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Chronic kidney disease (CKD) patients, characterized by traditional and nontraditional risk factors, are prone to develop atheromatosis and thus cardiovascular events and mortality. The angiogenesis of the adventitial vasa vasorum (aVV) surrounding the carotid has been described as the atheromatosis initiator. Therefore, the aim of the study was to (1) evaluate if the carotid aVV in CKD patients increases in comparison to its physiological value of healthy patients; (2) explore which traditional or nontraditional risk factor including inflammation, bone and mineral metabolism, and anemia could be related to the aVV angiogenesis. CKD patients without previous cardiovascular events (44, stages 3-4; 37, stage 5D) and 65 healthy subjects were compared. The carotid aVV and the intima-media thickness (cIMT) were evaluated by ultrasound. CKD patients at stages 3-4 showed higher aVV of the right carotid artery even after adjusting for age. Importantly, a multiple linear regression model showed hemoglobin levels > 12.5 g/dL as the factor for an estimated higher aVV of the right carotid artery. In conclusion, the association of hemoglobin with higher aVV could suggest the role of high hemoglobin in the higher incidence of adverse cardiovascular outcomes in CKD patients., Competing Interests: The authors declare that they have no competing interests.

Objective: The early identification of the onset of subclinical atheromatosis is essential in reducing the high mortality risk from cardiovascular disease (CVD) worldwide. Although carotid intima-media thickness (cIMT) is the most commonly used early predictor of ongoing atherosclerosis, an experimental model of atherosclerosis, demonstrated that increases in adventitial microvessels (vasa vasorum (VV)) precede endothelial dysfunction. Using the reported accuracy of contrast-enhanced ultrasound (CEU) to measure carotid adventitial VV, this study assessed whether measurements of carotid adventitial VV serve as a marker of subclinical atherosclerotic lesions in a control population with none of the classical risk factors for CVD., Methods and Results: Measurements of cIMT (B-mode ultrasound) and adventitial VV (CEU) were conducted in 65 subjects, 30-70 years old, 48% men, with none of the classical risk factors for CVD. Adventitial VV strongly correlated with its own cIMT only in the left carotid artery. Importantly, the left carotid adventitial VV directly correlated with age., Conclusions: The increases with age in left carotid adventitial VV in individuals with zero risk for atheromatosis suggest that the measurement of carotid adventitial VV could be an accurate and sensitive marker for the diagnosis of subclinical atheromatosis and therefore a prominent tool for monitoring the efficacy of anti-atheromatous therapies.

Abstract: Objective: To test the concept that diabetic patients with microangiopathy of the retinal microcirculation would also show an involvement of the carotid adventitial microcirculation, we aimed to assess the status of the vasa vasorum (VV) signal, measured by contrast-enhanced carotid ultrasound imaging, in type 2 diabetic patients with and without retinopathy. Methods and results: Using contrast-enhanced ultrasound imaging, we quantified the signal of the VV of the common carotid artery. We investigated two subgroups of type 2 diabetic patients who did not have previous cardiovascular disease: 51 with retinopathy and 56 without retinopathy. The reference VV signal was measured in a group of 65 healthy volunteers as the ratio of the contrast agent signal of the VV and that of the lumen of the artery. Patients and volunteers also underwent a clinical evaluation. The reference VV signal in the group of 65 healthy volunteers was 0.562 (SD = 0.142). Patients with diabetic retinopathy showed a higher mean adventitial VV signal (0.700; SD = 0.150) than those without retinopathy (0.621; SD = 0.120) (P < 0.0039). This difference remained highly significant after adjusting for cardiovascular risk factors. Common carotid intima–media thickness and carotid plaque prevalence were not different between diabetic subgroups. Conclusions: Type 2 diabetic patients with retinopathy show increased angiogenesis of the VV of the common carotid artery. This suggests the existence of a diabetic microangiopathic complication affecting the wall of the large arteries that may be an important contributor to the cardiovascular disease burden in diabetes mellitus. [Copyright &y& Elsevier]