We examined a total of 125 patients, of whom 70 suffered from rheumatoid arthritis (RA). The comparison group was composed of 40 patients diagnosed with osteoarthrosis deformans (OD) and 15 with atherosclerosis of the major arteries of the head (MAH). The control group consisted of 40 subjects randomized by sex and age. Studied were the carotid, vertebral arteries and the cerebral blood flow by means of colour duplex scanning on the unit "Vingmed system, 5, Norway, 2002". Patients with RA as compared with those from the control group showed thickening of the vascular wall of the carotid arteries, especially manifested in patients with seropositive rheumatoid arthritis and in those suffering from RA with systemic manifestations of the disease. The findings obtained by the duplex scanning in patients with RA as compared with those of the control group and OD patients demonstrated an increased number of stenotic lesions of the carotid and vertebral arteries particularly pronounced in seropositive RA and RA with extraarticular manifestations of the disease. Statistically reliable findings were obtained while studying the deformities of the carotid arteries. Comparing the RA groups revealed significant differences: in the group of patients suffering from RA with the systemic manifestations noted was an increased percentage of the kinking along both the common carotid artery (chi(2) = 1.76; NS) and the interpal carotid artery (chi(2) = 8.44; p = 0.01). The findings obtained in the present study strongly suggest that in RA patients there take place alterations in the IMC in the form of a thickening with disordered differentiation of the intima-medial layers and the lesion of the cardiovascular system, which is characterized by an early development of atherosclerosis. The degree of atherosclerotic alterations is associated with the presence of systemic manifestations of RA, high activity of the inflammatory process, and seropositivity by the rheumatoid factor.
Atherosclerosis and osteoporosis appear to be related, but prospective studies on the relationship are sparse. In order to examine whether carotid artery plaques with different morphology predict nonvertebral fractures, we followed 2,733 women, aged 55-74 years (75% of the eligible population in Troms?, Norway), for 6 years. At baseline, plaque morphology in terms of ultrasound echogenicity was categorized into three groups, ranging from low echogenicity (echolucent plaques with a high content of soft tissue) to strong echogenicity (echogenic plaques with a high content of dense fibrous tissue and calcified material). We found that the age-adjusted relative risk (RR) of fracture was significantly higher among women with echogenic plaques than among women without plaques: 1.7 (95% confidence interval [CI] 1.0-2.7). After adjustment for bone mineral density at baseline in addition to age, the RR was 1.6 (95% CI 1.0-2.6), and further adjustments for body mass index, body height, high-density lipoprotein cholesterol, smoking status, and muscle strength did not influence the association. Subjects with other plaque types were not at an increased risk compared to subjects without plaques: RR
Ultrasound measurements are both surrogate markers and risk factors for atherosclerosis end points. Carotid intima-media thickness (IMT) is most commonly used, but ultrasound can also define structures in higher spatial dimensions, such as total plaque area (TPA) and total plaque volume (TPV). Because there are minimal data regarding the relationship between IMT, TPA and TPV, we measured these variables in 272 Oji-Cree subjects. We found pairwise correlations for IMT:TPA, IMT:TPV and TPA:TPV of 0.507, 0.588 and 0.846, respectively (transformed variables, all P
Insulin resistance and intima-media thickness in the carotid and femoral arteries of clinically healthy 58-year-old men. The Atherosclerosis and Insulin Resistance Study (AIR).
Department of Medicine and Wallenberg Laboratory for Cardiovascular Research, Sahlgrenska University Hospital, Göteborg, Sweden. bjorn.fagerberg@medfak.gu.se
To examine whether insulin resistance was associated with ultrasound-assessed measures of atherosclerosis in men with varying degrees of obesity.
A random selection of subjects from the general population were divided into quintiles of a body mass index/blood glucose score that was shown to be a valid and reproducible index of the degree of insulin sensitivity as assessed by the clamp technique. Every fourth man in quintiles 1 and 5 and every 20th man in quintiles 2-4 (in total, 104 men) were selected for an ultrasound examination of the carotid and femoral arteries and a euglycaemic hyperinsulinaemic clamp examination, adjusted for fat-free mass.
A university hospital.
A total of 104 clinically healthy 58-year-old men of Swedish ancestry.
The mean common carotid artery intima-media thickness (IMT), but not the common femoral IMT, correlated significantly with glucose infusion rate (GIR) (r = - 0.20, P
BACKGROUND AND PURPOSE: Knowledge of the reproducibility of a diagnostic method is important in order to evaluate its usefulness. Few studies have examined interobserver and intermethod agreement on ultrasound measurements of carotid stenosis. METHODS: Intersonographer agreement on ultrasound measurements of carotid plaque morphology and the estimated degree of stenosis by three ultrasound methods were assessed in a random sample of 51 participants with stenotic carotid arteries selected from a population health survey. The degree of stenosis was assessed by measurements of velocity, lumen diameter reduction and cross-sectional lumen area. Intermethod agreement on the degree of carotid stenosis was also assessed. RESULTS: Agreement on plaque echogenicity and heterogeneity was moderate (kappa = 0.56 and kappa = 0.60, respectively). The mean degree of stenosis and median absolute difference between observers of the estimated degree of stenosis by the velocity method were 46.3 and 10.8%, respectively. The corresponding values were 51.0 and 5.8% for the diameter method, and 57.1 and 7.2%, for the cross-sectional lumen method. The limits of agreement for intersonographer reproducibility varied between +/-19.7 and 26.5%. For all methods, reproducibility increased with increasing degree of stenosis. Differences between the methods were large in low-grade stenosis but were acceptable in high-grade stenosis. CONCLUSIONS: Considerable differences in ultrasound measurement of stenosis, which could lead to different clinical conclusions, were regularly encountered no matter what ultrasound method was used.
A reduced glomerular filtration rate (GFR) in chronic kidney disease is a risk factor for cardiovascular disease. However, evidence indicates that a high GFR may also be a cardiovascular risk factor. This issue remains unresolved due to a lack of longitudinal studies of manifest cardiovascular disease with precise GFR measurements. Here, we performed a cross-sectional study of the relationship between high GFR measured as iohexol clearance and subclinical cardiovascular disease in the Renal Iohexol Clearance Survey in Tromsø 6 (RENIS-T6), a representative sample of the middle-aged general population. A total of 1521 persons without cardiovascular disease, chronic kidney disease, diabetes, or micro- or macroalbuminuria were examined with carotid ultrasonography and electrocardiography. The GFR in the highest quartile was associated with an increased odds ratio of having total carotid plaque area greater than the median of non-zero values (odds ratio 1.56, 95% confidence interval 1.02-2.39) or electrocardiographic signs of left ventricular hypertrophy (odds ratio 1.62, 95% confidence interval 1.10-2.38) compared to the lowest quartile. The analyses were adjusted for cardiovascular risk factors, urinary albumin excretion, and fasting serum glucose. Thus, high GFR is associated with carotid atherosclerosis and left ventricular hypertrophy and should be investigated as a possible risk factor for manifest cardiovascular disease in longitudinal studies.
The variation of ultrasound examination of the carotid arteries performed at two different hospitals was examined by retrospective analysis. Eighty-one patients were primarily examined by ultrasound at their local hospital on the suspicion of carotid stenosis. Following referral, they underwent a further scanning at the Dept. of Vascular Surgery, Rigshospitalet. Results for 143 carotid arteries were available for comparison. The overall agreement between the two examinations was only 59%. In nine of 40 (22%) cases an originally diagnosed minor stenosis was found to be significant and 3/19 (16%) with shown occlusion were found to be patent at the later examination. In order to draw clinical conclusions validation of each individual laboratory performing ultrasound examination of extracranial cervical arteries is necessary.
