Clinical value of MRI T2-mapping quantitative assessment of carotid plaque

2019 ◽  
Vol 61 (8) ◽  
pp. 1021-1025
Author(s):  
Shan Huang ◽  
Xijun Gong ◽  
Song Guan ◽  
Suisheng Zheng ◽  
Fei Li ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Plaque ◽  
Spin Echo ◽  
T2 Mapping ◽  
Optimal Threshold ◽  
Clinical Value ◽  
Carotid Artery Plaque ◽  
Asymptomatic Patients ◽  
Spin Echo Sequence ◽  
Cerebrovascular Symptoms

Background Stroke is a severe health problem, and magnetic resonance imaging (MRI) plays a significant role in stroke. Purpose To investigate the clinical value of MRI T2-mapping in carotid artery plaque. Material and Methods To locate the plaque in the carotid artery, 25 patients with carotid atherosclerosis were examined by 3.0-T MRI with three-dimensional (3D) time-of-flight and 3D fast spin-echo (FSE) T1-weighted scanning. The original images were obtained after T2-mapping (multi-spin-echo sequence) scanning. The T2 values of the plaque in the narrowest lumen were measured on T2 maps after postprocessing of the original images. Based on the symptoms, the patients were divided into two sub-groups; independent sample t-test was employed to compare the difference between the T2 values of the plaque in the two groups. We evaluated the optimal threshold and diagnostic efficacy of T2 values in predicting cerebrovascular symptoms by the receiver operating characteristic (ROC) curve. Results The T2 values of the carotid artery plaque in symptomatic and asymptomatic patients were 111.43 ± 46.54 ms and 59.25 ± 39.77 ms, respectively (t = −3.421, P < 0.01). ROC analysis showed that the T2 value of 65.38 ms was the optimal threshold to predict cerebrovascular symptoms. The specificity, sensitivity, and accuracy attained were 94.1% (16/17), 93.3% (14/15), and 93.8% (30/32), respectively. Conclusion We quantitatively assessed carotid plaque components by MRI T2-mapping technology. The T2 values of the carotid plaque were associated with cerebrovascular symptoms. The T2 values of the symptomatic plaque group were significantly higher than those of the asymptomatic group.

Abstract P322: Association of Hiv Infection With Carotid Artery Plaque Echomorphology in the Women’s Interagency HIV Study (wihs)

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Claudio A Bravo ◽  
Jee-Young Moon ◽  
Jean Claude Uwamungu ◽  
Robert Kaplan ◽  
Kathryn Anastos ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Carotid Artery ◽  
Hiv Infection ◽  
Carotid Plaque ◽  
Cd4 Count ◽  
Morbidity And Mortality ◽  
Hiv Care ◽  
Carotid Artery Plaque ◽  
Hiv Women ◽  
Hiv Negative

Introduction: Cardiovascular disease is a major contributor to morbidity and mortality among women living with HIV (WLWH). We previously found HIV infection to be associated with carotid artery plaque, a marker of subclinical atherosclerosis. Plaque morphology and composition may predict plaque rupture and cardiovascular disease events. We characterized the association of HIV-related factors with carotid plaque echomorphology in the WIHS. Methods: Using B-mode ultrasound, we characterized plaque (focal intima-media thickness >1.5 mm) at 6 locations in the right carotid artery in 1,722 participants (1,230 HIV+, 492 HIV-) of the WIHS, a cohort study of women with or at risk for HIV at 6 US sites. Plaque echomorphologic features included relative echogenicity (>50% of plaque is echolucent vs >50% of plaque is echogenic) and surface morphology (smooth vs irregular, i.e., height variations along contour of plaque). We used multinomial logistic regression to assess the odds of each feature vs no plaque comparing HIV+ and HIV- women, adjusting for demographic (e.g., age, race/ethnicity, socioeconomic status), behavioral (e.g., drug/alcohol use, smoking, HCV infection, smoking), cardiometabolic (e.g., systolic blood pressure, BMI, lipids, diabetes) and HIV-related risk factors (e.g., antiretroviral therapy use, current CD4+ T-cell count, AIDS). We further stratified WLWH by CD4+ count (<200, 200-499, 500+ cells/uL) and HIV-1 RNA suppression. Results: Among 1,722 women (median age 40, IQR 33-46, 59% black, 29% Hispanic, 71% HIV+), 160 (9%) had at least one carotid plaque (128 HIV+, 32 HIV-). In unadjusted analyses, WLWH had more echolucent plaque (5.3% vs 2.6%, p=0.02) and plaques with smooth surface (2.7% vs 0.6%, p=0.005) than HIV-negative women. After covariate adjustment, HIV serostatus remained significantly associated with smooth plaque (odds ratio [OR] 3.45, 95% CI 1.12-10.62) but not with echolucent plaque (OR 1.60, 95% CI 0.84-3.05). Stratified by HIV viremia, WLWH with unsuppressed HIV viremia had significantly more smooth plaque (OR 3.34, 95% CI 1.26-8.87) than HIV- women, whereas suppressed WLWH did not (OR 1.79, 95% CI 0.55-5.83). In a dose-response manner, lower CD4+ count among WLWH was associated with smooth plaque (e.g., OR for <200 cells/uL compared with HIV-negative women 7.43, 95% CI 1.46-37.87), and this association was of greater magnitude than that with irregular plaque (OR 2.46, 95% CI 1.14-5.32). Low CD4+ count was also associated with both echolucent (OR 3.36 for <200 cells/uL vs HIV-negative, 95% CI 1.29-8.77) and echogenic plaque (OR 2.65, 95% CI 1.18-5.96). Conclusions: Unsuppressed viremia and low CD4+ count, which are markers of suboptimal HIV care, were associated with certain echomorphologic features of carotid plaque. Further work should assess whether these features differentially lead to cardiovascular morbidity and mortality in WLWH.

Do Carotid Plaque Ulcers Heal? Potential Detection of Carotid Artery Plaque Healing by Carotid Ultrasound Imaging

2020 ◽  
Author(s):  
Marialaura Simonetto ◽  
Sushrut Dharmadhikari ◽  
Ari Bennett ◽  
Nelly Campo ◽  
Negar Asdaghi ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Ultrasound Imaging ◽  
Carotid Plaque ◽  
Carotid Ultrasound ◽  
Carotid Artery Plaque

scholarly journals Imaging Characteristics of Two-Dimensional Spin Echo T1-weighted Image in Carotid Artery Plaque

2012 ◽  
Vol 68 (1) ◽  
pp. 85-94
Author(s):  
Takanori Naka ◽  
Yuuya Sasaki ◽  
Seigo Kawaguchi ◽  
Mayumi Fujita ◽  
Miho Takeda ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Spin Echo ◽  
Two Dimensional ◽  
Carotid Artery Plaque ◽  
Weighted Image ◽  
Imaging Characteristics

Abstract 957: Elevated Levels of Neopterin are Associated with Carotid Complex Plaques in Patients with Stable Angina Pectoris

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Kenichi Sugioka ◽  
Takahiko Naruko ◽  
Takeshi Hozumi ◽  
Shoichi Ehara ◽  
Takuhiro Okuyama ◽  
...  
Keyword(s):  
Angina Pectoris ◽  
Carotid Artery ◽  
Stable Angina ◽  
Carotid Plaque ◽  
Coronary Vessels ◽  
Surface Irregularity ◽  
Stable Angina Pectoris ◽  
Carotid Artery Plaque ◽  
Plaque Score ◽  
Carotid Plaques

Background: Neopterin is produced by activated macrophages and serves as an activation marker for monocytes/macrophages. Serum levels of neopterin have been shown to be associated with the presence of complex coronary lesions in unstable angina pectoris. However, the relationship between neopterin levels and complex carotid lesions is still unknown. We investigated the association between plasma neopterin levels and the characteristics of carotid plaques in patients with stable angina pectoris (SAP). Moreover, we immunohistochemically studied the presence of neopterin in carotid endarterectomy specimens. Methods: We studied 65 SAP patients who were scheduled coronary angiography. In all patients, plasma neopterin levels were measured and carotid ultrasound was performed for evaluation of carotid artery plaque score (PS) defined by the sum of plaque thickness, plaque number (PN) and plaque surface irregularity. Frozen tissue of 40 endarterectomy specimens for extracranial high-grade carotid stenosis were immunohistochemically examed with antibodies against macrophages and neopterin. Results: There was no significant correlation between plasma neopterin levels and PS (P=0.38) or PN (P=0.49). On the other hand, plasma neopterin levels were significantly higher in patients with carotid plaque surface irregularity compared with patients without it (25.4 ± 13.5 nmol/L vs.16.9 ± 6.5 nmol/L, P=0.0015). Carotid plaque irregularity was detected more frequently in patients with higher neopterin levels (>=18.5 nmol/L median) compared with those with lower neopterin levels (41.9% vs. 16.1%, P=0.025). Using multivariate analyses, nepopterin levels (OR, 1.11; 95%CI, 1.01 to 1.21; P=0.023) and the number of diseased coronary vessels (OR, 2.51; 95%CI, 1.01 to 6.22; P=0.047) are independently associated with carotid plaque irregularity. Immunohistochemical staining showed abundant neopterin-positive macrophages in the unstable carotid plaques. Conclusions: Neopterin levels are associated with carotid complex plaques rather than the severity of carotid atherosclerotic change. Neopterin can be considered as one of the significant markers of plaque destabilization in not only coronary artery but carotid artery atherosclerotic lesions.

scholarly journals Detection of Symptomatic Carotid Plaque Using Source Data from MR and CT Angiography: A Correlative Study

2015 ◽  
Vol 39 (3-4) ◽  
pp. 151-161 ◽  
Author(s):  
Ajay Gupta ◽  
Hediyeh Baradaran ◽  
Edward E. Mtui ◽  
Hooman Kamel ◽  
Ankur Pandya ◽  
...  
Keyword(s):  
High Risk ◽  
Carotid Artery ◽  
Ct Angiography ◽  
Carotid Plaque ◽  
Source Imaging ◽  
Carotid Artery Plaque ◽  
Symptomatic Disease ◽  
Symptomatic Carotid ◽  
Calcified Plaque ◽  
Soft Plaque

Background: Carotid plaque MRI has been a useful method to characterize vulnerable atherosclerotic plaque elements. Recent investigations have suggested that source images from CT angiography (CTA) and MR angiography (MRA) can identify the simple high-risk features of symptom-producing carotid artery plaque. We studied the correlation and relative diagnostic accuracies of CTA and MRA source images in detecting symptomatic carotid artery plaque. Methods: Subjects were eligible if they had carotid stenosis between 50 and 99% and had MRA and CTA exams performed within 10 days of one another. We measured the soft (non-calcified) plaque and hard (calcified) plaque thickness on CTA axial source images and intraplaque high-intensity signal (IHIS) on 3D-time-of-flight MRA source images in subjects. We assessed whether a correlation existed between increasing CTA soft plaque thicknesses and the presence of MRA IHIS using the Student's t-test. We calculated the differences in sensitivity and specificity measures of CTA and MRA source-imaging data with the occurrence of recent ipsilateral stroke or transient ischemic attack (TIA) as the reference standard. We also performed logistic regression analyses to evaluate the predictive strength of plaque showing both IHIS and increased CTA soft plaque thickness in predicting symptomatic disease status. Results: Of 1994 screened patients, 48 arteries met the final inclusion criteria with MRA and CTA performed within 10 days of one another. The mean and median time between CTA and MRA exams were 2.0 days and 1 day, respectively. A total of 34 of 48 stenotic vessels (70.8%) were responsible for giving rise to ipsilateral stroke or TIA. CTA mean soft plaque thickness was significantly greater (4.47 vs. 2.30 mm, p < 0.0001) in patients with MRA-defined IHIS, while CTA hard plaque thickness was significantly greater (2.09 vs. 1.16 mm, p = 0.0134) in patients without MRA evidence of IHIS. CTA soft plaque thickness measurements were more sensitive than MRA IHIS (91.2 vs. 67.6%, p = 0.011) in detecting symptomatic plaque, while differences in specificity were not significantly different (p = 0.1573). In the subset of patients with both IHIS on MRA and plaque thickness >2.4 mm on CTA, the odds ratio of detecting symptomatic plaque, corrected for stenosis severity, was 45.3 (p < 0.0005). Conclusions: Unprocessed source images from CTA and MRA, which are routinely evaluated for clinical studies demonstrate the highly correlated presence of IHIS and increasing soft plaque thickness. In particular, plaque that shows high-risk features on both MRA and CTA are very strongly associated with symptom-producing carotid plaque. With further validation, such techniques are promising practical methods of extracting risk information from routine neck angiographic imaging.

Virtual Histology Intravascular Ultrasound Assessment of Carotid Artery Disease: The Carotid Artery Plaque Virtual Histology Evaluation (CAPITAL) Study

2007 ◽  
Vol 14 (5) ◽  
pp. 676-686 ◽  
Author(s):  
Edward B. Diethrich ◽  
M. Pauliina Margolis ◽  
Donald B. Reid ◽  
Allen Burke ◽  
Venkatesh Ramaiah ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Diagnostic Accuracy ◽  
Intravascular Ultrasound ◽  
Carotid Plaque ◽  
Carotid Artery Disease ◽  
Cerebral Protection ◽  
Histological Evaluation ◽  
Carotid Artery Plaque ◽  
Virtual Histology ◽  
Virtual Histology Intravascular Ultrasound

Purpose: To determine the diagnostic accuracy of virtual histology intravascular ultrasound imaging (VH IVUS) of carotid plaque and to assess the feasibility of VH IVUS to identify plaque with embolic potential in patients undergoing carotid artery stenting (CAS). Methods: Thirty patients (17 men; mean age 74±7 years) were entered nonrandomly into a single-center, prospective, 2-arm study following FDA and Institutional Review Board approval. In one arm, 15 patients underwent VH IVUS examination of carotid plaque with a cerebral protection device immediately followed by carotid endarterectomy (CEA). A comparison of “virtual” with true histology was then performed, classifying plaque type by VH IVUS and histopathology in a blinded study. In the second arm, 15 patients undergoing CAS had a preliminary VH IVUS scan performed with cerebral protection. Debris collected from the filter following stenting was examined histologically and compared with the VH IVUS data. Results: The diagnostic accuracy of VH IVUS to agree with true histology in different carotid plaque types was 99.4% in thin-cap fibroatheroma, 96.1% for calcified thin-cap fibroatheroma, 85.9% in fibroatheroma, 85.5% for fibrocalcific, 83.4% in pathological intimal thickening, and 72.4% for calcified fibroatheroma. Filter debris was captured in 2 patients prior to CEA and in 4 patients undergoing CAS for restenosis; VH IVUS classification of plaque composition was consistent with the histological evaluation of filter fragments. Calcified nodules projecting into the carotid artery lumen were associated with a higher incidence of previous neurological symptoms (66.7% versus 33.3%, p<0.05), while patients on aspirin has significantly less necrotic lipid core plaque detected by VH IVUS than patients not taking aspirin (6.4%±4.7% versus 9.7%±2.8%, p<0.05). Conclusion: This study showed a strong correlation between VH IVUS plaque characterization and the true histological examination of the plaque following endarterectomy, particularly in “vulnerable” plaque types. The feasibility study to examine VH IVUS data and the filter debris histology in CAS patients supports a larger prospective study.

scholarly journals Carotid artery plaque assessment using quantitative expansive remodeling evaluation and MRI plaque signal intensity

2016 ◽  
Vol 124 (3) ◽  
pp. 736-742 ◽  
Author(s):  
Yoshitaka Kurosaki ◽  
Kazumichi Yoshida ◽  
Ryu Fukumitsu ◽  
Nobutake Sadamasa ◽  
Akira Handa ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Risk Stratification ◽  
Signal Intensity ◽  
Plaque Vulnerability ◽  
Carotid Artery Plaque ◽  
Asymptomatic Patients ◽  
Group A ◽  
Group B ◽  
Group D ◽  
Ischemic Events

OBJECT Plaque characteristics and morphology are important indicators of plaque vulnerability. MRI-detected intraplaque hemorrhage has a great effect on plaque vulnerability. Expansive remodeling, which has been considered compensatory enlargement of the arterial wall in the progression of atherosclerosis, is one of the criteria of vulnerable plaque in the coronary circulation. The purpose of this study was risk stratification of carotid artery plaque through the evaluation of quantitative expansive remodeling and MRI plaque signal intensity. METHODS Both preoperative carotid artery T1-weighted axial and long-axis MR images of 70 patients who underwent carotid endarterectomy (CEA) or carotid artery stenting (CAS) were studied. The expansive remodeling ratio (ERR) was calculated from the ratio of the linear diameter of the artery at the thickest segment of the plaque to the diameter of the artery on the long-axis image. Relative plaque signal intensity (rSI) was also calculated from the axial image, and the patients were grouped as follows: Group A = rSI ≥ 1.40 and ERR ≥ 1.66; Group B = rSI< 1.40 and ERR ≥ 1.66; Group C = rSI ≥ 1.40 and ERR < 1.66; and Group D = rSI < 1.40 and ERR < 1.66. Ischemic events within 6 months were retrospectively evaluated in each group. RESULTS Of the 70 patients, 17 (74%) in Group A, 6 (43%) in Group B, 7 (44%) in Group C, and 6 (35%) in Group D had ischemic events. Ischemic events were significantly more common in Group A than in Group D (p = 0.01). CONCLUSIONS In the present series of patients with carotid artery stenosis scheduled for CEA or CAS, patients with plaque with a high degree of expansion of the vessel and T1 high signal intensity were at higher risk of ischemic events. The combined assessment of plaque characterization with MRI and morphological evaluation using ERR might be useful in risk stratification for carotid lesions, which should be validated by a prospective, randomized study of asymptomatic patients.

scholarly journals The Correlation Between Collagen Types and Ultrasound Feature Score in Evaluating the Vulnerability of Carotid Artery Plaque

2021 ◽  
Vol 8 ◽  
Author(s):  
Ruijun Han ◽  
Yanhong Yan ◽  
Yafang Ding ◽  
Yabo Huang ◽  
Peng Zhou ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Collagen Type ◽  
Collagen Type I ◽  
Type I ◽  
Vulnerable Group ◽  
Clinical Value ◽  
Carotid Artery Plaque ◽  
Type Iv ◽  
Ultrasound Score ◽  
The Stability

Objectives: To investigate whether ultrasound score has clinical value in identifying carotid artery-vulnerable plaque and the impacts of collagen distribution on the stability of plaque.Materials and Methods: Standard carotid artery ultrasound examinations were performed in 51 patients with carotid artery plaques before carotid endarterectomy. Hematoxylin-eosin staining and Sirius red–picric acid staining of plaque sections were performed to analyze the pathological features and collagen distribution. All plaques were classified into vulnerable and stable groups by pathological features. Ultrasound scores, cap thickness, and the ratios of different collagen types were recorded and analyzed between two groups and different parts of plaques.Results: Ultrasound scores of the vulnerable group were higher than those of the stable group (4.35 ± 1.23 vs. 2.09 ± 1.04, P = 0.001). AUC was 0.894 (best cutoff point three) in differentiating vulnerable and stable plaques. Compared with the stable group, the fibrous caps of the vulnerable group were thinner (P = 0.012); the area ratios of collagen type I to all collagen in the vulnerable group were lower (P = 0.033); however, the area ratios of collagen type IV to all collagen were higher (P = 0.026). Compared with downstream shoulders, the ultrasound scores of upstream shoulders of plaque were higher (P = 0.001), the fibrous caps of upstream shoulders were thinner (P = 0.001), and the area ratios of collagen type I to all collagen were lower (P = 0.022).Conclusion: Ultrasound score could have a clinical value in identifying vulnerable carotid artery plaque, and the collagen distribution could impact the stability of plaques, especially collagen type I and type IV. The results also prompted that the upstream shoulders were more vulnerable than the downstream shoulders.

scholarly journals Evaluation of a single-breath-hold radial turbo-spin-echo sequence for T2 mapping of the liver at 3T

2021 ◽  
Author(s):  
Diana Bencikova ◽  
Fei Han ◽  
Stephan Kannengieser ◽  
Marcus Raudner ◽  
Sarah Poetter-Lang ◽  
...  
Keyword(s):  
Spin Echo ◽  
T2 Mapping ◽  
Fat Suppression ◽  
Breath Hold ◽  
Turbo Spin Echo ◽  
Turbo Spin ◽  
Single Breath ◽  
Single Breath Hold ◽  
Spin Echo Sequence ◽  
Phantom Measurements

Abstract Objectives T2 mapping of the liver is a potential diagnostic tool, but conventional techniques are difficult to perform in clinical practice due to long scan time. We aimed to evaluate the accuracy of a prototype radial turbo-spin-echo (rTSE) sequence, optimized for multi-slice T2 mapping in the abdomen during one breath-hold at 3 T. Methods A multi-sample (fat: 0–35%) agarose phantom doped with MnCl2 and 80 subjects (73 patients undergoing abdomen MR examination and 7 healthy volunteers) were investigated. A radial turbo-spin-echo (rTSE) sequence with and without fat suppression, a Cartesian turbo-spin-echo (Cart-TSE) sequence, and a single-voxel multi-echo STEAM spectroscopy (HISTO) were performed in phantom, and fat-suppressed rTSE and HISTO sequences were performed in in vivo measurements. Two approaches were used to sample T2 values: manually selected circular ROIs and whole liver analysis with Gaussian mixture models (GMM). Results The rTSE-T2s values exhibited a strong correlation with Cart-TSE-T2s (R2 = 0.988) and with HISTO-T2s of water (R2 = 0.972) in phantom with an offset between rTSE and Cart-TSE maps (mean difference = 3.17 ± 1.18 ms). The application of fat suppression decreased T2 values, and the effect was directly proportional to the amount of fat. Measurements in patients yielded a linear relationship between rTSE- and HISTO-T2s (R2 = 0.546 and R2 = 0.580 for ROI and GMM, respectively). Conclusion The fat-suppressed rTSE sequence allows for fast and accurate determination of T2 values of the liver, and appears to be suitable for further large cohort studies. Key Points •Radial turbo-spin-echo T2 mapping performs comparably to Cartesian TSE-T2 mapping, but an offset in values is observed in phantom measurements. •Fat-suppressed radial turbo-spin-echo T2 mapping is consistent with T2 of water as assessed by MRS in phantom measurements. •Fat-suppressed radial turbo-spin-echo sequence allows fast T2 mapping of the liver in a single breath-hold and is correlated with MRS-based T2 of water.

CAROTID PLAQUE CHARACTERISTICS AND ITS PREVALENCE IN PATIENTS WITH CORONARY ARTERY DISEASE: AN OBSERVATIONAL STUDY

2021 ◽  
Vol 5 (10) ◽  
Author(s):  
Kirtiman Singh ◽  
Abhishek Rathore ◽  
Indu Bhana ◽  
Mahendra Chourasiya
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Carotid Artery ◽  
Common Carotid Artery ◽  
Carotid Plaque ◽  
Cardiovascular Events ◽  
Carotid Ultrasonography ◽  
Carotid Artery Plaque ◽  
The Common ◽  
Artery Disease

Background and Aims: To evaluate the prevalence and clinical significance of carotid artery plaque, in patients with coronary artery disease. Material and Methods: A total of 1000 patients with 40-80 years of age with coronary artery disease were enrolled. Carotid ultrasonography was performed in all these patients. Results: Among 100 patients with carotid artery disease, 36 had a carotid plaque. In plaque-positive cases, a majority of patients were in a 50 – 60-year age group. Dyslipidemia was found to be the most common risk factor for carotid plaque. In 36 plaque-positive cases, 20 (56%) were having the plaque at the carotid bulb and 16 (44%) were having the plaque at the common carotid artery. Out of 36 cases, 16 (44%) were hyperechogenic, 8 (22%) were calcified, 6 (17%) were moderate echogenic, 6 (17%) were low echogenic. Conclusion: High-resolution B-mode ultrasonography is a useful non-invasive method to evaluate carotid atherosclerosis. Carotid plaques of the common carotid artery are a surrogate marker of atherosclerosis and associated with cardiovascular events. Routine screening of patients with coronary artery disease may be considered. Keywords: Carotid artery stenosis, coronary artery disease, cardiovascular events, atherosclerosis, carotid ultrasonography.

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