Vitamin D and its correlation with blood lipids and intima-media thickness in term infants / Vitamina D y su correlación con los lípidos en sangre y el grosor de la íntima-media en lactantes

Background: an association between low 25(OH)D levels and blood lipids has been identified in children, adolescents, and adults but not in the early stages of life, and a relation to carotid and aortic intima-media thickness has not been well studied and is controversial. Objective: to identify whether 25(OH)D levels are correlated with blood lipids and aortic and carotid intima-media thickness in infants aged 3 to 9 months. Methods: a cross-sectional study was conducted in 109 healthy term infants between the ages of 3 and 9 months. Serum vitamin D [25(OH)D], total cholesterol, HDL-cholesterol, non-HDL-cholesterol, and aortic and carotid intima-media thickness were measured. Feeding method, vitamin D supplementation, and sun exposure habits were recorded. Results: only 2.8 % (n = 3) and 10.1 % (n = 14) had vitamin D deficiency and insufficiency, respectively. Infants with inadequate levels of vitamin D were younger (< 6 months) (p = 0.004), and a lower percentage of their body surface area was exposed to the sun (p = 0.006). A significant positive correlation was found between 25(OH)D levels and non-HDL-cholesterol in the infants that consumed breastmilk substitutes (rho = 0.600, p < 0.001) or were partially breastfed (rho = 0.371, p = 0.026), whereas a positive correlation was found with total cholesterol in the infants receiving breastmilk substitutes (rho = 0.618, p < 0.001). No significant correlation was found between vitamin D and aortic or carotid intima-media thickness. Conclusions: there was a positive correlation between 25(OH)D levels and both total and non-HDL-cholesterol only in infants receiving breastmilk substitutes. The frequency of vitamin D deficiency and insufficiency was low. (AU)

Introducción: se ha identificado una asociación entre los niveles de 25(OH)D y de lípidos en sangre en los niños, adolescentes y adultos, pero no en las primeras etapas de la vida, mientras que la asociación con el grosor de la íntima-media aórtica (a-IMT) o carotídea (c-IMT) no se ha estudiado totalmente y es objeto de controversia. Objetivo: identificar si existe correlación entre los niveles de 25(OH)D y de lípidos en sangre y el a-IMT y c-IMT en lactantes de 3 a 9 meses. Métodos: se realizó un estudio transversal en 109 lactantes sanos de entre 3 y 9 meses de edad; se midieron la vitamina D sérica [25(OH)D], el colesterol total, el colesterol HDL, el colesterol no HDL, el a-IMT y el c-IMT. Se registraron el tipo de alimentación, la suplementación con vitamina D y la exposición solar. Resultados: aquellos con niveles inadecuados de vitamina D fueron los menores de 6 meses (p = 0,004) y los expuestos en un menor porcentaje de su cuerpo al sol (p = 0,006). Se encontró una correlación positiva significativa entre la 25(OH)D, el colesterol total (rho = 0,618, p < 0,001) y el colesterol no HDL (rho = 0,600, p < 0.001) en aquellos que consumían sustitutos de la leche materna. No se encontró correlación entre la vitamina D y el grosor de la íntima-media aórtica o carotídea. Solo el 2,8 % y el 10,1 % presentaron deficiencia e insuficiencia de vitamina D, respectivamente. Conclusiones: se encontró una correlación positiva entre los niveles de 25(OH)D, colesterol total y colesterol no HDL en los lactantes que recibían sustitutos de la leche materna. (AU)

Vitamin D and its correlation with blood lipids and intima-media thickness in term infants.

INTRODUCTION: Background: an association between low 25(OH)D levels and blood lipids has been identified in children, adolescents, and adults but not in the early stages of life, and a relation to carotid and aortic intima-media thickness has not been well studied and is controversial. Objective: to identify whether 25(OH)D levels are correlated with blood lipids and aortic and carotid intima-media thickness in infants aged 3 to 9 months. Methods: a cross-sectional study was conducted in 109 healthy term infants between the ages of 3 and 9 months. Serum vitamin D [25(OH)D], total cholesterol, HDL-cholesterol, non-HDL-cholesterol, and aortic and carotid intima-media thickness were measured. Feeding method, vitamin D supplementation, and sun exposure habits were recorded. Results: only 2.8 % (n = 3) and 10.1 % (n = 14) had vitamin D deficiency and insufficiency, respectively. Infants with inadequate levels of vitamin D were younger (< 6 months) (p = 0.004), and a lower percentage of their body surface area was exposed to the sun (p = 0.006). A significant positive correlation was found between 25(OH)D levels and non-HDL-cholesterol in the infants that consumed breastmilk substitutes (rho = 0.600, p < 0.001) or were partially breastfed (rho = 0.371, p = 0.026), whereas a positive correlation was found with total cholesterol in the infants receiving breastmilk substitutes (rho = 0.618, p < 0.001). No significant correlation was found between vitamin D and aortic or carotid intima-media thickness. Conclusions: there was a positive correlation between 25(OH)D levels and both total and non-HDL-cholesterol only in infants receiving breastmilk substitutes. The frequency of vitamin D deficiency and insufficiency was low.

INTRODUCCIÓN: Introducción: se ha identificado una asociación entre los niveles de 25(OH)D y de lípidos en sangre en los niños, adolescentes y adultos, pero no en las primeras etapas de la vida, mientras que la asociación con el grosor de la íntima-media aórtica (a-IMT) o carotídea (c-IMT) no se ha estudiado totalmente y es objeto de controversia. Objetivo: identificar si existe correlación entre los niveles de 25(OH)D y de lípidos en sangre y el a-IMT y c-IMT en lactantes de 3 a 9 meses. Métodos: se realizó un estudio transversal en 109 lactantes sanos de entre 3 y 9 meses de edad; se midieron la vitamina D sérica [25(OH)D], el colesterol total, el colesterol HDL, el colesterol no HDL, el a-IMT y el c-IMT. Se registraron el tipo de alimentación, la suplementación con vitamina D y la exposición solar. Resultados: aquellos con niveles inadecuados de vitamina D fueron los menores de 6 meses (p = 0,004) y los expuestos en un menor porcentaje de su cuerpo al sol (p = 0,006). Se encontró una correlación positiva significativa entre la 25(OH)D, el colesterol total (rho = 0,618, p < 0,001) y el colesterol no HDL (rho = 0,600, p < 0.001) en aquellos que consumían sustitutos de la leche materna. No se encontró correlación entre la vitamina D y el grosor de la íntima-media aórtica o carotídea. Solo el 2,8 % y el 10,1 % presentaron deficiencia e insuficiencia de vitamina D, respectivamente. Conclusiones: se encontró una correlación positiva entre los niveles de 25(OH)D, colesterol total y colesterol no HDL en los lactantes que recibían sustitutos de la leche materna.

Cumulative Marijuana Use and Carotid Intima-Media Thickness at Middle Age: The CARDIA Study.

BACKGROUND: Long-term cardiovascular health effects of marijuana are understudied. Future cardiovascular disease is often indicated by subclinical atherosclerosis for which carotid intima-media thickness is an established parameter. METHODS: Using the data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, a cohort of 5115 Black and white women and men at Year 20 visit, we studied the association between carotid intima-media thickness in midlife and lifetime exposure to marijuana (1 marijuana year = 365 days of use) and tobacco smoking (1 pack-year = 20 cigarettes/day for 365 days). We measured carotid intima-media thickness by ultrasound and defined high carotid intima-media thickness at the threshold of the 75th percentile of all examined participants. We fit logistic regression models stratified by tobacco smoking exposure, adjusting for demographics, cardiovascular risk factors, and other drug exposures. RESULTS: Data was complete for 3257 participants; 2722 (84%) reported ever marijuana use; 374 (11%) were current users; 1539 (47%) reported ever tobacco smoking; 610 (19%) were current smokers. Multivariable adjusted models showed no association between cumulative marijuana exposure and high carotid intima-media thickness in never or ever tobacco smokers, odds ratio (OR) 0.87 (95% confidence interval [CI]: 0.63-1.21) at 1 marijuana-year among never smokers and OR 1.11 (95% CI: 0.85-1.45) among ever tobacco smokers. Cumulative exposure to tobacco was strongly associated with high carotid intima-media thickness, OR 1.88 (95%CI: 1.20-2.94) for 20 pack-years of exposure. CONCLUSIONS: This study adds to the growing body of evidence that there might be no association between the average population level of marijuana use and subclinical atherosclerosis.

Classification of Carotid Artery Intima Media Thickness Ultrasound Images with Deep Learning.

Cerebrovascular accident due to carotid artery disease is the most common cause of death in developed countries following heart disease and cancer. For a reliable early detection of atherosclerosis, Intima Media Thickness (IMT) measurement and classification are important. A new method for decision support purpose for the classification of IMT was proposed in this study. Ultrasound images are used for IMT measurements. Images are classified and evaluated by experts. This is a manual procedure, so it causes subjectivity and variability in the IMT classification. Instead, this article proposes a methodology based on artificial intelligence methods for IMT classification. For this purpose, a deep learning strategy with multiple hidden layers has been developed. In order to create the proposed model, convolutional neural network algorithm, which is frequently used in image classification problems, is used. 501 ultrasound images from 153 patients were used to test the model. The images are classified by two specialists, then the model is trained and tested on the images, and the results are explained. The deep learning model in the study achieved an accuracy of 89.1% in the IMT classification with 89% sensitivity and 88% specificity. Thus, the assessments in this paper have shown that this methodology performs reasonable results for IMT classification.

Relevancia del estudio etiológico de la disección de aorta: la historia familiar y la histología como protagonistas / Relevance of etiological study of aortic dissection: family history and histology as key players

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Integrating Active Learning and Transfer Learning for Carotid Intima-Media Thickness Video Interpretation.

Cardiovascular disease (CVD) is the number one killer in the USA, yet it is largely preventable (World Health Organization 2011). To prevent CVD, carotid intima-media thickness (CIMT) imaging, a noninvasive ultrasonography method, has proven to be clinically valuable in identifying at-risk persons before adverse events. Researchers are developing systems to automate CIMT video interpretation based on deep learning, but such efforts are impeded by the lack of large annotated CIMT video datasets. CIMT video annotation is not only tedious, laborious, and time consuming, but also demanding of costly, specialty-oriented knowledge and skills, which are not easily accessible. To dramatically reduce the cost of CIMT video annotation, this paper makes three main contributions. Our first contribution is a new concept, called Annotation Unit (AU), which simplifies the entire CIMT video annotation process down to six simple mouse clicks. Our second contribution is a new algorithm, called AFT (active fine-tuning), which naturally integrates active learning and transfer learning (fine-tuning) into a single framework. AFT starts directly with a pre-trained convolutional neural network (CNN), focuses on selecting the most informative and representative AU s from the unannotated pool for annotation, and then fine-tunes the CNN by incorporating newly annotated AU s in each iteration to enhance the CNN's performance gradually. Our third contribution is a systematic evaluation, which shows that, in comparison with the state-of-the-art method (Tajbakhsh et al., IEEE Trans Med Imaging 35(5):1299-1312, 2016), our method can cut the annotation cost by >81% relative to their training from scratch and >50% relative to their random selection. This performance is attributed to the several advantages derived from the advanced active, continuous learning capability of our AFT method.

Carotid artery intima-media thickness measurement in children with normal and increased body mass index: a comparison of three techniques.

BACKGROUND: Common carotid artery intima-media thickness is a marker of subclinical atherosclerosis. In children, increased intima-media thickness is associated with obesity and the risk of cardiovascular events in adulthood. OBJECTIVE: To compare intima-media thickness measurements using B-mode ultrasound, radiofrequency (RF) echo tracking, and RF speckle probability distribution in children with normal and increased body mass index (BMI). MATERIALS AND METHODS: We prospectively measured intima-media thickness in 120 children randomly selected from two groups of a longitudinal cohort: normal BMI and increased BMI, defined by BMI ≥85th percentile for age and gender. We followed Mannheim recommendations. We used M'Ath-Std for automated B-mode imaging, M-line processing of RF signal amplitude for RF echo tracking, and RF signal segmentation and averaging using probability distributions defining image speckle. Statistical analysis included Wilcoxon and Mann-Whitney tests, and Pearson correlation coefficient and intra-class correlation coefficient (ICC). RESULTS: Children were 10-13 years old (mean: 11.7 years); 61% were boys. The mean age was 11.4 years (range: 10.0-13.1 years) for the normal BMI group and 12.0 years (range: 10.1-13.5 years) for the increased BMI group. The normal BMI group included 58% boys and the increased BMI group 63% boys. RF echo tracking method was successful in 79 children as opposed to 114 for the B-mode method and all 120 for the probability distribution method. Techniques were weakly correlated: ICC=0.34 (95% confidence interval [CI]: 0.27-0.39). Intima-media thickness was significantly higher in the increased BMI than normal BMI group using the RF techniques and borderline for the B-mode technique. Mean differences between weight groups were: B-mode, 0.02 mm (95% CI: 0.00 to 0.04), P=0.05; RF echo tracking, 0.03 mm (95% CI: 0.01 to 0.05), P=0.01; and RF speckle probability distribution, 0.03 mm (95% CI: 0.01 to 0.05), P=0.002. CONCLUSION: Though techniques are not interchangeable, all showed increased intima-media thickness in children with increased BMI. RF echo tracking method had the lowest success rate at calculating intima-media thickness. For patient follow-up and cohort comparisons, the same technique should be used throughout.

Es la medida ecográfica manual del grosor íntima-media carotídeo un biomarcador cardiovascular reproducible? / Is manual ultrasonographic measurement of carotid intima-media thickness a reproducible cardiovascular biomarker?

Para establecer el poder discriminatorio entre sujetos enfermos y sanos de un biomarcador potencial es esencial conocer la variabilidad intrínseca de su método de medida. Este aspecto es especialmente importante en el caso de la medida ecográfica del grosor íntima-media carotídeo, cuyas variaciones submilimétricas, debidas en gran parte a la falta de precisión de la técnica ecográfica y no asumidas como tales, pueden tener un gran impacto clínico en la clasificación del riesgo cardiovascular. El objetivo de este trabajo es presentar la evidencia sobre la reproducibilidad de la medida del grosor del complejo íntima-media carotídeo, obtenida mediante ecografía, para discutir si la variabilidad de la técnica puede influir en el potencial de este parámetro como biomarcador (AU)

To establish the ability of a potential biomarker to discriminate between diseased and healthy subjects, it is essential to know the intrinsic variability of the methods used to measure the biomarker. This aspect is especially important in the ultrasonographic measurement of carotid intima-media thickness, where submillimetric variations due largely to the unrecognized lack of precision in the ultrasonographic technique can have a significant clinical impact on the classification of cardiovascular risk. This article aims to present the evidence about the reproducibility of carotid intima-media thickness measured by ultrasonography to discuss whether the variability inherent in the technique can influence the potential of this parameter as a biomarker (AU)

[Diagnostic value of carotid atherosclerosis score for ischemic stroke].

OBJECTIVE: To discuss the diagnostic value of carotid atherosclerosis score for ischemic stroke. METHODS: In the study, 151 patients with ischemic stroke were enrolled, who were diagnosed by cranial CT scan or cranial MRI scan, and examined with carotid duplex ultrasound, and 151 healthy check-up cases matched by age and sex were chosen as control group, who were excluded ischemic stroke by cranial CT scan or cranial MRI scan. All the control cases were examined with carotid duplex ultrasound also. Intima-media thickness (IMT), the number of carotid plaques, the size of each plaque, the location of the plaque and each plaque's echo, texture, surface regularity were estimated by carotid duplex ultrasound. RESULTS: The IMT of the case group and the control group were (0.946±0.185) mm and (0.863±0.148) mm, and there were significant differences (P<0.001); The parameters of arterial plaque correlated with ischemic stroke were plaque's echo, texture and surface regularity, however the plaque size and location were not correlated with ischemic stroke. The median and quartile of carotid artery plaque score were 3 and 2 respectively in case group, 1 and 2 respectively in control group, and there were significant differences (P<0.001); The parameters of carotid arterial atherosclerosis associated with ischemic stroke were carotid artery plaque score,carotid stenosis degree and IMT, but not the number of carotid plaques. The median and quartile of carotid arterial atherosclerosis score were 5 and 4 respectively in case group, 2 and 4 respectively in control group, and there were significant differences (P<0.001); The area under the curve (AUC) for IMT, the number of carotid plaques, carotid artery plaque score and carotid arterial atherosclerosis score were 0.679, 0.677, 0.704 and 0.805,respectively (P<0.001). The accuracy of carotid atherosclerosis score was the highest. CONCLUSION: Carotid artery plaque score and carotid atherosclerosis score can be used for the diagnosis of ischemic stroke, and the accuracy of carotid atherosclerosis score is higher.

Social mobility and subclinical atherosclerosis in a middle-income country: Association of intra- and inter-generational social mobility with carotid intima-media thickness in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

Over the past half century Brazil has undergone a process of dramatic industrialization and urbanization. Cardiovascular diseases (CVD) have become common due to rapid demographic, epidemiologic, and nutritional transitions. The association of social mobility with subclinical CVD has been rarely explored, particularly in developing societies. We investigated the association of intra- and inter-generational social mobility with carotid intima-media thickness (IMT), a marker of subclinical or asymptomatic atherosclerosis, in a large Brazilian sample (ELSA-Brasil). We used baseline data (2008-2010) for 7343 participants from ELSA-Brasil. Intra-generational social mobility was defined as the change in occupational social class between participants' first occupation and current occupation. Inter-generational social mobility was defined as the change in occupational social class of the head of the household when the participant started working and participants' current occupation. Social mobility groups were classified as: stable high (reference), upward, downward and stable low. Linear regression models were used to examine the associations between type of social mobility and IMT. Compared to those who experienced stable high occupational status across generations, downward inter-generational mobility was associated with greater IMT. Additionally, those who declined the most in occupational status had the highest values of IMT, even after adjustments for lifestyle and cardiovascular factors. For intra-generational mobility, stable low versus stable high social mobility was independently associated with higher IMT. Subclinical atherosclerosis is patterned by socioeconomic status both within and across generations, demonstrating an association even before symptoms of CVD appear. The health consequences of downward inter-generational social mobility were not fully explained by lifestyle and cardiovascular factors, whereas being consistently exposed to low occupational status within one's own adulthood was associated with greater IMT, suggesting a cumulative risk model. Primary prevention of atherosclerosis should be complemented by macrosocial policies aimed to reduce downward socioeconomic mobility between generations.

Factors associated with increased carotid intima-media thickness in obstructive sleep apnea/hypopnea syndrome.

BACKGROUND: Obstructive sleep apnea/hypopnea syndrome (OSAHS) is strongly associated with the increase of cardiovascular and cerebrovascular disorders. Carotid intima-media thickness (IMT) is used as a surrogate marker for subclinical or early atherosclerosis. Knowledge regarding early atherosclerosis in patients with OSAHS is scarce, and factors predicting carotid IMT have not been well studied. OBJECTIVE: To compare IMT in patients with OSAHS versus controls and explore the factors associated with increased IMT in OSAHS. METHODS: One hundred fifty-six OSAHS patients and 35 controls without history of vascular events, hypertension, and diabetes mellitus who underwent polysomnography were consecutively enrolled. Carotid IMT was measured using B-mode ultrasonography. Body mass index, waist circumference, hip circumference, waist-to-hip circumference ratio, Epworth Sleepiness Scale, and polysomnographic variables including arousal index, apnea/hypopnea index, mean oxygen saturation, and lowest oxygen saturation were assessed. Fasting plasma glucose, blood lipid profile, and high-sensitivity C-reactive protein were measured. RESULTS: Average carotid IMT of OSAHS patients was significantly thicker than controls (0.66 vs. 0.58 mm, P=0.002) and multivariable logistic regression analysis revealed that arousal index [odds ratio (OR), 0.77; confidence interval (CI), 0.63-0.95; P=0.01] and lowest oxygen saturation (OR, 1.91; CI, 1.24-2.95; P=0.003) were significantly associated with OSAHS patients. Among the OSAHS patients, age (OR, 1.16; CI, 1.10-1.22; P<0.0001), fasting plasma glucose (OR, 1.05; CI, 1.01-1.10; P=0.04), low-density lipoprotein cholesterol (OR, 1.03; CI, 1.02-1.05; P<0.0001), and high-sensitivity C-reactive protein (OR, 1.48; CI, 1.13-1.95; P=0.005) were significantly associated with patients with IMT≥0.65 mm. CONCLUSIONS: IMT was thicker in OSAHS patients without history of vascular events, hypertension, and diabetes mellitus. This study demonstrates that early atherosclerosis exists in this group of patients.

Should preclinical vascular abnormalities be measured in asymptomatic adults to improve cardiovascular risk stratification?

PURPOSE OF REVIEW: Guideline groups have issued contradictory decisions as to the value of noninvasive tests in asymptomatic adults at intermediate cardiovascular risk. Reclassification has only recently been accepted as a critical criterion to determine the utility of a diagnostic test. The present review examines potential limitations in reclassification and evaluates the utility of carotid ultrasound, pulse wave velocity and ankle brachial index from a clinical perspective. RECENT FINDINGS: Reclassification is less useful than generally believed, because therapy is already indicated in the majority of patients at intermediate risk and it is far from clear that treatment should be withheld in those who are downgraded in risk. Moreover, the additional benefit from more intensive therapy is much less than often thought. Reproducibility, standardization and reference values of noninvasive tests are obligatory before introduction in clinical care. SUMMARY: Routine screening of all those at intermediate risk does not appear to be justified. Screening should be performed on those individuals in whom the noninvasive test changes clinical care, which is most apparent for individuals at intermediate risk with LDL level less than 2.5 mmol/l, in whom positive noninvasive tests will result in the start of statin treatment. The primary value of these tests should not be to determine risk but to identify preclinical anatomic disease.