Vitorino Modesto dos Santos1, Laura Campos Modesto2
doi: http://dx.doi.org/10.5195/ijms.2020.857
Volume 8, Number 3: 322-323
Received 28 11 2020: Rev-request 07 12 2020: Rev-recd 08 12 2020: Accepted 08 12 2020
We read the review by Albers SS et al. emphasizing the relationship between carotid artery morphology and the evolution of atherosclerotic carotid artery disease (CAD).1 The authors commented on the anatomic changes developing since birth and increasing with aging, which play a significant role in the development of atherosclerotic CAD. Mainly, due to the interactions with well-known risk factors of atherosclerotic plaques including hypertension, dyslipidemia, diabetes mellitus, and smoking; they also focused on intra-individual differences in the extension of carotid involvement.1 Their findings are useful in daily practice by indicating anatomical and demographic factors related to the CAD pathogenesis, and showing that people may have unilateral carotid changes when both arteries underwent actions of the same systemic risk factors.1 Increases in internal carotid kinking, carotid bulb diameter, internal and common carotid tortuosity, and bifurcation angle are more frequent with aging. Even in absence of disease, these alterations can contribute in disturbances of the intramural elastin, but the threshold at which the changes cause or protect from atherosclerotic CAD is not clear.1
In this setting, evaluations of carotid intima-media thickness (CIMT) in people with obesity, chronic kidney disease (CKD), and hyperparathyroidism seem be appropriate.2-4 For example, the comparison of CIMT in two groups (G1 and G2) of hemodialysis people with levels of parathormone (PTH)≤ 200 pg/ml (G1), mean age: 46 ± 5 years and above 500 pg/ml (G2), mean age: 48 ± 5 years. Patients were between the ages of 18 to 65 years and an ultrasonography study in the middle third of the right common carotids which showed no significant enhanced thickness and calcified plaques (G1: 42.86%, G2: 71.43%). CIMT was correlated with PTH levels. Worthy of note, the time on dialysis made no difference between CIMT of the groups.2 CIMT was studied in three groups of patients aged between 30 and 60 years: G1 obese with CKD; G2 non-obese with CKD; and G3 obese without CKD.3 All groups had measurements of CIMT higher than normal, mainly in patients of G3 (control group of study), showing that arterial changes are more related with obesity.3
There is a general accordance about the adoption of the earliest as possible procedures to reach and maintain a low cardiovascular risk during the entire life course. The role of vascular remodeling and risk factors for cardiovascular disorders since conception to 2 years of life also merit attention to allow for effective prevention.4 Recent review with meta-analyses of 6,221 studies including 7,977 individuals assess for CIMT in ages from 0 to 18 years revealed risk factors in the first 1,000 days of life. Small size for gestational age was the most significant association with increased CIMT in childhood, which is related to disturbed blood flow and pressure and atherosclerosis. Although further research is needed to confirm the findings, preventive measures are justified, as eradicating gestational smoking and providing adequate maternal nutrition.4
Additional concern is on the relation of increased CIMT with stroke risk and vascular dementia development; with the growing population of older individuals, preventive procedures should initiate as early as possible.5 Guidelines for control cardiovascular risks highlight the cost-effectiveness of primary and secondary prevention of stroke and high blood pressure, associated conditions with atherosclerosis that play a role in the evolution of vascular and Alzheimer's dementia. The weight control since the earliest infancy would reduce future cerebrovascular disorders and the development of dementia, increasing the quality of life of the elderly.5
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The Authors have no funding, financial relationships or conflicts of interest to disclose.
Conceptualization: VMS, LCM, Data Curation: VMS, LCM, Formal Analysis: VMS, LCM, Investigation: VMS, LCM, Methodology: VMS, Project Administration: VMS, Resources: VMS, LCM, Supervision: VMS, Validation: VMS, Visualization: VMS, LCM, Writing – Original Draft: VMS, LCM, Writing – Review & Editing: VMS, LCM.
1. Albers SS, Kucey AS, Engineer A. The role of intraindividual carotid artery variation in the development of atherosclerotic carotid artery disease: a literature review. Int J Med Students. 2019 Sep-Dec;7(3):82-91.
2. Costa AF, Barufaldi F, Silveira MA, dos Santos VM, Menezes Pde L. Association of PTH and carotid thickness in patients with chronic kidney failure and secondary hyperparathyroidism. J Bras Nefrol. 2014 Jul-Sep;36(3):315-9.
3. El-Masrya SA, Mohamed HA, Enaite AM, Ali MM, Ibrahim IA. Carotid intima-media thickness assessment in obese patients with chronic renal failure. J Arab Soc Med Res. 2018 Jul 20;13:18-24.
4. Epure AM, Rios-Leyvraz M, Anker D, Di Bernardo S, da Costa BR, Chiolero A, et al. Risk factors during first 1,000 days of life for carotid intima-media thickness in infants, children, and adolescents: A systematic review with meta-analyses. PLoS Med. 2020 Nov 23;17(11):e1003414.
5. Santos VM, Sá DAR. [The growth of centenarians: when to start dementia prevention?] Gac Méd Caracas. 2009 Sept;117(3):250-1. Esp.
Vitorino Modesto dos Santos, 1 MD, PhD, Adjunct-Professor of Internal Medicine, Armed Forces Hospital and Catholic University of Brasília-DF, Brazil
Laura Campos Modesto, 2 Medical student, University Center of Brasília-DF, Brazil
About the Author: Laura Campos Modesto is currently finishing the first-year as medical student in a six-year program of the Medical Course at the University Center of Brasília (Uniceub), Brasília-DF, Brazil.
Correspondence: Vitorino Modesto dos Santos. Address: 707/907-Campus Universitario, SEPN – Asa Norte, Brasilia, Brazil. Email: vitorinomodestos@gmail.com
Editor: Mihnea-Alexandru Găman Proofreader: Leah Komer Layout Editor: Judie Joo
Cite as: Santos VM, Modesto LC. Carotid Intima-Media Thickness and Cardiovascular Risk Factors. Int J Med Students. 2020 Sep-Dec;8(3):322-3.
Copyright © 2020 Vitorino Modesto dos Santos, Laura Campos Modesto
This work is licensed under a Creative Commons Attribution 4.0 International License.
International Journal of Medical Students, VOLUME 8, NUMBER 3, December 2020