Della-Morte David, Dong Chuanhui, Crisby Milita, Gardener Hannah, Cabral Digna, Elkind Mitchell S V, Gutierrez Jose, Sacco Ralph L, Rundek Tatjana
Department of Neurology, The Evelyn McKnight Brain Institute, Miller School of Medicine, University of Miami, Miami, FL, United States.
Department of Systems Medicine, School of Medicine, University of Rome Tor Vergata, Rome, Italy.
Front Cardiovasc Med. 2022 Jan 24;9:793755. doi: 10.3389/fcvm.2022.793755. eCollection 2022.
Low Gray-Scale Median (GSM) index is an ultrasonographic parameter of soft, lipid rich plaque morphology that has been associated with stroke and cardiovascular disease (CVD). We sought to explore the contribution of the modifiable and not-modifiable cardiovascular risk factors (RFs) to vulnerable plaque morphology measured by the low GSM index. A total of 1,030 stroke-free community dwelling individuals with carotid plaques present (mean age, 71.8 ± 9.1; 58% women; 56% Hispanic, 20% Non-Hispanic Black, 22% Non-Hispanic White) were assessed for minimum GSM (min GSM) using high-resolution B-mode carotid ultrasound. Multiple linear regression models were used to evaluate the association between RFs and minGSM after adjusting for sociodemographic characteristics. Within an individual, median plaque number was 2 (IQR: 1-3) and mean plaque number 2.3 (SD: 1.4). Mean minGSM was 78.4 ± 28.7 (IQR: 56-96), 76.3 ± 28.8 in men and 80 ± 28.5 in women; 78.7 ± 29.3 in Hispanics participants, 78.5 ± 27.2 in Non-Hispanic Black participants, and 78.2 ± 29 in Non-Hispanic white participants. In multivariable adjusted model, male sex (β = -5.78, = 0.007), obesity BMI (β = -6.92, = 0.01), and greater levels of fasting glucose (β = -8.02, = 0.02) and LDL dyslipidemia (β = -6.64, = 0.005) were positively associated with lower minGSM, while presence of glucose lowering medication resulted in a significant inverse association (β = 7.68, = 0.04). Interaction (with for interaction <0.1) and stratification analyses showed that effect of age on minGSM was stronger in men (β = -0.44, = 0.03) than in women (β = -0.20, = 0.18), and in individuals not taking glucose lowering medication (β = -0.33, = 0.009). Our study has demonstrated an important contribution of glycemic and lipid metabolism to vulnerable, low density or echolucent plaque morphology, especially among men and suggested that use of glucose lowering medication was associated with more fibrose-stable plaque phenotype (greater GSM). Further research is needed to evaluate effects of medical therapies in individuals with vulnerable, low density, non-stenotic carotid plaques and how these effects translate to prevention of cerebrovascular disease.
低灰度中位数（GSM）指数是一种超声参数，用于描述富含脂质的软斑块形态，与中风和心血管疾病（CVD）相关。我们试图探讨可改变和不可改变的心血管危险因素（RFs）对通过低GSM指数测量的易损斑块形态的影响。共有1030名无中风的社区居民，其颈动脉存在斑块（平均年龄71.8±9.1岁；58%为女性；56%为西班牙裔，20%为非西班牙裔黑人，22%为非西班牙裔白人），使用高分辨率B型颈动脉超声评估其最小GSM（min GSM）。在调整社会人口学特征后，使用多元线性回归模型评估RFs与minGSM之间的关联。个体内的斑块中位数为2（四分位数间距：1 - 3），平均斑块数为2.3（标准差：1.4）。平均minGSM为78.4±28.7（四分位数间距：56 - 96），男性为76.3±28.8，女性为80±28.5；西班牙裔参与者为78.7±29.3，非西班牙裔黑人参与者为78.5±27.2，非西班牙裔白人参与者为78.2±29。在多变量调整模型中，男性（β = -5.78，P = 0.007）、肥胖BMI（β = -6.92，P = 0.01）、较高的空腹血糖水平（β = -8.02，P = 0.02）和低密度脂蛋白血脂异常（β = -6.64，P = 0.005）与较低的minGSM呈正相关，而使用降糖药物则导致显著的负相关（β = 7.68，P = 0.04）。交互作用（交互作用P<0.1）和分层分析表明，年龄对minGSM的影响在男性中（β = -0.44，P = 0.03）比在女性中（β = -0.20，P = 0.18）更强，在未使用降糖药物的个体中（β = -0.33，P = 0.009）也是如此。我们的研究表明，血糖和脂质代谢对易损、低密度或无回声斑块形态有重要影响，尤其是在男性中，并表明使用降糖药物与更纤维化稳定的斑块表型（更高的GSM）相关。需要进一步研究来评估药物治疗对具有易损、低密度、非狭窄性颈动脉斑块个体的影响，以及这些影响如何转化为预防脑血管疾病。
