Reference values of carotid intima-media thickness and arterial stiffness in Chinese adults based on ultrasound radio frequency signal: A nationwide, multicenter study.
Journal
Chinese medical journal
ISSN: 2542-5641
Titre abrégé: Chin Med J (Engl)
Pays: China
ID NLM: 7513795
Informations de publication
Date de publication:
03 Jul 2024
03 Jul 2024
Historique:
received:
13
07
2023
medline:
3
7
2024
pubmed:
3
7
2024
entrez:
3
7
2024
Statut:
aheadofprint
Résumé
Carotid intima-media thickness (IMT) and diameter, stiffness, and wave reflections, are independent and important clinical biomarkers and risk predictors for cardiovascular diseases. The purpose of the present study was to establish nationwide reference values of carotid properties for healthy Chinese adults and to explore potential clinical determinants. A total of 3053 healthy Han Chinese adults (1922 women) aged 18-79 years were enrolled at 28 collaborating tertiary centers throughout China between April 2021 and July 2022. The real-time tracking of common carotid artery walls was achieved by the radio frequency (RF) ultrasound system. The IMT, diameter, compliance coefficient, β stiffness, local pulse wave velocity (PWV), local systolic blood pressure, augmented pressure (AP), and augmentation index (AIx) were then automatically measured and reported. Data were stratified by age groups and sex. The relationships between age and carotid property parameters were analyzed by Jonckheere-Terpstra test and simple linear regressions. The major clinical determinants of carotid properties were identified by Pearson's correlation, multiple linear regression, and analyses of covariance. All the parameters of carotid properties demonstrated significantly age-related trajectories. Women showed thinner IMT, smaller carotid diameter, larger AP, and AIx than men. The β stiffness and PWV were significantly higher in men than women before forties, but the differences reversed after that. The increase rate of carotid IMT (5.5 μm/year in women and 5.8 μm/year in men) and diameter (0.03 mm/year in both men and women) were similar between men and women. For the stiffness and wave reflections, women showed significantly larger age-related variations than men as demonstrated by steeper regression slopes (all P for age by sex interaction <0.05). The blood pressures, body mass index (BMI), and triglyceride levels were identified as major clinical determinants of carotid properties with adjustment of age and sex. The age- and sex-specific reference values of carotid properties measured by RF ultrasound for healthy Chinese adults were established. The blood pressures, BMI, and triglyceride levels should be considered for clinical application of corresponding reference values.
Sections du résumé
BACKGROUND
BACKGROUND
Carotid intima-media thickness (IMT) and diameter, stiffness, and wave reflections, are independent and important clinical biomarkers and risk predictors for cardiovascular diseases. The purpose of the present study was to establish nationwide reference values of carotid properties for healthy Chinese adults and to explore potential clinical determinants.
METHODS
METHODS
A total of 3053 healthy Han Chinese adults (1922 women) aged 18-79 years were enrolled at 28 collaborating tertiary centers throughout China between April 2021 and July 2022. The real-time tracking of common carotid artery walls was achieved by the radio frequency (RF) ultrasound system. The IMT, diameter, compliance coefficient, β stiffness, local pulse wave velocity (PWV), local systolic blood pressure, augmented pressure (AP), and augmentation index (AIx) were then automatically measured and reported. Data were stratified by age groups and sex. The relationships between age and carotid property parameters were analyzed by Jonckheere-Terpstra test and simple linear regressions. The major clinical determinants of carotid properties were identified by Pearson's correlation, multiple linear regression, and analyses of covariance.
RESULTS
RESULTS
All the parameters of carotid properties demonstrated significantly age-related trajectories. Women showed thinner IMT, smaller carotid diameter, larger AP, and AIx than men. The β stiffness and PWV were significantly higher in men than women before forties, but the differences reversed after that. The increase rate of carotid IMT (5.5 μm/year in women and 5.8 μm/year in men) and diameter (0.03 mm/year in both men and women) were similar between men and women. For the stiffness and wave reflections, women showed significantly larger age-related variations than men as demonstrated by steeper regression slopes (all P for age by sex interaction <0.05). The blood pressures, body mass index (BMI), and triglyceride levels were identified as major clinical determinants of carotid properties with adjustment of age and sex.
CONCLUSIONS
CONCLUSIONS
The age- and sex-specific reference values of carotid properties measured by RF ultrasound for healthy Chinese adults were established. The blood pressures, BMI, and triglyceride levels should be considered for clinical application of corresponding reference values.
Identifiants
pubmed: 38958034
doi: 10.1097/CM9.0000000000003156
pii: 00029330-990000000-01129
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2024 The Chinese Medical Association, produced by Wolters Kluwer, Inc. under the CC-BY-NC-ND license.
Références
Johri AM, Nambi V, Naqvi TZ, Feinstein SB, Kim ESH, Park MM, et al. Recommendations for the Assessment of carotid arterial plaque by ultrasound for the characterization of atherosclerosis and evaluation of cardiovascular risk: From the American Society of Echocardiography. J Am Soc Echocardiogr 2020;33:917–933. doi: 10.1016/j.echo.2020.04.021.
doi: 10.1016/j.echo.2020.04.021
Tomiyama H. Carotid artery: A window for the assessment of multiple cardiovascular risks. JMA J 2021;4:174–175. doi: 10.31662/jmaj.2021-0024.
doi: 10.31662/jmaj.2021-0024
Tardif JC, Heinonen T, Orloff D, Libby P. Vascular biomarkers and surrogates in cardiovascular disease. Circulation 2006;113:2936–2942. doi: 10.1161/CIRCULATIONAHA.105.598987.
doi: 10.1161/CIRCULATIONAHA.105.598987
Naqvi TZ, Lee MS. Carotid intima-media thickness and plaque in cardiovascular risk assessment. JACC Cardiovasc Imaging 2014;7:1025–1038. doi: 10.1016/j.jcmg.2013.11.014.
doi: 10.1016/j.jcmg.2013.11.014
Wilkinson IB, Maki-Petaja KM, Mitchell GF. Uses of arterial stiffness in clinical practice. Arterioscler Thromb Vasc Biol 2020;40:1063–1067. doi: 10.1161/ATVBAHA.120.313130.
doi: 10.1161/ATVBAHA.120.313130
Desbiens LC, Fortier C, Nadeau-Fredette AC, Madore F, Hametner B, Wassertheurer S, et al. Prediction of cardiovascular events by pulse waveform parameters: Analysis of CARTaGENE. J Am Heart Assoc 2022;11:e026603. doi: 10.1161/JAHA.122.026603.
doi: 10.1161/JAHA.122.026603
Willeit P, Tschiderer L, Allara E, Reuber K, Seekircher L, Gao L, et al. Carotid intima-media thickness progression as surrogate marker for cardiovascular risk: Meta-analysis of 119 clinical trials involving 100 667 patients. Circulation 2020;142:621–642. doi: 10.1161/CIRCULATIONAHA.120.046361.
doi: 10.1161/CIRCULATIONAHA.120.046361
Baldassarre D, Hamsten A, Veglia F, de Faire U, Humphries SE, Smit AJ, et al. Measurements of carotid intima-media thickness and of interadventitia common carotid diameter improve prediction of cardiovascular events: Results of the IMPROVE (carotid intima media thickness [IMT] and IMT-progression as predictors of vascular events in a high risk European population) study. J Am Coll Cardiol 2012;60:1489–1499. doi: 10.1016/j.jacc.2012.06.034.
doi: 10.1016/j.jacc.2012.06.034
Mitchell GF. Arterial stiffness in aging: Does it have a place in clinical practice? Recent advances in hypertension. Hypertension 2021;77:768–780. doi: 10.1161/HYPERTENSIONAHA.120.14515.
doi: 10.1161/HYPERTENSIONAHA.120.14515
Fritze F, Groß S, Ittermann T, Völzke H, Felix SB, Schminke U, et al. Carotid lumen diameter is associated with all-cause mortality in the general population. J Am Heart Assoc 2020;9:e015630. doi: 10.1161/JAHA.119.015630.
doi: 10.1161/JAHA.119.015630
Segers P, Rietzschel ER, Chirinos JA. How to measure arterial stiffness in humans. Arterioscler Thromb Vasc Biol 2020;40:1034–1043. doi: 10.1161/ATVBAHA.119.313132.
doi: 10.1161/ATVBAHA.119.313132
Teixeira R, Vieira MJ, Goncalves A, Cardim N, Goncalves L. Ultrasonographic vascular mechanics to assess arterial stiffness: A review. Eur Heart J Cardiovasc Imaging 2016;17:233–246. doi: 10.1093/ehjci/jev287.
doi: 10.1093/ehjci/jev287
Townsend RR, Wilkinson IB, Schiffrin EL, Avolio AP, Chirinos JA, Cockcroft JR, et al. Recommendations for improving and standardizing vascular research on arterial stiffness: A scientific statement from the American Heart Association. Hypertension 2015;66:698–722. doi: 10.1161/HYP.0000000000000033.
doi: 10.1161/HYP.0000000000000033
Drole Torkar A, Plesnik E, Groselj U, Battelino T, Kotnik P. Carotid intima-media thickness in healthy children and adolescents: Normative data and systematic literature review. Front Cardiovasc Med 2020;7:597768. doi: 10.3389/fcvm.2020.597768.
doi: 10.3389/fcvm.2020.597768
Jones DW, Hall JE. Racial and ethnic differences in blood pressure: Biology and sociology. Circulation 2006;114:2757–2759. doi: 10.1161/CIRCULATIONAHA.106.668731.
doi: 10.1161/CIRCULATIONAHA.106.668731
Howard G, Sharrett AR, Heiss G, Evans GW, Chambless LE, Riley WA, et al. Carotid artery intimal-medial thickness distribution in general populations as evaluated by B-mode ultrasound. ARIC Investigators. Stroke 1993;24:1297–1304. doi: 10.1161/01.str.24.9.1297.
doi: 10.1161/01.str.24.9.1297
Snijder MB, Stronks K, Agyemang C, Busschers WB, Peters RJ, van den Born BJ. Ethnic differences in arterial stiffness the Helius study. Int J Cardiol 2015;191:28–33. doi: 10.1016/j.ijcard.2015.04.234.
doi: 10.1016/j.ijcard.2015.04.234
Engelen L, Ferreira I, Stehouwer CD, Boutouyrie P, Laurent S; Reference Values for Arterial Measurements Collaboration. Reference intervals for common carotid intima-media thickness measured with echotracking: Relation with risk factors. Eur Heart J 2013;34:2368–2380. doi: 10.1093/eurheartj/ehs380.
doi: 10.1093/eurheartj/ehs380
Reference Values for Arterial Stiffness Collaboration. Determinants of pulse wave velocity in healthy people and in the presence of cardiovascular risk factors: ‘Establishing normal and reference values’. Eur Heart J 2010;31:2338–2350. doi: 10.1093/eurheartj/ehq165.
doi: 10.1093/eurheartj/ehq165
Herbert A, Cruickshank JK, Laurent S, Boutouyrie P; Reference Values for Arterial Measurements Collaboration. Establishing reference values for central blood pressure and its amplification in a general healthy population and according to cardiovascular risk factors. Eur Heart J 2014;35:3122–3133. doi: 10.1093/eurheartj/ehu293.
doi: 10.1093/eurheartj/ehu293
Mitchell GF, Parise H, Benjamin EJ, Larson MG, Keyes MJ, Vita JA, et al. Changes in arterial stiffness and wave reflection with advancing age in healthy men and women: The Framingham Heart Study. Hypertension 2004;43:1239–1245. doi: 10.1161/01.HYP.0000128420.01881.aa.
doi: 10.1161/01.HYP.0000128420.01881.aa
Yin LX, Ma CY, Wang S, Wang YH, Meng PP, Pan XF, et al. Reference values of carotid ultrafast pulse-wave velocity: A prospective, multicenter, population-based study. J Am Soc Echocardiogr 2021;34:629–641. doi: 10.1016/j.echo.2021.01.003.
doi: 10.1016/j.echo.2021.01.003
College of sonographers affiliated to CMDA. Guideline for vascular ultrasound examination. Chin J Ultrasonogr 2009;18:911–920. doi: 10.3760/cma.j.issn.1004-4477.2009.10.037
doi: 10.3760/cma.j.issn.1004-4477.2009.10.037
Joint Committee Issued Chinese Guideline for the Management of Dyslipidemia in Adults. 2016 Chinese guideline for the management of dyslipidemia in adults. Zhonghua Xin Xue Guan Bing Za Zhi 2016;44:833–853. doi: 10.3760/cma.j.issn.0253-3758.2016.10.005.
doi: 10.3760/cma.j.issn.0253-3758.2016.10.005
Zeng Q, He Y, Dong S, Zhao X, Chen Z, Song Z, et al. Optimal cut-off values of BMI, waist circumference and waist: Height ratio for defining obesity in Chinese adults. Br J Nutr 2014;112:1735–1744. doi: 10.1017/S0007114514002657.
doi: 10.1017/S0007114514002657
Zhai FF, Yang M, Wei Y, Wang M, Gui Y, Han F, et al. Carotid atherosclerosis, dilation, and stiffness relate to cerebral small vessel disease. Neurology 2020;94:e1811–e1819. doi: 10.1212/WNL.0000000000009319.
doi: 10.1212/WNL.0000000000009319
Meinders JM, Hoeks AP. Simultaneous assessment of diameter and pressure waveforms in the carotid artery. Ultrasound Med Biol 2004;30:147–154. doi: 10.1016/j.ultrasmedbio.2003.10.014.
doi: 10.1016/j.ultrasmedbio.2003.10.014
Climie RE, Boutouyrie P, Perier MC, Guibout C, van Sloten TT, Thomas F, et al. Individual and neighborhood deprivation and carotid stiffness. Hypertension 2019;73:1185–1194. doi: 10.1161/HYPERTENSIONAHA.118.12186.
doi: 10.1161/HYPERTENSIONAHA.118.12186
Zhou TL, Henry RMA, Stehouwer CDA, van Sloten TT, Reesink KD, Kroon AA. Blood pressure variability, arterial stiffness, and arterial remodeling. Hypertension 2018;72:1002–1010. doi: 10.1161/HYPERTENSIONAHA.118.11325.
doi: 10.1161/HYPERTENSIONAHA.118.11325
Laurent S, Cockcroft J, Van Bortel L, Boutouyrie P, Giannattasio C, Hayoz D, et al. Expert consensus document on arterial stiffness: Methodological issues and clinical applications. Eur Heart J 2006;27:2588–2605. doi: 10.1093/eurheartj/ehl254.
doi: 10.1093/eurheartj/ehl254
Aldridge ME, Do K, Oo T, Naqvi TZ. Carotid intima-media thickness and plaque assessment by trained medical residents: Validation and preliminary testing of a training protocol. J Am Soc Echocardiogr 2013;26:1457–1464. doi: 10.1016/j.echo.2013.08.009.
doi: 10.1016/j.echo.2013.08.009
Boutouyrie P, Chowienczyk P, Humphrey JD, Mitchell GF. Arterial stiffness and cardiovascular risk in hypertension. Circ Res 2021;128:864–886. doi: 10.1161/CIRCRESAHA.121.318061.
doi: 10.1161/CIRCRESAHA.121.318061
Ungvari Z, Tarantini S, Sorond F, Merkely B, Csiszar A. Mechanisms of vascular aging, a Geroscience perspective: JACC focus seminar. J Am Coll Cardiol 2020;75:931–941. doi: 10.1016/j.jacc.2019.11.061.
doi: 10.1016/j.jacc.2019.11.061
Ward MR, Pasterkamp G, Yeung AC, Borst C. Arterial remodeling. Mechanisms and clinical implications. Circulation 2000;102:1186–1191. doi: 10.1161/01.cir.102.10.1186.
doi: 10.1161/01.cir.102.10.1186
Markert MS, Della-Morte D, Cabral D, Roberts EL Jr., Gardener H, Dong C, et al. Ethnic differences in carotid artery diameter and stiffness: The Northern Manhattan Study. Atherosclerosis 2011;219:827–832. doi: 10.1016/j.atherosclerosis.2011.08.028.
doi: 10.1016/j.atherosclerosis.2011.08.028
Sass C, Herbeth B, Chapet O, Siest G, Visvikis S, Zannad F. Intima-media thickness and diameter of carotid and femoral arteries in children, adolescents and adults from the Stanislas cohort: Effect of age, sex, anthropometry and blood pressure. J Hypertens 1998;16:1593–1602. doi: 10.1097/00004872-199816110-00005.
doi: 10.1097/00004872-199816110-00005
Uejima T, Dunstan FD, Arbustini E, Łoboz-Grudzień K, Hughes AD, Carerj S, et al. Age-specific reference values for carotid arterial stiffness estimated by ultrasonic wall tracking. J Hum Hypertens 2020;34:214–222. doi: 10.1038/s41371-019-0228-5.
doi: 10.1038/s41371-019-0228-5
Tang CJ, Lee PY, Chuang YH, Huang CC. Measurement of local pulse wave velocity for carotid artery by using an ultrasound-based method. Ultrasonics 2020;102:106064. doi: 10.1016/j.ultras.2020.106064.
doi: 10.1016/j.ultras.2020.106064
Simova I, Katova T, Santoro C, Galderisi M. Comparison between regional and local pulse-wave velocity data. Echocardiography 2016;33:77–81. doi: 10.1111/echo.12985.
doi: 10.1111/echo.12985
Latham RD, Westerhof N, Sipkema P, Rubal BJ, Reuderink P, Murgo JP. Regional wave travel and reflections along the human aorta: A study with six simultaneous micromanometric pressures. Circulation 1985;72:1257–1269. doi: 10.1161/01.cir.72.6.1257.
doi: 10.1161/01.cir.72.6.1257
El Khoudary SR, Aggarwal B, Beckie TM, Hodis HN, Johnson AE, Langer RD, et al. Menopause transition and cardiovascular disease risk: Implications for timing of early prevention: A scientific statement from the American Heart Association. Circulation 2020;142:e506–e532. doi: 10.1161/CIR.0000000000000912.
doi: 10.1161/CIR.0000000000000912
Janner JH, Godtfredsen NS, Ladelund S, Vestbo J, Prescott E. Aortic augmentation index: Reference values in a large unselected population by means of the SphygmoCor device. Am J Hypertens 2010;23:180–185. doi: 10.1038/ajh.2009.234.
doi: 10.1038/ajh.2009.234
Segers P, Mahieu D, Kips J, Rietzschel E, De Buyzere M, De Bacquer D, et al. Amplification of the pressure pulse in the upper limb in healthy, middle-aged men and women. Hypertension 2009;54:414–420. doi: 10.1161/HYPERTENSIONAHA.109.133009.
doi: 10.1161/HYPERTENSIONAHA.109.133009
Zocalo Y, Bia D. Central pressure waveform-derived indexes obtained from carotid and radial tonometry and brachial oscillometry in healthy subjects (2-84 Y): Age-, height-, and sex-related profiles and analysis of indexes agreement. Front Physiol 2021;12:774390. doi: 10.3389/fphys.2021.774390.
doi: 10.3389/fphys.2021.774390
Kolade OO, O’Moore-Sullivan TM, Stowasser M, Coombes JS, Fassett RG, Marwick TH, et al. Arterial stiffness, central blood pressure and body size in health and disease. Int J Obes (Lond) 2012;36:93–99. doi: 10.1038/ijo.2011.79.
doi: 10.1038/ijo.2011.79
Nordestgaard BG, Chapman MJ, Ray K, Borén J, Andreotti F, Watts GF, et al. Lipoprotein(a) as a cardiovascular risk factor: Current status. Eur Heart J 2010;31:2844–2853. doi: 10.1093/eurheartj/ehq386.
doi: 10.1093/eurheartj/ehq386
Yaghi S, Elkind MS. Lipids and cerebrovascular disease: Research and practice. Stroke 2015;46:3322–3328. doi: 10.1161/STROKEAHA.115.011164.
doi: 10.1161/STROKEAHA.115.011164
Cecelja M, Jiang B, Keehn L, Hussain T, Silva Vieira M, Phinikaridou A, et al. Arterial stiffening is a heritable trait associated with arterial dilation but not wall thickening: A longitudinal study in the twins UK cohort. Eur Heart J 2018;39:2282–2288. doi: 10.1093/eurheartj/ehy165.
doi: 10.1093/eurheartj/ehy165