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Chung ST, Katz LEL, Stettler-Davis N, Shults J, Sherman A, Ha J, Stefanovski D, Boston RC, Rader DJ, Magge SN. The Relationship Between Lipoproteins and Insulin Sensitivity in Youth With Obesity and Abnormal Glucose Tolerance. J Clin Endocrinol Metab 2022; 107:1541-1551. [PMID: 35240684 PMCID: PMC9113822 DOI: 10.1210/clinem/dgac113] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Indexed: 02/13/2023]
Abstract
CONTEXT Youth with obesity and abnormal glucose tolerance have an increased risk for atherosclerosis but the relative contributions of insulin resistance and hyperglycemia to dyslipidemia and the development of subclinical atherosclerosis are unknown. OBJECTIVE This work aims to determine the association between insulin resistance, dyslipidemia, and carotid intimal thickness (cIMT) in adolescents with normal and abnormal glucose tolerance. METHODS An observational cohort study in 155 youth: 44 obese insulin sensitive (OIS; fasting insulin ≤ 20 µM/mL, body mass index [BMI] ≥ 95th percentile), 35 obese insulin resistant (OIR; fasting insulin > 20 µM/mL, BMI ≥ 95th percentile), 34 obese abnormal glucose tolerant (AGT; BMI ≥ 95th percentile), and 42 Lean (BMI 5th-85th percentile). Lipids, lipoprotein particle size and concentration (-P), insulin sensitivity (SI an intravenous glucose test), and CMIT were compared using linear models adjusted for age, race/ethnicity, biological sex, and Tanner stage. Lipid/lipoprotein profile and CMIT were reevaluated in a subset after 2 years. RESULTS Compared to OIS and Lean, OIR and AGT had elevated triglycerides and low high-density lipoprotein cholesterol (HDL-C) but similar total cholesterol and low-density lipoprotein cholesterol (LDL-C). Among OIS, OIR, AGT, lower SI was associated with atherogenic lipids (higher triglycerides, LDL-C, non-HDL-C, and lower HDL-C) and lipoproteins (higher total LDL-P and small HDL-P, and lower large HDL-P). There was a steeper decline in the association of SI with HDL-C and large HDL-P in AGT compared with OIR and OIS. cIMT was comparable across groups and inversely correlated with SI, with no change after 2 years. CONCLUSION Among youth with obesity, insulin resistance was associated with an atherogenic lipoprotein/lipid profile and cIMT, regardless of glucose tolerance status. Insulin resistance in AGT youth was associated with a shift to smaller HDL-P compared to normoglycemic youth with obesity. Alterations in HDL-P metabolism may be early adverse manifestations of hyperglycemia in youth with obesity.
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Affiliation(s)
- Stephanie T Chung
- Section on Pediatric Diabetes, Obesity, and Metabolism, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Lorraine E Levitt Katz
- Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Justine Shults
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Arthur Sherman
- Laboratory of Biological Modeling, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Joon Ha
- Department of Mathematics, Howard University, Washington, DC, USA
| | - Darko Stefanovski
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ray C Boston
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Medicine, St. Vincent Hospital, University of Melbourne, Melbourne, Australia
| | - Daniel J Rader
- Departments of Medicine and Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sheela N Magge
- Division of Pediatric Endocrinology and Diabetes, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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2
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Gentile M, Iannuzzo G, Simeon V, Mattiello A, Rubba F, Panico C, Panico S, Rubba P. Association between atherogenic index of plasma and carotid intima-media thickness in a cohort of Mediterranean women. Acta Cardiol 2021; 76:987-992. [PMID: 33302810 DOI: 10.1080/00015385.2020.1858537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The association between early atherosclerosis (IMT) and Atherogenic index of plasma (AIP), a marker of atherogenicity (log triglycerides/HDL Cholesterol) was evaluated in a population-based cohort study in women, aged 30-69, living in the metropolitan area of Naples, Southern Italy (Progetto ATENA). Serum cholesterol, HDL-cholesterol, LDL-cholesterol, Triglyceride, Insulin, HOMA, Apo B, hs-CPR were measured in 390 menopausal women, as a part of 5.062 participants of the cohort. Women in the second and third tertile of AIP showed an increased common carotid intima-media thickness compared with those in the first tertile: II vs I tertile (O.R. = 2.24, p = 0.007), III vs I tertile (O.R. = 2.29, p = 0.005), adjusted for age and Systolic pressure or II vs I tertile (O.R. = 2.19, p = 0.014), III vs I tertile (O.R. = 2.13, p = 0.026), adjusted for age, Systolic pressure, Body mass index and Apo B. Women in the second and third tertile of AIP compared to those in the first tertile, showed an OR of 2.14 (p = 0.016) and 1.99 (p = 0.033) respectively, of having elevates level of IMT, adjusted for traditional cardiovascular risk factor (age, Systolic Pressure, BMI, LDL Cholesterol, Diabetes diagnosis). This finding shows that in this group of menopausal women increased IMT is associated with elevated AIP independently of age and different cardiovascular risk factors. These results are in line with the hypothesis that AIP may be an useful clinical tools to give additional information in the risk assessment for atherosclerotic disease, in particular in postmenopausal women.
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Affiliation(s)
- M. Gentile
- Dipartimento di Medicina Clinica e Chirurgia, Università “Federico II” di Napoli, Italy
| | - G. Iannuzzo
- Dipartimento di Medicina Clinica e Chirurgia, Università “Federico II” di Napoli, Italy
| | - V. Simeon
- Unità Statistica Medica, Dipartimento di Salute Mentale e Fisica e Medicina Preventiva, Università degli Studi della Campania ‘Luigi Vanvitelli’, Napoli, Italy
| | - A. Mattiello
- Dipartimento di Medicina Clinica e Chirurgia, Università “Federico II” di Napoli, Italy
| | - F. Rubba
- Dipartimento di Sanità Pubblica, Università degli Studi di Napoli Federico II, Napoli, Italy
| | - C. Panico
- Dipartimento di Medicina Clinica e Chirurgia, Università “Federico II” di Napoli, Italy
| | - S. Panico
- Dipartimento di Medicina Clinica e Chirurgia, Università “Federico II” di Napoli, Italy
| | - P. Rubba
- Dipartimento di Medicina Clinica e Chirurgia, Università “Federico II” di Napoli, Italy
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3
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Shim SY, Lee GB, Shim JS, Jung SJ, Kim HC. Association between a family history of diabetes and carotid artery atherosclerosis in Korean adults. Epidemiol Health 2021; 43:e2021049. [PMID: 34525777 PMCID: PMC8510832 DOI: 10.4178/epih.e2021049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/03/2021] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES Diabetes is a well-known risk factor for atherosclerosis, but the association between a family history of diabetes and atherosclerosis remains unknown. In this study, we assessed the association between a family history of diabetes and increased carotid intima-media thickness (IMT), a marker of subclinical atherosclerosis, in a middle-aged Korean population. METHODS This cross-sectional study included 3,974 community-dwelling adults (1,404 male and 2,570 female) aged 30-64 years from the Cardiovascular and Metabolic Diseases Etiology Research Center cohort. The presence of a family history of diabetes was assessed through face-to-face interviews using a standardized questionnaire. Carotid IMT was assessed using B-mode ultrasonography, and increased IMT was defined as a value in the top quartile of the IMT values of all participants. Multivariate logistic regression was used to evaluate independent associations between a family history of diabetes and increased IMT. RESULTS A family history of diabetes was significantly associated with increased carotid IMT (odds ratio, 1.23; 95% confidence interval, 1.03 to 1.48) after adjusting for sex; age; body mass index; systolic blood pressure; total cholesterol, triglyceride, and hemoglobin A1c levels; smoking; alcohol consumption; exercise; use of antidiabetic, antihypertensive, and antilipidemic drugs; and a family history of hypertension. The positive association remained significant after excluding participants with diabetes (odds ratio, 1.21; 95% confidence interval, 1.00 to 1.47). CONCLUSIONS A family history of diabetes was positively associated with increased carotid IMT, even in participants without diabetes. Therefore, information on a family history of diabetes may help identify individuals at high risk of atherosclerotic cardiovascular disease.
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Affiliation(s)
- Sun Young Shim
- Department of Public Health, Graduate School, Yonsei University, Seoul, Korea.,Cardiovascular and Metabolic Diseases Etiology Research Center, Yonsei University College of Medicine, Seoul, Korea
| | - Ga Bin Lee
- Department of Public Health, Graduate School, Yonsei University, Seoul, Korea.,Cardiovascular and Metabolic Diseases Etiology Research Center, Yonsei University College of Medicine, Seoul, Korea
| | - Jee-Seon Shim
- Cardiovascular and Metabolic Diseases Etiology Research Center, Yonsei University College of Medicine, Seoul, Korea.,Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sun Jae Jung
- Department of Public Health, Graduate School, Yonsei University, Seoul, Korea.,Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hyeon Chang Kim
- Department of Public Health, Graduate School, Yonsei University, Seoul, Korea.,Cardiovascular and Metabolic Diseases Etiology Research Center, Yonsei University College of Medicine, Seoul, Korea.,Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
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4
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Yurdadogan T, Malsch C, Kotseva K, Wood D, Leyh R, Ertl G, Karmann W, Müller-Scholden L, Morbach C, Breunig M, Wagner M, Gelbrich G, Bots ML, Heuschmann PU, Störk S. Functional versus morphological assessment of vascular age in patients with coronary heart disease. Sci Rep 2021; 11:18164. [PMID: 34518567 PMCID: PMC8437950 DOI: 10.1038/s41598-021-96998-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 08/04/2021] [Indexed: 01/21/2023] Open
Abstract
Communicating cardiovascular risk based on individual vascular age (VA) is a well acknowledged concept in patient education and disease prevention. VA may be derived functionally, e.g. by measurement of pulse wave velocity (PWV), or morphologically, e.g. by assessment of carotid intima-media thickness (cIMT). The purpose of this study was to investigate whether both approaches produce similar results. Within the context of the German subset of the EUROASPIRE IV survey, 501 patients with coronary heart disease underwent (a) oscillometric PWV measurement at the aortic, carotid-femoral and brachial-ankle site (PWVao, PWVcf, PWVba) and derivation of the aortic augmentation index (AIao); (b) bilateral cIMT assessment by high-resolution ultrasound at three sites (common, bulb, internal). Respective VA was calculated using published equations. According to VA derived from PWV, most patients exhibited values below chronological age indicating a counterintuitive healthier-than-anticipated vascular status: for VAPWVao in 68% of patients; for VAAIao in 52% of patients. By contrast, VA derived from cIMT delivered opposite results: e.g. according to VAtotal-cIMT accelerated vascular aging in 75% of patients. To strengthen the concept of VA, further efforts are needed to better standardise the current approaches to estimate VA and, thereby, to improve comparability and clinical utility.
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Affiliation(s)
- Tino Yurdadogan
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany.
| | - Carolin Malsch
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Kornelia Kotseva
- National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland
| | - David Wood
- Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | - Rainer Leyh
- Department of Cardiothoracic and Thoracic Vascular Surgery, University Hospital Würzburg, Würzburg, Germany
| | - Georg Ertl
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany.,Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Wolfgang Karmann
- Department of Medicine, Klinik Kitzinger Land, Kitzingen, Germany
| | - Lara Müller-Scholden
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany
| | - Caroline Morbach
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany
| | - Margret Breunig
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany
| | - Martin Wagner
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany.,Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Götz Gelbrich
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Peter U Heuschmann
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany
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5
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Licenziati MR, Iannuzzo G, Morlino D, Campana G, Renis M, Iannuzzi A, Valerio G. Fat mass and vascular health in overweight/obese children. Nutr Metab Cardiovasc Dis 2021; 31:1317-1323. [PMID: 33589322 DOI: 10.1016/j.numecd.2020.12.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 12/08/2020] [Accepted: 12/12/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM Childhood obesity is one of the most serious public health challenges of the 21st century. Body mass index (BMI), the most widely used marker of body fatness, has serious limitations, particularly in children, since it does not accurately discriminate between lean and fat mass. Aim of our study was to investigate if the estimate of fat mass, as derived by a new prediction model, was associated with carotid intima media thickness (IMT) and the cross-sectional area of the intima media complex (CSA-IMC) in overweight or obese children. METHODS AND RESULTS As many as 375 overweight/obese Italian children, 54.7% males, aged 5-15 years, admitted to a tertiary care hospital, were consecutively enrolled in a study on cardiovascular markers of atherosclerosis. All children underwent an ultrasound carotid examination. Mean weight was 62.2 ± 20.8 Kg and fat-mass was 26.2 ± 10.7 Kg. Multiple regression analyses showed a significant association of fat mass with carotid IMT (β 0.156, p 0.01) and CSA-IMC (β 0.216, p < 0.001); these associations remained significant after controlling for the main cardiovascular risk factors (age, sex, blood pressure, HOMA-index, triglycerides, LDL-cholesterol, HDL-cholesterol, birth weight and high-sensitivity C-reactive protein). CONCLUSION Fat mass calculated with the new formula is independently associated with subclinical atherosclerosis in overweight/obese children.
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Affiliation(s)
- Maria Rosaria Licenziati
- Obesity and Endocrine Disease Unit, Department of Neurosciences, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Gabriella Iannuzzo
- Department of Clinical Medicine and Surgery Federico II University, Naples, Italy
| | - Delia Morlino
- Department of Clinical Medicine and Surgery Federico II University, Naples, Italy
| | - Giuseppina Campana
- Obesity and Endocrine Disease Unit, Department of Neurosciences, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Maurizio Renis
- Division of Internal Medicine, Cava dei Tirreni Hospital, Salerno, Italy
| | - Arcangelo Iannuzzi
- Department of Medicine and Medical Specialties, A. Cardarelli Hospital, Naples, Italy.
| | - Giuliana Valerio
- Department of Movement Sciences and Wellbeing, Parthenope University of Naples, Italy
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6
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Orlandi M, Graziani F, D'Aiuto F. Periodontal therapy and cardiovascular risk. Periodontol 2000 2020; 83:107-124. [PMID: 32385887 DOI: 10.1111/prd.12299] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cardiovascular diseases are the worldwide leading cause of mortality. Cardiovascular diseases are noncommunicable conditions with a complex pathogenesis, and their clinical manifestations include major cardiovascular events such as myocardial infarction and stroke. Epidemiologic evidence suggests a consistent association between periodontitis and increased risk of cardiovascular diseases. Some evidence supports a beneficial effect of the treatment of periodontitis on both surrogate and hard cardiovascular outcomes. This narrative review has been conducted as an update of the most recent evidence on the effects of periodontitis treatment on cardiovascular outcomes since the last commissioned review of the European Federation of Periodontology-American Academy of Periodontology World Workshop in 2012. Newer evidence originating from published randomized controlled trials confirms a positive effect of periodontal treatment on surrogate measures of cardiovascular diseases, whereas there have been no randomized controlled trials investigating the effect of periodontal treatment on the incidence of cardiovascular disease events such as myocardial infarction and stroke. In conclusion, there is sufficient evidence from observational and experimental studies on surrogate cardiovascular measures to justify the design and conduct of appropriately powered randomized controlled trials investigating the effect of effective periodontal interventions on cardiovascular disease outcomes (ie, myocardial infarction and stroke) with adequate control of traditional cardiovascular risk factors.
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Affiliation(s)
- Marco Orlandi
- Periodontology Unit, UCL Eastman Dental Institute, London, UK
| | - Filippo Graziani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy.,Sub-Unit of Periodontology, Halitosis and Periodontal Medicine, University Hospital of Pisa, Pisa, Italy
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7
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Di Taranto MD, Giacobbe C, Buonaiuto A, Calcaterra I, Palma D, Maione G, Iannuzzo G, Di Minno MND, Rubba P, Fortunato G. A Real-World Experience of Clinical, Biochemical and Genetic Assessment of Patients with Homozygous Familial Hypercholesterolemia. J Clin Med 2020; 9:jcm9010219. [PMID: 31947532 PMCID: PMC7019873 DOI: 10.3390/jcm9010219] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 12/30/2019] [Accepted: 01/10/2020] [Indexed: 01/09/2023] Open
Abstract
Homozygous familial hypercholesterolemia (HoFH), the severest form of familial hypercholesterolemia (FH), is characterized by very high LDL-cholesterol levels and a high frequency of coronary heart disease. The disease is caused by the presence of either a pathogenic variant at homozygous status or of two pathogenic variants at compound heterozygous status in the LDLR, APOB, PCSK9 genes. We retrospectively analyzed data of 23 HoFH patients (four children and 19 adults) identified during the genetic screening of 724 FH patients. Genetic screening was performed by sequencing FH causative genes and identifying large rearrangements of LDLR. Among the HoFH patients, four out of 23 (17.4%) were true homozygotes, whereas 19 out of 23 (82.6%) were compound heterozygotes for variants in the LDLR gene. Basal LDL-cholesterol was 12.9 ± 2.9 mmol/L. LDL-cholesterol levels decreased to 7.2 ± 1.8 mmol/L when treated with statin/ezetimibe and to 5.1 ± 3.1 mmol/L with anti-PCSK9 antibodies. Homozygous patients showed higher basal LDL-cholesterol and a poorer response to therapy compared with compound heterozygotes. Since 19 unrelated patients were identified in the Campania region (6,000,000 inhabitants) in southern Italy, the regional prevalence of HoFH was estimated to be at least 1:320,000. In conclusion, our results revealed a worse phenotype for homozygotes compared with compound heterozygotes, thereby highlighting the role of genetic screening in differentiating one genetic status from the other.
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Affiliation(s)
- Maria Donata Di Taranto
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, 80131 Naples, Italy; (C.G.); (D.P.); (G.M.)
- CEINGE S.C.a r.l. Biotecnologie Avanzate, 80131 Naples, Italy
- Correspondence: (M.D.D.T.); (G.F.); Tel.: +39-081-7463530 (M.D.D.T.); +39-081-7464200 (G.F.)
| | - Carola Giacobbe
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, 80131 Naples, Italy; (C.G.); (D.P.); (G.M.)
- CEINGE S.C.a r.l. Biotecnologie Avanzate, 80131 Naples, Italy
| | - Alessio Buonaiuto
- Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, 80131 Naples, Italy; (A.B.); (I.C.); (G.I.); (P.R.)
| | - Ilenia Calcaterra
- Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, 80131 Naples, Italy; (A.B.); (I.C.); (G.I.); (P.R.)
| | - Daniela Palma
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, 80131 Naples, Italy; (C.G.); (D.P.); (G.M.)
- CEINGE S.C.a r.l. Biotecnologie Avanzate, 80131 Naples, Italy
| | - Giovanna Maione
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, 80131 Naples, Italy; (C.G.); (D.P.); (G.M.)
- CEINGE S.C.a r.l. Biotecnologie Avanzate, 80131 Naples, Italy
| | - Gabriella Iannuzzo
- Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, 80131 Naples, Italy; (A.B.); (I.C.); (G.I.); (P.R.)
| | - Matteo Nicola Dario Di Minno
- Dipartimento di Scienze Mediche Traslazionali, Università degli Studi di Napoli Federico II, 80131 Naples, Italy;
| | - Paolo Rubba
- Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, 80131 Naples, Italy; (A.B.); (I.C.); (G.I.); (P.R.)
| | - Giuliana Fortunato
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, 80131 Naples, Italy; (C.G.); (D.P.); (G.M.)
- CEINGE S.C.a r.l. Biotecnologie Avanzate, 80131 Naples, Italy
- Correspondence: (M.D.D.T.); (G.F.); Tel.: +39-081-7463530 (M.D.D.T.); +39-081-7464200 (G.F.)
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8
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Laila SR, Astuti DA, Suparto IH, Handharyani E, Sajuthi D. Metabolic and morphometric changes in Indonesian cynomolgus monkeys (Macaca fascicularis) fed an atherogenic diet composed of locally sourced ingredients. Vet World 2018; 11:1609-1617. [PMID: 30587897 PMCID: PMC6303492 DOI: 10.14202/vetworld.2018.1609-1617] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 10/10/2018] [Indexed: 11/30/2022] Open
Abstract
Background and Aim: This study was designed to determine the effects of a new atherogenic diet formulated at Institut Pertanian Bogor (IPB) (Bogor, Indonesia) on metabolic, morphometric, and carotid artery imaging of cynomolgus monkeys. Materials and Methods: A total of 20 adult male cynomolgus monkeys fed IPB-1 atherogenic diet for 1 year. Total plasma cholesterol (TPC), high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, triglycerides, and morphometric measurements were evaluated at baseline and monthly during the study. Carotid plaques and intima-media thickness (IMT) were measured using ultrasonography at baseline and after 8 months of treatment. Results: This diet increased TPC, LDL, and TPC/HDL ratio and induced carotid atherosclerosis in this model. The TPC, LDL, and TPC/HDL ratio were positively associated; however, HDL was negatively associated with carotid plaques and IMT. Conclusion: The IPB-1 atherogenic diet formulated with locally and readily available ingredients provides an economically and scientifically feasible monkey model to study atherosclerosis in Indonesia and Southeast Asia.
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Affiliation(s)
- Sri Rahmatul Laila
- Department of Anatomy, Physiology and Pharmacology, Faculty of Veterinary Medicine, Bogor Agricultural University, Bogor, Indonesia
| | - Dewi Apri Astuti
- Primate Research Center, Bogor Agricultural University, Bogor, Indonesia.,Department of Nutrition and Feed Technology, Faculty of Animal Science, Bogor Agricultural University, Bogor, Indonesia
| | - Irma Herawati Suparto
- Primate Research Center, Bogor Agricultural University, Bogor, Indonesia.,Department of Chemistry, Faculty of Mathematics and Natural Sciences, Bogor Agricultural University, Bogor, Indonesia
| | - Ekowati Handharyani
- Primate Research Center, Bogor Agricultural University, Bogor, Indonesia.,Department of Veterinary Clinic, Reproduction and Pathology, Faculty of Veterinary Medicine, Bogor Agricultural University, Bogor, Indonesia
| | - Dondin Sajuthi
- Primate Research Center, Bogor Agricultural University, Bogor, Indonesia.,Department of Veterinary Clinic, Reproduction and Pathology, Faculty of Veterinary Medicine, Bogor Agricultural University, Bogor, Indonesia
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9
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Iannuzzi A, Gentile M, Iannuzzo G, Covetti G, Panico C, Mattiello A, Fata EL, D'Elia L, Michele MD, Rubba P. Atherogenic Lipoprotein Subfractions and Carotid Atherosclerosis in Menopausal Women. Angiology 2017; 69:666-671. [PMID: 29179568 DOI: 10.1177/0003319717744315] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of the study was to evaluate the relationship between cholesterol contained in very-low-density lipoproteins (VLDL-C), intermediate-density lipoproteins (IDL-C), low-density lipoproteins, high-density lipoproteins, and carotid intima-media thickness (cIMT) and carotid plaques in 228 postmenopausal women (63.1 ± 8.2 years) who participated in the ATENA Project and underwent clinical, biochemical (including the assay of lipoproteins using the Lipoprint system), and carotid ultrasound tests. Very-low-density lipoprotein cholesterol had a statistically significant linear association with cIMT ( P < .001), which remained significant after adjustment for age, smoking, systolic blood pressure, glucose, and body mass index ( r2 = .20, P < .05). Higher concentrations of IDL-C and cholesterol contained in triglyceride-rich lipoproteins (TRL-C, ie, VLDL-C + IDL-C) were associated with plaques in the common carotid (tertile III/tertile I: odds ratio [OR] = 2.52, 95% confidence interval [CI] = 1.21-5.32, P < .02; OR = 2.30, 95% CI = 1.05-5.01, P < .05, respectively), after adjustment for main cardiovascular risk factors. In conclusion, high concentrations of VLDL-C and TRL-C are independently associated with the presence of carotid plaques. Their assay represents a useful tool for improving our knowledge on the role of different classes of lipoproteins in atherosclerosis.
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Affiliation(s)
- Arcangelo Iannuzzi
- 1 Department of Medicine and Medical Specialties, Antonio Cardarelli Hospital, Naples, Italy
| | - Marco Gentile
- 2 Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Gabriella Iannuzzo
- 2 Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Giuseppe Covetti
- 1 Department of Medicine and Medical Specialties, Antonio Cardarelli Hospital, Naples, Italy
| | - Camilla Panico
- 2 Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Amalia Mattiello
- 2 Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Ersilia La Fata
- 2 Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Lanfranco D'Elia
- 2 Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | | | - Paolo Rubba
- 2 Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
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Rubba P, Gentile M, Marotta G, Iannuzzi A, Sodano M, De Simone B, Jossa F, Iannuzzo G, Giacobbe C, Di Taranto MD, Fortunato G. Causative mutations and premature cardiovascular disease in patients with heterozygous familial hypercholesterolaemia. Eur J Prev Cardiol 2017; 24:1051-1059. [DOI: 10.1177/2047487317702040] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Paolo Rubba
- Dipartimento di Medicina Clinica e Chirurgia, Università ‘Federico II’ di Napoli, Italy
| | - Marco Gentile
- Dipartimento di Medicina Clinica e Chirurgia, Università ‘Federico II’ di Napoli, Italy
| | - Gennaro Marotta
- Dipartimento di Medicina Clinica e Chirurgia, Università ‘Federico II’ di Napoli, Italy
| | | | - Marta Sodano
- Dipartimento di Medicina Clinica e Chirurgia, Università ‘Federico II’ di Napoli, Italy
| | - Biagio De Simone
- Dipartimento di Medicina Clinica e Chirurgia, Università ‘Federico II’ di Napoli, Italy
| | - Fabrizio Jossa
- Dipartimento di Medicina Clinica e Chirurgia, Università ‘Federico II’ di Napoli, Italy
| | - Gabriella Iannuzzo
- Dipartimento di Medicina Clinica e Chirurgia, Università ‘Federico II’ di Napoli, Italy
| | - Carola Giacobbe
- CEINGE S.c.a r.l. Biotecnologie Avanzate, Napoli, Italy
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, Napoli, Italy
| | | | - Giuliana Fortunato
- CEINGE S.c.a r.l. Biotecnologie Avanzate, Napoli, Italy
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, Napoli, Italy
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11
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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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12
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Gentile M, Iannuzzo G, Mattiello A, Marotta G, Iannuzzi A, Panico S, Rubba P. Association between Lp (a) and atherosclerosis in menopausal women without metabolic syndrome. Biomark Med 2016; 10:397-402. [PMID: 26999640 DOI: 10.2217/bmm.16.4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM The association between Lipoprotein (a) (Lp [a]) and common carotid intima media thickness (IMT) has been evaluated in 222 menopausal women. MATERIAL & METHODS Lp (a) and IMT were measured, carotid ultrasound examination (B-Mode imaging) was performed and mean max IMT was calculated. RESULTS Lp (a) was significantly lower in women with metabolic syndrome (MS). In a multivariate analysis Lp (a) showed the following odds ratio (OR; all p < 0.05) of having common carotid IMT (≥1.30 mm): 1.03, adjusted for age, low-density lipoprotein cholesterol (LDL) and waist circumference; 1.02, adjusted for age LDL, homeostatic assessment model (HOMA). In women without MS, after controlling for age, LDL and waist circumference, we found the following OR for increased IMT (≥1.30; OR: 1.03; for Lp [a]); 1.02 adjusted for age, LDL and HOMA (all p < 0.05). In women with MS these relationships were not statistically significant. CONCLUSION Lp (a) gives additional information in the risk assessment for atherosclerotic cardiovascular disease, especially in menopausal women without MS.
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Affiliation(s)
- Marco Gentile
- Department of Clinical Medicine & Surgery, University "Federico II" Medical School - Naples, Italy
| | - Gabriella Iannuzzo
- Department of Clinical Medicine & Surgery, University "Federico II" Medical School - Naples, Italy
| | - Amalia Mattiello
- Department of Clinical Medicine & Surgery, University "Federico II" Medical School - Naples, Italy
| | - Gennaro Marotta
- Department of Clinical Medicine & Surgery, University "Federico II" Medical School - Naples, Italy
| | | | - Salvatore Panico
- Department of Clinical Medicine & Surgery, University "Federico II" Medical School - Naples, Italy
| | - Paolo Rubba
- Department of Clinical Medicine & Surgery, University "Federico II" Medical School - Naples, Italy
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Iannuzzi M, D'Angelillo A, Tortori A, Pazzano D, De Serio L, Covetti G, Bresciani A, Iannuzzi A. Carotid artery diameter and wall stiffness in proteinuric renal disease without severely reduced kidney function. JOURNAL OF CLINICAL ULTRASOUND : JCU 2016; 44:175-181. [PMID: 26402850 DOI: 10.1002/jcu.22292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 08/04/2015] [Indexed: 06/05/2023]
Abstract
PURPOSE To evaluate the carotid artery diameter, and wall thickness and stiffness in patients with glomerulopathy and proteinuria without severely reduced kidney function. METHODS We compared 30 control subjects to 30 patients with glomerular disease, proteinuria, and glomerular filtration rate > 30 ml/min/1.73 m(2) : membranous glomerulonephritis (n = 13), minimal change disease (n = 2), focal and segmental glomerulosclerosis (n = 3), IgA nephropathy (n = 5), lupus nephritis (n = 5), antiphospholipid antibody nephropathy (n = 1), cryoglobulinemic glomerulonephritis (n = 1). The laboratory evaluations included carotid artery diameter, intima-media thickness, and stiffness measurements. RESULTS Carotid cross-sectional area of intima-media complex was thicker in patients (18.6 ± 1.4 [x ± SEM]) than in controls (14.8 ± 0.6 mm(2) , p = 0.014), as was carotid artery wall stiffness (8.96 ± 0.86 versus 5.65 ± 0.38, [x ± SEM], p < 0.01). This difference remained significant after adjustment for age, sex, and metabolic cardiovascular risk factors: carotid stiffness was 9.19 ± 0.67 (99% confidence interval [CI] 7.40-10.98)] in patients and 4.80 ± 0.75 (99% CI 2.79-7.11) in controls; adjusted mean difference 4.40 (99% CI 1.46-7.34); p <0.001. CONCLUSIONS This study showed, for the first time, signs of altered structural and elastic properties of the arterial wall in patients with proteinuria and glomerular disease without severely reduced kidney function.
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Affiliation(s)
- MariaRosaria Iannuzzi
- Nephrology and Dialysis Unit, Antonio Cardarelli Hospital, Naples, Via A. Cardarelli 9, 80131, Naples, Italy
| | - Antonio D'Angelillo
- Nephrology and Dialysis Unit, Antonio Cardarelli Hospital, Naples, Via A. Cardarelli 9, 80131, Naples, Italy
| | | | - Dario Pazzano
- Department of Internal Medicine, Unit of Nephrology and Dialysis, University of Messina, Messina, Italy
| | | | - Giuseppe Covetti
- Department of Medicine, Antonio Cardarelli Hospital, Naples, Italy
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Bhuiyan AR, Srinivasan SR, Chen W, Fernandez C, Xu JH, Berenson GS. Timing of menarche related to carotid artery intima-media thickness in black and white young adult women: the Bogalusa Heart Study. Ann Epidemiol 2015; 25:414-9. [PMID: 25840807 DOI: 10.1016/j.annepidem.2015.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 01/07/2015] [Accepted: 02/04/2015] [Indexed: 12/29/2022]
Abstract
PURPOSE The early onset of menarche is related to the adulthood risk of cardiovascular (CV) disease. This study examines the relation of early onset of menarche to carotid artery intima-media thickness (IMT), which is a surrogate marker of CV disease, among asymptomatic young adult women in a black-white community. METHODS A cohort of 461 women (31% black, 69% white) aged 24 to 43 years (mean of 35.6 years) were participants in the Bogalusa Heart Study. The age at menarche was retrospectively collected. In addition to CV risk factor variable measurements B-mode ultrasound images of the far walls of carotid artery segments were obtained. The multivariate linear regression model along with mediating effect by Sobel test was applied to analyze menarcheal age effect on carotid artery IMT, adjusting for covariates. RESULTS Waist to height ratio was significantly greater (P = .01) in early menarcheal age (<11 years) versus menarcheal age (≥11 years) in both black and white women. Homeostasis model assessment of insulin resistance (HOMA-IR) was significantly greater (P = .01) in early menarcheal age (<11 years) versus menarcheal age (≥11 years) in white women and also similar direction in black women. Internal carotid artery IMT was the same in early menarcheal age (<11 years) versus menarcheal age (≥11 years) in white women but higher (P = .02) in black women. Given as previously mentioned these different associations, the mediation analysis by race was performed. The effect of early menarcheal age (<11 years) versus menarcheal age (≥11 years) was mediated by waist to height ratio and HOMA-IR in white women after adjusting for parental education and age. The mediating effect of waist to height ratio (Sobel test = -2.26 and P = .02) and HOMA-IR (Sobel test = -1.85 and P = .06) on internal carotid artery IMT was noted in white women. The direct effect of early menarcheal age (<11 years) versus menarcheal age (≥11 years) on internal carotid artery IMT (β = -0.150, P = .01) was observed in black women. CONCLUSIONS The observed deleterious effect of early onset of menarche on carotid artery IMT in asymptomatic black and white younger adult women has biological, social, and public health implications.
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Affiliation(s)
- Azad R Bhuiyan
- Epidemiology and Biostatistics, School of Health Sciences, College of Public Service, Jackson State University, Jackson, MS.
| | - Sathanur R Srinivasan
- Epidemiology Department, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA
| | - Wei Chen
- Epidemiology Department, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA
| | - Camilo Fernandez
- Epidemiology Department, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA
| | - Ji-Hua Xu
- Epidemiology Department, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA
| | - Gerald S Berenson
- Epidemiology Department, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA
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Cigarette smoking exacerbates the adverse effects of age and metabolic syndrome on subclinical atherosclerosis: the Bogalusa Heart Study. PLoS One 2014; 9:e96368. [PMID: 24789040 PMCID: PMC4008534 DOI: 10.1371/journal.pone.0096368] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 04/05/2014] [Indexed: 01/21/2023] Open
Abstract
Age and metabolic syndrome are major risk factors for atherosclerosis. However, limited information is available regarding whether cigarette smoking, another major, modifiable risk factor, has synergistic effects with age and metabolic syndrome on subclinical atherosclerosis, particularly in young adults. This aspect was examined in 1,051 adults (747 whites and 304 blacks; aged 24–43 years) from the Bogalusa Heart Study. General linear models were used to examine the effects of cigarette smoking and its interactive effects with age and metabolic syndrome on carotid intima-media thickness (CIMT). After adjusting for age, race, and sex, current smokers had lower BMI (mean±SE: 27.4±0.4, 29.3±0.5, and 29.9±0.3 kg/m2 in current, former, and never smokers, respectively; p<0.0001) and lower levels of fasting glucose (82.8±0.9, 89.5±2.3, and 87.1±1.1 mg/dL, respectively; p = 0.001) and insulin (10.6±0.4, 14.2±1.0, 13.6±0. 6 µU/ml, respectively; p<0.0001). Despite being lean and having favorable levels of glucose and insulin, current smokers had greater CIMT (0.850±0.012, 0.808±0.011, and 0.801±0.006 mm, respectively; p = 0.0004). Importantly, cigarette smoking showed significant interactions with age and metabolic syndrome on CIMT: Age-related change in CIMT in current smokers was significantly greater (0.013±0.002 mm/year) than in nonsmokers (former and never smokers combined) (0.008±0.001 mm/year) (p for interaction = 0.005); the difference in CIMT between those with and without metabolic syndrome was significantly greater in current smokers (0.154±0.030 mm, p<0.0001) than in nonsmokers (0.031±0.014 mm, p = 0.03) (p for interaction<0.0001). In conclusion, cigarette smoking significantly exacerbates the adverse effects of age and metabolic syndrome on subclinical atherosclerosis in young adults, which underscores the importance of prevention and cessation of cigarette smoking behavior in the young.
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Perwaiz Khan S, Gul P, Khemani S, Yaqub Z. Determination of site-specific carotid-intima media thickness: common -carotid artery and carotid bifurcation in hypercholesterolemia patients. Pak J Med Sci 2013; 29:1249-52. [PMID: 24353730 PMCID: PMC3858954 DOI: 10.12669/pjms.295.3830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 07/12/2013] [Indexed: 11/24/2022] Open
Abstract
Objective: To determine site specific carotid intima-media thickness: common–carotid artery and carotid bifurcation in hypercholesterolemia patients as a marker for atherosclerosis. Methods: Fifty patients with hypercholesterolemia and twenty controls were selected after getting informed consent regarding the investigation of carotid- intima media thickness by B-mode ultrasound. All the patients of hypercholesterolemia with LDL-C > 160mg/dL had family history of coronary artery diseases. This procedure was carried out in the Radiology Department of Dr. Ziauddin Hospitals. Measurement of carotid -intima media thickness, B-mode ultrasonography of common carotid artery, carotid bifurcation and internal carotid artery (left and right carotid arteries) was performed with Toshiba (M# SSA-580A/E2) ultrasound scanner with linear probe. The posterior or far wall of the carotid artery is, the distance between the leading edge first bright line (lumen -intima interface) and the leading edge of the second bright line (media-adventitia interface) of far wall was recorded as intima -media thickness. The average mean of six segments of intima-media thickness was taken as mean CIMT of right and left common carotid, bifurcation and internal carotid arteries. Results: Maximal CIMT was significantly increased at sites common carotid, carotid bifurcation and internal carotid arteries in fifty patients with hypercholesterolemia as compared to controls. At carotid bifurcation mean of maximal CIMT was (0.9+ 0.3mm). Range of maximum CIMT in hypercholesterolemia patients was (0.8- 3.3mm) and in controls (0.4- 0.8 mm). The thickness was more frequently increased at site of bifurcation. Conclusions: Carotid intima- media thickness in hypercholesterolemia patients was increased and carotid bifurcation was site that has shown greater increase in intima-media thickness and plaques in these patients predict high risk for atherosclerosis.
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Affiliation(s)
- Samia Perwaiz Khan
- Dr. Samia Perwaiz Khan, MBBS, M. Phil, PhD, Associate Professor of Pharmacology, Ziauddin University, Karachi, Pakistan
| | - Pashmina Gul
- Dr. Pashmina Gul, FCPS, Dr. Ziauddin Hospital, Karachi, Pakistan
| | - Saleem Khemani
- Dr. Saleem Khemani, MCPS, DMRD, Dr. Ziauddin Hospital, Karachi, Pakistan
| | - Zia Yaqub
- Prof. Dr. Zia Yaqub, DABIM, DABCVD, Consultant Cardiologist, National Institute of Cardiovascular Diseases, Karachi, Pakistan
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Gentile M, Panico S, Mattiello A, Ubaldi S, Iannuzzo G, De Michele M, Iannuzzi A, Rubba P. Association between small dense LDL and early atherosclerosis in a sample of menopausal women. Clin Chim Acta 2013; 426:1-5. [PMID: 23994569 DOI: 10.1016/j.cca.2013.08.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 08/06/2013] [Accepted: 08/09/2013] [Indexed: 11/17/2022]
Abstract
The association between small dense LDL particles and early atherosclerosis has been evaluated in a sample of middle-aged women. We analysed the relation between sd-LDL and common carotid intima media thickness in 228 menopausal women. LDL separation was performed by Lipoprint System: 7 LDL subfractions were obtained, mean LDL size and LDL score (% of sd-LDL) were calculated. Multivariate analysis showed a significant association between IMT (≥ 1.30 mm) and mean LDL size after controlling for age (OR 7.80; 95% CI 1.47-41.39; p = 0.016 for mean LDL particle size). IMT remained significantly related to mean LDL particle size after controlling for age and Apo B. In a subsequent multivariate analysis, after controlling for age, IMT (≥ 1.30 mm) was significantly related to LDL score (OR 12.15; 95% CI 1.29-114.36; p = 0.029 for LDL score), or age and Apo B (OR 10.13; 95% CI 1.07-95.71; p = 0.043 for LDL score). Our results suggest an association between sd-LDL and IMT, independently of age and Apo B. This data may indicate that sd-LDL are markers of early carotid atherosclerosis, and suggest that measurement of sd-LDL-C gives useful information in the risk assessment for atherosclerotic disease in menopausal women.
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Affiliation(s)
- Marco Gentile
- Department of Clinical Medicine and Surgery, University "Federico II" Medical School, Naples, Italy.
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18
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Li S, Chen W, Srinivasan SR, Xu J, Berenson GS. Relation of childhood obesity/cardiometabolic phenotypes to adult cardiometabolic profile: the Bogalusa Heart Study. Am J Epidemiol 2012; 176 Suppl 7:S142-9. [PMID: 23035138 DOI: 10.1093/aje/kws236] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Not all obese adults have cardiometabolic abnormalities. It is unknown whether this is true in children and, if true, whether children who have metabolically healthy overweight/obesity (MHO) will also have favorable cardiometabolic profiles in adulthood. These aspects were examined in 1,098 individuals who participated as both children (aged 5-17 years) and adults (aged 24-43 years) in the Bogalusa Heart Study between 1997 and 2002 in Bogalusa, Louisiana. MHO was defined as being in the top body mass index quartile, while low density lipoprotein cholesterol, triglycerides, mean arterial pressure, and glucose were in the bottom 3 quartiles, and high density lipoprotein cholesterol was in the top 3 quartiles. Forty-six children (4.2%) had MHO, and they were more likely to retain MHO status in adulthood compared with children in other categories (P < 0.0001). Despite markedly increased obesity in childhood and in adulthood, these same MHO children and adults showed a cardiometabolic profile generally comparable to that of nonoverweight/obese children (P > 0.05 in most cases). Moreover, there was no difference in carotid intima-media thickness in adulthood between MHO children and nonoverweight/obese children. Further, carotid intima-media thickness in adulthood was lower in MHO children than in metabolically abnormal, overweight/obese children (P = 0.003). In conclusion, the MHO phenotype starts in childhood and continues into adulthood.
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Affiliation(s)
- Shengxu Li
- Tulane Center for Cardiovascular Health, Department of Epidemiology, Tulane University, New Orleans, Louisiana, USA
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Bots ML, Sutton-Tyrrell K. Lessons from the past and promises for the future for carotid intima-media thickness. J Am Coll Cardiol 2012; 60:1599-604. [PMID: 22999720 DOI: 10.1016/j.jacc.2011.12.061] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Revised: 12/06/2011] [Accepted: 12/17/2011] [Indexed: 11/30/2022]
Abstract
Carotid intima-media thickness (CIMT) measurements have been used in cardiovascular research for more than 2 decades. There is a wealth of evidence showing that CIMT can be assessed in a reproducible manner and that increased CIMT relates to unfavorable risk factor levels and atherosclerosis elsewhere in the arterial system and to the risk of vascular events. Change in CIMT over time can be readily assessed, and trials showed that the rate of change is modifiable by treatment. Several issues important for the cardiovascular research community and its application in clinical practice are still outstanding. Promising future areas for CIMT measurements are: 1) application in studies among children and adolescents; 2) use of CIMT trials positioned decisively before the start of a morbidity and mortality trial; and 3) the use of CIMT measurement in risk stratification in those with an intermediate 10-year risk estimate.
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Affiliation(s)
- Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
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20
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Longo-Mbenza B, Nsenga JN, Mokondjimobe E, Gombet T, Assori IN, Ibara JR, Ellenga-Mbolla B, Vangu DN, Fuele SM. Helicobacter pylori infection is identified as a cardiovascular risk factor in Central Africans. Vasc Health Risk Manag 2012; 6:455-61. [PMID: 22923995 PMCID: PMC3423148 DOI: 10.2147/vhrm.s28680] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Helicobacter pylori is now incriminated in the pathogenesis of atherosclerosis. OBJECTIVE To examine the importance of H. pylori infection as a cardiovascular disease (CVD) risk factor. METHODS Two hundred five patients (128 with H. pylori infection [HP-seropositive] and 77 without) had a baseline assessment for other potential CVD risk factors and were followed prospectively for 10 years (1999-2008). They were assessed on a monthly basis for the outcomes of carotid plaque, angina pectoris, myocardial infarction, and stroke. In the HP-seropositive group, male sex and quartile 4 for IgG anti-H. pylori antibodies (anti-HP Ab) were correlated with traditional CVD risk factors, stroke, myocardial infarction, and angina pectoris. RESULTS At the baseline assessment, the levels of carotid intima-media thickness, blood fibrinogen, total cholesterol, fasting plasma glucose, and uric acid were higher in H. pylori-infected patients than in the uninfected group. Serum HDL-cholesterol was significantly lower in the HP-seropositive group. Men had higher levels of IgG anti-HP Ab, waist circumference, blood pressure, uric acid, and total cholesterol than women. Within the HP-seropositive group, individuals in quartile 4 for IgG anti-HP Ab had higher rates of elevated fibrinogen, diabetes mellitus, low high-density lipoprotein cholesterol, arterial hypertension, and high total cholesterol than those in quartile 1. After adjusting for traditional CVD risk factors, H. pylori infection was the only independent predictor of incident carotid plaque (multivariate odds ratio [OR] = 2.3, 95% confidence interval [CI]: 1.2-7.2; P < 0.0001) and incident acute stroke (multivariate OR = 3.6, 95% CI: 1.4-8.2; P < 0.0001). Within the HP-seropositive group and after adjusting for traditional CVD risk factors, male sex was the only independent predictor of incident angina pectoris (multivariate OR = 3.5, 95% CI: 1.6-16; P < 0.0001), incident acute stroke (multivariate OR = 3.2, 95% CI: 1.4-28; P < 0.0001), and acute myocardial infarction (multivariate OR = 7.2, 95% CI: 3.1-18; P < 0.0001). CONCLUSION Our study provides evidence for an association among known CVD risk factors, carotid plaque, stroke, and H. pylori infection. Among infected individuals, there is a significant association among severity of HP-seropositivity, male sex, and CVD. The eradication of H. pylori infection may therefore reduce the emerging burden of CVD in Africa.
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Park JS, Cho MH, Ahn CW, Kim KR, Huh KB. The association of insulin resistance and carotid atherosclerosis with thigh and calf circumference in patients with type 2 diabetes. Cardiovasc Diabetol 2012; 11:62. [PMID: 22682537 PMCID: PMC3444381 DOI: 10.1186/1475-2840-11-62] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Accepted: 06/08/2012] [Indexed: 01/24/2023] Open
Abstract
Background The relationship between body composition parameters such as thigh and calf circumference and insulin resistance or atherosclerosis in type 2 diabetes is poorly understood. The aim of this study was to investigate the relationship between insulin resistance, atherosclerosis, and thigh and calf circumference in patients with type 2 diabetes. Methods A total of 4,427 subjects with type 2 diabetes were enrolled in this study. Insulin sensitivity was assessed according the rate constant for plasma glucose disappearance (Kitt) determined via the short insulin tolerance test. Biochemical and anthropometric profiles were measured according to a standardized protocol. Visceral fat thickness and carotid intima media thickness (IMT) were measured by ultrasonography. Results Insulin sensitivity index (Kitt) was significantly correlated with weight adjusted thigh and calf circumference. Thigh circumference was inversely associated with IMT in men and women and calf circumference was negatively correlated with IMT in women. Multiple stepwise regression analysis revealed that thigh circumference was independently correlated with insulin sensitivity index (Kitt) and IMT. Furthermore, in multivariate logistic regression analysis, thigh circumference was an independent determinant factor for carotid atherosclerosis in patients with type 2 diabetes even after adjusting for other cardiovascular risk factors. Conclusions Thigh and calf circumference were correlated with insulin resistance and carotid atherosclerosis, and thigh circumference was independently associated with insulin resistance and carotid atherosclerosis in patients with type 2 diabetes.
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Affiliation(s)
- Jong Suk Park
- Division of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
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Peters SAE, den Ruijter HM, Palmer MK, Grobbee DE, Crouse JR, O'Leary DH, Evans GW, Raichlen JS, Lind L, Bots ML. Manual or semi-automated edge detection of the maximal far wall common carotid intima-media thickness: a direct comparison. J Intern Med 2012; 271:247-56. [PMID: 21726301 DOI: 10.1111/j.1365-2796.2011.02422.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Automated edge detection is thought to be superior to manual edge detection in quantification of the far wall common carotid intima-media thickness (CIMT), yet published evidence making a direct comparison is not available. METHODS Data were used from the METEOR study, a randomized placebo-controlled trial among 984 individuals showing that rosuvastatin attenuated the rate of change of 2 year change in CIMT among low-risk individuals with subclinical atherosclerosis. For this post hoc analysis, CIMT images of the far wall of the common carotid artery were evaluated using manual and semi-automated edge detection and reproducibility, relation to cardiovascular risk factors, rates of change over time and effects of lipid-lowering therapy were assessed. RESULTS Reproducibility was high for both reading methods. Direction, magnitude and statistical significance of risk factor relations were similar across methods. Rate of change in CIMT in participants assigned to placebo was 0.0066 mm per year (SE: 0.0027) for manually and 0.0072 mm per year (SE: 0.0029) for semi-automatically read images. The effect of lipid-lowering therapy on CIMT changes was -0.0103 mm per year (SE: 0.0032) for manual reading and -0.0111 mm per year (SE: 0.0034) for semi-automated reading. CONCLUSION Manual and semi-automated readings of the maximal far wall of the common CIMT images both result in high reproducibility, show similar risk factor relations, rates of change and treatment effects. Hence, choices between semi-automated and manual reading software for CIMT studies likely should be based on logistical and cost considerations rather than differences in expected data quality when the choice is made to use far wall common CIMT measurements.
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Affiliation(s)
- S A E Peters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
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Gender divergence on the impact of multiple cardiovascular risk factors on the femoral artery intima-media thickness in asymptomatic young adults: the Bogalusa Heart Study. Am J Med Sci 2012; 343:40-5. [PMID: 21681071 DOI: 10.1097/maj.0b013e31821da9c0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Gender divergence on the impact of multiple cardiovascular risk factors on the femoral artery intima-media thickness (IMT) has not been studied in a biracial (black-white) community-based asymptomatic young adults. METHODS Femoral IMT was measured by B-mode ultrasonography in 1080 individuals (age, 24-43 years; 71% white; 43% men) enrolled in the Bogalusa Heart Study. RESULTS Femoral IMT showed a gender difference (men > women; P = 0.001), but no racial difference. In a multivariate model, age, cigarette smoking, systolic blood pressure and total cholesterol to high-density lipoprotein cholesterol ratio related independently, in that order, to IMT in women, and age and low-density lipoprotein cholesterol in men. In women, mean IMT increased with increasing number of risk factors defined as values above the age-, race- and gender-specific 75th percentile of systolic blood pressure, waist circumference, total cholesterol to high-density lipoprotein cholesterol ratio and insulin along with positive smoking status (P for trend = 0.001), with respective mean IMT (mm) values of 0.61, 0.65, 0.72 and 0.77, for 0, 1 to 2, 3 and 4 to 5 risk factors. There was no such significant trend in men. CONCLUSIONS Although men versus women had thicker IMT, the observed increasing trend of femoral IMT with increasing number of risk factors in asymptomatic young women suggests that women may be relatively more susceptible to the burden of multiple risk factors.
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Rubba P, Agewall S. Early arterial abnormalities in young adulthood. Atherosclerosis 2012; 220:319-20. [DOI: 10.1016/j.atherosclerosis.2011.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Accepted: 08/06/2011] [Indexed: 11/30/2022]
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Toprak A, Kandavar R, Toprak D, Chen W, Srinivasan S, Xu JH, Anwar A, Berenson GS. C-reactive protein is an independent predictor for carotid artery intima-media thickness progression in asymptomatic younger adults (from the Bogalusa Heart Study). BMC Cardiovasc Disord 2011; 11:78. [PMID: 22208681 PMCID: PMC3264529 DOI: 10.1186/1471-2261-11-78] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Accepted: 12/30/2011] [Indexed: 11/29/2022] Open
Abstract
Background Conflicting information exists regarding the association between hsCRP and the progression of early stages of atherosclerosis. The purpose of the study was to investigate the association of high sensitiviy c-reactive protein (hsCRP) along with major cardiovascular (CV) risk factors on early carotid atherosclerosis progression in a large, population-based cohort study. Methods The study cohort included 839 young adults (aged 24 to 43 years, 70% white, 42% men) enrolled in Bogalusa Heart Study, who in 2001-2002 attended baseline examination with measurements of CV risk factors. Progression of carotid artery intima-media thickness (IMT) was assessed during a mean follow-up of 2.4 years. Results Carotid artery IMT progression rates were as follows: composite carotid artery = 9.2 ± 52 μm/y, common carotid artery = 0.0 ± 51 μm/y, carotid bulb = 8.8 ± 103 μm/y, and internal carotid artery = 18.9 ± 81 μm/y. Elevated baseline hsCRP, reflecting an inflammatory state, showed independent association with composite carotid artery IMT progression. Increased age, systolic blood pressure, fasting glucose, LDL cholesterol, and current smoking were other risk associates of carotid artery IMT progression in young adults, indicating an underlying burden on the CV system by multiple risk factors. Conclusion In this population-based study, we observed independent categorical association of increased hsCRP with carotid artery IMT progression in young adults. This study underlines the importance of assesssing hsCRP levels along with smoking and traditional CV risk factor profiles in asymptomatic young adults.
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Affiliation(s)
- Ahmet Toprak
- Tulane Center for Cardiovascular Health, New Orleans, LA, USA
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Dahlén EM, Andreasson T, Cinthio M, Nystrom FH, Östgren CJ, Länne T. Is there an underestimation of intima-media thickness based on M-mode ultrasound technique in the abdominal aorta? Clin Physiol Funct Imaging 2011; 32:1-4. [PMID: 22152072 DOI: 10.1111/j.1475-097x.2011.01045.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Measuring intima-media thickness (IMT) in the common carotid artery (CCA) is a valuable resource for the evaluation of subclinical atherosclerosis. The main objective of this study was to explore whether a B-mode ultrasound technique, Philips ATL, and an M-mode ultrasound technique, Wall Track System (WTS), show interchangeable results when measured in CCA and the abdominal aorta (AA). A total of 24 healthy, young subjects were examined. IMT and lumen diameter (LD) of the AA and the CCA were measured twice by two skilled ultrasonographers with two different ultrasound equipment B-mode: (Philips, ATL and M-mode: WTS).The intra-observer variability of IMT in CCA and AA using B-mode showed a coefficient of variation 8% and 9%, and with M-mode 11% and 15%, respectively. Interobserver variability of IMT in CCA and AA using B-mode was 6% and 12%, and with M-mode 11% and 18%, respectively. CCA IMT was 0·53 ± 0·07 and 0·53 ± 0·09 mm using B-mode and M-mode, respectively. However, in AA, IMT was 0·61 ± 0·05 and 0·54 ± 0·10 mm using B-mode and M-mode, respectively. Thus, AA IMT was 11·5% thicker using B-mode (P < 0·01). We received adequate IMT readings from the carotid artery as well as the AA using two commonly used B-mode and M-mode techniques. B-mode technique seems to show less variability, especially in the AA. More importantly, the two techniques measured different IMT thickness in the aorta, emphasizing the importance of using similar technique when comparing the impact of absolute values of IMT on cardiovascular disease.
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Affiliation(s)
- Elsa M Dahlén
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
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Effect of number of ultrasound examinations on the assessment of carotid intima-media thickness changes over time: the example of the METEOR study. J Hypertens 2011; 29:1145-54. [PMID: 21546878 DOI: 10.1097/hjh.0b013e328345d85e] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To evaluate the effect of the number and positioning during follow-up of ultrasound examinations on the rate of change in carotid intima-media thickness (CIMT) using METEOR (Measuring Effects on Intima-Media Thickness: an Evaluation of Rosuvastatin) as an example. METHODS METEOR was a randomized, placebo-controlled trial showing that rosuvastatin reduced progression of 2-year change in CIMT among low-risk patients with subclinical atherosclerosis. In the full METEOR protocol, ultrasound examinations were performed twice before randomization, once each at 6, 12, and 18 months after randomization, and then twice at the end of study at 24 months. For the present study, 17 study designs were retrospectively constructed with varying number and position of ultrasound examinations during the study. Differences in the rate of change in maximum CIMT between these study designs were compared. RESULTS Variations in frequency of ultrasound visits gave results in the same direction and magnitude for the change in maximum CIMT for both groups (i.e. nonsignificant change for rosuvastatin and significant progression for placebo, and a significant difference between treatments). However, standard errors were larger when the number of exams reduced. This finding was consistent over different lengths of follow-up, sample sizes, and with CIMT measurements made on different locations. CONCLUSION Protocols with different number and timing of ultrasound examinations minimally affect the direction and magnitude of treatment effects on the rate of change in CIMT. However, reductions in exam frequency increase standard errors of rates of change, suggesting larger sample sizes would be required to have the same level of statistical power.
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Ciccone MM, Balbarini A, Teresa Porcelli M, Santoro D, Cortese F, Scicchitano P, Favale S, Butitta F, De Pergola G, Gullace G, Novo S. Carotid artery intima-media thickness: normal and percentile values in the Italian population (camp study). EUROPEAN JOURNAL OF CARDIOVASCULAR PREVENTION AND REHABILITATION : OFFICIAL JOURNAL OF THE EUROPEAN SOCIETY OF CARDIOLOGY, WORKING GROUPS ON EPIDEMIOLOGY & PREVENTION AND CARDIAC REHABILITATION AND EXERCISE PHYSIOLOGY 2011; 18:650-655. [PMID: 21450588 DOI: 10.1177/1741826711398841] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
AIMS Carotid intima-media thickness (IMT) is one of the best non-invasive parameters for evaluating previous vascular lesions and could be used to identify a preclinical stage of the atherosclerotic process. The aim of our research was to develop an epidemiological study of the normal mean values of IMT of the common carotid artery, adjusted for age and sex, in the Italian population. METHODS AND RESULTS In this multicenter study, a total of 1017 patients (596 males, mean age: 58.5 + 13.2 years) were enrolled at four different Italian centers. Inclusion criteria were the absence of cardiovascular risk factors or presence of not more than one. Patients underwent two-dimensional echo-color Doppler scanning of the carotid arteries, adopting a high-definition vascular echographic apparatus and a 11-3 MHz linear electronic probe. The arithmetical mean of the IMT value was calculated. Data obtained from this study show the carotid IMT changes in relation to age and sex. In particular, it grows higher with increasing age, and is always higher in men than in women. CONCLUSION In relation to the percentile distribution of the values in the population analyzed, the normal range of m-IMT could be established just on the basis of the patient's age and sex. In this way, the ultrasound scan operator can rely on a simple reference scheme. This will help to refine the use of carotid ultrasound as an excellent tool for detecting asymptomatic carotid alterations and patients at high risk for cerebral and cardiovascular disease.
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Affiliation(s)
- Marco Matteo Ciccone
- Section of Cardiovascular Disease, Department of Emergency and Organ Transplantation, School of Medicine, University of Bari, Italy.
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Kaźmierski R, Michalak S, Kozubski W. Ultrasound-based markers of carotid atherosclerosis correlate well with the number of classical atherosclerotic risk factors. Neurol Neurochir Pol 2011; 45:317-27. [DOI: 10.1016/s0028-3843(14)60102-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Nguyen QM, Toprak A, Xu JH, Srinivasan SR, Chen W, Berenson GS. Progression of segment-specific carotid artery intima-media thickness in young adults (from the Bogalusa Heart Study). Am J Cardiol 2011; 107:114-9. [PMID: 21146698 DOI: 10.1016/j.amjcard.2010.08.054] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Revised: 08/21/2010] [Accepted: 08/21/2010] [Indexed: 11/25/2022]
Abstract
Carotid intima-media thickness (CIMT) progression is predictive of future cardiovascular events in middle-age and older adults. However, information is scant on segment-specific CIMT progression by race (black vs white) and gender and its predictors during short-term follow-up in asymptomatic young adults. B-mode ultrasound images of the far walls of both carotid arteries were obtained in 842 subjects aged 24 to 43 years and enrolled in the Bogalusa Heart Study (70% whites and 42% men). The CIMT and cardiometabolic risk variables were measured at baseline and after an average of 2.4 years. The mean CIMT progression rates/year adjusted for age, race, and gender were greatest at the bulb, followed by the internal and common carotid segments (p <0.0001). In a multivariate logistic model, age, mean arterial pressure, and high-density lipoprotein cholesterol were significantly associated with common CIMT progression. Smoking, age, insulin resistance index, and mean arterial pressure were significantly associated with bulb CIMT progression; and the waist/height ratio, smoking, age, and mean arterial pressure were significantly associated with internal CIMT progression, independent of the baseline CIMT and traditional cardiometabolic risk variables, including adiponectin, C-reactive protein, and intercellular adhesion molecules. In addition, the status of progression was associated with a greater prevalence of metabolic syndrome (common and internal CIMT, p <0.05; bulb CIMT, p <0.0001) and diabetes (bulb CIMT only, p <0.001). In conclusion, in younger adults, the magnitude of progression of CIMT within a short period varied in a segment-specific manner, regardless of race or gender, and was predictable using modifiable traditional risk factors. This could have implications for preventive and interventional cardiology.
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Zhao X, Underhill HR, Zhao Q, Cai J, Li F, Oikawa M, Dong L, Ota H, Hatsukami TS, Chu B, Yuan C. Discriminating carotid atherosclerotic lesion severity by luminal stenosis and plaque burden: a comparison utilizing high-resolution magnetic resonance imaging at 3.0 Tesla. Stroke 2010; 42:347-53. [PMID: 21183749 DOI: 10.1161/strokeaha.110.597328] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE To determine associations between stenosis, measures of plaque burden, and compositional features of carotid atherosclerosis, including high-risk features of intraplaque hemorrhage (IPH) and surface disruption. METHODS Institutional Review Board approval and informed consent for all participants were obtained before study initiation. Patients with either carotid stenosis >50% by duplex ultrasound or suspected coronary artery disease underwent multi-contrast carotid MRI at 3.0 T. For each artery, stenosis, percent wall volume (PWV=100%×wall volume/total vessel volume), and mean wall thickness (MWT) were measured. Presence or absence of a lipid-rich necrotic core, calcification, IPH, and surface disruption were recorded. RESULTS One hundred eighty-one patients were included in the final analysis. The area under the curve (AUC) calculated from receiver-operating-characteristics analysis found the presence of IPH was similarly classified by stenosis (AUC=0.82), PWV (AUC=0.88), and MWT (AUC=0.88). Notably, IPH was present in the lowest category of each parameter. Prevalence of IPH in arteries with 0% stenosis was 4.4%. In arteries with PWV <40%, prevalence was 3.2%; in arteries with MWT <1.0 mm, prevalence was 2.3%. Strength of classification for surface disruption was similarly classified by stenosis (AUC=0.87), PWV (AUC=0.93), and MWT (AUC=0.94). CONCLUSIONS Measures of plaque burden do not substantially improve disease assessment compared to stenosis. The finding of IPH in all categories of stenosis and plaque burden suggests that direct characterization of plaque composition and surface status is necessary to fully discriminate disease severity.
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Affiliation(s)
- Xihai Zhao
- Department of Radiology, University of Washington, Seattle, WA 98109, USA
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Paul TK, Chen W, Srinivasan SR, Rice J, Toprak A, He J, Berenson GS. Framingham risk score is associated with femoral artery intima-media thickness in asymptomatic young adults (the Bogalusa heart study). Atherosclerosis 2010; 213:627-31. [PMID: 20970137 DOI: 10.1016/j.atherosclerosis.2010.09.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Revised: 09/20/2010] [Accepted: 09/20/2010] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Femoral artery intima-media thickness (IMT), like carotid IMT, is a surrogate indicator of atherosclerotic coronary and peripheral vascular diseases. The Framingham risk score (FRS) is widely being used in the early prediction of coronary artery disease (CAD). However, the association between FRS and femoral artery IMT has not been studied in asymptomatic younger black and white adult population. Our objective was to examine the association between FRS and femoral artery IMT in asymptomatic younger adults. METHODS Subjects (n=1080; 71% white, 43% male) aged 24-43 years enrolled in the Bogalusa heart study. Femoral IMT was measured by B-mode ultrasonography. Age, gender, systolic blood pressure, diastolic blood pressure, low density lipoprotein cholesterol, high density lipoprotein cholesterol, cigarette smoking and type2 diabetes were used to calculate individual FRS. RESULTS FRS was lower in females (p=0.001) than males. Age-adjusted femoral IMT showed gender differences (males>females, p=0.001) among whites only; and no race difference in both genders. A significant positive linear relationship between tertiles of FRS and IMT of femoral artery was noted in whites and blacks alike (p for trend<0.0001). In a multivariate analysis that included FRS, race, body mass index (BMI), log insulin, log triglycerides, exercise and alcohol intake; FRS, insulin and BMI were significantly and independently associated in that order with femoral IMT. CONCLUSIONS The findings support the use of FRS in both white and black younger adults and underscore the importance of prevention and control of FRS variables in youth.
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Affiliation(s)
- Timir K Paul
- Tulane Center for Cardiovascular Health, Tulane School of Public Health, Tulane University Health Sciences Center, New Orleans, LA 70112, USA.
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Riches NO, Alder S, White GL, Druding R, Bond MG, De Michele M. Standardized ultrasound protocol, trained sonographers and digital system for carotid atherosclerosis screening. J Cardiovasc Med (Hagerstown) 2010; 11:683-8. [DOI: 10.2459/jcm.0b013e328338919b] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Dogan S, Duivenvoorden R, Grobbee DE, Kastelein JJP, Shear CL, Evans GW, Visseren FL, Bots ML. Ultrasound protocols to measure carotid intima-media thickness in trials; comparison of reproducibility, rate of progression, and effect of intervention in subjects with familial hypercholesterolemia and subjects with mixed dyslipidemia. Ann Med 2010; 42:447-64. [PMID: 20645885 DOI: 10.3109/07853890.2010.499132] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Current ultrasound protocols to measure carotid intima-media thickness (CIMT) in trials rather differ. The ideal protocol combines high reproducibility with a high precision in the measurement of the rate of change in CIMT over time and with a precise estimate of a treatment effect. To study these aspects, a post-hoc analysis was performed using data from two randomized double-blind, placebo-controlled trials: one among 872 subjects with familial hypercholesterolemia (FH) and the other among 752 subjects with mixed dyslipidemia (MD), respectively. Participants were randomized to torcetrapib or placebo on top of optimal atorvastatin therapy. METHODS CIMT information was collected from the left and right carotid artery from two walls (the near and far wall) of three segments (common carotid, bifurcation, and internal carotid artery) at four different angles (right: 90, 120, 150, and 180 degrees on Meijer's carotid arc; left: 270, 240, 210, and 180 degrees, respectively). Based on combinations of these measurements, 60 different protocols were constructed to estimate a CIMT measure per participant (20 protocols for mean common CIMT, 40 protocols for mean maximum CIMT). For each protocol we assessed reproducibility (intra-class correlation coefficient (ICC), mean difference of duplicate base-line scans); 2-year progression rate in the atorvastatin group with its standard error (SE); and treatment effect (difference in rate of change in CIMT between torcetrapib and placebo) with its SE. RESULTS Reproducibility: ICC ranged from 0.77 to 0.91 among FH patients and from 0.68 to 0.86 among MD patients. CIMT progression rates ranged from -0.0030 to 0.0020 mm/year in the FH trial and from 0.00084 to 0.01057 mm/year in the MD trial, with SE ranging from 0.00054 to 0.00162 and from 0.00083 to 0.00229, respectively. The difference in CIMT progression rate between treatment arms ranged from -0.00133 to 0.00400 mm/year in the FH trial and from -0.00231 to 0.00486 mm/year in the MD trial. The protocol with the highest reproducibility, highest CIMT progression/precision ratio, and the highest treatment effect/precision ratio were those measuring mean common CIMT with measurements of the near and far wall at multiple angles. When the interest is in the mean maximum CIMT, protocols using multiple segments and angles performed the best. CONCLUSION Our findings support the position that the number and specific combination of segments, angles, and walls interrogated are associated with differences in reproducibility, magnitude, and precision of progression of CIMT over time, and treatment effect. The best protocols were mean common CIMT protocols in which both the near and far walls are measured at multiple angles.
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Affiliation(s)
- Soner Dogan
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
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Abstract
Carotid ultrasound provides quantitative measurements of carotid intima-media thickness (CIMT) that can be used to assess cardiovascular disease (CVD) risk in individuals and monitor ongoing disease progression and regression in clinical trials. It is non-invasive, rapid, reproducible, and carries no risk. Numerous epidemiological studies have established that CIMT is a marker of subclinical atherosclerosis and is associated with established CVD risk factors and with both prevalent and incident CVD. The use of CIMT in outcome trials as a surrogate or predictor of CVD outcomes is widespread. Carotid ultrasound is being employed to test the efficacy of CVD treatment in order to identify potential useful drugs earlier and to possibly speed regulatory approval. Successive trials have generated lessons learned and applied, with slow but steady improvement in CIMT measurement reproducibility.
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Affiliation(s)
- Daniel H O'Leary
- Carney Hospital, Tufts University School of Medicine, 2100 Dorchester Avenue, Dorchester, Boston, MA 02124, USA.
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Rubba F, Gentile M, Iannuzzi A, Panico S, Mattiello A, Quagliata L, Triassi M, Rubba P. Vascular preventive measures: the progression from asymptomatic to symptomatic atherosclerosis management. Evidence on usefulness of early diagnosis in women and children. Future Cardiol 2010; 6:211-20. [PMID: 20230262 DOI: 10.2217/fca.10.4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
This review reports our experience in evaluating the progression from asymptomatic to symptomatic atherosclerosis in an evidence-based context. In particular, studies published in the last 5 years were analyzed in more detail and their relevance to cardiovascular prevention in women and children is discussed. The evaluation of carotid artery intima-media thickness by ultrasonography and the measurement of coronary artery calcification using computed tomography scanning can provide evidence for the presence and extent of atherosclerosis in adults. Intima-media thickness was demonstrated to predict prognosis and help in clinical decision making. Computed tomography estimates of advanced coronary atherosclerosis are markers of advanced atherosclerosis and are of value for screening adult men, but their value in women and children is doubtful owing to radiation risk. Intima-media thickness measurement, even when acknowledging its limitations, is a preferred approach, with the promising perspective of the availability of portable devices of lower cost in the near future. Further evaluation of the potential role for the emerging biomarkers and imaging techniques could clarify the clinical relevance of emerging risk profiles such as the metabolic syndrome. Ultrasound methods provide information regarding the extent and progression of early atherosclerotic abnormalities in women and in children and predict cardiovascular prognosis.
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Affiliation(s)
- Fabiana Rubba
- Preventive Services Department, AOU Federico II, Naples, Italy.
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Delaney JAC, Scherzer R, Polak J, Biggs ML, Kronmal R, Chen H, Sidney S, Grunfeld C. Effect of inter-reader variability on outcomes in studies using carotid intima media thickness quantified by carotid ultrasonography. Eur J Epidemiol 2010; 25:385-92. [PMID: 20309612 DOI: 10.1007/s10654-010-9442-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2009] [Accepted: 03/08/2010] [Indexed: 01/19/2023]
Abstract
Systematic differences between readers or equipment in imaging studies are not uncommon; failure to account for such differences when using Carotid Ultrasonography may introduce bias into associations between carotid intima media thickness (cIMT) and outcomes. We demonstrate the impact of this source of systematic measurement error (SME) using data on 5,521 participants from the Multi-Ethnic Study of Atherosclerosis (MESA) and 661 participants from the Study of Fat Redistribution and Metabolic Change in HIV Infection (FRAM). Participants were between 37 and 78 years old. Two outcomes were considered: (1) the effect of HIV infection on cIMT (between study) and (2) the association of cIMT with cardiovascular events (within study). All estimates were adjusted for demographics (age, gender, and ethnicity) and for traditional cardiovascular disease risk factors (smoking, blood pressure, diabetes and cholesterol). When comparing the FRAM and MESA cohorts to estimate the association of HIV infection on common cIMT, accounting for machine and reader variability (between study variability) reduced the difference associated with HIV infection from +0.080 mm (95% Confidence Interval (CI):0.065-0.095) to +0.037 mm (95% CI:0.003 to 0.072) while internal cIMT declined from +0.254 mm (95% CI:0.205-0.303) to +0.192 mm (95% CI:0.076-0.308). Attenuation of the association between cIMT and cardiovascular endpoints occurred when within study reader variability was not accounted for. The effect of SME due to use of multiple readers or machines is most important when comparisons are made between two different study populations. Within-cohort measurement error dilutes the association with events.
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Affiliation(s)
- Joseph A C Delaney
- Collaborative Health Studies Coordinating Center, Department of Biostatistics, University of Washington, Bldg.29, Suite 310, 6200 NE 74th Street, Seattle, WA 98115, USA.
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Nguyen QM, Srinivasan SR, Xu JH, Chen W, Berenson GS. Distribution and cardiovascular risk correlates of plasma soluble intercellular adhesion molecule-1 levels in asymptomatic young adults from a biracial community: the Bogalusa Heart Study. Ann Epidemiol 2010; 20:53-9. [PMID: 20006276 DOI: 10.1016/j.annepidem.2009.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Revised: 09/15/2009] [Accepted: 10/03/2009] [Indexed: 01/19/2023]
Abstract
PURPOSE That circulating soluble form of intercellular adhesion molecule-1 (sICAM-1) is associated with an increased risk for coronary artery disease is well recognized. However, information is scant regarding the distribution and cardiovascular (CV) risk correlates of sICAM-1 in asymptomatic young adults. METHODS Plasma sICAM-1 was measured in 1,184 black and white persons in the Bogalusa Heart Study cohort (70% white, 43% male), aged 24 to 44 years. CV risk was assessed in terms of CV risk factors, status of parental CV disease, and composite carotid intima-media thickness (IMT). RESULTS sICAM-1 levels displayed race difference (whites > blacks, p<0.0001), but no sex difference. In multivariate analysis including age, race, sex, smoking status, waist circumference, mean arterial pressure, low- and high-density lipoprotein (LDL and HDL) cholesterols, triglycerides, insulin resistance index, C-reactive protein (CRP), and adiponectin, the significant predictors of sICAM-1, in order of entry, were race (white > black), smoking, CRP, and waist circumference. Furthermore, there was a smoking by waist circumference interaction in that smoking attenuated the magnitude of correlation between waist circumference and sICAM-1. Levels of sICAM-1 adjusted for age, race, sex, and smoking increased with number of metabolic syndrome components (p for trend<0.01); positive family history of CV disease (p<0.05); and increased in composite carotid IMT specific for age, race, and sex (p for trend<0.05). CONCLUSION These findings underscore the potential value of plasma sICAM-1 as an additional biomarker for CV risk among asymptomatic young adults.
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Affiliation(s)
- Quoc Manh Nguyen
- Tulane Center for Cardiovascular Health, Tulane University Health Sciences Center, New Orleans, LA 70112, USA
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Association between depression and intima-media thickness of carotid bulb in asymptomatic young adults. Am J Med 2009; 122:1151.e1-8. [PMID: 19958896 DOI: 10.1016/j.amjmed.2009.07.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2008] [Revised: 07/07/2009] [Accepted: 07/07/2009] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Although there is growing evidence that symptoms of depression influence the development of coronary artery disease, information on the underlying subclinical atherosclerotic process is scant in young adults. The study examined the association between symptoms of depression and subclinical atherosclerosis, determined by carotid intima-media thickness in asymptomatic young individuals. METHODS A cross-sectional study was performed in Bogalusa, Louisiana, a semi-rural biracial (black-white) community. A sample of 996 individuals aged 24 to 44 years (71% were white and 43% were male) enrolled in the Bogalusa Heart Study. The variables included symptoms of depression measured by the Center for Epidemiological Studies-Depression Scale; intima-media thickness of different segments of carotid artery by B-mode ultrasonography; measures of adiposity and glucose homeostasis, lipoproteins, and blood pressure; and cigarette smoking status. RESULTS Both the adjusted and the unadjusted associations between depression score and carotid bulb intima-media thickness were significant, whereas similar associations with internal carotid and common carotid thickness were nonsignificant. In the multivariable regression model, after adjusting for all covariates, a positive effect of depression scores (Center for Epidemiological Studies-Depression score) and a negative effect of interaction between depression score ratio of total cholesterol (TC)/high-density lipoprotein (HDL) were significant. In a subgroup analysis (among individuals with a ratio of TC/HDL < or = 5) a positive effect of depression on carotid bulb intima-media thickness was significant, whereas the interaction between depression and ratio of TC/HDL was nonsignificant. In subsequent analysis, if individuals with a higher ratio of TC/HDL were included, both depression and negative interaction term were significant. CONCLUSION The observations show the detrimental effect of depression on subclinical vascular changes in asymptomatic young individuals. The findings underscore the need for considering depression in risk factor profiling. Further study is recommended to investigate the basis of a lower carotid bulb intima-media thickness among subjects with a high depression score and a high ratio of TC/HDL.
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Zanchetti A, Hennig M, Hollweck R, Bond G, Tang R, Cuspidi C, Parati G, Facchetti R, Mancia G. Baseline values but not treatment-induced changes in carotid intima-media thickness predict incident cardiovascular events in treated hypertensive patients: findings in the European Lacidipine Study on Atherosclerosis (ELSA). Circulation 2009; 120:1084-90. [PMID: 19738145 DOI: 10.1161/circulationaha.108.773119] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Baseline carotid intima-media thickness (IMT) and plaques are considered predictors of cardiovascular events, but whether they maintain predictive value in treated hypertensive patients and whether time-related (or treatment-induced) IMT changes are additional predictors are unknown. METHODS AND RESULTS Analyses were performed of the data from the European Lacidipine Study on Atherosclerosis (ELSA), a large, randomized, intervention trial in which 2334 hypertensive patients from 7 European countries were followed up under effective antihypertensive treatment for 3.75 years. Kaplan-Meier curves indicated progressively lower survival free of any type of outcome except stroke, with increasing baseline IMT quartiles or increasing IMT values, even after adjustment for major baseline risk factors. Incidence of any outcome except stroke also was related to baseline number of carotid plaques. However, when both baseline and on-treatment IMT values were entered in Cox proportional-hazards models, differences in IMT compared with baseline did not predict cardiovascular outcomes. Although on-treatment rather than baseline IMT values significantly entered some of the proportional-hazards models, baseline and on-treatment IMTs were highly correlated, and therefore these results are inconclusive. CONCLUSIONS ELSA shows that carotid intima-media thickening and plaques are important added risks of cardiovascular outcomes in a treated hypertensive population independently of blood pressure and traditional risk factors. However, the analysis failed to show a predictive role of treatment-dependent IMT changes. These negative conclusions should be tempered by the limitations inherent in the smallness of these changes compared with the large individual differences in baseline IMTs.
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Affiliation(s)
- Alberto Zanchetti
- Centro Interuniversitario di Fisiologia Clinica e Ipertensione, Università di Milano, Milan, Italy.
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Urbina EM, Williams RV, Alpert BS, Collins RT, Daniels SR, Hayman L, Jacobson M, Mahoney L, Mietus-Snyder M, Rocchini A, Steinberger J, McCrindle B. Noninvasive assessment of subclinical atherosclerosis in children and adolescents: recommendations for standard assessment for clinical research: a scientific statement from the American Heart Association. Hypertension 2009; 54:919-50. [PMID: 19729599 DOI: 10.1161/hypertensionaha.109.192639] [Citation(s) in RCA: 467] [Impact Index Per Article: 31.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Deterioration in endothelial function and arterial stiffness are early events in the development of cardiovascular diseases. In adults, noninvasive measures of atherosclerosis have become established as valid and reliable tools for refining cardiovascular risk to target individuals who need early intervention. With limited pediatric data, the use of these techniques in children and adolescents largely has been reserved for research purposes. Therefore, this scientific statement was written to (1) review the current literature on the noninvasive assessment of atherosclerosis in children and adolescents, (2) make recommendations for the standardization of these tools for research, and (3) stimulate further research with a goal of developing valid and reliable techniques with normative data for noninvasive clinical evaluation of atherosclerosis in pediatric patients. Precise and reliable noninvasive tests for atherosclerosis in youth will improve our ability to estimate future risk for heart attack and stroke. Currently, large longitudinal studies of cardiovascular risk factors in youth, such as the Bogalusa and Muscatine studies, lack sufficient adult subjects experiencing hard outcomes, such as heart attack and stroke, to produce meaningful risk scores like those developed from Framingham data.
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Long-term anti-tumour necrosis factor therapy reverses the progression of carotid intima–media thickness in female patients with active rheumatoid arthritis. Rheumatol Int 2009; 30:193-8. [DOI: 10.1007/s00296-009-0935-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Accepted: 03/28/2009] [Indexed: 11/26/2022]
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Toprak A, Wang H, Chen W, Paul T, Ruan L, Srinivasan S, Berenson G. Prehypertension and black-white contrasts in cardiovascular risk in young adults: Bogalusa Heart Study. J Hypertens 2009; 27:243-50. [PMID: 19226697 DOI: 10.1097/hjh.0b013e32831aeee3] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to examine the association of prehypertension with measures of cardiovascular disease risk in a biracial (black-white) population of young adults. METHODS As part of the Bogalusa Heart Study, echocardiography and carotid ultrasonography were performed along with cardiovascular risk factor measurements in 1379 young adult participants (age range 20-44 years, average 36 years; 43% men, 70% white). Participants were categorized as normotensives (60%), prehypertensives (27%) and hypertensives (13%). RESULTS The prevalence of prehypertension was significantly higher among men than women (35 vs. 22%) and among blacks than whites (29 vs. 27%). Compared with normotensives, prehypertensives had a greater adverse cardiovascular risk factor profile. Male sex and BMI equally and significantly contributed to the prehypertension status in both whites [odds ratio (OR) and 95% confidence interval 2.66 (1.88-3.74) and 1.10 (1.07-1.14)] and blacks [OR: 2.56 (1.51-4.33) and 1.05 (1.01-1.09)]. Additionally, prehypertensives compared with normotensives had significantly higher left ventricular (LV) mass index, LV internal diameter, and carotid artery intima-media thickness. CONCLUSION The condition of prehypertension in young adults shows men>women and black women>white women, and participants with prehypertension already have adverse profiles of risk factors and indices of subclinical cardiovascular disease. A greater percentage of blacks at a relatively young age fall into the hypertensive category. These findings underscore the need for aggressive management of cardiovascular risk in youth at levels below those considered as hypertension.
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Affiliation(s)
- Ahmet Toprak
- Tulane Center for Cardiovascular Health, New Orleans, Louisiana 70112, USA
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Toprak A, Reddy J, Chen W, Srinivasan S, Berenson G. Relation of pulse pressure and arterial stiffness to concentric left ventricular hypertrophy in young men (from the Bogalusa Heart Study). Am J Cardiol 2009; 103:978-84. [PMID: 19327426 DOI: 10.1016/j.amjcard.2008.12.011] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2008] [Revised: 12/12/2008] [Accepted: 12/12/2008] [Indexed: 11/16/2022]
Abstract
Differences in geometric adaptation of the left ventricle and associated cardiovascular risk may reflect the differential effects of classic risk factors and arterial stiffness on the left ventricle. In the present study, the influence of cardiovascular risk factors and arterial stiffness indexes on left ventricular (LV) geometry types were studied in a large community-based cohort of young adults. As part of the Bogalusa Heart Study, echocardiographic examinations of the heart were performed on 786 black and white adults (age range 24 to 43 years, average 36; 42% men, 70% white). Arterial stiffness indexes of the study cohort included aorta-femoral pulse wave velocity, carotid artery elastic modulus, and arterial compliance using tonometry. Pulse pressure in young adults with concentric LV hypertrophy (47 +/- 11 mm Hg) was significantly higher than in those with eccentric LV hypertrophy (40 +/- 8 mm Hg) and normal geometry (37 +/- 7 mm Hg). Multinomial logistic regression analysis showed that widened pulse pressure, the presence of diabetes mellitus, and increased body mass index were associated with concentric LV hypertrophy compared with normal geometry. Similarly, higher Peterson's and Young's elastic modulus of the carotid arteries and lower large- and small-artery compliance, in addition to increased body mass index, diabetes mellitus, and black race, were associated with concentric LV hypertrophy in young adults. In conclusion these data suggested that concentric LV hypertrophy was associated with widened pulse pressure, increased arterial stiffness, and decreased arterial compliance in young adults.
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Affiliation(s)
- Ahmet Toprak
- Tulane Center for Cardiovascular Health, New Orleans, LA, USA
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El Aidi H, Mani V, Weinshelbaum KB, Aguiar SH, Taniguchi H, Postley JE, Samber DD, Cohen EI, Stern J, van der Geest RJ, Reiber JHC, Woodward M, Fuster V, Gidding SS, Fayad ZA. Cross-sectional, prospective study of MRI reproducibility in the assessment of plaque burden of the carotid arteries and aorta. Nat Rev Cardiol 2009; 6:219-28. [PMID: 19174763 PMCID: PMC3338149 DOI: 10.1038/ncpcardio1444] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2007] [Accepted: 12/03/2008] [Indexed: 12/21/2022]
Abstract
Introduction This cross sectional study was conducted to test reproducibility of analysis of MRI parameters in carotids and thoracic descending aorta (TOA), evaluate the correlation of plaque burden and associations with subject age and gender. Methods Three hundred subjects, with cardiovascular risk factors, underwent a black blood MRI of both carotids and TOA. Mean wall area, wall thickness, lumen area, total vessel area and wall area/total vessel area (WA/TVA) ratio were manually measured. Inter-reader and intra-reader-reproducibility was tested on 187 and 20 randomly chosen subjects respectively. Results The intra-observer-reproducibility for the analysis was high (Intraclass-Correlation-Coefficients (ICC’s >0.8), except mean WA/TVA ratio of TOA. Similarly, the inter-observer reproducibility was acceptable (ICC’s >0.7 for mean wall area, lumen area and total vessel area). MRI parameters in aorta and carotids increased with age for both sexes (p<0.001). Except for mean wall thickness of TOA and WA/TVA ratio, MRI parameters were significantly higher in males than in females. All MRI measurements except the mean wall thickness and WA/TVA ratio were highly reproducible. There was good correlation for mean wall area between carotids and aorta compatible with the systemic nature of atherosclerosis. Similar to clinical presentation of cardiovascular diseases we found greater values in most MRI parameters (except for WA/TVA ratio) in males than in females and with increasing age. Conclusions These data suggest that analysis of most MRI measurements of plaque burden is reproducible and that there is correlation between plaque burden between carotids and aorta validating the systemic distribution of the disease.
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Affiliation(s)
- Hamza El Aidi
- Translational and Molecular Imaging Institute, Mount Sinai School of Medicine, New York, NY 10029, USA
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Abstract
New and experimental imaging techniques are being developed that will permit better visualization and compositional characterization of atheromatous plaques. This review provides discussion of techniques that are currently used in clinical practice, as well as techniques that are investigational only, including coronary angiography, intravascular ultrasound, computed tomography, magnetic resonance imaging, positron emission tomography, and single-photon emission computed tomography. Types of atheromatous plaque are reviewed, and the value of examining vascular calcification in risk assessment is discussed. Experimental use of these imaging techniques in animal models and in clinical studies will enhance our understanding of the development of plaque and will determine whether these techniques would be useful and practical for predicting disease course. Early detection and identification of the type of plaque that is present may generate novel opportunities for primary prevention through changes in lifestyle or even through drug therapy, especially in patients at high cardiovascular risk.
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Affiliation(s)
- Borja Ibañez
- Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital and School of Medicine, New York, New York 10029, USA
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Balci DD, Balci A, Karazincir S, Ucar E, Iyigun U, Yalcin F, Seyfeli E, Inandi T, Egilmez E. Increased carotid artery intima-media thickness and impaired endothelial function in psoriasis. J Eur Acad Dermatol Venereol 2008; 23:1-6. [PMID: 18702627 DOI: 10.1111/j.1468-3083.2008.02936.x] [Citation(s) in RCA: 145] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Psoriasis is associated with an increased risk of atherosclerosis. This study compared subclinical atherosclerosis of the carotid and brachial arteries in psoriasis vulgaris patients and healthy controls using high-resolution ultrasonography. METHODS We studied 43 psoriasis patients and 43 healthy controls matched for age and sex. Flow-mediated dilatation (FMD) and nitroglycerin-induced dilatation (NTD) of the brachial artery and intima-media thickness (IMT) of the common carotid arteries (CCA) were measured ultrasonographically. Diabetes mellitus, hypertension, renal failure, a history of cardiovascular or cerebrovascular disease were exclusion criteria. Subjects who were receiving lipid-lowering therapy, antihypertensive or anti-aggregant drugs, nitrates or long-term systemic steroids were also excluded. RESULTS The mean IMT values of the right, left and averaged CCA of the psoriasis patients were significantly higher, compared with the controls (0.607+/-0.144 mm vs. 0.532+/-0.101 mm, 0.611+/-0.157 mm vs. 0.521+/-0.117 mm, and 0.609+/-0.146 mm vs. 0.526+/-0.104 mm; P=0.006, P=0.003 and P=0.003, respectively). The mean FMD and NTD values of the psoriasis patients were significantly lower, compared with the controls (13.36+/-6.39 mm vs. 19.60+/-11.23 mm and 21.08+/-8.38 mm vs. 26.85+/-12.38 mm; P=0.002 and P=0.013, respectively). Multiple linear regression analysis revealed a significant association between psoriasis and the IMT, FMD and NTD. Moreover, the FMD in psoriasis patients was associated with disease duration. CONCLUSION Psoriasis patients had impaired endothelial function and thicker IMT of the CCA, compared with the healthy control subjects. The presence of psoriasis was an independent risk factor for subclinical atherosclerosis.
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Affiliation(s)
- D D Balci
- Department of Dermatology, Mustafa Kemal University Faculty of Medicine, Antakya, Turkey.
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Bhuiyan AR, Chen W, Srinivasan SR, Rice JC, Mock NB, Tang R, Gene Bond M, Boerwinkle E, Berenson GS. Interaction of G-protein beta3 subunit and nitric oxide synthase gene polymorphisms on carotid artery intima-media thickness in young adults: the Bogalusa Heart Study. Am J Hypertens 2008; 21:917-21. [PMID: 18551105 DOI: 10.1038/ajh.2008.188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND G-protein beta3 subunit (GNB3) gene C825T and endothelial nitric oxide (eNOS) gene G894T polymorphisms both influence arterial structure and function. However, information is scant regarding the interaction of these genes on arterial wall thickness. METHODS This aspect was examined in 654 white and black subjects, aged 25-43 years (72.9% white, 39.3% male). Arterial wall thickness was assessed in terms of the average intima-media thickness (IMT) of common carotid, internal carotid, and carotid bulb segments by B-mode ultrasonography. RESULTS Frequencies of T allele of the GNB3 C825T polymorphism (0.718 vs. 0.304, P < 0.0001) and G allele of the eNOS G894T polymorphism (0.868 vs. 0.661, P < 0.0001) were higher in blacks compared to whites. In a multivariate model including gender, age, mean arterial pressure, body mass index, triglycerides/HDL cholesterol ratio, insulin resistance index, smoking, and/or race, there was no significant genotypic effect on carotid IMT with respect to GNB3 C825T or eNOS G894T polymorphisms among whites, blacks, and total sample. However, the carriers of TT genotype of the GNB3 C825T and T allele of the eNOS G894T had a significantly lower carotid IMT among blacks (P = 0.003) and the total sample (P = 0.006). CONCLUSION These results indicate that the genetic variations of the eNOS gene in combination with the GNB3 gene jointly influence carotid artery wall thickening process in young adults, especially in blacks.
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Casella IB, Presti C, Porta RMP, Sabbag CRD, Bosch MA, Yamazaki Y. A practical protocol to measure common carotid artery intima-media thickness. Clinics (Sao Paulo) 2008; 63:515-20. [PMID: 18719764 PMCID: PMC2664129 DOI: 10.1590/s1807-59322008000400017] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2008] [Accepted: 05/29/2008] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To describe and test a practical protocol to measure common carotid intima-media thickness that uses the combined values of two longitudinal examination angles to increase sensitivity. METHOD Between February and September 2005, 206 patients underwent duplex scan examination of carotid vessels, and the intima-media thickness of 407 common carotids were measured in three angles: transversal, longitudinal posterolateral, and anterolateral, with three intima-media thickness measurements for each near and far wall. In addition to numbers obtained from the three angles of measurement, a fourth visual perspective was obtained by combining the intima-media thickness results of posterolateral and anterolateral longitudinal views and considering the thickest wall measurement. RESULTS Two hundred seventy (66.3%) carotid arteries had an intima-media thickness thicker than 1mm. The mean intima-media thickness values achieved by the different incidences were 1.26+/-0.6 mm (transversal), 1.17+/-0.54 mm (longitudinal anterolateral), and 1.18+/-0.58 mm (longitudinal posterolateral). A significant difference in intima-media thickness measurement values was observed when the three angles of examination plus the combined positive results of both longitudinal angles were compared by ANOVA (P=0.005). The LSD Post-Hoc test determined that the combined longitudinal view results were similar to the transversal views (P=0.28) and had greater intima-media thickness means than isolated anterolateral or posterolateral longitudinal views (P=0.02 and 0.05, respectively). CONCLUSIONS The protocol presented is a practical method for obtaining common carotid artery intima-media thickness measurements. The combined longitudinal posterolateral and anterolateral longitudinal views provide a more sensitive evaluation of the inner layers of the carotid walls than isolated longitudinal views.
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Chen HW, Kuo CL, Huang CS, Kuo SJ, Liu CS. Oxidized Low-Density Lipoproteins, Autoantibodies against Oxidized Low-Density Lipoproteins and Carotid Intima Media Thickness in a Clinically Healthy Population. Cardiology 2007; 110:252-9. [DOI: 10.1159/000112409] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2007] [Accepted: 08/05/2007] [Indexed: 01/21/2023]
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