Prospective Association of Obesity Patterns with Subclinical Carotid Plaque Development in Early Postmenopausal Chinese Women.

OBJECTIVE: This study aimed to examine the prospective associations of general and abdominal obesity patterns with carotid plaque development among early postmenopausal Chinese women. METHODS: A total of 518 postmenopausal women aged 50 to 64 years were recruited between 2002 and 2004 and were followed up at 3 years and 5 years. Carotid plaque was measured using B-mode ultrasonography, whereas general and abdominal obesity were defined as BMI ≥ 25 kg/m2 and waist-hip ratio ≥ 0.85, respectively. Sociodemographic, lifestyle, mental health, disease history, and clinical measurements were also assessed for confounding control. Multivariable binary logistic regression analyses on plaque development at 5 years were performed among 322 women with no carotid plaque at baseline. RESULTS: Over the 5-year follow-up period, 70 women (21.7%) developed carotid plaque. Baseline abdominal obesity independently predicted plaque development (adjusted odds ratio = 2.30; 95% CI: 1.15-4.60), but general obesity did not. Women with normal-weight abdominal obesity were more than twice as likely to develop carotid plaque (adjusted odds ratio = 2.43; 95% CI: 1.02-5.75) compared with women with no obesity, with their risk comparable to women with both general and abdominal obesity. CONCLUSIONS: Abdominal obesity was a critical predictor of subclinical carotid plaque development among early postmenopausal Chinese women. Policy makers should recognize the need to identify high-risk midlife women with normal-weight abdominal obesity in public health and clinical practice.

Associations of consuming specific fruit and vegetable subgroups with LDL-C status in early postmenopausal Chinese women.

OBJECTIVE: Aging and menopausal changes contribute to increased cardiovascular risks in postmenopausal women. This study examined the associations of total and specific fruit and vegetable consumption with low-density lipoprotein cholesterol (LDL-C) status, a critical cardiovascular risk factor, in early postmenopausal Chinese women. METHODS: A total of 508 postmenopausal Hong Kong Chinese women aged 50 to 64 years were recruited into a cohort study on cardiovascular risks. Sociodemographic characteristics, medical conditions, use of medications, and lifestyle factors were obtained via structured interviews. Dietary intake was assessed using a validated food frequency questionnaire. LDL-C and total cholesterol concentrations were determined using biochemical enzymatic techniques and categorized according to the Adult Treatment Panel III classification. RESULTS: Ordinal logistic regression analysis showed that women with total fruit and vegetable intake in the highest quartile were 33% less likely (odds ratio [OR] = 0.67; 95% CI, 0.44-1.03) to have a worse LDL-C status than those with lower intake after adjustments. The intakes of total vegetables (OR = 0.63; 95% CI, 0.41-0.96) and vegetable subgroups in the highest quartiles, including darkgreen leafy vegetables (OR = 0.60; 95% CI, 0.41-0.89) and corn and tubers (OR = 0.62; 95% CI, 0.40-0.96), were significantly inversely associated with LDL-C status. Further adjustment for total cholesterol did not attenuate the associations. CONCLUSIONS: A daily consumption of vegetables equivalent to about four servings or more might be beneficial for LDL-C control in early Chinese postmenopausal women. In particular, darkgreen leafy vegetables, as well as corn and tubers, deserve greater advocacy for their ability to improve lipid profiles and hence cardiovascular health.

Safety and efficacy of sonographically guided high-intensity focused ultrasound for symptomatic uterine fibroids: preliminary study of a modified protocol.

OBJECTIVES: We aimed to assess the safety and efficacy of sonographically guided high-intensity focused ultrasound for treating patients with symptomatic uterine fibroids using a modified protocol. METHODS: This work was part of an ongoing prospective phase 1 study. Twenty patients with 22 symptomatic fibroids were treated with sonographically guided high-intensity focused ultrasound under no anesthesia. The modified protocol consisted of repeated and shortened (<25 minutes) treatment sessions of high-input acoustic intensity (1000-1500 W/cm(2)) and intensified sonication pulses (1500-2000) at each spot. The primary end points were periprocedural complications. The secondary end points were symptomatic improvement and radiologic evidence of treatment responses, including the degree of fibroid infarction and volume shrinkage 3 months after treatment. Symptomatic improvement was assessed by a pain score, a pictorial chart menstrual score, the Urogenital Distress Inventory short form, and the Incontinence Impact Questionnaire short form. The degree of fibroid infarction was assessed by the nonperfused ratio on contrast-enhanced magnetic resonance imaging, defined as the ratio of the nonperfused fibroid volume to the total fibroid volume. RESULTS: Nineteen patients tolerated the treatment well, with no major adverse events. One patient who received treatment for a fibroid located within 6 cm from the skin had third-degree skin burns at 2 sites of 1 cm in diameter. Fibroid-related abdominal pain, pictorial chart, Urogenital Distress Inventory, and Incontinence Impact Questionnaire scores were significantly improved (P < .05). The median nonperfused ratio at 3 months was 20% (95% confidence interval, 5%-32.5%). Median volume shrinkage at 3 months was 17.2% (95% confidence interval, 4.3%-26.6%). CONCLUSIONS: Sonographically guided high-intensity focused ultrasound using a modified protocol may be safe and effective for symptomatic uterine fibroids in selected patients to avoid skin burns.

Comparison of clinical outcomes of tris-acryl microspheres versus polyvinyl alcohol microspheres for uterine artery embolization for leiomyomas: results of a randomized trial.

PURPOSE: To compare tris-acryl microspheres and polyvinyl alcohol (PVA) microspheres as embolic agents in uterine artery embolization (UAE) for uterine leiomyomas in terms of clinical outcome, inflammatory response, and adverse reactions. MATERIALS AND METHODS: A double-blinded randomized controlled trial was performed, with 27 patients in the tris-acryl microsphere group and 29 in the PVA microsphere group. The primary endpoint was clinical success, defined as a 2-year freedom from subsequent surgery as a result of persistent or deteriorated symptoms. Secondary endpoints included (i) posttreatment leiomyoma enlargement, (ii) leiomyoma volume reduction at 3 and 9 months, (iii) significant residual intratumoral perfusion, (iv) increase in inflammatory and stress markers, (v) incidence of complications, and (vi) duration of hospital stay. RESULTS: There was no statistically significant difference between the two groups in patient demographics, clinical presentation, initial tumor findings, change in inflammatory and stress markers after treatment, incidence of complications, and duration of hospital stay. Tris-acryl microspheres were associated with a higher rate of clinical success than PVA microspheres (96.3% [26 of 27] vs 69% [20 of 29]; P = .012), a lower incidence of posttreatment leiomyoma enlargement (P = .030), and a lower incidence of significant residual intratumoral perfusion (P = .030). CONCLUSIONS: In the treatment of uterine leiomyomas, UAE with tris-acryl microspheres was associated with a higher clinical success rate, a lower incidence of tumor enlargement, and no significant differences in adverse reactions and inflammatory response compared with the use of PVA microspheres. Tris-acryl microspheres therefore represent the preferred agent for UAE of uterine leiomyomas.

Psychological factors and subclinical atherosclerosis in postmenopausal Chinese women in Hong Kong.

BACKGROUND: Substantial evidence shows that psychological factors are associated with cardiovascular diseases. However, data on the association between psychological factors and subclinical atherosclerosis is lacking in postmenopausal Chinese women. OBJECTIVES: To examine the associations of perceived stress and trait anxiety with subclinical atherosclerosis in postmenopausal Chinese women in Hong Kong. Their relationships with biological and behavioral risk factors were also examined. METHODS: Between 2002 and 2004, we recruited 518 postmenopausal women aged 50-64 years. Perceived stress and trait anxiety were evaluated by the perceived stress scale and the state-trait anxiety inventory, respectively. Subclinical atherosclerosis was determined by measuring carotid intima-media thickness (IMT) and plaque using B-mode ultrasonography. RESULTS: Perceived stress and trait anxiety showed no significant association with IMT or plaque. Multivariate analyses showed high perceived stress scores were associated with an increased risk of elevated total cholesterol (OR=2.10; 95% CI=1.17-3.77) and elevated low-density lipoprotein cholesterol (LDL-C) (OR=2.39; 95% CI=1.36-4.21). High trait anxiety scores were associated with a 2.7-fold risk of elevated LDL-C (OR=2.74; 95% CI=1.56-4.80). Women with high perceived stress or trait anxiety scores were more likely to be physically inactive. CONCLUSIONS: Perceived stress and trait anxiety were associated with atherogenic lipid levels, but not subclinical atherosclerosis. Maintaining high physical activity may help alleviate psychological stress and anxiety.

Distribution of C-reactive protein and its association with subclinical atherosclerosis in asymptomatic postmenopausal Chinese women.

Substantial evidence shows that C-reactive protein (CRP) is associated with atherosclerosis. However, data on the association between CRP and subclinical atherosclerosis are lacking in postmenopausal Chinese women. We aimed to describe the distribution of CRP and its association with metabolic syndrome (MS) and subclinical atherosclerosis in postmenopausal Chinese women in Hong Kong. Between 2002 and 2004, we recruited 518 postmenopausal women aged 50 to 64 years. Metabolic syndrome was defined according to the National Cholesterol Education Program Adult Treatment Panel III criteria. Subclinical atherosclerosis was determined by measuring carotid intima-media thickness (IMT) and plaque (focal wall thickening ≥1.5 mm) using high-resolution B-mode ultrasonography. Median CRP level was 1.00 mg/L. Women with MS had higher median CRP levels than those without MS (1.85 vs 0.80 mg/L, P < .05), and there was a modest trend toward increasing CRP levels with more metabolic components (P for trend < .05). Adjusted for age, hormonal use, and lifestyle factors, women with CRP levels of 0.5 to less than 1.0 mg/L had significantly higher mean IMT compared with those with CRP levels of less than 0.5 mg/L (0.78 vs 0.74 mm, P < .05). Odds ratio for plaque was 1.92 (95% confidence interval, 1.06-3.50) for women with CRP levels of 1.0 to less than 3.0 mg/L compared with those with CRP levels of less than 0.5 mg/L. Further adjustment for MS eliminated the associations. C-reactive protein did not add prognostic value to MS in the prediction of subclinical atherosclerosis. Compared with women without MS and who had CRP levels of less than 3.0 mg/L, those with CRP of at least 3.0 mg/L alone had similar IMT levels (0.75 vs 0.74 mm) and prevalence of plaque (19.4% vs 20.0%). Similarly, women with MS and who had CRP levels of at least 3.0 mg/L had similar IMT levels (0.81 vs 0.81 mm) and prevalence of plaque (30.1% vs 29.7%) compared with those with MS alone. C-reactive protein was strongly associated with MS and its individual components. However, it is not an independent predictor of subclinical atherosclerosis in postmenopausal Chinese women.

Carotid atherosclerosis and the risk factors in early postmenopausal Chinese women.

OBJECTIVES: To describe the distribution of intima-media thickness (IMT) and the prevalence of plaque by carotid segments, walls and sides, and to examine their associated risk factors in asymptomatic, early postmenopausal Chinese women in Hong Kong. METHODS: Between 2002 and 2004, the study recruited 518 postmenopausal women aged 50-64 years. They were examined by B-mode ultrasound to measure the IMT and the prevalence of plaque at the near and far walls of common carotid (CCA), bifurcation (bulb), and internal carotid (ICA) of both the left and right carotid arteries. Blood pressures, obesity indices, lipids and glucose levels, sociodemographic, medical and lifestyle factors were also obtained. RESULTS: The mean IMT was 0.76+/-0.12 mm (range: 0.53-1.33 mm). IMT was significantly thicker on the far wall than on the near wall and differed among segments (being thickest at the bulb and the narrowest at the ICA). 21.8% had at least one plaque in the carotid artery with most of the plaque found at the bulb area. Systolic blood pressure had statistically significant relationship with IMT that were fairly homogeneous among different segments. Lipids were associated with the CCA and bulb IMT, but not the ICA IMT. Diabetes predicted only CCA IMT. Older age, higher waist-hip-ratio and low-density lipoprotein cholesterol were significant predictors of plaques at all sites combined. CONCLUSIONS: We described the distribution of IMT and the prevalence of plaque in asymptomatic, early postmenopausal Chinese women. Associations of risk factors with IMT of different arterial segments were also observed.

Association of general and abdominal obesities and metabolic syndrome with subclinical atherosclerosis in asymptomatic Chinese postmenopausal women.

OBJECTIVE: This study aimed to investigate the relationships between obesity, especially abdominal obesity, andmetabolic syndrome (MS) with carotid intima-media thickness (IMT) and plaque, markers of subclinical atherosclerosis, in asymptomatic Chinese postmenopausal women in Hong Kong. DESIGN: A total of 518 postmenopausal women aged 50 to 64 years were recruited through random telephone dialing. Body mass index (BMI), waist circumference, waist-to-hip ratio, sociodemographic characteristics, blood pressures, medical, biochemical and lifestyle factors were obtained. MS was defined on the basis of the National Cholesterol and Education Program, Adult Treatment Panel III criteria. Subclinical atherosclerosis was determined by measuring IMT and plaque using high-resolution B-mode ultrasonography. RESULTS: Women with a BMI of 25 kg/mor greater, a waist circumference of 80 cm or greater, a waist-to-hip ratio of 0.85 or greater, or MS were observed to have higher IMT values and prevalence of plaque. Multivariate analyses revealed that waist circumference was significantly associated with IMT independent of age, hormone therapy, lifestyle and sociodemographic factors, and BMI (P < 0.05), whereas a waist-to-hip ratio of 0.85 or greater was significantly associated with plaque (odds ratio = 1.7; 95% CI: 1.0-2.8) after controlling for age, hormone therapy, lifestyle and sociodemographic factors, BMI, and the traditional cardiovascular risk factors. MS was also associated with IMT after adjustment for age, hormone therapy, lifestyle and sociodemographic factors, and BMI (P < 0.05), whereas its association with plaque was also significant (odds ratio = 1.7; 95% CI: 1.0-2.6) after controlling for age. CONCLUSIONS: Abdominal obesity and MS are independent of general obesity markers of subclinical atherosclerosis in Chinese postmenopausal women.

Total cerebral blood flow estimated by color velocity imaging quantification ultrasound: a predictor for recurrent stroke?

Although the Virchow's triad on thrombosis includes reduced blood flow as a factor, there has been relatively little data on the importance of total cerebral blood flow on the risk of subsequent stroke. In the current study, we investigate whether total cerebral blood flow helps predict stroke recurrence. Extracranial arterial blood flow volume estimated by color velocity imaging quantification ultrasound (CVIQ) is an index of cerebral blood flow measurement. We performed a cohort study of 210 consecutive acute stroke patients. Patients were studied with transcranial Doppler and duplex ultrasound for intra- and extracranial large artery disease within 3 days of symptom onset. The association between the risk of recurrent stroke and CVIQ was analyzed with Cox proportional hazards model. Thirty-nine patients (17.7%) developed an ischemic stroke during a mean follow-up of 47.5 months. The mean extracranial blood flow volume was significantly lower for patients who had a recurrent stroke than those without (594.4+/-130.3 versus 683.8+/-176.9 mL/min; P=0.003). In a Cox proportional hazards model adjusting for potential confounding variables, extracranial blood flow volume (hazard ratio (HR) for lowest tertile, 4.1; 95% confidence interval (CI), 1.5 to 11.0) along with male sex (HR, 2.5; 95% CI, 1.3 to 5.1), diabetes (HR, 2.5; 95% CI, 1.2 to 5.0) and large artery stenosis (HR, 2.2; 95% CI, 1.1 to 4.4) were independent predictors for stroke recurrence. Our data indicated that patient with low amount of blood flow to the brain is at risk of recurrent stroke.

Potential value of post stroke extracranial arterial blood flow volume in the prediction of stroke functional outcome.

BACKGROUND AND PURPOSE: Cerebral vasoreactivity and collateral circulation are important protective mechanisms against cerebral ischemia. Previous studies suggest that the efficiency of these mechanisms can be reflected by extracranial arterial blood flow volume. Brain damage leading to neurological impairments can influence patients' functional recovery after stroke. This study attempted to explore the potential value of post stroke extracranial arterial blood flow volume in the prediction of stroke patients' functional outcome. METHODS: We prospectively studied 362 consecutive patients who were hospitalized for recent acute strokes. All patients underwent extracranial arterial blood flow volume measurement of the carotid and vertebral arteries by color velocity imaging quantification within 3 days after admission. Their functional recovery was assessed 6 months after stroke. The effect of post stroke extracranial arterial blood flow volume on patients' functional outcome was tested by multivariate ordinal regression after controlling for other independent variables. Significance was at p<0.05. RESULTS: Post stroke extracranial arterial blood flow volume together with age, pre-stroke modified Rankin scale, the National Institutes of Health Stroke Scale and diabetes mellitus had significant effects on the patients' 6-month functional outcome as measured by the modified Rankin scale after controlling for other independent variables (p<0.05). CONCLUSIONS: Post stroke extracranial arterial blood flow volume is an independent outcome predictor. The graded predictive power of this parameter is potentially more superior than other outcome predictors by allowing classification of stroke outcome according to the degree of severity. A large prospective study is thus warranted to investigate its clinical value in the management of stroke patients.