Sonographic evaluation of carotid artery atherosclerosis in the elderly: relationship of disease severity to stroke and transient ischemic attack.

Polak, Joseph F.; O'Leary, D H; Kronmal, Richard A.; Wolfson, Sidney K.; Bond, M. Gene; Tracy, Russell P.; Gardin, Julius M.; Kittner, Steven J.; Savage, Peter J.

doi:10.1148/radiology.188.2.8327679

Cited by 138 publications

(87 citation statements)

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“…Although specific obesity-related factors may initiate the vascular changes, lipid, glucose and blood pressure elevations may subsequently accentuate these vasculotrophic effects to produce the vascular complications associated with the major cardiac risk factors in obese subjects. 26 As there is an association between carotid IMT and subsequent cardiovascular events, 27,28 one may anticipate that carotid IMT changes are a surrogate for changes in other vessels. In our study, although WHTR did correlate with the augmentation index (reflecting aortic stiffness), age was the only significant determinant of these vascular changes in a multivariate analysis.…”

Section: Discussionmentioning

confidence: 99%

Association of central obesity with early Carotid intima-media thickening is independent of that from other risk factors

et al. 2008

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Aim:We investigated whether anthropometric measurements or metabolic risk factors correlated more with vascular changes associated with obesity. Methods: One hundred never smoking subjects (71 women, 29 men) without vascular events, with blood pressure (BP) o140/ 90 mm Hg, LDL cholesterol o4 mmol/l, glucose o6.2 mmol/l participated. Anthropometric measurements (body mass index (BMI), waist/hip ratio (WHR), waist circumference (WC) and Waist/height ratio WHTR) and metabolic risk factors (glucose, insulin, lipid and uric acid levels plus BP) were assessed. Subjects underwent vascular measurements (Carotid intima-media thickness (IMT) using duplex ultrasonography, vascular stiffness assessment (Augmentation Index) by applanation tonometry and brachial artery reactivity tests). Results: Risk factors were in the 'normal distribution'. BMI, WHR, WC, WHTR correlated significantly with triglyceride, HDL, LDL, insulin, glucose, uric acid and systolic BP levels (Po0.001). IMT correlated with WHTR, BMI, WC, Glucose (Po0.001), Homoeostasis Model Assessment (HOMA) and cholesterol levels (Po0.05). Only Age, WHTR or BMI were significant correlates of IMT in a multivariate analysis (Po0.01) including WHTR or BMI, with age, sex, systolic BP, HDLc and HOMA. Augmentation Index correlated with age (Po0.0001), WHTR and WC (Po0.0005) but with age only in a multivariate analysis. Brachial reactivity did not correlate with any anthropometric or metabolic parameters. Anthropometric cutoff points, (BMI X25, WC X102 cm men, X88 cm women, WHR X0.9 men, X0.8 women and WHTR X0.5 men and women) significantly differentiated normal from abnormal metabolic and vascular measurements. The WHTR ratio X0.5 was as reliable as the BMI cutoff X25 in determining metabolic and vascular abnormalities. BMI and WHTR were strongly associated with 89% agreement (Po0.0001). Conclusion: These results demonstrated that in 'healthy individuals', anthropometric parameters and metabolic risk factors correlated with each other, but anthropometric parameters were the only significant correlates of carotid IMT. A waist/height ratio X0.5 predicts both early vascular and metabolic changes. These data support a risk factor independent vasculotrophic effect of obesity.

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Section: Discussionmentioning

confidence: 99%

Association of central obesity with early Carotid intima-media thickening is independent of that from other risk factors

et al. 2008

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“…(18) Ultrasound studies were conducted on 3377 of 3532 (96%) of examination cycle 6 participants (1995 -1998). A scan sequence was recorded with a high-resolution linear-array transducer equipped with a pulsed Doppler spectral analyzer (Model SSA-270A; Toshiba America Medical Systems, Tustin, CA).…”

Section: Carotid Ultrasoundmentioning

confidence: 99%

Association of Carotid Artery Atherosclerosis With Circulating Biomarkers of Extracellular Matrix Remodeling: The Framingham Offspring Study

Romero

Vasan

Beiser

et al. 2008

Journal of Stroke and Cerebrovascular Diseases

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Objective-To relate circulating biomarkers of extracellular matrix (ECM) turnover to site-specific measures of carotid artery atherosclerosis on duplex ultrasound.Background-Matrix metalloproteinases (MMPs) and their inhibitors (TIMPs) regulate ECM remodeling, a key feature of atherosclerosis, and their circulating concentrations can be assayed. MMP-9, TIMP-1 and protocollagen-III n-terminal propeptide (PIIINP) may relate differentially to the severity of atherosclerosis at different carotid artery sites. However, data examining this premise are sparse.

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“…Distributions and associations of plaque characteristics, as well as representative gray-scale images used to characterize them, have been previously published. 10 …”

Section: Carotid Ultrasoundmentioning

confidence: 99%

“…While carotid IMT and stenosis have been demonstrated to have strong associations with clinically-evident stroke, 10,14,15 CT-defined infarcts, 16,17 and more recently with MRI-defined infarcts, 18,19 less information is available on relationships of atherosclerosis severity to other MRI abnormalities such as 3 and between ventricular and sulcal enlargement and severity of carotid atherosclerosis. 2 Given the strong and consistent relationships of MRI abnormalities to severity of carotid atherosclerosis, the question arises whether there are other ultrasound-definable characteristics of carotid disease that are related to MRI abnormalities.…”

Section: Carotid Disease and The Brainmentioning

confidence: 99%

“…39 Given their generally symmetric nature, one might not expect to find them in association with unilateral carotid stenosis or high-risk plaque, but if ultrasound-defined carotid disease is a general marker of systemic atherosclerosis, as appears to be the case, 10 then some relationships with these MRI abnormalities might be expected. Carotid IMT was related to all these findings even after adjustment for other cardiovascular disease risk factors, but plaque characteristics for the most part were not, suggesting that these atrophic changes are more strongly related to atherosclerosis severity than to any particular type of carotid plaque.…”

Section: Mri-defined Gray and White Matter Changesmentioning

confidence: 99%

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Relationships of Cerebral MRI Findings to Ultrasonographic Carotid Atherosclerosis in Older Adults

Manolio

Burke

O’Leary

et al. 1999

ATVB

182

160

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Abstract-Cerebral magnetic resonance imaging (MRI) has demonstrated a high prevalence of infarct-like lesions, white matter hyperintensities, and evidence of cerebral atrophy in older adults. While these findings are generally believed to be related to ischemia and atherosclerosis, their relationship to atherosclerosis in the carotid arteries remains to be explored. Study subjects were part of the multicenter Cardiovascular Health Study, a cross-sectional study of 3502 women and men Ն65 years of age undergoing cranial MRI and carotid ultrasonography. MRI infarcts were detected in 1068 participants (29.3%) and measurable carotid plaque in 2745 (75.3%). MRI infarcts, ventricular and sulcal widening, and white matter score were strongly associated with carotid intimal-medial thickness (IMT) and stenosis degree after adjustment for age and sex (all PϽ0.01). Associations with plaque characteristics were less strong and less consistent; MRI infarcts were weakly associated only with surface irregularity, and ventricular size was weakly associated only with lesion density (both PϽ0.04). In contrast, sulcal widening was strongly related to plaque characteristics, with scores being higher in those with heterogeneous and irregular plaque (both PϽ0.009 Key Words: stroke Ⅲ cerebrovascular disorders Ⅲ carotid arteries Ⅲ atherosclerosis Ⅲ aged Ⅲ epidemiology Ⅲ risk factors C erebral magnetic resonance imaging (MRI) has demonstrated a high prevalence of infarct-like lesions, white matter hyperintensities, and evidence of cerebral atrophy in older adults. 1-3 While these findings are related to standard risk factors for cardiovascular disease and are believed to be consequences of ischemia, 4 -6 their relationship to atherosclerosis in the carotid arteries has not been widely explored.Because the carotid arteries provide the majority of the brain's blood supply, detailed information on extent, severity, and characteristics of carotid atherosclerosis can be used to explore its relationships to cerebral MRI findings. Lesion characteristics such as increased density, heterogeneity, and surface irregularity have been shown to relate to prevalent clinically defined transient ischemic attack and stroke, 6 but these associations have not been examined for cerebral MRI findings.The Cardiovascular Health Study (CHS) cohort represents a large, multicenter sample of older men and women examined by both carotid ultrasonography and cerebral MRI. Cross-sectional data from these examinations were analyzed (1) to describe prevalences of MRI-defined infarcts, infarctlike lesions, and gray and white matter changes by quintile of common and internal carotid intimal-medial thickness (IMT); degree of carotid stenosis; and characteristics of carotid plaque; (2) to determine independence of carotid atherosclerosis/MRI abnormality associations from known clinical and subclinical cardiovascular disease and cardiovascular disease risk factors; and (3) to define relationships of MRI infarcts and ipsilateral carotid artery disease. MethodsCHS participants ...

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Sonographic evaluation of carotid artery atherosclerosis in the elderly: relationship of disease severity to stroke and transient ischemic attack.

Cited by 138 publications

References 0 publications

Association of central obesity with early Carotid intima-media thickening is independent of that from other risk factors

Association of central obesity with early Carotid intima-media thickening is independent of that from other risk factors

Association of Carotid Artery Atherosclerosis With Circulating Biomarkers of Extracellular Matrix Remodeling: The Framingham Offspring Study

Relationships of Cerebral MRI Findings to Ultrasonographic Carotid Atherosclerosis in Older Adults

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