301
|
Johnson HM, Stein JH. Measurement of carotid intima-media thickness and carotid plaque detection for cardiovascular risk assessment. J Nucl Cardiol 2011; 18:153-62. [PMID: 21132418 DOI: 10.1007/s12350-010-9319-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Heather M Johnson
- University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA
| | | |
Collapse
|
302
|
Peters SA, Dogan S, Meijer R, Palmer MK, Grobbee DE, Crouse JR, O'Leary DH, Evans GW, Raichlen JS, Bots ML. The Use of Plaque Score Measurements to Assess Changes in Atherosclerotic Plaque Burden Induced by Lipid-Lowering Therapy Over Time: The METEOR Study. J Atheroscler Thromb 2011; 18:784-95. [DOI: 10.5551/jat.8169] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
|
303
|
Conventional and behavioral risk factors explain differences in sub-clinical vascular disease between black and Caucasian South Africans: the SABPA study. Atherosclerosis 2010; 215:237-42. [PMID: 21208616 DOI: 10.1016/j.atherosclerosis.2010.12.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Revised: 11/30/2010] [Accepted: 12/02/2010] [Indexed: 01/28/2023]
Abstract
OBJECTIVES There is an emerging burden of cardiovascular disease among urban black Africans in South Africa, which has been largely explained by the transition from traditional African lifestyles to more westernized behavior. We examined the role of health behaviors in explaining the excess burden of sub clinical vascular disease seen in black Africans compared to Caucasians. METHODS This was a cross-sectional study, comprising of urban African teachers (n=192 black, 206 Caucasian) working for one of the four Kenneth Kaunda Education districts in the North West Province, South Africa. Conventional cardiovascular risk factors, 24 h ambulatory blood pressure and objectively measured physical activity (Actical® accelerometers), smoking (confirmed by serum cotinine), and alcohol (serum gamma glutamyl transferase) were assessed. The main outcome was a marker of sub-clinical vascular disease, mean carotid intima media thickness (mCIMT), measured using high resolution ultrasound. RESULTS Compared with Caucasians, the black Africans demonstrated higher mCIMT (age and sex adjusted β=0.044, 95% CI, 0.024-0.064 mm). The blacks also had higher 24h systolic and diastolic blood pressure, triglycerides, adiposity, and C-reactive protein. In addition, blacks were less physically active (790.0 kcal/d vs 947.3 kcal/d, p<0.001), more likely to smoke (25% vs 16.3%, p=0.002), and demonstrated higher alcohol abuse (gamma glutamyl transferase, 66.6 μ/L vs 27.2 μ/L, p<0.001) compared with Caucasians. The difference in mCIMT between blacks and Caucasians was attenuated by 34% when conventional risk factors were added to the model and a further 18% when health behaviors were included. CONCLUSION There is an excess burden of sub clinical vascular disease seen in black Africans compared to Caucasians, which can be largely explained by health behaviors and conventional risk factors.
Collapse
|
304
|
Camhi SM, Katzmarzyk PT, Broyles ST, Srinivasan SR, Chen W, Bouchard C, Berenson GS. Subclinical atherosclerosis and metabolic risk: role of body mass index and waist circumference. Metab Syndr Relat Disord 2010; 9:119-25. [PMID: 21133775 DOI: 10.1089/met.2010.0079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Carotid artery intima-media thickness (IMT) is greater in adults with elevated metabolic risk profiles. However, the influence of body mass index (BMI) or waist circumference (WC) on the relationship between IMT and metabolic risk is unclear. METHODS Adults from the Bogalusa Heart Study were classified as normal weight, overweight, or obese and into WC categories (men, low <94 cm, moderate 94-101.9 cm, high ≥102 cm; women, low <80 cm, moderate 80-87.9 cm, high ≥88 cm). Elevated metabolic risk was defined by cardiovascular risk factor clustering (≥2 abnormal risk factors or insulin resistance (upper quartile of homeostasis model of insulin resistance). Carotid ultrasound measurements were obtained and mean IMT was calculated. General linear models compared IMT between elevated versus normal metabolic risk groups, adjusting for sex, age, race/ethnicity, and either BMI or WC category. RESULTS Adults were 24-43 years of age (n = 991) and 41% had elevated metabolic risk (42% male, 28% African American, 38% obese). IMT (mm) was greater in adults with elevated metabolic risk (0.83 ± 0.007) versus normal risk (0.80 ± 0.006) whether adjusted by BMI or WC (both P < 0.0005). IMT was greater in adults with elevated compared to normal metabolic risk within normal-weight (0.84 ± 0.016 vs. 0.79 ± 0.008; P = 0.002), and obese adults (0.86 ± 0.009 vs. 0.80 ± 0.01; P = 0.03), but not significantly different between risk groups in overweight adults. Similar results were found when stratified by WC category. CONCLUSION Adults with elevated metabolic risk have greater IMT than those with normal risk in normal-weight, overweight, low WC, and high WC, but not significant for overweight or moderate WC categories.
Collapse
Affiliation(s)
- Sarah M Camhi
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | | | | | | | | | | | | |
Collapse
|
305
|
Chahal NS, Lim TK, Jain P, Chambers JC, Kooner JS, Senior R. The Distinct Relationships of Carotid Plaque Disease and Carotid Intima-Media Thickness with Left Ventricular Function. J Am Soc Echocardiogr 2010; 23:1303-9. [DOI: 10.1016/j.echo.2010.08.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Indexed: 10/19/2022]
|
306
|
Costanzo P, Perrone-Filardi P, Vassallo E, Paolillo S, Cesarano P, Brevetti G, Chiariello M. Does Carotid Intima-Media Thickness Regression Predict Reduction of Cardiovascular Events? J Am Coll Cardiol 2010; 56:2006-20. [PMID: 21126642 DOI: 10.1016/j.jacc.2010.05.059] [Citation(s) in RCA: 160] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Revised: 04/23/2010] [Accepted: 05/17/2010] [Indexed: 10/18/2022]
|
307
|
Polak JF, Pencina MJ, Meisner A, Pencina KM, Brown LS, Wolf PA, D'Agostino RB. Associations of carotid artery intima-media thickness (IMT) with risk factors and prevalent cardiovascular disease: comparison of mean common carotid artery IMT with maximum internal carotid artery IMT. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2010; 29:1759-68. [PMID: 21098848 PMCID: PMC3186063 DOI: 10.7863/jum.2010.29.12.1759] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE The goal of this study was to compare internal carotid artery (ICA) intima-media thickness (IMT) with common carotid artery (CCA) IMT as global markers of cardiovascular disease (CVD). METHODS Cross-sectional measurements of the mean CCA IMT and maximum ICA IMT were made on ultrasound images acquired from the Framingham Offspring cohort (n = 3316; mean age, 58 years; 52.7% women). Linear regression models were used to study the associations of the Framingham risk factors with CCA and ICA IMT. Multivariate logistic regression models and receiver operating characteristic (ROC) curve analysis were used to compare the associations of prevalent CVD with CCA and ICA IMT and determine sensitivity and specificity. RESULTS The association between age and the mean CCA IMT corresponded to an increase of 0.007 mm/y; the increase was 0.037 mm/y for the ICA IMT. Framingham risk factors accounted for 28.6% and 27.5% of the variability in the CCA and ICA IMT, respectively. Age and gender contributed 23.5% to the variability of the CCA IMT and 22.5% to that of the ICA IMT, with the next most important factor being systolic blood pressure (1.9%) for the CCA IMT and smoking (1.6%) for the ICA IMT. The CCA IMT and ICA IMT were statistically significant predictors of prevalent CVD, with the ICA IMT having a larger area under the ROC curve (0.756 versus 0.695). CONCLUSIONS Associations of risk factors with CCA and ICA IMT are slightly different, and both are independently associated with prevalent CVD. Their value for predicting incident cardiovascular events needs to be compared in outcome studies.
Collapse
Affiliation(s)
- Joseph F Polak
- Department of Radiology, Tufts Medical Center, Boston, MA 02111, USA.
| | | | | | | | | | | | | |
Collapse
|
308
|
Palatini P, Puato M, Rattazzi M, Pauletto P. Effect of regular physical activity on carotid intima-media thickness. Results from a 6-year prospective study in the early stage of hypertension. Blood Press 2010; 20:37-44. [PMID: 20977389 DOI: 10.3109/08037051.2010.524080] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIM To study the effect of leisure-time physical activity on the progression of carotid intima-media thickness (IMT) in the early stage of hypertension. METHODS We studied 47 sedentary and 40 physically active young pre-hypertensive or stage 1 hypertensive subjects. IMT was assessed in the common carotid artery, carotid bulb and internal carotid artery at baseline and after 6.5 years. RESULTS Cumulative maximum IMT of the three carotid segments (M-MAX, 0.13 ± 0.08 vs 0.10 ± 0.07 mm, p = 0.006) and cumulative mean IMT (m-IMT, 0.11 ± 0.07 vs 0.09 ± 0.06 mm, p = 0.01), adjusted for confounders, increased to a greater degree in the sedentary than the active subjects. Differences in known risk factors explained a large proportion of the observed association. Inclusion of baseline cholesterol in the regression model attenuated the strength of the association for both M-MAX (p = 0.04) and m-IMT (p = 0.049). When also baseline blood pressure, heart rate, and body mass index were taken into account the association with physical activity status remained significant for maximum IMT of internal carotid artery (p = 0.034) and was of borderline significance for M-MAX (p = 0.066). CONCLUSIONS Physical activity can delay the progression of carotid IMT in hypertension. This effect is mediated in substantial part by the better risk factor profile in active subjects.
Collapse
Affiliation(s)
- Paolo Palatini
- Dipartimento di Medicina Clinica e Sperimentale, Università di Padova, Via Giustiniani 2, Padua, Italy.
| | | | | | | |
Collapse
|
309
|
Sachpekidis V, Bhan A, Paul M, Gianstefani S, Smith L, Reiken J, Walker N, Harries D, Pearson P, Monaghan MJ. The additive value of three-dimensional derived left atrial volume and carotid imaging in dobutamine stress echocardiography. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2010; 12:46-53. [DOI: 10.1093/ejechocard/jeq104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
310
|
Abizanda P, Atienzar P, Casado L, Romero L, Sánchez-Jurado PM, León M, Martín-Sebastiá E, López-Jiménez E, Paterna G, Martínez-Sánchez E. Cardiovascular risk factors are associated with subclinical atherosclerosis in high functioning older adults. Maturitas 2010; 67:54-9. [DOI: 10.1016/j.maturitas.2010.04.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Revised: 04/08/2010] [Accepted: 04/23/2010] [Indexed: 01/19/2023]
|
311
|
Taylor AJ, Kerry R. A ‘system based’ approach to risk assessment of the cervical spine prior to manual therapy. INT J OSTEOPATH MED 2010. [DOI: 10.1016/j.ijosm.2010.05.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
312
|
Kurnatowska I, Grzelak P, Stefańczyk L, Nowicki M. Tight relations between coronary calcification and atherosclerotic lesions in the carotid artery in chronic dialysis patients. Nephrology (Carlton) 2010; 15:184-9. [PMID: 20470277 DOI: 10.1111/j.1440-1797.2009.01169.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
AIM Both vascular calcification and atherosclerosis are highly prevalent in patients with end-stage renal disease (ESRD) and have been associated with increased cardiovascular morbidity. Because those two phenomena might be only coincidentally related in chronic haemodialysis (HD) patients, in this study, coronary artery calcification (CAC), common carotid artery intima media thickness (CCA-IMT) and thickness of atherosclerotic plaques in the carotid artery were simultaneously measured. METHODS In a cross-sectional study of 47 HD patients (31 male, mean age 56.8 +/- 11.4 years, and 16 female, mean age 56.0 +/- 7.5 years) without history of major cardiovascular complications. CCA-IMT and presence and thickness of atherosclerotic plaques were measured with ultrasound and CAC with multidetector computed tomography. RESULTS The CAC were present in 70.2% of patients. The mean CAC was 1055 +/- 232, the mean CCA-IMT was 0.96 +/- 0.21. The atherosclerotic plaques in the common carotid arteries were visualized in 38 patients (80.1%), the mean thickness of the atherosclerotic plaque was 1.61 +/- 0.8 mm. We found a significant positive correlation between CAC and CCA-IMT (r = 0.70, P < 0.001). The thickness of atherosclerosis plaque positively correlated with CAC as well as with CCA-IMT (r = 0.60, P < 0.001 and r = 0.7, P < 0.003, respectively). CONCLUSION The study revealed close relationships between CAC, intima media thickness and the thickness of atherosclerotic plaques in dialysis patients. It may indicate that both vascular calcification and atherosclerotic lesions frequently coexist in patients with ESRD and that the intima media thickness could serve as a surrogate marker of vascular calcification.
Collapse
Affiliation(s)
- Ilona Kurnatowska
- Departments of Nephrology, Hypertension and Kidney Transplantation, Medical University, Łódź, Poland
| | | | | | | |
Collapse
|
313
|
Lee SWL, Siu Han Hai JJ, Kong SL, Lam YM, Lam S, Chan PH, Chan KW, Wong KL, Tam CC, Chan RHW. Side Differences of Carotid Intima-Media Thickness in Predicting Cardiovascular Events Among Patients With Coronary Artery Disease. Angiology 2010; 62:231-6. [PMID: 20688786 DOI: 10.1177/0003319710379109] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Population-based studies have demonstrated differences in intima—media thickness (IMT) measured from the left and right common carotid arteries (CCAs). However, its prognostic implications among patients with established coronary artery disease (CAD) remain unknown. Correlations between the left and right CCAs and the composite end point of cardiac death or nonfatal acute coronary syndrome among 149 patients with angiographically confirmed stable CAD were studied. A total of 22 patients had cardiovascular events during the 32.1 ± 10.9 months follow-up. Multivariate analysis revealed that prior ischemic stroke (hazard ratio [HR]: 15.36, 95% confidence interval [CI]: 4.49-52.59, P < .001), extent of CAD (HR: 1.56, 95%CI: 1.01-2.42, P = .046), and right CCA IMT (HR: 17.07, 95%CI: 2.16-134.69, P = .007) but not the left CCA IMT, independently predicted cardiovascular events. The right CCA IMT independently predicted event-free survival among patients with established CAD, suggesting that the left and right CCA may exhibit different prognostic values in our population.
Collapse
Affiliation(s)
- Stephen Wai-luen Lee
- Cardiology Division, Department of Medicine, Queen Mary Hospital, Hong Kong SAR, China, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China, Department of Medicine, Tung Wah Hospital, Hong Kong SAR, China
| | - Jo Jo Siu Han Hai
- Cardiology Division, Department of Medicine, Queen Mary Hospital, Hong Kong SAR, China, Department of Medicine, Tung Wah Hospital, Hong Kong SAR, China
| | - Shun-ling Kong
- Cardiology Division, Department of Medicine, Queen Mary Hospital, Hong Kong SAR, China
| | - Yui-ming Lam
- Cardiology Division, Department of Medicine, Queen Mary Hospital, Hong Kong SAR, China
| | - Simon Lam
- Cardiology Division, Department of Medicine, Queen Mary Hospital, Hong Kong SAR, China
| | - Pak-hei Chan
- Cardiology Division, Department of Medicine, Queen Mary Hospital, Hong Kong SAR, China
| | - Ki-wan Chan
- Cardiology Division, Department of Medicine, Queen Mary Hospital, Hong Kong SAR, China
| | - Ka-lam Wong
- Cardiology Division, Department of Medicine, Queen Mary Hospital, Hong Kong SAR, China
| | - Chor-cheung Tam
- Cardiology Division, Department of Medicine, Queen Mary Hospital, Hong Kong SAR, China
| | - Raymond Hon-wah Chan
- Cardiology Division, Department of Medicine, Queen Mary Hospital, Hong Kong SAR, China, Department of Medicine, Tung Wah Hospital, Hong Kong SAR, China
| |
Collapse
|
314
|
Palareti G, Valdré L, Favaretto E, Bovina V, Cini M, Legnani C. No early signs of atherosclerotic alterations in carriers of inherited thrombophilia. Eur J Intern Med 2010; 21:273-7. [PMID: 20603034 DOI: 10.1016/j.ejim.2010.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2009] [Revised: 04/05/2010] [Accepted: 04/25/2010] [Indexed: 01/10/2023]
Abstract
BACKGROUND Congenital thrombophilia is a risk factor for venous thromboembolism (VTE). Whether it is associated with increased risk of arterial disease is today a matter of debate. We aimed to look for early signs of atherosclerotic alterations in carriers of inherited thrombophilic alterations (ITA). METHODS Between January 2006 and September 2008 ultrasonography assessment of the carotid arteries with measurement of intima-media thickness (IMT), and determination of the ankle/brachial pressure index (ABI), was performed in: a) 161 carriers of ITA (deficiency of antithrombin, protein C or S, factor V Leiden or prothrombin G20210A mutations), 84 of whom with previous VTE, and b) 180 subjects without ITA, matched for age, sex and previous VTE. All subjects were <66 year old. RESULTS Carotid plaques were found in 8 subjects [3 (1.9%) with ITA]. Increased IMT values (>1mm) were detected in 6 subjects with and 1 without thrombophilia (p=0.055). The prevalence of IMT values>90(th) percentile was not different in subjects with/without thrombophilia (15.2% vs 11.6%, p=0.416). At multivariate analysis only age was significantly associated with increased odds ratios for IMT values>90(th) percentile. No subjects had abnormal (<0.9) ABI values. CONCLUSIONS The present study, the first to investigate the presence of atherosclerotic markers in relatively young subjects with inherited thrombophilia, did not find a particular prevalence of signs of early atherosclerotic markers in these subjects.
Collapse
Affiliation(s)
- Gualtiero Palareti
- Dept. Angiology & Blood Coagulation Marino Golinelli, University Hospital S. Orsola-Malpighi, Bologna, Italy.
| | | | | | | | | | | |
Collapse
|
315
|
Adraktas DD, Brasic N, Furtado AD, Cheng SC, Ordovas K, Chun K, Chien JD, Schaeffer S, Wintermark M. Carotid atherosclerosis does not predict coronary, vertebral, or aortic atherosclerosis in patients with acute stroke symptoms. Stroke 2010; 41:1604-9. [PMID: 20595672 PMCID: PMC2941092 DOI: 10.1161/strokeaha.109.577437] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2010] [Accepted: 03/12/2010] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to determine whether significant atherosclerotic disease in the carotid arteries predicts significant atherosclerotic disease in the coronary arteries, vertebral arteries, or aorta in patients with symptoms of acute ischemic stroke. METHODS Atherosclerotic disease was imaged using CT angiography in a prospective study of 120 consecutive patients undergoing emergent CT evaluation for symptoms of stroke. Using a comprehensive CT angiography protocol that captured the carotid arteries, coronary arteries, vertebral arteries, and aorta, we evaluated these arteries for the presence and severity of atherosclerotic disease. Significant atherosclerotic disease was defined as >50% stenosis in the carotid, coronary, and vertebral arteries, or >or=4 mm thickness and encroaching in the aorta. Presence of any and significant atherosclerotic disease was compared in the different types of arteries assessed. RESULTS Of these 120 patients, 79 had CT angiography examinations of adequate image quality and were evaluated in this study. Of these 79 patients, 33 had significant atherosclerotic disease. In 26 of these 33 patients (79%), significant disease was isolated to 1 type of artery, most often to the coronary arteries (N=14; 54%). Nonsignificant atherosclerotic disease was more systemic and involved multiple arteries. CONCLUSIONS Significant atherosclerotic disease in the carotid arteries does not predict significant atherosclerotic disease in the coronary arteries, vertebral arteries, or aorta in patients with symptoms of acute ischemic stroke. Significant atherosclerotic disease is most often isolated to 1 type of artery in these patients, whereas nonsignificant atherosclerotic disease tends to be more systemic.
Collapse
Affiliation(s)
- Dionesia D Adraktas
- Department of Radiology, University of California, San Francisco, San Francisco, Calif, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
316
|
Yu RHY, Ho SC, Lam CWK, Woo JLF, Ho SSY. Psychological factors and subclinical atherosclerosis in postmenopausal Chinese women in Hong Kong. Maturitas 2010; 67:186-91. [PMID: 20638205 DOI: 10.1016/j.maturitas.2010.06.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2009] [Revised: 06/15/2010] [Accepted: 06/16/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Substantial evidence shows that psychological factors are associated with cardiovascular diseases. However, data on the association between psychological factors and subclinical atherosclerosis is lacking in postmenopausal Chinese women. OBJECTIVES To examine the associations of perceived stress and trait anxiety with subclinical atherosclerosis in postmenopausal Chinese women in Hong Kong. Their relationships with biological and behavioral risk factors were also examined. METHODS Between 2002 and 2004, we recruited 518 postmenopausal women aged 50-64 years. Perceived stress and trait anxiety were evaluated by the perceived stress scale and the state-trait anxiety inventory, respectively. Subclinical atherosclerosis was determined by measuring carotid intima-media thickness (IMT) and plaque using B-mode ultrasonography. RESULTS Perceived stress and trait anxiety showed no significant association with IMT or plaque. Multivariate analyses showed high perceived stress scores were associated with an increased risk of elevated total cholesterol (OR=2.10; 95% CI=1.17-3.77) and elevated low-density lipoprotein cholesterol (LDL-C) (OR=2.39; 95% CI=1.36-4.21). High trait anxiety scores were associated with a 2.7-fold risk of elevated LDL-C (OR=2.74; 95% CI=1.56-4.80). Women with high perceived stress or trait anxiety scores were more likely to be physically inactive. CONCLUSIONS Perceived stress and trait anxiety were associated with atherogenic lipid levels, but not subclinical atherosclerosis. Maintaining high physical activity may help alleviate psychological stress and anxiety.
Collapse
Affiliation(s)
- Ruby H Y Yu
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | | | | | | | | |
Collapse
|
317
|
Hamirani YS, Larijani V, Isma’eel H, Pagali SR, Bach P, Karlsberg RP, Budoff MJ. Association of plaque in the carotid and coronary arteries, using MDCT angiography. Atherosclerosis 2010; 211:141-5. [DOI: 10.1016/j.atherosclerosis.2010.01.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2009] [Accepted: 01/09/2010] [Indexed: 10/19/2022]
|
318
|
Panayiotou AG, Nicolaides AN, Griffin M, Tyllis T, Georgiou N, Bond D, Martin RM, Hoppensteadt D, Fareed J, Humphries SE. Leukocyte telomere length is associated with measures of subclinical atherosclerosis. Atherosclerosis 2010; 211:176-81. [PMID: 20219198 DOI: 10.1016/j.atherosclerosis.2010.01.037] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2009] [Revised: 12/20/2009] [Accepted: 01/22/2010] [Indexed: 11/18/2022]
Abstract
AIMS Our aim was to test the association of mean leukocyte telomere length (LTL) with ultrasonic measures of subclinical atherosclerosis such as intima-media thickness in the common carotid (IMTcc) and sum of plaque areas (SPA) and with serological markers. METHODS AND RESULTS Carotid and femoral bifurcations were scanned in 762 general population volunteers (46% men) over 40. Four features were considered: (a) IMTcc, (b) sum plaque areas of carotid plaques (SPAcar), (c) sum plaque area of common femoral plaques (SPAfem) and (d) sum plaque area (SPA--sum of the plaque areas of the largest plaques present in each of both carotid and femoral bifurcations). Mean LTL was determined with a quantitative real-time PCR-based method. IMTcc was strongly associated with mean LTL both before and after correction for traditional risk factors (B=-0.002; 95% CI=-0.004 to -0.00; p=0.014). In sex-specific analysis, the association was stronger in men (p for sex interaction<0.001). SPAfem was associated with LTL in women before and after correction (B=-0.195; 95% CI=-0.38 to -0.01; p=0.037) (p for sex interaction<0.001). LTL was also associated with age and sex-adjusted levels of hsCRP (p=0.012), sCD40L (p=0.042), homocysteine (p=0.006), creatinine (p=0.02), ApoA1 (p=0.01), Lp(a) (p=0.04) and HOMA-IR (p=0.008). CONCLUSIONS Our results support the telomere hypothesis and highlight potential differences in the biological mechanisms leading to intima-media thickening and/or plaque formation between vascular beds. They may provide insights into a novel treatment of antisenescence to prevent atherosclerosis.
Collapse
Affiliation(s)
- A G Panayiotou
- Department of Medicine, Division of Cardiovascular Genetics, UCL, London, UK.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
319
|
Tessitore E, Rundek T, Jin Z, Homma S, Sacco RL, Di Tullio MR. Association between carotid intima-media thickness and aortic arch plaques. J Am Soc Echocardiogr 2010; 23:772-7. [PMID: 20510582 PMCID: PMC2908509 DOI: 10.1016/j.echo.2010.04.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2009] [Indexed: 10/19/2022]
Abstract
BACKGROUND Large aortic arch plaques are associated with ischemic stroke. Carotid intima-media thickness (CIMT) is a marker of subclinical atherosclerosis and a strong predictor of cardiovascular disease and stroke. The association between CIMT and aortic arch plaques has been studied in patients with strokes, but not in the general population. The aim of this study was to investigate this association in an elderly asymptomatic cohort and to assess the possibility of using CIMT to predict the presence or absence of large aortic arch plaques. METHODS Stroke-free control subjects from the Aortic Plaque and Risk of Ischemic Stroke (APRIS) study underwent transesophageal echocardiography and high-resolution B-mode ultrasound of the carotid arteries. CIMT was measured at the common carotid artery, bifurcation, and internal carotid artery. The association between CIMT and aortic arch plaques was analyzed using multivariate regression models. The positive and negative predictive values of CIMT for large (>or=4 mm) aortic arch plaques were calculated. RESULTS Among 138 subjects, large aortic arch plaques were present in 35 (25.4%). Only CIMT at the bifurcation was associated with large aortic arch plaques after adjustment for atherosclerotic risk factors (P=.007). The positive and negative predictive values of CIMT for aortic arch plaque>or=4 mm at the bifurcation above the 75th percentile (>or=0.95 mm) were 42% and 80%, respectively. The negative predictive value increased to 87% when the median CIMT value (0.82 mm) was used. CONCLUSIONS CIMT at the bifurcation is independently associated with aortic arch plaque>or=4 mm. Its strong negative predictive value for large plaques indicates that CIMT may be used as an initial screening test to exclude severe arch atherosclerosis in the general population.
Collapse
Affiliation(s)
- Elena Tessitore
- Department of Medicine, Columbia University, New York, New York 10032, USA
| | | | | | | | | | | |
Collapse
|
320
|
Yoon HJ, Jeong MH, Kim KH, Ahn Y, Cho JG, Park JC, Kang JC, Bae JH. Carotid Intima-Media Thickness, Not Carotid Plaque, is Associated With Large Territory Cerebral Infarction in Patients With Ischemic Stroke. Korean Circ J 2010; 40:272-6. [PMID: 20589199 PMCID: PMC2893367 DOI: 10.4070/kcj.2010.40.6.272] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2009] [Revised: 11/23/2009] [Accepted: 12/25/2009] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Carotid intima-media thickness (IMT) has been associated with an increased risk of ischemic stroke. To better understand this association, we evaluated the relationships of vascular risk factors, including carotid IMT and carotid plaque, and large territory cerebral infarction and small vessel stroke. SUBJECTS AND METHODS A total of 502 patients with acute ischemic stroke were divided into two groups according to neurologic examinations and imaging studies; 1) a large territory infarction group (group I: n=126, 64.4+/-11 years, 78 males) and 2) a small vessel stroke group (group II: n=376, 62.5+/-11 years, 242 males). We evaluated associations between (a) territory and non-territory strokes and (b) age, sex, potential vascular risk factors, carotid image and cardiac function (by echocardiography). RESULTS We did not find significant between group differences of age, sex, diabetes, previous history of ischemic stroke, plaque (presence, site and size of carotid plaque), and velocity of carotid blood flow and left ventricle ejection fraction. However, group I had a higher incidence of hypertension (p=0.006), smoking (p=0.003), and dyslipidemia (p=0.001). Group I had thicker carotid IMT than group II (right carotid: 0.81+/-0.21 mm vs. 0.76+/-0.19 mm, p=0.035; left carotid: 0.88+/-0.23 mm vs. 0.80+/-0.20 mm, p=0.014) and a higher e/e' level (12.08 vs. 9.66, p<0.001). Dyslipidemia, thicker carotid IMT and elevated E/E' ratios were significant independent predictors for large territory infarction in patients with ischemic stroke. CONCLUSION Carotid IMT is significantly increased in patients with large territory infarction compared with those with small vessel stroke.
Collapse
Affiliation(s)
- Hyun Ju Yoon
- The Heart Research Center of Chonnam National University Hospital, Gwangju, Korea
| | - Myung Ho Jeong
- The Heart Research Center of Chonnam National University Hospital, Gwangju, Korea
| | - Kye Hun Kim
- The Heart Research Center of Chonnam National University Hospital, Gwangju, Korea
| | - Younggeun Ahn
- The Heart Research Center of Chonnam National University Hospital, Gwangju, Korea
| | - Jeong Gwan Cho
- The Heart Research Center of Chonnam National University Hospital, Gwangju, Korea
| | - Jong Chun Park
- The Heart Research Center of Chonnam National University Hospital, Gwangju, Korea
| | - Jung Chaee Kang
- The Heart Research Center of Chonnam National University Hospital, Gwangju, Korea
| | - Jang Ho Bae
- Department of Cardiology, Konyang University College of Medicine, Daejeon, Korea
| |
Collapse
|
321
|
Exploring interactions among metabolic syndrome traits. Methods and meaning. Atherosclerosis 2010; 210:45-7. [DOI: 10.1016/j.atherosclerosis.2010.02.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Accepted: 02/16/2010] [Indexed: 11/20/2022]
|
322
|
Association of COPD with carotid wall intima-media thickness in vascular surgery patients. Respir Med 2010; 104:712-6. [DOI: 10.1016/j.rmed.2009.10.027] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2009] [Revised: 10/30/2009] [Accepted: 10/30/2009] [Indexed: 11/19/2022]
|
323
|
Yoshioka M, Uchida Y, Sugiura S, Ando F, Shimokata H, Nomura H, Nakashima T. The impact of arterial sclerosis on hearing with and without occupational noise exposure: a population-based aging study in males. Auris Nasus Larynx 2010; 37:558-64. [PMID: 20430548 DOI: 10.1016/j.anl.2010.02.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2009] [Revised: 02/01/2010] [Accepted: 02/23/2010] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Arterial sclerosis contributes to inadequate blood supply to multiple organs, suggesting that general atherosclerosis may play an important role in the inner ear. Since noise is a major etiology for hearing loss, the aim of this study was to evaluate both the respective and the combined effects of arterial sclerosis and occupational noise exposure on hearing after accounting for age in middle-aged and elderly men. METHODS The evaluation was conducted using 773 subjects from a population-based sample of 1189 men, aged 40-83 years. The impact of carotid atherosclerosis (CA) or retinal arteriolosclerosis (RA) on hearing was assessed according to history of occupational noise exposure (Noise) obtained in a questionnaire. Differences in the mean pure-tone thresholds at each frequency, between the CA (+) and CA (-) groups or between the RA (+) and RA (-) groups, based on noise exposure were compared using the general linear model (GLM) Procedure in SAS, with adjustments for age. Then, the main effect of CA or RA, and the interactive effect of noise and either CA or RA on pure-tone threshold at seven frequencies were analyzed using an analysis of covariance (ANCOVA), after adjusting for age. RESULTS In the Noise (+) group, a statistically significant deterioration in hearing was found in the CA (+) group compared with the CA (-) group at 500 and 1000 Hz. The results in RA were significant at even lower frequencies than in CA. In the results from ANCOVA, the significant main effect of CA was shown in the pure-tone threshold at 8000 Hz, but not in the analysis of RA. A significant interactive effect of either CA or RA and Noise was observed in hearing at the range from 125 to 1000 Hz. CONCLUSIONS The present study suggests that the impact of arterial sclerosis on hearing is limited but significantly hazardous in middle-aged and elderly men, and that arterial sclerosis exacerbates the deleterious effects of noise on hearing. Early recognition of arterial sclerosis might be contributory to the hearing prognosis after middle age, especially for noise-exposed men.
Collapse
Affiliation(s)
- Mayumi Yoshioka
- Department of Otorhinolaryngology Cognitive and Speech Medicine, Nagoya University School of Medicine, 65 Tsuruma-Cho, Showa Ward, Nagoya City, Aichi Prefecture 466-8550, Japan
| | | | | | | | | | | | | |
Collapse
|
324
|
Kyriacou EC, Pattichis C, Pattichis M, Loizou C, Christodoulou C, Kakkos SK, Nicolaides A. A review of noninvasive ultrasound image processing methods in the analysis of carotid plaque morphology for the assessment of stroke risk. ACTA ACUST UNITED AC 2010; 14:1027-38. [PMID: 20378477 DOI: 10.1109/titb.2010.2047649] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Noninvasive ultrasound imaging of carotid plaques allows for the development of plaque-image analysis methods associated with the risk of stroke. This paper presents several plaque-image analysis methods that have been developed over the past years. The paper begins with a review of clinical methods for visual classification that have led to standardized methods for image acquisition, describes methods for image segmentation and denoising, and provides an overview of the several texture-feature extraction and classification methods that have been applied. We provide a summary of emerging trends in 3-D imaging methods and plaque-motion analysis. Finally, we provide a discussion of the emerging trends and future directions in our concluding remarks.
Collapse
Affiliation(s)
- Efthyvoulos C Kyriacou
- Department of Computer Science and Engineering, Frederick University, CY-3080 Limassol, Cyprus.
| | | | | | | | | | | | | |
Collapse
|
325
|
Ultrasound-assessed plaque occurrence in the carotid and femoral arteries are independent predictors of cardiovascular events in middle-aged men during 10 years of follow-up. Atherosclerosis 2010; 209:469-73. [DOI: 10.1016/j.atherosclerosis.2009.10.016] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2009] [Revised: 10/09/2009] [Accepted: 10/10/2009] [Indexed: 11/22/2022]
|
326
|
Furtado AD, Adraktas DD, Brasic N, Cheng SC, Ordovas K, Smith WS, Lewin MR, Chun K, Chien JD, Schaeffer S, Wintermark M. The triple rule-out for acute ischemic stroke: imaging the brain, carotid arteries, aorta, and heart. AJNR Am J Neuroradiol 2010; 31:1290-6. [PMID: 20360341 DOI: 10.3174/ajnr.a2075] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Ischemic stroke is commonly embolic, either from carotid atherosclerosis or from cardiac origin. These potential sources of emboli need to be investigated to accurately prescribe secondary stroke prevention. Moreover, the mortality in ischemic stroke patients due to ischemic heart disease is greater than that of age-matched controls, thus making evaluation for coronary artery disease important in this patient population. The purpose of this study was to evaluate the image quality of a comprehensive CTA protocol in patients with acute stroke that expands the standard CTA coverage to include all 4 chambers of the heart and the coronary arteries. MATERIALS AND METHODS One hundred twenty patients consecutively admitted to the emergency department with suspected cerebrovascular ischemia undergoing standard-of-care CTA were prospectively enrolled in our study. We used an original tailored acquisition protocol using a 64-section CT scanner, consisting of a dual-phase intravenous injection of iodinated contrast and saline flush, in conjunction with a dual-phase CT acquisition, ascending from the top of the aortic arch to the vertex of the head, then descending from the top of the aortic arch to the diaphragm. No beta blockers were administered. The image quality, attenuation, and CNRs of the carotid, aortic, vertebral, and coronary arteries were assessed. RESULTS Carotid, aorta, and vertebral artery image quality was 100% diagnostic (rated good or excellent) in all patients. Coronary artery image quality was diagnostic in 58% of RCA segments, 73% of LAD segments, and 63% of LCX segments. When we considered proximal segments only, the diagnostic quality rose to 71% in the RCA, 83% in the LAD, and 74% in the LCX. CONCLUSIONS Our stroke protocol achieved excellent opacification of the left heart chambers, the cervical arteries, and each coronary artery, in addition to adequate carotid and coronary artery image quality.
Collapse
Affiliation(s)
- A D Furtado
- Department of Radiology, University of California, San Francisco, San Francisco, California, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
327
|
Lanktree MB, Hegele RA, Schork NJ, Spence JD. Extremes of unexplained variation as a phenotype: an efficient approach for genome-wide association studies of cardiovascular disease. CIRCULATION. CARDIOVASCULAR GENETICS 2010; 3:215-21. [PMID: 20407100 PMCID: PMC3084495 DOI: 10.1161/circgenetics.109.934505] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Matthew B Lanktree
- Department of Medicine, Robarts Research Institute, University of Western Ontario, London, Canada
| | | | | | | |
Collapse
|
328
|
[Subclinial atherosclerosis as a predictor of functional limitation at one year in high-functioning older adults: the Albacete study]. Rev Esp Geriatr Gerontol 2010; 45:125-30. [PMID: 20338671 DOI: 10.1016/j.regg.2009.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2009] [Revised: 09/28/2009] [Accepted: 09/29/2009] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Subclinical atherosclerosis is associated with cardiovascular morbidity and mortality, but its relationship with functional limitation as a precursor of disability has not been determined. MATERIAL AND METHODS A longitudinal cohort study was performed in 171 high-functioning community-dwelling adults aged more than 64 years old (mean age 73.7 years, 110 women). All received a carotid ultrasound examination at the beginning of the study. Subclinical atherosclerosis was determined by the presence or absence of atherosclerotic plaques and the sum of the diameters of all the plaques (SDP) in the carotid bilateral tree. Subjects were followed-up at 12 months. The association between subclinical atherosclerosis and functional limitation was assessed with the Timed Up and Go test (TUG) at entry and at 1 year, adjusted by demographic, functional, affective, cognitive and cardiovascular risk factors as covariables. RESULTS At 1 year after baseline, 37 subjects (21.6%) performed the TUG 20% more slowly: 30 with plaque (30.7%) and seven without plaque (9.5%) (p=0.001). Those with plaque had an adjusted increased risk of performing the TUG 20% more slowly than those without plaque [OR 5.5, 95% CI 2.2-15.8]. SDP was 1.48 mm greater in subjects with more than 20% slowing on the TUG [3.34 vs 1.85; 95% CI 0.52-2.44]. For each 2-mm increment in the SDP, subjects had a 1.9-fold greater adjusted risk of performing the TUG 20% more slowly at 1 year [95% CI 1.4-2.5]. CONCLUSION Subclinical atherosclerosis is an independent predictor of functional limitation at 1 year in high-functioning older adults.
Collapse
|
329
|
Hyperuricemia and its association with carotid intima-media thickness in hypertensive and non hypertensive patients. J Saudi Heart Assoc 2010; 22:19-23. [PMID: 23960588 DOI: 10.1016/j.jsha.2010.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Accepted: 12/30/2009] [Indexed: 12/22/2022] Open
Abstract
Carotid intima-media thickness (C-IMT) measured noninvasively by ultrasonography is widely used as a marker for increased risk of cardiovascular disease. Also hyperuricemia (HU) is a well recognized risk factor for cardiovascular diseases. The study was designed to assess the relation between hyperuricemia and carotid intima-media thickness C-IMT in patients with and without hypertension (HTN). This study included 126 patients divided into four groups: (1) Group A, included 59 hypertensive patients with hyperuricemia. (2) Group B, included 29 hypertensive patients without hyperuricemia. (3) Group C, included 17 patients with hyperuricemia and normal blood pressure without history of hypertension. (4) Group D, included 21 control subjects. We measured carotid intima-media thickness by B-mode ultrasound in the common carotid and internal carotid artery. Routine echocardiography and uric acid level was assessed for all patients. We found that C-IMT was significantly higher in group A, B and C than group D; and it was significantly higher in group A than B. This means that C-IMT is significantly higher in all hypertensive groups than control group but it was significantly higher in hypertensive hyperuricemia (group A) than those hypertensives without hyperuricemia. We also observed a higher C-IMT in hyperuricemic non hypertensive patients than control group this means that hyperuricemia per se could be a risk factor for atherosclerosis. Uric acid levels among the whole number of patients included in the study and among the groups with hyperuricemia (group A and C) were positively correlated with the intimal-media thickness (IMT) while there were no correlations in the other two groups without hyperuricemia. We found that left ventricular hypertrophy (LVH) was significantly higher in hypertensive patients (group A&B) than normotensives (group C&D) either with or without hyperuricemia and this was evident in the hypertensive hyperuricemic patients (group A); but unexpectedly we observed the presence of LVH in the hyperuricemic non hypertensive patients (group C) which was significantly higher than the control group (group D). This means that hyperuricemia is a risk factor for development of LVH hypertrophy independently of hypertension. Therefore, higher serum uric acid levels are associated with increased C-IMT and left ventricular hypertrophy in hypertensive and even non hypertensive patients. So, early screening for hyperuricemia and lowering serum uric acid levels might be beneficial in slowing progression of atherogenesis.
Collapse
|
330
|
Asymmetric dimethylarginine levels and carotid intima-media thickness in obese patients with polycystic ovary syndrome and their relationship to metabolic parameters. Fertil Steril 2010; 93:1227-33. [DOI: 10.1016/j.fertnstert.2008.10.073] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2008] [Revised: 10/29/2008] [Accepted: 10/30/2008] [Indexed: 11/21/2022]
|
331
|
Taylor AE, Ebrahim S, Ben-Shlomo Y, Martin RM, Whincup PH, Yarnell JW, Wannamethee SG, Lawlor DA. Comparison of the associations of body mass index and measures of central adiposity and fat mass with coronary heart disease, diabetes, and all-cause mortality: a study using data from 4 UK cohorts. Am J Clin Nutr 2010; 91:547-56. [PMID: 20089729 DOI: 10.3945/ajcn.2009.28757] [Citation(s) in RCA: 205] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Measures of regional adiposity have been proposed as alternatives to the measurement of body mass index (BMI) for identifying persons at risk of future disease. OBJECTIVE The objective was to compare the magnitudes of association of BMI and alternative measurements of adiposity with coronary heart disease, diabetes, and cardiovascular disease risk factors and all-cause mortality. DESIGN Data from 4 cohorts of adults [3937 women from the British Women's Heart and Health Study (BWHHS); 2367 and 1950 men from phases 1 and 3, respectively, of the Caerphilly Prospective Study (CaPS); 403 men and women from the Boyd Orr Study; and 789 men and women from the Maidstone-Dewsbury Study] were analyzed. RESULTS The magnitudes of associations of BMI with incident coronary heart disease and cardiovascular disease risk factors were similar to those with measurements of central adiposity [waist circumference (WC), waist-hip ratio (WHR), or waist-height ratio (WHtR)] and more direct measurements of fat mass (bioimpedance/skinfold thickness). In CaPS (men only), there was no strong evidence of differences in the strengths of association with incident diabetes between BMI, WC, WHR, and WHtR (P for heterogeneity > 0.49 for all). In the BWHHS (women only), there was statistical evidence that WC [hazard ratio (HR): 2.35; 95% CI: 2.03, 2.73] and WHtR (HR: 2.29; 95% CI: 1.98, 2.66) were more strongly associated with diabetes than with BMI (HR: 1.80; 95% CI: 1.59, 2.04) (P for heterogeneity < 0.02 for both). Central adiposity measurements were positively associated with all-cause mortality, as was BMI, but only when those with a BMI (in kg/m(2)) <22.5 were removed from the analyses. CONCLUSION No strong evidence supports replacing BMI in clinical or public health practice with other adiposity measures.
Collapse
Affiliation(s)
- Amy E Taylor
- Department of Social Medicine, University of Bristol, Bristol, UK
| | | | | | | | | | | | | | | |
Collapse
|
332
|
Volkmann ER, Grossman JM, Sahakian LJ, Skaggs BJ, FitzGerald J, Ragavendra N, Charles-Schoeman C, Chen W, Gorn A, Karpouzas G, Weisman M, Wallace DJ, Hahn BH, McMahon M. Low physical activity is associated with proinflammatory high-density lipoprotein and increased subclinical atherosclerosis in women with systemic lupus erythematosus. Arthritis Care Res (Hoboken) 2010; 62:258-65. [PMID: 20191526 PMCID: PMC2853476 DOI: 10.1002/acr.20076] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To investigate the association between physical activity, functional activity of high-density lipoprotein (HDL), and subclinical cardiovascular disease in patients with systemic lupus erythematosus (SLE). METHODS A total of 242 SLE patients (all women) participated in this cross-sectional study from February 2004 to February 2008. Carotid plaque and intima-media thickness (IMT), antioxidant function of HDL, and traditional cardiac risk factors were measured. Physical activity was assessed from self-reports by calculating the metabolic equivalents (METS) per week and by the physical function domain of the Medical Outcomes Study Short Form 36 (SF-36). Data were analyzed using bivariate and multivariate regression analyses. RESULTS Number of METS per week spent performing strenuous exercise was negatively correlated with IMT (r = -0.4, P = 0.002) and number of plaques (r = -0.30, P = 0.0001). Physical function as assessed by the SF-36 was also negatively correlated with IMT (r = -0.14, P = 0.03) and number of plaques (r = -0.14, P = 0.04). In multivariate analyses, number of strenuous exercise METS was significantly associated with IMT (t = -2.2, P = 0.028) and number of plaques (t = -2.5, P = 0.014) when controlling for markers of SLE disease activity and damage, but not after controlling for traditional cardiac risk factors. Low physical activity, defined as <225 total METS per week, was associated with the presence of proinflammatory HDL (P = 0.03). CONCLUSION Low physical activity is associated with increased subclinical atherosclerosis and proinflammatory HDL in patients with SLE. Increased strenuous exercise may reduce the risk of atherosclerosis in SLE.
Collapse
Affiliation(s)
- Elizabeth R Volkmann
- David Geffen School of Medicine, University of California, Los Angeles, CA 90095-1670, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
333
|
Ray A, Tamsma JT, Hovens MMC, op 't Roodt J, Huisman MV. Accuracy of carotid plaque detection and intima-media thickness measurement with ultrasonography in routine clinical practice. Eur J Intern Med 2010; 21:35-9. [PMID: 20122611 DOI: 10.1016/j.ejim.2009.10.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2009] [Revised: 09/20/2009] [Accepted: 10/01/2009] [Indexed: 12/01/2022]
Abstract
BACKGROUND Current guidelines in cardiovascular disease prevention advocate the use of carotid ultrasound measurements for risk stratification. Carotid abnormalities (plaques or increased intima-media thickness (IMT)) are associated with high risk of coronary and peripheral artery disease. An office-based measurement by clinicians would considerably broaden the clinical applicability of carotid ultrasound. In the present study we have assessed the accuracy of ultrasound detection of carotid plaques and intima-media thickness by trained internists in a routine outpatient setting. METHODS AND RESULTS Carotid ultrasound was performed in 112 vascular outpatients by internists, after a six-week training period. The internists' results were independently compared to the reference standard, consisting of carotid ultrasound performed in a specialized vascular laboratory. Sensitivity and specificity were calculated for plaque detection and IMT determination. The mean time required to perform the scans on the outpatient department was 7.3 min (range 4.5 to 16.7 min). A high level of accuracy for detecting plaques (sensitivity 78.5%; specificity 93.6%) was achieved. Identifying abnormal IMT had lower sensitivity but adequate specificity of 46.7% and 87.6%, respectively. CONCLUSIONS In conclusion, our findings demonstrate that clinicians can be trained well enough in six weeks to accurately and efficiently detect carotid plaques in an outpatient setting. IMT abnormalities were less accurately detected in the office-based approach and may require a specialized vascular laboratory.
Collapse
Affiliation(s)
- A Ray
- Section of Vascular Medicine, Department of General Internal Medicine & Endocrinology, Leiden University Medical Center, Leiden, The Netherlands.
| | | | | | | | | |
Collapse
|
334
|
Lee YH, Shin MH, Kweon SS, Rhee JA, Ryu SY, Ahn HR, Choi JS. Metabolic syndrome and carotid artery parameter in Koreans aged 50 years and older. Circ J 2010; 74:560-6. [PMID: 20103972 DOI: 10.1253/circj.cj-09-0477] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Few studies have reported on the relationship between metabolic syndrome (MetS) and carotid artery structure. The objective of this study was to examine the relationship between MetS and carotid artery parameters such as the common carotid artery intima-media thickness (CCA-IMT), plaques, and the diameter of the common carotid artery (CCAd). METHODS AND RESULTS The study population consisted of 1.730 community-dwelling Koreans aged 50 years and older without hypertension, diabetes mellitus or dyslipidemia. MetS was defined according to the modified National Cholesterol Education Program's Adult Treatment Panel III criteria. The risk for abnormal CCA-IMT (>or=1.00 mm) was significant in women with MetS (odds ratio (OR) 2.22; 95% confidence interval (CI) 1.14-4.31), but not in men with MetS (OR 1.06; 95%CI 0.39-2.91). No significant relationship between MetS and carotid plaques was observed in either sex. The relationship between MetS and high CCAd (highest quintile) was significant in both men (OR 2.19; 95%CI 1.38-3.49) and women (OR 2.02; 95%CI 1.39-2.94). CONCLUSIONS MetS independently correlates with carotid atherosclerosis and carotid enlargement. The effect of MetS on carotid atherosclerosis is more pronounced in women than in men.
Collapse
Affiliation(s)
- Young-Hoon Lee
- Department of Preventive Medicine, College of Medicine, Seonam University, Namwon city, South Korea
| | | | | | | | | | | | | |
Collapse
|
335
|
Di Bello V, Carerj S, Perticone F, Benedetto F, Palombo C, Talini E, Giannini D, La Carrubba S, Antonini-Canterin F, Di Salvo G, Bellieni G, Pezzano A, Romano MF, Balbarini A. Carotid Intima-Media Thickness in Asymptomatic Patients With Arterial Hypertension Without Clinical Cardiovascular Disease: Relation With Left Ventricular Geometry and Mass and Coexisting Risk Factors. Angiology 2010; 60:705-13. [DOI: 10.1177/0003319708329337] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We analyzed in NYHA I hypertensives the interactions between Carotid Intima-Media Thickness (IMT), Hypertension and Cardiovascular (CV) risk factors and relationships between IMT, CV risk factors and left ventricular (LV) geometric remodelling. 198 asymptomatic, never treated, essential hypertensives (age: 58.2 ± 13) and 67 (age-gender matched) healthy subjects, were studied. Complete clinical examination, 2D Doppler echocardiography and vascular echography were performed in all study subjects. Major values of IMT are present in concentric LVH. Distribution of IMT among risk factors groups shows an higher IMT respect to increasing number of risk factors (P < 0.001). Significant correlation are present between pulse pressure and IMT (P < 0.006; r = 0.19) and IMT and LVM (P < 0.0001; r = 0.35). Altered patterns of LV geometry and carotid structural changes occur in many patients with essential hypertension. LVH or carotid remodeling are greater in elderly, in patients with higher systolic BP and with associated CV risk factors.
Collapse
Affiliation(s)
| | | | - Francesco Perticone
- Department of Experimental and Clinical Medicine; G. Salvatore, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Frank Benedetto
- Cardiology Unit, Hospital "E. Morelli," Reggio Calabria, Italy
| | - Carlo Palombo
- Department of Internal Medicine (CP), University of Pisa, Italy
| | - Enrica Talini
- Cardiac Thoracic and Vascular Department, , University of Pisa, Italy
| | - Danilo Giannini
- Cardiac Thoracic and Vascular Department, University of Pisa, Italy
| | | | | | - Giovanni Di Salvo
- Department of Pediatric Cardiology, Second University of Naples, Monaldi Hospital, Naples, Italy
| | | | | | | | - Alberto Balbarini
- Cardiac Thoracic and Vascular Department, , University of Pisa, Italy
| |
Collapse
|
336
|
Wald DS, Bestwick JP, Morton G, Drummond L, Jenkins N, Khodabakhsh P, Curzen NP. Combining carotid intima-media thickness with carotid plaque on screening for coronary heart disease. J Med Screen 2009; 16:155-9. [PMID: 19805757 DOI: 10.1258/jms.2009.009039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Ultrasound-detected carotid artery intima-media thickness (IMT) and carotid plaque are possible screening tests for coronary heart disease (CHD) among asymptomatic individuals. OBJECTIVE To assess the increase in screening performance of combining carotid IMT and plaque compared with each measurement alone in the identification of individuals with CHD. METHODS Ultrasound examination of left and right carotid arteries was performed on 100 individuals (median age 57), 55 with a history of CHD (unstable angina or myocardial infarction) and 45 without. IMT measurements were taken from the common carotid artery and plaque was identified above, at and below the carotid bifurcation. Associations between IMT and plaque were determined using logistic regression, and screening performance was assessed from the distributions of IMT and plaque among cases and controls. RESULTS At a false-positive rate of 5%, IMT (cut-off >0.75 mm) identified 30% (95% CI 14-58) of affected individuals. There was an increase in the detection rate of 8 percentage points (1-33%) using IMT and plaque combined compared with IMT alone. As the false-positive increased, the difference in the detection rate increased, up to a maximum of 20 percentage points (5-38%) at a false-positive rate of 20%. The comparison of IMT and plaque combined with plaque alone could only be estimated for the false-positive rate observed using plaque alone (18%); at this point the detection rate was 72% for plaque and 75% for plaque and IMT combined, an increase of 3 percentage points (0-4%). CONCLUSION In screening for CHD, combining carotid IMT measurement with plaque assessment is better than using either measurement alone, but the improvement in discrimination is not sufficient to make carotid ultrasound screening for CHD worthwhile.
Collapse
Affiliation(s)
- David S Wald
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine, Queen Mary University of London, London, UK.
| | | | | | | | | | | | | |
Collapse
|
337
|
Aortic pulse pressure is associated with carotid IMT in chronic kidney disease: report from Chronic Renal Insufficiency Cohort. Am J Hypertens 2009; 22:1235-41. [PMID: 19779470 DOI: 10.1038/ajh.2009.156] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Patients with chronic kidney disease (CKD) have a disproportionate risk of cardiovascular disease. This study was designed to assess the association between two noninvasive measures of cardiovascular risk, pulse wave analysis (PWA), and carotid intima-media thickness (IMT), in a cohort of CKD patients enrolled in the Chronic Renal Insufficiency Cohort (CRIC) study. METHODS Three hundred and sixty-seven subjects with CKD enrolled in the CRIC study at the University of Pennsylvania site (mean age 59.9 years, blood pressure 129/74 mm Hg, estimated glomerular filtration rate 48 ml/min/1.73 m2, IMT 0.8 mm) had both carotid IMT and PWA measurements. Carotid ultrasound was also used to determine the presence of plaque. PWA was used to determine augmentation index (AI), amplification ratio (AMPR), aortic pulse pressure (C_PP), and central aortic systolic pressure (C_SP). RESULTS IMT was significantly associated with all PWA-derived measures. However, on multivariable linear regression analysis, only AMPR (regression coefficient -0.072, P = 0.006), C_PP (regression coefficient 0.0025, P < 0.001), and C_SP (regression coefficient 0.0017, P < 0.001) remained significantly associated with IMT. The prevalence of carotid plaque in the cohort was 59%. Of the PWA-derived measures, only C_PP was significantly associated with the presence of carotid plaque (P < 0.001). CONCLUSIONS PWA-derived measures are associated with carotid IMT and plaque in the CKD. Of these measures, C_PP was most associated with carotid IMT and plaque.
Collapse
|
338
|
Deans KA, Bezlyak V, Ford I, Batty GD, Burns H, Cavanagh J, de Groot E, McGinty A, Millar K, Shiels PG, Tannahill C, Velupillai YN, Sattar N, Packard CJ. Differences in atherosclerosis according to area level socioeconomic deprivation: cross sectional, population based study. BMJ 2009; 339:b4170. [PMID: 19861369 PMCID: PMC2768777 DOI: 10.1136/bmj.b4170] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
OBJECTIVES To examine the relation between area level social deprivation and ultrasound markers of atherosclerosis (common carotid intima-media thickness and plaque score), and to determine whether any differences can be explained by "classic" (currently recognised) or "emerging" (novel) cardiovascular risk factors. DESIGN Cross sectional, population based study. SETTING NHS Greater Glasgow Health Board area. PARTICIPANTS 666 participants were selected on the basis of how their area ranked in the Scottish Index of Multiple Deprivation 2004. Approximately equal numbers of participants from the most deprived areas and the least deprived areas were included, as well as equal numbers of men and women and equal numbers of participants from each age group studied (35-44, 45-54, and 55-64 years). MAIN OUTCOME MEASURES Carotid intima-media thickness and plaque score, as detected by ultrasound. RESULTS The mean age and sex adjusted intima-media thickness was significantly higher in participants from the most deprived areas than in those from the least deprived areas (0.70 mm (standard deviation (SD) 0.16 mm) v 0.68 mm (SD 0.12 mm); P=0.015). On subgroup analysis, however, this difference was only apparent in the highest age tertile in men (56.3-66.5 years). The difference in unadjusted mean plaque score between participants from the most deprived and those from the least deprived areas was more striking than the difference in intima-media thickness (least deprived 1.0 (SD 1.5) v most deprived 1.7 (SD 2.0); P<0.0001). In addition, a significant difference in plaque score was apparent in the two highest age tertiles in men (46.8-56.2 years and 56.3-66.5 years; P=0.0073 and P<0.001) and the highest age tertile in women (56.3-66.5 years; P<0.001). The difference in intima-media thickness between most deprived and least deprived males remained significant after adjustment for classic risk factors, emerging risk factors, and individual level markers of socioeconomic status (P=0.010). Adjustment for classic risk factors and emerging cardiovascular risk factors, either alone or in combination, did not abolish the deprivation based difference in plaque presence (as a binary measure; adjusted odds ratio of 1.73, 95% confidence interval 1.07 to 2.82). However, adjustment for classic risk factors and individual level markers of early life socioeconomic status abolished the difference in plaque presence between the most deprived and the least deprived individuals (adjusted odds ratio 0.94, 95% CI 0.54 to 1.65; P=0.84). CONCLUSIONS Deprivation is associated with increased carotid plaque score and intima-media thickness. The association of deprivation with atherosclerosis is multifactorial and not adequately explained by classic or emerging risk factors.
Collapse
Affiliation(s)
- Kevin A Deans
- Department of Vascular Biochemistry, Glasgow Royal Infirmary, Glasgow G31 2ER.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
339
|
Heffron SP, Parastatidis I, Cuchel M, Wolfe ML, Tadesse MG, Mohler ER, Ischiropoulos H, Rader DJ, Reilly MP. Inflammation induces fibrinogen nitration in experimental human endotoxemia. Free Radic Biol Med 2009; 47:1140-6. [PMID: 19631267 PMCID: PMC3651370 DOI: 10.1016/j.freeradbiomed.2009.07.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2008] [Revised: 06/23/2009] [Accepted: 07/11/2009] [Indexed: 11/21/2022]
Abstract
Elevated plasma fibrinogen is a prothrombotic risk factor for cardiovascular disease (CVD). Recent small studies report that fibrinogen oxidative modifications, specifically tyrosine residue nitration, can occur in inflammatory states and may modify fibrinogen function. HDL cholesterol is inversely related to CVD and suggested to reduce the oxidation of LDL cholesterol, but whether these antioxidant functions extend to fibrinogen modifications is unknown. We used a recently validated ELISA to quantify nitrated fibrinogen during experimental human endotoxemia (N=23) and in a cohort of healthy adults (N=361) who were characterized for inflammatory and HDL parameters as well as subclinical atherosclerosis measures, carotid artery intima-medial thickness (IMT) and coronary artery calcification (CAC). Fibrinogen nitration increased following endotoxemia and directly correlated with accelerated ex vivo plasma clotting velocity. In the observational cohort, nitrated fibrinogen was associated with levels of CRP and serum amyloid A. Nitrated fibrinogen levels were not lower with increasing HDL cholesterol and did not associate with IMT and CAC. In humans, fibrinogen nitration was induced during inflammation and was correlated with markers of inflammation and clotting function but not HDL cholesterol or subclinical atherosclerosis in our modest sample. Inflammation-induced fibrinogen nitration may be a risk factor for promoting CVD events.
Collapse
Affiliation(s)
- Sean P. Heffron
- Cardiovascular Institute, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA
| | | | - Marina Cuchel
- Institute of Translational Medicine and Therapeutics, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA
| | - Megan L. Wolfe
- Institute of Translational Medicine and Therapeutics, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA
| | - Mahlet G. Tadesse
- Department of Mathematics, Georgetown University, Washington, DC 20057, USA
| | - Emille R. Mohler
- Cardiovascular Institute, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA
- Institute of Translational Medicine and Therapeutics, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA
| | | | - Daniel J. Rader
- Cardiovascular Institute, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA
- Institute of Translational Medicine and Therapeutics, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA
| | - Muredach P. Reilly
- Cardiovascular Institute, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA
- Institute of Translational Medicine and Therapeutics, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA
| |
Collapse
|
340
|
Wald DS, Bestwick JP. Carotid Ultrasound Screening for Coronary Heart Disease: Results Based on a meta-analysis of 18 Studies and 44,861 Subjects. J Med Screen 2009; 16:147-54. [DOI: 10.1258/jms.2009.009038] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Carotid artery ultrasound is a possible screening test for future coronary heart disease (CHD) events to select individuals for preventive treatment. Objectives To assess the screening performance of carotid artery intima-media thickness (IMT) and carotid plaque in the identification of individuals with CHD. Methods meta-analysis of case-control and cohort studies, reporting carotid IMT or plaque in individuals with and without CHD. Screening performance (detection rates [DRs] for specified false-positive rates [FPRs]) was assessed from the relative Gaussian distributions of IMT among individuals with and without CHD and from the proportion of affected and unaffected individuals with plaque. Results Eighteen studies, involving 2920 individuals with CHD (mean age range 46–73 years) and 41,941 without (aged 44–73 years) were included in the meta-analysis. For plaque the DR was 62% for an FPR of 30%; likelihood ratio (2.1 [95% CI 1.6–2.4]). For IMT, the DR was 65% for the same 30% FPR (IMT cut-off ≥0.82 mm); likelihood ratio 2.2 (1.9–2.5). The results were similar in case-control and cohort studies. Conclusion Neither carotid plaque nor IMT has a CHD screening performance that is sufficiently discriminatory between affected and unaffected individuals to be a worthwhile screening test.
Collapse
Affiliation(s)
- David S Wald
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Jonathan P Bestwick
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| |
Collapse
|
341
|
Davidson MH, Fox KM, Gandhi SK, Ohsfeldt RL, McKenney JM. Medical management of patients before the incidence of a cardiovascular event. J Clin Lipidol 2009; 3:315-21. [DOI: 10.1016/j.jacl.2009.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Revised: 08/10/2009] [Accepted: 08/26/2009] [Indexed: 10/20/2022]
|
342
|
Saba L, Sanfilippo R, Montisci R, Mallarini G. Carotid artery wall thickness: comparison between sonography and multi-detector row CT angiography. Neuroradiology 2009; 52:75-82. [PMID: 19727693 DOI: 10.1007/s00234-009-0589-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2009] [Accepted: 08/17/2009] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Prospective studies have shown that an increased thickness of the carotid wall is a significant predictor of coronary and cerebrovascular complications. Our purpose was to assess the agreement between multi-detector row computed tomography (CT) angiography (MDCTA) and colour Doppler ultrasound (CD-US) in measuring carotid artery wall thickness (CAWT) and the intima-media thickness (IMT). METHODS Altogether, 97 subjects (age range 64-84 years) were prospectively analysed using a four-detector row CT and a sonographic scanner. In total, 46 subjects had shown cerebral ischaemic symptoms. CAWT and IMT were measured in each patient using MDCTA and CD-US (by applying a digital calliper), respectively. Continuous data were described as the mean value +/- standard deviation and were compared using the Mann-Whitney U test. A p value <0.05 was considered significant. Bland-Altman statistics was employed to measure the agreement between MDCTA and CD-US. RESULTS CAWT ranged from 0.5 to 1.53 mm, with a mean value of 0.9072 mm. IMT ranged from 0.46 to 1.5 mm, with a mean value of 0.8839 mm. By analysing the Bland-Altman plot, we observed an excellent agreement between CD-US and MDCTA with a bias between methods of 0.023 +/- 0.0424 mm. A limit of agreement from -0.06 to 0.106 was recorded. Correlation coefficient r was 0.9855 (95% confidence interval 0.9808-0.989). Mann-Whitney U test indicated a p value of 0.377. CONCLUSIONS Obtained results indicated a significant agreement between MDCTA and CD-US in the measurement of CAWT and IMT.
Collapse
Affiliation(s)
- Luca Saba
- Department of Radiology, Policlinico Universitario, University of Cagliari, s.s. 554 Monserrato, Cagliari 09045, Italy.
| | | | | | | |
Collapse
|
343
|
Mathiesen EB, Johnsen SH. Ultrasonographic measurements of subclinical carotid atherosclerosis in prediction of ischemic stroke. Acta Neurol Scand 2009:68-72. [PMID: 19566503 DOI: 10.1111/j.1600-0404.2009.01210.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Carotid intima-media thickness (IMT) and plaque measurements are widely used to quantify atherosclerosis and assess the risk of future stroke, and are used as surrogate endpoints for clinical disease. In recent years, it has become clear that carotid IMT and plaque reflect biologically and genetically different aspects of the atherosclerotic process, and are differentially related to risk factors and cardiovascular disease. Plaques are focal manifestations of atherosclerosis while increased IMT represents mainly hypertensive medial hypertrophy. Several prospective studies have showed that IMT and plaque measurements, such as total plaque area and plaque number, are predictive of future stroke. Plaque echogenicity predicts future stroke independent of plaque size. The contribution of IMT and plaque measurements in individual stroke risk prediction in the general population seems to be limited, but may be useful as a tool for individual stratification of high-risk patients.
Collapse
Affiliation(s)
- E B Mathiesen
- Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway.
| | | |
Collapse
|
344
|
Kwon TG, Kim KW, Park HW, Jeong JH, Kim KY, Bae JH. Prevalence and significance of carotid plaques in patients with coronary atherosclerosis. Korean Circ J 2009; 39:317-21. [PMID: 19949637 PMCID: PMC2771847 DOI: 10.4070/kcj.2009.39.8.317] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2008] [Revised: 02/18/2009] [Accepted: 03/22/2009] [Indexed: 11/17/2022] Open
Abstract
Background and Objectives Carotid artery intima-media thickness (CIMT) has recently been recommended as a non-invasive tool for primary prevention of cardiovascular events; the association between CIMT and adverse cardiovascular events is well-known. We sought to evaluate the prevalence and significance of carotid artery plaque, especially in patients with coronary atherosclerosis. Subjects and Methods The study population consisted of 1,705 consecutive patients {933 males (54.7%); mean age, 59.7±10.9 years} who underwent coronary angiography and carotid artery scanning using high-resolution ultrasonography. Carotid plaque was defined as a focal structure encroaching into the arterial lumen by at least 50% of the surrounding IMT value or a thickness >1.2 mm. Results Carotid plaque was identified in 30.3% (516/1,705) of the patients. Of patients in whom the plaque location could be evaluated (n=1,027), carotid plaque was located at the common carotid artery {n=64/267 (24.0%)}, carotid bulb {n=194/267 (72.7%)}, and at both sites {n=9/267 (3.4%)}. The prevalence of hypertension (58.5% vs. 45.2%, p<0.001) and diabetes mellitus (30.6% vs. 23.5%, p=0.007) was higher in patients with carotid plaques. The patients with carotid plaques were older (65.4±8.9 years vs. 57.2±10.7 years, p<0.0001), had a thicker CIMT (0.89±0.20 mm vs. 0.77±0.16 mm, p<0.001), and higher fasting blood sugar (FBS) levels (132.1±60.7 mg/dL vs. 121.6±47.1 mg/dL, p<0.001) than those without carotid plaque. Patients with carotid plaque more frequently presented with acute coronary syndrome (32.4% vs. 23.9%, p<0.001) than those without carotid plaque. Significant coronary artery stenosis by coronary angiography (75.4% vs. 58.3%, p<0.001), especially multi-vessel disease (46.3% vs. 27.2%, p<0.001), was more frequent in patients with carotid plaques. On multivariate analysis, old age (≥65 years), hypertension, and increased CIMT (≥1.0 mm) were independent predictors of carotid plaque. Carotid plaque (odds ratio, 1.85; 95% confidence interval, 1.39-2.45; p<0.001) was an independent predictor of multivessel disease based on multivariate regression analysis. Conclusion Carotid plaque was common (30.3%) in Korean patients with coronary atherosclerosis, but it is still relatively uncommon compared to Western populations. Carotid plaque was associated with old age, hypertension, and increased IMT, and was an independent predictor of multi-vessel disease.
Collapse
Affiliation(s)
- Taek-Geun Kwon
- Division of Cardiology, Heart Center, Konyang University Hospital, Daejeon, Korea
| | | | | | | | | | | |
Collapse
|
345
|
Tan TY, Lu CH, Lin TK, Liou CW, Chuang YC, Schminke U. Factors associated with gender difference in the intima-media thickness of the common carotid artery. Clin Radiol 2009; 64:1097-103. [PMID: 19822243 DOI: 10.1016/j.crad.2009.06.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Revised: 06/08/2009] [Accepted: 06/10/2009] [Indexed: 11/24/2022]
Abstract
AIM To investigate the gender differences associated with a thinner intima-media thickness (IMT) of the common carotid artery (CCA) in women. MATERIALS AND METHODS In a sample of 218 consecutive healthy volunteers comprising 110 men and 108 women, the IMT of the CCA was measured using B-mode ultrasonography. Blood pressure, fasting blood sugar, body mass index (BMI), blood lipid profile, homocysteine, folic acid, uric acid, high sensitive C-reactive protein, and thiobarbituric acid reactive substances (TBARS) levels were measured and compared with each other in both genders. RESULTS The IMT of the CCA was significantly thinner in women than in men (p=0.012). Blood pressure, fasting plasma glucose, BMI, low-density lipoprotein cholesterol, triglycerides, homocysteine, uric acid, and TBARS were significantly (p<0.05) lower, folic acid and high-density lipoprotein cholesterol (HDL-C) were significantly (p<0.0001) higher in women compared with men. Multivariable logistic regression analysis revealed that higher serum levels of homocysteine, uric acid, and TBARS, and lower serum levels of HDL-C were significantly (p<0.05) associated with male sex. Multiple linear regression analysis further revealed that age, sex, and BMI were independently associated with CCA IMT. CONCLUSIONS The IMT of the CCA was thinner in women than in men. Traditional vascular risk factors explain only a small amount of variance in multivariate regression models supporting the hypothesis that other behavioural, sex hormone-related or genetic factors, which have not been sufficiently explored so far, may play a role in the gender differences of IMT.
Collapse
Affiliation(s)
- T-Y Tan
- Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | | | | | | | | | | |
Collapse
|
346
|
Griffin M, Nicolaides A, Tyllis T, Georgiou N, Martin RM, Bond D, Panayiotou A, Tziakouri C, Doré CJ, Fessas C. Carotid and femoral arterial wall changes and the prevalence of clinical cardiovascular disease. Vasc Med 2009; 14:227-32. [DOI: 10.1177/1358863x08101542] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract The Cyprus Study is a prospective cohort study of cardiovascular disease (CVD). Its aim is to determine the relationship of intima–media thickness (IMT) of the common carotid (IMTcc), maximum thickness of IMT in the carotid bifurcation (IMTmax), number of carotid and femoral bifurcations with plaque and total plaque thickness (TPT) (sum of the maximum plaque measurements taken from the four bifurcations scanned) with the prevalence of clinical CVD. A total of 767 individuals (46% male) over the age of 40 years were recruited from a mountain village and a town outside the capital Nicosia. In addition to clinical examination, carotid and common femoral bifurcations were scanned with ultrasound. After controlling for conventional risk factors, there was little evidence of an association of IMTcc with CVD prevalence. However, IMTmax and TPT were associated with 2.9-fold (1.22 to 7.07) and 6.87-fold (2.42 to 19.43) increased odds of CVD prevalence, respectively. In conclusion, the TPT and number of bifurcations with plaque are more strongly associated with the prevalence of CVD. These findings warrant investigation in prospective studies to document associations with incident CVD events.
Collapse
Affiliation(s)
- Maura Griffin
- Vascular Noninvasive Screening and Diagnostic Centre
| | - Andrew Nicolaides
- The Cyprus Institute of Neurology and Genetics; Department of Biological Sciences, University of Cyprus; Department of Vascular Surgery, Imperial College; Vascular Screening and Diagnostic Centre, Cyprus
| | - Theodosis Tyllis
- The Cyprus Institute of Neurology and Genetics; Vascular Screening and Diagnostic Centre, Cyprus
| | - Niki Georgiou
- The Cyprus Institute of Neurology and Genetics; Vascular Screening and Diagnostic Centre, Cyprus
| | - Richard M Martin
- MRC Centre for Causal Analysis in Translational Epidemiology, Department of Social Medicine, University of Bristol
| | - Dawn Bond
- Vascular Noninvasive Screening and Diagnostic Centre
| | | | | | | | | |
Collapse
|
347
|
Liang LR, Wong ND, Shi P, Zhao LC, Wu LX, Xie GQ, Wu YF. Cross-sectional and longitudinal association of cigarette smoking with carotid atherosclerosis in Chinese adults. Prev Med 2009; 49:62-7. [PMID: 19465047 DOI: 10.1016/j.ypmed.2009.05.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2008] [Revised: 04/09/2009] [Accepted: 05/16/2009] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the cross-sectional and longitudinal association of cigarette smoking with carotid atherosclerosis in middle-aged and older Chinese adults. METHODS The study population consisted of 1132 residents in Beijing (748 women and 384 men) aged 35 to 64 years. Information on baseline smoking characteristics, including smoking status and pack-years was collected in 1993-1994. The cohort was resurveyed in 2002 and common carotid artery intima-media thickness (CCA-IMT) and carotid plaques were measured by B-mode ultrasound. RESULTS The multivariable-adjusted mean CCA-IMT at resurvey was significantly associated with smoking status at both resurvey and baseline, and was 0.72 mm for consistent current smokers, 0.71 mm for former and inconsistent smokers, and 0.70 mm for consistent never smokers at both surveys, respectively (p-trend<0.01). The multivariable-adjusted odds ratio [OR, 95% confidence interval (CI)] of having carotid plaques was 1.5 (1.0-2.1) for consistent current smokers vs consistent never smokers. In addition, there was a significant dose-response relationship between baseline smoking pack-years and multivariable-adjusted mean CCA-IMT and risk of having carotid plaques at resurvey. CONCLUSION Smoking is associated with carotid atherosclerosis in middle-aged and older Chinese adults both cross-sectionally and longitudinally. Smoking cessation may play a significant role in prevention and control of cardiovascular diseases in China.
Collapse
Affiliation(s)
- Li-Rong Liang
- Department of Epidemiology, Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | | | | | | | | | | |
Collapse
|
348
|
Guimarães AV, Brandt CT, Ferraz A. Complexo miointimal das carótidas comum e interna em portadores de esquistossomose mansônica hepatoesplênica. Rev Col Bras Cir 2009; 36:292-9. [DOI: 10.1590/s0100-69912009000400004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2008] [Accepted: 01/17/2009] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Avaliar a espessura do complexo miointimal (IMT) das carótidas comum e interna, em portadores de esquistossomose hepatoesplênica (EHE) não tratados cirurgicamente, já submetidos a cirurgia para descompressão do sistema porta por esplenectomia e ligadura da veia gástrica esquerda, e comparar com volutários de condições sócio-econômico-ambientais similares, não portadores de esquistossomose. MÉTODOS: Utilizando aparelho de ultra-som Doppler de 7,5MHz foram mensurados os IMT de três grupos de voluntários, de ambos os gêneros, com idades que variaram de 20 a 60 anos, sendo avaliados os IMT máximos, IMT médios, IMT mínimos e seus desvios-padrão, das carótidas comuns e internas e feitas as comparações entre os grupos e suas associações com fatores de risco: idade, hipertensão arterial e tabagismo. RESULTADOS: Não houve diferença significante na média dos IMT, entre os lados direito e esquerdo e nem entre os grupos. Nos pacientes tratados cirurgicamente, assim como nos indivíduos-controle confirmou-se a associação, já conhecida, com os fatores de risco para aterosclerose (idade, hipertensão arterial e tabagismo). Contudo, não se observou este comportamento nos pacientes não operados. CONCLUSÃO: A EHE sem tratamento cirúrgico parece conferir "alguma proteção" contra a aterogênese em seres humanos; todavia, os achados não dão suporte definitivo a esta hipótese.
Collapse
|
349
|
Association between central systolic blood pressure, white matter lesions in cerebral MRI and carotid atherosclerosis. Hypertens Res 2009; 32:869-74. [DOI: 10.1038/hr.2009.121] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
350
|
Cuspidi C, Meani S, Valerio C, Fusi V, Sala C, Zanchetti A, Mancia G. Carotid atherosclerosis and cardiovascular risk stratification: Role and cost‐effectiveness of echo‐Doppler examination in untreated essential hypertensives. Blood Press 2009; 15:333-9. [PMID: 17472023 DOI: 10.1080/08037050601066553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To investigate the impact and cost-effectiveness of carotid ultrasonographic examination on total risk stratification in low-medium risk hypertensive patients in relation to age (< 50 and > 50 years) and gender. METHODS Five hundred and eighty untreated hypertensives classified at low-medium risk, after the routine work-up recommended by the 2003 ESH/ ESC guidelines, were included in the study and total risk was reassessed by adding the results of carotid ultrasonography. RESULTS According to the stratification based on routine work-up 16.3% of the whole population was considered at low added risk and 83.7% at medium added risk. Carotid subclinical damage was found in 158 patients (27.0%), who were then reclassified in the high-risk stratum. Prevalence rates of patients reclassified in the high-risk stratum as a consequence of carotid damage were as follows: 12.6% in men < 50 years, 14.1% in women < 50 years, 53.0% in men > or = 50 years and 40.1% in women > or = 50 years. The cost per detected case of carotid atherosclerosis was 473 euro in patients < 50 years and 133 euro in those > or = 50 years. CONCLUSIONS Our results show that: (i) the use of carotid ultrasonography allows a much more accurate identification of high-risk individuals; (ii) its impact and cost-effectiveness on the risk stratification process differs markedly according to the age and gender; (iii) the selective use of this procedure in subjects at high risk of target organ damage may substantially improve the cost of primary prevention.
Collapse
Affiliation(s)
- Cesare Cuspidi
- Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Milan, Italy.
| | | | | | | | | | | | | |
Collapse
|