Analysis of femoral artery intima-media thickness during the cardiac cycle

Femoral Intima-media Thickness, Risk Factors, and Markers of Inflammation in Cardiovascular Disease

Introduction: The burden of coronary artery disease (CAD) and peripheral vascular pathologies caused by atherosclerosis is constantly increasing. There is continuous research aiming to develop new methods that can evaluate the extent of atherosclerotic disease in different vascular beds, thus estimating global risk. Similar to carotid artery thickness, which is an established marker for increased cardiovascular risk and cerebrovascular disease, femoral intima-media thickness (f-IMT) may have the same role in case of peripheral arterial involvement. The aim of the study was determine whether f-IMT, determined at the level of the superficial femoral artery, is related to traditional risk factors, markers of peripheral vascular atherosclerosis and inflammation.

Material and methods: Forty-six patients with known cardiovascular disease were included in the study. Demographical data, cardiovascular history, and risk factors were assessed. We determined metabolic parameters (uric acid, fasting glucose, total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides), renal function (creatinine and GFR), and inflammation status for all patients. Each patient underwent ultrasound examination of the superficial femoral artery, by which f-IMT was determined for right and left limbs. Ankle-brachial index was also calculated. Data from the low (f-IMT <0.75 mm) and high (f-IMT >0.75 mm) f-IMT groups were compared and correlation coefficients were determined in each groups for f-IMT in relation to the other parameters.

Results: Mean age was 71.08 ± 9.78 years. 86.95% of the patients suffered from hyper-tension, 56.62% had coronary heart disease, and 21.73% had a history of stroke. More females had history of hypertension and CAD. The most prevalent cardiovascular risk factors were dyslipidemia (68.86%), diabetes (21.73%), and smoking (21.73%). There were significant differences between gender groups for total cholesterol levels (161.36 ± 25.04 mg/dL, 95%CI 150.26–172.47 in males vs. 201.33 ± 52.73 mg/dL, 95%CI 170.07–223.60 in females, p = 0.02), creatinine values (1.04 ± 0.22 mg/dL, 95%CI 0.94–1.14 for males vs. 0.91 ± 0.23 mg/dL, 95%CI 0.81–1.00 for females, p = 0.018), and left f-IMT (0.87 ± 0.18 mm, 95%CI 0.79–0.95 for males vs. 0.75 ± 0.10 mm, 95%CI 0.70–0.79 for females, p = 0.0049). In the group with low f-IMT, a significant, reverse correlation was established between f-IMT, uric acid (r = −0.483, p = 0.042), and right ABI (r = −730, p = 0.0006). In the group with high f-IMT, age (r = 0.408, p = 0.031), fasting glucose (r = 0.407, p = 0.034), total cholesterol (r = 0.429, p = 0.02), HDL-cholesterol (r = −0.56, p = 0.0019), triglycerides (r = 0.45, p = 0.01), hs-CRP (r = 0.45, p = 0.01), and left ABI (r = −0.71, p <0.0001) showed a significant correlation to f-IMT.

Conclusions: Increased femoral intima-media thickness is related to age, cardiovascular risk factors, and markers of peripheral arterial disease. Patients with higher f-IMT have a more augmented inflammatory status. Based on these correlations, in patients with cardiovascular disease, f-IMT could become a marker for increased cardiovascular risk.