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 well established correlation between intima-media thickness (IMT) and the risk of cardiovascular and cerebrovascular events and death is usually measured in subjects with multiple vascular risk factors, which makes it difficult, after application of the usual analysis-of-variance linear combination of effects model, to establish whether each cardiovascular risk factor has, per se, an effect on IMT. In this study we investigated five "pure" groups of patients (865), i.e. each presenting only one of the following risk factors: hypertension, obesity, overweight, smoking, hypercholesterolaemia and a control group of 37 healthy subjects. We measured, both as discrete and as continuous variables, the following indices: intima-media thickening of the common carotid artery (IMT(C)) and of the common femoral artery (IMT(F)) and the ankle-brachial index (ABI). Descriptive statistics were used to analyse the prevalence of pathological values for the three indices in the different groups. Subsequently the entire group of 902 subjects was included in a correlation analysis in which the Pearson correlation coefficient for each pair of variables was computed. In order to assign the risk factors a continuous ranking, and obtain a more general idea of the correlation structure, principal component analysis (PCA) was used. The scores obtained from PCA made it possible to build a scale of severity of the vascular risk factors considered. All the risk factors considered were demonstrated to strongly affect the studied indices. Overweight was shown to be the least important risk factor with regard to intima-media thickening, followed by smoking, hypercholesterolaemia, hypertension and finally obesity, which emerged as the greatest risk factor. The strong correlation between the indices made it possible to compute a composite general score, which provides an univocal risk estimation at single-patient level. IMT(F) was demonstrated to be the most sensitive descriptor. The construction of this risk scale has implications for preventive treatment and the frequency of instrumental examinations, allowing clear quantitative definition of the extent of the damage.Atherosclerosis 02/2011; 216(1):109-14. · 3.71 Impact Factor
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ABSTRACT: Fabry disease is considered primarily as a progressive small vessel disease, with ischaemic degenerative lesions involving the kidneys, brain and heart. Macrovascular involvement in male patients includes an accelerated wall hypertrophy of the radial artery and a thickening of the intima-media of the common carotid artery. The aim of this study is to evaluate the prevalence and severity of carotid artery atherosclerosis in hemizygous and heterozygous patients with Fabry disease, compared with a matched control population. The common carotid artery intima-media thickness (IMT) of 53 patients with Fabry disease (24 men, 29 women) was measured by high-definition ultrasonography, and the presence or absence of atherosclerotic plaques reported. Results were compared with those of 120 age-matched healthy individuals (83 men, 37 women). The common carotid artery IMT was increased to the same extent in male and female patients with Fabry disease (706+/-211 microm and 749+/-395 microm, respectively) compared with that of the control population (614+/-113 microm). In the Fabry population, IMT did not correlate with either systolic blood pressure or with renal function (plasma creatinine). In the control population, only systolic blood pressure was positively and significantly correlated with IMT. Atherosclerotic plaques in the common carotid artery were not observed in any patient with Fabry disease, whereas 34% of the control population had carotid artery plaques, as evidenced by focal non-homogeneous intima-media thickening greater than 1.2 mm. This study presents evidence of a major increase in common carotid artery IMT, both in hemizygous and heterozygous patients with Fabry disease, in the absence of focal atherosclerotic plaques. These results suggest that the conduit arteries may be protected from atherosclerosis in Fabry disease.Acta paediatrica (Oslo, Norway: 1992). Supplement 05/2006; 95(451):63-8.
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ABSTRACT: Carotid artery intima-media thickness (IMT) is a measure of atherosclerosis. Levels of vascular risk factors that are associated with increased IMT change over time. This study aimed to examine the time course of vascular risk factors in older persons with 'high' versus 'low' IMT over a 10-year period. The Hoorn Study is a population-based cohort study on glucose metabolism and vascular disease initiated in 1989. Carotid IMT was assessed in 2000-2001 (n = 581) and in 2005-2007 (n = 261). The time course of vascular risk factors from 1989 to 2000-2001 of the group with the highest tertile of IMT in 2000-2001 was compared with the group with the lowest tertile of IMT with linear mixed models, adjusted for age, sex, and medication use. A similar analysis was performed for change in IMT between the 2000-2001 and 2005-2007 examinations. Persons in the highest tertile of IMT at follow-up (2000-2001) had a higher waist circumference, BMI, systolic blood pressure, and higher total cholesterol, low-density lipoprotein cholesterol, triglycerides, fasting glucose and glycated haemoglobin levels at baseline (1989) than persons in the lowest tertile. Both groups showed a similar increase in weight, blood pressure and glucose levels over time, but persons in the highest tertile of IMT showed a greater decrease in lipid levels. None of the risk factors were associated with change in IMT over 5 years. Persons with increased carotid IMT had an unfavourable risk factor profile throughout the preceding decade. This provides a window of opportunity for early prevention of atherosclerosis.European journal of cardiovascular prevention and rehabilitation: official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology 11/2009; 17(2):168-74. · 2.51 Impact Factor