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Gorgui J, Gasbarrino K, Georgakis MK, Karalexi MA, Nauche B, Petridou ET, Daskalopoulou SS. Circulating adiponectin levels in relation to carotid atherosclerotic plaque presence, ischemic stroke risk, and mortality: A systematic review and meta-analyses. Metabolism 2017; 69:51-66. [PMID: 28285652 DOI: 10.1016/j.metabol.2017.01.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 12/07/2016] [Accepted: 01/03/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Low circulating levels of adiponectin, an anti-inflammatory and vasculoprotective adipokine, are associated with obesity, type 2 diabetes, and atherosclerotic disease. Presence of unstable plaques in the carotid artery is a known etiological factor causing ischemic strokes. Herein, we systematically reviewed the association between circulating adiponectin and progression of carotid atherosclerotic disease, particularly evaluating the occurrence of (1) carotid atherosclerotic plaques, (2) ischemic stroke, and (3) mortality in subjects who suffered a previous ischemic stroke. METHODS Medline, Embase, Biosis, Scopus, Web of Science, and Pubmed were searched for published studies and conference abstracts. The effect size and 95% confidence intervals (CIs) of the individual studies were pooled using fixed-effect or random-effect models. The quality of the eligible studies was evaluated using the Newcastle-Ottawa quality assessment scale. Sensitivity, subgroup, and meta-regression analyses were performed to address the impact of various risk factors on the association between adiponectin and ischemic stroke risk. RESULTS Twelve studies fulfilled the inclusion criteria for 3 independent meta-analyses. The association of increasing circulating adiponectin levels (5μg/mL-increment) with presence of carotid plaque was not conclusive (n=327; OR: 1.07; 95% CI: 0.85-1.35; 2 studies), whereas high adiponectin levels showed a significant 8% increase in risk of ischemic stroke (n=13,683; 7 studies), with a more sizable association observed among men compared to women. HDL was observed to have a marginal effect on the association between adiponectin and ischemic stroke, while other evaluated parameters were not found to be effect modifiers. A non-significant association of adiponectin with mortality was yielded (n=663; OR: 2.58; 95% CI: 0.69-9.62; 3 studies). Although no publication bias was evident, there was significant between-study heterogeneity in most analyses. CONCLUSION It appears that the direction of the relationship between adiponectin and carotid atherosclerotic plaque presence is dependent on the duration, severity, and nature of the underlying disease, while increased adiponectin levels were associated with an increase in risk for ischemic stroke. Lastly, the results from the mortality meta-analysis remain inconclusive. Future properly designed studies are necessary to further elucidate the role of adiponectin on atherosclerotic plaque development, and its related outcomes.
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Affiliation(s)
- Jessica Gorgui
- Department of Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
| | - Karina Gasbarrino
- Department of Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
| | - Marios K Georgakis
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece.
| | - Maria A Karalexi
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece.
| | - Bénédicte Nauche
- Medical Library, McGill University Health Centre, Montreal, Quebec, Canada.
| | - Eleni Th Petridou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece.
| | - Stella S Daskalopoulou
- Department of Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
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Toprak MS, Ozturk ZG, Ekmekci OB, Ekmekci H, Ikitimur B, Karadag B, Cakmak HA, Ilerigelen B, Sonmez H. Comparison of exercise treadmill test, flow mediated dilatation, and inflammation in individuals with low risk of adverse cardiovascular events. ASIAN BIOMED 2017. [DOI: 10.5372/1905-7415.0902.380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract
Background
The relationship between endothelial dysfunction, a risk factor for coronary artery disease, and the incidence of cardiovascular disease (CVD) in the general population is not well known.
Objectives
To determine the utility of an exercise treadmill test (ETT) combined with inflammatory markers to show endothelial dysfunction for individuals with a low risk of adverse cardiovascular (CV) events.
Methods
Biomarkers of inflammation (lipoprotein-related phospholipase A2 (Lp-PLA2) and high-sensitive C-reactive protein (hs-CRP)) and biomarkers of endothelial dysfunction (nitric oxide, oxidized low-density lipoprotein (Ox-LDL), and sialic acid) were assessed in 60 apparently healthy patients with a positive (+) or negative (−) ETT and across endothelial function assessed by flow mediated dilatation (FMD) and Lp-PLA2 tertiles.
Results
Lp-PLA2 levels were increased in ETT (−) compared with ETT (+) patients. Half of ETT (−) patients were found to have levels of Lp-PLA2 in the highest tertile. There was a significant inverse relationship between ETT and inflammatory biomarkers when adjusted for age, Lp-PLA2 (r = −0.28, P = 0.04), or hs-CRP (r = −0.35, P = 0.01). No differences were found for biomarkers of endothelial dysfunction. All variables were reassessed across FMD tertiles. Total lipids, Ox-LDL, triglyceride, and Lp-PLA2 were higher for the lowest FMD tertile.
Conclusion
The elevation of Lp-PLA2 in ETT (−) patients and the inverse relationship with inflammatory biomarkers, suggest that ETT cannot address endothelial dysfunction for individuals with apparently low risk of adverse CV events, and cannot be used for risk stratification of the general population.
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Affiliation(s)
- Muhammed Sait Toprak
- Department of Medical Biochemistry , Cerrahpasa Medical School , University of Istanbul , Istanbul 34452 , Turkey
| | - Zeynep Gungor Ozturk
- Department of Medical Biochemistry , Cerrahpasa Medical School , University of Istanbul , Istanbul 34452 , Turkey
| | - Ozlem Balci Ekmekci
- Department of Medical Biochemistry , Cerrahpasa Medical School , University of Istanbul , Istanbul 34452 , Turkey
| | - Hakan Ekmekci
- Department of Medical Biochemistry , Cerrahpasa Medical School , University of Istanbul , Istanbul 34452 , Turkey
| | - Baris Ikitimur
- Department of Cardiology , Cerrahpasa Medical School , University of Istanbul , Istanbul 34452 , Turkey
| | - Bilgehan Karadag
- Department of Cardiology , Cerrahpasa Medical School , University of Istanbul , Istanbul 34452 , Turkey
| | - Huseyin Altug Cakmak
- Department of Cardiology , Cerrahpasa Medical School , University of Istanbul , Istanbul 34452 , Turkey
| | - Baris Ilerigelen
- Department of Cardiology , Cerrahpasa Medical School , University of Istanbul , Istanbul 34452 , Turkey
| | - Huseyin Sonmez
- Department of Medical Biochemistry , Cerrahpasa Medical School , University of Istanbul , Istanbul 34452 , Turkey
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Bećarević M, Mirković D, Ignjatović S. Double positivity of the IgG isotype of both anticardiolipin and anti-β2gpI antibodies is associated with the highest number of vascular impairment parameters in patients with primary antiphospholipid syndrome: preliminary data. Clin Rheumatol 2016; 35:2947-2954. [PMID: 27743141 DOI: 10.1007/s10067-016-3438-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 09/20/2016] [Accepted: 09/27/2016] [Indexed: 11/28/2022]
Abstract
Although numerous studies investigated the association between homocysteine (Hcy), tumor necrosis factor alpha (TNF-α), C-reactive protein (CRP) and apolipoproteins (apos) with thrombosis and/or recurrent pregnancy losses, studies that analyzed the abovementioned parameters and multiple positivity of antiphospholipid antibodies (aPL Abs) in patients with primary antiphospholipid syndrome (PAPS) are lacking. Therefore, the aim of this study was to analyze the presence of various combinations of the abovementioned parameters and their associations with clinical and/or serological features of PAPS. High-pressure liquid chromatography (HPLC) was used for determination of Hcy, while apoAI, apoB, and lipoprotein (Lp) (a) concentrations were estimated by immunonephelometry. High-sensitivity C-reactive protein (hsCRP) was measured by immunoturbidimetry. Apo (a), TNF-α, and aPL Abs were measured by ELISA. Various combinations of analyzed parameters (Hcy/CRP/TNF/apoAI/apoB/apo (a)/Lp (a)) were not associated with a single presence of either aPL Abs. Double positivity for both isotypes of anticardiolipin (aCL) Abs (IgG + IgM) was associated with the increased apoB levels. The presence of the IgG isotype of both aCL + anti-beta2 glycoprotein I (aβ2gpI) Abs was associated with the highest number of analyzed parameters (i.e., increased levels of hsCRP, Lp (a), and apo (a)). The presence of the IgG isotype of both aCL + aβ2gpI Abs was associated with the highest number of vascular impairment parameters in patients with PAPS, and this combination confers the highest risk for the recurrence of thrombotic episodes. This is the first report that analyzed the association between various combinations of vascular impairment parameters with multiple aPL Ab positivity. Our results provide a rationale for further investigations of therapeutic approaches for PAPS patients.
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Affiliation(s)
- Mirjana Bećarević
- Medical Faculty, Department of Pharmacy, University of Novi Sad, Hajduk Veljkova 3, Novi Sad, 21000, Serbia. .,Clinical Center of Serbia, Belgrade, Serbia.
| | - Duško Mirković
- Clinical Center of Serbia, Belgrade, Serbia.,Pharmaceutical Faculty, University of Belgrade, Belgrade, Serbia
| | - Svetlana Ignjatović
- Clinical Center of Serbia, Belgrade, Serbia.,Pharmaceutical Faculty, University of Belgrade, Belgrade, Serbia
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Kingstone LL, Shabana W, Chakraborty S, Kingstone M, Nguyen T, Thornhill RE, Berthiaume A, Chatelain R, Currie G. Vulnerable Carotid Artery Plaque Evaluation: Detection Agreement between Advanced Ultrasound, Computed Tomography, and Magnetic Resonance Imaging: A Phantom Study. J Med Imaging Radiat Sci 2015; 46:90-101. [PMID: 31052074 DOI: 10.1016/j.jmir.2014.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 06/06/2014] [Accepted: 06/06/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE Imaging plaque morphology, in addition to luminal grading, may improve stroke risk-management by identifying structural atherosclerotic plaques alterations responsible for cerebrovascular events. The purpose of this study was to evaluate the agreement between our enhanced ultrasound (US) imaging method and high-resolution cross-sectional imaging modalities, such as multidetector-row computed tomography (CT) and magnetic resonance imaging (MRI), in the characterization of vulnerable plaques. METHODS Sixty tissue-like phantoms were created to simulate various types of diseased plaque segments. We prospectively assessed each sample with US, CT, and MRI. Plaque characteristics considered included surface irregularity, ulceration, fissure, and presence of internal fluid core(s). We evaluated the agreement between and among the three modalities, as well as the accuracy of each compared with the true pathology. RESULTS There was moderate to substantial agreement among the three modalities in the detection of morphologic characteristics. There was no significant difference in accuracy between US and CT in the presence of ulceration(s) (P = .23), lucency (P = .23), or fissures (P = .07); however, US was significantly more accurate than MRI for each of these characteristics (P = .0001, P = .0001, P = .02, respectively). None of the three modalities did display any significant difference in accuracy in the identification of irregular surface. There was substantial agreement among the three radiologists (intraclass correlation coefficient, 0.61; 95% confidence interval, 0.46-0.74) in their assessment of plaque subtype, ranging from 80%-85% accuracy in identifying the plaque subtypes for each classification. CONCLUSIONS Enhanced plaque imaging can identify potentially significant plaque characteristics and provide insight into early causative conditions of carotid atherosclerosis. Our results suggest that the types of plaque pathologies derived from our US method showed good agreement with CT and surpass information gathered on MRI. This imaging protocol could potentially shift the paradigm in early carotid plaque imaging likely to predict the onset of vulnerable plaques, thus improving preventative management of atherosclerosis.
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Affiliation(s)
- Lysa Legault Kingstone
- Department of Diagnostic Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada; School of Dentistry and Health Sciences, Charles Sturt University, Wagga Wagga, Australia.
| | - Wael Shabana
- Department of Diagnostic Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Santanu Chakraborty
- Department of Diagnostic Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Michael Kingstone
- Department of Diagnostic Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Thanh Nguyen
- Department of Diagnostic Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Rebecca E Thornhill
- Department of Diagnostic Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Alain Berthiaume
- Department of Diagnostic Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Robert Chatelain
- Department of Diagnostic Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Geoffrey Currie
- School of Dentistry and Health Sciences, Charles Sturt University, Wagga Wagga, Australia; Australian School of Advanced Medicine, Macquarie University, Sydney, Australia
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Kingstone LL, Currie GM, Torres C. The Pathogenesis, Analysis, and Imaging Methods of Atherosclerotic Disease of the Carotid Artery: Review of the Literature. J Med Imaging Radiat Sci 2011; 43:84-94. [PMID: 31052031 DOI: 10.1016/j.jmir.2011.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2011] [Revised: 08/11/2011] [Accepted: 09/21/2011] [Indexed: 11/28/2022]
Abstract
Cerebrovascular (CVA) accidents are the second leading cause of death worldwide and their numbers are increasing. Strokes can arise from several causes, with extracranial carotid artery atherosclerosis (CAS) being one of the leading causes. CAS causes these strokes either by diminishing blood flow distal to the diseased stenotic segment of the artery or, as more recently discovered, by a thromboembolic event of material from the plaque site itself. The specific etiology of CAS is unknown, but causative factors in the formation of atherosclerotic plaque of the carotid arteries have been linked to specific morphological areas within the plaque that may be vulnerable to rupture, leading to thromboemboli into the cerebrovascular circulation. The current means for imaging and reporting CAS is through the measurement of the severity of luminal diameter stenosis caused by atherosclerotic disease. Recent developments in medical imaging techniques have expanded the role of early imaging and detection of CAS. Although current practice uses luminal narrowing as the surrogate marker to assess CAS, it has been recently discovered that plaque morphology and composition may help predict the clinical behavior of CAS and better determine the necessary medical intervention or risk of stroke. Although a single optimized imaging modality for standard CAS imaging has not been established or agreed on, various modalities can provide key elements to a successful exam. This review article will evaluate the most commonly used methods for CAS imaging along with the new and upcoming uses, advantages, and limitations for advanced CAS imaging.
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Affiliation(s)
- Lysa Legault Kingstone
- Department of Diagnostic Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada; School of Dentistry and Health Sciences, Charles Sturt University, Wagga Wagga, Australia
| | - Geoffrey M Currie
- School of Dentistry and Health Sciences, Charles Sturt University, Wagga Wagga, Australia; Australian School of Advanced Medicine, Macquarie University, Sydney, Australia
| | - Carlos Torres
- Department of Diagnostic Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada
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