human
***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: The Monitored Atherosclerosis Regression Study ( MARS ) was a r and omized , double-blind , placebo-controlled angiographic trial of lipid-lowering therapy in subjects with coronary artery disease . Subjects were counseled to follow a low-fat , low-cholesterol diet . At every clinic visit , data were obtained on body weight , dietary intake , alcohol consumption , and tobacco use . Semiannual determinations of early preintrusive atherosclerosis were made with high-resolution B-mode ultrasonography of the carotid artery intima-media thickness ( IMT ) . We evaluated the effects of lifestyle modification ( diet , alcohol , smoking , and weight loss ) on the rate of carotid artery IMT progression on the 94 subjects r and omly assigned to the placebo group .  Dietary cholesterol , insoluble fiber , body mass index , and smoking were significant predictors of the annual rate of carotid artery IMT progression ( P < 0.05 ) . For subjects experiencing IMT progression , increased intakes of monounsaturated fat relative to saturated fat and stearic acid ( 18:0 ) consumption were significant predictors of a reduction in the annual rate of carotid artery IMT progression ; for subjects experiencing IMT regression , male sex was a significant predictor of a reduction in the annual rate of carotid artery IMT regression . Modifications reducing body mass index by 5 kg/m2 , quitting a 10 cigarette/d smoking habit , and reducing dietary cholesterol intake by 100 mg/d on average would reduce the annual rate of carotid wall IMT progression by 0.13 mm/y , which is equivalent to the maximum rate of IMT progression observed in the MARS placebo group . Progression of early preintrusive atherosclerosis can be reduced and overall regression can occur with dietary and lifestyle modification Background and Purpose — It is unclear whether elevated serum C-reactive protein ( CRP ) is causal to the initiation and progression of atherosclerosis . We undertook a prospect i ve longitudinal cohort study to address this question . Methods — In a population -based sample of 3122 subjects , we measured  carotid intima media thickness ( IMT ) at baseline and after 3 years and surveyed clinical events . Associations between baseline high-sensitivity CRP ( hs-CRP ) and baseline IMT , and IMT progression were determined before and after controlling for vascular risk factors . The relationship between baseline IMT and clinical events during follow up was determined . Results — All vascular risk factors were significantly associated with hs-CRP ( P<0.001 ) . Hs-CRP was significantly associated with baseline IMT in all carotid segments ( P<0.001 ) , but this association was no longer significant after controlling for age , gender , and cardiovascular risk factors . Hs-CRP was not related to individual IMT progression . Interactions between hs-CRP and body mass index , HbA1c , or blood pressure showed no association with IMT progression . Baseline hs-CRP was related to the risk of clinical events ( myocardial infa rct ion or stroke or death , hazard ratio of 1.22 per mg/L hs-CRP increase , 95 % CI : 1.07 to 1.39 , P=0.004 , adjusted for age and gender ) , but this association was not significant after controlling for age , gender , and cardiovascular risk factors ( 1.59 , 95 % CI : 0.96 to 2.64 , P=0.072 ) . Conclusions — Our results suggest that hs-CRP is not an independent causal factor for the initiation and progression of early atherosclerotic changes of the carotid arteries . Univariate associations between  hs-CRP and IMT were largely explained by confounding by age , gender , and cardiovascular risk factors PURPOSE Polycystic ovary syndrome ( PCOS ) is an extremely prevalent disorder in which elevated blood markers of cardiovascular risk and altered endothelial function have been found . This study was design ed to determine if abnormal carotid intima-media thickness ( IMT ) and brachial flow-mediated dilation ( FMD ) in young women with PCOS may be explained by insulin resistance and elevated adipocytokines . METHODS A prospect i ve study in 50 young women with PCOS ( age : 25.2 + /- 1 years ; body mass index [ BMI ] : 28.7 + /- 0.8 ) and 50 matched ovulatory controls ( age : 25.1 + /- 0.7 years ; BMI : 28.5 + /- 0.5 ) was performed . Carotid IMT , brachial FMD , and blood for fasting glucose , insulin , leptin , adiponectin and resistin  were measured . RESULTS PCOS , IMT was increased ( P < .01 ) , FMD was decreased ( P < .01 ) , fasting insulin was increased ( P < .01 ) , QUICKI ( a marker of insulin resistance ) was decreased ( P < .01 ) , and adiponectin was lower ( P < .05 ) , whereas leptin and resistin were not different compared with matched controls . Whereas BMI or waist/hip ratios did not correlate with IMT or FMD , insulin and QUICKI correlated positively and negatively with IMT ( P < .01 ) . There was a significant negative correlation between adiponectin and IMT ( P < .05 ) . These correlations were unchanged when adjusting for BMI and the correlation between IMT and adiponectin was unaffected by insulin resistance parameters . CONCLUSIONS These data suggest that young women with PCOS have evidence for altered endothelial function . Adverse endothelial parameters were correlated with insulin resistance and lower adiponectin . Both insulin resistance and adiponectin appear to be important parameters . It is hypothesized that the type of fat distribution may influence these factors OBJECTIVES The object of this study was to assess the effects of menopause and a diet/exercise intervention on sub clinical atherosclerosis progression . BACKGROUND Sub clinical atherosclerosis has been linked to higher coronary heart disease and stroke rates and is greater among postmenopausal women according to cross-sectional analyses . Whether menopause is associated with an accelerated progression of sub clinical disease is unknown , as is the extent to which lifestyle intervention can alter the course of progression . METHODS Intima-media thickness ( IMT ) measures of the common carotid artery ( CCA ) , internal carotid artery ( ICA ) , and bulb segments of the carotid arteries were measured twice during the course of 4 years in 353 women from the Women 's Healthy Lifestyle Project , a dietary and exercise clinical trial design ed to prevent adverse risk factor changes through the menopause . A third measure was obtained 2.5 years later for 113 women . RESULTS The progression of IMT was observed for the average of all segments ( AVG ) , the CCA , and the bulb ( 0.007 mm/year , 0.008 mm/year , and 0.012 mm/year ; p < 0.01 for all ) , but not for the ICA . Among controls , menopause was associated with accelerated IMT progression ( 0.003 mm/year for premenopausal women vs. 0.008 mm/year for perimenopausal/postmenopausal women for AVG IMT ; p = 0.049 ) . Additionally , among the 160 perimenopausal/postmenopausal women , the intervention slowed IMT progression ( 0.008 mm/year for the control group vs. 0.004 mm/year for the intervention group for AVG IMT ; p = 0.02 ) . Similar results were found for the CCA and bulb segments . CONCLUSIONS These data demonstrate that the menopause transition is associated with accelerated sub clinical atherosclerosis progression and that a diet/exercise intervention slows menopause-related atherosclerosis progression OBJECTIVE To evaluate endothelial function with flow-mediated dilatation ( FMD ) and carotid intima media thickness ( IMT ) in young nonobese polycystic ovary syndrome ( PCOS ) patients . DESIGN Prospect i ve case-control study . SETTING Healthy volunteers and nonobese young PCOS patients in clinical research . PATIENT(S ) Thirty-nine PCOS patients with mean age of 22.82 + /- 5.53 years and 30 body mass index- and age-matched healthy controls were evaluated . INTERVENTION(S ) Insulin resistance was calculated with area under the curve , quantitative insulin sensitivity check , and the Matsuda index .  Endothelial function was assessed with FMD and carotid IMT by ultrasonography . MAIN OUTCOME MEASURE(S ) Antropometric , hormonal , biochemical ( insulin and glucose , tumor necrosis factor-alpha , hs-c-reactive protein , and homocysteine levels , and so forth ) , FMD , and IMT were measured . RESULT ( S ) There was a significant insulin resistance in PCOS patients . Serum FSH , total and free testosterone , cortisol , and rostenedione , and DHEA-S levels of PCOS patients were also higher than control subjects , but we could not find any significant difference in terms of endothelial function determined with FMD . CONCLUSION ( S ) Existence of insulin resistance alone may not be an adequate factor for deterioration of endothelial function and carotid IMT in young , nonobese patients with PCOS . Other factors such as duration of insulin resistance , older age , presence of obesity , and inflammatory markers may play an important role in this process Background and Purpose — Carotid intima-media thickness ( IMT ) is an independent predictor of  vascular events in age groups > 45 years . However , there is little information about the predictive value of IMT in younger individuals . Methods — In the Carotid Atherosclerosis Progression Study ( CAPS ; n=5056 ; age range 19 to 90 years ; mean age 50.1 years ) , common carotid artery ( CCA ) IMT , bifurcation IMT , internal carotid artery IMT and vascular risk factors were evaluated at baseline . The incidence of stroke , myocardial infa rct ion ( MI ) , and death was determined prospect ively . Data for younger ( < 50 years ; n=2436 ) and older subjects ( ≥50 years ; n=2620 ) were analyzed separately using Cox proportional hazard regression models . Results — During a mean follow-up period of 4.2 years , there were 228 cases of MI , 107 strokes , and 50 deaths . IMT at all carotid segments was highly predictive of all end points ( eg , hazard rate ratios [ HRRs ] per 1 SD CCA-IMT increase were 1.43 [ 95 % CI : 1.35 to 1.51 ] for MI , 1.47 [ 1.35 to 1.60 ] for stroke , and 1.45 [ 1.38 to 1.52 ] for MI , stroke or death ; all P<0.0001 ) . Even after adjustment for age , sex , and vascular risk factors , the predictive value of CCA-IMT and bifurcation IMT remained significant for MI and the combined end point . For the latter , the HRRs were considerably higher in the younger than in the older age group ( eg , HRR per 0.1 mm CCA-IMT was 1.34 [ 1.16 to 1.55 ] vis-à-vis 1.10 [ 1.05 to 1.15 ] ; P=0.011 for age-IMT interaction ) . Conclusions — Carotid IMT independently predicts future vascular events . Its predictive value is at least as high in younger subjects as in older subjects CONTEXT Polycystic ovary syndrome ( PCOS ) is associated with comorbidities that may contribute to increased risk of cardiovascular disease . PCOS is associated with increased risk of metabolic syndrome , dyslipidemia , and diabetes , but it remains unclear whether traditional cardiovascular ( CV ) risk factors can help predict coronary artery disease in this population . OBJECTIVE The objectives of the study were to detect early-onset sub clinical coronary atherosclerosis ( using coronary artery calcium as a marker ) in young women with PCOS , compared with age- and body mass index-matched controls , and to compare traditional CV risk factors and inflammatory markers in the two groups . DESIGN This was a prospect i ve case-control study . SETTING The study was conducted at a university hospital . SUBJECTS Twenty-four obese ( body mass index > or= 30 kg/m2 ) PCOS subjects and 24 obese controls participated . OUTCOME MEASURES Coronary artery calcium , inflammatory markers ( high-sensitivity C-reactive protein , IL-6 , TNFalpha , adiponectin , leptin ) , fasting blood tests ( glucose , lipids , insulin ) , and dual-energy x-ray absorptiometry scan for body fat distribution were measured . RESULTS Coronary artery calcium was detected in eight of 24 PCOS subjects ( 33 % ) and two of 24 controls ( 8 % ) ( odds ratio 5.5 , 95 % confidence interval 1.03 , 29.45 , P < 0.03 ) . Traditional CV risk factors did not differ significantly between the two groups 
    Output:
    
agent
***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: The Monitored Atherosclerosis Regression Study ( MARS ) was a r and omized , double-blind , placebo-controlled angiographic trial of lipid-lowering therapy in subjects with coronary artery disease . Subjects were counseled to follow a low-fat , low-cholesterol diet . At every clinic visit , data were obtained on body weight , dietary intake , alcohol consumption , and tobacco use . Semiannual determinations of early preintrusive atherosclerosis were made with high-resolution B-mode ultrasonography of the carotid artery intima-media thickness ( IMT ) . We evaluated the effects of lifestyle modification ( diet , alcohol , smoking , and weight loss ) on the rate of carotid artery IMT progression on the 94 subjects r and omly assigned to the placebo group .  Dietary cholesterol , insoluble fiber , body mass index , and smoking were significant predictors of the annual rate of carotid artery IMT progression ( P < 0.05 ) . For subjects experiencing IMT progression , increased intakes of monounsaturated fat relative to saturated fat and stearic acid ( 18:0 ) consumption were significant predictors of a reduction in the annual rate of carotid artery IMT progression ; for subjects experiencing IMT regression , male sex was a significant predictor of a reduction in the annual rate of carotid artery IMT regression . Modifications reducing body mass index by 5 kg/m2 , quitting a 10 cigarette/d smoking habit , and reducing dietary cholesterol intake by 100 mg/d on average would reduce the annual rate of carotid wall IMT progression by 0.13 mm/y , which is equivalent to the maximum rate of IMT progression observed in the MARS placebo group . Progression of early preintrusive atherosclerosis can be reduced and overall regression can occur with dietary and lifestyle modification Background and Purpose — It is unclear whether elevated serum C-reactive protein ( CRP ) is causal to the initiation and progression of atherosclerosis . We undertook a prospect i ve longitudinal cohort study to address this question . Methods — In a population -based sample of 3122 subjects , we measured  carotid intima media thickness ( IMT ) at baseline and after 3 years and surveyed clinical events . Associations between baseline high-sensitivity CRP ( hs-CRP ) and baseline IMT , and IMT progression were determined before and after controlling for vascular risk factors . The relationship between baseline IMT and clinical events during follow up was determined . Results — All vascular risk factors were significantly associated with hs-CRP ( P<0.001 ) . Hs-CRP was significantly associated with baseline IMT in all carotid segments ( P<0.001 ) , but this association was no longer significant after controlling for age , gender , and cardiovascular risk factors . Hs-CRP was not related to individual IMT progression . Interactions between hs-CRP and body mass index , HbA1c , or blood pressure showed no association with IMT progression . Baseline hs-CRP was related to the risk of clinical events ( myocardial infa rct ion or stroke or death , hazard ratio of 1.22 per mg/L hs-CRP increase , 95 % CI : 1.07 to 1.39 , P=0.004 , adjusted for age and gender ) , but this association was not significant after controlling for age , gender , and cardiovascular risk factors ( 1.59 , 95 % CI : 0.96 to 2.64 , P=0.072 ) . Conclusions — Our results suggest that hs-CRP is not an independent causal factor for the initiation and progression of early atherosclerotic changes of the carotid arteries . Univariate associations between  hs-CRP and IMT were largely explained by confounding by age , gender , and cardiovascular risk factors PURPOSE Polycystic ovary syndrome ( PCOS ) is an extremely prevalent disorder in which elevated blood markers of cardiovascular risk and altered endothelial function have been found . This study was design ed to determine if abnormal carotid intima-media thickness ( IMT ) and brachial flow-mediated dilation ( FMD ) in young women with PCOS may be explained by insulin resistance and elevated adipocytokines . METHODS A prospect i ve study in 50 young women with PCOS ( age : 25.2 + /- 1 years ; body mass index [ BMI ] : 28.7 + /- 0.8 ) and 50 matched ovulatory controls ( age : 25.1 + /- 0.7 years ; BMI : 28.5 + /- 0.5 ) was performed . Carotid IMT , brachial FMD , and blood for fasting glucose , insulin , leptin , adiponectin and resistin  were measured . RESULTS PCOS , IMT was increased ( P < .01 ) , FMD was decreased ( P < .01 ) , fasting insulin was increased ( P < .01 ) , QUICKI ( a marker of insulin resistance ) was decreased ( P < .01 ) , and adiponectin was lower ( P < .05 ) , whereas leptin and resistin were not different compared with matched controls . Whereas BMI or waist/hip ratios did not correlate with IMT or FMD , insulin and QUICKI correlated positively and negatively with IMT ( P < .01 ) . There was a significant negative correlation between adiponectin and IMT ( P < .05 ) . These correlations were unchanged when adjusting for BMI and the correlation between IMT and adiponectin was unaffected by insulin resistance parameters . CONCLUSIONS These data suggest that young women with PCOS have evidence for altered endothelial function . Adverse endothelial parameters were correlated with insulin resistance and lower adiponectin . Both insulin resistance and adiponectin appear to be important parameters . It is hypothesized that the type of fat distribution may influence these factors OBJECTIVES The object of this study was to assess the effects of menopause and a diet/exercise intervention on sub clinical atherosclerosis progression . BACKGROUND Sub clinical atherosclerosis has been linked to higher coronary heart disease and stroke rates and is greater among postmenopausal women according to cross-sectional analyses . Whether menopause is associated with an accelerated progression of sub clinical disease is unknown , as is the extent to which lifestyle intervention can alter the course of progression . METHODS Intima-media thickness ( IMT ) measures of the common carotid artery ( CCA ) , internal carotid artery ( ICA ) , and bulb segments of the carotid arteries were measured twice during the course of 4 years in 353 women from the Women 's Healthy Lifestyle Project , a dietary and exercise clinical trial design ed to prevent adverse risk factor changes through the menopause . A third measure was obtained 2.5 years later for 113 women . RESULTS The progression of IMT was observed for the average of all segments ( AVG ) , the CCA , and the bulb ( 0.007 mm/year , 0.008 mm/year , and 0.012 mm/year ; p < 0.01 for all ) , but not for the ICA . Among controls , menopause was associated with accelerated IMT progression ( 0.003 mm/year for premenopausal women vs. 0.008 mm/year for perimenopausal/postmenopausal women for AVG IMT ; p = 0.049 ) . Additionally , among the 160 perimenopausal/postmenopausal women , the intervention slowed IMT progression ( 0.008 mm/year for the control group vs. 0.004 mm/year for the intervention group for AVG IMT ; p = 0.02 ) . Similar results were found for the CCA and bulb segments . CONCLUSIONS These data demonstrate that the menopause transition is associated with accelerated sub clinical atherosclerosis progression and that a diet/exercise intervention slows menopause-related atherosclerosis progression OBJECTIVE To evaluate endothelial function with flow-mediated dilatation ( FMD ) and carotid intima media thickness ( IMT ) in young nonobese polycystic ovary syndrome ( PCOS ) patients . DESIGN Prospect i ve case-control study . SETTING Healthy volunteers and nonobese young PCOS patients in clinical research . PATIENT(S ) Thirty-nine PCOS patients with mean age of 22.82 + /- 5.53 years and 30 body mass index- and age-matched healthy controls were evaluated . INTERVENTION(S ) Insulin resistance was calculated with area under the curve , quantitative insulin sensitivity check , and the Matsuda index .  Endothelial function was assessed with FMD and carotid IMT by ultrasonography . MAIN OUTCOME MEASURE(S ) Antropometric , hormonal , biochemical ( insulin and glucose , tumor necrosis factor-alpha , hs-c-reactive protein , and homocysteine levels , and so forth ) , FMD , and IMT were measured . RESULT ( S ) There was a significant insulin resistance in PCOS patients . Serum FSH , total and free testosterone , cortisol , and rostenedione , and DHEA-S levels of PCOS patients were also higher than control subjects , but we could not find any significant difference in terms of endothelial function determined with FMD . CONCLUSION ( S ) Existence of insulin resistance alone may not be an adequate factor for deterioration of endothelial function and carotid IMT in young , nonobese patients with PCOS . Other factors such as duration of insulin resistance , older age , presence of obesity , and inflammatory markers may play an important role in this process Background and Purpose — Carotid intima-media thickness ( IMT ) is an independent predictor of  vascular events in age groups > 45 years . However , there is little information about the predictive value of IMT in younger individuals . Methods — In the Carotid Atherosclerosis Progression Study ( CAPS ; n=5056 ; age range 19 to 90 years ; mean age 50.1 years ) , common carotid artery ( CCA ) IMT , bifurcation IMT , internal carotid artery IMT and vascular risk factors were evaluated at baseline . The incidence of stroke , myocardial infa rct ion ( MI ) , and death was determined prospect ively . Data for younger ( < 50 years ; n=2436 ) and older subjects ( ≥50 years ; n=2620 ) were analyzed separately using Cox proportional hazard regression models . Results — During a mean follow-up period of 4.2 years , there were 228 cases of MI , 107 strokes , and 50 deaths . IMT at all carotid segments was highly predictive of all end points ( eg , hazard rate ratios [ HRRs ] per 1 SD CCA-IMT increase were 1.43 [ 95 % CI : 1.35 to 1.51 ] for MI , 1.47 [ 1.35 to 1.60 ] for stroke , and 1.45 [ 1.38 to 1.52 ] for MI , stroke or death ; all P<0.0001 ) . Even after adjustment for age , sex , and vascular risk factors , the predictive value of CCA-IMT and bifurcation IMT remained significant for MI and the combined end point . For the latter , the HRRs were considerably higher in the younger than in the older age group ( eg , HRR per 0.1 mm CCA-IMT was 1.34 [ 1.16 to 1.55 ] vis-à-vis 1.10 [ 1.05 to 1.15 ] ; P=0.011 for age-IMT interaction ) . Conclusions — Carotid IMT independently predicts future vascular events . Its predictive value is at least as high in younger subjects as in older subjects CONTEXT Polycystic ovary syndrome ( PCOS ) is associated with comorbidities that may contribute to increased risk of cardiovascular disease . PCOS is associated with increased risk of metabolic syndrome , dyslipidemia , and diabetes , but it remains unclear whether traditional cardiovascular ( CV ) risk factors can help predict coronary artery disease in this population . OBJECTIVE The objectives of the study were to detect early-onset sub clinical coronary atherosclerosis ( using coronary artery calcium as a marker ) in young women with PCOS , compared with age- and body mass index-matched controls , and to compare traditional CV risk factors and inflammatory markers in the two groups . DESIGN This was a prospect i ve case-control study . SETTING The study was conducted at a university hospital . SUBJECTS Twenty-four obese ( body mass index > or= 30 kg/m2 ) PCOS subjects and 24 obese controls participated . OUTCOME MEASURES Coronary artery calcium , inflammatory markers ( high-sensitivity C-reactive protein , IL-6 , TNFalpha , adiponectin , leptin ) , fasting blood tests ( glucose , lipids , insulin ) , and dual-energy x-ray absorptiometry scan for body fat distribution were measured . RESULTS Coronary artery calcium was detected in eight of 24 PCOS subjects ( 33 % ) and two of 24 controls ( 8 % ) ( odds ratio 5.5 , 95 % confidence interval 1.03 , 29.45 , P < 0.03 ) . Traditional CV risk factors did not differ significantly between the two groups 
    Output:
    