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Novel technology permits quantification of common carotid artery (CCA) displacement, which is traditionally ignored. We evaluated associations with CCA displacement and cardiovascular disease (CVD) risk and events in a large, multi-ethnic cohort. Right CCA longitudinal displacement (LD), transverse displacement (TD), and grayscale median (GSM) were evaluated using ultrasound speckle-tracking and texture analysis software in 2050 participants. Regression analyses were used to define relationships between CCA LD, TD, GSM, and CVD risk factors. Cox proportional hazards models were used to assess relationships between LD, TD, and incident CVD events. Participants were mean (SD) 64 (10) years old. There were 791 cases with a CVD event over a 12-year median follow-up. The mean LD was 0.29 (0.20) mm. In multivariable models including age, sex, race/ethnicity, heart rate, and CVD risk factors, LD was associated positively with active smoking (β = 0.08, p < 0.001) and inversely with black (β = -0.08, p < 0.001), Chinese (β = -0.05, p < 0.001), and Hispanic (β = -0.04, p < 0.05) race/ethnicities relative to white individuals, heart rate (β = -0.03/10 beats/min, p < 0.001), and diastolic blood pressure (β = -0.01/5 mmHg, p < 0.05). In fully adjusted models, LD and TD were associated with GSM ( p < 0.01), but neither predicted incident CVD events (LD: hazard ratio (HR) 0.77 [0.48 to 1.24], p = 0.3; TD: HR 1.12 [0.8 to 1.57], p = 0.5). CCA LD and TD are associated with race/ethnicity and CVD risk factors but not incident CVD events. LD and TD are not measures of arterial stiffness but their association with GSM suggests that lower LD and TD may be related to structural changes within the carotid arterial wall.

Background We hypothesized that measures of common carotid artery echolucency and grayscale texture features were associated with cardiovascular disease ( CVD ) risk factors and could predict CVD events. Methods and Results Using a case-cohort design, we measured common carotid artery ultrasound images from 1788 participants in Exam 1 of the MESA study (Multi-Ethnic Study of Atherosclerosis) to derive 4 grayscale features: grayscale median, entropy, gray level difference statistic-contrast, and spatial gray level dependence matrices-angular second moment. CVD risk factor associations were determined by linear regression. Cox proportional hazard models with inverse selection probability weighting and adjustments for age, sex, race/ethnicity, CVD risk factors, and C-reactive protein were used to determine if standardized values for grayscale median, entropy, gray level difference statistic-contrast, and spatial gray level dependence matrices-angular second moment could predict incident coronary heart disease, stroke, and total CVD events over a median 13 years follow-up. Participants were mean ( SD ) 63.1 (10.3) years of age, 52.6% female, 32.1% white, 27.8% black, 23.3% Hispanic, and 16.8% Chinese. There were 283 coronary heart disease, 120 stroke, and 416 CVD events. Several associations of grayscale features with CVD risk factors were identified. In fully adjusted models, higher gray level difference statistic-contrast was associated with a lower risk of incident coronary heart disease (hazard ratio 0.82, 95% CI 0.71-0.94, p adj =0.005) and CVD events (hazard ratio 0.87, 95% CI 0.77-0.98, p adj =0.018); higher spatial gray level dependence matrices-angular second moment was associated with a higher risk of CVD events (hazard ratio 1.09, 95% CI 1.00-1.19, p adj =0.044). Conclusions Gray level difference statistic-contrast and spatial gray level dependence matrices-angular second moment predicted CVD events independent of risk factors, indicating their potential use as biomarkers to assess future CVD risk.

Aims: While coronary artery calcium (CAC) has been extensively validated for predicting clinical events, most outcome studies of CAC have evaluated coronary heart disease (CHD) rather than atherosclerotic cardiovascular disease (ASCVD) events (including stroke). Also, virtually all CAC studies are of short- or intermediate-term follow-up, so studies across multi-ethnic cohorts with long-term follow-up are warranted prior to widespread clinical use. We sought to evaluate the contribution of CAC using the population-based MESA cohort with over 10 years of follow-up for ASCVD events, and whether the association of CAC with events varied by sex, race/ethnicity, or age category., Methods and Results: We utilized MESA, a prospective multi-ethnic cohort study of 6814 participants (51% women), aged 45-84 years, free of clinical CVD at baseline. We evaluated the relationship between CAC and incident ASCVD using Cox regression models adjusted for age, race/ethnicity, sex, education, income, cigarette smoking status, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, diabetes, lipid-lowering medication, systolic blood pressure, antihypertensive medication, intentional physical exercise, and body mass index. Only the first event for each individual was used in the analysis. Overall, 500 incident ASCVD (7.4%) events were observed in the total study population over a median of 11.1 years. Hard ASCVD included 217 myocardial infarction, 188 strokes (not transient ischaemic attack), 13 resuscitated cardiac arrest, and 82 CHD deaths. Event rates in those with CAC = 0 Agatston units ranged from 1.3% to 5.6%, while for those with CAC > 300, the 10-year event rates ranged from 13.1% to 25.6% across different age, gender, and racial subgroups. At 10 years of follow-up, all participants with CAC > 100 were estimated to have >7.5% risk regardless of demographic subset. Ten-year ASCVD event rates increased steadily across CAC categories regardless of age, sex, or race/ethnicity. For each doubling of CAC, we estimated a 14% relative increment in ASCVD risk, holding all other risk factors constant. This association was not significantly modified by age, sex, race/ethnicity, or baseline lipid-lowering use., Conclusions: Coronary artery calcium is associated strongly and in a graded fashion with 10-year risk of incident ASCVD as it is for CHD, independent of standard risk factors, and similarly by age, gender, and ethnicity. While 10-year event rates in those with CAC = 0 were almost exclusively below 5%, those with CAC ≥ 100 were consistently above 7.5%, making these potentially valuable cutpoints for the consideration of preventive therapies. Coronary artery calcium strongly predicts risk with the same magnitude of effect in all races, age groups, and both sexes, which makes it among the most useful markers for predicting ASCVD risk.

Objective: This pilot study determined if the ultrasound texture feature "contrast" was associated with cardiovascular disease (CVD) risk factors and subclinical arterial disease., Methods: We evaluated ultrasound images of the right common carotid artery (CCA) from a convenience sample of 151 participants and examined relationships between contrast, CVD risk factors, carotid intima-media thickness (IMT) and coronary artery calcium (CAC). Grey level difference statistics algorithms were used to evaluate the texture feature "contrast" from carotid ultrasound images. Right CCA IMT measurements were made in triplicate in the distal 1 cm segment of the far wall of the artery and CAC score was measured using the Agatston scoring method., Results: In individual models that included age, sex and race, grey level difference statistics contrast (outcome) was associated independently with age [beta (standard error) = -0.87 (0.38) per year; p = 0.02], C-reactive protein [-2.22 (0.96) per mg dl -1 ; p = 0.02], high-density lipoprotein cholesterol [0.61 (0.24) per mg dl -1 ; p = 0.01] and CCA IMT [-0.06 (0.02) microns; p = 0.001]. Other CVD risk factors and CAC were not associated independently with contrast., Conclusion: These findings support the potential use of the ultrasound texture contrast for evaluating arterial injury and CVD risk. Advances in knowledge: This paper contributes to the literature in that it describes how the greyscale texture feature "contrast" is related to CVD risk factors.

Several in vitro and animal studies have showed that inflammatory markers play a role in bone remodeling and pathogenesis of osteoporosis. Additionally, some human longitudinal studies showed suggestive associations between elevated inflammatory markers and increased risk of nontraumatic fractures. We examined several inflammatory markers and multiple fracture types in a single study of older individuals with extensive follow-up. We assessed the association of four inflammatory markers with the risk of incident hip fractures among 5265 participants of the Cardiovascular Health Study (CHS) and a composite endpoint of incident fractures of the hip, pelvis, humerus, or proximal forearm in 4477 participants. Among CHS participants followed between 1992 and 2009, we observed 480 incident hip fractures during a median follow-up of 11 years. In the composite fracture analysis cohort of 4477 participants, we observed 711 fractures during a median follow-up of 7 years. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for hip fracture associated with doubling of IL-6 were HR 1.15 (95% CI, 1.02 to 1.30) overall and HR 1.17 (95% CI, 1.01 to 1.35) in women. We also observed a positive association between each unit increase in white blood cell (WBC) count and risk of hip fracture: HR 1.04 (95% CI, 1.01 to 1.06) overall and HR 1.06 (95% CI, 0.95 to 1.20) in women. We observed no significant associations between any of the four inflammatory markers and a composite fracture endpoint. Our findings suggest that chronic inflammatory and immune processes may be related to higher rates of incident hip fractures. © 2017 American Society for Bone and Mineral Research., (© 2017 American Society for Bone and Mineral Research.)

BackgroundCoronary artery calcium (CAC) predicts coronary heart disease (CHD) events better than carotid wall plaque presence; however, differences in the utility of CAC burden and carotid plaque burden across the spectrum of cardiovascular disease (CVD) events is unknown.Methods and resultsCVD, CHD and stroke/transient ischemic attack (TIA) events were evaluated prospectively in a multiethnic cohort without CVD at baseline. Carotid plaque score was determined by the number of ultrasound-detected plaques in the common, bifurcation, and internal carotid artery segments. CAC was detected by computed tomography. Predictive values were compared using Cox proportional hazards models, C-statistics, and net reclassification, adjusting for traditional CVD risk factors. At baseline, the 4955 participants were mean (SD) 61.6 (10.1) years old and 52.8% female; 48.9% had CAC >0 and 50.8% had at least 1 carotid plaque. After 11.3 (3.0) years of follow-up, 709 CVD, 498 CHD, and 262 stroke/TIA events occurred. CAC score compared to carotid plaque score was a stronger predictor of CVD (hazard ratio [HR], 1.78; 95% CI, 1.16-1.98; P

Background and aims Vitamin K-dependent protein (VKDP) activity may have a role in preventing cardiovascular calcification, but has not previously been studied in large, generally healthy populations. Methods Using an elevated ankle-brachial index (ABI) as a measure of medial vascular calcification, we performed a case-cohort analysis within the Multi-Ethnic Study of Atherosclerosis, measuring Des-gamma-carboxy prothrombin (DCP) to estimate VKDP activity. In secondary analyses of the weighted subcohort, we examined the cross-sectional associations between DCP and prevalent vascular calcification of the coronary vessels, aortic and mitral valves, and aortic wall, and with vascular stiffness. Results In adjusted analysis, cases (n = 104) had 0.21 ng/ml (−0.94–0.52) lower DCP concentrations than the subcohort (n = 613). Furthermore, amongst the 717 participants in the weighted cohort, VKDP activity was not associated with coronary artery, mitral valve, aortic valve or aortic wall calcification, nor was it associated with vascular stiffness. Conclusions Our negative results do not support a role of circulating VKDP activity in cardiovascular calcification in community-dwelling adults. [ABSTRACT FROM AUTHOR]

A response from the authors of a research on calibration and discrimination among multiple cardiovascular risk scores in a modern multiethnic cohort that was published in a 2014 issue is presented.

Introduction: Novel ultrasound technology permits quantification of common carotid artery (CCA) longitudinal displacement (LD) which has been ignored in traditional carotid artery stiffness measurements. We evaluated associations of CCA LD, CCA echolucency (gray scale median [GSM], an indicator of early arterial injury), cardiovascular disease (CVD) risk factors, and incident CVD events in a large, multi-ethnic cohort initially free of clinical CVD. Methods: Right CCA LD and GSM were evaluated using ultrasound speckle-tracking and texture analysis software in a case-cohort study of 1800 participants in the MESA. Multivariable regression analyses were used to define relationships between CCA LD, GSM, and CVD risk factors. Cox proportional hazards models with inverse probability of selection weighting were used to assess the relationships between LD and incident CVD events. Results: Participants were mean (standard deviation) 64 (10) years old (48% female, 40% White, 28% Black, 22% Hispanic, 10% Chinese). There were 1259 controls and 791 cases with a CVD event over a 12 year median follow-up. Mean LD was 0.29 (0.20) mm. Mean GSM was 61.5 (22.7) units. In a multivariable model that included age, sex, race/ethnicity, heart rate, and CVD risk factors, LD was associated positively with active smoking (β=0.08, p<0.001) and inversely with Black (β=-0.07, p<0.001), Chinese (β=-0.05, p<0.001), and Hispanic (β=-0.05, p<0.05) race/ethnicities relative to Whites, heart rate (β=-0.03/10 beat/min, p<0.001) and diastolic blood pressure (β=-0.01/5 mmHg, p<0.05). In fully adjusted models, LD was associated with GSM (β=2.78/SD; p=0.009), but did not predict incident CVD events (Figure; hazard ratio=0.77, 95% confidence interval 0.48-1.24, p=0.28) Conclusions: CCA LD is associated with race/ethnicity and CVD risk factors. Its strong association with GSM suggests that lower LD represents arterial injury, however LD does not predict incident CVD events. [ABSTRACT FROM AUTHOR]

Background: Grayscale analysis of ultrasound images can characterize arterial wall structure and tissue composition. We hypothesized that measures of carotid artery grayscale texture were associated with cardiovascular disease (CVD) risk factors and could predict CVD events. Methods: Using a case-cohort design, we measured common carotid artery ultrasound images from 1788 participants in Exam 1 of the Multi-Ethnic Study of Atherosclerosis to derive 4 grayscale features: grayscale median (GSM), entropy, gray level difference statistic-contrast (GLDS-CON), and spatial gray level dependence matrices-angular second moment (SGLDM-ASM). CVD risk factor associations were determined by linear regression. Cox proportional hazards models with inverse selection probability weighting and adjustments for age, sex, race/ethnicity, CVD risk factors, and C-reactive protein were used to determine if standardized values for these novel markers could predict incident coronary heart disease (CHD), stroke, and total CVD events over a median 13 years follow-up. Results: Participants were mean (standard deviation, SD) 63.1 (10.3) years of age, 53% female, 32% White, 28% Black, 23% Hispanic, 17% Chinese. There were 283 CHD, 120 stroke, and 416 CVD events. Several associations of GSM, entropy, GLDS-CON, and SGLDM-ASM with CVD risk factors were identified. In fully adjusted models, higher GLDS-CON was associated with a lower risk of incident CHD (HR 0.82, 95% CI 0.71- 0.94, padj=0.005) and CVD events (HR 0.87, 95% CI 0.77-0.98, padj=0.018); higher SGLDM-ASM was associated with a higher risk of CVD events (HR 1.09, 95% CI 1.00-1.19, padj=0.044). Conclusions: Ultrasound carotid artery texture features are associated with CVD risk factors and two, GLDS-CON and SGLDM-ASM, predicted CVD events independent of risk factors, indicating their potential use as novel biomarkers to assess arterial wall composition and CVD risk. [ABSTRACT FROM AUTHOR]