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Bellinge JW, Chan DC, Pang J, Francis RJ, Page MM, Watts GF, Schultz CJ. Plasma lipoprotein(a) is associated with calcification activity of the thoracic aorta and aortic valve in statin naïve individuals with diabetes mellitus. Eur J Clin Invest 2024; 54:e14167. [PMID: 38265272 DOI: 10.1111/eci.14167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 01/25/2024]
Affiliation(s)
- Jamie W Bellinge
- Medical School, University of Western Australia, Perth, Western Australia, Australia
- Department of Nuclear Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Dick C Chan
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Jing Pang
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Roslyn J Francis
- Medical School, University of Western Australia, Perth, Western Australia, Australia
- Department of Nuclear Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Michael M Page
- Medical School, University of Western Australia, Perth, Western Australia, Australia
- Department of Clinical Biochemistry, Western Diagnostic Pathology, Perth, Australia
| | - Gerald F Watts
- Medical School, University of Western Australia, Perth, Western Australia, Australia
- Cardiometabolic Service, Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Carl J Schultz
- Medical School, University of Western Australia, Perth, Western Australia, Australia
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
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Schultz CJ, Dalgaard F, Bellinge JW, Murray K, Sim M, Connolly E, Blekkenhorst LC, Bondonno CP, Lewis JR, Gislason GH, Tjønneland A, Overvad K, Hodgson JM, Bondonno NP. Dietary Vitamin K 1 Intake and Incident Aortic Valve Stenosis. Arterioscler Thromb Vasc Biol 2024; 44:513-521. [PMID: 38152887 DOI: 10.1161/atvbaha.123.320271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 11/30/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Leaflet calcification contributes to the development and progression of aortic valve stenosis. Vitamin K activates inhibitors of vascular calcification and may modulate inflammation and skeletal bone loss. Therefore, we aimed to determine whether higher dietary intakes of vitamin K1 are associated with a lower incidence of aortic stenosis. METHODS In the Danish Diet, Cancer and Health study, participants aged 50 to 64 years completed a 192-item food frequency questionnaire at baseline, from which habitual intakes of vitamin K1 were estimated. Participants were prospectively followed using linkage to nationwide registers to determine incident aortic valve stenosis (primary outcome) and aortic stenosis with subsequent complications (aortic valve replacement, heart failure, or cardiovascular disease-related mortality; secondary outcome). RESULTS In 55 545 participants who were followed for a maximum of 21.5 years, 1085 were diagnosed with aortic stenosis and 615 were identified as having subsequent complications. Participants in the highest quintile of vitamin K1 intake had a 23% lower risk of aortic stenosis (hazard ratio, 0.77 [95% CI, 0.63-0.94]) and a 27% lower risk of aortic stenosis with subsequent complications (hazard ratio, 0.73 [95% CI, 0.56-0.95]), compared with participants in the lowest quintile after adjusting for demographics and cardiovascular risk factors. CONCLUSIONS In this study, a high intake of vitamin K1-rich foods was associated with a lower incidence of aortic stenosis and a lower risk of aortic stenosis with subsequent complications.
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Affiliation(s)
- Carl J Schultz
- School of Medicine (C.J.S., J.W.B., M.S., C.P.B., J.R.L., J.M.H.), University of Western Australia
- Department of Cardiology, Royal Perth Hospital, Australia (C.J.S., J.W.B.)
| | - Frederik Dalgaard
- Department of Cardiology, Herlev & Gentofte University Hospital, Copenhagen, Denmark (F.D., G.H.G.)
| | - Jamie W Bellinge
- School of Medicine (C.J.S., J.W.B., M.S., C.P.B., J.R.L., J.M.H.), University of Western Australia
- Department of Cardiology, Royal Perth Hospital, Australia (C.J.S., J.W.B.)
| | - Kevin Murray
- Department of Cardiology, Royal Perth Hospital, Australia (C.J.S., J.W.B.)
| | - Marc Sim
- School of Medicine (C.J.S., J.W.B., M.S., C.P.B., J.R.L., J.M.H.), University of Western Australia
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Australia (M.S., E.C., L.C.B., C.P.B., J.R.L., J.M.H., N.P.B.)
| | - Emma Connolly
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Australia (M.S., E.C., L.C.B., C.P.B., J.R.L., J.M.H., N.P.B.)
| | - Lauren C Blekkenhorst
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Australia (M.S., E.C., L.C.B., C.P.B., J.R.L., J.M.H., N.P.B.)
| | - Catherine P Bondonno
- School of Medicine (C.J.S., J.W.B., M.S., C.P.B., J.R.L., J.M.H.), University of Western Australia
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Australia (M.S., E.C., L.C.B., C.P.B., J.R.L., J.M.H., N.P.B.)
| | - Joshua R Lewis
- School of Medicine (C.J.S., J.W.B., M.S., C.P.B., J.R.L., J.M.H.), University of Western Australia
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Australia (M.S., E.C., L.C.B., C.P.B., J.R.L., J.M.H., N.P.B.)
- Centre for Kidney Research, Children's Hospital at Westmead, School of Public Health, Sydney Medical School, The University of Sydney, NSW, Australia (J.R.L.)
| | - Gunnar H Gislason
- Department of Cardiology, Herlev & Gentofte University Hospital, Copenhagen, Denmark (F.D., G.H.G.)
- National Institute of Public Health, University of Southern Denmark, Odense (G.H.G.)
- Danish Heart Foundation, Copenhagen, Denmark (G.H.G.)
| | - Anne Tjønneland
- Danish Cancer Institute, Copenhagen, Denmark (A.T., N.P.B.)
- Department of Public Health, University of Copenhagen, Denmark (A.T.)
| | - Kim Overvad
- Department of Public Health, Aarhus University, Denmark (K.O.)
| | - Jonathan M Hodgson
- School of Medicine (C.J.S., J.W.B., M.S., C.P.B., J.R.L., J.M.H.), University of Western Australia
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Australia (M.S., E.C., L.C.B., C.P.B., J.R.L., J.M.H., N.P.B.)
| | - Nicola P Bondonno
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Australia (M.S., E.C., L.C.B., C.P.B., J.R.L., J.M.H., N.P.B.)
- Danish Cancer Institute, Copenhagen, Denmark (A.T., N.P.B.)
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Pokharel P, Bellinge JW, Dalgaard F, Murray K, Sim M, Yeap BB, Connolly E, Blekkenhorst LC, Bondonno CP, Lewis JR, Gislason G, Tjønneland A, Overvad K, Hodgson JM, Schultz C, Bondonno NP. Vitamin K1 Intake and Incident Diabetes in the Danish Diet, Cancer, and Health Study. J Clin Endocrinol Metab 2023; 108:e1253-e1263. [PMID: 37235778 PMCID: PMC10583989 DOI: 10.1210/clinem/dgad293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/10/2023] [Accepted: 05/22/2023] [Indexed: 05/28/2023]
Abstract
CONTEXT Observational studies have reported lower risks of type 2 diabetes with higher vitamin K1 intake, but these studies overlook effect modification due to known diabetes risk factors. OBJECTIVE To identify subgroups that might benefit from vitamin K1 intake, we examined associations between vitamin K1 intake and incident diabetes overall and in subpopulations at risk of diabetes. METHODS Participants from the prospective cohort, the Danish Diet, Cancer, and Health Study, with no history of diabetes were followed up for diabetes incidence. The association between intake of vitamin K1, estimated from a food frequency questionnaire completed at baseline, and incident diabetes was determined using multivariable-adjusted Cox proportional-hazards models. RESULTS In 54 787 Danish residents with a median (interquartile range) age of 56 (52-60) years at baseline, 6700 individuals were diagnosed with diabetes during 20.8 (17.3-21.6) years of follow-up. Vitamin K1 intake was inversely and linearly associated with incident diabetes (P < .0001). Compared to participants with the lowest vitamin K1 intake (median:57 µg/d), participants with the highest intakes (median:191 µg/d) had a 31% lower risk of diabetes (HR; 95% CI, 0.69; 0.64-0.74) after multivariable adjustments. The inverse association between vitamin K1 intake and incident diabetes was present in all subgroups (namely, men and women, ever and never smokers, low and high physical activity groups, and in participants who were normal to overweight and obese), with differences in absolute risk between subgroups. CONCLUSION Higher intake of foods rich in vitamin K1 was associated with a lower risk of diabetes. If the associations observed are causal, our results indicate that more cases of diabetes would be prevented in subgroups at higher risk (men, smokers, participants with obesity, and those with low physical activity).
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Affiliation(s)
- Pratik Pokharel
- Nutrition and Biomarkers, The Danish Cancer Society Research Center, Copenhagen 2100, Denmark
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia 6000, Australia
| | - Jamie W Bellinge
- Medical School, University of Western Australia, Perth, Western Australia 6009, Australia
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia 6000, Australia
| | - Frederik Dalgaard
- Department of Medicine, Nykøbing Falster Sygehus, Nykøbing 4800, Denmark
- Department of Cardiology, Herlev & Gentofte University Hospital, Copenhagen 2730, Denmark
| | - Kevin Murray
- School of Population and Global Health, University of Western Australia, Perth, Western Australia 6009, Australia
| | - Marc Sim
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia 6000, Australia
- Medical School, University of Western Australia, Perth, Western Australia 6009, Australia
| | - Bu B Yeap
- Medical School, University of Western Australia, Perth, Western Australia 6009, Australia
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, Western Australia 6150, Australia
| | - Emma Connolly
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia 6000, Australia
| | - Lauren C Blekkenhorst
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia 6000, Australia
| | - Catherine P Bondonno
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia 6000, Australia
- Medical School, University of Western Australia, Perth, Western Australia 6009, Australia
| | - Joshua R Lewis
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia 6000, Australia
- Medical School, University of Western Australia, Perth, Western Australia 6009, Australia
- Centre for Kidney Research, Children's Hospital at Westmead, School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia
| | - Gunnar Gislason
- Department of Cardiology, Herlev & Gentofte University Hospital, Copenhagen 2730, Denmark
- The National Institute of Public Health, University of Southern Denmark, Odense 5230, Denmark
- The Danish Heart Foundation, Copenhagen 1120, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen 2200, Denmark
| | - Anne Tjønneland
- Diet, Cancer and Health, The Danish Cancer Society Research Center, Copenhagen 2100, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen 1353, Denmark
| | - Kim Overvad
- Department of Public Health, Aarhus University, Aarhus 8000, Denmark
| | - Jonathan M Hodgson
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia 6000, Australia
- Medical School, University of Western Australia, Perth, Western Australia 6009, Australia
| | - Carl Schultz
- Medical School, University of Western Australia, Perth, Western Australia 6009, Australia
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia 6000, Australia
| | - Nicola P Bondonno
- Nutrition and Biomarkers, The Danish Cancer Society Research Center, Copenhagen 2100, Denmark
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia 6000, Australia
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Bellinge JW, Francis RJ, Lee SC, Vickery A, Macdonald W, Gan SK, Chew GT, Phillips M, Lewis JR, Watts GF, Schultz CJ. The effect of Vitamin-K 1 and Colchicine on Vascular Calcification Activity in subjects with Diabetes Mellitus (ViKCoVaC): A double-blind 2x2 factorial randomized controlled trial. J Nucl Cardiol 2022; 29:1855-1866. [PMID: 33825140 DOI: 10.1007/s12350-021-02589-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 02/03/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND There is currently no treatment for attenuating progression of arterial calcification. 18F-sodium fluoride positron emission tomography (18F-NaF PET) locates regions of calcification activity. We tested whether vitamin-K1 or colchicine affected arterial calcification activity. METHODS 154 patients with diabetes mellitus and coronary calcification, as detected using computed tomography (CT), were randomized to one of four treatment groups (placebo/placebo, vitamin-K1 [10 mg/day]/placebo, colchicine [0.5 mg/day]/placebo, vitamin-K1 [10 mg/day]/ colchicine [0.5 mg/day]) in a double-blind, placebo-controlled 2x2 factorial trial of three months duration. Change in coronary calcification activity was estimated as a change in coronary maximum tissue-to-background ratio (TBRmax) on 18F-NaF PET. RESULTS 149 subjects completed follow-up (vitamin-K1: placebo = 73:76 and colchicine: placebo = 73:76). Neither vitamin-K1 nor colchicine had a statistically significant effect on the coronary TBRmax compared with placebo (mean difference for treatment groups 0·00 ± 0·16 and 0·01 ± 0·17, respectively, p > 0.05). There were no serious adverse effects reported with colchicine or vitamin-K1. CONCLUSIONS In patients with type 2 diabetes, neither vitamin-K1 nor colchicine significantly decreases coronary calcification activity, as estimated by 18F-NaF PET, over a period of 3 months. CLINICAL TRIAL REGISTRATION ACTRN12616000024448.
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Affiliation(s)
- Jamie W Bellinge
- School of Medicine, Faculty of Health and Biomedical Science, University of Western Australia, Royal Perth Hospital Campus, M570, Po Box X2213, Perth, Western Australia, Australia
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Roslyn J Francis
- School of Medicine, Faculty of Health and Biomedical Science, University of Western Australia, Royal Perth Hospital Campus, M570, Po Box X2213, Perth, Western Australia, Australia
- Department of Nuclear Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Sing Ching Lee
- School of Medicine, Faculty of Health and Biomedical Science, University of Western Australia, Royal Perth Hospital Campus, M570, Po Box X2213, Perth, Western Australia, Australia
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Alistair Vickery
- School of Medicine, Faculty of Health and Biomedical Science, University of Western Australia, Royal Perth Hospital Campus, M570, Po Box X2213, Perth, Western Australia, Australia
- Black Swan Health, Perth, Western Australia, Australia
| | - William Macdonald
- Department of Nuclear Medicine, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Seng Khee Gan
- School of Medicine, Faculty of Health and Biomedical Science, University of Western Australia, Royal Perth Hospital Campus, M570, Po Box X2213, Perth, Western Australia, Australia
- Department of Endocrinology and Diabetes, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Gerard T Chew
- School of Medicine, Faculty of Health and Biomedical Science, University of Western Australia, Royal Perth Hospital Campus, M570, Po Box X2213, Perth, Western Australia, Australia
- Department of Endocrinology and Diabetes, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Michael Phillips
- Harry Perkins Institute for Medical Research, and Centre for Medical Research, University of Western Australia and, Nedlands, Western Australia, Australia
| | - Joshua R Lewis
- School of Medicine, Faculty of Health and Biomedical Science, University of Western Australia, Royal Perth Hospital Campus, M570, Po Box X2213, Perth, Western Australia, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Centre for Kidney Research, Children's Hospital Westmead, School of Public Health, University of Sydney, Westmead, New South Wales, Australia
| | - Gerald F Watts
- School of Medicine, Faculty of Health and Biomedical Science, University of Western Australia, Royal Perth Hospital Campus, M570, Po Box X2213, Perth, Western Australia, Australia
- Cardiometabolic service, Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Carl J Schultz
- School of Medicine, Faculty of Health and Biomedical Science, University of Western Australia, Royal Perth Hospital Campus, M570, Po Box X2213, Perth, Western Australia, Australia.
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia.
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5
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Bellinge JW, Francis RJ, Lee SC, Bondonno NP, Sim M, Lewis JR, Watts GF, Schultz CJ. The effect of vitamin K1 on arterial calcification activity in subjects with diabetes mellitus: a post hoc analysis of a double-blind, randomized, placebo-controlled trial. Am J Clin Nutr 2022; 115:45-52. [PMID: 34637494 DOI: 10.1093/ajcn/nqab306] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 09/02/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Coronary and aortic artery calcifications are generally slow to develop, and their burden predicts cardiovascular disease events. In patients with diabetes mellitus, arterial calcification is accelerated and calcification activity can be detected using 18F-sodium fluoride positron emission tomography (18F-NaF PET). OBJECTIVES We aimed to determine whether vitamin K1 supplementation inhibits arterial calcification activity in individuals with diabetes mellitus. METHODS This was a post hoc analysis of the ViKCoVaC (effect of Vitamin-K1 and Colchicine on Vascular Calcification activity in subjects with Diabetes Mellitus) double-blind randomized controlled trial conducted in Perth, Western Australia. Individuals with diabetes mellitus and established coronary calcification (coronary calcium score > 10), but without clinical coronary artery disease, underwent baseline 18F-NaF PET imaging, followed by oral vitamin K1 supplementation (10 mg/d) or placebo for 3 mo, after which 18F-NaF PET imaging was repeated. We tested whether individuals randomly assigned to vitamin K1 supplementation had reduced development of new 18F-NaF PET positive lesions within the coronary arteries and aorta. RESULTS In total, 149 individuals completed baseline and follow-up imaging studies. Vitamin K1 supplementation independently decreased the odds of developing new 18F-NaF PET positive lesions in the coronary arteries (OR: 0.35; 95% CI: 0.16, 0.78; P = 0.010), aorta (OR: 0.27; 95% CI: 0.08, 0.94; P = 0.040), and in both aortic and coronary arteries (OR: 0.28; 95% CI: 0.13, 0.63; P = 0.002). CONCLUSIONS In individuals with diabetes mellitus, supplementation with 10 mg vitamin K1/d may prevent the development of newly calcifying lesions within the aorta and the coronary arteries as detected using 18F-NaF PET. Further long-term studies are needed to test this hypothesis.This trial was registered at anzctr.org.au as ACTRN12616000024448.
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Affiliation(s)
- Jamie W Bellinge
- Division of Internal Medicine, Medical School, University of Western Australia, Perth, Western Australia, Australia.,Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Roslyn J Francis
- Division of Internal Medicine, Medical School, University of Western Australia, Perth, Western Australia, Australia.,Department of Nuclear Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Sing C Lee
- Division of Internal Medicine, Medical School, University of Western Australia, Perth, Western Australia, Australia.,Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Nicola P Bondonno
- Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia.,School of Biomedical Sciences, University of Western Australia, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Marc Sim
- Division of Internal Medicine, Medical School, University of Western Australia, Perth, Western Australia, Australia.,Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
| | - Joshua R Lewis
- Division of Internal Medicine, Medical School, University of Western Australia, Perth, Western Australia, Australia.,Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia.,Centre for Kidney Research, Children's Hospital Westmead, School of Public Health, University of Sydney, Westmead, New South Wales, Australia
| | - Gerald F Watts
- Division of Internal Medicine, Medical School, University of Western Australia, Perth, Western Australia, Australia.,Cardiometabolic Service, Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Carl J Schultz
- Division of Internal Medicine, Medical School, University of Western Australia, Perth, Western Australia, Australia.,Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
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Bellinge JW, Petrov GP, Taggu W. Reel syndrome, a diagnostic conundrum: a case report. Eur Heart J Case Rep 2021; 5:ytab394. [PMID: 34703981 PMCID: PMC8536869 DOI: 10.1093/ehjcr/ytab394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 04/30/2021] [Accepted: 09/20/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Pacemaker lead dislodgement and failure, related to device manipulation, is a rare complication of permanent pacemaker (PPM) insertion. Reel's, Twiddler's, and Ratchet syndrome are rare causes of pacemaker failure with varying mechanisms, defined by their classical lead and generator findings on chest X-ray imaging. Misleading patient presentations may be attributed to lead stimulation of surrounding structures. CASE SUMMARY A 77-year-old female was admitted with abdominal wall pulsations, abdominal pain, and lower limb jerking 3 months following PPM insertion. Following exclusion of a ruptured abdominal aortic aneurysm, the presence of Reel syndrome was noted on the patient's chest X-ray and the electrocardiogram showed inappropriate pacing. Deactivation of the pacemaker resulted in immediate symptom cessation and urgent repositioning of pacemaker leads was undertaken. DISCUSSION This case highlights the importance of considering pacemaker complications causing non-cardiac symptomatology. Pacemaker lead stimulation of surrounding structures can present in an unconventional fashion, veiling the diagnosis. However, a structured approach to undifferentiated neuromuscular presentations in patients with PPMs should consider lead dislodgement as a differential diagnosis. Rapid recognition of lead dislodgement, device deactivation, and re-implantation or repositioning of the leads are critical in preventing potentially life-threatening complications.
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Affiliation(s)
- Jamie W Bellinge
- Department of Cardiology, Joondalup Health Campus, Grand Blvd &, Shenton Ave, Joondalup, Western Australia 6027, Australia
- School of Medicine, University of Western Australia, 35 Stirling Hwy, Crawley, Western Australia 6009, Australia
| | - George P Petrov
- Department of Cardiology, Joondalup Health Campus, Grand Blvd &, Shenton Ave, Joondalup, Western Australia 6027, Australia
| | - Wasing Taggu
- Department of Cardiology, Joondalup Health Campus, Grand Blvd &, Shenton Ave, Joondalup, Western Australia 6027, Australia
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7
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Bellinge JW, Schultz CJ. Optimizing arterial 18F-sodium fluoride positron emission tomography analysis. J Nucl Cardiol 2021; 28:1887-1890. [PMID: 31873832 DOI: 10.1007/s12350-019-01992-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 11/30/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Jamie W Bellinge
- School of Medicine, University of Western Australia, Perth, WA, Australia.
- Department of Cardiology, Royal Perth Hospital, 197 Wellington St, Perth, WA, 6000, Australia.
| | - Carl J Schultz
- School of Medicine, University of Western Australia, Perth, WA, Australia
- Department of Cardiology, Royal Perth Hospital, 197 Wellington St, Perth, WA, 6000, Australia
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8
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Palmer CR, Bellinge JW, Dalgaard F, Sim M, Murray K, Connolly E, Blekkenhorst LC, Bondonno CP, Croft KD, Gislason G, Tjønneland A, Overvad K, Schultz C, Lewis JR, Hodgson JM, Bondonno NP. Association between vitamin K 1 intake and mortality in the Danish Diet, Cancer, and Health cohort. Eur J Epidemiol 2021; 36:1005-1014. [PMID: 34591201 PMCID: PMC8542554 DOI: 10.1007/s10654-021-00806-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 09/06/2021] [Indexed: 01/07/2023]
Abstract
Reported associations between vitamin K1 and both all-cause and cause-specific mortality are conflicting. The 56,048 participants from the Danish Diet, Cancer, and Health prospective cohort study, with a median [IQR] age of 56 [52–60] years at entry and of whom 47.6% male, were followed for 23 years, with 14,083 reported deaths. Of these, 5015 deaths were CVD-related, and 6342 deaths were cancer-related. Intake of vitamin K1 (phylloquinone) was estimated from a food-frequency questionnaire (FFQ), and its relationship with mortality outcomes was investigated using Cox proportional hazards models. A moderate to high (87–192 µg/d) intake of vitamin K1 was associated with a lower risk of all-cause [HR (95%CI) for quintile 5 vs quintile 1: 0.76 (0.72, 0.79)], cardiovascular disease (CVD)-related [quintile 5 vs quintile 1: 0.72 (0.66, 0.79)], and cancer-related mortality [quintile 5 vs quintile 1: 0.80 (0.75, 0.86)], after adjusting for demographic and lifestyle confounders. The association between vitamin K1 intake and cardiovascular disease-related mortality was present in all subpopulations (categorised according to sex, smoking status, diabetes status, and hypertension status), while the association with cancer-related mortality was only present in current/former smokers (p for interaction = 0.002). These findings suggest that promoting adequate intakes of foods rich in vitamin K1 may help to reduce all-cause, CVD-related, and cancer-related mortality at the population level.
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Affiliation(s)
- Claire R Palmer
- Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
| | - Jamie W Bellinge
- School of Medicine, University of Western Australia, Perth, Australia
- Department of Cardiology, Royal Perth Hospital, Perth, Australia
| | - Frederik Dalgaard
- Department of Cardiology, Herlev & Gentofte University Hospital, Copenhagen, Denmark
| | - Marc Sim
- Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
- School of Medicine, University of Western Australia, Perth, Australia
| | - Kevin Murray
- School of Population and Global Health, University of Western Australia, Perth, Australia
| | - Emma Connolly
- Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
| | - Lauren C Blekkenhorst
- Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
- School of Medicine, University of Western Australia, Perth, Australia
| | - Catherine P Bondonno
- Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
- School of Medicine, University of Western Australia, Perth, Australia
| | - Kevin D Croft
- School of Biomedical Sciences, University of Western Australia, Royal Perth Hospital, Rear 50 Murray St, Perth, WA, 6000, Australia
| | - Gunnar Gislason
- Department of Cardiology, Herlev & Gentofte University Hospital, Copenhagen, Denmark
- The National Institute of Public Health, University of Southern Denmark, Odense, Denmark
- The Danish Heart Foundation, Copenhagen, Denmark
| | - Anne Tjønneland
- The Danish Cancer Society Research Centre, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Kim Overvad
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Aalborg University Hospital, Aalborg, Denmark
| | - Carl Schultz
- School of Medicine, University of Western Australia, Perth, Australia
- Department of Cardiology, Royal Perth Hospital, Perth, Australia
| | - Joshua R Lewis
- Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
- School of Medicine, University of Western Australia, Perth, Australia
- Centre for Kidney Research, Children's Hospital at Westmead, School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Jonathan M Hodgson
- Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
- School of Medicine, University of Western Australia, Perth, Australia
| | - Nicola P Bondonno
- Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, Perth, Australia.
- School of Biomedical Sciences, University of Western Australia, Royal Perth Hospital, Rear 50 Murray St, Perth, WA, 6000, Australia.
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9
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Bellinge JW, Dalgaard F, Murray K, Connolly E, Blekkenhorst LC, Bondonno CP, Lewis JR, Sim M, Croft KD, Gislason G, Torp‐Pedersen C, Tjønneland A, Overvad K, Hodgson JM, Schultz C, Bondonno NP. Vitamin K Intake and Atherosclerotic Cardiovascular Disease in the Danish Diet Cancer and Health Study. J Am Heart Assoc 2021; 10:e020551. [PMID: 34369182 PMCID: PMC8475061 DOI: 10.1161/jaha.120.020551] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Dietary vitamin K (K1 and K2) may reduce atherosclerotic cardiovascular disease (ASCVD) risk via several mechanisms. However, studies linking vitamin K intake with incident ASCVD are limited. We aimed to determine the relationship between dietary vitamin K intake and ASCVD hospitalizations. Methods and Results In this prospective cohort study, participants from the Danish Diet, Cancer, and Health Study, with no prior ASCVD, completed a food‐frequency questionnaire at baseline and were followed up for hospital admissions of ASCVD; ischemic heart disease, ischemic stroke, or peripheral artery disease. Intakes of vitamin K1 and vitamin K2 were estimated from the food‐frequency questionnaire, and their relationship with ASCVD hospitalizations was determined using Cox proportional hazards models. Among 53 372 Danish citizens with a median (interquartile range) age of 56 (52–60) years, 8726 individuals were hospitalized for any ASCVD during 21 (17–22) years of follow‐up. Compared with participants with the lowest vitamin K1 intakes, participants with the highest intakes had a 21% lower risk of an ASCVD‐related hospitalization (hazard ratio, 0.79; 95% CI: 0.74–0.84), after multivariable adjustments for relevant demographic covariates. Likewise for vitamin K2, the risk of an ASCVD‐related hospitalization for participants with the highest intakes was 14% lower than participants with the lowest vitamin K2 intake (hazard ratio, 0.86; 95% CI, 0.81–0.91). Conclusions Risk of ASCVD was inversely associated with diets high in vitamin K1 or K2. The similar inverse associations with both vitamin K1 and K2, despite very different dietary sources, highlight the potential importance of vitamin K for ASCVD prevention.
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Affiliation(s)
- Jamie W. Bellinge
- School of MedicineUniversity of Western AustraliaPerthAustralia
- Department of CardiologyRoyal Perth HospitalPerthAustralia
| | - Frederik Dalgaard
- Department of CardiologyHerlev & Gentofte University HospitalCopenhagenDenmark
| | - Kevin Murray
- School of Population and Global HealthUniversity of Western AustraliaPerthWAAustralia
| | - Emma Connolly
- Institute for Nutrition ResearchSchool of Medical and Health SciencesEdith Cowan UniversityPerthAustralia
| | - Lauren C. Blekkenhorst
- School of MedicineUniversity of Western AustraliaPerthAustralia
- Institute for Nutrition ResearchSchool of Medical and Health SciencesEdith Cowan UniversityPerthAustralia
| | - Catherine P. Bondonno
- School of MedicineUniversity of Western AustraliaPerthAustralia
- Institute for Nutrition ResearchSchool of Medical and Health SciencesEdith Cowan UniversityPerthAustralia
| | - Joshua R. Lewis
- School of MedicineUniversity of Western AustraliaPerthAustralia
- Institute for Nutrition ResearchSchool of Medical and Health SciencesEdith Cowan UniversityPerthAustralia
- Centre for Kidney ResearchChildren's Hospital at WestmeadSchool of Public HealthSydney Medical SchoolThe University of SydneySydneyNSWAustralia
| | - Marc Sim
- School of MedicineUniversity of Western AustraliaPerthAustralia
- Institute for Nutrition ResearchSchool of Medical and Health SciencesEdith Cowan UniversityPerthAustralia
| | - Kevin D. Croft
- School of Biomedical SciencesUniversity of Western AustraliaRoyal Perth HospitalPerthWAAustralia
| | - Gunnar Gislason
- Department of CardiologyHerlev & Gentofte University HospitalCopenhagenDenmark
- The National Institute of Public HealthUniversity of Southern DenmarkOdenseDenmark
- The Danish Heart FoundationCopenhagenDenmark
| | - Christian Torp‐Pedersen
- Department of Clinical Investigation and CardiologyNordsjælland HospitalHillerødDenmark
- Department of Public HealthAarhus UniversityAarhusDenmark
| | - Anne Tjønneland
- The Danish Cancer Society Research CentreCopenhagenDenmark
- Department of Public HealthUniversity of CopenhagenCopenhagenDenmark
| | - Kim Overvad
- Department of Public HealthAarhus UniversityAarhusDenmark
- Aalborg University HospitalAalborgDenmark
| | - Jonathan M. Hodgson
- School of MedicineUniversity of Western AustraliaPerthAustralia
- Institute for Nutrition ResearchSchool of Medical and Health SciencesEdith Cowan UniversityPerthAustralia
| | - Carl Schultz
- School of MedicineUniversity of Western AustraliaPerthAustralia
- Department of CardiologyRoyal Perth HospitalPerthAustralia
| | - Nicola P. Bondonno
- Institute for Nutrition ResearchSchool of Medical and Health SciencesEdith Cowan UniversityPerthAustralia
- School of Biomedical SciencesUniversity of Western AustraliaRoyal Perth HospitalPerthWAAustralia
- The Danish Cancer Society Research CentreCopenhagenDenmark
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10
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Kelsey LJ, Bellinge JW, Majeed K, Parker LP, Richards S, Schultz CJ, Doyle BJ. Low Endothelial Shear Stress Is Associated With High-Risk Coronary Plaque Features and Microcalcification Activity. JACC Cardiovasc Imaging 2021; 14:2262-2264. [PMID: 34274284 DOI: 10.1016/j.jcmg.2021.06.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/01/2021] [Accepted: 06/17/2021] [Indexed: 11/30/2022]
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Abstract
PURPOSE OF REVIEW Diabetes mellitus is no longer considered a cardiovascular disease (CVD) risk equivalent, but the optimal methods of risk stratification are a matter of debate. The coronary calcium score (CCS) is a measure of the burden of atherosclerosis and is widely used for CVD risk stratification in the general population. We review recently published data to describe the role of the CCS in people with diabetes mellitus. RECENT FINDINGS People with diabetes mellitus have 10-year event rates for CVD and CVD mortality that are considered high, at a much lower level of CCS than the general population. Different categories of CCS are pertinent to men and women with diabetes mellitus. CCS may be particularly useful in clinical settings when CVD risk is known to be increased but difficult to quantify, for example peri-menopausal women, young persons with diabetes, type 1 diabetic individuals and others. With modern techniques, the radiation dose of a CSS has fallen to levels wherein screening and surveillance could be considered. SUMMARY The CCS is able to quantify CVD risk in people with diabetes mellitus when there is clinical uncertainty and identifies those with very high event rates. Future research should aim to identify effective risk reduction strategies in this important group.
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Affiliation(s)
- Jamie W Bellinge
- School of Medicine, Faculty of Health and Biomedical Science, University of Western Australia
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Sing Ching Lee
- School of Medicine, Faculty of Health and Biomedical Science, University of Western Australia
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Carl J Schultz
- School of Medicine, Faculty of Health and Biomedical Science, University of Western Australia
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
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12
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Majeed K, Bellinge JW, Butcher SC, Alcock R, Spiro J, Playford D, Hillis GS, Newby DE, Mori TA, Francis R, Schultz CJ. Coronary 18F-sodium fluoride PET detects high-risk plaque features on optical coherence tomography and CT-angiography in patients with acute coronary syndrome. Atherosclerosis 2020; 319:142-148. [PMID: 33358367 DOI: 10.1016/j.atherosclerosis.2020.12.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 11/08/2020] [Accepted: 12/11/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND AIMS 18F-Sodium Fluoride Positron Emission Tomography (18F-NaF PET) non-invasively detects micro-calcification activity, the earliest stage of atherosclerotic arterial calcification. We studied the association between coronary 18F-NaF uptake and high-risk plaque features on intra-coronary optical coherence tomography (OCT) and CT-angiography (CTCA) and the potential application to patient-level risk stratification. METHODS Sixty-two prospectively recruited patients with acute coronary syndrome (ACS) underwent multi-vessel OCT, 18F-NaF PET and CTCA. The maximum tissue to background ratio (TBRmax = standardised uptake value (SUV)max/SUVbloodpool) was measured in each coronary segment on 18F-NaF PET scans. High-risk plaque features on OCT and CTCA were compared in matched coronary segments. The number of patients testing positive (>2SD above the normal range) for micro-calcification activity was determined. RESULTS In 62 patients (age, mean ± standard deviation (SD) = 61 ± 9 years, 85% male) the coronary segments with elevated 18F-NaF uptake had higher lipid arc (LA) (median [25th-75th centile]: 74° [35°-117°] versus 48° [15°-83°], p=0.021), higher prevalence of macrophages [n(%): 37 (62%) versus 89 (39%), p=0.008] and lower plaque free wall (PFW) (50° [7°-110°] versus 94° [34°-180°], p=0.027) on OCT, and a higher total plaque burden (p=0.011) and higher dense calcified plaque burden (p= 0.001) on CTCA, when compared with 18F-NaF negative segments. Patients grouped by increasing number of coronary lesions positive for microcalcification activity (0,1, ≥2) showed decreasing plaque free wall, increasing calcification and increasing macrophages on OCT (respectively p=0.008, p < 0.001 and p=0.028). CONCLUSIONS 18F-NaF uptake is associated with high-risk plaque features on OCT and CTCA in a per-segment and per-patient analysis in subjects hospitalized for ACS.
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Affiliation(s)
- Kamran Majeed
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia; Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Jamie W Bellinge
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia; Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Steele C Butcher
- School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia
| | - Richard Alcock
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Jon Spiro
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - David Playford
- School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia
| | - Graham S Hillis
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia; Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - David E Newby
- Centre for Cardiovascular Science, Clinical Research Imaging Centre, Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, UK
| | - Trevor A Mori
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Roslyn Francis
- Medical School, University of Western Australia, Perth, Western Australia, Australia; Nuclear Medicine Department, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Carl J Schultz
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia; Medical School, University of Western Australia, Perth, Western Australia, Australia.
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13
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Bellinge JW, Francis RJ, Lee SC, Phillips M, Rajwani A, Lewis JR, Watts GF, Schultz CJ. 18F-Sodium Fluoride Positron Emission Tomography Activity Predicts the Development of New Coronary Artery Calcifications. Arterioscler Thromb Vasc Biol 2020; 41:534-541. [PMID: 33267660 DOI: 10.1161/atvbaha.120.315364] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The coronary calcium score (CCS) predicts cardiovascular disease risk in individuals with diabetes, and rate of progression of CCS is an additional and incremental marker of risk. 18F-sodium fluoride positron emission tomography (18F-NaF PET) detects early and active calcifications within the vasculature. We aimed to ascertain the relationship between 18F-NaF PET activity and CCS progression in patients with diabetes. Approach and Results: We identified individuals between 50 and 80 years with diabetes and no history of clinical coronary artery disease. Those with a CCS ≥10 were invited to undergo 18F-NaF PET scanning and then repeat CCS >2 years later. 18F-NaF PET and CCS analysis were performed on a per-coronary and a per-patient level. We compared the proportion of CCS progressors in 18F-NaF PET-positive versus 18F-NaF PET-negative coronary arteries. Forty-one participants with 163 coronary arteries underwent follow-up CCS 2.8±0.5 years later. 18F-NaF PET-positive coronary arteries (n=52) were more likely to be CCS progressors, compared with negative coronary arteries (n=111; 86.5% versus 52.3%, P<0.001). Adjusting for baseline CCS, 18F-NaF PET-positive disease was an independent predictor of subsequent CCS progression (odds ratio, 2.92 [95% CI, 1.32-6.45], P=0.008). All subjects (100%, 15/15) with ≥2 18F-NaF-positive coronary arteries progressed in CCS. CONCLUSIONS In subjects with diabetes, 18F-NaF PET positivity at baseline, independently predicted the progression of calcifications within the coronary arteries 2.8 years later. These findings suggest 18F-NaF PET may be a promising technique for earlier identification of patients at higher risk of cardiovascular events.
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Affiliation(s)
- Jamie W Bellinge
- School of Medicine (J.W.B., R.J.F., S.C.L., A.R., J.R.L., G.F.W., C.J.S.), University of Western Australia, Perth.,Department of Cardiology (J.W.B., S.C.L., A.R., C.J.S.), Department of Cardiology, Royal Perth Hospital, Perth, Western Australia
| | - Roslyn J Francis
- School of Medicine (J.W.B., R.J.F., S.C.L., A.R., J.R.L., G.F.W., C.J.S.), University of Western Australia, Perth.,Department of Nuclear Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia (R.J.F.)
| | - Sing Ching Lee
- School of Medicine (J.W.B., R.J.F., S.C.L., A.R., J.R.L., G.F.W., C.J.S.), University of Western Australia, Perth.,Department of Cardiology (J.W.B., S.C.L., A.R., C.J.S.), Department of Cardiology, Royal Perth Hospital, Perth, Western Australia
| | - Michael Phillips
- Harry Perkins Institute for Medical Research (M.P.), University of Western Australia, Perth.,Centre for Medical Research (M.P.), University of Western Australia, Perth
| | - Adil Rajwani
- School of Medicine (J.W.B., R.J.F., S.C.L., A.R., J.R.L., G.F.W., C.J.S.), University of Western Australia, Perth.,Department of Cardiology (J.W.B., S.C.L., A.R., C.J.S.), Department of Cardiology, Royal Perth Hospital, Perth, Western Australia
| | - Joshua R Lewis
- School of Medicine (J.W.B., R.J.F., S.C.L., A.R., J.R.L., G.F.W., C.J.S.), University of Western Australia, Perth.,School of Medical and Health Sciences, Edith Cowan University, Perth, Australia (J.R.L.).,Centre for Kidney Research, Children's Hospital at Westmead, School of Public Health, Sydney Medical School, The University of Sydney, NSW, Australia (J.R.L.)
| | - Gerald F Watts
- School of Medicine (J.W.B., R.J.F., S.C.L., A.R., J.R.L., G.F.W., C.J.S.), University of Western Australia, Perth.,Cardiometabolic Service (G.F.W.), Department of Cardiology, Royal Perth Hospital, Perth, Western Australia
| | - Carl J Schultz
- School of Medicine (J.W.B., R.J.F., S.C.L., A.R., J.R.L., G.F.W., C.J.S.), University of Western Australia, Perth.,Department of Cardiology (J.W.B., S.C.L., A.R., C.J.S.), Department of Cardiology, Royal Perth Hospital, Perth, Western Australia
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14
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Bellinge JW, Majeed K, Carr SS, Jones J, Hong I, Francis RJ, Schultz CJ. Coronary artery 18F-NaF PET analysis with the use of an elastic motion correction software. J Nucl Cardiol 2020; 27:952-961. [PMID: 30684262 DOI: 10.1007/s12350-018-01587-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 12/14/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION 18F-Sodium Fluoride Positron Emission Tomography (18F-NaF PET) is a novel molecular imaging modality with promise for use as a risk stratification tool in cardiovascular disease. There are limitations in the analysis of small and rapidly moving coronary arteries using traditional PET technology. We aimed to validate the use of a motion correction algorithm (eMoco) on coronary 18F-NaF PET outcome parameters. METHODS Patients admitted with an acute coronary syndrome underwent 18F-NaF PET and computed tomography coronary angiography. 18F-NaF PET data were analyzed using a diastolic reconstruction, an ungated reconstruction and the eMoco reconstruction. RESULTS Twenty patients underwent 18F-NaF PET imaging and 17 patients had at least one positive lesion that could be used to compare PET reconstruction datasets. eMoco improved noise (the coefficient of variation of the blood pool radiotracer activity) compared to the diastolic dataset (0.09 [0.07 to 0.12] vs 0.14[0.11 to 0.17], p < .001) and marginally improved coronary lesion maximum tissue-to-background ratios compared to the ungated dataset (1.33 [1.05 to 1.48]vs 1.29 [1.04 to 1.40], p = .011). CONCLUSION In this pilot dataset, the eMoco reconstruction algorithm for motion correction appears to have potential in improving coronary analysis of 18F-NaF PET by reducing noise and increasing maximum counts. Further testing in a larger patient dataset is warranted.
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Affiliation(s)
- Jamie W Bellinge
- Cardiology Department, Royal Perth Hospital, 197 Wellington St, Perth, WA, 6000, Australia.
- School of Medicine, University of Western Australia, Crawley, WA, Australia.
| | - Kamran Majeed
- Cardiology Department, Royal Perth Hospital, 197 Wellington St, Perth, WA, 6000, Australia
- School of Medicine, University of Western Australia, Crawley, WA, Australia
| | - Stuart S Carr
- School of Medicine, University of Western Australia, Crawley, WA, Australia
| | - Judson Jones
- Molecular Imaging, Siemens Medical Solutions USA, Inc., Knoxville, TN, USA
| | - Inki Hong
- Molecular Imaging, Siemens Medical Solutions USA, Inc., Knoxville, TN, USA
| | - Roslyn J Francis
- School of Medicine, University of Western Australia, Crawley, WA, Australia
- Nuclear Medicine Department, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Carl J Schultz
- Cardiology Department, Royal Perth Hospital, 197 Wellington St, Perth, WA, 6000, Australia
- School of Medicine, University of Western Australia, Crawley, WA, Australia
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15
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Bellinge JW, Paul JJ, Walsh LS, Garg L, Watts GF, Schultz C. The impact of non-vitamin K antagonist oral anticoagulants (NOACs) on anticoagulation therapy in rural Australia. Med J Aust 2018; 208:18-23. [PMID: 29320668 DOI: 10.5694/mja17.00132] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 05/02/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To determine the use of different anticoagulation therapies in rural Western Australia; to establish whether remoteness from health care services affects the choice of anticoagulation therapy; to gather preliminary data on anticoagulation therapy safety and efficacy. DESIGN Retrospective cohort study of patients hospitalised with a principal diagnosis of atrial fibrillation/flutter (AF) or venous thromboembolism (VTE) during 2014-2015. SETTING Four hospitals serving two-thirds of the rural population of Western Australia. PARTICIPANTS 609 patients with an indication for anticoagulation therapy recorded in their hospital discharge summary for index admission. MAIN OUTCOME MEASURES Prescribing rates of anticoagulation therapies by indication for anticoagulation and distance of patient residence from their hospital. The primary safety outcome was re-hospitalisation with a major or clinically relevant non-major bleeding event; the primary lack-of-efficacy outcome was re-hospitalisation for a thromboembolic event. RESULTS The overall rates of prescription of NOACs and warfarin were similar (34% v 33%). A NOAC was prescribed more often than warfarin for patients with AF (56.0% v 42.2% of those who received an anticoagulant; P < 0.001), but less often for patients with VTE (29% v 48%; P < 0.001). Warfarin was prescribed for 38% of patients who lived locally, a NOAC for 31% (P = 0.013); for non-local patients, the respective proportions were 29% and 36% (P = 0.08). 69% of patients with AF and a CHA2DS2-VASc score ≥ 1 were prescribed anticoagulation therapy. Patients treated with NOACs had fewer bleeding events than patients treated with warfarin (nine events [4%] v 20 events [10%]; P = 0.027). CONCLUSIONS In rural WA, about one-third of patients with an indication for anticoagulation therapy receive NOACs, but one-third of patients with AF and at risk of stroke received no anticoagulant therapy, and may benefit from NOAC therapy.
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16
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Bellinge JW, Francis RJ, Majeed K, Watts GF, Schultz CJ. In search of the vulnerable patient or the vulnerable plaque: 18F-sodium fluoride positron emission tomography for cardiovascular risk stratification. J Nucl Cardiol 2018; 25:1774-1783. [PMID: 29992525 DOI: 10.1007/s12350-018-1360-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 06/18/2018] [Indexed: 02/07/2023]
Abstract
Cardiovascular disease (CVD) remains a leading cause of death. Preventative therapies that reduce CVD are most effective when targeted to individuals at high risk. Current risk stratification tools have only modest prognostic capabilities, resulting in over-treatment of low-risk individuals and under-treatment of high-risk individuals. Improved methods of CVD risk stratification are required. Molecular imaging offers a novel approach to CVD risk stratification. In particular, 18F-sodium fluoride (18F-NaF) positron emission tomography (PET) has shown promise in the detection of both high-risk atherosclerotic plaque features and vascular calcification activity, which predicts future development of new vascular calcium deposits. The rate of change of coronary calcium scores, measured by serial computed tomography scans over a 2-year period, is a strong predictor of CVD risk. Vascular calcification activity, as measured with 18F-NaF PET, has the potential to provide prognostic information similar to consecutive coronary calcium scoring, with a single-time-point convenience. However, owing to the rapid motion and small size of the coronary arteries, new solutions are required to address the traditional limitations of PET imaging. Two different methods of coronary PET analysis have been independently proposed and here we compare their respective strengths, weaknesses, and the potential for clinical translation.
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Affiliation(s)
- Jamie W Bellinge
- Department of Cardiology, Royal Perth Hospital, 197 Wellington St, Perth, WA, 6000, Australia.
- School of Medicine, University of Western Australia, Perth, Australia.
| | - Roslyn J Francis
- School of Medicine, University of Western Australia, Perth, Australia
- Department of Nuclear Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - Kamran Majeed
- Department of Cardiology, Royal Perth Hospital, 197 Wellington St, Perth, WA, 6000, Australia
- School of Medicine, University of Western Australia, Perth, Australia
| | - Gerald F Watts
- Department of Cardiology, Royal Perth Hospital, 197 Wellington St, Perth, WA, 6000, Australia
- School of Medicine, University of Western Australia, Perth, Australia
| | - Carl J Schultz
- Department of Cardiology, Royal Perth Hospital, 197 Wellington St, Perth, WA, 6000, Australia
- School of Medicine, University of Western Australia, Perth, Australia
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