Carotid extramedial thickness is associated with local arterial stiffness in children

Cumulative burden and trajectories of body mass index and blood pressure from childhood and carotid intima-media thickness in young adulthood

There are significant gaps in understanding of the association between levels and rate of change of body mass index (BMI) and blood pressure (BP) at different ages during childhood and carotid intima-media thickness (CIMT) in adulthood. We investigated the association between trajectories of BMI and BP from childhood to adulthood and adult CIMT among Iranian participants in the Tehran Lipid and Glucose Study (TLGS) cohort. A total of 1334 participants (692 men), from the TLGS cohort (1999-2018) with repeated measurements of BMI and BP (2-6 times) from childhood (3-18 years) to young adulthood (20-40 years) were selected. Trajectory parameters included levels and linear slopes of BMI and BP growth curve models, and cumulative burden defined as the area under those curves (AUC). After adjusting for confounders, AUC of BMI and diastolic blood pressure (DBP) were significantly associated with high CIMT in adulthood, with the standardized odds ratios (OR) and 95% confidence interval (95% CI) of 1.35 (1.12-1.62) and 1.27 (1.01-1.60), respectively. Associations between level-independent slopes of BMI and adult CIMT were significantly positive (ORs: 1.27 to 1.26) during childhood ages (3-18 years). Further, levels of BMI (ORs: 1.23 to 1.29) and DBP (ORs: 1.25 to 1.33) during the ages of 13-18 and 11-17 years, respectively, were significantly associated with CIMT in adulthood (all P < 0.05). The cumulative burden of BMI and DBP was associated with CIMT in adulthood. Adolescence is a crucial period for high CIMT, which has implications for early prevention of atherosclerosis.

Age-related carotid extra-media thickening is associated with increased blood pressure and arterial stiffness

Ageing results in higher blood pressure and arterial stiffening leading to increased cardiovascular disease (CVD) risk. The extra-media thickness (EMT) is a composite measure of the arterial adventitia, perivascular adipose tissue (PVAT) and the jugular vein, but the association among EMT and ageing, blood pressure and arterial stiffness is largely unknown. We hypothesized that EMT is associated with ageing, blood pressure and arterial stiffness. Fifty (18M/32F, age range 20-79 years.) individuals underwent measures of EMT (media-adventitia border to jugular lumen interface) via ultrasonography, blood pressure (brachial; carotid), arterial stiffness (carotid beta-stiffness, distensibility and Young's modulus) and body composition (dual X-ray absorptiometry). Independent two-tailed t-tests compared characteristics between young and middle-aged/older adults (MA/O). Bivariate correlations assessed the relation between EMT, ageing, blood pressure and arterial stiffness endpoints. Partial correlations were used to adjust for age, sex, body mass index (BMI) and body fat percentage. Compared to young, MA/O adults had higher EMT, blood pressure, arterial stiffness, BMI and BF% (all, p ≤ 0.05). Carotid EMT was positively correlated with age (r = 0.46), brachial SBP (r = 0.32), carotid SBP (r = 0.42), PP (r = 0.42), beta-stiffness (r = 0.37) and Young's elastic modulus (r = 0.43) (all, p ≤ 0.05), and negatively correlated with carotid distensibility (r = -0.34, p ≤ 0.05). All endpoints correlated with EMT remained after adjusting for BMI, BF% and sex (p ≤ 0.05). These data suggest EMT is a clinically relevant target that may be associated with age-related CVD risk in humans, yet further investigation is required to elucidate the role of EMT in age-related increases in blood pressure and arterial stiffness.

Aortic adventitial thickness as a marker of aortic atherosclerosis, vascular stiffness, and vessel remodeling in systemic lupus erythematosus

INTRODUCTION

There is limited human imaging data on the association of adventitial thickness (AT) with arterial disease. Systemic lupus erythematosus (SLE) is a prototypical disease model for studying markers of premature arterial disease.

OBJECTIVE

To determine if increased aortic AT is associated with aortic atherosclerosis [increased intima media thickness (IMT) or plaques], stiffness [increased pressure-strain elastic modulus (PSEM)], and vessel remodeling.

METHODS

In total, 70 SLE patients and 26 age- and sex-matched controls underwent transesophageal echocardiography (TEE). Two-dimensional guided M-mode images were obtained to assess AT, IMT, and plaques, and PSEM at the proximal, mid, and distal thoracic aorta. Images were interpreted by 3 observers unaware of the subjects' clinical data and each other's measurements. Abnormal aortic AT, IMT, and PSEM were defined as > 2SD above the overall mean values in controls and corresponded to > 1 mm, > 1 mm, and > 10.6 Pascal units, respectively. Plaques were defined as focal-protruding IMT > 50% of the surrounding vessel wall.

RESULTS

Abnormal aortic AT, atherosclerosis, and abnormal stiffness were more frequent in SLE patients than in controls (all p ≤ 0.02). In SLE patients, abnormal AT combined with atherosclerosis was associated with larger aortic end-diastolic diameters than in controls (p ≤ 0.05). In SLE patients, aortic AT was greater in patients with atherosclerosis and in those with abnormal stiffness than in patients without these abnormalities (all p ≤ 0.02). In patients with abnormal AT, the degree of aortic stiffness was similar to those with atherosclerosis (p = 0.22).

CONCLUSION

In patients with SLE, increased aortic AT is associated with aortic atherosclerosis, abnormal stiffness, and eccentric vessel remodeling. Key Points • In patients with SLE, abnormal aortic adventitial thickness is associated with aortic atherosclerosis, abnormal stiffness, and eccentric vessel remodeling. • In patients with SLE, aortic adventitial thickening may contribute to the extent of aortic atherosclerosis, abnormal aortic stiffness, and vessel remodeling. • To our knowledge, this is the first human imaging study to characterize the aortic adventitial layer and delineate its association with aortic disease.