Intima-media thickness (IMT) is increasingly used as a surrogate end point of vascular outcomes in clinical trials aimed at determining the success of interventions that lower risk factors for atherosclerosis and associated diseases (stroke, myocardial infarction and peripheral artery diseases). The necessity to promote further criteria to distinguish early atherosclerotic plaque formation from thickening of IMT and to standardize IMT measurements is expressed through this updated consensus. Plaque is defined as a focal structure that encroaches into the arterial lumen of at least 0.5 mm or 50% of the surrounding IMT value or demonstrates a thickness >1.5 mm as measured from the media-adventitia interface to the intima-lumen interface. Standard use of IMT measurements is based on physics, technical and disease-related principles as well as agreements on how to perform, interpret and document study results. Harmonization of carotid image acquisition and analysis is needed for the comparison of the IMT results obtained from epidemiological and interventional studies around the world. The consensus concludes that there is no need to ‘treat IMT values’ nor to monitor IMT values in individual patients apart from exceptions named, which emphasize that inside randomized clinical trials should be performed. Although IMT has been suggested to represent an important risk marker, according to the current evidence it does not fulfill the characteristics of an accepted risk factor. Standardized methods recommended in this consensus statement will foster homogenous data collection and analysis. This will help to improve the power of randomized clinical trials incorporating IMT measurements and to facilitate the merging of large databases for meta-analyses.

Quiz Ref ID The management of inflammatory bowel diseases (IBDs) has been rapidly evolving in the past 2 decades. The efficacy of thiopurines and tumor necrosis factor antagonists (anti-TNFs) has been assessed by numerous trials, most of which have demonstrated clinical benefits.^1,2 Thiopurines are effective in maintaining the remission of both Crohn disease and ulcerative colitis.¹ Anti-TNF agents are superior to azathioprine in patients with Crohn disease not previously treated with thiopurines² and are approved in patients with moderate to severe Crohn disease or ulcerative colitis for whom thiopurines have not resulted in disease control.^3,4 Furthermore, combination therapy with anti-TNF agents and thiopurines seems to be more effective than monotherapy in patients with IBD who have not been treated previously with either thiopurines or anti-TNF agents.^2,5 It is less clear whether combination therapy is superior to anti-TNF monotherapy in patients exposed to thiopurines.⁶

Background — Elastic artery stiffness, a result of arterial aging, is an independent indicator of cardiovascular risk. The aim of the present longitudinal study was to compare the progression of aortic stiffness over a 6-year period in treated hypertensive subjects and normotensive subjects, and to evaluate the determinants of this progression. Methods and Results — Data for the present analysis were gathered from 483 subjects who had 2 health checkups at the Centre d’Investigations Préventives et Cliniques, the first one in 1992–1993 and the second one in 1998–1999. Carotid-femoral pulse wave velocity (PWV) was used to evaluate aortic stiffness in 187 hypertensive subjects who were under treatment at the time of the first visit and throughout the follow-up period, and in 296 subjects who were classified as normotensive during the first visit and who remained treatment-free throughout the follow-up period. In both populations, PWV progression was higher in older subjects. Annual rates of progression in PWV in treated hypertensives were significantly higher than in normotensives. Only treated hypertensives with well-controlled blood pressure levels at the time of both visits had a PWV progression similar to that of normotensives. In treated hypertensives, high heart rate and high creatinine during the first visit were associated with an accelerated progression in PWV. Conclusions — The presence of high blood pressure, high heart rate, and high serum creatinine were the major determinants of accelerated progression of aortic stiffness in treated hypertensives. This is the first longitudinal study to evaluate the determinants of arterial aging over an extended period of time.

Rationale: Increased risk for cardiovascular morbidity and mortality has been related to both lung function impairment and metabolic syndrome. Data on the relationship between lung function and metabolic syndrome are sparse. Objectives: To investigate risk for lung function impairment according to metabolic syndrome traits. Methods: This cross-sectional population-based study included 121,965 men and women examined at the Paris Investigations Préventives et Cliniques Center between 1999 and 2006. The lower limit of normal was used to define lung function impairment (FEV₁ or FVC < lower limit of normal). Metabolic syndrome was assessed according to the American Heart Association/National Heart, Lung, and Blood Institute statement. Measurements and Main Results: We used a logistic regression model and principal component analysis to investigate the differential associations between lung function impairment and specific components of metabolic syndrome. Lung function impairment was associated with metabolic syndrome (prevalence = 15.0%) independently of age, sex, smoking status, alcohol consumption, educational level, body mass index, leisure-time physical activity, and cardiovascular disease history (odds ratio [OR] [95% confidence interval], 1.28 [1.20–1.37] and OR, 1.41 [1.31–1.51] for FEV₁ and FVC, respectively). Three factors were identified from factor analysis: “lipids” (low high-density lipoprotein cholesterol, high triglycerides), “glucose–blood pressure” (high fasting glycemia, high blood pressure), and “abdominal obesity” (large waist circumference). All factors were inversely related to lung function, but abdominal obesity was the strongest predictor of lung function impairment (OR, 1.94 [1.80–2.09] and OR, 2.11 [1.95–2.29], for FEV₁ and FVC, respectively). Similar results were obtained for women and men. Conclusions: We found a positive independent relationship between lung function impairment and metabolic syndrome in both sexes, predominantly due to abdominal obesity. Further studies are required to clarify the underlying mechanisms.