(Stroke. 1995;26:386-391.)
© 1995 American Heart Association, Inc.
Articles |
Arterial Wall Thickness Is Associated With Prevalent Cardiovascular Disease in Middle-Aged Adults
The Atherosclerosis Risk in Communities (ARIC) Study
From the Departments of Public Health Sciences (G.L.B., G.W.E., G.H.) and Neurology (G.L.B., W.A.R., G.H., R.W.B.), Bowman Gray School of Medicine, and Department of Epidemiology, School of Public Health, University of North Carolina (W.R., G.H.), Chapel Hill; ARIC Ultrasound Reading Center, Winston-Salem, NC (W.A.R., R.W.B.); National Heart, Lung, and Blood Institute, Bethesda, Md (A.R.S.); Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis (R.S.C.); and the ECG Reading Center University of Alberta, Edmonton, Canada (P.M.R.).
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Abstract |
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 Top Abstract IntroductionSubjects and MethodsResultsDiscussionReferences |
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Background and Purpose This study was done to assess the relationship between prevalent cardiovascular disease and arterial wall thickness in middle-aged US adults.
Methods The association of preexisting coronary heart disease, cerebrovascular disease, and peripheral vascular disease with carotid and popliteal intimal-medial thickness (IMT) (measured by B-mode ultrasound) was assessed in 13 870 black and white men and women, aged 45 to 64, during the Atherosclerosis Risk in Communities (ARIC) Study baseline examination (1987 through 1989). Prevalent disease was determined according to both participant self-report and measurements at the baseline examination (including electrocardiogram, fasting blood glucose, and medication use).
Results Across four race and gender strata, mean carotid far wall IMT was consistently greater in participants with prevalent clinical cardiovascular disease than in disease-free subjects. Similarly, the prevalence of cardiovascular disease was consistently greater in participants with progressively thicker IMT. The greatest differences in carotid IMT associated with prevalent disease were observed for reported symptomatic peripheral vascular disease (0.09 to 0.22 mm greater IMT in the four race-gender groups).
Conclusions These data document the substantially greater arterial wall thickness observed in middle-aged adults with prevalent cardiovascular disease. Both carotid and popliteal arterial IMT were related to clinically manifest cardiovascular disease affecting distant vascular beds, such as the cerebral, peripheral, and coronary artery vascular beds.
Key Words: atherosclerosis • cardiovascular diseases • epidemiology • ultrasonics
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Introduction |
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TopAbstractIntroductionSubjects and MethodsResultsDiscussionReferences |
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Advances in noninvasive B-mode ultrasound techniques for the measurement of arterial intimal-medial thickness (IMT) allow for the assessment of atherosclerosis in free-living population-based settings.1 These ultrasound techniques involve the assessment of IMT in the carotid artery and other relatively superficial vascular beds. Measures of wall thickness are currently used as surrogates for and intermediate end points of atherosclerosis in observational studies and are also used to document regression or progression of atherosclerosis in clinical trials.2 3 4 5 6 7 However, the relationship between arterial wall thickness (measured by ultrasound) and cardiovascular disease has not been well documented. Although it has been observed that individuals with clinically manifest coronary heart disease, cerebrovascular disease, and peripheral vascular disease have more atherosclerosis than disease-free individuals,8 9 10 11 12 most such observations have been made in select populations such as hospitalized patients or as part of autopsy series. An association between increased carotid artery IMT and a more adverse cardiovascular disease (CVD) risk factor profile has also been documented.6 13 14 15 16 However, only one study has examined the relationship between IMT and cardiovascular disease in population-based samples.17 This article examines the relationship in middle-aged adults of prevalent coronary heart disease, cerebrovascular disease, and peripheral vascular disease to carotid and popliteal arterial wall thickness (thus including arterial measurements) in more central (carotid) and more peripheral (popliteal) locations.
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Subjects and Methods |
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TopAbstractIntroductionSubjects and MethodsResultsDiscussionReferences |
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The Atherosclerosis Risk in Communities (ARIC) Study is a prospective study investigating the etiology and natural history of atherosclerosis and its clinical sequelae. The ARIC Study has measured CVD risk factors and outcomes in a population-based sample of 15 800 adults aged 45 to 64 at the baseline examination (1987 through 1989). The cohort consists of a probability sample selected from four US communities.4 Approximately 4000 adults were enrolled in the study from each of the following areas: the northwest suburbs of Minneapolis, Minn; Washington County, Md, which includes the city of Hagerstown; Forsyth County, NC, which includes the city of Winston-Salem; and Jackson, Miss. The Jackson center enrolled only black participants to allow more statistical power to conduct racial comparisons. The number of participants in each race and gender group ranged from 1400 (black men) to more than 5400 (white women). The mean age of the cohort was similar across race and gender groups and ranged from 53 to 55 years. More detailed description of the recruitment technique has been previously reported.4
B-mode real-time ultrasound (Biosound 2000 II SA) was used to evaluate
the arterial wall thickness in the carotid and popliteal arterial beds.
The carotid arteries were examined bilaterally in the areas of the
common carotid artery (1 cm proximal to the dilatation of the carotid
bulb), the carotid bifurcation (1 cm proximal to the flow divider), and
the internal carotid artery (1 cm distal to the flow divider) on the
left and right sides (Fig 1
). To enhance the
reproducibility of carotid measures in this population-based sample,
standardized interrogation angles were used. The popliteal artery was
assessed at a single site using similar techniques. Data are
presented from this vascular bed to assess the relationship between
prevalent disease and wall thickness in a more peripheral artery. Wall
thickness measures presented here are from participants examined
after May 15, 1987, and thus ultrasound data were available for 13 870
participants.
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The ARIC ultrasound reading protocol was designed to precisely measure IMT. Measurements were performed centrally at the ARIC Ultrasound Reading Center. To ensure reliability and validity of these measurements, programs of centralized training, certification, and quality control were implemented for both the sonographers and the readers. More detailed descriptions of the ultrasound scanning and reading techniques have been previously published.13 18 19 20 21 In cases of missing data at any of the six carotid sites, maximum likelihood techniques were used to estimate the mean wall thickness.22
Prevalent disease was defined using both participant self-report and physical measurements, when available. Angina was assessed using the Rose Questionnaire23 and was defined by the presence of chest pain upon walking that was relieved within 10 minutes after stopping or slowing down. Myocardial infarction (MI) was defined by (1) a participant-reported episode involving hospitalization for 1 week or more; (2) physician diagnosis of MI; or (3) a diagnostic Q wave detected on the baseline resting electrocardiogram. Silent MI was defined as a diagnostic Q wave detected on the baseline resting electrocardiogram in the absence of self-report or hospitalization. Peripheral vascular disease was defined by a self-reported history of angioplasty or bypass surgery of the lower extremity or by the self-reported presence of pain in the lower extremities while walking that was relieved within 10 minutes after standing still. Cerebrovascular disease was defined as a self-reported stroke or transient ischemic attack that was verified by a study physician's review of reported symptoms. CVD was defined as the presence of any of the following diseases: angina, MI, cerebrovascular disease, or peripheral vascular disease. Diabetes was defined by either self-reported medication use (insulin or oral agents) or a fasting (8 hours or more) serum glucose level of at least 140 mg/dL.
The overall mean far wall IMT thicknesses for the carotid and popliteal arteries were used in these analyses. The association between prevalent disease and wall thickness was evaluated based on (1) differences in age-adjusted mean IMT in relation to the presence or absence of disease and (2) age-adjusted disease prevalence as a function of increasing wall thickness. Analyses are presented both stratified by and adjusted for race and gender. ANCOVA was used to assess differences in mean IMT across prevalent disease groups to adjust for age, race, and gender, and also to determine whether the relationship between wall thickness and prevalent CVD was independent of known CVD risk factor levels (blood pressure, blood lipids, cigarette smoking, and diabetes).
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Results |
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TopAbstractIntroductionSubjects and MethodsResultsDiscussionReferences |
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Prevalence rates for CVD and diabetes are shown by race, gender, and age group in Table 1
. The prevalence of all types of
CVD and diabetes increased with age in all race and gender groups. The
prevalence of MI was higher in men than in women, and angina prevalence
assessed by the Rose Questionnaire was greater in women than in men. MI
rates were higher in white than in black men, and higher in black than
in white women. The number of silent MIs was relatively small, and the
rate of silent MI was similar across race and gender groups. The rate
of cerebrovascular disease was low, and it was less frequent in white
than in black participants. Clinically manifest peripheral vascular
disease was rare in these middle-aged adults, but it was more frequent
in men than in women. Diabetes prevalence was greatest in black
participants in both women (18% versus 7%) and men (16% versus
8%).
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Age-adjusted mean carotid artery far wall IMT is presented
in Table 2 for participants with and without prevalent
disease. Participants classified as having a history of MI had a mean
IMT greater than disease-free participants in all race and gender
groups, with an overall difference of 0.07 mm. However, this difference
was not statistically significant in black men. Similar IMT differences
were observed for angina (0.04 mm), cerebrovascular disease (0.05 mm),
peripheral vascular disease (0.15 mm), diabetes (0.06 mm), and all CVD
(0.06 mm).
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Fig 2 presents the age-, race-, and
gender-adjusted disease prevalence by quartile of carotid wall
thickness. The prevalence of MI, angina, peripheral vascular disease,
and cerebrovascular disease increased across the IMT quartiles, with
the lowest disease prevalence in participants with the smallest IMT and
the highest disease prevalence in participants with the largest IMT. Of
interest, the association between the overall mean carotid IMT and
prevalent disease was also observed at the six sites (left and right
common, bifurcation, and internal carotid segments). Participants with
two or more prevalent diseases had a greater IMT than those with only
one reported prevalent disease (data not shown).
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To determine the extent to which the relationship observed between
prevalent disease and wall thickness was associated with current levels
of CVD risk factors, similar analyses were conducted adjusting for
hypertension, low-density lipoprotein cholesterol, high-density
lipoprotein cholesterol, smoking, and diabetes. Although the risk
factor–adjusted differences in wall thickness between disease and
disease-free groups were reduced in all race and gender groups (Table 3), in general, similar patterns between carotid IMT and
prevalent disease were observed for CVD and peripheral vascular
disease.
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Age-adjusted mean popliteal artery far wall thickness in participants
with and without prevalent disease is presented in Table 4. As was the case for carotid wall thickness, popliteal
artery wall thickness was greater in participants with prevalent
disease than in those free of disease. Of interest, black men had the
greatest popliteal wall thickness differences across prevalent disease
categories. In general, a relationship between mean popliteal IMT,
adjusted for age, race, and gender, and prevalent disease was observed
for each vascular disease. Adjustment for the major CVD risk factors
reduced the magnitude of the observed race- and gender-stratified
associations (Table 5). Again, black men showed the
greatest differences, but the overall difference (age-, race-, gender-,
and risk factor–adjusted) remained statistically significant for all
prevalent diseases.
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Discussion |
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TopAbstractIntroductionSubjects and MethodsResultsDiscussionReferences |
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These data demonstrate increased arterial wall thickness, as measured by B-mode ultrasound, in participants with prevalent coronary heart disease, cerebrovascular disease, peripheral vascular disease, and total CVD. The carotid IMT in participants with CVD was 10% greater in those with MI, 6% greater in those with angina, 6% greater in those with cerebrovascular disease, 19% greater in those with peripheral vascular disease, and 8% greater in those with any form of CVD. The observed differences in wall thickness across disease groups are consistent with the associations between prevalent CVD and carotid atherosclerosis observed in previous clinical autopsy and ultrasound studies.1 2 3 5 24 25
In the present study, CVD was associated with increased wall thickness at both the common carotid and popliteal arteries. Although the magnitude and the significance of the observed wall thickness differences between participants with and without disease differed across race and gender groups, the trend of greater IMT with disease was virtually universally observed. It should be noted that although this study involved an extremely large cohort, the numbers of affected participants in certain prevalent disease categories (silent MI, cerebrovascular disease, and peripheral vascular disease) were relatively modest. Other researchers have seen similar associations between ultrasound-measured carotid wall thickness and coronary heart disease,17 24 25 although to our knowledge the associations between CVD and popliteal wall thickness have not been previously addressed. A similar pattern was observed in these data between symptomatic CVD and wall thickness at both the popliteal and carotid arteries.
We were interested in determining whether the observed relationships between CVD and wall thickness could be explained in part by differences in CVD risk factors between the groups. After adjustment for known CVD risk factors (blood lipids, blood pressure, smoking, and diabetes), the magnitude of the IMT differences decreased. However, age-, race-, and gender-adjusted relationships of carotid wall thickness with MI, angina, cerebrovascular disease, peripheral vascular disease, and total CVD remained statistically significant after adjustment for risk factor levels. It is important to note that because these analyses were adjusted for current risk factor levels, it is possible that even more of the relationship between wall thickness and prevalent disease could have been explained if we had had access to past levels of risk factors in these participants.
Age, race, and gender differences in prevalent disease confirm what has been observed in other studies. The observed increased prevalence of CVD with increased age is certainly well known. An increased prevalence of diabetes and cerebrovascular disease in US black versus US white participants has been observed in other studies of adults.26 The greater prevalence of MI in men than in women (and in black versus white women) is similar to that seen in previously reported results and corroborated by race and gender differences in US coronary heart disease mortality rates.26 The increased prevalence of angina determined by the Rose Questionnaire in women has been observed in other studies.27
There are a number of potential limitations to our study. Whenever possible, physical measurements were used to define disease. However, in general we relied almost entirely on participant self-report of symptoms or doctor-diagnosed prevalent disease. This could result in a misclassification of some participants as either having disease or being disease free. The impact of this on our estimate of the association between wall thickness and disease would likely be to bias our results toward the apparent lack of a significant association. In addition, individuals with the greatest atherosclerotic burden are less likely to survive a vascular event; our cross-sectional estimates are based only on survivors of these events. Thus, we likely underestimated the true relationship. The fact that the observed effects were consistent across race, gender, and vascular bed adds further credibility to the results.
These data support the existence of a relationship between prevalent CVD and arterial wall thickness in a population-based sample of US adults. Both popliteal and carotid wall thickness were related to CVD manifest in other vascular beds, suggesting that the measurements reflect systemic atherosclerosis. They verify that use of B-mode ultrasound to assess atherosclerosis as an intermediate measurement or end point in prospective observational studies and clinical trials appears to be warranted.
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Acknowledgments |
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This study was supported by contracts N01-HC-55015, N01-HC-55016, N01-HC-55018, N01-HC-55019, N01-HC-55021, and N01-HC-55022 from the National Heart, Lung, and Blood Institute, National Institutes of Health. We would like to acknowledge the help of the following people who played an important role in the collection of these data: Catherine Paton (University of North Carolina–Chapel Hill), Jeannette Bensen, Delilah Posey, Amy Haire (Forsyth County Field Center, Winston-Salem, NC); Connie Myers, Virginia Overman, Stephanie Parker, Liz Sullivan (Jackson Field Center, Jackson, Miss); Dot Buckingham, Marilyn Bowers, Ellie Justiniano, Irene Keske (Minneapolis Field Center, Golden Valley, Minn); Carol Christman, Sonny Harrell, Joel Hill, Joan Nelling (Washington County Field Center, Hagerstown, Md); Valerie Stinson, Pam Pfile, Hoang Pham, Teri Trevino (Central Hemostasis Laboratory, Houston, Tex); Sandra Sanders, Charles E. Rhodes, Doris Epps, Selma Soyal (Central Lipid Laboratory, Houston, Tex); Regina DeLacy, Delilah Cook, Carolyn Bell, Teresa Crotts, Suzanne Pillsbury (Ultrasound Reading Center, Winston-Salem, NC); Mal Foley, Tom Goodwin, Richard Hayes, Ann Howard (Coordinating Center, Chapel Hill, NC).
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Footnotes |
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Reprint requests to Gregory L. Burke, MD, MS, Bowman Gray School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157.
Received August 19, 1994; revision received December 14, 1994; accepted December 14, 1994.
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References |
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S. Demircan, A. T. Sezgin, M. Baltali, O. Gulcan, S. Topcu, F. Yigit, T. Erol, R. Turkoz, H. Muderrisoglu, and B. Ozin Intima-Media Thickness in Patients With Rheumatic Mitral Stenosis Angiology, November 1, 2007; 58(5): 614 - 619. [Abstract] [PDF]
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 K. Sander, C. Schulze Horn, C. Briesenick, and D. Sander High-Sensitivity C-Reactive Protein Is Independently Associated With Early Carotid Artery Progression in Women But Not in Men: The INVADE Study Stroke, November 1, 2007; 38(11): 2881 - 2886. [Abstract] [Full Text] [PDF]
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 O. W Nielsen and A. Sajadieh Diagnosing left ventricular hypertrophy in arterial hypertension BMJ, October 6, 2007; 335(7622): 681 - 682. [Full Text] [PDF]
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S. Sen, A. Hinderliter, P. K. Sen, J. Simmons, J. Beck, S. Offenbacher, E. M. Ohman, and S. M. Oppenheimer Aortic Arch Atheroma Progression and Recurrent Vascular Events in Patients With Stroke or Transient Ischemic Attack Circulation, August 21, 2007; 116(8): 928 - 935. [Abstract] [Full Text] [PDF]
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 J. E. Williams, D. J. Couper, R. Din-Dzietham, F. J. Nieto, and A. R. Folsom Race-Gender Differences in the Association of Trait Anger with Subclinical Carotid Artery Atherosclerosis: The Atherosclerosis Risk in Communities Study Am. J. Epidemiol., June 1, 2007; 165(11): 1296 - 1304. [Abstract] [Full Text] [PDF]
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I. J. Kullo and A. R. Malik Arterial Ultrasonography and Tonometry as Adjuncts to Cardiovascular Risk Stratification J. Am. Coll. Cardiol., April 3, 2007; 49(13): 1413 - 1426. [Abstract] [Full Text] [PDF]
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 J. M. Lee, C. Shirodaria, C. E Jackson, M. D Robson, C. Antoniades, J. M Francis, F. Wiesmann, K. M Channon, S. Neubauer, and R. P Choudhury Multi-modal magnetic resonance imaging quantifies atherosclerosis and vascular dysfunction in patients with type 2 diabetes mellitus Diabetes and Vascular Disease Research, March 1, 2007; 4(1): 44 - 48. [Abstract] [PDF]
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W. Osika, F. Dangardt, J. Gronros, U. Lundstam, A. Myredal, M. Johansson, R. Volkmann, T. Gustavsson, L. Ming Gan, and P. Friberg Increasing Peripheral Artery Intima Thickness From Childhood to Seniority Arterioscler Thromb Vasc Biol, March 1, 2007; 27(3): 671 - 676. [Abstract] [Full Text] [PDF]
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 J. C. Stewart, D. L. Janicki, M. F. Muldoon, K. Sutton-Tyrrell, and T. W. Kamarck Negative Emotions and 3-Year Progression of Subclinical Atherosclerosis Arch Gen Psychiatry, February 1, 2007; 64(2): 225 - 233. [Abstract] [Full Text] [PDF]
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C. Napoli, L. O. Lerman, F. de Nigris, M. Gossl, M. L. Balestrieri, and A. Lerman Rethinking Primary Prevention of Atherosclerosis-Related Diseases Circulation, December 5, 2006; 114(23): 2517 - 2527. [Full Text] [PDF]
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 M Allocca, A Crosignani, A Gritti, G Ghilardi, D Gobatti, D Caruso, M Zuin, M Podda, and P M Battezzati Hypercholesterolaemia is not associated with early atherosclerotic lesions in primary biliary cirrhosis Gut, December 1, 2006; 55(12): 1795 - 1800. [Abstract] [Full Text] [PDF]
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 V. O. Palmieri, I. Grattagliano, P. Portincasa, and G. Palasciano Systemic Oxidative Alterations Are Associated with Visceral Adiposity and Liver Steatosis in Patients with Metabolic Syndrome J. Nutr., December 1, 2006; 136(12): 3022 - 3026. [Abstract] [Full Text] [PDF]
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 B. A. Parker, S. J. Ridout, and D. N. Proctor Age and flow-mediated dilation: a comparison of dilatory responsiveness in the brachial and popliteal arteries Am J Physiol Heart Circ Physiol, December 1, 2006; 291(6): H3043 - H3049. [Abstract] [Full Text] [PDF]
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S. G. Tsouli, D. N. Kiortsis, V. Xydis, M. I. Argyropoulou, M. Elisaf, and A. D. Tselepis Antibodies Against Various Forms of Mildly Oxidized Low-Density Lipoprotein Are Not Associated With Carotid Intima-Media Thickness in Patients With Primary Hyperlipidemia Angiology, October 1, 2006; 57(5): 615 - 622. [Abstract] [PDF]
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S. Makita, A. Ohira, Y. Naganuma, Y. Moriai, H. Niinuma, A. Abiko, and K. Hiramori Increased Carotid Artery Stiffness Without Atherosclerotic Change in Patients With Aortic Dissection Angiology, August 1, 2006; 57(4): 478 - 486. [Abstract] [PDF]
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 M. J Roman, T. Z Naqvi, J. M Gardin, M. Gerhard-Herman, M. Jaff, and E. Mohler American Society of Echocardiography Report: Clinical application of noninvasive vascular ultrasound in cardiovascular risk stratification: a report from the American Society of Echocardiography and the Society for Vascular Medicine and Biology Vascular Medicine, August 1, 2006; 11(3): 201 - 211. [PDF]
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 J. R. Crouse III Thematic review series: Patient-Oriented Research. Imaging atherosclerosis: state of the art J. Lipid Res., August 1, 2006; 47(8): 1677 - 1699. [Abstract] [Full Text] [PDF]
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 L. Keltikangas-Jarvinen, L. Pulkki-Raback, S. Puttonen, J. Viikari, and O. T. Raitakari Childhood Hyperactivity as a Predictor of Carotid Artery Intima Media Thickness Over a Period of 21 Years: The Cardiovascular Risk in Young Finns Study Psychosom Med, July 1, 2006; 68(4): 509 - 516. [Abstract] [Full Text] [PDF]
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R. Elosua, J. M. Ordovas, L. A. Cupples, C.-Q. Lai, S. Demissie, C. S. Fox, J. F. Polak, P. A. Wolf, R. B. D'Agostino Sr., and C. J. O'Donnell Variants at the APOA5 locus, association with carotid atherosclerosis, and modification by obesity: the Framingham Study J. Lipid Res., May 1, 2006; 47(5): 990 - 996. [Abstract] [Full Text] [PDF]
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 M Kivimaki, G Davey Smith, M Juonala, J E Ferrie, L Keltikangas-Jarvinen, M Elovainio, L Pulkki-Raback, J Vahtera, M Leino, J S A Viikari, et al. Socioeconomic position in childhood and adult cardiovascular risk factors, vascular structure, and function: cardiovascular risk in young Finns study Heart, April 1, 2006; 92(4): 474 - 480. [Abstract] [Full Text] [PDF]
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A. T. Hirsch, Z. J. Haskal, N. R. Hertzer, C. W. Bakal, M. A. Creager, J. L. Halperin, L. F. Hiratzka, W. R.C. Murphy, J. W. Olin, J. B. Puschett, et al. ACC/AHA 2005 Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic): Executive Summary A Collaborative Report From the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation J. Am. Coll. Cardiol., March 21, 2006; 47(6): 1239 - 1312. [Full Text] [PDF]
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S. Ashfaq, J. L. Abramson, D. P. Jones, S. D. Rhodes, W. S. Weintraub, W. C. Hooper, V. Vaccarino, D. G. Harrison, and A. A. Quyyumi The Relationship Between Plasma Levels of Oxidized and Reduced Thiols and Early Atherosclerosis in Healthy Adults J. Am. Coll. Cardiol., March 7, 2006; 47(5): 1005 - 1011. [Abstract] [Full Text] [PDF]
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 S. Ohuchi, K. Kawazoe, H. Izumoto, and K. Yoshioka Magnetic Resonance Angiography in Coronary Artery Bypass Grafting Asian Cardiovasc Thorac Ann, February 1, 2006; 14(1): 43 - 46. [Abstract] [Full Text] [PDF]
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N. Ranjit, A. V. Diez-Roux, L. Chambless, D. R. Jacobs Jr, F. J. Nieto, and M. Szklo Socioeconomic Differences in Progression of Carotid Intima-Media Thickness in the Atherosclerosis Risk in Communities Study Arterioscler Thromb Vasc Biol, February 1, 2006; 26(2): 411 - 416. [Abstract] [Full Text] [PDF]
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E. Corrado, M. Rizzo, R. Tantillo, I. Muratori, F. Bonura, G. Vitale, and S. Novo Markers of Inflammation and Infection Influence the Outcome of Patients With Baseline Asymptomatic Carotid Lesions: A 5-Year Follow-Up Study Stroke, February 1, 2006; 37(2): 482 - 486. [Abstract] [Full Text] [PDF]
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 Evolving treatment paradigms for vascular risk reduction in type 2 diabetes: Report of an international symposium held in Barcelona, Spain, January 27-29, 2006 The British Journal of Diabetes & Vascular Disease, January 1, 2006; 6(1_suppl): S1 - S12. [PDF]
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 A. Kafetzakis, G. Kochiadakis, A. Laliotis, I. Peteinarakis, E. Touloupakis, N. Igoumenidis, and A. Katsamouris Association of Subclinical Wall Changes of Carotid, Femoral, and Popliteal Arteries With Obstructive Coronary Artery Disease in Patients Undergoing Coronary Angiography Chest, October 1, 2005; 128(4): 2538 - 2543. [Abstract] [Full Text] [PDF]
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S. Makita, M. Nakamura, and K. Hiramori The Association of C-Reactive Protein Levels With Carotid Intima-Media Complex Thickness and Plaque Formation in the General Population Stroke, October 1, 2005; 36(10): 2138 - 2142. [Abstract] [Full Text] [PDF]
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 V. Aboyans, J. Guilloux, P. Lacroix, C. Yildiz, A. Postil, and M. Laskar Common carotid intima-media thickness measurement is not a pertinent predictor for secondary cardiovascular events after coronary bypass surgery. A prospective study Eur. J. Cardiothorac. Surg., September 1, 2005; 28(3): 415 - 419. [Abstract] [Full Text] [PDF]
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M. Hintsanen, M. Kivimaki, M. Elovainio, L. Pulkki-Raback, P. Keskivaara, M. Juonala, O. T. Raitakari, and L. Keltikangas-Jarvinen Job Strain and Early Atherosclerosis: The Cardiovascular Risk in Young Finns Study Psychosom Med, September 1, 2005; 67(5): 740 - 747. [Abstract] [Full Text] [PDF]
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 S. S. Najjar, A. Scuteri, and E. G. Lakatta Arterial Aging: Is It an Immutable Cardiovascular Risk Factor? Hypertension, September 1, 2005; 46(3): 454 - 462. [Abstract] [Full Text] [PDF]
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M. Frick, H. F Alber, A. Rinner, A. Suessenbacher, H. Ulmer, S. P Schwarzacher, O. Pachinger, and F. Weidinger Relationship of sonographic wall components of the brachial artery to hypertension and coronary atherosclerosis Vascular Medicine, August 1, 2005; 10(3): 185 - 190. [Abstract] [PDF]
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W.H. L. Kao, W.-C. Hsueh, D. L. Rainwater, D. H. O'Leary, I. G. Imumorin, M. P. Stern, and B. D. Mitchell Family History of Type 2 Diabetes Is Associated With Increased Carotid Artery Intimal-Medial Thickness in Mexican Americans Diabetes Care, August 1, 2005; 28(8): 1882 - 1889. [Abstract] [Full Text] [PDF]
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J. G. Terry, J. J. Carr, R. Tang, G. W. Evans, E. O. Kouba, R. Shi, D. R. Cook, J. L.C. Vieira, M. A. Espeland, M. F. Mercuri, et al. Coronary Artery Calcium Outperforms Carotid Artery Intima-Media Thickness as a Noninvasive Index of Prevalent Coronary Artery Stenosis Arterioscler Thromb Vasc Biol, August 1, 2005; 25(8): 1723 - 1728. [Abstract] [Full Text] [PDF]
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P.-J. Touboul, J. Labreuche, E. Vicaut, P. Amarenco, and on behalf of the GENIC Investigators Carotid Intima-Media Thickness, Plaques, and Framingham Risk Score as Independent Determinants of Stroke Risk Stroke, August 1, 2005; 36(8): 1741 - 1745. [Abstract] [Full Text] [PDF]
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D. N. Kiortsis, S. Tsouli, E. S. Lourida, V. Xydis, M. I. Argyropoulou, M. Elisaf, and A. D. Tselepis Lack of Association Between Carotid Intima-Media Thickness and PAF-Acetylhydrolase Mass and Activity in Patients with Primary Hyperlipidemia Angiology, July 1, 2005; 56(4): 451 - 458. [Abstract] [PDF]
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M. Elovainio, L. Keltikangas-Jarvinen, M. Kivimaki, L. Pulkki, S. Puttonen, T. Heponiemi, M. Juonala, J. S. A. Viikari, and O. T. Raitakari Depressive Symptoms and Carotid Artery Intima-Media Thickness in Young Adults: The Cardiovascular Risk in Young Finns Study Psychosom Med, July 1, 2005; 67(4): 561 - 567. [Abstract] [Full Text] [PDF]
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H. Kramer, D. R. Jacobs Jr, D. Bild, W. Post, M. F. Saad, R. Detrano, R. Tracy, R. Cooper, and K. Liu Urine Albumin Excretion and Subclinical Cardiovascular Disease Hypertension, July 1, 2005; 46(1): 38 - 43. [Abstract] [Full Text] [PDF]
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A. Vryonidou, A. Papatheodorou, A. Tavridou, T. Terzi, V. Loi, I.-A. Vatalas, N. Batakis, C. Phenekos, and A. Dionyssiou-Asteriou Association of Hyperandrogenemic and Metabolic Phenotype with Carotid Intima-Media Thickness in Young Women with Polycystic Ovary Syndrome J. Clin. Endocrinol. Metab., May 1, 2005; 90(5): 2740 - 2746. [Abstract] [Full Text] [PDF]
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J. M. Lee and R. P Choudhury ARBITER 2: targeting HDL to retard atherosclerosis progression: Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol (ARBITER) 2 The British Journal of Diabetes & Vascular Disease, March 1, 2005; 5(2): 78 - 80. [PDF]
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E. R. Fox, H. A. Taylor Jr, E. J. Benjamin, J. Ding, P. R. Liebson, D. Arnett, E. M. Quin, and T. N. Skelton Left Ventricular Mass Indexed to Height and Prevalent MRI Cerebrovascular Disease in an African American Cohort: The Atherosclerotic Risk in Communities Study Stroke, March 1, 2005; 36(3): 546 - 550. [Abstract] [Full Text] [PDF]
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 A. Y.-M. Wang, S. S.-Y. Ho, M. Wang, E. K.-H. Liu, S. Ho, P. K.-T. Li, S.-F. Lui, and J. E. Sanderson Cardiac Valvular Calcification as a Marker of Atherosclerosis and Arterial Calcification in End-stage Renal Disease Arch Intern Med, February 14, 2005; 165(3): 327 - 332. [Abstract] [Full Text] [PDF]
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M. Juonala, J. S.A. Viikari, M. Kahonen, L. Taittonen, T. Ronnemaa, T. Laitinen, N. Maki-Torkko, V. Mikkila, L. Rasanen, H. K. Akerblom, et al. Geographic Origin as a Determinant of Carotid Artery Intima-Media Thickness and Brachial Artery Flow-Mediated Dilation: The Cardiovascular Risk in Young Finns Study Arterioscler Thromb Vasc Biol, February 1, 2005; 25(2): 392 - 398. [Abstract] [Full Text] [PDF]
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 P R J Ames, A Margarita, K B Sokoll, M Weston, and V Brancaccio Premature atherosclerosis in primary antiphospholipid syndrome: preliminary data Ann Rheum Dis, February 1, 2005; 64(2): 315 - 317. [Abstract] [Full Text] [PDF]
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E. D. Beishuizen, M. A. van de Ree, J. W. Jukema, J. T. Tamsma, J. C. M. van der Vijver, A. E. Meinders, H. Putter, and M. V. Huisman Two-Year Statin Therapy Does Not Alter the Progression of Intima-Media Thickness in Patients With Type 2 Diabetes Without Manifest Cardiovascular Disease Diabetes Care, December 1, 2004; 27(12): 2887 - 2892. [Abstract] [Full Text] [PDF]
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J. H. Stein, P. S. Douglas, S. R. Srinivasan, M. G. Bond, R. Tang, S. Li, W. Chen, and G. S. Berenson Distribution and Cross-Sectional Age-Related Increases of Carotid Artery Intima-Media Thickness in Young Adults: The Bogalusa Heart Study Stroke, December 1, 2004; 35(12): 2782 - 2787. [Abstract] [Full Text] [PDF]
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M. Juonala, J. S.A. Viikari, T. Laitinen, J. Marniemi, H. Helenius, T. Ronnemaa, and O. T. Raitakari Interrelations Between Brachial Endothelial Function and Carotid Intima-Media Thickness in Young Adults: The Cardiovascular Risk in Young Finns Study Circulation, November 2, 2004; 110(18): 2918 - 2923. [Abstract] [Full Text] [PDF]
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 M.L. Eigenbrodt, Z. Bursac, E.P. Eigenbrodt, D.J. Couper, R.E. Tracy, and J.L. Mehta Mathematical estimation of the potential effect of vascular remodelling/dilatation on B-mode ultrasound intima-medial thickness QJM, November 1, 2004; 97(11): 729 - 737. [Abstract] [Full Text] [PDF]
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D. R. Seals and F. A. Dinenno Collateral damage: cardiovascular consequences of chronic sympathetic activation with human aging Am J Physiol Heart Circ Physiol, November 1, 2004; 287(5): H1895 - H1905. [Abstract] [Full Text] [PDF]
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P. Jerrard-Dunne, M. Sitzer, P. Risley, A. Buehler, S. von Kegler, and H. S. Markus Inflammatory Gene Load Is Associated With Enhanced Inflammation and Early Carotid Atherosclerosis in Smokers Stroke, November 1, 2004; 35(11): 2438 - 2444. [Abstract] [Full Text] [PDF]
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R. Elosua, J. M. Ordovas, L. A. Cupples, C. S. Fox, J. F. Polak, P. A. Wolf, R. A. D'Agostino Sr., and C. J. O'Donnell Association of APOE genotype with carotid atherosclerosis in men and women: the Framingham Heart Study J. Lipid Res., October 1, 2004; 45(10): 1868 - 1875. [Abstract] [Full Text] [PDF]
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 M. T. Magyar, G. Paragh, E. Katona, A. Valikovics, I. Seres, L. Csiba, and D. Bereczki Serum Cholesterols Have a More Important Role Than Triglycerides in Determining Intima-Media Thickness of the Common Carotid Artery in Subjects Younger Than 55 Years of Age J. Ultrasound Med., September 1, 2004; 23(9): 1161 - 1169. [Abstract] [Full Text] [PDF]
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C. M. Hutter, M. A. Austin, and S. E. Humphries Familial Hypercholesterolemia, Peripheral Arterial Disease, and Stroke: A HuGE Minireview Am. J. Epidemiol., September 1, 2004; 160(5): 430 - 435. [Abstract] [Full Text] [PDF]
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K. Esposito, D. Giugliano, F. Nappo, R. Marfella, and for the Campanian Postprandial Hyperglycemia Study Regression of Carotid Atherosclerosis by Control of Postprandial Hyperglycemia in Type 2 Diabetes Mellitus Circulation, July 13, 2004; 110(2): 214 - 219. [Abstract] [Full Text] [PDF]
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J. F Viles-Gonzalez, V. Fuster, and J. J Badimon Atherothrombosis: A widespread disease with unpredictable and life-threatening consequences Eur. Heart J., July 2, 2004; 25(14): 1197 - 1207. [Abstract] [Full Text] [PDF]
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G. B. J. Mancini, B. Dahlof, and J. Diez Surrogate Markers for Cardiovascular Disease: Structural Markers Circulation, June 29, 2004; 109(25_suppl_1): IV-22 - IV-30. [Full Text] [PDF]
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F. Monzani, N. Caraccio, M. Kozakowa, A. Dardano, F. Vittone, A. Virdis, S. Taddei, C. Palombo, and E. Ferrannini Effect of Levothyroxine Replacement on Lipid Profile and Intima-Media Thickness in Subclinical Hypothyroidism: A Double-Blind, Placebo- Controlled Study J. Clin. Endocrinol. Metab., May 1, 2004; 89(5): 2099 - 2106. [Abstract] [Full Text] [PDF]
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H. Volzke, D. M. Robinson, U. Schminke, J. Ludemann, R. Rettig, S. B. Felix, C. Kessler, U. John, and W. Meng Thyroid Function and Carotid Wall Thickness J. Clin. Endocrinol. Metab., May 1, 2004; 89(5): 2145 - 2149. [Abstract] [Full Text] [PDF]
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A. Sramek, P. Bucciarelli, A.B. Federici, P.M. Mannucci, V. De Rosa, G. Castaman, M. Morfini, M.G. Mazzucconi, A. Rocino, M. Schiavoni, et al. Patients With Type 3 Severe von Willebrand Disease Are Not Protected Against Atherosclerosis: Results From a Multicenter Study in 47 Patients Circulation, February 17, 2004; 109(6): 740 - 744. [Abstract] [Full Text] [PDF]
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J. K. Olijhoek, Y. van der Graaf, J.-D. Banga, A. Algra, T. J. Rabelink, F. L. J. Visseren, and for the SMART Study Group The Metabolic Syndrome is associated with advanced vascular damage in patients with coronary heart disease, stroke, peripheral arterial disease or abdominal aortic aneurysm Eur. Heart J., February 2, 2004; 25(4): 342 - 348. [Abstract] [Full Text] [PDF]
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J. E Macioch, C D. Katsamakis, J. Robin, P. R Liebson, P. M Meyer, C. Geohas, J. S Raichlen, M. H Davidson, and S. B Feinstein Effect of contrast enhancement on measurement of carotid artery intimal medial thickness Vascular Medicine, February 1, 2004; 9(1): 7 - 12. [Abstract] [PDF]
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P. Poredos Intima-media thickness: indicator of cardiovascular risk and measure of the extent of atherosclerosis Vascular Medicine, February 1, 2004; 9(1): 46 - 54. [Abstract] [PDF]
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A. Scuteri, T. A. Manolio, E. K. Marino, A. M. Arnold, and E. G. Lakatta Prevalence of specific variant carotid geometric patterns and incidence of cardiovascular events in older persons: The cardiovascular health study (CHS E-131) J. Am. Coll. Cardiol., January 21, 2004; 43(2): 187 - 193. [Abstract] [Full Text] [PDF]
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O. T. Raitakari, M. Juonala, M. Kahonen, L. Taittonen, T. Laitinen, N. Maki-Torkko, M. J. Jarvisalo, M. Uhari, E. Jokinen, T. Ronnemaa, et al. Cardiovascular Risk Factors in Childhood and Carotid Artery Intima-Media Thickness in Adulthood: The Cardiovascular Risk in Young Finns Study JAMA, November 5, 2003; 290(17): 2277 - 2283. [Abstract] [Full Text] [PDF]
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J. Karvonen, M. Paivansalo, Y. A. Kesaniemi, and S. Horkko Immunoglobulin M Type of Autoantibodies to Oxidized Low-Density Lipoprotein Has an Inverse Relation to Carotid Artery Atherosclerosis Circulation, October 28, 2003; 108(17): 2107 - 2112. [Abstract] [Full Text] [PDF]
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G. Hansa, K. Bhargava, M. Bansal, S. Tandon, and R. R Kasliwal Carotid Intima-Media Thickness and Coronary Artery Disease: an Indian Perspective Asian Cardiovasc Thorac Ann, September 1, 2003; 11(3): 217 - 221. [Abstract] [Full Text]
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T. J. Wang, B.-H. Nam, R. B. D'Agostino, P. A. Wolf, D. M. Lloyd-Jones, C. A. MacRae, P. W. Wilson, J. F. Polak, and C. J. O'Donnell Carotid Intima-Media Thickness Is Associated With Premature Parental Coronary Heart Disease: The Framingham Heart Study Circulation, August 5, 2003; 108(5): 572 - 576. [Abstract] [Full Text] [PDF]
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G. Ramakrishna, T. W Rooke, and L. T Cooper Iron and peripheral arterial disease: revisiting the iron hypothesis in a different light Vascular Medicine, August 1, 2003; 8(3): 203 - 210. [Abstract] [PDF]
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