Search

Background: The objective of this cohort study was to assess the predictive value of main arterial markers for cardiovascular death in middle-aged subjects with metabolic syndrome (MetS). Methods: This prospective longitudinal study analyzed data from 5829 metabolic syndrome subjects without overt cardiovascular disease aged between 40 and 64 years and enrolled in the Lithuanian High Cardiovascular Risk primary prevention program. Initial assessment comprised the evaluation of aortic pulse wave velocity (aPWV), carotid intima-media thickness (cIMT), carotid stiffness index, cardio-ankle vascular index (CAVI), ankle-brachial index (ABI), aortic augmentation index adjusted for a heart rate of 75 bpm (AIXHR75), and endothelium-dependent flow-mediated dilatation (FMD). Results: During the mean follow-up period of 6.35 ± 2.99 years, 170 subjects (2.9%) had died, with 41 out of these deaths (24.1%) related to cardiovascular causes. Cox proportional hazard regression analysis revealed associations between cardiovascular deaths and increases in aPWV (HR 1.34, 95% CI 1.14–1.58, p < 0.001), CAVI (HR 1.28, 95% CI 1.09–1.50, p = 0.002), and cIMT (HR 1.004, 95% CI 1.001–1.006, p = 0.003), as well as a decrease in ABI (HR 0.020, 95% CI 0.001–0.359, p = 0.008). However, after adjustment for age and gender, only aPWV remained a statistically significant predictor. Common survival tree analysis foregrounded the predictive significance of C-reactive protein (CRP), as the primary variable associated with an increased risk of cardiovascular death, followed by aPWV and smoking as secondary and tertiary variables. The analysis also demonstrated sex-related differences: in women, the primary predictive variable was aPWV, whereas in men, CRP was identified as the primary variable, followed by CAVI and cIMT. Conclusions: The findings of this study suggest that, among the markers of subclinical arterial damage, an increase in both aPWV and CAVI has a statistically significant predictive value for cardiovascular mortality in the middle-aged subjects with MetS. However, only aPWV demonstrated predictive value that was independent of age and gender. [ABSTRACT FROM AUTHOR]

• The effect of pPE on CCA-IMT has been poorly investigated. • 13 studies on CCA-IMT in pPE women were sistematically analyzed. • Average CCA-IMT was slightly, but significantly, increased in pPE women vs controls. • The overall effect of pPE on CCA-IMT was small and not statistically significant. • Intensive therapy, late-onset PE and short follow-up may explain these findings. During the last two decades, a few studies have evaluated the common carotid artery (CCA) intima-media thickness (IMT) in women with previous history of pre-eclampsia (pPE) in comparison to women with uncomplicated pregnancies, providing not univocal results. This systematic review and meta -analysis has been designed to summarize the main findings of these studies and to examine the overall influence of pPE on CCA-IMT. All studies assessing CCA-IMT in pPE women in comparison to women who had uncomplicated pregnancies, selected from PubMed and EMBASE databases, were included. Studies evaluating women with previous history of early-onset (EO) or late-onset (LO) PE vs healthy controls were separately analyzed. Continuous data (CCA-IMT) were pooled as a standardized mean difference (SMD) comparing pPE group with healthy controls. The subtotal and overall SMDs of CCA-IMT were calculated using the random-effect model. The full-texts of 12 studies with 583 pPE women and 610 healthy controls were analyzed. The average time after delivery was 8.5 yrs (range 1.1–20 yrs). The average CCA-IMT was significantly increased in pPE women than healthy controls in five studies (41.7 % of total), whereas it was similar between the two study groups or surprisingly reduced in pPE women vs controls in more than half of studies (58.3 % of total). The effect of pPE on CCA-IMT was very small for the studies including women with previous LO-PE (subtotal SMD 0.067, 95 %CI −0.339,0.472, P = 0.75) and small for those analyzing women with previous EO-PE (subtotal SMD 0.250, 95 %CI-0.231,0.732, P = 0.31). Overall, the effect of pPE on CCA-IMT was small and not statistically significant (SMD 0.143, 95 %CI −0.167,0.453, P = 0.37). Substantial heterogeneity was detected for the included studies, with an overall I2 statistic value of 81 % (P < 0.001). Egger's test for a regression intercept yielded a P-value of 0.58, indicating no publication bias. On meta -regression analysis, none of the moderators and/or potential confounders was significantly associated with effect modification (all P > 0.05). Women with previous history of PE have an increased burden of cardiovascular risk factors, but do not appear to be affected by significant subclinical carotid atherosclerosis, up to 20 years postpartum. [ABSTRACT FROM AUTHOR]

Arteriovenous fistula (AVF) dysfunction is a common complication in patients undergoing maintenance hemodialysis (MHD). Elevated serum levels of fibroblast growth factor 21 (FGF21) are associated with atherosclerosis and cardiovascular mortality. However, its association with vascular access outcomes remains elusive. The present study evaluated the relationship of serum FGF21 levels with AVF dysfunction and all-cause mortality in patients undergoing MHD. We included patients undergoing MHD using AVF from January 2018 to December 2019. FGF21 concentration was detected using enzyme-linked immunosorbent assay. Patients were followed up to record two clinical outcomes, AVF functional patency loss and all-cause mortality. The follow-up period ended on April 30, 2022. Among 147 patients, the mean age was 58.49 ± 14.41 years, and the median serum level of FGF21 was 150.15 (70.57–318.01) pg/mL. During the median follow-up period of 40.83 months, the serum level of FGF21 was an independent risk factor for AVF functional patency loss (per 1 pg/mL increase, HR 1.002 [95% CI: 1.001–1.003, p = 0.003]). Patients with higher serum levels of FGF21 were more likely to suffer from all-cause mortality (per 1 pg/mL increase, HR 1.002 [95% CI: 1.000–1.003, p = 0.014]). The optimal cutoffs for FGF21 to predict AVF functional patency loss and all-cause mortality in patients undergoing MHD were 149.98 pg/mL and 146.43 pg/mL, with AUCs of 0.701 (95% CI: 0.606–0.796, p < 0.001) and 0.677 (95% CI: 0.595–0.752, p = 0.002), respectively. Serum FGF21 levels were an independent risk factor and predictor for AVF functional patency loss and all-cause mortality in patients undergoing MHD. [ABSTRACT FROM AUTHOR]

Context Current evidence of cardiovascular (CV) risk in primary hyperparathyroidism (PHPT) is still inconsistent. Objective To prospectively investigate changes of early atherosclerosis in patients with PHPT undergoing parathyroidectomy (PTx) or conservative management, according to consensus criteria. Methods Biochemical parameters of PHPT, CV risk factors (systolic and diastolic blood pressure, cholesterol [total, high-density, and low-density], triglyceride, HbA1c, HOMA-IR), and carotid intima-media thickness (IMT) and plaque were assessed in 52 consecutive postmenopausal PHPT patients both at baseline and ≥ 24 months after surgery (PTx, n = 22) or conservative management (non-PTx, n = 30). Results At baseline, PTx and non-PTx showed comparable age, BMI, renal function, and 25(OH)D levels, and did not differ for CV risk factors, IMT and plaques, or for prevalence of smoking, diabetes mellitus, or antihypertensive or statin therapy, while all parameters characterizing PHPT differed. Follow-up duration in PTx was longer than in non-PTx (P =.004). Parameters characterizing PHPT significantly improved ≥ 24 months after surgery, whereas in non-PTx serum phosphate slightly decreased and parathyroid hormone increased. Systolic and diastolic blood pressure increased at follow-up in both groups, while other CV risk factors did not significantly vary. In PTx, IMT did not significantly vary after surgery (0.85 ± 0.14 to 0.89 ± 0.22 mm, P =.366), whereas it significantly increased in non-PTx (0.80 ± 0.18 to 0.93 ± 0.23 mm, P =.008), even adjusting for blood pressure. Plaque prevalence and incidence did not significantly differ in the 2 groups. Conclusion Our results suggest that in postmenopausal patients with PHPT, subclinical atherosclerosis could be halted by PTx, whereas it worsens over time in nonoperated patients with milder disease. [ABSTRACT FROM AUTHOR]

Background: While patients with systemic sclerosis (SSc) are predisposed to cardiovascular events, data regarding this from India is sparse. We analysed correlates of subclinical atherosclerosis in Indian patients with SSc. Methods: Patients with SSc fulfilling the 2013 classification criteria (n = 61) were recruited after obtaining written informed consent. Clinical risk factors for cardiovascular disease (CVD) were assessed. A carotid ultrasound was performed to assess the mean carotid intima-media thickness (CIMT). Total and endothelial microparticles (EMP, positive for CD31 and CD146) were estimated from plasma. Serum cytokines known to play a role in atherosclerosis (interleukin-1β [IL-1β], tumour necrosis factor-alpha, IL-6 and IL-17) were assessed. Forty-one age- and sex-similar healthy controls were recruited for comparison. Clinical and serological risk factors for CVD were compared between SSc with and without carotid plaque. Linear regression analyses were conducted to identify predictors of CIMT and carotid plaque in SSc. Results: Patients with SSc had lower body-mass index than healthy controls, however, had higher CIMT, higher serum IL-1β, IL-6, total microparticles and EMP than control subjects. SSc with carotid plaque (n = 13) were older, and more likely to be male, but demonstrated no differences in serological markers of CVD. On multivariable-adjusted regression analyses, age was the only significant predictor of CIMT in SSc and male sex was the only significant predictor of carotid plaque in SSc. Conclusions: Carotid plaques were present in one-fifth of young patients with SSc. Older age and male sex predicted a higher risk of subclinical atherosclerosis in SSc. [ABSTRACT FROM AUTHOR]

A neurodegenerative condition affecting geriatric dogs is called "canine cognitive dysfunction", (CCD) a disease that is similar to Alzheimer's disease in many aspects. Vascular risk factors have been implicated in the development of all-cause dementia and Alzheimer's disease in humans. The purpose of this study was to determine the carotid pulse wave velocity in CCD dogs by Doppler ultrasonography and compare with normal dogs. Carotid ultrasonography was done on 17 CCD dogs that were positive base on CCD rating scale. One way ANOVA (post-hoc Scheffe) was used to compare the velocities among the vessels. Mean values of RI and PI in CDS(cognitive dysfunction syndrome) positive dogs were more than those of CDS negative dogs and the mean values of PSV, EnDV and MV in CDS positive dogs were less than those of CDS negative dogs. But there was no significant association between the values of carotid pulse wave velocity among CDS positive and negative doges. However, the results of this study may be useful as a baseline data for future investigations. [ABSTRACT FROM AUTHOR]

Background: Gamma-glutamyl transpeptidase (GGT) is an important molecule produced by hepatocytes that has been noticed as a prooxidative enzyme. GGT has been found to be included in the inflammation process and oxidative damage in multiple diseases in human. Psoriatic arthritis (PsA) is an inflammatory disorder leading to high mortality and morbidity due to cardiovascular events. However, GGT role in PsA remains unclear. The aim of this study is to determine the association of GGT with PsA activity and atherosclerosis in PsA patients. Also, to investigate if GGT can serve as an indicator of subclinical atherosclerosis in PsA patients. Results: This study was performed on 30 PsA patients and 30 matched healthy subjects. All patients underwent detailed history taking and clinical assessment. Disease activity in PsA (DAPSA) score was used to assess disease activity in PsA patients. GGT level in serum was quantified by utilizing enzyme-linked immunosorbent assay and correlated with carotid intima media thickness (CIMT) and PsA disease activity. Patients' mean age and disease duration was 43.37 ± 7.65 years (30–55 years) and 7.97 ± 4.214 years (2–15 years) respectively. Levels of GGT in serum were significantly increased in patients compared to GGT serum levels in controls (p < 0.001). Serum GGT levels showed significant positive correlation with DAPSA score, LDL, cholesterol triglycerides, and right and left CIMT (r = 0.913, 0.587, 0.779, 0.803, 0.736, 0.728 and p < 0.001 respectively) and significant negative correlation with HDL (r = − 0.681 and p < 0.001). However, GGT serum levels and PsA disease duration did not show significant correlation. Conclusion: Serum GGT was associated with high disease activity, high lipid profile, and large CIMT in PsA patients. GGT might be an indicator of subclinical atherosclerosis and increased disease activity in patients with PsA. [ABSTRACT FROM AUTHOR]

Background: Multiple sclerosis (MS) is characterized by inflammation and demyelination in the central nervous system. Recent studies have suggested a potential association between MS and an increased risk of atherosclerosis, a systemic vascular disease involving arterial wall thickening. Understanding this relationship is crucial, given the heightened cardiovascular risk observed in MS patients. Objective: To investigate factors influencing the development of atherosclerosis in patients with multiple sclerosis (pwMS), focusing on carotid intima-media thickness (CIMT) as a marker. Methods: 114 pwMS (82 females and 32 males) and 127 control subjects (57 females and 70 males) were included. The mean CIMT between the two groups was compared. Additionally, the effects of annual relapse rate, EDSS (Expanded Disability Status Scale), MS duration, treatment duration, and type of Disease-modifying treatment (DMT) on CIMT were evaluated. Results: This study included 241 participants with a mean (SD) age of 41.13 years (10.93). CIMT was significantly higher in pwMS compared to controls (p < 0.001). Even after adjusting for age, sex, and BMI (Body Mass Index), CIMT remained significantly higher in the pwMS group (p < 0.001). Spearman's correlation analysis revealed significant associations between CIMT and age, BMI, EDSS score, and disease duration (all p < 0.05). Additionally, the SPMS (Secondary Progressive Multiple Sclerosis) disease course was significantly associated with higher CIMT (p < 0.001). Linear regression analysis identified age as the most significant predictor of increased CIMT in pwMS (p < 0.001), followed by BMI (p = 0.054). Conclusion: This study demonstrates a significant association between MS and increased CIMT. Additionally, age emerged as the most prominent predictor of high CIMT in pwMS, followed by BMI. These findings suggest a potential link between MS and increased cardiovascular risk. Further research is warranted to explore the underlying mechanisms and investigate the long-term cardiovascular outcomes in this population. [ABSTRACT FROM AUTHOR]

Up to the last update, the gut microbiome (GM) had been associated with a different physiologic host process, including those affecting cardiovascular health. The carotid intima-media thickness (IMT) is an indicator of atherosclerosis and cardiovascular risk. The GM influence on atherosclerosis progression has garnered growing attention in recent years but the consensus in subclinical atherosclerosis remains elusive. The aim of this narrative review is to investigate the connection between the GM and carotid IMT, encompassing mechanisms like the microbiome impact on metabolite production, and systemic inflammation, and its effects on endothelial function. The literature analysis revealed that the GM appears to exert an influence on carotid IMT development, likely through mechanisms involving metabolites' production, systemic inflammation, and endothelial function modulation. Additional research, however, is needed to finely elucidate the relationship between the GM and atherosclerosis. Specifically, more extensive studies are required to pinpoint individuals at the highest risk of developing atherosclerosis based on their GM composition. This will facilitate the enhancement and optimization of cardiovascular disease prevention strategies and enable the treatments' customization for each patient. Further investigations are required to refine patient outcomes in the context of probiotics and other interventions aimed at improving microbiome composition and function. [ABSTRACT FROM AUTHOR]

Aim: Elevated levels of cholesterol in the bloodstream, also referred to as hypercholesterolemia, pose a significant risk for the onset of cardiovascular and cerebrovascular diseases. Oxysterols, cholesterol-derived oxidized compounds that form enzymatically or non-enzymatically, contribute to the development of atherosclerosis and coronary artery disease. This study aimed to examine the critical oxysterol levels in children and adolescents with hypercholesterolemia and explore the correlation between these levels, oxidative stress, and atherosclerosis progression. Materials and methods: The study included 20 patients with familial hypercholesterolemia (FH) and 20 healthy individuals aged between 6 and 18 years. Participants were categorized into children (6–9 years) and adolescents (10–18 years). Pediatric and adolescent patients were selected from among subjects with LDL-C ≥ 130 mg/dL and diagnosed with heterozygous familial hypercholesterolemia (HeFH) based on the presence of mutations in the LDL receptor (LDL-R) gene. Patients with HeFH who were receiving regular atorvastatin therapy were included in the study. Results: There were no notable differences in catalase and paraoxonase (PON1) activities among the groups. However, the patient group displayed substantially higher levels of malondialdehyde (MDA) (P = 0.0108) and superoxide dismutase (SOD) activity (P = 0.0103). Compared to the healthy control group, serum chitotriosidase (CHITO) activity (P = 0.037) and chitinase 3-like protein 1 (YKL-40) levels (P = 0.0027) were significantly elevated in the patient group. Furthermore, the carotid intima-media thickness (CIMT) measurements of the patient group were significantly greater than those of the healthy group (**P < 0.0001****). The patient group exhibited significantly elevated levels of 5,6-α-epoxycholesterol, Cholestane-3β,5α,6β-triol (C-triol), and 7-ketocholesterol (7-KC), whereas 27-hydroxycholesterol (27-OHC) was significantly more abundant in the healthy group. On the other hand, while 27-OHC/Total cholesterol (Total-C) levels were significantly higher in healthy individuals, the C-Triol/Total-C ratio was significantly higher in patients. No significant differences were found between the groups in terms of 7-KC/Total-C and 5,6-α-epoxycholesterol/Total-C levels. Conclusion: This study highlights the key roles of oxysterols, oxidative stress, and macrophage activation in the development of atherosclerosis in pediatric and adolescent patients with FH. Elevated C-Triol levels in FH patients, alongside increased CIMT, point to early vascular changes despite atorvastatin therapy. In contrast, higher 27-OHC levels in healthy controls suggest differential oxysterol regulation due to cholesterol-lowering treatments in FH patients. C-Triol and 27-OHC/Total-C ratios showed potential as biomarkers to distinguish patients with FH. These findings emphasize the need for therapies targeting oxidative stress and macrophage activation in addition to cholesterol-lowering interventions. [ABSTRACT FROM AUTHOR]

Background and Objectives: Soluble alpha Klotho (s.Klotho) is an emerging marker for chronic kidney disease (CKD) prognosis. The objective was to study the association between s.Klotho and CKD‐related decrease in glomerular filtration rate (GFR), bone and vascular damage. Method: A total of 118 patients with CKD stage 2–4 were enrolled and 107 patients continued in the study. Clinical and laboratory parameters were recorded at time of enrollment and 12 months. A double sandwich ELISA for s.Klotho was recorded in controls (n = 25) and patients' serum samples at 6 months (n = 107) and 12 months (n = 102). Primary endpoints like 40% or more fall in GFR, a requirement for renal replacement therapy (RRT), and death with different grades of s.Klotho deficiency were studied. Results: Of the 107 patients (80 male and 27 female), mean s.Klotho was 3.46 ng/mL (02.3–04.2). The GFR fall was significantly different (p value < 0.0001) in the different grades of s.Klotho deficiency with Grade 4 s.Klotho deficiency (0.1–2.99 ng/mL) having the maximum fall of GFR at 9.2 mL/min/1.73 m2 (04.8–12.0) and minimum in Grade 2 (3–5.99 ng/mL) at 1.35 mL/min/1.73 m2 (03.0–02.75). The Ankle Brachial Pressure Index positively correlated with s.Klotho and the correlation coefficient was 0.536 (0.382–0.662) (p < 0.001). The carotid intimal medial thickness negatively correlated with s.Klotho and the correlation coefficient was −0.712 (95% CI: −0.797–−0.601, p < 0.001). All five deaths had s.Klotho Grade 4 (severe) deficiency. The event‐free survival rate was maximum (100%) in Grade 2 Klotho deficiency and lowest (55%) in Grade 4 s.Klotho deficiency. Conclusions: s.Klotho levels decreased significantly in patients with progressive kidney failure. s.Klotho levels significantly correlated with the presence of vascular disease. Death and need for RRT were significantly more in patients with severe s.Klotho deficiency. [ABSTRACT FROM AUTHOR]

Background: Coronary artery disease (CAD) prevalence in young individuals is rising, particularly in South Asian populations. Carotid artery hemodynamic parameters and their relation with CAD have not been studied much in young patients. Aims and Objectives: The aim of the study was to study the relationship between Carotid artery hemodynamic parameters, and CAD severity in young patients. Materials and Methods: A cross-sectional and single-center study was conducted involving consecutive patients undergoing coronary angiography due to acute coronary syndrome and aged under 40. Carotid ultrasonography and Doppler were performed to assess Carotid artery hemodynamic parameters. Gensini and SYNTAX scores were used to evaluate the severity and complexity of CAD. A total of 136 patients were included in the study. Results: The mean age was 36.24±4.030 years, with 92 males. CAD patients demonstrated significantly increased carotid intima-media thickness (CIMT) (0.730±0.157 vs. 0.488±0.09; P<0.001) and resistive index (RI) in the right internal carotid artery (RICA) (P=0.004). Carotid blood flow velocities were significantly reduced in CAD patients, including peak systolic velocity (PSV) in both the RICA and left ICA (LICA) (P<0.05) and end-diastolic velocity of the RICA (P=0.049). Mean SYNTAX 9.526±6.762 and mean Gensini 23.403±18.58. CIMT correlated significantly with CAD complexity in terms of vessels involved (P=0.036) and of SYNTAX score (P=0.046). CIMT, PSV RICA, PSV LICA, and RI RICA are the significant CAD predictors. Conclusion: CIMT and Carotid artery hemodynamic parameters are valuable predictors of CAD occurrence, severity, and complexity even in young individuals, highlighting their clinical utility in risk assessment for this population. [ABSTRACT FROM AUTHOR]

Background: Erectile dysfunction (ED) can stem from various organic and functional causes but is often linked to vascular health and cardiovascular disease. Limited data exist on how cardiovascular disease markers correlate with objective ED tests like the Nocturnal Penile Tumescence and Rigidity (NPTR) test and Penile Color Doppler Ultrasound (PCDU). Methods: A prospective observational study was performed, and 58 men with ED were assessed using the International Index of Erectile Function-15 (IIEF-15), NPTR test, and PCDU. Peripheral vascular health was evaluated through carotid intima-media thickness (cIMT) and brachial flow-mediated dilation (FMD). Results: Out of the participants, 44 had normal NPTR results, while 14 had abnormal results. The group with abnormal NPTR results was significantly older and had higher rates of hypertension and diabetes. Although the IIEF-15 scores were similar between the two groups, those with abnormal NPTR results had a lower peak systolic velocity (PSV) and a higher prevalence of impaired PSV. Correlations between the IIEF, NPTR, PCDU, and peripheral vascular markers lost significance after the age adjustment. Conclusions: This study suggests that abnormal NPTR results, combined with cardiovascular risk factors, may signal vascular ED and generalized vasculopathy, highlighting the need for cardiovascular assessment. An accurate ED diagnosis should integrate clinical evaluation with multiple tests while considering aging as a key risk factor. [ABSTRACT FROM AUTHOR]

Cardiovascular disease is associated with increased fracture risk in the general population. Few data exist on the association between cardiovascular health and incident fracture risk in patients with advanced CKD, a high-risk population for fractures. We aimed to assess the link between fracture risk and cardiovascular health in a prospective cohort of 210 patients with CKD stage G4–5. Incident fractures were recorded during a prospective follow-up of 5 years. Laboratory parameters, abdominal aortic calcification score, echocardiography, ultrasound assessment of brachial artery flow-mediated dilatation and carotid intima-media thickness, and maximal stress ergometry were obtained at baseline. A total of 51 fractures were observed in 40 (19%) patients during follow-up. In separate multivariable Cox proportional hazards models adjusted for age, gender, and baseline eGFR, TnT (HR 1.007, CI 95% 1.003–1.010, p < 0.001) and ProBNP (HR 1.000, CI 95% 1.000–1.000, p = 0.017) were associated with incident fractures and the association persisted after adjusting for coronary artery disease (CAD). The patients unable to perform the ergometry test had a higher risk of incident fractures compared to others (36.1% vs 15.5%, p = 0.009). A cardiovascular composite risk score summarizing TnT, ProBNP, and ergometry data was independently associated with incident fractures in a multivariable Cox model (HR 1.373, CI 95% 1.180–1.599, p < 0.001). Patients with the lowest score were observed with no fractures, while patients with the highest score were observed with a fracture risk of 40.5% during follow-up. Risk of incident fractures is associated with biomarkers of cardiovascular health and a composite cardiovascular risk score in patients with advanced CKD. [ABSTRACT FROM AUTHOR]

Background : In view of the conflicting results from previous studies, the benefit of paclitaxel-coated balloons for arteriovenous fistulas is uncertain and equipoise remains. Although an industry-led trial testing the efficacy of sirolimus-coated balloons in AVFs is in progress, the benefit of sirolimus-coated balloons for arteriovenous fistulas is currently unknown. The purpose of this trial is to compare the efficacy of additional paclitaxel-coated or sirolimus-coated balloons on outcomes after a plain balloon fistuloplasty to preserve the patency of arteriovenous fistulae used for haemodialysis. Methods: The study design is a multicentre randomised controlled trial. Following a successful plain balloon fistuloplasty, participants will be randomised to further treatment with a paclitaxel-coated balloon, a sirolimus-coated balloon, or an uncoated control balloon. We will recruit 642 patients, each with one or two treatment segments, over a 3-year period. Patients will remain in the trial and be followed up for 1 year. The primary endpoint is time to loss of treatment segment primary patency. Cox-proportional hazards models will be used to estimate hazard ratios for the time to loss of treatment segment primary patency for each treatment group relative to the control group. Analysis of the primary endpoint will be based on treatment segments rather than participants and a shared frailty will be estimated to account for the clustering of treatment segments within patients. Secondary endpoints are time to loss of primary patency at any treatment segment; time to end of access circuit primary patency; time to AVF abandonment; number of radiological or surgical interventions; adverse events; intima-media thickness and degree of stenosis at 3 months on ultrasound; and patient quality of life assessed by EQ-5D-5L and VASQoL. Discussion: The three-armed design in this proposal will provide an answer on the efficacy of both paclitaxel- and sirolimus-coated balloons in the same trial. This trial is likely to provide a clear answer regarding the efficacy of drug-coated balloons for arteriovenous fistulas. Trial registration: ISRCTN ISRCTN40182296. Registered on 4 August 2023. [ABSTRACT FROM AUTHOR]

Background : It becomes clearer that migraine is associated with vascular risks; however, preclinical vascular involvement is not sufficiently addressed. Evidences point that migraine attacks affect vascular endothelium. The aim of this study was to investigate endothelial dysfunction in migraineurs through assessment of carotid intima-media thickness (CIMT) and flow-mediated dilatation (FMD) of the brachial artery and their correlation with clinical characteristics of migraine, headache severity, and brain magnetic resonance imaging (MRI) findings. Results: A statistically significant difference was found between migraineurs and controls where carotid IMT was significantly higher and FMD of the brachial artery was significantly lower in migraineurs compared to controls. Carotid IMT was significantly higher and FMD was significantly lower in chronic migraine compared to episodic migraine patients. Mean IMT values were significantly higher in patients receiving ergots and in patients with subcortical white matter lesions in brain MRI. Mean FMD values were significantly lower in patients receiving ergots. There was a significant negative correlation between FMD and carotid IMT, age of the patients, disease duration, duration of headache attacks, headache frequency, and migraine disability assessment questionnaire (MIDAS) score. There were significant positive correlations between carotid IMT and age of patients, disease duration, headache frequency, MIDAS score, and number of MRI white matter lesions. For diagnosing endothelial dysfunction in migraineurs, the sensitivity and specificity of IMT were 72.5 and 70%, respectively, with a cut-off value of 0.575 mm and that of FMD were 82.5 and 90%, respectively, with a cut-off value of 20.55%. Conclusion: Migraine coincides with endothelial dysfunction which promotes atherogenesis and increased risk of cerebral ischemia. FMD could be used as a potential biomarker for endothelial dysfunction in migraine. The affection of IMT and FMD is more in patients receiving ergots which may influence the selection of treatment in migraineurs in the future. [ABSTRACT FROM AUTHOR]

Background: Carotid intima-media thickness (cIMT) is a measure of atherosclerotic vascular disease and a surrogate biomarker for cardiovascular risk in patients with chronic kidney disease (CKD). Mineral and bone disorders (MBD) are complications of CKD, contributing to vascular calcification and accelerated atherosclerosis. Increased fibroblast growth factor 23 (FGF23)—the earliest detectable serum abnormality associated with CKD-MBD—has been linked with cardiovascular disease in patients with CKD. This study aimed to identify factors and analyze the relationship associated with high cIMT, high FGF23, and poor MBD control in children with CKD. Methods: A cross-sectional study was conducted in Yogyakarta, Indonesia recruiting children with CKD. The correlations and factors between cIMT, FGF23, and MBD were explored. Results: We recruited 42 children aged 2–18 years old with CKD stages 2 to 5D. There were no significant correlations between cIMT and factors including advanced CKD, use of dialysis, body mass index, hypertension, anemia, MBD, FGF23 levels, and left ventricular mass index (LVMI). Patients with advanced CKD had poorly controlled anemia, hypertension, and higher LVMI. In multivariate analysis, CKD stages, hypertension stages, the presence of MBD, and LVMI were associated with FGF23 levels (p < 0.05). Conclusions: FGF23 levels increased with CKD progression, and MBD was more prevalent in advanced kidney disease. Elevated FGF23 is potentially associated with increased MBD prevalence in late-stage CKD. A larger study is needed to confirm the factors affecting cIMT in children with CKD. [ABSTRACT FROM AUTHOR]

Vascular aging encompasses structural and functional changes in the vasculature, significantly contributing to cardiovascular diseases, which are the leading cause of death globally. The incidence and prevalence of these diseases increase with age, with most morbidity and mortality attributed to myocardial infarction and stroke. Diagnosing and intervening in vascular aging while understanding the mechanisms behind age-induced vascular phenotypic and pathophysiological alterations offers the potential for delaying and preventing cardiovascular mortality in an aging population. This review delves into various aspects of vascular aging by examining age-related changes in arterial health at the cellular level, including endothelial dysfunction, cellular senescence, and vascular smooth muscle cell transdifferentiation, as well as at the structural level, including arterial stiffness and changes in wall thickness and diameter. We also explore aging-related changes in perivascular adipose tissue deposition, arterial collateralization, and calcification, providing insights into the physiological and pathological implications. Overall, aging induces phenotypic changes that augment the vascular system's susceptibility to disease, even in the absence of traditional risk factors, such as hypertension, diabetes, obesity, and smoking. Overall, age-related modifications in cellular phenotype and molecular homeostasis increase the vulnerability of the arterial vasculature to structural and functional alterations, thereby accelerating cardiovascular risk. Increasing our understanding of these modifications is crucial for success in delaying or preventing cardiovascular diseases. Non-invasive techniques, such as measuring carotid intima-media thickness, pulse wave velocity, and flow-mediated dilation, as well as detecting vascular calcifications, can be used for the early detection of vascular aging. Targeting specific pathological mechanisms, such as cellular senescence and enhancing angiogenesis, holds promise for innovative therapeutic approaches. [ABSTRACT FROM AUTHOR]

Objective: We aimed to evaluate cardiovascular risks and influencing factors by measuring aortic elasticity parameters and carotid intima thickness in children with cronic kidney disease (CKD), and also evaluated the hydration status of patients with bioimpedance spectroscopy (BIS) measurements and investigated the effect of hydration status on vascular functions. Patients and Methods: The study group included an average of 13.3 ± 3.7 years (16 girls and 22 boys, 38 CKD patients), control group on average 12.1 ± 2.9 (16 girls and 15 boys, 31 healthy children). Systolic and diastolic diameters of the aortic annulus and aorta at each level were obtained; z-scores, aortic strain, distensibility, stiffness index were calculated. Carotid intima-media thickness and flow -- mediated dilatation were studied. Bioimpedance spectroscopy was performed to all patients. Results: Interventricular septum and left atrial (p=0.002, p=0.013), sinus valsalva and sinotubular junction z scores (p=0.009, p=0.012) were found to be higher and distensibility and strain decreased, stiffness index increased in the abdominal aorta of patients with CKD (p=0.007, p=0.002, p=0.004). Patients with CKD had statistically significant over-hydration. Conclusion: Vascular wall changes that affect the elastic properties of the aortic wall begin to develop in childhood in patients with CKD. [ABSTRACT FROM AUTHOR]

Objective: Cardiovascular diseases are the main causes of mortality in the anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) patients. Carotid intima-media thickness (CIMT) measurement and pulse wave velocity (PWV) were performed to determine atherosclerosis and arterial stiffness as cardiovascular risk markers. Patients and Methods: The data of 31 patients with AAV were compared with 21 healthy controls. Demographic and laboratory findings were recorded. Results: Seventeen patients (54.8%) were male. Mean age was 52.6±11.5 years. CIMT was higher in the patient group [0.74 (0.65 -- 0.84) vs 0.63 (0.57-0.74) mm; p=0.048]. PWV [7.9 (6.7-9.3) vs 7.8 (6.8-8.5) m/s; p=0.295] and augmentation index (AI) [22.5 (11.0-30.0) vs. 23 (9.5-30.5) mm/Hg, p=0.801] were similar in both groups. CIMT was correlated with age (r: 0.538, p<0.001) and PWV (r: 0.554 p< 0.001) while there was no correlation with AI (r: 0.047, p= 0.764). Conclusion: The present study showed that CIMT is significantly increased and correlated with age and PWV in patients with AAV compared to controls. CIMT can be used as a screening tool as part of patient follow-up to identify patients at cardiac risk. [ABSTRACT FROM AUTHOR]

Background: Primary hypertension (HT) has a high mortality rate due to its atherosclerotic complications. Vitamin D (VD) deficiency has been reported to increase the development of non-dipper HT (ND-HT) and atherosclerosis, but there are also conflicting results. To our knowledge, there is no study investigating the relationship between VD and carotid artery intima-media thickness (C-IMT) in patients with HT. Therefore, we aimed to investigate the relationship between VD levels, ND-HT development, and C-IMT in patients with HT with no known cardiovascular disease (CVD). Methods: This study was conducted in 60 (63% female) patients with HT. Ambulatory blood pressure monitoring was performed using a portable digital recording device. C-IMT was measured using B-mode ultrasonography. Vitamin D levels were measured using elect roche milum inesc ence immunoassay. Those with C-IMT =0.750 mm were assumed to have subclinical atherosclerosis, and serum 25-(OH) D3 (VD) levels <20 ng/mL were VD deficient. Results: There was a significant negative linear relationship between VD levels and triglycerides (TG) and smoking, and a significant positive linear relationship between high-density lipoprotein cholesterol levels. Triglyceride levels were significantly (P = .015) higher in patients who were VD deficient compared to those who were VD sufficient. Patients with subclinical atherosclerosis were older (P = .002) than those without. Only patient age was positively associated with C-IMT (P < .001). There was no relationship between VD levels/VD deficiency and the presence of ND-HT and subclinical atherosclerosis. Conclusion: Our findings suggest that VD deficiency does not facilitate the development of ND-HT and subclinical atherosclerosis. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Vessel‐wall volume and localized three‐dimensional ultrasound (3DUS) metrics are sensitive to the change of carotid atherosclerosis in response to medical/dietary interventions. Manual segmentation of the media‐adventitia boundary (MAB) and lumen‐intima boundary (LIB) required to obtain these metrics is time‐consuming and prone to observer variability. Although supervised deep‐learning segmentation models have been proposed, training of these models requires a sizeable manually segmented training set, making larger clinical studies prohibitive. Purpose: We aim to develop a method to optimize pre‐trained segmentation models without requiring manual segmentation to supervise the fine‐tuning process. Methods: We developed an adversarial framework called the unsupervised shape‐and‐texture generative adversarial network (USTGAN) to fine‐tune a convolutional neural network (CNN) pre‐trained on a source dataset for accurate segmentation of a target dataset. The network integrates a novel texture‐based discriminator with a shape‐based discriminator, which together provide feedback for the CNN to segment the target images in a similar way as the source images. The texture‐based discriminator increases the accuracy of the CNN in locating the artery, thereby lowering the number of failed segmentations. Failed segmentation was further reduced by a self‐checking mechanism to flag longitudinal discontinuity of the artery and by self‐correction strategies involving surface interpolation followed by a case‐specific tuning of the CNN. The U‐Net was pre‐trained by the source dataset involving 224 3DUS volumes with 136, 44, and 44 volumes in the training, validation and testing sets. The training of USTGAN involved the same training group of 136 volumes in the source dataset and 533 volumes in the target dataset. No segmented boundaries for the target cohort were available for training USTGAN. The validation and testing of USTGAN involved 118 and 104 volumes from the target cohort, respectively. The segmentation accuracy was quantified by Dice Similarity Coefficient (DSC), and incorrect localization rate (ILR). Tukey's Honestly Significant Difference multiple comparison test was employed to quantify the difference of DSCs between models and settings, where p≤0.05$p\,\le \,0.05$ was considered statistically significant. Results: USTGAN attained a DSC of 85.7±13.0$85.7\,\pm \,13.0$% in LIB and 86.2±10.6${86.2}\,\pm \,{10.6}$% in MAB, improving from the baseline performance of 74.6±30.7${74.6}\,\pm \,{30.7}$% in LIB (p<10−12$<10^{-12}$) and 75.7±28.9${75.7}\,\pm \,{28.9}$% in MAB (p<10−12$<10^{-12}$). Our approach outperformed six state‐of‐the‐art domain‐adaptation models (MAB: p≤3.63×10−7$p \le 3.63\,\times \,10^{-7}$, LIB: p≤9.34×10−8$p\,\le \,9.34\,\times \,10^{-8}$). The proposed USTGAN also had the lowest ILR among the methods compared (LIB: 2.5%, MAB: 1.7%). Conclusion: Our framework improves segmentation generalizability, thereby facilitating efficient carotid disease monitoring in multicenter trials and in clinics with less expertise in 3DUS imaging. [ABSTRACT FROM AUTHOR]

While carotid intima-media thickness (cIMT) as a noninvasive surrogate measure of atherosclerosis is widely considered a risk factor for stroke, the intrinsic link underlying cIMT and stroke has not been fully understood. We aimed to evaluate the clinical value of cIMT in stroke through the investigation of phenotypic and genetic relationships between cIMT and stroke. We evaluated phenotypic associations using observational data from UK Biobank (N = 21,526). We then investigated genetic relationships leveraging genomic data conducted in predominantly European ancestry for cIMT (N = 45,185) and any stroke (AS, Ncase/Ncontrol=40,585/406,111). Observational analyses suggested an increased hazard of stroke per one standard deviation increase in cIMT (cIMTmax-AS: hazard ratio (HR) = 1.39, 95%CI = 1.09–1.79; cIMTmean-AS: HR = 1.39, 95%CI = 1.09–1.78; cIMTmin-AS: HR = 1.32, 95%CI = 1.04–1.68). A positive global genetic correlation was observed (cIMTmax-AS: =0.23, P=9.44 × 10−5; cIMTmean-AS: =0.21, P=3.00 × 10−4; cIMTmin-AS: =0.16, P=6.30 × 10−3). This was further substantiated by five shared independent loci and 15 shared expression-trait associations. Mendelian randomization analyses suggested no causal effect of cIMT on stroke (cIMTmax-AS: odds ratio (OR)=1.12, 95%CI=0.97–1.28; cIMTmean-AS: OR=1.09, 95%CI=0.93–1.26; cIMTmin-AS: OR=1.03, 95%CI = 0.90–1.17). A putative association was observed for genetically predicted stroke on cIMT (AS-cIMTmax: beta=0.07, 95%CI = 0.01–0.13; AS-cIMTmean: beta=0.08, 95%CI = 0.01–0.15; AS-cIMTmin: beta = 0.08, 95%CI = 0.01–0.16) in the reverse direction MR, which attenuated to non-significant in sensitivity analysis. Our work does not find evidence supporting causal associations between cIMT and stroke. The pronounced cIMT-stroke association is intrinsic, and mostly attributed to shared genetic components. The clinical value of cIMT as a surrogate marker for stroke risk in the general population is likely limited. [ABSTRACT FROM AUTHOR]

Background: Coronary artery calcium score (CACS) and carotid intima-media thickness (CIMT) are important markers for early detection of coronary atherosclerosis. The study aimed to investigate the relationship between the CIMT and the CACS as markers for atherosclerotic coronary artery disease (CAD). Methods: This single-center prospective study enrolled 41 cases with suspected CAD. The cases underwent carotid artery US and CA noncontrast CT (NCCT). A radiologist with eight years of experience in vascular US imaging performed the carotid artery US, while two radiologists with ten years of experience in cardiac imaging analyzed the coronary artery CT images and assigned a CAC-DRS category for each case. We used the Pearson correlation test to calculate the correlation between CIMT and CACS. The receiver operating characteristics (ROC) curve was used to estimate the best cutoff value of CIMT in predicting CA heavy calcification. Results: The study included 41 cases of suspected CAD, of which 12-showed heavy, and 29 showed non-heavy CA calcification. The mean CACS was 163, and the highest CIMT was 0.785 mm among the included patients. There was a significant positive correlation between the CACS and the highest CIMT (r 0.606 and P <0.001). A CIMT > 0.8 mm was the best cutoff for predicting heavy calcification, with a sensitivity of 91.7%, a specificity of 65.5%, and an accuracy of 73.2% based on ROC curve analysis. Conclusions: CIMT and CACS can be considered non-invasive predictive measures for CA atherosclerosis and subsequent CAD. Moreover, these markers might help cardiologists in clinical management. [ABSTRACT FROM AUTHOR]

Background: Transgender men use exogenous androgen for male pattern virilization. Hysterectomy and bilateral salpingo-oophorectomy (HBSO) is performed to stop the endogenous estrogen secretion. Cardiovascular disease (CVD) risk has been shown to increase with long-term use of androgens and the removal of estrogen. We aimed to investigate the CVD risk in these individuals by measuring internal and common carotid artery intima–media thicknesses (CIMT). Methods: In this cohort study, data were collected from transgender men who had undergone HBSO and used androgens for at least two years (median treatment duration was 5 years in our research). Cisgender women in the same age range were selected as the control group. Demographics, vital signs, and hematological values of transgender patients and cisgender women subjects in the control group were noted. CVD markers were compared with sonographically measured CIMT values. Results: The mean age and body mass index (BMI) of the study group were 32.6 and 25.3, respectively. Weight, systolic–diastolic blood pressure, hemoglobin, hematocrit, low-density lipoprotein (LDL), serum triglyceride (TG), HbA1c levels, internal CIMT, and common CIMT values of the study group were higher, while the high-density lipoprotein (HDL) level was significantly lower compared the control group (p1 = 0.025, p2 = 0.010, p3 = 0.002, p4 = 0.001, p5 = 0.001, p6 = 0.012, p7 = 0.008, p8 = 0.007, p9 = 0.013, and p10 = 0.001). There was also an increase in the body weight, BMI, LDL, and TG levels of the study group after the testosterone treatment (p1 = 0.025, p2 = 0.019, p3 = 0.001, p4 = 0.001, and p5 = 0.001). Conclusions: We demonstrated that the use of testosterone therapy in transgender men is associated with higher CIMT values. While further investigation is needed to assess morbidity and mortality rates, we recommend that regular clinical and radiological examinations be performed in these individuals to accurately evaluate the risk of CVD. [ABSTRACT FROM AUTHOR]

Purpose: Erectile dysfunction (ED) is associated with several vascular disorders, but the associations between ED and vascular parameters are still unclear. Materials and Methods: We analyzed and synthesized a comprehensive range of studies from PubMed, Web of Science, and Scopus regarding the associations between ED and the following measures: ankle-brachial index (ABI), pulse wave velocity (PWV), intima-media thickness (IMT), nitrate-mediated dilation (NMD), flow-mediated dilation (FMD), augmentation index (AI), endothelial progenitor cells (EPCs) and other vascular parameters. Subgroup analysis was conducted according to specific types of parameters. Study quality was assessed by using the Newcastle–Ottawa Scale. Sensitivity analysis was conducted to confirm the robustness of the pooled results. Results: Fifty-seven studies with 7,312 individuals were included. Twenty-eight studies were considered to be high-quality. ED patients had a 0.11 mm higher IMT (95% confidence interval [CI]: 0.07, 0.15), a 2.86% lower FMD (95% CI: -3.56, -2.17), a 2.34% lower NMD (95% CI: -3.37, -1.31), a 2.83% higher AI (95% CI: 0.02, 5.63), a 1.11 m/s higher PWV (95% CI: 0.01, 2.21), and a 0.72% lower percentage of EPCs (95% CI: -1.19, -0.24) compared to those without ED. However, ABI was similar between ED patients and non-ED individuals. According to sensitivity analysis, the pooled results were robust. Conclusions: Our study confirmed the associations between ED and several vascular parameters and highlighted the importance of prevention and management of vascular and endothelial dysfunction in ED patients. [ABSTRACT FROM AUTHOR]

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]

Vitamin D deficiency is a common cause of secondary hyperparathyroidism, particularly in elderly people. The aim of this study was to evaluate the associations of serum vitamin D and parathormone (PTH) concentrations with blood pressure values and hypertension-mediated target organ damage (HMOD), including left ventricular (LV) hypertrophy and carotid plaque (CP). We enrolled consecutive patients admitted to the Hypertension Center of Federico II University Hospital in Naples, Italy. All patients underwent carotid doppler ultrasound and echocardiography, measurement of vitamin D and PTH levels and main clinical and laboratory parameters. A total of 126 patients (mean age 54 years, 68% males) were enrolled. Pearson's correlation analysis indicated that PTH levels directly correlated with age, diabetes, dyslipidemia, hypertension, fasting glucose, and LV mass, and inversely with glomerular filtration rate, LDL cholesterol, and vitamin D. Vitamin D levels correlated inversely with PTH, diabetes and CP. Multivariate regression models indicated that an increased LV mass was associated with the presence of obesity (β = 0.342; P = 0.001). Maximal intima-media thickness was significantly associated with older age (β = 0.303; P = 0.033). Combined presence of low vitamin D/high PTH levels were associated with more than 4-fold increased risk of having CP in both univariate (OR = 4.77, p = 0.0001) and multivariate regression analysis (OR = 4.52, p = 0.014). In a population at high cardiovascular risk, vitamin D and PTH levels were not directly associated with blood pressure values and HMOD. Secondary hyperparathyroidism due to vitamin D deficiency is associated with carotid atherosclerosis independently of other common cardiovascular risk factors. • Vitamin D deficiency and Parathormone (PTH) excess are common findings in general population. • PTH affects glucose metabolism and PTH level was associated with higher fasting glucose. • Vitamin D and PTH are not directly associated with hypertension and related target organ damage. • Secondary hyperparathyroidism due to vitamin D deficiency is associate with carotid atherosclerosis. [ABSTRACT FROM AUTHOR]

Objective: To assess the clinical utility of ultrasound in predicting the risk of carotid vulnerable plaque rupture using pathological intraplaque hemorrhage as the gold standard. Methods: A total of 118 patients who underwent endarterectomy due to symptomatic carotid artery stenosis were enrolled. Conventional ultrasound assessed the plaque thickness, area stenosis rate, echo, and surface morphology. Neovascularization were assessed by contrast‐enhanced ultrasound (CEUS) and tracing intraplaque nonenhanced areas. According to neovascularization grade (0–4), plaques were classified as low‐, intermediate‐, and high risk. Fresh intraplaque hemorrhage within the pathology was adopted as the gold standard for diagnosing plaque rupture risk. Thus, we divided patients into ruptured risk and nonruptured risk groups to assess the value of crucial factors for plaque rupture risk using ultrasound. Results: Of the 118 patients, hypertension accounted for 71.2%, hyperlipidemia 68.6%, diabetes 52.5%, and statin history 64.4%. In the rupture risk group, diabetes, smoking, and stenosis rate were significantly higher than the nonrupture risk group (P <.001); plaque thickness ≥4 mm (P >.05); and mainly hypoechoic with irregular surface morphology (P <.001), nonenhanced areas in the plaques (P <.001), and neovascularization >grade 2 (P <.001). Compared with the low‐risk group, plaque rupture risk was 7.219 times higher in the medium‐risk group and 18.333 times higher in the high‐risk group. The kappa value of the interobserver consistency of crucial ultrasound parameters was >0.75, and the intraclass correlation coefficient was 0.919 (P <.01). Conclusions: Both conventional ultrasound and CEUS have significant clinical importance in the prediction of rupture risk in vulnerable carotid plaques, thereby enabling stroke risk stratification and the assessment of plaque rupture risk. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to extract carotid wall vibrations non-invasively and evaluate changes in the carotid artery caused by age, BMI, and sex. Such evaluation can increase the possibility of detecting wall stiffness and atherosclerosis in the early stages and prevent heart attack and death. Materials and Methods: To extract small vibrations of the carotid wall, the image-tracking method, and optical flow with four different methods were used. The study involved twenty participants, comprising six females and fourteen males, with a mean age of 36.25 years, mean weight of 75.2 Kg, and mean BMI of 25. The posterior wall motion and vibration were extracted using ultrasound RF signals. Results: 4 optical flow methods, Gunnar-Farneback, Horn-Schunk, Lucas-Kanade, and Lucas-Kanade derivative were used for all samples, and covariance, correlation, P-value, and R-squared were estimated. Results showed the differences in parameters such as age and BMI with carotid wall vibration. These values for age are (Cov = -0.1891, Corr = -0.6770, P-value < 0.001, r2 = -0.4590) and for BMI are (Cov = -0.0564, Corr = -0.6510, P-value < 0.001, r2 = 0.4238), respectively. For gender as a new parameter, a comparison between men's and women's vibrations was estimated. The range of measured vibrations by optical flow methods is about 0.0002 µm to 0.1µm, and the mean standard deviation is 0.04967 µm. Conclusion: The results presented that gender affects the vibration of the vessel wall, which in men is more than in women. In addition, increasing age and BMI may increase the stiffness of the carotid wall and reduce vibrations that were evaluated previously. Using the Gunner-Farneback method as image tracking for small vibrations is the best way with the highest accuracy. [ABSTRACT FROM AUTHOR]

Purpose: Restless legs syndrome is claimed to be associated with a higher risk of cardiovascular diseases. Intimamedia thickness has been reported to be the most valuable surrogate marker and predictor of atherosclerosis progression and upcoming cardiovascular diseases. In this study, we aimed to evaluate the relationship between restless legs syndrome and intima-media thickness of the carotid artery. Materials and Methods: In this case-control study, a total of 23 patients with restless legs syndrome without other known risk factors of cardiovascular diseases were evaluated with regard to the intima-media thickness of the carotid artery by employing a high-resolution B-mode ultrasound study. The findings of the ultrasound study between the case and the control group were compared and statistically analyzed. Results: Intima-media thickness was revealed to be of a lower value in subjects with restless legs syndrome (0.79 ± 0.10) compared to the control group (0.88 ± 0.13). Also, our study showed that older age and the presence of hypertension directly correlates with intima-media thickness. Conclusion: It can be concluded that restless legs syndrome is associated with a lower intima-media thickness. [ABSTRACT FROM AUTHOR]

Background and objectives: Metabolic-associated fatty liver disease (MAFLD) may increase the risk of cardiovascular events. In this study, we assessed the predictive value of pentraxin 3 (PTX3) for severe fibrosis and carotid intima-media thickness (CIMT) in patients with MAFLD. Methods: 188 patients (114 with MAFLD, 74 with dual etiology MAFLD and chronic hepatitis C) were included. All participants underwent clinical history and examination, metabolic parameter assessment, serum level evaluation of PTX3, Fibrosis-4 index and nafld fibrosis score scores, abdominal ultrasound, and CIMT assessment. Results: The serum PTX3 was significantly elevated in patients with advanced fibrosis compared to those with mild/moderate fibrosis (1.8 vs 1.4, p = 0.006). The PTX3 level was independently associated with advanced fibrosis (odds ratio = 1.26, 95% confidence interval 1.008-1.040). In MAFLD patients, the PTX3 levels in patients with low fibrosis compared to those with advanced fibrosis were 1.4 (1-2.1) and 1.9 (1.3-3.8), respectively (p = 0.027). A significantly greater CIMT was noted in patients with elevated PTX3 levels (3.85 (3.42-4) vs 4.05 (3.7-4.67), p = 0.0001) compared to those with low PTX3 levels. Conclusions: Serum PTX3 levels can accurately predict advanced fibrosis and CIMT in MAFLD patients. Thus, it could be useful for management and risk stratification. [ABSTRACT FROM AUTHOR]

Abstract Background The objective of this cohort study was to assess the predictive value of main arterial markers for cardiovascular death in middle-aged subjects with metabolic syndrome (MetS). Methods This prospective longitudinal study analyzed data from 5829 metabolic syndrome subjects without overt cardiovascular disease aged between 40 and 64 years and enrolled in the Lithuanian High Cardiovascular Risk primary prevention program. Initial assessment comprised the evaluation of aortic pulse wave velocity (aPWV), carotid intima-media thickness (cIMT), carotid stiffness index, cardio-ankle vascular index (CAVI), ankle-brachial index (ABI), aortic augmentation index adjusted for a heart rate of 75 bpm (AIXHR75), and endothelium-dependent flow-mediated dilatation (FMD). Results During the mean follow-up period of 6.35 ± 2.99 years, 170 subjects (2.9%) had died, with 41 out of these deaths (24.1%) related to cardiovascular causes. Cox proportional hazard regression analysis revealed associations between cardiovascular deaths and increases in aPWV (HR 1.34, 95% CI 1.14–1.58, p

Background: Coronary artery disease (CAD) prevalence in young individuals is rising, particularly in South Asian populations. Carotid artery hemodynamic parameters and their relation with CAD have not been studied much in young patients. Aims and Objectives: The aim of the study was to study the relationship between Carotid artery hemodynamic parameters, and CAD severity in young patients. Materials and Methods: A cross-sectional and single-center study was conducted involving consecutive patients undergoing coronary angiography due to acute coronary syndrome and aged under 40. Carotid ultrasonography and Doppler were performed to assess Carotid artery hemodynamic parameters. Gensini and SYNTAX scores were used to evaluate the severity and complexity of CAD. A total of 136 patients were included in the study. Results: The mean age was 36.24±4.030 years, with 92 males. CAD patients demonstrated significantly increased carotid intima-media thickness (CIMT) (0.730±0.157 vs. 0.488±0.09; P

Purpose: To evaluate the long-term effect of body composition, physical activity, and cardiorespiratory fitness (CRF) from puberty on arterial health in late adolescent males. Methods: The cumulative burden of physical activity (measured with accelerometer), CRF (VO2peak0.82), and body composition (body mass index, fat mass, and fat percentage) from puberty to late adolescence (sum of 4 time points from 12 to 18 y) was assessed in 102 males. Additional analysis on the first (T1) and last (T4) time points was performed. Intima-media thickness (IMT), carotid-femoral pulse wave velocity, and augmentation index adjusted to heart rate of 75 beats per minute (bpm) as dependent variables were measured at T4 and analyzed in multivariable regression models adjusted for known risk factors including maturation, blood pressure, and smoking habits. Results: T1 and cumulative body composition measures were independently associated with IMT, while cumulative (β = −0.011, P =.036) and T4 (β = −0.0.031, P =.001) CRF revealed independent associations with IMT. Individuals with moderate to vigorous physical activity >60 minutes per day at T1 showed relationship (β = −1.091, P =.026) with IMT independently of late adolescent physical activity. No significant relationship was present for arterial function. Conclusion: Arterial structure in adolescent males is associated with physical activity at 12 years while relationship with CRF can be seen in late adolescence and cumulatively from puberty to late adolescence. [ABSTRACT FROM AUTHOR]

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

Abstract 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

Background: Hashimoto thyroiditis (HT) is associated with myocardial dysfunction, it is attributed to the autoimmune chronic inflammation and other endocrine factors. Aim of the work: Detection of subclinical myocardial dysfunction in children with euthyroid Hashimoto thyroiditis using speckle tracking echocardiography and estimation of carotid intima- media thickness. Patients and Methods: We performed a case-control cross-sectional study that involved 15 children with euthyroid HT following up at the Endocrinology Clinic, Ain Shams University Children’s Hospital from October 2020 to July 2021 and 15 healthy controls of comparable age and sex. Both groups underwent conventional and speckle tracking echocardiography in addition to estimation of carotid intima-media thickness by high resolution ultrasound machine. Results: The children with euthyroid HT had a mean ± SD age of 13.20 ± 3.05 years, while that of the control group was 11.80 ± 3.03 years (p=0.21). Twelve (80%) of the children with HT and 11(73%) of the control group were females (p=0.66). The mean ± SD for serum-free T3, free T4 and thyroid stimulating hormone (TSH) were 3.57 ± 1.07, 1.43 ± 0.76 ng/dl, and 4.03 ± 2.27 IU/ml in patients, and were 3.59±9.21 pg/ml, 1.29±0.15 ng/dl and 3.4 ±0.3 IU/ml in control group (p = 0.474), (p=0.249) and (p=0.316) respectively. The mean (range) left ventricular global longitudinal strain of the cases and control group were within the normal range (-20.44± 1.24) (- 23 to -17.4) and (-20.94± 0.59) (-21.8 to -19.5) respectively) (p= 0.159). The mean carotid intima- media thickness was normal in both cases (0.35 ±0.05 cm) and controls (0.33 ±0.05 cm) (p = 0.47). Conclusion: Euthyroid state seems to protect against subclinical myocardial dysfunction in Hashimoto thyroiditis.

Abstract 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.

Objectives: To evaluate the intima-media thickness (IMT) and elasticity of the carotid artery in non-obese polycystic ovary syndrome (PCOS) patients using a quantitative technique for vascular elasticity measurement and to explore the influencing factors. Methods: Sixty non-obese patients without metabolic and cardiovascular diseases who were diagnosed with PCOS in the Women and Children's Hospital of Chongqing Medical University from January to December 2022 were prospectively selected (case group), and 60 healthy volunteers matched for body mass index were included as the control group. Body weight, height, heart rate, blood pressure, and waist-to-hip ratio were recorded. Fasting blood samples were drawn from the elbow vein to measure hormone levels including total testosterone (TT), sex hormone-binding globulin (SHBG), fasting plasma glucose (FPG), fasting insulin (FINS), lipids, and homocysteine (Hcy). The insulin resistance index (HOMA-IR) and free androgen index (FAI) were calculated. Ultrasound elastography was used to measure the IMT and elastic function parameters of the right carotid artery, including vessel diameter, wall displacement, stiffness coefficient, and pulse wave velocity. Differences in various parameters between the two groups were analyzed, and correlations between the carotid stiffness coefficient and other serological indicators were assessed using Spearman correlation analysis. Results: No significant differences in age, body mass index, heart rate, systolic blood pressure, and diastolic blood pressure were observed between the two groups (all P>0.05), while the waist-to-hip ratio (WHR) was higher in the case group than in the control group (P<0.05).The hormone level serological indicators TT and FAI were higher in the case group than in the control group, and SHBG was lower in the case group than in the control group (all P<0.05). The metabolism-related serum indicators LDL-C, HDL-C, FPG, triglycerides, and total cholesterol levels were not statistically different between the two groups (all P>0.05), and serum FINS, HOMA-IR, and Hcy levels were significantly higher in the case group than in the control group (all P<0.05).No significant difference in carotid artery diameter was observed between the case group and control group (P>0.05). The carotid artery displacement in the case group was significantly smaller than that in the control group (P<0.05), and carotid IMT, hardness coefficient, and pulse wave propagation velocity were greater in the case group than in the control group (all P<0.05). The carotid elastic stiffness coefficient was positively correlated with WHR, TT, SHBG, FAI, FINS, HOMA-IR and Hcy to varying extents and negatively correlated with SHBG. Conclusion: In non-obese PCOS patients with no metabolic or cardiovascular disease, the carotid stiffness coefficient was increased and correlated with indicators of hyperandrogenism, insulin resistance, and hyperhomocysteinemia. [ABSTRACT FROM AUTHOR]

Background/Objectives: Numerous risk factors associated with development of cardiovascular disease (CVD) have been unfavorably altered in patients with chronic kidney disease (CKD). Low omega-3 polyunsaturated fatty acid (PUFA) intake and vitamin D deficiency are potential cardiometabolic risk factors in patients with CKD. The aim of this study was to evaluate dietary intake and status of omega-3 PUFA and vitamin D in pre-dialysis and hemodialysis patients and to examine the association of dietary α-linolenic acid (ALA) and fish consumption with blood pressure and carotid intima–media thickness (C-IMT), representing a non-invasive marker of atherosclerosis in CKD patients. Methods: All 77 selected patients (36 pre-dialysis, 41 on hemodialysis) underwent standardized clinical, nutritional, and laboratory assessments. Repeated 24 h recalls were performed to assess dietary intake. The fatty acid profile was determined by gas–liquid chromatography. Results: Inadequate vitamin D intake and vitamin D status were found in 95% of patients. PUFA profiles did not differ between hemodialysis and pre-dialysis participants. Dietary intake of ALA was negatively correlated with systolic blood pressure (SBP) (p = 0.013), C-IMT (p = 0.002), serum CRP (p = 0.044), iPTH (p = 0.01), and 25(OH)D3 (p = 0.006). ALA intake of more than 0.23 g daily was linked with lower SBP (p = 0.001), serum 25(OH)D3 (p = 0.004), and C-IMT (p = 0.002). Conclusions: This study contributes to a better understanding of the relationship between dietary ALA intake and C-IMT in CKD. The results of this study could emphasize the significant role of the high prevalence of vitamin D deficiency and inadequate omega-3 PUFA intake and status regarding CVD health in CKD patients. [ABSTRACT FROM AUTHOR]

Rheumatoid arthritis (RA) is a chronic autoimmune disease associated with increased cardiovascular disease (CVD) risk and mortality. This work aimed to evaluate the serum levels of the novel CV biomarkers fetuin-A (fet-A), Dickkopf-1 (DKK-1), galectin-3 (Gal-3), interleukin-32 (IL-32), and catestatin (CST) in RA patients and their associations with RA parameters and CVD markers. A cohort of 199 RA patients was assessed for traditional CVD risk factors, RA disease activity, and biomarker levels. Carotid ultrasound was used to measure carotid intima-media thickness (cIMT) and carotid plaque presence (cPP). Multivariate analyses examined correlations between biomarkers and RA parameters, serological markers, and CVD markers. Adjusted models showed that elevated CST expression levels were associated with rheumatoid factor (RF) and anti-citrullinated protein antibody (ACPA) positivity (OR = 2.45, p = 0.0001 and OR = 1.48, p = 0.04, respectively) in the overall cohort and for RF in men and women, respectively. In addition, fet-A concentration was inversely associated with the erythrocyte sedimentation rate (ESR) in the overall cohort (β = −0.15, p = 0.038) and in women (β = −0.25, p = 0.004). Fet-A levels were also negatively correlated with disease activity (DAS28-ESR) scores (β = −0.29, p = 0.01) and fibrinogen concentration (β = −0.22, p = 0.01) in women. No adjusted associations were observed for Gal-3, DKK-1 or IL32 concentration. The study revealed no significant associations between the biomarkers and cIMT or cPP. The measurement of CST and fet-A levels could enhance RA patient management and prognosis. However, the utility of biomarkers for evaluating CV risk via traditional surrogate markers is limited, highlighting the need for continued investigations into their roles in RA. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular diseases remain a leading global cause of mortality worldwide especially in older adults. Although it is known that regular exercise reduces cardiovascular diseases incidence, its effects on specific cardiovascular aging parameters considering the influence of sex and different exercise designs are still not fully understood. Therefore, this systematic review and meta-analysis aims to evaluate the effects of different physical exercise protocols on age-related cardiovascular outcomes in older adults. Methods: This systematic review and meta-analysis will be reported in agreement with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Articles will be eligible if they are randomized controlled trials with a primary objective of evaluating the chronic effects of exercise interventions on cardiovascular aging parameters. Search strategy will be performed from the inception to September 30th, 2023, in the following electronic databases: MEDLINE (Ovid), SCOPUS (Elsevier), Embase, Sport Discus (EBSCO), Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science Core Collection (Clarivate Analytics). Data will be extracted and managed through Research Electronic Data Capture (REDCap) software. The Tool for the assEssment of Study qualiTy and reporting in EXercise (TESTEX) will be used to assess the methodological quality of included studies. Additionally, the quality of the findings will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) profiler. Meta-analysis based on the random-effects model will be performed (if deemed suitable, considering the methodological and clinical heterogeneity of the studies) to estimate the effects of exercise training on cardiovascular aging variables (i.e., cardiac output; arterial stiffness; stroke volume; endothelial function; and carotid intima-media thickness). Heterogeneity will be assessed with the I2 statistics, while the publication bias will be assessed based on Egger's test. Discussion: To the best of our knowledge, this will be the first systematic review and meta-analysis to investigate the impact of sex and training protocols on the cardiovascular aging parameters. Moreover, the findings of this systematic review and meta-analysis will provide evidence for health professionals in the management of elderly patients in order to optimize the exercise prescription to face the cardiovascular alterations related to the aging process, considering the effects of different protocols according to sex. Systematic review registration: PROSPERO CRD42023441015. [ABSTRACT FROM AUTHOR]

Investigate the impact of remnant cholesterol (RC) levels on carotid artery intima thickness (CIT) in type 2 diabetes mellitus (T2DM) patients. From September 2021 to September 2023, a prospective multicenter study involved 158 T2DM patients. They were divided into a higher RC group (n = 80) and a lower RC group (n = 78) based on median RC levels. Additionally, 92 healthy volunteers served as the control group. CIT, carotid media thickness (CMT), and carotid intima-media thickness (CIMT) were measured. General clinical data, lab results, CIMT, CIT, and CMT differences among the three groups were compared. Multiple regression analysis explored CIT factors in T2DM patients. 1. No significant sex, age, BMI, high-density lipoprotein cholesterol (HDL-C), T2DM duration, fasting blood glucose, or glycated hemoglobin differences were found among the groups (p > 0.05). 2. CIMT and CIT were significantly higher in T2DM than the control group (p < 0.05). 3. The higher RC group had thicker CIT than the lower RC group (p < 0.05), while CIMT differences were not significant (p > 0.05). Multiple linear regression analysis showed RC as an influencing CIT factor in T2DM patients (β = 0.473, p = 0.005). CIT is significantly thicker in T2DM patients with higher RC than in those with lower RC, and RC is the influence factor of CIT, which suggests that more attention should be paid to the detection of RC in T2DM patients. [ABSTRACT FROM AUTHOR]

Carotid intima-media thickness (cIMT), a marker of subclinical atherosclerosis, has been found to be associated with incident stroke. High-sensitivity C-reactive protein (CRP) and fibrinogen have been demonstrated to be associated with atherosclerosis. Previous studies on heritability estimates of IMT, CRP, and fibrinogen among Chinese populations are limited. This study aims to estimate the heritability of these risk factors in residents who participated in the Taichung Community Health Study (TCHS) and their family members. A total of 2671 study subjects from 805 families were enrolled in the study, selected from a random sample of TCHS participants and their family members. CRP, and fibrinogen were obtained from each participant, and a questionnaire interview was conducted. cIMT was measured by high-resolution B-mode ultrasound and expressed as the mean of the maximum. Heritability estimates and the familial correlation of cIMT, CRP, and fibrinogen among family pairs were determined with SAGE software. With multivariate adjustments, significant heritability was found for cIMT (h2 = 0.26, P < 0.001), CRP (h2 = 0.34, P < 0.001), and fibrinogen (h2 = 0.48, P < 0.001). The intrafamilial correlation coefficients for the three indexes in the parent–offspring pairs were significant (P < 0.001) and ranged from 0.17 to 0.41. The full sibship correlations were also significant (P < 0.001) for the three indexes and ranged from 0.19 to 0.47. This study indicates that a moderate proportion of the variability in CRP, fibrinogen, and cIMT can be attributed to genetic factors in Chinese populations. The findings suggest that CRP is associated with cIMT, whereas no significant association exists between fibrinogen and cIMT. [ABSTRACT FROM AUTHOR]

Carotid atherosclerosis disease assessment can predict the patient's risk of cardiovascular disease (CVD). The purpose of this review is to provide a comprehensive review of carotid atherosclerosis disease's pathophysiology, diagnostic evaluation, imaging applications, and treatment strategies. Carotid atherosclerosis is diagnosed using a variety of techniques, including transcranial Doppler imaging (TCD), computed tomography angiography (CTA), magnetic resonance angiography (MRA), and cerebral digital subtraction angiography (DSA), with duplex ultrasound (DUS) as the primary screening. Measurements of carotid intima- media thickness (CIMT) have drawn attention recently as a marker of early-stage carotid atherosclerosis or CVD risk prediction. The classification of cardiovascular risk may be enhanced by the expanding fields of stress testing and carotid plaque screening. [ABSTRACT FROM AUTHOR]

Background: Obesity in polycystic ovary syndrome (PCOS) may increase the risk of cardiovascular disease. Carotid intima-media thickness (CIMT) is an acceptable marker in assessing the risk of heart disease. Objective: This study aimed to evaluate the CIMT in PCOS women compared to non-PCOS women. Materials and Methods: This cross-sectional study was conducted on 48 women who referred to Imam Reza hospital, Kermanshah, Iran from July 2020-2021. Women were divided into 2 groups of PCOS and non-PCOS women (n = 24/each). The intima-media thickness of participants' carotid artery was measured on both sides in 3 areas, and its mean was recorded. Results: The mean thickness of the carotid artery intima-media in the case group was within the normal range; but it was significantly higher than the control group (0.71 ± 0.17 vs. 0.57 ± 0.09 mm, p = 0.019). Conclusion: Considering the higher thickness of CIMT in women with PCOS, it can be concluded that PCOS increases the risk of heart diseases in women. [ABSTRACT FROM AUTHOR]

Objective: To evaluate accuracy and feasibility of a handheld ultrasound machine for measuring carotid artery intima-media thicknesses (CIMT) and hemodynamic parameters by different expertise levels of ultrasound operators. Methods: : The operators were divided into three groups based on the level of their medical expertise: ultrasound technician, sonographer, and nursing staff. Operators from each group measured the CIMT and hemodynamic parameters of 25 volunteers using both handheld ultrasound and a conventional ultrasound machine. The reliability and reproducibility of handheld ultrasound measurements of CIMT and hemodynamic parameters (peak systolic velocity (PSV), end-diastolic velocity (EDV)) in operators were analyzed. Results: After a period of training, there was no statistically significant difference between the mean CIMT measured using handheld ultrasound among the three operators (0.45 ± 0.09 mm, 0.50 ± 0.07 mm, 0.46 ± 0.08 mm, P > 0.05, respectively), as well as PSV (83.30 ± 15.42 cm/s, 76.28 ± 13.26 cm/s, 81.12 ± 21.21 cm/s, P > 0.05, respectively) and EDV (21.04 ± 4.12 cm/s, 21.87 ± 5.05 cm/s, 20.17 ± 5.90 cm/s, respectively, P > 0.05). Furthermore, there was a good repeatability and consistent of handheld ultrasound device in measuring mean CIMT in the ultrasound technician and sonographer groups (r = 0.662, 0.691, respectively, P < 0.01). Conclusions: Under the premise of proper training, handheld ultrasound systems are feasible for rapid and primary assessment of carotid artery by operators with different levels of expertise. [ABSTRACT FROM AUTHOR]