Impact of Carotid Atherosclerosis on the Risk of Adverse Cardiac Events in Patients With and Without Coronary Disease

Steinvil, Arie; Sadeh, Ben; Bornstein, Natan M.; Havakuk, Ofer; Greenberg, Sharon A; Arbel, Yaron; Konigstein, Maayan; Finkelstein, Ariel; Banai, Shmuel; Halkin, Amir

doi:10.1161/strokeaha.114.005663

Cited by 29 publications

(25 citation statements)

References 14 publications

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“…This predictive ability has a wide range of potential applications among both asymptomatic individuals with vasculopathic risk factors and patients with symptoms of arterial diseases. 6,7 …”

Section: Introductionmentioning

confidence: 99%

Factors Significantly Associated With the Increased Prevalence of Carotid Atherosclerosis in a Northeast Chinese Middle-aged and Elderly Population

Pan

Lai

et al. 2016

Medicine

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Carotid atherosclerosis is associated with many serious cardiovascular diseases; hence, it is necessary to identify factors related to its occurrence in order to develop preventive and therapeutic strategies. This study was conducted to identify risk factors associated with carotid atherosclerosis among the population residing in Northeast China.This epidemiological survey was conducted in a representative group of relatively healthy community residents. All participants answered questions about their medical histories and underwent physical examination, blood biochemical analysis, and ultrasonography examinations of their necks and abdomens. The prevalence rates of carotid atherosclerosis under different factors and conditions were then analyzed.The results of this study showed that age, gender, and diabetes significantly affected the prevalence of carotid atherosclerosis in this Northeast Chinese population. In addition, gender-based subgroup analysis revealed additional factors correlated with the prevalence of carotid atherosclerosis in men or women, although their correlations were not significant in the overall population. While high serum TC and LDL-C levels were risk factors for carotid atherosclerosis in men, it showed no clear correlation with the prevalence of carotid atherosclerosis in women. In contrast, the prevalence of carotid atherosclerosis in female participants with high serum TG level, hypertension, obesity and nonalcoholic fatty liver disease were higher than that of the control population, a trend not observed in male participants.Older age, male sex, and diabetes were independently associated with increased risk of carotid atherosclerosis in Northeast China. These findings could lead to improved screening for carotid atherosclerosis for better disease management.

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Section: Introductionmentioning

confidence: 99%

Factors Significantly Associated With the Increased Prevalence of Carotid Atherosclerosis in a Northeast Chinese Middle-aged and Elderly Population

Pan

Lai

et al. 2016

Medicine

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“…Together with past manifestations of ACS, carotid atherosclerosis is thought to reflect a subsequent worsening of CAD and considered a risk factor for CAD. 5,6,14,15 The grade of CECP could be helpful to predict future CV events, irrespectively of its dot or extensive uptake pattern. 14 A semi-quantitative assessment method can be more accessible than a time-consuming quantitative technique.…”

Section: Prognosis Of Contrast-enhancement Of Carotid Plaque For CLmentioning

confidence: 99%

Implication of ultrasound contrast‐enhancement of carotid plaques in prevalence of acute coronary syndrome and occurrence of cardiovascular outcomes

Choi

Kim

et al. 2018

J of Clinical Ultrasound

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Purpose: Ultrasonographic contrast enhancement of carotid plaque (CECP) has been used to detect neovascularization of vasa vasorum and plaque. However, it is uncertain whether CECP can provide risk stratification of coronary artery disease (CAD). This study aimed to evaluate the relationship between CECP and manifestations of acute coronary syndrome (ACS) in established CAD patients and to explore the prognostic implication of CECP for cardiovascular (CV) clinical outcomes.Methods: A medical record review revealed that contrast-enhanced ultrasonography was performed to evaluate carotid atherosclerosis in 209 coronary artery-stented and 105 non-stented patients. The rate of ACS manifestations was compared depending on contrast uptake patterns: grade 0, absent; grade 1, dot; and grade 2, diffuse pattern. CV primary outcomes were assessed during a mean 7.6 months of follow-up.Results: Male sex, smoking, history of old myocardial infarction, intensive medications, and a favorable lipid profile were common in the stented versus non-stented group. Patients with grade 2 CECP had a higher rate of ACS, greater plaque thickness, and class I-II of Gray-Weale plaque echogenicity. During follow-up, 10 coronary revascularizations (nine ACSs), six strokes, and four heart failures occurred. Grade 2 CECP was more closely related with CV primary outcomes and showed a tendency toward more acute CV outcomes.Conclusion: ACS manifestations were proportionate to CECP grade. Diffuse CECP uptake could be a risk factor for acute CV outcomes. K E Y W O R D S acute coronary syndrome, carotid plaque, contrast-enhanced ultrasonography 1 | INTRODUCTION Contrast-enhanced ultrasonography (CEU) can not only clearly depict the carotid artery and its lesions, but also demonstrate neovascularization within carotid plaque. 1-3 Despite a lack of definitive evidence, ultrasonographic contrast-enhancement of carotid plaque (CECP) appears to be a marker of plaque vulnerability as it usually results from local inflammation, hemorrhage, or dissection. 1 Similarly, contrast uptake in the vasa vasorum could provide useful information about carotid atherosclerosis in its earliest stage, 4 and CECP has been related with subclinical or clinical cardiovascular (CV) events. 5,6Plaque histology has shown that the degree of CECP is related with the extent of neovascularization. 1,2 Diffuse or smoky rather than dot CECP patterns would be linked with extensive or hyperemic microvascularity. In vulnerable plaques, CEU may also be used to evaluate the effects of statins. 7 However, the relationship between CECP patterns and acute coronary syndrome (ACS) or chronic stable ischemic heart disease (IHD)

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“…Cardiovascular disease (CVD) is the leading cause of death worldwide, including the United States, Europe, and Japan. Previous studies have demonstrated that arteriosclerosis is a key mechanism in the development of CVD, and the degree of arteriosclerosis is a strong surrogate marker for determining the incidence of CVD 1 ) .…”

Section: Introductionmentioning

confidence: 99%

Relationship between Arterial Stiffness and Blood Pressure Drop During the Sit-to-stand Test in Patients with Diabetes Mellitus

Kobayashi

Fujikawa

Kobayashi

et al. 2017

JAT

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Aim: Patients with orthostatic hypotension (OH) have high arterial stiffness. Patients with diabetes mellitus (DM) often have cardiac autonomic neuropathy that leads to OH; however, whether OH is an indicator of arterial stiffness progression is unclear. We aimed to investigate whether the cardioankle vascular index (CAVI) varies between DM patients with and without OH using the sit-to-stand test (STST).Methods: One hundred and fifty-nine patients with DM underwent CAVI assessment and blood pressure (BP) and heart rate change evaluation during the STST. OH was defined as a decline in systolic BP (SBP) and/or diastolic BP of at least 20 mmHg or 10 mmHg, respectively, in the initial and late upright positions compared with that in the sitting position.Results: OH was diagnosed in 42 patients (26.4%). DM patients with OH had significantly higher CAVI (9.36 ± 1.15 versus 8.89 ± 1.18, p = 0.026) than those without OH. CAVI was significantly inversely correlated with systolic and diastolic BP changes (R = −0.347, p <0.001 and R = −0.314, p <0.001, respectively) in the initial upright position. Multivariate regression analysis revealed that age, SBP changes, and low frequency component in the initial upright position were independent determinants of CAVI.Conclusion: Patients with DM having large BP drops occurring when moving from sitting to standing have high arterial stiffness. A significant BP drop during the STST necessitates careful evaluation of advanced arterial stiffness in patient with DM.

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Impact of Carotid Atherosclerosis on the Risk of Adverse Cardiac Events in Patients With and Without Coronary Disease

Cited by 29 publications

References 14 publications

Factors Significantly Associated With the Increased Prevalence of Carotid Atherosclerosis in a Northeast Chinese Middle-aged and Elderly Population

Factors Significantly Associated With the Increased Prevalence of Carotid Atherosclerosis in a Northeast Chinese Middle-aged and Elderly Population

Implication of ultrasound contrast‐enhancement of carotid plaques in prevalence of acute coronary syndrome and occurrence of cardiovascular outcomes

Relationship between Arterial Stiffness and Blood Pressure Drop During the Sit-to-stand Test in Patients with Diabetes Mellitus

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