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Altamura C, Viticchi G, Rizzo AC, Maggio P, Brunelli N, Marcosano M, Lazzaro VD, Fiacco F, Agostoni EC, Silvestrini M, Vernieri F. Stroke territory and atherosclerosis in ischemic stroke patients with a history of migraine with aura. Front Neurol 2023; 14:1142424. [PMID: 36923493 PMCID: PMC10008946 DOI: 10.3389/fneur.2023.1142424] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 02/02/2023] [Indexed: 03/01/2023] Open
Abstract
Introduction The mechanisms subtending the increased stroke risk in migraine with aura (MA) are not fully understood. Our study aims to evaluate if the clinical profile in stroke patients with MA differentiates from those without MA. Methods We retrieved the prospective registered electronic clinical dossiers of adult patients younger than 60 years with acute ischemic stroke admitted in four hospitals between January 2016 and June 2022. Patients were classified by the history of MA (MA+ and MA-). Results We identified 851 stroke patients (59 MA+, 6.9%). Compared to MA-, MA+ patients were characterized by younger age (44.0 ± 10.6 vs 50.1 ± 8.2 years), female sex (59.3% vs 29.0%), and affected by cryptogenic (OR 2.594 95% CI 1.483-4.537), and cerebellar stroke (OR 3.218 95% CI 1.657-6.250; p ≤ 0.001 for all comparisons). After adjusting for age and sex, MA+ patients presented less frequently hypertension (OR 0.349 95% CI 0.167-0.470; p=0.005) and dyslipidemia (OR 0.523 95% CI 0.280-0.974; p = 0.041). After adjusting also for risk factors, the MA+ group had less frequently symptomatic large vessel stenosis (OR 0.126 95% CI 0.017-0,924; p = 0.042) and clinical atherosclerosis (OR 0.103 95% CI 0.014-0.761; p = 0.026), while intima-media thickness did not differ (p = 0.395). Discussion Cryptogenic and cerebellar stroke and fewer vascular risk factors and clinical atherosclerosis seem to characterize stroke patients with MA.
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Affiliation(s)
- Claudia Altamura
- Department of Medicine and Surgery, Unit of Headache and Neurosonology, Università Campus Bio-Medico di Roma, Roma, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
- *Correspondence: Claudia Altamura ✉
| | | | - Angelo Cascio Rizzo
- Neurology and Stroke Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Paola Maggio
- Neurology Unit, ASST Bergamo Est, Seriate, Italy
| | - Nicoletta Brunelli
- Department of Medicine and Surgery, Unit of Headache and Neurosonology, Università Campus Bio-Medico di Roma, Roma, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Marilena Marcosano
- Department of Medicine and Surgery, Unit of Headache and Neurosonology, Università Campus Bio-Medico di Roma, Roma, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Vincenzo Di Lazzaro
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology, and Psychiatry, Università Campus Bio-Medico di Roma, Roma, Italy
| | | | | | | | - Fabrizio Vernieri
- Department of Medicine and Surgery, Unit of Headache and Neurosonology, Università Campus Bio-Medico di Roma, Roma, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
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2
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Cheng Q, Zhou D, Wang J, Nie Z, Feng X, Huang Y, Liang Q, Feng Y. Sex-specific risk factors of carotid atherosclerosis progression in a high-risk population of cardiovascular disease. Clin Cardiol 2022; 46:22-31. [PMID: 36229937 PMCID: PMC9849433 DOI: 10.1002/clc.23931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/16/2022] [Accepted: 09/20/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The progression of carotid intima-media thickness (cIMT) and plaques are associated with cardiovascular health, especially for high-risk population of cardiovascular disease (CVD). HYPOTHESIS Risk factors for atherosclerosis may vary by sex. This study aimed to investigate the sex-specific risk factors of cIMT and plaque progression. METHODS We selected subjects who were identified as high-risk population of CVD, and collected their carotid ultrasound data and baseline characteristics. Linear regression and logistic regression analyses were used to identify risk factors for cIMT and plaque progression. Sex-specific risk factors were identified respectively. RESULTS A total of 7908 participants were included. The mean age was 57.75 ± 9.45 years and 61.51% were female. During mean follow-up of 1.92 ± 0.89 years, the median annual cIMT change rate was -7.25 μm/year. Seven hundred and fifteen subjects free from plaques at baseline developed plaque. Age, smoking, hypertension, and diabetes were common risk factors for carotid atherosclerosis progression in all participants. Smoking and alcohol drinking were significantly associated with increased cIMT change in women, while hypertension and antihypertensive medication were significant in men. Increased total cholesterol and diabetes were significantly associated with new plaque presence in women, while smoking, increased triglyceride, and dyslipidemia were significant in men (p ˂ .05 for all cases). The association of baseline cIMT and smoking with annual cIMT change rate and increased total cholesterol with new plaque presence were significantly differentiated between both sexes (p for interaction ˂ .05). CONCLUSIONS The risk factors for cIMT and plaque progression differed by sex.
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Affiliation(s)
- Qi Cheng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina,Hypertension Research Laboratory, Guangdong Provincial Clinical Research Center for Cardiovascular Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina
| | - Dan Zhou
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina,Hypertension Research Laboratory, Guangdong Provincial Clinical Research Center for Cardiovascular Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina
| | - Jiabin Wang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina,Hypertension Research Laboratory, Guangdong Provincial Clinical Research Center for Cardiovascular Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina
| | - Zhiqiang Nie
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina,Hypertension Research Laboratory, Guangdong Provincial Clinical Research Center for Cardiovascular Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina
| | - Xiaoxuan Feng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina,Hypertension Research Laboratory, Guangdong Provincial Clinical Research Center for Cardiovascular Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina
| | - Yuqing Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina,Hypertension Research Laboratory, Guangdong Provincial Clinical Research Center for Cardiovascular Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina
| | - Qiaomin Liang
- Community Health Center of Xiaolan TownZhongshanChina
| | - Yingqing Feng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina,Hypertension Research Laboratory, Guangdong Provincial Clinical Research Center for Cardiovascular Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina
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3
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Goicoechea S, Walsh M, Soult M, Halandras PM, Bechara C, Aulivola B, Crisostomo P. Female Gender Increases Risk of Stroke and Readmission after CEA and CAS. J Vasc Surg 2021; 75:1935-1944. [PMID: 34740804 DOI: 10.1016/j.jvs.2021.10.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 10/21/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Carotid endarterectomy (CEA) has historically demonstrated a higher rate of perioperative adverse events for female patients. However, recent evidence suggests similar outcomes for CEA between genders. In contrast, fewer studies have examined gender in carotid artery stenting (CAS). Using contemporary data from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database, we aim to determine if gender impacts differences in postoperative complications in patients who undergo CEA or CAS. METHODS The ACS NSQIP database was queried from 2005-2017 using Current Procedural Terminology (CPT) and International Classification of Diseases (ICD) codes for retrospective review. Patients with carotid intervention (CEA or CAS) were stratified into asymptomatic vs symptomatic cohorts to determine the effect of gender on 30-day postoperative outcomes. Symptomatic patients were defined as those with perioperative transient cerebral ischemic attack or stenosis of carotid artery with cerebral infarction. Descriptive statistics were calculated. Risk-adjusted odds of 30-day postoperative outcomes were calculated using multivariate regression analysis with fixed effects for age, race, and comorbidities. RESULTS There were 106,568 patients with CEA or CAS (104,412 CEA and 2,156 CAS). Average age was 70.9 years old and female patients accounted for 39.9% of the population. For asymptomatic patients that underwent CEA or CAS, female gender was associated with significantly higher rates of CVA/stroke (13%, p=0.005), readmission (10%, p=0.004), bleeding complication (32%, p=0.001), and UTI (54%, p=0.001) as well as less infection (26%, p=0.001). In the symptomatic cohort, female gender was associated with significantly higher rates of CVA/stroke (32%, p=0.034), bleeding complication (203%, p=0.001), and UTI (70%, p=0.011), while female gender was associated with a lower rate of pneumonia (39%, p=0.039). Subset analysis found that, compared to male patients, female patients <75yo have an increased rate of CVA/stroke (21%, p=0.001) and readmission (15%, p<0.001), while female patients ≥75yo did not. In asymptomatic and symptomatic patients that underwent CEA, female gender was associated with significantly higher rates of CVA/stroke (13%, p=0.006 and 31%, p=0.044, respectively), but this finding was present not in patients undergoing CAS. CONCLUSION In patients undergoing carotid intervention, female gender was associated with significantly increased rates of postoperative CVA/stroke in the asymptomatic and symptomatic cohorts as well as readmission in the asymptomatic cohort. Female gender was associated with higher rates of CVA/stroke following CEA, but not CAS. We recommend that randomized control trials ensure adequate representation of female patients to better understand gender-based disparities in carotid intervention.
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Affiliation(s)
- Steven Goicoechea
- Department of Surgery, Loyola University Medical Center, Maywood, IL
| | - Martin Walsh
- Department of Surgery, Loyola University Medical Center, Maywood, IL
| | - Michael Soult
- Department of Surgery, Division of Vascular Surgery and Endovascular Therapy, Loyola University Medical Center, Maywood, IL
| | - Pegge M Halandras
- Department of Surgery, Division of Vascular Surgery and Endovascular Therapy, Loyola University Medical Center, Maywood, IL
| | - Carlos Bechara
- Department of Surgery, Division of Vascular Surgery and Endovascular Therapy, Loyola University Medical Center, Maywood, IL
| | - Bernadette Aulivola
- Department of Surgery, Division of Vascular Surgery and Endovascular Therapy, Loyola University Medical Center, Maywood, IL
| | - Paul Crisostomo
- Department of Surgery, Division of Vascular Surgery and Endovascular Therapy, Loyola University Medical Center, Maywood, IL.
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Gomes VC, Fernando da Silva L, Zyngier SP, Silvestre GC, Queiroz A, Marques MA, Simão da Silva E. Left Common Carotid Artery Biomechanical Properties in Individuals over 80 years: Women Have Stiffer Vessels. Ann Vasc Surg 2020; 67:461-467. [PMID: 32173475 DOI: 10.1016/j.avsg.2020.01.107] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 01/16/2020] [Accepted: 01/30/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Considering the longevity of the worldwide population, the cardiovascular diseases deserve particular attention, especially the carotid artery disease in the ≥80-year-old population. The stiffness of the common carotid artery, for example, has been showed in numerous clinical studies as a marker of increased risk of stroke, dementia, and depression. Besides, with the emergence of new surgical techniques such as the transcarotid artery revascularization that uses the common carotid artery as a workstation, the biomechanical and histological features of this vessel, more than ever, must be detailed. METHODS Left common carotid artery fragments from 9 cadaver donors (≥80 years old) were evaluated. Biomechanical (failure stress, tension, and strain) and histological (percentage of collagen and elastic fibers) features of these samples were analyzed with special focus on gender differences. RESULTS Statistically significant differences in biomechanical and histological features between the genders were observed. The percentage of collagen fiber in intima (P = 0.008) and media (P = 0.041) layers was significantly lower in men than in women. A higher elasticity (failure strain) of the specimens in male gender was also observed (P = 0.025). No significant difference was observed in the layers thickness between the genders regardless which part of the arterial wall was considered. CONCLUSIONS These biomechanical and histological findings could be the responsible for the higher left common carotid artery stiffness observed among ≥80-year-old women when compared with men in numerous clinical studies in literature.
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Affiliation(s)
- Vivian Carla Gomes
- Vascular and Endovascular Surgery Division, Department of Surgery, Laboratory of Medical Investigation #2 (LIM 02), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
| | - Luiz Fernando da Silva
- Department of Pathology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Selene Perrotti Zyngier
- Department of Pathology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Gina Camillo Silvestre
- Vascular and Endovascular Surgery Division, Department of Surgery, Laboratory of Medical Investigation #2 (LIM 02), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Alexandre Queiroz
- Vascular and Endovascular Surgery Division, Department of Surgery, Laboratory of Medical Investigation #2 (LIM 02), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Michele Alberto Marques
- Vascular and Endovascular Surgery Division, Department of Surgery, Laboratory of Medical Investigation #2 (LIM 02), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Erasmo Simão da Silva
- Vascular and Endovascular Surgery Division, Department of Surgery, Laboratory of Medical Investigation #2 (LIM 02), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
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Boorman S, Douglas H, Driessen B, Gillespie MJ, Schaer TP. Fatal Ovarian Hemorrhage Associated With Anticoagulation Therapy in a Yucatan Mini-Pig Following Venous Stent Implantation. Front Vet Sci 2020; 7:18. [PMID: 32083102 PMCID: PMC7002391 DOI: 10.3389/fvets.2020.00018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 01/10/2020] [Indexed: 01/10/2023] Open
Abstract
Swine models are commonly utilized in endovascular research for development of intravascular interventions and medical device development. As part of a pilot study for a venous vascular stent device, a 5-year-old female Yucatan mini-pig underwent bilateral external iliac vein stent placement under general anesthesia. To reduce thrombotic complications by reduction of thrombus formation on wires, sheaths, and catheters, the pig was heparinized with a total of 300 IU/kg of heparin, establishing an activated clotting time (ACT) of 436 s. The ACT had returned to below 200 s by the end of the procedure. To prevent postoperative thrombosis, the pig received an anticoagulation therapy protocol consisting of enoxaparin, clopidogrel, and aspirin. There were no complications during the immediate postoperative period. However, the pig died 4 days after surgery. Necropsy established the cause of death as abdominal exsanguination due to severe, acute, intra-ovarian hemorrhage, most likely related to ovulation. Life-threatening ovarian hemorrhage is occasionally seen in women with congenital or acquired bleeding disorders; to our knowledge this is the first report of fatal ovarian hemorrhage in an animal enrolled in a pre-clinical research trial.
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Affiliation(s)
- Sophie Boorman
- Department of Clinical Sciences, College of Veterinary Medicine, JT Vaughan Large Animal Teaching Hospital, Auburn University, Auburn, AL, United States
| | - Hope Douglas
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Bernd Driessen
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Matthew J Gillespie
- Department of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Thomas P Schaer
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, United States
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Pérez-Cremades D, Mompeón A, Vidal-Gómez X, Hermenegildo C, Novella S. miRNA as a New Regulatory Mechanism of Estrogen Vascular Action. Int J Mol Sci 2018; 19:ijms19020473. [PMID: 29415433 PMCID: PMC5855695 DOI: 10.3390/ijms19020473] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 01/31/2018] [Accepted: 02/01/2018] [Indexed: 01/01/2023] Open
Abstract
The beneficial effects of estrogen on the cardiovascular system have been reported extensively. In fact, the incidence of cardiovascular diseases in women is lower than in age-matched men during their fertile stage of life, a benefit that disappears after menopause. These sex-related differences point to sexual hormones, mainly estrogen, as possible cardiovascular protective factors. The regulation of vascular function by estrogen is mainly related to the maintenance of normal endothelial function and is mediated by both direct and indirect gene transcription through the activity of specific estrogen receptors. Some of these mechanisms are known, but many remain to be elucidated. In recent years, microRNAs have been established as non-coding RNAs that regulate the expression of a high percentage of protein-coding genes in mammals and are related to the correct function of human physiology. Moreover, within the cardiovascular system, miRNAs have been related to physiological and pathological conditions. In this review, we address what is known about the role of estrogen-regulated miRNAs and their emerging involvement in vascular biology.
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Affiliation(s)
- Daniel Pérez-Cremades
- Department of Physiology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain.
- INCLIVA Biomedical Research Institute, 46010 Valencia, Spain.
| | - Ana Mompeón
- Department of Physiology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain.
- INCLIVA Biomedical Research Institute, 46010 Valencia, Spain.
| | - Xavier Vidal-Gómez
- Department of Physiology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain.
- INCLIVA Biomedical Research Institute, 46010 Valencia, Spain.
| | - Carlos Hermenegildo
- Department of Physiology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain.
- INCLIVA Biomedical Research Institute, 46010 Valencia, Spain.
| | - Susana Novella
- Department of Physiology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain.
- INCLIVA Biomedical Research Institute, 46010 Valencia, Spain.
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Selwaness M, Hameeteman R, Van 't Klooster R, Van den Bouwhuijsen Q, Hofman A, Franco OH, Niessen WJ, Klein S, Vernooij MW, Van der Lugt A, Wentzel JJ. Determinants of carotid atherosclerotic plaque burden in a stroke-free population. Atherosclerosis 2016; 255:186-192. [PMID: 27806835 DOI: 10.1016/j.atherosclerosis.2016.10.030] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 10/12/2016] [Accepted: 10/13/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIMS In a large stroke-free population, we sought to identify cardiovascular risk factors and carotid plaque components associated with carotid plaque burden, lumen volume and stenosis. METHODS The carotid arteries of 1562 stroke-free participants from The Rotterdam Study were imaged on a 1.5-Tesla MRI scanner. Inner and outer wall of the carotid arteries were automatically segmented and lumen volume (mm3), wall volume (outer wall-inner wall) and plaque burden (wall volume/outer wall volume) (%) were quantified. Plaque components were visually determined and luminal stenosis was assessed. We analyzed associations of cardiovascular risk factors and carotid plaque components with plaque burden and lumen volumes using regression analysis. RESULTS We investigated 2821 carotid plaques and found that women had larger plaque burden (50.7 ± 7.8% vs. 49.2 ± 7.7%, p < 0.0001) and smaller lumen volumes (933 ± 286 mm3vs. 1078 ± 334 mm3, p < 0.0001) than men. In women, age, HDL-cholesterol and systolic blood pressure, and in men, total cholesterol, non-HDL cholesterol and statin use were independently associated with higher plaque burden and lumen volume. Furthermore, smoking and diabetes were associated with lumen volume in men (respectively p = 0.04 and p = 0.002). Intraplaque hemorrhage (IPH) and lipid were related to a larger plaque burden (OR 1.30 [1.05-1.60] and OR 1.28[1.06-1.55]). Finally, within the highest quartile of plaque burden, IPH was strongly associated with luminal stenosis independent of age, sex, plaque burden and composition (Beta = 15.2; [11.8-18.6]). CONCLUSIONS Several cardiovascular risk factors and plaque components, in particular IPH, are associated with higher plaque burden. Carotid IPH is strongly associated with an increased luminal stenosis.
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Affiliation(s)
| | - Reinhard Hameeteman
- Department of Medical Informatics, Erasmus MC, Rotterdam, The Netherlands; Department of Radiology, Erasmus MC, Rotterdam, The Netherlands
| | - Ronald Van 't Klooster
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Albert Hofman
- Department of Epidemiology, MC, Rotterdam, The Netherlands
| | - Oscar H Franco
- Department of Epidemiology, MC, Rotterdam, The Netherlands
| | - Wiro J Niessen
- Department of Medical Informatics, Erasmus MC, Rotterdam, The Netherlands; Department of Radiology, Erasmus MC, Rotterdam, The Netherlands; Faculty of Applied Sciences, Delft University of Technology, The Netherlands
| | - Stefan Klein
- Department of Medical Informatics, Erasmus MC, Rotterdam, The Netherlands; Department of Radiology, Erasmus MC, Rotterdam, The Netherlands
| | - Meike W Vernooij
- Department of Epidemiology, MC, Rotterdam, The Netherlands; Department of Radiology, Erasmus MC, Rotterdam, The Netherlands
| | | | - Jolanda J Wentzel
- Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands.
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Tromba L, Tartaglia F, Blasi S, Giuliani A, Carbotta S, Kiltzanidi D, Cavaiola S, Tortorelli G, Carbotta G, Pelle F. Is Carotid Stenosis in Women a Gender-Related Condition? J Womens Health (Larchmt) 2015; 25:348-54. [PMID: 26555221 DOI: 10.1089/jwh.2015.5300] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We set out to study, through ultrasound examinations, the carotid bifurcation in men and women with/without carotid stenosis to look for anatomical and electrophysiologic differences. We evaluated other variables to look for differences that might explain the dissimilar behavior of this disease in the two sexes and the presence and impact of risk factors. METHODS We examined 974 subjects aged 25 to 88 years (478 men and 496 women) in whom we considered heart rate, smoking status, and the presence of hypertension, diabetes, hypercholesterolemia, and hypertriglyceridemia. Ultrasound examination of the neck vessels included measurement of intimal medial thickness (IMT), vessel diameter, and outflow area/inflow area ratio. We established plaque location, echogenicity and echostructure, and the percentage of stenosis owing to plaque and measured systolic velocity, flow direction, and the depth of detection of these parameters. We used the apnea and hyperpnea test to assess cerebrovascular reactivity. RESULTS Hypertension and hypercholesterolemia were the most frequent risk factors. Women had a higher heart rate, whereas men had significantly greater IMT. The presence of atheromatous plaque was significantly correlated with age in both sexes, with men having a higher prevalence of carotid plaques. The sexes differed significantly with regard to plaque location, echogenicity, echostructure, and intracranial circulation. Women had a slightly higher blood flow velocity in the intracranial arteries. Risk factors affected plaque formation and extent more in men than in women. CONCLUSIONS These findings suggest that carotid stenosis is a gender-related trait.
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Affiliation(s)
- Luciana Tromba
- 1 Surgical Sciences Department, Sapienza University of Rome , Rome, Italy
| | | | - Sara Blasi
- 1 Surgical Sciences Department, Sapienza University of Rome , Rome, Italy
| | | | - Sabino Carbotta
- 1 Surgical Sciences Department, Sapienza University of Rome , Rome, Italy
| | - Demetra Kiltzanidi
- 1 Surgical Sciences Department, Sapienza University of Rome , Rome, Italy
| | - Stefania Cavaiola
- 1 Surgical Sciences Department, Sapienza University of Rome , Rome, Italy
| | | | - Giovanni Carbotta
- 1 Surgical Sciences Department, Sapienza University of Rome , Rome, Italy
| | - Fabio Pelle
- 1 Surgical Sciences Department, Sapienza University of Rome , Rome, Italy
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9
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Dong C, Della-Morte D, Cabral D, Wang L, Blanton SH, Seemant C, Sacco RL, Rundek T. Sirtuin/uncoupling protein gene variants and carotid plaque area and morphology. Int J Stroke 2015; 10:1247-52. [PMID: 26332421 DOI: 10.1111/ijs.12623] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 06/22/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Sirtuins and uncoupling proteins have been implicated in cardiovascular diseases by controlling oxidative stress. AIMS We sought to investigate the association of sirtuins and uncoupling proteins single nucleotide polymorphisms with total carotid plaque area and morphology measured by ultrasonographic gray scale median. METHODS We analyzed 1356 stroke-free subjects (60% women, mean age = 68 ± 9 years) from the Northern Manhattan Study. Multiple linear regression models were used to evaluate the association of 85 single nucleotide polymorphisms in 11 sirtuins/uncoupling protein genes with total plaque area and gray scale median after controlling for demographics, vascular risk factors (RFs), and population stratification. We investigated effect modifications of these relationship by gender and RFs and performed stratified analysis if the interaction effect had P < 0·005. RESULTS Among individuals with present plaque (55%), the mean total plaque area was 20·3 ± 20·8 mm(2) and gray scale median 90 ± 29. After adjustment, SIRT6 rs107251 was significantly associated with total plaque area (β = 0·30 per copy of T allele increase, Bonferroni-corrected P = 0·005). T allele carriers of rs1430583 in UCP1 showed a decreased gray scale median in women but not in men. The minor allele carriers of rs4980329 and rs12363280 in SIRT3 had higher gray scale median in men but not in women. Variants in UCP3 gene were significantly associated with higher mean gray scale median in individuals with dyslipidemia. CONCLUSION Our findings suggest that polymorphisms in SIRT6/UCP1 genes may be important for increased carotid plaque burden and echodensity, but translation of these findings to an individual risk of cerebrovascular events needs further investigation. Significant associations of rs1430583 in women, rs12363280 in men, and rs1685354 in those with dyslipidemia also deserve further investigations.
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Affiliation(s)
- Chuanhui Dong
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - David Della-Morte
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA.,Department of Systems Medicine, School of Medicine, University of Rome Tor Vergata, Rome, Italy.,IRCCS San Raffaele Pisana, Rome, Italy
| | - Digna Cabral
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Liyong Wang
- John T. McDonald Department of Human Genetics, John P Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Susan H Blanton
- John T. McDonald Department of Human Genetics, John P Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Chaturvedi Seemant
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Ralph L Sacco
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA.,John T. McDonald Department of Human Genetics, John P Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, FL, USA.,Department of Epidemiology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Tatjana Rundek
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA.,Department of Epidemiology, Miller School of Medicine, University of Miami, Miami, FL, USA
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