THU0418 CAROTID ATHEROSCLEROSIS AND SONOGRAPHIC SIGNS OF URATE CRYSTAL DEPOSITS IN GOUT: AN ASSOCIATION STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 446.1-447
Author(s):  
I. Calabuig ◽  
A. Martínez-Sanchis ◽  
M. Andrés
Keyword(s):  
Association Analysis ◽  
Carotid Atherosclerosis ◽  
Subclinical Atherosclerosis ◽  
Power Doppler ◽  
Intima Media Thickness ◽  
Serum Urate ◽  
Assessment Tools ◽  
Urate Crystal ◽  
Urate Lowering Treatment ◽  
Double Contour

Background:Carotid subclinical atherosclerosis is prevalent in patients with gout, although poorly predicted by cardiovascular risk assessment tools. Gout itself is deemed to contribute to its development. However, a previous report did not show an association between clinical characteristics of gout and the presence of subclinical atherosclerosis [1].Objectives:To explore the association between sonographic signs of urate crystal deposits and carotid atherosclerosis.Methods:Consecutive new patients with crystal-proven gout attended in a tertiary Rheumatology unit were eligible for the study. It included musculoskeletal and carotid ultrasound assessment, performed by a trained sonographer blinded to clinical data. Patients were examined during intercritical periods; flare prophylaxis with low-dose colchicine or other agents was permitted, but patients under urate-lowering treatment were excluded. The musculoskeletal scans evaluated wrists, 2nd MCPs and 1st MTPs joints, and triceps and patellar tendons, for the presence of signs suggestive of urate crystal deposits (double contour, hyperechoic aggregates, and tophi), following OMERACT definitions. Also, local power-Doppler (PD) signal was registered and graded as 0 to 3. The sum of locations showing crystal deposits or positive PD signal (≥1) was estimated in order to assess crystal and inflammatory burden, respectively. Carotid arteries were scanned for increased intima-media thickness (IMT) and presence of atheroma plaques, according to Mannheim consensus. The association analysis was done by logistic regression, considering increased IMT or atheroma plaques as the dependent variables.Results:Eighty-eight new patients with gout were enrolled, mean aged 62.0 years (SD 14.5), 89.8% males. Mean gout duration was 5.9 years (SD 9.0), clinical tophi were observed in 16.1% of patients and mean serum urate level at diagnosis was 8.4 mg/dl (SD 1.5). All participants showed at least one sonographic sign of crystal deposits at the examined locations, with a mean sum of 9.4 (SD 4.0). Regarding individual signs, their mean (SD) sum was as follows: 4.6 (2.1) for tophi, 3.9 (2.8) for aggregates and 0.9 (1.0) for double contour. The mean sum of locations with positive PD signal was 1.1 (SD 1.0). Regarding carotid scans, increased IMT was seen in 26 patients (30.6%) and atheroma plaques in 51 (58.0%). Table 1 shows the results of the association analysis. Positive PD signal was significantly associated with the presence of atheroma plaques, while tophi showed a trend with both increased IMT and atheroma plaques.Conclusion:Sonographic deposits were consistently observed in new patients with gout. Crystal and inflammatory load, here shown as tophi and positive PD signal, seem associated with carotid atherosclerosis. This new finding may contribute to understanding the complex relationship between gout and atherosclerosis.References:[1]Ann Rheum Dis. 2017;76:1263.Disclosure of Interests: :Irene Calabuig: None declared, Agustín Martínez-Sanchis: None declared, Mariano Andrés Grant/research support from: Grünenthal, Consultant of: Grünenthal, Menarini, Speakers bureau: Grünenthal, Horizon

scholarly journals Sonographic Tophi and Inflammation Are Associated With Carotid Atheroma Plaques in Gout

2021 ◽  
Vol 8 ◽  
Author(s):  
Irene Calabuig ◽  
Agustín Martínez-Sanchis ◽  
Mariano Andrés
Keyword(s):  
Odds Ratio ◽  
Carotid Atherosclerosis ◽  
Power Doppler ◽  
Intima Media Thickness ◽  
Local Inflammation ◽  
Rheumatology Unit ◽  
Urate Crystal ◽  
Ultrasound Assessment ◽  
Urate Lowering Treatment ◽  
Gout Tophi

Objective: Gout and cardiovascular disease are closely related, but the mechanism connecting them remains unknown. This study aims to explore whether urate crystal deposits and inflammation (assessed by ultrasound) are associated with carotid atherosclerosis.Methods: We included consecutive patients with crystal-proven gout newly presenting to a tertiary rheumatology unit. Patients under urate-lowering treatment were excluded. Ultrasound assessment was performed during intercritical periods. Musculoskeletal scans evaluated six joints and four tendons for urate crystal deposits (double contour, aggregates, and tophi), and power Doppler (PD) signal (graded 0–3) as a marker of local inflammation. The sum of locations showing deposits or a positive PD signal (≥1) was registered. Carotids were scanned for increased intima-media thickness (IMT) and atheroma plaques, according to the Mannheim consensus. Associations were analyzed using logistic regression.Results: The study included 103 patients showing sonographic crystal deposits at the examined locations (mean sum 9.9, minimum 2); tophi were the most frequent. Two-thirds of participants presented a positive PD signal (30.1% grade 2–3). In the carotid scans, 59.2% of participants showed atheroma plaques, and 33.0% increased IMT. Tophi (odds ratio [OR] 1.24; 95% confidence interval [CI] 1.03–1.50) and a positive PD signal (OR 1.67; 95% CI 1.09–2.56) were significantly associated with atheroma plaques, while an increased IMT showed no sonographic association.Conclusion: Sonographic crystal deposits and subclinical inflammation were consistently observed in patients with intercritical gout. Tophi and a positive PD signal were linked to carotid atherosclerosis. Our findings may contribute to understanding the complex relationship between gout and atherosclerosis.

Abstract 14789: 2013 ACC/AHA Cholesterol Guideline Undertreats HIV-infected Adults With Carotid Atherosclerosis by Ultrasound

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Binh An P Phan ◽  
Bernard Weigel ◽  
Yifei Ma ◽  
Rebecca Scherzer ◽  
Danny Li ◽  
...  
Keyword(s):  
Carotid Atherosclerosis ◽  
Subclinical Atherosclerosis ◽  
Intima Media Thickness ◽  
Atherosclerotic Cardiovascular Disease ◽  
Antiretroviral Medication ◽  
Increased Risk ◽  
History Of ◽  
Ascvd Risk ◽  
Increase In Risk

Background: While HIV infection is associated with increased risk of ASCVD (atherosclerotic cardiovascular disease), it is unknown whether guidelines can identify HIV-infected adults who may benefit from statins. The purpose of our study was to compare the 2013 ACC/AHA and 2004 ATP III recommendations in a HIV population, and to evaluate associations with carotid artery intima-media thickness (CIMT) and plaque. Methods: We used ultrasound to measure CIMT at baseline and 3 years later in 352 HIV-infected adults with no ASCVD and not on statins. Plaque was defined as IMT > 1.5 mm. We compared 2013 ACC/AHA and 2004 ATP III recommendations, and evaluated associations with CIMT and plaque. Results: At baseline, the median age was 43 (IQR 39-49), 85% were male, 74% were on antiretroviral medication, and 50% had plaque. At follow-up, the median IMT progression was 0.052 mm/yr, and 66% had plaque. The 2013 guideline was more likely to recommend statins compared with the 2004 guideline, both overall (26% vs. 14%, p<.001), in those with plaque (32% vs. 17%, p=.0002), and in those without plaque (16% vs. 7%, p=.025). In unadjusted linear regression, the 2004 and 2013 risk score were strongly associated with CIMT (0.01 mm per 10% increase in risk, p<.001) and with CIMT progression (0.01 mm/yr per 10% increase in risk, p<.001). In multivariate analysis, older age, higher LDL-C, pack-years of smoking, and history of opportunistic infection were associated with baseline plaque. Conclusions: While the 2013 ACC/AHA guideline recommended statins to a greater number of HIV-infected adults compared to the 2004 ATP III guideline, both failed to recommend therapy in the majority of HIV-affected adults with carotid plaque. Both the 2004 and 2013 guidelines predicted higher levels of baseline CIMT and faster progression. HIV-specific guidelines that include detection of subclinical atherosclerosis may help to identify HIV-infected adults who are at increased ASCVD risk and may benefit from statins.

P1507Role of adjuvant carotid ultrasound in women undergoing stress echocardiography for the assessment of suspected angina with no previous history of coronary artery disease

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Gurunathan ◽  
M Shanmuganathan ◽  
R Hampson ◽  
R Khattar ◽  
R Senior
Keyword(s):  
Predictive Value ◽  
Carotid Plaque ◽  
Stress Echocardiography ◽  
Subclinical Atherosclerosis ◽  
Previous History ◽  
Scoring Systems ◽  
Intima Media Thickness ◽  
Carotid Intima Media Thickness ◽  
Assessment Tools ◽  
Carotid Ultrasound

Abstract Introduction Traditional risk assessment tools classify the majority of women at low risk despite cardiovascular disease remaining the leading cause of death in women. Additionally conventional stress testing techniques have poor predictive value in women, due to unique pathophysiological mechanisms causing ischaemia in women, and the lower prevalence of obstructive CAD. The study sought to evaluate the role of adjuvant carotid ultrasound (CU) in women attending for stress echocardiography (SE). Methods and results 415 women (Mean age 62±10 years, 28% Diabetes Mellitus, Mean BMI 28) attending for SE prospectively underwent CU, to assess Carotid Intima-media thickness (CIMT) and the presence of plaque. 47 women (11%) had inducible wall motion abnormalities, and carotid disease (CD) was present in 46% (Carotid plaque in 41%, 15% CIMT >75th percentile). Women with CD were older (65 vs 58 years, p<0.0001), more likely to have Diabetes (41% vs 21%, p=0.0001) and hypertension (67% vs 36%, p<0.01), and had higher pretest probability of CAD (59% vs 41%, p<0.0001). 40% of women classified as low Framingham, were found to have evidence of CD. Conversely, only 40% of women classified as high Framingham risk, had CD. The positive predictive value of SE for flow-limiting CAD was 51%, but the presence of carotid plaque improved this to 71% (p<0.01). Of all clinical and test parameters, carotid plaque (p=0.001) and SE result (p=0.01) were the only independent predictors of >70% angiographic. Conclusion CU significantly improves the accuracy of SE alone for identifying flow-limiting disease on coronary angiography. Non-invasive assessment of subclinical atherosclerosis using CU offers an individualized disease-guided approach in women, where conventional scoring systems offer modest risk stratification.

scholarly journals Age, gender and hypertension as major risk factors in development of subclinical atherosclerosis

2013 ◽  
Vol 3 (1) ◽  
pp. 26-29
Author(s):  
Ajla Rahimić Ćatić ◽  
Sandra Vegar Zubović ◽  
Jasminka Ðelilović Vranić ◽  
Svjetlana Lozo
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Carotid Artery ◽  
Early Detection ◽  
Common Carotid Artery ◽  
Carotid Atherosclerosis ◽  
Heart Diseases ◽  
Subclinical Atherosclerosis ◽  
Intima Media Thickness ◽  
Media Thickness

Introduction: Intima-media thickness (IMT) measurement of the common carotid artery (CCA) is considered as useful indicator of carotid atherosclerosis. Early detection of atherosclerosis and its associated risk factors is important to prevent stroke and heart diseases. The aim of the present study was to investigate which risk factors are better determinants of subclinical atherosclerosis, measured by common carotidartery intima media thickness (CCA-IMT).Methods: A total of 74 subjects were randomly selected in this cross – sectional study. Information on the patient’s medical history and laboratory fi ndings were obtained from their clinical records. Risk factors relevant to this study were age, gender, cigarette smoking status, diabetes, hypertension and dyslipidemia. Ultrasound scanning of carotid arteries was performed with a 7,5 MHz linear array transducer (GE Voluson730 pro). The highest value of six common carotid artery measurements was taken as the fi nal IMT. Increased CCA-IMT was defi ned when it was > 1 mm.Results: Our data demonstrated higher CCA-IMT values in male patients compared with female patients. Increased CCA-IMT was the most closely related to age (P<0.001), followed by systolic blood pressure (P=0.001), diastolic blood pressure (P=0.003) and glucose blood level (P=0.048).Conclusion: Age, gender and hypertension are the most important risk factors in development of carotid atherosclerosis. Early detection of atherosclerosis among high-risk populations is important in order to prevent stroke and heart diseases, which are leading causes of death worldwide.

scholarly journals Prediabetes Is Independently Associated with Subclinical Carotid Atherosclerosis: An Observational Study in a Non-Urban Mediterranean Population

2020 ◽  
Vol 9 (7) ◽  
pp. 2139
Author(s):  
Maria Belén Vilanova ◽  
Josep Franch-Nadal ◽  
Mireia Falguera ◽  
Josep Ramon Marsal ◽  
Sílvia Canivell ◽  
...  
Keyword(s):  
Observational Study ◽  
Carotid Atherosclerosis ◽  
Subclinical Atherosclerosis ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Intima Media Thickness ◽  
Carotid Intima Media Thickness ◽  
Normal Glucose Tolerance ◽  
Mediterranean Population ◽  
Tobacco Exposure

This was a prospective, observational study to compare the burden of subclinical atherosclerosis as measured by carotid ultrasonography in a cohort of subjects with prediabetes vs. subjects with normal glucose tolerance (NGT) from a non-urban Mediterranean population. Atherosclerosis was assessed through carotid intima-media thickness (c-IMT), the presence/absence of carotid plaques, and plaque number. Among 550 subjects included, 224 (40.7%) had prediabetes. The mean c-IMT and the prevalence of carotid plaque were significantly higher in the prediabetes group compared to the NGT group (0.72 vs. 0.67 mm, p < 0.001; and 37.9% vs. 19.6%; p < 0.001, respectively). Older age, male gender, and increased systolic blood pressure were positively correlated with c-IMT and were independent predictors of the presence of plaques. In contrast, prediabetes and low-density lipoprotein (LDL)-c were predictors of the presence of plaque (odds ratio [OR] = 1.64; 95% confidence interval [CI] = 1.05–2.57; p = 0.03 and OR = 1.01; 95% CI = 1.00–1.02; p = 0.006, respectively) together with tobacco exposure and the leukocyte count (OR = 1.77; 95% CI = 1.08–2.89; p = 0.023 and OR = 1.20; 95% CI = 1.05–1.38; p = 0.008, respectively). In a non-urban Mediterranean population, prediabetes was associated with established subclinical carotid atherosclerosis. These findings could have implications for the prevention and treatment of CV risk in these subjects before the first symptoms of cardiovascular disease appear.

Apolipoprotein(a), Fibrinopeptide A and Carotid Atherosclerosis in Middle-Aged Men

1994 ◽  
Vol 72 (04) ◽  
pp. 563-566 ◽  
Author(s):  
Tuomo Rankinen ◽  
Sari Väisänen ◽  
Michele Mercuri ◽  
Rainer Rauramaa
Keyword(s):  
Risk Factors ◽  
Cardiovascular Diseases ◽  
Carotid Atherosclerosis ◽  
Intima Media Thickness ◽  
Carotid Bifurcation ◽  
Carotid Intima Media Thickness ◽  
Fibrinopeptide A ◽  
Carotid Imt ◽  
Apolipoprotein A ◽  
The Difference

SummaryThe association between apolipoprotein(a) [apo(a)], fibrinogen, fibrinopeptide A (FPA) and carotid intima-media thickness (IMT) was analyzed in Eastern Finnish men aged 50 to 60 years. Apo(a) correlated directly with carotid bifurcation (r = 0.26, p = 0.001), but not with common carotid IMT. Men in the lowest quartile of apo(a) had thinner (p = 0.013) IMT in bifurcation [1.59 mm (95% Cl 1.49; 1.68)] compared to the men in the highest [1.91 mm (95% Cl 1.73; 2.09)] apo(a) quartile. The difference remained (p=0.038) after adjusting for confounders. Plasma fibrinogen was not related to carotid IMT, whereas FPA correlated with common carotid (r = 0.21, p = 0.016) and carotid bifurcation (r = 0.21, p = 0.018) IMT. These associations abolished after adjusting for the confounders. The data suggest that apo(a) associate with carotid atherosclerosis independent of other risk factors for ischemic cardiovascular diseases.

Correlation of Waist to Calf Circumference Ratio and Carotid Intima Media Thickness in Diabetes Mellitus

2020 ◽  
Vol 16 ◽  
Author(s):  
Harish A Rao ◽  
Prakash Harischandra ◽  
Srikanth Yadav
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Risk Factor ◽  
Carotid Atherosclerosis ◽  
Intima Media Thickness ◽  
Carotid Intima Media Thickness ◽  
Calf Circumference ◽  
Media Thickness

Introduction: Diabetes mellitus is a well-known risk factor for cardiovascular disease, because of the accelerated process of atherosclerosis. Obesity is an established risk factor and has gained immense importance in recent studies as an important risk factor for clinical cardiovascular disease, yet the fundamental component stays unclear. Calf circumference is another form for lean mass and peripheral subcutaneous fat and is inversely associated with occurrence of carotid plaques (CP). Multiplicative and opposite effects of both Calf Circumference (CC) and Waist Circumference (WC) in event of CP suggest that the two measures should be taken into account commonly while assessing vascular risk profile. Aim & Objective: To ascertain if waist to calf circumference ratio (WCR) is a marker of Carotid atherosclerosis in patients with type 2 diabetes mellitus. To asses s the correlation between waist to calf circumference ratio and carotid intima media thickness (CIMT ) in patients with Type 2 diabetes. Materials and methods: A cross sectional study at Hospital affiliated to Kasturba Medical college Mangalore from Sept 2016 to Sept 2018 . Method of study: Patients with type 2 DM as per ADA criteria, age >18years are recruited for the study. Results and discussion: In our study with 150 population 25 patients had carotid atherosclerosis and 20 patients had CIMT>1.1. The waist circumference in patients with CA is in the range of 93.07 and 99.85 & the CC in patients with CA is in the range of 29.49 to 31.25. The WCR in patients with CA is in the range of 3.12 to 3.26. The difference was statistically significant with a p value of <0.05. In our study it was found that WC and WCR correlated well with carotid atherosclerosis, and surprisingly calf circumference also correlated with carotid atherosclerosis but not as significant as both WC and WCR. Conclusion: To conclude, in our population based study of 150 subjects we found that carotid atherosclerosis is significantly more in people with increased waist calf circumference ratio. WCR may be a new, useful and practical anthropometric index that facilitates the early identification of diabetic subjects with high risk for cardiovascular disease. Validation of this finding in individual populations is required. Future studies should test the association of calf circumference with carotid intima media thickness and carotid plaques using better measures than ultrasound such as magnetic resonance imaging. Further research focusing on underlying mechanisms in the role of lean mass and peripheral fat mass is required.

scholarly journals The Relationship between Cardiovascular Risk Scores and Several Markers of Subclinical Atherosclerosis in an Asymptomatic Population

2021 ◽  
Vol 10 (5) ◽  
pp. 955
Author(s):  
Ovidiu Mitu ◽  
Adrian Crisan ◽  
Simon Redwood ◽  
Ioan-Elian Cazacu-Davidescu ◽  
Ivona Mitu ◽  
...  
Keyword(s):  
Risk Score ◽  
Subclinical Atherosclerosis ◽  
Ankle Brachial Index ◽  
Intima Media Thickness ◽  
Carotid Intima Media Thickness ◽  
Risk Scores ◽  
Cvd Risk ◽  
Cross Sectional ◽  
Single Center Study ◽  
Asymptomatic Individuals

Background: The current cardiovascular disease (CVD) primary prevention guidelines prioritize risk stratification by using clinical risk scores. However, subclinical atherosclerosis may rest long term undetected. This study aimed to evaluate multiple subclinical atherosclerosis parameters in relation to several CV risk scores in asymptomatic individuals. Methods: A cross-sectional, single-center study included 120 asymptomatic CVD subjects. Four CVD risk scores were computed: SCORE, Framingham, QRISK, and PROCAM. Subclinical atherosclerosis has been determined by carotid intima-media thickness (cIMT), pulse wave velocity (PWV), aortic and brachial augmentation indexes (AIXAo, respectively AIXbr), aortic systolic blood pressure (SBPao), and ankle-brachial index (ABI). Results: The mean age was 52.01 ± 10.73 years. For cIMT—SCORE was more sensitive; for PWV—Framingham score was more sensitive; for AIXbr—QRISK and PROCAM were more sensitive while for AIXao—QRISK presented better results. As for SBPao—SCORE presented more sensitive results. However, ABI did not correlate with any CVD risk score. Conclusions: All four CV risk scores are associated with markers of subclinical atherosclerosis in asymptomatic population, except for ABI, with specific particularities for each CVD risk score. Moreover, we propose specific cut-off values of CV risk scores that may indicate the need for subclinical atherosclerosis assessment.

Sign in / Sign up

Export Citation Format

Share Document