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The impact of long-term moderate and heavy alcohol consumption on incident atherosclerosis among persons living with HIV. Drug Alcohol Depend 2017; 181:235-241. [PMID: 29121596 PMCID: PMC5789452 DOI: 10.1016/j.drugalcdep.2017.09.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 09/20/2017] [Accepted: 09/26/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND Level of alcohol consumption is associated with differential risk of atherosclerosis, but little research has investigated this association among HIV+ persons. We evaluated the association between long-term alcohol use and incident atherosclerosis among HIV+ persons. METHODS We utilized data from HIV+ participants of the Women's Interagency HIV Study (n=483) and the Multicenter AIDS Cohort Study (n=305) without history of cardiovascular disease. Atherosclerosis was assessed two times by B-mode carotid artery ultrasound imaging from 2004 to 2013. Presence of plaque was defined as focal carotid intima-media thickness over 1.5mm. Those with no plaque at baseline and plaque at follow-up were considered incident cases of atherosclerosis. Group-based trajectory models were used to categorize participants into 10-year drinking patterns representing heavy, moderate, or abstinent-low. Multivariable logistic regressions were conducted to assess the association of long-term moderate and heavy use on atherosclerosis, compared to abstinent-low. RESULTS Heavy alcohol consumption was not statistically significantly associated with risk for incident atherosclerosis in women (AOR 1.10, CI 0.40-3.02) or men (AOR 1.31, CI 0.43-4.00), compared to abstinence-low. Moderate consumption was associated with 54% lower odds for incident disease in men (AOR 0.46, CI 0.21-1.00), but not in women (AOR 1.08, CI 0.58-2.00). In cohort-combined analyses, alcohol consumption was not statistically significantly association with incident atherosclerosis (moderate AOR 0.78, CI 0.48-1.27; heavy AOR 1.33, CI 0.66-2.69). CONCLUSION Moderate alcohol consumption was associated with a significant protective effect on incident atherosclerosis in men only. No other levels of alcohol consumption significantly predicted atherosclerosis in men and women compared to abstinent-low.
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Poredos P. Intima-media thickness: indicator of cardiovascular risk and measure of the extent of atherosclerosis. Vasc Med 2016; 9:46-54. [PMID: 15230488 DOI: 10.1191/1358863x04vm514ra] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The measurement of intima-media thickness (IMT) of large superficial arteries, especially the carotid, using high-resolution B-mode ultrasonography has emerged as one of the methods of choice for determining the anatomic extent of atherosclerosis and for assessing cardiovascular risk. IMT measurement obtained by ultrasonography correlates very well with pathohistologic measurements and the reproducibility of this technique is good. Population studies have shown a strong correlation between carotid IMT and several cardiovascular risk factors, and it has also been found to be associated with the extent of atherosclerosis and end-organ damage of high-risk patients. Therefore, increased carotid IMT is a measure of athero-sclerotic burden and a predictor of subsequent events. Because of its quantitative value, carotid IMT measurement is more and more frequently used in clinical trials to test the effects of different preventive measures, including drugs. More recently, there has been interest in the clinical use of this technique for detecting preclinical (asymptomatic) atherosclerosis and for identifying subjects at high risk. Measurement of carotid IMT could influence a clinician to intervene with medication and to use more aggressive treatment of risk factors in primary prevention, and in patients with atherosclerotic disease in whom there is evidence of progression and extension of atherosclerotic disease. For more extensive use of this method in clinical practice a consensus concerning the standardization of methods of measurement and precise definition of threshold between normal and pathologic IMT value is urgently needed.
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Affiliation(s)
- Pavel Poredos
- Department for Vascular Disease, University Medical Centre, Ljubljana, Slovenia.
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3
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Abstract
The plasma coagulation system in mammalian blood consists of a cascade of enzyme activation events in which serine proteases activate the proteins (proenzymes and procofactors) in the next step of the cascade via limited proteolysis. The ultimate outcome is the polymerization of fibrin and the activation of platelets, leading to a blood clot. This process is protective, as it prevents excessive blood loss following injury (normal hemostasis). Unfortunately, the blood clotting system can also lead to unwanted blood clots inside blood vessels (pathologic thrombosis), which is a leading cause of disability and death in the developed world. There are two main mechanisms for triggering the blood clotting, termed the tissue factor pathway and the contact pathway. Only one of these pathways (the tissue factor pathway) functions in normal hemostasis. Both pathways, however, are thought to contribute to thrombosis. An emerging concept is that the contact pathway functions in host pathogen defenses. This review focuses on how the initiation phase of the blood clotting cascade is regulated in both pathways, with a discussion of the contributions of these pathways to hemostasis versus thrombosis.
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Affiliation(s)
- Stephanie A Smith
- a Department of Biochemistry , University of Illinois at Urbana-Champaign , Urbana , IL , USA
| | - Richard J Travers
- a Department of Biochemistry , University of Illinois at Urbana-Champaign , Urbana , IL , USA
| | - James H Morrissey
- a Department of Biochemistry , University of Illinois at Urbana-Champaign , Urbana , IL , USA
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Baldassarre D, De Jong A, Amato M, Werba JP, Castelnuovo S, Frigerio B, Veglia F, Tremoli E, Sirtori CR. Carotid intima-media thickness and markers of inflammation, endothelial damage and hemostasis. Ann Med 2008; 40:21-44. [PMID: 17934910 DOI: 10.1080/07853890701645399] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Different soluble molecules involved in inflammation, endothelial damage, or hemostasis are recognized as potential cardiovascular risk markers. Studies to assess the role of these markers in the atherosclerotic process by evaluating their relationship to carotid intima-media thickness (C-IMT) tend to provide contrasting results. PURPOSE To perform a review of studies addressing the association between C-IMT and soluble markers and to investigate whether the observed inconsistencies could be explained by the characteristics of the patients included in different studies, for example prevalence of atherosclerotic disease (atherosclerotic burden), gender, age, or occurrence of specific vascular risk factors (VRFs). DATA SOURCES PubMed and Embase (January 1990 to March 2006). STUDY SELECTION Articles in English reporting original cross-sectional studies. DATA EXTRACTION Two authors independently extracted data on study design, population, sample size, ultrasonic methodology, and statistical approach. DATA SYNTHESIS Despite the marked heterogeneity of results presented in the literature, meta-analysis established that studies showing positive associations between C-IMT and plasma levels of C-reactive protein (CRP) or fibrinogen are in the majority. Funnel plot analyses suggested the absence of an important publication bias. Data on the relationships between C-IMT and other soluble markers are by contrast scanty, contradictory, or unconfirmed by multivariate (as opposed to univariate) analyses, and the freedom from publication bias here cannot be vouched for. The degree of atherosclerotic burden in the population studied does not account for the heterogeneity of findings reported. Gender, noninsulin-dependent diabetes mellitus (NIDDM) and hypercholesterolemia influence the association between C-IMT and CRP. Blood pressure and hypercholesterolemia influence the association between C-IMT and fibrinogen. For all the other soluble markers considered, the number of groups was too small for this kind of statistical considerations. LIMITATIONS Heterogeneity in ultrasound methodologies and in statistical approach limited comparability between studies. For most soluble markers, publication bias of positive results cannot be excluded. CONCLUSIONS Only CRP and fibrinogen seem to be unequivocally related to C-IMT. For all the other soluble markers considered, no clear-cut conclusions can be drawn.
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Affiliation(s)
- Damiano Baldassarre
- E. Grossi Paoletti Center, Department of Pharmacological Sciences, University of Milan, Italy.
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5
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Prior JC, Nielsen JD, Hitchcock CL, Williams LA, Vigna YM, Dean CB. What is the role of non-invasive measurements of atherosclerosis in individual cardiovascular risk prediction? Clin Sci (Lond) 2007; 112:517-25. [PMID: 17419685 DOI: 10.1042/cs20060266] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Primary prevention of CVD (cardiovascular disease) is mainly based on the assessment of individual cardiovascular risk factors. However, often, only the most important (conventional) cardiovascular risk factors are determined, and every level of risk factor exposure is associated with a substantial variation in the amount of atherosclerosis. Measuring the effect of risk factor exposure over time directly in the vessel might (partially) overcome these shortcomings. Several non-invasive imaging techniques have the potential to accomplish this, each of these techniques focusing on a different stage of the atherosclerotic process. In this review, we aim to define the current role of various of these non-invasive measurements of atherosclerosis in individual cardiovascular risk prediction, taking into account the most recent insights about validity and reproducibility of these techniques and the results of recent prospective outcome trials. We conclude that, although the clinical application of FMD (flow-mediated dilation) and PWA (pulse wave analysis) in individual cardiovascular risk prediction seems far away, there may be a role for PWV (pulse wave velocity) and IMT (intima-media thickness) measurements in the near future.
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Affiliation(s)
- Jerilynn C Prior
- Centre for Menstrual Cycle and Ovulation Research, Division of Endocrinology and Metabolism, Department of Medicine, University of British Columbia and Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.
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Varda NM, Peterlin B, Bradac SU, Gregoric A. Carotid artery intima-media thickness and angiotensin-converting enzyme gene polymorphism in the offspring of parents with premature stroke. Acta Paediatr 2005; 94:33-7. [PMID: 15858957 DOI: 10.1111/j.1651-2227.2005.tb01784.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To determine some common cardiovascular risk factors, alterations in the measurements of intima-media thickness (IMT) and the distribution of the angiotensin-converting enzyme (ACE) polymorphism in children of parents with premature stroke, and to investigate the cardiovascular risk of these children and the potential need for some preventive measures. METHODS A family history of cardiovascular disease represents a cardiovascular risk factor in the offspring. This association has not yet been clearly determined for cerebrovascular accidents. New technology allows us to investigate the risk for cardiovascular disease at an early presymptomatic stage. We applied the measurement of IMT of carotid arteries by ultrasound imaging and the determination of the ACE insertion/deletion (I/D) polymorphism in blood to evaluate the predisposition for cerebrovascular disease in the offspring of patients with previous stroke. We investigated 58 subjects whose parents had experienced a cerebrovascular accident before the age of 45 y and compared them with a matched control group whose parents had not suffered a stroke. RESULTS The results of IMT at various sites of the carotid arteries and the genotype distribution of the ACE gene were not significantly different between the study group and the control group. In addition, no differences were found in the serum levels of lipid fractions or other biochemical variables. CONCLUSION We conclude that determination of the carotid IMT and of the ACE I/D polymorphism do not permit discrimination of the cardiovascular risk in children of parents with or without premature stroke.
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Affiliation(s)
- N Marcun Varda
- Department of Paediatrics, Maribor Teaching Hospital, Maribor, Slovenia.
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7
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Srámek A, Bucciarelli P, Federici AB, Mannucci PM, De Rosa V, Castaman G, Morfini M, Mazzucconi MG, Rocino A, Schiavoni M, Scaraggi FA, Reiber JHC, Rosendaal FR. Patients With Type 3 Severe von Willebrand Disease Are Not Protected Against Atherosclerosis. Circulation 2004; 109:740-4. [PMID: 14970109 DOI: 10.1161/01.cir.0000112567.53841.10] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
The results of a number of studies in pigs and mice suggest that absence of von Willebrand factor (vWF) protects against the development of atherosclerosis. We studied whether patients with a complete deficiency of vWF (type 3 von Willebrand disease [vWD]) develop fewer atherosclerotic vessel wall changes than healthy controls.
Methods and Results—
This study included 47 individuals with type 3 vWD and 84 healthy controls. Early atherosclerotic changes were assessed by measuring the thickness of the intima-media in the carotid and femoral arteries by B-mode ultrasonography. Advanced atherosclerotic changes were quantified by summing the maximal thickness of atherosclerotic plaques in the carotid and femoral arteries and were expressed as a plaque score. Established risk factors were determined to adjust for possible differences between the groups. We found no substantial difference in intima-media thickness between vWD patients and controls (adjusted difference for carotid artery 0.007 mm, 95% CI −0.022 to 0.036 mm; femoral artery 0.069 mm, 95% CI −0.056 to 0.19 mm). Similar proportions of patients and controls had atherosclerotic plaques (19% and 17%, respectively). No difference was found in the plaque score between groups (adjusted difference −0.22 mm, 95% CI −0.69 to 0.26). Among vWD patients, we found no effect of treatment with vWF concentrates on intima-media thickness or plaque score.
Conclusions—
The results of this study indicate that vWF does not play a substantial role in human atherogenesis.
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Affiliation(s)
- A Srámek
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
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8
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de Maat MPM, Bladbjerg EM, Drivsholm T, Borch-Johnsen K, Møller L, Jespersen J. Inflammation, thrombosis and atherosclerosis: results of the Glostrup study. J Thromb Haemost 2003; 1:950-7. [PMID: 12871360 DOI: 10.1046/j.1538-7836.2003.00213.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Inflammation and thrombosis are important mechanisms in cardiovascular disease, as illustrated by the consistent association between inflammatory and hemostatic variables and the risk of cardiovascular events in epidemiological studies. However, the relationship between plasma concentrations of inflammatory and hemostatic markers and the severity of atherosclerosis is not yet well studied. We have evaluated 325 men and 370 women of 60 years, participating in the Danish Glostrup study. We diagnosed atherosclerosis by ultrasonographic measurement of intima-media thickness (IMT) of the right carotid artery and the assessment of plaque occurrence. Plasma samples were analyzed for the concentration of C-reactive protein (CRP), fibrinogen, d-dimer, plasminogen activator inhibitor type-1 (PAI-1) antigen and activity, tissue-type plasminogen activator (t-PA) antigen and activity, factor VII (FVII) antigen, FVII coagulant activity (FVII:C) and activated FVII (FVIIa). DNA variations were determined for fibrinogen, PAI-1, t-PA, FVII, factor XIII and methylene tetrahydrofolate reductase (MTHFR). Subjects with high IMT (upper 10% of distribution, n = 63) had higher CRP levels [2.2 mg L-1 (SE 0.3)] than subjects with IMT in the lowest tertile (n = 217) [1.7 mg L-1 (SE 0.1), P = 0.04], whereas there was no association between the hemostatic variables and IMT. There was an association between fibrinogen and d-dimer concentrations and number of plaques (P < 0.01), whereas there were no associations between CRP and the other hemostatic variables and the number of plaques. Genetic variation in the t-PA and MTHFR gene was associated with IMT. In conclusion, in the Glostrup population study, thrombosis and inflammation are associated with the severity of atherosclerosis, as reflected by IMT and plaque occurrence.
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Affiliation(s)
- M P M de Maat
- Department for Thrombosis Research, University of Southern Denmark and Department of Clinical Biochemistry, Ribe County Hospital, Esbjerg, Denmark.
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9
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Srámek A, Reiber JHC, Baak-Pablo R, Sturk A, Rosendaal FR. Lipoprotein(a) and ultrasonographically determined early atherosclerotic changes in the carotid and femoral artery. J Thromb Haemost 2003; 1:374-9. [PMID: 12871513 DOI: 10.1046/j.1538-7836.2003.00064.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Recent studies suggest that high lipoprotein(a) [Lp(a)] plasma levels are associated with symptomatic ischemic cardiovascular disease. We examined whether Lp(a) plasma levels are associated with early atherosclerotic vessel wall changes in a group of asymptomatic subjects. In a group of 142 asymptomatic men, the intima-media thickness (IMT) in the common carotid artery, the carotid bifurcation and the common femoral artery was determined by B-mode ultrasonography. In addition to Lp(a) levels, established risk factors, such as blood pressure and cholesterol levels were determined. Lipoprotein(a) values ranged from 2 mg L(-1) to 900 mg L(-1) (median 145 mg L(-1)). Linear regression analysis showed a clear association of IMT with the established risk factors but not with Lp(a) [regression coefficient carotid artery -0.0003, 95% confidence interval (CI) -0.002-0.001; regression coefficient femoral artery -0.0003, 95% CI -0.004-0.003]. We found no increased intima-media thickness in the carotid or femoral artery at high levels of Lp(a). Lipoprotein(a) levels are not associated with early atherosclerotic vessel wall changes in the carotid or femoral artery.
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Affiliation(s)
- A Srámek
- Department of Clinical Epidemiology, Leiden University Medical Center, The Netherlands
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10
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Mavri A, Stegnar M, Sentocnik JT, Videcnik V. Impact of weight reduction on early carotid atherosclerosis in obese premenopausal women. OBESITY RESEARCH 2001; 9:511-6. [PMID: 11557831 DOI: 10.1038/oby.2001.67] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To investigate the extent of carotid atherosclerosis and the effect of weight loss on carotid intima-media thickness (IMT) in obese premenopausal women. RESEARCH METHODS AND PROCEDURES In 43 obese premenopausal women who participated in a 3-month weight reduction program with a hypocaloric diet, IMT was measured by B-mode high-resolution ultrasound at entry and after 5 months of follow-up. Blood samples were analyzed at entry, after intervention, and after 5 months of follow-up. Nineteen lean women served as control subjects. RESULTS At entry, common carotid IMT (0.72 vs. 0.59 mm), carotid bulb IMT (0.90 vs. 0.71 mm), and overall mean IMT (0.81 vs. 0.65 mm) were greater in obese women than in lean women (all p < 0.01). After dietary intervention decreases in blood pressure, low density lipoprotein to high density lipoprotein cholesterol ratio, triglycerides, fibrinogen, plasminogen activator inhibitor-1, and an increase in tissue-type plasminogen activator activity levels were observed. These effects persisted after follow-up in 14 women who maintained reduced weight. Reduction in carotid bulb IMT (to 0.81 mm, p < 0.01) and overall mean IMT (to 0.79 mm, p < 0.05) was observed in this subgroup. No significant change of carotid IMT was detected in eight women who regained weight. Changes in IMT were associated independently and significantly with changes in body mass index, low density lipoprotein to high density lipoprotein cholesterol ratio, and plasminogen activator inhibitor-1 antigen. DISCUSSION Obese premenopausal women had greater IMT than did age-matched lean controls. It seems that this early atherosclerotic changes may be reversed by normalization of body weight.
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Affiliation(s)
- A Mavri
- University Medical Centre, Department of Angiology, Ljubljana, Slovenia.
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11
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Srámek A, Reiber JH, Gerrits WB, Rosendaal FR. Decreased coagulability has no clinically relevant effect on atherogenesis: observations in individuals with a hereditary bleeding tendency. Circulation 2001; 104:762-7. [PMID: 11502699 DOI: 10.1161/hc3501.094232] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hemostasis affects ischemic cardiovascular disease through its role in formation of occluding arterial thrombi. Several studies suggest that hemostasis also might play a role in atherogenesis. We investigated whether individuals with an inherited bleeding tendency are protected against development of atherosclerosis. METHODS AND RESULTS A total of 76 individuals with an inherited bleeding tendency (hemophilia and von Willebrand disease) and 142 healthy controls were included in the present study. Early atherosclerotic vessel-wall changes were quantified by measurement of intima-media thickness in the carotid and femoral arteries by B-mode ultrasonography. To validate intima-media thickness measurements, measurements also were performed in 77 individuals with clinically proven atherosclerosis and in 34 healthy, age-matched controls. A large difference in intima-media thickness was found between individuals with proven atherosclerosis and healthy controls, in particular for the femoral artery (difference for carotid artery, 0.16 mm; femoral artery, 0.53 mm). Comparison between patients with a bleeding tendency and healthy controls showed only minimally reduced intima-media in femoral artery in individuals with a bleeding tendency (adjusted difference, -0.078 mm; 95% CI, -0.17 to 0.018 mm). Subgroup analysis revealed that in subjects with moderate to severe hemophilia, vessel walls were thinnest (adjusted difference, -0.10 mm; 95% CI, -0.27 to 0.061 mm). CONCLUSIONS Hypocoagulability caused by hemophilia or von Willebrand disease has at most a limited effect on atherogenesis.
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Affiliation(s)
- A Srámek
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden
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12
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Srámek A, Bosch JG, Reiber JH, Van Oostayen JA, Rosendaal FR. Ultrasound assessment of atherosclerotic vessel wall changes: reproducibility of intima-media thickness measurements in carotid and femoral arteries. Invest Radiol 2000; 35:699-706. [PMID: 11204795 DOI: 10.1097/00004424-200012000-00001] [Citation(s) in RCA: 92] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
RATIONALE AND OBJECTIVES Ultrasonography is widely used in cardiovascular research to quantify early atherosclerotic vessel wall changes. In this article, we examined the short- and long-term reproducibility of this technique in the common carotid artery, carotid bifurcation, common femoral artery, and superficial femoral artery. Furthermore, we assessed the effect of progressed atherosclerosis on reproducibility. METHODS Repeated ultrasound examinations were performed by one observer on 15 healthy individuals and 18 patients suffering from coronary heart disease. Intima-media thickness was determined by B-mode ultrasonography. The examinations were repeated by the same observer after a short time interval (short-term) and after a few weeks (long-term) and expressed as the mean difference between the measurements and the coefficient of variation (CV). RESULTS The reproducibility of the intima-media thickness determination turned out to be best in the common carotid artery and the superficial femoral artery when performed in healthy controls (CV 5.6% and 5.5%, respectively). Reproducibility was less in patients with clinical atherosclerosis; this especially affected the reliability of the superficial femoral artery measurement (CV in healthy controls was 5.5%; in coronary heart disease patients, 17.5 %). The reliability of the intima-media thickness measurements in the common carotid artery (CV in healthy controls was 5.6%; in coronary heart disease patients, 9.5%) proved to be least affected by progressed atherosclerosis. A longer time interval between measurements did not affect the reproducibility of intima-media thickness measurements in healthy controls, whereas in the patients it led to some decrease of reproducibility and to a major decrease in reproducibility of the superficial femoral artery measurements (CV changed from 12.7% to 17.5%). CONCLUSIONS Ultrasonography is a reliable and accurate technique to determine intima-media thickness in superficial arteries. In studies in which the intima-media thickness determination is used as a marker for generalized and coronary atherosclerosis, the common carotid artery should always be included, whereas the benefit of inclusion of other arteries depends on age and the expected extent of atherosclerosis in the individuals studied.
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Affiliation(s)
- A Srámek
- Department of Clinical Epidemiology, Leiden University Medical Center, The Netherlands
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13
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Lievers KJ, Mennen LI, Rattink AP, Zwinderman AH, Jukema JW, Schouten EG, de Maat MP. The -323Ins10 polymorphism for factor VII is not associated with coronary atherosclerosis in symptomatic men. The REGRESS study group. Thromb Res 2000; 97:275-80. [PMID: 10709902 DOI: 10.1016/s0049-3848(99)00176-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Elevated factor VII coagulant activity (FVII:C) has been associated with an increased risk of ischaemic heart disease, particularly for fatal events. Results of studies on the association between FVII:C and atherosclerosis are not consistent. FVII:C levels are influenced by several environmental factors and by genetic factors. One of the genetic factors is the -323Ins10 polymorphism in the promoter region of the factor VII gene, which is strongly related to FVII:C, and thus may be associated with ischaemic heart disease. We studied the association of this polymorphism with the severity and progression of atherosclerosis. In 511 male patients of the Regression Growth Evaluation Statin Study, the genotype for the -323Ins10 polymorphism was determined. The minimum obstruction diameter and the mean segment diameter were determined at baseline and after a 2-year follow-up period, and new lesion formation was assessed as well. Cardiovascular events were recorded. No relationship was observed between the -323Ins10 polymorphism and angiographic measures of disease progression, nor on the risk of new cardiovascular events. The results suggest that there is no association between the -323Ins10 polymorphism for factor VII and the severity or progression of coronary atherosclerosis in male patients with symptomatic coronary artery disease.
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Affiliation(s)
- K J Lievers
- Department of Human Nutrition and Epidemiology, Agricultural University, Wageningen, The Netherlands
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14
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Lee AJ, Mowbray PI, Lowe GD, Rumley A, Fowkes FG, Allan PL. Blood viscosity and elevated carotid intima-media thickness in men and women: the Edinburgh Artery Study. Circulation 1998; 97:1467-73. [PMID: 9576427 DOI: 10.1161/01.cir.97.15.1467] [Citation(s) in RCA: 150] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Several hemostatic and rheological factors have been associated with incident cardiovascular events. However, there have been no reports on the relationship of rheological factors with early atherosclerosis and very few on hemostatic factors. We therefore studied the relationship between these factors and carotid intima-media thickness (IMT). METHODS AND RESULTS The Edinburgh Artery Study measured fibrinogen, tissue plasminogen activator (tPA), fibrin D-dimer, von Willebrand factor (vWF), blood and plasma viscosities, and hematocrit as part of its baseline examination during 1988-1989. At the 5-year follow-up, valid measurements of IMT had been recorded in 1106 men and women 60 to 80 years old. In men, blood viscosity (P< or =.001) and its major determinants, plasma viscosity, fibrinogen (both P< or =.01), and hematocrit (P< or =.05), were all linearly related to IMT. Furthermore, blood viscosity, fibrinogen (both P< or =.01), and plasma viscosity (P< or =.05) remained significantly associated on multivariate analysis. Correcting blood viscosity to a standard hematocrit of 45% had little effect on its association. In men, there was a significantly increased risk of having an IMT above versus below the upper quartile of its distribution (1.05 mm) for SD increases in blood viscosity (P< or =.01), fibrinogen, corrected blood viscosity, and plasma viscosity (all P< or =.05). With the exception of plasma viscosity, these risks were unaffected by adjustment for other common cardiovascular risk factors. No significant associations were found between any of the hemorheological factors and IMT in women or for tPA, fibrin D-dimer, or vWF in either sex. CONCLUSIONS These findings suggest that in men, blood viscosity and its major determinants are associated not only with incident cardiovascular events but also with the early stages of atherosclerosis. This may be one explanation for the link between rheological factors and events.
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Affiliation(s)
- A J Lee
- Wolfson Unit for Prevention of Peripheral Vascular Diseases, Department of Public Health Sciences, Edinburgh University Medical School, UK.
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15
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Garg UC, Arnett DK, Evans G, Eckfeldt JH. No association between factor V Leiden mutation and coronary heart disease or carotid intima media thickness: the NHLBI Family Heart Study. Thromb Res 1998; 89:289-93. [PMID: 9669751 DOI: 10.1016/s0049-3848(98)00019-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- U C Garg
- Department of Laboratory Medicine and Pathology, School of Medicine, University of Minnesota, Minneapolis 55454-1015, USA
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16
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Baker WF. Thrombosis and Hemostasis in Cardiology: Review of Pathophysiology and Clinical Practice (Part I). Clin Appl Thromb Hemost 1998. [DOI: 10.1177/107602969800400107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The adverse consequences of thrombosis are per haps nowhere more evident than in clinical cardiology. Throm bosis and hemostasis are primary issues in the management of patients with atrial fibrillation, prosthetic heart valves, severe left ventricular dysfunction, and coronary artery disease. Clini cal trials have defined a crucial role for anticoagulation with warfarin in patients with atrial fibrillation to reduce the inci dence of stroke. Anticoagulation with warfarin and aspirin in combination offers significant protection from systemic emboli in patients with mechanical prosthetic valves, without a sub stantial increased risk of hemorrhage. The risk of systemic emboli may also be reduced by anticoagulation in patients with severe left ventricular dysfunction. Disturbance of the normal balance of hemostasis is a major factor in the pathophysiology of coronary artery disease. Antiplatelet therapy, antithrombin agents, anticoagulants, and fibrinolytic agents have been used to prevent and treat acute coronary thrombosis and to prevent reocclusion following thrombolysis and interventional therapy. Guidelines are presented for antithrombotic therapy in the prac tice of clinical cardiology.
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Affiliation(s)
- William F. Baker
- Central California Heart Institute, Bakersfield, California and Department of Medicine, Center for Health Sciences, University of California at Los Angeles, Los Angeles, California, U.S.A
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Stormorken H, Sakariassen KS. Hemostatic risk factors in arterial thrombosis and atherosclerosis: the thrombin-fibrin and platelet-vWF axis. Thromb Res 1997; 88:1-25. [PMID: 9336870 DOI: 10.1016/s0049-3848(97)00157-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- H Stormorken
- Department of Biology, University of Oslo, Norway
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de Maat MP, Green F, de Knijff P, Jespersen J, Kluft C. Factor VII polymorphisms in populations with different risks of cardiovascular disease. Arterioscler Thromb Vasc Biol 1997; 17:1918-23. [PMID: 9351354 DOI: 10.1161/01.atv.17.10.1918] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Increased plasma factor VII coagulant activity (FVII:C) has been associated with the risk of ischemic heart disease (IHD). Differences in plasma FVII:C among individuals are associated with three common polymorphisms in the FVII gene. Therefore, we investigated FVII polymorphisms in four populations that differ in their risk of developing cardiovascular disease, namely, Europeans, Greenland Inuit, Gujarati Indians, and Afrocaribbeans. We studied (1) the promoter polymorphism, which is the result of a decanucleotide insertion in the FVII promoter at position -323 from the start of translation; (2) the hypervariable region 4 polymorphism (HVR4), which is the result of a variable number of tandem repeats in intron 7; and (3) the RQ353 polymorphism, a guanine-to-adenine substitution in the position of the codon for amino acid 353 resulting in an amino acid replacement of arginine (R) by glutamine (Q) in the FVII protein. The frequencies of these three polymorphisms and their linkage disequilibrium were different in the four populations studied. The frequencies of the alleles associated with higher plasma FVII:C were lower in the Europeans than in the Inuit, a population with a lower incidence of IHD. There was an association between both the promoter polymorphism and the RQ353 polymorphism and the plasma FVII:C in the Europeans, the Inuit, and the Gujarati Indians, and an association only between the RQ353 polymorphism and plasma FVII:C in the Afrocaribbeans. Only in the Inuit was the HVR4 polymorphism associated with plasma FVII:C. In multiple regression analysis, the additional information provided by the promoter polymorphism when the other polymorphisms were already included in the model was the most pronounced, suggesting that the promoter polymorphism may be the functional mutation having the greatest effect on determining plasma FVII:C.
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Affiliation(s)
- M P de Maat
- Gaubius Laboratory TNO-PG, Leiden, The Netherlands
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Eichner JE, Moore WE, Schechter E, Reynolds DW, Morrissey JH, Comp PC. Activated factor VII levels in patients with angiographically confirmed coronary artery disease. Am J Cardiol 1997; 80:217-9. [PMID: 9230166 DOI: 10.1016/s0002-9149(97)00324-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We have examined factor VIIa levels in consecutive consenting patients undergoing coronary angiography (n = 702) to determine if levels are related to the presence of coronary arterial narrowing and to the degree and extent of that narrowing. Both men and women with clinically defined coronary artery disease (> or = 50% stenosis in at least 1 vessel) had factor VIIa levels that were similar to men and women with less stenosis or normal coronary arteries.
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Affiliation(s)
- J E Eichner
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma, Oklahoma Medical Research Foundation, and the Oklahoma City Veterans Hospital, 73190, USA
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Pan WH, Bai CH, Chen JR, Chiu HC. Associations between carotid atherosclerosis and high factor VIII activity, dyslipidemia, and hypertension. Stroke 1997; 28:88-94. [PMID: 8996495 DOI: 10.1161/01.str.28.1.88] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND PURPOSE A subsample of 147 Chinese subjects from a population-based study of cardiovascular diseases (Cardiovascular Disease Risk Factor Two-Township Study) participated in an ancillary study on extracranial carotid color duplex ultrasonography that aimed to assess the relations of coagulation factors to stroke and carotid atherosclerosis. METHODS Logistic models were used to study the associations between cardiovascular disease risk factors and stroke/carotid atherosclerosis, controlling for the effects of age and sex. RESULTS Stroke was significantly associated with hypertension and high values of plasma glucose but not with fibrinogen, factor VIIc, or factor VIIIc. Carotid plaques identified in this study were mostly mild and moderate. The presence of these mild and moderate carotid plaques was significantly associated with high values of factor VIII activity, hypercholesterolemia, hypertriglyceridemia, and hypertension. The highest tertile of factor VIIIc (> 1.53) was associated with an odds ratio of 3.35 for carotid atherosclerosis when compared with the lowest tertile (< 1.20). A multiple logistic regression including all significant risk factors showed that the degree of association between factor VIIIc and atherosclerosis was attenuated to an odds ratio of 2.65 (P = .061). CONCLUSIONS In the present study, the roles of hypertension, hypercholesterolemia, and hypertriglyceridemia have been implicated in the pathogenesis of carotid atherosclerosis, and roles for hypertension and hyperglycemia in stroke were indicated. A positive association between factor VIIIc and carotid atherosclerosis in this Chinese population was found. Whether this association is independent of the effect of other cardiovascular risk factors awaits further study.
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Affiliation(s)
- W H Pan
- Division of Epidemiology and Public Health, Academia Sinica, Taipei, Taiwan, ROC.
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Suzuki M, Shinozaki K, Kanazawa A, Hara Y, Hattori Y, Tsushima M, Harano Y. Insulin resistance as an independent risk factor for carotid wall thickening. Hypertension 1996; 28:593-8. [PMID: 8843883 DOI: 10.1161/01.hyp.28.4.593] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
It has been reported that insulin resistance is associated with essential hypertension and that an aggregation of risk factors-hypertension, dyslipidemia, and glucose intolerance-together with insulin resistance leads to the more frequent appearance of coronary artery disease. We examined the relation between early asymptomatic atherosclerosis and these risk factors in 72 nondiabetic subjects with essential hypertension (41 men, 31 women) aged 50 to 59 years. Intima-media thickness and plaque formation of the carotid artery were assessed by B-mode ultrasonography, and insulin sensitivity was measured by the steady-state plasma glucose method. Lipoprotein profile was analyzed by ultracentrifugation. The intima-media thickness of the common carotid artery significantly correlated with systolic pressure; mean blood pressure; steady-state plasma glucose, indicating insulin resistance; fasting insulin; area under the curve of plasma insulin and glucose; body mass index; apolipoprotein B; apolipoprotein B in low-density lipoprotein; lower ratio of cholesterol to apolipoprotein B of low-density lipoprotein; and decreased high-density lipoprotein cholesterol. By multiple regression analysis, steady-state plasma glucose was the strongest risk, followed by lower high-density lipoprotein and systolic pressure. These three factors accounted for 54.9% of all the risk for increased intima-media thickness of the common carotid artery. In conclusion, insulin resistance was the strongest risk factor for carotid intima-media thickness, followed by lower high-density lipoprotein cholesterol and hypertension. An effort to maintain normal insulin sensitivity is essential for the prevention of early atheromatous lesions in essential hypertension.
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Affiliation(s)
- M Suzuki
- Department of Medicine, National Cardiovascular Center, Osaka, Japan
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Burgmann H, Hollenstein U, Maca T, Zedwitz-Liebenstein K, Thalhammer F, Koppensteiner R, Ehringer H, Graninger W. Increased serum laminin and angiogenin concentrations in patients with peripheral arterial occlusive disease. J Clin Pathol 1996; 49:508-10. [PMID: 8763269 PMCID: PMC500545 DOI: 10.1136/jcp.49.6.508] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
AIM To measure serum laminin and angiogenin concentrations in patients with peripheral arterial occlusive disease (PAOD) Fontaine stages IIb, III, and IV. METHODS The study population comprised 38 patients (20 men and 18 women) with stage IV PAOD, 11 patients (six men and five women) with stage III PAOD, 18 patients (10 men and eight women) with stage IIb PAOD, and 23 patients (10 men and 13 women) with deep vein thrombosis. Fifteen normal subjects (matched for risk factors) and 10 patients (five men and five women) without PAOD served as controls. Serum samples were obtained at admission and serum laminin and angiogenin concentrations were measured using an enzyme linked immunosorbent assay. RESULTS Patients with stage IV PAOD had higher serum laminin (mean +/- SEM; 826 +/- 97 ng/ml) and angiogenin concentrations (467 +/- 26 pg/ml) than normal subjects (laminin: 379 +/- 21 ng/ml; angiogenin: 358 +/- 16 pg/ml) and patients without PAOD (laminin: 277 +/- 34 ng/ml; angiogenin: 406 +/- 25 pg/ml). A significant correlation was found between angiogenin and laminin and between serum laminin and fibrinogen concentrations in patients with stage IV disease. CONCLUSIONS Raised laminin and angiogenin concentrations may be indicators of endothelial damage caused by reduced vascular perfusion or compensatory revascularisation, or both.
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Affiliation(s)
- H Burgmann
- Department of Internal Medicine I, University of Vienna Medical School, Austria
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Duggirala R, González Villalpando C, O'Leary DH, Stern MP, Blangero J. Genetic basis of variation in carotid artery wall thickness. Stroke 1996; 27:833-7. [PMID: 8623101 DOI: 10.1161/01.str.27.5.833] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND PURPOSE Other than the documented associations of risk factors and carotid artery wall thickness, the genetic basis of variation in carotid artery intimal-medial thickness (IMT) is unknown. The purpose of this study was to examine the extent to which variation in common carotid artery (CCA) IMT and internal carotid artery (ICA) IMT are under genetic control. METHODS The sibship data used for this analysis were part of an epidemiological survey in Mexico City. The CCA and ICA analyses were based on 46 and 44 sibships of various sizes, respectively. The CCA and ICA IMTs were measured with carotid ultrasonography. Using a robust variance decomposition method, we performed genetic analyses of CCA IMT and ICA IMT measurements with models incorporating several cardiovascular risk factors (eg, lipids, diabetes, blood pressure, and smoking) as covariates. RESULTS After accounting for the effects of covariates, we detected high heritabilities for CCA IMT (h2 = 0.92 +/- 0.05, P = .001) and ICA IMT (h2 = 0.86 +/- 0.13, P = .029). Genes accounted for 66.0% of the total variation in CCA IMT, whereas 27.7% of variation was attributable to covariates. For ICA IMT, genes explained a high proportion (74.9%) of total phenotypic variation. The covariates accounted for 11.5% of variation in ICA IMT. CONCLUSIONS Our results suggest that substantial proportions of phenotypic variance in CCA IMT and ICA IMT are attributable to shared genetic factors.
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Affiliation(s)
- R Duggirala
- Department of Medicine, University of Texas Health Science Center at San Antonio, TX 78284-7873, USA.
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Cortellaro M, Baldassarre D, Cofrancesco E, Tremoli E, Colombo A, Boschetti C, Paoletti R. Relation between hemostatic variables and increase of common carotid intima-media thickness in patients with peripheral arterial disease. Stroke 1996; 27:450-4. [PMID: 8610312 DOI: 10.1161/01.str.27.3.450] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND PURPOSE Increases in common carotid intima-media thickness (CC-IMT), as measured by B-mode ultrasonography, have been widely used in both population studies and clinical trials in the search for risk factors for early atherosclerosis progression and have been found to correlate with age and with high concentrations of low-density lipoprotein cholesterol, leukocytes, and hemoglobin. We have now investigated the relation between several baseline hemostatic and conventional risk factors and CC-IMT changes over 16 months in 64 patients with peripheral arterial disease randomly selected from the prospective PLAT study series. METHODS Samples from 24 patients (37.5%) who showed increases in CC-IMT during the follow-up period were compared with those from 40 (62.5%) in whom CC-IMT remained unchanged. RESULTS Baseline conventional risk factors and coagulation variables were similar in the two groups except for higher plasma concentrations of von Willebrand factor (vWF) (178.3 +/- 53.6% versus 141.2 +/- 53.7%, P=.01) and factor VII (FVII) (133.9 +/- 36.4% versus 107.0 +/- 27.3%, P=.001) in the patients with increased CC-IMT. CC-IMT increase correlated positively with plasma levels of FVII (r=.31, P<.01) and vWF (r=.31, P<.01). Multiple stepwise regression analysis identified FVII as the only independent variable associated with an increase in CC-IMT (beta=.83, P=.01). CONCLUSIONS High plasma concentration of FVII and vWF may be associated with the progression of early carotid atherosclerosis in patients with peripheral arterial disease.
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Affiliation(s)
- M Cortellaro
- Institute of Internal Medicine, University of Milan (Italy)
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Abstract
The strong epidemiological association between elevated plasma clotting factors and coronary artery disease is generally interpreted as evidence that patients with coronary atherosclerosis are in a procoagulant (hypercoagulable) state. A dynamic global test was used to assess the overall coagulation status of 761 patients with coronary artery disease scheduled for coronary artery bypass grafting and compared to healthy matched controls (n = 100). Platelet reactivity to shear-stress was simultaneously measured from identical, non-anticoagulated blood samples. Contrary to expectation, the overall coagulation in cardiac patients did not differ significantly from that of controls. Furthermore, the coagulation status of patients bore no relationship to the severity of coronary atherosclerosis. The latter is in contrast with platelet reactivities, which were significantly increased in patients with > or = 2 vessel disease as compared with single vessel disease. The present results do not necessarily conflict with the finding of elevated plasma clotting factors in cardiac patients. However, they do not support the claim that these markers are a reflection of a hypercoagulable state. Indeed, this study confirms that such patients are in a prothrombotic state, which is related to enhanced platelet reactivities, and not to a prothrombotic imbalance of the coagulation mechanism.
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Affiliation(s)
- P Görög
- Thrombosis Unit, St. Bartholomew's Hospital Medical School, London, England
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Petersen LC, Valentin S, Hedner U. Regulation of the extrinsic pathway system in health and disease: the role of factor VIIa and tissue factor pathway inhibitor. Thromb Res 1995; 79:1-47. [PMID: 7495097 DOI: 10.1016/0049-3848(95)00069-4] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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