Carotid atherosclerosis and cardiovascular health metrics in old subjects from the AGES-Reykjavik study

Abstract

Background Ideal cardiovascular (CV) health by simultaneous presence of 7 ideal health metrics (blood pressure, cholesterol, glucose, smoking, BMI, physical activity and diet) has been defined by the American Heart Association. In the current study we investigated the association of a CV health score (range 0–14), on the extent and progression of carotid atherosclerosis, assessed as carotid intima-media thickness (cIMT) and total plaque area (TPA) by ultrasound at 5 years interval. Methods and Results A total of 219 participants (age 75.6±5.1) from the Age, Gene/Environment Susceptibility (AGES)-Reykjavik study were studied. Men with poor (low) CV health score had greater TPA than those with more optimal (high) score (61.5 (SD: 32.3), 44.4 (24.2) and 37.7 (23.2) mm2 for those with CV health score ≤ 6, 7–9 and ≥ 10 respectively, p<0.05). In linear analysis for men, log TPA was 0.088 mm2 (SE: 0.040 p<0.05) smaller for each additional point in the CV health score. CV health score was not associated with TPA in women, or cIMT in either sex. TPA increased in both sexes between visits. However, CV health score did not predict carotid atherosclerosis progression. Conclusions CV health score is associated with TPA in older men but not in women. Men with poor CV health score at the baseline visit had more extensive carotid atherosclerosis than those with better CV health score, although it did not predict the progression of carotid atherosclerosis.

Airflow obstruction, atherosclerosis and cardiovascular risk factors in the AGES Reykjavik study

“…The ultrasound protocol of the CIMT is described in more detail elsewhere (9,10). In brief, images of the right and left carotid artery (CCA), bifurcation, and internal carotid artery (ICA) were acquired with an Acuson Sequoia C256 with a two-dimensional 8 MHz linear array transducer.…”

“…Calcium was quantified by Agatston scores of coronary arteries, proximal aortic arch and distal aorta using computerized tomography (CT) images of the chest (10,11,12) Cerebral infarction: The scoring of cerebral infarcts has been described in detail elsewhere (13,14). In brief, infarcts were scored by trained radiographers and defined as defects of the brain parenchyma with a signal intensity isointense to cerebrospinal fluid on all MR images (FLAIR, PD/T2-weighted images), associated hyperintensity on T2-weighted and FLAIR images with a minimal diameter of 4 mm, except for infarcts in the cerebellum and brain stem which had no size criteria and did not require associated hyperintensity.…”

Ideal Cardiovascular Health and Subclinical Markers of Carotid Structure and Function

“…This same study is the sole, to date, that has addressed the association between ideal CVH and carotid plaques. 30 In this prior study, an inverse-graded association was reported between higher CVH score and total plaque area but only in men. We have extended these results using a much larger sample size and by reporting significant associations between CVH and carotid plaques in both sex.…”

“…[28][29][30][31] Lower CCA-IMT has also been associated with the number of ideal CVH metrics among adolescents 26 and among young adults in the United States, Finland, and Australia. 30 To the best of our knowledge, only 2 previous studies have specifically examined the association of CVH with CCA-IMT among adults. In the first study conducted in twins, ideal CVH was inversely associated with CCA-IMT, independently of shared genetic and familial factors.…”

“…In the second study, baseline ideal CVH score failed to demonstrate any significant association with CCA-IMT in either sex. 30 However, this was a study of small sample size (n=219) conducted in a highly selected population, including older survivors with established atherosclerosis. Furthermore, CCA-IMT was evaluated with standard B-mode carotid ultrasound compared with a high-resolution carotid echotracking in PPS3 with axial resolution of 17 μm for CCA-IMT evaluation.…”