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Khazaei M, Khosravi M, Mazaheri S, Mazdeh M, Ghiasian M, Taheri M, Ghafouri-Fard S. The effect of atorvastatin on the common carotid artery intima-media thickness in patients with ischemic stroke. Acta Clin Croat 2021; 59:223-226. [PMID: 33456108 PMCID: PMC7808223 DOI: 10.20471/acc.2020.59.02.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Occlusion of the initial segment of internal carotid artery is the most common reason for vascular events in the brain. The purpose of this study was to investigate the effect of one-year treatment with atorvastatin on intima-media thickness (IMT) of carotid arteries as a measure of atherosclerosis in stroke patients. In this prospective interventional study, 44 patients with ischemic stroke were investigated. Patients were treated with atorvastatin 40 mg once a day for one year. IMT of carotid arteries was measured by extracranial Doppler ultrasonography in the distal part of the common carotid artery at the beginning of the study, at 6 months and one year of treatment with atorvastatin. The IMT of both right and left carotid arteries decreased after 6- and 12-month atorvastatin treatment. Based on the results of this study, long-term administration of atorvastatin was associated with reduction in carotid artery IMT in patients with ischemic stroke. Such a decrease in IMT may prevent subsequent stroke or cardiovascular events in these patients.
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Affiliation(s)
| | - Mozhdeh Khosravi
- 1Neurophysiology Research Center, Hamadan University of Medical Sciences, Hamadan, Iran; 2Department of Neurology, Hamadan University of Medical Sciences, Hamadan, Iran; 3Urogenital Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 4Department of Medical Genetics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahir Mazaheri
- 1Neurophysiology Research Center, Hamadan University of Medical Sciences, Hamadan, Iran; 2Department of Neurology, Hamadan University of Medical Sciences, Hamadan, Iran; 3Urogenital Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 4Department of Medical Genetics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrdokht Mazdeh
- 1Neurophysiology Research Center, Hamadan University of Medical Sciences, Hamadan, Iran; 2Department of Neurology, Hamadan University of Medical Sciences, Hamadan, Iran; 3Urogenital Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 4Department of Medical Genetics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoud Ghiasian
- 1Neurophysiology Research Center, Hamadan University of Medical Sciences, Hamadan, Iran; 2Department of Neurology, Hamadan University of Medical Sciences, Hamadan, Iran; 3Urogenital Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 4Department of Medical Genetics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Taheri
- 1Neurophysiology Research Center, Hamadan University of Medical Sciences, Hamadan, Iran; 2Department of Neurology, Hamadan University of Medical Sciences, Hamadan, Iran; 3Urogenital Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 4Department of Medical Genetics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soudeh Ghafouri-Fard
- 1Neurophysiology Research Center, Hamadan University of Medical Sciences, Hamadan, Iran; 2Department of Neurology, Hamadan University of Medical Sciences, Hamadan, Iran; 3Urogenital Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 4Department of Medical Genetics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Khanna NN, Jamthikar AD, Araki T, Gupta D, Piga M, Saba L, Carcassi C, Nicolaides A, Laird JR, Suri HS, Gupta A, Mavrogeni S, Kitas GD, Suri JS. Nonlinear model for the carotid artery disease 10-year risk prediction by fusing conventional cardiovascular factors to carotid ultrasound image phenotypes: A Japanese diabetes cohort study. Echocardiography 2019; 36:345-361. [PMID: 30623485 DOI: 10.1111/echo.14242] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 12/04/2018] [Indexed: 12/11/2022] Open
Abstract
MOTIVATION This study presents a novel nonlinear model which can predict 10-year carotid ultrasound image-based phenotypes by fusing nine traditional cardiovascular risk factors (ethnicity, gender, age, artery type, body mass index, hemoglobin A1c, hypertension, low-density lipoprotein, and smoking) with five types of carotid automated image phenotypes (three types of carotid intima-media thickness (IMT), wall variability, and total plaque area). METHODOLOGY Two-step process was adapted: First, five baseline carotid image-based phenotypes were automatically measured using AtheroEdge™ (AtheroPoint™ , CA, USA) system by two operators (novice and experienced) and an expert. Second, based on the annual progression rates of cIMT due to nine traditional cardiovascular risk factors, a novel nonlinear model was adapted for 10-year predictions of carotid phenotypes. RESULTS Institute review board (IRB) approved 204 Japanese patients' left/right common carotid artery (407 ultrasound scans) was collected with a mean age of 69 ± 11 years. Age and hemoglobin were reported to have a high influence on the 10-year carotid phenotypes. Mean correlation coefficient (CC) between 10-year carotid image-based phenotype and age was improved by 39.35% in males and 25.38% in females. The area under the curves for the 10-year measurements of five phenotypes IMTave10yr , IMTmax10yr , IMTmin10yr , IMTV10yr , and TPA10yr were 0.96, 0.94, 0.90, 1.0, and 1.0. Inter-operator variability between two operators showed significant CC (P < 0.0001). CONCLUSIONS A nonlinear model was developed and validated by fusing nine conventional CV risk factors with current carotid image-based phenotypes for predicting the 10-year carotid ultrasound image-based phenotypes which may be used risk assessment.
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Affiliation(s)
- Narendra N Khanna
- Department of Cardiology, Indraprastha Apollo Hospitals, New Delhi, India
| | - Ankush D Jamthikar
- Department of Electronics and Communication Engineering, Visvesvaraya National Institute of Technology, Nagpur, India
| | - Tadashi Araki
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Deep Gupta
- Department of Electronics and Communication Engineering, Visvesvaraya National Institute of Technology, Nagpur, India
| | - Matteo Piga
- Department of Rheumatology, University Clinic and AOU of Cagliari, Cagliari, Italy
| | - Luca Saba
- Department of Radiology, University of Cagliari, Cagliari, Italy
| | - Carlo Carcassi
- Department of Genetics, University of Cagliari, Cagliari, Italy
| | - Andrew Nicolaides
- Department of Vascular Surgery, Imperial College, London, UK.,Vascular Diagnostic Center, University of Cyprus, Nicosia, Cyprus
| | - John R Laird
- Heart and Vascular Institute, Adventist Health St. Helena, St Helena, California
| | | | - Ajay Gupta
- Department of Radiology and Feil Family Brain and Mind Research Institute, Weill Cornell Medical Center, New York, New York
| | - Sophie Mavrogeni
- Cardiology Clinic, Onassis Cardiac Surgery Center, Athens, Greece
| | - George D Kitas
- Arthritis Research UK Centre for Epidemiology, Manchester University, Manchester, UK.,Director of Research & Development-Academic Affairs, Dudley Group NHS Foundation Trust, Dudley, UK
| | - Jasjit S Suri
- Stroke Monitoring and Diagnostic Division, AtheroPointTM, Roseville, California
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3
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Nezu T, Hosomi N, Aoki S, Suzuki N, Teshima T, Sugii H, Nagahama S, Kurose Y, Maruyama H, Matsumoto M. Effects of Cilnidipine, an L/N-Type Calcium Channel Blocker, on Carotid Atherosclerosis in Japanese Post-Stroke Hypertensive Patients: Results from the CA-ATTEND Study. J Atheroscler Thromb 2018; 25:490-504. [PMID: 29225324 PMCID: PMC6005225 DOI: 10.5551/jat.42101] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Aims: Although several antihypertensive agents reduced the carotid intima-media thickness (IMT), it remains unclear whether those agents affect the interadventitial diameter (IAD). We aimed to examine whether cilnidipine, an L/N-type calcium channel blocker, reduced the common carotid IMT or IAD in post-stroke hypertensive patients. Methods: The common carotid IMT and IAD were measured at the start of cilnidipine treatment and 12 months from that. The changes in the mean max-IMT or IAD between baseline and the 12-month follow-up were evaluated and compared between the thick group (max-IMT ≥ 1.1 mm) and the normal group (max-IMT < 1.1 mm). Results: A total of 603 post-stroke hypertensive subjects (mean age = 69.3 yr, 378 males) were included in the analysis. At baseline, IAD was increased stepwise according to the value of max-IMT (p for trend < 0.001). Among them, 326 subjects were followed up for 12 months. The mean max-IMT from baseline to 12 months did not change in the normal group (−0.01 mm, 95% confidence interval [CI] −0.03 to 0.01, n = 170), whereas a significant reduction was observed in the thick group (−0.09 mm, 95% CI −0.13 to −0.05, n = 156). The mean IAD was significantly reduced during the study period in the normal group (−0.14 mm, 95% CI −0.22 to −0.05) as well as in the thick group (−0.12 mm, 95% CI −0.21 to −0.03). Conclusions: Cilnidipine promoted the regression of common carotid IMT in post-stroke hypertensive patients, especially in the thick group. Cilnidipine also reduced the IAD in both normal and thick groups.
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Affiliation(s)
- Tomohisa Nezu
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Naohisa Hosomi
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Shiro Aoki
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences
| | | | - Tsukasa Teshima
- Post-Marketing Surveillance, Mochida Pharmaceutical Co., Ltd
| | - Hitoshi Sugii
- Post-Marketing Surveillance, Mochida Pharmaceutical Co., Ltd
| | | | - Yoshiki Kurose
- Post-Marketing Medical Research Department, EA Pharma Co., Ltd
| | - Hirofumi Maruyama
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Masayasu Matsumoto
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences.,Hoshigaoka Medical Center, Japan Community Healthcare Organization (JCHO)
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Yoon HJ, Kim KH, Park H, Cho JY, Hong YJ, Park HW, Kim JH, Ahn Y, Jeong MH, Cho JG, Park JC. Carotid plaque rather than intima-media thickness as a predictor of recurrent vascular events in patients with acute ischemic stroke. Cardiovasc Ultrasound 2017; 15:19. [PMID: 28738808 PMCID: PMC5525267 DOI: 10.1186/s12947-017-0110-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 07/13/2017] [Indexed: 11/13/2022] Open
Abstract
Background To investigate the impacts of carotid plaque and intima-media thickness (IMT) on future vascular events (VEs) in the patients with acute ischemic stroke. Methods A total of 479 consecutive Korean patients with acute ischemic stroke were divided into 2 groups according to development of VEs; VE group (65.4 ± 10.9 years) vs no VE group (62.8 ± 13.2 years). VEs were defined as the development of recurrent stroke, coronary events, peripheral arterial disease, and death. Clinical, laboratory, and imaging findings were compared between the groups. Results During 105.5 ± 29.0 months of follow up, VEs were developed in 142 patients (29.6%). In univariate analysis, VEs were significantly associated with age, gender, diabetes, renal function, lipid levels, left ventricular function, carotid plaque or IMT. In multivariate analysis, the presence of carotid plaque, diabetes, renal function and male gender were independent predictors of future VEs in the patients with ischemic stroke, but carotid IMT was not a predictor of future VEs. Event free survival was significantly lower in patients with carotid plaque than without carotid plaque on Kaplan-Meier analysis (log rank p < 0.001). Conclusion The present study demonstrated that diabetes, impaired renal function, male gender, and the presence of carotid plaque rather than IMT were independent predictors of future VEs in Korean patients with acute ischemic stroke. Active medical management and careful monitoring for the development of recurrent VEs are strongly recommended in patients with acute ischemic stroke and carotid plaque.
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Affiliation(s)
- Hyun Ju Yoon
- Department of Cardiovascular Medicine, Chonnam National University Hospital, 42 Jaebong-ro, Donggu, Gwangju, 501-757, South Korea.,Translational Research Center on Aging, Chonnam National University Hospital, 42 Jaebong-ro, Donggu, Gwangju, 501-757, South Korea
| | - Kye Hun Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, 42 Jaebong-ro, Donggu, Gwangju, 501-757, South Korea. .,Translational Research Center on Aging, Chonnam National University Hospital, 42 Jaebong-ro, Donggu, Gwangju, 501-757, South Korea.
| | - Hyukjin Park
- Department of Cardiovascular Medicine, Chonnam National University Hospital, 42 Jaebong-ro, Donggu, Gwangju, 501-757, South Korea
| | - Jae Yeong Cho
- Department of Cardiovascular Medicine, Chonnam National University Hospital, 42 Jaebong-ro, Donggu, Gwangju, 501-757, South Korea.,Translational Research Center on Aging, Chonnam National University Hospital, 42 Jaebong-ro, Donggu, Gwangju, 501-757, South Korea
| | - Young Joon Hong
- Department of Cardiovascular Medicine, Chonnam National University Hospital, 42 Jaebong-ro, Donggu, Gwangju, 501-757, South Korea
| | - Hyung Wook Park
- Department of Cardiovascular Medicine, Chonnam National University Hospital, 42 Jaebong-ro, Donggu, Gwangju, 501-757, South Korea
| | - Ju Han Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, 42 Jaebong-ro, Donggu, Gwangju, 501-757, South Korea
| | - Youngkeun Ahn
- Department of Cardiovascular Medicine, Chonnam National University Hospital, 42 Jaebong-ro, Donggu, Gwangju, 501-757, South Korea
| | - Myung Ho Jeong
- Department of Cardiovascular Medicine, Chonnam National University Hospital, 42 Jaebong-ro, Donggu, Gwangju, 501-757, South Korea
| | - Jeong Gwan Cho
- Department of Cardiovascular Medicine, Chonnam National University Hospital, 42 Jaebong-ro, Donggu, Gwangju, 501-757, South Korea.,Translational Research Center on Aging, Chonnam National University Hospital, 42 Jaebong-ro, Donggu, Gwangju, 501-757, South Korea
| | - Jong Chun Park
- Department of Cardiovascular Medicine, Chonnam National University Hospital, 42 Jaebong-ro, Donggu, Gwangju, 501-757, South Korea.,Translational Research Center on Aging, Chonnam National University Hospital, 42 Jaebong-ro, Donggu, Gwangju, 501-757, South Korea
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5
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Ren L, Cai J, Liang J, Li W, Sun Z. Impact of Cardiovascular Risk Factors on Carotid Intima-Media Thickness and Degree of Severity: A Cross-Sectional Study. PLoS One 2015; 10:e0144182. [PMID: 26636669 PMCID: PMC4670208 DOI: 10.1371/journal.pone.0144182] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 11/13/2015] [Indexed: 12/28/2022] Open
Abstract
Objective Age, hypertension, dyslipidemia and diabetes are common cardiovascular risk factors (CVRFs) that contribute to the development of atherosclerosis in cardiovascular system including carotid artery disease. However, the impact of these risk factors on the increased carotid intima-media thickness (cIMT) and degree of carotid severity remains to be further clarified. This study aims to evaluate the relationship between CVRFs and degree of carotid severity and cIMT in high-risk subjects. Methods Four thousand and three hundred ninety-four subjects with one or more risk factors were retrospectively reviewed in this study. Patients were divided into different groups based on age, the type and quantity of CVRFs. cIMT and degree of carotid artery stenosis were measured and analyzed based on carotid ultrasound imaging with findings compared to the CVRFs to determine the correlation between these variables. Results Aging was significantly associated with degree of severity (P < 0.05) and cIMT was significantly increased with age (P < 0.05). Individual CVRF analysis shows that hypertension was more related to the degree of severity than dyslipidemia and diabetes with corresponding abnormal cIMT rates being 79.39%, 72.98% and 32.37%, respectively. The prevalence of carotid atherosclerosis were 20.06%, 22.88% and 28.63%, respectively corresponding to patients with zero, one and more than one chronic diseases. The percentage of abnormal cIMT in hypertensive patient group with dyslipidemia is significantly higher than the other groups (P< 0.05). Conclusions This study shows a direct correlation between the degree of carotid severity and cIMT and cardiovascular risk factors, especially with age and hypertension. Carotid atherosclerosis is closely related to the number of cardiovascular risk factors.
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Affiliation(s)
- Lijie Ren
- Departments of Shenzhen Second People′s Hospital, clinical medicine college of Anhui Medical University, Shenzhen, Guangdong Province, China
- Department of neurology, Shenzhen Second People's Hospital, Shenzhen, Guangdong Province, China
| | - Jingjing Cai
- Departments of Shenzhen Second People′s Hospital, clinical medicine college of Anhui Medical University, Shenzhen, Guangdong Province, China
- Department of neurology, Shenzhen Second People's Hospital, Shenzhen, Guangdong Province, China
| | - Jie Liang
- Department of neurology, Shenzhen Second People's Hospital, Shenzhen, Guangdong Province, China
- Departments of Shenzhen Second People′s Hospital, clinical medicine college of Guangzhou Medical University, Shenzhen, Guangdong Province, China
| | - Weiping Li
- Department of neurosurgery, Shenzhen Second People's Hospital, Shenzhen, Guangdong Province, China
- * E-mail:
| | - Zhonghua Sun
- Department of Medical Radiation Sciences, Curtin University, Perth, Western Australia, Australia
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Serena J, Segura T, Roquer J, García-Gil M, Castillo J. The ARTICO study: identification of patients at high risk of vascular recurrence after a first non-cardioembolic stroke. BMC Neurol 2015; 15:28. [PMID: 25884666 PMCID: PMC4369369 DOI: 10.1186/s12883-015-0278-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 02/20/2015] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND About 20% of patients with a first ischaemic stroke will experience a new vascular event within the first year. The atherosclerotic burden, an indicator of the extension of atherosclerosis in a patient, has been associated with the risk of new cardiovascular events in the general population. However, no predictive models reliably identify groups at a high risk of recurrence. The ARTICO study prospectively analysed the predictive value for the risk of recurrence of specific atherosclerotic markers. METHODS The multicentre ARTICO study included 620 consecutive independent patients older than 60 years suffering from a first non-cardioembolic stroke. We analysed classical stroke risk factors; duplex study of supraaortic trunk including intima-media thickness (IMT) measurement; quantification of internal carotid (ICA) stenosis; number, morphology and surface characteristics of carotid plaques; ankle brachial index (ABI); and the presence of microalbuminuria. Patients were followed up at 6 and 12 months after inclusion. The primary end-point was death or major cardiovascular events. RESULTS Any vascular event or death at 12 months occurred in 78 (13.8%) patients. In 40 (7.1%) of these the vascular event was a stroke recurrence. Weight, history of diabetes mellitus, history of symptomatic PAD, ABI <0.9 and significant ICA stenosis (>50%) were associated with a higher risk of vascular events on follow-up in the bivariate analysis. In the final Cox regression analysis, body mass index (BMI), systolic blood pressure, history of diabetes mellitus, symptomatic PAD (HR, 2.76; 95% CI, 1.10-6.95; p=0.03), and particularly patients with both ICA stenosis >50% and PAD (HR 4.52; 95% CI, 2.14-9.53; p<0.001) were independently associated with an increased risk of vascular events. Neither isolated ICA stenosis >50% nor isolated abnormal ABI remained associated with an increased risk of recurrence in comparison with the whole population. CONCLUSIONS Symptomatic PAD identifies a high risk group of vascular recurrence after a first non-cardioembolic stroke. The associated increased risk was particularly high in patients with both ICA stenosis and either symptomatic or asymptomatic PAD. Neither asymptomatic PAD alone nor isolated ICA stenosis >50% were associated with an increased risk of recurrence in this particularly high-risk group of non-cardioembolic stroke.
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Affiliation(s)
- Joaquín Serena
- Department of Neurology, Hospital Universitario Dr. Josep Trueta, IdIBGi (Institut d'Investigació Biomèdica de Girona), 17007, Girona, Spain.
| | - Tomás Segura
- Department of Neurology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain.
| | - Jaume Roquer
- Department of Neurology, Hospital Universitari del Mar, Barcelona, Spain.
| | - María García-Gil
- Institut d'Investigació en Atenció Primària (IDIAP Jordi Gol), Girona, Spain.
| | - José Castillo
- Department of Neurology, Hospital Clínico Universitario, University of Santiago de Compostela, Santiago de Compostela, Spain.
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Keo HH, Baumgartner I, Hirsch AT, Duval S, Steg PG, Pasquet B, Bhatt DL, Roether J. Carotid plaque and intima-media thickness and the incidence of ischemic events in patients with atherosclerotic vascular disease. Vasc Med 2011; 16:323-30. [DOI: 10.1177/1358863x11419997] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We aimed to evaluate whether carotid intima-media thickness (CIMT) or the presence of plaque can confer additional predictive value of future cardiovascular (CV) ischemic events in patients with pre-existing atherosclerotic vascular disease. We identified 2317 patients enrolled in the REduction of Atherothrombosis for Continued Health (REACH) registry who had atherosclerotic vascular disease and baseline CIMT measurements. The entire range of CIMT was divided into quartiles and the fourth quartile (≥ 1.5 mm) was defined as carotid plaque. Mean ± standard deviation baseline CIMT was 1.31 ± 0.65 mm. Associated CV ischemic events and vascular-related hospitalizations were evaluated over a 2-year follow-up. There was a positive increase in adjusted hazard ratios (HRs) for all-cause mortality ( p = 0.04 for trend) and the quadruple endpoint (CV death, myocardial infarction (MI), stroke, hospitalization for CV events) with increasing quartiles of CIMT ( p = 0.0008 for trend), which was mainly driven by the fourth quartile (carotid plaque). HRs for all-cause mortality, CV death, CV death/MI/stroke and the quadruple endpoint comparing the highest (carotid plaque) with the lowest CIMT quartile were 2.09 (95% CI, 1.07–4.10; p = 0.03); 2.49 (1.10–5.67; p = 0.03); 1.71 (1.10–2.67; p = 0.02); and 1.73 (1.31–2.27; p = 0.0001). In conclusion, our analyses suggest that the presence of carotid plaque, rather than the thickness of intima-media, appears to be associated with increased risk of CV morbidity and mortality, but confirmation of these findings in other population and prospective studies is required.
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Affiliation(s)
- Hong H Keo
- Swiss Cardiovascular Center, Division of Angiology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Iris Baumgartner
- Swiss Cardiovascular Center, Division of Angiology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Alan T Hirsch
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Sue Duval
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Ph Gabriel Steg
- INSERM U-698, Paris, France; Université Paris 7, Paris, France; Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Blandine Pasquet
- Département d’Epidemiologie, Biostatistique et Recherche Clinique, AP-HP, Centre Hospitalier Bichat-Claude Bernard, Paris, France
| | - Deepak L Bhatt
- VA Boston Healthcare System, Brigham and Women’s Hospital, and Harvard Medical School, Boston, MA, USA
| | - Joachim Roether
- Department of Neurology, Asklepios Klinik Altona, Hamburg, Germany
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8
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Roquer J, Segura T, Serena J, Cuadrado-Godia E, Blanco M, García-García J, Castillo J. Value of carotid intima-media thickness and significant carotid stenosis as markers of stroke recurrence. Stroke 2011; 42:3099-104. [PMID: 21852617 DOI: 10.1161/strokeaha.110.612010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Data on the predictive value of carotid intima-media thickness (IMT) for stroke recurrence are scarce. We sought to analyze outcome differences in stroke patients with high IMT values compared with patients with significant carotid stenosis (SCS). METHODS The multicenter observational ARTICO study included 620 independent patients older than 60 years with a first-ever noncardioembolic stroke. Patients were followed-up for 1 year. The primary end point was a composite of cardiovascular events and death. The IMT-ARTICO substudy analyzed ultrasonographic data from 599 patients. After Doppler carotid echography, patients were classified into the SCS group (carotid stenosis ≥50%; 117 cases), high IMT group (patients with the common carotid IMT in the highest quartile ≥1.11 mm and without SCS; 110 cases), and control group (stroke patients with an IMT <1.11 mm and without SCS; 372 cases). We analyzed the impact of both conditions on the primary end point. RESULTS During follow-up, 88 patients (14.7%) had an end point event. Univariate analysis showed that male gender, diabetes, symptomatic peripheral arterial disease, ankle brachial index ≤0.9, SCS, and high IMT were related to the primary end point. Cox regression showed that peripheral arterial disease (hazard ratio [HR], 2.06; 95% confidence interval [CI], 1.18-3.59; P=0.011), SCS (HR, 3.02; 95% CI, 1.78-5.13; P=0.0001), and high IMT (HR, 1.86; 95% CI, 1.05-3.29; P=0.032) were related to the primary end point. If patients with scheduled revascularization procedures were excluded from the Cox regression, then ultrasonographic markers were SCS (HR, 1.84; 95% CI, 1.03-3.28; P<0.039) and high IMT (HR, 1.86; 95% CI, 1.06-3.27; P=0.030). CONCLUSIONS Both SCS and high IMT have an independent impact as markers of major cardiovascular events or death after a first-ever noncardioembolic stroke.
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Affiliation(s)
- Jaume Roquer
- Neurology Department, Hospital Universitari del Mar, Passeig Marítim 25-29, 0003 Barcelona, Spain.
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Saba L, Pascalis L, Sanfilippo R, Anzidei M, Bura R, Montisci R, Mallarini G. Carotid artery wall thickness and leukoaraiosis: preliminary results using multidetector row CT angiography. AJNR Am J Neuroradiol 2011; 32:955-61. [PMID: 21349963 DOI: 10.3174/ajnr.a2396] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE LA is a condition caused by chronic cerebral ischemia and it represents an independent risk for stroke. The purpose of this work was to determine whether CAWT studied by using MDCTA is correlated with LA and its severity. MATERIALS AND METHODS Ninety-eight patients ≥60 years of age were retrospectively studied by using multidetector row CT. Supra-aortic vessel analysis and brain CT were performed in the same procedure. In each patient, CAWT was measured with an internal digital caliper, and the presence and severity of LA were assessed. Correlation coefficients by using Spearman statistics and ROC curves were calculated. A P value < .05 was considered statistically significant. RESULTS Measurements of the distal common CAWT ranged from 0.5 to 1.53 mm. A correlation between LA and increased CAWT was observed (Pearson correlation, 0.33; P < .001). On the basis of a threshold of 0.9 mm, an important statistical association between increased CAWT and LA (P < .0001) was found. With the same threshold, ROC curve analysis indicated a sensitivity of 55% and a specificity of 75% for LA. CONCLUSIONS The results of this study show a statistically significant correlation between increased CAWT and LA (and its severity).
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Affiliation(s)
- L Saba
- Department of Radiology, Azienda Ospedaliero Universitaria Cagliari, Italy.
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Cardiovascular reactivity to psychological stress and carotid intima-media thickness in children. Psychophysiology 2009; 46:293-9. [DOI: 10.1111/j.1469-8986.2008.00776.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Talelli P, Greenwood RJ. Review: Recurrent stroke: where do we stand with the secondary prevention of noncardioembolic ischaemic strokes? Ther Adv Cardiovasc Dis 2008; 2:387-405. [DOI: 10.1177/1753944708093411] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Strokes recur in 6—20% of the patients, most commonly within the first year; after a TIA or minor stroke; most recurrences will occur within the first 90 days. Our ability to identify patients at high risk is poor and most recurrent strokes cannot be explained by traditional risk factors. In 30—45% of the cases the second stroke will be of a different subtype. Moreover, patients are faced with other risks, like cardiac events and cognitive decline. With the population aging, the need for timely and effective secondary prevention strategies is more pressing than ever. This paper summarizes recent advances in pharmacological secondary prevention after a non-cardioembolic ischaemic stroke, and highlights critical questions still in need of answers.
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Affiliation(s)
- Penelope Talelli
- Institute of Neurology, Sobell Department of Motor Neuroscience and Movement Disorders, University College London (UCL), Queen SQ, Box 146, London WC1N 3BG, UK,
| | - Richard J. Greenwood
- National Hospital for Neurology and Neurosurgery, University College London Hospitals, Queen Sq, London WC1N 3BG, United Kingdom
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Ward RP, Lammertin G, Virnich DE, Polonsky TS, Lang RM. Use of carotid intima-media thickness to identify patients with ischemic stroke and transient ischemic attack with low yield of cardiovascular sources of embolus on transesophageal echocardiography. Stroke 2008; 39:2969-74. [PMID: 18723422 DOI: 10.1161/strokeaha.108.519181] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Carotid intima-media thickness (CIMT) is associated with systemic atherosclerosis and cardioembolic conditions and predicts the risk of recurrent strokes. We sought to establish the relationship between CIMT and cardiovascular sources of embolus (CSE) on transesophageal echocardiography (TEE) and hypothesized that a noninvasive strategy of CIMT assessment and transthoracic echocardiography bubble study would identify patients with ischemic stroke or transient ischemic attack in whom TEE would provide little incremental diagnostic yield. METHODS In 180 patients with ischemic stroke or transient ischemic attack of undetermined origin referred for TEE, we prospectively performed CIMT measurement/plaque screen (Phase 1, n=96) or CIMT measurement/plaque screen and transthoracic echocardiography bubble study (Phase 2, n=84) before TEE. Phase 1 results were used to construct receiver operating characteristic curves to demonstrate the ability of CIMT to detect CSE on TEE and to identify the optimal CIMT cutoff value for prospective strategy testing (Phase 2). RESULTS In Phase 1, CIMT was found to correlate with TEE markers of aortic atherosclerosis, including complex aortic plaques, and combined CSE. The optimal CIMT cutoff for detection of CSE on TEE was 0.78 mm. In Phase 2, a positive noninvasive strategy test (CIMT >or=0.78 mm, +carotid plaque, and/or a positive transthoracic echocardiography bubble study) was present in 61%. The prevalence of CSE on TEE was significantly higher among those with a positive compared with a negative noninvasive strategy test (65% versus 9%, P<0.001), and this strategy had a sensitivity of 92% and a negative predictive value of 91% for the detection of any CSE on TEE. CONCLUSIONS In patients with stroke or transient ischemic attack of undetermined origin, a noninvasive strategy of CIMT assessment/plaque screen and transthoracic echocardiography bubble study can identify patients in whom further invasive evaluation with TEE will be of low diagnostic yield.
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Affiliation(s)
- R Parker Ward
- Non-Invasive Imaging Laboratories, Section of Cardiology, Department of Medicine, University of Chicago, Chicago, IL 60637, USA.
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Talelli P, Ellul J. Common carotid artery intima-media thickness: towards a definition of abnormal values in symptomatic cerebrovascular disease. Stroke 2006; 37:2655; author reply 2656. [PMID: 16990580 DOI: 10.1161/01.str.0000244822.21865.b4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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