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The Effect of Low-dose Combined Oral Contraceptive Pills on Brachial Artery Endothelial Function and Common Carotid Artery Intima–Media Thickness. J Stroke Cerebrovasc Dis 2014; 23:675-80. [DOI: 10.1016/j.jstrokecerebrovasdis.2013.06.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 06/05/2013] [Accepted: 06/07/2013] [Indexed: 11/22/2022] Open
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202
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Zhao J, Roman MJ, Devereux RB, Yeh F, Zhang Y, Haack K, Best LG, Cole SA, Lee ET, Howard BV. Leukotriene haplotype × diet interaction on carotid artery hypertrophy and atherosclerosis in American Indians: the Strong Heart Family Study. Atherosclerosis 2014; 233:165-71. [PMID: 24529139 PMCID: PMC3932307 DOI: 10.1016/j.atherosclerosis.2013.12.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 11/04/2013] [Accepted: 12/05/2013] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Gene × diet interaction plays an important role in atherosclerosis, an inflammatory disorder. Leukotrienes are the most potent inflammatory mediators, and genetic variants encoding leukotriene genes have been implicated in atherosclerosis. This study tests nutrigenetic interaction of a previously defined leukotriene haplotype on carotid artery hypertrophy and atherosclerosis in American Indians. METHODS This study included 3402 American Indians participating in the Strong Heart Family Study (SHFS). Carotid artery measurements, including intima-media thickness (IMT), vascular mass, and plaque, were assessed using ultrasound. Eleven tagSNPs in the leukotriene A4 hydrolase (LTA4H) gene were genotyped in all subjects. Main haplotype effect and haplotype × diet interaction were examined by generalized estimating equation, adjusting for known risk factors. RESULTS There was no significant main effect of haplotype or diet on any of the carotid artery measures. However, a previously defined LTA4H haplotype, called HapE, significantly interacted with dietary intake of n-3 and n-6 fatty acids on both IMT (P(HapE × n3) = 0.018, P(HapE × n6) = 0.040) and vascular mass (P(HapE × n3) = 0.012, P(HapE × n6) = 0.018), but not plaque. The direction of this nutrigenetic interaction on IMT was consistent with that reported in a recent study of Caucasian twins. CONCLUSION Dietary intake of polyunsaturated fatty acids significantly modifies the effect of a leukotriene haplotype on carotid artery hypertrophy but not atherosclerosis in American Indians, independent of established cardiovascular risk factors. Replication of nutrigenetic interaction in two distinct ethnic groups suggests the robustness and generalizability of our findings to diverse populations.
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Affiliation(s)
- Jinying Zhao
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA.
| | - Mary J Roman
- Weill Cornell Medical College, New York, NY, USA
| | | | - Fawn Yeh
- Center for American Indian Health Research, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Ying Zhang
- Center for American Indian Health Research, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Karin Haack
- Texas Biomedical Research Institute, San Antonio, TX, USA
| | - Lyle G Best
- Missouri Breaks Industries Research Inc, Timber Lake, SD, USA
| | - Shelley A Cole
- Texas Biomedical Research Institute, San Antonio, TX, USA
| | - Elisa T Lee
- Center for American Indian Health Research, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Barbara V Howard
- MedStar Health Research Institute Hyattsville, MD and Georgetown and Howard Universities Centers for Translational Sciences, Washington, DC, USA
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203
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Lewis JR, Zhu K, Thompson PL, Prince RL. The effects of 3 years of calcium supplementation on common carotid artery intimal medial thickness and carotid atherosclerosis in older women: an ancillary study of the CAIFOS randomized controlled trial. J Bone Miner Res 2014; 29:534-41. [PMID: 24155106 DOI: 10.1002/jbmr.2117] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 10/07/2013] [Accepted: 10/14/2013] [Indexed: 01/22/2023]
Abstract
Calcium is an essential nutrient for skeletal health; however, it has been suggested that supplemental calcium may be associated with adverse cardiovascular effects, raising widespread concern about their use. One suggested mechanism is via increasing carotid atherosclerosis, however few randomized controlled trials (RCT) of calcium supplements have assessed these mechanisms. The calcium intake fracture outcome study (CAIFOS) was a 5-year RCT (1998 to 2003) of 1.2 g of elemental calcium in the form of calcium carbonate in 1460 elderly women. An ancillary study of 1103 women assessed common carotid artery intimal medial thickness (CCA-IMT) and carotid atherosclerosis at year 3 (2001). The effects of supplementation were studied in intention-to-treat (ITT) and per-protocol (PP) analyses before and after adjustment for baseline cardiovascular risk factors. The mean age of participants at baseline was 75.2 ± 2.7 years. In ITT analyses, women randomized to calcium supplementation had no difference in multivariable-adjusted mean CCA-IMT (calcium 0.778 ± 0.006 mm, placebo 0.783 ± 0.006 mm, p = 0.491) and maximum CCA-IMT (calcium 0.921 ± 0.007 mm, placebo 0.929 ± 0.006 mm, p = 0.404). Women randomized to calcium did not have increased carotid atherosclerosis (calcium 47.2%, placebo 52.7%, p = 0.066). However, in women taking at least 80% of the supplements, a significant reduction in carotid atherosclerosis was observed in unadjusted but not in multivariate-adjusted models (p = 0.033 and p = 0.064, respectively). Participants in the highest tertile of total calcium (diet and supplements) had reduced carotid atherosclerosis in unadjusted and multivariable-adjusted analyses compared with participants in the lowest tertile (odds ratio [OR] = 0.67 [95% confidence interval (CI) 0.50-0.90], p = 0.008, and OR = 0.70 [95% CI 0.51-0.96], p = 0.028, respectively). In conclusion, these findings do not support the hypothesis that calcium supplementation increases carotid artery intimal medial thickness or carotid atherosclerosis, and high calcium intake may reduce this surrogate cardiovascular risk factor.
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Affiliation(s)
- Joshua R Lewis
- School of Medicine and Pharmacology, Sir Charles Gairdner Hospital Unit, University of Western Australia, Nedlands, Australia; Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Australia
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Pike D, Lindenmaier TJ, Sin DD, Parraga G. Imaging evidence of the relationship between atherosclerosis and chronic obstructive pulmonary disease. ACTA ACUST UNITED AC 2014. [DOI: 10.2217/iim.13.70] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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205
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Buscemi S, Nicolucci A, Lucisano G, Galvano F, Grosso G, Belmonte S, Sprini D, Migliaccio S, Cianferotti L, Brandi ML, Rini GB. Habitual fish intake and clinically silent carotid atherosclerosis. Nutr J 2014; 13:2. [PMID: 24405571 PMCID: PMC3893519 DOI: 10.1186/1475-2891-13-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 01/07/2014] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Fish consumption is recommended as part of a healthy diet. However, there is a paucity of data concerning the relation between fish consumption and carotid atherosclerosis. We investigated the association between habitual fish consumption and asymptomatic carotid atherosclerosis, defined as the presence of plaques and/or increased intima-media thickness (≥ 0.90 mm), in non-diabetic participants. METHODS Nine hundred-sixty-one (range of age: 18-89 yrs; 37.1% males) adult participants without clinically known atherosclerotic disease were randomly recruited among the customers of a shopping mall in Palermo, Italy, and cross-sectionally investigated. Each participant answered a food frequency questionnaire and underwent high-resolution ultrasonographic evaluation of both carotid arteries. Routine laboratory blood measurements were obtained in a subsample of 507 participants. RESULTS Based on habitual fish consumption, participants were divided into three groups: non-consumers or consumers of less than 1 serving a week (24.0%), consumers of 1 serving a week (38.8%), and consumers of ≥ 2 servings a week (37.2%). Age-adjusted prevalence of carotid atherosclerosis (presence of plaques or intima media thickness ≥ 0.9 mm) was higher in the low fish consumption group (13.3%, 12.1% and 6.6%, respectively; P = 0.003). Multivariate analysis evidenced that carotid atherosclerosis was significantly associated with age (OR = 1.12; 95% CI = 1.09-1.14), hypertension on pharmacologic treatment (OR = 1.81; 95% CI = 1.16-2.82), and pulse pressure (OR = 1.03; 95% CI = 1.01-1.04), while consuming ≥2 servings of fish weekly was protective compared with the condition of consumption of <1 serving of fish weekly (OR = 0.46; 95% CI = 0.26-0.80). CONCLUSIONS High habitual fish consumption seems to be associated with less carotid atherosclerosis, though adequate interventional trials are necessary to confirm the role of fish consumption in prevention of cardiovascular disease.
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Affiliation(s)
- Silvio Buscemi
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS) - Laboratorio di Nutrizione Clinica, University of Palermo, Palermo, Italy.
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206
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Kulshreshtha A, Goyal A, Veledar E, McClellan W, Judd S, Eufinger SC, Bremner JD, Goldberg J, Vaccarino V. Association between ideal cardiovascular health and carotid intima-media thickness: a twin study. J Am Heart Assoc 2014; 3:e000282. [PMID: 24385450 PMCID: PMC3959690 DOI: 10.1161/jaha.113.000282] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background The American Heart Association (AHA) recently developed the Cardiovascular Health Index (CVHI), a health metric consisting of 7 modifiable risk factors. The relationship of the CVHI with preclinical markers, such as carotid intima‐media thickness (CIMT) has not been assessed. Methods We examined 490 male monozygotic and dizygotic twins without overt cardiovascular disease. CIMT was measured using B‐mode ultrasonography. Each of the 7 CVHI components (blood pressure, fasting glucose, total cholesterol, body mass index, physical activity, healthy diet, and smoking) was given a point score of 0, 1, or 2 to represent poor, intermediate, or ideal health, respectively. A CVHI summation score was computed (range 0 to 14) and categorized as inadequate (0 to 4), average (5 to 9), or optimum (10 to 14) cardiovascular health. Mixed‐model regression was used to examine the association of the CVHI with CIMT. Results The mean age of the twins was 55.4 years, and 61% were monozygotic. The mean CIMT was 0.75 (±0.11) mm and the mean CVHI score was 7.7 (±2.1). There was an inverse correlation between CVHI and CIMT (Spearman r=−0.22, P<0.01). For every 5‐unit increase in overall CVHI score (indicating better cardiovascular health category), CIMT decreased by 0.045 mm (P<0.001) after adjusting for demographic variables and other confounders. Within monozygotic twin pairs, a 5‐unit increment in CVHI score was associated with a 0.05 mm lower CIMT (P<0.001). Conclusions The CVHI is independently associated with CIMT and the association is not confounded by shared genetic and other familial factors.
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Affiliation(s)
- Ambar Kulshreshtha
- Department of Epidemiology, Emory University School of Public Health, Atlanta, GA
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207
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Bal S, Goyal M, Smith E, Demchuk AM. Central nervous system imaging in diabetic cerebrovascular diseases and white matter hyperintensities. HANDBOOK OF CLINICAL NEUROLOGY 2014; 126:291-315. [PMID: 25410230 DOI: 10.1016/b978-0-444-53480-4.00021-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Diabetes mellitus is an important vascular risk factor for cerebrovascular disease. This occurs through pathophysiologic changes to the microcirculation as arteriolosclerosis and to the macrocirculation as large artery atherosclerosis. Imaging techniques can provide detailed visualization of the cerebrovasculature using CT (computed tomography) angiography and MR (magnetic resonance) angiography. Newer techniques focused on advanced parenchymal imaging include CT perfusion, quantitative MRI, and diffusion tensor imaging; each identifies brain lesion burden due to diabetes mellitus. These imaging approaches have provided insights into the diabetes mellitus brain and cerebral circulation pathophysiology. Imaging has taught us that diabetics develop cerebral atrophy, silent infarcts, and white matter disease more rapidly than other patient populations. Longitudinal studies are needed to quantify the rate and extent of such structural brain and blood vessel changes and how they relate to cognitive decline. Diabetes prevention and treatment strategies will then be possible to slow the development of such changes.
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Affiliation(s)
- Simerpreet Bal
- Department of Clinical Neurosciences and Radiology, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Mayank Goyal
- Department of Clinical Neurosciences and Radiology, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Eric Smith
- Department of Clinical Neurosciences and Radiology, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Andrew M Demchuk
- Department of Clinical Neurosciences and Radiology, Foothills Medical Centre, Calgary, Alberta, Canada.
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208
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Lin YC, Dalal D, Churton S, Brennan DM, Korman NJ, Kim ESH, Husni ME. Relationship Between Metabolic Syndrome and Carotid Intima-Media Thickness: Cross-Sectional Comparison Between Psoriasis and Psoriatic Arthritis. Arthritis Care Res (Hoboken) 2013; 66:97-103. [DOI: 10.1002/acr.22144] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 08/20/2013] [Indexed: 02/06/2023]
Affiliation(s)
| | | | - Sarah Churton
- University Hospitals Case Medical Center; Cleveland Ohio
| | | | - Neil J. Korman
- University Hospitals Case Medical Center; Cleveland Ohio
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209
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Costanzo L, Campisano MB, Capodanno D, Sole A, Grasso C, Ragusa M, Ronsivalle G, Tamburino C, Tamburino C, Di Pino L. The SYNTAX score does not predict presence of carotid disease in a multivessel coronary disease population. Catheter Cardiovasc Interv 2013; 83:1169-75. [PMID: 24323404 DOI: 10.1002/ccd.25320] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 08/30/2013] [Accepted: 11/28/2013] [Indexed: 11/08/2022]
Abstract
BACKGROUND Numerous reports have shown the relationship between carotid artery atherosclerosis and coronary artery disease (CAD). However, the association between complex CAD evaluated by SYNTAX score (SxScore) and prevalence of carotid lesion (CL) has not been fully investigated. We sought to assess the prevalence of carotid atherosclerosis in patients with multivessel CAD assessed by SxScore and the relationship between SxScore severity and features of carotid atherosclerosis. METHODS AND RESULTS Subjects were 204 consecutive patients with multivessel CAD assessed by coronary angiography and no previous history of carotid atherosclerosis that underwent carotid ultrasound scan from June 2012 to 2013. Presence of CL, significant carotid disease (SCD) and carotid plaque morphology was evaluated. At least one CL was found in 159 patients (77.9%) with no significant difference among SxScore groups (P = 0.20 and P = 0.54, respectively). High prevalence of complex carotid plaque (CCP) was found without significant different distribution in SxScore groups (P = 0.69). Age was independently associated with the presence of CL [odds ratio (OR) 1.055; 95% confidence interval (CI): 1.015-1.097; P = 0.007] and SCD (OR 1.057; 95% CI: 1.008-1.097; P = 0.019). Age and diabetes were independently associated with CCP (OR 1.58; 95% CI: 1.023-1.095; P = 0.001; OR 1.848; 95% CI: 1.026-3.327; P = 0.041). SxScore was not independently associated with CL, SCD and CCP (all P > 0.2). CONCLUSIONS We found high prevalence of CL in patients with multivessel complex CAD. However, SxScore does not seem to correlate with carotid atherosclerosis.
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Affiliation(s)
- Luca Costanzo
- Division of Angiology, Cardiotoracovascular Department, Ferrarotto-Policlinic Hospital, University of Catania, Catania, Italy
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210
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Ibrahimi P, Jashari F, Nicoll R, Bajraktari G, Wester P, Henein MY. Coronary and carotid atherosclerosis: how useful is the imaging? Atherosclerosis 2013; 231:323-333. [PMID: 24267246 DOI: 10.1016/j.atherosclerosis.2013.09.035] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 09/13/2013] [Accepted: 09/30/2013] [Indexed: 02/08/2023]
Abstract
The recent advancement of imaging modalities has made possible visualization of atherosclerosis disease in all phases of its development. Markers of subclinical atherosclerosis or even the most advanced plaque features are acquired by invasive (IVUS, OCT) and non-invasive imaging modalities (US, MRI, CTA). Determining plaques prone to rupture (vulnerable plaques) might help to identify patients at risk for myocardial infarction or stroke. The most accepted features of plaque vulnerability include: thin cap fibroatheroma, large lipid core, intimal spotty calcification, positive remodeling and intraplaque neovascularizations. Today, research is focusing on finding imaging techniques that are less invasive, less radiation and can detect most of the vulnerable plaque features. While, carotid atherosclerosis can be visualized using noninvasive imaging, such as US, MRI and CT, imaging plaque feature in coronary arteries needs invasive imaging modalities. However, atherosclerosis is a systemic disease with plaque development simultaneously in different arteries and data acquisition in carotid arteries can add useful information for prediction of coronary events.
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Affiliation(s)
- Pranvera Ibrahimi
- Heart Centre and Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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211
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Jung CH, Baek AR, Kim KJ, Kim BY, Kim CH, Kang SK, Mok JO. Association between Cardiac Autonomic Neuropathy, Diabetic Retinopathy and Carotid Atherosclerosis in Patients with Type 2 Diabetes. Endocrinol Metab (Seoul) 2013; 28:309-19. [PMID: 24396696 PMCID: PMC3871040 DOI: 10.3803/enm.2013.28.4.309] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 07/10/2013] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND It is not clear whether microangiopathies are associated with subclinical atherosclerosis in type 2 diabetes mellitus (T2DM). We investigated the relation of cardiac autonomic neuropathy (CAN) and other microangiopathies with carotid atherosclerosis in T2DM. METHODS A total of 131 patients with T2DM were stratified by mean carotid intima-media thickness (CIMT) ≥ or <1.0 mm and the number of carotid plaques. CAN was assessed by the five standard cardiovascular reflex tests according to the Ewing's protocol. CAN was defined as the presence of at least two abnormal tests or an autonomic neuropathy points ≥2. Diabetic microangiopathies were assessed. RESULTS Patients with CAN comprised 77% of the group with mean CIMT ≥1.0 mm, while they were 29% of the group with CIMT <1.0 mm (P=0.016). Patients with diabetic retinopathy (DR) comprised 68% of the group with CIMT ≥1.0 mm, while they were 28% of the group without CIMT thickening (P=0.003). Patients with CAN comprised 51% of the group with ≥2 carotid plaques, while they were 23% of the group with ≤1 carotid plaque (P=0.014). In multivariable adjusted logistic regression analysis, the patients who presented with CAN showed an odds ratio [OR] of 8.6 (95% confidence interval [CI], 1.6 to 44.8) for CIMT thickening and an OR of 2.9 (95% CI, 1.1 to 7.5) for carotid plaques. Furthermore, patients with DR were 3.8 times (95% CI, 1.4 to 10.2) more likely to have CIMT thickening. CONCLUSION These results suggest that CAN is associated with carotid atherosclerosis, represented as CIMT and plaques, independent of the traditional cardiovascular risk factors in T2DM. CAN or DR may be a determinant of subclinical atherosclerosis in T2DM.
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Affiliation(s)
- Chan-Hee Jung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Ae-Rin Baek
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Kyu-Jin Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Bo-Yeon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Chul-Hee Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Sung-Koo Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Ji-Oh Mok
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea
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Diomedi M, Scacciatelli D, Misaggi G, Balestrini S, Balucani C, Sallustio F, Di Legge S, Stanzione P, Silvestrini M. Increased Common Carotid Artery Wall Thickness Is Associated with Rapid Progression of Asymptomatic Carotid Stenosis. J Neuroimaging 2013; 24:473-8. [DOI: 10.1111/jon.12068] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Marina Diomedi
- Stroke Unit; Neuroscience Department; Tor Vergata University of Rome
- IRCCS; Santa Lucia Foundation; Rome
| | - Daria Scacciatelli
- Center for Biostatistics and Bioinformatics; Tor Vergata University of Rome; Rome
| | - Giulia Misaggi
- Stroke Unit; Neuroscience Department; Tor Vergata University of Rome
| | | | - Clotilde Balucani
- Neurological Clinic; Marche Polytechnic University; Ancona
- Department of Neurology; SUNY Downstate Medical Center; Brooklyn NY
| | | | - Silvia Di Legge
- Stroke Unit; Neuroscience Department; Tor Vergata University of Rome
| | - Paolo Stanzione
- Stroke Unit; Neuroscience Department; Tor Vergata University of Rome
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213
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Grimaud O, Lapostolle A, Berr C, Helmer C, Dufouil C, Kihal W, Alpérovitch A, Chauvin P. Gender differences in the association between socioeconomic status and subclinical atherosclerosis. PLoS One 2013; 8:e80195. [PMID: 24282522 PMCID: PMC3839909 DOI: 10.1371/journal.pone.0080195] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 09/30/2013] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES This study explored the pattern of associations between socioeconomic status (SES) and atherosclerosis progression (as indicated by carotid intima media thickness, CIMT) across gender. DESIGN Cross-sectional analysis of a sample of 5474 older persons (mean age 73 years) recruited between 1999 and 2001 in the 3C study (France). We fitted linear regression models including neighborhood SES, individual SES and cardiovascular risk factors. RESULTS CIMT was on average 24 µm higher in men (95% CI: 17 to 31). Neighborhood SES was inversely associated with CIMT in women only (highest versus lowest tertiles: -12.2 µm, 95%CI -22 to -2.4). This association persisted when individual SES and risk factors were accounted for. High individual education was associated with lower CIMT in men (-21.4 µm 95%CI -37.5 to -5.3) whereas high professional status was linked to lower CIMT among women (-15.7 µm 95%CI: -29.2 to -2.2). Adjustment for cardiovascular risk factors resulted in a slightly more pronounced reduction of the individual SES-CIMT association observed in men than in women. CONCLUSION In this sample, neighborhood and individual SES displayed different patterns of associations with subclinical atherosclerosis across gender. This suggests that the causal pathways leading to SES variations in atherosclerosis may differ among men and women.
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Affiliation(s)
| | | | - Claudine Berr
- Institut National de la Santé et de la Recherche Médicale, U1061, Montpellier, France
| | - Catherine Helmer
- Institut National de la Santé et de la Recherche Médicale, U897, Bordeaux, France
| | - Carole Dufouil
- Université Bordeaux Segalen, Bordeaux, France
- Institut National de la Santé et de la Recherche Médicale 708, Paris, France
| | | | - Annick Alpérovitch
- Université Bordeaux Segalen, Bordeaux, France
- Institut National de la Santé et de la Recherche Médicale 708, Paris, France
| | - Pierre Chauvin
- Institut National de la Santé et de la Recherche Médicale U707, Paris, France
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Xiang J, Zhang T, Yang QW, Liu J, Chen Y, Cui M, Yin ZG, Li L, Wang YJ, Li J, Zhou HD. Carotid artery atherosclerosis is correlated with cognitive impairment in an elderly urban Chinese non-stroke population. J Clin Neurosci 2013; 20:1571-5. [DOI: 10.1016/j.jocn.2013.02.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 01/30/2013] [Accepted: 02/04/2013] [Indexed: 11/28/2022]
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215
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Bhatt SP, Dransfield MT. Chronic obstructive pulmonary disease and cardiovascular disease. Transl Res 2013; 162:237-51. [PMID: 23727296 DOI: 10.1016/j.trsl.2013.05.001] [Citation(s) in RCA: 164] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Revised: 04/30/2013] [Accepted: 05/07/2013] [Indexed: 11/18/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is an inflammatory disease of the lung associated with progressive airflow limitation and punctuated by episodes of acute exacerbation. There is growing recognition that the inflammatory state associated with COPD is not confined to the lungs but also involves the systemic circulation and can impact nonpulmonary organs. Epidemiologic and mechanistic studies indicate that COPD is associated with a high frequency of coronary artery disease, congestive heart failure and cardiac arrhythmias, independent of shared risk factors. Possible pathways include complex interrelationships between chronic low-grade systemic inflammation and oxidative stress as well as shared risk factors such as age, cigarette smoking, and environmental pollutants. In this review, we provide an overview of the epidemiologic data linking COPD with cardiovascular disease, comment on the interrelationships among COPD, inflammation, and cardiovascular disease, and highlight diagnostic and therapeutic challenges.
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Affiliation(s)
- Surya P Bhatt
- UAB Lung Health Center, University of Alabama at Birmingham, Birmingham, Ala
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216
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Ozgen Alpaydin A, Konyar Arslan I, Serter S, Sakar Coskun A, Celik P, Taneli F, Yorgancioglu A. Metabolic syndrome and carotid intima-media thickness in chronic obstructive pulmonary disease. Multidiscip Respir Med 2013; 8:61. [PMID: 24040911 PMCID: PMC3844672 DOI: 10.1186/2049-6958-8-61] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 07/23/2013] [Indexed: 12/01/2022] Open
Abstract
Background The aim of this study is to investigate the prevalence of metabolic syndrome (MetS), carotid intima media thickness (IMT), and serum C-reactive protein (CRP) levels in patients with chronic obstructive pulmonary disease (COPD), and the possible relationships among them. Methods Fifty stable COPD patients and 40 healthy controls were included in the study. The participants were further divided into four groups according to their smoking status. Pulmonary function tests were performed in COPD patients. Anthropometric measurements and blood chemistry analysis, serum CRP levels and carotid intima-media thickness (IMT) measurements were performed in all the study population. Results Prevalence of metabolic syndrome was 43% in COPD patients and 30% in the control group (p = 0.173). FEV1% and FEV1/FVC were higher in COPD patients with MetS (p = 0.001 and p = 0.014, respectively) compared to those without MetS. Prevalence of MetS was significantly different among the COPD patients with different stages (p = 0.017) with the highest value in stage 2 (59%). Carotid IMT was significantly higher in COPD patients than in control group (1.07 ± 0.25 mm and 0.86 ± 0.18 mm, respectively; p < 0.001). Serum CRP levels were not different in COPD patients and controls, however they were higher in individuals with MetS compared to those without MetS regardless of COPD presence (p = 0.02). Conclusions Early markers of atherogenesis, in terms of carotid IMT, were found to be higher in COPD patients than in healthy controls. MetS prevalence was observed to decrease as the severity of airflow obstruction increased. Therefore, screening COPD patients for these cardiovascular risk factors would be a novel approach even in absence of symptoms.
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Affiliation(s)
- Aylin Ozgen Alpaydin
- Department of Pulmonary Diseases, Dokuz Eylul University Medical Faculty, Inciraltı, 35340 Izmir, Turkey.
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Panayiotou AG, Griffin MB, Tyllis T, Georgiou N, Bond D, Humphries SE, Nicolaides AN. Association of genotypes at the matrix metalloproteinase (MMP) loci with carotid IMT and presence of carotid and femoral atherosclerotic plaques. Vasc Med 2013; 18:298-306. [DOI: 10.1177/1358863x13502698] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We aimed to test the association between matrix metalloproteinase ( MMP) genetic polymorphisms and (a) intima–media thickness in the common carotid (IMTcc) and (b) the presence of plaques in the carotid and femoral bifurcations. Carotid and femoral bifurcations were scanned with ultrasound in 762 Cypriot community dwellers (46% men) over the age of 40 years. IMTcc and the presence of plaques were recorded. The MMP1 1G/2G, MMP3 5A/6A, MMP7 -181A>G, MMP9 R279Q, and MMP12 -82A>G polymorphisms were determined with the TaqMan method. In men, the presence of plaques in any bifurcation was associated with the MMP9 279Q allele (ORadjusted=4.50; 95% CI=2.0 to 10.1; p<0.001) and the MMP7 -181A allele was associated with the presence of femoral plaques (ORadjusted=2.61; 95% CI=1.36 to 4.99; p=0.004). In women, the presence of femoral plaques was associated with the MMP12 -82G allele (ORadjusted=1.9; 95% CI=1.14 to 3.16; p=0.014). Our results suggest that the effect of common MMP genotypes on plaque presence may be site- and sex-dependent.
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Affiliation(s)
- Andrie G Panayiotou
- Cyprus International Institute for Environmental and Public Health in association with Harvard School of Public Health, Cyprus University of Technology, Limassol, Cyprus
| | - Maura B Griffin
- Vascular Noninvasive Screening and Diagnostic Centre, London, UK
| | | | - Niki Georgiou
- Vascular Screening and Diagnostic Centre, Nicosia, Cyprus
| | - Dawn Bond
- Vascular Noninvasive Screening and Diagnostic Centre, London, UK
| | - Steve E Humphries
- Division of Medicine, Centre for Cardiovascular Genetics, University College London, London, UK
| | - Andrew N Nicolaides
- Cyprus International Institute for Environmental and Public Health in association with Harvard School of Public Health, Cyprus University of Technology, Limassol, Cyprus
- Vascular Noninvasive Screening and Diagnostic Centre, London, UK
- Vascular Screening and Diagnostic Centre, Nicosia, Cyprus
- Department of Vascular Surgery, Imperial College, London, UK
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Steiropoulos P, Bogiatzi C, Archontogeorgis K, Nena E, Xanthoudaki M, Boglou P, Tzouvelekis A, Papanas N, Tsivgoulis G, Bouros D. Is there evidence of early vascular disease in patients with obstructive sleep apnoea without known comorbidities? Preliminary findings. Open Cardiovasc Med J 2013; 7:61-8. [PMID: 24044028 PMCID: PMC3772567 DOI: 10.2174/1874192401307010061] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 06/05/2013] [Indexed: 12/30/2022] Open
Abstract
We evaluated early atherosclerotic lesions in 20 non-smokers with newly diagnosed Obstructive Sleep Apnoea (OSA) and without known comorbidities by measuring common carotid artery intima media thickness (CCA-IMT), transcranial Doppler ultrasound (TCD), and ankle brachial index (ABI). These were compared with 20 healthy age- and BMI-matched controls. In OSA patients, CCA-IMT was not significantly higher vs. controls (0.74±0.17 vs. 0.66±0.12 mm, p=0.201) and it was positively correlated with neck circumference (r=0.466, p=0.039), arousal index (r=0.663, p=0.001), gamma-glutamyl transpeptidase activity (r=0.474, p=0.035) while it was negatively correlated with Forced Expiratory Volume in 1 sec (r=-0.055, p=0.012). No difference was noted between patients and controls in terms of vascular stenosis on TCD examination, while asymptomatic peripheral artery disease was found in one patient with OSA. In conclusion, OSA patients without known comorbidities exhibit a non-significant increase in CCA-IMT without further evidence of vascular disease, but additional experience in a larger patient series is needed.
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Affiliation(s)
- P Steiropoulos
- Department of Pneumonology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - C. Bogiatzi
- Department of Neurology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - K. Archontogeorgis
- Department of Pneumonology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - E. Nena
- Department of Pneumonology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - M. Xanthoudaki
- Department of Pneumonology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - P. Boglou
- Department of Pneumonology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - A. Tzouvelekis
- Department of Pneumonology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - N. Papanas
- Second Department of Internal Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - G. Tsivgoulis
- Department of Neurology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - D. Bouros
- Department of Pneumonology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
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Ogawa-Furuya N, Yamaguchi T, Yamamoto M, Kanazawa I, Sugimoto T. Serum osteocalcin levels are inversely associated with abdominal aortic calcification in men with type 2 diabetes mellitus. Osteoporos Int 2013; 24:2223-30. [PMID: 23563931 DOI: 10.1007/s00198-013-2289-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 01/07/2013] [Indexed: 10/27/2022]
Abstract
UNLABELLED We found that serum osteocalcin (OC) and undercarboxylated OC (ucOC) levels were negatively associated with abdominal aortic calcification in type 2 diabetes mellitus (T2DM) men. This finding suggests that circulating OC and ucOC are not only related to glucose or fat metabolism but also to arteriosclerosis. INTRODUCTION Recent studies revealed that serum osteocalcin levels were associated with not only bone metabolism but also glucose and fat metabolism. However, the relationship between serum OC levels and arteriosclerosis remains controversial. We examined whether or not bone metabolic markers including OC are associated with abdominal aortic calcification in patients with type 2 diabetes mellitus. METHODS We recruited 118 men and 100 postmenopausal women with T2DM. We evaluated the abdominal aortic calcification score (ACS) on a lateral lumbar radiograph and examined the association between serum OC or undercarboxylated OC levels and ACS. RESULTS The ACS of 3 and greater, which corresponded well to the highest quartile, was significantly and negatively associated with serum OC and ucOC levels in men by logistic regression analyses after adjusting for age, BMI, serum levels of creatinine and LDL cholesterol, radial bone mineral density, smoking, duration of DM, hemoglobin A1c, and the index of insulin resistance [odds ratio (OR) 0.36, 95 % confidence interval (CI) 0.19-0.70, P < 0.005, and OR 0.28, 95 % CI 0.12-0.69, P < 0.01, per standard deviation increase in OC and ucOC, respectively]. These observations were still significant after an additional adjustment for other bone markers. In contrast, there were no significant relationships with serum OC or ucOC levels and ACS in women. CONCLUSIONS These findings suggest that serum OC and ucOC levels are associated with not only bone metabolism but also arteriosclerosis in men, but not in women with type 2 diabetes mellitus.
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Affiliation(s)
- N Ogawa-Furuya
- Department of Internal Medicine 1, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane 693-8501, Japan.
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Li MF, Tu YF, Li LX, Lu JX, Dong XH, Yu LB, Zhang R, Bao YQ, Jia WP, Hu RM. Low-grade albuminuria is associated with early but not late carotid atherosclerotic lesions in community-based patients with type 2 diabetes. Cardiovasc Diabetol 2013; 12:110. [PMID: 23883448 PMCID: PMC3725174 DOI: 10.1186/1475-2840-12-110] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Accepted: 07/11/2013] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Low-grade albuminuria is associated with cardiovascular risk factors and mortality. Our aim was to investigate the association between low-grade albuminuria and carotid atherosclerotic lesions in community-based patients with type 2 diabetes. METHODS A cross-sectional study was performed in 475 community-based patients with type 2 diabetes (190 males and 285 females) with normal urinary albumin-to-creatinine ratios (UACR) (< 3.5 mg/mmol) from Shanghai, China. The subjects were stratified into tertiles based on UACR levels (the lowest tertile was UACR ≤ 1.19 mg/mmol, and the highest tertile was UACR ≥ 2 mg/mmol). Carotid intima-media thickness (CIMT), carotid atherosclerotic plaque formation and stenosis were assessed and compared among the three groups based on ultrasonography. The urinary albumin excretion rate was determined as the mean of the values obtained from three separate early morning urine samples. RESULTS Compared with the subjects with UACR in the lowest tertile, the subjects with UACR in the middle and highest tertiles had greater CIMT values (0.88 ± 0.35 mm, 0.99 ± 0.43 mm and 1.04 ± 0.35 mm, respectively; all p < 0.05) and a higher prevalence of carotid atherosclerotic plaques (25.3%, 39.0% and 46.2%, respectively; all p < 0.05) after adjusting for sex and age. Fully adjusted multiple linear regression and logistic regression analyses revealed that UACR tertiles were significantly associated with elevated CIMT (p = 0.007) and that, compared with the subjects in the first tertile of UACR, those in the second and third tertiles had 1.878- and 2.028-fold risk of carotid plaques, respectively. However, there was no statistical association between UACR tertile and the prevalence of carotid stenosis. CONCLUSIONS Higher UACR within the normal range was independently associated with early but not late carotid atherosclerotic lesions in community-based patients with type 2 diabetes. Low-grade albuminuria contributes to the risk of carotid atherosclerosis and may be used as an early marker for the detection of atherosclerosis in patients with type 2 diabetes.
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Affiliation(s)
- Mei-Fang Li
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital; Shanghai Diabetes Institute; Shanghai Clinical Center for Diabetes; Shanghai Key Clinical Center for Metabolic Diseases; Shanghai Key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai 200233, China
| | - Yin-Fang Tu
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital; Shanghai Diabetes Institute; Shanghai Clinical Center for Diabetes; Shanghai Key Clinical Center for Metabolic Diseases; Shanghai Key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai 200233, China
| | - Lian-Xi Li
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital; Shanghai Diabetes Institute; Shanghai Clinical Center for Diabetes; Shanghai Key Clinical Center for Metabolic Diseases; Shanghai Key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai 200233, China
| | - Jun-Xi Lu
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital; Shanghai Diabetes Institute; Shanghai Clinical Center for Diabetes; Shanghai Key Clinical Center for Metabolic Diseases; Shanghai Key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai 200233, China
| | - Xue-Hong Dong
- Department of Endocrinology and Metabolism, HuaShan Hospital, Institute of Endocrinology and Diabetology at Fudan University, 12 Wulumuqi Road, Shanghai 200040, China
| | - Li-Bo Yu
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital; Shanghai Diabetes Institute; Shanghai Clinical Center for Diabetes; Shanghai Key Clinical Center for Metabolic Diseases; Shanghai Key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai 200233, China
| | - Rong Zhang
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital; Shanghai Diabetes Institute; Shanghai Clinical Center for Diabetes; Shanghai Key Clinical Center for Metabolic Diseases; Shanghai Key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai 200233, China
| | - Yu-Qian Bao
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital; Shanghai Diabetes Institute; Shanghai Clinical Center for Diabetes; Shanghai Key Clinical Center for Metabolic Diseases; Shanghai Key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai 200233, China
| | - Wei-Ping Jia
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital; Shanghai Diabetes Institute; Shanghai Clinical Center for Diabetes; Shanghai Key Clinical Center for Metabolic Diseases; Shanghai Key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai 200233, China
| | - Ren-Ming Hu
- Department of Endocrinology and Metabolism, HuaShan Hospital, Institute of Endocrinology and Diabetology at Fudan University, 12 Wulumuqi Road, Shanghai 200040, China
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221
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Fromm A, Thomassen L, Naess H, Meijer R, Eide GE, Kråkenes J, Vedeler CA, Gerdts E, Larsen TH, Kuiper KKJ, Laxdal E, Russell D, Tatlisumak T, Waje-Andreassen U. The Norwegian Stroke in the Young Study (NOR-SYS): rationale and design. BMC Neurol 2013; 13:89. [PMID: 23865483 PMCID: PMC3721997 DOI: 10.1186/1471-2377-13-89] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 07/16/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ischemic stroke in young adults is a major health problem being associated with a higher vascular morbidity and mortality compared to controls, and a stroke recurrence rate of 25% during the first decade. The assumed cause of infarction and the detected risk factors determine the early- and long-term treatment. However, for many patients the cause of stroke remains unknown. Risk factor profile and etiology differ in young and elderly ischemic stroke patients, and atherosclerosis is the determined underlying condition in 10 to 15%. However, subclinical atherosclerosis is probably more prevalent and may go unrecognized. METHODS/DESIGN NOR-SYS is a prospective long-term research program. Standardized methods are used for anamnestic, clinical, laboratory, imaging, and ultrasound data collection in ischemic stroke patients aged ≤60 years, their partners and joint adult offspring. The ultrasound protocol includes the assessment of intracranial, carotid and femoral arteries, abdominal aorta, and the estimation of VAT. To date, the study is a single centre study with approximately 400 patients, 250 partners and 350 adult offspring expected to be recruited at our site. DISCUSSION NOR-SYS aims to increase our knowledge about heredity and the development of arterial vascular disease in young patients with ischemic stroke and their families. Moreover, optimization of diagnostics, prophylaxis and early intervention are major targets with the intention to reduce stroke recurrence and other clinical arterial events, physical disability, cognitive impairment and death.
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Kawai T, Ohishi M, Takeya Y, Onishi M, Ito N, Oguro R, Yamamoto K, Kamide K, Rakugi H. Carotid plaque score and intima media thickness as predictors of stroke and mortality in hypertensive patients. Hypertens Res 2013; 36:902-9. [PMID: 23823172 DOI: 10.1038/hr.2013.61] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 03/06/2013] [Accepted: 03/08/2013] [Indexed: 11/09/2022]
Abstract
The mean intima media thickness (IMT) and plaque score from carotid ultrasonography are both widely used to evaluate macrovascular atherosclerotic change. The present study sought to examine which parameter more effectively predicts patient prognosis. This hospital-based cohort study included 356 patients with essential hypertension (mean age: 62.4 ± 0.6). We investigated how the mean IMT and plaque score correlated with various parameters, including pulse wave velocity (PWV), and we assessed the ability of the mean IMT and plaque score to predict cardiovascular events and total mortality. The mean IMT and plaque score significantly correlated with systemic atherosclerotic change, target organ damage, age and PWV. Subjects with a higher mean IMT and subjects with higher plaque scores showed higher frequencies of stroke and total mortality. In addition, subjects with marginal thickening of the intima media (mean ≥ 0.7) showed a significantly higher frequency of stroke than subjects with a mean IMT of <0.7. After adjustment for traditional risk factors, plaque score was significantly and independently predictive of stroke, and the predictive ability of the plaque score for the onset of stroke was equivalent to that of PWV. The mean IMT and plaque score showed a nonsignificant trend of higher risk of mortality after adjustment for traditional risk factors. The mean IMT and plaque score were significantly correlated with systemic atherosclerotic change. We revealed that plaque score predicted the onset of stroke more accurately than the mean IMT, and the accuracy of this prediction was equivalent to that from PWV in hypertensive patients. We also showed that marginal thickening of the intima media (as measured by mean IMT) may be a predictor of stroke.
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Affiliation(s)
- Tatsuo Kawai
- Department of Geriatric Medicine and Nephrology, Osaka University Graduate School of Medicine, Suita, Japan
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Alteration of vascular function is an important factor in the correlation between visit-to-visit blood pressure variability and cardiovascular disease. J Hypertens 2013; 31:1387-95; discussion 1395. [DOI: 10.1097/hjh.0b013e328360f796] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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224
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Saba L, Tallapally N, Gao H, Molinari F, Anzidei M, Piga M, Sanfilippo R, Suri JS. Semiautomated and automated algorithms for analysis of the carotid artery wall on computed tomography and sonography: a correlation study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:665-674. [PMID: 23525393 DOI: 10.7863/jum.2013.32.4.665] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES The purpose of this study was to compare automated and semiautomated algorithms for analysis of carotid artery wall thickness and intima-media thickness on multidetector row computed tomographic (CT) angiography and sonography, respectively, and to study the correlation between them. METHODS Twenty consecutive patients underwent multidetector row CT angiographic and sonographic analysis of carotid arteries (mean age, 66 years; age range, 59-79 years). The intima-media thickness of the 40 carotid arteries was measured with novel and dedicated automated software analysis and by 4 observers who manually calculated the intima-media thickness. The carotid artery wall thickness was automatically estimated by using a specific algorithm and was also semiautomatically quantified. The correlation between groups was calculated by using the Pearson ρ statistic, and scatterplots were calculated. We evaluated intermethod agreement using Bland-Altman analysis. RESULTS By comparing automated carotid artery wall thickness, automated intima-media thickness, semiautomated carotid artery wall thickness, and semiautomated intima-media thickness analyses, a statistically significant association was found, with the highest values obtained for the association between semiautomated and automated intima-media thickness analyses(Pearson ρ = 0.9; 95% confidence interval, 0.82-0.95; P = 0.0001). The lowest values were obtained for the association between semiautomated intima-media thickness and automated carotid artery wall thickness analyses (Pearson ρ = 0.44; 95% confidence interval, 0.15-0.66; P = 0.0047). In the Bland-Altman analysis, the better results were obtained by comparing the semiautomated and automated algorithms for the study of intima-media thickness, with an interval of -16.1% to +43.6%. CONCLUSIONS The results of this preliminary study showed that carotid artery wall thickness and intima-media thickness can be studied with automated software, although the CT analysis needs to be further improved.
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Affiliation(s)
- Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria di Cagliari-Polo di Monserrato, Cagliari, Italy.
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Abstract
Carotid artery intima-media thickness (IMT) is a biomarker for cardiovascular disease that also predicts the risk of cardiovascular mortality. Angiotensin-converting enzyme (ACE) inhibition is a unique therapeutic modality because it both treats hypertension and improves arterial health and cardiovascular disease outcomes. Controversy exists regarding the role of ACE inhibitors and angiotensin receptor blockers (ARBs) in IMT regression. Our article provides an update on how ACE inhibitors and ARBs could play a role in decreasing IMT.
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Affiliation(s)
| | - Luke P. Brewster
- Assistant Professor of Vascular Surgery, Medical Director of Vascular Lab, Department of Surgery, Emory University School of Medicine, Atlanta, GA; Georgia Institute of Technology, Institute of Bioengineering and Biosciences, Atlanta, GA
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226
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Seldenrijk A, van Hout HPJ, van Marwijk HWJ, de Groot E, Gort J, Rustemeijer C, Diamant M, Penninx BWJH. Sensitivity to depression or anxiety and subclinical cardiovascular disease. J Affect Disord 2013; 146:126-31. [PMID: 22877964 DOI: 10.1016/j.jad.2012.06.026] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Revised: 06/20/2012] [Accepted: 06/20/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Depressive and anxiety disorders are highly overlapping, heterogeneous conditions that both have been associated with an increased risk of cardiovascular disease (CVD). Cognitive vulnerability traits for these disorders could help to specify what exactly drives CVD risk in depressed and anxious subjects. Our aim is to examine sensitivity to depression or anxiety in association with indicators of subclinical CVD. METHODS Data from 635 participants (aged 20-66 years) of the Netherlands Study of Depression and Anxiety were analyzed. Depression sensitivity was measured by the revised Leiden Index of Depression Sensitivity. Anxiety sensitivity was measured by the Anxiety Sensitivity Index. Subclinical CVD was measured as (1) carotid intima-media thickness and plaque presence using B-mode ultrasonography and (2) central arterial stiffness (augmentation index) using calibrated radial applanation tonometry. RESULTS After adjustment for sociodemographics, blood pressure, and LDL cholesterol, higher scores of anxiety sensitivity were associated with both increased likelihood of carotid plaques (OR per SD increase=1.34, 95%CI=1.06-1.68) and increased arterial stiffness (β=.06, p=.01). No significant associations were found with carotid intima-media thickness nor for depression sensitivity. LIMITATIONS The cross-sectional design precludes causal inference. Current mood state could have influenced the self-reported sensitivity data. CONCLUSIONS The presence of carotid plaques and central arterial stiffness was especially increased in subjects who tend to be highly fearful of anxiety-related symptoms. These observations suggest that vulnerability to anxiety, rather than to depression, represents a correlate of subclinical CVD.
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Affiliation(s)
- Adrie Seldenrijk
- EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
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227
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Hong H, Wang H, Liao H. Prehypertension is associated with increased carotid atherosclerotic plaque in the community population of Southern China. BMC Cardiovasc Disord 2013; 13:20. [PMID: 23510396 PMCID: PMC3618079 DOI: 10.1186/1471-2261-13-20] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 02/19/2013] [Indexed: 11/10/2022] Open
Abstract
Background The proceeding of blood pressure (BP) from normal level to the hypertension has been found to be associated with increased cardiovascular events and multiple vascular risk factors. However, whether the process is associated with increased carotid atherosclerotic plaque per se or not is still unclear. Methods Nine hundred and forty-two participants aged from 46 to 75 were enrolled from community population in Southern China. Their metabolic risk factors, carotid intima-media thickness (cIMT) and atherosclerotic plaque formation were analyzed and stratified by different blood pressure levels according to JNC-7 or ESH/ESC-2007 classification. Results From low BP level to higher BP level, multiple metabolic risk factors increased linearly. Prehypertension in JNC-7 classification (or normal BP and high normal BP in ESH/ESC-2007 classification) was correlated with thicker cIMT and more plaque formation than normotension (or optimal BP) (p < 0.001). After adjusting multiple metabolic factors, the differences were still significant (p < 0.05). Furthermore, prehypertensive participants had a trend to be thicker carotid IMT (OR and its 95% CI: 1.65, 0.97-2.82, p = 0.067) and significantly higher carotid plaque occurrence (OR and its 95% CI: 2.36, 1.43-3.88, p = 0.001) than normotensive ones. However, there was no significant difference of cIMT and plaque formation between normal BP and high normal BP (p > 0.05). Plaque formation in prehypertension was as significant as that in hypertension. Conclusion Prehypertension is associated with significantly increased carotid atherosclerotic plaque and is a primary stratify risk factor for carotid atherosclerosis which could cause ischemic stroke in middle-aged and elderly population in Southern China.
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Affiliation(s)
- Hua Hong
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, P. R. China.
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228
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Sangiorgi G, Roversi S, Biondi Zoccai G, Modena MG, Servadei F, Ippoliti A, Mauriello A. Sex-related differences in carotid plaque features and inflammation. J Vasc Surg 2013; 57:338-344. [PMID: 23058720 DOI: 10.1016/j.jvs.2012.07.052] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 07/11/2012] [Accepted: 07/22/2012] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Severe carotid stenosis is a frequent cause of stroke in both men and women. Whereas several sex-related comparisons are available on coronary atherosclerosis, there are few data appraising gender-specific features of carotid plaques. We aimed to systematically compare the pathology and inflammatory features of carotid plaques in men vs women. METHODS Carotid plaque specimens were collected from patients undergoing surgical endarterectomy for asymptomatic or symptomatic carotid stenosis. Histologic analysis was performed, as well as measurements of plaque composition and inflammation. RESULTS A total of 457 patients were included (132 women, 325 men). Baseline analyses showed a greater prevalence of hypercholesterolemia, hypertension, and former smoking status in women, despite a higher Framingham Heart Score in men (all P < .05). Women had a lower prevalence of thrombotic plaques, smaller percentage area of necrotic core, and hemorrhage extension (all P < .05). Plaque inflammation analysis showed a lower concentration of inflammatory and, in particular, of macrophage foam cells in the plaque cap of women (both P < .05). These differences were, however, no longer significant at multivariable analysis, including several baseline features, such as symptom status and stenosis severity. CONCLUSIONS Carotid plaques seem significantly different in women and men, but the main drivers of such pathologic differences are baseline features, including stenosis severity and symptom status.
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Affiliation(s)
- Giuseppe Sangiorgi
- Division of Cardiology, Cardiac Catheterization Laboratory, University of Tor Vergata, Rome, Italy
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Farro I, Bia D, Zócalo Y, Torrado J, Farro F, Florio L, Lluberas R, Armentano RL. Aging-related changes and reference values for the carotid intima-media thickness in a Uruguayan population. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2013; 2012:5622-5. [PMID: 23367204 DOI: 10.1109/embc.2012.6347269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
UNLABELLED Carotid intima-media thickness (CIMT) is a well-established subclinical marker of atherosclerosis. Non-invasive vascular evaluation has emerged as a useful tool to aid in individual cardiovascular (CV) risk stratification and diagnose. The use of CIMT in CV risk stratification requires knowing the expected reference values for the population studied. Our aim were: a) to evaluate the relationship between aging and CIMT, b) to analyze gender and side (right vs left) related-differences in CIMT and c) to determine the CIMT reference values for an Uruguayan population taking into account aging-related CIMT changes. METHODS 367 asymptomatic subjects without known CV disease or risk factors were included in the study. Subjects were divided into six age groups. High-resolution B-mode ultrasound images of both (right and left) common carotid arteries were obtained based on the techniques and recommendations described in international consensus. RESULTS No significant age-related differences in CIMT between men and women were observed. The mean left CIMT was thicker compared with right CIMT in groups 4, 5 and 6. However, there were no significant differences in those groups. The nomogram model was constructed from data base, in which the 95% confidence interval was considered. Diagnosis thresholds were determined as well. CONCLUSION We define reference values of CIMT for our population using gold standard techniques which contributes to standard techniques which contributes to an improved insight into clinical practice and can be used routinely for evaluation.
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Affiliation(s)
- Ignacio Farro
- Physiology Department and with the Centro Universitario de Investigación, Innovación y Diagnóstico (CUiiDARTE), Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
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Katano H, Ohno M, Yamada K. Protection by Physical Activity Against Deleterious Effect of Smoking on Carotid Intima-media Thickness in Young Japanese. J Stroke Cerebrovasc Dis 2013; 22:176-83. [DOI: 10.1016/j.jstrokecerebrovasdis.2011.07.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2011] [Accepted: 07/14/2011] [Indexed: 10/15/2022] Open
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Peters SAE, Bots ML. Carotid intima-media thickness studies: study design and data analysis. J Stroke 2013; 15:38-48. [PMID: 24324938 PMCID: PMC3779675 DOI: 10.5853/jos.2013.15.1.38] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 01/09/2013] [Accepted: 01/09/2013] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Carotid intima-media thickness (CIMT) measurements have been widely used as primary endpoint in studies into the effects of new interventions as alternative for cardiovascular morbidity and mortality. There are no accepted standards on the use of CIMT measurements in intervention studies and choices in the design and analysis of a CIMT study are generally based on experience and expert opinion. In the present review, we provide an overview of the current evidence on several aspects in the design and analysis of a CIMT study on the early effects of new interventions. SUMMARY OF ISSUES A balanced evaluation of the carotid segments, carotid walls, and image view to be used as CIMT study endpoint; the reading method (manual or semi-automated and continuously or in batch) to be employed, the required sample size, and the frequency of ultrasound examinations is provided. We also discuss the preferred methods to analyse longitudinal CIMT data and address the possible impact of, and methods to deal with missing and biologically implausible CIMT values. CONCLUSIONS Linear mixed effects models are the preferred way to analyse CIMT data and do appropriately handle missing and biologically implausible CIMT values. Furthermore, we recommend to use extensive CIMT designs that measure CIMT at regular points during the multiple carotid sites as such approach is likely to increase the success rates of CIMT intervention studies designed to evaluate the effects of new interventions on atherosclerotic burden.
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Affiliation(s)
- Sanne A E Peters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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232
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Zhang YH, Gao Y, Mao X, Shang J, Su BL. Assessment of carotid atherosclerosis in type 2 diabetes mellitus patients with microalbuminuria by high-frequency ultrasonography. Int J Endocrinol 2013; 2013:819584. [PMID: 23573090 PMCID: PMC3612477 DOI: 10.1155/2013/819584] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 02/21/2013] [Indexed: 11/23/2022] Open
Abstract
The aim of this study is to evaluate carotid atherosclerosis in patients of type 2 diabetes mellitus with microalbuminuria (MA) by high-frequency ultrasonography. Two hundred and fifty patients of type 2 diabetes mellitus were divided into two groups according to urinary albumin excretion rate (UAER): normoalbuminuria group (130 cases) and microalbuminuria group (120 cases). The intimal-medial thickness (IMT) and the atherosclerotic plaques of carotid artery were observed in both groups by high-frequency ultrasound. Fasting blood glucose (FBG), hemoglobin A1c, and lipid profiles were measured. The values of IMT of microalbuminuria group were significantly higher than those of normoalbuminuria group (P < 0.05). In univariate analysis, IMT was positively and significantly associated with age (r = 0.265, P < 0.05), waist circumference (r = 0.263, P < 0.05), body mass index (r = 0.285, P < 0.05), systolic blood pressure (r = 0.276, P < 0.05), UAER (r = 0.359, P < 0.05), HbA1c (r = 0.462, P < 0.05) and, duration of diabetes (r = 0.370, P < 0.05). In multivariate linear regression analysis, UAER and HbA1c were independent predictors of IMT (P < 0.05 for all). In the two groups, the rate of soft plaques was higher than that of dense plaques and calcified plaques. In conclusion, there is a significant association between microalbuminuria and IMT which is regarded as the early sign of carotid atherosclerosis in type 2 diabetic patients.
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Affiliation(s)
- Yu-Hong Zhang
- Department of Diagnostic Ultrasound, Second Affiliated Hospital of Dalian Medical University, 467 Zhongshan Road, Dalian 116023, China
- *Yu-Hong Zhang:
| | - Yuan Gao
- Department of Diagnostic Ultrasound, Xin Hua Hospital of Dalian University, Dalian 116023, China
| | - Xin Mao
- Department of Diagnostic Ultrasound, Second Affiliated Hospital of Dalian Medical University, 467 Zhongshan Road, Dalian 116023, China
| | - Jing Shang
- Department of Diagnostic Ultrasound, Second Affiliated Hospital of Dalian Medical University, 467 Zhongshan Road, Dalian 116023, China
| | - Ben-Li Su
- Department of Endocrinology, Second Affiliated Hospital of Dalian Medical University, Dalian 116023, China
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233
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Lahousse L, van den Bouwhuijsen QJA, Loth DW, Joos GF, Hofman A, Witteman JCM, van der Lugt A, Brusselle GG, Stricker BH. Chronic Obstructive Pulmonary Disease and Lipid Core Carotid Artery Plaques in the Elderly. Am J Respir Crit Care Med 2013; 187:58-64. [DOI: 10.1164/rccm.201206-1046oc] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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234
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Tan TY, Chuang YC. Association of Anthropometric Measurements with Components of Metabolic Syndrome and Carotid Intima-Media Thickness in Young Healthy Taiwanese. J Med Ultrasound 2012. [DOI: 10.1016/j.jmu.2012.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Touboul PJ, Hennerici MG, Meairs S, Adams H, Amarenco P, Bornstein N, Csiba L, Desvarieux M, Ebrahim S, Hernandez Hernandez R, Jaff M, Kownator S, Naqvi T, Prati P, Rundek T, Sitzer M, Schminke U, Tardif JC, Taylor A, Vicaut E, Woo KS. Mannheim carotid intima-media thickness and plaque consensus (2004-2006-2011). An update on behalf of the advisory board of the 3rd, 4th and 5th watching the risk symposia, at the 13th, 15th and 20th European Stroke Conferences, Mannheim, Germany, 2004, Brussels, Belgium, 2006, and Hamburg, Germany, 2011. Cerebrovasc Dis 2012; 34:290-6. [PMID: 23128470 DOI: 10.1159/000343145] [Citation(s) in RCA: 1260] [Impact Index Per Article: 96.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 09/03/2012] [Indexed: 12/11/2022] Open
Abstract
Intima-media thickness (IMT) provides a surrogate end point of cardiovascular outcomes in clinical trials evaluating the efficacy of cardiovascular risk factor modification. Carotid artery plaque further adds to the cardiovascular risk assessment. It is defined as a focal structure that encroaches into the arterial lumen of at least 0.5 mm or 50% of the surrounding IMT value or demonstrates a thickness >1.5 mm as measured from the media-adventitia interface to the intima-lumen interface. The scientific basis for use of IMT in clinical trials and practice includes ultrasound physics, technical and disease-related principles as well as best practice on the performance, interpretation and documentation of study results. Comparison of IMT results obtained from epidemiological and interventional studies around the world relies on harmonization on approaches to carotid image acquisition and analysis. This updated consensus document delineates further criteria to distinguish early atherosclerotic plaque formation from thickening of IMT. Standardized methods will foster homogenous data collection and analysis, improve the power of randomized clinical trials incorporating IMT and plaque measurements and facilitate the merging of large databases for meta-analyses. IMT results are applied to individual patients as an integrated assessment of cardiovascular risk factors. However, this document recommends against serial monitoring in individual patients.
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Affiliation(s)
- P-J Touboul
- Stroke Center Bichat Hospital 46, rue Henri-Huchard, FR–75018 Paris, France.
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Pasquali D, Arcopinto M, Renzullo A, Rotondi M, Accardo G, Salzano A, Esposito D, Saldamarco L, Isidori AM, Marra AM, Ruvolo A, Napoli R, Bossone E, Lenzi A, Baliga RR, Saccà L, Cittadini A. Cardiovascular abnormalities in Klinefelter syndrome. Int J Cardiol 2012; 168:754-9. [PMID: 23092857 DOI: 10.1016/j.ijcard.2012.09.215] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Revised: 09/18/2012] [Accepted: 09/29/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Several epidemiological studies have demonstrated an increased mortality from cardiovascular causes in patients with Klinefelter Syndrome (KS). Little information is available about the nature of the underlying cardiovascular abnormalities. Aim of the study was to investigate exercise performance, left ventricular architecture and function, vascular reactivity, and carotid intima-media thickness in a group of patients with KS. MATERIALS AND METHODS Sixty-nine patients with KS and 48 age-matched controls participated in our population-controlled study. Forty-eight Klinefelter subjects were on testosterone treatment at the time of the investigation while 21 were naive and underwent a complete Doppler echocardiographic examination, a cardiopulmonary exercise test as well as a vascular study including measures of carotid intima-media thickness and endothelial function with flow-mediated dilation of the brachial artery. Patients with KS on testosterone therapy (n=48) were also matched against a population of men with treated secondary hypogonadism (n=21). RESULTS Patients with KS exhibited a wide array of cardiovascular abnormalities including left ventricular diastolic dysfunction, reduced maximal oxygen consumption (p<0.01), increased intima-media thickness (p<0.05) (-34% and +42% vs. controls, respectively) and a high prevalence of chronotropic incompetence (55% of patients, p<0.01). No significant difference was found between treated and untreated KS in variance with men treated for secondary hypogonadism. CONCLUSION Left ventricular diastolic dysfunction, impaired cardiopulmonary performance, chronotropic incompetence, and increased intima-media thickness suggest that cardiovascular abnormalities are a common finding in KS that is not reversed by testosterone replacement therapy and may represent the pathophysiological underpinnings of the increased risk of dying from heart disease.
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Affiliation(s)
- Daniela Pasquali
- Department of Cardiothoracic and Respiratory Science, Endocrinology Unit, Second University of Naples, Italy
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Use of carotid intima-media thickness regression to guide therapy and management of cardiac risks. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2012; 14:50-6. [PMID: 22139639 DOI: 10.1007/s11936-011-0158-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OPINION STATEMENT Although carotid intima-media thickness (IMT) has been broadly used as a tool to evaluate cardiovascular risk, its role as a surrogate endpoint is still debated. The main issue is the fact that no study has ever been powered to show a relationship between changes in carotid IMT during follow-up and cardiovascular events. A meta-analysis of existing clinical studies was performed to investigate this relationship but it failed to demonstrate a predictive role of regression in carotid IMT for cardiovascular events. The reasons for the lack of a clear evidence for a predictive role of IMT progression are unknown but are likely multifactorial. Firstly, it may depend on the fact that this index is not a pure atherosclerosis index. Second, carotid atherosclerosis does not always reflect coronary atherosclerosis. Furthermore, methodologic problems related to intra- and interobserver variability make this index not adequately reproducible when tracking the progression of carotid atherosclerosis. A further meta-analysis based on individual patient data, instead of published data, has been planned to better address the predictive role of IMT. Lastly, in the future, the variability of ultrasound measurements of carotid IMT are likely to be reduced by further development of automatic calculation of this index by magnetic resonance imaging.
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238
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Liu KH, Chu WCW, Kong APS, Choi Ko GT, Ma RCW, Chan JWS, Chow LTC, Rasalkar DD, So WY, Tse LF, Corcoran HS, Ozaki R, Ahuja AT, Chan JCN. US Assessment of Medial Arterial Calcification: A Sensitive Marker of Diabetes-related Microvascular and Macrovascular Complications. Radiology 2012; 265:294-302. [DOI: 10.1148/radiol.12112440] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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239
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Association between conventional risk factors and different ultrasound-based markers of atherosclerosis at carotid and femoral levels in a middle-aged population. Int J Cardiovasc Imaging 2012; 29:589-99. [PMID: 23015308 DOI: 10.1007/s10554-012-0124-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Accepted: 09/03/2012] [Indexed: 02/07/2023]
Abstract
Ultrasound detection of sub-clinical atherosclerosis (ATS) may help identify individuals at high cardiovascular risk. Most studies evaluated intima-media thickness (IMT) at carotid level. We compared the relationships between main cardiovascular risk factors (CVRF) and five indicators of ATS (IMT, mean and maximal plaque thickness, mean and maximal plaque area) at both carotid and femoral levels. Ultrasound was performed on 496 participants aged 45-64 years randomly selected from the general population of the Republic of Seychelles. 73.4 % participants had ≥ 1 plaque (IMT thickening ≥ 1.2 mm) at carotid level and 67.5 % at femoral level. Variance (adjusted R2) contributed by age, sex and CVRF (smoking, LDL-cholesterol, HDL-cholesterol, blood pressure, diabetes) in predicting any of the ATS markers was larger at femoral than carotid level. At both carotid and femoral levels, the association between CVRF and ATS was stronger based on plaque-based markers than IMT. Our findings show that the associations between CVRF and ATS markers were stronger at femoral than carotid level, and with plaque-based markers rather than IMT. Pending comparison of these markers using harder cardiovascular endpoints, our findings suggest that markers based on plaque morphology assessed at femoral artery level might be useful cardiovascular risk predictors.
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240
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Troitzsch P, Paulista Markus MR, Dörr M, Felix SB, Jünger M, Schminke U, Schmidt CO, Völzke H, Baumeister SE, Arnold A. Psoriasis is associated with increased intima-media thickness--the Study of Health in Pomerania (SHIP). Atherosclerosis 2012; 225:486-90. [PMID: 23058814 DOI: 10.1016/j.atherosclerosis.2012.09.026] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 09/21/2012] [Accepted: 09/23/2012] [Indexed: 01/21/2023]
Abstract
BACKGROUND Psoriasis has been associated with cardiovascular diseases, but its relationship to markers of subclinical atherosclerosis has not been fully elucidated. The aim of the study is to analyze the association of psoriasis with common carotid artery intima-media thickness (CCA-IMT) and plaque prevalence of the carotid arteries. METHODS Data of 1987 men and women aged 25-88 years from the population-based Study of Health in Pomerania (SHIP) in north-eastern Germany were used. Cross-sectional associations of psoriasis with IMT and carotid plaque prevalence were analyzed using linear and logistic regression models adjusted for relevant confounders (age, sex, smoking, alcohol consumption, waist circumference, physical activity, systolic blood pressure, anti-hypertensive medication, acetylsalicylic acid, HbA(1c), total/HDL cholesterol ratio, lipid-lowering medication). RESULTS Psoriasis was associated with mean CCA-IMT, but not with carotid plaque prevalence. Comparisons between subjects with and without psoriasis showed an adjusted mean difference of the CCA-IMT of 0.016 mm (95% confidence interval [CI]: 0.004 mm-0.028 mm, p < 0.01) and an odds ratio for plaque prevalence of 1.12 (95% CI: 0.85-1.47) after adjusting for confounders. CONCLUSION Our findings suggest that psoriasis is associated with increased carotid mean IMT and might therefore contribute to the atherosclerotic process and subsequent cardiovascular events.
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Affiliation(s)
- Paulina Troitzsch
- Institute for Community Medicine, University Medicine of Greifswald, Germany.
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241
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Bartels S, Franco AR, Rundek T. Carotid intima-media thickness (cIMT) and plaque from risk assessment and clinical use to genetic discoveries. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.permed.2012.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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242
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Magge R, Lau BC, Soares BP, Fischette S, Arora S, Tong E, Cheng S, Wintermark M. Clinical risk factors and CT imaging features of carotid atherosclerotic plaques as predictors of new incident carotid ischemic stroke: a retrospective cohort study. AJNR Am J Neuroradiol 2012; 34:402-9. [PMID: 22859283 DOI: 10.3174/ajnr.a3228] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Parameters other than luminal narrowing are needed to predict the risk of stroke more reliably, particularly in patients with <70% stenosis. The goal of our study was to identify clinical risk factors and CT features of carotid atherosclerotic plaques, in a retrospective cohort of patients free of stroke at baseline, that are independent predictors of incident stroke on follow-up. MATERIALS AND METHODS We identified a retrospective cohort of patients admitted to our emergency department with suspected stroke between 2001-2007 who underwent a stroke work-up including a CTA of the carotid arteries that was subsequently negative for acute stroke. All patients also had to receive a follow-up brain study at least 2 weeks later. From a random sample, we reviewed charts and imaging studies of patients with subsequent new stroke on follow-up as well as those who remained stroke-free. All patients were classified either as "new carotid infarct patients" or "no-new carotid infarct patients" based on the Causative Classification for Stroke. Independently, the baseline CTA studies were processed using a custom, CT-based automated computer classifier algorithm that quantitatively assesses a set of carotid CT features (wall thickness, plaque ulcerations, fibrous cap thickness, lipid-rich necrotic core, and calcifications). Univariate and multivariate statistical analyses were used to identify any significant differences in CT features between the patient groups in the sample. Subsequent ROC analysis allowed comparison to the classic NASCET stenosis rule in identifying patients with incident stroke on follow-up. RESULTS We identified a total of 315 patients without a new carotid stroke between baseline and follow-up, and 14 with a new carotid stroke between baseline and follow-up, creating the main comparison groups for the study. Statistical analysis showed age and use of antihypertensive drugs to be the most significant clinical variables, and maximal carotid wall thickness was the most relevant imaging variable. The use of age ≥ 75 years, antihypertensive medication use, and a maximal carotid wall thickness of at least 4 mm was able to successfully identify 10 of the 14 patients who developed a new incident infarct on follow-up. ROC analysis showed an area under the ROC curve of 0.706 for prediction of new stroke with this new model. CONCLUSIONS Our new paradigm of using age ≥ 75 years, history of hypertension, and carotid maximal wall thickness of >4 mm identified most of the patients with subsequent new carotid stroke in our study. It is simple and may help clinicians choose the patients at greatest risk of developing a carotid infarct, warranting validation with a prospective observational study.
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Affiliation(s)
- R Magge
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
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Korukonda S, Doyley MM. Visualizing the radial and circumferential strain distribution within vessel phantoms using synthetic-aperture ultrasound elastography. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2012; 59:1639-1653. [PMID: 22899112 DOI: 10.1109/tuffc.2012.2370] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Noninvasive elastography (NIVE) produces elastograms that are difficult to interpret because NIVE visualizes strain in the transducer coordinate system. In this paper, we hypothesized that transforming normal and shear strain elastograms to the vessel coordinate system will produce better strain elastograms. To corroborate this hypothesis, we acquired synthetic-aperture (SA) ultrasound data from simulated and physical vessel phantoms. In both studies, SA echo frames were reconstructed from data acquired with a sparse transducer array. The simulation study was performed with homogeneous and heterogenous phantoms, but in the experimental study we used a modified ultrasound scanner to acquire SA data from homogeneous (n = 1) and heterogeneous (n = 3) vessel phantoms. Axial and lateral displacements were estimated by performing two-dimensional cross-correlation analysis on the beamformed RF echo frames. We generated radial and circumferential strain elastograms by transforming normal and shear strain elastograms to the vessel coordinate system. The results revealed: 1) radial and circumferential strain elastograms acquired from simulated data had a relative root mean squared error on the order of 0.1%; 2) experimentally acquired radial and circumferential strain elastograms had elastographic contrast-to-noise ratio (CNRe) between 10 and 40 dB, and elastographic signal-to-noise ratio (SNRe) between 10 and 35 dB, depending on the number of active transmission elements employed during imaging; 3) radial and circumferential strain elastograms produced with fewer than 8 active transmission elements were inferior to those computed with a greater number of active elements; and 4) plaques were evident in the strain elastograms, except in those obtained with the sparsest transducer array. This study demonstrated that a syntheticaperture ultrasound system could visualize radial and circumferential strain noninvasively.
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Affiliation(s)
- Sanghamithra Korukonda
- Hajim School of Engineering and Applied Sciences, Department of Electrical and Computer Engineering, University of Rochester, Rochester, NY, USA
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Cecelja M, Chowienczyk P. Role of arterial stiffness in cardiovascular disease. JRSM Cardiovasc Dis 2012; 1:10.1258_cvd.2012.012016. [PMID: 24175067 PMCID: PMC3738327 DOI: 10.1258/cvd.2012.012016] [Citation(s) in RCA: 212] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Propagation of the pressure wave along the arterial tree (pulse wave velocity [PWV]) is related to the intrinsic elasticity of the arterial wall. PWV is increased in stiffer arteries and, when measured over the aorta, is an independent predictor of cardiovascular morbidity and mortality. Given the predictive power of PWV, identifying strategies that prevent or reduce stiffening may be important in prevention of cardiovascular events. One view is that aortic stiffness occurs as a result of atherosclerosis along the aorta. However, there is little or no association between PWV and classical risk factors for atherosclerosis, other than age and blood pressure. Furthermore, PWV does not increase during early stages of atherosclerosis, as measured by intima-media thickness and non-calcified atheroma, but it does increase in the presence of aortic calcification that occurs within advanced atherosclerotic plaque. Age-related widening of pulse pressure is the major cause of age-related increase in prevalence of hypertension and has been attributed to arterial stiffening. This review summarizes the methods of measuring aortic stiffness in humans, the pathophysiological mechanisms leading to aortic stiffness, including its association with atherosclerosis, and the haemodynamic consequences of increased aortic stiffness.
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Affiliation(s)
- Marina Cecelja
- King's College London British Heart Foundation Centre, Department of Clinical Pharmacology, St Thomas' Hospital , London , UK
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Zhao B, Liu Y, Zhang Y, Chen Y, Yang Z, Zhu Y, Zhan W. Gender difference in carotid intima-media thickness in type 2 diabetic patients: a 4-year follow-up study. Cardiovasc Diabetol 2012; 11:51. [PMID: 22583598 PMCID: PMC3398844 DOI: 10.1186/1475-2840-11-51] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Accepted: 05/14/2012] [Indexed: 11/15/2022] Open
Abstract
Background Different population studies have reported gender difference in carotid intima-media thickness (CIMT), which is proved to be a risk factor of cardiovascular diseases. However, few longitudinal researches examine this gender difference in type 2 diabetes mellitus (T2DM) patients. Therefore, we prospectively analyzed CIMT in T2DM patients over a 4-year follow-up period. Methods 355 T2DM patients (mean age 59 years; 54.9% women) were included in the present study. CIMT were measured using Color Doppler ultrasound. CIMT was measured at baseline (CIMT) in 2006 and at follow-up in 2010. Biochemical and clinical measurements were collected at baseline. Results Mean value of CIMT1 and CIMT2 were 0.740 ± 0.148 mm and 0.842 ± 0.179 mm, respectively. Men had higher CIMT than women both at baseline and at follow-up (CIMT1: 0.762 ± 0.149 vs 0.723 ± 0.146 mm, P = 0.0149; CIMT2: 0.880 ± 0.189 vs 0.810 ± 0.164 mm, P = 0.0002). Mean annual progression of CIMT (dCIMT) was 0.025 ± 0.022 mm/year. dCIMT was larger in men than in women (0.030 ± 0.025 vs 0.022 ± 0.019 mm, P = 0.0006). In multiple regression analyses, age was an independent risk factor of CIMT in both genders, while dCIMT was associated with age only in men. Conclusions Gender difference in CIMT was confirmed in T2DM patients. Moreover, impact of ageing on CIMT progression only existed in men, which might be the reason that gender difference in CIMT increased with age.
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Affiliation(s)
- Bo Zhao
- Department of Ultrasonography, Ruijin Hospital, Shanghai Jiaotong University Medical School, 197 Ruijin 2nd Road, Shanghai 200025, People's Republic of China
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Casalnuovo G, Gerdts E, Simone GD, Izzo R, Marco MD, Giudice R, Trimarco B, Luca ND. Arterial stiffness is associated with carotid atherosclerosis in hypertensive patients (the Campania Salute Network). Am J Hypertens 2012; 25:739-45. [PMID: 22513830 DOI: 10.1038/ajh.2012.38] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Pulse pressure/stroke volume indexed to height(2.04) (PP/SVi) is a validated measure of arterial stiffness, but its relation to carotid atherosclerosis is unknown. METHODS Clinical, echocardiographic, and carotid ultrasound data from 6,209 hypertensive patients without prevalent cardiovascular (CV) disease in the Campania Salute Network were analyzed. The population was grouped into tertiles of PP/SVi. From carotid ultrasound, peak and mean intima-media thickness (IMT) and presence of carotid plaques in the common and internal carotid arteries were reported. RESULTS Increasing PP/SVi tertile was associated with a parallel increase in age, blood pressure, total serum cholesterol and the number of antihypertensive drugs used (all P < 0.01). Higher PP/SVi was also associated with greater peak and mean IMT (all P < 0.01), also when adjusting for age, gender, blood pressure, lipid profile, and diabetes mellitus (all P < 0.01). Similarly, compared to the lower PP/SVi tertile, the multiple adjusted prevalence ratio of carotid plaque was 7 (95% confidence interval (CI) 1-13, P < 0.03) in the middle tertile and 21 (95% CI 15-28, P < 0.0001) in the upper tertile, independently of confounders. CONCLUSION In treated hypertensive patients participating in the Campania Salute Network, higher PP/SVi is associated with carotid atherosclerosis independent of well-known clinical confounders.
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Buchanan DN, Lindenmaier T, McKay S, Bureau Y, Hackam DG, Fenster A, Parraga G. The relationship of carotid three-dimensional ultrasound vessel wall volume with age and sex: comparison to carotid intima-media thickness. ULTRASOUND IN MEDICINE & BIOLOGY 2012; 38:1145-1153. [PMID: 22579542 DOI: 10.1016/j.ultrasmedbio.2012.02.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Revised: 01/18/2012] [Accepted: 02/16/2012] [Indexed: 05/31/2023]
Abstract
The relationship of three-dimensional ultrasound (3DUS)-derived carotid vessel wall volume (VWV) was evaluated with respect to age and sex. B-mode and 3DUS images were acquired for 316 subjects from diverse groups including obese primary prevention, diabetic nephropathy, renal transplant and rheumatoid arthritis populations. The relationship for intima-media thickness (IMT) and VWV with age and sex were determined using Pearson-product-moment correlations. Mean IMT (r = 0.18, p = 0.001) and VWV (r = 0.24, p < 0.01) correlated modestly with age. There were modest correlations in males (IMT, r = 0.19, p = 0.003; VWV, r = 0.34, p < 0.001) and in females for IMT and age (r = 0.30, p = 0.007) but not between 3DUS VWV and age in females (r = 0.10, p = 0.4). Significant associations between plaque and VWV (r = 0.36, p = 0.001) but not IMT suggest different correlations in females that may be attributed to plaque.
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Affiliation(s)
- Daniel N Buchanan
- Imaging Research Laboratories, Robarts Research Institute, London, Ontario, Canada
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248
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Robertson CM, Gerry F, Fowkes R, Price JF. Carotid intima–media thickness and the prediction of vascular events. Vasc Med 2012; 17:239-48. [DOI: 10.1177/1358863x12445103] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Carotid intima–media thickness (cIMT) has received interest as a predictor of cardiovascular events in recent years. Use of cIMT in a clinical setting is limited by the variability in measurement and the lack of evidence for its use in clinical risk prediction. This review examines the major studies that have assessed the relationship between cIMT and cardiovascular event risk and discusses the current role of IMT in cardiovascular risk prediction.
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Affiliation(s)
| | - F Gerry
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - R Fowkes
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Jacqueline F Price
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
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Kuo F, Gardener H, Dong C, Cabral D, Della-Morte D, Blanton SH, Elkind MSV, Sacco RL, Rundek T. Traditional cardiovascular risk factors explain the minority of the variability in carotid plaque. Stroke 2012; 43:1755-60. [PMID: 22550054 DOI: 10.1161/strokeaha.112.651059] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND PURPOSE Subclinical atherosclerotic plaque is an important marker of increased vascular risk. Identifying factors underlying the variability in burden of atherosclerotic carotid plaque unexplained by traditional vascular risk factors may help target novel preventive strategies. METHODS As a part of the carotid substudy of the Northern Manhattan Study (NOMAS), 1790 stroke-free individuals (mean age, 69±9; 60% women; 61% Hispanic, 19% black, 18% white) were assessed for total plaque area (TPA) burden using 2-dimensional carotid ultrasound imaging. Multiple linear regression models were constructed. Model 1 used prespecified traditional risk factors: age, sex, low-density lipoprotein cholesterol, diabetes mellitus, pack-years of smoking, blood pressure, and treatment for blood pressure; and Model 2, an addition of socioeconomic and less traditional risk factors. The contributions of the components of the Framingham heart risk score and the NOMAS Global Vascular Risk Score to the TPA were explored. RESULTS Prevalence of carotid plaque was 58%. Mean TPA was 13±19 mm2. Model 1 explained 19.5% of the variance in TPA burden (R2=0.195). Model 2 explained 21.9% of TPA burden. Similarly, the Framingham heart risk score explained 18.8% and NOMAS global vascular risk score 21.5% of the TPA variance. CONCLUSIONS The variation in preclinical carotid plaque burden is largely unexplained by traditional and less traditional vascular risk factors, suggesting that other unaccounted environmental and genetic factors play an important role in the determination of atherosclerotic plaque. Identification of these factors may lead to new approaches to prevent stroke and cardiovascular disease.
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Affiliation(s)
- Frank Kuo
- Department of Neurology, Miller School of Medicine, University of Miami, Clinical Research Building, CRB 1348, 1120 NW 14th Street, Miami, FL 33136, USA.
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Akazawa S, Tojikubo M, Nakano Y, Nakamura S, Kawasaki T, Koga N. Usefulness of sum of the thickness of plaque in the carotid artery for predicting the presence and the extent of the coronary artery disease in patients with type 2 diabetes mellitus without known coronary artery disease. Diabetes Res Clin Pract 2012; 96:111-8. [PMID: 22309787 DOI: 10.1016/j.diabres.2011.11.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Revised: 10/18/2011] [Accepted: 11/21/2011] [Indexed: 11/26/2022]
Abstract
AIMS The usefulness of the sum of plaque thickness in the carotid artery (plaque score; PS), as a prediction of coronary artery disease (CAD) was investigated in patients with type 2 diabetes mellitus. METHODS B mode ultrasonographic scanning of the carotid artery and multislice computed tomography (MSCT) coronary angiography were performed in 227 diabetic patients without known cardiac disease. RESULTS The PS was useful to predict the presence of diseased [nonobstructive and obstructive] CAD (≧3 segments) and obstructive (≧50%) CAD with cut-off value of 3.5mm (area under curve: 0.745 and 0.782, respectively), according to a receiver operating characteristics curve analysis. A multivariate logistic analysis of baseline risk factors showed that the PS was independent risk factor for the prediction of diseased and obstructive coronary artery disease (R(2)=0.2165, p<0.0001 and R(2)=0.2265, p<0.0001, respectively). The PS was most significant predictor of the number of diseased and obstructive segments of the coronary artery in a multiple regression analysis (R(2)=0.2022, p<0.0001 and R(2)=0.2209, p<0.0001, respectively). CONCLUSIONS The PS in the carotid artery was useful for the prediction of the presence and the extent of CAD, and was most important as a screening test for the identification of a high risk group of asymptomatic diabetic patients.
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Affiliation(s)
- Shoichi Akazawa
- Shin-Koga Hospital, Department of Diabetes and Endocrinology, Japan.
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