Relationship between Waist Circumference and Elevation of Carotid Intima-media Thickness in Newly-diagnosed Diabetic Patients

Objective Waist circumference, as a brief indicator of visceral obesity, is associated with multi-metabolic disorders and cardiovascular diseases. The present study was aimed to find out the relationship between waist circumference and carotid intima media thickness （C-IMT）, as well as the best waist circumference cutoff for identifying C-IMT elevation in Chinese male patients with newly-diagnosed diabetes. Methods Five hundred and seventy-eight patients from Department of Endocrinology and Metabolism in Shanghai Sixth People＇s Hospital affiliated to Shanghai Jiao Tong University were enrolled. Both physical examination （for measurement of waist circumference） and carotid ultrasonography （for measurement of C-IMT） were performed. Results After grouping according to the quartiles of C-IMT, the waist circumference increased across all its quartiles. The waist circumference in 3rd and 4th quartiles （90.7_＋9.8 cm and 90.8＋9.6 cm） was significant higher than in 1st and 2nd quartiles （P〈0.05）. When subjects were divided into 4 groups according to waist circumference, the C-IMT of subjects with waist circumference 90-95 cm was significant higher than that of subjects with waist circumference 85-90 cm and less than 85 cm respectively （P〈0.05）. Both spearman and partial correlation analysis showed that C-IMT was positively correlated with waist circumference （P〈0.01）. C-IMT was found significantly elevated with the increase of waist circumference. Multiple stepwise regression analysis showed that waist circumference was one of the independent risk factors of C-IMT. After an average of 2.23_＋0.85 years follow up, there was a significant elevation of C-IMT in the group with baseline waist circumference over 90 cm P〈0.05）, while no significant difference was detected in the group with baseline waist circumference less than 90 cm （P=0.27）. Logistic regression showed that baseline waist circumference over 90 cm was associated with a relative risk to C-IMT elevation of 1.132 （95% CI 1.043-1.431, P〈0.05）. Conclusion Among newly-diagnosed diabetic male patients, waist circumference over 90 cm not only reflects sub-clinical atherosclerosis in early stage, but also predicts the progression of atherosclerosis.

The relationship between serum trimethylamine N-Oxide level and carotid intima media thickness in untreated essential hypertension patients

Background Circulating trimethylamine N-Oxide （TMAO） level has been linked to adverse cardiovascular outcome and mortality in the general population, and atherosclerosis is a window of the cardiovascular disease. Therefore, the present study was designed to investigate the relationship between TMAO level and atherosclerosis in untreated essential hypertension patients. Methods We measured serum TMAO level in atherosclerosis, subclinical atherosclerosis and controls matched by age and sex. The link between serum TMAO level and CIMT was subsequently assessed. Results The level of serum TMAO was significantly higher in atherosclerosis pa- tients than in controls. Serum TMAO level was positively correlated with carotid intima media thickness （r = 0.783, P 〈 0.001）, and logistic regression indicated that TMAO was a risk factor of atherosclerosis （OR, 1.904; 95% CI, 1.197- 2.733, P 〈 0.001）. Conclusions Serum TMAO concentration positively correlates to carotid intima media thickness, and should be a good predicted biomarker for atherosclerosis.

Evaluation of carotid intima-media thickness and carotid arterial stiffness in children with adenotonsillar hypertrophy

Background:Adenotonsillar hypertrophy can produce cardiopulmonary disease in children.However,it is unclear whether adenotonsillar hypertrophy causes atherosclerosis.This study evaluated carotid intimamedia thickness and carotid arterial stiffness in children with adenotonsillar hypertrophy.Methods:The study included 40 children with adenotonsillar hypertrophy(age:5-10 years)and 36 healthy children with similar age and body mass index.Systolic blood pressure,diastolic blood pressure,and pulse pressure were measured in all subjects.Carotid intima-media thickness,carotid arterial systolic diameter,and carotid arterial diastolic diameter were measured using a high-resolution ultrasound device.Based on these measurements,carotid arterial strain,carotid artery distensibility,beta stiffness index,and elasticity modulus were calculated.Results:Carotid intima-media thickness was greater in children with adenotonsillar hypertrophy(0.36±0.05 mm vs.0.34±0.04 mm,P=0.02)compared to healthy controls.Beta stiffness index(3.01±1.22 vs.2.98±0.98,P=0.85),elasticity modulus(231.39±99.23 vs.226.46±83.20,P=0.88),carotid arterial strain(0.17±0.06 vs.0.17±0.04,P=0.95),and carotid artery distensibility(13.14±3.88 vs.12.92±3.84,P=0.75)were similar between children with adenotonsillar hypertrophy and the healthy controls.Conclusions:The present study revealed increased carotid intima-media thickness in children with adenotonsillar hypertrophy.The risk of subclinical atherosclerosis may be higher in children with adenotonsillar hypertrophy.

Effect of glycemic control on markers of subclinical atherosclerosis in patients with type 2 diabetes mellitus:A review

Cardiovascular disease is the predominant cause of death in type 2 diabetes mellitus(T2DM).Evidence suggests a strong association between duration and degree of hyperglycemia and vascular disease.However,large trials failed to show cardiovascular benefit after intensive glycemic control,especially in patients with longer diabetes duration.Atherosclerosis is a chronic and progressive disease,with a long asymptomatic phase.Subclinical atherosclerosis,which is impaired in T2DM,includes impaired vasodilation,increased coronary artery calcification(CAC),carotid intima media thickness,arterial stiffness,and reduced arterial elasticity.Each of these alterations is represented by a marker of subclinical atherosclerosis,offering a cost-effective alternative compared to classic cardiac imaging.Their additional use on top of traditional risk assessment strengthens the predictive risk for developing coronary artery disease(CAD).We,herein,review the existing literature on the effect of glycemic control on each of these markers separately.Effective glycemic control,especially in earlier stages of the disease,attenuates progression of structural markers like intima-media thickness and CAC.Functional markers are improved after use of newer antidiabetic agents,such as incretin-based treatments or sodium-glucose cotransporter-2 inhibitors,especially in T2DM patients with shorter disease duration.Larger prospective trials are needed to enhance causal inferences of glycemic control on clinical endpoints of CAD.

Significance of Increased CIMT with Coexisting Carotid Plaques in Cerebral White Matter Lesions in Elders

It is very common that increased carotid intima media thickness （CIMT） and carotid plaque coexist in a single subject in elderly patients with white matter lesions （WMLs）. In this study we inves- tigated whether the coexistence of increased CIMT and carotid plaque is more strongly associated with the presence and extent of WMLs than either alone. All patients were classified into 1 of the following 4 groups： without either increased CIMT （I） or carotid plaque （P）： I（-）P（-）; with only increased CIMT： I（＋）P（-）; with only carotid plaque： I（-）P（＋）; and with both increased CIMT and carotid plaque： I（＋）P（＋） The presence and severity of periventricular WMLs （PWMLs） and deep WMLs （DWMLs） were as- sessed and the prevalence of MRI findings by the Cochran-Armitage trend test was calculated. The characteristics of subjects showed that the percentages of patients with increased CIMT and carotid plaque in the DWMLs group and the PWMLs group were significantly higher than those without WMLs group. Both DWMLs and PWMLs were strongly associated with age, carotid plaque and CIMT. Furthermore, the Cochran-Armitage trend test indicated that the prevalence of MRI findings of PWMLs and DWMLs increased in the order of I（-）P（-）〈 I（＋）P（-）〈 I（-）P（＋）〈 I（＋）P（＋） （P〈0.0001）. For the pa- tients with DWMLs, the grades of both I（＋）P（-） and I（＋）P（＋） were increased significantly compared to I（-）P（-） （P〈0.0025, P〈0.05, respectively） without such a difference found in patients with PWMLs. Our results suggested that the coexistence of increased CIMT and carotid plaque is most closely associated with WMLs, and that increased CIMT is associated with the severity of DWMLs, whereas carotid plaque is related to the presence of WMLs.

Association between dairy intake,lipids and vascular structure and function in diabetes

AIM To determine lipid species that change in response to a change in dairy consumption. In addition, to investigate whether dairy associated lipid species are correlated with changes in measures of vascular structure and function.METHODS A 12-mo randomised controlled trial was conducted to determine the effect of increased consumption of fruit, vegetables and dairy, compared to usual diet, on measures of vascular structure and function in adults with type 1 and type 2 diabetes(n = 108). Thispaper comprises post-hoc analyses investigating the relationship between dairy intake, serum lipid species and vascular health. Central and peripheral blood pressure, carotid femoral pulse wave velocity, augmentation index, serum lipid species and dietary intake were measured at baseline and 3-mo. Common carotid artery intima media thickness was measured at baseline and 12-mo.RESULTS Serum lipid species [lysophosphatidylcholine(LPC) 14:0, LPC 15:0, LPC 16:1, phosphatidylcholine(PC) 29:0 PC 30:0, PC 31:0 and cholesterol ester(CE) 14:0] were associated with the change in full fat dairy consumption(rho 0.19-0.25; P < 0.05). The 3-mo change in some lipids was positively associated with the 3-mo change in central systolic [LPC 14:0(rho 0.30; P = 0.007), PC 30:0(rho 0.28; P = 0.010)] and diastolic blood pressure [LPC 14:0(rho 0.32; P = 0.004), LPC 15:0(rho 0.23; P = 0.04), LPC 16:1(rho 0.23; P = 0.035), PC 29:0(rho 0.28; P = 0.01), PC 30:0(rho 0.36; P = 0.001), PC 31:0(rho 0.30; P = 0.007)] and 12-mo change in common carotid artery intimal medial thickness [CE 14:0(rho 0.22; P = 0.02)]. Pulse wave velocity and augmentation index were unrelated to dairy and lipid species.CONCLUSION An increase in dairy associated lipids appears to be associated with an increase in blood pressure and common carotid intimal medial thickness.