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Intima ± media thickness of the common carotid and other characteristics of the population (n 86)
Source publication
Increased thickness of the intima-media complex of the common carotid artery (IMT-CCA) is an early marker of atherosclerosis. The aim of the present study was to investigate the relationship between insulin resistance and IMT-CCA in premenopausal women.
86 young women, aged 18-31 y, were recruited for the study: 28 were normal weight (BMI<25 kg/m2)...
Context in source publication
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Objective:
Atherosclerosis developed during premenopausal years predicts postmenopausal atherosclerosis burden. Selective serotonin reuptake inhibitor (SSRI) antidepressants, recently approved for hot flushes, have been associated with increased ischemic stroke risk in several observational studies; however, effects on carotid artery atheroscleros...
Citations
... 13 Many previous studies evaluating the relationship between the NDP in blood pressure and target organ damage have shown that the NDP is an independent predictor of left ventricular hypertrophy, renal dysfunction, carotid artery stenosis disease and future cardiovascular events. 7,14, 15 In addition, many studies have associated the NDP with increased cardiovascular mortality and morbidity. 16,17 Previous studies have reported controversial results regarding the relationship between MS and the disruption of the diurnal blood pressure pattern. ...
Cite this article as: Güneş E, Güneş M, Çurgunlu A. Non dipping pattern frequency and metabolic syndrome relationship according to two different metabolic syndrome diagnostic methods in newly diagnosed hypertensive individuals. ABSTRACT Aim: The literature presents conflicting data regarding whether the non dipping pattern (NDP) in patients with metabolic syndrome (MS) compared to those without. In our study, we aimed to investigate the MS effect of the NDP in individuals with hypertension. Methods: This prospective study included 117 newly diagnosed hypertensive patients (79 women and 38 men) who were not receiving any anti-hypertensive treatment. MS was evaluated according to the currently used the US National Cholesterol Education Programme Adult Treatment Panel-III definition criteria (MS-ATP-III) and a new diagnostic scoring method (MS-Score). NDP defined, nocturnal blood pressure (BP) fell by <10% from daytime BP Results: The mean age of the patients who met the MS-ATP-III criteria was 53.9+8.1 years. The prevalence of the MS-ATP-III among the study population was 60.6%. The NDP frequency was similar in patients with and without MS-ATP-III, high MS-Score and low MS-Score group (respectively; 44.8%, 47.5%, p=0.79, 44.7%, 46.9%, p= 0.9). The reverse dipping pattern (RDP) frequency was higher in patients with MS-ATP-III compared to those without MS (13.8% and 2.5%, p=0.021), RDP was 10.8% in the high MS-Score group and 8.2% in the low MS-Score group (p=0.66). The LDL (mg/dL) values were higher in those with NDP compared to those without (142.6+32.2, 125.5+28.9, p=0.008). Conclusion: Despite the high prevalence of MS among newly diagnosed hypertensive patients, the prevalence of NDP does not show a different distribution in patients with MS in both the MS-ATP-III and MS-Score method.
... In this context, we previously found that a threshold value of only 90 mg/dl is an independent predictor of higher IMT-CCA [14]. We also reported that in subjects with overweight and obesity, the IMT-CCA is directly associated to insulin resistance [15], a family history of type 2 diabetes mellitus [16] and lower free testosterone levels in men [17]. ...
Aims:
To evaluate whether progressively higher fasting plasma glucose (FPG) is associated to thickening of the interventricular septum (IVS) among non-diabetic subjects with obesity.
Methodology:
We studied 227 consecutive non diabetic patients (155 women and 72 men, age range 18-72 years) with overweight or obesity (BMI≥25 Kg/m2), taking no medication or supplement. Hormonal, metabolic and routine laboratory parameters were collected. Echocardiography and ultrasonography echo-color Doppler of intima-media thickness of the common carotid artery (IMT-CCA) were performed to evaluate intima-media thickness of the common carotid artery (IVST) and early signs of atherosclerosis, respectively, in all enrolled subjects.
Results:
Of the 227 subjects, 48.9% had higher IVST values. Age (p 0.04), waist circumference (p 0.01), systolic (p <0.01) and diastolic blood pressure (p <0.01), FPG (p <0.01), insulin (p 0.04), HOMA IR (p = 0.01), uric acid (p <0.01) serum levels, IMT-CCA (p <0.01), and left atrial diameter (LAD) (p <0.01) were significantly higher in subjects with pathological IVST. Logistic regression models demonstrated an independent relation of FPG to IVST, both in semi and fully adjusted models (ORs 1.045 and 1.039, respectively). Moreover, graph presentation of the ORs and 95% CIs by FPG quintiles showed a positive risk trend for pathological IVST.
Conclusions:
Higher FPG levels represent an independent sensitive predictor of IVS thickening in subjects with obesity, even before overt diabetes. These results emphasize the importance of preventive management of the diabetes risk in obesity.
... In this context, we previously found that a threshold value of only 90 mg/dl is an independent predictor of higher IMT-CCA [14]. We also reported that in subjects with overweight and obesity, the IMT-CCA is directly associated to insulin resistance [15], a family history of type 2 diabetes mellitus [16] and lower free testosterone levels in men [17]. ...
Background
Alterations of glucose metabolism have a detrimental effect on cardiovascular risk parameters, even before overt diabetes, especially in obesity contexts. We aimed to evaluate whether progressively higher fasting plasma glucose (FPG) is associated to thickening of the interventricular septum (IVS) among non-diabetic subjects with obesity.
Methods
We studied 227 consecutive non diabetic patients (155 women and 72 men, age range 18–72 years) with overweight or obesity (BMI ≥ 25 Kg/m2), taking no medication or supplement. Hormonal, metabolic and routine laboratory parameters were collected. Echocardiography and ultrasonography echo-color Doppler of intima-media thickness of the common carotid artery (IMT-CCA) were performed to evaluate intima-media thickness of the common carotid artery (IVST) and early signs of atherosclerosis, respectively, in all enrolled subjects.
Results
Of the 227 subjects, 48.9% had higher IVST values. Age (p 0.04), waist circumference (p 0.01), systolic (p < 0.01) and diastolic blood pressure (p < 0.01), FPG (p < 0.01), insulin (p 0.04), HOMA IR (p = 0.01), uric acid (p < 0.01) serum levels, IMT-CCA (p < 0.01), and left atrial diameter (LAD) (p < 0.01) were significantly higher in subjects with pathological IVST. Logistic regression models demonstrated an independent relation of FPG to IVST, both in semi and fully adjusted models (ORs 1.045 and 1.039, respectively). Moreover, graph presentation of the ORs and 95% CIs by FPG quintiles showed a positive risk trend for pathological IVST.
Conclusions
Higher FPG levels represent an independent sensitive predictor of IVS thickening in subjects with obesity, even before overt diabetes. These results emphasize the importance of preventive management of the diabetes risk in obesity.
... Reduced sensitivity to insulin, or in other words, insulin resistance has been related in many studies with increased risk of atherosclerosis and carotid intima media thickness, even in healthy individuals [18,19]. The method most widely used in clinical practice to determine insulin resistance is the HOMA-IR formula. ...
Aim: To investigate the relationship between metabolic parameters and thyroid hormone changes which occur in patients treated with thyroid replacement therapy following total thyroidectomy.
Material and Method: The study comprised 30 patients who underwent total thyroidectomy. Evaluations were made preoperatively and after 6 and 12 months postoperatively. Body mass index was calculated by recording height and weight of all patients, waist size was measured, arterial blood pressure was measured with a sphyngomanometer on the right arm after 10 mins of rest. Peripheral blood samples were taken after 12-hour fasting for the evaluation of low density lipoprotein, high density lipoprotein, total cholesterol, triglyceride, fasting glucose, fasting insulin, thyroid stimulating hormone, free T3, free T4, C-reactive protein, and haemoglobin A1c values.
Results: In the postoperative 1-year follow-up, a significant increase was determined in total cholesterol, low-density protein and triglyceride levels, which are related to cardiovascular risk, but no significant change was determined in high density protein levels. In addition, a significant increase was determined in the postoperative trend of both systolic and diastolic arterial blood pressures compared to the preoperative values.
Conclusion: Although euthyroid was achieved with follow-up of thyroid functions in the patients who underwent bilateral total thyroidectomy, it was found that there could be changes in metabolic parameters. Therefore, with close monitoring of the metabolic profile of these patients, it can be recommended that lifestyle changes are made when medical intervention is insufficient.
... At Cox regression analysis, HbA1c ≥ 6.5% was not related to 1-yr post discharge mortality in diabetic and in non diabetic patients nosis of unknown type 2 diabetes or impaired glucose regulation allows initiation of treatment or lifestyle interventions, including diet and exercise to prevent type 2 diabetes and associated complications. Gaining information on family history for diabetes could help in identifying subjects with undiagnosed diabetes or at risk [43,44] . However, in the acute phase of STEMI, the identification of glucose intolerance is quite difficult since the common finding of hyperglycemia, irrespective of underlying diabetic status, is to be related mainly to the acute stress response [16][17][18][19][20][21]26] to myocardial ischemia [45] . ...
In population-based studies, including diabetic and nondiabetic cohorts, glycated hemoglobin A1c (HbA1c) has been reported as an independent predictor of all-cause and cardiovascular disease mortality. Data on the prognostic role of HbA1c in patients with acute myocardial infarction (MI) are not univocal since they stem from studies which mainly differ in patients' selection criteria, therapy (thrombolysis vs mechanical revascularization) and number consistency. The present review is focused on available evidence on the prognostic significance of HbA1c measured in the acute phase in patients with ST-elevation myocardial infarction (STEMI) submitted to primary percutaneous coronary intervention (PCI). We furthermore highlighted the role of HbA1c as a screening tool for glucose intolerance in patients with STEMI. According to available evidence, in contemporary cohorts of STEMI patients submitted to mechanical revascularization, HbA1c does not seem to be associated with short and long term mortality rates. However, HbA1c may represent a screening tool for glucose intolerance from the early phase on in STEMI patients. On a pragmatic ground, an HbA1c test has several advantages over fasting plasma glucose or an oral glucose tolerance test in an acute setting. The test can be performed in the non-fasting state and reflects average glucose concentration over the preceding 2-3 mo. We therefore proposed an algorithm based on pragmatic grounds which could be applied in STEMI patients without known diabetes in order to detect glucose intolerance abnormalities from the early phase. The main advantage of this algorithm is that it may help in tailoring the follow-up program, by helping in identifying patients at risk for the development of glucose intolerance after MI. Further validation of this algorithm in prospective studies may be required in the contemporary STEMI population to resolve some of these uncertainties around HbA1c screening cutoff points.
... Another early indicator of atherosclerosis is carotid intima-media thickness (c-IMT) [38,39]. Hulya et al. [40] found higher c-IMT in pre-diabetic patients as compared to controls. ...
Diabetes mellitus worsens cardiovascular risk profile of affected individuals. Its worldwide increasing prevalence and its negative influences on vascular walls morphology and function are able to induce the expression of several morbidities which worsen the clinical conditions of the patients getting them running towards a reduced survival curve.
Although overt diabetes increases the mortality rate of individuals due to its pathogenesis, poor information are in literature about the role of pre-diabetes and family history of diabetes mellitus in the outcome of general population.
This emphasizes the importance of early detection of vascular impairment in subjects at risk of developing diabetes.
The identification of early stages of atherosclerotic diseases in diabetic persons is a fundamental step in the risk stratification protocols followed-up by physicians in order to have a complete overview about the clinical status of such individuals. Common carotid intima-media thickness, flow-mediated vasodilatation, pulse wave velocity are instrumental tools able to detect the early impairment in cardiovascular system and stratify cardiovascular risk of individuals.
The aim of this review is to get a general perspective on the complex relationship between cardiovascular diseases onset, pre-diabetes and family history of diabetes. Furthermore, it points out the influence of diabetes on heart function till the expression of the so-called diabetic cardiomyopathy.
... Another early indicator of atherosclerosis is carotid intima-media thickness (c-IMT) [38,39]. Hulya et al. [40] found higher c-IMT in pre-diabetic patients as compared to controls. ...
... CCA-IMT is the most international validated cardiovascular risk marker. 40 Many works [41][42][43][44] have revealed its importance in the early detection of atherosclerosis. 45 ...
... The same results are reported in premenopausal or menopausal women. 43,55 On the contrary, men had an increased cardiovascular risk profile just in relationship to their own habits and constitution. 56 The CAMP study 42 showed age influencing CCA-IMT, due to the natural history and progression of atherosclerotic process. ...
Atherosclerosis and its complications are the most important causes of death all over the world, especially in Western countries. Diet habits, modern stress life, smoking, sedentary way of life and an involvement of genetic pattern of individuals lead to a sure degeneration of quality of life increasing the risk of atherosclerosis development. For this reason, the main purpose of actual medicine is to identify all the markers that could allow the physicians to evaluate the first moments of the development of this dangerous pathological process. The aim is to reduce the speed of its evolution, trying to delay indefinitely the risk coming from the morphological alterations of the vessels. 'Endothelium function' could allow physicians to detect the first moment of the natural history of atherosclerosis process. Its impairment is the first step in the degeneration of vascular structures. Many methods [flow-mediated vasodilatation (FMD); antero-posterior abdominal aorta diameter (APAO); intima-media thickness of the common carotid artery (CCA-IMT); arterial stiffness; and so on] try to evaluate its function, but many limitations come from general population characteristics. A standardization of the methods should take into account individuals' peculiarities. Two elements, not modifiable, should be taken into account for vascular evaluation: age and sex. The aim of this review is to outline the linkage among age, sex and instrumental evaluation of patients considered for a noninvasive assessment of their cardiovascular risk profile.
... The correlation between OSA-related hypoxemia and CCA-IMT was independently of AHI, indicating that hypoxia could represent an independent risk factor for arterial wall lesions [14]. Importantly, their patients had several comorbidities other than tobacco smoking (47.3% arterial hypertension, 18% dyslipidaemia and 17.4% diabetes mellitus) that can influence the progression of IMT [37][38][39]. However, after adjustment for confounding factors, the correlation between IMT and severity of OSA remained significant. ...
We evaluated early atherosclerotic lesions in 20 non-smokers with newly diagnosed Obstructive Sleep Apnoea (OSA) and without known comorbidities by measuring common carotid artery intima media thickness (CCA-IMT), transcranial Doppler ultrasound (TCD), and ankle brachial index (ABI). These were compared with 20 healthy age- and BMI-matched controls. In OSA patients, CCA-IMT was not significantly higher vs. controls (0.74±0.17 vs. 0.66±0.12 mm, p=0.201) and it was positively correlated with neck circumference (r=0.466, p=0.039), arousal index (r=0.663, p=0.001), gamma-glutamyl transpeptidase activity (r=0.474, p=0.035) while it was negatively correlated with Forced Expiratory Volume in 1 sec (r=-0.055, p=0.012). No difference was noted between patients and controls in terms of vascular stenosis on TCD examination, while asymptomatic peripheral artery disease was found in one patient with OSA. In conclusion, OSA patients without known comorbidities exhibit a non-significant increase in CCA-IMT without further evidence of vascular disease, but additional experience in a larger patient series is needed.
... However, this relation is not as robust as between HOMA-IR and MVD and, thus, favoring the use of HOMA-IR as an atherosclerosis risk predictor in epidemiological studies. There is accumulating evidence demonstrating an association between IR and increased carotid intimal-medial thickness, [16][17][18][19] coronary calcification, 20,21 and increased lipid content and plaque volume of nonculprit coronary lesions. 22 Taken in the context of this evidence and data from multiple large population studies showing that IR is associated with increased CV events (even after adjustment for components of the metabolic syndrome), 7-12 this suggests that IR might be the common root of metabolic syndrome 23 and a mediator of the associated CV risk. ...
The prevalence of insulin resistance (IR) is increasing worldwide because of increasing age, obesity, and physical inactivity. Emerging evidence supports a direct proatherogenic effect of IR on the coronary vasculature, but the relation between IR and angiographic atherosclerosis in a real-world clinical setting is uncertain. In this work, we assessed whether IR is independently associated with clinically significant angiographic atherosclerosis in nondiabetic individuals.
We examined the association between IR and the extent of coronary atherosclerosis determined by angiography in 1073 nondiabetic patients surviving acute myocardial infarction. Patients were divided into quartiles on the basis of the homeostasis model assessment grading of IR, and associations between IR and multivessel coronary artery disease, defined as ≥2 arteries with ≥70% stenosis (or ≥50% left main stenosis), were analyzed in bivariate and multivariable modeling. Overall, the cohort had a median age of 56 years; 28.9% women and 21.8% nonwhite. The crude prevalence of multivessel coronary artery disease was 37.8%, 42.3%, 47.2%, and 48.0% for homeostasis model assessment grading of IR quartiles 1, 2, 3, and 4, respectively (Ptrend=0.009). In multivariable modeling, compared with quartile 1, both quartile 3 (RR [95% confidence interval], 1.31 [1.07-1.60]) and quartile 4 (1.29 [1.03-1.60]) were independently associated with multivessel coronary artery disease. Covariates in the model included patient demographic and clinical characteristics and metabolic factors (low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol, triglyceride, glycosylated hemoglobin, and high-sensitivity C-reactive protein).
We demonstrate an independent association between IR and multivessel coronary artery disease in nondiabetic postmyocardial infarction patients. Our findings strengthen the experimental evidence for a direct atherogenic effect of IR independent of glucose control and other components of the metabolic syndrome.
