ASSESSMENT OF CAROTID INTIMAL MEDIAL THICKNESS (CIMT) IN YOUNG PATIENTS WITH ISCHEMIC STROKE: A CASE CONTROL STUDY

Background: Incidence of ischemic stroke in younger patients in increasing leading to higher morbidity and mortality. Data on carotid intimal medial thickness (CIMT) as atherosclerotic marker in young ischemic stroke patients are scarce. Aims and Objective: To evaluate bilateral CIMT thickness and its correlation with various CVD risk factors in young ischemic stroke patients. Methods: Total 40 patients (15 to 45 age group) and age matched 40 controls were taken. Demographic profile and risk factors were evaluated. All subjects were taken for CIMT assessment by B mode ultrasonography scan in multiangle measurements in the common carotid artery (CCA), carotid bifurcation (BIF) and internal carotid artery (ICA). Results: 72.5% of patients were in 35- 45 years age group. Stroke incidence was higher in male. Age specific value of CIMT was higher in all cases as compared to age matched controls in all age group. (p? 0.01) Increasing age, smoking and hypertension were significantly associated with higher bilateral CIMT. Conclusion: Ischemic stroke young population is associated with increased CIMT. Risk factors burden is contributory in speeding up atherosclerotic process leading to higher CIMT with multiple co morbidities. Keywords: carotid intimal medial thickness, carotid bifurcation, ischemic stroke

Arterial Platelet Adhesion in Atherosclerosis‐Prone Arteries of Obese, Insulin‐Resistant Nonhuman Primates

Background Platelet–endothelial interactions are thought to contribute to early atherogenesis. These interactions are potentiated by oxidative stress. We used in vivo molecular imaging to test the hypothesis that platelet–endothelial interactions occur at early stages of plaque development in obese, insulin‐resistant nonhuman primates, and are suppressed by NADPH‐oxidase‐2 inhibition. Methods and Results Six adult rhesus macaques fed a Western‐style diet for a median of 4.0 years were studied at baseline and after 8 weeks of therapy with the NADPH‐oxidase‐2‐inhibitor apocynin (50 mg/kg per day). Six lean control animals were also studied. Measurements included intravenous glucose tolerance test, body composition by dual‐energy X‐ray absorptiometry, carotid intimal medial thickness, carotid artery contrast ultrasound molecular imaging for platelet GPIbα (glycoprotein‐ Ibα) and vascular cell adhesion molecule‐1, and blood oxidative markers on mass spectrometry. Compared with lean controls, animals on a Western‐style diet were obese (median body mass: 16.0 versus 8.7 kg, P =0.003; median truncal fat: 49% versus 20%, P =0.002), were insulin resistant (4‐fold higher insulin–glucose area under the curve on intravenous glucose tolerance test, P =0.002), had 40% larger carotid intimal medial thickness ( P =0.004), and exhibited oxidative signatures on proteomics. In obese but not lean animals, signal enhancement on molecular imaging was significantly elevated for GPIbα and vascular cell adhesion molecule‐1. The signal correlated modestly with intimal medial thickness but not with the degree of insulin resistance. Apocynin significantly ( P <0.01) reduced median signal for GPIbα by >80% and vascular cell adhesion molecule‐1 signal by 75%, but did not affect intimal medial thickness, body mass, or intravenous glucose tolerance test results. Conclusion In nonhuman primates, diet‐induced obesity and insulin resistance leads to platelet–endothelial adhesion at early atherosclerotic lesion sites, which is associated with the expression of pro‐inflammatory adhesion molecules. These responses appear to be mediated, in part, through oxidative pathways.

Carotid Artery Intimal Medial thickness in Diabetic and Non-Diabetic Subjects in Central Kerala

Background: Increase in intimal medial thickness (IMT) of the carotid arteries is contemplated as a guide to atherosclerotic vascular disease and subclinical organ damage and foretell cardiovascular disease. The study aimed to analyse IMT in non-diabetic and diabetic subjects. Subjects and Methods: There were 105 diabetic and 95 non-diabetic subjects in this study. Common carotid artery (CCA) IMT was calculated using a linear probe of a high-resolution ultrasound medical system. Results: Diabetic subjects (0.95 mm) showed significantly higher mean intimal medial thickness (IMT) when compared non-diabetic subjects (0.85 mm) (p <0.05). Correlation of IMT was seen with age, total cholesterol, triglycerides, HDL & LDL cholesterol and systolic blood pressure (SBP) in diabetic subjects. Total cholesterol, SBP and diastolic blood pressure (DBP) showed a correlation with IMT in the non-diabetic subjects. Age, total cholesterol, SBP, and diabetes were independent risk factors for intimal medial thickness in multivariate linear regression analysis. Conclusion: Higher intimal medial thickness was seen in diabetic subjects when compared to non-diabetic subjects. We conclude that age, total cholesterol, SBP and duration of diabetes showed a significant correlation with IMT. IMT can be considered as a screening tool in diabetic patients for the early detection of atherosclerosis.

Irisin in Adolescent Type 1 Diabetic Patients and its Relation to Diabetes Control and Atherosclerosis

AIM: The objective of the study was to determine the role of irisin in adolescent type 1 diabetic patients. PATIENTS AND METHODS: Sixty-five type 1 diabetic patients and 50 healthy volunteers were enrolled in the study. Serum irisin, glycosylated hemoglobin (HbA1c), lipid profile, oxidized low-density lipoprotein (OxLDL), urinary albumin/creatinine ratio, carotid intimal-medial thickness (cIMT), and aortic intimal medial thickness (aIMT) were assessed for all participants in the study. RESULTS: HbA1c, albumin/creatinine ratio, lipid profile, OxLDL, irisin, cIMT, and aIMT were significantly higher in diabetic patients. Irisin had a positive correlation with age of diabetic patients, onset of diabetes, mid-arm circumference, waist/height ratio, body mass index, HbA1c, and cIMT. CONCLUSION: Irisin is a marker for detection of diabetes control and early detection of subclinical atherosclerosis. Irisin had a relation with obesity.

Sonographic Assessment of Intima Media Thickness of Common Carotid Artery in Normotensive and Hypertensive Individuals

Intimal medial thickness (IMT) is associated with many cardiovascular diseases as atherosclerosis, coronary artery disease, stroke and hypertension etc. Intimal medial thickness of common carotid arteries (CCA) canbe measured by high-resolution modality i.e, B-Mode Ultrasonography.

Abstract P493: Small Dense Low-density Lipoprotein Cholesterol and Carotid Intimal Medial Thickness Progression

Introduction: Carotid intimal medical thickness (cIMT) is associated with cardiovascular disease (CVD). The association between atherogenic lipoproteins including small dense low-density lipoprotein cholesterol (sdLDL-C) and carotid intimal medial thickness (cIMT) progression has not been fully evaluated in a prospective cohort study. Hypothesis: We assessed the hypothesis that sdLDL-C is the most atherogenic lipoproteins with regard to cIMT progression. Methods: Kyushu and Okinawa Population Study (KOPS) is a community-based, prospective, and observational study in Japan which has been underway since 2004 and a total of 18,762 participants have been enrolled. For this study, we included 2,030 male and female participants (median age 59 years at baseline) who were free of CVD and off cholesterol lowering medication, and had cIMT measured at both baseline and after 5 years follow-up survey. Using plasma samples obtained from those subjects after overnight fast, we measured total cholesterol, direct low-density lipoprotein cholesterol (LDL-C), sdLDL-C, LDL-triglycerides (LDL-TG), high-density lipoprotein cholesterol (HDL-C), HDL2-C, HDL3-C, triglycerides, Lp(a), adiponectin and high sensitivity C reactive protein (hs CRP). Their cIMT levels were measured by B-mode ultrasonography with a 10 MHz probe at far walls of their both right and left common carotid arteries. Results: Median cIMT at baseline was 0.63 mm and median 5 year progression was 0.18 mm. After adjustment for standard CVD risk factor including age, gender, systolic blood pressure, total cholesterol, HDL-C, smoking, diabetes, and hypertension treatment, only LDL-C, sdLDL-C, and the sdLDL-C/LDL-C ratio were associated with cIMT progression. Even in subjects with direct LDL-C < 100 mg/dL, considered to be at low CVD risk, elevated sdLDL-C were associated with cIMT progression ( P for trend = 0.009) in a model with established CVD risk factors, although the sdLDL-C/LDL-C ratio did not. Conclusions: In conclusion, both sdLDL-C and direct LDL-C are significantly associated with cIMT progression. Moreover sdLDL-C has stronger relationship with cIMT progression than does LDL-C; therefore, measurement of sdLDL-C may allow for the formulation of optimal therapy to cIMT progression.