artery) characteristics of arterial wall. A total of 250 hypercholesterolemic patients were enrolled. Biochemistry parameters were examined by routine methods. The molecular biological analysis included-R3500Q-mutation in the Apolipoprotein-B (Apo-B) gene, LDL-R gene mutation and polymorphism (and the promoter region), as large rearrangements. Determination of flow-mediated vasodilation and intima-media thickness of common carotid artery was performed with Hewlett Packard Sonos 5500, using automated computer software MedicaSoft. IMT.lab. There was no significant difference between the groups with respect to total cholesterol, LDL, HDL, Apo-B, Apolipoprotein A(1) (Apo-A(1) ), asymmetric dimethylarginine (ADMA), homocysteine, and cellular adhesion molecules. The Apo-B/Apo A(1) index differed significantly (t = 11.23, P < 0.001) between the two groups and this difference was found even after adjustment for age and gender. There was no significant difference with respect to the endothelial dependent and independent vasodilatation between the examined groups (P > 0.05). We were founded a significantly higher carotid IMT in the carriers versus noncarriers. This significant difference was confirmed after adjustment for age and gender. Statistically significant correlations we were founded between IMT mean and age (log) (r(xy) = 0.45; P < 0.01), cholesterol × years score (log) (r(xy) = 0.53; P < 0.01), Apo-B/A(1) (log) (r(xy) = 0.66; P < 0.001) in the group of the carriers. Backward selection process selected Apo-B/A(1) as the most important statistically significant factor related to IMT mean of common carotid artery (F = 105.22; P = 0.001; R(2) = 0.72). Our data demonstrate that carriers of the LDL-R defective gene have a higher carotid IMT and Apo B/Apo A(1) index than noncarriers, whereas no difference between the groups was found with respect to the level of lipid parameters, ADMA, total homocysteine, cell adhesion molecules and %FMD. Apo-B/A(1) is a predictor of IMT mean in the group of the carriers of the LDL-receptor gene.

Intima medial thickness of common carotid arteries by ultrasonogram is a good marker to assess disease activity in Takayasu′s arteritis

Intima medial thickness of common carotid arteries by ultrasonogram is a good marker to assess disease activity in Takayasu′s arteritis