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Anderson JL, Knight S, Dong L, May HT, Le VT, Bair TL, Knowlton KU. Coronary Calcium Is Elevated in Patients with Myocardial Infarction without Standard Modifiable Risk Factors. J Clin Med 2024; 13:2569. [PMID: 38731098 PMCID: PMC11084599 DOI: 10.3390/jcm13092569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 04/15/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024] Open
Abstract
Objectives: Recent reports have highlighted myocardial infarction (MI) patients without standard modifiable risk factors (SMRF), noting them to be surprisingly common and to have a substantial risk of adverse outcomes. The objective of this study was to address the challenge of identifying at-risk patients without SMRF and providing preventive therapy. Methods: Patients presenting between 2001 and 2021 to Intermountain Health catheterization laboratories with a diagnosis of MI were included if they also had a coronary artery calcium (CAC) scan by computed tomography within 2 years. SMRF were defined as a clinical diagnosis or treatment of hypertension, hyperlipidemia, diabetes, or smoking. The co-primary endpoints in SMRF-less patients were: (1) proportion of patients with an elevated (>50%ile) CAC score, and (2) an indication for statin therapy (i.e., CAC ≥ 100 AU or ≥75%ile). The 60-day and long-term major adverse cardiovascular events were determined. A comparison set included MI patients with SMRF. Results: We identified 429 MI patients with a concurrent CAC scan, of which 60 had no SMRF. SMRF status did not distinguish most risk factors or interventions. No-SMRF patients had a high CAC prevalence and percentile (82% ≥ 50%ile; median, 80%ile), and 77% met criteria for preventive therapy. As expected, patients with SMRF had high CAC scores and percentiles. Outcomes were more favorable for No-SMRF status and for lower CAC scores. Conclusions: Patients without SMRF presenting with an MI have a high prevalence and percentile of CAC. Wider application of CAC scans, including in those without SMRF, is promising as a method to identify an additional at-risk population for MI and to provide primary preventive therapy.
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Affiliation(s)
- Jeffrey L. Anderson
- Intermountain Medical Center Heart Institute, Salt Lake City, UT 84107, USA; (S.K.); (L.D.); (H.T.M.); (V.T.L.); (T.L.B.); (K.U.K.)
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT 84112, USA
| | - Stacey Knight
- Intermountain Medical Center Heart Institute, Salt Lake City, UT 84107, USA; (S.K.); (L.D.); (H.T.M.); (V.T.L.); (T.L.B.); (K.U.K.)
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT 84112, USA
| | - Li Dong
- Intermountain Medical Center Heart Institute, Salt Lake City, UT 84107, USA; (S.K.); (L.D.); (H.T.M.); (V.T.L.); (T.L.B.); (K.U.K.)
| | - Heidi T. May
- Intermountain Medical Center Heart Institute, Salt Lake City, UT 84107, USA; (S.K.); (L.D.); (H.T.M.); (V.T.L.); (T.L.B.); (K.U.K.)
| | - Viet T. Le
- Intermountain Medical Center Heart Institute, Salt Lake City, UT 84107, USA; (S.K.); (L.D.); (H.T.M.); (V.T.L.); (T.L.B.); (K.U.K.)
- Rocky Mountain University of Health Professions, Provo, UT 84606, USA
| | - Tami L. Bair
- Intermountain Medical Center Heart Institute, Salt Lake City, UT 84107, USA; (S.K.); (L.D.); (H.T.M.); (V.T.L.); (T.L.B.); (K.U.K.)
| | - Kirk U. Knowlton
- Intermountain Medical Center Heart Institute, Salt Lake City, UT 84107, USA; (S.K.); (L.D.); (H.T.M.); (V.T.L.); (T.L.B.); (K.U.K.)
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT 84112, USA
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Garg PK, Bhatia HS, Allen TS, Grainger T, Pouncey AL, Dichek D, Virmani R, Golledge J, Allison MA, Powell JT. Assessment of Subclinical Atherosclerosis in Asymptomatic People In Vivo: Measurements Suitable for Biomarker and Mendelian Randomization Studies. Arterioscler Thromb Vasc Biol 2024; 44:24-47. [PMID: 38150519 PMCID: PMC10753091 DOI: 10.1161/atvbaha.123.320138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
BACKGROUND One strategy to reduce the burden of cardiovascular disease is the early detection and treatment of atherosclerosis. This has led to significant interest in studies of subclinical atherosclerosis, using different phenotypes, not all of which are accurate reflections of the presence of asymptomatic atherosclerotic plaques. The aim of part 2 of this series is to provide a review of the existing literature on purported measures of subclinical disease and recommendations concerning which tests may be appropriate in the prevention of incident cardiovascular disease. METHODS We conducted a critical review of measurements used to infer the presence of subclinical atherosclerosis in the major conduit arteries and focused on the predictive value of these tests for future cardiovascular events, independent of conventional cardiovascular risk factors, in asymptomatic people. The emphasis was on studies with >10 000 person-years of follow-up, with meta-analysis of results reporting adjusted hazard ratios (HRs) with 95% CIs. The arterial territories were limited to carotid, coronary, aorta, and lower limb arteries. RESULTS In the carotid arteries, the presence of plaque (8 studies) was independently associated with future stroke (pooled HR, 1.89 [1.04-3.44]) and cardiac events (7 studies), with a pooled HR, 1.77 (1.19-2.62). Increased coronary artery calcium (5 studies) was associated with the risk of coronary heart disease events, pooled HR, 1.54 (1.07-2.07) and increasing severity of calcification (by Agaston score) was associated with escalation of risk (13 studies). An ankle/brachial index (ABI) of <0.9, the pooled HR for cardiovascular death from 7 studies was 2.01 (1.43-2.81). There were insufficient studies of either, thoracic or aortic calcium, aortic diameter, or femoral plaque to synthesize the data based on consistent reporting of these measures. CONCLUSIONS The presence of carotid plaque, coronary artery calcium, or abnormal ankle pressures seems to be a valid indicator of the presence of subclinical atherosclerosis and may be considered for use in biomarker, Mendelian randomization and similar studies.
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Affiliation(s)
- Parveen K Garg
- Division of Cardiology, University of Southern California, Keck School of Medicine, Los Angeles (G.P.)
| | - Harpreet S Bhatia
- Division of Cardiovascular Medicine, University of California San Diego (B.H., A.T., A.M.A.)
| | - Tara S Allen
- Division of Cardiovascular Medicine, University of California San Diego (B.H., A.T., A.M.A.)
| | - Tabitha Grainger
- Department of Surgery & Cancer, Imperial College London (G.T., P.A.-L., P.J.T.)
| | - Anna L Pouncey
- Department of Surgery & Cancer, Imperial College London (G.T., P.A.-L., P.J.T.)
| | - David Dichek
- Division of Cardiology, Department of Medicine, University of Washington, Seattle (D.D.)
| | | | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, James Cook University and Townsville University Hospital, Australia (G.J.)
| | - Matthew A Allison
- Division of Cardiovascular Medicine, University of California San Diego (B.H., A.T., A.M.A.)
| | - Janet T Powell
- Department of Surgery & Cancer, Imperial College London (G.T., P.A.-L., P.J.T.)
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Jacobi N, Ortman S, Buda L, Duprez D. Effect of insulin resistance on CAC scores in cancer survivors. CARDIO-ONCOLOGY (LONDON, ENGLAND) 2023; 9:21. [PMID: 37060010 PMCID: PMC10103502 DOI: 10.1186/s40959-023-00168-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/20/2023] [Indexed: 04/16/2023]
Abstract
BACKGROUND Many ca. survivors exhibit signs of IR, an important risk factor for the development of CAD. CAC scans offer a risk assessment of CV disease before cardiac damage has occurred. We investigated how IR affects CAC scores in cancer survivors. OBJECTIVES The aim of this study was to show that CAC scores differ significantly between insulin-sensitive- and -resistant cancer survivors. METHODS We enrolled 90 cancer survivors of a large community hospital from March 2021 to January 2022 into this pilot study. Patients were subdivided into three groups: insulin-sensitive (IS), insulin-resistant/prediabetic and insulin-resistant/diabetic. All patients received a CAC scan. RESULTS 70% of asymptomatic survivors overall and 81% of asymptomatic IR patients show CAD on CAC scans. 17 CAC scans in the IS group, 6 CAC scans in the IR/prediabetic group and 5 CAC scans in the IR/diabetic group showed an Agatston score of 0. The p-value between the three groups was statistically significant (p = 0.005) whereas the IR/prediabetic- and the IR/diabetic group did not differ statistically from each other. The mean MESA 10-year CHD risk with CAC was 7.8. There was a highly significant difference between the 3 groups (p < 0.001). The two IR groups did not differ statistically (p = 0.076). CONCLUSIONS Survivors with IR including prediabetes have less frequent zero CAC scores than insulin-sensitive survivors. Our study also showed that IR including prediabetes significantly increases the MESA 10-yr. CHD Risk with CAC in cancer survivors. This trial highlights the importance of screening survivors for IR and draws attention to the association of IR to CAC not only in diabetes but also in prediabetes. The high fraction of asymptomatic survivors with CAD is concerning and calls for further investigation. CAC scans are an inexpensive and efficient way of screening asymptomatic cancer survivors for CAD.
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Affiliation(s)
- N Jacobi
- Department of Hematology, Oncology, Hennepin Healthcare, Minneapolis, MN, USA.
| | - S Ortman
- Department of Medicine, Hennepin Healthcare, Minneapolis, MN, USA
| | - L Buda
- Department of Medicine, Hennepin Healthcare, Minneapolis, MN, USA
| | - Daniel Duprez
- Department of Cardiology, University of Minnesota, Minneapolis, MN, USA
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Bhatia H, Thomas I, Denenberg J, Allison M, McClelland R, Budoff M, McVeigh E, Criqui M. Coronary artery calcium and cardiovascular disease prediction by scanner type: the multi-ethnic study of atherosclerosis. Clin Radiol 2022; 77:e636-e642. [DOI: 10.1016/j.crad.2022.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/21/2022] [Indexed: 11/03/2022]
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Dudink E, Weijs B, Luermans J, Peeters F, Altintas S, Vernooy K, Pison L, Haest RJ, Kragten JA, Kietselaer B, Wildberger JE, Crijns H. Concealed Coronary Atherosclerosis In Idiopathic Paroxysmal Atrial Fibrillation is Associated with Imminent Cardiovascular Diseases. J Atr Fibrillation 2021; 13:2321. [PMID: 34950316 DOI: 10.4022/jafib.2321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 02/17/2020] [Accepted: 06/15/2020] [Indexed: 11/10/2022]
Abstract
Background Previous research showed a significant difference in the presence of subclinical coronary artery disease (CAD) on cardiac CT angiography (CTA) between patients with idiopathic paroxysmal atrial fibrillation (iAF) versus a matched sinus rhythm population (iSR). Here we present 5-year follow-up data and the consequences of subclinical CAD on baseline CTA on the development of cardiovascular disease in iAF. Methods In 99 iAF patients (who underwent CTA as part of work-up for pulmonary vein isolation) and 221 matched iSR controls (who underwent CTA for CAD assessment), the incidence of hypertension, diabetes and major cardiovascular events (MACCE) during follow-up was obtained. Multivariable Cox regression analysis was used to reveal predictors of incident cardiovascular disease in the iAF group. Results During a follow-up of 68±11 months, over one third of patients developed cardiovascular disease, with no difference between iAF and iSR (log-rank p=0.56), and comparable low rates of MACCE (4.0% vs 5.0%,p=0.71). Within the iAF group, age (HR1.12(1.03-1.20);p=0.006), left atrial diameter (HR1.16(1.03-1.31);p=0.01), Segment Involvement Score (total number of coronary segments with atherosclerotic plaque; HR1.43(1.09-1.89);p=0.01) and the number of calcified plaques on CTA (HR0.53(0.30-0.92);p=0.01) were independent predictors of incident cardiovascular disease. Conclusions Subclinical coronary disease on CTA may be useful to identify the subset of patients with iAF that harbour concealed cardiovascular risk factors and need intensive clinical follow-up to ensure timely initiation of appropriate therapy once CV disease develops, including anticoagulation and vascular prophylactic therapy.
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Affiliation(s)
- Eamp Dudink
- Department of Cardiology, Maastricht University Medical Center (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
| | - B Weijs
- Department of Cardiology, Maastricht University Medical Center (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
| | - Jglm Luermans
- Department of Cardiology, Maastricht University Medical Center (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
| | - Fecm Peeters
- Department of Cardiology, Maastricht University Medical Center (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
| | - S Altintas
- Department of Cardiology, Maastricht University Medical Center (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
| | - K Vernooy
- Department of Cardiology, Maastricht University Medical Center (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
| | - Lafg Pison
- Department of Cardiology, Maastricht University Medical Center (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
| | - R J Haest
- Department of Cardiology, St. Anna Hospital, Geldrop, the Netherlands
| | - J A Kragten
- Department of Cardiology, Zuyderland Medical Center, Heerlen, the Netherlands
| | - Bljh Kietselaer
- Department of Cardiology, Zuyderland Medical Center, Heerlen, the Netherlands
| | - J E Wildberger
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
| | - Hjgm Crijns
- Department of Cardiology, Maastricht University Medical Center (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
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Muhlestein JB, Knowlton KU, Le VT, Lappe DL, May HT, Min DB, Johnson KM, Cripps ST, Schwab LH, Braun SB, Bair TL, Anderson JL. Coronary Artery Calcium Versus Pooled Cohort Equations Score for Primary Prevention Guidance: Randomized Feasibility Trial. JACC Cardiovasc Imaging 2021; 15:843-855. [PMID: 34922872 DOI: 10.1016/j.jcmg.2021.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 11/03/2021] [Accepted: 11/05/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVES This study sought to determine the feasibility of performing an extensive randomized outcomes trial comparing a coronary artery calcium (CAC)- versus a pooled cohort equations (PCE) risk score-based strategy for initiating statin therapy for primary atherosclerotic cardiovascular disease (ASCVD) prevention. BACKGROUND Statin therapy is standard for the primary prevention of ASCVD in subjects at increased risk. National guidelines recommend using the American College of Cardiology/American Heart Association PCE risk score to guide a statin recommendation. Whether guidance by a CAC score is equivalent or superior is unknown. METHODS CorCal (Effectiveness of a Proactive Cardiovascular Primary Prevention Strategy, With or Without the Use of Coronary Calcium Screening, in Preventing Future Major Adverse Cardiac Events) was a randomized trial consenting 601 patients without known ASCVD, diabetes, or prior statin therapy recruited from primary care clinics and randomized to CAC- (n = 302) or PCE guidance (n = 299) of statin initiation for primary prevention. Enrolled subjects and their physicians made final treatment decisions. Primary outcomes compared the proportion of statin recommendations received and subject adherence over 1 year between CAC- and PCE-arm subjects. Modeled medical costs, adverse effects, and low-density lipoprotein-cholesterol (LDL-C) were additional measures of interest. RESULTS Subjects were well matched, and 540 (89.9%) completed entry testing and received a protocol-based recommendation. A statin was recommended in 101 (35.9%) CAC- and 124 (47.9%) PCE-arm subjects (P = 0.005). Compared to PCE-based recommendations, CAC-arm subjects were reclassified from statin to no statin in 36.0% and from no statin to statin in 5.6% of cases, resulting in a total reclassification of 20.6%. Physicians accepted the study-dictated recommendation to start a statin in 88.1% of CAC- vs 75.0% of PCE-arm subjects (P = 0.01). Patient-reported adherence to this recommendation at 3 months was 62.2% vs 42.2%, respectively (P = 0.009). At 1 year, statin adherence remained superior, LDL-C levels were lower, estimated costs were similar or reduced in CAC subjects, and few events occurred. CONCLUSIONS CAC guidance may be a more efficient, personalized, cost-effective, and motivating approach to statin initiation and maintenance in primary prevention. This feasibility phase of CorCal should be regarded as hypothesis-generating with respect to cardiovascular outcomes, which is being addressed in a large, longer-term outcomes trial. (Effectiveness of a Proactive Cardiovascular Primary Prevention Strategy, With or Without the Use of Coronary Calcium Screening, in Preventing Future Major Adverse Cardiac Events [CorCal]; NCT03439267).
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Affiliation(s)
- Joseph B Muhlestein
- Intermountain Medical Center Heart Institute, Murray, Utah, USA; University of Utah School of Medicine, Salt Lake City, Utah, USA.
| | - Kirk U Knowlton
- Intermountain Medical Center Heart Institute, Murray, Utah, USA; University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Viet T Le
- Intermountain Medical Center Heart Institute, Murray, Utah, USA; Rocky Mountain University of Health Professions, Masters of Physician Assistant Studies Program, Provo, Utah, USA
| | - Donald L Lappe
- Intermountain Medical Center Heart Institute, Murray, Utah, USA; University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Heidi T May
- Intermountain Medical Center Heart Institute, Murray, Utah, USA
| | - David B Min
- Intermountain Medical Center Heart Institute, Murray, Utah, USA
| | - Kevin M Johnson
- Intermountain Medical Center Heart Institute, Murray, Utah, USA
| | | | - Lesley H Schwab
- Intermountain Medical Center Heart Institute, Murray, Utah, USA
| | - Shelbi B Braun
- Intermountain Medical Center Heart Institute, Murray, Utah, USA
| | - Tami L Bair
- Intermountain Medical Center Heart Institute, Murray, Utah, USA
| | - Jeffrey L Anderson
- Intermountain Medical Center Heart Institute, Murray, Utah, USA; University of Utah School of Medicine, Salt Lake City, Utah, USA
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Szabóová E, Lisovszki A, Fatľová E, Kolarčik P, Szabó P, Molnár T. Prevalence of Microalbuminuria and Its Association with Subclinical Carotid Atherosclerosis in Middle Aged, Nondiabetic, Low to Moderate Cardiovascular Risk Individuals with or without Hypertension. Diagnostics (Basel) 2021; 11:diagnostics11091716. [PMID: 34574057 PMCID: PMC8464680 DOI: 10.3390/diagnostics11091716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/09/2021] [Accepted: 09/15/2021] [Indexed: 01/01/2023] Open
Abstract
Microalbuminuria is closely associated with the risk of cardiovascular disease and all-cause mortality in the general population. Less is known about its relationship with subclinical atherosclerosis. We aimed to assess the prevalence of microalbuminuria and its relationship with subclinical atherosclerosis in middle-aged, nondiabetic, apparently healthy individuals (N = 187; 40.1% men, 59.9% women; aged 35–55 years) as well as to evaluate its potential associations with established risk modifiers, especially with the presence of carotid plaque. Clinical and laboratory parameters, the estimated 10-year fatal cardiovascular risk (SCORE), as well as circulating, functional (flow mediated vasodilation, ankle-brachial index, augmentation index, and pulse wave velocity), and morphological markers (mean carotid intima–media thickness, and carotid plaque) of subclinical atherosclerosis were analysed in group with vs. without microalbuminuria. Microalbuminuria was present in 3.8% of individuals with SCORE risk 0.43 ± 0.79%. Functional markers predominated in both groups. Carotid intima–media thickness (mean ± SD) in both groups was in range: 0.5–0.55 ± 0.09–0.14 mm. Carotid plaque was more frequent in group with (14.3%) vs. without (4.4%) microalbuminuria. Microalbuminuria had no statistically significant effect on most markers of subclinical atherosclerosis, but the increasing value of microalbuminuria was significantly associated with the occurrence of carotid plaque (p = 0.035; OR = 1.035; 95% CI = 1.002–1.07). Additional multiple logistic regression analysis, where variables belonged to microalbuminuria, number of risk factors, and family history, finally showed only two variables: microalbuminuria (p = 0.034; OR = 1.04; 95%CI = 1.003–1.09) and the number of risk factors (p = 0.006; OR = 2.15; 95% CI = 1.24–3.73) with independent and significant impact on the occurrence of carotid plaque. Our results may indicate an association of microalbuminuria with the presence of carotid atherosclerotic plaque; in addition, microalbuminuria and the number of risk factors appear to be possible predictors of the carotid plaque occurrence. Monitoring microalbuminuria may improve the personalized cardiovascular risk assessment in nondiabetic, low-to-moderate cardiovascular risk individuals with or without hypertension.
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Affiliation(s)
- Eva Szabóová
- Department of Angiology, Faculty of Medicine, East Slovak Institute of Cardiovascular Diseases, Pavol Jozef Šafárik University, 040 01 Košice, Slovakia
- Correspondence:
| | - Alexandra Lisovszki
- 4th Department of Internal Medicine, Faculty of Medicine, Louis Pasteur University Hospital, Pavol Jozef Šafárik University, 040 01 Košice, Slovakia; (A.L.); (E.F.)
| | - Eliška Fatľová
- 4th Department of Internal Medicine, Faculty of Medicine, Louis Pasteur University Hospital, Pavol Jozef Šafárik University, 040 01 Košice, Slovakia; (A.L.); (E.F.)
| | - Peter Kolarčik
- Department of Health Psychology and Research Methodology, Faculty of Medicine, Pavol Jozef Šafárik University, 040 01 Košice, Slovakia;
| | - Peter Szabó
- Department of Aviation Technical Studies, Technical University of Košice, 040 01 Košice, Slovakia;
| | - Tomáš Molnár
- Department of Vascular Surgery, Faculty of Medicine, East Slovak Institute of Cardiovascular Diseases, Pavol Jozef Šafárik University, 040 01 Košice, Slovakia;
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Grundy SM, Stone NJ. Coronary Artery Calcium: Where Do We Stand After Over 3 Decades? Am J Med 2021; 134:1091-1095. [PMID: 34019857 DOI: 10.1016/j.amjmed.2021.03.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 11/19/2022]
Abstract
In 2018, cardiovascular society cholesterol guidelines recommended the use of coronary artery calcium to guide statin therapy in patients 40-79 years of age who are at intermediate risk by multiple risk factor equations (ie, estimated 10-year risk for atherosclerotic disease of 7.5%-19.9% but in whom statin benefit is uncertain). Many such patients have no coronary calcium and remain at <5% risk over the next decade; hence, statin therapy can be delayed until a repeat calcium scan is conducted. Exceptions include patients with severe hypercholesterolemia, diabetes, and a strong family history of atherosclerotic disease. If coronary calcium equals 1-99 Agatston units, the 10-year risk is borderline (5% to <7.5%) and statin therapy is optional pending a repeat scan. If coronary calcium equals 100-299 Agatston units, the patient is clearly statin eligible (7.5% to <20% 10-year risk). And finally, if coronary calcium is ≥300 Agatston units, a patient is at high risk and is a candidate for high-intensity statins. Risk factor analysis combined judiciously with coronary calcium scanning offers the strongest evidence-based approach to use of statins in primary prevention.
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Affiliation(s)
- Scott M Grundy
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas.
| | - Neil J Stone
- Northwestern University Feinberg School of Medicine, Chicago, Ill
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Minamimoto R. Series of myocardial FDG uptake requiring considerations of myocardial abnormalities in FDG-PET/CT. Jpn J Radiol 2021; 39:540-557. [PMID: 33517516 PMCID: PMC8175248 DOI: 10.1007/s11604-021-01097-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 01/16/2021] [Indexed: 12/18/2022]
Abstract
Distinct from cardiac PET performed with preparation to control physiological FDG uptake in the myocardium, standard FDG-PET/CT performed with 4-6 h of fasting will show variation in myocardial FDG uptake. For this reason, important signs of myocardial and pericardial abnormality revealed by myocardial FDG uptake tend to be overlooked. However, recognition of possible underlying disease will support further patient management to avoid complications due to the disease. This review demonstrates the mechanism of FDG uptake in the myocardium, discusses the factors affecting uptake, and provides notable image findings that may suggest underlying disease.
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Affiliation(s)
- Ryogo Minamimoto
- Division of Nuclear Medicine, Department of Radiology, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjyuku-ku, Tokyo, 162-8655, Japan.
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10
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Dunleavy MP, Guha A, Cardona A, Fortuna C, Daoud EG, Raman SV, Harfi TT. Prevalence of Coronary Artery Calcification on Pre-Atrial Fibrillation Ablation CT Pulmonary Venograms and its Impact on Selection for Statin Therapy. J Clin Med 2020; 9:jcm9061631. [PMID: 32481592 PMCID: PMC7356831 DOI: 10.3390/jcm9061631] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/19/2020] [Accepted: 05/22/2020] [Indexed: 11/20/2022] Open
Abstract
Atherosclerotic cardiovascular disease (ASCVD) shares many risk factors with atrial fibrillation (AF). Obtaining computed tomography images of the pulmonary veins (CTPV) before AF ablation procedures is common and can incidentally detect coronary artery calcification (CAC). The purpose of this study was to investigate the prevalence of CAC on pre-ablation CTPV, the frequency of CAC reporting on CTPV reports, and its impact on statin therapy among patients hospitalized for AF procedures. We retrospectively evaluated consecutive patients undergoing CTPV and AF procedures from October 2016 to December 2017 in a single-center tertiary hospital. The patients’ demographic and clinical characteristics were analyzed. The CAC presence on CTPV was visually assessed. The severity was classified qualitatively. The statin therapy status was evaluated using the patient’s admission and discharge medication lists. A total of 638 subjects were included in our study, with 34.5% female. The mean age was 63.3 ± 10.8 years. CAC was detected in 70.1% of all patients, and in 58.1% of patients without a history of ASCVD. When present, CAC was documented in 92.6% of the clinical CTPV reports. While coronary artery atherosclerosis was present in a majority of AF patients, and its presence was widely reported, it was not associated with increased statin therapy at discharge.
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Affiliation(s)
- Michael P. Dunleavy
- Division of Hospital Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA;
| | - Avirup Guha
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; (A.G.); (A.C.); (E.G.D.); (S.V.R.)
- Division of Cardiovascular Medicine, Harrington Heart and Vascular Institute, Cleveland, OH, 44106, USA
| | - Andrea Cardona
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; (A.G.); (A.C.); (E.G.D.); (S.V.R.)
| | | | - Emile G. Daoud
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; (A.G.); (A.C.); (E.G.D.); (S.V.R.)
| | - Subha V. Raman
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; (A.G.); (A.C.); (E.G.D.); (S.V.R.)
| | - Thura T. Harfi
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; (A.G.); (A.C.); (E.G.D.); (S.V.R.)
- Correspondence: ; Tel.: +1-614-685-6161
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Movahed MR, Sattur S, Vu J. Evaluating Association Between Coronary Calcifications Visualized During Invasive Coronary Angiography With Total Mortality. Crit Pathw Cardiol 2019; 19:30-32. [PMID: 31658119 DOI: 10.1097/hpc.0000000000000203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND High calcium score is independently associated with a greater cardiac event rate. Using a large database of patients who underwent coronary angiography for clinical reasons, we evaluated the association between reported degree of coronary calcification with mortality and baseline risk factors. METHODS Using angiographic data of 1917 patients from 1993 to 1997, we studied any association between the locations of coronary calcium that were seen during coronary angiography with coronary artery risk factors. Furthermore, we correlated the locations of calcium with all cause mortality. RESULTS A total of 1917 patients who underwent cardiac catheterization from 1993 to 1997 were studied. Total mortality was 22.9%. There was no association between the classic coronary risk factors (history of hypertension, hyperlipidemia, smoking, diabetes mellitus and family history) or race (White, Black, Hispanic, and Asian) with the occurrence of angiographic visible calcium in any location. Furthermore, we did not find any association between the locations of coronary calcium with all cause mortality. (All cause mortality occurred in 21.8% of patients with left main calcification vs. 23.3%, P = 0.63, in 24.6% of patients with left anterior descending artery calcification vs. 22.7%, P = 0.48, in 25.6% of patients with circumflex calcification vs. 23.1%, P = 0.52, in 25.7% of right coronary calcification vs. 22.7%, P = 0.47, in 24.6 of any coronary calcification vs. 22.5%, P = 0.4). CONCLUSIONS Race, coronary risk factors, and all cause mortality are not associated with angiographic documented coronary calcification in any location in patients undergoing diagnostic coronary angiography.
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Affiliation(s)
| | | | - John Vu
- Long Beach VA HealthCare System, Long Beach, CA
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Chapitre 2 : Maladies cardiovasculaires. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41 Suppl 1:S49-S57. [DOI: 10.1016/j.jogc.2019.02.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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13
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Kimura Y, Seguchi O, Iwasaki K, Toda K, Kikuchi N, Matsuda S, Kumai Y, Kuroda K, Wada K, Matsumoto Y, Fukushima S, Yanase M, Fujita T, Kobayashi J, Fukushima N. Impact of Coronary Artery Calcification in the Donor Heart on Transmitted Coronary Artery Disease in Heart Transplant Recipients. Circ J 2018; 82:3021-3028. [PMID: 30270311 DOI: 10.1253/circj.cj-18-0107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Coronary artery disease (CAD) after heart transplantation (HTx) develops as a combination of donor-transmitted coronary atherosclerosis (DTCA) and cardiac allograft vasculopathy. Assessing donor CAD before procurement is important. Because coronary artery calcification (CAC) is a predictor for CAD, donor-heart CAC is usually evaluated to estimate the risk of donor CAD. The usefulness of CAC for predicting DTCA, however, is not known. Methods and Results: Sixty-four HTx recipients whose donor underwent chest computed tomography before procurement or ≤2 weeks after HTx and who underwent coronary angiography and intravascular ultrasound (IVUS) ≤3 months after HTx were enrolled. Eight patients had CAC (CAC group) and 56 patients did not have CAC (no-CAC group). Patients in the CAC group were significantly older and had a higher prevalence of maximum intimal thickness (MIT) of the coronary artery ≥0.5 mm at initial IVUS than patients in the no-CAC group (100% vs. 55%, P=0.02). Adverse cardiac events and death were not significantly different. Everolimus tended to be used more often in the CAC group. CONCLUSIONS Donor-heart CAC is a significant predictor for MIT of the coronary artery ≥0.5 mm after HTx. The presence of CAC, however, is not associated with future cardiac events. The higher prevalence of everolimus use in the CAC group may have affected the results.
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Affiliation(s)
- Yuki Kimura
- Department of Transplantation, National Cerebral and Cardiovascular Center
| | - Osamu Seguchi
- Department of Transplantation, National Cerebral and Cardiovascular Center
| | - Keiichiro Iwasaki
- Department of Transplantation, National Cerebral and Cardiovascular Center
| | - Koichi Toda
- Department of Transplantation, National Cerebral and Cardiovascular Center
| | - Noriko Kikuchi
- Department of Transplantation, National Cerebral and Cardiovascular Center
| | - Sachi Matsuda
- Department of Pharmacy, National Cerebral and Cardiovascular Center
| | - Yuto Kumai
- Department of Transplantation, National Cerebral and Cardiovascular Center
| | - Kensuke Kuroda
- Department of Transplantation, National Cerebral and Cardiovascular Center
| | - Kyoichi Wada
- Department of Pharmacy, National Cerebral and Cardiovascular Center
| | - Yorihiko Matsumoto
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center
| | - Satsuki Fukushima
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center
| | - Masanobu Yanase
- Department of Transplantation, National Cerebral and Cardiovascular Center
| | - Tomoyuki Fujita
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center
| | - Junjiro Kobayashi
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center
| | - Norihide Fukushima
- Department of Transplantation, National Cerebral and Cardiovascular Center
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Fathala AL, Alabdulkarim FM, Shoukri M, Alanazi M. Association between breast arterial calcifications found on mammography and coronary artery calcifications in asymptomatic Saudi women. Ann Saudi Med 2018; 38:433-438. [PMID: 30531178 PMCID: PMC6302987 DOI: 10.5144/0256-4947.2018.433] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Currently, there are no data on the prevalence of breast arterial calcification (BAC) in Saudi women. Furthermore, there are no data on the relationship between BAC and coronary artery calcium score (CACS) as a coronary artery disease (CAD) risk factor in Saudi women who undergo mammography. OBJECTIVE Examine the role of BAC as a potential female-specific risk factor for CAD in Saudi women in order to investigate the relationship between BAC and CACS in women who undergo a screening mammography, and study the relationship between BAC and CAD risk factors, including age, diabetes mellitus, hypertension, chronic kidney disease (CKD), dyslipidemia, and family history of CAD. DESIGN Retrospective, medical records review. SETTING Single tertiary care center. PATIENTS AND METHODS The study cohort included women who had mammograms and a CACS scan, and for whom data on CAD risk stratification and CAD risk factors had been collected within one year of each other from 2014 to 2017. Women with CAD were excluded from the study. MAIN OUTCOME MEASURES Breast arterial calcification as a marker for coronary artery disease. SAMPLE SIZE 307 Saudi women. RESULTS BAC was found in 142 (46%) patients in the study population. BAC+ women were significantly older than the BAC- women (P=.001), and a strong association was found between BAC and CACS (P=.0001), diabetes (P=.0001), hypertension (P=.021), and CKD (P=.0031). However, no association was found between BAC and tobacco smoking, dyslipidemia, and family history of CAD. In addition, a strong correlation was found between CACS and the components of the BAC score (P less than .001). Multivariate linear regression analysis revealed that age, CAC, and CKD are the only strong predictors of BAC. CONCLUSIONS The proportion of BAC in Saudi women is 46%, and there may be a strong association between BAC and CAC, age, hypertension, and CKD. A large-scale prospective research study is necessary to validate the role of BAC on screening mammography as a CAD risk stratification tool and before routine reporting of BAC on a mammography report. LIMITATIONS Because this was a retrospective study, patient selection bias cannot be excluded. CONFLICT OF INTEREST None.
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Affiliation(s)
- Ahmed L Fathala
- Dr. Ahmed L. Fathala, MBC 28, Department of Radiology,, King Faisal Specialist Hospital and Research Centre, PO Box 3354, Riyadh 11211, Saudi Arabia, T:+ 966 114647272 , ORCID: http://orcid.org/0000-0002-2436.4226
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El Khoudary SR, Thurston RC. Cardiovascular Implications of the Menopause Transition: Endogenous Sex Hormones and Vasomotor Symptoms. Obstet Gynecol Clin North Am 2018; 45:641-661. [PMID: 30401548 DOI: 10.1016/j.ogc.2018.07.006] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The menopause transition (MT) is a critical period of women's lives marked by several physiologic changes and menopause-related symptoms that have implications for health. Risk for cardiovascular disease, the leading cause of death in women, increases after menopause, suggesting a contribution of the MT to its development. This article focuses on the relationship between 2 main features of the MT and women's cardiovascular health: (1) dynamic alterations of sex hormones, particularly endogenous estradiol and follicle-stimulating hormone, and (2) vasomotor symptoms, the cardinal symptom of the menopause. Limitations and future directions are discussed.
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Affiliation(s)
- Samar R El Khoudary
- Department of Epidemiology, Graduate School of Public Health, Epidemiology Data Center, University of Pittsburgh, 4420 Bayard Street, Suite 600, Pittsburgh, PA 15260, USA.
| | - Rebecca C Thurston
- Departments of Psychiatry and Epidemiology, School of Medicine, Graduate School of Public Health, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15213, USA
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16
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Lichtenstein G, Perlman A, Shpitzen S, Durst R, Shaham D, Leitersdorf E, Szalat A. Correlation between coronary artery calcification by non-cardiac CT and Framingham score in young patients. PLoS One 2018; 13:e0195061. [PMID: 29590197 PMCID: PMC5874063 DOI: 10.1371/journal.pone.0195061] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 03/15/2018] [Indexed: 01/07/2023] Open
Abstract
Background Previous studies have established a correlation between coronary artery calcification (CAC) measured by ECG-gated chest computed tomography (CT) and cardiovascular disease. Recent reports which included asymptomatic patients suggest that CAC measured on non-ECG gated CT is similarly associated with cardiovascular risk. This study investigates the correlation between the Framingham Risk Score (FRS) and an incidental finding of CAC on a non-gated chest CT performed for non-cardiac indications in young and seemingly healthy adults. Methods A cross-sectional study that included 162 CT scans performed in young patients aged 18–50 years old for non-cardiac indications in our institution was conducted. CAC score (CACS) was calculated using the Agatston method. FRS was calculated and compared to the CACS using three different approaches. The correlations between the CACS and several specific factors (i.e. age, body mass index, smoking, statins, etc.), were also evaluated. Results Mean age of patients was 36.43 year old and 105 (64.8%) were male. We found a significant positive correlation between the CACS and the FRS in all three approaches (p<0.05). Increased age, smoking and statin use were the only individual factors clearly associated with an increase in CACS (p = 0.002, p = 0.045 and p = 0.009, respectively). Conclusion This is the first report indicating that incidental CACS identified in non-gated MDCT is also associated with cardiovascular risk evaluated by FRS in a young population. Our findings suggest that young asymptomatic individuals with incidental CAC should be seriously evaluated for cardiovascular risk factors despite presumption of belonging to a low cardiovascular risk category.
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Affiliation(s)
- Gabriel Lichtenstein
- Center for Research, Prevention and Treatment of Atherosclerosis, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Amichai Perlman
- Internal Medicine Ward, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Shoshana Shpitzen
- Center for Research, Prevention and Treatment of Atherosclerosis, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ronen Durst
- Center for Research, Prevention and Treatment of Atherosclerosis, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Heart Institute, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Dorit Shaham
- Medical Imaging Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Eran Leitersdorf
- Center for Research, Prevention and Treatment of Atherosclerosis, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Internal Medicine Ward, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Auryan Szalat
- Center for Research, Prevention and Treatment of Atherosclerosis, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Internal Medicine Ward, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- * E-mail:
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Gatto L, Prati F. Primary prevention of coronary artery disease: let's start with calcium score. J Cardiovasc Med (Hagerstown) 2018. [PMID: 29538155 DOI: 10.2459/jcm.0000000000000563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
| | - Francesco Prati
- Cardiology Unit, San Giovanni Hospital.,CLI Foundation, Rome.,E.S. Health Science Foundation, Ravenna, Italy
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Trejo MC, Medina H, Rojas CA. Utility of coronary calcium score in women. REVISTA COLOMBIANA DE CARDIOLOGÍA 2018. [DOI: 10.1016/j.rccar.2017.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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19
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Association between cardiovascular disease risk scores and subclinical atherosclerosis prevalence in non-elderly adult patients from Argentina. Int J Cardiovasc Imaging 2017; 33:1521-1529. [DOI: 10.1007/s10554-017-1152-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 04/29/2017] [Indexed: 12/25/2022]
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20
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Darvishi B, Panahi Y, Ghanei M, Farahmand L. Investigating Prevalence and Pattern of Long-term Cardiovascular Disorders in Sulphur Mustard-exposed Victims and Determining Proper Biomarkers for Early Defining, Monitoring and Analysis of Patients’ Feedback on Therapy. Basic Clin Pharmacol Toxicol 2016; 120:120-130. [DOI: 10.1111/bcpt.12666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 08/19/2016] [Indexed: 01/13/2023]
Affiliation(s)
- Behrad Darvishi
- Chemical Injuries Research Centre; Baqiyatallah University of Medical Sciences; Tehran Iran
| | - Yunes Panahi
- Chemical Injuries Research Centre; Baqiyatallah University of Medical Sciences; Tehran Iran
| | - Mostafa Ghanei
- Chemical Injuries Research Centre; Baqiyatallah University of Medical Sciences; Tehran Iran
| | - Leila Farahmand
- Cancer Genetics Department; Breast Cancer Research Center; ACECR; Tehran Iran
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De'Ath HD, Oakland K, Brohi K. CT screened arterial calcification as a risk factor for mortality after trauma. Scand J Trauma Resusc Emerg Med 2016; 24:120. [PMID: 27724913 PMCID: PMC5057451 DOI: 10.1186/s13049-016-0317-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 10/04/2016] [Indexed: 01/06/2023] Open
Abstract
Background Arterial calcification on Computerised Tomography (CT) is a marker of cardiovascular disease. It is predictive of future adverse cardiac events and mortality in many disease states. The incidence of arterial disease and its impact on outcomes of the injured is not known. The objectives of this study were to describe the incidence of arterial calcification in trauma patients, and establish its impact on mortality. Methods A retrospective cohort study of all injured patients aged over 45 years presenting to a major trauma centre over a 34-month period. The presence and quantity of coronary, aortic and abdominal arterial calcification on admission CT scans of the chest, abdomen and pelvis was established, and the association between cardiovascular disease and in-hospital mortality following trauma was determined. Results Five hundred ninety-one patients were included in the study. Cardiac calcium was visible on 432 (73 %) scans, and abdominal arterial calcification on 472 (79.9 %). Fifty (8.5 %) patients died. Patients with Superior Mesenteric (SMA) and Common Iliac Artery calcification had a significantly higher mortality than those without (p < 0.01). In multivariarate analysis, only SMA calcification was independently associated with mortality (OR 2.462, 95 % CI 1.08–5.60, p = 0.032). Coronary calcium demonstrated no independent statistical relationship with death (Left Anterior Descending Artery OR 1.189, 95 % CI 0.51–2.78, Circumflex OR 1.290, 95 % CI 0.56–2.98, Right Coronary Artery OR 0.483, 95 % CI 0.21–1.10). Discussion This study has demonstrated that the identification of arterial calcification on admission CT scans of trauma patients is possible. Calcification was common, and present in around three-quarters of injured individuals over the age of 45 years. SMA calcium was an independent predictor of mortality. However, whilst the presence of arterial calcium demonstrated a tendency towards lower survival, this association was not significant in other territories, including the coronary arteries. Future studies should investigate further the association and pathophysiology linking SMA disease and mortality in trauma, in addition to the relationship between longer tem survival, adverse cardiac events and arterial calcification in injured patients. Conclusions Arterial calcification can be reliably identified on trauma CT scans, and is common in injured patients. Abdominal vascular calcification appears to be a better predictor of mortality than coronary artery disease. Electronic supplementary material The online version of this article (doi:10.1186/s13049-016-0317-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Henry D De'Ath
- Centre for Trauma Sciences, Blizard Institute, Barts and the London School of Medicine, Queen Mary University of London, Newark Street, London, E1 2AT, UK.
| | - Kathryn Oakland
- Centre for Trauma Sciences, Blizard Institute, Barts and the London School of Medicine, Queen Mary University of London, Newark Street, London, E1 2AT, UK
| | - Karim Brohi
- Centre for Trauma Sciences, Blizard Institute, Barts and the London School of Medicine, Queen Mary University of London, Newark Street, London, E1 2AT, UK
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Revilla‐Orodea A, Toro-Gil JA, Sevilla T, Sánchez‐Lite I, Goncalves-Ramírez LR, Amat-Santos IJ, Cortés-Villar C, Gómez-Salvador I, San Román JA. Coronary artery and aortic valve calcification evaluated with cardiac computed tomography in patients with chest pain: Prognostic value in clinical practice. Int J Cardiol 2016; 219:247-50. [DOI: 10.1016/j.ijcard.2016.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 06/12/2016] [Indexed: 10/21/2022]
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Elkeles RS, Flather M, Feher MD, Godsland I, Richmond W, Humphries SE, Rubens MB, Underwood SR. Prospective evaluation of diabetic ischaemic heart disease by computed tomography: the PREDICT study. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/14746514020020011001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Coronary heart disease (CHD) is the main cause of morbidity and mortality in type 2 diabetic subjects. Electron beam computed tomography (EBCT) of the coronary arteries provides a non-invasive method of detecting and quantifying coronary calcification (coronary calcium score), which is known to be an early marker of coronary atheroma in non-diabetic subjects. 600 type 2 diabetic subjects aged between 50 and 70 years of either sex will undergo EBCT. They will be followed-up for a mean period of four years. Recruitment started in September 2000 and preliminary results are expected in 2004. The primary aim is to assess the predictive power of the coronary calcium score for coronary events specifically in type 2 diabetic subjects. Secondary aims are to assess the relationship between coronary calcium score in type 2 diabetes and conventional risk factors, with novel risk markers, plasma homocysteine and C-reactive protein, and with key genetic markers of CHD.
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Affiliation(s)
- Robert S Elkeles
- Unit for Metabolic Medicine, Faculty of Medicine, Imperial College,
| | | | - Michael D Feher
- Beta Cell Unit, Chelsea and Westminster Hospital, 269 Fulham Road, London SW10 9NH
| | - Ian Godsland
- Unit for Metabolic Medicine, Faculty of Medicine, Imperial College
| | - William Richmond
- Department of Chemical Pathology, St Mary's Hospital, Praed Street, London, W2 1NY
| | - Stephen E Humphries
- Division of Cardiovascular Genetics, Rayne Institute, University College London, 5 University Street, London, WC1E 6JJ
| | | | - S Richard Underwood
- Department of Cardiac Imaging, Royal Brompton Hospital, Sydney Street, London SW3 6NP
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Lange DC, Glidden D, Secemsky EA, Ordovas K, Deeks SG, Martin JN, Bolger AF, Hsue PY. Mitral Annular and Coronary Artery Calcification Are Associated with Mortality in HIV-Infected Individuals. PLoS One 2015; 10:e0130592. [PMID: 26132465 PMCID: PMC4488486 DOI: 10.1371/journal.pone.0130592] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 05/22/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND HIV infection increases cardiovascular risk. Coronary artery calcification (CAC) and mitral annular calcification (MAC) identify patients at risk for cardiovascular disease (CVD). The purpose of this study was to examine the association between MAC, CAC and mortality in HIV-infected individuals. METHODS AND RESULTS We studied 152 asymptomatic HIV-infected individuals with transthoracic echocardiography (TTE) and computed tomography (CT). MAC was identified on TTE using standardized criteria. Presence of CAC, CAC score and CAC percentiles were determined using the modified Agatston criteria. Mortality data was obtained from the Social Security and National Death Indices (SSDI/NDI). The median age was 49 years; 87% were male. The median duration of HIV was 16 years; 84% took antiretroviral therapy; 64% had an undetectable viral load. CVD risk factors included hypertension (35%), smoking (62%) and dyslipidemia (35%). Twenty-five percent of individuals had MAC, and 42% had CAC. Over a median follow-up of 8 years, 11 subjects died. Subjects with CAC had significantly higher mortality compared to those with MAC only or no MAC. The Harrell's C-statistic of CAC was 0.66 and increased to 0.75 when MAC was added (p = 0.05). MAC, prior CVD, age and HIV viral load were independently associated with higher age- and gender-adjusted CAC percentiles in an adjusted model (p < 0.05 for all). CONCLUSION In HIV patients, the presence of MAC, traditional risk factors and HIV viral load were independently associated with CAC. Presence of CAC and MAC may be useful in identifying HIV-infected individuals at higher risk for death.
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Affiliation(s)
- David C. Lange
- Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - David Glidden
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, California, United States of America
| | - Eric A. Secemsky
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Karen Ordovas
- Department of Radiology, University of California, San Francisco, San Francisco, California, United States of America
| | - Steven G. Deeks
- Division of HIV/AIDS Positive Health Program, San Francisco General Hospital, University of California, San Francisco, San Francisco, California, United States of America
| | - Jeffrey N. Martin
- Department of Epidemiology and Biostatistics, San Francisco General Hospital, University of California, San Francisco, California, United States of America
| | - Ann F. Bolger
- Division of Cardiology, Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California, United States of America
| | - Priscilla Y. Hsue
- Division of Cardiology, Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California, United States of America
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Choi HM, Hyun YY, Lee KB, Kim H. High estimated glomerular filtration rate is associated with coronary artery calcification in middle-aged Korean men without chronic kidney disease. Nephrol Dial Transplant 2015; 30:996-1001. [DOI: 10.1093/ndt/gfv109] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Oliveira JLM, Hirata MH, Sousa AGDMR, Gabriel FS, Hirata TDC, Tavares IDS, Melo LD, Dória FDS, Sousa ACS, Pinto IMF. Male Gender and Arterial Hypertension are Plaque Predictors at Coronary Computed Tomography Angiography. Arq Bras Cardiol 2015; 104:409-16. [PMID: 25861034 PMCID: PMC4495456 DOI: 10.5935/abc.20150028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 01/15/2015] [Accepted: 01/19/2015] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Systemic Arterial Hypertension (SAH) is one of the main risk factors for Coronary Artery Disease (CAD), in addition to male gender. Differences in coronary artery lesions between hypertensive and normotensive individuals of both genders at the Coronary Computed Tomography Angiography (CCTA) have not been clearly determined. OBJECTIVE To Investigate the calcium score (CS), CAD extent and characteristics of coronary plaques at CCTA in men and women with and without SAH. METHODS Prospective cross-sectional study of 509 patients undergoing CCTA for CAD diagnosis and risk stratification, from November 2011 to December 2012, at Instituto de Cardiologia Dante Pazzanese. Individuals were stratified according to gender and subdivided according to the presence (HT +) or absence (HT-) of SAH. RESULTS HT+ women were older (62.3 ± 10.2 vs 57.8 ± 12.8, p = 0.01). As for the assessment of CAD extent, the HT+ individuals of both genders had significant CAD, although multivessel disease is more frequent in HT + men. The regression analysis for significant CAD showed that age and male gender were the determinant factors of multivessel disease and CS ≥ 100. Plaque type analysis showed that SAH was a predictive risk factor for partially calcified plaques (OR = 3.9). CONCLUSION Hypertensive men had multivessel disease more often than women. Male gender was a determinant factor of significant CAD, multivessel disease, CS ≥ 100 and calcified and partially calcified plaques, whereas SAH was predictive of partially calcified plaques.
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Song KD, Kim SM, Choe YH, Jung W, Lee SC, Chang SA, Choi YH, Sung J. Integrated cardiac magnetic resonance imaging with coronary magnetic resonance angiography, stress-perfusion, and delayed-enhancement imaging for the detection of occult coronary artery disease in asymptomatic individuals. Int J Cardiovasc Imaging 2015; 31 Suppl 1:77-89. [DOI: 10.1007/s10554-015-0665-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 04/15/2015] [Indexed: 10/23/2022]
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Robbins JM, Petrone AB, Carr JJ, Pankow JS, Hunt SC, Heiss G, Arnett DK, Ellison RC, Gaziano JM, Djoussé L. Association of ideal cardiovascular health and calcified atherosclerotic plaque in the coronary arteries: the National Heart, Lung, and Blood Institute Family Heart Study. Am Heart J 2015; 169:371-378.e1. [PMID: 25728727 DOI: 10.1016/j.ahj.2014.12.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 12/30/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND The American Heart Association (AHA) established recommendations based on 7 ideal health behaviors and factors with the goal of improving cardiovascular health (CVH) and reducing both morbidity and mortality from cardiovascular disease by 20% by 2020. Few studies have investigated their association with subclinical coronary heart disease. We sought to examine whether the 7 AHA CVH metrics were associated with calcified atherosclerotic plaque in the coronary arteries. METHODS In a cross-sectional design, we studied 1,731 predominantly white men and women from the National Heart, Lung, and Blood Institute Family Heart Study without prevalent coronary heart disease. Diet was assessed by a semiquantitative food frequency questionnaire. Coronary artery calcium (CAC) was measured by cardiac computed tomography. We defined prevalent CAC using an Agatston score of 100+ and fitted generalized estimating equations to calculate prevalence odds ratios of CAC. RESULTS Mean age was 56.8 years, and 41% were male. The median number of ideal CVH metrics was 3, and no participant met all 7. There was a strong inverse relationship between number of ideal CVH metrics and prevalent CAC. Odds ratios (95% CI) for CAC of 100+ were 1.0 (reference), 0.37 (0.29-0.45), 0.35 (0.26-0.44), and 0.27 (0.20-0.36) among subjects with 0 to 1, 2, 3, and 4+ ideal CVH metrics, respectively (P = .0001), adjusting for sex, age, field center, alcohol, income, education, and energy consumption. CONCLUSIONS These data demonstrate a strong and graded inverse relationship between AHA ideal CVH metrics and prevalent CAC in adult men and women.
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Shah N, Soon K, Wong C, Kelly AM. Screening for asymptomatic coronary heart disease in the young 'at risk' population: Who and how? IJC HEART & VASCULATURE 2014; 6:60-65. [PMID: 28785628 PMCID: PMC5497146 DOI: 10.1016/j.ijcha.2014.12.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 12/20/2014] [Indexed: 01/13/2023]
Abstract
Deaths due to coronary heart disease (CHD) remain high worldwide, despite recent achievements. An effective screening strategy may improve outcomes further if implemented in a high or ‘at risk’ cohort. Asymptomatic CHD in the young maybe underappreciated and applying an effective screening strategy to a young cohort may lead to improved outcomes due to significant socioeconomic impact from the consequences of CHD in this sub-group. A positive family history of CHD, which is known to be associated with an increased risk of future myocardial events, could aid in identifying the ‘at risk’ young cohort. Traditional cardiovascular risk scoring systems are in wide use but lack the sensitivity or specificity required to estimate risk in an individual. Rather their use is limited to predicting population attributable risk. Functional studies such as exercise stress tests are readily available and cost effective but do not have the required sensitivity required to suggest their use as part of a screening protocol. Coronary CT angiography has been demonstrated to have high sensitivity for the detection of CHD and therefore may be suitable for screening purposes but there are concerns regarding radiation exposure. Here we review the evidence for the use of potential screening strategies and the suitability of using such strategies to estimate risk of CHD in a young ‘at risk’ population.
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Abstract
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women. The syndrome is typified by its heterogeneous presentation, which includes hirsutism (a function of hypersecretion of ovarian androgens), menstrual irregularity and infertility (that is due to infrequent or absent ovulation). Furthermore, PCOS predisposes patients to metabolic dysfunction and an increased risk of type 2 diabetes mellitus (T2DM). The aetiology of the syndrome has a major genetic component. Obesity exacerbates the insulin resistance that is a feature of PCOS in many women and amplifies the clinical and biochemical abnormalities. In clinical practice, the choice of investigations to be done depends mainly on the presenting symptoms. The approach to management is likewise dependent on the presenting complaint. Symptoms of androgen excess (hirsutism, acne and alopecia) require cosmetic measures, suppression of ovarian androgen function and anti-androgen therapy, alone or in combination. Ovulation rate is improved by diet and lifestyle intervention in overweight individuals but induction of ovulation by, in the first instance, anti-estrogens is usually required. Monitoring of glucose is important in overweight women and/or those with a family history of T2DM. Metformin is indicated for women with impaired glucose tolerance but whether this drug is otherwise useful in women with PCOS remains debatable.
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Affiliation(s)
- Channa N Jayasena
- Section of Investigative Medicine, Imperial College London, Hammersmith Hospital, DuCane Road, London W12 0NN, UK
| | - Stephen Franks
- Institute of Reproductive and Developmental Biology, Imperial College London, Hammersmith Hospital, DuCane Road, London W12 0NN, UK
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Abstract
Breast arterial calcification (BAC), observed as an incidental finding on screening mammograms, represents degenerative calcific changes occurring in the mammary arteries, with increasing age. The aim of this review is to discuss relevant literature examining relation between BAC and atherosclerosis. After a thorough literature search, in OVID and PubMed, 199 studies were identified, of which 25 were relevant to our review. Data were abstracted from each study and statistical analysis was done, including calculation of odds ratios and construction of forest plots. A total of 35,542 patients were enrolled across 25 studies looking at an association between BAC and coronary artery disease, cardiovascular disease, stroke, cerebral artery disease, carotid and peripheral artery diseases, and coronary artery calcification. A majority of the studies showed a statistically significant relation between BAC and presence of coronary artery disease cardiovascular disease and associated mortality. Sensitivity of BAC in predicting cardiovascular events was low, but specificity was high. BAC was predictive of incident and prevalent stroke but not mortality of stroke. Similarly, BAC was predictive of cerebral, carotid, and peripheral artery diseases. The role of BAC as a surrogate marker of coronary and systemic atherosclerosis is currently uncertain. Its role may be further elucidated by more large-scale prospective studies and clinical experience.
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Efe D, Aygün F, Acar T, Yildiz M, Gemici K. Investigation of relation between visceral and subcutaneous abdominal fat volumes and calcified aortic plaques via multislice computed tomography. Vascular 2014; 23:396-402. [PMID: 25245049 DOI: 10.1177/1708538114552012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The present study investigated effect of subcutaneous fat volume and abdominal visceral fat volume on aortic atherosclerosis via multislice computed tomography. MATERIALS AND METHODS The present study comprised 424 subjects who underwent non-contrast-enhanced abdominal CT in our clinic between June 2012 and June 2013. Using dedicated software visceral fat volume was calculated for each individual and then subcutaneous fat volume was calculated by subtracting visceral fat volume from total fat volume. By dividing visceral fat volume/subcutaneous fat volume participants were assigned to three groups according to their mean visceral fat volume/subcutaneous fat volume: Group 1 consisted of subjects with visceral fat volume/subcutaneous fat volume lower than 0.48 (Group 1 < 0.48); Group 2 consisted of subjects with visceral fat volume/subcutaneous fat volume equal to or higher than 0.48 and lower than 0.69 (0.48 ≤ Group 2 < 0.69); and Group 3 consisted of subjects with visceral fat volume/subcutaneous fat volume equal to or higher than 0.69 (Group 3 ≥ 0.69). RESULTS The mean abdominal aortic calcium scores according to Agatston scoring (au) were 136.8 ± 418.7 au in Group 1, 179.9 ± 463 au in Group 2 and 212.2 ± 486.9 in Group 3, respectively. CONCLUSIONS We have demonstrated a significant correlation between visceral fat volume and abdominal aorta atherosclerosis, while there was absence of significant correlation between subcutaneous fat volume and abdominal atherosclerosis.
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Affiliation(s)
- Duran Efe
- Department of Radiology, Faculty of Medicine, Mevlana University, Konya, Turkey
| | - Fatih Aygün
- Başkent University, Konya Medical and Research Center, Department of Cardiovascular Surgery, Turkey
| | - Türker Acar
- Department of Radiology, Faculty of Medicine, Mevlana University, Konya, Turkey
| | - Melda Yildiz
- Department of Radiology, Faculty of Medicine, Mevlana University, Konya, Turkey
| | - Kazım Gemici
- Department of General Surgery, Faculty of Medicine, Mevlana University, Konya, Turkey
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Robbins JM, Petrone AB, Ellison RC, Hunt SC, Carr JJ, Heiss G, Arnett DK, Gaziano JM, Djoussé L. Association of egg consumption and calcified atherosclerotic plaque in the coronary arteries: the NHLBI Family Heart Study. E-SPEN JOURNAL 2014; 9:e131-e135. [PMID: 25642410 PMCID: PMC4309282 DOI: 10.1016/j.clnme.2014.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Eggs are a ubiquitous and important source of dietary cholesterol and nutrients, yet their relationship to coronary heart disease (CHD) remains unclear. While some data have suggested a positive association between egg consumption and CHD, especially among diabetic subjects, limited data exist on the influence of egg consumption on subclinical disease. Thus, we sought to examine whether egg consumption is associated with calcified atherosclerotic plaques in the coronary arteries. METHODS In a cross-sectional design, we studied 1848 participants of the NHLBI Family Heart Study without known CHD. Egg consumption was assessed by a semi-quantitative food frequency questionnaire and coronary-artery calcium (CAC) was measured by cardiac CT. We defined prevalent CAC using an Agatston score of at least 100 and fitted generalized estimating equations to calculate prevalence odds ratios of CAC. RESULTS Mean age was 56.5 years and 41% were male. Median consumption of eggs was 1/week. There was no association between frequency of egg consumption and prevalent CAC. Odds ratios (95% CI) for CAC were 1.0 (reference), 0.95 (0.66-1.38), 0.94 (0.63-1.40), and 0.90 (0.57-1.42) for egg consumption of almost never, 1-3 times per month, once per week, and 2+ times per week, respectively (p for trend 0.66), adjusting for age, sex, BMI, smoking, alcohol, physical activity, income, field center, total calories, and bacon. Additional control for hypertension and diabetes mellitus, or restricting the analysis to subjects with diabetes mellitus or fasting glucose >126 mg/dL did not alter the findings. CONCLUSIONS These data do not provide evidence for an association between egg consumption and prevalent CAC in adult men and women.
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Affiliation(s)
- Jeremy M Robbins
- Division of Internal Medicine (JMR) and Aging (LD, ABP, JMG), Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, MA; Massachusetts Veterans Epidemiology and Research Information Center and Geriatric Research, Education, and Clinical Center (LD, JMG), Boston Veterans Affairs Healthcare System, Boston, MA; Section of Preventive Medicine & Epidemiology (RCE), Boston University, Boston, MA; Department of Cardiovascular Genetics, University of Utah, Salt Lake City (SCH); Department of Radiology (JJC), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Epidemiology (GH), School of Public Health, the University of North Carolina at Chapel Hill, NC; Division of Epidemiology (DKA), University of Minnesota, Minneapolis
| | - Andrew B Petrone
- Division of Internal Medicine (JMR) and Aging (LD, ABP, JMG), Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, MA; Massachusetts Veterans Epidemiology and Research Information Center and Geriatric Research, Education, and Clinical Center (LD, JMG), Boston Veterans Affairs Healthcare System, Boston, MA; Section of Preventive Medicine & Epidemiology (RCE), Boston University, Boston, MA; Department of Cardiovascular Genetics, University of Utah, Salt Lake City (SCH); Department of Radiology (JJC), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Epidemiology (GH), School of Public Health, the University of North Carolina at Chapel Hill, NC; Division of Epidemiology (DKA), University of Minnesota, Minneapolis
| | - R Curtis Ellison
- Division of Internal Medicine (JMR) and Aging (LD, ABP, JMG), Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, MA; Massachusetts Veterans Epidemiology and Research Information Center and Geriatric Research, Education, and Clinical Center (LD, JMG), Boston Veterans Affairs Healthcare System, Boston, MA; Section of Preventive Medicine & Epidemiology (RCE), Boston University, Boston, MA; Department of Cardiovascular Genetics, University of Utah, Salt Lake City (SCH); Department of Radiology (JJC), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Epidemiology (GH), School of Public Health, the University of North Carolina at Chapel Hill, NC; Division of Epidemiology (DKA), University of Minnesota, Minneapolis
| | - Steven C Hunt
- Division of Internal Medicine (JMR) and Aging (LD, ABP, JMG), Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, MA; Massachusetts Veterans Epidemiology and Research Information Center and Geriatric Research, Education, and Clinical Center (LD, JMG), Boston Veterans Affairs Healthcare System, Boston, MA; Section of Preventive Medicine & Epidemiology (RCE), Boston University, Boston, MA; Department of Cardiovascular Genetics, University of Utah, Salt Lake City (SCH); Department of Radiology (JJC), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Epidemiology (GH), School of Public Health, the University of North Carolina at Chapel Hill, NC; Division of Epidemiology (DKA), University of Minnesota, Minneapolis
| | - J Jeffrey Carr
- Division of Internal Medicine (JMR) and Aging (LD, ABP, JMG), Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, MA; Massachusetts Veterans Epidemiology and Research Information Center and Geriatric Research, Education, and Clinical Center (LD, JMG), Boston Veterans Affairs Healthcare System, Boston, MA; Section of Preventive Medicine & Epidemiology (RCE), Boston University, Boston, MA; Department of Cardiovascular Genetics, University of Utah, Salt Lake City (SCH); Department of Radiology (JJC), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Epidemiology (GH), School of Public Health, the University of North Carolina at Chapel Hill, NC; Division of Epidemiology (DKA), University of Minnesota, Minneapolis
| | - Gerardo Heiss
- Division of Internal Medicine (JMR) and Aging (LD, ABP, JMG), Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, MA; Massachusetts Veterans Epidemiology and Research Information Center and Geriatric Research, Education, and Clinical Center (LD, JMG), Boston Veterans Affairs Healthcare System, Boston, MA; Section of Preventive Medicine & Epidemiology (RCE), Boston University, Boston, MA; Department of Cardiovascular Genetics, University of Utah, Salt Lake City (SCH); Department of Radiology (JJC), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Epidemiology (GH), School of Public Health, the University of North Carolina at Chapel Hill, NC; Division of Epidemiology (DKA), University of Minnesota, Minneapolis
| | - Donna K Arnett
- Division of Internal Medicine (JMR) and Aging (LD, ABP, JMG), Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, MA; Massachusetts Veterans Epidemiology and Research Information Center and Geriatric Research, Education, and Clinical Center (LD, JMG), Boston Veterans Affairs Healthcare System, Boston, MA; Section of Preventive Medicine & Epidemiology (RCE), Boston University, Boston, MA; Department of Cardiovascular Genetics, University of Utah, Salt Lake City (SCH); Department of Radiology (JJC), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Epidemiology (GH), School of Public Health, the University of North Carolina at Chapel Hill, NC; Division of Epidemiology (DKA), University of Minnesota, Minneapolis
| | - J Michael Gaziano
- Division of Internal Medicine (JMR) and Aging (LD, ABP, JMG), Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, MA; Massachusetts Veterans Epidemiology and Research Information Center and Geriatric Research, Education, and Clinical Center (LD, JMG), Boston Veterans Affairs Healthcare System, Boston, MA; Section of Preventive Medicine & Epidemiology (RCE), Boston University, Boston, MA; Department of Cardiovascular Genetics, University of Utah, Salt Lake City (SCH); Department of Radiology (JJC), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Epidemiology (GH), School of Public Health, the University of North Carolina at Chapel Hill, NC; Division of Epidemiology (DKA), University of Minnesota, Minneapolis
| | - Luc Djoussé
- Division of Internal Medicine (JMR) and Aging (LD, ABP, JMG), Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, MA; Massachusetts Veterans Epidemiology and Research Information Center and Geriatric Research, Education, and Clinical Center (LD, JMG), Boston Veterans Affairs Healthcare System, Boston, MA; Section of Preventive Medicine & Epidemiology (RCE), Boston University, Boston, MA; Department of Cardiovascular Genetics, University of Utah, Salt Lake City (SCH); Department of Radiology (JJC), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Epidemiology (GH), School of Public Health, the University of North Carolina at Chapel Hill, NC; Division of Epidemiology (DKA), University of Minnesota, Minneapolis
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Alman AC, Johnson LR, Calverley DC, Grunwald GK, Lezotte DC, Hokanson JE. Validation of a method for quantifying carotid artery calcification from panoramic radiographs. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 116:518-24. [PMID: 24035118 DOI: 10.1016/j.oooo.2013.06.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 06/14/2013] [Accepted: 06/21/2013] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Carotid artery calcification can be visualized on panoramic radiographs. Incidental observation of these calcifications could identify patients in need of further screening. The purpose of this study was to validate the assessment and quantification of calcification on panoramic radiographs with the stenosis and the calculated resistive index (RI) from Doppler ultrasonography. STUDY DESIGN Digital panoramic radiographs were used to assess the area of carotid artery calcification using tools available in NIH's ImageJ. Inpatient and outpatient discharge records were reviewed to identify subjects with a completed carotid Doppler ultrasound exam (n = 122). RESULTS The quantification of carotid artery calcification was found to correlate well with the degree of stenosis (area under the curve [AUC] 0.81 [95% confidence interval [CI] 0.64, 0.98]) and the RI of the common carotid artery (AUC 0.79 [95% CI 0.59, 0.98]). CONCLUSION This method for quantification of carotid artery calcification could identify patients in need of further evaluation.
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Affiliation(s)
- Amy C Alman
- Assistant Professor, Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL, USA.
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Hernandez R, Allen NB, Liu K, Stamler J, Reid KJ, Zee PC, Wu D, Kang J, Garside DB, Daviglus ML. Association of depressive symptoms, trait anxiety, and perceived stress with subclinical atherosclerosis: results from the Chicago Healthy Aging Study (CHAS). Prev Med 2014; 61:54-60. [PMID: 24434161 PMCID: PMC4153417 DOI: 10.1016/j.ypmed.2013.12.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 12/28/2013] [Accepted: 12/31/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Examine the association between multiple psychological factors (depressive symptoms, trait anxiety, perceived stress) and subclinical atherosclerosis in older age. METHOD This cross-sectional study included 1101 adults ages 65-84 from the Chicago Healthy Aging Study (CHAS - 2007-2010). Previously validated self-report instruments were used to assess psychological factors. Non-invasive methods were used to assess subclinical atherosclerosis in two regions of the body, i.e., ankle-brachial blood pressure index (ABI) and coronary artery calcification (CAC). Multivariate logistic regression was used to examine the association between each psychological measure and subclinical atherosclerosis, after the adjustment for socio-demographic factors, sleep quality, young adulthood/early middle age and late-life CVD risk status, and psychological ill-being as appropriate. RESULTS The burden of major cardiovascular disease risk factors did not significantly differ across tertiles of psychological factors. In multivariate adjusted models, trait anxiety was associated with calcification: those in the second tertile were significantly more likely to have CAC >0 compared to those in the lowest anxiety tertile [OR=1.68; 95% CI=1.09-2.58], but no significant difference was observed for Tertile III of trait anxiety [OR=1.31; 95% CI=0.75-2.27]. No association was seen between psychological measures and ABI. CONCLUSION Of several psychological factors, only trait anxiety was significantly associated with CAC.
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Affiliation(s)
- Rosalba Hernandez
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Institute for Minority Health Research, University of Illinois at Chicago, Chicago, IL, USA.
| | - Norrina Bai Allen
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Kiang Liu
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jeremiah Stamler
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Kathryn Jean Reid
- Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Phyllis C Zee
- Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Department of Neurobiology, Weinberg College of Arts and Sciences, Northwestern University, Chicago, IL, USA
| | - Donghong Wu
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Joseph Kang
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Daniel B Garside
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Institute for Minority Health Research, University of Illinois at Chicago, Chicago, IL, USA
| | - Martha L Daviglus
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Institute for Minority Health Research, University of Illinois at Chicago, Chicago, IL, USA
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Shikuma CM, Barbour JD, Ndhlovu LC, Keating SM, Norris PJ, Budoff M, Parikh N, Seto T, Gangcuangco LMA, Ogata-Arakaki D, Chow D. Plasma monocyte chemoattractant protein-1 and tumor necrosis factor-α levels predict the presence of coronary artery calcium in HIV-infected individuals independent of traditional cardiovascular risk factors. AIDS Res Hum Retroviruses 2014; 30:142-6. [PMID: 23984974 DOI: 10.1089/aid.2013.0183] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Coronary artery calcium (CAC) is a validated subclinical measure of atherosclerosis. Studies in the general population have linked blood inflammatory biomarkers including monocyte chemoattractant protein-1 (MCP-1) and tumor necrosis factor (TNF)-α with the burden of CAC, but this relationship is often lost following correction for traditional cardiovascular risk factors. We assessed the relationship of various biomarkers to CAC, specifically in HIV-infected individuals on potent antiretroviral therapy (ART). Analyses utilized entry data from participants in the Hawaii Aging with HIV-Cardiovascular (HAHC-CVD) study. Computerized tomography examinations for CAC were obtained locally and analyzed by a central reading center in blinded fashion. Plasma biomarkers were assessed by multiplexing using Milliplex Human Cardiovascular Disease panels. Among a cohort of 130 subjects [88% male, median (IQR) age of 51 (46-57) years, CD4 count of 492 (341-635) cells/mm(3), 86.9% with HIV RNA ≤50 copies/ml], CAC was present in 46.9% of subjects. In univariate analyses higher levels of log-transformed MCP-1 and TNF-α were associated with the presence of CAC (p<0.05). In multivariate logistic regression models, MCP-1 and TNF-α remained significant after adjustment for traditional cardiovascular (CVD) risk factors. Similar results were found when analyses were assessed by Framingham risk score categories or when restricted to subjects with plasma HIV RNA ≤50 copies/ml. In contrast to findings in the general population, higher MCP-1 and TNF-α predict the presence of CAC independent of traditional CVD risk factors in HIV-infected subjects fully suppressed on ART, suggesting that HIV-mediated immune activation may play a role in CVD risk.
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Affiliation(s)
| | | | | | - Sheila M. Keating
- Blood Systems Research Institute, San Francisco, California
- University of California, San Francisco, California
| | - Philip J. Norris
- Blood Systems Research Institute, San Francisco, California
- University of California, San Francisco, California
| | - Matthew Budoff
- Los Angeles Biomedical Research Institute, Los Angeles, California
| | - Nisha Parikh
- University of Hawaii, Honolulu, Hawaii
- Queen's Medical Center, Honolulu, Hawaii
| | - Todd Seto
- University of Hawaii, Honolulu, Hawaii
- Queen's Medical Center, Honolulu, Hawaii
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Hou L, Lloyd-Jones DM, Ning H, Huffman MD, Fornage M, He K, Zhang X, Jacobs DR, Goff DC, Sidney S, Carr JJ, Liu K. White blood cell count in young adulthood and coronary artery calcification in early middle age: coronary artery risk development in young adults (CARDIA) study. Eur J Epidemiol 2013; 28:735-42. [PMID: 24030512 PMCID: PMC6614872 DOI: 10.1007/s10654-013-9842-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 08/13/2013] [Indexed: 01/19/2023]
Abstract
White blood cell (WBC) count is associated with incident coronary heart disease (CHD). Data are sparse regarding its association in young adults with future coronary artery calcification (CAC). Our study was conducted among coronary artery risk development in young adults (CARDIA) participants (n=3,094). We examined the association between baseline (Y0) WBC counts and CHD risk factors using linear regression models. We further assessed prospective associations between Y0 WBC and inflammatory biomarkers during the follow-up, and the presence of CAC 15 and 20 years later. In total, 272 and 566 subjects had CAC scores>0 at year (Y) 15 and Y20, respectively. Baseline total WBC counts were cross-sectionally associated with SBP, BMI, and smoking, or HDL-cholesterol (p≤0.01) at Y0, and prospectively associated with C-reactive protein at Y7, Y15, and Y20, and fibrinogen at Y5 and Y20 (p<0.01). After adjustment for potential confounding factors, baseline neutrophil count was borderline associated with CAC presence 15 years later (OR=1.18 per unit, 95% CI 1.00-1.44) and total WBC (OR=1.07, 95% CI 0.96-1.19) or eosinophil (OR=1.12, 95%CI 1.00-1.25) was borderline associated with CAC presence at Y20. Baseline total WBC counts in young adults was associated prospectively with CAC presence 20 years later after adjusting for age, sex, and race. Results are attenuated when other risk factors are accounted for. Our results suggest the possible early involvement of WBC, particularly eosinophils, in the early stages of atherosclerosis.
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Affiliation(s)
- Lifang Hou
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 N. Lake Shore Dr. suite 1400, Chicago, IL, 60611, USA,
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Oni ET, Agatston AS, Blaha MJ, Fialkow J, Cury R, Sposito A, Erbel R, Blankstein R, Feldman T, Al-Mallah MH, Santos RD, Budoff MJ, Nasir K. A systematic review: burden and severity of subclinical cardiovascular disease among those with nonalcoholic fatty liver; should we care? Atherosclerosis 2013; 230:258-67. [PMID: 24075754 DOI: 10.1016/j.atherosclerosis.2013.07.052] [Citation(s) in RCA: 259] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 07/19/2013] [Accepted: 07/31/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is an emerging disease and a leading cause of chronic liver disease. The prevalence in the general population is approximately 15-30% and it increases to 70-90% in obese or diabetic populations. NAFLD has been linked to increased cardiovascular disease (CVD) risk. It is therefore critical to evaluate the relationship between markers of subclinical CVD and NAFLD. METHOD An extensive search of databases; including the National Library of Medicine and other relevant databases for research articles meeting inclusion criteria: observational or cohort, studies in adult populations and clearly defined NAFLD and markers of subclinical CVD. RESULTS Twenty-seven studies were included in the review; 16 (59%) presented the association of NAFLD and carotid intima-media thickness (CIMT), 7 (26%) the association with coronary calcification and 7 (26%) the effect on endothelial dysfunction and 6 (22%) influence on arterial stiffness. CIMT studies showed significant increases among NAFLD patients compared to controls. These were independent of traditional risk factors and metabolic syndrome. The association was similar in coronary calcification studies. The presence of NAFLD is associated with the severity of the calcification. Endothelial dysfunction and arterial stiffness showed significant independent associations with NAFLD. Two studies argued the associations were not significant; however, these studies were limited to diabetic populations. CONCLUSION There is evidence to support the association of NAFLD with subclinical atherosclerosis independent of traditional risk factors and metabolic syndrome. However, there is need for future longitudinal studies to review this association to ascertain causality and include other ethnic populations.
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Affiliation(s)
- Ebenezer T Oni
- Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, FL, USA
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Reis JP, Loria CM, Lewis CE, Powell-Wiley TM, Wei GS, Carr JJ, Terry JG, Liu K. Association between duration of overall and abdominal obesity beginning in young adulthood and coronary artery calcification in middle age. JAMA 2013; 310:280-8. [PMID: 23860986 PMCID: PMC4226407 DOI: 10.1001/jama.2013.7833] [Citation(s) in RCA: 139] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Younger individuals are experiencing a greater cumulative exposure to excess adiposity over their lifetime. However, few studies have determined the consequences of long-term obesity. OBJECTIVE To examine whether the duration of overall and abdominal obesity was associated with the presence and 10-year progression of coronary artery calcification (CAC), a subclinical predictor of coronary heart disease. DESIGN, SETTING, AND PARTICIPANTS Prospective study of 3275 white and black adults aged 18 to 30 years at baseline in 1985-1986 who did not initially have overall obesity (body mass index [BMI] ≥30) or abdominal obesity (men: waist circumference [WC] >102 cm; women: >88 cm) in the multicenter, community-based Coronary Artery Risk Development in Young Adults (CARDIA) study. Participants completed computed tomography scanning for the presence of CAC during the 15-, 20-, or 25-year follow-up examinations. Duration of overall and abdominal obesity was calculated using repeat measurements of BMI and WC, respectively, performed 2, 5, 7, 10, 15, 20, and 25 years after baseline. MAIN OUTCOMES AND MEASURES Presence of CAC was measured by computed tomography at the year 15 (2000-2001), year 20 (2005-2006), or year 25 (2010-2011) follow-up examinations. Ten-year progression of CAC (2000-2001 to 2010-2011) was defined as incident CAC in 2010-2011 or an increase in CAC score of 20 Agatston units or greater. RESULTS During follow-up, 40.4% and 41.0% developed overall and abdominal obesity, respectively. Rates of CAC per 1000 person-years were higher for those who experienced more than 20 years vs 0 years of overall obesity (16.0 vs 11.0, respectively) and abdominal obesity (16.7 vs 11.0). Approximately 25.2% and 27.7% of those with more than 20 years of overall and abdominal obesity, respectively, experienced progression of CAC vs 20.2% and 19.5% of those with 0 years. After adjustment for BMI or WC and potential confounders, the hazard ratios for CAC for each additional year of overall or abdominal obesity were 1.02 (95% CI, 1.01-1.03) and 1.03 (95% CI, 1.02-1.05), respectively. The adjusted odds ratios for CAC progression were 1.04 (95% CI, 1.01-1.06) and 1.04 (95% CI, 1.01-1.07), respectively. Associations were attenuated but largely persisted following additional adjustment for potential intermediate metabolic factors during follow-up. CONCLUSIONS AND RELEVANCE Longer duration of overall and abdominal obesity was associated with subclinical coronary heart disease and its progression through midlife independent of the degree of adiposity. Preventing or at least delaying the onset of obesity in young adulthood may lower the risk of developing atherosclerosis through middle age.
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Affiliation(s)
- Jared P Reis
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland 20892, USA.
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Barazza A, Blachford C, Even-Or O, Joaquin VA, Briley-Saebo KC, Chen W, Jiang XC, Mulder WJM, Cormode DP, Fayad ZA, Fisher EA. The complex fate in plasma of gadolinium incorporated into high-density lipoproteins used for magnetic imaging of atherosclerotic plaques. Bioconjug Chem 2013; 24:1039-48. [PMID: 23617731 DOI: 10.1021/bc400105j] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
We have previously reported enhancing the imaging of atherosclerotic plaques in mice using reconstituted high density lipoproteins (HDL) as nanocarriers for the MRI contrast agent gadolinium (Gd). This study focuses on the underlying mechanisms of Gd delivery to atherosclerotic plaques. HDL, LDL, and VLDL particles containing Gd chelated to phosphatidyl ethanolamine (DTPA-DMPE) and a lipidic fluorophore were used to demonstrate the transfer of Gd-phospholipids among plasma lipoproteins in vitro and in vivo. To determine the basis of this transfer, the roles of phospholipid transfer protein (PLTP) and lipoprotein lipase (LpL) in mediating the migration of Gd-DTPA-DMPE among lipoproteins were investigated. The results indicated that neither was an important factor, suggesting that spontaneous transfer of Gd-DTPA-DMPE was the most probable mechanism. Finally, two independent mouse models were used to quantify the relative contributions of HDL and LDL reconstituted with Gd-DTPA-DMPE to plaque imaging enhancement by MR. Both sets of results suggested that Gd-DTPA-DMPE originally associated with LDL was about twice as effective as that injected in the form of Gd-HDL, and that some of Gd-HDL's effectiveness in vivo is indirect through transfer of the imaging agent to LDL. In conclusion, the fate of Gd-DTPA-DMPE associated with a particular type of lipoprotein is complex, and includes its transfer to other lipoprotein species that are then cleared from the plasma into tissues.
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Affiliation(s)
- Alessandra Barazza
- Leon H. Charney Division of Cardiology and Marc and Ruti Bell Program in Vascular Biology, Department of Medicine, New York University School of Medicine, Smilow 7, 522 First Avenue, New York, New York 10016, United States
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Schneer S, Bachar GN, Atar E, Koronowski R, Dicker D. Evaluation of framingham and systematic coronary risk evaluation scores by coronary computed tomographic angiography in asymptomatic adults. Am J Cardiol 2013; 111:700-4. [PMID: 23273527 DOI: 10.1016/j.amjcard.2012.11.023] [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: 09/12/2012] [Revised: 11/12/2012] [Accepted: 11/12/2012] [Indexed: 01/24/2023]
Abstract
Recently, coronary computed tomographic angiography (CCTA) was introduced as a tool for the early detection of coronary atherosclerosis. However, a disagreement exists regarding the accuracy of CCTA for the prediction of future cardiovascular risk compared to conventional clinical risks scores (e.g., Framingham and Systematic Coronary Risk Evaluation [SCORE] scores). The aim of the present study was to compare these 2 methods in asymptomatic Israeli subjects. CCTA was performed in 190 asymptomatic patients with ≥1 atherogenic risk factor as the primary screening tool for the presence of cardiovascular disease. The calcium score (CS) was measured in these subjects as a part of CCTA. In addition, the Framingham and SCORE scores were calculated, and statistical analysis using regression models was performed. The study included 190 subjects (84% men). The mean age was 55 ± 9.7 years. A significant correlation with the CS and plaque severity detected by CCTA was found when comparing the risk factors calculated by the SCORE and Framingham scores. A SCORE calculation of >2 versus <2 was related to a greater incidence of a CS >100 (42.9% vs 21.9; odds ratio [OR] 2.68, p = 0.001). When comparing high-risk (>4) and low-risk (<4) SCORE scores, the risk of atherosclerosis per CCTA was 50% versus 27.1% respectively (OR 2.7, p = 0.001). A high-risk Framingham (>20) versus low-risk Framingham (<20) score was related to a greater incidence of CS >100 (53.3% vs 28.6%; OR 3.18, p = 0.001). A high-risk versus low-risk SCORE score was related to greater plaque severity (79.2% vs 59.4%, respectively; OR 2.6, p = 0.001). A high-risk versus low-risk Framingham score was also related to greater plaque severity (93.3% vs 59%, respectively; OR 3.18, p = 0.001). The variables best predicting the severity of artery stenosis were age, gender, diabetes, and hypertension. In conclusion, the results of the present study indicate that the results of the Framingham and SCORE scores compared to those obtained using CCTA are good predictors of coronary artery disease. The use of these clinical scores seems important in identifying patients at risk of coronary atherosclerosis and treating them properly before the development of symptoms and also to help prevent the use of unnecessary invasive procedures.
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Christodoulides N, Pierre FN, Sanchez X, Li L, Hocquard K, Patton A, Muldoon R, Miller CS, Ebersole JL, Redding S, Yeh CK, Furmaga WB, Wampler DA, Bozkurt B, Ballantyne CM, McDevitt JT. Programmable bio-nanochip technology for the diagnosis of cardiovascular disease at the point-of-care. Methodist Debakey Cardiovasc J 2012; 8:6-12. [PMID: 22891104 DOI: 10.14797/mdcj-8-1-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Cardiovascular disease remains the leading cause of death in the world and continues to serve as the major contributor to healthcare costs. Likewise, there is an ever-increasing need and demand for novel and more efficient diagnostic tools for the early detection of cardiovascular disease, especially at the point-of-care (POC). This article reviews the programmable bio-nanochip (P-BNC) system, a new medical microdevice approach with the capacity to deliver both high performance and reduced cost. This fully integrated, total analysis system leverages microelectronic components, microfabrication techniques, and nanotechnology to noninvasively measure multiple cardiac biomarkers in complex fluids, such as saliva, while offering diagnostic accuracy equal to laboratory-confined reference methods. This article profiles the P-BNC approach, describes its performance in real-world testing of clinical samples, and summarizes new opportunities for medical microdevices in the field of cardiac diagnostics.
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Fujioka C, Funama Y, Kiguchi M, Ishifuro M, Kihara Y, Nagata Y, Awai K. Coronary artery calcium scoring on different 64-detector scanners using a low-tube voltage (80 kVp). Acad Radiol 2012; 19:1402-7. [PMID: 22925933 DOI: 10.1016/j.acra.2012.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2012] [Revised: 06/05/2012] [Accepted: 07/07/2012] [Indexed: 12/22/2022]
Abstract
PURPOSE The aim of this study was to compare the calcium score and reproducibility of coronary artery calcium scores obtained on the four kinds of 64-detector computed tomography (CT) scanners using standard (120 kVp) and low tube voltage (80 kVp) scan techniques. MATERIALS AND METHODS We scanned 80 and 120 kVp on all scanners. We calculated Agatston, volume, and mass scores for coronary artery calcium scoring on each scanner and compared the coefficients of variation of the calcium scores to evaluate reproducibility of among CT scanners. RESULTS The averages of the total mean Agatston score, total mean volume score, and total mean mass score at 80 kVp/120 kVp were 798.9/683.8, and 627.2/567.3, and 157.1/156.7, respectively. The total mean mass score was almost constant irrespective of the tube voltage. The total mean coefficients of variation for the four CT scanners were lower at 80 than 120 kVp (4.1% vs. 10.2% [total mean Agatston score], 3.2% vs. 9.6% [total mean volume score], and 3.2% vs. 9.4% [total mean mass score]). CONCLUSION Use of the low tube voltage technique can reduce variations in the coronary artery calcium scores obtained on different CT scanners.
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Parikh NI, Vasan RS. Assessing the clinical utility of biomarkers in medicine. Biomark Med 2012; 1:419-36. [PMID: 20477384 DOI: 10.2217/17520363.1.3.419] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Biomarkers in medicine have gained immense scientific and clinical interest in recent years. Biomarkers are potentially useful in the contexts of primary, secondary and tertiary prevention. Some of the characteristics of an ideal biomarker include that they are safe and easy to measure, are associated with acceptable costs (including those of the follow-up tests), and there is scientific evidence to suggest that biomarker use/modification influences disease outcomes. Additionally, variation in biomarker levels with gender and ethnicity should be elucidated, and the biomarker should have 'good performance characteristics' (i.e., sensitivity, specificity, positive- and negative-predictive values and positive- and negative-likelihood ratios). Risk prediction scores can combine information from several different biomarkers in order to estimate an individual's risk of developing an outcome, such as disease or death. Three commonly employed methods to test if a biomarker will add to traditional risk prediction models are model discrimination, model calibration and risk reclassification. 'Multimarker' strategies serve to integrate information from multiple biomarkers into risk prediction but may be limited by the presence of highly correlated biomarkers, economic costs and selection bias of biomarker candidates in a particular study sample. In the future, integration of biomarkers identified using emerging technologies from the 'omics fields (including genomics, proteomics, metabolomics, lipomics, ribomics and pharmacogenomics) may be useful for the 'personalization' of treatment/disease prevention.
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Affiliation(s)
- Nisha I Parikh
- Framingham Heart Study, 73 Mount Wayte Avenue, Suite 2, Framingham, MA 01702-5803, USA
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Randeva HS, Tan BK, Weickert MO, Lois K, Nestler JE, Sattar N, Lehnert H. Cardiometabolic aspects of the polycystic ovary syndrome. Endocr Rev 2012; 33:812-41. [PMID: 22829562 PMCID: PMC3461136 DOI: 10.1210/er.2012-1003] [Citation(s) in RCA: 182] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Accepted: 05/30/2012] [Indexed: 02/06/2023]
Abstract
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder amongst women of reproductive age and is associated with various metabolic perturbations, in addition to chronic anovulation and factors related to androgen excess. In general, women live longer than men and develop cardiovascular disease at an older age. However, women with PCOS, as compared with age- and body mass index-matched women without the syndrome, appear to have a higher risk of insulin resistance, hyperinsulinemia, glucose intolerance, dyslipidemia, and an increased prothrombotic state, possibly resulting in a higher rate of type 2 diabetes mellitus, fatty liver disease, subclinical atherosclerosis, vascular dysfunction, and finally cardiovascular disease and mortality. Further alterations in PCOS include an increased prevalence of sleep apnea, as well as various changes in the secretion and/or function of adipokines, adipose tissue-derived proinflammatory factors and gut hormones, all of them with direct or indirect influences on the complex signaling network that regulates metabolism, insulin sensitivity, and energy homeostasis. Reviews on the cardiometabolic aspects of PCOS are rare, and our knowledge from recent studies is expanding rapidly. Therefore, it is the aim of the present review to discuss and to summarize the current knowledge, focusing on the alterations of cardiometabolic factors in women with PCOS. Further insight into this network of factors may facilitate finding therapeutic targets that should ameliorate not only ovarian dysfunction but also the various cardiometabolic alterations related to the syndrome.
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Affiliation(s)
- Harpal S Randeva
- Division of Metabolic and Vascular Health, Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, United Kingdom.
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Li J, Flammer AJ, Nelson RE, Gulati R, Friedman PA, Thomas RJ, Sandhu NP, Reriani MK, Lerman LO, Lerman A. Normal vascular function as a prerequisite for the absence of coronary calcification in patients free of cardiovascular disease and diabetes. Circ J 2012; 76:2705-10. [PMID: 22850339 DOI: 10.1253/circj.cj-12-0683] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The absence of coronary artery calcium (CAC) is a marker of very low cardiovascular risk. Endothelial cells may have an effect on the initiation and propagation of arterial calcification. We aimed to identify the relationship between the absence of CAC and endothelial function in individuals without cardiovascular disease and diabetes. METHODS AND RESULTS CAC was assessed using electron-beam computed tomography and the calcium score was then computed. Endothelial function was measured by assessing reactive hyperemia-induced vasodilation and expressed by the reactive hyperemia index (RHI). Of 82 patients, 39 had non-detectable calcium (CAC score=0) and 43 had a CAC score >0. In the CAC score=0 group, the prevalence of normal endothelial function was 84.6%, compared to 48.8% in the CAC score >0 group, P=0.001. The absence of CAC was highly correlated with normal endothelial function (γ=0.704, P<0.001). On average, endothelial function was significantly better in the CAC score=0 group than in the CAC score >0 group (RHI 2.2±0.6 vs. 1.8±0.5, P=0.002). In a multivariate logistic regression model, only normal endothelial function (odds ratio [OR] 5.03, 95% confidence interval [CI] 1.55-16.27, P=0.007) and age (years) (OR 0.91, 95% CI 0.86-0.96, P=0.002) were independently associated with the absence of CAC. CONCLUSIONS Normal functional status of the vasculature may be important for the prevention of coronary calcification and may partly account for the low cardiovascular risk of absent CAC.
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Affiliation(s)
- Jing Li
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA
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Taraboanta C, Hague CJ, Mancini GBJ, Forster BB, Frohlich J. Coronary artery calcium findings in asymptomatic subjects with family history of premature coronary artery disease. BMC Cardiovasc Disord 2012; 12:53. [PMID: 22805651 PMCID: PMC3521199 DOI: 10.1186/1471-2261-12-53] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Accepted: 06/28/2012] [Indexed: 01/07/2023] Open
Abstract
Background To evaluate the frequency of positive coronary arteries calcium (CAC) scores in a unique population of asymptomatic first degree relatives (FDRs) of patients with angiographically confirmed early onset of coronary artery disease (CAD) and to assess their association with carotid ultrasound findings and other cardiovascular risk factors. Method and results We scanned, using 64-slice multi-detector computed tomography, 57 asymptomatic FDRs (47 ± 9 years old; 44% male, 56% female), out of the 111 FDRs previously phenotyped for cardiovascular (CV) risk factors. The controls were 616 individuals (57 ± 10 years old; 76% male, 24% female) with no family history of cardiovascular disease, chest pain or diabetes selected out of the 3500 subjects scanned between 2002 and 2007. FDRs had higher risk of abnormal CAC scores compared to controls; odds ratio (OR) for the 75th percentile was 1.96 (95% CI 1.04 – 3.67, p < 0.05). Conclusion The frequency of abnormal CAC scores is two-fold higher in asymptomatic FDRs than in controls. CAC scan provides additional information on CV risk assessment in asymptomatic FDRs, particularly for those in the intermediate risk category. Clinical trial registration NCT00387595
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Affiliation(s)
- Catalin Taraboanta
- Department of Pathology and Laboratory medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Hamad EA, Travin MI. The Complementary Roles of Radionuclide Myocardial Perfusion Imaging and Cardiac Computed Tomography. Semin Roentgenol 2012; 47:228-39. [DOI: 10.1053/j.ro.2011.11.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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