***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Intima-media thickness ( IMT ) is increasingly used as a surrogate end point of vascular outcomes in clinical trials aim ed at determining the success of interventions that lower risk factors for atherosclerosis and associated diseases ( stroke , myocardial infa rct ion and peripheral artery diseases ) . The necessity to promote further criteria to distinguish early atherosclerotic plaque formation from thickening of IMT and to st and ardize IMT measurements is expressed through this up date d 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 . St and ard 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 r and omized 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 . St and ardized methods recommended in this consensus statement will foster homogenous data collection and analysis . This will help to improve the power of r and omized clinical trials incorporating IMT measurements and to facilitate the merging of large data bases for meta-analyses Background and Purpose — The association between obesity and atherosclerotic disease is controversial . In the present analysis , we evaluated whether common carotid intima-media thickness ( IMT ) and area , 2 markers of pre clinical atherosclerosis , were increased in obese subjects . Methods — More than 5000 middle-aged women ( n=5062 ; age , 30 to 69 years ) living in the area of Naples , Southern Italy , were recruited for a prospect i ve , currently ongoing study on the etiology of cardiovascular disease and cancer in the female population ( the Progetto ATENA study ) . A sub sample of 310 participants underwent high-resolution B-mode ultrasound examination  , and the IMTs , intima-media areas , and lumen diameters of common carotid arteries were measured with a semiautomated computerized program . Subjects were divided into 3 groups on the basis of the recently published obesity guidelines for body mass index ( BMI ) , a marker of general obesity , and tertiles of waist-to-hip ratio ( WHR ) , a marker of regional obesity . Results — Women with a BMI ≥30 kg/m2 showed higher systolic and diastolic blood pressures , triglycerides , and fasting glucose and insulin , as well as lower high-density lipoprotein concentrations , than subjects with lower BMI . A gradual increase in common carotid IMT and intima-media area was observed when lean women ( 0.94±0.01 mm and 19.8±0.5 mm2 , respectively ) were compared with overweight ( 0.98±0.01 mm and 21.0±0.4 mm2 ) and obese ( 1.02±0.02 mm and 22.6±0.8 mm2 , P < 0.005 for linear trend ) individuals . Similarly , women in the highest tertile of WHR ( > 0.85 ) had adverse risk factor profiles and thicker carotid intima-media complex than those in the first 2 tertiles ( P < 0.01 and P < 0.05 for IMT and intima-media area , respectively ) . In multivariate analyses , BMI and WHR were significant predictors of carotid wall thickness , independently of other traditional and nontraditional cardiovascular risk factors ( age , blood pressure , lipid abnormalities , fasting insulin ) . Conclusions — The present results indicate a grade d and independent association between general and abdominal obesity — reflected by high BMI and WHR— and carotid artery wall thickening in a population of middle-aged women Obesity is associated with impaired endothelial function assessed as flow-mediated vasodilation ( FMD ) , the procedure of which involves transient brachial artery occlusion and following reactive hyperemia . Acute aerobic exercise can improve FMD . This study examined the effects of repeated FMD procedures and acute aerobic exercise on FMD in obese young men .  Upper arm cuff inflation of 200 mmHg for 5 min and subsequent deflation was induced at 0 , 1 and 2 h to examine effects of repeated FMD procedures on FMD in obese subjects , as well as in lean controls . To observe the combined effects of FMD procedures and acute exercise on FMD in obese subjects , 45 min moderate exercise was performed immediately after FMD procedure at 0 h , with the procedure repeated at 1 and 2 h. The results showed that , after repeated FMD procedures , FMD in obese subjects increased from 5.9 ± 4.0 % to 6.5 ± 3.2 % and 8.4 ± 2.8 % ( P = 0.017 ) , whereas FMD demonstrated no changes in lean controls ( P = 0.90 ) . After repeated FMD procedures and exercise , FMD in the  obese subjects increased from 7.3 ± 3.5 % to 9.5 ± 4.0 % and 11.0 ± 4.3 % ( P = 0.0004 ) . The present findings demonstrate that both repeated FMD procedures and acute aerobic exercise  improve FMD in obese subjects OBJECTIVES We sought to assess the prognostic utility of brachial artery reactivity ( BAR ) in patients at risk of cardiovascular events . BACKGROUND Impaired flow-mediated vasodilation measured by BAR is a marker of endothelial dysfunction . Brachial artery reactivity is influenced by risk factors and is responsive to various pharmacological and other treatments . However , its prognostic importance is uncertain , especially relative to other predictors of outcome . METHODS A total of 444 patients were prospect ively enrolled to undergo BAR and follow-up .  These patients were at risk of cardiovascular events , based on the presence of risk factors or known or suspected cardiovascular disease . We took a full clinical history , performed BAR , and obtained carotid intima-media thickness ( IMT ) and left ventricular mass and ejection fraction . Patients were followed up for cardiovascular events and all-cause mortality . Multivariate Cox regression analysis was performed to assess the independent association of investigation variables on outcomes . RESULTS The patients exhibited abnormal BAR ( 5.2 + /- 6.1 % [ mean + /- SD ] ) but showed normal nitrate-mediated dilation ( 9.9 + /- 7.2 % ) and normal mean IMT ( 0.67 + /- 0.12 mm [ average ] ) . Forty-nine deaths occurred over the median follow-up period of 24 months ( interquartile range 10 to 34 ) . Patients in the lowest tertile group of BAR ( < 2 % ) had significantly more events than those in the combined group of highest and mid-tertiles ( p = 0.029 , log-rank test ) . However , mean IMT ( rather than flow-mediated dilation ) was the vascular factor independently associated with mortality , even in the subgroup ( n = 271 ) with no coronary artery disease and low risk . CONCLUSIONS Brachial artery reactivity is lower in patients with events , but is not an independent predictor of cardiovascular outcomes in this cohort of patients BACKGROUND The purpose of the present study was to compare endothelial function in lean ( body mass index [ BMI ] = 18.0 - 24.9 kg/m2 ) ; overweight ( BMI = 25 - 29.9 kg/m2 ) ; and obese ( BMI > 30 kg/m2 ) , healthy , eumenorrheic women . METHODS Eighteen lean , 22 overweight , and 19 obese eumenorrheic middle-aged women were studied . Vascular structure and function were assessed via non-invasive ultrasound imaging of the carotid and brachial arteries . Body composition , blood pressure , fasting blood lipids , glucose , and insulin  also were measured . RESULTS The groups demonstrated significantly ( p<0.001 ) different mean values for total body , lean body , and fat masses . The obese group demonstrated significantly ( p<0.05 ) elevated fasting glucose and insulin levels and lower high-density lipoprotein levels as compared to the lean group . The overweight group also demonstrated elevated fasting glucose levels as compared to the lean group ( p<0.05 ) with no significant difference from the obese group . Only systolic blood pressure differed among the three groups , being elevated in the obese group compared to the lean group ( p<0.05 ) . The obese group demonstrated significantly ( p<0.05 ) elevated carotid artery lumen diameter , carotid artery wall cross-sectional area , and brachial artery lumen diameter with significantly ( p<0.05 ) lower flow-mediated dilation as compared to the lean group . The overweight group demonstrated elevated carotid artery wall cross-sectional area and brachial artery lumen diameter as well as lower flow-mediated dilation as compared to the lean group ( p<0.05 ) . CONCLUSIONS The results of this study support the hypothesis that carotid artery wall cross-sectional area is elevated and flow-mediated dilation reduced in overweight and obese eumennorheic women as compared to lean counterparts in relation to BMI classification 
    Output:
    
Obesity is associated with poorer arterial endothelial function and increased sub clinical atherosclerosis , consistent with these aspects of vascular health at least partially contributing to the increased risk of cardiovascular events in adults with obesity .