Association of Airflow Limitation With Carotid Atherosclerosis in a Japanese Community - The Hisayama Study

Carotid Ultrasound Screening Programs in Rural Communities: A Systematic Review

Carotid atherosclerosis assessments inform about stroke and cardiovascular risk. It is known that stroke and cardiovascular disease (CVD) prevalence is higher in rural communities than in urban communities. We aimed to conduct a systematic review of rural carotid ultrasound screening programs to define carotid atherosclerosis using traditional and emerging imaging biomarkers, prevalence, and risk factors. We searched Ovid/MEDLINE, Ovid/EMBASE, SCOPUS and CINAHL from inception to 3 April 2020 for rural population studies that utilized carotid ultrasound screening for adults ≥40 years of age and free of known cerebrovascular disease. Studies were included if participants received a bilateral ultrasound scanning of the carotid arteries and reported at least one marker of carotid atherosclerosis pathology. A random effect meta-analyses calculated the estimated prevalence of carotid plaque. In total, 22/3461 articles that met all of the inclusion criteria were included. Studies reported increased intima media thickness (IMT), carotid plaque presence and carotid artery stenosis. There were no studies reporting on novel imaging markers, such as carotid stiffness, carotid plaque morphology or neovascularization. The overall random effect pooled prevalence of carotid plaque was 34.1% (95% CI, 33.6–35.0); the prevalence of increased IMT was 11.2–41.5%, and the prevalence of carotid artery stenosis was 0.4–16.0%. There is an absence of data necessary to understand the carotid atherosclerosis prevalence across global rural populations. Represented studies have focused on East Asian countries where a high burden of rural carotid artery disease has been reported. There is no rural evidence to guide the use of novel ultrasound carotid biomarkers such as stiffness or neovascularization.

Promoting analysis of real-world data: Prospects for preventive cardiology in Japan

According to the statistics for 2018 in Japan, cardiovascular disease and cerebrovascular disease were the most common causes of death (cardiovascular disease with 208,210, cerebrovascular disease with 108,165), and these two diseases account for 23.2% of all deaths. Stroke, especially cerebral hemorrhage, was the main cause of death in Japan after World War II. Along with improved management of hypertension, the mortality rate from cerebral hemorrhage reached a high of 266.7 per 100,000 men in 1960 and 213.9 per 100,000 women in 1951, then decreased to 15.9 per 100,000 men and 6.9 per 100,000 women in 2013. However, mortality from lifestyle-related diseases such as metabolic syndrome and ischemic heart disease has been on the rise since 1990 due to the westernization of diet, urban lifestyles, and lack of exercise habits. Moreover, since aging is the greatest risk factor for heart failure, the number of patients with heart failure in Japan will inevitably increase in the future. A large amount of evidence has demonstrated that prevention and proper management of risk factors can reduce the future incidence of cardiovascular disease. Specific health checkups (metabolic syndrome checkups) have been carried out in Japan since 2008. Big data on physical examinations are valuable real-world data that can be utilized for clinical research. As the importance of preventive cardiology increases in the future, we should analyze the real-world data from health checkups in Japan in detail and disseminate these results to clinical practice, which will contribute to development of preventive cardiology and the promotion of public health.

Association Between Airflow Limitation and Carotid Intima-Media Thickness in the Japanese Population

PURPOSE

This study aimed to reveal the association between airflow limitation (AL) and carotid intima-media thickness (IMT) according to smoking status in Japan.

SUBJECTS AND METHODS

This cross-sectional study was performed in 2809 subjects, who underwent a comprehensive health examination with pulmonary function tests and carotid ultrasonographic measurement. AL was defined as forced expiratory volume in 1 s/forced vital capacity of <0.7. The subjects were divided into the following four groups: never smokers without AL, never smokers with AL, former/current smokers without AL, and former/current smokers with AL. Mean IMT, the maximum measurable IMT value in the left and right common carotid arteries (IMT-C max), and mean IMT-C max were measured by carotid ultrasonography. The carotid wall thickness as defined as follows: IMT ≥ 1.1 mm (IMT1.1), IMT-C max ≥ 1.2 mm (IMTc1.2), and IMT-C max > 1.5 mm (IMTc1.5), based on each measured region. The association between AL and the carotid wall thickness according to smoking status was assessed by logistic regression analysis.

RESULTS

The mean carotid IMT and mean IMT-C max were significantly higher in never smokers with AL and former/current smokers with or without AL than in never smokers without AL. In logistic regression models adjusted for sex, age, body mass index, hypertension, dyslipidemia, hyperglycemia, physical activity, and alcohol consumption, the risk of carotid wall thickness (IMT1.1 [odds ratio {OR}: 1.55; 95% confidence interval {CI}: 1.07-2.24]; IMTc1.2 [OR: 1.52; 95% CI: 1.03-2.24]; IMTc1.5 [OR: 1.99; 95% CI: 1.15-3.46]) were significantly higher in former/current smokers with AL than in never smokers without AL.

CONCLUSION

The present results suggest that greater IMT and risk of carotid wall thickness were associated with AL and smoking experience.

High risk of subclinical atherosclerosis in COPD exacerbator phenotype

It is not known whether COPD exacerbations contribute to an increased vascular risk already associated with the disease. For this reason, we prospectively evaluated 127 patients referred for a monographic COPD consultation. We classify as exacerbators those who had experienced two or more moderate exacerbations in the previous year, or who had had a hospital admission. All underwent a blood analysis, respiratory function tests, global cardiovascular and coronary risk estimates (with four of the most frequently used scores, and the Chronic Obstructive Pulmonary Disease Coronaropathy Risk (COPDCoRi) score, respectively); and an EcoDoppler to measure carotid intima-media thickness and the ankle-brachial index. Finally, we included 50 patients with exacerbator phenotypes and 57 with non-exacerbator phenotypes, ranging from 63 ± 7 years old, 74% of whom were male. The exacerbator phenotype increased the risk of carotid intima-media thickness above the 75th percentile range by a factor of almost three, independently of the severity of COPD and global cardiovascular risk. The association between the exacerbator phenotype and high c-IMT was more evident in patients under 65. In conclusion, the presence of subclinical atherosclerosis is independently associated with the exacerbator phenotype, with more pronounced differences in younger patient; which suggests that we should intensify control of vascular risk factors in these groups of patients.