Carotid-wall intima-media thickness and cardiovascular events.

BACKGROUND: Intima-media thickness of the walls of the common carotid artery and internal carotid artery may add to the Framingham risk score for predicting cardiovascular events. METHODS: We measured the mean intima-media thickness of the common carotid artery and the maximum intima-media thickness of the internal carotid artery in 2965 members of the Framingham Offspring Study cohort. Cardiovascular-disease outcomes were evaluated for an average follow-up of 7.2 years. Multivariable Cox proportional-hazards models were generated for intima-media thickness and risk factors. We evaluated the reclassification of cardiovascular disease on the basis of the 8-year Framingham risk score category (low, intermediate, or high) after adding intima-media thickness values. RESULTS: A total of 296 participants had a cardiovascular event. The risk factors of the Framingham risk score predicted these events, with a C statistic of 0.748 (95% confidence interval [CI], 0.719 to 0.776). The adjusted hazard ratio for cardiovascular disease with a 1-SD increase in the mean intima-media thickness of the common carotid artery was 1.13 (95% CI, 1.02 to 1.24), with a nonsignificant change in the C statistic of 0.003 (95% CI, 0.000 to 0.007); the corresponding hazard ratio for the maximum intima-media thickness of the internal carotid artery was 1.21 (95% CI, 1.13 to 1.29), with a modest increase in the C statistic of 0.009 (95% CI, 0.003 to 0.016). The net reclassification index increased significantly after addition of intima-media thickness of the internal carotid artery (7.6%, P<0.001) but not intima-media thickness of the common carotid artery (0.0%, P=0.99). With the presence of plaque, defined as intima-media thickness of the internal carotid artery of more than 1.5 mm, the net reclassification index was 7.3% (P=0.01), with an increase in the C statistic of 0.014 (95% CI, 0.003 to 0.025). CONCLUSIONS: The maximum internal and mean common carotid-artery intima-media thicknesses both predict cardiovascular outcomes, but only the maximum intima-media thickness of (and presence of plaque in) the internal carotid artery significantly (albeit modestly) improves the classification of risk of cardiovascular disease in the Framingham Offspring Study cohort. (Funded by the National Heart, Lung, and Blood Institute.).

Aortic intima-media thickness measured by trans-abdominal ultrasound as an early life marker of subclinical atherosclerosis.

UNLABELLED: Atherosclerosis is a chronic inflammatory process that begins in early life. Improved identification of markers of early atherosclerosis via neonatal aortic intima-media thickness (aIMT) measurement may allow the development of interventions to prevent or reduce later cardiovascular disease. CONCLUSION: Using aIMT, studies have shown that antenatal factors such as intra-uterine growth retardation, prematurity, maternal factors and inflammation are associated with early cardiovascular changes.

Structure and immunohistochemistry of the human lenticulostriate arteries.

BACKGROUND: Data about the structure and immunohistochemistry of the lenticulostriate arteries (LSAs), although very important for medical research and clinical practice, have been rarely reported in literature. MATERIALS AND METHODS: Fourty serially sectioned LSAs were stained with hematoxilin and eosin, and prepared for immunohistochemistry. RESULTS: Our examination revealed a typical endothelial lining and a narrow subendothelial space with subintimal smooth muscle cells occasionally. The internal elastic lamina was fragmented or absent in the smallest LSAs branches. The mediacoat, with a mean diameter of 148.5 µm, contained typical smooth muscle cells which formed 14.2 layers on average and showed a positive immune reactions for alfa-actin, desmine, laminin and collagen IV. The thin adventitial coat contained fibroblasts, collagen fibers, and nerve bundles, with the strongest immunopositivity to thyrosin hydroxilase. The immune reactions against CD31 and CD34 proteins,endothelial nitric oxide synthase, S 100 protein, neurofilament protein and synaptophysin,seem to be performed in the LSAs wall for the first time. Similarly,the thickness of the LSAs wall and its coats have never been reported, nor the number of the smooth muscle cell layers. CONCLUSIONS: Our results related to the structure and immunohistochemistry of the LSAs could be important in cerebrovascular pathology, neurology and neurosurgery.

Gender differences in vascular function and insulin sensitivity in young adults.

To examine influence of insulin resistance and other clinical risk factors for the MetS (metabolic syndrome) on vascular structure and function in young adults. This cross-sectional study was conducted in a cohort of young adults (mean age 22 years) and their siblings participating in a longitudinal study of cardiovascular risk (n=370). Insulin sensitivity was determined by euglycaemic insulin clamp. EDD (endothelium-dependent dilation) was determined by flow-mediated dilation using high-resolution ultrasound imaging of the brachial artery. EID (endothelium-independent dilation) was determined by NTG (nitroglycerine)-mediated dilation. The diameter and cIMT (intima-media thickness) of the carotid artery were also measured. There was no significant difference between males and females for age or body mass index. However, males had significantly higher glucose and triacylglycerol (triglyceride) levels, while the females had significantly higher HDL-C (high-density lipoprotein-cholesterol) and insulin sensitivity (13.00 ± 0.33 compared with 10.71 ± 0.31 mg·kg-1 of lean body mass·min-1, P<0.0001). Although peak EDD was significantly lower (6.28 ± 0.26 compared with 8.50 ± 0.28%, P<0.0001) in males than females, this difference was largely explained by adjustment for brachial artery diameter (P=0.15). Peak EID also was significantly lower in males than females (20.26 ± 0.44 compared with 28.64 ± 0.47%, P<0.0001), a difference that remained significantly lower after adjustment for brachial artery diameter. Males had a significantly greater cIMT compared with females (females 0.420 ± 0.004 compared with males 0.444 ± 0.004 mm, P=0.01), but when adjusted for carotid diameter, there was no significant difference (P=0.163). Although there were gender differences in vascular function and structure in the young adult population examined in this study, many of the differences were eliminated simply by adjusting for artery diameter. However, the lower EID observed in males could not be explained by artery diameter. Future studies need to continue to examine influence of gender on EID and other measures of vascular function.

Differences in left and right carotid intima-media thickness and the associated risk factors.

AIM: To investigate the difference between the left and right carotid artery intima-media thickness (CIMT) with increasing age and to analyse the importance of the various risk factors associated with left and right CIMT, respectively. MATERIALS AND METHODS: Four hundred and forty-seven people were assigned into six groups based on age. CIMT and haemodynamic parameters of both carotid arteries were measured using the Quality Intima-Media Thickness (QIMT) technique. In addition, biochemical and anthropometric indices were also measured. Their associations were evaluated using simple and partial correlation analysis, adjusted for age. RESULTS: Bilateral CIMTs became thicker with age (p<0.001) and the left CIMT was significantly thicker compared with the right between the ages of 35 and 65 years (p=0.01-0.05). In addition, the right CIMT thickened 10 years later compared with the left. Partial correlation analysis showed that the right CIMT correlated better with haemodynamic parameters compared with the left CIMT, but the left CIMT showed better correlation with biochemical indices. CONCLUSION: Haemodynamic and biochemical changes had different effects on the CIMT depending on the side affected. In addition, the left CIMT was thicker than the right between the ages of 35 and 65 years old.

Oxidative stress markers are not valuable markers in lean and early age of polycystic ovary syndrome patients.

BACKGROUND: Early atherosclerosis and increased risk of cardiovascular diseases (CVD) have been reported in patients with polycystic ovary syndrome (PCOS). Oxidative stress is an accepted risk factor for the development of CVD. AIM: To evaluate the association between oxidative stress markers [ischemia-modified albumin (IMA), total antioxidant status (TAS), and total oxidant status (TOS) levels], carotid intima- media thickness (CIMT), endocrine and metabolic parameters in patients with PCOS. MATERIALS, SUBJECTS, AND METHODS: We studied 52 patients with PCOS and 36 age- and body mass index (BMI)-matched controls. The diagnosis of PCOS was made according to the Rotterdam criteria. Metabolic, hormonal parameter and IMA, TAS, TOS levels were measured. RESULTS: No statistically significant difference was determined in relation to age, BMI and waist-hip ratio, IMA, TAS, and TOS levels between groups. Mean IMA level was higher in PCOS patients, however, statistical significant difference was not observed. Mean CIMT and homeostasis model assessment of insulin resistance levels were significantly higher in patients with PCOS than in control subjects. CONCLUSION: Our study has shown that although CIMT levels, showing CVD risk, were higher in PCOS patients, TAS and TOS oxidative stress markers were found to be similar between groups, IMA was higher in PCOS patients however the difference was not reach statistical significant. The present results suggest that CIMT increases before the state of ischemia and shows preischemic state of vasculature, while oxidative stress markers are considered to be indicators of ischemia and reperfusion injury in progressive vascular disease. Further studies are needed to show the association between oxidative stress markers, CVD and PCOS.

Effect of sedentary behaviour and vigorous physical activity on segment-specific carotid wall thickness and its progression in a healthy population.

AIMS: This study investigated whether sedentary behaviour and different activity levels have an independent association with carotid intima-media thickness (IMT) and with the 3-year IMT progression in different carotid segments. METHODS AND RESULTS: The study population included 614 healthy men and women (mean age = 44 +/- 8 years) without carotid atherosclerosis and without increased coronary heart disease risk, who underwent B-mode carotid ultrasound and objective physical activity assessment by accelerometer (mean monitoring time = 5.7 +/- 1.5 days). Time spent in sedentary (57.6 +/- 9.1%), light (41.0 +/- 9.2%), moderate and vigorous activities was determined. Sedentary behaviour was expressed as the ratio of time spent in sedentary and light activity (sedentary/light ratio) as these two activities occupied the majority of waking time. In 495 subjects, the carotid ultrasound was repeated 3 years after the baseline examination. After adjustment for age and the established risk factors that were independent determinants of carotid wall thickness in our population, sedentary/light ratio was independently associated only with the common carotid artery (CCA) IMT. The 3-year increase in CCA IMT was significantly lower in subjects with periods of vigorous activity (7 +/- 40 microm) when compared with those with light activity only or with periods of moderate activity (22 +/- 51 and 19 +/- 46 microm, respectively, P < 0.05). CONCLUSION: The healthy, young-to-middle age population of this study spent more than half of their waking time in sedentary activities. The proportion of time spent in sedentary activities was directly associated with baseline CCA IMT, independently of age and established atherosclerotic risk factors. In the longitudinal analysis, period of vigorous activity influenced the 3-year IMT progression in CCA.

Cardiovascular risk factors, nonalcoholic fatty liver disease, and carotid artery intima-media thickness in an adolescent population in southern Italy.

The objective of this study was to determine, in an adolescent population, the prevalence of nonalcoholic fatty liver disease (NAFLD) and the association of NAFLD and cardiovascular risk factors with carotid artery intima-media thickness (IMT), a marker of subclinical atherosclerosis. The authors conducted a population-based study among 642 randomly selected adolescents aged 11-13 years in Reggio Calabria, southern Italy, between November 2007 and October 2008. Prevalences of overweight and obesity were 30.5% and 13.5%, respectively. The overall prevalence of NAFLD was 12.5%, increasing to 23.0% in overweight/obese adolescents. In univariate analysis, increased IMT was positively associated with the presence of NAFLD, body mass index (BMI), waist circumference, systolic blood pressure (all P's < 0.001), diastolic blood pressure (P = 0.006), gamma-glutamyl transpeptidase (P = 0.006), alanine aminotransferase (P = 0.007), and C-reactive protein (P = 0.008) and was inversely associated with high density lipoprotein cholesterol (P < 0.001). In multivariate analysis, NAFLD (P = 0.002), BMI (P = 0.004), waist circumference (P = 0.003), and systolic blood pressure (P = 0.005) retained significant associations. The authors conclude that NAFLD, BMI, waist circumference, and systolic blood pressure are independent markers of increased IMT in a random sample of adolescents.

Higher systolic blood pressure is associated with progression of carotid intima-media thickness in patients with chronic kidney disease.

To examine the relationship between systolic blood pressure and progression of carotid intima-media thickness in patients with chronic kidney disease (CKD), we studied 3364 patients from a community-based cohort of elderly individuals of whom 724 had CKD defined as creatinine clearances of stage 3 or less. The contribution of systolic blood pressure was evaluated in four ranges (<120, 120-129, 130-139, and > or = 140 mm Hg). All multiple linear regression analyses were adjusted for traditional and nontraditional cardiovascular risk factors. The higher ranges of systolic blood pressure at baseline were associated with a greater carotid intima-media thickness at the initiation of the study in patients with or without CKD. Covariate-adjusted averages of carotid intima-media thickness at the initiation of the study in patients with CKD significantly increased across the four strata of systolic blood pressure. Higher systolic blood pressure at baseline was associated with a significantly greater yearly change in covariate-adjusted mean carotid intima-media thickness and vascular events in patients with CKD over a 4-year follow-up period.

Automated detection of the arterial inner walls of the common carotid artery based on dynamic B-mode signals.

In this paper we propose a novel scheme able to automatically detect the intima and adventitia of both near and far walls of the common carotid artery in dynamic B-mode RF (radiofrequency) image sequences, with and without plaques. Via this automated system the lumen diameter changes along the heart cycle can be detected. Three image sequences have been tested and all results are compared to manual tracings made by two professional experts. The average errors for near and far wall detection are 0.058 mm and 0.067 mm, respectively. This system is able to analyze arterial plaques dynamically which is impossible to do manually due to the tremendous human workload involved.

Regional differences in aorta of goat (capra hircus).

Regional differences in the aortic wall are important in explaining the physicomechanical properties and disease distribution in this artery. The goat is a suitable model for studying cardiovascular disease, but the regional features of its aorta are scarcely reported. The purpose of the study was therefore to describe the regional differences in the wall of its aorta. Sixteen healthy adult male domestic goats (capra hircus) were euthanised with intravenous sodium pentabarbitone and specimens obtained from the ascending, arch, each vertebral level of descending thoracic, and various segments of abdominal aorta. The specimens were fixed in 10% formaldehyde solution and routinely processed for paraffin embedding. Seven micron thick sections were stained with Mason's Trichrome and Weigert Resorcin Fuchsin stains. Light microscopic examination revealed that the aortic wall consists of tunica intima comprising endothelium, subendothelial zone and internal elastic lamina, media, and adventitia. Endothelium comprises flat and round endotheliocytes. The population of round cells declines as the internal elastic lamina increases in prominence caudally. Tunica media in ascending, arch, and proximal thoracic aorta comprises two zones: namely a luminal elastic and adventitial musculo-elastic zone, in which muscle islands interrupt some elastic lamellae. These islands progressively diminish caudally until by the eleventh thoracic vertebra they are only patchy. Beyond this point and in the abdominal aorta they are absent and tunica media consists of regular concentric elastic lamellae. Tunica adventitia, on the other hand, increases in thickness and elastic fibre content caudally. Regional variations exist in all three layers of goat aorta. The nature of these differences suggests that they are related to haemodynamic factors. Furthermore, the variations may form the basis for regional differences in physicomechanical strength and disease distribution along the aorta.

Growth-related micromorphological characteristics of the porcine common carotid artery.

The purpose of this study was to gain knowledge about the micromorphology of the porcine common carotid artery (CCA) during the period of growth over the bodyweight range of 10-40 kg. CCA samples from German landrace pigs (DL) aged either 2 or 3 months (DL-2 and DL-3) were compared with samples from Göttingen minipigs (GM) aged either 18 or 40 months (GM-18 and GM-40) using transmitted light (phase-contrast mode) and transmission electron microscopy. The GM-18, GM-40 and the DL-3 groups had typical muscular artery histological characteristics. Contrasting to this, the 2-month-old DL pigs had a transitional artery type being characterized by a significantly higher proportion of elastic fibres and a significantly lower number of smooth muscle cells than did the 1 month older DL-3. During the period of maturation, the tunica media of the CCA in GM animals thickened by 1.3× and in DL animals by 2.5× resulting in an overall increased vessel wall thickness. The cumulated thickness of the tunica interna (endothelium, stratum subendotheliale and internal elastic lamina) and the tunica media (including the external elastic lamina) of DL-3 and GM-40 pigs were similar to each other and comparable to that of humans. With an increasing vessel wall thickness, the luminal diameter decreased in GM by 19% and in DL by 11%. Additionally, in the older age groups, GM-40 and DL-3, the internal elastic lamina principally was continuous, but there were also interrupted large segments of elastic lamina separated by gaps. In addition, the principal internal elastic lamina was duplicated in several places.

Wall thickness of coronary vessels varies transmurally in the LV but not the RV: implications for local stress distribution.

Since the right and left ventricles (RV and LV) function under different loading conditions, it is not surprising that they differ in their mechanics (intramyocardial pressure), structure, and metabolism; such differences may also contribute to differences in the coronary vessel wall. Our hypothesis is that intima-media thickness (IMT), IMT-to-radius (IMT-to-R) ratio, and vessel wall stress vary transmurally in the LV, much more than in the RV. Five normal Yorkshire swine were used in this study. The major coronary arteries were cannulated through the aorta and perfusion fixed with 6.25% glutaraldehyde and casted with a catalyzed silicone-elastomer solution. Arterial and venous vessels were obtained from different transmural locations of the RV and LV, processed for histological analysis, and measured with an imaging software. A larger transmural gradient was found for IMT, IMT-to-R ratio, and diastolic circumferential stress in vessels from the LV than the nearly zero transmural slope in the RV. The IMT of arterial vessels in the LV showed a slope of 0.7 +/- 0.5 compared with 0.3 +/- 0.3 of arterial vessels in the RV (P

ApoE phenotype is associated with inflammatory markers in middle-aged subjects.

OBJECTIVES: Apolipoprotein (apo) E phenotype has been associated with inflammation markers. The determinants of these associations and the relationship between novel inflammation marker, resistin, and apoE phenotype are studied here. METHODS AND RESULTS: Middle-aged subjects of the population- based cohort (n = 526) of the OPERA- study were studied. Intima-media thickness (IMT) was measured with carotid ultrasound. The results suggest that, apoE phenotype was a significant independent predictive factor for resistin (p < 0.01) and hsCRP (p < 0.01) levels. The association of ApoE phenotype with hsCRP was seen among the subjects with the normal renal function (p = 0.005). ApoE4 was associated (p < 0.01) with the lowest hsCRP in the lowest IMT quartile while it's relation with the highest resistin levels was evident in the highest IMT quartile. CONCLUSIONS: ApoE phenotype is an independent determinant of plasma resistin and hsCRP levels. The extent of atherosclerosis and renal function seem to modify the effects of apoE phenotype on inflammatory parameters.

Factors associated with gender difference in the intima-media thickness of the common carotid artery.

AIM: To investigate the gender differences associated with a thinner intima-media thickness (IMT) of the common carotid artery (CCA) in women. MATERIALS AND METHODS: In a sample of 218 consecutive healthy volunteers comprising 110 men and 108 women, the IMT of the CCA was measured using B-mode ultrasonography. Blood pressure, fasting blood sugar, body mass index (BMI), blood lipid profile, homocysteine, folic acid, uric acid, high sensitive C-reactive protein, and thiobarbituric acid reactive substances (TBARS) levels were measured and compared with each other in both genders. RESULTS: The IMT of the CCA was significantly thinner in women than in men (p=0.012). Blood pressure, fasting plasma glucose, BMI, low-density lipoprotein cholesterol, triglycerides, homocysteine, uric acid, and TBARS were significantly (p<0.05) lower, folic acid and high-density lipoprotein cholesterol (HDL-C) were significantly (p<0.0001) higher in women compared with men. Multivariable logistic regression analysis revealed that higher serum levels of homocysteine, uric acid, and TBARS, and lower serum levels of HDL-C were significantly (p<0.05) associated with male sex. Multiple linear regression analysis further revealed that age, sex, and BMI were independently associated with CCA IMT. CONCLUSIONS: The IMT of the CCA was thinner in women than in men. Traditional vascular risk factors explain only a small amount of variance in multivariate regression models supporting the hypothesis that other behavioural, sex hormone-related or genetic factors, which have not been sufficiently explored so far, may play a role in the gender differences of IMT.

Measurement of common carotid artery intima-media thickness in clinical practice: comparison of B-mode and RF-based technique.

PURPOSE: The common carotid artery intima-media thickness (CCA-IMT) is usually measured using B-mode ultrasound images. A different approach for CCA-IMT detection is based on radio frequency (RF) multiple M-line analysis. MATERIALS AND METHODS: The present study explores the relationship between B-mode and RF measurement of CCA-IMT, as well as the reproducibility of both methods in 136 patients recently diagnosed with cardiovascular disease. Within one session, repeated measurements were made in the distal CCA bilaterally, using the B-mode (averaged over 10 mm) and RF technique (averaging 12 M-lines over 14 mm). RESULTS: The two methods correlate well (Pearson r = 0.765). The CCA-IMT values measured with B-mode and RF were 0.779 +/- 0.196 mm and 0.734 +/- 0.172 mm, respectively. B-mode CCA-IMT is significantly larger than RF CCA-IMT (mean difference of 0.045 mm, SEM 7.8 microm; t = 5.82; p < 0.001). In the multivariate regression analysis, carotid artery stenosis, inhomogeneous IMT and diabetes mellitus were the main predictors of differences between B-mode and RF CCA-IMT. The intrapatient variation for B-mode and RF-based CCA-IMT is comparable (0.05 +/- 0.04 mm and 0.07 +/- 0.05 mm, respectively). CONCLUSION: CCA-IMT values measured with RF and B-mode have similar reproducibility and exhibit acceptable correlation, but RF CCA-IMT is significantly smaller. The difference between both methods is mainly due to advanced atherosclerosis. Hence, both methods can be used reliably to measure CCA-IMT in clinical practice.

Some segmental morphological and morphometrical features of the intima and media of the aortic wall in Chinchilla lanigera.

BACKGROUND: The aim of this study is to describe the morphology, morphometry and ultrastructure of segments of the thoracic and abdominal aorta portions in Chinchilla lanigera. Thickness measurements of the tunica intima and media complex of the aorta were taken. MATERIALS AND METHODS: In all observed specimens, the thickness values for the tunica intima and media complex of the cranial thoracic aorta were significantly higher (mean: 702.19 µm) when compared to the values of other analysed aortic segments (means: 354.18 µm; 243.55 µm). Complex statistical methods were used to assess the differences between various aortic segments. RESULTS AND CONCLUSIONS: The components of the vessel walls show variations in structure and thickness, presumably due to an adaptation to functional demand.