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1.
Rev. cuba. med. mil ; 53(2)jun. 2024.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1583722

ABSTRACT

Introducción: Se realizó una revisión narrativa de los estudios publicados desde 2016 hasta 2021 sobre los aspectos clínicos, etiológicos, imagenológicos y terapéuticos de las diferentes formas clínica de la enfermedad cerebral vascular en los ancianos. Se consultaron las bases de datos de Medline (PubMed), SciELO, Cochrane y Google Académico. Se tuvieron en cuenta los artículos originales, publicados en revistas con revisión por pares, que incluyeran pacientes mayores de 65 años, con diagnóstico de enfermedad vascular cerebral. Objetivo: Actualizar sobre las particularidades de la enfermedad vascular cerebral en el adulto mayor. Desarrollo: En la enfermedad cerebrovascular del adulto mayor se observan condiciones particulares: biológicas, psicológicas y sociales, que son menos frecuente o incluso pueden estar ausentes, en los grupos etarios más jóvenes. La arterioesclerosis de grandes vasos, el cardioembolismo, la enfermedad de pequeños vasos y la angiopatía cerebral amiloidea constituyen las etiologías predominantes, aunque pueden existir otras causas. El deterioro cognitivo vascular representa la segunda causa de demencia y es una forma clínica de presentación de la enfermedad vascular cerebral en este grupo etario. Conclusiones: La enfermedad cerebrovascular en el adulto mayor, presenta características particulares que se resumen en: mayor comorbilidad y riqueza de factores de riesgo, que obligan a un enfoque diagnóstico sistémico, dialécticamente interrelacionado y personalizado, en el cual las neuroimágenes ocupan un lugar de singular importancia; que, en interacción con la clínica, permitirán un diagnóstico y seguimiento evolutivo más integral de estos pacientes.


Introduction: A narrative review was carried out of the studies published from 2016 to 2021 on the clinical, etiological, imaging and therapeutic aspects of the different clinical forms of vascular cerebral disease in the elderly. The databases of Medline (PubMed), SciELO, Cochrane and Google Scholar were consulted. Original articles, published in peer-reviewed journals, that included patients over 65 years of age, with a diagnosis of cerebral vascular disease, were taken into account. Objective: Update on the particularities of cerebral vascular disease in older adults. Development: In cerebrovascular disease of the elderly, particular conditions are observed: biological, psychological and social, which are less frequent or may even be absent in younger age groups. Large vessel atherosclerosis, cardioembolism, small vessel disease, and cerebral amyloid angiopathy are the predominant etiologies, although other causes may exist. Vascular cognitive impairment represents the second cause of dementia and is a clinical form of presentation of cerebral vascular disease in this age group. Conclusions: Cerebrovascular disease in the elderly presents particular characteristics that are summarized in: greater comorbidity and richness of risk factors, which require a systemic, dialectically interrelated and personalized diagnostic approach, in which neuroimaging occupies a unique place. importance; which, in interaction with the clinic, will allow a more comprehensive diagnosis and evolutionary follow-up of these patients.

2.
Article in Chinese | WPRIM | ID: wpr-1021214

ABSTRACT

BACKGROUND:CXC motif chemokine 5(CXCL5)is a neutrophil activating peptide derived from epithelial cells,which may be involved in arterial diseases.However,there is yet no report on the effect of CXCL5 in vascular calcification. OBJECTIVE:To explore the role of CXCL5 in the vascular calcification of carotid atherosclerosis(CAS). METHODS:(1)Cytological experiment:Mouse vascular smooth muscle cells(VSMCs)were divided into five groups:osteogenic medium group,Vector group(vector,blank plasmid transfected into VSMCs),CXCL5 group(CXCL5 plasmid transfected into VSMCs),si-NC group(CXCL5 negative control siRNA transfected into VSMCs),si-CXCL5 group(CXCL5 siRNA transfected into VSMCs),Vector+LY2157299 group and CXCL5+LY2157299 group(LY2157299 transferred into the cells 24 hours after cell transfection).Alizarin red staining,alkaline phosphatase staining,and calcium content determination were performed to evaluate the osteogenic differentiation level of VSMCs.(2)Animal experiment:Forty-eight ApoE-/-mice were randomly divided into four groups(n=12 per group):Con+si-NC group,Con+si-CXCL5 group,CAS+si-NC group and CAS+si-CXCL5 group.Animal models were not prepared in the first two groups,in which si-NC or si-CXCL5 lentivirus was injected into the tail vein;carotid atherosclerosis models were made in the latter two groups,in which si-NC or si-CXCL5 lentivirus was injected into the tail vein.Von Kossa staining and immunohistochemical staining were used to evaluate carotid vascular calcification and the expression of CXCL5 and transforming growth factor-β receptor 1(TGFBR1)in mice. RESULTS AND CONCLUSION:In the CXCL5 group,the protein level of runt-related transcription factor 2(RUNX2)was up-regulated and the level of α-smooth muscle actin was down-regulated,in contrary to the findings in the si-CXCL5 group.In addition,CXCL5 overexpression upregulated the level of TGFBR1,while CXCL5 knockdown inhibited the level of TGFBR1.Compared with the Vector group,the intensity of alizarin red staining,alkaline phosphatase activity and calcium content in the CXCL5 group increased significantly(P<0.05).Compared with the si-NC group,the intensity of alizarin red staining,alkaline phosphatase activity and calcium content in the si-CXCL5 group decreased significantly(P<0.05).When LY2157299 inhibited TGFBR1 expression,the osteogenic differentiation of VSMCs induced by CXCL5 was reduced.Compared with the Con+si-NC group,the expression of CXCL5 protein in the carotid artery and calcification area in the CAS+si-NC group increased significantly(P<0.05).Compared with the CAS+si-NC group,the expression of CXCL5 protein in the carotid artery and vascular calcification area in the CAS+si-CXCL5 group decreased significantly(P<0.05).In addition,compared with the Con+si-NC group,the expression of RUNX2 protein in the carotid artery in the CAS+si-NC group increased significantly(P<0.05),while the expression of α-smooth muscle actin protein decreased significantly(P<0.05).Compared with the CAS+si-NC group,the expression of RUNX2 protein in the carotid artery in CAS+si-CXCL5 group decreased significantly(P<0.05),while the expression of α-smooth muscle actin protein increased significantly(P<0.05).In conclusion,CXCL5 can induce osteogenic transformation of VSMCs by activating the TGFBR1 pathway,and inhibition of CXCL5 expression is effective in improving carotid arterial calcification in CAS mice.

3.
China Modern Doctor ; (36): 46-49,67, 2023.
Article in Chinese | WPRIM | ID: wpr-1038054

ABSTRACT

Objective To explore the effect of different types of helicobacter pylori(Hp)on carotid atherosclerosis(CAS)and the efficacy of rosuvastatin.Methods Totally 346 subjects were examined in the physical examination center of our hospital from February 2020 to June 2022.According to the results of 14C urea breath test and Hp antibody typing,they were divided into 102 cases of type Ⅰ Hp infection group,79 cases of type Ⅱ Hp infection group and 165 cases of Hp negative group,inflammatory factors,blood lipids and carotid artery ultrasound were also examined.All subjects with carotid atherosclerosis were instructed to treat with rosuvastatin 10mg/d,and the level of low density lipoprotein cholesterol(LDL-C)was rechecked after 4 weeks.Results There were significant differences in high sensitivity C-reactive protein(hs-CRP),IL-6 and tumor necrosis factor-α(TNF-α)between the three groups(P<0.05).Compared with Hp negative group,cholesterol(TC)and LDL-C in type Ⅰ and type Ⅱ Hp infection groups were significantly increased,while high density lipoprotein cholesterol(HDL-C)in type Ⅰ Hp infection group was significantly decreased;compared with type Ⅱ Hp infection group,LDL-C in type Ⅰ Hp infection group was significantly increased,and HDL-C was significantly decreased(P<0.05).The detection rate of stable plaque and unstable plaque in Hp positive subjects was significantly higher than that in Hp negative subjects(P<0.05);the detection rate of stable plaque and unstable plaque in type Ⅰ Hp infected subjects was significantly higher than that in type Ⅱ Hp infected subjects(P<0.05);after adjusting for age,hypertension,diabetes and other risk factors,it was still an independent risk factor of carotid atherosclerotic plaque vulnerability.After 4 weeks,the LDL-C level of CAS subjects in the three groups before and after treatment was significantly different(P<0.05).Compared with the type Ⅰ Hp group,the LDL-C level of CAS subjects in the Hp-negative group was significantly lower(P<0.05).Conclusion Hp infection,especially type Ⅰ Hp infection,is related to dyslipidemia,stimulation of inflammatory reaction and instability of carotid plaque,affecting the efficacy of lipid-lowering drugs.

4.
Article in Chinese | WPRIM | ID: wpr-1017776

ABSTRACT

Objective To investigate the correlation of serum atresia zonule protein 1(ZO-1)and anti-β2-glycoprotein 1 antibody(aβ2-GP1)levels with infarct lesion extent and degree of carotid atherosclerosis in pa-tients with cerebral infarction.Methods A total of 103 patients with cerebral infarction treated in Baoding No.1 Central Hospital from January 2020 to January 2023 were selected as the study group,and 51 healthy subjects in the same hospital during the same period were selected as the control group.Patients with cerebral infarction were divided into large infarction group(infarct lesion extent>50 cm2),middle infarction group(infarct lesion extent as 10-50 cm2),and small infarction group(infarct lesion extent<10 cm2)according to the infarct lesion extent.According to the results of carotid ultrasound,the patients with cerebral infarction were divided into plaque stage group,thickening stage group and normal vessel wall group.Enzyme-linked im-munosorbent assay was used to detect serum ZO-1,aβ2-GP1 levels,and the levels of ZO-1 and aβ2-GP1 in each group were compared.Spearman correlation analysis was used to analyze the correlation between serum ZO-1,aβ2-GP1 levels and the infarct lesion extent and the degree of carotid atherosclerosis in patients with cerebral infarction.Results The study group had a significantly lower serum level of ZO-1 and a significantly higher serum level of aβ2-GP1 than the control group(P<0.05).Among the 103 patients with cerebral in-farction,there were 32 cases in the large infarction group,34 cases in the middle infarction group,and 37 cases in the small infarction group.The small infarction group had a significantly higher level of ZO-1 and a signifi-cantly lower level of aβ2-GP1 than the medium infarction group and large infarction group(P<0.05).The middle infarction group had a significantly higher level of ZO-1 and a significantly lower level of aβ2-GP1 than the large infarction group(P<0.05).Among 103 patients with cerebral infarction,there were 29 cases in the plaque stage group,38 cases in the thickening stage group,6 cases in the normal vessel wall group.The plaque stage group had a significantly lower serum level of serum ZO-1 and a significantly higher level of aβ2-GP1 than the thickening stage group and normal vessel wall group(P<0.05).The thickening stage group had a significantly lower serum level of ZO-1 and a significantly higher serum level of aβ2-GP1 than the normal ves-sel wall group(P<0.05).Spearman correlation analysis showed that the serum level of ZO-1 was negatively correlated with the degree of carotid atherosclerosis and the extent of infarction(P<0.05),and the serum level of aβ2-GP1 was positively correlated with the degree of carotid atherosclerosis and the extent of infarc-tion(P<0.05).Conclusion The levels of serum ZO-1 and aβ2-GP1 in patients with cerebral infarction are significantly correlated with the degree of carotid atherosclerosis and the extent of infarction,which have po-tential value in the diagnosis,treatment and prognosis of patients with cerebral infarction.

5.
Article in Chinese | WPRIM | ID: wpr-984593

ABSTRACT

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.

6.
Article in Chinese | WPRIM | ID: wpr-998584

ABSTRACT

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.

7.
Article in Chinese | WPRIM | ID: wpr-994316

ABSTRACT

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.

8.
Article in Chinese | WPRIM | ID: wpr-996823

ABSTRACT

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.

9.
J. Vasc. Bras. (Online) ; J. vasc. bras;22: e20220084, 2023. tab
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1448591

ABSTRACT

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.

10.
Rev. cuba. med ; 61(1)mar. 2022.
Article in Spanish | LILACS, CUMED | ID: biblio-1408975

ABSTRACT

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)


Subject(s)
Humans , Male , Female , Carotid Artery Diseases/epidemiology , Carotid Intima-Media Thickness , Hypothyroidism/drug therapy , Hypothyroidism/epidemiology
11.
Article in Chinese | WPRIM | ID: wpr-1038883

ABSTRACT

@#To analyze the correlation between trace element levels and carotid atherosclerosis(CAS),explore the risk factors of CAS. Methods People who underwent physical examination,and performed carotid artery ultrasonography,trace element detection and inflammatory factors detection were collected from January 2020 to February 2022 in the Physical Examination Center of the First Hospital of Jilin University. 325 cases were selected in strict accordance with the inclusion and exclusion criteria,the subjects were classified into two groups according to carotid intima-media thickness(IMT). There were 146 cases in the normal carotid artery group and 179 cases in the carotid atherosclerosis group. Chi-square test,t test and rank sum test were used to compare the differences in basic information,serum trace element levels,C-reactive protein(CRP) and blood biochemistry between the two groups;Spearman correlation analysis was used to explore the correlation between carotid IMT and trace elements,CRP and inflammatory factors;multivariate Logistic regression was used to analyze the risk factors of CAS;all tests were performed on two sides,and the difference was statistically significant at P<0.05.Results (1)The age,waist circumference,carotid IMT,systolic blood pressure,prevalence rate of diabetes,the ratio of smoking,drinking and male in the carotid atherosclerosis group were higher than those in the normal carotid artery group,and the difference was statistically significant(P<0.05). (2)There were statistical differences(P<0.05) in the contents of CRP,iron,zinc,LDL-C,FBG and UA between the normal carotid artery group and the carotid atherosclerosis group. The contents of CRP,iron,LDL-C,FBG and UA in the carotid atherosclerosis group were higher than those in the normal carotid group,and the zinc content in the carotid atherosclerosis group was lower than that in the normal carotid artery group. (3)Carotid IMT was positively correlated with age,waist circumference,systolic blood pressure,diastolic blood pressure,iron,CRP,triglycerides,LDL-C,fasting blood glucose,uric acid,while negatively correlated with zincand ratio of zinc and copper. (4)Multivariate Logistic regression analysis of carotid atherosclerosis,the results showed that age,gender,the ratio of smoking,the ratio of drinking,CRP,zinc,LDL-C,and fasting blood glucose were risk factors for carotid atherosclerosis,and zinc was a protective factor for carotid atherosclerosis. Conclusion Trace element iron is positively correlated with carotid IMT,and the higher its level is,the higher the risk of CAS;the trace element zinc is negatively correlated with carotid IMT,and the higher its level is,the lower the risk of CAS is;zinc is a protective factor for CAS.

12.
Article in Chinese | WPRIM | ID: wpr-1038901

ABSTRACT

@#Objective To investigate the relationship between homocysteine levels and carotid atherosclerosis in patients with diabetic kidney disease.Methods One hundred and fifty-nine inpatients with type 2 diabetic kidney disease were enrolled.Carotid intima-media thickness (CIMT) and the presence or absence of carotid plaque formation were detected.According to results,they were divided into two groups.50 cases are the normal carotid artery group;109 cases are the carotid atherosclerosis group,with or without plaque formation in the neck artery.The general clinical data,biochemical indexes and carotid color Doppler ultrasound indexes of the two groups of patients were collected and compared.Logistic regression analysis was used to compare the effects of independent variables on CIMT thickening and plaque formation.According to the level of Hcy,patients was divided into three groups,the incidence of carotid atherosclerosis were compared among groups.ROC curve was used to analyze the predictive value of Hcy for carotid atherosclerosis in patients with diabetic kidney disease.Results (1)Among the patients with diabetic kidney disease,the Hcy,urea,and age of the carotid atherosclerosis group were higher than that of the normal group,the difference was statistically significant (P<0.05);(2)Hcy was an independent risk factor for CIMT thickening and plaque formation (P<0.05);(3)Differences in CIMT thickening and plaque formation rate among the three groups of patients with different Hcy levels were statistically significant (P<0.05);(4)Analyze the value of Hcy for the diagnosis of carotid atherosclerosis through the ROC curve:the area under the ROC curve is 0.731,P<0.001.Conclusions (1)In patients with diabetic nephropathy,patients with concurrent carotid atherosclerosis have significantly increased Hcy levels,and as Hcy levels increase,the incidence of carotid atherosclerosis increases;(2)Elevated Hcy is an independent risk factor for carotid atherosclerosis in patients with diabetic nephropathy,and has certain predictive value for the occurrence of carotid atherosclerosis.

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Article in Chinese | WPRIM | ID: wpr-1011573

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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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Journal of Medical Biomechanics ; (6): E684-E691, 2022.
Article in Chinese | WPRIM | ID: wpr-961786

ABSTRACT

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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Article in Chinese | WPRIM | ID: wpr-954167

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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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Article in Chinese | WPRIM | ID: wpr-957590

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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.

17.
Clinics ; Clinics;77: 100107, 2022. tab
Article in English | LILACS-Express | LILACS | ID: biblio-1404330

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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.

18.
Adv Rheumatol ; 62: 4, 2022. tab
Article in English | LILACS-Express | LILACS | ID: biblio-1360069

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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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Article in Chinese | WPRIM | ID: wpr-906116

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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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Article in Chinese | WPRIM | ID: wpr-1039774

ABSTRACT

@#Objective To investigate the relationship between IL-23R gene polymorphism and carotid atherosclerosis and vulnerability of carotid plaque in patients with ischemic stroke.Methods A total of 460 patients with ischemic stroke hospitalized in our department from January 2019 to October 2019 were recruited in this study.The patients were divided into non-plaque group (112 cases),stable plaque group (164 cases) and vulnerable plaque group (184 cases),according to the results of carotid ultrasonography.Genotype was determined by polymerase chain reaction-restriction fragment length polymorphism for the IL-23R gene rs6682925 polymorphism.Results The genotype and allele frequencies of rs6682925 in stable plaque group and vulnerable plaque group were significantly different from non-plaque group (P<0.05).There was no significant difference in genotype and allele frequencies of rs6682925 between stable plaque group and vulnerable plaque group (P>0.05).After adjusting risk factors (age,FIB,HCY and diabetes),the risk of rs6682925 CC genotype carriers suffer from carotid atherosclerotic plaque was 2.616 times that of TT genotype (95%CI 1.399~4.904,P=0.001).Conclusions IL-23R rs6682925 gene polymorphism is associated with carotid atherosclerosis,and the rs6682925 CC genotype might act as a risk factor for carotid atherosclerosis plaque.However,rs6682925 gene polymorphism may not associated with vulnerability of carotid plaque.

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