Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.754
Filtrar
1.
Niger J Clin Pract ; 23(6): 759-763, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32525108

RESUMO

Objective: The aim of this study was to detect the prevalence of soft tissue calcifications in the head and neck using cone beam computed tomography (CBCT) and to determine their clinical importance. Subjects and Methods: Soft tissue calcifications in the head and neck region were retrospectively evaluated in 1557 CBCT images obtained between 2013 and 2015. The findings were categorized as follows: tonsillolith (calcified tonsil), carotid artery calcification (CAC), sialolith (salivary stone), calcified triticeous cartilage (CTC), calcified lymph node (CLN), rhinolith, antrolith, calcification of the superior cornu of the thyroid cartilage (CSCTC), calcified stylohyoid ligaments (CSL), myositis ossifican, osteoma cutis, and intracranial calcification. A Chi-square test was performed for categorical variables. In the 1557 CBCT images, 520 (33.4%) contained had at least one soft tissue calcification in the head and neck region. Results: Tonsilloliths (18.8%) were the most prevalent soft tissue calcification, followed by CTC (5.8%), CAC (4.3%), intracranial calcifications (3.9%), CSL (3.7%), CSCTC (2.1%), osteoma cutis (1%), sialoliths (0.7%), antroliths (0.5%), myositis ossificans (0.4%), rhinoliths, and CLN (0.2%). Conclusion: There was a high prevalence of soft tissue calcifications in the head and neck region on CBCT images. Tonsilloliths were the most common type of calcification. CBCT imaging may aid the diagnosis and assessment of these calcifications.


Assuntos
Calcinose/diagnóstico por imagem , Calcinose/epidemiologia , Tomografia Computadorizada de Feixe Cônico/métodos , Cabeça/diagnóstico por imagem , Pescoço/diagnóstico por imagem , Tonsila Palatina/diagnóstico por imagem , Adulto , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/epidemiologia , Doenças das Cartilagens/diagnóstico por imagem , Doenças das Cartilagens/epidemiologia , Feminino , Humanos , Linfadenopatia/diagnóstico por imagem , Linfadenopatia/epidemiologia , Masculino , Pessoa de Meia-Idade , Doenças Faríngeas/diagnóstico por imagem , Doenças Faríngeas/epidemiologia , Prevalência , Estudos Retrospectivos
2.
J Stroke Cerebrovasc Dis ; 29(7): 104845, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32389559

RESUMO

BACKGROUND: A systematic evaluation of the relationship between frailty and large artery atherosclerosis (LAA) burden has not been carried out. Here, we aimed to assess the association between these variables in community-dwelling older adults living in Atahualpa (rural Ecuador). METHODS: Participants underwent frailty assessment and determinations of LAA in several vascular beds. Frailty was estimated by the Edmonton Frailty Scale (EFS). LAA was investigated in the peripheral vascular bed by means of ankle-brachial index determinations, in the extracranial carotid bed by B-mode ultrasounds, and in the intracranial bed by high-resolution CT and time-of-flight MRA. Ordinal logistic regression with interaction models were fitted to assess the independent association between levels of cognitive frailty and the LAA burden. Casual mediation and sensitivity analysis, and the E value, evaluated the effect of age in this association. RESULTS: Out of 331 included individuals, 176 (53%) were robust and the remaining 47% were either pre-frail (n = 78) or frail (n = 77). Atherosclerosis affected only one (any) vascular bed in 111 (34%) individuals, two beds in 75 (23%), and three beds in 22 (7%); the remaining 123 (37%) had no evidence of atherosclerosis. Univariate analysis showed a significant inverse association between the robust status of cognitive frailty and LAA burden (p = 0.006). This association vanishes after considering the effect of covariates. Causal mediation analysis confirms that age captures 51.8% (95% C.I.: 34.6 to 97.2%) of the effect of the association. Sensitivity analysis and E-value computation find that the amount of bias provided by age is enough to explain away the effect estimate. CONCLUSIONS: This study found no independent relationship between cognitive frailty and LAA burden.


Assuntos
Doenças das Artérias Carótidas/epidemiologia , Envelhecimento Cognitivo , Idoso Fragilizado , Fragilidade/epidemiologia , Vida Independente , Arteriosclerose Intracraniana/epidemiologia , Doença Arterial Periférica/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Índice Tornozelo-Braço , Doenças das Artérias Carótidas/diagnóstico por imagem , Angiografia Cerebral , Envelhecimento Cognitivo/psicologia , Angiografia por Tomografia Computadorizada , Estudos Transversais , Equador/epidemiologia , Idoso Fragilizado/psicologia , Fragilidade/diagnóstico , Fragilidade/psicologia , Nível de Saúde , Humanos , Arteriosclerose Intracraniana/diagnóstico por imagem , Angiografia por Ressonância Magnética , Saúde Mental , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico , Medição de Risco , Fatores de Risco , Ultrassonografia
3.
PLoS One ; 15(4): e0232636, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32353062

RESUMO

BACKGROUND: While HIV infection is associated with increased cardiovascular risk, benefit from statin is not well established in HIV-infected adults. We assessed whether statins are associated with a decrease in carotid artery intima-media thickness (cIMT) progression and all-cause mortality in HIV-infected adults who are at elevated ASCVD risk and recommended for statins. METHODS: Carotid IMT was measured at baseline and follow-up in 127 HIV-infected adults who meet ACC/AHA criteria to be on statins. Inverse probability of treatment weighting (IPTW) was used to address selection bias. Multivariable models were used to control for baseline characteristics. RESULTS: 28 subjects (22%) were on statins and 99 subjects (78%) were not. Mean cIMT at baseline was 1.2 mm (SD = 0.34) in statin users and 1.1 mm (SD = 0.34) in non-users, and the multivariable adjusted difference was 0.05mm (95%CI -0.11, 0.21 p = 0.53). After 3.2 years of follow-up, average cIMT progression was similar in statin users and non-users (0.062mm/yr vs. 0.058 mm/yr) and the multivariable adjusted difference over the study period was 0.004 mm/yr (95% CI -0.018, 0.025, p = 0.74). All-cause mortality appeared higher in non-statin users compared with statin users, but the difference was not significant (adjusted HR = 0.74, 95%CI 0.17-3.29, p = 0.70). CONCLUSION: In a HIV cohort who had elevated ASCVD risk and meet ACC/AHA criteria for statins, treatment with statins was not associated with a reduction in carotid atherosclerosis progression or total mortality. Future studies are needed to further explore the impact of statins on cardiovascular risk in the HIV-infected population.


Assuntos
Doenças das Artérias Carótidas/epidemiologia , Causas de Morte , Infecções por HIV/complicações , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Doenças das Artérias Carótidas/diagnóstico , Doenças das Artérias Carótidas/prevenção & controle , Espessura Intima-Media Carotídea , Estudos de Coortes , Progressão da Doença , Feminino , Seguimentos , Infecções por HIV/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco
4.
Lancet Glob Health ; 8(5): e721-e729, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32353319

RESUMO

BACKGROUND: Estimation of the epidemiological burden of carotid atherosclerosis can serve as a basis for prevention and management of cardiovascular disease. We aimed to provide the first estimation on the prevalence, number of cases, and risk factors for carotid atherosclerosis in the general population globally and regionally. METHODS: In this systematic review, meta-analysis, and modelling study, we searched PubMed, MEDLINE, Embase, Global Health, and China National Knowledge Infrastructure for articles published from database inception until May 7, 2019, with no language restrictions, for population-based studies that quantified prevalence of carotid atherosclerosis by means of increased carotid intima-media thickness, carotid plaque, and carotid stenosis. Studies were eligible if they included bilaterally scanned carotid arteries using ultrasonography and defined increased carotid intima-media thickness as a thickness of 1·0 mm or more, carotid plaque as a focal carotid intima-media thickness of 1·5 mm or more encroaching into the lumen or at least 0·5 mm or 50% compared with the surrounding carotid intima-media thickness values, and carotid stenosis as 50% or more stenosis. Studies were excluded if the sample was not representative of the general population. We also included studies identified in our previous systematic review and meta-analysis of the prevalence of carotid atherosclerosis in China. We estimated age-specific and sex-specific prevalences of increased carotid intima-media thickness, carotid plaque, and carotid stenosis. We used UN population data to generate the number of people affected in 2000, 2015, and 2020. We did random-effects meta-analyses to assess the effects of risk factors for increased carotid intima-media thickness and carotid plaque. We derived regional numbers of people living with increased carotid intima-media thickness and carotid plaque in 2015 using a risk factors-based model by WHO region. All analyses were done in populations aged 30-79 years due to availability of data. This systematic review and meta-analysis is registered online on PROSPERO, CRD42019134709. FINDINGS: We identified 8632 articles through our database search, of which 515 were eligible for full-text review, including 37 articles from our previous study, and 59 articles were eligible for inclusion in our systematic review and meta-analysis. Overall, in people aged 30-79 years in 2020, the global prevalence of increased carotid intima-media thickness is estimated to be 27·6% (95% CI 16·9-41·3), equivalent to 1066·70 million affected people and a percentage change of 57·46% from 2000; of carotid plaque is estimated to be 21·1% (13·2-31·5), equivalent to 815·76 million affected people and a percentage change of 58·97% from 2000; and carotid stenosis is estimated to be 1·5% (1·1-2·1), equivalent to 57·79 million affected people and a percentage change of 59·13% from 2000. The prevalence of increased carotid intima-media thickness, carotid plaque, and carotid stenosis increased consistently with age and was higher in men than in women. Current smoking, diabetes, and hypertension were common risk factors for increased carotid intima-media thickness and carotid plaque. In 2015, the Western Pacific region had the largest share of global cases of increased carotid intima-media thickness (317·62 million [33·36%] of 952·13 million affected people) and carotid plaque (240·77 million [33·20%] of 725·25 million), whereas the African region had the smallest share of cases of increased carotid intima-media thickness (59·08 million [6·21%]) and the Eastern Mediterranean region had the smallest share of carotid plaque cases (44·59 million [6·15%]). INTERPRETATION: A substantial global burden of carotid atherosclerosis exists. Effective strategies are needed for primary prevention and management of carotid atherosclerosis. High-quality epidemiological investigations on carotid atherosclerosis are needed to better address the global burden of carotid atherosclerosis at finer levels. FUNDING: None.


Assuntos
Doenças das Artérias Carótidas/epidemiologia , Saúde Global/estatística & dados numéricos , Humanos , Modelos Estatísticos , Prevalência , Fatores de Risco
5.
Cardiovasc Diabetol ; 19(1): 54, 2020 05 06.
Artigo em Inglês | MEDLINE | ID: mdl-32375803

RESUMO

BACKGROUND: Since studies of the relationship between carotid disease and diabetic retinopathy (DR) have shown apparent inconsistencies, the aim of this study was to conduct a systematic review of available published data. METHODS: Electronic databases were searched independently by two reviewers, according to an iterative protocol, for relevant articles. The search term used was "diabetes AND (carotid disease OR intima-media OR carotid plaque OR carotid stenosis OR carotid arterial disease OR carotid artery disease OR carotid atherosclerosis) AND (retinopathy OR diabetic retinopathy)". RESULTS: From 477 publications, 14 studies were included. There were differences in the variables used as markers of carotid disease and DR across the included studies. Ten studies used carotid disease as the dependent variable, and the remainder used DR. All but one study involved cross-sectional data. Most studies reported a statistically significant association between at least one parameter of carotid disease as assessed by ultrasound and DR presence or severity. Only four studies reported no significant association. A common limitation was the use of convenience participant sampling. CONCLUSIONS: There appears to be an increased likelihood of DR when there is ultrasonographic evidence of carotid disease, and vice versa. The available studies suggest that there may be a direct relationship between DR and carotid macrovascular disease and/or that these complications co-exist due to shared risk factors. If carotid disease is detected, retinal assessment should be performed. If DR is identified, intensive cardiovascular disease risk management should be considered. Additional longitudinal studies are needed to assess the directionality of the association.


Assuntos
Doenças das Artérias Carótidas/epidemiologia , Retinopatia Diabética/epidemiologia , Doenças das Artérias Carótidas/diagnóstico por imagem , Retinopatia Diabética/diagnóstico , Humanos , Prognóstico , Medição de Risco , Fatores de Risco
6.
Stroke ; 51(6): 1743-1749, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32375585

RESUMO

Background and Purpose- Embolic stroke of undetermined source (ESUS) constitutes a large proportion of acute ischemic stroke. It is crucial to identify possible stroke etiologies in this patient subgroup to individually tailor secondary stroke prevention strategies. This study aimed to assess the prevalence of carotid plaques causing <50% stenosis in ESUS patients on computed tomography angiography and the association of these plaques with ipsilateral strokes. Methods- Patients from INTERRSeCT-a multicenter prospective study of patients with acute ischemic stroke-were included in this study if their stroke etiology was not large artery atherosclerosis (>50% stenosis), and neck computed tomography angiography was obtained. Degree of stenosis (<30% versus 30%-50%), maximum plaque thickness, degree of plaque calcification (<50% versus ≥50%), plaque irregularity, ulceration, hypodensity, carotid web, and focal vessel outpouching were assessed for both carotid arteries on computed tomography angiography. Prevalence of carotid plaques with <50% stenosis (nonstenotic plaques), ipsilateral and contralateral to the stroke, in ESUS patients was determined and compared with non-ESUS patients. Features of these plaques with versus without ipsilateral stroke in ESUS patients were compared. Uni- and multivariable logistic regression was performed to determine associations between nonstenotic carotid plaque, plaque characteristics, and ipsilateral stroke in ESUS patients. Results- Four hundred forty-six patients were included in the study (median age, 73 years; 218 men), 138 of which were ESUS patients (median age, 70 years; 61 men). Nonstenotic carotid plaques (with <50% stenosis) were present in 54 of 138 (39.1%) ESUS patients. Twelve (8.7%) patients had bilateral carotid plaques. Forty (60.6%) of these plaques were ipsilateral and 26 (39.4%) contralateral to the side of the stroke (P=0.004). Nonstenotic carotid plaques were significantly associated with ipsilateral strokes (adjusted odds ratio, 1.83 [95% CI, 1.05-3.18]). Conclusions- In patients with ESUS, nonstenotic carotid plaques were significantly more common on the side of the ischemic stroke, suggesting that these plaques could be a potential stroke etiology in patients in whom the ischemic stroke is classified currently as ESUS.


Assuntos
Isquemia Encefálica , Doenças das Artérias Carótidas , Angiografia por Tomografia Computadorizada , Embolia , Placa Aterosclerótica , Acidente Vascular Cerebral , Calcificação Vascular , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/epidemiologia , Isquemia Encefálica/etiologia , Doenças das Artérias Carótidas/complicações , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/epidemiologia , Embolia/diagnóstico por imagem , Embolia/epidemiologia , Embolia/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Placa Aterosclerótica/complicações , Placa Aterosclerótica/diagnóstico por imagem , Placa Aterosclerótica/epidemiologia , Prevalência , Estudos Prospectivos , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Calcificação Vascular/complicações , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/epidemiologia
7.
Artigo em Chinês | MEDLINE | ID: mdl-32447888

RESUMO

Objective: To investigate the association between occupational stress and carotid atherosclerosis among the workers in a steel plant. Methods: In October 2018, a total of 2947 workers from a steel plant, who underwent occupational health examination in the center for occupational health examination from March to May 2017, were selected as subjects. Job Content Questionnaire (JCQ) and Effort-Reward Imbalance (ERI) were used to investigate the job content and the degree of occupational stress. According to the results of carotid artery examination, the subjects were divided into normal carotid artery group with 2013 workers, increased carotid intima-media thickness (IMT) group with 277 workers, stable plaque group with 236 workers, and unstable plaque group with 421 workers. A unified questionnaire was distributed to each group, and related physical and biochemical examinations were performed. A multivariate unconditional logistic regression analysis was performed to investigate the risk factors for unstable plaque. Results: There were significant differences between the groups in sex, educational level, marital status, work in shifts, smoking, drinking, age, and working years (P<0.05) , while there was no significant difference in exercise between groups (P>0.05) . Based on the JCQ score, 761 (25.8%) had no stress, 959 (32.5%) had mild stress, 699 (23.7%) had moderate stress, and 528 (17.9%) had severe stress; based on the ERI score, 2526 (85.7%) had high effort and low reward and 421 (14.3%) did not have the high-effort and low-reward conditions. There was a significant difference in the composition of JCQ and ERI scores between groups (P<0.05) . Moderate stress (odds ratio [OR]=1.695) , severe stress (OR=5.443) , ERI (OR=7.391) , work in shift (OR=1.784) , old age (OR=1.009) , high systolic blood pressure (OR=1.105) , high fasting blood glucose (OR=1.212) , abnormal total cholesterol (OR=3.693) , abnormal apolipoprotein B (OR=39.215) , and abnormal high-sensitivity C-reactive protein (OR=1.632) were the risk factors for unstable plaque. Conclusion: Occupational stress may be involved in the development of carotid atherosclerosis.


Assuntos
Doenças das Artérias Carótidas/epidemiologia , Metalurgia , Estresse Ocupacional/epidemiologia , Espessura Intima-Media Carotídea , Estudos Transversais , Humanos , Aço
8.
Nutr Metab Cardiovasc Dis ; 30(6): 915-921, 2020 06 09.
Artigo em Inglês | MEDLINE | ID: mdl-32402586

RESUMO

BACKGROUND AND AIMS: Obesity increases the risk of metabolic abnormalities, which contributes to elevated cardiovascular risk. However, the independent role of obesity in the development of cardiovascular disease is still debatable. There are individuals with an obesity phenotype without metabolic abnormalities: "metabolically healthy obesity" (MHO). This study evaluates the association between MHO and carotid intima-media thickness (CIMT), an early marker of subclinical atherosclerosis. METHODS AND RESULTS: This is a cross-sectional analysis of the baseline data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). We used a strict definition to classify MHO: body mass index ≥30 kg/m2 and meeting none of the four metabolic syndrome criteria. Data from 10,335 participants were analyzed. The obesity prevalence in our population was 21.2% (n = 2191). The prevalence of MHO was 5.6% (n = 124). When individuals were stratified according to metabolic health, we found the metabolically healthy individuals were younger, more likely to be women and never smokers. The mean CIMT of the sample was 0.81 mm (±0.20). The mean CIMT of the metabolically healthy subsample was 0.70 mm (±0.13) in individuals without obesity and 0.76 mm (±0.13) in individuals with obesity (p < 0.001). The mean CIMT of the metabolically unhealthy subsample was 0.81 mm (±0.20) in individuals without obesity and 0.88 mm (±0.20) in individuals with obesity (p < 0.001). These findings remained essentially unchanged after multivariate adjustment for confounding factors. CONCLUSION: The concept of MHO, even with the strict definition, seems inadequate, as even in this population, obesity is associated with higher CIMT levels.


Assuntos
Doenças das Artérias Carótidas/diagnóstico por imagem , Espessura Intima-Media Carotídea , Obesidade Metabolicamente Benigna/epidemiologia , Adulto , Idoso , Índice de Massa Corporal , Brasil/epidemiologia , Doenças das Artérias Carótidas/epidemiologia , Estudos Transversais , Feminino , Nível de Saúde , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Obesidade Metabolicamente Benigna/diagnóstico , Fenótipo , Valor Preditivo dos Testes , Prevalência , Medição de Risco , Fatores de Risco
9.
PLoS Med ; 17(4): e1003095, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32320401

RESUMO

BACKGROUND: An elevated level of serum uric acid (SUA) is associated with an increased risk of cardiovascular disease. Pharmacological intervention with urate-lowering agents, such as the conventional purine analogue xanthine oxidase (XO) inhibitor, allopurinol, has been used widely for a long period of time in clinical practice to reduce SUA levels. Febuxostat, a novel non-purine selective inhibitor of XO, has higher potency for inhibition of XO activity and greater urate-lowering efficacy than conventional allopurinol. However, clinical evidence regarding the effects of febuxostat on atherosclerosis is lacking. The purpose of the study was to test whether treatment with febuxostat delays carotid intima-media thickness (IMT) progression in patients with asymptomatic hyperuricemia. METHODS AND FINDINGS: The study was a multicenter, prospective, randomized, open-label, blinded-endpoint clinical trial undertaken at 48 sites throughout Japan between May 2014 and August 2018. Adults with both asymptomatic hyperuricemia (SUA >7.0 mg/dL) and maximum IMT of the common carotid artery (CCA) ≥1.1 mm at screening were allocated equally using a central web system to receive either dose-titrated febuxostat (10-60 mg daily) or as a control-arm, non-pharmacological lifestyle modification for hyperuricemia, such as a healthy diet and exercise therapy. Of the 514 enrolled participants, 31 were excluded from the analysis, with the remaining 483 people (mean age 69.1 years [standard deviation 10.4 years], female 19.7%) included in the primary analysis (febuxostat group, 239; control group, 244), based on a modified intention-to-treat principal. The carotid IMT images were recorded by a single sonographer at each site and read in a treatment-blinded manner by a single analyzer at a central core laboratory. The primary endpoint was the percentage change from baseline to 24 months in mean IMT of the CCA, determined by analysis of covariance using the allocation adjustment factors (age, gender, history of type 2 diabetes, baseline SUA, and baseline maximum IMT of the CCA) as the covariates. Key secondary endpoints included changes in other carotid ultrasonographic parameters and SUA and the incidence of clinical events. The mean values (± standard deviation) of CCA-IMT were 0.825 mm ± 0.173 mm in the febuxostat group and 0.832 mm ± 0.175 mm in the control group (mean between-group difference [febuxostat - control], -0.007 mm [95% confidence interval (CI) -0.039 mm to 0.024 mm; P = 0.65]) at baseline; 0.832 mm ± 0.182 mm in the febuxostat group and 0.848 mm ± 0.176 mm in the control group (mean between-group difference, -0.016 mm [95% CI -0.051 mm to 0.019 mm; P = 0.37]) at 24 months. Compared with the control group, febuxostat had no significant effect on the primary endpoint (mean percentage change 1.2% [95% CI -0.6% to 3.0%] in the febuxostat group (n = 207) versus 1.4% [95% CI -0.5% to 3.3%] in the control group (n = 193); mean between-group difference, -0.2% [95% CI -2.3% to 1.9%; P = 0.83]). Febuxostat also had no effect on the other carotid ultrasonographic parameters. The mean baseline values of SUA were comparable between the two groups (febuxostat, 7.76 mg/dL ± 0.98 mg/dL versus control, 7.73 mg/dL ± 1.04 mg/dL; mean between-group difference, 0.03 mg/dL [95% CI -0.15 mg/dL to 0.21 mg/dL; P = 0.75]). The mean value of SUA at 24 months was significantly lower in the febuxostat group than in the control group (febuxostat, 4.66 mg/dL ± 1.27 mg/dL versus control, 7.28 mg/dL ± 1.27 mg/dL; mean between-group difference, -2.62 mg/dL [95% CI -2.86 mg/dL to -2.38 mg/dL; P < 0.001]). Episodes of gout arthritis occurred only in the control group (4 patients [1.6%]). There were three deaths in the febuxostat group and seven in the control group during follow-up. A limitation of the study was the study design, as it was not a placebo-controlled trial, had a relatively small sample size and a short intervention period, and only enrolled Japanese patients with asymptomatic hyperuricemia. CONCLUSIONS: In Japanese patients with asymptomatic hyperuricemia, 24 months of febuxostat treatment did not delay carotid atherosclerosis progression, compared with non-pharmacological care. These findings do not support the use of febuxostat for delaying carotid atherosclerosis in this population. TRIAL REGISTRATION: University Hospital Medical Information Network Clinical Trial Registry UMIN000012911.


Assuntos
Doenças Assintomáticas/terapia , Doenças das Artérias Carótidas/prevenção & controle , Progressão da Doença , Febuxostat/uso terapêutico , Supressores da Gota/uso terapêutico , Hiperuricemia/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Doenças Assintomáticas/epidemiologia , Doenças das Artérias Carótidas/sangue , Doenças das Artérias Carótidas/epidemiologia , Espessura Intima-Media Carotídea , Febuxostat/farmacologia , Feminino , Supressores da Gota/farmacologia , Humanos , Hiperuricemia/sangue , Hiperuricemia/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Método Simples-Cego , Ácido Úrico/antagonistas & inibidores , Ácido Úrico/sangue
10.
Stroke ; 51(5): 1493-1502, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32279619

RESUMO

Background and Purpose- Collateral circulation status at baseline is associated with functional outcome after ischemic stroke and effect of endovascular treatment. We aimed to identify clinical and imaging determinants that are associated with collateral grade on baseline computed tomography angiography in patients with acute ischemic stroke due to an anterior circulation large vessel occlusion. Methods- Patients included in the MR CLEAN trial (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands; n=500) and MR CLEAN Registry (n=1488) were studied. Collateral status on baseline computed tomography angiography was scored from 0 (absent) to 3 (good). Multivariable ordinal logistic regression analyses were used to test the association of selected determinants with collateral status. Results- In total, 1988 patients were analyzed. Distribution of the collateral status was as follows: absent (7%, n=123), poor (32%, n=596), moderate (39%, n=735), and good (23%, n=422). Associations for a poor collateral status in a multivariable model existed for age (adjusted common odds ratio, 0.92 per 10 years [95% CI, 0.886-0.98]), male (adjusted common odds ratio, 0.64 [95% CI, 0.53-0.76]), blood glucose level (adjusted common odds ratio, 0.97 [95% CI, 0.95-1.00]), and occlusion of the intracranial segment of the internal carotid artery with occlusion of the terminus (adjusted common odds ratio 0.50 [95% CI, 0.41-0.61]). In contrast to previous studies, we did not find an association between cardiovascular risk factors and collateral status. Conclusions- Older age, male sex, high glucose levels, and intracranial internal carotid artery with occlusion of the terminus occlusions are associated with poor computed tomography angiography collateral grades in patients with acute ischemic stroke eligible for endovascular treatment.


Assuntos
Glicemia/metabolismo , Doenças das Artérias Carótidas/diagnóstico por imagem , Artéria Carótida Interna/diagnóstico por imagem , Circulação Colateral , Infarto da Artéria Cerebral Média/diagnóstico por imagem , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea , Doenças das Artérias Carótidas/epidemiologia , Angiografia Cerebral , Angiografia por Tomografia Computadorizada , Diástole , Feminino , Humanos , Infarto da Artéria Cerebral Média/epidemiologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Países Baixos/epidemiologia , Doença Arterial Periférica/epidemiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Sistema de Registros , Fatores Sexuais , Acidente Vascular Cerebral
11.
High Blood Press Cardiovasc Prev ; 27(3): 231-238, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32219668

RESUMO

INTRODUCTION: Age is traditionally considered a major cardiovascular (CV) risk factor, but its real weight in the absence of other modifiable risk factors is not clear. AIM: To compare the prevalence of subclinical carotid atherosclerosis, and its association with the main CV risk factors, between older adults and hypertensive adults. METHODS: Cross-sectional study on 210 consecutive patients: 70 older adults (age ≥ 80 years), and 140 hypertensive adults having at least another CV risk factor. Patients had no history of peripheral artery disease or major CV events. RESULTS: Mean age was 54.2 ± 7.2 years in hypertensive adults and 88.5 ± 5.5 years in older adults with a female prevalence in the latter group. Dyslipidemia and smoking were more prevalent in hypertensive adults, while chronic kidney disease was more prevalent in older adults. Prevalence of carotid plaques did not differ between hypertensive adults and older adults (48.2% vs 55.6%, respectively, p = 0.311). Age ≥ 80 years was not associated with a higher risk of carotid plaques even after adjusting for other risk factors (p = 0.204). Hypertension and dyslipidemia were the risk factors more strongly associated with carotid plaques in older adults and hypertensive adults, respectively. When older adults with hypertension were excluded from the analysis, prevalence of carotid plaques was significantly higher in hypertensive adults (p = 0.042). CONCLUSION: Hypertension and dyslipidemia are the major determinant of atherosclerosis regardless of age in our study. Our findings support the concept that aging is not necessarily synonymous with atherosclerosis and highlight the key role played by superimposed CV risk factors on arterial ''bad aging''.


Assuntos
Envelhecimento , Aterosclerose/epidemiologia , Doenças das Artérias Carótidas/epidemiologia , Dislipidemias/epidemiologia , Hipertensão/epidemiologia , Adulto , Fatores Etários , Idoso de 80 Anos ou mais , Doenças Assintomáticas , Aterosclerose/diagnóstico por imagem , Biomarcadores/sangue , Pressão Sanguínea , Doenças das Artérias Carótidas/diagnóstico por imagem , Estudos Transversais , Dislipidemias/sangue , Dislipidemias/diagnóstico , Feminino , Nível de Saúde , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Itália/epidemiologia , Lipídeos/sangue , Masculino , Pessoa de Meia-Idade , Placa Aterosclerótica , Prevalência , Prognóstico , Medição de Risco , Fatores de Risco , Fatores Sexuais
12.
Arterioscler Thromb Vasc Biol ; 40(5): 1383-1391, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32160772

RESUMO

OBJECTIVE: Carotid bifurcation geometry has been believed to be a risk factor for the initiation of atherosclerosis because of its influence on hemodynamics. However, the relationships between carotid bifurcation geometry and plaque vulnerability are not fully understood. This study aimed to determine the association between carotid bifurcation geometry and plaque vulnerability using magnetic resonance vessel wall imaging. Approach and Results: A total of 501 carotid arteries with nonstenotic atherosclerosis were included from the cross-sectional, multicenter CARE II study (Chinese Atherosclerosis Risk Evaluation). Four standardized carotid bifurcation geometric parameters (bifurcation angle, internal carotid artery planarity, luminal expansion FlareA, and tortuosity Tort2D) were derived from time-of-flight magnetic resonance angiography. Presence of vulnerable plaque, which was characterized by intraplaque hemorrhage, large lipid-rich necrotic core, or disrupted luminal surface, was determined based on multicontrast carotid magnetic resonance vessel wall images. Vulnerable plaques (N=43) were found to occur at more distal locations (ie, near the level of flow divider) than stable plaques (N=458). Multivariable logistic regression showed that the luminal expansion FlareA (odds ratio, 0.45 [95% CI, 0.25-0.81]; P=0.008) was associated with plaque vulnerability after adjustment for age, sex, maximum wall thickness, plaque location, and other geometric parameters. CONCLUSIONS: Smaller luminal expansion at carotid bifurcation is associated with vulnerable plaque. The finding needs to be verified with longitudinal studies and the underlying mechanism should be further explored with hemodynamics measurement in the future.


Assuntos
Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/diagnóstico por imagem , Angiografia por Ressonância Magnética , Placa Aterosclerótica , Idoso , Artérias Carótidas/patologia , Doenças das Artérias Carótidas/epidemiologia , Doenças das Artérias Carótidas/patologia , China/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prevalência , Medição de Risco , Fatores de Risco , Ruptura Espontânea
13.
Immunohorizons ; 4(2): 108-118, 2020 02 21.
Artigo em Inglês | MEDLINE | ID: mdl-32086320

RESUMO

Atherosclerosis prevalence is increased in chronic obstructive pulmonary disease (COPD) patients, independent of other risk factors. The etiology of the excess vascular disease in COPD is unknown, although it is presumably related to an underlying (if cryptic) systemic immune response. Autoantibodies with specificity for glucose-regulated protein 78 (GRP78), a multifunctional component of the unfolded protein response, are common in COPD patients and linked to comorbidities of this lung disease. We hypothesized anti-GRP78 autoreactivity might also be a risk factor for atherosclerosis in COPD patients. Carotid intima-medial thickness (cIMT) was measured in 144 current and former smokers by ultrasound. Concentrations of circulating IgG autoantibodies against full-length GRP78, determined by ELISA, were greater among subjects with abnormally increased cIMT (p < 0.01). Plasma levels of autoantibodies against a singular GRP78 peptide segment, amino acids 246-260 (anti-GRP78aa 246-260), were even more highly correlated with cIMT, especially among males with greater than or equal to moderate COPD (r s = 0.62, p = 0.001). Anti-GRP78aa 246-260 concentrations were independent of CRP, IL-6, and TNF-α levels. GRP78 autoantigen expression was upregulated among human aortic endothelial cells (HAECs) stressed by incubation with tunicamycin (an unfolded protein response inducer) or exposure to culture media flow disturbances. Autoantibodies against GRP78aa 246-260, isolated from patient plasma by immunoprecipitation, induced HAEC production of proatherosclerotic mediators, including IL-8. In conclusion, anti-GRP78 autoantibodies are highly associated with carotid atherosclerosis in COPD patients and exert atherogenic effects on HAECs. These data implicate Ag-specific autoimmunity in the pathogenesis of atherosclerosis among COPD patients and raise possibilities that directed autoantibody reduction might ameliorate vascular disease in this high-risk population.


Assuntos
Autoanticorpos/sangue , Doenças das Artérias Carótidas/imunologia , Proteínas de Choque Térmico/imunologia , Doença Pulmonar Obstrutiva Crônica/imunologia , Adulto , Idoso , Sequência de Aminoácidos , Autoanticorpos/farmacologia , Biomarcadores/sangue , Doenças das Artérias Carótidas/sangue , Doenças das Artérias Carótidas/epidemiologia , Doenças das Artérias Carótidas/patologia , Espessura Intima-Media Carotídea , Comorbidade , Células Endoteliais/efeitos dos fármacos , Células Endoteliais/metabolismo , Células Endoteliais/patologia , Feminino , Proteínas de Choque Térmico/química , Proteínas de Choque Térmico/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/sangue , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/patologia , Fatores de Risco
14.
J Stroke Cerebrovasc Dis ; 29(4): 104643, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32005569

RESUMO

BACKGROUND: Atrial fibrillation (AF) is a major cause of cardio-embolism in patients with stroke and transient ischemic attack (TIA). Insertable cardiac monitors (ICM) make long-term monitoring for AF possible, but limited health care resources make patient selection important. AF is associated with atherosclerosis and markers of this could potentially be used to guide AF monitoring. METHODS AND RESULTS: One-hundred fourteen TIA-patients without AF were thoroughly monitored for AF with ECG, 72-hour Holter monitoring and ICM with a median monitoring time of 2.2 years. Patients with AF (n = 18) were significantly older than patients without AF (age 71.1 versus 64.4 years, P = .008) but were otherwise similar in regards to comorbidities. AF patients had significantly thicker carotid intima-media and also more often presence of carotid plaques than patients without AF, but no difference was found after adjusting for age and sex. No difference in noncontrast cardiac CT calculated coronary artery calcium score was found between the 2 groups. Serum biomarkers did not differ between groups, except for brain natriuretic peptide (BNP), where patients with BNP in the upper tertile were more likely to have AF than patients with BNP in the lowest tertile, odds ratio 5.96 (95% confidence interval 1.04-34.07, P = .045). CONCLUSIONS: Carotid intima-media thickness and coronary artery calcium score were poor predictors of AF in patients with TIA. Apart from BNP, the examined biomarkers (hs-CRP, MR-proADM, c-TnI, copeptin) had no predictive value, but larger scale studies are needed to confirm these findings.


Assuntos
Fibrilação Atrial/diagnóstico , Eletrocardiografia Ambulatorial , Ataque Isquêmico Transitório/epidemiologia , Tecnologia de Sensoriamento Remoto , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/fisiopatologia , Biomarcadores/sangue , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/epidemiologia , Espessura Intima-Media Carotídea , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/epidemiologia , Dinamarca/epidemiologia , Eletrocardiografia Ambulatorial/instrumentação , Feminino , Humanos , Incidência , Ataque Isquêmico Transitório/diagnóstico , Ataque Isquêmico Transitório/fisiopatologia , Masculino , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/sangue , Valor Preditivo dos Testes , Tecnologia de Sensoriamento Remoto/instrumentação , Fatores de Risco , Processamento de Sinais Assistido por Computador , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/epidemiologia , Adulto Jovem
15.
Med Sci Monit ; 26: e919606, 2020 Jan 16.
Artigo em Inglês | MEDLINE | ID: mdl-31941880

RESUMO

BACKGROUND Carotid atherosclerosis (CA) is a common disease in middle-aged and elderly people, which is closely related to cardiovascular and cerebrovascular disease. In this study, we investigated the benefits of the electrocardiogram (ECG)-based R wave pulse wave index (ERWVI) for the diagnosis of CA. MATERIAL AND METHODS According to CA examinations by color Doppler ultrasound, patients were assigned to positive and negative groups. The ECG R wave-Pulse wave transit time (ERWPTT) was obtained by synchronously collecting ECG signals (R wave in ECG) and the time variations in maximum finger pulse oxygen (DOP) on the ECG monitor. RESULTS ERPWI was positively correlated with sex, age, BMI, diastolic/systolic blood pressure, fasting blood glucose, uric acid, cholesterol and triglyceride levels, LDL-cholesterol, non-alcoholic fatty liver disease (NAFLD), creatinine, and homocysteine, and was negatively correlated with HDL-cholesterol (P<0.05). With the increase of ERPWI, the incidence of CA significantly increased to various degrees among the subgroups (P<0.05). The binary logistic regression model showed that ERPWI was an independent risk factor for atherosclerosis. The ROC curve showed that when ERPWI was above 0.505, the incidence of CA increased significantly. CONCLUSIONS There is a close relationship between ERPWI and CA. ERPWI is an independent risk factor for CA. ERPWI ≥0.505 can be used as a diagnostic threshold for CA and a reference index for the diagnosis of CA.


Assuntos
Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/diagnóstico , Eletrocardiografia , Análise de Onda de Pulso , Doenças das Artérias Carótidas/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Curva ROC
16.
Vascular ; 28(3): 285-294, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31964294

RESUMO

BACKGROUND: Subclinical atherosclerosis (SA) in the carotid, femoral, and coronary territories is a powerful predictor of cardiovascular (CV) events. Whether it is sufficient to assess SA in a single vascular territory in early-stage disease is uncertain. We aimed to determine the prevalence and concordance of SA in these vascular beds in asymptomatic patients without known CV disease. METHODS: We enrolled patients aged 35 to 75 years who were asymptomatic, without known CV disease, and had undergone carotid and femoral Doppler ultrasonography and calcium scoring. Those receiving statins were excluded. SA was defined as the presence of plaques in the carotid and/or femoral arteries or the presence of calcium in the coronary arteries (Agatston score >0). RESULTS: A total of 212 patients were identified with a mean age of 53 ± 7 years, of which 60% (128 patients) were men. The prevalence of SA was 62%. The distribution of SA between the three territories was similar, involving the carotid territory in 38% of cases, the femoral in 31%, and the coronaries in 37%. The concordance between the different vascular territories was weak, with a k index of 0.21 between the coronary and carotid territories, 0.27 between the coronary and femoral territories, and 0.34 between the carotid and femoral territories. CONCLUSIONS: The prevalence of SA in asymptomatic patients without known CV disease is high. The concordance in the presence of SA between the three vascular territories is weak. Therefore, all three vascular beds need to be investigated.


Assuntos
Doenças das Artérias Carótidas/epidemiologia , Doença da Artéria Coronariana/epidemiologia , Artéria Femoral , Doença Arterial Periférica/epidemiologia , Calcificação Vascular/epidemiologia , Adulto , Idoso , Argentina/epidemiologia , Doenças Assintomáticas , Doenças das Artérias Carótidas/diagnóstico por imagem , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico , Feminino , Artéria Femoral/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico por imagem , Placa Aterosclerótica , Prevalência , Ultrassonografia Doppler , Calcificação Vascular/diagnóstico
17.
J Neurointerv Surg ; 12(1): 33-37, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31308199

RESUMO

PURPOSE: To evaluate the occurrence and risk factors of acute in-stent thrombosis or stent occlusion in patients with tandem occlusions receiving intracranial mechanical thrombectomy and emergent extracranial internal carotid artery stenting with a dual layer carotid stent. METHODS: Multicenter retrospective data collection and analysis of stroke databases of seven comprehensive stroke centers from three European countries. RESULTS: Overall, 160 patients (mean (SD) age 66 (12) years; 104 men (65%); median (IQR) baseline NIHSS 14 (9-18); IV lysis, n=97 (60.6%)) were treated for a cervical carotid artery occlusion or stenosis using a CASPER stent (MicroVention), and received mechanical thrombectomy for an intracranial occlusion between April 2014 and November 2018. During the procedure or within 72 hours, formation of thrombus and complete occlusion of the CASPER stent was observed in 33/160 (20.8%) and in 12/160 patients (7.5%), respectively. In 25/33 (75.8%) and in 9/12 patients (75%), respectively, this occurred during the procedure. No statistically significant difference was observed between patients with and without thrombus formation with regard to pre-existing long term medication with anticoagulants or intraprocedural administration of heparin, acetylsalicylic acid (ASA), or heparin and ASA. Favorable early neurological outcome was similar in patients with (n=15; 45.5%) and without (n=63; 49.6%) thrombus formation at the CASPER stent. CONCLUSION: Acute thrombosis or occlusion of CASPER stents in thrombectomy patients receiving emergent extracranial internal carotid artery stenting for tandem occlusions were observed more often during the procedure than within 72 hours of follow-up, were less frequent then previously reported, and showed no impact on early neurological outcome.


Assuntos
Doenças das Artérias Carótidas/cirurgia , Artéria Carótida Interna/cirurgia , Procedimentos Endovasculares/efeitos adversos , Stents/efeitos adversos , Trombose/etiologia , Idoso , Doenças das Artérias Carótidas/complicações , Doenças das Artérias Carótidas/epidemiologia , Procedimentos Endovasculares/instrumentação , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Trombose/epidemiologia , Resultado do Tratamento
18.
J Stroke Cerebrovasc Dis ; 29(2): 104576, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31839546

RESUMO

BACKGROUND: Little is known on factors influencing cognitive function in rural communities. Using the Atahualpa Project cohort, we aimed to assess whether the carotid intima-media thickness (cIMT) - used as a surrogate of extracranial carotid atherosclerosis - is associated with cognitive performance and further decline in community-dwelling adults living in a rural setting. METHODS: The study included Atahualpa residents aged greater than or equal to 40 years who had ultrasound examination of the extracranial carotid arteries and a baseline Montreal Cognitive Assessment (MoCA), as well as the subset of individuals who also had a follow-up MoCA at least 1 year after baseline. Relationship between cIMT and cognitive function was assessed by means of generalized linear and longitudinal models, adjusted for relevant covariates. Mediation analysis was utilized to establish the proportion of the effect between increased cIMT and cognitive performance, which is mediated by age. RESULTS: A total of 561 individuals were included for the cross-sectional study, and 510 of them were assessed for the prospective cohort. Univariate analysis showed a significant association between increased cIMT and worse cognitive performance (P < .001), which vanishes after considering the effect of age and low scholarity. Causal mediation analysis confirms that age captures 82.6% (95% C.I.: 63.9% to 100%) of the effect of this association. There was no relationship between increased cIMT and cognitive decline in the follow-up. CONCLUSIONS: In this rural population, the association between increased cIMT and cognitive dysfunction is mostly mediated by increasing age.


Assuntos
Doenças das Artérias Carótidas/diagnóstico por imagem , Espessura Intima-Media Carotídea , Cognição , Envelhecimento Cognitivo/psicologia , Disfunção Cognitiva/psicologia , Saúde da População Rural , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Doenças das Artérias Carótidas/epidemiologia , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/epidemiologia , Estudos Transversais , Equador/epidemiologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo
19.
Stroke ; 51(2): 504-510, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31847749

RESUMO

Background and Purpose- Carotid artery plaque with <50% luminal stenosis may be an underappreciated stroke mechanism. We assessed how many stroke causes might be reclassified after accounting for nonstenosing plaques with high-risk features. Methods- We included patients enrolled in the Cornell Acute Stroke Academic Registry from 2011 to 2015 who had anterior circulation infarction, magnetic resonance imaging of the brain, and magnetic resonance angiography of the neck. High-risk plaque was identified by intraplaque hemorrhage ascertained from routine neck magnetic resonance angiography studies using validated methods. Infarct location was determined from diffusion-weighted imaging. Intraplaque hemorrhage and infarct location were assessed separately in a blinded fashion by a neuroradiologist. We used the McNemar test for matched data to compare the prevalence of intraplaque hemorrhage ipsilateral versus contralateral to brain infarction. We reclassified stroke subtypes by including large-artery atherosclerosis as a cause if there was intraplaque hemorrhage ipsilateral to brain infarction, regardless of the degree of stenosis. Results- Among the 1721 acute ischemic stroke patients registered in the Cornell Acute Stroke Academic Registry from 2011 to 2015, 579 were eligible for this analysis. High-risk plaque was more common ipsilateral versus contralateral to brain infarction in large-artery atherosclerotic (risk ratio [RR], 3.7 [95% CI, 2.2-6.1]), cryptogenic (RR, 2.1 [95% CI, 1.4-3.1]), and cardioembolic strokes (RR, 1.7 [95% CI, 1.1-2.4]). There were nonsignificant ipsilateral-contralateral differences in high-risk plaque among lacunar strokes (RR, 1.2 [95% CI, 0.4-3.5]) and strokes of other determined cause (RR, 1.5 [95% CI, 0.7-3.3]). After accounting for ipsilateral high-risk plaque, 88 (15.2%) patients were reclassified: 38 (22.6%) cardioembolic to multiple potential etiologies, 6 (8.5%) lacunar to multiple, 3 (15.8%) other determined cause to multiple, and 41 (20.8%) cryptogenic to large-artery atherosclerosis. Conclusions- High-risk carotid plaque was more prevalent ipsilateral to brain infarction across several ischemic stroke subtypes. Accounting for such plaques may reclassify the etiologies of up to 15% of cases in our sample.


Assuntos
Isquemia Encefálica/epidemiologia , Doenças das Artérias Carótidas/epidemiologia , Placa Aterosclerótica/patologia , Acidente Vascular Cerebral/classificação , Acidente Vascular Cerebral/epidemiologia , Idoso , Infarto Encefálico/classificação , Infarto Encefálico/patologia , Isquemia Encefálica/classificação , Artérias Carótidas/patologia , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Placa Aterosclerótica/diagnóstico , Prevalência , Fatores de Risco
20.
J Stroke Cerebrovasc Dis ; 29(2): 104448, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31852597

RESUMO

OBJECTIVES: To investigate the differences in characteristics of carotid plaques between patients Xining at high altitude and Jinan at sea level using magnetic resonance (MR) imaging. METHODS: Subjects were recruited from a cross-sectional, observational, multicenter imaging study of CARE-II study. Forty-nine (mean age 63.3 ± 12.0 years, 33 males) and 51 (mean age 64.5 ± 12.0 years, 34 males) patients were recruited from a site located in a high altitude region and a site located near sea level, respectively. All patients underwent multicontrast MR vessel wall imaging for carotid arteries on 3.0 T MR scanner. The carotid plaques features were compared between 2 patient groups. RESULTS: Compared with patients at sea level, those at high altitude had significantly greater lumen area (58.5 ± 17.8 mm2 versus 50.0 ± 19.6 mm2, P = .008), smaller maximum normalized wall index (48.6% ± 14.2% versus 57.8% ± 16.3%, P = .002), and smaller percentage volume of calcium (0.9% versus 5.6%, P < .001) in the symptomatic carotid artery. After adjustment for clinical risk factors including age, sex, systolic blood pressure, LDL-C, and statin use, these differences in plaque morphology and composition remained statistically significant. After further adjustment for normalized wall index as a measure of plaque burden, percentage volume of calcification was still significantly smaller in patients at high altitude area than that in patients at sea level area (P = .047). CONCLUSION: Symptomatic subjects from a high altitude area have lower plaque burden and less calcification in the carotid artery compared to those from an area near sea level.


Assuntos
Altitude , Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/diagnóstico por imagem , Angiografia por Ressonância Magnética , Placa Aterosclerótica , Calcificação Vascular/diagnóstico por imagem , Idoso , Doenças das Artérias Carótidas/epidemiologia , China/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Calcificação Vascular/epidemiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA