Ultrasonographic measurements of subclinical carotid atherosclerosis in prediction of ischemic stroke

The association between metabolic dysfunction-associated steatotic liver disease, cardiovascular and cerebrovascular diseases and the thickness of carotid plaque

BACKGROUND

The relationship between metabolic dysfunction-associated steatotic liver disease (MASLD) and atherosclerosis has been controversial, which has become a hit of recent research. The study aimed to explore the association between MASLD, cardiovascular and cerebrovascular diseases (CCVD), and the thickness of carotid plaque which was assessed by ultrasound.

METHODS

From September 2018 to June 2019, 3543 patients were enrolled. We asked participants to complete questionnaires to obtain information. All patients underwent liver ultrasound and bilateral carotid ultrasound to obtain carotid intima-media thickness (IMT) and maximum carotid plaque thickness (CPT). Hepatic steatosis was quantified during examination according to Hamaguchi's ultrasonographic score, from 0 to 6 points. A score < 2 was defined as without fatty liver, and a score ≥ 2 was defined as fatty liver. Information about blood lipids was collected based on the medical records.

RESULTS

We found common risk factors for CCVD events, MASLD, and atherosclerosis. There was a significant correlation between MASLD and carotid plaque, but not with CPT. No association was found between MASLD and CCVD events. CPT and IMT were thicker in CCVD patients than in non-CCVD patients. No significant difference was found between IMT and CPT in MASLD patients and non-MASLD patients. CCVD was independently and consistently associated with higher IMT, and free fatty acid (FFA).

CONCLUSIONS

According to our results, we recommend carotid ultrasound examination of the patients when FFA is increased, regardless of the presence of risk factors and MASLD. Due to the distribution of CPT of both CCVD and MASLD patients in the CPT 2-4 mm group, contrast-enhanced ultrasound is necessary to assess the vulnerability of the plaque when CPT ≥ 2 mm. Timely treatment of vulnerable plaques may reduce the incidence of future CCVD events.

The clinical value of carotid plaque score in patients with metabolic syndrome and cardiovascular diseases

OBJECTIVE

To investigate the relationship between carotid plaque load score (CPS) and metabolic syndrome (MS) and cardiovascular diseases (CVD), in order to provide theoretical basis for the precaution and control of MS and CVD.

METHODS

A total of 1962 patients were incorporated into the study and divided into MS group and non-MS group, CVD group and non-CVD group. CPS and CIMT were obtained by carotid artery ultrasound, and the data of each group were statistically analyzed.

RESULTS

Age, BMI, basal metabolic rate, body fat rate, gender, and the incidence of central obesity, hypertension, diabetes and dyslipidemia are statistical different between MS group and non-MS group (P < 0.05). CIMT between CVD group and non-CVD group are statistical different (1.040 ± 0.239 VS 0.972 ± 0.297, P < 0.001). CPS was statistically significant between MS group and non-MS group(2.254 ± 2.728 VS 1.548 ± 2.219, P = 0.003) and between CVD group and non-CVD group (2.322 ± 2.760 VS 1.688 ± 2.347, P = 0.004).

CONCLUSION

Patients in MS group and CVD group have higher carotid plaque burden than those in non-MS group and non-CVD group. The higher the CPS was, the higher the incidence of MS and CVD was, and the distribution of CPS in MS and CVD population was consistent.

The association between inflammatory biomarkers and carotid artery plaque in normal-weight and metabolically healthy Chinese adults: a cross-sectional study

Existing evidence has indicated a role of inflammation in the development of carotid artery plaque (CAP). We thus evaluated the association between inflammation and CAP in a population with normal body weight and metabolically healthy status. A total of 8050 normal-body-weight and metabolically healthy participants (2613 men and 5437 women, aged 40.5 ± 11.3 y) were included in this study. Inflammatory status was evaluated by three parameters: serum hs-CRP (high-sensitivity C-reactive protein), WBC (white blood cell) count, and NLR (neutrophil-to-lymphocyte ratio). CAP was detected by ultrasound B-mode imaging. Clinical data were abstracted from medical records. Metabolically healthy status was defined as no history of metabolic diseases and normal blood pressure, fasting blood glucose level, hemoglobin A1c level, lipid profile, and liver ultrasonographic findings. The serum level of hs-CRP, but not WBC or NLR, was associated with the risk of CAP after adjustment for age, sex, BMI, blood pressure, fasting blood glucose, glycated hemoglobin A1c, lipid profile, and estimated glomerular filtration rate. The adjusted odds ratio for the risk of CAP was 2.71 (1.64, 4.46) for participants with a high level of hs-CRP (≥3 mg/L), compared with those with a low level (<1 mg/L). Each unit increase in hs-CRP was associated with a 24% higher risk of CAP (OR = 1.24; 95% CI: 1.12, 1.37). Inflammation was associated with the risk of CAP even in individuals with a normal body weight and metabolically healthy status.

Hypertension Predisposition and Thermoregulation Delays in Adolescents with Polycystic Ovary Syndrome: A Pilot Study

Background: Polycystic ovary syndrome (PCOS) is a heterogeneous disorder in which clinical, sonographic, and endophenotypic features have been underinvestigated or inconclusive, especially in the early stages of the disease (adolescence/young adulthood). Objective: This prospective pilot study focused on the differences of multiple physiological functions between Greek adolescent/young adult females suffering from PCOS and age- and body mass index (BMI)- matched healthy controls. Study design: Nineteen PCOS patients and eighteen healthy controls (aged 13 to 23 years) were studied for: (i) biochemical and hormonal dysfunction by measuring circulating glucose, insulin, and androgen levels; (ii) arterial stiffness with pulse wave analysis (PWA) by Sphygmocord; (iii) intima-media thickness (IMT) by ultrasound; (iv) heart rate variability (HRV) by Task Force Monitor; and (v) QT, QRS, QT, P, QRSD by electrocardiogram (ECG). Statistical analysis included Hedge’s g correction for small samples bias, and the results are shown using the Hedge’s g effect size and 95% CI, in line with precision medicine prerequisites. Results: Significant differences in pulse wave velocity (PWV) (g = 0.964 [0.296, 1.632]), subendocardial viability ratio (SEVR) carotid (g = −0.679 [−1.329, −0.030]), pulse pressure (PP) carotid (g = 0.942 [0.275, 1.608]), systolic pressure (SP) carotid (g = 0.785 [0.129, 1.440]), free-testosterone (g = 0.677 [0.042, 0.312]), and Delta4-androstenedione (g = 0.735 [0.097, 0.373]) were observed between PCOS patients and controls. No differences were detected in the remaining endocrine and PWA or ECG biomarkers. Conclusions: Our multidisciplinary approach showed early onset of vascular dysfunction, predisposition to hypertension, thermoregulation delays, and metabolic syndrome changes in adolescent/young adult PCOS.

Serum Lipocalin-2 Levels Are Increased and Independently Associated With Early-Stage Renal Damage and Carotid Atherosclerotic Plaque in Patients With T2DM

OBJECTIVES

Diabetic nephropathy (DN), one of the major complications of diabetes mellitus, is the major cause of end-stage renal failure that finally increases the risk of cardiovascular disease and mortality. The aim of this study is to explore the relationship between serum lipocalin-2 (LCN-2) levels and DN and carotid atherosclerotic plaque (CAP) in patients with type 2 diabetes mellitus (T2DM).

METHODS

We have performed a prospective study of 749 T2DM patients with or without DN. Blood samples were collected and used to test serum LCN-2 levels, renal function, as well as biochemical parameters. CAP in these subjects was determined by ultrasonography.

RESULTS

In these 749 subjects with T2DM, an increased morbidity of CAP was observed in T2DM patients with DN as compared with those without this complication (P < 0.05). Interestingly, serum LCN-2 levels were significantly increased in T2DM patients with DN or CAP compared with T2DM alone [97.71 (71.49-130.13) vs. 77.29 (58.83-115.05) ng/ml, P < 0.001]. In addition, serum LCN-2 levels in T2DM patients with DN and CAP were significantly higher than that of T2DM patients with DN or CAP [131.37 (101.43-182.04) vs. 97.71(71.49-130.13) ng/ml, P < 0.001]. Furthermore, serum LCN-2 levels were positively correlated with hemoglobin A1c, systolic blood pressure, hypertension, CAP, and DN, as well as renal function factors including uric acid, creatinine, the estimated glomerular filtration rate, and urinary albumin-to-creatinine ratio, respectively (P < 0.05), but negatively correlated with HDL-c (P < 0.05). The multinomial logistic regression analysis showed that serum LCN-2 was independently associated with DN and CAP in patients with T2DM after the adjustment for risk factors (P < 0.001).

CONCLUSIONS

Early-stage renal damage is a risk factor associated with the incidence of CAP in patients with T2DM. Serum LCN-2 is significantly increased and associated with early-stage renal damage and the incidence of CAP in patients with T2DM.

Transition from metabolically healthy to unhealth status associated with risk of carotid artery plaque in Chinese adults

Objective

We aimed to evaluate the association between the shift of metabolic status and future risk of carotid artery plaque (CAP) in community-based Chinese adults.

Methods

The current study included 9836 Chinese adults (4085 males and 5751 females, mean age 35.8 years) with metabolically healthy status at baseline (2013). Metabolically healthy status was defined as no self-reported history of metabolic diseases and cancer, and normal blood pressure, fasting blood glucose, glycated hemoglobin A1c level, and lipid profiles. Metabolically unhealthy status was defined if any of the following metabolic abnormalities were confirmed twice during follow up: high blood pressure, impaired glucose regulation, high triglycerides, high total cholesterol, high low-density lipoprotein cholesterols, or low high-density lipoprotein cholesterols. The transition was confirmed if participants’ metabolic status shifted from baseline healthy to unhealthy status during follow up (2014–2018).

Results

We have identified 133 incident cases of CAP during follow up. Compared to those who remained metabolically healthy, the transition to high blood pressure, high total cholesterol, and high low-density lipoprotein cholesterols, were associated with high risk of developing carotid artery plaque (Hazards ratios (HRs) ranged from 1.69 to 2.34; p < 0.05 for all). The transition to impaired glucose regulation, high total triglycerides, and low high-density lipoprotein cholesterols, were associated with high risk of carotid artery plaque only in participants with metabolically healthy overweight at baseline (HR ranged from 1.95 to 4.62; p < 0.05 for all).

Conclusion

The transition from baseline metabolically healthy status to unhealth status was associated with high risk of incident CAP.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12872-021-02279-w.

The association of metabolic health obesity with incidence of carotid artery plaque in Chinese adults

BACKGROUND AND AIMS

We aimed to evaluate the association between different obese phenotypes with carotid artery plaque (CAP) event.

METHOD AND RESULTS

The current retrospective cohort study was performed in 32,778 Chinese adults (19,221 men and 13,557 women, aged 41.9 ± 11.0 years). Obese phenotypes were assessed based on baseline body mass index (<24.0 vs. ≥24.0 kg/m²) and metabolic characteristics (health vs. unhealth). All the participants were further classified into four groups: metabolic health and normal weight (MHNW), metabolic unhealth and normal weight (MUHNW), metabolic health and overweight (MHO), and metabolic unhealth and overweight (MUHO). Ultrasound B-mode imaging was annually performed to evaluate CAP throughout the study. We have identified 2142 CAP cases during 5-year follow-up. Comparing with the MHNW group, the hazard ratios for the risk of incident CAP was 2.44 (95% CI:1.92 and 3.09) for the MUHNW group, 1.52 (95% CI:1.06 and 2.18) for the MHO group, and 1.8 (95% CI:1.4 and 2.33) for the MUHO group. The association was more pronounced in young adults (<65 y) than that in aged adults (≥65 y). Sensitivity analysis generated similar results with the main analysis.

CONCLUSION

MUHNW, MHO, and MUHO were associated with the risk of CAP.

The change in kidney function was associated with carotid artery plaque in a community-based population: A cohort study

BACKGROUND AND AIMS

We performed the current study to evaluate the association between dynamic change in estimated glomerular filtration rate (eGFR) and the risk of carotid artery plaque (CAP) in a community-based population.

METHODS AND RESULTS

A total number of 37,093 Chinese adults (21,790 men and 15,303 women, aged 42.6 ± 11.6 years) free of chronic kidney diseases were enrolled. The change in eGFR was calculated based on two measurements in 2013 and 2014 (mean interval: 1.2 y). Participants were further classified into three groups based on the change in eGFR: fast-decrease (<-3.3%), stable (from -3.3% to 3.3%), and fast-increase (≥3.3%). CAP was annually assessed by ultrasound B model throughout the study (2013-2018). We have identified 1,624 new cases of CAP (16.0 per 1000 person-year) during follow up. Compared to participants with stable eGFR, participants in both fast-decrease and fast-increase groups were associated with 1.99 folds (HR = 1.99, 95% CI: 1.54, 2.57) and 3.15 folds (HR = 3.15, 95% CI: 2.38, 4.16) higher likelihood of developing CAP. The association between continuous change in eGFR and the risk of CAP demonstrate a "U" shape. Sensitivity analysis generated similar results with main analysis.

CONCLUSIONS

Both fast decrease and increase in eGFR were associated with the risk of developing CAP in Chinese adults.

Effect of cilostazol on carotid plaque volume measured by three-dimensional ultrasonography in patients with type 2 diabetes: The FANCY study

AIMS

To conduct a prospective randomized study to evaluate cilostazol, a phosphodiesterase 3 inhibitor, and compare it with aspirin for the prevention of the progression of atherosclerosis in patients with type 2 diabetes (T2D).

MATERIALS AND METHODS

Fifty patients with T2D and carotid atherosclerotic plaques were randomly assigned to either a 200 mg/d cilostazol (CTZ) group or a 100 mg/d aspirin (ASA) group for 6 months. The primary endpoint was change in plaque volume measured by carotid three-dimensional ultrasonography. The secondary endpoints were changes in carotid intima-media thickness (IMT) and endothelial function, assessed by laser Doppler.

RESULTS

Twenty-four patients in the CTZ group and 23 in the ASA group were included in the final analysis. The mean ± SD age of male (n = 20) and female (n = 16) patients was 62.2 and 59.1 years, respectively. The total plaque volume was slightly decreased in the CTZ group (from 183.8 ± 52.5 to 181.5 ± 54.0 mm³ ; P = .567), but significantly increased in the ASA group (from 112.9 ± 21.2 to 128.5 ± 23.3 mm³ ; P = .043). A significant regression in the maximum IMT was observed only in the CTZ group (right: from 2.19 ± 0.17 to 1.96 ± 0.12 mm; left: from 2.02 ± 0.20 to 1.72 ± 0.19 mm). The CTZ group exhibited an increase in HDL cholesterol and a decrease in triglycerides and liver enzymes.

CONCLUSIONS

Cilostazol treatment for 6 months significantly attenuated the progression of carotid plaque compared with aspirin in patients with T2D (NCT03248401).

Association between carotid intima media thickness and small dense low-density lipoprotein cholesterol in acute ischaemic stroke

BACKGROUND

Intima-media thickness (IMT) and small dense low-density lipoprotein cholesterol (sdLDL-C) have been reported to be related to atherosclerosis and stroke. This study is trying to explore the association between IMT and sdLDL-C in Chinese acute ischaemic stroke (AIS) subjects.

METHODS

This study enrolled total 368 consecutive AIS patients and 165 non-AIS controls from November 2016 to February 2019. Mean IMT and carotid plaques were measured by using carotid ultrasonography method. Blood glucose and lipid parameters were measured by using an automatic biochemical instrument. SdLDL-C was detected by using the Lipoprint LDL system. IMT > 1.0 mm was defined as increased IMT. Plaque stability based on the nature of the echo was determined by ultrasound examination. Risk factors for IMT were identified by using multivariate logistic regression analysis. A logistic regression model was established to predict AIS risk. Python software (Version 3.6) was used for the statistical analysis of all data.

RESULTS

The carotid IMT, proportion of plaques, and the sdLDL-C, triglycerides (TG) and glucose levels were obviously higher in AIS patients than those in controls. SdLDL-C level in the IMT thickening group was higher than that in the normal IMT group. SdLDL-C and total cholesterol (TC) were risk factors for IMT, while sdLDL-C was an independent risk factor. The IMT value of the unstable plaque group was markedly higher than that of the stable plaque group. The predictive value of IMT for AIS was better than that of low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (non-HDL-C) but not as good as that of sdLDL-C. A logistic regression model was established to predict AIS risk. Additionally, carotid IMT and sdLDL-C were closely related to AIS severity and outcomes.

CONCLUSIONS

SdLDL-C and TC were risk factors for increased IMT, while sdLDL-C was an independent risk factor. A prediction model based on IMT and other variables was established to screen the population with high AIS risk.

Prospective study of hemoglobin A1c and incident carotid artery plaque in Chinese adults without diabetes

Background

Diabetes has been reported to be associated with carotid artery plaque (CAP). However, it remains unclear whether hemoglobin A1c (HbA1c) level, a marker for long-term glycemic status, is associated with altered CAP risk in individuals with fasting blood glucose (FBG) concentrations below the current cutoff for diabetes.

Methods

Included were 16,863 Chinese adults (aged 18 years or more; 9855 men and 7008 women) with fasting blood glucose < 7.0 mmol/L at baseline (2013). Both HbA1c level and CAP (assessed via ultrasound B-mode imaging) were annually assessed during 2014–2018. All the participants were further classified into three groups based on baseline HbA1c level: ≤ 5.6%, 5.7–6.4%, and ≥ 6.5%. We used Cox proportional-hazards model to evaluate the association between HbA1c level and incident CAP, adjusting for a series of potential confounders.

Results

During 5 years of follow up, 3942 incident CAP cases were identified. Individuals with higher baseline HbA1c had higher future risk of CAP (p-trend < 0.001). In the full-adjusted model, each percent increase of HbA1c was associated with a 56% (HR = 1.56, 95% CI 1.37, 1.78) higher risk of CAP. Excluding participants with chronic inflammation, as assessed by high-sensitivity C-reactive protein and white blood cell, and those with FBG ≥ 5.6 mmol/L at baseline generated similar results.

Conclusions

Elevated HbA1c level was associated with high risk of developing CAP in Chinese adults without FBG defined diabetes.

Circulating Factors and Ultrasono-findings are Linked to Previous Atherosclerotic Burden and Recurrent Risk

Abstract: Background:

In the progression of atherosclerosis, platelet activation and the interaction of platelets with leukocytes play a crucial role in arterial thrombus formation and are associated with the pathophysiology of carotid and cerebrovascular disease (CVD), including ischemic stroke. With aged participants, we evaluated and followed up the change in circulating factor and platelet-leukocyte aggregate levels in participants with or without CVD history. This study investigated whether circulating factor changes and ultrasonographic characteristics link to CVD risk and other relating long-term outcomes.

Materials and Methods:

Two hundred fifteen participants who enrolled in the study were divided into two groups with CVD and without CVD history. We evaluated and analyzed the correlation between ultrasonography-based morphological characteristics and circulating factor-based functional changes in both groups.

Results:

There was no difference in p-selectin level between both groups. However, activated monocyte and platelet-monocyte aggregate levels were higher in patients with previous CVD than without previous CVD. Circulating factor and ultrasonographical characteristics were correlated in the group with CVD, whereas these factors were not correlated in the group without CVD.

Conclusion:

We found that circulating blood factor levels showed a different tendency in participants with and without CVD history. The results depict that atherosclerotic severity might depend on the history of CVD and progression of atherosclerosis. We suggest that the circulating factor levels, atherosclerotic severity, and history of CVD are considered in the observation of pathologic progression to manage the development of CVD risks and CVD relating outcomes.

High-Sensitivity CRP (C-Reactive Protein) Is Associated With Incident Carotid Artery Plaque in Chinese Aged Adults

Background and Purpose—

CRP (C-reactive protein) is an inflammatory biomarker which predicts the risk of cardiovascular diseases. However, whether CRP is associated with carotid artery plaque (CAP) remains unclear.

Methods—

The current retrospective study was performed in 8229 Chinese aged adults (aged 65–99 years; 4677 men and 3552 women). hs-CRP (high-sensitivity CRP) concentrations were measured at baseline (2013), and further classified into 3 groups: low risk (<1.0 mg/L), intermediate risk (1.0–3.0 mg/L), and high risk (≥3.0 mg/L). Ultrasound B-mode imaging was repeatedly performed annually to detect CAP during 5-year follow-up (2013–2018). Potential confounders, including body mass index, blood pressure, fasting blood glucose, alanine transferase, aspartate transferase, alkaline phosphatase, gamma-glutamyl transferase, total bilirubin, direct bilirubin, blood urea nitrogen, creatinine, and uric acid, lipid profiles, were also collected at baseline. White blood cell was collected as well. We used a logistic regression model for the cross-sectional relation between CRP concentration and CAP status and proportional hazardous Cox model for prospective analyses.

Results—

Comparing to the low-risk group, the adjusted odds ratios for CAP was 1.66 (95% CI, 1.43–1.92) in the intermediate-risk group and 1.72 (95% CI, 1.39–2.13) in the high-risk group, after adjustment for potential confounders. We identified 512 incident CAP cases during 5-year follow-up. Each mg/L increase of hs-CRP was associated with a hazard ratio of 1.1 (95% CI, 1.03–1.17) to developing CAP. Sensitivity analysis generated similar results with prospective analyses after excluding participants with overweight and obesity, with elevated fasting blood glucose, LDL (low-density lipoprotein) cholesterol, and white blood cell. The association lost significant when we excluded participants with elevated blood pressure, however, few cases of CAP (n=41) was recruited in participants with normal blood pressure during follow-up.

Conclusions—

High hs-CRP concentration was associated with the high risk of developing CAP in Chinese aged adults.

Risk Factors of Subclinical Atherosclerosis and Plaque Burden in High Risk Individuals: Results From a Community-Based Study

China is going through major change and the incidence of first-ever stroke has increased dramatically. In this study, we aim to determine the ultrasound characteristics of carotid intima-media thickness (CIMT) and carotid plaques (CP) in the Chinese community-based population with high risk of stroke. 1009 stroke-free participants from Datun community were classified at high risk of stroke and included in this cross-sectional study. We performed B-mode carotid ultrasound imaging in all of the study subjects to measure the CIMT in the common carotid artery (CCA) far wall and CP in the CCA, bifurcation and internal carotid artery. Stepwise logistic regression analyses were used to determine factors associated with elevated CIMT and subclinical atherosclerosis, as well as plaque burden (≥2 plaques). Our results showed that traditional risk factors including aging, hypertension, current smoking and the level of high density lipoprotein cholesterol are associated with subclinical atherosclerosis and plaque burden in high-risk community residents. To improve primary prevention in this population, we may consider intense blood pressure and lipid management, and smoking cessation.

Interleukin-6 is an independent predictor of progressive atherosclerosis in the carotid artery: The Tromsø Study

BACKGROUND AND AIMS

Novel biomarkers are linked to cardiovascular disease (CVD). The aim of the present study was to investigate the association between 28 blood biomarkers and the formation and progression of carotid plaque.

METHODS

In a nested case control study with 703 participants from the population based Tromsø Study, a large biomarker panel was measured in blood obtained at baseline. Carotid ultrasound was assessed both at baseline and at 6 years of follow-up. Four groups were defined: Group 1: no plaque at baseline or at follow-up (reference group); Group 2: novel plaque at follow-up; Group 3: stable plaque at follow-up; Group 4: progression of plaque at follow-up. By multinomial logistic regression analyses, we assessed the risk of being in the different plaque groups with regard to traditional cardiovascular risk factors and levels of biomarkers at baseline.

RESULTS

Adjusted for traditional risk factors, interleukin-6 (IL-6) was an independent predictor of plaque progression (OR 1.44, 95% CI 1.12-1.85 per SD increase in IL-6 level). This result remained significant after inclusion of other novel biomarkers to the model, and when subjects with former CVD were excluded. Neopterin was protective of novel plaque formation (OR 0.73, 95% CI 0.57-0.93). Myeloperoxidase and Caspase-1 were independent predictors of plaque progression, but this effect disappeared when excluding subjects with former CVD.

CONCLUSIONS

IL-6 is an independent predictor of plaque progression, suggesting that it may be a marker of progressive atherosclerosis in the general population and that its central role in CVD may be related to promotion of plaque growth.

Association of body flexibility and carotid atherosclerosis in Japanese middle-aged men: a cross-sectional study

OBJECTIVE

This study examined the associations of body flexibility with carotid arterial remodelling, including intima-media thickness (IMT) and plaque formation in middle-aged men.

METHODS

The subjects of this cross-sectional study included 1354 Japanese men aged 35-59 years without histories of stroke or cardiac diseases. The arm extensibility test, which can estimate flexibility of the upper extremity (composed of shoulder external rotation and forearm supination), and the sit-and-reach test were performed. Common carotid IMT and plaque formation (≥1.1 mm) were estimated by ultrasound.

RESULTS

The proportion of subjects who fully completed the arm extensibility test was 55.0%, and who had plaques in the common carotid artery was 37.8%. IMT was associated with poor arm extensibility (β=-0.073, 95% CI -0.02224 to -0.00041, P=0.004), while plaque formation was associated with poor sit-and-reach (OR 0.98579, 95% CI 0.97257 to 0.99919, P=0.038) after adjustment by all covariates.

CONCLUSIONS

This study demonstrated that poor upper extremity and trunk flexibility were associated with characteristics of early onset of atherosclerosis. Furthermore, these associations were independent of covariates such as age, blood pressure, blood lipids glucose levels and abdominal fat accumulation, handgrip strength and lifestyle, including sleeping, drinking, exercise and smoking habits. Poor flexibility may reflect subclinical atherosclerosis in middle-aged men.

Carotid intima media thickness and blood biomarkers of atherosclerosis in patients after stroke or myocardial infarction

AIM

To test if circulating levels of markers of inflammation, endothelial function, and chronic infections, as well as association between these markers and carotid intima media thickness (CIMT), depend on the stage of atherosclerosis expressed as a history of a major vascular event.

METHODS

The associations were analyzed separately in 75 healthy controls, 79 patients 3-6 months after the first-ever non-cardioembolic ischemic stroke (IS), and 37 patients 3-6 months after the first-ever myocardial infarction (MI). Data were collected prospectively in 2005. We measured high sensitivity C-reactive protein (hs-CRP), procalcitonin, E-selectin, intercellular adhesion molecule-1 (ICAM-1), serum level of immune complexes (IC), and identified antibodies against Herpes simplex virus type 1 (HSV), Cytomegalovirus, Chlamydia pneumonia, and Helicobacter pylori. Correlations with CIMT were determined using Pearson R and verified after adjustment for age, sex, hypertension, diabetes, and statin therapy.

RESULTS

Median ICAM-1 concentration was significantly lower in controls than in post-IS patients (188 μg/L vs 215 μg/L), and significantly lower in post-IS patients than in post-MI patients (215 μg/L vs 260 μg/L). Control patients also had significantly lower IC level (0.03 U/L) and HSV antibody index (6.0) compared to both post-IS (0.6 U/L, 9.6) and post-MI (0.4 U/L, 9.2) patients. CIMT was correlated with age (Pearson R=0.38, P=0.001) in the control group, immune complexes (R=0.26, P=0.023) in the post-IS group, and with hs-CRP (R=0.40, P=0.017) in the post-MI group. These correlations were confirmed using multiple regression analysis.

CONCLUSIONS

Our study supports linear correlations between CIMT and IC and hs-CRP levels. However, these associations seem to depend on the type of vascular burden.

Features and risk factors of carotid atherosclerosis in a population with high stroke incidence in China

Epidemiological studies have reported associations between traditional cardiovascular risk factors and carotid intima-media thickness (CIMT) or carotid plaque. However, definite risk factors at different phases of carotid atherosclerosis remain controversial. We aimed to explore risk factors and characteristics of carotid atherosclerosis at different stages in a low-income population with a high incidence of stroke in China. Between April 2014 and January 2015, we recruited 3789 stroke-free and cardiovascular disease-free residents aged ≥ 45 years. B-mode ultrasonography was performed to measure CIMT and the presence of carotid plaque. Traditional risk factors were compared between the increased CIMT group and normal CIMT group, and between those with and without carotid plaque. A total of 3789 participants were assessed in this study, with a mean age (standard deviation) of 59.92 (9.70) years. The prevalence of increased CIMT and carotid plaque increased with older age and higher education levels. Age, hypertension, diabetes, and high low-density lipoprotein cholesterol levels were risk factors for increased CIMT and carotid plaque. Furthermore, compared to never smoking, passive smoking was positively associated with increased CIMT, with an odds ratio (95% confidence interval) of 1.26 (1.05, 1.53; P = 0.016); high body mass index was an obvious protective factor against carotid plaque, with an odds ratio (95% confidence interval) of 0.97 (0.95, 0.99; P = 0.004). It is important to identify factors associated with atherosclerosis to prevent cardiovascular disease and stroke and reduce the burden of stroke in this high-risk population.

Echogenicity of the Common Carotid Artery Intima-Media Complex in Stroke

The grey-scale median of the common carotid artery intima-media complex (IM-GSM) characterizes arterial wall composition, and a low IM-GSM is associated with increased cardiovascular mortality in the elderly. We aimed to determine differences in the IM-GSM between a cohort with cerebrovascular disease and a healthy cohort. Eighty-two healthy individuals (control group: 63.2 ± 8.7 y) and 96 patients with either stroke or transient ischemic attacks (CRVD group: 68.6 ± 9.8 y) were studied. Common carotid artery intima-media thickness and IM-GSM obtained by ultrasound were analyzed using semi-automated edge-detection software. The IM-GSM was significantly lower in the CRVD group than in the control group (106 ± 24 vs. 124 ± 27 au, p < 0.001). The IM-GSM was similar for the infarct and non-infarct sides in CRVD. In the pooled cohort of all participants, the lower the quartile of IM-GSM, the greater were the carotid artery intima-media thickness and carotid artery remodeling. These results suggest the presence of an altered atherosclerotic phenotype in the intima-media complex of CRVD patients that can be detected by ultrasound.

Carotid Intima-Media Thickness is Not Associated with Markers of Atherosclerosis in Stroke Patients

BACKGROUND

It has been argued that carotid intima-media thickness (IMT) could better reflect an adaptive response of the vessel wall rather than being a marker of atherosclerosis. We explore this hypothesis by analyzing the ARTICO data.

METHODS

The ARTICO study was designed to evaluate the prognostic value of the pathological ankle-brachial index (ABI) for the emergence of new vascular events in patients who have suffered a noncardioembolic stroke. Collected variables were as follows: vascular risk factors, mean waist perimeter, quantification of carotid IMT, characteristics of carotid plaques, ABI, and presence of microalbuminuria.

RESULTS

A total of 591 patients with a complete carotid evaluation were available. There was no correlation between ABI and IMT (Spearman's, p NS). Logistic regression revealed that pathological ABI correlated significantly only with internal carotid artery stenosis greater than or equal to 50% (OR [odds ratio] 2.80, 1.66-4.71, P < .01) and peripheral artery disease (OR 3.33, 1.63-6.78, P < .01). However, multivariate regression analysis demonstrated that carotid IMT was independently associated with age (OR 1.05, 95% confidence interval [CI] 1.02-1.09, P < .01), hypertension (OR 1.83, 95% CI 1.02-3.26, P = .04), waist circumference (OR 1.03, 95% CI 1.01-1.05, P < .01), and microalbuminuria (OR 2.02, 95% CI 1.22-3.35, P < .01).

CONCLUSION

In our patients, carotid IMT does not seem to be associated with unequivocal markers of atheromatosis such as the existence of relevant carotid plaques or pathological ABI. These results as well as the association of IMT with age, hypertension, microalbuminuria, and mean waist perimeter support the hypothesis that IMT must be considered a risk factor for general vascular disease rather than a marker of atherosclerotic burden.

Evidence HDAC9 genetic variant associated with ischemic stroke increases risk via promoting carotid atherosclerosis

BACKGROUND AND PURPOSE

A novel association between a single nucleotide polymorphism on chromosome 7p21.1 and large-vessel ischemic stroke was recently identified. The most likely underlying gene is histone deacetylase 9 (HDAC9). The mechanism by which HDAC9 increases stroke risk is not clear; both vascular and neuronal mechanisms have been proposed.

METHODS

We determined whether the lead single nucleotide polymorphisms were associated with asymptomatic carotid plaque (N=25 179) and carotid intima-media thickness (N=31 210) detected by carotid ultrasound in a meta-analysis of population-based and community cohorts. Immunohistochemistry was used to determine whether HDAC9 was expressed in healthy human cerebral and systemic arteries. In the Tampere Vascular Study, we determined whether HDAC9 mRNA expression was altered in carotid (N=29), abdominal aortic (N=15), and femoral (N=24) atherosclerotic plaques compared with control (left internal thoracic, N=28) arteries.

RESULTS

Both single nucleotide polymorphisms (rs11984041 and rs2107595) were associated with common carotid intima-media thickness (rs2107595; P=0.0018) and with presence of carotid plaque (rs2107595; P=0.0022). In both cerebral and systemic arteries, HDAC9 labeling was seen in nuclei and cytoplasm of vascular smooth muscle cells, and in endothelial cells. HDAC9 expression was upregulated in carotid plaques compared with left internal thoracic controls (P=0.00000103). It was also upregulated in aortic and femoral plaques compared with controls, with mRNA expression increased in carotid compared with femoral plaques (P=0.0038).

CONCLUSIONS

Our results are consistent with the 7p21.1 association acting via promoting atherosclerosis, and consistent with alterations in HDAC9 expression mediating this increased risk. Further studies in experimental models are required to confirm this link.

Association between metabolic syndrome and carotid atherosclerosis: a community-based study in Hong Kong

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.

Clinical usefulness of carotid ultrasound to improve stroke risk assessment: ten-year results from the Carotid Atherosclerosis Progression Study (CAPS)

BACKGROUND AND PURPOSE

To prevent strokes it is essential to correctly classify people according to their risk of stroke. The aim of the present study was to assess whether carotid ultrasound improves the stroke risk prediction in asymptomatic individuals.

METHODS

The baseline visit of the Carotid Atherosclerosis Progression Study (CAPS) included assessment of conventional risk factors and carotid ultrasound. During the 10-year follow-up of 4995 subjects, strokes, transient ischaemic attacks (TIA) and deaths were recorded. We assessed the additional usefulness of carotid ultrasound compared to the Framingham Stroke Risk Score (FSRS) with reclassification statistics using four risk categories.

RESULTS

Most risk models were not improved by carotid ultrasound. For individual stroke prediction, intima-media thickness (IMT) or plaque of the internal carotid arteries were more useful than common carotid or bifurcational IMT. The model predicting 'any stroke or death' was significantly improved when ultrasound parameters were included - 339 subjects (7.2%) were reclassified to another risk category (122 were shifted to a higher, 217 to a lower risk category); 182 (53.7%) were correctly reclassified. The net reclassification improvement (NRI) was 7.7% (p = 0.029) and the integrated discrimination improvement (IDI) was 0.73% (p = 0.023).

CONCLUSIONS

When carotid ultrasound is not restricted to the common carotid artery but includes the internal carotid segments, the inclusion of ultrasound data into stroke risk models may improve the risk classification of individuals. Further validation in primary prevention cohorts is warranted.

Advances in noninvasive imaging for evaluating clinical risk and guiding therapy in carotid atherosclerosis

Managing asymptomatic carotid atherosclerosis with a view to preventing ischemic stroke is a challenging task. As the annual risk of stroke in untreated asymptomatic patients on average is less than the risk of surgical intervention, the key question is how to identify those asymptomatic individuals whose risk of stroke is elevated and who would benefit from surgery, while sparing low-risk asymptomatic patients from the risks of surgical intervention. The advent of a multitude of noninvasive carotid imaging techniques offers an opportunity to improve risk stratification in patients and to monitor the response to medical therapies; assessing efficacy at individual and population levels. As part of this, plaque measurement techniques (using ultrasound, computed tomography or MRI) may be employed in monitoring plaque/component regression and progression. Novel imaging applications targeted to plaque characteristics, inflammation and neovascularization, including contrast-enhanced ultrasound and MRI, dynamic contrast-enhanced MRI, and fluorodeoxyglucose-PET, are also being explored. Ultimately, noninvasive imaging and other advances in risk stratification aim to improve and individualize the management of patients with carotid atherosclerosis.

Carotid atherosclerosis predicts lower cognitive test results: a 7-year follow-up study of 4,371 stroke-free subjects - the Tromsø study

BACKGROUND

Carotid artery atherosclerosis is a major risk factor for stroke and subsequent cognitive impairment. Prospective population studies have shown associations between carotid intima-media thickness (IMT) and stenosis and cognitive decline and dementia in elderly stroke-free persons, whereas results in the middle-aged are conflicting.

METHODS

In this prospective population-based study, 4,371 stroke-free middle-aged participants underwent carotid ultrasound examination and assessment of vascular risk factors at baseline and were tested for cognitive function 7 years later. Associations between IMT, number of plaques and total plaque area and cognitive test scores on verbal memory test, digit symbol-coding test and tapping test were assessed in linear regression models.

RESULTS

In the multivariable analyses adjusted for sex, age, education, depression and vascular risk factors, the presence of plaques was significantly associated with lower test scores on the verbal memory test (p = 0.01) and on the digit symbol-coding test (p = 0.03). The number of plaques (p = 0.01) and the total plaque area (p = 0.02) were associated with lower scores on the verbal memory test. No significant association was seen between common carotid artery IMT and cognitive test scores. The tapping test was not associated with the carotid ultrasound variables.

CONCLUSIONS

In this middle-aged general population, subclinical carotid atherosclerosis measured as the presence of plaques, number of plaques and total plaque area were independent long-term predictors of lower cognitive test scores.

Correlation between Doppler velocities and duplex ultrasound carotid cross-sectional percent stenosis

RATIONALE AND OBJECTIVES

Cross-sectional imaging is being increasingly proposed as a suitable tool to characterize carotid plaques. The aim of this work was to correlate the Doppler velocity parameters with the cross-sectional percent stenosis (CPoS) of internal carotid artery (ICA) and to identify the cutoff values of these parameters in five progressive classes of stenosis area severity (ie, 40%-49%, 50%-59%, 60%-69%, 70%-79%, 80%-90%).

MATERIALS AND METHODS

High-quality scans from 90 patients (mean age, 74 ± 9 years) with 43%-90% ICA stenosis were analyzed. ICA peak-systolic (PSV) and end-diastolic (EDV) velocities were measured at maximum stenosis level. Total ICA area and residual lumen (RL) were measured to derive the CPoS. A simple physical model described by the equation Velocity = Flow rate/Area was considered. Effectively, the CPoS is expected to negatively correlate with the inverse of velocity parameters, assuming flow rate to be constant. Multiple stepwise regression analyses were used to investigate the relationships between velocity and echographic measures.

RESULTS

With CPoS as the dependent variable, the first significant regressor was the inverse ICA-EDV (r(2) = 0.64; P < .0001) followed by inverse ICA-PSV (r(2) = 0.43; P < .0001). ICA-EDV mean values throughout five progressive classes of stenosis were: 28 cm/second for 40%-49% stenosis, 35 cm/second for 50%-59%, 43 cm/second for 60%-69%, 69 cm/second for 70%-79%. and 103 cm/second for 80%-90%. ICA-PSV mean values were: 97 cm/second for 40%-49%, 110 cm/second for 50%-59%, 136 cm/second for 60%-69%, 224 cm/second for 70%-79%, and 286 cm/second for 80%-90%.

CONCLUSION

ICA-EDV is the parameter that better correlates with CPoS. Nevertheless, ICA-PSV maintained a highly significant correlation with CPoS. Moreover, the categorization of Doppler parameters in five progressive classes of severity of stenosis could provide physicians with an easily accessible tool in clinical practice, complementary to the morphological evaluation of cross-sectional stenosis.

Subclinical carotid atherosclerosis and cognitive function

Carotid artery atherosclerosis is a major risk factor for stroke and subsequent cognitive impairment. Recent studies indicate that carotid atherosclerosis without clinical stroke may also be an independent risk factor for cognitive decline and dementia. Ultrasonography is an easily assessable and non-invasive method to measure different stages of the carotid artery atherosclerotic process and is widely used in clinical assessment as well as in epidemiological and clinical research. We give a brief review of studies that have investigated degrees of the subclinical atherosclerosis in the carotid arteries in relation to cognitive function and dementia, and we discuss several possible mechanisms that could explain the association between atherosclerosis and cognitive impairment.

Value of carotid intima-media thickness and significant carotid stenosis as markers of stroke recurrence

BACKGROUND AND PURPOSE

Data on the predictive value of carotid intima-media thickness (IMT) for stroke recurrence are scarce. We sought to analyze outcome differences in stroke patients with high IMT values compared with patients with significant carotid stenosis (SCS).

METHODS

The multicenter observational ARTICO study included 620 independent patients older than 60 years with a first-ever noncardioembolic stroke. Patients were followed-up for 1 year. The primary end point was a composite of cardiovascular events and death. The IMT-ARTICO substudy analyzed ultrasonographic data from 599 patients. After Doppler carotid echography, patients were classified into the SCS group (carotid stenosis ≥50%; 117 cases), high IMT group (patients with the common carotid IMT in the highest quartile ≥1.11 mm and without SCS; 110 cases), and control group (stroke patients with an IMT <1.11 mm and without SCS; 372 cases). We analyzed the impact of both conditions on the primary end point.

RESULTS

During follow-up, 88 patients (14.7%) had an end point event. Univariate analysis showed that male gender, diabetes, symptomatic peripheral arterial disease, ankle brachial index ≤0.9, SCS, and high IMT were related to the primary end point. Cox regression showed that peripheral arterial disease (hazard ratio [HR], 2.06; 95% confidence interval [CI], 1.18-3.59; P=0.011), SCS (HR, 3.02; 95% CI, 1.78-5.13; P=0.0001), and high IMT (HR, 1.86; 95% CI, 1.05-3.29; P=0.032) were related to the primary end point. If patients with scheduled revascularization procedures were excluded from the Cox regression, then ultrasonographic markers were SCS (HR, 1.84; 95% CI, 1.03-3.28; P<0.039) and high IMT (HR, 1.86; 95% CI, 1.06-3.27; P=0.030).

CONCLUSIONS

Both SCS and high IMT have an independent impact as markers of major cardiovascular events or death after a first-ever noncardioembolic stroke.

High rate of increased carotid intima-media thickness and atherosclerotic plaques in Chinese asymptomatic subjects with central obesity

Both central obesity and increased carotid intima-media thickness (IMT) are markers of atherosclerosis and associated with cardiovascular diseases (CVD). Information of IMT in Chinese subjects with central obesity is limited. This study was performed to assess the rate of atherosclerosis and abnormal IMT in asymptomatic Chinese subjects with central obesity, and to investigate the association between IMT values and CVD risk factors including hypertension, hyperglycaemia and dyslipidaemia. We studied 122 centrally obese adults who had good past health. IMT measurements on carotid arteries were performed and fasting blood taken for plasma glucose and lipid profiles. Abnormal IMT was defined as > 0.9 mm. Atherosclerosis was defined as the presence of one or more visible plague. Of the 122 subjects, the mean (±SD) age was 59.4 ± 5.8 years (median [range]: 59.0 [45-75] years). The median IMT value was 0.70 mm (range: 0.53-1.19 mm) [men vs. women: 0.74 mm vs. 0.66 mm, P-value: < 0.001]. IMT values and the rate of atherosclerosis increased with age and the number of CVD risk factors (P-value for trend: < 0.05). Using binary logistic regression to predict the presence of atherosclerosis with the presence of abnormal IMT, age, gender, and other CVD risk factors as independent variables, age (OR [95% CI] = 1.13 [1.03, 1.23], P = 0.009) and abnormal IMT (OR [95% CI] = 4.05 [1.09, 15.03], P = 0.037) were independently associated with atherosclerosis. In conclusion, among Hong Kong Chinese asymptomatic subjects with central obesity, there was a high rate of CVD risk factors. We found that 19% of these subjects had carotid atherosclerotic plaques and 10% of them had abnormal IMT (>0.9 mm). Carotid IMT study may serve as an appropriate screening tool to diagnose atherosclerosis in the centrally obese middle-aged population.

Significance of plasma D-dimer in relation to the severity of atherosclerosis among patients evaluated by non-invasive indices of cardio-ankle vascular index and carotid intima-media thickness

The aim of this study is to elucidate the usefulness of plasma D-dimer for the prediction of thrombotic events in highly atherosclerotic patients. The severity of atherosclerosis was measured by non-invasive methods including cardio-ankle vascular index (CAVI) and carotid intima-media thickness (IMT) in 100 patients with atherosclerosis aged 72.1 years on average. CAVI was significantly correlated with the levels of D-dimer, platelet aggregation (Plt Aggre), uric acid (UA), creatinine (Cr), blood urea nitrogen (BUN), and C-reactive protein (CRP), whereas IMT was significantly correlated with the levels of Cr, BUN, and CRP. CAVI and IMT were suitable for stratification of the patients. A comparison of hemostatic markers (D-dimer, fibrinogen and Plt Aggre) between the less sclerotic group (group A; CAVI <8.0 and IMT <1.1 mm, n = 26) and the highly sclerotic group (group B; CAVI >8.0 and IMT >1.1 mm, n = 32) revealed that the incidence of thrombosis was significantly higher in group B (18.8%) than in group A (3.8%) and that D-dimer was significantly higher (p < 0.01, Mann-Whitney U test) in group B (0.48 mug/ml, median) than in group A (0.32 mug/ml, median). Moreover, multiple linear regression analyses of CAVI and IMT indicated that D-dimer and age were significant variables. In conclusion, D-dimer is significantly associated with thrombosis in highly atherosclerotic patients.