Association of Serum 25-hydroxyvitamin D in Carotid Intima-media Thickness: A Study from South India.

BACKGROUND: Abnormal carotid intima-media thickness (IMT) is a marker of carotid atherosclerosis which is a risk factor for cerebrovascular and cardiovascular diseases. Recent studies have found an association of 25-hydroxyvitamin D deficiency with abnormal carotid IMT. PURPOSE: The purpose of the study was to investigate the association of serum 25-hydroxyvitamin D levels with carotid IMT in Indian participants. MATERIALS AND METHODS: We prospectively recruited 300 participants at Yashoda Hospital, Hyderabad, during the study period between January 2012 and December 2014. All participants were assessed for fasting blood sugar, lipid profile, C-reactive protein (CRP), serum alkaline phosphatase, serum calcium, serum phosphorous, serum 25-hydroxyvitamin D levels, and carotid Doppler examination. RESULTS: Among the 300 participants, men were 190 (63.3%) and mean age was 51.9 ± 7.7 years with a range from 35 to 64 years. On risk factors evaluation, 105 (35%) were hypertensive, 79 (26.3%) diabetics, 63 (21%) smokers, and 56 (18.6%) were alcoholics. On evaluation of biochemical parameters, 81 (27%) had dyslipidemia, 120 (40%) had elevated CRP levels, 119 (39.6%) had 25-hydroxyvitamin D deficiency, mean alkaline phosphatase was 93.9 ± 14.9 IU/L, serum calcium (mg/dL) was 9.2 ± 2.3, and serum phosphorous 4.4 ± 1.2 mg/dL. On carotid imaging, 121 (40.3%) had abnormal IMT. After multivariate analysis, 25-hydroxyvitamin D deficiency (odds ratio [OR]: 2.14; 95% confidence interval [CI]: 1.29-3.55), dyslipidemia (OR: 2.53; 95% CI: 1.46-4.40), elevated CRP (OR: 2.27; 95% CI: 1.37-3.76), smoking (OR: 2.09; 95% CI: 1.16-3.77), and diabetes (OR: 1.84; 95% CI: 1.05-3.21) were independently associated with abnormal IMT. CONCLUSION: In our study, we established 25-hydroxyvitamin D deficiency as an independently associated with abnormal IMT in Indian participants.

Prevalence and risk factors of asymptomatic carotid artery stenosis in Indian population: An 8-year follow-up study.

BACKGROUND: Asymptomatic carotid artery stenosis (ACAS) is a marker for cerebrovascular disease, coronary atherosclerosis, and death. AIM: To investigate the prevalence of ACAS in the Indian population, and to correlate ACAS with other vascular risk factors. MATERIALS AND METHODS: We prospectively recruited 1500 individuals who were older than 40 years and asymptomatic for cerebrovascular disease between June 2003 and December 2014. Evaluation of vascular risk factors was done for all the participants. Color Doppler of bilateral carotid arteries was performed for all the participants. Carotid stenosis of 1-49% and ≥50% was considered to be mild and significant stenosis, respectively. RESULTS: There were 1016 (67.7%) men, with a mean age of 58.1 ± 10.6 years (age range: 40-98 years). The prevalence of significant carotid stenosis was 5.2%. After adjustment using multiple regression analysis, age >70 years (OR: 2.0; 95% CI: 1.48-2.74), hypertension (OR: 1.8; 95% CI: 1.11-2.96), diabetes (OR: 2.3; 95%CI: 1.45-3.89), smoking (OR: 3.6; 95% CI: 2.18-6.03), dyslipidemia (OR: 4.0; 95% CI: 2.52-6.63), history of migraine (OR: 3.6; 95% CI: 2.54-9.13), history of periodontitis (OR: 3.2; 95% CI: 1.90-5.68), and family history of stroke (OR: 7.1; 95% CI: 4.20-12.2) were significantly associated with >50% stenosis. Duration (>15 years) of hypertension (OR: 2.5; 95% CI: 1.33-6.43), diabetes (OR: 6.2; 95% CI: 3.41-11.3), and smoking (OR: 5.2; 95% CI: 2.20-12.1) markedly worsened the risk. During the 8-year follow up, 14 participants (1.4%) with mild stenosis and 3 participants (4.7%) with significant stenosis developed stroke. CONCLUSIONS: Our study suggests that 5.2% of asymptomatic individuals > 40 years of age harbor significant extracranial carotid artery disease. Presence of multiple vascular risk factors markedly increases the risk of carotid stenosis.

Prevalence and risk factors of carotid intima-media thickness in asymptomatic individual subjects in a tertiary care center in India.

BACKGROUND: Carotid intima-media thickness (IMT) is increasingly identified as a marker of atherosclerosis and increased risk of cerebrovascular disease. AIM: We aimed to investigate the prevalence of carotid IMT in asymptomatic Indian individuals, more than 40 years of age, and correlate it with other risk factors for cerebrovascular ischemia. MATERIALS AND METHODS: Individuals attending outpatient services of Nizam's Institute of Medical Sciences, who were asymptomatic for cerebrovascular ischemia underwent detailed history and carotid Doppler examination. IMT on mid common carotid artery (CCA) was measured. All subjects' blood was taken for biochemical estimation of fasting blood sugar and total cholesterol levels. RESULTS: Out of 1,392 subjects, 571 (41%) had abnormal IMT and 821 (59%) had normal IMT. On comparison of the two groups, the factors significantly associated with abnormal IMT were mean older age (59 vs 50.7 years; P < 0.0001) and higher prevalence of hypertension (257 (45%) vs 236 (28.7%); P < 0.0001), diabetes (159 (27.8%) vs 139 (16.9%); P < 0.0001), and hypercholesterolemia (124 (21.7%) vs113 (13.7%); P = 0.0001). After adjustment with multiple logistic regression, significant predictors were age (odds 3.2; 95% confidence interval (CI) 2.5-4.1), male gender (odds 1.5; 95% CI 1.1-1.9), hypercholesterolemia (odds 1.5; 95% CI 1.1-2.0), hypertension (odds 1.4; 95% CI 1.1-1.8), and diabetes (odds 1.3; 95% CI 1.0-1.7). CONCLUSION: We found age, sex, hypertension, diabetes, and hypercholesterolemia to be independent risk factor for abnormal IMT in asymptomatic subjects over 40 years of age.