Carotid Plaque Morphology in Asymptomatic Patients with and without Metabolic Syndrome

Cury, Marcus Vinícius Martins; Presti, Calógero; Bonadiman, Suellen Stevam Timotheo; Casella, Ivan Benaduce; Benabou, Joseph Elias; Silva, Erasmo Simão da; Luccia, Nélson De; Puech-Leão, Pedro

doi:10.1016/j.avsg.2016.05.092

Cited by 5 publications

(5 citation statements)

References 38 publications

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“…Individually, we did observe increased rates of hypertension (97.7 vs. 91.3%, p = 0.01), hyperlipidemia (91.5 vs. 84.3%, p = 0.04), and diabetes (61.2 vs. 41.6%, p < 0.01) in the obese population, consistent with metabolic syndrome. 13 We observed a strong trend toward female gender in the obese population but this did not reach statistical significance. (Table 1)…”

Section: Resultsmentioning

confidence: 64%

Transcarotid revascularization in obese patients

et al. 2022

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Objective Transcarotid revascularization (TCAR) is a minimally invasive hybrid surgical carotid stenting technique which utilizes cerebral flow reversal as embolic protection during carotid lesion manipulation. This investigation was performed to define the perioperative risks associated with this operation in the obese patient. Methods A retrospective review of tandem carotid revascularization databases maintained at two high-volume health systems was performed to capture all TCARs performed between 2015 and 2022. A threshold of body mass index of 35 kg/m2 defined the “obese” patient. Demographics, intraoperative, perioperative, and follow-up characteristics were compared using univariate analysis. Results We performed 793 TCAR procedures that qualified for study inclusion within the prespecified time. After applying our obesity definition, 129 patients qualified as obese and were compared to the remainder. There were no significant differences in baseline demographics as comparable Charlson Comorbidity Indices were noted between groups; however, obese patients had a significantly higher prevalence of hypertension, hyperlipidemia, and diabetes. Intraoperative, case complexity in the obese patients did not seem to be increased, as measured by operative time (68.4 ± 23.0 vs 64.2 ± 25.8 min, p = 0.09), fluoroscopic time (4.9 ± 3.2 vs 4.6 ± 3.6 min, p = 0.38), and estimated blood loss (40.6 ± 49.0 vs 46.6 ± 49.4 min, p = 0.22). Similarly, no disparities were observed with respect to ipsilateral stroke (3.1 vs. 1.7%, p = 0.29), contralateral stroke (0 vs. 0.2%, p > 0.99), death (0 vs. 1.1%, p = 0.61), and stroke/death (3.1 vs. 3.0%, p > 0.99) in the 30-day perioperative period. Both cohorts were followed for approximately 1 year (12.0 ± 13.4 vs 11.6 ± 13.4 months, p = 0.76). During this period, rates of ipsilateral stroke (3.1% vs. 2.7%, p > 0.99), contralateral stroke (1.1 vs. 0.8%, p > 0.99), and death (4.7 vs. 6.2%, p = 0.68) were similar. Conclusions TCAR performed in the obese population was not more challenging by intraoperative characteristics and did not result in a statistically higher incidence of adverse events in the perioperative phase.

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Section: Resultsmentioning

confidence: 64%

Transcarotid revascularization in obese patients

et al. 2022

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“…In this study we found that the rate of high-risk plaques was higher in patients with metabolic syndrome. However, another study that used duplex ultrasound to investigate carotid plaque morphology in asymptomatic patients with and without metabolic syndrome found that metabolic syndrome did not affect the stenosis grade or the rate of unstable carotid plaques [25]. This study suggests that metabolic syndrome is more likely to lead to unstable plaques.…”

Section: Discussionmentioning

confidence: 75%

“…We are unsure why there is a difference between our results and the other study, but the patients with metabolic syndrome in the previous study used more classes of antihypertensive drugs and were treated with statins for a longer period than the patients without metabolic syndrome, so this may have caused some bias in the results. There are differences between the two studies in terms of the patient populations, because our study was in a Chinese population and the other study was undertaken in Brazil [25]. Also, there are some differences in the plaque analysis between these two studies.…”

Section: Discussionmentioning

confidence: 92%

“…Previous study has shown that metabolic syndrome has a relationship with atherosclerosis [4,24]. In particular, the previous studies found the abdominal obesity and high blood pressure [4] or waist circumference and insulin resistance [25] components of metabolic syndrome were significantly associated with coronary plaques. In this study we found that the rate of high-risk plaques was higher in patients with metabolic syndrome.…”

Section: Discussionmentioning

confidence: 98%

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Prevalence of high-risk coronary plaques in patients with and without metabolic syndrome and the relationship with prognosis

Luo

Han

et al. 2020

BMC Cardiovasc Disord

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Background: Metabolic syndrome (MS) is a disorder, characterized by clusters of cardiovascular risk factors such as central obesity, insulin resistance, dyslipidemia and hypertension. Patients with MS may have a higher plaque burden that increases their risk of major adverse cardiovascular events (MACEs). This study aimed to analyze the prevalence of high-risk coronary plaques in patients with and without MS by coronary computed tomography angiography (CCTA) and to investigate the relationship between MS, high-risk coronary plaques, and their prognosis. Methods: This was a retrospective cohort study of 1136 patients who underwent CCTA due to chest pain without obstructive heart disease (≥50% coronary stenosis) between January 2014 and December 2015 in our hospital. The relationships between high risk coronary plaques, MS, and other clinical factors were assessed. Multicollinearity analysis was performed to identify the collinearity between the variables. The proportional hazard assumption was checked and using Schoenfeld residual test. Cox proportional hazards model and Kaplan-Meier survival analysis assessed the relationship between MS, high-risk coronary plaques and MACEs.Results: High-risk plaques were more frequent in the MS group than non-MS group (P = 0.004). MS (HR = 2.128, 95%CI: 1.524-2.970, P < 0.001), presence of high-risk plaques (HR = 11.059, 95%CI: 7.749-57.232, P < 0.001) and high sensitivity C-reactive protein (hsCRP) (HR = 1.629, 95%CI: 1.128-2.352, P = 0.009) were related with an increased risk of MACEs in patients with risk factors for coronary heart disease. In patients with high-risk plaques, MS (HR = 2.265, 95%CI: 1.629-3.150, P < 0.001) and hsCRP (HR = 1.267, 95%CI: 1.191-1.348, P = 0.004) were related with an increased risk of MACEs. Kaplan-Meier analysis showed differences in MACEs between the MS and non-MS groups in the whole population and those with high-risk plaques (both P < 0.0001).Conclusions: High-risk plaques were more common in patients with MS. MS and the presence of high-risk plaques were independent risk factors for MACEs.

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“…36 In a cohort of 148 patients with an asymptomatic carotid plaque (using duplex ultrasound with computer assisted analysis), MetS did not affect the stenosis grade or lead to more unstable carotid plaques. 37 Because MetS may be a predictor for development of atherosclerosis, its role as clinical predictor in the more advanced stages of atherosclerosis may be less contributory. 34,38 Contradictory clinical outcomes have been reported in other diseases and interventions.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Metabolic Syndrome on the Occurrence of Restenosis After Carotid Endarterectomy

Vries

Timmerman

Laarhoven

et al. 2019

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDS This study presents the largest published cohort so far on the effect of metabolic syndrome (MetS) on restenosis and death after carotid endarterectomy. Data from previous studies are conflicting regarding an effect of MetS on the restenosis rate. This study shows that MetS has little clinical relevance in advanced atherosclerotic carotid disease with regard to restenosis and death after surgery. MetS is useful in screening and detection of the early stages of atherosclerosis but has no role in the outcome or management of severe atherosclerosis of the carotid artery requiring surgical treatment. Objectives: The metabolic syndrome (MetS) is a cluster of risk factors for cardiovascular disease. The effect of MetS on clinical outcome in patients with cerebrovascular disease remains largely unknown because conflicting results have been published. This study aimed to determine the influence of MetS on the occurrence of restenosis after carotid endarterectomy (CEA). Methods: All patients who underwent CEA between June 2003 and December 2014 in two tertiary academic referral centres in The Netherlands were included. MetS was defined if three or more of the following criteria were present: hypertension, obesity, high fasting serum blood glucose, high serum triglycerides, or low serum high density lipoprotein cholesterol. The primary outcome measure was the occurrence of ipsilateral restenosis after index surgery. The secondary outcome measure was (all cause) mortality during follow up. For the primary analysis, missing data were multiply imputed using multivariable imputation by chained equations. A Cox proportional hazards model was used to perform an adjusted analysis on the multiply imputed data sets. Results: A total of 1668 CEA procedures (in 1577 patients) were performed. The presence or absence of MetS could not be determined in 263 patients because of missing data. There was no significant difference in freedom from restenosis in the MetS group vs. the no-MetS group (hazard ratio [HR], 1.10; 95% confidence interval [CI] 0.98e1.23; p ¼ .10) or in all cause mortality (HR 1.20; 95% CI 0.94e1.54; p ¼ .14). Conclusion: This study shows that MetS does not predict restenosis after CEA. Also, the presence of MetS did not influence patient survival negatively.

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Carotid Plaque Morphology in Asymptomatic Patients with and without Metabolic Syndrome

Cited by 5 publications

References 38 publications

Transcarotid revascularization in obese patients

Transcarotid revascularization in obese patients

Prevalence of high-risk coronary plaques in patients with and without metabolic syndrome and the relationship with prognosis

The Effect of Metabolic Syndrome on the Occurrence of Restenosis After Carotid Endarterectomy

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