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Journal of Atherosclerosis and... Oct 2022We investigated whether retinal arteriolosclerosis (RA) could be used for cardiovascular disease (CVD) risk stratification of individuals categorized according to the...
AIM
We investigated whether retinal arteriolosclerosis (RA) could be used for cardiovascular disease (CVD) risk stratification of individuals categorized according to the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) Blood Pressure (BP) guideline.
METHODS
We studied 291,522 participants without a history of CVD and not taking any BP-lowering medications from the JMDC Claims Database. RA was defined as Keith-Wagener-Barker system grade ≥ 1. Each participant was classified into one of the six groups: (1) normal or elevated BP without RA, (2) normal or elevated BP with RA, (3) stage 1 hypertension without RA, (4) stage 1 hypertension with RA, (5) stage 2 hypertension without RA, and (6) stage 2 hypertension with RA.
RESULTS
Median (interquartile range) age was 46 (40-53) years, and 141,397 (48.5%) of the participants were men. During a mean follow-up of 1,223±830 days, 527 myocardial infarction (MI), 5,718 angina pectoris, 2,890 stroke, and 5,375 heart failure (HF) events occurred. Multivariable Cox regression analyses revealed that the risk of CVD increased with BP category, and this association was pronounced by the presence of RA. Compared with normal or elevated BP without RA, the hazard ratios (HRs) for MI (HR 1.17, 95% CI 0.93-1.47) were higher in stage 1 hypertension without RA. The HRs for MI further increased in stage 1 hypertension with RA (1.86 [1.17-2.95]). This association was present in stroke and HF.
CONCLUSION
Incorporation of the assessment for RA may facilitate the CVD risk stratification of people classified based on the 2017 ACC/AHA BP guideline, particularly for those categorized in stage 1 hypertension.
Topics: Arteriolosclerosis; Blood Pressure; Cardiology; Female; Heart Failure; Humans; Hypertension; Male; Middle Aged; Myocardial Infarction; Risk Assessment; Risk Factors; Stroke; United States
PubMed: 34866070
DOI: 10.5551/jat.63262 -
The American Journal of Surgical... Jul 2015Liver involvement in diabetes is well recognized in the form of steatohepatitis and glycogenic hepatopathy. More recently, sinusoidal fibrosis, even in the absence of...
Liver involvement in diabetes is well recognized in the form of steatohepatitis and glycogenic hepatopathy. More recently, sinusoidal fibrosis, even in the absence of steatosis, has also been suggested to be associated with diabetes (diabetic hepatosclerosis); however, case-control studies are lacking. In addition, microangiopathy (hyaline arteriolosclerosis), a well-known complication of diabetes, has not been well studied in liver. Therefore, we undertook a cross-sectional blinded study with the specific aim of evaluating the association between hepatic sinusoidal fibrosis and hepatic arteriolosclerosis (HA) with diabetes. Liver biopsy findings from 89 diabetic patients obtained between January 2006 and December 2009 were compared with those of 89 nondiabetic patients matched by age and hepatitis C virus infection status. Patients with cirrhosis, liver mass, right heart failure, significant alcohol use, or insufficient available clinical information were excluded. Medical records were reviewed for the presence of diabetes, body mass index, diabetes treatment, and comorbidities at the time of biopsy (eg, underlying liver disease, hypertension, dyslipidemia). Liver biopsies were evaluated blinded to all clinical data (including presence or absence of diabetes) for a variety of histologic features, especially patterns of fibrosis and HA. Diabetic patients had a higher average body mass index (33 vs. 30 m/kg, P=0.0039), prevalence of hypertension (78% vs. 33%, P<0.0001), and dyslipidemia (52% vs. 20%, P<0.0001). Among diabetic patients, 87% had type 2 diabetes, and 57% used insulin. Whereas sinusoidal fibrosis, with or without steatosis, was not significantly associated with the presence of diabetes, HA was significantly more prevalent among diabetic patients compared with controls: 45% versus 29% (P=0.0298). The presence of both diabetes and hypertension had a significant odds for HA: with an adjusted odds ratio of 2.632 (95% confidence interval, 1.178-5.878; P=0.0183). Biliary changes were associated with HA in some cases (10.6%).In this study, we describe the histopathologic entity of HA for the first time. It is a small-vessel complication (microangiopathy) of the liver observed mainly in patients with diabetes who also have arterial hypertension. The clinical and prognostic implications of this finding, particularly regarding liver injury, remain to be further investigated.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Arteriolosclerosis; Case-Control Studies; Child; Cross-Sectional Studies; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Diabetic Angiopathies; Female; Humans; Hypertension; Liver; Male; Middle Aged; Young Adult
PubMed: 25786083
DOI: 10.1097/PAS.0000000000000419 -
Renal Failure Nov 2019We aimed to evaluate the relationship between biopsy-proven kidney lesions, subclinical markers of atherosclerosis and intrarenal resistive index (RRI) in chronic...
We aimed to evaluate the relationship between biopsy-proven kidney lesions, subclinical markers of atherosclerosis and intrarenal resistive index (RRI) in chronic kidney disease (CKD) patients. This cross-sectional, single-center study prospectively enrolled 44 consecutive CKD patients (57% male gender, 54.1 (95%CI, 49.7-58.6) years, median eGFR 28.1 (15.0-47.7) mL/min) diagnosed by renal biopsy during 6 months in our clinic. RRI, carotid intima-media thickness (IMT), Kauppila score for abdominal aortic calcification (AACs) were assessed. Traditional and nontraditional atheroscleosis risk factors were also evaluated. Most of the patients had a diagnosis of glomerular nephropathy, with IgA nephropathy and diabetic nephropathy being the most frequent. RRI increased proportionally with CKD stages. Patients with RRI >0.7 (39%) were older, had diabetic and vascular nephropathies more frequently, higher mean arterial blood pressure, increased systemic atherosclerosis burden (IMT and AACs), higher percentage of global glomerulosclerois, GBM thickness, arteriolosclerosis and interstitial fibrosis/tubular atrophy. RRI directly correlated with age (rs = 0.55, < 0.001) and with all the studied atherosclerosis markers (clinical atherosclerosis score rs = 0.50, = 0.02; AACs rs = 0.50, < 0.01; IMT rs = 0.34, = 0.02). Also, global glomerulosclerosis (rs = 0.31, = 0.03) and interstitial fibrosis/tubular atrophy (rs = 0.35, = 0.01) were directly correlated with RRI. In multivariable adjusted binomial logistic regression models, only arteriolosclerosis was retained as independent predictor of RRI >0.7. The analysis of RRI may be useful in the evaluation of the general vascular condition of the patient with CKD, supplying information about both microvascular and macrovascular impairment. Moreover, RRI correlates well with renal histopathologic characteristics, particularly with arteriolosclerosis.
Topics: Adult; Aged; Arteriolosclerosis; Atherosclerosis; Biopsy; Carotid Intima-Media Thickness; Cross-Sectional Studies; Feasibility Studies; Female; Glomerular Filtration Rate; Humans; Kidney Glomerulus; Male; Middle Aged; Prospective Studies; Regional Blood Flow; Renal Insufficiency, Chronic; Risk Factors; Vascular Resistance
PubMed: 31599199
DOI: 10.1080/0886022X.2019.1674159 -
Stroke Jan 2020
Review
Topics: Arteriolosclerosis; Cerebral Small Vessel Diseases; Humans; Ischemia; Magnetic Resonance Imaging; Mutation; Stroke
PubMed: 31752611
DOI: 10.1161/STROKEAHA.119.024151 -
Der Pathologe Sep 2019Arteriosclerosis is the general term for a group of arterial vascular diseases characterized by arterial wall thickening and loss of elasticity, which are caused by...
Arteriosclerosis is the general term for a group of arterial vascular diseases characterized by arterial wall thickening and loss of elasticity, which are caused by different biological processes. The most commonly used classification defines four distinct histopathological types: arteriolosclerosis, medial sclerosis, fibromuscular intimal hyperplasia and atherosclerosis. The pathobiological remodeling of the arterial wall essentially represents different repair responses of vascular cells to molecular stress factors and microlesions. This article should contribute to the clarification of the nomenclature and the histopathological classification of the disease symptoms, to elucidate the biological processes underlying the different pathologies during arteriosclerosis and to raise awareness for these differences, because these can decisively contribute to the success of selected treatment modalities.
Topics: Arteries; Arteriosclerosis; Humans
PubMed: 31435781
DOI: 10.1007/s00292-019-00656-z -
Stroke Feb 2016Although several forms of sleep disruption are associated with stroke, few studies have examined the relationship between sleep and histopathologic measures of...
BACKGROUND AND PURPOSE
Although several forms of sleep disruption are associated with stroke, few studies have examined the relationship between sleep and histopathologic measures of cerebrovascular disease. We tested the hypothesis that greater sleep fragmentation is associated with a higher burden of cerebral vessel and infarct pathology at autopsy.
METHODS
We used ordinal logistic regression models to relate sleep fragmentation measured by actigraphy to the severity of arteriolosclerosis, atherosclerosis, and cerebral amyloid angiopathy, and the number of macroscopic and microscopic infarcts assessed by structured brain autopsy in 315 participants from the Rush Memory and Aging Project.
RESULTS
Greater sleep fragmentation was associated with more severe arteriolosclerosis (odds ratio, 1.27; 95% confidence interval, 1.02-1.59; P=0.03 per 1 SD greater sleep fragmentation) and more subcortical macroscopic infarcts (odds ratio, 1.31; 95% confidence interval, 1.01-1.68; P=0.04). These associations were independent of established cardiovascular risk factors and diseases, and several medical comorbidities.
CONCLUSIONS
Sleep fragmentation is associated with arteriolosclerosis and subcortical infarcts in older adults.
Topics: Actigraphy; Aged, 80 and over; Arteriolosclerosis; Autopsy; Brain Infarction; Cerebral Amyloid Angiopathy; Cerebral Infarction; Female; Humans; Independent Living; Intracranial Arteriosclerosis; Logistic Models; Male; Odds Ratio; Severity of Illness Index; Sleep Deprivation
PubMed: 26768207
DOI: 10.1161/STROKEAHA.115.011608 -
JAMA Neurology Nov 2019Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease associated with repetitive head impacts, including those from US football, that presents with...
IMPORTANCE
Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease associated with repetitive head impacts, including those from US football, that presents with cognitive and neuropsychiatric disturbances that can progress to dementia. Pathways to dementia in CTE are unclear and likely involve tau and nontau pathologic conditions.
OBJECTIVE
To investigate the association of white matter rarefaction and cerebrovascular disease with dementia in deceased men older than 40 years who played football and had CTE.
DESIGN, SETTING, AND PARTICIPANTS
This cross-sectional study involves analyses of data from the ongoing Understanding Neurologic Injury and Traumatic Encephalopathy (UNITE) Study, which is conducted via and included brain donors from the Veterans Affairs-Boston University-Concussion Legacy Foundation brain bank between 2008 and 2017. An original sample of 224 men who had played football and were neuropathologically diagnosed with CTE was reduced after exclusion of those younger than 40 years and those missing data.
EXPOSURES
The number of years of football play as a proxy for repetitive head impacts.
MAIN OUTCOMES AND MEASURES
Neuropathological assessment of white matter rarefaction and arteriolosclerosis severity (on a scale of 0-3, where 3 is severe); number of infarcts, microinfarcts, and microbleeds; and phosphorylated tau accumulation determined by CTE stage and semiquantitative rating of dorsolateral frontal cortex (DLFC) neurofibrillary tangles (NFTs) (none or mild vs moderate or severe). Informant-based retrospective clinical interviews determined dementia diagnoses via diagnostic consensus conferences.
RESULTS
A total of 180 men were included. The mean (SD) age of the sample at death was 67.9 (12.7) years. Of 180, 120 [66.7%]) were found to have had dementia prior to death. Moderate to severe white matter rarefaction (84 of 180 [46.6%]) and arteriolosclerosis (85 of 180 [47.2%]) were common; infarcts, microinfarcts, and microbleeds were not. A simultaneous equations regression model controlling for age and race showed that more years of play was associated with more severe white matter rarefaction (β, 0.16 [95% CI, 0.02-0.29]; P = .03) and greater phosphorylated tau accumulation (DLFC NFTs: β, 0.15 [95% CI, 0.004-0.30]; P = .04; CTE stage: β, 0.27 [95% CI, 0.14-0.41]; P < .001). White matter rarefaction (β, 0.16 [95% CI, 0.02-0.29]; P = .03) and DLFC NFTs (β, 0.16 [95% CI, 0.03-0.28]; P = .01) were associated with dementia. Arteriolosclerosis and years of play were not associated, but arteriolosclerosis was independently associated with dementia (β, 0.21 [95% CI, 0.07-0.35]; P = .003).
CONCLUSIONS AND RELEVANCE
Among older men who had played football and had CTE, more years of football play were associated with more severe white matter rarefaction and greater DLFC NFT burden. White matter rarefaction, arteriolosclerosis, and DLFC NFTs were independently associated with dementia. Dementia in CTE is likely a result of neuropathologic changes, including white matter rarefaction and phosphorylated tau, associated with repetitive head impact and pathologic changes not associated with head trauma, such as arteriolosclerosis.
PubMed: 31380975
DOI: 10.1001/jamaneurol.2019.2244 -
Nephrology (Carlton, Vic.) May 2020To investigate the possible associations between intrarenal arteriolosclerosis as determine by renal biopsy and endothelial function as well as arterial stiffness... (Observational Study)
Observational Study
AIM
To investigate the possible associations between intrarenal arteriolosclerosis as determine by renal biopsy and endothelial function as well as arterial stiffness measured by peripheral arterial tonometry (EndoPAT).
METHODS
This was a cross-sectional study. Patients who underwent both renal biopsy and EndoPAT were recruited, and intrarenal arteriolosclerosis was graded according to the pathological slice. Endothelial function and arterial stiffness were both measured by EndoPAT and were expressed by the reactive hyperemia index (RHI) and augmentation index (AIx), respectively. AIx@75, representing the AIx standardized to a heart rate of 75 bpm was also determined.
RESULTS
In total, 113 patients were assessed, the mean age was 51 ± 13, and 68.1% were men. The natural logarithm RHI (LnRHI), AIx and AIx@75 were significantly different among different grades of intrarenal arteriolosclerosis (P = .030, P < .001, P < .001, respectively). In the multivariable adjusted model, for every SD increase in the AIx and AIx@75, the odds of having more severe arteriolosclerosis were 2.506 times (95% confidence interval [CI] 1.464-4.288, P = .001] and 3.191 times (95% CI 1.780-5.719, P < .001) higher, respectively, and the association between the LnRHI and intrarenal arteriolosclerosis was nullified (P = .059). The positive values of the AIx and AIx@75 for the diagnosis of severe intrarenal arteriolosclerosis were 0.80 (95% CI 0.73-0.88, P < .001) and 0.78 (95% CI 0.70-0.87, P < .001), respectively.
CONCLUSION
Subjects with more severe intrarenal arteriolosclerosis have greater peripheral vascular stiffness; AIx and AIx@75 reflected peripheral vascular stiffness could be used to identify patients with severe intrarenal arteriolosclerosis.
Topics: Aged; Arterioles; Arteriolosclerosis; Biopsy; Cross-Sectional Studies; Female; Fingers; Humans; Kidney; Kidney Diseases; Male; Manometry; Middle Aged; Plaque, Atherosclerotic; Predictive Value of Tests; Severity of Illness Index; Vascular Stiffness
PubMed: 31576636
DOI: 10.1111/nep.13665 -
Contributions To Nephrology 2018Cerebrovascular disease is a major cause of death in dialysis patients, who have a much higher incidence of stroke compared to the normal population. Recent studies have... (Review)
Review
Cerebrovascular disease is a major cause of death in dialysis patients, who have a much higher incidence of stroke compared to the normal population. Recent studies have shown that asymptomatic cerebral small-vessel disease, including silent brain infarction (SBI), white matter hyperintensities (WMHs), and cerebral microbleeds (CMBs), is related to the future onset of stroke. Cerebral small-vessel disease is caused by microvascular damage to the small penetrating arteries of the middle cerebral artery including arteriolosclerosis, fibrinoid necrosis, and lipohyalinosis attributed to advanced age, hypertension, etc. SBI is thought to occur due to cerebral small vessel occlusion caused by vascular necrosis, CMB vascular breakdown caused by vascular fragility, and WMH chronic ischemia caused by decreased perfusion. Because small-vessel disease is more prevalent in dialysis patients compared with the normal population, further evidence on small-vessel disease needs to be accumulated in order to prevent future strokes in these patients.
Topics: Cause of Death; Cerebral Small Vessel Diseases; Humans; Renal Dialysis; Renal Insufficiency, Chronic; Stroke
PubMed: 30041200
DOI: 10.1159/000485692 -
Nephrology (Carlton, Vic.) Sep 2015Hypertension contributes critically to the development of renal arteriolosclerosis in chronic kidney disease (CKD), but the impact of vascular function indexes including... (Observational Study)
Observational Study
AIM
Hypertension contributes critically to the development of renal arteriolosclerosis in chronic kidney disease (CKD), but the impact of vascular function indexes including central blood pressure on renal arteriolosclerosis has not been investigated. We determined whether vascular function indexes were related to renal arteriolosclerosis and renal clinical outcomes in CKD.
METHODS
This cross-sectional study was implemented in our hospital. Subjects were in-patients with CKD aged ≥20 years who underwent a renal biopsy. Vascular function indexes included central systolic blood pressure (SBP), cardio-ankle vascular index (CAVI), and renal resistive index. Central SBP was measured non-invasively using an automated device. Arteriolosclerosis was assessed histologically. Renal clinical outcomes included estimated glomerular filtration rate using serum creatinine (eGFRcreat) or cystatin C (eGFRcys), and the urinary albumin-creatinine ratio.
RESULTS
Among vascular function indexes, central SBP was weakly correlated with renal arteriolosclerosis (n = 55). Renal arteriolosclerosis was increased in hypertensive or hyperuricaemic patients, and negatively correlated with serum high-density lipoprotein (HDL) cholesterol and eGFRcys, which were independent risk factors for renal arteriolosclerosis in a stepwise multivariate regression analysis. Of the vascular function indexes, CAVI showed the strongest correlation with all renal clinical outcomes. Central SBP was correlated with only urinary albumin-creatinine ratio, while renal resistive index was correlated with eGFRcreat and urinary albumin-creatinine ratio.
CONCLUSION
Decreased serum HDL cholesterol was independently and most closely associated with renal arteriolosclerosis. Of the vascular function indexes, CAVI had the greatest impact on renal clinical outcomes, although it was not associated with renal arteriolosclerosis.
Topics: Adult; Aged; Aged, 80 and over; Ankle Brachial Index; Arteriolosclerosis; Biomarkers; Biopsy; Blood Pressure; Creatinine; Cross-Sectional Studies; Cystatin C; Female; Glomerular Filtration Rate; Hemodynamics; Humans; Hyperlipidemias; Hypertension; Hyperuricemia; Kidney; Male; Middle Aged; Renal Artery Obstruction; Renal Insufficiency, Chronic; Vascular Resistance; Young Adult
PubMed: 25854541
DOI: 10.1111/nep.12483