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Certo Pereira J, Santos R, Moscoso Costa F, Monge J, de Araújo Gonçalves P, Dores H. Coronary atherosclerotic burden in veteran athletes: The relationship between cardiovascular risk and volume of exercise. Rev Port Cardiol 2024:S0870-2551(24)00079-9. [PMID: 38583858 DOI: 10.1016/j.repc.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/19/2024] [Accepted: 03/21/2024] [Indexed: 04/09/2024] Open
Abstract
INTRODUCTION AND OBJECTIVES The association between exercise and coronary atherosclerosis still remains unclarified. We aimed to analyze the prevalence of high coronary atherosclerotic burden in veteran athletes, considering cardiovascular (CV) risk and volume of exercise. METHODS A total of 105 asymptomatic male veteran athletes (48±5.6 years old) were studied. A high coronary atherosclerotic burden was defined as one of the following characteristics in coronary computed tomography angiography: calcium score >100, >75th percentile, obstructive plaques, involving left main, three-vessels or two-vessels including proximal anterior descending artery, segment involvement score >5 or CT-adapted Leaman score ≥5. CV risk was stratified by SCORE2 and volume of exercise by metabolic equivalent task score. RESULTS Most athletes (n=88) were engaged in endurance sports for 17.1±9.8 years, with a median exercise volume of 66 [IQR 44-103] metabolic equivalent of tasks/hour/week. The mean Systematic Coronary Risk Evaluation 2 was 2.8±1.5%; 76.9% of athletes had a low-moderate risk and none a very high risk. High coronary atherosclerotic burden was present in 25.7% athletes. Athletes with high cardiovascular risk and high exercise volume (above the median) showed significantly high coronary atherosclerotic burden compared to those with low-moderate risk and high volume (50.0% vs. 15.6%; p=0.017). Among athletes with low to moderate risk, a high volume of exercise tended to be protective, while in those with low volume, there was similar rate of high coronary atherosclerotic burden, regardless of CV risk. CONCLUSIONS A combination of higher volume of exercise and high cardiovascular risk revealed the worst association with coronary atherosclerosis in veteran athletes. The relationship between these variables is controversial, but integrating exercise characteristics and risk assessment into preparticipation evaluation is essential.
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Affiliation(s)
| | | | | | | | - Pedro de Araújo Gonçalves
- Hospital de Santa Cruz, Lisboa, Portugal; Hospital da Luz, Lisbon, Portugal; CHRC, NOVA Medical School, Lisbon, Portugal; NOVA Medical School, Lisbon, Portugal
| | - Hélder Dores
- Hospital da Luz, Lisbon, Portugal; CHRC, NOVA Medical School, Lisbon, Portugal; NOVA Medical School, Lisbon, Portugal
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2
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Bao M, Song Y, Han X, Wu S, Li J. Comparison of BP variability, cumulative BP, and BP trajectory for predicting cardiovascular events in the general population. Hellenic J Cardiol 2024; 76:11-21. [PMID: 37532023 DOI: 10.1016/j.hjc.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 07/08/2023] [Accepted: 07/15/2023] [Indexed: 08/04/2023] Open
Abstract
OBJECTIVE Systolic blood pressure variability (SBPV), cumulative systolic BP (cumSBP), and systolic blood pressure trajectory (trajSBP) are major indices describing characteristics of BP changes. The aim of this study was to compare their discrimination abilities for cardiovascular (CV) events. METHODS In 51698 subjects, associations were assessed using Cox regression in the overall cohort and Framingham risk score (FRS) stratified groups. Individuals with <10%, 10%-20%, and >20% 10-year CV risk were categorized into the low-, intermediate-, and high-risk group, respectively. Discrimination capabilities were evaluated using the area under curve (AUC), Harrell's C index, net reclassification index (NRI), and integrated discrimination index (IDI). RESULTS Within a mean follow-up of 6.83 ± 0.89 years, 2330 participants had CV events, and all three markers were significantly associated with CV events. TrajSBP provided the best additional discriminative value for CV events, with improvements of 1.54% in AUC%, 0.01 in Harrell's C, 37.52% in NRI%, and 0.59% in IDI%. CumSBP had good additional discriminative capability in the intermediate to high FRS groups, but the effect sizes were smaller than those of trajSBP. Although, SBPV improved the predictive capabilities in the low-to intermediate-risk groups, the effect sizes were much smaller than those of the other indices. Sensitivity analyses excluding patients who underwent antihypertensive therapy revealed similar patterns but higher effect sizes than in the overall population. CONCLUSION TrajSBP provides the best additional discrimination capabilities based on traditional risk profiles and may assist the risk stratification and individual prediction for future CV events.
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Affiliation(s)
- Minghui Bao
- Department of Cardiology, Peking University First Hospital, Peking University, Beijing, China.
| | - Yongjian Song
- Department of Cardiology, Zhangjiakou First Hospital, Hebei, China
| | - Xu Han
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan, China
| | - Shouling Wu
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan, China
| | - Jianping Li
- Department of Cardiology, Peking University First Hospital, Peking University, Beijing, China
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Kitjanukit S, Kuanprasert S, Suwannasom P, Phrommintikul A, Wongyikul P, Phinyo P. Coronary artery calcium (CAC) score for cardiovascular risk stratification in a Thai clinical cohort: A comparison of absolute scores and age-sex-specific percentiles. Heliyon 2024; 10:e23901. [PMID: 38226260 PMCID: PMC10788496 DOI: 10.1016/j.heliyon.2023.e23901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 01/17/2024] Open
Abstract
Purposes Coronary artery calcium (CAC) score provides a quantification of atherosclerotic plaque within the coronary arteries. This study aimed to examine the prevalence and CAC score distribution and to evaluate the association of each CAC score classifications with major adverse cardiovascular events (MACE) in a Thai clinical cohort. Methods This study was a retrospective observational cohort. We included patients aged above 35 years who underwent CAC score testing. The absolute and age-sex specific percentile classifications were categorized as 0, 1 to 10, 11 to 100, 101 to 400, and >400 and 0, <75th, 75th - 90th, and >90th, respectively. The endpoint was MACE, including cardiovascular death, myocardial infarction, heart failure hospitalization, coronary artery revascularization procedure, and stroke. Multivariable Cox regression was used to estimate the hazard ratios. The discriminative performance between classifications were compared using Harrell's C-statistics. The agreement was assessed via Cohen's Kappa. Results This study included 440 patients, with approximately 70% of Thai patients exhibiting a CAC score. CAC score distributed higher in male than female and increased with age. Both CAC score classification demonstrated the acceptable predictive performance. However, fair agreement was observed between classifications (Cohen's kappa 0.51, 95%CI 0.42-0.59). Within the absolute classification, a higher CAC score was associated with increased hazard ratios for MACE across stratified age-sex-specific percentile levels. In contrast, the hazard ratios for MACE did not consistently rise with higher age-sex-specific percentile CAC score when stratified by absolute CAC score levels. Conclusions Both absolute and age-sex-specific percentile CAC score demonstrated acceptable performance in predicting MACE. However, the absolute CAC score classification may be more suitable for risk stratification within the Thai clinical cohort. Our findings offer supportive information that could inform future recommendations for CAC score testing criteria within national clinical practice guidelines.
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Affiliation(s)
- Supitcha Kitjanukit
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Srun Kuanprasert
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pannipa Suwannasom
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Arintaya Phrommintikul
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pakpoom Wongyikul
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Phichayut Phinyo
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Musculoskeletal Science and Translational Research, Chiang Mai University, Chiang Mai, Thailand
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Ohlsson C, Nethander M, Norlén AK, Poutanen M, Gudmundsson EF, Aspelund T, Sigurdsson S, Ryberg H, Gudnason V, Tivesten Å. Serum DHEA and Testosterone Levels Associate Inversely With Coronary Artery Calcification in Elderly Men. J Clin Endocrinol Metab 2023; 108:3272-3279. [PMID: 37391895 PMCID: PMC10655543 DOI: 10.1210/clinem/dgad351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 05/16/2023] [Accepted: 06/07/2023] [Indexed: 07/02/2023]
Abstract
CONTEXT Epidemiological and preclinical data support cardiovascular, mainly protective, effects of sex steroids in men, but the mechanisms underlying the cardiovascular actions of sex steroids are poorly understood. Vascular calcification parallels the development of atherosclerosis, but is increasingly recognized as a diversified, highly regulated process, which itself may have pathophysiological importance for clinical cardiovascular events. OBJECTIVE To investigate the association between serum sex steroids and coronary artery calcification (CAC) in elderly men. METHODS We used gas chromatography tandem mass spectrometry to analyze a comprehensive sex steroid profile, including levels of dehydroepiandrosterone (DHEA), androstenedione, estrone, testosterone, estradiol, and dihydrotestosterone, in men from the population-based AGES-Reykjavik study (n = 1287, mean 76 years). Further, sex hormone-binding globulin (SHBG) was assayed and bioavailable hormone levels calculated. CAC score was determined by computed tomography. The main outcome measures were cross-sectional associations between dehydroepiandrosterone, androstenedione, estrone, testosterone, dihydrotestosterone, and estradiol and quintiles of CAC. RESULTS Serum levels of DHEA, androstenedione, testosterone, dihydrotestosterone, and bioavailable testosterone showed significant inverse associations with CAC, while estrone, estradiol, bioavailable estradiol, and SHBG did not. DHEA, testosterone, and bioavailable testosterone remained associated with CAC after adjustment for traditional cardiovascular risk factors. In addition, our results support partially independent associations between adrenal-derived DHEA and testes-derived testosterone and CAC. CONCLUSION Serum levels of DHEA and testosterone are inversely associated with CAC in elderly men, partially independently from each other. These results raise the question whether androgens from both the adrenals and the testes may contribute to male cardiovascular health.
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Affiliation(s)
- Claes Ohlsson
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Osteoporosis Centre, Centre for Bone and Arthritis Research at the Sahlgrenska Academy, University of Gothenburg, SE-413 45 Gothenburg, Sweden
- Department of Drug Treatment, Sahlgrenska University Hospital, Region Västra Götaland, SE-413 45 Gothenburg, Sweden
| | - Maria Nethander
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Osteoporosis Centre, Centre for Bone and Arthritis Research at the Sahlgrenska Academy, University of Gothenburg, SE-413 45 Gothenburg, Sweden
- Bioinformatics and Data Centre, Sahlgrenska Academy, University of Gothenburg, SE-405 30 Gothenburg, Sweden
| | - Anna-Karin Norlén
- Department of Clinical Chemistry, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
| | - Matti Poutanen
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Osteoporosis Centre, Centre for Bone and Arthritis Research at the Sahlgrenska Academy, University of Gothenburg, SE-413 45 Gothenburg, Sweden
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, FI-20520 Turku, Finland
| | | | - Thor Aspelund
- Faculty of Medicine, University of Iceland, 101 Reykjavik, Iceland
| | | | - Henrik Ryberg
- Department of Clinical Chemistry, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
| | - Vilmundur Gudnason
- Icelandic Heart Association, 201 Kopavogur, Iceland
- Faculty of Medicine, University of Iceland, 101 Reykjavik, Iceland
| | - Åsa Tivesten
- Wallenberg Laboratory for Cardiovascular and Metabolic Research, Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, SE-413 45 Gothenburg, Sweden
- Department of Endocrinology, Sahlgrenska University Hospital, Region Västra Götaland, SE-413 45 Gothenburg, Sweden
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Capisizu AS, Stanciu SM, Cuzino D. A Pilot Study on the Association between Cardiovascular Risk Factors and Coronary Artery Calcification in a Group of Patients Investigated via Cardiac Computed Tomography in a European Country with High Cardiovascular Risk. Biomedicines 2023; 11:2926. [PMID: 38001927 PMCID: PMC10669034 DOI: 10.3390/biomedicines11112926] [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: 08/28/2023] [Revised: 10/19/2023] [Accepted: 10/25/2023] [Indexed: 11/26/2023] Open
Abstract
(1) Background: Cardiovascular disease is the leading cause of mortality worldwide; the prevention and early detection of coronary artery disease are of critical importance; and the coronary artery calcium score is a powerful method in the assessment of coronary artery disease. Among European countries, Romania ranks as a country with a very high risk of cardiovascular diseases, but the data are limited in regard to the prevalence of the calcium score. (2) Methods: A retrospective study was conducted to establish the coronary calcium score in a group of patients investigated via cardiac CT and to determine the correlation with the presence of cardiovascular risk factors. (3) Results: According to the Agatston calcium score, 50% of the patients had a positive calcium score. High calcium scores above 400 UA were present in 12.6% of patients. Regarding the association between the presence of cardiovascular risk factors and the levels of coronary artery calcification, a mild level of calcification was associated with age over 50 years (X2 = 3.88, p = 0.04, OR = 3.25; 95% CI 0.94-11.14); a moderate level of calcification with the age of patients over 50 years (X2 = 6.54, p = 0.01, OR = 5.58; 95% CI 1.29-24.16), dyslipidemia (X2 = 7.28, p = 0.007, OR = 3.37; 95% CI 1.34-8.51), and arterial hypertension (X2 = 5.37, p = 0.02, OR = 2.88; 95% CI 1.14-7.27); a severe level of calcification with hypertension (X2 = 4.61, p = 0.03, OR = 7.03; 95% CI 0.90-54.81); and a very severe level of calcification with hypertension (X2 = 4.61, p = 0.03, OR = 7.03; 95% CI 0.90-54.81), smoking (X2 = 8.07, p = 0.004, OR = 4.44; 95% CI 1.47-13.44), and diabetes (X2 = 13.65, p = 0.001, OR = 6.59; 95% CI 2.5-20.18). (4) Conclusion: Half of the patients investigated by using cardiac CT had a calcium score of zero. Predictors for coronary calcium scores in relation to risk factors varied. For the very severe coronary calcification level, the strongest predictor was the presence of smoking and diabetes, which increased the odds for very severe calcification by 13.46 times. Patients who had multiple cardiovascular risk factors, hypertension, diabetes, and smoking were 9.18 times more likely to have very severe calcification.
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Affiliation(s)
- Adriana Sorina Capisizu
- Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Bvd., 050474 Bucharest, Romania
| | - Silviu Marcel Stanciu
- Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Bvd., 050474 Bucharest, Romania
- Center for Cardiovascular Diseases, Laboratory of Noninvasive Cardiovascular Functional Explorations, Central Military Emergency University Hospital “Dr. Carol Davila”, 134 Calea Plevnei Str., 010825 Bucharest, Romania
| | - Dragos Cuzino
- Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Bvd., 050474 Bucharest, Romania
- Clinical Radiology-Medical Imaging Center, Central Military Emergency University Hospital “Dr. Carol Davila”, 134 Calea Plevnei Str., 010825 Bucharest, Romania
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Abedi F, Sadeghi M, Omidkhoda N, Kelesidis T, Ramezani J, Samadi S, Mohammadpour AH. HDL-cholesterol concentration and its association with coronary artery calcification: a systematic review and meta-analysis. Lipids Health Dis 2023; 22:60. [PMID: 37158895 PMCID: PMC10165789 DOI: 10.1186/s12944-023-01827-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 04/29/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Coronary artery calcification (CAC) is a potential risk marker of coronary atherosclerosis that has high specificity and sensitivity. However, the association between high-density lipoprotein cholesterol (HDL-C) concentration and CAC incidence and progression is controversial. METHODS PubMed, Embase, Web of Science, and Scopus were systematically searched to identify relevant observational studies up to March 2023 and assessed the methodological quality using Newcastle-Ottawa Scale (NOS) scale. Random-effects meta-analysis was used to estimate pooled odds ratios (OR) and 95% confidence interval considering heterogeneity across studies. RESULTS Of the 2,411 records, 25 cross-sectional (n = 71,190) and 13 cohort (n = 25,442) studies were included in the systematic review. Ten cross-sectional and eight cohort studies were not eligible and were omitted from the meta-analysis. A total of 15 eligible cross-sectional studies (n = 33,913) were included in the meta-analysis and pooled results revealed no significant association between HDL-C and CAC > 0, CAC > 10, or CAC > 100 [pooled OR: 0.99 (0.97, 1.01)]. Meta-analysis of the 5 eligible prospective cohort studies (n = 10,721) revealed no significant protective effect of high HDL-C against CAC > 0 [pooled OR: 1.02 (0.93, 1.13)]. CONCLUSIONS According to this analysis of observational studies, high HDL-C levels were not found to predict protection against CAC. These results suggest HDL quality rather than HDL quantity is important for certain aspects of atherogenesis and CAC. REGISTRATION NUMBER CRD42021292077.
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Affiliation(s)
- Farshad Abedi
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Masoumeh Sadeghi
- Department of Epidemiology, Faculty of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Navid Omidkhoda
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Theodoros Kelesidis
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Javad Ramezani
- Department of Cardiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sara Samadi
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Amir Hooshang Mohammadpour
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
- Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.
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Mello FM, Bensenor IM, Santos IS, Bittencourt MS, Lotufo PA, Fuller R. Serum Uric Acid Levels and Subclinical Atherosclerosis: Results From the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Curr Probl Cardiol 2023; 48:101525. [PMID: 36455798 DOI: 10.1016/j.cpcardiol.2022.101525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 11/25/2022] [Indexed: 11/30/2022]
Abstract
High serum uric acid (sUA) has been associated with coronary artery calcium (CAC) and increased carotid intima-media thickness (cIMT) in people at high cardiovascular risk. However, association is unclear in apparently healthy individuals. Our study aims to evaluate association between sUA and subclinical atherosclerosis measures: CAC and increased cIMT, in apparently healthy adults enrolled in ELSA-Brasil. A total of 4096 participants without previous coronary artery disease, stroke, and use of urate-lowering drugs, underwent CAC and cIMT assessment. All analyses were stratified by sex. Serum uric acid categorized by quintiles was the exposure variable. Thorough cardiovascular risk factor evaluation was performed, and association between sUA quintiles and CAC and cIMT was analyzed by linear regression using ln(CAC + 1) and cIMT, both as continuous variables. Median age of the sample was 49.0 (44.0-56.0) years (women: 55.1%; 59.1% were white). Mean values of sUA were 6.5 ± 1.4 mg/dL for men, and 4.9 ± 1.2 mg/dL for women. The highest quintile (Q5) of sUA was independently associated with cIMT in women (beta-coefficient: 0.022; 95% CI: 0.007-0.036; P = 0.003) and men (beta-coefficient: 0.020; 95% CI: 0.002-0.038; P = 0.032). Regarding CAC, no association was found: men's Q5 (beta-coefficient: -0.142; 95% CI: -0.436 to 0.153; P = 0.347) and women's Q5 (beta-coefficient: 0.046; 95% CI: -0.152 to 0.245; P = 0.647). In this cohort, the highest sUA quintiles were independently associated with cIMT in both women and men. No association was found between sUA and the presence of CAC.
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Yazdi A, Fariba F, Karimian F, Jiryaee N. Relationship between Calcium Score and Conventional Risk Factors in the Diagnosis of Atherosclerosis. Med J Islam Repub Iran 2022; 36:58. [PMID: 36128291 PMCID: PMC9448493 DOI: 10.47176/mjiri.36.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/02/2022] [Indexed: 11/30/2022] Open
Abstract
Background: The coronary artery calcium score has been established as a highly specific feature of coronary atherosclerosis. The present study aimed to assess the possible association of coronary artery risk factors involving atherosclerosis with the coronary artery calcification (CAC) scores using coronary computed tomographic angiography (CCTA). Methods: The present cross-sectional study, performed on 252 patients in need of CCTA during April 2019 and September 2019 at Farshchian hospital in Hamadan, Iran. The demographic information and risk factors were acquired from the files of patients. Furthermore, the CACs of patients were calculated and expressed as the Agatston score. Based on the Agatston scale, participants were divided into 4 CAC scores: zero (CAC = 0), mild (CAC = 1-99), moderate (CAC = 100-399), and severe (CAC ≥400). The association between possible coronary artery disease (CAD) risk variables and the CAC score was investigated using multinomial logistic regression. Results: Of 252 participants, approximately 40% of studied patients had a positive CAC score (CAC > 0). CAC significantly shifts toward higher scores in smokers, patients with diabetes, hypertension, and older patients. Mild (CAC = 1-99) and moderate CAC (100-399) were significantly associated with diabetes (odds ratio [OR], 3.26; 95% CI, 1.48-7.17) and (OR, 12; 95% CI, 4.40-32.71) for mild and moderate CAC, respectively. However, the strongest predictor for severe CAC was diabetes (OR, 7.72; 95% CI, 2.10-28.35). Conclusion: Coronary artery calcium scoring is a marker for risk factors associated with atherosclerosis. In this study, more than half of patients in CAC screening had CAC = 0. The strongest predictor of severe CAC>0 was smoking and diabetes. Regarding this association between health condition and CAC, determining the CAC can prevent major coronary heart disease events in these patients.
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Affiliation(s)
- Amirhossein Yazdi
- Department of Cardiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Farnaz Fariba
- Department of Cardiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran,Corresponding author: Dr Farnaz Fariba,
| | - Fatemeh Karimian
- Department of Cardiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Nasrin Jiryaee
- Department of Community and Preventive Medicine, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
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9
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Bertisch SM, Reid M, Lutsey PL, Kaufman JD, McClelland R, Patel SR, Redline S. Gender differences in the association of insomnia symptoms and coronary artery calcification in the multi-ethnic study of atherosclerosis. Sleep 2021; 44:zsab116. [PMID: 33987669 PMCID: PMC8503822 DOI: 10.1093/sleep/zsab116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 04/27/2021] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES To quantify the gender-specific associations between insomnia symptoms and subclinical atherosclerosis, measured by coronary artery calcium (CAC) scores, which has strong predictive value for incident cardiovascular disease. METHODS We analyzed data from 1,429 participants in the Multi-Ethnic Study of Atherosclerosis (MESA). Participants completed standardized questionnaires and underwent polysomnography (PSG) and 7-day actigraphy. Insomnia symptoms were defined as: self-reported trouble falling, staying or returning to sleep, early-morning awakenings, or hypnotic use, for ≥5 nights/week. MESA assessed CAC using computed tomography. We employed multivariable linear regression to model the probability of CAC >0 overall and to model the linear continuous effect among those with nonzero CAC. RESULTS Our sample was a mean age of 68.1 ± 9.1 years, 53.9% female, and 36.2% white, 28.0% black, 24.2% Hispanic, and 11.5% Chinese-American. Insomnia symptoms were present in 49.7% of men and 47.2% of women. In multivariable-adjusted analyses, insomnia symptoms was associated with an 18% higher prevalence of CAC (PR 1.18, 95% CI 1.04, 1.33) among females, but no association was observed among males (PR 1.00, 95% CI 0.91, 1.08). There was no evidence that the association between insomnia symptoms and prevalence of CAC >0 differed by objective sleep duration status (by single-night PSG or multi-night actigraphy) in females or males. CONCLUSIONS We found that among women, insomnia symptoms were associated with an 18% higher prevalence of CAC compared to no insomnia. Insomnia symptoms were not associated with CAC prevalence in men. Additionally, there was no evidence that the association between insomnia symptoms and CAC score >0 differed by objective short sleep duration status.
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Affiliation(s)
- Suzanne M Bertisch
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Michelle Reid
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA, USA
| | - Pamela L Lutsey
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Joel D Kaufman
- Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, WA, USA
| | - Robyn McClelland
- Department of Biostatistics, University of Washington School of Public Health, Seattle, WA, USA
| | - Sanjay R Patel
- Center for Sleep and Cardiovascular Outcomes Research, University of Pittsburgh, Pittsburgh, PA, USA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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10
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Burns RB, Pignone M, Michos ED, Kanjee Z. Would You Recommend Aspirin to This Patient for Primary Prevention of Atherosclerotic Cardiovascular Disease? : Grand Rounds Discussion From Beth Israel Deaconess Medical Center. Ann Intern Med 2021; 174:1439-1446. [PMID: 34633837 DOI: 10.7326/m21-2596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of death in the United States. Reducing ASCVD risk through primary prevention strategies has been shown to be effective; however, the role of aspirin in primary prevention remains unclear. The decision to recommend aspirin has been limited by the difficulty clinicians and patients face when trying to balance benefits and harms. In 2016, the U.S. Preventive Services Task Force addressed this issue by determining the risk level at which prophylactic aspirin generally becomes more favorable, recommending aspirin above a risk cut point (>10% estimated ASCVD risk). In 2019, the American College of Cardiology and the American Heart Association issued a guideline on the primary prevention of CVD that recommends low-dose aspirin might be considered for the primary prevention of ASCVD among select adults aged 40 to 70 years who are at higher ASCVD risk but not at increased risk for bleeding. Here, 2 experts discuss how to apply this guideline in general and to a patient in particular while answering the following questions: How do you assess ASCVD risk, and what is the role, if any, of the coronary artery calcium score?; At what risk threshold of benefits and harms would you recommend aspirin or not?; and How do you help a patient come to a decision about starting or stopping aspirin therapy?
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Affiliation(s)
- Risa B Burns
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts (R.B.B., Z.K.)
| | - Michael Pignone
- Dell Medical School, The University of Texas at Austin, Austin, Texas (M.P.)
| | - Erin D Michos
- Johns Hopkins University School of Medicine, Baltimore, Maryland (E.D.M.)
| | - Zahir Kanjee
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts (R.B.B., Z.K.)
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11
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Pan YK, Sun MH, Wang JJ, Chen XB, Kan XJ, Ge YH, Guo ZP. Effect of different reconstruction algorithms on coronary artery calcium scores using the reduced radiation dose protocol: a clinical and phantom study. Quant Imaging Med Surg 2021; 11:1504-1517. [PMID: 33816187 DOI: 10.21037/qims-20-437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background This study aimed to evaluate the effects of different iterative reconstruction (IR) algorithms on coronary artery calcium (CAC) score quantification using the reduced radiation dose (RRD) protocol in an anthropomorphic phantom and in patients. Methods A thorax phantom, containing 9 calcification inserts with varying hydroxyapatite (HA) densities, was scanned with the reference protocol [120 kv, 80 mAs, filtered back projection (FBP)] and RRD protocol (120 kV, 20-80 mAs, 5 mAs interval) using a 256-slice computed tomography (CT) scanner. Raw data were reconstructed with different reconstruction algorithms [iDose4 levels 1-7 and iterative model reconstruction (IMR) levels 1-3]. Signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and Agatston score (AS) were calculated for each image series. The correction factor was derived from linear regression analysis between the reference image series and other image series with different parameters. Additionally, 40 patients were scanned with the RRD protocol (50 mAs) and reconstructed with FBP, iDose4 level 4, and IMR level 2. AS was calculated for the 3-group image series, and was corrected by applying a correction factor for the IMR group. The agreement of risk stratification with different reconstruction algorithms was also analyzed. Results For the phantom study, the iDose4 and IMR groups had significantly higher SNR and CNR than the FBP group (all P<0.05). There were no significant differences in the total AS after comparing image series reconstructed with iDose4 (level 1-7) and FBP (all P>0.05), while AS from the IMR (level 1-3) image series were lower than the FBP group (all P<0.05). The tube current of 50 mAs was determined for the clinical study, and the correction factor was 1.14. For the clinical study, the median AS from the iDose4 and IMR groups were both significantly lower compared to the FBP image series [(112.89 (63.01, 314.09), 113.22 (64.78, 364.95) vs. 118.59 (65.05, 374.48), both P<0.05]. After applying the correction factor, the adjusted AS from the IMR group was not significantly different from that of the FBP group [126.48 (69.62, 355.85) vs. 118.59 (65.05, 374.48), P=0.145]. Moreover, the agreement in risk stratification between FBP and IMR improved from 0.81 to 0.85. Conclusions The RRD CAC scoring scan using the IMR reconstruction algorithm is clinically feasible, and a correction factor can help reduce the AS underestimation effect.
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Affiliation(s)
- Yu-Kun Pan
- Department of Radiology, Central China Fuwai Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Ming-Hua Sun
- Department of Radiology, Henan Provincial People's Hospital, Department of Radiology of Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - Jia-Jia Wang
- Department of Radiology, Central China Fuwai Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | | | - Xiao-Jing Kan
- Department of Radiology, Henan Provincial People's Hospital, Department of Radiology of Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - Ying-Hui Ge
- Department of Radiology, Henan Provincial People's Hospital, Department of Radiology of Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
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12
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Wang TKM, Chan N, Cremer PC, Kanj M, Baranowski B, Saliba W, Wazni OM, Jaber WA. Incorporating coronary calcification by computed tomography into CHA2DS2-VASc score: impact on cardiovascular outcomes in patients with atrial fibrillation. Europace 2021; 23:1211-1218. [PMID: 33585883 DOI: 10.1093/europace/euab032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 01/27/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS CHA2DS2-VASc score is widely utilized for risk stratification and guiding anticoagulation in patients with atrial fibrillation (AF). Cardiac computed tomography (CCT) routinely performed for pulmonary vein isolation (PVI) can also identify coronary artery calcifications (CAC). We evaluated the frequency and outcomes of incorporating CAC into the CHA2DS2-VASc score in AF patients undergoing PVI. METHODS AND RESULTS Consecutive patients in a prospective PVI registry during 2014-18 having CCT within 1 year of PVI were studied. Reclassification of CHA2DS2-VASc score and associations between CAC as a binary variable detected on CCT with clinical characteristics, stroke as primary endpoint, death, myocardial infarction, and major adverse cardiovascular events (MACE) were analysed. Amongst 3604 AF patients, 2238 (62.1%) had CAC detected on CCT and was associated with most traditional cardiovascular risk factors. Coronary artery calcification was independently associated with all pre-specified endpoints adjusting for clinical parameters in multivariable analysis. Adjusting for CHA2DS2-VASc score, CAC was associated with stroke (hazards ratio 3.64, 95% confidence interval 1.25-10.6, P = 0.018), death (2.26, 1.29-3.98, P = 0.006), and MACE (2.08, 1.36-3.16, P = 0.001) during 2.8 ± 1.6-year follow-up. Incorporating CAC as a vascular disease parameter of CHA2DS2-VASc score, anticoagulation decision-making would be revised in 723 (20.1%) patients, including an additional 488 (13.5%) patients where anticoagulation would be now indicated. CONCLUSION Coronary artery calcification is prevalent in AF patients undergoing PVI and independently associated stroke, death and MACE even when adjusted for traditional CHA2DS2-VASc score. Adding CAC as vascular component to the CHA2DS2-VASc score requires further research as it potentially modified the anticoagulation management in 20% of our AF cohort.
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Affiliation(s)
- Tom Kai Ming Wang
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, 9500 Euclid Avenue, Main Campus J1-5, Cleveland Clinic, Cleveland,OH 44195, USA
| | - Nicholas Chan
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, 9500 Euclid Avenue, Main Campus J1-5, Cleveland Clinic, Cleveland,OH 44195, USA
| | - Paul C Cremer
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, 9500 Euclid Avenue, Main Campus J1-5, Cleveland Clinic, Cleveland,OH 44195, USA
| | - Mohamed Kanj
- Section of Cardiac Electrophysiology and Pacing, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland,OH, USA
| | - Bryan Baranowski
- Section of Cardiac Electrophysiology and Pacing, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland,OH, USA
| | - Walid Saliba
- Section of Cardiac Electrophysiology and Pacing, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland,OH, USA
| | - Oussama M Wazni
- Section of Cardiac Electrophysiology and Pacing, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland,OH, USA
| | - Wael A Jaber
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, 9500 Euclid Avenue, Main Campus J1-5, Cleveland Clinic, Cleveland,OH 44195, USA
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13
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Khan A, Palka J, Joshi PH, Khera A, Brown ES. Association of depressive symptom severity with coronary artery calcium: The Dallas heart study. J Affect Disord 2020; 276:267-271. [PMID: 32697708 PMCID: PMC7484243 DOI: 10.1016/j.jad.2020.07.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 06/19/2020] [Accepted: 07/05/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Previous studies have yielded mixed results regarding the relationship between depressive symptoms and coronary artery calcium (CAC). This analysis sought to evaluate this relationship using a multiethnic, population-based cohort. METHODS Data were extracted from the second phase of the Dallas Heart Study (DHS-2). Depressive symptom severity was measured with the 16-item Quick Inventory of Depressive Symptomatology-Self Report (QIDS), a validated depressive symptom severity scale. A regression analysis was performed using QIDS score as the predictor variable and CAC as the outcome variable. Covariates included age, sex, ethnicity, diabetes, hypertension, smoking, systolic blood pressure, total cholesterol, HDL cholesterol, and body mass index. RESULTS The cohort consisted of 2,293 individuals with a mean age of 50 years and included 47.1% female and 47.1% black participants. The mean QIDS score was 4.37(±3.69), and 43.3% had CAC > 0. Regression results indicated that QIDS does not statistically significantly predict whether one does or does not have CAC, when controlling for age, sex, and ethnicity (β = 0.088, p = .240, OR = 1.092, 95% CI 0.943-1.264). LIMITATIONS Cross sectional design is limited to one point in time, very depressed patients with higher CAC burden may not have participated, and depressive symptoms may be associated with subclinical atherosclerosis differently with a formal diagnosis of depression. CONCLUSION Depressive symptoms were not associated with presence or severity of CAC in a multiethnic population based sample. Future studies are needed to determine if other prognostic markers of coronary heart disease are associated with depressive symptoms.
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Affiliation(s)
- Amber Khan
- Department of Psychiatry, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd. Dallas,Dallas, TX, USA
| | - Jayme Palka
- Department of Psychiatry, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd. Dallas,Dallas, TX, USA
| | - Parag H Joshi
- Department of Internal Medicine, Division of Cardiology, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Amit Khera
- Department of Internal Medicine, Division of Cardiology, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - E Sherwood Brown
- Department of Psychiatry, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd. Dallas,Dallas, TX, USA.
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14
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Jamthikar AD, Gupta D, Saba L, Khanna NN, Viskovic K, Mavrogeni S, Laird JR, Sattar N, Johri AM, Pareek G, Miner M, Sfikakis PP, Protogerou A, Viswanathan V, Sharma A, Kitas GD, Nicolaides A, Kolluri R, Suri JS. Artificial intelligence framework for predictive cardiovascular and stroke risk assessment models: A narrative review of integrated approaches using carotid ultrasound. Comput Biol Med 2020; 126:104043. [PMID: 33065389 DOI: 10.1016/j.compbiomed.2020.104043] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/10/2020] [Accepted: 10/04/2020] [Indexed: 12/12/2022]
Abstract
RECENT FINDINGS Cardiovascular disease (CVD) is the leading cause of mortality and poses challenges for healthcare providers globally. Risk-based approaches for the management of CVD are becoming popular for recommending treatment plans for asymptomatic individuals. Several conventional predictive CVD risk models based do not provide an accurate CVD risk assessment for patients with different baseline risk profiles. Artificial intelligence (AI) algorithms have changed the landscape of CVD risk assessment and demonstrated a better performance when compared against conventional models, mainly due to its ability to handle the input nonlinear variations. Further, it has the flexibility to add risk factors derived from medical imaging modalities that image the morphology of the plaque. The integration of noninvasive carotid ultrasound image-based phenotypes with conventional risk factors in the AI framework has further provided stronger power for CVD risk prediction, so-called "integrated predictive CVD risk models." PURPOSE of the review: The objective of this review is (i) to understand several aspects in the development of predictive CVD risk models, (ii) to explore current conventional predictive risk models and their successes and challenges, and (iii) to refine the search for predictive CVD risk models using noninvasive carotid ultrasound as an exemplar in the artificial intelligence-based framework. CONCLUSION Conventional predictive CVD risk models are suboptimal and could be improved. This review examines the potential to include more noninvasive image-based phenotypes in the CVD risk assessment using powerful AI-based strategies.
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Affiliation(s)
- Ankush D Jamthikar
- Department of Electronics and Communication Engineering, Visvesvaraya National Institute of Technology, Nagpur, Maharashtra, India
| | - Deep Gupta
- Department of Electronics and Communication Engineering, Visvesvaraya National Institute of Technology, Nagpur, Maharashtra, India
| | - Luca Saba
- Department of Radiology, University of Cagliari, Italy
| | - Narendra N Khanna
- Department of Cardiology, Indraprastha APOLLO Hospitals, New Delhi, India
| | - Klaudija Viskovic
- Department of Radiology and Ultrasound, University Hospital for Infectious Diseases, Croatia
| | - Sophie Mavrogeni
- Cardiology Clinic, Onassis Cardiac Surgery Center, Athens, Greece
| | - John R Laird
- Heart and Vascular Institute, Adventist Health St. Helena, St Helena, CA, USA
| | - Naveed Sattar
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Scotland, UK
| | - Amer M Johri
- Department of Medicine, Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Gyan Pareek
- Minimally Invasive Urology Institute, Brown University, Providence, RI, USA
| | - Martin Miner
- Men's Health Center, Miriam Hospital Providence, Rhode Island, USA
| | - Petros P Sfikakis
- Rheumatology Unit, National Kapodistrian University of Athens, Greece
| | - Athanasios Protogerou
- Department of Cardiovascular Prevention & Research Unit Clinic & Laboratory of Pathophysiology, National and Kapodistrian Univ. of Athens, Greece
| | - Vijay Viswanathan
- MV Hospital for Diabetes and Professor M Viswanathan Diabetes Research Centre, Chennai, India
| | - Aditya Sharma
- Division of Cardiovascular Medicine, University of Virginia, Charlottesville, VA, USA
| | - George D Kitas
- R & D Academic Affairs, Dudley Group NHS Foundation Trust, Dudley, United Kingdom
| | - Andrew Nicolaides
- Vascular Screening and Diagnostic Centre and University of Nicosia Medical School, Nicosia, Cyprus
| | | | - Jasjit S Suri
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA, USA.
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15
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Dores H, Gonçalves PDA, Monge J, Costa R, Tátá L, Cardim N, Neuparth N, Sharma S. Coronary atherosclerotic burden in veteran male recreational athletes with low to intermediate cardiovascular risk. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.repce.2020.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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16
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Dores H, Gonçalves PDA, Monge J, Costa R, Tátá L, Cardim N, Neuparth N, Sharma S. Coronary atherosclerotic burden in veteran male recreational athletes with low to intermediate cardiovascular risk. Rev Port Cardiol 2020; 39:587-594. [PMID: 32948392 DOI: 10.1016/j.repc.2019.10.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 10/11/2019] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Although there is evidence that a significant proportion of veteran athletes have coronary atherosclerotic disease (CAD), its prevalence in recreational athletes with low to intermediate cardiovascular (CV) risk is not established. This study aimed to characterize the coronary atherosclerotic burden in veteran male recreational athletes with low to intermediate CV risk. METHODS Asymptomatic male athletes aged ≥40 years with low to intermediate risk, who exercised >4 hours/week for >5 years, underwent cardiac computed tomography (CT) for coronary artery calcium (CAC) scoring and CT angiography. High coronary atherosclerotic burden was defined as at least one of the following: CAC score >100; CAC score ≥75th percentile; obstructive CAD; disease involving the left main, three vessels or two vessels including the proximal left anterior descending artery; segment involvement score >5; or CT Leaman score ≥5. Athletes were categorized by tertiles of exercise volume, calculated by metabolic equivalent of task (MET) scores. RESULTS A total of 105 athletes were included, all with SCORE <4%, mainly engaged in high-dynamic sports. Median exercise volume was 66 (44-103) METs/hour/week, with 8±5 hours training/week and 17±10 years of exercise. A high coronary atherosclerotic burden was present in 27 (25.7%) athletes. Ten (9.5%) athletes had CAC score >100, 13 (12.4%) had CAC score ≥75th percentile and six (5.7%) had obstructive lesions. The extent and severity of coronary plaques did not differ according to exercise volume. CONCLUSIONS The prevalence of subclinical CAD detected by cardiac CT in veteran male recreational athletes with low to intermediate CV risk was high. Up to a quarter of our cohort had a high coronary atherosclerotic burden.
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Affiliation(s)
- Hélder Dores
- Hospital das Forças Armadas, Lisbon, Portugal; Hospital da Luz, Lisbon, Portugal; NOVA Medical School, Lisbon, Portugal; CEDOC (Chronic Diseases Research Center), Lisbon, Portugal.
| | - Pedro de Araújo Gonçalves
- Hospital da Luz, Lisbon, Portugal; NOVA Medical School, Lisbon, Portugal; CEDOC (Chronic Diseases Research Center), Lisbon, Portugal
| | - José Monge
- Hospital das Forças Armadas, Lisbon, Portugal
| | | | - Luís Tátá
- Hospital das Forças Armadas, Lisbon, Portugal
| | - Nuno Cardim
- Hospital da Luz, Lisbon, Portugal; NOVA Medical School, Lisbon, Portugal; CEDOC (Chronic Diseases Research Center), Lisbon, Portugal
| | - Nuno Neuparth
- NOVA Medical School, Lisbon, Portugal; CEDOC (Chronic Diseases Research Center), Lisbon, Portugal
| | - Sanjay Sharma
- Cardiology Clinical Academic Group, St. George's Hospital, London, United Kingdom
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17
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Denissen SJAM, van der Aalst CM, Vonder M, Gratama JWC, Adriaansen HJ, Kuijpers D, Roeters van Lennep JE, Vliegenthart R, van der Harst P, Braam RL, van Dijkman PRM, Oudkerk M, de Koning HJ. Screening for coronary artery calcium in a high-risk population: the ROBINSCA trial. Eur J Prev Cardiol 2020; 28:1155-1159. [DOI: 10.1177/2047487320932263] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 05/15/2020] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Marleen Vonder
- Centre for Medical Imaging North-East Netherlands (CMI-NEN), University Medical Centre Groningen, The Netherlands
| | | | - Henk J Adriaansen
- Clinical Chemistry and Hematology Laboratory, Gelre Hospitals, The Netherlands
| | - Dirkjan Kuijpers
- Department of Radiology, University Medical Center Groningen, The Netherlands
- Department of Radiology, Haaglanden Medical Centre Bronovo, The Netherlands
| | | | - Rozemarijn Vliegenthart
- Centre for Medical Imaging North-East Netherlands (CMI-NEN), University Medical Centre Groningen, The Netherlands
| | - Pim van der Harst
- Centre for Medical Imaging North-East Netherlands (CMI-NEN), University Medical Centre Groningen, The Netherlands
- Department of Cardiology, University Medical Centre Groningen, The Netherlands
- Department of Cardiology, University Medical Centre Utrecht, The Netherlands
| | | | - Paul R M van Dijkman
- Department of Cardiology, Leids University Medical Centre, The Netherlands
- Department of Cardiology, Haaglanden Medical Centre Bronovo, The Netherlands
| | - Matthijs Oudkerk
- University of Groningen, University Medical Centre Groningen, The Netherlands
- Institute for Diagnostic Accuracy – iDNA, The Netherlands
| | - Harry J de Koning
- Department of Public Health, Erasmus Medical Centre, The Netherlands
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18
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Aengevaeren VL, Mosterd A, Sharma S, Prakken NHJ, Möhlenkamp S, Thompson PD, Velthuis BK, Eijsvogels TMH. Exercise and Coronary Atherosclerosis: Observations, Explanations, Relevance, and Clinical Management. Circulation 2020; 141:1338-1350. [PMID: 32310695 PMCID: PMC7176353 DOI: 10.1161/circulationaha.119.044467] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Physical activity and exercise training are effective strategies for reducing the risk of cardiovascular events, but multiple studies have reported an increased prevalence of coronary atherosclerosis, usually measured as coronary artery calcification, among athletes who are middle-aged and older. Our review of the medical literature demonstrates that the prevalence of coronary artery calcification and atherosclerotic plaques, which are strong predictors for future cardiovascular morbidity and mortality, was higher in athletes compared with controls, and was higher in the most active athletes compared with less active athletes. However, analysis of plaque morphology revealed fewer mixed plaques and more often only calcified plaques among athletes, suggesting a more benign composition of atherosclerotic plaques. This review describes the effects of physical activity and exercise training on coronary atherosclerosis in athletes who are middle-aged and older and aims to contribute to the understanding of the potential adverse effects of the highest doses of exercise training on the coronary arteries. For this purpose, we will review the association between exercise and coronary atherosclerosis measured using computed tomography, discuss the potential underlying mechanisms for exercise-induced coronary atherosclerosis, determine the clinical relevance of coronary atherosclerosis in middle-aged athletes and describe strategies for the clinical management of athletes with coronary atherosclerosis to guide physicians in clinical decision making and treatment of athletes with elevated coronary artery calcification scores.
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Affiliation(s)
- Vincent L Aengevaeren
- Department of Physiology (V.L.A., T.M.H.E.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Cardiology (V.L.A.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Arend Mosterd
- Department of Cardiology, Meander Medical Center, Amersfoort, The Netherlands (A.M.)
| | - Sanjay Sharma
- Cardiology Clinical and Academic Group, St George's University of London, United Kingdom (S.S.)
| | - Niek H J Prakken
- Department of Radiology, University Medical Center Groningen, The Netherlands (N.H.J.P.)
| | - Stefan Möhlenkamp
- Clinic of Cardiology and Intensive Care Medicine, Bethanien Hospital Moers, Germany (S.M.)
| | | | - Birgitta K Velthuis
- Department of Radiology, University Medical Center Utrecht, The Netherlands (B.K.V.)
| | - Thijs M H Eijsvogels
- Department of Physiology (V.L.A., T.M.H.E.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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19
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Östgren CJ, Söderberg S, Festin K, Angerås O, Bergström G, Blomberg A, Brandberg J, Cederlund K, Eliasson M, Engström G, Erlinge D, Fagman E, Hagström E, Lind L, Mannila M, Nilsson U, Oldgren J, Ostenfeld E, Persson A, Persson J, Persson M, Rosengren A, Sundström J, Swahn E, Engvall JE, Jernberg T. Systematic Coronary Risk Evaluation estimated risk and prevalent subclinical atherosclerosis in coronary and carotid arteries: A population-based cohort analysis from the Swedish Cardiopulmonary Bioimage Study. Eur J Prev Cardiol 2020; 28:250-259. [PMID: 33891684 DOI: 10.1177/2047487320909300] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 02/06/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND It is not clear if the European Systematic Coronary Risk Evaluation algorithm is useful for identifying prevalent subclinical atherosclerosis in a population of apparently healthy individuals. Our aim was to explore the association between the risk estimates from Systematic Coronary Risk Evaluation and prevalent subclinical atherosclerosis. DESIGN The design of this study was as a cross-sectional analysis from a population-based study cohort. METHODS From the general population, the Swedish Cardiopulmonary Bioimage Study randomly invited individuals aged 50-64 years and enrolled 13,411 participants mean age 57 (standard deviation 4.3) years; 46% males between November 2013-December 2016. Associations between Systematic Coronary Risk Evaluation risk estimates and coronary artery calcification and plaques in the carotid arteries by using imaging data from a computed tomography of the heart and ultrasonography of the carotid arteries were examined. RESULTS Coronary calcification was present in 39.5% and carotid plaque in 56.0%. In men, coronary artery calcium score >0 ranged from 40.7-65.9% and presence of carotid plaques from 54.5% to 72.8% in the age group 50-54 and 60-65 years, respectively. In women, the corresponding difference was from 17.1-38.9% and from 41.0-58.4%. A doubling of Systematic Coronary Risk Evaluation was associated with an increased probability to have coronary artery calcium score >0 (odds ratio: 2.18 (95% confidence interval 2.07-2.30)) and to have >1 carotid plaques (1.67 (1.61-1.74)). CONCLUSION Systematic Coronary Risk Evaluation estimated risk is associated with prevalent subclinical atherosclerosis in two major vascular beds in a general population sample without established cardiovascular disease or diabetes mellitus. Thus, the Systematic Coronary Risk Evaluation risk chart may be of use for estimating the risk of subclinical atherosclerosis.
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Affiliation(s)
- Carl J Östgren
- Department of Medical and Health Sciences, Linköping University, Sweden
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Karin Festin
- Department of Medical and Health Sciences, Linköping University, Sweden
| | - Oskar Angerås
- Department of Cardiology, Sahlgrenska University Hospital, Sweden.,Department of Molecular and Clinical Medicine, University of Gothenburg, Sweden
| | - Göran Bergström
- Department of Molecular and Clinical Medicine, University of Gothenburg, Sweden.,Department of Clinical Physiology, Sahlgrenska University Hospital, Sweden
| | - Anders Blomberg
- Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - John Brandberg
- Department of Radiology, Sahlgrenska University Hospital, Sweden.,Department of Radiology, University of Gothenburg, Sweden
| | - Kerstin Cederlund
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Sweden
| | - Mats Eliasson
- Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Gunnar Engström
- Department of Clinical Sciences in Malmö, Lund University, Sweden
| | - David Erlinge
- Department of Clinical Sciences Lund, Lund University, Sweden.,Skåne University Hospital, Sweden
| | - Erika Fagman
- Department of Radiology, Sahlgrenska University Hospital, Sweden.,Department of Radiology, University of Gothenburg, Sweden
| | - Emil Hagström
- Department of Medical Sciences, Uppsala University, Sweden.,Uppsala Clinical Research Center, Uppsala University, Sweden
| | - Lars Lind
- Department of Medical Sciences, Uppsala University, Sweden
| | - Maria Mannila
- Department of Medicine, Karolinska University Hospital, Sweden
| | - Ulf Nilsson
- Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Jonas Oldgren
- Department of Medical Sciences, Uppsala University, Sweden.,Uppsala Clinical Research Center, Uppsala University, Sweden
| | - Ellen Ostenfeld
- Department of Clinical Sciences Lund, Lund University, Sweden.,Skåne University Hospital, Sweden
| | - Anders Persson
- Department of Medical and Health Sciences, Linköping University, Sweden.,Centre of Medical Image Science and Visualization, Linkoping University, Sweden.,Department of Radiology, Linköping University, Sweden
| | - Jonas Persson
- Department of Clinical Sciences, Danderyd University Hospital, Sweden
| | - Margaretha Persson
- Department of Clinical Sciences in Malmö, Lund University, Sweden.,Skåne University Hospital, Sweden
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, University of Gothenburg, Sweden.,Sahlgrenska University Hospital, Sweden
| | - Johan Sundström
- Department of Medical Sciences, Uppsala University, Sweden.,The George Institute for Global Health, University of New South Wales, Australia
| | - Eva Swahn
- Department of Medical and Health Sciences, Linköping University, Sweden.,Department of Cardiology, Linköping University, Sweden
| | - Jan E Engvall
- Department of Medical and Health Sciences, Linköping University, Sweden.,Centre of Medical Image Science and Visualization, Linkoping University, Sweden.,Department of Clinical Physiology, Linköping University, Sweden
| | - Tomas Jernberg
- Department of Clinical Sciences, Danderyd University Hospital, Sweden
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Subjects with diffuse idiopathic skeletal hyperostosis have an increased burden of coronary artery disease: An evaluation in the COPDGene cohort. Atherosclerosis 2019; 287:24-29. [PMID: 31181416 DOI: 10.1016/j.atherosclerosis.2019.05.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 04/29/2019] [Accepted: 05/29/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND AIMS Diffuse idiopathic skeletal hyperostosis (DISH) is a common incidental finding on medical imaging and often thought to be benign. Our objective was to investigate whether DISH is associated with coronary artery disease as measured with the coronary artery calcification (CAC) score in a large cohort of current and former smokers. METHODS In a subset of subjects from the COPDGene study, DISH was scored by a minimum of two independent readers if there were four adjacent levels of flowing osteophytes and a third reader adjudicated discrepancies. CAC was calculated using a modified Agatston method. Associations of DISH with the presence and extent of CAC were analyzed with and without adjustment for COPD and known atherosclerotic risk factors, including age, sex, race, diabetes, hypertension, high cholesterol, body mass index and smoking. RESULTS DISH was present in 361 subjects (13.2%) from a total group of 2728. Median (interquartile range) Agatston was 81 (0-329) in DISH subjects compared to 0 (0-94 in subjects without DISH (p < 0.001). DISH prevalence was 8.8% in CAC = 0, 12.8% in CAC1-100, 20.0% in CAC100-400 and 24.7% in CAC.400. Subjects with DISH had a significantly higher risk of having coronary artery calcifications; OR [CI95%] 1.37[1.05-1.78] (p=0.019) after correction for age, gender, race, COPD and atherosclerotic risk factors. CONCLUSIONS Subjects with DISH, a common musculoskeletal disorder involving bone formation anterior to the spine, have an increased burden of coronary artery disease, and therefore DISH may be a more relevant incidental finding than commonly thought.
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21
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Sekikawa A, Mahajan H, Kadowaki S, Hisamatsu T, Miyagawa N, Fujiyoshi A, Kadota A, Maegawa H, Murata K, Miura K, Edmundowicz D, Ueshima H. Association of blood levels of marine omega-3 fatty acids with coronary calcification and calcium density in Japanese men. Eur J Clin Nutr 2019; 73:783-792. [PMID: 30050076 PMCID: PMC6348058 DOI: 10.1038/s41430-018-0242-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 04/09/2018] [Accepted: 05/29/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND/OBJECTIVES Clinical trials of eicosapentaenoic acid (EPA) among high-risk groups in Japan in which consumption of mairne-omega-3 fatty acids (OM3) is much higher than other countries showed slower progression of coronary atherosclerosis. We aimed to determine the cross-sectional associations of coronary artery calcification (CAC) and calcium density with OM3, EPA, and docosahexaenoic acid (DHA), two principal OM3, in the general population in Japan. SUBJECTS/METHODS The Shiga Epidemiological Study of Subclinical Atherosclerosis examined a population-based sample of 1074 men aged 40-79 in 2006-08 for computed tomography-measured CAC score (CCS), a well-established biomarker of coronary atherosclerosis, CAC density score (CDS), a potential marker of plaque stabilization, serum levels of OM3, and risk factors. RESULTS Prevalence of CCS > 0, ≥ 100, and ≥ 300 was 65.8%, 25.9%, and 12.9%, respectively; the mean (SD) OM3, EPA, and DHA were 10.1% (3.2), 3.2% (1.7), and 5.9% (1.6), respectively. Odds ratios (95% CI, p-value) of CCS 0, 100, and 300 in ordinal logistic regression associated with 1 SD increase of OM3, EPA, and DHA were 0.91 (0.81-1.03, p = 0.12), 0.99 (0.88-1.11, p = 0.87) and 0.84 (0.74-0.94, p = < 0.01), respectively. The inverse association of DHA with CCS remained significant in multivariate-adjusted model: odds ratio of 0.87 (0.77-0.99, p = 0.03). Blood levels of OM3, EPA, or DHA did not have any significant associations with CDS. CONCLUSIONS DHA but not EPA had a significant inverse association with coronary atherosclerosis in the general population with high levels of OM3. Future trials are warranted comparing the effect of high-dose DHA and EPA on atherosclerosis and cardiovascular outcomes.
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Grants
- (A) 25253046 Ministry of Education, Culture, Sports, Science, and Technology (MEXT)
- R01 HL068200 NHLBI NIH HHS
- (B) 26293140 Ministry of Education, Culture, Sports, Science, and Technology (MEXT)
- RF1AG051615 U.S. Department of Health & Human Services | National Institutes of Health (NIH)
- (A) 15H02528 Ministry of Education, Culture, Sports, Science, and Technology (MEXT)
- (A) 13307016 Ministry of Education, Culture, Sports, Science, and Technology (MEXT)
- no number GlaxoSmithKline (GlaxoSmithKline Plc.)
- (A) 21249043 MEXT | National Institutes of Natural Sciences (NINS)
- (A) 23249036 Ministry of Education, Culture, Sports, Science, and Technology (MEXT)
- (B) 21790579 Ministry of Education, Culture, Sports, Science, and Technology (MEXT)
- (A) 17209023 Ministry of Education, Culture, Sports, Science, and Technology (MEXT)
- RF1 AG051615 NIA NIH HHS
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Affiliation(s)
- Akira Sekikawa
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Hemant Mahajan
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sayaka Kadowaki
- Department of Public Health, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Takashi Hisamatsu
- Department of Environmental Medicine and Public Health, Faculty of Medicine, Shimane University, Matsue, Shimane, Japan
| | - Naoko Miyagawa
- Department of Public Health, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Akira Fujiyoshi
- Department of Public Health, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Aya Kadota
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Hiroshi Maegawa
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Kiyoshi Murata
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Katsuyuki Miura
- Department of Public Health, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Daniel Edmundowicz
- Department of Medicine, Lewis Kats School of Medicine, Temple University, Philadelphia, PA, USA
| | - Hirotsugu Ueshima
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Shiga, Japan
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22
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Krishnamoorthy P, Gupta S, Lu M, Friend EJ, Pressman GS. Usefulness of the Echocardiographic Calcium Score to Refine Risk of Major Adverse Cardiovascular Events Beyond the Traditional Framingham Risk Score. Am J Cardiol 2019; 123:392-395. [PMID: 30527772 DOI: 10.1016/j.amjcard.2018.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 09/27/2018] [Accepted: 10/05/2018] [Indexed: 10/28/2022]
Abstract
Echocardiographic calcifications are associated with major adverse cardiovascular events (MACE). A recently described semiquantitative Global Cardiac Calcium Score (GCCS) has been associated with mortality and stroke, with increasing scores associated with increasing risk. This score assigns points for calcium in the aortic root and valve, mitral valve and annulus, and submitral apparatus, with additional points for restricted leaflet mobility. We tested the hypothesis that the GCCS could improve prediction of MACE beyond traditional risk scores. This was a retrospective study of 216 subjects from a general echocardiography database (mean age 59 ± 15; 51% male). Follow-up was 3.8 ± 1.7 years. The Framingham Risk Score (FRS) and Pooled Cohort Equations (PCE) were applied to each patient. Mean GCCS was 3.2 ± 2. In the total cohort, GCCS predicted MACE (myocardial infarction, stroke, all-cause mortality), even after adjusting for FRS (odd ratio 1.19, p = 0.03). There were 106 subjects (49%) in the low-risk FRS group, 71 (33%) in the intermediate-risk group, and 39 (18%) in the high-risk group. GCCS ≥3 was associated with increased MACE (vs <3) in the low-risk group (p = 0.03), while GCCS <3 was associated with decreased MACE (vs ≥3) in the high-risk group (p = 0.04). When applied to the PCE risk estimate (dichotomized at <7.5% vs ≥7.5%) the GCCS similarly refined risk prediction. In conclusion, the semiquantitative GCCS appears to be a marker of additional unaccounted risk factors; it is easily applied and can further stratify risk of MACE beyond traditional FRS or PCE estimates.
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23
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Racial Disparities in the Cardiac Computed Tomography Assessment of Coronary Artery Disease: Does Gender Matter. Cardiol Rev 2018; 27:14-22. [PMID: 30520779 DOI: 10.1097/crd.0000000000000206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Coronary heart disease (CHD) represents a significant healthcare burden in terms of hospital resources, morbidity, and mortality. Primary prevention and early detection of risk factors for the development of CHD are pivotal to successful intervention programs and prognostication. Yet, there remains a paucity of evidence regarding differences in the assessment of these risk factors and the tools of assessment among different ethnicities. We conducted a narrative review to assess the utility of cardiac computed tomography, particularly coronary artery calcification (CAC), in different ethnicities. We also looked to see whether age, sex, comorbidities, and genetic background have peculiar influences on CAC. In this review, we highlight some of the pivotal studies regarding the question of CAC in relation to the development of CHD among different ethnicities. We identify several key trends in the literature showing that although African Americans have high rates of CHD, their risk of CAC may be relatively lower compared with other ethnicities. Similarly, South Asian patients may be at a high risk for adverse cardiac events due to elevated CAC. We also note that several studies are limited by small sample size and were based on 1 large cohort study. Future studies should include a large international prospective cohort to truly evaluate the effects of ethnicity on CAC and CHD risk. To appropriately apply CAC in the clinical practice, the variations in its scoring based on a subject's age, sex, comorbidity, and ethnicity should be addressed and interpreted beforehand.
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24
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Munden RF, Carter BW, Chiles C, MacMahon H, Black WC, Ko JP, McAdams HP, Rossi SE, Leung AN, Boiselle PM, Kent MS, Brown K, Dyer DS, Hartman TE, Goodman EM, Naidich DP, Kazerooni EA, Berland LL, Pandharipande PV. Managing Incidental Findings on Thoracic CT: Mediastinal and Cardiovascular Findings. A White Paper of the ACR Incidental Findings Committee. J Am Coll Radiol 2018; 15:1087-1096. [PMID: 29941240 DOI: 10.1016/j.jacr.2018.04.029] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 04/23/2018] [Indexed: 12/21/2022]
Abstract
The ACR Incidental Findings Committee presents recommendations for managing incidentally detected mediastinal and cardiovascular findings found on CT. The Chest Subcommittee was composed of thoracic radiologists who developed the provided guidance. These recommendations represent a combination of current published evidence and expert opinion and were finalized by informal iterative consensus. The recommendations address the most commonly encountered mediastinal and cardiovascular incidental findings and are not intended to be a comprehensive review of all incidental findings associated with these compartments. Our goal is to improve the quality of care by providing guidance on how to manage incidentally detected thoracic findings.
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Affiliation(s)
- Reginald F Munden
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, North Carolina.
| | - Brett W Carter
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Caroline Chiles
- Wake Forest University Health Sciences Center, Winston-Salem, North Carolina
| | | | - William C Black
- Dartmouth-Hitchcock Medical Center and Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Jane P Ko
- NYU Langone Health, New York, New York
| | | | | | - Ann N Leung
- Stanford University Medical Center, Stanford, California
| | - Phillip M Boiselle
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida
| | - Michael S Kent
- Beth Israel Deaconess Medical Center, Division of Thoracic Surgery and Interventional Pulmonology, Boston, Massachusetts
| | - Kathleen Brown
- David Geffen School of Medicine at UCLA, Los Angeles, California
| | | | | | - Eric M Goodman
- Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Manhasset, New York
| | | | | | - Lincoln L Berland
- Professor Emeritus, University of Alabama at Birmingham, Birmingham, Alabama
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25
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Danielsen KV, Wiese S, Hove J, Bendtsen F, Møller S. Pronounced Coronary Arteriosclerosis in Cirrhosis: Influence on Cardiac Function and Survival? Dig Dis Sci 2018. [PMID: 29516327 DOI: 10.1007/s10620-018-5006-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The relation between excessive alcohol consumption and coronary arteriosclerosis has remained controversial. The etiology of cirrhosis has been considered a substantial risk factor for development of arteriosclerotic lesions. The coronary artery calcium-score derived from coronary CT angiography is a robust marker of coronary arteriosclerosis. AIMS To study the burden of coronary arteriosclerosis in cirrhotic patients of various etiologies and association to cardiac dysfunction and survival. METHODS Fifty-seven patients with cirrhosis without cardiovascular disease underwent coronary CT angiography, tissue Doppler echocardiography, electrocardiogram and registration of clinical and biochemical characteristics. RESULTS In patients with cirrhosis the median coronary artery calcium-score was increased in comparison with age and race-adjusted healthy reference values (men: 328 vs. 9 HU and women: 136 vs. 0 HU; p < 0.001). Moreover, the coronary artery calcium-score in alcohol-related cirrhosis was significantly higher than in nonalcohol-related cirrhosis (362 vs. 46 HU, p < 0.001). Coronary artery calcium-score correlated with age (p = 0.002) but not with established cardiovascular risk factors including smoking, type 2 diabetes, hypertension, gender, or hypercholesterolemia. Coronary artery calcium-score was associated with diastolic dysfunction, lateral e´ (p = 0.025), but not with other markers of cardiac dysfunction. During a median follow-up of 25 months 12 patients (21%) died but coronary artery calcium-score was not associated with survival. CONCLUSIONS Coronary arteriosclerosis was particular extensive in patients with alcoholic cirrhosis. However, the current results suggest that coronary arteriosclerosis only have limited influence on cardiac function and survival. Surprisingly, no other established risk factors apart from age seemed to interfere with coronary arteriosclerosis in cirrhotic patients.
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Affiliation(s)
- Karen V Danielsen
- Centre for Functional and Diagnostic Imaging, Department of Clinical Physiology and Nuclear Medicine, Hvidovre Hospital, Hvidovre, Denmark. .,Centre for Gastroenterology and Hepatology, Department of medicine, Hvidovre Hospital, Hvidovre, Denmark.
| | - Signe Wiese
- Centre for Functional and Diagnostic Imaging, Department of Clinical Physiology and Nuclear Medicine, Hvidovre Hospital, Hvidovre, Denmark.,Centre for Gastroenterology and Hepatology, Department of medicine, Hvidovre Hospital, Hvidovre, Denmark
| | - Jens Hove
- Department of Cardiology, Hvidovre Hospital, Copenhagen, Denmark
| | - Flemming Bendtsen
- Centre for Gastroenterology and Hepatology, Department of medicine, Hvidovre Hospital, Hvidovre, Denmark
| | - Søren Møller
- Centre for Functional and Diagnostic Imaging, Department of Clinical Physiology and Nuclear Medicine, Hvidovre Hospital, Hvidovre, Denmark
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26
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Flachskampf FA, Nihoyannopoulos P. Our obsession with normal values. Echo Res Pract 2018; 5:R17-R21. [PMID: 29563145 PMCID: PMC5900447 DOI: 10.1530/erp-17-0082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 03/21/2018] [Indexed: 11/08/2022] Open
Abstract
Normal values provide the background for interpretation of quantitative imaging data and thus are essential information for daily routine. Nevertheless, the ways how normal values are obtained, presented and interpreted, often do not receive the attention they deserve. We review the concepts of normalcy, the implications of typical normal ranges including the types of distribution of normal data, the possibilities to index for confounding biological factors like body surface area and the limitations of the very concept of normal values, demonstrating that there are no easy statistical solutions for difficult clinical problems.
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Affiliation(s)
- Frank A Flachskampf
- Department of Medical Sciences, Clinical Physiology and Cardiology, Akademiska, Uppsala University, Uppsala, Sweden
| | - Petros Nihoyannopoulos
- Imperial College London, NHLI, Hammersmith Hospital, London, UK.,Cardiology, Athens University, Athens, Greece
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27
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Osawa K, Nakanishi R, Budoff M. Coronary Artery Calcification. Glob Heart 2018; 11:287-293. [PMID: 27741976 DOI: 10.1016/j.gheart.2016.08.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 07/26/2016] [Accepted: 08/01/2016] [Indexed: 11/28/2022] Open
Abstract
Coronary artery calcification (CAC) is an established marker of subclinical atherosclerosis and an independent predictor of future coronary heart disease in the asymptomatic primary prevention population, particularly in the intermediate risk cohort. CAC also helps in reclassifying those patients and their risk of cardiovascular events into higher or lower risk categories. MESA (Multi-Ethnic Study of Atherosclerosis) is a National Heart, Lung, and Blood Institute-sponsored population-based medical research study involving 6,814 men and women from 6 U.S. communities without a medical history of clinical cardiovascular disease. The evidence from this population cohort revealed that CAC scoring was independently predictive and highly effective at risk stratification of major adverse cardiac events. This review provides available data based on MESA. We focus on the utility of CAC for cardiovascular disease risk stratification of individuals, and we describe its diagnostic value in identifying patients at risk.
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Affiliation(s)
- Kazuhiro Osawa
- Los Angeles Biomedical Research Institute at Harbor, University of California-Los Angeles, Los Angeles, CA, USA
| | - Rine Nakanishi
- Los Angeles Biomedical Research Institute at Harbor, University of California-Los Angeles, Los Angeles, CA, USA
| | - Matthew Budoff
- Los Angeles Biomedical Research Institute at Harbor, University of California-Los Angeles, Los Angeles, CA, USA.
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28
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Blaha MJ, Yeboah J, Al Rifai M, Liu K, Kronmal R, Greenland P. Providing Evidence for Subclinical CVD in Risk Assessment. Glob Heart 2018; 11:275-285. [PMID: 27741975 DOI: 10.1016/j.gheart.2016.08.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 07/27/2016] [Accepted: 08/01/2016] [Indexed: 10/20/2022] Open
Abstract
When the MESA (Multi-Ethnic Study of Atherosclerosis) began, the Framingham risk score was the preferred tool for 10-year global coronary heart disease risk assessment; however, the Framingham risk score had limitations including derivation in a homogenous population lacking racial and ethnic diversity and exclusive reliance on traditional risk factors without consideration of most subclinical disease measures. MESA was designed to study the prognostic value of subclinical atherosclerosis and other risk markers in a multiethnic population. In a series of landmark publications, MESA demonstrated that measures of subclinical cardiovascular disease add significant prognostic value to the traditional Framingham risk variables. In head-to-head studies comparing these markers, MESA established that the coronary artery calcium score may be the single best predictor of coronary heart disease risk. Results from MESA have directly influenced recent prevention guidelines including the recommendations on risk assessment and cholesterol-lowering therapy. The MESA study has published its own risk score, which allows for the calculation of 10-year risk of coronary heart disease before and after knowledge of a coronary artery calcium score.
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Affiliation(s)
- Michael J Blaha
- Johns Hopkins Ciccarone Center for Prevention of Heart Disease, Baltimore, MD, USA.
| | - Joseph Yeboah
- Department of Internal Medicine/Cardiology, Wake Forest University Health Sciences, Winston Salem, NC, USA
| | - Mahmoud Al Rifai
- Departments of Preventive Medicine and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kiang Liu
- Departments of Preventive Medicine and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Richard Kronmal
- Department of Biostatistics, University of Washington School of Public Health, Seattle, WA, USA
| | - Philip Greenland
- Departments of Preventive Medicine and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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29
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Dores H, de Araújo Gonçalves P, Cardim N, Neuparth N. Coronary artery disease in athletes: An adverse effect of intense exercise? Rev Port Cardiol 2018; 37:77-85. [PMID: 29325803 DOI: 10.1016/j.repc.2017.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 03/29/2017] [Accepted: 06/29/2017] [Indexed: 01/07/2023] Open
Abstract
Regular physical exercise is responsible for various health benefits, and is recommended for primary and secondary cardiovascular (CV) prevention. Despite these recognized benefits, various clinical events can occur in athletes, including acute myocardial infarction and sudden cardiac death (SCD); the main cause of SCD in veteran athletes is coronary artery disease (CAD). The relationship between intense exercise training and CAD is controversial, and a U-shaped association has been hypothesized. If this is the case, screening for subclinical CAD in older athletes may be justified, and various different methodologies have been proposed. However, the methodology for screening veteran athletes is not consensual, and several markers of CAD, in addition to clinical CV risk factors, could improve risk stratification in this population. In the present paper we review the published data on CAD in athletes, focusing on the relationship between the dose of exercise and CAD, as well as the implications for pre-participation screening of veteran athletes.
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Affiliation(s)
- Hélder Dores
- Hospital das Forças Armadas, Lisbon, Portugal; Hospital da Luz, Lisbon, Portugal; NOVA Medical School, Lisbon, Portugal; CEDOC (Chronic Diseases Research Center), NOVA Medical School, Lisbon, Portugal.
| | - Pedro de Araújo Gonçalves
- Hospital da Luz, Lisbon, Portugal; NOVA Medical School, Lisbon, Portugal; CEDOC (Chronic Diseases Research Center), NOVA Medical School, Lisbon, Portugal; Hospital de Santa Cruz, CHLO, Lisbon, Portugal
| | - Nuno Cardim
- Hospital da Luz, Lisbon, Portugal; NOVA Medical School, Lisbon, Portugal
| | - Nuno Neuparth
- NOVA Medical School, Lisbon, Portugal; CEDOC (Chronic Diseases Research Center), NOVA Medical School, Lisbon, Portugal
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30
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Dores H, de Araújo Gonçalves P, Cardim N, Neuparth N. Coronary artery disease in athletes: An adverse effect of intense exercise? REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.repce.2018.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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31
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Chowdhury MM, Zieliński LP, Sun JJ, Lambracos S, Boyle JR, Harrison SC, Rudd JHF, Coughlin PA. Editor's Choice - Calcification of Thoracic and Abdominal Aneurysms is Associated with Mortality and Morbidity. Eur J Vasc Endovasc Surg 2018; 55:101-108. [PMID: 29225032 PMCID: PMC5772171 DOI: 10.1016/j.ejvs.2017.11.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 11/07/2017] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Cardiovascular events are common in people with aortic aneurysms. Arterial calcification is a recognised predictor of cardiovascular outcomes in coronary artery disease. Whether calcification within abdominal and thoracic aneurysm walls is correlated with poor cardiovascular outcomes is not known. PATIENTS AND METHODS Calcium scores were derived from computed tomography (CT) scans of consecutive patients with either infrarenal (AAA) or descending thoracic aneurysms (TAA) using the modified Agatston score. The primary outcome was subsequent all cause mortality during follow-up. Secondary outcomes were cardiovascular mortality and morbidity. RESULTS A total of 319 patients (123 TAA and 196 AAA; median age 77 [71-84] years, 72% male) were included with a median follow-up of 30 months. The primary outcome occurred in 120 (37.6%) patients. In the abdominal aortic aneurysm group, the calcium score was significantly related to both all cause mortality and cardiac mortality (odds ratios (OR) of 2.246 (95% CI 1.591-9.476; p < 0.001) and 1.321 (1.076-2.762; p = 0.003)) respectively. In the thoracic aneurysm group, calcium score was significantly related to all cause mortality (OR 6.444; 95% CI 2.574-6.137; p < 0.001), cardiac mortality (OR 3.456; 95% CI 1.765-4.654; p = 0.042) and cardiac morbidity (OR 2.128; 95% CI 1.973-4.342; p = 0.002). CONCLUSIONS Aortic aneurysm calcification, in either the thoracic or the abdominal territory, is significantly associated with both higher overall and cardiovascular mortality. Calcium scoring, rapidly derived from routine CT scans, may help identify high risk patients for treatment to reduce risk.
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Affiliation(s)
- Mohammed M Chowdhury
- Division of Vascular and Endovascular Surgery, Addenbrooke's Hospital, Cambridge University Hospital Trust, Cambridge, UK.
| | - Lukasz P Zieliński
- Division of Vascular and Endovascular Surgery, Addenbrooke's Hospital, Cambridge University Hospital Trust, Cambridge, UK
| | - James J Sun
- Division of Vascular and Endovascular Surgery, Addenbrooke's Hospital, Cambridge University Hospital Trust, Cambridge, UK
| | - Simon Lambracos
- Division of Vascular and Endovascular Surgery, Addenbrooke's Hospital, Cambridge University Hospital Trust, Cambridge, UK
| | - Jonathan R Boyle
- Division of Vascular and Endovascular Surgery, Addenbrooke's Hospital, Cambridge University Hospital Trust, Cambridge, UK
| | - Seamus C Harrison
- Division of Vascular and Endovascular Surgery, Addenbrooke's Hospital, Cambridge University Hospital Trust, Cambridge, UK
| | - James H F Rudd
- Division of Cardiovascular Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Patrick A Coughlin
- Division of Vascular and Endovascular Surgery, Addenbrooke's Hospital, Cambridge University Hospital Trust, Cambridge, UK
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32
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Suemoto CK, Bittencourt MS, Santos IS, Benseñor IM, Lotufo PA. Coronary artery calcification and cognitive function: cross-sectional results from the ELSA-Brasil study. Int J Geriatr Psychiatry 2017; 32:e188-e194. [PMID: 28240378 DOI: 10.1002/gps.4698] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 02/03/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVES We examined the relationship between coronary artery calcification (CAC) score and performance in cognitive tests in a large Brazilian sample. METHODS In this cross-sectional study, 4104 participants (mean age = 50.9 ± 8.8 years old, 54% female) from the Brazilian Longitudinal Study of Adult Health had complete information for CAC and cognitive tests. We used linear regression models adjusted for sociodemographics, cardiovascular risk factors (hypertension, diabetes, smoking, alcohol use, physical activity, and body mass index), depression, and thyroid function. To investigate potential different associations for middle-aged and older adults, we stratified the analysis by age groups. RESULTS Participants with CAC ≥ 100 Agatston score had poorer performance in the trail making test compared to those with CAC < 100 Agatston score (β = -0.101, 95% CI = -0.194; -0.010, p = 0.03). We did not find any other association between CAC and cognitive tests. When we investigated the effect modification between CAC and age on cognitive tests, only the effect modification on global cognition (p = 0.02) and trail making test was significant (p = 0.0003). CONCLUSIONS Higher CAC was weakly associated with poorer performance in an executive function test in a large sample from the Brazilian Longitudinal Study of Adult Health. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Claudia K Suemoto
- Division of Geriatrics, University of São Paulo Medical School, São Paulo, Brazil.,Center for Clinical and Epidemiological Research, Hospital Universitário, University of São Paulo, São Paulo, Brazil
| | - Marcio S Bittencourt
- Center for Clinical and Epidemiological Research, Hospital Universitário, University of São Paulo, São Paulo, Brazil
| | - Itamar S Santos
- Center for Clinical and Epidemiological Research, Hospital Universitário, University of São Paulo, São Paulo, Brazil.,Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil
| | - Isabela M Benseñor
- Center for Clinical and Epidemiological Research, Hospital Universitário, University of São Paulo, São Paulo, Brazil.,Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil
| | - Paulo A Lotufo
- Center for Clinical and Epidemiological Research, Hospital Universitário, University of São Paulo, São Paulo, Brazil.,Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil
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Adams LC, Böker SM, Bender YY, Fallenberg EM, Wagner M, Liebig T, Hamm B, Makowski MR. Detection of vessel wall calcifications in vertebral arteries using susceptibility weighted imaging. Neuroradiology 2017; 59:861-872. [PMID: 28730268 DOI: 10.1007/s00234-017-1878-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 06/30/2017] [Indexed: 01/01/2023]
Abstract
PURPOSE Calcification of the brain supplying arteries has been linked to an increased risk for cerebrovascular disease. The purpose of this study was to test the potential of susceptibility weighted MR imaging (SWMR) for the detection of vertebral artery calcifications, based on CT as a reference standard. METHODS Four hundred seventy-four patients, who had received head CT and 1.5 T MR scans with SWMR, including the distal vertebral artery, between January 2014 and December 2016, were retrospectively evaluated and 389 patients were included. Sensitivity and specificity for the detection of focal calcifications and intra- and interobserver agreement were calculated for SWMR and standard MRI, using CT as a standard of reference. The diameter of vertebral artery calcifications was used to assess correlations between imaging modalities. Furthermore, the degree of vessel stenosis was determined in 30 patients, who had received an additional angiography. RESULTS On CT scans, 40 patients showed a total of 52 vertebral artery calcifications. While SWMR reached a sensitivity of 94% (95% CI 84-99%) and a specificity of 97% (95% CI 94-98%), standard MRI yielded a sensitivity of 33% (95% CI 20-46%), and a specificity of 93% (95% CI 90-96%). Linear regression analysis of size measurements confirmed a close correlation between SWMR and CT measurements (R 2 = 0.74, p < 0.001). Compared to standard MRI (ICC = 0.52; CI 0.45-0.59), SWMR showed a higher interobserver agreement for calcification measurements (ICC = 0.84; CI 0.81-0.87). CONCLUSIONS For detection of distal vertebral artery calcifications, SWMR demonstrates a performance comparable to CT and considerably higher than conventional MRI.
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Affiliation(s)
- Lisa C Adams
- Department of Radiology, Charité, Charitéplatz 1, 10117, Berlin, Germany.
| | - Sarah M Böker
- Department of Radiology, Charité, Charitéplatz 1, 10117, Berlin, Germany
| | - Yvonne Y Bender
- Department of Radiology, Charité, Charitéplatz 1, 10117, Berlin, Germany
| | - Eva M Fallenberg
- Department of Radiology, Charité, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Moritz Wagner
- Department of Radiology, Charité, Charitéplatz 1, 10117, Berlin, Germany
| | - Thomas Liebig
- Department of Neuroradiology, Charité, Charitéplatz 1, 10117, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité, Charitéplatz 1, 10117, Berlin, Germany
| | - Marcus R Makowski
- Department of Radiology, Charité, Charitéplatz 1, 10117, Berlin, Germany
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Abstract
Cardiovascular risk assessment is fundamental to prevention of cardiovascular disease, because it helps determine the size of the potential benefits that might accrue to individual patients from use of statins, aspirin, and other preventive interventions. Current guidelines recommend specific algorithms for cardiovascular risk assessment that combine information from traditional risk factors including blood pressure, lipids, and smoking, along with age and sex and other factors. These algorithms are the subject of active research and controversy. This article addresses the rationale, current guidelines and use, and potential future directions of cardiovascular risk assessment.
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Affiliation(s)
- Mark J Pletcher
- Departments of Epidemiology & Biostatistics and Medicine, University of California, San Francisco, 550 16th Street, Mission Hall 2nd Floor, San Francisco, CA 94143-0560, USA.
| | - Andrew E Moran
- Division of General Medicine, Presbyterian Hospital, Columbia University Medical Center, 630 West 168th Street, 9th Floor East, Room 105, New York, NY 10032, USA
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Correction Factors for CT Coronary Artery Calcium Scoring Using Advanced Modeled Iterative Reconstruction Instead of Filtered Back Projection. Acad Radiol 2016; 23:1480-1489. [PMID: 27614365 DOI: 10.1016/j.acra.2016.07.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 07/16/2016] [Accepted: 07/19/2016] [Indexed: 11/19/2022]
Abstract
RATIONALE AND OBJECTIVES Iterative reconstruction (IR) computed tomography (CT) techniques allow for radiation dose reduction while maintaining image quality. However, CT coronary artery calcium (CAC) scores may be influenced by certain IR algorithms. The aim of our study is to identify suitable correction factors to ensure consistency between IR and filtered back projection (FBP)-based CAC scoring. MATERIAL AND METHODS A phantom study was performed to derive suitable correction factors for CAC scores and volume (VOL) values with advanced modeled iterative reconstruction (or ADMIRE) strength level 3 (ADM3) and 5 (ADM5) vs FBP. CT data from 40 patients were retrospectively analyzed, and CAC score and VOL values were obtained following reconstruction with FBP, ADM3, and ADM5. Linear regression analysis was performed to obtain correction factors. Results with and without application of the correction factors were compared. Inter-reader agreement for risk class stratification was analyzed. RESULTS Phantom experiments determined a correction factor of 1.14 for ADM3 and 1.25 for ADM5. FBP-based CAC scores (897 ± 1413) were significantly higher than uncorrected scores with ADM3 (746 ± 1184, P ≤ .001) and ADM5 (640 ± 1036, P ≤ .001). After application of correction factors, no significant differences were found for CAC scores based on FBP (897 ± 1413) and ADM3 (853 ± 1353, P = .07). The inter-reader agreement for risk stratification was excellent (k = 0.91). CONCLUSION ADM3 can be applied to CAC scoring with use of a correction factor. When applying a correction factor of 1.14, excellent agreement with standard FBP for both CAC score and VOL can be achieved.
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Jarmul JA, Pignone M, Pletcher MJ. Interpreting Hemoglobin A1C in Combination With Conventional Risk Factors for Prediction of Cardiovascular Risk. Circ Cardiovasc Qual Outcomes 2016; 8:501-7. [PMID: 26349840 DOI: 10.1161/circoutcomes.115.001639] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Hemoglobin A1C (HbA1C) is associated with increased risk of cardiovascular events, but its use for prediction of cardiovascular disease (CVD) events in combination with conventional risk factors has not been well defined. METHODS AND RESULTS To understand the effect of HbA1C on CVD risk in the context of other CVD risk factors, we analyzed HbA1C and other CVD risk factor measurements in 2000 individuals aged 40 to 79 years without pre-existing diabetes mellitus or CVD from the 2011 to 2012 National Health and Nutrition Examination Surveys survey. The resulting regression model was used to predict the HbA1C distribution based on individual patient characteristics. We then calculated post-test 10-year atherosclerotic CVD risk incorporating the actual versus predicted HbA1C, according to established methods, for a set of example scenarios. Age, sex, race/ethnicity, and traditional cardiovascular risk factors were significant predictors of HbA1C in our model, with the expected HbA1C distribution being significantly higher in non-Hispanic black, non-Hispanic Asian, and Hispanic individuals than that in non-Hispanic white/other individuals. Incorporating the expected HbA1C distribution into pretest atherosclerotic CVD risk has a modest effect on post-test atherosclerotic CVD risk. In the patient examples, we assessed that having an HbA1C of <5.7% reduced post-test risk by 0.4% to 2.0% points, whereas having an HbA1C of ≥6.5% increased post-test risk by 1.0% to 2.5% points, depending on the scenario. The post-test risk increase from having an HbA1C of ≥6.5% tends to approximate the risk increase from being 5 years older. CONCLUSIONS HbA1C has modest effects on predicted atherosclerotic CVD risk when considered in the context of conventional risk factors.
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Dorans KS, Wilker EH, Li W, Rice MB, Ljungman PL, Schwartz J, Coull BA, Kloog I, Koutrakis P, D'Agostino RB, Massaro JM, Hoffmann U, O'Donnell CJ, Mittleman MA. Residential Proximity to Major Roads, Exposure to Fine Particulate Matter, and Coronary Artery Calcium: The Framingham Heart Study. Arterioscler Thromb Vasc Biol 2016; 36:1679-85. [PMID: 27312220 DOI: 10.1161/atvbaha.116.307141] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 06/06/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Long-term exposure to traffic and particulate matter air pollution is associated with a higher risk of cardiovascular disease, potentially via atherosclerosis promotion. Prior research on associations of traffic and particulate matter with coronary artery calcium Agatston score (CAC), an atherosclerosis correlate, has yielded inconsistent findings. Given this background, we assessed whether residential proximity to major roadway or fine particulate matter were associated with CAC in a Northeastern US study. APPROACH AND RESULTS We measured CAC ≤2 times from 2002 to 2005 and 2008 to 2011 among Framingham Offspring or Third-Generation Cohort participants. We assessed associations of residential distance to major roadway and residential fine particulate matter (2003 average; spatiotemporal model) with detectable CAC, using generalized estimating equation regression. We used linear mixed effects models to assess associations with loge(CAC). We also assessed associations with CAC progression. Models were adjusted for demographic variables, socioeconomic position markers, and time. Among 3399 participants, 51% had CAC measured twice. CAC was detectable in 47% of observations. At first scan, mean age was 52.2 years (standard deviation 11.7); 51% male. There were no consistent associations with detectable CAC, continuous CAC, or CAC progression. We observed heterogeneous associations of distance to major roadway with odds of detectable CAC by hypertensive status; interpretation of these findings is questionable. CONCLUSIONS Our findings add to prior work and support evidence against strong associations of traffic or fine particulate matter with the presence, extent, or progression of CAC in a region with relatively low levels of and little variation in fine particulate matter.
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Affiliation(s)
- Kirsten S Dorans
- From the Department of Epidemiology (K.S.D., E.H.W., W.L., J.S., M.A.M.), Department of Environmental Health (E.H.W., J.S., P.K.), and Department of Biostatistics (B.A.C.), Harvard T.H. Chan School of Public Health, Boston, MA; Cardiovascular Epidemiology Research Unit, Department of Cardiology, Beth Israel Deaconess Medical Center (K.S.D., E.H.W., W.L., M.B.R., P.L.L., M.A.M.), Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center (M.B.R.), Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital (U.H.), and Cardiovascular Medicine, Brigham and Women's Hospital (C.J.O.), Harvard Medical School, Boston, MA; Unit of Environmental Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden (P.L.L.); Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Beer Sheva, Israel (I.K.); National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA (R.B.D., J.M.M., C.J.O.); Department of Mathematics and Statistics, Boston University, MA (R.B.D.); Department of Biostatistics, Boston University School of Public Health, Boston, MA (J.M.M.); and Cardiology Section, Department of Medicine, Boston Veteran's Administration Health System, Boston, MA (C.J.O.)
| | - Elissa H Wilker
- From the Department of Epidemiology (K.S.D., E.H.W., W.L., J.S., M.A.M.), Department of Environmental Health (E.H.W., J.S., P.K.), and Department of Biostatistics (B.A.C.), Harvard T.H. Chan School of Public Health, Boston, MA; Cardiovascular Epidemiology Research Unit, Department of Cardiology, Beth Israel Deaconess Medical Center (K.S.D., E.H.W., W.L., M.B.R., P.L.L., M.A.M.), Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center (M.B.R.), Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital (U.H.), and Cardiovascular Medicine, Brigham and Women's Hospital (C.J.O.), Harvard Medical School, Boston, MA; Unit of Environmental Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden (P.L.L.); Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Beer Sheva, Israel (I.K.); National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA (R.B.D., J.M.M., C.J.O.); Department of Mathematics and Statistics, Boston University, MA (R.B.D.); Department of Biostatistics, Boston University School of Public Health, Boston, MA (J.M.M.); and Cardiology Section, Department of Medicine, Boston Veteran's Administration Health System, Boston, MA (C.J.O.)
| | - Wenyuan Li
- From the Department of Epidemiology (K.S.D., E.H.W., W.L., J.S., M.A.M.), Department of Environmental Health (E.H.W., J.S., P.K.), and Department of Biostatistics (B.A.C.), Harvard T.H. Chan School of Public Health, Boston, MA; Cardiovascular Epidemiology Research Unit, Department of Cardiology, Beth Israel Deaconess Medical Center (K.S.D., E.H.W., W.L., M.B.R., P.L.L., M.A.M.), Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center (M.B.R.), Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital (U.H.), and Cardiovascular Medicine, Brigham and Women's Hospital (C.J.O.), Harvard Medical School, Boston, MA; Unit of Environmental Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden (P.L.L.); Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Beer Sheva, Israel (I.K.); National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA (R.B.D., J.M.M., C.J.O.); Department of Mathematics and Statistics, Boston University, MA (R.B.D.); Department of Biostatistics, Boston University School of Public Health, Boston, MA (J.M.M.); and Cardiology Section, Department of Medicine, Boston Veteran's Administration Health System, Boston, MA (C.J.O.)
| | - Mary B Rice
- From the Department of Epidemiology (K.S.D., E.H.W., W.L., J.S., M.A.M.), Department of Environmental Health (E.H.W., J.S., P.K.), and Department of Biostatistics (B.A.C.), Harvard T.H. Chan School of Public Health, Boston, MA; Cardiovascular Epidemiology Research Unit, Department of Cardiology, Beth Israel Deaconess Medical Center (K.S.D., E.H.W., W.L., M.B.R., P.L.L., M.A.M.), Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center (M.B.R.), Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital (U.H.), and Cardiovascular Medicine, Brigham and Women's Hospital (C.J.O.), Harvard Medical School, Boston, MA; Unit of Environmental Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden (P.L.L.); Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Beer Sheva, Israel (I.K.); National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA (R.B.D., J.M.M., C.J.O.); Department of Mathematics and Statistics, Boston University, MA (R.B.D.); Department of Biostatistics, Boston University School of Public Health, Boston, MA (J.M.M.); and Cardiology Section, Department of Medicine, Boston Veteran's Administration Health System, Boston, MA (C.J.O.)
| | - Petter L Ljungman
- From the Department of Epidemiology (K.S.D., E.H.W., W.L., J.S., M.A.M.), Department of Environmental Health (E.H.W., J.S., P.K.), and Department of Biostatistics (B.A.C.), Harvard T.H. Chan School of Public Health, Boston, MA; Cardiovascular Epidemiology Research Unit, Department of Cardiology, Beth Israel Deaconess Medical Center (K.S.D., E.H.W., W.L., M.B.R., P.L.L., M.A.M.), Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center (M.B.R.), Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital (U.H.), and Cardiovascular Medicine, Brigham and Women's Hospital (C.J.O.), Harvard Medical School, Boston, MA; Unit of Environmental Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden (P.L.L.); Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Beer Sheva, Israel (I.K.); National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA (R.B.D., J.M.M., C.J.O.); Department of Mathematics and Statistics, Boston University, MA (R.B.D.); Department of Biostatistics, Boston University School of Public Health, Boston, MA (J.M.M.); and Cardiology Section, Department of Medicine, Boston Veteran's Administration Health System, Boston, MA (C.J.O.)
| | - Joel Schwartz
- From the Department of Epidemiology (K.S.D., E.H.W., W.L., J.S., M.A.M.), Department of Environmental Health (E.H.W., J.S., P.K.), and Department of Biostatistics (B.A.C.), Harvard T.H. Chan School of Public Health, Boston, MA; Cardiovascular Epidemiology Research Unit, Department of Cardiology, Beth Israel Deaconess Medical Center (K.S.D., E.H.W., W.L., M.B.R., P.L.L., M.A.M.), Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center (M.B.R.), Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital (U.H.), and Cardiovascular Medicine, Brigham and Women's Hospital (C.J.O.), Harvard Medical School, Boston, MA; Unit of Environmental Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden (P.L.L.); Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Beer Sheva, Israel (I.K.); National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA (R.B.D., J.M.M., C.J.O.); Department of Mathematics and Statistics, Boston University, MA (R.B.D.); Department of Biostatistics, Boston University School of Public Health, Boston, MA (J.M.M.); and Cardiology Section, Department of Medicine, Boston Veteran's Administration Health System, Boston, MA (C.J.O.)
| | - Brent A Coull
- From the Department of Epidemiology (K.S.D., E.H.W., W.L., J.S., M.A.M.), Department of Environmental Health (E.H.W., J.S., P.K.), and Department of Biostatistics (B.A.C.), Harvard T.H. Chan School of Public Health, Boston, MA; Cardiovascular Epidemiology Research Unit, Department of Cardiology, Beth Israel Deaconess Medical Center (K.S.D., E.H.W., W.L., M.B.R., P.L.L., M.A.M.), Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center (M.B.R.), Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital (U.H.), and Cardiovascular Medicine, Brigham and Women's Hospital (C.J.O.), Harvard Medical School, Boston, MA; Unit of Environmental Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden (P.L.L.); Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Beer Sheva, Israel (I.K.); National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA (R.B.D., J.M.M., C.J.O.); Department of Mathematics and Statistics, Boston University, MA (R.B.D.); Department of Biostatistics, Boston University School of Public Health, Boston, MA (J.M.M.); and Cardiology Section, Department of Medicine, Boston Veteran's Administration Health System, Boston, MA (C.J.O.)
| | - Itai Kloog
- From the Department of Epidemiology (K.S.D., E.H.W., W.L., J.S., M.A.M.), Department of Environmental Health (E.H.W., J.S., P.K.), and Department of Biostatistics (B.A.C.), Harvard T.H. Chan School of Public Health, Boston, MA; Cardiovascular Epidemiology Research Unit, Department of Cardiology, Beth Israel Deaconess Medical Center (K.S.D., E.H.W., W.L., M.B.R., P.L.L., M.A.M.), Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center (M.B.R.), Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital (U.H.), and Cardiovascular Medicine, Brigham and Women's Hospital (C.J.O.), Harvard Medical School, Boston, MA; Unit of Environmental Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden (P.L.L.); Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Beer Sheva, Israel (I.K.); National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA (R.B.D., J.M.M., C.J.O.); Department of Mathematics and Statistics, Boston University, MA (R.B.D.); Department of Biostatistics, Boston University School of Public Health, Boston, MA (J.M.M.); and Cardiology Section, Department of Medicine, Boston Veteran's Administration Health System, Boston, MA (C.J.O.)
| | - Petros Koutrakis
- From the Department of Epidemiology (K.S.D., E.H.W., W.L., J.S., M.A.M.), Department of Environmental Health (E.H.W., J.S., P.K.), and Department of Biostatistics (B.A.C.), Harvard T.H. Chan School of Public Health, Boston, MA; Cardiovascular Epidemiology Research Unit, Department of Cardiology, Beth Israel Deaconess Medical Center (K.S.D., E.H.W., W.L., M.B.R., P.L.L., M.A.M.), Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center (M.B.R.), Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital (U.H.), and Cardiovascular Medicine, Brigham and Women's Hospital (C.J.O.), Harvard Medical School, Boston, MA; Unit of Environmental Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden (P.L.L.); Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Beer Sheva, Israel (I.K.); National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA (R.B.D., J.M.M., C.J.O.); Department of Mathematics and Statistics, Boston University, MA (R.B.D.); Department of Biostatistics, Boston University School of Public Health, Boston, MA (J.M.M.); and Cardiology Section, Department of Medicine, Boston Veteran's Administration Health System, Boston, MA (C.J.O.)
| | - Ralph B D'Agostino
- From the Department of Epidemiology (K.S.D., E.H.W., W.L., J.S., M.A.M.), Department of Environmental Health (E.H.W., J.S., P.K.), and Department of Biostatistics (B.A.C.), Harvard T.H. Chan School of Public Health, Boston, MA; Cardiovascular Epidemiology Research Unit, Department of Cardiology, Beth Israel Deaconess Medical Center (K.S.D., E.H.W., W.L., M.B.R., P.L.L., M.A.M.), Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center (M.B.R.), Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital (U.H.), and Cardiovascular Medicine, Brigham and Women's Hospital (C.J.O.), Harvard Medical School, Boston, MA; Unit of Environmental Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden (P.L.L.); Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Beer Sheva, Israel (I.K.); National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA (R.B.D., J.M.M., C.J.O.); Department of Mathematics and Statistics, Boston University, MA (R.B.D.); Department of Biostatistics, Boston University School of Public Health, Boston, MA (J.M.M.); and Cardiology Section, Department of Medicine, Boston Veteran's Administration Health System, Boston, MA (C.J.O.)
| | - Joseph M Massaro
- From the Department of Epidemiology (K.S.D., E.H.W., W.L., J.S., M.A.M.), Department of Environmental Health (E.H.W., J.S., P.K.), and Department of Biostatistics (B.A.C.), Harvard T.H. Chan School of Public Health, Boston, MA; Cardiovascular Epidemiology Research Unit, Department of Cardiology, Beth Israel Deaconess Medical Center (K.S.D., E.H.W., W.L., M.B.R., P.L.L., M.A.M.), Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center (M.B.R.), Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital (U.H.), and Cardiovascular Medicine, Brigham and Women's Hospital (C.J.O.), Harvard Medical School, Boston, MA; Unit of Environmental Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden (P.L.L.); Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Beer Sheva, Israel (I.K.); National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA (R.B.D., J.M.M., C.J.O.); Department of Mathematics and Statistics, Boston University, MA (R.B.D.); Department of Biostatistics, Boston University School of Public Health, Boston, MA (J.M.M.); and Cardiology Section, Department of Medicine, Boston Veteran's Administration Health System, Boston, MA (C.J.O.)
| | - Udo Hoffmann
- From the Department of Epidemiology (K.S.D., E.H.W., W.L., J.S., M.A.M.), Department of Environmental Health (E.H.W., J.S., P.K.), and Department of Biostatistics (B.A.C.), Harvard T.H. Chan School of Public Health, Boston, MA; Cardiovascular Epidemiology Research Unit, Department of Cardiology, Beth Israel Deaconess Medical Center (K.S.D., E.H.W., W.L., M.B.R., P.L.L., M.A.M.), Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center (M.B.R.), Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital (U.H.), and Cardiovascular Medicine, Brigham and Women's Hospital (C.J.O.), Harvard Medical School, Boston, MA; Unit of Environmental Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden (P.L.L.); Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Beer Sheva, Israel (I.K.); National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA (R.B.D., J.M.M., C.J.O.); Department of Mathematics and Statistics, Boston University, MA (R.B.D.); Department of Biostatistics, Boston University School of Public Health, Boston, MA (J.M.M.); and Cardiology Section, Department of Medicine, Boston Veteran's Administration Health System, Boston, MA (C.J.O.)
| | - Christopher J O'Donnell
- From the Department of Epidemiology (K.S.D., E.H.W., W.L., J.S., M.A.M.), Department of Environmental Health (E.H.W., J.S., P.K.), and Department of Biostatistics (B.A.C.), Harvard T.H. Chan School of Public Health, Boston, MA; Cardiovascular Epidemiology Research Unit, Department of Cardiology, Beth Israel Deaconess Medical Center (K.S.D., E.H.W., W.L., M.B.R., P.L.L., M.A.M.), Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center (M.B.R.), Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital (U.H.), and Cardiovascular Medicine, Brigham and Women's Hospital (C.J.O.), Harvard Medical School, Boston, MA; Unit of Environmental Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden (P.L.L.); Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Beer Sheva, Israel (I.K.); National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA (R.B.D., J.M.M., C.J.O.); Department of Mathematics and Statistics, Boston University, MA (R.B.D.); Department of Biostatistics, Boston University School of Public Health, Boston, MA (J.M.M.); and Cardiology Section, Department of Medicine, Boston Veteran's Administration Health System, Boston, MA (C.J.O.)
| | - Murray A Mittleman
- From the Department of Epidemiology (K.S.D., E.H.W., W.L., J.S., M.A.M.), Department of Environmental Health (E.H.W., J.S., P.K.), and Department of Biostatistics (B.A.C.), Harvard T.H. Chan School of Public Health, Boston, MA; Cardiovascular Epidemiology Research Unit, Department of Cardiology, Beth Israel Deaconess Medical Center (K.S.D., E.H.W., W.L., M.B.R., P.L.L., M.A.M.), Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center (M.B.R.), Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital (U.H.), and Cardiovascular Medicine, Brigham and Women's Hospital (C.J.O.), Harvard Medical School, Boston, MA; Unit of Environmental Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden (P.L.L.); Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Beer Sheva, Israel (I.K.); National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA (R.B.D., J.M.M., C.J.O.); Department of Mathematics and Statistics, Boston University, MA (R.B.D.); Department of Biostatistics, Boston University School of Public Health, Boston, MA (J.M.M.); and Cardiology Section, Department of Medicine, Boston Veteran's Administration Health System, Boston, MA (C.J.O.).
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Valenti V, Hartaigh BÓ, Cho I, Schulman-Marcus J, Gransar H, Heo R, Truong QA, Shaw LJ, Knapper J, Kelkar AA, Sciarretta S, Chang HJ, Callister TQ, Min JK. Absence of Coronary Artery Calcium Identifies Asymptomatic Diabetic Individuals at Low Near-Term But Not Long-Term Risk of Mortality: A 15-Year Follow-Up Study of 9715 Patients. Circ Cardiovasc Imaging 2016; 9:e003528. [PMID: 26848062 DOI: 10.1161/circimaging.115.003528] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Data regarding coronary artery calcification (CAC) prognosis in diabetic individuals are limited to 5-years follow-up. We investigated the long-term risk stratification of CAC among diabetic compared with nondiabetic individuals. METHODS AND RESULTS Nine thousand seven hundred and fifteen asymptomatic individuals undergoing CAC scoring were followed for a median (interquartile range) of 14.7 (13.9-15.6) years. The incidence density rate and hazard ratios with 95% confidence intervals were used to calculate all-cause mortality. Incremental prognostic utility of CAC was evaluated using the area under the receiver operator characteristic curve and net reclassification improvement. Diabetics (54.7±10.8 years; 59.4% male) comprised 8.3% of the cohort (n=810), of which 188 (23.2%) died. For CAC=0, the rate of mortality was similar between diabetic and nondiabetic individuals for the first 5 years (P>0.05), with a nonlinear increased risk of mortality for diabetics after 5 years (P<0.05). The adjusted risk of death for those in the highest (CAC>400) versus the lowest (CAC=0) category of CAC increased by a hazards of 4.64 (95% confidence interval =3.74-5.76) and 3.41 (95% confidence interval =2.22-5.22) for nondiabetic and diabetic individuals, respectively. The presence of CAC improved discrimination (area under the receiver operator characteristic curve range: 0.73-0.74; P<0.01) and reclassification (category-free net reclassification improvement range: 0.53-0.50; P<0.001) beyond conventional risk factors in nondiabetic and diabetic individuals, respectively. CONCLUSIONS CAC=0 is associated with a favorable 5-year prognosis for asymptomatic diabetic and nondiabetic individuals. After 5 years, the risk of mortality increases significantly for diabetic individuals even in the presence of a baseline CAC=0.
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Affiliation(s)
- Valentina Valenti
- From the Department of Radiology, Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY (V.V., B.ó.H., I.C., R.H., Q.A.T., J.K.M.); Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT (B.ó.H.); Department of Medicine, Division of Cardiology, NewYork Presbyterian Hospital/Weill Cornell Medical College, New York, NY (J.S.-M.); Department of Imaging, and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (H.G.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Department of Internal Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S., J.K., A.A.K.); IRCCS Neuromed, Pozzilli (IS), Italy (S.S.); Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (S.S.); and Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.)
| | - Bríain Ó Hartaigh
- From the Department of Radiology, Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY (V.V., B.ó.H., I.C., R.H., Q.A.T., J.K.M.); Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT (B.ó.H.); Department of Medicine, Division of Cardiology, NewYork Presbyterian Hospital/Weill Cornell Medical College, New York, NY (J.S.-M.); Department of Imaging, and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (H.G.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Department of Internal Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S., J.K., A.A.K.); IRCCS Neuromed, Pozzilli (IS), Italy (S.S.); Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (S.S.); and Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.)
| | - Iksung Cho
- From the Department of Radiology, Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY (V.V., B.ó.H., I.C., R.H., Q.A.T., J.K.M.); Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT (B.ó.H.); Department of Medicine, Division of Cardiology, NewYork Presbyterian Hospital/Weill Cornell Medical College, New York, NY (J.S.-M.); Department of Imaging, and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (H.G.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Department of Internal Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S., J.K., A.A.K.); IRCCS Neuromed, Pozzilli (IS), Italy (S.S.); Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (S.S.); and Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.)
| | - Joshua Schulman-Marcus
- From the Department of Radiology, Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY (V.V., B.ó.H., I.C., R.H., Q.A.T., J.K.M.); Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT (B.ó.H.); Department of Medicine, Division of Cardiology, NewYork Presbyterian Hospital/Weill Cornell Medical College, New York, NY (J.S.-M.); Department of Imaging, and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (H.G.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Department of Internal Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S., J.K., A.A.K.); IRCCS Neuromed, Pozzilli (IS), Italy (S.S.); Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (S.S.); and Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.)
| | - Heidi Gransar
- From the Department of Radiology, Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY (V.V., B.ó.H., I.C., R.H., Q.A.T., J.K.M.); Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT (B.ó.H.); Department of Medicine, Division of Cardiology, NewYork Presbyterian Hospital/Weill Cornell Medical College, New York, NY (J.S.-M.); Department of Imaging, and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (H.G.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Department of Internal Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S., J.K., A.A.K.); IRCCS Neuromed, Pozzilli (IS), Italy (S.S.); Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (S.S.); and Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.)
| | - Ran Heo
- From the Department of Radiology, Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY (V.V., B.ó.H., I.C., R.H., Q.A.T., J.K.M.); Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT (B.ó.H.); Department of Medicine, Division of Cardiology, NewYork Presbyterian Hospital/Weill Cornell Medical College, New York, NY (J.S.-M.); Department of Imaging, and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (H.G.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Department of Internal Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S., J.K., A.A.K.); IRCCS Neuromed, Pozzilli (IS), Italy (S.S.); Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (S.S.); and Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.)
| | - Quynh A Truong
- From the Department of Radiology, Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY (V.V., B.ó.H., I.C., R.H., Q.A.T., J.K.M.); Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT (B.ó.H.); Department of Medicine, Division of Cardiology, NewYork Presbyterian Hospital/Weill Cornell Medical College, New York, NY (J.S.-M.); Department of Imaging, and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (H.G.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Department of Internal Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S., J.K., A.A.K.); IRCCS Neuromed, Pozzilli (IS), Italy (S.S.); Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (S.S.); and Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.)
| | - Leslee J Shaw
- From the Department of Radiology, Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY (V.V., B.ó.H., I.C., R.H., Q.A.T., J.K.M.); Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT (B.ó.H.); Department of Medicine, Division of Cardiology, NewYork Presbyterian Hospital/Weill Cornell Medical College, New York, NY (J.S.-M.); Department of Imaging, and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (H.G.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Department of Internal Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S., J.K., A.A.K.); IRCCS Neuromed, Pozzilli (IS), Italy (S.S.); Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (S.S.); and Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.)
| | - Joseph Knapper
- From the Department of Radiology, Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY (V.V., B.ó.H., I.C., R.H., Q.A.T., J.K.M.); Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT (B.ó.H.); Department of Medicine, Division of Cardiology, NewYork Presbyterian Hospital/Weill Cornell Medical College, New York, NY (J.S.-M.); Department of Imaging, and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (H.G.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Department of Internal Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S., J.K., A.A.K.); IRCCS Neuromed, Pozzilli (IS), Italy (S.S.); Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (S.S.); and Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.)
| | - Anita A Kelkar
- From the Department of Radiology, Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY (V.V., B.ó.H., I.C., R.H., Q.A.T., J.K.M.); Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT (B.ó.H.); Department of Medicine, Division of Cardiology, NewYork Presbyterian Hospital/Weill Cornell Medical College, New York, NY (J.S.-M.); Department of Imaging, and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (H.G.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Department of Internal Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S., J.K., A.A.K.); IRCCS Neuromed, Pozzilli (IS), Italy (S.S.); Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (S.S.); and Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.)
| | - Sebastiano Sciarretta
- From the Department of Radiology, Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY (V.V., B.ó.H., I.C., R.H., Q.A.T., J.K.M.); Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT (B.ó.H.); Department of Medicine, Division of Cardiology, NewYork Presbyterian Hospital/Weill Cornell Medical College, New York, NY (J.S.-M.); Department of Imaging, and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (H.G.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Department of Internal Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S., J.K., A.A.K.); IRCCS Neuromed, Pozzilli (IS), Italy (S.S.); Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (S.S.); and Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.)
| | - Hyuk-Jae Chang
- From the Department of Radiology, Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY (V.V., B.ó.H., I.C., R.H., Q.A.T., J.K.M.); Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT (B.ó.H.); Department of Medicine, Division of Cardiology, NewYork Presbyterian Hospital/Weill Cornell Medical College, New York, NY (J.S.-M.); Department of Imaging, and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (H.G.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Department of Internal Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S., J.K., A.A.K.); IRCCS Neuromed, Pozzilli (IS), Italy (S.S.); Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (S.S.); and Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.)
| | - Tracy Q Callister
- From the Department of Radiology, Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY (V.V., B.ó.H., I.C., R.H., Q.A.T., J.K.M.); Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT (B.ó.H.); Department of Medicine, Division of Cardiology, NewYork Presbyterian Hospital/Weill Cornell Medical College, New York, NY (J.S.-M.); Department of Imaging, and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (H.G.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Department of Internal Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S., J.K., A.A.K.); IRCCS Neuromed, Pozzilli (IS), Italy (S.S.); Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (S.S.); and Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.)
| | - James K Min
- From the Department of Radiology, Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY (V.V., B.ó.H., I.C., R.H., Q.A.T., J.K.M.); Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT (B.ó.H.); Department of Medicine, Division of Cardiology, NewYork Presbyterian Hospital/Weill Cornell Medical College, New York, NY (J.S.-M.); Department of Imaging, and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (H.G.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Department of Internal Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S., J.K., A.A.K.); IRCCS Neuromed, Pozzilli (IS), Italy (S.S.); Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (S.S.); and Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.).
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Wu XH, Chen XY, Wang LJ, Wong KS. Intracranial Artery Calcification and Its Clinical Significance. J Clin Neurol 2016; 12:253-61. [PMID: 27165425 PMCID: PMC4960208 DOI: 10.3988/jcn.2016.12.3.253] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 12/20/2015] [Accepted: 12/21/2015] [Indexed: 01/19/2023] Open
Abstract
Intracranial arterial calcification (IAC) is an easily identifiable entity on plain head computed tomography scans. Recent studies have found high prevalence rates for IAC worldwide, and this may be associated with ischemic stroke and cognitive decline. Aging, traditional cardiovascular risk factors, and chronic kidney disease have been found to be associated with IAC. The severity of IAC can be assessed using different visual grading scales or various quantitative methods (by measuring volume or intensity). An objective method for assessing IAC using consistent criteria is urgently required to facilitate comparisons between multiple studies involving diverse populations. There is accumulating evidence from clinical studies that IAC could be utilized as an indicator of intracranial atherosclerosis. However, the pathophysiology underlying the potential correlation between IAC and ischemic stroke-through direct arterial stenosis or plaque stability-remains to be determined. More well-designed clinical studies are needed to explore the predictive values of IAC in vascular events and the underlying pathophysiological mechanisms.
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Affiliation(s)
- Xiao Hong Wu
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Xiang Yan Chen
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
| | - Li Juan Wang
- Department of Neurology, The First Hospital of Jilin University, Jilin, China
| | - Ka Sing Wong
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
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40
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Coronary artery calcium scores and cardiovascular risk factors in 31,545 asymptomatic Korean adults. Int J Cardiovasc Imaging 2016; 32 Suppl 1:139-45. [DOI: 10.1007/s10554-016-0892-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 04/05/2016] [Indexed: 11/27/2022]
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41
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Pereira AC, Gomez LM, Bittencourt MS, Staniak HL, Sharovsky R, Foppa M, Blaha MJ, Bensenor IM, Lotufo PA. Age, Gender, and Race-Based Coronary Artery Calcium Score Percentiles in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Clin Cardiol 2016; 39:352-9. [PMID: 27082165 DOI: 10.1002/clc.22539] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 02/28/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Coronary artery calcium (CAC) has been demonstrated to independently predict the risk of cardiovascular events and all-cause mortality, especially among White populations. Although the population distribution of CAC has been determined for several White populations, the distribution in ethnically admixed groups has not been well established. HYPOTHESIS The CAC distribution, stratified for age, gender and race, is similar to the previously described distribution in the MESA study. METHODS The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) is a prospective cohort study designed to investigate subclinical cardiovascular disease in 6 different centers of Brazil. Similar to previous studies, individuals with self-reported coronary or cerebrovascular disease and those treated for diabetes mellitus were excluded from analysis. RESULTS Percentiles of CAC distribution were estimated with nonparametric techniques. The analysis included 3616 individuals (54% female; mean age, 50 years). As expected, CAC prevalence and burden were steadily higher with increasing age, as well as increased in men and in White individuals. Our results revealed that for a given CAC score, the ELSA-derived CAC percentile would be lower in men compared with the Multi-Ethnic Study of Atherosclerosis (MESA) and would be higher in women compared with MESA. CONCLUSIONS In our sample of the Brazilian population, we observed significant differences in CAC by sex, age, and race. Adjusted for age and sex, low-risk individuals from the Brazilian population present with significantly lower CAC prevalence and burden compared with other low-risk individuals from other worldwide populations. Using US-derived percentiles in Brazilian individuals may lead to overestimating relative CAC burden in men and underestimating relative CAC burden in women.
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Affiliation(s)
- Alexandre C Pereira
- Center for Clinical and Epidemiologic Research, University of São Paulo, São Paulo, Brazil.,Heart Institute, São Paulo, Brazil
| | | | | | - Henrique Lane Staniak
- Center for Clinical and Epidemiologic Research, University of São Paulo, São Paulo, Brazil
| | - Rodolfo Sharovsky
- Center for Clinical and Epidemiologic Research, University of São Paulo, São Paulo, Brazil
| | - Murilo Foppa
- Department of Cardiology, Federal University, Rio Grande do Sul, Porto Alegre, Brazil
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland
| | - Isabela M Bensenor
- Center for Clinical and Epidemiologic Research, University of São Paulo, São Paulo, Brazil.,School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Paulo A Lotufo
- Center for Clinical and Epidemiologic Research, University of São Paulo, São Paulo, Brazil.,School of Medicine, University of São Paulo, São Paulo, Brazil
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Nadjiri J, Hausleiter J, Jähnichen C, Will A, Hendrich E, Martinoff S, Hadamitzky M. Incremental prognostic value of quantitative plaque assessment in coronary CT angiography during 5 years of follow up. J Cardiovasc Comput Tomogr 2016; 10:97-104. [PMID: 26837235 DOI: 10.1016/j.jcct.2016.01.007] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 12/16/2015] [Accepted: 01/11/2016] [Indexed: 01/17/2023]
Abstract
OBJECTIVE We sought to assess the incremental prognostic value of quantitative plaque characterization beyond established CT risk scores. BACKGROUND Several plaque characteristics detectable by coronary computed tomographic angiography (coronary CTA) are thought to be indicative of vulnerable plaques and subsequent cardiac events, particularly low attenuation plaque volume (LAPV), positive remodeling and the napkin-ring sign which is high density vascular adhesion with a small center of low density. It is unknown how quantitative plaque assessment can contribute to the long-term prediction of cardiovascular events in relation to established CT risk scores such as the calcium score or Segment Stenosis Score (SSS). METHODS In 1168 consecutive patients with suspected coronary artery disease (CAD), calcium score measurement and coronary plaque characterization was performed comprising the presence of calcified, non-calcified, and partially calcified plaques on a per-segment basis. In all non-calcified or partially calcified plaques, semi-automated plaque analysis was performed to quantify low attenuation plaque volume (density <30 HU), total non-calcified plaque volume (<150 HU, TNCPV) and remodeling index. The presence of the napkin-ring sign was assessed visually. The study endpoint was the occurrence of major adverse cardiac events (MACE), a composite of cardiac death, myocardial infarction and coronary revascularization more than 90 days after coronary CTA. RESULTS During a clinical follow up of 5.7 years, MACE was observed in 46 patients (3.9%). All plaque characteristics were associated with MACE. The strongest association was observed for LAPV (HR 1.12, p < 0.0001). LAPV showed incremental prognostic value in a stepwise multivariable model including the Morise Score for clinical risk, calcium score and SSS (p = 0.036). CONCLUSION LAPV, TPV, PR and presence of the napkin-ring sign are predictors of MACE independently of clinical risk presentation. LAPV carries slight additional prognostic information beyond the calcium score and conventional coronary CTA analysis. It may therefore improve risk prediction after CT imaging.
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Affiliation(s)
- Jonathan Nadjiri
- Institut für Radiologie und Nuklearmedizin, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Ludwig-Maximilians-Universität München, Munich, Germany
| | - Christin Jähnichen
- Institut für Radiologie und Nuklearmedizin, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Albrecht Will
- Institut für Radiologie und Nuklearmedizin, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Eva Hendrich
- Institut für Radiologie und Nuklearmedizin, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Stefan Martinoff
- Institut für Radiologie und Nuklearmedizin, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Martin Hadamitzky
- Institut für Radiologie und Nuklearmedizin, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
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Hegele RA, Gidding SS, Ginsberg HN, McPherson R, Raal FJ, Rader DJ, Robinson JG, Welty FK. Nonstatin Low-Density Lipoprotein-Lowering Therapy and Cardiovascular Risk Reduction-Statement From ATVB Council. Arterioscler Thromb Vasc Biol 2015; 35:2269-80. [PMID: 26376908 DOI: 10.1161/atvbaha.115.306442] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 08/28/2015] [Indexed: 12/15/2022]
Abstract
Pharmacological reduction of low-density lipoprotein (LDL) cholesterol using statin drugs is foundational therapy to reduce cardiovascular disease (CVD) risk. Here, we consider the place of nonstatin therapies that also reduce LDL cholesterol in prevention of CVD. Among conventional nonstatins, placebo-controlled randomized clinical trials showed that bile acid sequestrants, niacin, and fibrates given as monotherapy each reduce CVD end points. From trials in which patients' LDL cholesterol was already well controlled on a statin, adding ezetimibe incrementally reduced CVD end points, whereas adding a fibrate or niacin showed no incremental benefit. Among emerging nonstatins, monoclonal antibodies against proprotein convertase subtilisin kexin type 9 added to a statin and given for ≤78 weeks showed preliminary evidence of reductions in CVD outcomes. Although these promising early findings contributed to the recent approval of these agents in Europe and in North America, much larger and longer duration outcomes studies are ongoing for definitive proof of CVD benefits. Other nonstatin agents recently approved in the United States include lomitapide and mipomersen, which both act via distinctive LDL receptor independent mechanisms to substantially reduce LDL cholesterol in homozygous familial hypercholesterolemia. We also address some unanswered questions, including measuring alternative biochemical variables to LDL cholesterol, evidence for treating children with monitoring of subclinical atherosclerosis, and potential risks of extremely low LDL cholesterol. As evidence for benefit in CVD prevention accumulates, we anticipate that clinical practice will shift toward more assertive LDL-lowering treatment, using both statins and nonstatins initiated earlier in appropriately selected patients.
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Affiliation(s)
- Robert A Hegele
- From the Department of Medicine, Robarts Research Institute, Schulich School of Medicine, Western University, London, Ontario, Canada (R.A.H.); Nemours Cardiac Center, A. I. duPont Hospital for Children, Wilmington, DE (S.S.G.); Irving Institute for Clinical and Translational Research, Department of Medicine, Columbia University, New York, NY (H.N.G.); Department of Medicine and Biochemistry, Atherogenomics Laboratory, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (R.M.); Carbohydrate and Lipid Metabolism Research Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa (F.J.R); Department of Genetics (D.J.R.) and Division of Translational Medicine and Human Genetics, Department of Medicine (D.J.R.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Epidemiology and Medicine, University of Iowa, Iowa City (J.G.R.); and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (F.K.W.).
| | - Samuel S Gidding
- From the Department of Medicine, Robarts Research Institute, Schulich School of Medicine, Western University, London, Ontario, Canada (R.A.H.); Nemours Cardiac Center, A. I. duPont Hospital for Children, Wilmington, DE (S.S.G.); Irving Institute for Clinical and Translational Research, Department of Medicine, Columbia University, New York, NY (H.N.G.); Department of Medicine and Biochemistry, Atherogenomics Laboratory, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (R.M.); Carbohydrate and Lipid Metabolism Research Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa (F.J.R); Department of Genetics (D.J.R.) and Division of Translational Medicine and Human Genetics, Department of Medicine (D.J.R.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Epidemiology and Medicine, University of Iowa, Iowa City (J.G.R.); and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (F.K.W.)
| | - Henry N Ginsberg
- From the Department of Medicine, Robarts Research Institute, Schulich School of Medicine, Western University, London, Ontario, Canada (R.A.H.); Nemours Cardiac Center, A. I. duPont Hospital for Children, Wilmington, DE (S.S.G.); Irving Institute for Clinical and Translational Research, Department of Medicine, Columbia University, New York, NY (H.N.G.); Department of Medicine and Biochemistry, Atherogenomics Laboratory, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (R.M.); Carbohydrate and Lipid Metabolism Research Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa (F.J.R); Department of Genetics (D.J.R.) and Division of Translational Medicine and Human Genetics, Department of Medicine (D.J.R.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Epidemiology and Medicine, University of Iowa, Iowa City (J.G.R.); and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (F.K.W.)
| | - Ruth McPherson
- From the Department of Medicine, Robarts Research Institute, Schulich School of Medicine, Western University, London, Ontario, Canada (R.A.H.); Nemours Cardiac Center, A. I. duPont Hospital for Children, Wilmington, DE (S.S.G.); Irving Institute for Clinical and Translational Research, Department of Medicine, Columbia University, New York, NY (H.N.G.); Department of Medicine and Biochemistry, Atherogenomics Laboratory, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (R.M.); Carbohydrate and Lipid Metabolism Research Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa (F.J.R); Department of Genetics (D.J.R.) and Division of Translational Medicine and Human Genetics, Department of Medicine (D.J.R.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Epidemiology and Medicine, University of Iowa, Iowa City (J.G.R.); and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (F.K.W.)
| | - Frederick J Raal
- From the Department of Medicine, Robarts Research Institute, Schulich School of Medicine, Western University, London, Ontario, Canada (R.A.H.); Nemours Cardiac Center, A. I. duPont Hospital for Children, Wilmington, DE (S.S.G.); Irving Institute for Clinical and Translational Research, Department of Medicine, Columbia University, New York, NY (H.N.G.); Department of Medicine and Biochemistry, Atherogenomics Laboratory, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (R.M.); Carbohydrate and Lipid Metabolism Research Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa (F.J.R); Department of Genetics (D.J.R.) and Division of Translational Medicine and Human Genetics, Department of Medicine (D.J.R.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Epidemiology and Medicine, University of Iowa, Iowa City (J.G.R.); and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (F.K.W.)
| | - Daniel J Rader
- From the Department of Medicine, Robarts Research Institute, Schulich School of Medicine, Western University, London, Ontario, Canada (R.A.H.); Nemours Cardiac Center, A. I. duPont Hospital for Children, Wilmington, DE (S.S.G.); Irving Institute for Clinical and Translational Research, Department of Medicine, Columbia University, New York, NY (H.N.G.); Department of Medicine and Biochemistry, Atherogenomics Laboratory, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (R.M.); Carbohydrate and Lipid Metabolism Research Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa (F.J.R); Department of Genetics (D.J.R.) and Division of Translational Medicine and Human Genetics, Department of Medicine (D.J.R.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Epidemiology and Medicine, University of Iowa, Iowa City (J.G.R.); and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (F.K.W.)
| | - Jennifer G Robinson
- From the Department of Medicine, Robarts Research Institute, Schulich School of Medicine, Western University, London, Ontario, Canada (R.A.H.); Nemours Cardiac Center, A. I. duPont Hospital for Children, Wilmington, DE (S.S.G.); Irving Institute for Clinical and Translational Research, Department of Medicine, Columbia University, New York, NY (H.N.G.); Department of Medicine and Biochemistry, Atherogenomics Laboratory, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (R.M.); Carbohydrate and Lipid Metabolism Research Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa (F.J.R); Department of Genetics (D.J.R.) and Division of Translational Medicine and Human Genetics, Department of Medicine (D.J.R.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Epidemiology and Medicine, University of Iowa, Iowa City (J.G.R.); and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (F.K.W.)
| | - Francine K Welty
- From the Department of Medicine, Robarts Research Institute, Schulich School of Medicine, Western University, London, Ontario, Canada (R.A.H.); Nemours Cardiac Center, A. I. duPont Hospital for Children, Wilmington, DE (S.S.G.); Irving Institute for Clinical and Translational Research, Department of Medicine, Columbia University, New York, NY (H.N.G.); Department of Medicine and Biochemistry, Atherogenomics Laboratory, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (R.M.); Carbohydrate and Lipid Metabolism Research Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa (F.J.R); Department of Genetics (D.J.R.) and Division of Translational Medicine and Human Genetics, Department of Medicine (D.J.R.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Epidemiology and Medicine, University of Iowa, Iowa City (J.G.R.); and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (F.K.W.)
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Dirrichs T, Penzkofer T, Reinartz SD, Kraus T, Mahnken AH, Kuhl CK. Extracoronary Thoracic and Coronary Artery Calcifications on Chest CT for Lung Cancer Screening: Association with Established Cardiovascular Risk Factors - The "CT-Risk" Trial. Acad Radiol 2015; 22:880-9. [PMID: 25957500 DOI: 10.1016/j.acra.2015.03.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 02/28/2015] [Accepted: 03/02/2015] [Indexed: 02/06/2023]
Abstract
RATIONALE AND OBJECTIVES To investigate the correlation between prevalence and degree of coronary artery calcification (CAC) and extracoronary calcifications (ECCs), scored quantitatively according to Agatston and semiquantitatively by visual analysis, in chest computed tomography (CT) studies obtained for lung cancer screening in asymptomatic subjects and in patients with known coronary heart disease (CHD), and to compare the association of ECC and CAC to established cardiovascular risk factors. MATERIALS AND METHODS Prospective study on 501 males (67 ± 8 years) with a history of working dust exposure who underwent nongated low-dose chest CT for lung cancer screening. Of these, 63 (12.6%) had a history of CHD, the remaining 438 subjects (87.4%) were clinically asymptomatic and without a history of CHD. On the day of the CT study, subjects underwent a thorough clinical examination including blood tests and completed a standardized questionnaire to establish a complete medical history. ECC and CAC scores were quantified according to Agatston and, in addition, by visual rating of calcium load of individual vessel territories on a five-point scale from "absent" to "extensive." Results were correlated with the respective subjects' cardiovascular risk factors and with the presence or absence of CHD. RESULTS ECC scores correlated significantly with CAC scores (two-sided Spearman 0.515; P < .001). ECC scores were associated significantly (P < .001) with cardiovascular risk factors (smoking history, hypertension, diabetes, and hypercholesterolemia) and with subjects' Framingham/prospective cardiovascular münster study scores, whereas CAC scores were associated only with the presence of hypercholesterolemia. CAC scores were strongly associated with CHD than ECC scores (area under the curve, 0.88 vs. 0.66 at receiver operating characteristic analysis). Visual scoring of ECC/CAC load correlated closely with the respective Agatston values (P < .001) and revealed the same association (or lack thereof) with cardiovascular risk factors/CHD. CONCLUSIONS In nongated low-dose CT for lung cancer screening, CAC and ECC load can be accurately established by visual analysis. ECC and CAC scores correlate closely, but not perfectly. There is a strong association between established cardiovascular risk factors and ECC load, but not CAC load, providing further evidence that ECC scoring may complement CAC scoring for broader risk assessment, for example, regarding prediction of extracoronary vascular events.
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CT attenuation features of individual calcified coronary plaque: differences among asymptomatic, stable angina pectoris, and acute coronary syndrome groups. PLoS One 2015; 10:e0131254. [PMID: 26106881 PMCID: PMC4481104 DOI: 10.1371/journal.pone.0131254] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 05/29/2015] [Indexed: 11/19/2022] Open
Abstract
Background Coronary artery calcium (CAC) assessed by non-contrast cardiac CT has been shown to be an independent factor from the Framingham risk factors in predicting cardiovascular events. However, many patients with acute coronary syndrome (ACS) have low CAC score. A recent study that re-analyzed the previous CAC CT scan of MESA cohort showed that in subjects with global lower density, CAC was associated with higher risk of ACS. We aimed to further evaluate the characteristics of CAC attenuation features in ACS subjects, in comparison to asymptomatic and stable angina pectoris (SAP) groups. Methods In a period of 18 months, 524 consecutive subjects received standard CAC CT scans in our department; 278 of 524 subjects with presence of CAC (225 men, age = 60.6±9.5 years; ACS = 41, SAP = 78, asymptomatic = 159) were enrolled. Agatston score, number of plaques (NP) per subject and mean (HMEAN) and standard deviation (HSD) of attenuation of each calcified plaque were measured. Three regression models to distinguish the groups were built: model 1, conventional risk factors only; model 2, Agatston score plus model 1; model 3, plaque attenuation features plus model 2. Results Agatston score in ACS group (median = 112.9) was higher than in the asymptomatic group (median = 54.4, P = 0.028) and similar to the SAP group (median = 237.8, P = 0.428). Calcified plaques in the ACS group showed lower (HMEAN = 180.5) and more homogenous (HSD = 31.2) attenuation than those of the asymptomatic group (HMEAN = 205.9, P = 0.002; HSD = 52.4, P = 0.006) and the SAP group (HMEAN = 204.1, P = 0.016; HSD = 54.4, P = 0.011). Model 3 significantly improved the distinction between ACS and asymptomatic groups (area under curve [AUC] = 0.93) as compared to model 2 (AUC = 0.83, P = 0.003) and model 1 (AUC = 0.79, P = 0.001). Conclusions Calcified plaques in the ACS group were characteristically of low and homogenous CT attenuation. With validation in a large cohort, analysis of CT attenuation features may improve risk stratification of ACS using CAC CT scan.
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Cainzos-Achirica M, Rampal S, Chang Y, Ryu S, Zhang Y, Zhao D, Cho J, Choi Y, Pastor-Barriuso R, Lim SY, Bruguera J, Elosua R, Lima JAC, Shin H, Guallar E. Brachial-ankle pulse wave velocity is associated with coronary calcium in young and middle-aged asymptomatic adults: The Kangbuk Samsung Health Study. Atherosclerosis 2015; 241:350-6. [PMID: 26071657 DOI: 10.1016/j.atherosclerosis.2015.05.031] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 05/04/2015] [Accepted: 05/21/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To evaluate the association between brachial-ankle pulse wave velocity (baPWV), a convenient, non-radiating, readily available measurement of arterial stiffness, and coronary artery calcium (CAC), a reliable marker of coronary atherosclerosis, in a large sample of young and middle-aged asymptomatic adults; and to assess the incremental value of baPWV for detecting prevalent CAC beyond traditional risk factors. METHODS Cross-sectional study of 15,185 asymptomatic Korean adults who voluntarily underwent a comprehensive health screening program including measurement of baPWV and CAC. BaPWV was measured using an oscillometric method with cuffs placed on both arms and ankles. CAC burden was assessed using a multi-detector CT scan and scored following Agatston's method. RESULTS The prevalence of CAC > 0 and CAC > 100 increased across baPWV quintiles. The multivariable-adjusted odds ratios (95% CI) for CAC > 0 comparing baPWV quintiles 2-5 versus quintile 1 were 1.06 (0.87-1.30), 1.24 (1.02-1.50), 1.39 (1.15-1.69) and 1.60 (1.31-1.96), respectively (P trend < 0.001). Similarly, the relative prevalence ratios for CAC > 100 were 1.30 (0.74-2.26), 1.59 (0.93-2.71), 1.74 (1.03-2.94) and 2.59 (1.54-4.36), respectively (P trend < 0.001). For CAC > 100, the area under the ROC curve for baPWV alone was 0.71 (0.68-0.74), and the addition of baPWV to traditional risk factors significantly improved the discrimination and calibration of models for detecting prevalent CAC > 0 and CAC > 100. CONCLUSIONS BaPWV was independently associated with the presence and severity of CAC in a large sample of young and middle-aged asymptomatic adults. BaPWV may be a valuable tool for identifying apparently low-risk individuals with increased burden of coronary atherosclerosis.
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Affiliation(s)
- Miguel Cainzos-Achirica
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA; Ciccarone Center for the Prevention of Heart Disease, Department of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Sanjay Rampal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA; Department of Social and Preventive Medicine, Julius Centre University of Malaya, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yoosoo Chang
- Center for Cohort Studies, Total Healthcare Screening Center, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea; Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea
| | - Seungho Ryu
- Center for Cohort Studies, Total Healthcare Screening Center, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea; Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea
| | - Yiyi Zhang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
| | - Di Zhao
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
| | - Juhee Cho
- Center for Cohort Studies, Total Healthcare Screening Center, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea; Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea
| | - Yuni Choi
- Center for Cohort Studies, Total Healthcare Screening Center, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea
| | | | - So Yeon Lim
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
| | - Jordi Bruguera
- Division of Cardiology and Institut Hospital del Mar d'Investigacions Mèdiques, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Roberto Elosua
- Division of Cardiology and Institut Hospital del Mar d'Investigacions Mèdiques, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Joao A C Lima
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hocheol Shin
- Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea.
| | - Eliseo Guallar
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA.
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Dauriz M, Porneala BC, Guo X, Bielak LF, Peyser PA, Durant NH, Carnethon MR, Bonadonna RC, Bonora E, Bowden DW, Florez JC, Fornage M, Hivert MF, Jacobs DR, Kabagambe EK, Lewis CE, Murabito JM, Rasmussen-Torvik LJ, Rich SS, Vassy JL, Yao J, Carr JJ, Kardia SL, Siscovick D, O'Donnell CJ, Rotter JI, Dupuis J, Meigs JB. Association of a 62 Variants Type 2 Diabetes Genetic Risk Score With Markers of Subclinical Atherosclerosis: A Transethnic, Multicenter Study. CIRCULATION. CARDIOVASCULAR GENETICS 2015; 8:507-15. [PMID: 25805414 PMCID: PMC4472563 DOI: 10.1161/circgenetics.114.000740] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 03/09/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Type 2 diabetes mellitus (T2D) and cardiovascular disease share risk factors and subclinical atherosclerosis (SCA) predicts events in those with and without diabetes mellitus. T2D genetic risk may predict both T2D and SCA. We hypothesized that greater T2D genetic risk is associated with higher extent of SCA. METHODS AND RESULTS In a cross-sectional analysis, including ≤9210 European Americans, 3773 African Americans, 1446 Hispanic Americans, and 773 Chinese Americans without known cardiovascular disease and enrolled in the Framingham Heart Study, Coronary Artery Risk Development in Young Adults, Multi-Ethnic Study of Atherosclerosis, and Genetic Epidemiology Network of Arteriopathy studies, we tested a 62 T2D-loci genetic risk score for association with measures of SCA, including coronary artery or abdominal aortic calcium score, common and internal carotid artery intima-media thickness, and ankle-brachial index. We used ancestry-stratified linear regression models, with random effects accounting for family relatedness when appropriate, applying a genetic-only (adjusted for sex) and a full SCA risk factors-adjusted model (significance, P<0.01=0.05/5, number of traits analyzed). An inverse association with coronary artery calcium score in Multi-Ethnic Study of Atherosclerosis Europeans (fully-adjusted P=0.004) and with common carotid artery intima-media thickness in the Framingham Heart Study (P=0.009) was not confirmed in other study cohorts, either separately or in meta-analysis. Secondary analyses showed no consistent associations with β-cell and insulin resistance genetic risk sub-scores in the Framingham Heart Study and in the Coronary Artery Risk Development in Young Adults. CONCLUSIONS SCA does not have a major genetic component linked to a burden of 62 T2D loci identified by large genome-wide association studies. A shared T2D-SCA genetic basis, if any, might become apparent from better functional information about both T2D and cardiovascular disease risk loci.
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Affiliation(s)
- Marco Dauriz
- General Medicine Division, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
- Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, University of Verona Medical School & Hospital Trust of Verona, Verona, Italy
| | - Bianca C. Porneala
- General Medicine Division, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Xiuqing Guo
- Institute for Translational Genomics & Population Sciences, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
| | - Lawrence F. Bielak
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI
| | - Patricia A. Peyser
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI
| | - Nefertiti H. Durant
- Division of Pediatrics & Adolescent Medicine, Department of Pediatrics, University of Alabama Birmingham School of Medicine, Birmingham, AL
| | - Mercedes R. Carnethon
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Riccardo C. Bonadonna
- Division of Endocrinology, Department of Clinical & Experimental Medicine, University of Parma School of Medicine & AOI of Parma, Parma, Italy
| | - Enzo Bonora
- Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, University of Verona Medical School & Hospital Trust of Verona, Verona, Italy
| | - Donald W. Bowden
- Centers for Diabetes Research & Human Genomics, Wake Forest School of Medicine, Winston-Salem, NC
- Department of Biochemistry & Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Jose C. Florez
- Department of Medicine, Harvard Medical School, Boston, MA
- Diabetes Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA
- Program in Medical & Population Genetics, Broad Institute, Cambridge, MA
| | - Myriam Fornage
- Institute of Molecular Medicine & Human Genetics Center, University of Texas Health Science Center at Houston, Houston, TX
| | - Marie-France Hivert
- Harvard Pilgrim Health Care Institute, Department of Population Medicine, Harvard Medical School, Boston, MA
- Diabetes Unit, Massachusetts General Hospital, Boston, MA
- Division of Endocrinology & Metabolism, Department of Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - David R. Jacobs
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Edmond K. Kabagambe
- Division of Epidemiology, Department of Medicine, Vanderbilt University, Nashville, TN
| | - Cora E. Lewis
- Department of Epidemiology, University of Alabama Birmingham School of Public Health, Birmingham, AL
| | - Joanne M. Murabito
- Department of Medicine, Section of General Internal Medicine, Boston University School of Medicine, Boston
- National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA
| | | | - Stephen S. Rich
- Center for Public Health Genomics, University of Virginia, Charlottesville, VA
| | - Jason L. Vassy
- Department of Medicine, Harvard Medical School, Boston, MA
- Section of General Internal Medicine, VA Boston Healthcare System, Boston, MA
- Division of General Internal Medicine & Primary Care, Brigham and Women's Hospital, Boston, MA
| | - Jie Yao
- Institute for Translational Genomics & Population Sciences, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
| | | | - Sharon L.R. Kardia
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI
| | | | - Christopher J. O'Donnell
- Department of Medicine, Harvard Medical School, Boston, MA
- National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA
- Cardiology Division, Department of Medicine, Massachusetts General Hospital & Harvard Medical School, Boston, MA
| | - Jerome I. Rotter
- Institute for Translational Genomics & Population Sciences, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
| | - Josée Dupuis
- National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - James B. Meigs
- General Medicine Division, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
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A review of the effect of diet on cardiovascular calcification. Int J Mol Sci 2015; 16:8861-83. [PMID: 25906474 PMCID: PMC4425113 DOI: 10.3390/ijms16048861] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 03/19/2015] [Accepted: 04/07/2015] [Indexed: 12/14/2022] Open
Abstract
Cardiovascular (CV) calcification is known as sub-clinical atherosclerosis and is recognised as a predictor of CV events and mortality. As yet there is no treatment for CV calcification and conventional CV risk factors are not consistently correlated, leaving clinicians uncertain as to optimum management for these patients. For this reason, a review of studies investigating diet and serum levels of macro- and micronutrients was carried out. Although there were few human studies of macronutrients, nevertheless transfats and simple sugars should be avoided, while long chain ω-3 fats from oily fish may be protective. Among the micronutrients, an intake of 800 μg/day calcium was beneficial in those without renal disease or hyperparathyroidism, while inorganic phosphorus from food preservatives and colas may induce calcification. A high intake of magnesium (≥380 mg/day) and phylloquinone (500 μg/day) proved protective, as did a serum 25(OH)D concentration of ≥75 nmol/L. Although oxidative damage appears to be a cause of CV calcification, the antioxidant vitamins proved to be largely ineffective, while supplementation of α-tocopherol may induce calcification. Nevertheless other antioxidant compounds (epigallocatechin gallate from green tea and resveratrol from red wine) were protective. Finally, a homocysteine concentration >12 µmol/L was predictive of CV calcification, although a plasma folate concentration of >39.4 nmol/L could both lower homocysteine and protect against calcification. In terms of a dietary programme, these recommendations indicate avoiding sugar and the transfats and preservatives found in processed foods and drinks and adopting a diet high in oily fish and vegetables. The micronutrients magnesium and vitamin K may be worthy of further investigation as a treatment option for CV calcification.
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Racial Differences in the Ability of Subclinical Atherosclerosis Testing to Predict CVD. CURRENT CARDIOVASCULAR RISK REPORTS 2015. [DOI: 10.1007/s12170-015-0453-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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50
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Diederichsen AC, Mahabadi AA, Gerke O, Lehmann N, Sand NP, Moebus S, Lambrechtsen J, Kälsch H, Jensen JM, Jöckel KH, Mickley H, Erbel R. Increased discordance between HeartScore and coronary artery calcification score after introduction of the new ESC prevention guidelines. Atherosclerosis 2015; 239:143-9. [DOI: 10.1016/j.atherosclerosis.2015.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Revised: 12/09/2014] [Accepted: 01/05/2015] [Indexed: 10/24/2022]
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