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Gateva A, Assyov Y, Karamfilova V, Kamenov Z. Common carotid artery intima media thickness (CIMT) in patients with prediabetes and newly diagnosed type 2 diabetes mellitus. J Diabetes Complications 2024; 38:108766. [PMID: 38759539 DOI: 10.1016/j.jdiacomp.2024.108766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 04/17/2024] [Accepted: 05/09/2024] [Indexed: 05/19/2024]
Abstract
AIM To evaluate the relationship between common carotid artery intima media thickness (CIMT) in patients with prediabetes and new-onset diabetes mellitus without proven cardiovascular disease and some classic cardio-metabolic risk factors. PATIENTS AND METHODS The study included 461 obese patients with an average age of 53.2 ± 10.7 years, divided into three groups - group 1 without carbohydrate disturbances (n = 182), group 2 with prediabetes (n = 193) and group 3 with newly diagnosed diabetes mellitus (n = 86). RESULTS The patients with new-onset diabetes had significantly higher mean CIMT values compared to those with prediabetes or without carbohydrate disturbances and a higher frequency of abnormal IMT values. CIMT correlated significantly with age, systolic BP, diastolic BP and fasting blood glucose and showed a high predictive value for the presence of diabetic neuropathy and sudomotor dysfunction. Patients with abnormal CIMT values had a higher incidence of arterial hypertension, dyslipidemia, metabolic syndrome, peripheral neuropathy, and sudomotor dysfunction. Patients who developed type 2 diabetes during follow-up had a significantly higher initial mean CIMT, which showed the highest predictive value for the risk of new-onset diabetes, with CIMT≥0.7 mm having 53 % sensitivity and 83 % specificity for the risk of progression to diabetes mellitus. CONCLUSION Patients with new-onset diabetes mellitus had significantly greater intima media thickness of the common carotid artery and a greater frequency of abnormal CIMT values compared to those with normoglycemia and prediabetes. CIMT has a high predictive value for the presence of diabetic neuropathy, sudomotor dysfunction and the risk of new onset diabetes.
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Affiliation(s)
- Antoaneta Gateva
- Medical University Sofia, Internal Medicine Department, Clinic of endocrinology, University Hospital Alexandrovska, Bulgaria.
| | - Yavor Assyov
- Medical University Sofia, Internal Medicine Department, Clinic of endocrinology, University Hospital Alexandrovska, Bulgaria
| | - Vera Karamfilova
- Medical University Sofia, Internal Medicine Department, Clinic of endocrinology, University Hospital Alexandrovska, Bulgaria
| | - Zdravko Kamenov
- Medical University Sofia, Internal Medicine Department, Clinic of endocrinology, University Hospital Alexandrovska, Bulgaria
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2
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Abe TA, Olanipekun T, Yan F, Effoe V, Udongwo N, Oshunbade A, Thomas V, Onuorah I, Terry JG, Yimer WK, Ghali JK, Correa A, Onwuanyi A, Michos ED, Benjamin EJ, Echols M. Carotid Intima-Media Thickness and Improved Stroke Risk Assessment in Hypertensive Black Adults. Am J Hypertens 2024; 37:290-297. [PMID: 38236147 PMCID: PMC10941087 DOI: 10.1093/ajh/hpae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/04/2023] [Accepted: 11/30/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND We aim to determine the added value of carotid intima-media thickness (cIMT) in stroke risk assessment for hypertensive Black adults. METHODS We examined 1,647 participants with hypertension without a history of cardiovascular (CV) disease, from the Jackson Heart Study. Cox regression analysis estimated hazard ratios (HRs) for incident stroke per standard deviation increase in cIMT and quartiles while adjusting for baseline variables. We then evaluated the predictive capacity of cIMT when added to the pool cohort equations (PCEs). RESULTS The mean age at baseline was 57 ± 10 years. Each standard deviation increase in cIMT (0.17 mm) was associated with approximately 30% higher risk of stroke (HR 1.27, 95% confidence interval: 1.08-1.49). Notably, cIMT proved valuable in identifying residual stroke risk among participants with well-controlled blood pressure, showing up to a 56% increase in the odds of stroke for each 0.17 mm increase in cIMT among those with systolic blood pressure <120 mm Hg. Additionally, the addition of cIMT to the PCE resulted in the reclassification of 58% of low to borderline risk participants with stroke to a higher-risk category and 28% without stroke to a lower-risk category, leading to a significant net reclassification improvement of 0.22 (0.10-0.30). CONCLUSIONS In this community-based cohort of middle-aged Black adults with hypertension and no history of CV disease at baseline, cIMT is significantly associated with incident stroke and enhances stroke risk stratification.
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Affiliation(s)
- Temidayo A Abe
- Division of Cardiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Titilope Olanipekun
- Division of Internal Medicine, Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Fengxia Yan
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA
- Department of Medicine, Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Valery Effoe
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA
- Department of Medicine, Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Ndausung Udongwo
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Adebamike Oshunbade
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Victoria Thomas
- Division of Cardiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ifeoma Onuorah
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - James G Terry
- Division of Cardiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Wondwosen K Yimer
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Jalal K Ghali
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA
- Department of Medicine, Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Adolfo Correa
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Anekwe Onwuanyi
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA
- Department of Medicine, Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Erin D Michos
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Emelia J Benjamin
- Department of Medicine, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Department of Medicine, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Melvin Echols
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA
- Department of Medicine, Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, Georgia, USA
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Spence JD. Vessel Wall Volume and Plaque Volume Should Replace Carotid Intima-Media Thickness. Am J Hypertens 2024; 37:270-272. [PMID: 38198747 DOI: 10.1093/ajh/hpae004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 01/06/2024] [Indexed: 01/12/2024] Open
Affiliation(s)
- J David Spence
- Neurology & Clinical Pharmacology, Western University, London, Ontario, Canada
- Stroke Prevention & Atherosclerosis Research Centre, Robarts Research Institute, London, Ontario, Canada
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4
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Bianchini E, Guala A, Golemati S, Alastruey J, Climie RE, Dalakleidi K, Francesconi M, Fuchs D, Hartman Y, Malik AEF, Makūnaitė M, Nikita KS, Park C, Pugh CJA, Šatrauskienė A, Terentes-Printizios D, Teynor A, Thijssen D, Schmidt-Trucksäss A, Zupkauskienė J, Boutouyrie P, Bruno RM, Reesink KD. The Ultrasound Window Into Vascular Ageing: A Technology Review by the VascAgeNet COST Action. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:2183-2213. [PMID: 37148467 DOI: 10.1002/jum.16243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/24/2023] [Accepted: 04/14/2023] [Indexed: 05/08/2023]
Abstract
Non-invasive ultrasound (US) imaging enables the assessment of the properties of superficial blood vessels. Various modes can be used for vascular characteristics analysis, ranging from radiofrequency (RF) data, Doppler- and standard B/M-mode imaging, to more recent ultra-high frequency and ultrafast techniques. The aim of the present work was to provide an overview of the current state-of-the-art non-invasive US technologies and corresponding vascular ageing characteristics from a technological perspective. Following an introduction about the basic concepts of the US technique, the characteristics considered in this review are clustered into: 1) vessel wall structure; 2) dynamic elastic properties, and 3) reactive vessel properties. The overview shows that ultrasound is a versatile, non-invasive, and safe imaging technique that can be adopted for obtaining information about function, structure, and reactivity in superficial arteries. The most suitable setting for a specific application must be selected according to spatial and temporal resolution requirements. The usefulness of standardization in the validation process and performance metric adoption emerges. Computer-based techniques should always be preferred to manual measures, as long as the algorithms and learning procedures are transparent and well described, and the performance leads to better results. Identification of a minimal clinically important difference is a crucial point for drawing conclusions regarding robustness of the techniques and for the translation into practice of any biomarker.
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Affiliation(s)
| | - Andrea Guala
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Spyretta Golemati
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Jordi Alastruey
- Department of Biomedical Engineering, King's College London, London, UK
| | - Rachel E Climie
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
- INSERM, U970, Paris Cardiovascular Research Center (PARCC), Université de Paris, Hopital Europeen Georges Pompidou - APHP, Paris, France
| | - Kalliopi Dalakleidi
- Biomedical Simulations and Imaging (BIOSIM) Laboratory, School of Electrical and Computer Engineering, National Technical University of Athens, Athens, Greece
| | - Martina Francesconi
- Institute of Clinical Physiology, CNR, Pisa, Italy
- University of Pisa, Pisa, Italy
| | - Dieter Fuchs
- Fujifilm VisualSonics, Amsterdam, The Netherlands
| | - Yvonne Hartman
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Afrah E F Malik
- CARIM School for Cardiovascular Diseases and Heart and Vascular Center, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Monika Makūnaitė
- Biomedical Engineering Institute, Kaunas University of Technology, Kaunas, Lithuania
| | - Konstantina S Nikita
- Biomedical Simulations and Imaging (BIOSIM) Laboratory, School of Electrical and Computer Engineering, National Technical University of Athens, Athens, Greece
| | - Chloe Park
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Christopher J A Pugh
- Cardiff School of Sport & Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Agnė Šatrauskienė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Centre of Cardiology and Angiology, Vilnius University Hospital Santaros klinikos, Vilnius, Lithuania
| | - Dimitrios Terentes-Printizios
- First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandra Teynor
- Faculty of Computer Science, Augsburg University of Applied Sciences, Augsburg, Germany
| | - Dick Thijssen
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Arno Schmidt-Trucksäss
- Department of Sport, Exercise and Health, Division Sport and Exercise Medicine, University of Basel, Basel, Switzerland
| | - Jūratė Zupkauskienė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Pierre Boutouyrie
- INSERM, U970, Paris Cardiovascular Research Center (PARCC), Université de Paris, Hopital Europeen Georges Pompidou - APHP, Paris, France
| | - Rosa Maria Bruno
- INSERM, U970, Paris Cardiovascular Research Center (PARCC), Université de Paris, Hopital Europeen Georges Pompidou - APHP, Paris, France
| | - Koen D Reesink
- CARIM School for Cardiovascular Diseases and Heart and Vascular Center, Maastricht University Medical Center+, Maastricht, The Netherlands
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Zhou XD, Targher G, Byrne CD, Somers V, Kim SU, Chahal CAA, Wong VWS, Cai J, Shapiro MD, Eslam M, Steg PG, Sung KC, Misra A, Li JJ, Brotons C, Huang Y, Papatheodoridis GV, Sun A, Yilmaz Y, Chan WK, Huang H, Méndez-Sánchez N, Alqahtani SA, Cortez-Pinto H, Lip GYH, de Knegt RJ, Ocama P, Romero-Gomez M, Fudim M, Sebastiani G, Son JW, Ryan JD, Ikonomidis I, Treeprasertsuk S, Pastori D, Lupsor-Platon M, Tilg H, Ghazinyan H, Boursier J, Hamaguchi M, Nguyen MH, Fan JG, Goh GBB, Al Mahtab M, Hamid S, Perera N, George J, Zheng MH. An international multidisciplinary consensus statement on MAFLD and the risk of CVD. Hepatol Int 2023; 17:773-791. [PMID: 37204656 PMCID: PMC10198034 DOI: 10.1007/s12072-023-10543-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 04/18/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Fatty liver disease in the absence of excessive alcohol consumption is an increasingly common condition with a global prevalence of ~ 25-30% and is also associated with cardiovascular disease (CVD). Since systemic metabolic dysfunction underlies its pathogenesis, the term metabolic (dysfunction)-associated fatty liver disease (MAFLD) has been proposed for this condition. MAFLD is closely intertwined with obesity, type 2 diabetes mellitus and atherogenic dyslipidemia, which are established cardiovascular risk factors. Unlike CVD, which has received attention in the literature on fatty liver disease, the CVD risk associated with MAFLD is often underestimated, especially among Cardiologists. METHODS AND RESULTS A multidisciplinary panel of fifty-two international experts comprising Hepatologists, Endocrinologists, Diabetologists, Cardiologists and Family Physicians from six continents (Asia, Europe, North America, South America, Africa and Oceania) participated in a formal Delphi survey and developed consensus statements on the association between MAFLD and the risk of CVD. Statements were developed on different aspects of CVD risk, ranging from epidemiology to mechanisms, screening, and management. CONCULSIONS The expert panel identified important clinical associations between MAFLD and the risk of CVD that could serve to increase awareness of the adverse metabolic and cardiovascular outcomes of MAFLD. Finally, the expert panel also suggests potential areas for future research.
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Affiliation(s)
- Xiao-Dong Zhou
- Department of Cardiovascular Medicine, The Heart Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Giovanni Targher
- Department of Medicine, Section of Endocrinology, Diabetes, and Metabolism, University of Verona, Verona, Italy
| | - Christopher D Byrne
- Southampton National Institute for Health and Care Research Biomedical Research Centre, University Hospital Southampton, and University of Southampton, Southampton General Hospital, Southampton, UK
| | - Virend Somers
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, USA
| | - Seung Up Kim
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea
| | - C Anwar A Chahal
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, USA
- Center for Inherited Cardiovascular Diseases, WellSpan Health, Lancaster, PA, USA
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, EC1A 7BE, West Smithfield, UK
| | - Vincent Wai-Sun Wong
- State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | - Jingjing Cai
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Michael D Shapiro
- Center for Prevention of Cardiovascular Disease, Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Mohammed Eslam
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital, University of Sydney, Sydney, NSW, 2145, Australia
| | - Philippe Gabriel Steg
- Université Paris -Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, FACT (French Alliance for Cardiovascular Trials), INSERM U1148, Paris, France
| | - Ki-Chul Sung
- Department of Internal Medicine, Division of Cardiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Anoop Misra
- Fortis C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, Chirag Enclave, National Diabetes Obesity and Cholesterol Foundation and Diabetes Foundation (India), New Delhi, India
| | - Jian-Jun Li
- State Key Laboratory of Cardiovascular Diseases, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Carlos Brotons
- Biomedical Research Institute Sant Pau (IIB Sant Pau), Sardenya Primary Health Care Center, Barcelona, Spain
| | - Yuli Huang
- Department of Cardiology, Shunde Hospital, Southern Medical University, Jiazi Road, Lunjiao Town, Shunde District, Foshan, China
| | - George V Papatheodoridis
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece
| | - Aijun Sun
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yusuf Yilmaz
- Institute of Gastroenterology, Marmara University, Istanbul, Turkey
- Department of Gastroenterology, School of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Wah Kheong Chan
- Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Hui Huang
- Department of Cardiology, The Eighth Affiliated Hospital of Sun Yat-Sen University, 3025 Shennan Middle Road, Shenzhen, China
| | - Nahum Méndez-Sánchez
- Liver Research Unit, Medica Sur Clinic and Foundation and Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Saleh A Alqahtani
- Liver Transplantation Unit, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, 720 Rutland Avenue, Baltimore, MD, USA
| | - Helena Cortez-Pinto
- Laboratório de Nutrição e Metabolismo, Faculdade de Medicina, Clínica Universitária de Gastrenterologia, Universidade de Lisboa, Lisbon, Portugal
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Robert J de Knegt
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Gravendijkwal 230, Room Ha 206, Rotterdam, The Netherlands
| | - Ponsiano Ocama
- Department of Internal Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Manuel Romero-Gomez
- Department of Digestive and Liver Diseases, Institute of Biomedicine of Seville, University Hospital Virgen del Rocio, University of Seville, Seville, Spain
| | - Marat Fudim
- Department of Cardiology, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Giada Sebastiani
- Division of Gastroenterology and Hepatology, Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital, 1001 Blvd. Décarie, Montreal, Canada
| | - Jang Won Son
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - John D Ryan
- Department of Hepatology, RCSI School of Medicine and Medical Sciences, Dublin/Beaumont Hospital, Dublin, Ireland
| | - Ignatios Ikonomidis
- Preventive Cardiology Laboratory and Cardiometabolic Clinic, Second Cardiology Department, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Sombat Treeprasertsuk
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Daniele Pastori
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Monica Lupsor-Platon
- Department of Medical Imaging, "Prof. Dr. Octavian Fodor" Regional Institute of Gastroenterology and Hepathology, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Herbert Tilg
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University Innsbruck, Innsbruck, Austria
| | - Hasmik Ghazinyan
- Department of Hepatology, Nork Clinical Hospital of Infectious Disease, Yerevan, Armenia
| | - Jerome Boursier
- Hepato-Gastroenterology Department, University Hospital, 4 Larrey Street, 49933, Angers Cedex 09, France
- HIFIH Laboratory, UPRES 3859, SFR 4208, LUNAM University, Angers, France
| | - Masahide Hamaguchi
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465, Kajii-Cho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, Japan
| | - Mindie H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA
- Department of Epidemiology and Population Health, Stanford University Medical Center, Palo Alto, CA, USA
| | - Jian-Gao Fan
- Center for Fatty Liver, Department of Gastroenterology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - George Boon-Bee Goh
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore, Singapore
| | - Mamun Al Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Saeed Hamid
- Department of Medicine, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Nilanka Perera
- Department of Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Jacob George
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital, University of Sydney, Sydney, NSW, 2145, Australia.
| | - Ming-Hua Zheng
- MAFLD Research Center, Department of Hepatology, The First Affiliated Hospital of Wenzhou Medical University, No. 2 Fuxue Lane, Wenzhou, 325000, China.
- Institute of Hepatology, Wenzhou Medical University, Wenzhou, China.
- Key Laboratory of Diagnosis and Treatment for the Development of Chronic Liver Disease in Zhejiang Province, Wenzhou, China.
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Spence JD. Assessment of atherosclerosis: should coronary calcium score and intima-media thickness be replaced by ultrasound measurement of carotid plaque burden and vessel wall volume? Curr Opin Lipidol 2023; 34:126-132. [PMID: 37093105 DOI: 10.1097/mol.0000000000000880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
PURPOSE OF REVIEW To describe the uses of vessel wall volume (VWV) and measurement of carotid plaque burden, as total plaque area (TPA) and total plaque volume (TPV), and to contrast them with measurement of carotid intima-media thickness (IMT) and coronary calcium (CAC). RECENT FINDINGS Measurement of carotid plaque burden (CPB) is useful for risk stratification, research into the genetics and biology of atherosclerosis, for measuring effects of new therapies for atherosclerosis, and for treatment of high-risk patients with severe atherosclerosis. It is as predictive of risk as CAC, with important advantages. IMT is only a weak predictor of risk and changes so little over time that it is not useful for assessing effects of therapy. SUMMARY Measurement of CPB and VWV are far superior to measurement of carotid IMT in many ways, and should replace it. Vessel wall volume can be measured in persons with no plaque as an alternative to IMT. There are important advantages of CPB over coronary calcium; CPB should be more widely used in vascular prevention.
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Affiliation(s)
- J David Spence
- Professor Emeritus of Neurology, Western University, and Director, Stroke Prevention & Atherosclerosis Research Centre, Robarts Research Institute, 1400 Western Road, London, ON N6G 2V4, Canada
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Evaluation of Intima-Media Thickness and Arterial Stiffness as Early Ultrasound Biomarkers of Carotid Artery Atherosclerosis. Cardiol Ther 2022; 11:231-247. [PMID: 35362868 PMCID: PMC9135926 DOI: 10.1007/s40119-022-00261-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Indexed: 02/07/2023] Open
Abstract
Carotid atherosclerosis is a major and potentially preventable cause of ischemic stroke. It begins early in life and progresses silently over the years. Identification of individuals with subclinical atherosclerosis is needed to initiate early aggressive vascular prevention. Although carotid plaque appears to be a powerful predictor of cardiovascular risk, carotid intima-media thickness (CIMT) and arterial stiffness can be detected at the initial phases and, therefore, they are considered important new biomarkers of carotid atherosclerosis. There is a well-documented association between CIMT and cerebrovascular events. CIMT provides a reliable marker in young people, in whom plaque formation or calcification is not established. However, the usefulness of CIMT measurement in the improvement of risk cardiovascular models is still controversial. Carotid stiffness is also significantly associated with ischemic stroke. Carotid stiffness adds value to the existing risk prediction based on Framingham risk factors, particularly individuals at intermediate cardiovascular risk. Carotid ultrasound is used to assess carotid atherosclerosis. During the last decade, automated techniques for sophisticated analysis of vascular mechanics have evolved, such as speckle tracking, and new methods based on deep learning have been proposed with promising outcomes. Additional research is needed to investigate the imaging-based cardiovascular risk prediction of CIMT and stiffness.
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8
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Theofilis P, Oikonomou E, Lazaros G, Vogiatzi G, Anastasiou M, Mystakidi VC, Goliopoulou A, Christoforatou E, Bourouki E, Vavouranaki G, Marinos G, Tousoulis D. The association of diabetes mellitus with carotid atherosclerosis and arterial stiffness in the Corinthia study. Nutr Metab Cardiovasc Dis 2022; 32:567-576. [PMID: 35110000 DOI: 10.1016/j.numecd.2021.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 10/24/2021] [Accepted: 12/12/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND AIMS Evaluation of arterial stiffness and carotid atherosclerotic burden can provide important prognostic information regarding the risk of future cardiovascular events. The aim of this study was to assess these vascular properties in patients with diabetes mellitus (DM). METHODS AND RESULTS In the context of the observational "Corinthia" study, we analyzed 1757 participants with determined DM status. Carotid ultrasonography was performed to evaluate intima-media thickness (cIMT) and carotid plaque burden. Arterial stiffness was estimated via assessment of carotid-to-femoral pulse wave velocity (cfPWV). Individuals with DM had increased mean cIMT, maximum cIMT, carotid plaque burden, and cfPWV compared to those without DM. After multivariable regression analysis, the presence of DM was still associated with significantly increased mean cIMT (by 0.074 mm, p = .004), maximum cIMT (by 0.134 mm, p = .007), cfPWV (by 0.929 m/s, p < .001), and a higher prevalence of carotid plaques (odds ratio 1.52, 95% confidence intervals 1.11, 2.10, p = .01). In a propensity score-matched cohort, mean cIMT, maximum cIMT, and carotid plaque burden were significantly higher in individuals with DM. Analysis according to territory of cIMT measurement displayed substantial differences in left (DM: 1.32 ± 0.78 mm vs. no DM: 1.20 ± 0.66 mm, p = .04) and right carotid bulbs (DM: 1.33 ± 0.82 mm vs. no DM: 1.18 ± 0.69 mm, p = .02) with respect to DM status while non-significant variations were observed in left (DM: 0.98 ± 0.49 mm vs. no DM: 0.91 ± 0.35 mm, p = .06) and right common carotid artery (DM: 0.95 ± 0.50 mm vs. no DM: 0.92 ± 0.40 mm, p = .36). CONCLUSIONS Diabetes mellitus is associated with increased cfPWV and cIMT, with more pronounced lesions in the carotid bulb.
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Affiliation(s)
- Panagiotis Theofilis
- 1st Cardiology Department, General Hospital of Athens Hippokration, University of Athens Medical School, Athens, Greece
| | - Evangelos Oikonomou
- 1st Cardiology Department, General Hospital of Athens Hippokration, University of Athens Medical School, Athens, Greece.
| | - George Lazaros
- 1st Cardiology Department, General Hospital of Athens Hippokration, University of Athens Medical School, Athens, Greece
| | - Georgia Vogiatzi
- 1st Cardiology Department, General Hospital of Athens Hippokration, University of Athens Medical School, Athens, Greece
| | - Maria Anastasiou
- 1st Cardiology Department, General Hospital of Athens Hippokration, University of Athens Medical School, Athens, Greece
| | - Vasiliki Chara Mystakidi
- 1st Cardiology Department, General Hospital of Athens Hippokration, University of Athens Medical School, Athens, Greece
| | - Athina Goliopoulou
- 1st Cardiology Department, General Hospital of Athens Hippokration, University of Athens Medical School, Athens, Greece
| | - Evangelia Christoforatou
- 1st Cardiology Department, General Hospital of Athens Hippokration, University of Athens Medical School, Athens, Greece
| | - Evgenia Bourouki
- 1st Cardiology Department, General Hospital of Athens Hippokration, University of Athens Medical School, Athens, Greece
| | - Georgia Vavouranaki
- 1st Cardiology Department, General Hospital of Athens Hippokration, University of Athens Medical School, Athens, Greece
| | - Georgios Marinos
- 1st Cardiology Department, General Hospital of Athens Hippokration, University of Athens Medical School, Athens, Greece
| | - Dimitris Tousoulis
- 1st Cardiology Department, General Hospital of Athens Hippokration, University of Athens Medical School, Athens, Greece
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9
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Polak JF, Backlund JYC, Budoff M, Raskin P, Bebu I, Lachin JM. Coronary Artery Disease Events and Carotid Intima-Media Thickness in Type 1 Diabetes in the DCCT/EDIC Cohort. J Am Heart Assoc 2021; 10:e022922. [PMID: 34873921 PMCID: PMC9075257 DOI: 10.1161/jaha.121.022922] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Carotid artery intima‐media thickness (IMT) is associated with the risk of subsequent cardiovascular events in the general population. This association has not been established in type 1 diabetes. Methods and Results We studied if carotid IMT is associated with the risk of a first coronary artery disease event in participants with type 1 diabetes in the EDIC (Epidemiology of Diabetes Interventions and Complications) study, the long‐term observational follow‐up of the DCCT (Diabetes Control and Complications Trial). Between 1994 and 1996, common carotid artery and internal carotid artery IMT were measured with high‐resolution ultrasound in 1309 study participants with a mean age of 35 years and diabetes duration of 13.8 years; 52% were men. Cox proportional hazards models evaluated the association of standardized common carotid artery IMT and internal carotid artery IMT with subsequent cardiovascular events over the next 17 years. Models were adjusted for age, sex, mean hemoglobin A1c levels, and traditional cardiovascular risk factors. Associations of common carotid artery IMT with subsequent CAD were significant after adjustment for imaging device, sex, and age (hazard ratio [HR], 1.23 per 0.09 mm [95% CI, [1.04–1.45]; P=0.0141), but did not remain significant after further adjustment for traditional risk factors and hemoglobin A1c (HR, 1.14 per 0.09 mm [95% CI, 0.97–1.33]; P=0.1206). No significant associations with subsequent coronary artery disease events were seen for internal carotid artery IMT. Conclusions In the DCCT/EDIC cohort with type 1 diabetes, common carotid artery IMT, but not internal carotid artery IMT, is weakly associated with subsequent coronary artery events, an association eliminated after adjusting for coexistent traditional cardiovascular risk factors. Registration URL: https://www.clinicaltrials.gov; Unique identifiers: NCT00360815 and NCT00360893.
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Affiliation(s)
- Joseph F Polak
- Department of Radiology Lemuel Shattuck HospitalTufts University School of Medicine and Boston University School of Medicine Boston MA
| | - Jye-Yu C Backlund
- The Biostatistics Center The George Washington University Rockville MD
| | - Matt Budoff
- UCLA School of MedicineLos Angeles Biomedical Research Institute Torrance CA
| | - Philip Raskin
- University of Texas Southwestern Medical Center Dallas TX
| | - Ionut Bebu
- The Biostatistics Center The George Washington University Rockville MD
| | - John M Lachin
- The Biostatistics Center The George Washington University Rockville MD
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10
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Talpur AS, Amar Z, Zafar S, Memon A, Eimal Latif AH, Hafizyar F, Hashim S, Nazary K. Association Between Diabetic Retinopathy and Carotid Intima-Media Thickness. Cureus 2021; 13:e15575. [PMID: 34277197 PMCID: PMC8270072 DOI: 10.7759/cureus.15575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction Patients with diabetes having advanced stage of diabetic retinopathy (DR) may predict future risk of coronary artery disease. To predict cardiovascular outcomes carotid intima-media thickness (CIMT) is utilized in diabetic patients. The aim of our study was the evaluation of the relationship between retinopathy and CIMT as two valuable non-invasive methods for early detection of micro- and macrovascular complication of diabetes. Methods This comparative cross-sectional study was conducted in the internal medicine ward of tertiary care hospital in Pakistan from November 2020 to January 2021. Three hundred patients with type 2 diabetes mellitus and 300 control subjects were enrolled in the study after taking informed consent. Ophthalmological examination was done to screen patients for DR. CIMT was evaluated by a Doppler ultrasound for both carotid arteries. Results Carotid artery intimal thickness was more in patients with retinopathy compared to patients without retinopathy in both right (0.77 ± 0.16 vs. 0.66 ± 0.12; p-value: <0.0001) and left carotid artery (0.77 ± 0.15 vs. 0.65 ± 0.11; p-value: <0.0001). Conclusion In our study, there was a correlation between DR and CIMT. Screening for DR, which may be a potential early marker for complications, may help detect patients at risk of various macro and microvascular complications.
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Affiliation(s)
- Abdul Subhan Talpur
- Internal Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
| | - Zain Amar
- Internal Medicine, Isra University, Hyderabad, PAK
| | | | | | | | | | - Sara Hashim
- Pathology, Bolan Medical College, Quetta, PAK
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11
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Chinese Guideline on the Primary Prevention of Cardiovascular Diseases. CARDIOLOGY DISCOVERY 2021; 1:70-104. [DOI: 10.1097/cd9.0000000000000025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Abstract
Cardiovascular disease is the leading cause of mortality in China. Primary prevention of cardiovascular disease with a focus on lifestyle intervention and risk factor control has been shown to effectively delay or prevent the occurrence of cardiovascular events. To promote a healthy lifestyle and enhance the detection, diagnosis, and treatment of cardiovascular risk factors such as hypertension, dyslipidemia, and diabetes, and to improve the overall capacity of primary prevention of cardiovascular disease, the Chinese Society of Cardiology of Chinese Medical Association has collaborated with multiple societies to summarize and evaluate the latest evidence with reference to relevant guidelines and subsequently to develop recommendations for primary cardiovascular disease prevention in Chinese adults. The guideline consists of 10 sections: introduction, methodology for developing the guideline, epidemiology of cardiovascular disease in China and challenges in primary prevention, general recommendations for primary prevention, assessment of cardiovascular risk, lifestyle intervention, blood pressure control, lipid management, management of type 2 diabetes, and use of aspirin. The promulgation and implementation of this guideline will play a key role in promoting the practice of primary prevention for cardiovascular disease in China.
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12
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Roumeliotis S, Liakopoulos V, Roumeliotis A, Stamou A, Panagoutsos S, D’Arrigo G, Tripepi G. Prognostic Factors of Fatal and Nonfatal Cardiovascular Events in Patients With Type 2 Diabetes: The Role of Renal Function Biomarkers. Clin Diabetes 2021; 39:188-196. [PMID: 33986571 PMCID: PMC8061536 DOI: 10.2337/cd20-0067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
In this study, 158 patients with different degrees of renal function were followed for 7 years to assess the prognostic value of various risk factors, including carotid intima-media thickness (cIMT) and biomarkers of renal function, for incident cardiovascular morbidity and mortality in patients with type 2 diabetes. The investigators found that estimated glomerular filtration rate, albuminuria, and history of cardiovascular disease (CVD) can be used for prognosis of CVD, whereas cIMT adds little to the accuracy of this prediction.
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Affiliation(s)
- Stefanos Roumeliotis
- Division of Nephrology and Hypertension, 1 Department of Internal Medicine, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Institute of Clinical Physiology (IFC-CNR), Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | - Vassilios Liakopoulos
- Division of Nephrology and Hypertension, 1 Department of Internal Medicine, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Athanasios Roumeliotis
- Division of Nephrology and Hypertension, 1 Department of Internal Medicine, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aikaterini Stamou
- Department of Microbiology, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stylianos Panagoutsos
- Department of Nephrology, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Graziella D’Arrigo
- Institute of Clinical Physiology (IFC-CNR), Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | - Giovanni Tripepi
- Institute of Clinical Physiology (IFC-CNR), Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, Reggio Calabria, Italy
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13
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Leńska-Mieciek M, Jurczak-Kobus P, Kuls-Oszmaniec A, Fiszer U, Sobocki J. Carotid artery intima-media thickness in adults receiving long-term home parenteral nutrition. Nutr Metab Cardiovasc Dis 2021; 31:489-497. [PMID: 33127253 DOI: 10.1016/j.numecd.2020.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 07/20/2020] [Accepted: 09/16/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND AIMS Nutrition regimen in parenteral nutrition (PN) patients allows for a control of diet components. This may affect the process of lipid deposition in the vascular wall and change the risk of atherosclerosis. This study aims to examine the effect of long-term PN in adults on carotid intima-media thickness. METHODS AND RESULTS Thirty long-term PN patients (15 men and 15 women, mean age 64.7 ± 8.5 years) and thirty healthy volunteers (HV) (15 men and 15 women, mean age 64.9 ± 8.77 years) entered the study. Total amino acid and lipid formulation intake as well as duration of PN were calculated for PN patients. The common carotid artery intima-media thickness (CCA IMT) was examined in both groups. A lower CCA IMT (right/left mean: PN - 776 ± 121 vs HV - 848 ± 121 μm, p < 0.05; right/left maximum CCA IMT: PN - 935 ± 139 vs HV - 1024 ± 135 μm, p < 0.05) in PN patients was observed. A lower serum level of total (PN - 131.43 ± 43.12 vs HV - 209.2 ± 48.01 mg/dl, p < 0.05) and HDL (PN- 44.16 ± 12.45 vs HV - 72.57 ± 25.04 mg/dl, p < 0.05) cholesterol was reported in the PN patients. A correlation between patients' age and CCA IMT was observed in the control group, but not in the PN patients (right/left mean CCA IMT - PN: r = 0.48, p-0.007 vs HV: p-0.073; right/left maximum CCA IMT - PN: r = 0.48, p-0.008, vs HV: p-0.073). CONCLUSIONS Long term PN in adults is associated with lower CCA IMT. Long-term PN patients are a unique group in which carotid intima-media thickness does not correlate with the age.
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Affiliation(s)
- Marta Leńska-Mieciek
- Department of Neurology and Epileptology, Centre of Postgraduate Medical Education, 231 Czerniakowska st, 00-416 Warsaw, Poland.
| | - Paulina Jurczak-Kobus
- Department of General Surgery and Clinical Nutrition, Centre of Postgraduate Medical Education, 231 Czerniakowska st, 00-416 Warsaw, Poland.
| | - Aleksandra Kuls-Oszmaniec
- Department of Neurology and Epileptology Professor Orlowski's Hospital, 231 Czerniakowska st, 00-416 Warsaw, Poland.
| | - Urszula Fiszer
- Department of Neurology and Epileptology, Centre of Postgraduate Medical Education, 231 Czerniakowska st, 00-416 Warsaw, Poland.
| | - Jacek Sobocki
- Department of General Surgery and Clinical Nutrition, Centre of Postgraduate Medical Education, 231 Czerniakowska st, 00-416 Warsaw, Poland.
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14
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Spence JD. IMT is not atherosclerosis. Atherosclerosis 2020; 312:117-118. [DOI: 10.1016/j.atherosclerosis.2020.09.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 08/28/2020] [Accepted: 09/16/2020] [Indexed: 11/27/2022]
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15
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Schäfer M, Nadeau KJ, Reusch JEB. Cardiovascular disease in young People with Type 1 Diabetes: Search for Cardiovascular Biomarkers. J Diabetes Complications 2020; 34:107651. [PMID: 32546422 PMCID: PMC7585936 DOI: 10.1016/j.jdiacomp.2020.107651] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/31/2020] [Accepted: 06/01/2020] [Indexed: 12/15/2022]
Abstract
Premature onset of cardiovascular disease is common in people with type 1 diabetes and is relatively understudied in youth. Several reports in adolescents and young adults with diabetes demonstrate evidence of arterial stiffness and cardiac dysfunction, yet critical gaps exist in our current understanding of the temporal progression of cardiac and vascular dysfunction in these youth, and mechanistic investigations with robust pathophysiologic assessment are lacking. This review attempts to summarize relevant cardiovascular studies concerning children, adolescents, and young adults with type 1 diabetes. We focus on imaging-based biomarkers routinely applied to youth and adults that are well-established in their ability to predict adjudicated cardiovascular outcomes, and their relevant physiologic interpretation. Particularly, we focus the attention to 1) cardiac ventricular strain imaging techniques which are known to be predictive of clinical outcomes in patients with heterogenous causes of heart failure, and 2) stiffness in large arteries, a well-established prognostic marker of cardiovascular events. We conclude that there remains an urgent need for sensitive and quantitative biomarkers to define the natural history of cardiac and vascular disease origination and progression in type 1 diabetes, and set the stage for interpreting interventional studies focused on preventing, reversing or slowing disease progression.
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Affiliation(s)
- Michal Schäfer
- Division of Pediatric Cardiology, Department of Pediatrics, University of Colorado - School of Medicine, Aurora, CO, United States of America.
| | - Kristen J Nadeau
- Section of Pediatric Endocrinology, Department of Pediatrics, University of Colorado - School of Medicine, Aurora, CO, United States of America
| | - Jane E B Reusch
- Section of Endocrinology, Rocky Mountain Regional VAMC, CO, United States of America; Division of Endocrinology, Department of Medicine, United States of America; Center for Women's Health Research, University of Colorado - School of Medicine, Aurora, CO, United States of America
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16
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Winckler K, Thorsteinsson B, Wiinberg N, Jensen AK, Lundby-Christensen L, Heitmann BL, Lund SS, Krarup T, Jensen T, Vestergaard H, Breum L, Sneppen S, Boesgaard T, Madsbad S, Gluud C, Vaag A, Almdal TP, Tarnow L. Prediction of carotid intima-media thickness and its relation to cardiovascular events in persons with type 2 diabetes. J Diabetes Complications 2020; 34:107681. [PMID: 32741659 DOI: 10.1016/j.jdiacomp.2020.107681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 06/09/2020] [Accepted: 07/13/2020] [Indexed: 11/25/2022]
Abstract
AIMS To investigate measures of carotid intima-media thickness (IMT) and conventional cardiovascular (CV) risk factors as predictors of future carotid IMT, and the prediction of CV events during follow-up based on measures of carotid IMT. METHODS Observational longitudinal study including 230 persons with type 2 diabetes (T2D). RESULTS Mean age at follow-up was 66.7 (SD 8.5) years, 30.5% were women and mean body mass index (BMI) was 31.8 (4.4) kg/m2. Carotid IMT was measured at baseline, after 18 months of intervention in the Copenhagen Insulin and Metformin Therapy (CIMT) trial and after a mean follow-up of 6.4 (1.0) years. Baseline carotid IMT, carotid IMT after 18 months' intervention, and CV risk factors (age, sex and baseline systolic blood pressure) gave the best prediction of carotid IMT (root mean-squared error of prediction of 0.106 and 95% prediction error probability interval of -0.160, 0.204). CONCLUSIONS Measures of carotid IMT combined with CV risk factors at baseline predicts attained carotid IMT better than measures of carotid IMT or CV risk factors alone. Carotid IMT did not predict CV events, and the present results do not support the use of carotid IMT as a predictor of CV events in persons with T2D.
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Affiliation(s)
- Karoline Winckler
- Department of Endocrinology and Nephrology, Nordsjaellands Hospital, Hilleroed, Denmark.
| | - Birger Thorsteinsson
- Department of Endocrinology and Nephrology, Nordsjaellands Hospital, Hilleroed, Denmark; University of Copenhagen, Denmark
| | - Niels Wiinberg
- Department of Physiology and Nuclear Medicine, Bispebjerg and Frederiksberg Hospital, Denmark.
| | - Andreas Kryger Jensen
- Section of Biostatistics, Institute of Public Health, University of Copenhagen, Denmark; Department of Research, Nordsjaellands Hospital, Hilleroed, Denmark.
| | | | - Berit Lilienthal Heitmann
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Denmark; Department of Public Health, Section for General Practice, University of Copenhagen, Copenhagen, Denmark.
| | - Søren S Lund
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Ingelheim, Germany
| | - Thure Krarup
- Department of Endocrinology, Copenhagen University Hospital, Bispebjerg, Denmark
| | - Tonny Jensen
- Department of Endocrinology, Rigshospitalet, University of Copenhagen, Denmark
| | - Henrik Vestergaard
- University of Copenhagen, Denmark; Department of Endocrinology, Copenhagen University Hospital, Herlev, Denmark,; The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, Denmark
| | - Leif Breum
- Department of Medicine, University Hospital Koege, Denmark
| | - Simone Sneppen
- Department of Medicine, Copenhagen University Hospital, Gentofte, Denmark
| | | | - Sten Madsbad
- University of Copenhagen, Denmark; Department of Endocrinology, Copenhagen University Hospital, Hvidovre, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Thomas P Almdal
- Department of Endocrinology, Rigshospitalet, University of Copenhagen, Denmark
| | - Lise Tarnow
- Department of Research, Nordsjaellands Hospital, Hilleroed, Denmark; Steno Diabetes Center Sjaelland, Holbaek, Denmark.
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17
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Palma CCSSV, Lopes PM, Silva ELC, Bevilaqua MDFDM, Bomfim ADS, Gomes MB. Vascular Age as a Cardiovascular Risk Marker in Asymptomatic Patients with Type 2 Diabetes. Diabetes Metab Syndr Obes 2020; 13:2505-2514. [PMID: 32765029 PMCID: PMC7369301 DOI: 10.2147/dmso.s251780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 06/16/2020] [Indexed: 11/23/2022] Open
Abstract
AIM There is a wide variety of cardiovascular outcomes in patients with type 2 diabetes (T2DM), even in asymptomatic individuals. Carotid intima-media thickness (CIMT) is a marker of subclinical atherosclerosis and can be considered as a predictor of cardiovascular risk (CVR). The aim of this study was to evaluate the relationship between CIMT-determined vascular age (VA), CVR scores, and thyroid function in asymptomatic patients with T2DM. PATIENTS AND METHODS Clinical laboratory and CIMT parameters were measured in 154 asymptomatic patients with T2DM. The Framingham risk score (FRS) was performed with chronological age (CA) and with VA. A multinomial logistic regression model was used to analyze variables related to CVR reclassification. RESULTS The use of CIMT-determined VA led to the reclassification of 54 (35.52%) out of 152 asymptomatic T2DM patients, being 20 (37.03%) to a lower categorical risk and 34 (62.96%) to a higher categorical risk according to FRS. The variables that were associated to reclassification to a higher categorical risk were positive family history (FH) of premature coronary artery disease (p=0.046), FH of thyroid disease (p=0.010), use of statins (p=0.027), and free T4 levels (p=0.009). CONCLUSION VA determined from CIMT allowed the reclassification of the CVR in asymptomatic T2DM patients. FH of premature CAD, FH of known thyroid disease, use of statins, and free T4 levels were associated to a reclassification into a higher risk category. The use of doppler to perform CIMT measure is currently more accessible, especially in a low-middle income country like Brazil. However, further prospective studies must be performed to establish the predictive values of CIMT on atherosclerosis and how thyroid function acts like cardiovascular risk marker on CVR scores.
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Affiliation(s)
| | - Pablo Moura Lopes
- Department of Internal Medicine, Cardiology Unit, State University Hospital of Rio de Janeiro, Rio de Janeiro, Brasil
| | - Eliete Leão Clemente Silva
- Department of Internal Medicine, Diabetes Unit, State University Hospital of Rio de Janeiro, Rio de Janeiro, Brasil
| | | | - Alfredo de Souza Bomfim
- Department of Internal Medicine, Cardiology Unit, State University Hospital of Rio de Janeiro, Rio de Janeiro, Brasil
| | - Marilia Brito Gomes
- Department of Internal Medicine, Diabetes Unit, State University Hospital of Rio de Janeiro, Rio de Janeiro, Brasil
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18
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Inoue H, Saito M, Kouchi K, Asahara S, Nakamura F, Kido Y. Association between mean platelet volume in the pathogenesis of type 2 diabetes mellitus and diabetic macrovascular complications in Japanese patients. J Diabetes Investig 2020; 11:938-945. [PMID: 31833219 PMCID: PMC7378450 DOI: 10.1111/jdi.13198] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/05/2019] [Accepted: 12/10/2019] [Indexed: 12/18/2022] Open
Abstract
AIMS/INTRODUCTION Mean platelet volume (MPV) is a widely used biological marker of platelet function and activity. Increased MPV is associated with accelerated thrombopoiesis and an elevated risk of cardiovascular disease. However, it is not known whether higher MPV is related to the pathogenesis of type 2 diabetes and diabetic macrovascular complications in Japanese patients. Therefore, we analyzed MPV and its correlation with atherosclerosis in Japanese patients with type 2 diabetes and those who had prediabetes. MATERIALS AND METHODS We divided the patients into three groups: normoglycemic patients (n = 56), prediabetes patients (n = 44) and type 2 diabetes patients group, (n = 115). We measured platelet parameters and evaluated arterial stiffness in the three groups. RESULTS Significantly higher MPV was found in the type 2 diabetes mellitus and prediabetes patients compared with normoglycemic patients. MPV was significantly correlated with fasting blood glucose and glycated hemoglobin levels. Multiple linear regression analysis showed that MPV was positively correlated with HbA1c, even after adjustment for confounding factors. In the evaluation of arterial stiffness by measuring the cardio-ankle vascular index and maximum intima-media thickness, MPV showed a positive correlation with these parameters. CONCLUSIONS These findings suggest that MPV was significantly increased in the early stage of type 2 diabetes. We showed positive correlations between MPV and HbA1c levels, and between MPV and arterial stiffness in Japanese patients with type 2 diabetes.
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Affiliation(s)
- Hiroyuki Inoue
- Clinical LaboratoryNara Prefecture General Medical CenterNaraJapan
- Division of Medical ChemistryDepartment of Metabolism and DiseasesKobe University Graduate School of Health SciencesKobeJapan
| | - Mayumi Saito
- Clinical LaboratoryNara Prefecture General Medical CenterNaraJapan
| | - Kumiko Kouchi
- Clinical LaboratoryNara Prefecture General Medical CenterNaraJapan
| | - Shun‐ichiro Asahara
- Division of Diabetes and EndocrinologyDepartment of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | | | - Yoshiaki Kido
- Division of Medical ChemistryDepartment of Metabolism and DiseasesKobe University Graduate School of Health SciencesKobeJapan
- Division of Diabetes and EndocrinologyDepartment of Internal MedicineKobe University Graduate School of MedicineKobeJapan
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19
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Nijpels G, Beulens JWJ, van der Heijden AAWA, Elders PJ. Innovations in personalised diabetes care and risk management. Eur J Prev Cardiol 2019; 26:125-132. [DOI: 10.1177/2047487319880043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Type 2 diabetes is associated with an increased risk of developing macro and microvascular complications. Nevertheless, there is substantial heterogeneity between people with type 2 diabetes in their risk of developing such complications. Personalised medicine for people with type 2 diabetes may aid in efficient and tailored diabetes care for those at increased risk of developing such complications. Recently, progress has been made in the development of personalised diabetes care in several areas. Particularly for the risk prediction of cardiovascular disease, retinopathy and nephropathy, innovative methods have been developed for prediction and tailored monitoring or treatment to prevent such complications. For other complications or subpopulations of people with type 2 diabetes, such as the frail elderly, efforts are currently ongoing to develop such methods. In this review, we discuss the recent developments in innovations of personalised diabetes care for different complications and subpopulations of people with type 2 diabetes, their performance and modes of application in clinical practice.
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Affiliation(s)
- Giel Nijpels
- Department of General Practice and Elderly Care Medicine, Amsterdam UMC – location VUmc, Amsterdam Public Health Research Institute, The Netherlands
| | - Joline WJ Beulens
- Department of Epidemiology and Biostatistics, Amsterdam UMC – location VUmc, Amsterdam Public Health Research Institute, The Netherlands
| | - Amber AWA van der Heijden
- Department of General Practice and Elderly Care Medicine, Amsterdam UMC – location VUmc, Amsterdam Public Health Research Institute, The Netherlands
| | - Petra J Elders
- Department of General Practice and Elderly Care Medicine, Amsterdam UMC – location VUmc, Amsterdam Public Health Research Institute, The Netherlands
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20
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Saba L, Jamthikar A, Gupta D, Khanna NN, Viskovic K, Suri HS, Gupta A, Mavrogeni S, Turk M, Laird JR, Pareek G, Miner M, Sfikakis PP, Protogerou A, Kitas GD, Viswanathan V, Nicolaides A, Bhatt DL, Suri JS. Global perspective on carotid intima-media thickness and plaque: should the current measurement guidelines be revisited? INT ANGIOL 2019; 38:451-465. [PMID: 31782286 DOI: 10.23736/s0392-9590.19.04267-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Carotid intima-media thickness (cIMT) and carotid plaque (CP) currently act as risk predictors for CVD/Stroke risk assessment. Over 2000 articles have been published that cover either use cIMT/CP or alterations of cIMT/CP and additional image-based phenotypes to associate cIMT related markers with CVD/Stroke risk. These articles have shown variable results, which likely reflect a lack of standardization in the tools for measurement, risk stratification, and risk assessment. Guidelines for cIMT/CP measurement are influenced by major factors like the atherosclerosis disease itself, conventional risk factors, 10-year measurement tools, types of CVD/Stroke risk calculators, incomplete validation of measurement tools, and the fast pace of computer technology advancements. This review discusses the following major points: 1) the American Society of Echocardiography and Mannheim guidelines for cIMT/CP measurements; 2) forces that influence the guidelines; and 3) calculators for risk stratification and assessment under the influence of advanced intelligence methods. The review also presents the knowledge-based learning strategies such as machine and deep learning which may play a future role in CVD/stroke risk assessment. We conclude that both machine learning and non-machine learning strategies will flourish for current and 10-year CVD/Stroke risk prediction as long as they integrate image-based phenotypes with conventional risk factors.
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Affiliation(s)
- Luca Saba
- Department of Radiology, University of Cagliari, Cagliari, Italy
| | - Ankush Jamthikar
- Department of Electronics and Communication Engineering, Visvesvaraya National Institute of Technology, Nagpur, India
| | - Deep Gupta
- Department of Electronics and Communication Engineering, Visvesvaraya National Institute of Technology, Nagpur, India
| | - Narendra N Khanna
- Department of Cardiology, Indraprastha APOLLO Hospitals, New Delhi, India
| | - Klaudija Viskovic
- Department of Radiology and Ultrasound, University Hospital for Infectious Diseases, Zagreb, Croatia
| | | | - Ajay Gupta
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Sophie Mavrogeni
- Cardiology Clinic, Onassis Cardiac Surgery Center, Athens, Greece
| | - Monika Turk
- Department of Neurology, University Medical Center Maribor, Maribor, Slovenia
| | - John R Laird
- Heart and Vascular Institute, Adventist Health St. Helena, St Helena, CA, USA
| | - Gyan Pareek
- Minimally Invasive Urology Institute, Brown University, Providence, RI, USA
| | - Martin Miner
- Men's Health Center, Miriam Hospital, Providence, RI, USA
| | - Petros P Sfikakis
- Unit of Rheumatology, National Kapodistrian University of Athens, Athens, Greece
| | - Athanasios Protogerou
- Department of Cardiovascular Prevention and Research, Clinic and Laboratory of Pathophysiology, National and Kapodistrian, University of Athens, Athens, Greece
| | - George D Kitas
- R and D Academic Affairs, Dudley Group NHS Foundation Trust, Dudley, UK
| | - Vijay Viswanathan
- MV Hospital for Diabete, Professor M Viswanathan Diabetes Research Center, Chennai, India
| | - Andrew Nicolaides
- Vascular Screening and Diagnostic Center, University of Nicosia Medical School, Nicosia, Cyprus
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart, Vascular Center, Harvard Medical School, Boston, MA, USA
| | - Jasjit S Suri
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA, USA -
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21
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Rutters F, Nijpels G, Elders P, Stehouwer CDA, van der Heijden AA, Groeneveld L, 't Hart LM, Dekker JM, Beulens JWJ. Cohort Profile: The Hoorn Studies. Int J Epidemiol 2019; 47:396-396j. [PMID: 29244153 DOI: 10.1093/ije/dyx227] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2017] [Indexed: 01/06/2023] Open
Affiliation(s)
- Femke Rutters
- Department of Epidemiology and Biostatistics, VU Medical Centre, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Giel Nijpels
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Department of General Practice and Elderly Care Medicine, VU Medical Centre, Amsterdam, The Netherlands
| | - Petra Elders
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Department of General Practice and Elderly Care Medicine, VU Medical Centre, Amsterdam, The Netherlands
| | - Coen D A Stehouwer
- Department of Internal Medicine and Cardiovascular Research Institute, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Amber A van der Heijden
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Department of General Practice and Elderly Care Medicine, VU Medical Centre, Amsterdam, The Netherlands
| | - Lenka Groeneveld
- Department of Epidemiology and Biostatistics, VU Medical Centre, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Leen M 't Hart
- Department of Epidemiology and Biostatistics, VU Medical Centre, Amsterdam, The Netherlands.,Department of Molecular Cell Biology.,Department of Molecular Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jacqueline M Dekker
- Department of Epidemiology and Biostatistics, VU Medical Centre, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Joline W J Beulens
- Department of Epidemiology and Biostatistics, VU Medical Centre, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands
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22
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Cardoso CRL, Salles GC, Leite NC, Salles GF. Prognostic impact of carotid intima-media thickness and carotid plaques on the development of micro- and macrovascular complications in individuals with type 2 diabetes: the Rio de Janeiro type 2 diabetes cohort study. Cardiovasc Diabetol 2019; 18:2. [PMID: 30630491 PMCID: PMC6327523 DOI: 10.1186/s12933-019-0809-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 01/03/2019] [Indexed: 12/18/2022] Open
Abstract
Background The prognostic importance of carotid atherosclerosis in individuals with diabetes is unsettled. We aimed to evaluate the relationships between parameters of carotid atherosclerosis and the future occurrence of micro- and cardiovascular complications in individuals with type 2 diabetes. Methods Ultrasonographic parameters of carotid atherosclerosis, intima-media thickness (CIMT) and plaques, were measured at baseline in 478 participants who were followed-up for a median of 10.8 years. Multivariate Cox analysis was used to examine the associations between carotid parameters and the occurrence of microvascular (retinopathy, renal, and peripheral neuropathy) and cardiovascular complications (total cardiovascular events [CVEs] and cardiovascular mortality), and all-cause mortality. The improvement in risk stratification was assessed by using the C-statistic and the integrated discrimination improvement (IDI) index. Results During follow-up, 116 individuals had a CVE and 115 individuals died (56 from cardiovascular diseases); 131 newly-developed or worsened diabetic retinopathy, 156 achieved the renal composite outcome (94 newly developed microalbuminuria and 78 deteriorated renal function), and 83 newly-developed or worsened peripheral neuropathy. CIMT, either analysed as a continuous or as a categorical variable, and presence of plaques predicted CVEs occurrence and renal outcomes, but not mortality or other microvascular complications. Individuals with an increased CIMT and plaques had a 1.5- to 1.8-fold increased risk of CVEs and a 1.6-fold higher risk of renal outcome. CIMT and plaques modestly improved cardiovascular risk discrimination over classic risk factors, with IDIs ranging from 7.8 to 8.4%; but more markedly improved renal risk discrimination, with IDIs from 14.8 to 18.5%. Conclusions Carotid atherosclerosis parameters predicted cardiovascular and renal outcomes, and improved renal risk stratification. Ultrasonographic carotid imaging may be useful in type 2 diabetes management.
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Affiliation(s)
- Claudia R L Cardoso
- Department of Internal Medicine, School of Medicine, University Hospital Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rua Rodolpho Rocco, 255, Cidade Universitária, Rio de Janeiro, CEP 21941-913, Brazil
| | - Guilherme C Salles
- Civil Engineering Program, COPPE, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Nathalie C Leite
- Department of Internal Medicine, School of Medicine, University Hospital Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rua Rodolpho Rocco, 255, Cidade Universitária, Rio de Janeiro, CEP 21941-913, Brazil
| | - Gil F Salles
- Department of Internal Medicine, School of Medicine, University Hospital Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rua Rodolpho Rocco, 255, Cidade Universitária, Rio de Janeiro, CEP 21941-913, Brazil.
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23
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Chowdhury MZI, Yeasmin F, Rabi DM, Ronksley PE, Turin TC. Prognostic tools for cardiovascular disease in patients with type 2 diabetes: A systematic review and meta-analysis of C-statistics. J Diabetes Complications 2019; 33:98-111. [PMID: 30446478 DOI: 10.1016/j.jdiacomp.2018.10.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 10/10/2018] [Accepted: 10/11/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Diabetes is associated with an increased risk for cardiovascular diseases (CVD). Risk prediction models are tools widely used to identify individuals at particularly high-risk of adverse events. Many CVD risk prediction models have been developed but their accuracy and consistency vary. OBJECTIVE This study reviews the literature on available CVD risk prediction models specifically developed or validated in patients with diabetes and performs a meta-analysis of C-statistics to assess and compare their predictive performance. METHODS The online databases and manual reference checks of all identified relevant publications were searched. RESULTS Fifteen CVD prediction models developed for patients with diabetes and 11 models developed in a general population but later validated in diabetes patients were identified. Meta-analysis of C-statistics showed an overall pooled C-statistic of 0.67 and 0.64 for validated models developed in diabetes patients and in general populations respectively. This small difference in the C-statistic suggests that CVD risk prediction for diabetes patients depends little on the population the model was developed in (p = 0.068). CONCLUSIONS The discriminative ability of diabetes-specific CVD prediction models were modest. Improvements in the predictive ability of these models are required to understand both short and long-term risk before implementation into clinical practice.
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Affiliation(s)
- Mohammad Z I Chowdhury
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada.
| | - Fahmida Yeasmin
- Department of Mathematics and Statistics, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada.
| | - Doreen M Rabi
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada; Department of Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada.
| | - Paul E Ronksley
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada.
| | - Tanvir C Turin
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada; Department of Family Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada.
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24
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Tanaka A, Kawaguchi A, Oyama JI, Ishizu T, Ito H, Fukui J, Kondo T, Kuroki S, Nanasato M, Higashi Y, Kaku K, Inoue T, Murohara T, Node K. Differential effect of concomitant antidiabetic agents on carotid atherosclerosis: a subgroup analysis of the PROLOGUE study. Heart Vessels 2018; 34:375-384. [PMID: 30284018 DOI: 10.1007/s00380-018-1275-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 09/28/2018] [Indexed: 11/28/2022]
Abstract
Accumulated evidence shows that some antidiabetic agents attenuate the progression of carotid atherosclerosis assessed as intima-media thickness (IMT). Although some studies have demonstrated an inhibitory effect of dipeptidyl peptidase-4 inhibitors on carotid IMT progression, in the PROLOGUE study sitagliptin failed to slow progression relative to conventional therapy for 24 months. We hypothesized that differences in the concomitant antidiabetic agents between the groups have influenced the progression of carotid IMT. We performed a post hoc analysis of the PROLOGUE study using subgroups stratified by concomitant antidiabetic agents. Although no subgroup with any combination of agents in the overall patients showed a significant difference between sitagliptin group and conventional therapy group in the changes from baseline in mean common carotid artery (CCA)-IMT at 24 months, a significant attenuation of mean CCA-IMT progression was observed in the sitagliptin group relative to conventional therapy group only in three combination subgroups aged < 70 years, namely no thiazolidinedione; no thiazolidinedione or biguanide; and no thiazolidinedione, biguanide or α-glucosidase inhibitor, even after adjustment for multiple confounding factors. In the three subgroups, no significant difference between sitagliptin group and conventional therapy group in the changes from baseline in HbA1c at 24 months was detected. Our data suggest that some concomitant agents, whose prescription frequencies were increased in the conventional therapy group, may have masked the inhibitory effect of sitagliptin on carotid IMT progression in the PROLOGUE study.
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Affiliation(s)
- Atsushi Tanaka
- Department of Cardiovascular Medicine, Saga University, Saga, Japan.
| | | | - Jun-Ichi Oyama
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | - Tomoko Ishizu
- Department of Clinical Laboratory Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroshi Ito
- Department of Cardiovascular and Respiratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Jun Fukui
- Division of Cardiology, Hokusho Central Hospital, Sasebo, Japan
| | - Taizo Kondo
- Department of Cardiovascular Medicine, Gifu Prefectural Tajimi Hospital, Tajimi, Japan
| | | | - Mamoru Nanasato
- Cardiovascular Center, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan
| | - Yukihito Higashi
- Department of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Kohei Kaku
- Department of General Internal Medicine, Kawasaki Medical School, Kurashiki, Japan
| | - Teruo Inoue
- Department of Cardiovascular Medicine, Dokkyo Medical University, Mibu, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, Saga, Japan.
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25
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Petersen KS, Keogh JB, Lister NB, Clifton PM. Dietary quality and carotid intima media thickness in type 1 and type 2 diabetes: Follow-up of a randomised controlled trial. Nutr Metab Cardiovasc Dis 2018; 28:830-838. [PMID: 29853429 DOI: 10.1016/j.numecd.2018.05.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 05/02/2018] [Accepted: 05/02/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND AIMS The relationship between dietary intake and carotid intima media thickness (IMT) and pulse wave velocity (PWV) in individuals with type 1 and type 2 diabetes has not been well studied. We investigated the association between dietary intake and common carotid artery intima media thickness (CCA IMT) and PWV in a cohort with type 1 and type 2 diabetes. METHODS AND RESULTS A one-year randomised controlled trial was conducted to investigate the effect of improving dietary quality on CCA IMT. These subjects were followed up again approximately 12 months after the completion of the trial (i.e. approximately 24 month since baseline). The study cohort included 87 subjects that had dietary intake and CCA IMT measured at baseline and after a mean of 2.3 years' follow-up. PWV was measured in a subsample of this cohort. Age and baseline mean CCA IMT were strongly associated with mean CCA IMT at 24 months. After adjustment for age and baseline mean CCA IMT, baseline consumption of carbohydrate (r = -0.28; p = 0.01), sugars (r = -0.27; p = 0.01), fibre (r = -0.26; p = 0.02), magnesium (r = -0.25; p = 0.02) and the Alternate Health Eating Index (AHEI) score (r = -0.23; p = 0.03) were inversely associated with mean CCA IMT at 24 months. Mixed linear modelling showed an interaction between mean CCA IMT and AHEI at baseline (p = 0.024). Those who were in the highest AHEI tertile at baseline had greater CCA IMT regression at 24 months compared to those in the lowest tertile, after adjustment for baseline age, BMI, smoking pack years, time since diabetes diagnosis, and mean arterial pressure at baseline (mean -0.043 mm; 95% CI -0.084, -0.003; p = 0.029). CONCLUSIONS In this prospective analysis greater diet quality at baseline, as measured by the AHEI, was associated with greater CCA IMT regression after approximately two years. This suggests that greater diet quality is associated with better longer term vascular health in individuals with type 1 and type 2 diabetes.
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Affiliation(s)
- K S Petersen
- School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide SA, Australia
| | - J B Keogh
- School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide SA, Australia
| | - N B Lister
- School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide SA, Australia
| | - P M Clifton
- School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide SA, Australia.
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26
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Britton AR, Grobbee DE, den Ruijter HM, Anderson TJ, Desvarieux M, Engström G, Evans GW, Hedblad B, Kauhanen J, Kurl S, Lonn EM, Mathiesen EB, Polak JF, Price JF, Rembold CM, Rosvall M, Rundek T, Salonen JT, Stehouwer C, Tuomainen TP, Bots ML. Alcohol Consumption and Common Carotid Intima-Media Thickness: The USE-IMT Study. Alcohol Alcohol 2018; 52:483-486. [PMID: 28525540 PMCID: PMC5860521 DOI: 10.1093/alcalc/agx028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 04/20/2017] [Indexed: 12/04/2022] Open
Abstract
Aims Epidemiological evidence indicates a protective effect of light to moderate alcohol consumption compared to non-drinking and heavy drinking. Although several mechanisms have been suggested, the effect of alcohol on atherosclerotic changes in vessel walls is unclear. Therefore, we explored the relationship between alcohol consumption and common carotid intima media thickness, a marker of early atherosclerosis in the general population. Methods Individual participant data from eight cohorts, involving 37,494 individuals from the USE-IMT collaboration were used. Multilevel age and sex adjusted linear regression models were applied to estimate mean differences in common carotid intima-media thickness (CIMT) with alcohol consumption. Results The mean age was 57.9 years (SD 8.6) and the mean CIMT was 0.75 mm (SD 0.177). About, 40.5% reported no alcohol consumed, and among those who drank, mean consumption was 13.3 g per day (SD 16.4). Those consuming no alcohol or a very small amount (<5 g per day) had significantly lower common CIMT values than those consuming >10 g per day, after adjusting for a range of confounding factors. Conclusion In this large CIMT consortium, we did not find evidence to support a protective effect of alcohol on CIMT.
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Affiliation(s)
- Annie R Britton
- Department of Epidemiology and Public Health University College London, London WC1E 6BT, UK
| | - Diederick E Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands.,Laboratory of Experimental Cardiology, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
| | - Hester M den Ruijter
- Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary AB T2N, Canada
| | - Todd J Anderson
- Columbia University, 116th and Broadway, New York, NY 10027, USA
| | - Moise Desvarieux
- Department of Clinical Sciences in Malmö, Lund University, Skane University Hospital, Jan Waldenströms gata 35, Malmö, Sweden
| | - Gunnar Engström
- Department of Biostatistical Sciences and Neurology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Greg W Evans
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, FI-70211 Kuopio, Finland
| | - Bo Hedblad
- Department of Biostatistical Sciences and Neurology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Jussi Kauhanen
- Department of Medicine, Division of Cardiology and Population Health Research Institute, McMaster University, Hamilton, ON LSL 2X2, Ontario, Canada
| | - Sudhir Kurl
- Department of Medicine, Division of Cardiology and Population Health Research Institute, McMaster University, Hamilton, ON LSL 2X2, Ontario, Canada
| | - Eva M Lonn
- Brain and Circulation Research Group, Department of Clinical Medicine, University of Tromsö, N-9037 Tromsø, Norway
| | - Ellisiv B Mathiesen
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
| | - Joseph F Polak
- Department of Radiology, Tufts University School of Medicine, 800 Washington St, Boston, MA 02111, USA
| | - Jacqueline F Price
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, EH16 4UX, UK
| | - Christopher M Rembold
- Cardiology Division, Department of Internal Medicine, University of Virginia, Charlottesville, VA 22908-0158, USA
| | - Maria Rosvall
- Department of Biostatistical Sciences and Neurology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Tatjana Rundek
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Jukka T Salonen
- MAS-Metabolic Analytical Services Oy, 00990 Helsinki, Finland
| | - Coen Stehouwer
- Department of Internal Medicine and Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, 6229 ER Maastricht, The Netherlands
| | - Tomi-Pekka Tuomainen
- Department of Medicine, Division of Cardiology and Population Health Research Institute, McMaster University, Hamilton, ON LSL 2X2, Ontario, Canada
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
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27
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Stehouwer CDA. New risk equations for complications of type 2 diabetes are welcome, but a broader perspective is needed. Lancet Diabetes Endocrinol 2017; 5:759-761. [PMID: 28803839 DOI: 10.1016/s2213-8587(17)30232-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 06/22/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Coen D A Stehouwer
- Department of Internal Medicine, Maastricht University Medical Centre+, 6202 AZ Maastricht, Netherlands.
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28
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Hernández M, López C, Real J, Valls J, Ortega-Martinez de Victoria E, Vázquez F, Rubinat E, Granado-Casas M, Alonso N, Molí T, Betriu A, Lecube A, Fernández E, Leslie RD, Mauricio D. Preclinical carotid atherosclerosis in patients with latent autoimmune diabetes in adults (LADA), type 2 diabetes and classical type 1 diabetes. Cardiovasc Diabetol 2017; 16:94. [PMID: 28750634 PMCID: PMC5532780 DOI: 10.1186/s12933-017-0576-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 07/21/2017] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND LADA is probably the most prevalent form of autoimmune diabetes. Nevertheless, there are few data about cardiovascular disease in this group of patients. The aim of this study was to investigate the frequency of carotid atherosclerotic plaques in patients with LADA as compared with patients with classic type 1 diabetes and type 2 diabetes. METHODS Patients with LADA were matched for age and gender in different proportions to patients with type 2 diabetes, and classic type 1 diabetes. None of the patients had clinical cardiovascular disease. All subjects underwent B-mode carotid ultrasound to detect atheroma plaques. Demographics were obtained from all subjects. RESULTS We included 71 patients with LADA, 191 patients with type 2 diabetes and 116 patients with type 1 diabetes. Carotid atherosclerosis was more frequent in patients with LADA compared with type 2 diabetes (73.2% vs. 56.9%, P = 0.0018) and classic type 1 diabetes (57.1%, P = 0.026); these changes occurred despite healthier macrovascular risk profiles in the former. Age (P < 0.001), smoking (P = 0.003) and hypertension (P = 0.019) were independently associated with carotid atherosclerosis. Multiple plaques were also more frequent in patients with LADA as compared with classic type 1 diabetes and type 2 diabetes (45.1% and 33.6% vs. 27.2%, respectively, P = 0.022). The frequency of carotid plaques increased with increasing diabetes duration in LADA patients compared with type 2 diabetes (85.7% vs. 58.8%, inverse OR 5.72 [1.5-21.8]; P = 0.009). CONCLUSIONS LADA patients do not present with less carotid atherosclerosis than patients with type 1 and type 2 diabetes. Their macrovascular risk occurs despite a healthier macrovascular risk profile than those patients with type 2 diabetes.
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Affiliation(s)
- Marta Hernández
- Department of Endocrinology and Nutrition, University Hospital Arnau de Vilanova, Lleida, Spain
- Nursing School, Universitat de Lleida, Lleida, Spain
- Institut de Recerca Biomèdica de Lleida, Lleida, Spain
| | - Carolina López
- Nursing School, Universitat de Lleida, Lleida, Spain
- Institut de Recerca Biomèdica de Lleida, Lleida, Spain
| | - Jordi Real
- Unitat de Suport a la Recerca Lleida, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Epidemiologia i Salut Pública, Universitat International de Catalunya, Sant Cugat del Vallés, Spain
| | - Joan Valls
- Institut de Recerca Biomèdica de Lleida, Lleida, Spain
- Department of Basic Medical Sciences, Universitat de Lleida, Lleida, Spain
| | - Emilio Ortega-Martinez de Victoria
- Department of Endocrinology and Nutrition, CIBEROBN-Spanish Biomedical Research Centre in Physiopathology of Obesity, Hospital Clínic, Barcelona, Spain
| | - Federico Vázquez
- Department of Endocrinology and Nutrition, CIBER of Diabetes and Associated Metabolic Diseases, Health Sciences Research Institute & University Hospital Germans Trias i Pujol, Carretera Canyet S/N, Badalona, 08916 Spain
| | | | - Minerva Granado-Casas
- Nursing School, Universitat de Lleida, Lleida, Spain
- Department of Endocrinology and Nutrition, CIBER of Diabetes and Associated Metabolic Diseases, Health Sciences Research Institute & University Hospital Germans Trias i Pujol, Carretera Canyet S/N, Badalona, 08916 Spain
| | - Nuria Alonso
- Department of Endocrinology and Nutrition, CIBER of Diabetes and Associated Metabolic Diseases, Health Sciences Research Institute & University Hospital Germans Trias i Pujol, Carretera Canyet S/N, Badalona, 08916 Spain
| | - Teresa Molí
- UDETMA, Department of Nephrology, University Hospital Arnau de Vilanova, Lleida, Spain
| | - Angels Betriu
- Institut de Recerca Biomèdica de Lleida, Lleida, Spain
- UDETMA, Department of Nephrology, University Hospital Arnau de Vilanova, Lleida, Spain
| | - Albert Lecube
- Department of Endocrinology and Nutrition, University Hospital Arnau de Vilanova, Lleida, Spain
- Nursing School, Universitat de Lleida, Lleida, Spain
- Institut de Recerca Biomèdica de Lleida, Lleida, Spain
| | - Elvira Fernández
- UDETMA, Department of Nephrology, University Hospital Arnau de Vilanova, Lleida, Spain
| | - Richard David Leslie
- The Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK
| | - Dídac Mauricio
- Institut de Recerca Biomèdica de Lleida, Lleida, Spain
- Department of Endocrinology and Nutrition, CIBER of Diabetes and Associated Metabolic Diseases, Health Sciences Research Institute & University Hospital Germans Trias i Pujol, Carretera Canyet S/N, Badalona, 08916 Spain
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Clustering of cardiovascular risk factors and carotid intima-media thickness: The USE-IMT study. PLoS One 2017; 12:e0173393. [PMID: 28323823 PMCID: PMC5360240 DOI: 10.1371/journal.pone.0173393] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 02/20/2017] [Indexed: 01/23/2023] Open
Abstract
Background The relation of a single risk factor with atherosclerosis is established. Clinically we know of risk factor clustering within individuals. Yet, studies into the magnitude of the relation of risk factor clusters with atherosclerosis are limited. Here, we assessed that relation. Methods Individual participant data from 14 cohorts, involving 59,025 individuals were used in this cross-sectional analysis. We made 15 clusters of four risk factors (current smoking, overweight, elevated blood pressure, elevated total cholesterol). Multilevel age and sex adjusted linear regression models were applied to estimate mean differences in common carotid intima-media thickness (CIMT) between clusters using those without any of the four risk factors as reference group. Results Compared to the reference, those with 1, 2, 3 or 4 risk factors had a significantly higher common CIMT: mean difference of 0.026 mm, 0.052 mm, 0.074 mm and 0.114 mm, respectively. These findings were the same in men and in women, and across ethnic groups. Within each risk factor cluster (1, 2, 3 risk factors), groups with elevated blood pressure had the largest CIMT and those with elevated cholesterol the lowest CIMT, a pattern similar for men and women. Conclusion Clusters of risk factors relate to increased common CIMT in a graded manner, similar in men, women and across race-ethnic groups. Some clusters seemed more atherogenic than others. Our findings support the notion that cardiovascular prevention should focus on sets of risk factors rather than individual levels alone, but may prioritize within clusters.
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Bots ML, Evans GW, Tegeler CH, Meijer R. Carotid Intima-media Thickness Measurements: Relations with Atherosclerosis, Risk of Cardiovascular Disease and Application in Randomized Controlled Trials. Chin Med J (Engl) 2017; 129:215-26. [PMID: 26830994 PMCID: PMC4799550 DOI: 10.4103/0366-6999.173500] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Advances in the field of carotid ultrasound have been incremental, resulting in a steady decrease in measurement variability. Improvements in edge detection algorithms point toward increasing automation of CIMT measurements. The major advantage of CIMT is that it is completely noninvasive and can be repeated as often as required. It provides a continuous measure since all subjects have a measurable carotid wall. It is also relatively inexpensive to perform, and the technology is widely available. A graded relation between raising LDL cholesterol and increased CIMT is apparent. Increased CIMT has been shown consistently to relate the atherosclerotic abnormalities elsewhere in the arterial system. Moreover, increased CIMT predicts future vascular events in both populations from Caucasian ancestry and those from Asian ancestry. Furthermore, lipid‑lowering therapy has been shown to affect CIMT progression within 12–18 months in properly designed trials with results congruent with clinical events trials. In conclusion, when one wants to evaluate the effect of a pharmaceutical intervention that is to be expected to beneficially affect atherosclerosis progression and to reduce CV event risk, the use of CIMT measurements over time is a valid, suitable, and evidence‑based choice.
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Affiliation(s)
- Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Petersen KS, Keogh JB, Meikle PJ, Garg ML, Clifton PM. Clinical and dietary predictors of common carotid artery intima media thickness in a population with type 1 and type 2 diabetes: A cross-sectional study. World J Diabetes 2017; 8:18-27. [PMID: 28138361 PMCID: PMC5237814 DOI: 10.4239/wjd.v8.i1.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 09/13/2016] [Accepted: 11/17/2016] [Indexed: 02/05/2023] Open
Abstract
AIM To determine the clinical and dietary predictors of common carotid artery intima media thickness (CCA IMT) in a cohort of subjects with type 1 and type 2 diabetes.
METHODS Participants with type 1 (n = 23) and type 2 diabetes (n = 127) had mean and mean maximum CCA IMT measured using B mode ultrasound. Dietary intake was measured using a food frequency questionnaire. Clinical and dietary predictors of mean and mean maximum CCA IMT were determined using linear regression analysis adjusted for potential confounders.
RESULTS The main predictors of mean and mean maximum CCA IMT were age and weight. After multivariate adjustment there were no dietary predictors of CCA IMT. However, in subjects that were not prescribed a lipid lowering medication alcohol consumption was positively associated with CCA IMT after multivariate adjustment. No difference existed in CCA IMT between subjects with type 1 or type 2 diabetes once age was adjusted for.
CONCLUSION CCA IMT was predominantly predicted by age and weight in these subjects with diabetes. The finding that CCA IMT was not different between people with type 1 and type 2 diabetes warrants further investigation in a larger cohort.
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Endes S, Caviezel S, Schaffner E, Dratva J, Schindler C, Künzli N, Bachler M, Wassertheurer S, Probst-Hensch N, Schmidt-Trucksäss A. Associations of Novel and Traditional Vascular Biomarkers of Arterial Stiffness: Results of the SAPALDIA 3 Cohort Study. PLoS One 2016; 11:e0163844. [PMID: 27685325 PMCID: PMC5042378 DOI: 10.1371/journal.pone.0163844] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 09/15/2016] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND AND OBJECTIVES There is a lack of evidence concerning associations between novel parameters of arterial stiffness as cardiovascular risk markers and traditional structural and functional vascular biomarkers in a population-based Caucasian cohort. We examined these associations in the second follow-up of the Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults (SAPALDIA 3). METHODS Arterial stiffness was measured oscillometrically by pulse wave analysis to derive the cardio-ankle vascular index (CAVI), brachial-ankle (baPWV) and aortic pulse wave velocity (aPWV), and amplitude of the forward and backward wave. Carotid ultrasonography was used to measure carotid intima-media thickness (cIMT) and carotid lumen diameter (LD), and to derive a distensibility coefficient (DC). We used multivariable linear regression models adjusted for several potential confounders for 2,733 people aged 50-81 years. RESULTS CAVI, aPWV and the amplitude of the forward and backward wave were significant predictors of cIMT (p < 0.001). All parameters were significantly associated with LD (p < 0.001), with aPWV and the amplitude of the forward wave explaining the highest proportion of variance (2%). Only CAVI and baPWV were significant predictors of DC (p < 0.001), explaining more than 0.3% of the DC variance. CONCLUSION We demonstrated that novel non-invasive oscillometric arterial stiffness parameters are differentially associated with specific established structural and functional local stiffness parameters. Longitudinal studies are needed to follow-up on these cross-sectional findings and to evaluate their relevance for clinical phenotypes.
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Affiliation(s)
- Simon Endes
- Department of Sport, Exercise and Health, Div. Sports and Exercise Medicine, University of Basel, Switzerland
- * E-mail:
| | - Seraina Caviezel
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Emmanuel Schaffner
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Julia Dratva
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Christian Schindler
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Nino Künzli
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Martin Bachler
- Biomedical Systems, Health & Environment Department, AIT Austrian Institute of Technology GmbH, Vienna, Austria
| | - Siegfried Wassertheurer
- Biomedical Systems, Health & Environment Department, AIT Austrian Institute of Technology GmbH, Vienna, Austria
| | - Nicole Probst-Hensch
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Arno Schmidt-Trucksäss
- Department of Sport, Exercise and Health, Div. Sports and Exercise Medicine, University of Basel, Switzerland
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Abstract
Measurement of plaque burden is different from measurement of carotid intima-media thickness (IMT). Carotid total plaque area is a stronger predictor of cardiovascular risk than IMT, and in contrast to progression of IMT, which does not predict cardiovascular events, progression of total plaque area and total plaque volume strongly predict cardiovascular events. Measurement of plaque burden is useful in genetic research, and in evaluation of new therapies for atherosclerosis. Perhaps more importantly, it can be used for management of patients. A strategy called "treating arteries instead of treating risk factors" markedly reduces risk among patients with asymptomatic carotid stenosis.
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Affiliation(s)
- J David Spence
- Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, Ontario N6G 2V4, Canada.
| | - Grace Parraga
- Imaging Research Laboratories, Department of Medical Biophysics, Robarts Research Institute, Western University, London, Ontario, Canada
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Liao X, Norata GD, Polak JF, Stehouwer CDA, Catapano A, Rundek T, Ezhov M, Sander D, Thompson SG, Lorenz MW, Balakhonova T, Safarova M, Grigore L, Empana JP, Lin HJ, McLachlan S, Bokemark L, Ronkainen K, Schminke U, Lind L, Willeit P, Yanez DN, Steinmetz H, Poppert H, Desvarieux M, Ikram MA, Johnsen SH, Iglseder B, Friera A, Xie W, Plichart M, Su TC, Srinivasan SR, Schmidt C, Tuomainen TP, Völzke H, Nijpels G, Willeit J, Franco OH, Suarez C, Zhao D, Ducimetiere P, Chien KL, Robertson C, Bergström G, Kauhanen J, Dörr M, Dekker JM, Kiechl S, Sitzer M, Bickel H, Sacco RL, Hofman A, Mathiesen EB, Gabriel R, Liu J, Berenson G, Kavousi M, Price JF. Normative values for carotid intima media thickness and its progression: Are they transferrable outside of their cohort of origin? Eur J Prev Cardiol 2016; 23:1165-73. [DOI: 10.1177/2047487315625543] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 12/15/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Ximing Liao
- Department of Neurology, Goethe University, Frankfurt am Main, Germany
| | - Giuseppe D Norata
- Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Italy
- SISA Centre for the Study of Atherosclerosis, Bassini Hospital, Cinisello Balsamo, Italy
| | - Joseph F Polak
- Tufts University School of Medicine, Tufts Medical Center, Boston, USA
| | - Coen DA Stehouwer
- Department of Internal Medicine and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, The Netherlands
| | - Alberico Catapano
- IRCSS Multimedica, Milan, Italy
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Italy
| | - Tatjana Rundek
- Department of Neurology, Miller School of Medicine, University of Miami, USA
| | - Marat Ezhov
- Atherosclerosis Department, Cardiology Research Centre, Moscow, Russia
| | - Dirk Sander
- Department of Neurology, Benedictus Hospital Tutzing & Feldafing, Feldafing, Germany
- Department of Neurology, Technische Universität München, Germany
| | - Simon G Thompson
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, UK
| | - Matthias W Lorenz
- Department of Neurology, Goethe University, Frankfurt am Main, Germany
| | | | - Maya Safarova
- Atherosclerosis Department, Cardiology Research Centre, Moscow, Russia
| | - Liliana Grigore
- SISA Centre for the Study of Atherosclerosis, Bassini Hospital, Cinisello Balsamo, Italy
| | - Jean-Philippe Empana
- Paris Cardiovascular Research Centre (PARCC), University Paris Descartes, Sorbonne Paris Cité, France
| | - Hung-Ju Lin
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Stela McLachlan
- Centre for Population Health Sciences, University of Edinburgh, UK
| | - Lena Bokemark
- Wallenberg Laboratory for Cardiovascular Research, Institution for Medicin, Department for Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Sweden
| | - Kimmo Ronkainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Ulf Schminke
- Department of Neurology, Greifswald University Clinic, Germany
| | - Lars Lind
- Department of Medicine, Uppsala University, Sweden
| | - Peter Willeit
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, UK
- Department of Neurology, Medical University Innsbruck, Austria
| | - David N Yanez
- Department of Biostatistics, University of Washington, Seattle, USA
| | - Helmuth Steinmetz
- Department of Neurology, Goethe University, Frankfurt am Main, Germany
| | - Holger Poppert
- Department of Neurology, Technische Universität München, Germany
| | - Moise Desvarieux
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Department of Neurology, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Department of Radiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Stein Harald Johnsen
- Department of Clinical Medicine, University of Tromsø, Norway
- Department of Neurology, University Hospital of Northern Norway, Tromsø, Norway
| | - Bernhard Iglseder
- Parcelsus Medical University, Salzburg, Austria
- Department of Geriatric Medicine, Gemeinnützige Salzburger Landeskliniken Betriebsgesellschaft GmbH Christian-Doppler-Klinik, Salzburg, Austria
| | - Alfonsa Friera
- Radiology Department, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Spain
| | - Wuxiang Xie
- Department of Epidemiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, China
| | - Matthieu Plichart
- Assistance Publique, Hôpitaux de Paris, Hôpital Broca, Paris, France
| | - Ta-Chen Su
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Sathanur R Srinivasan
- Center for Cardiovascular Health, Department of Epidemiology, Biochemistry, Tulane University School of Public Health and Tropical Medicine, New Orleans, USA
| | - Caroline Schmidt
- Wallenberg Laboratory for Cardiovascular Research, Institution for Medicin, Department for Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Sweden
| | - Tomi-Pekka Tuomainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Henry Völzke
- Institute for Community Medicine, SHIP/Clinical-Epidemiological Research, Greifswald, Germany
| | - Giel Nijpels
- Department of General Practice, VU University Medical Centre, Amsterdam, The Netherlands
- EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Johann Willeit
- Department of Neurology, Medical University Innsbruck, Austria
| | - Oscar H Franco
- Department of Epidemiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Carmen Suarez
- Internal Medicine Department, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Spain
| | - Dong Zhao
- Department of Epidemiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, China
| | | | - Kuo-Liong Chien
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | | | - Göran Bergström
- Wallenberg Laboratory for Cardiovascular Research, Institution for Medicin, Department for Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Sweden
| | - Jussi Kauhanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Marcus Dörr
- Department B for Internal Medicine, University Medicine Greifswald, Germany
- German Centrefor Cardiovascular Research (DZHK), partner site Greifswald, Germany
| | - Jaqueline M Dekker
- Department of Epidemiology and Biostatistics, University Medical Centre, Amsterdam, The Netherlands
| | - Stefan Kiechl
- Department of Neurology, Medical University Innsbruck, Austria
| | - Matthias Sitzer
- Department of Neurology, Goethe University, Frankfurt am Main, Germany
- Department of Neurology, Klinikum Herford, Germany
| | - Horst Bickel
- Department of Psychiatry and Psychotherapy, Technische Universität München, Germany
| | - Ralph L Sacco
- Department of Neurology, Miller School of Medicine, University of Miami, USA
| | - Albert Hofman
- Department of Epidemiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Ellisiv B Mathiesen
- Department of Clinical Medicine, University of Tromsø, Norway
- Department of Neurology, University Hospital of Northern Norway, Tromsø, Norway
| | - Rafael Gabriel
- Instituto de Investigación IdiPAZ, Hospital Universitario La Paz, Madrid, Spain
| | - Jing Liu
- Department of Epidemiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, China
| | - Gerald Berenson
- Department of Medicine, Pediatrics, Biochemistry, Epidemiology, Tulane University School of Medicine and School of Public Health and Tropical Medicine, New Orleans, USA
| | - Maryam Kavousi
- Department of Epidemiology and Biostatistics, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Jackie F Price
- Centre for Population Health Sciences, University of Edinburgh, UK
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Cheng LJ, Xu ZR, Zhang Q, Wang ZD, Wu FW, Yang WX. Effects of comprehensive intensive therapies on the change of intima-media thickness of carotid arteries in type 2 diabetic patients: A report of 4-year follow-up with a literature review. Diab Vasc Dis Res 2016; 13:31-40. [PMID: 26499916 DOI: 10.1177/1479164115605001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The aim was to evaluate the effect of comprehensive intensive therapy on the carotid and femoral arteries of intima-media thickness in patients with type 2 diabetes mellitus after 4-year follow-up. METHODS In this prospective 4-year study, patients (N = 210) with newly diagnosed type 2 diabetes received either comprehensive intensive therapy (n = 110) or conventional therapy (n = 100). Blood pressure, blood glucose and lipid levels were monitored every 3-6 months, and carotid and femoral arteries of intima-media thickness were monitored with ultrasonography. For the literature review, various databases were searched until 20 December 2014 for studies that evaluated effects of intensive multi-factorial therapies on comprehensive intensive therapy in type 2 diabetes mellitus patients. RESULTS The comprehensive intensive therapy group had a smaller rate of carotid intima-media thickness increase than the conventional therapy (control) group (p < 0.05). The carotid intima-media thickness in comprehensive intensive therapy group remained stable while the adjusted rate of carotid intima-media thickness increase was 12.55% in the control group. The femoral intima-media thickness change was also smaller in comprehensive intensive therapy group but the difference over time did not reach significance. CONCLUSION The carotid intima-media thickness remained stable in type 2 diabetes mellitus patients who received comprehensive intensive therapy, suggesting that multi-factorial intensive therapies might have potential in reducing macro-vascular events in these patients.
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Affiliation(s)
- Li-Juan Cheng
- Department of Geriatrics, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhe-Rong Xu
- Department of Geriatrics, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qin Zhang
- Department of Geriatrics, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhao-Di Wang
- Department of Geriatrics, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Fang-Wei Wu
- Department of Geriatrics, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Wei-Xia Yang
- Department of Geriatrics, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Zhao Y, Wong N. Should adults with type 2 diabetes be screened for atherosclerotic cardiovascular disease? F1000Res 2015; 4:F1000 Faculty Rev-1167. [PMID: 26937273 PMCID: PMC4752024 DOI: 10.12688/f1000research.6625.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2015] [Indexed: 11/24/2022] Open
Abstract
Diabetes mellitus is associated with greater risks for cardiovascular diseases (CVD). Multiple noninvasive screening tools for CVD including cardiac CT, carotid intima-media thickness test, myocardial perfusion imaging have been examined in those with diabetes, but the prognostic value of these tests vary and issues remain regarding their cost-benefit ratios, potential harms of radiation, and how they fit into screening algorithms for CVD. We discuss in this report the needs and criteria for screening tests and summarize the evidence from observational studies and clinical trials. We also explore whether there should be more sensitive screening modalities to better detect both short and long-term cardiovascular risk among asymptomatic patients with diabetes.
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Affiliation(s)
- Yanglu Zhao
- Heart Disease Prevention Program, Division of Cardiology, C240, Medical Sciences, University of California, Irvine, CA, 92697, USA
| | - Nathan Wong
- Heart Disease Prevention Program, Division of Cardiology, C240, Medical Sciences, University of California, Irvine, CA, 92697, USA
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Nezu T, Hosomi N, Aoki S, Matsumoto M. Carotid Intima-Media Thickness for Atherosclerosis. J Atheroscler Thromb 2015; 23:18-31. [PMID: 26460381 DOI: 10.5551/jat.31989] [Citation(s) in RCA: 194] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The carotid intima-media thickness (IMT) is a widely used surrogate marker for atherosclerosis worldwide. The carotid IMT can be simply, noninvasively, and reproducibly measured through B-mode carotid ultrasound. The carotid IMT is also a strong predictor of future cerebral and cardiovascular events. In addition, regressions of increased carotid IMT by lipid-lowering and antihypertensive drugs have been reported. Despite the strong association between increased carotid IMT and cardiovascular disease, it remains unclear whether routine carotid IMT measurement is useful for the detection of subclinical atherosclerosis in clinical practice. Researches should consider other methodological aspects, such as the definition of carotid plaques, the choice of measurement sites on the common or internal carotid artery, and the assessment of maximum or minimum IMT. The detailed guidelines for measuring carotid IMT vary by county. Thus, the usefulness of the carotid IMT may be assessed in different countries taking racial differences into account. Other important parameters revealed by carotid ultrasound, such as artery stenosis and the characteristics and size of plaques, should also be considered. Physicians should comprehensively interpret the results of carotid ultrasonography. Therefore, carotid ultrasonography is an essential tool for assessing cardiovascular risk in clinical settings.
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Affiliation(s)
- Tomohisa Nezu
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences
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38
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Lorenz MW, Price JF, Robertson C, Bots ML, Polak JF, Poppert H, Kavousi M, Dörr M, Stensland E, Ducimetiere P, Ronkainen K, Kiechl S, Sitzer M, Rundek T, Lind L, Liu J, Bergström G, Grigore L, Bokemark L, Friera A, Yanez D, Bickel H, Ikram MA, Völzke H, Johnsen SH, Empana JP, Tuomainen TP, Willeit P, Steinmetz H, Desvarieux M, Xie W, Schmidt C, Norata GD, Suarez C, Sander D, Hofman A, Schminke U, Mathiesen E, Plichart M, Kauhanen J, Willeit J, Sacco RL, McLachlan S, Zhao D, Fagerberg B, Catapano AL, Gabriel R, Franco OH, Bülbül A, Scheckenbach F, Pflug A, Gao L, Thompson SG. Carotid intima-media thickness progression and risk of vascular events in people with diabetes: results from the PROG-IMT collaboration. Diabetes Care 2015; 38:1921-9. [PMID: 26180107 PMCID: PMC4580609 DOI: 10.2337/dc14-2732] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 06/20/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Carotid intima-media thickness (CIMT) is a marker of subclinical organ damage and predicts cardiovascular disease (CVD) events in the general population. It has also been associated with vascular risk in people with diabetes. However, the association of CIMT change in repeated examinations with subsequent CVD events is uncertain, and its use as a surrogate end point in clinical trials is controversial. We aimed at determining the relation of CIMT change to CVD events in people with diabetes. RESEARCH DESIGN AND METHODS In a comprehensive meta-analysis of individual participant data, we collated data from 3,902 adults (age 33-92 years) with type 2 diabetes from 21 population-based cohorts. We calculated the hazard ratio (HR) per standard deviation (SD) difference in mean common carotid artery intima-media thickness (CCA-IMT) or in CCA-IMT progression, both calculated from two examinations on average 3.6 years apart, for each cohort, and combined the estimates with random-effects meta-analysis. RESULTS Average mean CCA-IMT ranged from 0.72 to 0.97 mm across cohorts in people with diabetes. The HR of CVD events was 1.22 (95% CI 1.12-1.33) per SD difference in mean CCA-IMT, after adjustment for age, sex, and cardiometabolic risk factors. Average mean CCA-IMT progression in people with diabetes ranged between -0.09 and 0.04 mm/year. The HR per SD difference in mean CCA-IMT progression was 0.99 (0.91-1.08). CONCLUSIONS Despite reproducing the association between CIMT level and vascular risk in subjects with diabetes, we did not find an association between CIMT change and vascular risk. These results do not support the use of CIMT progression as a surrogate end point in clinical trials in people with diabetes.
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Affiliation(s)
- Matthias W Lorenz
- Department of Neurology, Johann Wolfgang Goethe University, Frankfurt am Main, Germany
| | - Jackie F Price
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, U.K
| | - Christine Robertson
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, U.K
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Joseph F Polak
- Tufts University School of Medicine, Tufts Medical Center, Boston, MA
| | - Holger Poppert
- Department of Neurology, University Hospital of the Technical University of Munich, Munich, Germany
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Marcus Dörr
- Department of Internal Medicine B/Cardiology, Greifswald University Clinic, Greifswald, Germany
| | - Eva Stensland
- Department of Clinical Medicine, University of Tromsø, Tromsø, Norway
| | | | - Kimmo Ronkainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Stefan Kiechl
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Matthias Sitzer
- Department of Neurology, Johann Wolfgang Goethe University, Frankfurt am Main, Germany Department of Neurology, Klinikum Herford, Herford, Germany
| | - Tatjana Rundek
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL
| | - Lars Lind
- Department of Medicine, Uppsala University, Uppsala, Sweden
| | - Jing Liu
- Department of Epidemiology, Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Göran Bergström
- Wallenberg Laboratory for Cardiovascular Research, University of Gothenburg, Gothenburg, Sweden
| | - Liliana Grigore
- SISA Center for the Study of Atherosclerosis, Bassini Hospital, Cinisello Balsamo, Italy IRCCS MultiMedica, Milan, Italy
| | - Lena Bokemark
- Wallenberg Laboratory for Cardiovascular Research, University of Gothenburg, Gothenburg, Sweden
| | - Alfonsa Friera
- Radiology Department, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - David Yanez
- Department of Biostatistics, University of Washington, Seattle, WA
| | - Horst Bickel
- Department of Psychiatry, University Hospital of the Technical University of Munich, Munich, Germany
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Henry Völzke
- Institute for Community Medicine, SHIP/Clinical-Epidemiological Research, University of Greifswald, Greifswald, Germany German Centre for Cardiovascular Research, Greifswald, Germany
| | - Stein Harald Johnsen
- Department of Clinical Medicine, University of Tromsø, Tromsø, Norway Department of Neurology and Neurophysiology, University Hospital of Northern Norway, Tromsø, Norway
| | | | - Tomi-Pekka Tuomainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Peter Willeit
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, U.K
| | - Helmuth Steinmetz
- Department of Neurology, Johann Wolfgang Goethe University, Frankfurt am Main, Germany
| | - Moise Desvarieux
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY École des Hautes Études en Santé Publique, Paris, France INSERM U 738, Paris, France
| | - Wuxiang Xie
- Department of Epidemiology, Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Caroline Schmidt
- Wallenberg Laboratory for Cardiovascular Research, University of Gothenburg, Gothenburg, Sweden
| | - Giuseppe D Norata
- SISA Center for the Study of Atherosclerosis, Bassini Hospital, Cinisello Balsamo, Italy Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy
| | - Carmen Suarez
- Internal Medicine Department, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - Dirk Sander
- Department of Neurology, University Hospital of the Technical University of Munich, Munich, Germany Department of Neurology, Benedictus Hospital Tutzing and Feldafing, Feldafing, Germany
| | - Albert Hofman
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands Department of Epidemiology, Harvard School of Public Health, Boston, MA
| | - Ulf Schminke
- Department of Neurology, Greifswald University Clinic, Greifswald, Germany
| | - Ellisiv Mathiesen
- Department of Clinical Medicine, University of Tromsø, Tromsø, Norway Department of Neurology and Neurophysiology, University Hospital of Northern Norway, Tromsø, Norway
| | - Matthieu Plichart
- INSERM U 970, Paris, France Gerontology Department, Broca Hospital, Paris, France
| | - Jussi Kauhanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Johann Willeit
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Ralph L Sacco
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL
| | - Stela McLachlan
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, U.K
| | - Dong Zhao
- Department of Epidemiology, Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Björn Fagerberg
- Wallenberg Laboratory for Cardiovascular Research, University of Gothenburg, Gothenburg, Sweden
| | - Alberico L Catapano
- IRCCS MultiMedica, Milan, Italy Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy
| | - Rafael Gabriel
- Instituto de Investigación IdiPAZ, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, Spain
| | - Oscar H Franco
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Alpaslan Bülbül
- Department of Neurology, Johann Wolfgang Goethe University, Frankfurt am Main, Germany
| | - Frank Scheckenbach
- Department of Neurology, Johann Wolfgang Goethe University, Frankfurt am Main, Germany
| | - Anja Pflug
- Department of Neurology, Johann Wolfgang Goethe University, Frankfurt am Main, Germany
| | - Lu Gao
- MRC Biostatistics Unit, Institute of Public Health, Cambridge, U.K
| | - Simon G Thompson
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, U.K
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Ibrahimi P, Jashari F, Johansson E, Grönlund C, Bajraktari G, Wester P, Henein MY. Common carotid intima-media features determine distal disease phenotype and vulnerability in asymptomatic patients. Int J Cardiol 2015; 196:22-8. [PMID: 26070179 DOI: 10.1016/j.ijcard.2015.05.168] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 05/27/2015] [Accepted: 05/29/2015] [Indexed: 02/08/2023]
Abstract
OBJECTIVES There is a growing awareness of the importance of carotid plaque features evaluation in stroke prediction. Carotid intima-media thickness (IMT) and recently its echogenicity were used for stroke prediction, although their clinical relevance was not well determined. The aim of this study was to assess the relationship between common carotid artery (CCA) ultrasound markers of atherosclerosis and distal, bifurcation and internal carotid artery (ICA), plaque features. METHODS We analyzed 137 carotid arteries in 87 asymptomatic patients with known carotid disease (mean age 69 ± 6 year, 34.5% females). Intima media thickness (IMT) and its gray scale median (IM-GSM) were measured at the CCA. Plaque textural features including gray scale median (GSM), juxtaluminal black area (JBA-mm(2)) without a visible cap, and plaque coarseness, at bifurcation and ICA were also determined. CCA measurements were correlated with those of the distal plaques. RESULTS An increased IMT in CCA correlated with plaque irregularities in the bifurcation and ICA (r=0.53, p<0.001), while IM-GSM was closely related to plaque echogenicity (GSM) (r=0.76, p<0.001), and other textural plaque features. Both, IMT and IM-GSM correlated weakly with stenosis severity (r=0.27, p=0.001 and r=-0.18, p=0.026) respectively. CONCLUSION In asymptomatic patients, measurements of CCA reflect distal, bifurcation and ICA disease, with IMT reflecting plaque irregularities and IM-GSM as markers of textural plaque abnormalities. Integrating measurements of both IMT and IM-GSM in a model could be used as a better marker of disease vulnerability over and above each measure individually.
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Affiliation(s)
- Pranvera Ibrahimi
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Fisnik Jashari
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Elias Johansson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden
| | - Christer Grönlund
- Department of Biomedical Engineering - Radiation Sciences, Umeå University, Umeå, Sweden
| | - Gani Bajraktari
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Per Wester
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Michael Y Henein
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
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40
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Petersen KS, Clifton PM, Blanch N, Keogh JB. Effect of improving dietary quality on carotid intima media thickness in subjects with type 1 and type 2 diabetes: a 12-mo randomized controlled trial. Am J Clin Nutr 2015; 102:771-9. [PMID: 26354542 DOI: 10.3945/ajcn.115.112151] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 08/04/2015] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND People with diabetes are at a heightened risk of cardiovascular disease compared with the general population. To our knowledge, randomized controlled trials investigating the effect of improving dietary quality on carotid intima media thickness, a marker of subclinical atherosclerosis and predictor of cardiovascular disease, have not been conducted in populations with diabetes. OBJECTIVE We aimed to determine whether increasing fruit (+1 serving; 150 g/d), vegetable (+2 servings; 150 g/d), and dairy (+1 serving; 200-250 g/d) intakes slows 12-mo common carotid artery intima media thickness (CCA IMT) progression, compared with a control group continuing to consume their usual diet, in people with type 1 and type 2 diabetes. DESIGN A 12-mo randomized controlled trial was conducted. The primary outcome was mean CCA IMT, measured at baseline and 12 mo, with B-mode ultrasound. Participants in the intervention group received counseling from a dietitian at baseline and 1, 3, 6, and 9 mo, and compliance was measured with a food-frequency questionnaire at baseline, 3 mo, and 12 mo. The control group continued consuming their usual diet. RESULTS In total, 118 participants completed the study. Vegetable (46 g/d; 95% CI: 14, 77 g/d; P < 0.001) and fruit (179 g/d; 95% CI: 119, 239 g/d; P < 0.001) intakes were increased at 3 mo in the intervention group compared with the control group. This increase was not maintained at 12 mo, but intake increased overall in the cohort (fruit, 48 g/d; vegetables, 14 g/d). An increase in dairy consumption was not achieved, but yogurt intake was higher in the intervention group at 3 mo (38 g; 95% CI: 12, 65 g; P < 0.001); this was not maintained at 12 mo. At 12 mo, CCA IMT regressed (mean ± SD: -0.01 ± 0.04 mm; P < 0.001), with a greater effect in the treatment group (mean ± SD: -0.02 ± 0.04 mm compared with -0.004 ± 0.04 mm; P = 0.009). CONCLUSION Improving dietary quality in people with well-controlled type 1 and type 2 diabetes may slow CCA IMT progression. This trial was registered at https://www.anzctr.org.au as ACTRN12613000251729.
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Affiliation(s)
- Kristina S Petersen
- School of Pharmacy and Medical Sciences & Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Peter M Clifton
- School of Pharmacy and Medical Sciences & Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Natalie Blanch
- School of Pharmacy and Medical Sciences & Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Jennifer B Keogh
- School of Pharmacy and Medical Sciences & Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
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41
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Shore AC, Colhoun HM, Natali A, Palombo C, Östling G, Aizawa K, Kennbäck C, Casanova F, Persson M, Gooding K, Gates PE, Khan F, Looker HC, Adams F, Belch J, Pinnoli S, Venturi E, Morizzo C, Goncalves I, Ladenvall C, Nilsson J. Measures of atherosclerotic burden are associated with clinically manifest cardiovascular disease in type 2 diabetes: a European cross-sectional study. J Intern Med 2015; 278:291-302. [PMID: 25752315 DOI: 10.1111/joim.12359] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND There is a need to develop and validate surrogate markers of cardiovascular disease (CVD) in subjects with diabetes. The macrovascular changes associated with diabetes include aggravated atherosclerosis, increased arterial stiffness and endothelial dysfunction. The aim of this study was to determine which of these factors is most strongly associated with clinically manifest cardiovascular events. METHODS Vascular changes were measured in a cohort of 458 subjects with type 2 diabetes (T2D) and CVD (myocardial infarction, stroke or lower extremity arterial disease), 527 subjects with T2D but without clinically manifest CVD and 515 subjects without T2D and with or without CVD. RESULTS Carotid intima-media thickness (IMT) and ankle-brachial pressure index were independently associated with the presence of CVD in subjects with T2D, whereas pulse wave velocity and endothelial function provided limited independent additive information. Measurement of IMT in the carotid bulb provided better discrimination of the presence of CVD in subjects with T2D than measurement of IMT in the common carotid artery. The factors most significantly associated with increased carotid IMT in T2D were age, disease duration, systolic blood pressure, impaired renal function and increased arterial stiffness, whereas there were no or weak independent associations with metabolic factors and endothelial dysfunction. CONCLUSIONS Measures of atherosclerotic burden are associated with clinically manifest CVD in subjects with T2D. In addition, vascular changes that are not directly related to known metabolic risk factors are important in the development of both atherosclerosis and CVD in T2D. A better understanding of the mechanisms involved is crucial for enabling better identification of CVD risk in T2D.
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Affiliation(s)
- A C Shore
- Diabetes and Vascular Medicine, University of Exeter Medical School and NIHR Exeter Clinical Research Facility, Exeter, UK
| | - H M Colhoun
- Medical Research Institute, University of Dundee, Dundee, UK
| | - A Natali
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - C Palombo
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy
| | - G Östling
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - K Aizawa
- Diabetes and Vascular Medicine, University of Exeter Medical School and NIHR Exeter Clinical Research Facility, Exeter, UK
| | - C Kennbäck
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - F Casanova
- Diabetes and Vascular Medicine, University of Exeter Medical School and NIHR Exeter Clinical Research Facility, Exeter, UK
| | - M Persson
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - K Gooding
- Diabetes and Vascular Medicine, University of Exeter Medical School and NIHR Exeter Clinical Research Facility, Exeter, UK
| | - P E Gates
- Diabetes and Vascular Medicine, University of Exeter Medical School and NIHR Exeter Clinical Research Facility, Exeter, UK
| | - F Khan
- Medical Research Institute, University of Dundee, Dundee, UK
| | - H C Looker
- Medical Research Institute, University of Dundee, Dundee, UK
| | - F Adams
- Medical Research Institute, University of Dundee, Dundee, UK
| | - J Belch
- Medical Research Institute, University of Dundee, Dundee, UK
| | - S Pinnoli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - E Venturi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - C Morizzo
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy
| | - I Goncalves
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - C Ladenvall
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - J Nilsson
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
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Vlachopoulos C, Xaplanteris P, Aboyans V, Brodmann M, Cífková R, Cosentino F, De Carlo M, Gallino A, Landmesser U, Laurent S, Lekakis J, Mikhailidis DP, Naka KK, Protogerou AD, Rizzoni D, Schmidt-Trucksäss A, Van Bortel L, Weber T, Yamashina A, Zimlichman R, Boutouyrie P, Cockcroft J, O'Rourke M, Park JB, Schillaci G, Sillesen H, Townsend RR. The role of vascular biomarkers for primary and secondary prevention. A position paper from the European Society of Cardiology Working Group on peripheral circulation. Atherosclerosis 2015; 241:507-32. [DOI: 10.1016/j.atherosclerosis.2015.05.007] [Citation(s) in RCA: 476] [Impact Index Per Article: 52.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 04/29/2015] [Accepted: 05/14/2015] [Indexed: 02/07/2023]
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Natural history of atherosclerotic disease progression as assessed by (18)F-FDG PET/CT. Int J Cardiovasc Imaging 2015; 32:49-59. [PMID: 25898891 DOI: 10.1007/s10554-015-0660-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 04/13/2015] [Indexed: 10/23/2022]
Abstract
The aim of this study was to assess the impact of cardiovascular risk factors and plaque inflammation on the progression of atherosclerosis as assessed by positron emission tomography/computed tomography (PET/CT) imaging with (18)F-radiolabled fluorodeoxyglucose ((18)F-FDG). This study was designed as a retrospective cohort study. Patients who received a (18)F-FDG PET/CT scan and follow-up scan 9-24 months later without systemic inflammation or steroid medication were eligible for the study. (18)F-FDG PET/CT included a full diagnostic contrast enhanced CT scan. Cardiovascular risk factors and medication were documented. Calcified plaque volume, lumen area and (18)F-FDG uptake, quantified by the target-to-background ratio (TBR), were measured in the carotid arteries, aorta and iliac arteries. Influence of cardiovascular risk factors and vessel wall inflammation on atherosclerotic disease progression was analyzed. Ninety-four patients underwent baseline and follow-up whole body (18)F-FDG PET/CT (mean follow-up time 14.5 ± 3.5 months). Annualized calcified plaque volume increased by 15.4 % (p < 0.0001), carotid and aortic lumen area decreased by 10.5 % (p < 0.0001) and 1.7 % (p = 0.045). There was no significant difference in (18)F-FDG uptake at baseline and follow-up (mean TBR 1.44 ± 0.18 vs. 1.42 ± 0.19, p = 0.18). Multiple linear regression analysis identified hypertension as an independent predictor for total, aortic and iliac calcified plaque volume progression (all p < 0.04). Carotid lumen reduction was predicted by hypercholesterolemia (p = 0.008) while aortic lumen reduction was associated with BMI and mean (18)F-FDG uptake (p ≤ 0.005). Furthermore we observed a dose response relationship between the number of cardiovascular risk factors and calcified plaque volume progression in the aorta (p = 0.03). Findings from this study provide data on the natural history of atherosclerotic disease burden in multiple vascular beds and emphasize the value of morphological and physiologic information provided by (18)F-FDG PET/CT imaging.
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Rosvall M, Persson M, Östling G, Nilsson P, Melander O, Hedblad B, Engström G. Risk factors for the progression of carotid intima-media thickness over a 16-year follow-up period: The Malmö Diet and Cancer Study. Atherosclerosis 2015; 239:615-21. [DOI: 10.1016/j.atherosclerosis.2015.01.030] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 01/09/2015] [Accepted: 01/27/2015] [Indexed: 12/24/2022]
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Eikendal AL, Groenewegen KA, Anderson TJ, Britton AR, Engström G, Evans GW, de Graaf J, Grobbee DE, Hedblad B, Holewijn S, Ikeda A, Kitagawa K, Kitamura A, Lonn EM, Lorenz MW, Mathiesen EB, Nijpels G, Dekker JM, Okazaki S, O’Leary DH, Polak JF, Price JF, Robertson C, Rembold CM, Rosvall M, Rundek T, Salonen JT, Sitzer M, Stehouwer CD, Hoefer IE, Peters SA, Bots ML, den Ruijter HM. Common Carotid Intima-Media Thickness Relates to Cardiovascular Events in Adults Aged <45 Years. Hypertension 2015; 65:707-13. [DOI: 10.1161/hypertensionaha.114.04658] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although atherosclerosis starts in early life, evidence on risk factors and atherosclerosis in individuals aged <45 years is scarce. Therefore, we studied the relationship between risk factors, common carotid intima-media thickness (CIMT), and first-time cardiovascular events in adults aged <45 years. Our study population consisted of 3067 adults aged <45 years free from symptomatic cardiovascular disease at baseline, derived from 6 cohorts that are part of the USE-IMT initiative, an individual participant data meta-analysis of general-population–based cohort studies evaluating CIMT measurements. Information on risk factors, CIMT measurements, and follow-up of the combined end point (first-time myocardial infarction or stroke) was obtained. We assessed the relationship between risk factors and CIMT and the relationship between CIMT and first-time myocardial infarction or stroke using a multivariable linear mixed-effects model and a Cox proportional-hazards model, respectively. During a follow-up of 16.3 years, 55 first-time myocardial infarctions or strokes occurred. Median CIMT was 0.63 mm. Of the risk factors under study, age, sex, diastolic blood pressure, body mass index, total cholesterol, and high-density lipoprotein cholesterol related to CIMT. Furthermore, CIMT related to first-time myocardial infarction or stroke with a hazard ratio of 1.40 per SD increase in CIMT, independent of risk factors (95% confidence interval, 1.11–1.76). CIMT may be a valuable marker for cardiovascular risk in adults aged <45 years who are not yet eligible for standard cardiovascular risk screening. This is especially relevant in those with an increased, unfavorable risk factor burden.
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Affiliation(s)
- Anouk L.M. Eikendal
- From the Department of Radiology (A.L.M.E.), Department of Cardiovascular Epidemiology, Julius Center for Health Sciences and Primary Care (K.A.G., D.E.G., S.A.E.P., M.L.B., H.M.d.R.), and Department of Experimental Cardiology (I.E.H., H.M.d.R.), University Medical Center, Utrecht, Utrecht, The Netherlands; Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada (T.J.A.); Department of Epidemiology and Public Health University College
| | - Karlijn A. Groenewegen
- From the Department of Radiology (A.L.M.E.), Department of Cardiovascular Epidemiology, Julius Center for Health Sciences and Primary Care (K.A.G., D.E.G., S.A.E.P., M.L.B., H.M.d.R.), and Department of Experimental Cardiology (I.E.H., H.M.d.R.), University Medical Center, Utrecht, Utrecht, The Netherlands; Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada (T.J.A.); Department of Epidemiology and Public Health University College
| | - Todd J. Anderson
- From the Department of Radiology (A.L.M.E.), Department of Cardiovascular Epidemiology, Julius Center for Health Sciences and Primary Care (K.A.G., D.E.G., S.A.E.P., M.L.B., H.M.d.R.), and Department of Experimental Cardiology (I.E.H., H.M.d.R.), University Medical Center, Utrecht, Utrecht, The Netherlands; Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada (T.J.A.); Department of Epidemiology and Public Health University College
| | - Annie R. Britton
- From the Department of Radiology (A.L.M.E.), Department of Cardiovascular Epidemiology, Julius Center for Health Sciences and Primary Care (K.A.G., D.E.G., S.A.E.P., M.L.B., H.M.d.R.), and Department of Experimental Cardiology (I.E.H., H.M.d.R.), University Medical Center, Utrecht, Utrecht, The Netherlands; Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada (T.J.A.); Department of Epidemiology and Public Health University College
| | - Gunnar Engström
- From the Department of Radiology (A.L.M.E.), Department of Cardiovascular Epidemiology, Julius Center for Health Sciences and Primary Care (K.A.G., D.E.G., S.A.E.P., M.L.B., H.M.d.R.), and Department of Experimental Cardiology (I.E.H., H.M.d.R.), University Medical Center, Utrecht, Utrecht, The Netherlands; Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada (T.J.A.); Department of Epidemiology and Public Health University College
| | - Greg W. Evans
- From the Department of Radiology (A.L.M.E.), Department of Cardiovascular Epidemiology, Julius Center for Health Sciences and Primary Care (K.A.G., D.E.G., S.A.E.P., M.L.B., H.M.d.R.), and Department of Experimental Cardiology (I.E.H., H.M.d.R.), University Medical Center, Utrecht, Utrecht, The Netherlands; Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada (T.J.A.); Department of Epidemiology and Public Health University College
| | - Jacqueline de Graaf
- From the Department of Radiology (A.L.M.E.), Department of Cardiovascular Epidemiology, Julius Center for Health Sciences and Primary Care (K.A.G., D.E.G., S.A.E.P., M.L.B., H.M.d.R.), and Department of Experimental Cardiology (I.E.H., H.M.d.R.), University Medical Center, Utrecht, Utrecht, The Netherlands; Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada (T.J.A.); Department of Epidemiology and Public Health University College
| | - Diederick E. Grobbee
- From the Department of Radiology (A.L.M.E.), Department of Cardiovascular Epidemiology, Julius Center for Health Sciences and Primary Care (K.A.G., D.E.G., S.A.E.P., M.L.B., H.M.d.R.), and Department of Experimental Cardiology (I.E.H., H.M.d.R.), University Medical Center, Utrecht, Utrecht, The Netherlands; Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada (T.J.A.); Department of Epidemiology and Public Health University College
| | - Bo Hedblad
- From the Department of Radiology (A.L.M.E.), Department of Cardiovascular Epidemiology, Julius Center for Health Sciences and Primary Care (K.A.G., D.E.G., S.A.E.P., M.L.B., H.M.d.R.), and Department of Experimental Cardiology (I.E.H., H.M.d.R.), University Medical Center, Utrecht, Utrecht, The Netherlands; Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada (T.J.A.); Department of Epidemiology and Public Health University College
| | - Suzanne Holewijn
- From the Department of Radiology (A.L.M.E.), Department of Cardiovascular Epidemiology, Julius Center for Health Sciences and Primary Care (K.A.G., D.E.G., S.A.E.P., M.L.B., H.M.d.R.), and Department of Experimental Cardiology (I.E.H., H.M.d.R.), University Medical Center, Utrecht, Utrecht, The Netherlands; Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada (T.J.A.); Department of Epidemiology and Public Health University College
| | - Ai Ikeda
- From the Department of Radiology (A.L.M.E.), Department of Cardiovascular Epidemiology, Julius Center for Health Sciences and Primary Care (K.A.G., D.E.G., S.A.E.P., M.L.B., H.M.d.R.), and Department of Experimental Cardiology (I.E.H., H.M.d.R.), University Medical Center, Utrecht, Utrecht, The Netherlands; Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada (T.J.A.); Department of Epidemiology and Public Health University College
| | - Kazuo Kitagawa
- From the Department of Radiology (A.L.M.E.), Department of Cardiovascular Epidemiology, Julius Center for Health Sciences and Primary Care (K.A.G., D.E.G., S.A.E.P., M.L.B., H.M.d.R.), and Department of Experimental Cardiology (I.E.H., H.M.d.R.), University Medical Center, Utrecht, Utrecht, The Netherlands; Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada (T.J.A.); Department of Epidemiology and Public Health University College
| | - Akihiko Kitamura
- From the Department of Radiology (A.L.M.E.), Department of Cardiovascular Epidemiology, Julius Center for Health Sciences and Primary Care (K.A.G., D.E.G., S.A.E.P., M.L.B., H.M.d.R.), and Department of Experimental Cardiology (I.E.H., H.M.d.R.), University Medical Center, Utrecht, Utrecht, The Netherlands; Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada (T.J.A.); Department of Epidemiology and Public Health University College
| | - Eva M. Lonn
- From the Department of Radiology (A.L.M.E.), Department of Cardiovascular Epidemiology, Julius Center for Health Sciences and Primary Care (K.A.G., D.E.G., S.A.E.P., M.L.B., H.M.d.R.), and Department of Experimental Cardiology (I.E.H., H.M.d.R.), University Medical Center, Utrecht, Utrecht, The Netherlands; Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada (T.J.A.); Department of Epidemiology and Public Health University College
| | - Matthias W. Lorenz
- From the Department of Radiology (A.L.M.E.), Department of Cardiovascular Epidemiology, Julius Center for Health Sciences and Primary Care (K.A.G., D.E.G., S.A.E.P., M.L.B., H.M.d.R.), and Department of Experimental Cardiology (I.E.H., H.M.d.R.), University Medical Center, Utrecht, Utrecht, The Netherlands; Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada (T.J.A.); Department of Epidemiology and Public Health University College
| | - Ellisiv B. Mathiesen
- From the Department of Radiology (A.L.M.E.), Department of Cardiovascular Epidemiology, Julius Center for Health Sciences and Primary Care (K.A.G., D.E.G., S.A.E.P., M.L.B., H.M.d.R.), and Department of Experimental Cardiology (I.E.H., H.M.d.R.), University Medical Center, Utrecht, Utrecht, The Netherlands; Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada (T.J.A.); Department of Epidemiology and Public Health University College
| | - Giel Nijpels
- From the Department of Radiology (A.L.M.E.), Department of Cardiovascular Epidemiology, Julius Center for Health Sciences and Primary Care (K.A.G., D.E.G., S.A.E.P., M.L.B., H.M.d.R.), and Department of Experimental Cardiology (I.E.H., H.M.d.R.), University Medical Center, Utrecht, Utrecht, The Netherlands; Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada (T.J.A.); Department of Epidemiology and Public Health University College
| | - Jacqueline M. Dekker
- From the Department of Radiology (A.L.M.E.), Department of Cardiovascular Epidemiology, Julius Center for Health Sciences and Primary Care (K.A.G., D.E.G., S.A.E.P., M.L.B., H.M.d.R.), and Department of Experimental Cardiology (I.E.H., H.M.d.R.), University Medical Center, Utrecht, Utrecht, The Netherlands; Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada (T.J.A.); Department of Epidemiology and Public Health University College
| | - Shuhei Okazaki
- From the Department of Radiology (A.L.M.E.), Department of Cardiovascular Epidemiology, Julius Center for Health Sciences and Primary Care (K.A.G., D.E.G., S.A.E.P., M.L.B., H.M.d.R.), and Department of Experimental Cardiology (I.E.H., H.M.d.R.), University Medical Center, Utrecht, Utrecht, The Netherlands; Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada (T.J.A.); Department of Epidemiology and Public Health University College
| | - Daniel H. O’Leary
- From the Department of Radiology (A.L.M.E.), Department of Cardiovascular Epidemiology, Julius Center for Health Sciences and Primary Care (K.A.G., D.E.G., S.A.E.P., M.L.B., H.M.d.R.), and Department of Experimental Cardiology (I.E.H., H.M.d.R.), University Medical Center, Utrecht, Utrecht, The Netherlands; Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada (T.J.A.); Department of Epidemiology and Public Health University College
| | - Joseph F. Polak
- From the Department of Radiology (A.L.M.E.), Department of Cardiovascular Epidemiology, Julius Center for Health Sciences and Primary Care (K.A.G., D.E.G., S.A.E.P., M.L.B., H.M.d.R.), and Department of Experimental Cardiology (I.E.H., H.M.d.R.), University Medical Center, Utrecht, Utrecht, The Netherlands; Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada (T.J.A.); Department of Epidemiology and Public Health University College
| | - Jacqueline F. Price
- From the Department of Radiology (A.L.M.E.), Department of Cardiovascular Epidemiology, Julius Center for Health Sciences and Primary Care (K.A.G., D.E.G., S.A.E.P., M.L.B., H.M.d.R.), and Department of Experimental Cardiology (I.E.H., H.M.d.R.), University Medical Center, Utrecht, Utrecht, The Netherlands; Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada (T.J.A.); Department of Epidemiology and Public Health University College
| | - Christine Robertson
- From the Department of Radiology (A.L.M.E.), Department of Cardiovascular Epidemiology, Julius Center for Health Sciences and Primary Care (K.A.G., D.E.G., S.A.E.P., M.L.B., H.M.d.R.), and Department of Experimental Cardiology (I.E.H., H.M.d.R.), University Medical Center, Utrecht, Utrecht, The Netherlands; Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada (T.J.A.); Department of Epidemiology and Public Health University College
| | - Christopher M. Rembold
- From the Department of Radiology (A.L.M.E.), Department of Cardiovascular Epidemiology, Julius Center for Health Sciences and Primary Care (K.A.G., D.E.G., S.A.E.P., M.L.B., H.M.d.R.), and Department of Experimental Cardiology (I.E.H., H.M.d.R.), University Medical Center, Utrecht, Utrecht, The Netherlands; Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada (T.J.A.); Department of Epidemiology and Public Health University College
| | - Maria Rosvall
- From the Department of Radiology (A.L.M.E.), Department of Cardiovascular Epidemiology, Julius Center for Health Sciences and Primary Care (K.A.G., D.E.G., S.A.E.P., M.L.B., H.M.d.R.), and Department of Experimental Cardiology (I.E.H., H.M.d.R.), University Medical Center, Utrecht, Utrecht, The Netherlands; Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada (T.J.A.); Department of Epidemiology and Public Health University College
| | - Tatjana Rundek
- From the Department of Radiology (A.L.M.E.), Department of Cardiovascular Epidemiology, Julius Center for Health Sciences and Primary Care (K.A.G., D.E.G., S.A.E.P., M.L.B., H.M.d.R.), and Department of Experimental Cardiology (I.E.H., H.M.d.R.), University Medical Center, Utrecht, Utrecht, The Netherlands; Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada (T.J.A.); Department of Epidemiology and Public Health University College
| | - Jukka T. Salonen
- From the Department of Radiology (A.L.M.E.), Department of Cardiovascular Epidemiology, Julius Center for Health Sciences and Primary Care (K.A.G., D.E.G., S.A.E.P., M.L.B., H.M.d.R.), and Department of Experimental Cardiology (I.E.H., H.M.d.R.), University Medical Center, Utrecht, Utrecht, The Netherlands; Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada (T.J.A.); Department of Epidemiology and Public Health University College
| | - Matthias Sitzer
- From the Department of Radiology (A.L.M.E.), Department of Cardiovascular Epidemiology, Julius Center for Health Sciences and Primary Care (K.A.G., D.E.G., S.A.E.P., M.L.B., H.M.d.R.), and Department of Experimental Cardiology (I.E.H., H.M.d.R.), University Medical Center, Utrecht, Utrecht, The Netherlands; Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada (T.J.A.); Department of Epidemiology and Public Health University College
| | - Coen D.A. Stehouwer
- From the Department of Radiology (A.L.M.E.), Department of Cardiovascular Epidemiology, Julius Center for Health Sciences and Primary Care (K.A.G., D.E.G., S.A.E.P., M.L.B., H.M.d.R.), and Department of Experimental Cardiology (I.E.H., H.M.d.R.), University Medical Center, Utrecht, Utrecht, The Netherlands; Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada (T.J.A.); Department of Epidemiology and Public Health University College
| | - Imo E. Hoefer
- From the Department of Radiology (A.L.M.E.), Department of Cardiovascular Epidemiology, Julius Center for Health Sciences and Primary Care (K.A.G., D.E.G., S.A.E.P., M.L.B., H.M.d.R.), and Department of Experimental Cardiology (I.E.H., H.M.d.R.), University Medical Center, Utrecht, Utrecht, The Netherlands; Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada (T.J.A.); Department of Epidemiology and Public Health University College
| | - Sanne A.E. Peters
- From the Department of Radiology (A.L.M.E.), Department of Cardiovascular Epidemiology, Julius Center for Health Sciences and Primary Care (K.A.G., D.E.G., S.A.E.P., M.L.B., H.M.d.R.), and Department of Experimental Cardiology (I.E.H., H.M.d.R.), University Medical Center, Utrecht, Utrecht, The Netherlands; Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada (T.J.A.); Department of Epidemiology and Public Health University College
| | - Michiel L. Bots
- From the Department of Radiology (A.L.M.E.), Department of Cardiovascular Epidemiology, Julius Center for Health Sciences and Primary Care (K.A.G., D.E.G., S.A.E.P., M.L.B., H.M.d.R.), and Department of Experimental Cardiology (I.E.H., H.M.d.R.), University Medical Center, Utrecht, Utrecht, The Netherlands; Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada (T.J.A.); Department of Epidemiology and Public Health University College
| | - Hester M. den Ruijter
- From the Department of Radiology (A.L.M.E.), Department of Cardiovascular Epidemiology, Julius Center for Health Sciences and Primary Care (K.A.G., D.E.G., S.A.E.P., M.L.B., H.M.d.R.), and Department of Experimental Cardiology (I.E.H., H.M.d.R.), University Medical Center, Utrecht, Utrecht, The Netherlands; Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada (T.J.A.); Department of Epidemiology and Public Health University College
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Azarpazhooh MR, Kazemi-Bajestani SMR, Esmaeili H, Vedadian P, Ebrahimi M, Parizadeh SMR, Heidari-Bakavoli AR, Moohebati M, Safarian M, Mokhber N, Nematy M, Mazidi M, Ferns GA, Ghayour-Mehrabani M. Cardiovascular Risk Factors and Nutritional Intake are not Associated with Ultrasound-defined Increased Carotid Intima Media Thickness in Individuals Without a History of Cardiovascular Events. Int J Prev Med 2014; 5:1412-21. [PMID: 25538837 PMCID: PMC4274548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 10/13/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Carotid ultrasound appears to be useful in the assessment of cardiovascular risk. In this study, we have assessed the carotid intima-media thickness (CIMT) in a group of individuals without a history of cardiovascular events. METHODS A sample of 431subjects (189 [43.9%] males and 242 [56.1%] females) was obtained from an urban population using a stratified-cluster method in Mashhad stroke and heart atherosclerosis disorder study. None of the subjects had a history of the cardiovascular event. Carotid artery duplex ultrasound was used to determine the CIMT in all subjects, and to identify those with an abnormal value (CIMT [+]; i.e., CIMT ≥ 0.8 mm). Dietary intake of participants was assessed using a questionnaire for 24-h dietary recall. The relationship between anthropometric, biochemical and dietary data and CIMT were assessed. RESULTS The mean age of subjects was 48.7 ± 8.0 years. Of the 431 patients, 118 (27.4%) were found to be CIMT (+). Of the cardiovascular parameters assessed, only age (odds ratio [OR] [95% confidence interval (CI)], 1.11 [0.56-4.34]; P < 0.01) and male gender (OR [95% CI], 1.14 [0.63-2.23]; P < 0.05) were significant independent predictors of ultrasound defined CIMT. Crude and total energy adjusted intake were not associated with the presence of CIMT (+). CONCLUSIONS It appears that within a relatively young Iranian population of individuals without a history of cardiovascular event, the presence of CIMT (+) defined by duplex ultrasound cut-off value of ≥0.8 mm, did not associate with several modifiable cardiovascular risk factors or measures of dietary intake.
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Affiliation(s)
- Mahmoud Reza Azarpazhooh
- Biochemistry and Nutrition Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Habib Esmaeili
- Department of Statistics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Payam Vedadian
- Biochemistry and Nutrition Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahmoud Ebrahimi
- Cardiovascular Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Ali Reza Heidari-Bakavoli
- Cardiovascular Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohsen Moohebati
- Cardiovascular Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Safarian
- Biochemistry and Nutrition Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Naghmeh Mokhber
- Psychiatry and Behavioral Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohsen Nematy
- Biochemistry and Nutrition Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohsen Mazidi
- Biochemistry and Nutrition Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Gorden A Ferns
- Division of Medical Education, Brighton and Sussex Medical School, RM 342, Mayfield House, University of Brighton, BN1 9PH, UK
| | - Majid Ghayour-Mehrabani
- Biochemistry and Nutrition Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran,Cardiovascular Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran,Correspondence to: Dr. Majid Ghayour-Mobarhan, Cardiovascular Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. E-mail:
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Martinsson A, Östling G, Persson M, Sundquist K, Andersson C, Melander O, Engström G, Hedblad B, Smith JG. Carotid Plaque, Intima-Media Thickness, and Incident Aortic Stenosis. Arterioscler Thromb Vasc Biol 2014; 34:2343-8. [DOI: 10.1161/atvbaha.114.304015] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective—
Aortic stenosis (AS) shares risk factors with atherosclerotic vascular disease. Carotid intima-media thickness (IMT) and plaque may reflect the cumulative damage from exposure to different atherosclerotic risk factors. We examined the relationship of carotid IMT and plaque with incident AS in a prospective population-based study.
Approach and Results—
A random sample of participants (age, 45–68 years) in the population-based Malmö Diet and Cancer Study underwent B-mode ultrasound with measurements of IMT and the presence of plaque in the common carotid artery (n=5079). Potential risk factors for incident AS were studied in age- and sex-adjusted and expanded multivariable-adjusted Cox regression models. A total of 69 (1.4%) participants developed AS during up to 20 years of follow-up. Significant risk factors for AS in age- and sex-adjusted analyses were (
P
<0.05) body mass index, low-density lipoprotein cholesterol, hypertension, diabetes mellitus, smoking, C-reactive protein, plaque, and IMT. In contrast, high-density lipoprotein cholesterol, triglycerides, height, and leukocyte count were not significantly associated with AS (
P
>0.05). After adjustments, IMT, plaque, age, smoking, C-reactive protein, low-density lipoprotein cholesterol, and diabetes mellitus remained significantly associated with incident AS. IMT was no longer significantly associated with AS after adjustments for plaque and systolic blood pressure, but plaque remained significantly associated with incident AS.
Conclusions—
Traditional cardiovascular risk factors were individually associated with incident AS, and in multivariable models low-density lipoprotein cholesterol, smoking, age, presence of plaque, C-reactive protein, and diabetes mellitus remained significant predictors of incident AS. AS represents a vascular disorder related to carotid plaque, with potential implications for the pathophysiology and prevention of this disease.
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Affiliation(s)
- Andreas Martinsson
- From the Department of Cardiology, Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden (A.M., J.G.S); Cardiovascular Epidemiology, Department of Clinical Sciences (G.Ö., M.P., G.E., B.H., J.G.S.), Department of Clinical Sciences, Center for Primary Health Care Research (K.S.), and Department of Internal Medicine, Skåne University Hospital (O.M., J.G.S.), Lund University, Malmö, Sweden; and Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark (C
| | - Gerd Östling
- From the Department of Cardiology, Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden (A.M., J.G.S); Cardiovascular Epidemiology, Department of Clinical Sciences (G.Ö., M.P., G.E., B.H., J.G.S.), Department of Clinical Sciences, Center for Primary Health Care Research (K.S.), and Department of Internal Medicine, Skåne University Hospital (O.M., J.G.S.), Lund University, Malmö, Sweden; and Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark (C
| | - Margaretha Persson
- From the Department of Cardiology, Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden (A.M., J.G.S); Cardiovascular Epidemiology, Department of Clinical Sciences (G.Ö., M.P., G.E., B.H., J.G.S.), Department of Clinical Sciences, Center for Primary Health Care Research (K.S.), and Department of Internal Medicine, Skåne University Hospital (O.M., J.G.S.), Lund University, Malmö, Sweden; and Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark (C
| | - Kristina Sundquist
- From the Department of Cardiology, Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden (A.M., J.G.S); Cardiovascular Epidemiology, Department of Clinical Sciences (G.Ö., M.P., G.E., B.H., J.G.S.), Department of Clinical Sciences, Center for Primary Health Care Research (K.S.), and Department of Internal Medicine, Skåne University Hospital (O.M., J.G.S.), Lund University, Malmö, Sweden; and Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark (C
| | - Charlotte Andersson
- From the Department of Cardiology, Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden (A.M., J.G.S); Cardiovascular Epidemiology, Department of Clinical Sciences (G.Ö., M.P., G.E., B.H., J.G.S.), Department of Clinical Sciences, Center for Primary Health Care Research (K.S.), and Department of Internal Medicine, Skåne University Hospital (O.M., J.G.S.), Lund University, Malmö, Sweden; and Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark (C
| | - Olle Melander
- From the Department of Cardiology, Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden (A.M., J.G.S); Cardiovascular Epidemiology, Department of Clinical Sciences (G.Ö., M.P., G.E., B.H., J.G.S.), Department of Clinical Sciences, Center for Primary Health Care Research (K.S.), and Department of Internal Medicine, Skåne University Hospital (O.M., J.G.S.), Lund University, Malmö, Sweden; and Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark (C
| | - Gunnar Engström
- From the Department of Cardiology, Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden (A.M., J.G.S); Cardiovascular Epidemiology, Department of Clinical Sciences (G.Ö., M.P., G.E., B.H., J.G.S.), Department of Clinical Sciences, Center for Primary Health Care Research (K.S.), and Department of Internal Medicine, Skåne University Hospital (O.M., J.G.S.), Lund University, Malmö, Sweden; and Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark (C
| | - Bo Hedblad
- From the Department of Cardiology, Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden (A.M., J.G.S); Cardiovascular Epidemiology, Department of Clinical Sciences (G.Ö., M.P., G.E., B.H., J.G.S.), Department of Clinical Sciences, Center for Primary Health Care Research (K.S.), and Department of Internal Medicine, Skåne University Hospital (O.M., J.G.S.), Lund University, Malmö, Sweden; and Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark (C
| | - J. Gustav Smith
- From the Department of Cardiology, Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden (A.M., J.G.S); Cardiovascular Epidemiology, Department of Clinical Sciences (G.Ö., M.P., G.E., B.H., J.G.S.), Department of Clinical Sciences, Center for Primary Health Care Research (K.S.), and Department of Internal Medicine, Skåne University Hospital (O.M., J.G.S.), Lund University, Malmö, Sweden; and Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark (C
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Katakami N, Osonoi T, Takahara M, Saitou M, Matsuoka TA, Yamasaki Y, Shimomura I. Clinical utility of brachial-ankle pulse wave velocity in the prediction of cardiovascular events in diabetic patients. Cardiovasc Diabetol 2014; 13:128. [PMID: 25186287 PMCID: PMC4172854 DOI: 10.1186/s12933-014-0128-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Accepted: 08/20/2014] [Indexed: 11/11/2022] Open
Abstract
Background Brachial-ankle pulse wave velocity (baPWV) is a method to estimate arterial stiffness, which reflects the stiffness of both the aorta and peripheral artery; it would be applicable to general practice, since its measurementis automated. The aim of this study was to evaluate whether baPWV can be predictors of future cardiovascular events (CVE) in diabetic patients. Methods We prospectively evaluated the association between baPWV or carotid intima-media thickness (carotid IMT) at baseline and new onset of CVE in 1040 type 2 diabetic patients without CVE. The predictability of baPWV and/or carotid IMT for identifying patients at high risk for CVE was evaluated by time-dependent receiver-operating-characteristic (ROC) curve analysis. Results During a median follow-up of 7.5 years, 113 had new CVD events. The cumulative incidence rates of CVE were significantly higher in patients with high baPWV values (≥1550 cm/s) as compared to those with low baPWV values (<1550 cm/s) (p < 0.001, log-rank test). Similarly, the cumulative incidence rate of CVE was significantly higher in patients with higher maximum carotid IMT (maxIMT) values (≥1.0 mm) as compared to those with lower maxIMT values (<1.0 mm) (p < 0.001, log-rank test). Subjects with both “high PWV” and “high IMT” had a significantly higher risk of developing CVE as compared to those with either “high PWV” or “high IMT,” as well as those with neither. A multivariate Cox proportional hazards regression model revealed that both baPWV (HR = 1.30, [95%CI: 1.07-1.57]; p = 0.009) and maxIMT (HR = 1.20, [95%CI: 1.01-1.41]; p = 0.033) were independent predictors for CVE, even after adjustment for the conventional risk factors. Time-dependent ROC curve analyses revealed that the addition of maxIMT to the Framingham risk score resulted in significant increase in AUC (from 0.60 [95%CI: 0.54-0.67] to 0.63 [95%CI: 0.60-0.82]; p = 0.01). Notably, the addition of baPWV to the Framingham risk score and maxIMT resulted in further and significant (p = 0.02) increase in AUC (0.72 [95%CI: 0.67-0.78]). Conclusions Evaluation of baPWV, in addition to carotid IMT and conventional risk factors, improved the ability to identify the diabetic individuals with high risk for CVE. Electronic supplementary material The online version of this article (doi:10.1186/s12933-014-0128-5) contains supplementary material, which is available to authorized users.
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Petersen KS, Clifton PM, Keogh JB. The association between carotid intima media thickness and individual dietary components and patterns. Nutr Metab Cardiovasc Dis 2014; 24:495-502. [PMID: 24374005 DOI: 10.1016/j.numecd.2013.10.024] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Revised: 10/14/2013] [Accepted: 10/16/2013] [Indexed: 12/13/2022]
Abstract
AIMS To review: 1) the correlation between individual dietary components and carotid intima media thickness (cIMT); 2) the relationship between dietary patterns and cIMT; 3) the effect of dietary interventions on cIMT progression. DATA SYNTHESIS An electronic search for epidemiological and intervention trials investigating the association between dietary components or patterns of intake and cIMT was performed in PUBMED, EMBASE and the Cochrane Library. Epidemiological data shows that a higher intake of fruit, wholegrains and soluble fibre and lower consumption of saturated fat in favour of polyunsaturated fat is associated with lower cIMT. In people at high risk of cardiovascular disease >93 g/day of fruit is associated with lower cIMT. Lower cIMT has also been observed when >0.79 serves/day of wholegrains and >25 g/day of fibre, predominately in the soluble form is consumed. Saturated fat is positively associated with cIMT, for every 10 g/day increase in saturated fat cIMT is 0.03 mm greater. Olive oil is inversely associated with cIMT, with a benefit seen when >34 g/day is consumed. While there are many epidemiological studies exploring the association between dietary intake and cIMT there are few intervention studies. Intervention studies show that a Mediterranean diet may reduce cIMT progression, especially in those with a higher cIMT. CONCLUSIONS A Mediterranean style dietary pattern, which is high in fruits, wholegrains, fibre and olive oil and low in saturated fat, may reduce carotid atherosclerosis development and progression. However further research from randomised controlled trials is required to understand the association between diet and cIMT and the underlying mechanisms.
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Affiliation(s)
- K S Petersen
- School of Pharmacy and Medical Sciences, Division of Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA 5000, Australia
| | - P M Clifton
- School of Pharmacy and Medical Sciences, Division of Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA 5000, Australia
| | - J B Keogh
- School of Pharmacy and Medical Sciences, Division of Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA 5000, Australia.
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Bots ML, Groenewegen KA, Anderson TJ, Britton AR, Dekker JM, Engström G, Evans GW, de Graaf J, Grobbee DE, Hedblad B, Hofman A, Holewijn S, Ikeda A, Kavousi M, Kitagawa K, Kitamura A, Ikram MA, Lonn EM, Lorenz MW, Mathiesen EB, Nijpels G, Okazaki S, O'Leary DH, Polak JF, Price JF, Robertson C, Rembold CM, Rosvall M, Rundek T, Salonen JT, Sitzer M, Stehouwer CDA, Franco OH, Peters SAE, den Ruijter HM. Common carotid intima-media thickness measurements do not improve cardiovascular risk prediction in individuals with elevated blood pressure: the USE-IMT collaboration. Hypertension 2014; 63:1173-81. [PMID: 24614213 DOI: 10.1161/hypertensionaha.113.02683] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Carotid intima-media thickness (CIMT) is a marker of cardiovascular risk. It is unclear whether measurement of mean common CIMT improves 10-year risk prediction of first-time myocardial infarction or stroke in individuals with elevated blood pressure. We performed an analysis among individuals with elevated blood pressure (i.e., a systolic blood pressure ≥140 mm Hg and a diastolic blood pressure ≥ 90 mm Hg) in USE-IMT, a large ongoing individual participant data meta-analysis. We refitted the risk factors of the Framingham Risk Score on asymptomatic individuals (baseline model) and expanded this model with mean common CIMT (CIMT model) measurements. From both models, 10-year risks to develop a myocardial infarction or stroke were estimated. In individuals with elevated blood pressure, we compared discrimination and calibration of the 2 models and calculated the net reclassification improvement (NRI). We included 17 254 individuals with elevated blood pressure from 16 studies. During a median follow-up of 9.9 years, 2014 first-time myocardial infarctions or strokes occurred. The C-statistics of the baseline and CIMT models were similar (0.73). NRI with the addition of mean common CIMT was small and not significant (1.4%; 95% confidence intervals, -1.1 to 3.7). In those at intermediate risk (n=5008, 10-year absolute risk of 10% to 20%), the NRI was 5.6% (95% confidence intervals, 1.6-10.4). There is no added value of measurement of mean common CIMT in individuals with elevated blood pressure for improving cardiovascular risk prediction. For those at intermediate risk, the addition of mean common CIMT to an existing cardiovascular risk score is small but statistically significant.
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Affiliation(s)
- Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
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