Early-Onset Carotid Atherosclerosis Is Associated With Increased Intima-Media Thickness and Elevated Serum Levels of Inflammatory Markers

Abstract

Background and Purpose-Several factors have been held responsible for the development of atherosclerosis. To avoid the masking effect of age, we evaluated correlates of carotid atherosclerosis in patients Ͻ55 years of age. Methods-Plasma lipids, oxidative resistance of low-density lipoprotein, homocysteine, inflammatory markers, plasma viscosity, and red cell deformability were measured in fasting blood samples of 100 subjects: 45 patients with Ͼ30% stenosis of the internal carotid artery, 20 patients with carotid occlusion, and 35 control subjects. Stenosis and intima-media thickness (IMT) of the carotid artery were evaluated by duplex ultrasound. Results-White blood cell (WBC) count, plasma fibrinogen, C-reactive protein (CRP), and lipoprotein(a) levels were significantly higher in patients than in control subjects, and patients had increased IMT (PϽ0.01 for all comparisons). There was a tendency for higher homocysteine levels in patients. Smokers had higher WBC, fibrinogen, and CRP levels. After the effect of smoking was controlled for, WBC count, natural logarithmic transform of homocysteine, and online-measured IMT remained significantly higher in patients than in control subjects. WBC, fibrinogen, and CRP levels were highest in the highest IMT quartile (Pϭ0.012, Pϭ0.007, and Pϭ0.036, respectively). Conclusions-Inflammatory markers and homocysteine have a more important role than lipid factors in early-onset carotid atherosclerosis. We cannot recommend the measurement of low-density lipoprotein peroxidation as a routine screening test to identify high-risk patients for early-onset carotid atherosclerosis. The confounding effect of smoking on inflammatory markers should be considered in studies on atherosclerosis.

White blood cell subsets are associated with carotid intima-media thickness and pulse wave velocity in an older Chinese population: the Guangzhou Biobank Cohort Study

“…The present findings for WBC count and IMT mirrors those reported previously in participants at risk of diabetes, 15,16 and patients with carotid atherosclerosis 17 and other population studies. 19,20 It appeared to be the increase in lymphocyte number, which was mainly responsible for the overall association with WBCs in the present study, as this was the only predictor to remain significant following full adjustment.…”

“…16 Further, carotid atherosclerosis patients had higher WBC counts than controls and also higher IMT than controls. 17 One large-scale longitudinal study demonstrated that the change in IMT over 9 years was significantly associated with baseline WBC 18 and another showed a positive relationship between WBC and maximal internal carotid plaque thickness, 19 which was particularly strong in Hispanics. In contrast, in a large Japanese study, WBC did not correlate with IMT.…”

Inflammation and Carotid Artery—Risk for Atherosclerosis Study (ICARAS)

“…Furthermore, the present results are in line with numerous former crosssectional studies. [37][38][39][40] Despite major advances in treatment of stroke, early identification and prevention of incident events remain crucial, because more than two thirds of all strokes occur without prior symptoms. Recently, Bertges et al 2 demonstrated that progression of carotid artery disease as indicated by duplex ultrasound investigations translates clinically into a substantially increased risk for ipsilateral neurological events.…”

New Risk Factors for Atherosclerosis and Patient Risk Assessment

“…32 Elevated hs-CRP constitutes an independent predictor of advanced carotid plaques in dyslipidemic subjects, 33 and early-onset carotid atherosclerosis is associated with increased intima-media thickness and elevated serum levels of inflammatory markers. 34 A graded association between hs-CRP and carotid atherosclerosis has been demonstrated in women but not in men. 35 Recently, the American Heart Association has endorsed optional use of hs-CRP to guide physicians in identifying patients without known cardiovascular disease who may be at higher risk than estimated by major risk factors alone.…”