Thrombosis Research

2019

DOI: 10.1016/j.thromres.2019.02.030

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Association between fibrinogen and fibrinogen γ’ and atherosclerotic plaque morphology and composition in symptomatic carotid artery stenosis: Plaque-At-RISK study

Anouk C. van Dijk

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Samantha J. Donkel

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et al.

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Cited by 14 publications

(15 citation statements)

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“…It appears, that especially in “younger” populations inflammation and plaques composition are main triggers for adverse outcome, since atherosclerotic plaques with thin fibrous caps and large necrotic cores are clearly associated with cardiovascular events and death [15]. In this context, fibrinogen was recently found to be inversely associated with intraplaque hemorrhage- and necrotic core-volume, independently of inflammation [16]. Fernández-Friera et al lately described that arterial inflammation is highly prevalent in middle-aged individuals with known subclinical atherosclerosis, and thus may trigger early cardiovascular events [17].…”

Section: Discussionmentioning

confidence: 99%

Carotid ultrasound investigation as a prognostic tool for patients with diabetes mellitus

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et al. 2019

Cardiovasc Diabetol

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Background Experimental and clinical data indicate a major influence of diabetes on atherogenesis. We aimed to assess whether the effect of diabetes on long-term mortality in asymptomatic patient with carotid stenosis is contingent upon the degree of the carotid atherosclerotic burden. Methods 1065 patients with neurological asymptomatic carotid atherosclerosis as evaluated by duplex sonography were prospectively followed for cause-specific mortality. Results During a median of 11.8 years, a total of 549 deaths, including 362 cardiovascular deaths, were recorded. Diabetes and glycohemoglobin A1c (Hba1c) levels were significantly associated with mortality. Diabetes displayed an independent risk for all-cause (adjusted HR 1.62; 95% CI 1.35–1.94) and cardiovascular death (adjusted HR 1.75, 95% CI 1.40–2.19). The adjusted hazard ratio per increase of 1% of Hba1c levels was 1.21 (P < 0.01) for all-cause and 1.31 (P < 0.01) for cardiovascular mortality, respectively. Patients with diabetes mellitus and a higher degree of carotid stenosis and were at great risk of adverse outcome. Only 21% of the asymptomatic diabetic patients with carotid narrowing over 50% survived, whereas 62% of the patients without diabetes and with carotid atherosclerosis below 50% were still alive after 12-years of follow-up. The high risk for all-cause and cardiovascular death of these patients remained significant after adjustment for various established cardiovascular risk factors in multivariable regression analysis (adjusted hazard ratio 2.4, P < 0.001; compared to patients without diabetes and < 50% carotid atherosclerosis). Conclusion Diabetic patients with carotid stenosis ≥ 50% are at exceptional high risk for all-cause and cardiovascular death. Thus, routinely ultrasound investigation of the carotid arteries might be a valuable prognostic tool for patients with diabetes mellitus.

“…It appears, that especially in “younger” populations inflammation and plaques composition are main triggers for adverse outcome, since atherosclerotic plaques with thin fibrous caps and large necrotic cores are clearly associated with cardiovascular events and death [15]. In this context, fibrinogen was recently found to be inversely associated with intraplaque hemorrhage- and necrotic core-volume, independently of inflammation [16]. Fernández-Friera et al lately described that arterial inflammation is highly prevalent in middle-aged individuals with known subclinical atherosclerosis, and thus may trigger early cardiovascular events [17].…”

Section: Discussionmentioning

confidence: 99%

Carotid ultrasound investigation as a prognostic tool for patients with diabetes mellitus

¹

,

²

,

³

et al. 2019

Cardiovasc Diabetol

View full text Add to dashboard Cite

Background Experimental and clinical data indicate a major influence of diabetes on atherogenesis. We aimed to assess whether the effect of diabetes on long-term mortality in asymptomatic patient with carotid stenosis is contingent upon the degree of the carotid atherosclerotic burden. Methods 1065 patients with neurological asymptomatic carotid atherosclerosis as evaluated by duplex sonography were prospectively followed for cause-specific mortality. Results During a median of 11.8 years, a total of 549 deaths, including 362 cardiovascular deaths, were recorded. Diabetes and glycohemoglobin A1c (Hba1c) levels were significantly associated with mortality. Diabetes displayed an independent risk for all-cause (adjusted HR 1.62; 95% CI 1.35–1.94) and cardiovascular death (adjusted HR 1.75, 95% CI 1.40–2.19). The adjusted hazard ratio per increase of 1% of Hba1c levels was 1.21 (P < 0.01) for all-cause and 1.31 (P < 0.01) for cardiovascular mortality, respectively. Patients with diabetes mellitus and a higher degree of carotid stenosis and were at great risk of adverse outcome. Only 21% of the asymptomatic diabetic patients with carotid narrowing over 50% survived, whereas 62% of the patients without diabetes and with carotid atherosclerosis below 50% were still alive after 12-years of follow-up. The high risk for all-cause and cardiovascular death of these patients remained significant after adjustment for various established cardiovascular risk factors in multivariable regression analysis (adjusted hazard ratio 2.4, P < 0.001; compared to patients without diabetes and < 50% carotid atherosclerosis). Conclusion Diabetic patients with carotid stenosis ≥ 50% are at exceptional high risk for all-cause and cardiovascular death. Thus, routinely ultrasound investigation of the carotid arteries might be a valuable prognostic tool for patients with diabetes mellitus.

“…Low HDL-C levels lead to the progression of atherosclerosis 5,7,8 . Fibrinogen, a component of the coagulation cascade, has pro-inflammatory effects and has been demonstrated to have an essential role in atherogenesis 4 . Serum albumin, responsible for the vast majority of total osmotic pressure, plays a crucial role in inhibiting platelet activation and aggregation 9 .…”

Section: Resultsmentioning

confidence: 99%

“…Inflammation has an important role in the development, advancement, and destabilization of carotid atherosclerosis 2, 3 . Atherosclerotic lesions in the carotid arteries have been found to be related to inflammatory markers 3, 4 .…”

Section: Introductionmentioning

confidence: 99%

The role of monocyte to HDL ratio in predicting clinically significant carotid stenosis in patients with asymptomatic carotid artery disease

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2020

Rev. Assoc. Med. Bras.

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SUMMARY OBJECTIVE Monocyte count to HDL-C Ratio (MHR) and Fibrinogen to Albumin Ratio (FAR) have recently emerged as markers of inflammation in atherosclerotic diseases. Our goal was to investigate the relationships of MHR and FAR with the severity of carotid artery stenosis (CAS) in patients with asymptomatic carotid artery disease. METHODS This retrospective study consisted of 300 patients with asymptomatic CAS. Pre-angiographic MHR, FAR, and high-sensitive C-reactive protein (hsCRP) were measured. Carotid angiography was performed in patients with ≥50% stenosis on carotid ultrasonography. Patients were first split into 2 groups based on the degree of CAS and then tertiles (T) of MHR. RESULTS 96 patients had clinically insignificant CAS (<50%) (Group-1), and 204 patients had clinically significant CAS (≥50%) (Group-2). Group-2 had higher MHR, FAR, and hsCRP than group-1. Patients in T3 had higher MHR, FAR, and hsCRP than in T1 and T2. MHR, FAR, and hsCRP were correlated with each other (p<0.001, for all). MHR, FAR, and hsCRP were independent predictors of significant CAS. MHR better predicted a significant CAS than FAR and hsCRP (p<0.05). CONCLUSION Pre-angiographic MHR may be a better predictor than FAR and hsCRP in identifying a clinically significant carotid stenosis in patients with asymptomatic CAS. Patients with asymptomatic CAS and a high level of MHR should be followed-up closely to supervise risk-factor control and intensify treatment.

“…The underlying mechanism remained unclear. However, sex is considered as a biological variable underlies physiological variation in vascular function, fibrinogen, and coagulation [36, 41]. Sex hormones could contribute to the progress of macrovascular related diseases [42].…”

Section: Discussionmentioning

confidence: 99%

Prospective study of hemoglobin A1c and incident carotid artery plaque in Chinese adults without diabetes

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et al. 2019

Cardiovasc Diabetol

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BackgroundDiabetes has been reported to be associated with carotid artery plaque (CAP). However, it remains unclear whether hemoglobin A1c (HbA1c) level, a marker for long-term glycemic status, is associated with altered CAP risk in individuals with fasting blood glucose (FBG) concentrations below the current cutoff for diabetes.MethodsIncluded were 16,863 Chinese adults (aged 18 years or more; 9855 men and 7008 women) with fasting blood glucose < 7.0 mmol/L at baseline (2013). Both HbA1c level and CAP (assessed via ultrasound B-mode imaging) were annually assessed during 2014–2018. All the participants were further classified into three groups based on baseline HbA1c level: ≤ 5.6%, 5.7–6.4%, and ≥ 6.5%. We used Cox proportional-hazards model to evaluate the association between HbA1c level and incident CAP, adjusting for a series of potential confounders.ResultsDuring 5 years of follow up, 3942 incident CAP cases were identified. Individuals with higher baseline HbA1c had higher future risk of CAP (p-trend < 0.001). In the full-adjusted model, each percent increase of HbA1c was associated with a 56% (HR = 1.56, 95% CI 1.37, 1.78) higher risk of CAP. Excluding participants with chronic inflammation, as assessed by high-sensitivity C-reactive protein and white blood cell, and those with FBG ≥ 5.6 mmol/L at baseline generated similar results.ConclusionsElevated HbA1c level was associated with high risk of developing CAP in Chinese adults without FBG defined diabetes.

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