Normative values and correlates of carotid artery intima-media thickness and carotid atherosclerosis in Andean-Hispanics: The Prevencion Study
Introduction
Cardiovascular disease (CVD) has emerged as a leading cause of death in Latin America [1]. The early identification of subjects at risk for cardiovascular disease is important because prevention strategies instituted early are likely to have the highest impact in cardiovascular outcomes at the population level and these should be tailored to individual risk. Various cardiovascular risk stratification schemes have been developed using prospective data derived predominantly from Caucasian populations. These are largely based on individual risk factors that independently predict the risk of atherosclerotic cardiovascular disease. Given the ethnic diversity in the profile of CVD, varied risk associations and different levels of genetic–environmental interactions in different populations, such studies performed in Caucasian populations cannot be directly applied to Latin-American populations. Until prospective studies are available, the assessment of markers of subclinical atherosclerosis represents a useful approach to assess the correlates of atherosclerotic risk in Latin-American populations and individuals.
High-resolution carotid ultrasonography can determine the presence or extent of atherosclerosis in situ. Carotid artery intima-media thickness (cIMT) independently predicts the risk of cardiac (myocardial infarction, angina pectoris, coronary intervention) and cerebrovascular events (stroke or transient ischemic attack) [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], the involvement of other arterial beds with atherosclerosis [14], [15], [16] and is well suited for use in large-scale population studies as a marker of subclinical disease due to the relative simplicity and non-invasive nature of the technique. Appropriate interpretation of individual cIMT should be based on gender, age- and population-specific normative data [17]. However, such data are not available for Hispanic populations.
Andean populations represent an important proportion of South American Hispanics. Andean countries have important similarities, including related native Amerindian populations and historical patterns of colonization, which have influenced the patterns of genetic admixture and the cultural characteristics of their inhabitants. Although previous important studies have described cIMT and associated cardiovascular risk factors in Latin-American populations [18], [19], [20], studies assessing correlates of cIMT and the presence of carotid plaque in Andean adults are needed. In this study, we aimed to: (1) establish normative data for cIMT suitable for use among Andean-Hispanics; (2) assess the correlates of subclinical atherosclerosis assessed by cIMT and the presence of carotid plaque in this population.
Section snippets
Study population and sampling design
The objectives and design of the PREVENCION study have been previously published [21]. PREVENCION is a population-based study undertaken in the second largest city in Peru, with a population that is comparable to other urban populations in Peru and resembles urban populations in Andean countries such as Bolivia and Ecuador. This population consists largely of Mestizos (“Mixed”), with the degree of admixture being predominantly Andean-Amerindian (autochthonous Quechua and Aymara), with small
Results
The study population comprised 1448 participants [687 (47.4%) men] aged 20–87 years (mean age 52.4 years), of whom 472 (214 [45.3%] men) were found to be healthy. Important demographic, clinical and laboratory characteristics of the study population are shown in Table 1.
Discussion
We report on the cross-sectional associations between carotid atherosclerosis and classic cardiovascular risk factors in a large population-based sample of Andean-Hispanics. We also provide, for the first time, normative data for this population, which can be used to define abnormally high cIMT values in Andean-Hispanic adults aged 20–80 years. We show that cIMT in this population is associated with age, gender, SBP, LDL-C, current smoking, impaired fasting glucose and diabetes mellitus, but
Conflict of interest statement
Junichiro Takahashi and Gen Toshima are employees of Skylight Biotech (Tokyo, Japan) which provide commercially available services for HPLC measurements of serum lipoproteins. The other authors have no conflicts of interest.
Sources of funding
The PREVENCION study was supported by the Santa Maria Research Institute, AQP, Peru. JAC is supported by National Institutes of Health grant RO1-HL080076 and American Heart Association National Research Award #0885031N. CAP is supported by the National Institutes of Health Office of the Director, Fogarty International Center, Office of AIDS Research, National Cancer Center, National Eye Institute, National Heart, Blood, and Lung Institute, National Institute of Dental & Craniofacial Research,
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- 1
On behalf of the PREVENCION Investigators.