title: The Relationship among Carotid Artery Remodeling, Cardiac Geometry, and Serum N-Terminal Pro-B-Type Natriuretic Peptide Level in Asymptomatic Asians: Sex-Differences and Longitudinal GEE Study.
abstract: BACKGROUND
  Carotid artery remodeling is known to be associated with a variety of cardiovascular diseases. However, there is limited information regarding gender differences in carotid remodeling. We sought to investigate the associations among blood pressure (BP), carotid artery remodeling and cardiac geometries, and further explore gender differences.
  
  
  METHODS
  In a large cohort of asymptomatic adults undergoing routine health screening with repeated observations, we related measures of carotid artery diameter (CCAD) to various BP components, cardiac geometries and blood N-terminal pro-brain natriuretic peptide (NT-proBNP) level, both from baseline cross-sectional and longitudinal dataset using generalized estimating equations (GEE).
  
  
  RESULTS
  A total of 2,914 person-visits (baseline: n=998, mean age: 47 ± 8.9 years, 34% female) were studied (median: 6 ± 1.73 years follow up). We observed that CCAD was larger in men (p<0.01) and positively related to baseline age or all blood pressure components (including systolic BP [SBP], diastolic BP [DBP] and pulse pressure [PP], all p<0.01) even after accounting for clinical covariates, which did not change significantly at follow up (repeat-visit longitudinal GEE models). At baseline, per each increased unit of CCAD was associated with elevated LV mass index (β-coef: 6.72, with odds ratio [OR]: 1.47, 95% CI: 1.06 to 2.07 for ventricular hypertrophy; AUROC: 0.65, CCAD cut-off: 7.25mm) and NT-proBNP (β-coef: 5.35, OR: 4.22, 95% CI: 1.42 to 12.6 for >=300pg/mL; AUROC: 0.79, CCAD cut-off: 7.95mm, all p<0.05), which remained significant in multi-variate and longitudinal models. There was a prominent sex interaction (p for interaction with age and systolic BP: 0.004 and 0.028 respectively), where the longitudinal associations of age and systolic BP with increasing CCAD as more pronounced in women than men.
  
  
  CONCLUSIONS
  These data demonstrated that carotid artery remodeling may parallel subclinical biomarker of cardiac dysfunction, and further showed greater effects of aging and higher blood pressure on such remodeling process in women than men. Further study is warranted to understand how this predisposition of elderly hypertensive women to vascular remodeling may play a role in clinical settings.
authors.affiliation: Division of Cardiovascular Surgery, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Medical College, New Taipei City, Taiwan; Mackay Medicine, Nursing and Management College, Taipei, Taiwan.
authors.forename: Chen-Yen
authors.initials: CY
authors.lastname: Chien
authors.affiliation: Mackay Medical College, New Taipei City, Taiwan; Health Evaluation Center, Mackay Memorial Hospital, Taipei, Taiwan; Department of Medical Technology, Yuanpei University of Science and Technology, Hsin-Chu, Taiwan; Graduate Institute of Health Care Organization Administration, College of Public Health, National Taiwan University, Taipei, Taiwan.
authors.forename: Chuan-Chuan
authors.initials: CC
authors.lastname: Liu
authors.affiliation: Department of Neurology, Mackay Memorial Hospital, Taipei, Taiwan.
authors.forename: Helen L
authors.initials: HL
authors.lastname: Po
authors.affiliation: Mackay Medical College, New Taipei City, Taiwan; Cardiovascular Division, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Medicine, Nursing and Management College, Taipei, Taiwan.
authors.forename: Chih-Hsuan
authors.initials: CH
authors.lastname: Yen
authors.affiliation: Mackay Medical College, New Taipei City, Taiwan; Cardiovascular Division, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Medicine, Nursing and Management College, Taipei, Taiwan.
authors.forename: Charles Jia-Yin
authors.initials: CJ
authors.lastname: Hou
authors.affiliation: Mackay Medical College, New Taipei City, Taiwan; Cardiovascular Division, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Medicine, Nursing and Management College, Taipei, Taiwan.
authors.forename: Jen-Yuan
authors.initials: JY
authors.lastname: Kuo
authors.affiliation: Mackay Medical College, New Taipei City, Taiwan; Graduate Institute of Health Care Organization Administration, College of Public Health, National Taiwan University, Taipei, Taiwan; Cardiovascular Division, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Medicine, Nursing and Management College, Taipei, Taiwan; Department of Health Industry Management, Kainan University, Taoyuan, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Chung-Lieh
authors.initials: CL
authors.lastname: Hung
authors.affiliation: Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Shoei-Shen
authors.initials: SS
authors.lastname: Wang
authors.affiliation: Mackay Medical College, New Taipei City, Taiwan; Cardiovascular Division, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Medicine, Nursing and Management College, Taipei, Taiwan.
authors.forename: Hung-I
authors.initials: HI
authors.lastname: Yeh
authors.affiliation: Yong Loo Lin School of Medicine, NUS, National University Health System, Singapore, Singapore.
authors.forename: Carolyn S P
authors.initials: CS
authors.lastname: Lam
mesh_terms: D000367:Age Factors; D044466:Asian People; D058070:Asymptomatic Diseases; D015415:Biomarkers; D001794:Blood Pressure; D002339:Carotid Arteries / Q000473:pathology* / Q000503:physiopathology; D003430:Cross-Sectional Studies; D004452:Echocardiography; D005260:Female; D006321:Heart / Q000503:physiopathology; D006331:Heart Diseases / Q000473:pathology / Q000503:physiopathology; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D012727:Sex Characteristics; D013624:Taiwan; D066253:Vascular Remodeling / Q000502:physiology
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain