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Liang L, Chen J, Zhang C, Luo B, Zhou T, Wang X, Wang Y. Association of Lipoprotein-associated phospholipase A2 With Carotid Intima-Media Thickness in Acute Cerebral Infarction Patients. Angiology 2024:33197241233774. [PMID: 38424714 DOI: 10.1177/00033197241233774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Lipoprotein-associated phospholipase A2 (Lp-PLA2) is an inflammatory marker associated with atherosclerotic and cardiovascular diseases. This study aimed to explore the association of Lp-PLA2 with carotid intima-media thickness (cIMT) in patients with acute ischemic stroke (AIS) and explore a threshold level to predict the risk of vulnerable plaques. This retrospective observational study included patients with AIS in the Neurology Department of our Hospital between January 2018 and December 2019. The study included 293 patients aged 65.29 ± 12.11 years, including 212 males, of whom 124 had carotid intima-media thickening (42.32%). Multivariable logistic regression showed that Lp-PLA2 level was an independent risk factor for cIMT (odds ratio [OR] = 1.004, 95% confidence interval [95% CI] 1.001-1.008, P = .008). Threshold effect analysis showed that the risk of vulnerable carotid plaque occurrence increased by 2% for every 1 ng/mL increase in Lp-PLA2 level with serum Lp-PLA2 levels between 157 and 279 ng/mL; this increase was statistically significant (OR = 1.02, 95% CI 1.01-1.03, P < .001). Serum Lp-PLA2 is an independent risk factor for increased cIMT in patients with AIS, and a threshold Lp-PLA2 level between 157 and 279 ng/mL showed a higher risk of carotid plaque rupture.
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Affiliation(s)
- Libing Liang
- Department of Neurology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
- Department of Neurology, The First People's Hospital of Foshan, Foshan, China
| | - Jingjuan Chen
- Department of Neurology, The First People's Hospital of Foshan, Foshan, China
| | - Chengguo Zhang
- Department of Neurology, The First People's Hospital of Foshan, Foshan, China
| | - Baigui Luo
- Science and Education Department, The First People's Hospital of Foshan, Foshan, China
| | - Tianen Zhou
- Emergency Department, The First People's Hospital of Foshan, Foshan, China
| | - Xiaofeng Wang
- Department of Neurology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Yukai Wang
- Department of Neurology, The First People's Hospital of Foshan, Foshan, China
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Jochmann SL, Sievering EMW, Ernst J, Ringlstetter R, Grosshennig A, Weissenborn K, Grosse GM. Sex-Specific Risk Factors of Nonstenotic Carotid Plaque in Embolic Stroke of Unknown Source: A Case-Control Study. Stroke 2024; 55:296-300. [PMID: 38152961 DOI: 10.1161/strokeaha.123.044833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/29/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Many ischemic strokes are diagnosed as embolic strokes of undetermined source (ESUS). Recent evidence suggests that nonstenotic carotid plaque (nsCP) may be a substantial contributor to the risk for ESUS. We aimed to investigate the risk factor profile associated with nsCP in ESUS and defined stroke etiologies. METHODS In this retrospective case-control study, we investigated consecutive patients with acute ischemic stroke due to ESUS, small-vessel disease, or cardioembolism proven by magnetic resonance imaging. The association of vascular risk factors age, arterial hypertension, diabetes, dyslipoproteinemia, body mass index, alcohol consumption, tobacco use, kidney failure, and history of stroke with the presence of nsCP was investigated using binary logistic regression analysis and further stratified by stroke etiology and sex. RESULTS In total, 609 patients (median age, 76 years; 46% women) who were treated from 2018 to 2020 were considered. In patients with ESUS, sex played a more important role for the prevalence of nsCP than in defined etiologies. Female patients with ESUS had lower odds of exhibiting nsCP compared with male patients with ESUS (adjusted odds ratio, 0.36 [95% CI, 0.15-0.86]). In male patients with ESUS, we observed that age (adjusted odds ratio per 10-year increase, 2.55 [95% CI, 1.26-5.17]) and hypertension (adjusted odds ratio, 2.49 [95% CI, 0.56-11.1]) were the main risk factors for nsCP, whereas in female patients with ESUS also tobacco use was particularly relevant (adjusted odds ratio, 3.71 [95% CI, 0.61-22.5]). These results were in line with a sensitivity analysis in nsCP located ipsilateral to the infarct. CONCLUSIONS Sex differences play an important role in nsCP prevalence in patients with ESUS. These findings may have important implications for the management in targeted secondary prevention following ESUS.
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Affiliation(s)
- Svenja L Jochmann
- Department of Neurology, (S.L.J., E.M.W.S., J.E., K.W., G.M.G.), Hannover Medical School, Germany
| | - Esther M W Sievering
- Department of Neurology, (S.L.J., E.M.W.S., J.E., K.W., G.M.G.), Hannover Medical School, Germany
| | - Johanna Ernst
- Department of Neurology, (S.L.J., E.M.W.S., J.E., K.W., G.M.G.), Hannover Medical School, Germany
| | - Rieke Ringlstetter
- Institute of Biostatistics (R.R., A.G.), Hannover Medical School, Germany
| | - Anika Grosshennig
- Institute of Biostatistics (R.R., A.G.), Hannover Medical School, Germany
| | - Karin Weissenborn
- Department of Neurology, (S.L.J., E.M.W.S., J.E., K.W., G.M.G.), Hannover Medical School, Germany
| | - Gerrit M Grosse
- Department of Neurology, (S.L.J., E.M.W.S., J.E., K.W., G.M.G.), Hannover Medical School, Germany
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Nordin S, Norberg M, Braf I, Johansson H, Lindahl B, Lindvall K, Nordin M, Nyman E, Vallström C, Wennberg P, Liv P, Näslund U. Associations between emotional support and cardiovascular risk factors and subclinical atherosclerosis in middle-age. Psychol Health 2023:1-15. [PMID: 37994844 DOI: 10.1080/08870446.2023.2286296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/31/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVE To test the hypothesis of low emotional support being associated with lifestyle and biomedical cardiovascular disease (CVD) risk factors, estimated risk of CVD morbidity and mortality, and subclinical atherosclerosis in middle-aged healthy adults. METHODS AND MEASURES Cross-sectional data were obtained from participants aged 40-60 years who had one or more conventional CVD risk factor. They underwent assessment based on questionnaires, clinical examination, blood sampling, and carotid ultrasound of plaque formation and carotid intima-media wall thickness (cIMT). Based on the Interview Schedule for Social Interaction, the participants were categorised as either low in emotional support (n = 884) or as a referent (n = 2570). Logistic regression analyses were conducted to study the associations. RESULTS Logistic regression analyses showed that low emotional support was significantly associated with smoking, alcohol consumption and physical inactivity (OR = 1.53 - 1.94), estimated risk of CVD morbidity and mortality (OR = 1.56 - 1.68), and plaque formation (OR = 1.39). No significant associations were found regarding biomedical CVD risk factors or cIMT. CONCLUSION The findings suggest that low social support is associated with lifestyle CVD risk factors, estimated risk of CVD morbidity and mortality, and subclinical atherosclerosis in middle-aged healthy adults, encouraging causal evaluation with longitudinal data investigating an impact of emotional support on mechanisms underlying CVD.
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Affiliation(s)
- Steven Nordin
- Department of Psychology, Umeå University, Umeå, Sweden
| | - Margareta Norberg
- Section of Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Irma Braf
- Department of Psychology, Umeå University, Umeå, Sweden
| | - Helene Johansson
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Bernt Lindahl
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Kristina Lindvall
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Maria Nordin
- Department of Psychology, Umeå University, Umeå, Sweden
| | - Emma Nyman
- Heart Centre and Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | - Patrik Wennberg
- Section of Family Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Per Liv
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Ulf Näslund
- Heart Centre and Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Weng S, Chen J, Ding C, Hu D, Liu W, Yang Y, Peng D. Utilizing machine learning algorithms for the prediction of carotid artery plaques in a Chinese population. Front Physiol 2023; 14:1295371. [PMID: 38028761 PMCID: PMC10657816 DOI: 10.3389/fphys.2023.1295371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
Background: Ischemic stroke is a significant global health issue, imposing substantial social and economic burdens. Carotid artery plaques (CAP) serve as an important risk factor for stroke, and early screening can effectively reduce stroke incidence. However, China lacks nationwide data on carotid artery plaques. Machine learning (ML) can offer an economically efficient screening method. This study aimed to develop ML models using routine health examinations and blood markers to predict the occurrence of carotid artery plaques. Methods: This study included data from 5,211 participants aged 18-70, encompassing health check-ups and biochemical indicators. Among them, 1,164 participants were diagnosed with carotid artery plaques through carotid ultrasound. We constructed six ML models by employing feature selection with elastic net regression, selecting 13 indicators. Model performance was evaluated using accuracy, sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), F1 score, kappa value, and Area Under the Curve (AUC) value. Feature importance was assessed by calculating the root mean square error (RMSE) loss after permutations for each variable in every model. Results: Among all six ML models, LightGBM achieved the highest accuracy at 91.8%. Feature importance analysis revealed that age, Low-Density Lipoprotein Cholesterol (LDL-c), and systolic blood pressure were important predictive factors in the models. Conclusion: LightGBM can effectively predict the occurrence of carotid artery plaques using demographic information, physical examination data and biochemistry data.
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Affiliation(s)
- Shuwei Weng
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Research Institute of Blood Lipid and Atherosclerosis, Changsha, Hunan, China
| | - Jin Chen
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Research Institute of Blood Lipid and Atherosclerosis, Changsha, Hunan, China
| | - Chen Ding
- Department of Cardiology, Suzhou Dushu Lake Hospital, Dushu Lake Hospital Affiliated to Soochow University, Medical Center of Soochow University, Suzhou, Jiangsu, China
| | - Die Hu
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Research Institute of Blood Lipid and Atherosclerosis, Changsha, Hunan, China
| | - Wenwu Liu
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Research Institute of Blood Lipid and Atherosclerosis, Changsha, Hunan, China
| | - Yanyi Yang
- Health Management Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Daoquan Peng
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Research Institute of Blood Lipid and Atherosclerosis, Changsha, Hunan, China
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Xie W, Bian W, Song Z, Deng X, Qu J, Zhang Z. Association between triglyceride-glucose index and carotid atherosclerosis in patients with psoriatic arthritis. Rheumatology (Oxford) 2023; 62:3584-3591. [PMID: 36897031 DOI: 10.1093/rheumatology/kead100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 02/07/2023] [Accepted: 02/21/2023] [Indexed: 03/11/2023] Open
Abstract
OBJECTIVE To investigate the association of the triglyceride-glucose (TyG) index with atherosclerotic risk among patients with PsA. METHODS This cross-sectional study included 165 consecutive PsA patients receiving carotid ultrasonography with integrated TyG index, calculated as ln [fasting triglycerides (mg/dl) × fasting glucose (mg/dl)/2]. Logistic regression models were applied to analyse the association of TyG index as continuous variables and tertiles with carotid atherosclerosis and carotid artery plaque. Fully adjusted model included sex, age, smoking, BMI, comorbidities and psoriatic-related variables. RESULTS Overall, PsA patients with carotid atherosclerosis had substantially higher TyG index than those without [8.82 (0.50) vs 8.54 (0.55), P = 0.002]. The frequency of carotid atherosclerosis was increased with increases in TyG index tertiles, showing 14.8%, 34.5%, 44.6% for tertile 1, 2 and 3, respectively (P = 0.003). Multivariate logistic analyses showed that each 1-unit increase in TyG index was significantly associated with prevalent carotid atherosclerosis [unadjusted odds ratio (OR) 2.65 (1.39-5.05); fully adjusted OR 2.69 (1.02-7.11)]. Compared with patients in tertile 1 of TyG index, the unadjusted and fully adjusted OR for occurrence of carotid atherosclerosis were 4.64 (1.85-11.60) and 5.10 (1.54-16.93) in patients in tertile 3. Similarly, higher prevalent carotid artery plaque was observed with increasing TyG index [unadjusted OR 3.11 (1.54-6.26); fully adjusted OR 3.61 (1.15-11.38)] or in tertile 3 vs tertile 1 [unadjusted OR 10.20 (2.83-36.82); fully adjusted OR 17.89 (2.88-111.11)]. Additionally, TyG index provided incremental predictive capacity beyond established risk factors, shown by an increase in discrimination ability (all P < 0.001). CONCLUSIONS TyG index was positively correlated with the burden of atherosclerosis in PsA patients, independent of traditional cardiovascular risk factors and psoriatic-related factors. These findings suggest that TyG index may be a promising atherosclerotic marker for the PsA population.
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Affiliation(s)
- Wenhui Xie
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, China
| | - Wei Bian
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, China
| | - Zhibo Song
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, China
| | - Xuerong Deng
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, China
| | - Jiahao Qu
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, China
| | - Zhuoli Zhang
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, China
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Pan J, Yang B, Wang Z, Tang L, Jia P, Yang S, Zeng H. Triglyceride-Glucose Index is Related to Carotid Artery Plaque in Railway Workers: A Cross-Sectional Study. Diabetes Metab Syndr Obes 2023; 16:2561-2571. [PMID: 37645236 PMCID: PMC10461744 DOI: 10.2147/dmso.s418358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023] Open
Abstract
Aim China has the highest rail transportation density in the world. Compared to other occupational populations, railway workers in China face increased risk of chronic non-communicable diseases. This study aims to investigate the relationship between the triglyceride-glucose (TyG) index and carotid artery plaque (CAP) in a population of railway workers in southwest China. Methods The cross-sectional study was conducted among 3169 railway workers who were categorized into four groups based on TyG index quartiles. The presence of CAP was assessed using carotid Doppler ultrasound. Logistic regression and restricted cubic spline analyses were used to estimate the association between TyG index and CAP, and subgroup analyses were performed based on age, blood pressure, metabolic dysfunction-associated fatty liver disease (MAFLD), smoking, drinking, and physical activity. Results Participants with higher TyG index quartiles had a higher prevalence of CAP, with 11.63%, 14.11%, 20.20%, and 18.56% from the first to fourth quartile, respectively. The multi-adjusted logistic regression models showed a positive association between TyG index and the risk of CAP (odds ratio [OR]: 1.22, 95% confidence interval [CI]: 1.06-1.41) when treated as a continuous variable. When analyzed as a categorical variable with increasing TyG index tertiles, the risk of CAP substantially increased with ORs (95% CIs) of 1.22 (0.90-1.65) for the second quartile, 1.70 (1.27-2.28) for the third quartile, and 1.46 (1.08-1.98) for the fourth quartile compared to the lowest quartile. Restricted cubic spline revealed that the association gradually strengthened with the increase of the TyG index below 9.56. Conclusion TyG index was significantly associated with CAP, notably in populations with elevated quartiles of TyG index among railway workers. Monitoring the TyG index could be a useful risk management strategy for CAP in occupation population.
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Affiliation(s)
- Jia Pan
- Department of Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu University, Chengdu, Sichuan, People’s Republic of China
| | - Bo Yang
- Department of Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu University, Chengdu, Sichuan, People’s Republic of China
| | - Zihang Wang
- Department of West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Lei Tang
- Department of Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu University, Chengdu, Sichuan, People’s Republic of China
| | - Peng Jia
- Department of School of Resources and Environmental Sciences, Wuhan University, Wuhan, People’s Republic of China
- Department of International Institute of Spatial Health Epidemiology (ISLE), Wuhan University, Wuhan, People’s Republic of China
| | - Shujuan Yang
- Department of Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu University, Chengdu, Sichuan, People’s Republic of China
- Department of West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
- Department of International Institute of Spatial Health Epidemiology (ISLE), Wuhan University, Wuhan, People’s Republic of China
| | - Honglian Zeng
- Department of Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu University, Chengdu, Sichuan, People’s Republic of China
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Koskinen JS, Kytö V, Juonala M, Viikari JSA, Nevalainen J, Kähönen M, Lehtimäki T, Hutri‐Kähönen N, Laitinen TP, Tossavainen P, Jokinen E, Magnussen CG, Raitakari OT. Childhood Dyslipidemia and Carotid Atherosclerotic Plaque in Adulthood: The Cardiovascular Risk in Young Finns Study. J Am Heart Assoc 2023; 12:e027586. [PMID: 36927037 PMCID: PMC10122878 DOI: 10.1161/jaha.122.027586] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 01/12/2023] [Indexed: 03/18/2023]
Abstract
Background Childhood exposure to dyslipidemia is associated with adult atherosclerosis, but it is unclear whether the long-term risk associated with dyslipidemia is attenuated on its resolution by adulthood. We aimed to address this question by examining the links between childhood and adult dyslipidemia on carotid atherosclerotic plaques in adulthood. Methods and Results The Cardiovascular Risk in Young Finns Study is a prospective follow-up of children that began in 1980. Since then, follow-up studies have been conducted regularly. In 2001 and 2007, carotid ultrasounds were performed on 2643 participants at the mean age of 36 years to identify carotid plaques and plaque areas. For childhood lipids, we exploited several risk factor measurements to determine the individual cumulative burden for each lipid during childhood. Participants were categorized into the following 4 groups based on their childhood and adult dyslipidemia status: no dyslipidemia (reference), incident, resolved, and persistent. Among individuals with carotid plaque, linear regression models were used to study the association of serum lipids with plaque area. The prevalence of plaque was 3.3% (N=88). In models adjusted for age, sex, and nonlipid cardiovascular risk factors, the relative risk for carotid plaque was 2.34 (95% CI, 0.91-6.00) for incident adult dyslipidemia, 3.00 (95% CI, 1.42-6.34) for dyslipidemia resolved by adulthood, and 5.23 (95% CI, 2.57-10.66) for persistent dyslipidemia. Carotid plaque area correlated with childhood total, low-density lipoprotein, and non-high-density lipoprotein cholesterol levels. Conclusions Childhood dyslipidemia, even if resolved by adulthood, is a risk factor for adult carotid plaque. Furthermore, among individuals with carotid plaque, childhood lipids associate with plaque size. These findings highlight the importance of primordial prevention of dyslipidemia in childhood to reduce atherosclerosis development.
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Affiliation(s)
- Juhani S. Koskinen
- Research Centre of Applied and Preventive Cardiovascular MedicineUniversity of TurkuTurkuFinland
- Centre for Population Health ResearchUniversity of Turku and Turku University HospitalTurkuFinland
- Division of MedicineTurku University HospitalTurkuFinland
- Department of MedicineSatakunta Central HospitalPoriFinland
| | - Ville Kytö
- Research Centre of Applied and Preventive Cardiovascular MedicineUniversity of TurkuTurkuFinland
- Centre for Population Health ResearchUniversity of Turku and Turku University HospitalTurkuFinland
- Heart CentreTurku University Hospital and University of TurkuTurkuFinland
| | - Markus Juonala
- Research Centre of Applied and Preventive Cardiovascular MedicineUniversity of TurkuTurkuFinland
- Centre for Population Health ResearchUniversity of Turku and Turku University HospitalTurkuFinland
- Division of MedicineTurku University HospitalTurkuFinland
- Department of MedicineUniversity of TurkuTurkuFinland
| | - Jorma S. A. Viikari
- Division of MedicineTurku University HospitalTurkuFinland
- Department of MedicineUniversity of TurkuTurkuFinland
| | | | - Mika Kähönen
- Department of Clinical PhysiologyTampere University HospitalTampereFinland
- Faculty of Medicine and Health Technology and Finnish Cardiovascular Research Center TampereTampere UniversityTampereFinland
| | - Terho Lehtimäki
- Faculty of Medicine and Health Technology and Finnish Cardiovascular Research Center TampereTampere UniversityTampereFinland
- Department of Clinical ChemistryFimlab LaboratoriesTampereFinland
| | - Nina Hutri‐Kähönen
- Tampere Centre for Skills Training and SimulationTampere University, Faculty of Medicine and Health TechnologyTampereFinland
| | - Tomi P. Laitinen
- Department of Clinical Physiology and Nuclear MedicineKuopio University HospitalKuopioFinland
- Institute of Clinical MedicineUniversity of Eastern FinlandKuopioFinland
| | - Päivi Tossavainen
- Department of Pediatrics and Adolescent MedicineOulu University HospitalOuluFinland
- PEDEGO Research UnitUniversity of OuluOuluFinland
| | - Eero Jokinen
- Department of PediatricsUniversity of HelsinkiFinland
- Hospital for Children and AdolescentsHelsinki University HospitalHelsinkiFinland
| | - Costan G. Magnussen
- Research Centre of Applied and Preventive Cardiovascular MedicineUniversity of TurkuTurkuFinland
- Centre for Population Health ResearchUniversity of Turku and Turku University HospitalTurkuFinland
- Baker Heart and Diabetes InstituteMelbourneVictoriaAustralia
| | - Olli T. Raitakari
- Research Centre of Applied and Preventive Cardiovascular MedicineUniversity of TurkuTurkuFinland
- Centre for Population Health ResearchUniversity of Turku and Turku University HospitalTurkuFinland
- Department of Clinical Physiology and Nuclear MedicineTurku University HospitalTurkuFinland
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Yun C, Xin Q, Zhang S, Chen S, Wang J, Wang C, Wang M, Zhao M, Sun Y, Hou Z, Wu S, Xue H. Combined effect of inter-arm systolic blood pressure difference and carotid artery plaque on cardiovascular diseases and mortality: A prospective cohort study. Front Cardiovasc Med 2022; 9:904685. [PMID: 36440038 PMCID: PMC9685796 DOI: 10.3389/fcvm.2022.904685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 10/20/2022] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVES Previous studies have confirmed the relations between inter-arm systolic blood pressure difference (IASBPD) and carotid artery plaque with the risk of cardiovascular diseases (CVD). But it is unclear whether the combined effect of IASBPD and carotid artery plaque further increases the risk of CVD and all-cause mortality. MATERIALS AND METHODS We enrolled 4,970 participants (≥40 years old) in the prospective Kailuan study. All participants underwent dual-arm blood pressure and carotid artery ultrasounds. IASBPD was the absolute value of the difference between dual-arm blood pressure. All the participants were divided into four groups according to their IASBPD levels and the presence or absence of carotid artery plaque and Cox proportional hazards models were used to calculate the hazard ratios (HRs) and 95% confidence interval (CI) for incident CVD and all-cause mortality. RESULTS During a median follow-up of 7 years, 179 CVD events and 266 deaths occurred. Multivariable Cox Regression showed that participants with IASBPD ≥ 10 mmHg and plaque had a significantly higher incidence of CVD, cerebral infarction (CI), and myocardial infarction (10, 7.27, and 1.36%, respectively). After adjusting for covariates, the IASBPD ≥ 10 mmHg and carotid plaque group significantly increased risks for CVD (HR 2.38; 95% CI, 1.40∼4.05), CI (HR, 2.47; 95% CI, 1.31∼4.67), and all-cause mortality (HR, 2.08; 95% CI, 1.20∼3.59). CONCLUSION Our study indicated that the combination of IASBPD and carotid artery plaque was associated with incident CVD and all-cause mortality.
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Affiliation(s)
- Cuijuan Yun
- School of Medicine, Nankai University, Tianjin, China
- Department of Cardiology, The Sixth Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Qian Xin
- Department of Cardiology, The Sixth Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Sijin Zhang
- School of Medicine, Nankai University, Tianjin, China
- Department of Cardiology, The Sixth Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Jianli Wang
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Chi Wang
- Department of Cardiology, The Sixth Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Miao Wang
- School of Medicine, Nankai University, Tianjin, China
| | - Maoxiang Zhao
- Department of Cardiology, The Sixth Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Yizhen Sun
- Department of Cardiology, The Sixth Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Ziwei Hou
- School of Medicine, Nankai University, Tianjin, China
- Department of Cardiology, The Sixth Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Hao Xue
- Department of Cardiology, The Sixth Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China
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Ishii H. Cardiovascular events and atherosclerosis in patients with type 2 diabetes and impaired glucose tolerance -What are the medical treatments to prevent cardiovascular events in such patients? J Diabetes Investig 2022; 13:1114-1121. [PMID: 35377559 PMCID: PMC9248425 DOI: 10.1111/jdi.13799] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 11/30/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) and impaired glucose tolerance (IGT) significantly induce advanced coronary artery disease and systemic atherosclerosis. Thus, T2DM and IGT are traditional risk factors of cardiovascular disease (CVD). On the other hand, acute coronary syndrome is frequently caused by the rupture of coronary atherosclerotic plaques, which reduces patients' quality of life and may result in death. To date, many trials have sought to identify ways to determine the coronary plaque volume and its vulnerability, and many studies have demonstrated that some specific antihyperglycemic agents may prevent coronary or carotid plaque progression, decrease plaque volume, induce plaque stability, and improve clinical outcomes in patients with T2DM and IGT. This article reviews i) the association between coronary or carotid plaques and abnormal glucose tolerance, including T2DM; and ii) the effects of oral antihyperglycemic drugs to improve clinical outcomes and stabilize atherosclerotic plaques in patients with T2DM and IGT.
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Affiliation(s)
- Hideki Ishii
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, 371-8511, Japan
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10
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Cheng X, Li Z, Yang M, Liu Y, Wang S, Huang M, Gao S, Yang R, Li L, Yu C. Association of HbA1c with carotid artery plaques in patients with coronary heart disease: a retrospective clinical study. Acta Cardiol 2022; 78:442-450. [PMID: 35356852 DOI: 10.1080/00015385.2022.2040822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND AND AIMS Haemoglobin A1c (HbA1c) levels have been shown to be related to carotid artery plaques. However, studies on the relationship between HbA1c levels and carotid artery plaques in patients with coronary heart disease (CHD) are limited and inconsistent. Our objective was to examine the correlation between HbA1c levels and carotid artery plaques in patients with CHD. METHODS The study comprised 9275 Chinese adults with CHD from January 1, 2014, to September 30, 2020. HbA1c levels were assessed, and colour Doppler ultrasound was used to evaluate the carotid artery, including plaque presence, intima-media thickness, and plaque echo properties, to investigate the association between HbA1c and carotid plaque. A logistic regression model was used to assess the association between carotid artery plaques, carotid plaque echogenicity, and HbA1c. RESULTS The HbA1c level of the plaque-present group was higher than that of the plaque-absent group [6.1 (5.6-7.2) vs. 5.8 (5.5-6.5), p < 0.001]. In multiple linear regression analysis, intima-media thickness was associated with HbA1c (p < 0.001). Logistic regression showed that a higher HbA1c level was associated with plaque incidence as well as hyperechoic and heterogeneous plaques (p < 0.001). These associations persist after adjusting for age, sex, blood pressure, lipid profiles, alcohol consumption, and tobacco exposure. CONCLUSION HbA1c levels are notably associated with carotid artery plaque incidence, intima-media thickness, and plaque echogenicity in patients with CHD. These findings show that different levels of HbA1c may be an indicator for carotid artery plaques and thus, should be observed in patients with CHD.
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Affiliation(s)
- Xufeng Cheng
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Zhu Li
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Mingjie Yang
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yijia Liu
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Shuo Wang
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Mengnan Huang
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Shan Gao
- Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Rongrong Yang
- School of Health Science and Engineering, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Lin Li
- Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Chunquan Yu
- Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
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11
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Kiyosawa R, Saito T, Yamada S, Harada K. Efficacy of Post-Dilatation during Carotid Artery Stenting for Unstable Plaque Using a Double-Layer Stent Evaluated by OFDI. J Neuroendovasc Ther 2022; 16:395-401. [PMID: 37502638 PMCID: PMC10370631 DOI: 10.5797/jnet.oa.2022-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 02/22/2022] [Indexed: 07/29/2023]
Abstract
Objective This study aimed to use optical frequency domain imaging (OFDI) to evaluate the efficacy of post-dilatation (PD) after stent placement for unstable plaques during carotid artery stenting (CAS) using a double-layer stent. Methods Twelve unstable carotid plaque lesions diagnosed by MRI were evaluated using OFDI during CAS. The pre-procedural minimum lumen diameter was 1.6 ± 0.7 mm. Each lesion was pre-dilated with balloon catheters (diameter, 5.3 ± 0.5 mm), and a double-layer stent was deployed. PD was performed with balloon catheters of the same size as those used for pre-dilatation. Cross-sectional OFDI images within the stented segment were evaluated at 1-mm intervals for a 20-mm segment, including the most stenotic lesion. Slice rates for the presence of in-stent plaque protrusion (PP) and plaque between the double-layer lumen were calculated. Results No procedural complications occurred with the use of an embolic protection device. Compared to after stent placement, slice rates for any PP (44 ± 19% to 62 ± 22%, P <0.05) and plaque between the double-layer lumen (79 ± 16% to 91 ± 34%, P <0.05) were significantly increased after PD; slice rates for >500 μm PP (7.5 ± 14% to 0%, P <0.05) were significantly decreased. Visible debris were captured in 50% of lesions. Conclusion PD after double-layer carotid stent placement decreases in-stent large PP. Double-layer construction contributed to the prevention of large PP, as the PP may have been crushed into debris by PD.
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Affiliation(s)
- Ryuichiro Kiyosawa
- Department of Neurosurgery, Fukuoka Wajiro Hospital, Fukuoka, Fukuoka, Japan
| | - Takaya Saito
- Department of Neurosurgery, Fukuoka Wajiro Hospital, Fukuoka, Fukuoka, Japan
| | - Shingo Yamada
- Department of Neurosurgery, Fukuoka Wajiro Hospital, Fukuoka, Fukuoka, Japan
| | - Kei Harada
- Department of Neurosurgery, Fukuoka Wajiro Hospital, Fukuoka, Fukuoka, Japan
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12
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Xu Y, Hu T, Shen Y, Wang Y, Ma X, Bao Y. Association of High Muscle Mass with Carotid Atherosclerosis: A Community-Based Population Cohort Study. J Nutr Health Aging 2022; 26:1087-1093. [PMID: 36519772 DOI: 10.1007/s12603-022-1871-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Although low muscle mass may make an under-appreciated contribution to increasing the risk of cardiovascular diseases, no prospective studies have explored the association between low muscle mass and carotid atherosclerosis. We investigated whether muscle mass was related to a higher carotid intima-media thickness (C-IMT) and carotid artery plaque in a community-based population. METHODS The study included 1,253 asymptomatic participants without known cardiovascular disease, who underwent carotid ultrasonography at baseline in 2013-2014 and received a re-examination in 2015-2016. The skeletal muscle mass index was estimated using a bioelectrical impedance analyzer. We assessed the relationship between the skeletal muscle mass index and the development of C-IMT and carotid plaque, both, using multivariate-adjusted logistic regression models. RESULTS During the follow up, 400 (51.0%) subjects with normal C-IMT at baseline developed elevated C-IMT and 215 (17.2%) subjects developed carotid plaque. The risk of elevated C-IMT occurrence linearly decreased with an increase in skeletal muscle mass index quintiles or its continuous data, after multivariate-adjustment in men and women, respectively (both P for trend < 0.05; both P < 0.05). Subgroup analyses showed that this association was BMI-dependent. Besides, there was an inverse association between a high skeletal muscle mass index and carotid artery plaque in women, but the association disappeared after multivariate adjustment. In men, the skeletal muscle mass index was not associated with the incidence of carotid plaque. CONCLUSIONS Skeletal muscle mass was inversely associated with the incidence of carotid atherosclerosis, suggesting muscle mass maintenance may play a role in modifying atherosclerosis.
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Affiliation(s)
- Y Xu
- Xiaojing Ma and Yuqian Bao (http://orcid.org/0000-0002-4754-3470), Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai 200233, China, Tel: 86-21-64369181; Fax: 86-21-64368031, ;
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13
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Oki R, Hamasaki Y, Komaru Y, Miyamoto Y, Matsuura R, Akari S, Nakamura T, Murase T, Doi K, Nangaku M. Plasma xanthine oxidoreductase is associated with carotid atherosclerosis in stable kidney transplant recipients. Nephrology (Carlton) 2021; 27:363-370. [PMID: 34626042 DOI: 10.1111/nep.13983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/30/2021] [Accepted: 10/09/2021] [Indexed: 11/30/2022]
Abstract
AIM Xanthine oxidoreductase (XOR) is known as an enzyme related to purine metabolism, catalysing the oxidation of hypoxanthine to xanthine and of xanthine to uric acid. We investigated the relationship between plasma XOR activity in stable kidney transplantation (KT) recipients and carotid artery lesions. METHODS A total of 42 KT patients visiting our outpatient clinic on regular basis were recruited. Associations between plasma XOR activity and the existence of plaque in the common carotid artery (CCA) or internal carotid artery (ICA) and maximum intima-medial thickness (IMT) of CCA (max-CIMT) > 0.9 mm were examined using univariate and multivariate analyses. RESULTS At blood sampling, the mean and SD patient age was 52.7 ± 13.8 years old. Plasma XOR(pmol/h/ml) activity was significantly higher in patients with CCA/ICA plaque or max-CIMT >0.9 mm than those without. [23.9 (11.8, 38.3) vs. 8.29 (6.67, 17.5), p < .01, 23.9 (16.9, 71.2) vs. 9.16 (6.67, 28.2), p = .01] Univariate and multivariate logistic regression analyses revealed age and plasma XOR activity as independent predictors of CCA/ICA plaque or max-CIMT >0.9 mm. Receiver operator characteristic curve analyses revealed that the cutoff value of plasma XOR activity for the diagnosis of CCA/ICA plaque or CCA-IMT > 0.9 mm was 16.3 pmol/h/ml. CONCLUSION Plasma XOR activity is associated independently with atherosclerotic changes in the carotid artery of stable post-KT patients.
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Affiliation(s)
- Rikako Oki
- Department of Hemodialysis and Apheresis, The University of Tokyo Hospital, Tokyo, Japan
| | - Yoshifumi Hamasaki
- Department of Hemodialysis and Apheresis, The University of Tokyo Hospital, Tokyo, Japan
| | - Yohei Komaru
- Department of Hemodialysis and Apheresis, The University of Tokyo Hospital, Tokyo, Japan
| | - Yoshihisa Miyamoto
- Department of Hemodialysis and Apheresis, The University of Tokyo Hospital, Tokyo, Japan
| | - Ryo Matsuura
- Department of Hemodialysis and Apheresis, The University of Tokyo Hospital, Tokyo, Japan
| | - Seigo Akari
- Medical Affairs Department, Sanwa Kagaku Kenkyusho Co., Ltd., Aichi, Japan
| | - Takashi Nakamura
- Medical Affairs Department, Sanwa Kagaku Kenkyusho Co., Ltd., Aichi, Japan
| | - Takayo Murase
- Radioisotope and Chemical Analysis Center, Mie Research Park, Sanwa Kagaku Kenkyusho Co., Ltd., Mie, Japan
| | - Kent Doi
- Department of Acute Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Masaomi Nangaku
- Department of Hemodialysis and Apheresis, The University of Tokyo Hospital, Tokyo, Japan
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14
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Razavi AC, Bazzano LA, He J, Krousel-Wood M, Chen J, Fernandez C, Whelton SP, Kelly TN. Early Contributors to Healthy Arterial Aging Versus Premature Atherosclerosis in Young Adults: The Bogalusa Heart Study. J Am Heart Assoc 2021; 10:e020774. [PMID: 34096330 PMCID: PMC8477892 DOI: 10.1161/jaha.121.020774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background Early identification of healthy arterial aging versus premature atherosclerosis is important for optimal atherosclerotic cardiovascular disease risk stratification and prevention. We sought to identify predictors for the long‐term absence of carotid plaque among young adults. Methods and Results We included 508 participants from the Bogalusa Heart Study without clinical atherosclerotic cardiovascular disease who were free of carotid plaque at baseline (2001–2002) and underwent ultrasound imaging at follow‐up (2013–2016). Modified Poisson regression estimated the persistent absence of plaque over 12.8 years. Participants were on average age 36.2 years at baseline, 64% were women, and 29% were Black. Although nearly all participants (97%) had a 10‐year atherosclerotic cardiovascular disease risk <7.5%, there were 162 people (32%) who developed premature atherosclerosis. Aside from younger age (risk ratio [RR], 1.21; 95% CI, 1.07–1.36, per 10 years) and a total cholesterol/high‐density lipoprotein cholesterol ratio <3.5 (RR, 1.15; 95% CI, 1.01–1.30), normal values of traditional risk factors did not predict long‐term absence of plaque. Independent from traditional markers including glomerular filtration rate, serum calcium‐phosphate product (RR, 1.07; 95% CI, 1.01–1.14, per 1‐SD lower), phosphate (RR, 1.15; 95% CI, 1.03–1.29, per 1 mg/dL lower), and dietary sodium <2300 mg/day (RR, 1.20; 95% CI, 1.02–1.41) were significantly associated with the non‐development of plaque. Conclusions Nearly one third of young adults with a low burden of traditional risk factors developed premature atherosclerosis. Beyond younger age and an ideal lipoprotein profile, lower calcium‐phosphate homeostasis and low sodium intake were associated with long‐term absence of carotid plaque. These results suggest that dietary and intrinsic minerals are early contributors to the development of arterial aging phenotypes.
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Affiliation(s)
- Alexander C Razavi
- Department of Medicine Tulane University School of Medicine New Orleans LA.,Department of Epidemiology Tulane University, School of Public Health and Tropical Medicine New Orleans LA
| | - Lydia A Bazzano
- Department of Medicine Tulane University School of Medicine New Orleans LA.,Department of Epidemiology Tulane University, School of Public Health and Tropical Medicine New Orleans LA
| | - Jiang He
- Department of Medicine Tulane University School of Medicine New Orleans LA.,Department of Epidemiology Tulane University, School of Public Health and Tropical Medicine New Orleans LA
| | - Marie Krousel-Wood
- Department of Medicine Tulane University School of Medicine New Orleans LA.,Department of Epidemiology Tulane University, School of Public Health and Tropical Medicine New Orleans LA
| | - Jing Chen
- Department of Medicine Tulane University School of Medicine New Orleans LA.,Department of Epidemiology Tulane University, School of Public Health and Tropical Medicine New Orleans LA
| | - Camilo Fernandez
- Department of Medicine Tulane University School of Medicine New Orleans LA.,Department of Epidemiology Tulane University, School of Public Health and Tropical Medicine New Orleans LA
| | - Seamus P Whelton
- The Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins University School of Medicine Baltimore MD
| | - Tanika N Kelly
- Department of Medicine Tulane University School of Medicine New Orleans LA.,Department of Epidemiology Tulane University, School of Public Health and Tropical Medicine New Orleans LA
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15
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Vista FP 4th, Ngo MT, Cho SB, Kwak HS, Chong KT. Carotid Artery Plaque Identification and Display System (MRI-CAPIDS) Using Opensource Tools. Diagnostics (Basel) 2020; 10:E1111. [PMID: 33371362 DOI: 10.3390/diagnostics10121111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/07/2020] [Accepted: 12/15/2020] [Indexed: 11/21/2022] Open
Abstract
Magnetic resonance imaging (MRI) represents one modality in atherosclerosis risk assessment, by permitting the classification of carotid plaques into either high- or low-risk lesions. Although MRI is generally used for observing the impact of atherosclerosis on vessel lumens, it can also show both the size and composition of itself, as well as plaque information, thereby providing information beyond that of simple stenosis. Software systems are a valuable aid in carotid artery stenosis assessment wherein commercial software is readily available but is not accessible to all practitioners because of its often high cost. This study focuses on the development of a software system designed entirely for registration, marking, and 3D visualization of the wall and lumen, using freely available open-source tools and libraries. It was designed to be free from “feature bloat” and avoid “feature-creep.” The image loading and display module of the modified QDCM library was improved by a minimum of 10,000%. A Bezier function was used in order to smoothen the curve of the polygon (referring to the shape formed by the marked points) by interpolating additional points between the marked points. This smoother curve led to a smoother 3D view of the lumen and wall.
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16
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Bueno A, March JR, Garcia P, Cañibano C, Ferruelo A, Fernandez-Casado JL. Carotid Plaque Inflammation Assessed by 18F-FDG PET/CT and Lp-PLA 2 Is Higher in Symptomatic Patients. Angiology 2020; 72:260-267. [PMID: 33089697 DOI: 10.1177/0003319720965419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Carotid plaque inflammation assessed by 2-deoxy-2-[18F]fluoro-D-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) and lipoprotein-associated phospholipase A2 (Lp-PLA2) levels are higher in symptomatic patients. The aim of this study was to assess correlations between 18F-FDG uptake on PET scan of carotid artery plaques, plasma levels of Lp-PLA2, and cerebrovascular symptoms. The study included 45 consecutive patients (22 symptomatic, 23 asymptomatic) with >70% carotid stenosis. Patients were examined by hybrid PET/CT, and maximum standardized uptake values (SUVmax) were recorded. Blood samples were obtained, and plasma was stored at -80 °C for subsequent Lp-PLA2 analysis. Symptomatic and asymptomatic patients showed no significant difference in classical cardiovascular risk factors. Asymptomatic carotid stenosis patients more frequently had a history of coronary artery disease (P = .025) and peripheral artery disease (P = .012). The symptomatic group had higher 18F-FDG uptake in carotid plaques (P < .001), higher plasma Lp-PLA2 (P < .01), and higher high-sensitive C-reactive protein (P = .022). 2-Deoxy-2-[18F]fluoro-D-glucose uptake on PET/CT and plasma Lp-PLA2 show a statistically significant association with the symptomatic status of carotid plaques.
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Affiliation(s)
- Alicia Bueno
- Angiology and Vascular Surgery Department, 16503Hospital Universitario de Getafe, Madrid, Spain.,Getafe Health Research Institute, Madrid, Spain
| | - Jose Ramon March
- Angiology and Vascular Surgery Department, 16503Hospital Universitario de Getafe, Madrid, Spain.,Getafe Health Research Institute, Madrid, Spain
| | - Pilar Garcia
- Getafe Health Research Institute, Madrid, Spain.,Nuclear Medicine Department, 16503Hospital Universitario de Getafe, Madrid, Spain
| | - Cristina Cañibano
- Angiology and Vascular Surgery Department, 16503Hospital Universitario de Getafe, Madrid, Spain.,Getafe Health Research Institute, Madrid, Spain
| | - Antonio Ferruelo
- Department of Critical Care, 16503Hospital Universitario de Getafe, Madrid, Spain.,Ciber Enfermedades Respiratorias (CIBER), Getafe Health Research Institute, Madrid, Spain
| | - Jose Luis Fernandez-Casado
- Angiology and Vascular Surgery Department, 16503Hospital Universitario de Getafe, Madrid, Spain.,Getafe Health Research Institute, Madrid, Spain
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17
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Abstract
Current risk stratification for stroke is still based upon percentage of carotid stenosis, despite this measure providing minimal patient-specific information on the actual risk of stroke for both symptomatic individuals without significant carotid artery stenosis as well as asymptomatic carotid stenosis patients. A continuously growing body of literature suggests that the identification and quantification of certain carotid plaque characteristics, including lipid-rich necrotic core (LRNC), thin/ruptured fibrous cap (FC), and intraplaque hemorrhage (IPH), provide a superior means of predicting future stroke. These characteristics are identifiable via magnetic resonance imaging (MRI), with most features detectable using commercially available coils and sequences utilized in routine clinical practice in as little as 4 minutes. The presence of LRNC, a thin/ruptured FC, and IPH is associated with increased risk of future stroke or TIA. Plaques with greater than 40% LRNC with a thin overlying FC are prone to rupture. LRNC is T2 hypointense and lacks enhancement on contrast enhanced T1 weighted images. Increasing LRNC size is associated with the development of new ulceration, FC rupture, increasing plaque burden, as well as fatal and nonfatal myocardial infarction, ischemic stroke, hospitalization for acute coronary syndrome (ACS), and symptom-driven revascularization, allowing for MR biomarkers of carotid plaque vulnerability to be utilized for systemic athero-thrombotic risk and not just stroke/TIA. LRNC typically shrinks with appropriate statin therapy, with PCSK9 inhibitors possibly playing a role in patients with inadequate response. Carotid plaques with IPH represent a more advanced stage of atherosclerotic disease. IPH is detectable with field strengths of both 3.0 T and 1.5 T and will demonstrate high signal on all T1 weighted imaging sequences. The presence of IPH increases the risk of future stroke in both symptomatic and asymptomatic patients, with multivariate analysis identifying IPH as a predictor of stroke, independent of percent stenosis, with no statistical difference in men vs. women, demonstrating that simple carotid stenosis measurements and traditional risk factor analysis may be inadequate in identifying patients at the highest risk for adverse cerebrovascular events. In the evaluation for recurrent stroke in recently symptomatic patients with >50% carotid stenosis, the estimated annual stroke risk is 23.2% in IPH+ patients and only 0.6% in IPH- patients, calling into question the current risk-benefit assessment for CEA. Additionally, a recent meta-analysis suggests that IPH+ plaque in patients with symptomatic <50% stenosis may be the etiology of embolic strokes previously labeled as "embolic stroke of undetermined source" (ESUS). There are no prospective drug trials testing the ability of any lipid-lowering therapies to decrease IPH and/or total plaque volume (TPV). Given the continuously increasing evidence of IPH as a significant predictor of carotid plaque progression and future adverse vascular events, trials aimed at targeted therapy for IPH represents a significant need.
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Affiliation(s)
- Michael E Porambo
- Department of Radiology, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - J Kevin DeMarco
- Department of Radiology, Walter Reed National Military Medical Center, Bethesda, MD, USA.,Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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18
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Motoyama R, Saito K, Tonomura S, Ishibashi-Ueda H, Yamagami H, Kataoka H, Morita Y, Uchihara Y, Iihara K, Takahashi JC, Sugie K, Toyoda K, Nagatsuka K. Utility of Complementary Magnetic Resonance Plaque Imaging and Contrast-Enhanced Ultrasound to Detect Carotid Vulnerable Plaques. J Am Heart Assoc 2020; 8:e011302. [PMID: 30977413 PMCID: PMC6507198 DOI: 10.1161/jaha.118.011302] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background We aimed to improve the assessment quality of plaque vulnerability with combined use of magnetic resonance imaging and contrast-enhanced ultrasound ( CEUS ). Methods and Results We prospectively enrolled 71 patients with internal carotid artery stenosis who underwent carotid endarterectomy and performed preoperative CEUS and magnetic resonance plaque imaging. We distinguished high-signal-intensity plaques ( HIP s) and non- HIP s based on magnetization-prepared rapid acquisition with gradient echo images. We graded them according to the CEUS contrast effect and compared the CEUS images with the carotid endarterectomy specimens. Among the 70 plaques, except 1 carotid endarterectomy tissue sample failure, 59 were classified as HIP s (43 symptomatic) and 11 were classified as non- HIP s (5 symptomatic). Although the magnetization-prepared rapid acquisition with gradient echo findings alone had no significant correlation with symptoms ( P=0.07), concomitant use of magnetization-prepared rapid acquisition with gradient echo and CEUS findings did show a significant correlation ( P<0.0001). CEUS showed that all 5 symptomatic non- HIP s had a high-contrast effect. These 5 plaques were histopathologically confirmed as vulnerable, with extensive neovascularization but only a small amount of intraplaque hemorrhage. Conclusions Complementary use of magnetic resonance imaging and CEUS to detect intraplaque hemorrhage and neovascularization in plaques can be useful for evaluating plaque vulnerability, consistent with the destabilization process associated with neovessel formation and subsequent intraplaque hemorrhage.
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Affiliation(s)
- Rie Motoyama
- 1 Department of Neurology National Cerebral and Cardiovascular Center Osaka Japan.,8 Department of Neurology Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology Tokyo Japan
| | - Kozue Saito
- 1 Department of Neurology National Cerebral and Cardiovascular Center Osaka Japan.,5 Department of Neurology Nara Medical University Nara Japan
| | - Shuichi Tonomura
- 1 Department of Neurology National Cerebral and Cardiovascular Center Osaka Japan
| | | | - Hiroshi Yamagami
- 1 Department of Neurology National Cerebral and Cardiovascular Center Osaka Japan
| | - Hiroharu Kataoka
- 3 Department of Neurosurgery National Cerebral and Cardiovascular Center Osaka Japan
| | - Yoshiaki Morita
- 4 Department of Radiology National Cerebral and Cardiovascular Center Osaka Japan
| | - Yuto Uchihara
- 5 Department of Neurology Nara Medical University Nara Japan
| | - Koji Iihara
- 3 Department of Neurosurgery National Cerebral and Cardiovascular Center Osaka Japan.,6 Department of Neurosurgery Graduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Jun C Takahashi
- 3 Department of Neurosurgery National Cerebral and Cardiovascular Center Osaka Japan
| | - Kazuma Sugie
- 5 Department of Neurology Nara Medical University Nara Japan
| | - Kazunori Toyoda
- 7 Department of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Osaka Japan
| | - Kazuyuki Nagatsuka
- 1 Department of Neurology National Cerebral and Cardiovascular Center Osaka Japan
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19
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Wu Y, Dai Y, Jia Y, Yu S, Xu S, Wang W. Carotid artery plaques and unilateral spatial neglect in the elderly. Medicine (Baltimore) 2020; 99:e18998. [PMID: 31977916 PMCID: PMC7004680 DOI: 10.1097/md.0000000000018998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The causes for falls in the elderly are varied, and visual spatial neglect could be 1 contributing factor. Further, the presence of a carotid artery plaque, especially on the right side, might influence the visual spatial attention of the elderly.Our aim was to identify the intrinsic association between carotid plaques and lateralization of spatial attention in the elderly. Further, we sought to understand and potentially prevent the consequences of unilateral spatial neglect such as injury from falls.Participants aged 64 to 93 years were divided into a group with carotid artery plaque(s) of the right side or both sides (BOTH, n = 38; and 9/ 38 were right side only) and a group without right-side carotid artery plaque(s) (LEFT, n = 53). Participants were asked to perform a line bisection task and undergo doppler ultrasonography examinations.Contrary to expectations, compared to LEFT, the mean index and net scores of the line bisection errors in BOTH were significantly less leftward, but the mean diameter of the right-side common carotid artery in BOTH was significantly larger.Our results indicate that the presence of carotid plaque(s) might be linked to increased risk of falls in the elderly. The attenuated spatial neglect in participants with right-side carotid artery plaque(s) might be due to compensatory carotid artery dilatation.
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Affiliation(s)
- Yixiao Wu
- Department of Ultrasound B, Beishan Community Health Service Center
| | - Yue Dai
- Department of Clinical Psychology and Psychiatry/ School of Public Health, Zhejiang University College of Medicine, Hangzhou, China
| | - Yanli Jia
- Department of Clinical Psychology and Psychiatry/ School of Public Health, Zhejiang University College of Medicine, Hangzhou, China
| | - Shuhang Yu
- Department of Clinical Psychology and Psychiatry/ School of Public Health, Zhejiang University College of Medicine, Hangzhou, China
| | - Siyuan Xu
- Department of Clinical Psychology and Psychiatry/ School of Public Health, Zhejiang University College of Medicine, Hangzhou, China
| | - Wei Wang
- Department of Clinical Psychology and Psychiatry/ School of Public Health, Zhejiang University College of Medicine, Hangzhou, China
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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Yu LY, Hu KC, Liu CJ, Hung CL, Bair MJ, Chen MJ, Wang HY, Wu MS, Shih SC, Liu CC. Helicobacter pylori infection combined with non-alcoholic fatty liver disease increase the risk of atherosclerosis: Focus in carotid artery plaque. Medicine (Baltimore) 2019; 98:e14672. [PMID: 30817593 PMCID: PMC6831312 DOI: 10.1097/md.0000000000014672] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Atherosclerosis has severe consequences on human health. Carotid artery plaques are a condition typically caused by atherosclerosis. Previous studies showed that nonalcoholic fatty liver disease (NAFLD) and Helicobacter pylori (H pylori) are risks factors for carotid artery plaque formation. We hypothesize that the combination of NAFLD with H pylori infection increases the risk of carotid artery plaque formation.A total of 4669 subjects aged > 40 years who underwent routine health checkups between January 2006 and December 2015 were retrospectively reviewed. A serial examination, including abdominal ultrasound, carotid artery ultrasound and esophago-gastroduodenoscopy (EGD), and biopsy urease testing, was conducted.In total, 2402 subjects were enrolled. There were no differences in H pylori infection status among patients with or without NAFLD. There was a trend of more participants with both NAFLD and H pylori infection (number [N]=583) presenting carotid artery plaque (N = 187,32.08%) than participants without NAFLD and H pylori infection (N = 589) who presented plaque formation (N = 106, 18.00%). Participants who had both H pylori infection and NAFLD had the highest risk of any carotid artery plaque (odds ratio [OR], 1.93; 95% confidence interval [CI], 1.413-2.636) based on a multivariate logistic regression analysis. This analysis also showed that age >60 years, male sex, low-density lipoprotein (LDL) >130 mg/dL, and H pylori infection were independent risk factors for concomitant NAFLD and carotid artery plaque formation.The combination of H pylori infection and NAFLD increases carotid artery plaque formation. H pylori eradication and NAFLD control may be warranted to prevent carotid artery plaque formation.
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Affiliation(s)
- Lo-Yip Yu
- Division of Gastroenterology, Department of Internal Medicine, Healthy Evaluation Center
| | - Kuang-Chun Hu
- Division of Gastroenterology, Department of Internal Medicine, Healthy Evaluation Center
| | - Chun-Jen Liu
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chung-Lieh Hung
- Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei
| | - Ming-Jong Bair
- Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Taitung Branch, Taitung
| | - Ming-Jen Chen
- Division of Gastroenterology, Department of Internal Medicine, Healthy Evaluation Center
| | - Horng-Yuan Wang
- Division of Gastroenterology, Department of Internal Medicine, Healthy Evaluation Center
| | - Ming-Shiang Wu
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Shou-Chuan Shih
- Division of Gastroenterology, Department of Internal Medicine, Healthy Evaluation Center
| | - Chuan-Chuan Liu
- Division of Gastroenterology, Department of Internal Medicine, Healthy Evaluation Center
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21
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Hu KC, Wu MS, Chu CH, Wang HY, Lin SC, Po HL, Bair MJ, Liu CC, Su TH, Chen CL, Liu CJ, Shih SC. Hyperglycemia combined Helicobacter pylori infection increases risk of synchronous colorectal adenoma and carotid artery plaque. Oncotarget 2017; 8:108655-108664. [PMID: 29312558 PMCID: PMC5752471 DOI: 10.18632/oncotarget.22094] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 09/23/2017] [Indexed: 01/06/2023] Open
Abstract
Background Cardiovascular disease and colorectal cancer have severe consequences to human health and may occur simultaneously or sequentially. Carotid artery plaque is a predictor of cardiovascular disease, and colorectal adenoma is a premalignant lesion of colorectal cancer. We investigated the core risk factors of carotid artery plaque and colorectal adenoma. Results In total, 2361 subjects were enrolled. In multivariate analysis, age ≥ 60 years, male sex, BMI > 27, LDL > 130 mg/dL, HbA1c ≥ 6.5%, hs-CRP > 0.3 mg/L and H. pylori infection were independent risk factors for synchronous colorectal adenoma and carotid artery plaque formation. In the H. pylori-positive and -negative groups, the proportions and odds ratio (OR) for synchronous colon adenoma and carotid artery plaque increased with increasing HbA1c. OR for synchronous colon adenoma and carotid artery plaque was significantly higher in the participants with HbA1c levels of 5.7%–6.4% and HbA1c ≥ 6.5% than in those with normal HbA1c in the H. pylori-negative group. The OR was more significant increased for H. pylori-positive patients when HbA1c level ≥ 6.5% was 15.87 (95% CI 8.661–29.082, p < 0.0001). Materials and Methods The records of 4669 subjects aged > 40 years who underwent bidirectional gastrointestinal endoscopy and carotid artery ultrasound examination on the same day or within 12 months of endoscopy examination from January 2006 to December 2015 were reviewed. All subjects had a gastric biopsy specimen tested for Helicobacter pylori. Conclusions Hyperglycemia combined with H. pylori infection was an increased risk factor for synchronous colorectal adenoma and carotid artery plaque formation. Diabetes control and H. pylori eradication may be warranted in higher prevalence areas.
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Affiliation(s)
- Kuang-Chun Hu
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.,Healthy Evaluation Center, MacKay Memorial Hospital, Taipei, Taiwan.,MacKay Medicine, Nursing and Management College, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.,MacKay Medical College, Taipei, Taiwan
| | - Ming-Shiang Wu
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Cheng-Hsin Chu
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.,MacKay Medicine, Nursing and Management College, Taipei, Taiwan
| | - Horng-Yuan Wang
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.,Healthy Evaluation Center, MacKay Memorial Hospital, Taipei, Taiwan.,MacKay Medicine, Nursing and Management College, Taipei, Taiwan
| | - Shee-Chan Lin
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.,MacKay Medicine, Nursing and Management College, Taipei, Taiwan
| | - Helen L Po
- Department of Neurology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Ming-Jong Bair
- Gastroenterology Division, Department of Internal Medicine, MacKay Memorial Hospital, Taitung Branch, Taiwan
| | - Chuan-Chuan Liu
- Healthy Evaluation Center, MacKay Memorial Hospital, Taipei, Taiwan
| | - Tung-Hung Su
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chi-Ling Chen
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chun-Jen Liu
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Shou-Chuan Shih
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.,Healthy Evaluation Center, MacKay Memorial Hospital, Taipei, Taiwan.,MacKay Medicine, Nursing and Management College, Taipei, Taiwan.,MacKay Medical College, Taipei, Taiwan
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22
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Ichinose N, Hama S, Tsuji T, Soh Z, Hayashi H, Kiura Y, Sakamoto S, Okazaki T, Ishii D, Shinagawa K, Kurisu K. Predicting ischemic stroke after carotid artery stenting based on proximal calcification and the jellyfish sign. J Neurosurg 2017; 128:1280-1288. [PMID: 28686117 DOI: 10.3171/2017.1.jns162379] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Carotid artery stenting (CAS) has been considered to prevent ischemic strokes caused by stenosis of the cervical carotid artery. The most common complication of CAS is new cerebral infarction. The authors have previously reported that the jellyfish sign-the rise and fall of the mobile component of the carotid plaque surface detected by carotid ultrasonography-suggests thinning and rupture of the fibrous cap over the unstable plaque content, such as the lipid-rich necrotic core or internal plaque hemorrhage. The authors' aim in the present study was to evaluate the risk of a new ischemic lesion after CAS by using many risk factors including calcification (size and location) and the jellyfish sign. METHODS Eighty-six lesions (77 patients) were treated with CAS. The presence of ischemic stroke was determined using diffusion-weighted imaging (DWI). Risk factors included calcification of the plaque (classified into 5 groups for size and 3 groups for location) and the jellyfish sign, among others. Multiple linear regression analysis (stepwise analysis and partial least squares [PLS] analysis) was conducted, followed by a machine learning analysis using an artificial neural network (ANN) based on the log-linearized gaussian mixture network (LLGMN). The additive effects of the jellyfish sign and calcification on ischemic stroke after CAS were examined using the Kruskal-Wallis test, followed by the Steel-Dwass test. RESULTS The stepwise analysis selected the jellyfish sign, proximal calcification (proximal Ca), low-density lipoprotein (LDL) cholesterol, and patient age for the prediction model to predict new DWI lesions. The PLS analysis revealed the same top 3 variables (jellyfish sign, proximal Ca, and LDL cholesterol) according to the variable importance in projection scores. The ANN was then used, showing that these 3 variables remained. The accuracy of the ANN improved; areas under the receiver operating characteristic curves of the stepwise analysis, the PLS analysis, and the ANN were 0.719, 0.727, and 0.768, respectively. The combination of the jellyfish sign and proximal Ca indicates a significantly increased risk for ischemic stroke after CAS. CONCLUSIONS The jellyfish sign, proximal Ca, and LDL cholesterol were considered to be important predictors for new DWI lesions after CAS. These 3 factors can be easily determined during a standard clinical visit. Thus, these 3 variables-especially the jellyfish sign and proximal Ca-may be useful for reducing the ischemic stroke risk in patients with stenosis of the cervical carotid artery.
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Affiliation(s)
- Nobuhiko Ichinose
- 1Department of Neurosurgery, Graduate School of Biomedical and Health Science; and
| | - Seiji Hama
- 1Department of Neurosurgery, Graduate School of Biomedical and Health Science; and
| | - Toshio Tsuji
- 2Graduate School of Engineering, Hiroshima University, Hiroshima, Japan
| | - Zu Soh
- 2Graduate School of Engineering, Hiroshima University, Hiroshima, Japan
| | - Hideaki Hayashi
- 2Graduate School of Engineering, Hiroshima University, Hiroshima, Japan
| | - Yoshihiro Kiura
- 1Department of Neurosurgery, Graduate School of Biomedical and Health Science; and
| | - Shigeyuki Sakamoto
- 1Department of Neurosurgery, Graduate School of Biomedical and Health Science; and
| | - Takahito Okazaki
- 1Department of Neurosurgery, Graduate School of Biomedical and Health Science; and
| | - Daizo Ishii
- 1Department of Neurosurgery, Graduate School of Biomedical and Health Science; and
| | - Katsuhiro Shinagawa
- 1Department of Neurosurgery, Graduate School of Biomedical and Health Science; and
| | - Kaoru Kurisu
- 1Department of Neurosurgery, Graduate School of Biomedical and Health Science; and
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Abstract
Atherosclerotic carotid stenosis (ACS) is a major cause of ischemic stroke. Screening for asymptomatic ACS is important to identify the patients who require longitudinal surveillance, medication, or endovascular surgery. The aim of this study was to assess the prevalence and risk factors for ACS and carotid plaque (CP) in Korea using a population-based screening study.We recruited participants during visits to several community welfare centers in Korea. The baseline characteristics of the study population were collected. All patients underwent duplex ultrasonography to examine their bilateral carotid arteries. ACS was defined as the presence of plaque with ≥50% vessel diameter reduction and peak systolic velocity (PSV) ≥125 cm/s or PSV ratio ≥2.0. CP was defined as the presence of plaque with <50% vessel diameter reduction. The Mann-Whitney test, χ test, Fisher exact test, and logistic regression were used in the statistical analysis.A total of 3030 participants were enrolled in this study (male 43.7% and female 56.3%). The prevalence of ACS and CP was 1.1% and 5.7%, respectively. Significant risk factors for CP included age ≥80 years (odds ratio [OR], 8.11; 95% confidence interval [CI], 3.45-18.93), male sex (OR, 2.16; 95% CI, 1.29-3.61), hypertension (OR, 1.72; 95% CI, 1.21-2.45), and hyperlipidemia (OR, 1.84; 95% CI, 1.30-2.62). The presence of ACS was significantly associated with age (OR, 1.07; 95% CI, 1.03-1.12), hypertension (OR, 3.16; 95% CI, 1.34-7.46), and being an ex-smoker (OR, 6.81; 95% CI, 1.66-27.93) or current smoker (OR, 6.97; 95% CI, 1.78-27.31) after adjusting for confounding factors.This population-based screening study revealed that ACS was uncommon and had a prevalence of 1.1% in the study population. Age, hypertension, and smoking were risk factors for ACS. Further investigations into the prevalence and risk factors of ACS are required, as are studies on the cost-effectiveness of a national screening program.
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Affiliation(s)
- Shin Young Woo
- Vascular Center, Heart Vascular and Stroke Institute, Samsung Medical Center
| | - Jin Hyun Joh
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sang-Ah Han
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Ho-Chul Park
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
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24
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Bekwelem W, Jensen PN, Norby FL, Soliman EZ, Agarwal SK, Lip GYH, Pan W, Folsom AR, Longstreth WT, Alonso A, Heckbert SR, Chen LY. Carotid Atherosclerosis and Stroke in Atrial Fibrillation: The Atherosclerosis Risk in Communities Study. Stroke 2016; 47:1643-6. [PMID: 27217511 DOI: 10.1161/strokeaha.116.013133] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 04/05/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Whether consideration of carotid intima-media thickness (cIMT) and carotid plaque would improve risk prediction of ischemic stroke in persons with atrial fibrillation (AF) is unknown. The purpose of this study was to assess the improvement in risk prediction of stroke by adding cIMT and carotid plaque to the CHA2DS2-VASc (variables age, heart failure, hypertension, diabetes mellitus, myocardial infarction, and peripheral arterial disease) score. METHODS We included participants from the Atherosclerosis Risk in Communities (ARIC) study (mean age, 63 years) who developed AF within 5 years after carotid measurement, were not on warfarin, and had no prior stroke at AF diagnosis. AF was ascertained from study ECGs and diagnosis codes, and stroke was physician adjudicated. Multivariable Cox models were used to assess association between carotid indices and ischemic stroke. Improvement in 10-year risk prediction of stroke was assessed by the C-statistic, net reclassification improvement, and relative integrated discrimination improvement. RESULTS There were 81 (11.2%) stroke events that occurred among 724 participants with AF during a mean follow-up of 8.5 years. Increased cIMT and presence of carotid plaque were significantly associated with increased stroke risk. The addition of cIMT+plaque to the CHA2DS2-VASc score marginally increased the C-statistic (95% confidence interval) from 0.685 (0.623-0.747) to 0.698 (0.638-0.759). The net reclassification improvement and integrated discrimination improvement for cIMT+plaque were 0.091 (95% confidence interval, 0.012-0.170) and 0.101 (95% confidence interval, 0.002-0.226), respectively. CONCLUSIONS Increased cIMT and presence of carotid plaque are associated with increased risk of ischemic stroke in individuals with AF. Furthermore, they may improve risk prediction of stroke, over and above the CHA2DS2-VASc score.
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Affiliation(s)
- Wobo Bekwelem
- From the University of Minnesota, Minneapolis (W.B., F.L.N., W.P., A.R.F., A.A., L.Y.C.); University of Washington, Seattle (P.N.J., W.T.L., S.R.H.); Wake Forest University, Winston-Salem, NC (E.Z.S.); Mt. Sinai School of Medicine, New York, NY (S.K.A.); and University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.).
| | - Paul N Jensen
- From the University of Minnesota, Minneapolis (W.B., F.L.N., W.P., A.R.F., A.A., L.Y.C.); University of Washington, Seattle (P.N.J., W.T.L., S.R.H.); Wake Forest University, Winston-Salem, NC (E.Z.S.); Mt. Sinai School of Medicine, New York, NY (S.K.A.); and University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.)
| | - Faye L Norby
- From the University of Minnesota, Minneapolis (W.B., F.L.N., W.P., A.R.F., A.A., L.Y.C.); University of Washington, Seattle (P.N.J., W.T.L., S.R.H.); Wake Forest University, Winston-Salem, NC (E.Z.S.); Mt. Sinai School of Medicine, New York, NY (S.K.A.); and University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.)
| | - Elsayed Z Soliman
- From the University of Minnesota, Minneapolis (W.B., F.L.N., W.P., A.R.F., A.A., L.Y.C.); University of Washington, Seattle (P.N.J., W.T.L., S.R.H.); Wake Forest University, Winston-Salem, NC (E.Z.S.); Mt. Sinai School of Medicine, New York, NY (S.K.A.); and University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.)
| | - Sunil K Agarwal
- From the University of Minnesota, Minneapolis (W.B., F.L.N., W.P., A.R.F., A.A., L.Y.C.); University of Washington, Seattle (P.N.J., W.T.L., S.R.H.); Wake Forest University, Winston-Salem, NC (E.Z.S.); Mt. Sinai School of Medicine, New York, NY (S.K.A.); and University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.)
| | - Gregory Y H Lip
- From the University of Minnesota, Minneapolis (W.B., F.L.N., W.P., A.R.F., A.A., L.Y.C.); University of Washington, Seattle (P.N.J., W.T.L., S.R.H.); Wake Forest University, Winston-Salem, NC (E.Z.S.); Mt. Sinai School of Medicine, New York, NY (S.K.A.); and University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.)
| | - Wei Pan
- From the University of Minnesota, Minneapolis (W.B., F.L.N., W.P., A.R.F., A.A., L.Y.C.); University of Washington, Seattle (P.N.J., W.T.L., S.R.H.); Wake Forest University, Winston-Salem, NC (E.Z.S.); Mt. Sinai School of Medicine, New York, NY (S.K.A.); and University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.)
| | - Aaron R Folsom
- From the University of Minnesota, Minneapolis (W.B., F.L.N., W.P., A.R.F., A.A., L.Y.C.); University of Washington, Seattle (P.N.J., W.T.L., S.R.H.); Wake Forest University, Winston-Salem, NC (E.Z.S.); Mt. Sinai School of Medicine, New York, NY (S.K.A.); and University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.)
| | - W T Longstreth
- From the University of Minnesota, Minneapolis (W.B., F.L.N., W.P., A.R.F., A.A., L.Y.C.); University of Washington, Seattle (P.N.J., W.T.L., S.R.H.); Wake Forest University, Winston-Salem, NC (E.Z.S.); Mt. Sinai School of Medicine, New York, NY (S.K.A.); and University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.)
| | - Alvaro Alonso
- From the University of Minnesota, Minneapolis (W.B., F.L.N., W.P., A.R.F., A.A., L.Y.C.); University of Washington, Seattle (P.N.J., W.T.L., S.R.H.); Wake Forest University, Winston-Salem, NC (E.Z.S.); Mt. Sinai School of Medicine, New York, NY (S.K.A.); and University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.)
| | - Susan R Heckbert
- From the University of Minnesota, Minneapolis (W.B., F.L.N., W.P., A.R.F., A.A., L.Y.C.); University of Washington, Seattle (P.N.J., W.T.L., S.R.H.); Wake Forest University, Winston-Salem, NC (E.Z.S.); Mt. Sinai School of Medicine, New York, NY (S.K.A.); and University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.)
| | - Lin Y Chen
- From the University of Minnesota, Minneapolis (W.B., F.L.N., W.P., A.R.F., A.A., L.Y.C.); University of Washington, Seattle (P.N.J., W.T.L., S.R.H.); Wake Forest University, Winston-Salem, NC (E.Z.S.); Mt. Sinai School of Medicine, New York, NY (S.K.A.); and University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.)
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Gijsen FJH, Nieuwstadt HA, Wentzel JJ, Verhagen HJM, van der Lugt A, van der Steen AFW. Carotid Plaque Morphological Classification Compared With Biomechanical Cap Stress: Implications for a Magnetic Resonance Imaging-Based Assessment. Stroke 2015; 46:2124-8. [PMID: 26081843 DOI: 10.1161/strokeaha.115.009707] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 04/21/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND PURPOSE Two approaches to target plaque vulnerability-a histopathologic classification scheme and a biomechanical analysis-were compared and the implications for noninvasive risk stratification of carotid plaques using magnetic resonance imaging were assessed. METHODS Seventy-five histological plaque cross sections were obtained from carotid endarterectomy specimens from 34 patients (>70% stenosis) and subjected to both a Virmani histopathologic classification (thin fibrous cap atheroma with <0.2-mm cap thickness, presumed vulnerable) and a peak cap stress computation (<140 kPa: presumed stable; >300 kPa: presumed vulnerable). To demonstrate the implications for noninvasive plaque assessment, numeric simulations of a typical carotid magnetic resonance imaging protocol were performed (0.62×0.62 mm(2) in-plane acquired voxel size) and used to obtain the magnetic resonance imaging-based peak cap stress. RESULTS Peak cap stress was generally associated with histological classification. However, only 16 of 25 plaque cross sections could be labeled as high-risk (peak cap stress>300 kPa and classified as a thin fibrous cap atheroma). Twenty-eight of 50 plaque cross sections could be labeled as low-risk (a peak cap stress<140 kPa and not a thin fibrous cap atheroma), leading to a κ=0.39. 31 plaques (41%) had a disagreement between both classifications. Because of the limited magnetic resonance imaging voxel size with regard to cap thickness, a noninvasive identification of only a group of low-risk, thick-cap plaques was reliable. CONCLUSIONS Instead of trying to target only vulnerable plaques, a more reliable noninvasive identification of a select group of stable plaques with a thick cap and low stress might be a more fruitful approach to start reducing surgical interventions on carotid plaques.
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Affiliation(s)
- Frank J H Gijsen
- From the Departments of Biomedical Engineering-Thoraxcenter (F.J.H.G., H.A.N., J.J.W., A.F.W.v.d.S.), Vascular Surgery (H.J.M.V.), and Radiology (A.v.d.L.), Erasmus MC, Rotterdam, The Netherlands; and Department of Applied Sciences, Delft University of Technology, Delft, The Netherlands (A.F.W.v.d.S.).
| | - Harm A Nieuwstadt
- From the Departments of Biomedical Engineering-Thoraxcenter (F.J.H.G., H.A.N., J.J.W., A.F.W.v.d.S.), Vascular Surgery (H.J.M.V.), and Radiology (A.v.d.L.), Erasmus MC, Rotterdam, The Netherlands; and Department of Applied Sciences, Delft University of Technology, Delft, The Netherlands (A.F.W.v.d.S.)
| | - Jolanda J Wentzel
- From the Departments of Biomedical Engineering-Thoraxcenter (F.J.H.G., H.A.N., J.J.W., A.F.W.v.d.S.), Vascular Surgery (H.J.M.V.), and Radiology (A.v.d.L.), Erasmus MC, Rotterdam, The Netherlands; and Department of Applied Sciences, Delft University of Technology, Delft, The Netherlands (A.F.W.v.d.S.)
| | - Hence J M Verhagen
- From the Departments of Biomedical Engineering-Thoraxcenter (F.J.H.G., H.A.N., J.J.W., A.F.W.v.d.S.), Vascular Surgery (H.J.M.V.), and Radiology (A.v.d.L.), Erasmus MC, Rotterdam, The Netherlands; and Department of Applied Sciences, Delft University of Technology, Delft, The Netherlands (A.F.W.v.d.S.)
| | - Aad van der Lugt
- From the Departments of Biomedical Engineering-Thoraxcenter (F.J.H.G., H.A.N., J.J.W., A.F.W.v.d.S.), Vascular Surgery (H.J.M.V.), and Radiology (A.v.d.L.), Erasmus MC, Rotterdam, The Netherlands; and Department of Applied Sciences, Delft University of Technology, Delft, The Netherlands (A.F.W.v.d.S.)
| | - Antonius F W van der Steen
- From the Departments of Biomedical Engineering-Thoraxcenter (F.J.H.G., H.A.N., J.J.W., A.F.W.v.d.S.), Vascular Surgery (H.J.M.V.), and Radiology (A.v.d.L.), Erasmus MC, Rotterdam, The Netherlands; and Department of Applied Sciences, Delft University of Technology, Delft, The Netherlands (A.F.W.v.d.S.)
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McNally JS, McLaughlin MS, Hinckley PJ, Treiman SM, Stoddard GJ, Parker DL, Treiman GS. Intraluminal thrombus, intraplaque hemorrhage, plaque thickness, and current smoking optimally predict carotid stroke. Stroke 2014; 46:84-90. [PMID: 25406146 DOI: 10.1161/strokeaha.114.006286] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE Intraplaque hemorrhage (IPH) is associated with acute and future stroke. IPH is also associated with lumen markers of stroke risk including stenosis, plaque thickness, and ulceration. Whether IPH adds further predictive value to these other variables is unknown. The purpose of this study was to determine whether IPH improves carotid-source stroke prediction. METHODS In this retrospective cross-sectional study, patients undergoing stroke workup were imaged with MRI and IPH detection. Seven hundred twenty-six carotid-brain image pairs were analyzed after excluding vessels with noncarotid plaque stroke sources (420) and occlusions (7) or near-occlusions (3). Carotid imaging characteristics were recorded, including percent diameter and mm stenosis, plaque thickness, ulceration, intraluminal thrombus, and IPH. Clinical confounders were recorded, and a multivariable logistic regression model was fitted. Backward elimination was used to determine essential carotid-source stroke predictors with a threshold 2-sided P<0.10. Receiver operating characteristic analysis was performed to determine discriminatory value. RESULTS Significant predictors of carotid-source stroke included intraluminal thrombus (odds ratio=103.6; P<0.001), IPH (odds ratio=25.2; P<0.001), current smoking (odds ratio=2.78; P=0.004), and thickness (odds ratio=1.24; P=0.020). The final model discriminatory value was excellent (area under the curve=0.862). This was significantly higher than the final model without IPH (area under the curve=0.814), or models using only stenosis as a continuous variable (area under the curve=0.770) or cutoffs of 50% and 70% (area under the curve=0.669), P<0.001. CONCLUSIONS After excluding patients with noncarotid plaque stroke sources, optimal discrimination of carotid-source stroke was obtained with intraluminal thrombus, IPH, plaque thickness, and smoking history but not ulceration and stenosis.
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Affiliation(s)
- J Scott McNally
- From the Utah Center for Advanced Imaging Research, Department of Radiology (J.S.M., M.S.M., P.J.H., S.M.T., D.L.P., G.S.T.), Study Design and Biostatistics Center, Department of Orthopedics (G.J.S.), and Department of Surgery (G.S.T.), University of Utah, Salt Lake City; and Department of Surgery, VA Salt Lake City Health Care System, UT (G.S.T.).
| | - Michael S McLaughlin
- From the Utah Center for Advanced Imaging Research, Department of Radiology (J.S.M., M.S.M., P.J.H., S.M.T., D.L.P., G.S.T.), Study Design and Biostatistics Center, Department of Orthopedics (G.J.S.), and Department of Surgery (G.S.T.), University of Utah, Salt Lake City; and Department of Surgery, VA Salt Lake City Health Care System, UT (G.S.T.)
| | - Peter J Hinckley
- From the Utah Center for Advanced Imaging Research, Department of Radiology (J.S.M., M.S.M., P.J.H., S.M.T., D.L.P., G.S.T.), Study Design and Biostatistics Center, Department of Orthopedics (G.J.S.), and Department of Surgery (G.S.T.), University of Utah, Salt Lake City; and Department of Surgery, VA Salt Lake City Health Care System, UT (G.S.T.)
| | - Scott M Treiman
- From the Utah Center for Advanced Imaging Research, Department of Radiology (J.S.M., M.S.M., P.J.H., S.M.T., D.L.P., G.S.T.), Study Design and Biostatistics Center, Department of Orthopedics (G.J.S.), and Department of Surgery (G.S.T.), University of Utah, Salt Lake City; and Department of Surgery, VA Salt Lake City Health Care System, UT (G.S.T.)
| | - Gregory J Stoddard
- From the Utah Center for Advanced Imaging Research, Department of Radiology (J.S.M., M.S.M., P.J.H., S.M.T., D.L.P., G.S.T.), Study Design and Biostatistics Center, Department of Orthopedics (G.J.S.), and Department of Surgery (G.S.T.), University of Utah, Salt Lake City; and Department of Surgery, VA Salt Lake City Health Care System, UT (G.S.T.)
| | - Dennis L Parker
- From the Utah Center for Advanced Imaging Research, Department of Radiology (J.S.M., M.S.M., P.J.H., S.M.T., D.L.P., G.S.T.), Study Design and Biostatistics Center, Department of Orthopedics (G.J.S.), and Department of Surgery (G.S.T.), University of Utah, Salt Lake City; and Department of Surgery, VA Salt Lake City Health Care System, UT (G.S.T.)
| | - Gerald S Treiman
- From the Utah Center for Advanced Imaging Research, Department of Radiology (J.S.M., M.S.M., P.J.H., S.M.T., D.L.P., G.S.T.), Study Design and Biostatistics Center, Department of Orthopedics (G.J.S.), and Department of Surgery (G.S.T.), University of Utah, Salt Lake City; and Department of Surgery, VA Salt Lake City Health Care System, UT (G.S.T.)
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Jung YS, Shin MH, Kim IS, Kweon SS, Lee YH, Kim OJ, Kim YJ, Chung HJ, Kim OS. Relationship between periodontal disease and subclinical atherosclerosis: the Dong-gu study. J Clin Periodontol 2013; 41:262-8. [PMID: 24256094 DOI: 10.1111/jcpe.12204] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2013] [Indexed: 12/01/2022]
Abstract
AIM We assessed the association of periodontal disease and number of missing teeth with subclinical atherosclerosis in an adult Korean population. MATERIALS AND METHODS Cross-sectional data from 5404 individuals aged ≥50 years were obtained from the 2008-2010 Dong-gu study. Periodontal examinations were conducted to determine the number of missing teeth, pocket depth (PD), clinical attachment loss (CAL), and bleeding on probing (BOP). The percentages of sites with PD ≥ 4 mm (PD 4%), CAL ≥ 4 mm (CAL 4%), and BOP (BOP%) were recorded for each participant. B-mode ultrasound was performed to determine common carotid artery intima-media thickness (CCA IMT) and the presence of carotid plaques. Multivariate linear regression models were used to assess the associations between periodontal parameters and CCA IMT and carotid plaque. RESULTS Number of missing teeth was associated with increased CCA IMT, and BOP% was associated with increased CCA IMT in females only. This association was robust in never smokers. CONCLUSIONS The number of missing teeth was associated with CCA IMT, and BOP% was associated with CCA IMT in females only. These associations were robust in never smokers. Our results suggest that tooth loss due to oral disease may play a role in subclinical carotid atherosclerosis.
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Affiliation(s)
- Young-Suk Jung
- Department of Periodontology, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, South Korea
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Persson M, Östling G, Smith G, Hamrefors V, Melander O, Hedblad B, Engström G. Soluble urokinase plasminogen activator receptor: a risk factor for carotid plaque, stroke, and coronary artery disease. Stroke 2013; 45:18-23. [PMID: 24253546 DOI: 10.1161/strokeaha.113.003305] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Recent studies indicate that the urokinase system could have an important role in atherogenesis and plaque rupture. The relationships among the soluble urokinase plasminogen activator receptor (suPAR), carotid plaque, and incidence of ischemic stroke and coronary artery disease (CAD) events were studied in a prospective cohort. METHODS Occurrence of carotid plaque and plasma levels of suPAR were assessed in 5166 men and women, aged 45 to 68 years, participating in the Malmö Diet and Cancer study. Incidences of ischemic stroke and CAD were monitored during a mean follow-up of 15 years. RESULTS Subjects with carotid plaque had significantly higher levels of suPAR compared with those without carotid plaque. suPAR was associated with increased incidence of ischemic stroke (hazard ratio [HR] for third versus first tertile, 1.50; 95% confidence interval [CI], 1.06-2.11) and CAD (HR, 1.55; 95% CI, 1.13-2.13) after adjustment for risk factors. The risk factor-adjusted HR for ischemic stroke was 2.21 (95% CI, 1.52-3.22) in subjects with carotid plaque and high suPAR (ie, third tertile) and 1.51 (95% CI, 1.05-2.17) in subjects with carotid plaque and low suPAR compared with those without carotid plaque and low suPAR (reference). High levels of suPAR significantly increased the risk of ischemic stroke and CAD in subjects with carotid plaque. CONCLUSIONS suPAR is associated with increased occurrence of carotid plaque and increased incidence of ischemic stroke and CAD. Presence of both elevated levels of suPAR and carotid plaque increases the risk of ischemic stroke in an additive way.
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Affiliation(s)
- Margaretha Persson
- From the Clinical Research Unit, Medicine, Skåne University Hospital Malmö, Malmö, Sweden (M.P., G.Ö., O.M.); and Department of Clinical Sciences Malmö, Lund University, Lund, Sweden (M.P., G.Ö., G.S., V.H., O.M., B.H., G.E.)
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Vrijenhoek JEP, Den Ruijter HM, De Borst GJ, de Kleijn DPV, De Vries JPPM, Bots ML, Van de Weg SM, Vink A, Moll FL, Pasterkamp G. Sex is associated with the presence of atherosclerotic plaque hemorrhage and modifies the relation between plaque hemorrhage and cardiovascular outcome. Stroke 2013; 44:3318-23. [PMID: 24130138 DOI: 10.1161/strokeaha.113.002633] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND PURPOSE Plaque hemorrhage (PH) may lead to accelerated progression of atherosclerotic disease. The presence of local PH in the carotid plaque predicts future cardiovascular events in any vascular territory. We investigated the prevalence of local PH and the predictive value of PH for the occurrence of cardiovascular events in men and women separately. METHODS Atherosclerotic plaques from 1422 patients (969 men, 453 women) who underwent carotid endarterectomy were analyzed histologically for the presence of PH. Patients were monitored for 3 years for cardiovascular events (nonfatal stroke, nonfatal myocardial infarction, vascular death, and vascular intervention). RESULTS Plaques from men showed a significantly higher prevalence of PH compared with women (67% versus 54%; P<0.001). In 1353 patients with available follow-up data, with a median duration of 2.9 years, 270 events had occurred in men (29%) and 94 in women (22%). Stratified by presence of PH, the event rate was 32% in men with PH versus 23% in men without PH, and 23% in women with PH versus 21% in women without PH. A multivariable Cox proportional hazards model found a significant interaction between sex and PH. PH was significantly associated with events in men (adjusted hazard ratio, 1.9; 95% CI, 1.2-2.8) but not in women (adjusted hazard ratio, 1.0; 95% CI, 0.6-1.7). CONCLUSIONS Atherosclerotic carotid plaques obtained from men reveal a higher prevalence of PH compared with women. Local PH is strongly related to secondary manifestations of cardiovascular disease in men but not in women.
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Affiliation(s)
- Joyce E P Vrijenhoek
- From the Experimental Cardiology Laboratory (J.E.P.V., H.M.D.R., D.P.V.d.K., S.M.V.d.W., G.P.), Julius Center of Health Sciences and Primary Care (H.M.D.R., M.L.B.), and Departments of Vascular Surgery (J.E.P.V., G.J.D.B., F.L.M.) and Pathology (A.V.), University Medical Center, Utrecht, the Netherlands; Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands (J.E.P.V., D.P.V.d.K.); Department of Surgery and Cardiovascular Research Institute, National University (NU) & National University Hospital (NUH), Singapore (D.P.V.d.K.); and Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, the Netherlands (J.-P.P.M.D.V.)
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Isaacs A, Willems SM, Bos D, Dehghan A, Hofman A, Ikram MA, Uitterlinden AG, Oostra BA, Franco OH, Witteman JC, van Duijn CM. Risk scores of common genetic variants for lipid levels influence atherosclerosis and incident coronary heart disease. Arterioscler Thromb Vasc Biol 2013; 33:2233-9. [PMID: 23766260 DOI: 10.1161/atvbaha.113.301236] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Circulating levels of total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol, and triglycerides are recognized risk factors for cardiovascular disease. We tested the hypothesis that the cumulative effects of common genetic variants for lipids are collectively associated with subclinical atherosclerosis and incident coronary heart disease. APPROACH AND RESULTS Participants were drawn from the Erasmus Rucphen Family Study (n=2269) and the Rotterdam Study (n=8130). Linear regression and Cox proportional hazards models were applied to assess the influence of 4 risk scores derived from common genetic variants for lipids (total cholesterol, LDL-C, high-density lipoprotein cholesterol, and triglycerides) on carotid plaque, intima-media thickness, incident myocardial infarction, and coronary heart disease. Adjusted for age and sex, all 4 risk scores were associated with carotid plaque. This relationship was the strongest for the LDL-C score, which increased plaque score by 0.102 per SD increase in genetic risk score (P=3.2 × 10(-8)). The LDL-C score was also nominally associated with intima-media thickness, which increased 0.006 mm per SD increase in score (P=0.05). Both the total cholesterol and LDL-C scores were associated with incident myocardial infarction and coronary heart disease with hazard ratios between 1.10 and 1.13 per SD increase in score. Inclusion of additional risk factors as covariates minimally affected these results. CONCLUSIONS Common genetic variants with small effects on lipid levels are, in combination, significantly associated with subclinical and clinical cardiovascular outcomes. As knowledge of genetic variation increases, preclinical genetic screening tools might enhance the prediction and prevention of clinical events.
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Affiliation(s)
- Aaron Isaacs
- Genetic Epidemiology Unit, Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.
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Nash SD, Cruickshanks KJ, Klein R, Klein BEK, Nieto FJ, Ryff CD, Krantz EM, Shubert CR, Nondahl DM, Acher CW. Socioeconomic status and subclinical atherosclerosis in older adults. Prev Med 2011; 52:208-12. [PMID: 21195728 PMCID: PMC3062713 DOI: 10.1016/j.ypmed.2010.12.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2010] [Revised: 11/23/2010] [Accepted: 12/23/2010] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study investigated the long-term effects of socioeconomic status (SES) on atherosclerosis. METHODS Data from the Epidemiology of Hearing Loss Study and the Beaver Dam Eye Study (Beaver Dam, WI, 1998-2000), were used to examine adult SES (education, household income, and longest-held job) and childhood SES (household density and parental home ownership at age 13) associations with carotid intima-media thickness (IMT) and carotid plaque in a cohort of 2042 men and women aged 53 to 94 years. RESULTS For education, income, and occupation (women), those in the lowest SES group had statistically larger age-sex-adjusted IMT than those in the highest SES group (<12 vs. >12 years education: 0.92 vs. 0.86 mm respectively, P<0.0001), (<$10,000 vs. >$45,000: 0.97 vs. 0.87 mm, P<0.0001), (operator/fabricator/labor vs. manager/professional: 0.89 vs. 0.82 mm, P<0.001). Associations were similar using carotid plaque as the outcome. Participants with low levels of both adult and childhood SES measures had age-sex-adjusted IMT greater than those with persistently high levels of SES (0.93 vs. 0.84 mm, P<0.0001). CONCLUSIONS Measures of SES at two points in the life-span were associated with subclinical atherosclerosis.
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Affiliation(s)
- Scott D Nash
- Department of Population Health Sciences, University of Wisconsin, Madison, WI 53726-2336, USA.
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Roepke SK, Chattillion EA, von Känel R, Allison M, Ziegler MG, Dimsdale JE, Mills PJ, Patterson TL, Ancoli-Israel S, Calleran S, Harmell AL, Grant I. Carotid plaque in Alzheimer caregivers and the role of sympathoadrenal arousal. Psychosom Med 2011; 73:206-13. [PMID: 21217096 DOI: 10.1097/PSY.0b013e3182081004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To test the hypothesis that those who provide care for a spouse diagnosed with Alzheimer's disease would have increased prevalence of carotid artery plaque compared with noncaregiving controls and that prolonged sympathoadrenal arousal to acute stress would relate to this difference. Providing care for a spouse with Alzheimer's disease has been associated with an increased risk of coronary heart disease, potentially due to the impact of caregiving stress on the atherosclerotic disease process. METHODS Participants were 111 spousal caregivers (74 ± 8 years of age; 69% women) to patients with Alzheimer's disease and 51 noncaregiving controls (75 ± 6 years of age; 69% women). Inhome assessment of carotid artery plaque via B-mode ultrasonography was conducted. Plasma catecholamine response to an acute speech stressor task was also measured. RESULTS Logistic regression indicated that caregiving status (i.e., caregiver versus noncaregiver) was associated significantly with a 2.2 times greater odds for the presence of plaque independent of other risk factors of atherosclerosis (95% confidence interval, 1.01-4.73, p = .048). Decreased recovery to basal levels of epinephrine after a psychological stress task was associated significantly with the presence of plaque in caregivers, but not in noncaregivers. Norepinephrine recovery post stressor was not associated with plaque in either group. CONCLUSIONS Caregivers had a higher frequency of carotid plaque compared with noncaregivers. Poorer epinephrine recovery after acute stress was associated with the presence of plaque in caregivers but not in noncaregivers. A prolonged sympathoadrenal response to acute stress might enhance the development of atherosclerosis in chronically stressed Alzheimer caregivers.
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