Prevention Conference V: Beyond secondary prevention: identifying the high-risk patient for primary prevention: noninvasive tests of atherosclerotic burden: Writing Group III

Exploring Possible Links: Thigh Muscle Mass, Apolipoproteins, and Glucose Metabolism in Peripheral Artery Disease-Insights from a Pilot Sub-Study following Endovascular Treatment

Peripheral artery disease (PAD) compromises walking and physical activity, which results in further loss of skeletal muscle. The cross-sectional area of the thigh muscle has been shown to be correlated with systemic skeletal muscle volume. In our previous pilot study, we observed an increase in thigh muscle mass following endovascular treatment (EVT) in patients with proximal vascular lesions affecting the aortoiliac and femoropopliteal arteries. Considering the potential interactions between skeletal muscle, lipid profile, and glucose metabolism, we aimed to investigate the relationship between thigh muscle mass and apolipoproteins as well as glucose metabolism in PAD patients undergoing EVT. This study is a prespecified sub-study conducted as part of a pilot study. We prospectively enrolled 22 symptomatic patients with peripheral artery disease (PAD) and above-the-knee lesions, specifically involving the blood vessels supplying the thigh muscle. The mid-thigh muscle area was measured with computed tomography before and 6 months after undergoing EVT. Concurrently, we measured levels of apolipoproteins A1 (Apo A1) and B (Apo B), fasting blood glucose, 2 h post-load blood glucose (using a 75 g oral glucose tolerance test), and glycated hemoglobin A1c (HbA1c). Changes in thigh muscle area (delta muscle area: 2.5 ± 8.1 cm2) did not show significant correlations with changes in Apo A1, Apo B, fasting glucose, 2 h post-oral glucose tolerance test blood glucose, HbA1c, or Rutherford classification. However, among patients who experienced an increase in thigh muscle area following EVT (delta muscle area: 8.41 ± 5.93 cm2), there was a significant increase in Apo A1 (pre: 121.8 ± 15.1 mg/dL, 6 months: 136.5 ± 19.5 mg/dL, p < 0.001), while Apo B remained unchanged (pre: 76.4 ± 19.2 mg/dL, 6 months: 80.5 ± 4.9 mg/dL). Additionally, post-oral glucose tolerance test 2 h blood glucose levels showed a decrease (pre: 189.7 ± 67.5 mg/dL, 6 months: 170.6 ± 69.7 mg/dL, p = 0.075). Patients who exhibited an increase in thigh muscle area demonstrated more favorable metabolic changes compared to those with a decrease in thigh muscle area (delta muscle area: -4.67 ± 2.41 cm2). This pilot sub-study provides insights into the effects of EVT on thigh muscle, apolipoproteins, and glucose metabolism in patients with PAD and above-the-knee lesions. Further studies are warranted to validate these findings and establish their clinical significance. The trial was registered on the University Hospital Medical Information Network Clinical Trials Registry (UMIN000047534).

Ankle-Brachial Index and Risk of Sudden Cardiac Death in the Community: The ARIC Study

BACKGROUND

Sudden cardiac death (SCD) is a significant global public health problem accounting for 15% to 20% of all deaths. A great majority of SCD is associated with coronary heart disease, which may first be detected at autopsy. The ankle-brachial index (ABI) is a simple, noninvasive measure of subclinical atherosclerosis. The purpose of this study was to examine the relationship between ABI and SCD in a middle-aged biracial general population.

METHODS AND RESULTS

Participants of the ARIC (Atherosclerosis Risk in Communities) study with an ABI measurement between 1987 and 1989 were included. ABI was categorized as low (≤0.90), borderline (0.90-1.00), normal (1.00-1.40), and noncompressible (>1.40). SCD was defined as a sudden pulseless condition presumed to be caused by a ventricular tachyarrhythmia in a previously stable individual and was adjudicated by a committee of cardiac electrophysiologists, cardiologists, and internists. Cox proportional hazards models were used to evaluate the associations between baseline ABI and incident SCD. Of the 15 081 participants followed for a median of 23.5 years, 556 (3.7%) developed SCD (1.96 cases per 1000 person-years). Low and borderline ABIs were associated with an increased risk of SCD (demographically adjusted hazard ratios [HRs], 2.27 [95% CI, 1.64-3.14] and 1.52 [95% CI, 1.17-1.96], respectively) compared with normal ABI. The association between low ABI and SCD remained significant after adjustment for traditional cardiovascular risk factors (HR, 1.63 [95% CI, 1.15-2.32]).

CONCLUSIONS

Low ABI is independently associated with an increased risk of SCD in a middle-aged biracial general population. ABI could be incorporated into future SCD risk prediction models.

Comparative study on the efficacy of PRP gel and UC-MSCs gel as adjuvant therapies in the treatment of DFU wounds

BACKGROUND

Diabetic foot ulcer (DFU) is a common and serious complication of diabetes, and its treatment is challenging. Platelet-rich plasma (PRP) gel and umbilical cord mesenchymal stem cells (UC-MSCs) gel have been concerned as new therapies for DFU in recent years, and comparative studies on the efficacy and mechanisms of these methods, however, are rarely reported.

METHODS

Thirty patients with DFU were selected and divided into the PRP group and the UC-MSCs group, and wound healing, foot blood vessels (ABI index), infection index (CRP), neuropathy symptoms (TCSS score), and foot skin temperature before and after treatment were compared between the two groups. SPSS 21.0 was used for statistical analysis.

RESULTS

The results showed that the efficacy of the UC-MSCs gel group was significantly better than that of the PRP group in terms of wound healing rate, time to complete wound closure, ABI index, CRP level and TCSS score. No statistically significant difference in foot skin temperature was observed between the two groups.

CONCLUSION

The efficacy of UC-MSCs gel is significantly superior to that of PRP gel in the treatment of DFU, with shortened time to complete wound closure, increased wound healing rate, better pain and infection control, and improved vascular and neurological symptoms.

The level of the neudesin in type-2 diabetic patients and the relationship between the metabolic parameters and carotid intima-media thickness

BACKGROUND

Neudesin is a protein that is secreted from adipose tissue and central nervous system and has a regulatory function on energy metabolism. Although the effect of this protein is shown in the experimental model of type-2 diabetes mellitus (type-2DM), its effect in humans is not clearly known. In this study, we aimed to evaluate the relationship between serum neudesin level and metabolic, anthropometric and cardiovascular parameters in newly diagnosed type-2DM patients (group 1).

METHODS

Forty patients in each were included in our study for group 1 and for the control group (group 2), which consisted of age and sex-matched healthy subjects. Serum neudesin, hs-CRP, carotid intima media thickness (CIMT), Body Mass Index (BMI) and insulin resistance (HOMA-IR) levels were compared prospectively.

RESULTS

Serum neudesin levels were significantly higher in diabetic patients than in the control group (type-2DM: 64.69±3.06 ng/mL, control: 55.52±5.48 ng/mL, P=0.004*). There was an independent relationship between serum neudesin and HOMA-IR and BMI. Although there is a correlation between serum neudesin and CIMT; this feature disappeared in the regression analysis.

CONCLUSIONS

Serum neudesin increased in new diagnosis type-2DM patients. This increase seems to be related to obesity and insulin resistance. However, more extensive research is needed to clarify this issue.

Peripheral Vascular Ageing in Pulmonary Arterial Hypertension as Assessed by Common Carotid Artery Intima Thickness and Intima/Media Thickness Ratio: An Investigation Using Non-Invasive High-Resolution Ultrasound

BACKGROUND

Pulmonary arterial hypertension (PAH; World Heath Organization [WHO] Group 1) is associated with increased pulmonary arterial pressure and resistance, with pulmonary vascular remodelling. The vascular anatomy of the systemic arteries has been less well studied.

METHOD

Nineteen (19) patients with PAH, confirmed by right heart catheterisation (RHC), 14 patients with left ventricular heart failure with reduced ejection fraction (LVrEF), and 30 healthy subjects were enrolled. Common carotid artery (CCA) intima thickness, intima/media (I/M) thickness ratio, and intima-media thickness (IMT) were assessed using non-invasive ultrasound (22 MHz centre frequency).

RESULTS

The CCA intima thickness was correlated with several RHC variables (all p<0.05). The intima was 56% thicker (+0.05 mm; 95% CI 0.03, 0.06; p<0.0001) and the I/M thickness ratio was 128% greater (+0.21; 95% CI 0.13, 0.28; p<0.0001) in patients with PAH than healthy subjects. These values were also significantly higher than in patients with LVrEF. In ROC curve analysis, the c-values for CCA intima thickness (0.92) and I/M ratio (0.87), but not for IMT, correctly indicated which individuals belonged to the PAH or healthy control groups. The CCA IMT showed no corresponding significant group differences or associations and was of no use according to receiver operating curve analysis.

CONCLUSIONS

Patients with PAH displayed signs of peripheral vascular remodelling, challenging the common opinion that vascular changes in PAH are restricted to the lung vasculature. Correlations with cardiopulmonary variables from RHC support peripheral vascular coupling and the association with vascular ageing. Results from this pilot study warrant further confirmation.

Gender differences in fasting and postprandial metabolic traits predictive of subclinical atherosclerosis in an asymptomatic Chinese population

The prediction utility of Framingham Risk Score in populations with low conventional cardiovascular risk burden is limited, particularly among women. Gender-specific markers to predict cardiovascular risk in overtly healthy people are lacking. In this study we hypothesize that postprandial responses triggered by a high-calorie meal test differ by gender in their ability to triage asymptomatic subjects into those with and without subclinical atherosclerosis. A total of 101 healthy Chinese subjects (46 females, 55 males) at low risk of coronary heart disease completed the study. Subjects underwent cardiovascular imaging and postprandial blood phenotyping after consuming a standardized macronutrient meal. Prediction models were developed using logistic regression and subsequently subjected to cross-validation to obtain a de-optimized receiver operating characteristic (ROC) curve. Distinctive gender differences in postprandial trajectories of glucose, lipids and inflammatory markers were observed. We used gender-specific association with different combinations of postprandial predictors to develop 2 models for predicting risk of subclinical atherosclerosis in males (ROC AUC = 0.7867, 95% CI 0.6567, 0.9166) and females (ROC AUC = 0.9161, 95% CI 0.8340, 0.9982) respectively. We report novel postprandial models for predicting subclinical atherosclerosis in apparently healthy Asian subjects using a gender-specific approach, complementing the conventional Framingham Risk Score.Clinical Trial Registration: The trial was registered at clinicaltrials.gov as NCT03531879.

Association between triglyceride-glucose index and carotid atherosclerosis detected by ultrasonography

Background

Several previous studies have indicated that the triglyceride-glucose index (TyG) index is associated with carotid atherosclerosis (CA); however, the evidence of the association is limited and inconsistent, which may result from small sample sizes or differences in study populations. Therefore, we examined the relation between the TyG index and CA in a large general population of Chinese middle-aged and elderly population.

Methods

A total of 59,123 middle-aged and elderly participants were enrolled. The TyG index was calculated as ln[fasting triglycerides (mg/dL)×fasting glucose (mg/dL)/2]. Logistic regression models were used to analyze the relationship between the TyG index as continuous variables and quartiles and CA. The relationships between the TyG index and CA according to sex, age groups, blood pressure groups and body mass index groups were also assessed.

Results

The multivariate logistic regression analysis showed that the TyG index was significantly associated with the prevalence of CA (OR: 1.48; 95% CI 1.39–1.56), carotid intima-media thickness (CMT) (1.55; 1.45–1.67), plaques (1.38; 1.30–1.47) and stenosis severity (> 50%) (1.33; 1.14–1.56). Compared with the quartile 1, quartile 4 was significantly associated with a higher prevalence of CA (1.59; 1.45–1.75), CMT (1.93; 1.82–2.18), plaques (1.36; 1.22–1.51) and stenosis severity (> 50%) (1.56; 1.20–2.04). Subgroup analyses showed significant associations between the continuous TyG index and the prevalence of CA, CMT, plaques and stenosis severity (> 50%) according to sex, with a higher prevalence of CA, CMT, and plaques among males, while a higher prevalence of stenosis severity in females (> 50%). For participants aged < 60 years old and with hypertension, the relationship between the TyG index and stenosis severity (> 50%) was not observed (1.47; 0.97–2.22 and 1.13; 0.91–1.41). For body mass index (BMI), the association was just observed among overweight participants (1.48; 1.17–1.86). In addition, similar results were also observed when the TyG index was used as a categorical variable.

Conclusions

There is a positive association between the TyG index and CA. The association is higher in males and middle-aged individuals than those in females and elderly individuals. Besides, the relationship is stronger among individuals with normal blood pressure and underweight subjects.

Chemical Exchange Saturation Transfer Magnetic Resonance Imaging Identifies Abnormal Calf Muscle-Specific Energetics in Peripheral Artery Disease

BACKGROUND

Peripheral artery disease (PAD) results in exercise-induced ischemia in leg muscles. ³¹Phosphorus (P) magnetic resonance spectroscopy demonstrates prolonged phosphocreatine recovery time constant after exercise in PAD but has low signal to noise, low spatial resolution, and requires multinuclear hardware. Chemical exchange saturation transfer (CEST) is a quantitative magnetic resonance imaging method for imaging substrate (CEST asymmetry [CEST_asym]) concentration by muscle group. We hypothesized that kinetics measured by CEST could distinguish between patients with PAD and controls.

METHODS

Patients with PAD and age-matched normal subjects were imaged at 3T with a transmit-receive coil around the calf. Four CEST mages were acquired over 24-second intervals. The subjects then performed plantar flexion exercise on a magnetic resonance imaging-compatible ergometer until calf exhaustion. Twenty-five CEST images were obtained at end exercise. Regions of interest were drawn around individual muscle groups, and (CEST_asym) decay times were fitted by exponential curve to CEST values. In 10 patients and 11 controls, ³¹P spectra were obtained 20 minutes later after repeat exercise. Five patients and 5 controls returned at a mean of 1±1 days later for repeat CEST studies.

RESULTS

Thirty-five patients with PAD (31 male, age 66±8 years) and 29 controls (11 male, age 63±8 years) were imaged with CEST. The CEST_asym decay times for the whole calf (341±332 versus 153±72 seconds; P<0.03) as well as for the gastrocnemius and posterior tibialis were longer in patients with PAD. Agreement between CEST_asym decay and phosphocreatine recovery time constant was good.

CONCLUSIONS

CEST is a magnetic resonance imaging method that can distinguish energetics in patients with PAD from age-matched normal subjects on a per muscle group basis. CEST agrees reasonably well with the gold standard ³¹P magnetic resonance spectroscopy. Moreover, CEST has higher spatial resolution, creates an image, and does not require multinuclear hardware and thus may be more suitable for clinical studies in PAD.

Helicobacter pylori infection and the progression of atherosclerosis: A systematic review and meta-analysis

OBJECTIVE

In recent years, many studies have tried to prove whether Helicobacter pylori (H. pylori) can promote the progression of atherosclerosis (AS), but the reported results are conflicting. Carotid intima-media thickness (CIMT), flow-mediated dilation (FMD), or pulse wave velocity (PWV) are the most commonly used indicators to evaluate the progress of AS. So, we collected and evaluated these three indicators to provide evidence-based medicine for the clinic.

MATERIALS AND METHODS

We included and evaluated studies on H. pylori infection and CIMT, FMD, or PWV from PubMed, Cochrane trials, and Embase databases before September 1, 2021, and language restrictions: English. Research types include cross-sectional studies, cohort studies, and case-control studies. The MINORS scale was used to evaluate the quality of these studies. For all studies, we choose a random-effects model and calculate the weighted mean difference (WMD) for analysis, and all our analyses use STATA software.

RESULTS

Meta-analysis shows that H. pylori infection can significantly increase CIMT (WMD = 0.059, 95% CI: 0.039, 0.079, p < 0.001). Based on subgroup analysis, we found that the relationship between the two is more significant in the young and middle-aged people younger than 60 years old and people without cardiovascular disease. In addition, we also found an association between H. pylori infection and FMD (WMD = -3.873, 95% CI: -5.684, -2.062, p < 0.001), but it is a pity that there are few literatures that meet the standards. Finally, We concluded that H. pylori infection can significantly increase PWV (WMD = 88.033, 95%CI: 67.297,108.768. I²  = 99.63%, p < 0.001). In the subgroup analysis, we also found that this correlation is similar to CIMT, and it is more significant in the young and middle-aged population under 60 and those without cardiovascular disease. We also found in the sub-analysis that there was a significant increase in CIMT in CagA-positive individuals in H. pylori-infected patients (WMD = 0.16, 95%CI: 0.02, 0.29. p = 0.03).

CONCLUSION

Helicobacter pylori infection can promote the process of AS, especially in people under the age of 60 and people without cardiovascular risk factors, and we hope that our meta-analysis can provide ideas for the early prevention of AS.

Carotid Artery Plaque Progression: Proposal of a New Predictive Score and Role of Carotid Intima-Media Thickness

Background: We aimed to investigate if the carotid intima-media thickness (IMT) at baseline and the HAD₂S score, composed of the sum of single risk factors (hypertension, age ≥ 75 years, diabetes, dyslipidemia, smoking), were predictive of plaque progression. Methods: We performed a retrospective analysis on real-life prospectively collected data from patients with any detectable carotid plaque at follow up. The plaque score, calculated at baseline (T0) and at a median follow up of 36.6 months (IQR 39.6–34.3) (T3), was defined as 0: no plaque or stenosis < 30%; 1: stenosis in the range 30–49%; 2: in the range 50–69%; 3: in the range 70–99% and 4: occlusion. Carotid IMT was measured at T0 and T3; HAD₂S score was calculated at baseline. Results: We included 340 patients with a mean age of 69.9 (9.1) years and 25.3% subjects had plaque progression. Individuals with progression had a median HAD₂S score of 3 (1) while those without progression had 2 (1). Patients with progression had a mean baseline IMT of 0.86 (0.17) while those without progression had 0.77 (0.18) (p < 0.0001). A correlation between progression and baseline IMT was found (p = 0.002). Conclusion: Baseline IMT could be considered a predictor of progression. Patients with progression had an HAD₂S score higher than those without evolution.

Coronary Artery Calcium: Where Do We Stand After Over 3 Decades?

In 2018, cardiovascular society cholesterol guidelines recommended the use of coronary artery calcium to guide statin therapy in patients 40-79 years of age who are at intermediate risk by multiple risk factor equations (ie, estimated 10-year risk for atherosclerotic disease of 7.5%-19.9% but in whom statin benefit is uncertain). Many such patients have no coronary calcium and remain at <5% risk over the next decade; hence, statin therapy can be delayed until a repeat calcium scan is conducted. Exceptions include patients with severe hypercholesterolemia, diabetes, and a strong family history of atherosclerotic disease. If coronary calcium equals 1-99 Agatston units, the 10-year risk is borderline (5% to <7.5%) and statin therapy is optional pending a repeat scan. If coronary calcium equals 100-299 Agatston units, the patient is clearly statin eligible (7.5% to <20% 10-year risk). And finally, if coronary calcium is ≥300 Agatston units, a patient is at high risk and is a candidate for high-intensity statins. Risk factor analysis combined judiciously with coronary calcium scanning offers the strongest evidence-based approach to use of statins in primary prevention.

Impact of iliac arterial calcification on procedure success and long-term outcomes among patients undergoing endovascular intervention

OBJECTIVES

Vascular calcification is a well-known phenomenon and affects coronary and carotid arteries as well as other arterial beds. Presence of arterial calcification is associated with major adverse events in patients undergoing percutaneous coronary artery or carotid artery intervention. Even though there is a clear association between worse outcome and coronary-carotid calcification, there is no research that interrogated the relationship between iliac arterial calcification and clinical outcomes because of lack of data. Therefore, in this study, we aimed to investigate the impact of iliac arterial calcification on procedure success rates and long-term outcomes among patients undergoing endovascular intervention.

METHODS

The records of 453 consecutive patients who underwent endovascular intervention due to symptomatic peripheral artery disease were analyzed. Patients were divided into two groups based on the presence or absence of heavy calcification of iliac arteries. For each group, technical aspects of procedures and subsequent clinical outcomes were analyzed.

RESULTS

According to our study, the rate of restenosis following endovascular intervention at 6 and 12 months were similar between two groups. On the other hand, long-term restenosis was significantly higher in patients with heavy calcification of iliac arteries as compared to patients with low calcification on iliac arteries (32.2% vs. 12.8%, p < 0.05).

CONCLUSIONS

Our data showed that there was a strong association between heavy calcification of iliac arteries and long-term restenosis in patients undergoing endovascular intervention.

An Update on Cardiovascular Risk Factors After Kawasaki Disease

First described in Japan 50 years ago, Kawasaki disease is a worldwide multisystem disease. It is an acute self-limited vasculitis of unknown etiology that can lead to coronary artery lesions, such as dilatation, aneurysms, and stenosis in children. It is one of the common causes of acquired heart disease among children in developed countries. The coronary aneurysm is a severe complication in the acute stage, possibly leading to stenotic lesions or myocardial ischemia. More concerns have centered on endothelial damage and the early onset of atherosclerosis in patients with KD. Although the coronary artery aneurysm is small or degenerated, the vascular structure does not return to normal, vascular endothelial dysfunction and remodeling continue. Most patients diagnosed with coronary artery sequelae are at risk of long-term complications. There are still many unknown aspects regarding the long-term prognosis of patients. Concerns have centered on the early onset of atherosclerosis in patients with KD. There is still no consensus on the relationship between Kawasaki disease and atherosclerosis. This study aimed to evaluate if patients with a history of KD were at risk of accelerated atherosclerosis.

Increased Carotid Intima-Media Thickness and Endothelial Cell-Specific Molecule-1 (Endocan) Levels in Obese Children

Obesity in children appears to be associated with increased risk of cardiovascular and metabolic diseases later in life. Early development of insulin resistance (IR) may lead to endothelial dysfunction and increased carotid intima-media thickness (cIMT) even in childhood. We compared endothelial cell-specific molecule-1 (endocan) levels in pediatric obese patients with those in healthy controls to determine whether endocan could be used as a biological marker of complications caused by endothelial damage. In 80 obese pubertal children (44 males [M] and 36 females [F], mean age: 12.8 ± 2.5 years), anthropometric measurements, cIMT, endocan levels, and IR indices (homeostasis model assessment of insulin resistance [HOMA-IR]) were evaluated and compared with 80 healthy pubertal patients (42M/38F, mean age: 12.3 ± 3.2 years). High-resolution ultrasound was used to measure the cIMT. Obese children had higher levels of endocan compared with the controls (P < .001). Fasting insulin levels and HOMA-IR were also higher in obese children (P < .001 for both). In addition, obese children had an increased cIMT (P < .001). In obese children, there was a significant correlation between cIMT and HOMA-IR (β = -1.314, P = .002) and between cIMT and endocan (β = .483, P = .004). Measuring cIMT and endocan levels (noninvasive investigations) in obese children, together with early preventive measures, could significantly decrease morbidity and mortality in adulthood.

A preliminary pilot study investigating the impact of endovascular treatment on leg muscle volume in peripheral artery disease and its relation to baseline glycemic control

BACKGROUND AND AIMS

Peripheral artery disease (PAD), intermittent claudication, and impaired mobility contribute to the loss of skeletal muscle. This study investigated the impact of endovascular treatment (EVT) in patients suffering from PAD above the knee and its relation to baseline glycemic control.

METHODS AND RESULTS

Mid-thigh muscle volume was measured before EVT, 3 months after EVT and 6 months after EVT. Mid-thigh muscle volumes of ipsilateral PAD patients with ischemic and non-ischemic legs were compared. Correlations between total thigh muscle volume and clinical characteristics were analyzed using univariable and multivariable analysis. Overall, thigh muscle volume increased after EVT. The mid-thigh muscle volume was significantly lower in patients with ipsilateral lesions and in those with ischemic lower limbs. The thigh muscle volume of those with ischemic lower limbs increased after EVT. Baseline glycated hemoglobin was the only factor that was negatively correlated with changes in the muscle volume after EVT. Muscle volume significantly increased in normoglycemic HbA1c<6.5% (47 mmol/mol) patients. There was no significant alteration in the muscle volume of hyperglycemic HbA1c ≥ 6.5% patients.

CONCLUSION

Ischemic muscle atrophy was ameliorated after EVT in normoglycemic patients. There is a need for a large-scale trial to investigate whether EVT can protect or delay skeletal muscle loss.

The Efficacy of Colchicine on Carotid Intima-Media Thickness: A Prospective Comparative Study

OBJECTIVES

Inflammation plays an important role in the development of atherosclerotic vascular disease, which is the leading cause of morbidity and mortality in the adult population. Several clinical trials have shown that suppression of the inflammatory response can delay or decrease the atherosclerotic process. The aim of this study was to investigate carotid intima-media thickness (CIMT) between patients with chronic disease history plus gout using colchicine and patients with cardiovascular risk factors.

MATERIALS AND METHODS

In total, 102 patients (85 female, 17 male) were included. There were two groups in the study: Group 1 - patients with chronic diseases including cardiovascular risk factors plus gout using colchicine (0,5 mg twice a day); and Group 2 - patients with chronic diseases including cardiovascular risk factors only. All patients underwent ultrasonography for the measurement of CIMT. Additionally, the serum concentrations of C-reactive protein (CRP) and the levels of lipids such as cholesterol, triglyceride, LDL, HDL were measured.

RESULTS

The mean age of patients was 62.35±6.68 years and 64.27±5.32 years in Group 1 and Group 2, respectively. There was also no statistically significant difference in the levels of lipids between groups (p>0.05). The value of CIMT and CRP in Group 1 and Group 2 were 0.98±0.20 and 0.26±0.14, 1.18±0.15 and 0.58±0.42, respectively. There was a statistically significant difference between groups (p<0.05). The colchicine group was found to have a statistically significant lowering of CIMT and CRP compared to the non-colchicine group.

CONCLUSIONS

It appears that colchicine in addition to statins and other standard treatments is an effective treatment for the interception of cardiovascular and cerebrovascular events in patients with cardiovascular risk factors.

Effects of ultrasound technology advances on measurement of carotid intima-media thickness: A review

In this review, we describe how technological advances in ultrasound imaging related to transducer construction and image processing fundamentally alter generation of ultrasound images to produce better quality images with higher resolution. However, carotid intima-media thickness (IMT) measurements made from images acquired on modern ultrasound systems are not comparable to historical population nomograms that were used to determine wall thickness thresholds that inform atherosclerotic cardiovascular disease risk. Because it is nearly impossible to replicate instrumentation settings that were used to create the reference carotid IMT nomograms and to place an individual's carotid IMT value in or above a clinically relevant percentile, carotid IMT measurements have a very limited role in clinical medicine, but remain a useful research tool when instrumentation, presets, image acquisition, and measurements can be standardized. In addition to new validation studies, it would be useful for the ultrasound imaging community to reach a consensus regarding technical aspects of ultrasound imaging acquisition, processing, and display for blood vessels so standard presets and imaging approaches could reliably yield the same measurements.

Association between nontraditional lipid profiles and peripheral arterial disease in Chinese adults with hypertension

BACKGROUND

Data on the relationship between nontraditional lipid profiles [total cholesterol (TC)/high-density lipoprotein cholesterol (HDL-C) ratio, triglyceride (TG)/HDL-C ratio, low-density lipoprotein cholesterol (LDL-C)/HDL-C ratio, non-high-density lipoprotein cholesterol (non-HDL-C)] and the risk of peripheral artery disease (PAD) are limited. The present study investigated the relationship of nontraditional lipid indices with PAD in hypertensive patients.

METHODS

This cross-sectional study was performed among 10,900 adults with hypertension. Participants were diagnosed with PAD when their ankle-brachial index (ABI) was < 0.9. The association between nontraditional lipid profiles and PAD was examined using multivariate logistic regression analysis and the restricted cubic spline.

RESULTS

All nontraditional lipid indices were independently and positively associated with PAD in a dose-response fashion. After multivariable adjustment, the per SD increments of the TC/HDL-C, TG/HDL-C, LDL-C/HDL-C ratios and non-HDL-C were all significantly associated with 37, 14, 40, and 24% higher risk for PAD, respectively. The adjusted ORs (95% CI) for PAD were 1.77 (1.31, 2.40), 1.71 (1.25, 2.34), 2.03 (1.50, 2.74), and 1.70 (1.25, 2.31) when comparing the highest tertile to the lowest tertile of the TC/HDL-C, TG/HDL-C, LDL-C/HDL-C ratios and non-HDL-C, respectively.

CONCLUSIONS

Among Chinese hypertensive adults, all nontraditional lipid indices were positively associated with PAD, and the LDL-C/HDL-C and TC/HDL-C ratios were better than the other nontraditional lipid indices for predicting PAD. These findings may improve the risk stratification of cardiovascular disease and dyslipidemia management.

TRIAL REGISTRATION

CHiCTR, ChiCTR1800017274 . Registered 20 July 2018.

Association between neutrophil to lymphocyte ratio and carotid artery wall thickness in healthy pregnant women

OBJECTIVE

Pregnancy may elicit a state of mild inflammation that might affect, either directly or indirectly, haematological parameters associated with systemic inflammation. In particular, both Neutrophil-to-lymphocyte ratio (NLR) and Red blood cells Distribution Width (RDW) have been found to be elevated in complicated pregnancy. However, data regarding the association of these haematological parameters with common carotid artery (CCA) intima-media thickness (IMT) in healthy pregnancy are scanty. Aim of this study was to evaluate possible changes in CCA-IMT during normal pregnancy and in the postpartum period, and to correlate these changes with NLR and RDW.

STUDY DESIGN

Between October 2019 and February 2020, a prospective study was carried out on 73 consecutive healthy pregnant women (32.8 ± 4.9 yrs/old). Women underwent obstetric assessment, complete blood cell counts with calculation of NLR and RDW, two-dimensional transthoracic echocardiography and carotid Doppler ultrasonography.

RESULTS

During normal pregnancy, both NLR and RDW progressively increased (p < 0.0001); likewise, parameters of carotid dimensions also significantly increased (p < 0.0001). Hematological and morphological changes all decreased in postpartum period. By univariable logistic regression, the variables which showed the greatest independent association with CCA-IMT (defined as CCA-IMT ≥0.55 mm) were: age (HR 1.33, 95% CI 1.15-1.53, p < 0.0001), pre-pregnant BMI (HR 2.75, 95% CI 1.72-4.41, p < 0.0001), third trimester E/e' ratio (HR 1.64, 95% CI 1.34-2.02, p < 0.0001), and third trimester NLR (HR 3.00, 95% CI 1.64-5.50, p < 0.0001). Multivariable logistic regression analysis demonstrated that third trimester NLR was the only variable that retained statistical significance (HR 2.49, 95% CI 1.35-4.59, p = 0.003). An NLR ≥ 2 reached 83% of sensitivity and 99% of specificity in identifying a CCA-IMT ≥0.55 mm (AUC = 0.95). A strong linear correlation of both third trimester NLR and RDW with CCA-IMT was observed (r = 0.89 and 0.83, respectively).

CONCLUSIONS

Pregnancy is a state of chronic mild inflammation and the progressive increase in NLR and RDW during normal pregnancy is significantly associated with CCA intimal-medial thickening.

Association of Visceral Adipose Tissue and Subclinical Atherosclerosis in US-Born Mexican Americans but not First Generation Immigrants

Background Excess visceral adipose tissue (VAT) is a primary driver for the cardiometabolic complications of obesity; VAT-associated cardiovascular disease risk varies by race, but most studies have been done on Non-Hispanics. This study aimed to evaluate the clinical and metabolic correlates of VAT, its association with subclinical atherosclerosis, and the factors affecting this association in Mexican Americans. Methods and Results Participants (n=527) were drawn from the Cameron County Hispanic Cohort (CCHC), on whom a carotid ultrasound to assess carotid intima media thickness and a dual-energy X-ray absorptiometry scan to assess for VAT were obtained. Those in the highest quartiles of VAT were more likely to have hypertension, hypertriglyceridemia, low high-density lipoprotein, diabetes mellitus, and metabolic syndrome. Increased carotid intima media thickness was more prevalent in those in the highest quartile for VAT (57.4% versus 15.4% for the lowest quartile; P<0.001). There was a graded increase in mean carotid intima media thickness with increasing VAT, after adjusting for covariates; for every 10 cm² increase in VAT, there was an increase of 0.004 mm (SE=0.002; P=0.0299) in mean carotid intima media thickness. However, this association was only seen among second or higher generation US-born Mexican Americans but not among first generation immigrants (P=0.024). Conclusions Excess VAT is associated with indicators of metabolic disorders and subclinical atherosclerosis in Mexican Americans regardless of body mass index. However, acculturation appears to be an important modulator of this association. Longitudinal follow-up with targeted interventions among second or higher generation Hispanics to lower VAT and improve cardiometabolic risk may help prevent premature cardiovascular disease in this cohort.

Association between serum albumin and peripheral arterial disease in hypertensive patients

The authors aimed to evaluate the relationship of serum albumin with peripheral arterial disease (PAD) and investigate any possible effect modifiers in hypertensive patients. In the cross-sectional study, a total of 10,900 Chinese hypertensive patients aged ≥18 years were enrolled. The outcome was PAD, defined as an ankle-brachial index (ABI) <0.90 in either leg. The overall mean (SD) serum albumin was 46.8 (4.2) g/L. There were significant inverse associations of serum albumin with PAD (per SD increment; OR: 0.83; 95% CI: 0.72, 0.94). Compared with the lowest tertile (<45.1 g/L), the multivariate-adjusted ORs (95% CI) for participants in the middle tertile (45.1-48.2 g/L) and highest tertile (≥48.2 g/L) of serum albumin were 0.89 (95% CI: 0.67, 1.16) and 0.65 (95% CI: 0.47, 0.90), respectively. Conversely, lower albumin (<48.2 g/L) concentrations were associated with increased odds of PAD (OR: 1.45; 95% CI: 1.08-1.96) compared with higher concentrations. Furthermore, the albumin-PAD association was significantly stronger in males (OR: 2.08; 95% CI: 1.31, 3.30) than in females (OR: 1.06; 95% CI: 0.70, 1.58; p interaction = .024). In conclusion, among Chinese hypertensive adults, lower serum albumin was associated with the prevalence of PAD only in males but not in females.

Is there an association between sarcoidosis and atherosclerosis?

Sarcoidosis is a multisystemic chronic inflammatory disease that the specific etiology is not known clearly. The aim of this study is, to investigate the presence of subclinical atherosclerosis and endothelial dysfunction by using carotid intima-media thickness and flow-mediated dilatation measurements, measuring the copeptin values, which is a stress marker, and interpreting the association of copeptin values with these two variables in sarcoidosis patients without conventional risk factors for coronary artery disease. Seventy-four patients (50 f, 24 m) with histopathological diagnosis of sarcoidosis and 60 healthy volunteers (35 f, 25 m) with similar sociodemographic characteristics were included in this study. CIMT, FMD, and serum copeptin levels of all participants were measured. The values of CIMT and Copeptin in sarcoidosis patients were significantly higher (p = 0.001, p < 0.001 respectively), and FMD was significantly lower (p = 0.01) than the control group. In sarcoidosis patients not significant correlation found among CIMT with copeptin (r: 0.16, p = 0.18) and FMD with copeptin (r: 0.01, p = 0.96). With the demonstration of the presence of subclinical atherosclerosis and endothelial dysfunction, we suggest; sarcoidosis patients may be followed more closely in terms of cardiovascular diseases. And new studies are needed to investigate the pathophysiology and the effects of high copeptin levels in sarcoidosis patients.

Peripheral artery disease in outpatients with a recent history of acute coronary syndrome or at high atherothrombotic risk

OBJECTIVES

The frequency and implications of peripheral artery disease (PAD) in some risk groups are not entirely characterized in Latin America. We studied PAD prevalence, risk factors, and six-month outcomes in stable outpatients with a history of a recent acute coronary syndrome (ACS), or at high coronary risk.

METHODS

We recruited 830 outpatients in 43 Mexican sites (median age: 64.8 years; 57.8% men). Inclusion criteria were age >18 years, and ACS within 30 days, or age <55 years plus ≥2 major vascular risk factors, or age ≥55 years plus ≥1 vascular risk factors. Patients received standardized assessments at baseline and six-month follow-up for medical history, ankle-brachial index (ABI), and the Edinburgh Claudication Questionnaire (ECQ).

RESULTS

ABI <0.8 was found in 10.5%, <0.9 in 22.5%, >1.3 in 4.8%, and >1.4 in 3.6%, without differences according to sex or selection criteria. Positive ECQ was found in 7.6%. ABI <0.9 was directly associated with age, diabetes, ACS, and chronic kidney disease, but inversely associated with BMI >27. The six-month case-fatality and atherothrombotic events rates were 1.6% and 3.6%, respectively. In patients with ABI <0.9 and ABI <0.8, the six-month case-fatality rates were 2.5% (p = 0.27) and 5.4% (p = 0.03), respectively. In a Cox proportional-hazards model, baseline factors associated with death were age ≥65, ABI <0.8, and ACS.

CONCLUSIONS

Subclinical PAD is more common than symptomatic claudication in high-risk coronary outpatients. Low ABI is associated with reduced short-term survival in patients with recent ACS or at high coronary risk.

Ideal Cardiovascular Health Metrics on the New Occurrence of Peripheral Artery Disease: A Prospective Cohort Study in Northern China

Peripheral artery disease (PAD) is a common atherosclerotic disease which could lead to severe cardiovascular and cerebrovascular events. Previous studies have indicated the ideal cardiovascular health (ICVH) was associated with many atherosclerotic diseases and cardiovascular events. This study aimed to find out the relationship between ICVH metrics and the new occurrence of PAD. We collected information of baseline from 2010 on the seven ICVH metrics (including smoking, body mass index, dietary intake, physical activity, blood pressure, total cholesterol and fasting blood glucose); and assessed PAD by ankle brachial index among the enrolled participants. The relationship between the ICVH metrics and new occurrence of PAD was analyzed using the multivariate logistic regression in 2018. There were 214 participants were diagnosed with the new occurrence of PAD during the follow-up visit. Participants with PAD tend to be older, with a lower level of education and a higher morbidity of hypertension. Among the seven ICVH metrics, BMI seems to be the most sensitive metric to the occurrence of PAD after adjusting the other risk factors (HR (95% CI) = 0.704 (0.529-0.937), P = 0.0163). We further found out as the number of ICVH metric increased, the morbidity of PAD decreased gradually (HR (95% CI) = 0.888 (0.801-0.984), P for trend= 0.0240). There is no difference between different age and gender groups. The ICVH metrics affect the new occurrence of PAD in a Chinese population. It enhances the importance of ideal health behaviors and factors in the prevention of PAD.

Usefulness of carotid ultrasonography and treatment of carotid disease

Carotid stenosis is an important etiology of ischemic stroke. Most of the strokes associated with carotid stenosis are caused by artery-to-artery embolism. The risk of embolism highly depends on the stenosis degree and the vulnerability of the carotid plaque. Carotid ultrasonography is useful for evaluating the characteristics of carotid plaque. This review aims to provide information on performing and interpreting the result of carotid ultrasonography and the treatment of carotid artery disease based on the current guidelines. The degree of stenosis can be measured by the diameter reduction and flow velocity criteria. The risk of embolism is highest when the stenosis degree is around 70% to 80%. A heterogeneous echolucent plaque with an irregular surface or an ulcer shows a high risk of embolism. Appropriate treatment is important for the patients with carotid stenosis. In symptomatic patients, a potent antiplatelet treatment, especially during the acute stage, is beneficial. Patients with asymptomatic stenosis over 50% can also be considered for antiplatelet treatments. The associated risk factors should be managed according to the targets. Medically intractable cases or patients with high risk of embolism may receive carotid endarterectomy or carotid artery stenting depending on the concomitant disease and the degree of carotid stenosis. Considering the safety of ultrasound imaging, treatment may be followed-up by carotid ultrasonography.

Diagnostic accuracy of carotid intima media thickness by B-mode ultrasonography in coronary artery disease patients

Introduction

Cardiovascular diseases (CVD) are the main cause of premature deaths worldwide, and atherosclerosis (AS) is a major risk factor associated with them. B-mode ultrasound is a well-validated research tool that has been translated increasingly into clinical practice. The aim of the study was to assess the diagnostic accuracy of carotid intima media thickness by B-mode ultrasonography in coronary artery disease patients.

Material and methods

This was a case control study, including 100 cases and the same number of controls. Patients with positive angiographic findings and chest pain were considered as cases and those without as negative. Duplex carotid ultrasound was used to detect intima-media thickness (IMT). B-mode real-time ultrasonic images were obtained with a 7 MHz transducer. An intima media thickness of 0.6 mm was considered as being without plaque.

Results

The angiographic findings were single-vessel disease, double-vessel disease, and triple-vessel disease in 18%, 11.5%, and 20.5% of cases, respectively, while there were no findings in controls. There was plaque formation in 14.5% and calcification in 12% of the cases. Sensitivity of B-mode ultrasonography was found to be 78%, specificity 75%, positive predictive value 75.72%, and negative predictive value 77.31%.

Conclusions

Carotid ultrasonography can be utilised as a valuable screening tool due to having several advantages, including ease of application, reproducibility, low cost, and strong correlation with atherosclerosis.

To fast or not to fast: Lipid measurement and cardiovascular disease risk estimation in rural sub-Saharan Africa

Background

Cardiovascular disease (CVD) morbidity and mortality are increasing in sub-Saharan Africa (sSA), highlighting the need for tools to enable CVD risk stratification in the region. Although non-HDL-cholesterol (nHDL-C) has been promoted as a method to measure lipids without a requirement for fasting in the USA, its diagnostic validity has not been assessed in sSA. We sought to estimate: 1) the association between LDL-cholesterol (LDL-C) and nHDL-C, 2) the impact of fasting on their measurement, and 3) their correlation with carotid atherosclerosis, within a rural Ugandan population with high HIV prevalence.

Methods

We collected traditional CVD risk factors, blood for serum lipid levels, self-reported fasting status, and performed carotid ultrasonography in 301 participants in rural Uganda. We fit regression models, stratified by fasting status, to estimate associations between carotid intima media thickness (cIMT), LDL-C, and nHDL-C.

Results

Median age was 50 years (interquartile range = 46-54), 49% were female, 51% were HIV-positive, and at the time of blood collection, 70% had fasted overnight. Mean LDL-C, nHDL-C, and triglycerides in the non-fasting and fasting groups were 85 vs 88 mg/dL (P = 0.39), 114 vs 114 mg/dL (P = 0.98), and 130 vs 114 mg/dL (P = 0.05) mg/dL, respectively. In unadjusted models, mean cIMT (mm) was associated with both increased LDL-C (β = 0.0078 per 10mg/dL, P < 0.01) and nHDL-C (β = 0.0075, P < 0.01), and these relationships were similar irrespective of fasting status. After adjustment for traditional CVD risk factors, we observed similar associations, albeit with muted effect sizes within the fasting group.

Conclusions

We found a high correlation between LDL-C and nHDL-C, and both were correlated with cIMT, irrespective of fasting or HIV serostatus in rural Uganda. Our findings support use of either fasting or non-fasting serum lipids for CVD risk estimation in rural sSA.

Xanthelasma Palpebrarum: More than Meets the Eye

Xanthelasma palpebrarum (XP) is the most common form of cutaneous xanthomata, and is important aesthetically, because of its close relation to the eyes, as well as medically for its association with cardiovascular disease (CVD). To provide avant-garde review discussing the various aspects of XP, including its aetio-pathogenesis and various treatment modalities. A structured Pubmed and Medline were searched for relevant articles. The finding of recent research has strongly espoused the link between XP and CVD, and mechanisms have been suggested for its formation. The new technologies have led to a multitude of treatment options for XP. XP is a multi-faceted entity; other than simple treatment of the cosmetic aspect of the disease, one must be cognizant of its cardiovascular implications.

Coronary artery disease and restenosis after peripheral endovascular intervention are predictors of poor outcome in peripheral arterial disease

Background: Few data are available on long-term atherothrombotic events after percutaneous transluminal angioplasty (PTA) for peripheral arterial disease (PAD). Restenosis after PTA may be a marker of a more aggressive atherothrombosis. Aim: To ascertain whether restenosis detected by duplex sonography (DUS) after PTA for iliac and femoro-popliteal disease is associated with a higher risk of cardiovascular events. Methods: We conducted a prospective cohort study of patients undergoing iliac or femoro-popliteal PTA for PAD. Patients were seen at one month, six months, one year and every year thereafter after PTA. At each visit, DUS was performed and accordingly restenosis was stratified into two categories (absent/present). The outcome was the composite of major adverse cardiovascular events (MACE). Results: Two hundred and fifty patients (aged 69 ± 11 years, male 59.2%) were enrolled. During a mean follow-up of 1207 ± 904 days, 102 (40.8%) patients developed restenosis. Restenosis was more frequent in patients with diabetes and critical limb ischaemia. MACEs (n = 76) were more frequent in the patients that developed restenosis vs. those that did not (40.2 vs. 23.6%, p = .005). Predictors of MACEs were diabetes (HR 2.02, 95%CI: 1.19-3.41, p = .009), presence of coronary heart disease at enrolment (HR 2.84, 95%CI: 1.78-4.53, p = .001) and restenosis (HR 1.87, 95%CI: 1.16-3.00, p = .010). Conclusion: Restenosis at DUS, diabetes, and coronary heart disease in patients who underwent iliac or femoro-popliteal PTA for PAD are associated with increased risk of arterial thrombotic event. Intervention trials are required to show the benefit of different therapeutic approaches in such patients at high risk of clinical deterioration.

Association of overweight and obesity with cardiovascular risk factors in patients with atherosclerotic diseases

Background

The aim of this study was to compare demographic, clinical and biochemical characteristics, including inflammatory markers, according to the nutritional status of patients with verified atherosclerotic disease.

Methods

This cross-sectional study involved 1045 consecutive patients with verified carotid disease or peripheral arterial disease (PAD). Anthropometric parameters and data on cardiovascular risk factors and therapy for hypertension and hyperlipidemia were collected for all participants.

Results

Carotid disease was positively and PAD was negatively associated with body mass index (BMI). Negative association between obesity and PAD was significant only in former smokers, not in current smokers or in patients who never smoked. Overweight and general obesity were significantly related to metabolic syndrome (p < 0.001), lower values of high - density lipoprotein cholesterol (p < 0.001), increased triglycerides (p < 0.001), hyperglycemia (p < 0.001), self-reported diabetes (p < 0.001), hypertension (p < 0.001), high serum uric acid (p < 0.001), increased high sensitivity C-reactive protein (p = 0.020) and former smoking (p = 0.005) after adjustment for age, gender and type of disease. Antihypertensive therapy seems to be less effective in patients who are overweight and obese.

Conclusions

In conclusion, overweight and general obesity were significantly related to several cardiovascular risk factors.

Correlation between Breast Arterial Calcification and the 10-year fatal cardiovascular risk by means of the SCORE Risk System

Objectives:

The aim of this study was to investigate the relationship between Breast Arterial Calcification (BAC) on mammography and the 10-year fatal Cardiovascular Disease (CVD) risk by using SCORE risk system.

Methods:

The study was conducted from September 2013 to July 2014. A total of 66 women with BAC and 66 age-matched controls without BAC were analyzed. The groups were compared with respect to demographics, clinical, reproductive, laboratory parameters, and 10-year fatal CVD risk.

Results:

The mean ages of the women in the study was 54.0 years (40-85 years). Hypertension, systolic blood pressure, levels of serum total cholesterol and the calculated SCORE risk were higher in the BAC (+) group than in the BAC (-) group (p=0.04, p=0.031, p=0.046, and p=0.038 respectively). Multivariate analysis showed that none of them was independent factor of BAC on mammograms, only the 10-year fatal CVD risk was close to being statistically significant (OR:1.17, CI:0.98-1.38, p=0.06).

Conclusion:

BAC on mammography was found to be related to the 10-year fatal CVD risk as calculated by the SCORE risk score system. Additional large-scale prospective studies are required to further assess whether BAC can be considered a useful screening tool for CVD risk prediction in women who screened for breast cancer by mammography.

Platelet number is negatively and independently associated with carotid intima-media thickness in apparently healthy overweight/obese subjects

BACKGROUND AND AIM

A significant change of platelet number may be a risk factor for atherosclerotic cardiovascular disease. The aim of this study was to investigate the association between platelet number and early signs of atherosclerosis, evaluated by carotid intima-media thickness (c-IMT), in a apparently healthy population mainly represented by obese subjects.

METHODS AND RESULTS

As many as 961 subjects, 686 women and 275 men, aged between 18 and 74 years, were enrolled in the study. Of these, 54 individuals (5.6% of all subjects) were normal weight, 259 individuals (27.0% of all subjects) were overweight, and 648 individuals (67.4% of all subjects) were obese. Waist circumference (WC) and blood glucose, insulin, total cholesterol, high and low density lipoprotein cholesterol, triglycerides and platelet count were also detected in all subjects, who underwent carotid echo color doppler ultrasound to measure c-IMT. c-IMT was significantly and positively associated to age (r = 0.204, P < 0.0001), fasting glucose (r = 0.073, P < 0.0240), total cholesterol (r = 0.096, P = 0.0031), and systolic and diastolic blood pressure (r = 0.140, P < 0.0001 and r = 0.119, P < 0.0003 respectively); c-IMT was significantly and negatively correlated with platelet count (r = -0.165, P < 0.0001). Only age (P < 0.0001) and systolic blood pressure (P = 0.0393), positively, and platelet number (P < 0.0001), negatively, were significantly and independently associated to c-IMT in a final multiple regression analysis.

CONCLUSION

Lower platelet number represented an independent determinant of c-IMT in a population, mainly represented by obese patients. These results suggest that a decrease of platelet number may well be an early defensive mechanism in subjects developing the thickening of carotid artery.

Endothelial dysfunction and the risk of atherosclerosis in overt and subclinical hypothyroidism

Hypothyroidism is associated with increased risk of atherosclerosis. We assessed carotid intima-media thickness (CIMT), as a marker of atherosclerosis, and endothelial function in patients with hypothyroidism. We included 70 female patients with hypothyroidism in the study, 40 patients with overt and 30 patients with subclinical hypothyroidism. Forty, age- and sex-matched, subjects with normal thyroid functions were also included as a control group. CIMT was measured using high-resolution color-coded Doppler ultrasonography. Endothelial function was assessed by measuring the percent of change in blood flow following heat-mediated vasodilation using laser Doppler flowmetry. CIMT was significantly higher in patients with overt and subclinical hypothyroidism as compared with the control group (0.7 ± 0.2 and 0.6 ± 0.2 mm respectively vs 0.45 ± 0.07 mm, P < 0.001 for both). The percent of change in blood flow following heat-mediated vasodilation was significantly impaired in patients with overt and subclinical hypothyroidism as compared with the control group (328 ± 17 and 545 ± 406% respectively vs 898 ± 195%, P < 0.001 for both). The impairment was more significant in overt as compared with subclinical hypothyroidism (P = 0.014). CIMT negatively correlated with percent of change in blood flow following heat-mediated vasodilation in patients with overt and subclinical hypothyroidism (P < 0.001 for both). We concluded that CIMT is significantly higher in patients with overt and subclinical hypothyroidism compared with normal control subjects. Impairment of endothelial function is a contributing factor to the increased risk of atherosclerosis in both groups of patients.

Peripheral artery disease and osteoporosis: Not only age‑related (Review)

Osteoporosis and atherosclerosis are two chronic degenerative diseases that share several biochemical pathways and risk factors. Previous studies have associated osteoporosis with carotid atherosclerosis, cardiovascular mortality and stroke, but data on the relationship with peripheral artery disease are few and conflicting. The OPG/RANK/RANKL system and Wnt/beta catenin signaling seem to be deeply involved in the pathogenesis of bone alterations and atherosclerotic processes also affect arteries of the lower extremities. Hypovitaminosis D could also play a role in the relationship of these two diseases. New and larger studies are necessary to shed light on this association and to design new drugs able to act in both these chronic degenerative diseases.

Impaired ankle-brachial index in antiphospholipid syndrome: Beyond the traditional risk factors

INTRODUCTION

The patients with antiphospholipid syndrome (APS) associate an increased risk of atherosclerosis.

OBJECTIVE

To determine the predictors of an abnormal ankle-brachial index (ABI), surrogate measure of atherosclerosis, in patients with APS.

METHODS

The ABI was measured according to standard recommendations in 106 patients. Traditional cardiovascular risk factors were assessed in all cases. A large spectrum of APS antibodies was determined in 73 patients.

RESULTS

A total of 106 patients diagnosed with APS were included. 28.3% patients included were found to have low ABI. Anti-beta 2-glycoprotein I (aβ2GPI) IgG antibodies [4.00 (1.00-79.00) vs 3.00 (0.00-29.00) U/mL, P = 0.02] and antiprothrombin (aPT) IgM antibodies [4.50 (0.00-82.00) vs 3.00 (0.00-14.00) U/mL, P = 0.05] titers were found to be higher in patients with abnormal ABI. However, after multivariate regression analysis, only the aβ2GPI IgG titer remained predictor of low ABI (P = 0.04).

CONCLUSIONS

aβ2GPI IgG associated with impaired ABI in patients with APS. This relation might reflect their involvement in the atherosclerosis occurrence.

Rationale and design of a trial to personalize risk assessment in familial coronary artery disease

BACKGROUND

The lifetime risk of coronary artery disease (CAD) is doubled in people with a family history of premature disease, yet this risk is not captured in most 5- or 10-year risk assessment algorithms. Coronary artery calcium scoring (CCS) is a marker of subclinical CAD risk, which has been shown in observational studies to provide prognostic information that is incremental to clinical assessment; is relatively inexpensive; and is performed with a small radiation dose. However, the use of CCS in guiding prevention is not strongly supported by guidelines. Showing definitive evidence of the efficacy and cost-effectiveness of CCS is therefore of importance.

STUDY DESIGN

The proposed randomized controlled trial of the use of CCS will be targeted to 40- to 70-year-old first-degree relatives of patients with CAD onset <60 years old or second-degree relatives of patients with onset <50 years old. Control patients will undergo standard risk scoring and be blinded to CCS results. In the intervention group, primary prevention in patients undergoing CCS will be informed by this score. At 3 years, effectiveness will be assessed on change in plaque volume at computed tomography coronary angiography, the extent of which has been strongly linked to outcome.

SUMMARY

The CAUGHT-CAD trial will provide evidence to inform the guidelines regarding the place of CCS in decision making regarding primary prevention of patients with a family history of premature disease.

Influence of carotid atherosclerotic plaques on pulse wave assessment with arterial tonometry

OBJECTIVE

Aortic stiffness and central pressure measurements have become increasingly important for the overall estimation of cardiovascular risk. The aim of this study is to verify whether the presence of stenosis in the carotid arteries due to atherosclerotic plaques may induce a bias in the measurement of carotid-femoral pulse wave velocity (PWV) and in the analysis of central pulse waveform variables assessed by carotid tonometry.

METHODS

Eighty-four patients (age: 67.1 ± 12.4 years) undergoing screening for carotid atherosclerosis were enrolled, divided into three groups according to carotid ultrasound findings (NASCET criteria): 28 patients without significant stenosis, 30 patients with bilateral plaques, and 26 patients with right or left monolateral stenosis. PWV and other variables derived from the central pulse waveform analysis (central blood pressure, augmentation index and forward and backward waves) were measured at both right and left carotid arteries by a validated PulsePen tonometer. A repeatability study was performed in 28 young healthy patients (age: 25.4 ± 2.9 years).

RESULTS

A high degree of correlation was found between bilateral measurements in all groups, and particularly in groups with monolateral carotid stenosis, with no significant difference attributable to lateralized stenosis. Right-left differences in asymmetric groups were 0.35 ± 5.12 mmHg (R = 0.960) for central blood pressure, -2.12 ± 7.39% (R = 0.743) for augmentation index, 0.64 ± 1.56 m/s (R = 0.947) for PWV, 0.08 ± 8.48 mmHg for forward wave (R = 0.742) and 0.35 ± 2.35 mmHg for backward wave (R = 0.907).

CONCLUSION

Measurement of PWV and of variables derived from the central pulse waveform analysis by carotid tonometry is not biased by the presence of local atherosclerotic plaques.

Comparison of carotid intima-media thickness and coronary artery calcium score for estimating subclinical atherosclerosis in patients with fatty liver disease

Introduction

Fatty liver disease (FLD) is correlated with cardiovascular disease. Carotid intima–media thickness (CIMT) and coronary artery calcium score (CACS) can noninvasively identify subclinical atherosclerosis and predict risk for cardiovascular events. This study evaluated CIMT and CACS measurements to detect subclinical atherosclerosis in patients with and without FLD.

Methods

Patients who underwent carotid and abdominal ultrasounds as well as cardiac computed tomography (CT) scans were evaluated retrospectively. The differences between the mean CIMT value and CACS measurements in patients with FLD and those with normal livers were estimated.

Results

Among 819 patients (average age of 53.3 ± 11.2 years), 330 had FLD. The CIMT was greater in patients with FLD compared to the controls (0.79 ± 0.17 vs 0.76 ± 0.17 mm, p = 0.012), and carotid plaques were more commonly seen in patients with FLD. The incidence of a composite of larger CIMT (≥ 75th percentile) plus plaque presence was higher in FLD patients (43.3 vs 36.0%, p = 0.041). Particularly among young patients (≤ 50), the CIMT was larger in patients with FLD than in the controls. FLD increased the risk of a composite of large CIMT plus plaque presence in young patients (odds ratio 1.92, 95% confidence interval 1.05–3.49, p = 0.034). However, patients with FLD had no greater incidence of CACS of over 100 than the controls.

Conclusion

CIMT was a better marker of underlying subclinical atherosclerotic risk among patients with FLD than CACS. FLD particularly, increases the risk of subclinical atherosclerosis in patients younger than 50 years of age. These patients should undergo screening CIMT to detect atherosclerosis and modify risk factors.

Prehypertension is associated with peripheral arterial disease and low ankle-brachial index

Patients with prehypertension suffer endothelial dysfunction and are at increased cardiovascular risk. Ankle-brachial index (ABI) constitutes an efficient tool for diagnosing peripheral arterial disease; but also an ABI < 0.9 is an independent and positive predictor of endothelial dysfunction and is associated with increased cardiovascular risk and mortality.

The aim

of this study was testing whether ABI was decreased in prehypertensive patients when compared with normotensive subjects.

Methods

We included 70 prehypertensive patients older than 19 years, in whom the ABI was registered with a 5 megahertz Doppler (Summit Doppler L250, Life Dop., USA). The highest ankle systolic pressure was divided by the highest brachial systolic pressure. We also included 70 normotensive subjects in whom the ABI was registered in the same way. The measurements were performed by the same physician who was blinded about the study.

Statistical analysis was performed with odds ratio and student t-test.

Results

The ABI values in normotensive subjects were 1.023 ± 0.21, whereas prehypertensive patients significantly had lower ABI (0.90 ± 0.14p = 0.00012).

We found ABI <0.9 in 30 prehypertensive patients (42.85%) and 13 normotensive patients (18.5%). The odds ratio of ABI <0.90 in prehypertensive patients was 3.288 (IC₉₅ 1.5–7.0, p = 0.0023).

A regression analysis failed to show any independent association between ABI values and any other clinical parameter.

Conclusions

Prehypertensive patients had lower ABI and higher prevalence of peripheral artery disease when compared with normotensive subjects; this fact increases their cardiovascular risk. ABI must be included in global evaluation of prehypertensive subjects.

Prevalence of peripheral artery disease (PAD) and factors associated: An epidemiological analysis from the population-based Screening PRE-diabetes and type 2 DIAbetes (SPREDIA-2) study

AIM

To describe the prevalence of Peripheral Artery Disease (PAD) in a random population sample and to evaluate its relationship with Mediterranean diet and with other potential cardiovascular risk factors such as serum uric acid and pulse pressure in individuals ranged 45 to 74 years.

METHODS

Cross-sectional analysis of 1568 subjects (mean age 6.5 years, 43% males), randomly selected from the population. A fasting blood sample was obtained to determine glucose, lipids, and HbA1C levels. An oral glucose tolerance test was performed in non-diabetic subjects. PAD was evaluated by ankle-brachial index and/or having a prior diagnosis.

RESULTS

PAD prevalence was 3.81% (95% CI, 2.97-4.87) for all participants. In men, PAD prevalence was significantly higher than in women [5.17% (95% CI, 3.74-7.11) vs. 2.78% (95% CI, 1.89-4.07); p = 0.014]. Serum uric acid in the upper quartile was associated with the highest odds ratio (OR) of PAD (for uric acid > 6.1 mg/dl, OR = 4.31; 95% CI, 1.49-12.44). The remaining variables more strongly associated with PAD were: Heart rate >90 bpm (OR = 4.16; 95%CI, 1.62-10.65), pulse pressure in the upper quartile (≥ 54 mmHg) (OR = 3.82; 95%CI, 1.50-9.71), adherence to Mediterranean diet (OR = 2.73; 95% CI, 1.48-5.04), and former smoker status (OR = 2.04; 95%CI, 1.00-4.16).

CONCLUSIONS

Our results show the existence of a low prevalence of peripheral artery disease in a population aged 45-74 years. Serum uric acid, pulse pressure and heart rate >90 bpm were strongly associated with peripheral artery disease. The direct association between Mediterranean diet and peripheral artery disease that we have found should be evaluated through a follow-up study under clinical practice conditions.

Prognostic Value of Ankle-Brachial Index in Patients Undergoing Percutaneous Coronary Intervention: In-Hospital and 1-Year Outcomes From the SHINANO Registry

Concomitant coronary and peripheral artery disease is associated with higher periprocedural and long-term percutaneous coronary intervention (PCI) complication rates. We evaluated in-hospital and 1-year clinical outcomes of patients with low or borderline ankle-brachial indexes (ABIs) undergoing PCIs in the drug-eluting stent era. We divided 1370 SHINANO registry patients into 3 groups-low (ABI ≤ 0.9), borderline (0.9 < ABI ≤ 1.0), and normal (1.0 ≤ ABI < 1.4). During the 1-year follow-up, more PCI-related complications occurred in the low and borderline ABI groups than in the normal ABI group (7.7% vs 8.8% vs 4.0%, respectively). Low ABI patients were more likely to experience adverse clinical events (6.3% vs 3.6% vs 3.0%, respectively; log-rank P = .020 for low vs normal ABI), with a hazard ratio of 2.27 (95% confidence interval, 1.12-4.61; P = .023), compared with patients with normal ABIs. Patients with abnormal ABIs had a significantly higher incidence of PCI-related complications and a less favorable 1-year prognosis. Routine ABI measurement before PCI may help predict PCI-related complication incidence and 1-year prognosis.

The Childhood Roots of Cardiovascular Disease Disparities

A recent national review of the social determinants of cardiovascular disease (CVD) underscored the growing recognition that poor socioeconomic conditions early in life place children at higher risk for CVD as adults. There is growing evidence that chronic elevation of allostatic load as a consequence of high levels of early childhood stress can trigger early atherosclerotic changes in children independently of behaviors. Elevated levels of circulating cortisol have been documented in children as young as 4 years who were raised in highly stressful circumstances. Chronic elevation of cortisol is associated with increased release of inflammatory proteins such as interleukin 6, which can lead to fibrosis and scarring in the vessel walls of the arterial circulation, resulting in increased intima-media thickness. Increased intima-media thickness of the carotid artery has been found in individuals with low socioeconomic status as early as age 18 years and has been associated with increased CVD risk throughout the adult years. The American Academy of Pediatrics has recommended that it is the task of pediatricians and other health care professionals to screen for toxic stress among children during their early years and to take steps known to reduce stress reactivity, thereby helping these children to reduce their risk of early atherosclerotic changes and increased CVD throughout the life course.

Peripheral Artery Disease and Its Clinical Relevance in Patients with Chronic Obstructive Pulmonary Disease in the COPD and Systemic Consequences-Comorbidities Network Study

RATIONALE

Knowledge about the prevalence of objectively assessed peripheral artery disease (PAD) and its clinical relevance in patients with chronic obstructive pulmonary disease (COPD) is scarce.

OBJECTIVES

We aimed to: (1) assess the prevalence of PAD in COPD compared with distinct control groups; and (2) study the association between PAD and functional capacity as well as health status.

METHODS

The ankle-brachial index was used to diagnose PAD (ankle-brachial index ≤ 0.9). The 6-minute-walk distance, health status (St. George's Respiratory Questionnaire), COPD Assessment Test, and EuroQol-5-Dimensions were assessed in patients enrolled in the German COPD and Systemic Consequences-Comorbidities Network cohort study. Control groups were derived from the Study of Health in Pomerania.

MEASUREMENTS AND MAIN RESULTS

A total of 2,088 patients with COPD (61.1% male; mean [SD] age, 65.3 [8.2] years, GOLD (Global Initiative for Chronic Obstructive Lung Disease) stages I-IV: 9.4, 42.5, 37.5, and 10.5%, respectively) were included, of which 184 patients (8.8%; GOLD stage I-IV: 5.1, 7.4, 11.1, and 9.5%, respectively, vs. 5.9% in patients with GOLD stage 0 in the COPD and Systemic Consequences-Comorbidities Network) had PAD. In the Study of Health in Pomerania, PAD ranged from 1.8 to 4.2%. Patients with COPD with PAD had a significantly shorter 6-minute-walk distance (356 [108] vs. 422 [103] m, P < 0.001) and worse health status (St. George's Respiratory Questionnaire: 49.7 [20.1] vs. 42.7 [20.0] points, P < 0.001; COPD Assessment Test: 19.6 [7.4] vs. 17.9 [7.4] points, P = 0.004; EuroQol-5-Dimensions visual analog scale: 51.2 [19.0] vs. 57.2 [19.6], P < 0.001). Differences remained significant after correction for several confounders.

CONCLUSIONS

In a large cohort of patients with COPD, 8.8% were diagnosed with PAD, which is higher than the prevalence in control subjects without COPD. PAD was associated with a clinically relevant reduction in functional capacity and health status.

Aortic velocity propagation: A novel echocardiographic method in predicting atherosclerotic coronary artery disease burden

Background

The major burden of cardiovascular disease mortality around the globe is due to atherosclerosis and its complications. Hence its early detection and management with easily accessible and noninvasive methods are valuable. Aortic velocity propagation (AVP) through color M-mode of the proximal descending aorta determines aortic stiffness, reflecting atherosclerosis. The aim of this study was to find the utility of AVP in predicting coronary artery disease (CAD) burden assessed through SYNTAX (SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery) score and compared with carotid intima-media thickness (CIMT), which is an established surrogate marker of atherosclerosis.

Methods

In this cross-sectional comparative study, we measured AVP by color M-mode and CIMT by using Philips QLAB-IMT software in 100 patients, who underwent conventional coronary angiogram (CAG) between May 2013 and November 2014. Coronary artery disease is considered significant if >50% diameter stenosis is present in any epicardial coronary artery and insignificant if otherwise.

Results

Initially, to know the normal range we measured AVP and CIMT in 50 patients without any major risk factors for CAD but CAG was not done. Aortic velocity propagation ranged from 46 cm/s to 76 cm/s (mean = 58.62 ± 6.46 cm/s), CIMT ranged from 0.50 mm to 0.64 mm (mean = 0.55 ± 0.03 mm). Among 100 patients who underwent CAG we found 69% had significant CAD, 13% had insignificant CAD, and 18% had normal coronaries. Those with significant CAD had significantly lower AVP (41.65 ± 4.94 cm/s) [F (2,97) = 44.05, p < 0.0001] and significantly higher CIMT (0.86 ± 0.11 mm) [F (2,97) =35.78, p < 0.0001]. AVP had significant strong negative correlation with CIMT (r = −0.836, p < 0.0001, n = 100) and SYNTAX score (r = –0.803, p < 0.0001, n = 69), while CIMT was positively correlated with SYNTAX score significantly (r = 0.828, p < 0.0001, n = 69).

Conclusions

AVP and CIMT can predict CAD burden in a robust way. AVP may emerge as an exquisite bedside tool to predict atherosclerotic burden and guide in implementing preventive therapy for cardiovascular disease.

Impressive predictive value of ankle-brachial index for very long-term outcomes in patients with cardiovascular disease: IMPACT-ABI study

Background

The ankle—brachial index (ABI) is a marker of generalized atherosclerosis and is predictive of future cardiovascular events. However, few studies have assessed its relation to long-term future cardiovascular events, especially in patients with borderline ABI. We therefore evaluated the relationship between long-term future cardiovascular events and ABI.

Methods

In the IMPACT-ABI study, a single-center, retrospective cohort study, we enrolled 3131 consecutive patients (67 ± 13 years; 82% male) hospitalized for cardiovascular disease and measured ABI between January 2005 and December 2012. After excluding patients with an ABI > 1.4, the remaining 3056 patients were categorized as having low ABI (≤ 0.9), borderline ABI (0.91–0.99), or normal ABI (1.00–1.40). The primary endpoint was MACE (cardiovascular death, myocardial infarction [MI] and stroke). The secondary endpoints were cardiovascular death, MI, stroke, admission due to heart failure, and major bleeding.

Results

During a 4.8-year mean follow-up period, the incidences of MACE (low vs. borderline vs. normal: 32.9% vs. 25.0% vs. 14.6%, P<0.0001) and cardiovascular death (26.2% vs. 18.7% vs. 8.9%, P<0.0001) differed significantly across ABIs. The incidences of stroke (9.1% vs. 8.6% vs. 4.8%, P<0.0001) and heart failure (25.7% vs. 20.8% vs. 8.9%, P<0.0001) were significantly higher in the low and borderline ABI groups than in the normal ABI group. But the incidences of MI and major bleeding were similar in the borderline and normal ABI groups. The hazard ratios for MACE adjusted for traditional atherosclerosis risk factors were significantly higher in patients with low and borderline ABI than those with normal ABI (HR, 1.93; 95%CI: 1.44–2.59, P < 0.0001, HR, 1.54; 95% CI: 1.03–2.29, P = 0.035).

Conclusions

The incidence of long-term adverse events was markedly higher among patients with low or borderline ABI than among those with normal ABI. This suggests that more attention should be paid to patients with borderline ABIs, especially with regard to cardiovascular death, stroke, and heart failure.

Screening for asymptomatic coronary artery disease in patients with type 2 diabetes mellitus

Diabetes is a very frequent disease and it is estimated that its prevalence will continuously increase during the next two decades. The arteriosclerotic process in diabetic patients progresses earlier and more diffusely, and it is more accelerated in the diabetic patient than in the overall population. In diabetic subjects, acute myocardial infarction (AMI) and stroke are the leading causes of death, but the presence of arterial disease is not always detected before the development of the acute arterial event. Several times, AMI is asymptomatic or present nonspecific symptoms, and it is the initial form of presentation of coronary artery disease causing an important delay in initiating cardiovascular treatment in these patients. The purpose of this review article is to discuss how to screen and early diagnose the presence of coronary artery disease in asymptomatic diabetic patients, based on new available diagnostic resources. Currently, the most recommended technique used for screening coronary artery disease in these patients is myocardial perfusion scintigraphy or stress echocardiography because of greater sensitivity and specificity in relation to the exercise test. However, technological advances have enabled the development of new imaging diagnostic methods that are less invasive than conventional coronary angiography, and which gradually gain importance in the diagnosis of coronary artery disease as they show higher effectiveness with lower invasiveness and risk. Arch Endocrinol Metab. 2016;60(2):143-51.