Carotid Atherosclerosis is Associated with Middle Cerebral Artery Pulsatility Index

Hemodynamic parameters and diabetes mellitus in community-dwelling middle-aged adults and elders: a community-based study

Hemodynamic parameters have been correlated with stroke, hypertension, and arterial stenosis. While only a few small studies have examined the link between hemodynamics and diabetes mellitus (DM). This case-control study enrolled 417 DM patients and 3475 non-DM controls from a community-based cohort. Peak systolic velocity (PSV), end-diastolic velocity (EDV), blood flow velocity (MFV), pulsatility index (PI), and the resistance index (RI) of the common carotid arteries were measured by color Doppler ultrasonography. Generalized linear regression analyses showed that as compared to the non-DM controls, the age-sex-adjusted means of PSV, EDV, and MFV were - 3.28 cm/sec, - 1.94 cm/sec, and - 2.38 cm/sec, respectively, lower and the age-sex-adjusted means of RI and PI were 0.013 and 0.0061, respectively, higher for the DM cases (all p-values < 0.0005). As compared to the lowest quartiles, the multivariable-adjusted ORs of DM for the highest quartiles of PSV, EDV, MFV, RI, and PI were 0.59 (95% confidence interval [CI] 0.41-0.83), 0.45 (95% CI 0.31-0.66), 0.53 (95% CI 0.37-0.77), 1.61 (95% CI 1.15-2.25), and 1.58 (95% CI 1.12-2.23), respectively. More importantly, the additions of EDV significantly improved the predictabilities of the regression models on DM. As compared to the model contained conventional CVD risk factors alone, the area under the receiver operating curve (AUROC) increased by 1.00% (95% CI 0.29-1.73%; p = 0.0059) and 0.80% (95% CI 0.15-1.46%; p = 0.017) for models that added EDV in continuous and quartile scales, respectively. Additionally, the additions of PSV and MFV also significantly improved the predictabilities of the regression models (all 0.01 < p-value < 0.05). This study reveals a significant correlation between DM and altered hemodynamic parameters. Understanding this relationship could help identify individuals at higher risk of DM and facilitate targeted preventive strategies to reduce cardiovascular complications in DM patients.

Non-linear association and benchmark dose of blood pressure on carotid artery intima-media thickening in a general population of southern China

Background and aims

This study aimed to evaluate whether there is a J-curve association between blood pressure (BP) and carotid artery intima-media thickening (CAIT) and estimate the effect of the turning point of BP on CAIT.

Methods and results

Data from 111,494 regular physical examinations conducted on workers and retirees (aged 18 years or older) between January 2011 and December 2016, exported from the hospital information system, were analyzed. Restricted cubic splines (RCS) logistic regression was employed to access the association of BP with CAIT, and Bayesian benchmark dose methods were used to estimate the benchmark dose as the departure point of BP measurements. All the pnon-linear values of BP measurements were less than 0.05 in the RCS logistic regression models. Both systolic blood pressure (SBP) and diastolic blood pressure (DBP) had J-curve associations with the risk of CAIT at a turning point around 120/70 mmHg in the RCS. The benchmark dose for a 1% change in CAIT risk was estimated to be 120.64 mmHg for SBP and 72.46 mmHg for DBP.

Conclusion

The J-curve associations between SBP and DBP and the risk of CAIT were observed in the general population in southern China, and the turning point of blood pressure for significantly reducing the risk of CAIT was estimated to be 120.64/72.46 mmHg for SBP/DBP.

Pulsatility analysis of the circle of Willis

Purpose

To evaluate the phenomenological significance of cerebral blood pulsatility imaging in aging research.

Methods

N = 38 subjects from 20 to 72 years of age (24 females) were imaged with ultrafast MRI with a sampling rate of 100 ms and simultaneous acquisition of pulse oximetry data. Of these, 28 subjects had acceptable MRI and pulse data, with 16 subjects between 20 and 28 years of age, and 12 subjects between 61 and 72 years of age. Pulse amplitude in the circle of Willis was assessed with the recently developed method of analytic phase projection to extract blood volume waveforms.

Results

Arteries in the circle of Willis showed pulsatility in the MRI for both the young and old age groups. Pulse amplitude in the circle of Willis significantly increased with age (p = 0.01) but was independent of gender, heart rate, and head motion during MRI.

Discussion and conclusion

Increased pulse wave amplitude in the circle of Willis in the elderly suggests a phenomenological significance of cerebral blood pulsatility imaging in aging research. The physiologic origin of increased pulse amplitude (increased pulse pressure vs. change in arterial morphology vs. re-shaping of pulse waveforms caused by the heart, and possible interaction with cerebrospinal fluid pulsatility) requires further investigation.

Hypertension Correlates With Stronger Blood Flow Pulsatility in Small Perforating Cerebral Arteries Assessed With 7 Tesla Magnetic Resonance Imaging

BACKGROUND

Hypertension alters the structure and function of cerebral blood vessels, and is an important risk factor for stroke and cerebral small vessel disease (cSVD). However, the pathophysiological process is not yet well understood. This study aimed to investigate the relationship between the pulsatility measures in small perforating arteries and hypertension, since hypertension-induced arterial stiffening may lead to a higher blood flow pulsatility and lower damping.

METHODS

We examined 28 patients with essential hypertension and 25 age- and sex-matched healthy controls (mean age: 63.4, range: 43-81 years, 26 males). Blood flow velocity waveforms were acquired in the lenticulostriate arteries (LSAs) and the middle cerebral artery using phase-contrast MRI at 7 Tesla. Several cSVD markers were scored. The velocity and pulsatility measures were compared between the hypertensives and controls.

RESULTS

A higher pulsatility index (PI) in the LSAs and a lower damping factor (DF) was found in the hypertensive compared to the normotensive group (P=0.015, P=0.015, respectively), but no association was found for the PI in the middle cerebral artery. Higher systolic and mean arterial pressures were associated with higher PI in the LSA and DF. For diastolic blood pressure, only an association with a lower DF was found. Adjusting for cSVD score did not alter these relationships.

CONCLUSIONS

This study shows a higher PI in the LSAs and a lower DF in subjects with hypertension, independent of cSVD presence. This supports the hypothesis that hypertension-induced arterial remodeling may alter the intracerebral blood flow velocity profiles, which could eventually contribute to cerebral tissue damage.

REGISTRATION

URL: https://trialsearch.who.int/; Unique identifier: NL7537 and NL8798.

LncRNA HCG11 Accelerates Atherosclerosis via Regulating the miR-224-3p/JAK1 Axis

Atherosclerosis (AS) is the typical cardiovascular disease, which is the main underlying inducement of cardiovascular diseases. Aberrant expression of long noncoding RNA HLA complex group 11 (HCG11) was engaged with atherosclerosis. The objective of the present research was to explore the role and the potential mechanism of HCG11 in AS. Human umbilical vein endothelial cells (HUVECs) were stimulated with oxidized low-density lipoprotein (ox-LDL) to induce the AS model in vitro. The cell viability was detected by MTT assay. Flow cytometry was performed to determine cell pyroptosis. Gene and protein levels were detected by qPCR or Western blot assay. The interaction between HCG11, miR-224-3p, and Janus kinase 1 (JAK1) was validated by dual-luciferase reporter assays. Ox-LDL treatment aggravated cell pyroptosis and inflammation in HUVECs. And the levels of HCG11 and JAK1 was enhanced in ox-LDL-induced HUVECs, while miR-224-3p expression was reduced. Additionally, knockdown of HCG11 or miR-224-3p overexpression reversed the ox-LDL-induced cell viability decline and the increase of cell pyroptosis and inflammation-related proteins, including gasdermin D N-terminal (GSDMD-N), Caspase-1, NOD-like receptor family pyrin domain-containing 3 (NLRP3), interleukin 18 (IL-18), and interleukin 1beta (IL-1β). Moreover, HCG11 could modulate the JAK1 expression via targeting miR-224-3p. The inhibitory effect of HCG11 silencing on cell pyroptosis and inflammation was reversed by miR-224-3p knockdown. Furthermore, overexpression of miR-224-3p could repress the ox-LDL-induced cell pyroptosis and inflammation via regulating JAK1 expression. Knockdown of HCG11 alleviated cell pyroptosis and inflammation induced by ox-LDL via targeting the miR-224-3p/JAK1 axis, indicating that HCG11 could be the latent target of diagnosis or treatment for AS.

Correlation Analysis of Huayu Tongmai Decoction Intervention and Prognosis Indexes of Patients with Carotid Atherosclerosis

Background

Carotid atherosclerosis (CAS) is a common disease which seriously threatens the health of senile patients. The studies have indicated that traditional Chinese medicine (TCM) may effectively improve the symptom of CAS, while the therapeutic effect of Huayu Tongmai decoction on CAS remains unclear. Thus, this study aimed to explore the correlation between traditional Chinese medicine Huayu Tongmai decoction intervention and prognosis indexes of patients with CAS.

Methods

Ninety CAS patients admitted to Zibo TCM-Integrated Hospital from September 2018 to September 2020 were selected as the research object and randomly divided into the control group and the observation group according to the male-female ratio of 1 : 1. Patients in the control group accepted the atorvastatin intervention, and on this basis, patients in the observation group were further intervened with TCM Huayu Tongmai decoction. Before and after treatment, patients' levels of total cholesterol (TC), triglyceride (TG), and low-density lipoprotein cholesterol (LDL-C) were measured by the enzyme photometric colorimetry; hypersensitive c-reactive protein (hs-CRP) levels were measured by the ELISA method; nitric oxide (NO) levels were measured by the nitrate reductase assay and endothelin-1 (ET-1) levels were measured by radioimmunoassay; and the right and left carotid internal diameter (CAD), intima-media thickness (IMT), and plaque volume were measured by carotid ultrasonography.

Results

The TC, TG, and LDL-C levels significantly decreased in patients compared to those before intervention; compared with the control group, patients who accepted Huayu Tongmai decoction combined with atorvastatin saw more significant improvement in their blood lipid indexes (P < 0.01); after intervention, patients' hs-CRP and ET-1 levels dropped significantly while the NO level rose remarkably, and between the two groups, the improvement in levels of hs-CRP, ET-1, and NO of patients in the observation group was significantly better (P < 0.01); it was concluded from the imaging diagnosis results that compared with using atorvastatin alone, the combined intervention could better improve patients' CAD, IMT, and plaque volume.

Conclusion

Huayu Tongmai decoction can effectively improve patients' blood lipid, reduce inflammatory response, enhance levels of relevant regulatory factors of CAS, and alleviate the symptoms.

Middle Cerebral Artery Pulsatility Index Correlates with Prognosis and Diastolic Dysfunctions in Acute Ischemic Stroke

OBJECTIVE

To determine transcranial Doppler ultrasonography (TCD) parameters related to unfavorable outcomes, and to clarify the correlations between those parameters and heart functions in acute ischemic stroke without major vessel stenoses and occlusions.

MATERIALS AND METHODS

Patients were selected from a comprehensive stroke center between October 2012 and June 2019. Inclusion criteria were: 1) acute ischemic stroke without major vessel stenoses and occlusions; and 2) ability to measure blood flow in the middle cerebral artery by TCD. Unfavorable outcomes were defined as a modified Rankin Scale score of 2-6 at 3 months after onset. First, we investigated TCD parameters related to unfavorable outcomes. Second, correlations between those parameters and heart functions as assessed by transthoracic echocardiography were evaluated.

RESULTS

We screened 1,527 consecutive ischemic stroke patients, including 130 patients (109 [83%] male; median age, 60 years). Middle cerebral artery pulsatility index (M1 PI) (Odds ratio (OR) 0.057, 95%confidence interval (CI) 0.007-0.494, p = 0.009) was independently associated with unfavorable outcomes. Concerning the relation between M1 PI and heart functions, peak early filling velocity/velocity of mitral annulus early diastolic motion (E/e') (OR 1.195, 95%CI 1.011-1.413, p = 0.037) was a factor independently associated with high M1 PI.

CONCLUSIONS

High M1 PI predicts unfavorable outcome regardless of ischemic stroke subtype without major vessel stenoses and occlusions. High M1 PI correlates with high E/e', suggesting diastolic dysfunction.

Carotid Atherosclerosis and Longitudinal Changes of MRI Visual Rating Measures in Stroke Survivors: A Seven-Year Follow-Up Study

OBJECTIVES

We aimed to assess longitudinal changes in MRI measures of brain atrophy and white matter lesions in stroke and transient ischemic attack (TIA) survivors, and explore whether carotid stenosis predicts progression of these changes, assessed by visual rating scales.

MATERIALS AND METHODS

All patients with a first-ever stroke or TIA admitted to Bærum Hospital, Norway, in 2007/2008, were invited in the acute phase and followed for seven years. Carotid ultrasound was performed during the hospital stay. Carotid stenosis was defined as ≥50% narrowing of lumen. MRI was performed one and seven years after the index event and analyzed according to the visual rating scales Fazekas scale (0-3), Medial Temporal Lobe Atrophy (MTLA) (0-4) score, and Global Cortical Atrophy (GCA) scale (0-3). Patients with MRI scans at both time points were included in this sub-study.

RESULTS

Of 227 patients recruited, 76 had both MRI examinations. Mean age 73.9±10.6, 41% women, and 9% had ≥50% carotid stenosis. Mean Fazekas scale was 1.7±0.9 and 1.8±1.0, mean MTLA score 1.0 ±1.0 and 1.7±1.0, and mean GCA scale score 1.4±0.7 and 1.4±0.6 after one and seven years, respectively. 71% retained the same Fazekas scale score, while 21% showed progression. Deterioration in GCA scale was seen in 20% and increasing MTLA score in 57%. Carotid stenosis was not associated with progression on Fazekas score, MTLA score or GCA scale.

CONCLUSIONS

Three out of five showed progression on the MTLA score. Carotid stenosis was not associated with longitudinal change of visual rating scales.

Identification of Potential Key Genes Involved in the Carotid Atherosclerosis

Purpose

Carotid atherosclerosis is a kind of systemic atherosclerosis in the carotid arteries. However, the efficiency of treatment is insufficient. Therefore, it is urgent to find therapeutic targets and deepen the understanding of carotid atherosclerosis.

Materials and Methods

In this study, we analyzed differentially expressed genes (DEGs) between atheroma plaque and macroscopically intact tissue (control samples). Furthermore, we performed Gene Ontology (GO) and Kyoto Encyclopedia of Gene and Genomes (KEGG) enrichment analysis based on the DEGs. Four methods were used to identify the hub genes in the protein–protein interaction networks of the DEGs. Furthermore, we also performed network module analysis to reveal carotid atherosclerosis-related gene modules and biological functions.

Results

The enrichment results showed that the biological functions were related to inflammation, immunity, chemokine and cell adhesion molecule, such as PIK-Akt signaling pathway, Rap1 signaling pathway, MAPK signaling pathway, NOD-like receptor signaling pathway and B cell receptor signaling pathway. In addition, we screened the hub genes. A total of 16 up-regulated genes (C3AR1, CCR1, CCR2, CD33, CD53, CXCL10, CXCL8, CXCR4, CYBB, FCER1G, FPR2, ITGAL, ITGAM, ITGAX, ITGB2, and LILRB2) were identified as hub genes. A total of 5 gene modules were obtained. We found that biological functions obtained for each cluster were mostly related to immunity, chemokines and cell adhesion molecules.

Conclusion

The present study identified key DEGs in atheroma plaque compared with control samples. The key genes involved in the development of carotid atherosclerosis may provide valuable therapeutic targets for carotid atherosclerosis.

12-Hydroxyeicosapentaenoic acid inhibits foam cell formation and ameliorates high-fat diet-induced pathology of atherosclerosis in mice

Atherosclerosis is a chronic inflammatory disease associated with macrophage aggregate and transformation into foam cells. In this study, we sought to investigate the impact of dietary intake of ω3 fatty acid on the development of atherosclerosis, and demonstrate the mechanism of action by identifying anti-inflammatory lipid metabolite. Mice were exposed to a high-fat diet (HFD) supplemented with either conventional soybean oil or α-linolenic acid-rich linseed oil. We found that as mice became obese they also showed increased pulsatility and resistive indexes in the common carotid artery. In sharp contrast, the addition of linseed oil to the HFD improved pulsatility and resistive indexes without affecting weight gain. Histological analysis revealed that dietary linseed oil inhibited foam cell formation in the aortic valve. Lipidomic analysis demonstrated a particularly marked increase in the eicosapentaenoic acid-derived metabolite 12-hydroxyeicosapentaenoic acid (12-HEPE) in the serum from mice fed with linseed oil. When we gave 12-HEPE to mice with HFD, the pulsatility and resistive indexes was improved. Indeed, 12-HEPE inhibited the foamy transformation of macrophages in a peroxisome proliferator-activated receptor (PPAR)γ-dependent manner. These results demonstrate that the 12-HEPE-PPARγ axis ameliorates the pathogenesis of atherosclerosis by inhibiting foam cell formation.