Impact of weight reduction on early carotid atherosclerosis in obese premenopausal women.

OBJECTIVE: To investigate the extent of carotid atherosclerosis and the effect of weight loss on carotid intima-media thickness (IMT) in obese premenopausal women. RESEARCH METHODS AND PROCEDURES: In 43 obese premenopausal women who participated in a 3-month weight reduction program with a hypocaloric diet, IMT was measured by B-mode high-resolution ultrasound at entry and after 5 months of follow-up. Blood samples were analyzed at entry, after intervention, and after 5 months of follow-up. Nineteen lean women served as control subjects. RESULTS: At entry, common carotid IMT (0.72 vs. 0.59 mm), carotid bulb IMT (0.90 vs. 0.71 mm), and overall mean IMT (0.81 vs. 0.65 mm) were greater in obese women than in lean women (all p < 0.01). After dietary intervention decreases in blood pressure, low density lipoprotein to high density lipoprotein cholesterol ratio, triglycerides, fibrinogen, plasminogen activator inhibitor-1, and an increase in tissue-type plasminogen activator activity levels were observed. These effects persisted after follow-up in 14 women who maintained reduced weight. Reduction in carotid bulb IMT (to 0.81 mm, p < 0.01) and overall mean IMT (to 0.79 mm, p < 0.05) was observed in this subgroup. No significant change of carotid IMT was detected in eight women who regained weight. Changes in IMT were associated independently and significantly with changes in body mass index, low density lipoprotein to high density lipoprotein cholesterol ratio, and plasminogen activator inhibitor-1 antigen. DISCUSSION: Obese premenopausal women had greater IMT than did age-matched lean controls. It seems that this early atherosclerotic changes may be reversed by normalization of body weight.

LYS-plasminogen shortens the duration of local thrombolytic treatment of peripheral arterial occlusions--a randomized controlled trial.

Local thrombolytic treatment of peripheral arterial occlusions, which has been accepted as a therapeutic alternative to surgical treatment, is not always successful. One of the reasons for unsuccessful thrombolytic treatment might be a low concentration of plasminogen in the thrombus or insufficient activation of the thrombolytic system. Therefore the purpose of this study was to determine whether the success of local treatment of peripheral arterial occlusions of lower extremities with streptokinase could be improved by enriching the thrombus with exogenous plasminogen and furthermore, if the therapeutic success depends on a systemic fibrinolytic effect. In a prospective randomized study two groups of patients with acute and subacute arterial occlusions of the lower limbs (Stage III, IV) were treated with a continuous infusion of local low dose of streptokinase (SK). The first group (45 patients, mean age 73 years) was treated with SK only (3750 IU/hour) (SK group). While the patients in the second group (43 patients, mean age 72 years) received exogenous lys-plasminogen (7.5 mg) before application of SK in thrombi (SK-Plg group). The treatment was successful in 69% (31 out of 45 patients) of the SK group and in 77% (33 out of 43 patients) of the SK-Plg group. Although lysis of thrombi was observed more frequently in the SK-Plg group than in the SK-group, the clinical outcome was comparable between groups. In successfully treated patients from the SK-Plg group the duration of treatment was significantly shorter than in the SK group (33 +/- 8 hr vs. 53 +/- 11 hr, p < 0.01). A significant decrease of fibrinogen concentration as an indicator of activation of fibrinolysis was not observed in the majority of treated patients. On the other hand, in successfully treated patients of both groups, the following was observed: 24 hour after the beginning of treatment, euglobulin clot lysis times were shortened to half of baselines values, and the plasminogen concentration was also significantly reduced (to 55% of the baseline value). In unsuccessfully treated patients no significant changes in fibrinolytic parameters were observed. The results of our study indicated that enrichment of the thrombus with exogenous plasminogen does not significantly improve the percentage of successful recanalization of peripheral arteries with a local low dose of SK, but significantly shortens the duration of treatment up to reperfusion. The study also showed that in local thrombolysis for the treatment of arterial occlusion a certain degree of systemic activation of the fibrinolytic system is essential for successful dissolution of the thrombi.

Carotid intima-media thickness in young patients with familial hypercholesterolaemia.

OBJECTIVE: To assess the extent of early atherosclerotic changes of the carotid arteries in young patients with familial hypercholesterolaemia (FH) detected as increased intima-media thickness (IMT), and to determine the relations between IMT and some clinical and blood variables such as lipid and lipoprotein(a) (Lp(a)) concentration and haemostatic factors. DESIGN: The IMT of the carotid bifurcation, the proximal 1 cm of the internal carotid artery, and the distal 1 cm of the common carotid artery was determined in all subjects using B mode ultrasonography. Blood lipids, fasting glucose, and several haemostatic variables were also analysed. SUBJECTS: 28 patients with FH (12 males and 16 females aged 11 to 27 years, one homozygote, 27 heterozygotes) and 28 sex and age matched normolipidaemic healthy subjects. RESULTS: The mean carotid IMT (the average of six measurements of the maximum far wall IMT in the three carotid segments on each side) was significantly greater in patients with FH than in controls (mean (SD) 0.71 (0.15) v 0.49 (0.08) mm, P < 0.001). In all subjects, the mean IMT was significantly correlated with total cholesterol (r = 0.59), low density lipoprotein (LDL) cholesterol (r = 0.60), triglycerides (r = 0.27), and systolic blood pressure (r = 0.47). No correlation was found between the mean IMT and Lp(a), fibrinogen, tissue plasminogen activator, and plasminogen activator inhibitor 1. CONCLUSIONS: The majority of young patients with FH have a greater intima-media thickness of the carotid arteries than healthy subjects. Since the individual susceptibility of patients with FH to increased LDL cholesterol is different, B mode ultrasonography could provide a useful tool to identify those who are more likely to develop premature atherosclerotic disease.

Carotid arteries in central retinal vessel occlusion as assessed by Doppler ultrasound.

Doppler ultrasound was used to detect possible flow changes in the carotid arteries of patients with central retinal artery and vein occlusion. Twenty-three patients with central retinal artery occlusion (mean age 56, SD 11, years) were examined 4 to 48 months after the development of the occlusion and compared with age and sex matched control subjects with no history of any disease known to be associated with pathological changes in carotid vessels. Significant stenosis or occlusion of one or more carotid arteries was discovered in eight patients with retinal artery occlusion, while the ultrasonic findings were normal in all the controls (p less than 0.005). Blood flow was evaluated by the same method in 16 patients with central retinal vein occlusion (mean age 57, SD 9, years) six to 48 months after the event. A control group was chosen according to the same criteria as in previous comparison. Pathological ultrasonic findings were observed neither in the patients with retinal vein occlusion nor in the control group. The results suggested a possible aetiological relation between pathological changes in the carotid arteries and occlusion of the central retinal artery, but not occlusion of the central retinal vein.

Late results of local thrombolytic treatment of peripheral arterial occlusions.

One hundred thirty-four patients, in whom acute and subacute arterial occlusions of lower limbs were treated with low dose intraarterial streptokinase, were observed for periods of up to five years. Primary recanalization of occluded vessels was achieved in 66 patients, but in the remaining 68 patients recanalization was not observed. In 45% of the patients with successful thrombolytic treatment, percutaneous dilatation (PTA) of remnant stenosis was performed. In patients with successful recanalization the reocclusion rate was greatest in the first year (17.4%); the first two weeks after therapy were most critical in this respect. The reocclusion rate during the succeeding years ranged from 4% to 9% per year. The cumulative patency rate after five years was 63.4%. Late results were better in patients in whom more proximal vascular segments were affected. The preservation of vessel patency was highly dependent on the severity and extent of the previous atherosclerotic process and especially on the state of peripheral (runoff) arteries. Presence of diabetes mellitus increased the reocclusion rate of recanalized vessels. Of the patients with unsuccessful recanalization, only 5 reported some symptomatic improvement during the observation period, 39 (57%) needed immediate amputation, and an additional 8 (4.7%) were amputated later on. Considering the fact that all patients were previously refused for bypass surgery owing to unsuitable runoff vessels or bad general condition, the long-term results were surprisingly good, suggesting that thrombolytic treatment, combined in remnant stenosis with PTA, was an efficient method in patients with acute or subacute arterial occlusions.