Ultrasound assessment of age-related arterial wall changes

Koronarna bolest srca (KBS) i moždani udar (MU) su vodeći uzroci smrti u svijetu. Uspješno prepoznavanje pacijenata s povišenim rizikom za obolijevanje od kardiovaskularnih bolesti (KVB) omogućava poduzimanje mjera primarne prevencije. Međutim, metode procjene rizika zasnivane na tradicionalnim čimbenicima rizika (npr. Framinghamska ljestvica, SCORE) nisu se pokazale dovoljno pouzdanima u otkrivanju najčešćeg uzroka KVB – ateroskleroze. Starenje je jedan od značajnijih ireverzibilnih rizičnih čimbenika za razvoj KVB. Dovodi do postupne promjene strukture i funkcije krvnih žila koja počinje rano u životu. Većina složenih podležećih degenerativnih mehanizama se isprepliće s mehanizmima koji dovode do ateroskleroze. Ukupna debljina intime i medije stijenke karotidnih arterija (eng. cIMT=carotid intima-media thickness) mjerena ultrazvukom u B-načinu rada je pouzdana, neinvazivna i relativno jeftina metoda otkrivanja subkliničke ateroskleroze koja se može ponavljati bez nuspojava za pacijenta. Epidemiološka istraživanja su pokazala značajnu i neovisnu korelaciju cIMT s kardiovaskularnim incidentima. Usprkos tome, još uvijek je upitno poboljšanje stratifikacije rizika ubrajanjem cIMT među tradicionalne rizične čimbenike za KVB. Na temelju dobno- i spolno- specifične percentilne vrijednosti cIMT, kronološka dob se može preračunati u tzv. vaskularnu dob, koncept koji označava težinu aterosklerotske bolesti. Kontrola čimbenika rizika za KVB mogla bi dovesti do usporavanja razvoja ranih aterosklerotskih promjena. Pretilost je značajni i neovisni čimbenik rizika za KVB te je povezana s višom vrijednosti i ubrzanom progresijom cIMT. Stoga smo na skupini pretilih osoba ispitali hipotezu da smanjenje tjelesne mase (TM) reducira cIMT u pretilih osoba. Istraživanje je pratilo 19 pretilih ispitanika, sudionika programa za smanjenje TM pod liječničkim nadzorom. Nakon 6 mjeseci ispitanici su podijeljeni u tri skupine prema uspješnosti gubitka TM. Rezultati istraživanja nisu pokazali statistički značajnu razliku smanjenja cIMT između skupina.Coronary heart disease and stroke are the leading causes of death in the world. Primary prevention measures can reduce the risk of cardiovascular disease after a patient has been accurately assessed. However, risk assessment methods based on traditional risk factors (i.e. Framingham risk score, SCORE) fail to directly reveal the presence of the most common cause of cardiovascular disease – atherosclerosis. Ageing is considered a major and irreversible risk factor for cardiovascular disease. Age-related gradual changes of vascular structure and function start early in life. Most of the complex mechanisms that lead to degenerative changes in the arterial wall are common with those mediating atherosclerosis. B-mode ultrasound measurement of carotid intima-media thickness (cIMT) is a reproducible, noninvasive and relatively low-cost method of determining the presence of subclinical atherosclerosis without any known adverse effects. Epidemiological studies have shown that cIMT is significantly and independently correlated with future cardiovascular events. Nevertheless, the usefulness of adding cIMT to the traditional risk factors is still questionable as risk stratification improvement is limited. On the basis of the estimated age- and sex- specific percentile of cIMT, patients' chronological age can be adjusted for their atherosclerotic burden, a concept that is called vascular age. Reducing risk factors for cardiovascular disease could lead to slower progression of early atherosclerotic changes. Obesity is a significant and independent risk factor for cardiovascular disease and it is related to the increased value and faster progression of cIMT. The objective of this paper is to investigate whether weight loss reduces cIMT in obese subjects. The study followed 19 obese subjects which participated in weight reduction program under medical supervision. At six-month follow-up subjects were divided into three groups based on the extent of weight loss. However, results did not find statistically significant differences between groups