Biomarkers Related to Carotid Intima-Media Thickness and Plaques in Long-Term Survivors of Ischemic Stroke

Sevoflurane: an opportunity for stroke treatment

In developed countries, stroke is the leading cause of death and disability that affects long-term quality of life and its incidence is increasing. The incidence of ischemic stroke is much higher than that of hemorrhagic stroke. Ischemic stroke often leads to very serious neurological sequelae, which severely reduces the patients' quality of life and becomes a social burden. Therefore, ischemic stroke has received increasing attention. As a new type of anesthetic, sevoflurane has a lower solubility, works faster in the human body, and has less impact on the cardiovascular system than isoflurane. At the same time, studies have shown that preconditioning and postconditioning with sevoflurane have a beneficial effect on stroke. We believe that the role of sevoflurane in stroke may be a key area for future research. Therefore, this review mainly summarizes the relevant mechanisms of sevoflurane preconditioning and postconditioning in stroke in the past 20 years, revealing the bright prospects of sevoflurane in stroke treatment.

IL-17A-Mediated Excessive Autophagy Aggravated Neuronal Ischemic Injuries via Src-PP2B-mTOR Pathway

We previously reported that astrocyte-derived proinflammatory cytokine interleukin (IL)-17A could aggravate neuronal ischemic injuries and strength autophagy both in oxygen-glucose deprivation (OGD)/reoxygenation (R)-treated neurons and peri-infarct region of mice with middle cerebral artery occlusion (MCAO)/reperfusion (R)-simulated ischemic stroke. In this study, the role and molecular mechanism of IL-17A in autophagy were further explored under ischemic condition. We found that exogenous addition of rmIL-17A remarkably (P < 0.001) decreased cell viability, which companying with the increases of LC3 II accumulation (P < 0.05 or 0.01) and Beclin 1 levels (P < 0.05 or 0.001), and reduction of p62 levels (P < 0.01 or 0.001) in OGD/R-treated cortical neurons (n = 6). The levels of P-mTOR (Ser 2448) (P < 0.001) and P-S6 (Ser 240/244) (P < 0.01) significantly decreased without the involvement of Akt, ERK1/2 and AMPK in cortical neurons under rmIL-17A and OGD/R treatments (n = 6). Interestingly, the co-IP analysis exhibited that PP2B and mTOR could be reciprocally immunoprecipitated; and the addition of rmIL-17A increased their interactions, PP2B activities (P < 0.001), P-Src (P < 0.001), and P-PLCγ1 (P < 0.01) levels in OGD/R-treated neurons (n = 6 or 5). The PP2B inhibitor Cyclosporin A blocked the induction of excessive autophagy (P < 0.05 or <0.001) and increased cell viability (P < 0.001) after OGD/R and rmIL-17A treatments (n = 6). In addition, the ICV injection of IL-17A neutralizing mAb could attenuate autophagy levels (P < 0.01 or 0.001, n = 6) and improve neurological functions (P < 0.01 or 0.001, n = 10) of mice after 1 h MCAO/R 24 h or 7 d. These results suggested that IL-17A-mediated excessive autophagy aggravates neuronal ischemic injuries via Src-PP2B-mTOR pathway, and IL-17A neutralization may provide a potential therapeutic effect for ischemic stroke.

Relationship between glycated hemoglobin and low Ankle-Brachial Index: a cross-sectional observational study from the Beijing Vascular Disease Evaluation Study (BEST Study)

BACKGROUND

Studies have confirmed that the low Ankle Brachial Index (ABI) and high glycated hemoglobin (HbA1c) level were both risk factors of cardiovascular disease (CVD). However, the association has rarely been explored between ABI and HbA1c. This study was to evaluate the independent relationship between HbA1c and low ABI.

METHODS

A total of 3102 subjects (male 1539, female 1563, aged 67.72±10.69 years) were enrolled into the study from 2010 to 2018. The odds ratio (OR) and linear regression coefficient of low ABI group (defined as ABI≤0.9) and ABI value in associations with the HbA1c were modelled using multivariable logistic and linear regression analyses by adjusting for possible confounders.

RESULTS

Compared with participants with normal ABI, those presenting the low ABI showed a significantly older age, smoking rate, higher level of heart rate (HR), systolic blood pressure (SBP), pulse pressure (PP), fasting plasma glucose (FPG), triglyceride (TG), highly sensitive C-reactive protein (hs-CRP), HbA1c and carotid femoral pulse wave velocity (CF-PWV); and higher prevalence rate of hypertension, diabetes, coronary artery disease (CAD); and higher rate on medication of statins, diabetes drug and cardiovascular drug (all P<0.001). After multiple adjustment for age, sex, smoke, FPG, blood lipids, hs-CRP, SBP, diastolic blood pressure (DBP), PP, CF-PWV, hypertension, diabetes, CAD and medications, the OR of HbA1c for low ABI was of statistical significance (95% CI: 1.204-1.410, P<0.001). After further multivariate adjustment analysis by linear regression, with left and right ABI as dependent variables, the results showed that HbA1c was independently linearly correlated to left and right ABI (all P<0.001).

CONCLUSIONS

HbA1c was an independent associated factor of lower ABI and linearly correlated to ABI level independent of fasting plasma glucose and other cardiovascular factors. We should not only focus on the HbA1c in diabetes mellitus patients, but also people with lower ABI.

Correlation of Glycosylated Hemoglobin Levels with Histological and Ultrasound Characteristics of the Carotid Plaque in Diabetic and Nondiabetic Patients

BACKGROUND

The purpose of this study is to investigate the correlation of glycosylated hemoglobin (HbA1c) levels with histological characters of atherosclerotic plaque that makes it vulnerable, as well as ultrasound (US) criteria that can contribute to the prognosis of carotid disease.

MATERIAL AND METHODS

This is a single-center prospective study. Our study population consists of 74 diabetic and nondiabetic patients with carotid atherosclerosis who underwent carotid endarterectomy in our department. Patient categorization was based on the following criteria: levels of HbA1c, gender, and risk factors (smoking, hypertension), carotid stenosis rate, symptomatic or asymptomatic carotid disease, histological examination of the atherosclerotic plaque, and US morphological criteria of the plaque.

RESULTS

The mean age of the patients was 68.2 years (standard deviation = 7.8); 58.1% were smokers, 71.6% had arterial hypertension, 37.8% had symptomatic carotid disease, and 64.9% had atherosclerotic plaque type 6. Futhermore, 95.9% of the patients had a carotid stenosis rate more than 70% and 4.1% had from 50% to 69%. Older patients had more frequent type 7 and 8 atherosclerotic plaque based on American Heart Association scoring system than younger patients (P = 0.041). The relative likelihood of atherosclerotic plaque type 7 and 8 was 1.12 times higher in older patients (Odds ratio [OR] = 1.12, P = 0.029). Patients with higher levels of HbA1cwere more likely to have type 6 atherosclerotic plaque than those with atherosclerotic lesions type 7 and 8 (P < 0.001). Specifically, increasing the level of HbA1c by 1 mg/dl increases the likelihood of the presence of vulnerable plaque by 2.55%. Moreover, the relative likelihood of a type 6 atherosclerotic plaque was 10.4 times higher in the older patients (OR = 10.4, P < 0.001).

CONCLUSIONS

This study demonstrates that levels of HbA1c and advanced age are 2 factors that may be correlated with the presence of vulnerable carotid plaques in diabetic population. Moreover, HbA1c is an independent factor that could possibly be used as a prognostic marker for carotid artery disease, although further studies are needed to explore this association to elucidate the precise role of HbA1c.

Ranking of stroke and cardiovascular risk factors for an optimal risk calculator design: Logistic regression approach

PURPOSE

Conventional cardiovascular risk factors (CCVRFs) and carotid ultrasound image-based phenotypes (CUSIP) are independently associated with long-term risk of cardiovascular (CV) disease. In this study, 26 cardiovascular risk (CVR) factors which consisted of a combination of CCVRFs and CUSIP together were ranked. Further, an optimal risk calculator using AtheroEdge composite risk score (AECRS1.0) was designed and benchmarked against seven conventional CV risk (CVR) calculators.

METHODS

Two types of ranking were performed: (i) ranking of 26 CVR factors and (ii) ranking of eight types of 10-year risk calculators. In the first case, multivariate logistic regression was used to compute the odds ratio (OR) and in the second, receiver operating characteristic curves were used to evaluate the performance of eight types of CVR calculators using SPSS23.0 and MEDCALC12.0 with validation against STATA15.0.

RESULTS

The left and right common carotid arteries (CCA) of 202 Japanese patients were examined to obtain 404 ultrasound scans. CUSIP ranked in the top 50% of the 26 covariates. Intima-media thickness variability (IMTV) and IMTV_10yr were the most influential carotid phenotypes for left CCA (OR = 250, P < 0.0001 and OR = 207, P < 0.0001 respectively) and right CCA (OR = 1614, P < 0.0001 and OR = 626, P < 0.0001 respectively). However, for the mean CCA, AECRS1.0 and AECRS1.0_10yr reported the most highly significant OR among all the CVR factors (OR = 1.073, P < 0.0001 and OR = 1.104, P < 0.0001). AECRS1.0_10yr also reported highest area-under-the-curve (AUC = 0.904, P < 0.0001) compared to seven types of conventional calculators. Age and glycated haemoglobin reported highest OR (1.96, P < 0.0001 and 1.05, P = 0.012) among all other CCVRFs.

CONCLUSION

AECRS1.0_10yr demonstrated the best performance due to presence of CUSIP and ranked at the first place with highest AUC.

Red blood cell distribution width and carotid intima-media thickness in patients with metabolic syndrome

Background

To evaluate the relationship between red blood cell distribution width (RDW) and carotid intima-media thickness (CIMT) in metabolic syndrome (MetS) patients.

Methods

In this study, we analyzed 803 patients with MetS who underwent carotid ultrasonography examination at Henan Province Hospital of Traditional Chinese Medicine from October 2014 to September 2015. Demographic data were collected using a questionnaire. An automatic biochemistry analyzer measured RDW. Pearson correlation coefficient, multivariate linear and logistic regression was used to evaluate the correlation between RDW and CIMT.

Results

Compared with control group, case group had higher RDW level (P < 0.001) and CIMT (P < 0.001). CIMT was positively related to RDW (r = 0.436, P < 0.001). Logistic regression indicated that RDW was a predictor of CIMT ≥ 1 mm. Compared with the first quartile, people with third and fourth quartile level gave obvious higher risk of carotid artery atherosclerotic trend (OR = 1.41, 95% CI:1.01–197; OR = 2.10, 95% CI: 1.30–3.40). Using a cutoff point of 13.9%, RDW predicts elevated CIMT with a sensitivity of 62.1% and a specificity of 70.3%.

Conclusion

High RDW is related to the increased CIMT in MetS patients, which highlights the role of RDW in the progression of elevated CIMT in MetS patients.

Paradigms and mechanisms of inhalational anesthetics mediated neuroprotection against cerebral ischemic stroke

Cerebral ischemic stroke is a leading cause of serious long-term disability and cognitive dysfunction. The high mortality and disability of cerebral ischemic stroke is urging the health providers, including anesthesiologists and other perioperative professioners, to seek effective protective strategies, which are extremely limited, especially for those perioperative patients. Intriguingly, several commonly used inhalational anesthetics are recently suggested to possess neuroprotective effects against cerebral ischemia. This review introduces multiple paradigms of inhalational anesthetic treatments that have been investigated in the setting of cerebral ischemia, such as preconditioning, proconditioning and postconditioning with a variety of inhalational anesthetics. The pleiotropic mechanisms underlying these inhalational anesthetics-afforded neuroprotection against stroke are also discussed in detail, including the common pathways shared by most of the inhalational anesthetic paradigms, such as anti-excitotoxicity, anti-apoptosis and anti-inflammation. There are also distinct mechanisms involved in specific paradigms, such as preserving blood brain barrier integrity, regulating cerebral blood flow and catecholamine release. The ready availability of these inhalational anesthetics bedside and renders them a potentially translatable stroke therapy attracting great efforts for understanding of the underlying mechanisms.

Prognostic value of hemoglobin A1c in nondiabetic and diabetic patients with acute ischemic stroke

Background: Diabetes is a well-known risk factor for acute ischemic stroke (AIS). Some recent studies point to hemoglobin A1c (HbA1c) may have prognostic value in nondiabetic and diabetic patients with ischemic stroke (IS). The aim of this study was to evaluate the prognostic value of HbA1c on mortality and morbidity in AIS patients with and without diabetic. Methods: In this prospective observational study, 150 diabetic and nondiabetic patients with AIS were evaluated for serum HbA1c level, hypertension (HTN), hyperlipidemia, and smoking in the first 24 hours of admission to determine their value to predict mortality and mortality at 30 and 90 days. Morbidity was estimated by the National Institutes of Health Stroke Scale (NIHSS) and follow-up visits were scheduled 30 and 90 days after admission. Results were analyzed with independent t-test and logistic regression analysis. Results: In this study, 73 patients (48.7%) were female and the rest were men. At 30 days, the diabetic patients had a significantly higher mortality, but no significant difference was found between diabetics and morbidity. No significant statistical differences were seen between HbA1c and 30 and 90 days with mortality and morbidity among diabetic patients. Furthermore, no significant statistical difference was seen between HbA1c and 30 and 90 days morbidity and between HbA1c and 30 days mortality in nondiabetic patients. However, in nondiabetic patients, on multiple logistic regression analysis, a significant correlation was seen between 90 days month mortality and HbA1c (P = 0.002). Conclusion: HbA1c can be as a predictive biomarker in nondiabetic patients with AIS.

Elevated hemoglobin A1c Is Associated with Carotid Plaque Vulnerability: Novel Findings from Magnetic Resonance Imaging Study in Hypertensive Stroke Patients

The association between hemoglobin A1c (HbA1c) level and carotid plaque vulnerability has been rarely studied by magnetic resonance imaging (MRI). The present study of MRI-identified carotid atherosclerotic lesions in hypertensive patients with acute stroke therefore sought to determine the associations between HbA1c level and plaque morphological and compositional characteristics and acute cerebral infarction (ACI) severity. Eighty hypertensive patients with acute stroke were enrolled; stratified into high (≥6.5%) and low (<6.5%) HbA1c groups; and underwent carotid and brain MRI to assess carotid plaque features and ACI volume in the region supplied by the internal carotid artery (ICA) in the symptomatic side. Plaque burden [percent wall volume (PWV), max wall thickness (max-WT)] and lipid-rich necrotic core (LRNC) were larger in the high as compared to the low HbA1c group. High HbA1c was an independent risk factor for the presence of plaque (odds ratio [OR] = 3.71) and LRNC plaque (OR = 7.08). HbA1c independently correlated with ACI severity among patients with ICA region cerebral infarction and carotid plaque. Our study suggested that an elevated HbA1c may have an adverse effect on carotid plaque vulnerability especially those with larger LRNC volumes in hypertensive stroke patients, which might exacerbate the severity of ACIs.

Carotid Plaque Characterization, Stenosis, and Intima-Media Thickness According to Age and Gender in a Large Registry Cohort

Carotid intima-media thickness (CIMT) is a well-established predictor of cardiovascular disease events. Not well described, however, is the prevalence of plaque and stenosis severity and how this varies according to extent of CIMT, age, and gender. We evaluated the extent of carotid plaque and stenosis severity according to CIMT, age, and gender in a large CIMT screening registry. We studied 9,347 women and 12,676 men (n = 22,023) who received carotid ultrasound scans. The presence and severity of both carotid plaque and stenosis was compared according to extent of CIMT (≥1 mm vs <1 mm), age, and gender using the chi-square test of proportions. Among those aged <45 to ≥80 years, the prevalence of CIMT ≥1 mm ranged from 0.13% to 29.3% in women and 0.6% to 40.1% in men, stenosis ≥50% from 0.1% to 14.9% in women and 0.1% to 13.2% in men, and mixed and/or soft plaque from 7.1% to 66.5% in women, and 9.2% to 65.8% in men (all p <0.001 across age groups). Even when CIMT levels were <1 mm, >30% of patients demonstrated mixed or soft plaque potentially prone to rupture. Of those with CIMT ≥1 mm, more than 70% had such mixed or soft plaque and more than 40% demonstrated stenoses of 30% or greater. In conclusion, we describe in a large CIMT registry study a substantial age-related increase in both men and women of increased CIMT, plaque presence, and severity, and stenosis. Even in those with normal CIMT, mixed or soft plaque was common, further demonstrating the value in assessing for plaque when doing carotid ultrasound.