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Objectives: Increased carotid intima-media thickness (C-IMT) is a non-invasive marker of atherosclerosis and predicts vascular events. Moreover, increasing evidence suggests an association between carotid atherosclerosis and cognitive decline. The purpose of this study is to investigate the relationship between C-IMT and the development of cognitive impairment in a large population-based sample. Methods: This study was based on the data of the participants of the INVADE (Intervention project on cerebrovascular diseases and dementia in the district of Ebersberg, Bavaria) project. Vascular risk factors, Geriatric depression scale (GDS) and "6 Item Cognitive Impairment Test" (6CIT) were evaluated at baseline and after 2 years. The relationship between C-IMT and cognitive impairment was analysed using multivariate logistic regression. Results: Complete baseline data were available in 3386 subjects (mean age 67.7 [95% confidence interval (CI): 67.5, 68.0] years, 41% male). During follow-up, 174 subjects developed a new cognitive impairment. In the subgroup without cognitive impairment at baseline a significant association between cognitive decline after 2 years and elevated C-IMT at baseline could be detected with a significantly higher baseline C-IMT in those with cognitive decline (0.87 mm vs. 0.78 mm; p< 0.0001). After adjustment for various risk factors only age, GDS baseline 6CIT and C-IMT were independently associated with the development of a new cognitive impairment. Conclusions: Our data indicate that an increased carotid intima-media thickness predicts a cognitive decline in an elderly population without prevalent cognitive impairment. Copyright© 2009 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: Uncontrolled hypertension is a major primary healthcare problem., Aim: To investigate whether blood pressure (BP) control in primary care could be improved by nurses taking responsibility for managing hypertensive patients., Methods: Randomized trial with two groups: usual or intensive care. Patients diagnosed previously as hypertensive and with a systolic office BP greater than 140mmHg were randomized to an intensive care programme managed by trained nurses or to usual care. The intensive care programme included a visit every 6 weeks to the general practitioner's office, with standardized BP measurement, self-measurement training, risk factor checks and advice on BP reduction. The intervention lasted for 1 year. The primary endpoints were systolic BP obtained by 24-hour ambulatory BP monitoring after 1 year and the change compared with baseline., Results: Two hundred patients from 19 physicians were enrolled (102 in the intensive care group). Data on ambulatory BP were available from 140 patients. Systolic BP declined from 134.4+/-14.0 to 126.3+/-10.4mmHg in the intensive care group and from 132.4+/-13.5 to 128.2+/-13.0mmHg in the usual care group. There was no statistically significant difference in values after 1 year (p=0.332). The reduction in systolic BP was significantly greater in the intensive care group (7.6 vs 3.3mmHg in the usual care group; p=0.036). Similar results were observed for diastolic BP and day- and night-time measurements., Conclusions: An intensive medical care programme in the office setting managed by trained nurses can improve BP control effectively. Nurses could take more responsibility for managing hypertensive patients.

Evidence on the role of high-sensitivity C-reactive protein (hsCRP) at different stages of atherosclerosis is limited. We therefore analyzed the relationship between hsCRP and measures of subclinical and advanced atherosclerosis in a population-based sample of the INVADE study (n = 3,092, >55 years). The parameters of interest were IMT, ABI, and the stage of atherosclerosis. Differences between participants with normal and pathological hsCRP were analyzed by t test for independent samples or Fishers' exact test. Differences of hsCRP between IMT quartiles, ABI quartiles, and different stages of atherosclerosis were analyzed by one-way ANOVA. Adjusted stepwise multiple linear regression analysis (IMT and ABI) and adjusted analysis of variance (stage of atherosclerosis) were performed, including significant baseline parameters as covariates. ANOVA showed significant differences of hsCRP among IMT quartiles, ABI quartiles, and patients with and without atherosclerosis. The adjusted analyses confirmed that the effects of IMT, ABI, and atherosclerosis on hsCRP were independent from other significant baseline parameters, but did not yield a significant difference between subclinical and advanced stages of atherosclerosis. The present analysis indicates an independent relationship between hsCRP and both IMT and ABI as measures of subclinical atherosclerosis. The comparison of subclinical and advanced stages of atherosclerosis yielded no significant difference, indicating that hsCRP is sensitive to identify vascular risk patients, but not suited to monitor progression of the disease.

Background: The so-called INVADE project examines the efficacy of consistent diagnosis and treatment of cerebrovascular risk factors on the incidence of stroke., Methods: This analysis compares known cardiovascular risk factors (elevated blood pressure, dipositas, hyperlipidemia, diabetes mellitus, and smoking) and respective medication of 2930 patients with respect to cerebrovascular disease, peripheral arterial disease (PAD), and coronary heart disease (CHD) between baseline and follow-up examination after 2 years of intervention., Results: Using the ankle-brachial index (ABI), 381 patients (13%) with asymptomatic PAD were identified. Comparison between baseline and follow-up examination revealed significant reductions in the following risk factors. Cerebrovascular disease: elevated blood pressure -12.8%, dipositas -4.2%, and LDL -8.1%. For PAD the results were: elevated blood pressure -7.2%, smoking -1.2%, elevated cholesterol -6.4%, dipositas -3.2%, and LDL -7.4%. For CHD the results were: elevated blood pressure -11.3%, elevated cholesterol -13.0%, and LDL -14.9%., Conclusion: By the use of ABI, previously undiagnosed asymptomatic PAD was identified in 13% of all patients. Two-year intervention on the primary care level yielded significant reduction of known vascular risk factors.

Background and Purpose: High-sensitivity C-reactive protein (hsCRP) is known to be associated with atherosclerosis and cardiovascular events. Limited information exists regarding the importance of sex differences for the association between hsCRP and the progression of early stages of atherosclerosis. Therefore, we investigated the effect of hsCRP on early carotid atherosclerosis progression and major vascular risk factors in men and women., Methods: We analyzed the data of INVADE (intervention project on cerebrovascular diseases and dementia in the community of Ebersberg, Bavaria), a prospective, population-based study. In addition to common risk factors, measurements of carotid intima-media-thickness and hsCRP were performed at baseline and after 2 years., Results: Complete baseline data were available for 3387 subjects including 2001 women, and complete follow-up data were available for 2346 subjects. Within this study population, women were older and had higher systolic blood pressure and cholesterol levels. The prevalence of smoking and ischemic heart disease was more frequent in men. The baseline carotid intima-media-thickness was significantly higher in men compared with women (0.82 mm; 95% CI, 0.812 to 0.834 mm versus 0.77 mm; 95% CI, 0.763 to 0.779 mm; P<0.0001). Carotid intima-media-thickness progression after risk factor adjustment was significantly associated with hsCRP in women (P=0.006) but not in men (P=0.39)., Conclusions: The association between hsCRP and progression of early carotid atherosclerosis shows sex differences. In further studies analyzing the role of inflammation for cardiovascular diseases and atherosclerosis, these sex differences should be considered.

Background: The INVADE project (Intervention project of cerebrovascular diseases and dementia in the district of Ebersberg) analyzes the effect of risk factor evaluation and modification on the incidence of stroke and dementia. Here we evaluated the changes of risk factors after two years in the INVADE population, particularly in participants with diabetes mellitus and coronary heart disease (CHD)., Patients and Methods: Baseline data of 3909 participants were available. In addition to common risk factors and new risk indicators, various social demographic data and life style parameters were analyzed. A guideline-based therapy was proposed for each participant based on an individual risk profile. The differences between baseline and the 2-year follow-up data were analyzed using the paired t-test and the McNemar test., Results: Complete follow-up data were available in 3185 participants (1288 men; mean age 69.5 years). For the overall project population the reduction of traditional risk factors was effective, particularly in subjects with hypertension or diabetes. The prevalence of hypertension was 76 %, including 19 % newly diagnosed subjects. In this subgroup, the systolic blood pressure could be reduced by 4.7 mmHg. 20.3 % of the participants showed a diabetes mellitus, blood glucose level decreased about 8 %. Additionally an improvement in hypertension therapy and lipid levels was seen. Comparable results were achieved in the CHD subgroup. Additionally, in the overall study population treatment with antihypertensives and statins increased significantly., Discussion: Even after two years, the INVADE project was able to reduce vascular risk factors particularly in high risk patients with diabetes and CHD. Based on these findings, the primary aim of the project, the reduction of stroke and dementia incidence, can be achieved.