Genotype-specific association between circulating soluble cellular adhesion molecules and carotid intima-media thickness in community residents: J-SHIPP study. Shimanami Health Promoting Program

sVCAM-1 concentration and carotid IMT values in patients with acute myocardial infarction--Atherosclerotic markers of the presence, progress and prognosis

PURPOSE

Vascular cell adhesion molecule 1 (VCAM-1) plays a role in the adhesion and migration of leukocytes from blood to arterial intima and correlate with the development of atherosclerosis. The aim of the study was to establish whether soluble VCAM-1 (sVCAM-1) may act as an independent risk factor of coronary artery disease occurrence and whether it may reflect a degree of its advancement, if sVCAM-1 has a potential relation with intima-media thickness measurement (IMT), if sVCAM-1 may be useful as a predictor of further cardiovascular events.

MATERIAL AND METHODS

The study group was composed of 78 patients who were consecutively hospitalized in 2010-2011 due to myocardial infarction (MI). Selected clinical and biochemical risk factors were assessed, sVCAM-1 concentrations and IMT were measured.

RESULTS

Concentrations of sVCAM-1 were significantly higher in the study group as compared to the healthy controls. No significant dependence between sVCAM-1 concentration and the value of IMT in carotid arteries was found. There were no significantly statistical differences between the advancement of coronary artery changes and sVCAM-1 concentration. During the follow-up that lasted from 2 to 4 years (average period - 2.8 years), 4 patients died in the study group (5.1%). sVCAM-1 concentrations (but not IMT values) were significantly statistically higher in the group of patients who died (2248.5±443.5 vs. 990.2±433.6, p=0.0003).

CONCLUSIONS

sVCAM-1 concentrations are useful indicators of the presence of atherosclerosis in coronary arteries, but not its advancement. sVCAM-1 (but not IMT) can be a predictive indicator of an increased risk of death during follow-up in patients after myocardial infarction.

Quantitative trait locus analysis of circulating adhesion molecules in hyperlipidemic apolipoprotein E-deficient mice

Circulating soluble adhesion molecules have been suggested as useful markers to predict several clinical conditions such as atherosclerosis, type 2 diabetes, obesity, and hypertension. To determine genetic factors influencing plasma levels of soluble vascular cell adhesion molecule-1 (VCAM-1) and P-selectin, quantitative trait locus (QTL) analysis was performed on an intercross between C57BL/6J (B6) and C3H/HeJ (C3H) mouse strains deficient in apolipoprotein E-deficient (apoE-/-). Female F2 mice were fed a western diet for 12 weeks. One significant QTL, named sVcam1 (71 cM, LOD 3.9), on chromosome 9 and three suggestive QTLs on chromosomes 5, 13 and 15 were identified to affect soluble VCAM-1 levels. Soluble P-selectin levels were controlled by one significant QTL, named sSelp1 (8.5 cM, LOD 3.4), on chromosome 16 and two suggestive QTLs on chromosomes 10 and 13. Both adhesion molecules showed significant or an apparent trend of correlations with body weight, total cholesterol, and LDL/VLDL cholesterol levels in the F2 population. These results indicate that plasma VCAM-1 and P-selectin levels are complex traits regulated by multiple genes, and this regulation is conferred, at least partially, by acting on body weight and lipid metabolism in hyperlipidemic apoE-/- mice.

John JA, Xiang M, Cushman M, Lobo RA, Mack WJ. Inflammatory markers and progression of subclinical atherosclerosis in healthy postmenopausal women (from the Estrogen in the Prevention of Atherosclerosis Trial)

The objective of this study was to determine whether high-sensitivity C-reactive protein (hs-CRP) and serum soluble intercellular adhesion molecule-1 (sICAM-1) correlate with progression of subclinical atherosclerosis. Secondarily, the long-term effect of oral estradiol on hs-CRP and sICAM-1 were determined. Data were analyzed from 180 healthy postmenopausal women aged 45 to 80 years randomly assigned to either unopposed micronized 17beta-estradiol 1 mg/day or placebo in the Estrogen in the Prevention of Atherosclerosis Trial (EPAT). Carotid artery intima-media thickness (CIMT), hs-CRP, and sICAM-1 were measured at baseline and every 6 months thereafter for 2 years. Unopposed 17beta-estradiol significantly increased hs-CRP (p = 0.01) and decreased sICAM-1 compared with placebo (p = 0.04). Changes in hs-CRP and sICAM-1 did not correlate with changes in carotid artery intima-media thickness. In conclusion, although unopposed 17beta-estradiol significantly altered hs-CRP and sICAM-1, neither marker was associated with progression of subclinical atherosclerosis.

No association between INSIG2 Gene rs7566605 polymorphism and being overweight in Japanese population

Obesity is a complex trait reflecting numerous genetic and environmental factors. Recently, a common genetic polymorphism (rs7566605) associated with a higher BMI was found in proximity to the insulin induced protein 2 (INSIG2 ) gene, with replication in four unrelated populations living in Western countries. We investigated the susceptibility to the polymorphism amongst the general Japanese population (n = 1976). The frequency of appearance of the single-nucleotide polymorphism (SNP) in the Japanese (G allele; 0.652, C allele; 0.348) was not different from that found in subjects of European origin as reported previously. However, the BMI levels in each of these genotypes did not differ significantly (GG; 23 +/- 3, GC; 24 +/- 3, CC; 24 +/- 3 kg/m(2), P = 0.906). In a separate analysis according to sex (male; P = 0.462, female; P = 0.879), age decade (40s; P = 0.057, 50s; P = 0.998, 60s; P = 0.622, 70s; 0.425, respectively), and tertiles of the BMI (1st; P = 0.409, 2nd; P = 0.088, 3rd; P = 0.780), the differences did not achieve statistical significance. The frequency of obesity did not differ among the genotypes (25 kg/m(2); 30.3, 30.8, 28.2%, P = 0.729, 30 kg/m(2); 2.9, 3.8, 2.8%, P = 0.549). No associations were also observed for related plasma markers; high-molecular weight (HMW) adiponectin (P = 0.510), high-sensitive C-reactive protein (P = 0.788), resistin (P = 0.937) and homeostasis of minimal assessment of insulin resistance (P = 0.634). These results indicate a lack of association between SNP rs7566605 and being overweight among the Japanese (in the middle-aged and elderly population).

High-density lipoprotein-cholesterol and risk of stroke and carotid atherosclerosis: a systematic review

BACKGROUND AND PURPOSE

Epidemiological studies have found no relationship between total cholesterol and stroke risk, but little attention has been paid to high-density lipoprotein-cholesterol (HDL-C).

METHODS

We performed a systematic PubMed literature search for epidemiological studies that examined the association between HDL-C level and stroke or carotid intima-media thickness (IMT).

RESULTS

We identified 18 studies on the relationship between HDL-C and stroke risk and 37 on HDL-C and carotid IMT. Eight of ten prospective cohort studies (n=238,739) and three of eight case-control studies (n=3604 cases, 8220 controls) supported an association between elevated HDL-C level and decreased risk of stroke. Prospective cohort studies reporting on relative risk per unit increase in HDL-C showed an 11-15% decreased stroke risk per 10-mg/dl increase in HDL-C. Of 37 studies on carotid IMT, 31 reported cross-sectional, one longitudinal, and five both cross-sectional and longitudinal associations between HDL-C level and carotid IMT. Of 36 cross-sectional studies (n=51,288), 20 showed an inverse association between HDL-C level and carotid IMT. Of six longitudinal studies (n=20,065), three showed no association, one showed a weak association in a subgroup of white women and two showed a significant inverse relationship between HDL-C level and carotid IMT. Pooled estimates could not be calculated because of the variation in study designs and analysis.

CONCLUSIONS

The weight of evidence in the literature supports an inverse association between HDL-C level and stroke or carotid atherosclerosis, but more data are needed to firmly establish this protective effect.

CAMP-response element-binding protein mediates tumor necrosis factor-alpha-induced vascular cell adhesion molecule-1 expression in endothelial cells

Hypertension causes endothelial dysfunction, which plays an important role in atherogenesis. The vascular cell adhesion molecule-1 (VCAM-1) contributes to atherosclerotic lesion formation by recruiting leukocytes from blood into tissues. Tumor necrosis factor-alpha (TNFalpha) induces endothelial dysfunction and VCAM-1 expression in endothelial cells (ECs). We examined whether the cAMP-response element binding protein (CREB), a transcription factor that mediates cytokine expression and vascular remodeling, is involved in TNFalpha-induced VCAM-1 expression. TNFalpha induced phosphorylation of CREB with a peak at 15 min of stimulation in a dose-dependent manner in bovine aortic ECs. Pharmacological inhibition of p38 mitogen-activated protein kinase (p38-MAPK) inhibited TNFalpha-induced CREB phosphorylation. Adenovirus-mediated overexpression of a dominant-negative form of CREB suppressed TNFalpha-induced VCAM-1 and c-fos expression. Although activating protein 1 DNA binding activity was attenuated by overexpression of dominant negative CREB, nuclear factor-kappaB activity was not affected. Our results suggest that the p38-MAPK/CREB pathway plays a critical role in TNFalpha-induced VCAM-1 expression in vascular endothelial cells. The p38MAPK/CREB pathway may be a novel therapeutic target for the treatment of atherosclerosis.

Effect of Transdermal Hormone Replacement Therapy on Carotid Artery Wall Thickness and Levels of Vascular Inflammatory Markers in Postmenopausal Women

Carotid intima-media thickness (IMT) and vascular inflammatory markers have been shown to be involved in atherosclerosis. This study was designed to investigate the effect of transdermal hormone replacement therapy (HRT) on carotid IMT and vascular inflammatory markers in postmenopausal women and to explore the interrelationship between the change in carotid IMT and the changes in vascular inflammatory markers. Thirty-five postmenopausal women (mean age 57.0+/-7.7 years) received transdermal HRT (continuous 17beta-estradiol patch [36 microg/day] plus cyclic oral medroxyprogesterone acetate [2.5 mg/day, for 12 days/ month]) for 12 months, and 32 controls (mean age 58.0+/-7.5 years) did not. Carotid IMT, assessed by ultrasound, and circulating vascular inflammatory markers, i.e., C-reactive protein (CRP), intercellular adhesion molecule (ICAM)-1, vascular cell adhesion molecule (VCAM)-1, E-selectin, monocyte chemoattractant protein (MCP)-1, and matrix metalloproteinase (MMP)-9 were measured before and after 12 months of treatment. In the HRT group, carotid IMT decreased significantly (p<0.01), from 0.71+/-0.13 mm to 0.65+/-0.12 mm, and the ICAM-1, VCAM-1, E-selectin, and MCP-1 levels decreased significantly (p<0.01 for all), but the CRP and MMP-9 levels remained unchanged. Carotid IMT and vascular inflammatory markers were unchanged in the control group. In the HRT group, the change in carotid IMT was significantly correlated with the change in serum E-selectin (r=0.38, p<0.05), but not with the changes in other vascular inflammatory markers. These results suggest that transdermal HRT reduced carotid artery wall thickness, and that the reduction may have been induced by an antiatherosclerotic effect combined with the direct effect of estrogen and decreased levels of estrogen-induced E-selectin.

Microalbuminuria and arterial stiffness in a general population: the Shimanami Health Promoting Program (J-SHIPP) study

Microalbuminuria is an early marker of renal damage and has been shown to predict future cardiovascular mortality and morbidity in patients with diabetes or hypertension, as well as in subjects in the general population. In this study, we investigated the hypothesis that the presence of microalbuminuria reflects the advancement of arterial stiffness by using a study group of 136 community residents who had no cardiovascular diseases except for hypertension and who were not taking any medications. Urinary albumin concentration was determined by the standard method and corrected by creatinine. Microalbuminuria was defined as a urinary albumin/creatinine ratio of 2.0-30.0 mg/mmol creatinine. Arterial stiffness was evaluated by pulse wave velocity (PWV) determined at three points: from the heart to the carotid artery, to the brachial artery, and to the ankle. Carotid arterial pressure was determined using a tonometric sensor. Carotid ultrasonography was performed to measure carotid intima-media thickness (IMT) and carotid arterial internal dimension. Subjects with microalbuminuria had higher blood pressure and wider pulse pressure not only in the brachial artery but also in the carotid artery. Microalbuminuria was associated with significantly higher PWV compared with that of normoalbuminuric subjects at all sites studied (mean PWV: 821.2+/-137.4 cm/s vs. 933.8+/-137.5 cm/s, p<0.0001). Stepwise regression analysis revealed that the presence of mircroalbuminuria (p=0.047) was a significant independent predictor of PWV in addition to age, sex, and systolic blood pressure. These findings suggest that microalbuminuria is associated with advanced atherosclerosis in the general population. Underlying arterial stiffness may explain the high cardiovascular mortality in subjects with microalbuminuria. Hypertension may be the mechanism linking microalbuminuria and arterial stiffness in the general population.

Home Blood Pressure Is a Better Predictor of Carotid Atherosclerosis than Office Blood Pressure in Community-Dwelling Subjects

An increase in the thickness of the intima-media (IMT) of the carotid artery is associated with an increased risk of cardiovascular morbidity and mortality. Hypertension is one of the underlying mechanisms for the progression of carotid atherosclerosis. However, office blood pressure (BP) has been shown to have only a weak association with carotid IMT. Since self-measured home BP has less variation than office BP, home BP could be a better predictor of carotid atherosclerosis. To explore this hypothesis, we compared the relationships between carotid IMT and office BP or home BP in a community-dwelling population. One-hundred and one community residents, aged 50 years or older and not taking any medication, were enrolled in this study. Morning home BP was measured according to the guidelines of the Japanese Society of Hypertension. The results were recorded for 2 weeks and averaged. Carotid atherosclerosis was defined as IMT > or =0.80 mm, which corresponds to the first quartile. Home systolic BP showed a more significant association with carotid IMT (r=0.422, p <0.0001) than with office systolic BP (r=0.021, p=0.027). Logistic regression analysis for the presence of carotid atherosclerosis further showed that the relative risk of hypertension defined using home BP (> or =135/85 mmHg) was 6.3 (95% confidence interval [CI]: 2.0 to 19.6), while that using office BP was 1.5 (95% CI: 0.5 to 4.2). These results suggest that home BP is a better predictor of the development of carotid atherosclerosis than office BP.

Risk factors for the progression of early carotid atherosclerosis in a male working population

Increased intima-media thickness (IMT) of the carotid artery may represent early atherosclerosis. Although several studies have evaluated risk factors for carotid IMT, only limited information is available concerning risk factors for the progression of carotid IMT. The present study was designed to determine risk factors for the progression of carotid IMT in a male working population. Male employees of a regional transport company (n = 220, 50.9 +/- 4.4 years) underwent baseline physical and laboratory examinations, and ultrasonographic assessment of the maximum common carotid IMT between 1992 and 1994, and they were reexamined 5 years later. In a multivariate analysis at baseline, carotid IMT was positively associated with age, diastolic blood pressure and total cholesterol, and negatively with high density lipoprotein (HDL) cholesterol. During the follow-up period, carotid IMT increased from 0.669 +/- 0.135 mm to 0.784 +/- 0.229 mm, or at a rate of 0.023 +/- 0.039 mm/year. In a multivariate regression analysis using baseline values of carotid IMT, age, body mass index, diastolic blood pressure, total cholesterol, HDL cholesterol and HbA1c as independent variables, the progression of carotid IMT was associated only with baseline total cholesterol. These findings suggest that in middle-aged men, although age, blood pressure, and total cholesterol were associated with baseline carotid IMT, total cholesterol level appeared to be the strongest determinant of the progression of carotid IMT, a result which underscores the importance of maintaining lower cholesterol levels to prevent early atherosclerosis.

Genetics of intima-media thickness

PURPOSE OF REVIEW

Increased carotid artery intima-media thickness is associated with an increased risk of coronary heart disease or cerebrovascular disease and is a powerful predictor of cardiovascular and cerebrovascular outcomes. Consequently, the measurement is now used in a number of case control, cohort and familial and linkage studies as an intermediate phenotype for the investigation of the genetic and environmental determinants of atherosclerosis. The aim of this paper is to review the most recent available data on the genetic determinants of carotid intima-media thickness.

RECENT FINDINGS

Genes could account for a significant amount of variation in carotid intima-media thickness: up to 30-66%. Carotid intima-media thickness progressed more rapidly with age in familial hypercholesterolemia patients than in patients without his condition. Familial hypercholesterolemia patients with a null LDL receptor allele tended to have higher carotid intima-media thickness than patients carrying the LDL receptor defective allele. Small association studies showing positive or negative results with the angiotensinogen gene variants as well as with the angiotensin converting enzyme I/D polymorphism add to the confusion in this largely controversial area. Differing results may depend on the vascular territory and genetic background. New associations have been described in small studies.

SUMMARY

Studies on the association of polymorphisms and intima-media thickness are frequently disappointing and lead occasionally to conflicting results. Among study limitations is the fact that mostly single gene effects are considered; longitudinal cohort studies may be more appropriate than case control studies. Ongoing large prospective population studies and clinical trials have integrated the measurements of intima-media thickness and genotype determination with a genomic approach. As a result, in the near future we may see more important and robust results with significant consequences on our understanding of genetic determinants of atherosclerotic cardiovascular disease.

Polymorphism of the Monocyte Chemoattractant Protein (MCP-1) Gene Is Associated with the Plasma Level of MCP-1 But Not with Carotid Intima-Media Thickness

Monocyte chemoattractant protein-1 (MCP-1) plays an important role in atherosclerosis. Recently, single nucleotide polymorphisms (SNPs) in the MCP-1 regulatory region have been identified, and an in vitro study demonstrated that the SNP at position -2518 of the MCP-1 gene affected transcription of the gene. The purpose of this study was to clarify the association of the plasma level of MCP-1 and the SNP of the MCP-1 gene with carotid atherosclerosis in community-based subjects. The study subjects consisted of 325 community residents, aged 50 years or older (mean age, 70.5 +/- 9.4 years) and free from any cardiovascular complications. Carotid intima-media thickness (IMT) was measured in the right common carotid artery using ultrasonography. The plasma level of MCP-1 was measured by enzyme-linked immunosorbent assay (ELISA). The SNP of the MCP-1 gene was determined by the polymerase chain reaction (PCR)-restriction fragment length polymorphism (RFLP) technique. The plasma level of MCP-1 was significantly associated with IMT (r = 0.12, p < 0.05) and carotid arterial dimension (r = 0.13, p < 0.05). There was a significant difference in plasma MCP-1 level between the genotypes (AA, 166 +/- 36 ng/ml; GG + AG, 184 +/- 56 ng/ml; p = 0.036). Analysis restricted to the subjects not receiving antihypertensive drugs or other medication further increased the statistical significance. However, carotid IMT and carotid arterial diameter were not significantly different among the MCP-1 genotypes. Stepwise regression analysis for plasma MCP-1 revealed that the MCP-1 genotype was an independent determinant of plasma MCP-1 level. These findings indicate that plasma MCP-1 is associated with carotid atherosclerosis. Although -2518 SNP is associated with the plasma level of MCP-1, it was not directly associated with carotid atherosclerosis.

An interaction between systolic blood pressure and angiotensin-converting enzyme gene polymorphism on carotid atherosclerosis

The insertion/deletion (I/D) polymorphism of the human angiotensin-converting enzyme (ACE) gene is a major determinant of circulating ACE activity, with the D allele being associated with higher ACE levels than the I allele. Thus, chronic exposure to high levels of circulating and tissue ACE may well predispose to vascular wall thickening and atherosclerosis. However, the effect of the ACE gene on carotid atherosclerosis remains controversial. We investigated the association between ACE gene I/D polymorphism and risk factor-dependent augmentation of carotid arterial remodeling in subjects with several risk factors for atherosclerosis. We evaluated sclerotic lesions of the common carotid artery with intima-media thickness (IMT) by ultrasonography in 184 patients (mean age +/- SD, 67 +/- 14 years old) and studied whether any risk factor-gene interactions were associated with carotid atherosclerosis. Out of the 184 subjects, 71 had the ACE II genotype, 87 the ID genotype and 26 the DD genotype. There was no significant difference in IMT among the three ACE genotypes. In total subjects, multiple regression analysis showed that age, total-cholesterol (T-C), and HDL-cholesterol (HDL-C) were significantly associated with IMT. However, the association between risk factors and IMT was genotype-specific. Systolic blood pressure (SBP) and HDL-C were significantly associated with IMT in ACE D carriers (DD+ID), but not in subjects with the ACE II genotype. Similarly, T-C was significantly associated with IMT only in subjects with the ACE II genotype. A general linear model of the interaction between the ACE genotype and the conventional risk factors showed that the SBP-ACE genotype interaction were significantly associated with IMT (F = 7.915; p = 0.005). This finding further supports the idea that analysis of risk factor-gene interaction could be a useful tool for deriving specific predictive information about the development of atherosclerosis.