Ultrasound detection of increased carotid intima-media thickness and carotid plaque in an office practice setting: does it affect physician behavior or patient motivation?

Background: The aim of this multicenter study was to determine if identifying increased carotid intima-media thickness (CIMT) or carotid plaque during office-based ultrasound screening examinations could alter physicians' treatment plans and patients' motivation regarding health-related behaviors.

Methods: Carotid ultrasound studies were performed by a nonsonographer clinician using a handheld system. Changes in physicians' treatment plans and patients' motivation on the basis of scan results were analyzed using multivariate regression.

Effects of simvastatin on cerebrospinal fluid biomarkers and cognition in middle-aged adults at risk for Alzheimer's disease.

Background: Statins reduce amyloid-beta (Abeta) levels in the brain and cerebrospinal fluid (CSF) in animals and may thereby favorably alter the pathobiology of AD. It is unclear if statins modify Abeta metabolism or improve cognition in asymptomatic middle-aged adults at increased risk for AD.

Methods: In a 4-month randomized, double-blind, controlled study, we evaluated the effects of simvastatin 40 mg daily vs.

Usefulness of increased skin cholesterol to identify individuals at increased cardiovascular risk (from the Predictor of Advanced Subclinical Atherosclerosis study).

In patients with symptomatic coronary heart disease, skin cholesterol (SC) content is associated with the presence and extent of coronary artery disease; however, its relation to subclinical arterial disease in asymptomatic patients is unknown. The purpose of this study was to determine the relations between SC and carotid intima-media thickness (CIMT) in asymptomatic subjects across a wide range of cardiovascular risk. SC was measured using a noninvasive assay.

Left atrial volume is associated with inflammation and atherosclerosis in patients with kidney disease.

Background: Left atrial volume (LAV) is an independent echocardiographic predictor of cardiovascular events in the general population. We evaluated predictors of LAV in patients with advanced chronic kidney disease (CKD).

Hypothesis: Increasing LAV identifies increased cardiovascular risk in patients with CKD.

Mitral annular calcification is associated with reduced left ventricular function and inflammation in patients with chronic kidney disease.

Background: Mitral annular calcification (MAC) is prevalent in patients with chronic kidney disease (CKD); however, it is not known whether the increased cardiovascular risk observed in patients with CKD and MAC is related to atherosclerotic burden, because they share common risk factors.

Methods: Transthoracic echocardiography was performed in patients with CKD undergoing pre-kidney transplantation evaluation. Fasting lipids, high-sensitivity C-reactive protein, parathyroid hormone, calcium, and creatinine levels were measured.

Does detection of carotid plaque affect physician behavior or motivate patients?

Background: Imaging techniques to identify subclinical atherosclerosis are becoming more widespread, but few data exist regarding their influence on patient or physician behavior. We evaluated the impact of ultrasound screening to identify carotid artery plaques on physician treatment plans and patient motivation.

Methods: Subjects included asymptomatic patients without known vascular disease who had 2 or more cardiac risk factors.

Distribution and predictors of carotid intima-media thickness in young adults.

The authors' aim was to determine reference values and predictors for carotid intima-media thickness (CIMT) in the Bogalusa Heart Study. Carotid ultrasound images from 1203 young adults (mean age 36 years; 30% black, 43% male) were reviewed. Age-, sex-, and race-specific CIMT percentiles were estimated using multivariable regression.

Carotid intima-media thickness testing by non-sonographer clinicians: the office practice assessment of carotid atherosclerosis study.

Background: The purpose of this study was to determine whether a non-sonographer clinician (NSC) could obtain ultrasound images of the carotid artery, measure carotid intima-media thickness (CIMT), and identify findings indicating increased cardiovascular risk in an office setting.

Methods: Eight NSCs from five sites were trained to use a handheld ultrasound device to screen the carotid arteries for plaques and to measure CIMT.

Results: NSCs scanned 150 subjects who provided 900 images, of which 873 (97%) were interpretable.

Increases in central aortic impedance precede alterations in arterial stiffness measures in type 1 diabetes.

Objective: Increased pulse pressure has been associated with increased cardiovascular risk in individuals with diabetes. Changes in central aortic properties can increase central pulse pressure and may adversely affect microvascular perfusion and cardiac performance. This study was performed to define early changes in central arterial properties in a group of young individuals with type 1 diabetes.

An abbreviated carotid intima-media thickness scanning protocol to facilitate clinical screening for subclinical atherosclerosis.

Background: Carotid intima-media thickness (CIMT) testing can assist with cardiovascular risk prediction; however, the requirement for rigorous, time-consuming protocols has limited it use in clinical practice.

Methods: Bilateral images of the common carotid artery (CCA), bulb, and internal carotid artery segments were obtained using a comprehensive scanning protocol. Three abbreviated scanning protocols were evaluated for their ability to identify patients with increased CIMT (> or = 75th percentile).

Coronary flow velocity changes in response to hypercapnia: assessment by transthoracic Doppler echocardiography.

Background: The effects of hypercapnia on coronary arteries in human beings are not known. We used transthoracic Doppler echocardiography to evaluate coronary blood flow velocity (CFV) changes in response to hypercapnia in healthy adults.

Methods: Twenty adults underwent transthoracic Doppler echocardiography of the left anterior descending coronary artery while breathing room air, 40% fraction of inspired oxygen, and 40% fraction of inspired oxygen with carbon dioxide supplemented to end-tidal tensions of +5, +7.

Implications of cardiac risk and low-density lipoprotein cholesterol distributions in the United States for the diagnosis and treatment of dyslipidemia: data from National Health and Nutrition Examination Survey 1999 to 2002.

Background: Updated guidelines from the National Cholesterol Education Program Adult Treatment Panel III stratify patients into 5 groups of coronary heart disease (CHD) risk that determine intensity of lipid-lowering therapy. The present study assesses the distribution of low-density lipoprotein cholesterol (LDL-C) in the United States across the 5 groups of CHD risk as defined in the updated guidelines.

Methods And Results: Subjects included 7399 individuals 20 to 79 years of age in the 1999 to 2002 National Health and Nutrition Examination Survey representing 171 million individuals in the United States.

Safety and efficacy of extended-release niacin for the treatment of dyslipidaemia in patients with HIV infection: AIDS Clinical Trials Group Study A5148.

Background: Dyslipidaemia is very common in patients with HIV infection, but current therapies are often suboptimal. Since niacin may cause insulin resistance and hepatotoxicity, it has generally been avoided in this setting.

Methods: Non-diabetic male subjects (n=33) who had well-controlled HIV infection on antiretroviral therapy, fasting triglycerides > or =2.

Effects of intensive versus moderate lipid-lowering therapy on myocardial ischemia in older patients with coronary heart disease: results of the Study Assessing Goals in the Elderly (SAGE).

Background: Clinical trials have demonstrated that, compared with placebo, intensive statin therapy reduces ischemia in patients with acute coronary syndromes and in patients with stable coronary artery disease. However, no studies to date have assessed intensive versus moderate statin therapy in older patients with stable coronary syndromes.

Methods And Results: A total of 893 ambulatory coronary artery disease patients (30% women) 65 to 85 years of age with > or = 1 episode of myocardial ischemia that lasted > or = 3 minutes during 48-hour ambulatory ECG at screening were randomized to atorvastatin 80 mg/d or pravastatin 40 mg/d and followed up for 12 months.

Predictors of carotid intima-media thickness progression in young adults: the Bogalusa Heart Study.

Background And Purpose: We sought to evaluate the predictors of carotid intima-media thickness (CIMT) progression in young adults and to determine whether they differed between the sexes. Although risk factors for the progression of atherosclerosis in middle-aged and elderly adults are well known, they are less well understood in young adults. CIMT is a validated measure of subclinical atherosclerosis.