OBJECTIVETo study the relationship between carotid atherosclerosis and cerebral infarction (CI).

METHODSBetween November 2008 and March 2009, 147 CI patients (CI group) and 48 patients with non-cerebrovascular diseases (control group) were enrolled from inpatients of Neurology Department of our hospital. The diagnostic criterion of thickened carotid intima was set as 1.0 mmcarotid plaque was as IMT 1.5 mm. Carotid atherosclerosis was divided into three levels: normal intima, thickened intima, and plaque formation. The color Doppler ultrasonography data of carotid arteries in all patients were analyzed and the severity of carotid atherosclerosis was compared between the two groups.

RESULTSIn the CI group, 36 (24.5%) patients had normal carotid intima, 22 (15.0%) had thickened carotid intima, and 89 (60.5%) had carotid plaque. In the control group, 22 (45.8%) patients had normal carotid intima, 4 (8.3%) had thickened carotid intima, and 22 (45.8%) had carotid plaque. The severity of carotid atherosclerosis in the CI group was higher than that in the control group (P = 0.022). There was significant difference in the constitution of carotid plaque between the two groups (P = 0.001); the CI group mainly had the soft plaque (55/89, 61.8%), whereas the control group mainly had the hard plaque (17/22, 77.3%). The first three common locations of carotid plaque in both groups were carotid bifurcation (CI group: 73.7%; control group: 64.1%), common carotid artery (CI group: 20.4%; control group: 25.6%), and internal carotid artery (CI group: 5.9%; control group: 10.3%). The location of carotid plaque between the two groups was not significantly different (P = 0.438). There was no difference in the carotid inner diameter or resistance index between the two groups (P > 0.05).

CONCLUSIONSCarotid atherosclerosis is to some extent able to reveal the atherosclerotic condition of cerebral arteries and act as an important predictor for the risk of CI. The color Doppler ultrasonography of carotid arteries can provide a convenient way for the prevention and treatment of CI.

Adult ; Aged ; Aged, 80 and over ; Carotid Arteries ; diagnostic imaging ; pathology ; Carotid Artery Diseases ; complications ; epidemiology ; pathology ; Cerebral Infarction ; epidemiology ; etiology ; pathology ; Female ; Humans ; Male ; Middle Aged ; Risk Factors ; Ultrasonography, Doppler, Color

Cardiovascular disease (CVD) is still the major cause of the morbidity and mortality in hemodialysis (HD) patients. The characteristics of major arterial changes, atherosclerosis and related risk factors in HD patients remain unclear. We aimed to evaluate the atherosclerotic process in asymptomatic HD patients and healthy volunteers, and to determine the association between the risk factor (s) and the atherosclerotic process in these groups. 92 HD patients (female: 43, male: 49) and 62 age and sex matched healthy volunteers (female: 27, male: 35) were enrolled in this study. Diabetics, smokers, and patients with symptomatic CVD were excluded. The right and left carotid intima-media thicknesses (CIMTs) were measured and plaque structures were studied by B-mode ultrasound. The mean CIMT in patients and control group were 0.79 +/- 0.16 mm and 0.54 +/- 0.09 mm, respectively. Mean CIMT in HD patients was thicker (p < 0.001) and the presence ratio of plaque was higher in patients group (n=38, %61.2 vs n=9, %17.3) (p < 0.001). Calcified type of plaque was more frequent in HD patients than control group. Age (r=0.48, p < 0.001), left ventricular mass (r=0.42, p < 0.05), and homocysteine (r=0.46, p < 0.01), mean hematocrit (r=-0.36, p < 0.05), plasma CRP (r=0.50, p < 0.001), ESR (r=0.43, p < 0.01) and albumin (r= -0.34, p < 0.05) levels were correlated with the CIMT measurements and plaque presence, significantly. -CIMT as an atherosclerotic process indicator is thicker in asymptomatic HD patients than healthy subjects. We concluded that in addition to various classical risk factors, uremic environment may also contribute to acceleration of the atherosclerotic process.
Adult ; Aged ; Carotid Artery Diseases/*epidemiology/*pathology ; Female ; Human ; Incidence ; Kidney Failure, Chronic/*epidemiology/therapy ; Male ; Middle Aged ; *Renal Dialysis ; Risk Factors

OBJECTIVES: We evaluated the association between common carotid artery intima-media thickness (CCA-IMT), brachial-ankle pulse wave velocity (baPWV), carotid plaque, and peripheral arterial disease (PAD) as indicators of macroangiopathy and diabetic retinopathy as an indicator of microangiopathy in type 2 diabetic patients. METHODS: We analyzed 605 type 2 diabetic patients registered at a public health center in Korea. Following overnight fasting, venous blood and urine samples were collected and analyzed. The CCA-IMT, levels of carotid plaque, baPWV, and ankle-brachial index (ABI) of the subjects were assessed. We used non-mydriatic fundus photography to diagnose diabetic retinopathy. Multiple logistic regression analyses were used to evaluate the association between macroangiopathy and diabetic retinopathy. CCA-IMT and baPWV were divided into tertiles: CCA-IMT, 0.39 to 0.65 mm, 0.66 to 0.78 mm, and 0.79 to 1.30 mm; baPWV, 9.9 to 15.8 m/s, 15.9 to 18.9 m/s, and 19.0 to 38.0 m/s. RESULTS: The association between baPWV and diabetic retinopathy remained significant after adjustment, with an increasing odds ratio (OR) in the second tertile (OR, 2.41; 95% confidence interval [CI], 1.27 to 4.55) and the third tertile (OR, 4.63; 95% CI, 2.33 to 9.21). No significant differences were observed in carotid plaque, PAD, and each tertile of CCA-IMT. CONCLUSIONS: BaPWV was associated with diabetic retinopathy, while CCA-IMT, carotid plaque, and PAD were not. This study suggests that the association between macroangiopathy and microangiopathy may be attributable to functional processes rather than structural processes within the vascular system.
Aged ; Aged, 80 and over ; Ankle Brachial Index ; Carotid Artery Diseases/epidemiology/*pathology ; Confidence Intervals ; Diabetes Mellitus, Type 2/epidemiology/*pathology ; Diabetic Retinopathy/epidemiology/*pathology ; Female ; Humans ; Logistic Models ; Male ; Odds Ratio ; Peripheral Arterial Disease/epidemiology/*pathology ; Republic of Korea/epidemiology ; Risk Assessment ; Tunica Intima/pathology ; Tunica Media/pathology

INTRODUCTIONThe aim of the study was to evaluate cerebral microangiopathy in type 2 noninsulin- dependent diabetes mellitus (NIDDM) patients and to establish potentially conducive factors.

MATERIALS AND METHODSA group of 34 patients with NIDDM and 31 gender- and agematched normal controls (NC) were assessed by extracranial Doppler ultrasound, in order to evaluate the pulsatility index (PI) and the resistance index (RI) in the internal carotid arteries (ICAs); transcranial Doppler was utilised to assess the same parameters in the middle cerebral arteries (MCAs). All patients underwent screening for favouring factors for cerebral vascular remodelling.

RESULTSOf the 34 NIDDM patients, 21 patients (61.76%) (subgroup A) presented with microangiopathic complications [of these, 19 patients (90.46%) had diabetic nephropathy (DN)] versus 13 NIDDM patients (38.24%) (subgroup B) without complications. In subgroup A, 16 patients (76.19%) had PI >1 and RI >0.7 in the ICAs and MCAs (changes consistent with cerebral microangiopathy) versus 5 patients (35.46%) in subgroup B, and no modifications in NC. Of the 19 patients with DN, 14 patients (73.68 %) had impaired haemodynamic indices. Univariate regression analysis showed the following risk factors for the cerebral haemodynamics changes: fibrinogen (F) (OR = 3.11), C-reactive protein (CRP) (OR = 2.40), duration of DM (OR = 2.40), proteinuria (OR = 1.80), serum creatinine (OR = 1.66). Multivariate regression analysis showed as predictors for impaired haemodynamic indices: duration of DM (HR =1.70), proteinuria (HR = 1.70). The haemodynamic indices in the ICAs correlated with duration of DM (r = 0.87, P <0.0001), F (r = 0.86; P <0.0001), CRP (r = 0.80; P <0.0001); in the MCAs with the duration of DM (r = 0.66, P <0.0001), F (r = 0.38; P <0.0001), CRP (r = 0.88; P <0.0001).

CONCLUSIONCerebral microangiopathy has a high prevalence in NIDDM patients. These cerebral vascular changes correlate with the duration of DM, parameters of inflammation, and proteinuria.

Carotid Artery Diseases ; diagnostic imaging ; epidemiology ; etiology ; Carotid Artery, Internal ; diagnostic imaging ; pathology ; Case-Control Studies ; Diabetes Mellitus, Type 2 ; complications ; diagnostic imaging ; Diabetic Angiopathies ; diagnostic imaging ; epidemiology ; etiology ; Female ; Humans ; Inflammation ; Male ; Middle Aged ; Prevalence ; Prognosis ; Risk Assessment ; Risk Factors ; Romania ; Time Factors ; Ultrasonography, Doppler, Pulsed

Aged ; Body Mass Index ; Carotid Arteries ; diagnostic imaging ; pathology ; Carotid Artery Diseases ; diagnosis ; epidemiology ; etiology ; Cholesterol, HDL ; blood ; Fatty Liver ; complications ; diagnosis ; epidemiology ; Female ; Humans ; Insulin Resistance ; Intercellular Signaling Peptides and Proteins ; blood ; Male ; Metabolic Syndrome ; complications ; Middle Aged ; Obesity ; complications ; Risk Factors ; Triglycerides ; blood ; Tunica Intima ; diagnostic imaging ; pathology ; Ultrasonography