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Resumo Contexto Artérias carótidas são locais de frequentes patologias, sendo a mais comum a aterosclerose, podendo resultar na formação de placas com estenose. Para avaliarmos as carótidas em pacientes assintomáticos, o método de ultrassonografia Doppler ou ecodoppler é, atualmente, o exame de eleição, indicado para a triagem e o diagnóstico de lesões vasculares. As diretrizes atuais recomendam o rastreamento em pacientes que apresentem fatores de risco para estenose carotídea e que estejam aptos e dispostos ao tratamento medicamentoso/intervenção carotídea. A triagem em pacientes assintomáticos na população adulta em geral e sem fatores de risco significativos não é recomendada. Objetivos Avaliar se os especialistas médicos se baseiam na literatura para solicitar o ecodoppler como screening. Métodos Realizou-se seleção retrospectiva dos pacientes a partir da solicitação de ecodoppler. Os dados coletados foram computados e analisados com o programa RStudio versão 1.3.959. Resultados Avaliou-se a solicitação como adequada, desde que os pacientes apresentassem pelo menos um fator de risco para placas carotídeas. Entre 152 pacientes, 55 preenchiam critérios para screening de carótidas, a principal indicação na população estudada foi o check-up vascular. Hipertensão arterial foi o fator de risco mais prevalente. Os especialistas em cirurgia vascular obtiveram êxito maior ao solicitar o exame de maneira adequada [razão de chances de indicações corretas de 3,52 (IC 1,14-10,87), com p = 0,02]. A assertividade nas indicações de ecodoppler foi de 36% (IC95% 29-42%). Conclusões Conclui-se que houve excesso de solicitação de ultrassonografia de carótidas como screening. Os cirurgiões vasculares solicitaram o exame de maneira mais assertiva.
Abstract Background Carotid arteries are frequently the site of pathologies, the most common being atherosclerosis, which may result in the formation of plaques, causing stenosis. Doppler ultrasound is currently the exam of choice for assessment of the carotid arteries in asymptomatic patients to screen for and diagnose vascular lesions. Current guidelines recommend screening patients who have risk factors for carotid stenosis and who are able and willing to undergo medical treatment and/or carotid intervention. Screening asymptomatic patients in the general adult population who have no significant risk factors is not recommended. Objectives To assess whether medical experts rely on the literature to request Doppler ultrasound for screening. Methods A retrospective selection of patients was performed based on requests for carotid ultrasound. The data collected were computed and analyzed using RStudio version 1.3.959. Results The request was evaluated as appropriate as long as the patients presented at least one risk factor for carotid plaques. Fifty-five out of 152 patients met criteria for carotid screening. The most frequent indication in the study population was vascular check-up. Arterial hypertension was the most prevalent risk factor. Vascular surgery specialists were more likely to order the exam correctly (odds ratio for correct indications: 3.52 [CI 1.14 - 10.87], with p=0.02). The rate of correct Doppler ultrasound requests was 36% (95%CI 29 to 42%). Conclusions An excess of requests for carotid ultrasound screening was found in this study. Vascular surgeons more often requested the test correctly.
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ObjectiveTo evaluate the effect of Huatan Tongluo prescription on the vulnerability of atherosclerotic plaques in the carotid arteries of patients with hypertension of phlegm-stasis combination syndrome. MethodA total of 132 eligible patients were randomly divided into an observation group （66 cases） and a control group （66 cases）. The control group received oral atorvastatin calcium tablets and enteric-coated aspirin tablets， while the observation group received Huatan Tongluo prescription in addition to the treatment received by the control group. The treatment duration was 6 months. A carotid artery ultrasound examination was performed to record the number of plaques， the maximum plaque area， the maximum plaque cross-sectional thickness， and the intima-media thickness （IMT） of the carotid artery. Crouse score， plaque vulnerability score， and phlegm-stasis combination syndrome score were assessed. Blood lipid levels ［total cholesterol （TC）， triglyceride （TG）， high-density lipoprotein cholesterol （HDL-C）， and low-density lipoprotein cholesterol （LDL-C）］， inflammatory markers ［neutrophil-to-lymphocyte ratio （NLR）， monocyte-to-lymphocyte ratio （MLR）， interleukin-6 （IL-6）， and high-sensitivity C-reactive protein （hs-CRP）］， vascular endothelial function ［endothelin-1 （ET-1）， von Willebrand factor （vWF）， and nitric oxide （NO）］， and relevant proteins ［pentraxin 3 （PTX3） and galectin-3 （Gal-3）］ levels were measured. Safety evaluation was conducted， and comparisons were made in terms of carotid artery stenosis rate， plaque regression efficacy， and traditional Chinese medicine （TCM） syndrome efficacy. ResultCompared with the results before treatment， both groups showed significant reductions in IMT， plaque number， maximum plaque area， and maximum plaque cross-sectional thickness （P<0.05）. After treatment， the observation group exhibited more significant reductions in the above indicators compared with the control group （P<0.05）. After treatment， Crouse scores， plaque vulnerability scores， and phlegm-stasis combination syndrome scores in both groups were lower than those before treatment （P<0.05）. After treatment， the observation group had lower scores in these indicators than the control group （P<0.05）. In terms of blood lipid levels， both groups showed decreases in TC， TG， and LDL-C levels， and an increase in HDL-C levels after treatment compared to those before treatment （P<0.05）. The observation group exhibited greater improvements in these lipid parameters than the control group （P<0.05）. Inflammatory markers NLR， MLR， IL-6， and hs-CRP significantly decreased in both groups after treatment compared with those before treatment （P<0.05）. The observation group showed more significant reductions in these markers than the control group after treatment （P<0.05）. After treatment， both groups demonstrated decreases in levels of ET-1， vWF， PTX3， and Gal-3， along with an increase in NO levels compared with those before treatment （P<0.05）. The observation group showed more significant improvements in these markers than the control group after treatment （P<0.05）. After treatment， the observation group had a lower carotid artery stenosis rate than the control group （P<0.05）. The plaque regression efficacy rate was 51.72% （30/58） in the observation group， and the total effective rate of TCM syndrome was 84.48% （49/58）， both of which were higher than 18.64% （11/59） and 52.54% （31/59） in the control group （χ²=10.061， 13.799， P<0.05）. No adverse reactions related to the Huatan Tongluo prescription were observed during the treatment period. ConclusionIn addition to statin therapy， Huatan Tongluo prescription can effectively reverse carotid artery atherosclerotic plaques in patients with hypertension and carotid artery stenosis， reduce plaque vulnerability， exhibit lipid-lowering and anti-inflammatory effects， and improve vascular endothelial function. The treatment demonstrates favorable clinical efficacy and safety. Therefore， it is very worthy of clinical promotion and application.
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ObjectiveTo explore the effect of tuina manipulation with different cervical rotation angle on carotid atherosclerosis. MethodsTwenty-five New Zealand rabbits were randomly selected， 5 of which as the control group， and the other 20 rabbits as the modeling group. The modeling group were made by arterial intimal balloon injury combined with high-fat diet， and were randomly divided into model group， cervical rotation angle of 90° group， cervical rotation angle of 105° group and cervical rotation angle of 120° group （5 rabbits in each group） after successful modeling. After relaxing the neck muscles of rabbits with manipulation of one-finger meditation， rolling and dialing， the cervical vertebrae of each group was rotated by 90°， 105°and 120° respectively for 2 weeks， while the other two groups were not intervened. Then took the entire length of the left common carotid artery from the rabbit， observed the pathological morphology of the carotid artery tissue using HE staining， and observed the expression of CD68 and MMP-2 in the carotid artery tissue using immunohistochemistry staining， and conducted semi quantitative analysis. ResultsHE staining showed that there was no obvious pathological change in the carotid artery in the control group； the model group showed subintimal foam cells gathered， vascular smooth muscle cells increased and arranged disorderly， and some vascular smooth muscle cells entered the intima from the media to form a fibrous cap. Compared with the model group， the number of foam cells increased and the symptoms of lumen stenosis were improved in all groups of cervical rotation； compared with the group with 90°rotation， the endothelium tended to fall off slightly in the group with 105°rotation and 120°rotation. Compared with the control group， the model group and the cervical rotation angle of 90° group ， cervical rotation angle of 105° group and cervical rotation angle of 120° group showed an increase in positive expression of CD68 and MMP-2 （P＜0.05）； compared with the model group， the positive expression of CD68 and MMP-2 in the cervical rotation angle of 90° group， cervical rotation angle of 105° group and cervical rotation angle of 120° group decreased （P＜0.05）； there was no statistically significant difference in CD68 positive expression among cervical rotation angle of 90° group， cervical rotation angle of 105° group and cervical rotation angle of 120° group compared in pairs （P＞0.05）； the positive expression of MMP-2 in the group of cervical rotation angle of 105° group and cervical rotation angle of 120 °group was higher than that in cervical rotation angle of 90° group （P＜0.05）. ConclusionTuina manipulation can promote the stability of plaque by reducing the CD68 content of macrophages and the level of MMP-2 in plaque； but as the rotation angle of the cervical spine increased， the expression of MMP-2 may increase， which may reduce the plaque stability to a certain extent and affect the therapeutic effect of tuina.
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ObjectiveTo compare the therapeutic effects of oral Chinese medicines （including Chinese patent medicines） on coronary artery disease （CAD） by the Bayesian network Meta-analysis. MethodThe randomized controlled trials of treating CAD with oral Chinese medicines were retrieved from the China National Knowledge Infrastructure （CNKI）， Wanfang Data， VIP， PubMed， Web of Science， Embase， and Cochrane Library from the inception to December 1， 2022. The Cochrane risk of bias assessment tool was used to evaluate the quality of the included articles. The direct meta-analysis was performed to compare the performance of oral Chinese medicines alone and in combination with Western medicine in the treatment of CAD in terms of intima-media thickness （IMT）， vascular endothelial function， plaque score， hypersensitive C-reactive protein （hs-CRP）， total cholesterol （TC）， triglyceride （TG）， high-density lipoprotein cholesterol （HDL-C）， low-density lipoprotein cholesterol （LDL-C）， and total response rate. Furthermore， the Bayesian network Meta-analysis was performed to compare the therapeutic effects of different Chinese medicines. ResultA total of 41 articles were included. The direct meta-analysis results showed that Chinese medicines combined with Western medicine outperformed Western medicine alone in recovering all the indicators of CAD. The Bayesian network meta-analysis yielded the following results. In terms of the total response rate， modified Huangqi Guizhi Wuwutang and Sanqi Huayu pills had obvious advantages over other Chinese medicines. In terms of IMT and plaque score， Xiaoban Huazhuo decoction， Yiqi Tongluo formula， Ruangan Jiangzhi capsules， and Guanxin Shutong capsules had obvious advantages over other Chinese medicines. In terms of blood lipid indicators， Shenqi Roumai mixture， Ruangan Jiangzhi capsules， Xiaoban Huazhuo decoction， Qiwei Sanxiong decoction， and Sanqi Huayu pills were superior to other Chinese medicines. The Chinese medicines above mainly had the functions of activating blood， resolving stasis， resolving phlegm， and dredging vessels. ConclusionThe combination of oral Chinese medicines and Western medicine is effective in treating CAD. Clinicians can use the drugs targeting abnormal indicators according to the results of this Bayesian network meta-analysis combined with the actual situation of patients to achieve better therapeutic effects.
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Objective:To investigate the relationship between carotid atherosclerosis(CAS)and subclinical left ventricular(LV)dysfunction in type 2 diabetes mellitus patients with preserved LV ejection fraction(LVEF).Methods:A total of 120 patients with type 2 diabetes mellitus who had LVEF≥50% were selected in the Department of Endocrinology, the First Affiliated Hospital of Air Force Medical University from June 2021 to October 2021. The global longitudinal strain(GLS)was obtained by two-dimensional speckle tracking echocardiography(STE)to assess subclinical LV systolic function. The mitral ratio of peak early to late diastolic filling velocity(E/A), and mitral velocity to early diastolic velocity of the mitral annulus(E/E′)ratio were obtained by pulsed tissue Doppler echocardiography to assess LV diastolic function. Acrroding to bilateral carotid ultrasound examination, the subjects were divided into normal carotid arteries group( n=46) and CAS group( n=74). Demographics and biochemical parameters were compared between two groups. Binary logistic regression and Pearson correlation analysis were used to evaluate the relationship between CAS and subclinical LV dysfunction. Results:The CAS group had a higher proportion of men, older age, and a longer duration of diabetes than the normal carotid arteries group(all P<0.05). There was no difference in LVEF and GLS between the two groups [normal carotid arteries group vs CAS group, LVEF: (60.72±4.73)% vs(60.07±4.28)%; GLS: (18.24±3.72)% vs(17.81±3.47)%, respectively; both P>0.05]. However, compared with normal carotid arteries group, E/A ratio was decreased and E/E′ ratio was significantly increased in CAS group(both P<0.01). Pearson correlation analysis showed that GLS was not correlated with carotid plaque thickness and carotid intima-media thickness(CIMT; both P>0.05). By contrast, E/E′ ratio was positively correlated with carotid plaque thickness and CIMT(both P<0.05). Binary logistic regression analysis showed that GLS and E/E′ ratio were not associated with CAS( both P>0.05). However, decreased E/A ratio was significantly associated with the existence of CAS( OR=0.09, 95% CI 0.01-0.67, P=0.018). Conclusions:In type 2 diabetes mellitus patients without overt heart failure and with preserved LVEF, the occurrence of CAS is not associated with subclinical LV systolic impairment assessed by GLS, but is significantly associated with LV diastolic dysfunction, and is independent of traditional cardiovascular risk factors.
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Introducción: El hipotiroidismo subclínico se relaciona con alteraciones cardiovasculares como la aterosclerosis carotidea subclínica por daños endoteliales como consecuencia de varios factores siendo el grosor intima-media carotideo (GIMC) un marcador reconocido, cuya elevación se menciona con frecuencia asociada a esta disfunción tiroidea. Objetivo: Determinar los efectos del tratamiento sustitutivo de pacientes con hipotiroidismo subclínico en el GIMC. Métodos: Se realizó un estudio de intervención que incluyó 94 pacientes con diagnóstico de hipotiroidismo subclínico sin tratamiento sustitutivo, que acudieron a la consulta de Endocrinología del hospital 10 de octubre a los cuales se les realizó determinación de TSH, colesterol total, colesterol LDL, colesterol HDL, triglicéridos y se les realizó US carotideo al inicio del estudio y al año de logrado el estado eutiroideo con tratamiento sustitutivo, para establecer diferencias en los parámetros evaluados antes y después del tratamiento sustitutivo. Resultados: Previo al tratamiento se encontró hipercolesterolemia en el 87,2 por ciento de los pacientes e hipertrigliceridemia en y 38,3 por ciento, mientras que, que valores elevados de colesterol LDL y disminuidos de colesterol HDL fueron hallados en el 55,3 por ciento y 19,3 por ciento de los mismos, el GIMC se mostró dentro del rango de normalidad. Tras el tratamiento con levotiroxina todos los valores medios de los parámetros estudiados se modificaron excepto en el caso de los triglicéridos Conclusiones: El tratamiento sustitutivo del hipotiroidismo subclínico tiene efectos beneficiosos sobre el GIMC, lo que pudiera ser secundario, entre otros factores, a la mejoría del perfil lipídico(AU)
Introduction: Subclinical hypothyroidism is related to cardiovascular alterations such as subclinical carotid atherosclerosis due to endothelial damage as a consequence of various factors, carotid intima-media thickness (CIMT) being a recognized marker, whose elevation is frequently mentioned in association with this thyroid dysfunction. Objective: To determine the effects of replacement therapy in patients with subclinical hypothyroidism in CIMT. Methods: An intervention study was carried out in 94 patients diagnosed with subclinical hypothyroidism, who did not have substitutive treatment. They were treated in Endocrinology consultation at 10 de Octubre hospital. These subjects underwent determination of TSH, total cholesterol, LDL cholesterol, cholesterol HDL, triglycerides. They got carotid ultrasound at the beginning of the study and one year after achieving euthyroid status with replacement treatment, to establish differences in the parameters evaluated before and after replacement treatment. Results: Prior to treatment, hypercholesterolemia was found in 87.2 percent of patients and hypertriglyceridemia in 38.3 percent, while elevated LDL cholesterol and decreased HDL cholesterol values were found in 55.3 percent and 19. .3 percent of them, CIMT was within the normal range. After treatment with levothyroxine, all the mean values of the parameters studied were modified, except in the case of triglycerides. Conclusions: Subclinical hypothyroidism replacement therapy has beneficial effects on CIMT, which could be secondary, among other factors, to the improvement of the lipid profile(AU)
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Humans , Male , Female , Carotid Artery Diseases/epidemiology , Carotid Intima-Media Thickness , Hypothyroidism/drug therapy , Hypothyroidism/epidemiologyABSTRACT
Abstract Background: We aimed to assess the concordance of recommendation for initiating statin therapy according to the 2019 World Health Organization (WHO) cardiovascular disease (CVD) risk charts and to the presence of carotid plaque (CP) identified with carotid ultrasound in Mexican mestizo rheumatoid arthritis (RA) patients, and to determine the proportion of patients reclassified to a high cardiovascular risk after the carotid ultrasound was performed. Methods: This was a cross-sectional study nested of a RA patients' cohort. A total of 157 Mexican mestizo RA patients were included. The cardiovascular evaluation was performed using the 2019 WHO CVD risk charts (laboratory-based model) for the Central Latin America region. A carotid ultrasound was performed in all patients. The indication to start statin therapy was considered if the patient was classified as high risk, moderate risk if > 40 years with total cholesterol (TC) > 200 mg/dl or LDL-C > 120 mg/dl, and low risk if > 40 years with TC > 300 mg/dl, according to the WHO CVD risk chart or if the patient had carotid plaque (CP). Cohen's kappa (k) coefficient was used to evaluate the concordance between statin therapy initiation. Results: Initiation of statin therapy was considered in 49 (31.2%) patients according to the 2019 WHO CVD risk charts and 49 (31.2%) patients by the presence of CP. Cardiovascular risk reclassification by the presence of CP was observed in 29 (18.9%) patients. A slight agreement (k = 0.140) was observed when comparing statin therapy recommendations between 2019 WHO CVD risk charts and the presence of CP. Conclusion: The WHO CVD risk charts failed to identify a large proportion of patients with subclinical atherosclerosis detected by the carotid ultrasound and the concordance between both methods was poor. Therefore, carotid ultra-sound should be considered in the cardiovascular evaluation of RA patients.
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Abstract Background: This study aimed to evaluate the associations between Lipoprotein (a) ‒ Lp(a) levels and carotid Intima-Media Thickness (cIMT) and with carotid plaques in healthy subjects because of previous contradictory data. Methods: A total of 317 healthy normolipidemic subjects (20‒77 years old) were selected. The cIMT and atherosclerotic plaques were determined by B-mode ultrasonography. Mann-Whitney tests were performed to compare the groups according to Lp(a) levels and to explore the associations between Lp(a), carotid plaques, and cIMT, logistic and linear regression analyses were performed. Results: Studied population (51% females, median age 43 years old) presented carotid plaques and cIMT ≥ 0.9 mm in 23% and 18% of the participants, respectively. The group with Lp(a) levels > 30 mg/dL presented significantly higher age and atherosclerotic plaques. Indeed, multivariate linear regression analysis showed a significant association between Lp(a), age, and race. On the other hand, logistic regression analysis demonstrated that the subjects with Lp(a) > 30 mg/dL have a significantly high risk of carotid plaques. Conclusion: The data from the present study indicate that Lp(a) levels above 30 mg/dL contribute to the development of carotid plaques even in apparently healthy participants.
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Objective:To investigate the relationship between prolonged PR interval and carotid atherosclerosis(CAS)in middle-aged and elderly patients with type 2 diabetes mellitus(T2DM).Methods:A total of 537 middle-aged and elderly inpatients with T2DM in the Southern Branch of the Sixth People′s Hospital of Shanghai Jiaotong University from January 2019 to January 2021 were selected as the research objects. Color Doppler ultrasound was used to detect bilateral carotid artery intima-media thickness(CIMT). The subjects were divided into carotid atherosclerosis group(CAS group, n=352)and non-carotid atherosclerosis group(NCAS group, n=185). The difference in the PR interval of ECG between the two groups was compared. Pearson or Spearman rank correlation analysis was used for evaluating the correlation of PR interval and CAS lesions with various clinical index. The relationship between PR interval and CAS lesions was adopted by multivariate logistic regression analysis. Results:The average PR interval of middle-aged and elderly patients with T2DM was(164.57±23.02)ms. The average PR interval in CAS group was significantly higher than that in NCAS group [(169.76±24.28) vs (154.70±16.42)ms, P<0.01]. The results of multifactorial logistic regression analysis showed that age, low density lipoprotein-cholesterol, serum osteocalcin, and PR interval were independent factors influencing the development of CAS lesions in middle-aged and elderly patients with T2DM( OR=1.079, 1.936, 0.879, 1.039, respectively, P<0.05 or P<0.01)where each 1 ms increase in PR interval was associated with a 3.9% increase in the risk of CAS in middle-aged and elderly patients with T2DM( OR=1.039, 95% CI 1.006-1.073, P=0.020). Multivariate logistic regression analysis showed that middle-aged and elderly type 2 diabetic patients with PR interval≥158 ms were 4.072 times more likely to have CAS lesions than those with PR interval<158 ms( OR=4.072, 95% CI 1.417-11.702, P<0.01). Conclusion:The PR interval of electrocardiogram is correlated with CAS lesions in middle-aged and elderly patients with T2DM. Middle-aged and elderly type 2 diabetic patients with significantly prolonged PR interval should be reminded to screen for CAS lesions early.
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Carotid atherosclerotic stenosis is associated with an increased risk of stroke onset and recurrence. The histopathological features of the vulnerable plaques include the presence of lipid necrotic cores, intra-plaque hemorrhage, intra-plaque neovascularization, active inflammation, and thin/ruptured fibrous caps. The intraplaque neovascularization may promote the intra-plaque hemorrhage, and is associated with the rupture of plaques, the formation of local emboli, and the distal embolism. Contrast-enhanced ultrasound can identify the vulnerable carotid plaques by evaluating intraplaque neovascularization.
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【Objective】 To investigate the association of normal weight obesity （NWO） with carotid atherosclerosis （CAS） and peripheral arterial stiffness （PAS） in persons received physical examination. 【Methods】 A total of 1 894 people with normal BMI （18.5-23.9 kg/m2） were consecutively enrolled for this study. All these people had completed body fat measurement， carotid artery ultrasound examination and peripheral arterial stiffness detection. Then they were divided into control group， CAS group， PAS group， and CAS + PAS group according to the test results mentioned above. Clinical data were compared between different groups to assess the baseline situation. Besides， Multivariate Logistic regression analysis was performed to determine independent risk factors for atherosclerosis. 【Results】 The proportion of NWO in CAS group， PAS group， and CAS + PAS group was significantly higher than that in normal group （P<0.05）. Univariate analysis results showed that NWO was correlated with greater risks of both CAS and PAS （P<0.05）. However， multiple factors analysis suggested that NWO was not associated with PAS， but with CAS （OR=1.286， 95% CI： 1.032-1.603， P<0.05）. 【Conclusion】 NWO is closely related to the occurrence of CAS and may be an independent risk factor for CAS. Attention should be paid to the body fat mass of the NWO population. Early intervention is needed to prevent the occurrence of CAS in these people.
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Objective To evaluate the rupture risk of carotid atherosclerotic plaque under cervical rotatory manipulation. Methods The fluid-structure interaction (FSI) model of carotid atherosclerotic plaque was established, and tensile deformation of the plaque and lumen under cervical rotatory manipulation was simulated.Mechanical parameters such as the maximum flow shear stress(FSS), the maximum wall shear stress (WSS), the maximum plaque wall stress (PWS), wall tensile stress (WTS) and wall pressure (WP) of the plaque and lumen were recorded. Results Under 16% carotid tensile deformation, the maximum WSS of the plaque was 40.54 Pa. The maximum PWS was 66.16 kPa, which was far smaller than the threshold of plaque rupture.The maximum WTS of fiber cap and the maximum strain were 156.75 kPa and 0.56, which were larger than the fracture strain range. The maximum WTS of the lumen was 1 040.30 kPa, which approached the threshold of medial membrane rupture and might cause vascular injury. Conclusions When the cervical spine rotates to the end range of motion, large carotid artery stretch may cause damage to epidermal tissues of the plaque, leading to abscission. Lesions, ulcers, bleeding and vascular damage may form inside the plaque, which will affect stability of the plaque. Cervical rotatory manipulation should be performed cautiously in patients with cervical diseases who also have carotid atherosclerotic plaques.The finite element assessment of plaques before manipulation may be an effective safety screening method.
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Objective:To discuss the clinical efficacy of modified Danshenyin and Erchentang in treating carotid atherosclerosis （CAS）， and the effect on intimal injury. Method:Patients （151 cases） were divided into control group （75 cases） and observation group （76 cases）. Specifically， 69 cases in control finished the treatment （4 cases fell off in follow-up， and 2 cases were eliminated）， and 69 cases in observation group finished the treatment （3 cases fell off in follow-up， and 4 cases were eliminated）. Patients in both group got atorvastatin calcium tablets， 10 mg/time， 1 time/day， and aspirin enteric-coated tablets， 100 mg/time， 1 time/day. Patients in control group got Hedan tablets， 2 tablets/time， 3 times/day. Patients in observation group got modified Danshenyin and Erchentang， 1 dose/day. The treatment lasted for 4 months. Before and after treatment， color Doppler ultrasound of carotid artery was detected， and carotid intima-media thickness （IMT）， plaque number， plaque area， plaque thickness and hemodynamics were recorded. Levels of nitric oxide （NO）， endothelin-1 （ET-1）， von Willebrand factor （vWF）， soluble intercellular adhesion molecule-1 （sICAM-1）， vascular endothelial growth factor （VEGF）， matrix metalloproteinase-9 （MMP-9）， triglyceride （TG）， total cholesterol （TC）， high-density lipoprotein cholesterol （HDL-C）， low-density lipoprotein cholesterol （LDL-C）， whole-blood low-shear viscosity （LBV）， whole-blood high-shear viscosity （HBV）， plasma viscosity （PV）， platelet aggregation rate （PAR）， fibrinogen （FIB）， homocysteine （Hcy）， interleukin-6 （IL-6）， IL-10， tumor necrosis factor-<italic>α</italic> （TNF-<italic>α</italic>）， serum superoxide dismutase （SOD）， malondialdehyde （MDA）， oxidized low density lipoprotein （ox LDL） and circulating glutathione peroxidase （GSH-Px） were detected before and after treatment. And the safety was evaluated. Result:After treatment， IMT， number， area and thickness of plaque in observation group were less than those in control group （<italic>P</italic><0.01）. Peak systolic velocity and end diastolic velocity in observation group were higher than those in control group （<italic>P</italic><0.01）， while pulsatility index and resistance index were lower than those in control group （<italic>P</italic><0.01）. And levels of ET-1， vWF， sICAM-1， VEGF， MMP-9， TG， TC， LDL-C， LBV， HBV， PV， PAR， FIB， Hcy， IL-6， TNF-<italic>α</italic>， MDA and ox-LDL were lower than those in control group （<italic>P</italic><0.01）， whereas levels of NO， HDL-C， IL-10， SOD and GSH-Px were higher than those in control group （<italic>P</italic><0.01）. And there was no adverse reaction caused by traditional Chinese medicine. Conclusion:Modified Danshenyin and Erchentang can reduce plaque， improve hemodynamics and hemorheology， and regulate blood lipid metabolism and vascular endothelial factor， with anti-inflammatory and anti-oxidation damages. It can protect vascular intima， and inhibit the occurrence and development of CAS， with a safety in clinical use.
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AIM: To analyze the effects of atorvastatin and folic acid tablets on homocysteine and carotid atherosclerosis in patients with type H hypertension. METHODS: A total of 140 patients with H-type hypertension admitted to our hospital from January 2016 to October 2018 were enrolled in the study. Random number table method was divided into observation group (70 cases) and control group (70 cases). The control group was treated with folic acid tablets on the basis of routine blood pressure reduction. The observation group was given atorvastatin calcium tablets on the basis of the control group, and the treatment was 10 weeks. Comparing the two groups of homocysteine, low-density lipoprotein, brachial-ankle pulse wave velocity, carotid intima-media thicknessbefore and after treatment, blood pressure and heart rate levels, and observed the occurrence of adverse reactions. During a follow-up of one year, the incidence of cardiovascular and cerebrovascular events was compared between the two groups. RESULTS:The plasma Hcy level and LDL level in the observation group was significantly lower than that in the control group (P0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). CONCLUSION:Atorvastatin combined with folic acid tablets can effectively reduce carotid atherosclerosis in patients with type H hypertension, and it can reduce the levels of Hcy and LDL, and it is clinically safe.
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Objective To investigate the relationship between serum cystatin C(CysC)level and vascular complications in type 2 diabetes mellitus(T2DM)patients with normal renal function. Methods Totally 218 T2DM patients who were treated in the Department of Endocrinology,Affiliated Hospital of Chengde Medical College from January 2017 to May 2018 were enrolled.All subjects were divided into four groups based on the quartiles of serum CysC levels:G1 group:≤ 0.56 mg/L,58 cases;G2 group:0.57-0.73 mg/L,52 cases;G3 group:0.74-1.11 mg/L,56 cases;G4 group:≥ 1.12 mg/L,52 cases.The general data,biochemical indicators,glycated albumin,hemoglobin A
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Humans , Biomarkers/blood , Cardiovascular Diseases/complications , Cystatin C/blood , Diabetes Mellitus, Type 2/complications , Kidney , Risk FactorsABSTRACT
Objective@# To learn the interaction of serum direct bilirubin and blood lipids on the risk of carotid atherosclerosis and carotid plaque.@*Methods @#The subjects were selected from Hangzhou Wuyunshan Sanatorium from March 2016 to December 2018. Demographic information,laboratory testing results and carotid intima-media thickness（IMT）were collected. The logistic regression model was employed for the association of direct bilirubin,blood lipids and their interaction with the risk of carotid atherosclerosis and carotid plaque. @*Results@#Totally 8 308 subjects were recruited. Among them,616（7.41%） subjects had carotid atherosclerosis,and 2 409（29.00%）subjects had plaques. The results of multivariate and multinomial logistic regression analysis showed that high level of direct bilirubin was associated with decreased risks of carotid atherosclerosis（OR=0.701,95%CI：0.537-0.916）and carotid plaque（OR=0.647,95%CI：0.527-0.795）;high TC level（OR=1.335,95% CI：1.106-1.611）, high LDL-C level（OR=1.338,95%CI：1.098-1.629）and low HDL-C level（OR=1.431,95%CI：1.148-1.783）were associated with increased risks of carotid atherosclerosis;high TC level（OR=1.325,95% CI：1.151-1.525）and high LDL-C（OR=1.311,95%CI：1.130-1.520）were associated with increased risks of carotid plaque. There were interactions between direct bilirubin and TC or LDL-C on the risk of carotid plaque（P<0.05）. Compared with the subjects with high level of direct bilirubin and normal level of TC,the subjects with normal level of direct bilirubin and high level of TC had significantly higher risk of carotid plaque（OR=1.831,95%CI：1.438-2.333）;compared with the subjects with high level of direct bilirubin and normal level of LDL-C,the subjects with normal level of direct bilirubin and high level of LDL-C had significantly higher risk of carotid plaque（OR=1.814,95%CI：1.427-2.306）.@*Conclusion @#The interactions between direct bilirubin and TC or LDL-C increase the risk of carotid plaque. It is important to strengthen blood lipid control in the patients with normal level of direct bilirubin and hyperlipidemia.
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OBJECTIVE@#Increased carotid artery intima-media thickness (CIMT) and carotid plaque as manifestations of carotid atherosclerosis have been used as markers of cardiovascular disease (CVD). The components of metabolic syndrome (MetS) are linked to CVD, but the association between MetS and CVD is controversial.@*METHODS@#A total of 8,933 Chinese adults aged 40 years or older from 2010 to 2014 were selected from the Jidong and Kailuan communities. MetS was defined by the International Diabetes Federation criteria. CIMT and carotid plaque were measured using color Doppler ultrasound. Logistic regression models were used to assess the association of MetS with carotid plaque and CIMT.@*RESULTS@#MetS was found among 3,461 (3,461/8,933) participants. The odds ratio and 95% confidence internal (CI) for carotid plaques in participants with MetS was 1.16 (1.03-1.30). The risk of carotid plaques increased with the number of MetS components. The average CIMT was higher in participants with MetS (β = 0.020, 95% CI, 0.014-0.027) and in participants with more MetS components.@*CONCLUSION@#Individuals with MetS are at an increased risk for carotid atherosclerosis compared to those without MetS.
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Objective To explore relationship between the nature of carotid atherosclerotic plaque and the number and function of endothelial progenitor cells in peripheral blood.Methods A prospective study of 80 carotid atherosclerotic plaque patients were selected from June 2016 to March 2017 in Guangdong Second Provincial General Hospital.All patients were examined with Cranial magnetic resonance imaging or X-ray computed tomography,pathological examination,carotid artery color Doppler ultrasonography.Patients were divided into hard plaque group (n =42) and soft plaque group (n =38) according to the nature of carotid atherosclerotic plaque.Forty healthy subjects were selected as controls.Monocytes were obtained from 10 ml of elbow venous blood by density gradient centrifugation.Adherent cells were cultured and identified by confocal laser microscopy.The number,migration,proliferation and adhesion of EPCs in soft plaque group and hard plaque group were evaluated.Results The number of proliferating cells (0.847 ± 0.037),migrating cells(27.697±8.248) and adherent cells (46.184± 7.876) in the normal control group were significantly higher than those in the hard plaque group ((0.647±0.019),(18.643±3.289),(32.165±4.325)) and the soft plaque group ((0.679± 0.023),(23.576± 6.327),(40.587±6.523)) (all P＜ 0.001),while the proliferation,migration and adherent cells in the hard plaque group were lower than those in the soft plaque group (all P＜0.001).Conclusion The nature of carotid atherosclerosis plaque is closely related to the number and function of endothelial progenitor cells in peripheral blood.The number of endothelial progenitor cells in carotid atherosclerosis patients with hard plaque is small,and their proliferation,migration and adhesion ability are impaired.
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To investigate the association of serum 3-nitrotyrosine ( 3-NT ) with carotid atherosclerosis in newly diagnosed type 2 diabetic patients. 96 patients with newly diagnosed type 2 diabetes mellitus treated in the department of endocrinology of Tangshan Gongren Hospital were recruited, and were divided into two groups depending on their carotid atherosclerosis status as carotid atherosclerosis group ( CAS group, n = 54 ) and non-carotid atherosclerosis group ( NCAS group, n=42); while 51 healthy subjects without type 2 diabetes mellitus from the medical examination center were recruited as normal control group ( NC group, n=51) . Demographic and clinical data of all subjects were collected. Serum 3-NT levels were measured by Enzyme-Linked Immunosorbent Assay ( ELISA) . ( 1) The levels of 3-NT in CAS group and NCAS group were all higher than those in NC group, and the level of 3-NT in CAS group was higher than that in NCAS group (all P<0.05);(2) In type 2 diabetic patients, 3-NT was positively correlated with HbA1C and low density lipoprotein-cholesterol ( both P<0. 05); ( 3) Logistic regression analysis showed that age (OR=1.271, P=0.023), HbA1C(OR=1.812, P=0.005) , Hcy (OR=1.194, P=0.019), and 3-NT (OR=1.593, P=0.011) were risk factors of CAS in type 2 diabetic patients. Serum 3-NT was closely correlated with carotid atherosclerosis in newly diagnosed type 2 diabetic patients, suggesting that serum 3-NT may be involved in the carotid atherosclerosis of newly diagnosed type 2 diabetic patients.
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Objective To investigate the occurrence of carotid atherosclerosis in a population of permanent residents (age ≥40 years) at high risk of stroke in Xuejiadao Street,Huangdao District,Qingdao City,and to provide a scientific basis for reduction of carotid atherosclerosis in high-risk communities.Methods Using a cluster sampling method,10 007 permanent residents of age ≥40 years were enrolled in the study.Based on data from an early population screening project,1 478 subjects at high risk of carotid atherosclerosis and stroke were included for analysis.These study subjects were divided into a carotid atherosclerosis risk group and a normal group.General data were recorded,and the results of a physical examination and clinical and biochemical tests were used to analyze risk factors.Results Of 1 478 high-risk subjects aged (58.8± 9.7) years,726 had normal arteries.Of these,264 (36.36％) were males and 462 (63.64％)were females.Carotid atherosclerosis was identified in 752 cases aged (61.4± 9.5) years,with a detection rate of 50.88％.Of these,390 were males (51.86％) and 362 were females (48.14％).Univariate analysis showed that age,male sex,history of heart disease,diabetes,or hypertension,smoking,alcohol intake,waist circumference,and elevated homocysteine and low-density lipoprotein cholesterol levels were positively correlated with carotid atherosclerosis in those at high risk of stroke,while physical exercise showed a negative correlation;these results were statistically significant (P＜0.05).Multiple logistic regression analysis [OR (95％CI)] showed that age [1.621 (1.410-1.865)],male sex [0.474 (0.378-0.594)],history of heart disease [1.336 (1.085-1.645)],diabetes [1.312 (1.021-1.685)],or hypertension [1.408 (1.074-1.846)],and increased low-density lipoprotein cholesterol [1.444 (1.191-1.751)] were positively correlated with carotid atherosclerosis in those at high risk of stroke,while physical exercise [0.810 (0.690-0.950)] showed a negative correlation;these results were statistically significant (P＜0.05).Conclusion Targeting elderly men at high risk of stroke for intervention and guidance to manage hypertension,diabetes,and other chronic diseases,as well as comprehensive preventive and control measures,including reasonable physical exercise,can effectively reduce the occurrence of carotid atherosclerosis in communities.