Background and Purpose-The apolipoprotein B (apoB)/apolipoprotein A-I (apoA-I) ratio is a measure of the relationship between different lipoprotein particles and a powerful predictor of coronary death. The aim was to examine whether apoB/apoA-I was associated with the metabolic syndrome (MetS) at baseline and also with the future change in carotid artery intima-media thickness (IMT). Methods-In 313 58-year-old men, carotid artery IMT was measured bilaterally by high-resolution B-mode ultrasound at baseline and after 3 years of follow-up. Serum apolipoprotein concentrations and the components of MetS were measured at study entry. Results-ApoB/apoA-I showed statistically significant associations with body mass index, waist-to-hip ratio, high-density lipoprotein (HDL) cholesterol, triglycerides, low-density lipoprotein (LDL) particle size, insulin, and diastolic blood pressure. Two thirds of the patients with MetS had high apoB/apoA-I ratios (Ͼ0.90) compared with one third of those without the syndrome (PϽ0.001). The IMT change was associated with apoB, total cholesterol, LDL cholesterol, triglycerides, and inversely with HDL cholesterol and LDL particle size at entry, and there was a strong colinearity between these variables. The subjects with apoB/apoA-I above the first tertile (0.74) had a 20-m-higher (95% CI, 7 to 33) annual increase in IMT compared with those below this level after adjustment for blood pressure and smoking. Conclusions-The apoB/apoA-I ratio was strongly associated with MetS and its components at baseline. ApoB/apoA-I at baseline was related to the change in carotid artery IMT during 3 years of follow-up. There was a strong colinearity between apoB/apoA and the atherogenic lipids. (Stroke. 2004;35:000-000.)

Abstract. Wallenfeldt K, Hulthe J, Bokemark L, Wikstrand J, Fagerberg B (Sahlgrenska University Hospital, Gothenburg University, Gothenburg, Sweden). Carotid and femoral atherosclerosis, cardiovascular risk factors and C-reactive protein in relation to smokeless tobacco use or smoking in 58-year-old men. J Intern Med 2001; 250: 492±501.Objectives. To examine the associations between smokeless tobacco use, smoking, cardiovascular risk factors, in¯ammation and ultrasound-assessed measures of atherosclerosis in the carotid and femoral arteries. Subjects. The study was performed in a populationbased sample of clinically healthy men (n 391) all 58 years old. Exclusion criteria were cardiovascular or other clinically overt diseases or continuous medication with cardiovascular drugs. Methods. The habits of smoking and oral moist snuff use were assessed by questionnaires. C-reactive protein (CRP) was assessed by high sensitive enzymelinked immunosorbent assay (ELISA). Intima-media thickness (IMT) in the carotid bulb, the common carotid artery and the common femoral artery and plaque occurrence were measured by ultrasound. Results. The use of oral moist snuff was associated with serum triglycerides and waist±hip ratio (WHR), but not with CRP or ultrasound-assessed measures of subclinical atherosclerosis. Smoking, on the other hand, was associated with CRP, the components in the metabolic syndrome and IMT as well as plaques in the carotid and femoral arteries. In comparison to never-smokers the current smokers had higher values of WHR, triglycerides, C-reactive protein and IMT in carotid bulb and femoral artery. Ex-smokers were in general more obese and had a femoral IMT that was in-between that of neversmokers and current smokers. Conclusions. Tobacco smoking, but not oral moist snuff use, was associated with carotid and femoral artery IMT, and increased levels of CRP. Current smoking was also associated with abdominal obesity. Ex-smokers though, are generally more obese. Smoking was also associated with hyperinsulinaemia, dyslipidaemia and high blood pressure, i.e. the metabolic syndrome. The inhaled smoke from the combustion of tobacco seems to be an important aetiological factor in the atherosclerotic process.

Objective. To investigate the association between plasma oxidized low-density lipoprotein (OxLDL) and the progress of clinically silent atherosclerosis, as measured by ultrasound in the carotid arteries. Design. Prospective, observational study with more than 3 years of follow-up. Setting. One-centre study at university hospital. Material and methods. The subjects (n ¼ 326) were obtained by stratified sampling from a population sample of men who were 58 years old at baseline. Carotid artery intima-media thickness (IMT) was measured bilaterally by high-resolution B-mode ultrasound at baseline and after follow-up. Plasma OxLDL cholesterol concentrations and conventional cardiovascular risk factors were measured at study entry. Automated measurements of IMT were performed. Plaque occurrence and size were assessed (plaque status). Plasma OxLDL at entry was measured by a specific monoclonal antibody, mAb-4E6.Results. OxLDL at entry, but not LDL cholesterol, was associated with the number and size of plaques at follow-up (P ¼ 0.008), also after adjustment for plaque status at entry (P ¼ 0.033). The plasma OxLDL concentration at entry was associated with change in carotid artery IMT (r ¼ 0.17; P ¼ 0.002) and in a stepwise multiple regression analysis this association remained after adjustment for other cardiovascular risk factors (P ¼ 0.005). Conclusions. These results provide new information, supporting the concept that circulating OxLDL was associated with the silent phase of atherosclerosis progression in clinically healthy men independently of conventional risk factors.

Circulating E2 is a predictor of progression of carotid artery intima-media thickness in middle-aged men. Further studies are needed to investigate the role of endogenous E2 for incident cardiovascular disease events.

Abstract. Wallenfeldt K, Hulthe J, Fagerberg B (Sahlgrenska University Hospital, Gothenburg University, Gothenburg, Sweden). The metabolic syndrome in middle-aged men according to different definitions and related changes in carotid artery intima-media thickness (IMT) during 3 years of follow-up. J Intern Med 2005; 258: 28-37.Objectives. To examine the occurrence over time of the metabolic syndrome (MetS) according to different definitions and the relation to change during follow-up in carotid artery intima-media thickness (IMT), measured by ultrasound. Design. A cohort of 316, originally 58-year-old men, initially free of diabetes and cardiovascular disease, was followed for 3.2 ± 0.2 years. IMT was measured bilaterally by high-resolution B-mode ultrasound at baseline and follow-up. The MetS was classified according to slightly modified World Health Organization (WHO) and National Cholesterol Education Program (NCEP) criteria. Results. In 88% WHO and NCEP definitions resulted in identical classifications. IMT was larger both at baseline and after 3 years in men fulfilling the criteria for the MetS, according to either of the definitions, compared to those without factors in the syndrome. Men who fulfilled the WHO criteria for the MetS, at the initial and final examination showed a statistically significant increase in carotid artery IMT during the study [76 (95% CI: 14-130) lm, n ¼ 37]. Men fulfilling the WHO criteria for the MetS at baseline tended to have a larger annual increase in IMT than those not fulfilling the criteria or having no risk factors in the syndrome. Conclusions. More than 10% of the men had the MetS both at baseline and after 3 years, and this was associated with an increase in IMT using the WHO definition. Several of the components included in the MetS deteriorated during follow-up, i.e. body mass index (BMI), waist-to-hip ratio (WHR), waist circumference, blood glucose and blood pressure.