The vascular effects of metabolic impairment clusters in subjects of different ethnicities

BACKGROUND: Although metabolic syndrome affects vascular function, the impact of individual impairments and their clustering is unclear. OBJECTIVE: To assess the vascular impact of metabolic impairments before they reach treatment thresholds in different ethnic groups. METHODS: Metabolic variables, inflammatory markers, endothelium dependent vasodilatation (EDV) and carotid intima media thickness (CIMT) were measured in population samples of 82 Caucasians and 78 matched Afro-Caribbeans with no vascular disease. Insulin resistance was assessed using homeostasis model assessment (HOMA-IR). EDV was measured as the change in the height of the inflection point of the digital volume pulse following intravenous infusion of 5 mcg/min of albuterol (DeltaRIDeltaLB). Regression models were used to investigate the independent effects of metabolic impairment clusters and their interaction with ethnicity on EDV and CIMT. RESULTS: HOMA-IR (2.4-3.8, p < 0.0001), IL-6 levels (1.1-2.8 pg/mL, p = 0.02) and CIMT (0.71-0.83 mm, p = 0.009) increased whereas in DeltaRIBASELINE (77.6-72.9 percentage points, p < 0.0001) and DeltaRIDeltaLB (15.5-7.1 percentage points, p < 0.0001) decreased with the number of metabolic impairments present. DeltaRIDeltaLB decreased by 1.6 (95% CI 0.2-3.7) percentage points and CIMT increased by 0.06 (95% CI 0.02-0.10) mm for each metabolic impairment present after adjusting for age, gender, ethnicity and HOMA-IR. There were significant interactions between Afro-Caribbean ethnicity and metabolic impairments for IL-6 (p = 0.037) and DeltaRIDeltaLB (p = 0.002). CONCLUSIONS: Clustering of metabolic impairments is associated with inflammatory activation, impaired EDV and increased CIMT even before reaching treatment thresholds for individual impairments. This effect was more marked in Afro-Caribbean subjects.     

Increased age, high body mass index and low HDL-C levels are related to an echolucent carotid intima-media: the METEOR study

Abstract. Peters SAE, Lind L, Palmer MK, Grobbee DE, Crouse JR III, O’Leary DH, Evans GW, Raichlen J, Bots ML, den Ruijter HM, on behalf of the METEOR study group (University Medical Center Utrecht, Utrecht, The Netherlands; Uppsala University Hospital, Uppsala, Sweden; Keele University, Keele, UK; Wake Forest University School of Medicine, Winston‐Salem, NC, USA; Caritas Carney Hospital, Boston, MA, USA; and AstraZeneca, Wilmington, DE, USA). Increased age, high body mass index and low HDL‐C levels are related to an echolucent carotid intima–media: the METEOR study. J Intern Med 2012; 272: 257–266. Introduction. Echolucent plaques are related to a higher cardiovascular risk. Studies to investigate the relationship between echolucency and cardiovascular risk in the early stages of atherosclerosis are limited. We studied the relationship between cardiovascular risk factors and echolucency of the carotid intima–media in low‐risk individuals. Methods. Data were analysed from the Measuring Effects on Intima‐Media Thickness: an Evaluation of Rosuvastatin (METEOR) study, a randomized placebo‐controlled trial including 984 individuals which showed that rosuvastatin attenuated the rate of change of carotid intima–media thickness (CIMT). In this post hoc analysis, duplicate baseline ultrasound images from the far wall of the left and right common carotid arteries were used for the evaluation of the echolucency of the carotid intima–media, measured by grey‐scale median (GSM) on a scale of 0–256. Low GSM values reflect echolucent, whereas high values reflect echogenic structures. The relationship between baseline GSM and cardiovascular risk factors was evaluated using linear regression models. Results. Mean baseline GSM (± SD) was 84 ± 29. Lower GSM of the carotid intima–media was associated with older age, high body mass index (BMI) and low levels of high‐density lipoprotein cholesterol (HDL‐C) [beta ?4.49, 95% confidence interval (CI) ?6.50 to ?2.49; beta ?4.51, 95% CI ?6.43 to ?2.60; beta 2.45, 95% CI 0.47 to 4.42, respectively]. Common CIMT was inversely related to GSM of the carotid intima–media (beta ?3.94, 95% CI ?1.98 to ?5.89). Conclusion. Older age, high BMI and low levels of HDL‐C are related to echolucency of the carotid intima–media. Hence, echolucency of the carotid intima–media may be used as a marker of cardiovascular risk profile to provide more information than thickness alone.     

Searching for the right outcome? A systematic review and meta‐analysis of controlled trials using carotid intima‐media thickness or pulse wave velocity to infer antiatherogenic properties of thiazolidinediones

Introduction: Recent meta‐analyses cast doubt over purported beneficial effects of Peroxisome Proliferator Activated Receptor‐Gamma (PPAR‐γ) receptor agonists. Thiazolidinedione (TZD) trials using surrogate outcomes to postulate an antiatherogenic paradigm have been criticised as misinformative. We conducted an independent systematic review and meta‐analysis of controlled TZD studies incorporating carotid intima‐media thickness (CIMT) or pulse wave velocity (PWV) as primary outcome measures. The aim was to provide an evidence‐based overview of TZD intervention studies using markers prospectively linked to vascular outcome in type 2 diabetes. Methods: Systematic search of known databases for TZD intervention trials using mean thickness CIMT(n = 9) and ankle‐brachial PWV(n = 6) as primary outcome measures was performed. CIMT and PWV pooled weighted mean difference was calculated using a random effects model accounting for heterogeneity and publication bias. An indirect meta‐analysis provided a comparison of rosiglitazone and pioglitazone effects. Results: A composite of combined placebo and comparator controlled trials demonstrated a significant weighted mean difference of–0.06 mm for CIMT (95% CI–0.09 to–0.02, p = 0.001) and–0.72 ms^?1 for PWV (95% CI–1.28 to–0.16, p = 0.011) in favour of thiazolidiendione treatment. No TZD intraclass variation in CIMT (p = 0.96) or PWV (p = 0.33) change was observed. Conclusion: TZDs exhibit significant beneficial effects on aorto‐carotid atherosclerosis when assessed using prospectively validated non‐invasive techniques. Inferring clinical benefit in the absence of confirmatory outcome trials is questionable and caution should be exercised when interpreting intervention data with surrogate endpoints. TZD‐induced congestive cardiac failure or other unknown PPAR‐γ adverse effects are plausible explanations for the conflicting results of intervention trials using markers of atherosclerosis and clinical event outcomes.     

Carotid intima-media thickness and the risk of new vascular events in patients with manifest atherosclerotic disease: the SMART study.

AIMS: Carotid intima-media thickness (CIMT) is an independent predictor of vascular events in the general population. Currently, little is known about the relationship between CIMT and new vascular events in patients with manifest arterial disease. We aimed to assess the strength of this relationship. METHODS AND RESULTS: The study was performed in the first consecutive 2374 patients with manifest arterial disease enrolled in the cohort study SMART (Second Manifestations of ARTerial disease), a cohort study among patients with manifest arterial disease or cardiovascular risk factors. Common CIMT was measured at baseline in both carotid arteries. Vascular events were vascular death, non-fatal myocardial infarction, or stroke, whichever occurred first. Adjusted for age and sex, an increase in common CIMT of 1 SD ( approximately 0.32 mm) was associated with the occurrence of vascular events [hazard ratio (HR) 1.18; 95% confidence interval (95% CI) 1.04-1.32]. Increasing CIMT was most strongly related to ischaemic stroke incidence (HR 1.35; 95% CI 1.16-1.59). Results were similar in the 2177 patients without large common carotid plaques (CIMT <2 mm at all measurements sites). The findings were similar after additional adjustment for risk factors of CIMT and vascular risk. CONCLUSION: Common CIMT is associated with the occurrence of new vascular events, mostly for ischaemic stroke, in patients with manifest arterial disease. This relation does not appear to depend on the presence of plaques.     

Carotid plaque and intima-media thickness and the incidence of ischemic events in patients with atherosclerotic vascular disease

We aimed to evaluate whether carotid intima-media thickness (CIMT) or the presence of plaque can confer additional predictive value of future cardiovascular (CV) ischemic events in patients with pre-existing atherosclerotic vascular disease. We identified 2317 patients enrolled in the REduction of Atherothrombosis for Continued Health (REACH) registry who had atherosclerotic vascular disease and baseline CIMT measurements. The entire range of CIMT was divided into quartiles and the fourth quartile (≥ 1.5 mm) was defined as carotid plaque. Mean ± standard deviation baseline CIMT was 1.31 ± 0.65 mm. Associated CV ischemic events and vascular-related hospitalizations were evaluated over a 2-year follow-up. There was a positive increase in adjusted hazard ratios (HRs) for all-cause mortality (p = 0.04 for trend) and the quadruple endpoint (CV death, myocardial infarction (MI), stroke, hospitalization for CV events) with increasing quartiles of CIMT (p = 0.0008 for trend), which was mainly driven by the fourth quartile (carotid plaque). HRs for all-cause mortality, CV death, CV death/MI/stroke and the quadruple endpoint comparing the highest (carotid plaque) with the lowest CIMT quartile were 2.09 (95% CI, 1.07-4.10; p = 0.03); 2.49 (1.10-5.67; p = 0.03); 1.71 (1.10-2.67; p = 0.02); and 1.73 (1.31-2.27; p = 0.0001). In conclusion, our analyses suggest that the presence of carotid plaque, rather than the thickness of intima-media, appears to be associated with increased risk of CV morbidity and mortality, but confirmation of these findings in other population and prospective studies is required.     

Role of echocardiographic left ventricular mass and carotid intima‐media thickness in the cardiovascular risk assessment of asymptomatic patients with type 2 diabetes mellitus

Background: Standard cardiovascular (CV) risk assessment may underestimate risk in people with type 2 diabetes mellitus (T2DM). Cardiac and vascular imaging to detect subclinical disease may augment risk prediction. This study investigated the association between CV risk, left ventricular hypertrophy (LVH) and carotid intima‐media thickness (CIMT) in patients with T2DM free of CV symptoms. Methods: People with T2DM without known CV disease were recruited from general practice. The 5‐year risk of CV events was calculated using an adjusted Framingham equation and the prevalence of LVH and abnormal CIMT across bands of CV risk assessed. In those at intermediate risk, the number needed to scan (NNS) to reclassify one person to high risk was calculated across the group and compared in those above and below 55 years. The association between LV mass and CIMT was also assessed. Results: Mean age 57 years (SD11), 51% female. Median 5‐year CV risk 14.3% (interquartile range 10.3, 19.5), 51% had LVH (American Society of Echocardiography criteria) and 31% an abnormal CIMT (age and sex criteria). In the 52% at intermediate risk, 37% had LVH and 36% an abnormal CIMT. The NNS was 1.7 using both imaging techniques, 2.7 using cardiac imaging alone or 2.8 using vascular imaging alone. Almost twice as many people >55 years had an abnormal CIMT than those <55 years. Conclusions: Cardiac and vascular imaging to detect subclinical disease can be used to augment prediction of CV risk in people with T2DM at intermediate risk. The value of reclassifying risk is as yet unproven and requires outcome data from intervention studies.     

Gallstones are associated with carotid atherosclerosis

Background/Aims: Gallstone disease (GD) and cardiovascular disease (CD) are common diseases worldwide with considerable economical impact and they are strongly associated. Carotid atherosclerosis is an excellent marker of risk for CD like stroke and myocardial infarction. The aim of this study was to assess the association between gallstones and carotid atherosclerosis. Methods: A cross‐sectional study was conducted. We evaluated subjects with ultrasonographical evidence of GD and asymptomatic subjects without such evidence. Anthropometric, clinical and biochemical variables were collected. The Metabolic syndrome was evaluated using adult treatment panel III criteria. Carotid artery intima–media thickness (CIMT) was determined by a standard ultrasound protocol. Insulin‐like growth factor‐1 (IGF‐1) serum levels were measured in all subjects. Results: We studied 191 subjects: 62 subjects with GD (53.2% males) and 129 asymptomatic subjects without GD (65.9% males). Subjects with GD exhibited a higher body mass index, body fat percent, insulin serum levels and CIMT (P<0.05 for all). The prevalence of GD was higher in subjects with a CIMT>0.75 independently of other factors [odds ratio (OR) 2.12, 95% confidence interval (CI) 1.04–4.34; P=0.039], and for every 0.1 mm increase in CIMT the independent probability to be a case of GD increased by a factor of 1.25 (95% CI 1.02–1.53; P=0.027). IGF‐1 levels did not differ among groups. Conclusions: Subjects with GD exhibit greater carotid atherosclerosis, and therefore have a higher risk for stroke and myocardial infarction.     

Noninvasive Assessment of Atherosclerosis in Patients with Isolated Hypertension

Background: Endothelial dysfunction is considered the first stage in the development of atherosclerosis. Brachial artery flow‐mediated dilatation (FMD) has been used to assess endothelial dysfunction. An impaired FMD response may reflect a vascular phenotype prone to atherosclerosis. The thickness of the common carotid intima‐media (CIMT) as measured by ultrasound represents a marker of structural atherosclerosis. Recently, it has been shown that color M‐mode propagation velocity measured along the origin of descending thoracic aorta (AVP) may reflect atherosclerosis. In this study, the effects of isolated hypertension on these atherosclerosis markers are investigated. Methods: Fifty patients with newly diagnosed hypertension and forty healthy people were enrolled. Patients were evaluated with transthoracic echocardiography. Diastolic functions were evaluated by transmitral filling parameters of deceleration time (DT), E/A ratio, and isovolumetric relaxation time (IVRT). Carotid intima‐media thickness, FMD, and AVP were measured. Results: Age, gender, and BMI of both groups were similar. Compared to control group CIMT, DT and IVRT values were significantly higher, and FMD and AVP values were significantly lower in hypertensive patients. There were significant correlations between AVP and CIMT (r =−0.699, P < 0.001), AVP and FMD (r = 0.400, P < 0.001), and FMD and CIMT (r =−0.600, P < 0.001). Carotid intima‐media thickness, AVP, and FMD were significantly correlated with systolic and diastolic blood pressures and DT and IVRT. Conclusions: In patients with isolated hypertension, AVP and FMD decrease and CIMT increases. In addition, CIMT is inversely correlated with AVP and FMD, and AVP is directly correlated with FMD. (ECHOCARDIOGRAPHY 2010;27:155‐160)     

Hemoglobin and atherosclerosis in patients with manifest arterial disease. The SMART-study

BACKGROUND: Decreased hemoglobin levels are known to be associated with an increased risk of coronary mortality and morbidity. This is largely thought to result from the development of left ventricular hypertrophy. Similar remodeling mechanisms of the vessel wall that may result in atherosclerosis are likely to be present. We studied whether hemoglobin levels are related to different vascular indicators of atherosclerosis. METHODS AND RESULTS: This cross-sectional study was performed in the first consecutive 2514 patients with manifest arterial disease enrolled in the SMART-study (Second Manifestations of ARTerial disease). The relation of hemoglobin levels with common carotid IMT (CIMT), presence of a>/=50% internal carotid artery stenosis (ICAS) and prevalent peripheral arterial disease (PAD) was assessed with linear and logistic regression analyses. Each mmol/l increase in hemoglobin was associated with a lower CIMT (-0.03 mm [95% CI: -0.04; -0.01]) and a lower prevalence of >/=50% ICAS (odds ratio: 0.84 [95% CI: 0.73; 0.97]) after adjustment for age, gender and potential confounders. Hemoglobin was not related to prevalence of peripheral arterial disease (1.02 [95% CI: 0.89; 1.16]). CONCLUSIONS: This study shows that in patients with manifest arterial disease, increasing hemoglobin levels are associated with reduced severity of atherosclerosis.     

Increased subclinical atherosclerosis in young adults with metabolic syndrome: the Bogalusa Heart Study

OBJECTIVES: The purpose of this study was to investigate the association of metabolic syndrome (MetS) with subclinical atherosclerosis, determined by ultrasound carotid intima-media thickness (CIMT) measurements, in young adults. BACKGROUND: Metabolic syndrome is associated with subclinical atherosclerosis and increased cardiovascular risk in older and middle-aged adults; however, these associations have not been studied among young adults. METHODS: Non-diabetic subjects from Bogalusa Heart Study, a longitudinal study of atherosclerosis in young adults, underwent B-mode ultrasonography of the carotid arteries. Metabolic syndrome was defined with the National Cholesterol Education Program Adult Treatment Panel III (MetSNCEP) and World Health Organization (MetSWHO) definitions. CIMT and MetS associations were evaluated with multivariable regression and area under receiver-operator characteristic curve (AUC) analyses. RESULTS: Of 507 subjects (29% black, 39% male, mean [SD] age 32 [3] years), 67 (13%) had MetSNCEP and 65 (13%) had MetSWHO. Common (mean = 0.70 [0.11] mm vs. 0.66 [0.08] mm, p = 0.002) and internal CIMT (0.72 [0.21] mm vs. 0.68 [0.12] mm, p = 0.020) were higher among those with MetS(NCEP) than those without MetS(NCEP). Common (0.69 [0.11] mm vs. 0.66 [0.08] mm, p = 0.020) and internal CIMT (0.73 [0.23] mm vs. 0.68 [0.12] mm, p = 0.012) also were higher among those with MetSWHO than those without MetSWHO. Composite CIMT increased with the number of MetS components present (MetSNCEP r = 0.997, p < 0.001; MetSWHO r = 0.946, p = 0.053). Metabolic syndromeNCEP (AUC = 0.557, 95% confidence interval [CI] 0.513 to 0.601) and MetSWHO (AUC = 0.539, 95% CI 0.495 to 0.584) both predicted composite CIMT > or =75th percentile. CONCLUSIONS: In young adults, MetS is associated with increased atherosclerotic burden, and therefore, increased cardiovascular risk. These results support the importance of screening and early intervention in this population.     

Intima media thickness as a surrogate marker for generalised atherosclerosis

Vascular markers of atherosclerotic burden allow atherosclerosis to be studied in the sub-clinical phase of the disease, and facilitate the assessment of new therapies for modifying coronary heart disease (CHD) risk factors. B-mode ultrasound enables non-invasive, direct visualization of the arterial wall. The intima media thickness of the carotid artery (CIMT) quantified using this technique, is a reliable marker of atherosclerotic burden. Furthermore, it demonstrates greater sensitivity in detecting early atherosclerosis compared with angiography.The validity of ultrasonographically-determined CIMT as a surrogate marker of atherosclerotic disease has been established; CIMT is positively associated with the incidence of coronary events, relates to atherosclerotic disease elsewhere in the arterial system and has common risk factors to the development of CHD. Furthermore, ultrasonographically-determined CIMT demonstrates good inter- and intra-observer reproducibility making it suitable for tracking the progression or regression of atherosclerotic disease over time.The validity of CIMT as a vascular marker of atherosclerosis progression has been demonstrated in clinical trials. Intervention studies have shown that modification of CHD risk factors can significantly reduce progression of CIMT. Hence, B-mode ultrasonography is being used increasingly to elucidate the efficacy of new therapies, enabling the benefits of treatment to be established more rapidly and with fewer patients compared with clinical outcome trials.     

Change in body mass index from adolescence to young adulthood and increased carotid intima-media thickness at 28 years of age: the Atherosclerosis Risk in Young Adults study

Obesity has become a major health problem in Western societies by increasing the risk of atherosclerosis and cardiovascular disease. Although data on tracking of body mass index (BMI) are available, little is known about the impact of weight change over time on the development of vascular damage. OBJECTIVE: To evaluate the relationship between adolescent BMI as well as change in BMI from adolescence into young adulthood and cardiovascular risk, as estimated by common carotid intima-media thickness (CIMT). DESIGN: Cohort study. SUBJECTS: A total of 750 healthy young adults, aged 27-30 y, who attended secondary school in Utrecht, the Netherlands. MEASUREMENTS: Data on adolescent weight, height, blood pressure and puberty stage were available from the original school health records of the Municipal Health Service. At young adulthood, a questionnaire on cardiovascular risk factors was completed and fasting blood sample was drawn and common CIMT was measured. RESULTS: One standard deviation (s.d.) increase in adolescent BMI was associated with 2.3 microm [95% confidence interval (CI): 1.3; 3.3] increase in mean common CIMT in young adults after adjustment for gender, adolescent age, adolescent blood pressure, puberty stage and lumen diameter. Further adjustment for adult cardiovascular risk factors did not change the relationship (linear regression coefficient=2.1 microm/s.d.; 95% CI: 1.0; 3.1). Adjustment for adult BMI attenuated the association (linear regression coefficient=0.9 microm/s.d.; 95% CI: -0.3; 2.2) as the majority of overweight and obese adolescents remained overweight or became obese young adults. Subjects who remained in the upper BMI distribution from adolescence into young adulthood had a significantly higher common CIMT compared to those who showed relative weight loss over time (mean difference 14.7 mum; P<0.001). These latter showed similar CIMT values as individuals with constant low BMI. CONCLUSION: Adolescent BMI predicts cardiovascular risk, as estimated by common CIMT in young adulthood. Individuals who experience the largest increase in BMI and those who remain overweight over time have the thickest common CIMT.     

Relationship between the slow coronary flow and carotid artery intima-media thickness]

OBJECTIVE: This study was planned to investigate the relationship between slow coronary flow and the carotid artery intima-media thickness (CIMT) which is an indicator of early atherosclerotic changes in vascular tree. METHODS: Consecutive patients (n=203) who were free of any coronary lesions in coronary angiograms were enrolled. The patients were assigned into slow flow (97) and normal flow (106) groups according to the corrected TIMI frame count (CTFC) of every three coronary arteries. Carotid artery intima-media thickness was measured via computer software regarding far-wall method in both common carotid arteries. Maximum and mean CIMT values were compared between the two groups. The accuracy of CIMT in the prediction of slow coronary flow was estimated using Receiver Operating Characteristic curve (ROC) analysis. RESULTS: Maximum and mean CIMT values were 0.814+/-0.106 mm and 0.668+/-0.080 mm for normal flow group and 0.966+/-0.133 mm, 0.780+/-0.105 mm for slow flow group, respectively (p<0.001). Using 0.861 as the cut-off value for maximum CIMT positive and negative predictive values of slow flow were 80.1% and 70.2% (area under the ROC curve=0.809; p<0.001; 95% CI 0.750-0.868). CONCLUSIONS: We find out that CIMT and CTFC are strongly correlated. This implies that slow coronary flow could be an early marker of subclinical atherosclerosis. So patients with slow flow should be followed-up prospectively for possibility of manifest atherosclerosis.     

Subclinical Atherosclerosis In Young β-thalassemia Major Patients

Subclinical atherosclerosis in young β-thalassemia major (β-TM) patients and its risk factors including dyslipidemia compared to type 1 diabetic patients were assessed. Ninety subjects were included and divided into three groups: group I comprised 30 β-TM patients with a mean age of 18.4 ± 6.18 years; group II comprised of 30 type 1 diabetic patients with a mean age of 19.23 ± 4.25 years, and 30 healthy subjects served as controls in group III. Fasting lipid profiles, hemoglobin (Hb) electrophoresis, serum ferritin and high resolution ultrasound for the measurement of carotid artery intima media thickness (CIMT) were done. Serum triglycerides, total cholesterol, apoprotein A (ApoA), and CIMT were significantly elevated, while high density lipoproteins (HDL) were significantly lowered in thalassemic and diabetic patients compared to controls. In thalassemic patients, CIMT was positively correlated with age, Hb F, ferritin and cholesterol levels. Atherogenic lipid profiles in young thalassemic patients with increased CIMT highlights their importance as prognostic factors for vascular risk stratification.     

Risk factors for cardiovascular disease do not fully explain differences in carotid intima–media thickness between Indigenous and European Australians without diabetes

Objective To investigate whether cardiovascular risk factors can explain the higher carotid intima–media thickness (CIMT) in Indigenous compared with European Australians. Design Cross‐sectional study in three subgroups. Patients Non‐diabetic urban European (n = 86), urban Indigenous (n = 69), and remote Indigenous (n = 60) Australians aged 25–64 years. Measurements CIMT, age, sex, anthropometry, blood pressure, smoking status, fasting glucose and insulin, haemoglobin (Hb)A1c, homocysteine, C‐reactive protein (CRP), lipids, urinary albumin and creatinine. Results CIMT and levels of risk factors, except fasting glucose and total cholesterol, worsened across the three groups. Log_n fasting insulin [β = 0·022, 95% confidence interval (CI) 0–0·0439], age (β = 0·006, 95% CI 0·004–0·007), gender (female β = –0·005 vs. male, 95% CI –0·084 to –0·026), mean arterial pressure (MAP) (β = 0·001, 95% CI 0·001–0·002) and ethnicity/location [urban Indigenous (β = 0·027, 95% CI –0·010 to 0·064 vs. European); remote Indigenous (β = 0·083, 95% CI 0·042–0·123 vs. European)] explained 41% of variance in CIMT. Significant interactions were seen for ethnicity/location with age (P = 0·014) and MAP (P = 0·018). Age was consistently associated with CIMT across the three populations, and was associated with larger increments in CIMT for the Indigenous subgroups (β = 0·007, 95% CI 0·005–0·009 urban; β = 0·007, 95% CI 0·004–0·010 remote) compared with Europeans (β = 0·003, 95% CI 0·002–0·006) in models including age, sex and MAP. MAP was only associated with CIMT in the remote Indigenous subgroup. Conclusion After adjusting for selected risk factors, CIMT in remote Indigenous participants was still higher than in Europeans. The slope of the association between age and CIMT steepened from urban Europeans to remote Indigenous.     

Differences in biological risk factors for cardiovascular disease between three ethnic groups in the Whitehall II study

This study compares risk factors for cardiovascular disease in civil servants of three ethnic groups screened as part of the Whitehall II cohort study. Previously identified risk factors for cardiovascular disease in 360 Afro-Caribbean and 577 South Asian subjects are compared with the 8973 white Caucasian subjects. Controlling for socio-economic status is more precise than in most previous studies of cardiovascular differences between ethnic groups. After controlling for socio-economic confounding factors, age and sex, South Asian subjects were found to have increased prevalence of hypertension (defined as either having systolic pressure of > 160, diastolic pressure of > 95 or being on antihypertensives) OR 2.3 (95% CI 1.6-3.3), diabetes OR 4.2 (95%, CI 3.0-5.8) and a high risk lipid profile, although total cholesterol was lower than in the white population. Afro-Caribbean subjects had more hypertension OR 4.0 (95% CI 2.8-5.7) and diabetes OR 2.8 (95% CI 1.7-4.6), but this was accompanied by a favourable lipid profile with low cholesterol and high HDL. Afro-Caribbean alcohol and smoking habits were low-risk. Socio-economic status was found to be an important confounding factor for ethnic differences in biochemical risk factors for cardiovascular disease. However, adjusting for socioeconomic class only attenuates observed differences; it does not abolish them.     

Childhood predictors of cardiovascular disease in adulthood. A systematic review and meta‐analysis

Childhood obesity predicts the risk of adult adiposity, which is associated with the earlier onset of cardiovascular disease [adult atherosclerotic cardiovascular disease, ACVD: hypertension, increased carotid intima media thickness (CIMT) stroke, ischemic heart disease (IHD)] and dysglycaemia. Because it is not known whether childhood obesity contributes to these diseases, we conducted a systematic review of studies that examine the ability of measures of obesity in childhood to predict dysglycaemia and ACVD. Data sources were Web of Science, MEDLINE, PubMed, CINAHL, Cochrane, SCOPUS, ProQuest and reference lists. Studies measuring body mass index (BMI), skin fold thickness and waist circumference were selected; of 1,954 studies, 18 met study criteria. Childhood BMI predicted CIMT: odds ratio (OR), 3.39 (95% confidence interval (CI), 2.02 to 5.67, P < 0.001) and risk of impaired glucose tolerance in adulthood, but its ability to predict ACVD events (stroke, IHD; OR, 1.04; 95% CI, 1.02 to 1.07; P < 0.001) and hypertension (OR, 1.17, 95% CI 1.06 to 1.27, P = 0.003) was weak–moderate. Body mass index was not predictive of systolic BP (r ?0.57, P = 0.08) and weakly predicted diastolic BP (r 0.21, P = 0.002). Skin fold thickness in childhood weakly predicted CIMT in female adults only (r_s0.09, P < 0.05). Childhood BMI predicts the risk of dysglycaemia and abnormal CIMT in adulthood, but its ability to predict hypertension and ACVD events was weak and moderate, respectively. Skin fold thickness was a weak predictor of CIMT in female adults.     

The relationship between serum trimethylamine N-Oxide level and carotid intima media thickness in untreated essential hypertension patients

Background Circulating trimethylamine N-Oxide(TMAO)level has been linked to adverse cardiovascular outcome and mortality in the general population,and atherosclerosis is a window of the cardiovascular disease.Therefore,the present study was designed to investigate the relationship between TMAO level and atherosclerosis in untreated essential hypertension patients. Methods We measured serum TMAO level in atherosclerosis,subclinical atherosclerosis and controls matched by age and sex. The link between serum TMAO level and CIMT was subsequently assessed. Results The level of serum TMAO was significantly higher in atherosclerosis patients than in controls. Serum TMAO level was positively correlated with carotid intima media thickness(r =0.783,P 0.001),and logistic regression indicated that TMAO was a risk factor of atherosclerosis(OR,1.904;95% CI,1.197-2.733,P 0.001). Conclusions Serum TMAO concentration positively correlates to carotid intima media thickness,and should be a good predicted biomarker for atherosclerosis.     

Glycemic and blood pressure control in older patients with hypertension and diabetes: association with carotid atherosclerosis

Backgroud Numerous studies have confirmed the effectiveness of slowing the progression of atherosclerosis by blood pressure (Bp) control in patients with hypertension and several studies also showed the efficacy of intensive glycemic control in decreasing progression of carotid intima-media thickness (CIMT) in patients with type 1 and type 2 diabetes. However, few studies have compared the relative importance of glycemic vs. Bp control in patients with diabetes and hypertension. We aimed to investigate the association between Bp and glycemic control and subclinical carotid atherosclerosis in older patients with hypertension and type 2 diabetes. Methods In a cross-sectional study, B-mode high-resolution ultrasonography of the carotid artery was performed in 670 subjects (508 males and 162 females) aged 60 years or over who had self-reported hypertension and diabetes but no history of coronary heart disease or stroke. Subjects were categorized by their systolic blood pressure: tight control, < 130 mmHg; usual control, 130–139 mmHg; or uncontrolled, ≥ 140 mmHg, and by their hemoglobin A1c (HbA1c) level: tight control, < 6.5%; usual control, 6.5%–7.5%; or uncontrolled, ≥ 7.5%, respectively. Results The mean CIMT was 8.20 ± 0.11 mm, and carotid plaque was found in 52.5% (352/670) subjects. Overall, 62.1% of the subjects had subclinical carotid atherosclerosis, defined as having either carotid plaque or elevated CIMT (≥ 1.1 mm). The mean CIMT was significantly different between Bp control categories (7.60 ± 0.09 mm, 7.90 ± 0.08 mm, and 8.60 ± 0.12 mm, respectively, P = 0.03) but not between glycemic control categories (8.20 ± 0.10 mm, 8.1 ± 0.08 mm, and 8.40 ± 0.14 mm, respectively, P = 0.13) using ANCOVA analysis. Multivariable logistic regression adjusting for potential confounding factors showed that usual or uncontrolled Bp control were associated with having carotid plaque (OR = 1.08 and OR = 1.42, respectively), or elevated CIMT [Odd ratio (OR) = 1.17, 95% confidence interval (CI) 1.04–2.24, and OR = 1.54, 95% CI 1.36–2.96, respectively compared to tight Bp control; but did not show glycemic control as independent predictor of either having carotid plaque or elevated CIMT. Conclusions In older patients with hypertension and diabetes, blood pressure control, but not glycemic control is associated with subclinical carotid atherosclerosis.     

Polymorphism of the angiotensin-converting enzyme (ACE) and angiotesinogen (AGT) genes and their associations with blood pressure and carotid artery intima media thickness among healthy Finnish young adults--the Cardiovascular Risk in Young Finns Study

The roles of angiotensin converting enzyme (ACE) insertion-deletion (I/D) and angiotensinogen (AGT) m235t polymorphisms in cardiovascular diseases have been investigated extensively during the past decade but results have been inconsistent. A sex-specific association between the ACE I/D polymorphism and systolic blood pressure (BP) was seen among Finnish children and adolescents previously. We investigated if these polymorphisms associate with the BP and carotid artery intima media thickness (IMT) in the same cohort during their adulthood. IMT data were available for 224 ACE I/D genotyped individuals and 202 AGT m235t genotyped individuals. Systolic and diastolic blood pressure values did not differ between ACE and AGT genotypes. Age and BMI adjusted mean IMT was 0.02 (95% CI: -0.05 to 0.02, p=0.33) and 0.03 mm (95% CI: -0.07 to 0.001, p=0.06) lower among the ID and DD genotype groups, respectively, compared to the II genotype group. MT and TT genotype groups had 0.02 mm (95% CI: -0.01 to 0.05, p=0.17) higher and 0.01 mm (95% CI: -0.04 to 0.02, p=0.59) lower mean IMT, respectively, compared to the MM genotype group. We conclude that ACE I/D and AGT m235t polymorphisms are not associated with carotid IMT in healthy young Finnish adults.