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Guo S, Gu C, Sun L, Qi Z, Wang B. Evaluation of Carotid Stiffness in Metabolic Syndrome by Real-Time Shear Wave Elasticity Imaging and Ultrafast Pulse Wave Velocity. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:1280-1286. [PMID: 38806338 DOI: 10.1016/j.ultrasmedbio.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 04/13/2024] [Accepted: 05/07/2024] [Indexed: 05/30/2024]
Abstract
OBJECTIVE This study utilized real-time shear wave elasticity imaging (SWE) and ultrafast pulse wave velocity (ufPWV) to assess carotid arterial stiffness, aiming to predict atherosclerosis risk in patients with metabolic syndrome (MS). METHODS In this study, 181 patients with metabolic syndrome (MS group) were compared with 73 healthy adults. The MS group was divided into three groups: MS I group: CIMT was normal (CIMT < 1.0 mm, no plaque, n = 61); MS II group: CIMT thickening (1.0 mm ≤ CIMT<1.5 mm, no plaque, n = 39); MS III group: plaque group (CIMT ≥ 1.5 mm, plaque, n = 81). Concurrently, the group of 73 healthy individuals was designated as the control set (NC). Parameters assessed include carotid intima-media thickness (CIMT), elastic modulus values of the carotid artery's anterior and posterior walls (Mean, Max, Min), pulse wave velocity at systole's commencement (PWV-BS), and pulse wave velocity at systole's termination (PWV-ES). Differences, distribution characteristics, and correlations across these groups were analyzed. RESULTS A significant association was found between PWV-BS, PWV-ES, and arteriosclerosis severity, with these factors gaining importance as arteriosclerosis progressed. Notably, PWV-ES differences were significant across the four groups (p < 0.05). Both MS III and MS II groups exhibited higher PWV-ES values compared to the MS I group and controls. Statistically significant differences were observed between MS III, MS II, and MS I groups relative to the control group (p < 0.05). Additionally, the Mean, Max, and Min values of the anterior and posterior carotid walls in the MS III group surpassed those of the other groups. CONCLUSION Real-time shear wave elasticity imaging and ultrafast pulse wave velocity are valuable tools for assessing atherosclerosis risk in MS patients. These non-invasive, safe, and reproducible imaging techniques can quantitatively evaluate the stiffness of the common carotid artery's wall, offering important insights into cardiovascular risk assessment.
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Affiliation(s)
- Shuai Guo
- First Hospital of Qin Huangdao, Qin Huangdao, China
| | - Changcong Gu
- First Hospital of Qin Huangdao, Qin Huangdao, China
| | - Lijuan Sun
- First Hospital of Qin Huangdao, Qin Huangdao, China.
| | - Zhengqin Qi
- First Hospital of Qin Huangdao, Qin Huangdao, China
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Qian H, Zhang Z, Tao Z, Xie Y, Yin Y, He W, Zhang L. Association of Circular RNAs levels in blood and Essential Hypertension with Carotid Plaque. Clin Exp Hypertens 2023; 45:2180020. [PMID: 36843004 DOI: 10.1080/10641963.2023.2180020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
BACKGROUND As one of the essential hypertension (EH)-mediated target organ damage, carotid plaque is a crucial subclinical precursor for cardiovascular events. Therefore, it is vital to identify the risk factors and pathogenesis for EH with carotid plaque. METHODS Based on our previous microarray analysis, we selected four circRNAs as the candidate circRNAs and detected their expression levels in blood of 192 subjects (64 healthy controls, 64 EH patients, and 64 EH patients with carotid plaque) by qRT-PCR analysis. The regulatory mechanism of circRNAs involved in carotid plaque was predicted by bioinformatics analysis. RESULTS The level of hsa_circ_0124782 increased significantly and the levels of hsa_circ_0131618 and hsa_circ_0127342 decreased significantly in the EH group and EH with carotid plaque group compared with the control group (P < .05). Functional enrichment analysis showed that three circRNAs might be implicated in pathogenesis for carotid plaque. CONCLUSION Our study revealed the relationship between three circRNAs and carotid plaque, suggesting that they may serve as potential biomarkers for EH with carotid plaque.
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Affiliation(s)
- Haiyan Qian
- Department of Preventive Medicine, School of Medicine, Ningbo University, Ningbo, China
| | - Zebo Zhang
- Department of Preventive Medicine, School of Medicine, Ningbo University, Ningbo, China
| | - Zhenbo Tao
- Department of Preventive Medicine, School of Medicine, Ningbo University, Ningbo, China.,Ningbo Municipal Centre for Disease Control and Prevention, Ningbo, China
| | - Yanqing Xie
- Institute of Geriatrics, the Affiliated Hospital of Medical School, Ningbo University, Ningbo, China
| | - Yueqi Yin
- Department of Preventive Medicine, School of Medicine, Ningbo University, Ningbo, China
| | - Wenming He
- Institute of Geriatrics, the Affiliated Hospital of Medical School, Ningbo University, Ningbo, China
| | - Lina Zhang
- Department of Preventive Medicine, School of Medicine, Ningbo University, Ningbo, China.,Institute of Geriatrics, the Affiliated Hospital of Medical School, Ningbo University, Ningbo, China
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Yun K, He T, Zhen S, Quan M, Yang X, Man D, Zhang S, Wang W, Han X. Development and validation of explainable machine-learning models for carotid atherosclerosis early screening. J Transl Med 2023; 21:353. [PMID: 37246225 DOI: 10.1186/s12967-023-04093-8] [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: 11/25/2022] [Accepted: 03/28/2023] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND Carotid atherosclerosis (CAS), an important factor in the development of stroke, is a major public health concern. The aim of this study was to establish and validate machine learning (ML) models for early screening of CAS using routine health check-up indicators in northeast China. METHODS A total of 69,601 health check-up records from the health examination center of the First Hospital of China Medical University (Shenyang, China) were collected between 2018 and 2019. For the 2019 records, 80% were assigned to the training set and 20% to the testing set. The 2018 records were used as the external validation dataset. Ten ML algorithms, including decision tree (DT), K-nearest neighbors (KNN), logistic regression (LR), naive Bayes (NB), random forest (RF), multiplayer perceptron (MLP), extreme gradient boosting machine (XGB), gradient boosting decision tree (GBDT), linear support vector machine (SVM-linear), and non-linear support vector machine (SVM-nonlinear), were used to construct CAS screening models. The area under the receiver operating characteristic curve (auROC) and precision-recall curve (auPR) were used as measures of model performance. The SHapley Additive exPlanations (SHAP) method was used to demonstrate the interpretability of the optimal model. RESULTS A total of 6315 records of patients undergoing carotid ultrasonography were collected; of these, 1632, 407, and 1141 patients were diagnosed with CAS in the training, internal validation, and external validation datasets, respectively. The GBDT model achieved the highest performance metrics with auROC of 0.860 (95% CI 0.839-0.880) in the internal validation dataset and 0.851 (95% CI 0.837-0.863) in the external validation dataset. Individuals with diabetes or those over 65 years of age showed low negative predictive value. In the interpretability analysis, age was the most important factor influencing the performance of the GBDT model, followed by sex and non-high-density lipoprotein cholesterol. CONCLUSIONS The ML models developed could provide good performance for CAS identification using routine health check-up indicators and could hopefully be applied in scenarios without ethnic and geographic heterogeneity for CAS prevention.
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Affiliation(s)
- Ke Yun
- National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
- Department of Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Tao He
- Neusoft Research Institute, Neusoft Corporation, Shenyang, Liaoning Province, China
| | - Shi Zhen
- Department of Software Engineering, Northeastern University, Shenyang, Liaoning Province, China
| | - Meihui Quan
- National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
- Department of Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Xiaotao Yang
- National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
- Department of Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Dongliang Man
- National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
- Department of Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Shuang Zhang
- National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
- Department of Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Wei Wang
- Department of Physical Examination Center, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China.
| | - Xiaoxu Han
- National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China.
- Department of Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China.
- Laboratory Medicine Innovation Unit, Chinese Academy of Medical Sciences, Shenyang, Liaoning Province, China.
- NHC Key Laboratory of AIDS Immunology (China Medical University), The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China.
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Zhan C, Wang Q, Chen Z, Pang H, Tu J, Ning X, Wang J, Fei S, Ji X. Association of metabolic syndrome with carotid atherosclerosis in low-income Chinese individuals: A population-based study. Front Cardiovasc Med 2022; 9:943281. [PMID: 36061552 PMCID: PMC9437543 DOI: 10.3389/fcvm.2022.943281] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/03/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThis study aimed to explore the association of the presence and number of components of metabolic syndrome (MetS) with carotid atherosclerosis by measuring the presence of carotid plaque and total plaque area (TPA) in a population from a low-income area with high incidence of stroke of northern China.MethodsA cross-sectional study was conducted in a rural area of Tianjin, China from April 2014 to January 2015. The presence of plaque and TPA measurement was determined by carotid ultrasound. The presence and number of components of MetS was ascertained using the modified International Diabetes Federation criteria for the Asian population.ResultsAmong a total of 3,583 individuals aged ≥ 45 years, the overall prevalence of MetS was 54.5%. MetS and its components were related to the presence of carotid plaque as well as TPA. Multivariate analysis showed MetS was associated with a 20% higher risk of carotid plaque presence (95% confidence interval: 1.01, 1.42; P = 0.036) and an 18% increase in TPA (95% confidence interval: 0.08, 0.27; P < 0.001). The number of MetS components showed an increasing trend with the risk of carotid plaque presence and increased TPA. Among single components of MetS, high BP accounted for the largest proportion and was an independent risk factor of carotid plaque and increased TPA.ConclusionsAmong individuals aged 45 years or more, we confirmed MetS and its components were associated with carotid atherosclerosis in a low-income population of northern China. The presence of MetS and a higher number of MetS components exacerbated the risk of carotid atherosclerosis; among the five MetS components, high blood pressure was associated with the greatest risk. Targeted atherosclerosis prevention and intervention should include identification and treatment of MetS, especially high blood pressure.
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Affiliation(s)
- Changqing Zhan
- Department of Neurology, Wuhu No. 2 People's Hospital, Wuhu, China
| | - Qiao Wang
- Department of Pathology, Wuhu No. 2 People's Hospital, Wuhu, China
| | - Zongsheng Chen
- Department of Neurology, Wuhu No. 2 People's Hospital, Wuhu, China
| | - Hongbo Pang
- Department of Neurology, Wuhu No. 2 People's Hospital, Wuhu, China
| | - Jun Tu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
- Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, China
- Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, China
| | - Xianjia Ning
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
- Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, China
- Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, China
| | - Jinghua Wang
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
- Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, China
- Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, China
- Jinghua Wang
| | - Shizao Fei
- Department of Neurology, Wuhu No. 2 People's Hospital, Wuhu, China
- Shizao Fei
| | - Xuelei Ji
- Department of Endocrinology, Wuhu No. 2 People's Hospital, Wuhu, China
- *Correspondence: Xuelei Ji
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Liu H, Chen Z, Ding J, Mamateli S, Cai J, Qiao T. Relationship of the Low-Density Lipoprotein Cholesterol/High-Density Lipoprotein Cholesterol Ratio with a Vulnerable Plaque in Patients with Severe Carotid Artery Stenosis: A Case-Control Study in the Han Chinese Population. Curr Neurovasc Res 2022; 19:160-170. [PMID: 35770391 DOI: 10.2174/1567202619666220629160733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 03/05/2022] [Accepted: 03/09/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Carotid plaque is often an important factor in ischemic stroke after it changes from stable to vulnerable, and low-density lipoprotein cholesterol (LDL-c) and high-density lipoprotein cholesterol (HDL-c) are associated with plaque vulnerability. We aimed to investigate whether the LDL-c/HDL-c ratio, an easily available and novel biomarker, is associated with vulnerable plaques and enhances the warning effect on vulnerability compared to LDL-c or HDL-c alone. METHODS We conducted a retrospective study of 187 patients with severe CAS admitted to the Department of Vascular Surgery at the Nanjing Drum Tower Hospital from January 2019 to July 2021. They were divided into a stable plaque group and a vulnerable plaque group according to carotid ultrasonography, carotid angiography (CTA), and plaque pathology. Baseline information was collected and compared between the two groups. Correlation analysis was used to determine the degree of correlation between clinical variables. Univariate and multifactor logistic regression analyses were used to examine independent risk factors for vulnerable plaque in patients with severe CAS. Receiver operating characteristic (ROC) curves were used to assess the capacity of LDL-c/HDL-c to predict the occurrence of vulnerable plaque. RESULTS The age of the vulnerable plaque group was 68.12 ± 8.90 years, with 85 males (89.91%); the age of the stable plaque group was 68.77 ± 8.43 years, with 70 males (89.74%). Multivariate logistic regression analysis showed that LDL-c/HDL-c, smoking and diabetes were independent risk factors for vulnerable plaque (all P <0.05). The risk of vulnerable plaque was 4.78-fold greater in the highest LDL-c/HDL-c quartile (≥ 2.63) than in the lowest quartile (≤ 1.31) (P-trend <0.001), and the area under the ROC curve for LDL-c/HDL-c (AUC=0.681, P <0.001) was higher than that for LDL-c and HDL-c. CONCLUSION LDL-c/HDL-c, smoking and diabetes were independent risk factors for vulnerable plaque in patients with severe CAS, and LDL-c/HDL-c had a higher predictive value for the presence of vulnerable plaque compared with other lipid parameters.
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Affiliation(s)
- Heqian Liu
- Department of vascular Surgery, Nanjing Drum Tower Hospital Clinical College of Xuzhou Medical University, Nanjing, 210008, China
| | - Zhipeng Chen
- Department of vascular Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, China
| | - Jiawen Ding
- Department of vascular Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, China
| | - Subinuer Mamateli
- Department of vascular Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, China
| | - Jing Cai
- Department of vascular Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, China
| | - Tong Qiao
- Department of vascular Surgery, Nanjing Drum Tower Hospital Clinical College of Xuzhou Medical University, Nanjing, 210008, China
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Yang Q, Lin Q, Guo D, Wang H, Liu J, Zhang X, Tu J, Ning X, Yang Q, Wang J. Association of Carotid Intima Media Thickness With Metabolic Syndrome Among Low-Income Middle-Aged and Elderly Chinese: A Population-Based Cross-Sectional Study. Front Cardiovasc Med 2021; 8:669245. [PMID: 34869618 PMCID: PMC8639590 DOI: 10.3389/fcvm.2021.669245] [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: 02/19/2021] [Accepted: 10/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background: We aimed to evaluate the relationship between metabolic syndrome (MetS) including its components and carotid intima media thickness (CIMT) in a low-income Chinese population aged ≥45 years. Methods: The participants underwent a general health screening and B-mode carotid ultrasonography that measured CIMT. The diagnosis of MetS and its components was based on the modified International Diabetes Federation Criteria for the Asian Population. The univariate and multivariable linear regression analyses were used to evaluate the relationship between MetS and CIMT. Results: A total of 3,583 participants (mean age, 60 years) was included in the analyses (41.4% male and 58.6% female); more than 50% of the participants were diagnosed with MetS. In the multivariable linear regression analysis, the mean CIMT was 0.009 mm greater in the participants with MetS than in those without MetS (β = 0.009; 95% CI, 0.003–0.014; P < 0.05). Moreover, a high number of MetS components was associated with greater CIMT values; for example, CIMT increased by 0.007 and 0.015 mm for the individuals diagnosed with 3–4 and 5 MetS components, respectively. Among the MetS components, elevated blood pressure (β = 0.022; 95% CI, 0.015–0.029; P < 0.001) and abdominal obesity (β = 0.008; 95% CI, 0.001–0.015; P < 0.001) were positively correlated with CIMT. However, the increased triglyceride levels were negatively associated with CIMT (β = −0.008; 95% CI: −0.015 to −0.002; P = 0.012), especially among the elderly population. Conclusions: The risk of carotid atherosclerosis increased in the presence of multiple MetS components in a low-income, middle-aged, and elderly population. Accordingly, more detailed management strategies are essential for the early prevention and intervention of atherosclerosis in this low-income population with MetS, in China.
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Affiliation(s)
- Qiaoxia Yang
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Qiuxing Lin
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, China.,Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Neurological Institute, Ministry of Education and Tianjin City, Tianjin, China
| | - Dandan Guo
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Hanhua Wang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Jie Liu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, China.,Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Neurological Institute, Ministry of Education and Tianjin City, Tianjin, China
| | - Xin Zhang
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Jun Tu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, China.,Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Neurological Institute, Ministry of Education and Tianjin City, Tianjin, China.,Center of Clinical Epidemiology & Evidence-Based Medicine, Tianjin Jizhou People's Hospital, Tianjin, China
| | - Xianjia Ning
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, China.,Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Neurological Institute, Ministry of Education and Tianjin City, Tianjin, China.,Center of Clinical Epidemiology & Evidence-Based Medicine, Tianjin Jizhou People's Hospital, Tianjin, China
| | - Qing Yang
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Jinghua Wang
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, China.,Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Neurological Institute, Ministry of Education and Tianjin City, Tianjin, China.,Center of Clinical Epidemiology & Evidence-Based Medicine, Tianjin Jizhou People's Hospital, Tianjin, China
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Kim JS, Lee S, Kim GE, Oh DJ, Moon W, Bae JB, Han JW, Byun S, Suh SW, Choi YY, Choi KY, Lee KH, Kim JH, Kim KW. Construction and validation of a cerebral white matter hyperintensity probability map of older Koreans. NEUROIMAGE-CLINICAL 2021; 30:102607. [PMID: 33711622 PMCID: PMC7972979 DOI: 10.1016/j.nicl.2021.102607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 02/09/2021] [Accepted: 02/15/2021] [Indexed: 12/04/2022]
Abstract
We constructed WPM from healthy elderly Koreans. WPM may serve as a tool to study pathology and normal aging of distribution of WMH. WPM provides a prominent atlas of the age related distribution of WMH.
Background and purpose Although two white matter hyperintensity (WMH) probability maps of healthy older adults already exist, they have several limitations in representing the distribution of WMH in healthy older adults, especially Asian older adults. We constructed and validated a WMH probability map (WPM) of healthy older Koreans and examined the age-associated differences of WMH. Methods We constructed WPM using development dataset that consisted of high-resolution 3D fluid-attenuated inversion recovery images of 5 age groups (60–64 years, 65–69 years, 70–74 years, 75–79 years, and 80+ years). Each age group included 30 age-matched men and women each. We tested the validity of the WPM by comparing WMH ages estimated by the WPM and the chronological ages of 30 healthy controls, 30 hypertension patients, and 30 S patients. Results Older age groups showed a higher volume of WMH in both hemispheres (p < 0.001). About 90% of the WMH were periventricular in all age groups. With advancing age, the peak of the distance histogram from the ventricular wall of the periventricular WMH shifted away from the ventricular wall, while that of deep WMH shifted toward the ventricular wall. The estimated WMH ages were comparable to the chronological ages in the healthy controls, while being higher than the chronological ages in hypertension and stroke patients. Conclusions This WPM may serve as a standard atlas in research on WMH of older adults, especially Asians.
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Affiliation(s)
- Jun Sung Kim
- Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences, Seoul, South Korea
| | - Subin Lee
- Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences, Seoul, South Korea
| | - Grace Eun Kim
- Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences, Seoul, South Korea
| | - Dae Jong Oh
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Gyeonggido, South Korea
| | - Woori Moon
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Gyeonggido, South Korea
| | - Jong Bin Bae
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Gyeonggido, South Korea
| | - Ji Won Han
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Gyeonggido, South Korea
| | - Seonjeong Byun
- Department of Neuropsychiatry, National Medical Center, Seoul, South Korea
| | - Seung Wan Suh
- Department of Psychiatry, College of Medicine, Hallym University, Kangdong Sacred Heart Hospital, Seoul, South Korea
| | - Yu Yong Choi
- National Research Center for Dementia, Chosun University, Gwangju, South Korea; Biomedical Technology Center, Chosun University Hospital, Gwangju, South Korea
| | - Kyu Yeong Choi
- National Research Center for Dementia, Chosun University, Gwangju, South Korea
| | - Kun Ho Lee
- National Research Center for Dementia, Chosun University, Gwangju, South Korea; Department of Biomedical Science, Chosun University, Gwangju, South Korea
| | - Jae Hyoung Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggido, South Korea
| | - Ki Woong Kim
- Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences, Seoul, South Korea; Department of Neuropsychiatry, Seoul National University Bundang Hospital, Gyeonggido, South Korea; Department of Psychiatry, Seoul National University, College of Medicine, Seoul, South Korea.
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8
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Zhang L, Zhu L, Lu M, Zhao X, Li F, Cai J, Yuan C. Comparison of Carotid Plaque Characteristics Between Men and Women Using Magnetic Resonance Vessel Wall Imaging: A Chinese Atherosclerosis Risk Evaluation Study. J Magn Reson Imaging 2021; 54:646-654. [PMID: 33638575 DOI: 10.1002/jmri.27576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/11/2021] [Accepted: 02/11/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Carotid vulnerable plaque is a major cause of stroke and differs between men and women. Few studies have investigated the differences in carotid plaque features between sexes in a Chinese population. PURPOSE To compare carotid atherosclerotic plaque features between men and women in a Chinese population using magnetic resonance imaging. STUDY TYPE Cross-sectional. SUBJECTS A total of 567 patients (mean age: 61.5 ± 10.1 years; 404 men) who had recent stroke or transient ischemia attack and atherosclerotic plaque in at least one carotid artery. FIELD STRENGTH A 3.0 T. SEQUENCE T1- and T2-weighted turbo spin echo, three-dimensional time-of-flight (TOF) fast field echo and magnetization-prepared rapid acquisition gradient echo sequences. ASSESSMENT Plaque characteristics including lumen area (LA), wall area (WA), total vessel area (TVA), mean wall thickness (MWT), and mean normalized wall index (NWI); presence of calcification, lipid-rich necrotic core (LRNC), intraplaque hemorrhage (IPH), and fibrous cap rupture (FCR); and percent composition area (%area) were evaluated and compared between men and women. STATISTICAL TESTS Independent-sample t test, Mann-Whitney U test, chi-square test, and multiple linear and logistic regressions. RESULTS In symptomatic arteries, men had significantly greater LA (46.2 ± 15.6 mm2 vs. 40.7 ± 12.9 mm2 , P < 0.05), WA (33.9 ± 11.5 mm2 vs. 26.3 ± 7.5 mm2 , P < 0.05), and TVA (80.1 ± 20.4 mm2 vs. 67.0 ± 18.0 mm2 , P < 0.05); higher MWT (1.2 ± 0.4 mm vs. 1.0 ± 0.2 mm, P < 0.05); and higher prevalence of LRNC (72.3% vs. 46.0%, P < 0.05) and IPH (18.6% vs. 4.9%, P < 0.05) compared with women. In asymptomatic arteries, men had significantly greater LA (48.3 ± 16.9 mm2 vs. 42.1 ± 12.6 mm2 , P < 0.05), WA (32.9 ± 11.0 mm2 vs. 25.8 ± 6.1 mm2 , P < 0.05), and TVA (81.2 ± 22.1 mm2 vs. 67.9 ± 16.5 mm2 , P < 0.05); higher MWT (1.2 ± 0.3 mm vs. 1.0 ± 0.2 mm, P < 0.05); higher prevalence of LRNC (67.8% vs. 42.9%, P < 0.05), IPH (14.9% vs. 1.2%, P < 0.05), and FCR (6.4% vs. 1.2%, P < 0.05); and higher %LRNC area (24.8 ± 17.2% vs. 17.8 ± 14.1%, P < 0.05) compared with women. DATA CONCLUSION Men have similar plaque burden but more vulnerable atherosclerotic plaques compared with women in both symptomatic and asymptomatic carotid arteries in a Chinese population. EVIDENCE LEVEL 4 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Lichen Zhang
- Medical School of Chinese PLA, Beijing, China
- Department of Radiology, the Fifth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Lina Zhu
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1, Zhengzhou, Henan Province, China
| | - Mingming Lu
- Department of Radiology, Pingjin Hospital, Characteristic Medical Center of Chinese People's Armed Police Force, Tianjin, China
| | - Xihai Zhao
- Center For Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Feiyu Li
- Operation Department, RIMAG Medical Imaging Corporation, Beijing, China
| | - Jianming Cai
- Department of Radiology, the Fifth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, USA
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Fan L, Yang Q, Zhang X, Lin Q, Guo D, Liu J, Tu J, Wang J, Li Y, Ning X. Sex -Specific Differences in the Association Between Metabolic Syndrome and Carotid Intima-Media Thickness Among a Low-Income Population in China: A Cross-Sectional Study. Diabetes Metab Syndr Obes 2021; 14:3263-3272. [PMID: 34290511 PMCID: PMC8289329 DOI: 10.2147/dmso.s313702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/26/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Carotid atherosclerosis is a well-established biomarker associated with future cardiovascular disease and stroke. We explored the influence of sex on the relationship between metabolic syndrome (MetS) and its components with carotid intima-media thickness (CIMT) among a low-income population in China, which has a high incidence of stroke. METHODS This population-based study recruited participants aged ≥45 years from rural areas of Tianjin, China between April 2014 and January 2015. Anthropometric characteristics and biochemical profiles were measured. CIMT was assessed using ultrasonography. Diagnosis of MetS and its components was made using the modified International Diabetes Federation criteria for the Asian population. A multivariate linear regression model was used to evaluate the effects of sex on the relationship between the presence of MetS and its components and CIMT. RESULTS A total of 3583 individuals (men, 41.4%; women, 58.6%) were included in the analyses. MetS was prevalent in 54.5% (men, 42.3%; women, 63.2%) of the participants. Mean CIMT was 0.57 ± 0.09 mm. In the multivariate analysis, for both sexes, CIMT increased significantly when MetS was present compared with when it was not (both P < 0.001). A common trend was observed in both sexes, in that CIMT increased as the number of MetS components increased, with β (95% confidence interval [CI]) = 0.021 (0.000, 0.042) for men and 0.014 (0.002, 0.026) for women (both P < 0.05). Of the five MetS components, elevated blood pressure was an independent risk factor for increased CIMT in both sexes (men: β = 0.013; 95% CI: 0.003, 0.023; P = 0.008; women: β = 0.024; 95% CI: 0.016, 0.033; P < 0.001). Moreover, abdominal obesity was also an independent risk factor for increased CIMT in men (β = 0.013; 95% CI: 0.003, 0.023; P = 0.008) but not in women. CONCLUSION The presence and number of components of MetS were associated with CIMT in both men and women. Sex differences were found in the impact of individual components of MetS on CIMT. Early identification and management of MetS according to sex-specific risk of MetS should be considered to reduce the prevalence and burden of carotid atherosclerosis in rural China, which has a high incidence of stroke, a known consequence of carotid atherosclerosis.
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Affiliation(s)
- Liming Fan
- Department of Medical Clinical Laboratory, Tianjin Medical University General Hospital, Tianjin, 300052, People’s Republic of China
| | - Qiaoxia Yang
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, 300052, People’s Republic of China
| | - Xin Zhang
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, People’s Republic of China
| | - Qiuxing Lin
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, People’s Republic of China
- Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, 300052, People’s Republic of China
- Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, People’s Republic of China
| | - Dandan Guo
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, People’s Republic of China
| | - Jie Liu
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, 300052, People’s Republic of China
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, People’s Republic of China
- Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, 300052, People’s Republic of China
| | - Jun Tu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, People’s Republic of China
- Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, 300052, People’s Republic of China
- Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, People’s Republic of China
| | - Jinghua Wang
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, People’s Republic of China
- Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, 300052, People’s Republic of China
- Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, People’s Republic of China
| | - Yan Li
- Department of Anesthesiology, Tianjin Jizhou People’s Hospital, Tianjin, 301900, People’s Republic of China
- Yan Li Department of Anesthesiology, Tianjin Jizhou People’s Hospital, 18 Nanhuan Road, Jizhou District, Tianjin, 301900, People’s Republic of ChinaTel/Fax +86-22- 60733586 Email
| | - Xianjia Ning
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, People’s Republic of China
- Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, 300052, People’s Republic of China
- Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, People’s Republic of China
- Correspondence: Xianjia Ning Department of Neurology, Tianjin Medical University General Hospital, Laboratory of Epidemiology, Tianjin Neurological Institute & Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, 154 Anshan Road, Heping District, Tianjin, 300052, People’s Republic of ChinaTel +86-22-60817505Fax +86-22-60817448 Email
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Geng Y, Liu Y, Chen Y, Zhang Z, Wang L, Li X, Xia B, Song B, Zhang H. Association of LDLc to HDLc ratio with carotid plaques in a community-based population with a high stroke risk: A cross-sectional study in China. Clin Biochem 2020; 88:43-48. [PMID: 33242435 DOI: 10.1016/j.clinbiochem.2020.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/23/2020] [Accepted: 11/03/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND AIMS The association between low-density lipoprotein cholesterol (LDLc) to high-density lipoprotein cholesterol (HDLc) ratio (LDLc/HDLc) and carotid plaques remains controversial. We conducted a cross-sectional study to evaluate whether LDLc/HDLc is associated with carotid plaques in individuals with a high-stroke-risk. METHODS AND RESULTS The study initially enrolled 5529 residents aged 40 years or older from Yangzhou, China in 2013-2014. All participants received a questionnaire interview, physical examination, and laboratory tests. Risk factors for stroke included hypertension, diabetes mellitus, dyslipidemia, atrial fibrillation, smoking, less exercise, overweight/obesity, and family stroke history. Subjects with at least three of the risk factors or a history of stroke/transient ischemic attack (TIA) were defined as a high-stroke-risk population. Carotid ultrasonography was only conducted for this high-stroke-risk population. Logistic regression was used to examine the association of LDLc/HDLc with the presence of carotid plaques. Final analysis included 839 high-stroke-risk subjects and 40.6% were identified to have carotid plaques. Subjects with the highest tertiles group of LDLc/HDLc had a higher proportion of carotid plaques than the other two groups (47.1% vs. 34.6% and 40.4%, P < 0.001). With each unit increase of LDLc/HDLc, the chance of having carotid plaques increased by 65% (OR 1.65, 95%CI 1.31-2.08) after adjusted for potential confounders. Among most subgroups, a higher LDLc/HDLc was significantly correlated with the presence of carotid plaques. CONCLUSION Higher LDLc/HDLc was significantly associated with the presence of carotid plaques in the Chinese population with a high risk of stroke.
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Affiliation(s)
- Yang Geng
- Department of Neurology, Clinical Medical College, Yangzhou University, 98 Nantong West Road, Yangzhou 225001, China
| | - Yan Liu
- Department of Endocrinology, Clinical Medical College, Yangzhou University, 98 Nantong West Road, Yangzhou 225001, China
| | - Yan Chen
- Department of Center of Health Management, Clinical Medical College, Yangzhou University, 98 Nantong West Road, Yangzhou 225001, China
| | - Zhenwen Zhang
- Department of Endocrinology, Clinical Medical College, Yangzhou University, 98 Nantong West Road, Yangzhou 225001, China
| | - Liping Wang
- Department of Biobank, Clinical Medical College, Yangzhou University, 98 Nantong West Road, Yangzhou 225001, China
| | - Xiaobo Li
- Department of Neurology, Clinical Medical College, Yangzhou University, 98 Nantong West Road, Yangzhou 225001, China
| | - Binlan Xia
- Department of Ultrasonography, Clinical Medical College, Yangzhou University, 98 Nantong West Road, Yangzhou 225001, China
| | - Bin Song
- Department of Center of Health Management, Clinical Medical College, Yangzhou University, 98 Nantong West Road, Yangzhou 225001, China.
| | - Hengzhong Zhang
- Department of Center of Health Management, Clinical Medical College, Yangzhou University, 98 Nantong West Road, Yangzhou 225001, China.
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Ismail A, Aliyu AM, Ramalan MA. Audit of carotid doppler sonography: Spectrum of findings at a tertiary hospital in Northwestern Nigeria. Ann Afr Med 2020; 19:170-175. [PMID: 32820728 PMCID: PMC7694706 DOI: 10.4103/aam.aam_52_18] [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] [Indexed: 11/04/2022] Open
Abstract
Introduction Doppler sonography of the cervical segment of the carotid arteries is becoming a popular tool for evaluating atherosclerosis of the carotid artery. We present the audit of findings on carotid ultrasound examination among patients with clinical suspicion and risks for cerebrovascular disease and possible correlates in Northern Nigeria. Materials and Methods We performed carotid ultrasound examination on all patients referred for screening and clinical suspicion of cerebrovascular disease within the year 2017. The patients' characteristics, risk factors, presence of atheroma and characteristic of the atheroma, degree of stenotic disease as well as the presence of incidental ultrasound findings were reviewed and documented. Results Out of the 62 patients, 55 (88.7%) of them had various degrees and types of atheromatous plaques in different segments of the cervical carotid arteries, whereas 7 (11.3%) were normal. The predominant risk factor was smoking followed by diabetes mellitus, whereas the highest indication for the scan was transient ischemic attack. Incidental thyroid lesions such as nodules and cysts were encountered in 14 (22.6%) of the patients. There is a statistically significant difference between sex and age with the side of lesion, degree of stenosis, segment involved, and type of atheromatous plaque. Conclusion There is a statistically significant difference between sex and age with the side of lesion, degree of stenosis, segment involved, and type of atheromatous plaque. About one-fifth of our patients had incidental thyroid lesions. Therefore, routine screening of population at risk is highly recommended.
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Affiliation(s)
- Anas Ismail
- Department of Radiology, Aminu Kano Teaching Hospital/Bayero University, Kano, Nigeria
| | - Abdulmalik M Aliyu
- Department of Radiology, Rasheed Shekoni Teaching Hospital, Dutse, Jigawa State, Nigeria
| | - Mansur A Ramalan
- Department of Internal Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
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12
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Wang D, Wu Z, Zhou J, Zhang X. Rs9939609 polymorphism of the fat mass and obesity-associated (FTO) gene and metabolic syndrome susceptibility in the Chinese population: a meta-analysis. Endocrine 2020; 69:278-285. [PMID: 32303904 DOI: 10.1007/s12020-020-02280-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 03/23/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE The relationship between the rs9939609 allele of fat mass and obesity-associated (FTO) gene and metabolic syndrome (MS) susceptibility has been evaluated by many studies, however, the results still remained controversial in the Chinese population. In order to provide more accurate results, we performed this meta-analysis. METHODS We searched PubMed, and Wanfang Med Online in both English and Chinese, and eight eligible studies comprising of 5345 cases and 9523 controls were eventually selected into our meta-analysis. The meta-analysis was performed using the STATA 12.0 software. RESULTS In pooled analysis, the FTO gene rs9939609 polymorphism significantly increased MS susceptibility under per-allele comparisons (A vs. T) (OR 1.21, 95% CI 1.10-1.35, P < 0.001) and in dominant model (OR 1.35, 95% CI 1.13-1.62, P < 0.001). Subgroup analyses under per-allele comparisons (A vs. T) indicated that the elevated risk was observed in adults (OR 1.26, 95% CI 1.08-1.47, P = 0.003) but not in children and adolescents (OR 1.14, 95% CI 0.95-1.36, P = 0.17), and that the risk for increasing MS was only identified in IDF groups (OR 1.22, 95% CI 1.03-1.43, P = 0.018) but not in NCEP ATP III groups (OR 1.14, 95% CI 0.95-1.36, P = 0.17); in both population-based (PB) and hospital-based (HB) groups, A alleles of rs9939609 appeared to be linked to increased MS susceptibilities (HB group: OR 1.51, 95% CI 1.10-2.08, P = 0.01; PB group: OR 1.19, 95% CI 1.09-1.30, P < 0.001). No significant association was established in dominant model subgroup analyses except PB group (OR 1.29, 95% CI 1.05-1.53, P < 0.001). CONCLUSION Our results suggested that the FTO gene rs9939609 polymorphism significantly increased MS susceptibility in Chinese. Our results should be verified by well-designed studies with larger sample size.
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Affiliation(s)
- Dong Wang
- Department of Cardiology, Wuhan No.1 Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhihong Wu
- Department of Rheumatology, Wuhan No.1 Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jun Zhou
- Department of Cardiology, Wuhan No.1 Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Xiaotian Zhang
- Hubei Provincial Key Laboratory for Applied Toxicology, Hubei Provincial Center for Disease Control and Prevention, Wuhan, China.
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13
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Liu Y, Zhang Z, Xia B, Wang L, Zhang H, Zhu Y, Liu C, Song B. Relationship between the non-HDLc-to-HDLc ratio and carotid plaques in a high stroke risk population: a cross-sectional study in China. Lipids Health Dis 2020; 19:168. [PMID: 32660519 PMCID: PMC7359500 DOI: 10.1186/s12944-020-01344-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/06/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Evidence on the association between the non-high-density lipoprotein cholesterol (non-HDLc)-to-high-density lipoprotein cholesterol (HDLc) ratio (non-HDLc/HDLc) and carotid plaques is still limited. This study aims to assess the relationship between the non-HDLc/HDLc and carotid plaques in a population with a high risk of stroke. METHODS A cross-sectional study based on the community was conducted in Yangzhou, China. Residents (no younger than 40 years old) underwent questionnaire interviews, physical examinations, and laboratory testing during 2013-2014. The subjects with a high risk of stroke were further selected (at least three of eight risk factors including hypertension, atrial fibrillation, type 2 diabetes mellitus, dyslipidaemia, smoking, lack of exercise, overweight, and family history of stroke) or a transient ischaemic attack (TIA) or stroke history. Carotid ultrasonography was then performed on the high stroke risk participants. Carotid plaque was defined as a focal carotid intima-media thickness (cIMT) ≥1.5 cm or a discrete structure protruding into the arterial lumen at least 50% of the surrounding cIMT. Logistic regression was employed to evaluate the relationship between the non-HDLc/HDLc and carotid plaques. RESULTS Overall, 839 subjects with a high risk of stroke were ultimately included in the analysis, and carotid plaques were identified in 341 (40.6%) of them. Participants in the highest non-HDLc/HDLc tertile group presented a higher proportion of carotid plaques than did those in the other two groups. After adjustment for other confounders, each unit increase in the non-HDLc/HDLc was significantly associated with carotid plaques (OR 1.55, 95%CI 1.28-1.88). In the subgroup analysis, the non-HDLc/HDLc was positively and significantly associated with the presence of carotid plaques in most subgroups. Additionally, the non-HDLc/HDLc interacted significantly with three stratification variables, including sex (OR 1.31 for males vs. OR 2.37 for females, P interaction = 0.016), exercise (OR 1.18 for subjects without lack of exercise vs. OR 1.99 for subjects with lack of exercise, P interaction = 0.004) and heart diseases (OR 1.40 for subjects without heart diseases vs. OR 3.12 for subjects with heart diseases, P interaction = 0.033). CONCLUSION The non-HDLc/HDLc was positively associated with the presence of carotid plaques in a Chinese high stroke risk population. A prospective study or randomized clinical trial of lipid-lowering therapy in the Chinese population is needed to evaluate their causal relationship.
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Affiliation(s)
- Yan Liu
- Endocrine and Diabetes Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, 8 Huadian East Road, Nanjing, 210028 China
- Department of Endocrinology, Clinical Medical College, Yangzhou University, 98 Nantong West Road, Yangzhou, 225001 China
| | - Zhenwen Zhang
- Department of Endocrinology, Clinical Medical College, Yangzhou University, 98 Nantong West Road, Yangzhou, 225001 China
| | - Binlan Xia
- Department of Ultrasonography, Clinical Medical College, Yangzhou University, 98 Nantong West Road, Yangzhou, 225001 China
| | - Liping Wang
- Department of Biobank, Clinical Medical College, Yangzhou University, 98 Nantong West Road, Yangzhou, 225001 China
| | - Hengzhong Zhang
- Department of Center of Health Management, Clinical Medical College, Yangzhou University, 98 Nantong West Road, Yangzhou, 225001 China
| | - Yan Zhu
- Department of Endocrinology, Clinical Medical College, Yangzhou University, 98 Nantong West Road, Yangzhou, 225001 China
| | - Chao Liu
- Endocrine and Diabetes Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, 8 Huadian East Road, Nanjing, 210028 China
| | - Bin Song
- Department of Center of Health Management, Clinical Medical College, Yangzhou University, 98 Nantong West Road, Yangzhou, 225001 China
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Wang X, Li W, Song F, Wang L, Fu Q, Cao S, Gan Y, Zhang W, Yue W, Yan F, Shi W, Wang X, Zhang H, Zhang H, Wang Z, Lu Z. Carotid Atherosclerosis Detected by Ultrasonography: A National Cross-Sectional Study. J Am Heart Assoc 2018; 7:JAHA.118.008701. [PMID: 29622590 PMCID: PMC6015437 DOI: 10.1161/jaha.118.008701] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background Carotid atherosclerosis (CA) is a reflector of generalized atherosclerosis that is associated with systemic vascular disease. Data are limited on the epidemiology of carotid lesions in a large, nationally representative population sample. We aimed to evaluate the prevalence of CA detected by carotid ultrasonography and related risk factors based on a national survey in China. Methods and Results A total of 107 095 residents aged ≥40 years from the China National Stroke Prevention Project underwent carotid ultrasound examination. Participants with carotid endarterectomy or carotid stenting and those with stroke or coronary heart disease were excluded. Data from 84 880 participants were included in the analysis. CA was defined as increased intima–media thickness (IMT) ≥1 mm or presence of plaques. Of the 84 880 participants, 46.4% were men, and the mean age was 60.7±10.3 years. The standardized prevalence of CA was 36.2% overall, increased with age, and was higher in men than in women. Prevalence of CA was higher among participants living in rural areas than in urban areas. Approximately 26.5% of participants had increased IMT, and 13.9% presented plaques. There was an age‐related increase in participants with increased IMT, plaque presence, and stenosis. In multiple logistic regression analysis, older age, male sex, residence in rural areas, smoking, alcohol consumption, physical inactivity, obesity, hypertension, diabetes mellitus, and dyslipidemia were associated with CA. Conclusions CA was highly prevalent in a middle‐aged and older Chinese population. This result shows the potential clinical importance of focusing on primary prevention of atherosclerosis progression.
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Affiliation(s)
- Xiaojun Wang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College
| | - Wenzhen Li
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College
| | - Fujian Song
- Norwich Medical School, Faculty of Medicine and Health Science, University of East Anglia, Norwich, United Kingdom
| | - Longde Wang
- The National Health and Family Commission, Beijing, China
| | - Qian Fu
- School of Medicine and Health Management, Tongji Medical College
| | - Shiyi Cao
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College
| | - Yong Gan
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College
| | - Wei Zhang
- Department of Medical Ultrasound, Tongji Hospital & Medical College
| | - Wei Yue
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Feng Yan
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Wenhuan Shi
- Department of Science and Education, The Third Hospital of Shijiazhuang, Shijiazhuang, Hebei, China
| | - Xiaoli Wang
- Department of Neurology, Harrison International Peace Hospital, Hengshui, Hebei, China
| | - Hong Zhang
- Department of Science and Education, People's Hospital of Deyang City, Sichuan, China
| | - Hao Zhang
- Department of Neurology, Rizhao People's Hospital, Rizhao, Shandong, China
| | - Zhihong Wang
- Department of Neurosurgery, Shenzhen Second People's Hospital Shenzhen University, Shenzhen, Guangdong, China
| | - Zuxun Lu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College
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Wu Y, He J, Sun X, Zhao YM, Lou HY, Ji XL, Pang XH, Shan LZ, Kang YX, Xu J, Zhang SZ, Wang YJ, Ren YZ, Shan PF. Carotid atherosclerosis and its relationship to coronary heart disease and stroke risk in patients with type 2 diabetes mellitus. Medicine (Baltimore) 2017; 96:e8151. [PMID: 28953658 PMCID: PMC5626301 DOI: 10.1097/md.0000000000008151] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Carotid atherosclerosis (CA) and carotid plaque (CP) are highly correlated with cardiovascular disease. We aimed to determine the prevalence of CA and CP and their relationship with 10-year risks of stroke and coronary heart disease (CHD) in type 2 diabetes mellitus (T2DM).We studied 1584 T2DM patients aged 20 years and older. CA and CP were detected using ultrasonography. Ten-year stroke and CHD risk were determined using the United Kingdom Prospective Diabetes Study (UKPDS) risk engine.The prevalence of CA and CP increased gradually with age. Men had a higher prevalence of CA than women (CA: 58.18% vs 51.54%, P < .01). The 10-year CHD risk (27.9% vs 15.4%, P < .001) and stroke risk (15.2% vs 5.70%, P < .001) were higher in patients with CA than that of those without CA. Compared with patients without CA, the odds ratios (ORs) of CHD in CA and CP group were 4.47 and 10.78 for men, and 4.19 and 5.20 for women, respectively; in the case of stroke, the OR in CA and CP group were 8.83 and 12.07 for men, and 4.35 and 4.90 for women, respectively (P < .001 for all). Multivariate binary logistic regression analysis showed that CA was an independent risk factor for CHD [OR = 2.66, 95% confidence interval (95% CI), 2.05-3.46, P < .001] and stroke (OR = 3.11, 95% CI, 2.38-4.07, P < .001).CA and CP were prevalent in patients with T2DM and positively correlated with 10-year CHD and stroke risk. CA was an independent risk factor for 10-year CHD risk.
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Affiliation(s)
- Yan Wu
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital ZheJiang University College of Medicine
- Department of Endocrinology and Metabolism, Zhejiang Greentown Cardiovascular Hospital
| | - Jie He
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital ZheJiang University College of Medicine
| | - Xue Sun
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital ZheJiang University College of Medicine
| | - Yi-Ming Zhao
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital ZheJiang University College of Medicine
| | - Han-Yu Lou
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital ZheJiang University College of Medicine
| | - Xiao-li Ji
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital ZheJiang University College of Medicine
| | - Xiao-Hong Pang
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital ZheJiang University College of Medicine
| | - Li-Zhen Shan
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital ZheJiang University College of Medicine
| | - Ying-Xiu Kang
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital ZheJiang University College of Medicine
| | | | - Song-Zhao Zhang
- Department of Clinical Laboratory, the Second Affiliated Hospital ZheJiang University College of Medicine, Hangzhou, Zhejiang, P.R. China
| | - Yong-Jian Wang
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital ZheJiang University College of Medicine
| | - Yue-Zhong Ren
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital ZheJiang University College of Medicine
| | - Peng-Fei Shan
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital ZheJiang University College of Medicine
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Masson W, Epstein T, Huerín M, Lobo LM, Molinero G, Angel A, Masson G, Millán D, De Francesca S, Vitagliano L, Cafferata A, Losada P. Cardiovascular Risk Stratification in Patients with Metabolic Syndrome Without Diabetes or Cardiovascular Disease: Usefulness of Metabolic Syndrome Severity Score. High Blood Press Cardiovasc Prev 2017; 24:297-303. [PMID: 28502055 DOI: 10.1007/s40292-017-0209-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 05/05/2017] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION The estimated cardiovascular risk determined by the different risk scores, could be heterogeneous in patients with metabolic syndrome without diabetes or vascular disease. This risk stratification could be improved by detecting subclinical carotid atheromatosis. AIMS To estimate the cardiovascular risk measured by different scores in patients with metabolic syndrome and analyze its association with the presence of carotid plaque. METHODS Non-diabetic patients with metabolic syndrome (Adult Treatment Panel III definition) without cardiovascular disease were enrolled. The Framingham score, the Reynolds score, the new score proposed by the 2013 ACC/AHA Guidelines and the Metabolic Syndrome Severity Calculator were calculated. Prevalence of carotid plaque was determined by ultrasound examination. A Receiver Operating Characteristic analysis was performed. RESULTS A total of 238 patients were enrolled. Most patients were stratified as "low risk" by Framingham score (64%) and Reynolds score (70.1%). Using the 2013 ACC/AHA score, 45.3% of the population had a risk ≥7.5%. A significant correlation was found between classic scores but the agreement (concordance) was moderate. The correlation between classical scores and the Metabolic Syndrome Severity Calculator was poor. Overall, the prevalence of carotid plaque was 28.2%. The continuous metabolic syndrome score used in our study showed a good predictive power to detect carotid plaque (area under the curve 0.752). CONCLUSION In this population, the calculated cardiovascular risk was heterogenic. The prevalence of carotid plaque was high. The Metabolic Syndrome Severity Calculator showed a good predictive power to detect carotid plaque.
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Affiliation(s)
- Walter Masson
- Council of Epidemiology and Cardiovascular Prevention "Dr. Mario Ciruzzi", Argentine Society of Cardiology, Azcuenaga 980, C1115AAD, Buenos Aires, Argentina.
| | - Teo Epstein
- Council of Epidemiology and Cardiovascular Prevention "Dr. Mario Ciruzzi", Argentine Society of Cardiology, Azcuenaga 980, C1115AAD, Buenos Aires, Argentina
| | - Melina Huerín
- Council of Epidemiology and Cardiovascular Prevention "Dr. Mario Ciruzzi", Argentine Society of Cardiology, Azcuenaga 980, C1115AAD, Buenos Aires, Argentina
| | - Lorenzo Martín Lobo
- Council of Epidemiology and Cardiovascular Prevention "Dr. Mario Ciruzzi", Argentine Society of Cardiology, Azcuenaga 980, C1115AAD, Buenos Aires, Argentina
| | - Graciela Molinero
- Council of Epidemiology and Cardiovascular Prevention "Dr. Mario Ciruzzi", Argentine Society of Cardiology, Azcuenaga 980, C1115AAD, Buenos Aires, Argentina
| | - Adriana Angel
- Council of Epidemiology and Cardiovascular Prevention "Dr. Mario Ciruzzi", Argentine Society of Cardiology, Azcuenaga 980, C1115AAD, Buenos Aires, Argentina
| | - Gerardo Masson
- Council of Epidemiology and Cardiovascular Prevention "Dr. Mario Ciruzzi", Argentine Society of Cardiology, Azcuenaga 980, C1115AAD, Buenos Aires, Argentina
| | - Diana Millán
- Council of Epidemiology and Cardiovascular Prevention "Dr. Mario Ciruzzi", Argentine Society of Cardiology, Azcuenaga 980, C1115AAD, Buenos Aires, Argentina
| | - Salvador De Francesca
- Council of Epidemiology and Cardiovascular Prevention "Dr. Mario Ciruzzi", Argentine Society of Cardiology, Azcuenaga 980, C1115AAD, Buenos Aires, Argentina
| | - Laura Vitagliano
- Council of Epidemiology and Cardiovascular Prevention "Dr. Mario Ciruzzi", Argentine Society of Cardiology, Azcuenaga 980, C1115AAD, Buenos Aires, Argentina
| | - Alberto Cafferata
- Council of Epidemiology and Cardiovascular Prevention "Dr. Mario Ciruzzi", Argentine Society of Cardiology, Azcuenaga 980, C1115AAD, Buenos Aires, Argentina
| | - Pablo Losada
- Council of Epidemiology and Cardiovascular Prevention "Dr. Mario Ciruzzi", Argentine Society of Cardiology, Azcuenaga 980, C1115AAD, Buenos Aires, Argentina
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Lou Y, Li B, Su L, Mu Z, Sun M, Gu H, Ni J, Wu Y, Tu J, Wang J, Ning X. Association between body mass index and presence of carotid plaque among low-income adults aged 45 years and older: a population-based cross-sectional study in rural China. Oncotarget 2017; 8:81261-81272. [PMID: 29113385 PMCID: PMC5655280 DOI: 10.18632/oncotarget.17608] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 04/17/2017] [Indexed: 12/15/2022] Open
Abstract
Carotid plaque is a good surrogate endpoint for assessing arterial atherosclerosis, and atherosclerosis is a reliable predictor of cardiovascular diseases. However, the effect of body mass index on carotid plaque is unknown. Therefore, we aimed to explore the association between body mass index and carotid plaque in a low-income Chinese population. Residents aged ≥45 years and free of stroke and cardiovascular diseases were enrolled and divided into four groups based on body mass index. B-mode ultrasonography was performed to measure carotid plaque. The mean age of participants was 59.92 years overall. Significant correlations were observed between the presence of carotid plaque and male sex, older age, systolic blood pressure, fasting plasma glucose, and low-density lipoprotein cholesterol among the different BMI subgroups. Male sex increased the risk of carotid plaque in the overweight and obese groups. Older age and high level of low-density lipoprotein cholesterol were the independent risk factor for carotid plaque in four groups. Increased systolic blood pressure was an independent risk factor in the normal-weight, overweight, and obese groups; however, fasting plasma glucose was only significant in the normal-weight group. Thus, controlling the levels of low-density lipoprotein cholesterol, systolic blood pressure, and fasting plasma glucose is required to reduce carotid plaque risk.
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Affiliation(s)
- Yongzhong Lou
- Department of Neurology, Tianjin Haibin People's Hospital, Tianjin, China
| | - Bin Li
- Department of Neurology, Tianjin Haibin People's Hospital, Tianjin, China
| | - Lan Su
- Department of Neurology, Tianjin Haibin People's Hospital, Tianjin, China
| | - Zhenhong Mu
- Department of Neurology, Tianjin Haibin People's Hospital, Tianjin, China
| | - Minghao Sun
- Department of Neurology, Tianjin Haibin People's Hospital, Tianjin, China
| | - Hongfei Gu
- Department of Neurology, Tianjin Haibin People's Hospital, Tianjin, China
| | - Jingxian Ni
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.,Department of Epidemiology, Tianjin Neurological Institute, Tianjin, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, China
| | - Yanan Wu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.,Department of Epidemiology, Tianjin Neurological Institute, Tianjin, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, China
| | - Jun Tu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.,Department of Epidemiology, Tianjin Neurological Institute, Tianjin, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, China
| | - Jinghua Wang
- Department of Epidemiology, Tianjin Neurological Institute, Tianjin, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, China.,Center of Clinical Epidemiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Xianjia Ning
- Department of Epidemiology, Tianjin Neurological Institute, Tianjin, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, China.,Center of Clinical Epidemiology, Tianjin Medical University General Hospital, Tianjin, China
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18
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Wu Y, Yu Y, Zhao T, Wang S, Fu Y, Qi Y, Yang G, Yao W, Su Y, Ma Y, Shi J, Jiang J, Kou C. Interactions of Environmental Factors and APOA1-APOC3-APOA4-APOA5 Gene Cluster Gene Polymorphisms with Metabolic Syndrome. PLoS One 2016; 11:e0147946. [PMID: 26824674 PMCID: PMC4732668 DOI: 10.1371/journal.pone.0147946] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 01/11/2016] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE The present study investigated the prevalence and risk factors for Metabolic syndrome. We evaluated the association between single nucleotide polymorphisms (SNPs) in the apolipoprotein APOA1/C3/A4/A5 gene cluster and the MetS risk and analyzed the interactions of environmental factors and APOA1/C3/A4/A5 gene cluster polymorphisms with MetS. METHODS A study on the prevalence and risk factors for MetS was conducted using data from a large cross-sectional survey representative of the population of Jilin Province situated in northeastern China. A total of 16,831 participations were randomly chosen by multistage stratified cluster sampling of residents aged from 18 to 79 years in all nine administrative areas of the province. Environmental factors associated with MetS were examined using univariate and multivariate logistic regression analyses based on the weighted sample data. A sub-sample of 1813 survey subjects who met the criteria for MetS patients and 2037 controls from this case-control study were used to evaluate the association between SNPs and MetS risk. Genomic DNA was extracted from peripheral blood lymphocytes, and SNP genotyping was determined by MALDI-TOF-MS. The associations between SNPs and MetS were examined using a case-control study design. The interactions of environmental factors and APOA1/C3/A4/A5 gene cluster polymorphisms with MetS were assessed using multivariate logistic regression analysis. RESULTS The overall adjusted prevalence of MetS was 32.86% in Jilin province. The prevalence of MetS in men was 36.64%, which was significantly higher than the prevalence in women (29.66%). MetS was more common in urban areas (33.86%) than in rural areas (31.80%). The prevalence of MetS significantly increased with age (OR = 8.621, 95%CI = 6.594-11.272). Mental labor (OR = 1.098, 95%CI = 1.008-1.195), current smoking (OR = 1.259, 95%CI = 1.108-1.429), excess salt intake (OR = 1.252, 95%CI = 1.149-1.363), and a fruit and dairy intake less than 2 servings a week were positively associated with MetS (P<0.05). A family history of diabetes (OR = 1.630, 95%CI = 1.484-1.791), cardiovascular disease or cerebral diseases (OR = 1.297, 95%CI = 1.211-1.389) was associated with MetS. APOA1 rs670, APOA5 rs662799 and rs651821 revealed significant differences in genotype distributions between the MetS patients and control subjects. The minor alleles of APOA1 rs670, APOA5 rs662799 and rs651821, and APOA5 rs2075291 were associated with MetS (P<0.0016). APOA1 rs5072 and APOC3 rs5128, APOA5 rs651821 and rs662799 were in strong linkage disequilibrium to each other with r2 greater than 0.8. Five haplotypes were associated with an increased risk of MetS (OR = 1.23, 1.58, 1.80, 1.90, and 1.98). When we investigated the interactions of environmental factors and APOA1/C3/A4/A5 gene cluster gene polymorphisms, we found that APOA5 rs662799 had interactions with tobacco use and alcohol consumption (PGE<0.05). CONCLUSIONS There was a high prevalence of MetS in the northeast of China. Male gender, increasing age, mental labor, family history of diabetes, cardiovascular disease or cerebral diseases, current smoking, excess salt intake, fruit and dairy intake less than 2 servings a week, and drinking were associated with MetS. The APOA1/C3/A4/A5 gene cluster was associated with MetS in the Han Chinese. APOA5 rs662799 had interactions with the environmental factors associated with MetS.
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Affiliation(s)
- Yanhua Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 1163 Xinmin Street, Changchun, 130021, Jilin province, China
- Division of Clinical Epidemiology, First Hospital of Jilin University, Changchun, Jilin, 130021, China
| | - Yaqin Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 1163 Xinmin Street, Changchun, 130021, Jilin province, China
| | - Tiancheng Zhao
- Department of Endoscopy Center, China-Japan Union Hospital of Jilin University, Changchun, Jilin, 130021, China
| | - Shibin Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 1163 Xinmin Street, Changchun, 130021, Jilin province, China
| | - Yingli Fu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 1163 Xinmin Street, Changchun, 130021, Jilin province, China
| | - Yue Qi
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 1163 Xinmin Street, Changchun, 130021, Jilin province, China
| | - Guang Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 1163 Xinmin Street, Changchun, 130021, Jilin province, China
| | - Wenwang Yao
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 1163 Xinmin Street, Changchun, 130021, Jilin province, China
| | - Yingying Su
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 1163 Xinmin Street, Changchun, 130021, Jilin province, China
| | - Yue Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 1163 Xinmin Street, Changchun, 130021, Jilin province, China
| | - Jieping Shi
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 1163 Xinmin Street, Changchun, 130021, Jilin province, China
| | - Jing Jiang
- Division of Clinical Epidemiology, First Hospital of Jilin University, Changchun, Jilin, 130021, China
- * E-mail: (CGK); (JJ)
| | - Changgui Kou
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 1163 Xinmin Street, Changchun, 130021, Jilin province, China
- * E-mail: (CGK); (JJ)
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Yao MF, He J, Sun X, Ji XL, Ding Y, Zhao YM, Lou HY, Song XX, Shan LZ, Kang YX, Zhang SZ, Shan PF. Gender Differences in Risks of Coronary Heart Disease and Stroke in Patients with Type 2 Diabetes Mellitus and Their Association with Metabolic Syndrome in China. Int J Endocrinol 2016; 2016:8483405. [PMID: 28042294 PMCID: PMC5155098 DOI: 10.1155/2016/8483405] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 10/31/2016] [Accepted: 11/08/2016] [Indexed: 11/18/2022] Open
Abstract
Coronary heart disease (CHD) and stroke are common complications of type 2 diabetes mellitus (T2DM). We aimed to explore the differences in the risks of CHD and stroke between Chinese women and men with T2DM and their association with metabolic syndrome (MS). This study included 1514 patients with T2DM. The Asian Guidelines of ATPIII (2005) were used for MS diagnosis, and the UKPDS risk engine was used to evaluate the 10-year CHD and stroke risks. Women had lower CHD risk (15.3% versus 26.3%), fatal CHD risk (11.8% versus 19.0%), stroke risk (8.4% versus 10.3%), and fatal stroke risk (1.4% versus 1.6%) compared with men with T2DM (p < 0.05-0.001). The CHD risk (28.4% versus 22.6%, p < 0.001) was significantly higher in men with MS than in those without MS. The CHD (16.2% versus 11.0%, p < 0.001) and stroke risks (8.9% versus 5.8%, p < 0.001) were higher in women with MS than in those without MS. In conclusion, our findings indicated that Chinese women with T2DM are less susceptible to CHD and stroke than men. Further, MS increases the risk of both these events, highlighting the need for comprehensive metabolic control in T2DM.
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Affiliation(s)
- Mei-Fang Yao
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China
- Health Management Center, Zhejiang Hospital, Hangzhou 310013, China
| | - Jie He
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China
| | - Xue Sun
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China
| | - Xiao-Li Ji
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China
| | - Yue Ding
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China
| | - Yi-Ming Zhao
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China
| | - Han-Yu Lou
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China
| | - Xiao-Xiao Song
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China
| | - Li-Zhen Shan
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China
| | - Ying-Xiu Kang
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China
| | - Song-Zhao Zhang
- Department of Clinical Laboratory, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China
| | - Peng-Fei Shan
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China
- *Peng-Fei Shan:
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20
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Novel potential targets for prevention of arterial restenosis: insights from the pre-clinical research. Clin Sci (Lond) 2014; 127:615-34. [PMID: 25072327 DOI: 10.1042/cs20140131] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Restenosis is the pathophysiological process occurring in 10-15% of patients submitted to revascularization procedures of coronary, carotid and peripheral arteries. It can be considered as an excessive healing reaction of the vascular wall subjected to arterial/venous bypass graft interposition, endarterectomy or angioplasty. The advent of bare metal stents, drug-eluting stents and of the more recent drug-eluting balloons, have significantly reduced, but not eliminated, the incidence of restenosis, which remains a clinically relevant problem. Biomedical research in pre-clinical animal models of (re)stenosis, despite its limitations, has contributed enormously to the identification of processes involved in restenosis progression, going well beyond the initial dogma of a primarily proliferative disease. Although the main molecular and cellular mechanisms underlying restenosis have been well described, new signalling molecules and cell types controlling the progress of restenosis are continuously being discovered. In particular, microRNAs and vascular progenitor cells have recently been shown to play a key role in this pathophysiological process. In addition, the advanced highly sensitive high-throughput analyses of molecular alterations at the transcriptome, proteome and metabolome levels occurring in injured vessels in animal models of disease and in human specimens serve as a basis to identify novel potential therapeutic targets for restenosis. Molecular analyses are also contributing to the identification of reliable circulating biomarkers predictive of post-interventional restenosis in patients, which could be potentially helpful in the establishment of an early diagnosis and therapy. The present review summarizes the most recent and promising therapeutic strategies identified in experimental models of (re)stenosis and potentially translatable to patients subjected to revascularization procedures.
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21
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Yan Z, Liang Y, Jiang H, Cai C, Sun B, Qiu C. Metabolic Syndrome and Subclinical Carotid Atherosclerosis Among Chinese Elderly People Living in a Rural Community. Metab Syndr Relat Disord 2014; 12:269-76. [PMID: 24588080 DOI: 10.1089/met.2013.0135] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Zhongrui Yan
- Department of Neurology, Jining First People's Hospital, Shandong, China
| | - Yajun Liang
- School of Public Health, Jining Medical University, Shandong, China
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Stockholm, Sweden
| | - Hui Jiang
- Xing Long Zhuang Coal Mine Hospital, Yankuang Group, Shandong, China
| | - Chuanzhu Cai
- Xing Long Zhuang Coal Mine Hospital, Yankuang Group, Shandong, China
| | - Binglun Sun
- Xing Long Zhuang Coal Mine Hospital, Yankuang Group, Shandong, China
| | - Chengxuan Qiu
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Stockholm, Sweden
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22
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Jung JM, Young Kwon D, Han C, Park MH. Metabolic syndrome and early carotid atherosclerosis in the elderly. J Atheroscler Thromb 2014; 21:435-44. [PMID: 24477027 DOI: 10.5551/jat.18655] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIMS To investigate whether metabolic syndrome(MetS) can predict the new onset of carotid plaque or the progression of carotid intima-media thickness(C-IMT) and identify other associated factors in an elderly population without evidence of early carotid atherosclerosis. METHODS B-mode carotid ultrasonography was used to assess the presence of carotid plaque and the C-IMT at baseline and follow-up. Participants with carotid plaque or an increased C-IMT(≥1.0mm) at baseline were excluded from the study. The new occurrence of carotid plaque, defined as early carotid atherosclerosis and the progression of C-IMT, was evaluated. Multiple regression analyses were used to determine predictors of these findings. RESULTS A total of 370 participants over 60 years of age(median age=66 years, 34.1% men) were enrolled. After a median follow-up period of 25 months, 64 participants(17.3%) had newly developed carotid plaque. After adjusting for variables determined to be statistically significant in univariate analyses, a multivariable regression analysis showed that predictors of newly developed carotid plaque were metabolic syndrome(hazard ratio [HR]=1.916; 95% confidence interval [CI]: 1.059-3.466), white blood cell count(HR=1.313; 95% CI: 1.094-1.576) and vitamin B12(HR=1.001; 95% CI: 1.000-1.002) and total cholesterol(HR=1.009; 95% CI: 1.001-1.017) levels. A multiple linear regression analysis showed that the rate of change for C-IMT tended to be associated with the development of metabolic syndrome. CONCLUSIONS Metabolic syndrome is associated with the progression of early carotid atherosclerosis in the general population, suggesting that metabolic syndrome plays an important role in initiating the atherosclerotic process.
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Affiliation(s)
- Jin-Man Jung
- Departments of Neurology, Korea University Ansan Hospital, Korea University College of Medicine
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23
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You L, Liu A, Wuyun G, Wu H, Wang P. Prevalence of hyperuricemia and the relationship between serum uric acid and metabolic syndrome in the Asian Mongolian area. J Atheroscler Thromb 2014; 21:355-65. [PMID: 24401703 DOI: 10.5551/jat.20529] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM To investigate the prevalence of hyperuricemia and the association between the serum uric aci (SUA) levels and incidence of metabolic syndrome (MetS) in the Mongolian area of China. METHODS This cross-sectional survey was based on a population of 1,426 subjects (809 men and 617 women) 20-80 years of age who were recruited from Inner Mongolia, China. Metabolic and anthropometric indicators were measured according to standard methods. Hyperuricemia was defined as an SUA level of ≥7.0 mg/dL for men and ≥6.0 mg/dL for women. MetS was diagnosed based on the consensus criteria released in 2009 from a joint collaboration organization. RESULTS The prevalence of hyperuricemia was 17.7% in men and 5.2% in women. The prevalence of MetS in men was higher than that observed in women(36.7% vs. 17.8%). Waist circumference, BMI and the level of triglycerides were most strongly correlated with the SUA level in both sexes. Men with hyperuricemia had an increased risk of MetS [OR(95%CI)=2.95(2.00-4.35)], while men with a "normal" SUA level(>5.0 mg/dL and <6.3 mg/dL) had a higher risk of MetS, central obesity and hypertriglyceridemia than men in the lower level group (≤5 mg/dL). Women with a higher SUA level(≥4.3 mg/dL) had an increased risk of MetS, central obesity, hypertriglyceridemia and hypertension compared with women in the lowest tertile SUA group (≤3.5 mg/dL). CONCLUSIONS The SUA level is significantly associated with various metabolic indicators. In this study, waist circumference and the level of triglycerides were most strongly correlated with the SUA level in both sexes. Individuals with a normal level of SUA had an increased risk of MetS and other metabolic disorders. Further research on appropriate cut-off values for pre-hyperuricemia is expected, and the early detection of hyperuricemia is essential for the prevention of MetS.
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Affiliation(s)
- Lili You
- Department of Social Medicine& Health Education, School of Public Health, Peking University Health Science Center
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Pu Y, Liu L, Wang Y, Zou X, Pan Y, Soo Y, Leung T, Zhao X, Wong KS, Wang Y. Geographic and sex difference in the distribution of intracranial atherosclerosis in China. Stroke 2013; 44:2109-14. [PMID: 23760212 DOI: 10.1161/strokeaha.113.001522] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Geographic variation and sex difference in the distribution of intracranial atherosclerosis (ICAS) have not been fully discussed before in Chinese patients with cerebral ischemia. We performed this study with the aim to investigate geographic and sex difference in the distribution of ICAS in China. METHODS In this prospective multicenter study, we evaluated 2864 consecutive patients who experienced an acute cerebral ischemia within 7 days of symptom onset in 22 hospitals in China. All the inclusive patients underwent 3-dimensional time-of-flight MR angiography and duplex color Doppler ultrasound or contrast-enhanced MR angiography to document the presence of intracranial or extracranial stenosis. Intracranial large-artery atherosclerosis was defined as ≥50% diameter reduction on MR angiography. RESULTS The proportion of patients with ICAS was significantly higher in north China than in south China (50.22% versus 41.88%; P<0.0001). Patients in the north were likely to consume more alcohol and smoke more cigarettes and had significantly higher proportion of diabetes mellitus, family history of stroke, history of cerebral ischemia, heart disease, and higher body mass index. In patients aged >63 years, the percentage of ICAS in women was notably higher than in men (51.51% versus 45.40%; P=0.028). In elderly patients, women had higher proportion of diabetes mellitus, hypertension, hyperlipidemia, and heart disease than men. CONCLUSIONS There exists geographic and sex difference in the distribution of symptomatic ICAS in China. Public health measures should strengthen improving social determinants of health and risk factor prevention/control in high-risk populations for decreasing stroke risk.
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Affiliation(s)
- Yuehua Pu
- Department of Neurology, Beijing Tiantan Hospital of Capital Medical University, Beijing, China
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Jashari F, Ibrahimi P, Nicoll R, Bajraktari G, Wester P, Henein MY. Coronary and carotid atherosclerosis: similarities and differences. Atherosclerosis 2013; 227:193-200. [PMID: 23218802 DOI: 10.1016/j.atherosclerosis.2012.11.008] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2012] [Revised: 11/10/2012] [Accepted: 11/12/2012] [Indexed: 02/05/2023]
Abstract
Although a relationship is commonly accepted between coronary and carotid arterial disease, suggesting that atherosclerosis is a systemic condition, the extent of this association and correspondence has not been fully elucidated. This review discusses recent research in this field and highlights areas for future study. The prevalence of severe carotid stenosis increases with prevalence of coronary stenosis, with the latter being found in a significant number of stroke patients, while those with carotid stenosis may be at higher risk of myocardial infarction than stroke. There also appear to be common risk factors (age, diabetes, hypertension, smoking and dyslipidemia), although the effects in both vascular systems may not be identical. Furthermore, while the degree of stenosis in the coronary artery has little ability to predict acute coronary syndrome, which is caused by local thrombosis from a ruptured or eroded plaque, severe carotid stenosis causing hypoperfusion is highly predictive of stroke, although this effect may be time-limited. This apparent difference in event mechanism in the two arteries is interesting as is the difference in the rate of development of collaterals. Overall, the evidence shows that a clear relationship exists between disease in the coronary and carotid arteries, since conventional risk factors and the extent of stenosis and/or previous events emanating from one artery have a strong bearing on the prevalence of events in the other artery. Nevertheless, the exact correspondence between the two arteries is unclear, with sometimes contradictory study results. More research is needed to identify the full extent of risk factors for severe stenosis and cardio- or cerebral vascular events, among which, inflammatory biomarkers such as hs-CRP and prior vascular events are likely to play a key role.
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Affiliation(s)
- Fisnik Jashari
- Department of Public Health and Clinical Medicine, and Heart Centre, Umea University, SE-901 87 Umea, Sweden
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26
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Leng XY, Chen XY, Chook P, Xiong L, Lin WH, Liu JY, Tomlinson B, Thomas GN, Lam TH, Lam KSL, Cheung BMY, Wong KS. Association between metabolic syndrome and carotid atherosclerosis: a community-based study in Hong Kong. Metab Syndr Relat Disord 2013; 11:109-14. [PMID: 23350809 DOI: 10.1089/met.2012.0099] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Carotid atherosclerosis should not be neglected as a cause for stroke in China, despite its low prevalence. This study was performed to evaluate the association between ultrasonographic markers for different stages of carotid atherosclerosis and metabolic syndrome. METHODS This was a community-based study in Hong Kong. Metabolic syndrome was defined as having three or more of the following conditions or receiving specific treatment for these conditions: Abdominal obesity, elevated triglycerides, low high-density lipoprotein cholesterol, hypertension, and impaired fasting blood glucose. All subjects underwent carotid duplex ultrasonography. Mean carotid intima media thickness (CIMT) of bilateral common carotid arteries was used as the CIMT value for a single subject. CIMT within the 4(th) quartile was regarded as increased CIMT. Carotid plaque was defined as a focal CIMT of >1.5 mm. A carotid plaque obstructing ≥50% of vessel lumen was considered as carotid stenosis. RESULTS A total of 653 subjects (mean age 55.1±10.4; 47.2% male) were recruited. Metabolic syndrome was found in 188 (28.8%) subjects (30.8% in males and 27.0% in females). Mean CIMT was 0.74±0.12 mm. Increased CIMT, carotid plaque, and carotid stenosis were detected in 163 (25.0%), 95 (14.5%), and 6 (1.4%) subjects, respectively. In multivariate linear regression, CIMT significantly increased with increasing numbers of metabolic syndrome components (P<0.001). In multivariate logistic regression analysis, metabolic syndrome was independently associated with increased CIMT [odds ratio (OR) 1.17; 95% confidence interval (CI) 1.11-2.64; P=0.014), but not presence of carotid plaque (OR 1.50; 95% CI 0.92-2.46; P=0.108). CONCLUSIONS Metabolic syndrome may be independently associated with the early stage but not the later and advanced stages of carotid atherosclerosis in community residents in China.
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Affiliation(s)
- Xin Yi Leng
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong , Shatin, Hong Kong SAR, China
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Ohnuki T, Takahashi W, Ohnuki Y, Kawada S, Takizawa S. Significance of the presence of metabolic syndrome in patients with asymptomatic arteriosclerosis affecting the aorta and the cerebral, extra-cranial carotid and coronary arteries. Intern Med 2013; 52:523-7. [PMID: 23448759 DOI: 10.2169/internalmedicine.52.8858] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The presence of metabolic syndrome (MetS) is strongly associated with stroke and cardiovascular diseases. However, the relationship between MetS and the localization of atherosclerosis at various sites remains uncertain. In this study, in order to reveal the relevance of MetS to atherosclerosis at several sites, we investigated the relationships among vascular risk factors, asymptomatic cerebral infarction and atherosclerosis in the aorta and carotid and coronary arteries in adults without overtly symptomatic cerebrovascular or cardiovascular disease. METHODS The subjects in this study included 2,759 Japanese participants (1,845 men and 914 women, mean age: 52 years) with no history of stroke or cardiovascular events. The diagnosis of MetS was made based on modifications to criteria obtained from the National Cholesterol Education Program Adult Treatment Panel. In all subjects, the presence of cerebral infarction in the extra-cranial carotid, coronary and aortic arteries was investigated using MRI, B-mode ultrasonography and CT. RESULTS Of the 2,759 subjects, 796 (28.9%) fulfilled the criteria for MetS. The presence of MetS increased the odds ratio (OR) to 1.89 (95% confidence interval (CI): 1.35-2.65, p-value <0.0001) for asymptomatic cerebral infarction, 1.70 (95% CI: 1.37-2.10, p-value <0.0001) for carotid arteriosclerosis, 2.07 (95% CI: 1.62-2.27, p-value <0.0001) for coronary calcification and 1.67 (95% CI: 1.33-2.09, p-value<0.0001) for aortic calcification. CONCLUSION The presence of MetS was found to be significantly correlated with arteriosclerosis in all regions, including the cerebral small-vessels, extra-cranial carotid arteries, coronary arteries and abdominal aorta. MetS might be a predictor for small and large vessel disease throughout the body.
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Affiliation(s)
- Tomohide Ohnuki
- Division of Neurology, Department of Internal Medicine, Tokai University School of Medicine, Japan.
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