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Wu TT, Zheng YY, Ma X, Xiu WJ, Yang HT, Hou XG, Yang Y, Chen Y, Ma YT, Xie X. Mutated CYP17A1 promotes atherosclerosis and early-onset coronary artery disease. Cell Commun Signal 2023; 21:155. [PMID: 37370070 PMCID: PMC10294473 DOI: 10.1186/s12964-023-01061-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/29/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Coronary artery disease (CAD) is a multi-factor complex trait and is heritable, especially in early-onset families. However, the genetic factors affecting the susceptibility of early-onset CAD are not fully characterized. METHODS In the present study, we identified a rare nonsense variant in the CYP17A1 gene from a Chinese Han family with CAD. To validate the effect of this variation on atherosclerosis and early-onset coronary artery disease, we conducted studies on population, cells, and mice. RESULTS The mutation precisely congregated with the clinical syndrome in all the affected family members and was absent in unaffected family members and unrelated controls. Similar to the human phenotype, the CYP17A1-deficient mice present the phenotype of metabolic syndrome with hypertension, increased serum glucose concentration, and presentation of central obesity and fatty liver. Furthermore, CYP17A1 knockout mice or CYP17A1 + ApoE double knockout mice developed more atherosclerotic lesions than wild type (WT) with high fat diary. In cell models, CYP17A1 was found to be involved in glucose metabolism by increasing glucose intake and utilization, through activating IGF1/mTOR/HIF1-α signaling way, which was consistent in CYP17A1 knockout mice with impaired glucose tolerance and insulin resistance. CONCLUSIONS Through our study of cells, mice and humans, we identified CYP17A1 as a key protein participating in the pathophysiology of the atherosclerotic process and the possible mechanism of CYP17A1 C987X mutation induced atherosclerosis and early-onset CAD involving glucose homeostasis regulation was revealed. Video Abstract.
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Affiliation(s)
- Ting-Ting Wu
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, No. 137, Liyushan Road, Urumqi, 830011, People's Republic of China
| | - Ying-Ying Zheng
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, No. 137, Liyushan Road, Urumqi, 830011, People's Republic of China
| | - Xiang Ma
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, No. 137, Liyushan Road, Urumqi, 830011, People's Republic of China
| | - Wen-Juan Xiu
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, No. 137, Liyushan Road, Urumqi, 830011, People's Republic of China
| | - Hai-Tao Yang
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, No. 137, Liyushan Road, Urumqi, 830011, People's Republic of China
| | - Xian-Geng Hou
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, No. 137, Liyushan Road, Urumqi, 830011, People's Republic of China
| | - Yi Yang
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, No. 137, Liyushan Road, Urumqi, 830011, People's Republic of China
| | - You Chen
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, No. 137, Liyushan Road, Urumqi, 830011, People's Republic of China
| | - Yi-Tong Ma
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, No. 137, Liyushan Road, Urumqi, 830011, People's Republic of China.
| | - Xiang Xie
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, No. 137, Liyushan Road, Urumqi, 830011, People's Republic of China.
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eldesouky M, Abd-elazim A, Elhakim H, Fayed H. Impact of KIF6 Trp719Arg gene variant on Coronary Artery Disease Development.. [DOI: 10.21203/rs.3.rs-2705882/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Abstract
Coronary artery disease (CAD) is a multifactorial disease resulting from the interaction of genetic varia-tion and environmental traditional risk factors (TRFs), including diabetes mellitus, smoking, dyslipidemia, and hypertension. KIF6 Trp719Arg (rs20455; A>G) is an interesting gene variant reported as one of the most important risk factors for CAD in different populations. The study enrolled 150 participants belong-ing to the National Heart Institute (NHI) catheterization unit in Egypt, who were grouped into three main study groups regarding the presence of different TRFs. Biochemical investigations and clinical data were assessed and recorded. Analysis for KIF6 Trp719Arg polymorphism (rs20455; A>G) was performed for all participants using the TaqMan genotyping real-time PCR assay (rs20455). The study demonstrated that diabetes mellitus, hypertension, dyslipidemia, and smoking were highly statistically significant among CAD with TRF and non-CAD with TRF patients with p-values of 0.009*, 0.003*, 0.046*, and 0.001**, re-spectively. The family history of premature CAD represents a high percentage of CAD without TRF pa-tients compared to the other groups with a statistical difference of p-value= 0.004*. A high prevalence of AG+GG genotypes among the different groups was obtained, representing 66.0% of CAD with TRF, 76.0% of CAD without TRF, and 60% of non-CAD with TRF patients. The present study elucidated the impact of KIF6 Trp719Arg as a dependent risk factor for CAD, as it could have a significant role in CAD develop-ment when it interacts with one or more of the other traditional risk factors.
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Abstract
Over the past decade, substantial progress has been made in the discovery of alleles contributing to the risk of coronary artery disease. In addition to providing causal insights into disease, these endeavours have yielded and enabled the refinement of polygenic risk scores. These scores can be used to predict incident coronary artery disease in multiple cohorts and indicate the clinical response to some preventive therapies in post hoc analyses of clinical trials. These observations and the widespread ability to calculate polygenic risk scores from direct-to-consumer and health-care-associated biobanks have raised many questions about responsible clinical adoption. In this Review, we describe technical and downstream considerations for the derivation and validation of polygenic risk scores and current evidence for their efficacy and safety. We discuss the implementation of these scores in clinical medicine for uses including risk prediction and screening algorithms for coronary artery disease, prioritization of patient subgroups that are likely to derive benefit from treatment, and efficient prospective clinical trial designs.
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Khetarpal SA, Honigberg MC, Natarajan P. Implications of Premature Coronary Artery Calcification in Primary and Secondary Prevention of Atherosclerotic Cardiovascular Disease. JAMA Cardiol 2021; 6:1233-1234. [PMID: 34495295 DOI: 10.1001/jamacardio.2021.3393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Sumeet A Khetarpal
- Cardiology Division, Department of Medicine, Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston.,Program in Medical and Population Genetics and the Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, Massachusetts
| | - Michael C Honigberg
- Cardiology Division, Department of Medicine, Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston.,Program in Medical and Population Genetics and the Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, Massachusetts
| | - Pradeep Natarajan
- Cardiology Division, Department of Medicine, Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston.,Program in Medical and Population Genetics and the Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, Massachusetts
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Higny J, Dupont M. Cardiac CT findings in patients with family history of premature CAD: an observational study. Acta Cardiol 2021; 77:580-585. [PMID: 34431450 DOI: 10.1080/00015385.2021.1967612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION A family history of premature CAD may promote enhanced development of coronary atherosclerosis in a sibling population. Baseline CV algorithms may underestimate the risk of coronary incidents in individuals at familial risk. Cardiac CT provides high diagnostic performance for the detection of coronary plaques. There is little data on the use of this technology in the initial diagnostic approach of these patients. The prognostic value of early detection of coronary plaques by cardiac CT remains unknown in this population. OBJECTIVES The study aimed to estimate the global CV risk and the pre-test probability of CAD in patients with a family history of premature CAD. We investigated the potential role of cardiac CT imaging in the assessment of coronary risk in patients from high-risk families. We sought to remind the 2019 ESC guidelines for screening for CAD in asymptomatic subjects. METHODS Fifty siblings of patients with premature CAD were investigated. The pre-test probability of CAD was determined with the Clinical Model of the CAD consortium. The risk of CV disease was calculated and compared with three different risk algorithms (SCORE, FRS, PROCAM). All patients underwent cardiac CT with both non-contrast and contrast imaging. Coronary artery calcium (CAC) scoring was calculated and CT angiograms were analyzed. Patients with suspected CT obstructive CAD underwent coronary angiography. Clinical outcomes in terms of treatment were analyzed. RESULTS The pre-test probability of CAD was low: CAD consortium <10% in 60%, SCORE <5% in 100%, FRS <10% in 88%, CAC scoring <100% in 68%. However, PROCAM was <10% in 16 cases (32%). Only 12 patients (24%) presented normal CCTA findings. In patients with abnormal CCTA findings (n = 38), PROCAM was higher than FRS in 20 patients (53%). Coronary angiography was performed in 31 cases (62%) for suspected CT obstructive CAD. Most patients presented no significant lesions (55%). Revascularization was performed in 8 patients (16%), 6 of them (75%) presented CAC scoring <100, 4 of them (50%) presented CAC scoring <400. After investigation, lipid-lowering therapy was enhanced by 66%. CONCLUSION Coronary atherosclerotic-phenotyping using cardiac CT may provide discriminatory information allowing earlier identification of patients at familial risk of premature CAD. This diagnostic workup strategy may help to guide and improve the management of these patients. However, there is a paucity of data concerning the prognostic significance of this technology in relatives at familial risk of premature CAD. Therefore, further randomized controlled trials are needed to assess the incremental risk-predictive value of this approach in this population.
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Affiliation(s)
- Julien Higny
- Département de Pathologie Cardiovasculaire, CHU UCL Namur, Yvoir, Belgique
| | - Michaël Dupont
- Département de Radiologie, CHU UCL Namur, Yvoir, Belgique
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K Thomas A, Radhakrishnan D. A Study on the Impact of the Novel Biochemical Parameter-Calcium Score in Preventing the Progression of the Cardiovascular Diseases to Invasive Interventions. J Nutr Sci Vitaminol (Tokyo) 2021; 66:S11-S17. [PMID: 33612577 DOI: 10.3177/jnsv.66.s11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Cardiovascular diseases is increasing its pace day by day. Though the traditional biomarkers are made available the novel biomarkers are being incorporated to predict the risk of cardiovascular diseases for earlier detection. The present study aimed to investigate the impact of calcium score level the novel biochemical parameter in preventing the progression of the cardiovascular patients to PTCA (percutaneous transluminal coronary angioplasty) and CABG (coronary artery bypass grafting). Four hundred cardiovascular patients irrespective of sex were randomly selected from Visakhapatnam district Andhrapradesh. Information of subjects was collected using an interview schedule. Data collected were consolidated and tabulated. From this group a sub sample of 50 patients was selected and grouped as primordial, secondary and post PTCA. The subjects were then analyzed for their biochemical parameters before and after intervention. Statistical analysis was done and interpreted. An extensive evidence of calcium score was shown among 61.2% of the cardiovascular patients, a minimum evidence of 22.2% and moderate evidence of about 16.5%. The paired sample t-test is employed to observe any statistical significant difference between the before and after treatment effects. The analysis for the calcium score level was found to be significantly lower (mean difference=424.0134; t=13.297; df=49; p=0.01) in post intervention (mean=88.3766±88.40) than pre-intervention (512.39±260.79812). The present study identified calcium score the novel biochemical parameter as a key preventive measure among the usual biochemical management conducted by the clinicians to diagnosis and confirm the progression of the disease.
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Kayikcioglu M, Kuman Tuncel O, Tokgozoglu L. Impact of the COVID-19 pandemic in patients with a previous history of premature myocardial infarction. Am J Prev Cardiol 2020; 4:100128. [PMID: 33230505 PMCID: PMC7673226 DOI: 10.1016/j.ajpc.2020.100128] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/08/2020] [Accepted: 11/11/2020] [Indexed: 11/29/2022] Open
Abstract
Objectives The coronavirus-disease-2019 (COVID-19) pandemic has led to the restructuring of health-services to prioritize the treatment of COVID-19. The severe restrictions on daily life affected the management of chronic diseases. Patients with a previous history of premature myocardial infarction (MI) are a vulnerable group requiring frequent and continued medical attention both in the pandemic and non-pandemic era. The present study was conducted to provide insight into the impact of COVID-19 outbreak on heart-healthy lifestyle and management of patients with a history of premature MI. Methods This cross-sectional study included 170 consecutive patients with a history of premature MI who were already in regular follow-up in a tertiary out-patient prevention clinic before the pandemic. Inclusion criteria included age ≥18 years and being on regular follow up with the diagnosis of premature MI (documented MI before the age of 55 years) at least for one year. All patients were contacted by phone-call and replied to a 23-item questionnaire measuring the impact of the pandemic on the management, healthy lifestyle habits, and anxiety level. Results One patient died due to COVID-19 infection; therefore the analyses were conducted in 169 patients (age: 47.67 ± 11.84 years, 21.3% women). The median age at first MI was 39 (IQR 10) years and the median time elapsed since the first MI was 7 years (IQR 10). The study population was highly compliant with the follow-up visits (78.1%) and pharmacological therapy (97%) before the pandemic according to the medical files. The majority (82.2%) of the patients were aware that having a history of premature MI would increase the risk and harm of COVID-19. Anxiety level increased in 62.7% of the study patients. Overall, 65.7% of the patient group reported a disruption at least in ≥1 component(s) of healthy life-behaviors (non-compliance with the heart-healthy diet, an increase in alcohol intake, an increase in smoking, and/or reduced physical activity) since the emergence of the outbreak. The anxiety level (p = 0.001) and the prevalence of appetite change (p < 0.0001) and weight gain (p < 0.0001) was lower in the lifestyle compliant group than the non-compliant group. Avoidance of seeking medical care was reported in 33.7% of the patients. Statin use was 99.4% before the pandemic and decreased to 89.9% (p < 0.0001) despite the fact that medications were reimbursed and widely available. Conclusions The COVID-19 pandemic significantly affected the heart-healthy lifestyle and anxiety levels of patients with a history of premature MI who were already in regular follow-up in a tertiary prevention clinic and led to significant avoidance of medical care. More rigorous follow-up, education, and reassurance of these patients with telemedicine are necessary for the prevention of further increase in their risk.
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Affiliation(s)
- Meral Kayikcioglu
- Ege University Medical Faculty, Department of Cardiology, İzmir, Turkey
| | | | - Lale Tokgozoglu
- Hacettepe University Medical Faculty, Department of Cardiology, Ankara, Turkey
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Parental history of coronary artery disease among adults with hypothyroidism: Case controlled study. Ann Med Surg (Lond) 2020; 60:92-101. [PMID: 33133591 PMCID: PMC7588661 DOI: 10.1016/j.amsu.2020.10.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/16/2020] [Accepted: 10/18/2020] [Indexed: 11/23/2022] Open
Abstract
Background Thyroid dysfunction has a negative impact on coronary artery diseases (CAD) through several changes in its risk factors like dyslipidemia, glucose intolerance, and components of metabolic syndrome. Parental history of premature CAD may be an important risk factor for their offspring. Objective To investigate whether overt and subclinical hypothyroidism and the risk of atherosclerosis are present in adults with parental history of CAD. Materials and methods This case control study included 135 hypothyroid patients and 100 age-sex matched controls. Data were analyzed regarding CAD risk factors, hormonal and biochemical measures including retinol Binding Protein-4, fasting serum insulin, high-sensitivity C-reactive protein, lipid profile, fasting serum glucose, and serum malondialdehyde. Results Parental history of CAD was significantly higher in overt hypothyroidism than subclinical group (P = 0.001). The level of RBP-4 in hypothyroid patients was significantly higher than euthyroid subjects (P = 0.03), and was higher in hypothyroid patients with positive parental history of CAD (p = 0.01). There were positive relationships between RBP-4 and related cardiovascular risk factors and with hypothyroidism, its sensitivity and specificity were 47.9% and 42.5% respectively. The positive predictive value was 60.8% and the negative predictive value was 30.4%. Hypothyroid patients with parental history of CAD had a risk of 3.7 times more than the euthyroid subjects. Conclusions In hypothyroidism patients, parental history of CAD is a predictor of future coronary events and the related risk factors. RBP-4 is positively correlated with waist circumference, BMI, lipid profile, High-sensitivity CRP, MDA, fasting serum glucose, fasting serum insulin, HOMA indices and TSH.
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Chacko M, Sarma PS, Harikrishnan S, Zachariah G, Jeemon P. Family history of cardiovascular disease and risk of premature coronary heart disease: A matched case-control study. Wellcome Open Res 2020; 5:70. [PMID: 32518841 PMCID: PMC7256470 DOI: 10.12688/wellcomeopenres.15829.2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Self-reported family history of cardiovascular disease (CVD) is an independent risk factor for future coronary heart disease (CHD) events. However, inclusion of family history of CVD in the traditional risk scores failed to improve risk prediction of CHD. It is proposed that family history of CVD may substantially increase the risk of CHD among younger individuals. Methods: We conducted a matched case-control study with 170 hospital-based premature CHD patients (<55 years in men and <65 years in women) from a tertiary care centre in Thiruvananthapuram, Kerala and age and sex matched community-based controls in 1:1 ratio. Conditional logistic regression analysis was conducted to assess the independent association of family history of cardiovascular disease (CVD) and premature CHD. We estimated McNemar's odds ratios and their 95 percent confidence intervals. Results: The prevalence of any family history of CVD and CHD in the control population was 24% and 21%, respectively. The family history of CVD was independently associated with premature CHD (odds ratio (OR) = 9.0; 95% confidence interval (CI) 4.7-17.3). There was a dose-response relationship between family history and premature CHD as the risk increased linearly with increase in number of affected family members. Conclusions: Family history of CVD is an independent risk factor for premature CHD. The risk of premature CHD increases linearly with increase in number of affected family members. Collecting family history beyond parental history of CVD is important for risk stratification. Targeting young individuals with family history of CVD for intensive risk reduction interventions may help to prevent future events.
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Affiliation(s)
- Manas Chacko
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - P. Sankara Sarma
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - Sivadasanpillai Harikrishnan
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - Geevar Zachariah
- Department of Cardiology, Mother Heart Care, Mother Hospital, Thrissur, Kerala, India
| | - Panniyammakal Jeemon
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
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Chacko M, Sarma PS, Harikrishnan S, Zachariah G, Jeemon P. Family history of cardiovascular disease and risk of premature coronary heart disease: A matched case-control study. Wellcome Open Res 2020; 5:70. [PMID: 32518841 PMCID: PMC7256470 DOI: 10.12688/wellcomeopenres.15829.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2020] [Indexed: 03/30/2024] Open
Abstract
Background: Self-reported family history of cardiovascular disease (CVD) is an independent risk factor for future coronary heart disease (CHD) events. However, inclusion of family history of CVD in the traditional risk scores failed to improve risk prediction of CHD. It is proposed that family history of CVD may substantially increase the risk of CHD among younger individuals. Methods: We conducted a matched case-control study with 170 hospital-based premature CHD patients (<55 years in men and <65 years in women) from a tertiary care centre in Thiruvananthapuram, Kerala and age and sex matched community-based controls in 1:1 ratio. Conditional logistic regression analysis was conducted to assess the independent association of family history of cardiovascular disease (CVD) and premature CHD. We estimated McNemar's odds ratios and their 95 percent confidence intervals. Results: The prevalence of any family history of CVD and CHD in the control population was 24% and 21%, respectively. The family history of CVD was independently associated with premature CHD (odds ratio (OR) = 9.0; 95% confidence interval (CI) 4.7-17.3). There was a dose-response relationship between family history and premature CHD as the risk increased linearly with increase in number of affected family members. Conclusions: Family history of CVD is an independent risk factor for premature CHD. The risk of premature CHD increases linearly with increase in number of affected family members. Collecting family history beyond parental history of CVD is important for risk stratification. Targeting young individuals with family history of CVD for intensive risk reduction interventions may help to prevent future events.
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Affiliation(s)
- Manas Chacko
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - P. Sankara Sarma
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - Sivadasanpillai Harikrishnan
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - Geevar Zachariah
- Department of Cardiology, Mother Heart Care, Mother Hospital, Thrissur, Kerala, India
| | - Panniyammakal Jeemon
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
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Sato T, Minami Y, Asakura K, Katamine M, Kato A, Katsura A, Muramatsu Y, Kakizaki R, Nemoto T, Hashimoto T, Fujiyoshi K, Kameda R, Meguro K, Shimohama T, Ako J. Age- and Gender-Related Differences in Coronary Lesion Plaque Composition on Optical Coherence Tomography. Circ J 2020; 84:463-470. [PMID: 31983726 DOI: 10.1253/circj.cj-19-0859] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND The pathophysiology and chronological course of atherosclerosis seems to be different between men and women due to biological differences, and age and gender differences in plaque composition of coronary lesions remain to be elucidated.Methods and Results:A total of 860 consecutive patients with a median age of 69 years (IQR, 60-78 years) who underwent optical coherence tomography (OCT) of culprit lesions was included. The composition of culprit plaque on OCT was compared between female (n=171) and male (n=689) subjects in younger (<70 years old) and elderly (≥70 years old) patients. In elderly patients, the prevalence of thin-cap fibroatheroma (TCFA) was significantly higher in women than in men (30.6 vs. 15.2%, P<0.001). In younger patients, the prevalence of large calcification was significantly higher in women than in men (60.0 vs. 32.8%, P<0.001). The prevalence of other vulnerable plaque characteristics (i.e., macrophages, microchannels, and spotty calcification), was similar between women and men. Elderly women had a significantly higher prevalence of TCFA (OR, 2.13; 95% CI: 1.33-3.44, P=0.002) than other patients. CONCLUSIONS Women had a higher prevalence of TCFA and of large calcification than men in patients ≥70 and <70 years old, respectively. This may facilitate the understanding of gender differences in the pathogenesis of coronary atherosclerosis, and the tailoring of therapy and of prevention according to age and gender.
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Affiliation(s)
- Toshimitsu Sato
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Yoshiyasu Minami
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Kiyoshi Asakura
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Masahiro Katamine
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Ayami Kato
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Aritomo Katsura
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Yusuke Muramatsu
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Ryota Kakizaki
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Teruyoshi Nemoto
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Takuya Hashimoto
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Kazuhiro Fujiyoshi
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Ryo Kameda
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Kentaro Meguro
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Takao Shimohama
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
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Jellinger PS, Handelsman Y, Rosenblit PD, Bloomgarden ZT, Fonseca VA, Garber AJ, Grunberger G, Guerin CK, Bell DSH, Mechanick JI, Pessah-Pollack R, Wyne K, Smith D, Brinton EA, Fazio S, Davidson M. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY GUIDELINES FOR MANAGEMENT OF DYSLIPIDEMIA AND PREVENTION OF CARDIOVASCULAR DISEASE. Endocr Pract 2019; 23:1-87. [PMID: 28437620 DOI: 10.4158/ep171764.appgl] [Citation(s) in RCA: 620] [Impact Index Per Article: 124.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The development of these guidelines is mandated by the American Association of Clinical Endocrinologists (AACE) Board of Directors and American College of Endocrinology (ACE) Board of Trustees and adheres with published AACE protocols for the standardized production of clinical practice guidelines (CPGs). METHODS Recommendations are based on diligent reviews of the clinical evidence with transparent incorporation of subjective factors, according to established AACE/ACE guidelines for guidelines protocols. RESULTS The Executive Summary of this document contains 87 recommendations of which 45 are Grade A (51.7%), 18 are Grade B (20.7%), 15 are Grade C (17.2%), and 9 (10.3%) are Grade D. These detailed, evidence-based recommendations allow for nuance-based clinical decision-making that addresses multiple aspects of real-world medical care. The evidence base presented in the subsequent Appendix provides relevant supporting information for Executive Summary Recommendations. This update contains 695 citations of which 203 (29.2 %) are EL 1 (strong), 137 (19.7%) are EL 2 (intermediate), 119 (17.1%) are EL 3 (weak), and 236 (34.0%) are EL 4 (no clinical evidence). CONCLUSION This CPG is a practical tool that endocrinologists, other health care professionals, health-related organizations, and regulatory bodies can use to reduce the risks and consequences of dyslipidemia. It provides guidance on screening, risk assessment, and treatment recommendations for a range of individuals with various lipid disorders. The recommendations emphasize the importance of treating low-density lipoprotein cholesterol (LDL-C) in some individuals to lower goals than previously endorsed and support the measurement of coronary artery calcium scores and inflammatory markers to help stratify risk. Special consideration is given to individuals with diabetes, familial hypercholesterolemia, women, and youth with dyslipidemia. Both clinical and cost-effectiveness data are provided to support treatment decisions. ABBREVIATIONS 4S = Scandinavian Simvastatin Survival Study A1C = glycated hemoglobin AACE = American Association of Clinical Endocrinologists AAP = American Academy of Pediatrics ACC = American College of Cardiology ACE = American College of Endocrinology ACS = acute coronary syndrome ADMIT = Arterial Disease Multiple Intervention Trial ADVENT = Assessment of Diabetes Control and Evaluation of the Efficacy of Niaspan Trial AFCAPS/TexCAPS = Air Force/Texas Coronary Atherosclerosis Prevention Study AHA = American Heart Association AHRQ = Agency for Healthcare Research and Quality AIM-HIGH = Atherothrombosis Intervention in Metabolic Syndrome With Low HDL/High Triglycerides trial ASCVD = atherosclerotic cardiovascular disease ATP = Adult Treatment Panel apo = apolipoprotein BEL = best evidence level BIP = Bezafibrate Infarction Prevention trial BMI = body mass index CABG = coronary artery bypass graft CAC = coronary artery calcification CARDS = Collaborative Atorvastatin Diabetes Study CDP = Coronary Drug Project trial CI = confidence interval CIMT = carotid intimal media thickness CKD = chronic kidney disease CPG(s) = clinical practice guideline(s) CRP = C-reactive protein CTT = Cholesterol Treatment Trialists CV = cerebrovascular CVA = cerebrovascular accident EL = evidence level FH = familial hypercholesterolemia FIELD = Secondary Endpoints from the Fenofibrate Intervention and Event Lowering in Diabetes trial FOURIER = Further Cardiovascular Outcomes Research with PCSK9 Inhibition in Subjects With Elevated Risk trial HATS = HDL-Atherosclerosis Treatment Study HDL-C = high-density lipoprotein cholesterol HeFH = heterozygous familial hypercholesterolemia HHS = Helsinki Heart Study HIV = human immunodeficiency virus HoFH = homozygous familial hypercholesterolemia HPS = Heart Protection Study HPS2-THRIVE = Treatment of HDL to Reduce the Incidence of Vascular Events trial HR = hazard ratio HRT = hormone replacement therapy hsCRP = high-sensitivity CRP IMPROVE-IT = Improved Reduction of Outcomes: Vytorin Efficacy International Trial IRAS = Insulin Resistance Atherosclerosis Study JUPITER = Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin LDL-C = low-density lipoprotein cholesterol Lp-PLA2 = lipoprotein-associated phospholipase A2 MACE = major cardiovascular events MESA = Multi-Ethnic Study of Atherosclerosis MetS = metabolic syndrome MI = myocardial infarction MRFIT = Multiple Risk Factor Intervention Trial NCEP = National Cholesterol Education Program NHLBI = National Heart, Lung, and Blood Institute PCOS = polycystic ovary syndrome PCSK9 = proprotein convertase subtilisin/kexin type 9 Post CABG = Post Coronary Artery Bypass Graft trial PROSPER = Prospective Study of Pravastatin in the Elderly at Risk trial QALY = quality-adjusted life-year ROC = receiver-operator characteristic SOC = standard of care SHARP = Study of Heart and Renal Protection T1DM = type 1 diabetes mellitus T2DM = type 2 diabetes mellitus TG = triglycerides TNT = Treating to New Targets trial VA-HIT = Veterans Affairs High-Density Lipoprotein Cholesterol Intervention Trial VLDL-C = very low-density lipoprotein cholesterol WHI = Women's Health Initiative.
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13
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Abderrahman HA, Al-Abdallat IM, Idhair AK. Age threshold for proper definition of premature coronary artery disease in males. J Forensic Leg Med 2018; 58:45-49. [PMID: 29730481 DOI: 10.1016/j.jflm.2018.04.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 02/05/2018] [Accepted: 04/26/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND There is no universally accepted definition for the cut point age before which atherosclerosis is considered "premature." This is a retrospective study aimed to utilize the medico legal autopsy information for finding a proper definition of the age threshold of premature atherosclerosis in males. OBJECTIVES This work aimed to utilize autopsy reports data that were issued at Jordan University Hospital to evaluate age-related differences in the distribution of coronary atherosclerotic and myocardial lesions and the determination of the age threshold at which such differences became apparent in male deaths. Such a threshold might provide a proper definition for premature atherosclerosis and premature sudden atherosclerotic cardiac death. At the same time, the meaning of a reference age for mature atherosclerotic death incidents could be elucidated. METHODS A total of 1139 male autopsy reports with sudden coronary atherosclerotic death were reviewed. RESULTS There is an overall decreasing trend in the prevalence of coronary thrombosis with age, where the prevalence of coronary thrombosis was more common in younger age groups and constitutes 59.9% of cases in the age groups less than 45 years in comparison to 42.7% of cases in the ages more than 65 years. The same trend was noticed for the prevalence of cases without evident myocardial fibrosis. On the other hand, the trend was increasing for stenosis without apparent thrombosis and for myocardial fibrosis. In spite of that, the detailed pattern of the prevalence of these pathologies with age did not show a steady, and a continuous change through the whole spanned age groups. Instead, two distinct phases were observed, the first phase represents the cases less than 49 years of age and the second phase represents the cases more than the age of 54 and the age group between 50/54 is what we called the "turn-interval." CONCLUSION sThe "turn-interval" was considered as the scientific basis to define the age threshold that differentiates the premature atherosclerotic coronary diseases. Accordingly, it was proposed that male premature coronary artery diseases constituted the cases suffering from the heart attack, or died as a result of cardiac attacks below the age of 49, and the mature disease that affects people who is older than 54 years old.
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Affiliation(s)
- Hasan A Abderrahman
- Associated Professor, Faculty of Medicine, The University of Jordan, Jordan.
| | - Imad M Al-Abdallat
- Professor Forensic Medicine and Toxicology, Faculty of Medicine, University of Jordan, Jordan; Head of Forensic Division, Jordan University Hospital, Jordan.
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14
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Khera A, Joshi P. What's a Malignant Family History?: You'll Know It When You See It. JACC Cardiovasc Imaging 2017; 10:1136-1138. [PMID: 28109931 DOI: 10.1016/j.jcmg.2016.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 11/10/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Amit Khera
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Parag Joshi
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
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15
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Allport SA, Kikah N, Abu Saif N, Ekokobe F, Atem FD. Parental Age of Onset of Cardiovascular Disease as a Predictor for Offspring Age of Onset of Cardiovascular Disease. PLoS One 2016; 11:e0163334. [PMID: 28002456 PMCID: PMC5176186 DOI: 10.1371/journal.pone.0163334] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 09/07/2016] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The risk for cardiovascular disease (CVD) is higher for individuals with a first-degree relative who developed premature CVD (with a threshold at age 55 years for a male or 65 years for a female). However, little is known about the effect that each unit increase or decrease of maternal or paternal age of onset of CVD has on offspring age of onset of CVD. We hypothesized that there is an association between maternal and paternal age of onset of CVD and offspring age of onset of CVD. METHODS We used the Framingham Heart Study database and performed conditional imputation for CVD-censored parental age (i.e. parents that didn't experience onset of CVD) and Cox proportional regression analysis, with offspring's age of onset of CVD as the dependent variable and parental age of onset of CVD as the primary predictor. Modifiable risk factors in offspring, such as cigarette smoking, body mass index (BMI), diabetes mellitus, systolic blood pressure (SBP), high-density lipoprotein (HDL) level, and low-density lipoprotein (LDL) level, were controlled for. Separate analyses were performed for the association between maternal age of onset of CVD and offspring age of onset of CVD and the association between paternal age of onset of CVD and offspring age of onset of CVD. RESULTS Parental age of onset of CVD was predictive of offspring age of onset of CVD for maternal age of onset of CVD (P < .0001; N = 1401) and for paternal age of onset of CVD (P = 0.0134; N = 1221). A negative estimate of the coefficient of interest signifies that late onset of cardiovascular events in parents is protective of onset of CVD in offspring. Cigarette smoking and HDL level were important associated confounders. CONCLUSIONS Offspring age of onset of cardiovascular disease is significantly associated with both maternal and paternal age of onset CVD. The incorporation of the parameters, maternal or paternal age of onset of CVD, into risk estimate calculators may improve accuracy of identification of high-risk patients in clinical settings.
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Affiliation(s)
- Shannon Anjelica Allport
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- The University of Texas Health Science Center School of Public Health, Dallas, Texas, United States of America
| | - Ngum Kikah
- The University of Texas Health Science Center School of Public Health, Dallas, Texas, United States of America
| | - Nessim Abu Saif
- The University of Texas Health Science Center School of Public Health, Dallas, Texas, United States of America
- Trinity School of Medicine, Kingstown, St. Vincent and the Grenadines
| | - Fonkem Ekokobe
- Texas A &M Health Science Center School of Medicine, Dallas, Texas, United States of America
| | - Folefac D. Atem
- The University of Texas Health Science Center School of Public Health, Dallas, Texas, United States of America
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16
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Hindieh W, Pilote L, Cheema A, Al-Lawati H, Labos C, Dufresne L, Engert JC, Thanassoulis G. Association Between Family History, a Genetic Risk Score, and Severity of Coronary Artery Disease in Patients With Premature Acute Coronary Syndromes. Arterioscler Thromb Vasc Biol 2016; 36:1286-92. [DOI: 10.1161/atvbaha.115.306944] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 03/31/2016] [Indexed: 12/16/2022]
Abstract
Objective—
A genetic risk score (GRS) for coronary artery disease has recently been shown to be independent of family history (FHx) in predicting future cardiovascular events. We sought to determine whether the presence of these risk factors, either individually or together, was associated with a higher burden of angiographic coronary artery disease.
Approach and Results—
We included 763 patients with premature acute coronary syndrome (median age, 50 [46–53] years; 30.8% women) with at least 1 major epicardial vessel stenosis enrolled in the Gender and Sex Determinants of Cardiovascular Disease From Bench to Beyond in Premature Acute Coronary Syndrome (GENESIS-PRAXY) study, a multicentre prospective cohort study of premature patients with acute coronary syndrome (aged ≤55 years). The prevalence of multivessel disease (ie, ≥2 vessels with >50% stenosis) in individuals with FHx was 49.7% as compared with 37.9% in those without FHx (
P
<0.01 for comparison). In adjusted models for age, sex, traditional risk factors, and GRS, FHx was associated with a higher prevalence of 3-vessel disease (odds ratio [OR], 1.42; 95% confidence interval, 0.91–2.21;
P
=0.12 for 2-vessel disease and OR, 2.26; 95% confidence interval, 1.29–3.95;
P
=0.005 for 3-vessel disease). Individuals with a high GRS were also more likely to have multivessel disease (OR, 1.41; 95% confidence interval, 1.01–1.99;
P
=0.047) after adjustment for traditional risk factors, including FHx. Individuals with both a FHx and a high GRS as compared with those with neither had the highest ORs for multivessel disease (adjusted OR, 2.14; 95% confidence interval, 1.24–3.69;
P
=0.0064).
Conclusions—
In patients with premature acute coronary syndrome, the presence of either a high GRS or FHx is associated with greater severity of coronary artery disease at angiography. Whether preventive strategies targeted to genetically predisposed individuals will reduce the burden of early acute coronary syndrome warrants further study.
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Affiliation(s)
- Waseem Hindieh
- From the Department of Medicine, McGill University, Montreal, Québec, Canada (W.H., L.P., C.L., J.C.E., G.T.); Department of Medicine, University of Toronto, Toronto, Ontario, Canada (A.C., H.A.-L.); and McGill University Health Center Research Institute, Montreal, QC, Canada (L.D., J.C.E.)
| | - Louise Pilote
- From the Department of Medicine, McGill University, Montreal, Québec, Canada (W.H., L.P., C.L., J.C.E., G.T.); Department of Medicine, University of Toronto, Toronto, Ontario, Canada (A.C., H.A.-L.); and McGill University Health Center Research Institute, Montreal, QC, Canada (L.D., J.C.E.)
| | - Asim Cheema
- From the Department of Medicine, McGill University, Montreal, Québec, Canada (W.H., L.P., C.L., J.C.E., G.T.); Department of Medicine, University of Toronto, Toronto, Ontario, Canada (A.C., H.A.-L.); and McGill University Health Center Research Institute, Montreal, QC, Canada (L.D., J.C.E.)
| | - Hatim Al-Lawati
- From the Department of Medicine, McGill University, Montreal, Québec, Canada (W.H., L.P., C.L., J.C.E., G.T.); Department of Medicine, University of Toronto, Toronto, Ontario, Canada (A.C., H.A.-L.); and McGill University Health Center Research Institute, Montreal, QC, Canada (L.D., J.C.E.)
| | - Christopher Labos
- From the Department of Medicine, McGill University, Montreal, Québec, Canada (W.H., L.P., C.L., J.C.E., G.T.); Department of Medicine, University of Toronto, Toronto, Ontario, Canada (A.C., H.A.-L.); and McGill University Health Center Research Institute, Montreal, QC, Canada (L.D., J.C.E.)
| | - Line Dufresne
- From the Department of Medicine, McGill University, Montreal, Québec, Canada (W.H., L.P., C.L., J.C.E., G.T.); Department of Medicine, University of Toronto, Toronto, Ontario, Canada (A.C., H.A.-L.); and McGill University Health Center Research Institute, Montreal, QC, Canada (L.D., J.C.E.)
| | - James C. Engert
- From the Department of Medicine, McGill University, Montreal, Québec, Canada (W.H., L.P., C.L., J.C.E., G.T.); Department of Medicine, University of Toronto, Toronto, Ontario, Canada (A.C., H.A.-L.); and McGill University Health Center Research Institute, Montreal, QC, Canada (L.D., J.C.E.)
| | - George Thanassoulis
- From the Department of Medicine, McGill University, Montreal, Québec, Canada (W.H., L.P., C.L., J.C.E., G.T.); Department of Medicine, University of Toronto, Toronto, Ontario, Canada (A.C., H.A.-L.); and McGill University Health Center Research Institute, Montreal, QC, Canada (L.D., J.C.E.)
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17
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Travison TG, O'Donnell CJ, Bhasin S, Massaro JM, Hoffmann U, Vasan RS, D'Agostino RB, Basaria S. Circulating Sex Steroids and Vascular Calcification in Community-Dwelling Men: The Framingham Heart Study. J Clin Endocrinol Metab 2016; 101:2160-7. [PMID: 26930184 PMCID: PMC4870846 DOI: 10.1210/jc.2015-4299] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT The relationship between sex steroids and atherosclerosis is poorly understood. OBJECTIVE To describe the association of serum total T (TT), calculated free T (cFT), estrone (E1), estradiol (E2), and SHBG to vascular calcification in adult men. DESIGN Observational study (Framingham Heart Study). Analyses are cross-sectional. TT, E1, and E2 were measured by liquid chromatography-tandem mass spectrometry, and SHBG by immunofluorometric assay. Estimates of association were obtained by Tobit regression, which acknowledges the influence of floor effects on outcomes. SETTING General community. PARTICIPANTS A total of 1654 community-dwelling men from the Offspring and Third Generation cohorts of the Framingham Heart Study. MAIN OUTCOME MEASURES Coronary artery calcification (CAC), abdominal aortic calcification, and thoracic aortic calcification were measured by computed tomography. RESULTS Mean (standard deviation [SD]) age was 49 (10) years. Mean (SD) TT, cFT, and SHBG were: 616 (224) ng/dL, 111 (45) pg/mL, and 46 (23) nmol/L, respectively. Mean (SD) E2 and E1 were 28 (10) and 39 (14) pg/mL. Vascular calcification at all sites was negatively associated with TT and cFT and positively associated with E2 and E1. A 100-ng/dL between-subjects increase in TT was associated with a mean (95% confidence interval) age-adjusted difference in CAC of -23% (-41%, -4%) (P = .02). After model adjustment for other cardiovascular risk factors, the estimated associations between T and vascular calcification scores were statistically nonsignificant. CONCLUSIONS Decreased circulating T and E2 levels are associated with an age-adjusted increase in CAC, but these associations appear to express relationships either attributable to or mediated by established cardiovascular risk factors.
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Affiliation(s)
- Thomas G Travison
- Hebrew SeniorLife Institute for Aging Research (T.G.T.), Roslindale, Massachusetts 02131; Research Program on Men's Health, Aging and Metabolism (T.G.T., S.Bh., S.Ba.), Brigham and Women's Hospital, Boston, Massachusetts 02115; Harvard Medical School (T.G.T., C.J.O., S.Bh., U.H., S.Ba.), Boston, Massachusetts 02115; National Heart, Lung and Blood Institute's Framingham Heart Study (C.J.O., J.M.M., R.S.V., R.B.D.), Framingham, Massachusetts 01702; Cardiology Division (C.J.O.), Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114; Department of Biostatistics (J.M.M.), Boston University School of Public Health, Boston, Massachusetts 02118; Department of Radiology (U.H.), Massachusetts General Hospital, Boston, Massachusetts 02114; Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, Boston, Massachusetts 02118; and Department of Mathematics (R.B.D.), Boston University, Boston, Massachusetts 02215
| | - Christopher J O'Donnell
- Hebrew SeniorLife Institute for Aging Research (T.G.T.), Roslindale, Massachusetts 02131; Research Program on Men's Health, Aging and Metabolism (T.G.T., S.Bh., S.Ba.), Brigham and Women's Hospital, Boston, Massachusetts 02115; Harvard Medical School (T.G.T., C.J.O., S.Bh., U.H., S.Ba.), Boston, Massachusetts 02115; National Heart, Lung and Blood Institute's Framingham Heart Study (C.J.O., J.M.M., R.S.V., R.B.D.), Framingham, Massachusetts 01702; Cardiology Division (C.J.O.), Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114; Department of Biostatistics (J.M.M.), Boston University School of Public Health, Boston, Massachusetts 02118; Department of Radiology (U.H.), Massachusetts General Hospital, Boston, Massachusetts 02114; Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, Boston, Massachusetts 02118; and Department of Mathematics (R.B.D.), Boston University, Boston, Massachusetts 02215
| | - Shalender Bhasin
- Hebrew SeniorLife Institute for Aging Research (T.G.T.), Roslindale, Massachusetts 02131; Research Program on Men's Health, Aging and Metabolism (T.G.T., S.Bh., S.Ba.), Brigham and Women's Hospital, Boston, Massachusetts 02115; Harvard Medical School (T.G.T., C.J.O., S.Bh., U.H., S.Ba.), Boston, Massachusetts 02115; National Heart, Lung and Blood Institute's Framingham Heart Study (C.J.O., J.M.M., R.S.V., R.B.D.), Framingham, Massachusetts 01702; Cardiology Division (C.J.O.), Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114; Department of Biostatistics (J.M.M.), Boston University School of Public Health, Boston, Massachusetts 02118; Department of Radiology (U.H.), Massachusetts General Hospital, Boston, Massachusetts 02114; Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, Boston, Massachusetts 02118; and Department of Mathematics (R.B.D.), Boston University, Boston, Massachusetts 02215
| | - Joseph M Massaro
- Hebrew SeniorLife Institute for Aging Research (T.G.T.), Roslindale, Massachusetts 02131; Research Program on Men's Health, Aging and Metabolism (T.G.T., S.Bh., S.Ba.), Brigham and Women's Hospital, Boston, Massachusetts 02115; Harvard Medical School (T.G.T., C.J.O., S.Bh., U.H., S.Ba.), Boston, Massachusetts 02115; National Heart, Lung and Blood Institute's Framingham Heart Study (C.J.O., J.M.M., R.S.V., R.B.D.), Framingham, Massachusetts 01702; Cardiology Division (C.J.O.), Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114; Department of Biostatistics (J.M.M.), Boston University School of Public Health, Boston, Massachusetts 02118; Department of Radiology (U.H.), Massachusetts General Hospital, Boston, Massachusetts 02114; Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, Boston, Massachusetts 02118; and Department of Mathematics (R.B.D.), Boston University, Boston, Massachusetts 02215
| | - Udo Hoffmann
- Hebrew SeniorLife Institute for Aging Research (T.G.T.), Roslindale, Massachusetts 02131; Research Program on Men's Health, Aging and Metabolism (T.G.T., S.Bh., S.Ba.), Brigham and Women's Hospital, Boston, Massachusetts 02115; Harvard Medical School (T.G.T., C.J.O., S.Bh., U.H., S.Ba.), Boston, Massachusetts 02115; National Heart, Lung and Blood Institute's Framingham Heart Study (C.J.O., J.M.M., R.S.V., R.B.D.), Framingham, Massachusetts 01702; Cardiology Division (C.J.O.), Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114; Department of Biostatistics (J.M.M.), Boston University School of Public Health, Boston, Massachusetts 02118; Department of Radiology (U.H.), Massachusetts General Hospital, Boston, Massachusetts 02114; Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, Boston, Massachusetts 02118; and Department of Mathematics (R.B.D.), Boston University, Boston, Massachusetts 02215
| | - Ramachandran S Vasan
- Hebrew SeniorLife Institute for Aging Research (T.G.T.), Roslindale, Massachusetts 02131; Research Program on Men's Health, Aging and Metabolism (T.G.T., S.Bh., S.Ba.), Brigham and Women's Hospital, Boston, Massachusetts 02115; Harvard Medical School (T.G.T., C.J.O., S.Bh., U.H., S.Ba.), Boston, Massachusetts 02115; National Heart, Lung and Blood Institute's Framingham Heart Study (C.J.O., J.M.M., R.S.V., R.B.D.), Framingham, Massachusetts 01702; Cardiology Division (C.J.O.), Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114; Department of Biostatistics (J.M.M.), Boston University School of Public Health, Boston, Massachusetts 02118; Department of Radiology (U.H.), Massachusetts General Hospital, Boston, Massachusetts 02114; Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, Boston, Massachusetts 02118; and Department of Mathematics (R.B.D.), Boston University, Boston, Massachusetts 02215
| | - Ralph B D'Agostino
- Hebrew SeniorLife Institute for Aging Research (T.G.T.), Roslindale, Massachusetts 02131; Research Program on Men's Health, Aging and Metabolism (T.G.T., S.Bh., S.Ba.), Brigham and Women's Hospital, Boston, Massachusetts 02115; Harvard Medical School (T.G.T., C.J.O., S.Bh., U.H., S.Ba.), Boston, Massachusetts 02115; National Heart, Lung and Blood Institute's Framingham Heart Study (C.J.O., J.M.M., R.S.V., R.B.D.), Framingham, Massachusetts 01702; Cardiology Division (C.J.O.), Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114; Department of Biostatistics (J.M.M.), Boston University School of Public Health, Boston, Massachusetts 02118; Department of Radiology (U.H.), Massachusetts General Hospital, Boston, Massachusetts 02114; Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, Boston, Massachusetts 02118; and Department of Mathematics (R.B.D.), Boston University, Boston, Massachusetts 02215
| | - Shehzad Basaria
- Hebrew SeniorLife Institute for Aging Research (T.G.T.), Roslindale, Massachusetts 02131; Research Program on Men's Health, Aging and Metabolism (T.G.T., S.Bh., S.Ba.), Brigham and Women's Hospital, Boston, Massachusetts 02115; Harvard Medical School (T.G.T., C.J.O., S.Bh., U.H., S.Ba.), Boston, Massachusetts 02115; National Heart, Lung and Blood Institute's Framingham Heart Study (C.J.O., J.M.M., R.S.V., R.B.D.), Framingham, Massachusetts 01702; Cardiology Division (C.J.O.), Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114; Department of Biostatistics (J.M.M.), Boston University School of Public Health, Boston, Massachusetts 02118; Department of Radiology (U.H.), Massachusetts General Hospital, Boston, Massachusetts 02114; Section of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, Boston, Massachusetts 02118; and Department of Mathematics (R.B.D.), Boston University, Boston, Massachusetts 02215
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Mulders TA, Taraboanta C, Franken LC, van Heel E, Klass G, Forster BB, Arad Y, Boekholdt SM, Groenink M, Fröhlich J, Guerci AD, Stroes ES, Pinto-Sietsma SJ. Coronary artery calcification score as tool for risk assessment among families with premature coronary artery disease. Atherosclerosis 2016; 245:155-60. [DOI: 10.1016/j.atherosclerosis.2015.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 12/01/2015] [Accepted: 12/04/2015] [Indexed: 01/07/2023]
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19
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Hecht HS. Coronary artery calcium scanning: past, present, and future. JACC Cardiovasc Imaging 2016; 8:579-596. [PMID: 25937196 DOI: 10.1016/j.jcmg.2015.02.006] [Citation(s) in RCA: 205] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 02/01/2015] [Accepted: 02/05/2015] [Indexed: 02/06/2023]
Abstract
Coronary artery calcium scanning (CAC) has emerged as the most robust predictor of coronary events in the asymptomatic primary prevention population, particularly in the intermediate-risk cohort. Every study has demonstrated its superiority to risk factor-based paradigms, e.g., the Framingham Risk Score, with outcome-based net reclassification indexes ranging from 52.0% to 65.6% in the intermediate-risk, 34.0% to 35.8% in the high-risk, and 11.6% to 15.0% in the low-risk cohorts. CAC improves medication and lifestyle adherence and is cost-effective in specified populations, with the ability to effectively stratify the number needed to treat and scan for different therapeutic strategies and patient cohorts. Data have emerged clearly demonstrating the worse prognosis associated with increasing CAC on serial scans, suggesting a potential role for evaluating residual risk and treatment success or failure. CAC is also strongly associated with the development of stroke and congestive heart failure.
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Affiliation(s)
- Harvey S Hecht
- Icahn School of Medicine at Mount Sinai, New York, New York.
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20
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Lee JH, Han D, ó Hartaigh B, Rizvi A, Gransar H, Park HB, Park HE, Choi SY, Chun EJ, Sung J, Park SH, Han HW, Min JK, Chang HJ. Warranty Period of Zero Coronary Artery Calcium Score for Predicting All-Cause Mortality According to Cardiac Risk Burden in Asymptomatic Korean Adults. Circ J 2016; 80:2356-2361. [DOI: 10.1253/circj.cj-16-0731] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Ji Hyun Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System
- Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital and Weill Cornell Medical College
| | - Donghee Han
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System
- Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital and Weill Cornell Medical College
| | - Bríain ó Hartaigh
- Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital and Weill Cornell Medical College
| | - Asim Rizvi
- Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital and Weill Cornell Medical College
| | | | - Hyung-Bok Park
- Division of Cardiology, Cardiovascular Center, Myongji Hospital
| | - Hyo Eun Park
- Division of Cardiology, Department of Internal Medicine, Healthcare System Gangnam Center, Seoul National University Hospital
| | - Su-Yeon Choi
- Division of Cardiology, Department of Internal Medicine, Healthcare System Gangnam Center, Seoul National University Hospital
| | - Eun Ju Chun
- Division of Radiology, Seoul National University Bundang Hospital
| | - Jidong Sung
- Division of Cardiology, Heart Stroke & Vascular Institute, Samsung Medical Center
| | | | - Hae-Won Han
- Department of Internal Medicine, Gangnam Heartscan Clinic
| | - James K. Min
- Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital and Weill Cornell Medical College
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System
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Knapper JT, Khosa F, Blaha MJ, Lebeis TA, Kay J, Sandesara PB, Kelkar AA, Berman DS, Quyyumi AA, Budoff MJ, Min JK, Valenti V, Giambrone AE, Callister TQ, Shaw LJ. Coronary calcium scoring for long-term mortality prediction in patients with and without a family history of coronary disease. Heart 2015; 102:204-8. [DOI: 10.1136/heartjnl-2015-308429] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 11/19/2015] [Indexed: 01/07/2023] Open
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22
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Ye Z, Bailey KR, Austin E, Kullo IJ. Family history of atherosclerotic vascular disease is associated with the presence of abdominal aortic aneurysm. Vasc Med 2015; 21:41-6. [PMID: 26566659 DOI: 10.1177/1358863x15611758] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
We investigated whether family history (FHx) of atherosclerotic cardiovascular disease (ASCVD) was associated with presence of abdominal aortic aneurysm (AAA). The study cohort comprised of 696 patients with AAA (70±8 years, 84% men) and 2686 controls (68±10 years, 61% men) recruited from noninvasive vascular and stress electrocardiogram (ECG) laboratories at Mayo Clinic. AAA was defined as a transverse diameter of abdominal aorta ⩾ 3 cm or history of AAA repair. Controls were not known to have AAA. FHx was defined as having at least one first-degree relative with aortic aneurysm or with onset of ASCVD (coronary, cerebral or peripheral artery disease) before age 65 years. FHx of aortic aneurysm or ASCVD were each associated with presence of AAA after adjustment for age, sex, conventional risk factors and ASCVD: adjusted odds ratios (OR; 95% confidence interval): 2.17 (1.66-2.83, p < 0.01) and 1.31 (1.08-1.59, p < 0.01), respectively. FHx of ASCVD remained associated with AAA after additional adjustment for FHx of aortic aneurysm: adjusted OR: 1.27 (1.05-1.55, p = 0.01). FHx of ASCVD in multiple arterial locations was associated with higher odds of having AAA: the adjusted odds were 1.23 times higher for each additionally affected arterial location reported in the FHx (1.08-1.40, p = 0.01). Our results suggest both unique and shared environmental and genetic factors mediating susceptibility to AAA and ASCVD.
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Affiliation(s)
- Zi Ye
- Division of Cardiovascular Diseases and the Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA
| | - Kent R Bailey
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Erin Austin
- Division of Cardiovascular Diseases and the Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA
| | - Iftikhar J Kullo
- Division of Cardiovascular Diseases and the Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA
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23
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Age and sex differences in the effect of parental stroke on the progression of carotid intima-media thickness. Atherosclerosis 2015; 241:229-33. [DOI: 10.1016/j.atherosclerosis.2015.02.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 02/06/2015] [Accepted: 02/11/2015] [Indexed: 10/24/2022]
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24
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Koulaouzidis G, Wong K, Charisopoulou D, McArthur T, Jenkins PJ, Henein MY. Coronary artery calcification is not related to coronary heart disease isolated family history. Int J Cardiol 2015; 190:271-2. [PMID: 25932803 DOI: 10.1016/j.ijcard.2015.04.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 04/09/2015] [Indexed: 10/23/2022]
Affiliation(s)
- G Koulaouzidis
- Heart Centre and Department of Public Health and Clinical Medicine, Umea University, Sweden; Academic Department of Cardiology, Hull York Medical School, Castle Hill Hospital, Kingston-upon-Hull, UK.
| | - K Wong
- Academic Department of Cardiology, Hull York Medical School, Castle Hill Hospital, Kingston-upon-Hull, UK
| | - D Charisopoulou
- Heart Centre and Department of Public Health and Clinical Medicine, Umea University, Sweden
| | | | | | - M Y Henein
- Heart Centre and Department of Public Health and Clinical Medicine, Umea University, Sweden
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25
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Kim YJ, Yong HS, Kim SM, Kim JA, Yang DH, Hong YJ. Korean guidelines for the appropriate use of cardiac CT. Korean J Radiol 2015; 16:251-85. [PMID: 25741189 PMCID: PMC4347263 DOI: 10.3348/kjr.2015.16.2.251] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 01/03/2015] [Indexed: 01/07/2023] Open
Abstract
The development of cardiac CT has provided a non-invasive alternative to echocardiography, exercise electrocardiogram, and invasive angiography and cardiac CT continues to develop at an exponential speed even now. The appropriate use of cardiac CT may lead to improvements in the medical performances of physicians and can reduce medical costs which eventually contribute to better public health. However, until now, there has been no guideline regarding the appropriate use of cardiac CT in Korea. We intend to provide guidelines for the appropriate use of cardiac CT in heart diseases based on scientific data. The purpose of this guideline is to assist clinicians and other health professionals in the use of cardiac CT for diagnosis and treatment of heart diseases, especially in patients at high risk or suspected of heart disease.
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Affiliation(s)
- Young Jin Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul 120-752, Korea
| | - Hwan Seok Yong
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul 152-703, Korea
| | - Sung Mok Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea
| | - Jeong A Kim
- Department of Radiology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang 411-706, Korea
| | - Dong Hyun Yang
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
| | - Yoo Jin Hong
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul 120-752, Korea
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Cardiovascular Disease Risk Assessment: a Review of Risk Factor-based Algorithms and Assessments of Vascular Health. CURRENT CARDIOVASCULAR RISK REPORTS 2014. [DOI: 10.1007/s12170-014-0419-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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27
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Cohen R, Budoff M, McClelland RL, Sillau S, Burke G, Blaha M, Szklo M, Uretsky S, Rozanski A, Shea S. Significance of a positive family history for coronary heart disease in patients with a zero coronary artery calcium score (from the Multi-Ethnic Study of Atherosclerosis). Am J Cardiol 2014; 114:1210-4. [PMID: 25152422 PMCID: PMC4177938 DOI: 10.1016/j.amjcard.2014.07.043] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 07/09/2014] [Accepted: 07/09/2014] [Indexed: 01/07/2023]
Abstract
Although a coronary artery calcium (CAC) score of 0 is associated with a very low 10-year risk for cardiac events, this risk is nonzero. Subjects with a family history of coronary heart disease (CHD) has been associated with more subclinical atherosclerosis than subjects without a family history of CHD. The purpose of this study was to assess the significance of a family history for CHD in subjects with a CAC score of 0. The Multi-Ethnic Study of Atherosclerosis cohort includes 6,814 participants free of clinical cardiovascular disease (CVD) at baseline. Positive family history was defined as reporting a parent, sibling, or child who had a heart attack. Time to incident CHD or CVD event was modeled using the multivariable Cox regression; 3,185 subjects were identified from the original Multi-Ethnic Study of Atherosclerosis cohort as having a baseline CAC score of 0 (mean age 58 years, 37% men). Over a median follow-up of 10 years, 101 participants (3.2%) had CVD events and 56 (1.8%) had CHD events. In age- and gender-adjusted analyses, a family history of CHD was associated with an ∼70% increase in CVD (hazard ratio 1.73, 95% confidence interval 1.17 to 2.56) and CHD (hazard ratio 1.72, 95% confidence interval 1.01 to 2.91) events. CVD events remained significant after further adjustment for ethnicity, risk factors, and baseline medication use. In conclusion, asymptomatic subjects with a 0 CAC score and a positive family history of CHD are at increased risk for CVD and CHD events compared with those without a family history of CHD, although absolute event rates remain low.
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Affiliation(s)
- Randy Cohen
- Division of Cardiology, Mt. Sinai St. Luke's-Roosevelt Hospital, New York, New York.
| | - Matthew Budoff
- Division of Cardiology, Los Angeles Biomedical Research Center, Torrence, California
| | - Robyn L McClelland
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Stefan Sillau
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Gregory Burke
- Division of Public Health Sciences, Wake Forest University, Winston-Salem, North Carolina
| | - Michael Blaha
- Ciccarone Preventive Cardiology Center, Johns Hopkins University, Baltimore, Maryland
| | - Moyses Szklo
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
| | - Seth Uretsky
- Department of Cardiology, Morristown Medical Center, Morristown, New Jersey
| | - Alan Rozanski
- Division of Cardiology, Mt. Sinai St. Luke's-Roosevelt Hospital, New York, New York
| | - Steven Shea
- Department of Medicine, Columbia University, New York, New York; Department of Epidemiology, Columbia University, New York, New York
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Amsterdam EA, Wenger NK, Brindis RG, Casey DE, Ganiats TG, Holmes DR, Jaffe AS, Jneid H, Kelly RF, Kontos MC, Levine GN, Liebson PR, Mukherjee D, Peterson ED, Sabatine MS, Smalling RW, Zieman SJ. 2014 AHA/ACC Guideline for the Management of Patients with Non-ST-Elevation Acute Coronary Syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 64:e139-e228. [PMID: 25260718 DOI: 10.1016/j.jacc.2014.09.017] [Citation(s) in RCA: 2055] [Impact Index Per Article: 205.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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29
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Amsterdam EA, Wenger NK, Brindis RG, Casey DE, Ganiats TG, Holmes DR, Jaffe AS, Jneid H, Kelly RF, Kontos MC, Levine GN, Liebson PR, Mukherjee D, Peterson ED, Sabatine MS, Smalling RW, Zieman SJ. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014; 130:e344-426. [PMID: 25249585 DOI: 10.1161/cir.0000000000000134] [Citation(s) in RCA: 628] [Impact Index Per Article: 62.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Ertelt K, Généreux P, Mintz GS, Brener SJ, Kirtane AJ, McAndrew TC, Francese DP, Ben-Yehuda O, Mehran R, Stone GW. Clinical profile and impact of family history of premature coronary artery disease on clinical outcomes of patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction: analysis from the HORIZONS-AMI Trial. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2014; 15:375-80. [PMID: 25288517 DOI: 10.1016/j.carrev.2014.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 09/02/2014] [Accepted: 09/08/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND/PURPOSE Family history of coronary artery disease (CAD) is a well-established risk factor of future cardiovascular events. The authors sought to examine the relationship between family history of CAD and clinical profile and prognosis of patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). MATERIALS/METHODS Baseline features and clinical outcomes at 30 days and at 3 years from 3601 patients with STEMI enrolled in the HORIZONS-AMI trial were compared in patients with and without family history of premature CAD, which was present in 1059 patients (29.4%). RESULTS These patients were younger (median 56.7 vs. 62.1years, P<0.0001) and more often current smokers (52.4% vs. 43.5%, P<0.0001), had more dyslipidemia (47.7% vs. 41.1%, P=0.0003), less diabetes mellitus (14.1% vs. 17.5%, P=0.01) and had shorter symptom onset to balloon times (median 213 vs. 225 min, P=0.02). Patients with a family history of premature CAD had higher rates of final TIMI 3 flow (93.8% vs. 90.6%, P=0.002), and myocardial blush grade 2 or 3 (83.2% vs. 78.0% P=0.0008), and fewer procedural complications. Although the unadjusted 30-day and 3-year mortality rates were lower in patients with a family history of premature CAD (1.8% vs. 3.0%, P=0.046 and 4.8% vs. 7.7%, P=0.002, respectively), by multivariable analysis the presence of a family history of premature CAD was not an independent predictor of death at 3 years (HR [95%CI]=1.00 [0.70, 1.44], P=0.98). CONCLUSIONS A family history of premature CAD is not an independent predictor of higher mortality.
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Affiliation(s)
| | - Philippe Généreux
- Cardiovascular Research Foundation, New York, NY, USA; Columbia University Medical Center, New York, NY, USA; Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Québec, Canada.
| | - Gary S Mintz
- Cardiovascular Research Foundation, New York, NY, USA
| | - Sorin J Brener
- Cardiovascular Research Foundation, New York, NY, USA; New York Methodist Hospital, Brooklyn, NY, USA
| | - Ajay J Kirtane
- Cardiovascular Research Foundation, New York, NY, USA; Columbia University Medical Center, New York, NY, USA
| | | | | | | | - Roxana Mehran
- Cardiovascular Research Foundation, New York, NY, USA; Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gregg W Stone
- Cardiovascular Research Foundation, New York, NY, USA; Columbia University Medical Center, New York, NY, USA
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Khaleghi M, Isseh IN, Bailey KR, Kullo IJ. Family history as a risk factor for peripheral arterial disease. Am J Cardiol 2014; 114:928-32. [PMID: 25107577 DOI: 10.1016/j.amjcard.2014.06.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 06/12/2014] [Accepted: 06/12/2014] [Indexed: 10/25/2022]
Abstract
The association of a family history of peripheral arterial disease (PAD) with the presence of PAD is largely unknown. We conducted a case-control study of 2,296 patients with PAD (69 ± 10 years, 64% men) and 4,390 controls (66 ± 11 years, 62% men) identified from noninvasive vascular and stress testing laboratories at Mayo Clinic, Rochester, Minnesota, from October 2006 through June 2012. PAD was defined as an ankle brachial index of ≤ 0.9 at rest and/or after exercise, a history of lower extremity revascularization, or having poorly compressible leg arteries. Controls were patients with normal ankle brachial index or without a history of PAD. Family history of PAD was defined as having at least 1 first-degree relative who had undergone revascularization or stent placement for PAD before the age of 65 years. Logistic regression analyses were used to evaluate whether a family history of PAD was associated with the presence of PAD, independent of conventional risk factors. A family history of PAD was present more often in patients with PAD than in controls, with a resulting odds ratio (OR) of 2.20 (95% confidence interval [CI] 1.82 to 2.67). The association remained significant after adjustment for conventional risk factors (OR 1.97, 95% CI 1.60 to 2.42). The association was stronger in younger subjects (age <68 years; adjusted OR 2.46, 95% CI 1.79 to 3.38) than in older subjects (adjusted OR 1.61, 95% CI 1.22 to 2.12). A greater number of affected relatives with PAD was also associated with greater odds of presence of PAD (adjusted OR 1.86, 95% CI 1.48 to 2.33 and adjusted OR 2.56, 95% CI 1.60 to 4.11 for patients with 1 and ≥ 2 affected relatives with PAD, respectively). In conclusion, individuals with a family history of PAD have nearly double the odds of having PAD relative to those without such a history.
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32
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Andersson C, Vasan RS. Is there a role for coronary artery calcium scoring for management of asymptomatic patients at risk for coronary artery disease?: Clinical risk scores are sufficient to define primary prevention treatment strategies among asymptomatic patients. Circ Cardiovasc Imaging 2014; 7:390-7; discussion 397. [PMID: 24642921 DOI: 10.1161/circimaging.113.000470] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Charlotte Andersson
- The National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA
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33
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Khaleghi M, Isseh IN, Jouni H, Sohn S, Bailey KR, Kullo IJ. Family History as a Risk Factor for Carotid Artery Stenosis. Stroke 2014; 45:2252-6. [DOI: 10.1161/strokeaha.114.006245] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mahyar Khaleghi
- From the Divisions of Cardiovascular Diseases (M.K., I.N.I., H.J., I.J.K.) and Biomedical Statistics and Informatics (S.S., K.R.B.), Mayo Clinic, Rochester, MN
| | - Iyad N. Isseh
- From the Divisions of Cardiovascular Diseases (M.K., I.N.I., H.J., I.J.K.) and Biomedical Statistics and Informatics (S.S., K.R.B.), Mayo Clinic, Rochester, MN
| | - Hayan Jouni
- From the Divisions of Cardiovascular Diseases (M.K., I.N.I., H.J., I.J.K.) and Biomedical Statistics and Informatics (S.S., K.R.B.), Mayo Clinic, Rochester, MN
| | - Sunghwan Sohn
- From the Divisions of Cardiovascular Diseases (M.K., I.N.I., H.J., I.J.K.) and Biomedical Statistics and Informatics (S.S., K.R.B.), Mayo Clinic, Rochester, MN
| | - Kent R. Bailey
- From the Divisions of Cardiovascular Diseases (M.K., I.N.I., H.J., I.J.K.) and Biomedical Statistics and Informatics (S.S., K.R.B.), Mayo Clinic, Rochester, MN
| | - Iftikhar J. Kullo
- From the Divisions of Cardiovascular Diseases (M.K., I.N.I., H.J., I.J.K.) and Biomedical Statistics and Informatics (S.S., K.R.B.), Mayo Clinic, Rochester, MN
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Blankstein R, Foody JM. Screening for coronary artery disease in patients with family history… how, when, and in whom? Circ Cardiovasc Imaging 2014; 7:417-9. [PMID: 24847006 DOI: 10.1161/circimaging.114.001985] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ron Blankstein
- From the Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA (R.B.); Harvard Medical School, Boston, MA (R.B., J.M.F.); and Preventive Cardiology, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (R.B., J.M.F.).
| | - JoAnne M Foody
- From the Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA (R.B.); Harvard Medical School, Boston, MA (R.B., J.M.F.); and Preventive Cardiology, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (R.B., J.M.F.)
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Improving assessment of cardiovascular disease risk by using family history: an integrative literature review. J Cardiovasc Nurs 2014; 28:E18-27. [PMID: 23782863 DOI: 10.1097/jcn.0b013e318294b206] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Cardiovascular disease (CVD) is the number one killer in the United States. Although the causes of CVD are multifactorial, including genetic and environmental influences, it is largely a preventable disease. The cornerstone of CVD prevention is accuracy in risk prediction to identify patients who will benefit from interventions aimed at reducing risk. Nurse practitioners commonly perform CVD risk assessments and are well positioned to impact preventive therapy. Cardiovascular disease risk scoring systems currently in use substantially underestimate risk in large part because these do not include family history of premature CVD as a high-risk factor. PURPOSE We sought to examine the state of evidence for the use of family history as a predictor in CVD risk stratification. CONCLUSIONS A comprehensive literature search using the Medical Subject Headings terms of family history of CVD, family history of premature CVD, risk assessment, and risk estimation displayed 416 articles; a review of the titles and subsequent evaluation of the articles eliminated 392 references, leaving 24 for review. By incorporating family history in risk assessment, categorization of CVD risk improves substantially. The evidence demonstrates that family history is an independent contributor to risk appraisal and unequivocally supports its incorporation to improve accuracy in global CVD risk estimation. CLINICAL IMPLICATIONS Underestimation of CVD risk leaves patients and providers misinformed, promoting the ongoing epidemic of chronic disease. Translating this evidence into practice by establishing a clinical algorithm that incorporates family history into risk prediction will standardize CVD risk assessment, improve the identification of high-risk patients, and provide the indicated aggressive care to prevent CVD.
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Suh B, Shin DW, Lee SP, Lee H, Lee H, Park EA, Cho B. Family history of coronary heart disease is more strongly associated with coronary than with carotid atherosclerosis in healthy asymptomatic adults. Atherosclerosis 2014; 233:584-589. [DOI: 10.1016/j.atherosclerosis.2014.01.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 12/31/2013] [Accepted: 01/21/2014] [Indexed: 11/25/2022]
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Panagiotakos DB. Family history of coronary heart disease as a predictor of the incidence and progression of coronary artery calcification. Atherosclerosis 2014; 233:30-1. [PMID: 24529118 DOI: 10.1016/j.atherosclerosis.2013.07.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Accepted: 07/01/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Demosthenes B Panagiotakos
- School of Health Science and Education, Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.
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38
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Prabhakaran D, Jeemon P. Should your family history of coronary heart disease scare you? ACTA ACUST UNITED AC 2013; 79:721-32. [PMID: 23239210 DOI: 10.1002/msj.21348] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Traditional risk factors explain most of the risk associated with coronary heart disease, and after adjustment for risk factors family history was believed to contribute very little to population-attributable risk of coronary heart disease. However, the INTERHEART study demonstrated an independent association of family history of coronary heart disease with acute myocardial infarction. To assess this relationship more comprehensively in multiple datasets in different populations, we carried out a detailed review of the available evidence. Case-control studies involving 17,202 cases and 30,088 controls yielded a pooled unadjusted odds ratio (random-effects model, overall I(2) = 64.6%, P = 0.000) of 2.03 (95% confidence interval: 1.79-2.30), whereas cohort studies that included 313,837 individuals yielded an unadjusted relative risk for future coronary heart disease (random-effects model, overall I(2) = 88.7%, P = 0.000) of 1.60 (95% confidence interval: 1.44-1.77). Although the presence of family history of coronary heart disease indicates a cumulative exposure of shared genes and environment, the risk estimates for family history did not attenuate significantly after adjustment for conventional coronary heart disease risk factors in several studies. It is probably an oversimplification to dichotomize the family history variable into a simple "yes" or "no" risk factor, as the significance of family history is influenced by several variables, such as age, sex, number of relatives, and age at onset of disease in the relatives. Moreover, a quantitative risk-assessment model for the family history variable, such as the "family risk score," has a positive linear relationship with coronary heart disease. More studies are warranted to assess the benefits and risks of intensive interventions, both targeted individually and at the family level, among individuals with a valid family history and borderline elevated risk factors.
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39
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Pandey AK, Blaha MJ, Sharma K, Rivera J, Budoff MJ, Blankstein R, Al-Mallah M, Wong ND, Shaw L, Carr J, O'Leary D, Lima JAC, Szklo M, Blumenthal RS, Nasir K. Family history of coronary heart disease and the incidence and progression of coronary artery calcification: Multi-Ethnic Study of Atherosclerosis (MESA). Atherosclerosis 2013; 232:369-76. [PMID: 24468150 DOI: 10.1016/j.atherosclerosis.2013.11.042] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 09/20/2013] [Accepted: 11/07/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We evaluated family history as a predictor of incident and progressive coronary artery calcium (CAC) using data from the Multi-Ethnic Study of Atherosclerosis (MESA). BACKGROUND MESA is a multi-center prospective study of 6814 asymptomatic individuals. The relationship between family history of coronary heart disease (CHD) and CAC incidence or progression has not been described previously. METHODS A total of 5099 participants had detailed information about family history of CHD (late versus premature and parental versus sibling history). The mean time between CAC scans was 3.1 ± 1.3 years. The association of late versus premature family history was assessed against CAC change using multivariate regression model adjusted for demographics and cardiac risk factors. RESULTS A family history of premature CHD was associated with an odds ratio (OR) of 1.55 (p < 0.01) for incident development of CAC after adjusting for risk factors and demographics. A premature family history was associated with 14.4 units (p < 0.01) greater volume scores compared to those with no family history in similarly adjusted models by median regression analysis. A combined parental and sibling family history was associated with the greatest incidence and progression in demographic-adjusted models. Caucasians demonstrated the most consistent predictive relationship between family history of premature CHD and incidence (p < 0.01) and progression (p < 0.05) of CAC, though no significant interaction with ethnicity was noted. CONCLUSIONS Family history of premature CHD is associated with enhanced development and progression of subclinical disease, independent of other risk factors, in a multiethnic, population-based study.
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Affiliation(s)
- Arvind K Pandey
- Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Michael J Blaha
- Johns Hopkins Ciccarone Preventive Cardiology Center, Baltimore, MD, USA
| | - Kavita Sharma
- Johns Hopkins Ciccarone Preventive Cardiology Center, Baltimore, MD, USA
| | - Juan Rivera
- Johns Hopkins Ciccarone Preventive Cardiology Center, Baltimore, MD, USA
| | - Matthew J Budoff
- Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA, USA
| | - Ron Blankstein
- Non-invasive Cardiovascular Imaging Program, Brigham and Women's Hospital, Boston, MA, USA
| | - Mouaz Al-Mallah
- Heart and Vascular Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Nathan D Wong
- Division of Cardiology, University of California, Irvine, CA, USA
| | - Leslee Shaw
- Division of Cardiology, Emory University, Atlanta, GA, USA
| | - Jeffery Carr
- Department of Radiology, Wake Forest University Health Sciences, Winston-Salem, NC, USA
| | | | - Joao A C Lima
- Johns Hopkins Ciccarone Preventive Cardiology Center, Baltimore, MD, USA
| | - Moyses Szklo
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Roger S Blumenthal
- Johns Hopkins Ciccarone Preventive Cardiology Center, Baltimore, MD, USA
| | - Khurram Nasir
- Johns Hopkins Ciccarone Preventive Cardiology Center, Baltimore, MD, USA; Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, FL, USA; Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA; Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL, USA.
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Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE, Chavey WE, Fesmire FM, Hochman JS, Levin TN, Lincoff AM, Peterson ED, Theroux P, Wenger NK, Wright RS, Zoghbi WA, Arend TE, Oetgen WJ, May C, Bradfield L, Keller S, Ramadhan E, Tomaselli GF, Brown N, Robertson RM, Whitman GR, Bezanson JL, Hundley J. 2012 ACCF/AHA Focused Update Incorporated Into the ACCF/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction. Circulation 2013; 127:e663-828. [DOI: 10.1161/cir.0b013e31828478ac] [Citation(s) in RCA: 181] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Hong SJ, Chang HJ, Park S, Kang DR, Shin S, Cho IJ, Shim CY, Hong GR, Ha JW, Chung N. Impact of atorvastatin treatment in first-degree relatives of patients with premature coronary artery disease with endothelial dysfunction: a double-blind, randomized, placebo-controlled crossover trial. Clin Cardiol 2013; 36:480-5. [PMID: 23754711 DOI: 10.1002/clc.22152] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 05/06/2013] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND A family history of premature coronary artery disease (CAD) is a well-known risk factor for cardiovascular events. HYPOTHESIS Atorvastatin may improve endothelial dysfunction (ED) in the first-degree relatives (FDRs) of patients with premature CAD with ED. METHODS Thirty-five FDRs (median age, 52 years [interquartile range (IQR), 46-57 years], 21 male) of patients with premature CAD with ED were recruited in a prospective trial with a crossover double-blind design: 6 weeks of treatment with atorvastatin 40 mg/day followed by placebo, or vice versa. After each treatment, the digital pulse wave amplitude was determined by EndoPAT to obtain the reactive hyperemia index (RHI), a measure for endothelial function. The primary outcome was the difference of RHI between atorvastatin and placebo treatment. RESULTS Low-density lipoprotein cholesterol was lower after atorvastatin compared with placebo treatment (124 [102-145] mg/dL vs 67 [50-73] mg/dL, P < 0.001). However, RHI was not different after atorvastatin compared with placebo treatment (1.9 [1.5-2.4] vs 1.9 [1.6-2.2], P = 0.902). Also, the augmentation index was similar after each treatment. These results were observed both in subjects who had indications for statin treatment (31%) and those who did not (69%) according to National Cholesterol Education Program Adult Treatment Panel III guidelines. CONCLUSIONS Despite improvement in the lipid profile, atorvastatin failed to improve ED in the FDRs of patients with premature CAD with ED. Although we identified those with ED in FDRs of patients with premature CAD as a high-risk group for future cardiovascular events, atorvastatin treatment may not be a beneficial primary prevention strategy for this population.
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Affiliation(s)
- Sung-Jin Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Pandey AK, Pandey S, Blaha MJ, Agatston A, Feldman T, Ozner M, Santos RD, Budoff MJ, Blumenthal RS, Nasir K. Family history of coronary heart disease and markers of subclinical cardiovascular disease: Where do we stand? Atherosclerosis 2013; 228:285-94. [DOI: 10.1016/j.atherosclerosis.2013.02.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 01/13/2013] [Accepted: 02/14/2013] [Indexed: 10/27/2022]
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Van daele CM, De Meyer T, De Buyzere ML, Gillebert TC, Denil SLIJ, Bekaert S, Chirinos JA, Segers P, De Backer GG, De Bacquer D, Rietzschel ER. Addition of a novel, protective family history category allows better profiling of cardiovascular risk and atherosclerotic burden in the general population. The Asklepios Study. PLoS One 2013; 8:e63185. [PMID: 23658806 PMCID: PMC3642069 DOI: 10.1371/journal.pone.0063185] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 03/29/2013] [Indexed: 11/19/2022] Open
Abstract
Objectives Whereas the importance of family history (FH) is widely recognized in cardiovascular risk assessment, its full potential could be underutilized, when applied with its current simple guidelines-based definition (cFH): presence of premature cardiovascular disease (CVD) in a first-degree relative. We tested the added value of a new, extended family history definition (eFH), also taking into account later onset of disease, second-degree relatives and number of affected relatives, on profiling cardiovascular risk and atherosclerotic burden in the general population. Design longitudinal population study. Setting random, representative population sample from Erpe-Mere and Nieuwerkerken (Belgium, primary care). Subjects 2524 male/female volunteers, aged 35–55 years, free from overt CVD. Main outcome measures Subjects were extensively phenotyped including presence of atherosclerosis (ultrasound) and a newly developed FH questionnaire (4 generations). Results Compared to cFH, eFH was superior in predicting an adverse risk profile (glycemic state, elevated blood pressure, lipid abnormalities, presence of metabolic syndrome components) and presence of atherosclerosis (all age & sex-adjusted p<0.05). Unlike cFH, eFH remained a significant predictor of subclinical atherosclerosis after adjusting for confounders. Most relations with eFH were not graded but showed clear informational breakpoints, with absence of CVD (including late onset) in any first-degree relative being a negative predictor of atherosclerosis, and a particularly interesting phenotype for further study. Conclusions A novel, extended FH definition is superior to the conventional definition in profiling cardiovascular risk and atherosclerotic burden in the general population. There remain clear opportunities to refine and increase the performance and informational content of this simple, readily-available inexpensive tool.
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Affiliation(s)
- Caroline M Van daele
- Department of Cardiovascular Diseases, Ghent University Hospital, Ghent, Belgium.
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Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE, Chavey WE, Fesmire FM, Hochman JS, Levin TN, Lincoff AM, Peterson ED, Theroux P, Wenger NK, Wright RS, Jneid H, Ettinger SM, Ganiats TG, Philippides GJ, Jacobs AK, Halperin JL, Albert NM, Creager MA, DeMets D, Guyton RA, Kushner FG, Ohman EM, Stevenson W, Yancy CW. 2012 ACCF/AHA focused update incorporated into the ACCF/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013; 61:e179-347. [PMID: 23639841 DOI: 10.1016/j.jacc.2013.01.014] [Citation(s) in RCA: 373] [Impact Index Per Article: 33.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Sunman H, Yorgun H, Canpolat U, Hazırolan T, Kaya EB, Ateş AH, Dural M, Aytemir K, Tokgözoğlu L, Kabakçı G, Akata D, Oto A. Association between family history of premature coronary artery disease and coronary atherosclerotic plaques shown by multidetector computed tomography coronary angiography. Int J Cardiol 2013; 164:355-8. [PMID: 21807431 DOI: 10.1016/j.ijcard.2011.07.043] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2011] [Revised: 07/07/2011] [Accepted: 07/10/2011] [Indexed: 11/24/2022]
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Abed Y, Abu-Haddaf S. Risk Factors of Hypertension at UNRWA Primary Health Care Centers in Gaza Governorates. ACTA ACUST UNITED AC 2013. [DOI: 10.5402/2013/720760] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Universally, hypertension is a major public health problem. Identification of risk factors for hypertension supports intervention policies to minimize the disease morbidity and mortality. The main objective is to fill a gap in research literature by establishing baseline information for hypertension risk factors among Palestinians. Methods. A case control study was conducted at UNRWA health care services in Gaza Strip. A proportional systematic random sample of 120 cases matched with sex, and locality to 120 controls were chosen. Data was collected using a questionnaire which included socio-demographic data, lifestyle, and health profile. Collected data was analyzed using SPSS V13. Results. The most common modifiable risk factors of hypertension were physical inactivity (76.7% versus 15.9%), obesity (67.5% versus 29.2%), diabetes mellitus (19.2% versus 7.5%), and ex-smoking (15.5% versus 1%). Cases and controls show statistical significant differences in values for the lipid profile. Hypertension was significantly associated with low socio economic status, education, and employment. The most common non-modifiable risk factors were age, and family history (85.8% versus 71.7%). Multiple logistic analysis controlling for age showed that significant predictors of hypertension were obesity, physical inactivity, low monthly income and family history. Conclusion. Most of the identified hypertension risk factors are preventable.
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Affiliation(s)
- Y. Abed
- School of Public Health, Al-Quds University, Jeruslem, Palestine
| | - S. Abu-Haddaf
- Quality Control Department, Palestinian Ministry of Health, Gaza, Palestine
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Angiotensinogen gene polymorphism and HDL2 are linked to coronary artery calcification in individuals with family history of early coronary disease. Atherosclerosis 2013; 226:339-40. [DOI: 10.1016/j.atherosclerosis.2012.11.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 11/13/2012] [Indexed: 11/23/2022]
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Nasir K, Clouse M. Role of nonenhanced multidetector CT coronary artery calcium testing in asymptomatic and symptomatic individuals. Radiology 2012; 264:637-49. [PMID: 22919038 DOI: 10.1148/radiol.12110810] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Arteriosclerotic cardiovascular disease is the leading cause of death in the United States, with coronary artery disease (CAD) accounting for half of all cardiovascular disease deaths. Current risk assessment approaches for coronary heart disease, such as the Framingham risk score, substantially misclassify intermediate- to long-term risk for the occurrence of CAD in asymptomatic individuals. A screening modality such as a simple non-contrast-enhanced, or noncontrast, computed tomographic (CT) detection of coronary artery calcium (CAC) improves the ability to accurately predict risk in vulnerable groups and adds information above and beyond global risk assessment as shown by the recent Multi-Ethnic Study of Atherosclerosis. In addition, absence of CAC is associated with a very low risk of future CAD and as a result can be used to identify a group among which further testing and pharmacotherapies can be avoided. The Expert Consensus Document by the American College of Cardiology Foundation and the American Heart Association now recommends screening individuals at intermediate risk but did not find enough evidence to recommend CAC testing and further stratification of those in the low- or high-risk categories for CAD. In addition, emerging guidelines have suggested that absence of CAC can act as a "gatekeeper" for further testing among low- and intermediate-risk patients presenting with chest pain. This review of the current literature outlines the role of CAC testing in both asymptomatic and symptomatic individuals.
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Affiliation(s)
- Khurram Nasir
- Center for Prevention and Wellness, Baptist Health South Florida, 1691 Michigan Ave, Suite 500, Miami Beach, FL 33139, USA.
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Wahl S, Möhlenkamp S, Erbel R, Moebus S, Andrich S, Stang A, Jöckel KH, Dragano N. Screening results for subclinical coronary artery calcification in asymptomatic individuals in relation to a detailed parental history of premature coronary heart disease. Eur J Epidemiol 2012; 28:301-10. [DOI: 10.1007/s10654-012-9743-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Accepted: 10/23/2012] [Indexed: 10/27/2022]
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Claassen L, Henneman L, van der Weijden T, Marteau T, Timmermans D. Being at risk for cardiovascular disease: Perceptions and preventive behavior in people with and without a known genetic predisposition. PSYCHOL HEALTH MED 2012; 17:511-21. [DOI: 10.1080/13548506.2011.644246] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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