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Comparison of ultrasound-measured properties of the common carotid artery to tobacco smoke exposure in a cohort of Indonesian patients

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Allen R. Yu1, Bima Hasjim1, Luke E. Yu1, Christopher Gabriel1, Alexander Anshus1, Jonathan B. Lee1, Michael J. Louthan1, Esther C. Kim1, Katrina Lee1, Christina Tse1, Thomas Keown1, Shadi Lahham2, Maili Alvarado2, Steven Bunch2, Abdulatif Gari2, J. Christian Fox1,2


1 School of Medicine, University of California, Irvine, USA


2 Department of Emergency Medicine, University of California, Irvine, USA


Corresponding Author: Shadi Lahham, Email: slahham@uci.edu


© 2017 World Journal of Emergency Medicine


DOI: 10.5847/wjem.j.1920–8642.2017.03.003


BACKGROUND: The purpose of this study was to use point-of-care ultrasound (POCUS) to investigate the relationship between tobacco smoke exposure and the characteristics of the common carotid artery (CCA). The effect of both primary and secondary smoking on CCA properties was evaluated.

METHODS: We performed a prospective cross-sectional study across 20 primary care clinics in Bandung, West Java, Indonesia in July 2016. Point of care ultrasound was performed on a convenience sample of Indonesian patients presenting to clinic. The CCA wall stiffness and carotid intima-media thickness (CIMT) were measured during diastole and systole. These measurements were correlated with smoke exposure and cardiovascular disease.

RESULTS: We enrolled 663 patients in the study, with 426 patients enrolled in the smoking category and 237 patients enrolled in the second-hand smoke category. There was an overall positive correlation with the measured lifestyle factors and the ultrasound-measured variables in the group of individuals who smoked. For all variables, age seemed to contribute the most out of all of the lifestyle factors for the positive changes in CIMT and CCA wall stiffness.

CONCLUSION: Our data yielded correlations between CCA properties and cardiovascular risk, as well as between CIMT and arterial stiffness. We were also able to demonstrate an increase in thickness of the CIMT in patients who have been exposed by tobacco through the use of ultrasound. Further large scale studies comparing patients with multiple cardiac risk factors need to be performed to confirm the utility of ultrasound findings of cardiovascular disease and stroke.

(World J Emerg Med 2017;8(3):177–183)


KEY WORDS: Carotid artery thickness; Point of care ultrasound; Indonesia; Intimal thickness

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