Effects of acupuncture on carotid intima-media thickness and cerebral blood flow velocity in patients with mild-to-moderate hypertension / 中国针灸

OBJECTIVE@#To observe the characteristics of carotid intima-media thickness (IMT) and cerebral blood flow velocity in patients with mild-to-moderate hypertension, and to evaluate the effects of acupuncture on carotid IMT and blood flow velocity of middle cerebral artery and vertebral-basilar artery.@*METHODS@#A total of 240 patients with mild-to-moderate hypertension who met the inclusion criteria were treated with acupuncture method proposed by academician . The acupoints of Renying (ST 9), Quchi (LI 11), Hegu (LI 4), Zusanli (ST 36) and Taichong (LR 3) were selected. The treatment was given once a day, five times a week for 3 months. The carotid ultrasonography and transcranial color Doppler were performed before treatment and 3 months after treatment to evaluate the improvements of carotid IMT and brain blood flow velocity.@*RESULTS@#Among 175 patients, 94.3% suffered from impaired carotid IMT. After acupuncture intervention, 7.7%-10.9% patients had improved IMT but 4.6%-6.3% had aggravated carotid IMT. There was no significant difference of carotid IMT before and after treatment (>0.05). About 50% patients had abnormal intracranial blood flow velocity; after acupuncture intervention, 27.4%-33.3% patients who had the abnormal blood flow velocity had normal one, but 27.0%-52.5% patients who had normal blood flow velocity had abnormal one. After acupuncture intervention, the low-speed blood flow of MCA, VA and BA in female patients aged 41-60 years and the low-speed blood flow of MCA and VA in female patients aged 61-70 years were significantly improved (all <0.05); the high-speed blood flow of MCA and VA in male patients aged 61-70 years and the high-speed blood flow of VA and BA in female patients aged 41-60 years were significantly decreased (all <0.05).@*CONCLUSION@#Nearly 95% of patients with mild-to-moderate hypertension had carotid IMT, and about 50% had abnormal blood flow velocity of intracranial artery. The present study failed to found significant effects of acupuncture on carotid IMT, but it shows acupuncture can generally improve the low blood flow velocity in women with mild-to-moderate hypertension.

Relationship between homocysteine in plasma and carotid atherosclerosis in the elderly patients / 上海交通大学学报（医学版）

Objective • To study the relationship between homocysteine (HCY) in plasma and carotid atherosclerosis in the elderly patients and its clinical significance. Methods • The intima-media thickness (IMT) of the common carotid arteries and the sclerotic lesions at the carotid arteries bulbs were evaluated by color Doppler ultrasonography in 99 elderly in-patients (65 years old or above). Fasting venous blood was drew from the patients for the determination of plasma HCY and other indexes. According to the plasma HCY concentration, the patients were divided into two groups, i.e., control group (HCY<15 μmol/L) and high HCY group (HCY ≥ 15 μmol/L). General clinical data, carotid plaque number, plaque thickness, plaque stability and carotid IMT were investigated in the two group of patients. Results • The numbers (P=0.015), stability (P=0.013) and thickness (P=0.001) of carotid plaques between the two groups were significantly different. After balancing the effects of age by the partial correlation analysis, plasma HCY concentration was positively correlated with the number (partial correlation coefficient=0.133, P=0.049), instability (partial correlation coefficient=0.046, P=0.023) and thickness (partial correlation coefficient=0.119, P=0.024) of carotid plaques. Nevertheless, the difference in the IMT of carotid arteries between the two groups was not significant (P=0.057). Conclusion • Plasma HCY concentration is correlated with the number, stability and thickness of carotid plaques.

Relationship between tooth loss and carotid intima-media thickness in Korean adults

PURPOSE: The aim of this study was to examine the relationship between tooth loss and sub-clinical atherosclerosis in Korean adults. MATERIALS AND METHODS: The subjects were part of a cohort study conducted in Ansan city by the Korea University medical school as part of the Korean Genome project. 749 subjects over than 40 years old were evaluated. After taking panoramic radiography, the amount of tooth loss was calculated. The intima-media thickness (IMT) was assessed by using ultrasonography at the common carotid artery. Traditional cardiovascular risk factors for atherosclerosis were also evaluated. The relationship between tooth loss and the IMT was evaluated using ANOVA with Scheffe's multiple comparison method in univariate analysis. Multiple regression analysis was also performed to determine the significance between the IMT and tooth loss. RESULTS: With age, tooth loss increased, but there was no significant increase in other traditional cardiovascular risk factors. Univariate analysis revealed the IMT to be positively related with the amount of tooth loss. Regression analysis of the IMT in the anterior and posterior tooth loss revealed that only the posterior tooth loss was significantly related with the IMT at all sites of the common carotid artery (right far wall, P = .015; left far wall, P = .008; right near wall, P < .001; left near wall, P = .001). CONCLUSION: This study verified the positive relationship between the increased tooth loss at the posterior area and the accumulation of atheroma in arteries.

The Effect of Latent Syphilis on Carotid Intima-Media Thickness in Acute Ischemic Stroke Patients

BACKGROUND: Neurosyphilis develops into ischemic stroke due to the occlusion of intracranial arteries, which has the histopathological change of intracranial syphilitic arteritis. There might be an association between a latent syphilis and arterial changes before the neurosyphilis develops. We evaluated the relationship between the latent syphilis and the carotid intima-media thickness (IMT) in acute ischemic stroke patients to study whether the latent syphilis affected pathological arterial changes. METHODS: Retrospectively consecutive 96 acute ischemic first ever stroke patients were selected from the Gachon stroke registration from January 2003 to May 2005. The latent syphilis group was made up of 44 patients and the non-syphilis group matched in the age and the sex and consisted of 52 patients. The stroke subtype was classified by TOAST classification. RESULTS: The mean carotid IMT of the latent syphilis group (3.06+/-3.78 mm right, 2.68+/-3.39 mm left) was thicker than that of the non-syphilis group (1.49 +/-2.37 mm right, 1.43+/-1.99 mm left)(p<0.05). The hs-CRP was more elevated in the latent syphilis group than the non-syphilis group (1.6+/-2.2 mg/dl, 1.0+/-2.3 mg/dl respectively) (p<0.05). There were no significant differences of in each of the risk factors between the two groups. CONCLUSIONS: Our results showed the patients with latent syphilis had thicker carotid IMT, and a higher level of hs-CRP than the non-syphilis patients. It could be possible that the latent syphilis attributed to the pathological changes by the inflammation in the extracranial carotid artery.

Measurements of Carotid Intima, Media, and Intima-media Thickness and Their Clinical Importance / 의학물리

The severity of carotid intima-media thickness (IMT) is an independent predictor of atherosclerosis which causes transient cerebral ischemia, stroke, and coronary events such as myocardial infarction. The IMT consists of intima thickness (IT) and media thickness (MT). However, the Individual clinical significance of IT and MT has not been well studied. We devised a method of measuring IT, MT, and IMT using B-mode ultrasound image processing technique for the diagnosis of atherosclerosis. To inspect the clinical significance of IT, MT, and IMT, one hundred forty-four consecutive patients (mean age; 57 years old, 72 males) were underwent common carotid artery scanning using high-resolution ultrasound. Results showed that, the IT (p<0.05), MT (p<0.05) as well as IMT (p<0.01) of patients with atherosclerotic disease were significantly thicker than that of the patients without atherosclerotic disease. Patients with hypertension showed significantly thicker IT (p<0.01), MT (p<0.001), and IMT (p<0.001). However, only IT was thicker in patients with smoking (p<0.01). The IT (r=0.374, p=0.001), MT (r=0.433, p=0.000), and IMT (r=0.479, p=0.000) showed positive correlation with age. The coefficients of determination (r(2)) were estimated to be 92.4% for IMT and MT, 49.1% for IMT and IT, and 27.4% for IT and MT. This result suggests that the intima layer of the carotid artery has a different physiology with the media layer.

Study of the relationship between carotid atherosclerosis and progressing stroke / 中国康复理论与实践

@#ObjectiveTo investigate the relationship between carotid atherosclerosis and progressing stroke.Methods103 patients with acute cerebral infarction within the first 24 hours from onset were tested with carotid color doppler ultrasonography during the first week from admission. Univariate and multiple logistic regression analyses were performed to examine the relationship between carotid intima media thickness (IMT), plaque structure, the degree of artery stenosis and the early deterioration of cerebral infarction.ResultsPrevalence of carotid plaque and thickness of IMT in patients with progressing stroke were higher than that in non progressing patients. In logistic regression, presence of carotid plaque was independent predictors of progressing stroke. Plaque size, extent of artery stenosis and IMT were not included in the regression model.ConclusionPlaque structure and its chemical feature may be the cause of progressing stroke.

Correlations of Atherosclerotic Risk Factors and Carotid Artery Intima-media Thickness in Healthy Subjects

PURPOSE: Atherosclerotic risk factors are highly associated with the progression and severity of cerebrovascular disease; the carotid artery intima-media thickness (IMT) correlates well with the known risk factors for atherosclerosis. The aims of this study are to evaluate the associations of the carotid artery IMT with the atherosclerotic risk factors and to determine the reference values of the carotid artery IMT in healthy subjects who were without cardiovascular symptoms. METHOD: Ultrasound high-resolution B-mode imaging of the carotid artery was performed in 273 subjects (168 men, 105 women). We investigated the mean carotid artery IMT and the correlation between the carotid artery IMT and the atherosclerotic risk factors. RESULT: The mean carotid artery IMT values were 0.70+/-0.25 mm in the common carotid artery, 0.61+/-0.15 mm in the internal carotid artery, 0.55+/-0.26 mm in the external carotid artery and 0.92+/-0.45 mm in the carotid bulb. The mean carotid artery IMT was significantly increased with increasing age (P<0.05), and particularly in males. Age, systolic and diastolic blood pressure, body mass index, total cholesterol and LDL cholesterol levels correlated with the mean carotid artery IMT. Especially, the presence of plaque (26 subjects) was correlated with the mean carotid artery IMT in the internal carotid artery (P<0.05) and bulb (P<0.01). CONCLUSION: This study revealed the correlation between the carotid artery IMT and the atherosclerotic risk factors; we also elucidated the reference values for the mean carotid artery IMT in healthy subjects who were without cardiovascular diseases and symptoms.

Reference values of carotid artery intima-media thickness and association with atherosclerotic risk factors in healthy subjects in Korea / 대한내과학회지

BACKGROUND: Atherosclerosis is an important cause of cardiovascular and cerebrovascular diseases, which are the major cause of death in middle-aged and older adults. However atherosclerotic lesions are not easily detected before they cause symptoms and signs which means that early detection is important. In Korea it has been reported that the carotid artery intima-media thickness (IMT) correlates well with the atherosclerotic risk factors in type 2 diabetes mellitus, but there is little data available on the carotid artery IMT in healthy subjects. Therefore, the aims of this study were to determine the reference values of the carotid artery IMT in healthy subjects and to investigate the associations of the carotid artery IMT with the atherosclerotic risk factors. METHODS: Ultrasound high-resolution B-mode imaging of the carotid arteries was conducted in 757 healthy subjects (385 men, 372 women) in order to determine the mean and maximal carotid artery IMT and the presence of carotid artery atherosclerotic plaques. RESULTS: The mean carotid artery IMT values with respect to gender were 0.69+/-0.18 mm in men and 0.67+/-0.16 mm in women (NS). The mean carotid artery IMT values with respect to age in men and women were 0.57+/-0.09 mm vs 0.57+/-0.10 mm in those aged 30 to 39, 0.61+/-0.11 mm vs 0.60+/-0.10 mm in those aged 40 to 49, 0.72+/-0.21 mm vs 0.67+/-0.12 mm in those aged 50 to 59, 0.77+/-0.15 mm vs 0.71+/-0.13 mm in those aged 60 to 69 and 0.88+/-0.18 mm vs 0.76+/-0.20 mm in those aged 70 to 79, respectively. The mean carotid artery IMT was significantly greater with increasing age (p<0.001), particularly between those aged 40 to 49 and 50 to 59 (p<0.001). The maximal carotid artery IMT values for men (0.72+/-0.22 mm) were significantly greater than women (0.69+/-0.15 mm). The maximal carotid artery IMT values with respect to age in men and women were 0.60+/-0.10 mm vs 0.61+/-0.12 mm in those aged 30 to 39, 0.65+/-0.11 mm vs 0.64+/-0.11 mm in those aged 40 to 49, 0.79+/-0.29 mm vs 0.71+/-0.14 mm in those aged 50 to 59, 0.83+/-0.20 mm vs 0.77+/-0.18 mm in those aged 60 to 69 and 0.97+/-0.29 mm vs 0.80+/-0.22 mm in those aged 70 to 79. The mean carotid artery IMT was significantly greater with increasing age (p<0.001), particularly between those aged 40 to 49 and 50 to 59 (p<0.001). Age, systolic and diastolic BP, body mass index, waist/hip ratio, total cholesterol, LDL cholesterol correlated with the mean and maximal carotid artery IMT, and smoking, serum glucose, triglyceride, and HDL cholesterol levels were not correlated with the mean and maximal carotid artery IMT. Being male correlated with the maximal carotid artery IMT, but not correlated with the mean carotid artery IMT. CONCLUSION: This study suggested reference values for the mean and maximal carotid artery IMT in healthy subjects, which can be an index for the carotid artery IMT of Koreans. Furthermore, there were significant correlations between the carotid artery IMT and the atherosclerotic risk factors in healthy subjects.

Carotid Intima Media Thickness (IMT) in Relation to Subclinical Atherosclerosis in Turner Syndrome / 대한산부인과학회잡지

OBJECTIVE: This study was undertaken to determine whether women with Turner syndrome have greater subclinical atherosclerosis and evaluate the relationship to risk factors for atherosclerosis. METHODS: 18 Women with Turner syndrome and 18 women as control group were measured the intima media thickness (IMT) of common carotid artery by B-mode ultrasound. We compared the IMT between cases and controls, and analyzed risk factors which affect the IMT. RESULTS: There are no differences between the groups in age and body mass index (BMI). The height was shorter (147.8+/-7.9 vs 160.3+/-5.9, p<0.001) and the waist-hip ratio (WHR) was significantly increased in Turner syndrome (0.86+/-0.04 vs 0.78+/-0.04, p<0.001). Fasting blood sugar (FBS) (90.1+/-9.9 vs 79.4+/-4.4 mg/dl, p<0.001), fasting insulin (9.5+/-3.0 vs 4.7+/-1.0 IU/ml, p=0.009), total cholesterol (187.1+/-21.3 vs 154.8+/-21.8 mg/dl, p=0.014), and LDL (111.3+/-10.0 vs 82.8+/-16.4 mg/dl, p=0.009) were significantly higher in Turner syndrome. Compare to control, the IMT was significantly increased in Turner syndrome (0.61+/-0.09 vs 0.49+/-0.02 mm, p=0.002). In the analysis of correlation between the IMT and clinical & biochemical characteristics, Turner syndrome status, WHR, FBS and fasting insulin were significantly affecting factors (Coefficients of correlation: 0.720, p<0.001; 0.671, P<0.001; 0.445, p=0.020; 0.904, p<0.001). CONCLUSION: These results suggested that women with Turner syndrome might have an increased risk of subclinical atherosclerosis and insulin resistance was most important risk factor.

Carotid Artery Intima-Media Thickness and Large-Artery Atherosclerotic Cerebral Infarction

BACKGROUND: Carotid artery intima-media thickness (IMT) is an early structural marker of the atherosclerotic processes and an increased carotid IMT is a strong predictor of stroke. The measurement of carotid IMT is a useful non-invasive measure in risk stratification of ischemic stroke. The objective of the present study is to evaluate whether mea-surement of carotid IMT contributes to the prediction of large-artery atherosclesrotic cerebral infarction. METHODS: By TOAST classifications, 88 patients with ischemic stroke [67 with large-artery disease (LAD) and 21 with small-artery disease (SAD)] were selected from a stroke registry (2000.7~2001.7). Carotid IMT was defined as the mean of IMT measured by B-mode ultrasonography (12 MHz linear probe) at 10 sites of both distal common carotid arteries. The dif-ferences of carotid IMT were analyzed statistically between the LAD and SAD groups according to age or sex. RESULTS: The carotid IMT was 0.84+/-0.08 mm for the LAD and 0.77+/-0.04 mm for the SAD groups. There were no statistically significant differences (p > 0.05) of carotid IMT(total, age, sex) between the LAD and SAD groups. CONCLUSIONS: In this study, the carotid IMT was not associated with LAD as wells as SAD. However, with the increase in age, there is a tendency to increase the differences of carotid IMT between LAD and SAD groups.

Intima Media Thickness(IMT) in Relation to Insulin Resistance and Subclinical Atherosclerosis in Polycystic Ovary Syndrome(PCOS) / 대한산부인과학회잡지

OBJECTIVES: The purpose of this study was to determine whether women with PCOS have greater subclinical atherosclerosis and evaluate the relationship to risk factors for atherosclerosis. METHODS: Women with PCOS(n=24) and age and body mass index(BMI)-matched cycling women(n=16) as control group underwent carotid scanning for the measurement of the IMT. We compared IMT and plaque between cases and controls, assessed some risk factors for atherosclerosis, and analyzed factors affecting IMT. RESULTS: There was no difference between the groups in waist-hip ratio(WHR) and in the levels of total cholesterol, triglyceride(TG), LDL, Lp(a), fibrinogen, homocystein, plasminogen activator inhibitor 1. However, HDL was significantly lower, and systolic and diastolic blood pressure, fasting blood sugar or insulin concentration and IMT was significantly higher in PCOS group than control group (51.1+/-11.6 vs 60.4+/- 10.0mg/dl, 119.4+/-12.5 vs 109.0+/-11.6mmHg, 79.1+/-11.1 vs 68.9+/-7.8mmHg, 93.6+/-11.1 vs 85.0+/-5.9 mg/dl, 8.9+/-5.2 vs 5.0+/-3.3milliunit/ml, 0.57+/-0.12 vs 0.49+/-0.11mm respectively, all p<.05). In the analysis of correlation between the IMT and clinical characteristics, PCOS status, BMI, systolic and diastolic blood pressure, fasting blood sugar or insulin concentration, TG, HDL, fibrinogen were significantly independent variables (Coefficients of correlation were 0.358, 0.461, 0.452, 0.349, 0.405, 0.466, 0.478, -0.433, 0.349 respectively, all p<.05). The factors affecting IMT by multivariate regression were PCOS status and fasting insulin concentration. CONCLUSIONS: We concluded that women with PCOS might have an increased risk of subclinical atherosclerosis and insulin resistance was assumed to be the main risk factor of atherosclerosis.