Blood pressure class and carotid artery intima–media thickness in a population at the secondary epidemiological transition

Association of previous schistosome infection with fatty liver and coronary heart disease: A cross-sectional study in china

BACKGROUND

More than 11 million people were estimated to have been infected by Schistosoma japonicum in China before the 1950s. However, few studies have been conducted to evaluate the longitudinal effects of previous schistosome infection (PSI).

OBJECTIVE

We aimed to evaluate the association of PSI with fatty liver and coronary heart disease in China.

METHODS

A cross-sectional study was conducted in regions which were all reportedly heavily endemic for S japonicum in China. All data were collected using a questionnaire administered and health examinations by well-trained medical professionals. 2867 participants aged 40 years and older were enrolled. Among these, 731 patients with PSI were selected as study subjects and 2136 subjects served as controls. Comparisons between groups were performed with or without an adjustment for a covariate, using Student's t tests for continuous variables and chi-square testing for categorical variables. Multivariable logistic models were used to estimate the associations between PSI and fatty liver or coronary heart disease.

RESULTS

The PSI participants had significantly lower levels of triglyceride, low-density lipoprotein cholesterol, fasting blood glucose, uric acid, serum creatinine, urea nitrogen, platelet, total protein and globulin as well as a lower prevalence of fatty liver (13.3% vs 53.6%, P < .001) and coronary heart disease (3.4% vs 6.0%, P < .05) compared with the uninfected, contemporaneous controls (without PSI), whereas the PSI participants had higher levels of high-density lipoprotein cholesterol, direct bilirubin and a higher prevalence of hepatic dysfunction compared with those without PSI (P < .05).

CONCLUSION

We found PSI significantly negatively associated with fatty liver and coronary heart disease. However, further studies on schistosomiasis may provide new directions for prevention and treatment of fatty liver and coronary heart disease.

Correlation of Pre-Hypertension with Carotid Artery Damage in Middle-Aged and Older Adults

The intima–media thickness (IMT), luminal diameters (LDs), flow velocities (FVs), compliance, and β-stiffness of the carotid artery (CA) are considered as independent risk factors for cardiovascular diseases (CVDs). Pre-hypertension (PHT) is also an independent CVD risk factor. This study investigated the association between CA damage (CAD) and PHT. A total of 544 adults participated; their blood pressures (BPs) and CA characteristics were measured using a mercury-free sphygmomanometer and ultrasound. Analysis of covariance (ANCOVA) was performed to assess the differences in the CA characteristics according to the BPs, multinomial logistic regression to evaluate the risk of CAD associated with PHT. In ANCOVA, the CA characteristics of PHT were significantly different from normotensive. The odds ratios (ORs) of IMTmax, LDmax, LDmin, peak-systolic FV (PFV), end-diastolic FV (EFV), PFV/LDmin, EFV/LDmax, compliance, and β-stiffness of PHT were 4.20, 2.70, 3.52, 2.41, 3.06, 3.55, 3.29, 2.02, and 1.84 times higher than those of the normotensive, respectively, in Model 2. In Model 3 adjusted for age, the ORs of LDmax, LDmin, EFV, PFV/LDmin, and EFV/LDmax of PHT were 2.10, 2.55, 1.96, 2.20, and 2.04 times higher than those of the normotensive, respectively. Therefore, the present study revealed that CAD is closely correlated with pre-hypertensive status in adults.

Infection with Soil-Transmitted Helminths Is Associated with Increased Insulin Sensitivity

Objective

Given that helminth infections have been shown to improve insulin sensitivity in animal studies, which may be explained by beneficial effects on energy balance or by a shift in the immune system to an anti-inflammatory profile, we investigated whether soil-transmitted helminth (STH)-infected subjects are more insulin sensitive than STH-uninfected subjects.

Design

We performed a cross-sectional study on Flores island, Indonesia, an area with high prevalence of STH infections.

Methods

From 646 adults, stool samples were screened for Trichuris trichiura by microscopy and for Ascaris lumbricoides, Necator americanus, Ancylostoma duodenale, and Strongyloides stercoralis by qPCR. No other helminth was found. We collected data on body mass index (BMI, kg/m²), waist-to-hip ratio (WHR), fasting blood glucose (FBG, mmol/L), insulin (pmol/L), high sensitive C-reactive protein (ng/ml) and Immunoglobulin E (IU/ml). The homeostatic model assessment for insulin resistance (HOMAIR) was calculated and regression models were used to assess the association between STH infection status and insulin resistance.

Results

424 (66%) participants had at least one STH infection. STH infected participants had lower BMI (23.2 vs 22.5 kg/m², p value = 0.03) and lower HOMAIR (0.97 vs 0.81, p value = 0.05). In an age-, sex- and BMI-adjusted model a significant association was seen between the number of infections and HOMAIR: for every additional infection with STH species, the HOMAIR decreased by 0.10 (p for linear trend 0.01). This effect was mainly accounted for by a decrease in insulin of 4.9 pmol/L for every infection (p for trend = 0.07).

Conclusion

STH infections are associated with a modest improvement of insulin sensitivity, which is not accounted for by STH effects on BMI alone.

Carotid intima-media thickness value distributions in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

OBJECTIVE

Carotid intima-media thickness (IMT) is a noninvasive measurement of early atherosclerosis. Most IMT studies have involved populations with low rates of racial blending. The aim of the present article is to describe IMT value distributions and analyze the influence of sex and race on IMT values in a large Brazilian sample, a setting with a high rate of racial admixture.

METHODS

The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) is a multicenter cohort of 15,105 adult (aged 35-74 years) civil servants in six Brazilian cities. Baseline assessment included IMT measurements in both common carotid arteries. Race was self-reported. We studied the association between sex and race with IMT values using multiple linear regression models. We conducted analyses in all and low-risk individuals, defined as those without classical cardiovascular risk factors.

RESULTS

We analyzed complete IMT data from 10,405 ELSA-Brasil participants. We present nomograms by age for all and low-risk individuals, stratified by sex and race. We found that men had significantly higher maximal IMT values compared with women (β = 0.058; P < 0.001). This association remained for low-risk individuals (β = 0.027; P = 0.001). In addition, Brown and White individuals had lower maximal IMT values compared with Black individuals for all (β = -0.034 and β = -0.054, respectively; P < 0.001) and low-risk individuals (β = -0.027; P = 0.013 and β = -0.035; P < 0.001, respectively).

CONCLUSION

We found significantly higher IMT values in men. We found significantly higher IMT values in Black individuals than White and Brown individuals. These results persisted when analyses were restricted to low-risk individuals.

Prevalence of subclinical atherosclerosis is increased in systemic sclerosis and is associated with serum proteins: a cross-sectional, controlled study of carotid ultrasound

OBJECTIVES

SSc is associated with an increased prevalence of atherosclerosis (ATS). This study assessed the prevalence of subclinical ATS as measured by carotid US and explored serum proteins to identify potential biomarkers of SSc-ATS.

METHODS

Forty-six SSc female patients and 46 age- and ethnicity-matched controls underwent carotid US to assess the presence of plaque and carotid intima media thickness (CIMT). Abstracted data included demographics, ATS risk factors and serum measurements [cholesterol, proinflammatory high-density lipoprotein (piHDL), CRP, lipoproteins]. Serum cytokines/proteins analyses included circulating type I IFN activity by quantifying IFN-inducible genes, soluble junctional adhesion molecule A (sJAM-A) and 100 serum proteins by using a microplate-based multiplex platform. Proteins significant at P < 0.05 on bivariate analyses for the presence of plaque were used to develop a composite measure.

RESULTS

Patients with SSc had more plaque (45.6% vs 19.5%, P = 0.01) but similar CIMT compared with controls. Multiplex analysis detected significant associations between serum proteins of inflammation, vasculopathy and fibrosis with ATS in SSc, including IL-2, IL-6, CRP, keratinocyte growth factor, intercellular adhesion molecule 1, endoglin, plasminogen activator inhibitor 1 and insulin-like growth factor binding protein 3 associated with carotid plaque. Myeloid progenitor inhibitory factor 1, serum amyloid A, thrombomodulin, N-terminal pro-brain natriuretic peptide (BNP), and Clara cell secretory protein 16 kD correlated with CIMT. The median composite score for the plaque group was 6 and for the no plaque group it was 2 (P < 0.0001).

CONCLUSION

Patients with SSc have a higher prevalence of carotid plaque than matched controls, and patients with SSc-plaque vs patients without plaque have elevated serum proteins implicated in both vasculopathy and fibrosis. Further studies are needed to evaluate the role of these proteins in SSc compared with healthy controls.

Relationship between carotid intima media thickness and helminth infections on Flores Island, Indonesia

Objective

To examine the association between helminth infections and atherosclerosis.

Background

Chronic helminth infection, which can lead to poor nutritional status and anti-inflammatory response, might protect against the development of atherosclerosis.

Methods

A cross-sectional study was performed in Flores, Indonesia, an area highly endemic for soil-transmitted helminths (STH). Stool samples from 675 participants aged 18–80 years were collected and screened for Trichuris trichiura by microscopy and for Ascaris lumbricoides, Necator americanus, Ancylostoma duodenale, and Strongyloides stercoralis by qPCR. We collected data on body mass index (BMI), waist to hip ratio (WHR), blood pressure, fasting blood glucose (FBG), lipid, high sensitive C-reactive protein (hs-CRP), total immunoglobulin-E (TIgE) and Escherichia coli lipopolysaccharide stimulated cytokines (tumor necrosis factor and interleukin-10). In a subset of 301 elderly adults (≥40 years of age) carotid intima media thickness (cIMT) was measured.

Results

Participants with any STH infection had lower BMI (kg/m2) (mean difference −0.66, 95%CI [−1.26, −0.06]), WHR (−0.01, [−0.02, −0.00]), total cholesterol (mmol/L) (−0.22, [−0.43, −0.01]) and LDL-cholesterol (mmol/L) (−0.20, [−0.39, −0.00]) than uninfected participants. After additional adjustment for BMI the association between helminth infection and total cholesterol (mean difference −0.17, 95%CI [−0.37, 0.03]) as well as LDL-cholesterol (−0.15, [−0.33, 0.04]) was less pronounced. BMI, WHR, and total cholesterol were negatively associated with number species of helminth co-infections. Participants with high TIgE, an indicator of exposure to helminths, had lower FBG, TC, and HDL. The association between TIgE and TC and HDL remained significant after adjustment with BMI. No clear association was found between STH infection or TIgE and mean cIMT.

Conclusions

This cross-sectional study presents evidence that helminth infections were negatively associated with risk factors for cardiovascular disease, an association at least partially mediated by an effect on BMI. The significance of this finding needs to be determined.