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Context Previous research evaluating the effects in B-vitamins on the prevention and treatment of cardiovascular disease (CVD) has substantial limitations and lacks recently published large prospective studies; hence, conducting an updated meta-analysis is needed. Objective We investigated the association between vitamin B status and human CVD development in order to provide more specific advice about vitamin B intake for those at risk of CVD. Data Sources Relevant articles were identified by JSTOR, PubMed, and ProQuest databases. Data Extraction Key words used to identify the studies included the different combinations of B-vitamins, folate, folic acid, vitamin B6, vitamin B12, homocysteine, cardiovascular disease, stroke, coronary disease, myocardial infarction, and cerebrovascular and transient ischemic attack. The database search was supplemented by hand-searching of reference lists of selected articles. Data Analysis Pooled estimates were calculated from the mean differences using a random-effects model. Results Supplementation with folic acid was reported to have a clinical benefit of significantly reducing carotid intima-media thickness. Higher intakes of folic acid, vitamin B6, and vitamin B12 were generally associated with a lower risk of CVD in the general population, except in those without normal renal function and those with unstable angina or past non–ST-elevation myocardial infarction. Conclusion Vitamin B supplementation resulted in the greatest cardiovascular benefit in those with normal renal function and without unstable angina or non–ST-elevation myocardial infarction recently. Factors such as age, gender, and genetic polymorphisms contribute to varying effects. [ABSTRACT FROM AUTHOR]

ANCA-associated vasculitis (AAV) can affect multiple organs with severe life-threatening manifestations. Disease monitoring is difficult due to a lack of defined biomarkers. We aimed to assess the diagnostic role of serum interleukin-6 and vascular ultrasonography in AAV and subclinical atherosclerosis. The study included 20 AAV patients and two control groups of 34 patients with rheumatoid arthritis (RA) and 35 healthy controls. The levels of Il-6, carotid intima-media thickness test (CIMT), atherosclerotic plaque, and degree of stenosis were investigated. A GRACE-risk score was calculated for AAV and RA patients. The AAV patients had elevated levels of IL-6 (115 ± 23.96) compared to the RA patients (91.25 ± 42.63) and the healthy controls (15.65 ± 3.30), p < 0.001. IL-6 showed a diagnostic accuracy of 73% in distinguishing AAV from RA patients (AUC = 0.730; 95% CI 0.591 to 0834). In the AAV group, CIMT was 1.09, above the upper reference value of 0.90, p < 0.001. The AAV patients had a higher median GRACE risk score, and 60% of them had a high risk of cardiovascular events as compared to 35% of the RA patients. Sonography of extracranial vessels and serum levels of IL-6 can be used in daily clinical practice to diagnose and monitor patients with AAV. [ABSTRACT FROM AUTHOR]

Background: Since metabolic diseases and atherosclerotic vascular events are firmly associated, herein we investigate changes in central microcirculation and atherosclerosis-related body fat distribution in patients with type 2 diabetes mellitus and obesity. Methods: Resting brain perfusion single-photon emission computed tomography (SPECT) imaging with Technetium-99m hexamethylpropylene amine oxime ([99mTc]Tc-HMPAO SPECT) was performed, and the breath-holding index (BHI) and carotid intima-media thickness (cIMT) were measured to characterise central microcirculation. Besides CT-based abdominal fat tissue segmentation, C-peptide level, glycaemic and anthropometric parameters were registered to search for correlations with cerebral blood flow and vasoreactivity. Results: Although no significant difference was found between the resting cerebral perfusion of the two patient cohorts, a greater blood flow increase was experienced in the obese after the breath-holding test than in the diabetics (p < 0.05). A significant positive correlation was encountered between resting and provocation-triggered brain perfusion and C-peptide levels (p < 0.005). BMI and cIMT were negatively correlated (rho = −0.27 and −0.23 for maximum and mean cIMT, respectively), while BMI and BHI showed a positive association (rho = 0.31 and rho = 0.29 for maximum and mean BHI, respectively), which could be explained by BMI-dependent changes in fat tissue distribution. cIMT demonstrated a disproportional relationship with increasing age, and higher cIMT values were observed for the men. Conclusions: Overall, C-peptide levels and circulatory parameters seem to be strong applicants to predict brain microvascular alterations and related cognitive decline in such patient populations. [ABSTRACT FROM AUTHOR]

This article, published in Vascular Medicine, explores the association between carotid wall layers and invasively measured central blood pressure (CBP). The study found that increased carotid intima-media thickness (cIMT), which is often used as an indicator of early atherosclerosis, may be influenced by variations in carotid media layer thickness (cMT) rather than intima layer thickness (cIT). The researchers also discovered an inverted U-shaped relationship between cIMT and CBP, with a peak at systolic CBP values of 150-160 mmHg. These findings suggest that cIMT may not accurately reflect pressure overload-induced carotid atherosclerosis and further studies are needed to evaluate the value of cMT and cIT in predicting cardiovascular events. [Extracted from the article]

Abstract Background Myelodysplastic syndromes (MDS) are a heterogeneous group of clonal stem cell-derived disorders manifested by cytopenias peripherally. MDS initiates an inflammatory process which lead to atherosclerosis. Patients with MDS have 1.5-fold higher risks of cardiovascular risks. Objective Evaluation of cardiovascular risk and unraveling the possible correlation of carotid intima media thickness (CIMT) with clinical, hematologic, and laboratory variables in elderly patients with MDS. Methods We conducted a case–control research on 168 participants to elicit the serum level of homocysteine, serum high-sensitive C-reactive protein (Hs-CRP), and CIMT in relation to cardiovascular risk, 84 of whom had MDS diagnoses. From March 2021 to the end of May 2023, we chose them among the inpatients and outpatients of the Menoufia University Hospitals’ Clinical Hematology Division. We contrasted the chosen MDS patients with 84 healthy individuals as controls. Results Right and left CIMT were significantly higher in MDS patients than controls as well as for lipid profile, blood pressure, blood sugar, and Hs-CRP. Homocysteine was higher in MDS patients but of no statistical significance. Conclusion As CIMT and C-reactive protein level were significantly higher in studied patients, we may consider MDS group of patients to have higher risk for cardiovascular disease than normal people.

Interleukin 6 (IL-6) is a cytokine implicated in the development of atherosclerosis. This study aimed to determine the association of three IL-6 gene polymorphisms with increased carotid intima-media thickness (CIMT) and cardiometabolic risk factors. Three IL-6 polymorphisms (rs1800795, rs2069827, and rs1800796) were analyzed in 178 individuals with increased CIMT (CIMT ≥ 75th percentile) and 906 individuals without increased CIMT (CIMT

Background Carotid intima‐media thickness (cIMT) and carotid plaque are reliable indicators of cardiovascular disease risk, and research highlights that racial and ethnic minority individuals generally exhibit higher cIMT and carotid plaque than White individuals. At present, the mechanisms driving these disparities among different racial and ethnic and biological sex groups are poorly understood. Methods and Results Data came from the baseline examination of MESA (Multi‐Ethnic Study of Atherosclerosis). A total of 6814 participants aged 45 to 84 years free of clinical cardiovascular disease completed assessments on health behavior and perceived discrimination. Four sex‐stratified moderated mediation models examined associations between discrimination, cigarette smoking, and mean cIMT and plaque. We hypothesized that cigarette use would mediate the association between discrimination and carotid artery disease features, and that these would differ by race and ethnicity. Indirect effects of discrimination on plaque were observed among Hispanic women such that discrimination was associated with cigarette use and, in turn, higher plaque (β=0.04 [95% CI, 0.01–0.08]). Indirect effects of discrimination on mean cIMT were found among Hispanic (β=0.003 [95% CI, 0.0001–0.007]) and White men (β=0.04 [95% CI, 0.01–0.08]) such that discrimination was associated with cigarette use and, in turn, higher cIMT. Finally, a positive indirect effect of discrimination on plaque was observed among Hispanic men (β=0.03 [95% CI, 0.004–0.07]). No other racial and ethnic differences were observed. Conclusions To understand and address social determinants of cardiovascular disease, researchers must incorporate an intersectional framework that will allow us to understand the complex nature of discrimination and cardiovascular disease risk for individuals of varying intersecting identities and social positions.

Carotid intima-media thickness (CIMT) is a noninvasive marker of atherosclerosis, a typical pathologic process underlying cardiovascular diseases (CVDs). It is essential to explore the relationships between weight loss and the reduction of CIMT. This was an updated systematic review and meta-analysis. A systematic literature search was conducted to collect relevant clinical trials. The pooled results of meta-analyses were assessed by weighted mean difference (WMD) and the corresponding 95 % confidence interval (95% CI). Thirty-three articles involving 2273 participants were collected in this meta-analysis. Among all participants with obesity, the pooled mean of weight loss was −23.26 kg (95% CI: −27.71 to −18.81), and the pooled mean change of CIMT was −0.06 mm (95% CI: −0.08 to −0.04). Compared with Non-surgical interventions, Surgical ones could lead to much higher weight loss (P between groups < 0.001). A more significant CIMT reduction was identified among Surgical intervention patients than among Non-surgical intervention participants (P between groups < 0.001). Effective interventions, especially Surgical interventions, could reduce the weight of patients with obesity, followed by the decline of CIMT, which might further disturb atherosclerosis progression and lower CVD risk. [ABSTRACT FROM AUTHOR]

Background Subclinical atherosclerosis may be seen at an early age of ankylosing spondylitis (AS). Syndecan 1 (S1) expression is increased in response to proinflammatory cytokine and inflammation. High S1 may reduce carotid atherosclerosis progression. We aimed to investigate the relationship between S1 levels and subclinical atherosclerosis in patients with AS. Methods Fifty-eight patients diagnosed with AS and 58 age-, sex-, and body mass index-matched controls were included in the study. S1 level and carotid intima-media thickness (cIMT) were evaluated using appropriate methods. Results AS patients’ cIMT (0.53 ± 0.1 vs 0.45 ± 0.1 mm, p = .008), S1 (6.0 [1.7–149.2] vs 5.5 [1.0–29.8] ng/ml, p = .020), CRP (C-reactive protein) (2.1 [0.1–19.7] vs 1.1 [0.3–9.6] mg/dl, p = .012), fibrinogen (330.2 ± 87.0 vs 278.0 ± 54.5 mg/dl, p

Background Arterial hypertension causes cardiovascular adverse events mainly through endothelial dysfunction, atherosclerosis, and inflammation. Carotid intima-media thickness (CIMT) is a marker of subclinical atherosclerosis and endothelial dysfunction. Systemic immune-inflammation index (SII) reflects systemic inflammatory and immunity status. This index has strong prognostic value in malignancy and recently was demonstrated to be associated with adverse events in cardiovascular diseases. We aimed to interrogate the relationship between SII and CIMT in patients with hypertension. Methods A total of 215 consecutive hypertensive patients were included in the study. CIMT of all patients was obtained by B-mode arterial doppler ultrasound. SII was obtained by the following formula: (platelet × neutrophil/lymphocyte ratio) from admission complete blood count. Patients were divided into two groups by means of CIMT is above or below the value of 0.9 mm. SII and demographic characteristics of patients were compared between groups. Results Increased CIMT was detected in 55 (25.6%) of hypertensive patients. The patients with increased CIMT were older and had higher neutrophil count (p

Abstract Background Assessment of cardiovascular risk by scores lacks sensitivity and leaves the majority of future cardiovascular patients unidentified particularly individuals at low cardiovascular risk. The present analysis investigates into the correlation of carotid intima–media thickness (CIMT) and cardiovascular risk factors and derived scores as to the potential of improved cardiovascular risk prediction by combining the two. Methods The Stress, Atherosclerosis and ECG Study (STRATEGY) is a cross-sectional study of selectively healthy 107 women and 106 men without diagnosed and treated cardiovascular risk factors evenly distributed between 30 and 70 years. CIMT was determined by evaluating B-mode ultrasonograms offline according to a standardized protocol. The unpaired t-test was used to compare normal-distributed continuous variables, the Chi-squared test for normal-distributed categorical variables and the Mann–Whitney U test for non-normal distributed continuous variables. The association between risk prediction scores and CIMT was calculated by the Spearman rank correlation coefficient. Pearson correlation coefficient was used for the correlation between cardiovascular risk factors and CIMT. A multiple linear regression analysis was executed for the association of cardiovascular risk factors and CIMT. Results Age, systolic blood pressure, fasting glucose, total, LDL- and non-HDL-cholesterol and waist circumference were significantly associated with CIMT (each P ≤ 0.03). The Framingham Risk Score, the Prospective Cardiovascular Münster Study Score and the European Society of Cardiology Score correlated significantly but only moderately with CIMT. The Framingham Risk Score considering BMI correlated most strongly and predicted 27% of the CIMT variance in men and 20% in women. Conclusion In individuals without overt cardiovascular risk factors and thus at low cardiovascular risk, CIMT and cardiovascular risk factors correlated only partially suggesting that combining CIMT and conventional risk factors or common derived scores may improve risk prediction in individuals at low cardiovascular risk. The clinical benefit as to cardiovascular events of such combined risk prediction needs to be explored in large prospective cohorts of still healthy low-risk volunteers. DRKS ID DRKS00015209 07/02/2019 retrospectively registered https://www.drks.de/drks_web/navigate.do?navigationId=resultsExt

Abstract Objectives This analysis describes the protocol of a study with a case-cohort to design to prospectively evaluate the incidence of subclinical atherosclerosis and Cardiovascular Disease (CVD) in Chronic Inflammatory Disease (CID) participants compared to non-diseased ones. Methods A high-risk group for CID was defined based on data collected in all visits on self-reported medical diagnosis, use of medicines, and levels of high-sensitivity C-Reactive Protein >10 mg/L. The comparison group is the Aleatory Cohort Sample (ACS): a group with 10% of participants selected at baseline who represent the entire cohort. In both groups, specific biomarkers for DIC, markers of subclinical atherosclerosis, and CVD morbimortality will be tested using weighted Cox. Results The high-risk group (n = 2,949; aged 53.6 ± 9.2; 65.5% women) and the ACS (n=1543; 52.2±8.8; 54.1% women) were identified. Beyond being older and mostly women, participants in the high-risk group present low average income (29.1% vs. 24.8%, p < 0.0001), higher BMI (Kg/m2) (28.1 vs. 26.9, p < 0.0001), higher waist circumference (cm) (93.3 vs. 91, p < 0.0001), higher frequencies of hypertension (40.2% vs. 34.5%, p < 0.0001), diabetes (20.7% vs. 17%, p = 0.003) depression (5.8% vs. 3.9%, p = 0.007) and higher levels of GlycA a new inflammatory marker (p < 0.0001) compared to the ACS. Conclusions The high-risk group selected mostly women, older, lower-income/education, higher BMI, waist circumference, and of hypertension, diabetes, depression, and higher levels of GlycA when compared to the ACS. The strategy chosen to define the high-risk group seems adequate given that multiple sociodemographic and clinical characteristics are compatible with CID.

Abstract Background Acute type A aortic dissection (ATAAD) is a life-threatening condition that requires surgical intervention. Stroke remains an extremely serious adverse outcome that can occur in ATAAD patients undergoing aortic arch repair, leading to higher rates of patient mortality and decreased postoperative quality of life. In the present study, we sought to determine whether carotid intima–media thickness (cIMT) is a reliable predictor of postoperative stroke risk. Materials and methods This was a prospective study of 76 patients with ATAAD undergoing aortic arch repair. For all patients, cIMT was determined preoperatively through a Doppler-based method. Incidence of different forms of neurological dysfunction, including temporary neurological dysfunction (TND) and stroke, was monitored in these patients, and the relationship between cIMT and stroke incidence was assessed using a receiver-operating characteristic (ROC) curve. Prognostic variables associated with stroke risk were further identified through univariate and multivariate analyses. Results A total of 26/76 (34.2%) patients in the present study suffered from neurological dysfunction, of whom 16 (21.0%) suffered from TND and 10 (13.2%) suffered a stroke. The remaining 50 patients (65.8%) did not suffer from neurological dysfunction. The cIMT values in the stroke, TND, and neurological dysfunction-free patients in this study were 1.12 ± 0.19 (mm), 0.99 ± 0.13 (mm), and 0.87 ± 0.13 (mm), respectively. A total of 4 patients in this cohort died during the study, including 1 in the TND group and 3 in the stroke group. An ROC curve analysis indicated that cIMT could predict stroke with an area under the curve value of 0.844 (95% CI, 0.719–0.969; p 0.9 mm was independently associated with stroke risk (p = 0.018). Conclusion We found that cIMT can be used to predict postoperative stroke risk in ATAAD patients undergoing aortic arch repair, with a cIMT > 0.9 mm coinciding with increased stroke risk in these patients. Trial registration ChiCTR1900022289 . Date of registration 4 April 2019 retrospectively registered.

Aims: Lipoprotein(a) [Lp(a)] is an independent risk factor for atherosclerotic cardiovascular disease (ASCVD), and its level is genetically determined. Although guidelines and consensuses in various cardiovascular fields have emphasized the importance of Lp(a), screening for Lp(a) in China has not been well studied., Methods: A cross-sectional study was conducted using a random sample of 30,000 medical examiners from each of the five health check-up centres. The distribution of Lp(a) was described for those who completed Lp(a) testing, and logistic regression modelling was used to evaluate the relationship between Lp(a) levels and vascular structure and function in the population who underwent carotid ultrasound and brachial‒ankle pulse wave velocity (baPWV) measurements., Results: Lp(a) was measured in only 4400 (3.02%) of the 150,000 participants. Among those tested for Lp(a), the median concentration was 15.85 mg/dL. The proportion of participants with Lp(a) levels ≥ 30 mg/dL was 15.00%. Multiple logistic regression analysis revealed a significant correlation between Lp(a) and cIMT ≥ 1.0 mm (OR: 1.008, 95% CI: 1.001-1.014, P=0.020) and carotid artery plaques (OR: 1.010, 95% CI: 1.004-1.016, P=0.001) but no correlation with baPWV ≥ 1400 (OR: 0.999, 95% CI: 0.993-1.005, P=0.788) or baPWV ≥ 1800 (OR: 1.002, 95% CI: 0.993-1.011, P=0.634)., Conclusions: The detection rate of Lp(a) at health checkups is low, and Lp(a) is positively associated with cervical vascular sclerosis and plaque but not with baPWV. Therefore, the testing rate of Lp(a) and the awareness of the risk of vascular structural changes due to Lp(a) should be further improved.

There is a significant association of non-alcoholic fatty liver disease (NAFLD) with cardiovascular disease (CVD). Most CVDs begin with atherosclerosis in the arteries, which can be reliably measured as the carotid intima-media thickness (CIMT) by ultrasound. Given that ethnic and regional differences have an impact on NAFLD, we aimed to evaluate the association of NAFLD patients from India with subclinical atherosclerosis, measured as CIMT. A thorough literature search was performed on four electronic databases using combinations of several keywords. The relevant data were pooled in a random or fixed-effect model, based on heterogeneity, to calculate the pooled standardised mean difference (SMD), or odds ratio (OR) with 95% confidence interval (CI). The final analysis included a total of 15 studies with 1196 NAFLD and 1482 control subjects. NAFLD patients had a 21.3% higher mean CIMT than the controls. The pooled SMD was 1.001 (95% CI: 0.627-1.375, p < 0.001). Three studies that balanced cardiometabolic risk factors found a similar association (p = 0.037). Furthermore, NAFLD was significantly associated with the presence of high (>0.8 mm) CIMT (pooled OR = 5.4, 95% CI: 2.0-14 .9) and carotid plaques (pooled OR = 10.24, 95% CI: 5.74-18.26). The mean CIMT was also higher in diabetic NAFLD than in the diabetic control (pooled SMD = 1.07, 95% CI = 0.818-1.324, p < 0.001). There is a significant positive association between the marker of subclinical atherosclerosis and NAFLD in India. This might give more light on screening and follow-up plans for such patients., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Kumar et al.)

Introduction: Prior data suggest associations between hearing loss, cardiovascular (CV) risk factors, and CV disease. Whether specific hearing loss patterns, including a strial pattern associated with inner ear vascular disease, are associated with systemic endothelial dysfunction and carotid intima–media thickness (IMT) remains unclear. Methods: We evaluated participants without prevalent CVD in the Framingham Offspring Study who underwent formal audiogram testing and brachial and carotid artery ultrasounds. Audiograms were categorized as normal or as belonging to one of four abnormal patterns: cochlear-conductive, low-sloping, sensorineural, or strial. Endothelial function as measured by brachial artery flow-mediated dilation (FMDmm and FMD%). Internal and common intima–media thicknesses (icIMT and ccIMT, respectively) were compared between audiogram patterns. Results: We studied 1672 participants (mean age 59 years, 57.6% women). The prevalence of each hearing pattern was as follows: 43.7% normal; 20.3% cochlear-conductive; 20.3% sensorineural; 7.7% low-sloping; and 8.0% strial. Strial pattern hearing loss was nearly twice as prevalent (p = 0.001) in those in the highest quartile of ccIMT and nearly 50% higher in those in the highest icIMT quartile (p = 0.04). There were no statistically significant differences between the prevalence of the strial pattern comparing the lowest quartiles of FMDmm and FMD% with the upper three quartiles. Age- and sex-adjusted linear regression models did not show significant associations between the vascular measures and hearing patterns. Conclusion: Abnormal hearing patterns were not significantly associated with impaired brachial FMD and increased carotid IMT after adjusting for age and sex effects, which may reflect age and sex-related distributional differences based on hearing loss pattern. [ABSTRACT FROM AUTHOR]

Arterial hypertension causes cardiovascular adverse events mainly through endothelial dysfunction, atherosclerosis, and inflammation. Carotid intima-media thickness (CIMT) is a marker of subclinical atherosclerosis and endothelial dysfunction. Systemic immune-inflammation index (SII) reflects systemic inflammatory and immunity status. This index has strong prognostic value in malignancy and recently was demonstrated to be associated with adverse events in cardiovascular diseases. We aimed to interrogate the relationship between SII and CIMT in patients with hypertension. A total of 215 consecutive hypertensive patients were included in the study. CIMT of all patients was obtained by B-mode arterial doppler ultrasound. SII was obtained by the following formula: (platelet × neutrophil/lymphocyte ratio) from admission complete blood count. Patients were divided into two groups by means of CIMT is above or below the value of 0.9 mm. SII and demographic characteristics of patients were compared between groups. Increased CIMT was detected in 55 (25.6%) of hypertensive patients. The patients with increased CIMT were older and had higher neutrophil count (p <.001), neutrophil to lymphocyte ratio (NLR) (p <.001), C-reactive protein (CRP) (p =.047), CRP to albumin ratio (CAR) (p =.044) and SII (p <.001) Advanced age (OR: 1.054; 95% CI: 1.015–1.095; p =.006), NLR (OR: 3.213; 95% CI: 1.577–6.546; p =.001), and SII (OR: 3.906; 95% CI: 1.887–8.086; p <.001) were independent predictors of increased CIMT in multivariable logistic regression analysis. SII was an independent predictor of elevated CIMT in hypertensive patients. Preventive approaches for future atherosclerotic cardiovascular diseases can be developed in those with higher SII level. [ABSTRACT FROM AUTHOR]

Abstract Background The guideline recommendation to not measure carotid intima-media thickness (CIMT) for cardiovascular risk prediction is based on the assessment of just one single carotid segment. We evaluated whether there is a segment-specific association between different measurement locations of CIMT and cardiovascular risk factors. Methods Subjects from the population-based STAAB cohort study comprising subjects aged 30 to 79 years of the general population from Würzburg, Germany, were investigated. CIMT was measured on the far wall of both sides in three different predefined locations: common carotid artery (CCA), bulb, and internal carotid artery (ICA). Diabetes, dyslipidemia, hypertension, smoking, and obesity were considered as risk factors. In multivariable logistic regression analysis, odds ratios of risk factors per location were estimated for the endpoint of individual age- and sex-adjusted 75th percentile of CIMT. Results 2492 subjects were included in the analysis. Segment-specific CIMT was highest in the bulb, followed by CCA, and lowest in the ICA. Dyslipidemia, hypertension, and smoking were associated with CIMT, but not diabetes and obesity. We observed no relevant segment-specific association between the three different locations and risk factors, except for a possible interaction between smoking and ICA. Conclusions As no segment-specific association between cardiovascular risk factors and CIMT became evident, one simple measurement of one location may suffice to assess the cardiovascular risk of an individual.

Background: Assessment of cardiovascular risk by scores lacks sensitivity and leaves the majority of future cardiovascular patients unidentified particularly individuals at low cardiovascular risk. The present analysis investigates into the correlation of carotid intima–media thickness (CIMT) and cardiovascular risk factors and derived scores as to the potential of improved cardiovascular risk prediction by combining the two. Methods: The Stress, Atherosclerosis and ECG Study (STRATEGY) is a cross-sectional study of selectively healthy 107 women and 106 men without diagnosed and treated cardiovascular risk factors evenly distributed between 30 and 70 years. CIMT was determined by evaluating B-mode ultrasonograms offline according to a standardized protocol. The unpaired t-test was used to compare normal-distributed continuous variables, the Chi-squared test for normal-distributed categorical variables and the Mann–Whitney U test for non-normal distributed continuous variables. The association between risk prediction scores and CIMT was calculated by the Spearman rank correlation coefficient. Pearson correlation coefficient was used for the correlation between cardiovascular risk factors and CIMT. A multiple linear regression analysis was executed for the association of cardiovascular risk factors and CIMT. Results: Age, systolic blood pressure, fasting glucose, total, LDL- and non-HDL-cholesterol and waist circumference were significantly associated with CIMT (each P ≤ 0.03). The Framingham Risk Score, the Prospective Cardiovascular Münster Study Score and the European Society of Cardiology Score correlated significantly but only moderately with CIMT. The Framingham Risk Score considering BMI correlated most strongly and predicted 27% of the CIMT variance in men and 20% in women. Conclusion: In individuals without overt cardiovascular risk factors and thus at low cardiovascular risk, CIMT and cardiovascular risk factors correlated only partially suggesting that combining CIMT and conventional risk factors or common derived scores may improve risk prediction in individuals at low cardiovascular risk. The clinical benefit as to cardiovascular events of such combined risk prediction needs to be explored in large prospective cohorts of still healthy low-risk volunteers. DRKS ID DRKS00015209 07/02/2019 retrospectively registered https://www.drks.de/drks_web/navigate.do?navigationId=resultsExt [ABSTRACT FROM AUTHOR]

β-Thalassemia major (β-TM) is a severe genetic hemoglobin (Hb) disorder with cardiovascular complications such as atherosclerosis due to transfusion-dependent iron overload. We aimed to determine the associated factors with surrogate markers of subclinical atherosclerosis in these patients. Sixty subjects with β-TM referred to the Thalassemia Clinic of the Iranian Blood Transfusion Organization (IBTO) were included in our study. The blood samples were collected for laboratory measurements. The carotid intima-media thickness (CIMT), was measured by ultrasonography, and ankle-brachial index (ABI) was calculated. The multivariate linear analysis was performed to determine the appropriate indicators of subclinical atherosclerosis in β-TM. There was no significant difference in baseline characteristics between the study groups. In multivariate linear analysis, age and systolic blood pressure (SBP) were negatively associated with inverse-transformed CIMT [unstandardized β coefficient (B): −0.024, 95% confidence interval (95% CI): −0.032- −0.010, p < 0.001; B: −0.009, 95% CI: −0.017- −0.001, p 0.031, respectively]. There was also a significant correlation between the serum level of high-density lipoprotein cholesterol (HDL-C) and insulin with higher ABI, after adjustment for confounding variables (B: 0.003; 95% CI: 0.000–0.005; p = 0.030, and B: 0.004, 95% CI: 0.000–0.009, p = 0.037, respectively). Our results show that advancing age and increased SBP, HDL-C and insulin, associated with higher CIMT or ABI, are appropriate indicators of subclinical atherosclerosis in β-TM patients. [ABSTRACT FROM AUTHOR]

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)., Competing Interests: Professor Franz Schaefer had received a research grant from Fresenius Medical Care that is paid to his academic institution., (© 2024 The Author(s).)

Background: Cumulative evidence suggests that both traumatic stress and posttraumatic stress disorder (PTSD) are cross-sectionally and prospectively linked to cardiovascular disease (CVD). However, their association with proxy markers of atherosclerosis has hardly been investigated. Objective: The objective of this general population study was to relate traumatic stress and PTSD to carotid plaque and intima-media thickness (cIMT). Methods: 3119 adults from the general population were assessed regarding their traditional cardiovascular risk factors, and an ultrasound of the carotid arteries was performed in each participant. Based on a PTSD interview, every participant was assigned to one of three groups: no trauma; trauma, but no PTSD; and trauma with PTSD. The sample was stratified into five age groups. Results: Trauma exposure was reported by 54.5% of the sample and 2.0% had PTSD. Traumatized participants had increased odds of self-reported CVD events compared to those without trauma exposure, even when accounted for CVD risk factors and other covariates (odds ratio [OR] = 1.51; 95% confidence interval [CI]: 1.03–2.22). This association was driven by those aged 70 years or older. Only in those aged 40 to 49 years, there was an association between cIMT and PTSD. There were no further associations between carotid plaque or cIMT and traumatic stress or PTSD. Conclusions: Our findings in concert with prior research suggest that the association between traumatic stress, PTSD and atherosclerosis as well as its clinical endpoints is complex and remains inconclusive.

Xiangbin Meng,1,* Wenyao Wang,2,* Kuo Zhang,2,* Yu Qi,2 Shimin An,2 Siyuan Wang,2 Jilin Zheng,2 Joyce Kong,3 Henghui Liu,4 Jing Wu,4 Yong Zhou,5 Chuanyu Gao,1 Yi-Da Tang2 1Department of Cardiology, Zhengzhou University People’s Hospital, Zhengzhou, Henan, China; 2Department of Cardiology Medicine, Coronary Heart Disease Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; 3New York Institute of Technology-College of Osteopathic Medicine, Old Westbury, NY, USA; 4Beijing Recdata Technology Co., Ltd., Beijing, China; 5Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vascular Diseases, Beijing, China *These authors contributed equally to this work Background: Epicardial adipose tissue (EAT) is considered an important source of bioactive molecules that can influence coronary arteries directly and is related to the concurrent presence of both obstructive coronary stenosis and myocardial ischemia independently. Non-alcoholic fatty liver disease (NAFLD) has become an emergent health problem worldwide. Aim: This cross-sectional study aimed to address the relationship between the volume of EAT and NAFLD and other cardiovascular risk factors in the general population. Materials and methods: In this study, we selected a total of 2,238 participants aged at least 40 years from the Jidong community in Tangshan, China. The 64-slice CT was used to survey the volume of EAT and liver ultrasonography was used for the diagnosis of NAFLD. The study cohorts were compared according to EAT volume. Results: Cardiovascular risk factors, such as coronary artery calcium score, carotid intima-media thickness, NAFLD, and ideal cardiovascular health metrics were also found to be related to EAT. In multivariate logistic regression analysis, NAFLD groups showed significant association with higher EAT volume, after correcting for main cardiovascular disease risk factors (OR [95% CI], 1.407 [1.117, 1.773]). Conclusion: Our findings in a general community population provide evidence that EAT is strongly associated with NAFLD and other cardiovascular risk factors. Keywords: epicardial adipose tissue, EAT, coronary artery calcium, CAC, carotid intima-media thickness, CIMT, ideal cardiovascular health metrics, CVH

Objective: To evaluate if serum polyfluoroalkyl substances (PFAS) were associated with cardiometabolic markers. Methods: Serum PFAS were evaluated in 38 Arizona firefighters and 49 participants from the 2009 to 2010 National Health and Nutrition Exainination Survey (NHANES). Cardiometabolic markers including carotid intima-medial thickness (CIMT) were measured in the firefighters. Results: Firefighters had elevated perfluorohexane sulfonic acid (PFHxS) and lower perfiuorononanoic acid (PFNA) and perfluoroundecanoic acid (PFUA) compared to NHANES participants; for nine of the other 12 PFAS the values were not significantly different. There were significant negative associations among firefighters between perfluorodecanoic acid (PFDeA) and total cholesterol and PFUA and interleukin-6. PFAS concentrations were not associated with CIMT. Conclusion: PFHxS levels were elevated in firefighters compared to NHANES subjects. Serum PFAS concentrations were not associated with increased cardiometabolic risk measures in this population of firefighters. [ABSTRACT FROM AUTHOR]

Background: Acute type A aortic dissection (ATAAD) is a life-threatening condition that requires surgical intervention. Stroke remains an extremely serious adverse outcome that can occur in ATAAD patients undergoing aortic arch repair, leading to higher rates of patient mortality and decreased postoperative quality of life. In the present study, we sought to determine whether carotid intima-media thickness (cIMT) is a reliable predictor of postoperative stroke risk.Materials and Methods: This was a prospective study of 76 patients with ATAAD undergoing aortic arch repair. For all patients, cIMT was determined preoperatively through a Doppler-based method. Incidence of different forms of neurological dysfunction, including temporary neurological dysfunction (TND) and stroke, was monitored in these patients, and the relationship between cIMT and stroke incidence was assessed using a receiver-operating characteristic (ROC) curve. Prognostic variables associated with stroke risk were further identified through univariate and multivariate analyses.Results: A total of 26/76 (34.2%) patients in the present study suffered from neurological dysfunction, of whom 16 (21.0%) suffered from TND and 10 (13.2%) suffered a stroke. The remaining 50 patients (65.8%) did not suffer from neurological dysfunction. The cIMT values in the stroke, TND, and neurological dysfunction-free patients in this study were 1.12 ± 0.19 (mm), 0.99 ± 0.13 (mm), and 0.87 ± 0.13 (mm), respectively. A total of 4 patients in this cohort died during the study, including 1 in the TND group and 3 in the stroke group. An ROC curve analysis indicated that cIMT could predict stroke with an area under the curve value of 0.844 (95% CI, 0.719-0.969; p < 0.001). A multivariate analysis revealed that cIMT > 0.9 mm was independently associated with stroke risk (p = 0.018).Conclusion: We found that cIMT can be used to predict postoperative stroke risk in ATAAD patients undergoing aortic arch repair, with a cIMT > 0.9 mm coinciding with increased stroke risk in these patients.Trial Registration: ChiCTR1900022289. Date of registration 4 April 2019 retrospectively registered. [ABSTRACT FROM AUTHOR]

Background: Carotid intima-media thickness (cIMT) and carotid plaque are reliable indicators of cardiovascular disease risk, and research highlights that racial and ethnic minority individuals generally exhibit higher cIMT and carotid plaque than White individuals. At present, the mechanisms driving these disparities among different racial and ethnic and biological sex groups are poorly understood., Methods and Results: Data came from the baseline examination of MESA (Multi-Ethnic Study of Atherosclerosis). A total of 6814 participants aged 45 to 84 years free of clinical cardiovascular disease completed assessments on health behavior and perceived discrimination. Four sex-stratified moderated mediation models examined associations between discrimination, cigarette smoking, and mean cIMT and plaque. We hypothesized that cigarette use would mediate the association between discrimination and carotid artery disease features, and that these would differ by race and ethnicity. Indirect effects of discrimination on plaque were observed among Hispanic women such that discrimination was associated with cigarette use and, in turn, higher plaque (β=0.04 [95% CI, 0.01-0.08]). Indirect effects of discrimination on mean cIMT were found among Hispanic (β=0.003 [95% CI, 0.0001-0.007]) and White men (β=0.04 [95% CI, 0.01-0.08]) such that discrimination was associated with cigarette use and, in turn, higher cIMT. Finally, a positive indirect effect of discrimination on plaque was observed among Hispanic men (β=0.03 [95% CI, 0.004-0.07]). No other racial and ethnic differences were observed., Conclusions: To understand and address social determinants of cardiovascular disease, researchers must incorporate an intersectional framework that will allow us to understand the complex nature of discrimination and cardiovascular disease risk for individuals of varying intersecting identities and social positions.

Background: Cumulative evidence suggests that both traumatic stress and posttraumatic stress disorder (PTSD) are cross-sectionally and prospectively linked to cardiovascular disease (CVD). However, their association with proxy markers of atherosclerosis has hardly been investigated. Objective: The objective of this general population study was to relate traumatic stress and PTSD to carotid plaque and intima-media thickness (cIMT). Methods: 3119 adults from the general population were assessed regarding their traditional cardiovascular risk factors, and an ultrasound of the carotid arteries was performed in each participant. Based on a PTSD interview, every participant was assigned to one of three groups: no trauma; trauma, but no PTSD; and trauma with PTSD. The sample was stratified into five age groups. Results: Trauma exposure was reported by 54.5% of the sample and 2.0% had PTSD. Traumatized participants had increased odds of self-reported CVD events compared to those without trauma exposure, even when accounted for CVD risk factors and other covariates (odds ratio [OR] = 1.51; 95% confidence interval [CI]: 1.03–2.22). This association was driven by those aged 70 years or older. Only in those aged 40 to 49 years, there was an association between cIMT and PTSD. There were no further associations between carotid plaque or cIMT and traumatic stress or PTSD. Conclusions: Our findings in concert with prior research suggest that the association between traumatic stress, PTSD and atherosclerosis as well as its clinical endpoints is complex and remains inconclusive. Although traumatic stress and posttraumatic stress disorder have been linked to cardiovascular disease, they were not related to proxy markers of atherosclerosis in this general population study including 3119 adults. [ABSTRACT FROM AUTHOR]

Background: Environmental lead exposure is a known risk factor of cardiovascular disease (CVD) in animal and human epidemiological studies of adults, but limited research has been conducted in young populations. Moreover, the association between lead level and common carotid artery intima-media thickness (CIMT) has never been documented.Design: and Participants: In this study, 738 subjects were recruited from a cohort of Taiwanese adolescents and young adults to study the relationship between lead levels in urine and CVD risk factors, metabolic syndrome (MS) and CIMT.Results: The geometric mean of the urine lead level was 1.50 μg/g creatinine. We found a significant positive association between urine lead levels and CVD risk factors, including diastolic blood pressure (DBP), mean arterial pressure (MAP), as well as markers of glucose homeostasis, such as serum glucose, serum insulin, homeostasis model assessment of insulin resistance (HOMA-IR), homeostasis model assessment of β-cell function (HOMA-β), body mass index (BMI) z score, and CIMT. Overall, increased urine lead concentrations were positively correlated with the prevalence of MS, specifically the criteria of waist/BMI and serum HDL-C. The relationship between urine lead levels and CIMT remained unchanged in all subgroups.Conclusion: In this study, we found that increased urinary levels of lead were positively associated with CVD risk factors, CIMT, and MS in this cohort. Future research to explore the pathogenic basis of exposure to lead and risk of CVDs and their risk factors are warranted. [ABSTRACT FROM AUTHOR]

Background: Obstructive sleep apnea (OSA) is associated with several cardiovascular comorbidities including hypertension, arteriosclerosis, and heart failure. Uvulopalatopharyngoplasty (UPPP) is a frequently performed surgical treatment for OSA. Aims/Objectives: To analyze if UPPP can improve cardiac parameters associated with atherosclerosis and reduce the cardiac burden in OSA patients. Material and methods: A prospective cohort study was performed at a single tertiary care center where OSA patients undergoing UPPP were evaluated. Preoperative and 6-month postoperative cardiac parameters namely carotid artery intima-media thickness (CIMT), arterial stiffness parameters, echocardiography, and polysomnography (PSG) results were compared. Results: Fifty three patients were included in the study. The success and response rate of UPPP was 60.4%. Following the surgery, significant reduction in arterial stiffness index (β) (12.4 ± 4.1 vs. 11.2 ± 4.0, p =.01), and elasticity modulus (Ep) (172.8 ± 68.3 vs. 156.6 ± 55.3, p =.05) was noticed. Additionally, echocardiographic parameters namely velocity across aortic valve (121.9 ± 22.9 vs. 109.4 ± 17.7, p =.01) and velocity across pulmonary valve (107.4 ± 16.4 vs. 94.2 ± 16.9, p <.01) significantly decreased following UPPP. Conclusions and significance: UPPP significantly improves parameters related to carotid atherosclerosis and has the potential to reduce cardiac burden in OSA patients. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the association of diabetic retinopathy (DR) and CIMT (carotid intima-media thickness) in diabetic subjects and to identify the factors contributing to retinopathy. Study Design: Comparative cross-sectional study. Setting: Creek General Hospital, United Medical and Dental College. Period: August 2017 to July 2018. Material and Methods: After identification of 62 subjects with type 2 diabetes mellitus for the study, their complete history, physical examination and relevant laboratory investigations were recorded. The diabetic retinopathy was assessed by ophthalmoscopy. All subjects underwent Doppler ultrasound scanning of the carotid arteries for measurement of CIMT (carotid intima-media thickness). The data was analyzed through SPSS version 20.0. Student's t-test was used to assess the association between retinopathy and CIMT and other continuous variables. The association of categorical variables was assessed by Chi-square. P-value of <0.05 was considered significant. Results: The target population constituted 29% males and 71% females. Among the participating subjects 50.2% had retinopathy while 49.8% subjects without retinopathy were included in the study. There was a strong association of retinopathy with carotid intimamedia thickness. Retinopathy was also associated with duration of diabetes mellitus, measures of glycemic control, serum creatinine levels, total cholesterol, LDL cholesterol, and serum triglycerides. Conclusion: Retinopathy is strongly associated with CIMT. Poor glycemic control, nephropathy, dyslipidemia and duration of diabetes also show association with retinopathy. [ABSTRACT FROM AUTHOR]

Background: The exposure to chronic air pollution is associated with cardiovascular morbidity and mortality through atherosclerosis acceleration and progression. Carotid intima-media thickness (CIMT) is an important subclinical sign of atherosclerosis. Objective: To analyze the difference of CIMT between chemical industry workers with high and low exposure to air pollution. Method: There were 66 male subjects who consisted of 33 chemical industry workers in the production division and other 33 non-industry workers who have worked for more than 1 year. The subjects underwent the examination of CIMT in left and right carotid artery. Results: The mean of left CIMT test was 0.97 ± 0.08 mm in industry workers and 0.75 ± 0.15 mm in office workers. The mean of left CIMT test was 1.01 ± 0.09 mm in industry workers and 0.72 ± 0.10 mm in office workers. On the other hand, the mean of left and right CIMT test was 0.99 ± 0.07 mm in industry workers and 0.74 ± 0.11 mm in office workers. The difference analysis of left CIMT between two groups was examined by using unpaired t-test. There was no significant difference of CIMT value between subjects who worked in industry and office (p < 0.05; 9% CI 0.16–0.28). On the other hand, the difference analysis between left CIMT and the mean of left and right CIMT was measured by Mann-Whitney test. The results showed that there was a significant difference between two groups (p< 0.05). Conclusion: There was no significant difference between subjects with high and low exposure to air pollution (p < 0.05) [ABSTRACT FROM AUTHOR]

Background: Epicardial adipose tissue thickness has been considered to be a possible cardiovascular risk indicator in recent reports. Aim of this study was to evaluate the relationship of echocardiographic epicardial fat thickness (EFT) with carotid intima-media thickness (CIMT), in patients with type 2 diabetes mellitus (T2DM). Materials and Methods: In this hospital based cross sectional observational study a total of 64 patients with T2DM (mean age 54.51±6.60 years and 75.0% male) and 76 age and sex-matched non-diabetic control (mean age 54.97±6.11years and 71.1% male) were evaluated. Echocardiographic EFT and ultrasonographic CIMT were measured in all subjects. Results: Patients with T2DM had significantly increased EFT and CIMT than those of the non-diabetic controls (6.15±0.99 mm versus 4.39±0.61 mm, P< 0.001 and 0.77±0.09 mm versus 0.51±0.05 mm, P< 0.001, respectively). EFT was correlated with CIMT (r = 0.724, P < 0.001), duration of diabetes (r = 0.723, P < 0.001) and fasting plasma glucose level (r = 0.542, P < 0.001). Linear regression analysis showed that CIMT (β = 0.358, t = 3.658, P < 0.001) duration of diabetes (β = 0.324, t = 3.268, P = 0.001) and fasting plasma glucose level (β = 0.210, t = 3.302, P = 0.001) were found to be the independent predictors of EFT. Conclusion: The echocardiographic EFT was significantly higher in patients with T2DM; and it was well correlated with CIMT, duration of diabetes and fasting plasma glucose level as being the independent predictors of EFT.

Background: Subclinical atherosclerosis may be seen at an early age of ankylosing spondylitis (AS). Syndecan 1 (S1) expression is increased in response to proinflammatory cytokine and inflammation. High S1 may reduce carotid atherosclerosis progression. We aimed to investigate the relationship between S1 levels and subclinical atherosclerosis in patients with AS., Methods: Fifty-eight patients diagnosed with AS and 58 age-, sex-, and body mass index-matched controls were included in the study. S1 level and carotid intima-media thickness (cIMT) were evaluated using appropriate methods., Results: AS patients' cIMT (0.53 ± 0.1 vs 0.45 ± 0.1 mm, p = .008), S1 (6.0 [1.7-149.2] vs 5.5 [1.0-29.8] ng/ml, p = .020), CRP (C-reactive protein) (2.1 [0.1-19.7] vs 1.1 [0.3-9.6] mg/dl, p = .012), fibrinogen (330.2 ± 87.0 vs 278.0 ± 54.5 mg/dl, p < .001) values were significantly higher than the values of the control group. There was a negative correlation between cIMT and CRP (p = .034), age (p < .001), disease duration (p = .005), BASDAI (p = .048) and fibrinogen (p = .009) in AS patients. There was a negative correlation between cIMT and S1 (p = .029). In multivariate analysis, an independent relationship was found between cIMT and age (β = 0.611, p < .001) and syndecan (β = -0.196, p = .046)., Conclusion: S1 level may rise in AS patients to suppress the inverse effects of proinflammatory cytokines and inflammation. A negative relationship between the cIMT values of AS patients and S1 level may reveal that S1 has a protective effect on the development of atherosclerosis in AS patients, independent of disease activity.

Background: Patients with acute ST-segment elevation myocardial infarction (STEMI) often have fewer identifiable traditional risk factors compared to other types of acute coronary syndrome. Therefore, it is necessary to explore more sensitive predictive models different from traditional cardiovascular scoring systems to identify high-risk populations. The retrospective case-control study aimed to investigate the predictive value of carotid intima-media thickness (CIMT) and homocysteine (Hcy) on the occurrence of STEMI., Methods: A total of 198 patients with first STEMI were continuously selected into the observation group, who received emergency coronary angiography in Hefei Hospital Affiliated to Anhui Medical University from January 2020 to January 2022, and a total of 129 patients with chest pain and chest tightness who received coronary angiography to exclude significant coronary artery disease were selected as the control group in the above hospitals during the same period. Hcy was biochemical index determined by fasting blood sampling within 48 h after admission, while CIMT and carotid plaque was measured using ultrasound. Univariate and multivariate logistic regression analysis was used to screen out independent risk factors including Hcy, CIMT and carotid plaque of STEMI. On the basis of traditional risk factors, Hcy, CIMT and carotid plaque were introduced in order to form different combined diagnosis models. The receiver operating characteristic (ROC) curve of single indicator and multi-indicator combined diagnosis were plotted to evaluate the clinical usefulness of the study factors or diagnostic models. Based on those, a Nomogram was constructed to predict STEMI., Results: Hcy (OR =1.161, 95% CI: 1.084-1.244, P<0.001), CIMT (OR =206.968, 95% CI: 22.375-1,914.468, P<0.001), carotid plaque (OR =2.499, 95% CI: 1.214-5.142, P=0.013) were independent risk factors for STEMI (P<0.01). ROC results suggested that the area under the curve (AUC) of Hcy was 0.729, the optimal cut-off value was 13.525 µmol/L. The AUC of CIMT is 0.763, and the optimal cut-off value is 0.875mm. Combined with the independent predictors including smoking, diabetes, high density lipoprotein cholesterol, low density lipoprotein cholesterol, Hcy, CIMT, carotid plaque, the AUC of the diagnosis model was 0.892 (95% CI: 0.856-0.928, P<0.001). Based on the above results, a Nomogram for predicting STEMI was constructed with a C-index of 0.892. The results of the H-L fitting test show that χ 2 =1.5049, df=2, P=0.4712; the calibration curve of the Nomogram is close to the ideal curve, and the internal validation C-index was 0.880. The clinical decision curve analysis (DCA) shows that the "nomogram line" of the model is far from the "All line" and the "None line"., Conclusions: Hcy, CIMT, and carotid artery plaque could be independent risk factors of STEMI. The inclusion of these factors in addition to traditional risk factors can more fully and accurately predict the risk of STEMI. The Nomogram based on the results of this study is feasible and can bring clinical net benefit., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://cdt.amegroups.com/article/view/10.21037/cdt-23-312/coif). The authors have no conflicts of interest to declare., (2023 Cardiovascular Diagnosis and Therapy. All rights reserved.)

Incense burning, a source of household indoor air pollution, is possible to effect on cardiovascular system. Our study sought to examine the association of long-term exposure to household incense smoke with increased carotid intima-media thickness (CIMT). A cross-sectional study was conducted 132 adults aged ≥35 years. Participants were stratified into 3 groups by their long-term household incense use; nonexposed group, non–daily exposed group, and daily exposed group. A combined mean CIMT (mean difference = 0.04 mm; P < .01) and combined maximum CIMT (mean difference = 0.09 mm; P < .01) in the daily exposed group had greater than the nonexposed group. The mean CIMT and maximum CIMT of the left common carotid artery in the daily exposed group was significantly greater than the nonexposed group (P < .01). These findings suggest that incense burning inside the house may be a risk factor for cardiovascular disease morbidity and mortality. [ABSTRACT FROM AUTHOR]

Erectile dysfunction (ED) is associated with cardiovascular disease (CVD) and CVD mortality. However, the relationship between ED and subclinical CVD is less clear. We synthesized the available data on the association of ED and measures of subclinical CVD. We searched multiple databases for published literature on studies examining the association of ED and measures of subclinical CVD across four domains: endothelial dysfunction measured by flow-mediated dilation (FMD), carotid intima--media thickness (cIMT), coronary artery calcification (CAC), and other measures of vascular function such as the ankle--brachial index, toe--brachial index, and pulse wave velocity. We conducted random effects meta-analysis and meta-regression on studies that examined an ED relationship with FMD (15 studies; 2025 participants) and cIMT (12 studies; 1264 participants). ED was associated with a 2.64 percentage-point reduction in FMD compared to those without ED (95% CI: -3.12, -2.15). Persons with ED also had a 0.09-mm (95% CI: 0.06, 0.12) higher cIMT than those without ED. In subgroup meta-analyses, the mean age of the study population, study quality, ED assessment questionnaire (IIEF-5 or IIEF-15), or the publication date did not significantly affect the relationship between ED and cIMT or between ED and FMD. The results for the association of ED and CAC were inconclusive. In conclusion, this study confirms an association between ED and subclinical CVD and may shed additional light on the shared mechanisms between ED and CVD, underscoring the importance of aggressive CVD risk assessment and management in persons with ED. [ABSTRACT FROM AUTHOR]

Background and aims About 6–7% of high density lipoprotein (HDL) has a protein called apolipoprotein (apo) C-III that regulates lipoprotein metabolism and can provoke an inflammatory response. HDL without apoC-III is inversely associated with coronary heart disease (CHD), whereas HDL with apoC-III is directly associated with CHD. We investigated how the presence of apoC-III affects the association between HDL and early stages of atherosclerosis measured as carotid intima-media thickness (cIMT). Methods We examined the cross-sectional associations between the apoA-I concentrations of HDL subspecies with and without apoC-III and cIMT measured by high resolution B-mode carotid ultrasonography among 847 participants from the European multi-center Relationship between Insulin Sensitivity and Cardiovascular disease (RISC) study. Results HDL with and without apoC-III demonstrated significantly opposite associations with both cIMT indexes (p-heterogeneity of associations comparing the two subspecies was 0.002 for cIMT at common carotid artery (cIMT at CCA) and 0.006 for the maximum cIMT in any carotid segment (cIMT max)). Compared to the lowest quintile, the highest quintile of apoA-I in HDL without apoC-III was associated with 3.7% lower cIMT at CCA ( p- trend = 0.01) or 7.3% lower cIMT max ( p- trend = 0.003), while the highest quintile of apoA-I in HDL with apoC-III was associated with 4.4% higher cIMT at CCA ( p- trend = 0.001) or 7.9% higher cIMT max ( p- trend = 0.002). Total apoA-I as well as total HDL cholesterol was not associated with cIMT whereas higher levels of total apoC-III and apoC-III contained in HDL were significantly associated with higher cIMT ( p- trend<0.01). Conclusions HDL apoC-III is a promising target for atherosclerosis prevention and treatment. [ABSTRACT FROM AUTHOR]

Background: We investigate whether non-high-density lipoprotein cholesterol (non-HDL-C) provides a better estimate of cardiovascular risk than other lipid profiles in normotensive and euglycemic middle-aged and elderly adults. Methods: A total of 512 males and 958 females were enrolled from the Changfeng Study. A standard interview, anthropometric measurements and laboratory analyses were performed for each participant. Bilateral carotid intimamedia thicknesses (CIMTs) were measured using ultrasonography, and the presence of carotid plaques was assessed. Results: The mean values of non-HDL-C were 3.4 ± 0.8 mmol/l and 3.6 ± 0.9 mmol/l for male and female subjects, respectively. Compared with female subjects with non-HDL-C in the first quartile, female subjects with non-HDL-C in the fourth quartile had 1.317-fold increased risks for carotid plaques after adjusting for conventional cardiovascular disease (CVD) risk factors and increasing quartiles of all lipid levels. Non-HDL-C was positively associated with the CIMT after adjusting for CVD risk factors in female subjects (β = 0.062, P = 0.034). Conclusions: These results suggest that non-HDL-C is independently associated with carotid atherosclerosis in normotensive and euglycemic females. [ABSTRACT FROM AUTHOR]

Background It is important to consider left ventricular hypertrophy (LVH) and carotid intima-media thickness (CIMT) in assessing hypertensive patients' global cardiovascular risk profile, as LVH and arterial wall changes occur concurrently. This study aimed to assess the relationship between CIMT and left ventricular geometry and function in hypertensive patients. Methodology This cross-sectional study included 200 hypertensive individuals and sought to correlate their CIMT with left ventricular geometry and function in Lagos University Teaching Hospital. Hypertension was defined as blood pressure ≥140/90 mmHg or on treatment for hypertension presenting at the outpatient clinics. Patients who satisfied the inclusion criteria were recruited. Abnormal CIMT was defined as >0.9 mm. Patients' demographic data were obtained in addition to general characteristics, physical examination, transthoracic echocardiography, and CIMT. The statistical relationship between CIMT and left ventricular geometry and function was obtained and analyzed. Results Normal geometry and LVH were observed in 50.5% and 15.5%, respectively. Left ventricular geometry was associated with abnormal CIMT (χ 2 = 31.688, p < 0.001). Furthermore, the mean left ventricular mass index was statistically different between abnormal and normal CIMT (97.84 ± 30.5 vs. 80.75 ± 15.6; p < 0.001). Regarding left ventricular function, there was no significant difference in E-point septal separation, left ventricular fractional shortening, and left ventricular ejection fraction in abnormal versus normal CIMT groups. However, there was a significant association of CIMT with grades of diastolic dysfunction (χ 2 = 7.069, p = 0.029). Additionally, individual parameters of diastolic dysfunction such as left atrial volume index and septal mitral were significantly different (p < 0.001). Conclusions There was an association between age, left ventricular geometry, diastolic function, and CIMT in hypertensive individuals. Therefore, it is beneficial to evaluate CIMT and for these patients to receive more targeted blood pressure control which may reduce the risk of cardiovascular diseases., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Inuwa et al.)

Background: Factors affecting carotid artery stenosis have been generally investigated. However, considering the protective effect of altitude, studies on elderly individuals at high altitudes are few. Our aim is to investigate the systematic adaptive changes caused by high-altitude exposure through the causes of carotid artery stenosis., Materials and Methods: Carotid Doppler ultrasound was performed on 250 patients over the age of 50 years. The patients' age, gender, height, weight, smoking history, place of residence, and presence of comorbidities were questioned. Those with diabetes, hypertension, hyperlipidemia, and coronary disease were excluded from the study. Those who did not reside at high altitudes were excluded from the study. One hundred and thirty-five patients were included in the study. Carotid artery Doppler findings and biochemical parameters were recorded. Factors affecting stenosis in the carotid arteries were compared., Results: In our study, the factors affecting carotid stenosis were determined to be age, gender, presence of plaque, plaque type, and mean carotid intima-media thickness (CIMT). The mean CIMT of the patients was calculated as 0.71±0.14 mm. The mean CIMT measurement level was significantly higher in patients with plaque in the carotid artery (p<0.05). According to receiver operating characteristic curves, CIMT values higher than 0.72 mm increase plaque and stenosis formation in the common carotid artery (CCA) and internal carotid artery (ICA) in elderly people living at high altitudes (p<0.05, area under the curve [AUC]: 0.71-0.83)., Conclusions: The most important factors affecting carotid stenosis in individuals living at high altitudes are age, gender, CIMT, plaque, and plaque type. When soft plaques were detected, the risk of stenosis was found to be higher than in calcific plaques. Additionally, the number of factors affecting stenosis was greater on the left (ICA). This suggests that the left carotid system is more vulnerable. It can be said that in elderly individuals living at high altitudes, a CIMT higher than 0.72 mm is a cutoff value in the presence of plaque and stenosis in the carotid arteries., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Sukun et al.)

Urban traffic officers in many low- and middle-income countries are exposed to high levels of traffic-related air pollutants (TRAP) while working vehicle control on heavily congested streets. The impact of chronic TRAP exposure on the cardiovascular health, including the carotid intima-media thickness (CIMT), of this outdoor occupational group remains unclear. This cross-sectional study compared the average mean and maximum CIMT measurements of two groups of relatively young, healthy traffic police (32 ± 7 years; 77% male) in Quito, Ecuador, who were without clinical evidence of serious cardiovascular or other disease. Previously published background data on PM 10 (a TRAP surrogate) indicated that street levels of the pollutant were several orders of magnitude higher at the street intersections worked by traffic police compared to those working only in an office. Accordingly, officers permanently assigned to daily traffic control duties requiring them to stand 0-3 m from heavily trafficked street intersections were assigned to the high exposure group (n = 61). The control group (n = 54) consisted of officers from the same organization who were permanently assigned to office duties inside an administration building. Mean and maximum CIMT were measured with ultrasound. General linear models were used to compare the CIMT measurements of the high exposure and control groups, adjusting for covariates. The adjusted average mean and maximum CIMT measures of the high exposure group were increased by 11.5% and 10.3%, respectively, compared to the control group ( p = 0.0001). These findings suggest that chronic occupational exposure to TRAP is associated with increased CIMT in traffic police. This is important since even small increases in arterial thickening over time may promote earlier progression to clinical disease and increased premature mortality risk.

Background: Lifestyle-associated cardiovascular risk may be elevated already during adolescence translating into an increased disease burden in adulthood. The KiGGS cohort characterizes cardiovascular aging from childhood until young adulthood in the German general population. This study analyzes the effects of increased cardiovascular risk during adolescence on carotid properties in young adults. Methods: 1,545 participants of the representative healthy population sample of the national KiGGS-0 cohort (10-17 years of age) had carotid ultrasound-assessment 10 years later at the KiGGS-2 follow-up (20-28 years of age). A cardiovascular risk score (CV-R) was calculated at KiGGS-0 including variables of arterial hypertension, obesity, dyslipidemia and smoking. Carotid intima-media thickness (CIMT) and distensibility (DC) at KiGGS-2 were associated with CV-R. Results: Unfavorable alterations of all components of CV-R were associated with higher CIMT and/or reduced DC. Relative risks for pathologically elevated CIMT = 90th percentile and/or decreased DC = 10th percentile were elevated in participants with 'intermediate' (RRCIMT = 1.89 [1.23-2.91], p < 0.05; RRDC = 1.27 [0.79-2.06]) or 'high' risk (RRCIMT = 1.83 [0.95-3.52], p < 0.1; RRDC = 1.76 [0.93-3.32], p < 0.1) according to CV-R. Conclusions: If an intermediate or high cardiovascular risk according to CV-R is apparent in adolescence, signs of early vascular aging may occur at a very young age. The promotion of a favorable lifestyle to reduce risk factor burden even in the overall healthy general population at a young age seems to be crucial for primary prevention of cardiovascular diseases. [ABSTRACT FROM AUTHOR]

In recent decades, the increased incidence of cardiovascular disease (CVD) mortality among young adults has raised concerns. Although clinical manifestations of CVD typically occur later in life, the underlying pathological processes emerge early on. This review article summarizes the association between vitamin B deficiency-induced hyperhomocysteinemia and subclinical atherosclerosis in adolescents. Numerous studies have demonstrated that elevated homocysteine levels are an independent risk factor for endothelial dysfunction (ED) and arterial stiffness, which are key contributors to CVD. Notably, vitamin B deficiency, particularly in vitamin B9 and vitamin B12, emerges as a significant factor in childhood hyperhomocysteinemia, initiating the development of subclinical atherosclerosis in early life. A comprehensive review of relevant literature from prominent bibliographic databases, including PubMed/MEDLINE, PubMed Central, Google Scholar, and Cochrane, was performed. Four cross-sectional studies focusing on homocysteine levels as an exposure variable and markers of atherosclerosis as outcome measures were included and reviewed as part of our analysis. The reviewed studies demonstrate a positive correlation between homocysteine levels and markers of atherosclerosis, including increased carotid intima-media thickness (CIMT) and ED. Mainly, adolescents with vitamin B12 deficiency exhibit a significant positive correlation between homocysteine levels and CIMT. These findings underscore the potential of hyperhomocysteinemia as an early marker for detecting subclinical atherosclerosis in adolescents with vitamin B deficiency. Despite limited research in this area, recognizing the importance of early detection and management of subclinical atherosclerosis in adolescents can help mitigate the risk of severe cardiovascular events such as myocardial infarction and stroke in young adulthood., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Shirode et al.)

Background: Carotid atherosclerosis is an important etiological factor for ischemic stroke. Early carotid lesion detection may prevent further strokes. Doppler ultrasound measures carotid artery blood flow, intima-media thickness, stenosis, plaques, and lumen and wall changes., Objective: The objective of this study is to determine the association of carotid plaque size (CPS), carotid intima-media thickness (CIMT), resistive index (RI), and pulsatility index (PI) with acute ischemic stroke., Methodology: A total of 60 participants were taken, including 30 cases and 30 age- and sex-matched controls. Patients with acute ischemic stroke were included as cases and age- and sex-matched healthy volunteers were included as controls. A carotid duplex study was done in both groups, and the findings were compared., Results: The mean age of the ischemic stroke cases was 63.33±10.79 years; more than half were aged >60 years. Male patients were 73.3% and female patients were 26.7% of the cases. Age and gender were statistically similar (p>0.05) in groups (cases and controls). The plaques were homogenous in 30% of patients, calcified in 26.7%, and mixed in 6.7%. About 36.6% of patients did not have any plaque. CPS was greater among cases than controls in the right and left internal and left common carotid arteries; however, it was not statistically significant (p>0.05). The mean CIMT was 0.79±0.10 mm on the right side and 0.90±0.17 mm on the left side among cases. CIMT was significantly higher in the cases group than in the controls (p<0.05). The mean RI was significantly greater in the left common carotid artery (CCA) among the cases than in the controls (p<0.05). Patients aged over 60 years had significantly higher RI and PI values in the left internal carotid artery (ICA) compared to the younger cases (p<0.05). Smoking history had a significant association with left CCA RI and PI values (p<0.05). However, RI, PI, CPS, and CIMT among cases were similar in different groups like diabetic, non-diabetic, hypertensive, and non-hypertensive patients (p>0.05)., Conclusion: CIMT was significantly thicker among the patients with ischemic stroke compared to the control group. RI in the left CCA was significantly greater among the stroke patients than in the control group. The age of the patient and smoking habit had an association with RI and PI values. Most of the parameters were found to be significant on the left side, suggesting carotid atherosclerosis may not be symmetrical. A large-scale further study is needed to see the association of these variables with ischemic stroke patients., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Kawnayn et al.)

Rationale & Objective: Previous studies in chronic kidney disease (CKD) showed that vascular dysfunction in different circulatory beds progressively deteriorates with worsening CKD severity. This study evaluated muscle oxygenation and microvascular reactivity at rest, during an occlusion-reperfusion maneuver, and during exercise in patients with different stages of CKD versus controls., Study Design: Observational controlled study., Setting & Participants: 90 participants (18 per CKD stage 2, 3a, 3b, and 4, as well as 18 controls)., Predictor: CKD stage., Outcome: The primary outcome was muscle oxygenation at rest. Secondary outcomes were muscle oxygenation during occlusion-reperfusion and exercise, and muscle microvascular reactivity (hyperemic response)., Analytical Approach: Continuous measurement of muscle oxygenation [tissue saturation index (TSI)] using near-infrared spectroscopy at rest, during occlusion-reperfusion, and during a 3-minute handgrip exercise (at 35% of maximal voluntary contraction). Aortic pulse wave velocity and carotid intima-media thickness were also recorded., Results: Resting muscle oxygenation did not differ across the study groups (controls: 64.3% ± 2.9%; CKD stage 2: 63.8% ± 4.2%; CKD stage 3a: 64.1% ± 4.1%; CKD stage 3b: 62.3% ± 3.3%; CKD stage 4: 62.7% ± 4.3%; P=0.6). During occlusion, no significant differences among groups were detected in the TSI occlusion magnitude and TSI occlusion slope. However, during reperfusion the maximum TSI value was significantly lower in groups of patients with more advanced CKD stages compared with controls, as was the hyperemic response (controls: 11.2%±3.7%; CKD stage 2: 8.3%±4.6%; CKD stage 3: 7.8%±5.5%; CKD stage 3b: 7.3%±4.4%; CKD stage 4: 7.2%±3.3%; P=0.04). During the handgrip exercise, the average decline in TSI was marginally lower in patients with CKD than controls, but no significant differences were detected across CKD stages., Limitations: Moderate sample size, cross-sectional evaluation., Conclusions: Although no differences were observed in muscle oxygenation at rest or during occlusion, the microvascular hyperemic response during reperfusion was significantly impaired in CKD and was most prominent in more advanced CKD stages. This impaired ability of microvasculature to respond to stimuli may be a crucial component of the adverse vascular profile of patients with CKD and may contribute to exercise intolerance., Plain-Language Summary: Previous studies in chronic kidney disease (CKD) have shown that vascular dysfunction in different circulatory beds progressively deteriorates with CKD severity. This study evaluated muscle oxygenation and microvascular reactivity at rest, during an occlusion-reperfusion maneuver, and during exercise in patients with nondialysis CKD versus controls, as well as across different CKD stages. It showed that the microvascular hyperemic response after an arterial occlusion was significantly impaired in CKD and was worst in patients with more advanced CKD. No significant differences were detected in skeletal muscle oxygenation or muscle oxidative capacity at rest or during the handgrip exercise when comparing patients with CKD with controls or comparing across CKD stages. The impaired ability of microvasculature to respond to stimuli may be a component of the adverse vascular profile of patients with CKD and may contribute to exercise intolerance., (Copyright © 2023 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)

Backgrounds: Epicardial adipose tissue thickness has been considered to be a possible cardiovascular risk indicator in recent reports. Aims and Objective: The aim of the study was to evaluate the relationship of echocardiographic epicardial fat thickness (EFT) with carotid intima-media thickness (CIMT), in patients with type 2 diabetes mellitus (T2DM). Materials and Methods: In this hospital based cross sectional observational study a total of 64 patients with T2DM (mean age 54.51±6.60 years and 75.0% male) and 76 age and sex-matched non-diabetic control (mean age 54.97±6.11years and 71.1% male) were evaluated. Echocardiographic EFT and ultrasonographic CIMT were measured in all subjects. Results: Patients with T2DM had significantly increased EFT and CIMT than those of the nondiabetic controls (6.15±0.99 mm versus 4.39±0.61 mm, P< 0.001 and 0.77±0.09 mm versus 0.51±0.05 mm, P< 0.001, respectively). EFT was correlated with CIMT (r = 0.724, P < 0.001), duration of diabetes (r = 0.723, P < 0.001) and fasting plasma glucose level (r = 0.542, P < 0.001). Linear regression analysis showed that CIMT (β = 0.358, t = 3.658, P < 0.001) duration of diabetes (β = 0.324, t = 3.268, P = 0.001) and fasting plasma glucose level (β = 0.210, t = 3.302, P = 0.001) were found to be the independent predictors of EFT. Conclusion: The echocardiographic EFT was significantly higher in patients with T2DM; and it was well correlated with CIMT, duration of diabetes and fasting plasma glucose level as being the independent predictors of EFT. [ABSTRACT FROM AUTHOR]