Quantitative analysis of carotid atherosclerotic lesions and high-sensitivity C-reactive protein in community-dwelling elderly 80 years or older

Aim:   To investigate the association between the carotid atherosclerotic lesions assessed by high-resolution ultrasonography and high-sensitivity C-reactive protein (hs-CRP) in the community-dwelling elderly aged 80 years or older.
Methods:   One hundred and seventy-nine community-dwelling elderly aged 65 years or older (78 ± 6 years, 69 men and 113 women) participated in this study. High-resolution B-mode ultrasonography was performed on the common carotid arteries. Intima-media thickness (IMT) was measured using automatic measuring system and compared with standardized examinations included blood pressure, body mass index, hemoglobin-A1c, cholesterol, creatinine, uric acid, fibrinogen and hs-CRP.
Results:   Subjects were divided into two age groups: young-old aged 65–79 years (113 subjects, 74 ± 3 years) and old-old aged 80 years or older (66 subjects, 84 ± 3 years). The maximum (max) IMT was significantly increased in the old-old compared to that of the young-old (1.7 ± 1.0 vs 1.4 ± 0.6 mm; P  = 0.02). Multivariate analysis showed that hs-CRP was the strongest predictor of thickened max IMT in the young-old ( P  = 0.022). However, it was not the predictor of thickened max IMT in the old-old.
Conclusions:   Depending on age, hs-CRP may have different meanings in the atherosclerotic process. In particular, the predictive power of hs-CRP as a marker of atherosclerotic process was less significant in subjects aged 80 years or older.     

超声检测颈动脉粥样硬化、肱动脉舒张功能与脑梗死相关性探讨

目的探讨老年高血压病患者颈动脉粥样硬化、肱动脉内皮依赖性血管舒张功能与脑梗死发生的关系。方法100例患者分为高血压组(EH组)、脑梗死组(CI组)各50例,并与正常对照组(对照组)50例进行比较,分析血压、血脂、颈动脉内膜-中层厚度(IMT)、肱动脉内皮依赖性血管舒张(FMD)功能等变化。结果CI组表现为老年性高血压,舒张压降低明显,脉压增大;空腹血糖较对照组升高明显,但与EH组尚无显著差异;TG显著升高;CI组IMT显著增厚,斑块数及发生率显著增高,FMD下降明显。三组IMT与FMD均呈显著负相关,FMD与年龄呈负相关。结论CI组颈动脉粥样硬化程度显著增加,推测脉压增大、高TG是导致CI组患者斑块数增加引发脑梗死的直接重要危险因素。颈动脉粥样硬化、肱动脉FMD下降与脑梗死发生有密切相关性,IMT与FMD检查对预测脑梗死的发生并且对临床预防和治疗脑梗死提供重要依据。     

Correlation of erythrocyte fatty acid composition and dietary intakes with markers of atherosclerosis in patients with myocardial infarction

The purpose of this study was to examine the hypothesis that erythrocytes that are low in n-3 fatty acids and high in trans-fatty acids and nutrient intakes are associated with the risk of atherosclerosis. Fifty patients with acute nonfatal myocardial infarction were recruited to measure their dietary intake, erythrocyte fatty acid composition, intima medial thickness (IMT), and the Gensini score, which are markers of atherosclerosis. Trans-oleic acid of erythrocytes was positively (P = .05) correlated with the carotid IMT. After adjusting for age, sex, and energy intake, the IMT was negatively associated with the intake of protein, fat, phosphate, zinc, vitamin B₁, vitamin B₂, vitamin B₆, niacin, linoleic acid, linolenic acid, total fatty acids, total n-3 fatty acids, and total n-6 fatty acids. The Gensini score was also negatively associated with the intake of protein, fat, phosphate, sodium, zinc, vitamin E, vitamin B₁, vitamin B₂, vitamin B₆, niacin, linolenic acid, total fatty acids, and total n-3 fatty acids. In conclusion, lower levels of trans-oleic acid (elaidic acid) in erythrocytes and higher intakes of vitamins, minerals, and n-3 fatty acids were associated with the decreased risk of atherosclerosis. However, these findings need further investigation in randomized controlled clinical trials before public health recommendations for atherosclerosis prevention can be made.     

缬沙坦与阿托伐他汀联合治疗对高血压病人颈动脉内膜中层厚度的影响

①目的比较观察缬沙坦联合阿托伐他汀应用与单用对原发性高血压病人颈动脉内膜中层厚度（IMT）的影响及临床意义。②方法选择86例Ⅰ、Ⅱ级高血压且血脂正常病人,随机分为两组,A组应用缬沙坦80mg,每日1次;B组应用缬沙坦80mg,每日1次,并阿托伐他汀10mg,每日1次,治疗12周。治疗前、后超声测定IMT、总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白-C（LDL—C）。③结果治疗2周后血压已显著下降（t=11．10～24．00,P〈0．01）,12周后血压趋于稳定,两组的降压幅度无显著差别（t=0．35～1．34,P〉0．05）。与治疗前比较,A组IMT有显著降低（t=2．04、2．65,P〈0．05）,TC、TG、LDL—C无显著改变（t=0．20～0．64,P〉0．05）,B组TC、TG、LDL—C、IMT均显著降低（t=2．83～14．10,P〈0．01）,两组比较有显著差异（t=2．53～7．34,P〈0．05）。④结论缬沙坦联合阿托伐他汀应用与单用比较,对逆转原发性高血压病人颈动脉IMT的效果显著。     

血糖和脑梗死患者颈动脉内膜中层厚度的相关性研究

目的 探讨血糖对脑梗死患者颈动脉内膜中层厚度的影响.方法 对172例急性缺血性卒中患者的颈动脉分叉处内膜中层厚度(IMT)和糖尿病史、空腹血糖及糖化血红蛋白(HbA1c)进行相关性分析,同时分析糖尿病患者的血糖水平和颈动脉IMT的相关性.结果 颈动脉IMT增厚组的年龄(P<0.01)、糖尿病比例(P<0.01)、入院时的空腹血糖(P=0.035)及HbAlc(P=0.051)明显增高,其中,年龄(P=0.023)及糖尿病史(P<0.01)和颈动脉IMT的增厚存在独立相关性.在糖尿病患者中,空腹血糖及HbA1c的增高和颈动脉IMT的增厚无显著相关性(P>0.05).结论 急性缺血性卒中患者中,年龄及糖尿病史为颈动脉IMT增厚的独立危险因素.     

Testosterone and Cardiovascular Health

There is an ongoing debate in the medical community regarding the effects of testosterone on cardiovascular (CV) health. For decades, there has been conflicting evidence regarding the association of endogenous testosterone levels and CV disease (CVD) events that has resulted in much debate and confusion among health care providers and patients alike. Testosterone therapy has become increasingly widespread, and after the emergence of studies that reported increased CVD events in patients receiving testosterone therapy, the US Food and Drug Administration (FDA) released a warning statement about testosterone and its potential risk regarding CV health. Some of these studies were later found to be critically flawed, and some experts, including the American Association of Clinical Endocrinologists and an expert panel regarding testosterone deficiency and its treatment, reported that some of the FDA statements regarding testosterone therapy were lacking scientific evidence. This article summarizes the current evidence regarding the relationship between testosterone (endogenous and supplemental) and CV health. A literature review was conducted via search using PubMed and specific journal databases, including the New England Journal of Medicine and the Journal of the American College of Cardiology. Key search terms included testosterone and cardiovascular health, coronary artery disease, heart failure, androgen deprivation therapy, intima-media thickness, and adrenal androgens. Initial study selection was limited to publications within the past 10 years (January 1, 2007, through December 31, 2016); however, key publications outside of this time frame were selected if they provided important quantitative data or historical perspectives for the review of this topic. The search was further supplemented by reviewing references in selected articles.