Recent Advances in Primary and Secondary Prevention of Atherosclerotic Stroke

Georgios Tsivgoulis,Apostolos Safouris,김동억,Andrei V. Alexandrov 대한뇌졸중학회 2018 Journal of stroke Vol.20 No.2

Atherosclerosis is a major cause of ischemic stroke that can be effectively prevented with appropriate lifestyle modifications and control of cardiovascular risk factors. Medical advances in recent years along with aggressive cardiovascular risk factor modifications have resulted in decreased recurrence rates of atherosclerotic stroke. Non-statin lipid-lowering molecules have recently shown clinical benefit and are recommended for very high-risk patients to reduce their risk of stroke. Aggressive hypertension treatment is crucial to reduce atherosclerotic stroke risk. Advances in antithrombotic treatments include combinations of antiplatelets and new antiplatelet agents in the acute phase post-stroke, which carries a high risk of recurrence. Intensive medical treatment has also limited the indications for carotid interventions, especially for asymptomatic disease. Intracranial atherosclerotic disease may provoke stroke through various mechanisms; it is increasingly recognized as a cause of ischemic stroke with advanced imaging and is best managed with lifestyle modifications and medical therapy. The diagnostic search for the vulnerable culprit atherosclerotic plaque is an area of intense research, from the level of the intracranial arteries to that of the aortic arch. Ultrasonography and novel magnetic resonance imaging techniques (high-resolution vessel-wall imaging) may assist in the identification of vulnerable atherosclerotic plaques as the underlying cause in cryptogenic or misdiagnosed non-atherosclerotic ischemic stroke. Vertebrobasilar atherosclerotic disease is less common than carotid artery disease; thus, high-quality data on effective prevention strategies are scarcer. However, aggressive medical treatment is also the gold standard to reduce cerebrovascular disease located in posterior circulation.

A new atherosclerotic lesion probe based on hydrophobically modified chitosan nanoparticles functionalized by the atherosclerotic plaque targeted peptides

Park, K.,Hong, H.Y.,Moon, H.J.,Lee, B.H.,Kim, I.S.,Kwon, I.C.,Rhee, K. Elsevier Science Publishers 2008 Journal of controlled release Vol.128 No.3

We developed a new imaging probe for atherosclerotic lesion imaging by chemically conjugating an atherosclerotic plaque-homing peptide (termed the AP peptide) to hydrophobically modified glycol chitosan (HGC) nanoparticles. The AP peptide was previously discovered by using an in vivo phage display screening method. HGC nanoparticles were labeled with the near-infrared (NIR) fluorophore Cy5.5, yielding nanoparticles 314 nm in diameter. The binding characteristics of nanoparticles to cytokine (TNF-α)-activated bovine aortic endothelial cells (BAECs) were studied in vitro under static conditions and in a dynamic flow environment. AP-tagged HGC-Cy5.5 nanoparticles (100 @?g/ml, 2 h incubation) bound more avidly to TNF-α-activated BAECs than to unactivated BAECs. Nanoparticles were mostly located in the membranes of BAECs, although some were taken up by the cells and were visible in the cytoplasm, suggesting that the AP peptides in HGC nanoparticles retained target selectivity for activated BAECs. Binding selectivity of AP-tagged HGC-Cy5.5 nanoparticles was also studied in vivo. NIR fluorescence imaging demonstrated that AP-tagged HGC-Cy5.5 nanoparticles bound better to atherosclerotic lesions in a low-density lipoprotein receptor-deficient (Ldlr<SUP>-/-</SUP>) atherosclerotic mouse than to such lesions in a normal mouse. These results suggest that the newly designed AP-tagged HGC-Cy5.5 nanoparticles may be useful for atherosclerotic lesion imaging, and may also be employed to elucidate pathophysiological changes, at the molecular level, on atherosclerotic endothelium.

The Correlation of Pulse Wave Velocity and Atherosclerotic Risk Factor in Stroke Patients

( Bok Hee Jin ),( Min Ho Han ) 대한임상검사과학회 2015 대한임상검사과학회지(KJCLS) Vol.47 No.1

Pulse wave velocity (PWV) is used to non-invasively estimate the severity of arteriosclerosis by measuring arterial stiffness. Increased arterial stiffness measured by PWV stands for progressive arteriosclerosis and is caused by atherosclerotic risk factors. This study is focused on how brachial-ankle pulse wave velocity (baPWV) is related to the leading risk factors for arteriosclerosis or atherosclerosis. Subjects were 114, 69 males and 45 females who are in 60``s and had baPWV test for acute stroke. The results are as follows: the group with increased arterial stiffness showed significant increase in HbA1c, total cholesterol, BSBP (brachial artery systolic blood pressure), BDBP (brachial artery diastolic blood pressure), CSBP (central artery systolic blood pressure), CDBP (central artery diastolic blood pressure), augmentation index (AIx) and diabetes mellitus. Correlation analysis between baPWV and atherosclerotic risk factor showed significant relationship in age, HbA1c, LDL cholesterol, BSBP, BDBP, CSBP, CDBP and augmentation index. baPWV was independently related to age and BSBP in multiple linear regression analysis. The group with increased arterial stiffness was independently related to BDBP in multiple logistic regression analysis. This study might be meaningful in evaluating the relationship between arterial stiffness and atherosclerotic risk factor in a new way, and be helped to make various studies for cardiovascular disease.

심근 경색증 환자의 죽상경화증 위험요인별 질병관련 지식과 건강행위 이행

정혜선 성인간호학회 2001 성인간호학회지 Vol.13 No.4

Purpose: This study purposed to examine the disease-related knowledge level and compliance with mood health behavior in patients with myocardial infarction according to the atherosclerotic risk factors . Method: The subjects consisted of 72 patients with myocardial infarction and the data were collected by interviewing the subjects with questionnaires and reviewing their medical records from September. 15. 1999 to July 31, 2000. Data were analyzed using the SAS program. Results: 1) With regard to atherosclerotic risk factors: of the subjects, 91.7% lacked regular exercise, followed by smoking (61.1%). 2) The average knowledge score of the patients was 19.7 and the average compliance score was 53.9. 3) There were no significant differences in the total knowledge scores according to the patients' atherosclerotic risk factors. 4) Non-diabetics were significantly higher in knowledge scores on domain of risk factors than the diabetics. 5) The overweight patients were significantly higher in knowledge score on domain of nature of disease than the normal-weight patients. 6) The total compliance stores of the non-smokers were significantly higher than those of the smokers. 7) The total compliance scores of the patients who do regular exercise were significantly higher than those of the patients who forgo regular exercise. 8) The non-smokers were significantly higher in compliance scores on domain of diet than the smokers. 9) The diabetic patients were significantly higher in compliance scores on domain of smoking cessation than the non-diabetics. 10) Patients who do regular exercise were significantly higher in compliance scores on other domains than the patients who forgo regular exercise. Conclusion : According to the above findings, it can be concluded that intensive nursing care and education should be provided to patients who have atherosclerotic risk factors such as smoking. hypertension, diabetes mellitus, lack of exercise, over weight, or hypercholesterolemia to increase disease related knowledge level and to improve compliance with good health behavior.

Previous Statin Use and High-Resolution Magnetic Resonance Imaging Characteristics of Intracranial Atherosclerotic Plaque : The Intensive Statin Treatment in Acute Ischemic Stroke Patients With Intracranial Atherosclerosis Study

Chung, Jong-Won,Hwang, Jaechun,Lee, Mi Ji,Cha, Jihoon,Bang, Oh Young American Heart Association, Inc. 2016 Stroke Vol.47 No.7

<P>Background and Purpose-Although statin use has been linked to the stabilization of systemic atherosclerosis, its effect on symptomatic intracranial atherosclerotic plaques has yet to be explored. We hypothesized that premorbid statin use is associated with plaque instability in intracranial arteries and may lead to differential patterns (size and distribution) of ischemic lesions in patients with acute intracranial atherosclerotic stroke. Methods-One hundred and thirty-six patients with acute infarcts caused by intracranial atherosclerotic stroke underwent high-resolution magnetic resonance imaging. Patients were categorized into 3 groups based on their premorbid statin use: nonuser, low-dose user, and high-dose user, according to the 2013 American College of Cardiology/American Heart Association guidelines on blood cholesterol. Symptomatic lesions in intracranial arteries were analyzed using high-resolution magnetic resonance imaging for vascular morphology (degree of stenosis, remodeling index, and wall index) and plaque activation (pattern and volume of enhancement). The cortical distribution and volume of ischemic brain lesions were measured using diffusion-weighted imaging. Results-Among the enrolled patients, 38 (27.94%) were taking statins before the index stroke (22 low-dose statins and 16 high-dose statins). The degree of stenosis, remodeling index, and wall index did not differ between the 3 groups. However, the volume of plaque enhancement was significantly lower in statin users (nonuser, 33.26 +/- 40.72; low-dose user, 13.15 +/- 17.53; high-dose user, 3.13 +/- 5.26; P=0.002). Premorbid statin use was associated with a higher prevalence of nonembolic stroke and a decrease in large cortical infarcts (P=0.012). Conclusions-Premorbid statin usage is independently associated with reduced plaque enhancement and a decrease in large cortical lesions in patients with intracranial atherosclerotic stroke.</P>

사회경제적 요인에 따른 심혈관계 질환 발생 위험도 분석: 제7기1차년도 국민건강영양조사 자료(2016년)

변정호,이혜준,정한얼,최준호,최영은,조경희 대한가정의학회 2019 Korean Journal of Family Practice Vol.9 No.2

Background: The purpose of this study was to analyze the socioeconomic factors that affect atherosclerotic cardiovascular disease risk. Methods: We used data from 3,704 individuals between 40 and 79 years of age, who participated in the Korean National Health Examination and Nutrition Survey in 2016. Socioeconomic groups were categorized by income and education level. We analyzed the odds ratios and 95% confidence intervals (CIs) from logistic regression for the atherosclerotic cardiovascular disease risk in each group. Results: Using logistic regression analysis, the odds ratios and 95% CIs of atherosclerotic cardiovascular disease risk based on high, middle, and low socioeconomic factors were 1.0, 1.597 (95% CI, 1.279–1.993), and 5.689 (95% CI, 4.030–8.032), respectively. The results after adjusting for covariates (age, gender, obesity, alcohol consumption) also showed statistical significance. Conclusion: We conclude that socioeconomic factors such as income and education level are correlated with increased atherosclerotic cardiovascular disease risk. 연구배경:본연구는국민건강영양조사제7기 1차년도(2016년) 자료를 이용하여 사회경제적 요인에 따른 심혈관계 질환 발생 위험도를분석하였다. 방법:국민건강영양조사 제7기 1차년도(2016년) 자료를 이용하여 사회경제적 요인에 따른 범주형 변수의 빈도와 가중 백분율을 제시하고 Rao-Scott 보정을 적용한 카이제곱 검정(chi-square test)을 실시하였으며, 연속형 변수의 평균과 표준오차를 제시하고 분산분석(ANOVA)을 실시하였다. 사회경제적 요인과 심혈관계 질환 발생 위험도의 연관성을 확인하기 위해 로지스틱 회귀분석(logistic regression)을 실시하고, 상대 위험도로서 오즈비(OR) 및 95% 신뢰구간을산출하였다. 결과: 사회경제적 요인이 낮은 군에서 심혈관계 질환 발생 위험도는높은 군에 비해 유의하게 높았으며 나이, 성별, 비만, 음주를 보정한분석에서도 유의하게 높았음을 알 수 있었다. 사회경제적 요인이 낮은 군에서 심혈관계 질환 발생 위험인자 중 당뇨병 유병률, 고혈압 유병률, 흡연율이 유의하게 높았음을 알 수 있었다. 결론: 심혈관계 질환 발생 위험도에 영향을 주는 여러 요인 중 사회경제적 요인도 유의하게 있음을 확인하였다. 이에 개인의 사회경제적 요인이 개인의 건강 격차로 이어지지 않게 진료하는 임상 분야에서도 개인별로 알맞게 건강 습관 격려 및 건강 지식을 제공하며 맞춤형 진료가 필요하며 의료분야에서 사회경제적 요인에 의해 발생하는 건강 불평등을 해소하는 의료 정책 수립이 필요하다.

Gadolinium-Enhanced Magnetic Resonance Imaging of Atherosclerotic Plaques in Comparison with Histopathology: An In Vivo Study in Aorta of Rabbits

최병욱,허진,김영진,김태훈,최규옥,이혜정 대한자기공명의과학회 2009 Investigative Magnetic Resonance Imaging Vol.13 No.1

Purpose : We sought to evaluate enhancement of plaque with gadolinium-based contrast agent by magnetic resonance imaging (MRI) in comparison with histopathology, namely lipid-rich and macrophage-rich components that were two representative characteristics of plaque vulnerability using atherosclerotic rabbit aorta in order to determine which histopathologic component is relevant to the enhancement. Materials and Methods : New Zealand white rabbit (n=4, weight 3.0 to 3.5 kg, all male) was used for animal model of atherosclerosis. Atherosclerotic aortic lesions were induced by high-cholesterol diet and double balloon injury. T1-weight axial images were acquired before and after gadolinium-based contrast agent using a 3-T MRI. MR images and the matched histopathological sections (n=35) were divided into 4 quadrants or 3 (n=130). Enhancement ratio (ER, ER=SIpost/SIpre) on MRI was calculated for each quadrant and compared with histopathology in regard to lipid-rich and macrophage-rich areas. Results : Lipid-rich quadrants were 72 and fibrous quadrants were 58. The number of quadrants which had macrophage-rich areas was 105 and that of quadrants which did not have macrophage-rich areas was 25. ER was significantly higher in lipid-rich quadrants than in fibrous quadrants (mean ER 2.25±0.41 vs. 2.72±0.65, p=0.013). ER poorly correlated with macrophage-rich areas when lipid-component was controlled (correlation coefficient -0.203, p=0.236). Conclusion : Lipid-rich plaques showed stronger enhancement than fibrous plaques using a standard gadolinium-based extracellular contrast agent. Macrophage infiltration did not correlate with degree of enhancement. Further study is warranted that account for optimal time of imaging after contrast injection using various plaque models from early to advanced stages and all possible parameters associated with contrast enhancement.

Plasma phospholipid fatty acid composition in ischemic stroke: Importance of docosahexaenoic acid in the risk for intracranial atherosclerotic stenosis

Kim, Y.J.,Kim, O.Y.,Cho, Y.,Chung, J.H.,Jung, Y.S.,Hwang, G.S.,Shin, M.J. Elsevier Scientific Publ. Co 2012 Atherosclerosis Vol.225 No.2

Objective: While data on the relationship between fatty acid (FA) composition and the risk for total stroke have accumulated, the association between FA composition and the risk for intracranial atherosclerotic stenosis (ICAS) has never been studied. We compared plasma phospholipid FA composition between non-stroke control and ischemic stroke in Korean population, to discern the FA that distinguishes ICAS from total ischemic stroke patients. Methods: Non-stroke controls (n = 215) and stroke patients (no cerebral atherosclerotic stenosis, NCAS: n = 144 and ICAS: n = 104) were finally included in the analysis. Plasma phospholipid FA compositions were analyzed. Results: Age, coexistence of hypertension/diabetes were significantly different among the groups. Phospholipid FA compositions were significantly different between non-stroke control and ischemic stroke patients, and interestingly, between NCAS and ICAS in stroke patients. Pattern analysis showed that docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), the ω3-polyunsaturated FAs were important FAs in distinguishing NCAS and ICAS in strokes. Particularly, the risk of ICAS was inversely associated with levels of DHA contents in phospholipids (OR: 0.590, 95% CI: 0.350-0.993, p < 0.05), indicating that the risk may be increased at lower levels of DHA contents. Conclusion: DHA and EPA are important FAs for distinguishing NCAS and ICAS in strokes. Additionally, the risk of ICAS was inversely associated with the levels of phospholipid DHA, which indicates that sufficient amounts of DHA in plasma or in diet may reduce the risk of ICAS.

만성 신부전 환자에서 고호모시스틴혈증에 관한 연구

박미정(Mi Jung Park),이균상(Kyun Sang Lee),조민석(Min Seok Cho),김정기(Jeong Ki Kim),박병석(Byoung Seok Park),마성권(Seong Kwon Ma),고정희(Jung Hee Ko),나명윤(Myong Yun Nah),염충호(chung Ho Yeum),김수완(Soo Wan Kim),김남호(Nam Ho Kim 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.4

Objective : It has been reported that hyperhomocysteinemia is an independent risk factor for atherosclerotic complications, although the mechanisms re- main unclear. The major determinents of total fasting plasma homocysteine(tHcy) concentrations have been recently reported but there are still conflicting data on the influence of those in peritoneal and hemodialysis patients. Therefore, we evaluated the prevalence and association of vascular complications and the determinents of hyperhomocysteinemia in chronic renal failure patients receiving conservative treatment(predialysis), peritoneal dialysis(PD) and hemodia-lysis (HD) patients. Methods We measured the factors, including fasting plasma vitamine levels(folate, vitamin E4 and vitamin B12), serum creatinine concentration, dialysis adequacy-related varibles as well as associated risk factors for vascular diseases that might affect tHcy concentrations in 37 predilysis, 30 PD, 34 HD patients and 21 normal persons. Continuous variables were compared using independent sample t-test. Spearman's correlation was used to determine the strength of association between tHcy and other predictive varia41es. Percentages were compared using Pearson's chi-square test or Fisher's exact test, depending on the frequencies. Independent determinents of tHcy concentration and atherosclerotic vascular complications were identified using multiple regression analysis. Results : The prevalence of hyperhomocysteinemia was 83.8, 72, 88% among predialysis, PD and HD patients, respectively(Odds ratio was 103.33, 81.43, 150.0 vs. controls, respectively). tHcy values in pre- dialysis, PD and HD patients are significantly higher than those in controls(24.68±9.01, 21.04±8.82, 23.62± 9.46 vs. 8.80±2.07 ㎛oL/L, repectively, p<0.01). Pre- dialysis, PD and HD patients with atherosclerotic vascular complications had higher tHcy concentrations than did predialysis, PD and HD patients with- out vascular complications(21.93±8.71 vs. 32.09±4.71 ㎛oL/L, p<0.01, 17.57±5.85 vs. 28.74±9.70 ㎛oL/L, p<0.01, 19.00±4.29 vs. 33.28±10.13, p<0.01 respectively). We also observed increasing odds ratios of vascular events with increasing tHcy concentrations. For predialysis, PD and HD patients, fasting plasma folate level had negative correlation with tHcy concentrations by spearman's simple correlaltion. And using muliple regression analysis, we recognized hyperhomocysteinemia is an independent risk factor for atherosclerosis and fasting plasma folate is a major determinent of tHcy concentrations in predialysis, PD and HD patients. Conclusions: Hyperhomocysteinemia in predialysis, PD and HD patients was more prevalent than that in norrnal controls. Risk of atherosclerotic vascular complications increased with increasing tHcy concentrations. Hyperhomocysteinemia is an independent risk factor for atherosclerosis and fasting plasma folate is a major determinent of tHcy concentrations in predialysis, PD and HD patients.

Penetrating Atherosclerotic Ulcers of the Abdominal Aorta: A Case Report and Review of the Literature

Thomas Kotsis,Basileios Georgiou Spyropoulos,Nikolaos Asaloumidis,Panagitsa Christoforou,Konstantina Katseni,Ioannis Papaconstantinou 대한혈관외과학회 2019 Vascular Specialist International Vol.35 No.3

Penetrating atherosclerotic ulcers (PAUs) of the aorta are defined as atherosclerotic lesions with aortic intima and media ulceration, which may lead to a complete rupture of the adventitial wall. The present article aimed to report an unusual case of a surgically treated patient with abdominal aorta PAU with an illustration of the key features and to review and analyze the existing literature data. PAUs typically develop in elderly and hypertensive patients and in patients with advanced atherosclerosis. Although originally described for the descending thoracic aorta, a similar clinicopathological entity also occurs in the abdominal aorta. Patients with symptoms of a PAU should be treated immediately if they are fit for surgery. Exceptive observation by imaging modalities is necessary in patients with asymptomatic small (<2 cm) PAU, with or without focal dissection.