Nicole E. Jensky

Blood Pressure and Vascular Calcification

The aim of this study was to determine the associations between the presence and extent of calcified atherosclerosis in multiple vascular beds and systolic blood pressure, diastolic blood pressure, pulse pressure, mean arterial pressure, isolated systolic hypertension, and hypertension. A total of 9510 patients (42.5% women) underwent electron beam computed tomography scanning as part of a routine health maintenance screening. At the same visit, blood pressure was measured with the participant in the seated position using a mercury sphygmomanometer. Mean age was 58±11.4 years, and body mass index was 27.1±4.5. The prevalences of any calcification in the carotids, coronaries, subclavians, thoracic aorta, abdominal aorta, and iliacs were 31.9%, 57.2%, 31.7%, 37.0%, 54.3%, and 48.8%, respectively. In separate multivariable logistic models containing traditional cardiovascular disease risk factors, pulse pressure and systolic blood pressure were significantly associated with the presence of calcification in all of the vascular beds except the iliacs and subclavians, respectively, with pulse pressure having stronger magnitudes of the associations for most of the vascular beds. Age-stratified analyses indicated that these associations were stronger in those >60 years of age compared with subjects <60 years of age, and sex-stratified analyses demonstrated that men had a greater association compared with women. Also, the magnitudes of the associations for isolated systolic hypertension were, in general, larger than those for hypertension. Pulse pressure and isolated systolic hypertension are robust and important correlates for calcified atherosclerosis in different vascular beds. Isolated systolic hypertension may be clinically relevant in diagnosing or preventing calcified atherosclerosis.

The association between abdominal body composition and vascular calcification.

Subclinical cardiovascular disease (CVD) may be associated with both adipose and skeletal muscle tissues in the abdomen. Accordingly, we examined whether subcutaneous, intermuscular, and visceral adipose tissue, as well as abdominal lean muscle, were associated with the presence and extent of vascular calcification in multiple vascular beds. Three hundred and ninety four patients (58.1% men) underwent electron beam computed tomography (EBCT) scans as part of routine health maintenance screening. The coronary and carotid calcium scores were analyzed at the time of the scan, whereas the other calcium scores, as well as the body composition analyses, were analyzed retrospectively. Mean age was 55.2 ± 11.1 years and BMI was 26.9 ± 4.2. The prevalence of any calcification in the carotids, coronaries, thoracic aorta, abdominal aorta, and iliacs was 30.1, 60.1, 39.8, 55.7, and 56.8%, respectively. Compared to those with calcification in different vascular beds, those without vascular calcification generally had significantly more lean muscle and less adipose tissue. In separate multivariable logistic models, a 1 s.d. increment in the ratio of abdominal and visceral fat to total area of each corresponding compartments was significantly associated with an increased odds for the presence of thoracic aortic calcium (odds ratio (OR) = 1.6, 1.5, respectively; P = 0.01 for both). Conversely, increases in abdominal lean muscle were associated with significantly decreased odds of thoracic aortic calcification (OR = 0.34; P ≤ 0.01). A similar pattern of associations existed among the other vascular beds. Also, the association between lean muscle and vascular calcification was independent of visceral adipose tissue. In conclusion, adipose tissue was positively and lean body mass inversely associated with prevalent aortic calcification.

The association of bone density and calcified atherosclerosis is stronger in women without dyslipidemia: The multi-ethnic study of atherosclerosis

We tested whether the association between bone mineral density (BMD) and coronary artery calcification (CAC) varies according to dyslipidemia in community‐living individuals. Between 2002 and 2005, 305 women and 631 men (mean age of 64 years), who were not taking lipid‐lowering medications or estrogen were assessed for spine BMD, CAC, and total (TC), HDL‐ and LDL‐cholesterol and triglycerides. Participants were a random sample from the Multi‐Ethnic Study of Atherosclerosis (MESA) without clinical cardiovascular disease. Spine BMD at the L3 vertebrate was performed by computer tomography (CT). CAC prevalence was measured by CT. The total cholesterol to HDL ratio (TC:HDL) ≥ 5.0 was used as the primary marker of hyperlipidemia. The association of BMD with CAC differed in women with TC:HDL < 5.0 versus higher (p‐interaction = 0.01). In age‐ and race‐adjusted models, among women with TC:HDL < 5.0, each SD (43.4 mg/cc) greater BMD was associated with a 25% lower prevalence of CAC (prevalence ratio [PR] 0.75, 95% confidence interval [CI] 0.63–0.89), whereas among women with higher TC:HDL, higher BMD was not significantly associated with CAC (PR 1.22, 95% CI 0.82–1.82). Results were similar using other definitions of hyperlipidemia. In contrast, no consistent association was observed between BMD and CAC in men, irrespective of the TC:HDL ratio (p interaction 0.54). The inverse association of BMD with CAC is stronger in women without dyslipidemia. These data argue against the hypothesis that dyslipidemia is the key factor responsible for the inverse association of BMD with atherosclerosis.

Difference by sex but not by race/ethnicity in the visceral adipose tissue-depressive symptoms association: The Multi-Ethnic Study of Atherosclerosis

BACKGROUND Prior studies have investigated the association of clinical depression and depressive symptoms with body weight (i.e. body mass index (BMI) and waist circumference), but few have examined the association between depressive symptoms and intra-abdominal fat. Of these a limited number assessed the relationship in a multi-racial/ethnic population. METHODS Using data on 1017 men and women (45-84 years) from the Multi-Ethnic Study of Atherosclerosis (MESA) Body Composition, Inflammation and Cardiovascular Disease Study, we examined the cross-sectional association between elevated depressive symptoms (EDS) and CT-measured visceral fat mass at L2-L5 with multivariable linear regression models. EDS were defined as a Center for Epidemiological Studies Depression score ≥16 and/or anti-depressant use. Covariates included socio-demographics, inflammatory markers, health behaviors, comorbidities, and body mass index (BMI). Race/ethnicity (Whites [referent group], Chinese, Blacks and Hispanics) and sex were also assessed as potential modifiers. RESULTS The association between depressive symptoms and visceral fat differed significantly by sex (p=0.007), but not by race/ethnicity. Among men, compared to participants without EDS, those with EDS had greater visceral adiposity adjusted for BMI and age (difference=122.5 cm2, 95% CI=34.3, 210.7, p=0.007). Estimates were attenuated but remained significant after further adjustment by socio-demographics, inflammatory markers, health behaviors and co-morbidities (difference=94.7 cm2, 95% CI=10.5, 178.9, p=0.028). Among women, EDS was not significantly related to visceral adiposity in the fully adjusted model. CONCLUSIONS Sex, but not race/ethnicity, was found to modify the relationship between EDS and visceral fat mass. Among men, a significant positive association was found between depressive symptoms and visceral adiposity. No significant relationship was found among women.

Adipokines are associated with lower extremity venous disease: the San Diego population study

Summary.  Background: Obesity is a risk factor for venous disease. We tested the associations between adipokines and the presence and severity of venous disease. Methods: Participants for this analysis were drawn from a cohort of 2408 employees and retirees of a university in San Diego who were examined for venous disease using duplex ultrasonography. From this cohort, a case‐control study sample of all 352 subjects with venous disease and 352 age‐, sex‐ and race‐matched subjects without venous disease were included in this analysis. All subjects completed health history questionnaires, had a physical examination with anthropometric measurements and had venous blood analyzed for adipokines. Results: After adjustment for age, sex and race, those with venous disease had significantly higher levels of body mass index (BMI), leptin and interleukin‐6. Levels of resistin and tumor necrosis factor‐alpha were also higher but of borderline significance (0.05 < P < 0.10). Compared with the lowest tertile and with adjustment for age, sex, race and BMI, the 2nd and 3rd tertiles of resistin (odds ratios, 1.9 and 1.7, respectively), leptin (1.7 and 1.7) and tumor necrosis factor‐alpha (1.4 and 1.7) were associated with increasing severity of venous disease. Conversely, a 5 kg m−2 increment in BMI was associated with a higher odds ratio (1.5) for venous disease, which was independent of the adipokines included in this study. Conclusions: Both obesity and adipokines are significantly associated with venous disease. These associations appear to be independent of each other, suggesting potentially different pathways to venous disease.

The epidemiology of subclavian artery calcification

OBJECTIVES The purpose of the present study was to determine the prevalence and risk factor associations for subclavian artery calcification. BACKGROUND Arterial calcification is a marker of atherosclerosis, and its presence portends an adverse prognostic risk. The prevalence and associated risk factors for aortic arch, carotid, renal, and coronary calcification have been well described. Fewer data are available for subclavian artery calcification. METHODS Electron-beam computed tomography was used to evaluate the extent of vascular calcification in multiple arterial beds in 1387 consecutive individuals who presented for preventive medicine services at a university-affiliated disease prevention center. Laboratory values for blood pressure, lipids, anthropomorphic data, and self-reported medical history were obtained. RESULTS Subclavian artery calcification was present in 439 of 1387 individuals (31.7%). Those with subclavian artery calcification were significantly older, had a smaller body mass index, and were more likely to also have calcification of nonsubclavian vascular beds. When adjusted for cardiovascular disease risk factors, the presence of subclavian artery calcification was significantly associated with age (prevalence ratio [PR], 1.04; P < .001), hypertension (PR, 1.20; P = .01), history of smoking (PR, 1.21; P = .01), and calcification in nonsubclavian vascular beds (PR, 1.58; P = .01). Subclavian artery calcification was also associated with an increased pulse pressure (β-coefficient = 2.2, P = .008). CONCLUSIONS Subclavian artery calcification is relatively common and is significantly associated with age, smoking, hypertension, and nonsubclavian vascular calcification. There may be a relationship between vascular stiffness, as manifested by a widened pulse pressure, and the presence of subclavian artery calcification.

Null association between abdominal muscle and calcified atherosclerosis in community-living persons without clinical cardiovascular disease: the multi-ethnic study of atherosclerosis.

OBJECTIVE Lean muscle loss has been hypothesized to explain J-shaped relationships of body mass index (BMI) with cardiovascular disease (CVD), yet associations of muscle mass with CVD are largely unknown. We hypothesized that low abdominal lean muscle area would be associated with greater calcified atherosclerosis, independent of other CVD risk factors. MATERIALS/METHODS We investigated 1020 participants from the Multi-Ethnic Study of Atherosclerosis who were free of clinical CVD. Computed tomography (CT) scans at the 4th and 5th lumbar disk space were used to estimate abdominal lean muscle area. Chest and abdominal CT scans were used to assess coronary artery calcification(CAC), thoracic aortic calcification (TAC), and abdominal aortic calcification (AAC). RESULTS The mean age was 64±10 years, 48% were female, and mean BMI was 28±5 kg/m2. In models adjusted for demographics, physical activity, caloric intake, and traditional CVD risk factors, there was no inverse association of abdominal muscle mass with CAC (prevalence ratio [PR] 1.02 [95% CI 0.95,1.10]), TAC (PR 1.13 [95% CI 0.92, 1.39]) or AAC (PR 0.99 [95% CI 0.94, 1.04]) prevalence. Similarly, there was no significant inverse relationship between abdominal lean muscle area and CAC, TAC, and AAC severity. CONCLUSION In community-living individuals without clinical CVD, greater abdominal lean muscle area is not associated with less calcified atherosclerosis.