Athrogenic Indices Can Predict Atherosclerosis in Patients with Sarcoidosis Sarcoidosis and Atherosclerosis

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Okan Selendili
Ersin Günay
Emre Kacar
Sule Cilekar
Gurhan Oz
Ahmet Dumanli
Sibel Günay


Sarcoidosis; lipid profile; atherogenic index; atherosclerosis; cardiac involvement


Background: Sarcoidosis is a multisystemic disease of unknown etiology characterized by non-caseating granulomatous inflammation. In this study, we aimed to investigate the efficiency of atherogenic indices and ultrasonographic evaluation of carotid artery on predictive value of diagnosis of atherosclerosis in patients with sarcoidosis.

Methods: We included 44 subjects which were followed with diagnosis of sarcoidosis and 53 healthy subjects–for control group- matched with age and gender. Laboratory findings, pulmonary function tests and carotis artery ultrasonography data of all participants were evaluated.

Results: Of all patients with sarcoidosis 70.5% was female and mean age was 35.36±7.18 years. 64.2% of the control patients were female and the mean age was 33.58±8.13 years (P=0.511 and P=0.191, respectively). High-density-lipoprotein cholesterol level in the sarcoidosis group was significantly lower than the control patients (P=0.017), while other cholesterol levels were higher than the control patients (P<0.05). Intima-media thickness and peak systolic velocity (PSV) of carotid artery were higher in patients with sarcoidosis (P<0.001 and P=0.009, respectively). Atherogenic indices (Atherogenic Index (AI), Atherogenic Coefficient (AC) and Cardiogenic Risk Ratio (CRR)) were calculated much greater in patients with sarcoidosis than control (P<0.001, for all parameters). There was a positive correlation between Intima-Media thickness and PSV, AI, AC, and CRR. A positive correlation between PSV and atherogenic indices was also detected.

Conclusions: Sarcoidosis is a predisposing cause for atherosclerosis. Atherogenic indices, intima-media thickness of carotid artery and PSV could be considered as a useful predictor for atherosclerosis and cardiovascular diseases in asymptomatic sarcoidosis patients. 


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1. Spagnolo P, Rossi G, Trisolini R, Sverzellati N, Baughman RP, Wells AU. Pulmonary sarcoidosis. Lancet Respir Med. 2018;6(5):389-402.
2. Musellim B, Kumbasar OO, Ongen G, Cetinkaya E, Turker H, Uzaslan E, et al. Epidemiological features of Turkish patients with sarcoidosis. Respir Med. 2009; 103:907-912.
3. Heikkilä HM, Trosien J, Metso J, Jauhiainen M, Pentikäinen MO, Kovanen PT, Lindstedt KA. Mast cells promote atherosclerosis by inducing both an atherogenic lipid profile and vascular inflammation. J Cell Biochem. 2010 ;109:615-623.
4. Simonen P, Lehtonen J, Gylling H, M Kupari. Cholesterol metabolism in cardiac sarcoidosis. Atherosclerosis. 2016;248:210-215.
5. Gunay S, Sariaydin M, Acay A. New Predictor of Atherosclerosis in Subjects With COPD: Atherogenic Indices. Respir Care. 2016;61:1481-1487.
6. Acay A, Ulu MS, Ahsen A, Ozkececi G, Demir K, Ozuguz U, Yuksel S, Acarturk G. Atherogenic index as a predictor of atherosclerosis in subjects with familial Mediterranean fever. Medicina 2014;50:329-333.
7. Singh M, Pathak MS, Paul A. A study on atherogenic indices of pregnancy induced hypertension patients as compared to normal pregnant women. J Clin Diagn Res 2015 ;9:BC05-BC08.
8. Dobiasova M. Czech Calculator of atherogenic risk. Avaliable from: (Last accessed date 05/06/2018).
9. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al; ESC Scientific Document Group. 2018 ESC/ ESH Guidelines for the management of arterial hypertension. Eur Heart J 2018;39:3021–104
10. Caminhotto Rde O, Fonseca FL, Castro NC, et al. Atkins diet program rapidly decreases atherogenic index of plasma in trained adapted overweight men. Arch Endocrinol Metab. 2015 ;59:568-571.
11. Bakry OA, El Farargy SM, Ghanayem N, et al. Atherogenic index of plasma in non-obese women with androgenetic alopecia. Int J Dermatol. 2015 ;54:339-344.
12. Rybicki BA, Iannuzzi MC, Frederick MM, et al. Familial aggregation of sarcoidosis. A case-control etiologic study of sarcoidosis (ACCESS). Am J Respir Crit Care Med. 2001 ;164:2085-2091.
13. Okumus G, Musellim B, Cetinkaya E, et al. Extrapulmonary involvement in patients with sarcoidosis in Turkey. Respirology. 2011;16:446-450.
14. Rizzato G, Fraioli P, Montemurro L. Long-term therapy with deflazacort in chronic sarcoidosis. Chest. 1991;99:301-309.
15. Salazar A, Mañá J, Pintó X, et al. Corticosteroid therapy increases HDL-cholesterol concentrations in patients with active sarcoidosis and hypoalphalipoproteinemia. Clin Chim Acta. 2002;320:59-64.
16. Salazar A, Pintó X, Mañá J. Serum amyloid A and high-density lipoprotein cholesterol: serum markers of inflammation in sarcoidosis and other systemic disorders. Eur J Clin Invest. 2001;31:1070-1077.
17. Ivanišević J, Kotur-Stevuljević J, Stefanović A, et al. Dyslipidemia and oxidative stress in sarcoidosis patients. Clin Biochem. 2012;45:677-682.
18. Mochizuki I, Kubo K, Honda T. Relationship between mitochondria and the development of specific lipid droplets in capillary endothelial cells of the respiratory tract in patients with sarcoidosis. Mitochondrion. 2011 ;11:601-606.
19. Mochizuki I, Kubo K, Hond T. Widespread heavy damage of capillary endothelial cells in the pathogenesis of sarcoidosis--Evidence by monoclonal von Willebrand factor immunohistochemistry in the bronchus and lung of patients with sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis. 2014 ;31:182-190.
20. Psathakis K, Papatheodorou G, Plataki M, et al. 8-Isoprostane, a marker of oxidative stress, is increased in the expired breath condensate of patients with pulmonary sarcoidosis. Chest. 2004 ;125:1005-1011.
21. Tuleta I, Pingel S, Biener L, et al. Atherosclerotic Vessel Changes in Sarcoidosis. Adv Exp Med Biol. 2016;910:23-30.
22. Bargagli E, Rosi E, Pistolesi M, et al. Increased Risk of Atherosclerosis in Patients with Sarcoidosis. Pathobiology. 2017;84:258-263.
23. Siasos G, Tousoulis D, Gialafos E, et al. Association of sarcoidosis with endothelial function, arterial wall properties, and biomarkers of inflammation. Am J Hypertens. 2011;24:647-653.
24. Tuleta I, Skowasch D, Biener L, et al. Impaired Vascular Function in Sarcoidosis Patients. Adv Exp Med Biol. 2017;980:1-9.
25. Hellmann M, Dudziak M, Dubaniewicz A. Increased pulse wave velocity in pulmonary sarcoidosis: a preliminary study. Pol Arch Med Wewn. 2015;125:475-477.
26. Yusuf S, Hawken S, Ounpuu S, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004 ;364:937-952.
27. Santos-Gallego CG, Weiss AJ, Sanz J. Non-cardiac sarcoid actually affects the heart by reducing coronary flow reserve. Atherosclerosis. 2017 ;264:74-76.
28. Kul S, Kutlu GA, Guvenc TS, et al. Coronary flow reserve is reduced in sarcoidosis. Atherosclerosis. 2017 ;264:115-121.
29. Stein JH, Korcarz CE, Hurst RT, et al. Use of carotid ultrasound to identify subclinical vascular disease and evaluate cardiovascular disease risk: a consensus statement from the American Society of Echocardiography Carotid Intima-Media Thickness Task Force. Endorsed by the Society for Vascular Medicine. J Am Soc Echocardiogr. 2008 ;21:93-111.
30. Kasliwal RR, Bansal M, Desai D, Sharma M. Carotid intima-media thickness: Current evidence, practices, and Indian experience. Indian J Endocrinol Metab. 2014;18:13-22.
31. Spencer MP, Reid JM. Quantitation of carotid stenosis with continuous-wave (C-W) Doppler ultrasound. Stroke. 1979 ;10:326 –330.
32. Alexandrov AV. The Spencer’s Curve: clinical implications of a classic hemodynamic model. J Neuroimaging. 2007 ;17:6-10.
33. Von Reutern GM, Goertler MW, Bornstein NM, et al. Grading carotid stenosis using ultrasonic methods. Stroke. 2012 ;43:916-921.
34. Yong WC, Sanguankeo A, Upala S. Association between sarcoidosis, pulse wave velocity, and other measures of subclinical atherosclerosis: a systematic review and meta-analysis. Clin Rheumatol. 2017.
35. Hathout GM, Fink JR, El-Saden SM, Grant EG. Sonographic NASCET index: a new doppler parameter for assessment of internal carotid artery stenosis. AJNR Am J Neuroradiol. 2005 ;26:68-75.
36. Eliasziw M, Rankin RN, Fox AJ, et al. Accuracy and prognostic consequences of ultrasonography in identifying severe carotid artery stenosis. North American Symptomatic Carotid Endarterectomy Trial (NASCET) Group. Stroke 1995 ;26:1747–1752.
37. Grant EG, Benson CB, Moneta GL, et al. Carotid artery stenosis: gray-scale and Doppler US diagnosis--Society of Radiologists in Ultrasound Consensus Conference. Radiology. 2003 ;229:340-346.