Risk factors and early extracoronary atherosclerotic plaques detected by three-site ultrasound imaging in hypercholesterolemic men. Prévention Cardio-vasculaire en Médecine du Travail METRA Group

Ultrasonic detection of atherosclerotic plaque of carotid abdominal aortic and femoral arteries and evaluation of risk factors were performed in 208 hypercholesterolemic men without cardiovascular disease. Twenty-six percent of them had no plaque. Plaque at the carotid, aortic, and femoral sites was found in 37%, 48%, and 53% of subjects, respectively. Plaque was associated (1) in carotid arteries with increased total and low-density lipoprotein cholesterol; (2) in the aorta with increased age, pressure, glycemia, and smoking; and (3) in femoral arteries with increased age, systolic pressure, low-density lipoprotein cholesterol, and smoking. Multiple regression analysis showed correlations between carotid plaque and low-density lipoprotein cholesterol; aortic plaque and age, smoking, glycemia, and pressure; femoral plaque and age, smoking, and pressure. This suggests that multiple risk factors influence lesions, and risk profile differs according to atherosis site.     

Impact of multiple coronary risk factors on the intima-media thickness of different segments of carotid artery in healthy young adults (The Bogalusa Heart Study)

Although risk factors for coronary artery disease are also associated with increased carotid artery intima-media thickness (IMT) as measured by B-mode ultrasonography in middle-aged and older persons, information on the impact of multiple risk factors on the IMT of different segments of the carotid artery in young adults is limited. This relation was examined in a sample of 518 black and white subjects (mean age 32 years; 71% white, 39% male) enrolled in the Bogalusa Heart Study. IMT was thicker and more skewed in the bulb compared with other carotid segments. Race differences (blacks more than whites) were noted for the common carotid (p <0.001) and carotid bulb (bifurcation) IMT (women only, p <0.001). Men had a greater IMT in the common carotid (p <0.05), internal carotid (p <0.05), and carotid bulb (whites only, p <0.001). In a multivariate analysis, systolic blood pressure, race, age, low-density lipoprotein (LDL) cholesterol, and high-density lipoprotein (HDL) cholesterol weree entered into a model in that order and accounted for the 16.7% variance in the common carotid IMT; age, systolic blood pressure, HDL cholesterol, LDL cholesterol, race, and insulin levels explained the 19.4% variance in the carotid bulb IMT. Gender and body mass index (BMI) accounted for the 4.7% variance in the internal carotid IMT. Increases in IMT with increasing number of risk factors (cigarette smoking, higher total cholesterol to HDL cholesterol ratio, higher systolic blood pressure, greater waist circumference, and higher insulin level) were noted for the common carotid and carotid bulb segments (p for trend <0.001 for both). The observed deleterious trend of increasing IMT at different carotid segments with increasing number of risk factors in free-living, asymptomatic young subjects underscores the importance of profiling multiple risk factors early in life. Ultrasonography of carotid arteries, especially at the bifurcation, may be helpful along with measurements of risk factors for evaluation of asymptomatic atherosclerotic disease.     

A 2D Echo color-Doppler study of the extracranial carotid arteries in borderline arterial isolated systolic hypertension

BACKGROUND: The aim of this study was to evaluate the prevalence of atherosclerotic carotid lesions in isolated systolic borderline arterial hypertension by 2D echo color-Doppler and effect of night-time pressure fall by ambulatory blood pressure monitoring. METHODS: Outpatients from January 1992 to December 1998 were examined. One hundred and twenty normotensive control subjects and 99 isolated systolic borderline untreated hypertensives were studied, based on blood pressure fall were divided into dippers, with nocturnal systolic and/or diastolic blood pressure fall of >10%, and non dippers. Subjects with ischemic heart disease, valvulopathies, heart failure, renal insufficiency, cerebrovasculopathies, hypercholesterolemia (total cholesterol >200 mg/dl) and diabetes. Normotensives and hypertensives were homogenous for cardiovascular risk factors. A thickness of =/> 0.95 mm, calculated as a mean of 5 measurements of the common carotid artery, 2-3 cm from the carotid bifurcation, was considered a sign of myointimal thickening, and the plaque as a focal thickening of =/> 2 mm, based on echogenic characteristics and site. RESULTS: Compared to normotensives, isolated systolic borderline hypertensives, showed carotid arteries with an intima-media thickening (p=0.002) with one or more plaques (p=0.0001) much more frequently, while normal carotid arteries (p=0.0001) were less frequent. In normotensives, like in hypertensives, the prevalence of vasal lesions was not significantly different in dippers compared with non dippers. Plaques were most often localized at level of the common carotid and lesions were hard. CONCLUSIONS: The conclusions is drawn that isolated systolic hypertension is the sign of major vascular atherosclerotic lesions. The night-time pressure fall does not affect the importance of the lesions.     

Comparison of risk factors for vascular disease in the carotid artery and aorta in women with systemic lupus erythematosus

OBJECTIVE: To examine and compare risk factors for various stages of subclinical vascular disease in different vascular beds (carotid and aorta) in women with systemic lupus erythematosus (SLE) who have not yet developed clinical cardiovascular disease. METHODS: This cross-sectional study was conducted in 214 women without clinical cardiovascular disease who were enrolled in the Pittsburgh Lupus Registry. B-mode ultrasound was used to measure carotid plaque and intima-media wall thickness (IMT). Doppler probes were used to collect pulse-wave velocity waveforms from the right carotid and femoral arteries as a measure of aortic stiffness. All risk factor data were collected on the day of the ultrasound examinations. RESULTS: The mean +/- SD age of the women was 45.2 +/- 10.5 years and the median SLE disease duration was approximately 9 years. Sixty-eight (32%) of the women had at least 1 focal plaque. The mean +/- SD IMT was 0.71 +/- 0.1 mm, and the mean +/- SD pulse-wave velocity was 5.96 +/- 1.6 meters/second. Using logistic regression, we found that determinants of plaque included older age, higher systolic blood pressure, lower levels of high-density lipoprotein 3, and antidepressant use. Determinants of plaque severity were older age, higher systolic blood pressure, lower levels of albumin, and smoking. Independent determinants of the highest quartile of IMT were older age, higher pulse pressure, lower levels of albumin, elevated C-reactive protein levels, high cholesterol, and higher levels of glucose. Higher aortic stiffness was associated with older age, higher systolic blood pressure, higher C3 levels, lower white blood cell count, higher insulin levels, and renal disease. CONCLUSION: In women with SLE, the risk factors associated with carotid plaque and IMT are those typically associated with cardiovascular disease in the general population, whereas the risk factors associated with vascular stiffness include SLE-specific variables related to immune dysregulation and complement metabolism. The high prevalence of cardiovascular disease among lupus patients may result from both early adverse effects on vascular stiffening as well as later promotion of wall thickening and plaque through inflammatory-mediated processes. These observations provide clues for future mechanistic studies.     

Age and sex differences in the relationship between inherited and lifestyle risk factors and subclinical carotid atherosclerosis: the Tromsø study

BACKGROUND: Ultrasound measurement of carotid artery intima-media thickness (IMT) is regarded as a valid index of atherosclerosis. Age and sex differences in the distribution of, and risk factors for, IMT have not been investigated thoroughly. METHODS: In 1994-1995 a total of 6408 men and women aged 25-84 years living in the municipality of Troms?, Norway, underwent ultrasound examination of carotid artery IMT and measurements of cardiovascular risk factors. RESULTS: Age, systolic blood pressure, total cholesterol, HDL cholesterol, body mass index, and smoking were independent predictors of IMT in both sexes. Fibrinogen levels and physical activity were associated with IMT in men only, whereas triglyceride levels were associated with IMT independently of HDL cholesterol in women only. A family history of cardiovascular disease (CVD) was an independent predictor of IMT in both sexes, also when controlling for traditional CVD risk factors. The magnitude of the association between most risk factors and IMT did not differ depending on age, but the effects of physical activity and triglycerides were more pronounced at higher age. CONCLUSION: These data suggest that there are significant age and sex differences in the distribution and the determinants of subclinical atherosclerosis.     

Race (black-white) and gender divergences in the relationship of childhood cardiovascular risk factors to carotid artery intima-media thickness in adulthood: the Bogalusa Heart Study

It has been established that childhood cardiovascular (CV) risk factors are predictive of adulthood vascular changes as measured by carotid intima-media thickness (IMT). However, whether this relationship is race- and gender-specific is not known. This aspect was examined in a black-white cohort of 868 adults (29% blacks, 42% males) aged 25-44 years who were examined at least twice in childhood for traditional CV risk factors with an average follow-up period of 26.4 years. The average value of the two earliest childhood measurements was used as the childhood value, standardized to age, race, and gender-specific z-score. Carotid IMT was measured by B-mode ultrasonography. The mean of the maximum carotid IMT readings of three right and three left far walls for common, bulb and internal segments was used. In univariate analysis, significant correlates of adulthood carotid IMT (standardized to age-, race- and gender-specific z-score) were, in the order of decreasing magnitude, triglyceride and LDL cholesterol in white males; systolic blood pressure, LDL cholesterol, and body mass index (BMI) in white females; systolic blood pressure in black males; BMI and systolic blood pressure in black females. In multivariate regression analysis, significant predictors of carotid IMT were triglycerides and LDL cholesterol in white males; systolic blood pressure and LDL cholesterol in white females; systolic blood pressure in black males; and BMI and LDL cholesterol in black females. In conclusion, the predictability of childhood CV risk factors for increased carotid IMT in adulthood varies by race and gender. The prevention implications of these findings need further investigation.     

White coat hypertension and carotid atherosclerosis

To investigate further the relationship between atherosclerotic vascular disease and blood pressure, and the phenomenon of white coat hypertension, we performed a cross-sectional study of patients referred for carotid Doppler scanning, to determine the relationship between ambulatory blood pressure monitoring (ABPM) and carotid atherosclerosis. We studied 79 patients (51 men, 28 women) undergoing Doppler ultrasound examination of the carotid arteries: 44 (56%) had evidence of carotid atherosclerosis on Doppler ultrasound examination ("disease group"), whilst 35 (44%) had normal carotid arteries ("controls"). "Adequate" ABPM recordings, defined by > 90% of recordings over the 24 h, were available in 51 patients (30 positive, 21 negative). There were no significant differences in mean daytime, mean night-time or mean 24 h ABPM recordings between those with and without carotid atherosclerosis. Mean manual clinic systolic blood pressure was significantly greater in those with carotid atherosclerosis than in controls (146.7 +/- 25.2 vs 131.1 +/- 35 mmHg, p < 0.005). In patients with carotid atherosclerosis, the first systolic blood pressure ABPM recording was not significantly different from the mean manual clinic recording (mean difference -1.5 mmHg, 95% confidence interval (CI) -7.9 to 4.8 mmHg). The initial diastolic blood pressure ABPM recording was significantly higher than the mean manual recording. Carotid atherosclerosis was identified in 53% of normotensive controls compared with 56% of white coat hypertensives and 75% of persistent hypertensives. One-third (9/27) of the patients with normal carotid arteries did not have nocturnal dipping ("non-dippers") compared with 50% (12/24) of the atherosclerotic patients. This study suggests that carotid atherosclerosis may be associated with white coat hypertension. Our study adds to the body of evidence that white coat hypertension is associated with end-organ damage and is not simply a benign disease. Such patients should be screened for other cardiovascular risk factors and should be monitored for the development of persistent hypertension.     

Low free-thyroxine levels are a risk factor for subclinical atherosclerosis in euthyroid hyperlipidemic patients.

BACKGROUND: Patients displaying overt and subclinical hypothyroidism have more cardiovascular risk factors. Consequently, they are more likely to develop atherosclerosis and cardiovascular diseases. OBJECTIVE: To analyze whether low free-thyroxine levels (FTL) would also be associated with atherosclerosis in euthyroid patients. METHODS: We selected a group of 1434 healthy euthyroid male patients without known histories of thyroid disease and with levels of thyroid-stimulating hormone values within the normal range (mean 1.70+/-0.76 mUl/l, range 0.13-4.01 mUl/l). Mean age of these patients who had been referred for assessment of hyperlipidemia was 44.6 years and mean FTL was 14.25+/-3.06 pmol/l. We divided the population according to the degree of atherosclerosis in the carotid arteries. RESULTS: Mean age, body mass index, systolic blood pressure, cigarettes/day, blood level of glucose, cholesterol levels, and fibrinogen levels were significantly higher for the patients with atherosclerotic lesions whereas mean FTL was lower for patients with carotid atherosclerosis (P = 0.0002). The relationship between FTL and carotid atherosclerosis was independent from the following cardiovascular risk factors: age, hypertension, amount of excess weight, cholesterol level, fibrinogen level, smoking status, and presence versus absence of diabetes mellitus. CONCLUSIONS: Low FTL is a risk factor for atherosclerosis in male euthyroid hyperlipidemic patients.     

Impact of multiple cardiovascular risk factors on femoral artery intima-media thickness in asymptomatic young adults (the Bogalusa Heart Study)

Femoral artery intima-media thickness (IMT), like carotid IMT, is a surrogate indicator of atherosclerotic coronary and peripheral vascular diseases in middle-aged and older adults. Although risk factors for coronary artery disease are also associated with increased IMT, especially as measured in carotid arteries, there is a paucity of information with respect to the femoral artery in this regard in the asymptomatic, younger adult population. This study examined the impact of multiple risk factors on the common femoral artery IMT as measured by B-mode ultrasonography in 1,080 black and white subjects aged 24 to 43 years (71% white and 43% men) enrolled in the Bogalusa Heart Study. Femoral IMT showed gender difference (men more than women, p = 0.001), but no racial difference. In a multivariate model, systolic blood pressure, age, male gender, cigarette smoking, and total cholesterol/high-density lipoprotein cholesterol ratios related independently, in that order, to IMT. Mean IMT increased with an increasing number of risk factors defined as values above the age-, race-, and gender-specific 75th percentile of systolic blood pressure, waist circumference, total cholesterol/high-density lipoprotein cholesterol ratio, and insulin along with smoking status (p for trend = 0.003), with respective mean IMT values of 0.66, 0.69, 0.73, and 0.79 mm for 0, 1 to 2, 3, and 4 to 5 risk factors. The odds ratio for patients with >/=3 risk factors versus no risk factors having IMT in the top fifth percentile was 4.7 (p = 0.01). The observed adverse trend of increasing femoral IMT with an increasing number of risk factors in free-living, asymptomatic young subjects underscores the need for multiple risk factors profiling in early life. Further, ultrasonography of the femoral artery in conjunction with multiple risk factor profiling can be helpful in risk stratification.     

Intima-media thickness in cardiovascularly asymptomatic hypopituitary adults with growth hormone deficiency: relation to body mass index,gender, and other cardiovascular risk factors

OBJECTIVE: Increased cardiovascular mortality and carotid atherosclerosis have been observed in hypopituitary patients with untreated GH deficiency (GHD), but results are contradictory and relations to cardiovascular risk factors are not clear. The aim of this study was to investigate intima-media thickness (IMT) in relation to cardiovascular risk factors in adults with GHD. DESIGN: Cross-sectional observational study of 21 men and 13 women with GHD, but without cardiovascular disease, compared to two healthy control groups matched for age, sex and smoking habits. One control group was matched for body mass index (BMI) and the other group was nonobese. MEASUREMENTS: IMT of the carotid and femoral arteries, blood pressure, blood samples and anthropometric data. RESULTS: Patients had 12% thicker composite carotid IMT [(IMT of common carotid artery + IMT of bulb)/2] compared to nonobese controls (P = 0.022), but IMT was not different compared to BMI-matched controls. Femoral IMT did not differ between patients and controls. Patients had higher waist : hip ratio (WHR), heart rate, serum triglycerides and fasting insulin concentrations in combination with lower high-density lipoprotein (HDL) cholesterol and smaller low-density lipoprotein (LDL) peak particle size compared to both nonobese and to BMI-matched controls. This cardiovascular risk pattern was more pronounced in female patients than in male patients compared to their gender controls. Carotid IMT was related to age, serum cholesterol, LDL cholesterol and smoking in the patient group. Only age was independently related to carotid IMT in multivariate analysis. CONCLUSIONS: These results indicate that high BMI in GH-deficient patients contribute to their increased intima-media thickness. However, several cardiovascular risk factors are present in this patient group independent of their increased BMI, especially in women.     

Cardiovascular risk profile of asymptomatic healthy young adults with increased femoral artery intima-media thickness: The Bogalusa Heart Study

BACKGROUND: Femoral artery intima-media thickness (IMT), like carotid IMT, is a surrogate indicator of atherosclerotic coronary and peripheral vascular diseases in middle-aged and older adults. This study examined the cardiovascular disease risk profile of asymptomatic young adults with increased femoral artery IMT. METHODS: Femoral artery IMT was measured by B-mode ultrasonography in 1080 black and white subjects (aged 24-43 years; 71% white, 43% male) enrolled in the Bogalusa Heart Study. Individuals in the top (n=54) versus bottom fifth (n=54) percentiles distribution of femoral IMT were compared for traditional cardiovascular risk factors profile. Univariate analysis compared the two groups, t-tests and chi tests were performed. RESULTS: The top and bottom fifth percentiles of IMT differed with respect to age (P<0.001), systolic blood pressure (P<0.05), diastolic blood pressure (P<0.05), total cholesterol (P<0.01), low-density lipoprotein (LDL) cholesterol (P<0.001), non-high-density lipoprotein (HDL) cholesterol (P<0.01) and smoking status (P<0.01). In terms of prevalence of clinically defined traditional risk factors, individuals at the top versus bottom fifth percentile of IMT distribution had significantly higher prevalence of high LDL cholesterol (>OR=130 mg/dL), non-HDL cholesterol (>OR=160 mg/dL), and cigarette smoking. The odds ratio for individuals with three or more risk factors versus no risk factors having IMT in the top fifth percentile was 4.7 (P=0.01). CONCLUSION: The observed adverse effect of cardiovascular risk factors on IMT of femoral artery, a surrogate measure of coronary and peripheral atherosclerosis, in asymptomatic young individuals underscores the need for risk factors profiling in early life. These observations have important implications in preventive medicine.     

Vascular stiffness in women with systemic lupus erythematosus

Large-vessel manifestations of systemic lupus erythematosus (SLE), a multisystem disease characterized by disturbances in the immune system, include higher than expected rates of hypertension and cardiovascular disease. Reductions in the elasticity of central arteries may act as a marker of early changes that predispose to the development of major vascular disease. This study evaluated risk factors associated with aortic stiffness measured by pulse wave velocity (PWV) in women with SLE. We expected SLE-specific factors, especially variables indicative of inflammation and active disease, to be associated with increasing PWV. The study population included 220 women currently enrolled in the Pittsburgh Lupus REGISTRY: All risk factor data were collected on the day of the ultrasound examinations. PWV waveforms were collected from the right carotid and femoral arteries by Doppler probes. The mean age of the women was 45.5+/-10.8 years, the median SLE disease duration approximated 9 years, and the mean PWV was 6.1+/-1.7 m/s. Multiple regression models were stratified by menopausal status. Among postmenopausal women, PWV risk factors were primarily traditional factors and included age, systolic blood pressure, family history of vascular disease, carotid plaque, creatinine, obesity, glucose, white cell count, and cumulative SLE organ damage. Among premenopausal women, PWV risk factors consisted of a mix of SLE-related and traditional variables and included higher C3 levels, presence of ds-DNA antibodies, nonuse of hydroxychloroquine, lower leukocyte count, higher mean arterial pressure, and carotid plaque. SLE-specific variables appeared to be associated with increases in aortic PWV, indicating central artery stiffening. This was seen most clearly among premenopausal women. This finding may partially explain the higher rates of cardiovascular disease and hypertension observed in young women with SLE.     

Metabolic syndrome may not associate with carotid plaque in subjects with optimal, normal, or high-normal blood pressure

Much evidence indicates that metabolic syndrome is a risk factor for the development of cardiovascular disease, but whether metabolic syndrome is an independent risk factor for early atherosclerosis in the individuals with only minor hemodynamic abnormalities, if any, is not well investigated. Here we have investigated the association between metabolic syndrome and carotid atherosclerosis in individuals with blood pressure of <140/90 mm Hg. Between 1994 and 2003, 8143 subjects underwent general health screening including carotid ultrasonography. Of 8143 individuals, 5661 individuals without antihypertensive medications who had blood pressure of <140/90 mm Hg were considered to have optimal, normal, or high-normal blood pressure. After adjustment for age, systolic blood pressure, body mass index, total and high-density lipoprotein cholesterol, triglycerides, fasting glucose, and smoking status, metabolic syndrome was not found to be an independent risk factor for carotid plaque (odds ratio: 1.65; 95% CI; 0.72 to 3.76 in women and odds ratio: 0.95; 95% CI: 0.70 to 1.28 in men) or for carotid intima-media thickening (odds ratio: 0.56; 95% CI: 0.18 to 1.72 in women and odds ratio: 0.93 95% CI: 0.62 to 1.38 in men) in these subjects. Thus, presence of metabolic syndrome may not increase the prevalence of carotid atherosclerosis independent of other cardiovascular risk factors in Japanese individuals with optimal, normal, or high-normal blood pressure.     

Arterial stiffness is greater in African Americans than in whites: evidence from the Forsyth County, North Carolina, ARIC cohort

BACKGROUND: Impairment of arterial dilation is thought to occur earlier than arterial wall thickening in the atherosclerotic process. In comparison with whites, African Americans reportedly have a generalized attenuation of their vasodilation mechanisms. We set out to evaluate arterial stiffness and its correlates by ethnicity, hypothesizing that African Americans would have stiffer common carotid arteries (ie, lower arterial distension for a given systolic pressure) than their white counterparts. METHODS: The study population included 268 African Americans and 2459 whites, who were aged 45 to 64 years at baseline examination in 1986 to 1989, free of coronary heart disease and stroke/transient ischemic attack, from Forsyth County, North Carolina. The beta stiffness index and pulsatile arterial diameter change were derived from brachial blood pressure and from echo-tracked systolic and diastolic carotid arterial diameters. RESULTS: African Americans had stiffer carotid arteries than their white counterparts, with a right shift of the beta stiffness index distribution. After adjustment for selected cardiovascular risk factors, the mean beta stiffness index was 9% higher for African Americans (mean +/- SEM: 11.3 +/- 0.3) than for whites (mean +/- SEM: 10.3 +/- 0.1) among participants not taking antihypertensive medication. Socioeconomic status and comorbidities were differentially associated with arterial stiffness by ethnicity. Specifically, the association between these correlates and beta stiffness index was stronger in African Americans than in whites. CONCLUSIONS: This report on arterial mechanics in African Americans suggests that large artery stiffening either occurs earlier, or is more accelerated in African Americans than in whites in our sample, perhaps as a result of earlier exposure to multiple risk factors. This finding may have implications for hypertension prevention, as arterial stiffness is associated with the development of hypertension.     

Influence of age,risk factors,and cardiovascular and renal disease on arterial stiffness: clinical applications

Age is the main clinical determinant of large artery stiffness. Central arteries stiffen progressively with age, whereas peripheral muscular arteries change little with age. A number of clinical studies have analyzed the effects of age on aortic stiffness. Increase of central artery stiffness with age is responsible for earlier wave reflections and changes in pressure wave contours. The stiffening of aorta and other central arteries is a potential risk factor for increased cardiovascular morbidity and mortality. Arterial stiffening with aging is accompanied by an elevation in systolic blood pressure (BP) and pulse pressure (PP). Although arterial stiffening with age is a common situation, it has now been confirmed that older subjects with increased arterial stiffness and elevated PP have higher cardiovascular morbidity and mortality.

Increase in aortic stiffness with age occurs gradually and continuously, similarly for men and women. Cross-sectional studies have shown that aortic and carotid stiffness (evaluated by the pulse wave velocity) increase with age by approximately 10% to 15% during a period of 10 years. Women always have 5% to 10% lower stiffness than men of the same age.

Although large artery stiffness increases with age independently of the presence of cardiovascular risk factors or other associated conditions, the extent of this increase may depend on several environmental or genetic factors. Hypertension may increase arterial stiffness, especially in older subjects. Among other cardiovascular risk factors, diabetes type 1 and 2 accelerates arterial stiffness, whereas the role of dyslipidemia and tobacco smoking is unclear. Arterial stiffness is also present in several cardiovascular and renal diseases. Patients with heart failure, end stage renal disease, and those with atherosclerotic lesions often develop central artery stiffness. Decreased carotid distensibility, increased arterial thickness, and presence of calcifications and plaques often coexist in the same subject. However, relationships between these three alterations of the arterial wall remain to be explored.     

Relationships between vascular indexes and atherosclerotic risk factors in patients with type 2 diabetes mellitus

The relationships of cardio-ankle vascular index, (a new indicator of arterial stiffness), common carotid artery intima-media thickness, and ankle-brachial pressure index with atherosclerotic risk factors were compared in patients with type 2 diabetes. There were significant correlations between each pair of the above vascular indexes. Both cardio-ankle vascular index and intima-media thickness showed significant correlations with age, systolic blood pressure, pulse pressure, and serum total cholesterol. Ankle-brachial pressure index showed a significant negative correlation with pulse pressure but not with systolic blood pressure and total cholesterol. Logistic regression analysis showed that cardio-ankle vascular index and intima-media thickness were associated with systolic blood pressure and pulse pressure independently of age. These results suggest that there are significant associations among the 3 vascular indexes and that systolic blood pressure and pulse pressure are major, age-independent determinants of cardio-ankle vascular index and common carotid artery intima-media thickness in patients with diabetes.     

高血压病患者颈动脉粥样硬化与血压变异的相关性

目的 探讨高血压病患者颈动脉斑块与血压变异以及与心血管危险因素的关系.方法 对2009年4月至2010年6月在高血压科住院患者临床资料进行回顾性分析,其中408例患者颈动脉B超检查及其他临床资料完善,并且均做动态血压监测.结果 (1)颈动脉斑块检出率为55.3%,男女性别间差异无统计学意义,但随年龄增大阳性率显著增加.(2)颈动脉斑块与高血压病病程、空腹血糖、总胆固醇、低密度脂蛋白胆固醇相关.(3)24 h动态血压与颈动脉斑块:随着收缩压变异系数增大,颈动脉斑块发生率增加(P=0.001),舒张压变异系数与颈动脉斑块发生率无相关性(P=0.644),平均收缩压越大,发生率越高(P=0.002).(4)多元回归提示,颈动脉斑块与24 h平均收缩压、24 h收缩压变异系数相关(P<0.05).结论 在高血压病患者中,颈动脉粥样硬化与血压变异系数、尤其是收缩压变异系数独立相关.

Abstract：

Objective To investigate the relationship of carotid artery plaque and blood pressure variation and cardiovascular risk factors.Methods We retrospectively analyzed clinical data of in-patients treated in the department of hypertension between April 2009 and June 2010.Information on carotid ultrasonography and other clinical date were obtained from 408 patients.All patients were monitored by ambulatory blood pressure.Results (1) Carotid artery determined in plaque was 55.3%,there was no differences between men and women.However,the carotid artery plague was associated positively with age.Increased age was associated with a significantly increased positive rate.(2) Cardiovascular risk factors and carotid artery plaque: carotid artery plaque was associated with duration of disease, fasting blood sugar, total cholesterol, and low density lipoprotein-cholesterol.(3) 24 h ambulatory blood pressure and carotid artery plaque: the prevalence of carotid artery plaque increased with increasing coefficient of systolic variation (P=0.001).There was no correlation between the coefficient of diastolic variation and the prevalence (P=0.644).(4) Multivariate regression analysis indicated that carotid artery plaque was associated with duration of hypertension, 24 h mean systolic blood pressure, and coefficient of variation of 24 h blood pressure (P<0.05 ).Conclusion Carotid atherosclerosis is independently associated with coefficient of variation of blood pressure, especially with coefficient of variation of systolic blood pressure.     

Preventive Cardiology: the SHAPE of the Future

Traditional guidelines for prevention of atherosclerotic cardiovascular disease (ACVD) fail to identify very-high-risk individuals (the vulnerable patient) who have extensive atherosclerotic plaques in coronary and other arteries thereby at risk for a near future adverse event. They solely rely on screening for traditional risk factors of atherosclerosis (e.g., cholesterol, blood pressure, smoking, etc.) and do not treat differently those with and without extensive atherosclerotic plaques who have a similar risk factor profile (e.g., Framingham Risk Score). Recent studies have consistently shown that individuals with extensive plaque burden regardless of their risk factor profile are very high risk. Traditional risk factor-based guidelines clearly miss to identify the vulnerable patient whose risk factor profile is normal or borderline (i.e., low- or intermediate-risk categories). Often individuals with similar risk factor profiles have different levels of coronary plaque burden and are on different trajectories for a future cardiovascular event. Risk factors of atherosclerosis are at best predictors of ACVD but cannot identify who has or does not have the disease. While such an approach was the best available method in the 70s and 80s, we now have new noninvasive tools capable of detecting atherosclerosis itself. The existing traditional guidelines for primary prevention of ACVD need to be updated to save the vulnerable patient. To address this problem, the Association for Eradication of Heart Attack, a grassroots organization founded by a group of cardiovascular physicians and researchers, has proposed the SHAPE (Screening for Heart Attack Prevention and Education) guideline based on consensus among an international group of distinguished cardiovascular experts. The SHAPE guideline aims to complement existing guidelines in preventive cardiology and address the detection and treatment of the vulnerable patient. The SHAPE Task Force has thoroughly reviewed available evidence including recent studies and recommended that all asymptomatic men 45-75 years and women 55-75 years (except for a small group < 5% with a very low risk factor profile) must undergo noninvasive screening to detect and measure the amount of hidden atherosclerotic plaques in their coronary or carotid arteries. The higher the amount of plaques the more intensive treatment is recommended. The SHAPE Task Force urges health-care policy makers to update existing national guidelines for primary prevention of atherosclerotic cardiovascular disease.     

Combined effects of systolic blood pressure and serum cholesterol on cardiovascular mortality in young (<55 years) men and women.

AIMS: To evaluate the combined effects of the two most frequent modifiable risk factors, systolic blood pressure and serum cholesterol, on cardiovascular and coronary mortality, in a large French population aged 18 to 55 years. METHODS AND RESULTS: We studied 108,879 men (mean age 39.1+/-9.4 years) and 84,931 women (mean age 37.3+/-10.0 years) who had a health check-up at the IPC Center between 1978 and 1988. Mortality data for a mean period of 13 years were analysed. Systolic blood pressure and cholesterol levels were classified according to the cut-points proposed by international guidelines. In men, the prevalence of high cholesterol was more than twice as high in hypertensives as in normotensives; in women, it was more than three times higher. The combination of these two risk factors has additive effects on cardiovascular disease and coronary heart disease risk. In men, a borderline elevation of both systolic blood pressure (130-139 mmHg) and cholesterol (200-239 mg x dl(-1)) leads to a three- to four-fold increase in cardiovascular disease risk. Men with systolic blood pressure >or=160 mmHg represent a small percentage (about 5%) who have a 10-fold increase in cardiovascular disease and coronary heart disease risk, especially when high cholesterol is present. In women of the same age, similar trends were observed, but the results were less significant, probably due to the low cardiovascular disease mortality rates. CONCLUSIONS: In conclusion, in French subjects under 55 years of age, a combination of high systolic blood pressure and high serum cholesterol dramatically increased cardiovascular disease and coronary heart disease risk, especially in men. A more aggressive public health policy is needed to prevent the development of risk factors in younger subjects.     

Chlamydia pneumoniae seropositivity and early carotid atherosclerosis in a suburban Japanese population

To evaluate the association between Chlamydia pneumoniae (C. pneumoniae) infection and carotid atherosclerosis (CA), we investigated CA assessed by carotid B-mode ultrasound and known or suspected atherosclerotic risk factors including C. pneumoniae IgG and IgA antibodies in 2410 residents (mean age 54.5+/-13.6 years, 697 men) of a suburban Japanese town. CA was found in 30.1% of men and in 14.0% of women, IgG in 59.4% and in 51.4%, and IgA in 36.9% and in 32.4%, respectively. In univariate analysis, most conventional atherosclerotic risk factors and IgA antibody were significantly associated with CA in both sexes, but not IgG. In multivariate logistic regression analysis, independent risk factors for CA were confirmed with age and triglycerides (TG) in men and age, systolic blood pressure, pack-years of smoking, and low-density lipoprotein cholesterol (LDL-C) in women, but not IgG and IgA in either sex. These results do not support C. pneumoniae infection as an important risk factor for CA in this Japanese population.