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AIM: Diameter, intima-media thickness (IMT), and flow parameters, including resistance index (RI) and pulsatility index (PI), in the common carotid artery (CCA) are markers of arterial remodeling, atherosclerosis, and vascular resistance, respectively. We investigated the differences among these markers in association with plasma glucose level, serum insulin level, and insulin resistance in participants without cardiovascular disease. METHODS: CCA parameters (including the CCA interadventitial diameter and mean IMT at the time of 75-g oral glucose tolerance testing) were assessed in 4218 participants. RI and PI were assessed in 3380 of these participants. To assess plasma glucose and serum immunoreactive insulin profiles during oral glucose tolerance testing, we used the total areas under the curves (AUCglu and AUCins, respectively). We used the homeostasis model assessment of insulin resistance (HOMA-IR) and the Matsuda index to assess insulin resistance. Insulin secretion was assessed with the HOMA-ß. RESULTS: AUCglu was significantly associated with CCA interadventitial diameter (ß=0.048, Pï¼0.001), RI (ß=0.144, Pï¼0.001), and PI (ß=0.103, Pï¼0.001) but not with mean IMT. AUCins (ß=-0.064, Pï¼0.001) and HOMA-ß (ß=-0.054, Pï¼0.001) were significantly and negatively associated with CCA interadventitial diameter, but not with mean IMT. Both HOMA-IR and Matsuda index were significantly associated with RI and PI. CONCLUSIONS: These findings indicate that all CCA parameters except IMT are associated with impaired glucose metabolism in patients without cardiovascular disease.
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Enfermedades Cardiovasculares , Enfermedades de las Arterias Carótidas , Resistencia a la Insulina , Insulinas , Glucemia/metabolismo , Enfermedades Cardiovasculares/metabolismo , Arteria Carótida Común/diagnóstico por imagen , Grosor Intima-Media Carotídeo , Humanos , Factores de RiesgoRESUMEN
Background Few studies have evaluated the prognostic significance of diameter-based carotid sonographic measurements for mortality. We investigated whether a reduction in diameter of different carotid anatomical segments is associated with cardiovascular and all-cause mortality in a hospital-based cohort with universal health care. Methods and Results We conducted a retrospective cohort study of 38 201 patients who underwent carotid duplex ultrasound at a medical center in Taiwan. Carotid sonographic parameters were the diameter reduction percentage in carotid bifurcation, the internal carotid artery, the common carotid artery, and the external carotid artery and the overall carotid atherosclerotic burden score, determined by summing the scores from all segments. The vital status was ascertained by linking data to National Death Registry until 2017. During a median follow-up of 4.2 years, 5644 participants died, with 1719 deaths attributable to cardiovascular diseases. The multivariable-adjusted hazard ratios (HRs; 95% CIs) for cardiovascular mortality were 1.33 (1.16â1.53), 1.58 (1.361.84), and 1.89 (1.58, 2.26) for participants with 30% to <40%, 40% to <50%, and ≥50% reduction in carotid bifurcation diameter, respectively, compared with participants with <30% diameter reduction (P for trend <0.001). The corresponding HRs (95% CIs) for all-cause mortality were 1.25 (1.16â1.34), 1.42 (1.31â1.54), and 1.60 (1.45â1.77), respectively. Diameter reduction at other carotid sites and the carotid atherosclerotic burden score exhibited the same dose-response relationship. Conclusions This study suggests that reduction in carotid artery diameter, which can be determined through routinely available sonography, is an independent risk factor for all-cause and cardiovascular mortality.
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Enfermedades Cardiovasculares , Arteria Carótida Interna , Aterosclerosis/epidemiología , Enfermedades Cardiovasculares/epidemiología , Arteria Carótida Interna/diagnóstico por imagen , Arteria Carótida Interna/patología , Causas de Muerte , Humanos , Estudios Retrospectivos , Taiwán/epidemiología , UltrasonografíaRESUMEN
Among 2085 asymptomatic subjects (age: 51.0±10.7 years, 41.3% female) with data available on common carotid artery diameter (CCAD) and circulating total white blood cell (WBC) counts, higher circulating leukocytes positively correlated with higher high sensitivity C-reactive protein (hs-CRP).Higher WBC/segmented cells and monocyte counts were independently associated with greater relative wall thicknesses and larger CCADs,which in generalweremore pronounced in men and obese subjects (body mass index ≥ 25kg/m2) (all P interaction: < 0.05). Using multivariate adjusting models, only the monocyte count independently predicted theleft ventricularmass index (LVMi) (ß-Coef: 0.06, p = 0.01). Higher circulating WBC, segmented,and monocyte counts and a greater CCAD were all independently associated with a higher risk of heart failure (HF)/all-cause death during a median of 12.1 years of follow-up in fully adjusted models, with individuals manifesting both higher CCADs and monocyte countsincurring the highest risk of HF/death (adjusted hazard ratio: 2.81, 95% CI: 1.57. -5.03, p< 0.001; P interaction, 0.035; lower CCAD/lower monocyte as reference). We conclude that a higher monocyte count is associated with cardiac remodeling and carotid artery dilation.Both an elevated monocyte count and a larger CCAD may indicate a specific phenotype that confers the highest risk of HF, which likely signifies the role of circulating monocytes in the pathophysiology of heart failure with preserved ejection fraction (HFpEF).
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Study objectives: Debate persists as to whether obstructive sleep apnea (OSA) is an independent risk factor for atherosclerosis. The purpose of this study was to compare carotid intima-media thickness (IMT), an early sign of atherosclerosis, in obese and nonobese adults with OSA before and following positive airway pressure (PAP) treatment. Methods: A total of 206 adults newly diagnosed with OSA with an apnea-hypopnea index (AHI) of 15-75 events/hour and 53 controls with AHI <10 were studied. Waist circumference was used to classify participants as obese and nonobese. Bilateral common carotid artery B-mode ultrasound was performed at baseline to assess IMT, arterial diameter, arterial-wall mass, and circumferential wall stress. Measurements were repeated in 118 participants with OSA who completed a 4-month PAP treatment and had an average daily use over that period of ≥4 hours/day. Results: No significant differences in carotid IMT, diameter, or arterial-wall mass were present at baseline between participants with OSA and controls stratified by waist circumference, after adjusting for other cardiovascular risk factors. In participants with OSA, who had adequate PAP adherence over the 4-month treatment, carotid artery diameter significantly increased (mean change [95% confidence interval] = 0.13 [0.06, 0.20] mm; p = .0004), but no significant changes in carotid IMT, arterial-wall mass, and circumferential stress were observed in obese and nonobese participants. Conclusions: Regardless of obesity status, carotid IMT is not increased in adults with moderate to severe OSA versus controls and does not change following 4 months of PAP treatment.
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Arterias Carótidas , Grosor Intima-Media Carotídeo , Obesidad/complicaciones , Respiración con Presión Positiva , Apnea Obstructiva del Sueño/complicaciones , Apnea Obstructiva del Sueño/terapia , Adulto , Anciano , Aterosclerosis/complicaciones , Aterosclerosis/fisiopatología , Arterias Carótidas/diagnóstico por imagen , Enfermedades de las Arterias Carótidas/complicaciones , Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Enfermedades de las Arterias Carótidas/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Obesidad/diagnóstico , Factores de Riesgo , Apnea Obstructiva del Sueño/fisiopatología , Circunferencia de la CinturaRESUMEN
BACKGROUND AND AIMS: Vascular biomarkers are associated with risk burden and are capable to predict the development of future cardiovascular (CV) events; yet, their additive predictive value over and above established risk algorithms seems to be only modest. The present study evaluated the cross-sectional associations between vascular biomarkers, 10-year Framingham risk (FR) and prevalent CV events in a population with a high prevalence of hypertension and diabetes. METHODS AND RESULTS: As many as 681 subjects (419 men, age = 60 ± 10 years, 282 diabetics, 335 hypertensives, mean FR score = 22.5 ± 16.5%) underwent an integrated vascular examination including: radiofrequency-based ultrasound of common carotid artery (cca) to measure intima-media thickness (IMT), inter-adventitial diameter (IAD) and local pulse wave velocity (PWV); applanation tonometry to assess carotid pulse pressure (PP) and augmentation index (AIx); carotid-femoral PWV (cfPWV) measurement. One hundred and thirty-five subjects (19.8%) had history of CV events, and CV events were independently associated with male sex, age, antihypertensive treatment, current smoking, HDL-cholesterol and ccaIAD. In logistic regression model, only ccaIAD was associated with prevalence of CV events after adjustment for FR score, with the OR of 1.71 [1.34-2.19] (P < 0.0001) that remained unchanged when ccaIMT was included into the model (OR = 1.76 [1.36-2.27]; P < 0.0001). The association between prevalent CV events and ccaIAD was significant (OR of 1.65 [1.24-2.20]; P = 0.0005) also in a subgroup of subjects being at a high 10-year risk of CV disease (N = 330). CONCLUSIONS: In a population with a high prevalence of diabetes and hypertension, ccaIAD was the only vascular measure associated with prevalent CV events, independently of FR score.
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Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Enfermedades de las Arterias Carótidas/epidemiología , Arteria Carótida Común/diagnóstico por imagen , Anciano , Presión Sanguínea , Enfermedades de las Arterias Carótidas/fisiopatología , Arteria Carótida Común/fisiopatología , Grosor Intima-Media Carotídeo , Estudios Transversales , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiología , Femenino , Humanos , Hipertensión/diagnóstico , Hipertensión/epidemiología , Italia/epidemiología , Modelos Logísticos , Masculino , Manometría , Persona de Mediana Edad , Análisis Multivariante , Oportunidad Relativa , Valor Predictivo de las Pruebas , Prevalencia , Análisis de la Onda del Pulso , Medición de Riesgo , Factores de Riesgo , Rigidez VascularRESUMEN
Objective To investigate the relationship between resting heart rate (RHR)and carotid artery structure in young hypertensive patients.Methods A total of 663 primary hypertensive patients aged between 18 and 45 (38.01 ± 5.78) were chosen from the First Affiliated Hospital of Xinjiang Medical University from January,2009 to January,2012.Patients under this study were divided into three groups according to their RHRs:group A (RHR＜70 bpm,n=163),group B(70 bpm≤RHR＜80 bpm,n=268),group C (RHR≥80 bpm,n=232).Data on bilateral carotid artery intima-media thickness,common carotid artery diameter were detected by carotid ultra-sonography.Indexes of carotid artery were analyzed by both variance and bi-variate correlation analysis.Results 1)Differences in the blood pressure among three groups showed statistical significance (P＜0.01),with diastolic pressure in group A higher than in group B (P＜0.05),while both systolic and diastolic pressure in group C higher than in group B (P＜0.01).2)In group A,the right carotid artery diameter was higher than in group C(P＜0.05) and the left carotid artery diameter higher than in group B(P＜ 0.05) with the left carotid artery diameter higher than in group C (P＜0.05).3) Significant positive correlations were found between RHR and blood pressure (r =0.112,0.118) and negative correlation between RHR and left carotid artery diameter (r=-0.89).However,correlation between RHR and right carotid artery diameter was not significant (r=-0.075,P=0.068).Conclusion When blood pressure had an increase,we found that the carotid artery diameter was decreasing along with the increasing RHR among the young hypertensive patients.
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BACKGROUND: Central artery dilation and remodeling are associated with higher heart failure and cardiovascular risks. However, data regarding carotid artery diameter from hypertension to heart failure have remained elusive. We sought to investigate this issue by examining the association between carotid artery diameter and surrogates of ventricular dysfunction. METHODS AND RESULTS: Two hundred thirteen consecutive patients including 49 with heart failure and preserved ejection fraction (HFpEF), 116 with hypertension, and an additional 48 healthy participants underwent comprehensive echocardiography and tissue Doppler imaging. Ultrasonography of the common carotid arteries was performed for measurement of intima-media thickness and diameter (CCAD). Cardiac mechanics, including LV twist, were assessed by novel speckle-tracking software. A substantial graded enlargement of CCAD was observed across all 3 groups (6.8 ± 0.6, 7.7 ± 0.73, and 8.7 ± 0.95 mm for normal, hypertension, and HFpEF groups, respectively; ANOVA P<0.001) and correlated with serum brain natriuretic peptide level (R(2)=0.31, P<0.001). Multivariable models showed that CCAD was associated with increased LV mass, LV mass-to-volume ratio (ß-coefficient=10.9 and 0.11, both P<0.001), reduced LV longitudinal and radial strain (ß-coeffficient=0.81 and -3.1, both P<0.05), and twist (ß-coefficient=-0.84, P<0.05). CCAD set at 8.07 mm as a cut-off had a 77.6% sensitivity, 82.3% specificity, and area under the receiver operating characteristic curves (AUROC) of 0.86 (95% CI 0.80 to 0.92) in discriminating HFpEF. In addition, CCAD superimposed on myocardial deformation significantly expanded AUROC (for longitudinal strain, from 0.84 to 0.90, P of ΔAUROC=0.02) in heart failure discrimination models. CONCLUSIONS: Increased carotid artery diameter is associated with worse LV geometry, higher brain natriuretic peptide level, and reduced contractile mechanics in individuals with HFpEF.