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Lundberg C, Hansen T, Ahlström H, Lind L, Wikström J, Johansson L. The relationship between carotid intima-media thickness and global atherosclerosis. Clin Physiol Funct Imaging 2014; 34:457-62. [PMID: 24405735 PMCID: PMC4237190 DOI: 10.1111/cpf.12116] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Accepted: 11/15/2013] [Indexed: 11/28/2022]
Abstract
Background The aim of this study was to investigate the relationship between (i) carotid intima–media thickness (CIMT) at baseline as well as (ii) change in CIMT over 5 years (ΔCIMT) and atherosclerotically induced luminal narrowing in non-coronary arterial territories assessed by whole-body magnetic resonance angiography (WBMRA). Methods and results In subgroups of the Prospective Investigation of Vasculature in Uppsala Seniors (PIVUS) study, US measurements of CIMT in the common carotid arteries were analysed at 70 and 75 years and ΔCIMT was calculated (n = 272). WBMRA, assessing arterial stenosis in five different territories by which also a total atherosclerotic score (TAS) was calculated, was performed at 70 years (n = 306). Results Carotid intima–media thickness in the carotid artery at baseline was correlated with TAS (P = 0·0001) when adjusted to a set of traditional risk factors for atherosclerosis, as well as to stenosis in two of the different investigated territories (aorta and lower leg, P = 0·013 and P = 0·004), but there was no significant correlation between ΔCIMT and TAS (P = 0·41). Conclusions In the present study, CIMT, but not ΔCIMT over 5 years, in the carotid artery was related to overall stenoses in the body, as assessed by WBMRA. These findings support CIMT as a general marker for atherosclerosis.
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Affiliation(s)
- C Lundberg
- Department of Radiology, Oncology and Radiation Science, Uppsala University, Uppsala, Sweden
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52
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Guo J, Saylor DM, Glaser EP, Patwardhan DV. Impact of artificial plaque composition on drug transport. J Pharm Sci 2013; 102:1905-1914. [PMID: 23568279 DOI: 10.1002/jps.23537] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Revised: 01/28/2013] [Accepted: 03/18/2013] [Indexed: 11/07/2022]
Abstract
Drug-eluting stent (DES) implantation is a common treatment for atherosclerosis. The safety and efficacy of these devices will depend on the uptake and distribution of drug into the vessel wall. It is established that the composition of atherosclerotic vessels can vary dramatically with patients' age and gender. However, studies focused on elucidating and quantifying the impact of these variations on important drug transport properties, such as diffusion (D) and partition (k) coefficients, are limited. We have developed an improved tissue mimic or artificial plaque to probe the effect of varying concentrations of plaque constituents on drug transport in vitro. Based on these artificial plaques, we have quantified the impact of gelatin (hydrolyzed collagen) and lipid (cholesterol) concentration on D and k using two model drugs, tetracycline and fluvastatin. We found that for tetracycline, increasing the collagen concentration from 0.025 to 0.100 (w/w) resulted in a fivefold decrease in diffusivity, whereas there was no discernible impact on solubility. Increasing the lipid concentration up to 0.034 (w/w) resulted in only minor changes to transport properties of tetracycline. However, fluvastatin exhibited nearly a fivefold increase in k and 10-fold decrease in D with increased lipid concentration. These results were in reasonable agreement with existing models and exhibited behavior consistent with previous observations on drugs commonly used in DES applications. These observations suggest that variations in the chemical characteristics of atherosclerotic plaque can significantly alter the release rate and distribution of drug following DES implantation.
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Affiliation(s)
- Ji Guo
- Division of Chemistry and Materials Science, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland 20993.
| | - David M Saylor
- Division of Chemistry and Materials Science, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland 20993
| | - Ethan P Glaser
- Department of Chemistry and Biochemistry, University of Maryland Baltimore County (UMBC), Baltimore, Maryland 21250
| | - Dinesh V Patwardhan
- Division of Chemistry and Materials Science, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland 20993
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53
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Lundberg C, Johansson L, Barbier CE, Lind L, Ahlström H, Hansen T. Total atherosclerotic burden by whole body magnetic resonance angiography predicts major adverse cardiovascular events. Atherosclerosis 2013; 228:148-52. [PMID: 23474127 DOI: 10.1016/j.atherosclerosis.2013.02.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 01/25/2013] [Accepted: 02/13/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of the present study was to investigate the relationship between the Total Atherosclerotic Score (TAS), a measurement of the overall atherosclerotic burden of the arterial tree by whole body magnetic resonance angiography (WBMRA), and the risk of major adverse cardiovascular events (MACE), defined as cardiac death, myocardial infarction, stroke and/or coronary revascularization, assuming that TAS predicts MACE. METHODS AND RESULTS 305 randomly selected 70 year-old subjects (47% women) underwent WBMRA. Their atherosclerotic burden was evaluated and TAS > 0, that is atherosclerotic changes, were found in 68% of subjects. During follow-up (mean 4.8 years), MACE occurred in 25 subjects (8.2%). Adjusting for multiple risk factors, TAS was associated with MACE (OR 8.86 for any degree of vessel lumen abnormality, 95%CI 1.14-69.11, p = 0.037). In addition, TAS improved discrimination and reclassification when added to the Framingham risk score (FRS), and ROC (Receiver Operator Curve) increased from 0.681 to 0.750 (p = 0.0421). CONCLUSION In a population-based sample of 70 year old men and women WBMRA, with TAS, predicted MACE independently of major cardiovascular risk factors.
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Affiliation(s)
- Christina Lundberg
- Department of Radiology, Uppsala University hospital, 75185 Uppsala, Sweden.
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54
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Sangiorgi G, Roversi S, Biondi Zoccai G, Modena MG, Servadei F, Ippoliti A, Mauriello A. Sex-related differences in carotid plaque features and inflammation. J Vasc Surg 2012; 57:338-44. [PMID: 23058720 DOI: 10.1016/j.jvs.2012.07.052] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 07/11/2012] [Accepted: 07/22/2012] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Severe carotid stenosis is a frequent cause of stroke in both men and women. Whereas several sex-related comparisons are available on coronary atherosclerosis, there are few data appraising gender-specific features of carotid plaques. We aimed to systematically compare the pathology and inflammatory features of carotid plaques in men vs women. METHODS Carotid plaque specimens were collected from patients undergoing surgical endarterectomy for asymptomatic or symptomatic carotid stenosis. Histologic analysis was performed, as well as measurements of plaque composition and inflammation. RESULTS A total of 457 patients were included (132 women, 325 men). Baseline analyses showed a greater prevalence of hypercholesterolemia, hypertension, and former smoking status in women, despite a higher Framingham Heart Score in men (all P < .05). Women had a lower prevalence of thrombotic plaques, smaller percentage area of necrotic core, and hemorrhage extension (all P < .05). Plaque inflammation analysis showed a lower concentration of inflammatory and, in particular, of macrophage foam cells in the plaque cap of women (both P < .05). These differences were, however, no longer significant at multivariable analysis, including several baseline features, such as symptom status and stenosis severity. CONCLUSIONS Carotid plaques seem significantly different in women and men, but the main drivers of such pathologic differences are baseline features, including stenosis severity and symptom status.
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Affiliation(s)
- Giuseppe Sangiorgi
- Division of Cardiology, Cardiac Catheterization Laboratory, University of Tor Vergata, Rome, Italy
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55
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Agostoni E, Aliprandi A. Migraine and cardiocerebrovascular risk in women. ACTA ACUST UNITED AC 2012; 3:369-79. [PMID: 19803995 DOI: 10.2217/17455057.3.3.369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The interest of the medical community has recently focused on the relationship between gender and cardiocerebrovascular risk. In this paper, we will first review gender differences in cardiocerebrovascular disorders, then we will discuss the existing evidence on the links between migraine and stroke and cardiovascular disease in women, and speculate on the possible physiopathological interpretations of this emerging epidemiological link. In the third part of this work, we will address the issue of the effect of sex hormones on vascular risk, and consider the evidence concerning the safety of oral contraceptives and hormone-replacement therapy. Finally, we will outline the main trends of future research and its possible clinical and therapeutic implications.
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Affiliation(s)
- Elio Agostoni
- Department of Neurosciencies, Neurology Division, Manzoni Hospital, Lecco, Italy.
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56
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Taussky P, Hanel RA, Meyer FB. Clinical considerations in the management of asymptomatic carotid artery stenosis. Neurosurg Focus 2012; 31:E7. [PMID: 22133180 DOI: 10.3171/2011.9.focus11222] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Incidental findings pose considerable management dilemmas for the treating physician and psychological burden for the respective patient. With an aging population, more patients will be diagnosed with asymptomatic internal carotid artery stenosis. Patients will have to be counseled with regard to treatment options according to their individual risk profile and according to professionals' knowledge of evidence-based data derived from large randomized control trials. Treatment consensus has long been lacking for patients with asymptomatic carotid artery stenosis prior to any randomized controlled trials. Additionally, an individual's risk profile may be hard to assess according to knowledge gained from randomized controlled trials. Moreover, while earlier studies compared carotid endarterectomy and medical therapy, in the past years, a new therapeutic modality, carotid artery angioplasty and stenting, has emerged as a possible alternative. This has been evaluated in a recent randomized controlled trial, the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST), which compared carotid endarterectomy with angioplasty and stenting in both symptomatic and asymptomatic patients. The following review summarizes current knowledge of the natural history, diagnosis, and treatment strategies to counsel patients with asymptomatic carotid artery stenosis.
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Affiliation(s)
- Philipp Taussky
- Department of Neurosurgery, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA
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57
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Buchanan DN, Lindenmaier T, McKay S, Bureau Y, Hackam DG, Fenster A, Parraga G. The relationship of carotid three-dimensional ultrasound vessel wall volume with age and sex: comparison to carotid intima-media thickness. ULTRASOUND IN MEDICINE & BIOLOGY 2012; 38:1145-1153. [PMID: 22579542 DOI: 10.1016/j.ultrasmedbio.2012.02.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Revised: 01/18/2012] [Accepted: 02/16/2012] [Indexed: 05/31/2023]
Abstract
The relationship of three-dimensional ultrasound (3DUS)-derived carotid vessel wall volume (VWV) was evaluated with respect to age and sex. B-mode and 3DUS images were acquired for 316 subjects from diverse groups including obese primary prevention, diabetic nephropathy, renal transplant and rheumatoid arthritis populations. The relationship for intima-media thickness (IMT) and VWV with age and sex were determined using Pearson-product-moment correlations. Mean IMT (r = 0.18, p = 0.001) and VWV (r = 0.24, p < 0.01) correlated modestly with age. There were modest correlations in males (IMT, r = 0.19, p = 0.003; VWV, r = 0.34, p < 0.001) and in females for IMT and age (r = 0.30, p = 0.007) but not between 3DUS VWV and age in females (r = 0.10, p = 0.4). Significant associations between plaque and VWV (r = 0.36, p = 0.001) but not IMT suggest different correlations in females that may be attributed to plaque.
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Affiliation(s)
- Daniel N Buchanan
- Imaging Research Laboratories, Robarts Research Institute, London, Ontario, Canada
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58
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Bia D, Zócalo Y, Farro I, Torrado J, Farro F, Florio L, Olascoaga A, Brum J, Alallón W, Negreira C, Lluberas R, Armentano RL. Integrated Evaluation of Age-Related Changes in Structural and Functional Vascular Parameters Used to Assess Arterial Aging, Subclinical Atherosclerosis, and Cardiovascular Risk in Uruguayan Adults: CUiiDARTE Project. Int J Hypertens 2011; 2011:587303. [PMID: 22187622 PMCID: PMC3235479 DOI: 10.4061/2011/587303] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2011] [Revised: 08/26/2011] [Accepted: 08/27/2011] [Indexed: 11/20/2022] Open
Abstract
This work was carried out in a Uruguayan (South American) population to characterize aging-associated physiological arterial changes. Parameters markers of subclinical atherosclerosis and that associate age-related changes were evaluated in healthy people. A conservative approach was used and people with nonphysiological and pathological conditions were excluded. Then, we excluded subjects with (a) cardiovascular (CV) symptoms, (b) CV disease, (c) diabetes mellitus or renal failure, and (d) traditional CV risk factors (other than age and gender). Subjects (n = 388) were submitted to non-invasive vascular studies (gold-standard techniques), to evaluate (1) common (CCA), internal, and external carotid plaque prevalence, (2) CCA intima-media thickness and diameter, (3) CCA stiffness (percentual pulsatility, compliance, distensibility, and stiffness index), (4) aortic stiffness (carotid-femoral pulse wave velocity), and (5) peripheral and central pressure wave-derived parameters. Age groups: ≤20, 21-30, 31-40, 41-50, 51-60, 61-70, and 71-80 years old. Age-related structural and functional vascular parameters profiles were obtained and analyzed considering data from other populations. The work has the strength of being the first, in Latin America, that uses an integrative approach to characterize vascular aging-related changes. Data could be used to define vascular aging and abnormal or disease-related changes.
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Affiliation(s)
- Daniel Bia
- Physiology Department, School of Medicine and School of Science, CUiiDARTE, Republic University, General Flores 2125, 11800 Montevideo, Uruguay
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59
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Talens RP, Jukema JW, Trompet S, Kremer D, Westendorp RGJ, Lumey LH, Sattar N, Putter H, Slagboom PE, Heijmans BT. Hypermethylation at loci sensitive to the prenatal environment is associated with increased incidence of myocardial infarction. Int J Epidemiol 2011; 41:106-15. [PMID: 22101166 DOI: 10.1093/ije/dyr153] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Human epidemiological studies suggest that small size at birth and food deprivation during gestation confer an excess risk of coronary heart diseases (CHD) in adulthood, frequently in a sex-specific manner. Prior epigenetic studies indicate that such prenatal conditions are marked by persistent and sometimes sex-specific changes in DNA methylation. Here, we have investigated the association between DNA methylation and myocardial infarction (MI) at six loci sensitive to prenatal nutrition, anticipating potential sex-specificity. Method Within the placebo group of the PROSPER trial on pravastatin and the risk of CHD, we compared all individuals who were event free at baseline and developed MI during 3 years' follow-up (n = 122) with a similar-sized control group. Methylation at IL10, LEP, ABCA1, IGF2, INS and GNASAS was measured in DNA extracted from leucocytes using mass spectrometry. RESULTS DNA methylation at GNASAS was modestly higher in MI cases compared with controls (P = 0.030). A significant sex interaction was observed for INS (P = 0.014) and GNASAS (P = 0.031). Higher DNA methylation at these loci was associated with MI among women (INS: +2.5%, P = 0.002; GNASAS: +4.2%, P = 0.001). Hypermethylation at one locus and at both loci was associated with odds ratios (ORs) of 2.8 and 8.6, respectively (P(trend) = 3.0 × 10(-4)). No association was observed among men. CONCLUSIONS The risk of MI in women is associated with DNA methylation marks at specific loci previously shown to be sensitive to prenatal conditions. This observation may reflect a developmental component of MI.
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Affiliation(s)
- Rudolf P Talens
- Department of Molecular Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
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60
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Acciarresi M, De Rango P, Pezzella FR, Santalucia P, Amici S, Paciaroni M, Mommi V, Agnelli G, Caso V. Secondary Stroke Prevention in Women. WOMENS HEALTH 2011; 7:391-7. [DOI: 10.2217/whe.11.20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
In a meta-analysis of results from 21 randomized trials comparing antiplatelet therapy with placebo in 18,270 patients with prior stroke or transient ischemic attack, antiplatelet therapy was associated with a 28% relative odds reduction in nonfatal strokes and a 16% reduction in fatal strokes, while another trial for secondary prevention with atorvastastin 80 mg showed a 16% risk reduction in time to first occurrence of stroke (adjusted hazard ratio: 0·84, 95% CI: 0·71–0·99). However, few studies have examined the sex differences regarding the efficacy of these treatments. Specifically, recent studies have reported higher rates of perioperative complications during endarterectomy in women. Nonetheless, to date, the data on the effects of carotid artery stenting in women, coming from diverse studies and meta-analyses, have been limited owing to the small number of female patients examined. Owing to this, the evidence of the benefit for women is unclear. Peculiar pathophysiological aspects of stroke, the higher stroke risk in some specific periods in life (e.g., pregnancy, puerperium and older age) and worse documented stroke outcome in women suggest that sex does matter in stroke management. Thus, future randomized controlled trials need to be sex-balanced, in order to better understand the efficacy of appropriate secondary stroke prevention therapy in women.
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Affiliation(s)
- Monica Acciarresi
- Stroke Unit & Division of Cardiovascular Medicine, University of Perugia, Santa Maria della Misericordia Hospital, Sant'Andrea delle Fratte, 06126 – Perugia, Italy
| | - Paola De Rango
- Vascular & Endovascular Surgery Division, Hospital SM Misericordia, Perugia, Italy
| | | | - Paola Santalucia
- Neuroradiology Department, Fondazione IRCCS Ospedale Maggiore Policlinico Mangiagalli e Regina Elena, Milano, Italy
| | - Serena Amici
- Stroke Unit & Division of Cardiovascular Medicine, University of Perugia, Santa Maria della Misericordia Hospital, Sant'Andrea delle Fratte, 06126 – Perugia, Italy
| | - Maurizio Paciaroni
- Stroke Unit & Division of Cardiovascular Medicine, University of Perugia, Santa Maria della Misericordia Hospital, Sant'Andrea delle Fratte, 06126 – Perugia, Italy
| | - Valeria Mommi
- Stroke Unit & Division of Cardiovascular Medicine, University of Perugia, Santa Maria della Misericordia Hospital, Sant'Andrea delle Fratte, 06126 – Perugia, Italy
| | - Giancarlo Agnelli
- Stroke Unit & Division of Cardiovascular Medicine, University of Perugia, Santa Maria della Misericordia Hospital, Sant'Andrea delle Fratte, 06126 – Perugia, Italy
| | - Valeria Caso
- Stroke Unit & Division of Cardiovascular Medicine, University of Perugia, Santa Maria della Misericordia Hospital, Sant'Andrea delle Fratte, 06126 – Perugia, Italy
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Cecelja M, Jiang B, Bevan L, Frost ML, Spector TD, Chowienczyk PJ. Arterial stiffening relates to arterial calcification but not to noncalcified atheroma in women. A twin study. J Am Coll Cardiol 2011; 57:1480-6. [PMID: 21435518 PMCID: PMC3919172 DOI: 10.1016/j.jacc.2010.09.079] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Revised: 09/08/2010] [Accepted: 09/20/2010] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Our aim was to examine the relationship of arterial stiffness to measures of atherosclerosis, arterial calcification, and bone mineral density (BMD); the heritability of these measures; and the degree to which they are explained by common genetic influences. BACKGROUND Arterial stiffening relates to arterial calcification, but this association could result from coexistent atherosclerosis. A reciprocal relationship between arterial stiffening/calcification and BMD could explain the association between cardiovascular morbidity and osteoporosis. METHODS We examined, in 900 women from the Twins UK cohort, the relationship of carotid-femoral pulse wave velocity (cfPWV) to measures of atherosclerosis (carotid intima-media thickening; carotid/femoral plaque), calcification (calcified plaque [CP]; aortic calcification by computed tomography, performed in subsample of 40 age-matched women with low and high cfPWV), and BMD. RESULTS The cfPWV independently correlated with CP but not with intima-media thickness or noncalcified plaque. Total aortic calcium, determined by computed tomography, was significantly greater in subjects with high cfPWV (median Agatston score 450.4 compared with 63.2 arbitrary units in subjects with low cfPWV, p = 0.001). There was no independent association between cfPWV and BMD. Adjusted heritability estimates of cfPWV and CP were 0.38 (95% confidence interval: 0.19 to 0.59) and 0.61 (95% confidence interval: 0.04 to 0.83), respectively. Shared genetic factors accounted for 92% of the observed correlation (0.38) between cfPWV and CP. CONCLUSIONS These results suggest that the association between increased arterial stiffness and the propensity of the arterial wall to calcify is explained by a common genetic etiology and is independent of noncalcified atheromatous plaque and independent of BMD.
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Key Words
- arteriosclerosis
- atherosclerosis
- bone mineral density
- calcification
- ace, additive genetic component (a2), common (c2), and unique (e2 incorporating measurement error) environment components
- bmd, bone mineral density
- cfpwv, carotid-femoral pulse wave velocity
- ci, confidence interval
- cp, calcified plaque
- ct, computed tomography
- cvd, cardiovascular disease
- dz, dizygotic twins
- imt, intima-media thickness
- map, mean arterial pressure
- mz, monozygotic twins
- pwv, pulse wave velocity
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Affiliation(s)
- Marina Cecelja
- King's College London British Heart Foundation Centre, Cardiovascular Division, Department of Clinical Pharmacology, St. Thomas' Hospital, London, United Kingdom
| | - Benyu Jiang
- King's College London British Heart Foundation Centre, Cardiovascular Division, Department of Clinical Pharmacology, St. Thomas' Hospital, London, United Kingdom
| | - Lisa Bevan
- King's College London, Department of Twin Research and Genetic Epidemiology, St. Thomas' Hospital, London, United Kingdom
| | - Michelle L. Frost
- King's College London, Osteoporosis Unit, Guy's Hospital, London, United Kingdom
| | - Tim D. Spector
- King's College London, Department of Twin Research and Genetic Epidemiology, St. Thomas' Hospital, London, United Kingdom
| | - Phil J. Chowienczyk
- King's College London British Heart Foundation Centre, Cardiovascular Division, Department of Clinical Pharmacology, St. Thomas' Hospital, London, United Kingdom
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Abe T, Aoki T, Yata S, Okada M. Sleep duration is significantly associated with carotid artery atherosclerosis incidence in a Japanese population. Atherosclerosis 2011; 217:509-13. [PMID: 21411100 DOI: 10.1016/j.atherosclerosis.2011.02.029] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 02/16/2011] [Accepted: 02/17/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND Previous studies have indicated that sleep duration is associated with total mortality in a U-shaped fashion. The purpose of the current study was to examine the relationship between self-reported sleep duration and carotid artery atherosclerosis in a Japanese population. METHODS In 2009-2010, a total of 2498 participants (1195 men, 1303 women; age range, 23-92 years) were recruited from members of a Japanese community receiving annual health check-up at a local health center who agreed to participate in the study. Exclusion criteria were as follows: age <40 or ≥85 years; and more than one missing value from either laboratory data or questionnaire responses. A total of 2214 participants were entered into the study. Carotid artery arteriosclerosis was evaluated ultrasonographically and quantified as intima-medial thickness (IMT). The presence of carotid artery atherosclerosis was defined as IMT≥1.2 mm. Sleep durations were compared with IMT measurements after controlling for confounding factors such as age, sex, lipid profile, fasting plasma glucose, hemoglobin A1c, blood pressure, alcohol intake, and smoking habit. RESULTS Sleep duration ≥7 h correlated significantly with the incidence of IMT≥1.2 m when compared with a sleep duration of 6 h (multivariate-adjusted odds ratio, 1.263; 95% confidence interval, 1.031-1.546, P=0.024). Shorter sleep duration ≤5 h did not correlate significantly with the risk compared with a sleep duration of 6 h. CONCLUSION Long sleep duration (≥7 h) correlated significantly with the incidence of carotid artery atherosclerosis compared with a sleep duration of 6 h, but shorter sleep duration did not.
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Affiliation(s)
- Tsueko Abe
- Division of Preventive Medicine, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi, Chuo-ku, Niigata City 951-8510, Japan
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Rosero EB, Peshock RM, Khera A, Clagett P, Lo H, Timaran CH. Sex, race, and age distributions of mean aortic wall thickness in a multiethnic population-based sample. J Vasc Surg 2011; 53:950-7. [PMID: 21211932 DOI: 10.1016/j.jvs.2010.10.073] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Revised: 10/14/2010] [Accepted: 10/14/2010] [Indexed: 11/30/2022]
Abstract
BACKGROUND Reference values and age-related changes of the wall thickness of the abdominal aorta have not been described in the general population. We characterized age-, race-, and gender-specific distributions, and yearly rates of change of mean aortic wall thickness (MAWT), and associations between MAWT and cardiovascular risk factors in a multi-ethnic population-based probability sample. METHODS Magnetic resonance imaging measurements of MAWT were performed on 2466 free-living white, black, and Hispanic adult subjects. MAWT race/ethnicity- and gender-specific percentile values across age were estimated using regression analyses. RESULTS MAWT was greater in men than in women and increased linearly with age in all the groups and across all the percentiles. Hispanic women had the thinnest and black men the thickest aortas. Black men had the highest and white women the lowest age-related MAWT increase. Age, gender, ethnicity, smoking status, systolic blood pressure, low-density lipoprotein-cholesterol levels, high-density lipoprotein-cholesterol levels, and fasting glucose levels were independent predictors of MAWT. CONCLUSIONS Age, gender, and racial/ethnic differences in MAWT distributions exist in the general population. Such differences should be considered in future investigations assessing aortic atherosclerosis and the effects of anti-atherosclerotic therapies.
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Affiliation(s)
- Eric B Rosero
- Division of Vascular and Endovascular Surgery, Department of Surgery, Donald W. Reynolds Cardiovascular Clinical Research Center, University Of Texas Southwestern Medical School, Dallas, TX 75390-9157, USA
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Pulkki-Råback L, Puttonen S, Elovainio M, Raitakari OT, Juonala M, Keltikangas-Järvinen L. Adulthood EAS-temperament and carotid artery intima-media thickness: The Cardiovascular Risk in Young Finns study. Psychol Health 2010; 26:61-75. [DOI: 10.1080/08870440903270690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Laura Pulkki-Råback
- a Department of Psychology , University of Helsinki , P.O. Box 9, FIN-00014 Helsinki, Finland
- b Finnish Institute of Occupational Health , Topeliuksenkatu 41A a, 00250 Helsinki, Finland
| | - Sampsa Puttonen
- a Department of Psychology , University of Helsinki , P.O. Box 9, FIN-00014 Helsinki, Finland
- b Finnish Institute of Occupational Health , Topeliuksenkatu 41A a, 00250 Helsinki, Finland
| | - Marko Elovainio
- a Department of Psychology , University of Helsinki , P.O. Box 9, FIN-00014 Helsinki, Finland
- c National Institute for Health and Welfare , P. O. Box 220, FIN-00531 Helsinki, Finland
| | - Olli T. Raitakari
- d Department of Clinical Physiology , Turku University Hospital , P.O. Box 52, FIN-20521 Turku, Finland
| | - Markus Juonala
- e Research Centre of Applied and Preventive Cardiovascular Medicine , University of Turku , Kiinanmyllynkatu 10, 20520 Turku, Finland
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Polak JF, Pencina MJ, Meisner A, Pencina KM, Brown LS, Wolf PA, D'Agostino RB. Associations of carotid artery intima-media thickness (IMT) with risk factors and prevalent cardiovascular disease: comparison of mean common carotid artery IMT with maximum internal carotid artery IMT. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2010; 29:1759-1768. [PMID: 21098848 PMCID: PMC3186063 DOI: 10.7863/jum.2010.29.12.1759] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE The goal of this study was to compare internal carotid artery (ICA) intima-media thickness (IMT) with common carotid artery (CCA) IMT as global markers of cardiovascular disease (CVD). METHODS Cross-sectional measurements of the mean CCA IMT and maximum ICA IMT were made on ultrasound images acquired from the Framingham Offspring cohort (n = 3316; mean age, 58 years; 52.7% women). Linear regression models were used to study the associations of the Framingham risk factors with CCA and ICA IMT. Multivariate logistic regression models and receiver operating characteristic (ROC) curve analysis were used to compare the associations of prevalent CVD with CCA and ICA IMT and determine sensitivity and specificity. RESULTS The association between age and the mean CCA IMT corresponded to an increase of 0.007 mm/y; the increase was 0.037 mm/y for the ICA IMT. Framingham risk factors accounted for 28.6% and 27.5% of the variability in the CCA and ICA IMT, respectively. Age and gender contributed 23.5% to the variability of the CCA IMT and 22.5% to that of the ICA IMT, with the next most important factor being systolic blood pressure (1.9%) for the CCA IMT and smoking (1.6%) for the ICA IMT. The CCA IMT and ICA IMT were statistically significant predictors of prevalent CVD, with the ICA IMT having a larger area under the ROC curve (0.756 versus 0.695). CONCLUSIONS Associations of risk factors with CCA and ICA IMT are slightly different, and both are independently associated with prevalent CVD. Their value for predicting incident cardiovascular events needs to be compared in outcome studies.
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Affiliation(s)
- Joseph F Polak
- Department of Radiology, Tufts Medical Center, Boston, MA 02111, USA.
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Liao YC, Lin HF, Guo YC, Yu ML, Liu CK, Juo SHH. Sex-differential genetic effect of phosphodiesterase 4D (PDE4D) on carotid atherosclerosis. BMC MEDICAL GENETICS 2010; 11:93. [PMID: 20540798 PMCID: PMC2895592 DOI: 10.1186/1471-2350-11-93] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Accepted: 06/12/2010] [Indexed: 11/10/2022]
Abstract
BACKGROUND The phosphodiesterase 4D (PDE4D) gene was reported as a susceptibility gene to stroke. The genetic effect might be attributed to its role in modulating the atherogenic process in the carotid arteries. Using carotid intima-media thickness (IMT) and plaque index as phenotypes, the present study sought to determine the influence of this gene on subclinical atherosclerosis. METHODS Carotid ultrasonography was performed on 1013 stroke-free subjects who participated in the health screening programs (age 52.6 +/- 12.2; 47.6% men). Genotype distribution was compared among the high-risk (plaque index > or = 4), low-risk (index = 1-3), and reference (index = 0) groups. We analyzed continuous IMT data and further dichotomized IMT data using mean plus one standard deviation as the cutoff level. Because the plaque prevalence and IMT values displayed a notable difference between men and women, we carried out sex-specific analyses in addition to analyzing the overall data. Rs702553 at the PDE4D gene was selected because it conferred a risk for young stroke in our previous report. Previous young stroke data (190 cases and 211 controls) with an additional 532 control subjects without ultrasonic data were shown as a cross-validation for the genetic effect. RESULTS In the overall analyses, the rare homozygote of rs702553 led to an OR of 3.1 (p = 0.034) for a plaque index > or = 4. When subjects were stratified by sex, the genetic effect was only evident in men but not in women. Comparing male subjects with plaque index > or = 4 and those with plaque index = 0, the TT genotype was over-represented (27.6% vs. 13.4%, p = 0.008). For dichotomized IMT data in men, the TT genotype had an OR of 2.1 (p = 0.032) for a thicker IMT at the common carotid artery compared with the (AA + AT) genotypes. In women, neither IMT nor plaque index was associated with rs702553. Similarly, SNP rs702553 was only significant in young stroke men (OR = 1.8, p = 0.025) but not in women (p = 0.27). CONCLUSIONS The present study demonstrates a sex-differential effect of PDE4D on IMT, plaque index and stroke, which highlights its influence on various aspects of atherogenesis.
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Affiliation(s)
- Yi-Chu Liao
- Graduate Institute of Medicine, Kaohsiung Medical University, No. 100, TzYou First Road, Kaohsiung, 80708, Taiwan
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Ultrasound-assessed plaque occurrence in the carotid and femoral arteries are independent predictors of cardiovascular events in middle-aged men during 10 years of follow-up. Atherosclerosis 2010; 209:469-73. [DOI: 10.1016/j.atherosclerosis.2009.10.016] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2009] [Revised: 10/09/2009] [Accepted: 10/10/2009] [Indexed: 11/22/2022]
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Prahl U, Holdfeldt P, Bergström G, Fagerberg B, Hulthe J, Gustavsson T. Percentage white: a new feature for ultrasound classification of plaque echogenicity in carotid artery atherosclerosis. ULTRASOUND IN MEDICINE & BIOLOGY 2010; 36:218-226. [PMID: 20018430 DOI: 10.1016/j.ultrasmedbio.2009.10.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2009] [Revised: 08/20/2009] [Accepted: 10/03/2009] [Indexed: 05/28/2023]
Abstract
Atherosclerotic stenotic and nonstenotic plaques of the carotid artery with low echogenicity have been shown to be associated with cardiovascular disease. The aim was to develop a new method for semiautomated ultrasound image analysis to classify nonstenotic carotid plaques, evaluate cases with multiple plaques and examine the association between a new image analysis feature of echogenicity and predictors of cardiovascular disease. The new image analysis feature, percentage white (PW), represents the fraction of bright structures inside a plaque and is integrated in an objective semiautomated method to evaluate echogenicity (SAMEE) in carotid plaques. PW was constructed to take into account overall echogenicity of the image as well as noise surrounding the plaque. Consecutive ultrasound examinations of carotid plaques from a population-based screening of 64-year-old women with varying risk for cardiovascular disease were selected for the present project; 92 far-wall and 47 near-wall plaques were used as a training dataset to develop the SAMEE algorithm with visual classification according to Gray-Weale as reference; 273 plaques were used to validate the method. All plaques were included in an analysis relating predictors of cardiovascular to average PW in all plaques, PW in the biggest plaque and to the plaque with lowest PW in each subject, respectively. In the training dataset the intermethodological variability between SAMEE and visual classification showed a kappa of 0.78 and a sensitivity and specificity of 96% and 81%, respectively. In the validation set, SAMEE and visual classification showed a kappa of 0.77, a sensitivity of 96% and a specificity of 80%. The reproducibility of PW was high, evidenced by r = 0.96 and CV = 9.85% at repeated examinations. Average PW values were associated with several predictors of cardiovascular risk: lipoprotein (a), HbA1c, blood glucose, apolipoproteinB/apolipoproteinA-I; and associated negatively with the levels of adiponectin and apolipoprotein A-I. In conclusion, PW integrated within a SAMEE is a new feature for assessment of echogenicity in carotid plaques and shows excellent reproducibility and agreement with visual assessment.
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Affiliation(s)
- Ulrica Prahl
- Wallenberg Laboratory for Cardiovascular Research, and Center for Cardiovascular and Metabolic Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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Abe T, Tsuda A, Yata S, Matsuto T, Okada M. Hypertension is a major risk factor for future atherosclerotic changes in the Japanese population. Ann Clin Biochem 2009; 47:118-24. [DOI: 10.1258/acb.2009.009032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Great differences in age-standardized mortality rates by cardiovascular disease exist among countries. We prospectively assessed determinants of future cardiovascular changes in a Japanese cohort. Methods In 1996, 1011 men and 1153 women from a Japanese community participated in a study on cardiovascular risk factors at a local health centre. Of these, the 896 subjects who visited the centre both in 1996 and 2001 were selected for the analysis. The presence of cardiovascular changes was defined as the appearance of one or more of the following in five years: positive electrocardiographic findings, intima–media thickness of the carotid artery ≥0.8 mm and retinal vascular changes ≥Keith–Wegener–Barker classification stage I. Results Of the 607 subjects who had no history of cardiovascular disease in 1996, 421 showed changes in 2001. Both the age-adjusted and multivariate models showed that the risk of the cardiovascular changes increased as systolic blood pressure (SBP) increased to ≥135 mmHg (multivariate odds ratio = 1.739, 95% confidence interval = 1.076–2.810, P < 0.05) compared with those with an SBP of 110–134 mmHg. When we made the analyses only for laboratory test results by excluding SBP, body mass index, alcohol intake and current smoking from the regression model, high-density lipoprotein cholesterol and fasting plasma glucose were significant variables. Conclusion The risk of future cardiovascular changes is significantly greater with higher SBP in the Japanese population.
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Affiliation(s)
- Tsueko Abe
- Division of Preventive Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata City 951-8510
| | | | - Syogo Yata
- Kido Hospital, Niigata City 950-0891, Japan
| | - Takayuki Matsuto
- Division of Preventive Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata City 951-8510
| | - Masahiko Okada
- Division of Preventive Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata City 951-8510
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Mathiesen EB, Johnsen SH. Ultrasonographic measurements of subclinical carotid atherosclerosis in prediction of ischemic stroke. Acta Neurol Scand 2009:68-72. [PMID: 19566503 DOI: 10.1111/j.1600-0404.2009.01210.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Carotid intima-media thickness (IMT) and plaque measurements are widely used to quantify atherosclerosis and assess the risk of future stroke, and are used as surrogate endpoints for clinical disease. In recent years, it has become clear that carotid IMT and plaque reflect biologically and genetically different aspects of the atherosclerotic process, and are differentially related to risk factors and cardiovascular disease. Plaques are focal manifestations of atherosclerosis while increased IMT represents mainly hypertensive medial hypertrophy. Several prospective studies have showed that IMT and plaque measurements, such as total plaque area and plaque number, are predictive of future stroke. Plaque echogenicity predicts future stroke independent of plaque size. The contribution of IMT and plaque measurements in individual stroke risk prediction in the general population seems to be limited, but may be useful as a tool for individual stratification of high-risk patients.
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Affiliation(s)
- E B Mathiesen
- Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway.
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Freitas PD, Piccinato CE, Martins WDP, Mauad Filho F. Aterosclerose carotídea avaliada pelo eco-Doppler: associação com fatores de risco e doenças arteriais sistêmicas. J Vasc Bras 2009. [DOI: 10.1590/s1677-54492009005000001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
CONTEXTO: A aterosclerose carotídea apresenta alta prevalência populacional e associação com vários fatores de risco, contribuindo para altos índices de morbidade e mortalidade. OBJETIVO: Pesquisar a freqüência e associação da aterosclerose de carótidas extracranianas com: idade, sexo, hipertensão arterial, doença coronária isquêmica, tabagismo, diabetes melito tipo 2, obesidade, doença arterial oclusiva periférica, acidente vascular cerebral, oclusão carotídea, espessamento médio-intimal e acotovelamento. MÉTODOS: Foram avaliadas as artérias carótidas extracranianas, bilateralmente, de 367 indivíduos (132 homens e 235 mulheres) com idade média de 63 anos (35 a 91 anos) por anamnese, semiologia clínica e ultra-sonografia. A possibilidade da associação entre aterosclerose carotídea representada por placas ateromatosas inespecíficas com estenose > 10%, ateromatose discreta e difusa com estenose < 10% e os fatores de risco enunciados foi analisada estatisticamente pelo odds ratio e seus intervalos de confiança de 95%. RESULTADOS: A freqüência da aterosclerose carotídea foi de 52%, e do espessamento médio-intimal, de 30,2%. Houve associação entre a aterosclerose (ateromatose discreta e difusa e placas ateromatosas inespecíficas) com idade > 64 anos, acidente vascular cerebral, obesidade e tabagismo. Considerando-se somente estenoses carotídeas > 60%, houve associação com idade > 64 anos, oclusão carotídea e doença coronária. O espessamento médio-intimal apresentou associação com idade > 64 anos, acotovelamento, oclusão carotídea, hipertensão arterial e índice tornozelo-braquial < 0,9. CONCLUSÃO: A aterosclerose carotídea apresentou alta freqüência populacional (52%) e associação com idade, obesidade, acidente vascular cerebral, coronariopatia e tabagismo.
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El Aidi H, Mani V, Weinshelbaum KB, Aguiar SH, Taniguchi H, Postley JE, Samber DD, Cohen EI, Stern J, van der Geest RJ, Reiber JHC, Woodward M, Fuster V, Gidding SS, Fayad ZA. Cross-sectional, prospective study of MRI reproducibility in the assessment of plaque burden of the carotid arteries and aorta. Nat Rev Cardiol 2009; 6:219-28. [PMID: 19174763 PMCID: PMC3338149 DOI: 10.1038/ncpcardio1444] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2007] [Accepted: 12/03/2008] [Indexed: 12/21/2022]
Abstract
Introduction This cross sectional study was conducted to test reproducibility of analysis of MRI parameters in carotids and thoracic descending aorta (TOA), evaluate the correlation of plaque burden and associations with subject age and gender. Methods Three hundred subjects, with cardiovascular risk factors, underwent a black blood MRI of both carotids and TOA. Mean wall area, wall thickness, lumen area, total vessel area and wall area/total vessel area (WA/TVA) ratio were manually measured. Inter-reader and intra-reader-reproducibility was tested on 187 and 20 randomly chosen subjects respectively. Results The intra-observer-reproducibility for the analysis was high (Intraclass-Correlation-Coefficients (ICC’s >0.8), except mean WA/TVA ratio of TOA. Similarly, the inter-observer reproducibility was acceptable (ICC’s >0.7 for mean wall area, lumen area and total vessel area). MRI parameters in aorta and carotids increased with age for both sexes (p<0.001). Except for mean wall thickness of TOA and WA/TVA ratio, MRI parameters were significantly higher in males than in females. All MRI measurements except the mean wall thickness and WA/TVA ratio were highly reproducible. There was good correlation for mean wall area between carotids and aorta compatible with the systemic nature of atherosclerosis. Similar to clinical presentation of cardiovascular diseases we found greater values in most MRI parameters (except for WA/TVA ratio) in males than in females and with increasing age. Conclusions These data suggest that analysis of most MRI measurements of plaque burden is reproducible and that there is correlation between plaque burden between carotids and aorta validating the systemic distribution of the disease.
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Affiliation(s)
- Hamza El Aidi
- Translational and Molecular Imaging Institute, Mount Sinai School of Medicine, New York, NY 10029, USA
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Periprocedural hemodynamic instability with carotid angioplasty and stenting. ACTA ACUST UNITED AC 2008; 70:279-85; discussion 285-6. [DOI: 10.1016/j.surneu.2007.07.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2007] [Accepted: 07/03/2007] [Indexed: 10/22/2022]
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Olson FJ, Schmidt C, Gummesson A, Sigurdardottir V, Hulthe J, Wiklund O, Fagerberg B. Circulating matrix metalloproteinase 9 levels in relation to sampling methods, femoral and carotid atherosclerosis. J Intern Med 2008; 263:626-35. [PMID: 18341531 DOI: 10.1111/j.1365-2796.2008.01927.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To examine whether circulating levels of matrix metalloproteinase 9 (MMP-9) were associated with ultrasound-assessed intima-media thickness (IMT) and echolucent plaques in the carotid and femoral arteries. To examine preanalytical sources of variability in MMP-9 concentrations related to sampling procedures. SUBJECTS AND DESIGN Plasma and serum MMP-9 levels were compared with ultrasound assessed measures of femoral and carotid atherosclerosis, in a cross-sectional study of 61-year-old men (n = 473). Preanalytical sources of variability in MMP-9 levels were examined in 10 healthy subjects. Main outcome measures were circulating levels of MMP-9 in serum and plasma, IMT of the carotid and femoral arteries, and plaque status based on size and echolucency. SETTING Research unit at university hospital. RESULTS Plasma concentrations of total and active MMP-9 were associated with femoral artery IMT independently of traditional cardiovascular risk factors, and were higher in subjects with moderate to large femoral plaques. Plasma MMP-9 concentration was higher in men with echolucent femoral plaques (P = 0.006) compared with subjects without femoral plaques. No similar associations were found for carotid plaques. MMP-9 concentrations were higher in serum than in plasma, and higher when sampling was performed with Vacutainer than with syringe. MMP-9 levels in serum were more strongly associated with peripheral neutrophil count compared with MMP-9 levels in plasma. CONCLUSIONS Plasma MMP-9 levels were associated with atherosclerosis in the femoral artery, and total MMP-9 concentration was higher in men with echolucent femoral plaques. The choice of sample material and sampling method affect the measurements of circulating MMP-9 levels.
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Affiliation(s)
- F J Olson
- Wallenberg Laboratory for Cardiovascular Research, Sahlgrenska Academy at Göteborg University, Göteborg, Sweden.
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Berezan DJ, Xu Y, Falck JR, Kundu AP, Davidge ST. Ovariectomy, but not estrogen deficiency, increases CYP4A modulation of alpha(1)-adrenergic vasoconstriction in aging female rats. Am J Hypertens 2008; 21:685-90. [PMID: 18437124 DOI: 10.1038/ajh.2008.168] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Postmenopausal women are more likely to develop cardiovascular disease (CVD) than premenopausal women. Increased vasoconstriction in the peripheral vasculature may underlie this risk. In vascular smooth muscle, cytochrome P450 4A (CYP4A) enzymes form the vasoconstrictor 20-hydroxyeicosatetraenoic acid (20-HETE). CYP4A modulation of alpha(1)-adrenergic vasoconstriction is increased in aging male rats; however, this pathway has not been investigated in aging females. To generate an appropriate model of menopause, we ovariectomized aged Sprague-Dawley rats to create an aged, ovarian-depleted phenotype. Because estrogen has profound effects on the peripheral vasculature, we also determined the effect of estrogen replacement on CYP4A modulation of vasoconstriction. METHODS Aged (15-16 months) rats were assigned to be intact or ovariectomized. Ovariectomized rats received either placebo (OVX) or 17beta-estradiol (OVX-E) subcutaneously for 4 weeks. Mesenteric arteries were isolated and constricted with the alpha(1)-adrenergic agonist phenylephrine or intraluminal pressure in the absence or presence of the CYP4A inhibitor, DDMS. RESULTS Ovariectomy increased CYP4A modulation of alpha(1)-adrenergic vasoconstriction. This was unaffected by estrogen replacement. Arteries from OVX-E animals exhibited increased phenylephrine sensitivity and forced dilation relative to arteries from intact and OVX animals. Myogenic tone was increased in both OVX and OVX-E animals relative to intact rats; however, CYP4A inhibition had no effect on myogenic tone in any group. CONCLUSIONS In aged female rats, ovariectomy caused an increase in CYP4A modulation of alpha(1)-adrenergic vasoconstriction that was not prevented by estrogen replacement. Future study of these pathways may provide important targets for the prevention of CVD in aging women.
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Trompet S, de Craen AJM, Slagboom P, Shepherd J, Blauw GJ, Murphy MB, Bollen ELEM, Buckley BM, Ford I, Gaw A, Macfarlane PW, Packard CJ, Stott DJ, Westendorp RGJ, Jukema JW. Lymphotoxin-alpha C804A polymorphism is a risk factor for stroke. The PROSPER study. Exp Gerontol 2008; 43:801-5. [PMID: 18504081 DOI: 10.1016/j.exger.2008.04.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2008] [Revised: 04/08/2008] [Accepted: 04/15/2008] [Indexed: 11/30/2022]
Abstract
Inflammation plays a prominent role in the development of atherosclerosis, which is the most important risk factor for vascular events. Lymphotoxin-alpha (LTA) is a pro-inflammatory cytokine and is found to be expressed in atherosclerotic lesions. We investigated the association between the C804A polymorphism within the LTA gene and coronary and cerebrovascular events in 5804 participants of the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER). The primary endpoint was the combined endpoint of death from coronary heart disease, non-fatal myocardial infarction, and clinical stroke. Secondary endpoints were the coronary and cerebrovascular components separately. All associations were assessed with a Cox-proportional hazards model adjusted for sex, age, pravastatin use, and country. Our overall analysis showed a significant association between the C804A polymorphism and the primary endpoint (p = 0.03). After stratification for gender, this association was found only in males. Furthermore, we found that the association between the C804A polymorphism and the primary endpoint was mainly attributable to clinical strokes (p = 0.02). The C804A polymorphism in the LTA gene associates with clinical stroke, especially in men. But further research is warranted to confirm our results.
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Affiliation(s)
- S Trompet
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands.
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Primary Hypercholesterolemia, Carotid Atherosclerosis and Insulin Resistance Among Chinese. Lipids 2007; 43:117-24. [DOI: 10.1007/s11745-007-3138-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2007] [Accepted: 10/30/2007] [Indexed: 10/22/2022]
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Hansen T, Ahlström H, Johansson L. Whole-body screening of atherosclerosis with magnetic resonance angiography. Top Magn Reson Imaging 2007; 18:329-337. [PMID: 18025987 DOI: 10.1097/rmr.0b013e318159aaa2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
With whole-body magnetic resonance angiography (WBMRA), it is possible to examine the whole arterial tree except intracranial and coronary vessels in a single examination without the risks involved in ionizing radiation or arterial cannulation. Whole-body magnetic resonance angiography is well suited for repeated clinical examinations in patients with systemic diseases such as vasculitis or atherosclerosis and can also be used for scientific purposes. On the basis of the WBMRA overview, a possible further development of the WBMRA concept can be to perform further acquisitions at sites with atherosclerotic plaques with higher-resolution scans to determine the degree of stenosis more accurately or to achieve plaque characterization. A total validation of WBMRA compared with digital subtraction angiography (DSA) is not possible owing to the hazards of ionizing radiation. Studies have shown a high sensitivity and specificity for the pelvic and lower limb arteries in comparison with DSA. No systematic validation against DSA has been performed for the renal, aortic, and carotid arteries. Various methods have been used, however, for confirmation of vascular abnormalities found on WBMRA such as ultrasonography, dedicated MRA, or DSA, with reasonably high agreement. The WBMRA method has not been studied with regard to prediction of future cardiovascular (CV) events, as have intima media thickness, coronary artery calcium scoring, and the ankle-brachial index. The full usefulness of WBMRA in an epidemiological setting and as a complementary screening tool for assessing CV risk still needs to be validated against future CV events.
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Affiliation(s)
- Tomas Hansen
- Department of Radiology, Uppsala University Hospital, Uppsala, Sweden.
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Komorovsky R, Desideri A. Carotid ultrasound assessment of patients with coronary artery disease: a useful index for risk stratification. Vasc Health Risk Manag 2007; 1:131-6. [PMID: 17315399 PMCID: PMC1993944 DOI: 10.2147/vhrm.1.2.131.64077] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Carotid disease is a common finding in patients with coronary artery disease (CAD) and its presence is associated with worse clinical outcomes. Intima-media thickness provides incremental value over traditional risk factors in predicting cardiovascular events; however, it does not predict the absence of CAD or its extent and severity. The presence of carotid plaques is associated with an increased risk of cardiovascular events in patients with CAD regardless of the treatment strategy (medical therapy alone or myocardial revascularization). Hence, we advocate the screening of patients with diagnosed CAD for carotid atherosclerosis. The prognostic impact of ultrasound characteristics of carotid plaques on cardiovascular outcomes of patients with CAD remains controversial.
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Affiliation(s)
- Roman Komorovsky
- Cardiovascular Research Foundation, S Giacomo Hospital, Castelfranco Veneto, Italy.
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Dahl A, Omdal R, Waterloo K, Joakimsen O, Jacobsen EA, Koldingsnes W, Mellgren SI. Detection of cerebral embolic signals in patients with systemic lupus erythematosus. J Neurol Neurosurg Psychiatry 2006; 77:774-9. [PMID: 16500945 PMCID: PMC2077454 DOI: 10.1136/jnnp.2005.084285] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Involvement of the CNS in systemic lupus erythematosus (SLE) is caused by several pathogenic mechanisms including cerebral embolism. AIM To measure the frequency of microembolic signals (MES) by using transcranial Doppler (TCD) ultrasound and to assess their association with cerebral infarction, neuropsychological dysfunction, and biochemical, sonographic and clinical variables in an unselected group of patients with SLE. METHODS A 1-h TCD recording from the middle cerebral artery was carried out in 55 patients with SLE having a mean age of 46 (SD 13) years. MRI of the brain, carotid artery ultrasonography with intima-media thickness and atherosclerotic plaque assessments were carried out in addition to a broad biochemical and clinical assessment. All patients underwent a neuropsychological assessment. RESULTS Of the 55 patients, MES were detected in 5 (9%) and cerebral infarcts were found in 9 (18%). A significant association was found between MES and cerebral infarcts and considerably more neuropsychological deficits were found in MES-positive patients compared with the negative group. MES were not associated with other clinical, sonographic and biochemical factors believed to be associated with cerebral embolism. CONCLUSIONS Cerebral embolism may be one of the important mechanisms responsible for the high prevalence of cerebrovascular events and the neuropsychological deficits observed in patients with SLE. Although the number of MES-positive patients was small, the lack of a significant association between MES and other known risk factors for MES suggests a complex pathogenesis for the embolisation in these patients.
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Affiliation(s)
- A Dahl
- Department of Neurology, Rikshospitalet University Hospital, Sognsvannsveien 20, 0027 Oslo, Norway.
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82
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Abstract
Women with diabetes experience much greater relative risks of coronary heart disease (CHD) compared with the nondiabetic population than do men with diabetes. In type 2 diabetes, much of the greater elevation in risk in women is explained by a more adverse pattern of known CHD risk factors. In type 1 diabetes the picture is less clear, but current evidence suggests that a cardioprotective lipid profile is found in type 1 diabetic men, thus reducing the effect of diabetes on CHD, but that in women this is not the case. Also, in type 1 diabetic women there is some evidence of altered body fat distribution and a greater elevation in blood pressure. Whether these reflect a greater degree of insulin resistance in type 1 women, and what the origin of this might be, remains controversial. The practical consequence is that clinicians need to be aware that the usual cardioprotective effect of sex does not apply in diabetic women and that risk factor intervention is needed at an early age.
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Affiliation(s)
- Helen Colhoun
- The Conway Institute, University College Dublin, Belfield, Dublin 4, Ireland.
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83
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Hintsanen M, Kivimäki M, Elovainio M, Pulkki-Råback L, Keskivaara P, Juonala M, Raitakari OT, Keltikangas-Järvinen L. Job strain and early atherosclerosis: the Cardiovascular Risk in Young Finns study. Psychosom Med 2005; 67:740-7. [PMID: 16204432 DOI: 10.1097/01.psy.0000181271.04169.93] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study was to determine whether job strain and social support are associated with early atherosclerosis measured by carotid intima-media thickness (IMT) in young adults. METHODS The subjects were 478 men and 542 women (mean age 32.3) who were participating in the ongoing prospective Cardiovascular Risk in Young Finns study. Job strain was defined as a joint effect of job demands and job control. Early atherosclerosis was determined with IMT ultrasound. The associations between job strain, social support, and IMT were evaluated using multiple linear regressions. RESULTS In men, job strain was associated with increased IMT after adjustment for age. This association was not attenuated by additional adjustment for established risk factors of coronary heart disease. In women, job strain was not associated with IMT. No 3-way interaction of job demand, job control, and social support on IMT was found. CONCLUSION These findings suggest that job strain may be related to atherosclerosis already in its early nonsymptomatic stages in men.
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Affiliation(s)
- Mirka Hintsanen
- Department of Psychology, PUniversity of Helsinki, Helsinki, Finland
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84
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Schmidt C, Fagerberg B, Hulthe J. Non-stenotic echolucent ultrasound-assessed femoral artery plaques are predictive for future cardiovascular events in middle-aged men. Atherosclerosis 2005; 181:125-30. [PMID: 15939063 DOI: 10.1016/j.atherosclerosis.2004.12.034] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2004] [Revised: 11/19/2004] [Accepted: 12/14/2004] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of the present study was to examine the relationship between plaque occurrence, plaque size and plaque echogenicity, assessed by B-mode ultrasound, in the femoral artery and the development of clinical cardiovascular disease. BACKGROUND The relationship between carotid atherosclerosis assessed by B-mode ultrasound and cardiovascular disease has been thoroughly investigated. In comparison, the femoral arteries have received much less attention. METHODS The femoral artery was examined by high-resolution B-mode ultrasound in 391, 58-year-old men identified by screening in the city of Goteborg, Sweden. Assessment of plaque occurrence, plaque size (no, small, or moderate/large) and plaque characteristics in terms of echogenicity (no, echogenic or echolucent) were performed. RESULTS Subjects with a plaque present in the femoral artery at study baseline had a three-fold increase in odds ratio (OR 3.04, 95%, CI 1.24-7.42) for having a cardiovascular event during 6.6 years of follow-up compared to subjects without plaque. After adjustment for cardiovascular risk factors (LDL, triglycerides, systolic blood pressure and smoking) there was a borderline significant association between plaque occurrence and cardiovascular disease (OR = 2.64, p = 0.055). Plaque size could be demonstrated to be associated with cardiovascular events (p = 0.012, for trend). The results also showed that in this group of men, the risk of having a cardiovascular event was to a large extent confined to those with an echolucent plaque at baseline. However, no significant difference in risk prediction was seen between echogenic and echolucent plaques, respectively. CONCLUSIONS This is the first study to show that the presence of non-stenotic plaques in the femoral artery in middle-aged men without prior cardiovascular events has a predictive value for future cardiovascular events. The relationship was attenuated by adjustment for traditional cardiovascular risk factors. Data also indicates that plaque echolucency predicts increased risk.
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Affiliation(s)
- Caroline Schmidt
- The Wallenberg Laboratory for Cardiovascular Research, Sahlgrenska University Hospital, Göteborg University, Sweden
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85
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Comerota AJ, Salles-Cunha SX, Daoud Y, Jones L, Beebe HG. Gender differences in blood velocities across carotid stenoses. J Vasc Surg 2004; 40:939-44. [PMID: 15557908 DOI: 10.1016/j.jvs.2004.08.030] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Carotid duplex scanning is the standard test for documenting carotid disease. Carotid endarterectomy effectively reduces stroke in selected patients with carotid artery disease. Data from large national randomized trials suggest that the benefits of CEA may be gender dependent. Because many diagnoses are made and treatment is based on the results of carotid duplex ultrasound scanning alone, it is important to determine whether different diagnostic thresholds should be used in men and women. The purpose of this study was 2-fold: to examine whether there is an overall gender difference in carotid velocity at similar arteriographic stenoses, and to determine whether there are significant differences at clinically relevant thresholds of disease. METHODS A database of 938 carotid arteriogram entries was established prospectively, with accompanying measurements of peak systolic velocity (PSV) and end-diastolic velocity (EDV). The percent of internal carotid artery stenosis seen on arteriograms was calculated according to criteria from the North American Symptomatic Carotid Endarterectomy Trial. Analyses were made in 536 carotid arteries in men and 402 carotid arteries in women. In addition, the single most diseased artery per patient was analyzed by gender. PSV and EDV were averaged for data subsets according to 10% intervals of internal carotid artery stenoses. Velocity for each interval was compared between men and women with the Student t test. Receiver operator characteristic curves were developed to define optimal duplex criteria for 60% and 70% stenosis. RESULTS For all intervals, PSV and EDV averaged 9% and 6% higher, respectively, in women than in men. Significant gender differences existed between PSV and EDV for 60% and 70% stenosis (P = .03). When a single vessel per patient was analyzed these observations persisted, but lost significance for PSV at 60% stenosis (P = .18). Receiver operator characteristic curves at 90% sensitivity demonstrated that optimal PSV for 60% stenosis was 160 cm/s and 180 cm/s, and for 70% stenosis was 185 cm/s and 202 cm/s, in male and female patients, respectively. CONCLUSIONS Women have higher carotid blood flow velocity than men do. Gender differences exist, and are notably different at clinically relevant thresholds for intervention. These data indicate that different criteria should be used for interpreting carotid velocity profiles in women than in men, and have potentially important implications for patient care.
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86
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Li AE, Kamel I, Rando F, Anderson M, Kumbasar B, Lima JAC, Bluemke DA. Using MRI to Assess Aortic Wall Thickness in the Multiethnic Study of Atherosclerosis: Distribution by Race, Sex, and Age. AJR Am J Roentgenol 2004; 182:593-7. [PMID: 14975953 DOI: 10.2214/ajr.182.3.1820593] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Understanding the determinants of subclinical atherosclerosis may aid in elucidating the pathogenesis of atherosclerosis and guide prevention strategies. In this pilot study, we investigated the role of aortic wall thickness as a measure of subclinical atherosclerosis, assessed a method by which to measure aortic wall thickness using MRI, and attempted to define differences in aortic wall thickness by patient race, sex, and age. SUBJECTS AND METHODS. In this prospective study, 196 participants (99 black, 97 white; 98 men, 98 women) were selected from the Multiethnic Study of Atherosclerosis, which consists of participants 45-84 years old without clinical cardiovascular disease, who were recruited from six study centers in the United States. We performed fast spin-echo double inversion recovery MRI to measure thoracic aortic wall thickness. We tested interobserver agreement using the intraclass correlation coefficient, for sex and race differences in wall thickness using the Mann-Whitney test, and for associations between age and wall thickness using linear regression. RESULTS Reproducibility was excellent for measurements of average and maximal wall thickness on MRI. Average and maximal wall thickness increased with age (p < 0.001 and p = 0.002, respectively). Men had greater mean average wall thickness (2.32 vs 2.11 mm, p = 0.028) and mean maximal wall thickness (3.85 vs 3.31 mm, p = 0.010) than women. Blacks had greater mean maximal wall thickness than whites (3.74 vs 3.42 mm, p = 0.023). CONCLUSION MRI is a feasible method to measure aortic wall thickness with high interobserver agreement. Aortic wall thickness increases with age and also varies by race and sex.
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Affiliation(s)
- Arthur E Li
- Department of Radiology, Johns Hopkins University School of Medicine, MRI Rm. 143, Baltimore, MD 21287, USA
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87
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Ersoy H, Watts R, Sanelli P, Zimmerman RD, Kent KC, Bush HL, Prince MR. Atherosclerotic disease distribution in carotid and vertebrobasilar arteries: clinical experience in 100 patients undergoing fluoro-triggered 3D Gd-MRA. J Magn Reson Imaging 2003; 17:545-58. [PMID: 12720264 DOI: 10.1002/jmri.10288] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To determine how often three-dimensional gadolinium-enhanced magnetic resonance angiography (3D Gd-MRA) shows disease outside of the standard two-dimensional time-of-flight magnetic resonance angiography (2D TOF-MRA) imaging volume. MATERIALS AND METHODS One hundred consecutive patients with known or suspected cerebrovascular disease were examined using fluoro-triggered 3D Gd-MRA with a 1.5 Tesla scanner. All vessel segments from the aortic arch to the circle of Willis were independently evaluated for the presence of occlusive disease, ulceration, aneurysm, and anatomic variations by two radiologists blinded to clinical information. Branch vessel and circle of Willis visibility were also assessed. Kappa statistics were calculated to determine interobserver agreement. RESULTS Interobserver agreement for the degree of stenosis was good to excellent (kappa = 0.83-1.0). Disagreement was more frequent in the cases of mild stenoses and was less frequent for stenoses > or = 50%. In 38% of the patients, 3D Gd-MRA demonstrated either ulcerated plaques in carotid arteries (N = 14) or stenosis > or = 50% in great vessel (N = 20) and/or vertebral artery (N = 38) origins, none of which can be readily evaluated on standard TOF-MRA. CONCLUSION Fluoro-triggered 3D Gd-MRA provides a comprehensive evaluation of the carotid arteries including all vessel segments from the aortic arch to the circle of Willis.
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Affiliation(s)
- Hale Ersoy
- Department of Radiology, Weill Medical College of Cornell University, New York, New York, USA
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88
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Prandoni P, Bilora F, Marchiori A, Bernardi E, Petrobelli F, Lensing AWA, Prins MH, Girolami A. An association between atherosclerosis and venous thrombosis. N Engl J Med 2003; 348:1435-41. [PMID: 12686699 DOI: 10.1056/nejmoa022157] [Citation(s) in RCA: 432] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND In about a third of patients with venous thromboembolism, the cause of the disorder is unexplained. In patients with atherosclerosis, activation of both platelets and blood coagulation and an increase in fibrin turnover are detectable, which may lead to thrombotic complications. Whether atherosclerosis is associated with an increased risk of venous thrombosis is unknown. METHODS We performed ultrasonography of the carotid arteries in 299 unselected patients who had deep venous thrombosis of the legs without symptomatic atherosclerosis and in 150 control subjects. Patients with spontaneous thrombosis, patients with secondary thrombosis from acquired risk factors, and control subjects were assessed for plaques. RESULTS At least one carotid plaque was detected in 72 of the 153 patients with spontaneous thrombosis (47.1 percent; 95 percent confidence interval, 39.1 to 55.0), 40 of the 146 with secondary thrombosis (27.4 percent; 95 percent confidence interval, 20.2 to 34.6), and 48 of the 150 control subjects (32.0 percent; 95 percent confidence interval, 24.5 to 39.5). The odds ratios for carotid plaques in patients with spontaneous thrombosis, as compared with patients with secondary thrombosis and with controls, were 2.3 (95 percent confidence interval, 1.4 to 3.7) and 1.8 (95 percent confidence interval, 1.1 to 2.9), respectively. In a multivariate analysis that accounted for risk factors for atherosclerosis, the strength of this association did not change. CONCLUSIONS There is an association between atherosclerotic disease and spontaneous venous thrombosis. Atherosclerosis may induce venous thrombosis, or the two conditions may share common risk factors.
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Affiliation(s)
- Paolo Prandoni
- Department of Medical and Surgical Sciences, Second Chair of Internal Medicine, University of Padua Medical School, Padua, Italy.
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89
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Lee JW, Pomposelli F, Park KW. Association of sex with perioperative mortality and morbidity after carotid endarterectomy for asymptomatic carotid stenosis. J Cardiothorac Vasc Anesth 2003; 17:10-6. [PMID: 12635054 DOI: 10.1053/jcan.2003.3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To examine whether perioperative morbidity and mortality after carotid endarterectomy depend on the sex and the presence of symptoms on presentation. DESIGN Retrospective review of quality assurance database prospectively collected. SETTING A university teaching hospital. PARTICIPANTS One thousand two hundred eighty-seven patients who had 1,503 carotid endarterectomies from 1990 to 1999 from a quality assurance database. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The cases were divided into 4 groups by sex and symptoms on presentation: male-symptomatic (MS), male-asymptomatic (MA), female-symptomatic (FS), and female-asymptomatic (FA). The 4 groups were compared for preoperative demographic and comorbidity profiles, carotid plaque characteristics, and outcome. Outcome measures included in-hospital stroke, myocardial infarction (MI), congestive heart failure (CHF), and death. There were 496 cases in the MS group, 407 in the MA group, 315 in the FS group, and 285 in the FA group. Women were less likely to have a history of coronary artery disease, prior MI, or smoking, and their carotid plaques were less likely to be ulcerated or contain intraplaque hemorrhage. Even when controlling for the comorbidities and plaque characteristics, the incidence of each of the complications examined was low and not significantly different between the sexes in both the symptomatic and asymptomatic groups. The rate of stroke or death was 3.0% (MS) versus 1.9% (FS) (p = NS) and 1.2% (MA) versus 1.8% (FA) (p = NS). CONCLUSION There is no significant sex difference in perioperative cardiac or cerebrovascular complications. Women with symptomatic or asymptomatic carotid stenosis can have acceptably low complication rates from carotid endarterectomy and may benefit from the surgery as much as men.
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Affiliation(s)
- Jae-Woo Lee
- Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
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90
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Landonio S, Quirino T, Pelucchi A, Magni C, Coen M, Porretta T, Faggion I, Bonfanti P, Vigevani GM. Bilateral carotid stenosis in a young female HIV patient treated with highly active antiretroviral therapy. AIDS 2002; 16:2225-7. [PMID: 12409747 DOI: 10.1097/00002030-200211080-00018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Simona Landonio
- Department of Infectious Diseases, Luigi Sacco Hospital, Milan, Italy
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91
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Troyer A, Saloner D, Pan XM, Velez P, Rapp JH. Major carotid plaque surface irregularities correlate with neurologic symptoms. J Vasc Surg 2002; 35:741-7. [PMID: 11932673 DOI: 10.1067/mva.2002.121210] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE Many studies have linked carotid plaque surface irregularities with stroke risk, but this relationship has been obscured by the limited ability of available imaging modalities to resolve plaque surface morphology. To address this issue, we performed a prospective study correlating the presenting neurologic symptoms of patients with high-resolution magnetic resonance imaging (MRI; 200 microm) studies of ipsilateral plaque surface invaginations and ledges, lumen shape, and the location of the plaque bulk creating the stenosis. METHODS One hundred patients, 17 women and 83 men, 45 to 81 years old (mean, 68 years) underwent surgery. Forty-five patients had a transient ischemic attack (TIA) or stroke as the indication for surgery, and 55 patients had no symptoms. Angiograms were obtained in 50 patients. Carotid plaques were removed "en bloc" and placed in gadolinium doped saline for imaging in a Siemens Symphony, 1.5T scanner with a custom-built transmit-receive radiofrequency coil. The resulting slice thickness was 200 microm, with 200 microm by 200 microm in plane resolution. The MRI data and angiograms were reviewed by using National Institutes of Health Image software and read by consensus. A surface irregularity was categorized as a ledge or ulcer and measured by using electronic calipers. Luminal shape was determined at the point of maximal stenosis with a "slice" set at 90 degrees to the lumen axis. The location of the maximal stenosis was recorded. In the internal carotid artery, plaque bulk was designated to be on the flow divider wall or non-flow divider wall. RESULTS The mean maximal stenosis was 81.5% +/- 12.0%. Surface contour irregularities were found in 80 plaques. Thirty-five plaques were graded as having major surface contour irregularities, and 45 plaques were graded as having minor irregularities. There was a significant correlation between major surface irregularity and TIA or stroke (P <.01). Irregular plaques were identified with angiography, but the irregularity in size was underestimated (P <.01). Only 28% of plaques had circular lumens; 50% had elliptical lumens, and 22% had either crescentic or multi-lobular lumens. The maximal stenosis was located in the internal carotid artery in 82 plaques, the bifurcation in 17 plaques, and the common carotid artery in one plaque. CONCLUSION Surface irregularities were revealed by means of submillimeter resolution of the carotid plaques with MRI to be common, but only the presence of major irregularities correlated with the patient having TIA or stroke. Lumen shape and plaque location did not appear to predict stroke risk, but may effect imaging accuracy in determining the degree of stenosis. These data further define the relationship of plaque irregularity and cerebrovascular symptoms caused by atheroemboli.
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Affiliation(s)
- Aaron Troyer
- Surgical Services of the San Francisco Department of Veterans Affairs Medical Center, the University of California, San Francisco, 94121, USA
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92
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Chang JB, Stein TA. Ten-year outcome after saphenous vein patch angioplasty in males and females after carotid endarterectomy. Vasc Endovascular Surg 2002; 36:21-7. [PMID: 12704521 DOI: 10.1177/153857440203600105] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Many surgeons use a vein-patch angioplasty after endarterectomy of small (< 4 mm) diameter carotid arteries in males and females. Because evidence suggests that females may have a poorer outcome than males after revascularization, the long-term success of carotid endarterectomy may be different among the genders. The 10-year outcome after a saphenous vein-patch angioplasty in females was studied. Endarterectomies were performed on 708 carotid arteries of 615 patients, who had evidence of symptomatic disease or had asymptomatic greater than 80% stenosis. A segment of proximal greater saphenous vein was harvested for the patch. The 247 females had a mean age of 69.1 +/-9.8 (SD) years and a follow-up time of 4.0 +/-4.0 (SD) years. The 368 males had a mean age of 69.2 +/-8.8 (SD) years and a follow-up time of 4.4 +/-4.0 (SD) years. After endarterectomy, survival, the ipsilateral stroke-free rates and the restenosis-free rates were determined by life table analyses with 73 endarterectomies in 66 patients being at risk at 10 years. The 5- and 10-year survival rates in males were 81.9% and 62.2%, respectively. The 5- and 10-year survival rates in females were 82.6% and 73.0%, respectively. The 5- and 10-year ipsilateral stroke-free rates after carotid endarterectomy were 98.3% and 93.9% in males and 96.7% and 95.6% in females. The respective 5- and 10-year restenosis-free rates were 96.7% and 93.3% in males and 88.6% and 82.8% in females; p < 0.0002, by the Mantel-Cox test. Although survival and the incidence of an ipsilateral stroke were similar in females and males, the hemodynamic restenosis rate was higher in females. It is especially important to use routine duplex scanning to follow the post-endarterectomy health of the carotid artery in females.
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Affiliation(s)
- John B Chang
- Long Island Vascular Center, Roslyn, NY 11576, USA
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93
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Waddell TK, Dart AM, Gatzka CD, Cameron JD, Kingwell BA. Women exhibit a greater age-related increase in proximal aortic stiffness than men. J Hypertens 2001; 19:2205-12. [PMID: 11725165 DOI: 10.1097/00004872-200112000-00014] [Citation(s) in RCA: 155] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Large artery mechanical properties are a major determinant of pulse pressure and cardiovascular outcome. Sex differences in these properties may underlie the variation in cardiovascular risk profile between men and women, in relation to age. OBJECTIVE To investigate sex differences in the age-related stiffening of large arteries. DESIGN Cross-sectional. METHODS One hundred and twenty healthy men and women were recruited and divided equally into tertiles by age: young (mean +/- SD, 23 +/- 5 years), middle-age (47 +/- 3 years) and older (62 +/- 7 years). Lipids, mean arterial pressure and heart rate were matched within each tertile. Carotid tonometry and Doppler velocimetry were used to measure indices of large artery stiffness. RESULTS There was no sex difference in systemic arterial compliance (SAC) in the young group (mean +/- SEM, 0.61 +/- 0.05 arbitrary compliance units (ACU) in women compared with 0.67 +/- 0.04 ACU in men), but in the older population women had lower SAC than men (0.27 +/- 0.03 ACU compared with 0.57 +/- 0.04 ACU respectively; P < 0.001). Measures independent of aortic geometry (distensibility index and aortic impedance) indicated that stiffness was lower in young women than in men (P < 0.05), but the reverse was true in the older population (P < 0.01). This paralleled the brachial and carotid pulse pressures, which were lower in young (P < 0.01) and higher in older women compared with those in men (P < 0.05). Follicle stimulating hormone concentrations correlated strongly (r values 0.39-0.65) with all indices of central, but not peripheral, arterial function, whereas concentrations of luteinizing hormone, progesterone and oestradiol correlated less strongly. CONCLUSIONS In men and women matched for mean pressures, the age-related stiffening of large arteries is more pronounced in women, which is consistent with changes in female hormonal status.
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Affiliation(s)
- T K Waddell
- Alfred & Baker Medical Unit, Baker Medical Research Institute, Prahran, 3181 Victoria, Australia
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94
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Depairon M, Chessex S, Sudre P, Rodondi N, Doser N, Chave JP, Riesen W, Nicod P, Darioli R, Telenti A, Mooser V. Premature atherosclerosis in HIV-infected individuals--focus on protease inhibitor therapy. AIDS 2001; 15:329-34. [PMID: 11273212 DOI: 10.1097/00002030-200102160-00005] [Citation(s) in RCA: 203] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Lipid disorders associated with the use of protease inhibitors may contribute to the premature development of atherosclerosis. The purpose of the present study was to determine whether the administration of a protease inhibitor-containing regimen to middle-aged (30-50 years) HIV-infected individuals for 6 months or longer is associated with an increased prevalence of atherosclerosis. METHODS High-resolution B-mode ultrasound imaging was used to visualize the femoral and carotid arteries of 68 HIV-negative and 168 HIV-infected individuals, including 136 patients who had received protease inhibitors for 26.8 +/- 8.9 months (mean +/- SD). Atherogenic plaques were defined as a thickening of the intima-media > or = 1200 mm. RESULTS The proportion of participants with one or more plaques was higher in the HIV-infected group in comparison with the HIV-negative group (55 versus 38%; P = 0.02), and so was the prevalence of cigarette smoking (61 versus 46%; P = 0.03) and hyperlipidaemia (56 versus 24%; P < 0.001). The presence of plaque was independently associated with age, male gender, plasma low-density lipoprotein cholesterol levels and smoking. In univariate logistic regression analysis, an association was also found with HIV infection. Among HIV-infected subjects protease inhibitor therapy was not associated with the presence of plaque. CONCLUSIONS A large proportion of the middle-aged HIV-infected individuals examined during this study had one or more atherosclerotic plaques within the femoral or carotid arteries. The presence of peripheral atherosclerosis within this population is not associated with the use of protease inhibitors, but rather with 'classic' cardiovascular risk factors such as smoking and hyperlipidaemia, which are amenable to interventions.
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Affiliation(s)
- M Depairon
- Division of Hypertension and Vascular Medicine, CHUV University Hospital, Lausanne, Switzerland
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95
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Kuller LH, Matthews KA, Meilahn EN. Estrogens and women's health: interrelation of coronary heart disease, breast cancer and osteoporosis. J Steroid Biochem Mol Biol 2000; 74:297-309. [PMID: 11162938 DOI: 10.1016/s0960-0760(00)00106-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The determinants of blood levels of estrogen, estrogen metabolites, and relation to receptors and post-transitional effects are the likely primary cause of breast cancer. Very high risk women for breast cancer can now be identified by measuring bone mineral density and hormone levels. These high risk women have rates of breast cancer similar to risk of myocardial infarction. They are candidates for SERM therapies to reduce risk of breast cancer. The completion of the Women's Health Initiative and other such trials will likely provide a definite association of risk and benefit of both estrogen alone and estrogen-progesterone therapy, coronary heart disease, osteoporotic fracture, and breast cancer. The potential intervention of hormone replacement therapy, obesity, or weight gain and increased atherogenic lipoproteinemia may be of concern and confound the results of clinical trials. Estrogens, clearly, are important in the risk of bone loss and osteoporotic fracture. Obesity is the primary determinant of postmenopausal estrogen levels and reduced risk of fracture. Weight reduction may increase rates of bone loss and fracture. Clinical trials that evaluate weight loss should monitor effects on bone. The beneficial addition of increased physical activity, higher dose of calcium or vitamin D, or use of bone reabsorption drugs in coordination with weight loss should be evaluated. Any therapy that raises blood estrogen or metabolite activity and decreases bone loss may increase risk of breast cancer. Future clinical trials must evaluate multiple endpoints such as CHD, osteoporosis, and breast cancer within the study. The use of surrogate markers such as bone mineral density, coronary calcium, carotid intimal medial thickness and plaque, endothelial function, breast density, hormone levels and metabolites could enhance the evaluation of risk factors, genetic-environmental intervention, and new therapies.
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Affiliation(s)
- L H Kuller
- Department of Epidemiology, GSPH, University of Pittsburgh, 130 DeSoto Street, 15261, Pittsburgh, PA, USA.
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