Erythrocyte membrane n-3 fatty acid levels and carotid atherosclerosis in Chinese men and women

Objective

Prospective studies have supported the beneficial effects of n-3 fatty acid consumption on cardiac deaths, but limited data focused on atherosclerosis. We investigated the associations between n-3 fatty acids in erythrocytes and atherosclerosis in middle-aged and older Chinese.

Methods

847 subjects (285 men and 562 women), aged 40–65 years, from Guangzhou, China were included in this community-based cross-sectional study between December 2005 and January 2008. The levels of α-linolenic acid (ALA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in erythrocytes were measured by gas chromatography. Carotid ultrasound examination was conducted to obtain intima–media thickness of the common carotid artery and the carotid bifurcation. Dietary data and other covariates were collected using interviewer-administered questionnaires.

Results

After adjustment for age, sex, and other confounders, negative dose–response associations between the contents of individual n-3 polyunsaturated fatty acids in the erythrocyte membrane and the prevalence of carotid artery wall thickening and plaque were observed. A comparison in the highest and lowest tertiles gave odds ratios (95% confidence interval) for thickening in the walls of the common carotid artery of 0.58 (0. 34–0.97; P-trend = 0. 037) for DHA, and 0.39 (0.23–0.67; P-trend < 0.001) for ALA. However, EPA was not significantly associated with carotid atherosclerosis. Similar results were found for thickening at the carotid bifurcation and the occurrence of carotid artery plaque.

Conclusions

Higher levels of DHA and ALA in the erythrocyte membrane were significantly associated with a lower burden of subclinical atherosclerosis.     

Risk factors for serum alanine aminotransferase elevation: A cross-sectional study of healthy adult males in Tokyo,Japan

Background

Liver-protective effects of light-to-moderate alcohol consumption have been suggested.

Aims

To determine predictors of ALT elevation in asymptomatic subjects with and without ultrasonographical evidence of fatty liver.

Methods

Cross-sectional survey of 9703 healthy males. Exclusion criteria were HBV or HCV infection, any use of hepatotoxic medication, history of alcohol abuse, chronic renal or hepatic failure, or treatment for metabolic disorders. Presence of fatty liver was evaluated by ultrasonography; visceral adipose tissue (VAT) was measured by computed tomography (CT).

Results

7148 males (mean age, 50.3 ± 7.8 years) were included; 2406 (33.7%) had fatty liver at ultrasonography. ALT was elevated in 163 (3.4%) and 554 subjects (23.0%) of fatty liver-negative and fatty liver-positive subgroups, respectively. Light (40–140 g/week) alcohol consumption was significantly and independently associated with reduced prevalence of ALT elevation in the fatty liver-negative subgroup (OR = 0.568, 95% CI = 0.342–0.943, P = 0.029). ALT elevation was significantly related to age, VAT, high-density lipoprotein cholesterol (HDL-C) and triglyceride (TG) in the fatty liver-negative subgroup.

Conclusion

Light alcohol consumption is not associated with serum ALT elevation in the Japanese male population. Metabolic syndrome factors are significantly associated with prevalence of ALT elevation, irrespective of the presence of fatty liver.     

Salivary inflammatory cytokines may be novel markers of carotid atherosclerosis in a Japanese general population: The Suita study

Objective

Salivary biomarkers have been recently useful of periodontal disease, which is also risk factor of atherosclerosis. However, there are few studies of the association between salivary inflammatory cytokines and carotid atherosclerosis. We aimed to clarify the association between salivary inflammatory cytokines and periodontal disease and carotid atherosclerosis in a general urban population.

Methods

We studied 608 Japanese men and women (mean age: 65.4 years) in the Suita study. Carotid atherosclerosis was evaluated by high-resolution ultrasonography with atherosclerotic indexes of intima-media thickness (IMT). Periodontal status was evaluated by the Community Periodontal Index (CPI). Salivary levels of interleukin-1β, interleukin-6, tumor necrosis factor-α (TNF-α), and prostaglandin E2 (PGE2) were measured by enzyme linked immunosorbent assay. The risks of carotid atherosclerosis (≥75th percentiles of mean- [0.88 mm] and Max-IMT [1.50 mm]) according to the quartiles of salivary inflammatory cytokines were compared using of adjusted-logistic regression models.

Results and conclusion

All salivary inflammatory cytokines were positively associated with CPI. The adjusted odds ratios for carotid atherosclerosis of mean-IMT in the highest quartile of interleukin-6 and TNF-α were higher than those in the lowest quartiles (OR = 2.32 and 2.88; 95% confidence intervals = 1.19–4.51 and 1.51–5.49, respectively). The adjusted odds ratio for carotid atherosclerosis of mean-IMT in the highest quartile of PGE2 was greater than those in the lowest quartile in women (OR = 2.78; 95% confidence intervals = 1.11–6.95). In conclusion, higher levels of salivary inflammatory cytokines were associated with both periodontal disease and carotid atherosclerosis. Selected salivary inflammatory cytokines may be useful screening markers for periodontal disease and carotid atherosclerosis.     

The relationship between carotid blood pressure reactivity to mental stress and carotid intima-media thickness

Background

Brachial blood pressure (BP) reactivity to stress predicts large artery damage and future cardiovascular (CV) events. Central BP is an emerging risk factor associated with target organ damage (TOD). Currently, little is known about the central BP response to mental stress and its association to TOD.

Methods and results

Twenty-five healthy, non-obese adults completed a computerized mental stress test. Brachial and carotid systolic (S)BP reactivity to stress were calculated as SBP during stress minus resting SBP. Resting carotid intima-media thickness (IMT) was also measured. Carotid SBP reactivity to stress was significantly associated with carotid IMT, independent of age, sex, body mass index, non-high density lipoprotein cholesterol and brachial SBP reactivity to stress (r = 0.386, p < 0.05).

Conclusion

The relationship between carotid SBP reactivity and carotid IMT suggests that the central BP response to stress may prove to be an early risk marker for potential subclinical TOD.     

APOE polymorphism and carotid atherosclerosis in Korean population: The Dong-gu Study and the Namwon Study

Objective

We evaluated the association between APOE polymorphism and carotid atherosclerosis in two large independent cohorts from South Korea.

Methods

The datasets were from the Dong-gu Study (N = 9056) and the Namwon Study (N = 10,158). Carotid ultrasonography was performed to measure carotid intima-media thickness (IMT) and the presence of carotid plaques. The APOE polymorphism was determined by PCR-RFLP. We performed combined and separate analyses for the two datasets.

Results

In the combined analysis, individuals with E2E2 or E2E3 genotype had a lower common carotid IMT compared with individuals with E3E3 genotype (0.684 mm vs. 0.736 mm, p = 0.007; 0.718 mm vs. 0.736 mm, p < 0.001, respectively). This association was very slightly attenuated but remained statistically significant after adjustment for blood lipids (0.690 mm vs. 0.736 mm, p = 0.033; 0.725 mm vs. 0.736 mm, p = 0.005, respectively). Compared with individuals with E3E3 genotype, individuals with E2E3 genotype had lower risk for carotid plaque (odds ratio (OR) = 0.83, 95% confidence interval (CI) = 0.75–0.93), while individuals with E3E4 genotype had a higher risk for carotid plaque (OR = 1.09, 95% CI = 1.00–1.20). After adjustment for blood lipids, ORs of E2E3 genotype for carotid plaque was slightly attenuated but remained significant (OR = 0.87 95% CI = 0.78–0.97), while OR of E3E4 genotype were slightly attenuated and not significant (OR = 1.08, 95% CI, 0.99–1.18).

Conclusions

We found that APOE polymorphism is associated with carotid atherosclerosis and this association was partly mediated through blood lipid. Our results suggest that APOE polymorphism may influence atherosclerosis through non-lipid pathways.     

Role of rs1466535 low density lipoprotein receptor-related protein 1 (LRP1) gene polymorphism in carotid artery disease

Objective

An association between rs1466535 low density lipoprotein receptor-related protein 1 (LRP1) gene polymorphism and abdominal aortic aneurysm (AAA) was recently demonstrated. It has not yet been defined if this association is specific for AAA or related to atherosclerosis per se. Therefore, we aimed to evaluate the role of the rs1466535 polymorphism in conferring genetic susceptibility for carotid artery stenosis (CAS).

Methods

The rs1466535 polymorphism was evaluated in n = 814 patients with CAS and n = 814 subjects without evidence of carotid atherosclerosis by TaqMan technology.

Results

The percentage of T allele rs1466535 carriers was significantly higher in CAS patients (49.3%) than in controls (43.9%, p = 0.032). At the multiple logistic regression analysis, the allele T carrier status did not remain a significant determinant of CAS.

Conclusions

The rs1466535 LRP1 polymorphism is not a significant and independent risk factor for CAS. Our result suggests this polymorphism in the LRP1 gene is not associated with atherosclerosis in general as it is not associated with CAS (this study), whereas it is strictly associated with AAA (our previous paper).     

Normative and mean carotid intima-media thickness values according to metabolic syndrome in Koreans: The Namwon Study

Objectives

We determined the gender- and age-specific normative values of carotid intima-media thickness (IMT) in a healthy Korean population. We also present the mean age-specific carotid IMT values according to the presence of metabolic syndrome (MetS) and the number of MetS components.

Methods

A total of 9374 subjects from the Namwon Study aged 45–74 years were included in the analysis. Subjects without hypertension, diabetes, dyslipidemia, obesity, and current smoking were classified as the healthy reference population (n = 2595). MetS was identified by the presence of three or more of the following five components: abdominal obesity, high triglycerides, low high-density lipoprotein cholesterol, high blood pressure, and high fasting blood glucose. Common carotid artery IMT (CCA-IMT) and carotid bulb IMT values were determined in a region free of plaque by B-mode carotid ultrasonography.

Results

The mean normative CCA-IMT values of 45–49, 50–54, 55–59, 60–64, 65–69, and 70–74 year old males were 0.614, 0.671, 0.711, 0.759, 0.783, and 0.787 mm and 0.613, 0.653, 0.689, 0.718, 0.753, and 0.778 mm for females, respectively. An increase in CCA-IMT of 0.007 mm/year was estimated in both genders. The mean CCA-IMT values of subjects with 0, 1, 2, 3, 4, and 5 MetS components were 0.744, 0.753, 0.765, 0.766, 0.771, and 0.798 mm for males and 0.688, 0.705, 0.724, 0.734, 0.757, and 0.762 mm for females, respectively.

Conclusion

The gender-specific normative carotid IMT values were determined in a large healthy Korean population. An increasing trend in the CCA-IMT values was observed with an increasing number of MetS components in both genders.     

High-density lipoprotein subfractions and carotid plaque: The Northern Manhattan Study

Objective

The objective of this cross-sectional analysis was to investigate the relation between two major high-density lipoprotein cholesterol (HDL-C) subfractions (HDL2-C and HDL3-C) and carotid plaque in a population based cohort.

Methods

We evaluated 988 stroke-free participants (mean age 66 ± 8 years; 40% men; 66% Hispanic and 34% Non-Hispanic) with available data on HDL subfractions using precipitation method and carotid plaque area and thickness assessed by a high-resolution 2D ultrasound. The associations between HDL-C subfractions and plaque measurements were analyzed by quantile regression.

Results

Plaque was present in 56% of the study population. Among those with plaque, the mean ± SD plaque area was 19.40 ± 20.46 mm² and thickness 2.30 ± 4.45 mm. The mean ± SD total HDL-C was 46 ± 14 mg/dl, HDL2-C 14 ± 8 mg/dl, and HDL3-C 32 ± 8 mg/dl. After adjusting for demographics and vascular risk factors, there was an inverse association between HDL3-C and plaque area (per mg/dl: beta = −0.26 at the 75th percentile, p = 0.001 and beta = −0.32 at the 90th percentile, p = 0.02). A positive association was observed between HDL2-C and plaque thickness (per mg/dl; beta = 0.02 at the 90% percentile, p = 0.003). HDL-C was associated with plaque area (per mg/dl: beta = −0.18 at the 90th percentile, p = 0.01), but only among Hispanics.

Conclusion

In our cohort we observed an inverse association between HDL3-C and plaque area and a positive association between HDL2-C and plaque thickness. HDL-C subfractions may have different contributions to the risk of vascular disease. More studies are needed to fully elucidate HDL-C anti-atherosclerotic functions in order to improve HDL-based treatments in prevention of vascular disease and stroke.     

Relationship between white blood cell count and nonalcoholic fatty liver disease

Background

Higher levels of white blood cell (WBC) count are known to be associated with metabolic syndrome and insulin resistance. Nonalcoholic fatty liver disease (NAFLD) is also considered a hepatic manifestation of insulin resistance.

Aims

The present study aimed to determine the relation between WBC count and the presence of NAFLD based on abdominal sonographic findings.

Methods

A cross-sectional study with 3681 healthy subjects (2066 men, 1615 women) undergoing medical check-up was conducted. The odds ratios (ORs) and 95% confidence intervals (CIs) for NAFLD were calculated using multivariate logistic regression analyses across WBC quartiles.

Results

A graded independent relationship between higher levels of WBC count and the prevalence risk of NAFLD was observed. After adjusting for age, smoking status, regular exercise, body mass index (BMI), blood pressure, fasting plasma glucose, triglyceride, and HDL-cholesterol, the ORs (95% CIs) for NAFLD according to WBC quartiles were 1.00, 1.48 (1.10–1.98), 1.59 (1.18–2.14), and 1.84 (1.35–2.51) for men and 1.00, 1.15 (0.67–1.96), 1.88 (1.13–3.11), and 2.74 (1.68–4.46) for women.

Conclusions

WBC count was found to be independently associated with the presence of NAFLD regardless of classical cardiovascular risk factors and other components of metabolic syndrome.     

Genetic epidemiology and genome-wide linkage analysis of carotid artery ultrasound traits in multigenerational African ancestry families

Objective

Intima-media thickness, adventitial diameter and lumen diameter are indicators of cardiovascular disease risk. The influence of genetic factors on these measures in African ancestry populations is not well defined. Therefore, we estimated heritability and performed genome-wide linkage analysis of carotid ultrasound traits in 7 multigenerational families of African ancestry.

Methods

A total of 395 individuals (7 pedigrees; mean family size = 56; 2392 relative pairs) aged ≥18 years had a common carotid artery ultrasound scan. Statistical analyses were conducted using pedigree-based maximum likelihood methods.

Results

Significant covariates included age, sex, body mass index or height and waist, and systolic blood pressure. Residual heritabilities ranged from 0.35 ± 0.10 to 0.64 ± 0.12 (P < 0.0001). We identified a novel quantitative trait locus for adventitial and lumen diameters on chromosome 11 (max LOD = 4.09, 133 cm).

Conclusion

Further fine mapping of this region may identify specific mutations predisposing to subclinical vascular disease among African ancestry individuals.     

Association of metabolically abnormal but normal weight (MANW) and metabolically healthy but obese (MHO) individuals with arterial stiffness and carotid atherosclerosis

Objective

Despite recent interest in differential impact of body size phenotypes on cardiovascular outcomes and mortality, studies evaluating the association between body size phenotypes and indicators of atherosclerosis are limited. This study investigated the relationship of metabolically abnormal but normal weight (MANW) and metabolically healthy but obese (MHO) individuals with arterial stiffness and carotid atherosclerosis in Korean adults without cardiovascular disease.

Methods

A total of 1012 participants (575 men and 437 women, mean age 50.8 years), who underwent a health examination between April 2012 and May 2013 were prospectively enrolled based on inclusion and exclusion criteria. Study subjects were classified according to body mass index (BMI) and the presence/absence of metabolic syndrome.

Results

The prevalence of metabolically healthy normal weight (MHNW), MANW, MHO, and metabolically abnormal obese (MAO) were 54.84%, 6.42%, 22.83%, and 15.91%, respectively. Individuals with MANW had significantly higher brachial-ankle pulse wave velocity and maximal carotid intima-media thickness values than those with MHO, after adjusting for age and gender (P = 0.026 and P = 0.018, respectively). The odds ratio (OR) of arterial stiffness and carotid atherosclerosis in the MANW group were significantly higher than in the MHNW group in unadjusted models. Furthermore, multivariable models showed that increased OR of carotid atherosclerosis in the MANW group persisted even after adjusting for confounding factors (OR = 2.98, 95% CI = [1.54, 5.73], P = 0.011).

Conclusions

Compared to MHNW or MHO subjects, Korean men and women with the MANW phenotype exhibited increased arterial stiffness and carotid atherosclerosis.

Clinical trials no

NCT01594710.     

Genetic and environmental effects on carotid flow velocities: An international twin study

Introduction

Altered carotid blood flow velocities (CFV) have a complex background but the underlying genetic contribution is still unclear. We sought to evaluate the influence of genetics, shared and unshared environmental components on individual differences of CFV.

Methods

193 healthy twin pairs, 126 monozygotic (MZ) and 67 dizygotic (DZ) (mean age 53 ± 14 years) recruited in Italy, in the United States and in Hungary underwent bilateral color-coded Doppler flow assessment of the common carotid artery (CCA) and of the internal carotid artery (ICA) in order to assess the peak systolic (PSV) and end diastolic (EDV) velocities. Means of bilateral CFV values were used in the analysis.

Results

Age- and country-adjusted intra-class correlations were higher in monozygotic than in dizygotic pairs for mean PSV of the ICA indicating a heritability of 63%. Unique environmental factors contributed to 37% of ICA PSV. With regards to the mean PSV and EDV of the CCA, and EDV of the ICA, heritability analysis indicated no discernible role for genetic components, while the contributions of shared and unshared environmental factors ranged between 56% and 63%, and between 37% and 44% adjusted for age and country, respectively. Mean ICA/CCA ratio was driven by unique environmental factors (82%) with modest heritability (18%).

Conclusions

Our study showed that the heritability of ICA PSV and ICA/CCA ratio is moderate, while the findings do not support heritability of other investigated CFV values. Environmental effects account for a moderate to major portion of the variance. These findings support the value of early ultrasound screening as well as the prevention of modifiable environmental factors in case of altered carotid flow velocities.     

Egg consumption and carotid atherosclerosis in the Northern Manhattan Study

Background

The evidence supporting recommendations to limit intake of cholesterol rich foods is inconclusive. We aimed to examine the association between egg consumption and carotid atherosclerosis phenotypes, and the association with clinical vascular events in a prospective, urban, multi-ethnic population.

Methods and results

The Northern Manhattan Study is a population based cohort to determine stroke incidence, risk factors and prognosis. A sub-cohort of 1429 NOMAS participants with both carotid ultrasounds and comprehensive dietary information was evaluated (mean ± SD age of participants 65.80 ± 8.80, 40% male, 18% white, 20% black, 60% Hispanic). The association between egg consumption and carotid intima media thickness (cIMT) was assessed with linear regression. Logistic and quantile regression was used to examine the association between egg consumption and carotid plaque presence, thickness, and area. The relation between egg consumption and clinical vascular events (N = 2669) was examined with Cox models. The mean total cIMT was 0.91 ± 0.08 mm and 58% had carotid plaque present. Increasing egg consumption was inversely associated with cIMT, plaque presence, thickness, and area, in models adjusted for demographics, vascular risk factors and diet. For every additional egg consumed per week, the risk of plaque decreased by 11% (95% CI 3%–18%). No association was detected between egg consumption and risk of clinical vascular outcomes, over a mean follow up of 11 years and after adjustment for covariates.

Conclusions

Frequency of egg consumption in the low to moderate range was inversely related to several markers of carotid atherosclerosis. No association with clinical vascular events, including stroke, was detected. Our findings do not support current vascular health guidelines suggesting the extreme limitation or avoidance of egg consumption due to its cholesterol content.     

Mediterranean diet and carotid atherosclerosis in the Northern Manhattan Study

Objective

Adherence to a Mediterranean-style diet (MeDi) may protect against clinical vascular events by reducing atherosclerosis, but data is limited. This is the first observational study of the association between MeDi adherence and carotid plaque thickness and area.

Methods

The study included 1374 participants of the population-based Northern Manhattan Study with diet assessed and carotid intima-media thickness (cIMT) and plaque measured using B-mode ultrasound (mean age 66 ± 9 years, 60% female, 60% Hispanic, 18% White, 19% Black). A MeDi adherence score (range = 0–9, 9 representing maximal adherence) was examined continuously and in quintiles (3/4/5/6–9 vs. 0–2).

Results

Mean cIMT = 0.9 ± 0.1 mm and 57% had plaque (median plaque thickness = 1.5 mm, 75th percentile = 2.2; median plaque area = 4.2 mm², 75th percentile = 15.8). There was no association between MeDi and cIMT or plaque presence. MeDi adherence was inversely associated with the 75th percentile of plaque thickness and median of plaque area in quantile regression analyses. These associations persisted after controlling for demographics, smoking, physical activity, and total energy consumption (effect of a 1-point increase in MeDi score on the 75th percentile of plaque thickness = −0.049 mm, p = 0.03; median of plaque area = −0.371 mm², p = 0.03), and when additionally controlling for vascular disease biomarkers, medication use, BMI, and previous cardiac disease. The protective associations appeared strongest for those with a MeDi score of 5 (4th quintile) vs. 0–2 (bottom quintile). Differential effects of a MeDi on plaque thickness and area across race/ethnic groups was suggested.

Conclusions

Moderate and strict adherence to a MeDi may protect against a higher burden of carotid atherosclerotic plaque, which may mediate the protection against clinical vascular events. Efforts to improve adherence to a MeDi are critical to reducing the burden of atherosclerotic disease.     

Association Between Nonalcoholic Fatty Liver Disease and Cardiovascular Risk in Obese Children and Adolescents

Background

The recent rise in the prevalence of obesity likely explains nonalcoholic fatty liver disease (NAFLD) epidemic worldwide. We evaluated cardiac functions, cardiovascular risk, and associated parameters with grades of NAFLD in obese children.

Methods

Four hundred obese children were enrolled in the study. Obese children with NAFLD were classified in 2 subgroups according to ultrasonographic visualizing. Ninety-three obese children with NAFLD (mean age 11.73 ± 2.72 years in group 2 and 12.69 ± 2.61 years in group 3) were compared with 307 age- and sex-matched non-NAFLD obese children and 150 control subjects. Laboratory parameters were measured during the fasting state. Pulsed and tissue Doppler echocardiography were performed. Intima-media (IMT) and epicardial adipose tissue (EAT) thicknesses were measured.

Results

NAFLD groups had a significantly higher body mass index (29.15 ± 3.42 and 30.46 ± 4.60; P < 0.001), total adipose tissue mass (37.95 ± 4.46% and 46.57 ± 6.45%; P < 0.001), higher insulin, alanine aminotransferase, and aspartate aminotransferase levels. Increased end-systolic thickness of the interventricular septum (P < 0.001), larger left ventricular mass (P < 0.003) and index (P < 0.003) were found in NAFLD groups. Children with NAFLD had higher Tei index values. Also, carotid artery IMT and EAT thickness were significantly higher in obese children. Waist and hip circumference, total cholesterol level, total adipose tissue mass, and interventricular septum were statistically different in NAFLD groups.

Conclusions

Children with NAFLD had mildly altered left and right ventricular functions and all obese children had increased IMT and EAT thickness. Also, grade of liver steatosis was positively correlated with total adipose tissue mass and interventricular septum systolic thickness.     

The impact of serum uric acid level on arterial stiffness and carotid atherosclerosis: The Korean Multi-Rural Communities Cohort study

Objective

Serum uric acid level has been found to be associated with a risk factor for cardiovascular diseases. However, the topic has not been explored in the general population, especially in Korea. This study was designed to determine whether serum uric acid is associated with carotid atherosclerosis and arterial stiffness in the Korean Multi-Rural Communities Cohort study.

Methods

A total of 5568 participants from the Korean Multi-Rural Communities Cohort were evaluated for the risk of hyperuricemia in cardiovascular atherosclerosis. Important surrogates for cardiovascular atherosclerosis such as intima–media thickness (IMT) and brachial-ankle pulse wave velocity (baPWV) were assessed. We evaluated the association between these atherosclerosis indices and serum uric acid level or hyperuricemia through multivariate-adjusted logistic and linear regression analyses.

Results

There was a significant difference of carotid IMT and baPWV between males and females (p < 0.0001, respectively). Both male and female subjects with hyperuricemia showed higher baPWV than subjects without hyperuricemia (p = 0.0004 for males; p = 0.001 for females). Serum uric acid level was positively correlated with baPWV in males (β = 0.0006, p < 0.0001) and in females (β = 0.0001, p = 0.04), whereas no association between serum uric acid and carotid IMT was found in either gender. A linear relationship of baPWV with increasing serum uric acid level was observed in males (p = 0.0005) and in females (p = 0.004).

Conclusion

Serum uric acid level could be considered an important risk factor for arterial stiffness in Korean population, whereas carotid IMT is not associated with serum uric acid in either gender when using data from the Korean Multi-Rural Communities Cohort study.     

Correlations between serum levels of 25-hydroxyvitamin D and carotid atherosclerosis in patients with type 2 diabetes in Shanghai

Objective

To explore the potential association between the serum levels of 25-hydroxyvitamin D [25(OH)D] and carotid atherosclerosis in patients with type 2 diabetes.

Material and methods

Three hundred and fifty patients with type 2 diabetes were enrolled in this study in Shanghai, China. B-mode ultrasound was used to detect carotid plaques as indicators of atherosclerosis and measure carotid artery intima-media wall thickness (C-IMT) at two sites of carotid artery. Subjects were divided into group A (patients with carotid plaques) and group B (patients without carotid plaques) and be assessed clinically. Serum levels of 25(OH)D and other clinical parameters were measured. Multivariate logistic regression was performed to find predictors of carotid atherosclerosis in the entire group.

Results

The levels of serum 25(OH)D were lower in group A than in group B[19.60 (13.30–25.73) vs 23.19 (18.10–30.06) ng/ml, P < 0.001]. The C-IMT levels [(1.00 ± 0.17 vs 0.88 ± 0.20) mm, P_trend < 0.001] and proportion of people with carotid plaques(44/88 vs 20/87, P_trend < 0.001) in the lowest quartile of 25(OH)D were higher than in the highest quartile. Vitamin D concentrations were inversely associated with HbA1c in women(r = −0.194, P = 0.006), and C-IMT in men(r = −0.409, P < 0.001). Logistic regression analysis showed age, male sex, current smoke, history of hypertension, SBP, LDL-C and lg[25(OH)D] (OR: 0.924, 95%CI: 0.893–0.955, P < 0.001) were independently associated with the presence of carotid plaques in T2DM.

Conclusions

Serum vitamin D level is significantly and independently associated with carotid atherosclerosis in patients with T2DM in Shanghai, China.     

Type 2 diabetes is not associated with an altered plaque phenotype among patients undergoing carotid revascularization. A histological analysis of 1455 carotid plaques

Aims

Diabetes accelerates progression of atherosclerotic disease, but data on associations between diabetes and advanced atherosclerotic plaque composition are scarce.

Methods and results

We used one of the largest biobanks, the Athero-Express study (n = 1455) at carotid endarterectomy (CEA). All plaques were subjected to histological analysis to assess lipid core size, collagen, macrophages, smooth muscle cells, micro-vessel density and calcifications. In addition, within a subset of patients cytokines and chemokines were assessed.The 295 patients (20%) with type-2 diabetes showed a higher proportion of previous cardiovascular interventions and more stringent treatment for hypertension and hypercholesterolaemia compared with patients without type-2 diabetes. Surprisingly, no associations between diabetes and histological plaque characteristics were observed. In addition, no differences were observed in the expression of inflammatory chemokines, cytokines or advanced glycation end products in plaques of diabetic and non-diabetic patients.

Conclusion

In patients suffering from significant carotid artery disease, diabetes does not appear to be associated with specific atherosclerotic plaque characteristics.     

HDL-C,triglycerides and carotid IMT: A meta-analysis of 21,000 patients with automated edge detection IMT measurement

Objective

Common carotid artery (CCA) intima-media thickness (IMT), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C), but not triglyceride levels, are markers of future cardiovascular events. The relationship between these three factors is, however, unclear.

Methods

We included six large observational studies that used the same harmonized, B-mode ultrasound protocol, the same software for IMT measurement by automatic edge detection on CCA in a plaque-free region, following the Mannheim consensus, and certification of all sonographers. Using the best view of the CCA, the sonographer had to confirm that the quality index was ≥0.5 on a measurement performed on 10-mm length. We used individual data meta-analysis to estimate the cross-sectional associations of lipids with CCA-IMT.

Results

Overall, 21,587 patients with complete information on lipids and CCA-IMT were available. Age- and sex-adjusted CCA-IMT differed by −7.8 μm (95% CI −9.1 to −6.5 μm, P < 0.001) per 1 SD higher HDL-C level. After further adjustment for other atherosclerosis risk factors, the relationship was attenuated, but remained significant (regression coefficient, −3.7 μm; P < 0.001). This was found regardless of LDL-C levels (P for heterogeneity = 0.70). After adjustment for age and sex, triglycerides were positively associated with CCA-IMT, overall and in each LDL-C subgroup, but not after further adjustments for other risk factors.

Conclusions

Relationships between HDL-C and triglyceride levels and CCA-IMT were consistent with that previously observed with clinical events by the Emergency Risk Collaboration group, including at low LDL-C levels. This reinforces the need to verify whether raising HDL-C levels decreases both CCA-IMT and future clinical events.     

Association between periodontal disease and its treatment,flow-mediated dilatation and carotid intima-media thickness: A systematic review and meta-analysis

Objective

This meta-analysis sought to investigate the association between carotid intima-media thickness (c-IMT), flow-mediated dilation (FMD) and periodontitis (PD) and to assess the effect of periodontal treatment on c-IMT and FMD.

Methods

Electronic database searching, hand searching of bibliographic references of included papers, related reviews, and journals in relation to oral, cardiovascular and ultrasound imaging field was carried out. Random effects meta-analyses were performed to investigate the association of co-existence of increased c-IMT, impaired FMD and PD with potential changes in these variables following periodontal intervention.

Results

2009 citations and 101 full text articles were screened, with 35 meeting the review inclusion criteria of which 22 suitable for quantitative analysis. Meta-analysis demonstrated that the diagnosis of PD was associated with a mean increase in c-IMT of 0.08 mm (95% C.I. = 0.07–0.09) and a mean difference in FMD of 5.1% compared to controls (95% C.I. = 2.08–8.11%). A meta-analysis of the effects of periodontal treatment on FMD showed a mean improvement of 6.64% between test and control (95% C.I. = 2.83–10.44%).

Conclusions

This review demonstrated an association between increased c-IMT, impaired FMD and PD. Data from intervention studies suggested a beneficial effect of periodontal treatment on FMD indicating an improvement in endothelial function. The findings support investigation of periodontitis treatment on cardiovascular outcomes.