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PURPOSE: Aortic stiffness, assessed as estimated aortic pulse wave velocity (aPWV), and carotid intima-media thickness (cIMT) are markers of vascular age, and carotid plaques are a marker of early atherosclerosis. In this cross-sectional study we aimed to investigate the association between aPWV, cIMT and plaques across different age groups and in women and men, in a middle-aged healthy population. MATERIALS AND METHODS: Participants in the 6.5-year follow-up of the VIPVIZA trial who were aged 47, 57 and 67 underwent an oscillometric measurement which estimates aPWV between 2020 and 2023. Carotid ultrasound examinations were also performed. Linear and ordinal regression models were used to investigate how aPWV associates with cIMT and with carotid plaques, for the overall study group and stratified for age groups and sex. RESULTS: A total of 1046 subjects were included in the analyses. Linear associations between aPWV and cIMT (ß = 0.018, 95% CI: 0.006-0.030, p = 0.003), and between aPWV and plaques (OR: 1.19, 95% CI: 1.03-1.38, p = 0.018), were seen in the 57-year-olds. In the 47-year-olds a significant association was seen between aPWV and plaques (OR: 2.98 95% CI: 1.44-6.14, p = 0.003). No significant associations were seen in the 67-year-olds. For women, a significant association between aPWV and cIMT (ß = 0.011, 95% CI: 0.004-0.017, p = 0.002) was shown. CONCLUSION: Estimated aPWV was positively associated with increasing cIMT and the presence of carotid plaques in younger middle-aged individuals, and with cIMT in women, suggesting that measurement of estimated aPWV may improve cardiovascular risk assessment in younger middle-aged individuals and women.Clinical Trial Registration date 8 May 2013: URL: www.clinicaltrials.gov. Unique identifier: NCT01849575.

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What is the context? Vascular ageing is a process where the arteries become stiff, leading to impaired function and organ damage. Stiff arteries increase the risk of cardiovascular disease. Aortic pulse wave velocity is a measurement of arterial stiffness and a marker of vascular age. Carotid intima-media thickness and carotid plaque presence are other markers of vascular age and early atherosclerosis. There are limited data on the association between aortic pulse wave velocity, carotid intima-media thickness and carotid plaques.What is new? We measured estimated aortic pulse wave velocity using an oscillometric device and performed carotid ultrasound examinations for assessment of carotid intima-media thickness and carotid plaques in healthy middle-aged individuals across three different age groups. The association between aortic pulse wave velocity, carotid intima-media thickness and carotid plaques was examined in the different age groups and in women and men separately.What is the impact? Estimated aortic pulse wave velocity was associated with carotid intima-media thickness and carotid plaques in younger middle-aged individuals and with carotid intima-media thickness in women. Suggesting that for these groups ­ healthy younger middle-aged people, and especially women ­ measurement of estimated aortic pulse wave velocity could improve evaluation of cardiovascular risk.

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Grosor Intima-Media Carotídeo , Análisis de la Onda del Pulso , Rigidez Vascular , Humanos , Femenino , Masculino , Persona de Mediana Edad , Estudios Transversales , Anciano , Placa Aterosclerótica/diagnóstico por imagen , Placa Aterosclerótica/fisiopatología , Arterias Carótidas/diagnóstico por imagen , Arterias Carótidas/fisiopatología

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Cardiovascular disease (CVD) is the leading cause of morbidity and mortality worldwide, and atherosclerosis is the key factor promoting its development. Carotid intima-media thickening and the presence of carotid plaques are important indices of cardiovascular risk. In addition, inflammation is a major and complex factor in the development of atherosclerosis. The relationships between carotid atherosclerosis and certain inflammatory markers have rarely been studied in healthy individuals. Therefore, we aimed to investigate the associations between subclinical carotid atherosclerosis and various inflammatory biomarkers in a large Caucasian population free of evident CVD. In addition to recording study participants' demographic characteristics, anthropometric characteristics, and atherosclerotic risk factors, laboratory tests were performed to measure levels of hemoglobin A1c (HbA1c), high-sensitivity C-reactive protein, and inflammatory cytokines/chemokines, including interleukin (IL)-1ß, IL-6, IL-8, IL-10, IL-12p70, IL-17A, IL-18, IL-23, IL-33, interferon (IFN)-α2, IFN-γ, tumor necrosis factor-α, and monocyte chemoattractant protein (MCP)-1. This study included 264 asymptomatic individuals with a median age of 61.7 years (interquartile range, 54.5-67.5 years); 45.7% of participants were male. Participants were divided into two groups according to their carotid status: the normal carotid group, comprising 120 participants; and the pathological carotid group, comprising 144 participants. Compared with the normal carotid group, hypertension and diabetes mellitus were significantly more common and serum levels of HbA1c, IL-8, and MCP-1 were significantly higher in the pathological carotid group. Multivariate regression analysis revealed significant positive associations between pathological carotid findings and serum levels of IL-8 (highest tertile, OR: 2.4, p = 0.030) and MCP-1 (highest tertile, OR: 2.4, p = 0.040). Our results suggest that IL-8 and MCP-1 may serve as early indicators of subclinical atherosclerosis, thereby helping to identify individuals at increased risk of CVD before the onset of clinical symptoms.

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Biomarcadores , Enfermedades de las Arterias Carótidas , Grosor Intima-Media Carotídeo , Citocinas , Inflamación , Humanos , Masculino , Femenino , Persona de Mediana Edad , Biomarcadores/sangre , Anciano , Enfermedades de las Arterias Carótidas/sangre , Citocinas/sangre , Inflamación/sangre , Factores de Riesgo , Proteína C-Reactiva/metabolismo , Proteína C-Reactiva/análisis , Arterias Carótidas/patología , Hemoglobina Glucada/análisis , Hemoglobina Glucada/metabolismo , Quimiocina CCL2/sangre , Mediadores de Inflamación/sangre , Enfermedades Asintomáticas

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Background and Aims: Blood pressure, body mass index (BMI), and carotid intima-media thickness (CIMT) are well-known independent predictors of cardiovascular disease especially in adulthood. However, there is insufficient evidence regarding the statistical significance of the relationship between childhood CIMT, blood pressure and BMI. This systematic review and meta-analysis was therefore conducted to ascertain the relationship. Methods: This systematic review and meta-analysis was reported in accordance with the PRISMA statement. Three electronic databases were searched, namely EMBASE, MEDLINE and the Cochrane Library. Data were extracted independently by two review authors. Quantitative data were analyzed using Review Manager. Results: The meta-analysis was conducted using a random effects model and standard mean difference. The results of the meta-analysis indicated a statistically significant difference in CIMT of 0.86 (95% CI: 0.41-1.31) between normotensive versus hypertensive children. Again, overweight and moderately obese children had higher CIMT values as compared to normal weight children with a pooled standard mean difference of 0.72 (95% CI: 0.24-1.20) and 2.75 (95% CI: 0.73-4.77) respectively. The pooled standard mean difference of systolic and diastolic blood pressures was found to be 2.44 (95% CI: 1.69-3.19) and 1.28 (95% CI: 0.65-1.92) respectively between normal weight and overweight/obese children. Conclusion: The meta-analysis found a significant difference in CIMT between normotensive and hypertensive children, with overweight and moderately obese children having higher CIMT values. Thus, conducting CIMT screening for obese or overweight children and children with increased blood pressure can provide valuable information about their cardiovascular disease risk.

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PURPOSE: Data regarding the association between metabolically healthy obesity (MHO) and preclinical atherosclerosis in childhood are lacking. Carotid intima-media thickness (cIMT) is a noninvasive method used to assess cardiovascular risk. This study examined the relationships among cIMT, metabolic phenotypes, and cardiometabolic risk factors (CMRFs) in overweight and obese adolescents. METHODS: Anthropometric, biochemical, and cIMT data were collected. The study participants were categorized as MHO or metabolically unhealthy obesity (MUO) based on insulin resistance. CMRFs were assessed using blood pressure (BP); levels of triglycerides, high-density lipoprotein cholesterol (HDL-C), and fasting plasma glucose; or a diagnosis of diabetes mellitus. Differences in cIMT values were evaluated according to the metabolic phenotype and factors associated with cIMT. RESULTS: Among the 111 participants (80 boys, 72.1%), 23 (20.7%) were classified as MHO and 88 (79.3%) as MUO. The MHO group exhibited lower glycated hemoglobin and triglyceride levels and higher HDL-C levels compared to those exhibited by the MUO group (all P<0.01). The cIMT values did not differ significantly between the MHO and MUO groups. The high cIMT tertile group revealed higher systolic BP compared to that exhibited by the low cIMT tertile group (123.7±2.1 mmHg vs. 116.9±1.6 mmHg, P=0.028). Mean cIMT was positively correlated with age (ß=0.009) and body mass index (BMI) (ß=0.033) after adjusting for covariates (both P<0.05). CONCLUSION: In overweight and obese Korean adolescents, cIMT was associated with age and BMI but not with metabolic phenotype or CMRFs. Further research is warranted to determine the relationship between cIMT during adolescence and cardiovascular outcomes during adulthood.

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INTRODUCTION: We aimed to evaluate the relationship between carotid intima-media thickness (CIMT), which is a known indicator of cardiovascular risk and atherosclerosis, and uric acid level, which may be an easy marker for cardiovascular diseases due to its antioxidant and pro-oxidant properties in hemodialysis patients. METHODS: In this cross-sectional study, we evaluated 77 hemodialysis patients. The mean CIMT of these patients was measured and recorded by Doppler ultrasonography. Patients were divided into two groups according to their serum uric acid levels. Correlation analysis and linear regression analysis were used to define the relationship between study parameters. FINDINGS: The mean CIMT levels in the normouricemic group and the hyperuricemic group were 0.95 ± 0.15 and 1.07 ± 0.15, respectively. There was a statistically significant difference between the two groups (p = 0.001). There was a statistically significant and moderate linear correlation between serum uric acid level and mean CIMT (r = 0.402; p = 0.002). Univariate and multivariate linear regression analyses were performed to identify variables that could independently affect the mean CIMT value. According to analysis, uric acid (p < 0.001), hypertension (p = 0.008), albumin (p = 0.029), and C-reactive protein (p = 0.042) were found independent risk factors for mean CIMT value. DISCUSSION: We found a significant relationship between serum uric acid level and CIMT, which indicates carotid atherosclerosis. Serum uric acid level is a low-cost laboratory parameter that can be measured in almost all laboratories, and it may be valuable in the hemodialysis patient group to identify patients at high risk of carotid atherosclerosis.

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BACKGROUND: Diabetic kidney disease (DKD) is associated with a higher risk of cardiovascular disease (CVD). Pentoxifylline (PTF), a nonselective phosphodiesterase inhibitor with anti-inflammatory, antiproliferative, and antifibrotic actions, has demonstrated renal benefits in both clinical trials and meta-analyses. The present work aimed to study the effects of PTF on the progression of subclinical atherosclerosis (SA) in a population of patients with diabetes and moderate to severe chronic kidney disease (CKD). METHODS: In this open-label, randomized controlled, prospective single-center pilot study the evolution of carotid intima-media thickness (CIMT) and ankle-brachial index (ABI) were determined in 102 patients with type 2 diabetes mellitus and CKD assigned to PTF, aspirin or control groups during 18 months. We also determined the variations in the levels of inflammatory markers and Klotho (KL), a protein involved in maintaining cardiovascular health, and their relationship with the progression of SA. RESULTS: Patients treated with PTF presented a better evolution of CIMT, increased KL mRNA levels in peripheral blood cells (PBCs) and reduced the inflammatory state. The progression of CIMT values was inversely related to variations in KL both in serum and mRNA expression levels in PBCs. Multiple regression analysis demonstrated that PTF treatment and variations in mRNA KL expression in PBCs, together with changes in HDL, were significant determinants for the progression of CIMT (adjusted R2 = 0.24, P < 0.001) independently of traditional risk factors. Moreover, both variables constituted protective factors against a worst progression of CIMT [OR: 0.103 (P = 0.001) and 0.001 (P = 0.005), respectively]. CONCLUSIONS: PTF reduced SA progression assessed by CIMT variation, a beneficial effect related to KL gene expression in PBCs. TRIAL REGISTRATION: The study protocol code is PTF-AA-TR-2009 and the trial was registered on the European Union Drug Regulating Authorities Clinical Trials (EudraCT #2009-016595-77). The validation date was 2010-03-09.

Asunto(s)

Grosor Intima-Media Carotídeo , Diabetes Mellitus Tipo 2 , Progresión de la Enfermedad , Pentoxifilina , Insuficiencia Renal Crónica , Humanos , Proyectos Piloto , Masculino , Persona de Mediana Edad , Pentoxifilina/uso terapéutico , Femenino , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/tratamiento farmacológico , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/complicaciones , Estudios Prospectivos , Anciano , Resultado del Tratamiento , Factores de Tiempo , Nefropatías Diabéticas/diagnóstico , Nefropatías Diabéticas/tratamiento farmacológico , Glucuronidasa/sangre , Glucuronidasa/genética , Biomarcadores/sangre , Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Enfermedades de las Arterias Carótidas/tratamiento farmacológico , Enfermedades Asintomáticas , Mediadores de Inflamación/sangre , Inhibidores de Fosfodiesterasa/uso terapéutico , Antiinflamatorios/uso terapéutico , Aterosclerosis/tratamiento farmacológico , Aterosclerosis/diagnóstico , Osteocalcina

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Background and objectives: Gallstone disease (GD) is a prevalent health issue globally, particularly in developed nations, and has notable associations with cardiovascular disease (CVD). This prospective observational cross-sectional study aimed to investigate the association between gallstone disease and carotid intima-media thickness (CIMT), a marker of carotid atherosclerosis, in a tertiary care setting. Method: Conducted at a tertiary care center, the study included 96 participants (48 with gallstone disease and 48 age and sex-matched controls). Data collection involved demographic information, BMI calculation, abdominal ultrasonography for gallstone detection, and carotid ultrasonography for CIMT measurement. Statistical analysis was performed using SPSS version 26. Results: The study revealed higher CIMT values in GD patients compared to controls (P<0.001). Additionally, a positive correlation was observed between CIMT and age (r=0.450, P<0.001) and BMI (r=0.550, P<0.001). The Cohen's d-test indicated a clinically significant difference in CIMT between GD patients and controls (d=1.47). Conclusion: This study revealed a significant association between gallstone disease and elevated CIMT, correlating with higher BMI indicating a potential link between gallstone disease and increased risk of carotid atherosclerosis. These findings highlight the importance of assessing cardiovascular risk in patients with gallstone disease, highlighting the potential utility of carotid ultrasonography as a non-invasive screening tool. Early intervention strategies may be warranted to mitigate cardiovascular risks associated with gallstone disease.

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Background: Numerous observational studies have suggested an association between psychiatric traits and carotid intima-media thickness (cIMT). However, whether these associations have a causal relationship remains unknown, largely due to issues of reverse causality and potential confounders. This study aims to elucidate the potential causal role of psychiatric traits in the risk of arterial injury as measured by cIMT. Methods: We utilized instrumental variables for attention deficit/hyperactivity disorder (ADHD, n = 226,534), bipolar disorder (n = 353,899), major depressive disorder (n = 142,646), post-traumatic stress disorder (n = 174,494), obsessive-compulsive disorder (n = 9,725), autism spectrum disorder (n = 173,773), and anxiety disease (n = 17,310), derived from the largest corresponding genome-wide association studies (GWAS). Summary statistics for cIMT associations were obtained from a meta-analysis combining GWAS data from the Cohorts for Heart and Aging Research in Genomic Epidemiology consortia (n = 71,128) and the UK Biobank study (n = 45,185). The inverse-variance weighted method served as the primary analytical tool, supplemented by additional statistical methods in the secondary analyses to corroborate the findings. Adjustments were made according to the Bonferroni correction threshold. Results: The Mendelian randomization analyses indicated a suggestive causal link between genetically predicted ADHD and cIMT (beta = 0.05; 95% confidence interval, 0.01-0.09; p = 0.018). Sensitivity analyses largely concurred with this finding. However, no significant associations were found between other psychiatric traits and cIMT. Conclusions: This study provides insights into the risk effect of ADHD on cIMT, suggesting that arteriopathy and potential associated complications should be considered during the treatment and monitoring of patients with ADHD.

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OBJECTIVE: The survey aimed to evaluate the precise roles and importance of carotid plaque thickness and carotid intima-media thickness measured in plaque-free areas (PF CC-IMTmean) in future cardiovascular risk prediction. MATERIAL AND METHODS: 188 respondents between the age of 46 and 87 divided into two groups (I group - 94 respondents without plaques with CIMT measurement and II Group 94 respondents with carotid plaques; 118 men and 70 women; mean age ± SD, 61.80 ± 5.49) were prospectively examined by the carotid ultrasound Doppler (carotid measurements included plaque thickness PT - nonstenotic plaques (carotid stenosis <50%) and stenotic culprit plaques (carotid stenosis ≥50%), mean CIMT and maximum CIMT). Subjects were followed for 36 months from the inclusion in the study (regular control examinations). Data were recorded on new cases of mortality (CV mortality) and adverse CV events (myocardial infarction - -MI, surgical or endovascular revascularization - coronary or stroke). RESULTS: In this study, CIMT values vary between 0.62 and 1.43 mm (mean CIMT = 1.21 ± 0.2 mm) while 52 subjects had nonstenotic plaques (14 respondents plaque ulceration, 22 type 2 diabetes mellitus, 38 arterial hypertension) and 38 subjects had stenotic culprit plaques (17 respondents plaque ulceration, 20 type 2 diabetes mellitus, 31 arterial hypertension). After 36 months of follow-up, 76 vascular events were noted (MI, transient ischaemic attack - TIA, stroke and cardiovascular angioplasty or surgery) in this period. CONCLUSION: Respondents with carotid plaques had higher cardiovascular events occurrence (p < .01, high statistical difference). Carotid plaques as a parameter have higher predictive vascular event value importance than CIMT. Of note, stenotic plaques, the presence of ulceration on the free surface of the plaque, type 2 diabetes mellitus and hypertension were connected with the highest events occurrence.

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BACKGROUND: Hypertension is the leading risk factor for subclinical target-organ damage (TOD) and cardiovascular disease (CVD). Little is known about the relationship between different pressure measures and subclinical TOD, especially in young populations. We compared the strength of associations of subclinical TOD markers with perfusion and pulsatile pressure in young adults. METHODS: A total of 1 187 young adults from the African-PREDICT study were included. Ambulatory mean arterial pressure (MAP) and pulse pressure (PP) was obtained. Markers of subclinical TOD were measured and included left ventricular mass index (LVMi), carotid intimamedia thickness (cIMT), carotidfemoral pulse wave velocity (cfPWV), central retinal arteriolar equivalent (CRAE) and albumin to creatinine ratio (ACR). RESULTS: Measures of sub-clinical TOD (cIMT, cfPWV and CRAE), associated stronger with perfusion pressure (all p < 0.001) than pulsatile pressure in unadjusted models. Stronger associations were found between cfPWV (adjusted R2 = 0.26), CRAE (adjusted R2 = 0.12) and perfusion pressure (all p ≤ 0.001) than pulsatile pressure independent of several non-modifiable and modifiable risk factors. CONCLUSIONS: In young, healthy adults, perfusion pressure is more strongly associated with subclinical TOD markers than pulsatile pressure. These findings contribute to the understanding of the development of early cardiovascular changes and may guide future intervention strategies.

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Presión Arterial , Humanos , Masculino , Femenino , Adulto , Adulto Joven , Sudáfrica/epidemiología , Hipertensión/fisiopatología , Hipertensión/diagnóstico , Hipertensión/epidemiología , Análisis de la Onda del Pulso , Estudios Transversales , Velocidad de la Onda del Pulso Carotídeo-Femoral , Medición de Riesgo , Grosor Intima-Media Carotídeo , Factores de Riesgo , Factores de Edad , Monitoreo Ambulatorio de la Presión Arterial , Valor Predictivo de las Pruebas , Rigidez Vascular , Flujo Pulsátil , Población Negra , Adolescente

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Grosor Intima-Media Carotídeo , Humanos , Lípidos/sangre , Enfermedades Asintomáticas , Biomarcadores/sangre , Factores de Riesgo , Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Dislipidemias/sangre , Dislipidemias/diagnóstico , Dislipidemias/epidemiología , Medición de Riesgo , Valor Predictivo de las Pruebas , Masculino

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Aim: This meta-analysis investigates the association between testosterone replacement therapy [TRT] and carotid artery atherosclerosis. Methods: 3 databases were searched for studies up to June 2023 per the PRISMA guidelines. The eligibility criteria comprised RCTs and observational studies involving hypogonadal males receiving exogenous testosterone, in which CIMT was assessed. CAA was the primary outcome, whereas secondary outcomes included HDL, LDL, CRP, total cholesterol and total testosterone. The statistical analysis was performed using Review Manager. Results: Statistical analysis revealed no association between TRT and assessed outcomes. There was a significant increase in total testosterone levels, depicting indirect anti-atherosclerotic effects of TRT. Conclusion: Meta-analysis shows no relation between TRT and CIMT or other markers, allowing its safe usage for hypogonadal males.

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[Box: see text].

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Background: Limited research has been conducted to quantitatively assess the impact of systemic inflammation in metabolic dysfunction-associated fatty liver disease (MAFLD) and sub-clinical carotid atherosclerosis (SCAS). The systemic immune-inflammation index (SII), which integrates inflammatory cells, has emerged as a reliable measure of local immune response and systemic inflammation Therefore, this study aims to assess the mediating role of SII in the association between MAFLD and SCAS in type 2 diabetes mellitus (T2DM). Method: This study prospectively recruited 830 participants with T2DM from two centers. Unenhanced abdominal CT scans were conducted to evaluate MAFLD, while B-mode carotid ultrasonography was performed to assess SCAS. Weighted binomial logistic regression analysis and restricted cubic splines (RCS) analyses were employed to analyze the association between the SII and the risk of MAFLD and SCAS. Mediation analysis was further carried out to explore the potential mediating effect of the SII on the association between MAFLD and SCAS. Results: The prevalence of both MAFLD and SCAS significantly increased as the SII quartiles increased (P<0.05). MAFLD emerged as an independent factor for SCAS risk across three adjusted models, exhibiting odds ratios of 2.15 (95%CI: 1.31-3.53, P < 0.001). Additionally, increased SII quartiles and Ln (SII) displayed positive associations with the risk of MAFLD and SCAS (P < 0.05). Furthermore, a significant dose-response relationship was observed (P for trend <0.001). The RCS analyses revealed a linear correlation of Ln (SII) with SCAS and MAFLD risk (P for nonlinearity<0.05). Importantly, SII and ln (SII) acted as the mediators in the association between MAFLD and SCAS following adjustments for shared risk factors, demonstrating a proportion-mediated effect of 7.8% and 10.9%. Conclusion: SII was independently correlated with MAFLD and SCAS risk, while also acting as a mediator in the relationship between MAFLD and SCAS.

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Enfermedades de las Arterias Carótidas , Diabetes Mellitus Tipo 2 , Inflamación , Análisis de Mediación , Humanos , Masculino , Femenino , Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Enfermedades de las Arterias Carótidas/epidemiología , Enfermedades de las Arterias Carótidas/inmunología , Enfermedades de las Arterias Carótidas/metabolismo , Persona de Mediana Edad , Inflamación/metabolismo , Inflamación/inmunología , Diabetes Mellitus Tipo 2/inmunología , Diabetes Mellitus Tipo 2/metabolismo , Diabetes Mellitus Tipo 2/complicaciones , Estudios Prospectivos , Anciano , Factores de Riesgo , Enfermedad del Hígado Graso no Alcohólico/metabolismo , Enfermedad del Hígado Graso no Alcohólico/inmunología

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Grosor Intima-Media Carotídeo , Lípidos , Humanos , Lípidos/sangre , Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Enfermedades Asintomáticas , Factores de Riesgo , Valor Predictivo de las Pruebas

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Grosor Intima-Media Carotídeo , Esclerosis Múltiple , Humanos , Esclerosis Múltiple/diagnóstico por imagen , Esclerosis Múltiple/patología

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Background/aim: Type 2 diabetes mellitus (T2DM) is closely associated with atherosclerotic cardiovascular diseases (ASCVD). The objective of this study was to describe the degree of ASCVD risk factor control and their association with carotid intima-media thickness (CIMT) in T2DM patients followed up at a diabetes clinic in Southern, Sri Lanka. Materials and methods: A crosssectional study was conducted to examine the association between CIMT and nonalcoholic fatty liver disease (NAFLD)in 300 T2DM patients. Both CIMT and its associations with modifiable cardiometabolic risk factors were examined using ultrasonography. The recommended optimal targets for risk factors were defined as glycated hemoglobin (HbA1C) < 7 %, absence of NAFLD, albumin-to-creatinine ratio (ACR) < 30 mg, triglyceride (TG) < 150 mg/dL, low-density lipoprotein cholesterol (LDL-C) < 100 mg/dL, high-density lipoprotein cholesterol (HDL-C) in men > 40 and in women > 50 mg/dL, systolic blood pressure (SBP) < 130 mmHg, and diastolic blood pressure (DBP) < 80 mmHg. Results: SBP, DBP, LDL-C, TG, HDL-C, HbA1C, and ACR were optimally controlled in 59.3%, 75.0%, 46.7%, 84.3%, 46.0%, 33.0%, and 18.7% of patients, respectively. Notably, nearly half of the study subjects did not have NAFLD. Only three patients (1%) had achieved all therapeutic targets. There were statistically significant differences in CIMT between optimally controlled TG and suboptimally controlled TG group (p = 0.027) and between the groups with and without NAFLD (p = 0.045) when adjusted for age and duration of diabetes. CIMT showed significant and positive associations with LDL-C (p = 0.024), TG (p = 0.026), and NAFLD (p = 0.005). Among these, the presence of NAFLD had the highest odds of having higher CIMT when compared to LDL-C and TG. Conclusion: The majority of patients have not achieved the recommended targets for ASCVD risk factors and are at high risk of ASCVD. It is therefore necessary to identify the reasons for not achieving the treatment targets in order to reduce the ASCVD burden by controlling LDL-C, TG, and NAFLD.

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Factores de Riesgo Cardiometabólico , Grosor Intima-Media Carotídeo , Diabetes Mellitus Tipo 2 , Humanos , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/complicaciones , Masculino , Femenino , Persona de Mediana Edad , Estudios Transversales , Sri Lanka/epidemiología , Enfermedad del Hígado Graso no Alcohólico/epidemiología , Adulto , Países en Desarrollo , Hemoglobina Glucada/análisis , Hemoglobina Glucada/metabolismo , Anciano , Factores de Riesgo

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Background: Despite significant cardiovascular (CV) morbidity in children on dialysis and after kidney transplantation, data on the evolution of CV damage in children with chronic kidney disease (CKD) approaching kidney replacement therapy (KRT) is unknown. Methods: The burden, progression, and predictors of CV damage before KRT onset were explored in two prospective multicenter cohorts from Europe and Canada: Cardiovascular Comorbidity in Children with CKD (4C) and Haemodiafiltration, Heart and Height (3H) studies, conducted from 2009-19 and 2013-16, respectively. CV damage and risk factors were evaluated (i) cross sectionally at KRT-start (n = 248), and (ii) longitudinally over the 2-years preceding KRT start (n = 157; 331 patient-visits). Longitudinal analyses with mixed-effects models estimated associations of modifiable CV risk factors with change in carotid intima-media thickness (cIMT) standard deviation score (SDS), pulse wave velocity (PWV-SDS), left ventricular (LV) mass and systolic dysfunction. Findings: 248 patients, age 14.3 (12.2, 16.2) years were evaluated at median 35 (28-114) days before KRT start. Elevated cIMT-SDS and PWV-SDS were present in 43% and 25%, and LV hypertrophy and systolic dysfunction in 49% and 33%. Aortic stiffness and LV hypertrophy significantly increased, especially in the year before KRT start (adjusted odds ratio, OR 0.33, P = 0.002 and OR 0.54, P = 0.01, respectively). 79% of children had >3 modifiable CV risk factors at KRT onset. Diastolic BP and BMI were strongly associated with a linear increase in all CV measures. After controlling for CV risk factors, the time to KRT onset no longer predicted the burden of CV damage. Interpretation: This comprehensive CV evaluation shows the progressive accrual of modifiable risk factors and a high burden of CV damage in the years preceding KRT onset. CV damage in the pre-KRT period is preventable. Funding: Supported by EU4Health Programme (101085068) and Kidney Research UK (RP39/2013).

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Objective: The aim of this study was to assess the periodontal disease parameters in patients with ischemic stroke. Materials and methods: The study included 21 patients with ischemic brain stroke and a control group that was matched in number, age, and gender. All participants underwent a standard periodontal examination. The inclusion criterion of this study was the presence of at least 15 teeth. Periodontal epithelial surface area, periodontal inflamed surface area (PISA), and periodontal disease stage were determined. All participants were given a questionnaire to determine oral health-related quality of life (OHQL). Stroke risk factors were assessed. Results: Stroke patients had a significantly higher OHQL score than the control group (20.81 vs. 12.57) and a full-mouth plaque score (FMPS, 27.57 vs. 16.83), while full-mouth bleeding score (FMBS) was significantly higher in the control group than in the hospital group (10.17 vs. 6.42). For PISA, statistically significant negative correlations were found for smoking, cholesterol levels, and LDL levels, while significant positive correlations were found for FMBS, clinical attachment level and probing depth. Conclusion: Although PISA does represent the amount of periodontal tissue that is inflamed, tooth loss due to advanced periodontal disease combined with oral hygiene limitations imposed by the hospital setting and the stroke recovery process remain the most significant obstacles for a more meaningful understanding of the data represented by specific clinical, laboratory and various demographic parameters that characterize the two diseases.

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Elevated levels of the gut pro-hormone Proneurotensin (proNT) have been found to predict development of cardiovascular disease. However, it is still unknown whether higher proNT levels are associated with subclinical vascular damage. Herein, we investigated the relationship between higher proNT concentrations and augmented pulse pressure (PP) and carotid intima-media thickness (cIMT), indicators of increased arterial stiffness and subclinical atherosclerosis, respectively. Clinical characteristics, PP and cIMT were evaluated in 154 non-diabetic individuals stratified into tertiles according to fasting serum proNT concentrations. We found that, subjects with higher proNT levels exhibited a worse lipid profile and insulin sensitivity, increased C-reactive protein levels, along with higher values of PP and cIMT as compared to the lowest proNT tertile. Prevalence of elevated PP (≥ 60 mmHg) and subclinical carotid atherosclerosis (IMT > 0.9 mm) was increased in the highest tertile of proNT. In a logistic regression analysis adjusted for several confounders, subjects with higher proNT levels displayed a fivefold raised risk of having elevated PP values (OR 5.36; 95%CI 1.04-27.28; P = 0.05) and early carotid atherosclerosis (OR 4.81; 95%CI 1.39-16.57; P = 0.01) as compared to the lowest proNT tertile. In conclusion, higher circulating levels of proNT are a biomarker of subclinical vascular damage independent of other atherosclerotic risk factors.

Asunto(s)

Presión Sanguínea , Grosor Intima-Media Carotídeo , Precursores de Proteínas , Humanos , Masculino , Femenino , Persona de Mediana Edad , Precursores de Proteínas/sangre , Adulto , Neurotensina/sangre , Enfermedades de las Arterias Carótidas/sangre , Rigidez Vascular , Factores de Riesgo , Proteína C-Reactiva/metabolismo , Proteína C-Reactiva/análisis , Biomarcadores/sangre , Aterosclerosis/sangre , Anciano

RESUMEN

BACKGROUND & AIMS: Several reports inform an association between vascular aging and sarcopenia. However, both conditions appear along with aging. Therefore, their association may be circumstantial and not casually linked. Our aim was to determine if individuals with higher-than-expected vascular aging have a higher frequency of sarcopenia. METHODS: In 802 participants we calculated the association between pulse wave pressure and carotid intima media thickness and age and blood pressure, to derive predictive regression equations. In 161 of these participants we measured body composition by double beam X ray absorptiometry (DEXA), hand grip strength, rectus femoris thickness by ultrasound, activity energy expenditure by actigraphy and peak oxygen consumption and workload in an incremental exercise test. We calculated their expected values for pulse wave velocity and carotid intima media thickness and compared muscle mass and function between those with higher or lower than expected parameters. In 60 of these participants, we measured body composition sequentially to assess its change over time. RESULTS: Age and blood pressure predicted the variance of pulse wave velocity and carotid intima media thickness with R2 values of 0.94-0.97 and 0.54 to 0.66, respectively. No differences in the frequency of sarcopenia and in muscle mass and strength were observed between participants with higher or lower than expected pulse wave velocity and carotid intima media thickness. In the group with sequential assessments, no differences in the change of muscle mass over time were observed in participants with and without accelerated vascular aging. CONCLUSIONS: We were not able to find an association between vascular aging and sarcopenia.