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Zou Y, Zhang X, Bu X, Zhang Z, Wu Y, Ren Y, Mu L. Analysis of carotid plaque risk factors in a population at high risk of stroke in Yubei District, Chongqing, China. J Stroke Cerebrovasc Dis 2023; 32:107224. [PMID: 37364400 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 06/11/2023] [Accepted: 06/13/2023] [Indexed: 06/28/2023] Open
Abstract
OBJECTIVE To establish a scientific foundation for focused stroke prevention and treatment efforts by comprehending the risk variables connected to carotid plaque formation in adults over 40 who are at high risk of stroke in Yubei District, Chongqing, China. METHODS By comparing the differences in carotid plaque formation between people of different ages, smoking, blood pressure levels, low-density lipoprotein levels, and glycosylated hemoglobin levels, questionnaires and physical exams were performed on a random sample of permanent residents aged 40 years in three communities in Yubei District, Chongqing, China. The goal was to investigate the risk factors associated with carotid plaque formation in the population. RESULTS The incidence of carotid plaque gradually increased in the study population as age, blood pressure, low-density lipoprotein, and glycosylated hemoglobin levels increased. The difference in carotid plaque formation between people of different ages, smoking, blood pressure levels, low-density lipoprotein levels, and glycosylated hemoglobin levels was statistically significant (p<0.05). The findings of the multifactorial logistic regression analysis revealed that there was a tendency for the risk of developing carotid plaque to rise with age; the risk of developing carotid plaque in hypertensive patients was (OR=1.41,95% CI: 1.03-1.93); the population of smokers was (OR=2.01,95%CI:1.33-3.05); the low-density lipoprotein cholesterol borderline increased group was (OR=1.94,95%CI:1.03-3.66); the low-density lipoprotein cholesterol elevated group was (OR=2.71,95%CI: 1.26-5.84); glycosylated hemoglobin elevated group was (OR=1.40,95%CI: 1.01-1.94) (p<0.05). CONCLUSION Age, smoking, blood pressure, low-density lipoprotein, and glycosylated hemoglobin are all associated with carotid plaque formation in those over 40 who are at high risk of stroke. As a result, health education for residents needs to be strengthened to raise knowledge of carotid plaque prevention.
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Affiliation(s)
- Yujia Zou
- Department of Epidemiology, School of Public Health, Chongqing Medical University, Chongqing 400016, China
| | - Xiaohui Zhang
- Department of Chronic Diseases, Yubei District Center for Disease Control and Prevention, Chongqing 401120, China
| | - Xiaoqing Bu
- Department of Epidemiology, School of Public Health, Chongqing Medical University, Chongqing 400016, China
| | - Ziyan Zhang
- Department of Epidemiology, School of Public Health, Chongqing Medical University, Chongqing 400016, China
| | - Yi Wu
- Department of Epidemiology, School of Public Health, Chongqing Medical University, Chongqing 400016, China
| | - Yanni Ren
- Department of Epidemiology, School of Public Health, Chongqing Medical University, Chongqing 400016, China
| | - Lihong Mu
- Department of Epidemiology, School of Public Health, Chongqing Medical University, Chongqing 400016, China.
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Liu J, Ye M, Wang Y. Association between Triglyceride-Glucose Index and carotid plaque in Japanese population: a cross-sectional study. BMJ Open 2023; 13:e069663. [PMID: 37355272 PMCID: PMC10314459 DOI: 10.1136/bmjopen-2022-069663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 06/12/2023] [Indexed: 06/26/2023] Open
Abstract
OBJECTIVE Previous studies linking Triglyceride Glucose (TyG) Index to carotid plaque have yielded inconsistent results. Moreover, related studies on the population of Japan are rare. This study aims to provide further results. DESIGN A hospital-based cross-sectional study. SETTING The Shin Takeo Hospital. PARTICIPANTS We assessed 1904 Japanese participants (988 men and 916 women) whose mean age was 57±11.9 years, and those participants underwent health check-ups at Shinbuf Hospital at Shin Takeo Hospital from 1 April 2016 to 31 October 2017. METHODOLOGY Carotid plaque, triglyceride and fasting glucose and other relevant indicators were collected. We used ultrasonography to evaluate carotid plaque. A multivariable logistic regression model and generalised additive model were used to evaluate the association between the TyG Index and carotid plaque. Subgroup and interaction analyses were validated for the consistency of these correlations. RESULTS Following the adjustment of traditional carotid plaque risk factors, the non-linear relationship between the TyG Index and carotid plaque was investigated. Using a two-piecewise regression model, we calculated the inflection point to be 9.06. The OR and 95% CIs for the inflection points on the left and right sides were 1.70 (1.27 to 2.29) and 0.88 (0.52 to 1.47), respectively. According to the variables tested, the interactions between the TyG Index and all subgroup factors were analysed and significant interactions were not observed. CONCLUSION In individuals who underwent a comprehensive check-up in Japan, the relationship between the TyG Index and carotid plaque is non-linear. When the TyG Index is less than 9.06, it is associated with carotid plaque.
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Affiliation(s)
- Jiuling Liu
- Department of Neurology, Nanjing BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Min Ye
- Department of Neurology, Nanjing BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yuanwei Wang
- Department of Neurology, The Affiliated Shuyang Hospital of Xuzhou Medical University, Shuyang, Jiangsu, China
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Nath M, Misra S, Nair P, Kumar P. Carotid intima-media thickness and risk of mild cognitive impairment: A systematic review and meta-analysis. Acta Neurol Scand 2022; 145:139-150. [PMID: 34672362 DOI: 10.1111/ane.13542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/05/2021] [Accepted: 10/07/2021] [Indexed: 01/10/2023]
Abstract
Mild cognitive impairment (MCI) is an early phase of cognitive decline signalling the beginning of severe neurological diseases. Carotid intima-media thickness (cIMT) has shown some correlation with MCI development. This study was conducted to investigate the impact of elevated cIMT on the risk of MCI in adults. A literature search was conducted in PubMed, EMBASE, Cochrane Library, Scopus, Google Scholar and CINAHL databases till 30 July 2021, with keywords: ('Carotid Intima-Media Thickness' OR 'cIMT' OR 'IMT' AND 'Cognitive Impairment' OR 'Cognition' OR 'Cognitive Decline' AND 'Mild Cognitive Impairment' OR 'MCI'). Pooled standardized mean difference (SMD)/odds ratio (OR) and 95% confidence interval (CI) were determined for factor-disease association using either fixed (when I2 <50%) or random effect (when I2 >50%) models. Eight studies involving 1,585 MCI cases and 6,700 normal subjects were included in our meta-analysis which showed no significant association of increased cIMT with the risk of MCI [SMD 1.17, 95% CI -0.09 to 2.42]. However, sensitivity analysis revealed an outlier study significantly affecting the effect size. On omitting the outlier study, the re-evaluated meta-analysis revealed a significant association of cIMT with the risk of MCI [SMD 0.52, 95% CI 0.26 to 0.78]. This significant association was also observed during subgroup analysis in Caucasian population [SMD 0.65, 95% CI 0.13 to 1.18] but not in Asian population [SMD 0.39, 95% CI -0.01 to 0.79]. Elevated cIMT poses a potential risk for MCI. However, more population-based studies are required to corroborate these findings.
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Affiliation(s)
- Manabesh Nath
- Department of Neurology All India Institute of Medical Sciences New Delhi India
| | - Shubham Misra
- Department of Neurology All India Institute of Medical Sciences New Delhi India
| | - Pallavi Nair
- Department of Neurology All India Institute of Medical Sciences New Delhi India
| | - Pradeep Kumar
- Department of Neurology All India Institute of Medical Sciences New Delhi India
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Leonetti S, Tricò D, Nesti L, Baldi S, Kozakova M, Goncalves I, Nilsson J, Shore A, Khan F, Natali A. Soluble CD40 receptor is a biomarker of the burden of carotid artery atherosclerosis in subjects at high cardiovascular risk. Atherosclerosis 2022; 343:1-9. [DOI: 10.1016/j.atherosclerosis.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 11/25/2021] [Accepted: 01/13/2022] [Indexed: 11/02/2022]
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Guo XJ, Wu M, Pei SF, Xie P, Wu MY. Influence of Carotid Intima-Media Thickness Levels at Bifurcation on Short-Term Functional Outcomes Among Non-Cardiogenic Ischemic Stroke Patients with and without Type 2 Diabetes Mellitus. Diabetes Metab Syndr Obes 2022; 15:897-906. [PMID: 35356702 PMCID: PMC8958197 DOI: 10.2147/dmso.s351679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/10/2022] [Indexed: 04/13/2023] Open
Abstract
PURPOSE The intima-media thickness (IMT) is broadly reported to have relationships with non-cardiogenic ischemic stroke and with diabetes. But how does IMT affect the short-term prognosis of stroke seems unknown yet. We investigated the influence of the intima-media thickness at carotid bifurcation (IMTbif) on short-term functional outcomes among non-cardiogenic ischemic stroke patients with and without type 2 diabetes mellitus (T2DM). PATIENTS AND METHODS A total of 314 patients with non-cardiogenic ischemic stroke (122 with T2DM and 192 without diabetes) were included in this retrospective study. Poor functional outcome was defined as a modified Rankin Scale (mRS) > 2 at 3 months after stroke onset. Group comparisons were done in favorable and poor outcome groups. Linear regression analysis was utilized to verify the associations between IMTbif and mRS in subgroups with and without diabetes, respectively. RESULTS The median IMTbif of total patients was 1.40mm. Patients with poor outcomes were significantly older, had higher National Institutes of Health Stroke Scale (NIHSS) scores, lower haemoglobin, higher fasting glucose and higher systolic blood pressure values. Their IMTbif levels were also markedly higher. Among 122 included stroke patients with T2DM, IMTbif levels and NIHSS were independently associated with functional outcomes at 3 months, whereas there was no significant association between IMTbif levels and short-term functional outcomes among patients without diabetes. CONCLUSION The IMTbif levels were significantly associated with 3-month functional outcomes in non-cardiogenic ischemic stroke patients with T2DM. The ultrasound detection of the IMTbif therefore suggests a prognostic value among patients with stroke and T2DM.
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Affiliation(s)
- Xiao-Jing Guo
- Department of Neurology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, People’s Republic of China
| | - Mian Wu
- Department of Endocrinology and Metabolism, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, People’s Republic of China
| | - Shao-Fang Pei
- Department of Neurology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, People’s Republic of China
| | - Ping Xie
- Department of Ultrasonography, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, People’s Republic of China
| | - Min-Ya Wu
- Department of Neurology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, People’s Republic of China
- Correspondence: Min-Ya Wu, Department of Neurology, The Affiliated Suzhou Hospital of Nanjing Medical University, 242 Guangji Road, Suzhou, Jiangsu, People’s Republic of China, Tel +86 15151429862, Email
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Kabłak-Ziembicka A, Przewłocki T. Clinical Significance of Carotid Intima-Media Complex and Carotid Plaque Assessment by Ultrasound for the Prediction of Adverse Cardiovascular Events in Primary and Secondary Care Patients. J Clin Med 2021; 10:4628. [PMID: 34682751 PMCID: PMC8538659 DOI: 10.3390/jcm10204628] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/03/2021] [Accepted: 10/05/2021] [Indexed: 12/15/2022] Open
Abstract
Recently published recommendations from the American Society of Echocardiography on 'Carotid Arterial Plaque Assessment by Ultrasound for the Characterization of Atherosclerosis and Evaluation of Cardiovascular Risk' provoked discussion once more on the potential clinical applications of carotid intima-media complex thickness (CIMT) and carotid plaque assessment in the context of cardiovascular risk in both primary and secondary care patients. This review paper addresses key issues and milestones regarding indications, assessment, technical aspects, recommendations, and interpretations of CIMT and carotid plaque findings. We discuss lacks of evidence, limitations, and possible future directions.
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Affiliation(s)
- Anna Kabłak-Ziembicka
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 31-202 Krakow, Poland
- Noninvasive Cardiovascular Laboratory, John Paul II Hospital, Prądnicka 80, 31-202 Krakow, Poland
| | - Tadeusz Przewłocki
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, 31-202 Krakow, Poland;
- Department of Interventional Cardiology, John Paul II Hospital, Prądnicka 80, 31-202 Krakow, Poland
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Tjan A, Widiana IGR, Martadiani ED, Ayusta IMD, Asih MW, Sitanggang FP. Carotid artery stiffness measured by strain elastography ultrasound is a stroke risk factor. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021. [DOI: 10.1016/j.cegh.2021.100850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Cholesterol Efflux Capacity Associates with the Ankle-Brachial Index but Not All-Cause Mortality in Patients with Peripheral Artery Disease. Diagnostics (Basel) 2021; 11:diagnostics11081407. [PMID: 34441341 PMCID: PMC8394478 DOI: 10.3390/diagnostics11081407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/30/2021] [Accepted: 07/30/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Cholesterol efflux is an important mechanism by which high-density lipoproteins (HDLs) protect against cardiovascular disease. As peripheral artery disease (PAD) is associated with high mortality rates, mainly due to cardiovascular causes, we investigated whether cholesterol efflux capacity (CEC) of apolipoprotein B (apoB)-depleted plasma, a widely used surrogate of HDL function, may serve as a predictive marker for mortality in this patient population. Methods: In this prospective single-center study (median follow-up time: 9.3 years), apoB-containing lipoproteins were precipitated from plasma of 95 patients with PAD and incubated with J744-macrophages, which were loaded with radiolabeled cholesterol. CEC was defined as the fractional radiolabel released during 4 h of incubation. Results: Baseline CEC was lower in PAD patients that currently smoked (p = 0.015) and had a history of myocardial infarction (p = 0.011). Moreover, CEC showed a significant correlation with HDL-cholesterol (p = 0.003) and apolipoprotein A-I levels (p = 0.001) as well as the ankle-brachial index (ABI, p = 0.018). However, CEC did not differ between survivors and non-survivors. Neither revealed Kaplan–Meier and Cox regression analyses any significant association of CEC with all-cause mortality rates. Conclusion: Taken together, CEC is associated with ABI but does not predict all-cause mortality in patients with PAD.
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Tan Q, Qin C, Yang J, Wang T, Lin H, Lin C, Chen X. Inner diameters of the normal carotid arteries measured using three-dimensional digital subtraction catheter angiography: a retrospective analysis. BMC Neurol 2021; 21:292. [PMID: 34311729 PMCID: PMC8311942 DOI: 10.1186/s12883-021-02328-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 07/13/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose To obtain normal ranges for the inner diameters of the carotid arteries. Methods This retrospective analysis included consecutive patients with disease-free carotid arteries who had undergone 3D-DSA at two hospitals in Nanning, Guangxi, between March 2013 and March 2018. Demographic and clinical characteristics, including Essen Stroke Risk Score (ESRS), were extracted from the medical records. The 3D-DSA data were used to calculate the inner diameters of the carotid arteries. Results The analysis included 1182 patients (837 males) aged 58.81 ± 11.02 years. The inner diameters of the proximal carotid sinus (CS), CS bulge, distal CS, and common carotid artery (CCA) were larger on the right than on the left (P < 0.05). The inner diameters of the proximal CS, CS bulge, distal CS, and CCA on both sides were larger for males than females (P < 0.05). The inner diameters of the proximal CS, CS bulge, and distal CS on both sides were smaller for patients aged > 65 years than for patients aged ≤ 55 years (P < 0.05). Right CCA inner diameter did not vary with age, whereas left CCA inner diameter was larger for patients aged > 55 years than for patients aged ≤ 45 years (P < 0.05). The inner diameters of the proximal CS, CS bulge, and distal CS on both sides were smaller for patients with ESRS ≥ 3 than those with ESRS < 3 (P < 0.05). Conclusion This study provides reference values for the internal diameters of normal carotid arteries. Carotid artery diameters varied with side, sex, and age. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02328-z.
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Affiliation(s)
- Qingjing Tan
- Department of Neurology, First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, Guangxi, China
| | - Chao Qin
- Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
| | - Junwei Yang
- Department of Neurology, First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, Guangxi, China
| | - Tianbao Wang
- Department of Neurology, First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, Guangxi, China
| | - Haohai Lin
- Department of Neurology, First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, Guangxi, China
| | - Cuiting Lin
- Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Xiangren Chen
- Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
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Potential Role of Melatonin as an Adjuvant for Atherosclerotic Carotid Arterial Stenosis. Molecules 2021; 26:molecules26040811. [PMID: 33557283 PMCID: PMC7914857 DOI: 10.3390/molecules26040811] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/27/2021] [Accepted: 02/02/2021] [Indexed: 12/23/2022] Open
Abstract
Carotid artery stenosis (CAS) is an atherosclerotic disease characterized by a narrowing of the artery lumen and a high risk of ischemic stroke. Risk factors of atherosclerosis, including smoking, hypertension, hyperglycemia, hyperlipidemia, aging, and disrupted circadian rhythm, may potentiate atherosclerosis in the carotid artery and further reduce the arterial lumen. Ischemic stroke due to severe CAS and cerebral ischemic/reperfusion (I/R) injury after the revascularization of CAS also adversely affect clinical outcomes. Melatonin is a pluripotent agent with potent anti-inflammatory, anti-oxidative, and neuroprotective properties. Although there is a shortage of direct clinical evidence demonstrating the benefits of melatonin in CAS patients, previous studies have shown that melatonin may be beneficial for patients with CAS in terms of reducing endothelial damage, stabilizing arterial plaque, mitigating the harm from CAS-related ischemic stroke and cerebral I/R injury, and alleviating the adverse effects of the related risk factors. Additional pre-clinical and clinical are required to confirm this speculation.
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Kumar P, Sharma R, Misra S, Kumar A, Nath M, Nair P, Vibha D, Srivastava AK, Prasad K. CIMT as a risk factor for stroke subtype: A systematic review. Eur J Clin Invest 2020; 50:e13348. [PMID: 32671819 DOI: 10.1111/eci.13348] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 12/30/2022]
Abstract
INTRODUCTION An increase in the common carotid artery intima-media thickness (CCA-IMT) is generally considered an early marker of atherosclerosis and is a well-established predictor of cardiovascular disease (CVD). An association between changes in CCA-IMT and risk of stroke has been reported but has conflicting findings. OBJECTIVE The present meta-analysis was aimed to clarify the association between CCA-IMT with the risk of stroke and its subtype by estimating pooled analysis of published literature. METHODS Comprehensive search for all published articles was performed in electronic databases including PubMed, Embase, Cochrane Library, Trip Databases, Worldwide Science, CINAHL and Google Scholar from 01 January 1950 to 30 April 2020. RESULTS In our meta-analysis, a total of 19 studies, of which sixteen studies involving 3475 ischaemic stroke (IS) cases and 11 826 controls; six studies with 902 large vessel disease (LVD) and 548 small vessel disease (SVD) of IS subtypes; five studies with 228 intracerebral haemorrhage (ICH) and 1032 IS cases, were included. Our findings suggest a strong association between increased CCA-IMT with risk of IS as compared to control subjects [SMD = 1.46, 95% CI = 0.90-2.02]. However, there is an increased risk of LVD as compared to the SVD subtype of IS [SMD = 0.36, 95% CI = 0.19-0.52] and more chance of occurrence of IS rather than ICH [SMD = 0.71, 95% CI = 0.28-1.41]. CONCLUSIONS Carotid intima thickness measurements are found to be associated with the risk of stroke along with its subtypes and may be used as a diagnostic marker for predicting the risk of stroke events.
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Affiliation(s)
- Pradeep Kumar
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Rakhee Sharma
- Department of Pediatrics, Army Hospital Research and Referral, New Delhi, India
| | - Shubham Misra
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Amit Kumar
- Department of Pediatrics, Army Hospital Research and Referral, New Delhi, India
| | - Manabesh Nath
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Pallavi Nair
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Deepti Vibha
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Kameshwar Prasad
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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The relationship between famine exposure during early life and carotid plaque in adulthood. Eur J Clin Nutr 2020; 75:546-554. [PMID: 32939040 DOI: 10.1038/s41430-020-00756-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 08/24/2020] [Accepted: 09/05/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND Famine exposure is a potential risk factor for adverse cardiometabolic health. However, the relationship between famine exposure during early life and carotid plaque in adulthood remains unclear. Therefore, the aim was to investigate the relationship between famine exposure during early life and the risks for carotid plaque in adulthood. METHODS This was a cross-sectional study. Data were collected between 2017 and 2018 in Guangdong, China. Subjects who were born between 1 October 1952 and 30 September 1964, and had the carotid ultrasound measurement were enrolled. All included participants were divided into five groups: no exposure, fetal exposure, early-childhood exposure, mid-childhood exposure, and late-childhood exposure. Carotid plaque was assessed by carotid ultrasound examination. Multivariate logistic regression was used to estimate the odds ratio (OR) and confidence interval (CI) between famine exposure and carotid plaque. RESULTS There were 2652 subjects enrolled, 973 (36.7%) of them were males, and the mean age was 59.1 ± 3.6 years. The prevalence of carotid plaque in unexposed, fetal-exposed, early-childhood, mid-childhood, and late-childhood exposed groups were 40.2%, 40.8%, 55.3%, 56.8%, and 62.1%, respectively. When compared with the unexposed group, the fully adjusted ORs for carotid plaque from fetal-exposed, early-childhood, mid-childhood to late-childhood exposed were 1.023 (95% CI: 0.771, 1.357, P = 0.872), 1.755 (95% CI: 1.356, 2.275, P < 0.001), 1.780 (95% CI: 1.391, 2.280, P < 0.001), and 2.119 (95% CI: 1.643, 2.739, P < 0.001), respectively. Subgroup analyses showed that the famine effect on carotid plaque did not interact with body mass index, gender, smoking status, hypertension, and diabetes history (all P for interaction > 0.500). CONCLUSIONS Famine exposure during early life was significantly associated with an increased risk of carotid plaque in adulthood.
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Kolkenbeck-Ruh A, Woodiwiss AJ, Monareng T, Sadiq E, Mabena P, Robinson C, Motau TH, Stevens B, Manyatsi N, Tiedt S, Dembskey R, Abdool-Carrim T, Veller M, Cassimjee I, Modi G, Hale M, Norton GR. Complementary Impact of Carotid Intima-Media Thickness With Plaque in Associations With Noncardiac Arterial Vascular Events. Angiology 2019; 71:122-130. [PMID: 31303025 DOI: 10.1177/0003319719862681] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The ability of carotid intima-media thickness (IMT) to predict risk beyond plaque is controversial. In 952 participants (critical limb ischemia [CLI] or stroke, n = 473; community, n = 479), we assessed whether relationships with events for IMT complement the impact of plaque in young patients depending on the extent of thrombotic versus atherosclerotic disease. The extent of atherosclerotic versus thrombotic occlusion was determined in 54 patients with CLI requiring amputations. Thrombotic occlusion in CLI was associated with younger age (P < .0001) and less plaque (P = .02). Independent relations between plaque and CLI were noted in older (>50 years; P < .005 to <.0001) but not younger (P > .38) participants, while independent relations between plaque and stroke (P < .005 to <.0001) and between IMT and CLI (P < .0001) were noted in younger participants. Although in performance (area under the receiver operating curve) for event detection, IMT thresholds failed to add to plaque alone in older patients (0.680 ± 0.020 vs 0.664 ± 0.017, P = .27), IMT improved performance for combined stroke and CLI detection when added to plaque in younger patients (0.719 ± 0.023 vs 0.631 ± 0.026, P < .0001). Because in younger participants the high prevalence of thrombotic occlusion in CLI is associated with less plaque, IMT adds information in associations with arterial vascular events.
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Affiliation(s)
- Andrea Kolkenbeck-Ruh
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Angela J Woodiwiss
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Talib Monareng
- School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Eitzaz Sadiq
- School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Philanathi Mabena
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Chanel Robinson
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tshegofatso H Motau
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Belinda Stevens
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nomvuyo Manyatsi
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Scott Tiedt
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Reinhard Dembskey
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Talib Abdool-Carrim
- School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Martin Veller
- School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ismail Cassimjee
- School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Girish Modi
- School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Martin Hale
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gavin R Norton
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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14
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Katakami N, Matsuoka T, Shimomura I. Clinical utility of carotid ultrasonography: Application for the management of patients with diabetes. J Diabetes Investig 2019; 10:883-898. [PMID: 30884192 PMCID: PMC6626964 DOI: 10.1111/jdi.13042] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 03/12/2019] [Accepted: 03/13/2019] [Indexed: 02/06/2023] Open
Abstract
Carotid ultrasonography is a non-invasive, simple and inexpensive modality to assess the severity of atherosclerosis. This article reviews related articles, summarizes the rationale for the application of carotid ultrasonography in clinical practice, and addresses the features and the limitations of carotid ultrasonography in cardiovascular risk prediction. Numerous large studies have confirmed that various carotid ultrasound measures, such as carotid intima-media thickness, the presence or absence of carotid plaque, plaque number and plaque area, can be independent predictors of cardiovascular diseases in individuals with and without diabetes mellitus. Furthermore, many studies showed that the use of carotid intima-media thickness (especially maximum intima-media thickness, including plaque thickness) and/or carotid plaque in addition to traditional risk factors significantly improved the prediction of the occurrence of cardiovascular diseases, while controversy remains. Several studies showed that the progression of carotid intima-media thickness also can be a surrogate end-point of cardiovascular events. However, the accumulated evidence has not been sufficient. Further study with sufficient power should be carried out. As plaque disruption, which plays a crucial role in the pathogenesis of cardiovascular events, is dependent on the content of lipid in the atheroma and the thickness of the fibrous cap, tissue characterization of a plaque might be useful for determining its fragility. Interestingly, recent studies have shown that ultrasonic tissue characterization of carotid lesions could improve the prediction ability of future cardiovascular diseases. Thus, carotid ultrasonography is a useful modality for better clinical practice of atherosclerosis in patients with diabetes.
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Affiliation(s)
- Naoto Katakami
- Department of Metabolic MedicineOsaka University Graduate School of MedicineSuitaJapan
- Department of Metabolism and AtherosclerosisOsaka University Graduate School of MedicineSuitaJapan
| | - Taka‐aki Matsuoka
- Department of Metabolic MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Iichiro Shimomura
- Department of Metabolic MedicineOsaka University Graduate School of MedicineSuitaJapan
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15
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Clemens RK, Annema W, Baumann F, Roth-Zetzsche S, Seifert B, von Eckardstein A, Amann-Vesti BR. Cardiac biomarkers but not measures of vascular atherosclerosis predict mortality in patients with peripheral artery disease. Clin Chim Acta 2019; 495:215-220. [PMID: 30981846 DOI: 10.1016/j.cca.2019.04.061] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 04/03/2019] [Accepted: 04/10/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Peripheral artery disease (PAD) becomes more prevalent with advancing age and is associated with elevated risk of cardiovascular events and shortened life expectancy. We investigated the prognostic performance of cardiac and vascular biomarkers in a cohort of PAD patients. METHODS A total of 95 PAD patients were enrolled (mean age 68 years, range 47 to 86 years, 73 males). Carotid intima-media thickness (cIMT), ankle brachial index (ABI), high sensitive cardiac troponin T, and N-terminal pro-B-type Natriuretic Peptide (NT-proBNP) were measured. RESULTS During a median follow-up time of 9.5 years, 44 patients died and 51 patients survived. Upon Kaplan-Meier survival analysis hs-TnT (P < .001) or NT-proBNP levels (P < .001) above the median but not cIMT above the median (P = .488) or ABI below the median (P < .436)were associated with reduced survival rate. Upon univariate cox regression and after adjustment for age, gender, prior cerebral artery disease, and diabetes mellitus only the association between hs-cTnT and mortality remained significant (HR 1.93, 95% CI 1.33-2.79, P < .001). In receiver operating curve analysis hs-cTnT (area under the curve [AUC]: 0.77, 95% CI: 0.67-0.87, P < .001) NT-proBNP (AUC: 0.74, 95% CI: 0.64-0.84, P < .001) as well as hs-cTnT, and NT-proBNP combined (AUC: 0.79, 95% CI: 0.69-0.88, P < .001) were superior to cIMT (AUC: 0.64, 95%, CI: 0.53-0.76, P = .022) and ABI (AUC: 0.57, 95% CI: 0.44-0.68, P = .313) in discriminating risk for mortality. CONCLUSION hs-cTnT and NT-proBNP should be taken into account for prognosis of patients with PAD.
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Affiliation(s)
- Robert K Clemens
- Clinic for Angiology, University Hospital Zurich, Zurich, Switzerland.
| | - Wijtske Annema
- Institute of Clinical Chemistry, University Hospital Zurich, Zurich, Switzerland
| | - Frederic Baumann
- Clinic for Angiology, University Hospital Zurich, Zurich, Switzerland
| | | | - Burkhardt Seifert
- Department of Biostatistics and Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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16
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Magalhães JE, Barros IMLD, Pedrosa RP, Sampaio Rocha-Filho PA. Migraine and Markers of Carotid Atherosclerosis in Middle-Aged Women: A Cross-Sectional Study. Headache 2018; 59:77-85. [PMID: 30516278 DOI: 10.1111/head.13460] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE This study evaluated the association between migraine and the markers of carotid artery disease. BACKGROUND Migraine increases the risk of cardiovascular events, but its relationship with vascular dysfunction is unclear. METHODS In this cross-sectional study, middle-aged women with no known cardiovascular diseases underwent clinical, neurological, and laboratory evaluations; pulse wave velocity (PWV) assessment; and carotid artery ultrasonography. We divided the participants based on the presence of migraine and, further, based on the type of migraine. Associations between migraine and carotid thickening (intima-media thickness >0.9 mm), carotid plaques, or arterial stiffening (PWV >10 m/s) were evaluated using a multiple regression analysis. RESULTS The study comprised 112/277 (40%) women with migraine, of whom 46/277 (17%) reported having an aura. Compared to the non-migraineurs, the migraine with aura group had an increased risk of diffuse carotid thickening (3/46 [6.8%] vs 2/165 [1.3%], adjusted OR = 7.12, 95% CI 1.05-48.49). Migraine without aura was associated with a low risk of carotid plaques (3/66 [4.7%] vs 26/165 [16.7%], adjusted OR = 0.28, 95% CI 0.08-0.99) and arterial stiffening (21/66 [34.4%] vs 82/165 [51.2%], adjusted OR = 0.39, 95% CI 0.19-0.79). There were no correlations between migraine characteristics and arterial stiffness or carotid thickness measurements. CONCLUSION Migraine with aura is associated with an increased risk of carotid thickening, and migraine without aura is associated with a low risk of carotid plaques and arterial stiffening.
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Affiliation(s)
- João Eudes Magalhães
- Division of Neurology, Hospital Universitário Oswaldo Cruz of the Universidade de Pernambuco, Recife, Brazil.,Postgraduate program in Neuropsychiatry and Behavioral Sciences of the Universidade Federal de Pernambuco, Recife, Brazil
| | | | - Rodrigo Pinto Pedrosa
- Sleep and Heart Laboratory, Pronto Socorro Cardiológico de Pernambuco of the Universidade de Pernambuco, Recife, Brazil
| | - Pedro Augusto Sampaio Rocha-Filho
- Division of Neurology, Hospital Universitário Oswaldo Cruz of the Universidade de Pernambuco, Recife, Brazil.,Department of Neuropsychiatry of the Universidade Federal de Pernambuco, Recife, Brazil.,Postgraduate program in Neuropsychiatry and Behavioral Sciences of the Universidade Federal de Pernambuco, Recife, Brazil
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