Metabolic syndrome (MetS) predicts cardio and cerebrovascular events in a twenty years follow-up. A prospective study

ObjectivesTo investigate the extent of subclinical atherosclerosis in asymptomatic familial hypercholesterolemia (FH) patients using non-invasive images techniques.Patients, methods and resultsThe atherosclerotic burden of 36 molecularly defined FH patients (18 males, 45.7 ± 10.9 years) without evidence of cardiovascular disease receiving lipid-lowering treatment and 19 (47.8 ± 11.3 years) controls was investigated. Descending thoracic aorta magnetic resonance imaging (MRI) was performed in a 1.5 T equipment with T1 and T2 sequences to characterize atherosclerotic plaques and to measure aortic wall volumen. Carotid intima-media thickness (cIMT) and presence of plaques were measured using B-mode carotid ultrasound.Mean aortic wall volumen, cIMT and atherosclerotic plaques in aorta were significantly higher in FH cases (P < 0.001). A significant correlation between aortic wall volume and cIMT was observed (P < 0.01). Aortic MRI detected plaques in 94% and carotid ultrasound in 14% of cases. Lipid-rich plaques were observed only in FH cases (33%) and were associated with family history of premature coronary artery disease (P < 0.05).ConclusionsAsymptomatic middle-aged FH patients have significantly higher atherosclerotic burden than controls. cIMT has shown a significant correlation with aortic wall volume and MRI allowed the detection of lipid-rich plaques in FH subjects that were associated with family history of premature coronary artery disease.     

Prévalence et facteurs déterminants de l’épaisseur intima-media carotidienne élevée dans une population de 1203 hypertendus noirs africains

ObjectivesTo evaluate the prevalence and determinants of increased carotid intima-media thickness (IMT) in a population of black hypertensive patients and it influence of on the assessment of their overall cardiovascular risk.Patients and methodsThis was a 16-month, cross-sectional study conducted in the outpatient unit of the cardiology department of the Campus teaching hospital of Lome, and included 1203 hypertensive patients, both sexes, aged 35 years and more. Each patient benefited from a carotid IMT measure. Carotid IMT was increased if it was > 0.9 mm and the plaque was defined as a carotid IMT > 1.2 mm.ResultsThe mean age of our patients was 53.3 ± 10.4 years with a sex ratio of 1.6 in favor of women. The duration of hypertension was less than 5 years in 56.7% and hypertension was grade 1 in 47.7% of cases. The mean carotid IMT was 0.89 mm ± 0.20. The prevalence of the increased carotid IMT was 45.8% and that of an atheroma plaque was 15.8%. Carotid IMT was correlated with age (P ˂ 0.0001), duration of arterial hypertension (P = 0.01), history of stroke (P ˂ 0.0001), and presence of left ventricular hypertrophy to cardiac ultrasound (P = 0.01). The overall cardiovascular risk was modified after taking into account the carotid IMT. An increase in cardiovascular risk was observed in 30.5% of hypertensive patients.ConclusionIncreased carotid intima-media thickness is frequent in Togolese hypertension. The determining factors are age, duration of arterial hypertension, left ventricular hypertrophy and stroke. The systematic measurement of the carotid intima-media thickness would better evaluate the overall cardiovascular risk for our patients.     

Relationship between serum levels of osteocalcin and atherosclerotic disease in type 2 diabetes

AimsTo analyze the relationship between serum levels of osteocalcin and parameters of atherosclerosis in patients with type 2 diabetes mellitus (T2DM).MethodsThis cross-sectional study of 78 patients with T2DM evaluated intima–media thickness, and the prevalence of coronary heart disease, atherosclerotic plaques and aortic calcifications. Serum osteocalcin levels were also determined by radioimmunoassay.ResultsThe patients’ mean age was 57.8 ± 6.4 years (duration of diabetes: 13.4 years; mean HbA_1c level: 8.01%), and 37.2% had coronary heart disease, 56% had an abnormal intima–media thickness, 26.9% had carotid plaques and 32.1% had aortic calcifications. Coronary heart disease was associated with higher levels of osteocalcin in male vs female patients (1.95 ± 1.36 vs 0.93 ± 0.86 ng/mL, respectively; P = 0.006). Also, higher concentrations of osteocalcin were found in female patients with vs without abnormal intima–media thicknesses (2.17 ± 1.84 vs 1.25 ± 0.67 ng/mL, respectively; P = 0.042), carotid plaques (2.86 ± 2.10 vs 1.43 ± 1.09 ng/mL, respectively; P = 0.03) and aortic calcifications (2.85 ± 1.97 vs 1.26 ± 0.83 ng/mL, respectively; P = 0.002). Serum osteocalcin levels were associated with coronary heart disease on multivariate logistic regression (odds ratio: 2.27, 95% confidence interval: 1.21–4.25; P = 0.01).ConclusionIn T2DM patients, serum osteocalcin levels were associated with parameters of atherosclerosis, suggesting that osteocalcin is involved not only in bone metabolism, but also in atherosclerotic disease.     

Obstructive sleep apnoea correlates with C-reactive protein in obese Asian Indians

BackgroundC-reactive protein (CRP), a marker of systemic inflammation, is an important predictor of future cardiovascular events. Whether the relationship of obstructive sleep apnoea (OSA) and CRP is independent of adiposity, needs to be investigated.ObjectiveTo investigate the association of CRP levels with OSA in the obese and their comparison with lean subjects without OSA in Asian Indians residing in India.Methods and resultsOne hundred and eight obese subjects (62 treatment naïve obese subjects with OSA [cases] and 46 obese subjects without OSA [obese controls]) and 26 lean control subjects without OSA were studied. The subjects were without any apparent inflammatory disease. Obese subjects were matched for body mass index (BMI) and percentage body fat (%BF). Assessment included anthropometry, lipid profile and high sensitivity CRP (hs-CRP) levels. Mean hs-CRP levels were significantly higher in cases [(3.6 ± 2.0) mg/l than in obese controls (1.4 ± 1.4) mg/l, p < 0.001)] and in lean controls [(0.93 ± 0.71) mg/l, p > 0.05].ConclusionsIn this sample of Asian Indians, subjects with OSA had significantly higher CRP levels. These levels were directly proportional to the increase in severity of OSA and it was independent of adiposity. These observations have important implications for future cardiovascular risk in Asian Indians with OSA.     

Components of the metabolic syndrome, but not the metabolic syndrome per se, are associated with aortic distensibility

Background and aimReduction in aortic distensibility occurs early in the atherosclerosis process and carries a poor prognosis. Metabolic syndrome is common and it is associated with increased cardiovascular mortality. The aim of this cross-sectional study was to investigate the association between metabolic syndrome and aortic distensibility.Methods and resultsA total of 135 subjects without diabetes were studied. Metabolic syndrome was diagnosed using the NCEP-ATP-III criteria. Aortic distensibility was assessed non-invasively by ultrasonography. Multivariate analysis, after controlling for the components of the metabolic syndrome, and, additionally, for body mass index, pulse pressure, presence of coronary artery disease, use of statins and use of angiotensin converting enzyme inhibitors and/or angiotensin receptor blockers, demonstrated an independent association between aortic distensibility and age (p < 0.001), systolic blood pressure, (p = 0.02), diastolic blood pressure (p = 0.005), and history of hypertension (p < 0.001), but not metabolic syndrome status. Moreover, there was a suggestive association with albumin-to-creatinine ratio (p = 0.06).ConclusionsMetabolic syndrome per se is not associated with reduction in aortic distensibility. From the components of the metabolic syndrome, only blood pressure is a strong predictor of aortic distensibility. In addition, ageing and higher values of albumin-to-creatinine ratio are also associated with low aortic distensibility.     

Vitamin C consumption is associated with less progression in carotid intima media thickness in elderly men: A 3-year intervention study

Background and aimPlant foods may lower the risk of cardiovascular disease.Methods and resultsWe assessed changes in the intima media thickness (IMT) of the carotid artery and diet in elderly men. Men (n = 563) aged 70 ± 5 years were randomly assigned to 1 of 4 groups (dietary intervention, omega-3 supplementation, both or neither) using a 2 × 2 factorial design. B-mode ultrasound of the carotid arteries and calculation of dietary intake were performed at baseline and after 3 years. We previously showed that omega-3 supplementation did not influence the IMT, thus the dietary intervention (n = 233) and no dietary intervention (n = 231) groups were pooled.The dietary intervention group had less progression in the carotid IMT compared with the controls (0.044 ± 0.091 mm versus 0.062 ± 0.105 mm; P = 0.047). This group increased their daily vitamin C intake (P = 0.005) and intake of fruit, berries and vegetables (P ≤ 0.001). Increased intake of vitamin C and of fruit and berries was inversely associated with IMT progression (r = −0.181; P = 0.006 and r = −0.125; P = 0.056, respectively). Multivariate linear regression analysis showed that increased intakes of vitamin C and of fruit and berries were associated with less IMT progression in the intervention group and in the total study population, after adjustment for consumption of dietary cholesterol, cheese, saturated fat and group assignment.ConclusionVitamin C containing foods may protect against the progression of carotid atherosclerosis in elderly men.     

Slow heart rate recovery after exercise is associated with carotid atherosclerosis

ObjectiveSlow heart rate recovery (HRR) after exercise is an estimate of impaired parasympathetic tone and predictor of all-cause and cardiovascular mortality. Carotid atherosclerosis is associated with high risk of developing coronary heart disease (CHD) and stroke. We tested the hypothesis that slow HRR is associated with carotid atherosclerosis in a cross-sectional study of 12,712 middle-aged men (age 49.1 ± 8.9 years).MethodsCarotid atherosclerosis was measured using B-mode ultrasonography and defined as stenosis >25% and/or intima–media thickness >1.2 mm. HRR was calculated as the difference between peak heart rate during a graded exercise treadmill test and heart rate 2 min after cessation of exercise.ResultsThe prevalence of carotid atherosclerosis was 8.4%. The prevalence of atherosclerosis was significantly higher among subjects in the lowest (<44 bpm) versus the highest (>61 bpm) quartile of HRR (14.4% versus 4.1%, p < 0.001). In multivariable logistic regression models adjusted for established CHD risk factors, inflammatory markers, and exercise capacity, subjects in the lowest quartile of HRR (<44 bpm) were 1.50 times (95% CI: 1.13–2.00) more likely to have carotid atherosclerosis than subjects in the highest quartile (HRR >61 bpm).ConclusionsSlow heart rate recovery after exercise, an index of decreased parasympathetic activity, is associated with carotid atherosclerosis independent of established risk factors in middle-age men.     

Evaluation of possible subclinical atherosclerosis in adolescents with a family history of premature atherosclerosis

ObjectiveTo evaluate possible subclinical atherosclerosis using biomarkers and ultrasound-guided methods in a group of adolescents having fathers with premature atherosclerosis.MethodsThirty-three subjects whose fathers had a history of premature coronary artery disease and 30 counterparts whose fathers had no history of coronary artery disease were included in the study.ResultsThe homocysteine levels, high-sensitivity C-reactive protein levels, and cardiac chamber sizes and functions did not differ between the two groups. The carotid stiffness index β (CSI), the intima-media thickness (CIMT) and aortic pulse wave velocity (PWV) values were higher in the group with a family history of coronary artery disease, but only the difference in the CSI was statistically significant (CSI 3.07 ± 1.33 vs 3.88 ± 1.25, P = 0.015; CIMT 0.53 ± 0.09 mm vs 0.57 ± 0.08 mm, P = 0.068; PWV 3.49 ± 0.53 m/s vs 3.78 ± 0.63 m/s, P = 0.053).ConclusionAmong several markers of subclinical atherosclerosis, the CSI was significantly higher in adolescents who had a family history of premature atherosclerosis. The small sample size, the multifactorial nature of atherosclerosis or the insufficient power of these methods may explain these results.     

Role of homocysteine in aortic calcification and osteogenic cell differentiation

BackgroundThe role of homocysteine in atherosclerosis is unclear. We examined the relationship between plasma homocysteine and infrarenal aortic calcification, the presence of homocysteine in human atheroma and the influence of homocysteine on osteogenic differentiation in vitro.Methods and resultsIn 194 patients with symptomatic peripheral artery disease or abdominal aortic aneurysm, fasting plasma total homocysteine was independently associated with the severity of infrarenal aortic calcification measured by Computer Tomography Angiography (odds ratio 1.91, 95% confidence interval 1.17–3.21 for calcification ≥median). Homocysteine was identified in all 60 atheroma biopsies from 16 patients undergoing endarterectomy, and concentrations were significantly greater in the calcified biopsies (p = 0.003). In vitro studies demonstrated that 100 μmol/L homocysteine doubled the calcium deposition by mesenchymal stem cells during 16 days incubation in osteogenic medium (74 ± 4 compared to 42 ± 5 μg calcium/well without homocysteine, p < 0.001). Homocysteine also stimulated monocytic THP1 cells to promote aortic smooth muscle cell calcification as evidenced by significant higher calcium deposition and alkaline phosphatase activity compared to incubation without homocysteine (p ≤ 0.05).ConclusionsHomocysteine plays an important role in vascular calcification via multiple mechanisms. The presence of homocysteine in atheroma and its ability to enhance osteogenic cell differentiation may partly explain the association of homocysteine with atherosclerotic events.     

Carotid extra-medial thickness in childhood: early life effects on the arterial adventitia

ObjectiveStructural modification of the arterial adventitia may be an early event in atherosclerosis. Carotid extra-medial thickness is a new measure of arterial adventitial thickness. We examined the association of cardiovascular risk factors with extra-medial thickness, in childhood.MethodsCarotid extra-medial thickness was assessed by high-resolution ultrasound in 389 non-diabetic children aged 8-years. A non-fasting blood sample was collected from 314 participants. Associations of gender, age, lipoproteins, blood pressure, BMI z-score, waist:height ratio and parental history of early vascular disease, with extra-medial thickness were examined.ResultsCarotid extra-medial thickness was lower in girls (r = ?.163, P = .001) and directly associated with systolic (r = .128, P = .009), diastolic blood pressure (r = .130, P = .009), and height (r = .170, P = .0006). These associations remained after adjustment for carotid intima-media thickness. In multivariable analysis including carotid intima-media thickness, only gender and height were significantly associated with carotid extra-medial thickness. In gender-stratified analysis, the strongest associations with extra-medial thickness were BMI z-score (r = .181, P = .01), height (r = .210, P = .003) and diastolic blood pressure (r = .167, P = .02) for boys; and systolic blood pressure (r = .153, P = .03) and parental history of premature cardiovascular disease (r = .139, P = .05) for girls. The association of BMI z-score with extra-medial thickness differed by gender (P-interaction = .04).ConclusionsCarotid extra-medial thickness is independently associated with gender and height in childhood. Extra-medial thickness may provide important information concerning early arterial health, particularly related to the arterial adventitia.     

Recently postmenopausal women have the same prevalence of subclinical carotid atherosclerosis as age and traditional risk factor matched men

ObjectiveTo compare the prevalence of subclinical atherosclerosis between postmenopausal women and men of similar age early after the onset of menopause.MethodsIn the first part of this cross-sectional study 186 non-diabetic young postmenopausal women (n = 101, menopausal age ≤10 years) and men (n = 85) aged 40–60 years without overt CVD were consecutively recruited from the outpatients clinics of an academic hospital. Subclinical carotid atherosclerosis was assessed by high-resolution ultrasonography. The presence of carotid atherosclerosis was defined as either increased carotid intima-media thickness (IMT > 0.9 mm) and/or the presence of plaques. In the second part, 1:1 matching for age and traditional risk factors (hyperlipidemia, smoking, hypertension and BMI) was performed between men and women of this cohort resulting in a matched sub-sample of 76 subjects.ResultsBy multivariate analysis, gender was not an independent determinant of any measure of carotid atherosclerosis. In the matched sub-sample, carotid IMT and the number of segments with atherosclerosis did not significantly differ between women and men (0.734 ± 0.119 mm and 1.47 ± 1.6 versus 0.717 ± 0.138 mm and 1.47 ± 1.5, p = 0.575 and p = 0.999, respectively). Also, the prevalence of increased IMT (60.5% in both genders), carotid plaques and subclinical atherosclerosis (31.6% and 63.2% versus 28.9% and 65.8%, p = 0.803 and p = 0.811, respectively) was similar between men and women.ConclusionsThe prevalence and severity of carotid atherosclerosis was similar between men and young postmenopausal women matched for traditional risk factors. Whether these women may be better risk stratified irrespective of gender should be further assessed in prospective studies.     

Cardiovascular risk factors and subclinical atherosclerosis among Nunavik Inuit

ObjectiveTo evaluate subclinical atherosclerosis in Nunavik Inuit and its correlation to traditional cardiovascular disease risk factor.MethodThe intima–media thickness (IMT) of 12 segments of the carotid arteries (IMT_{12_seg}) free of plaque were assessed in randomly selected 40 years old and older Inuit from. Clinical assessment was performed which included fasting plasma glucose, fasting insulin, systemic blood pressure, body mass index, smoking, circulating blood lipids and oral glucose tolerance test. In addition, documented presence of ischemic heart disease (IHD), stroke, diabetes mellitus, hypertension and dyslipidemia were determined from medical files.ResultsThe average age of the 287 participants was 51.2 ± 0.6 years (56.8% women). Mean IMT_{12_seg} was 0.80 ± 0.17 mm (range: 0.55–1.47 mm). Compared with disease free Inuit, individuals with history of stroke showed greater carotid internal IMT (0.68 ± 0.01 mm vs. 0.96 ± 0.15 mm respectively; p < 0.005) but no difference was observed for IHD. Hypertensive and dyslipidemic Inuit had higher IMT_{12_seg} compared to risk factor free individuals but no difference was observed in diabetics. None of the clinical assessments were associated with IMT_{12_seg}. In a multivariate backward elimination model, only age, gender, and medically documented history of hypertension were found to be predictors of IMT_{12_seg} (adjusted r-square of 0.54; p < 0.0001).ConclusionCompared with disease free Nunavik Inuit, subclinical signs of atherosclerosis determined by IMT was higher in individual diagnosed with stroke. Independent predictors of IMT_{12_seg} in our group were age, gender and history of hypertension. No other traditional risk factors imparted IMT.     

Age and coumarin-type anticoagulation are associated with the occurrence of intraplaque hemorrhage, while statins are associated less with intraplaque hemorrhage: a large histopathological study in carotid and femoral plaques

IntroductionIntraplaque hemorrhage (IPH) is an important determinant of progression and destabilization of atherosclerotic plaque. We recently demonstrated that IPH is an independent predictor of future cardiovascular events after carotid endarterectomy. Thus far, it is unknown whether clinical patient characteristics, such as medication use, are associated with the occurrence of IPH. The purpose of this study was to examine the association of IPH with clinical patient characteristics.Methods and results1070 consecutive patients who underwent a carotid (n = 794) or femoral (n = 276) endarterectomy were included. Endarterectomy specimens were subjected to histopathological examination. IPH was observed in 644/794 (81%) carotid and 175/276 (63%) femoral plaques. Carotid IPH was positively correlated with advanced age (69 years [IQR: 62–75] vs. 65 years [IQR: 57–73]; P = 0.002) and coumarin-type anticoagulation use prior to operation (104/116 [90%] with coumarin derivatives vs. 540/678 [80%] without coumarin derivatives; P = 0.01). Carotid IPH was less frequently observed in patients that used statins prior to endarterectomy (468/595 [79%] with statin vs. 176/199 [88%] without statin; P = 0.002). In multivariate analysis, age, coumarin-type anticoagulation use and statin use were independently correlated with carotid IPH. No association was observed between femoral IPH and clinical patient characteristics.ConclusionAdvanced age and coumarin-type anticoagulation use are associated with the occurrence of IPH, while statin use is associated with less IPH.     

Is excessive daytime sleepiness a predictor of carotid atherosclerosis in sleep apnea?

ObjectiveTo elucidate the relationship between excessive daytime sleepiness (EDS) in obstructive sleep apnea (OSA) and carotid atherosclerosis determined by ultrasonography and serum surrogate markers.MethodsOne hundred and forty-seven patients (102 males) with snoring and sleep-disordered breathing were investigated. Carotid atherosclerosis was evaluated by serum analysis of high-sensitivity C-reactive protein and fibrinogen and four sonographic indices: intima media thickness (IMT) of the common carotid artery (CCA), IMT from the bulb to the internal carotid artery (ICA), combined IMT measurements from all segments and a plaque score. EDS was assessed by the Epworth Sleepiness Scale (ESS). Pearson correlation analysis, intergroup comparison (ANOVA) and two multiple regression models explored associations between confounders, surrogate markers and EDS.ResultsForty-four patients had no OSA (apnea–hypopnea index AHI < 5 h^?1), 27 mild (5–15), 25 moderate (15–30) and 51 severe OSA (>30). The ESS significantly distinguished severe OSA from non-OSA patients (p = 0.003). It showed significant correlations with the BMI, HbA1c, systolic RR, the AHI, sleep time spent with an oxygen saturation <90%, the respiratory arousal index, IMT of the CCA and combined IMT measurements, but no correlation with serum markers. The ESS was found to be an independent predictor of CCA-IMT in the pre-polysomnographic multiple regression model (p = 0.008), but not in the post-polysomnographic model after including respiratory variables.ConclusionEDS is associated with obesity, diabetes and all respiratory variables in OSA patients and may serve as an independent predictor of carotid atherosclerosis before polysomnography.     

Relation of self-reported sleep duration with carotid intima-media thickness in a general population sample

ObjectivesAn association of sleep with cardiovascular disease has been suggested. We analyzed the association of sleep duration with carotid intima-media thickness (IMT) as measure of generalized atherosclerosis.MethodsIMT of the common carotid arteries was measured in 2437 participants of the Study of Health in Pomerania (SHIP). Participants indicated their daily sleep duration as sum of night and afternoon sleep.ResultsThere was a J-shaped association of sleep duration (5 to 11/12 h) with IMT. In this association, IMT values were lowest among subjects with an average sleep duration of 7–8 h (0.76 ± 0.15 and 0.79 ± 0.16 mm, respectively) but increased with shorter and, still more so, with longer sleep duration. Subjects with only 5 h sleep showed age- and sex-adjusted differences of 0.042 mm IMT (95% confidence interval 0.008–0.076 versus 8 h sleep). IMT values were still greater among subjects with 11–12 h sleep (adjusted differences versus 8 h sleep 0.084 mm [0.040–0.128] IMT). Further adjustment for lifestyle indicators, socioeconomic determinants, and biological variables attenuated these differences, but they remained significant.ConclusionsBoth longer and shorter sleep duration is associated with an increased risk of atherosclerosis. These findings support the hypothesis that sleep is related to cardiovascular disease.     

Duration of type 2 diabetes strongly predicts all-cause and cardiovascular mortality in people referred for coronary angiography

ObjectiveType 2 diabetes represents a major cardiovascular risk factor. However, few studies have addressed the impact of the disease duration on mortality. Thus, we aimed to investigate the predictive value of diabetes duration for all-cause and cardiovascular mortality in subjects undergoing coronary angiography.MethodsWe studied 2455 participants of the LUdwigshafen RIsk and Cardiovascular health study (1768 males/687 females). They had a mean ± standard deviation (SD) age of 63.1 ± 9.0 years (range: 40.0–79.9) and a mean ± SD body mass index of 27.7 ± 4.0 kg/m². 704 subjects were newly diagnosed with type 2 diabetes according to the 2010 criteria of the American Diabetes Association and 446 subjects had a known history of type 2 diabetes. The mean ± SD duration of the follow-up for all-cause and cardiovascular mortality was 7.4 ± 2.3 years.ResultsA total of 543 deaths occurred during the follow-up. Among these, 343 were accounted for by cardiovascular diseases. The duration of type 2 diabetes was strongly and positively correlated with all-cause and cardiovascular mortality (both P < 0.001). The multivariate adjusted hazard ratios (95% confidence intervals) for cardiovascular mortality compared to subjects without diabetes were 1.76 (1.34–2.32), 2.86 (2.00–4.08), 2.96 (1.85–4.74), and 4.55 (3.24–6.39) for subjects with new onset type 2 diabetes and subjects with known type 2 diabetes (duration ≤5, >5 and ≤10, >10 years), respectively.ConclusionsThe data emphasise the need to consider the diabetes duration for the prediction of mortality in subjects at intermediate to high cardiovascular risk.     

Adrenalectomy improves increased carotid intima-media thickness and arterial stiffness in patients with aldosterone producing adenoma

ContextPrimary aldosteronism (PA) is the most frequent cause of secondary hypertension, and is associated with more prominent vascular stiffness and atherosclerosis. However, the effect of adrenalectomy on reversibility of vascular damage is unclear.ObjectiveOur objective was to investigate the vascular changes and possibility of reversibility after adrenalectomy in PA patients.MethodsWe prospectively analyzed 20 patients with aldosterone producing adenoma (APA) that received adrenalectomy from October 2006 to December 2008 and 21 patients with essential hypertension (EH) were enrolled as the control group. Carotid intima media thickness (CIMT) measurement by B-mode ultrasound of the right common carotid arteries and pulse wave velocity (PWV) measurement including brachial–ankle PWV (baPWV) and heart–ankle PWV (haPWV) were performed in both groups. The follow-up measurements were performed one-year after adrenalectomy in APA group.ResultsAPA patients had significantly higher diastolic blood pressure, plasma aldosterone concentration (PAC) and aldosterone-renin ratio (ARR), but lower serum potassium level and plasma renin activity (PRA) than EH patients. APA patients had significantly higher CIMT (0.64 ± 0.13 vs. 0.53 ± 0.10 mm, p = 0.006), higher baPWV (1589 ± 296 vs. 1405 ± 187 cm/s, p = 0.024) and haPWV (1095 ± 150 vs. 987 ± 114 cm/s, p = 0.013) comparing with EH patients. One-year after adrenalectomy, CIMT reduced significantly from 0.64 ± 0.13 mm to 0.59 ± 0.14 mm (p = 0.014), and baPWV and haPWV also showed significant reduction (baPWV, 1589 ± 296 to 1463 ± 188 cm/s, p = 0.035; haPWV, 1095 ± 150 to 1017 ± 109 cm/s, p = 0.019).ConclusionAPA patients have higher degree of early atherosclerosis and vascular stiffness. Adrenalectomy not only corrects the high blood pressure and biochemical parameters but also reverse adverse vascular change in APA patients.     

Impact of dyslipidaemia on arterial structure and function in urban indigenous Australians

BackgroundPremature cardiovascular disease (CDV) is highly prevalent in urban Indigenous Australians. We studied arterial structure and function in 144 volunteers aged 15–66 years to assess the role of dyslipidaemia and other traditional vascular risk factors on cardiovascular risk in young and older urban Indigenous Australians.MethodsWe assessed carotid intima-media thickness (CIMT) by high-resolution B-mode ultrasound imaging of the common carotid artery and peripheral wave reflection using applanation tonometry to obtain the aortic augmentation index (AI) in Indigenous Australian participants of the Darwin Region Urban Indigenous Diabetes (DRUID) study.ResultsParticipants aged 15–24 years demonstrated fewer cardiovascular risk factors than the older group (25–66 years) and predictors of CIMT and AI differed between younger and older groups. CIMT was higher in the older group (0.67 mm vs. 0.61 mm, p = 0.004) and in those with diabetes (0.81 mm vs. 0.67 mm, p < 0.001). AI was higher in the older group (24% vs. 0%, p < 0.001), but was not affected by diabetes status. On multivariate regression analysis, low HDL-cholesterol was the only independent predictor of CIMT in the younger group; triglycerides, heart rate (inverse) and height (inverse) were independent predictors of AI in the same group.ConclusionDyslipidaemia (low HDL-cholesterol or elevated triglycerides) is independently associated with non-invasive measures of cardiovascular disease in a relatively healthy and young subgroup of this high-risk population. We propose that triglycerides and low HDL-cholesterol may represent the most useful commonly measured clinical indicators of cardiovascular risk in young, urban Indigenous Australians.     

The incremental role of obstructive sleep apnoea on markers of atherosclerosis in patients with metabolic syndrome

ObjectiveMetabolic syndrome (MS) is associated with subclinical atherosclerosis, but the relative role of obstructive sleep apnoea (OSA) is largely unknown. The main objective of this study is to determine the impact of OSA on markers of atherosclerosis in patients with MS.MethodsEighty-one consecutive patients with MS according to the Adult Treatment Panel III underwent a clinical evaluation, polysomnography, laboratory and vascular measurements of carotid intima media thickness (IMT), carotid-femoral pulse wave velocity (PWV) and carotid diameter (CD) in a blind fashion. OSA was defined as an apnoea-hypopnoea index (AHI) ≥15 events/hour. Multiple linear regression was performed to determine the variables that were independently associated with the vascular parameters.ResultsFifty-one patients (63%) had OSA. No significant differences existed in age, sex, MS criteria, and cholesterol levels between patients with (MS+OSA) and without OSA (MS?OSA). Compared with MS?OSA patients, MS+OSA patients had higher levels of IMT (661 ± 117 vs. 767 ± 140 μm), PWV (9.6 ± 1.0 vs. 10.6 ± 1.6 m/s), and CD (6705 ± 744 vs. 7811 ± 862 μm) (P < 0.001 for each comparison). Among patients with MS+OSA, all vascular parameters were similar in patients with and without daytime sleepiness. The independent parameters associated with IMT, PWV, and CD were AHI, abdominal circumference, and systolic blood pressure (R² = 0.42); AHI and systolic blood pressure (R² = 0.38); and AHI, age, abdominal circumference and systolic blood pressure (R² = 0.45), respectively. The R² of AHI for IMT, PWV and CD was 0.12, 0.10 and 0.20, respectively.ConclusionsOSA is very common and has an incremental role in atherosclerotic burden in consecutive patients with MS.     

Risk factors of mild cognitive impairment in middle aged patients with type 2 diabetes: a cross-section study

The aim of this study was to evaluate the risk factors of mild cognitive impairment (MCI) in middle-aged patients with type 2 diabetes (T2DM).MethodsMontreal Cognitive Assessment (MoCA) was applied as cognition assessment implement. One hundred and fifty-seven middle-aged type 2 diabetic patients were enrolled in this cross-section study (age 40～69, mean age 55 ± 7). There were 93 patients with MCI (MoCA score < 26) in MCI group and 64 with normal cognitive function (MoCA score ≥ 26) in control group. Information of history of disease, family history, data of BMI, WHR, HbA1c, FINS, C-Peptide (C-P), SBP, DBP, blood lipid (TG, TC, LDL-C, HDL-C and carotid ultrasound (carotid IMT, carotid resistance index [RI]) was collected.ResultsThere were significant differences in the rate of patients with hypertension ([40.63 vs. 58.06%], P = 0.026), duration of diabetes mellitus ([3.09 ± 4.04 y vs. 4.80 ± 4.94 y], P = 0.024), C-P ([2.79 ± 1.09 ng/ml vs. 2.26 ± 1.00 ng/ml], P = 0.008), Max C-IMT ([0.81 ± 0.15 mm vs. 0.91 ± 0.15 mm], P < 0.001), Min C-RI (0.71 ± 0.06 vs. 0.68 ± 0.06, P < 0.05), and no significant differences in the duration of hypertension and hyperlipidemia, BMI, WHR, HbA1c, SBP, DBP and blood lipid between control group and MCI group. MoCA scores were positively correlated with C-P (r = 0.252, P = 0.005), and negatively correlated with the history of hypertension (r = ?0.244, P = 0.002), duration of DM (r = ?0.161, P = 0.044), Max C-IMT (r = ?0.253, P = 0.005) and Min C-RI (r = ?0.183, P = 0.023). Multiple regression analysis showed that history of hypertension (Beta = ?0.267, P = 0.002), C-P (Beta = 0.281, P = 0.001) and Min C-RI (Beta = ?0.221, P = 0.011) were significantly independent determinants for the MoCA scores.ConclusionsThe longer duration of diabetes, history of hypertension, lower serum C-P levels, thickened C-IMT and higher C-RI could be risk factors of MCI in type 2 diabetic patients. This finding could have an important impact on the management of cognitive decline in diabetic patients.