Variance In Carotid Intima-media Thickness Research Articles

The effects of lithium and inflammation on the atherosclerosis of older bipolar patients at high risk for cardiovascular disease

IntroductionAtherosclerosis can result in serious cardiovascular disease (CVD) and is associated with inflammation and psychopharmacological treatment in bipolar disorder.ObjectivesWe attempt to investigate the effects of lithium and inflammation on the atherosclerotic development in older bipolar adults at high risk for cardiovascular disease.MethodsThe euthymic out-patients with bipolar I disorder aged over 45 years and concurrent endocrine or cardiovascular disease were recruited to measure their bilateral carotid intima media thickness (CIMT) and circulating levels of lithium, valproate, sTNF-R1, sIL-6R, and lipid profile. All clinical information were obtained by directly interviewing patients and reviewing all medical records.ResultsForty eight patients with mean 48.3 years old and mean 27.2 years of age at illness onset were recruited. After controlling for the body mass index, multivariate regression analyses showed that older age, lower lithium level, and higher plasma sTNF-R1 level were associated with higher CIMT and collectively accounting for 33.1% of the variance in CIMT. Blood level of low density lipid or valproate has none relationship with CIMT.ConclusionsLithium treatment may protect older bipolar patient, even those at high risk for CVD, from atherosclerotic development. Furthermore, persistent inflammatory activation, particularly macrophage activation, may be associated with the accelerating development of atherosclerosis.DisclosureNo significant relationships.

530 - The effects of lithium and inflammation on the atherosclerosis of older bipolar patients at high risk for cardiovascular disease

Background:Atherosclerosis can result in serious cardiovascular disease (CVD) and is associated with inflammation and psychopharmacological treatment in bipolar disorder. We attempt to investigate the effects of lithium and inflammation on the atherosclerotic development in older bipolar adults at high risk for cardiovascular disease.Methods:The euthymic out-patients with bipolar I disorder aged over 45 years and concurrent endocrine or cardiovascular disease were recruited to measure their bilateral carotid intima media thickness (CIMT) and circulating levels of lithium, valproate, sTNF-R1, sIL-6R, and lipid profile. All clinical information were obtained by directly interviewing patients and reviewing all medical records.Results:Forty eight patients with mean 48.3 years old and mean 27.2 years of age at illness onset were recruited. After controlling for the body mass index, multivariate regression analyses showed that older age, lower lithium level, and higher plasma sTNF-R1 level were associated with higher CIMT and collectively accounting for 33.1% of the variance in CIMT. Blood level of low density lipid or valproate has none relationship with CIMT.Conclusion:Lithium treatment may protect older bipolar patient, even those at high risk for CVD, from atherosclerotic development. Furthermore, persistent inflammatory activation, particularly macrophage activation, may be associated with the accelerating development of atherosclerosis.

Association of traditional cardiovascular risk factors with carotid atherosclerosis among adults at a teaching hospital in south-western Nigeria.

SummaryBackgroundTraditional cardiovascular risk factors (CVRFs), which include age, gender, hypertension, diabetes mellitus, dyslipidaemia, smoking, alcohol consumption, chronic kidney disease and obesity, have been shown to be associated with atherosclerosis. We aimed to evaluate the impact of traditional CVRFs on carotid atherosclerosis (CA) in a sample of Nigerian adults.MethodsWe examined 162 subjects with traditional CVRFs in a cross-sectional study. Demographic and clinical data, including history of hypertension, diabetes mellitus, smoking, alcohol intake and chronic kidney disease, as well as systolic and diastolic blood pressure, weight and height were collected. Serum creatinine, fasting blood glucose and lipid profiles were also determined. Carotid intima–media thickness (CIMT) and presence of carotid plaque (CP) were evaluated by high-frequency B-mode ultrasound. Chi-squared and regression analyses were carried out to determine associations between variables of CIMT and CVRF. ResultsIncreased CIMT was associated with all CVRFs (p < 0.05) except gender (p > 0.05), while CP was associated with older age, obesity, hypertension and dyslipidaemia (p < 0.05). We found prevalence of increased CIMT was 53.7%, while that of CP was 16.1%. The prevalence of CA (increased CIMT and CP) also increased with increasing number of CVRFs in the subjects. Age ≥ 50 years, hypertension, dyslipidaemia, obesity and alcohol intake explained 78.7% of variance in CIMT, while age ≥ 50 years and hypertension explained 38.0% of variance in CP. ConclusionsCA was associated with presence and increasing number of traditional CVRFs. A significant percentage of variance in CA was, however, unexplained by traditional CVRFs.

A Pilot Study Providing Evidence for a Relationship between a Composite Lifestyle Score and Risk of Higher Carotid Intima-Media Thickness: Is There a Link to Oxidative Stress?

Lifestyle behaviours have been closely linked to the progressive cell damage associated with oxidative stress (OS) and the development of cardiovascular disease (CVD). Early detection of lifestyle-linked OS may therefore be useful in the early identification of prodromal disease. To test this hypothesis, this study assessed the relationship between a comprehensive redox balance lifestyle score (RBLS) and carotid intima-media thickness (CIMT), a recognized marker for CVD, and plasma biomarkers of OS. In a cross-sectional study design, 100 apparently healthy middle-aged participants were asked to complete a comprehensive lifestyle questionnaire, followed by DXA scanning, CIMT ultrasonography, and blood collection. The RBLS was composed of lifestyle components with pro- and antioxidant properties with a higher score indicative of lower oxidative activity. Multiple linear regression and logistic regression analysis were performed for statistical analysis. The RBLS was significantly associated with the risk for increased CIMT that was independent of conventional CVD risk factors (χ2(9) = 35.60, P ≤ 0.001). The adjusted model explained 42.4% of the variance in CIMT. Participants with RBLS below the median were at significantly increased risk of higher CIMT compared to participants with RBLS above the median (OR = 3.60, 95% CI: 1.19–10.88, P = 0.023). Significant associations were also observed between the RBLS, plasma total antioxidant capacity (TAC) (r(99) = 0.28, P = 0.006), hydroperoxide (HPX) (rs(99) = −0.28, P = 0.005), TAC/HPX ratio (r(98) = 0.41, P ≤ 0.001), γ-glutamyltransferase (r(97) = −0.23, P = 0.024), uric acid (r(98) = −0.20, P = 0.045), and inflammatory C-reactive protein (rs(97) = −0.25, P = 0.012) and interleukin-1β (r(97) = −0.21, P = 0.040). These findings highlight the importance of identifying the collective influence of lifestyle behaviours on OS activity and its potential to remodel the vascular endothelium.

Response to Letter Regarding Article, “Traditional Risk Factors Are Not Major Contributors to the Variance in Carotid Intima-Media Thickness”

HomeStrokeVol. 44, No. 12Response to Letter Regarding Article, “Traditional Risk Factors Are Not Major Contributors to the Variance in Carotid Intima-Media Thickness” Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBResponse to Letter Regarding Article, “Traditional Risk Factors Are Not Major Contributors to the Variance in Carotid Intima-Media Thickness” Tatjana Rundek, MD, PhD and Susan H. Blanton, PhD Tatjana RundekTatjana Rundek Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL Search for more papers by this author and Susan H. BlantonSusan H. Blanton Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL Search for more papers by this author Originally published5 Nov 2013https://doi.org/10.1161/STROKEAHA.113.003653Stroke. 2013;44:e236Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: January 1, 2013: Previous Version 1 We thank Santilli et al for their interest in our article and for emphasizing the potential important contribution of psychological factors to the development of subclinical atherosclerosis. Psychological factors, such as depression, anger, sustained anxiety, and alexithymia, have been associated with increased carotid intima-media thickness in the Multi-Ethnic Study of Atherosclerosis (MESA) and in HIV-infected patients.1,2There are many psychological, social, and cultural factors that may be potentially important determinants or modifiers of the atherosclerosis pathway from subclinical to overt vascular disease. Health-damaging psychological factors, such as stress, negative emotions, and health-promoting factors such as social support, are important predictors of cardiovascular disease (CVD) and stroke and may play a similar or larger role in CVD and stroke relative to traditional risk factors, including hypertension.3 However, available evidence addressing psychological, social, and cultural variables in relation to CVD and stroke and its intermediate phenotypes, such as carotid intima-media thickness and plaque in the general population as well as in diverse race-ethnic groups, is limited in the United States.In the Northern Manhattan Study (NOMAS), prestroke social isolation was a predictor of poststroke outcomes,4 suggesting that a lack of social support contributes to poorer outcomes because of poor compliance, depression, and stress. Limited research has addressed sociocultural processes, such as culturally driven beliefs, attitudes, and behaviors, that may help explain vascular risk in the general population and in individuals at increased risk for CVD and stroke. In addition, little is known about vulnerability factors, such as ethnic-specific stressors or resiliency factors such as family cohesion and social support, that have been suggested as possible mechanisms that may exacerbate or buffer vascular risk among diverse age, sex, and race-ethnic groups. In addition, little is known about the association between neighborhood environments, either physical (eg, food and recreational access) or social (eg, social cohesion), and risk of atherosclerosis and CVD.5The exact mechanism by which these psychosocial and cultural factors affect development of atherosclerosis is not well-understood. Alterations in the autonomic nervous system as a result of chronic health-damaging stressors may be the common mechanism linking them to cardiovascular responses and to an increased risk of atherosclerosis. More research is needed to elucidate the health-damaging and health-promoting biological mechanisms of psychological, social, and cultural factors on atherosclerosis.Therefore, we agree with Santilli et al that psychological and sociocultural factors may have a major role in the development of subclinical and clinical CVD, and research in this area is critically needed for CVD health prevention and health promotion.Tatjana Rundek, MD, PhDSusan H. Blanton, PhDDepartment of NeurologyMiller School of MedicineUniversity of MiamiMiami, FLDisclosuresNone.

Letter by Santilli et al Regarding Article, “Traditional Risk Factors Are Not Major Contributors to the Variance in Carotid Intima-Media Thickness”

With great interest we read the article by Rundek et al1 reporting, in a large and multiethnic population, that traditional vascular risk factors explain only 11% of the variance in carotid intima-media thickness (cIMT), with only an additional 5% explained by less traditional factors, including adiponectin, homocysteine, and inflammation. Despite the differences between cIMT protocols and population features among studies, >70% of the cIMT variance is consistently not explained by traditional risk factors.2 Besides ongoing research regarding the possible contribution of genetic determinants of IMT variance, made plausible by the heritable nature of the IMT trait, several environmental factors, including psychological factors such as depression, anger, and sustained anxiety, have been robustly shown to predict IMT and its progression, …

Insulin clearance is associated with carotid artery intima–media thickness

ObjectiveThe aim of this study was to investigate whether insulin clearance is independently associated with carotid artery intima–media thickness (IMT), a well-recognized index of vascular damage. Methods361 Non-diabetic Caucasian subjects were subjected to euglycemic hyperinsulinemic clamp to assess insulin sensitivity, and insulin clearance. IMT of the common carotid was measured by ultrasonography. ResultsAmong the study group, 270 subjects had normal glucose tolerance, 33 had impaired fasting glucose, and 58 had impaired glucose tolerance. Univariate correlations showed that age, BMI, waist, blood pressure, triglycerides, fasting and 2-h post-load glucose and insulin levels were positively correlated with carotid IMT whereas HDL, insulin clearance, and insulin-stimulated glucose disposal were negatively correlated with IMT. A multivariate regression analysis in a model including, in addition to insulin clearance, age, gender, BMI, waist, blood pressure, triglycerides, HDL, fasting and 2-h post-load glucose, insulin-stimulated glucose disposal, fasting and 2-h post-load insulin showed that the traits independently associated with carotid IMT were BMI (β = 0.42, P < 0.0001), insulin clearance (β = −0.29, P < 0.0001), age (β = 0.19, P < 0.0001), waist (β = 0.18, P = 0.01), diastolic blood pressure (β = 0.17, P = 0.01), and 2-h post-load glucose (β = 0.12, P = 0.03). These factors explained 26% of the variance in carotid IMT. Subjects in the lowest tertile of insulin clearance had a 4.06-fold higher odds of having vascular damage (IMT > 0.9 mm) as compared with those in the highest tertile (OR 4.06, 95%CI 1.15–13.24). ConclusionsInsulin clearance is independently associated with carotid IMT in adult non-diabetic subjects. Individuals with lower levels of insulin clearance have a higher odds of vascular damage.

Traditional Risk Factors Are Not Major Contributors to the Variance in Carotid Intima-Media Thickness

Carotid intima-media thickness (cIMT) was a widely accepted ultrasound marker of subclinical atherosclerosis in the past. Although traditional risk factors may explain ≈50% of the variance in plaque burden, they may not explain such a high proportion of the variance in IMT, especially when measured in plaque-freel ocations. We aimed this study to identify individuals with cIMT unexplained by traditional risk factors for future environmental and genetic research. As part of the Northern Manhattan Study, 1790 stroke-free individuals (mean age, 69±9 years; 60% women; 61% Hispanic; 19% black; 18% white) were assessed for cIMT using B-mode carotid ultrasound. Multiple linear regression models were evaluated: (1) incorporating prespecified traditional risk factors; and (2) including less traditional factors, such as inflammation biomarkers, adiponectin, homocysteine, and kidney function. Standardized cIMT residual scores were constructed to select individuals with unexplained cIMT. Mean total cIMT was 0.92±0.09 mm. The traditional model explained 11% of the variance in cIMT. Age (7%), male sex (3%), glucose (<1%), pack-years of smoking (<1%), and low-density lipoprotein cholesterol (<1%) were significant contributing factors. The model, including inflammatory biomarkers, explained 16% of the variance in cIMT. Adiponectin was the only additional significant contributor to the variance in cIMT. We identified 358 individuals (20%) with cIMT unexplained by the investigated risk factors. Vascular risk factors explain only a small proportion of variance in cIMT. Identification of novel genetic and environmental factors underlying unexplained subclinical atherosclerosis is of utmost importance for future effective prevention of vascular disease.

Lipids and lipoprotein ratios: Contribution to carotid intima media thickness in adolescents and young adults with type 2 diabetes mellitus

Dyslipidemia is common among adolescents with type 2 diabetes (T2D). To assess whether the lipoprotein ratios of low-density lipoprotein (LDL) cholesterol/high-density lipoprotein (HDL) cholesterol or triglycerides/HDL or non-HDL cholesterol are more useful than the traditional lipid panel to predict increased arterial thickness in adolescents and young adults with T2D. We evaluated 244 adolescents and young adults with T2D in a cross-sectional study (mean age 18 years; 56% African American; 65% female). Demographics, anthropometrics, and laboratory data were collected. Arterial thickness was assessed with carotid intima media thickness (IMT). Bivariate correlations and general linear models were used to determine the independent contributions of the various lipid parameters to carotid IMT. Bivariate correlations showed LDL/HDL ratio was the strongest predictor of carotid IMT (P < .02). After adjustment for potential covariates LDL/HDL was no longer significant. HDL cholesterol was the only lipid to independently (negatively) contribute to carotid IMT. Other risk factors that were independently associated with carotid IMT included age, race, sex, body mass index z score, and hemoglobin A1c. Together these cardiovascular risk factors explained <20% of the variance in carotid IMT. HDL cholesterol is the only lipid to independently associate with carotid IMT. Lipoprotein ratios and non-HDL did not provide additional information. The low variance in carotid IMT explained by traditional risk factors suggests nontraditional risk factors may be important to assess to better understand the contributors to early-stage atherosclerosis in adolescents and young adults with T2D.

Silent Ischemia Is Associated With Subclinical Atherosclerosis in African Males: The Sympathetic Activity and Ambulatory Blood Pressure in Africans Study

Silent myocardial ischemia is a predictor of subclinical atherosclerosis driven by increased cardiovascular risk markers, although still unknown in Africans. The aim of this study was to assess if cardiovascular risk markers will be associated with subclinical atherosclerosis. African men were stratified into (i) 24-hour silent ischemia (SI, n = 38) and (ii) without (nSI, n = 40) groups. Ambulatory blood pressure (BP), SI, 12-lead resting electrocardiogram, ultrasound carotid intima-media thickness (CIMT) measurements, and fasting blood samples were obtained. Above-normal cardiovascular risk markers, that is, glucose level, heart rate, BP, and CIMT, were evident in men with SI. Hypertension prevalence was 89% in the African SI men as opposed to 64% in the nSI men. Regression analyses revealed that only SI events in SI men explained 35% (95% confidence interval [CI]: 0.22;0.52) of the variance in CIMT, while in all African men it explained 29% (95% CI: 0.19;0.39). In conclusion, SI was associated with structural vascular disease in African men. This could imply that SI is not necessarily driven by hypertension in African men but through other possible mechanisms such as increased sympathetic nervous system activity.

Conventional and novel cardiovascular risk factors and markers of vascular damage in rural and urban Indian men

BackgroundIndia is undergoing rapid epidemiological and nutritional transition largely as a consequence of rapid urbanisation. We investigated conventional and novel cardiovascular risk factors in rural and urban Indian men and studied their association with markers of vascular damage. MethodsWe randomly selected and studied 149 rural, 142 urban slum residents and 150 urban middle class middle aged Indian men. We measured conventional (obesity, blood pressure, lipids, smoking habits) and novel (proinflammatory and prothrombotic factors) cardiovascular risk factors and markers of vascular damage (carotid intima media thickness (IMT), von Willebrand Factor (vWF), e-selectin). ResultsThere was a progressive increase in most of the conventional cardiovascular (CV) risk factors from rural to slum to urban middle class men. Plasminogen activator inhibitor-1 (PAI-1), platelet count, total homocysteine and C-reactive protein showed similar patterns. Carotid IMT was similar in the three groups; vWF was highest in rural and e-selectin in slum men. Adjusting for location, age explained 17%, obesity 3% and conventional risk factors 1% of the variance in carotid IMT, whilst novel cardiovascular risk factors were without any significant impact. ConclusionsUrbanisation increases obesity related as well as prothrombotic and proinflammatory CV risk factors in Indian men, but appears not to impact on IMT.

Risk factors for cardiovascular disease do not fully explain differences in carotid intima–media thickness between Indigenous and European Australians without diabetes

To investigate whether cardiovascular risk factors can explain the higher carotid intima-media thickness (CIMT) in Indigenous compared with European Australians. Cross-sectional study in three subgroups. Non-diabetic urban European (n = 86), urban Indigenous (n = 69), and remote Indigenous (n = 60) Australians aged 25-64 years. CIMT, age, sex, anthropometry, blood pressure, smoking status, fasting glucose and insulin, haemoglobin (Hb)A1c, homocysteine, C-reactive protein (CRP), lipids, urinary albumin and creatinine. CIMT and levels of risk factors, except fasting glucose and total cholesterol, worsened across the three groups. Log(n) fasting insulin [beta = 0.022, 95% confidence interval (CI) 0-0.0439], age (beta = 0.006, 95% CI 0.004-0.007), gender (female beta = -0.005 vs. male, 95% CI -0.084 to -0.026), mean arterial pressure (MAP) (beta = 0.001, 95% CI 0.001-0.002) and ethnicity/location [urban Indigenous (beta = 0.027, 95% CI -0.010 to 0.064 vs. European); remote Indigenous (beta = 0.083, 95% CI 0.042-0.123 vs. European)] explained 41% of variance in CIMT. Significant interactions were seen for ethnicity/location with age (P = 0.014) and MAP (P = 0.018). Age was consistently associated with CIMT across the three populations, and was associated with larger increments in CIMT for the Indigenous subgroups (beta = 0.007, 95% CI 0.005-0.009 urban; beta = 0.007, 95% CI 0.004-0.010 remote) compared with Europeans (beta = 0.003, 95% CI 0.002-0.006) in models including age, sex and MAP. MAP was only associated with CIMT in the remote Indigenous subgroup. After adjusting for selected risk factors, CIMT in remote Indigenous participants was still higher than in Europeans. The slope of the association between age and CIMT steepened from urban Europeans to remote Indigenous.

Risk of cardiovascular disease measured by carotid intima-media thickness at age 49-51: lifecourse study

Objective: To quantify the direct and indirect effects of fetal life, childhood, and adult life on risk of cardiovascular disease at age 49–51 years.Design: Follow up study of the “Newcastle...