Relationship between cardiovascular risk factors and the echogenicity and pattern of the carotid intima-media complex in men
Keywords:
Ultrasonography, Carotid intima-media thickness, Atherosclerosis, Risk factors, Metabolic syndrome XAbstract
CONTEXT AND OBJECTIVE: The thickness of the carotid intima-media complex (C-IMC) is considered to be a marker of early atherosclerosis, but visual and echogenic changes to the C-IMC can also be noted. The objective here was to evaluate the relationship between cardiovascular risk factors and the echogenicity of the C-IMC and identify those most associated with an “abnormal” C-IMC. DESIGN AND SETTING: Cross-sectional study in the ultrasound sector of the Department of Diagnostic Imaging, Universidade Federal de São Paulo. METHODS: Eighty men were evaluated. Measurements of arterial blood pressure, waist circumference (WC), lipid profile, fasting glucose, uric acid and high-sensitivity C-reactive protein were obtained. The thickness of the C-IMC was measured by means of B-mode ultrasound, and the intima-media grayscale mean (IM-GSM) and standard deviation (IM-SD) were calculated. RESULTS: The following were discriminating variables: fasting glucose (r2 = 0.036; P = 0.013), uric acid (r2 = 0.08; P = 0.03), IM-SD (r2 = 0.43; P < 0.001), IM-GSM (r2 = 0.35; P < 0.001) and thickness of the C-IMC (r2 = 0.29; P < 0.001). IM-GSM showed significant correlations with WC (r = -0.22; P = 0.005), fasting glucose (r = -0.24; P = 0.002) and high-density lipoprotein cholesterol (HDL-C) (r = 0.27; P = 0.0007). CONCLUSION: IM-GSM showed correlations with WC, fasting glucose and HDL-C. However, uric acid and IM-SD presented the greatest discriminating impact. These results suggest that visual changes in C-IMC may help identify patients with potential cardiovascular risk, independently of the thickness of the C-IMC.
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References
Ross R. Atherosclerosis--an inflammatory disease. N Engl J Med. 1999;340(2):115-26.
Kablak-Ziembicka A, Przewlocki T, Sokolowski A, Tracz W, Podolec P. Carotid intima-media thickness, hs-CRP and TNF-α are independently associated with cardiovascular event risk in patients with atherosclerotic occlusive disease. Atherosclerosis. 2011;214(1):185-90.
Graf IM, Schreuder FH, Hameleers JM, et al. Wall irregularity rather than intima-media thickness is associated with nearby atherosclerosis. Ultrasound Med Biol. 2009;35(6):955-61.
Chambless LE, Folsom AR, Davis V, et al. Risk factors for progression of common carotid atherosclerosis: the Atherosclerosis Risk in Communities Study, 1987-1998. Am J Epidemiol. 2000; 155(1):38-47.
Lind L, Andersson J, Rönn M, et al. Brachial artery intima-media thickness and echogenicity in relation to lipids and markers of oxidative stress in elderly subjects: the prospective investigation of the vasculature in Uppsala Seniors (PIVUS) Study. Lipids. 2008;43(2):133-41.
Lind L, Andersson J, Rönn M, Gustavsson T. The echogenicity of the intima-media complex in the common carotid artery is closely related to the echogenecity in plaques. Atherosclerosis. 2007;195(2):411-4.
Andersson J, Sundström J, Gustavsson T, et al. Echogenecity of the carotid intima-media complex is related to cardiovascular risk factors, dyslipidemia, oxidative stress and inflammation: the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study. Atherosclerosis. 2009;204(2):612-8.
Wohlin M, Sundström J, Andrén B, Larsson A, Lind L. An echolucent carotid artery intima-media complex is a new and independent predictor of mortality in an elderly male cohort. Atherosclerosis. 2009;205(2):486-91.
Labropoulos N, Leon LR Jr, Brewster LP, et al. Are your arteries older than your age? Eur J Vasc Endovasc Surg. 2005;30(6):588-96.
Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA. 2001;285(19):2486-97.
Pignoli P, Tremoli E, Poli A, Oreste P, Paoletti R. Intimal plus medial thickness of the arterial wall: a direct measurement with ultrasound imaging. Circulation. 1986;74(6):1399-406.
Belcaro G, Barsotti A, Nicolaides AN. “Ultrasonic biopsy” --a non- invasive screening technique to evaluate the cardiovascular risk and to follow up the progression and the regression of arteriosclerosis. Vasa. 1991;20(1):40-50.
Grant EG, Benson CB, Moneta GL, et al. Carotid artery stenosis: gray- scale and Doppler US diagnosis--Society of Radiologists in Ultrasound Consensus Conference. Radiology. 2003;229(2):340-6.
Sánchez-Castillo CP, Pichardo-Ontiveros E, López-R P. Epidemiología de la obesidad. [The epidemiology of obesity]. Gac Med Mex. 2004;140(Suppl 2):S3-20.
Ribeiro Filho FF, Mariosa LS, Ferreira SR, Zanella MT. Gordura visceral e síndrome metabólica: mais que uma simples associação [Visceral fat and metabolic syndrome: more than a simple association]. Arq Bras Endocrinol Metabol. 2006;50(2):230-8.
Sims EA. Are there persons who are obese, but metabolically healthy? Metabolism. 2001;50(12):1499-504.
Stary HC. Evolution and progression of atherosclerotic lesions in coronary arteries of children and young adults. Arteriosclerosis.. 1989;9(1 Suppl):I19-32.
Strong JP, Restrepo C, Guzmán M. Coronary and aortic atherosclerosis in New Orleans. II. Comparison of lesions by age, sex, and race. Lab Invest. 1978;39(4):364-9.
Arnlöv J, Ingelsson E, Sundström J, Lind L. Impact of body mass index and the metabolic syndrome on the risk of cardiovascular disease and death in middle-aged men. Circulation. 2010;121(2):230-6.
Feig DI, Kang DH, Johnson RJ. Uric acid and cardiovascular risk. N Engl J Med. 2008;359(17):1811-21.
Bard RL, Kalsi H, Rubenfire M, et al. Effect of carotid atherosclerosis screening on risk stratification during primary cardiovascular disease prevention. Am J Cardiol. 2004;93(8):1030-2.
Bernard S, Sérusclat A, Targe F, et al Incremental predictive value of carotid ultrasonography in the assessment of coronary risk in a cohort of asymptomatic type 2 diabetic subjects. Diabetes Care. 2005;28(5):1158-62.
Mackinnon AD, Jerrard-Dunne P, Sitzer M, et al. Rates and determinants of site-specific progression of carotid artery intima- media thickness: the carotid atherosclerosis progression study. Stroke. 2004;35(9):2150-4.
Lorenz MW, Markus HS, Bots ML, Rosvall M, Sitzer M. Prediction of clinical cardiovascular events with carotid intima-media thickness: a systematic review and meta-analysis. Circulation. 2007;115(4):459-67.
Tosetto A, Prati P, Baracchini C, Manara R, Rodeghiero F. Age-adjusted reference limits for carotid intima-media thickness as better indicator of vascular risk: population-based estimates from the VITA project. J Thromb Haemost. 2005;3(6):1224-30.
Riccioni G. Statins and carotid intima-media thickness reduction: an up-to-date review. Curr Med Chem. 2009;16(14):1799-805.
Loizou CP, Pantziaris M, Pattichis MS, Kyriacou E, Pattichis CS. Ultrasound image texture analysis of the intima and media layers of the common carotid artery and its correlation with age and gender. Comput Med Imaging Graph. 2009;33(4):317-24.