Construction of a machine learning model for identifying clinical high-risk carotid plaques based on radiomics / 中国胸心血管外科临床杂志

@#Objective     To construct a radiomics model for identifying clinical high-risk carotid plaques. Methods     A retrospective analysis was conducted on patients with carotid artery stenosis in China-Japan Friendship Hospital from December 2016 to June 2022. The patients were classified as a clinical high-risk carotid plaque group and a clinical low-risk carotid plaque group according to the occurrence of stroke, transient ischemic attack and other cerebrovascular clinical symptoms within six months. Six machine learning models including eXtreme Gradient Boosting, support vector machine, Gaussian Naive Bayesian, logical regression, K-nearest neighbors and artificial neural network were established. We also constructed a joint predictive model combined with logistic regression analysis of clinical risk factors. Results    Finally 652 patients were collected, including 427 males and 225 females, with an average age of 68.2 years. The results showed that the prediction ability of eXtreme Gradient Boosting was the best among the six machine learning models, and the area under the curve (AUC) in validation dataset was 0.751. At the same time, the AUC of eXtreme Gradient Boosting joint prediction model established by clinical data and carotid artery imaging data validation dataset was 0.823. Conclusion     Radiomics features combined with clinical feature model can effectively identify clinical high-risk carotid plaques.

Carotid atherosclerosis in the first five years since rheumatoid arthritis diagnosis: a cross sectional study

Abstract Background Systemic inflammation, documented before rheumatoid arthritis (RA) diagnosis, is associated with accelerated atherosclerosis. We aimed to compare the prevalence of carotid plaque (CP) in RA patients in the first five years since diagnosis and healthy controls, and to determine disease characteristics associated with the presence of subclinical atherosclerosis in RA patients. Methods This was a cross-sectional study. We recruited 60 RA patients in the first five years since diagnosis and 60 matched healthy controls. Carotid ultrasound was performed to detect the presence of CP and measure carotidintima media thickness (cIMT). Subclinical atherosclerosis was considered as the presence of CP and/or increased cIMT. Distribution was evaluated with the Kolmogorov-Smirnov test. Comparisons were made with Chi-square or Fisher's exact test for qualitative variables and Student's t or Mann-Whitney's U test for quantitative variables. A p-value < 0.05 was considered significant. Results There were no differences in the demographic characteristics between RA patients and controls. The mean disease duration was 2.66 ± 1.39 years. A higher prevalence of CP (30.0% vs. 11.7%, p = 0.013), bilateral CP (18.3% vs. 3.3%, p = 0.008), increased cIMT (30.0% vs. 6.7%, p = 0.001), and subclinical atherosclerosis (53.3% vs. 18.3%, p = < 0.001) was found in RA patients. RA patients with subclinical atherosclerosis were older (56.70 years vs. 50.00 years, p = 0.002), presented a higher prevalence of dyslipidemia (53.1% vs. 14.3%, p = 0.002), and higher prevalence of classification in moderate-high disease activity category measured by DAS28-CRP (68.8% vs. 35.7%, p = 0.010). The latter variable persisted independently associated with subclinical atherosclerosis in the binary logistic regression (OR 6.11, 95% CI 1.51-24.70, p = 0.011). Conclusions In the first five years since diagnosis, higher prevalence of subclinical atherosclerosis, including CP was found in RA patients. Carotid ultrasound should be considered part of the systematic CVR evaluation of RA at the time of diagnosis.

A cohort study on the correlation between fasting plasma glucose trajectories and new-onset carotid plaque / 中华健康管理学杂志

Objective:To investigate the correlation between fasting plasma glucose (FPG) and new-onset carotid plaque through latent class trajectory models.Methods:A total of 953 observation objects came from the first affiliated hospital of Zhengzhou University in accordance with the inclusion criteria. According to the FPG values of the observed subjects during the annual physical examination from January 2017 to December 2019, the following four different FPG trajectories groups were determined by latent class trajectory modelling tools: the low-stable group, the medium stable group, the medium-high stable group, and the high stable group. Carotid plaque incidence in each group was followed up in 2020 to compare the differences of the cumulative incidences of the four groups. The Cox proportional risk regression model was used to analyze the correlation between different FPG trajectories and new-onset carotid plaque.Results:The incidence of carotid plaque increased with the increase of FPG trajectories by 11.13%, 19.70%, 23.44%, 23.81%, respectively, with significance ( P<0.001). After adjusting gender, age, BMI and other confounding factors with the cox proportional risk regression model, the risk of carotid plaque in the FPG medium stable group, medium and high stable group, high-stable group was still 1.895 (95% CI: 1.296-2.769), 2.273 (95% CI: 1.241-4.161), 2.527 (95% CI: 1.219-5.241) times of the low stable group (all P<0.05). Conclusion:The long-term high FPG levels are independent risk factors for the incidence of carotid plaque, and controlling FPG at a low level steadily can reduce the risk of carotid plaque.

Clinical value of remnant lipoproteins and low density lipoprotein cholesterol particle concentration detected by vertical auto profile on the diagnosis of carotid plaque / 中华检验医学杂志

Objective:To explore the clinical value of peripheral remnant lipoproteins (RLP), low density lipoprotein cholesterol particle (LDL-P) and sdLDL particle (sdLDL-P) measurement in the diagnosis of carotid plaque, so as to provide practical basis for the accurate diagnosis of carotid plaque and the control of carotid plaque related cardiovascular and cerebrovascular diseases.Methods:People who underwent carotid plaque ultrasound examination in Xingtai Third Hospital , from January 2020 to June 2021 were selected as the research object. According to the ultrasound results, they were divided into carotid plaque group ( n=146) and control group without carotid plaque ( n=149). The fasting RLP, LDL-P and sdLDL-P of the two groups were measured by vertical auto profile (VAP) centrifugal separation phase, and the fasting TG and LDL-C were detected by routine mixed phase method. The indexes were compared between the two groups and the true positive rate, true negative rate, false positive rate and false negative rate of the diagnosis of carotid plaque were analyzed. The receiver operating characteristic curve of each test index was drawn, and AUC was used to evaluate the clinical diagnostic value of each test index for carotid plaque. Results:The levels of RLP, LDL-P and sdLDL-P in carotid plaque group were significantly higher than those in non-carotid plaque group ([1.07±0.36] mmol/L vs [0.59±0.17] mmol/L,[1 300±370] nmol/L vs [781±215] nmol/L,[435±139] nmol/L vs [156±59] nmol/L, all P<0.01). The true positive rate (78.08% [114/146],81.51% [119/146]) and true negative rate (84.56% [126/149], 86.58%[129/149]) of serum RLP and LDL-P for the diagnosis of carotid plaque were significantly higher than TG (58.90%[86/146], 43.62%[65/149]) and LDL-C (59.59% [87/146], 46.98% [70/149]), and the false positive rate (15.44% [23/149], 13.42% [20/149]) and false negative rate (21.92% [32/146], 18.49% [27/146]) were significantly lower than TG (56.38% [84/149], 41.10% [60/146]) and LDL-C (53.02% [79/149], 40.41% [59/146], all P<0.01). The AUC of the ROC curve of RLP (0.890), LDL-P (0.902) and sdLDL-P (0.973) for the diagnosis of carotid plaque was higher than TG (0.682) and LDL-C (0.712). The AUC of ROC curve of the RLP combined with sdLDL-P (0.977) for the diagnosis of carotid plaque was higher than the RLP and sdLDL-P (all P<0.01). Conclusion:The serum RLP, LDL-P and sdLDL-P can be used as indicators of carotid plaque, and their clinical diagnostic value are superior to TG and LDL-C; the combined diagnostic effect of lipoprotein subclass is better than that of single index alone.

Contrast-enhanced ultrasound features of carotid plaque and its relationship with peripheral blood leukocytes in patients with type 2 diabetes mellitus / 中华超声影像学杂志

Objective:To explore the features of atherosclerotic plaque in patients with type 2 diabetes mellitus by contrast-enhanced ultrasound (CEUS), and to analyze the correlation between the features and leukocyte count in peripheral blood.Methods:A total of 30 type 2 diabetic patients with carotid atherosclerotic plaque treated in Tangdu Hospital of Air Force Military Medical University who underwent CEUS from March 2018 to September 2021 were included as the diabetes group. Thirty-two non-diabetic patients with carotid atherosclerotic plaque who were matched for age and sex during the same period served as the control group. The optimized plaques were performed by CEUS to obtain parameters including peak (P), time to peak (TP), sharpness (S) and area under the curve (AUC) of time-intensity gamma fitting curve (FC curve). The differential count of leukocytes in peripheral blood was detected by the automatic hematology analyzer. Spearman rank correlation and multiple linear regression were used to analyze the correlation between CEUS parameters of plaque and the differential leukocyte count in peripheral blood.Results:①The peripheral blood leukocyte count, monocyte count and monocyte proportion in the diabetes group were higher than those in the control group (all P<0.05). ②P and AUC in the diabetes group were higher than those in the control group (all P<0.05). ③There was linear relationship( B=75.440, P<0.001) and positive correlation ( rs=0.929) between P and peripheral blood monocyte count in the diabetes group. Conclusions:The neovascularization density and perfusion in carotid plaques in patients with type 2 diabetes mellitus are increased, which may be related to the increase of leukocytes in circulation, especially monocytes.

Carotid intraplaque neovascularization is correlated with the risk of revascularization following percutaneous coronary intervention / 南方医科大学学报

OBJECTIVE@#To investigate the correlation of intraplaque neovascularization (IPN) detected by carotid contrast-enhanced ultrasound (CEUS) with revascularization in patients following percutaneous coronary intervention (PCI).@*METHODS@#This study was conducted among 105 patients who were followed up for more than 12 months after PCI. All the patients received CEUS examination for assessment of carotid plaque formation and IPN, which were compared between patients with revascularization (REV group, n=27) and those without revascularization (N-REV group, n=78). ROC curve was used to analyze the diagnostic efficacy of CEUS for predicting revascularization. Univariate and multivariate logistic regression analyses were performed to identify the risk factors associated with revascularization.@*RESULTS@#In the REV group, the IPN score was 0 in 1 (3.7%) patient, 1 in 8 (29.6%) patients, 2 in 15 (55.6%) patients and 3 in 3 (11.1%) patients. Significant differences were noted between REV and N-REV groups in plaque length (15.70±6.93 vs 12.10±6.64, P < 0.05), maximum plaque thickness (3.69±1.12 vs 3.14±1.18, P < 0.05) and IPN (1.74±0.71 vs 0.87±0.63, P < 0.001). IPN score was identified as an independent risk factor for revascularization in patients following PCI, and at the cutoff value of 1.5, its sensitivity, specificity, positive predictive value, and negative predictive value for predicting the occurrence of revascularization were 74%, 89%, 69%, and 91%, respectively, with an AUC of 0.848 (95% CI: 0.703-0.905, P < 0.001).@*CONCLUSION@#CEUS allows noninvasive and semi-quantitative assessment of neovascularization in carotid artery plaques, and IPN detected by CEUS is correlated with the risk of revascularization in patients following PCI.

Carotid doppler ultrasonography in patients with co-existing type 2 diabetes mellitus and hypertension in Nigeria

Background:The co-existence of diabetes mellitus (DM) and hypertension (HTN) has been rising globally with subclinical atherosclerotic complications. These vascular changes can be detected using carotid ultrasonography. Objectives: To determine and compare the carotid arterial structural wall changes and blood flow velocities of adults with co-existing DM and HTN with age-and sex-matched non-diabetic, non-hypertensive controls. Methods: A cross-sectional comparative study of 300 participants comprising 200 adults with co-existing DM and HTN and 100 age-and sex-matched controls was done. Their carotid arteries were examined bilaterally for plaques, carotid intima media thickness (CIMT) and flow velocities ­peak systolic velocity (PSV), end diastolic velocity (EDV), pulsatility index (PI) and resistive index (RI) using 4­12MHz linear array transducer. Visceral obesity and serum lipids were also assessed. Results: The mean age of the subjects was 56.13 ± 6.93 years; they comprised 38% males and 62% females. The subjects' CIMT was statistically significantly higher (p = 0.001) with a three-fold mean increase (45.5%) compared to the controls (13.7%). Lower flow velocities but higher indices were also observed in the subjects. Strong and significant correlations were observed between EDV and PI r =-0.663, p=>0.001), EDV and RI (r = -0.661, p=>0.001) and PI and RI (r =0.988, p= >0.001)among the subjects. Conclusion: Significant reduction in flow velocities with increased CIMT may be an early indication of subclinical atherosclerosis. Therefore, carotid ultrasonography should be mandatory in individuals at risk for early detection and possible prevention of atherosclerotic complications.

Professor ZHU Liang-Chun's Academic Experience in Treating Unstable Carotid Plaques Based on Theory of Phlegm and Blood Stasis / 中国实验方剂学杂志

Unstable carotid plaque is an independent risk factor for serious cerebrovascular events including stroke， making it considered as an intervention target for the primary and secondary prevention of cardiovascular diseases. Professor ZHU Liang-chun is a national distinguished master of traditional Chinese medicine （TCM） who is adept at treating difficult miscellaneous diseases with insects. He believes that the unstable carotid plaque falls into the category of “vessel impediment” in TCM according to the disease location and characteristics. The core pathogenesis of unstable carotid plaque lies in asthenia in origin and sthenia in superficiality， with spleen-kidney deficiency as the root cause and combined phlegm and blood stasis as the manifestations. He has pointed out that both phlegm and blood stasis should be emphasized in the treatment. In addition to the commonly used herbs for strengthening spleen， removing stasis， and resolving phlegm， the insects with strong effects of searching wind and dredging collateral can be added as appropriate to strengthen the power of removing stasis and dredging collateral. According to the pathogenesis of this disease， he develops the Qutan Tongluo Wenbanfang， which has been confirmed by modern pharmacological research to be efficient in resisting inflammation， regulating endothelial cell functions， lowering lipids， adjusting metabolism， and improving blood circulation， thereby ameliorating the related biological processes of atherosclerosis， suppressing atherosclerosis， and stabilizing plaques. As proved by clinical practice， Qutan Tongluo Wenbanfang helps to reduce blood lipids and reduce the area of unstable carotid plaque， indicating that it deserves clinical promotion.

The interaction between direct bilirubin and blood lipids on carotid atherosclerosis and carotid plaque / 预防医学

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.

Carotid plaque is a predictor of major adverse cardiac and cerebrovascular events in patients undergoing coronary angiography / La presencia de placa carotídea es predictor de eventos adversos cardiacos y cerebrovasculares en sujetos sometidos a coronariografía

Abstract Introduction: Carotid disease, measured as carotid intima-media thickness (CIMT) and carotid plaque (CP), is associated with major adverse cardiac and cerebrovascular events (MACCE) in people without the previous atherosclerotic disease; however, there are few published data in patients undergoing coronary angiography. The aim of the study is to determinate if the carotid disease is associated with MACCE after coronary angiography. Methods: A total of 390 consecutive patients underwent coronary angiography after exercise echocardiography and carotid ultrasonography between 2002 and 2013. MACCE was defined as stroke, myocardial infarction due to atherosclerosis progression or death due to a stroke or cardiac event. Results: Two patients were lost (0.5%). During a mean follow-up of 6.0 years (standard deviation of 2.9), 52 patients (13.4%) suffered MACCE. 1, 5, and 10 years, event-free survival was 96.4% (1.0), 88.7% (1.7), and 81.4% (2.8), respectively. Event rates at 10 years were higher in the CP group (23.2% vs. 10.2%, p = 0.013) and in the CIMT > 0.9 mm group (25.9% vs. 13.3%, p = 0.023). Multivariate analysis showed smoking habit (hazard ratio [HR] 2.51, 95% confidence interval [CI] 1.36-4.62, p = 0.003), glomerular filtration rate (HR 0.98, 95% CI 0.98-0.99), aortic stenosis (HR 2.99, 95% CI 1.24-7.21, p = 0.014), incomplete/no coronary revascularization (HR 1.97, 95% CI 1.06-3.67, p = 0.033), insulin treatment (HR 2.63, 95% CI 1.30-5.31, p = 0.006), and CP (HR 2.36, 95% CI 1.02-5.44, p = 0.044) as predictors of MACCE. Conclusions: CP is an independent predictor of MACCE in patients undergoing coronary angiography.

Resumen La enfermedad carotídea, definida como grosor de íntima media (GIMC) y placa (PC), se asocia con eventos adversos cardiacos y cerebrovasculares (EACC) en sujetos sin aterosclerosis previa; sin embargo hay pocos datos en pacientes sometidos a coronariografía. El objetivo del estudio es determinar si la enfermedad carotídea se asocia a EACC en pacientes remitidos a coronariografía Métodos: Entre 2002 y 2013 390 pacientes fueron sometidos a coronariografía tras ecocardiograma de esfuerzo y ecografía carotídea. Se definió EACC como accidente cerebrovascular, infarto de miocardio por progresión aterosclerótica o muerte por accidente cerebrovascular o causa cardiaca. Resultados: Durante un seguimiento medio de 6 años (desviación estándar 2, 9) se registraron 2 pérdidas y 52 eventos (13,4%). La supervivencia media libre de eventos a uno, cinco y diez años fue 96.4% (1.0), 88.7% (1.7) y 81.4% (2.8). Hubo mayor número de eventos a 10 años en el grupo de PC (23.2% frente 10.2%, p = 0.013) y GIMC > 0.9 mm (25,9% frente 13.3%, p = 0.023). En el análisis multivariado los predictores de EACC fueron tabaquismo (hazard ratio [HR] 2.51, intervalo de confianza [IC] al 95% 1.36-4.62, p = 0.003), filtrado glomerular renal (HR 0.98 IC95% 0.98-0.99), estenosis aórtica (HR 2.99, IC 95% 1.24-7.21, p = 0.014), revascularización incompleta/no revascularización (HR 1.97, IC 95% 1.06-3.67, p = 0.033), tratamiento con insulina (HR 2.63, IC 95% 1.30-5.31, p = 0.006) y PC (HR 2.36, 95%CI 1.02-5.44, p = 0.044). Conclusiones: La PC es un predictor independiente de EACC en pacientes sometidos a coronariografía.

Effect of Dazhu Hongjingtian Capsule on Unstable Carotid Plaque with Qi Deficiency and Blood Stasis Syndrome / 中国实验方剂学杂志

Objective: To discuss the effect of Dazhu Hongjingtian capsule to unstable carotid plaque (Qi deficiency and blood stasis syndrome), and its mechanisms in resisting oxidation, inflammation and thrombosis. Method: One hundred and twenty-three patients were randomly divided into control group (61 cases) and observation group (62 cases) by random number table. Patients in control group got aspirin enteric-coated tablets, 0.1 g/time, 1 time/day, and rosuvastatin calcium capsules, 10 mg/time, 1 time/day. In addition to the therapy of control group, patients in observation group were also given Dazhu Hongjingtian capsule, 4 grains/days, 3 times/days. And the outpatient follow-up was made once every 2 weeks for continued 16 weeks. Intima-media wall thickness (IMT), and number and size of plaque were detected by color Doppler ultrasound. And levels of triglyceride (TG), total cholesterol (TC), high-density lipoprotein (HDL-C), low-density lipoprotein (LDL-C), superoxide dismutase (SOD), malondialdehyde (MDA), hypersensitive C reactive protein (hs-CRP), homocysteine (Hcy), matrix metalloproteinase-2 (MMP-2), MMP-9, tissue inhibitor of matrix metalloproteinase-2 (TIMP-2), platelet alpha granular membrane protein (GMP-140), P-selectin on surface of platelets (CD62 p), lysosome glycoprotein (CD63), and vascular pseudotumor factor (VWF) were detected. Qi deficiency and blood stasis syndrome were graded. Result: After treatment, IMT in observation group was thinner than that in control group, number of plaque was less than that in control group, and size of plaque was smaller than those in control group (PPPPConclusion: In addition to the treatment for resisting platelet and regulating blood lipid, Dazhu Hongjingtian capsule can lessen and reduce arterial speckle regulate lipid metabolism, ameliorate symptoms of traditional Chinese medical (TCM) syndrome, with effects in resisting oxidation, inflammation and thrombotic formation.

Prevalence and influencing factors of carotid plaque in population at high-risk for cardiovascular disease in Jiangsu province / 中华流行病学杂志

Objective@#To understand the prevalence of carotid plaque (CP) in population at high-risk for cardiovascular disease (CVD) in Jiangsu province and identify related influencing factors.@*Methods@#Based on the China Patient-centered Evaluative Assessment of Cardiac Events Million Persons Project from 2015 to 2016, a total of 11 392 persons at high-risk for CVD were selected from six project areas in Jiangsu province for the questionnaire survey, physical measurement, laboratory test and bilateral ultrasound examination of carotid arteries. The prevalence of CP and influencing factors of abnormal carotid arteries, CP and plaque burden (CP≥2) were analyzed.@*Results@#Among the persons surveyed, 4 821 (42.3%) were males. The age of the persons surveyed was (59.4±8.9) years. There were 5 971 abnormal carotid arteries cases (52.4%), including 1 782 carotid intima-media thickness thickening cases (15.6%), 3 811 CP cases (33.5%) and 378 carotid stenosis cases (3.3%). Older age (OR=2.253, 95%CI: 2.127-2.386), urban residence (OR=2.622, 95%CI: 2.375-2.895), hypertension (OR=1.439, 95%CI: 1.195-1.732), smoking (OR=1.441, 95%CI: 1.259- 1.650), pulse pressure difference (OR=1.270, 95%CI: 1.198-1.347), fasting plasma glucose (FPG) (OR=1.109, 95%CI: 1.059-1.161) and LDL-C/HDL-C (OR=1.225, 95%CI: 1.164-1.288) were possible risk factors of CP in population at high risk for CVD. Being women (OR=0.558, 95%CI: 0.494-0.630), high BMI (OR=0.948, 95%CI: 0.904-0.994), higher levels of education (OR=0.708, 95%CI: 0.531-0.945), and higher annual household income (OR=0.773, 95%CI: 0.669-0.894) were the possible protective factors.@*Conclusions@#Over half of the population at high-risk for CVD in Jiangsu showed abnormal carotid arteries. High blood pressure, high blood glucose, high blood lipids and smoking were the main factors that could be changed.

Association between Serum Alkaline Phosphatase and Carotid Atherosclerosis in a Chinese Population: A Community-based Cross-sectional Study / 生物医学与环境科学（英文）

OBJECTIVE@#This study aimed to investigate the relationship between alkaline phosphatase (ALP) and common carotid intima media thickness (IMT), carotid plaque, and extracranial carotid artery stenosis (ECAS).@*METHODS@#A total of 3,237 participants aged ⪖ 40 years were recruited from Jidong community in 2013-2014. Participants were divided into five quintile groups based on their serum ALP levels. Carotid atherosclerosis was assessed using ultrasound. Abnormal IMT, carotid plaque, and ECAS were defined as IMT > 0.9 mm, IMT > 1.5 mm, and ⪖ 50% stenosis in at least one extracranial carotid artery, respectively.@*RESULTS@#Common carotid IMT values and the prevalence of carotid plaque increased across serum ALP quintiles. Higher ALP quintiles were correlated with an increased risk of abnormal IMT [fourth quintile: odds ratio (OR) 1.78, 95% confidence interval (CI) 1.13-2.82, P = 0.0135; fifth quintile: OR = 1.82, 95% CI: 1.15-2.87, P = 0.0110] and ECAS compared to the lowest quintile (fifth quintile: OR = 1.47, 95% CI: 1.09-1.97, P = 0.0106). The association between ALP and prevalence of carotid plaque became insignificant after adjustment for confounders.@*CONCLUSION@#Serum ALP levels were independently associated with abnormal common carotid IMT and ECAS. These conclusions need to be further corroborated in future prospective cohort studies.

Association between dyslipidemia and carotid plaque incidence in a research group: a prospective cohort study / 中华流行病学杂志

Objective@#To assess the association and intensity of baseline dyslipidemia with the incidence of carotid plaque in a researchers group in China.@*Methods@#A total of 716 researchers were enrolled in this prospective cohort study. Dyslipidemia was assessed in 2010. Follow-up study on carotid plaque was conducted in 2017.@*Results@#Over 8 years’ follow-up, 289 carotid plaque patients were identified among 716 individuals who did not have carotid plaque at baseline survey, with cumulative incidence of 40.36%. After adjustment of age, gender, BMI, waist circumference, FPG, SBP, DBP, ALT and uric acid, compared with non-dyslipidemia group, HR of carotid plaque for such populations with ≥3 types of dyslipidemia was 1.681 (95%CI: 1.090--2.593).@*Conclusions@#Dyslipidemia might be associated with higher risk of carotid plaque, and population with ≥3 types of dyslipidemia had higher risk for carotid plaque. Prevention of dyslipidemia or reduction of types of dyslipidemia might be one of the effective precautions for prevention of carotid plaque.

Relationship between vulnerability of carotid artery plaques evaluated by contrast-enhanced ultrasonography and the prognosis of cerebral infarction / 中华全科医师杂志

Seventy two patients with initial cerebral infarction admitted in the Second Hospital of Jiaxing from March 2017 to October 2017 were enrolled. Patients underwent conventional ultrasonography and contrast-enhanced ultrasonography for two-dimensional echo grading and neovascularization grading of carotid artery plaques respectively. There were 113 carotid plaques in 72 patients with cerebral infarction,27 cases recurred after 1 years with 44 patches. The echo grading of recurrence group was mainly grade Ⅰ and grade Ⅱ,the number of Ⅰ,Ⅱ,and Ⅲ plaques was 23,18,and 3,respectively. The echo grading of non-recurrence group was mainly grade Ⅲ,the number of Ⅰ,Ⅱ,and Ⅲ plaques was 36,23,and 40,respectively. The echo grading of carotid artery plaque between the two groups was significantly different (P<0.05). The grade of carotid neovascularization in recurrence group was mainly grade Ⅲ and grade Ⅳ,the number of Ⅰ,Ⅱ,Ⅲ and Ⅳ plaques was 2,5,27 and 10,respectively. The echo grading of non-recurrence group was mainly grade Ⅰ and grade Ⅱ,the number of Ⅰ,Ⅱ,Ⅲ and Ⅳ plaques was 24,52,14 and 9,respectively. There was significant difference in the grade of carotid neovascularization between the two groups (P<0.05). The area under curve(AUC) of echo grade<Ⅱ,echo grade<Ⅲ,neovascularization grade>Ⅰ,neovascularization grade>Ⅱ and neovascularization grade>Ⅲ in predicting the recurrence of cerebral infarction were 0.553,0.641,0.587,0.793 and 0.557,respectively,the AUC of neovascularization grade>Ⅱ was significantly higher than the other four criteria (P<0.01). The recurrence curves of carotid plaques with different neovascularization grades were significantly different (χ2=49.18,P<0.01). Carotid plaque vulnerability evaluated by contrast-enhanced ultrasonography is an effective indicator for predicting recurrence of cerebral infarction.

Carotid Plaque Stiffness Measured with Supersonic Shear Imaging and Its Correlation with Serum Homocysteine Level in Ischemic Stroke Patients

OBJECTIVE: To ascertain the feasibility of using shear wave velocity (SWV) in assessing the stiffness of carotid plaque by supersonic shear imaging (SSI) and explore preliminary clinical value for such evaluation. MATERIALS AND METHODS: Supersonic shear imaging was performed in 142 patients with ischemic stroke, including 76 males and 66 females with mean age of 66 years (range, 45–80 years). The maximum, minimum, and mean values of SWV were measured for 129 carotid plaques. SWVs were compared between echolucent and echogenic plaques. Correlations between SWVs and serum homocysteine levels were investigated. Based on neurological symptom, the surrogate marker of vulnerable plaque (VP), binary logistic regression was performed and area under curve (AUC) of homocysteine only and homocysteine combing SWVmean was calculated respectively. RESULTS: Echogenic plaques (n = 51) had higher SWVs than echolucent ones (n = 78) (SWVmin 3.91 [3.24–4.17] m/s vs. 1.51 [1.04–1.94] m/s; SWVmean, 4.29 [3.98–4.57] m/s vs. 2.09 [1.69–2.41] m/s; SWVmax, 4.67 [4.33–4.86] m/s vs. 2.62 [2.32–3.31] m/s all p values < 0.01). Pearson correlation analysis showed that stiffness of plaques was negatively correlated with homocysteine level. R values for SWVmin, SWVmean, and SWVmax were −0.205, −0.213, and −0.199, respectively. Binary logistic regression analysis showed that sex (p = 0.008), low-density lipoprotein (p = 0.015), triglycerides (p = 0.011), SWVmean (p = 0.004), and hyper-homocysteinemia (p = 0.010) were significantly associated with symptomatic ischemic stroke. Receiver operating characteristic curves revealed that SWVmean combing serum homocysteine level (AUC = 0.67) presented better diagnostic value than serum homocysteine only (AUC = 0.60) for symptomatic ischemic stroke. CONCLUSION: Supersonic shear imaging could be used to quantitatively evaluate stiffness of both echolucent and echogenic carotid plaques. More importantly, SWVs of plaques were not only correlated to serum homocysteine level, but also associated with symptomatic ischemic stroke, suggesting that SSI might be useful for understanding more about VP.

Oxidized human serum albumin as a possible correlation factor for atherosclerosis in a rural Japanese population: the results of the Yakumo Study

BACKGROUND@#The effect of the redox state of human serum albumin (HSA) on the antioxidant properties of the entire body has been a focus of recent research. The usefulness of HSA redox state as a biomarker for reducing oxidative stress has been investigated in clinical settings; however, evidence for its significance as a health index in non-clinical settings is yet to be established. This study aimed to examine the associations between HSA redox state and the atherosclerotic indices of carotid intima-media thickness (IMT) and plaque formation in a rural Japanese population.@*METHODS@#We conducted a cross-sectional study as part of a health check-up program in the rural area of Hokkaido, Japan, at the end of August 2013. A total of 281 residents (124 men and 157 women) were included in the final analysis. Lifestyle-related data were obtained through a self-reported questionnaire, and ultrasound examinations were performed to measure IMT and determine plaque formation. The high-performance liquid chromatography postcolumn bromocresol green method was used to separate HSA into human nonmercaptalbumin and human mercaptalbumin (HMA).@*RESULTS@#We found a significant negative relationship between the fraction of HMA [f(HMA)] and IMT (standardized β = - 0.132, p = 0.03). Moreover, f(HMA) was significantly associated with plaque formation (p < 0.01) with an odds ratio of 0.89 (95% confidence interval, 0.81-0.97) for every 10% increment in f(HMA).@*CONCLUSIONS@#We found that the HSA redox state, as determined by f(HMA), was associated with atherosclerotic indices in Japanese subjects. These results suggest that the HSA redox state indicates the risk of developing atherosclerosis.

Effect of vitamin D supplementation combined with standard secondary prevention and treatment in patients with coronary heart disease / 国际检验医学杂志

Objective To analyze the clinical value of vitamin D supplementation combined with standard secondary prevention and treatment in patients with coronary heart disease(CHD).Methods 120 patients with CHD were divided into the control group and the observation group,60 cases in each group.Both groups were given the standard secondary prevention and treatment and the observation group were additionally given vitamin D supplementation.The changes of glucose and lipid metabolism and carotid plaque before and after treatment were compared between the two groups,and the incidence of readmission in the two groups was sta-tistically analyzed.Results After 6 and 12 months of treatment,the fasting blood glucose(FPG),2 h post-prandial blood glucose(2 h PG),carotid intima-media thickness(IM T),coronary plaque integral and high-sen-sitivity C reactive protein(hs-CRP)in the observation group were lower than those in the control group,while glycosylated hemoglobin(HbA1c),serum calcium and 25(OH)D3were higher than those in the control group (P<0.05);There were no significant differences between the two groups in the incidence rates of adverse car-diovascular events and readmission(P>0.05).Conclusion In the treatment of patients with CHD,vitamin D supplementation combined with standard secondary prevention and treatment can regulate glucose and lipid metabolism,delay the progression of carotid atherosclerosis and reduce the incidence of adverse cardiovascular events.

The influence factors of maintenance dialysis patients with carotid plaque and its relationship with cardio-vascular disease / 实用医学杂志

Objective To analyze the influence factors of maintenance dialysis patients with carotid plaque and explore its relationship with cardiovascular disease(CVD). Methods 52 patients on peritoneal dialy-sis and 46 patients on maintenance hemodialysis were involved in this study. Bilateral carotid intima-media thick-ness(IMT)and plaque,the related clinical indicators and CVD were recorded. According to the mode of dialysis, carotid plaque,CVD respectively,we divided our population into two groups,and statistical analyses were made between the two groups. Results Age,percentage of male,the number of hypertension and diabetes,blood uric acid ,blood glucose ,the incidence of cardiovascular disease are higher ,but the level of albumin is lower in the carotid plaque group. Binary Logistic Regression analysis showed that hypertension ,albumin and uric acid signifi-cantly influenced carotid plaque formation (P < 0.05). CVD is closely related to the carotid plaque (r = 0.415 , P = 0.000). Left and right IMT value are higher in the patients with CVD (P < 0.01);carotid plaque mainly distributed in the common carotid artery(CCA)and carotid artery bifurcation(BIF),and with the larger number in the patients with CVD(P<0.01). Conclusions Carotid plaque formation is closely related with the occurrence of CVD in maintenance dialysis patients. Hypertension ,albumin and uric acid are risk factors for the formation of carotid plaque,so dialysis patients in addition to maintain the blood pressure and improve nutrition,are also very important to control the level of uric acid.

Improvement role of aspirin combined with statins on carotid plaque of patients with cerebral thrombosis / 中国生化药物杂志

Objective To investigate the improvement role of aspirin combined with statins on carotid plaque of patients with cerebral thrombosis.Methods80 cases of patients with cerebral thrombosis in our hospital from May 2014 to May 2016 were selected, these patients were divided into aspirin combined with statins treatment group (combined treatment group, 40 cases) and single aspirin treatment group (single treatment group, 40 cases) two groups according to the treatment methods, the NIHSS scores, Barthel indexes, clinical curative effects, IMT, plaque areas of the two groups were statistically analyzed.ResultsThe NIHSS score of the combined treatment group was significantly lower (P<0.05), the Barthel index was significantly higher (P<0.05), the total treatment efficiency 95.0% (38/40) was significantly higher than the single treatment group 80.0% (32/40) (P<0.05), the IMT was significantly shorter (P<0.05), the plaque area was significantly smaller than the single treatment group (P<0.05).ConclusionAspirin combined with statins can more effectively improve the carotid plaque of patients with cerebral thrombosis than aspirin alone, so is worthy of promotion and use in the clinical.