Abstract P021: Association of Blood Lactate with Carotid Atherosclerosis: The Atherosclerosis Risk in Communities (ARIC) Carotid MRI Study

Aim: Elevated blood lactate, a marker of decreased oxidative capacity, may be associated with high levels of oxidized LDL and consequent atherosclerosis. We assessed the association between elevated blood lactate and carotid atherosclerosis in a sample of 1496 adults, aged 60 - 82 years, in the general population. Methods: Maximum wall thickness of the internal carotid artery (MICA) was measured using gadolinium-enhanced magnetic resonance imaging (MRI) in 1496 participants from the Atherosclerosis Risk in Communities (ARIC) Study. Blood lactate was categorized into quartiles (Q1: < 5.9 mg/dl, Q2: 5.9 to 7.2mg/dl, Q3: 7.3 to 9.2 mg/dl, and Q4: >9.2 mg/dl). Results: Mean age was 70.3 years; 56% were women and 19% were African American. Higher lactate quartile was associated with greater odds of having MICA above the median (Odds ratio for Q1: 1.00, Q2: 1.06, Q3: 1.24 and Q4: 1.36; p for trend <0.001) after adjustment for age, gender, ethnicity, stature, body mass index (BMI), LDL, hypertension diagnosis, and diabetes diagnosis. The association between MICA and lactate was attenuated but remained significant (Q1: 1, Q2: 1.02, Q3: 1.12, Q4: 1.21, p for trend 0.011) after further adjustment for triglycerides/HDL ratio. Conclusion: Blood lactate is associated with internal carotid artery maximum wall thickness, a marker of carotid atherosclerosis. Attenuation of the association with adjustment for triglyceride/HDL ratio, a marker of insulin resistance, suggests that lactate’s association with wall thickness may be mediated through insulin resistance, at least in part.

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3039Vulnerability of carotid atherosclerosis: relationship with plaque location, plaque eccentricity and vessel remodeling patterns. Insight from the the MAGNETIC observational study

European Heart Journal ◽

10.1093/eurheartj/ehz745.0006 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

O Catalano ◽

C Cerabolini ◽

E Eshja ◽

G Bendotti ◽

M De Salvo ◽

...

Keyword(s):

Carotid Artery ◽

Wall Thickness ◽

Carotid Atherosclerosis ◽

Internal Carotid ◽

Intraplaque Hemorrhage ◽

Plaque Vulnerability ◽

Cross Sectional ◽

Fibrous Cap ◽

Vessel Remodeling ◽

Maximum Wall Thickness

Abstract Carotid atherosclerosis is a cause of brain ischemic events. Cardiovascular magnetic resonance (CMR) can assess plaque vulnerability. We investigated atherosclerosis vulnerability in relation to plaque location, eccentricity and vessel remodeling. Methods-Baseline CMR evaluations of the MAGNETIC observational study, were analyzed. We quantitated with MRI-Plaque View™, vessel lumen/wall and vulnerable plaque components of a 32-mm segment of common carotid artery (12 mm), bulb (8 mm) and internal carotid artery (12 mm). Lipid-rich necrotic core [LRNC], fibrous cap [CAP] and intraplaque hemorrhage [IPH] were expressed as percent of wall area. Results-A data-set of 8080 sections of adequate quality in 260 patients (198 male [76%], median age 71 years [65–76]), were analyzed. Patients were on therapy with antiplatelet, ACE-inhibitors/ARB and statins (196–229 out of 260 [75–88%]). We found significant differences in plaque composition according to longitudinal and circumferential location, eccentricity and vessel remodeling (table). At multivariate regression analysis, including classical RF and atherosclerotic burden, we found an independent association of: LRNC and IPH with longitudinal location, eccentricity and positive remodeling, and of CAP with eccentricity (p<0.001 for all). Lipid-rich necrotic core Fibrous cap Intraplaque hemorrhage Longitudinal distribution Common carotid artery 4% [1–10] p<0.001 6% [4–11] p<0.001 0% [0–3] p<0.001 Carotid bulb 7% [3–13] 9% [5–13] 1% [0–4] Internal carotid artery 3% [0–10] 7% [4–11] 0% [0–1] Circunferenzial location Antero-medial 4% [0–11] p<0.001 7% [4–12] p=0.07 0% [0–2] p<0.001 Antero-lateral 6% [1–12] 8% [5–12] 1% [0–4] Postero-lateral 5% [0–11] 7% [4–12] 0% [0–3] Postero-medial 5% [0–11] 7% [4–12] 0% [0–1] Plaque eccentricity Concentric 3% [0–9] p<0.001 7% [4–11] p<0.001 0% [0–2] p<0.001 Eccentric 9% [4–15] 9% [5–13] 1% [0–4] Remodelling pattern Negative 4% [0–10] p<0.001 7% [4–11] p<0.001 0% [0–2] p<0.001 Positive 7% [3–13] 8% [5–13] 1% [0–4] Plaque eccentricity was defined as eccentricity index (EI = [maximum wall thickness − minimum wall thickness]/maximum wall thickness) in the highest quartile. Positive remodeling was defined as remodeling index (= [vessel cross-sectional area − reference area]/cross-sectional area) in the highest quartile. Conclusions Carotid atherosclerotic plaque vulnerability seems to be independently associated with longitudinal location, plaque eccentricity and vessel positive remodeling. Acknowledgement/Funding Bayer AG, Leverkusen, Germany

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