Carotid artery plaque and LDL-to-HDL cholesterol ratio predict atherosclerotic status in coronary arteries in asymptomatic patients with type 2 diabetes mellitus

JAK3/STAT5b/PPARγ Pathway Mediates the Association between Di(2-ethylhexyl) Phthalate Exposure and Lipid Metabolic Disorder in Chinese Adolescent Students

Our previous studies found that di (2-ethylhexyl) phthalate (DEHP) could disorder lipid metabolism in adolescents but the mechanisms underlying this association remained unclear. This study was undertaken to clarify the mediating effect of JAK3/STAT5/PPARγ on disorder lipid levels induced by DEHP in adolescents. We recruited 478 adolescent students (median age 18.1 years). The mRNA expression and DNA methylation levels of JAK3/STAT5/PPARγ were detected by real-time PCR and the MethylTarget, respectively. We used multiple linear regression to analyze the association between DEHP metabolites (MEHP, MEOHP, MEHHP, MECPP, MCMHP, and ΣDEHP) levels, mRNA expression, and DNA methylation levels. The mediating effect of JAK3/STAT5/PPARγ mRNA expression levels was examined by mediation analysis. We found that all DEHP metabolite levels were positively correlated with TC/HDL-C and LDL-C/HDL-C (P < 0.05). The MEOHP level was negatively associated with DNA methylation levels and positively associated with mRNA levels of PPARγ and STAT5b (P < 0.05). The MEHP level was negatively associated with the DNA methylation level and positively associated with the mRNA level of JAK3 (P < 0.05). Higher MEOHP was associated with a higher level of TC/HDL-C, the mediation analysis showed the mediation effect was 17.18% for the JAK3 level, 10.76% for the STAT5b level, and 11% for the PPARγ level. Higher MEHP was associated with a higher level of LDL-C/HDL-C, the mediation effect was 14.49% for the JAK3 level. In conclusion, DEHP metabolites decreased the DNA methylation levels, inducing the increase of the mRNA levels of JAK3/STAT5/PPARγ. In addition, the mRNA levels mediated the association between DEHP exposure and disorder lipid levels.

Non-traditional lipid parameters as potential predictors of carotid plaque vulnerability and stenosis in patients with acute ischemic stroke

OBJECTIVE

Lipid abnormalities are important risk factors in patients with large atherosclerotic strokes. Recent studies have shown that non-traditional lipid parameters are crucial to the development of atherosclerosis and are closely related to the clinical outcome of acute ischemic stroke (AIS). Therefore, we aimed to investigate the relationship between non-traditional lipid parameters and carotid plaque stability and stenosis degree in patients with large atherosclerotic stroke.

METHODS

We retrospectively analyzed 336 patients with AIS. All patients were divided into the non-plaque group, stable plaque group, and vulnerable plaque group according to ultrasound examination. At the same time, the patients were divided into non-stenosis, mild stenosis, moderate stenosis, and severe stenosis groups according to the degree of stenosis. Non-traditional lipid parameters, including residual lipoprotein cholesterol (RLP-C), non-high-density lipoprotein cholesterol (non-HDL-C), non-HDL-C to high-density lipoprotein cholesterol ratio (non-HDL-C/HDL-C), triglyceride to HDL-C ratio (TG/HDL-C), Castelli's risk index (CRI), and the atherogenic index of plasma (AIP). Receiver operating characteristic (ROC) curves and multivariate logistic regression analyses were used to investigate the associations between the non-traditional lipid parameters and carotid plaque vulnerability. Spearman linear correlation analysis was used to test the correlation between variables and the degree of carotid plaque stenosis.

RESULTS

This study population included 336 patients with AIS, of whom 294 had a carotid plaque. Multivariate logistic regression model showed that RLP-C (OR, 3.361; 95%CI, 1.311-8.617), non-HDL-C/HDL-C (OR, 1.699; 95%CI, 1.279-2.258), non-HDL-C (OR, 1.704; 95%CI, 1.143-2.540), CRI-I (OR, 1.573; 95%CI, 1.196-2.068), and CRI-II (OR, 2.022; 95%CI, 1.369-2.985) were independent risk factors for carotid plaque vulnerability. In addition, Spearman correlation analysis showed that the values of RLP-C, non-HDL-C/HDL-C, non-HDL-C, TG/HDL-C, CRI-I, CRI-II, and AIP on admission were positively correlated with the degree of carotid plaque stenosis (all P < 0.001).

CONCLUSION

This study provides evidence that non-traditional lipid parameters (LP-C, non-HDL-C/HDL-C, non-HDL-C, CRI-I, and CRI-II) were potential predictors of carotid plaque vulnerability in patients with AIS. However, no significant correlation was observed between TG/HDL-C and AIP. RLP-C, non-HDL-C/HDL-C, non-HDL-C, TG/HDL-C, CRI-I, CRI-II, and AIP were closely related to the degree of carotid plaque stenosis. Non-traditional lipid parameters can be used as novel biomarkers of carotid plaque vulnerability and stenosis.

Quantifying PON1 on HDL with nanoparticle-gated electrokinetic membrane sensor for accurate cardiovascular risk assessment

Cardiovascular disease-related deaths (one-third of global deaths) can be reduced with a simple screening test for better biomarkers than the current lipid and lipoprotein profiles. We propose using a highly atheroprotective subset of HDL with colocalized PON1 (PON1-HDL) for superior cardiovascular risk assessment. However, direct quantification of HDL proteomic subclasses are complicated by the peroxides/antioxidants associated with HDL interfering with redox reactions in enzymatic calorimetric and electrochemical immunoassays. Hence, we developed an enzyme-free Nanoparticle-Gated Electrokinetic Membrane Sensor (NGEMS) platform for quantification of PON1-HDL in plasma within 60 min, with a sub-picomolar limit of detection, 3-4 log dynamic range and without needing sample pretreatment or individual-sample calibration. Using NGEMS, we report our study on human plasma PON1-HDL as a cardiovascular risk marker with AUC~0.99 significantly outperforming others (AUC~0.6-0.8), including cholesterol/triglycerides tests. Validation for a larger cohort can establish PON1-HDL as a biomarker that can potentially reshape cardiovascular landscape.

Association between lipid profile changes and risk of in-stent restenosis in ischemic stroke patients with intracranial stenosis: A retrospective cohort study

OBJECTIVE

The risk of ischemic stroke with intracranial stenosis is associated with various serum lipid levels. However, the effects of changes in the lipid profile on the risk of in-stent restenosis have not been verified. Therefore, we investigated the association between the occurrence of in-stent restenosis at 12-month follow-up and changes in various lipid profiles.

METHODS

In this retrospective cohort study, we included ischemic stroke patients who had undergone intracranial stenting for symptomatic intracranial stenosis between February 2010 and May 2020. We collected data about serum low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC), and triglyceride (TG) levels, and calculated the TC/HDL-C and LDL-C/HDL-C ratios at baseline and after 12 months. We conducted multivariable logistic regression analyses to verify the association between various lipid profile changes and in-stent restenosis at 12 months.

RESULTS

Among the 100 patients included in the study (mean age, 60.8 ± 10.0 years; male: 80 [80.0%]), in-stent restenosis was found in 13 (13.0%) patients. The risk of in-stent restenosis of more than 50% was significantly decreased when TC/HDL-C ratio (odds ratio [OR] 0.22, [95% confidence interval (CI) 0.05-0.87]) and LDL-C/HDL-C ratio (OR 0.23, [95% CI 0.06-0.93]) decreased or when HDL-C levels (OR 0.10, [95% CI 0.02-0.63]) were increased at 12 months compared with baseline measurements.

CONCLUSIONS

Improvement of HDL-C levels, TC/HDL-C ratio, and LDL-C/HDL-C ratio were associated with decreased risk of in-stent restenosis at 12-month follow-up. Management and careful monitoring of various lipid profiles including HDL-C levels, TC/HDL-C ratio, and LDL-C/HDL-C ratio may be important to prevent in-stent restenosis in patients with intracranial stenting.

Association of LDL to HDL ratio with new-onset atrial fibrillation after on-pump coronary artery bypass graft surgery

OBJECTIVE

This study aims to analyze the association between preoperative LDL/HDL ratio and new-onset atrial fibrillation (AF) after on-pump coronary artery bypass grafting (on-pump CABG), evaluate the clinic value of preoperative LDL/HDL ratio to identify postoperative rhythm.

METHODS

A retrospective study of consecutive patients (n = 2052) who underwent on-pump CABG at TEDA International Cardiovascular Hospital (Tianjin, China), from June 1, 2020, to December 30, 2021, was conducted. The association between preoperative LDL/HDL and new-onset POAF was analyzed by Lowess curve and univariate logistic regression. The receiver operating characteristic curve (ROC) and area under the curve (AUC) were used to evaluate the identification capacity of preoperative LDL/HDL level for new-onset POAF.

RESULTS

In studied populations, the incidence of new-onset POAF was about 29.24%. The lowess curve showed that the association between preoperative LDL/HDL ratio and POAF after on-pump CABG was similar to a linear relationship. With the increasement of preoperative LDL/HDL ratio, the incidence of POAF increased simultaneously. ROC analysis showed that preoperative LDL/HDL ratio could identify postoperative arrhythmia after on-pump CABG (AUC = 0.569,95% CI = 0.529-0.608, P = 0.006) among female patients, the best preoperative LDL/HDL ratio cutoff of 2.11, which was considered a predictive factor of incident POAF, showed a sensitivity of 83.60% (95% CI = 0.775-0.886) and a specificity of 30.02% (95% CI = 0.257-0.346).

CONCLUSION

Preoperative LDL/HDL ratio is associated with new-onset POAF, but there is a difference in different sex. Preoperative LDL/HDL level can help to identify postoperative rhythm in females.

Targeting ANGPTL3 by GalNAc-conjugated siRNA ANGsiR10 lowers blood lipids with long-lasting and potent efficacy in mice and monkeys

Angiopoietin-like protein 3 (ANGPTL3) is an important regulator of lipoproteins by inhibiting both lipoprotein and endothelial lipases. It has been intensively investigated as a drug target for the treatment of dyslipidemia. In the present study, a modified small interfering RNA (siRNA) conjugated with GalNAc ANGsiR10 was characterized by in vivo and in vitro studies for its effect on ANGPTL3 silencing, the reduction of plasma triglycerides (TGs), and cholesterol levels in disease models. The results showed that ANGsiR10 displayed a significant and long-lasting efficacy in reducing blood TG and cholesterol levels in both mice and monkeys. Remarkably, the maximal reductions of plasma TG levels in the hApoC3-Tg mice, a model with high TG levels, and the spontaneous dyslipidemia model of rhesus monkey were 96.3% and 67.7%, respectively, after a single dose of ANGsiR10, with long-lasting effects up to 15 weeks. The cholesterol levels were also reduced in response to treatment, especially the non-HDL-c level, without altering the ApoA/ApoB ratio. This study showed that ANGsiR10 is effective in treating dyslipidemia and is worth further development.

Lifestyle-Related Risk Factors for the Incidence and Progression of Chronic Kidney Disease in the Healthy Young and Middle-Aged Population

The prevalence of chronic kidney disease (CKD) increased by 88% from 1990 to 2016. Age of onset of lifestyle-related diseases (such as hypertension, diabetes mellitus, obesity, dyslipidemia, and hyperuricemia), which are risk factors for incident CKD, is lower now compared with the past. Thus, we aimed to evaluate the risk factors for the incidence and progression of CKD in the young and middle-aged population. There are differences in the risk for CKD among the young, middle-aged, and elderly populations. We aimed to assess obesity (which is basic component of metabolic syndrome), waist circumference, and abdominal adiposity, which are predictive factors of CKD in the younger population. Furthermore, we described the management and clinical evidence of hypertension, diabetes mellitus, dyslipidemia, and hyperuricemia for young and middle-aged patients, along with diet management and nutrients associated with kidney function. Kidney function in the young and middle-aged population is mostly normal, and they are considered a low-risk group for incident CKD. Thus, we expect this review to be useful in reducing the prevalence of CKD.

The association between blood glucose levels and lipids or lipid ratios in type 2 diabetes patients: A cross-sectional study

BACKGROUND

Lipids and lipid ratios are associated with complications of diabetes mellitus type 2 (T2DM), such as cardiovascular disease, but the relationship between blood glucose levels and lipid or lipid ratios is not fully understood in T2DM patients. This study assesses the association between blood glucose levels and lipid or lipid ratios in a cohort of T2DM patients.

METHODS

A total of 1,747 Chinese T2DM patients from the Ningxia province of China were included in this cross-sectional study. Lipid parameters, including triglycerides (TG), total cholesterol (TC), high-density lipoprotein (HDL-C), low-density lipoprotein (LDL-C), and fasting blood glucose levels were measured quantitatively using standard methods. Fasting blood glucose was divided into three groups. A multiple mixed-effect linear regression model was conducted to identify a potential association between blood glucose and lipid parameters.

RESULTS

There was a positive association between blood glucose and TG levels (β=0.34, 95% CI: (0.20, 0.48), p<0.01); every 1 mmol/L increase in blood glucose levels resulted in a 0.34 mmol/L increase in TG. Blood glucose levels were also associated with high LDL (β=0.08, 95% CI: (0.02, 0.14), p<0.01), TG/HDL-C (β=0.31, 95% CI: (0.13, 0.49), p<0.01), and LDL-C/HDL-C (β=0.13, 95% CI: (0.06, 0.20), p<0.01) levels. After controlling for demographic variables, health-related behaviors, and physical health variables, a positive association between blood glucose levels and TG (β=0.31, 95% CI: (0.17, 0.45), p<0.01) and LDL-C (β=0.08, 95% CI: (0.02, 0.13), p<0.01) levels and an in increase in TG/HDL-C (β=0.28, 95% CI: (0.09, 0.46), p<0.01) and LDL-C/HDL-C (β=0.11, 95% CI: (0.04, 0.18), p<0.01) ratios was found.

CONCLUSION

A correlation between blood glucose levels and serum lipids or lipid ratios has been established in this study. Blood glucose levels were positively associated with TG and LDL-C levels and elevated TG/HDL-C and LDL-C/HDL-C ratios.

Plasma atherogenic indices are independent predictors of slow coronary flow

Background

Although the pathophysiology of coronary slow flow (CSF) has not been fully elucidated, emerging data increasingly support potential role for subclinical diffuse atherosclerosis in the etiology of CSF. We aimed to investigate relationship between atherogenic indices and CSF.

Methods

130 patients with CSF diagnosed according to Thrombolysis in Myocardial Infarction (TIMI)-frame count (TFC) method and 130 controls who had normal coronary flow (NCF) were included in this retrospective study. Atherogenic indices (atherogenic index of plasma [AIP], Castelli risk indices I and II [CRI-I and II]) were calculated using conventional lipid parameters.

Results

The logistic regression analyses demonstrated that AIP (OR, 5.463; 95% confidence interval [CI], 1.357–21.991; p = 0.017) and CRI-II (OR, 1.624; 95% CI, 1.138–2.319; p = 0.008) were independent predictors of CSF. Receiver operating characteristic analysis showed that the optimal cutoff value to predict the occurrence of CSF was 0.66 for AIP (sensitivity, 59%; specificity, 73%; area under curve [AUC], 0.695; p < 0.001) and 3.27 for CRI-II (sensitivity, 60%; specificity, 79%; AUC, 0.726; p < 0.001).

Conclusions

AIP and CRI-II levels were independent predictors of CSF. Prospective studies in larger cohorts of patients may elucidate the role of atherogenic dyslipidemia in the pathophysiology of CSF.

Dysregulated Serum Lipid Metabolism Promotes the Occurrence and Development of Diabetic Retinopathy Associated With Upregulated Circulating Levels of VEGF-A, VEGF-D, and PlGF

Purpose: This study aims to explore the correlations of arteriosclerosis-associated plasma indices with various severity levels of diabetic retinopathy (DR) and to test the hypothesis that elevated circulating level of known angiogenic cytokines induced by hyperglycemia is associated with dyslipidemia on DR. Methods: This cross-sectional study consists of 131 patients with type 2 diabetes. The patients were categorized based on their DR status into those with no DR (diabetes mellitus, DM), non-proliferative diabetic retinopathy (NPDR), and proliferative diabetic retinopathy (PDR) groups. The biochemical profile including fasting glucose, glycated hemoglobin (HbA1c), lipid profile were estimated, plasma angiogenic cytokines (vascular endothelial growth factor, VEGF-A, -C, -D) and placental growth factor (PlGF) were analyzed by protein microarrays. The atherogenic plasma index (API) was defined as low-density lipoprotein cholesterol/high-density lipoprotein cholesterol (LDL-C/HDL-C); atherogenic index (AI) was calculated as (TC-(HDL-C))/HDL-C and atherogenic index of plasma (AIP) was defined as log (TG/HDL-C). Results: No significant differences were detected in the duration of hypertension, age, and gender between the three groups. Serum TC and LDL-C, AI, and API in the NPDR group and PDR group were significantly higher than those in the DM group. The circulating level of PlGF, VEGF-A, and VEGF-C were significantly correlated with the severity of DR. VEGF-D is a risk factor independent of API (Z = -2.61, P = 0.009) and AI (Z = -2.40, P = 0.016). Multivariate logistic regression showed that AI and API are strong risk factors for the occurrence and severity of DR. Associated with AI and API, VEGF-D and PlGF contribute to DR: VEGF-D [AI: P = 0.038, odd ratio (OR) = 1.38; VEGF-D: P = 0.002, OR = 1.00. API: P = 0.027, OR = 1.56, VEGF-D:P = 0.002, OR = 1.00] and PlGF [AI: P = 0.021, OR = 1.43; VEGF-D: P = 0.004, OR = 1.50. API: P = 0.011, OR = 1.66; VEGF-D: P = 0.005, OR = 1.49]. Conclusions: Total cholesterol (TC) and LDL-C are risk factors for presence of any DR. Atherogenic index and API are novel and better predictive indicators for the occurrence and severity of DR in comparion with the traditional lipid profiles. Abnormal lipid metabolism are associated with the upregulation of circulating cytokines that are linked to the severity of DR.

Cardiovascular Disease Prediction by Machine Learning Algorithms Based on Cytokines in Kazakhs of China

Background

Cardiovascular disease (CVD) is the leading cause of mortality worldwide. Accurately identifying subjects at high-risk of CVD may improve CVD outcomes. We sought to systematically examine the feasibility and performance of 7 widely used machine learning (ML) algorithms in predicting CVD risks.

Methods

The final analysis included 1508 Kazakh subjects in China without CVD at baseline who completed follow-up. All subjects were randomly divided into the training set (80%) and the test set (20%). L1-penalized logistic regression (LR), support vector machine with radial basis function (SVM), decision tree (DT), random forest (RF), k-nearest neighbors (KNN), Gaussian naive Bayes (NB), and extreme gradient boosting (XGB) were employed for prediction CVD outcomes. Ten-fold cross-validation was used during model developing and hyperparameters tuning in the training set. Model performance was evaluated in the test set in light of discrimination, calibration, and clinical usefulness. RF was applied to obtain the variable importance of included variables. Twenty-two variables, including sociodemographic characteristics, medical history, cytokines, and synthetic indices, were used for model development.

Results

Among 1508 subjects, 203 were diagnosed with CVD over a median follow-up of 5.17 years. All 7 models had moderate to excellent discrimination (AUC ranged from 0.770 to 0.872) and were well calibrated. LR and SVM performed identically with an AUC of 0.872 (95% CI: 0.829–0.907) and 0.868 (95% CI: 0.825–0.904), respectively. LR had the lowest Brier score (0.078) and the highest sensitivity (97.1%). Decision curve analysis indicated that SVM was slightly better than LR. The inflammatory cytokines, such as hs-CRP and IL-6, were identified as strong predictors of CVD.

Conclusion

SVM and LR can be applied to guide clinical decision-making in the Kazakh Chinese population, and further study is required to ensure their accuracies.

Triglyceride to high-density lipoprotein cholesterol and low-density lipoprotein cholestrol to high-density lipoprotein cholesterol ratios are predictors of cardiovascular risk in Iranian adults: Evidence from a population-based cross-sectional study

BACKGROUND

The superiority of TG/HDL-C and LDL-C/HDL-C ratios in predicting CVD risk is a matter of debates. Thus, the objective of this study was to compare TG/HDL-C and LDL-C to HDL-C ratios in predicting the risk of CVD events.

METHODS

In a population-based cross-sectional study, 567 representative participants aged 40 years or older were entered in the study in Babol, North of Iran. The demographic data, anthropometric measures, and the cardio metabolic risk factors were measured. The individual risk of CVD events was assessed by ACC/AHA risk model. ROC analysis was applied to estimate the diagnostic accuracy and the optimal cut-off points of TG/HDL-C and LDL-C/HDL-C ratios.

RESULTS

The AUC of TG/HDL-C and LDL-C/HDL-C ratios were rather similar and both parameters significantly predicted CVD risk in men comparably, and TG/HDL-C at optimal cutoff point of 3.6 produced 75% sensitivity and 39% specificity. However,in women TG/HDL-C with AUC of 0.65( p=0.091) at optimal cutoff value of 3.4 produced a sensitivity of 82% and specificity of 51%. The LDL-C/HDL-C ratio had no discriminative ability in predicting CVD risk in women. The adjusted OR of TG/HDL-C at 2nd quartile was significant (OR=3.22, 95% CI:1.25-8.29) and a greater association was found with 3rd and 4rth quartiles.

CONCLUSION

Both TG/HDL-C and LDL-C/HDL-C ratios comparably predict CVD risk in men, whereas in women only TG/ HDL-C is a significant predictor but not LDL-C/HDL-C.

Helicobacter pylori eradication increases the serum high density lipoprotein cholesterol level in the infected patients with chronic gastritis: A single-center observational study

Background

Extra-gastric manifestation of Helicobacter pylori infection involves systemic inflammation, which results in the production of several cytokines. Only a few clinical trials have investigated the effect of H. pylori eradication therapy on lipid metabolism in the infected patients with chronic gastritis. We aimed to evaluate the effect of H. pylori eradication therapy on lipid metabolism in a Japanese population with chronic gastritis.

Methods

One hundred and sixty-three patients with H. pylori-associated chronic gastritis were enrolled in this study between June 2015 and March 2017. They underwent H. pylori eradication therapy; the effects of the therapy were assessed by the urea breath test performed at least 4 weeks after the therapy. After confirming H. pylori eradication, the health screening examination was repeated between May 2016 and August 2018. The clinical parameters were compared before and after the administration of the eradication therapy.

Results

The mean age of the enrolled patients was 56.7 years, and the mean follow-up duration was 514.7 days. Weight, body mass index, and obesity index were significantly increased post-eradication therapy compared to those pre-eradication therapy. White blood cell and platelet counts were significantly decreased, and high density lipoprotein cholesterol (HDL) level was significantly increased (P = 0.001), while low density lipoprotein cholesterol (LDL), total cholesterol, and triglycerides levels were not altered significantly. Hence, the LDL/HDL ratio was significantly decreased.

Conclusions

This study reported that H. pylori eradication therapy increase the HDL levels in the infected patients with chronic gastritis. Hence, the LDL/HDL ratio, which is used to evaluate the risk of atherosclerosis, was significantly decreased post-eradication therapy compared to that pre-eradication therapy.

Clinical utility of carotid ultrasonography: Application for the management of patients with diabetes

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.

[Effects of ketogenic diet on lipid metabolism in children with intractable epilepsy]

OBJECTIVE

To study the effects of ketogenic diet (KD) on lipid metabolism in children with intractable epilepsy and the risk of atherosclerosis in children treated with KD assessed by changes in lipid profile.

METHODS

The clinical data of 47 children with intractable epilepsy from 2013 to 2017 were collected. Blood lipid levels including triglycerides (TG), total cholesterol (TC), high-density lipoprotein (HDL) and low-density lipoprotein (LDL), were detected before and 3 months after KD treatment. LDL/HDL ratio, arterial stiffness index (AI), atherogenic index of plasma (AIP) and lipid comprehensive index (LCI) were calculated to assess the risk of atherosclerosis.

RESULTS

After 3 months of KD treatment, the TG and TC levels were slightly higher than those before treatment, and the HDL levels were slightly lower than those before treatment, but the differences were not statistically significant (P>0.05). The LDL levels of the children after 3 months of KD treatment were significantly higher than those before treatment (P<0.05). After 3 months of KD treatment, the LDL/HDL ratio and AI, AIP and LCI levels of the children were increased compared with those before treatment, but only the increase of the LDL/HDL ratio was statistically significant (P<0.05).

CONCLUSIONS

KD treatment may lead to increase in LDL level and LDL/HDL ratio, suggesting that KD treatment may increase the risk of atherosclerosis.

The associations of lipids and lipid ratios with stroke: A prospective cohort study

Lipids and lipid ratios have been proven to be associated with cardiovascular disease; however, their relationships with stroke and stroke subtypes had not been fully understood. This study aims to assess the associations of lipids and lipid ratios with type-specific stroke and compare their predictive capacities for stroke occurrence. In this prospective cohort study, a total of 42 005 Chinese participants aged 20 to 80 who were free of stroke at baseline were included and selected into subgroups of stroke subtypes (ischemic, hemorrhagic, and total). Total stroke outcome included a combination of ischemic and hemorrhagic stroke. Over an average follow-up of 3.6 years, 781 participants developed stroke (623 ischemic and 158 hemorrhagic). In men, the highest TC/HDL-C quartile was significantly associated with increased ischemic stroke risk (multivariable-adjusted hazard ratio [HR], 1.52, 95% confidence interval [CI], 1.14-2.03) and total stroke risk (HR, 1.45, 95% CI, 1.12-1.87), and TC/HDL-C had the highest area under the receiver operating characteristic curve (AUC) for predicting ischemic (AUC, 0.868) and total stroke (AUC, 0.874). In women, the highest TG quartile was significantly associated with increased risk of ischemic (HR, 1.99, 95% CI, 1.11-3.59) and total stroke (HR, 1.85, 95% CI, 1.07-3.20), with AUCs of 0.850 and 0.861, respectively. No lipid variables were significantly associated with hemorrhagic stroke in both sex. In conclusion, TC/HDL-C ratio may better predict stroke risk in men, whereas TG was more valuable in predicting stroke risk in women. TC/HDL-C and TG may help to discriminate high stroke risk individuals and serve as potential targets for stroke prevention.

Application of High-Resolution CUBE Sequence in Exploring Stroke Mechanisms of Atherosclerotic Stenosis of Middle Cerebral Artery

BACKGROUND

This study aimed to analyze the vascular wall and atherosclerotic plaques of the middle cerebral artery (MCA) and compare their differences between patients with cerebral infarction and transient ischemic attack (TIA) using 3-dimensional fast-spin-echo T1-weighted sequence (namely CUBE).

METHODS

Forty-seven patients with atherosclerotic stenosis of the MCA were included in this study. They received magnetic resonance examinations with routine T1WI, T2WI, 3-dimensional time-of-flight magnetic resonance angiography and diffusion-weighted imaging, as well as high-resolution CUBE T1WI sequence. Two physicians independently observed the location and degree of enhancement of the atheromatous plaques. The vessel area and lumen area at the maximal-lumen-narrowing and reference site were measured to calculate the plaque area, rate of stenosis, and remodeling index of the MCA. The chi-squared test was used to compare the differences of degree of enhancement between the cerebral infarction and TIA groups. The differences of rate of stenosis and remodeling index were compared by independent sample t test.

RESULTS

Twenty-five lesion vessels in the infarction group and 22 in the TIA group were analyzed. The difference of stenosis rate between the groups was not statistically significant. The lesion vessels of infarction group had a significantly larger remodeling index and plaque area, and the plaques had a significantly higher degree of enhancement, compared to the TIA group.

CONCLUSIONS

CUBE T1WI can be used to characterize the MCA vessel wall and atherosclerotic plaque. Positive remodeling and enhanced plaques are closely correlated with the occurrence of brain stroke.

Risk factors and utility of maximum carotid intima-media thickness as a surrogate marker for coronary artery stenosis

Background

This study investigated the factors associated with coronary artery stenosis in outpatients. Furthermore, the usefulness of maximum carotid intima–media thickness (maximum-IMT) as a surrogate marker of coronary artery stenosis was evaluated.

Methods

We conducted a single-center retrospective study. A total of 601 outpatients (338 males; 263 females; mean age, 69.8±10.0 years) who underwent coronary computed tomography angiography between April 2006 and March 2012 were analyzed. The associations between coronary artery stenosis (≥75%) as determined by coronary computed tomography angiography and clinical and laboratory parameters were evaluated by multivariate logistic regression. Validation of maximum-IMT as measured by ultrasonography as a surrogate marker of coronary artery stenosis was analyzed by receiver operating characteristic (ROC) curve analysis.

Results

The estimated glomerular filtration rate (eGFR: mL/min/1.73 m²) (odds ratio [OR] 0.985, p<0.01), diabetes mellitus (OR 1.98, p<0.05), and maximum-IMT (mm) (OR 1.76, p<0.01) were significantly associated with coronary artery stenosis (≥75%). In analysis of each group categorized by identified factors, such as renal impairment (eGFR <60 mL/min/1.73 m²) and diabetes mellitus, the ROC curve of maximum-IMT was significant in the group of patients with diabetes mellitus without renal impairment (p<0.01) (cutoff value of maximum-IMT, 2.0 mm; sensitivity, 0.74; and specificity, 0.54) but not in other groups.

Conclusion

Renal impairment, diabetes mellitus, and increased maximum-IMT may be significant risk factors of coronary artery stenosis. Maximum-IMT as measured by ultrasonography may be a useful surrogate marker for coronary artery stenosis in patients with diabetes mellitus without renal impairment but not in other patients.

Range of L5 LDL levels in healthy adults and L5's predictive power in patients with hyperlipidemia or coronary artery disease

Electronegative L5 low-density lipoprotein (LDL) level may be a useful biomarker for predicting cardiovascular disease. We determined the range of plasma L5 levels in healthy adults (n = 35) and examined the power of L5 levels to differentiate patients with coronary artery disease (CAD; n = 40) or patients with hyperlipidemia (HLP) without evidence of CAD (n = 35) from healthy adults. The percent L5 in total LDL (L5%) was quantified by using fast-protein liquid chromatography with an anion-exchange column. Receiver operating characteristic curve analysis was performed to determine cut-off values for L5 levels. The mean L5% and plasma concentration of L5 (ie, [L5]) were significantly higher in patients with HLP or CAD than in healthy adults (P < 0.001). The ranges of L5% and [L5] in healthy adults were determined to be <1.6% and <1.7 mg/dL, respectively. In individuals with L5% >1.6%, the odds ratio was 9.636 for HLP or CAD. In individuals with [L5] >1.7 mg/dL, the odds ratio was 17.684 for HLP or CAD. The power of L5% or [L5] to differentiate patients with HLP or CAD from healthy adults was superior to that of the LDL/high-density lipoprotein ratio. The ranges of L5% and [L5] in healthy adults determined here may be clinically useful in preventing and treating cardiovascular disease.

Dyslipidaemia in type 2 diabetes mellitus: bad for the heart

PURPOSE OF REVIEW

Type 2 diabetes mellitus (T2DM) is associated with increased coronary heart disease (CHD) morbidity and mortality. These patients are also more prone to heart failure, arrhythmias and sudden cardiac death. Furthermore, coronary interventions performed in such high-risk patients have worse outcomes. In this narrative review, we discuss the role of diabetic dyslipidaemia on the risk of CHD in patients with T2DM. The effects of hypolipidaemic, antihypertensive and antidiabetic drugs on lipid and glucose metabolism in T2DM are also considered.

RECENT FINDINGS

Among CHD risk factors, diabetic dyslipidaemia characterized by moderately elevated low-density lipoprotein (LDL) cholesterol, increased triglycerides and small, dense LDL particles as well as decreased high-density lipoprotein cholesterol levels may contribute to the increased CHD risk associated with T2DM. Hypolipidaemic, antihypertensive and antidiabetic drugs can affect lipid and glucose parameters thus potentially influencing CHD risk. Such drugs may improve not only the quantity, but also the quality of LDL as well as postprandial lipaemia.

SUMMARY

Current data highlight the importance of treating diabetic dyslipidaemia in order to minimize CHD risk. Both fasting and postprandial lipids are influenced by drugs in patients with T2DM; physicians should take this into consideration in clinical decision making.

Factors Associated with Intima-Media Complex Thickness of the Common Carotid Artery in Japanese Noncardioembolic Stroke Patients with Hyperlipidemia: The J-STARS Echo Study

Aims: There may be ethnic differences in carotid atherosclerosis and its contributing factors between Asian and other populations. The purpose of this study was to examine intima-media complex thickness (IMT) of the carotid artery and associated clinical factors in Japanese stroke patients with hyperlipidemia from a cohort of the Japan Statin Treatment Against Recurrent Stroke Echo Study.

Methods: Patients with hyperlipidemia, not on statins, who developed noncardioembolic ischemic stroke were included in this study. Mean IMT and maximum IMT of the distal wall of the common carotid artery were centrally measured using carotid ultrasonography. Significant factors related to mean IMT and maximum IMT were examined using multivariable analysis.

Results: In 793 studied patients, mean IMT was 0.89 ± 0.15 mm and maximum IMT was 1.19 ± 0.32 mm. Age (per 10 years, parameter estimate = 0.044, p < 0.001), smoking (0.022, p = 0.004), category of blood pressure (0.022, p = 0.006), HDL cholesterol (per 10 mg/dl, −0.009, p = 0.008), and diabetes mellitus (0.033, p = 0.010) were independently associated with mean IMT. Age (per 10 years, 0.076, p < 0.001), smoking (0.053, p = 0.001), HDL cholesterol (−0.016, p = 0.036), and diabetes mellitus (0.084, p = 0.002) were independently associated with maximum IMT.

Conclusion: Baseline mean and maximum values of carotid IMT in Japanese noncardioembolic stroke patients with hyperlipidemia were 0.89 ± 0.15 mm and 1.19 ± 0.32 mm, respectively, which were similar to those previously reported from Western countries. Age, smoking, hypertension, HDL cholesterol, and diabetes mellitus were associated with mean IMT, and those, except for hypertension, were associated with maximum IMT.

Subclinical Carotid Atherosclerosis in Asymptomatic Subjects With Type 2 Diabetes Mellitus

BACKGROUND

Subjects with type 2 diabetes mellitus are considered to be at high risk for cardiovascular disease. The identification of carotid atherosclerosis is a validated surrogate marker of cardiovascular disease. Nurses are key professionals in the improvement and intensification of cardiovascular preventive strategies.

AIMS

The aim is to study the presence of carotid atherosclerosis in a group of asymptomatic subjects with type 2 diabetes mellitus and no previous clinical cardiovascular disease.

METHODS

A total of 187 patients with type 2 diabetes mellitus and 187 age- and sex-matched subjects without type 2 diabetes mellitus were studied in this cross-sectional, observational, cohort study. Standard operational procedures were applied by the nursing team regarding physical examination and carotid ultrasound assessment. Common, bulb, and internal carotid arteries were explored by measuring intima-media thickness and identifying atherosclerotic plaques.

RESULTS

Carotid intima-media thickness (c-IMT) and carotid plaque prevalence were significantly greater in diabetic subjects than in the control group. Carotid plaques and c-IMT were more frequent in men than in women and increased with increasing age. In the multivariate analysis, age, gender, waist circumference, systolic blood pressure, and hypercholesterolemia were positively associated with c-IMT, whereas age, gender, and weight were positively associated with carotid plaque.

CONCLUSION

The current nurse-led study shows that subjects with type 2 diabetes mellitus have a high prevalence of subclinical atherosclerosis that is associated with cardiovascular risk factors.

Combined arteriosclerotic assessment of ankle-brachial index and maximum intima-media thickness via CCTA is useful for predicting coronary artery stenosis in patients with type 2 diabetes

AIMS

Patients with diabetes mellitus (DM) are likely to develop asymptomatic myocardial infarction as a complication. However, coronary artery lesions are difficult to assess in internal medicine. This study aimed to develop a prediction formula for coronary artery stenosis, as determined by coronary computed tomographic angiography (CCTA), by analyzing risk factors in patients with type 2 DM.

METHODS

A prediction formula was developed based on a multivariate analysis of common factors in patients with ⩾50% coronary artery stenosis in a cohort of 327 patients with type 2 DM who underwent CCTA between 2007 and 2009, and cutoff values were calculated (derivation study). The validity of the optimal cutoff value was confirmed in a separate cohort of 317 patients with type 2 DM who underwent CCTA between 2010 and 2011 (validation study).

RESULTS

In the derivation study, five predictive factors (presence/absence of hypertension, estimated glomerular filtration rate, maximum intima-media thickness [max-IMT], ankle-brachial index [ABI], and use/nonuse of diabetic medication) were used to develop a prediction formula. In the validation study, positive predictive value (PPV) and negative predictive value (NPV) of the cutoff value derived from the prediction formula were 53% and 73%, respectively.

CONCLUSIONS

We developed a novel formula to predict coronary artery stenosis using five predictive factors. This formula is useful for determining whether computed tomography (CT) examination is necessary, even in clinical settings without CCTA equipment. Early detection of coronary artery stenosis in patients with DM may also lead to better health outcomes.

Synergistic in vitro antioxidant activity and observational clinical trial of F105, a phytochemical formulation including Citrus bergamia, in subjects with moderate cardiometabolic risk factors

We examined the clinical safety and efficacy of F105 in 11 subjects with moderate dyslipidemia. F105 is a combination of bergamot fruit extract (Citrus bergamia, BFE) and 9 phytoextracts selected for their ability to improve the antioxidant and anti-inflammatory activity of BFE. In vitro F105 exhibited a synergistic inhibition of oxygen radical absorbing capacity, peroxynitrite formation, and myeloperoxidase activity. Following 12 weeks of F105 daily, no treatment-related adverse events or changes in body mass were seen. Statistically significant changes were noted in total cholesterol (-7.3%), LDL-cholesterol (-10%), non-HDL cholesterol (-7.1%), cholesterol/HDL (-26%), and apolipoprotein B (-2.8%). A post hoc analysis of 8 subjects with HbA1c > 5.4 and HOMA-IR score > 2 or elevated triglycerides revealed additional statistically significant changes in addition to those previously observed in all subjects including triglycerides (-27%), oxLDL (-19%), LDL/HDL (-25%), triglycerides/HDL (-27%), oxLDL/HDL (-25%), and PAI-1 (-37%). A follow-up case report of a 70-year-old female patient, nonresponsive to statin therapy and placed on F105 daily, demonstrated improved cardiometabolic variables over 12 weeks similar to the subgroup. In summary, F105 was clinically well-tolerated and effective for ameliorating dyslipidemia in subjects with moderate cardiometabolic risk factors, particularly in the individuals with HbA1c > 5.4%.

Silent myocardial ischemia in asymptomatic patients with type 2 diabetes mellitus without previous histories of cardiovascular disease

BACKGROUND

The number of patients with type 2 diabetes mellitus (T2DM) continues to increase all over the world. Cardiovascular disease (CVD), especially coronary artery disease (CAD), is a major cause of the morbidity and mortality in patients with T2DM. The prognosis of patients with silent myocardial ischemia (SMI) is worse than that in those without.

METHODS AND RESULTS

Thus, to assess how many patients with SMI existed among those patients, CVD screening tests were performed in 128 asymptomatic patients with T2DM without previous histories of CVD. SMI could be detected in 24 patients (19%) by exercise stress tests and/or the coronary fractional flow reserve. Their 12-lead electrocardiogram and cardiac ultrasonography were both normal. Compared to those without SMI, those with had a statistically significant longer history of T2DM (17±1 versus 11±1years, p=0.006), and the co-existence of a family history of CVD (42% versus 21%, p=0.037). Furthermore, these factors were demonstrated as independent risk factors of SMI by a multivariate analysis (Odds ratio 1.060 and 4.000, respectively), and in accordance with the disease duration of T2DM, the prevalence of patients with SMI has been increasing (p=0.019).

CONCLUSIONS

Physicians should be aware of these conditions when examining patients with T2DM, especially with a family history of CVD and/or long disease duration (>11years) of T2DM, even though they have no symptoms, previous histories of CVDs, and/or abnormal findings on the 12-lead electrocardiogram and cardiac ultrasonography. This may be an effective, safe, and attractive diagnostic strategy for those asymptomatic patients with T2DM.

Hyperglycemia and Inflammatory Property of Circulating Monocytes are Associated with Inflammatory Property of Carotid Plaques in Patients Undergoing Carotid Endarterectomy

Aim: This study aims to determine the association between glucose metabolism and proinflammatory/anti-inflammatory properties of circulating monocytes or those of carotid plaques in patients who underwent carotid endarterectomy.

Methods: Clinical characteristics and expression levels of proinflammatory/anti-inflammatory markers in circulating monocytes/carotid plaques were examined in 12 patients with diabetes and 12 patients without diabetes.

Results: Circulating monocytes from patients with diabetes revealed higher tumor necrosis factor (TNF)-α and lower interleukin (IL)-10 expression levels compared with those from patients without diabetes, which was also observed in carotid plaques from patients with diabetes. Hyperglycemia revealed positive and negative correlations with the ratios of IL-6⁺ and IL-10⁺ cells in carotid plaques, respectively. Moreover, we determined a positive correlation between circulating monocytes and carotid plaques with respect to TNF-α and IL-6 expressions.

Conclusions: The inflammatory property of circulating monocytes was associated with that of carotid plaques. Hyperglycemia increased inflammatory properties and decreased anti-inflammatory properties of carotid plaques.

Coronary Artery Disease Screening With Carotid Ultrasound Examination by a Primary Care Physician

Background

In this study, we investigated the feasibility of primary care physicians using carotid ultrasound to perform coronary artery disease screening in asymptomatic patients with multiple coronary risk factors.

Methods

We retrospectively collected the data of 135 consecutive asymptomatic patients (mean age: 68.5 ± 8.4 years; male, 75%) who were referred to our institution due to abnormal findings on a carotid ultrasound performed by a primary care physician and who underwent coronary computed tomography angiography.

Results

The mean number of risk factors was 4.1 ± 1.2 and the mean intima-media thickness was 2.00 ± 0.63 mm. Mild (≤ 50%), moderate (51-75%), and severe (> 76%) coronary stenosis was observed in 54 (40%), 27 (20%), and 25 patients (19%), respectively, while no plaque was found in 24 patients (18%), and five patients (4%) could not be evaluated due to calcification. Consequently, coronary angiography was performed in 56 (41%) patients and coronary intervention was required in 31 patients (23%). A multivariate logistic regression analysis demonstrated that the ratio of low-density lipoprotein cholesterol levels to high-density lipoprotein cholesterol levels, the use of calcium channel blockers and the value of the diastolic blood pressure were related to > 50% coronary stenosis.

Conclusions

The use of carotid ultrasound in the coronary artery disease screening by primary care physicians resulted in a high prevalence of coronary artery disease and high probabilities of coronary angiography and revascularization, and thus it is considered to be a useful and feasible strategy for the screening of asymptomatic patients.

Different Impacts of Cardiovascular Risk Factors on Arterial Stiffness versus Arterial Wall Thickness in Japanese Patients with Type 2 Diabetes Mellitus

AIM

We statistically investigated whether the impact of cardiovascular risk factors on arterial stiffness would be different from that on arterial wall thickness.

METHODS

We analyzed 1648 Japanese type 2 diabetic patients. Arterial stiffness was evaluated by pulse wave verbosity (PWV) and wall thickness was assessed with carotid intima-media thickness (IMT) by ultrasonography. We developed a common regression model to PWV and IMT by extending the linear mixed model and statistically detected the difference in the impact of cardiovascular risk factors between the two indices.

RESULTS

There was a significant correlation between PWV and IMT (r=0.365, p ＜ 0.001). Sex, diabetic duration, hemoglobin A1c levels, and the presence of retinopathy and cardiovascular disease were comparable independent risk factors for elevated PWV and IMT. On the other hand, the impact of age, systolic blood pressure, and low- and high-density lipoprotein cholesterol levels were significantly different between the two measurements (all p ＜ 0.05). Cholesterol levels were significantly associated with IMT but not with PWV. Age and systolic blood pressure had a significant impact on both measurements, but the impact on PWV was significantly greater than that on IMT. Indeed, patients with low IMT but with advanced age and high systolic pressure had high PWV, whereas patients with low PWV but with impaired cholesterol levels had high IMT.

CONCLUSION

The extended linear mixed model statistically confirmed that the impact of cardiovascular risk factors on elevated PWV and IMT were not identical in Japanese patients with type 2 diabetes mellitus.

Circulating malondialdehyde-modified LDL-related variables and coronary artery stenosis in asymptomatic patients with type 2 diabetes

AIMS

To elucidate the levels of malondialdehyde-modified LDL (MDA-LDL)-related variables for predicting coronary artery stenosis (CAS) by coronary CT angiography (CCTA) in asymptomatic patients with type 2 diabetes (T2DM).

METHODS

Enrolled were 36 Japanese patients with T2DM who underwent CCTA and in whom MDA-LDL levels were measured. Definition of CAS was luminal narrowing of ≥50%. Trends through tertiles of each MDA-LDL-related variable were analyzed with a general linear model. The ability of each MDA-LDL-related variable to predict CAS was compared to areas under the curve (AUCs) in receiver operating characteristic curve (ROC) analysis.

RESULTS

Seventeen patients had CAS. Each MDA-LDL-related variable was an independent predictor of CAS (P = 0.039 for MDALDL, P = 0.013 for MDA-LDL/LDL-C, P = 0.047 for MDA-LDL/HDL-C, and P = 0.013 for (MDA-LDL/LDL-C)/HDL-C). AUCs of MDA-LDL, MDA-LDL/LDL-C, MDA-LDL/HDL-C, and (MDA-LDL/LDL-C)/HDL-C were 0.675 (95% CI 0.496-0.854), 0.765 (0.602-0.927), 0.752 (0.592-0.913), and 0.799 (0.643-0.955), respectively, for predicting CAS. Trends throughout the tertiles showed significant associations between MDA-LDL/LDL-C, MDA-LDL/HDL-C, or (MDALDL/LDL-C)/HDL-C and CAS (P = 0.003 for MDA-LDL/LDL-C, P = 0.042 for MDA-LDL/HDL-C, and P = 0.001 for (MDA-LDL/LDL-C)/HDL-C).

CONCLUSIONS

Data suggest that measurements of MDA-LDL/LDL-C, MDA-LDL/HDLC, and (MDA-LDL/LDL-C)/HDL-C are useful for predicting CAS.

The relationship between retinal nerve fiber layer thickness and carotid intima media thickness in patients with type 2 diabetes mellitus

AIMS

The aim of the present study was to investigate retinal nerve fiber layer (RNFL) thickness in patients with type 2 diabetes mellitus (T2D) using spectral-domain optical coherence tomography and to evaluate the relationship between RNFL thickness and carotid intima media thickness (CIMT).

METHODS

This study included 171 patients with T2D (53.2 ± 8.8 years) and age matched 61 healthy controls (51.9 ± 8.1 years). We evaluated anthropometric and metabolic parameters as well as RNFL and CIMT measurements in patients with T2D and controls. The Mann-Whitney U test was used to compare the continuous variables and the Chi-square test was used to compare categorical variables. Spearman's rank correlation test was used for calculation of associations between variables.

RESULTS

The average RNFL thickness was 84.82 ± 11.22 μm in patients with T2D and 92.35 ± 8.45 μm in healthy controls (p<0.001). Mean CIMT values were higher in patients with T2D (0.80 ± 0.1mm) than the healthy subjects (0.72 ± 0.1mm) (p<0.001). A significant negative correlation was found between age and all quadrants of RNFL. There was a negative correlation between average RNFL thickness and HbA1c (r=-0.176), uric acid (r=-0.145), CIMT (r=-0.190) and presence of carotid plaque (r=-0.193). The superior RNFL thickness was negatively associated with HbA1c (r=-0.175), CIMT (r=-0.207) and carotid plaque (r=-0.176). There was also an inverse correlation between the inferior RNFL thickness and HbA1c (r=-0.187) and carotid plaque (r=-0.157).

CONCLUSION

Thinning of RNFL might be associated with atherosclerosis in patients with T2D.

Arterial remodeling of basilar atherosclerosis in isolated pontine infarction

Isolated pontine infarctions are usually classified as paramedian pontine infarction (PPI) and lacunar pontine infarction (LPI). Although they have different shapes and locations, some recent studies proved that they might both be associated with basilar artery atherosclerosis in pathogenesis. This study aimed to explore the difference of basilar artery remodeling between two subtypes of pontine infarctions. Patients with PPI or LPI were scanned by High-resolution MRI (HR-MRI). The MR images of patients with basilar artery atherosclerosis were further analyzed to measure the vessel, lumen and wall areas at different segments of basilar arteries. Stenosis rate and remodeling index were calculated according to which arterial remodeling was divided into positive, intermediate and negative remodeling. Vascular risk factors and remodeling-related features were compared between PPI and LPI, and also between patients with and without positive remodeling. 34 patients with PPI and 21 patients with LPI had basilar artery atherosclerosis identified by HR-MRI. Positive remodeling was dominant in LPI group while in PPI group, three subtypes of remodeling were equal. Patients with positive remodeling had higher levels of low-density lipoprotein and homocysteine. Positive remodeling of basilar artery might reflect the low stability of basilar atherosclerotic plaques, which was more closely associated with LPI than PPI.

Subclinical atherosclerosis determinants in morbid obesity

BACKGROUND AND AIMS

Obesity is associated with increased cardiovascular risk. However, the impact of morbid obesity on vascular structure and function is not well understood. This study was designed to appraise subclinical atherosclerosis markers, including carotid intima media thickness (cIMT), endothelial function, and arterial wall stiffness, and their determinants, in morbidly obese patients.

METHODS AND RESULTS

In this cross-sectional study 194 overweight and obese patients were distributed in morbid-obese patients (MOP, n = 110), obese (OP, n = 84) and overweight patients (OwP, n = 33) groups. Demography, anthropometry, clinical and standard biochemical data were recorded. cIMT, endothelial function, defined as the small artery reactivity index (saRHI), and artery wall rigidity, studied by the augmentation index, were determined. More than 50% of the MOP, OP and OwP had a cIMT above the 75th percentile per age and gender. No differences in cIMT or saRHI were observed, although overweight and obese patients (OOP) had higher arterial rigidity compared with the morbid-obese patients. In a multivariate regression test, while cholesterol was the main determinant of cIMT in overweight and obese patients, glucose metabolism was the determinant in MOP.

CONCLUSION

More than half of the population have a cIMT above general population ranges. OwP, OP and MOP have similar cIMT and saRHI. However, OOP have greater arterial wall rigidity. Dysglycemia is the main factor associated with subclinical atherosclerosis in MOP.

Early and current physical activity: relationship with intima-media thickness and metabolic variables in adulthood

BACKGROUND

It is unclear whether early physical activity has a greater influence on intima-media thickness and metabolic variables than current physical activity.

OBJECTIVE

To analyze the relationship between current and early physical activity, metabolic variables, and intima-media thickness measures in adults.

METHOD

The sample was composed of 55 healthy subjects of both sexes (33 men and 22 women). Total body fat and trunk fat were estimated by dual-energy X-ray absorptiometry. Carotid and femoral intima-media thickness were measured using a Doppler ultrasound device. A 12-hour fasting blood sample collection was taken (fasting glucose and lipid profile). Early physical activity was assessed through face-to-face interview, and the current physical activity was assessed by pedometer (Digi-Walker Yamax, SW200), which was used for a period of seven days.

RESULTS

Current physical activity was negatively related to total cholesterol (rho=-0.31), while early physical activity was negatively related to triglycerides (rho=-0.42), total cholesterol (rho=-0.28), very low density lipoprotein (rho=-0.44), and carotid intima-media thickness (rho=-0.50). In the multivariate model, subjects engaged in sports activities during early life had lower values of very low density lipoprotein (b=-8.74 [b95%CI=-16.1; -1.47]) and carotid intima-media thickness (b=-0.17 [95%CI: -0.28; -0.05]).

CONCLUSION

Early 95%CI physical activity has a significant influence on carotid intima-media thickness, regardless of the current physical activity.

Comparison of the Framingham risk score, UK Prospective Diabetes Study (UKPDS) Risk Engine, Japanese Atherosclerosis Longitudinal Study-Existing Cohorts Combine (JALS-ECC) and maximum carotid intima-media thickness for predicting coronary artery stenosis in patients with asymptomatic type 2 diabetes

AIMS

To compare the efficacy of Framingham Risk Score (FRS), UK Prospective Diabetes Study (UKPDS) risk engine, a risk score based on the Japanese Atherosclerosis Longitudinal Study-Existing Cohorts Combine (JALS-ECC), the maximum intima-media thickness (max-IMT) determined on coronary computed tomography angiography (CCTA) and their combination in asymptomatic patients with type 2 diabetes.

METHODS

A total of 116 Japanese patients with type 2 diabetes underwent CCTA. The risk of coronary heart disease was calculated according to the FRS, UKPDS and JALS-ECC. We evaluated the reclassification of coronary artery stenosis (CAS) based on the risk score categories after adding each IMT related variable.

RESULTS

Sixty-eight patients had CAS. The areas under the curves (AUCs) in the receiver operating characteristic curve analyses of FRS, UKPDS and JALS-ECC were 0.763 (95% confidence interval [CI]: 0.674-0.853), 0.785 (95% CI: 0.703-0.868) and 0.767 (95% CI: 0.681-0.853), respectively. The AUCs for FRS, UKPDS and JALS-ECC combined with the max-IMT were 0.788 (95% CI: 0.705-0.872), 0.800 (95% CI: 0.720-0.879) and 0.786 (95% CI: 0.703-0.869), respectively. Combining the max-IMT with the risk scores improved the identification of subjects with stenotic lesions, in particular, those in the first, second and third tertiles of the FRS, first and second tertiles of the UKPDS and first and second tertiles of the JALS-ECC (P=0.054, P=0.056, P=0.015, P=0.082, P=0.060, P=0.007, and P=0.080, respectively). The net reclassification improvement increased following the addition of a max-IMT of ≥ 1.9 mm (32.4% in FRS, 19.9% in UKPDS and 51.7% in JALS-ECC).

CONCLUSIONS

These data suggest that combining a risk score with the max-IMT improves the prediction of CAS in comparison with the risk score alone.