Carotid Atherosclerosis In Epidemiological Investigations And Clinical Studies

PARTⅠPREVALENCE AND CORRELATION FACTORS OF CAROTID ATHEROSCLEROSIS AMONG THE MIDDLE AND OLD WORKERS IN CHONGQING IRON AND STEEL CORPORATIONObjective To investigate the prevalence and correlation factors of carotid atherosclerosis (CAS) among workers of Chongqing iron and steel corporation, and offer the information to prevent the cerebrovascular disease.Methods Recruited 512 asymptomatic individuals (mean age 56.8 years, ranged from 46 to 80) from the subsidiary workshop of Chongqing iron and steel corporation. Demographic data and serum were collected and the IMT of the CCA and plaque formation were evaluated by B-mode ultrasound. A logistic regression analysis was used to estimate the correlation factors of CAS.Results (1) The prevalence of carotid atherosclerosis among the iron and steel workers was 37.6%, Internal-Media Thickening was found in 10.2% of the people, the prevalence of nonstenotic plaque and stenotic plaque was 25.0% and 2.4% respectively. (2) It was shown by logistic regression analysis that age (OR 1.289, 95%CI 1.014~1.568, P<0.001), smoking (OR1.420, 95%CI 0.802~3.872, P<0.001), hypertension (OR 4.530, 95%CI 3.952~6.753, P<0.001), diabetes mellitus (OR 2.285, 95%CI 1.008~5.057, P<0.001), Hs-CRP(OR1.273, 95%CI 0.479~2.889, P=0.037), TC(OR1.032,95%CI 0.320~1.882, P=0.047) and LDL-C(OR2.313, 95%CI 1.237~4.331, P=0.008) were significantly associated with the severity of CAS. (3)The prevalence of the CAS was increased with the increasing number of correlation factors.Conclusion The prevalence of CAS among the iron and steel workers was higher than the common people. Age, smoking, hypertension, diabetes mellitus, Hs-CRP, TC and LDL-C were independent risk factors related to CAS. The prevalence of the CAS was increased with the increasing number of correlation factors. PARTⅡTHE RELATIONSHIP BETWEEN THE STABILITY OF CAROTID PLAQUE AND INFLAMMATION FACTORSObject To proceed the carotid ultrasound examination and detect the serum Hs-CRP,MCP-1 and MMP-9, in order to find the markers to reflect the instability of plaque. We aimed to evaluate the risk of the carotid arteriosclerosis and prevent the ischemia cerebrovascular disease. Methods Recruited 238 subjects from the patients of the second affiliated hospital of Chong Qing medical university or subjects who had taken part in the medical examination, the IMT of the CCA and the plaque formation was evaluated by B-mode ultrasound. Subjects were divided into 3 groups according to the results of carotid ultrasound examination: (1) normal subjects, (2) stable plaque group and (3) unstable plaque group. Traditional cardiovascular risk factors were investigated, and laboratory analysis included measurement of plasma lipids, blood sugar, hypersensitive C-reactive protein, Matrix metalloproteinases-9 and Monocyte chemoattractant protein-1. The relationship between the plaque instability, IMT and the serum inflammation factors was analyzed.Results①Serum TC, LDL-C, the prevalence of hypertension, diabetes mellitus and smoking rate in stable plaque group were different from control group; Besides that, serum TG levels in unstable plaque group were different from control subjects. The prevalence of hypertension, diabetes mellitus and serum LDL-C in unstable plaque group were higher than stable plaque group.②The prevalence of ischemia cerebrovascular disease in the unstable plaque group was higher than the others, which indicatd the sonography can predict the risk of the plaques.③If Hs-CRP≥3mmol/l was used as the diagnostic criteria of instability plaque,the sensitivity is up to 63.1%,and the specificity is 72.6%.④Serum Hs-CRP,MCP-1and MMP-9 in the unstable plaque group were higher than the other two groups. On multivariate logistic regression analysis, Serum Hs-CRP and MMP-9 were independently associated with plaque instability.⑤A linear correlation has been observed between the carotid Internal-Media Thickening and the serum Hs-CRP, but not the serum MCP-1 and MMP-9.Conclusion Serum Hs-CRP,MCP-1and MMP-9 were related to the instability of plaques, especially of the Hs-CRP and MMP-9, were considered as the independent prediction factors of the instable plaque. The sensitivity and specificity of single inflammation factor was limited. The measurement of serum inflammation markers combined with the B-mode sonography has benefited to discriminate the unstable plaques. PARTⅢTHE RELATIONSHIP OF THE GENETIC POLYMORPHISM OF APOE AND THE STABILITY OF CAROTID PLAQUEObject: Carotid artery atherosclerosis is a strong predictor for future stroke. It is yet unclear whether the apolipoprotein E polymorphism (ApoE) is related to plaque instability in carotid arteries. The aim of the present study was to investigate the role of genetic polymorphisms of ApoE in carotid artery atherosclerosis and the instability of plaques.Methods: A population-based cross-sectional study was performed on 238 subjects. Atherosclerosis was noninvasively assessed by the common carotid artery intima-media wall thickness and the presence of plaques in the carotid arteries. The subjects were divided into 3 groups: the instable plaque group, stable plaque group and control group according to the result of carotid ultrasound examination. The genetype of Apo E and serum Apo E concentration was measured. Combined with the information offered by the second part, the relationship between the genetic polymorphism of ApoE and the instability of carotid plaque was studied with linear and logistic regression analysis respectively, with adjustment for age and sex. Result:①All six expected genotypes were observed in the individuals genotyped. The most common genotype wasε3/3. Only one subject was withε2/2 genotype. The frequency ofε3/4 genotype in unstable plaque group was higher than stable plaque group and health subjects, and this was statistically significant.②The average of IMT of the subjects withε4 allele was 1.22mm, which was significant thicker than the subjects withoutε4 allele.③Serum TC,LDL-C,Hs-CRP and MCP-1 of the subjects withε4 allele were higher than the subjects without it, and this was statistically significant, which indicatd that the inflammatory activity in subjects withε4 allele was stronger than the subjects withoutε4 allele.ε4 allele is an independent relative factor of the unstable plaque when age, sex and blood fat were adiusted in logistic regression analysis, which indicated that theε4 allele can aggravate the artherosclerosis by other mechanism besides for serum lipid. A significantly age , gender and blood fat-adjusted odds ratio of 1.09 for the unstable plaque was observed in study subjects withε4 allele than those withoutε4 allele, which indicated the genetic polymorphisms of ApoE has influenced the arteriosclerosis through adjusting blood-fat or the chronic inflammation status.④The presence ofε4 allele increased the prevalence of CAS associated with a confirmed diagnosis of hypertention or diabetes mellitus, which indicated the subjects withε4 allele were more sensitive to hypertention or diabetes mellitus.Conclusion: ApoE polymorphism was associated with carotid atherosclerosis and the instability of plaques. Patients withε4 isoform had an increased carotid IMT and a more severe CAS than the subjects withoutε4 allele.ε4 allele is an independent risk factor of the instability of plaques. When we further adjusted the cardiovascular risk factors, such as age, gender and blood fat, our observations did not change. Those with anyε4 allele in combination with hypertension or diabetes mellitus were at substantially higher risk of CAS than those withoutε4 allele. The genetic polymorphism of ApoE has influenced the arteriosclerosis through adjusting the blood-fat or the chronic inflammation status. 17PARTⅣTHE RELATIONSHIP BETWEEN SMALL VESSEL DISEASE AND CAROTID ATHEROSCLEROSISObject To compare the risk factors of cerebral small vessel disease (SVD) or its subtypes(lacunar infarction and leukoaraiosis) and carotid atherosclerosis (CAS), deduce the effect of CAS on SVD and provide data for early prevention and cure.Methods Data of age, hypertension, diabetes mellitus, smoking, blood fat, alcohol, FIB, abdomen circumference and BMI were analysed in the patients with SVD(n=366), CAS (n=266) and controls. Patients with SVD were subdivided into lacunar infarction (LI) and leukoaraiosis (LA).Results A total of 506 patients met the inclusion criteria, among which, 174 were lacunar cerebral infarction, 192 were leukoaraiosis and140 were normal. Among the 391 patients who were examined by color Duplex ultrasound, 266 were found carotid atherosclerosis.①Multiple logistic regression analyses revealed that age, hypertension, diabetes mellitus, hypercholesterinemia, High LDL and smoking were more frequent in CAS group compared to the controls (p < 0.05). In SVD group, hypertension, diabetes mellitus, hypercholesterinemia were more important.②Age (OR 1.07, 95%CI 0.56 ~1.96, P<0.01) , Hypertension (OR 1.28, 95% CI 0.88 ~ 1.72, P < 0.01) were more common in SVD than CAS; but hypercholesterinemia (OR 0.53, 95% CI 0.23 ~ 1.22, P<0.01) was more important in CAS, LDLC and smoking were the risk factors of CAS but not SVD.③Age, hypertension were more important in LA than LI; on the contrary, hypercholesterinemia was more common in LI.④The pearson coefficient between SVD and CAS was 0.360, the incidence rate of CAS in LI was more frequent than LA.Conclusion①There are some differences in risk factor profile between SVD and CAS, the same to LI and LA.②The incidence of CAS is related to SVD to some extent, the relationship of CAS with LI is closer than LA.