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Aldana-Bitar J, Golub IS, Moore J, Krishnan S, Verghese D, Manubolu VS, Benzing T, Ichikawa K, Hamal S, Kianoush S, Anderson LR, Ramirez NR, Leipsic JA, Karlsberg RP, Budoff MJ. Colchicine and plaque: A focus on atherosclerosis imaging. Prog Cardiovasc Dis 2024:S0033-0620(24)00031-8. [PMID: 38423236 DOI: 10.1016/j.pcad.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 02/25/2024] [Indexed: 03/02/2024]
Abstract
Colchicine is an anti-inflammatory medication, classically used to treat a wide spectrum of autoimmune diseases. More recently, colchicine has proven itself a key pharmacotherapy in cardiovascular disease (CVD) management, atherosclerotic plaque modification, and coronary artery disease (CAD) treatment. Colchicine acts on many anti-inflammatory pathways, which translates to cardiovascular event reduction, plaque transformation, and plaque reduction. With the FDA's 2023 approval of colchicine for reducing cardiovascular events, a novel clinical pathway opens. This advancement paves the route for CVD management that synergistically merges lipid lowering approaches with inflammation inhibition modalities. This pioneering moment spurs the need for this manuscript's comprehensive review. Hence, this paper synthesizes and surveys colchicine's new role as an atherosclerotic plaque modifier, to provide a framework for physicians in the clinical setting. We aim to improve understanding (and thereby application) of colchicine alongside existing mechanisms for CVD event reduction. This paper examines colchicine's anti-inflammatory mechanism, and reviews large cohort studies that evidence colchicine's blossoming role within CAD management. This paper also outlines imaging modalities for atherosclerotic analysis, reviews colchicine's mechanistic effect upon plaque transformation itself, and synthesizes trials which assess colchicine's nuanced effect upon atherosclerotic transformation.
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Affiliation(s)
- Jairo Aldana-Bitar
- Division of Cardiology, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 West Carson Street, Torrance, CA 90502, USA; Cardiovascular Research Foundation of Southern California, Beverly Hills, CA, USA.
| | - Ilana S Golub
- Division of Cardiology, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 West Carson Street, Torrance, CA 90502, USA
| | - Jeff Moore
- Division of Cardiology, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 West Carson Street, Torrance, CA 90502, USA
| | - Srikanth Krishnan
- Division of Cardiology, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 West Carson Street, Torrance, CA 90502, USA; Department of Medicine, Division of Cardiology, University of California Los Angeles, Westwood, CA, USA
| | - Dhiran Verghese
- Division of Cardiology, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 West Carson Street, Torrance, CA 90502, USA
| | - Venkat S Manubolu
- Division of Cardiology, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 West Carson Street, Torrance, CA 90502, USA
| | - Travis Benzing
- Division of Cardiology, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 West Carson Street, Torrance, CA 90502, USA
| | - Keshi Ichikawa
- Division of Cardiology, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 West Carson Street, Torrance, CA 90502, USA
| | - Sajad Hamal
- Division of Cardiology, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 West Carson Street, Torrance, CA 90502, USA
| | - Sina Kianoush
- Division of Cardiology, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 West Carson Street, Torrance, CA 90502, USA
| | - Lauren R Anderson
- Cardiovascular Research Foundation of Southern California, Beverly Hills, CA, USA
| | - Noah R Ramirez
- Cardiovascular Research Foundation of Southern California, Beverly Hills, CA, USA
| | - Jonathon A Leipsic
- Department of Medicine and Radiology, University of British Columbia, Canada
| | - Ronald P Karlsberg
- Cardiovascular Research Foundation of Southern California, Beverly Hills, CA, USA
| | - Matthew J Budoff
- Division of Cardiology, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 West Carson Street, Torrance, CA 90502, USA
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Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024; 12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). INTERPRETATION Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. FUNDING Boehringer Ingelheim and Eli Lilly.
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Ryder M, Sabarai A, Saccà C, Sachson R, Sadler E, Safiee NS, Sahani M, Saillant A, Saini J, Saito C, Saito S, Sakaguchi K, Sakai M, Salim H, Salviani C, Sammons E, Sampson A, Samson F, Sandercock P, Sanguila S, Santorelli G, Santoro D, Sarabu N, Saram T, Sardell R, Sasajima H, Sasaki T, Satko S, Sato A, Sato D, Sato H, Sato H, Sato J, Sato T, Sato Y, Satoh M, Sawada K, Schanz M, Scheidemantel F, Schemmelmann M, Schettler E, Schettler V, Schlieper GR, Schmidt C, Schmidt G, Schmidt U, Schmidt-Gurtler H, Schmude M, Schneider A, Schneider I, Schneider-Danwitz C, Schomig M, Schramm T, Schreiber A, Schricker S, Schroppel B, Schulte-Kemna L, Schulz E, Schumacher B, Schuster A, Schwab A, Scolari F, Scott A, Seeger W, Seeger W, Segal M, Seifert L, Seifert M, Sekiya M, Sellars R, Seman MR, Shah S, Shah S, Shainberg L, Shanmuganathan M, Shao F, Sharma K, Sharpe C, Sheikh-Ali M, Sheldon J, Shenton C, Shepherd A, Shepperd M, Sheridan R, Sheriff Z, Shibata Y, Shigehara T, Shikata K, Shimamura K, Shimano H, Shimizu Y, Shimoda H, Shin K, Shivashankar G, Shojima N, Silva R, Sim CSB, Simmons K, Sinha S, Sitter T, Sivanandam S, Skipper M, Sloan K, Sloan L, Smith R, Smyth J, Sobande T, Sobata M, Somalanka S, Song X, Sonntag F, Sood B, Sor SY, Soufer J, Sparks H, Spatoliatore G, Spinola T, Squyres S, Srivastava A, Stanfield J, Staplin N, Staylor K, Steele A, Steen O, Steffl D, Stegbauer J, Stellbrink C, Stellbrink E, Stevens W, Stevenson A, Stewart-Ray V, Stickley J, Stoffler D, Stratmann B, Streitenberger S, Strutz F, Stubbs J, Stumpf J, Suazo N, Suchinda P, Suckling R, Sudin A, Sugamori K, Sugawara H, Sugawara K, Sugimoto D, Sugiyama H, Sugiyama H, Sugiyama T, Sullivan M, Sumi M, Suresh N, Sutton D, Suzuki H, Suzuki R, Suzuki Y, Suzuki Y, Suzuki Y, Swanson E, Swift P, Syed S, Szerlip H, Taal M, Taddeo M, Tailor C, Tajima K, Takagi M, Takahashi K, Takahashi K, Takahashi M, Takahashi T, Takahira E, Takai T, Takaoka M, Takeoka J, Takesada A, Takezawa M, Talbot M, Taliercio J, Talsania T, Tamori Y, Tamura R, Tamura Y, Tan CHH, Tan EZZ, Tanabe A, Tanabe K, Tanaka A, Tanaka A, Tanaka N, Tang S, Tang Z, Tanigaki K, Tarlac M, Tatsuzawa A, Tay JF, Tay LL, Taylor J, Taylor K, Taylor K, Te A, Tenbusch L, Teng KS, Terakawa A, Terry J, Tham ZD, Tholl S, Thomas G, Thong KM, Tietjen D, Timadjer A, Tindall H, Tipper S, Tobin K, Toda N, Tokuyama A, Tolibas M, Tomita A, Tomita T, Tomlinson J, Tonks L, Topf J, Topping S, Torp A, Torres A, Totaro F, Toth P, Toyonaga Y, Tripodi F, Trivedi K, Tropman E, Tschope D, Tse J, Tsuji K, Tsunekawa S, Tsunoda R, Tucky B, Tufail S, Tuffaha A, Turan E, Turner H, Turner J, Turner M, Tuttle KR, Tye YL, Tyler A, Tyler J, Uchi H, Uchida H, Uchida T, Uchida T, Udagawa T, Ueda S, Ueda Y, Ueki K, Ugni S, Ugwu E, Umeno R, Unekawa C, Uozumi K, Urquia K, Valleteau A, Valletta C, van Erp R, Vanhoy C, Varad V, Varma R, Varughese A, Vasquez P, Vasseur A, Veelken R, Velagapudi C, Verdel K, Vettoretti S, Vezzoli G, Vielhauer V, Viera R, Vilar E, Villaruel S, Vinall L, Vinathan J, Visnjic M, Voigt E, von-Eynatten M, Vourvou M, Wada J, Wada J, Wada T, Wada Y, Wakayama K, Wakita Y, Wallendszus K, Walters T, Wan Mohamad WH, Wang L, Wang W, Wang X, Wang X, Wang Y, Wanner C, Wanninayake S, Watada H, Watanabe K, Watanabe K, Watanabe M, Waterfall H, Watkins D, Watson S, Weaving L, Weber B, Webley Y, Webster A, Webster M, Weetman M, Wei W, Weihprecht H, Weiland L, Weinmann-Menke J, Weinreich T, Wendt R, Weng Y, Whalen M, Whalley G, Wheatley R, Wheeler A, Wheeler J, Whelton P, White K, Whitmore B, Whittaker S, Wiebel J, Wiley J, Wilkinson L, Willett M, Williams A, Williams E, Williams K, Williams T, Wilson A, Wilson P, Wincott L, Wines E, Winkelmann B, Winkler M, Winter-Goodwin B, Witczak J, Wittes J, Wittmann M, Wolf G, Wolf L, Wolfling R, Wong C, Wong E, Wong HS, Wong LW, Wong YH, Wonnacott A, Wood A, Wood L, Woodhouse H, Wooding N, Woodman A, Wren K, Wu J, Wu P, Xia S, Xiao H, Xiao X, Xie Y, Xu C, Xu Y, Xue H, Yahaya H, Yalamanchili H, Yamada A, Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Rhee CM, Budoff M, Brent G, You AS, Stenvinkel P, Novoa A, Flores F, Hamal S, Dailing C, Kinninger A, Nakata T, Kovesdy CP, Nguyen DV, Kalantar-Zadeh K. Serum Thyrotropin Elevation and Coronary Artery Calcification in Hemodialysis Patients. Cardiorenal Med 2022; 12:106-116. [PMID: 35551382 PMCID: PMC9452456 DOI: 10.1159/000525037] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 05/03/2022] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Hypothyroidism is highly prevalent in end-stage kidney disease patients, and emerging data show that lower circulating thyroid hormone levels lead to downregulation of vascular calcification inhibitors and coronary artery calcification (CAC) in this population. To date, no studies have examined the association of serum thyrotropin (TSH), the most sensitive and specific single biochemical metric of thyroid function, with CAC risk in hemodialysis patients. METHODS In secondary analyses of patients from the Anti-Inflammatory and Anti-Oxidative Nutrition in Hypoalbuminemic Dialysis Patients trial, we examined serum TSH levels and CAC risk assessed by cardiac computed tomography scans collected within a 90-day period. We evaluated the relationship between serum TSH with CAC Volume (VS) and Agatston score (AS) (defined as >100 mm3 and >100 Houndsfield Units, respectively) using multivariable logistic regression. RESULTS Among 104 patients who met eligibility criteria, higher TSH levels in the highest tertile were associated with moderately elevated CAC VS and AS in case-mix-adjusted analyses (ref: lowest tertile): adjusted ORs (95% CIs) 4.26 (1.18, 15.40) and 5.53 (1.44, 21.30), respectively. TSH levels >3.0 mIU/L (ref: ≤3.0 mIU/L) were also associated with moderately elevated CAC VS and AS. In secondary analyses, point estimates of incrementally lower direct free thyroxine levels trended toward elevated CAC VS and AS, although associations did not achieve statistical significance. CONCLUSIONS In hemodialysis patients, higher serum TSH was associated with elevated CAC VS and AS. Further studies are needed to determine if thyroid hormone supplementation can attenuate CAC burden in this population.
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Affiliation(s)
- Connie M. Rhee
- Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, CA
| | - Matthew Budoff
- Lundquist Institute at Harbor UCLA Medical Center, Torrance, CA
| | - Gregory Brent
- Division of Endocrinology, Diabetes and Metabolism, David Geffen School of Medicine at UCLA, Los Angeles, CA,Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Amy S. You
- Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, CA
| | - Peter Stenvinkel
- Department of Renal Medicine M99, Karolinska Institutet, Stockholm, Sweden
| | - Alejandra Novoa
- Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, CA
| | - Fred Flores
- Lundquist Institute at Harbor UCLA Medical Center, Torrance, CA
| | - Sajad Hamal
- Lundquist Institute at Harbor UCLA Medical Center, Torrance, CA
| | | | - April Kinninger
- Lundquist Institute at Harbor UCLA Medical Center, Torrance, CA
| | - Tracy Nakata
- Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, CA
| | - Csaba P. Kovesdy
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN,Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, TN
| | - Danh V. Nguyen
- Division of General Internal Medicine, University of California Irvine School of Medicine, Orange, CA
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, CA,Tibor Rubin Veterans Affairs Medical Center, Long Beach, CA
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You AS, Budoff M, Zeb I, Ahmadi N, Novoa A, Flores F, Hamal S, Kinninger A, Dailing C, Nakata T, Kovesdy CP, Nguyen DV, Brent GA, Kalantar-Zadeh K, Rhee CM. Elevated serum thyrotropin levels and endothelial dysfunction in a prospective hemodialysis cohort. Hemodial Int 2022; 26:57-65. [PMID: 34231302 PMCID: PMC10753993 DOI: 10.1111/hdi.12964] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/13/2021] [Accepted: 06/19/2021] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Thyroid dysfunction is a highly prevalent yet under-recognized complication in hemodialysis patients. In the general population, hypothyroidism has been associated with endothelial dysfunction due to impaired vasodilator synthesis and activity. Little is known about the association of serum thyrotropin (TSH), the most sensitive and specific single biochemical metric of thyroid function, with endothelial function in hemodialysis patients. METHODS In a secondary analysis of 99 patients from the Anti-inflammatory and anti-oxidative nutrition in hypoalbuminemic dialysis patients (AIONID) trial, we examined measurements of serum TSH and endothelial function ascertained by fingertip digital thermal monitoring (DTM), a novel method used to measure micro-vascular reactivity, collected within a 90-day period. DTM was used to measure changes in fingertip temperature during and after an ischemic stimulus (blood pressure cuff occlusion) as an indicator of changes in blood flow, and two DTM indices were assessed, namely adjusted (a) Temperature Rebound (TR), defined as the maximum temperature rebound post-cuff deflation, and adjusted (b) Area Under the Temperature Curve (TMP-AUC), defined as area under the curve between the maximum and minimum temperatures. We examined the relationship between serum TSH with impaired TR (separately) and TMP-AUC (both defined as less than the median level of observed values) using multivariable logistic regression. FINDINGS In unadjusted and case-mix analyses, higher serum TSH levels (defined as the three highest quartiles) were associated with lower (worse) TR (ref: lowest TSH quartile): ORs (95% CI) 2.64 (1.01-6.88) and 2.85 (1.08-7.57), respectively. In unadjusted and case-mix analyses, higher TSH levels were associated with lower (worse) TMP-AUC: ORs (95% CI) 2.64 (1.01-6.88) and 2.79 (1.06-7.38), respectively. DISCUSSION In HD patients, higher serum TSH levels were associated with worse micro-vascular reactivity measured by DTM. Further studies are needed to determine if thyroid hormone supplementation improves endothelial function in hemodialysis patients with lower levels of thyroid function.
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Affiliation(s)
- Amy S. You
- Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, California, USA
| | - Matthew Budoff
- Lundquist Institute, Harbor UCLA Medical Center, Torrance, California, USA
| | - Irfan Zeb
- Division of Cardiology, West Virginia University, Morgantown, West Virginia, USA
| | - Naser Ahmadi
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Alejandra Novoa
- Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, California, USA
| | - Ferdinand Flores
- Lundquist Institute, Harbor UCLA Medical Center, Torrance, California, USA
| | - Sajad Hamal
- Lundquist Institute, Harbor UCLA Medical Center, Torrance, California, USA
| | - April Kinninger
- Lundquist Institute, Harbor UCLA Medical Center, Torrance, California, USA
| | | | - Tracy Nakata
- Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, California, USA
| | - Csaba P. Kovesdy
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, Tennessee, USA
| | - Danh V. Nguyen
- Division of General Internal Medicine, University of California Irvine School of Medicine, Orange, California, USA
| | - Gregory A. Brent
- Division of Endocrinology, Diabetes and Metabolism, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, California, USA
- Tibor Rubin Veterans Affairs Medical Center, Long Beach, California, USA
| | - Connie M. Rhee
- Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, California, USA
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Birudaraju D, Hamal S, Tayek JA. Solumedrol Treatment for Severe Sepsis in Humans with a Blunted Adrenocorticotropic Hormone-Cortisol Response: A Prospective Randomized Double-Blind Placebo-Controlled Pilot Clinical Trial. J Intensive Care Med 2021; 37:693-697. [PMID: 34516312 DOI: 10.1177/08850666211038883] [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] [Indexed: 12/15/2022]
Abstract
PURPOSE To test the benefits of Solumedrol treatment in sepsis patients with a blunted adrenocorticotropic hormone (ACTH)-cortisol response (delta <13 µg/dL) with regard to the number of days on ventilator, days on intravenous blood pressure support, length of time in an intensive care unit (ICU), 14-day mortality, and 28-day mortality. The trial was prospective, randomized, and double-blind. As part of a larger sepsis trial, 54 patients with sepsis had an intravenous ACTH stimulation test using 250 µg of ACTH, and serum cortisol was measured at times 0, 30, and 60 min. Eleven patients failed to increase their cortisol concentration above 19.9 µg/dL and were excluded from the clinical trial as they were considered to have adrenal insufficiency. The remaining 43 patients had a baseline cortisol of 32 ± 1 µg/dL increased to 38 ± 3 µg/dL at 30 min and 40 ± 3 at 60 min. All cortisol responses were <12.9 µg/dL between time 0 and time 60, which is defined as a blunted cortisol response to intravenous ACTH administration. Twenty-one were randomized to receive 20 mg of intravenous Solumedrol and 22 were randomized to receive a matching placebo every 8 h for 7-days. There was no significant difference between the two randomized groups. Data analysis was carried out bya two-tailed test and P < .05 as significant. RESULTS Results: The mean age was 51 ± 2 (mean ± SEM) with 61% female. Groups were well matched with regard to APACHE III score in Solumedrol versus placebo (59 ± 6 vs 59 ± 6), white blood cell count (18.8 ± 2.2 vs 18.6 ± 2.6), and incidence of bacteremia (29 vs 39%). The 28-day mortality rate was reduced in the Solumedrol treated arm (43 ± 11 vs 73 ± 10%; P < .05). There was no change in days in ICU, days on blood pressure agents, or days on ventilator. Seven days of high-dose intravenous Solumedrol treatment (20 mg every 8 h) in patients with a blunted cortisol response to ACTH was associated with an improved 28-day survival. This small study suggests that an inability to increase endogenous cortisol production in patients with sepsis who are then provided steroid treatment could improve survival.
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Affiliation(s)
- Divya Birudaraju
- 117316Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, USA
| | - Sajad Hamal
- 117316Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, USA
| | - John A Tayek
- 309953David Geffen School of Medicine at UCLA, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
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Lakshmanan S, Shekar C, Kinninger A, Golub I, Dahal S, Birudaraju D, Cherukuri L, Hamal S, Roy S, Bhatt D, Budoff M, Nelson J. Association Of Atherogenic Index Of Plasma And Baseline Coronary Plaque Burden In EVAPORATE. J Cardiovasc Comput Tomogr 2021. [DOI: 10.1016/j.jcct.2021.06.256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dahal S, Calicchio F, Kinninger A, Lakshmanan S, Manubolu VS, Havistin R, Ahmad K, Rezvanizadeh V, Ghanem A, Hamal S, Behjatnia D, Crahan TC, Roy S, Budoff M. PREVALENCE OF OBSTRUCTIVE CORONARY ARTERY DISEASE ASSESSED BY CORONARY CT ANGIOGRAPHY IN DIFFERENT AGE POPULATION WITH CORONARY ARTERY CALCIUM SCORE OF ZERO. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02727-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lakshmanan S, Shekar C, Kinninger A, Golub I, Hamal S, Birudaraju D, Cherukuri L, Ahmad K, Chen M, Trad G, Luce JR, Roy S, Nelson J, Bhatt D, Budoff M. EFFECT OF ICOSAPENT ETHYL ON PERCENT ATHEROMA VOLUME IN PATIENTS WITH ELEVATED TRIGLYCERIDES ON STATIN THERAPY - INSIGHTS FROM THE EVAPORATE TRIAL. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02637-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Ahmad K, Lakshmanan S, Nimmagadda M, Verghese D, Cherukuri L, Kinninger A, Ghanem AK, Rezvanizadeh V, Dahal S, Manubolu V, Havistin R, Joshi T, Hadeed SJ, Hamal S, Flores F, Budoff MJ. CAN SIGNAL-PROCESSED ELECTROCARDIOGRAM (SPECG) DIAGNOSE SUBCLINICAL ATHEROSCLEROSIS? J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02673-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Birudaraju D, Cherukuri L, Kinninger A, Dahal S, Lakshmanan S, Rezvanizadeh V, Ghanem AK, Flores F, Hamal S, Pozon RG, Adudodla N, Tayek JA, Roy SK, Budoff MJ. Prevalence of normal coronary arteries by coronary computed tomography angiography (CCTA) in patients with type 2 diabetes mellitus from Semaglutide Treatment on Coronary Plaque Progression (STOP) trial. J Diabetes Complications 2021; 35:107840. [PMID: 33419635 DOI: 10.1016/j.jdiacomp.2020.107840] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/30/2020] [Accepted: 11/30/2020] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Coronary artery disease (CAD) is leading cause of morbidity and mortality among type 2 diabetics (T2DM). METHODS 140 T2DM will be enrolled in randomized, double blind, placebo controlled Semaglutide Treatment On Coronary Plaque Progression (STOP) trial to determine effect of weekly subcutaneous semaglutide on coronary plaque progression. All participants will undergo Coronary Artery Calcium (CAC) Scoring and Coronary Computed Tomography Angiography (CCTA) at our center. A Fisher test, ANOVA and Kruskal Wallis were used. RESULTS As of May 2020, 87 patients (81%) randomized (mean age 56.4 ± 8.4 yrs. and 62% male) with documented CAD by CCTA. Approximately 20% of screened study population were screen failed due to normal coronaries (n= 14) or HbA1C<7 (n=7). Of interest, 14 persons with diabetes with normal coronaries (no calcification) were significantly more likely to be females (21% vs 62%), have higher glomerular filtration rate (106.5 ± 19.4 vs 89.9 ± 22.6 mL/min/1.73m2; p= 0.006), and younger (53.4 ± 9.0 vs 56.4 ± 8.4 yrs.; p=0.02) than those who were randomized. CONCLUSION Among T2DM, there is a significant portion who have normal coronary arteries and may have a better prognosis. Excluding these participants from cardiovascular studies may improve power and decrease sample size.
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Affiliation(s)
- Divya Birudaraju
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Lavanya Cherukuri
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA, USA
| | - April Kinninger
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Suraj Dahal
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Suvasini Lakshmanan
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Vahid Rezvanizadeh
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Ahmed K Ghanem
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Ferdinand Flores
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Sajad Hamal
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Ryan G Pozon
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Nishitha Adudodla
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA, USA
| | - John A Tayek
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Sion K Roy
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Matthew J Budoff
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA, USA.
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Ahmad K, Rezvanizadeh V, Dahal S, Kinninger A, Ghanem AK, Lakshmanan S, Hamal S, Flores F, Dailing C, Roy SK, Budoff MJ. COVID-19 IgG/IgM antibody testing in Los Angeles County, California. Eur J Clin Microbiol Infect Dis 2021; 40:457-459. [PMID: 33241444 PMCID: PMC7688294 DOI: 10.1007/s10096-020-04111-3] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 11/20/2020] [Indexed: 11/26/2022]
Abstract
Evidence suggests that asymptomatic and mild SARS-CoV-2 infections comprise > 95% of all cases. Developing a test that indicates past infection and possible immunity against the virus is important. We administered 244 antibody tests to three groups of high-risk population. The test consisted of an IgG component and an IgM component. The overall IgM/IgG positivity for patients with none, mild, moderate, and severe symptoms were 21.1%, 21.8%, 14.2%, and 26.9%, respectively. Those with moderate or severe symptoms were no more or less likely to have positive antibody tests than those with no or mild symptoms.
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Affiliation(s)
- Khadije Ahmad
- Division of Cardiology, Department of Internal Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, 1124 W Carson Street, Torrance, CA, 90502, USA
| | - Vahid Rezvanizadeh
- Division of Cardiology, Department of Internal Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, 1124 W Carson Street, Torrance, CA, 90502, USA
| | - Suraj Dahal
- Division of Cardiology, Department of Internal Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, 1124 W Carson Street, Torrance, CA, 90502, USA
| | - April Kinninger
- Division of Cardiology, Department of Internal Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, 1124 W Carson Street, Torrance, CA, 90502, USA
| | - Ahmed K Ghanem
- Division of Cardiology, Department of Internal Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, 1124 W Carson Street, Torrance, CA, 90502, USA
| | - Suvasini Lakshmanan
- Division of Cardiology, Department of Internal Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, 1124 W Carson Street, Torrance, CA, 90502, USA
| | - Sajad Hamal
- Division of Cardiology, Department of Internal Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, 1124 W Carson Street, Torrance, CA, 90502, USA
| | - Ferdinand Flores
- Division of Cardiology, Department of Internal Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, 1124 W Carson Street, Torrance, CA, 90502, USA
| | - Christopher Dailing
- Division of Cardiology, Department of Internal Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, 1124 W Carson Street, Torrance, CA, 90502, USA
| | - Sion K Roy
- Division of Cardiology, Department of Internal Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, 1124 W Carson Street, Torrance, CA, 90502, USA
| | - Matthew J Budoff
- Division of Cardiology, Department of Internal Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, 1124 W Carson Street, Torrance, CA, 90502, USA.
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Cherukuri L, Birudaraju D, Kinninger A, Chaganti BT, Shekar C, Hamal S, Shaikh K, Flores F, Roy SK, Sotka W, Green SJ, Budoff MJ. Effect of a plant-based bioequivalent inorganic nitrate (NO3−) complex with vitamins, antioxidants and phytophenol rich food extracts in hypertensive individuals - A randomized, double-blind, placebo-controlled study. Clin Nutr ESPEN 2020; 40:327-335. [DOI: 10.1016/j.clnesp.2020.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 07/28/2020] [Accepted: 08/14/2020] [Indexed: 02/08/2023]
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Cherukuri L, Birudaraju D, Kinninger A, Chaganti BT, Pidikiti S, Pozon RG, Pozon ACG, Lakshmanan S, Dahal S, Hamal S, Flores F, Christopher D, Andreini D, Pontone G, Conte E, Nakanishi R, O’Rourke R, Hamilton-Craig C, Nasir K, Roy SK, Mao SS, Budoff MJ. Use of Advanced CT Technology to Evaluate Left Atrial Indices in Patients with a High Heart Rate or with Heart Rate Variability: The Converge Registry. J Nucl Med Technol 2020; 49:65-69. [DOI: 10.2967/jnmt.120.253781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 09/09/2020] [Indexed: 11/16/2022] Open
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Lakshmanan S, Shekar C, Kinninger A, Dahal S, Onuegbu A, Cai AN, Hamal S, Birudaraju D, Roy SK, Nelson JR, Budoff MJ, Bhatt DL. Comparison of mineral oil and non-mineral oil placebo on coronary plaque progression by coronary computed tomography angiography. Cardiovasc Res 2020; 116:479-482. [PMID: 31825484 PMCID: PMC7031703 DOI: 10.1093/cvr/cvz329] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 12/09/2019] [Indexed: 02/07/2023] Open
Affiliation(s)
- Suvasini Lakshmanan
- Department of Cardiology, Lundquist Institute for Biomedical Innovation and Research at Harbor UCLA Medical Center, 1124 West Carson Street Torrance, CA 90502, USA
| | - Chandana Shekar
- Department of Cardiology, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - April Kinninger
- Department of Cardiology, Lundquist Institute for Biomedical Innovation and Research at Harbor UCLA Medical Center, 1124 West Carson Street Torrance, CA 90502, USA
| | - Suraj Dahal
- Department of Cardiology, Lundquist Institute for Biomedical Innovation and Research at Harbor UCLA Medical Center, 1124 West Carson Street Torrance, CA 90502, USA
| | - Afiachukwu Onuegbu
- Department of Cardiology, Lundquist Institute for Biomedical Innovation and Research at Harbor UCLA Medical Center, 1124 West Carson Street Torrance, CA 90502, USA
| | - Andrew N Cai
- Department of Cardiology, Lundquist Institute for Biomedical Innovation and Research at Harbor UCLA Medical Center, 1124 West Carson Street Torrance, CA 90502, USA
| | - Sajad Hamal
- Department of Cardiology, Lundquist Institute for Biomedical Innovation and Research at Harbor UCLA Medical Center, 1124 West Carson Street Torrance, CA 90502, USA
| | - Divya Birudaraju
- Department of Cardiology, Lundquist Institute for Biomedical Innovation and Research at Harbor UCLA Medical Center, 1124 West Carson Street Torrance, CA 90502, USA
| | - Sion K Roy
- Department of Cardiology, Lundquist Institute for Biomedical Innovation and Research at Harbor UCLA Medical Center, 1124 West Carson Street Torrance, CA 90502, USA
| | - John R Nelson
- Department of Cardiology, California Cardiovascular Institute, Fresno, CA, USA
| | - Matthew J Budoff
- Department of Cardiology, Lundquist Institute for Biomedical Innovation and Research at Harbor UCLA Medical Center, 1124 West Carson Street Torrance, CA 90502, USA
| | - Deepak L Bhatt
- Department of Medicine, Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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Lakshmanan S, Onuegbu A, Dahal S, Cai A, Birudaraju D, Hamal S, Kinninger A, Roy S, Budoff M, Merz N, Handberg E, Pepine C. Differences In Burden Of Coronary Atherosclerosis By Coronary Cta In Symptomatic Women With Angina And No Obstructive Disease (inoca) Compared To Asymptomatic Women. J Cardiovasc Comput Tomogr 2020. [DOI: 10.1016/j.jcct.2020.06.078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lakshmanan S, Holda M, Shekar C, Dahal S, Onuegbu A, Kinninger A, Cai A, Golub I, Cherukuri L, Birudaraju D, Hamal S, Hadeed S, Roy S, Nelson J, Bhatt D, Budoff M. Association Of Thoracic And Pericardial Fat Volumes With Burden Of Baseline Coronary Plaque Components: Evaporate Trial. J Cardiovasc Comput Tomogr 2020. [DOI: 10.1016/j.jcct.2020.06.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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18
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Mao S, Li D, Gao Y, Flores F, Bever T, Yoon A, Hosseini H, Yang R, Vargas S, Kaur Y, Hamal S, Budoff M. Screening Patients At Risk Of Age-related Fragility Vertebral Fracture In The General Population Using Multiple-row Detector Quantitative Computed Tomography With Chest Or Heart Scan. J Cardiovasc Comput Tomogr 2020. [DOI: 10.1016/j.jcct.2020.06.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Shaikh K, Ellenberg SS, Nakanishi R, Snyder PJ, Lee J, Wenger NK, Lewis CE, Swerdloff RS, Preston P, Hamal S, Stephens-Sheilds A, Bhasin S, Cherukuri L, Cauley JA, Crandall JP, Cunningham GR, Ensrud KE, Matsumoto AM, Molich ME, Alla VM, Birudaraju D, Nezarat N, Rai K, Almeida S, Roy SK, Sheikh M, Trad G, Budoff MJ. Biomarkers and Noncalcified Coronary Artery Plaque Progression in Older Men Treated With Testosterone. J Clin Endocrinol Metab 2020; 105:5648063. [PMID: 31784747 PMCID: PMC7209773 DOI: 10.1210/clinem/dgz242] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 11/29/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Recent results from the Cardiovascular Trial of the Testosterone Trials showed that testosterone treatment of older men with low testosterone was associated with greater progression of noncalcified plaque (NCP). We evaluated the effect of anthropometric measures and cardiovascular biomarkers on plaque progression in individuals in the Testosterone Trial. METHODS The Cardiovascular part of the trial included 170 men aged 65 years or older with low testosterone. Participants received testosterone gel or placebo gel for 12 months. The primary outcome was change in NCP volume from baseline to 12 months, as determined by coronary computed tomography angiography (CCTA). We assayed several markers of cardiovascular risk and analyzed each marker individually in a model as predictive variables and change in NCP as the dependent variable. RESULTS Of 170 enrollees, 138 (73 testosterone, 65 placebo) completed the study and were available for the primary analysis. Of 10 markers evaluated, none showed a significant association with the change in NCP volume, but a significant interaction between treatment assignment and waist-hip ratio (WHR) (P = 0.0014) indicated that this variable impacted the testosterone effect on NCP volume. The statistical model indicated that for every 0.1 change in the WHR, the testosterone-induced 12-month change in NCP volume increased by 26.96 mm3 (95% confidence interval, 7.72-46.20). CONCLUSION Among older men with low testosterone treated for 1 year, greater WHR was associated with greater NCP progression, as measured by CCTA. Other biomarkers and anthropometric measures did not show statistically significant association with plaque progression.
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Affiliation(s)
- Kashif Shaikh
- Division of Cardiology, Lundquist Institute of Biomedical Innovation, Harbor-University of California at Los Angeles Medical Center, Torrance, California
- Division of Cardiovascular Diseases, Creighton University School of Medicine, Omaha, Nebraska
- Correspondence: Kashif Shaikh, MD, Advanced Cardiac Imaging Fellow, Division of Cardiology, Harbor UCLA, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, California. E-mail:
| | - Susan S Ellenberg
- Department of Biostatistics and Epidemiology, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rine Nakanishi
- Division of Cardiology, Lundquist Institute of Biomedical Innovation, Harbor-University of California at Los Angeles Medical Center, Torrance, California
| | - Peter J Snyder
- Division of Endocrinology, Diabetes, and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Juhwan Lee
- Division of Cardiology, Lundquist Institute of Biomedical Innovation, Harbor-University of California at Los Angeles Medical Center, Torrance, California
| | - Nanette K Wenger
- Department of Medicine, Division of Cardiology, Emory Heart and Vascular Center Emory University School of Medicine, Atlanta, Georgia
| | - Cora E Lewis
- Division of Preventive Medicine, University of Alabama at Birmingham, Alabama
| | - Ronald S Swerdloff
- Division of Endocrinology, Lundquist Institute of Biomedical Innovation, Harbor-University of California at Los Angeles Medical Center, Torrance, California
| | - Peter Preston
- Department of Biostatistics and Epidemiology, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sajad Hamal
- Division of Cardiology, Lundquist Institute of Biomedical Innovation, Harbor-University of California at Los Angeles Medical Center, Torrance, California
| | - Alisa Stephens-Sheilds
- Department of Biostatistics and Epidemiology, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Shalender Bhasin
- Department of Family and Preventive Medicine, Division of Epidemiology, University of California, San Diego School of Medicine, La Jolla, California
| | - Lavanya Cherukuri
- Division of Cardiology, Lundquist Institute of Biomedical Innovation, Harbor-University of California at Los Angeles Medical Center, Torrance, California
| | - Jane A Cauley
- Department of Epidemiology, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Jill P Crandall
- Divisions of Endocrinology and Geriatrics, Albert Einstein College of Medicine, Bronx, New York
| | - Glenn R Cunningham
- Departments of Medicine and Molecular & Cellular Biology, Division of Diabetes, Endocrinology and Metabolism, Baylor College of Medicine and Baylor St. Luke’s Medical Center, Houston, Texas
| | - Kristine E Ensrud
- Department of Medicine, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, Minnesota
- Minneapolis VA Health Care System, Minneapolis, Minnesota
| | - Alvin M Matsumoto
- Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs, Puget Sound Health System, and Division of Gerontology and Geriatric Medicine, Department of Internal Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Mark E Molich
- Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Venkata M Alla
- Division of Cardiovascular Diseases, Creighton University School of Medicine, Omaha, Nebraska
| | - Divya Birudaraju
- Division of Cardiology, Lundquist Institute of Biomedical Innovation, Harbor-University of California at Los Angeles Medical Center, Torrance, California
| | - Negin Nezarat
- Division of Cardiology, Lundquist Institute of Biomedical Innovation, Harbor-University of California at Los Angeles Medical Center, Torrance, California
| | - Kelash Rai
- Division of Cardiology, Lundquist Institute of Biomedical Innovation, Harbor-University of California at Los Angeles Medical Center, Torrance, California
| | - Shone Almeida
- Division of Cardiology, Lundquist Institute of Biomedical Innovation, Harbor-University of California at Los Angeles Medical Center, Torrance, California
| | - Sion K Roy
- Division of Cardiology, Lundquist Institute of Biomedical Innovation, Harbor-University of California at Los Angeles Medical Center, Torrance, California
| | - Mohammad Sheikh
- Division of Cardiology, Lundquist Institute of Biomedical Innovation, Harbor-University of California at Los Angeles Medical Center, Torrance, California
| | - George Trad
- Division of Cardiology, Lundquist Institute of Biomedical Innovation, Harbor-University of California at Los Angeles Medical Center, Torrance, California
| | - Mathew J Budoff
- Division of Cardiology, Lundquist Institute of Biomedical Innovation, Harbor-University of California at Los Angeles Medical Center, Torrance, California
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Birudaraju D, Lakhshmanan S, Mateusz H, Kinninger A, Cherukuri L, Shekar C, Ghanem A, Golub I, Rezvanizadeh V, Dahal S, Onuegbu A, Cai A, Flores F, Hamal S, Roy S, Nelson J, Budoff M. Association Of Serum Fibrinogen Levels With Thoracic Fat Volumes By Cardiac CT: EVAPORATE (Effect Of Vascepa On Improving Coronary Atherosclerosis In People With High Triglycerides (TGL) Taking Statin Therapy) Trial. J Cardiovasc Comput Tomogr 2020. [DOI: 10.1016/j.jcct.2020.06.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lakshmanan S, Holda M, Shekar C, Dahal S, Kinninger A, Golub I, Onuegbu A, Cai A, Birudaraju D, Cherukuri L, Hamal S, Roy S, Nelson J, Budoff M. Association Of Inflammatory Markers With Fatty Liver By Non Contrast Cardiac Ct:Evaporate Trial. J Cardiovasc Comput Tomogr 2020. [DOI: 10.1016/j.jcct.2020.06.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Lakshmanan S, Shekar C, Kinninger A, Dahal S, Onuegbu A, Cai AN, Hamal S, Birudaraju D, Cherukuri L, Flores F, Dailing C, Roy SK, Bhatt DL, Nelson JR, Budoff MJ. Association of high-density lipoprotein levels with baseline coronary plaque volumes by coronary CTA in the EVAPORATE trial. Atherosclerosis 2020; 305:34-41. [PMID: 32615321 DOI: 10.1016/j.atherosclerosis.2020.05.014] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/24/2020] [Accepted: 05/20/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND AIMS Dyslipidemia with elevated triglycerides (TGL) and low high-density lipoprotein cholesterol (HDL-C) predicts residual cardiovascular risk, despite goal LDL-C levels and optimal statin therapy. Coronary plaque characterization by CCTA can provide mechanistic understanding of coronary artery disease and associated prognosis. The role of HDL-C in the pathogenesis of atherosclerosis is not well understood in statin-treated patients with elevated TGL. We sought to examine the association of HDL-C levels with baseline coronary plaque volumes, namely total plaque (TP) and total non-calcified plaque (TNCP) volumes by CCTA in participants enrolled in the EVAPORATE trial. METHODS We analyzed 80 participants who were enrolled in the trial. Linear regression analysis as a univariate and multivariate model adjusted for significant cardiovascular risk factors was performed to evaluate independent association of HDL-C and baseline coronary plaque volumes. In an exploratory analysis, stratified by sex, we compared the association of serum HDL-C levels with baseline coronary plaque volumes in males and females. RESULTS Mean (SD) age of participants (n = 80) was 57.1 (8.6) years and 43% were male. Median (Inter Quartile Range/IQR) log-TNCP volume was 83.0 (0.1-7.3) mm3 and median (IQR) log-TP volume was 144.8 (0.1-7.1) mm3. After adjustment for relevant clinical covariates including age, gender, BMI, hypertension, diabetes, past smoking and baseline TGL levels, increasing levels of HDL-C remain independently associated with lower baseline log-TNCP volumes (β: 0.043 ± 0.021, p = 0.042) and baseline log-TP volumes (β: 0.046 ± 0.022, p = 0.035) on CCTA. On stratifying by sex in a multivariable regression analysis, HDL-C levels were inversely associated with baseline log-TNCP volumes (β: 0.066 ± 0.026, p = 0.018) and log-TP volumes (β: 0.077 ± 0.025, p = 0.004) in females, but not in males (log-TNCP volumes β: 0.038 ± 0.034, p = 0.282) and log-TP volumes (β: -0.033 ± 0.036, p = 0.364). CONCLUSIONS In a cohort of statin treated patients with known atherosclerosis and residually elevated TGL, there was a significant inverse relationship between HDL-C levels and baseline coronary plaque, TP and TNCP volumes on CCTA. Our findings provide more detailed mechanistic evidence regarding the protective role of HDL-C in coronary atherosclerosis in a high-risk cohort. Further investigation to evaluate the interaction of HDL-C levels and coronary plaque volumes on differential CVD risk in statin-treated patients with elevated TGL levels is warranted.
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Affiliation(s)
- Suvasini Lakshmanan
- Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, Torrance, CA, USA
| | | | - April Kinninger
- Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Suraj Dahal
- Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Afiachukwu Onuegbu
- Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Andrew N Cai
- Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Sajad Hamal
- Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Divya Birudaraju
- Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Lavanya Cherukuri
- Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Ferdinand Flores
- Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Christopher Dailing
- Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Sion K Roy
- Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Deepak L Bhatt
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - John R Nelson
- Department of Cardiology, California Cardiovascular Institute, Fresno, CA, USA
| | - Matthew J Budoff
- Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, Torrance, CA, USA.
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Lakshmanan S, Shekar C, Kinninger A, Birudaraju D, Dahal S, Onuegbu A, Cherukuri L, Hamal S, Flores F, Dailing C, Roy SK, Budoff M. Association of flow mediated vasodilation and burden of subclinical atherosclerosis by coronary CTA. Atherosclerosis 2020; 302:15-19. [DOI: 10.1016/j.atherosclerosis.2020.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 04/06/2020] [Accepted: 04/17/2020] [Indexed: 11/28/2022]
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Hamal S, Cherukuri L, Shaikh K, Kinninger A, Doshi J, Birudaraju D, Budoff MJ. Effect of semaglutide on coronary atherosclerosis progression in patients with type II diabetes: rationale and design of the semaglutide treatment on coronary progression trial. Coron Artery Dis 2020; 31:306-314. [PMID: 32271261 DOI: 10.1097/mca.0000000000000830] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Cardiovascular morbidity and mortality are a major burden in patients with type 2 diabetic mellitus. In a landmark study, semaglutide (an injectable glucagon like peptide-1 receptor agonist) has been shown to significantly reduce cardiovascular events, however, the mechanism of benefit is still unknown. The primary hypothesis of our current study is to assess the effect of semaglutide to reduce progression of noncalcified coronary atherosclerotic plaque volume as measured by serial coronary CTA as compared to placebo in persons with diabetes over 1 year. METHODS One hundred forty patients will be enrolled after signing informed consent and followed up for 12 months and with a phone call 30 days after medical discontinuation. All the participants will undergo coronary artery calcium scoring and coronary computed tomography angiography at our center at baseline and 12 months. Eligible participants will be randomly assigned to semaglutide 2 mg/1.5 ml (1.34 mg/ml) prefilled pen for subcutaneous (SC) injection or placebo 1.5 ml, pen-injector for SC injection in a 1:1 fashion as add-on to their standard of care. RESULTS As of July 2019, the study was approximately 30% enrolled with an estimated enrollment completion by first quarter of 2020 and end of study by first quarter 2021. Thirty patients were enrolled as of 23 July 2019. Preliminary data of demographics and clinical characteristics were summarized. CONCLUSION Our current study will provide important imaging-derived data that may add relevance to the clinically derived outcomes from liraglutide effect and action in diabetes: evaluation of cardiovascular outcome results and semaglutide and cardiovascular outcomes in patients with type 2 diabetic mellitus 6 trials.
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Affiliation(s)
- Sajad Hamal
- Department of Cardiology, Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, California, USA
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Lakshmanan S, Shekar C, Dahal S, Onuegbu A, Kinninger A, Cai A, Rezvanizadeh V, Golub I, Birudaraju D, Cherukuri L, Hamal S, Dailing C, Flores F, Roy SK, Nelson J, Budoff MJ. ASSOCIATION OF INFLAMMATORY MARKERS WITH BASELINE CORONARY PLAQUE VOLUMES BY CORONARY COMPUTED TOMOGRAPHY ANGIOGRAPHY (CCTA) FROM EVAPORATE (EFFECT OF VASCEPA ON IMPROVING CORONARY ATHEROSCLEROSIS IN PEOPLE WITH HIGH TRIGLYCERIDES TAKING STATIN THERAPY) TRIAL. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32347-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lakshmanan S, Kinninger A, Dahal S, Onuegbu A, Cai A, Birudaraju D, Hamal S, Roy SK, Budoff MJ. DISTRIBUTION OF CORONARY ARTERY CALCIUM (CAC) SCORES IN CERTIFIED BLUE ZONES OF CALIFORNIA. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32250-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Chaganti B, Kinninger A, Cherukuri L, Birudaraju D, Hamal S, Flores F, Dailing C, Krishnamoorthy S, Trine R, Gibson G, Budoff MJ. CORONARY ARTERY CALCIUM (CAC) AND GENOMIC RISK SCORES (GRS): ANALYTICAL APPROACH OF PILOT STUDY BASED CARDIOVASCULAR RISK. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32567-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Shaikh K, McClelland R, Alla VM, Almeida S, Siddiqui F, Nasir K, Nakanishi R, Szklo M, Wong ND, Kronmal R, Abidov A, Urja P, Anugula D, Hamal S, Budoff MJ. CORONARY ARTERY CALCIUM PROGRESSION AND CVD RISK AMONG THOSE ON STATIN THERAPY. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32599-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hamal S, Cherukuri L, Birudaraju D, Matsumoto S, Kinninger A, Chaganti BT, Flores F, Shaikh K, Roy SK, Budoff MJ. Short-term impact of aged garlic extract on endothelial function in diabetes: A randomized, double-blind, placebo-controlled trial. Exp Ther Med 2020; 19:1485-1489. [PMID: 32010327 PMCID: PMC6966134 DOI: 10.3892/etm.2019.8377] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 09/18/2019] [Accepted: 11/21/2019] [Indexed: 01/12/2023] Open
Abstract
Impaired endothelial function portends an increased risk of cardiovascular disease. Vascular oxidative stress and systemic inflammation play a critical role in the pathogenesis and progression of vascular disease. Aged garlic extract (AGE) may improve impaired vascular endothelial function, while decreasing the progression of atherosclerotic plaque. We hypothesized that AGE may improve endothelial function, and in this study, we examined this hypothesis to determine whether this can be achieved over a period of 3 months, measured by the cardio-ankle vascular index (CAVI), by reducing intracellular oxidant stress and stimulating nitric oxide generation in endothelial cells. We conducted a double-blinded placebo controlled, randomized clinical trial to investigate the effects of AGE on CAVI in subjects with type 2 diabetes mellitus. A total of 65 individuals (38 men and 27 women) with a mean age of 58.8±11.1 years were enrolled and randomized to the AGE or placebo group in a double-blind placebo controlled trial. An ANOVA model with treatment as the main effect was used to compare changes in CAVI from baseline to follow-up between groups. The primary objective of this study was reduction in CAVI over a 3-month period. In the AGE group, CAVI was reduced on average by 0.71±1.27 vs. a mean reduction of 0.13±0.94 in the placebo group (P=0.04). On the whole, this study demonstrates that AGE has a positive impact on endothelial function in patients with T2DM and may play a role in the primary prevention of cardiovascular disease.
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Affiliation(s)
- Sajad Hamal
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA 90502, USA
| | - Lavanya Cherukuri
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA 90502, USA
| | - Divya Birudaraju
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA 90502, USA
| | - Suguru Matsumoto
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA 90502, USA
| | - April Kinninger
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA 90502, USA
| | - Bhanu T. Chaganti
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA 90502, USA
| | - Ferdinand Flores
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA 90502, USA
| | - Kashif Shaikh
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA 90502, USA
| | - Sion K. Roy
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA 90502, USA
| | - Matthew J. Budoff
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA 90502, USA
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Shaikh K, Kinninger A, Cherukuri L, Birudaraju D, Nakanishi R, Almeida S, Jayawardena E, Shekar C, Flores F, Hamal S, Sheikh MS, Johanis A, Cu B, Budoff MJ. Aged garlic extract reduces low attenuation plaque in coronary arteries of patients with diabetes: A randomized, double-blind, placebo-controlled study. Exp Ther Med 2020; 19:1457-1461. [PMID: 32010322 PMCID: PMC6966158 DOI: 10.3892/etm.2019.8371] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 09/24/2019] [Accepted: 11/21/2019] [Indexed: 01/28/2023] Open
Abstract
Several previous studies have demonstrated that aged garlic extract (AGE) inhibits the progression of coronary artery calcification and non-calcified plaque (NCP) in the general population. However, its effects on plaque progression in patients with diabetes have not yet been investigated, at least to the best of our knowledge. This study investigated whether AGE reduces the coronary plaque volume measured by cardiac computed tomography angiography (CCTA) in patients with diabetes mellitus (DM). A total of 80 participants with DM with a median age of 57 years were prospectively assigned to consume 2,400 mg AGE/day (after completion, 37 participants) or placebo (after completion, 29 participants) orally. Both groups underwent CCTA at baseline and follow-up 365 days apart. In total, 66 participants completed the study. Coronary plaque volume, including total plaque (TP), dense calcium (DC), fibrous, fibro-fatty and low-attenuation plaque (LAP) volumes were measured based upon pre-defined intensity cut-off values using semi-automated software (QAngio CT). Changes in various plaque types were normalized to the total coronary artery length. The non-parametric Wilcoxon rank-sum test was performed to examine the differences in plaque formation between the 2 groups. No significant differences were found in the baseline characteristics between the AGE and placebo groups. Compared with the placebo group, the AGE group exhibited a statistically significant regression in normalized LAP [median and standard deviation (SD) -0.2 (18.8) vs. 2.5 (69.3), P=0.0415]. No differences were observed in TP, fibrous, or fibrofatty plaque volumes between the AGE and placebo group. On the whole, this study indicated that the %LAP change in the AGE group was significantly greater than that in the placebo group in patients with diabetes. However, further studies are warranted to evaluate whether AGE has the ability to stabilize vulnerable plaque and decrease adverse cardiovascular events.
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Affiliation(s)
- Kashif Shaikh
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA 90502, USA
| | - April Kinninger
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA 90502, USA
| | - Lavanya Cherukuri
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA 90502, USA
| | - Divya Birudaraju
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA 90502, USA
| | - Rine Nakanishi
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA 90502, USA
| | - Shone Almeida
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA 90502, USA
| | - Eranthi Jayawardena
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA 90502, USA
| | - Chandana Shekar
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA 90502, USA
| | - Ferdinand Flores
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA 90502, USA
| | - Sajad Hamal
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA 90502, USA
| | - Mohammed Salman Sheikh
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA 90502, USA
| | - Amit Johanis
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA 90502, USA
| | - Benedict Cu
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA 90502, USA
| | - Matthew J. Budoff
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA 90502, USA
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Hutchins E, Shaikh K, Kinninger A, Cherukuri L, Birudaraju D, Mao SS, Nakanishi R, Almeida S, Jayawardena E, Shekar C, Flores F, Hamal S, Sheikh S, Johanis A, Cu B, Trad G, Budoff MJ. Aged garlic extract reduces left ventricular myocardial mass in patients with diabetes: A prospective randomized controlled double-blind study. Exp Ther Med 2019; 19:1468-1471. [PMID: 32010324 PMCID: PMC6966199 DOI: 10.3892/etm.2019.8373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 11/08/2019] [Indexed: 01/19/2023] Open
Abstract
Increased left ventricular myocardial mass (LVM) is a well known prognostic marker of poor cardiac outcomes. Decreases in LVM have been shown to decrease the cardiovascular risk. Aged garlic extract (AGE) has been shown to have an overall favorable effect on cardiac health; however, to the best of our knowledge, no study to date has specifically examined its effects on left ventricular mass. This study investigated whether AGE can affect LVM measured by cardiac computed tomography angiography (CCTA) in patients with diabetes mellitus (DM). This is a double-blind, placebo controlled randomized trial. In total, 65 participants with DM with a mean age of 58 years were prospectively assigned to consume 2,400 mg AGE/day or the placebo orally. Both groups underwent CCTA at baseline and follow-up at 1 year apart. LVM was measured using automated software. The baseline characteristics did not differ between the AGE and placebo groups. There was a trend towards a significant reduction in LVM at follow-up as compared to baseline in the AGE group (119.30±34.77 vs. 121.0±34.70, P=0.059). No change was observed in LVM in the placebo group at 1-year follow-up as compared to baseline (124.6±37.33 vs. 124.6±35.13, P=0.9). On the whole, this study indicated that AGE may decrease or stabilize LVM. Further studies however, with a larger sample size and longer follow-up times are required to evaluate the effects of AGE on hypertension and LVM.
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Affiliation(s)
- Elizabeth Hutchins
- Los Angeles Biomedical Institute at Harbor-UCLA Medical Institute, Torrance, CA 90502, USA
| | - Kashif Shaikh
- Los Angeles Biomedical Institute at Harbor-UCLA Medical Institute, Torrance, CA 90502, USA
| | - April Kinninger
- Los Angeles Biomedical Institute at Harbor-UCLA Medical Institute, Torrance, CA 90502, USA
| | - Lavanya Cherukuri
- Los Angeles Biomedical Institute at Harbor-UCLA Medical Institute, Torrance, CA 90502, USA
| | - Divya Birudaraju
- Los Angeles Biomedical Institute at Harbor-UCLA Medical Institute, Torrance, CA 90502, USA
| | - Song Shou Mao
- Los Angeles Biomedical Institute at Harbor-UCLA Medical Institute, Torrance, CA 90502, USA
| | - Rine Nakanishi
- Los Angeles Biomedical Institute at Harbor-UCLA Medical Institute, Torrance, CA 90502, USA
| | - Shone Almeida
- Los Angeles Biomedical Institute at Harbor-UCLA Medical Institute, Torrance, CA 90502, USA
| | - Eranthi Jayawardena
- Los Angeles Biomedical Institute at Harbor-UCLA Medical Institute, Torrance, CA 90502, USA
| | - Chandana Shekar
- Los Angeles Biomedical Institute at Harbor-UCLA Medical Institute, Torrance, CA 90502, USA
| | - Fredinand Flores
- Los Angeles Biomedical Institute at Harbor-UCLA Medical Institute, Torrance, CA 90502, USA
| | - Sajad Hamal
- Los Angeles Biomedical Institute at Harbor-UCLA Medical Institute, Torrance, CA 90502, USA
| | - Salman Sheikh
- Los Angeles Biomedical Institute at Harbor-UCLA Medical Institute, Torrance, CA 90502, USA
| | - Amit Johanis
- Los Angeles Biomedical Institute at Harbor-UCLA Medical Institute, Torrance, CA 90502, USA
| | - Benedict Cu
- Los Angeles Biomedical Institute at Harbor-UCLA Medical Institute, Torrance, CA 90502, USA
| | - George Trad
- Los Angeles Biomedical Institute at Harbor-UCLA Medical Institute, Torrance, CA 90502, USA
| | - Matthew J Budoff
- Los Angeles Biomedical Institute at Harbor-UCLA Medical Institute, Torrance, CA 90502, USA
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Birudaraju D, Cherukuri L, Kinninger A, Chaganti BT, Shaikh K, Hamal S, Flores F, Roy SK, Budoff MJ. A combined effect of Cavacurcumin, Eicosapentaenoic acid (Omega-3s), Astaxanthin and Gamma -linoleic acid (Omega-6) (CEAG) in healthy volunteers- a randomized, double-blind, placebo-controlled study. Clin Nutr ESPEN 2019; 35:174-179. [PMID: 31987113 DOI: 10.1016/j.clnesp.2019.09.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 06/27/2019] [Revised: 08/19/2019] [Accepted: 09/25/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Inflammation plays a key role and is one of the early steps in the pathogenesis of endothelial function, thereby increasing the risk of hypertension (HTN), coronary artery disease (CAD), stroke and several other risk factors of cardiovascular disease (CVD). We assessed the efficacy for improving cardiovascular health (blood pressure, inflammation and endothelial reactivity) over a 4-week intervention period in healthy individuals. METHODS We performed a randomized, double-blinded, placebo-controlled, randomized clinical trial to investigate Curcumin, Eicosapentaenoic acid (EPA), Astaxanthin and Gamma -linoleic acid (GLA) (CEAG) supplements with 80 individuals (30 men and 50 women). The mean age of participants was 48.8 ± 16.0 years. Participants were enrolled and randomized to active or placebo and followed for 4 weeks. Paired and Independent T-tests were used to analyze the mean differences between and within groups. RESULTS The primary endpoints of the study were the effect on inflammatory markers (IL-6, CRP), endothelial function and blood pressure at 4 weeks. There was a significant reduction in mean SBP at 4 weeks in the CEAG group compared to placebo [mean ± SD 4.7 ± 6.8 (p = 0.002)]. Relative to placebo, active group showed a significant decrease in High sensitivity C Reactive Protein (hsCRP) (-0.49 ± 1.9 vs + 0.51 ± 2.5, p = 0.059) and blunted increase in IL-6 (+0.2 vs + 0.4 in placebo, p = 0.60). CONCLUSION Inflammatory markers were reduced or blunted by CEAG, with a robust increase in both EPA levels and the fatty acid index. Furthermore, systolic BP was reduced over 4 weeks with concurrent improvement in endothelial function. CLINICALTRIALS. GOV ID NCT03906825.
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Affiliation(s)
- Divya Birudaraju
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Department of Cardiology, Torrance, CA, USA
| | - Lavanya Cherukuri
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Department of Cardiology, Torrance, CA, USA
| | - April Kinninger
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Department of Cardiology, Torrance, CA, USA
| | - Bhanu T Chaganti
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Department of Cardiology, Torrance, CA, USA
| | - Kashif Shaikh
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Department of Cardiology, Torrance, CA, USA
| | - Sajad Hamal
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Department of Cardiology, Torrance, CA, USA
| | - Ferdinand Flores
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Department of Cardiology, Torrance, CA, USA
| | - Sion K Roy
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Department of Cardiology, Torrance, CA, USA
| | - Matthew J Budoff
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Department of Cardiology, Torrance, CA, USA.
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Shaikh K, Li D, Nakanishi R, Kinninger A, Almeida S, Cherukuri L, Shekar C, Roy SK, Birudaraju D, Rai K, Ahmad K, Shafter A, Kumar A, Hamal S, Alla VM, Budoff MJ. Low short-term and long-term cardiovascular and all-cause mortality in absence of coronary artery calcium: A 22-year follow-up observational study from large cohort. J Diabetes Complications 2019; 33:616-622. [PMID: 31278061 DOI: 10.1016/j.jdiacomp.2019.05.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 05/18/2019] [Accepted: 05/20/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES We sought to evaluate the gender-specific predictive value of coronary artery calcium (CAC) score on all-cause mortality and cardiovascular disease (CVD) mortality in individuals with and without diabetes mellitus (DM). BACKGROUND CAC score is a robust predictor of CVD and all-cause mortality during long-term follow-up in large cohorts in adults with DM. However, less is known about its sex-specific impact on all-cause mortality in DM. METHODS We evaluated 25,563 asymptomatic participants with no known history of coronary artery disease (CAD) who underwent clinically indicated CAC. 1999 (7.8%) individuals had diabetes. CAC was characterized as an Agatston score of 0, 1-99, 100-300, and ≫300. We evaluated the association between CAC and all-cause mortality and CVD mortality. RESULTS Overall, 1345 individuals died (5.3%) from all causes during a mean follow-up of 14.7 ± 3.8 years. CAC score was 0 in 57.5% females and 34.4% of males without DM, while 36.6% females and 20.3% males with DM had CAC-0. The frequency of CAC ≫ 300 was 18% and 36% in females and males with DM, respectively. CAC score of zero was associated with low all-cause mortality event rate in females and males with diabetes (1.7 and 2.5 events per 1000 person-years, respectively). Cardiovascular mortality per 1000 person years was ≪1 in females and males with CAC score of 0 irrespective of their diabetes. Adjusted multivariable analysis, compared to CAC-0, HR for all-cause mortality associated with CAC 1-99, 100-299 and ≫300 were 1.74(95% CI 0.65, 4.63, P-0.20), 5.54(95% CI 2.16, 14.22, P ≪ 0.001) and 5.75(95% CI 2.30, 14.37, P ≪ 0.001) in females with DM respectively; in males with DM HR associated with CAC 1-99, 100-299 and ≫300 were 1.87(95% CI 0.95, 3.66, P-0.06), 2.15(95% CI 1.05, 4.38, P-0.035) and 2.60(95% CI 1.34, 5.0, P-0.004), respectively. CONCLUSION Presence of subclinical atherosclerosis varies among individuals with DM. The absence of CAC was associated with very low cardiovascular as well as all-cause mortality events in all subgroups during long term follow-up.
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Affiliation(s)
- Kashif Shaikh
- Los Angeles Biomedical Institute, Harbor-UCLA Medical Center, USA
| | - Dong Li
- Los Angeles Biomedical Institute, Harbor-UCLA Medical Center, USA
| | - Rine Nakanishi
- Los Angeles Biomedical Institute, Harbor-UCLA Medical Center, USA
| | - April Kinninger
- Los Angeles Biomedical Institute, Harbor-UCLA Medical Center, USA
| | - Shone Almeida
- Los Angeles Biomedical Institute, Harbor-UCLA Medical Center, USA
| | | | - Chandana Shekar
- Los Angeles Biomedical Institute, Harbor-UCLA Medical Center, USA
| | - Sion K Roy
- Los Angeles Biomedical Institute, Harbor-UCLA Medical Center, USA
| | - Divya Birudaraju
- Los Angeles Biomedical Institute, Harbor-UCLA Medical Center, USA
| | - Kelash Rai
- Los Angeles Biomedical Institute, Harbor-UCLA Medical Center, USA
| | - Khadije Ahmad
- Los Angeles Biomedical Institute, Harbor-UCLA Medical Center, USA
| | - Ahmed Shafter
- Los Angeles Biomedical Institute, Harbor-UCLA Medical Center, USA
| | - Anoop Kumar
- Los Angeles Biomedical Institute, Harbor-UCLA Medical Center, USA
| | - Sajad Hamal
- Los Angeles Biomedical Institute, Harbor-UCLA Medical Center, USA
| | - Venkata M Alla
- Division of Cardiovascular Diseases, Creighton University School of Medicine, Omaha, NE, USA
| | - Mathew J Budoff
- Los Angeles Biomedical Institute, Harbor-UCLA Medical Center, USA.
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Win TT, Nakanishi R, Osawa K, Li D, Susaria SS, Jayawardena E, Hamal S, Kim M, Broersen A, Kitslaar PH, Dailing C, Budoff MJ. Apixaban versus warfarin in evaluation of progression of atherosclerotic and calcified plaques (prospective randomized trial). Am Heart J 2019; 212:129-133. [PMID: 31002997 DOI: 10.1016/j.ahj.2019.02.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 02/23/2019] [Indexed: 01/23/2023]
Abstract
Warfarin has been showed to increase vascular calcification. Apixaban, a direct factor Xa inhibitor, has no interaction with vitamin K and its effect on coronary plaques is unknown. We randomized and compared warfarin and apixaban on progression of coronary atherosclerotic plaques measured by coronary computed tomographic angiography in 66 subjects with non-valvular atrial fibrillation over the period of one-year follow up. There was significant higher total, calcified and low attenuation plaque volume in the group randomized to warfarin as compared to apixaban (all P < .05). Greater volume of total (β2 = 28.54; P = .03), low attenuation plaque (β2 = 3.58; P = .02) and calcified (β2 = 14.10; P = .005) plaque progression was observed in the VKA_group.
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Affiliation(s)
- Theingi Tiffany Win
- Division of Cardiology, Department of Medicine, University of New Mexico, Albuquerque, NM
| | - Rine Nakanishi
- Los Angeles Biomedical Research Center, Harbor-UCLA Medical Center, Torrance, CA
| | - Kazuhiro Osawa
- Los Angeles Biomedical Research Center, Harbor-UCLA Medical Center, Torrance, CA
| | - Dong Li
- Los Angeles Biomedical Research Center, Harbor-UCLA Medical Center, Torrance, CA
| | - Shriraj S Susaria
- Los Angeles Biomedical Research Center, Harbor-UCLA Medical Center, Torrance, CA
| | - Eranthi Jayawardena
- Los Angeles Biomedical Research Center, Harbor-UCLA Medical Center, Torrance, CA
| | - Sajad Hamal
- Los Angeles Biomedical Research Center, Harbor-UCLA Medical Center, Torrance, CA
| | - Michael Kim
- Los Angeles Biomedical Research Center, Harbor-UCLA Medical Center, Torrance, CA
| | - Alexander Broersen
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Pieter H Kitslaar
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands; Medis medical systems bv, Leiden, The Netherlands
| | - Christopher Dailing
- Los Angeles Biomedical Research Center, Harbor-UCLA Medical Center, Torrance, CA
| | - Matthew J Budoff
- Los Angeles Biomedical Research Center, Harbor-UCLA Medical Center, Torrance, CA.
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Birudaraju D, Cherukuri L, Kinninger A, Pozon R, Shekar C, Shaikh K, Hamal S, Flores F, Roy S, Budoff M. Acute Effects of Curcuminoids, EPA (Omega - 3), Astaxanthin and GLA On Cardiovascular Health. J Clin Lipidol 2019. [DOI: 10.1016/j.jacl.2019.04.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Cherukuri L, Shekar C, Kinninger A, Birudaraju D, Jayawardena E, Hamal S, Flores F, Tayek J, Roy S, Budoff M, Nelson J. Association between Lipids and Coronary Atherosclerotic Plaque Characteristics. J Clin Lipidol 2019. [DOI: 10.1016/j.jacl.2019.04.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Birudaraju D, Cherukuri L, Kinninger A, Shaikh K, Shekar C, Hamal S, Flores F, Roy S, Sotka W, Green S, Budoff M. Effects (Critical Role) of Nitrite and Nitrate determinants in Saliva and Plasma Correlating Cardio Metabolic factors. J Clin Lipidol 2019. [DOI: 10.1016/j.jacl.2019.04.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Shekar C, Li D, Cherukuri L, Birudaraju D, Shaikh K, Almeida S, Hamal S, Dailing C, Flores F, Roy S, Budoff M. CORONARY PLAQUE PROGRESSION WITH ADVANCING AGE. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)32159-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Cherukuri L, Shekar C, Li D, Birudaraju D, Hamal S, Flores F, Roy S, Sotka W, Green SJ, Budoff M. ACUTE AND SUSTAINED EFFECTS OF PLANT-BASED BIOEQUIVALENT INORGANIC NITRATE SUPPLEMENT TABLETS ON BLOOD PRESSURE REDUCTION IN PRE-HYPERTENSIVES MEN AND WOMEN. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)32335-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Lee J, Nakanishi R, Li D, Shaikh K, Shekar C, Osawa K, Nezarat N, Jayawardena E, Blanco M, Chen M, Sieckert M, Nelson E, Billingsley D, Hamal S, Budoff MJ. Randomized trial of rivaroxaban versus warfarin in the evaluation of progression of coronary atherosclerosis. Am Heart J 2018; 206:127-130. [PMID: 30227941 DOI: 10.1016/j.ahj.2018.08.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 08/14/2018] [Indexed: 12/12/2022]
Abstract
Warfarin, a vitamin K antagonist, is associated with systemic vascular calcification. We evaluated whether rivaroxaban (a direct oral factor Xa inhibitor with no interaction with vitamin K) will slow the progression in coronary plaque volumes compared with warfarin in patients with nonvalvular atrial fibrillation using coronary computed tomography angiography.
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Tayek CJ, Cherukuri L, Hamal S, Tayek JA. Importance of fasting blood glucose goals in the management of type 2 diabetes mellitus: a review of the literature and a critical appraisal. ACTA ACUST UNITED AC 2018; 5:113-117. [PMID: 31404422 PMCID: PMC6688759 DOI: 10.15406/jdmdc.2018.05.00148] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Prandial insulin has been essential for the improved management of the type 1 diabetic patient. Interestingly, many studies
have evaluated the addition of prandial insulin to the type 2 diabetic patients with improved control. The greatest drop in A1c
with the use of various type of prandial insulins have resulted in the decrease of 1.3% in the A1c measurement. Interestingly,
none of the published trials with goal of fasting blood glucose (FBG) have ever obtained the goal A1c. Since a drop in FBG of
28.7mg/dl is equal to a 1% drop in A1c, a simple approach to obtain a target A1c would be to focus on the FBG (per ADA: Average
Blood Glucose = A1c (%) x 28.7 - 46.7mg/d). However, average blood glucose requires multiple measurements and may be less accurate
then using just a FBG. Since prandial insulin clinical trials have only demonstrated a drop in A1c by 0.3-1.3% the use of only a
FBG to help patients get to goal may be easier to teach and to obtain. It might save time and money. Our hypothesis is that if
patient obtain a FBG <100 mg/dl for 2-3 months then 70% will be at an A1c goal <7.0%. After a few months of good
fasting glucose control the provider can use this equation (FBG+80)/30 to estimate A1c. For example, a FBG of 130mg/dl would be
(130 + 80)/30 = 7.0%; or a FBG of 190 would be (190+80)/30 =eA1c 9% (estimate of A1c). While type 1 diabetes has a very complex
daily glucose pattern, the approach to type 2 diabetics on insulin could become simplified.
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Affiliation(s)
- Chandler J Tayek
- Department of Internal Medicine, Los Angeles Bio-Medical Research Institute, USA
| | - Lavanya Cherukuri
- Department of Internal Medicine, Los Angeles Bio-Medical Research Institute, USA
| | - Sajad Hamal
- Department of Internal Medicine, Los Angeles Bio-Medical Research Institute, USA
| | - John A Tayek
- Department of Internal Medicine, Los Angeles Bio-Medical Research Institute, USA
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Matsumoto S, Nakanishi R, Li D, Alani A, Rezaeian P, Prabhu S, Abraham J, Fahmy MA, Dailing C, Flores F, Hamal S, Broersen A, Kitslaar PH, Budoff MJ. Aged Garlic Extract Reduces Low Attenuation Plaque in Coronary Arteries of Patients with Metabolic Syndrome in a Prospective Randomized Double-Blind Study. J Nutr 2016; 146:427S-432S. [PMID: 26764322 DOI: 10.3945/jn.114.202424] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [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: 08/22/2014] [Accepted: 04/01/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although several previous studies have demonstrated that aged garlic extract (AGE) inhibits the progression of coronary artery calcification, its effect on noncalcified plaque (NCP) has been unclear. OBJECTIVE This study investigated whether AGE reduces coronary plaque volume measured by cardiac computed tomography angiography (CCTA) in patients with metabolic syndrome (MetS). METHODS Fifty-five patients with MetS (mean ± SD age: 58.7 ± 6.7 y; 71% men) were prospectively assigned to consume 2400 mg AGE/d (27 patients) or placebo (28 patients) orally. Both groups underwent CCTA at baseline and follow-up 354 ± 41 d apart. Coronary plaque volume, including total plaque volume (TPV), dense calcium (DC), NCP, and low-attenuation plaque (LAP), were measured based upon predefined intensity cutoff values. Multivariable linear regression analysis, adjusted for age, gender, number of risk factors, hyperlipidemia medications, history of coronary artery disease, scan interval time, and baseline %TPV, was performed to examine whether AGE affected each plaque change. RESULTS The %LAP change was significantly reduced in the AGE group compared with the placebo group (-1.5% ± 2.3% compared with 0.2% ± 2.0%, P = 0.0049). In contrast, no difference was observed in %TPV change (0.3% ± 3.3% compared with 1.6% ± 3.0%, P = 0.13), %NCP change (0.2% ± 3.3% compared with 1.4% ± 2.9%, P = 0.14), and %DC change (0.2% ± 1.4%, compared with 0.2% ± 1.7%, P = 0.99). Multivariable linear regression analysis found a beneficial effect of AGE on %LAP regression (β: -1.61; 95% CI: -2.79, -0.43; P = 0.008). CONCLUSIONS This study indicates that the %LAP change was significantly greater in the AGE group than in the placebo group. Further studies are needed to evaluate whether AGE has the ability to stabilize vulnerable plaque and decrease adverse cardiovascular events. This trial was registered at clinicaltrials.gov as NCT01534910.
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Affiliation(s)
- Suguru Matsumoto
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
| | - Rine Nakanishi
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
| | - Dong Li
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
| | - Anas Alani
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
| | - Panteha Rezaeian
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
| | | | - Jeby Abraham
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
| | - Michael A Fahmy
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
| | - Christopher Dailing
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
| | - Ferdinand Flores
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
| | - Sajad Hamal
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
| | | | - Pieter H Kitslaar
- Leiden University Medical Center, Leiden, Netherlands; and Medis Medical Imaging Systems, Leiden, Netherlands
| | - Matthew J Budoff
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA;
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Walker SL, Roberts CH, Atkinson SE, Khadge S, Macdonald M, Neupane KD, Ranjit C, Sapkota BR, Dhakal S, Hawksworth RA, Mahat K, Ruchal S, Hamal S, Hagge DA, Lockwood DNJ. The effect of systemic corticosteroid therapy on the expression of toll-like receptor 2 and toll-like receptor 4 in the cutaneous lesions of leprosy Type 1 reactions. Br J Dermatol 2012; 167:29-35. [PMID: 22348338 DOI: 10.1111/j.1365-2133.2012.10891.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Leprosy is complicated by immunological reactions which can occur before, during and after successful completion of multidrug therapy. Genetic studies have suggested that polymorphisms in toll-like receptors (TLRs) may affect the susceptibility of an individual with leprosy to developing Type 1 reactions. OBJECTIVES To examine the gene and protein expression of TLRs in the cutaneous lesions of leprosy Type 1 reactions at the onset of reaction and during systemic corticosteroid therapy. METHODS Patients who were being treated for leprosy type 1 reactions with corticosteroids as part of a randomized controlled trial of corticosteroid treatment had skin biopsies performed before, during and at the end of treatment. The gene and protein expression of TLR2 and TLR4 were measured. RESULTS We have demonstrated that the gene hARP-P0 is a suitable control gene for TLR gene expression studies in this population. The gene and protein expression of TLR2 and TLR4 were both reduced significantly during corticosteroid treatment. CONCLUSIONS This is the first study to examine the expression of TLR2 and TLR4 in vivo in individuals experiencing leprosy Type 1 reactions. The data support the possibility of an important role for TLR2 and TLR4 in the pathogenesis of this important complication of leprosy.
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Affiliation(s)
- S L Walker
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
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Malla R, Sharma R, Rauniyar B, Kc MB, Maskey A, Joshi D, Hamal S. Left ventricular noncompaction. JNMA J Nepal Med Assoc 2009; 48:180-184. [PMID: 20387366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
Left Ventricular Noncompaction (LVNC) is a genetic cardiac disease of emerging importance with a distinct clinical and pathophysiological presentation. The most common clinical manifestations include heart failure, arrhythmias and embolic events, and in children it may be associated with facial dysmorphisms and Wolff-Parkinson-White syndrome. The diagnosis of LVNC, however, is often missed, most often as a consequence of ignorance of the condition. Echocardiography is considered the reference standard for the diagnosis of LVNC. Prognosis remains poor for patients with impaired systolic left ventricular function, as treatment options are very limited. Because of the familial association of LVNC, first-degree relatives should be screened by Echocardiography.
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Affiliation(s)
- R Malla
- Department of Cardiology, Shahid Gangalal National Heart Center, Bansbari, Kathmandu, Nepal
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Abstract
Left Ventricular Noncompaction(LVNC) is a genetic cardiac disease of emerging importance with a distinct clinical and pathophysiological presentation. The most common clinical manifestations include heart failure,arrhythmias and embolic events, and in children it may be associatedwith facial dysmorphisms and Wolff–Parkinson–Whitesyndrome. The diagnosis of LVNC, however, is often missed, most often as a consequence of ignorance of the condition. Echocardiography is considered the reference standard for the diagnosis of LVNC. Prognosis remains poor for patients with impaired systolic left ventricular function, as treatment options are very limited. Because of the familial association of LVNC, fi rst-degree relatives should be screened by Echocardiography.Key Words: heart, left ventricle, noncompaction
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