The significance of detection of preclinical atherosclerosis
Abstract
Background: Atherosclerosis is a chronic disease, which can go on for many decades with no clinically noticable changes. When clinical symptoms appear, the disease has usually already significantly progressed. There is currently no effective treatment for atherosclerosis. The disease can only be prevented. This is why it is important to detect it in its early stages, when preventive measures are the most effective. Today, with a help of non-invasive investigation methods, mostly ultrasound based, we can detect changes in the structure and function of artery wall, which are typical for the early stages of atherosclerosis or predict the disease course.
Conclusions: Such changes are: lower capability of artery expansion during an increased blood flow (endothelial dysfunction), intima-media thickening, artery walls, artery calcination and ankle-brachial index decrease. The research showed that these symptoms of preclinical atherosclerosis are tightly connected to authenticity of the risk factors, their number and duration, and that there is a tight connection between the general cardiovascular danger and the manifestation of preclinical and morphological changes of an artery wall. Preclinical atherosclerotic changes are very important signals of cardiovascular changes and are independent of classical atherosclerotic risk factors. Contrary to the current means of evaluating risks (see tables) that enable us to evaluate statistical values concerning risks for the population based on present risk factors, assessing the preclinical forms of atherosclerosis enables us to recognize those individuals who are at greatest risk, i.e. those where a process of atherosclerosis has already begun and who need immediate elimination of the risk factors. In this way, the finding of a disturbance in the vein wall (endothelial dysfunction) or its structure (intima-media thickening) can help choose the right preventive measure, meaning that in patients, where the general risk is, according to classical risk factors, which were established to be low or medium, suggesting the usage of intensive preventive measures, including the usage of drugs, used for treating current risk factors, even though there is a borderline or a minor increase of their values.
Downloads
References
Stary HS. Changes of components and structure of atherosclerotic lesions developing from childhood to middle age in coronary arteries. Basic Reas Cardiol 1994; 89 Suppl 1: 17–32.
Poredoš P. Endothelial dysfunction in the pathogenesis of atherosclerosis. Clin Appl Thromb Hemost 2001; 7: 276–80.
Dawson DL, Strandness DE Jr. Arterial wall thickness with high related resolution B-mode imaging. In: Bernstein EF, ed. Vascular diagnosis. Chapter 46, Mosby, 420–38.
Smith Jr SC, Greenland P, Grundy SM. AHA conference proceedings. Prevention conference. V. Beyond secondary prevention: identifying the high risk patient for primary prevention: executive summary. Circulation 2000; 101: 111–6.
Simon A, Megnien JL, Gariepy J, Levenson J. Early atherosclerosis in human hypertension. Am J Hypertens 1998 Jul; 11: 882–3.
Pignoli P, Tremoli E, Poli A, Oreste P, Paoletti R. Intimal plus medial thickness of the arterial wall: a direct measurement with ultrasound imaging. Circulation 1986; 74: 1399–406.
Poredoš P, Kek A, Verhovec R. Morphological and functional changes of the arterial wall in subjects at risk of atherosclerosis and in patients with peripheral arterial occlusive disease. VASA 1997; 26: 271–6.
Wikstrand J, Wendelhag I. Methodological consideration of ultrasound investigation of intima-media thickness and lumen diameter. J Intern Med 1994; 236: 555–9.
Howard G, Burke GL, Evans GW, Crouse JR 3rd, Riley W, Arnett D, et al. Relations of intimal-medial thickness among sites within the carotid artery as evaluated by B-mode ultrasound. ARIC Investigators. Atherosclerosis Risk in Communities. Stroke 1994; 25 (8): 1581–7.
Zanchetti A, Crepaldi G, Bond MG, Gallus G, Veglia F, Mancia G, et al. Systolic and pulse blood pressures (but not diastolic blood pressure and serum cholesterol) are associated with alterations in carotid intima-media thickness in the moderately hypercholesterolemic hypertensive patients of the Plaque Hypertension Lipid Lowering Italian Study. PHYLLIS study group. J Hypertens 2001; 19: 79–88.
Salonen JT, Salonen R. Risk factors for carotid and femoral atherosclerosis in hypercholesterolemic men. J Intern Med 1994; 236: 561–6.
Guvener N, Tutuncu NB, Oto A, Erbas T. Major determinants of the carotid intima-media thickness in type 2 diabetic patients: age and body mass index. Endocr J 2000; 47: 525–33.
Poredoš P, Orehek M, Tratnik E. Smoking is associated with dose-related increase of intima-media thickness and endothelial dysfunction. Angiology 1999; 50: 201–8.
Bond MG, Barnes RW, Riley WA, Wilmoth SK, Chambless LE, Howard G, et al. High-resolution B-mode ultrasound scanning methods in the atherosclerosis risk in communities study (ARIC). J Neuroimaging 1991; 1: 68–73.
Žižek B, Poredoš P. Dependence of morphological changes of the carotid arteries on essential hypertension and accompanying risk factors. Int Angiol 2002; 21: 70–7.
Furberg CD, Adams HP, Applegate WB, Byington RP, Espeland MA, Hartwell T, et al. Effect of lovastatin in early carotid atherosclerosis and cardiovascular events. Circulation 1994; 90: 1679–87.
Tang R, Henning M, Thomasson B, Scherz R, Ravinetto R, Cattalini R, et al. Baseline reproducibility of B-mode ultrasonic measurement of carotid artery intima-media thickness: the European Lacidipine Study on Atherosclerosis (ELSA). J Hypertens 2000; 18: 197–201.
Pfeifer M, Verhovec R, Žižek B, Preželj J, Poredoš P, Clayton RC. Growth hormone (GH) treatment reverses early atherosclerotic changes in GH-deficient adults. J Clin Endocrin Metabol 1999; 84: 453–7.
Salonen JT, Salonen R. Ultrasound B-mode imaging in observational studies of atherosclerotic progression. Circulation 1993; 87 Suppl 3: II56–65.
Chambless LE, Heiss G, Folsom AR, Rosamond W, Szklo M, Sharrett AR, et al. Association of coronary heart disease incidence with carotid arterial wall thickness and major risk factors: the Atherosclerosis Risk in Communities (ARIC) Study, 1987–1993. Am J Epidemiol 1997; 146: 483–94.
O´Leary DH, Polak JF, Kronmal RA, Manolio TA, Burke GL, Wolfson Jr. SK. Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. New Engl J Med 1999; 340: 14–22.
Simon A, Gariepy J, Chironi G, Megnien JL, Levenson J. Intima media thickness: a new tool for diagnosis and treatment of cardiovascular risk. J Hypertens 2002; 20: 159–69.
Held C, Hjemdahl P, Eriksson SV, Björkander I, Forslund L, Rehnqvist N. Prognostic implications of intima-media thickness and plaques in the carotid and femoral arteries in patients with stable angina pectoris. Europ Heart J 2001; 22: 62–72.
Expert Panel (Adult Treatment Panel III). Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). J Am Med Assoc 2001; 285: 2486–97.
Higashi Y, Sasaki S, Nakagawa K, Kimura M, Noma K, Sasaki S, et al. Low body mass index is a risk factor for impaired endothelium-dependent vasodilation in humans: role of nitric oxide and oxidative stress. J Am Coll Cardiol 2003; 42: 256–63.
Raitakari OT, Celermajer DS. Testing for endothelial dysfunction. Ann Med 2000; 32: 293–304.
Ferri C, Desideri G, Valenti M, Bellini C, Pasin M, Santucci A, et al. Early upregulation of endothelial adhesion molecules in obese hypertensive men. Hypertension 1999; 34 (4 Pt 1): 568–73.
Salomaa V, Stinson V, Kark JD, Folsom AR, Davis CE, Wu KK. Association of fibrinolytic parameters with early atherosclerosis. The ARIC study. Circulation 1995; 91: 284–90.
Lerman A, Edwards BS, Hallett JW, Heublein DM, Sandberg SM, Bumett JCJ. Circulation and tissue endothelin immunoreactivity in advanced athero-sclerosis. N Engl J Med 1991; 325: 997–1001.
Pasceri V, Willerson J, Yeh ETH. Direct proinflammatory effect of C-reactive protein on human endothelial cells. Circulation 2000; 102: 2165–8.
Celermajer DS, Sorensen KE, Gooch VM, Spiegelhalter DJ, Miller OI, Sullivan ID, et al. Non-invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis. Lancet 1992; 340: 1111–5.
Steinberg HO, Chaker H, Leaming R, Johnson A, Brechtel G, Baron AD. Obesity/insulin resistance is associated with endothelial dysfunction. Implications for the syndrome of insulin resistance. J Clin Invest 1996; 97: 2601–10.
Belcaro G, Geroulakos G, Laurora G, et al. Inter/intra-observer variability of carotid and femoral bifurcation intima-media thickness measurements. Panminerva Med 1993; 35: 75–9.
Alam TA, Seifalian AM, Baker D. A review of methods currently used for assessment of in vivo endothelial function. Eur J Vasc Endovasc Surg 2005; 29: 269–76.
Jiang X, Yang F, Tan H, Liao D, Bryan RM Jr, Randhawa JK, et al. Hyperhomocystinemia impairs endothelial function and eNOS activity via PKC activation. Arterioscler Thromb Vasc Biol 2005; 25: 2515–21.
Tikiz C, Utuk O, Pirildar T, Bayturan O, Bayindir P, Taneli F, et al. Effects of Angiotensin-converting enzyme inhibition and statin treatment on inflammatory markers and endothelial functions in patients with long-term rheumatoid arthritis. J Rheumatol 2005; 32: 2095–101.
Kabat A, Dhein S. L-Arginine Supplementation Prevents the Development of Endothelial Dysfunction in Hyperglycemia. Pharmacology 2006; 76: 185–91.
Sciacqua A, Candigliota M, Ceravolo R, Scozzafava A, Sinopoli F, Corsonello A, et al. Weight loss in combination with physical activity improves endothelial dysfunction in human obesity. Diabetes Care 2003; 26: 1673–8.
Kitta Y, Nakamura T, Kodama Y, Takano H, Umetani K, Fujioka D, et al. Endothelial vasomotor dysfunction in the brachial artery is associated with late in-stent coronary restenosis. J Am Coll Cardiol 2005; 46: 648–55.
London GM, Guerin AP, Marchais SJ, Metivier F, Pannier B, Adda H. Arterial media calcification in end-stage renal disease: impact on all-cause and cardiovascular mortality. Nephrol Dial Transplant 2003; 18: 1731–40.
Kuller LH, Matthews KA, Sutton-Tyrrell K, Edmundowicz D, Bunker CH. Coronary and aortic calcification among women 8 years after menopause and their premenopausal risk factors: the health women study. Arterioscler Thromb Vasc Biol 1999; 19; 2189–98.
Iribarren C, Sidney S, Sternfeld B, Browner WS. Calcification of the aortic arch: risk factors and association with coronary heart disease, stroke, and peripheral vascular disease. JAMA 2000; 283: 2810–5.
Matsushita M, Nishikimi N, Sakurai T, Nimura Y. Relationship between aortic calcification and atherosclerotic disease in patients with abdominal aortic aneurysm. Int Angiol 2000; 19: 276–9.
Acarturk E, Bozkurt A, Cayli M, Demir M. Mitral annular calcification and aortic valve calcification may help in predicting significant coronary artery disease. Angiology 2003; 54: 561–7.
Dincer I, Ozdol C, Dandachi R, Akyurek O, Atmaca Y, Kilickap M, et al. Predictive value of mitral annular calcification for the diagnosis of coronary artery disease in patients with dilated cardiomyopathy. Angiology 2001; 52: 515–20.
Yamamoto H, Shavelle D, Takasu J, Lu B, Mao SS, Fischer H, et al. Valvular and thoracic aortic calcium as a marker of the extent and severity of angiographic coronary artery disease. Am Heart J 2003; 146: 153–9.
Atar S, Jeon DS, Luo H, Siegel RJ. Mitral annular calcification: a marker of severe coronary artery disease in patients under 65 years old. Heart 2003; 89: 161–4.
Kondos GT, Hoff JA, Sevrukov A, Daviglus ML, Garside DB, Devries SS, et al. Electron beam tomography coronary artery calcium and cardiac events: a 37-months follow up of 5635 initially asymptomatic low-to intermediate-risk adults. Circulation 2003; 107: 2571–6.
Blacher J, Guerin AP, Pannier B, Marchais SJ, London GM. Arterial calcifications, arterial stiffness, and cardiovascular risk in end-stage renal disease. Hypertension 2001; 38: 938–42.
Kamensky G, Lisy L, Polak E, Piknova E, Plevova N. Mitral annular calcifications and aortic plaques as predictors of increased cardiovascular mortality. J Cardiol 2001; 37 Suppl 1: 21–6.
Soylu M, Demir AD, Ozdemir O, Uzun Y, Korkmaz S. Relationship between plaque morphology of carotid artery and aortic valve calcification. Angiology 2003; 54: 637–40.
TASC document: Investigation of patients with intermittent claudication. J Vasc Surg 2000; 31: 62–74.
Newman AB, Siscovick DS, Manolio TA, Polak J, Fried LP, Borhani NO, et al. Ankle-arm index as a marker of atherosclerosis in the Cardiovascular Health Study. Circulation 1993; 88: 837–45.
Dormandy J, Mahir M, Ascady G, Balsano F, De Leeuw P, Blombery P, et al. Fate of the patients with chronic leg ischemia. J Cardiovasc Surg 1989; 30: 50–7.
Kuller LH, Shemanski L, Psaty BM, Borhani NO, Gardin J, Ham MN, et al. Subclinical disease as an independent risk factor for cardiovascular disease. Circulation 1995; 92: 720–6.
Newman AB, Shemanski L, Teri AM, Cushman M, Mittelmark M, Polak JF, et al. Ankle-arm index as a predictor of cardiovascular disease and mortality in the Cardiovascular Health Study. Arterioscler Thromb Vasc Biol 1999; 19: 538–45.
Dormandy JA, Creager MA. Ankle: arm blood pressure index as a predictor of atherothrombotic events: evidence from CAPRIE. Cerebrovasc Dis 1999; 9: 1–128. Abstract 4.
Duprez D. HOPE brings hope for the use of the ankle-brachial index as cardiovascular risk marker. Europ Heart J 2004; 25: 1–2.
Östergren J, Sleight P, Dagenais G, Danis K, Bosch J, Oilong Y, et al, for the HOPE study investigators. Impact of ramipril in patients with evidence of clinical or subclinical peripheral arterial disease. Europ Heart J 2004; 25: 17–24.
The Author transfers to the Publisher (Zdravniški vestnik/Slovenian Medical Journal) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Zdravniški vestnik/Slovenian Medical Journal) has the right to transfer the rights, acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.
