Hand Osteoarthritis and Subclinical Cardiovascular Disease in Middle-Aged Women.

Objective: To determine subclinical cardiovascular disease (sCVD) in middle-aged women with clinically manifested hand osteoarthritis (HOA) and to improve the characterization of cardiovascular risk in this population. Design: We cross-sectionally evaluated the relationship between HOA and sCVD in 1,803 volunteers from the Mexican Teachers' Cohort. From 2012 to 2016, a subsample from Mexico City, the Northern state Nuevo León, and the Southern states Chiapas and Yucatán was invited for clinical evaluations, during which neurologists examined carotid arteries using ultrasound, and a standardized HOA questionnaire was also administered. HOA was defined as age ≥45 years, hand joint pain, and morning stiffness that lasted no longer than 30 minutes. sCVD was assessed using the intima-media thickness (IMT) and atherosclerotic plaques. Results: Among participants with a mean age of 51 years (±4), 18.4% met the criteria for HOA, and the prevalence of carotid atherosclerosis was 23.1%. After multivariable adjustment, women diagnosed with HOA had a 1.8% (95% confidence interval [CI] 0.3, 3.3) greater mean IMT than those without this joint disease. Similarly, women with HOA had 36% (95% CI 1.01, 1.84) higher odds of carotid atherosclerosis. Conclusions: HOA is associated with sCVD in middle-aged women. This relationship might be due to low-grade chronic inflammation; however, further research is required to clarify the underlying mechanisms.

Prevalence and Burden of Carotid and Femoral Atherosclerosis in Subjects Without Known Cardiovascular Disease in a Large Community Hospital in South-America.

INTRODUCTION: Clinical guidelines recommend measurement of arterial (carotid and femoral) plaque burden by vascular ultrasound (VUS) as a risk modifier in individuals at low or moderate risk without known atherosclerotic cardiovascular disease (ASCVD). AIM: To evaluate the prevalence of carotid and femoral plaques by age and sex, the burden of subclinical atherosclerosis (SA), and its association with classic CVRF in subjects over 30 years of age without ASCVD. METHODS: We prospectively enrolled 5775 consecutive subjects referred for cardiovascular evaluation and determined the prevalence and burden of SA using 2D-VUS in carotid and femoral arteries. RESULTS: Sixty-one percent were men with a mean age of 51.3 (SD 10.6) years. Overall, plaque prevalence was 51% in carotid arteries, 39.3% in femoral arteries, 62.4% in carotid or femoral arteries, and 37.6% in neither. The prevalence of plaques and SA burden showed an increasing trend with age, being higher in men than in women and starting before the age of 40, both in the carotid and femoral sites. There was also an increasing prevalence of plaques according to the number of CVRF, and interestingly we found a high prevalence of plaques in subjects with 0 or 1 classic CVRF. CONCLUSIONS: We observed an increased prevalence and burden of carotid or femoral SA, higher in men, beginning before the fourth decade of life and increasing with age. Despite a significant association with classic CVRF, a significant number of subjects with low CVRF were diagnosed with SA.

The impact of diabetes and subclinical hypothyroidism association with coronary artery calcium: results from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

ABSTRACT Objective: We aimed to analyze the association of diabetes and subclinical hypothyroidism with subclinical atherosclerosis measured by coronary artery calcium (CAC) in the baseline of the ELSA-Brasil study. Materials and methods: CAC was measured using a 64-detector computed tomographic scanner. The association of CAC > 0 was presented as an odds ratio (OR) and 95% confidence intervals (95%CI) in logistic models and as β (95%CI) in linear models after multivariable adjustment for confounders. Results: We analyzed 3,809 participants (mean-age (SD) 50.5 (8.8); 51.7% women). In the main analysis, we did not find an association of diabetes and subclinical hypothyroidism with CAC. However, in stratified analysis according to age strata, we found no significative interaction terms, an important heterogeneity between the groups, with the younger age strata showing an association of the group with both diseases and CAC > 0 (OR 7.16; 95%CI, 1.14; 44.89) with a wide but significative 95%CI, suggesting that the smaller number of participants in the younger group may influence the results. Our findings also showed an association of CAC > 0 and log (CAC+1) with diabetes in logistic (OR, 1.31; 95%CI, 1.05-1.63) and linear models (β, 0.24, 0.16, 0.40), respectively. Diabetes was independently associated with CAC > 0 in linear models. Discussion: In conclusion, our results showed a great heterogeneity in stratified analysis based on age in the younger age strata. Although we found no significant interaction factors, the smaller sample size for the analysis may influence the negative findings.

DNA Methylation of the IL-17A Gene Promoter Is Associated with Subclinical Atherosclerosis and Coronary Artery Disease: The Genetics of Atherosclerotic Disease Mexican Study.

The interleukin-17 (IL-17) has a crucial role during inflammation and has been associated with cardiovascular diseases, but its role in epigenetics is still poorly understood. Therefore, the aim of this study was to evaluate the DNA methylation status of the IL-17A gene promoter to establish whether it may represent a risk factor for subclinical atherosclerosis (SA) or clinical coronary artery disease (CAD). We included 38 patients with premature CAD (pCAD), 48 individuals with SA, and 43 healthy controls. Methylation in the CpG region of the IL-17A gene promoter was assessed via methylation-specific polymerase chain reaction (MSP). Individuals with SA showed increased methylation levels compared to healthy controls and pCAD patients, with p < 0.001 for both. Logistic regression analysis showed that high methylation levels represent a significant risk for SA (OR = 5.68, 95% CI = 2.38-14.03, p < 0.001). Moreover, low methylation levels of the IL-17A gene promoter DNA represent a risk for symptomatic pCAD when compared with SA patients (OR = 0.16, 95% CI = 0.06-0.41, p < 0.001). Our data suggest that the increased DNA methylation of the IL-17A gene promoter is a risk factor for SA but may be a protection factor for progression from SA to symptomatic CAD.

The impact of diabetes and subclinical hypothyroidism association with coronary artery calcium: results from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

Objective: We aimed to analyze the association of diabetes and subclinical hypothyroidism with subclinical atherosclerosis measured by coronary artery calcium (CAC) in the baseline of the ELSA-Brasil study. Materials and methods: CAC was measured using a 64-detector computed tomographic scanner. The association of CAC > 0 was presented as an odds ratio (OR) and 95% confidence intervals (95%CI) in logistic models and as ß (95%CI) in linear models after multivariable adjustment for confounders. Results: We analyzed 3,809 participants (mean-age (SD) 50.5 (8.8); 51.7% women). In the main analysis, we did not find an association of diabetes and subclinical hypothyroidism with CAC. However, in stratified analysis according to age strata, we found no significative interaction terms, an important heterogeneity between the groups, with the younger age strata showing an association of the group with both diseases and CAC > 0 (OR 7.16; 95%CI, 1.14; 44.89) with a wide but significative 95%CI, suggesting that the smaller number of participants in the younger group may influence the results. Our findings also showed an association of CAC > 0 and log (CAC+1) with diabetes in logistic (OR, 1.31; 95%CI, 1.05-1.63) and linear models (ß, 0.24, 0.16, 0.40), respectively. Diabetes was independently associated with CAC > 0 in linear models. Discussion: In conclusion, our results showed a great heterogeneity in stratified analysis based on age in the younger age strata. Although we found no significant interaction factors, the smaller sample size for the analysis may influence the negative findings.

La ultrasonografía Doppler en la enfermedad femoropoplitea como marcador de riesgo cardiovascular emergente / The doppler ultrasonography in femoropopliteal disease as an emerging cardiovascular risk marker

Introducción: La enfermedad aterosclerótica femoropoplitea es una patología cada vez más frecuente, con manifestaciones clínicas muchas veces oligo o asintomática. Está considerada una enfermedad preclínica o subclínicas, pues se puede considerar un marcador de riesgo cardiovascular emergente (aterosclerosis subclínicas), categoría que le atribuye elevada asociación con la enfermedad coronaria y cerebro vascular. Objetivo: Describir la utilidad de la Ultrasonografia doppler en la enfermedad femoropoplitea como marcador de riesgo cardiovascular emergente. Desarrollo: En términos generales, el patrón predominante en la enfermedad arterial periférica (EAP), es la patología oclusiva del sector Femoropoplíteo, aunque puede variar de acuerdo con el sexo y las características o Factor de Riesgo individuales. Conclusiones: Podemos afirmar la importancia del uso de las herramientas y/o instrumentos diagnósticos no invasivos, como la Ultrasonografia de alta resolutividad (estudios de imagen), en la detección temprana (prevención) de individuos, sanos, y/o asintomáticos con factores de riesgo cardiovasculares para la EAP, conociendo el curso evolutivo de la enfermedad que nos ocupa(AU)

Introduction: Femoropopliteal atherosclerotic disease is an increasingly frequent pathology with clinical manifestations that are often oligo or asymptomatic. It is considered a preclinical or subclinical disease since it can be deemed an emerging cardiovascular risk marker (subclinical atherosclerosis), a category that attributes a high association with coronary and cerebrovascular disease. Objective: To describe the usefulness of Doppler Ultrasonography in femoropopliteal disease as a marker of emerging cardiovascular risk. Development: In general terms, the predominant pattern in peripheral arterial disease (PAD) is the occlusive pathology of the Femoropopliteal sector, although it may vary according to sex and individual characteristics or RF. Conclusions: We can affirm the importance of the use of non-invasive diagnostic tools and/or instruments, such as high resolution Doppler Ultrasonography (imaging studies), in the early detection (prevention) of healthy and/or asymptomatic individuals with cardiovascular risk factors, knowing the evolutionary course of the disease in question(AU)

Carotid atherosclerosis in the first five years since rheumatoid arthritis diagnosis: a cross sectional study.

BACKGROUND: Systemic inflammation, documented before rheumatoid arthritis (RA) diagnosis, is associated with accelerated atherosclerosis. We aimed to compare the prevalence of carotid plaque (CP) in RA patients in the first five years since diagnosis and healthy controls, and to determine disease characteristics associated with the presence of subclinical atherosclerosis in RA patients. METHODS: This was a cross-sectional study. We recruited 60 RA patients in the first five years since diagnosis and 60 matched healthy controls. Carotid ultrasound was performed to detect the presence of CP and measure carotid-intima media thickness (cIMT). Subclinical atherosclerosis was considered as the presence of CP and/or increased cIMT. Distribution was evaluated with the Kolmogorov-Smirnov test. Comparisons were made with Chi-square or Fisher's exact test for qualitative variables and Student's t or Mann-Whitney's U test for quantitative variables. A p-value < 0.05 was considered significant. RESULTS: There were no differences in the demographic characteristics between RA patients and controls. The mean disease duration was 2.66 ± 1.39 years. A higher prevalence of CP (30.0% vs. 11.7%, p = 0.013), bilateral CP (18.3% vs. 3.3%, p = 0.008), increased cIMT (30.0% vs. 6.7%, p = 0.001), and subclinical atherosclerosis (53.3% vs. 18.3%, p = < 0.001) was found in RA patients. RA patients with subclinical atherosclerosis were older (56.70 years vs. 50.00 years, p = 0.002), presented a higher prevalence of dyslipidemia (53.1% vs. 14.3%, p = 0.002), and higher prevalence of classification in moderate-high disease activity category measured by DAS28-CRP (68.8% vs. 35.7%, p = 0.010). The latter variable persisted independently associated with subclinical atherosclerosis in the binary logistic regression (OR 6.11, 95% CI 1.51-24.70, p = 0.011). CONCLUSIONS: In the first five years since diagnosis, higher prevalence of subclinical atherosclerosis, including CP was found in RA patients. Carotid ultrasound should be considered part of the systematic CVR evaluation of RA at the time of diagnosis.

The association of diabetes, subclinical hypothyroidism and carotid intima-media thickness: results from the Brazilian Longitudinal Study of Adult Health (ELSA-Brazil).

INTRODUCTION: The association of diabetes with subclinical thyroid diseases may increase the risk of cardiovascular diseases. We analyzed the association of subclinical hypothyroidism, diabetes, and both diseases with carotid Intima-Media Thickness (cIMT) as a surrogate maker for early cardiovascular disease in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). METHODS: Cross-sectional analysis with data from the 3rd visit (2017‒2019). Linear regression models were used to evaluate the association of subclinical hypothyroidism, diabetes and of both diseases with a cIMT presented as Beta (95% Confidence Interval ‒ 95% CI) without adjustment, with adjustment for sociodemographic variables (Model 1) and multivariable adjustment (Model 1 more cardiovascular risk factors). We also used logistic regression models to analyze the Odds Ratio (OR) and 95% CI for the association of both diseases using cIMT > P75%. RESULTS: After the exclusion of patients with previous cardiovascular disease, 5,077 participants with no diseases, 1578 with diabetes, 662 with subclinical hypothyroidism, and 234 with both diseases were included in the analysis. Linear regression models showed an association of cIMT with only diabetes (ß = 0.019; 95% CI 0.012 to 0.027; p < 0.0001) and subclinical hypothyroidism more diabetes (ß = 0.03; 95% CI 0.010‒0.047, p < 0.0001). The logistic regression model reported an association between diabetes and CIMT higher than P75% (OR = 1.49, 95% CI 1.30‒1.71). No interaction between diabetes and subclinical hypothyroidism was detected using cIMT respectively as a continuous (p = 0.29) or as a categorical variable (p = 0.92). DISCUSSION: Diabetes was associated with higher cIMT values. However, no additive effect of subclinical hypothyroidism associated with diabetes over cIMT was detected.

Dietary patterns and subclinical atherosclerosis incidence and progression: Results from ELSA-Brasil.

BACKGROUND AND AIMS: Cardiovascular disease (CVD) is the main cause of disease burden worldwide. Coronary artery calcification (CAC) score is a subclinical atherosclerosis marker able to predict the risk of CVD in asymptomatic patients, and few studies have investigated the association between dietary patterns (DP) and CAC score prospectively. Thus, the aim of this study was to estimate the association between baseline DP and CAC score incidence and progression on the ELSA-Brasil cohort. METHODS AND RESULTS: This study is a longitudinal prospective analysis of the ELSA-Brasil participants who underwent a CAC exam on baseline and follow-up (n = 2,824). CAC incidence was defined as a baseline CAC score equal to zero (n = 2,131) and subsequent follow-up CAC score greater than zero. CAC progression was defined according to the Hokanson method for the individuals who presented a CAC score greater than zero at the baseline (n = 639). Dietary data were assessed at the baseline using a food frequency questionnaire (FFQ), and factor analysis was applied to identify DP. Poisson regression models with robust variance and linear regression models were applied to estimate the association between baseline DP and CAC incidence and progression. The incidence of CAC was 14.6%, while 60.3% of the individuals presented CAC progression. Three DP were identified: convenience, Brazilian traditional, and prudent. We did not find a significant association between baseline DP and CAC incidence or progression. CONCLUSION: Our findings from this longitudinal prospective analysis showed that baseline DP are not associated with CAC incidence or progression.

Early Life Determinants of Vascular Structure in Fetuses, Infants, Children, and Adolescents: A Systematic Review and Meta-Analysis.

OBJECTIVE: To investigate the association between early life exposures during the first 1000 days (conception to age 24 months) and aortic intima-media thickness (aIMT), an early indicator of cardiovascular disease (CVD) risk, in youths. STUDY DESIGN: The MEDLINE, Embase, Scopus, CINAHL, and Allied and Complementary Medicine databases were searched from inception to July 2021. Eligibility criteria included observational controlled studies in youths aged <20 years with risk factors/exposures during the first 1000 days and aIMT measurements (unadjusted mean ± SD). Outcome data were pooled using a random-effects meta-analysis. Meta-regression was used to investigate confounders. RESULTS: A total of 8657 articles were identified, of which 34 were included in our meta-analysis. The age of participants ranged from 22.9 weeks gestation in utero to 10.9 years. In the meta-analysis (n = 1220 cases, n = 1997 controls), the following factors were associated with greater aIMT: small for gestational age (SGA) status (14 studies, mean difference, 0.082 mm; 95% CI, 0.051-0.112; P < .001; I2 = 97%), intrauterine growth restriction (6 studies; mean difference, 0.198 mm, 95% CI, 0.088-0.309; P < .001; I2 = 97%), preeclampsia (2 studies; mean difference, 0.038 mm; 95% CI, 0.024-0.051; P < .001; I2 = 38%), and large for gestational age (LGA) status (3 studies; mean difference, 0.089 mm; 95% CI, 0.043-0.0136; P < .001; I2 = 93%). In meta-regression, older age (P < .001), higher prevalence of maternal smoking (P = .04), and SGA (P < .001) were associated with greater difference in aIMT in preterm participants compared with controls. Limitations included the high heterogeneity present in most meta-analyses and the scope of our meta-regression. CONCLUSIONS: Adverse early life exposures are associated with greater aIMT in youths, consistent with an increased risk for CVD later in life. Further research is needed to determine whether intervention and preventive strategies deliver clinical benefits to improve future cardiovascular health.

Carotid atherosclerosis in the first five years since rheumatoid arthritis diagnosis: a cross sectional study

Abstract Background Systemic inflammation, documented before rheumatoid arthritis (RA) diagnosis, is associated with accelerated atherosclerosis. We aimed to compare the prevalence of carotid plaque (CP) in RA patients in the first five years since diagnosis and healthy controls, and to determine disease characteristics associated with the presence of subclinical atherosclerosis in RA patients. Methods This was a cross-sectional study. We recruited 60 RA patients in the first five years since diagnosis and 60 matched healthy controls. Carotid ultrasound was performed to detect the presence of CP and measure carotidintima media thickness (cIMT). Subclinical atherosclerosis was considered as the presence of CP and/or increased cIMT. Distribution was evaluated with the Kolmogorov-Smirnov test. Comparisons were made with Chi-square or Fisher's exact test for qualitative variables and Student's t or Mann-Whitney's U test for quantitative variables. A p-value < 0.05 was considered significant. Results There were no differences in the demographic characteristics between RA patients and controls. The mean disease duration was 2.66 ± 1.39 years. A higher prevalence of CP (30.0% vs. 11.7%, p = 0.013), bilateral CP (18.3% vs. 3.3%, p = 0.008), increased cIMT (30.0% vs. 6.7%, p = 0.001), and subclinical atherosclerosis (53.3% vs. 18.3%, p = < 0.001) was found in RA patients. RA patients with subclinical atherosclerosis were older (56.70 years vs. 50.00 years, p = 0.002), presented a higher prevalence of dyslipidemia (53.1% vs. 14.3%, p = 0.002), and higher prevalence of classification in moderate-high disease activity category measured by DAS28-CRP (68.8% vs. 35.7%, p = 0.010). The latter variable persisted independently associated with subclinical atherosclerosis in the binary logistic regression (OR 6.11, 95% CI 1.51-24.70, p = 0.011). Conclusions In the first five years since diagnosis, higher prevalence of subclinical atherosclerosis, including CP was found in RA patients. Carotid ultrasound should be considered part of the systematic CVR evaluation of RA at the time of diagnosis.

The association of diabetes, subclinical hypothyroidism and carotid intima-media thickness: results from the Brazilian Longitudinal Study of Adult Health (ELSA-Brazil)

Abstract Introduction: The association of diabetes with subclinical thyroid diseases may increase the risk of cardiovascular diseases. We analyzed the association of subclinical hypothyroidism, diabetes, and both diseases with carotid Intima-Media Thickness (cIMT) as a surrogate maker for early cardiovascular disease in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Methods: Cross-sectional analysis with data from the 3rd visit (2017‒2019). Linear regression models were used to evaluate the association of subclinical hypothyroidism, diabetes and of both diseases with a cIMT presented as Beta (95% Confidence Interval - 95% CI) without adjustment, with adjustment for sociodemographic variables (Model 1) and multivariable adjustment (Model 1 more cardiovascular risk factors). We also used logistic regression models to analyze the Odds Ratio (OR) and 95% CI for the association of both diseases using cIMT > P75%. Results: After the exclusion of patients with previous cardiovascular disease, 5,077 participants with no diseases, 1578 with diabetes, 662 with subclinical hypothyroidism, and 234 with both diseases were included in the analysis. Linear regression models showed an association of cIMT with only diabetes (β = 0.019; 95% CI 0.012 to 0.027; p < 0.0001) and subclinical hypothyroidism more diabetes (β = 0.03; 95% CI 0.010‒0.047, p < 0.0001). The logistic regression model reported an association between diabetes and CIMT higher than P75% (OR = 1.49, 95% CI 1.30‒1.71). No interaction between diabetes and subclinical hypothyroidism was detected using cIMT respectively as a continuous (p = 0.29) or as a categorical variable (p = 0.92). Discussion: Diabetes was associated with higher cIMT values. However, no additive effect of subclinical hypothyroidism associated with diabetes over cIMT was detected.

Carotid intima-media thickness in patients with psoriasis with and without metabolic syndrome / Grosor de intima-media carotídea en pacientes con psoriasis con y sin síndrome metabólico

Abstract Introduction: Patients with psoriasis have an increased prevalence of cardiovascular risk factors as well as cardiovascular disease. Objective: To determine if patients with psoriasis and metabolic syndrome (MS) have a higher frequency of subclinical atherosclerosis compared with those with psoriasis without MS. Materials and Methods: A cross-sectional study was conducted in patients with psoriasis; MS was defined according to ATP III criteria. Demographic, clinical, and anthropometric data were obtained. Blood chemistry, high sensitive C-reactive protein (hs-CRP), and insulin were measure. Subclinical atherosclerosis was defined as high carotid intima-media thickness (CIMT) by Mode B ultrasound. Results: 92 patients with psoriasis were included, 67 (72.8%) with MS and 25 (27.2%) without MS. Subjects with psoriasis and MS had significantly higher weight, body mass index, waist circumference, systolic blood pressure, glucose, insulin, triglycerides, insulin resistance, hs-CRP, and lower level of high-density lipoprotein cholesterol, compared with subjects without MS. High CIMT was greater in patients with psoriasis and MS than in those without MS. Age and MS were independent predictors of increased CIMT after multiple linear regression analysis. Conclusions: MS is associated with greater inflammation and subclinical atherosclerosis in patients with psoriasis.

Resumen Introducción: Los pacientes con psoriasis tienen prevalencia incrementada de factores de riesgo y enfermedad cardiovascular. Objetivo: Determinar si los pacientes con psoriasis y síndrome metabólico (SM) tienen mayor frecuencia de ateroesclerosis subclínica comparados con pacientes con psoriasis y sin SM. Material y Métodos: Estudio transversal, en pacientes con psoriasis; SM fue definido con base en criterios ATP III. Se obtuvieron datos demográficos, clínicos y antropométricos. Se realizó química sanguínea, proteína C reactiva de alta sensibilidad (PCR-hs) e insulina. Ateroesclerosis subclínica fue definida como grosor de íntima-media carotídeo (GIMC) elevado, medido por ultrasonido tipo B. Resultados: Se incluyeron 92 pacientes con psoriasis, 67 (72.8 %) con SM y 25 (27.2 %) sin SM. Los sujetos con psoriasis y SM tuvieron valores significativamente más elevados de peso, índice de masa corporal, circunferencia de cintura, tensión arterial sistólica, glucosa, insulina, triglicéridos, resistencia a insulina, PCR-hs y menores niveles de colesterol de alta densidad, comparados con sujetos sin SM. El GIMC fue mayor en pacientes con psoriasis y SM. La edad y el SM fueron predictores independientes de mayor GIMC después de realizar múltiples análisis de regresión lineal. Conclusiones: Síndrome metabólico está asociado con mayor inflamación y ateroesclerosis subclínica en pacientes con psoriasis.

Utilidad de los índices aterogénicos del perfil lipídico en el diagnóstico de aterosclerosis subclínica / Utility of the atherogenic indices of the lipid profile in the diagnosis of subclinical atherosclerosis

Introducción: Los índices aterogénicos hacen referencia a un conjunto de indicadores bioquímicos que a partir de la relación entre variables lipídicas permiten predecir el riesgo de daño aterosclerótico. Objetivo: Evaluar la utilidad de los índices aterogénicos en el diagnóstico de aterosclerosis subclínica en pacientes con dislipidemia. Métodos: Se realizó un estudio descriptivo en 812 pacientes con diagnóstico clínico de dislipidemia en el Hospital Clínico Quirúrgico Hermanos Ameijeiras, en el período 2015-2020. Resultados: La edad media de los pacientes fue de 56,79 ± 10,24 años, predominó el grupo de 60 y más años con un 40,9 por ciento y el sexo femenino para un 73,8 por ciento. El 61,2 por ciento de los pacientes tienen presente algún tipo de obesidad. La presencia de HTA y el consumo de tabaco afectan el 52 por ciento y 24,6 por ciento de la población estudiada. El 74,8 por ciento (607 casos) fue clasificado como riesgo cardiovascular medio según los criterios de Framingham, mientras que el 12,9 por ciento fue clasificado como riesgo alto. Se identificaron 323 (39,8 por ciento) pacientes con presencia de aterosclerosis subclínica. Las diferencias de los valores medios de los índices aterogénicos entre los grupos con presencia de aterosclerosis subclínica fueron estadísticamente significativas para los índices cCtotal/ cHDL y cLDL/cHDL (p<0,05). En el análisis multivariado los índices asociados al riesgo de presentar aterosclerosis subclínica fueron la relación cCtotal/cHDL (R=1,11) y cLDL/cHDL (R=1,12) (p<0,05). Conclusiones: Los índices aterogénicos son de utilidad en el diagnóstico de aterosclerosis subclínica, los cocientes cCtotal/cHDL y cLDL/cHDL son los que están asociados significativamente con la probabilidad de presentar daño aterosclerótico carotideo(AU)

Introduction: Atherogenic indices refer to a set of biochemical indicators that, based on the relationship between lipid variables, allow predicting the risk of atherosclerotic damage. Objective: To evaluate the usefulness of atherogenic indices in the diagnosis of subclinical atherosclerosis in patients with dyslipidemia. Methods: A descriptive study was carried out in 812 patients with clinical diagnosis of dyslipidemia at Hermanos Ameijeiras Surgical Clinical Hospital, from 2015 to 2020. Results: The mean age of the patients was 56.79 ± 10.24 years, the group of 60 and over predominated with 40.9percent and the female sex with 73.8percent. Some type of obesity was present in 61.2percent of the patients. The presence of hypertension and tobacco consumption affect 52percent and 24.6percent of the population studied, respectively. 74.8percent (607 cases) were classified as medium cardiovascular risk according to Framingham criteria, while 12.9percent were classified as high risk. Three hundred twenty three (39.8percent) patients with subclinical atherosclerosis were identified. The differences in the mean values of the atherogenic indices between the groups with subclinical atherosclerosis were statistically significant for the total C/HDLc and LDLc/HDLc indices (p<0.05). In the multivariate analysis, the indices associated with the risk of subclinical atherosclerosis were the ratio of Total C/HDLc (R=1.11) and LDLc/HDLc (R=1.12) (p<0.05). Conclusions: The atherogenic indices are useful in the diagnosis of subclinical atherosclerosis; cCtotal/cHDL and cLDL/cHDL ratios are those that are significantly associated with the probability of carotid atherosclerotic damage(AU)

Sugar- and artificially-sweetened soda consumption and subclinical atherosclerosis among Mexican women.

BACKGROUND AND AIMS: Sugar-sweetened soda consumption is associated with most cardiometabolic risk factors. The role of artificially-sweetened beverages in cardiovascular disease (CVD) is inconclusive, but their consumption correlates with health impairment. Little is known about the contribution of soda consumption in subclinical stages of atherosclerosis. Therefore, we evaluated the relation between sugar- and artificially-sweetened soda consumption and carotid intima-media thickness (IMT) among Mexican women. METHODS AND RESULTS: We cross-sectionally evaluated 1093 women enrolled in the Mexican Teachers' Cohort who were free of CVD, diabetes or cancer. Sugar- and artificially-sweetened soda consumption was estimated from a validated 140-item food frequency questionnaire in 2008 and all women underwent a carotid ultrasound assessment three years later. Participants were categorized into tertiles of soda consumption in servings/week. Subclinical atherosclerosis was defined as a mean left and/or right IMT ≥0.8 mm or the presence of plaque on either common carotid artery. In multivariable regression models, women in the highest tertile of sugar-sweetened soda consumption had 2.6% (95%CI: 0.8, 4.5) mean increased IMT, and had 2-fold the risk of carotid atherosclerosis (PR: 2.0, 95%CI: 1.3, 3.2) compared to those in the lowest tertile. In stratified analyses, older and postmenopausal women who consumed sugar-sweetened soda had an increased IMT and atherosclerosis risk. Artificially-sweetened soda consumption was not associated with IMT or carotid atherosclerosis. CONCLUSIONS: Sugar-sweetened soda consumption was associated with subclinical atherosclerosis among disease-free Mexican women. Public health strategies to decrease CVD should consider the impact of sugar-sweetened soda consumption, particularly in older women.

Helicobacter pylori infection and DNMT3a polymorphism are associated with the presence of premature coronary artery disease and subclinical atherosclerosis. Data from the GEA Mexican Study.

BACKGROUND: The association between H. pylori infection and coronary artery disease (CAD) is well-known. Alterations in DNA methylation in CAD have been reported, which can be induced by H. pylori through the DNA demethylases (DNMTs). The objective was to analyze the association and interaction of H. pylori infection and DMNT3a gene polymorphisms with premature CAD (pCAD) and subclinical atherosclerosis (SA). METHODS: The study included 561 patients with pCAD, 318 subjects with SA, and 599 healthy controls. Antibodies against H. pylori and DNMT3a rs13420827, rs752208, and rs1550117 polymorphisms were determined. RESULTS: The pCAD group presented the highest seroprevalence of H. pylori infection (87.7%) compared to the SA (74.5%, p = 1 × 10-6) and the control group (63.1%, p = 7 × 10-23). A significant association was observed between H. pylori infection and pCAD (OR = 2.729, p = 1.0 × 10-6). The rs13420827 polymorphism was associated with a high risk of H. pylori infection in the whole population (padditive = 0.009, pdominant = 0.018, and pcodominant2 = 0.013) and in individuals with SA (padditive = 0.003, pdominant = 0.020, precessive = 0.013, and pcodominant2 = 0.005). The coexistence of H. pylori infection and the rs13420827GG genotype increases the risk of pCAD (pinteraction = 1.1 × 10-5). CONCLUSIONS: According to the model adjusted for more confounding variables, H. pylori infection was associated with almost three times the risk of developing pCAD. The rs13420827G allele was associated with an increased risk of H. pylori infection in the whole population and in individuals with SA. Individuals in whom H. pylori infection and the rs13420827GG genotype coexist are at increased risk of pCAD.

Osteoprotegerin Gene Polymorphisms Are Associated with Subclinical Atherosclerosis in the Mexican Mestizo Population.

Subclinical atherosclerosis (SA) is the presence of coronary calcification in the absence of cardiovascular symptoms, and it usually progresses to atherosclerotic disease. Studies have shown an association of osteoprotegerin gene (OPG) variants with calcification process in cardiovascular diseases; however, to this day there are no studies that evaluate individuals in the asymptomatic stage of atherosclerotic disease. Therefore, the purpose of this study was to analyze the association of four genetic variants and haplotypes of the OPG gene with the development of SA, through TaqMan genotyping assays. We also aimed to identify potential response elements for transcription factors in these genetic variants. The study included 1413 asymptomatic participants (1041 were controls and 372 were individuals with SA). The rs3102735 polymorphism appeared as a protective marker (OR = 0.693; 95% CI = 0.493−0.974; pheterozygote = 0.035; OR = 0.699; 95% CI = 0.496−0.985; pcodominant 1 = 0.040) and two haplotypes were associated with SA, one as a decreased risk: GACC (OR = 0.641, 95% CI = 0.414−0.990, p = 0.045) and another as an increased risk: GACT (OR = 1.208, 95% CI = 1.020−1.431, p = 0.029). Our data suggest a lower risk of SA in rs3102735 C carriers in a representative sample of Mexican mestizo population.

FOXA3 Polymorphisms Are Associated with Metabolic Parameters in Individuals with Subclinical Atherosclerosis and Healthy Controls-The GEA Mexican Study.

FOXA3 is a transcription factor involved in the macrophage cholesterol efflux and macrophage reverse cholesterol transport reducing the atherosclerotic lesions. Thus, the present study aimed to establish if the FOXA3 polymorphisms are associated with subclinical atherosclerosis (SA) and cardiometabolic parameters. Two FOXA3 polymorphisms (rs10410870 and rs10412574) were determined in 386 individuals with SA and 1070 controls. No association with SA was observed. The rs10410870 polymorphism was associated with a low risk of having total cholesterol >200 mg/dL, non-HDL-cholesterol > 160 mg/dL, and a high risk of having LDL pattern B and insulin resistance adipose tissue in individuals with SA, and with a high risk of having interleukin 10 p75 in individuals with SA, and with a low risk of LDL pattern B and a high risk of a magnesium deficiency in controls. Independent analysis in 846 individuals showed that the rs10410870 polymorphism was associated with a high risk of aortic valve calcification. In summary, FOXA3 polymorphisms were not associated with SA; however, they were associated with cardiometabolic parameters in individuals with and without SA.

Factores asociados a la aparición de aterosclerosis subclínica en lupus eritematoso sistémico / Factors associated with the appearance of subclinical atherosclerosis in systemic lupus erythematosus

RESUMEN Introducción: El lupus eritematoso sistémico es una enfermedad inflamatoria, crónica, multisistémica, que se define por sus múltiples rasgos clínicos y por la casi invariable presencia de autoanticuerpos dirigidos contra uno o más componentes del núcleo celular. Objetivo: Caracterizar a los pacientes con lupus eritematoso sistémico e identificar su posible relación con la aterosclerosis subclínica. Métodos: Se realizó un estudio transversal, descriptivo, de pacientes con diagnóstico de lupus eritematoso sistémico, atendidos en el Centro de Reumatología en La Habana, durante el periodo comprendido entre octubre del 2015 a octubre del 2017. La muestra fue no probabilística y estuvo formada por 50 pacientes. Se empleó estadística descriptiva e inferencial. Resultados: Del total de pacientes el 54,0 % (n = 27) presentaba aterosclerosis subclínica. Los factores de riesgo tradicionales que mostraron asociación con la presencia de placa en pacientes con LES fueron la hipercolesterolemia, 70,4 % (n = 19) e hipertrigliceridemia 55,6 % (n = 15). Se observó relación entre el tiempo de evolución, presencia de daño acumulado, compromiso renal, cifras de PCR y dosis acumulada de esteroides, con la presencia de aterosclerosis subclínica. Conclusiones: Se constató en pacientes con LES y presencia de placa un promedio de edad mayor. Los factores de riesgo tradicionales que mostraron asociación con la presencia de placa aterosclerótica fueron hipercolesterolemia e hipertrigliceridemia. Se comprobó asociación entre el tiempo de evolución, daño acumulado, compromiso renal, cifras de PCR y dosis acumulada de esteroides, con la presencia de placa. En los pacientes del estudio el uso de cloroquina estuvo asociado a la no aparición de aterosclerosis subclínica.

ABSTRACT Introduction: Systemic lupus erythematosus is an inflammatory, chronic, multisystemic disease, which is defined by its multiple clinical features and by the almost invariable presence of autoantibodies directed against one or more components of the cell nucleus. Objective: To characterize patients with Systemic Lupus Erythematosus and to identify its possible relationship with subclinical atherosclerosis. Methods: A descriptive cross-sectional study of patients diagnosed with Systemic Lupus Erythematosus, treated at the Rheumatology Center in Havana, was carried out during the period from October 2015 to October 2017. The sample was non-probabilistic and consisted of 50 patients. Descriptive and inferential statistics were used. Results: Of the total number of patients, 54.0% (n=27) had subclinical atherosclerosis. The traditional risk factors that showed association with the presence of plaque in patients with SLE were hypercholesterolemia, 70.4% (n=19) and hypertriglyceridemia 55.6% (n=15). A relationship was observed between the time of evolution, the presence of accumulated damage, renal compromise, CRP figures and accumulated dose of steroids, with the presence of subclinical atherosclerosis. Conclusions: A higher average age was found in patients with SLE and presence of plaque. The traditional risk factors that showed association with the presence of atherosclerotic plaque were hypercholesterolemia and hypertriglyceridemia. An association was found between the time of evolution, the presence of accumulated damage, renal compromise, CRP figures and the accumulated dose of steroids, with the presence of plaque. In the study patients, the use of chloroquine was associated with the absence of subclinical atherosclerosis.

Carotid intima-media thickness in patients with psoriasis with and without metabolic syndrome.

INTRODUCTION: Patients with psoriasis have an increased prevalence of cardiovascular risk factors as well as cardiovascular disease. OBJECTIVE: To determine if patients with psoriasis and metabolic syndrome (MS) have a higher frequency of subclinical atherosclerosis compared with those with psoriasis without MS. MATERIALS AND METHODS: A cross-sectional study was conducted in patients with psoriasis; MS was defined according to ATP III criteria. Demographic, clinical, and anthropometric data were obtained. Blood chemistry, high sensitive C-reactive protein (hs-CRP), and insulin were measure. Subclinical atherosclerosis was defined as high carotid intima-media thickness (CIMT) by Mode B ultrasound. RESULTS: 92 patients with psoriasis were included, 67 (72.8%) with MS and 25 (27.2%) without MS. Subjects with psoriasis and MS had significantly higher weight, body mass index, waist circumference, systolic blood pressure, glucose, insulin, triglycerides, insulin resistance, hs-CRP, and lower level of high-density lipoprotein cholesterol, compared with subjects without MS. High CIMT was greater in patients with psoriasis and MS than in those without MS. Age and MS were independent predictors of increased CIMT after multiple linear regression analysis. CONCLUSIONS: MS is associated with greater inflammation and subclinical atherosclerosis in patients with psoriasis.