Reference values for carotid artery intima-media thickness among community adult dwellers in Shenzhen City / 中华预防医学杂志

Objective: To establish reference values for carotid intima-media thickness (CIMT) of adult dwellers in Shenzhen City. Methods: The study was conducted based on the Shenzhen heart failure epidemiological survey from 2021 to 2022. In this survey, residents aged 18 years and above in Shenzhen were selected by using a multi-stage stratified random sampling method. General information, cardiovascular disease (CVD) related behavior and carotid ultrasound examination and etc. were collected from the participants. People with CVD factors, a history of atherosclerotic cardiovascular disease, carotid plaque or having no carotid ultrasound examination results were excluded. The parameter regression model based on fractional polynomial was used to establish the reference values of CIMT by age and sex. Results: A total of 2 163 healthy individuals were enrolled in the final analysis, including 576 males (26.6%) and 1 587 females (73.4%). The fractional polynomial regression of the CIMT mean and standard deviation was obtained. For men, the regression was meanCIMT=0.324 7+0.006 9×age and SDCIMT=0.076 9+0.001 2×age. For women, the regression was meanCIMT=0.354 9+0.005 4×age and SDCIMT=0.041 6+0.002 0×age. Conclusion: The age and sex reference values for CIMT of adult people in Shenzhen established in this study could provide the latest reference standards for early screening of subclinical CVD.

Network Meta-analysis of Chinese patent medicine containing Hirudo in treatment of atherosclerosis / 中国中药杂志

This study aimed to evaluate the efficacy and safety of Chinese patent medicines containing Hirudo in the treatment of atherosclerosis(AS) by network Meta-analysis, and to provide evidence-based reference for clinical treatment of AS. The clinical randomized controlled trial(RCT) on the treatment of atherosclerosis with Chinese patent medicines containing Hirudo were searched in CNKI, Wanfang, VIP, SinoMed, PubMed and EMbase from the establishment of the databases to July 1, 2022. And data extraction and quality assessment of the included RCT was performed according to the Cochrane standards. Stata 17 and ADDIS 1.16.5 were then used for Bayesian model network Meta-analysis. Finally, 67 RCTs with a total sample size of 6 826 cases were included, 3 569 cases in the experimental group and 3 257 cases in the control group, involving three oral Chinese patent medicines. Network Meta-analysis showed that in terms of reducing intima-media thickness(IMT), the top three Chinese patent medicines were Tongxinluo Capsules+sta-tins>Maixuekang Capsules+statins>Maixuekang Capsules. In terms of reducing plaque area, the top one was Maixuekang Capsules+sta-tins, and the other Chinese patent medicines had similar efficacy. For lowering AS Crouse scores, the top three were Maixuekang Capsules>Tongxinluo Capsules+statins>Naoxintong Capsules. For decreasing plaque number, the top three were Naoxintong Capsules+sta-tins>Tongxinluo Capsules+statins>Tongxinluo Capsules. With regard to adverse reactions/events, Naoxintong Capsules+statins had the lo-west incidence. In conclusion, in Chinese patent medicines containing Hirudo for the treatment of AS, Tongxinluo Capsules+statins, Maixuekang Capsules, Maixuekang Capsules+statins, and Naoxintong Capsules+statins were the primary choices to reduce IMT, AS Crouse scores, plaque area, and plaque number, respectively. The efficacy of Chinese patent medicines containing Hirudo with or without statins was more significant than that of statins alone in the four outcome indexes. Additionally, the treatment of AS should be evaluated comprehensively, and attention should be paid to Chinese patent medicines or their combination with western medicine, to optimize the treatment effect and minimize adverse reactions as the benchmark.

Efectos del tratamiento sustitutivo del hipotiroidismo subclínico en el grosor intima-media carotideo / Effects of replacement therapy for subclinical hypothyroidism on carotid intima-media thick

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)

Tongdu Tiaoshen acupuncture combined with carotid endarterectomy for carotid artery stenosis: a randomized controlled trial / 中国针灸

OBJECTIVE@#To observe the clinical therapeutic effect of Tongdu Tiaoshen acupuncture combined with carotid endarterectomy (CEA) and simple CEA on carotid artery stenosis (CAS).@*METHODS@#A total of 60 patients with CAS were randomized into an observation group (30 cases, 2 cases dropped off) and a control group (30 cases, 3 cases dropped off). Both groups were treated with eversion CEA (eCEA). The conventional treatment of internal medicine and antiplatelet drugs i.e. aspirin enteric-coated tablet and clopidogrel hydrogen sulfate tablet were given in the control group for 4 weeks. On the basis of the treatment in the control group, Tongdu Tiaoshen acupuncture was applied at Baihui (GV 20), Fengfu (GV 16), Yamen (GV 15), cervical Jiaji (EX-B 2), Dazhui (GV 14), etc. in the observation group, once a day, 1-day rest was taken after 6-day treatment, 2 weeks were as one course and totally 2 courses were required. The carotid intima-media thickness (IMT) before and after treatment was detected by ultrasonic diagnostic apparatus, the TCM symptom score was compared before and after treatment and in the follow-up of 6 months after treatment, the clinical efficacy was evaluated in the two groups. The occurrence of endpoints within 1 year was recorded.@*RESULTS@#After treatment, the carotid IMT and TCM symptom scores were decreased compared before treatment in the both groups (P<0.05), and the changes in the observation group were greater than the control group (P<0.05). In the follow-up, the TCM symptom scores were decreased compared before treatment in the both groups (P<0.05). The total effective rate was 96.4% (27/28) in the observation group, which was superior to 88.9% (24/27) in the control group (P<0.05). There were 1 case of stoke in the observation group and 2 cases of stroke in the control group within 1-year follow-up, and there was no significant difference in the number of endpoints between the two groups within 1 year (P>0.05).@*CONCLUSION@#Tongdu Tiaoshen acupuncture combined with CEA can effectively reduce the IMT in patients with CAS, improve the TCM symptom score, the efficacy is superior to simple CEA treatment.

Interleukin-8 is increased in chronic kidney disease in children, but not related to cardiovascular disease / A Interleucina-8 é aumentada na doença renal crônica em crianças, mas não se relaciona a doença cardiovascular

Abstract Introduction: In this study, we aimed to detect the cytokine that is involved in the early stage of chronic kidney disease and associated with cardiovascular disease. Methods: We included 50 patients who were diagnosed with predialytic chronic kidney disease and 30 healthy pediatric patients in Ege University Medical Faculty Pediatric Clinic, İzmir/Turkey. Interleukin-8 (IL-8), interleukin-10 (IL-10), interleukin-13 (IL-13), and transforming grow factor-β1 (TGF-β1) levels (pg/mL) were measured by ELISA. Carotid-femoral pulse wave velocity (PWV), augmentation index (Aix), carotid intima media thickness (cIMT), and left ventricular mass index (LVMI) were evaluated as markers of cardiovascular disease. The presence of a cardiovascular disease marker was defined as an abnormality in any of the parameters (cIMT, PWV, Aix, and left ventricular mass index (SVKI)). The patient group was divided into two groups as with and without cardiovascular disease. Results: Mean Aix and PWV values were higher in CKD patients than controls (Aix: CKD 32.8±11.11%, healthy subjects: 6.74±6.58%, PWV CKD: 7.31±4.34m/s, healthy subjects: 3.42±3.01m/s, respectively; p=0.02, p=0.03). The serum IL-8 levels of CKD were significantly higher than of healthy subjects 568.48±487.35pg/mL, 33.67±47.47pg/mL, respectively (p<0.001). There was no statistically significant difference between IL-8, IL-10, IL-13, TGF-1, in CKD patients with and without cardiovascular disease (p> 0.05). Discussion: IL-8 is the sole cytokine that increases in pediatric patients with chronic kidney disease among other cytokines (IL-10, IL-13 and TGF-β1). However, we did not show that IL-8 is related to the presence of cardiovascular disease.

Resumo Introdução: Neste estudo, o objetivo foi detectar a citocina envolvida no estágio inicial da doença renal crônica e associada à doença cardiovascular. Métodos: Incluímos 50 pacientes diagnosticados com doença renal crônica pré-dialítica e 30 pacientes pediátricos saudáveis na Clínica Pediátrica da Faculdade de Medicina, Universidade de Ege, İzmir/Turquia. Níveis de interleucina-8 (IL-8), interleucina-10 (IL-10), interleucina-13 (IL-13), fator de transformação do crescimento -β1 (TGF-β1) (pg/mL) foram medidos por ELISA. Velocidade de onda de pulso carotídeo-femoral (VOP), índice de amplificação (AIx), espessura da camada íntima-média da carótida (cIMT), índice de massa do ventrículo esquerdo (IMVE) foram avaliados como marcadores de doença cardiovascular. A presença de marcador de doença cardiovascular foi definida como uma anormalidade em qualquer dos parâmetros (cIMT, VOP, AIx, índice de massa do ventrículo esquerdo (IMVE)). Os pacientes foram divididos em dois grupos como com e sem doença cardiovascular. Resultados: Valores médios de AIx e VOP foram maiores em pacientes com DRC que nos controles (AIx: DRC: 32,8±11,11%, indivíduos saudáveis: 6,74±6,58%, VOP: DRC: 7,31±4,34m/s, indivíduos saudáveis: 3,42±3,01m/s, respectivamente; p=0,02, p=0,03). Níveis séricos de IL-8 de DRC foram significativamente maiores que de indivíduos saudáveis 568,48±487,35pg/mL, 33,67±47,47pg/mL, respectivamente (p<0,001). Não houve diferença estatisticamente significativa entre IL-8, IL-10, IL-13, TGF-1, em pacientes com DRC com e sem doença cardiovascular (p> 0,05). Discussão: IL-8 é a única citocina que aumenta em pacientes pediátricos com doença renal crônica entre outras citocinas (IL-10, IL-13 e TGF-β1). Entretanto, IL-8 não se associou à presença de doença cardiovascular.

O efeito da atorvastatina + aspirina na função endotelial difere com a idade em pacientes com HIV: Um estudo de caso-controle / The effect of atorvastatin + aspirin on the endothelial function differs with age in patients with HIV: A case-control study

Resumo Fundamento Pacientes com HIV têm maior probabilidade de apresentar doenças cardiovasculares quando comparados à população em geral. Objetivo Este foi um estudo de caso-controle que teve como objetivo avaliar quais fatores estavam associados a uma redução na espessura médio-intimal da carótida (IMT) da carótida e ao aumento na dilatação mediada por fluxo (DMF) da artéria braquial em pacientes com HIV que receberam atorvastatina + aspirina por um período de 6 meses. Métodos Foi realizada uma análise secundária de um ensaio clínico, que incluiu pessoas vivendo com HIV e baixo risco cardiovascular. Um total de 38 pacientes alocados para o braço de intervenção e tratados por 6 meses com uma combinação de atorvastatina + aspirina foram incluídos. Todos os participantes foram submetidos a ultrassonografia da carótida e da artéria braquial, tanto no início quanto no final do estudo. Os casos que responderam com aumento >10% da dilatação braquial (DMF) e redução da espessura médio-intimal da carótida (IMT) foram considerados casos, e aqueles que não responderam foram considerados controles. Avaliamos os fatores associados às respostas positivas obtidas através da IMT e DMF. Resultados A redução do IMT não se associou significativamente a nenhum dos fatores de risco avaliados: idade (p = 0,211), sexo (p = 0,260), tabagismo (p = 0,131) ou tempo de diagnóstico do HIV (p = 0,836). Um aumento na DMF foi significativamente associado com a idade entre aqueles na faixa etária de 40-59 anos, p = 0,015 (OR = 4,37; IC 95%: 1,07-17,79). Conclusões Os indivíduos mais velhos foram mais propensos a apresentar um aumento na DMF após 6 meses de tratamento com atorvastatina + aspirina.

Abstract Background Patients with HIV are more likely to present with cardiovascular disease when compared to the general population. Objective This was a case-control study that aimed to assess which factors were associated with a reduction in the carotid intima-media thickness (IMT) and an increase in the brachial artery flow-mediated dilation (FMD) in HIV patients who received atorvastatin + aspirin during a period of 6 months. Methods A secondary analysis of a clinical trial was conducted, which included people living with HIV infection and low cardiovascular risk. A total of 38 patients allocated to the intervention arm and treated for 6 months with a combination of atorvastatin + aspirin were included. All participants underwent a carotid and brachial artery ultrasound, both at the beginning and the end of the study. Cases that responded with an increase of >10% of the brachial dilatation (FMD) and reduction of the carotid intima-media thickness (IMT) were considered cases, and those who did not respond were considered controls. We assessed the factors associated with the positive responses obtained through IMT and FMD. Results A reduction in the IMT was not significantly associated with any of the evaluated risk factors: age (p=0.211), gender (p=0.260), smoking (p=0.131) or time since HIV diagnosis (p=0.836). An increase in the FMD was significantly associated with age amongst those in the 40-59 age group, p = 0.015 (OR = 4.37; 95% CI: 1.07-17.79). Conclusions Older individuals were more likely to present with an increased FMD after 6 months of treatment with atorvastatin + aspirin.

Hipertensão arterial e ácido úrico sérico em idosos - estudo SEPHAR III / Arterial hypertension and serum uric acid in elderly- SEPHAR III study

Resumo Fundamento: A hiperuricemia é um achado frequente em pacientes com hipertensão arterial e há evidências cada vez maiores de que essa entidade seja também um fator de risco para doença cardiovascular. Objetivos: No contexto da população em processo de envelhecimento, este estudo tem o objetivo de avaliar níveis de ácido úrico sérico e a prevalência e o controle da hipertensão arterial em um subgrupo da população de adultos romenos (>65 anos), em relação à influência da idade nesses parâmetros. Métodos: A amostra do estudo consiste em 1920 adultos incluídos na pesquisa SEPHAR III, dos quais 447 eram pacientes idosos (>65 anos de idade). Durante as duas visitas do estudo, três aferições de pressão arterial (PA) foram realizadas em intervalos de 1 minuto, e foram realizadas medições de níveis de ácido úrico sérico, função renal por taxa de filtração glomerular, pressão arterial e espessura íntima-média. A hipertensão e os controles foram definidos de acordo com as diretrizes atuais. A avaliação da espessura íntima-média foi determinada pela avaliação por ultrassom Doppler modo B. Um nível de significância p < 0,05 foi adotado para a análise estatística. Resultados: Pacientes adultos tinham níveis de ácido úrico sérico significativamente mais baixos, se comparados a pacientes idosos, independentemente dos níveis de taxa de filtração glomerular. Pacientes adultos tinham níveis de espessura íntima-média, comparados a pacientes idosos. Conclusão: De forma semelhante às pesquisas anteriores, neste estudo, a idade representou um dos fatores contribuintes ao nível aumentado de ácido úrico sérico. Também foi obtido um aumento da prevalência da hipertensão arterial com a idade, com um mau controle da pressão arterial.

Abstract Background: Hyperuricemia is a frequent finding in patients with arterial hypertension, and there is increasing evidence that this entity is also a risk factor for cardiovascular disease. Objective: In the context of an aging population, this study aims to evaluate serum uric acid levels and arterial hypertension prevalence and control in a subgroup of Romanian adults (>65 years), concerning the influence of age on these parameters. Method: The study sample consists of 1,920 adults included in SEPHAR III survey, of whom 447 were elderly patients (>65 years of age). During the two study visits, three blood pressure (BP) measurements were performed at 1-min intervals and serum uric acid levels, kidney function by estimated glomerular filtration rate, blood pressure, and intima media thickness measurements were conducted. Hypertension and controls were defined according to the current guidelines. Intima-media thickness evaluation was assessed by B-mode Doppler ultrasound evaluation. A significance level p < 0.05 was adopted for the statistical analysis. Results: Adult patients had a significant lower serum uric acid levels, compared to elderly patients, regardless of glomerular filtration rate levels. Adult patients showed a significantly lower intima-media thickness levels, when compared to elderly patients. Conclusion: Similar to previous studies, in the present study, age represented one of the factors contributing to the increased level of serum uric acid. An increasing prevalence of arterial hypertension with age, together with a poor control of blood pressure, was also obtained.

Agrupamentos de fatores de risco cardiometabólicos e sua associação com aterosclerose e inflamação crônica em adultos e idosos em florianópolis, Sul do Brasil / Clusters of cardiometabolic risk factors and their association with atherosclerosis and chronic inflammation among adults and elderly in florianópolis, Southern Brazil

Resumo Fundamento O aumento significativo de doenças cardiovasculares em países em desenvolvimento alerta sobre seu impacto em populações carentes. Objetivo Identificar a relação de agrupamentos de componentes da síndrome metabólica (SM) com aterosclerose e inflamação crônica em adultos e idosos. Métodos Análise transversal usando dados de dois estudos populacionais de tipo coorte realizados em Florianópolis, sul do Brasil (EpiFloripa Adult Cohort Study, n = 862, 39,9±11,5 anos; EpiFloripa Aging Cohort Study, n = 1197, 69,7±7,1 anos). Pressão arterial (PA), circunferência da cintura (CC), e níveis plasmáticos de lipídio e glicose foram analisados como fatores individuais ou como agrupamentos de componentes da SM (como número de componentes presentes em um indivíduo ou como combinações). Os desfechos incluíram espessura intima-media carotídea (EIMC), placas ateroscleróticas, e níveis de proteína C reativa (CRP). Regressão linear múltipla e regressão logística, ajustadas quanto aos fatores de confusão, foram usadas para análise. O nível de significância adotado foi de 5%. Resultados Indivíduos com PA e CC elevadas, dislipidemia e hiperglicemia (61,5%) apresentaram maiores valores de EIMC e PCR que aqueles que não apresentaram componentes de SM. CC elevada foi um determinante comum de inflamação sistêmica, ao passo que a coexistência de PA elevada e CC elevada (agrupamentos de dois ou três fatores) associou-se com maior EIMC (β entre +3,2 e +6,1 x 10-2 mm; p < 0,05) e PCR (EXPβ entre 2,18 e 2,77; p < 0,05). Conclusão A coexistência de PA e CC elevadas associou-se com maiores valores de EIMC e níveis de PCR. A obesidade central, isolada ou em combinação com outros fatores de risco, teve efeito sobre a inflamação sistêmica.

Abstract Background The significant increase in cardiovascular diseases in developing countries alerts about their impact on underprivileged populations. Objective To identify the relationship of clusters of metabolic syndrome (MS) components with atherosclerosis and chronic inflammation among adults and elderly. Methods Cross-sectional analysis using data from two population-based cohort studies in Florianópolis, Southern Brazil (EpiFloripa Adult Cohort Study, n = 862, 39.9±11.5 years; EpiFloripa Aging Cohort Study, n = 1197, 69.7±7.1 years). Blood pressure (BP), waist circumference (WC), and lipid and glucose levels were analyzed as individual factors or as clusters (either as the number of components present in an individual or as combinations of components). Outcomes included carotid intima-media thickness (IMT), atherosclerotic plaques, and C-reactive protein (CRP) levels. Multiple linear and logistic regression analyses adjusted for confounding factors were used. The statistical significance adopted was 5%. Results Individuals with high BP, elevated WC, dyslipidemia and hyperglycemia (6.1% of the sample) showed higher IMT and CRP than those negatives for all MetS components. Elevated WC was a common determinant of systemic inflammation, while the coexistence of high BP and elevated WC (clusters of two or three factors) was associated with higher IMT (β between +3.2 and +6.1 x 10-2 mm; p value < 0.05) and CRP (EXPβ between 2.18 and 2.77; p value < 0.05). Conclusion The coexistence of high BP and elevated WC was associated with increased IMT and CRP levels, but central obesity affected systemic inflammation either alone or in combination with other risk factors.

Perfil Aterosclerótico da Artéria Carótida como Preditor de Risco para Reestenose após Implante de Stent Coronário / Carotid Artery Atherosclerotic Profile as Risk Predictor for Restenosis After Coronary Stenting

Resumo Fundamento: A incidência de reestenose da artéria coronária após o implante de um stent não farmacológico é mais baixa que na angioplastia com balão; no entanto, ainda apresenta altas taxas. Objetivo: O objetivo deste estudo foi identificar novos indicadores de risco para reestenose de stent usando ultrassonografia das carótidas que, em conjunto com indicadores já existentes, ajudariam na escolha do stent. Métodos: Realizamos um estudo prospectivo transversal incluindo 121 pacientes consecutivos com doença arterial coronariana que foram submetidos à intervenção coronária percutânea com angiografia nos 12 meses anteriores. Após os casos de reestenose de stent serem identificados, os pacientes foram submetidos à ultrassonografia de carótidas para avaliar a espessura da camada íntima média e placas ateroscleróticas. Os dados foram analisados por regressão múltipla de Cox. O nível de significância foi p<0,05. Resultados: A idade mediana dos pacientes foi de 60 anos (1º quartil = 55, 3º quartil = 68), e 64,5% dos pacientes eram do sexo masculino. A angiografia coronária mostrou que 57 pacientes (47,1%) apresentaram reestenose de stent. Cinquenta e cinco pacientes (45,5%) apresentaram placas ateroscleróticas ecolucentes nas artérias carótidas e 54,5% apresentaram placas ecogênicas ou nenhuma placa. Dos pacientes que apresentaram placas ecolucentes, 90,9% apresentaram reestenose do stent coronário, e daqueles com placas ecogênicas ou nenhuma placa, 10,6% apresentaram reestenose de stent. A presença de placas ecolucentes nas artérias carótidas aumentou o risco de reestenose de stent coronário em 8,21 vezes (RR=8,21;IC95%: 3,58-18,82; p<0,001). Conclusões: A presença de placas ateroscleróticas ecolucentes na artéria carótida constitui um preditor de risco de reestenose de stent coronário e deve ser considerada na escolha do tipo de stenta ser usado na angioplastia coronária.

Abstract Background: The incidence of restenosis of the coronary artery after a bare-metal stent implant has been lower than in simple balloon angioplasty; however, it still shows relatively high rates. Objective: The aim of this study was to find new risk indicators for in-stent restenosis using carotid ultrasonography, that, in addition to the already existing indicators, would help in decision-making for stent selection. Methods: We carried out a cross-sectional prospective study including 121 consecutive patients with chronic coronary artery disease who had undergone percutaneous coronary intervention with repeat angiography in the previous 12 months. After all cases of in-stent restenosis were identified, patients underwent carotid ultrasonography to evaluate carotid intima-media thickness and atherosclerosis plaques. The data were analyzed by Cox multiple regression. The significance level was set a p<0.05. Results: Median age of patients was 60 years (1st quartile = 55, 3rd quartile = 68), and 64.5% of patients were male. Coronary angiography showed that 57 patients (47.1%) presented in-stent restenosis. Fifty-five patients (45.5%) had echolucent atherosclerotic plaques in carotid arteries and 54.5% had echogenic plaques or no plaques. Of patients with who had echolucent plaques, 90.9% presented coronary in-stent restenosis. Of those who had echogenic plaques or no plaques, 10.6% presented in-stent restenosis. The presence of echolucent plaques in carotid arteries increased the risk of coronary in-stent restenosis by 8.21 times (RR=8.21; 95%CI: 3.58-18.82; p<0.001). Conclusions: The presence of echolucent atherosclerotic plaques in carotid artery constitutes a risk predictor of coronary instent restenosis and should be considered in the selection of the type of stent to be used in coronary angioplasty.

Increased serum chemerin levels associated with carotid intima-media thickness / Aumento dos níveis séricos de chemerin associados à espessura das camadas intima-media carotídea

ABSTRACT Background: Elevated levels of chemerin can predict future ischemic cerebrovascular disease. Although chemerin is thought to play a role in atherosclerotic inflammation, whether circulating chemerin levels are associated with the severity of atherosclerosis remains to be determined. Objectives: Through the use of carotid Doppler ultrasonography, our aim in this study was to investigate the relationships of serum chemerin levels with carotid intima-media thickness (CIMT) as an indicator of generalized atherosclerosis. Methods: This study compared 40 patients with ischemic stroke and 40 healthy subjects. Measurements were made at end-diastole using color Doppler ultrasonography (CDUS) after a 5-min rest interval in a quiet and dark room. CIMT was defined as the distance between the innermost edge of the luminal echo to the innermost edge of the media/adventitia echo. CIMT was measured in the posterior wall of both common carotid arteries within 1 cm proximally to the bulbus. Three measurements were made on both sides and the average measurement was taken as the CIMT. Serum chemerin levels were determined in all patients and healthy subjects. Results: Serum chemerin levels were significantly higher in the patient group than in the control group (p=0.004). Serum chemerin levels were positively correlated with CIMT (p<0.05). There was a significant difference between the groups with regard to CIMT (p<0.001). Conclusion: Elevated serum chemerin levels appear to be associated with CIMT, thus suggesting that a link exists between chemerin and atherosclerotic ischemic cerebrovascular disease.

RESUMO Introdução: Níveis elevados de chemerin podem prever doenças cerebrovasculares isquêmicas futuras. Embora se acredite que a chemerin desempenhe um papel na inflamação aterosclerótica, ainda não foi determinado se os níveis circulantes de chemerin estão associados à gravidade da aterosclerose Objetivos: Por meio do uso da ultrassonografia Doppler da carótida, nosso objetivo neste estudo foi investigar as relações dos níveis séricos de chemerin com a espessura da íntima-média da carótida (EIMC) como um indicador de aterosclerose generalizada. Métodos: Este estudo comparou 40 pacientes com AVC isquêmico e 40 indivíduos saudáveis. As medidas foram feitas no final da diástole usando ultrassonografia Doppler em cores (USDC), após um intervalo de descanso de 5 minutos em um quarto silencioso e escuro. A EIMC foi definida como a distância entre a borda mais interna do eco luminal e a borda mais interna do eco da mídia/adventícia. EIMC foi medido na parede posterior de ambas as artérias carótidas comuns dentro de 1 cm proximalmente ao bulbo. Três medições foram feitas em ambos os lados e a medição média foi tomada como o EIMC. Os níveis séricos de chemerin foram determinados em todos os pacientes e indivíduos saudáveis. Resultados: Os níveis séricos de chemerin foram significativamente maiores no grupo de pacientes do que no grupo controle (p=0,004). Os níveis séricos de chemerin foram positivamente correlacionados com EIMC (p<0,05). Houve diferença significativa entre os grupos em relação à EIMC (p<0,001). Conclusão: Níveis séricos elevados de chemerin parecem estar associados com a EIMC, sugerindo que existe uma ligação entre chemerin e doença cerebrovascular isquêmica aterosclerótica.

Carotid Intima and Media Thickness Correlation with Central Blood Pressure Measurements by Tonometric and Oscillometric Methods: A Proof of Concept

Abstract Background The early detection of vascular damage in subclinical stages of hypertensive disease may be the key point in the prevention of cardiovascular outcomes. Objectives to correlate parameters of structural vascular damage (measurement of the carotid intima-media thickness) with parameters of functional vascular damage (central hemodynamic measurements) in pre-hypertensive and hypertensive patients taking up to two classes of anti-hypertensive drugs. Methods This was a cross-sectional descriptive study conducted with a convenience sample of patients attending the Liga de Hipertensão Arterial , a multidisciplinary program for the diagnosis and treatment of systemic hypertension, of the Federal university of Goias. Patients with arrythmia, diabetes, previous cardiovascular or cerebrovascular diseases, and end-stage diseases were excluded. Carotid Doppler test, measurements of peripheral and central blood pressure by applanation tonometry (Sphygmocor®) and oscillometry (Mobil-O-Graph®) were performed. The t-test was used for comparisons and the Pearson correlation test for correlations, considering a p<0.05 statistically significant. Results twenty patients (12 women) were evaluated, mean age 53.8 ± 14.3 years. Higher values of central pulse pressure (42.9±13.9 vs. 34.7±9.6, p=0.01) and pulse wave velocity (PWV) (9.0±1.9 vs. 7.9±1.5, p=0.01) were obtained by applanation tonometry compared with oscillometry. No difference between the methods was observed for the other measures. A significant correlation was found between carotid artery intima-media thickness (CA-IMT) and PWV (r=0.659; p=0.002) by the oscillometric test, but not with applanation tonometry. No correlation was found between central hemodynamic variables and the presence of carotid artery plaques. Conclusion PWV, estimated by oscillometry, was the only central hemodynamic parameter that correlated significantly with CA-IMT in pre-hypertensive and hypertensive patients at low cardiovascular risk. International Journal of Cardiovascular Sciences. 2020; [online].ahead print, PP.0-0

Hypoadiponectinemia as a marker of increased cardiovascular risk in patients with non-alcoholic fatty liver disease: correlation with albumin/creatinine ratio

ABSTRACT Objective: We assessed plasma adiponectin and its correlation with carotid intima-media-thickness (CIMT), as a marker of atherosclerosis, and urine albumin/creatinine ratio (ACR) in patients with non-alcoholic fatty liver disease (NAFLD). Subjects and methods: The study included 100 Egyptian subjects (50 patients with NAFLD with no history of diabetes or hypertension and 50 age and sex-matched normal healthy control subjects). Urine albumin/creatinine ratio (ACR) was assessed in all participants and fasting plasma adiponectin was measured using ELISA technique. Ultrasonography was used to diagnose NAFLD. CIMT was assessed using high-resolution Doppler ultrasonography. Results: Mild albuminuria was detected in patients with NAFLD (mean urine ACR = 42 ± 30 mg/g). Plasma adiponectin was significantly lower and urine ACR and CIMT significantly higher in patients with NAFLD as compared with the control group (P < 0.001 for all). A significant negative correlation was found between plasma adiponectin and both urine ACR and CIMT in patients with NAFLD (P < 0.001 and < 0.05 respectively). A significant positive correlation was also found between CIMT and urine ACR in those patients (P < 0.05). Plasma adiponectin and urine ACR were independent determinants of CIMT in patients with NAFLD (P < 0.01 and < 0.05 respectively). Conclusion: Patients with NAFLD, without diabetes, have an increased risk of atherosclerosis and cardiovascular disease. Hypoadiponectinemia and low-grade albuminuria are important markers of that risk.

Expressão de Proteína-1 Relacionada a Receptor de Lipoproteína de Baixa Densidade (LRP1) em Monócito em Correlação com EIMC em Pacientes Mexicanos Hipertensos / Monocyte Low-Density Lipoprotein Receptor-Related Protein 1 (LRP1) Expression Correlates with cIMT in Mexican Hypertensive Patients

Resumo Fundamento A hipertensão arterial (HTA) representa um grande fator de risco de morbidade e mortalidade cardiovascular. Ainda não se sabe que mecanismos moleculares específicos estão associados ao desenvolvimento de hipertensão essencial. Objetivo Neste trabalho, analisamos a associação entre expressão mRNA de monócito LRP1, expressão de proteína LRP1, e espessura íntima-média de carótida (EIMC) de pacientes com hipertensão essencial. Métodos A expressão mRNA de monócito LRP1 e os níveis de proteína e EIMC foram quantificados em 200 indivíduos mexicanos, sendo 91 normotensos (NT) e 109 hipertensos (HT) A significância estatística foi definida em p < 0,05. Resultados O grupo de pacientes HT tinha EIMC maior altamente significativa em comparação com os pacientes NT (p = 0,002), e isso está relacionado ao aumento na expressão mRNA de LRP1 (6,54 versus. 2,87) (p = 0,002) e expressão de proteína LRP1 (17,83 versus 6,25), respectivamente (p = 0,001). Essas diferenças foram mantidas mesmo quando dividimos nossos grupos de estudo, levando em consideração apenas aqueles que apresentavam dislipidemia na expressão de mRNA (p = 0,041) e de proteínas (p < 0,001). Também se identificou que a indução de LRP1 mediada por LRP1 em monócitos em de maneira dependente de dose e tempo, com diferença significativa em NT versus HT (0,195 ± 0,09 versus 0,226 ± 0,12, p = 0,046). Conclusão Foi encontrado um aumento em EIMC em indivíduos com hipertensão, associada a expressões de proteína LRP1 e mRNA mais altas em monócitos, independente da presença de dislipidemia em pacientes HT. Esses resultados que a upregulation de LRP1 em monócitos de pacientes hipertensos mexicanos poderia estar envolvida na diminuição da EIMC. (Arq Bras Cardiol. 2021; 116(1):56-65)

Abstract Background Arterial hypertension (HTA) represents a major risk factor for cardiovascular morbidity and mortality. It is not yet known which specific molecular mechanisms are associated with the development of essential hypertension. Objective In this study, we analyzed the association between LRP1 monocyte mRNA expression, LRP1 protein expression, and carotid intima media thickness (cIMT) of patients with essential hypertension. Methods The LRP1 monocyte mRNA expression and protein levels and cIMT were quantified in 200 Mexican subjects, 91 normotensive (NT) and 109 hypertensive (HT). Statistical significance was defined as p < 0.05. Results HT patients group had highly significant greater cIMT as compared to NT patients (p=0.002) and this correlated with an increase in the expression of LRP1 mRNA expression (6.54 vs. 2.87) (p = 0.002) and LRP1 protein expression (17.83 vs. 6.25), respectively (p = 0.001). These differences were maintained even when we divided our study groups, taking into account only those who presented dyslipidemia in both, mRNA (p = 0.041) and proteins expression (p < 0.001). It was also found that Ang II mediated LRP1 induction on monocytes in a dose and time dependent manner with significant difference in NT vs. HT (0.195 ± 0.09 vs. 0.226 ± 0.12, p = 0.046). Conclusion An increase in cIMT was found in subjects with hypertension, associated with higher mRNA and LRP1 protein expressions in monocytes, irrespective of the presence of dyslipidemias in HT patients. These results suggest that LRP1 upregulation in monocytes from Mexican hypertensive patients could be involved in the increased cIMT. (Arq Bras Cardiol. 2021; 116(1):56-65)

Education and household income and carotid intima-media thickness in Japan: baseline data from the Aidai Cohort Study in Yawatahama, Uchiko, Seiyo, and Ainan

BACKGROUND@#Epidemiological evidence for the relationship between education and income and carotid intima-media thickness (CIMT) has been limited and inconsistent. The present cross-sectional study investigated this issue using baseline data from the Aidai Cohort Study.@*METHODS@#Study subjects were 2012 Japanese men and women aged 34-88 years. Right and left CIMT were measured at the common carotid artery using an automated carotid ultrasonography device. Maximum CIMT was defined as the largest CIMT value in either the left or right common carotid artery. Carotid wall thickening was defined as a maximum CIMT value > 1.0 mm.@*RESULTS@#The prevalence of carotid wall thickening was 13.0%. In participants under 60 years of age (n = 703) and in those aged 60 to 69 years (n = 837), neither education nor household income was associated with carotid wall thickening or with maximum CIMT. Among those aged 70 years or older (n = 472), however, higher educational level, but not household income, was independently related to a lower prevalence of carotid wall thickening: the multivariate-adjusted odds ratio for high vs. low educational level was 0.43 (95% confidence interval 0.21-0.83, p for trend = 0.01). A significant inverse association was observed between education, but not household income, and maximum CIMT (p for trend = 0.006).@*CONCLUSIONS@#Higher educational level may be associated with a lower prevalence of carotid wall thickening and a decrease in maximum CIMT only in participants aged 70 years or older.

Fresh vegetable and fruit consumption and carotid atherosclerosis in high-cardiovascular-risk population: a cross-sectional study in Jiangsu, China / Consumo de frutas e verduras frescas e aterosclerose carotídea em uma população de alto risco cardiovascular: um estudo transversal em Jiangsu, China / Consumo de verduras frescas y fruta y la aterosclerosis carotídea en una población con alto riesgo cardiovascular: un estudio trasversal en Jiangsu, China

This study aimed to investigate the association of vegetable and fruit consumption with carotid plaque (CP) and carotid intima-media thickness (CIMT), two predictors of carotid atherosclerosis, within urban and rural adults at high risk of developing cardiovascular diseases (CVDs) in regional China. A total of 11,392 adults at high CVD risk were identified from general population of 71,511 in this cross-sectional study, conducted between November of 2015 and May of 2016 in the Jiangsu Province. Among these 11,392 high risk participants, CP prevalence was 36.7%. The independent variables, vegetable and fruit intake frequency, were assessed by a food frequency questionnaire. The outcome variables, CIMT and CP, were measured by ultrasound examination. The ANCOVA analysis showed no association between CIMT values and vegetable and fruit intake frequencies. Multivariate logistic regression models were introduced to examine the association between vegetable and fruit intake and CP. After adjustment for potential confounders, the odds ratios (ORs) for participants who occasionally and daily consumed vegetable to experience any CP were 0.67 (95%CI: 0.58-0.78) and 0.70 (95%CI: 0.62-0.79), respectively, compared with those rarely consumed vegetable. While the adjusted ORs were 0.77 (95%CI: 0.64-0.92) and 0.80 (95%CI: 0.68-0.94), separately, for occasional and daily vegetable consumers to develop single CP relative to their counterparts who rarely consumed any vegetables. However, no significant association between fruit consumption and CP was observed. Among the Chinese population at high CVD risk, consumption of fresh vegetables was negatively associated with the risk of developing carotid plaque.

O estudo buscou investigar a associação entre consumo de frutas e verduras e placa carotídea (PC) e espessura íntima-média carotídea (EIMC), dois preditores de aterosclerose entre adultos das áreas urbana e rural com alto risco de desenvolver doenças cardiovasculares (DCVs) em uma região da China. Foram identificados 11.392 adultos com alto risco de DCV, entre 71.511 indivíduos da população geral, em um estudo transversal entre novembro de 2015 e maio de 2016 na Província de Jiangsu. Entre esses 11.392 participantes de alto risco, a prevalência de PC foi de 36,7%. As variáveis independentes, ou seja, frequências de consumo de frutas e verduras, foram avaliadas através de um questionário de frequência alimentar. As variáveis de desfecho, EIMC e PC, foram medidas por ultrassom. A análise ANCOVA não mostrou associação entre valores de EIMC e frequências de consumo de frutas e verduras. Foram introduzidos modelos de regressão logística multivariada para examinar a associação entre consumo de frutas e verduras e PC. Depois de ajustar para potenciais fatores de confusão, as ORs para participantes com consumo eventual e diário de verduras para qualquer PC foram 0,67 (IC95%: 0,58-0,78) e 0,70 (IC95%: 0,62-0,79), respectivamente, comparado com aqueles com consumo raro de verduras. Enquanto isso, as ORs ajustados foram 0,77 (IC95%: 0,64-0,92) e 0,80 (IC95%: 0,68-0,94), separadamente, para adultos com consumo eventual e diário de verduras para desenvolver uma PC única, comparado aos que relatavam consumo raro de verduras. Entretanto, não foi observada uma associação significativa entre consumo de frutas e PC. Entre a população chinesa com alto risco de DCV, o consumo de verduras frescas mostrou associação negativa com o risco de desenvolvimento de placa carotídea.

El objetivo de este estudio fue investigar la asociación del consumo de frutas y verduras con la placa carotídea (PC) y el grosor íntima-media carotídeo (GIMC), dos predictores de la aterosclerosis carotídea en adultos urbanos y rurales, con alto riesgo de desarrollar enfermedades cardiovasculares (ECV) en una región de China. Se identificaron, en este estudio transversal, a 11.392 adultos con alto riesgo de ECV dentro de una población general de 71.511, realizado entre noviembre de 2015 y mayo de 2016 en la provincia de Jiangsu. De estos 11.392 participantes en alto riesgo, la prevalencia de PC fue de un 36,7%. Las variables independientes, así como la frecuencia de consumo de verduras y fruta, se evaluaron mediante un cuestionario de frecuencia de comidas. Las variables de resultado, GIMC y PC, se midieron por un examen de ultrasonido. El análisis ANCOVA mostró que no existía asociación entre los valores GIMC y la frecuencia en el consumo de verduras y frutas. Los modelos de regresión logística multivariantes se introdujeron para examinar la asociación entre el consumo de verduras y frutas y la PC. Tras el ajuste para los factores potenciales de confusión, las ORs de haber tenido alguna PC para los participantes que ocasionalmente y diariamente consumían verduras fueron 0,67 (IC95%: 0,58-0,78) y 0,70 (IC95%: 0,62-0,79), respectivamente, comparadas con quienes raramente consumían verduras. Mientras que las ORs ajustadas fueron 0,77 (IC95%: 0,64-0,92) y 0,80 (IC95%: 0,68-0,94), separadamente, para los consumidores ocasionales y los consumidores diarios de verduras de desarrollar una única PC, en relación con sus contrapartes que raramente consumían verduras. No obstante, no se observó una asociación significativa entre el consumo de frutas y la PC. Entre la población con alto riesgo de ECV, el consumo de verdura fresca estuvo negativamente asociado con el riesgo de desarrollar PC.

Relação entre Velocidade de Onda de Pulso e Biomarcadores Cardiovasculares em Pacientes com Fatores de Risco / Relationship between Pulse Wave Velocity and Cardiovascular Biomarkers in Patients with Risk Factors

Resumo Fundamento A relação entre velocidade de onda de pulso (VOP) e biomarcadores de mudanças estruturais do ventrículo esquerdo e artérias carótidas ainda é pouco elucidada. Objetivo Investigar a relação entre VOP e esses biomarcadores. Métodos Estudo transversal, retrospectivo e analítico. Revisamos prontuários médicos de pacientes com diabetes mellitus, dislipidemia, e pré-hipertensão ou hipertensão, que realizaram medida de pressão arterial central (PAC) utilizando o Mobil-O-Graph®, e doppler de carótida ou ecocardiografia três meses antes ou após a medida da PAC. Análise estatística realizada por correlação de Pearson ou de Spearman, análise de regressão múltipla e de regressão bivariada, e teste t (independente) ou de Mann-Whitney. Um p<0,05 indicou significância estatística. Resultados Prontuários de 355 pacientes foram avaliados, 56,1 ±14,8 anos, 51% homens. A VOP correlacionou-se com espessuras da íntima média (EIM) das carótidas (r=0,310) do septo do ventrículo esquerdo (r=0,191) e da parede posterior do ventrículo esquerdo (r=0.215), e com diâmetro do átrio esquerdo (r=0,181). A EIM associou-se com VOP ajustada por idade e pressão sistólica periférica (p=0,0004); uma EIM maior que 1mm aumentou em 3,94 vezes a chance de se apresentar VOP acima de 10m/s. A VOP foi significativamente maior em indivíduos com hipertrofia do ventrículo esquerdo (p=0,0001), EIM > 1 mm (p=0,006), placa de carótida (p=0,0001), estenose ≥ 50% (p=0,003), e lesões de órgãos-alvo (p=0,0001). Conclusões A VOP correlacionou-se com a EIM e com parâmetros ecocardiográficos, e se associou independentemente com EIM. Essa associação foi mais forte em pacientes com hipertrofia do ventrículo esquerdo, EIM aumentada, placa de carótida, estenose ≥ 50%, e lesões de órgãos-alvo. (Arq Bras Cardiol. 2020; 115(6):1125-1132)

Abstract Background The relationship between pulse wave velocity (PWV) and biomarkers of structural changes of the left ventricle and carotid arteries remains poorly understood. Objective To investigate the relationship between PWV and these biomarkers. Methods This was an analytical, retrospective, cross-sectional study. Medical records of patients with diabetes mellitus, dyslipidemia, and pre-hypertension or hypertension, who underwent central blood pressure (CBP) measurement using Mobil-O-Graph®, and carotid doppler or echocardiography three months before and after the CBPM were analyzed. Statistical analysis was performed using Pearson or Spearman correlation, linear bivariate and multiple regression analysis, and the t test (independent) or Mann-Whitney test. A p <0.05 indicated statistical significance. Results Medical records of 355 patients were analyzed, mean age 56.1 (±14.8) years, 51% male. PWV was correlated with intima-media thickness (IMT) of carotids (r=0.310) and left ventricular septal thickness (r=0.191), left ventricular posterior wall thickness (r=0.215), and left atrial diameter (r=0.181). IMT was associated with PWV adjusted by age and peripheral systolic pressure (p=0.0004); IMT greater than 1 mm increased the chance of having PWV above 10 m/s by 3.94 times. PWV was significantly higher in individuals with left ventricular hypertrophy (p=0.0001), IMT > 1 mm (p=0.006), carotid plaque (p=0.0001), stenosis ≥ 50% (p=0.003), and target-organ damage (p=0.0001). Conclusion PWV was correlated with IMT and echocardiographic parameters, and independently associated with IMT. This association was stronger in individuals with left ventricular hypertrophy, increased IMT, carotid plaque, stenosis ≥ 50%, and target organ damage. (Arq Bras Cardiol. 2020; 115(6):1125-1132)

Relação entre espessura da artéria Carótida, Vitamina D, Perfil Glicêmico e Antropometria / Relationship between Carotid artery thickness, Vitamin D, Glycemic Profile and Anthropometry

O objetivo foi avaliar se a espessura íntima carotídea está associada à vitamina D, perfil glicêmico e antropométrico. Foram coletados dados pessoais, antropométricos, bioquímicos e laudo de ultrassonografia carotídea, o qual foi utilizado a fim de avaliar o espessamento em milímetros e constatar ou não placas ateroscleróticas. As variáveis estudadas foram tratadas com o coeficiente de correlação de Pearson, ANOVA e Kruskal-Wallis. A média do IMC dos 51 pacientes foi de 29,47±6,39 kg/m². A espessura carotídea foi ≥1 mm em 54,90%. Quanto à vitamina D, 41,18% apresentaram hipovitaminose. A correlação da espessura carotídea com dados antropométricos, glicemia de jejum e HbA1c foi diretamente proporcional e inversamente com os valores de vitamina D, embora sem diferença significativa. As variáveis estudadas não puderam ser associadas com diferença significativa à espessura da camada média intimal da carótida nesta amostra.

The aim of this study was to evaluate the association of carotid intima thickness with vitamin D, glycemia and anthropometry. Personal, anthropometric and biochemical data, and carotid ultrasound report (to check thickening in millimeters and for the presence of atherosclerotic plaques) were collected. The variables studied were treated with Pearson's correlation coefficient, ANOVA and Kruskal-Wallis. The mean BMI of the 51 patients was 29.47 ± 6.39kg/m². The carotid thickness was ≥1mm in 54.90%. Regarding vitamin D, 41.18% had hypovitaminosis. The carotid thickness was directly proportionally correlated with anthropometric data, fasting blood glucose and HbA1c, and inversely correlated with vitamin D values, although without significant difference. The studied variables were not significantly associated with carotid intima thickness in this sample.

Analysis of cardiovascular risk and carotid intima-media thickness in patients with psoriasis

Abstract Background: Psoriasis is associated with atherosclerosis and increased cardiovascular risk. Currently, an automated ultrasound, called quantitative intima media thickness, has proven to be a useful method to evaluate subclinical atherosclerosis. Objectives: To compare increased cardiovascular risk in psoriasis patients receiving two types of treatments: Methotrexate and tumor necrosis factor inhibitor and to evaluate the correlation between the Framingham score and quantitative intima media thickness. Methods: Fifty patients with plaque psoriasis were selected from June 2017 to July 2018, divided into two groups, receiving methotrexate and tumor necrosis factor inhibitor. Measurement of abdominal circumference, blood pressure, body mass index and presence of metabolic syndrome were performed. Afterwards, the patients were evaluated for increased cardiovascular risk with the Framingham score and for the quantitative intima media thickness of the carotid arteries. Results: The mean age was 54.8 (±12.5) with a slight male predominance (58%). Overall, 84% of the patients had elevated waist circumference, 82% had a body mass index above ideal, and 50% had a metabolic syndrome. For the correlation between quantitative intima media thickness and Framingham Score, Pearson's linear correlation coefficient was 0.617 (p < 0.001), indicating a moderate to strong positive association. Study limitations: The protective effect of the therapies cited in relation to the increased cardiovascular risk was not evaluated. Conclusions: A moderate to strong positive association was found correlating the Framingham Score values with the quantitative intima media thickness measurement and it is not possible to state which drug has the highest increased cardiovascular risk.

Subclinical Carotid Atherosclerosis and Reduced DAD Score for Cardiovascular Risk Stratification in HIV-Positive Patients / Aterosclerose Carotídea Subclínica e DAD Escore Reduzido para Estratificação de Risco Cardiovascular em Pacientes HIV Positivos

Abstract Background: HIV-positive patients are twice as likely than the general population to have a heart attack and are four times at greater risk of sudden death. In addition to the increased risk, these individuals present with cardiovascular events on average approximately 10 years earlier than the general population. Objective: To compare Framingham and reduced DAD (Data Collection on Adverse Effects of Anti-HIV Drugs Cohort) scores for cardiovascular risk assessment in HIV-positive patients and potential impact on clinical decision after evaluation of subclinical carotid atherosclerosis. Methods: Seventy-one HIV-positive patients with no history of cardiovascular disease were clinically evaluated, stratified by the Framingham 2008 and reduced DAD scores and submitted to subclinical carotid atherosclerosis evaluation. Agreement between scores was assessed by Kappa index and p < 0.05 was considered statistically significant. Results: mean age was 47.2 and 53.5% among males. The rate of subclinical atherosclerosis was 39.4%. Agreement between scores was 49% with Kappa of 0.735 in high-risk patients. There was no significant difference between scores by ROC curve discrimination analysis. Among patients with intermediate risk and Framingham and reduced DAD scores, 62.5% and 30.8% had carotid atherosclerosis, respectively. Conclusion: The present study showed a correlation between the scores and medium-intimal thickening, besides a high correlation between patients classified as high risk by the Framingham 2008 and reduced DAD scores. The high prevalence of carotid atherosclerosis in intermediate risk patients suggests that most of them could be reclassified as high risk.

Resumo Fundamento: Pacientes HIV positivos possuem 2 vezes maior risco que a população geral de apresentarem infarto e 4 vezes maior de morte súbita. Além do risco aumentado, esses indivíduos apresentam eventos cardiovasculares, em média, aproximadamente, 10 anos antes que a população geral. Objetivo: Comparar os escores Framingham e DAD reduzido para avaliação de risco cardiovascular em pacientes HIV positivos e o potencial impacto na decisão clínica após avaliação de aterosclerose carotídea subclínica. Métodos: Foram avaliados clinicamente 71 pacientes HIV positivos sem antecedentes de doenças cardiovasculares, estratificados pelos escores Framingham 2008 e DAD reduzido e submetidos a avaliação de aterosclerose carotídea subclínica. A concordância entre os escores foi avaliada pelo índice Kappa e os valores de p < 0,05 foram considerados estatisticamente significativos. Resultados: A idade média foi 47,2 e 53,5% do sexo masculino. A ocorrência de aterosclerose subclínica foi de 39,4%. A concordância entre os escores foi de 49% com Kappa de 0,735 nos pacientes de alto risco. Não houve diferença significativa entre os escores por meio de análise de discriminação com curva ROC. Dos pacientes com risco intermediário no Framingham e DAD reduzido, 62,5% e 30,8% respectivamente apresentavam aterosclerose carotídea. Conclusão: O presente estudo mostrou correlação entre os escores e espessamento médio-intimal e alta concordância entre os pacientes classificados como alto risco nos escores Framingham 2008 e DAD escore reduzido. A observação de alta prevalência de aterosclerose carotídea em pacientes de risco intermediário sugere que grande parte desses pacientes poderia ser reclassificada como alto risco.