Cardiovascular risk factors for early carotid atherosclerosis in the general population: the Edinburgh Artery Study.
ABSTRACT Recent attempts to identify cardiovascular risk factors affecting early-stage carotid atherosclerosis, measured by ultrasonographically assessed intima-media thickness, have been inconclusive.
To study the relationship between traditional cardiovascular risk factors and intima-media thickness.
Ultrasonic evaluation of the intima-media thickness of the common carotid artery was included in the 5-year follow-up examination of participants of the Edinburgh Artery Study. We had valid readings of intima-media thickness for 1106 men and women aged 60-80 years. Information on a range of cardiovascular risk factors had been collected during the baseline examination.
For men, in addition to age, lifetime smoking (measured in terms of pack years) was the only cardiovascular risk factor associated with increased intima-media thickness (P< or = 0.01) in the univariate analysis. Both systolic blood pressure (P < or = 0.001) and the high-density lipoprotein (HDL: total cholesterol ratio (P < or = 0.01) were correlated with intima-media thickness for women. When all the variables had been included in a multivariate analysis, pack years of smoking and the HDL:total cholesterol ratio were associated with early atherosclerotic development in men. In an equivalent analysis for women, alcohol consumption, systolic blood pressure and the HDL:total cholesterol ratio were associated with intima-media thickness.
These data suggest that risk factors affecting intima-media thickness differ for men and women. Further sex-specific analyses of prospective population studies are required in order to clarify the role of 'traditional' cardiovascular risk factors in the early stages of carotid atherosclerosis.
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ABSTRACT: The estimation of risk for atherosclerotic and cardiovascular events based only on the presence of classical risk factors is often insufficient. Therefore, efforts have been made to find markers that indicate the presence of preclinical disease in individual subjects like blood markers of atherosclerosis and preclinical deterioration of the arterial wall. Elevated levels of several inflammatory mediators have been found in subjects with atherosclerosis. Prospective epidemiological studies have found increased vascular risk in association with increased basal levels of cytokines, the cell adhesion molecules P-selectin and E-selectin; and acute-phase reactants such as high sensitive C-reactive protein (hsCRP), fibrinogen, and serum amyloid A. For clinical purposes, the most promising inflammatory biomarker appears to be hsCRP. In the last decade, markers of plaque stability and unstable coronary artery disease have been sought such as myeloperoxidase, soluble CD40 ligand, pregnancy-associated plasma protein A, free fatty acids and placental growth factor. Further, markers of endothelial dysfunction (ED), like circulating molecules as well as indicators of functional deterioration of the arterial wall, that represent a common denominator of harmful effects of risk factors on the vessel wall were identified. It was show that endothelial dysfunction is closely related to different risk factors of atherosclerosis, and to their intensity and duration. Measurement of the intima-media thickness (IMT) using high resolution B-mode ultrasonography has emerged as one of the methods of choice for determining the anatomic extent of preclinical atherosclerosis and for assessing cardiovascular risk. A strong correlation between carotid IMT and several cardiovascular risk factors was shown and it has also been found to be associated with the extent of atherosclerosis and end-organ damage of high risk patients. Determination of markers of preclinical atherosclerosis could influence the decision of a clinician to intervene with medication and to use more aggressive treatment of risk factors in primary prevention, and in patients with atherosclerotic disease.The Open Atherosclerosis & Thrombosis Journal 07/2011; 4(1). DOI:10.2174/1876506801104010001
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ABSTRACT: Background—Increased carotid intimal-medial thickness (IMT) and coronary artery calcification (CAC) are used as 2 markers of early atherosclerosis. Our objectives were to assess whether increased IMT and CAC are related and to determine the relationship between cardiovascular risk factors and carotid IMT in young adults. Methods and Results—A sample of 182 men and 136 women aged 33 to 42 years living in Muscatine, Iowa, underwent B-mode carotid ultrasound to determine the mean of 12 measurements of maximal carotid IMT. CAC was defined as calcification in the proximal coronary arteries in $3 contiguous pixels with a density of $130 HU. The mean IMT was 0.788 mm (SD 0.127) for men and 0.720 mm (SD 0.105) for women. CAC was present in 27% of men and 14% of women and was significantly associated with IMT in men (P,0.025) and women (P,0.005). With multivariate analysis, after adjustment for age, significant risk factors for carotid IMT were LDL cholesterol ( P,0.001) and pack-years of smoking (P,0.05) in men and LDL cholesterol (P,0.001) and systolic blood pressure (P,0.01) in women. These risk factors remained significant after CAC was included in the multivariate model. Conclusions—There is an association between increased carotid IMT and CAC and between cardiovascular risk factors and increased IMT in young adults. Carotid IMT may provide information in addition to CAC that can be used to identify young adults with premature atherosclerosis. (Circulation. 1999;100:838-842.)