The association between cerebral atherosclerosis and arterial stiffness in acute ischemic stroke

Kim, J.,Cha, M.J.,Lee, D.H.,Lee, H.S.,Nam, C.M.,Nam, H.S.,Kim, Y.D.,Heo, J.H. Elsevier Scientific Publ. Co 2011 Atherosclerosis Vol.219 No.2

Objective: Arterial stiffness is associated with cardiovascular risk factors and atherosclerosis. Measurement of pulse wave velocity (PWV) is one of the most representative and noninvasive techniques for assessing arterial stiffness. We investigated the association of cerebral atherosclerosis with brachial-ankle PWV (baPWV) in acute ischemic stroke patients. If present, we sought to determine whether the relationship differed between atherosclerosis in the intracranial artery and atherosclerosis in the extracranial artery. Methods: We included 801 patients with acute ischemic stroke who had undergone angiographic study and baPWV measurement between January 2007 and May 2010. Patients with cerebral artery atherosclerosis were categorized into those with intracranial atherosclerosis, those with extracranial atherosclerosis and those with both intracranial and extracranial atherosclerosis. We determined factors that were associated with baPWV. Results: Univariate and multivariate analyses showed that high baPWV was significantly associated with older age, lower body mass index, higher brachial systolic pressure, and diabetes mellitus. Increased baPWV was associated with the presence of atherosclerosis (≥50% stenosis) in the intracranial cerebral artery as well as in both the intracranial and extracranial arteries, but not with atherosclerosis in the extracranial cerebral artery. The burden of intracranial cerebral atherosclerosis, which was assessed based on the number of arteries with atherosclerosis, was also closely associated with baPWV. Conclusion: Arterial stiffness was associated with the presence and burden of intracranial cerebral atherosclerosis in stroke patients, but was not associated with the extracranial cerebral atherosclerosis. These findings suggest a potential pathophysiological association between increased arterial stiffness and intracranial cerebral atherosclerosis.

노인에서 대동맥경화증의 지표로써의 경동맥경화증

신영우,전국진 대한노인병학회 2001 Annals of geriatric medicine and research Vol.5 No.1

Plasma osteoprotegerin levels increase with the severity of cerebral artery atherosclerosis

Kim, Jinkwon,Song, Tae-Jin,Yang, Seung-Hee,Lee, Ok-Hee,Nam, Hyo Suk,Kim, Young Dae,Kim, Eun Hee,Lee, Hye Sun,Nam, Chung Mo,Heo, Ji Hoe Elsevier 2013 Clinical biochemistry Vol.46 No.12

<P><B>Abstract</B></P> <P><B>Objectives</B></P> <P>Osteoprotegerin (OPG) is a member of the tumor necrosis factor receptor superfamily and suggested as a marker of atherosclerosis. We investigated whether plasma OPG levels were associated with the presence and severity of cerebral atherosclerosis.</P> <P><B>Design and methods</B></P> <P>We used an enzyme-linked immunosorbent assay to measure the plasma OPG levels of 107 patients with acute cerebral infarction. We compared the plasma OPG levels according to the presence and number of arteries with cerebral atherosclerosis (≥50% stenosis).</P> <P><B>Results</B></P> <P>Of 107 patients, 73 (68.2%) had cerebral atherosclerosis. OPG levels were increased in patients with cerebral atherosclerosis (374.69±206.48 vs 261.17±166.91pg/mL, p=0.006). OPG levels showed positive correlation with the number of cerebral arteries with atherosclerosis (Spearman's <I>rho</I> =0.342, p<0.001). After adjustment for vascular risk factors, OPG>229.9pg/mL was independently associated with the presence [OR 4.61, 95% CI 1.57–13.55, p=0.005, binary logistic regression] of cerebral atherosclerosis and number [OR 3.20, 95% CI 1.26–8.12, p=0.014, ordinal logistic regression] of arteries with cerebral atherosclerosis.</P> <P><B>Conclusions</B></P> <P>Plasma OPG levels were significantly associated with the presence and severity of cerebral atherosclerosis. This finding suggests that plasma OPG might have a role in cerebral atherosclerosis.</P> <P><B>Highlights</B></P> <P> <UL> <LI> Elevated OPG levels have been reported in patients with atherosclerotic diseases. </LI> <LI> The relationship between OPG and cerebral atherosclerosis is not well known. </LI> <LI> OPG levels were associated with presence and severity of cerebral atherosclerosis. </LI> </UL> </P>

Transesophageal Echocardiographic Evaluation of Atherosclerosis

Masami Nishino,Jun Tanouchi 대한심장학회 2008 Korean Circulation Journal Vol.38 No.11

Transesophageal echocardiography (TEE) is a promising method for evaluating thoracic aortic atherosclerosis and coronary atherosclerosis. The highest impact of TEE as a clinical tool is in searching for cardiac embolic sources in patients with stroke and atrial fibrillation and in conducting detailed evaluations in patients with valvular disease, especially those with mitral valvular disease. However, it is also clinically useful in the evaluation of thoracic aortic atherosclerosis and coronary atherosclerosis. TEE is capable of evaluating thoracic aortic atherosis (intima- media complex thickness) and sclerosis (stiffness parameter β) simultaneously. In addition, TEE can evaluate coronary atherosclerosis by non-invasively revealing narrowing or occlusion of the coronary arteries and providing information about coronary flow reserve. TEE imaging has improved with the advent of harmonic imaging, multiplane probes, contrast agents, and three-dimensional TEE. Future technology, including integrated backscatter (IBS), tissue Doppler, and strain imaging, will lead to further improvements in TEE. Thoracic aortic atherosclerosis and coronary atherosclerosis assessment should be performed in any patient undergoing TEE Transesophageal echocardiography (TEE) is a promising method for evaluating thoracic aortic atherosclerosis and coronary atherosclerosis. The highest impact of TEE as a clinical tool is in searching for cardiac embolic sources in patients with stroke and atrial fibrillation and in conducting detailed evaluations in patients with valvular disease, especially those with mitral valvular disease. However, it is also clinically useful in the evaluation of thoracic aortic atherosclerosis and coronary atherosclerosis. TEE is capable of evaluating thoracic aortic atherosis (intima- media complex thickness) and sclerosis (stiffness parameter β) simultaneously. In addition, TEE can evaluate coronary atherosclerosis by non-invasively revealing narrowing or occlusion of the coronary arteries and providing information about coronary flow reserve. TEE imaging has improved with the advent of harmonic imaging, multiplane probes, contrast agents, and three-dimensional TEE. Future technology, including integrated backscatter (IBS), tissue Doppler, and strain imaging, will lead to further improvements in TEE. Thoracic aortic atherosclerosis and coronary atherosclerosis assessment should be performed in any patient undergoing TEE

Biomarkers and location of atherosclerosis: Matrix metalloproteinase-2 may be related to intracranial atherosclerosis

Jeon, S.B.,Chun, S.,Choi-Kwon, S.,Chi, H.S.,Nah, H.W.,Kwon, S.U.,Kim, W.K.,Kim, J.S. Elsevier Scientific Publ. Co 2012 Atherosclerosis Vol.223 No.2

Background: Various biomarkers are linked with the pathophysiology of atherosclerosis. We hypothesized that these factors may be associated with the location and burden of cerebral atherosclerosis. Methods: We evaluated 177 consecutive patients with chronic (>6 months) ischemic stroke: 68 with small vessel occlusion (SVO) and 109 with large-artery atherosclerosis (LAA), with the latter further sub-classified into 80 patients with intracranial atherosclerosis (ICAS) and 29 with extracranial atherosclerosis (ECAS). The number of ≥50% steno-occlusions on magnetic resonance angiography was used to assess the burden of atherosclerosis. Serum concentrations of the biomarkers (matrix metalloproteinases (MMP)-2 and -9, homocysteine, interleukin (IL)-6, tumor necrosis factor-α, C-reactive protein, adiponectin, leptin, resistin, free fatty acid, and lipoprotein(a)) and the metabolic syndrome were measured in each study subject. Results: Decreased plasma concentrations of MMP-2 (p = 0.020) and homocysteine (p = 0.038) were more closely associated with ICAS than with ECAS, whereas increased IL-6 concentrations were related to severe (≥4 steno-occlusions) atherosclerosis (p = 0.031). Multiple logistic regression analysis showed that the lowest tertile of MMP-2 was independently associated with ICAS (OR 4.84, 95% CI 1.29-18.19, p = 0.022). Conclusion: Low MMP-2 plasma levels are associated with intracranial location of cerebral atherosclerosis, suggesting that MMP-2 may play a role in the development of ICAS.

비침습적 지표들을 이용한 관상동맥 중증도 평가

윤세희 ( Se Hee Yoon ),배장호 ( Jang Ho Bae ),김기영 ( Ki Young Kim ),현대우 ( Dae Woo Hyun ),김완호 ( Wan Ho Kim ),구훈섭 ( Hoon Sup Koo ) 대한내과학회 2005 대한내과학회지 Vol.69 No.5

목적 : 관상동맥 경화증이 있는 환자군에서 관상동맥 경화의 정도와 비침습적 동맥 경화 지표와의 사이에 상관관계가 있는지 알아보고, 이들 지표들간의 상관관계가 있는지 알아보고자 이 연구를 시행하였다. 방법 : 관상동맥 조영술상 병변이 확인되고 비침습적 동맥경화 지표(경동맥 내중막 두께, 동맥 경직도, 내피세포 기능)를 동시에 시행한 연속적인 275명의 환자(평균 연령; 60세, 남자; 140명)를 대상으로 하였다. 관상동맥 경화의 정도는 50% 이상의 협착이 있는 주요 관상동맥 수에 따라 0, 1, 2, 3으로 분류하여 동맥 경화지표에 따른 상관관계를 비교하였다. 관상동맥의 협착이 10% 이상 50% 미만인 경우를 0으로 하였다. 경동맥 내중막 두께는 고해상도 초음파와 MATH software를 이용하여 반자동으로 측정하였고, 내피세포 기능은 상완 동맥 혈류의존 확장능(FMD, %)을 구하여 측정하였고, 동맥 경직도는 맥파속도를 대동맥, 하지 동맥, 상지 동맥에서 각각 측정하여 분석했다. 결과 : 경동맥 내중막 두께는 0군(n=125), 1군(n=75), 2군(n=38), 3군(n=21)에서 각각 0.85±0.16㎜, 0.88±0.15㎜, 0.91±0.19㎜, 0.98±0.18㎜로 관상동맥 경화의 정도에 따라 유의하게(r=0.211, p=0.001) 증가되는 경향을 보였다. 동맥 경직도와 내피세포 기능은 관상동맥 경화 정도에 따른 유의한 변화가 관찰되지 않았다. 경동맥 내중막 두께는 이들 지표들 중 대동맥의 경직도와만 서로 유의한 상관관계를 보였고(r=0.179, p=0.004), 대동맥 경직도는 하지와 상지의 동맥 경직도와 유의한 상관관계를 보였으나 다른 지표들과는 상관관계가 없었다. 내피 세포 기능과 상관관계는 이들 지표들 중에는 관찰되지 않았다. 결론 : 관상동맥 경화가 있는 환자군에서 관상동맥 경화의 정도와 상관이 있는 비침습적 지표로는 경동맥 내중막 두께였으나 독립적 인자는 아니었고, 이들 환자군에서 경동맥 내중막 두께는 대동맥 경직도와 유의한 상관관계가 관찰되었다. Background : We performed this study to evaluate the association between the extent of coronary atherosclerosis and the noninvasive atherosclerosis surrogates such as carotid intima-media thickness (IMT), endothelial function, and arterial stiffness in patients with coronary atherosclerosis. Methods : The study population was consisted of 275 consecutive patients (mean age; 60 yrs, 140 males), who had coronary atherosclerosis by coronary angiography. The extent of coronary atherosclerosis was classified to 0 (n=125), 1 (n=75), 2 (n=38), 3 (n=21) according to the vessel number narrowed by more than 50%. Carotid IMT was semi-automatically measured using MATH software and high-resolution ultrasound. Endothelial function was measured by flow-mediated brachial artery dilation (FMD, %). Arterial stiffness was measured by obtaining pulse wave velocity in the aorta, upper and lower extremities. Results : Carotid IMT was significantly (r=0.211, p=0.001) increased according to the extent of coronary atherosclerosis (0.85±0.16㎜, 0.88±0.15㎜, 0.91±0.19㎜, 0.98±0.18㎜, respectively). However, there was no significant association between the other surrogates and the extent of coronary atherosclerosis. Carotid IMT also showed the significant association with the aortic stiffness (r=0.179, p=0.004). There was not any more significant association among the other surrogates in this study. Conclusions : The extent of coronary atherosclerosis is associated with carotid IMT but not independently, only out of several noninvasive atherosclerosis surrogates in patients with coronary atherosclerosis. And carotid IMT is also associated with the aortic stiffness in this study population. (Korean J Med 69:493-502, 2005)

Plasma total homocysteine and the methylenetetrahydrofolate reductase 677C>T polymorphism do not contribute to the distribution of cervico‐cerebral atherosclerosis in ischaemic stroke patients

Oh, S‐,H.,Kim, N‐,K.,Kim, H‐,S.,Kim, W‐,C.,Kim, O‐,J. Blackwell Publishing Ltd 2011 European Journal of Neurology Vol.18 No.3

<P><B>Objective: </B> To evaluate the effects of plasma total homocysteine (tHcyt) and the MTHFR 677C>T polymorphism on determining the intracranial‐ (IC) and extracranial (EC) locations of atherosclerosis.</P><P><B>Methods: </B> Brain MR angiography was performed on 463 patients with symptomatic ischaemic stroke to detect significant atherosclerosis (more than 50% stenosis of vessel diameter) in the IC‐ and EC arteries. Relationships between IC‐ or EC atherosclerosis and plasma tHcyt level and/or MTHFR 677C>T genotypes were analyzed after adjusting for vascular risk factors.</P><P><B>Results: </B> The odd ratios (ORs) of plasma tHcyt were not significantly higher in patients with either IC‐ or EC atherosclerosis than in patients with no atherosclerosis. When the study subjects were stratified into three subgroups according to their plasma tHcyt levels, neither the crude ORs nor adjusted ORs of each IC‐ and EC atherosclerosis in highest and middle plasma tHcyt tertile were significantly different from those in lowest plasma tHcyt tertile. The ORs of the MTHFR 677TT genotype in IC‐ and EC atherosclerosis were not significantly different from those in no atherosclerosis. There was no dose‐dependent effect of MTHFR 677T allele on either IC‐ or EC atherosclerosis.</P><P><B>Conclusion: </B> Plasma tHcyt level and the MTHFR 677C>T polymorphism do not contribute to the distribution of cervico‐cerebral atherosclerosis in ischaemic stroke patients.</P>

뇌경색증과 심근경색증 환자에서 죽상동맥경화 위험요인의 비교연구

조길우(Keal Woo Cho),박종춘(Jong Chun Park),강정채(Jung Chaee Kang) 대한내과학회 1991 대한내과학회지 Vol.41 No.4

N/A Thrombotic cerebral infarction (CI) and myocardial infarction (MI) have been considered reliable indicatiors for the presence of atherosclerosis because they are usually caused by atherosclerosis. Atherogenesis and clinical manifestation of atherosclerosis are influenced by several risk factors for atherosclerosis, which have been studied intensively and extensively. However, it is uncertain why atherosclerosis manifests clinically as a variety of disease entities different in their involved anatomic sties such as cerebrum and mycardium in cerebral infarction and myocardial infarction, respectively. This study is aimed at evaluating the relative role of each atherosclerosis risk factor on the clinical manifestation of atherosclerosis as thrombotic cerebral infarction or myocardial infarction. The risk factors for atherosclerosis were examined and compared in thrombotic cerebral infarction (n=154), myocardial infarction (n=135), and normal subjects (n=98) The risk factors showing mare singificantly high values in CI and MI than in the controls were alcohol drinking (p<0.05, p<0.001), smoking (p<0.01, p<0.001), systolic and diadstolie blood pressures(p<0.001, p<0. 001), total-cholesterol(p<0.001, p<0.01), LDL- cholesterol(p<0.01, p<0.01), and ratio of total- cholesterol to HDL-cholesterol(p<0.01, p<0.01). Mean age and triglyceride were higher only in CI than in the control(p<0.05, p<0.01). No difference was found in sex distribution and HDL-cholersterol. 2) Mean age(p < 0.05), systolic and diastolic blood C T prssures(p <0.001), ECG-LVH(p <0.001), triglyceride (p < 0.05), and the proportions of the sedentary worker and female were significantly higher in IC than MI. 3) Smokers, hard workers, and males were more frequently observed in MI than CI. 4) Discrimination accuracies of the selected risk factors such as age(over 65year), sex(male), smoking, diabetes mellitus, hypertension, ECG-LVH, high triglyceride, high LDL-cholesterol, and high total- cholesterol to HDL-cholesterol ratio were 67.6% for CI and 77.9% for MI, and 72.7% for all. 5) Multivariated logistic analysis revealed that hypertension, smoking, and ECG-LVH were the independent risk foactors having a significantly different role in CI and MI, and hypertension and ECG-LVH were more colsely related to Cl than MI (β=0.9348, 0.5698, p=0.001, 0.002, respectively) and smoking to MI than CI (p=0.5800, p=0.001). These results show that some risk factors for atherosclerosis have a different role in the clincial manifestation of atherosclerosis.

Features of atherosclerosis in hemodialysis patients

( Kyong Ah Park ),( Hye Min Jo ),( Ji Soo Han ),( Min Jin Kim ),( Do Hyung Kwun ),( Moo Yong Park ),( Soo Jeong Choi ),( Jin Kuk Kim ),( Seung Duk Hwang ) 대한신장학회 2013 Kidney Research and Clinical Practice Vol.32 No.4

Background: Cardiovascular disease is the main cause of mortality in dialysis patients. Carotid intima-media thickness (CIMT) is used as a surrogate marker of early atherosclerosis. Atherosclerosis can cause vascular access failure. The purpose of this study was to define the clinical features of atherosclerosis in hemodialysis patients based on CIMT and to define the relationship between CIMT and access failure. Methods: In this cross-sectional study, the CIMT of 60 patients on hemodialysis was examined using B-mode Doppler ultrasonography between May 2012 and November 2012. Carotid atherosclerosis was defined as a CIMTZ0.9 mm or the incidence of atherosclerotic plaques. Results: The patients` mean age was 54.5710.6 years, and 60% of the patients were male. The CIMT was 0.8170.47 mm (range, 0.35-2.50 mm). The group with atherosclerosis was characterized by older age compared with those without atherosclerosis. Patients with atherosclerosis showed much shorter durations of access patency than their counterparts in the nonatherosclerosis group (hazard ratio, 2.822; 95% confidence interval, 1.113-7.156; P¼0.029). Moreover, being overweight was associated with a 2.47-fold (95% confidence interval, 1.101-5.548) increased primary access failure. Conclusion: This study shows that atherosclerosis is associated with older age. Patients who are overweight and have atherosclerosis may have shortened access patency.

Stroke Risk After Coronary Artery Bypass Graft Surgery and Extent of Cerebral Artery Atherosclerosis

Lee, E.J.,Choi, K.H.,Ryu, J.S.,Jeon, S.B.,Lee, S.W.,Park, S.W.,Park, S.J.,Lee, J.W.,Choo, S.J.,Chung, C.H.,Jung, S.H.,Kang, D.W.,Kim, J.S.,Kwon, S.U. Elsevier Biomedical 2011 JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY - Vol.57 No.18

Objectives: We aimed to define the relationship between cerebral atherosclerosis and stroke after coronary artery bypass grafting (CABG). Background: Although cerebral atherosclerosis may play a crucial role in the advent of post-CABG stroke, only extracranial carotid artery disease has been extensively studied, and the effects of atherosclerosis on the mechanisms underlying post-CABG stroke remain unclear. Methods: Pre-operative magnetic resonance angiography was performed on 1,367 consecutive CABG patients to assess intracranial and extracranial cerebral atherosclerosis. Disease severity was evaluated by atherosclerosis score, as determined by the number of steno-occlusions of cerebral arteries and the degree thereof. Post-CABG strokes (within 14 days) were classified as atherosclerotic (strokes attributable to pre-defined atherosclerosis) or other (strokes caused by other mechanisms). Associations between post-CABG stroke and each type of atherosclerotic disease (extracranial carotid artery disease, intracranial, extracranial, or extracranial and/or intracranial cerebral atherosclerosis), differentiated according to the involved arteries, were analyzed. Results: Stroke occurred in 33 patients, and the atherosclerosis score was independently associated with stroke development (odds ratio: 1.35; 95% confidence interval: 1.16 to 1.56). Atherosclerotic stroke was defined in 15 (45%), and constituted >40% of both immediate (within 24 h) and delayed strokes. Intracranial, extracranial, and extracranial and/or intracranial cerebral atherosclerosis were significantly associated with stroke. Conclusions: Cerebral atherosclerosis was closely related to the occurrence of post-CABG stroke, being both an independent risk factor for and the cause of a significant proportion of strokes. Pre-operative evaluation of intracranial and extracranial cerebral arteries, apart from the extracranial carotid artery, may be useful to predict the likelihood of post-CABG stroke.