Associations of edge-detected and manual-traced common carotid artery intima-media thickness with incident peripheral artery disease: The Multi-Ethnic Study of Atherosclerosis

Relationships of Leg Ischemia Symptoms and Carotid Artery Atherosclerosis with Hypertensive-Disorders-of-Pregnancy-Associated Peptides in Patients with Lower Extremity Arterial Disease

Objectives: We have proposed seven peptides with low molecular weights in blood as biomarkers for the diagnosis of hypertensive disorders of pregnancy (HDP). The purpose of this cross-sectional study was to investigate the relationships of the HDP-associated peptides with symptoms of leg ischemia and degree of atherosclerosis in patients with lower extremity arterial disease (LEAD). Methods: The subjects were 165 outpatients with LEAD (145 men and 20 women aged 74.3 ± 8.1 years [47-93 years]). Their symptoms of leg ischemia, leg arterial flow, and degree of atherosclerosis were evaluated using the Rutherford classification of Clinical Ischemia Category, ankle-brachial index (ABI) and the intima-media thickness (IMT) of carotid arteries, respectively. Serum concentrations of the HDP-related peptides were measured by mass spectrometry. Results: The grade of the Rutherford classification was positively associated with levels of the peptides with m/z 2091 and 2378 and was inversely associated with levels of the peptide with m/z 2081. The category of the Rutherford classification was inversely associated with ABI. There were no HDP-associated peptides that showed significant relationships with IMT. Conclusions: The peptides with m/z 2081, 2091, and 2378 are possible biomarkers of leg ischemia but are not associated with carotid atherosclerosis in LEAD patients.

Evaluating Social Determinants of Health Variables in Advanced Analytic and Artificial Intelligence Models for Cardiovascular Disease Risk and Outcomes: A Targeted Review

Introduction/Purpose

Predictive models incorporating relevant clinical and social features can provide meaningful insights into complex interrelated mechanisms of cardiovascular disease (CVD) risk and progression and the influence of environmental exposures on adverse outcomes. The purpose of this targeted review (2018-2019) was to examine the extent to which present-day advanced analytics, artificial intelligence, and machine learning models include relevant variables to address potential biases that inform care, treatment, resource allocation, and management of patients with CVD.

Methods

PubMed literature was searched using the prespecified inclusion and exclusion criteria to identify and critically evaluate primary studies published in English that reported on predictive models for CVD, associated risks, progression, and outcomes in the general adult population in North America. Studies were then assessed for inclusion of relevant social variables in the model construction. Two independent reviewers screened articles for eligibility. Primary and secondary independent reviewers extracted information from each full-text article for analysis. Disagreements were resolved with a third reviewer and iterative screening rounds to establish consensus. Cohen's kappa was used to determine interrater reliability.

Results

The review yielded 533 unique records where 35 met the inclusion criteria. Studies used advanced statistical and machine learning methods to predict CVD risk (10, 29%), mortality (19, 54%), survival (7, 20%), complication (10, 29%), disease progression (6, 17%), functional outcomes (4, 11%), and disposition (2, 6%). Most studies incorporated age (34, 97%), sex (34, 97%), comorbid conditions (32, 91%), and behavioral risk factor (28, 80%) variables. Race or ethnicity (23, 66%) and social variables, such as education (3, 9%) were less frequently observed.

Conclusions

Predictive models should adjust for race and social predictor variables, where relevant, to improve model accuracy and to inform more equitable interventions and decision making.

Increased serum chemerin levels associated with carotid intima-media thickness

BACKGROUND

Elevated levels of chemerin can predict future ischemic cerebrovascular disease. Although chemerin is thought to play a role in atherosclerotic inflammation, whether circulating chemerin levels are associated with the severity of atherosclerosis remains to be determined.

OBJECTIVES

Through the use of carotid Doppler ultrasonography, our aim in this study was to investigate the relationships of serum chemerin levels with carotid intima-media thickness (CIMT) as an indicator of generalized atherosclerosis.

METHODS

This study compared 40 patients with ischemic stroke and 40 healthy subjects. Measurements were made at end-diastole using color Doppler ultrasonography (CDUS) after a 5-min rest interval in a quiet and dark room. CIMT was defined as the distance between the innermost edge of the luminal echo to the innermost edge of the media/adventitia echo. CIMT was measured in the posterior wall of both common carotid arteries within 1 cm proximally to the bulbus. Three measurements were made on both sides and the average measurement was taken as the CIMT. Serum chemerin levels were determined in all patients and healthy subjects.

RESULTS

Serum chemerin levels were significantly higher in the patient group than in the control group (p=0.004). Serum chemerin levels were positively correlated with CIMT (p<0.05). There was a significant difference between the groups with regard to CIMT (p<0.001).

CONCLUSION

Elevated serum chemerin levels appear to be associated with CIMT, thus suggesting that a link exists between chemerin and atherosclerotic ischemic cerebrovascular disease.

Subclinical atherosclerosis in the carotid artery: can the ankle-brachial index predict it in type 2 diabetes patients?

Atherosclerosis is a progressive asymmetrical systemic disease that progresses faster in patients with diabetes comorbidity. Therefore, type 2 diabetic (T2DM) patients who have a high risk of, or have already detected, early atherosclerosis should be treated aggressively to prevent premature mortality. We hypothesised that subclinical atherosclerosis is predictable with the ankle-brachial index (ABI). There are currently only a few studies to indicate which specific value of ABI can predict atherosclerosis in the carotid artery. Our study aimed to examine ABI ≤ 1.1 ability to predict ultrasound-visualised atherosclerosis in carotid arteries in patients with T2DM, who had not been previously diagnosed with atherosclerosis. A population-based cross-sectional multicentric study was performed in 216 participants (mean age 59 ± 8 years). Carotid artery intima-medial thickness (IMT) ≥1 mm ± plaque was defined as a marker for subclinical atherosclerosis and was compared with ABI. Mean duration of T2DM was 7.05 ± 6.0 years. Atherosclerosis in the carotid artery was found in 96 (44%) patients, with no significant differences between genders (47 vs 53%, p = .206). ABI ≤1.1 was associated with the carotid artery mean IMT ≥1 mm (p = .037), plaque (p = .027) and IMT ≥1 mm ± plaque (p = .037). The association between ABI ≤ 1.1 and IMT ≥ 1 mm ± plaque remained significant after adjustment for risk factors and age >50 years. Observations demonstrated that ABI ≤ 1.1 could be an indicator of subclinical atherosclerosis for T2DM male patients over 50 years old.

Traditional and non-traditional risk factors for peripheral artery disease development/progression in patients with type 2 diabetes: the Rio de Janeiro type 2 diabetes cohort study

BACKGROUND

The prognostic importance of non-traditional risk factors for peripheral artery disease (PAD) development/progression is scarcely studied in diabetes. We investigated if carotid intima-media thickness (CIMT) and carotid-femoral pulse wave velocity (cf-PWV) added prognostic information beyond traditional cardiovascular risk markers for PAD outcomes.

METHODS

Ankle-brachial index (ABI) was measured at baseline and after a median of 91 months of follow-up in 681 individuals with type 2 diabetes. Multivariate Cox regressions examined the associations between the candidate variables and the outcome. PAD development/progression was defined by a reduction in ABI ≥ 0.15 (to a level < 0.9) or limb revascularization procedures, lower-extremity amputations or death due to PAD. The improvement in risk discrimination was assessed by increases in C-statistics of the models.

RESULTS

Seventy-seven patients developed/progressed PAD: 50 reduced ABI to < 0.9, seven had lower-limb revascularizations, and 20 had amputations or death. Age, male sex, diabetes duration, presence of microvascular complications (peripheral neuropathy and diabetic kidney disease), baseline HbA_1c, 24-h systolic BP (SBP) and mean cumulative office SBP and LDL-cholesterol were associated with PAD development/progression in several models. CIMT and cf-PWV were additionally associated with PAD outcomes, and their inclusion further improved risk discrimination (with C-statistic increases between 0.025 and 0.030). The inclusion of ambulatory 24-h SBP, instead of office SBP, also improved PAD risk discrimination.

CONCLUSIONS

Increased CIMT and aortic stiffness are associated with greater risks of developing/progressing PAD, beyond traditional risk factors, in type 2 diabetes.