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Nielsen RV, Fuster V, Bundgaard H, Fuster JJ, Johri AM, Kofoed KF, Douglas PS, Diederichsen A, Shapiro MD, Nicholls SJ, Nordestgaard BG, Lindholt JS, MacRae C, Yuan C, Newby DE, Urbina EM, Bergström G, Ridderstråle M, Budoff MJ, Bøttcher M, Raitakari OT, Hansen TH, Näslund U, Sillesen H, Eldrup N, Ibanez B. Personalized Intervention Based on Early Detection of Atherosclerosis: JACC State-of-the-Art Review. J Am Coll Cardiol 2024; 83:2112-2127. [PMID: 38777513 DOI: 10.1016/j.jacc.2024.02.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/12/2024] [Accepted: 02/22/2024] [Indexed: 05/25/2024]
Abstract
Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality worldwide and challenges the capacity of health care systems globally. Atherosclerosis is the underlying pathophysiological entity in two-thirds of patients with CVD. When considering that atherosclerosis develops over decades, there is potentially great opportunity for prevention of associated events such as myocardial infarction and stroke. Subclinical atherosclerosis has been identified in its early stages in young individuals; however, there is no consensus on how to prevent progression to symptomatic disease. Given the growing burden of CVD, a paradigm shift is required-moving from late management of atherosclerotic CVD to earlier detection during the subclinical phase with the goal of potential cure or prevention of events. Studies must focus on how precision medicine using imaging and circulating biomarkers may identify atherosclerosis earlier and determine whether such a paradigm shift would lead to overall cost savings for global health.
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Affiliation(s)
- Rikke V Nielsen
- Department of Medical Science, Novo Nordisk Foundation, Hellerup, Denmark; Department of Cardiothoracic Anesthesiology, Rigshospitalet University Hospital Copenhagen, Copenhagen, Denmark.
| | - Valentin Fuster
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Mount Sinai Fuster Heart Hospital, New York, New York, USA
| | - Henning Bundgaard
- Department of Cardiology, Rigshospitalet University Hospital Copenhagen, Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jose J Fuster
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; CIBER en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Amer M Johri
- Department of Medicine Queen's University, Kingston, Ontario, Canada
| | - Klaus F Kofoed
- Department of Cardiology, Rigshospitalet University Hospital Copenhagen, Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Radiology, Rigshospitalet University Hospital Copenhagen, Copenhagen, Denmark
| | - Pamela S Douglas
- Duke University School of Medicine, Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Axel Diederichsen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Michael D Shapiro
- Center for Prevention of Cardiovascular Disease, Section on Cardiovascular Disease, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Stephen J Nicholls
- Victorian Heart Institute, Monash University, Melbourne, Victoria, Australia
| | - Børge G Nordestgaard
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Biochemistry and The Copenhagen General Population Study, Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark. https://twitter.com/BNordestgaard
| | - Jes S Lindholt
- Department of Cardiothoracic and Vascular Surgery, Elite Research Centre of Individualised Treatment of Arterial Disease (CIMA), Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Calum MacRae
- Harvard Medical School, Department of Medicine, Boston, Massachusetts, USA
| | - Chun Yuan
- Department of Radiology and Imaging Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - David E Newby
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, Scotland
| | - Elaine M Urbina
- Preventive Cardiology, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, Cincinnati, Ohio, USA
| | - Göran Bergström
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Matthew J Budoff
- Department of Medicine, Lundquist Institute at Harbor-UCLA, Torrance, California, USA
| | - Morten Bøttcher
- University Clinic for Cardiovascular Research, Department of Cardiology, Aarhus University/Gødstrup Hospital, Aarhus, Denmark
| | - Olli T Raitakari
- Centre for Population Health Research, Research Centre of Applied and Preventive Cardiovascular Medicine, InFLAMES Research Flagship, University of Turku, Turku, Finland; Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
| | - Thomas H Hansen
- Department of Cardiology, Rigshospitalet University Hospital Copenhagen, Copenhagen, Denmark
| | - Ulf Näslund
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Henrik Sillesen
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Nikolaj Eldrup
- Department of Vascular Surgery, Rigshospitalet University Hospital Copenhagen, Copenhagen, Denmark
| | - Borja Ibanez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; CIBER en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Cardiology Department, IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain.
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Generoso G, Agarwal V, Shaw LJ, Cardoso R, Blankstein R, Bittencourt MS. Changes in use of preventive medications after assessment of chest pain by coronary computed tomography angiography: A meta-analysis. J Cardiovasc Comput Tomogr 2024; 18:233-242. [PMID: 38262852 DOI: 10.1016/j.jcct.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/11/2023] [Accepted: 01/07/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND Coronary computed tomography angiogram (CCTA) is a crucial tool for diagnosing CAD, but its impact on altering preventive medications is not well-documented. This systematic review aimed to compare changes in aspirin and statin therapy following CCTA and functional stress testing in patients with suspected CAD, and in those underwent CCTA when stratified by the presence/absence of plaque. RESULTS Eight studies involving 42,812 CCTA patients and 64,118 cardiac stress testing patients were analyzed. Compared to functional testing, CCTA led to 66 % more changes in statin therapy (pooled RR, 95 % CI [1.28-2.15]) and a 74 % increase in aspirin prescriptions (pooled RR, 95 % CI [1.34-2.26]). For medication modifications based on CCTA results, 13 studies (47,112 patients with statin data) and 11 studies (12,089 patients with aspirin data) were included. Patients with any plaque on CCTA were five times more likely to use or intensify statins compared to those without CAD (pooled RR, 5.40, 95 % CI [4.16-7.00]). Significant heterogeneity remained, which decreased when stratified by diabetes rates. Aspirin use increased eightfold after plaque detection (pooled RR, 8.94 [95 % CI, 4.21-19.01]), especially with obstructive plaque findings (pooled RR, 9.41, 95 % CI [2.80-39.02]). CONCLUSION In conclusion, CCTA resulted in higher changes in statin and aspirin therapy compared to cardiac stress testing. Detection of plaque by CCTA significantly increased statin and aspirin therapy.
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Affiliation(s)
- Giuliano Generoso
- Center for Clinical and Epidemiological Research, University Hospital University of Sao Paulo, Sao Paulo, Brazil
| | - Vikram Agarwal
- Cardiovascular Imaging Program, Department of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Leslee J Shaw
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA
| | - Rhanderson Cardoso
- Cardiovascular Imaging Program, Department of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Ron Blankstein
- Cardiovascular Imaging Program, Department of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Marcio S Bittencourt
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
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Masrouri S, Shapiro MD, Khalili D, Hadaegh F. Impact of coronary artery calcium on mortality and cardiovascular events in metabolic syndrome and diabetes among younger adults. Eur J Prev Cardiol 2024; 31:744-753. [PMID: 38323650 DOI: 10.1093/eurjpc/zwae039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/11/2024] [Accepted: 01/28/2024] [Indexed: 02/08/2024]
Abstract
AIMS Whether coronary artery calcium (CAC) testing in younger individuals with metabolic syndrome (MetS) and diabetes mellitus (DM) helps predict cardiovascular disease (CVD) and death independent of traditional risk factors (RFs) remains less clear. METHODS AND RESULTS We pooled data obtained from 5174 individuals aged 38-55 years from the CARDIA (Coronary Artery Risk Development in Young Adults; n = 3047, year 20) and MESA (Multi-Ethnic Study of Atherosclerosis; n = 2127, Visit 1) studies who completed computed tomography of CAC. The mean age (SD) of participants (44.7% men) was 47.3 (4.2) years. Multivariable Cox proportional hazards regression models were used to estimate hazard ratios (HRs) of CVD, coronary heart disease (CHD), and all-cause death. There were 1085 participants (21.0%) with prevalent CAC at baseline. A total of 461 (8.9%) had DM, 1025 (19.8%) had MetS without DM, and 3688 (71.3%) had neither condition. Over a median follow-up of 14.2 years, 256 (5.0%) participants died, and 304 (5.9%) CVD and 188 (3.6%) CHD events occurred. The CAC score was independently associated with incident CVD in those with DM (HR: 95% CI; 1.22: 1.08-1.38), MetS (1.18: 1.08-1.31), and neither condition (1.36: 1.26-1.46). The corresponding HRs for CAC ≥ 100 were 2.70 (1.25-5.83), 3.29 (1.87-5.79), and 6.30 (4.02-9.86), respectively. Similar associations for CHD and death were found. The impact of CAC ≥ 100 on CVD and CHD was lower in the presence of DM (P interaction < 0.05). The association of CAC with all outcomes in individuals with DM remained significant after adjusting with haemoglobin A1c levels. CONCLUSION Coronary artery calcium score is independently associated with cardiovascular events and death over nearly 15 years after screening at ages 38-55 years, with a less pronounced impact on CVD and CHD events in the presence of DM.
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Affiliation(s)
- Soroush Masrouri
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 24, Yamen Street, Velenjak, Tehran 1985717413, Iran
| | - Michael D Shapiro
- Center for Prevention of Cardiovascular Disease, Section on Cardiovascular Medicine, Wake Forest University School of Medicine, 1 Medical Center Boulevard, Winston Salem, North Carolina 27157, USA
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 24, Yamen Street, Velenjak, Tehran 1985717413, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 24, Yamen Street, Velenjak, Tehran 1985717413, Iran
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Haq A, Walser‐Kuntz E, Gamam A, Albers A, Bae A, Benson G, Miedema MD. Clinical characteristics and statin eligibility of patients under 50 with ST-elevation myocardial infarction. Clin Cardiol 2024; 47:e24231. [PMID: 38362951 PMCID: PMC10870333 DOI: 10.1002/clc.24231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 02/17/2024] Open
Abstract
AIMS This study seeks to understand the clinical characteristics, risk factors, and statin eligibility of younger adults who present with STEMI. METHODS We performed a retrospective analysis of a prospective cohort of STEMI patients <50 years. Baseline characteristics, medical history, prior medications, drug use, lipid profiles, cardiovascular risk factors were examined. Ten-year ASCVD risk was calculated utilizing the Pooled Cohort Equations. Statin eligibility was determined according to the 2019 American College of Cardiology (ACC)/American Heart Association (AHA) and the 2022 US Preventive Services Task Force (USPSTF) guidelines. RESULTS Six hundred and thirty-five individuals were included, the majority were men (82.4%) and white (89%), with a median age was 46.9 [42.0-48.0]. The most prevalent risk factors were current smoking (59%), hyperlipidemia (44%), and hypertension (37%). Drug use was rare (8.3%). Preventative medication use was low, aspirin was the most common (14%), followed by ACE inhibitors/ARBs (12%), statins (11%), and beta-blockers (9.1%). Mean HDL-C was low at 36.4 ± 12.0 mg/dL, while mean LDL was unremarkable at 112.4 ± 37.9 mg/dL. According to the 2019 ACC/AHA guidelines, 45.5% were classified as statin recommended, 8.7% were classified as statin considered, and 45.8% were classified as statin not recommended. According to the 2022 USPSTF guidelines, 29% were classified as statin recommended, 12.4% were classified as statin considered, and 58.6% were classified as statin not recommended. CONCLUSIONS Younger adults with STEMI exhibit high rates of tobacco use and low rates of preventative medications use. Approximately half of the cohort did not meet criteria for statin initiation.
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Affiliation(s)
- Ayman Haq
- Division of Cardiovascular MedicineAbbott Northwestern HospitalMinneapolisMinnesotaUSA
- Nolan Family Center for Cardiovascular HealthMinneapolis Heart Institute FoundationMinneapolisMinnesotaUSA
| | - Evan Walser‐Kuntz
- Nolan Family Center for Cardiovascular HealthMinneapolis Heart Institute FoundationMinneapolisMinnesotaUSA
| | - Abdulrahman Gamam
- Nolan Family Center for Cardiovascular HealthMinneapolis Heart Institute FoundationMinneapolisMinnesotaUSA
| | - Alexis Albers
- Nolan Family Center for Cardiovascular HealthMinneapolis Heart Institute FoundationMinneapolisMinnesotaUSA
| | - Aaron Bae
- Nolan Family Center for Cardiovascular HealthMinneapolis Heart Institute FoundationMinneapolisMinnesotaUSA
| | - Gretchen Benson
- Nolan Family Center for Cardiovascular HealthMinneapolis Heart Institute FoundationMinneapolisMinnesotaUSA
| | - Michael D. Miedema
- Division of Cardiovascular MedicineAbbott Northwestern HospitalMinneapolisMinnesotaUSA
- Nolan Family Center for Cardiovascular HealthMinneapolis Heart Institute FoundationMinneapolisMinnesotaUSA
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Zhao M, Zhang N, Wang M, Yao S, Wang C, Yun C, Zhang S, Sun Y, Hou Z, Chen S, Wu S, Li Y, Xue H. Transitions in Metabolic Health and Onset Age of Cardiovascular Diseases. Am J Prev Med 2023; 65:1059-1068. [PMID: 37295660 DOI: 10.1016/j.amepre.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023]
Abstract
INTRODUCTION The cardiometabolic risk associated with metabolically healthy obesity remains the subject of debate. It is unclear whether changes in metabolically healthy obesity status affect premature cardiovascular disease (CVD) risk. Authors aimed to investigate the association of metabolically healthy obesity and its transition over time with incident CVD by age at onset. METHODS In a community-based, prospective cohort study, 54,441 adults without CVD in or before 2010 were followed for incident CVD until 2020. This sample was analyzed in 2022. Four age groups were examined (<55, 55-65, 65-75, and ≥75 years) for CVD onset. In each age group, participants were cross-classified by BMI categories and metabolic health. The Cox proportional hazards model with age as the underlying time scale was used to examine the associations of metabolic health status and its transition with CVD across BMI categories. RESULTS During a median follow-up of 9.59 years, 3,038 participants developed CVD. Individuals with metabolically unhealthy obesity at baseline had the highest hazard ratio for CVD onset at any age, ranging from 2.68 (95% CI=2.02, 3.55) for CVD onset in those aged <55 years to 1.55 (95% CI=1.09, 2.10) for CVD onset in those aged ≥75 years. Individuals who had metabolically healthy obesity at baseline or even remained metabolically healthy during 2006-2010 were still at increased risk of premature CVD, and the association attenuated with increasing age of CVD onset. CONCLUSIONS The metabolically healthy obesity phenotype is dynamic and its transition to a metabolically unhealthy phenotype or even stable metabolically healthy obesity is associated with an increased risk of CVD. The associations were more evident for CVD onset at younger ages.
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Affiliation(s)
- Maoxiang Zhao
- Department of Cardiology, The First Medical Center, Chinese People's Liberation Army Hospital, Medical School of Chinese People's Liberation Army, Beijing, China
| | - Nan Zhang
- Department of Cardiology, The First Medical Center, Chinese People's Liberation Army Hospital, Medical School of Chinese People's Liberation Army, Beijing, China
| | - Miao Wang
- School of Medicine, Nankai University, Tianjin, China
| | - Siyu Yao
- Department of Cardiology, The Sixth Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Chi Wang
- Department of Cardiology, The First Medical Center, Chinese People's Liberation Army Hospital, Medical School of Chinese People's Liberation Army, Beijing, China
| | - Cuijuan Yun
- Department of Cardiology, The First Medical Center, Chinese People's Liberation Army Hospital, Medical School of Chinese People's Liberation Army, Beijing, China
| | - Sijin Zhang
- Department of Cardiology, The First Medical Center, Chinese People's Liberation Army Hospital, Medical School of Chinese People's Liberation Army, Beijing, China
| | - Yizhen Sun
- Department of Cardiology, The First Medical Center, Chinese People's Liberation Army Hospital, Medical School of Chinese People's Liberation Army, Beijing, China
| | - Ziwei Hou
- Department of Cardiology, The First Medical Center, Chinese People's Liberation Army Hospital, Medical School of Chinese People's Liberation Army, Beijing, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan Hospital, Tangshan, China
| | - Shouling Wu
- Department of Cardiology, Kailuan Hospital, Tangshan, China
| | - Yang Li
- Department of Cardiology, The Sixth Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Hao Xue
- Department of Cardiology, The Sixth Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
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Weight N, Moledina S, Rashid M, Chew N, Castelletti S, Buchanan GL, Salinger S, Gale CP, Mamas MA. Temporal analysis of non-ST segment elevation-acute coronary syndrome (NSTEACS) outcomes in 'young' patients under the age of fifty: A nationwide cohort study. Int J Cardiol 2023; 391:131294. [PMID: 37625485 DOI: 10.1016/j.ijcard.2023.131294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/25/2023] [Accepted: 08/21/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND The characteristics and risk factor profile of young patients presenting with non-ST segment elevation acute coronary syndrome (NSTEACS) and how they may have changed over time is not well reported. METHODS We identified 26,708 NSTEACS patients aged under 50 presenting to United Kingdom (UK) hospitals between 2010 and 2017 from Myocardial Ischaemia National Audit Project (MINAP). We calculated incidence of NSTEACS per 100,000 UK population, using Office of National Statistics (ONS) population estimates, prevalence of comorbidities, ethnicity, and in-hospital mortality. We formed biennial groups to enable comparison, 2010-2011, 2012-2013, 2014-2015 and 2016-2017. RESULTS The incidence of NSTEACS per 100,000 population showed minimal change between 2010 and 2017 (2010: 5.4 per 100,000 and 2017; 4.9 per 100,000). Rates of smoking (2010-11; 58% and 2016-17; 53%), and family history of coronary artery disease (CAD) (2010-11; 51% and 2016-17; 44%) fell, but the proportion of patients from an ethnic minority background (2010-11; 12% and 2016-17; 20%), with diabetes mellitus (DM) (2010-11; 14%, and 2016-17; 18%) and female patients (2010-11; 22% and 2016-17; 24%) increased over the study period. Mortality from NSTEACS remained unchanged (2010-11; 1% and 2016-17; 1%). CONCLUSIONS The incidence of NSTEACS in patients aged under fifty has not reduced despite reduction in prevalence of risk factors such as smoking hypercholesterolaemia in those admitted to UK hospitals. Despite improved rates of early invasive coronary angiography and percutaneous coronary intervention in 'young' NSTEACS patients, in-hospital mortality remains unchanged.
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Affiliation(s)
- Nicholas Weight
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, UK
| | - Saadiq Moledina
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, UK
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, UK
| | - Nicholas Chew
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
| | - Silvia Castelletti
- Cardiology Department, Istituto Auxologico Italiano IRCCS, San Luca Hospital, Milan, (Italy)
| | - Gill Louise Buchanan
- Cardiology Department, North Cumbria Integrated Care NHS Foundation Trust, Carlisle, UK
| | - Sonja Salinger
- Clinic for Cardiovascular Diseases, Clinical Center Niš, Faculty of Medicine, University of Niš, Niš, Serbia
| | - Chris P Gale
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK; Leeds Institute of Data Analytics, University of Leeds, Leeds, UK; Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, UK.
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Ichikawa K, Hansen S, Manubolu VS, Pourafkari L, Fazlalizadeh H, Aldana-Bitar J, VanWagner LB, Krishnan S, Budoff MJ. Prognostic value of coronary artery calcium score for the prediction of atherosclerotic cardiovascular disease in participants with suspected nonalcoholic hepatic steatosis: Results from the multi-ethnic study of atherosclerosis. Am Heart J 2023; 265:104-113. [PMID: 37517431 PMCID: PMC10592252 DOI: 10.1016/j.ahj.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/20/2023] [Accepted: 07/25/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) is associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD) events; thus, a diagnostic approach to help identify NAFLD patients at high risk is needed. In this study, we hypothesized that coronary artery calcium (CAC) screening could help stratify the risk of ASCVD events in participants with suspected nonalcoholic hepatic steatosis. METHODS A total of 713 participants with suspected nonalcoholic hepatic steatosis without previous cardiovascular events from the Multi-Ethnic Study of Atherosclerosis (MESA) were followed for the occurrence of incident ASCVD. Nonalcoholic hepatic steatosis was defined using nonenhanced computed tomography and liver/spleen attenuation ratio <1. Cox proportional hazards regression models were used to estimate hazard ratios (HR). C-statistics and areas under the time-dependent receiver operating characteristic curves (tAUC) were used to compare incremental contributions of CAC score when added to the clinical risk factors. RESULTS In multivariable analyses, CAC score was found to be independently associated with incident ASCVD (HR = 1.33, 95% CI = 1.22-1.44, P < .001). The addition of CAC score to clinical risk factors increased the C-statistic from 0.677 to 0.739 (P < .001) and tAUC at 10 years from 0.668 to 0.771, respectively. In subgroup analyses, the incremental prognostic value of CAC score was more significant in participants with low/borderline- (<7.5%) and intermediate- (7.5%-20%) 10-year ASCVD risk scores. CONCLUSIONS The inclusion of CAC score in global risk assessment was found to significantly improve the classification of incident ASCVD events in participants with suspected nonalcoholic hepatic steatosis, indicating a potential role for CAC screening in risk assessment.
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Affiliation(s)
- Keishi Ichikawa
- Lundquist Institute, Harbor-UCLA Medical Center, Torrance, CA
| | - Spencer Hansen
- Department of Biostatistics, University of Washington, Seattle, WA
| | | | | | | | | | - Lisa B VanWagner
- Department of Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, TX
| | - Srikanth Krishnan
- Lundquist Institute, Harbor-UCLA Medical Center, Torrance, CA; Department of Medicine, Division of Cardiology, University of California Los Angeles, Westwood, CA
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Shali S, Luo L, Yao K, Sun X, Wu H, Zhang S, Xu L, Gao W, Li J, Qian J, Zheng Y, Dai Y, Ge J. Triglyceride-glucose index is associated with severe obstructive coronary artery disease and atherosclerotic target lesion failure among young adults. Cardiovasc Diabetol 2023; 22:283. [PMID: 37865782 PMCID: PMC10590519 DOI: 10.1186/s12933-023-02004-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 09/23/2023] [Indexed: 10/23/2023] Open
Abstract
BACKGROUND Early diagnosis and treatment effectiveness of early-onset coronary artery disease (EOCAD) are crucial, and non-invasive predictive biomarkers are needed for young adults. We aimed to evaluate the usefulness of the triglyceride-glucose (TyG) index, a novel marker of insulin resistance, in identifying young CAD patients and predicting their risk of developing target lesion failure (TLF). METHODS We recruited EOCAD patients (luminal narrowing ≥ 70%) and controls free from CAD (luminal narrowing < 30%), both aged 45 years or younger, from 38 hospitals in China between 2017 and 2020. EOCAD patients who underwent successful percutaneous coronary intervention were followed for incident TLF. TyG index was defined as Ln [fasting triglyceride (mg/dL) × fasting blood glucose (mg/dL)/2]. We used logistic regression and Cox proportional hazards modeling to evaluate the association of TyG index with prevalent EOCAD and incident TLF, respectively. The discriminatory ability of TyG index was assessed by the area under the receiver-operating characteristic curve (AUC). RESULTS Among the included 1513 EOCAD patients (39.6 ± 4.4 years, 95.4% male) and 1513 age-matched controls (39.0 ± 4.4 years, 46.4% male), TyG index was positively associated with the prevalence of EOCAD (adjusted odds ratio: 1.40, 95% confidence interval [CI] 1.23-1.60, per standard deviation [SD] increase in TyG index). The addition of TyG index to an empirical risk model provided an improvement in diagnostic ability for EOCAD, with a net reclassification improvement of 0.10 (95% CI 0.03-0.17, p = 0.005). During a medium of 33 month (IQR: 31-34 months) follow-up, 43 (3.3%) patients experienced TLF. Multivariate Cox regression model revealed that TyG index was an independent risk factor for TLF (adjusted hazard ratio [HR]: 2.410, 95% CI 1.07-5.42 comparing the top to bottom TyG index tertile groups; HR: 1.30, 95% CI 1.01-1.73, per SD increase in TyG index). Compared with a model of conventional risk factors alone, the addition of the TyG index modestly improved the AUC (0.722-0.734, p = 0.04) to predict TLF. CONCLUSIONS TyG index is positively associated with prevalent EOCAD and incident TLF. TyG index appeared to be a valuable component of future efforts to improve CAD risk stratification and TLF outcome prediction among young adults.
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Affiliation(s)
- Shalaimaiti Shali
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Disease, Fudan University, Shanghai, 200032, China
- National Clinical Research Center for Interventional Medicine, Shanghai, 200032, China
| | - Lingfeng Luo
- Human Phenome Institute, Fudan University, Shanghai, 200433, China
| | - Kang Yao
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Disease, Fudan University, Shanghai, 200032, China
- National Clinical Research Center for Interventional Medicine, Shanghai, 200032, China
| | - Xiangdong Sun
- Department of Cardiology, Xinyang Central Hospital, Xinyang Normal University, Xinyang, Henan, 464000, China
| | - Hongyi Wu
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Disease, Fudan University, Shanghai, 200032, China
- National Clinical Research Center for Interventional Medicine, Shanghai, 200032, China
| | - Shuning Zhang
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Disease, Fudan University, Shanghai, 200032, China
- National Clinical Research Center for Interventional Medicine, Shanghai, 200032, China
| | - Lili Xu
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Disease, Fudan University, Shanghai, 200032, China
- National Clinical Research Center for Interventional Medicine, Shanghai, 200032, China
| | - Wei Gao
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Disease, Fudan University, Shanghai, 200032, China
- National Clinical Research Center for Interventional Medicine, Shanghai, 200032, China
| | - Jianxuan Li
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Disease, Fudan University, Shanghai, 200032, China
- National Clinical Research Center for Interventional Medicine, Shanghai, 200032, China
| | - Juying Qian
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Disease, Fudan University, Shanghai, 200032, China
- National Clinical Research Center for Interventional Medicine, Shanghai, 200032, China
| | - Yan Zheng
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Disease, Fudan University, Shanghai, 200032, China.
- Human Phenome Institute, Fudan University, Shanghai, 200433, China.
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, 20438, China.
| | - Yuxiang Dai
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Disease, Fudan University, Shanghai, 200032, China.
- National Clinical Research Center for Interventional Medicine, Shanghai, 200032, China.
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Disease, Fudan University, Shanghai, 200032, China.
- National Clinical Research Center for Interventional Medicine, Shanghai, 200032, China.
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9
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Pinxterhuis TH, Ploumen EH, Zocca P, Doggen CJM, Schotborgh CE, Anthonio RL, Roguin A, Danse PW, Benit E, Aminian A, Hartmann M, Linssen GCM, von Birgelen C. Impact of premature coronary artery disease on adverse event risk following first percutaneous coronary intervention. Front Cardiovasc Med 2023; 10:1160201. [PMID: 37745109 PMCID: PMC10512829 DOI: 10.3389/fcvm.2023.1160201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 06/05/2023] [Indexed: 09/26/2023] Open
Abstract
Objectives We assessed differences in risk profile and 3-year outcome between patients undergoing percutaneous coronary intervention (PCI) for premature and non-premature coronary artery disease (CAD). Background The prevalence of CAD increases with age, yet some individuals develop obstructive CAD at younger age. Methods Among participants in four randomized all-comers PCI trials, without previous coronary revascularization or myocardial infarction (MI), we compared patients with premature (men <50 years; women <55 years) and non-premature CAD. Various clinical endpoints were assessed, including multivariate analyses. Results Of 6,171 patients, 887 (14.4%) suffered from premature CAD. These patients had fewer risk factors than patients with non-premature CAD, but were more often smokers (60.7% vs. 26.4%) and overweight (76.2% vs. 69.8%). In addition, premature CAD patients presented more often with ST-segment elevation MI and underwent less often treatment of multiple vessels, and calcified or bifurcated lesions. Furthermore, premature CAD patients had a lower all-cause mortality risk (adj.HR: 0.23, 95%-CI: 0.10-0.52; p < 0.001), but target vessel revascularization (adj.HR: 1.63, 95%-CI: 1.18-2.26; p = 0.003) and definite stent thrombosis risks (adj.HR: 2.24, 95%-CI: 1.06-4.72; p = 0.034) were higher. MACE rates showed no statistically significant difference (6.6% vs. 9.4%; adj.HR: 0.86, 95%-CI: 0.65-1.16; p = 0.33). Conclusions About one out of seven PCI patients was treated for premature CAD. These patients had less complex risk profiles than patients with non-premature CAD; yet, their risk of repeated revascularization and stent thrombosis was higher. As lifetime event risk of patients with premature CAD is known to be particularly high, further efforts should be made to improve modifiable risk factors such as smoking and overweight. TWENTE trials (TWENTE I, clinicaltrials.gov: NCT01066650), DUTCH PEERS (TWENTE II, NCT01331707), BIO-RESORT (TWENTE III, NCT01674803), and BIONYX (TWENTE IV, NCT02508714).
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Affiliation(s)
- Tineke H. Pinxterhuis
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, Netherlands
- Department of Health Technology and Services Research, Faculty BMS, Technical Medical Centre, University of Twente, Enschede, Netherlands
| | - Eline H. Ploumen
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, Netherlands
- Department of Health Technology and Services Research, Faculty BMS, Technical Medical Centre, University of Twente, Enschede, Netherlands
| | - Paolo Zocca
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, Netherlands
| | - Carine J. M. Doggen
- Department of Health Technology and Services Research, Faculty BMS, Technical Medical Centre, University of Twente, Enschede, Netherlands
| | | | - Rutger L. Anthonio
- Department of Cardiology, Treant Zorggroep, Scheper Hospital, Emmen, Netherlands
| | - Ariel Roguin
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera and B. Rappaport-Faculty of Medicine, Israel, Institute of Technology, Haifa, Israel
| | - Peter W. Danse
- Department of Cardiology, Rijnstate Hospital, Arnhem, Netherlands
| | - Edouard Benit
- Department of Cardiology, Jessa Hospital, Hasselt, Belgium
| | - Adel Aminian
- Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | - Marc Hartmann
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, Netherlands
| | | | - Clemens von Birgelen
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, Netherlands
- Department of Health Technology and Services Research, Faculty BMS, Technical Medical Centre, University of Twente, Enschede, Netherlands
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10
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Blankstein R, Chandrashekhar Y. Is the Concept of Primary and Secondary Prevention Outdated?: Imaging Provides an Answer. JACC Cardiovasc Imaging 2023; 16:1247-1249. [PMID: 37673486 DOI: 10.1016/j.jcmg.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
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11
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Desai R, Mishra V, Chhina AK, Jain A, Vyas A, Allamneni R, Lavie CJ, Sachdeva R, Kumar G. Cardiovascular Disease Risk Factors and Outcomes of Acute Myocardial Infarction in Young Adults: Evidence From 2 Nationwide Cohorts in the United States a Decade Apart. Curr Probl Cardiol 2023; 48:101747. [PMID: 37087077 DOI: 10.1016/j.cpcardiol.2023.101747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 04/17/2023] [Indexed: 04/24/2023]
Abstract
The purpose of this study was to evaluate 2 national in-patient cohorts of young adults (18-44 years) hospitalized with acute myocardial infarction (AMI) a decade apart to highlight its prevalence, associated comorbidities, and in-hospital outcomes. We identified hospitalizations for AMI in young adults in 2007 and 2017 using the weighted data from the National Inpatient Sample. We compared admission rates, sociodemographic characteristics, in-hospital morbidity, complications, mortality, rate of coronary interventions, and healthcare utilization between the 2 cohorts. We found that the admission rate of AMI increased among young adults in 2017 vs 2007. The overall admission rate was higher in males, although with a decline (77.1% vs 66.1%), whereas it rose from 28.9% to 33.9% in females. Hypertension (47.8% vs 60.7%), smoking (49.7% vs 55.8%), obesity (14.8% vs 26.8%), and diabetes mellitus (22.0% vs 25.6%) increased in the 2017 cohort. Post-AMI complications: cardiogenic shock (aOR = 1.16 [1.06-1.27]) and fatal arrhythmias heightened with comparable all-cause mortality (aOR = 1.01 [0.93-1.10], P = 0.749). Reperfusion interventions, percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) decreased in the 2017 cohort (PCI; aOR = 0.95 [0.91-0.98], CABG; aOR = 0.66 [0.61-0.71], P < 0.001). Our study highlights the rise in AMI hospitalizations, plateauing of mortality, sex-based and racial disparities, the surge in post-MI complications, and a reassuring decline in the requirement of reperfusion interventions in young AMI patients over the decade.
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Affiliation(s)
- Rupak Desai
- Division of Cardiology, Atlanta VA Medical Center, Decatur, GA.
| | - Vinayak Mishra
- Department of Medicine, House Officer, Grant Medical College and Sir JJ Hospital, Mumbai, India
| | | | - Akhil Jain
- Department of Internal Medicine, Mercy Catholic Medical Center, Darby, PA
| | - Ankit Vyas
- Department of Internal Medicine, Baptist Hospitals of Southeast Texas Beaumont, Beaumont, TX
| | - Rakesh Allamneni
- Department of Hospital Medicine, Medstar Harbor Hospital, Baltimore, MD
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA
| | - Rajesh Sachdeva
- Division of Cardiology, Atlanta VA Medical Center, Decatur, GA
| | - Gautam Kumar
- Division of Cardiology, Atlanta VA Medical Center, Decatur, GA; Division of Cardiology, Emory University School of Medicine, Atlanta, GA
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12
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Gupta R. Genetics-based risk scores for prediction of premature coronary artery disease. Indian Heart J 2023; 75:327-334. [PMID: 37633460 PMCID: PMC10568063 DOI: 10.1016/j.ihj.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 07/24/2023] [Accepted: 08/20/2023] [Indexed: 08/28/2023] Open
Abstract
Premature coronary artery disease (CAD) is endemic in India. Global Burden of Diseases study has reported that it led to 286,000 deaths in 2019 in India. Many of these patients have standard risk factors but a third have none. Clinical risk algorithms and imaging provide limited risk information in premature CAD. CAD is multifactorial and studies have now focused on the predictive capability of clusters of genes and single nucleotide polymorphisms (SNPs) using gene risk score (GRS). Older studies combined data from 10 to 12 genes and 100-500 SNPs to calculate GRS, however, following the advent of genome-wide association studies (GWAS), millions of SNPs have been incorporated. Studies have reported that GWAS-based GRS may be more discriminative than conventional tools. Recent studies, especially among South Asians, have reported that GRS improves net reclassification by 15% (12-19%) for younger individuals. Aggressive lifestyle interventions and lipid-lowering therapies can ameliorate risk in high-GRS individuals and potentially prevent premature CAD.
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Affiliation(s)
- Rajeev Gupta
- Department of Preventive Cardiology & Medicine, Eternal Heart Care Centre & Research Institute, Jaipur, India.
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13
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Ichikawa K, Susarla S, Budoff MJ. The use of coronary artery calcium scoring in young adults. J Cardiovasc Comput Tomogr 2023; 17:242-247. [PMID: 37198083 PMCID: PMC10524889 DOI: 10.1016/j.jcct.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/15/2023] [Accepted: 04/26/2023] [Indexed: 05/19/2023]
Abstract
Although overall atherosclerotic cardiovascular disease (ASCVD) incidence has been declining in the United States, there is evidence that the incidence of ASCVD events in young adults is increasing. The early initiation of preventive therapies could result in a greater number of life-years saved, and therefore determining the appropriate way to identify high-risk young adults is becoming increasingly important. The coronary artery calcium (CAC) score, an established marker of coronary artery atherosclerosis, can improve discrimination for ASCVD risk beyond established risk prediction tools. Based on abundant evidence, the American College of Cardiology/American Heart Association (ACC/AHA) guidelines currently recommend an approach of using CAC scores as a tool for risk assessment and decision-making regarding drug therapy for primary prevention in middle-aged individuals. However, CAC scoring is not recommended for universal screening in young adults, where its yield and utility for altering clinical decisions are limited. Recent studies have demonstrated the nonnegligible prevalence of CAC and its strong association with ASCVD in young adults, suggesting its potential to reclassify risk and improve selection of young adults most likely to benefit from early preventive therapies. Although convincing clinical trials have not been performed in this population yet, CAC scores should be used selectively in young adults whose ASCVD risk may be sufficiently high to warrant a CAC score assessment. This review summarizes the evidence available regarding CAC scoring in young adults, and discusses an appropriate future role of CAC scores in preventing ASCVD in this population.
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Affiliation(s)
- Keishi Ichikawa
- Lundquist Institute, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Shriraj Susarla
- Lundquist Institute, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Matthew J Budoff
- Lundquist Institute, Harbor-UCLA Medical Center, Torrance, CA, USA.
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14
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Al Mousa E, Al-Azzam S, Araydah M, Karasneh R, Ghnaimat M, Al-Makhamreh H, Al Khawaldeh A, Ali Abu Al-Samen M, Haddad J, Al Najjar S, Alsalaheen Abbadi H, Hammoudeh AJ. A Jordanian Multidisciplinary Consensus Statement on the Management of Dyslipidemia. J Clin Med 2023; 12:4312. [PMID: 37445345 DOI: 10.3390/jcm12134312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/12/2023] [Accepted: 06/25/2023] [Indexed: 07/15/2023] Open
Abstract
Atherosclerotic cardiovascular disease (ASCVD) is the primary contributor to global mortality rates, which significantly escalates healthcare expenditures. Risk factors for ASCVD (including dyslipidemia) frequently present in clusters rather than separately. Addressing these risk factors is crucial in the early initiation of a comprehensive management plan that involves both lifestyle modifications and pharmacotherapy to reduce the impact of ASCVD. A team of Jordanian professionals from various medical organizations and institutes took the initiative to create a set of guidelines for dyslipidemia screening and therapy. A detailed, comprehensive literature review was undertaken utilizing several databases and keywords. This consensus statement provides recommendations for dyslipidemia management in Jordanians on several issues including cardiovascular risk estimation, screening eligibility, risk categories, treatment goals, lifestyle changes, and statin and non-statin therapies. It is recommended that all Jordanian individuals aged 20 years old or older undergo lipid profile testing. This should be followed by determining the level of cardiovascular risk depending on the presence or absence of ASCVD and cardiovascular risk factors, eligibility for lipid-lowering therapy, and the target low-density cholesterol serum level to be achieved. In conclusion, prioritizing the management of dyslipidemia is of the utmost importance in improving public health and reducing the burden of cardiovascular diseases.
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Affiliation(s)
- Eyas Al Mousa
- Jordanian Atherosclerosis and Hypertension Society, Amman 11942, Jordan
| | - Sayer Al-Azzam
- Clinical Pharmacy Department, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid 22110, Jordan
| | | | - Reema Karasneh
- Department of Basic Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan
| | - Mohammad Ghnaimat
- Jordan Society of Internal Medicine, Amman 11942, Jordan
- Jordan Society of Nephrology, Amman 11942, Jordan
| | - Hanna Al-Makhamreh
- Cardiology Division, School of Medicine, University of Jordan, Amman 11942, Jordan
| | | | | | - Jihad Haddad
- Scientific Committee, Jordanian Atherosclerosis and Hypertension Society, Amman 11942, Jordan
| | - Said Al Najjar
- Cardiology Department at Albasheer Hospital (MOH), Amman 11942, Jordan
| | | | - Ayman J Hammoudeh
- Scientific Committee, Cardiovascular Academy Group of the Jordan Cardiac Society, Amman 11942, Jordan
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15
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Saito Y, Inohara T, Kohsaka S, Wada H, Takamisawa I, Yamaji K, Amano T, Kobayashi Y, Kozuma K. Characteristics and outcomes of patients with no standard modifiable risk factors undergoing primary revascularization for acute myocardial infarction: Insights from the nationwide Japanese percutaneous coronary intervention registry. Am Heart J 2023; 258:69-76. [PMID: 36642224 DOI: 10.1016/j.ahj.2023.01.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 12/21/2022] [Accepted: 01/07/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND Identification of and therapeutic approaches to standard modifiable risk factors (SMuRFs), including hypertension, diabetes, dyslipidemia, and smoking, have led to improved survival of patients at risk for coronary events. However, recent studies have indicated that a significant proportion of patients with acute myocardial infarction (AMI) have no SMuRFs. We aimed to assess in-hospital outcomes and the prevalence of these patients using the Japanese nationwide percutaneous coronary intervention (J-PCI) registry. METHODS The J-PCI is a procedure-based registration program in Japan. A total of 115,437 PCI procedures were performed on patients with AMI between January 2019 and December 2020. The participants were divided into 2 groups: those with at least 1 SMuRF and those without any SMuRFs. The primary outcome was in-hospital mortality. RESULTS Of the 115,437 patients with AMI, 1,777 (1.6%) had no SMuRFs. Patients without SMuRFs were older; more likely to have left main disease; and more likely to present with heart failure, cardiogenic shock, and cardiac arrest than those with SMuRFs, resulting in higher rates of mechanical circulatory support use and impaired post-PCI coronary blood flow. In-hospital mortality was significantly higher in patients without SMuRFs than in those with SMuRFs (18.3% vs 5.3%, P < .001), irrespective of the presence or absence of ST-segment elevation. CONCLUSIONS In Japan, where annual health checks are mandated under universal health care coverage, the vast majority of patients with AMI undergoing PCI have SMuRFs. However, although small in number, patients without SMuRFs are more likely to present with life-threatening conditions and have worse in-hospital survival.
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Affiliation(s)
- Yuichi Saito
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.
| | - Taku Inohara
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Hideki Wada
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Izunokuni, Japan
| | - Itaru Takamisawa
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Kyohei Yamaji
- Department of Cardiology, Kyoto University, Kyoto, Japan
| | - Tetsuya Amano
- Department of Cardiology, Aichi Medical University, Nagakute, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Ken Kozuma
- Department of Cardiology, Teikyo University Hospital, Tokyo, Japan
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16
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Zeitouni M, Sulman D, Silvain J, Kerneis M, Guedeney P, Barthelemy O, Brugier D, Sabouret P, Procopi N, Collet JP, Montalescot G. Prevention and treatment of premature ischaemic heart disease with European Society of Cardiology Guidelines. Heart 2023; 109:527-534. [PMID: 36270781 DOI: 10.1136/heartjnl-2022-321688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/03/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To determine if the changes in the European Society Cardiology/European Atherosclerotic Society (ESC/EAS) guidelines improved the identification for primary prevention therapy in young adults at risk of a premature myocardial infarction. METHODS Patients admitted for a first ST-segment elevation myocardial infarction (STEMI) in the ePARIS registry (n=2757) between 2010 and 2018 were classified by age: <55, 55-65 and >65 years old. Using Systematic Coronary Risk Estimation 2, we evaluated whether patients would have been detected and treated with primary prevention statins before their first STEMI based on the 2021 EAS/ESC guidelines versus 2019 and 2016 guidelines. Eligibility for intensive proprotein convertase subtilisin/kexin type 9 (PCSK9i) in secondary prevention was also assessed. RESULTS Following 2021 ESC guidelines, 62.5% of individuals aged <55 years old would have been eligible for statins before their first STEMI, similarly to older age categories. In comparison, only 17% and 18% of young individuals would have been eligible for primary prevention statins prior to their first STEMI with 2016 and 2019 guidelines, compared with group 55-65 years (41% and 35%) and >65 years old (19% and 72%), p<0.01. After their first STEMI, 25% of patients <55 years would be eligible for PCSK9i, compared with 23.2% and 15% in patients aged 55-65 years and >65 years. CONCLUSIONS The 2021 ESC guidelines allowed a much better detection of young individuals before their first STEMI than prior ESC guidelines. In secondary prevention, most of young individuals did not reach low-density lipoprotein cholesterol levels recommended, but only one quarter would be eligible for PCSK9i.
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Affiliation(s)
- Michel Zeitouni
- Department of Cardiologie, Sorbonne University - Paris 06 (UPMC), ACTION Study Group, INSERM UMRS 1166, Cardiology Institute, Pitié-Salpêtrière (AP-HP) University Hospital, Paris, France
| | - David Sulman
- Department of Cardiologie, Sorbonne University - Paris 06 (UPMC), ACTION Study Group, INSERM UMRS 1166, Cardiology Institute, Pitié-Salpêtrière (AP-HP) University Hospital, Paris, France
| | - Johanne Silvain
- Department of Cardiologie, Sorbonne University - Paris 06 (UPMC), ACTION Study Group, INSERM UMRS 1166, Cardiology Institute, Pitié-Salpêtrière (AP-HP) University Hospital, Paris, France
| | - Mathieu Kerneis
- Department of Cardiologie, Sorbonne University - Paris 06 (UPMC), ACTION Study Group, INSERM UMRS 1166, Cardiology Institute, Pitié-Salpêtrière (AP-HP) University Hospital, Paris, France
| | - Paul Guedeney
- Department of Cardiologie, Sorbonne University - Paris 06 (UPMC), ACTION Study Group, INSERM UMRS 1166, Cardiology Institute, Pitié-Salpêtrière (AP-HP) University Hospital, Paris, France
| | - Olivier Barthelemy
- Department of Cardiologie, Sorbonne University - Paris 06 (UPMC), ACTION Study Group, INSERM UMRS 1166, Cardiology Institute, Pitié-Salpêtrière (AP-HP) University Hospital, Paris, France
| | - Delphine Brugier
- Department of Cardiologie, Sorbonne University - Paris 06 (UPMC), ACTION Study Group, INSERM UMRS 1166, Cardiology Institute, Pitié-Salpêtrière (AP-HP) University Hospital, Paris, France
| | - Pierre Sabouret
- Department of Cardiologie, Sorbonne University - Paris 06 (UPMC), ACTION Study Group, INSERM UMRS 1166, Cardiology Institute, Pitié-Salpêtrière (AP-HP) University Hospital, Paris, France
| | - Niki Procopi
- Department of Cardiologie, Sorbonne University - Paris 06 (UPMC), ACTION Study Group, INSERM UMRS 1166, Cardiology Institute, Pitié-Salpêtrière (AP-HP) University Hospital, Paris, France
| | - Jean-Philippe Collet
- Department of Cardiologie, Sorbonne University - Paris 06 (UPMC), ACTION Study Group, INSERM UMRS 1166, Cardiology Institute, Pitié-Salpêtrière (AP-HP) University Hospital, Paris, France
| | - Gilles Montalescot
- Department of Cardiologie, Sorbonne University - Paris 06 (UPMC), ACTION Study Group, INSERM UMRS 1166, Cardiology Institute, Pitié-Salpêtrière (AP-HP) University Hospital, Paris, France
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17
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Hayek A, Marquis-Gravel G. Lipid lowering in primary prevention: time to focus on young patients. Heart 2023; 109:500-501. [PMID: 36446544 DOI: 10.1136/heartjnl-2022-321972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Ahmad Hayek
- Interventional Cardiology, Department of Medicine, Montreal Heart Institute, Montreal, Quebec, Canada
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18
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An J, Zhang Y, Zhou H, Zhou M, Safford MM, Muntner P, Moran AE, Reynolds K. Incidence of Atherosclerotic Cardiovascular Disease in Young Adults at Low Short-Term But High Long-Term Risk. J Am Coll Cardiol 2023; 81:623-632. [PMID: 36792277 PMCID: PMC10251803 DOI: 10.1016/j.jacc.2022.11.051] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 11/15/2022] [Indexed: 02/15/2023]
Abstract
BACKGROUND Young adults may have high long-term atherosclerotic cardiovascular disease (ASCVD) risk despite low short-term risk. OBJECTIVES In this study, we sought to compare the performance of short-term and long-term ASCVD risk prediction tools in young adults and evaluate ASCVD incidence associated with predicted short-term and long-term risk. METHODS We included adults aged 18 to 39 years, from 2008 to 2009 in a U.S. integrated health care system, and followed them through 2019. We calculated 10-year and 30-year ASCVD predicted risk and assessed ASCVD incidence. RESULTS Among 414,260 young adults, 813 had an incident ASCVD event during a median of 4 years (maximum 11 years). Compared with 10-year predicted risk, 30-year predicted risk improved reclassification (net reclassification index: 16%) despite having similar discrimination (Harrell's C: 0.749 vs 0.726). Overall, 1.0% and 2.2% of young adults were categorized as having elevated 10-year (≥7.5%) and elevated 30-year (≥20%) predicted risk, respectively, and 1.6% as having low 10-year (<7.5%) but elevated 30-year predicted risk. The ASCVD incidence rate per 1,000 person-years was 2.60 (95% CI: 1.92-3.52) for those with elevated 10-year predicted risk, 1.87 (95% CI: 1.42-2.46) for those with low 10-year but elevated 30-year predicted risk, and 0.32 (95% CI: 0.30-0.35) for those with low 10-year and 30-year predicted risk. The age- and sex-adjusted incidence rate ratio was 3.04 (95% CI: 2.25-4.10) comparing those with low 10-year but elevated 30-year predicted risk and those with low 10-year and 30-year predicted risk. CONCLUSIONS Long-term ASCVD risk prediction tools further discriminate a subgroup of young adults with elevated observed risk despite low estimated short-term risk.
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Affiliation(s)
- Jaejin An
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA.
| | - Yiyi Zhang
- Division of General Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Hui Zhou
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
| | - Mengnan Zhou
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Monika M Safford
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Andrew E Moran
- Division of General Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Kristi Reynolds
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
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Bullock-Palmer RP, Michos ED, Gaballa D, Blankstein R. The Role of Imaging in Preventive Cardiology in Women. Curr Cardiol Rep 2023; 25:29-40. [PMID: 36576679 DOI: 10.1007/s11886-022-01828-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2022] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW The prevalence of CVD in women is increasing and is due to the increased prevalence of CV risk factors. Traditional CV risk assessment tools for prevention have failed to accurately determine CVD risk in women. CAC has shown to more precisely determine CV risk and is a better predictor of CV outcomes. Coronary CTA provides an opportunity to determine the presence of CAD and initiate prevention in women presenting with angina. Identifying women with INOCA due to CMD with use of cPET or cMRI with MBFR is vital in managing these patients. This review article outlines the role of imaging in preventive cardiology for women and will include the latest evidence supporting the use of these imaging tests for this purpose. RECENT FINDINGS CV mortality is higher in women who have more extensive CAC burden. Women have a greater prevalence of INOCA which is associated with higher MACE. INOCA is due to CMD in most cases which is associated with traditional CVD risk factors. Over half of these women are untreated or undertreated. Recent study showed that stratified medical therapy, tailored to the specific INOCA endotype, is feasible and improves angina in women. Coronary CTA is useful in the setting of women presenting with acute chest pain to identify CAD and initiate preventive therapy. CAC confers greater relative risk for CV mortality in women versus (vs.) men. cMRI or cPET is useful to assess MBFR to diagnose CMD and is another useful imaging tool in women for CV prevention.
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20
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Kong G, Chin YH, Chong B, Goh RSJ, Lim OZH, Ng CH, Muthiah M, Foo R, Vernon ST, Loh PH, Chan MY, Chew NWS, Figtree GA. Higher mortality in acute coronary syndrome patients without standard modifiable risk factors: Results from a global meta-analysis of 1,285,722 patients. Int J Cardiol 2023; 371:432-40. [PMID: 36179904 DOI: 10.1016/j.ijcard.2022.09.062] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Standard modifiable cardiovascular risk factors (SMuRF), comprising diabetes, hyperlipidemia, hypertension, and smoking, are used for risk stratification in acute coronary syndrome (ACS). Recent studies showed an increasing proportion of SMuRF-less ACS patients. METHODS Embase, Medline and Pubmed were searched for studies comparing SMuRF-less and SMuRF patients with first presentation of ACS. We conducted single-arm analyses to determine the proportion of SMuRF-less patients in the ACS cohort, and compared the clinical presentation and outcomes of these patients. RESULTS Of 1,285,722 patients from 15 studies, 11.56% were SMuRF-less. A total of 7.44% of non-ST-segment-elevation ACS patients and 12.87% of ST-segment-elevation myocardial infarction (STEMI) patients were SMuRF-less. The proportion of SMuRF-less patients presenting with STEMI (60.71%) tended to be higher than those with SMuRFs (49.21%). Despite lower body mass index and fewer comorbidities such as chronic kidney disease, peripheral arterial disease, stroke and heart failure, SMuRF-less patients had increased in-hospital mortality (RR:1.57, 95%CI:1.38 to 1.80) and cardiogenic shock (RR:1.39, 95%CI:1.18 to 1.65), but lower risk of heart failure (RR:0.91, 95%CI:0.83 to 0.99). On discharge, SMuRF-less patients were prescribed less statins (RR:0.93, 95%CI:0.91 to 0.95), beta-blockers (RR:0.94, 95%CI:0.92 to 0.96), P2Y12 inhibitors (RR: 0.98, 95%CI: 0.96 to 0.99), and angiotensin-converting-enzyme inhibitor or angiotensin-receptor blocker (RR:0.92, 95%CI:0.75 to 0.91). CONCLUSION In this study level meta-analysis, SMuRF-less ACS patients demonstrate higher mortality compared with patients with at least one traditional atherosclerotic risk factor. Underuse of guideline-directed medical therapy amongst SMuRF-less patients is concerning. Unraveling novel risk factors amongst SMuRF-less individuals is the next important step. SUMMARY Standard modifiable cardiovascular risk factors (SMuRF), comprising diabetes mellitus, hyperlipidemia, hypertension, and smoking, are often used for risk stratification in acute coronary syndrome (ACS). Recent studies showed an increasing proportion of SMuRF-less ACS patients. Of 1,285,722 ACS patients, 11.56% were SMuRF-less. Despite lower body mass index and fewer comorbidities, SMuRF-less patients had increased in-hospital mortality and cardiogenic shock. However, despite worse outcomes, SMuRF-less patients were prescribed less guideline-directed medical therapies on discharge.
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21
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Siddiqi HK, Defilippis EM, Biery DW, Singh A, Wu WY, Divakaran S, Berman AN, Rizk T, Januzzi JL, Bohula E, Stewart G, Carli MDI, Bhatt DL, Blankstein R. Mortality and Heart Failure Hospitalization Among Young Adults With and Without Cardiogenic Shock After Acute Myocardial Infarction. J Card Fail 2023; 29:18-29. [PMID: 36130688 PMCID: PMC10403806 DOI: 10.1016/j.cardfail.2022.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 08/15/2022] [Accepted: 08/22/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To investigate risk factors and outcomes of cardiogenic shock complicating acute myocardial infarction (AMI-CS) in young patients with AMI. BACKGROUND AMI-CS is associated with high morbidity and mortality rates. Data regarding AMI-CS in younger individuals are limited. METHODS AND RESULTS Consecutive patients with type 1 AMI aged 18-50 years admitted to 2 large tertiary-care academic centers were included, and they were adjudicated as having cardiogenic shock (CS) by physician review of electronic medical records using the Society for Cardiovascular Angiography and Interventions CS classification system. Outcomes included all-cause mortality (ACM), cardiovascular mortality (CVM) and 1-year hospitalization for heart failure (HHF). In addition to using the full population, matching was also used to define a comparator group in the non-CS cohort. Among 2097 patients (mean age 44 ± 5.1 years, 74% white, 19% female), AMI-CS was present in 148 (7%). Independent risk factors of AMI-CS included ST-segment elevation myocardial infarction, left main disease, out-of-hospital cardiac arrest, female sex, peripheral vascular disease, and diabetes. Over median follow-up of 11.2 years, young patients with AMI-CS had a significantly higher risk of ACM (adjusted HR 2.84, 95% CI 1.68-4.81; P < 0.001), CVM (adjusted HR 4.01, 95% CI 2.17-7.71; P < 0.001), and 1-year HHF (adjusted HR 5.99, 95% CI 2.04-17.61; P = 0.001) compared with matched non-AMI-CS patients. Over the course of the study, there was an increase in the incidence of AMI-CS among young patients with MI as well as rising mortality rates for patients with both AMI-CS and non-AMI-CS. CONCLUSIONS Of young patients with AMI, 7% developed AMI-CS, which was associated with a significantly elevated risk of mortality and HHF.
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Affiliation(s)
- Hasan K Siddiqi
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ersilia M Defilippis
- New York Presbyterian-Columbia University Irving Medical Center, New York, New York
| | - David W Biery
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Wanda Y Wu
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sanjay Divakaran
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Adam N Berman
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Theresa Rizk
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - James L Januzzi
- Cardiovascular Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Erin Bohula
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Garrick Stewart
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Marcelo DI Carli
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Deepak L Bhatt
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ron Blankstein
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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22
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Blaha MJ, Abdelhamid M, Santilli F, Shi Z, Sibbing D. Advanced subclinical atherosclerosis: A novel category within the cardiovascular risk continuum with distinct treatment implications. Am J Prev Cardiol 2022; 13:100456. [PMID: 36632617 PMCID: PMC9826921 DOI: 10.1016/j.ajpc.2022.100456] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 12/19/2022] [Accepted: 12/23/2022] [Indexed: 12/26/2022] Open
Abstract
Traditionally, guidelines divide patients into primary and secondary prevention for atherosclerotic cardiovascular disease (ASCVD) risk management. However, the modern understanding of the biological progression of atherosclerosis is inconsistent with this binary approach. Therefore, a new approach demonstrating both atherosclerosis and ASCVD risk as a continuum is needed to give clinicians a framework for better matching risk and intensity of therapy. Advances in coronary imaging have most clearly brought this problem into view, as for example coronary artery calcium (CAC) scoring has shown that some individuals in the primary prevention have equal or higher ASCVD risk as certain subgroups in secondary prevention. This article introduces "advanced subclinical atherosclerosis" as a new and distinct clinical group that sits between the traditional groups of primary and secondary prevention. Importantly, this article also introduces a new graphic to visualize this intermediate population that is explicitly based on plaque burden. The aim of the graphic is both to educate and to allow for better identification of a patient's cardiovascular risk and guide more effective risk-based management.
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Affiliation(s)
- Michael J. Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Blalock 524D1, 600 N. Wolfe Street, Baltimore, MD 21287, USA,Corresponding author.
| | - Magdy Abdelhamid
- Department of Cardiovascular Medicine, Faculty of Medicine, Kasr Al Ainy, Cairo University, Egypt
| | - Francesca Santilli
- Department of Medicine and Aging and Center for Advanced Studies and Technology, University of Chieti, Chieti, Italy
| | - Zhongwei Shi
- Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dirk Sibbing
- Ludwig-Maximilians University (LMU), Germany and Privatklinik Lauterbacher Mühle am Ostersee, Munich, Seeshaupt, Germany
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23
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Kang J, Kim S, Chang Y, Kim Y, Jung HS, Ryu S. Age-stratified effects of coronary artery calcification on cardiovascular and non-cardiovascular mortality in Korean adults. Eur Heart J Cardiovasc Imaging 2022; 24:17-24. [PMID: 36063434 DOI: 10.1093/ehjci/jeac184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/11/2022] [Indexed: 12/24/2022] Open
Abstract
AIMS The role of coronary artery calcium score (CACS) in predicting cardiovascular disease (CVD) and non-CVD mortality in young adults is unclear. We investigated the association of CACS with CVD and non-CVD mortality in young and older individuals. METHODS AND RESULTS CVD-free Koreans (n = 160 821; mean age, 41.4 years; 73.2% young individuals aged <45 years) who underwent cardiac tomography estimation of CACS (69.7% one-time measurement), were followed-up for a median of 5.6 years. The vital status and cause of death were ascertained from the national death records. Sub-distribution hazard ratios (SHR) and 95% confidence intervals (CIs) for cause-specific mortality were estimated using the Fine and Gray proportional hazards models. Overall, a higher CACS was strongly associated with an increased risk of CVD mortality. Among young individuals, multivariable-adjusted SHR (95% CIs) for CVD mortality comparing a CACS of 1-100, 101-300, and >300 to 0 CACS were 5.67 (2.33-13.78), 22.34 (5.72-87.19), and 74.1 (18.98-239.3), respectively, and among older individuals, corresponding SHR were 1.51 (0.60-3.84), 8.57 (3.05-24.06), and 6.41 (1.98-20.74). The addition of CACS to Framingham risk score significantly but modestly improved risk prediction for CVD mortality in young individuals. Conversely, CACS was significantly associated with non-CVD mortality only in older individuals. CONCLUSIONS Strong associations of CACS with CVD mortality, but not non-CVD mortality, were observed in young individuals, beginning in the low CACS category. Our findings reaffirm the need for early intervention for young adults even with low CACS to reduce CVD mortality.
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Affiliation(s)
- Jeonggyu Kang
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 04514, Republic of Korea
| | - Seolhye Kim
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 04514, Republic of Korea
| | - Yoosoo Chang
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 04514, Republic of Korea.,Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Samsung Main Building B2, 250 Taepyung-ro 2ga, Jung-gu 04514, Republic of Korea.,Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul 06355, Republic of Korea
| | - Yejin Kim
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 04514, Republic of Korea
| | - Hyun-Suk Jung
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 04514, Republic of Korea
| | - Seungho Ryu
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 04514, Republic of Korea.,Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Samsung Main Building B2, 250 Taepyung-ro 2ga, Jung-gu 04514, Republic of Korea.,Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul 06355, Republic of Korea
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24
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Makover ME, Shapiro MD, Toth PP. There is urgent need to treat atherosclerotic cardiovascular disease risk earlier, more intensively, and with greater precision: A review of current practice and recommendations for improved effectiveness. Am J Prev Cardiol 2022; 12:100371. [PMID: 36124049 PMCID: PMC9482082 DOI: 10.1016/j.ajpc.2022.100371] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 07/10/2022] [Accepted: 08/05/2022] [Indexed: 12/12/2022] Open
Abstract
Atherosclerotic cardiovascular disease (ASCVD) is epidemic throughout the world and is etiologic for such acute cardiovascular events as myocardial infarction, ischemic stroke, unstable angina, and death. ASCVD also impacts risk for dementia, chronic kidney disease peripheral arterial disease and mobility, impaired sexual response, and a host of other visceral impairments that adversely impact the quality and rate of progression of aging. The relationship between low-density lipoprotein cholesterol (LDL-C) and risk for ASCVD is one of the most highly established and investigated issues in the entirety of modern medicine. Elevated LDL-C is a necessary condition for atherogenesis induction. Basic scientific investigation, prospective longitudinal cohorts, and randomized clinical trials have all validated this association. Yet despite the enormous number of clinical trials which support the need for reducing the burden of atherogenic lipoprotein in blood, the percentage of high and very high-risk patients who achieve risk stratified LDL-C target reductions is low and has remained low for the last thirty years. Atherosclerosis is a preventable disease. As clinicians, the time has come for us to take primordial and primary prevention more serously. Despite a plethora of therapeutic approaches, the large majority of patients at risk for ASCVD are poorly or inadequately treated, leaving them vulnerable to disease progression, acute cardiovascular events, and poor aging due to loss of function in multiple visceral organs. Herein we discuss the need to greatly intensify efforts to reduce risk, decrease disease burden, and provide more comprehensive and earlier risk assessment to optimally prevent ASCVD and its complications. Evidence is presented to support that treatment should aim for far lower goals in cholesterol management, should take into account many more factors than commonly employed today and should begin significantly earlier in life.
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25
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Tian X, Chen S, Zuo Y, Zhang Y, Zhang X, Xu Q, Luo Y, Wu S, Wang A. Association of lipid, inflammatory, and metabolic biomarkers with age at onset for incident cardiovascular disease. BMC Med 2022; 20:383. [PMID: 36352412 PMCID: PMC9647925 DOI: 10.1186/s12916-022-02592-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 09/30/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Risk profiles for premature cardiovascular disease (CVD) are unclear. This study aimed to examine baseline risk profiles for incident CVD by age at onset in Chinese population. METHODS A total of 97,841 participants without CVD were enrolled from the Kailuan cohort study. Four age groups were examined (< 55, 55 to < 65, 65 to < 75, and ≥ 75 years) for CVD onset. Risk profiles included clinical, lipid, metabolic, and inflammatory risk factors and biomarkers. RESULTS Of the clinical factors, diabetes was associated with the highest relative risk for incident CVD in participants younger than 55 years (sub-distributional hazard ratio [sHR], 4.08; 95% confidence interval [CI], 3.47-4.80). Risk factors that were also noted for CVD onset in participants younger than 55 years included hypertension, metabolism syndrome, overweight or obese, dyslipidemia, and smoking. Among the biomarkers, insulin resistance measured by triglyceride-glucose index had the highest sHR (1.42; 95% CI, 1.35-1.49) for CVD in participants younger than 55 years. In comparison, weaker but significant associations with CVD in participants younger than 55 years were noted for most lipids, metabolic biomarkers, and inflammatory biomarkers. Most risk factors and biomarkers had associations that attenuated with increasing age at onset. Some biomarkers had similar CVD age association, while a few had no association with CVD onset at any age. CONCLUSIONS These findings showed that diabetes and insulin resistance, in addition to hypertension, metabolism syndrome, overweight or obese, dyslipidemia, and smoking, appeared to be the strongest risk factors for premature onset of CVD, and most risk factors had attenuated relative rates at older ages.
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Affiliation(s)
- Xue Tian
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No.10 Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, 57 Xinhua East Rd, Tangshan, 063000, China
| | - Yingting Zuo
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yijun Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaoli Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qin Xu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yanxia Luo
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No.10 Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, China. .,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.
| | - Shouling Wu
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, 57 Xinhua East Rd, Tangshan, 063000, China.
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China. .,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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26
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Navar AM, Fine L, Ambrosius WT, Brown A, Douglas P, Johnson K, Khera AV, Lloyd-Jones D, Michos ED, Mujahid M, Muñoz D, Nasir K, Redmond N, Ridker PM, Robinson J, Schopfer D, Tate DF, Lewis CE(B. Earlier Treatment in Adults with High Lifetime Risk of Cardiovascular Diseases: What Prevention Trials are Feasible and Could Change Clinical Practice? Report of a National Heart, Lung, and Blood Institute (NHBLI) Workshop. Am J Prev Cardiol 2022; 12:100430. [DOI: 10.1016/j.ajpc.2022.100430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/26/2022] [Accepted: 11/11/2022] [Indexed: 11/15/2022] Open
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27
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Shah RV, Miller P, Colangelo LA, Chernofsky A, Houstis NE, Malhotra R, Velagaleti RS, Jacobs DR, Gabriel KP, Reis JP, Lloyd‐Jones DM, Clish CB, Larson MG, Vasan RS, Murthy VL, Lewis GD, Nayor M. Blood-Based Fingerprint of Cardiorespiratory Fitness and Long-Term Health Outcomes in Young Adulthood. J Am Heart Assoc 2022; 11:e026670. [PMID: 36073631 PMCID: PMC9683648 DOI: 10.1161/jaha.122.026670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 07/25/2022] [Indexed: 11/16/2022]
Abstract
Background Cardiorespiratory fitness is a powerful predictor of health outcomes that is currently underused in primary prevention, especially in young adults. We sought to develop a blood-based biomarker of cardiorespiratory fitness that is easily translatable across populations. Methods and Results Maximal effort cardiopulmonary exercise testing for quantification of cardiorespiratory fitness (by peak oxygen uptake) and profiling of >200 metabolites at rest were performed in the FHS (Framingham Heart Study; 2016-2019). A metabolomic fitness score was derived/validated in the FHS and was associated with long-term outcomes in the younger CARDIA (Coronary Artery Risk Development in Young Adults) study. In the FHS (derivation, N=451; validation, N=914; age 54±8 years, 53% women, body mass index 27.7±5.3 kg/m2), we used LASSO (least absolute shrinkage and selection operator) regression to develop a multimetabolite score to predict peak oxygen uptake (correlation with peak oxygen uptake r=0.77 in derivation, 0.61 in validation; both P<0.0001). In a linear model including clinical risk factors, a ≈1-SD higher metabolomic fitness score had equivalent magnitude of association with peak oxygen uptake as a 9.2-year age increment. In the CARDIA study (N=2300, median follow-up 26.9 years, age 32±4 years, 44% women, 44% Black individuals), a 1-SD higher metabolomic fitness score was associated with a 44% lower risk for mortality (hazard ratio [HR], 0.56 [95% CI, 0.47-0.68]; P<0.0001) and 32% lower risk for cardiovascular disease (HR, 0.68 [95% CI, 0.55-0.84]; P=0.0003) in models adjusted for age, sex, and race, which remained robust with adjustment for clinical risk factors. Conclusions A blood-based biomarker of cardiorespiratory fitness largely independent of traditional risk factors is associated with long-term risk of cardiovascular disease and mortality in young adults.
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Affiliation(s)
- Ravi V. Shah
- Vanderbilt Translational and Clinical Research CenterCardiology DivisionVanderbilt University Medical CenterNashvilleTN
| | - Patricia Miller
- Department of BiostatisticsBoston University School of Public HealthBostonMA
| | - Laura A. Colangelo
- Department of Preventive MedicineFeinberg School of MedicineNorthwestern UniversityChicagoIL
| | - Ariel Chernofsky
- Department of BiostatisticsBoston University School of Public HealthBostonMA
| | - Nicholas E. Houstis
- Cardiology DivisionDepartment of MedicineMassachusetts General HospitalHarvard Medical SchoolBostonMA
| | - Rajeev Malhotra
- Cardiology DivisionDepartment of MedicineMassachusetts General HospitalHarvard Medical SchoolBostonMA
| | | | - David R. Jacobs
- Division of Epidemiology and Community HealthSchool of Public HealthUniversity of MinnesotaMinneapolisMN
| | | | - Jared P. Reis
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood InstituteBethesdaMD
| | - Donald M. Lloyd‐Jones
- Department of Preventive MedicineFeinberg School of MedicineNorthwestern UniversityChicagoIL
- Division of CardiologyDepartment of MedicineNorthwestern University Feinberg School of MedicineChicagoIL
| | | | - Martin G. Larson
- Department of BiostatisticsBoston University School of Public HealthBostonMA
- Boston University’s and National Heart, Lung, and Blood Institute’s Framingham Heart StudyFraminghamMA
| | - Ramachandran S. Vasan
- Boston University’s and National Heart, Lung, and Blood Institute’s Framingham Heart StudyFraminghamMA
- Sections of Cardiovascular Medicine and Preventive Medicine and EpidemiologyDepartment of MedicineBoston University School of MedicineBostonMA
- Department of EpidemiologyBoston University School of Public Health, and the Center for Computing and Data SciencesBoston UniversityBostonMA
| | - Venkatesh L. Murthy
- Department of EpidemiologyBoston University School of Public Health, and the Center for Computing and Data SciencesBoston UniversityBostonMA
- Division of Cardiovascular MedicineDepartment of Medicine, and Frankel Cardiovascular Center University of MichiganAnn ArborMI
| | - Gregory D. Lewis
- Cardiology DivisionDepartment of MedicineMassachusetts General HospitalHarvard Medical SchoolBostonMA
- Pulmonary Critical Care UnitMassachusetts General HospitalBostonMA
| | - Matthew Nayor
- Sections of Cardiovascular Medicine and Preventive Medicine and EpidemiologyDepartment of MedicineBoston University School of MedicineBostonMA
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28
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Lugo-Gavidia LM, Nolde JM, Carnagarin R, Burger D, Chan J, Robinson S, Bosio E, Matthews VB, Schlaich MP. Association of Circulating Platelet Extracellular Vesicles and Pulse Wave Velocity with Cardiovascular Risk Estimation. Int J Mol Sci 2022; 23. [PMID: 36142436 DOI: 10.3390/ijms231810524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/06/2022] [Accepted: 09/08/2022] [Indexed: 11/17/2022] Open
Abstract
Elevated circulating platelet-derived extracellular vesicles (EVs) have been reported in conditions associated with thrombotic risk. The present study aimed to assess the relationship between circulating platelet-derived EV levels, cardiovascular risk stratification and vascular organ damage, as assessed by pulse wave velocity (PWV). A total of 92 patients were included in the present analysis. Platelet EV were evaluated by flow cytometry (CD41+/Annexin v+). The cardiovascular risk was determined using the 2021 ESC guideline stratification and SCORE2 and SCORE-OP. PWV was performed as a surrogate to assess macrovascular damage. Risk stratification revealed significant group differences in EV levels (ANOVA, p = 0.04). Post hoc analysis demonstrated significantly higher levels of EVs in the very high-risk group compared with the young participants (12.53 ± 8.69 vs. 7.51 ± 4.67 EV/µL, p = 0.03). Linear regression models showed SCORE2 and SCORE-OP (p = 0.04) was a predictor of EV levels. EVs showed a significant association with macrovascular organ damage measured by PWV (p = 0.01). PWV progressively increased with more severe cardiovascular risk (p < 0.001) and was also associated with SCORE2 and SCORE-OP (p < 0.001). Within the pooled group of subjects with low to moderate risk and young participants (<40 years), those with EV levels in the highest tertile had a trend towards higher nocturnal blood pressure levels, fasting glucose concentration, lipid levels, homocysteine and PWV. Levels of platelet-derived EVs were highest in those patients with very high CV risk. Within a pooled group of patients with low to moderate risk, an unfavourable cardiometabolic profile was present with higher EV levels.
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Sharma SK, Makkar JS, Bana A, Sharma K, Kasliwal A, Sidana SK, Degawat PR, Bhagat KK, Chaurasia AK, Natani V, Sharma SK, Gupta R. Premature coronary artery disease, risk factors, clinical presentation, angiography and interventions: Hospital based registry. Indian Heart J 2022:S0019-4832(22)00127-4. [PMID: 35995321 DOI: 10.1016/j.ihj.2022.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/19/2022] [Accepted: 08/17/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND & AIMS Premature coronary artery disease (CAD) is endemic in India. We performed a study to identify risk factors, clinical presentation, angiographic findings and interventions in premature CAD. METHODS Successive patients who underwent percutaneous intervention (PCI) were enrolled from January 2018 to June 2021. Premature CAD was defined as women 45-59 y and men 40-54 y and very premature as women <45 y and men <40 y. Descriptive statistics are presented. Univariate odds ratio (OR) and 95% confidence intervals (95%CI) were calculated to identify differences in various groups. RESULTS 4672 patients (women 936, men 3736) were enrolled. Premature CAD was in 1238 (26.5%; women 31.9%; men 25.1%) and very premature in 212 (4.5%; women 6.5%, men 4.0%). In premature and very premature vs non-premature CAD, OR (95%CI) for high cholesterol ≥200 mg/dl [women 1.52(1.03-2.25) and 1.59(0.79-3.20); men 1.73(1.38-2.17) and 1.92(1.22-3.03)], non-HDL cholesterol ≥130 mg/dl [women 1.84(1.35-2.52) and 1.32(0.72-2.42); men 1.69(1.43-1.90) and 1.67(1.17-2.34)], LDL cholesterol [men 1.10(0.95-1.25) and 1.04(0.77-1.41)], and tobacco [women 1.40(0.84-2.35) and 2.14(0.95-4.82); men 1.63(1.34-1.98) and 1.27(0.81-1.97)] were higher while hypertension, diabetes and chronic kidney disease were more in non-premature(p < 0.05). Presentation as STEMI was marginally more in women with premature [1.13(0.85-1.51)] and very premature [1.29(0.75-2.22)] CAD and was significantly higher in men [1.35(1.16-1.56) and 1.79(1.29-2.49)]. Location and extent of CAD were not different. CONCLUSIONS In India, a third of CAD patients presenting for coronary intervention have premature disease. Important risk factors are high total and non-HDL cholesterol and tobacco (men) with greater presentation as STEMI. Extent and type of CAD are similar to non-premature CAD indicating severe disease.
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Ambatiello LG. Stress-induced arterial hypertension. TERAPEVT ARKH 2022; 94:908-913. [DOI: 10.26442/00403660.2022.07.201733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 08/11/2022] [Indexed: 11/22/2022]
Abstract
Stress is considered as one of the factors associated with the development of many diseases, including the cardiovascular system. The history of studying stress as a risk factor for hypertension began in the first half of the 20th century and continued after the introduction of 24-hour blood pressure monitoring (ABPM) into clinical practice. Then it turned out that there is normotension, stable hypertension and latent hypertension: masked (when clinical BP is within the normal range, and arterial hypertension is recorded according to ABPM and/or self-monitoring of BP) and white coat hypertension (increased BP during a visit to the doctor when normal values of blood pressure according to ABPM or self-monitoring of BP). Currently, both variants of latent hypertension are classified as stress-induced arterial hypertension. Several models have been proposed for the study of stress, but two of them are more common in clinical studies: the Karasek model (based on an imbalance between job demands and job decision latitude) and the Siegrist model (based on an imbalance of effort and reward). There are only few studies in where attempts have been made to link the increase in BP with the parameters of stress response (for example, with hormonal levels) or genetic predisposition. The review discusses the most significant studies of stress-induced arterial hypertension published to date.
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Sagris M, Antonopoulos AS, Theofilis P, Oikonomou E, Siasos G, Tsalamandris S, Antoniades C, Brilakis ES, Kaski JC, Tousoulis D. Risk factors profile of young and older patients with myocardial infarction. Cardiovasc Res 2022; 118:2281-2292. [PMID: 34358302 DOI: 10.1093/cvr/cvab264] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 08/03/2021] [Indexed: 12/18/2022] Open
Abstract
Myocardial infarction (MI) among young adults (<45 years) represents a considerable proportion of the total heart attack incidents. The underlying pathophysiologic characteristics, atherosclerotic plaque features, and risk factors profile differ between young and older patients with MI. This review article discusses the main differences between the younger and elderly MI patients as well as the different pathogenic mechanisms underlying the development of MI in the younger. Young patients with MI often have eccentric atherosclerotic plaques with inflammatory features but fewer lesions, and are more likely to be smokers, obese, and have poor lifestyle, such as inactivity and alcohol intake. Compared to older MI patients, younger are more likely to be men, have familial-combined hyperlipidaemia and increased levels of lipoprotein-a. In addition, MI in younger patients may be related to use of cannabis, cocaine use, and androgenic anabolic steroids. Genomic differences especially in the pathways of coagulation and lipid metabolism have also been identified between young and older patients with MI. Better understanding of the risk factors and the anatomic and pathophysiologic processes in young adults can improve MI prevention and treatment strategies in this patient group. Awareness could help identify young subjects at increased risk and guide primary prevention strategies. Additional studies focusing on gene pathways related to lipid metabolism, inflammation, and coagulation are needed.
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Affiliation(s)
- Marios Sagris
- Division of Cardiovascular Medicine, 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens 115 27, Greece
| | - Alexios S Antonopoulos
- Division of Cardiovascular Medicine, 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens 115 27, Greece
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK
| | - Panagiotis Theofilis
- Division of Cardiovascular Medicine, 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens 115 27, Greece
| | - Evangelos Oikonomou
- Division of Cardiovascular Medicine, 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens 115 27, Greece
| | - Gerasimos Siasos
- Division of Cardiovascular Medicine, 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens 115 27, Greece
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Sotirios Tsalamandris
- Division of Cardiovascular Medicine, 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens 115 27, Greece
| | - Charalambos Antoniades
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK
- Division of Cardiovascular Medicine, Oxford Centre of Research Excellence, British Heart Foundation, Oxford, OX3 9DU, UK
- Division of Cardiovascular Medicine, Oxford Biomedical Research Centre, National Institute of Health Research, Oxford, OX3 9DU, UK
| | - Emmanouil S Brilakis
- Division of Cardiovascular Medicine, Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN 55407, USA
| | - Juan C Kaski
- Division of Cardiovascular Medicine, Molecular and Clinical Sciences Research Institute, St George's University of London, London SW17 0RE, UK
| | - Dimitris Tousoulis
- Division of Cardiovascular Medicine, 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens 115 27, Greece
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Verma KP, Inouye M, Meikle PJ, Nicholls SJ, Carrington MJ, Marwick TH. New Cardiovascular Risk Assessment Techniques for Primary Prevention: JACC Review Topic of the Week. J Am Coll Cardiol 2022; 80:373-387. [PMID: 35863853 DOI: 10.1016/j.jacc.2022.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 05/20/2022] [Accepted: 05/25/2022] [Indexed: 10/17/2022]
Abstract
Risk factor-based models fail to accurately estimate risk in select populations, in particular younger individuals. A sizable number of people are also classified as being at intermediate risk, for whom the optimal preventive strategy could be more precise. Several personalized risk prediction tools, including coronary artery calcium scoring, polygenic risk scores, and metabolic risk scores may be able to improve risk assessment, pending supportive outcome data from clinical trials. Other tools may well emerge in the near future. A multidimensional approach to risk prediction holds the promise of precise risk prediction. This could allow for targeted prevention minimizing unnecessary costs and risks while maximizing benefits. High-risk individuals could also be identified early in life, creating opportunities to arrest the development of nascent coronary atherosclerosis and prevent future clinical events.
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Affiliation(s)
- Kunal P Verma
- Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia; Baker Department of Cardio-Metabolic Health, University of Melbourne, Melbourne, Victoria, Australia; Monash Heart, Melbourne, Victoria, Australia
| | - Michael Inouye
- Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia; Cambridge Baker Systems Genomics Initiative, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Peter J Meikle
- Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia; Baker Department of Cardiovascular Research, Translation and Implementation, La Trobe University, Melbourne, Victoria, Australia
| | - Stephen J Nicholls
- Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia; Monash Heart, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia
| | | | - Thomas H Marwick
- Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia; Baker Department of Cardio-Metabolic Health, University of Melbourne, Melbourne, Victoria, Australia; Baker Department of Cardiovascular Research, Translation and Implementation, La Trobe University, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia.
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Suzuki S, Saito Y, Yamashita D, Matsumoto T, Sato T, Wakabayashi S, Kitahara H, Sano K, Kobayashi Y. Clinical Characteristics and Prognosis of Patients With No Standard Modifiable Risk Factors in Acute Myocardial Infarction. Heart Lung Circ 2022; 31:1228-1233. [PMID: 35843858 DOI: 10.1016/j.hlc.2022.06.666] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/10/2022] [Accepted: 06/15/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Recently, the impact of the lack of standard modifiable risk factors, including hypertension, diabetes, dyslipidaemia, and current smoking, has been investigated in ST-segment elevation myocardial infarction (MI). The present study aimed to evaluate clinical characteristics and prognosis of the patients with no standard risk factors in acute MI. METHODS This bi-centre registry included 1,093 patients with acute MI undergoing percutaneous coronary intervention. The participants were divided into two groups: patients having at least one of the four standard risk factors and those having none of the risk factors. The study endpoints included major adverse cardiovascular events (MACE) (death, recurrent MI, and stroke) and major bleeding events during hospitalisation. Any MACE and major bleeding events after discharge were also evaluated as an exploratory analysis. RESULTS Of 1,093 patients, 64 (5.9%) had none of the four standard risk factors. The patients with no standard risk factors were likely to present with Killip class IV and cardiac arrest. The rate of in-hospital MACE was higher in patients with no risk factors than in their counterparts (25.0% vs 9.9%; p<0.001), whereas the incidence of in-hospital major bleeding was not significantly different between the two groups (9.4% vs 6.7%; p=0.44). Active cancer and autoimmune/inflammatory diseases were often found in patients with no standard risk factors. After discharge, no significant differences were observed in the risks of MACE and major bleeding events between the two groups. CONCLUSIONS No standard modifiable risk factors were not uncommon and were associated with poor short-term outcomes in patients with acute MI.
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Affiliation(s)
- Sakuramaru Suzuki
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan; Department of Cardiovascular Medicine, Eastern Chiba Medical Center, Togane, Japan
| | - Yuichi Saito
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.
| | - Daichi Yamashita
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Tadahiro Matsumoto
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Takanori Sato
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Shinichi Wakabayashi
- Department of Cardiovascular Medicine, Eastern Chiba Medical Center, Togane, Japan
| | - Hideki Kitahara
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Koichi Sano
- Department of Cardiovascular Medicine, Eastern Chiba Medical Center, Togane, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
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Ando H, Yamaji K, Kohsaka S, Ishii H, Sakakura K, Goto R, Nakano Y, Takashima H, Ikari Y, Amano T. Clinical Presentation and In-Hospital Outcomes of Acute Myocardial Infarction in Young Patients: Japanese Nationwide Registry. JACC Asia 2022; 2:574-585. [PMID: 36518720 PMCID: PMC9743453 DOI: 10.1016/j.jacasi.2022.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 03/11/2022] [Accepted: 03/27/2022] [Indexed: 01/11/2023]
Abstract
Background Acute myocardial infarction (AMI) in young patients is a concerning issue because of its adverse health and social impacts. Nevertheless, risk factors and prognosis of AMI in young patients are yet to be characterized. Objectives This study aimed to characterize AMI in young patients who underwent primary percutaneous coronary intervention (PCI) using large-scale nationwide all-comer registry data in Japan, the Japanese Percutaneous Coronary Intervention (J-PCI). Methods This retrospective cohort study evaluated the J-PCI registry data of patients with AMI aged 20 to 79 years who underwent primary PCI between January 2014 and December 2018. Data on risk factor profiles, clinical features, post-procedural complications, and in-hospital outcomes were reviewed. Results Among 213,297 patients with AMI who underwent primary PCI, 23,985 (11.2%) were young (ages 20 to 49 years). Compared with the older group (ages 50 to 79 years; n = 189,312), the younger group included a higher number of men, smokers, patients with dyslipidemia, and patients with single-vessel disease, and a lower number of patients with hypertension and diabetes. Despite favorable clinical profiles, younger age was associated with a higher rate of presentation with cardiopulmonary arrest (CPA). Further, concomitant CPA was strongly associated with in-hospital mortality in young patients (odds ratio: 14.2; 95% CI: 9.2 - 21.9). Conclusions Younger patients with AMI presented a higher risk of CPA, which was strongly associated with in-hospital mortality. The results of this study highlight the importance of primary AMI prevention strategies in young individuals.
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Affiliation(s)
- Hirohiko Ando
- Department of Cardiology, Aichi Medical University, Nagakute, Japan,Address for correspondence: Dr Hirohiko Ando, Department of Cardiology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute 480-1195, Japan.
| | - Kyohei Yamaji
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Hideki Ishii
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Reiji Goto
- Department of Cardiology, Aichi Medical University, Nagakute, Japan
| | - Yusuke Nakano
- Department of Cardiology, Aichi Medical University, Nagakute, Japan
| | | | - Yuji Ikari
- Department of Cardiology, Tokai University, Isehara, Japan
| | - Tetsuya Amano
- Department of Cardiology, Aichi Medical University, Nagakute, Japan
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Meah MN, Maurovich-Horvat P, Williams MC, Newby DE. Debates in cardiac CT: Coronary CT angiography is the best test in asymptomatic patients. J Cardiovasc Comput Tomogr 2022; 16:290-293. [PMID: 35216929 DOI: 10.1016/j.jcct.2022.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 12/30/2022]
Abstract
Cardiovascular disease remains a major cause of mortality, accounting for a third of all global deaths annually. Although there have been major improvements in our ability to detect and to treat patients with coronary heart disease, most myocardial infarctions occur in previously asymptomatic individuals. Identification of individuals at risk of myocardial infarction remains challenging and primary prevention guidelines rely on the use of cardiovascular risk scores that can be supplemented by coronary artery calcium scores. Coronary artery calcium scores provide a simple surrogate late marker of atherosclerosis but is unable to identify the early high risk non-calcified plaque which can be particularly problematic in younger individuals. Coronary computed tomography angiography is increasingly being used as the imaging strategy of choice in patients with symptoms of coronary heart disease. As an anatomical test, it can non-invasively detect the presence of coronary atherosclerosis, providing clinicians with a strong mandate to commence symptom relieving and preventative therapies. For asymptomatic individuals, it allows precise targeting of therapies to those with coronary heart disease rather than those "at risk" of disease. Moreover, our ability to calculate risk using coronary computed tomography angiography is rapidly improving with the use of techniques, such as plaque quantification and characterisation. These techniques have the potential to provide clinicians with tools to target cardiovascular disease prevention in a precision medicine approach. We here debate the ways in which coronary computed tomography angiography could improve the selection of asymptomatic individuals for preventative therapies over and above risk calculators and calcium scoring.
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Affiliation(s)
- Mohammed N Meah
- BHF Centre of Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | | | - Michelle C Williams
- BHF Centre of Cardiovascular Science, University of Edinburgh, Edinburgh, UK; Edinburgh Imaging, Queen's Medical Research Institute University of Edinburgh, Edinburgh, UK
| | - David E Newby
- BHF Centre of Cardiovascular Science, University of Edinburgh, Edinburgh, UK; Edinburgh Imaging, Queen's Medical Research Institute University of Edinburgh, Edinburgh, UK.
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Yu J, Wang AA, Zimmerman LP, Deng Y, Vu THT, Tedla YG, Soulakis ND, Ahmad FS, Kho AN. A Cohort Analysis of Statin Treatment Patterns Among Small-Sized Primary Care Practices. J Gen Intern Med 2022; 37:1845-1852. [PMID: 34997391 PMCID: PMC9198125 DOI: 10.1007/s11606-021-07191-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 10/01/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Small-sized primary care practices, defined as practices with fewer than 10 clinicians, delivered the majority of outpatient visits in the USA. Statin therapy in high-risk individuals reduces atherosclerotic cardiovascular disease (ASCVD) events, but prescribing patterns in small primary care practices are not well known. This study describes statin treatment patterns in small-sized primary care practices and examines patient- and practice-level factors associated with lack of statin treatment. METHODS We conducted a retrospective cohort analysis of statin-eligible patients from practices that participated in Healthy Hearts in the Heartland (H3), a quality improvement initiative aimed at improving cardiovascular care measures in small primary care practices. All statin-eligible adults who received care in one of 53 H3 practices from 2013 to 2016. Statin-eligible adults include those aged at least 21 with (1) clinical ASCVD, (2) low-density lipoprotein cholesterol (LDL-C) ≥ 190 mg/dL, or (3) diabetes aged 40-75 and with LDL-C 70-189 mg/dL. Eligible patients with no record of moderate- to high-intensity statin prescription are defined by ACC/AHA guidelines. RESULTS Among the 13,330 statin-eligible adults, the mean age was 58 years and 52% were women. Overall, there was no record of moderate- to high-intensity statin prescription among 5,780 (43%) patients. Younger age, female sex, and lower LDL-C were independently associated with a lack of appropriate intensity statin therapy. Higher proportions of patients insured by Medicaid and having only family medicine trained physicians (versus having at least one internal medicine trained physician) at the practice were also associated with lower appropriate intensity statin use. Lack of appropriate intensity statin therapy was higher in independent practices than in Federally Qualified Health Centers (FQHCs) (50% vs. 40%, p value < 0.01). CONCLUSIONS There is an opportunity for improved ASCVD risk reduction in small primary care practices. Statin treatment patterns and factors influencing lack of treatment vary by practice setting, highlighting the importance of tailored approaches to each setting.
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Affiliation(s)
- Jingzhi Yu
- Center for Health Information Partnerships (CHiP), Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Ann A Wang
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lindsay P Zimmerman
- Center for Health Information Partnerships (CHiP), Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Yu Deng
- Center for Health Information Partnerships (CHiP), Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Thanh-Huyen T Vu
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Yacob G Tedla
- Center for Health Information Partnerships (CHiP), Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nicholas D Soulakis
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Faraz S Ahmad
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Abel N Kho
- Center for Health Information Partnerships (CHiP), Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Javaid A, Dardari ZA, Mitchell JD, Whelton SP, Dzaye O, Lima JAC, Lloyd-Jones DM, Budoff M, Nasir K, Berman DS, Rumberger J, Miedema MD, Villines TC, Blaha MJ. Distribution of Coronary Artery Calcium by Age, Sex, and Race Among Patients 30-45 Years Old. J Am Coll Cardiol 2022; 79:1873-1886. [PMID: 35550683 DOI: 10.1016/j.jacc.2022.02.051] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/24/2022] [Accepted: 02/28/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Coronary artery calcium (CAC) is a measure of atherosclerotic burden and is well-validated for risk stratification in middle- to older-aged adults. Few studies have investigated CAC in younger adults, and there is no calculator for determining age-, sex-, and race-based percentiles among individuals aged <45 years. OBJECTIVES The purpose of this study was to determine the probability of CAC >0 and develop age-sex-race percentiles for U.S. adults aged 30-45 years. METHODS We harmonized 3 datasets-CARDIA (Coronary Artery Risk Development in Young Adults), the CAC Consortium, and the Walter Reed Cohort-to study CAC in 19,725 asymptomatic Black and White individuals aged 30-45 years without known atherosclerotic cardiovascular disease. After weighting each cohort equally, the probability of CAC >0 and age-sex-race percentiles of CAC distributions were estimated using nonparametric techniques. RESULTS The prevalence of CAC >0 was 26% among White males, 16% among Black males, 10% among White females, and 7% among Black females. CAC >0 automatically placed all females at >90th percentile. CAC >0 placed White males at the 90th percentile at age 34 years compared with Black males at age 37 years. An interactive webpage allows one to enter an age, sex, race, and CAC score to obtain the corresponding estimated percentile. CONCLUSIONS In a large cohort of U.S. adults aged 30-45 years without symptomatic atherosclerotic cardiovascular disease, the probability of CAC >0 varied by age, sex, and race. Estimated percentiles may help interpretation of CAC scores among young adults relative to their age-sex-race matched peers and can henceforth be included in CAC score reporting.
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Affiliation(s)
- Aamir Javaid
- Division of Cardiology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Zeina A Dardari
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, Maryland, USA
| | - Joshua D Mitchell
- Division of Cardiology, Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA
| | - Seamus P Whelton
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, Maryland, USA
| | - Omar Dzaye
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, Maryland, USA
| | - Joao A C Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital and School of Medicine, Baltimore, Maryland, USA
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
| | - Matthew Budoff
- Lundquist Institute at Harbor-UCLA Medical Center, Los Angeles, California, USA
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA; Center for Cardiovascular Computational and Precision Health (C3-PH) and Center for Outcomes Research, Houston Methodist, Houston, Texas, USA
| | | | | | | | - Todd C Villines
- Division of Cardiology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, Maryland, USA.
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Yang L, Pu T, Zhang Y, Yan H, Yu H, Gao W. The R93C Variant of PCSK9 Reduces the Risk of Premature MI in a Chinese Han Population. Front Genet 2022; 13:875269. [PMID: 35480303 PMCID: PMC9035790 DOI: 10.3389/fgene.2022.875269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 03/11/2022] [Indexed: 12/27/2022] Open
Abstract
Background: Dyslipidemia is a common risk factor for premature myocardial infarction (PMI). Our previous work has shown that single-nucleotide polymorphisms (SNPs) of LDLR, APOB, and PCSK9 are associated with dyslipidemia, but how these SNPs correlate with risk for PMI is unknown. Objective: This study aims to evaluate the association between SNPs of LDLR, APOB, and PCSK9 and risk of PMI in Chinese Han population. Methods: Two cohorts were established. In Cohort 1 (413 in the PMI group and 1,239 in the control group), SNPs of APOB, LDLR, and PCSK9 with minor allele frequency (MAF) > 1%, which has been shown to impact the risk of PMI in a Chinese Han population, were thoroughly examined, and gene–environment interactions were analyzed. A model for PMI risk prediction was developed in Cohort 1 and externally validated in Cohort 2 (577 in the PMI group and 270 in the control group). Results: The distribution of the T allele at the PCSK9 R93C variant (rs151193009, C > T) was lower in the PMI group than that in the control group (PMI vs. Control in Cohort 1, 0.8% vs. 2.3%, Padjust < 0.05; in Cohort 2, 1.0% vs. 2.4%, Padjust < 0.05). The T allele at PCSK9 R93C variant (rs151193009, C > T) reduced the risk of PMI by ∼60% regardless of adjusting for confounding factors (in Cohort 1, adjusted odds ratio (OR) 0.354, 95% confidence interval (CI) 0.139–0.900, p = 0.029; in Cohort 2, adjusted OR 0.394, 95% CI 0.157–0.987, p = 0.047). No gene–environment interactions were observed between the R93C variant and diabetes/hypertension/smoking in PMI occurrence in this Chinese Han population. Our model showed good performance in predicting the risk of PMI in Cohort 1 (AUC 0.839, 95% CI 0.815–0.862, p < 0.001) and in an external cohort (AUC 0.840, 95% CI 0.810–0.871, p < 0.001). Conclusions: The PCSK9 R93C variant was associated with significantly reduced risk of PMI in the Chinese Han population, and the model we developed performed well in predicting PMI risk in this Chinese Han population.
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Affiliation(s)
- Lincheng Yang
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, China
| | - Tian Pu
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, China
| | - Yan Zhang
- Department of Cardiology and Institute of Cardiovascular Disease, Peking University First Hospital, NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing, China
| | - Hua Yan
- Department of Cardiology, Wuhan Asia Heart Hospital, Hubei, China
| | - Haiyi Yu
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, China
- *Correspondence: Haiyi Yu, ; Wei Gao,
| | - Wei Gao
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, China
- *Correspondence: Haiyi Yu, ; Wei Gao,
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Affiliation(s)
- Seamus P Whelton
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Wendy S Post
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Rana JS, Moffet HH, Liu JY, Nasir K, Blankstein R, Karter AJ, Sidney S. Smoking and Risk of Premature Atherosclerotic Cardiovascular Disease. Am J Prev Med 2022; 62:466-468. [PMID: 35190104 PMCID: PMC9020497 DOI: 10.1016/j.amepre.2021.08.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/03/2021] [Accepted: 08/20/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Jamal S Rana
- Department of Cardiology, Kaiser Permanente Northern California, Oakland, California; Division of Research, Kaiser Permanente Northern California, Oakland, California; Department of Medicine, University of California San Francisco, San Francisco, California.
| | - Howard H Moffet
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Jennifer Y Liu
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas
| | - Ron Blankstein
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andrew J Karter
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Stephen Sidney
- Division of Research, Kaiser Permanente Northern California, Oakland, California
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Leopold JA, Antman EM. Ideal Cardiovascular Health in Young Adults With Established Cardiovascular Diseases. Front Cardiovasc Med 2022; 9:814610. [PMID: 35252395 PMCID: PMC8893279 DOI: 10.3389/fcvm.2022.814610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022] Open
Abstract
There has been an increase in the prevalence of cardiovascular diseases among young adults in the United States that has been attributed, in part, to a rise in overweight and obesity, use of combustible tobacco and unhealthy diet and exercise patterns. These factors are influenced further by socioeconomic status and other social determinants of health. In the My Research Legacy study, we examined ideal cardiovascular health in young adults aged 18– <50 years with cardiovascular disease using the Life's Simple 7 survey and data from digital health devices. Young adults with cardiovascular disease (n = 349) were older, had a lower socioeconomic status, a higher prevalence of risk factors, and lower Life's Simple 7 Health Scores (6.4 ± 1.5 vs. 7.1 ± 1.5, p < 0.01) compared to young adults without cardiovascular disease (n = 696). Analysis of digital health device data revealed that young adults with cardiovascular disease performed a similar number of weekly minutes of moderate and vigorous exercise as those without disease leading to similar ideal activity scores. Young adults with cardiovascular disease also shared similarities in modifiable risk factors with adults aged ≥50 years with cardiovascular disease (n = 217), including weight, dietary habits, and weekly minutes of exercise. Latent class analysis identified two phenogroups of young adults with cardiovascular disease: phenogroup 1 was characterized by more advantageous cardiovascular health factors and behaviors resulting in higher Life's Simple 7 Health Scores than phenogroup 2 (7.4 ± 1.2 vs. 5.5 ± 1.1, p < 0.01). These findings in young adults with cardiovascular disease may inform the design of behavioral and therapeutic interventions in the future to decrease cardiovascular morbidity and mortality.
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Zhang M, Zuo HJ, Yang HX, Nan N, Song XT. Trends in conventional cardiovascular risk factors and myocardial infarction subtypes among young Chinese men with a first acute myocardial infarction. Clin Cardiol 2021; 45:129-135. [PMID: 34964143 PMCID: PMC8799041 DOI: 10.1002/clc.23770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 12/05/2021] [Accepted: 12/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is limited data on the characteristics of conventional risk factors (RFs) in young Chinese men hospitalized with a first acute myocardial infarction (AMI). HYPOTHESIS We analyzed the trends in and prevalence of cardiovascular RFs and subtypes of MI during the first AMI in young Chinese men. METHODS A total of 2739 men aged 18-44 years hospitalized for a first AMI were identified from 2007 to 2017. The overall prevalence of RFs and their respective temporal trends and subtypes of AMI were evaluated. RESULTS The most prevalent conditions were smoking, followed by hypertension and then obesity. Patients aged <35 years had a much higher prevalence of hypercholesterolemia and obesity. Compared with a similar reference population in the United States, young Chinese men had a higher prevalence of smoking and dyslipidemia, but a lower prevalence of obesity, hypertension, and diabetes. The prevalence of hypertension increased from 2007 through 2017 (p trend <.001), whereas smoking decreased gradually. AMI frequently presented as ST-segment elevation MI (STEMI) (77.5%). Cluster of conventional RFs (3 RFs, odds ratio [OR]: 1.69, 95% confidence interval [CI]: 1.11-2.57; ≥4 RFs, OR: 2.50, 95% CI: 1.55-4.03] and multivessel disease (OR = 1.32, 95% CI: 1.08-1.60) increased the risk of non-STEMI (NSTEMI). CONCLUSIONS Conventional RFs were highly prevalent in young Chinese men who were hospitalized for first AMI events, and the temporal trends varied different between China and US populations. Multivessel disease and cluster of conventional RFs are closely related to NSTEMI. Optimized preventive strategies among young adults are warranted.
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Affiliation(s)
- Min Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hui-Juan Zuo
- Department of Community Health Research, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hong-Xia Yang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Nan Nan
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xian-Tao Song
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Arora S, Qamar A, Gupta P, Hendrickson M, Singh A, Vaduganathan M, Pandey A, Bansal A, Batra V, Mukhopadhyay S, Yusuf J, Tyagi S, Girish MP, Kaul P, Bhatt DL, Gupta M. Guideline based eligibility for primary prevention statin therapy - Insights from the North India ST-elevation myocardial infarction registry (NORIN-STEMI). J Clin Lipidol 2021:S1933-2874(21)00349-4. [PMID: 34996741 DOI: 10.1016/j.jacl.2021.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 11/10/2021] [Accepted: 12/15/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Current risk scores to estimate atherosclerotic cardiovascular disease (ASCVD) risk and allocate statins in at-risk persons have largely been developed in Western populations; their applicability in India is uncertain. OBJECTIVE To assess eligibility for primary prevention statin therapy using the 2018 U.S Multisociety Guideline and other contemporary cholesterol guidelines in patients presenting with ST-elevation myocardial infarction (STEMI) in the North India STEMI (NORIN-STEMI) registry. METHODS NORIN-STEMI registry prospectively enrolled 3,635 patients at 2 tertiary care centers in Delhi, India from January 2019 to February 2020. Pooled cohort risk equations were used to estimate ASCVD risk at presentation. Patients were evaluated for statin eligibility using the 2018 U.S Multisociety Guideline, United States Preventive Services Task Force (USPSTF), and National Cholesterol Education Program (NCEP) III cholesterol guidelines. RESULTS A total of 2,551 met the inclusion criteria. The median age was 54 years; 17% were women. The median ASCVD risk was 7.0%. At the time of MI, 54% of patients were eligible for primary prevention statin therapy by Multisociety Guideline, 46% by USPSTF, and 30% by NCEP III guidelines. These findings were applicable in both women and men. Compared with patients aged ≥50 years, those <50 years were less likely to be recommended statin therapy by all the three guidelines. CONCLUSION A significant proportion of patients with STEMI in India did not meet the current guideline-based threshold for statin therapy for primary prevention. Novel risk stratification tools are needed to identify patients for primary prevention statin therapy in this population.
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Mortensen MB, Dzaye O, Bødtker H, Steffensen FH, Bøtker HE, Jensen JM, Rønnow Sand NP, Maeng M, Warnakula Olesen KK, Sørensen HT, Kanstrup H, Blankstein R, Blaha MJ, Nørgaard BL. Interplay of Risk Factors and Coronary Artery Calcium for CHD Risk in Young Patients. JACC Cardiovasc Imaging 2021; 14:2387-2396. [PMID: 34147446 DOI: 10.1016/j.jcmg.2021.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/30/2021] [Accepted: 05/03/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The aim of this study was to examine prevalence, predictors, and impact of coronary artery calcium (CAC) across different risk factor burdens on the prevalence of obstructive coronary artery disease (CAD) and future coronary heart disease (CHD) risk in young patients. BACKGROUND The interplay of risk factors and CAC for predicting CHD in young patients aged ≤45 years is not clear. METHODS The study included 3,691 symptomatic patients (18-45 years of age) from the WDHR (Western Denmark Heart Registry) undergoing coronary computed tomographic angiography. CHD events were myocardial infarction and late revascularization. RESULTS During a median of 4.1 years of follow-up, 57 first-time CHD events occurred. In total, 3,180 patients (86.1%) had CAC = 0 and 511 patients (13.9%) had CAC >0. Presence of CAC increased with number of risk factors (odds ratio: 4.5 [95% CI: 2.7-7.3] in patients with >3 vs 0 risk factors). The prevalence of obstructive CAD at baseline and the rate of future CHD events increased in a stepwise manner with both higher CAC and number of risk factors. The CHD event rate was lowest at 0.5 (95% CI: 0.1-3.6) per 1,000 person-years in patients with 0 risk factors and CAC = 0. Among patients with >3 risk factors, the event rate was 3.1 (95% CI: 1.0-9.7) in patients with CAC = 0 compared with 36.3 (95% CI: 17.3-76.1) in patients with CAC >10. CONCLUSIONS In young patients, there is a strong interplay between CAC and risk factors for predicting the presence of obstructive CAD and for future CHD risk. In the presence of risk factors, even a low CAC score is a high-risk marker. These results demonstrate the importance of assessing risk factors and CAC simultaneously when assessing risk in young patients.
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Affiliation(s)
- Martin Bødtker Mortensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
| | - Omar Dzaye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Henrik Bødtker
- Department of Clinical Medicine, Aarhus University Hospital, Denmark
| | | | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Niels Peter Rønnow Sand
- Department of Cardiology, University Hospital of Southwest Jutland and Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Helle Kanstrup
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Ron Blankstein
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Abstract
Drug treatment to reduce cholesterol to new target levels is now recommended in four moderate- to high-risk patient populations: patients who have already sustained a cardiovascular event, adult diabetic patients, individuals with low density lipoprotein cholesterol levels ≥190 mg/dL and individuals with an estimated 10-year cardiovascular risk ≥7.5%. Achieving these cholesterol target levels did not confer any additional benefit in a systematic review of 35 randomised controlled trials. Recommending cholesterol lowering treatment based on estimated cardiovascular risk fails to identify many high-risk patients and may lead to unnecessary treatment of low-risk individuals. The negative results of numerous cholesterol lowering randomised controlled trials call into question the validity of using low density lipoprotein cholesterol as a surrogate target for the prevention of cardiovascular disease.
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Affiliation(s)
- Robert DuBroff
- Internal Medicine/Cardiology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Aseem Malhotra
- Visiting Professor of Evidence-Based Medicine, Bahiana School of Medicine, Salvador, Brazil
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Cainzos-Achirica M, Patel KV, Nasir K. The Evolving Landscape of Cardiovascular Disease Prevention. Methodist Debakey Cardiovasc J 2021; 17:1-7. [PMID: 34824676 PMCID: PMC8588765 DOI: 10.14797/mdcvj.383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Miguel Cainzos-Achirica
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, US.,Center for Outcomes Research, Houston Methodist, Houston, TX, US.,Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Medical Institutions, Baltimore, MD, US
| | - Kershaw V Patel
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, US
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, US.,Center for Outcomes Research, Houston Methodist, Houston, TX, US.,Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Medical Institutions, Baltimore, MD, US
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Rizk T, Blankstein R. Not All Heart Attacks are Created Equal: Thinking Differently About Acute Myocardial Infarction in the Young. Methodist Debakey Cardiovasc J 2021; 17:60-67. [PMID: 34824682 PMCID: PMC8588727 DOI: 10.14797/mdcvj.345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/13/2021] [Indexed: 11/24/2022] Open
Abstract
Cardiovascular disease, particularly myocardial infarction, remains a major cause of morbidity and mortality among young individuals. Although myocardial infarctions have declined significantly in the general population, this decline has not been uniformly observed in younger cohorts. Young adults often have different risk factors, including a higher burden of tobacco use and substance abuse, and they are less likely to be treated with preventive therapies since they are often categorized as having low risk. This review examines the existing literature on myocardial infarction in young patients, with a focus on risk factors, therapeutic challenges, and opportunities for prevention.
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Affiliation(s)
- Theresa Rizk
- Duke University School of Medicine, Durham, North Carolina, US.,Brigham and Women's Hospital, Brookline, Massachusetts, US
| | - Ron Blankstein
- Brigham and Women's Hospital, Brookline, Massachusetts, US.,Harvard Medical School, Cambridge, Massachusetts, US
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Minhas AMK, Awan MU, Raza M, Virani SS, Sharma G, Blankstein R, Blaha MJ, Al-Kindi SG, Kaluksi E, Nasir K, Khan SU. Clinical and Economic Burden of Percutaneous Coronary Intervention in Hospitalized Young Adults in the United States, 2004-2018. Curr Probl Cardiol 2021; 47:101070. [PMID: 34843809 DOI: 10.1016/j.cpcardiol.2021.101070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/21/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The clinical and economic burden of percutaneous coronary intervention (PCI) in young adults (<45 years) is understudied. METHODS AND RESULTS We used the National Inpatient Sample database between 2004 and 2018 to study trends in PCI volume, in-hospital mortality, length of stay (LOS), and health care expenditure among adults aged 18- 44 years who underwent PCI. The data were weighted to explore national estimates of the entire US hospitalized population. We identified 558,611 PCI cases, equivalent to 31.4 per 1,000,000 person-years; 25.4% were women, and 69.5% were White adults. Overall, annual PCI volume significantly decreased from 41.6 per 100,000 in 2004 to 21.9 per 100,000 in 2018, mainly due to 83% volume reduction in non-myocardial infarction (MI) cases. The prevalence of cardiometabolic comorbidities, smoking, and drug abuse increased. Overall, in-hospital mortality was 0.87%; women had higher mortality than men (1.12% vs. 0.78%; P=0.01). The crude and risk-adjusted in-hospital mortality significantly increased between 2004 and 2018. Women, STEMI, NSTEMI, drug abuse, heart failure, peripheral vascular disease, and renal failure were associated with higher odds of in-hospital mortality. Inflation-adjusted cost significantly increased over time ($21,567 to $24,173). CONCLUSION We noted reduction in PCI volumes but increasing mortality and clinical comorbidities among young patients undergoing PCI. Demographic disparities existed with women having higher in-hospital mortality than men.
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Affiliation(s)
| | | | - Munis Raza
- Department of Cardiovascular Medicine, University of Louisville, Louisville, KY
| | - Salim S Virani
- Michael E. DeBakey Veterans Affair Medical Center & Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Garima Sharma
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University, Baltimore, MD
| | - Ron Blankstein
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University, Baltimore, MD
| | - Sadeer G Al-Kindi
- Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve University, Cleveland, OH
| | - Edo Kaluksi
- Guthrie Health System/Robert Packer Hospital, Sayre, PA
| | - Khurram Nasir
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX; Division of Health Equity & Disparities Research, Center for Outcomes Research, Houston Methodist, Houston, TX; Center for Computational Health & Precision Medicine (C3-PH), Houston Methodist, Houston, TX
| | - Safi U Khan
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
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Jonas R, Earls J, Marques H, Chang HJ, Choi JH, Doh JH, Her AY, Koo BK, Nam CW, Park HB, Shin S, Cole J, Gimelli A, Khan MA, Lu B, Gao Y, Nabi F, Nakazato R, Schoepf UJ, Driessen RS, Bom MJ, Thompson RC, Jang JJ, Ridner M, Rowan C, Avelar E, Généreux P, Knaapen P, de Waard GA, Pontone G, Andreini D, Al-Mallah MH, Jennings R, Crabtree TR, Villines TC, Min JK, Choi AD. Relationship of age, atherosclerosis and angiographic stenosis using artificial intelligence. Open Heart 2021; 8:openhrt-2021-001832. [PMID: 34785589 PMCID: PMC8596051 DOI: 10.1136/openhrt-2021-001832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/08/2021] [Indexed: 01/08/2023] Open
Abstract
Objective The study evaluates the relationship of coronary stenosis, atherosclerotic plaque characteristics (APCs) and age using artificial intelligence enabled quantitative coronary computed tomographic angiography (AI-QCT). Methods This is a post-hoc analysis of data from 303 subjects enrolled in the CREDENCE (Computed TomogRaphic Evaluation of Atherosclerotic Determinants of Myocardial IsChEmia) trial who were referred for invasive coronary angiography and subsequently underwent coronary computed tomographic angiography (CCTA). In this study, a blinded core laboratory analysing quantitative coronary angiography images classified lesions as obstructive (≥50%) or non-obstructive (<50%) while AI software quantified APCs including plaque volume (PV), low-density non-calcified plaque (LD-NCP), non-calcified plaque (NCP), calcified plaque (CP), lesion length on a per-patient and per-lesion basis based on CCTA imaging. Plaque measurements were normalised for vessel volume and reported as % percent atheroma volume (%PAV) for all relevant plaque components. Data were subsequently stratified by age <65 and ≥65 years. Results The cohort was 64.4±10.2 years and 29% women. Overall, patients >65 had more PV and CP than patients <65. On a lesion level, patients >65 had more CP than younger patients in both obstructive (29.2 mm3 vs 48.2 mm3; p<0.04) and non-obstructive lesions (22.1 mm3 vs 49.4 mm3; p<0.004) while younger patients had more %PAV (LD-NCP) (1.5% vs 0.7%; p<0.038). Younger patients had more PV, LD-NCP, NCP and lesion lengths in obstructive compared with non-obstructive lesions. There were no differences observed between lesion types in older patients. Conclusion AI-QCT identifies a unique APC signature that differs by age and degree of stenosis and provides a foundation for AI-guided age-based approaches to atherosclerosis identification, prevention and treatment.
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Affiliation(s)
- Rebecca Jonas
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | | | - Hugo Marques
- UNICA, Unit of Cardiovascular Imaging, CHRC Campus Nova Medical School, Lisboa, Portugal
| | - Hyuk-Jae Chang
- Cardiology, Yonsei University Health System, Seodaemun-gu, Seoul, Korea
| | | | - Joon-Hyung Doh
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Ae-Young Her
- Cardiology, Kangwon National University Hospital, Chuncheon, Kangwon, Korea
| | - Bon Kwon Koo
- Department of Internal Medicine, Seoul National University Hospital, Jongno-gu, Seoul, Korea
| | - Chang-Wook Nam
- Cardiovascular Center, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Hyung-Bok Park
- Division of Cardiology, Department of Internal Medicine, Catholic Kwandong University International Saint Mary's Hospital, Incheon, Korea (the Republic of)
| | - Sanghoon Shin
- Cardiology, Ewha Women's University Mokdong Hospital, Seoul, Korea
| | - Jason Cole
- Mobile Cardiology Associates, Mobile, Alabama, USA
| | - Alessia Gimelli
- Department of Imaging, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | | | - Bin Lu
- Department of Radiology, Fuwai Hospital State Key Laboratory of Cardiovascular Disease, Beijing, China
| | - Yang Gao
- Fuwai Hospital State Key Laboratory of Cardiovascular Disease, Beijing, China
| | - Faisal Nabi
- Houston Methodist Hospital, Houston, Texas, USA
| | - Ryo Nakazato
- Cardiovascular Center, Saint Luke's International Hospital, Chuo-ku, Tokyo, Japan
| | - U Joseph Schoepf
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Roel S Driessen
- VU University Medical Centre Amsterdam, Amsterdam, Noord-Holland, Netherlands
| | - Michiel J Bom
- Department of Cardiology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | - James J Jang
- Cardiology, Kaiser Permanente, San Jose, California, USA
| | | | | | - Erick Avelar
- Oconee Heart and Vascular Center, Saint Marys Medical Group, Athens, Georgia, USA
| | - Philippe Généreux
- Division of Cardiology, Hopital du Sacre-Coeur de Montreal, Montreal, Québec, Canada
| | - Paul Knaapen
- Cardiology, VU University Medical Centre Amsterdam, Amsterdam, Noord-Holland, Netherlands
| | - Guus A de Waard
- Cardiology, VU University Medical Centre Amsterdam, Amsterdam, Noord-Holland, Netherlands
| | - Gianluca Pontone
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico, Milano, Lombardia, Italy
| | - Daniele Andreini
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico, Milano, Lombardia, Italy
| | | | | | | | - Todd C Villines
- Medicine (Cardiology), University of Virginia Health System, Charlottesville, Virginia, USA
| | | | - Andrew D Choi
- Division of Cardiology and Department of Radiology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
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