Skin Cholesterol Content Shows Carotid Intima-Media Thickness
Background: A noninvasive assay to measure skin Tc recently has become available for use in the outpatient setting as a cardiovascular (CV) risk prediction tool. The purpose of this study was to determine whether skin tissue cholesterol content (skin Tc) levels are associated with increased carotid intima–media thickness (CIMT) after adjusting for known CV risk factors and Framingham CV risk.
Methods: Consecutive patients without known vascular disease who were referred for determination of CIMT underwent B-mode ultrasonography of the carotid arteries and measurement of skin Tc using a noninvasive assay. Use of medications, cardiac risk factors, and Framingham 10-year CV risk were determined prospectively. Multivariable regression was used to determine predictors of increased CIMT.
Results: Among 81 subjects, the mean (SD) age was 55.6 (7.7) years and the mean skin Tc was 95.9 (18.3) U. Carotid intima–media thickness was significantly higher among individuals in the highest quartile of skin Tc (0.87 vs 0.76 mm, P = .011). In multivariable analyses, skin Tc was associated with increased CIMT even after adjusting for age, sex, glucose, systolic blood pressure, total/high-density lipoprotein cholesterol ratio, and use of lipid-lowering therapy (odds ratio [OR] per 10-unit increase = 1.590, 95% CI 1.525-1.658, P = .031). Skin Tc also was associated with increased CIMT after adjustment for Framingham risk (OR = 1.341, 95% CI 1.302-1.380, P = .048).
Conclusions: Skin Tc is an easy-to-measure, noninvasive marker that can help identify subclinical atherosclerosis in asymptomatic middle-aged adults, even after controlling for risk factors and CV risk predicted by the Framingham model.
Histological studies have demonstrated that skin tissue cholesterol content (skin Tc) is associated with aortic and coronary artery sterol and lipid deposition. Biochemical assays have further shown that cholesterol quantified in the outermost layer of the epidermis, the stratum corneum, correlates well with epidermal cholesterol content. An assay that measures cholesterol content within the stratum corneum and does not require a skin biopsy is available for outpatient measurement of skin Tc and potentially for cardiovascular (CV) risk prediction. Using this assay, increased skin Tc has been associated with positive exercise treadmill stress tests and both the presence and extent of angiographic coronary artery disease (CAD) in individuals with anginal symptoms who were referred for stress testing and/or coronary angiography. A univariable association between skin Tc and Framingham CV risk also has been reported. The ability of skin Tc to predict CV disease in asymptomatic individuals in addition to standard CV risk factors, however, is not known. Furthermore, the relationship between skin Tc and subclinical atherosclerosis has not been studied previously.
Carotid intima–media thickness (CIMT) is a validated measure of subclinical atherosclerosis that identifies both prevalent and incident CV disease in middle-aged and older adults. The purpose of this study was to determine whether skin Tc levels are associated with increased CIMT even after adjusting for known CV risk factors and CV risk using the Framingham risk prediction model.
Background: A noninvasive assay to measure skin Tc recently has become available for use in the outpatient setting as a cardiovascular (CV) risk prediction tool. The purpose of this study was to determine whether skin tissue cholesterol content (skin Tc) levels are associated with increased carotid intima–media thickness (CIMT) after adjusting for known CV risk factors and Framingham CV risk.
Methods: Consecutive patients without known vascular disease who were referred for determination of CIMT underwent B-mode ultrasonography of the carotid arteries and measurement of skin Tc using a noninvasive assay. Use of medications, cardiac risk factors, and Framingham 10-year CV risk were determined prospectively. Multivariable regression was used to determine predictors of increased CIMT.
Results: Among 81 subjects, the mean (SD) age was 55.6 (7.7) years and the mean skin Tc was 95.9 (18.3) U. Carotid intima–media thickness was significantly higher among individuals in the highest quartile of skin Tc (0.87 vs 0.76 mm, P = .011). In multivariable analyses, skin Tc was associated with increased CIMT even after adjusting for age, sex, glucose, systolic blood pressure, total/high-density lipoprotein cholesterol ratio, and use of lipid-lowering therapy (odds ratio [OR] per 10-unit increase = 1.590, 95% CI 1.525-1.658, P = .031). Skin Tc also was associated with increased CIMT after adjustment for Framingham risk (OR = 1.341, 95% CI 1.302-1.380, P = .048).
Conclusions: Skin Tc is an easy-to-measure, noninvasive marker that can help identify subclinical atherosclerosis in asymptomatic middle-aged adults, even after controlling for risk factors and CV risk predicted by the Framingham model.
Histological studies have demonstrated that skin tissue cholesterol content (skin Tc) is associated with aortic and coronary artery sterol and lipid deposition. Biochemical assays have further shown that cholesterol quantified in the outermost layer of the epidermis, the stratum corneum, correlates well with epidermal cholesterol content. An assay that measures cholesterol content within the stratum corneum and does not require a skin biopsy is available for outpatient measurement of skin Tc and potentially for cardiovascular (CV) risk prediction. Using this assay, increased skin Tc has been associated with positive exercise treadmill stress tests and both the presence and extent of angiographic coronary artery disease (CAD) in individuals with anginal symptoms who were referred for stress testing and/or coronary angiography. A univariable association between skin Tc and Framingham CV risk also has been reported. The ability of skin Tc to predict CV disease in asymptomatic individuals in addition to standard CV risk factors, however, is not known. Furthermore, the relationship between skin Tc and subclinical atherosclerosis has not been studied previously.
Carotid intima–media thickness (CIMT) is a validated measure of subclinical atherosclerosis that identifies both prevalent and incident CV disease in middle-aged and older adults. The purpose of this study was to determine whether skin Tc levels are associated with increased CIMT even after adjusting for known CV risk factors and CV risk using the Framingham risk prediction model.