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Okamura T, Tsukamoto K, Arai H, Fujioka Y, Ishigaki Y, Koba S, Ohmura H, Shoji T, Yokote K, Yoshida H, Yoshida M, Deguchi J, Dobashi K, Fujiyoshi A, Hamaguchi H, Hara M, Harada-Shiba M, Hirata T, Iida M, Ikeda Y, Ishibashi S, Kanda H, Kihara S, Kitagawa K, Kodama S, Koseki M, Maezawa Y, Masuda D, Miida T, Miyamoto Y, Nishimura R, Node K, Noguchi M, Ohishi M, Saito I, Sawada S, Sone H, Takemoto M, Wakatsuki A, Yanai H. Japan Atherosclerosis Society (JAS) Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases 2022. J Atheroscler Thromb 2024; 31:641-853. [PMID: 38123343 DOI: 10.5551/jat.gl2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Affiliation(s)
- Tomonori Okamura
- Preventive Medicine and Public Health, Keio University School of Medicine
| | | | | | - Yoshio Fujioka
- Faculty of Nutrition, Division of Clinical Nutrition, Kobe Gakuin University
| | - Yasushi Ishigaki
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Iwate Medical University
| | - Shinji Koba
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Hirotoshi Ohmura
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
| | - Tetsuo Shoji
- Department of Vascular Medicine, Osaka Metropolitan University Graduate school of Medicine
| | - Koutaro Yokote
- Department of Endocrinology, Hematology and Gerontology, Chiba University Graduate School of Medicine
| | - Hiroshi Yoshida
- Department of Laboratory Medicine, The Jikei University Kashiwa Hospital
| | | | - Juno Deguchi
- Department of Vascular Surgery, Saitama Medical Center, Saitama Medical University
| | - Kazushige Dobashi
- Department of Pediatrics, School of Medicine, University of Yamanashi
| | | | | | - Masumi Hara
- Department of Internal Medicine, Mizonokuchi Hospital, Teikyo University School of Medicine
| | - Mariko Harada-Shiba
- Cardiovascular Center, Osaka Medical and Pharmaceutical University
- Department of Molecular Pathogenesis, National Cerebral and Cardiovascular Center Research Institute
| | - Takumi Hirata
- Institute for Clinical and Translational Science, Nara Medical University
| | - Mami Iida
- Department of Internal Medicine and Cardiology, Gifu Prefectural General Medical Center
| | - Yoshiyuki Ikeda
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Shun Ishibashi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Jichi Medical University, School of Medicine
- Current affiliation: Ishibashi Diabetes and Endocrine Clinic
| | - Hideyuki Kanda
- Department of Public Health, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University
| | - Shinji Kihara
- Medical Laboratory Science and Technology, Division of Health Sciences, Osaka University graduate School of medicine
| | - Kazuo Kitagawa
- Department of Neurology, Tokyo Women's Medical University Hospital
| | - Satoru Kodama
- Department of Prevention of Noncommunicable Diseases and Promotion of Health Checkup, Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine
| | - Masahiro Koseki
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Yoshiro Maezawa
- Department of Endocrinology, Hematology and Gerontology, Chiba University Graduate School of Medicine
| | - Daisaku Masuda
- Department of Cardiology, Center for Innovative Medicine and Therapeutics, Dementia Care Center, Doctor's Support Center, Health Care Center, Rinku General Medical Center
| | - Takashi Miida
- Department of Clinical Laboratory Medicine, Juntendo University Graduate School of Medicine
| | | | - Rimei Nishimura
- Department of Diabetes, Metabolism and Endocrinology, The Jikei University School of Medicine
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
| | - Midori Noguchi
- Division of Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University
| | - Mitsuru Ohishi
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Isao Saito
- Department of Public Health and Epidemiology, Faculty of Medicine, Oita University
| | - Shojiro Sawada
- Division of Metabolism and Diabetes, Faculty of Medicine, Tohoku Medical and Pharmaceutical University
| | - Hirohito Sone
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine
| | - Minoru Takemoto
- Department of Diabetes, Metabolism and Endocrinology, International University of Health and Welfare
| | | | - Hidekatsu Yanai
- Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine Kohnodai Hospital
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Robinson CH, Hussain J, Jeyakumar N, Smith G, Birken CS, Dart A, Dionne J, Garg A, Kandasamy S, Karam S, Marjerrison S, South AM, Thabane L, Wahi G, Zappitelli M, Chanchlani R. Long-Term Cardiovascular Outcomes in Children and Adolescents With Hypertension. JAMA Pediatr 2024:2818399. [PMID: 38709137 DOI: 10.1001/jamapediatrics.2024.1543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
Importance Hypertension affects 6% of all children, and its prevalence is increasing. Childhood hypertension tracks into adulthood and is associated with subclinical cardiovascular disease; however, there is a lack of evidence linking childhood hypertension to cardiovascular outcomes, which may contribute to underdiagnosis and undertreatment. Objective To determine the long-term associated risk of major adverse cardiac events (MACE) among children diagnosed with hypertension. Design, Setting, and Participants This was a population-based, retrospective, matched cohort study conducted from 1996 to 2022. The study included all children (aged 3-18 years) alive in Ontario, Canada, from 1996 to 2021, who were identified using provincial administrative health databases. Children with prior kidney replacement therapy were excluded. Exposure Incident hypertension diagnosis, identified by validated case definitions using diagnostic and physician billing claims. Each case was matched with 5 controls without hypertension by age, sex, birth weight, maternal gestational hypertension, prior comorbidities (chronic kidney disease, diabetes, cardiovascular surgery), and a propensity score for hypertension. Main Outcomes and Measures The primary outcome was MACE (a composite of cardiovascular death, stroke, hospitalization for myocardial infarction or unstable angina, or coronary intervention). Time to MACE was evaluated using the Kaplan-Meier method and Cox proportional hazards regression. Results A total of 25 605 children (median [IQR] age, 15 [11-17] years; 14 743 male [57.6%]) with hypertension were matched to 128 025 controls without hypertension. Baseline covariates were balanced after propensity score matching, and prior comorbidities were uncommon (hypertension vs control cohort: malignancy, 1451 [5.7%] vs 7908 [6.2%]; congenital heart disease, 1089 [4.3%] vs 5408 [4.2%]; diabetes, 482 [1.9%] vs 2410 [1.9%]). During a median (IQR) of 13.6 (7.8-19.5) years of follow-up, incidence of MACE was 4.6 per 1000 person-years in children with hypertension vs 2.2 per 1000 person-years in controls (hazard ratio, 2.1; 95% CI, 1.9-2.2). Children with hypertension were at higher associated risk of stroke, hospitalization for myocardial infarction or unstable angina, coronary intervention, and congestive heart failure, but not cardiovascular death, compared with nonhypertensive controls. Conclusions and Relevance Children diagnosed with hypertension had a higher associated long-term risk of MACE compared with controls without hypertension. Improved detection, follow-up, and control of pediatric hypertension may reduce the risk of adult cardiovascular disease.
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Affiliation(s)
- Cal H Robinson
- Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Junayd Hussain
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Nivethika Jeyakumar
- Lawson Health Research Institute and London Health Sciences Centre, London, Ontario, Canada
| | - Graham Smith
- Lawson Health Research Institute and London Health Sciences Centre, London, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Catherine S Birken
- Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Allison Dart
- Department of Pediatrics and Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Janis Dionne
- Department of Pediatrics, Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anika Garg
- Infant, Child, and Youth Health Lab, Brock University, St Catharine's, Ontario, Canada
| | - Sujane Kandasamy
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Sabine Karam
- Department of Medicine, Division of Nephrology and Hypertension, University of Minnesota, Minneapolis
| | - Stacey Marjerrison
- Division of Pediatric Nephrology, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Andrew M South
- Department of Pediatrics, Brenner Children's, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit, St Joseph's Healthcare, Hamilton, Ontario, Canada
- Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Gita Wahi
- Division of Pediatric Nephrology, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Michael Zappitelli
- Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rahul Chanchlani
- ICES, Toronto, Ontario, Canada
- Division of Pediatric Nephrology, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
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3
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Li Z, Gong R, Chu H, Zeng J, Chen C, Xu S, Hu L, Gao W, Zhang L, Yuan H, Cheng Z, Wang C, Du M, Zhu Q, Zhang L, Rong L, Hu X, Yang L. A universal plasma metabolites-derived signature predicts cardiovascular disease risk in MAFLD. Atherosclerosis 2024; 392:117526. [PMID: 38581738 DOI: 10.1016/j.atherosclerosis.2024.117526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 03/19/2024] [Accepted: 03/21/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Metabolic associated fatty liver disease (MAFLD) is a novel concept proposed in 2020, which is more practical for identifying patients with fatty liver disease with high risk of disease progression. Fatty liver is a driver for extrahepatic complications, particularly cardiovascular diseases (CVD). Although the risk of CVD in MAFLD could be predicted by carotid ultrasound test, a very early stage prediction method before the formation of pathological damage is still lacking. METHODS Stool microbiomes and plasma metabolites were compared across 196 well-characterized participants encompassing normal controls, simple MAFLD patients, MAFLD patients with carotid artery pathological changes, and MAFLD patients with diagnosed coronary artery disease (CAD). 16S rDNA sequencing data and untargeted metabolomic profiles were interrogatively analyzed using differential abundance analysis and random forest (RF) machine learning algorithm to identify discriminatory gut microbiomes and metabolomic. RESULTS Characteristic microbial changes in MAFLD patients with CVD risk were represented by the increase of Clostridia and Firmicutes-to-Bacteroidetes ratios. Faecalibacterium was negatively correlated with mean-intima-media thickness (IMT), TC, and TG. Megamonas, Bacteroides, Parabacteroides, and Escherichia were positively correlated with the exacerbation of pathological indexes. MAFLD patients with CVD risk were characterized by the decrease of lithocholic acid taurine conjugate, and the increase of ethylvanillin propylene glycol acetal, both of which had close relationship with Ruminococcus and Gemmiger. Biotin l-sulfoxide had positive correlation with mean-IMT, TG, and weight. The general auxin pesticide beta-naphthoxyacetic acid and the food additive glucosyl steviol were both positively correlated with the increase of mean-IMT. The model combining the metabolite signatures with 9 clinical parameters accurately distinguished MAFLD with CVD risk in the proband and validation cohort. It was found that citral was the most important discriminative metabolite marker, which was validated by both in vitro and in vivo experiments. CONCLUSIONS Simple MAFLD patients and MAFLD patients with CVD risk had divergent gut microbes and plasma metabolites. The predictive model based on metabolites and 9 clinical parameters could effectively discriminate MAFLD patients with CVD risk at a very early stage.
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Affiliation(s)
- Zhonglin Li
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Rui Gong
- Health Management Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huikuan Chu
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Junchao Zeng
- Health Management Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Can Chen
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, China
| | - Sanping Xu
- Health Management Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lilin Hu
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Wenkang Gao
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Li Zhang
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Hang Yuan
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Zilu Cheng
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Cheng Wang
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, China
| | - Meng Du
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, China
| | - Qingjing Zhu
- Jinyintan Hospital, Tongji Medical College, Huazhong University of Science and Technology, China; Wuhan Medical Treatment Centre, Wuhan, 430070, China
| | - Li Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Lin Rong
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China.
| | - Xiaoqing Hu
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China.
| | - Ling Yang
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China.
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4
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Zhang W, Zhu J, Wu X, Feng T, Liao W, Li X, Chen J, Zhang L, Xiao C, Cui H, Yang C, Yan P, Wang Y, Tang M, Chen L, Liu Y, Zou Y, Wu X, Zhang L, Yang C, Yao Y, Li J, Liu Z, Jiang X, Zhang B. Phenotypic and genetic effect of carotid intima-media thickness on the risk of stroke. Hum Genet 2024:10.1007/s00439-024-02666-1. [PMID: 38578439 DOI: 10.1007/s00439-024-02666-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 03/05/2024] [Indexed: 04/06/2024]
Abstract
While carotid intima-media thickness (cIMT) as a noninvasive surrogate measure of atherosclerosis is widely considered a risk factor for stroke, the intrinsic link underlying cIMT and stroke has not been fully understood. We aimed to evaluate the clinical value of cIMT in stroke through the investigation of phenotypic and genetic relationships between cIMT and stroke. We evaluated phenotypic associations using observational data from UK Biobank (N = 21,526). We then investigated genetic relationships leveraging genomic data conducted in predominantly European ancestry for cIMT (N = 45,185) and any stroke (AS, Ncase/Ncontrol=40,585/406,111). Observational analyses suggested an increased hazard of stroke per one standard deviation increase in cIMT (cIMTmax-AS: hazard ratio (HR) = 1.39, 95%CI = 1.09-1.79; cIMTmean-AS: HR = 1.39, 95%CI = 1.09-1.78; cIMTmin-AS: HR = 1.32, 95%CI = 1.04-1.68). A positive global genetic correlation was observed (cIMTmax-AS: [Formula: see text]=0.23, P=9.44 × 10-5; cIMTmean-AS: [Formula: see text]=0.21, P=3.00 × 10-4; cIMTmin-AS: [Formula: see text]=0.16, P=6.30 × 10-3). This was further substantiated by five shared independent loci and 15 shared expression-trait associations. Mendelian randomization analyses suggested no causal effect of cIMT on stroke (cIMTmax-AS: odds ratio (OR)=1.12, 95%CI=0.97-1.28; cIMTmean-AS: OR=1.09, 95%CI=0.93-1.26; cIMTmin-AS: OR=1.03, 95%CI = 0.90-1.17). A putative association was observed for genetically predicted stroke on cIMT (AS-cIMTmax: beta=0.07, 95%CI = 0.01-0.13; AS-cIMTmean: beta=0.08, 95%CI = 0.01-0.15; AS-cIMTmin: beta = 0.08, 95%CI = 0.01-0.16) in the reverse direction MR, which attenuated to non-significant in sensitivity analysis. Our work does not find evidence supporting causal associations between cIMT and stroke. The pronounced cIMT-stroke association is intrinsic, and mostly attributed to shared genetic components. The clinical value of cIMT as a surrogate marker for stroke risk in the general population is likely limited.
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Affiliation(s)
- Wenqiang Zhang
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, West China- PUMC C. C. Chen Institute of Health, Sichuan University, No. 16, Section 3, South Renmin Road, Wuhou District, Chengdu, 610041, China
| | - Jingwei Zhu
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, West China- PUMC C. C. Chen Institute of Health, Sichuan University, No. 16, Section 3, South Renmin Road, Wuhou District, Chengdu, 610041, China
| | - Xuan Wu
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, West China- PUMC C. C. Chen Institute of Health, Sichuan University, No. 16, Section 3, South Renmin Road, Wuhou District, Chengdu, 610041, China
| | - Tianle Feng
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, West China- PUMC C. C. Chen Institute of Health, Sichuan University, No. 16, Section 3, South Renmin Road, Wuhou District, Chengdu, 610041, China
| | - Wei Liao
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, West China- PUMC C. C. Chen Institute of Health, Sichuan University, No. 16, Section 3, South Renmin Road, Wuhou District, Chengdu, 610041, China
| | - Xuan Li
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, West China- PUMC C. C. Chen Institute of Health, Sichuan University, No. 16, Section 3, South Renmin Road, Wuhou District, Chengdu, 610041, China
| | - Jianci Chen
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, West China- PUMC C. C. Chen Institute of Health, Sichuan University, No. 16, Section 3, South Renmin Road, Wuhou District, Chengdu, 610041, China
| | - Li Zhang
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, West China- PUMC C. C. Chen Institute of Health, Sichuan University, No. 16, Section 3, South Renmin Road, Wuhou District, Chengdu, 610041, China
| | - Chenghan Xiao
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, West China- PUMC C. C. Chen Institute of Health, Sichuan University, No. 16, Section 3, South Renmin Road, Wuhou District, Chengdu, 610041, China
- Department of Maternal, Child and Adolescent Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Huijie Cui
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, West China- PUMC C. C. Chen Institute of Health, Sichuan University, No. 16, Section 3, South Renmin Road, Wuhou District, Chengdu, 610041, China
| | - Chao Yang
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, West China- PUMC C. C. Chen Institute of Health, Sichuan University, No. 16, Section 3, South Renmin Road, Wuhou District, Chengdu, 610041, China
| | - Peijing Yan
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, West China- PUMC C. C. Chen Institute of Health, Sichuan University, No. 16, Section 3, South Renmin Road, Wuhou District, Chengdu, 610041, China
| | - Yutong Wang
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, West China- PUMC C. C. Chen Institute of Health, Sichuan University, No. 16, Section 3, South Renmin Road, Wuhou District, Chengdu, 610041, China
| | - Mingshuang Tang
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, West China- PUMC C. C. Chen Institute of Health, Sichuan University, No. 16, Section 3, South Renmin Road, Wuhou District, Chengdu, 610041, China
| | - Lin Chen
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, West China- PUMC C. C. Chen Institute of Health, Sichuan University, No. 16, Section 3, South Renmin Road, Wuhou District, Chengdu, 610041, China
| | - Yunjie Liu
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, West China- PUMC C. C. Chen Institute of Health, Sichuan University, No. 16, Section 3, South Renmin Road, Wuhou District, Chengdu, 610041, China
| | - Yanqiu Zou
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, West China- PUMC C. C. Chen Institute of Health, Sichuan University, No. 16, Section 3, South Renmin Road, Wuhou District, Chengdu, 610041, China
| | - Xueyao Wu
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, West China- PUMC C. C. Chen Institute of Health, Sichuan University, No. 16, Section 3, South Renmin Road, Wuhou District, Chengdu, 610041, China
| | - Ling Zhang
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, West China- PUMC C. C. Chen Institute of Health, Sichuan University, No. 16, Section 3, South Renmin Road, Wuhou District, Chengdu, 610041, China
- Department of Iatrical Polymer Material and Artificial Apparatus, School of Polymer Science and Engineering, Sichuan University, Chengdu, China
| | - Chunxia Yang
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, West China- PUMC C. C. Chen Institute of Health, Sichuan University, No. 16, Section 3, South Renmin Road, Wuhou District, Chengdu, 610041, China
| | - Yuqin Yao
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, West China- PUMC C. C. Chen Institute of Health, Sichuan University, No. 16, Section 3, South Renmin Road, Wuhou District, Chengdu, 610041, China
- Department of Occupational and Environmental Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Jiayuan Li
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, West China- PUMC C. C. Chen Institute of Health, Sichuan University, No. 16, Section 3, South Renmin Road, Wuhou District, Chengdu, 610041, China
| | - Zhenmi Liu
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, West China- PUMC C. C. Chen Institute of Health, Sichuan University, No. 16, Section 3, South Renmin Road, Wuhou District, Chengdu, 610041, China
- Department of Maternal, Child and Adolescent Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Xia Jiang
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, West China- PUMC C. C. Chen Institute of Health, Sichuan University, No. 16, Section 3, South Renmin Road, Wuhou District, Chengdu, 610041, China.
- Department of Nutrition and Food Hygiene, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
- Department of Clinical Neuroscience, Karolinskaa Institutet, Stockholm, Sweden.
| | - Ben Zhang
- Hainan General Hospital and Hainan Affiliated Hospital, Hainan Medical University, Haikou, China; West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
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5
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Pfister R, Kaur R, Maesom G, Hager RL. Associations between Multiple Health Indicators and Carotid Artery Intima-Media Thickness in A Healthy and Active Elderly Population. J Cardiovasc Dev Dis 2024; 11:101. [PMID: 38667719 PMCID: PMC11050605 DOI: 10.3390/jcdd11040101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/23/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
The purpose of this study was to examine correlations between health indicators (age, BMI, blood pressure (BP), functional strength (FS), handgrip strength, and predicted VO2 max) and carotid intima-media thickness (cIMT) in an active 50 years+ population. Study participants' mean cIMT was also compared to the cIMT mean of the general population. Health screenings were conducted on 1818 participants at the Huntsman World Senior Games from 2016 to 2019. Pearson's correlations, Spearman's correlations, and ANOVA were performed using SPSS. Weak but significant correlations were evident between cIMT and age (r = 0.283, p < 0.001), systolic BP (r = 0.253, p = 0.001), diastolic BP (r = 0.074, p = 0.016), weight (r = 0.170, p < 0.001), height (r = 0.153, p < 0.001), handgrip L (r = 0.132, p < 0.001), handgrip R (r = 0.074, p < 0.029), and BMI (r = 0.07, p = 0.029); non-significant correlations were evident with predicted VO2 max (r = -0.035, p = 0.382), and FS (r = -0.025, p = 0.597). When controlling for age, systolic BP, and sex, only handgrip L (r = 0.225, p = 0.014) was significantly correlated with cIMT. Mean cIMT for this cohort was lower across all sexes and age-matched groups (cIMT = 0.6967 mm (±0.129)). Physical activity is linked to reduced cIMT. Most health-related indicators in this study were significantly but weakly correlated with cIMT. Additional research is needed before common indicators can be used as a surrogate for cIMT and CVD risk. Results from this study can provide clinicians with additional information to reduce CVD risk through modifiable risk factors. Classic CVD risk factors such as systolic BP and BMI should be considered in patients regardless of lifestyle.
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Affiliation(s)
- Robin Pfister
- Sydney Medical School, University of Sydney, City Rd, Level 2 & 3, Sydney, NSW 2050, Australia;
| | - Rajneesh Kaur
- Sydney Medical School, University of Sydney, City Rd, Level 2 & 3, Sydney, NSW 2050, Australia;
| | - Gary Maesom
- Department of Nursing/Health Professions, Utah Valley University, 800 West University Parkway, Orem, UT 84058, USA;
| | - Ronald L. Hager
- Department of Exercise Sciences, College of Life Sciences, Brigham Young University, Provo, UT 84602, USA;
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6
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Raitakari OT, Magnussen CG, Juonala M, Kartiosuo N, Pahkala K, Rovio S, Koskinen JS, Mykkänen J, Laitinen TP, Kähönen M, Nuotio J, Viikari JSA. Subclinical atherosclerosis in young adults predicting cardiovascular disease: The Cardiovascular Risk in Young Finns Study. Atherosclerosis 2024:117515. [PMID: 38582639 DOI: 10.1016/j.atherosclerosis.2024.117515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/05/2024] [Accepted: 03/07/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND AND AIMS Atherosclerosis is accompanied by pre-clinical vascular changes that can be detected using ultrasound imaging. We examined the value of such pre-clinical features in identifying young adults who are at risk of developing atherosclerotic cardiovascular disease (ASCVD). METHODS A total of 2641 individuals free of ASCVD were examined at the mean age of 32 years (range 24-45 years) for carotid artery intima-media thickness (IMT) and carotid plaques, carotid artery elasticity, and brachial artery flow-mediated endothelium-dependent vasodilation (FMD). The average follow-up time to event/censoring was 16 years (range 1-17 years). RESULTS Sixty-seven individuals developed ASCVD (incidence 2.5%). The lowest incidence (1.1%) was observed among those who were estimated of having low risk according to the SCORE2 risk algorithm (<2.5% 10-year risk) and who did not have plaque or high IMT (upper decile). The highest incidence (11.0%) was among those who were estimated of having a high risk (≥2.5% 10-year risk) and had positive ultrasound scan for carotid plaque and/or high IMT (upper decile). Carotid plaque and high IMT remained independently associated with higher risk in multivariate models. The distributions of carotid elasticity indices and brachial FMD did not differ between cases and non-cases. CONCLUSIONS Screening for carotid plaque and high IMT in young adults may help identify individuals at high risk for future ASCVD.
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Affiliation(s)
- Olli T Raitakari
- Centre for Population Health Research, University of Turku and Turku University Hospital, 20520, Turku, Finland; Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, 20520, Turku, Finland; Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, 20520, Turku, Finland.
| | - Costan G Magnussen
- Centre for Population Health Research, University of Turku and Turku University Hospital, 20520, Turku, Finland; Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, 20520, Turku, Finland; Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Markus Juonala
- Department of Medicine, University of Turku, Turku, Finland; Division of Medicine, Turku University Hospital, Turku, Finland
| | - Noora Kartiosuo
- Centre for Population Health Research, University of Turku and Turku University Hospital, 20520, Turku, Finland; Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, 20520, Turku, Finland; Department of Mathematics and Statistics, University of Turku, Turku, Finland
| | - Katja Pahkala
- Centre for Population Health Research, University of Turku and Turku University Hospital, 20520, Turku, Finland; Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, 20520, Turku, Finland; Paavo Nurmi Centre and Unit for Health and Physical Activity, University of Turku, 20520, Turku, Finland
| | - Suvi Rovio
- Centre for Population Health Research, University of Turku and Turku University Hospital, 20520, Turku, Finland; Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, 20520, Turku, Finland; Department of Public Health, University of Turku and Turku University Hospital, 20520, Turku, Finland
| | - Juhani S Koskinen
- Centre for Population Health Research, University of Turku and Turku University Hospital, 20520, Turku, Finland; Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, 20520, Turku, Finland; Department of Medicine, University of Turku, Turku, Finland; Division of Medicine, Turku University Hospital, Turku, Finland
| | - Juha Mykkänen
- Centre for Population Health Research, University of Turku and Turku University Hospital, 20520, Turku, Finland; Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, 20520, Turku, Finland
| | - Tomi P Laitinen
- Department of Clinical Physiology and Nuclear Medicine Kuopio University Hospital, Kuopio, Finland; Institute of Clinical Medicine University of Eastern Finland, Kuopio, Finland
| | - Mika Kähönen
- Finnish Cardiovascular Research Center Tampere, Tampere University, Tampere, Finland; Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Joel Nuotio
- Centre for Population Health Research, University of Turku and Turku University Hospital, 20520, Turku, Finland; Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Jorma S A Viikari
- Department of Medicine, University of Turku, Turku, Finland; Division of Medicine, Turku University Hospital, Turku, Finland
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7
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Abe TA, Olanipekun T, Yan F, Effoe V, Udongwo N, Oshunbade A, Thomas V, Onuorah I, Terry JG, Yimer WK, Ghali JK, Correa A, Onwuanyi A, Michos ED, Benjamin EJ, Echols M. Carotid Intima-Media Thickness and Improved Stroke Risk Assessment in Hypertensive Black Adults. Am J Hypertens 2024; 37:290-297. [PMID: 38236147 PMCID: PMC10941087 DOI: 10.1093/ajh/hpae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/04/2023] [Accepted: 11/30/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND We aim to determine the added value of carotid intima-media thickness (cIMT) in stroke risk assessment for hypertensive Black adults. METHODS We examined 1,647 participants with hypertension without a history of cardiovascular (CV) disease, from the Jackson Heart Study. Cox regression analysis estimated hazard ratios (HRs) for incident stroke per standard deviation increase in cIMT and quartiles while adjusting for baseline variables. We then evaluated the predictive capacity of cIMT when added to the pool cohort equations (PCEs). RESULTS The mean age at baseline was 57 ± 10 years. Each standard deviation increase in cIMT (0.17 mm) was associated with approximately 30% higher risk of stroke (HR 1.27, 95% confidence interval: 1.08-1.49). Notably, cIMT proved valuable in identifying residual stroke risk among participants with well-controlled blood pressure, showing up to a 56% increase in the odds of stroke for each 0.17 mm increase in cIMT among those with systolic blood pressure <120 mm Hg. Additionally, the addition of cIMT to the PCE resulted in the reclassification of 58% of low to borderline risk participants with stroke to a higher-risk category and 28% without stroke to a lower-risk category, leading to a significant net reclassification improvement of 0.22 (0.10-0.30). CONCLUSIONS In this community-based cohort of middle-aged Black adults with hypertension and no history of CV disease at baseline, cIMT is significantly associated with incident stroke and enhances stroke risk stratification.
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Affiliation(s)
- Temidayo A Abe
- Division of Cardiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Titilope Olanipekun
- Division of Internal Medicine, Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Fengxia Yan
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA
- Department of Medicine, Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Valery Effoe
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA
- Department of Medicine, Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Ndausung Udongwo
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Adebamike Oshunbade
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Victoria Thomas
- Division of Cardiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ifeoma Onuorah
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - James G Terry
- Division of Cardiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Wondwosen K Yimer
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Jalal K Ghali
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA
- Department of Medicine, Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Adolfo Correa
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Anekwe Onwuanyi
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA
- Department of Medicine, Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Erin D Michos
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Emelia J Benjamin
- Department of Medicine, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Department of Medicine, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Melvin Echols
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA
- Department of Medicine, Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, Georgia, USA
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8
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Karagun B. Carotid intima media thickness as a marker of increased cardiovascular risk due to androgenic anabolic steroids in male bodybuilders: a cross-sectional study. J Sports Med Phys Fitness 2024; 64:311-317. [PMID: 38213269 DOI: 10.23736/s0022-4707.23.15556-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
BACKGROUND The usage of androgenic-anabolic steroids (AAS) leads to severe side effects. The aim of our study was to investigate the effects of AAS on the increase in the carotid intima-media thickness which is regarded as predictor of cardiovascular disorders and determine the association of ASS usage to urinary, hepatic, and hematological systems as well as lipid disorders. METHODS A total of 60 male bodybuilders (30 AAS users with a mean age of 31.2±8.9 years and 30 AAS nonusers with a mean age of 31.2±8.9 years) were assessed in this cross-sectional study. The patients' demographic, radiologic, hormonal, and biochemical parameters were recorded. The carotid intima-media thickness (CIMT) was measured using B-mode ultrasound in both groups. Abdominal ultrasonography was used to assess for the presence of fatty liver. RESULTS CIMT was significantly increased in AAS (0.72±0.13 mm) users than in the controls (0.47±0.07 mm) (P<0.001). The mean duration of AAS usage was 2.70±2.13 years. There was a statistically significant positive correlation between the duration of AAS usage and CIMT (r=0.710; P<0.001). A statistically significant negative correlation among HDL, LH, and CIMT was found in the correlation analysis between biochemical parameters and CIMT among AAS users (respectively, r and P values were: r=0.399; P=0.029; r=-0.366; P=0.047; r=-0.287; P=0.035). Likewise, a negative correlation (r=-0.425; P=0.019) was found between FSH and CIMT. CONCLUSIONS We found that the usage of AAS among male bodybuilders has led to an increase in CIMT, which is associated with poor cardiovascular health. The results of our study highlight the vital importance of educating male bodybuilders who use these chemicals about the side effects.
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Affiliation(s)
- Baris Karagun
- Division of Endocrinology and Metabolism, Toros State Hospital, Mersin, Türkiye -
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9
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Martin SS, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Barone Gibbs B, Beaton AZ, Boehme AK, Commodore-Mensah Y, Currie ME, Elkind MSV, Evenson KR, Generoso G, Heard DG, Hiremath S, Johansen MC, Kalani R, Kazi DS, Ko D, Liu J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Perman SM, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Tsao CW, Urbut SM, Van Spall HGC, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Palaniappan LP. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation 2024; 149:e347-e913. [PMID: 38264914 DOI: 10.1161/cir.0000000000001209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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10
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Mendo CW, Gaudreau P, Lefebvre G, Marrie RA, Potter BJ, Wister A, Wolfson C, Keezer MR, Sylvestre MP. The association between grip strength and carotid intima media thickness: A Mendelian randomization analysis of the Canadian Longitudinal Study on Aging. Ann Epidemiol 2024; 89:15-20. [PMID: 38061557 DOI: 10.1016/j.annepidem.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 11/10/2023] [Accepted: 12/04/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND Several two-sample Mendelian randomization studies have reported discordant results concerning the association between grip strength and cardiovascular disease, possibly due to the number of instrumental variables used, pleiotropic bias, and/ or effect modification by age and sex. METHODS We conducted a sex- and age-stratified one-sample Mendelian randomization study in the Canadian Longitudinal Study on Aging. We investigated whether grip strength is associated with carotid intima media thickness (cIMT), a marker of vascular atherosclerosis event risk, using eighteen single nucleotide polymorphisms (SNP) identified as specifically associated with grip strength. RESULTS A total of 20,258 participants of self-reported European ancestry were included in the analytic sample. Our Mendelian randomization findings suggest a statistically significant association between grip strength and cIMT (MR coefficient of 0.02 (95% CI: 0.01, 0.04)). We found no statistically significant differences between sexes (p-value = 0.201), or age groups [(≤ 60 years old versus >60 years old); p-value = 0.421]. CONCLUSION This study provides evidence that grip strength is inversely associated with cIMT. Our one-sample MR study design allowed us to demonstrate that there is no evidence of heterogeneity of effects according to age group or biological sex.
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Affiliation(s)
- Christian W Mendo
- Centre de Recherche du Centre hospitalier de l'Université de Montréal, Canada; École de Santé Publique de l'Université de Montréal, Canada
| | - Pierrette Gaudreau
- Centre de Recherche du Centre hospitalier de l'Université de Montréal, Canada; Département de Médecine de l'Université de Montréal, Canada
| | | | - Ruth A Marrie
- Max Rady College of Medicine, University of Manitoba, Canada
| | - Brian J Potter
- Centre de Recherche du Centre hospitalier de l'Université de Montréal, Canada; Département de Médecine de l'Université de Montréal, Canada; Centre Cardiovasculaire du Centre hospitalier de l'Université de Montréal, Canada
| | - Andrew Wister
- Centre Cardiovasculaire du Centre hospitalier de l'Université de Montréal, Canada; Gerontology Research Centre, Simon Fraser University, Canada
| | - Christina Wolfson
- Departement of Gerontology, Simon Fraser University, Canada; Department of Medicine, McGill University, Canada; Research Institute of the McGill University Health Centre, Canada
| | - Mark R Keezer
- Centre de Recherche du Centre hospitalier de l'Université de Montréal, Canada; École de Santé Publique de l'Université de Montréal, Canada; Department of Neurosciences, Université de Montréal, Canada
| | - Marie-Pierre Sylvestre
- Centre de Recherche du Centre hospitalier de l'Université de Montréal, Canada; École de Santé Publique de l'Université de Montréal, Canada.
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11
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Lind L. A comparison of intima media thickness in the common carotid artery, the bulb and plaque area as predictions of incident atherosclerotic events. PLoS One 2023; 18:e0294722. [PMID: 37983212 PMCID: PMC10659152 DOI: 10.1371/journal.pone.0294722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 11/06/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND AND AIMS There is a debate on how to evaluate carotid artery intima-media thickness (IMT). We here compared IMT of the common carotid artery (CCA) and bulb with plaque area regarding incident atherosclerotic disease. METHODS In the PIVUS study (age 70 at baseline, 53% women, n = 856), IMT-CCA, IMT-bulb and plaque area were measured at ages 70, 75 and 80 years and these three measurements were used in updated Cox proportional hazard analysis. RESULTS Over 15 years follow-up, 135 individuals experienced a first-time atherosclerotic disease (myocardial infarction or ischemic stroke). IMT-CCA was not significantly related to this composite endpoint (p = 0.10). IMT-bulb was significantly related to the endpoint (p = 0.003), but this relationship was attenuated following adjustment for CVD risk factors (p = 0.02). On the contrary, plaque area was consistently related to incident atherosclerotic disease also following adjustment for CVD risk factors (p<0.001). When added on top of traditional risk factors, both IMT-bulb and plaque area, but not IMT-CCA, improved the discrimination compared to the traditional risk factors (+5.2%, p = 0.0026 for IMT-bulb, +3.8%, p = 0.013 for plaque area and 0.0% for IMT-CCA). CONCLUSION In elderly subjects, both IMT-bulb and plaque area improved the discrimination regarding incident atherosclerotic disease when added to traditional risk factors. This was not seen for IMT-CCA. IMT-CCA was therefore inferior compared to the other two carotid artery ultrasonographic measurements in this sample of elderly subjects.
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Affiliation(s)
- Lars Lind
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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12
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Badescu MC, Badulescu OV, Costache AD, Mitu O, Lupu VV, Dmour BA, Lupu A, Foia LG, Costache II, Rezus C. Atherosclerosis in Patients with Congenital Hemophilia: A Focus on Peripheral Artery Disease. Life (Basel) 2023; 13:2221. [PMID: 38004361 PMCID: PMC10672485 DOI: 10.3390/life13112221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/15/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023] Open
Abstract
Advances in the treatment of hemophilia have increased the life expectancy of this population and we are currently facing diseases associated with aging, including cardiovascular ones. Coronary atherosclerosis, with acute myocardial infarction as the most severe form of manifestation, has been recognized as part of the comorbidities of hemophiliacs. However, little is known about peripheral artery disease. Available data show that hemophiliacs have cardiovascular risk factors and atherosclerosis similar to the general population. Impaired thrombus formation and phenotype of atheroma plaque rather than the burden of atherosclerosis explains their lower cardiovascular mortality. Since the effect of traditional cardiovascular risk factors overpowers that of decreased coagulability and promotes the onset and progression of atherosclerotic lesions, screening for traditional cardiovascular risk factors and peripheral artery disease should be integrated into standard hemophilia care. There is evidence that invasive treatments and long-term antithrombotic therapy are generally safe, provided that coagulation factor levels are taken into account and replacement therapy is given when necessary.
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Affiliation(s)
- Minerva Codruta Badescu
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (M.C.B.); (O.M.); (B.-A.D.); (I.-I.C.); (C.R.)
- III Internal Medicine Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Oana Viola Badulescu
- Department of Pathophysiology, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania
- Hematology Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Alexandru Dan Costache
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (M.C.B.); (O.M.); (B.-A.D.); (I.-I.C.); (C.R.)
- Cardiovascular Rehabilitation Clinic, Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Ovidiu Mitu
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (M.C.B.); (O.M.); (B.-A.D.); (I.-I.C.); (C.R.)
- Cardiology Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Vasile Valeriu Lupu
- Pediatrics Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania (A.L.)
| | - Bianca-Ana Dmour
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (M.C.B.); (O.M.); (B.-A.D.); (I.-I.C.); (C.R.)
| | - Ancuta Lupu
- Pediatrics Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania (A.L.)
| | - Liliana Georgeta Foia
- Department of Biochemistry, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania;
| | - Irina-Iuliana Costache
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (M.C.B.); (O.M.); (B.-A.D.); (I.-I.C.); (C.R.)
- Cardiology Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Ciprian Rezus
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (M.C.B.); (O.M.); (B.-A.D.); (I.-I.C.); (C.R.)
- III Internal Medicine Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
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13
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Liu J, Sze NSK, Narushima M, O’Leary D. Weight Change and Risk of Atherosclerosis Measured by Carotid Intima-Media Thickness (cIMT) from a Prospective Cohort-Analysis of the First-Wave Follow-Up Data of the Canadian Longitudinal Study on Aging (CLSA). J Cardiovasc Dev Dis 2023; 10:435. [PMID: 37887882 PMCID: PMC10607020 DOI: 10.3390/jcdd10100435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/02/2023] [Accepted: 10/16/2023] [Indexed: 10/28/2023] Open
Abstract
To explore impact of weight change (WC) on risk of atherosclerosis measured by cIMT, 20,700 participants from the CLSA follow-up were included in analysis. WC was defined as the difference of weight measured at follow-up and baseline, then quartered into four groups (Q1-Q4). cIMT > 1.0 mm was defined as high risk for atherosclerosis. Adjusted odds ratio (OR (95% CI)) from logistic regression models were used to evaluate the association between WC and risk of atherosclerosis. At follow-up, participants had gained 0.118 kg weight, on average, and 16.4% of them were at high risk for atherosclerosis. The mean levels of cIMT were comparable between participants from Q1 to Q4. Compared to Q2 (reference), the ORs (95% CI) were 1.00 (0.86, 1.15), 1.19 (1.03,1.38), and 1.25 (1.08,1.45) for Q1, Q3, and Q4, respectively. A similar pattern was observed when analyses were conducted for ages < 65 vs. 65+ separately, but it was weaker for those aged 65+. Results from the jointed distribution analyses indicated that moderate weight loss might increase risk for atherosclerosis among participants with obese BMI at baseline, but not for those with cardiovascular event status at baseline. Weight gain, however, would increase risk for atherosclerosis regardless of cardiovascular event status, or overweight/obese BMI at baseline.
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Affiliation(s)
- Jian Liu
- Department of Health Sciences, Brock University, St. Catharines, ON L2S 3A1, Canada; (N.S.K.S.); (M.N.); (D.O.)
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14
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Wong ND, Sattar N. Cardiovascular risk in diabetes mellitus: epidemiology, assessment and prevention. Nat Rev Cardiol 2023; 20:685-695. [PMID: 37193856 DOI: 10.1038/s41569-023-00877-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/06/2023] [Indexed: 05/18/2023]
Abstract
Cardiovascular diseases (CVDs) are the leading causes of morbidity and mortality in individuals with type 2 diabetes mellitus (T2DM). Secular changes in CVD outcomes have occurred over the past few decades, mainly due to a decline in the incidence of ischaemic heart disease. The onset of T2DM at a young age (<40 years), leading to a greater number of life-years lost, has also become increasingly common. Researchers are now looking beyond established risk factors in patients with T2DM towards the role of ectopic fat and, potentially, haemodynamic abnormalities in mediating important outcomes (such as heart failure). T2DM confers a wide spectrum of risk and is not necessarily a CVD risk equivalent, indicating the importance of risk assessment strategies (such as global risk scoring, consideration of risk-enhancing factors and assessment of subclinical atherosclerosis) to inform treatment. Data from epidemiological studies and clinical trials demonstrate that successful control of multiple risk factors can reduce the risk of CVD events by ≥50%; however, only ≤20% of patients achieve targets for risk factor reduction (plasma lipid levels, blood pressure, glycaemic control, body weight and non-smoking status). Improvements in composite risk factor control with lifestyle management (including a greater emphasis on weight loss interventions) and evidence-based generic and novel pharmacological therapies are therefore needed when the risk of CVD is high.
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Affiliation(s)
- Nathan D Wong
- Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine, CA, USA.
| | - Naveed Sattar
- Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK.
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15
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Seekircher L, Tschiderer L, Lind L, Safarova MS, Kavousi M, Ikram MA, Lonn E, Yusuf S, Grobbee DE, Kastelein JJP, Visseren FLJ, Walters M, Dawson J, Higgins P, Agewall S, Catapano A, de Groot E, Espeland MA, Klingenschmid G, Magliano D, Olsen MH, Preiss D, Sander D, Skilton M, Zozulińska-Ziółkiewicz DA, Grooteman MPC, Blankestijn PJ, Kitagawa K, Okazaki S, Manzi MV, Mancusi C, Izzo R, Desvarieux M, Rundek T, Gerstein HC, Bots ML, Sweeting MJ, Lorenz MW, Willeit P. Intima-media thickness at the near or far wall of the common carotid artery in cardiovascular risk assessment. EUROPEAN HEART JOURNAL OPEN 2023; 3:oead089. [PMID: 37840587 PMCID: PMC10575622 DOI: 10.1093/ehjopen/oead089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/03/2023] [Accepted: 09/12/2023] [Indexed: 10/17/2023]
Abstract
Aims Current guidelines recommend measuring carotid intima-media thickness (IMT) at the far wall of the common carotid artery (CCA). We aimed to precisely quantify associations of near vs. far wall CCA-IMT with the risk for atherosclerotic cardiovascular disease (CVD, defined as coronary heart disease or stroke) and their added predictive values. Methods and results We analysed individual records of 41 941 participants from 16 prospective studies in the Proof-ATHERO consortium {mean age 61 years [standard deviation (SD) = 11]; 53% female; 16% prior CVD}. Mean baseline values of near and far wall CCA-IMT were 0.83 (SD = 0.28) and 0.82 (SD = 0.27) mm, differed by a mean of 0.02 mm (95% limits of agreement: -0.40 to 0.43), and were moderately correlated [r = 0.44; 95% confidence interval (CI): 0.39-0.49). Over a median follow-up of 9.3 years, we recorded 10 423 CVD events. We pooled study-specific hazard ratios for CVD using random-effects meta-analysis. Near and far wall CCA-IMT values were approximately linearly associated with CVD risk. The respective hazard ratios per SD higher value were 1.18 (95% CI: 1.14-1.22; I² = 30.7%) and 1.20 (1.18-1.23; I² = 5.3%) when adjusted for age, sex, and prior CVD and 1.09 (1.07-1.12; I² = 8.4%) and 1.14 (1.12-1.16; I²=1.3%) upon multivariable adjustment (all P < 0.001). Assessing CCA-IMT at both walls provided a greater C-index improvement than assessing CCA-IMT at one wall only [+0.0046 vs. +0.0023 for near (P < 0.001), +0.0037 for far wall (P = 0.006)]. Conclusions The associations of near and far wall CCA-IMT with incident CVD were positive, approximately linear, and similarly strong. Improvement in risk discrimination was highest when CCA-IMT was measured at both walls.
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Affiliation(s)
- Lisa Seekircher
- Institute of Health Economics, Department of Medical Statistics, Informatics, and Health Economics, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Lena Tschiderer
- Institute of Health Economics, Department of Medical Statistics, Informatics, and Health Economics, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Lars Lind
- Department of Medicine, Uppsala University, Uppsala, Sweden
| | - Maya S Safarova
- Division of Cardiovascular Medicine, Department of Medicine, Froedtert and Medical College of Wisconsin, Milwaukee, WI, USA
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Eva Lonn
- Department of Medicine and Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Hamilton General Hospital, Hamilton, Ontario, Canada
| | - Salim Yusuf
- Department of Medicine and Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Hamilton General Hospital, Hamilton, Ontario, Canada
| | - Diederick E Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - John J P Kastelein
- Department of Vascular Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Matthew Walters
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Jesse Dawson
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Peter Higgins
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Stefan Agewall
- Department of Clinical Sciences, Division of Cardiology, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
- Institute of Clinical Sciences, University of Oslo, Oslo, Norway
| | - Alberico Catapano
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
- IRCCS Multimedica, Milan, Italy
| | - Eric de Groot
- Imagelabonline & Cardiovascular, Erichem, The Netherlands
- Department of Gastroenterology and Hepatology, Amsterdam UMC-Academic Medical Centre, Amsterdam, The Netherlands
| | - Mark A Espeland
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Dianna Magliano
- Department of Epidemiology and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, Australia
| | - Michael H Olsen
- Department of Internal Medicine, Holbaek Hospital, University of Southern Denmark, Odense, Denmark
| | - David Preiss
- Nuffield Department of Population Health, MRC Population Health Research Unit, Clinical Trial Service Unit, University of Oxford, Oxford, UK
| | - Dirk Sander
- Department of Neurology, Benedictus Hospital Tutzing & Feldafing, Feldafing, Germany
- Department of Neurology, Technische Universität München, Munich, Germany
| | - Michael Skilton
- Faculty of Medicine and Health, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| | | | - Muriel P C Grooteman
- Department of Nephrology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Amsterdam, The Netherlands
| | - Peter J Blankestijn
- Department of Nephrology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kazuo Kitagawa
- Department of Neurology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Shuhei Okazaki
- Department of Neurology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Maria V Manzi
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Costantino Mancusi
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Raffaele Izzo
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Moise Desvarieux
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- METHODS Core, Centre de Recherche Epidémiologie et Statistique Paris Sorbonne Cité (CRESS), Institut National de la Santé et de la Recherche Médicale (INSERM) UMR 1153, Paris, France
| | - Tatjana Rundek
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Hertzel C Gerstein
- Department of Medicine and Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Hamilton General Hospital, Hamilton, Ontario, Canada
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michael J Sweeting
- Department of Health Sciences, University of Leicester, Leicester, UK
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Papworth Road, Cambridge CB2 0BB, UK
| | - Matthias W Lorenz
- Department of Neurology, Goethe University, Frankfurt am Main, Germany
- Klinik für Neurologie, Krankenhaus Nordwest, Frankfurt am Main, Germany
| | - Peter Willeit
- Institute of Health Economics, Department of Medical Statistics, Informatics, and Health Economics, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Papworth Road, Cambridge CB2 0BB, UK
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16
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Mohammadi T, Hooshanginezhad Z, Mohammadi B, Dolatshahi S. The association of stroke risk factors with the future thickness of carotid atherosclerotic plaques. Neurol Res 2023; 45:818-826. [PMID: 37125820 DOI: 10.1080/01616412.2023.2208484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 04/23/2023] [Indexed: 05/02/2023]
Abstract
OBJECTIVES An advancing atherosclerotic plaque is a risk factor for stroke. We conducted this study to assess the relationship between risk factors of stroke with changing in the thickness of carotid plaques thickness evident on sonography. METHODS We carried out a secondary analysis of data from a study on carotid bifurcation plaques. Data were collected in the sonography laboratories of two university hospitals. In total, 564 (240; 42.6% men) patients with atherosclerotic plaques in the carotid bifurcation and internal carotid artery with stenosis ≥ 30% evident on duplex sonography were included. We developed machine learning models using an extreme gradient boosting algorithm with Shapley additive explanation method to find important risk factors and their interactions. The outcome was a change in the carotid plaque thickness after 36 months, and the predictors were initial plaque thickness and the risk factors of stroke. RESULTS Two regression models were developed for left and right carotid arteries. The R-squared values were 0.964 for the left, and 0.993 for the right model. Overall, the three top features were BMI, age, and initial plaque thickness for both left and right plaques. However, the risk factors of stroke showed stronger interaction in predicting plaque thickening of the left carotid more than the right carotid artery. DISCUSSION The effect of each predictor on plaque thickness is complicated by interactions with other risk factors, particularly for the left carotid artery. The side of carotid artery involvement should be considered for stroke prevention.
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Affiliation(s)
- Tanya Mohammadi
- College of Science, School of Mathematics, Statistics, and Computer Science, University of Tehran, Tehran, Iran
| | - Zahra Hooshanginezhad
- School of Medicine, Department of Cardiology, Jahrom University of Medical Sciences, Jahrom, Iran
| | | | - Sina Dolatshahi
- Shahid Rajaiee Heart Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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17
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Tobe A, Tanaka A, Furusawa K, Shirai Y, Funakubo H, Otsuka S, Kubota Y, Kunieda T, Yoshioka N, Sato S, Kudo N, Ishii H, Murohara T. Heterogeneous Carotid Plaque Predicts Cardiovascular Events after Percutaneous Coronary Intervention. J Atheroscler Thromb 2023; 30:1187-1197. [PMID: 36503894 PMCID: PMC10499458 DOI: 10.5551/jat.63622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 10/25/2022] [Indexed: 09/05/2023] Open
Abstract
AIM The relationship between carotid artery ultrasound findings and clinical outcomes in patients who undergo percutaneous coronary intervention (PCI) has not been completely elucidated. METHODS This single-center retrospective study investigated 691 patients who underwent PCI and carotid ultrasound testing. Maximum carotid intima-media thickness (CIMT) was defined as the greatest CIMT at the maximally thick point among the common carotid artery, carotid bulb, and internal carotid artery. A carotid plaque was defined as vessel wall thickening with a CIMT ≥ 1.5 mm. The characteristics of carotid plaque (heterogeneity, calcification, or irregular/ulcerated surface) were evaluated visually. Patients were divided into those with and without heterogeneous carotid plaque (maximum CIMT ≥ 1.5 mm and heterogeneous texture). The endpoint was the incidence of a major adverse cardiovascular event (MACE) defined as a composite of cardiovascular (CV) death, myocardial infarction, and ischemic stroke. RESULTS Among 691 patients, 309 were categorized as having a heterogeneous plaque. Patients with heterogeneous plaques were at a higher risk of MACE than those without (p=0.002). A heterogeneous plaque was independently associated with MACE after adjusting for covariates (hazard ratio [HR], 1.71; 95% confidence interval [CI], 1.01-2.90; p=0.046). Calcified or irregular/ulcerated plaques were correlated with a higher incidence of MACE, but both were not independently associated with MACE (HR, 1.35; 95% CI, 0.69-2.64, p=0.38 and HR, 0.98; 95% CI, 0.57-1.69; p=0.95, respectively). CONCLUSION The presence of a heterogeneous carotid plaque in patients who underwent PCI predicted future CV events. These patients may require more aggressive medical therapy and careful follow-up.
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Affiliation(s)
- Akihiro Tobe
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akihito Tanaka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenji Furusawa
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshinori Shirai
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroshi Funakubo
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satoshi Otsuka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshiaki Kubota
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takeshige Kunieda
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Yoshioka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Sara Sato
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobutaka Kudo
- Department of Cardiology, Handa City Hospital, Aichi, Japan
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Cardiology, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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18
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Perone F, Bernardi M, Redheuil A, Mafrica D, Conte E, Spadafora L, Ecarnot F, Tokgozoglu L, Santos-Gallego CG, Kaiser SE, Fogacci F, Sabouret A, Bhatt DL, Paneni F, Banach M, Santos R, Biondi Zoccai G, Ray KK, Sabouret P. Role of Cardiovascular Imaging in Risk Assessment: Recent Advances, Gaps in Evidence, and Future Directions. J Clin Med 2023; 12:5563. [PMID: 37685628 PMCID: PMC10487991 DOI: 10.3390/jcm12175563] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/14/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
Optimal risk assessment for primary prevention remains highly challenging. Recent registries have highlighted major discrepancies between guidelines and daily practice. Although guidelines have improved over time and provide updated risk scores, they still fail to identify a significant proportion of at-risk individuals, who then miss out on effective prevention measures until their initial ischemic events. Cardiovascular imaging is progressively assuming an increasingly pivotal role, playing a crucial part in enhancing the meticulous categorization of individuals according to their risk profiles, thus enabling the customization of precise therapeutic strategies for patients with increased cardiovascular risks. For the most part, the current approach to patients with atherosclerotic cardiovascular disease (ASCVD) is homogeneous. However, data from registries (e.g., REACH, CORONOR) and randomized clinical trials (e.g., COMPASS, FOURIER, and ODYSSEY outcomes) highlight heterogeneity in the risks of recurrent ischemic events, which are especially higher in patients with poly-vascular disease and/or multivessel coronary disease. This indicates the need for a more individualized strategy and further research to improve definitions of individual residual risk, with a view of intensifying treatments in the subgroups with very high residual risk. In this narrative review, we discuss advances in cardiovascular imaging, its current place in the guidelines, the gaps in evidence, and perspectives for primary and secondary prevention to improve risk assessment and therapeutic strategies using cardiovascular imaging.
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Affiliation(s)
- Francesco Perone
- Cardiac Rehabilitation Unit, Rehabilitation Clinic “Villa delle Magnolie”, Castel Morrone, 81020 Caserta, Italy;
| | - Marco Bernardi
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00185 Rome, Italy; (M.B.); (D.M.); (L.S.)
| | - Alban Redheuil
- Laboratoire d’Imagerie Biomédicale, Sorbonne University, INSERM 1146, CNRS 7371, 75005 Paris, France;
| | - Dario Mafrica
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00185 Rome, Italy; (M.B.); (D.M.); (L.S.)
| | - Edoardo Conte
- Cardiology Department, Galeazzi-Sant’Ambrogio Hospital IRCCS, 20100 Milan, Italy;
| | - Luigi Spadafora
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00185 Rome, Italy; (M.B.); (D.M.); (L.S.)
| | - Fiona Ecarnot
- Department of Cardiology, University Hospital Besancon, University of Franche-Comté, 25000 Besancon, France;
| | - Lale Tokgozoglu
- Department of Cardiology, Medical Faculty, Hacettepe University, 06230 Ankara, Turkey;
| | - Carlos G. Santos-Gallego
- Atherothrombosis Research Unit, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA;
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Health System, New York, NY 10029, USA;
| | - Sergio Emanuel Kaiser
- Discipline of Clinical and Experimental Pathophysiology, Rio de Janeiro State University, Rio de Janeiro 23070-200, Brazil;
| | - Federica Fogacci
- Hypertension and Cardiovascular Risk Research Group, Medical and Surgical Sciences Department, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy;
| | | | - Deepak L. Bhatt
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Health System, New York, NY 10029, USA;
| | - Francesco Paneni
- Department of Cardiology, University Heart Center, University Hospital Zurich, 8091 Zurich, Switzerland;
- Center for Translational and Experimental Cardiology (CTEC), University Hospital Zurich and University of Zurich, 8091 Zurich, Switzerland
| | - Maciej Banach
- Department of Preventive Cardiology and Lipidology, Medical University of Lodz (MUL), Rzgowska 281/289, 93-338 Lodz, Poland;
- Cardiovascular Research Centre, University of Zielona Gora, 65-417 Zielona Gora, Poland
| | - Raul Santos
- Heart Institute, University of Sao Paulo Medical School, São Paulo 05403-903, Brazil;
| | - Giuseppe Biondi Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, 00185 Roma, Italy;
- Mediterranea Cardiocentro, 80122 Napoli, Italy
| | - Kausik K. Ray
- Imperial Centre for Cardiovascular Disease Prevention and Imperial Clinical Trials Unit, Department of Public Health and Primary Care, Imperial College London, London SW7 2BX, UK;
| | - Pierre Sabouret
- Heart Institute, Cardiology Department, Paris and National College of French Cardiologists, Pitié-Salpétrière Hospital, Sorbonne University, 75013 Paris, France
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19
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Noflatscher M, Hunjadi M, Schreinlechner M, Sommer P, Lener D, Theurl M, Kirchmair R, Bauer A, Ritsch A, Marschang P. Inverse Correlation of Cholesterol Efflux Capacity with Peripheral Plaque Volume Measured by 3D Ultrasound. Biomedicines 2023; 11:1918. [PMID: 37509557 PMCID: PMC10376979 DOI: 10.3390/biomedicines11071918] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/30/2023] Open
Abstract
INTRODUCTION Cardiovascular disease (CVD) is a systemic multifocal illness called atherosclerosis that causes artery constriction and blockage. By causing cholesterol to build up in the artery wall, hypercholesterolemia is a major factor in the pathophysiology of atherosclerotic plaque development. Reverse cholesterol transport is the process of transporting cholesterol from the periphery back to the liver through cholesterol efflux mediated by high-density lipoprotein (HDL). It was suggested that the cholesterol efflux capacity (CEC), which is inversely linked with cardiovascular risk, can serve as a stand-in measure for reverse cholesterol transport. In this work, we sought to investigate a potential link between the peripheral plaque volume (PV) and CEC. METHODS Since lipid-lowering therapy interferes with CEC, we performed a cross-sectional study of 176 patients (48.9% females) with one cardiovascular risk factor or known CVD that did not currently take lipid-lowering medication. CEC was determined using cAMP-treated 3H-cholesterol-labeled J774 cells. Cholesterol ester transfer protein (CETP)-mediated cholesterol ester transfer was measured by quantifying the transfer of cholesterol ester from radiolabeled exogenous HDL cholesterol to Apolipoprotein B-containing lipoproteins. PV in the carotid and the femoral artery, defined as the total PV, was measured using a 3D ultrasound system equipped with semi-automatic software. RESULTS In our patients, we discovered an inverse relationship between high total PV and CEC (p = 0.027). However, there was no connection between total PV and low-density lipoprotein cholesterol, lipoprotein (a), or CETP-mediated cholesterol ester transfer. CONCLUSION In patients not receiving lipid-lowering treatment, CEC inversely correlates with peripheral atherosclerosis, supporting its role in the pathophysiology of atherosclerosis.
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Affiliation(s)
- Maria Noflatscher
- Department of Internal Medicine III (Cardiology, Angiology), Medical University of Innsbruck, Anichstr. 35, A-6020 Innsbruck, Austria
| | - Monika Hunjadi
- Department of Internal Medicine I, Medical University of Innsbruck, Anichstr. 35, A-6020 Innsbruck, Austria
| | - Michael Schreinlechner
- Department of Internal Medicine III (Cardiology, Angiology), Medical University of Innsbruck, Anichstr. 35, A-6020 Innsbruck, Austria
| | - Philip Sommer
- Department of Internal Medicine III (Cardiology, Angiology), Medical University of Innsbruck, Anichstr. 35, A-6020 Innsbruck, Austria
| | - Daniela Lener
- Department of Internal Medicine III (Cardiology, Angiology), Medical University of Innsbruck, Anichstr. 35, A-6020 Innsbruck, Austria
| | - Markus Theurl
- Department of Internal Medicine III (Cardiology, Angiology), Medical University of Innsbruck, Anichstr. 35, A-6020 Innsbruck, Austria
| | - Rudolf Kirchmair
- Department of Internal Medicine III (Cardiology, Angiology), Medical University of Innsbruck, Anichstr. 35, A-6020 Innsbruck, Austria
| | - Axel Bauer
- Department of Internal Medicine III (Cardiology, Angiology), Medical University of Innsbruck, Anichstr. 35, A-6020 Innsbruck, Austria
| | - Andreas Ritsch
- Department of Internal Medicine I, Medical University of Innsbruck, Anichstr. 35, A-6020 Innsbruck, Austria
| | - Peter Marschang
- Department of Internal Medicine III (Cardiology, Angiology), Medical University of Innsbruck, Anichstr. 35, A-6020 Innsbruck, Austria
- Department of Internal Medicine, Central Hospital of Bolzano (SABES-ASDAA), Via Lorenz Boehler 5, I-39100 Bolzano, Italy
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20
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Costo-Muriel C, Calderón-García JF, Rico-Martín S, Galán-González J, Escudero-Sánchez G, Sánchez-Bacaicoa C, Rodríguez-Velasco FJ, Santano-Mogena E, Fonseca C, Muñoz-Torrero JFS. Relationship between the novel and traditional anthropometric indices and subclinical atherosclerosis evaluated by carotid intima-media thickness (c-IMT). Front Nutr 2023; 10:1170450. [PMID: 37457970 PMCID: PMC10348712 DOI: 10.3389/fnut.2023.1170450] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023] Open
Abstract
Introduction Over the last few years, novel anthropometric indices have been developed as an alternative to body mass index (BMI) and other traditional anthropometric measurements to enhance the estimate of fat proportion and its relationship to a future cardiovascular event. The purpose of this study was to investigate the association of carotid intima-media thickness (c-IMT) estimated by Doppler ultrasound with current anthropometric indices (traditional and novel). Methods A cross-sectional study was conducted on a total of 789 Spanish patients. Traditional (BMI, WHR, and WHtR) and new (WWI, AVI, ABSI, BRI, BAI, CUN-BAE, and CI) anthropometric indices were determined, and carotid Doppler ultrasound was performed to evaluate c-IMT (≥0.90 mm). Results Most of the anthropometric indices analyzed were significantly higher among patients with pathological c-IMT, except for BMI, BAI, and CUN-BAE. In multiple linear regression analysis, c-IMT was positively related to ABSI, AVI, BRI, CI, and WWI but not to CUN-BAE, BAI, or traditional anthropometric indices. Similarly, in univariate analysis, all indices were associated with a c-IMT of ≥0.90 mm (p < 0.05), except BMI, BAI, and CUN-BAE; however, only ABSI (adjusted OR: 1.61; 95% CI: 1.08-2.40; p = 0.017), CI (adjusted OR: 1.73; 95% CI: 1.15-2.60; p = 0.008), and WWI (adjusted OR: 1.74; 95% CI: 1.14-2.64; p = 0.009) were significantly associated in multivariate analysis. Finally, CI, ABSI, and WWI provided the largest AUC, and BMI and CUN-BAE showed the lowest AUC. Conclusion ABSI, CI, and WWI were positively associated with pathological c-IMT (≥0.90 mm), independent of other confounders.
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Affiliation(s)
- Clara Costo-Muriel
- Department of Internal Medicine, Hospital Comarcal de la Axarquía, Málaga, Spain
| | - Julián F. Calderón-García
- Department of Nursing, Nursing and Occupational Therapy College, University of Extremadura, Cáceres, Spain
| | - Sergio Rico-Martín
- Department of Nursing, Nursing and Occupational Therapy College, University of Extremadura, Cáceres, Spain
| | | | | | | | | | - Esperanza Santano-Mogena
- Department of Nursing, Nursing and Occupational Therapy College, University of Extremadura, Cáceres, Spain
| | - César Fonseca
- Department of Nursing, University of Évora, Evora, Portugal
- Department of Nursing, Comprehensive Health Research Centre (CHRC), Evora, Portugal
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21
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Androutsakos T, Mouziouras D, Katelani S, Psichogiou M, Sfikakis PP, Protogerou AD, Argyris AA. A Comparative Study on the Presence and Reversibility of Subclinical Arterial Damage in HCV-Infected Individuals and Matched Controls. Viruses 2023; 15:1374. [PMID: 37376673 DOI: 10.3390/v15061374] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/12/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
Background: The arterial pathology and mechanisms of increased cardiovascular disease (CVD) risk in HCV-infected individuals are not yet clear. The aim of this study was to identify types of arterial pathology in treatment-naive chronic HCV patients and to test their reversibility after successful treatment. Methods: Consecutive, never-treated, HCV-infected patients were compared with age and CVD-related risk factors, matched controls, healthy individuals (HI), patients with rheumatoid arthritis (RA) and people living with HIV (PLWH), in terms of arterial stiffening by pulse wave velocity, arterial atheromatosis/hypertrophy by carotid plaques/intima-media thickness and impaired pressure wave reflections by augmentation index. After three months of sustained virological response (SVR) administered using direct-acting antivirals, vascular examination was repeated in HCV-infected patients to test drug and viral-elimination effect in subclinical CVD. Results: Thirty HCV patients were examined at baseline; fourteen of them were re-examined post-SVR. Compared with HI, HCV patients had significantly more plaques, which is similar to that of RA patients and the PLWH group. No other differences were found in all other vascular biomarkers, and regression among HCV patients also revealed no differences 3 months post-SVR. Conclusions: Accelerated atheromatosis, rather than arterial stiffening, arterial remodeling and peripheral impaired hemodynamics is the underlying pathology leading to increased CVD risk in HCV patients.
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Affiliation(s)
- Theodoros Androutsakos
- Clinic/Laboratory of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Dimitrios Mouziouras
- Department of Gastroenterology, Laiko General Hospital, School of Medicine, National and Kapodistrian University Athens, 11527 Athens, Greece
- Cardiovascular Prevention and Research Unit, Clinic/Laboratory of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Stamatia Katelani
- Clinic/Laboratory of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Mina Psichogiou
- First Department of Internal Medicine, Laiko General Hospital, School of Medicine, National and Kapodistrian University Athens, 11527 Athens, Greece
| | - Petros P Sfikakis
- First Department of Propaedeutic Medicine, Laiko General Hospital, School of Medicine, National and Kapodistrian University Athens, 11527 Athens, Greece
| | - Athanase D Protogerou
- Clinic/Laboratory of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Cardiovascular Prevention and Research Unit, Clinic/Laboratory of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Antonios A Argyris
- Cardiovascular Prevention and Research Unit, Clinic/Laboratory of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
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22
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Tschiderer L, Seekircher L, Izzo R, Mancusi C, Manzi MV, Baldassarre D, Amato M, Tremoli E, Veglia F, Tuomainen TP, Kauhanen J, Voutilainen A, Iglseder B, Lind L, Rundek T, Desvarieux M, Kato A, de Groot E, Aşçi G, Ok E, Agewall S, Beulens JWJ, Byrne CD, Calder PC, Gerstein HC, Gresele P, Klingenschmid G, Nagai M, Olsen MH, Parraga G, Safarova MS, Sattar N, Skilton M, Stehouwer CDA, Uthoff H, van Agtmael MA, van der Heijden AA, Zozulińska-Ziółkiewicz DA, Park HW, Lee MS, Bae JH, Beloqui O, Landecho MF, Plichart M, Ducimetiere P, Empana JP, Bokemark L, Bergström G, Schmidt C, Castelnuovo S, Calabresi L, Norata GD, Grigore L, Catapano A, Zhao D, Wang M, Liu J, Ikram MA, Kavousi M, Bots ML, Sweeting MJ, Lorenz MW, Willeit P. Association of Intima-Media Thickness Measured at the Common Carotid Artery With Incident Carotid Plaque: Individual Participant Data Meta-Analysis of 20 Prospective Studies. J Am Heart Assoc 2023:e027657. [PMID: 37301757 DOI: 10.1161/jaha.122.027657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/12/2023] [Indexed: 06/12/2023]
Abstract
Background The association between common carotid artery intima-media thickness (CCA-IMT) and incident carotid plaque has not been characterized fully. We therefore aimed to precisely quantify the relationship between CCA-IMT and carotid plaque development. Methods and Results We undertook an individual participant data meta-analysis of 20 prospective studies from the Proof-ATHERO (Prospective Studies of Atherosclerosis) consortium that recorded baseline CCA-IMT and incident carotid plaque involving 21 494 individuals without a history of cardiovascular disease and without preexisting carotid plaque at baseline. Mean baseline age was 56 years (SD, 9 years), 55% were women, and mean baseline CCA-IMT was 0.71 mm (SD, 0.17 mm). Over a median follow-up of 5.9 years (5th-95th percentile, 1.9-19.0 years), 8278 individuals developed first-ever carotid plaque. We combined study-specific odds ratios (ORs) for incident carotid plaque using random-effects meta-analysis. Baseline CCA-IMT was approximately log-linearly associated with the odds of developing carotid plaque. The age-, sex-, and trial arm-adjusted OR for carotid plaque per SD higher baseline CCA-IMT was 1.40 (95% CI, 1.31-1.50; I2=63.9%). The corresponding OR that was further adjusted for ethnicity, smoking, diabetes, body mass index, systolic blood pressure, low- and high-density lipoprotein cholesterol, and lipid-lowering and antihypertensive medication was 1.34 (95% CI, 1.24-1.45; I2=59.4%; 14 studies; 16 297 participants; 6381 incident plaques). We observed no significant effect modification across clinically relevant subgroups. Sensitivity analysis restricted to studies defining plaque as focal thickening yielded a comparable OR (1.38 [95% CI, 1.29-1.47]; I2=57.1%; 14 studies; 17 352 participants; 6991 incident plaques). Conclusions Our large-scale individual participant data meta-analysis demonstrated that CCA-IMT is associated with the long-term risk of developing first-ever carotid plaque, independent of traditional cardiovascular risk factors.
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Affiliation(s)
- Lena Tschiderer
- Institute of Health Economics Medical University of Innsbruck Innsbruck Austria
| | - Lisa Seekircher
- Institute of Health Economics Medical University of Innsbruck Innsbruck Austria
| | - Raffaele Izzo
- Department of Advanced Biomedical Sciences Federico II University Naples Italy
| | - Costantino Mancusi
- Department of Advanced Biomedical Sciences Federico II University Naples Italy
| | - Maria V Manzi
- Department of Advanced Biomedical Sciences Federico II University Naples Italy
| | - Damiano Baldassarre
- Department of Medical Biotechnology and Translational Medicine University of Milan Milan Italy
- Centro Cardiologico Monzino Stituto di Ricovero e Cura a Carattere Scientifico Milan Italy
| | - Mauro Amato
- Centro Cardiologico Monzino Stituto di Ricovero e Cura a Carattere Scientifico Milan Italy
| | | | | | - Tomi-Pekka Tuomainen
- Institute of Public Health and Clinical Nutrition University of Eastern Finland Kuopio Finland
| | - Jussi Kauhanen
- Institute of Public Health and Clinical Nutrition University of Eastern Finland Kuopio Finland
| | - Ari Voutilainen
- Institute of Public Health and Clinical Nutrition University of Eastern Finland Kuopio Finland
| | - Bernhard Iglseder
- Department of Geriatric Medicine Gemeinnützige Salzburger Landeskliniken Betriebsgesellschaft GmbH Christian-Doppler-Klinik Salzburg Austria
- Department of Geriatric Medicine Paracelsus Medical University Salzburg Austria
| | - Lars Lind
- Department of Medicine Uppsala University Uppsala Sweden
| | - Tatjana Rundek
- Department of Neurology University of Miami Miller School of Medicine Miami FL
| | - Moise Desvarieux
- Department of Epidemiology, Mailman School of Public Health Columbia University New York NY
- METHODS Core, Centre de Recherche Epidémiologie et Statistique Paris Sorbonne Cité Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche 1153 Paris France
| | - Akihiko Kato
- Blood Purification Unit Hamamatsu University Hospital Hamamatsu Japan
| | - Eric de Groot
- Imagelabonline and Cardiovascular Erichem the Netherlands
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center-Academic Medical Centre Amsterdam the Netherlands
| | - Gülay Aşçi
- Nephrology Department Ege University School of Medicine Bornova-Izmir Turkey
| | - Ercan Ok
- Nephrology Department Ege University School of Medicine Bornova-Izmir Turkey
| | - Stefan Agewall
- Department of Clinical Sciences, Danderyd Hospital Division of Cardiology Karolinska Institutet Stockholm Sweden
- Institute of Clinical Sciences University of Oslo Oslo Norway
| | - Joline W J Beulens
- Department of Epidemiology and Data Science, Amsterdam University Medical Center-Location Vrije Universiteit Medical Center Amsterdam the Netherlands
| | - Christopher D Byrne
- School of Human Development and Health, Faculty of Medicine University of Southampton Southampton UK
- Southampton National Institute for Health and Care Research, Biomedical Research Centre University Hospital Southampton Southampton UK
| | - Philip C Calder
- School of Human Development and Health, Faculty of Medicine University of Southampton Southampton UK
- Southampton National Institute for Health and Care Research, Biomedical Research Centre University Hospital Southampton Southampton UK
| | - Hertzel C Gerstein
- Department of Medicine and Population Health Research Institute McMaster University Hamilton Ontario Canada
- Hamilton General Hospital Hamilton Ontario Canada
| | - Paolo Gresele
- Division of Internal and Cardiovascular Medicine, Department of Medicine and Surgery University of Perugia Perugia Italy
| | | | - Michiaki Nagai
- Department of Internal Medicine General Medicine and Cardiology, Hiroshima City Asa Hospital Hiroshima Japan
| | - Michael H Olsen
- Department of Internal Medicine, Holbaek Hospital University of Southern Denmark Odense Denmark
| | - Grace Parraga
- Department of Medical Biophysics, Robarts Research Institute Western University London ON Canada
| | - Maya S Safarova
- Department of Cardiovascular Medicine University of Kansas Medical Center Kansas City KS
| | - Naveed Sattar
- British Heart Foundation Glasgow Cardiovascular Research Centre University of Glasgow Glasgow UK
| | - Michael Skilton
- Charles Perkins Centre, Faculty of Medicine and Health University of Sydney Sydney NSW Australia
| | - Coen D A Stehouwer
- Department of Internal Medicine and Cardiovascular Research Institute Maastricht Maastricht University Medical Centre Maastricht the Netherlands
| | - Heiko Uthoff
- Department of Angiology University Hospital Basel Basel Switzerland
| | - Michiel A van Agtmael
- Department of Internal Medicine Amsterdam University Medical Center, Vrije Universiteit Amsterdam the Netherlands
| | - Amber A van der Heijden
- Department of General Practice, Amsterdam University Medical Center-Location Vrije Universiteit Medical Center Amsterdam the Netherlands
| | | | - Hyun-Woong Park
- Division of Cardiology, Department of Internal Medicine Chungnam National University Sejong Hospital Sejong-si South Korea
| | - Moo-Sik Lee
- Department of Preventive Medicine, College of Medicine Konyang University Daejeon South Korea
- Department of Occupational and Environmental Medicine Konyang University Hospital Daejeon South Korea
| | - Jang-Ho Bae
- Heart Center, Konyang University Hospital Daejeon South Korea
- Department of Cardiology Konyang University College of Medicine Daejeon South Korea
| | - Oscar Beloqui
- Department of Internal Medicine University Clinic of Navarra Navarra Spain
| | - Manuel F Landecho
- Department of Internal Medicine University Clinic of Navarra Navarra Spain
| | - Matthieu Plichart
- Paris Cardiovascular Research Centre University Paris Descartes Paris France
- Fondation Santé Service, Hospital at Home Levallois-Perret France
| | | | | | - Lena Bokemark
- Wallenberg Laboratory for Cardiovascular Research University of Gothenburg Gothenburg Sweden
| | - Göran Bergström
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Clinical Physiology Sahlgrenska University Hospital, Region Västragötaland Gothenburg Sweden
| | - Caroline Schmidt
- Wallenberg Laboratory for Cardiovascular Research University of Gothenburg Gothenburg Sweden
| | - Samuela Castelnuovo
- Centro Dislipidemie, Aziende Socio Sanitarie Territoriali Grande Ospedale Metropolitano Niguarda Milan Italy
| | - Laura Calabresi
- Department of Pharmacological and Biomolecular Sciences University of Milan Milan Italy
| | - Giuseppe D Norata
- Department of Pharmacological and Biomolecular Sciences University of Milan Milan Italy
- Società Italiana per lo Studio dell'Aterosclerosi Center for the Study of Atherosclerosis, Bassini Hospital Cinisello Balsamo Italy
| | - Liliana Grigore
- Stituto di Ricovero e Cura a Carattere Scientifico Multimedica Milan Italy
| | - Alberico Catapano
- Department of Pharmacological and Biomolecular Sciences University of Milan Milan Italy
- Stituto di Ricovero e Cura a Carattere Scientifico Multimedica Milan Italy
| | - Dong Zhao
- Department of Epidemiology, Beijing Anzhen Hospital Capital Medical University Beijing China
| | - Miao Wang
- Department of Epidemiology, Beijing Anzhen Hospital Capital Medical University Beijing China
| | - Jing Liu
- Department of Epidemiology, Beijing Anzhen Hospital Capital Medical University Beijing China
| | - M Arfan Ikram
- Department of Epidemiology Erasmus University Medical Center Rotterdam the Netherlands
| | - Maryam Kavousi
- Department of Epidemiology Erasmus University Medical Center Rotterdam the Netherlands
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care University Medical Center Utrecht Utrecht the Netherlands
| | - Michael J Sweeting
- Department of Health Sciences University of Leicester Leicester UK
- Department of Public Health and Primary Care University of Cambridge Cambridge UK
| | - Matthias W Lorenz
- Klinik für Neurologie Krankenhaus Nordwest Frankfurt am Main Germany
- Department of Neurology Goethe University Frankfurt am Main Germany
| | - Peter Willeit
- Institute of Health Economics Medical University of Innsbruck Innsbruck Austria
- Department of Public Health and Primary Care University of Cambridge Cambridge UK
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23
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Spence JD. Assessment of atherosclerosis: should coronary calcium score and intima-media thickness be replaced by ultrasound measurement of carotid plaque burden and vessel wall volume? Curr Opin Lipidol 2023; 34:126-132. [PMID: 37093105 DOI: 10.1097/mol.0000000000000880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
PURPOSE OF REVIEW To describe the uses of vessel wall volume (VWV) and measurement of carotid plaque burden, as total plaque area (TPA) and total plaque volume (TPV), and to contrast them with measurement of carotid intima-media thickness (IMT) and coronary calcium (CAC). RECENT FINDINGS Measurement of carotid plaque burden (CPB) is useful for risk stratification, research into the genetics and biology of atherosclerosis, for measuring effects of new therapies for atherosclerosis, and for treatment of high-risk patients with severe atherosclerosis. It is as predictive of risk as CAC, with important advantages. IMT is only a weak predictor of risk and changes so little over time that it is not useful for assessing effects of therapy. SUMMARY Measurement of CPB and VWV are far superior to measurement of carotid IMT in many ways, and should replace it. Vessel wall volume can be measured in persons with no plaque as an alternative to IMT. There are important advantages of CPB over coronary calcium; CPB should be more widely used in vascular prevention.
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Affiliation(s)
- J David Spence
- Professor Emeritus of Neurology, Western University, and Director, Stroke Prevention & Atherosclerosis Research Centre, Robarts Research Institute, 1400 Western Road, London, ON N6G 2V4, Canada
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24
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Watanabe D, Gando Y, Murakami H, Kawano H, Yamamoto K, Morishita A, Miyatake N, Miyachi M. Longitudinal trajectory of vascular age indices and cardiovascular risk factors: a repeated-measures analysis. Sci Rep 2023; 13:5401. [PMID: 37012303 PMCID: PMC10070355 DOI: 10.1038/s41598-023-32443-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 03/28/2023] [Indexed: 04/05/2023] Open
Abstract
This study aimed to identify the modifiable cardiovascular risk factors associated with longitudinal changes, which are nine functional and structural biological vascular aging indicators (BVAIs), to propose an effective method to prevent biological vascular aging. We conducted a longitudinal study of 697 adults (a maximum of 3636 BVAI measurements) who were, at baseline, aged between 26 and 85 years and whose BVAIs were measured at least twice between 2007 and 2018. The nine BVAIs were measured using vascular testing and an ultrasound device. Covariates were assessed using validated questionnaires and devices. During the mean follow-up period of 6.7 years, the average number of BVAI measurements ranged from 4.3 to 5.3. The longitudinal analysis showed a moderate positive correlation between the common carotid intima-media thickness (IMT) and chronological age in both men (r = 0.53) and women (r = 0.54). In the multivariate analysis, BVAIs were associated with factors such as age, sex, residential area, smoking status, blood clinical chemistry test levels, number of comorbidities, physical fitness, body mass, physical activity, and dietary intake. The IMT is the most useful BVAI. Our findings suggest that modifiable cardiovascular risk factors are associated with longitudinal changes in BVAI as represented by IMT.
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Affiliation(s)
- Daiki Watanabe
- Faculty of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa-City, Saitama, 359-1192, Japan
- Department of Physical Activity Research, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 1-23-1 Toyama, Shinjuku-Ku, Tokyo, 162-8636, Japan
| | - Yuko Gando
- Department of Physical Activity Research, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 1-23-1 Toyama, Shinjuku-Ku, Tokyo, 162-8636, Japan
- Faculty of Sport Science, Surugadai University, 698 Azu, Hanno-City, Saitama, 357-8555, Japan
| | - Haruka Murakami
- Department of Physical Activity Research, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 1-23-1 Toyama, Shinjuku-Ku, Tokyo, 162-8636, Japan
- Faculty of Sport and Health Science, Ritsumeikan University, 1-1-1 Noji-Higashi, Kusatsu-City, Shiga, 525-8577, Japan
| | - Hiroshi Kawano
- Faculty of Letters, Kokushikan University, 4-28-1 Setagaya, Setagaya-Ku, Tokyo, 154-8515, Japan
| | - Kenta Yamamoto
- Faculty of Pharmaceutical Sciences, Teikyo Heisei University, 4-21-2 Nakano, Nakano-Ku, Tokyo, 164-8530, Japan
| | - Akie Morishita
- Okayama Southern Institute of Health, Okayama Health Foundation, 408-1 Hirata, Okayama-City, Okayama, 700-0952, Japan
| | - Nobuyuki Miyatake
- Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-Cho, Kita-Gun, Kagawa, 761-0793, Japan
| | - Motohiko Miyachi
- Faculty of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa-City, Saitama, 359-1192, Japan.
- Department of Physical Activity Research, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 1-23-1 Toyama, Shinjuku-Ku, Tokyo, 162-8636, Japan.
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25
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Implementing Carotid Ultrasonography in Optimizing Primary Cardiovascular Prevention Strategy: Has the Time Come? J Clin Med 2023; 12:jcm12062193. [PMID: 36983195 PMCID: PMC10053698 DOI: 10.3390/jcm12062193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 03/09/2023] [Indexed: 03/16/2023] Open
Abstract
The cardiovascular (CV) disease continuum begins from a cluster of CV risk factors, proceeds with the development of asymptomatic atherosclerotic lesions and ends with the occurrence of CV events [...]
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26
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Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Beaton AZ, Boehme AK, Buxton AE, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Fugar S, Generoso G, Heard DG, Hiremath S, Ho JE, Kalani R, Kazi DS, Ko D, Levine DA, Liu J, Ma J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Virani SS, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association. Circulation 2023; 147:e93-e621. [PMID: 36695182 DOI: 10.1161/cir.0000000000001123] [Citation(s) in RCA: 1009] [Impact Index Per Article: 1009.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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27
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Poli A, Catapano AL, Corsini A, Manzato E, Werba JP, Catena G, Cetin I, Cicero AFG, Cignarella A, Colivicchi F, Consoli A, Landi F, Lucarelli M, Manfellotto D, Marrocco W, Parretti D, Perrone Filardi P, Pirillo A, Sesti G, Volpe M, Marangoni F. LDL-cholesterol control in the primary prevention of cardiovascular diseases: An expert opinion for clinicians and health professionals. Nutr Metab Cardiovasc Dis 2023; 33:245-257. [PMID: 36566123 DOI: 10.1016/j.numecd.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 10/04/2022] [Indexed: 11/29/2022]
Abstract
AIMS Although adequate clinical management of patients with hypercholesterolemia without a history of known cardiovascular disease is essential for prevention, these subjects are often disregarded. Furthermore, the scientific literature on primary cardiovascular prevention is not as rich as that on secondary prevention; finally, physicians often lack adequate tools for the effective management of subjects in primary prevention and have to face some unsolved relevant issues. This document aims to discuss and review the evidence available on this topic and provide practical guidance. DATA SYNTHESIS Available algorithms and risk charts represent the main tool for the assessment of cardiovascular risk in patients in primary prevention. The accuracy of such an estimate can be substantially improved considering the potential contribution of some additional risk factors (C-reactive protein, lipoprotein(a), family history of cardiovascular disease) and conditions (environmental pollution, sleep quality, socioeconomic status, educational level) whose impact on the cardiovascular risk has been better understood in recent years. The availability of non-invasive procedures to evaluate subclinical atherosclerosis may help to identify subjects needing an earlier intervention. Unveiling the presence of these conditions will improve cardiovascular risk estimation, granting a more appropriate intervention. CONCLUSIONS The accurate assessment of cardiovascular risk in subjects in primary prevention with the use of algorithms and risk charts together with the evaluation of additional factors will allow physicians to approach each patient with personalized strategies, which should translate into an increased adherence to therapy and, as a consequence, a reduced cardiovascular risk.
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Affiliation(s)
- Andrea Poli
- NFI - Nutrition Foundation of Italy, Milan, Italy.
| | - Alberico L Catapano
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy; Center for the Study of Dyslipidaemias, IRCCS MultiMedica, Sesto S. Giovanni, Milan, Italy
| | - Alberto Corsini
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Enzo Manzato
- Department of Medicine, University of Padova, Padova, Italy; SISA - Italian Society for the Study of Atherosclerosis, Italy
| | - José Pablo Werba
- Unit of Atherosclerosis Prevention, Monzino Cardiology Center, IRCCS, Milan, Italy
| | | | - Irene Cetin
- Department of Woman, Mother and Neonate Hospital Buzzi, Milan, University of Milan, Italy; SIGO - Italian Society of Gynecology and Obstetrics, Italy
| | - Arrigo F G Cicero
- Hypertension and Cardiovascular Risk Research Center, Medical and Surgical Sciences Department, IRCCS AOU di Bologna, Bologna, Italy; SINut - Italian Nutraceutical Society, Italy
| | - Andrea Cignarella
- Department of Medicine, University of Padova, Padova, Italy; Italian Research Center for Gender Health and Medicine, Italy
| | - Furio Colivicchi
- Division of Clinical Cardiology, San Filippo Neri Hospital, Rome, Italy; ANMCO - Italian National Association of Hospital Cardiologists, Italy
| | - Agostino Consoli
- Department of Medicine and Aging Sciences, University G. D'Annunzio, Chieti, Italy; SID - Italian Society of Diabetology, Italy
| | - Francesco Landi
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy; SIGG - Italian Society of Gerontology and Geriatrics, Italy
| | - Maurizio Lucarelli
- SNaMID - National Society of Medical Education in General Practice, Italy
| | - Dario Manfellotto
- Department of Internal Medicine, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy; FADOI - Federation of Associations of Hospital Internists, Italy
| | - Walter Marrocco
- SIMPeSV and FIMMG - Italian Society of Preventive and Lifestyle Medicine and Italian Federation of General Practitioners, Italy
| | | | - Pasquale Perrone Filardi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy; SIC - Italian Society of Cardiology, Italy
| | - Angela Pirillo
- Center for the Study of Dyslipidaemias, IRCCS MultiMedica, Sesto S. Giovanni, Milan, Italy; Center for the Study of Atherosclerosis, E. Bassini Hospital, Cinisello Balsamo, Milan, Italy
| | - Giorgio Sesti
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy; SIMI - Italian Society of Internal Medicine, Italy
| | - Massimo Volpe
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Italy; SIPREC - Italian Society for Cardiovascular Prevention, Italy
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28
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Misra DP, Hauge EM, Crowson CS, Kitas GD, Ormseth SR, Karpouzas GA. Atherosclerotic Cardiovascular Risk Stratification in the Rheumatic Diseases:: An Integrative, Multiparametric Approach. Rheum Dis Clin North Am 2023; 49:19-43. [PMID: 36424025 DOI: 10.1016/j.rdc.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Cardiovascular disease (CVD) risk is increased in most inflammatory rheumatic diseases (IRDs), reiterating the role of inflammation in the initiation and progression of atherosclerosis. An inverse association of CVD risk with body weight and lipid levels has been described in IRDs. Coronary artery calcium scores, plaque burden and characteristics, and carotid plaques on ultrasound optimize CVD risk estimate in IRDs. Biomarkers of cardiac injury, autoantibodies, lipid biomarkers, and cytokines also improve risk assessment in IRDs. Machine learning and deep learning algorithms for phenotype and image analysis hold promise to improve CVD risk stratification in IRDs.
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Affiliation(s)
- Durga Prasanna Misra
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Rae Bareli Road, Lucknow 226014, India
| | - Ellen M Hauge
- Division of Rheumatology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99 DK-8200, Aarhus, Denmark
| | - Cynthia S Crowson
- Department of Quantitative Health Sciences and Division of Rheumatology, Mayo Clinic, 200 first St SW, Rochester, MN 55905, USA
| | | | - Sarah R Ormseth
- The Lundquist Institute and Harbor-UCLA Medical Center, 1124 West Carson Street, Building E4-R17, Torrance, CA 90502, USA
| | - George A Karpouzas
- The Lundquist Institute and Harbor-UCLA Medical Center, 1124 West Carson Street, Building E4-R17, Torrance, CA 90502, USA.
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29
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Pillay P, Carter J, Taylor H, Lewington S, Clarke R. Independent Relevance of Different Measures of Adiposity for Carotid Intima-Media Thickness in 40 000 Adults in UK Biobank. J Am Heart Assoc 2023; 12:e026694. [PMID: 36625300 PMCID: PMC9939056 DOI: 10.1161/jaha.122.026694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 11/15/2022] [Indexed: 01/11/2023]
Abstract
Background Uncertainty persists about carotid intima-media thickness (CIMT) as a marker of subclinical atherosclerosis and the independent relevance of different measures of adiposity for CIMT. We assessed the independent relevance of general adiposity (body mass index), central adiposity (waist circumference), and body composition (fat mass index and fat-free mass index) with CIMT among adults in the United Kingdom. Methods and Results Multivariable linear regression of cross-sectional analyses of UK Biobank assessed the mean percentage difference in CIMT associated with equivalent differences in adiposity measures. To assess independent associations, body mass index and waist circumference were mutually adjusted, as were fat mass index and fat-free mass index. Among 39 367 participants (mean [SD] age 64 [8] years, 52% female, 97% White), median (interquartile range) CIMT was 0.65 (0.14) mm in women and 0.69 (0.18) mm in men. All adiposity measures were linearly and positively associated with CIMT after adjusting for confounders. Fat-free mass index was most strongly associated with CIMT after adjustment for fat mass index (% difference in CIMT: 1.23 [95% CI 0.93-1.53] women; 3.44 [3.01-3.86] men), while associations of fat mass index were attenuated after adjustment for fat-free mass index (0.28 [-0.02, 0.58] women; -0.59 [-0.99, -0.18] men). After mutual adjustment, body mass index remained positively associated with CIMT, but waist circumference was completely attenuated. Conclusions Fat-free mass index was the adiposity measure most strongly associated with CIMT, suggesting that CIMT may reflect vascular compensatory remodeling rather than atherosclerosis. Hence, screening for subclinical atherosclerosis should evaluate carotid plaques in addition to CIMT.
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Affiliation(s)
- Preyanka Pillay
- Nuffield Department of Population HealthUniversity of OxfordUK
| | - Jennifer Carter
- Nuffield Department of Population HealthUniversity of OxfordUK
| | - Hannah Taylor
- Nuffield Department of Population HealthUniversity of OxfordUK
| | - Sarah Lewington
- Nuffield Department of Population HealthUniversity of OxfordUK
| | - Robert Clarke
- Nuffield Department of Population HealthUniversity of OxfordUK
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Paraskevas KI, Spence JD, Mikhailidis DP, Antignani PL, Gloviczki P, Eckstein HH, Spinelli F, Stilo F, Saba L, Poredos P, Dardik A, Liapis CD, Mansilha A, Faggioli G, Pini R, Jezovnik MK, Sultan S, Musiałek P, Goudot G, Lavenson GS, Jawien A, Blinc A, Myrcha P, Fernandes E Fernandes J, Geroulakos G, Kakkos SK, Knoflach M, Proczka RM, Capoccia L, Rundek T, Svetlikov AS, Silvestrini M, Ricco JB, Davies AH, Di Lazzaro V, Suri JS, Lanza G, Fraedrich G, Zeebregts CJ, Nicolaides AN. Why do guidelines recommend screening for abdominal aortic aneurysms, but not for asymptomatic carotid stenosis? A plea for a randomized controlled trial. Int J Cardiol 2023; 371:406-412. [PMID: 36162523 DOI: 10.1016/j.ijcard.2022.09.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/18/2022] [Accepted: 09/20/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Current guidelines do not recommend screening for asymptomatic carotid artery stenosis (AsxCS). The rationale behind this recommendation is that detection of AsxCS may lead to an unnecessary carotid intervention. In contrast, screening for abdominal aortic aneurysms is strongly recommended. METHODS A critical analysis of the literature was performed to evaluate the implications of detecting AsxCS. RESULTS Patients with AsxCS are at high risk for future stroke, myocardial infarction and vascular death. Population-wide screening for AsxCS should not be recommended. Additionally, screening of high-risk individuals for AsxCS with the purpose of identifying candidates for a carotid intervention is inappropriate. Instead, selective screening for AsxCS should be considered and should be viewed as an opportunity to identify individuals at high risk for atherosclerotic cardiovascular disease and future cardiovascular events for the timely initiation of intensive medical therapy and risk factor modification. CONCLUSIONS Although mass screening should not be recommended, there are several arguments suggesting that selective screening for AsxCS should be considered. The rationale supporting such selective screening is to optimize risk factor control and to initiate intensive medical therapy for prevention of future cardiovascular events, rather than to identify candidates for an intervention.
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Affiliation(s)
| | - J David Spence
- Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, ON, Canada
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London, UK
| | | | - Peter Gloviczki
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Francesco Spinelli
- Vascular Surgery Division, Campus Bio-Medico University of Rome, Rome, Italy
| | - Francesco Stilo
- Vascular Surgery Division, Campus Bio-Medico University of Rome, Rome, Italy
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliera Universitaria Di Cagliari, Cagliari, Italy
| | - Pavel Poredos
- Department of Vascular Disease, University Medical Centre Ljubljana, Slovenia
| | - Alan Dardik
- Division of Vascular and Endovascular Surgery, Yale University School of Medicine, New Haven, CT, USA
| | | | - Armando Mansilha
- Faculty of Medicine of the University of Porto, Porto, Portugal; Department of Angiology and Vascular Surgery, Hospital de S. Joao, Porto, Portugal
| | - Gianluca Faggioli
- Vascular Surgery, University of Bologna "Alma Mater Studiorum", Policlinico S. Orsola Malpighi, Bologna, Italy
| | - Rodolfo Pini
- Vascular Surgery, University of Bologna "Alma Mater Studiorum", Policlinico S. Orsola Malpighi, Bologna, Italy
| | - Mateja K Jezovnik
- Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Centre at Houston, Houston, TX, USA
| | - Sherif Sultan
- Western Vascular Institute, Department of Vascular and Endovascular Surgery, University Hospital Galway, National University of Ireland, Galway, Ireland
| | - Piotr Musiałek
- Jagiellonian University Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland
| | - Guillaume Goudot
- Vascular medicine department, Georges Pompidou European hospital, APHP, Université de Paris Cité, Paris, France
| | - George S Lavenson
- Department of Surgery, Uniformed Services University, Bethesda, MD, USA
| | - Arkadiusz Jawien
- Department of Vascular Surgery and Angiology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Aleš Blinc
- Department of Vascular Diseases, Division of Internal Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Piotr Myrcha
- Department of General and Vascular Surgery, Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
| | | | - George Geroulakos
- Department of Vascular Surgery, "Attikon" University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Stavros K Kakkos
- Department of Vascular Surgery, University Hospital of Patras, Patras, Greece
| | - Michael Knoflach
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Robert M Proczka
- 1(st) Department of Vascular Surgery, Medicover Hospital, Warsaw, Poland
| | - Laura Capoccia
- Department of Surgery "Paride Stefanini", Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Tatjana Rundek
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Alexei S Svetlikov
- Division of Vascular and Endovascular Surgery, North-Western Scientific Clinical Center of Federal Medical Biological Agency of Russia, St. Petersburg, Russia
| | - Mauro Silvestrini
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Jean-Baptiste Ricco
- Department of Clinical Research, University of Poitiers, CHU de Poitiers, Poitiers, France
| | - Alun H Davies
- Department of Surgery and Cancer, Section of Vascular Surgery, Imperial College London, Charing Cross Hospital, London, UK
| | - Vincenzo Di Lazzaro
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Universita Campus Bio-Medico di Roma, Rome, Italy
| | - Jasjit S Suri
- Stroke Diagnostic and Monitoring Division, Atheropoint™, Roseville, CA, USA
| | - Gaetano Lanza
- Vascular Surgery Department, IRCSS Multimedica Hospital, Castellanza, Italy
| | - Gustav Fraedrich
- Department of Vascular Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Clark J Zeebregts
- Department of Surgery (Division of Vascular Surgery), University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Andrew N Nicolaides
- Department of Surgery, University of Nicosia Medical School, Nicosia, Cyprus
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Nyman E, Grönlund C, Vanoli D, Liv P, Norberg M, Bengtsson A, Wennberg P, Wester P, Näslund U. Reduced progression of carotid intima media thickness by personalised pictorial presentation of subclinical atherosclerosis in VIPVIZA-A randomised controlled trial. Clin Physiol Funct Imaging 2023. [PMID: 36642849 DOI: 10.1111/cpf.12811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 12/16/2022] [Accepted: 01/11/2023] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Reduced progression of atherosclerosis can decrease the risk of cardiovascular disease (CVD). This study aimed at evaluating the effect of a pictorial intervention showing atherosclerotic severity on the progression of carotid atherosclerosis. METHODS A prospective randomised open-label blinded end-point trial with participants aged 40-60 years enroled from a routine CVD prevention programme. The intervention group (n: 1575) and their treating physicians received an image based presentation of subclinical atherosclerotic severity measured by carotid ultrasound. The control group (n: 1579) did not receive any information about ultrasound results. Carotid ultrasound at baseline and at 3-year follow-up contained plaque detection and measurements of carotid intima media thickness (cIMT). The left, right and bilateral-mean-cIMT, plaque prevalence and total plaque area (TPA) at 3-year follow-up were compared between groups. Significance level was set to p = 0.01 to adjust for multiple comparisons. RESULTS The intervention group revealed reduced cIMT progression in the left-mean-cIMT of -0.011 mm (p = 0.001) compared with the control group. The intervention effect on cIMT progression was most prominent in individuals with increased cIMT and plaque prevalence at baseline (-0.021 mm, p = 0.005). There were no differences in progression between groups for the right-and bilateral-mean-cIMT (-0.005 mm, p = 0.223 and -0.005 mm, p = 0.036, respectively), nor any differences between groups for plaque prevalence or TPA (odds ratio 0.88, p = 0.09 and 0.89, p = 0.21, respectively). CONCLUSION Pictorial presentation of subclinical atherosclerotic severity sent to both the individual and their treating physician resulted in significantly reduced left cIMT progression. Pictorial presentation has the potential to increase adherence in CVD prevention.
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Affiliation(s)
- Emma Nyman
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | - Davide Vanoli
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Per Liv
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Margareta Norberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Anna Bengtsson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.,Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Patrik Wennberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Per Wester
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Ulf Näslund
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Assessment of indices of conjunctival microvascular function in patients with and without obstructive coronary artery disease. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 50:26-33. [PMID: 36707373 DOI: 10.1016/j.carrev.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/08/2023] [Accepted: 01/10/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND Atherosclerotic heart disease often remains asymptomatic until presentation with a major adverse cardiovascular event. Primary preventive therapies improve outcomes, but conventional screening often misattributes risk. Vascular imaging can be utilised to detect atherosclerosis, but often involves ionising radiation. The conjunctiva is a readily accessible vascular network allowing non-invasive hemodynamic evaluation. AIM To compare conjunctival microcirculatory function in patients with and without obstructive coronary artery disease. METHODS We compared the conjunctival microcirculation of myocardial infarction patients (MI-cohort) to controls with no obstructive coronary artery disease (NO-CAD cohort). Conjunctival imaging was performed using a smartphone and slit-lamp biomicroscope combination. Microvascular indices of axial (Va) and cross-sectional (Vcs) velocity; blood flow rate (Q); and wall shear rate (WSR) were compared in all conjunctival vessels between 5 and 45 μm in diameter. RESULTS A total of 127 patients were recruited (66 MI vs 61 NO-CAD) and 3602 conjunctival vessels analysed (2414 MI vs 1188 NO-CAD). Mean Va, Vcs and Q were significantly lower in the MI vs NO-CAD cohort (Va 0.50 ± 0.17 mm/s vs 0.55 ± 0.15 mm/s, p < 0.001; Vcs 0.35 ± 0.12 mm/s vs 0.38 ± 0.10 mm/s, p < 0.001; Q 154 ± 116 pl/s vs 198 ± 130 pl/s, p < 0.001). To correct for differences in mean vessel diameter, WSR was compared in 10-36 μm vessels (3268/3602 vessels) and was lower in the MI-cohort (134 ± 64 s-1 vs 140 ± 63 s-1, p = 0.002). CONCLUSIONS Conjunctival microcirculatory alterations can be observed in patients with obstructive coronary artery disease. The conjunctival microvasculature merits further evaluation in cardiovascular risk screening.
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Karim R, Xu W, Kono N, Li Y, Yan M, Stanczyk FZ, Hodis HN, Mack WJ. Comparison of Cardiovascular Disease Risk Factors Between 2 Subclinical Atherosclerosis Measures in Healthy Postmenopausal Women: Carotid Artery Wall Thickness and Echogenicity: Carotid Artery Wall Thickness and Echogenicity. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:35-44. [PMID: 35388917 PMCID: PMC9537358 DOI: 10.1002/jum.15985] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 03/17/2022] [Accepted: 03/21/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Although carotid artery intima media thickness (CIMT) is a widely used determinant of subclinical atherosclerosis, gray-scale median of the intima-media complex (IM-GSM) of the common carotid artery is a relatively novel measure of echogenicity reflecting composition of the arterial wall. It is important to compare cardiovascular disease (CVD) risk factor correlates across CIMT and IM-GSM to determine whether these measures reflect distinct aspects of atherosclerosis. METHODS Baseline information from a completed randomized clinical trial of 643 healthy postmenopausal women without clinically apparent CVD was included in this cross-sectional study. The women were on average ± SD 61 ± 7 years old, and predominantly non-Hispanic White. CIMT and IM-GSM were measured by high-resolution B-mode ultrasonogram in the far wall of the right common carotid artery. CVD risk factors including age, race, body mass index (BMI), smoking, weekly hours of physical activity, systolic (SBP) and diastolic blood pressure (DBP), lipids, glucose, and inflammatory markers were measured at baseline. Linear regression models were used to assess associations of CVD risk factors with CIMT and IM-GSM. Multivariable models included groups of risk factors added one at a time with and withoutbasic demographic factors (age, race, BMI, physical activity) with model R2 values compared between CIMT and IM-GSM. RESULTS In multivariable analysis, age, Black race, BMI, SBP, and DBP were associated with CIMT (all P < .05), whereas age, Hispanic race, BMI, SBP, physical activity, LDL-cholesterol, and leptin were correlates of IM-GSM (all P < .05). Adjusted for age, race, BMI, and physical activity, the R2 value for SBP was greater for CIMT association, whereas R2 values for lipids, glucose, inflammatory markers, and adipokines were greater for IM-GSM associations. CONCLUSIONS CIMT and IM-GSM assess different attributes of subclinical atherosclerosis. Integrating both measures may provide improved assessment of atherosclerosis in asymptomatic individuals.
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Affiliation(s)
- Roksana Karim
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Atherosclerosis Research Unit, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Wenrui Xu
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Naoko Kono
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Atherosclerosis Research Unit, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Yanjie Li
- Atherosclerosis Research Unit, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Mingzhu Yan
- Atherosclerosis Research Unit, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Frank Z Stanczyk
- Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Howard N Hodis
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Atherosclerosis Research Unit, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Wendy J Mack
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Atherosclerosis Research Unit, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Chen W, Wang L, Hu B, Zheng Y, Zhang S, Zhou Z, Mai Y. Predictive Value of Noninvasive Peripheral Atherosclerosis Measurement for Coronary Artery Disease in Patients with Long T2DM Duration. Diabetes Metab Syndr Obes 2023; 16:1075-1083. [PMID: 37095753 PMCID: PMC10122498 DOI: 10.2147/dmso.s404937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 03/22/2023] [Indexed: 04/26/2023] Open
Abstract
Objective This study aimed to compare the predictive value of carotid or femoral artery ultrasound for coronary artery disease (CAD) in type 2 Diabetes mellitus (T2DM) patients free from known CAD, and to assess the relationship with the severity of coronary artery stenosis. Methods Cross-sectional study in adults with a T2DM duration of at least 5 years and without established CAD. Carotid plaque score (CPS) and Gensini score were used to measure the severity of carotid and coronary artery stenosis, respectively, and patients were divided into no or mild group, moderate group, and severe group according to the tertile of the score. Univariate and multivariate logistic regression analysis was used to explore the possible risk factors for CAD. Receiver operating characteristic (ROC) curves were created to determine the most accurate assessment for detecting significant CAD (≥50% stenosis). Results 245 patients (137 male) aged 68.21±9.5 years (range: 36-95 years), with T2DM duration 12.04± 6.17 years (range: 5-34 years), and without CVD were included. CAD was diagnosed in 165 patients (67.3%). Multiple regression analysis showed that CPS, femoral plaque, and smoking were independently and positively correlated with CAD. CPS yielded the highest area under the curve for detecting significant coronary disease (AUC=0.7323). In contrast, the area under the curve of femoral artery plaque and carotid intima-media thickness was lower than 0.7, which was at a lower prediction level. Conclusion In patients with long T2DM duration, CPS has a higher ability to predict the occurrence and severity of CAD. However, femoral artery plaque has special value in predicting moderate to severe coronary artery disease in patients with long-term T2DM.
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Affiliation(s)
- Wanjiao Chen
- Health Science Center, Ningbo University, Ningbo, 315020People’s Republic of China
| | - Li Wang
- Health Science Center, Ningbo University, Ningbo, 315020People’s Republic of China
| | - Bin Hu
- Health Science Center, Ningbo University, Ningbo, 315020People’s Republic of China
| | - Ying Zheng
- Health Science Center, Ningbo University, Ningbo, 315020People’s Republic of China
| | - Shuya Zhang
- Health Science Center, Ningbo University, Ningbo, 315020People’s Republic of China
| | - Zhong Zhou
- The First Affiliated Hospital of Ningbo University, Ningbo, 315020, People’s Republic of China
- Correspondence: Zhong Zhou; Yifeng Mai, The First Affiliated Hospital of Ningbo University, 247 Renmin Road, Jiangbei District, Ningbo, Zhejiang Province, 315020, People’s Republic of China, Tel +8613736099999, Email ;
| | - Yifeng Mai
- The First Affiliated Hospital of Ningbo University, Ningbo, 315020, People’s Republic of China
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Miura Y, Suzuki H. Hypertriglyceridemia and Atherosclerotic Carotid Artery Stenosis. Int J Mol Sci 2022; 23:ijms232416224. [PMID: 36555866 PMCID: PMC9785250 DOI: 10.3390/ijms232416224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/14/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022] Open
Abstract
Both fasting and non-fasting hypertriglyceridemia have emerged as residual risk factors for atherosclerotic disease. However, it is unclear whether hypertriglyceridemia increases the risks of the progression of carotid artery stenosis. Statins are well known to prevent carotid plaque progression and improve carotid plaque instability. In addition, statin therapy is also known to reduce cerebrovascular events in patients with carotid artery stenosis and to improve clinical outcomes in patients undergoing revascularization procedures. On the other hand, there have been no randomized controlled trials showing that the combination of non-statin lipid-lowering drugs with statins has additional beneficial effects over statin monotherapy to prevent cerebrovascular events and stenosis progression in patients with carotid artery stenosis. In this article, the authors demonstrate the mechanisms of atherosclerosis formation associated with hypertriglyceridemia and the potential role of lipid-lowering drugs on carotid artery stenosis. The authors also review the articles reporting the relationships between hypertriglyceridemia and carotid artery stenosis.
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Affiliation(s)
| | - Hidenori Suzuki
- Correspondence: ; Tel.: +81-59-232-1111; Fax: +81-59-231-5212
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Gao X, Lv T, Li G, Tse G, Liu T. Association Between Atherosclerosis-Related Cardiovascular Disease and Uveitis: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2022; 12:diagnostics12123178. [PMID: 36553185 PMCID: PMC9777442 DOI: 10.3390/diagnostics12123178] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/08/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Uveitis is not only an intraocular inflammatory disease, but also an indicator of systemic inflammation. It is unclear whether uveitis can increase the risk of cardiovascular disease (CVD) through the atherosclerotic pathway. METHODS PubMed and Embase databases were searched until 5 September, 2022. Original studies investigating uveitis and cardiovascular events were selected. The random-effects model was used to calculate the difference of groups in pooled estimates. RESULTS A total of six observational studies that included mainly ankylosing spondylitis (AS) patients were included. Of these, three studies reported data on carotid plaques and carotid intima-media thickness (cIMT) and the other three studies provided data on atherosclerosis-related CVD. No significant difference was found in cIMT between uveitis and controls (MD = 0.01, 95% CI = -0.03-0.04, p = 0.66), consistent with the findings of carotid plaque incidence (OR = 1.30, 95% CI = 0.71-2.41, p = 0.39). However, uveitis was associated with a 1.49-fold increase in atherosclerosis-related CVD (HR = 1.49, 95% CI = 1.20-1.84, p = 0.0002). CONCLUSIONS Uveitis is a predictor of atherosclerosis-related CVD in AS patients. For autoimmune disease patients with uveitis, earlier screening of cardiovascular risk factors and the implementation of corresponding prevention strategies may be associated with a better prognosis.
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Affiliation(s)
- Xinyi Gao
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Tonglian Lv
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Guangping Li
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
- Kent and Medway Medical School, Canterbury CT2 7NZ, UK
- Correspondence: (G.T.); or (T.L.)
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
- Correspondence: (G.T.); or (T.L.)
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Reference values of the carotid elastic modulus using shear wave elastography and arterial stiffness change in coronary slow flow. Eur J Radiol 2022; 157:110582. [DOI: 10.1016/j.ejrad.2022.110582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/17/2022] [Accepted: 10/26/2022] [Indexed: 11/23/2022]
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Reply. J Am Coll Cardiol 2022; 80:e193. [DOI: 10.1016/j.jacc.2022.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 09/08/2022] [Indexed: 11/16/2022]
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Abstract
Klinisches Problem Rauchen beeinflusst das kardiovaskuläre System des Körpers. Primär führt es entweder zu atheromatösen Plaques mit potenzieller Gefäßstenosierung oder zu aneurysmatischen Gefäßveränderungen mit potenzieller Rupturgefahr. Radiologische Standardverfahren Je nach Lokalisation ermöglicht die Sonographie eine initiale Einschätzung der Veränderungen. Eine Angiographie in Kombination mit Computertomographie (CT) oder Magnetresonanztomographie (MRT) ermöglicht die weiterführende Beurteilung und ggf. Therapieplanung. Ohne klinische Symptomatik wird bei Rauchern ohne sonstige Risikofaktoren oder Komorbiditäten keine bildgebende Diagnostik lediglich aufgrund des Rauchens empfohlen. Methodische Innovationen Aktuelle Leitlinien der entsprechenden Pathologien erkennen das Rauchen einstimmig als modifizierbaren Risikofaktor für kardiovaskuläre Erkrankungen an, weshalb stets eine Raucherentwöhnung als erster Schritt zur Prävention sekundärer Akutereignisse empfohlen wird. Bei Verdacht auf ein chronisches Koronarsyndrom erhöht das Rauchen die klinische Wahrscheinlichkeit, wodurch eher eine bildgebende Diagnostik indiziert werden sollte. Leistungsfähigkeit Obwohl das Rauchen weitreichende Folgen am gesamten kardiovaskulären System zeigt, bleibt zu klären, ob Raucher durch eine Modifikation aktueller Leitlinien zur Vorsorge und Diagnose hinsichtlich harter klinischer Endpunkte profitieren würden. Empfehlung für die Praxis Raucher sollten aufgrund des deutlich erhöhten kardiovaskulären Risikos zu einer Raucherentwöhnung beraten werden. Hinsichtlich konkreter Krankheitsbilder bedingt das Rauchen keine prinzipielle Modifikation der bildgebenden Abklärung, bei intermediärem Risiko kann aber tendenziell früher zur Bildgebung geraten werden.
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Affiliation(s)
- Mathias Pamminger
- Universitätsklinik für Radiologie, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich
| | - Agnes Mayr
- Universitätsklinik für Radiologie, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich.
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Roy Cardinal MH, Durand M, Chartrand-Lefebvre C, Soulez G, Tremblay C, Cloutier G. Associative Prediction of Carotid Artery Plaques Based on Ultrasound Strain Imaging and Cardiovascular Risk Factors in People Living With HIV and Age-Matched Control Subjects of the CHACS Cohort. J Acquir Immune Defic Syndr 2022; 91:91-100. [PMID: 35510848 DOI: 10.1097/qai.0000000000003016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 04/26/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is a need for a specific atherosclerotic risk assessment for people living with HIV (PLWH). SETTING A machine learning classification model was applied to PLWH and control subjects with low-to-intermediate cardiovascular risks to identify associative predictors of diagnosed carotid artery plaques. Associations with plaques were made using strain elastography in normal sections of the common carotid artery and traditional cardiovascular risk factors. METHODS One hundred two PLWH and 84 control subjects were recruited from the prospective Canadian HIV and Aging Cohort Study (57 ± 8 years; 159 men). Plaque presence was based on clinical ultrasound scans of left and right common carotid arteries and internal carotid arteries. A classification task for identifying subjects with plaque was defined using random forest (RF) and logistic regression models. Areas under the receiver operating characteristic curves (AUC-ROCs) were applied to select 5 among 50 combinations of 4 or less features yielding the highest AUC-ROCs. RESULTS To retrospectively classify individuals with and without plaques, the 5 most discriminant combinations of features had AUC-ROCs between 0.76 and 0.79. AUC-ROCs from RF were statistically significantly higher than those obtained with logistic regressions ( P = 0.0001). The most discriminant features of RF classifications in PLWH were age, smoking status, maximum axial strain and pulse pressure (equal weights), and sex and antiretroviral therapy exposure (equal weights). When considering the whole population, the HIV status was identified as a cofactor associated with carotid artery plaques. CONCLUSIONS Strain elastography adds to traditional cardiovascular risk factors for identifying individuals with carotid artery plaques.
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Affiliation(s)
- Marie-Hélène Roy Cardinal
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center, Montréal, Québec, Canada
| | - Madeleine Durand
- Department of Internal Medicine, University of Montreal Hospital, Montréal, Québec, Canada
- Department of Medicine, University of Montreal, Montréal, Québec, Canada
| | - Carl Chartrand-Lefebvre
- Department of Radiology, University of Montreal Hospital, Montréal, Québec, Canada
- Department of Radiology, Radio-oncology, and Nuclear Medicine, University of Montreal, Montréal, Québec, Canada
| | - Gilles Soulez
- Department of Radiology, University of Montreal Hospital, Montréal, Québec, Canada
- Department of Radiology, Radio-oncology, and Nuclear Medicine, University of Montreal, Montréal, Québec, Canada
- Institute of Biomedical Engineering, University of Montreal, Montréal, Québec, Canada
| | - Cécile Tremblay
- Department of Microbiology and Infectious Diseases, University of Montreal Hospital, Montréal, Québec, Canada; and
- Department of Microbiology, Infectious Diseases, and Immunology, University of Montreal, Montréal, Québec, Canada
| | - Guy Cloutier
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center, Montréal, Québec, Canada
- Department of Radiology, Radio-oncology, and Nuclear Medicine, University of Montreal, Montréal, Québec, Canada
- Institute of Biomedical Engineering, University of Montreal, Montréal, Québec, Canada
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41
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Więckowska B, Kubiak KB, Jóźwiak P, Moryson W, Stawińska-Witoszyńska B. Cohen's Kappa Coefficient as a Measure to Assess Classification Improvement following the Addition of a New Marker to a Regression Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191610213. [PMID: 36011844 PMCID: PMC9407914 DOI: 10.3390/ijerph191610213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/13/2022] [Accepted: 08/15/2022] [Indexed: 05/27/2023]
Abstract
The need to search for new measures describing the classification of a logistic regression model stems from the difficulty in searching for previously unknown factors that predict the occurrence of a disease. A classification quality assessment can be performed by testing the change in the area under the receiver operating characteristic curve (AUC). Another approach is to use the Net Reclassification Improvement (NRI), which is based on a comparison between the predicted risk, determined on the basis of the basic model, and the predicted risk that comes from the model enriched with an additional factor. In this paper, we draw attention to Cohen's Kappa coefficient, which examines the actual agreement in the correction of a random agreement. We proposed to extend this coefficient so that it may be used to detect the quality of a logistic regression model reclassification. The results provided by Kappa's reclassification were compared with the results obtained using NRI. The random variables' distribution attached to the model on the classification change, measured by NRI, Kappa, and AUC, was presented. A simulation study was conducted on the basis of a cohort containing 3971 Poles obtained during the implementation of a lower limb atherosclerosis prevention program.
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Affiliation(s)
- Barbara Więckowska
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, 60-806 Poznan, Poland
| | - Katarzyna B. Kubiak
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, 60-806 Poznan, Poland
| | - Paulina Jóźwiak
- Department of Preventive Medicine, Poznan University of Medical Sciences, 60-781 Poznan, Poland
| | - Wacław Moryson
- Department of Epidemiology and Hygiene, Chair of Social Medicine, Poznan University of Medical Sciences, 60-806 Poznan, Poland
| | - Barbara Stawińska-Witoszyńska
- Department of Epidemiology and Hygiene, Chair of Social Medicine, Poznan University of Medical Sciences, 60-806 Poznan, Poland
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Nonterah EA, Crowther NJ, Klipstein‐Grobusch K, Oduro AR, Kavousi M, Agongo G, Anderson TJ, Asiki G, Boua PR, Choma SSR, Couper DJ, Engström G, de Graaf J, Kauhanen J, Lonn EM, Mathiesen EB, Micklesfield LK, Okazaki S, Polak JF, Rundek T, Salonen JT, Tollman SM, Tuomainen T, Grobbee DE, Ramsay M, Bots ML. Racial and Ethnic Differences in the Association Between Classical Cardiovascular Risk Factors and Common Carotid Intima-Media Thickness: An Individual Participant Data Meta-Analysis. J Am Heart Assoc 2022; 11:e023704. [PMID: 35876421 PMCID: PMC9375511 DOI: 10.1161/jaha.121.023704] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 03/21/2022] [Indexed: 01/02/2023]
Abstract
Background The major risk factors for atherosclerotic cardiovascular disease differ by race or ethnicity but have largely been defined using populations of European ancestry. Despite the rising prevalence of cardiovascular disease in Africa there are few related data from African populations. Therefore, we compared the association of established cardiovascular risk factors with carotid-intima media thickness (CIMT), a subclinical marker of atherosclerosis, between African, African American, Asian, European, and Hispanic populations. Methods and Results Cross-sectional analyses of 34 025 men and women drawn from 15 cohorts in Africa, Asia, Europe, and North America were undertaken. Classical cardiovascular risk factors were assessed and CIMT measured using B-mode ultrasound. Ethnic differences in the association of established cardiovascular risk factors with CIMT were determined using a 2-stage individual participant data meta-analysis with beta coefficients expressed as a percentage using the White population as the reference group. CIMT adjusted for risk factors was the greatest among African American populations followed by Asian, European, and Hispanic populations with African populations having the lowest mean CIMT. In all racial or ethnic groups, men had higher CIMT levels compared with women. Age, sex, body mass index, and systolic blood pressure had a significant positive association with CIMT in all races and ethnicities at varying magnitudes. When compared with European populations, the association of age, sex, and systolic blood pressure with CIMT was weaker in all races and ethnicities. Smoking (beta coefficient, 0.39; 95% CI, 0.09-0.70), body mass index (beta coefficient, 0.05; 95% CI, 0.01-0.08) and glucose (beta coefficient, 0.13; 95% CI, 0.06-0.19) had the strongest positive association with CIMT in the Asian population when compared with all other racial and ethnic groups. High-density lipoprotein-cholesterol had significant protective effects in African American (beta coefficient, -0.31; 95% CI, -0.42 to -0.21) and African (beta coefficient, -0.26; 95% CI, -0.31 to -0.19) populations only. Conclusions The strength of association between established cardiovascular risk factors and CIMT differed across the racial or ethnic groups and may be due to lifestyle risk factors and genetics. These differences have implications for race- ethnicity-specific primary prevention strategies and also give insights into the differential contribution of risk factors to the pathogenesis of cardiovascular disease. The greatest burden of subclinical atherosclerosis in African American individuals warrants further investigations.
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Affiliation(s)
- Engelbert A. Nonterah
- Navrongo Health Research CentreGhana Health ServiceNavrongoGhana
- Julius Global HealthJulius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands
| | - Nigel J. Crowther
- Department of Chemical PathologyFaculty of Health SciencesNational Health Laboratory ServiceUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Kerstin Klipstein‐Grobusch
- Julius Global HealthJulius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands
- Division of Epidemiology and BiostatisticsSchool of Public HealthFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Abraham R. Oduro
- Navrongo Health Research CentreGhana Health ServiceNavrongoGhana
| | - Maryam Kavousi
- Department of EpidemiologyErasmus University Medical CentreRotterdamthe Netherlands
| | - Godfred Agongo
- Navrongo Health Research CentreGhana Health ServiceNavrongoGhana
- Department of Biochemistry and Forensic ScienceCK Tedam University of Technology and Applied Sciences (UTAS)NavrongoGhana
| | - Todd J. Anderson
- Department of Cardiac Sciences and Libin Cardiovascular Institute of AlbertaUniversity of CalgaryAlbertaCanada
| | - Gershim Asiki
- African Population and Health Research Centre (APHRC)NairobiKenya
| | - Palwendé R. Boua
- Clinical Research Unit of NanoroInstitut de Recherché en Sciences de la SantéNanoroBurkina Faso
| | - Solomon S. R. Choma
- Department of Pathology and Medical SciencesDIMAMO Health and Demographic Surveillance SystemUniversity of LimpopoSouth Africa
| | - David J. Couper
- Collaborative Studies Coordinating CenterDepartment of BiostatisticsUniversity of North Carolina at Chapel HillNC
| | - Gunnar Engström
- Department of Clinical Sciences in MalmöLund UniversitySkåne University HospitalMalmöSweden
| | - Jacqueline de Graaf
- Division of Vascular MedicineDepartment of General Internal MedicineNijmegen University Medical CentreNijmegenthe Netherlands
| | - Jussi Kauhanen
- The Institute of Public Health and clinical NutritionSchool of MedicineFaculty of Health SciencesUniversity of Eastern Finland (UEF)HelsinkiFinland
| | - Eva M. Lonn
- Division of Cardiology and Population Health Research InstituteDepartment of MedicineMcMaster UniversityHamiltonOntarioCanada
| | - Ellisiv B. Mathiesen
- Brain and Circulation Research GroupInstitute of Clinical MedicineUniversity of TromsøNorway
| | - Lisa K. Micklesfield
- South African Medical Research Council/Developmental Pathways for Health Research Unit (DPHRU)Department of PaediatricsSchool of Clinical MedicineFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Shuhei Okazaki
- Department of Neurology, Stroke CenterOsaka University Graduate School of MedicineOsakaJapan
| | | | | | | | - Stephen M. Tollman
- South African Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt)School of Public HealthFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Tomi‐Pekka Tuomainen
- The Institute of Public Health and clinical NutritionSchool of MedicineFaculty of Health SciencesUniversity of Eastern Finland (UEF)HelsinkiFinland
| | - Diederick E. Grobbee
- Julius Global HealthJulius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands
| | - Michéle Ramsay
- Sydney Brenner Institute of Molecular BioscienceFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Michiel L. Bots
- Julius Global HealthJulius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands
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Sofogianni A, Stalikas N, Antza C, Tziomalos K. Cardiovascular Risk Prediction Models and Scores in the Era of Personalized Medicine. J Pers Med 2022; 12:jpm12071180. [PMID: 35887677 PMCID: PMC9317494 DOI: 10.3390/jpm12071180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 06/29/2022] [Accepted: 07/07/2022] [Indexed: 12/14/2022] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of death worldwide. Management of cardiovascular risk factors, particularly hypertension and dyslipidemia, has been shown to reduce cardiovascular morbidity and mortality. However, current guidelines recommend adjusting the intensity of blood pressure- and lipid-lowering treatment according to the cardiovascular risk of the patient. Therefore, cardiovascular risk prediction is a sine qua non for optimizing cardiovascular prevention strategies, particularly in patients without established CVD or type 2 diabetes mellitus (T2DM). As a result, several cardiovascular risk prediction equations have been developed. Nevertheless, it is still unclear which is the optimal prediction risk equation. In the present review, we summarize the current knowledge regarding the accuracy of the most widely used cardiovascular risk prediction equations. Notably, most of these risk scores have not been validated in external cohorts or were shown to over- or underestimate risk in populations other than those in which they derive. Accordingly, country-specific risk scores, where available, should be preferred for cardiovascular risk stratification.
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Affiliation(s)
- Areti Sofogianni
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 54636 Thessaloniki, Greece;
| | - Nikolaos Stalikas
- Department of Cardiology, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 54636 Thessaloniki, Greece;
| | - Christina Antza
- Third Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Papageorgiou Hospital, 54636 Thessaloniki, Greece;
| | - Konstantinos Tziomalos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 54636 Thessaloniki, Greece;
- Correspondence: ; Tel.: +30-2310-994621; Fax: +30-2310-994773
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44
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Regional and demographic variations of Carotid artery Intima and Media Thickness (CIMT): A Systematic review and meta-analysis. PLoS One 2022; 17:e0268716. [PMID: 35819948 PMCID: PMC9275715 DOI: 10.1371/journal.pone.0268716] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 05/05/2022] [Indexed: 11/19/2022] Open
Abstract
Background and objective
Carotid artery intima media thickness (CIMT) is a strong predictor of Coronary Heart Disease (CHD) and independent phenotype of early atherosclerosis. The global variation of CIMT and its demographic association is yet unclear. We evaluated regional variations of CIMT based on WHO regions and assessed the differences by age and sex.
Methods
A systematic search was conducted on studies published between 1980 January up to December 2020. PubMed, Oxford Medicine Online, EBSCO, Taylor & Francis, Oxford University Press and Embase data bases were used for searching. Supplementary searches were conducted on the Web of Science and Google Scholar. Grey literature was searched in “Open Grey” website. The two major criteria used were “adults” and “carotid intima media”. The search strategy for PubMed was created first and then adapted for the Oxford Medicine Online, EBSCO, Taylor & Francis, Oxford University Press and Embase databases. Covidence software (Veritas Health Innovation, Melbourne, Australia; http://www.covidence.org) was used to manage the study selection process. Meta-analyses were done using the random-effects model. An I2 ≥ 50% or p< 0:05 were considered to indicate significant heterogeneity.
Results
Of 2847 potential articles, 46 eligible articles were included in the review contributing data for 49 381 individuals (mean age: 55.6 years, male: 55.8%). The pooled mean CIMT for the non-CHD group was 0.65mm (95%CI: 0.62–0.69). There was a significant difference in the mean CIMT between regions (p = 0.04). Countries in the African (0.72mm), American (0.71mm) and European (0.71mm) regions had a higher pooled mean CIMT compared to those in the South East Asian (0.62mm), West Pacific (0.60mm) and Eastern Mediterranean (0.60mm) regions. Males had a higher pooled mean CIMT of 0.06mm than females in the non CHD group (p = 0.001); there were also regional differences. The CHD group had a significantly higher mean CIMT than the non-CHD group (difference = 0.23mm, p = 0.001) with regional variations. Carotid artery segment-specific-CIMT variations are present in this population. Older persons and those having CHD group had significantly thicker CIMTs.
Conclusions
CIMT varies according to region, age, sex and whether a person having CHD. There are significant regional differences of mean CIMT between CHD and non-CHD groups. Segment specific CIMT variations exist among regions. There is an association between CHD and CIMT values.
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45
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Khan F, Gonçalves I, Shore AC, Natali A, Palombo C, Colhoun HM, Östling G, Casanova F, Kennbäck C, Aizawa K, Persson M, Gooding KM, Strain D, Looker H, Dove F, Belch J, Pinnola S, Venturi E, Kozakova M, Nilsson J. Plaque characteristics and biomarkers predicting regression and progression of carotid atherosclerosis. Cell Rep Med 2022; 3:100676. [PMID: 35858591 PMCID: PMC9381367 DOI: 10.1016/j.xcrm.2022.100676] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 04/10/2022] [Accepted: 06/10/2022] [Indexed: 11/18/2022]
Abstract
The factors that influence the atherosclerotic disease process in high-risk individuals remain poorly understood. Here, we used a combination of vascular imaging, risk factor assessment, and biomarkers to identify factors associated with 3-year change in carotid disease severity in a cohort of high-risk subjects treated with preventive therapy (n = 865). The results show that changes in intima-media thickness (IMT) are most pronounced in the carotid bulb. Progression of bulb IMT demonstrates independent associations with baseline bulb IMT, the plaque gray scale median (GSM), and the plasma level of platelet-derived growth factor (PDGF) (standardized β-coefficients and 95% confidence interval [CI] −0.14 [−0.06 to −0.02] p = 0.001, 0.15 [0.02–0.07] p = 0.001, and 0.20 [0.03–0.07] p < 0.001, respectively). Plasma PDGF correlates with the plaque GSM (0.23 [0.15–0.29] p < 0.001). These observations provide insight into the atherosclerotic process in high-risk subjects by showing that progression primarily occurs in fibrotic plaques and is associated with increased levels of PDGF. High age, male gender, and smoking increases risk of carotid disease progression Plaques that progress are more echogenic, indicating an increased degree of fibrosis Progression is associated with high plasma levels of pro-fibrotic growth factors Regression is most common in large, less fibrotic plaques
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Affiliation(s)
- Faisel Khan
- Division of Systems Medicine, University of Dundee, Dundee, UK
| | - Isabel Gonçalves
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden; Department of Cardiology, Skåne University Hospital, Malmö, Sweden
| | - Angela C Shore
- Diabetes and Vascular Medicine, University of Exeter Medical School and NIHR Exeter Clinical Research Facility, Exeter, UK
| | - Andrea Natali
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Carlo Palombo
- Department of Surgical, Medical, Molecular, and Critical Area Pathology, University of Pisa, Pisa, Italy
| | - Helen M Colhoun
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Gerd Östling
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Francesco Casanova
- Diabetes and Vascular Medicine, University of Exeter Medical School and NIHR Exeter Clinical Research Facility, Exeter, UK
| | - Cecilia Kennbäck
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Kunihiko Aizawa
- Diabetes and Vascular Medicine, University of Exeter Medical School and NIHR Exeter Clinical Research Facility, Exeter, UK
| | | | - Kim M Gooding
- Diabetes and Vascular Medicine, University of Exeter Medical School and NIHR Exeter Clinical Research Facility, Exeter, UK
| | - David Strain
- Diabetes and Vascular Medicine, University of Exeter Medical School and NIHR Exeter Clinical Research Facility, Exeter, UK
| | - Helen Looker
- Division of Systems Medicine, University of Dundee, Dundee, UK
| | - Fiona Dove
- Division of Systems Medicine, University of Dundee, Dundee, UK
| | - Jill Belch
- Division of Systems Medicine, University of Dundee, Dundee, UK
| | - Silvia Pinnola
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Elena Venturi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Michaela Kozakova
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy; Department of Surgical, Medical, Molecular, and Critical Area Pathology, University of Pisa, Pisa, Italy
| | - Jan Nilsson
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden.
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46
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Shin JY. Low serum creatinine to cystatin C ratio is independently associated with sarcopenia and high carotid plaque score in patients with type 2 diabetes. Nutr Metab Cardiovasc Dis 2022; 32:1454-1462. [PMID: 35256230 DOI: 10.1016/j.numecd.2022.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 01/24/2022] [Accepted: 02/07/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND AIMS Low serum creatinine (Cr) to cystatin C (cysC) ratio has been suggested to be associated with low muscle mass and strength and poor prognosis in various chronic disease. We investigated the associations of CCR with sarcopenia and carotid plaque score (PS) in patients with type 2 diabetes mellitus. METHODS AND RESULTS A total of 1577 patients with type 2 diabetes were enrolled. High PS was defined as PS ≥ 3. Sarcopenia was assessed by the measurement of appendicular skeletal muscle mass (ASM) and grip strength (GS). Compared to the highest CCR group, the lowest tertile group was older; had higher C-reactive protein levels, CIMT, and PS, but lower cysC-based estimated glomerular filtration rate (cysC-eGFR), ASM/BMI, and GS. Positive correlations between CCR and ASM/BMI (r = 0.239 in men and 0.303 in women, p < 0.001) and GS (r = 0.282 in men and 0.270 in women, p < 0.001) were observed in both genders. Odds ratios and 95% confidence intervals for high PS after adjusting for age and sex were 1.22 (0.92-1.61, p = 0.18) in the middle and 1.74 (1.31-2.30, p < 0.001) in the lowest tertiles, respectively, with those of the lowest tertile remaining significant after further adjusting for multiple confounders. CONCLUSIONS Low CCR was independently associated with sarcopenia and high PS in patients with type 2 diabetes mellitus, especially after adjusting for ASM/BMI and GS.
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Affiliation(s)
- Jang Yel Shin
- Department of Internal Medicine, Yonsei University, Wonju College of Medicine, Wonju, Republic of Korea.
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47
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Li X, Wang X, Li W, Wang W. Increased carotid intima-media thickness is independently associated with the occurrence of depressive disorders in patients with obstructive sleep apnea without cardiocerebrovascular disease. J Psychiatr Res 2022; 150:122-129. [PMID: 35367656 DOI: 10.1016/j.jpsychires.2022.03.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 02/16/2022] [Accepted: 03/24/2022] [Indexed: 11/19/2022]
Abstract
STUDY OBJECTIVES This study aimed to explore the relationship between carotid intima-media thickness (cIMT) and depression in patients with obstructive sleep apnea (OSA) without cardiocerebrovascular diseases. METHODS This study evaluated self-rating depression scale (SDS) scores, night sleep, and cIMT in 114 patients with OSA without cardiocerebrovascular diseases. RESULTS Among the 114 patients, 79.8% were male (mean age: 46.7 ± 11.58 years; range: 22-72 years). Moreover, 46.5%, 44.7%, and 7.89% of the patients presented with depressive disorders (8, 24, and 21 with severe, moderate, and mild degrees of depression, respectively), cIMT increase, and carotid plaques, respectively. Logistic regression with adjustment for age, sex, and other confounding factors revealed that, compared with patients with OSA without depressive disorders, those with depressive disorders had higher cIMT (odds ratio [OR] = 1.839; 95% confidence interval [CI]: 1.210-2.795), D-value (the difference between nocturnal mean blood oxygen saturation and the lowest blood oxygen saturation; OR = 1.434; 95% CI: 1.259-1.633]), and time spent at O2 saturation below 90% (OR = 1.060; 95% CI: 1.001-1.123). CONCLUSIONS cIMT and D-value are independently associated with depression in patients with OSA, which provides clinical evidence regarding the involvement of vascular damage in OSA-induced depression.
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Affiliation(s)
- Xiaomeng Li
- Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang, China
| | - Xingjian Wang
- Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang, China
| | - Wenyang Li
- Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang, China
| | - Wei Wang
- Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang, China.
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Yu M, Wang L, Zhang S, Feng H, Wu J, Li X, Yuan J. Association between Neck Circumference and Subclinical Atherosclerosis among Chinese Steelworkers: A Cross-Sectional Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116740. [PMID: 35682318 PMCID: PMC9180598 DOI: 10.3390/ijerph19116740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/13/2022] [Accepted: 05/28/2022] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to determine whether neck circumference (NC) is associated with subclinical atherosclerosis among Chinese steelworkers in North China. A cross-sectional survey was conducted among steelworkers in northern China (n = 3467). Carotid intima-media thickness (CIMT) was measured at the distal wall of the common carotid artery proximal to the bifurcation point along a plaque-free segment 10 mm long on each side by B-ultrasound. The mean of the common CIMT was used bilaterally in this study. In the cross-sectional analysis, large NC was associated with the presence of abnormal CIMT. Logistic regression analysis was used to assess the relationship between NC tertiles and CIMT. The multivariable-adjusted odds ratio was 1.76 (95% CI: 1.40 to 2.22; p for trend <0.001) for the highest tertile versus the lowest tertile and was 1.07 (95% CI: 1.04 to 1.10; p < 0.001) per 1 standard deviation increment in NC. Among steelworkers in North China, relatively large NC level is associated with elevated odds of subclinical atherosclerosis.
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Ibanez B, García-Lunar I, Fuster V. The Intima-Media Thickness Age Is Over: The Time of Multiterritorial Subclinical Plaque Quantification Has Come. J Am Coll Cardiol 2022; 79:1983-1985. [PMID: 35589159 DOI: 10.1016/j.jacc.2022.03.361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Borja Ibanez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; IIS-Fundacion Jiménez Díaz University Hospital, Madrid, Spain; CIBERCV, Madrid, Spain
| | - Inés García-Lunar
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; CIBERCV, Madrid, Spain; Cardiology Department, University Hospital Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Valentin Fuster
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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Arterial Ultrasound Testing to Predict Atherosclerotic Cardiovascular Events. J Am Coll Cardiol 2022; 79:1969-1982. [PMID: 35589158 DOI: 10.1016/j.jacc.2022.03.352] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Studies have indicated that the presence and size of subclinical atherosclerotic plaques improve the prediction of atherosclerotic cardiovascular events (ASCVE) over and above that provided by conventional risk factors alone. However, the relative contribution of different ultrasonographic measurements and sites of measurements on the 10-year ASCVD risk is largely unknown. OBJECTIVES Our aims were to determine the relative performance of carotid intima-media thickness, plaque thickness, and plaque area in 10-year ASCVD prediction when added to conventional risk factors as well as whether the vascular territory of these measurements, carotid or common femoral bifurcation, and the number of bifurcations with plaque (NBP) influence prediction. METHODS We enrolled 985 adults (mean age: 58.1 ± 10.2 years) free of atherosclerotic cardiovascular disease. Conventional risk factors were recorded, and both carotid and common femoral bifurcations were scanned with ultrasonography. The primary endpoint was a composite of first-time fatal or nonfatal ASCVE. RESULTS Over a mean ± SD follow-up of 13.2 ± 3.7 years, ASCVE occurred in 154 (15.6%) participants. By adding different plaque measurements to conventional risk factors in a Cox model, net reclassification improvement was 10.4% with maximum intima-media thickness, 9.5% with carotid plaque thickness, and 14.2% with carotid plaque area. It increased to 16.1%, 16.6%, and 16.6% (P < 0.0001) by adding measurements from 4 bifurcations: NBP, total plaque thickness, and total plaque area, respectively. CONCLUSIONS NBP, total plaque thickness, or total plaque area from both the carotid and common femoral bifurcations provides a better prediction of future ASCVE than measurements from a single site. The results need to be validated in an independent cohort.
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