Common carotid intima-media thickness and arterial stiffness: indicators of cardiovascular risk in high-risk patients. The SMART Study (Second Manifestations of ARTerial disease)

Reply to Saleh, C. Comment on "Bažadona et al. The Interconnection between Carotid Intima-Media Thickness and Obesity: Anthropometric, Clinical and Biochemical Correlations. Medicina 2023, 59, 1512"

We would like to begin by expressing our gratitude for the interest shown in our research [...].

Subclinical atherosclerosis in patients with relapsing-remitting multiple sclerosis

BACKGROUND

Multiple sclerosis is an inflammatory disorder of the central nervous system. Inflammation may create high susceptibility to subclinical atherosclerosis. The purpose of this study was to compare subclinical atherosclerosis and the role of inflammatory cytokines between the group of patients with relapsing-remitting multiple sclerosis (RRMS) and healthy controls matched for age and sex.

METHODS

The study group consisted of 112 non-diabetic and non-hypertensive RRMS patients treated with disease modifying drugs (DMD) and the control group was composed of 51 healthy subjects. The common carotid artery (CCA) intima media thickness (IMT) was investigated. Serum levels of risk factors for atherosclerosis and inflammatory cytokines were also determined.

RESULTS

The mean CCA IMT (0.572 ± 0.131 mm vs. 0.571 ± 0.114 mm) did not differ (p > 0.05) between patients and controls. The RRMS patients' CCA IMT was significantly correlated with serum interleukin 6 (IL-6) (p = 0.027), high-sensitivity C-reactive protein (hs-CRP) (p = 0.027), cystatin C (p < 0.0005), glucose (p = 0.031), cholesterol (p = 0.008), LDL (p = 0.021), erythrocyte sedimentation rate (p = 0.001) and triglyceride (p = 0.018) level. We fitted generalized linear models in order to assess the relationship between CCA IMT and IL‑6 with adjustment for sex and age. The obtained results showed that adjusted for age (p < 0.001) and sex (p = 0.048) IL‑6 serum levels statistically significantly (p = 0.009) predict CCA IMT only in the RRMS group.

CONCLUSION

The findings of the present study suggest that when treated with DMD RRMS might not be an independent risk factor for early atherosclerosis presenting with arterial wall thickening; however, the results suggest a significant association of IL‑6 serum levels with CCA IMT only in the RRMS group.

Carotid Doppler findings among patients admitted with stroke in two tertiary care facilities in Uganda: A Hospital-based Cross-sectional Study

Background

Carotid Atherosclerotic Disease (CAD) Doppler findings including carotid artery stenosis, thickened intima media thickness, and high-risk atherosclerotic plaques are associated with increased risk of stroke and symptomatic cerebrovascular disease. However, few studies have explored these Doppler characteristics among stroke patients in Africa. This study, therefore, investigates these carotid artery Doppler characteristics among stroke patients in Uganda.

Methods

A hospital-based cross-sectional study of 95 stroke patients attending two national referral hospitals in Uganda between March and July 2022. Following the caption of their sociodemographic and clinical characteristics, they underwent Doppler sonography of the extracranial carotid arteries using a standard carotid Doppler protocol. Multivariate logistic regression was used to determine factors associated with abnormal carotid Doppler parameters (i.e., carotid intima-media thickness, carotid stenosis).

Results

The mean age of the study participants was 61 ± 13 years with 60% (57/95) of the participants being male. Most participants had an ischemic stroke (67%), hypertension (76.4%), and used alcohol (58.9%). The prevalence of significant carotid stenosis in participants with ischemic stroke was 12.5% (8/64) (i.e., 7.8% had severe carotid stenosis and 4.7% had moderate stenosis). The prevalence of high carotid intima media thickness (CIMT) and atherosclerotic plaques were 31.6% (30/95) and 26.3% (25/95), respectively. Most atherosclerotic plaques were echogenic. Age above 60 years (adjusted odds ratio [aOR] = 5.2, 95% Confidence Interval [CI]:1.97-14; p < 0.010), high low-density lipoprotein cholesterol (aOR = 4.2, 95% CI: 1.29-8.79; p = 0.013) increased the likelihood of having abnormal CIMT.

Conclusion

The burden of carotid atherosclerotic disease is increasing among stroke patients in Uganda. Large-scale epidemiological studies are needed to further profile the disease in high risk populations.

Determinants of Arterial Stiffness in Patients with Morbid Obesity. The Role of Echocardiography and Carotid Ultrasound Imaging

Background and objective: Morbid obesity is accompanied by an increased cardiovascular (CV) risk, which justifies a multidisciplinary, integrative approach. Arterial stiffness has a well-defined additional role in refining individual CV risk. Given that echocardiography and carotid ultrasound are usual methods for CV risk characterization, we aimed to identify the imaging parameters with a predictive value for early-onset arterial stiffness. Material and methods: We conducted a study in which 50 patients (divided into two equal groups with morbid obesity and without obesity), age and gender matched, untreated for cardiovascular risk factors, were addressed to bariatric surgery or non-inflammatory benign pathology surgery. Before the surgical procedures, we evaluated demographics, anthropometric data and biochemical parameters including adipokines (chemerin, adiponectin). Arterial stiffness was evaluated using the Medexpert ArteriographTM TL2 device. Transthoracic echocardiography and carotid ultrasound were also performed. We also analyzed adipocyte size and vascular wall thickness in intraoperative biopsies. Results: Left ventricle (LV) mass index (p = 0.2851), LV ejection fraction (LVEF) (p = 0.0073), epicardial adipose tissue thickness (p = 0.0001) as echocardiographic parameters and carotid intima–media thickness (p = 0.0033), relative wall thickness (p = 0.0295), wall to lumen thickness ratio (p = 0.0930) and carotid cross-sectional area (p = 0.0042) as ultrasound parameters were significant measures in our groups and were assessed in relation to adipocyte size, blood vessel wall thickness and adipokines serum levels. Statistical analysis revealed directly proportional relationships between LV mass index (p = 0.008), carotid systolic thickness of the media (p = 0.009), diastolic thickness of the media (p = 0.007), cross-sectional area (p = 0.001) and blood vessel wall thickness. Carotid relative wall thickness positively correlates with adipocyte size (p = 0.023). In patients with morbid obesity, chemerin and adiponectin/chemerin ratio positively correlates with carotid intima–media thickness (p = 0.050), systolic thickness of the media (p = 0.015) and diastolic thickness of the media (p = 0.001). The multiple linear regression models revealed the role of epicardial adipose tissue thickness and carotid cross-sectional area in predicting adipocyte size which in turn is an independent factor for arterial stiffness parameters such as pulse wave velocity, subendocardial viability ratio and aortic augmentation index. Conclusions: Our results suggest that epicardial adipose tissue thickness, carotid intima–media thickness, relative wall thickness and carotid cross-sectional area might be useful imaging parameters for early prediction of arterial stiffness in patients with morbid obesity.

Plasma Campesterol Is Positively Associated with Carotid Plaques in Asymptomatic Subjects

BACKGROUND

Increased cholesterol absorption and reduced synthesis are processes that have been associated with cardiovascular disease risk in a controversial way. However, most of the studies involving markers of cholesterol synthesis and absorption include conditions, such as obesity, diabetes, dyslipidemia, which can be confounding factors. The present study aimed at investigating the relationships of plasma cholesterol synthesis and absorption markers with cardiovascular disease (CVD) risk factors, cIMT (carotid intima-media thickness), and the presence of carotid plaques in asymptomatic subjects.

METHODS

A cross-sectional study was carried out in 270 asymptomatic individuals and anthropometrical parameters, fasting plasma lipids, glucometabolic profiles, high-sensitivity C-reactive protein (hs-CRP), markers of cholesterol synthesis (desmosterol and lathosterol), absorption (campesterol and sitosterol), cIMT, and the presence of atherosclerotic plaques were analyzed.

RESULTS

Among the selected subjects aged between 19 and 75 years, 51% were females. Age, body mass index, systolic and diastolic blood pressure, total cholesterol, non-HDL-C, triglycerides, glucose, and lathosterol/sitosterol ratios correlated positively with cIMT (p ≤ 0.05). Atherosclerotic plaques were present in 19% of the subjects. A direct association of carotid plaques with campesterol, OR = 1.71 (95% CI = 1.04-2.82, p ≤ 0.05) and inverse associations with both ratios lathosterol/campesterol, OR = 0.29 (CI = 0.11-0.80, p ≤ 0.05) and lathosterol/sitosterol, OR = 0.45 (CI = 0.22-0.95, p ≤ 0.05) were observed in univariate logistic regression analysis.

CONCLUSIONS

The findings suggested that campesterol may be associated with atherosclerotic plaques and the lathosterol/campesterol or sitosterol ratios suggested an inverse association. Furthermore, synthesis and absorption of cholesterol are inverse processes, and the absorption marker, campesterol, may reflect changes in body cholesterol homeostasis with atherogenic potential.

Coeliac and cardiovascular disease: a possible relationship between two apparently separate conditions

Coeliac disease (CD) is an autoimmune condition with a high prevalence among general population and multisystemic involvement: a more complex scene than a merely gastrointestinal disease. Therefore, an early diagnosis and treatment with a gluten-free diet is mainly important to reduce mortality and comorbidities. Together with autoimmune diseases (as Hashimoto thyroiditis, insulin-dependent diabetes mellitus, autoimmune liver disease and connective tissue diseases), also an accelerated progression of atherosclerosis and a higher prevalence of heart disease have been reported in coeliacs. In the present paper we tried to collect from literature the emergent data on the probable relationship between coeliac and cardiovascular disease, focusing on pathophysiological bases of vascular injury. Data and opinions on the development of cardiovascular risk in patients with CD are conflicting. However, the major evidence supports the theory of an increased cardiovascular risk in CD, due to many mechanisms of myocardial injury, such as chronic malabsorption, abnormalities of intestinal permeability, and direct immune response against self-proteins. The conclusions that come from these data suggest the utility of a careful cardiovascular follow up in coeliac patients.

Association of Vascular Properties With the Brain White Matter Hyperintensity in Middle-Aged Population

Background The periventricular white matter is more sensitive to the systemic hemodynamic alterations than the deep white matter because of differences in its vascular structure and systemic circulation relationship. We hypothesize that periventricular white matter hyperintensity (PVWMH) volume shows greater association than deep white matter hyperintensity (DWMH) volume with vascular properties (VPs) reflecting arterial stiffness and cardiovascular remodeling, indicators of the systemic circulation. Methods and Results A total of 426 participants (age, 59.0±6.1 years; 57.5% women; and 39.7% Black race) in the Genetic Study of Atherosclerosis Risk who were aged ≥50 years and had brain magnetic resonance imaging were studied. VPs included pulse pressure, hypertensive response to exercise, diastolic brachial artery diameter, diastolic common carotid artery diameter, common carotid artery distensibility coefficient, and left ventricular function. The relative associations of VPs with PVWMH and DWMH as multiple measures within the same individual were determined using multilevel linear models. We also determined if age modified the differences in VPs associations with PVWMH and DWMH. Our findings indicated that, within the same subject, PVWMH volume had greater association than DWMH volume with pulse pressure (P=0.002), hypertensive response to exercise (P=0.04), diastolic brachial artery diameter (P=0.012), and diastolic common carotid artery diameter (P=0.04), independent of age and cardiovascular risk factors. The differences of PVWMH versus DWMH associations with VPs did not differ at any age threshold. Conclusions We show, for the first time, that PVWMH has greater association than DWMH, independent of age, with vascular measurements of arterial stiffness and cardiovascular remodeling suggesting that changes in the systemic circulation affect the PVWMH and DWMH differently.

Transcranial sonography depicts a larger substantia nigra echogenic area in renal transplant patients on calcineurin inhibitors than on rapamycin

BACKGROUND

After kidney transplantation neurologic manifestations may develop, including Parkinson's disease (PD). An enlarged substantia nigra (SN) by transcranial sonography has been recognized as a marker of PD.

METHODS

In renal transplant recipients (RTRs = 95) and controls (n = 20), measurement of mesencephalon, SN, third ventricle, spleen and carotid intima-media thickness (cIMT) and middle cerebral artery (MCA), kidney and spleen arteries Doppler resistive index (RI) were performed.

RESULTS

RTRs had larger SN, third ventricle and cIMT and higher renal RI than controls. The SN was larger in the CNIs group than in controls and rapamycin group, while the third ventricle was similar between patients but larger than in controls. In RTRs, SN showed a direct linear correlation with spleen and the third ventricle with age, cIMT and RI of the MCA, kidney and spleen. In CNIs group the SN correlated positively with age and cIMT, while the third ventricle reproduced RTRs correlations. Rapamycin group showed a direct linear relationship between the third ventricle and age and RI of the MCA, kidney and spleen; SN showed no correlations.

CONCLUSION

RTRs on CNIs present a larger SN area than on rapamycin, probably due to the antiproliferative effect of rapamycin. This finding might be relevant when interpreting TCS in RTRs.

Relationship between lipoprotein (a) and subclinical carotid atherosclerosis in asymptomatic individuals

BACKGROUND

This study aimed to evaluate the associations between Lipoprotein (a) ‒ Lp(a) levels and carotid Intima-Media Thickness (cIMT) and with carotid plaques in healthy subjects because of previous contradictory data.

METHODS

A total of 317 healthy normolipidemic subjects (20‒77 years old) were selected. The cIMT and atherosclerotic plaques were determined by B-mode ultrasonography. Mann-Whitney tests were performed to compare the groups according to Lp(a) levels and to explore the associations between Lp(a), carotid plaques, and cIMT, logistic and linear regression analyses were performed.

RESULTS

Studied population (51% females, median age 43 years old) presented carotid plaques and cIMT ≥ 0.9 mm in 23% and 18% of the participants, respectively. The group with Lp(a) levels > 30 mg/dL presented significantly higher age and atherosclerotic plaques. Indeed, multivariate linear regression analysis showed a significant association between Lp(a), age, and race. On the other hand, logistic regression analysis demonstrated that the subjects with Lp(a) > 30 mg/dL have a significantly high risk of carotid plaques.

CONCLUSION

The data from the present study indicate that Lp(a) levels above 30 mg/dL contribute to the development of carotid plaques even in apparently healthy participants.

Relationship Between Dietary Patterns and Carotid Atherosclerosis Among People Aged 50 Years or Older: A Population-Based Study in China

Background: The relationship between dietary patterns and atherosclerosis is inconclusive. Usually, diets vary greatly among different regions due to cultural differences and lifestyles. Few studies to date based on a Chinese population have investigated the relationship between dietary patterns and the formation of atherosclerosis in carotid arteries. We aimed to investigate whether dietary patterns were related to carotid atherosclerosis among an adult population in Tianjin, China. Methods: This cross-sectional study included a total of 2,346 participants aged 50 years or older (mean: 59.7 ± 6.29 years). Dietary intakes were assessed using a validated 81-item semiquantitative food frequency questionnaire, and factor analysis was used to identify dietary patterns. Carotid atherosclerosis was defined as a common carotid artery intima-media thickness ≥1.0 mm or plaques, or a carotid bifurcation intima-media thickness ≥1.2 mm. Multiple logistic regression models were used to explore the relationship between dietary patterns and carotid atherosclerosis. Results: Three factors were determined: "health" dietary pattern (factor 1), "traditional Tianjin" dietary pattern (factor 2), and "sweets" dietary pattern (factor 3). The multivariable-adjusted odds ratios (95% CI) of carotid atherosclerosis for the increasing quartiles of the sweets dietary pattern scores in women were as follows: 1.00 (reference), 1.33 (0.91, 1.97), 1.21 (0.82, 1.79), 1.64 (1.08, 2.51) (p for trend <0.05). No significant difference was found between any dietary pattern and carotid atherosclerosis in men. Conclusion: Greater adherence to "sweets" dietary patterns was positively related to a higher prevalence of carotid atherosclerosis in women aged 50 or older. No relationship was found between any dietary pattern and carotid atherosclerosis in men. Further prospective studies are warranted to test this finding in other populations.

Relationship between Indices of Vascular Function and Presence of Overt Cardiovascular Disease among Persons with Poorly Controlled Type 2 Diabetes

The aim of this study was to assess the factors associated with impaired vascular function in patients with poorly controlled type 2 diabetes (DM2) with and without overt cardiovascular disease (CVD). Ninety-five patients with DM2 and poor glycemic control were recruited and divided into two groups: Group 1, with known CVD (n = 38), and Group 2, without CVD (n = 57). Patients in Group 2 were further subdivided into those with short (<5 years, group 2b) and long (>5 years, group 2a) diabetes duration. Subclinical markers of atherosclerosis were assessed. Glycemic control was similar in the two groups (HbA1c: 9.2% (1.5) vs. 9.4% (1.8), p = 0.44). In Group 1, lower FMD (3.13 (2.16)% vs. 4.7 (3.4)%, p < 0.05) and higher cIMT (1.09 (0.3) mm vs. 0.96 (0.2) mm, p < 0.05) was seen compared with Group 2, whereas PWV was similar (12.1 (3.4) vs. 11.3 (3.0) m/s, p = 0.10). Patients in Group 2b had significantly lower PWV and cIMT and higher FMD compared to Group 1 (p < 0.05). Among patients with poorly controlled T2D, more pronounced vascular dysfunction was present in those with overt macrovascular disease. In patients with T2D without known CVD, vascular dysfunction was associated with disease duration. The use of vascular indices for cardiovascular risk stratification in patients with T2D requires further study.

Accelerated Atherosclerosis in Systemic Lupus Erythematosus: Role of Fibroblast Growth Factor 23- Phosphate Axis

PURPOSE

Despite management advances, accelerated atherosclerotic cardiovascular disease (ACVD) remains a major cause of morbimortality in systemic lupus erythematosus (SLE) patients; that is not fully explained by traditional risk factors. Fibroblast growth factor-23 (FGF23) is a bone-derived phosphaturic hormone with multiple klotho-dependent and independent effects, including promotion of atherosclerosis and vascular calcification, particularly in the context of chronic kidney disease. Increased circulating FGF23 was reported in SLE patients, particularly with lupus nephritis (LN); but its atherogenic role in these disorders was not explored.

SUBJECTS AND METHODS

Three study groups of predominantly middle-aged females were categorized by the 2012 SLE International Collaborating Clinics (SLICC) criteria as SLE (without LN), LN, or controls matching for traditional CVD risk profile. Measures of SLE activity, damage, steroid therapy, and glomerular filtration rate were calculated. Fasting blood samples were checked for serum lipid profile, anti-DNA, urea, creatinine, uric acid, proteins, albumin, calcium, phosphorus, C3, C4, CRP, vitamin-D3, intact parathyroid hormone and FGF23 (iFGF23). By carotid ultrasonography, mean common carotid artery intima-media thickness (CC-IMT), plaque score (PS) and internal carotid resistive index (ICRI) were recorded.

RESULTS

CC-IMT, ICRI and serum iFGF23 differed along the study groups (LN>SLE>controls). In both SLE and LN patients, serum iFGF23 had a significant positive correlation with serum phosphorus, CC-IMT and PS. On multivariate analysis, the strongest predictor of increased CC-IMT was cumulative steroid dose in SLE and serum iFGF23 in LN patients. Most significant independent predictors of increased serum iFGF23 were hyperphosphatemia in SLE and proteinuria in LN patients.

CONCLUSION

FGF23-phosphate axis has a key role in accelerated ACVD in SLE patients. Serum phosphorus and iFGF23 should be included in ACVD risk profile assessment of these patients. Prospective studies shall define the role of dietary and/or pharmacologic control of hyperphosphatemia and proteinuria in reducing circulating iFGF23 and ACVD in them.

Neurohormones, inflammatory mediators, and cardiovascular injury in the setting of heart failure

Neurohormones and inflammatory mediators have effects in both the heart and the peripheral vasculature. In patients with heart failure (HF), neurohormonal activation and increased levels of inflammatory mediators promote ventricular remodeling and development of HF, as well as vascular dysfunction and arterial stiffness. These processes may lead to a vicious cycle, whereby arterial stiffness perpetuates further ventricular remodeling leading to exacerbation of symptoms. Although significant advances have been made in the treatment of HF, currently available treatment strategies slow, but do not halt, this cycle. The current treatment for HF patients involves the inhibition of neurohormonal activation, which can reduce morbidity and mortality related to this condition. Beyond benefits associated with neurohormonal blockade, other strategies have focused on inhibition of inflammatory pathways implicated in the pathogenesis of HF. Unfortunately, attempts to target inflammation have not yet been successful to improve prognosis of HF. Further work is required to interrupt key maladaptive mechanisms involved in disease progression.

Albuminuria and polyvascular disease improve multivariate predictive models after an acute cardiovascular event. The AIRVAG cohort

BACKGROUND AND AIMS

There is no consensus regarding risk stratification tools for secondary prevention in atherosclerotic cardiovascular disease. Our aim was to compare the discriminative performance of the Framingham, REGICOR, SCORE, and REACH risk functions and the Bohula-TIMI and SMART risk scores, as well as to assess the potential added value of other clinical variables for the prediction of recurrent events in patients with established vascular disease.

METHODS

A cohort of 269 patients with established vascular disease (52.8% coronary, 32% cerebrovascular, 15.2% PAD) was included. The survival functions of risk groups (low/medium/high) according to commonly used cutoff points for each function/score were compared, and hazard ratios for each were estimated using Cox regression. We calculated Δ Harrell's C statistic, cat-NRI, and cNRI after adding new predictors to a base model including age, sex, total cholesterol, current smoking status, hypertension, and diabetes.

RESULTS

After six years of follow-up (median 4.82 years), 61 events occurred (23%). High-risk groups had a higher risk of recurrent event: SMART (HR: 3.17 [1.55-6.5]), Framingham (HR: 3.08 [1.65-5.75]), REGICOR (HR: 2.71 [1.39-5.27]), SCORE (HR: 2.14 [1.01-4.5], REACH (HR: 5.74 [2.83-11.7]), B-TIMI (HR: 3.68 [0.88-15.3]). Polyvascular disease (three territories HR: 5.6 [2.2-14.25]), albuminuria (HR: 3.55 [2.06-6.11]), and heart failure (HR: 3.11 [1.34-7.25]) also increased risk. Discrimination (Harrell's C) was low but improved after adding albuminuria and polyvascular disease. Both variables also improved the performance of the base model (cNRI.326 [.036; .607]).

CONCLUSIONS

The Framingham, REGICOR, SCORE, and REACH functions and the B-TIMI and SMART scores showed low yet similar performance in secondary prevention. Albuminuria and polyvascular disease improved the predictive performance of major classical cardiovascular risk factors.

Light-To-Moderate Raw Garlic Consumption Frequency Is Inversely Associated With Thickened Carotid Intima-Media Thickness: A Population-Based Study

Background: Previous animal and clinical studies have reported beneficial effects of garlic preparations on carotid intima-media thickness (cIMT). However, no epidemiological study has yet investigated the association between dietary raw garlic consumption and cIMT in the general population. The objective of this study was investigating the association between dietary raw garlic consumption and thickened cIMT in Chinese adults.

Methods: This cross-sectional study used data from the Tianjin Chronic Low-grade Systemic Inflammation and Health Cohort Study. A total of 4,329 general adults from 2015 to 2017 were included in this study. Frequency of consumption of raw garlic was summarized as four categories for analysis: < 1 time/week, 1 time/week, 2-3 times/week, ≥4 times/week with a validated food frequency questionnaire. The thickened cIMT was defined as common carotid artery IMT ≥ 1.0 mm or a carotid bifurcation IMT ≥ 1.2 mm by ultrasonography. Multivariable logistic regression analysis was used to examine the association between frequency of raw garlic consumption and thickened cIMT.

Results: The prevalence of thickened cIMT is 22.9% among these participants. The adjusted odds ratios (95% confidence intervals) associated with the different frequencies were 1.00 (reference) for < 1 time/week, 0.74 (0.59, 0.94) for 1 time/week, 0.71 (0.55, 0.92) for 2–3 times/week, and 0.94 (0.71, 1.25) for ≥ 4 times/week.

Conclusions: Light-to-moderate raw garlic consumption was inversely associated with thickened cIMT, whereas greater raw garlic consumption (i.e., ≥4 times/week) was not associated with thickened cIMT. Future longitudinal studies should be conducted to test these findings.

Impedance plethysmography-based method in the assessment of subclinical atherosclerosis

BACKGROUND AND AIMS

The aim of this study was to examine an association of individual and combined pulse waveform parameters derived from bioimpedance measurements, that is pulse waves from a distal impedance plethysmographic (IPG), a whole-body impedance cardiographic (ICG) and transformed distal impedance plethysmographic (tIPG) signals, with markers of subclinical atherosclerosis, i.e. carotid intima-media thickness (cIMT), brachial artery flow-mediated dilation (FMD) and carotid artery distensibility (Cdist). The level of the association was also compared for arterial pulse wave velocity (PWV) and cIMT, FMD, and Cdist.

METHODS

IPG, ICG, tIPG signals were measured from 1741 Finnish adults aged 30-45 years. The association between pulse wave parameters and cIMT, FMD and Cdist was studied using bootstrapped stepwise Akaike's Information Criterion method resulting in selection of parameters other than PWV, i.e. parameters having stronger association with cIMT, FMD and Cdist than PWV, in the model. Then risk scores were calculated from the selected pulse wave parameters and their association between cIMT, FMD and Cdist was studied with multivariable linear regression analysis.

RESULTS

The risk score was found to be the third strongest predictor of subclinical atherosclerosis as indicated by cIMT measurement, the second strongest predictor of FMD and the strongest predictor of Cdist. These findings show that several individual pulse wave parameters were associated more strongly with cIMT, FMD, and Cdist than PWV when adjusted with clinical risk factors.

CONCLUSIONS

Impedance based pulse waveform analysis provides a useful tool for assessing cardiovascular risk and estimating presence of structural changes in the vasculature.

Evaluation of H-type hypertension prevalence and its influence on the risk of increased carotid intima-media thickness among a high-risk stroke population in Hainan Province, China

H-type hypertension, defined as a combination of hypertension and hyperhomocysteinemia (Hhcy), is associated with atherosclerosis and, therefore, increased stroke risk. However, the role of hypertension and Hhcy in high-risk stroke populations has not been studied. The present study investigated the prevalence of H-type hypertension in a high-risk stroke population of Hainan Province, China and to assess possible joint effects between hypertension and Hhcy for increased carotid intima-media thickness (CIMT). In this community-based cross-sectional study, 959 high-risk stroke subjects (age, 65.8 ± 10.8 years; 46.6% men) were recruited from Hainan Province, China. The demographic and clinical characteristics were collected, and blood samples were obtained. Analysis of variance or chi-square tests were performed to compare variates among groups based on both homocysteine levels and blood pressure status. The associations of hypertension and Hhcy with increased CIMT were evaluated through logistic regression. The prevalence of H-type hypertension was 34.8% in this population, with a higher ratio of H-type hypertension in men than in women. Compared with the normotension and normal homocysteine subgroup, the risk of increased CIMT was significantly higher in the subgroup with hypertension and Hhcy (odds ratio [OR] = 2.639; 95% confidence interval [CI], 1.690-4.091) after adjusting for age and sex. Increased CIMT was affected by an additive synergetic interaction between Hhcy and hypertension (synergy index = 1.105). It emphasized the clinical importance of anti-hypertension and lowering Hhcy in the high-risk stroke population.

Association of Factor V Leiden With Subsequent Atherothrombotic Events: A GENIUS-CHD Study of Individual Participant Data

BACKGROUND

Studies examining the role of factor V Leiden among patients at higher risk of atherothrombotic events, such as those with established coronary heart disease (CHD), are lacking. Given that coagulation is involved in the thrombus formation stage on atherosclerotic plaque rupture, we hypothesized that factor V Leiden may be a stronger risk factor for atherothrombotic events in patients with established CHD.

METHODS

We performed an individual-level meta-analysis including 25 prospective studies (18 cohorts, 3 case-cohorts, 4 randomized trials) from the GENIUS-CHD (Genetics of Subsequent Coronary Heart Disease) consortium involving patients with established CHD at baseline. Participating studies genotyped factor V Leiden status and shared risk estimates for the outcomes of interest using a centrally developed statistical code with harmonized definitions across studies. Cox proportional hazards regression models were used to obtain age- and sex-adjusted estimates. The obtained estimates were pooled using fixed-effect meta-analysis. The primary outcome was composite of myocardial infarction and CHD death. Secondary outcomes included any stroke, ischemic stroke, coronary revascularization, cardiovascular mortality, and all-cause mortality.

RESULTS

The studies included 69 681 individuals of whom 3190 (4.6%) were either heterozygous or homozygous (n=47) carriers of factor V Leiden. Median follow-up per study ranged from 1.0 to 10.6 years. A total of 20 studies with 61 147 participants and 6849 events contributed to analyses of the primary outcome. Factor V Leiden was not associated with the combined outcome of myocardial infarction and CHD death (hazard ratio, 1.03 [95% CI, 0.92-1.16]; I2=28%; P-heterogeneity=0.12). Subgroup analysis according to baseline characteristics or strata of traditional cardiovascular risk factors did not show relevant differences. Similarly, risk estimates for the secondary outcomes including stroke, coronary revascularization, cardiovascular mortality, and all-cause mortality were also close to identity.

CONCLUSIONS

Factor V Leiden was not associated with increased risk of subsequent atherothrombotic events and mortality in high-risk participants with established and treated CHD. Routine assessment of factor V Leiden status is unlikely to improve atherothrombotic events risk stratification in this population.

The role of cystatin-C and fetuin-A in the determination of early atherosclerotic risk in psoriasis patients

Psoriasis is associated with an increased risk of atherosclerosis. The objective of this study is evaluate the relationship between carotid intima-media thickness (CIMT) serum and cystatin-C, fetuin-A levels in determining the increased risk of subclinical atherosclerosis in psoriasis patients. In this study, age and gender compatible 80 psoriasis patients and 78 healthy individuals were included. For both groups, serum cystatin-C, fetuin-A, high-sensitivity C-reactive protein (hs-CRP), oxidized low-density lipoprotein (ox-LDL), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglyceride, total cholesterol, and creatinine levels were recorded and carotid intima-media thickness (CIMT) was measured via B-mode ultrasonography by cardiology department. In binary comparisons between patient and control groups, cystatin-C, fetuin-A, hs-CRP, and CIMT values were higher in psoriasis patients and there was a statistically significant difference (P < .05). In control group, serum HDL-C level was statistically significant higher (P < .05). There was no statistically significant difference in hs-CRP, ox-LDL, LDL-C, triglyceride, total cholesterol, and creatinine levels between the groups (P > .05). Our study supported that psoriasis is a risk factor for development of atherosclerosis and we think that cystatin-C can be used as an important marker in determining subclinical atherosclerosis in patients with psoriasis.

Dill Extract Induces Elastic Fiber Neosynthesis and Functional Improvement in the Ascending Aorta of Aged Mice with Reversal of Age-Dependent Cardiac Hypertrophy and Involvement of Lysyl Oxidase-Like-1

Elastic fibers (90% elastin, 10% fibrillin-rich microfibrils) are synthesized only in early life and adolescence mainly by the vascular smooth muscle cells through the cross-linking of its soluble precursor, tropoelastin. Elastic fibers endow the large elastic arteries with resilience and elasticity. Normal vascular aging is associated with arterial remodeling and stiffening, especially due to the end of production and degradation of elastic fibers, leading to altered cardiovascular function. Several pharmacological treatments stimulate the production of elastin and elastic fibers. In particular, dill extract (DE) has been demonstrated to stimulate elastin production in vitro in dermal equivalent models and in skin fibroblasts to increase lysyl oxidase-like-1 (LOXL-1) gene expression, an enzyme contributing to tropoelastin crosslinking and elastin formation. Here, we have investigated the effects of a chronic treatment (three months) of aged male mice with DE (5% or 10% v/v, in drinking water) on the structure and function of the ascending aorta. DE treatment, especially at 10%, of aged mice protected pre-existing elastic lamellae, reactivated tropoelastin and LOXL-1 expressions, induced elastic fiber neo-synthesis, and decreased the stiffness of the aging aortic wall, probably explaining the reversal of the age-related cardiac hypertrophy also observed following the treatment. DE could thus be considered as an anti-aging product for the cardiovascular system.

Arterial stiffness as a risk factor for cardiovascular events and all-cause mortality in people with Type 2 diabetes

AIM

To quantify the risk of different non-invasive arterial stiffness measurements with macrovascular disease and all-cause mortality in high-risk people with Type 2 diabetes.

METHODS

We conducted a prospective cohort study of 1910 people with Type 2 diabetes included in the Second Manifestations of ARTerial disease (SMART) study. Arterial stiffness was assessed by brachial artery pulse pressure, normal range (≥0.9) ankle-brachial index and carotid artery distension. Cox regression was used to evaluate the effects of arterial stiffness on risk of cardiovascular events (composite of myocardial infarction, stroke and vascular mortality) and all-cause mortality.

RESULTS

A total of 380 new cardiovascular events and 436 deaths occurred during a median (interquartile range) follow-up of 7.5 (4.1-11.0) years. A 10-mmHg higher brachial pulse pressure was related to higher hazard of cardiovascular events (hazard ratio 1.09, 95% CI 1.02 to 1.16) and all-cause mortality (hazard ratio 1.10, 95% CI 1.03 to 1.16). A 0.1-point lower ankle-brachial index within the normal range was related to a higher hazard of cardiovascular events (hazard ratio 1.13, 95% CI 1.01 to 1.27) and all-cause mortality (hazard ratio 1.17, 95% CI 1.04 to 1.31). A one-unit (10^-3 ×kPa^-1 ) lower carotid artery distensibility coefficient was related to a higher hazard of vascular mortality (hazard ratio 1.04, 95% CI 1.00 to 1.09) and all-cause mortality (hazard ratio 1.04, 95% CI 1.00 to 1.07).

CONCLUSION

Increased arterial stiffness, as measured by either increased pulse pressure, normal-range ankle-brachial index or carotid artery distensibility coefficient, is related to increased hazard of cardiovascular events and all-cause mortality in people with Type 2 diabetes.

Computational analysis for non-invasive detection of stenosis in peripheral arteries

Atherosclerosis usually affects the entire cardiovascular system, including peripheral blood vessels. Peripheral arterial stenosis may indicate possible serious vascular disorders related to more vital organs. If peripheral arterial stenosis can be discerned at an early stage, it can serve as a warning sign to take precautions, such as using more invasive diagnostic techniques or adopting a healthier life style. In this study, peripheral regions, such as the thigh, upper arm, and neck are modelled considering stenosis of their major arteries. Stenosis generates a fluctuating pressure field on the arterial wall, which leads to vibration on the skin's surface. This stenosis-induced pressure field is modelled as a harmonic load and applied to the inner surface of the arterial structure. The vibration response on bare skin is computationally determined using the superposition of modal responses. Realistic geometries and hyperelastic material properties are used in modelling the layers of skin, fat, muscle, and bones. The results indicate that stenosis severities higher than 70% lead to a considerable increase in vibration-response amplitudes, especially at frequencies greater than 250 Hz. The detailed analysis of skin responses provides useful information to detect the stenosis location, where the sum of the vibration amplitudes attains its maximum value around the stenosis.

Epicardial adipose tissue thickness as a new risk factor for atherosclerosis in patients with ankylosing spondylitis

PURPOSE

The aim of this study was to compare epicardial adipose tissue thickness (EATT), which is a novel cardiometabolic risk factor in patients with ankylosing spondylitis (AS), and carotid intima media thickness (CIMT) with healthy controls to assess the relationship between these markers and disease activity.

MATERIALS AND METHODS

This study involved 38 patients with AS and 38 controls with no history of cardiovascular disease. CIMT was measured by Doppler ultrasound, and EATT by echocardiography, in all participants. Total cholesterol (TC), low density lipoprotein (LDL) cholesterol, high density lipoprotein cholesterol, triglycerides, thyroid stimulating hormone, erythrocyte sedimentation rate, C-reactive protein, and hemogram measurements were performed in all subjects after 8 hours of fasting. In addition, the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Bath Ankylosing Spondylitis Functional Index (BASFI) scores of the patients with AS were recorded.

RESULTS

EATT was significantly higher in patients with AS (0.45 ± 0.17 mm) compared with healthy (0.37 ± 0.10 mm) controls (p= 0.01). Significant positive correlations were detected between EAT thickness and BASFI, CIMT, and disease duration in patients with AS (p= 0.008, p= 0.024, and p= 0.012, respectively). Significant negative correlations were observed between EATT and TC and LDL cholesterol concentrations (p= 0.016 and p= 0.009, respectively). No significant difference was detected in CIMT between the patients (0.515 ± 0.08 mm) and the controls (0.517 ± 0.094 mm, p= 0.98). No significant correlation was observed between CIMT of the patients with AS and the BASDAI, BASFI, TC, HDL cholesterol, systolic blood pressure, or diastolic blood pressure values. Significant positive correlations were observed between CIMT and waist circumference, weight, body mass index, and LDL cholesterol in patients with AS and the controls.

CONCLUSIONS

This study demonstrated increased EATT in patients with AS compared with a healthy population, which was positively correlated with disease duration and BASFI.

Abdominal Fat Depots and Subclinical Carotid Artery Atherosclerosis in Women With and Without HIV Infection

BACKGROUND

Data on associations between abdominal fat depot mass and subclinical atherosclerosis are limited, especially in women with HIV.

METHODS

We assessed cross-sectional associations of dual X-ray absorptiometry scan-derived estimates of visceral adipose tissue (VAT) and abdominal subcutaneous adipose tissue (SAT) with 3 measures of subclinical carotid artery atherosclerosis-carotid artery stiffness (Young's modulus of elasticity), presence of carotid artery lesions, and carotid artery intima-media thickness-in a subsample of participants in the Women's Interagency HIV Study. Statistical models adjusted for demographic variables, HIV serostatus, behavioral variables, and cardiovascular risk factors.

RESULTS

There were 244 women with and 99 without HIV infection (median age 42, 62% black). VAT mass (but not SAT) was associated with greater carotid artery stiffness in a fully adjusted linear regression model, including adjustment for SAT (β = 11.3 log 10·N·m per kg VAT, 95% confidence interval: 1.0 to 21.7). Greater SAT mass was associated with lower odds of having a carotid artery lesion in a fully adjusted model, including adjustment for VAT [adjusted odds ratio, 0.49 per kg of SAT (0.25 to 0.94)]. Neither VAT nor SAT was associated with carotid artery intima-media thickness. The VAT/SAT ratio was not statistically associated with any of the outcomes after covariate adjustment.

CONCLUSIONS

In our cross-sectional study of women, the majority of whom had HIV, greater VAT mass was associated with increased carotid artery stiffness, whereas greater SAT mass was associated with a reduced odds of prevalent carotid artery lesions.

Association of aortic stiffness, carotid intima-media thickness and endothelial function with cardiovascular events in metabolic syndrome subjects

PURPOSE

The objective of this study was to assess predictive value of various arterial markers for cardiovascular (CV) events in patients with metabolic syndrome (MetS).

MATERIALS AND METHODS

A longitudinal study with the follow-up period of 3.9 ± 1.7 years investigated 2728 middle-aged (53.9 ± 6.2 years old, 63% women) MetS subjects without overt CV disease. The study cohort was comprised of the participants of the Lithuanian High Cardiovascular Risk primary prevention program. The baseline assessment included the evaluation of brachial flow-mediated dilatation (FMD), carotid intima-media thickness (cIMT), carotid stiffness index, aortic pulse wave velocity (aPWV), aortic augmentation index (AIx), and cardio-ankle vascular index). The data on the cardiovascular outcome (fatal or non-fatal myocardial infarction or stroke) was collected by using the databases of the two major national registries.

RESULTS

Over the follow-up period, 83 (3%) patients had at least one cardiovascular event. In a univariate analysis, occurrence of CV events was associated with the following parameters: higher mean blood pressure, aPWV, AIx and cIMT, and lower FMD (all p < .05). In Cox proportional hazard regression analysis, the occurrence of CV event was associated with an increase in aPWV (HR 1.29, 95% CI 1.04-1.60, p = .019), AIx (HR 1.53, 95% CI 1.16-2.02, p = .003), and cIMT (HR 1.31, 95% CI 1.14-1.50, p < .001), and with the decrease in FMD (HR 0.83, 95% CI 0.71-0.97, p = .016) even after the adjustment for age, gender, and common cardiometabolic risk factors. In a two-level survival trees analysis, we established that patients with cIMT > 794 mcm had higher CV risk (p < .001) and their prognosis was further compromised by aPWV > 11.1 m/s (p = .023). Meanwhile, in patients with cIMT ≤ 794mcm, the FMD cut-off point of 6.5% further stratified the risk (p = .003).

CONCLUSIONS

In our prospective study, CV risk in the middle-aged patients with MetS was associated with an increase in cIMT and aPWV, and with a decrease in FMD.

Youth-Onset Type 2 Diabetes and the Developing Brain

PURPOSE OF REVIEW

This review describes the literature evaluating the potential adverse effects of youth-onset type 2 diabetes on the developing brain. A summary of recently published articles and the current state of knowledge are covered succinctly in this manuscript.

RECENT FINDINGS

Current literature suggests both cognitive and brain structural differences are found in youth with type 2 diabetes. Studies have shown poorer scores in a number of neurocognitive domains, particularly in areas of executive functioning and memory. Additionally, imaging studies have found differences in brain gray matter volume, white matter volume, and microstructural integrity. These findings are largely consistent with the adult literature. Youth with type 2 diabetes demonstrate lower cognitive scores and structural brain differences. Although causality has not yet been established, these findings are important because these individuals are still undergoing neurodevelopmental maturation.

Association between bone metabolism regulators and arterial stiffness in type 2 diabetes patients

BACKGROUND AND AIM

Osteopontin (OPN), osteonectin (ON) and osteocalcin (OC) play an important role in the development of vascular calcifications, but it is unclear whether these bone metabolism regulators contribute to the development of arterial stiffness in type 2 diabetes patients. We therefore aim to determine the relationship between plasma concentrations of OPN, ON, OC and arterial stiffness in type 2 diabetes patients.

METHODS

Cross-sectional study of 1003 type 2 diabetes patients included in the Second Manifestations of ARTerial disease (SMART)-cohort. Generalized linear models were used to evaluate the relation between plasma levels of OPN, ON and OC and arterial stiffness as measured by pulse pressure (PP), ankle-brachial index (ABI) (≥0.9), carotid artery distension and an arterial stiffness summary score. Analyses were adjusted for age, sex, kidney function, diabetes duration and diastolic blood pressure. Higher OPN plasma levels were significantly related to a lower ABI (β-0.013; 95%CI -0.024 to -0.002) and a higher arterial stiffness summary score (OR1.24; 95%CI 1.03-1.49). OPN levels were not related to PP (β 0.59; 95%CI -0.63-1.81) or absolute carotid artery distention (β -7.03; 95%CI -20.00-5.93). ON and OC plasma levels were not related to any of the arterial stiffness measures.

CONCLUSION

Only elevated plasma levels of OPN are associated with increased arterial stiffness in patients with type 2 diabetes as measured by the ankle-brachial index and arterial stiffness summary score. These findings indicate that OPN may be involved in the pathophysiology of arterial stiffness and call for further clinical investigation.

Assessment of Arterial Stiffness in Stable Heart Transplant Recipients

INTRODUCTION

Arterial stiffness depends on both genetic and environmental factors. The aim of this study was to assess arterial stiffness in patients after heart transplant.

METHODS

The study was conducted between May and June 2017. Fifty patients from the Transplantology Clinic of the Institute of Cardiology in Anin, Warsaw, Poland, were enrolled in the study. Pulse wave velocity (PWV), central systolic blood pressure (CSBP), and central diastolic blood pressure (CDBP) were measured and patients' medical records were also analyzed.

RESULTS

In the study, 50 patients aged 57.9 years on average were evaluated, of whom 88% were male patients, with average PWV of 8.94 m/s and an average time after transplant of 9.7 years. The study has shown that age (R = 0.77), total cholesterol concentration (R = 0.22, P = .017) and creatinine concentration (R = 0.34; P = .15) show positive correlation with PWV.

CONCLUSIONS

Our data indicates that age has significant impact on arterial stiffness and the type of immunosuppressive drugs and transplant rejection episodes do not impact an increase in arterial stiffness.

Quantitative Assessment of Thin-Layer Tissue Viscoelastic Properties Using Ultrasonic Micro-Elastography With Lamb Wave Model

Characterizing the viscoelastic properties of thin-layer tissues with micro-level thickness has long remained challenging. Recently, several micro-elastography techniques have been developed to improve the spatial resolution. However, most of these techniques have not considered the medium boundary conditions when evaluating the viscoelastic properties of thin-layer tissues such as arteries and corneas; this might lead to estimation bias or errors. This paper aims to integrate the Lamb wave model with our previously developed ultrasonic micro-elastography imaging system for obtaining accurate viscoelastic properties in thin-layer tissues. A 4.5-MHz ring transducer was used to generate an acoustic radiation force for inducing tissue displacements to produce guided wave, and the wave propagation was detected using a confocally aligned 40-MHz needle transducer. The phase velocity and attenuation were obtained from k-space by both the impulse and the harmonic methods. The measured phase velocity was fit using the Lamb wave model with the Kelvin-Voigt model. Phantom experiments were conducted using 7% and 12% gelatin and 1.5% agar phantoms with different thicknesses (2, 3, and 4 mm). Biological experiments were performed on porcine cornea and rabbit carotid artery ex vivo. Thin-layer phantoms with different thicknesses were confirmed to have the same elasticity; this was consistent with the estimates of bulk phantoms from mechanical tests and the shear wave rheological model. The trend of the measured attenuations was also confirmed with the viscosity results obtained using the Lamb wave model. Through the impulse and harmonic methods, the shear viscoelasticity values were estimated to be 8.2 kPa for $0.9~\text {Pa}{\cdot} \text {s}$ and 9.6 kPa for $0.8~\text {Pa}{\cdot} \text {s}$ in the cornea and 27.9 kPa for $0.1~\text {Pa}\cdot \text {s}$ and 26.5 kPa for $0.1~\text {Pa}\cdot \text {s}$ in the artery.

Risk factors and determinants of carotid intima-media thickness in children: protocol for a systematic review and meta-analysis

INTRODUCTION

Carotid intima-media thickness (CIMT) is a surrogate marker of atherosclerosis that is measured in adults and children to better understand the natural history of cardiovascular disease (CVD). In adults, CIMT is predictive of myocardial infarction and stroke. In children and adolescents, CIMT is used to assess vascular changes in the presence of CVD risk factors (obesity, hypertension, smoking, etc) or clinical conditions associated with a high risk for premature CVD. However, there is no comprehensive overview, in a life-course epidemiology perspective, of the risk factors and determinants of CIMT in children. It is also important to evaluate between-study differences in CIMT measurement methods and take them into consideration when drawing conclusions. Our objective is to systematically review the evidence on the relationship between CIMT and prenatal and postnatal exposures or interventions in children, as well as documenting and discussing the CIMT measurement methods.

METHODS AND ANALYSIS

Systematic searches of the Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica (EMBASE)and Central Register of Controlled Trials (CENTRAL) databases will be conducted. The reference lists and other literatures sources will be browsed. Observational and experimental studies in children from birth up to 18 years will be included. Prenatal and postnatal exposures or interventions assessed in relationship with CIMT will be considered for inclusion. Examples might include gestational age, obesity, hypertension, tobacco exposure, specific at-risk conditions (chronic kidney disease, diabetes, etc) or statin treatment. The outcome will be CIMT assessed by ultrasonography. The setting, scanning and measurement methods for each included study will be described in detail. Results will be synthesised descriptively and, if appropriate, will be pooled across studies to perform meta-analyses. Separate meta-analyses for each exposure or intervention type will be conducted.

ETHICS AND DISSEMINATION

This systematic review will be published in a peer-reviewed journal. A report will be prepared for clinicians and other healthcare decision-makers.

PROSPERO REGISTRATION NUMBER

CRD42017075169.

Vascular characteristics in young women-Effect of extensive endurance training or a sedentary lifestyle

AIM

To explore whether high-level endurance training in early age has an influence on the arterial wall properties in young women.

METHODS

Forty-seven athletes (ATH) and 52 controls (CTR), all 17-25 years of age, were further divided into runners (RUN), whole-body endurance athletes (WBA), sedentary controls (SC) and normally active controls (AC). Two-dimensional ultrasound scanning of the carotid arteries was conducted to determine local common carotid artery (CCA) geometry and wall distensibility. Pulse waves were recorded with a tonometer to determine regional pulse wave velocity (PWV) and pulse pressure waveform.

RESULTS

Carotid-radial PWV was lower in WBA than in RUN (P < .05), indicating higher arterial distensibility along the arm. Mean arterial pressure was lower in ATH than in CTR and in RUN than in WBA (P < .05). Synthesized aortic augmentation index (AI@75) was lower among ATH than among CTR (-12.8 ± 1.6 vs -2.6 ± 1.2%, P < .001) and in WBA than in RUN (-16.4 ± 2.5 vs -10.7 ± 2.0%, P < .05), suggesting a diminished return of reflection waves to the aorta during systole. Carotid-femoral PWV and intima-media thickness (IMT), lumen diameter and radial distensibility of the CCA were similar in ATH and CTR.

CONCLUSION

Elastic artery distensibility and carotid artery IMT are not different in young women with extensive endurance training over several years and in those with sedentary lifestyle. On the other hand, our data suggest that long-term endurance training is associated with potentially favourable peripheral artery adaptation, especially in sports where upper body work is added. This adaptation, if persisting later in life, could contribute to lower cardiovascular risk.

Mitochondrial DNA 3243A>G heteroplasmy is associated with changes in cytoskeletal protein expression and cell mechanics

Mitochondrial and mechanical alterations in cells have both been shown to be hallmarks of human disease. However, little research has endeavoured to establish connections between these two essential features of cells in both functional and dysfunctional situations. In this work, we hypothesized that a specific genetic alteration in mitochondrial function known to cause human disease would trigger changes in cell mechanics. Using a previously characterized set of mitochondrial cybrid cell lines, we examined the relationship between heteroplasmy for the mitochondrial DNA (mtDNA) 3243A>G mutation, the cell cytoskeleton, and resulting cellular mechanical properties. We found that cells with increasing mitochondrial dysfunction markedly differed from one another in gene expression and protein production of various co-regulated cytoskeletal elements. The intracellular positioning and organization of actin also differed across cell lines. To explore the relationship between these changes and cell mechanics, we then measured cellular mechanical properties using atomic force microscopy and found that cell stiffness correlated with gene expression data for known determinants of cell mechanics, γ-actin, α-actinin and filamin A. This work points towards a mechanism linking mitochondrial genetics to single-cell mechanical properties. The transcriptional and structural regulation of cytoskeletal components by mitochondrial function may explain why energetic and mechanical alterations often coexist in clinical conditions.

A Review on Atherosclerotic Biology, Wall Stiffness, Physics of Elasticity, and Its Ultrasound-Based Measurement

Functional and structural changes in the common carotid artery are biomarkers for cardiovascular risk. Current methods for measuring functional changes include pulse wave velocity, compliance, distensibility, strain, stress, stiffness, and elasticity derived from arterial waveforms. The review is focused on the ultrasound-based carotid artery elasticity and stiffness measurements covering the physics of elasticity and linking it to biological evolution of arterial stiffness. The paper also presents evolution of plaque with a focus on the pathophysiologic cascade leading to arterial hardening. Using the concept of strain, and image-based elasticity, the paper then reviews the lumen diameter and carotid intima-media thickness measurements in combined temporal and spatial domains. Finally, the review presents the factors which influence the understanding of atherosclerotic disease formation and cardiovascular risk including arterial stiffness, tissue morphological characteristics, and image-based elasticity measurement.

Cardiometabolic risk factors in children with celiac disease on a gluten-free diet

Celiac disease (CD) is an immune-mediated systemic condition evoked by gluten and related prolamines in genetically predisposed subjects. It is characterised by a variable combination of gluten-dependent clinical symptoms, CD-specific antibodies, HLA-DQ2 and HLA-DQ8 haplotypes, and enteropathy. The only therapy of CD consists of a life-long gluten free diet (GFD). Strict GFD adherence results in full clinical, serological and histological remission, avoiding long-term complications in CD patients. However, this diet is not without problems. Gluten free products have high levels of lipids, sugar and salt to improve food palatability and consistency, and subjects with CD show an excessive consumption of hypercaloric and hyperlipidic foods to compensate dietetic restriction. GFD may therefore have a negative impact on cardiometabolic risk factors such as obesity, serum lipid levels, insulin resistance, metabolic syndrome, and atherosclerosis. In adults, some studies have suggested that GFD have a beneficial effect on cardiovascular profile, whereas others have shown an atherogenic effect of GFD. In children, very few studies are available on the issue. Thus, the aim of the present narrative review was to analyze the current clinical evidence on the impact of GFD on cardiometabolic risk factors in children with CD.

Physical Activity and Characteristics of the Carotid Artery Wall in High-Risk Patients-The SMART (Second Manifestations of Arterial Disease) Study

Background

Physical activity reduces the risk of vascular disease. This benefit is not entirely explained through an effect on vascular risk factors. We examined the relationship of physical activity and characteristics of the carotid artery wall in patients with vascular disease or risk factors.

Methods and Results

Cross‐sectional analyses were performed in 9578 patients from the SMART (Second Manifestations of Arterial Disease) study, a prospective cohort study among patients with vascular disease or risk factors. Physical activity was assessed using questionnaires. Carotid intima‐media thickness and carotid artery stenosis of both common carotid arteries was measured. In a subset of 3165 participants carotid diastolic diameter and distension were assessed. Carotid stiffness was expressed as the distensibility coefficient and Young's elastic modulus. Regression analyses adjusted for vascular risk factors showed that physical activity was inversely associated with diastolic diameter (fifth versus first quintile B=−0.13 mm; 95% CI, −0.21 to −0.05) and decreased risk of carotid artery stenosis (relative risk, 0.58; 95% CI, 0.48–0.69). A light level of physical activity was associated with less carotid stiffness (second versus first quintile; Young's elastic modulus B=−0.11 kPa⁻¹×10⁻³; 95% CI, −0.16 to −0.06; distensibility coefficient B=0.93 kPa×10³; 95% CI, 0.34–1.51), but there was no additional benefit with increasing levels of physical activity. In patients with vascular disease, physical activity was inversely associated with common carotid intima‐media thickness, but not in patients with vascular risk factors.

Conclusions

In patients with vascular disease or risk factors, increased physical activity was associated with smaller carotid diastolic diameter, decreased risk of carotid artery stenosis, and less carotid stiffness, but it only showed benefits on carotid intima‐media thickness in patients with vascular disease.

Vascular and Endothelial Function in Youth with Type 2 Diabetes Mellitus

PURPOSE OF REVIEW

This review aims to discuss the burden of type 2 diabetes in youth and summarize the studies that have utilized noninvasive techniques to assess early vascular disease in youth with type 2 diabetes.

RECENT FINDINGS

Noninvasive imaging modalities provide researchers with tools to investigate the vasculature in adolescents with type 2 diabetes. The data published to date consistently show adolescents with type 2 diabetes have greater vascular thickness and stiffness and worse endothelial function compared to their obese and lean peers. As the prevalence of type 2 diabetes continues to increase adolescent youth, there is concern adolescents with type 2 diabetes are at risk to develop early onset cardiovascular disease and complications. Future studies need to address treatments that have the potential to improve or reverse vascular dysfunction and decrease the rate of cardiovascular disease and complications.

Decreased fibrinolytic activity is associated with carotid artery stiffening in arterial hypertension

Background:

A prothrombotic state is associated with the presence and severity of organ damage in hypertensive patients. In these patients, evidence of subclinical carotid functional changes anticipates major cardiovascular events. The aim of this study was to investigate the association of hemostatic markers with carotid artery stiffness in hypertension.

Materials and Methods:

In 116 untreated essential hypertensive patients recruited at a referral center in the University of Udine, we assessed common carotid artery stiffness by B-mode ultrasonography and measured plasma fibrinogen, D-dimer, plasminogen activator inhibitor-1 (PAI-1), and homocysteine by the currently available methods. For statistical reasons, the patients were divided according to the median value of each index of carotid stiffness, and continuous variables were further analyzed by univariate correlation and stepwise multivariate regression analysis.

Results:

PAI-1 levels were significantly higher in patients with low coefficient of distensibility (P = 0.018) and high Young's elastic modulus (P = 0.012), whereas no association of fibrinogen, D-dimer, and homocysteine levels was observed with carotid coefficient of distensibility, Young's elastic modulus, and β-stiffness. On univariate analysis, Young's elastic modulus was significantly and positively correlated with PAI-1 levels (r = 0.286, P = 0.002), a correlation that on multivariate regression resulted to be independent of other confounders (β = 0.289, P = 0.028).

Conclusion:

An independent association of plasma PAI-1 levels with carotid artery stiffness suggests a possible contribution of decreased fibrinolytic activity to the early functional abnormalities of arterial vessels in hypertensive patients. This contribution might be relevant for subsequent development of hypertension-related cardiovascular complications.

Evaluation of carotid artery dynamics & correlation with cardiac & hepatic iron in β-thalassaemia patients

Background & objectives:

Early atherosclerosis and vascular complication have been described in thalassaemia patients. There is lack of data or guidelines regarding monitoring of vascular health in thalassaemia. This study was conducted to compare carotid artery structural and functional indices such as carotid artery intima-media thickness (CIMT), stiffness index (SI) and Young's elastic modulus (YEM) in β-thalassemia patients with age and sex matched controls, and to correlate these parameters with serum ferritin, cardiac iron, and hepatic iron.

Methods:

This cross-sectional study included 53 β-thalassaemia patients receiving regular blood transfusions. Carotid artery indices such as CIMT, SI, and YEM were calculated by duplex ultrasound and colour Doppler. Serum ferritin levels were measured by chemiluminescence. Cardiac and hepatic iron estimation were done using MRI T2* sequences analyzed by a special thalassaemia software.

Results:

Mean CIMT of cases and controls were 0.48 ± 0.04 and 0.44±0.02 mm, respectively and these were significantly different (P<0.001). Similarly significant differences were noted in SI and YEM of cases (2.45±0.79 and 96.12±34.85, respectively) as compared to controls (1.98±0.54 and 68.60±24.29, respectively) (P<0.001). There was significant inverse correlation between stiffness index and cardiac iron overload assessed by MRI cardiac T2* (P=0.03). Mean SI and YEM of cases were (2.1736 ± 0.2986 and 107.3± 41.6, respectively) significantly higher among non-splenectomized patients compared to splenectomized patients (2.0136 ± 0.263 and 86.9 ± 25.2, respectively) (P<0.05).

Interpretation & conclusions:

CIMT and arterial stiffness indices were significantly increased in β-thalassaemia patients compared to controls which was indicative of early atherogenic changes. This study supports the hypothesis that iron overload is a risk factor for early atherosclerosis and cardiovascular disease.

Beat-to-Beat Blood Pressure and Two-dimensional (axial and radial) Motion of the Carotid Artery Wall: Physiological Evaluation of Arterial Stiffness

The physiological relationship between local arterial displacement and blood pressure (BP) plays an integral role in assess- ment of the mechanical properties of arteries. In this study, we used more advanced methods to obtain reliable continuous BP and the displacement of the common carotid artery (CCA) simultaneously. We propose a novel evaluation method for arterial stiffness that relies on determining the physiological relationship between the axial and radial displacements of the CCA wall and beat-to-beat BP. Patients (total of 138) were divided into groups according to the following three criteria: essential hyper- tension (EH) and normotension, male and female, elderly and younger. The Pearson correlation test and canonical correlation analysis showed that the CCA indices were significantly correlated with BP indices (r = 0:787; p < 0:05). The slope of the CCA displacement/pressure curve showed a progressive reduction with increasing age and EH disease occurrence (EH: 0.496 vs. normotension: 0.822; age <= 60:0.585 vs. age > 60:0.783). Our method provides an explicit reference value and relationship for the manner in which the CCA wall responds to changes in BP. Short-term and continuous BP were significantly correlated with CCA displacement and exhibited a close inverse relationship with each subject's BP and EH, age, and systolic blood pressure.

Vascular or chronological age: which is the better marker to estimate the cardiovascular risk in patients with type 1 diabetes?

AIMS

To evaluate whether using vascular age (VA) instead of chronological age (CA) in the Framingham score would enhance the cardiovascular disease (CVD) risk estimation in patients with type 1 diabetes (T1D).

METHODS

This was a cross-sectional study comprising 58 T1D patients and 38 control subjects matched by age, gender and body mass index. To estimate the VA, we used carotid intima-media thickness normality estimation tables that took into account age, gender and ethnic group.

RESULTS

Compared to the control group, T1D patients had an older VA with an 8.8-year difference (p < 0.001), a higher CVD risk stratification comparing CA and VA (p < 0.001). In the group of T1D patients, there was a 9.4-year difference between VA and CA (p < 0.001), mainly due to a greater increase in women compared to men (11.2 vs 6.4 years, respectively) and 29.3 % of the patients with T1D increased their CVD risk stratification using VA as a parameter. Still, in the group of T1D patients, women had a higher increase in VA for each 1-year increase in CA than men (1.2 years vs 0.8 years, respectively, p < 0.001). This difference persisted as we compared women with T1D with women in the control group (0.4 years), p = 0.006.

CONCLUSIONS

T1D patients have an increased VA, a marker of subclinical atherosclerosis. The use of VA age may contribute to the identification of high CVD risk in T1D. In patients with T1D, a younger chronological age, particularly in women, might not be a protective factor for CVD.

The role of non-invasive cardiovascular imaging in the assessment of cardiovascular risk in rheumatoid arthritis: where we are and where we need to be

This review assesses the risk assessment of cardiovascular disease (CVD) in rheumatoid arthritis (RA) and how non-invasive imaging modalities may improve risk stratification in future. RA is common and patients are at greater risk of CVD than the general population. Cardiovascular (CV) risk stratification is recommended in European guidelines for patients at high and very high CV risk in order to commence preventative therapy. Ideally, such an assessment should be carried out immediately after diagnosis and as part of ongoing long-term patient care in order to improve patient outcomes. The risk profile in RA is different from the general population and is not well estimated using conventional clinical CVD risk algorithms, particularly in patients estimated as intermediate CVD risk. Non-invasive imaging techniques may therefore play an important role in improving risk assessment. However, there are currently very limited prognostic data specific to patients with RA to guide clinicians in risk stratification using these imaging techniques. RA is associated with increased risk of CV mortality, mainly attributable to atherosclerotic disease, though in addition, RA is associated with many other disease processes which further contribute to increased CV mortality. There is reasonable evidence for using carotid ultrasound in patients estimated to be at intermediate risk of CV mortality using clinical CVD risk algorithms. Newer imaging techniques such as cardiovascular magnetic resonance and CT offer the potential to improve risk stratification further; however, longitudinal data with hard CVD outcomes are currently lacking.

The evaluation of endothelial function and structure in hirsute patients in reproductive age

OBJECTIVE

To evaluate the endothelial function and structure in patients with hirsutism in reproductive age.

STUDY DESIGN

The study was conducted on 69 consecutive women admitted with complaints of hirsutism and 63 voluntary healthy women, as controls. A total of 132 subjects who applied to the Gynecology and Infertility Outpatient Clinics were included. Participants with modified Ferriman Gallway (mFG) score over 8 were considered to be hirsute. The demographic, metabolic, hormonal characteristics, risk factors of cardiovascular disease, CIMT (carotis intima media thickness) and FMD (flow-mediated dilatation) were compared between hirsute women and those in the control group. A prospective case-control study was performed.

RESULTS

There was no statistically significant difference in CIMT (0,50±0,08 vs 0,52±0,08, p=0.38) and FMD (10,80±6,83 vs 9,57±6,52, p=0.34) values between the study and control groups, respectively. There was no statistically significant correleation between CIMT and FMD values with age, body mass index (BMI), waist circumference, hip circumference, waist/hip ratio, CRP (C-reactive protein), total cholesterol, LDL (low density lipoprotein), HDL (high density lipoprotein), total testosteron, FAI (free androjen index), androstenedion, SHBG (sex hormone binding globuline), DHEA-S, hirsutism score, sistolic blood pressure, diastolic blood pressure, HOMA-IR (homeostatic model of assesment insuline resistance) value.

CONCLUSION

The effect of the presence of hirsutism on either CIMT and FMD values, among young patients was not significant. Since endothelial dysfunction might became evident after a long period of physio-pathological process, our findings obtained from younger patients may not really show the impact of hirsutism on endothelial function in short term.

The Effect of ACE Gene Polymorphisms on Doppler Blood Flow Parameters of Carotid and Brachial Arteries in Patients With Myocardial Infarction

The authors investigated the relationship between the angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphism and the blood flow characteristics of common carotid (CCA) and brachial arteries (BA) by color Doppler ultrasound (CDUS) in patients with acute anterior myocardial infarction (AAMI). Sixty four patients (11 women and 53 men), aged 25 to 77 years, with AAMI were studied. The ACE genotypes were established. Peak-systolic (PSV) and end-diastolic velocity (EDV) of right and left CCA, PSV of right BA, and intimal-medial thickness (IMT) of both CCAs were measured by CDUS. All results were evaluated statistically. The ACE genotypes were distributed as follows: 43.8% DD, 43.8% ID, and 12.5% II. PSVs of BA and both CCAs were lower in patients with DD and ID than with II (p<0.05). EDVs of both CCAs were also lower in the same groups, but statistically not significant (p>0.05). IMTs of both CCAs did not differ among patients with various ACE genotypes (p>0.05). These results suggest that ACE I/D polymorphism influences Doppler blood flow parameters of both BA and CCA, but does not affect IMT of CCA.

Intima-Media Thickness and Arterial Distensibility in Behçet’s Disease

The etiology of Behçet’s disease, a systemic vasculitis, is unknown. Vascular involvement may be seen in 25% of patients with Behçet’s disease. Vasculitis make the prognosis of Behçet's disease severe. The aim of this study is to examine the structural and functional changes and relations of these changes with progression and prognosis of Behçet’s disease. For this purpose, 40 patients with Behçet’s disease and 40 healthy volunteer control subjects were analyzed, additionally patients with Behçet’s disease were divided into 2 subgroups as those with vascular complications and those without vascular complications. Intima-media thickness and arterial distensibility were measured in all subjects with carotid artery ultrasonography. Carotid artery distensibility was significantly lower in the patient group compared to the control group (0.67 ±0.2, 0.93 ±0.4, p<0.05), and carotid artery IMT was significantly higher (0.59 ±12, 0.80 ±0.11, p<0.05). A statistically significant increase in IMT has been detected (0.77 ±11, 0.86 ±11, p<0.05) in patients with Behçet’s disease with vascular involvement compared to patients with Behçet’s disease without vascular involvement, arterial distensibility in patients with vascular disease was similar with those who has no vascular disease (0.69 ±0.25, 0.63 ±0.25, p>0.05). There was a significant negative linear regression between arterial distensibility and systolic blood pressure (SBP) (B=-1x10-2, p<0.05), and a significant positive linear regression has also been found between IMT and SBP and diastolic blood pressure (DBP) and pulse pressure (PP) (B=6.8x10-3 for SBP, p<0.05, B=6.9x10-3 for DBP, p<0.05, B=6x10-3 for PP, p<0.05). As a result, IMT increases and AD decreases in patients with Behçet’s disease compared to results in the control group. Although more studies are required for this subject, use of noninvasive parameters such as IMT and AD, which reflect the structural and functional characteristics of vasculature, may be useful to define disease progression and subjects at high risk.

Habitual aerobic exercise is associated with smaller femoral artery intima–media thickness with age in healthy men and women

BACKGROUND

Femoral artery intima-media thickness (IMT), an independent predictor of atherosclerotic disease risk, increases with age in sedentary adults. It is not known whether regular aerobic exercise modulates femoral IMT with ageing.

METHODS AND RESULTS

Study 1: Femoral IMT was measured in 173 sedentary, moderately active, and endurance-trained young (20-39 years), middle-aged (40-59 years) and older (60-79 years) men. IMT increased with age in all activity groups (P<0.001). However, IMT was 20-27% smaller in age-matched, endurance-trained compared with sedentary men (P<0.001), and the age-associated increase in IMT was 33% smaller in endurance-trained compared with sedentary men (+0.32 versus +0.45 mm). There was a trend for the IMT to be smaller in moderately active compared with sedentary older men, and the age-associated increase in IMT was 37% smaller in moderately active than sedentary men (+0.28 mm). Study 2: Among 74 premenopausal and postmenopausal sedentary or endurance-trained women, IMT was higher (P<0.001) in postmenopausal compared with premenopausal women regardless of activity status. However, IMT was 15% smaller in endurance-trained compared with sedentary postmenopausal women (P<0.001), and the premenopausal to postmenopausal difference in IMT was approximately 45% smaller in endurance-trained compared with sedentary women (+0.13 versus +0.23 mm).

CONCLUSIONS

Femoral IMT increases with age even in habitually exercising adults. However, the age-associated increase and absolute level of IMT are smaller in middle-aged and older adults who perform regular aerobic-endurance exercise, and may contribute to their lower incidence of atherosclerotic disease.