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Jakub Kęsik J, Paja W, Terlecki P, Iłżecki M, Klebowski B, Depciuch J. Raman spectroscopy combined with machine learning and chemometrics analyses as a tool for identification atherosclerotic carotid stenosis from serum. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2024; 326:125198. [PMID: 39340949 DOI: 10.1016/j.saa.2024.125198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 08/26/2024] [Accepted: 09/22/2024] [Indexed: 09/30/2024]
Abstract
Atherosclerosis carotid stenosis (ACS) is one of the main causes of stroke. Unfortunately, the highest number of people go to the doctor with an advanced disease or as a result of a stroke, because carotid atherosclerosis does not cause obvious symptoms. Therefore, it is important to find a diagnostic method to detect the disease during routine tests (using blood or serum). Consequently, in this article, Raman spectroscopy was tested as a potential diagnostic method. Indeed, Raman spectra of serum collected from ACS and control patients showed decrease of Raman peak around 1520 cm-1 and increase of peak around 3050 cm-1 in people with ACS. Moreover in people with ACS shift of peaks originating from amides II, I and lipids vibrations were noticed in comparison with control group. Interestingly, decision tree algorithm showed that peaks at 1656 cm-1 and 2957 cm-1 could be a spectroscopy markers of atherosclerotic carotid stenosis. Continuing, Principal Component Analysis (PCA) clearly showed distinguishing between serum collected from ACS and control patients, while machine learning algorithms showed high value of accuracy, sensitivity and selectivity (more than 90 %). Finally, value of area under the curve of Receiver Operating Characteristic (AUC-ROC) showed value of 0.81 for Raman range between 800 cm-1 and 1800 cm-1 and 0.86 for 2800 cm-1-3000 cm-1 range. Obtained results clearly showed possibility of Raman spectroscopy in detection of ACS from serum.
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Affiliation(s)
- Jan Jakub Kęsik
- Department of Vascular Surgery and Angiology, Medical University of Lublin, Poland.
| | - Wiesław Paja
- Institute of Computer Science, College of Natural Sciences, University of Rzeszow, Poland
| | - Piotr Terlecki
- Department of Vascular Surgery and Angiology, Medical University of Lublin, Poland
| | - Marek Iłżecki
- Department of Vascular Surgery and Angiology, Medical University of Lublin, Poland
| | - Bartosz Klebowski
- Institute of Nuclear Physics, Polish Academy of Sciences, Krakow, Poland
| | - Joanna Depciuch
- Institute of Nuclear Physics, Polish Academy of Sciences, Krakow, Poland; Department of Biochemistry and Molecular Biology, Medical University of Lublin, Poland.
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Zou X, Li Y, Zhang S, Zhang J, Wang Y, Shi S, Zhao Z, Zhao Y, Liu T, Kolberg B, Li J, Shi X. Relationship between triglyceride-glucose index and carotid artery plaques in ischemic stroke patients: Based on blood pressure status, sex, and age. J Stroke Cerebrovasc Dis 2024; 33:107992. [PMID: 39236783 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 08/28/2024] [Accepted: 09/02/2024] [Indexed: 09/07/2024] Open
Abstract
BACKGROUND Numerous studies have shown that the triglyceride-glucose (TyG) index is a reliable substitute marker for insulin resistance. Nevertheless, its correlation with carotid artery plaques (CAPs) among patients with ischemic stroke (IS) remains to be elucidated. METHODS 9248 IS patients hospitalized at the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine were grouped according to the quartiles of TyG index. Patients were further stratified by blood pressure status, sex, age and hypertension control status. Employing logistic regression to examine the connection between the TyG index and CAPs.Additionally, analyzing the receiver operating characteristic (ROC) curve to evaluate the predictive value of the TyG index for CAPs. RESULTS Participants with an elevated TyG index had an increased prevalence of CAPs. The TyG index was positively correlated with CAPs (OR: 1.26, CI: 1.14-1.40, P<0.001). Compared with normal blood pressure and prehypertensive patients, the TyG index was markedly correlated with CAPs among hypertensive patients (OR: 1.29, 95% CI: 1.15-1.44, P<0.001). Females had a higher OR value than males(OR: 1.31, 95% CI: 1.11-1.54, P=0.001 versus OR: 1.24, 95% CI: 1.09-1.41, P=0.001). Older patients (>60 years) had a higher OR value than their middle-aged counterparts (≤60 years) (OR: 1.35; 95% CI: 1.16-1.58, P<0.001 versus OR: 1.20; 95% CI: 1.05-1.37, P=0.007). Patients with poorly-controlled hypertension had a higher OR value than patients with well-controlled hypertension(OR: 1.36; 95% CI: 1.14-1.63, P=0.001 versus OR: 1.24; 95% CI: 1.07-1.44, P=0.003). After adjusting for potential confounding factors, the area under the ROC curve (AUC) value in the overall population, sex-stratified group, hypertensive patients and hypertension control status-stratified group were all above 0.7 (P<0.01), demonstrating good forecasting capability. CONCLUSIONS In IS patients, the TyG index was significantly associated with CAPs. Additionally, this correlation was more pronounced in hypertensive patients, females, older individuals and patients with poorly-controlled hypertension.
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Affiliation(s)
- Xin Zou
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China; National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin 300193, China
| | - Yueying Li
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China; National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin 300193, China
| | - Shiwen Zhang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China; National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin 300193, China
| | - Jinsheng Zhang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China; National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin 300193, China
| | - Ye Wang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China; National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin 300193, China
| | - Shaojing Shi
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China; National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin 300193, China
| | - Zixuan Zhao
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China; National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin 300193, China
| | - Yiran Zhao
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China; National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin 300193, China
| | - Ting Liu
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China; National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin 300193, China
| | - Bernhard Kolberg
- Department of Internal Medicine, Mannheim Medical School of Heidelberg University, Mannheim 68167, Germany
| | - Jing Li
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China; National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin 300193, China.
| | - Xuemin Shi
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China; National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin 300193, China
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Costa D, Scalise E, Ielapi N, Bracale UM, Faga T, Michael A, Andreucci M, Serra R. Omics Science and Social Aspects in Detecting Biomarkers for Diagnosis, Risk Prediction, and Outcomes of Carotid Stenosis. Biomolecules 2024; 14:972. [PMID: 39199360 PMCID: PMC11353051 DOI: 10.3390/biom14080972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Revised: 08/04/2024] [Accepted: 08/08/2024] [Indexed: 09/01/2024] Open
Abstract
Carotid stenosis is characterized by the progressive narrowing of the carotid arteries due to the formation of atherosclerotic plaque, which can lead to stroke and death as major complications. Numerous biomarkers allow for its study and characterization, particularly those related to "omics" sciences. Through the most common research databases, we report representative studies about carotid stenosis biomarkers based on genomics, transcriptomics, proteomics, and metabolomics in a narrative review. To establish a priority among studies based on their internal validity, we used a quality assessment tool, the Scale for the Assessment of Narrative Review Articles (SANRA). Genes, transcriptomes, proteins, and metabolites can diagnose the disease, define plaque connotations, predict consequences after revascularization interventions, and associate carotid stenosis with other patient comorbidities. It also emerged that many aspects determining the patient's psychological and social sphere are implicated in carotid disease. In conclusion, when taking the multidisciplinary approach that combines human sciences with biological sciences, it is possible to comprehensively define a patient's health and thus improve their clinical management through precision medicine.
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Affiliation(s)
- Davide Costa
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (D.C.); (E.S.)
- Interuniversity Center of Phlebolymphology (CIFL), “Magna Graecia” University, 88100 Catanzaro, Italy
| | - Enrica Scalise
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (D.C.); (E.S.)
- Interuniversity Center of Phlebolymphology (CIFL), “Magna Graecia” University, 88100 Catanzaro, Italy
| | - Nicola Ielapi
- Department of Public Health and Infectious Disease, “Sapienza” University of Rome, 00185 Roma, Italy;
| | | | - Teresa Faga
- Department of Health Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (T.F.); (A.M.)
| | - Ashour Michael
- Department of Health Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (T.F.); (A.M.)
| | - Michele Andreucci
- Department of Health Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (T.F.); (A.M.)
| | - Raffaele Serra
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (D.C.); (E.S.)
- Interuniversity Center of Phlebolymphology (CIFL), “Magna Graecia” University, 88100 Catanzaro, Italy
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Ding R, Guan W, Yi M, Qin X, Wei S, Lu H, Wang Y, Lin C, Mei F, Xu H, Wu L. Identification of metabolic components of carotid plaque in high-risk patients utilizing liquid chromatography-tandem mass spectrometry. RAPID COMMUNICATIONS IN MASS SPECTROMETRY : RCM 2024; 38:e9763. [PMID: 38745395 DOI: 10.1002/rcm.9763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/14/2024] [Accepted: 04/14/2024] [Indexed: 05/16/2024]
Abstract
OBJECTIVE Carotid atherosclerosis is a chronic progressive vascular disease that can be complicated by stroke in severe cases. Prompt diagnosis and treatment of high-risk patients are quite difficult due to the lack of reliable clinical biomarkers. This study aimed to explore potential plaque metabolic markers of stroke-prone risk and relevant targets for pharmacological intervention. METHOD Carotid intima and plaque sample tissues were obtained from 20 patients with cerebrovascular symptoms of carotid origin. An untargeted metabolomics approach based on liquid chromatography-tandem mass spectrometry was utilized to characterize the metabolic profiles of the tissues. Multivariate and univariate analysis tools were used. RESULTS A total of 154 metabolites were significantly altered in carotid plaque when compared with thickened intima. Of these, 62 metabolites were upregulated, whereas 92 metabolites were downregulated. Support vector machines identified the 15 most important metabolites, such as N-(cyclopropylmethyl)-N'-phenylurea, 9(S)-HOTrE, ACar 12:2, quinoxaline-2,3-dithiol, and l-thyroxine, as biomarkers for high-risk plaques. Metabolic pathway analysis showed that abnormal purine and nucleotide metabolism, amino acid metabolism, glutathione metabolism, and vitamin metabolism may contribute to the occurrence and progression of carotid atherosclerotic plaque. CONCLUSIONS Our study identifies the biomarkers and related metabolic mechanisms of carotid plaque, which is stroke-prone, and provides insights and ideas for the precise prevention and targeted intervention of the disease.
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Affiliation(s)
- Rui Ding
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Wenfei Guan
- Department of Vascular Surgery, Yichang Central People's Hospital, First College of Clinical Medical Science, China Three Gorges University, Yichang, Hubei, China
| | - Man Yi
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xiaohong Qin
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Shanshan Wei
- Department of Oncology, Wuchang Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, China
| | - Haoran Lu
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yuxuan Wang
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Chunnan Lin
- Department of Neurosurgery, Maoming People's Hospital, Maoming, Guangdong, China
| | - Fei Mei
- Department of Vascular Surgery, Yichang Central People's Hospital, First College of Clinical Medical Science, China Three Gorges University, Yichang, Hubei, China
| | - Haitao Xu
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Liquan Wu
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
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Sagris D, Korompoki E, Strambo D, Mavraganis G, Michel P, Eskandari A, Vemmos K, Lastras C, Rodriguez-Pardo J, Fuentes B, Díez-Tejedor E, Tiili P, Lehto M, Putaala J, Cuadrado-Godia E, Farington-Terrero E, Arauz A, Kamel H, Soledad Rosales J, Rodriguez Perez MS, Gomez Schneider M, Barboza M, Tsiskaridze A, Ntaios G. Prevalence and Factors Associated with Carotid Stenosis in Acute Ischemic Stroke Patients with Atrial Fibrillation. Neuroepidemiology 2024:1-10. [PMID: 38981461 DOI: 10.1159/000539693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 03/26/2024] [Indexed: 07/11/2024] Open
Abstract
INTRODUCTION Among stroke patients with atrial fibrillation (AF), it is not uncommon to identify carotid atherosclerosis. This study aimed to estimate the prevalence of, and factors associated with, carotid atherosclerosis among patients with AF and acute ischemic stroke. PATIENTS AND METHODS Prospectively collected data from consecutive patients with anterior ischemic stroke and AF who underwent carotid imaging from 10 stroke registries were categorized retrospectively according to the degree of stenosis in: no atherosclerosis, stenosis <50%, stenosis ≥50%, and occlusion. Logistic regression analysis was used to identify factors associated with ipsilateral carotid atherosclerosis. RESULTS Among 2,955 patients with ischemic stroke and AF, carotid atherosclerosis was evident in 1,022 (34.6%) patients, while carotid stenosis ≥50% and occlusion were identified in 204 (6.9%) and 168 (5.7%) patients, respectively. Ipsilateral carotid stenosis ≥50% or occlusion was associated with higher age (OR: 1.15, 95% CI: 1.01-1.32, per decade), previous ischemic stroke or transient ischemic attack (OR: 1.70, 95% CI: 1.29-2.25), peripheral artery disease (OR: 1.85, 95% CI: 1.23-2.78), coronary artery disease (OR: 1.53, 95% CI: 1.16-2.04), and statin treatment on admission (OR: 1.30, 95% CI: 1.01-1.67). Patients with lacunar stroke had a lower likelihood of stenosis ≥50% or occlusion (OR: 0.29, 95% CI: 0.13-0.68). Compared to the absence of atherosclerotic disease, atherosclerosis in one and two arterial beds was associated with the identification of ipsilateral carotid stenosis (OR: 1.49, 95% CI: 1.22-2.98 and OR: 3.18, 95% CI: 1.85-5.49, respectively). CONCLUSION Among acute ischemic stroke patients with AF, 1 out of 3 had ipsilateral carotid atherosclerosis, and 1 out of 8 had ipsilateral carotid stenosis ≥50% or occlusion. Atherosclerosis in two arterial beds was the most important predictor for the identification of ipsilateral carotid stenosis. Among ischemic stroke patients with AF, carotid atherosclerosis is common, while carotid imaging should not be overlooked, especially in those with coronary or/and peripheral artery disease.
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Affiliation(s)
- Dimitrios Sagris
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece,
| | - Eleni Korompoki
- Department of Clinical Therapeutics, Medical School of Athens, Alexandra Hospital, Athens, Greece
| | - Davide Strambo
- Stroke Center and Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Georgios Mavraganis
- Department of Clinical Therapeutics, Medical School of Athens, Alexandra Hospital, Athens, Greece
| | - Patrik Michel
- Stroke Center and Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Ashraf Eskandari
- Stroke Center and Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Konstantinos Vemmos
- Department of Clinical Therapeutics, Medical School of Athens, Alexandra Hospital, Athens, Greece
| | - Clara Lastras
- Department of Neurology and Stroke Center, Hospital La Paz Institute for Health Research - IdiPAZ (La Paz University Hospital-Universidad Autónoma de Madrid), Madrid, Spain
| | - Jorge Rodriguez-Pardo
- Department of Neurology and Stroke Center, Hospital La Paz Institute for Health Research - IdiPAZ (La Paz University Hospital-Universidad Autónoma de Madrid), Madrid, Spain
| | - Blanca Fuentes
- Department of Neurology and Stroke Center, Hospital La Paz Institute for Health Research - IdiPAZ (La Paz University Hospital-Universidad Autónoma de Madrid), Madrid, Spain
| | - Exuperio Díez-Tejedor
- Department of Neurology and Stroke Center, Hospital La Paz Institute for Health Research - IdiPAZ (La Paz University Hospital-Universidad Autónoma de Madrid), Madrid, Spain
| | - Paula Tiili
- Department of Neurology, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Mika Lehto
- Department of Cardiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Jukka Putaala
- Department of Neurology, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Elisa Cuadrado-Godia
- Department of Neurology, Neurovascular Research Group, Institut Hospital del Mar d'Investigació Biomèdica, Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Esmirna Farington-Terrero
- Stroke Clinic, Instituto Nacional de Neurologıa y Neurocirugia Manuel Velasco Suarez, Mexico City, Mexico
| | - Antonio Arauz
- Stroke Clinic, Instituto Nacional de Neurologıa y Neurocirugia Manuel Velasco Suarez, Mexico City, Mexico
| | - Hooman Kamel
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Department of Neurology, Weill Cornell Medicine, New York, New York, USA
| | - Julieta Soledad Rosales
- Department of Neurology, Institute for Neurological Research, FLENI, Buenos Aires, Argentina
| | | | - Maia Gomez Schneider
- Department of Neurology, Institute for Neurological Research, FLENI, Buenos Aires, Argentina
| | - Miguel Barboza
- Neurosciences Department, Hospital Dr. Rafael A. Calderon Guardia, CCSS, University of Costa Rica, San José, Costa Rica
| | - Alexander Tsiskaridze
- Department of Neurology, Ivane Javakhishvili Tbilisi State University, Tbilisi, Georgia
| | - George Ntaios
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
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Columbo JA, Stone DH. Appropriateness of care: Asymptomatic carotid stenosis including transcarotid artery revascularization. Semin Vasc Surg 2024; 37:179-187. [PMID: 39151997 PMCID: PMC11330557 DOI: 10.1053/j.semvascsurg.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/14/2024] [Accepted: 03/27/2024] [Indexed: 08/19/2024]
Abstract
Carotid artery stenosis is one of the most common diagnoses treated by vascular specialists in the United States. The optimal management of carotid stenosis remains controversial, however, with notable variation surrounding diagnostic imaging modalities, longitudinal surveillance, medical therapies, and procedural interventions. Data from high-quality randomized controlled trials and observational studies form the foundation for current management paradigms and societal guidelines that inform clinical practice. Presently, a diagnosis of carotid disease is most often established with duplex ultrasound and supplemental cross-sectional imaging using computed tomography or magnetic resonance angiography as needed to provide additional anatomic information. All patients with documented occlusive disease should receive goal-directed medical therapy with antiplatelet agents and a lipid-reduction strategy, most commonly with a statin. Those with severe carotid stenosis and an acceptable life expectancy may be considered for carotid artery revascularization. The proceduralist should optimally consider a shared decision-making approach in which the tradeoffs of revascularization can be carefully considered with the patient to optimize informed therapeutic decision making. In current practice, three distinct procedure options exist to treat carotid artery stenosis, including carotid endarterectomy, transfemoral carotid artery stenting, and transcarotid artery revascularization. It should be noted that each procedure, although often used interchangeably in most clinical settings, carry technical nuances and outcome disparities. In this review, each of these topics are explored and various approaches are outlined surrounding the appropriate use of treatments for patients with asymptomatic carotid artery stenosis.
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Affiliation(s)
- Jesse A Columbo
- Geisel School of Medicine at Dartmouth, Hanover, NH; Section of Vascular Surgery, 3V, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03766; Veterans Affairs Medical Center, White River Junction, VT.
| | - David H Stone
- Geisel School of Medicine at Dartmouth, Hanover, NH; Section of Vascular Surgery, 3V, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03766; Veterans Affairs Medical Center, White River Junction, VT
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Zhao Y, Cui H. Finite element analysis of braided dense-mesh stents for carotid artery stenosis. Comput Methods Biomech Biomed Engin 2024; 27:609-619. [PMID: 37018022 DOI: 10.1080/10255842.2023.2196597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 03/23/2023] [Indexed: 04/06/2023]
Abstract
When braided dense-mesh stents are used to treat carotid stenosis, the structural mechanics of vascular stents, the contact mechanics with blood vessels, and the fluid mechanics in the blood environment need to be studied in depth to reduce the damage of stents to blood vessels and the incidence of in-stent restenosis. Three types of braided stents with 8, 16, and 24 strands and laser-cut stents with the corresponding size parameters were designed, and the bending behavior of each of these types of stent, deployment, and fluid dynamic analysis of the 24-strand braided stent were simulated. The results show that the bending stress of the 8-, 16-, and 24-strand braided stents is 46.33%, 50.24%, and 31.86% of that of their laser-cut counterparts. In addition, higher strand density of the braided stents was associated with greater bending stress; after the 24-strand braided stent was expanded within the stented carotid artery, the carotid stenosis rate was reduced from 81.52% to 46.33%. After stent implantation, the maximum stress on the vessel wall in a zero-pressure diastolic environment decreased from 0.34 to 0.20 MPa, the maximum pressure on the intravascular wall surface decreased from 4.89 to 3.98 kPa, the area of high-pressure region decreased, the wall shear force of the stenotic segment throat decreased, and blood flow increased in the stenosis segments. The braided stent had less bending stress and better flexibility than the laser-cut stent under the same stent size parameters; after the 24-strand braided stent was implanted into the stented vessel, it could effectively dilate the vessel, and the blood flow status was improved.
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Affiliation(s)
- Yunchuan Zhao
- Shanghai Institute for Minimally Invasive Therapy, University of Shanghai for Science and Technology, Shanghai, P.R. China
| | - Haipo Cui
- Shanghai Institute for Minimally Invasive Therapy, University of Shanghai for Science and Technology, Shanghai, P.R. China
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Tong T, Xu A, Tan S, Jiang H, Liu L, Deng S, Wang H. Biological Effects and Biomedical Applications of Areca Nut and Its Extract. Pharmaceuticals (Basel) 2024; 17:228. [PMID: 38399443 PMCID: PMC10893415 DOI: 10.3390/ph17020228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/03/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
The dried, mature fruit of the palm tree species Areca catechu L. is known as the areca nut (AN) or betel nut. It is widely cultivated in the tropical regions. In many nations, AN is utilized for traditional herbal treatments or social activities. AN has historically been used to address various health issues, such as diarrhea, arthritis, dyspepsia, malaria, and so on. In this review, we have conducted a comprehensive summary of the biological effects and biomedical applications of AN and its extracts. Initially, we provided an overview of the constituents in AN extract. Subsequently, we summarized the biological effects of AN and its extracts on the digestive system, nervous system, and circulatory system. And we elucidated the contributions of AN and its extracts in antidepressant, anti-inflammatory, antioxidant, and antibacterial applications. Finally, we have discussed the challenges and future perspectives regarding the utilization of AN and its extracts as emerging pharmaceuticals or valuable adjuncts within the pharmaceutical field.
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Affiliation(s)
- Ting Tong
- Hunan Key Laboratory of Economic Crops Genetic Improvement and Integrated Utilization, Hunan Binglang Science Institute, School of Life and Health Sciences, Hunan University of Science and Technology, Xiangtan 411201, China
| | - Aiqing Xu
- Hunan Key Laboratory of Economic Crops Genetic Improvement and Integrated Utilization, Hunan Binglang Science Institute, School of Life and Health Sciences, Hunan University of Science and Technology, Xiangtan 411201, China
| | - Shuhua Tan
- Hunan Key Laboratory of Economic Crops Genetic Improvement and Integrated Utilization, Hunan Binglang Science Institute, School of Life and Health Sciences, Hunan University of Science and Technology, Xiangtan 411201, China
| | - Hengzhi Jiang
- Hunan Key Laboratory of Economic Crops Genetic Improvement and Integrated Utilization, Hunan Binglang Science Institute, School of Life and Health Sciences, Hunan University of Science and Technology, Xiangtan 411201, China
| | - Lixin Liu
- Hunan Key Laboratory of Economic Crops Genetic Improvement and Integrated Utilization, Hunan Binglang Science Institute, School of Life and Health Sciences, Hunan University of Science and Technology, Xiangtan 411201, China
| | - Senwen Deng
- Hunan Key Laboratory of Economic Crops Genetic Improvement and Integrated Utilization, Hunan Binglang Science Institute, School of Life and Health Sciences, Hunan University of Science and Technology, Xiangtan 411201, China
| | - Haihua Wang
- Hunan Key Laboratory of Economic Crops Genetic Improvement and Integrated Utilization, Hunan Binglang Science Institute, School of Life and Health Sciences, Hunan University of Science and Technology, Xiangtan 411201, China
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Oliveira TF, Centellas CDR, Dalio MB, Joviliano EE. Short term outcomes of carotid surgery: the real-world experience of a single teaching center. J Vasc Bras 2024; 23:e20230033. [PMID: 38433985 PMCID: PMC10903515 DOI: 10.1590/1677-5449.202300332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 11/27/2023] [Indexed: 03/05/2024] Open
Abstract
Background Surgical treatment of symptomatic extracranial carotid stenosis is well established for preventing neurological events and should adhere to optimal quality standards. However, there is growing concern as to whether results of controlled trials are replicable in real-world settings. Objectives To assess a symptomatic carotid stenosis population that underwent surgery and its short-term outcomes in a real-world context at a professional training center. Methods Observational study using data collected from medical records from January 2012 to January 2023. Patients undergoing operations for other carotid diseases and with concomitant heart surgery were excluded. Results A total of 70 patients undergoing angioplasty or carotid endarterectomy were included. Population subsets undergoing angioplasty or endarterectomy were similar. Differences in anesthetic modality and a longer operative time in the carotid endarterectomy subgroup were statistically significant. There were 4 cases of stroke, only 3 of which (2 minor and 1 major) were related to the index lesion. Thus, the rate of major operation-related stroke was 1.43% and the rate of any lesion-related stroke was 4.29%. There was 1 case of AMI in the angioplasty group and there were no deaths in the sample. The overall rate of major adverse cardiovascular events was 5.71%. There were no statistical differences between the endarterectomy and angioplasty groups regarding the main outcomes. Conclusions The rates of outcomes of ischemic stroke, acute myocardial infarction, death, and major adverse cardiovascular events at this center are in line with the rates reported by randomized controlled trials, demonstrating the feasibility of carotid surgery in centers with teaching programs.
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Affiliation(s)
- Tércio Ferreira Oliveira
- Universidade de São Paulo - USP, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brasil.
| | | | - Marcelo Bellini Dalio
- Universidade de São Paulo - USP, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brasil.
| | - Edwaldo Edner Joviliano
- Universidade de São Paulo - USP, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brasil.
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10
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da Silva AA, Moro AB, Toregeani JF. Indications for carotid Doppler ultrasound in asymptomatic patients - are we ordering it correctly? J Vasc Bras 2023; 22:e20220084. [PMID: 37576728 PMCID: PMC10421587 DOI: 10.1590/1677-5449.202200841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 05/18/2023] [Indexed: 08/15/2023] Open
Abstract
Background Carotid arteries are frequently the site of pathologies, the most common being atherosclerosis, which may result in the formation of plaques, causing stenosis. Doppler ultrasound is currently the exam of choice for assessment of the carotid arteries in asymptomatic patients to screen for and diagnose vascular lesions. Current guidelines recommend screening patients who have risk factors for carotid stenosis and who are able and willing to undergo medical treatment and/or carotid intervention. Screening asymptomatic patients in the general adult population who have no significant risk factors is not recommended. Objectives To assess whether medical experts rely on the literature to request Doppler ultrasound for screening. Methods A retrospective selection of patients was performed based on requests for carotid ultrasound. The data collected were computed and analyzed using RStudio version 1.3.959. Results The request was evaluated as appropriate as long as the patients presented at least one risk factor for carotid plaques. Fifty-five out of 152 patients met criteria for carotid screening. The most frequent indication in the study population was vascular check-up. Arterial hypertension was the most prevalent risk factor. Vascular surgery specialists were more likely to order the exam correctly (odds ratio for correct indications: 3.52 [CI 1.14 - 10.87], with p=0.02). The rate of correct Doppler ultrasound requests was 36% (95%CI 29 to 42%). Conclusions An excess of requests for carotid ultrasound screening was found in this study. Vascular surgeons more often requested the test correctly.
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Affiliation(s)
| | | | - Jeferson Freitas Toregeani
- Centro Universitário da Fundação Assis Gurgacz - FAG, Cascavel, PR, Brasil.
- Universidade Estadual do Oeste do Paraná - UNIOESTE, Cascavel, PR, Brasil.
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11
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Zakaria NA, Cheng TC, Nasaruddin RA, Che Hamzah J. Neovascular Glaucoma Complicating Central Retinal Artery Occlusion Despite Cilioretinal Artery Sparing. Cureus 2023; 15:e43303. [PMID: 37700979 PMCID: PMC10492658 DOI: 10.7759/cureus.43303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2023] [Indexed: 09/14/2023] Open
Abstract
This case report aims to describe a case of unilateral central retinal artery occlusion (CRAO) with cilioretinal artery sparing, which was complicated by neovascular glaucoma (NVG). A 75-year-old Indian woman with underlying normal tension glaucoma presented with the sudden onset of painless generalized blurring of the right eye's vision for a week. Her right eye vision was hand motion with the presence of a right relative afferent pupillary defect. Fundus examination revealed retinal whitening over the macula sparing the papillomacular bundle with generalized retinal arteriolar attenuation, which was suggestive of right CRAO with cilioretinal artery sparing. Systemic examination revealed high blood pressure (175/75 mmHg) without ocular bruit or audible murmur on auscultation. Optical coherence tomography of the macula showed inner retinal thickening over the temporal macula. Ultrasound carotid Doppler and computed tomography angiography of the carotid showed more than 75% stenosis over the right distal internal carotid artery. Unfortunately, she developed rubeosis iridis over her right eye two weeks after her presentation, which required pan-retinal photocoagulation. She subsequently progressed to NVG, requiring maximum anti-glaucoma medications to stabilize intraocular pressure. In conclusion, CRAO is a sight-threatening medical emergency. Thorough investigations are required to determine the underlying cause so that early intervention can be done to reduce the risk of a similar attack in the fellow eye and the risk of a cerebrovascular event or cardiac ischemia, which could be life-threatening. The presence of a cilioretinal artery does not prevent ocular neovascularization in CRAO. Hence, patients should also be closely monitored after the initial diagnosis to prevent devastating complications such as NVG.
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Affiliation(s)
- Nur Aisyah Zakaria
- Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, MYS
- Department of Ophthalmology, Hospital Canselor Tuanku Muhriz, Jalan Yaacob Latif, Kuala Lumpur, MYS
| | - Teck Chee Cheng
- Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, MYS
- Department of Ophthalmology, Hospital Canselor Tuanku Muhriz, Jalan Yaacob Latif, Kuala Lumpur, MYS
| | - Rona A Nasaruddin
- Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, MYS
- Department of Ophthalmology, Hospital Canselor Tuanku Muhriz, Jalan Yaacob Latif, Kuala Lumpur, MYS
| | - Jemaima Che Hamzah
- Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, MYS
- Department of Ophthalmology, Hospital Canselor Tuanku Muhriz, Jalan Yaacob Latif, Kuala Lumpur, MYS
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12
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Said S, Dardik A, Ochoa Chaar CI. What are the benefits and drawbacks of statins in carotid artery disease? A perspective review. Expert Rev Cardiovasc Ther 2023; 21:763-777. [PMID: 37994875 DOI: 10.1080/14779072.2023.2286011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/16/2023] [Indexed: 11/24/2023]
Abstract
INTRODUCTION The prevalence of carotid artery stenosis in the general population is approximately 3%, but approximately 20% among people with acute ischemic stroke. Statins are recommended by multiple international guidelines as the drug of choice for lipid control in people with asymptomatic or symptomatic carotid artery stenosis due to their lipid-lowering and other pleiotropic effects. AREAS COVERED This review discusses the guidelines for statin usage as a cornerstone in the prevention and management of atherosclerotic carotid artery disease and the impact of statins on stroke incidence and mortality. Statin side effects, alternative therapy, and genetic polymorphisms are reviewed. EXPERT OPINION Statin therapy is associated with a decreased incidence of stroke and mortality as well as improved outcomes for patients treated with carotid revascularization. Statins are a safe and effective class of medications, but the initiation of therapy warrants close monitoring to avoid rare and potentially serious side effects. Lack of clinical efficacy or the presence of side effects suggests a need for treatment with an alternative therapy such as PCSK9 inhibitors. Understanding the interplay between the mechanisms of statins and PCSK9 inhibition therapies will allow optimal benefits while minimizing risks. Future research into genetic polymorphisms may improve patient selection for personalized therapy.
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Affiliation(s)
- Shreef Said
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Alan Dardik
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
- Department of Cellular and Molecular Physiology, Yale School of Medicine, New Haven, CT, USA
- Department of Surgery, VA Connecticut Healthcare Systems, West Haven, CT, USA
| | - Cassius Iyad Ochoa Chaar
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
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13
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Ismail A, Ravipati S, Gonzalez-Hernandez D, Mahmood H, Imran A, Munoz EJ, Naeem S, Abdin ZU, Siddiqui HF. Carotid Artery Stenosis: A Look Into the Diagnostic and Management Strategies, and Related Complications. Cureus 2023; 15:e38794. [PMID: 37303351 PMCID: PMC10250083 DOI: 10.7759/cureus.38794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2023] [Indexed: 06/13/2023] Open
Abstract
Carotid stenosis (CS) is a buildup of atherosclerotic plaque within the artery leading to a wide range of symptoms, from mild symptoms, including blurred vision and confusion, to much more life-threatening presentations, including paralysis due to stroke. The presentation is insidious, with symptoms exhibiting predominantly at severe stenosis; hence the emphasis is placed on the importance of early diagnosis, treatment, and lifestyle modifications. CS is seen undergoing almost the same pathogenesis of any atherosclerotic plaque formation, from endothelial damage of the artery lumen to the formation of a fibrous cap with a foam cell, lipid-filled core. The findings of our review article were consistent with the recent literature, depicting that comorbid hypertension, diabetes, and chronic kidney disease (CKD), and lifestyle aspects, including smoking and diet, played the most salient role in plaque development. Among several imaging modalities, duplex ultrasound (DUS) imaging is the widely preferred method in clinical practice. Carotid endarterectomy (CEA) and carotid stenting are the primarily advocated procedures for symptomatic severe stenosis, with similar long-term outcomes. Although, earlier clinical trials showed promising results in mitigating the risk of stroke among asymptomatic severe CS with surgical intervention. However, recent advancements have shifted the focus to medical management alone due to comparable results among the asymptomatic population. Both surgical and medical regimens are beneficial in treating patients, but it is still an ongoing debate as to which is predominantly superior. The currently advancing trials and research will help elucidate definitive guidelines. However, the massive impact of lifestyle modifications advocates some degree of individualized multidisciplinary management strategies.
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Affiliation(s)
- Aqsa Ismail
- Department of Medicine, United Medical and Dental College, Karachi, PAK
| | - Shivani Ravipati
- Department of Medicine, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Vijayawada, IND
| | | | - Hashim Mahmood
- Department of Medicine, University College of Medicine and Dentistry, University of Lahore, Lahore, PAK
| | - Alizay Imran
- Department of Surgery, Windsor University School of Medicine, Chicago, USA
| | - Eduardo J Munoz
- Department of General Medicine, Montemorelos University, Montemorelos, MEX
| | - Saad Naeem
- Department of Internal Medicine, Faisalabad Medical University, Faisalabad, PAK
- Department of Internal Medicine, Punjab Social Security Hospital, Faisalabad, PAK
| | - Zain U Abdin
- Department of Medicine, District Head Quarters Hospital, Faisalabad, PAK
| | - Humza F Siddiqui
- Department of Medicine, Jinnah Sindh Medical University, Karachi, PAK
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14
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Alsalmi DK, Abdeen R. Prevalence and Risk Factors of Carotid Artery Stenosis (CAS) Among Cardiac Surgery Patients. Cureus 2023; 15:e37634. [PMID: 37200653 PMCID: PMC10186855 DOI: 10.7759/cureus.37634] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2023] [Indexed: 05/20/2023] Open
Abstract
INTRODUCTION Cardiac disease and carotid atherosclerosis rates have increased in recent years. Carotid artery stenosis (CAS) has been recognized as a high-risk factor of perioperative stroke among cardiac surgery patients. Aims: The aims of the study are to identify the prevalence and common risk factors of CAS among patients undergoing cardiac surgery that include coronary artery bypass surgery or valvular cardiac surgery. MATERIALS AND METHODS This retrospective cross-sectional study was conducted in the radiology department at Medina Cardiac Center, Al Madinah Al-Munawara. The inclusion criteria for the study were patients aged ≥ 20 years who were scheduled for coronary artery bypass surgery or valvular cardiac surgery and had carotid duplex examination before surgery. A Philips X matrix IU22 linear-array ultrasound probe (Philips, Bothell, WA) was used to scan the common carotid artery (CCA), internal carotid artery (ICA), external carotid artery (ECA), and vertebral artery. Results: Of the 261 patients in this study, 78.5% (n = 205) were male. The mean age of patients was 61.6 ± 11.3 years (median: 62.0; range: 55.5-68.0). The overall prevalence of CAS was 71% (n = 187): 52% (n = 136) with bilateral CAS and 19.5% (n = 51) with unilateral CAS. Age group was significantly associated with bilateral CAS and the severity of CAS (p = 0.001). Diabetes mellitus, hypertension and both diabetes mellitus and hypertension together were significantly associated with CAS status (p < 0.05, for all). A significantly higher proportion of smokers had a mild level of CAS on the left side compared to non-smokers (55.8% vs. 46.5%, p = 0.033). Gender and weight status were not linked to severity of CAS. CONCLUSION This study shows a high prevalence of CAS among cardiac surgery patients. In addition, older age, diabetes mellitus, and hypertension were found to be major risk factors for CAS. Gender and weight status were not associated with CAS. Preoperative carotid duplex scan is a useful exam to identify CAS among cardiac surgery patients and, therefore, to predict and reduce postoperative neurological complications.
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Affiliation(s)
- Danah K Alsalmi
- Faculty of Applied Medical Sciences, Radiologic Sciences, King Abdulaziz University, Jeddah, SAU
| | - Rawan Abdeen
- Faculty of Applied Medical Sciences, Radiologic Sciences, King Abdulaziz University, Jeddah, SAU
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15
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Wang LY, Wu TW, Chou CL, Lu SX, Cheng CF. Reply to "The impact of hyperlipidemia and carotid atherosclerosis". J Chin Med Assoc 2023; 86:453. [PMID: 36740740 DOI: 10.1097/jcma.0000000000000896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Li-Yu Wang
- Department of Neurology, MacKay Memorial Hospital, New Taipei City, Taiwan, ROC
| | - Tzu-Wei Wu
- Department of Neurology, MacKay Memorial Hospital, New Taipei City, Taiwan, ROC
| | - Chao-Liang Chou
- Department of Neurology, MacKay Memorial Hospital, New Taipei City, Taiwan, ROC
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan, ROC
| | - Shu-Xin Lu
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan, ROC
| | - Chun-Fang Cheng
- Department of Health, Bali Health Station, New Taipei City Government, New Taipei City, Taiwan, ROC
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16
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Lisowska A, Dubatówka M, Chlabicz M, Jamiołkowski J, Kondraciuk M, Szyszkowska A, Knapp M, Szpakowicz A, Łukasiewicz A, Kamiński K. Disparities in the Prevalence and Risk Factors for Carotid and Lower Extremities Atherosclerosis in a General Population—Bialystok PLUS Study. J Clin Med 2023; 12:jcm12072627. [PMID: 37048709 PMCID: PMC10095274 DOI: 10.3390/jcm12072627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/01/2023] Open
Abstract
This study was conducted in a representative sample of area residents aged 20–80 years old. The aim of the study was to assess the prevalence of classic risk factors of atherosclerosis in the studied population and to search for new risk factors in these patient subpopulations. A total of 795 people (mean age 48.64 ± 15.24 years, 45.5% male) were included in the study group. Two independent data analyses were performed. In the first analysis, the study group was divided into two subgroups depending on the presence or absence of atherosclerotic plaques in carotid arteries (APCA). APCA were observed in 49.7% of the study group: in the population aged between 41 and 60 years in 49.3%, and those between 61 and 70 years in 86.3%. Patients with APCA were more often diagnosed with arterial hypertension, diabetes, and hypercholesterolemia. In the second analysis, the study group was divided into two subgroups depending on the presence of lower extremities atherosclerotic disease (LEAD). Patients with an ABI (ankle-brachial index) ≤ 0.9 constituted 8.5% of the study group, and they were significantly older, and more often diagnosed with diabetes and APCA. To identify the factors most strongly associated with APCA and an ABI ≤ 0.9, logistic regression was used, with stepwise elimination of variables. The strongest factors associated with APCA were current smoking and diastolic central pressure. We did not note such an association and did not find additional parameters to facilitate the diagnosis of LEAD in asymptomatic patients. The most important observation in our study was the high prevalence of APCA in the study population, especially in the group of young people under the age of 60.
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17
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Lu SX, Wu TW, Chou CL, Cheng CF, Wang LY. Combined effects of hypertension, hyperlipidemia, and diabetes mellitus on the presence and severity of carotid atherosclerosis in community-dwelling elders: A community-based study. J Chin Med Assoc 2023; 86:220-226. [PMID: 36652568 DOI: 10.1097/jcma.0000000000000839] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Hypertension, hyperlipidemia, and diabetes mellitus (DM) are common cardiovascular disease (CVD) comorbidities and well-known major determinants of atherosclerosis. However, their combined effects and relative contributions have not been well explored. This study aimed to characterize the characteristics of carotid atherosclerosis and dissect the relative effects of these common CVD comorbidities on the presence and severity of carotid atherosclerosis in community-dwelling elderly individuals. METHODS We enrolled 817 elders from communities in northern Taiwan. We evaluated their cardiovascular risk profiles and scanned their extracranial carotid arteries using high-resolution ultrasonography systems. RESULTS The prevalence rates for hypertension, hyperlipidemia, and DM were 45.4%, 37.1%, and 16.8%, respectively. Sixty-two (7.6%) and 188 (23.0%) elderly had all three and two of these common CVD comorbidities, respectively. The prevalent rates of carotid plaque and moderate-to-severe atherosclerosis were 62.9% and 35.5%, respectively. The percentages of one or more common CVD comorbidities in elders with carotid plaque and moderate-to-severe atherosclerosis were 78.2% and 83.1%, respectively. Multivariate analyses showed that the number of common CVD comorbidities was the most predictive determinant. Multivariable-adjusted odds ratios (ORs) per comorbidity for the presence of carotid plaque and advanced carotid atherosclerosis were 1.52 (95% CI, 1.28-1.81) and 1.57 (95% CI, 1.28-1.93), respectively. Models containing hypertension and DM were the second most predictive. Combinatory analyses showed distinct relationship patterns between carotid atherosclerosis and hypertension, hyperlipidemia, and DM. Hypertension was significantly correlated with higher ORs for the presence of carotid plaque and advanced carotid atherosclerosis but not for hyperlipidemia. CONCLUSION Carotid plaques are highly prevalent in community-dwelling elders. The number of common CVD comorbidities was the most predictive determinant of carotid plaques and advanced carotid atherosclerosis. Our results indicate that to reduce the impact of atherosclerotic diseases, blood pressure controls precede the control of blood lipids and glucose in the community-dwelling elders.
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Affiliation(s)
- Shu-Xin Lu
- Department of Neurology, MacKay Memorial Hospital, New Taipei City, Taiwan, ROC
| | - Tzu-Wei Wu
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan, ROC
| | - Chao-Liang Chou
- Department of Neurology, MacKay Memorial Hospital, New Taipei City, Taiwan, ROC
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan, ROC
| | - Chun-Fang Cheng
- Bali Health Station, Department of Health, New Taipei City Government, New Taipei City, Taiwan, ROC
| | - Li-Yu Wang
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan, ROC
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18
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Kurian AL, Lucke-Wold B. Update on Management of Symptomatic Carotid Stenosis. JOURNAL OF NEUROSCIENCE AND NEUROLOGICAL SURGERY 2023; 13:255. [PMID: 37547058 PMCID: PMC10403258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Carotid artery stenosis (CAS) is one of the leading causes of cerebral ischemia and stroke.7 When plaque builds up in the internal carotid artery, it blocks blood flow to the brain. Oftentimes, this condition only comes to light after a patient experiences a stroke or stroke-like symptoms. When this occurs, cholesterol-lowering medications and blood thinners can help to increase blood flow to the brain. However, if the plaque is so large that it severely narrows the lumen of the artery, surgery may be required to restore blood flow to the brain. Patients with severe stenosis can undergo procedures such as carotid endarterectomies (CEA), stenting, and transcarotid artery revascularization (TCAR) for this purpose. In this review, we discuss these procedures and which patients warrant which type of intervention. We look at the pathophysiology of internal carotid artery stenosis and current treatment options, while highlighting emerging treatment options. This review aims to increase understanding of the management of symptomatic carotid artery stenosis as well as provide a groundwork for more innovative treatments.
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Affiliation(s)
- Annu L Kurian
- Florida State University College of Medicine, Tallahassee, U.S.A
| | - Brandon Lucke-Wold
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, U.S.A
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Habib S, Hafeez MS, Yuo TH, Subramaniam K. The Unstable Carotid Plaque. Anesthesiol Clin 2022; 40:737-749. [PMID: 36328626 DOI: 10.1016/j.anclin.2022.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Carotid revascularization is performed to prevent cerebrovascular events in patients with symptomatic (>50%) and asymptomatic high degree (>70%) carotid stenosis. As this operation carries significant risks for perioperative stroke, careful selection of patients who will benefit from the procedure is essential. Certain plaque characteristics, including texture, are associated with increased tendency for rupture and can be used to identify high-risk patients. Medical therapy, carotid endarterectomy, and carotid stenting are the mainstays for patient management. With careful selection of patients, all anesthesia techniques (general anesthesia, monitored anesthesia care, and regional anesthesia) can be used safely for these revascularization procedures.
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Affiliation(s)
- Salim Habib
- Department of Vascular Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, USA; Division of Vascular Surgery, Department of Surgery, University of Pittsburgh School of Medicine, UPMC Presbyterian Hospital, 200 Lothrop Street, Pittsburgh, PA 15143, USA
| | - Muhammad Saad Hafeez
- Department of Vascular Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, USA; Division of Vascular Surgery, Department of Surgery, University of Pittsburgh School of Medicine, UPMC Presbyterian Hospital, 200 Lothrop Street, Pittsburgh, PA 15143, USA
| | - Theodore H Yuo
- Division of Vascular Surgery, Department of Surgery, University of Pittsburgh School of Medicine, UPMC Presbyterian Hospital, 200 Lothrop Street, Pittsburgh, PA 15143, USA
| | - Kathirvel Subramaniam
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, 3471 5th Avenue Ste 402, Pittsburgh, PA 15213, USA.
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20
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Johal A, Imburgio S, Pannu V, Pozdniakova H, Udongwo N, Hossain M, Patel S. A Rare and Unusual Cause of Ischemic Stroke to Be Aware of. J Med Cases 2022; 13:536-540. [PMID: 36506759 PMCID: PMC9728151 DOI: 10.14740/jmc4015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/07/2022] [Indexed: 11/28/2022] Open
Abstract
Congenital absence of an internal carotid artery (ICA) is an extremely rare vascular anomaly. This case report presents an instance of right ICA agenesis to highlight the importance of early identification of this anomaly and its impact on disease presentation and complications. With transient ischemic attack (TIA), cerebrovascular accident (CVA), and cerebral aneurysms being among the chief presenting scenarios or course of the anomaly, it is important to have a high level of suspicion for these in patients with known ICA agenesis. Understanding the underlying development of this vasculature and its impact on cerebral circulation aids in identifying possible findings on imaging. This case report aims to delineate the pathophysiology of ICA agenesis, recognition of the vasculature that contributes to the anomaly, different presentations of the disease, complications, and obstacles in management.
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Affiliation(s)
- Anmol Johal
- Department of Medicine, Jersey Shore University Medical Center, Neptune City, NJ 07753, USA,Corresponding Author: Anmol Johal, Department of Medicine, Jersey Shore University Medical Center, Neptune City, NJ 07753, USA.
| | - Steven Imburgio
- Department of Medicine, Jersey Shore University Medical Center, Neptune City, NJ 07753, USA
| | - Viraaj Pannu
- Department of Medicine, Jersey Shore University Medical Center, Neptune City, NJ 07753, USA
| | - Helen Pozdniakova
- Department of Medicine, Jersey Shore University Medical Center, Neptune City, NJ 07753, USA
| | - Ndausung Udongwo
- Department of Medicine, Jersey Shore University Medical Center, Neptune City, NJ 07753, USA
| | - Mohammad Hossain
- Department of Medicine, Jersey Shore University Medical Center, Neptune City, NJ 07753, USA
| | - Swapnil Patel
- Department of Medicine, Jersey Shore University Medical Center, Neptune City, NJ 07753, USA
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21
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Wu D, Cui G, Huang X, Chen Y, Liu G, Ren L, Li Y. An accurate and explainable ensemble learning method for carotid plaque prediction in an asymptomatic population. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 221:106842. [PMID: 35569238 DOI: 10.1016/j.cmpb.2022.106842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 04/17/2022] [Accepted: 04/26/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE The identification of carotid plaque, one of the most crucial tasks in stroke screening, is of great significance in the assessment of subclinical atherosclerosis and preventing the onset of stroke. However, traditional ultrasound examination is not prevalent or cost-effective for asymptomatic people, particularly low-income individuals in rural areas. Thus, it is necessary to develop an accurate and explainable model for early identification of the risk of plaque prevalence that can help in the primary prevention of stroke. METHODS We developed an ensemble learning method to predict the occurrence of carotid plaques. A dataset comprising 1440 subjects (50% with plaques and 50% without plaques) and ten-fold cross-validation were utilized to evaluate the model performance. Four machine learning methods (extreme gradient boosting (XGBoost), gradient boosting decision tree, random forest, and support vector machine) were evaluated. Subsequently, the interpretability of the XGBoost model, which provided the best performance, was analyzed from three aspects: feature importance, feature effect on prediction model, and feature effect on prediction decision for a specific subject. RESULTS The XGBoost algorithm provided the best performance (sensitivity: 0.8678, specificity: 0.8592, accuracy: 0.8632, F1 score: 0.8621, area under the curve: 0.8635) in carotid plaque prediction and also had excellent performance under missing data circumstances. Further, interpretability analysis showed that the decisions of the XGBoost model were highly congruent with clinical knowledge. CONCLUSION The model results are superior to those of state-of-the-art methods. Thus, it is a promising carotid plaque prediction tool that could be used in the primary prevention of stroke.
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Affiliation(s)
- Dan Wu
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong Province, China
| | - Guosheng Cui
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong Province, China
| | - Xiaoxiang Huang
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong Province, China; School of Control Science and Engineering, Shandong University, Jinan, Shandong Province, China
| | - Yining Chen
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong Province, China
| | - Guanzheng Liu
- School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, Shenzhen, Guangdong Province, China
| | - Lijie Ren
- Department of neurology, Shenzhen Second People's Hospital, Shenzhen, Guangdong Province, China.
| | - Ye Li
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong Province, China.
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22
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Hassani S, Fisher M. Management of Atherosclerotic Carotid Artery Disease: A Brief Overview and Update. Am J Med 2022; 135:430-434. [PMID: 34732352 DOI: 10.1016/j.amjmed.2021.09.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 09/22/2021] [Accepted: 09/28/2021] [Indexed: 11/01/2022]
Abstract
Extracranial carotid atherosclerotic disease has been associated with approximately 15%-20% of ischemic stroke cases and is a leading cause of mortality and disability worldwide. Medical, surgical, and endovascular therapies for the prevention of stroke from carotid disease have advanced considerably over the past quarter century. The objective of this review is to outline the clinical presentation of symptomatic carotid artery stenosis and the risk factors associated with development of carotid artery stenosis and then summarize the current evidence-based medical treatment modalities, along with available surgical and endovascular therapies.
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Affiliation(s)
- Sara Hassani
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.
| | - Marc Fisher
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
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23
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Carotid artery screening in asymptomatic individuals of different ethnic origins. COR ET VASA 2022. [DOI: 10.33678/cor.2021.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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24
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Bibangambah P, Hemphill LC, Acan M, Tsai AC, Sentongo RN, Kim JH, Yang IT, Siedner MJ, Okello S. Prevalence and correlates of carotid plaque in a mixed HIV-serostatus cohort in Uganda. BMC Cardiovasc Disord 2021; 21:593. [PMID: 34911457 PMCID: PMC8672630 DOI: 10.1186/s12872-021-02416-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/07/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The extent to which the risk of atherosclerotic cardiovascular disease (ACVD) is increased among people living with HIV (PLWH) in sub-Saharan Africa remains unknown. SETTING Cross-sectional analysis nested within the Ugandan Noncommunicable Diseases and Aging Cohort, including PLWH in rural Uganda > 40 years taking antiretroviral therapy (ART) for at least 3 years, and a population-based control group of HIV-uninfected age- and sex-matched persons. METHODS We conducted carotid ultrasonography and collected ACVD risk factor data. Our outcome of interest was carotid plaque, defined as > 1.5 mm thickness from the intima-lumen interface to the media-adventitia interface. We fit multivariable logistic regression models to estimate correlates of carotid plaque including HIV-specific and traditional cardiovascular risk factors. RESULTS We enrolled 155 (50.2%) PLWH and 154 (49.8%) HIV-uninfected comparators, with a mean age of 51.4 years. Among PLWH, the median CD4 count was 433 cells/mm3 and 97.4% were virologically suppressed. Carotid plaque prevalence was higher among PLWH (8.4% vs 3.3%). HIV infection (aOR 3.90; 95% CI 1.12-13.60) and current smokers (aOR 6.60; 95% CI 1.22-35.80) had higher odds of carotid plaque, whereas moderate (aOR 0.13, 95% CI 0.01-1.55) and vigorous intensity of physical activity (aOR 0.34, 95% CI 0.07-1.52) were associated with decreased odds of carotid plaque. CONCLUSION In rural Uganda, PLWH have higher prevalence of carotid plaque compared to age- and sex-matched HIV-uninfected comparators. Future work should explore how biomedical and lifestyle modifications might reduce atherosclerotic burden among PLWH in the region.
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Affiliation(s)
- Prossy Bibangambah
- Department of Radiology, Mbarara University of Science and Technology, P.O. Box, 1410, Mbarara, Uganda.
| | - Linda C. Hemphill
- grid.32224.350000 0004 0386 9924Massachusetts General Hospital, Boston, MA USA ,grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA
| | - Moses Acan
- grid.33440.300000 0001 0232 6272Department of Radiology, Mbarara University of Science and Technology, P.O. Box, 1410 Mbarara, Uganda
| | - Alexander C. Tsai
- grid.32224.350000 0004 0386 9924Massachusetts General Hospital, Boston, MA USA
| | - Ruth N. Sentongo
- grid.33440.300000 0001 0232 6272Department of Radiology, Mbarara University of Science and Technology, P.O. Box, 1410 Mbarara, Uganda
| | - June-Ho Kim
- grid.32224.350000 0004 0386 9924Massachusetts General Hospital, Boston, MA USA
| | - Isabelle T. Yang
- grid.254880.30000 0001 2179 2404Geisel School of Medicine at Dartmouth, Hanover, NH USA
| | - Mark J. Siedner
- grid.33440.300000 0001 0232 6272Department of Radiology, Mbarara University of Science and Technology, P.O. Box, 1410 Mbarara, Uganda ,grid.32224.350000 0004 0386 9924Massachusetts General Hospital, Boston, MA USA ,grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA
| | - Samson Okello
- grid.33440.300000 0001 0232 6272Department of Radiology, Mbarara University of Science and Technology, P.O. Box, 1410 Mbarara, Uganda
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25
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Chen J, Qin Q, Yan S, Yang Y, Yan H, Li T, Wang L, Gao X, Li A, Ding S. Gut Microbiome Alterations in Patients With Carotid Atherosclerosis. Front Cardiovasc Med 2021; 8:739093. [PMID: 34869642 PMCID: PMC8639581 DOI: 10.3389/fcvm.2021.739093] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 10/18/2021] [Indexed: 01/15/2023] Open
Abstract
Carotid atherosclerosis (CAS) is a reflection of systemic atherosclerosis and the main pathological processes of cardiovascular disease (CVD), namely, carotid intima-media thickening, carotid plaque formation, and carotid stenosis. Accumulating evidence indicates that the gut microbiota plays an important role in CVD and gut-brain disorders, but the associations of the composition and metabolites of the gut microbiome with CAS have not been studied comprehensively. We performed a gut microbiome genome-wide association study in 31 patients with CAS and 51 healthy controls using whole-genome shotgun sequencing. We found that several risk factors (waist circumference, body mass index, diastolic blood pressure, systolic blood pressure, fasting blood glucose, glycated hemoglobin A1c, total cholesterol, triglyceride, and low-density lipoprotein cholesterol) and inflammatory markers (white blood cell count and absolute value of neutrophils) were significantly higher in the CAS group than in the control group. In addition, 21 species and 142 pathways were enriched in the CAS group, and 10 species and 1 pathway were enriched in the control group. Specifically, Bacteroides eggerthii, Escherichia coli, and Klebsiella pneumoniae were the most abundant species in the CAS group, whereas Parabacteroides unclassified, Prevotella copri, Bacteroides sp 3_1_19, and Haemophilus parainfluenzae were the most abundant species in the control group. Finally, we found that most gut microbes and microbial pathways that were enriched in the CAS group had significant positive correlations with clinical characteristics, whereas the microbes and pathways enriched in healthy controls had significant negative correlations with clinical characteristics excluding high-density lipoprotein cholesterol. In addition, the associations between gut microbes and some microbial pathways (short-chain fatty acid, lipopolysaccharide, and menaquinol biosynthesis) were identified. Our results indicate the existence of a cyclic pathway that elevates the circulating concentrations of trimethylamine-N-oxide in patients with CAS but reduces its concentrations in healthy controls.
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Affiliation(s)
- Jingfeng Chen
- Health Management Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qian Qin
- Health Management Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Su Yan
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Yang Yang
- Health Management Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hang Yan
- Health Management Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Tiantian Li
- Health Management Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lin Wang
- Health Management Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xinxin Gao
- Health Management Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ang Li
- Health Management Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Gene Hospital of Henan, Precision Medicine Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Suying Ding
- Health Management Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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26
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Zaki MM, Koch MJ, Patel AB, Shankar GM. A case report of simultaneous surgery for concurrent symptomatic carotid artery and cervical spinal stenosis. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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27
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Lazar RM, Wadley VG, Myers T, Jones MR, Heck DV, Clark WM, Marshall RS, Howard VJ, Voeks JH, Manly JJ, Moy CS, Chaturvedi S, Meschia JF, Lal BK, Brott TG, Howard G. Baseline Cognitive Impairment in Patients With Asymptomatic Carotid Stenosis in the CREST-2 Trial. Stroke 2021; 52:3855-3863. [PMID: 34433306 DOI: 10.1161/strokeaha.120.032972] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Studies of carotid artery disease have suggested that high-grade stenosis can affect cognition, even without stroke. The presence and degree of cognitive impairment in such patients have not been reported and compared with a demographically matched population-based cohort. METHODS We studied cognition in 1000 consecutive CREST-2 (Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trial) patients, a treatment trial for asymptomatic carotid disease. Cognitive assessment was after randomization but before assigned treatment. The cognitive battery was developed in the general population REGARDS Study (Reasons for Geographic and Racial Differences in Stroke), involving Word List Learning Sum, Word List Recall, and Word List fluency for animal names and the letter F. The carotid stenosis patients were >45 years old with ≥70% asymptomatic carotid stenosis and no history of prevalent stroke. The distribution of cognitive performance for the patients was standardized, accounting for age, race, and education using performance from REGARDS, and after further adjustment for hypertension, diabetes, dyslipidemia, and smoking. Using the Wald Test, we tabulated the proportion of Z scores less than the anticipated deviate for the population-based cohort for representative percentiles. RESULTS There were 786 baseline assessments. Mean age was 70 years, 58% men, and 52% right-sided stenosis. The overall Z score for patients was significantly below expected for higher percentiles (P<0.0001 for 50th, 75th, and 95th percentiles) and marginally below expected for the 25th percentile (P=0.015). Lower performance was attributed largely to Word List Recall (P<0.0001 for all percentiles) and for Word List Learning (50th, 75th, and 95th percentiles below expected, P≤0.01). The scores for left versus right carotid disease were similar. CONCLUSIONS Baseline cognition of patients with severe carotid stenosis showed below normal cognition compared to the population-based cohort, controlling for demographic and cardiovascular risk factors. This cohort represents the largest group to date to demonstrate that poorer cognition, especially memory, in this disease. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT02089217.
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Affiliation(s)
- Ronald M Lazar
- UAB Evelyn F. McKnight Brain Institute, Department of Neurology, The University of Alabama at Birmingham. (R.M.L., T.M.)
| | - Virginia G Wadley
- Department of Medicine, The University of Alabama at Birmingham. (V.G.W.)
| | - Terina Myers
- UAB Evelyn F. McKnight Brain Institute, Department of Neurology, The University of Alabama at Birmingham. (R.M.L., T.M.)
| | | | - Donald V Heck
- Diagnostic Radiology, Novant Health, Winston-Salem, NC (D.V.H.)
| | - Wayne M Clark
- Department of Neurology, Oregon Health & Science University, Portland (W.M.C.)
| | - Randolph S Marshall
- Department of Neurology, Columbia University Irving Medical Center, New York NY. (R.S.M.)
| | - Virginia J Howard
- Department of Epidemiology, The University of Alabama at Birmingham. (V.J.H.)
| | - Jenifer H Voeks
- Department of Neurology, Medical University of South Carolina, Charleston, SC (J.H.V.)
| | - Jennifer J Manly
- Gertrude H. Sergievsky Center and the Taub Institute for Research in Aging and Alzheimer's Disease, Columbia University Irving Medical Center, New York NY. (J.J.M.)
| | - Claudia S Moy
- Department of Health & Human Services, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (C.S.M.)
| | - Seemant Chaturvedi
- Department of Neurology, University of Maryland School of Medicine, Baltimore. (S.C.)
| | - James F Meschia
- Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M., T.G.B.)
| | - Brajesh K Lal
- Department of Surgery, University of Maryland School of Medicine, Baltimore. (B.K.L.)
| | - Thomas G Brott
- Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M., T.G.B.)
| | - George Howard
- Department of Biostatistics, University of Alabama School of Public Health (G.H.)
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28
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See AP, Charbel FT. Bypass for flow-augmentation in atherosclerotic carotid occlusion: a review of the literature and career experience. J Neurosurg Sci 2021; 65:305-321. [PMID: 33709658 DOI: 10.23736/s0390-5616.21.05094-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Atherosclerosis of the internal carotid artery and intracranial vessels can compromise cerebral hemodynamics and cause stroke. Cerebral bypass has a half-century history in augmenting or replacing blood flow the brain. Several trials have investigated various applications of cerebral bypass in flow augmentation for atherosclerotic disease. This review discusses the clinical science of cerebrovascular atherosclerosis to provide the context in which cerebral bypass is currently applied. This includes prior clinical trials, ongoing clinical trials, and consensus guidelines, and is complemented by studies in the physiologic science of cerebrovascular flow. The scientific background is supplemented by the description of the technical art of bypass surgery based on a three-decade experience. Successful application of cerebral bypass to augment flow in atherosclerotic cerebrovascular disease requires correct diagnosis of compromised hemodynamic reserve refractory to medical optimization and an appropriate matching of bypass flow with cerebral demand.
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29
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Sadeghi JK, Nofi C, Frankini LA, Landis GS, Etkin Y. Epiglottic hematoma after carotid endarterectomy with cervical block. J Vasc Surg Cases Innov Tech 2020; 6:528-530. [PMID: 33134635 PMCID: PMC7588747 DOI: 10.1016/j.jvscit.2020.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 07/30/2020] [Indexed: 11/20/2022] Open
Abstract
There are few trials assessing the risks and benefits of performing a cervical plexus block (CPB) in urgent carotid endarterectomies (CEA). We describe a case of a patient who underwent urgent CEA under CPB and suffered a complication of postoperative epiglottic hematoma. There were clinical findings that helped to distinguish the hematoma from other, more common postoperative complications. The mainstay of treatment was steroids and observation. Epiglottic hematomas after cervical blocks for CEAs are rare but potentially lethal complications. More research is needed investigating complications related to CPBs performed for CEAs.
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Affiliation(s)
- John K. Sadeghi
- Department of Surgery at Northshore-LIJMC, Northwell Health, Division of Vascular and Endovascular Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY
| | - Colleen Nofi
- Department of Surgery at Northshore-LIJMC, Northwell Health, Division of Vascular and Endovascular Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY
| | - Larry A. Frankini
- Department of Surgery at Northshore-LIJMC, Northwell Health, Division of Vascular and Endovascular Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY
| | - Gregg S. Landis
- Department of Surgery at Northshore-LIJMC, Northwell Health, Division of Vascular and Endovascular Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY
| | - Yana Etkin
- Department of Surgery at Northshore-LIJMC, Northwell Health, Division of Vascular and Endovascular Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY
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30
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Lattanzi S, Rinaldi C, Pulcini A, Corradetti T, Angelocola S, Zedde ML, Ciliberti G, Silvestrini M. Clinical phenotypes of embolic strokes of undetermined source. Neurol Sci 2020; 42:297-300. [DOI: 10.1007/s10072-020-04700-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/28/2020] [Indexed: 11/28/2022]
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31
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Kang KM, Byun MS, Lee JH, Yi D, Choi HJ, Lee E, Lee Y, Lee JY, Kim YK, Sohn BK, Sohn CH, Lee DY. Association of carotid and intracranial stenosis with Alzheimer's disease biomarkers. ALZHEIMERS RESEARCH & THERAPY 2020; 12:106. [PMID: 32912336 PMCID: PMC7488394 DOI: 10.1186/s13195-020-00675-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 09/01/2020] [Indexed: 12/20/2022]
Abstract
Background To clarify whether atherosclerosis of the carotid and intracranial arteries is related to Alzheimer’s disease (AD) pathology in vivo, we investigated the associations of carotid and intracranial artery stenosis with cerebral beta-amyloid (Aβ) deposition and neurodegeneration in middle- and old-aged individuals. Given different variations of the pathologies between cognitive groups, we focused separately on cognitively normal (CN) and cognitively impaired (CI) groups. Methods A total of 281 CN and 199 CI (mild cognitive impairment and AD dementia) subjects underwent comprehensive clinical assessment, [11C] Pittsburgh compound B-positron emission tomography, and magnetic resonance (MR) imaging including MR angiography. We evaluated extracranial carotid and intracranial arteries for the overall presence, severity (i.e., number and degree of narrowing), and location of stenosis. Results We found no associations between carotid and intracranial artery stenosis and cerebral Aβ burden in either the CN or the CI group. In terms of neurodegeneration, exploratory univariable analyses showed associations between the presence and severity of stenosis and regional neurodegeneration biomarkers (i.e., reduced hippocampal volume [HV] and cortical thickness in the AD-signature regions) in both the CN and CI groups. In confirmatory multivariable analyses controlling for demographic covariates and diagnosis, the association between number of stenotic intracranial arteries ≥ 2 and reduced HV in the CI group remained significant. Conclusions Neither carotid nor intracranial artery stenosis appears to be associated with brain Aβ burden, while intracranial artery stenosis is related to amyloid-independent neurodegeneration, particularly hippocampal atrophy.
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Affiliation(s)
- Koung Mi Kang
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Min Soo Byun
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jun Ho Lee
- Department of Neuropsychiatry, National Center for Mental Health, Seoul, Republic of Korea
| | - Dahyun Yi
- Institute of Human Behavioral Medicine, Medical Research Center Seoul National University, Seoul, Republic of Korea
| | - Hye Jeong Choi
- Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Eunjung Lee
- Department of Radiology, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Younghwa Lee
- Department of Neuropsychiatry, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Jun-Young Lee
- Department of Neuropsychiatry, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea.,Department of Psychiatry, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Yu Kyeong Kim
- Department of Nuclear Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Bo Kyung Sohn
- Department of Psychiatry, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Chul-Ho Sohn
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea. .,Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
| | - Dong Young Lee
- Institute of Human Behavioral Medicine, Medical Research Center Seoul National University, Seoul, Republic of Korea. .,Department of Neuropsychiatry, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea. .,Department of Psychiatry, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
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32
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Badea R, Terecoasa E, Ribigan A, Dimitriade A, Carp A, Dorobat B, Antochi F, Bajenaru O. Factors Associated with Severe Carotid Artery Stenosis in a Population with One of the Highest Incidences of Ischemic Stroke in Europe - Single National Center Analysis. MAEDICA 2020; 15:339-347. [PMID: 33312250 PMCID: PMC7726510 DOI: 10.26574/maedica.2020.15.3.339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Introduction: Despite significant advances in its prevention and acute-phase treatment, stroke is still one of the leading causes of disability and death worldwide. Ischemic stroke accounts for 80 to 87% of all strokes, with 15-30% of cases being caused by extracranial carotid artery (CA) stenosis. Methods: This is an observational, cross-sectional, single-center, prospective, registry-based study. The current research presents the preliminary results after analyzing the demographic features, biological data, and cardio- and cerebro-vascular risk factors of the first 74 patients included in the first "Romanian registry for cervical and cerebral arterial stenosis." Results: In our group of patients, the severity of carotid artery stenosis was related to fibrinogen, total cholesterol, and triglyceride blood levels. Moreover, patients who underwent carotid artery stenosis were more prone to having peri-procedural complications if they had a low blood platelet count. Concerning the associated pathologies of patients with severe carotid atheromatosis, the risk of having lower cognitive abilities was higher in subjects with atrial fibrillation, regardless of the severity of carotid artery stenosis. Conclusions: The presented study brings essential information about a population more prone to cerebral ischemic events than that of most other countries. All data obtained until this moment and which will further result from analyzing the clinical, demographic, and biological features of patients included in this registry should be used for implementing populational strategies for preventing further strokes.
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Affiliation(s)
- R Badea
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania Emergency University Hospital of Bucharest, Romania
| | - E Terecoasa
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania Emergency University Hospital of Bucharest, Romania
| | - A Ribigan
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania Emergency University Hospital of Bucharest, Romania
| | - A Dimitriade
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania Emergency University Hospital of Bucharest, Romania
| | - A Carp
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania Emergency University Hospital of Bucharest, Romania
| | - B Dorobat
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania Emergency University Hospital of Bucharest, Romania
| | - F Antochi
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania Emergency University Hospital of Bucharest, Romania
| | - O Bajenaru
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania Emergency University Hospital of Bucharest, Romania
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Global and regional prevalence, burden, and risk factors for carotid atherosclerosis: a systematic review, meta-analysis, and modelling study. LANCET GLOBAL HEALTH 2020; 8:e721-e729. [PMID: 32353319 DOI: 10.1016/s2214-109x(20)30117-0] [Citation(s) in RCA: 363] [Impact Index Per Article: 90.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/02/2020] [Accepted: 03/18/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Estimation of the epidemiological burden of carotid atherosclerosis can serve as a basis for prevention and management of cardiovascular disease. We aimed to provide the first estimation on the prevalence, number of cases, and risk factors for carotid atherosclerosis in the general population globally and regionally. METHODS In this systematic review, meta-analysis, and modelling study, we searched PubMed, MEDLINE, Embase, Global Health, and China National Knowledge Infrastructure for articles published from database inception until May 7, 2019, with no language restrictions, for population-based studies that quantified prevalence of carotid atherosclerosis by means of increased carotid intima-media thickness, carotid plaque, and carotid stenosis. Studies were eligible if they included bilaterally scanned carotid arteries using ultrasonography and defined increased carotid intima-media thickness as a thickness of 1·0 mm or more, carotid plaque as a focal carotid intima-media thickness of 1·5 mm or more encroaching into the lumen or at least 0·5 mm or 50% compared with the surrounding carotid intima-media thickness values, and carotid stenosis as 50% or more stenosis. Studies were excluded if the sample was not representative of the general population. We also included studies identified in our previous systematic review and meta-analysis of the prevalence of carotid atherosclerosis in China. We estimated age-specific and sex-specific prevalences of increased carotid intima-media thickness, carotid plaque, and carotid stenosis. We used UN population data to generate the number of people affected in 2000, 2015, and 2020. We did random-effects meta-analyses to assess the effects of risk factors for increased carotid intima-media thickness and carotid plaque. We derived regional numbers of people living with increased carotid intima-media thickness and carotid plaque in 2015 using a risk factors-based model by WHO region. All analyses were done in populations aged 30-79 years due to availability of data. This systematic review and meta-analysis is registered online on PROSPERO, CRD42019134709. FINDINGS We identified 8632 articles through our database search, of which 515 were eligible for full-text review, including 37 articles from our previous study, and 59 articles were eligible for inclusion in our systematic review and meta-analysis. Overall, in people aged 30-79 years in 2020, the global prevalence of increased carotid intima-media thickness is estimated to be 27·6% (95% CI 16·9-41·3), equivalent to 1066·70 million affected people and a percentage change of 57·46% from 2000; of carotid plaque is estimated to be 21·1% (13·2-31·5), equivalent to 815·76 million affected people and a percentage change of 58·97% from 2000; and carotid stenosis is estimated to be 1·5% (1·1-2·1), equivalent to 57·79 million affected people and a percentage change of 59·13% from 2000. The prevalence of increased carotid intima-media thickness, carotid plaque, and carotid stenosis increased consistently with age and was higher in men than in women. Current smoking, diabetes, and hypertension were common risk factors for increased carotid intima-media thickness and carotid plaque. In 2015, the Western Pacific region had the largest share of global cases of increased carotid intima-media thickness (317·62 million [33·36%] of 952·13 million affected people) and carotid plaque (240·77 million [33·20%] of 725·25 million), whereas the African region had the smallest share of cases of increased carotid intima-media thickness (59·08 million [6·21%]) and the Eastern Mediterranean region had the smallest share of carotid plaque cases (44·59 million [6·15%]). INTERPRETATION A substantial global burden of carotid atherosclerosis exists. Effective strategies are needed for primary prevention and management of carotid atherosclerosis. High-quality epidemiological investigations on carotid atherosclerosis are needed to better address the global burden of carotid atherosclerosis at finer levels. FUNDING None.
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Porcu M, Mannelli L, Melis M, Suri JS, Gerosa C, Cerrone G, Defazio G, Faa G, Saba L. Carotid plaque imaging profiling in subjects with risk factors (diabetes and hypertension). Cardiovasc Diagn Ther 2020; 10:1005-1018. [PMID: 32968657 DOI: 10.21037/cdt.2020.01.13] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Carotid artery stenosis (CAS) due to the presence of atherosclerotic plaque (AP) is a frequent medical condition and a known risk factor for stroke, and it is also known from literature that several risk factors promote the AP development, in particular aging, smoke, male sex, hypertension, hyperlipidemia, smoke, diabetes type 1 and 2, and genetic factors. The study of carotid atherosclerosis is continuously evolving: even if the strategies of treatment still depends mainly on the degree of stenosis (DoS) determined by the plaque, in the last years the attention has moved to the study of the plaque components in order to identify the so called "vulnerable" plaque: features like the fibrous cap status and thickness, the volume of the lipid-rich necrotic core and the presence of intraplaque hemorrhage (IPH) are risk factors for plaque rupture, that can be studied with modern imaging techniques. The aim of this review is to give a general overview of the principle histological and imaging features of the subcomponent of carotid AP (CAP), focalizing in particular on the features of CAP of patients affected by hypertension and diabetes (in particular type 2 diabetes mellitus).
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Affiliation(s)
- Michele Porcu
- Department of Radiology, AOU Cagliari, University of Cagliari, Italy
| | | | - Marta Melis
- Department of Neurology, AOU of Cagliari, University of Cagliari, Italy
| | - Jasjit S Suri
- Diagnostic and Monitoring Division, AtheroPoint, Roseville, California, USA
| | - Clara Gerosa
- Department of Pathology, AOU Cagliari, University of Cagliari, Cagliari, Italy
| | - Giulia Cerrone
- Department of Pathology, AOU Cagliari, University of Cagliari, Cagliari, Italy
| | - Giovanni Defazio
- Department of Neurology, AOU of Cagliari, University of Cagliari, Italy
| | - Gavino Faa
- Department of Pathology, AOU Cagliari, University of Cagliari, Cagliari, Italy
| | - Luca Saba
- Department of Radiology, AOU Cagliari, University of Cagliari, Italy
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Poorthuis MHF, Halliday A, Massa MS, Sherliker P, Clack R, Morris DR, Clarke R, de Borst GJ, Bulbulia R, Lewington S. Validation of Risk Prediction Models to Detect Asymptomatic Carotid Stenosis. J Am Heart Assoc 2020; 9:e014766. [PMID: 32310014 PMCID: PMC7428515 DOI: 10.1161/jaha.119.014766] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 02/07/2020] [Indexed: 12/27/2022]
Abstract
Background Significant asymptomatic carotid stenosis (ACS) is associated with higher risk of strokes. While the prevalence of moderate and severe ACS is low in the general population, prediction models may allow identification of individuals at increased risk, thereby enabling targeted screening. We identified established prediction models for ACS and externally validated them in a large screening population. Methods and Results Prediction models for prevalent cases with ≥50% ACS were identified in a systematic review (975 studies reviewed and 6 prediction models identified [3 for moderate and 3 for severe ACS]) and then validated using data from 596 469 individuals who attended commercial vascular screening clinics in the United States and United Kingdom. We assessed discrimination and calibration. In the validation cohort, 11 178 (1.87%) participants had ≥50% ACS and 2033 (0.34%) had ≥70% ACS. The best model included age, sex, smoking, hypertension, hypercholesterolemia, diabetes mellitus, vascular and cerebrovascular disease, measured blood pressure, and blood lipids. The area under the receiver operating characteristic curve for this model was 0.75 (95% CI, 0.74-0.75) for ≥50% ACS and 0.78 (95% CI, 0.77-0.79) for ≥70% ACS. The prevalence of ≥50% ACS in the highest decile of risk was 6.51%, and 1.42% for ≥70% ACS. Targeted screening of the 10% highest risk identified 35% of cases with ≥50% ACS and 42% of cases with ≥70% ACS. Conclusions Individuals at high risk of significant ACS can be selected reliably using a prediction model. The best-performing prediction models identified over one third of all cases by targeted screening of individuals in the highest decile of risk only.
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Affiliation(s)
- Michiel H. F. Poorthuis
- Clinical Trial Service Unit and Epidemiological Studies UnitNuffield Department of Population HealthUniversity of Oxford,United Kingdom
- MRC Population Health Research UnitNuffield Department of Population HealthUniversity of Oxford,United Kingdom
- Department of Vascular SurgeryUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Alison Halliday
- Nuffield Department of Surgical SciencesJohn Radcliffe HospitalUniversity of OxfordUnited Kingdom
| | - M. Sofia Massa
- Clinical Trial Service Unit and Epidemiological Studies UnitNuffield Department of Population HealthUniversity of Oxford,United Kingdom
| | - Paul Sherliker
- Clinical Trial Service Unit and Epidemiological Studies UnitNuffield Department of Population HealthUniversity of Oxford,United Kingdom
- MRC Population Health Research UnitNuffield Department of Population HealthUniversity of Oxford,United Kingdom
| | - Rachel Clack
- Clinical Trial Service Unit and Epidemiological Studies UnitNuffield Department of Population HealthUniversity of Oxford,United Kingdom
| | - Dylan R. Morris
- Clinical Trial Service Unit and Epidemiological Studies UnitNuffield Department of Population HealthUniversity of Oxford,United Kingdom
- MRC Population Health Research UnitNuffield Department of Population HealthUniversity of Oxford,United Kingdom
| | - Robert Clarke
- Clinical Trial Service Unit and Epidemiological Studies UnitNuffield Department of Population HealthUniversity of Oxford,United Kingdom
| | - Gert J. de Borst
- Department of Vascular SurgeryUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Richard Bulbulia
- Clinical Trial Service Unit and Epidemiological Studies UnitNuffield Department of Population HealthUniversity of Oxford,United Kingdom
- MRC Population Health Research UnitNuffield Department of Population HealthUniversity of Oxford,United Kingdom
| | - Sarah Lewington
- Clinical Trial Service Unit and Epidemiological Studies UnitNuffield Department of Population HealthUniversity of Oxford,United Kingdom
- MRC Population Health Research UnitNuffield Department of Population HealthUniversity of Oxford,United Kingdom
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Ji X, Leng XY, Dong Y, Ma YH, Xu W, Cao XP, Hou XH, Dong Q, Tan L, Yu JT. Modifiable risk factors for carotid atherosclerosis: a meta-analysis and systematic review. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:632. [PMID: 31930033 DOI: 10.21037/atm.2019.10.115] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Carotid atherosclerosis is a major cause of stroke, but the conclusion about risk factors for carotid atherosclerosis is still controversial. The aim of our present meta-analysis and systematic review was to explore the modifiable risk factors for carotid atherosclerosis. Methods We searched PubMed from January 1962 to October 2018 to include longitudinal and cross-sectional studies. The results were pooled using random effects model. Heterogeneity was measured by I2 statistic and publication bias was assessed by funnel plots. Results A total of 14,700 articles were screened, of which 76 with 27 factors were eligible. Our meta-analysis of cross-sectional studies indicated nine factors (hyperlipidemia, hyperhomocysteinemia, hypertension, hyperuricemia, smoking, metabolic syndrome, hypertriglyceridemia, diabetes, and higher low density lipoprotein) were significantly associated with the presence of carotid plaque, among which four (hyperlipidemia, hyperhomocysteinemia, hypertension, and hyperuricemia) could elevate the risk of atherosclerosis by at least 50%; and one factor (hypertension) was associated with increased carotid intima-media thickness. In the systematic review, another five factors [negative emotion, socioeconomic strain, alcohol, air pollution, and obstructive sleep apnea syndrome (OSAS)] were also related to the presence of atherosclerosis. The cross-sectional associations with most of the above 14 factors were further confirmed by longitudinal studies. Among them, the managements of 4 factors (hypertension, hyperlipidemia, diabetes and OSAS) were indicated to prevent carotid atherosclerosis by cohort studies. Conclusions Effective interventions targeting pre-existing disease, negative emotion, lifestyle and diet may reduce the risk of carotid atherosclerosis. Further good-quality prospective studies are needed to confirm these findings.
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Affiliation(s)
- Xi Ji
- Department of Neurology, Qingdao Municipal Hospital, Dalian Medical University, Dalian 116044, China.,Department of Neurology, Xuchang People's Hospital, Xuchang 461000, China
| | - Xin-Yi Leng
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Yi Dong
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China
| | - Ya-Hui Ma
- Department of Neurology, Qingdao Municipal Hospital, Dalian Medical University, Dalian 116044, China
| | - Wei Xu
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao 266071, China
| | - Xi-Peng Cao
- Clinical Research Center, Qingdao Municipal Hospital, Qingdao University, Qingdao 266071, China
| | - Xiao-He Hou
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao 266071, China
| | - Qiang Dong
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China
| | - Lan Tan
- Department of Neurology, Qingdao Municipal Hospital, Dalian Medical University, Dalian 116044, China.,Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao 266071, China
| | - Jin-Tai Yu
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China
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Aortic and Internal Carotid Atherosclerosis in Patients with Carotid Stenosis: Semiautomatic Volumetric Analysis of Low-Attenuation Plaque on Curved Planar Reformations Using MDCT Angiographic Data. BIOMED RESEARCH INTERNATIONAL 2019; 2019:5817534. [PMID: 31143773 PMCID: PMC6501255 DOI: 10.1155/2019/5817534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 04/10/2019] [Indexed: 11/17/2022]
Abstract
This retrospective study included 65 patients who underwent multidetector computed tomography (MDCT) carotid angiography; 28 patients were <70 years old (group 1), and 37 were ≥70 years old (group 2). Each low-attenuation (<30 Hounsfield units [HU]) plaque volume (LPV) and total uncalcified plaque volume ([TUPV] ≤150 HU) were semiautomatically measured on each aortic arch and internal carotid artery (ICA) curved planar reformations (CPR), using MDCT angiographic data. Correlation coefficients were employed to assess the impact of each plaque volume on various factors including ICA stenosis. The correlations (r > 0.5) were observed between aortic LPV and each ICA stenosis ratio and >30% stenosis in group 1, between aortic TUPV and male gender in group 1, and between ICA-TUPV and each aortic TUPV or the largest plaque thickness in group 2. Marginal correlations were observed between hyperlipidemia and aortic LPV and ICA-TUPV in group 1. There was no association between cerebral infarction and the aortic and ICA plaques. Both the aortic arch and ICA plaque volumes can be measured clinically. The increasing aortic LPV may be a significant factor associated with the development of ICA stenosis in patients younger than 70 years old.
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Wang L, He X. The relationship between the carotid and coronary artery stenosis: a study based on angiography. Neurol Res 2019; 41:722-727. [PMID: 31131734 DOI: 10.1080/01616412.2019.1609165] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objective: Previous studies have demonstrated a strong association between carotid artery stenosis (CAS) and coronary artery stenosis disease (COAS). However, prior evaluated methods are non-invasive examinations. This study was aimed to access the relationship between CAS and COAS by the means of angiography. Methods: This is a single-center, retrospectively reviewed study based on digital subtraction angiography (DSA) of carotid artery and coronary artery angiography (CAG). We collected a total of 231 patients undergoing DSA and CAG at the same-day between June 2013 and May 2015. The patients were stratified according to the degree of CAS and COAS, mild stenosis <50%, moderate stenosis 50-69%, severe stenosis 70-99%, occlusion 100%. The correlation of CAS with COAS, as well as the risk factors, was analyzed. Results: A total of 231 patients was enrolled in this study, male 71.9% (166/231). The age ranges from 32 to 80, mean age 60.06 ± 9.98. Of these patients, 79 patients were severe CAS and 128 patients were severe COAS. Statistical analysis demonstrated that the independent risk factors of severe COAS ≥70%, were age, sex, previous cerebral infraction, coronary heart diseases, and coronary artery surgery. CAS was associated with COAS (Spearman r = 0.333, P < 0.01). The more serious the CAS, the more involved COAS (Kendall's tab-b = 0.294, p < 0.01). Conclusions: The DSA confirmed CAS was associated with CAG confirmed COAS. The heavier the CAS is, the more the number of the affected coronary artery.
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Affiliation(s)
- Lifeng Wang
- a Department of Neurology, Capital Medical University Affiliated Anzhen Hospital , Beijing , China
| | - Xiaofen He
- b Department of interventional neuroradiology, Capital Medical University Affiliated Anzhen Hospital , Beijing , China
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Reiff T, Eckstein HH, Mansmann U, Jansen O, Fraedrich G, Mudra H, Böckler D, Böhm M, Brückmann H, Debus ES, Fiehler J, Lang W, Mathias K, Ringelstein EB, Schmidli J, Stingele R, Zahn R, Zeller T, Hetzel A, Bodechtel U, Binder A, Glahn J, Hacke W, Ringleb PA. Angioplasty in asymptomatic carotid artery stenosis vs. endarterectomy compared to best medical treatment: One-year interim results of SPACE-2. Int J Stroke 2019; 15:1747493019833017. [PMID: 30873912 PMCID: PMC7416333 DOI: 10.1177/1747493019833017] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 12/10/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Treatment of individuals with asymptomatic carotid artery stenosis is still handled controversially. Recommendations for treatment of asymptomatic carotid stenosis with carotid endarterectomy (CEA) are based on trials having recruited patients more than 15 years ago. Registry data indicate that advances in best medical treatment (BMT) may lead to a markedly decreasing risk of stroke in asymptomatic carotid stenosis. The aim of the SPACE-2 trial (ISRCTN78592017) was to compare the stroke preventive effects of BMT alone with that of BMT in combination with CEA or carotid artery stenting (CAS), respectively, in patients with asymptomatic carotid artery stenosis of ≥70% European Carotid Surgery Trial (ECST) criteria. METHODS SPACE-2 is a randomized, controlled, multicenter, open study. A major secondary endpoint was the cumulative rate of any stroke (ischemic or hemorrhagic) or death from any cause within 30 days plus an ipsilateral ischemic stroke within one year of follow-up. Safety was assessed as the rate of any stroke and death from any cause within 30 days after CEA or CAS. Protocol changes had to be implemented. The results on the one-year period after treatment are reported. FINDINGS It was planned to enroll 3550 patients. Due to low recruitment, the enrollment of patients was stopped prematurely after randomization of 513 patients in 36 centers to CEA (n = 203), CAS (n = 197), or BMT (n = 113). The one-year rate of the major secondary endpoint did not significantly differ between groups (CEA 2.5%, CAS 3.0%, BMT 0.9%; p = 0.530) as well as rates of any stroke (CEA 3.9%, CAS 4.1%, BMT 0.9%; p = 0.256) and all-cause mortality (CEA 2.5%, CAS 1.0%, BMT 3.5%; p = 0.304). About half of all strokes occurred in the peri-interventional period. Higher albeit statistically non-significant rates of restenosis occurred in the stenting group (CEA 2.0% vs. CAS 5.6%; p = 0.068) without evidence of increased stroke rates. INTERPRETATION The low sample size of this prematurely stopped trial of 513 patients implies that its power is not sufficient to show that CEA or CAS is superior to a modern medical therapy (BMT) in the primary prevention of ischemic stroke in patients with an asymptomatic carotid stenosis up to one year after treatment. Also, no evidence for differences in safety between CAS and CEA during the first year after treatment could be derived. Follow-up will be performed up to five years. Data may be used for pooled analysis with ongoing trials.
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Affiliation(s)
- T Reiff
- Department of Neurology, University
Hospital of Heidelberg, Heidelberg, Germany
| | - HH Eckstein
- Department for Vascular and
Endovascular Surgery, Technical University of Munich, Munich, Germany
| | - U Mansmann
- Institute of Medical Informatics,
Biometry and Epidemiology, Ludwig Maximilian University Munich, Munich,
Germany
| | - O Jansen
- Department of Radiology and
Neuroradiology, UKSH Campus Kiel, Kiel, Germany
| | - G Fraedrich
- Department of Vascular Surgery,
University Hospital of Innsbruck, Innsbruck, Austria
| | - H Mudra
- Department of Internal Medicine,
Städtisches Klinikum München-Neuperlach, Munich, Germany
| | - D Böckler
- Department of Vascular Surgery,
University Hospital of Heidelberg, Heidelberg, Germany
| | - M Böhm
- Department of Internal Medicine,
University Hospital of Homburg/Saar, Homburg, Germany
| | - H Brückmann
- Department of Neuroradiology,
Ludwig-Maximilians-Universität, Munich, Germany
| | - ES Debus
- Department of Vascular Surgery,
University Hospital of Hamburg, Hamburg, Germany
| | - J Fiehler
- Department of Neuroradiology,
University Hospital of Hamburg, Hamburg, Germany
| | - W Lang
- Department of Vascular Surgery,
University Hospital Erlangen, Erlangen, Germany
| | - K Mathias
- Department of Radiology, Klinikum
Dortmund, Dortmund, Germany
| | - EB Ringelstein
- Department of Neurology,
University Hospital of Münster, Münster, Germany
| | - J Schmidli
- Department of Vascular Surgery,
University Hospital of Bern, Bern, Switzerland
| | - R Stingele
- Department of Neurology,
University of Kiel, Kiel, Germany
| | - R Zahn
- Department of Internal Medicine,
Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - T Zeller
- Department of Angiology,
University Hospital Freiburg, Bad Krozingen, Germany
| | - A Hetzel
- Department of Neurology,
University Hospital Freiburg, Freiburg, Germany
| | - U Bodechtel
- Department of Neurology,
University Hospital of Dresden, Dresden, Germany
| | - A Binder
- Department of Neurology, UKSH
Campus Kiel, Kiel, Germany
| | - J Glahn
- Department of Neurology, Johannes
Wesling Klinikum, Minden, Germany
| | - W Hacke
- Department of Neurology, University
Hospital of Heidelberg, Heidelberg, Germany
| | - PA Ringleb
- Department of Neurology, University
Hospital of Heidelberg, Heidelberg, Germany
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Ukweh ON, Ekpo EU. Carotid Intima-Media Thickness and Carotid Plaque: A Pilot Study of Risk Factors in an Indigenous Nigerian Population. J Stroke Cerebrovasc Dis 2019; 28:1346-1352. [PMID: 30777620 DOI: 10.1016/j.jstrokecerebrovasdis.2019.01.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 12/16/2018] [Accepted: 01/31/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Risk factors for carotid intima-media thickness (cIMT) and carotid plaque (CP) differ by ethnicity; however, this is not well understood in some ethnic populations. This work examines the risk factors for cIMT and CP in an indigenous Nigerian population. METHODS We assessed cIMT and CP in 122 participants and then performed biochemical analysis: fasting blood glucose (FBG), hemoglobin A1c, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglyceride (TG), and total cholesterol (TC). The clinical history and anthropometric characteristics of participants were recorded. Linear models were used to assess the factors associated with cIMT and CP, and stepwise multivariate regression analyses were conducted to assess the predictors of cIMT and CP. RESULTS The cIMT thickness varied from .5 mm to 1.3 mm. Family history of heart disease (FHHDx), physical activity, FBG, HDL-C, TG, TC, body mass index (BMI), systolic pressure, and waist circumference were significantly associated with cIMT (P ≤ .01). High systolic (β = .008) and diastolic (β = .17) pressure, FHHDx (β = .24), age (β = .004), physical activity (β = -.09), and waist circumference (β = -.017) significantly predicted 85% of the variation in cIMT (P < .001 for all). Family history of hypertension (FHH), LDL-C, and high blood pressure were significantly associated with CP (P ≤ .05). The significant predictors of CP were FHH (β = .145, P = .03), smoking (β = .167, P = .01), HDL-C (β = .283, P < .001), weight (β = .150, P = .04), and BMI (β = .183, P = .01), explaining most of the 43.2% variation in CP. CONCLUSIONS Some of the risk factors differ from those of other ethnicities, suggesting a need for population-specific approach to risk assessment and early detection of subclinical disease.
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Affiliation(s)
- Ofonime N Ukweh
- Department of Radiology, College of Medical Sciences, University of Calabar, Calabar, Cross River, Nigeria
| | - Ernest U Ekpo
- Discipline of Medical Radiation Sciences, Faculty of Medicine and Health, University of Sydney, Lidcombe, NSW, Australia.
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Song P, Xia W, Zhu Y, Wang M, Chang X, Jin S, Wang J, An L. Prevalence of carotid atherosclerosis and carotid plaque in Chinese adults: A systematic review and meta-regression analysis. Atherosclerosis 2018; 276:67-73. [PMID: 30036743 DOI: 10.1016/j.atherosclerosis.2018.07.020] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 07/10/2018] [Accepted: 07/13/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS The national representative prevalence of carotid atherosclerosis (CAS) or carotid plaque (CP) in the general Chinese population has never been estimated. We aim to generate the prevalence and number of people with CAS and CP in the general Chinese population. METHODS We searched China National Knowledge Infrastructure, Wanfang Data, VIP Database for Chinese Technical Periodical, PubMed, Embase and Medline. Articles reporting the prevalence of CAS or CP in the general Chinese population were included. A multilevel mixed-effects logistic regression was used to estimate the age- and gender-specific prevalence of CAS and CP. The effects of risk factors for CAS were assessed by a random-effects meta-analysis. RESULTS The prevalence of CAS and CP increased with advanced age. Males had a higher prevalence of CAS and CP than females consistently across all age groups. Overall, 27.22% and 20.15% of Chinese people aged 30-79 years were with CAS and CP, respectively, in 2010, equivalent to 207.73 million and 153.82 million affected individuals. With demographic ageing, the number of people affected by CAS and CP will increase to 267.25 million and 199.83 million, respectively, by 2020. In addition, current smoking, hypertension and diabetes were found to be risk factors for CAS. More than 70% of the national CAS cases were in rural China in 2010. CONCLUSIONS CAS and CP are highly prevalent in China. The huge disease burden of CAS and CP calls for efforts on effective preventive health strategies and early-detection of CVDs in people with CAS or CP, especially in rural areas.
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Affiliation(s)
- Peige Song
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China; Centre for Global Health Research, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Wei Xia
- School of Nursing, University of Hong Kong, Hong Kong, China
| | - Yajie Zhu
- George Institute for Global Health, University of Oxford, Oxford, United Kingdom
| | - Manli Wang
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Xinlei Chang
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Shuai Jin
- School of Nursing, Peking University, Beijing, China
| | - Jingpin Wang
- School of Nursing, Peking University, Beijing, China
| | - Lin An
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China.
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