51
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Han D, Kuronuma K, Rozanski A, Budoff MJ, Miedema MD, Nasir K, Shaw LJ, Rumberger JA, Gransar H, Blumenthal RS, Blaha MJ, Berman DS. Implication of thoracic aortic calcification over coronary calcium score regarding the 2018 ACC/AHA Multisociety cholesterol guideline: results from the CAC Consortium. Am J Prev Cardiol 2021; 8:100232. [PMID: 34467259 PMCID: PMC8385171 DOI: 10.1016/j.ajpc.2021.100232] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 07/26/2021] [Accepted: 08/02/2021] [Indexed: 12/16/2022] Open
Abstract
TAC in segments of the ascending and descending thoracic aorta can be assessed by routine CAC scanning. TAC assessment with the threshold of 300 improved risk prediction and reclassification for CVD mortality when added to the ASCVD risk score and CAC. TAC >300 may improve patient selection for those who would benefit more strongly from statin use, from intermediate ASCVD risk patients who should consider a statin (CAC=1-100), and those where a statin is not recommended (CAC=0).
Objective TAC is associated with an increased atherosclerotic cardiovascular disease (ASCVD) risk, but it is unclear how to interpret thoracic aortic calcification (TAC) findings in conjunction with ASCVD risk and coronary artery calcium (CAC) score according to 2018 ACC/AHA Multisociety cholesterol guidelines. We evaluate the incremental value of thoracic aortic calcification TAC over CAC for predicting and reclassifying ASCVD mortality risk. Method The study included 30,630 asymptomatic individuals (mean age: 55 ± 8 years, male: 64%) from the CAC Consortium. TAC was categorized as TAC 0, 1-300, and >300. Patients were categorized as low (<5%), borderline (5–7.5%), intermediate (7.5–20%), or high (≥20%) 10-year ASCVD risk according to the Pooled Cohorts Equation. In the intermediate risk group, the utility of TAC beyond CAC for statin eligibility was assessed according to the guideline. CAC was categorized as CAC=0 (no statin), CAC 1-100 (favors statin), or CAC>100 (initiate stain). Results During the median 11.2 years (IQR 9.2–12.4) follow-up, 345 (1.1%) CVD deaths occurred. TAC>300 was associated with increased CVD mortality after adjusting for ASCVD risk and CAC (HR:4.72, 95% CI: 3.39–6.57, p<0.001). In borderline and intermediate risk groups, TAC improved discrimination when added to a model included ASCVD risk and CAC (C-statistic: 0.77 vs. 0.68 in borderline group; 0.67 vs. 0.63 in intermediate group, both p < 0.05). The addition of TAC over CAC improved risk reclassification in borderline, intermediate and high-risk groups (categorical net reclassification index: 0.40, 0.29, and 0.49, respectively, all p < 0.001). Of intermediate risk participants for whom consideration of CAC was recommended based on the guideline, TAC >300 was associated with an increased CVD mortality risk across each statin eligibility group (all p < 0.001, compared to TAC 0). Conclusion TAC was independently associated with CVD death. Among individuals with borderline or intermediate ASCVD risk, a TAC threshold of 300 may provide added prognostic and reclassification value beyond the current guideline-based approach.
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Affiliation(s)
- Donghee Han
- Department of Imaging and Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA 90048, United States
| | - Keiichiro Kuronuma
- Department of Imaging and Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA 90048, United States
| | - Alan Rozanski
- Division of Cardiology, Mount Sinai St. Luke's Hospital, New York, United States
| | - Matthew J Budoff
- Department of Medicine, Harbor-UCLA Medical Center, University of California Los Angeles, Los Angeles, CA, United States
| | - Michael D Miedema
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN, United States
| | - Khurram Nasir
- Division Cardiovascular Prevention and Wellness, Houston Methodist Hospital, Houston, TX, United States
| | - Leslee J Shaw
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York United States
| | | | - Heidi Gransar
- Department of Imaging and Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA 90048, United States
| | - Roger S Blumenthal
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins University, Baltimore, MD, United States
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins University, Baltimore, MD, United States
| | - Daniel S Berman
- Department of Imaging and Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA 90048, United States
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Cardiovascular disease risk calculators to reflect the subclinical atherosclerosis of coronary artery in rheumatoid arthritis: a pilot study. BMC Rheumatol 2021; 5:39. [PMID: 34455977 PMCID: PMC8404264 DOI: 10.1186/s41927-021-00213-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 06/18/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Cardiovascular diseases (CVDs) are the leading cause of death in patients with rheumatoid arthritis (RA). Coronary artery calcium (CAC) score quantifies the severity of atherosclerosis. We estimated CVD risk using several methods and compared these with the CAC score to identify the most suitable CVD risk calculator in RA patients. METHODS We recruited RA patients, and the 10-year CVD risk was assessed using various tools, viz. Framingham risk score, Systemic Coronary Risk Evaluation (SCORE), Atherosclerotic Cardiovascular Disease (ASCVD) risk estimator plus, QRISK3, Expanded Risk Score in Rheumatoid Arthritis (ERS-RA), and Reynolds risk score. Computed tomography was used to determine the CAC score of each patient. Correlation analysis and linear regression analysis between the CAC score and CVD risk score was performed. RESULTS In total, 54 RA patients were enrolled. ERS-RA showed the highest correlation coefficient (r = 0.430, P = 0.001). In multivariate linear regression analysis, ERS-RA (β = 10.01, 95% confidence interval 3.78-16.23) showed a positive association with the CAC score in RA patients. CONCLUSIONS The ERS-RA method was highly correlated with the CAC score in RA patients. Therefore, the application of the ERS-RA method may be suitable for predicting subclinical atherosclerosis and CVD risk in RA patients.
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53
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Playford D, Hamilton-Craig C, Dwivedi G, Figtree G. Examining the Potential for Coronary Artery Calcium (CAC) Scoring for Individuals at Low Cardiovascular Risk. Heart Lung Circ 2021; 30:1819-1828. [PMID: 34332891 DOI: 10.1016/j.hlc.2021.04.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 01/24/2021] [Accepted: 04/15/2021] [Indexed: 10/20/2022]
Abstract
Atherosclerosis is the commonest cause of death in Australia. Cardiovascular (CV) risk calculators have an important role in preventative cardiology, although they are are strongly age-dependent and designed to identify individuals at high risk of an imminent event. The imprecision around "intermediate" or "low" risk generates therapeutic uncertainty, and a significant proportion of patients presenting with myocardial infarction come from these groups, often with no warning. This highlights a conundrum: "Low" risk does not mean "no" risk. A fresh approach may be required to address the clinical conundrum around CV preventative approaches in non-high-risk individuals. While probabilistic calculators do not measure atherosclerosis, calculation of Coronary Artery Calcium (CAC) scores by low-dose computed tomography (CT) can provide a snapshot of atherosclerotic burden. In intermediate-risk individuals, CAC is well-established as an aid to CV risk prediction. Although CAC scoring in low-risk asymptomatic people may be considered controversial, CAC has emerged as the single best predictor of CV events in asymptomatic individuals, independent of traditional risk factor calculators. Therefore, apart from the contribution of age and sex, the somewhat arbitrary distinction between "intermediate" and "low" CV risk using probabilistic calculators may need to be reconsidered. A zero CAC score has a very low future event rate and non-zero CAC scores are associated with a progressive, graded increase in risk as the CAC score rises. In this review, we examine the evidence for CAC screening in low-risk individuals, and propose more widespread use of CAC using simple new model intended to enhance established CV risk prediction equations.
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Affiliation(s)
- David Playford
- The University of Notre Dame, Sydney, Fremantle, WA, Australia.
| | | | - Girish Dwivedi
- Harry Perkins Institute for Medical Research (University of Western Australia), Perth, WA, Australia; Fiona Stanley Hospital, Perth, WA, Australia
| | - Gemma Figtree
- Royal North Shore Hospital, Sydney, NSW, Australia; Kolling Institute, University of Sydney, Sydney, NSW, Australia
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54
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Ouyang L, Su X, Li W, Tang L, Zhang M, Zhu Y, Xie C, Zhang P, Chen J, Huang H. ALKBH1-demethylated DNA N6-methyladenine modification triggers vascular calcification via osteogenic reprogramming in chronic kidney disease. J Clin Invest 2021; 131:146985. [PMID: 34003800 PMCID: PMC8279589 DOI: 10.1172/jci146985] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 05/11/2021] [Indexed: 02/05/2023] Open
Abstract
Vascular calcification (VC) predicts cardiovascular morbidity and mortality in chronic kidney disease (CKD). To date, the underlying mechanisms remain unclear. We detected leukocyte DNA N6-methyladenine (6mA) levels in patients with CKD with or without aortic arch calcification. We used arteries from CKD mice infected with vascular smooth muscle cell-targeted (VSMC-targeted) adeno-associated virus encoding alkB homolog 1 (Alkbh1) gene or Alkbh1 shRNA to evaluate features of calcification. We identified that leukocyte 6mA levels were significantly reduced as the severity of VC increased in patients with CKD. Decreased 6mA demethylation resulted from the upregulation of ALKBH1. Here, ALKBH1 overexpression aggravated whereas its depletion blunted VC progression and osteogenic reprogramming in vivo and in vitro. Mechanistically, ALKBH1-demethylated DNA 6mA modification could facilitate the binding of octamer-binding transcription factor 4 (Oct4) to bone morphogenetic protein 2 (BMP2) promoter and activate BMP2 transcription. This resulted in osteogenic reprogramming of VSMCs and subsequent VC progression. Either BMP2 or Oct4 depletion alleviated the procalcifying effects of ALKBH1. This suggests that targeting ALKBH1 might be a therapeutic method to reduce the burden of VC in CKD.
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Affiliation(s)
- Liu Ouyang
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Cardiology, the Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Xiaoyan Su
- Department of Nephropathy, Tungwah Hospital, Sun Yat-sen University, Dongguan, China
| | - Wenxin Li
- Department of Cardiology, the Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Liangqiu Tang
- Department of Cardiology, Yuebei People’s Hospital, Shantou University Medical College, Shaoguan, China
| | - Mengbi Zhang
- Department of Nephropathy, Tungwah Hospital, Sun Yat-sen University, Dongguan, China
| | - Yongjun Zhu
- Department of Cardiology, the Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Changming Xie
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Cardiology, the Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Puhua Zhang
- Department of Nephrology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jie Chen
- Department of Radiation Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hui Huang
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Cardiology, the Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
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Patel J, Pallazola VA, Dudum R, Greenland P, McEvoy JW, Blumenthal RS, Virani SS, Miedema MD, Shea S, Yeboah J, Abbate A, Hundley WG, Karger AB, Tsai MY, Sathiyakumar V, Ogunmoroti O, Cushman M, Savji N, Liu K, Nasir K, Blaha MJ, Martin SS, Al Rifai M. Assessment of Coronary Artery Calcium Scoring to Guide Statin Therapy Allocation According to Risk-Enhancing Factors: The Multi-Ethnic Study of Atherosclerosis. JAMA Cardiol 2021; 6:1161-1170. [PMID: 34259820 DOI: 10.1001/jamacardio.2021.2321] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Importance The 2018 American Heart Association/American College of Cardiology Guideline on the Management of Blood Cholesterol recommends the use of risk-enhancing factor assessment and the selective use of coronary artery calcium (CAC) scoring to guide the allocation of statin therapy among individuals with an intermediate risk of atherosclerotic cardiovascular disease (ASCVD). Objective To examine the association between risk-enhancing factors and incident ASCVD by CAC burden among those at intermediate risk of ASCVD. Design, Setting, and Participants The Multi-Ethnic Study of Atherosclerosis is a multicenter population-based prospective cross-sectional study conducted in the US. Baseline data for the present study were collected between July 15, 2000, and July 14, 2002, and follow-up for incident ASCVD events was ascertained through August 20, 2015. Participants were aged 45 to 75 years with no clinical ASCVD or diabetes at baseline, were at intermediate risk of ASCVD (≥7.5% to <20.0%), and had a low-density lipoprotein cholesterol level of 70 to 189 mg/dL. Exposures Family history of premature ASCVD, premature menopause, metabolic syndrome, chronic kidney disease, lipid and inflammatory biomarkers, and low ankle-brachial index. Main Outcomes and Measures Incident ASCVD over a median follow-up of 12.0 years. Results A total of 1688 participants (mean [SD] age, 65 [6] years; 976 men [57.8%]). Of those, 648 individuals (38.4%) were White, 562 (33.3%) were Black, 305 (18.1%) were Hispanic, and 173 (10.2%) were Chinese American. A total of 722 participants (42.8%) had a CAC score of 0. Among those with 1 to 2 risk-enhancing factors vs those with 3 or more risk-enhancing factors, the prevalence of a CAC score of 0 was 45.7% vs 40.3%, respectively. Over a median follow-up of 12.0 years (interquartile range [IQR], 11.5-12.6 years), the unadjusted incidence rate of ASCVD among those with a CAC score of 0 was less than 7.5 events per 1000 person-years for all individual risk-enhancing factors (with the exception of ankle-brachial index, for which the incidence rate was 10.4 events per 1000 person-years [95% CI, 1.5-73.5]) and combinations of risk-enhancing factors, including participants with 3 or more risk-enhancing factors. Although the individual and composite addition of risk-enhancing factors to the traditional risk factors was associated with improvement in the area under the receiver operating curve, the use of CAC scoring was associated with the greatest improvement in the C statistic (0.633 vs 0.678) for ASCVD events. For incident ASCVD, the net reclassification improvement for CAC was 0.067. Conclusions and Relevance In this cross-sectional study, among participants with CAC scores of 0, the presence of risk-enhancing factors was generally not associated with an overall ASCVD risk that was higher than the recommended treatment threshold for the initiation of statin therapy. The use of CAC scoring was associated with significant improvements in the reclassification and discrimination of incident ASCVD. The results of this study support the utility of CAC scoring as an adjunct to risk-enhancing factor assessment to more accurately classify individuals with an intermediate risk of ASCVD who might benefit from statin therapy.
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Affiliation(s)
- Jaideep Patel
- Pauley Heart Center, Division of Cardiology, Virginia Commonwealth University Medical Center, Richmond.,Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland
| | - Vincent A Pallazola
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland
| | - Ramzi Dudum
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland
| | - Philip Greenland
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - John W McEvoy
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland.,National Institute for Prevention and Cardiovascular Health, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Roger S Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland
| | - Salim S Virani
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.,Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Michael D Miedema
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis
| | - Steven Shea
- Departments of Medicine and Epidemiology, Columbia University, New York, New York
| | - Joseph Yeboah
- Department of Cardiology, Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - Antonio Abbate
- Pauley Heart Center, Division of Cardiology, Virginia Commonwealth University Medical Center, Richmond
| | - William G Hundley
- Pauley Heart Center, Division of Cardiology, Virginia Commonwealth University Medical Center, Richmond
| | - Amy B Karger
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis
| | - Michael Y Tsai
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis
| | - Vasanth Sathiyakumar
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland
| | - Oluseye Ogunmoroti
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland
| | - Mary Cushman
- Division of Hematology, University of Vermont, Burlington
| | - Nazir Savji
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland
| | - Kiang Liu
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Khurram Nasir
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland.,Division of Cardiovascular Prevention and Wellness, Department of Cardiovascular Medicine, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas.,Center for Cardiovascular, Computational, and Precision Health, Department of Cardiovascular Medicine, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas.,Division of Health Equity and Disparities Research, Center for Outcomes Research, Houston Methodist Hospital, Houston, Texas
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland
| | - Seth S Martin
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland
| | - Mahmoud Al Rifai
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland.,Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
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Gokce N, Karki S, Dobyns A, Zizza E, Sroczynski E, Palmisano JN, Mazzotta C, Hamburg NM, Pernar LI, Carmine B, Carter CO, LaValley M, Hess DT, Apovian CM, Farb MG. Association of Bariatric Surgery With Vascular Outcomes. JAMA Netw Open 2021; 4:e2115267. [PMID: 34251443 PMCID: PMC8276087 DOI: 10.1001/jamanetworkopen.2021.15267] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
IMPORTANCE Bariatric surgical weight loss is associated with reduced cardiovascular mortality; however, the mechanisms underlying this association are incompletely understood. OBJECTIVES To identify variables associated with vascular remodeling after bariatric surgery and to examine how sex, race, and metabolic status are associated with microvascular and macrovascular outcomes. DESIGN, SETTING, AND PARTICIPANTS This population-based longitudinal cohort included 307 individuals who underwent bariatric surgery. Participants were enrolled in the bariatric weight loss program at Boston Medical Center, a large, multi-ethnic urban hospital, with presurgical and postsurgical assessments. Data were collected from December 11, 2001 to August 27, 2019. Data were analyzed in September 2019. EXPOSURE Bariatric surgery. MAIN OUTCOMES AND MEASURES Flow-mediated dilation (FMD) and reactive hyperemia (RH) (as measures of macrovascular and microvascular function, respectively) and clinical variables were measured preoperatively at baseline and at least once postoperatively within 12 months of the bariatric intervention. RESULTS A total of 307 participants with obesity (mean [SD] age, 42 [12] years; 246 [80%] women; 199 [65%] White; mean [SD] body mass index, 46 [8]) were enrolled in this study. Bariatric surgery was associated with significant weight loss and improved macrovascular and microvascular function across subgroups of sex, race, and traditional metabolic syndrome (mean [SD] pre- vs postsurgery weight: 126 [25] kg vs 104 [25] kg; P < .001; mean [SD] pre- vs postsurgery FMD: 9.1% [5.3] vs 10.2% [5.1]; P < .001; mean [SD] pre- vs postsurgery RH: 764% [400] vs 923% [412]; P < .001). Factors associated with change in vascular phenotype correlated most strongly with adiposity markers and several metabolic variables depending on vascular territory (eg, association of weight change with change in RH: estimate, -3.2; 95% CI, -4.7 to -1.8; association of hemoglobin A1c with change in FMD: estimate, -0.5; 95% CI, -0.95 to -0.05). While changes in macrovascular function among individuals with metabolically healthy obesity were not observed, the addition of biomarker assessment using high-sensitivity C-reactive protein plasma levels greater than 2 mg/dL identified participants with seemingly metabolically healthy obesity who had low-grade inflammation and achieved microvascular benefit from weight loss surgery. CONCLUSIONS AND RELEVANCE The findings of this study suggest that bariatric intervention is associated with weight loss and favorable remodeling of the vasculature among a wide range of individuals with cardiovascular risk. Moreover, differences in arterial responses to weight loss surgery by metabolic status were identified, underscoring heterogeneity in physiological responses to adiposity change and potential activation of distinct pathological pathways in clinical subgroups. As such, individuals with metabolically healthy obesity represent a mixed population that may benefit from more refined phenotypic classification.
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Affiliation(s)
- Noyan Gokce
- Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts
| | - Shakun Karki
- Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts
| | - Alyssa Dobyns
- Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts
| | - Elaina Zizza
- Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts
| | - Emily Sroczynski
- Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts
| | - Joseph N. Palmisano
- Department of Public Health, Boston University School of Medicine, Boston, Massachusetts
| | - Celestina Mazzotta
- Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts
| | - Naomi M. Hamburg
- Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts
| | - Luise I. Pernar
- Department of General Surgery, Boston University School of Medicine, Boston, Massachusetts
| | - Brian Carmine
- Department of General Surgery, Boston University School of Medicine, Boston, Massachusetts
| | - Cullen O. Carter
- Department of General Surgery, Boston University School of Medicine, Boston, Massachusetts
| | - Michael LaValley
- Department of Public Health, Boston University School of Medicine, Boston, Massachusetts
| | - Donald T. Hess
- Department of General Surgery, Boston University School of Medicine, Boston, Massachusetts
| | - Caroline M. Apovian
- Section of Endocrinology, Diabetes, Nutrition, and Weight Management, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts
| | - Melissa G. Farb
- Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts
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57
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Mortensen MB, Blaha MJ. Is There a Role of Coronary CTA in Primary Prevention? Current State and Future Directions. Curr Atheroscler Rep 2021; 23:44. [PMID: 34146160 DOI: 10.1007/s11883-021-00943-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2021] [Indexed: 01/19/2023]
Abstract
PURPOSE OF REVIEW Information on subclinical atherosclerosis burden provides prognostic information on atherosclerotic cardiovascular disease (ASCVD) risk beyond what can be achieved by traditional risk factors alone and may therefore improve allocation of preventive treatment in primary prevention. The purpose of this review is to discuss the potential role and value of assessing subclinical atherosclerosis using coronary artery calcium (CAC) versus computed tomography angiography (CTA) among asymptomatic patients in the context of current primary prevention cholesterol guidelines. RECENT FINDINGS Since 2013, primary prevention cholesterol guidelines have lowered the treatment threshold for initiating statin therapy resulting in high statin eligibility and sensitivity for detecting ASCVD events. Thus, one of the main advantages of assessing subclinical atherosclerosis is to identify those individuals who are at so low ASCVD risk that preventive treatment may safely be withhold. Numerous studies have shown that both CAC and CTA provide highly valuable information on ASCVD risk in the individual patient. However, while extensive data exist regarding the ability of CAC to improve treatment allocation in the context of primary prevention guidelines, such data is sparse for CTA. Furthermore, there is no data to show that CTA improves risk classification and treatment allocation in primary prevention beyond what can be achieved by assessment of CAC. Although CTA provides important information regarding prognosis in symptomatic patients undergoing clinical CTA, there is no strong evidence to support its use in the primary prevention setting. Thus, the potential value of CTA in primary prevention is not clear and is currently not recommended by guidelines.
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Affiliation(s)
- Martin Bødtker Mortensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard, 8200, Aarhus N, Denmark. .,Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA.
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
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58
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Jansz TT, Go MH, Hartkamp NS, Stöger JL, Celeng C, Leiner T, de Jong PA, Visseren FJ, Verhaar MC, van Jaarsveld BC. Coronary Artery Calcification as a Marker for Coronary Artery Stenosis: Comparing Kidney Failure to the General Population. Kidney Med 2021; 3:386-394.e1. [PMID: 34136785 PMCID: PMC8178454 DOI: 10.1016/j.xkme.2021.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Rationale & Objective The presence of calcified plaques in the coronary arteries is associated with cardiovascular mortality and is a hallmark of chronic kidney failure, but it is unclear whether this is associated with the same degree of coronary artery stenosis as in patients without kidney disease. We compared the relationship of coronary artery calcification (CAC) and stenosis between dialysis patients and patients without chronic kidney disease (CKD). Study Design Observational cohort study. Setting & Participants 127 dialysis patients and 447 patients without CKD with cardiovascular risk factors underwent cardiac computed tomography (CT), consisting of non–contrast-enhanced CT and CT angiography. CAC score and degree of coronary artery stenosis were assessed by independent readers. Predictor Dialysis treatment. Outcome Association between calcification and stenosis. Analytical Approach Logistic regression to determine the association between CAC score and the presence of stenosis in a matched cohort and, in the full cohort, testing for the interaction of dialysis status with this relationship. Results 112 patients were matched from each cohort, totaling 224 patients, using propensity scores for dialysis, balancing numerous cardiovascular risk factors. Median CAC score was 210 (IQR, 19-859) in dialysis patients and 58 (IQR, 0-254) in patients without CKD; 35% of dialysis patients and 36% of patients without CKD had coronary artery stenosis ≥ 50%. Per each 100-unit higher CAC score, the matched dialysis cohort had significantly lower ORs for stenosis than the non-CKD cohort, 0.67 (95% CI, 0.52-0.83) for stenosis ≥ 50% and 0.75 (95% CI, 0.62-0.90) for stenosis ≥ 70%. Limitations No comparison with the gold standard fractional flow reserve. Conclusions Dialysis patients have higher risk for coronary artery stenosis with higher CAC scores, but this risk is comparatively lower than in patients without CKD with similar CAC scores. In dialysis patients, a high CAC score can easily be found without significant stenosis. Our data enable “translation” of degree of calcification to the probability of coronary stenosis in dialysis patients.
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Affiliation(s)
- Thijs T. Jansz
- Departments of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht
| | - Meike H.Y. Go
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht
- On behalf of the UCC-SMART study group, Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht
| | - Nolan S. Hartkamp
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht
- Department of Radiology, Amsterdam UMC, Amsterdam
| | - J. Lauran Stöger
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht
- Department of Radiology, Leiden University Medical Center, Leiden
| | - Csilla Celeng
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht
| | - Tim Leiner
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht
| | - Pim A. de Jong
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht
| | - Frank J.L. Visseren
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht
- On behalf of the UCC-SMART study group, Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht
| | - Marianne C. Verhaar
- Departments of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht
| | - Brigit C. van Jaarsveld
- Department of Nephrology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, Amsterdam
- Dianet Dialysis Centers, Utrecht, the Netherlands
- Address for Correspondence: Brigit C. van Jaarsveld, MD, PhD, Meibergdreef 9, D3-324, 1105 AZ Amsterdam, the Netherlands.
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59
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Ell P, Martin JM, Cehic DA, Ngo DTM, Sverdlov AL. Cardiotoxicity of Radiation Therapy: Mechanisms, Management, and Mitigation. Curr Treat Options Oncol 2021; 22:70. [PMID: 34110500 DOI: 10.1007/s11864-021-00868-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2021] [Indexed: 12/15/2022]
Abstract
OPINION STATEMENT Radiation therapy is a key component of modern-day cancer therapy and can reduce the rates of recurrence and death from cancer. However, it can increase risk of cardiovascular (CV) events, and our understanding of the timeline associated with that risk is shorter than previously thought. Risk mitigation strategies, such as different positioning techniques, and breath hold acquisitions as well as baseline cardiovascular risk stratification that can be undertaken at the time of radiotherapy planning should be implemented, particularly for patients receiving chest radiation therapy. Primary and secondary prevention of cardiovascular disease (CVD), as appropriate, should be used before, during, and after radiation treatment in order to minimize the risks. Opportunistic screening for subclinical coronary disease provides an attractive possibility for primary/secondary CVD prevention and thus mitigation of long-term CV risk. More data on long-term clinical usefulness of this strategy and development of appropriate management pathways would further strengthen the evidence for the implementation of such screening. Clear guidelines in initial cardiovascular screening and cardiac aftercare following radiotherapy need to be formulated in order to integrate these measures into everyday clinical practice and policy and subsequently improve post-treatment morbidity and mortality for these patients.
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Affiliation(s)
- P Ell
- GenesisCare, Lake Macquarie Private Hospital, Gateshead, NSW, Australia
| | - J M Martin
- GenesisCare, Lake Macquarie Private Hospital, Gateshead, NSW, Australia.,Calvary Mater Newcastle, Waratah, NSW, 2298, Australia.,College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - D A Cehic
- GenesisCare, Buildings 1&11, The Mill, 41-43 Bourke Road, Alexandria, NSW, 2015, Australia
| | - D T M Ngo
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.,Hunter Cancer Research Alliance, Waratah, NSW, 2298, Australia
| | - A L Sverdlov
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia. .,Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia. .,Hunter Cancer Research Alliance, Waratah, NSW, 2298, Australia. .,Hunter New England Local Health District, Newcastle, NSW, 2305, Australia.
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60
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Blaha MJ, DeFilippis AP. Multi-Ethnic Study of Atherosclerosis (MESA): JACC Focus Seminar 5/8. J Am Coll Cardiol 2021; 77:3195-3216. [PMID: 34167645 DOI: 10.1016/j.jacc.2021.05.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/04/2021] [Accepted: 05/10/2021] [Indexed: 10/21/2022]
Abstract
The MESA (Multi-Ethnic Study of Atherosclerosis) is a National Heart, Lung, and Blood Institute-sponsored prospective study aimed at studying the prevalence, progression, determinants, and prognostic significance of subclinical cardiovascular disease in a sex-balanced, multiethnic, community-dwelling U.S. cohort. MESA helped usher in an era of noninvasive evaluation of subclinical atherosclerosis presence, burden, and progression for the evaluation of atherosclerotic cardiovascular disease risk, beyond what could be predicted by traditional risk factors alone. Concepts developed in MESA have informed international patient care guidelines, providing new tools to effectively guide public health policy, population screening, and clinical decision-making. MESA is grounded in an open science model that continues to be a beacon for collaborative science. In this review, we detail the original goals of MESA, and describe how the scope of MESA has evolved over time. We highlight 10 significant MESA contributions to cardiovascular medicine, and chart the path forward for MESA in the year 2021 and beyond.
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Affiliation(s)
- Michael J Blaha
- Johns Hopkins Ciccarone Center or the Prevention of Cardiovascular Disease, Baltimore, Maryland, USA.
| | - Andrew P DeFilippis
- Johns Hopkins Ciccarone Center or the Prevention of Cardiovascular Disease, Baltimore, Maryland, USA; Division of Cardiology. Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Abstract
PURPOSE OF REVIEW Vascular calcification (VC) is associated with increased cardiovascular event rates, particularly in patients with end-stage kidney disease (ESKD). Dysregulated mineral metabolism and inflammation have been shown to promote VC, however, treatment options targeting VC specifically are not available. This review outlines the pathophysiological mechanisms contributing to VC in ESKD and describes recent studies evaluating the effects of the first-in-class inhibitor of VC, SNF472. RECENT FINDINGS SNF472 directly inhibits calcium phosphate crystal formation and aggregation. SNF472 has completed early phase clinical trials with a favourable safety profile and Phase 2 clinical trial data have shown attenuation of coronary artery and aortic valve calcification in patients receiving hemodialysis. SUMMARY Therapeutic agents that directly target VC may prevent the multiple complications associated with dystrophic calcification in patients with ESKD.
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62
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Golub I, Lakshmanan S, Dahal S, Budoff MJ. Utilizing coronary artery calcium to guide statin use. Atherosclerosis 2021; 326:17-24. [PMID: 34000565 DOI: 10.1016/j.atherosclerosis.2021.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 04/16/2021] [Accepted: 04/21/2021] [Indexed: 11/28/2022]
Abstract
Cardiovascular disease (CVD) is the leading cause of death worldwide, and accounts for over 30% of annual global fatality. Coronary artery calcium (CAC) screening, a highly distinct marker of coronary atherosclerosis, serves as an important arbitrator of atherosclerotic cardiovascular disease (ASCVD). Particularly in asymptomatic individuals, CAC testing offers a model for initiating or prolonging preventative statin therapies and subsequently up- or down-risking of patients. Though recent 2018 ACC/AHA Guidelines on Blood Cholesterol recommend CAC as an arbitrator of statin use, it remains uncertain whether these recommendations have been universally followed. Thus, we present a thorough discussion about CAC as an important determinator of ASCVD risk. In this regard we highlight the key points behind coronary artery calcium scoring, as a critical platform for stratifying risk and guiding future preventative treatments. This review paper supplies a background for the 2018 Cholesterol Guidelines: the rationalization behind CAC as a crucial arbitrator of cardiovascular risk. This paper will first (1) outline the role of CAC in reclassifying ASCVD risk. Next, it will (2) discuss studies that illustrate CAC's markedly novel reduction in the number needed to treat (NNT) to ameliorate one major cardiac event. Being years removed from 2018 Guidelines provides this paper the lens to (3) elucidate upcoming value-based advantages, cost effectiveness, and patient adherence brought by CAC. Last, this paper will also (4) extend the utility of CAC beyond that of the general population, and (5) discuss pertinent limitations brought by CAC score. By summarizing the framework behind recent cholesterol guidelines for ASCVD risk assessment, this review will address the debate of use of CAC for both the clinical setting and preventative therapy applications.
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Affiliation(s)
- Ilana Golub
- Harbor-UCLA Medical Center Lundquist Institute, Torrance, CA, USA
| | | | - Suraj Dahal
- Harbor-UCLA Medical Center Lundquist Institute, Torrance, CA, USA
| | - Matthew J Budoff
- Harbor-UCLA Medical Center Lundquist Institute, Torrance, CA, USA.
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63
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Nasir K, Cainzos-Achirica M. Role of coronary artery calcium score in the primary prevention of cardiovascular disease. BMJ 2021; 373:n776. [PMID: 33947652 DOI: 10.1136/bmj.n776] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
First developed in 1990, the Agatston coronary artery calcium (CAC) score is an international guideline-endorsed decision aid for further risk assessment and personalized management in the primary prevention of atherosclerotic cardiovascular disease. This review discusses key international studies that have informed this 30 year journey, from an initial coronary plaque screening paradigm to its current role informing personalized shared decision making. Special attention is paid to the prognostic value of a CAC score of zero (the so called "power of zero"), which, in a context of low estimated risk thresholds for the consideration of preventive therapy with statins in current guidelines, may be used to de-risk individuals and thereby inform the safe delay or avoidance of certain preventive therapies. We also evaluate current recommendations for CAC scoring in clinical practice guidelines around the world, and past and prevailing barriers for its use in routine patient care. Finally, we discuss emerging approaches in this field, with a focus on the potential role of CAC informing not only the personalized allocation of statins and aspirin in the general population, but also of other risk-reduction therapies in special populations, such as individuals with diabetes and people with severe hypercholesterolemia.
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Affiliation(s)
- Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
- Center for Outcomes Research, Houston Methodist, Houston, TX, USA
| | - Miguel Cainzos-Achirica
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
- Center for Outcomes Research, Houston Methodist, Houston, TX, USA
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64
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Ghoshhajra BB, Hedgire SS, Hurwitz Koweek LM, Beache GM, Brown RKJ, Davis AM, Hsu JY, Johnson TV, Kicska GA, Kligerman SJ, Litmanovich D, Maroules CD, Meyersohn N, Rabbat MG, Villines TC, Wann S, Abbara S. ACR Appropriateness Criteria® Asymptomatic Patient at Risk for Coronary Artery Disease: 2021 Update. J Am Coll Radiol 2021; 18:S2-S12. [PMID: 33958114 DOI: 10.1016/j.jacr.2021.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 01/14/2021] [Indexed: 01/07/2023]
Abstract
Coronary atherosclerotic disease is a leading cause of mortality and morbidity due to major cardiovascular events in the United States and abroad. Risk stratification and early preventive measures can reduce major cardiovascular events given the long latent asymptomatic period. Imaging tests can detect subclinical coronary atherosclerosis and aid initiation of targeted preventative efforts based on patient risk. A summary of available imaging tests for low-, intermediate-, and high-risk asymptomatic patients is outlined in this document. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Brian B Ghoshhajra
- Panel Vice Chair, Massachusetts General Hospital, Boston, Massachusetts.
| | - Sandeep S Hedgire
- Research Author, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, Assistant Clinical Director CV Division, Vascular Imaging
| | - Lynne M Hurwitz Koweek
- Panel Chair, Duke University Medical Center, Durham, North Carolina, Director, Cardiovascular Imaging, Medical Director of CT; Duke University Medical Center
| | - Garth M Beache
- University of Louisville School of Medicine, Louisville, Kentucky
| | - Richard K J Brown
- University of Utah, Department of Radiology and Imaging Sciences, Salt Lake City, Utah
| | - Andrew M Davis
- University of Chicago Medical Center, Chicago, Illinois, American College of Physicians, Associate Vice-Chair for Quality, Department of Medicine, University of Chicago
| | - Joe Y Hsu
- Kaiser Permanente, Los Angeles, California
| | - Thomas V Johnson
- Sanger Heart and Vascular Institute, Charlotte, North Carolina, Cardiology Expert
| | | | | | | | - Christopher D Maroules
- Naval Medical Center Portsmouth, Portsmouth, Virginia. Section Chief, Cardiovascular Imaging, Naval Medical Center Portsmouth, Board of Directors, Society of Cardiovascular Computed Tomography
| | | | - Mark G Rabbat
- Loyola University Medical Center, Maywood, Illinois, Society for Cardiovascular Magnetic Resonance
| | - Todd C Villines
- University of Virginia Health Center, Charlottesville, Virginia, Society of Cardiovascular Computed Tomography
| | - Samuel Wann
- Ascension Healthcare Wisconsin, Milwaukee, Wisconsin, Nuclear Cardiology Expert
| | - Suhny Abbara
- Specialty Chair, UT Southwestern Medical Center, Dallas, Texas
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65
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Cheong BYC, Wilson JM, Spann SJ, Pettigrew RI, Preventza OA, Muthupillai R. Coronary artery calcium scoring: an evidence-based guide for primary care physicians. J Intern Med 2021; 289:309-324. [PMID: 33016506 DOI: 10.1111/joim.13176] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 08/24/2020] [Indexed: 12/12/2022]
Abstract
Primary care physicians often must decide whether statin therapy would be appropriate (in addition to lifestyle modification) for managing asymptomatic individuals with borderline or intermediate risk for developing atherosclerotic cardiovascular disease (ASCVD), as assessed on the basis of traditional risk factors. In appropriate subjects, a simple, noninvasive measurement of coronary artery calcium can help clarify risk. Coronary atherosclerosis is a chronic inflammatory disease, with atherosclerotic plaque formation involving intimal inflammation and repeated cycles of erosion and fibrosis, healing and calcification. Atherosclerotic plaque formation represents the prognostic link between risk factors and future clinical events. The presence of coronary artery calcification is almost exclusively an indication of coronary artery disease, except in certain metabolic conditions. Coronary artery calcification can be detected and quantified in a matter of seconds by noncontrast electrocardiogram-gated low-dose X-ray computed tomography (coronary artery calcium scoring [CACS]). Since the publication of the seminal work by Dr. Arthur Agatston in 1990, a wealth of CACS-based prognostic data has been reported. In addition, recent guidelines from various professional societies conclude that CACS may be considered as a tool for reclassifying risk for atherosclerotic cardiovascular disease in patients otherwise assessed to have intermediate risk, so as to more accurately inform decisions about possible statin therapy in addition to lifestyle modification as primary preventive therapy. In this review, we provide an overview of CACS, from acquisition to interpretation, and summarize the scientific evidence for and the appropriate use of CACS as put forth in current clinical guidelines.
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Affiliation(s)
- B Y C Cheong
- From the, Department of Cardiovascular Radiology, Texas Heart Institute, Houston, TX, USA.,Department of Diagnostic and Interventional Radiology, CHI St. Luke's Health-Baylor St. Luke's Medical Center, Houston, TX, USA.,Department of Cardiology, CHI St. Luke's Health-Baylor St. Luke's Medical Center, Houston, TX, USA
| | - J M Wilson
- Department of Cardiology, HCA Houston Healthcare Medical Center, Houston, TX, USA
| | - S J Spann
- The University of Houston College of Medicine, Houston, TX, USA
| | - R I Pettigrew
- College of Medicine and Department of Biomedical Engineering, Texas A&M University, Houston, TX, USA
| | - O A Preventza
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.,Department of Cardiovascular Surgery, Texas Heart Institute, Houston, TX, USA
| | - R Muthupillai
- From the, Department of Cardiovascular Radiology, Texas Heart Institute, Houston, TX, USA.,Department of Diagnostic and Interventional Radiology, CHI St. Luke's Health-Baylor St. Luke's Medical Center, Houston, TX, USA
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66
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Van Dyke TE, El Kholy K, Ishai A, Takx RA, Mezue K, Abohashem SM, Ali A, Yuan N, Hsue P, Osborne MT, Tawakol A. Inflammation of the periodontium associates with risk of future cardiovascular events. J Periodontol 2021; 92:348-358. [PMID: 33512014 PMCID: PMC8080258 DOI: 10.1002/jper.19-0441] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 09/10/2020] [Accepted: 09/25/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND While growing evidence suggests a link between periodontal disease (PD) and cardiovascular disease (CVD), the independence of this association and the pathway remain unclear. Herein, we tested the hypotheses that: (1) inflammation of the periodontium (PDinflammation ) predicts future CVD independently of disease risk factors shared between CVD and PD, and (2) the mechanism linking the two diseases involves heightened arterial inflammation. METHODS 18 F-fluorodeoxyglucose positron emission tomography/computed tomography (18 F-FDG-PET/CT) imaging was performed in 304 individuals (median age 54 years; 42.4% male) largely for cancer screening; individuals without active cancer were included. PDinflammation and arterial inflammation were quantified using validated 18 F-FDG-PET/CT methods. Additionally, we evaluated the relationship between PDinflammation and subsequent major adverse cardiovascular events (MACE) using Cox models and log-rank tests. RESULTS Thirteen individuals developed MACE during follow-up (median 4.1 years). PDinflammation associated with arterial inflammation, remaining significant after adjusting for PD and CVD risk factors (standardized β [95% CI]: 0.30 [0.20-0.40], P < 0.001). PDinflammation predicted subsequent MACE (standardized HR [95% CI]: 2.25 [1.47 to 3.44], P <0.001, remaining significant in multivariable models), while periodontal bone loss did not. Furthermore, mediation analysis suggested that arterial inflammation accounts for 80% of the relationship between PDinflammation and MACE (standardized log odds ratio [95% CI]: 0.438 [0.019-0.880], P = 0.022). CONCLUSION PDinflammation is independently associated with MACE via a mechanism that may involve increased arterial inflammation. These findings provide important support for an independent relationship between PDinflammation and CVD.
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Affiliation(s)
- Thomas E. Van Dyke
- Forsyth Institute, Cambridge, MA
- Harvard School of Dental Medicine, Boston, MA
| | - Karim El Kholy
- Forsyth Institute, Cambridge, MA
- Harvard School of Dental Medicine, Boston, MA
| | | | | | - Kene Mezue
- Cardiovascular Imaging Research Center, Boston, MA
- Nuclear Cardiology, Boston, MA
- Cardiology Division, Massachusetts General Hospital, and Harvard Medical School, Boston, MA
| | - Shady M. Abohashem
- Cardiovascular Imaging Research Center, Boston, MA
- Nuclear Cardiology, Boston, MA
- Cardiology Division, Massachusetts General Hospital, and Harvard Medical School, Boston, MA
| | | | - Neal Yuan
- San Francisco General Hospital and the University of California San Francisco, San Francisco, CA
| | - Priscilla Hsue
- San Francisco General Hospital and the University of California San Francisco, San Francisco, CA
| | - Michael T. Osborne
- Cardiovascular Imaging Research Center, Boston, MA
- Nuclear Cardiology, Boston, MA
- Cardiology Division, Massachusetts General Hospital, and Harvard Medical School, Boston, MA
| | - Ahmed Tawakol
- Cardiovascular Imaging Research Center, Boston, MA
- Nuclear Cardiology, Boston, MA
- Cardiology Division, Massachusetts General Hospital, and Harvard Medical School, Boston, MA
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67
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Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Cheng S, Delling FN, Elkind MSV, Evenson KR, Ferguson JF, Gupta DK, Khan SS, Kissela BM, Knutson KL, Lee CD, Lewis TT, Liu J, Loop MS, Lutsey PL, Ma J, Mackey J, Martin SS, Matchar DB, Mussolino ME, Navaneethan SD, Perak AM, Roth GA, Samad Z, Satou GM, Schroeder EB, Shah SH, Shay CM, Stokes A, VanWagner LB, Wang NY, Tsao CW. Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation 2021; 143:e254-e743. [PMID: 33501848 DOI: 10.1161/cir.0000000000000950] [Citation(s) in RCA: 3176] [Impact Index Per Article: 1058.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2021 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors related to cardiovascular disease. RESULTS Each of the 27 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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68
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Yamagishi M, Tamaki N, Akasaka T, Ikeda T, Ueshima K, Uemura S, Otsuji Y, Kihara Y, Kimura K, Kimura T, Kusama Y, Kumita S, Sakuma H, Jinzaki M, Daida H, Takeishi Y, Tada H, Chikamori T, Tsujita K, Teraoka K, Nakajima K, Nakata T, Nakatani S, Nogami A, Node K, Nohara A, Hirayama A, Funabashi N, Miura M, Mochizuki T, Yokoi H, Yoshioka K, Watanabe M, Asanuma T, Ishikawa Y, Ohara T, Kaikita K, Kasai T, Kato E, Kamiyama H, Kawashiri M, Kiso K, Kitagawa K, Kido T, Kinoshita T, Kiriyama T, Kume T, Kurata A, Kurisu S, Kosuge M, Kodani E, Sato A, Shiono Y, Shiomi H, Taki J, Takeuchi M, Tanaka A, Tanaka N, Tanaka R, Nakahashi T, Nakahara T, Nomura A, Hashimoto A, Hayashi K, Higashi M, Hiro T, Fukamachi D, Matsuo H, Matsumoto N, Miyauchi K, Miyagawa M, Yamada Y, Yoshinaga K, Wada H, Watanabe T, Ozaki Y, Kohsaka S, Shimizu W, Yasuda S, Yoshino H. JCS 2018 Guideline on Diagnosis of Chronic Coronary Heart Diseases. Circ J 2021; 85:402-572. [PMID: 33597320 DOI: 10.1253/circj.cj-19-1131] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
| | - Nagara Tamaki
- Department of Radiology, Kyoto Prefectural University of Medicine Graduate School
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Graduate School
| | - Kenji Ueshima
- Center for Accessing Early Promising Treatment, Kyoto University Hospital
| | - Shiro Uemura
- Department of Cardiology, Kawasaki Medical School
| | - Yutaka Otsuji
- Second Department of Internal Medicine, University of Occupational and Environmental Health, Japan
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School
| | | | | | - Hajime Sakuma
- Department of Radiology, Mie University Graduate School
| | | | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School
| | | | - Hiroshi Tada
- Department of Cardiovascular Medicine, University of Fukui
| | | | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | | | - Kenichi Nakajima
- Department of Functional Imaging and Artificial Intelligence, Kanazawa Universtiy
| | | | - Satoshi Nakatani
- Division of Functional Diagnostics, Department of Health Sciences, Osaka University Graduate School of Medicine
| | | | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
| | - Atsushi Nohara
- Division of Clinical Genetics, Ishikawa Prefectural Central Hospital
| | | | | | - Masaru Miura
- Department of Cardiology, Tokyo Metropolitan Children's Medical Center
| | | | | | | | - Masafumi Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University
| | - Toshihiko Asanuma
- Division of Functional Diagnostics, Department of Health Sciences, Osaka University Graduate School
| | - Yuichi Ishikawa
- Department of Pediatric Cardiology, Fukuoka Children's Hospital
| | - Takahiro Ohara
- Division of Community Medicine, Tohoku Medical and Pharmaceutical University
| | - Koichi Kaikita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | - Tokuo Kasai
- Department of Cardiology, Uonuma Kinen Hospital
| | - Eri Kato
- Department of Cardiovascular Medicine, Department of Clinical Laboratory, Kyoto University Hospital
| | | | - Masaaki Kawashiri
- Department of Cardiovascular and Internal Medicine, Kanazawa University
| | - Keisuke Kiso
- Department of Diagnostic Radiology, Tohoku University Hospital
| | - Kakuya Kitagawa
- Department of Advanced Diagnostic Imaging, Mie University Graduate School
| | - Teruhito Kido
- Department of Radiology, Ehime University Graduate School
| | | | | | | | - Akira Kurata
- Department of Radiology, Ehime University Graduate School
| | - Satoshi Kurisu
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center
| | - Eitaro Kodani
- Department of Internal Medicine and Cardiology, Nippon Medical School Tama Nagayama Hospital
| | - Akira Sato
- Department of Cardiology, University of Tsukuba
| | - Yasutsugu Shiono
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Kyoto University Graduate School
| | - Junichi Taki
- Department of Nuclear Medicine, Kanazawa University
| | - Masaaki Takeuchi
- Department of Laboratory and Transfusion Medicine, Hospital of the University of Occupational and Environmental Health, Japan
| | | | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center
| | - Ryoichi Tanaka
- Department of Reconstructive Oral and Maxillofacial Surgery, Iwate Medical University
| | | | | | - Akihiro Nomura
- Innovative Clinical Research Center, Kanazawa University Hospital
| | - Akiyoshi Hashimoto
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University
| | - Kenshi Hayashi
- Department of Cardiovascular Medicine, Kanazawa University Hospital
| | - Masahiro Higashi
- Department of Radiology, National Hospital Organization Osaka National Hospital
| | - Takafumi Hiro
- Division of Cardiology, Department of Medicine, Nihon University
| | | | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center
| | - Naoya Matsumoto
- Division of Cardiology, Department of Medicine, Nihon University
| | | | | | | | - Keiichiro Yoshinaga
- Department of Diagnostic and Therapeutic Nuclear Medicine, Molecular Imaging at the National Institute of Radiological Sciences
| | - Hideki Wada
- Department of Cardiology, Juntendo University Shizuoka Hospital
| | - Tetsu Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University
| | - Yukio Ozaki
- Department of Cardiology, Fujita Medical University
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
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69
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The evolving role of coronary artery calcium in preventive cardiology 30 years after the Agatston score. Curr Opin Cardiol 2021; 35:500-507. [PMID: 32649358 DOI: 10.1097/hco.0000000000000771] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW On the brink of the 30th anniversary of the Agatston score we summarize the epidemiological data that shaped the recommendations relevant to coronary artery calcium (CAC) included in the 2018/2019 US and European guidelines for the primary prevention of atherosclerotic cardiovascular disease (ASCVD). We also discuss the implications of novel CAC research conducted in asymptomatic populations within the past 2 years. RECENT FINDINGS Based on a wealth of observational evidence, CAC has emerged as a mainstay in personalized risk assessment and is now endorsed as a class IIa tool in both US and European guidelines. In the past 2 years, data supporting the prognostic power of CAC has kept mounting, with longer term follow-up data now available. CAC has been evaluated in a variety of patient populations including individuals with severe hypercholesterolemia, diabetes mellitus and younger adults with family history of ASCVD, in all of whom it may be able to inform a more personalized management. Novel CAC scoring approaches are also discussed. SUMMARY Despite a strong endorsement in recent guidelines, active research in the last 2 years has provided further insights on the potential utility of CAC in informing a more individualized preventive management in broader populations.
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Orringer CE, Blaha MJ, Blankstein R, Budoff MJ, Goldberg RB, Gill EA, Maki KC, Mehta L, Jacobson TA. The National Lipid Association scientific statement on coronary artery calcium scoring to guide preventive strategies for ASCVD risk reduction. J Clin Lipidol 2021; 15:33-60. [PMID: 33419719 DOI: 10.1016/j.jacl.2020.12.005] [Citation(s) in RCA: 112] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 12/07/2020] [Indexed: 12/21/2022]
Abstract
An Expert Panel of the National Lipid Association reviewed the evidence related to the use of coronary artery calcium (CAC) scoring in clinical practice for adults seen for primary prevention of atherosclerotic cardiovascular disease. Recommendations for optimal use of this test in adults of various races/ethnicities, ages and multiple domains of primary prevention, including those with a 10-year ASCVD risk <20%, those with diabetes or the metabolic syndrome, and those with severe hypercholesterolemia were provided. Recommendations were also made on optimal timing for repeat calcium scoring after an initial test, use of CAC scoring in those taking statins, and its role in informing the clinician patient discussion on the benefit of aspirin and anti-hypertensive drug therapy. Finally, a vision is provided for the future of coronary calcium scoring.
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Affiliation(s)
- Carl E Orringer
- University of Miami, Miller School of Medicine, Cardiovascular Division.
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease
| | - Ron Blankstein
- Brigham and Women's Hospital, Harvard Medical School, Cardiovascular Division
| | | | - Ronald B Goldberg
- Diabetes Research Institute, University of Miami Miller School of Medicine
| | - Edward A Gill
- University of Colorado School of Medicine, Anschutz Campus
| | - Kevin C Maki
- Department of Applied Health Science, School of Public Health, and Midwest Biomedical Research, Indiana University
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Cainzos-Achirica M, Bittencourt MS, Osei AD, Haque W, Bhatt DL, Blumenthal RS, Blankstein R, Ray KK, Blaha MJ, Nasir K. Coronary Artery Calcium to Improve the Efficiency of Randomized Controlled Trials in Primary Cardiovascular Prevention. JACC Cardiovasc Imaging 2020; 14:1005-1016. [PMID: 33221237 DOI: 10.1016/j.jcmg.2020.10.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/08/2020] [Accepted: 10/14/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES This study sought to assess the value, in terms of sample size and cost, of using the coronary artery calcium (CAC) score to enrich the study population of primary prevention randomized controlled trials (RCTs) with participants at high absolute risk of atherosclerotic cardiovascular disease (ASCVD) events. BACKGROUND The feasibility of RCTs assessing the efficacy of novel add-on therapies for primary prevention among high-risk individuals treated with statins may be limited by sample size and cost. METHODS We evaluated 3,075 statin-naive participants from the MESA (Multi-Ethnic Study of Atherosclerosis) with estimated 10-year ASCVD risk of ≥7.5%. CAC of >100, CAC of >400, high sensitivity C-reactive protein levels of >2 and >3 mg/l, ankle-brachial index of <0.9, and triglyceride levels of >175 mg/dl were each evaluated as enrichment criteria on top of estimated ASCVD risk of ≥7.5%, ≥10%, ≥15% and ≥20%. For each criterion, using the observed 5-year incidence of CVD, we projected the incidence of CVD assuming a 28% relative risk reduction with high-intensity statin therapy and after addition of novel therapy with additive relative risk reductions of 15% and 25%. Sample size and cost of a hypothetical primary prevention 5-year RCT of a novel therapy on top of statins versus statins alone were then computed by using the projected incidences. Yearly costs per included participant of $6,000 to $9,000 and of $500/$600 per screened nonparticipant were assumed. RESULTS CAC of >400, present in 15% to 23% participants, consistently identified the subgroups with highest 5-year incident events and outperformed the other features yielding the smallest projected sample size, ranging 33% to 58% lower than using risk estimations alone for participant selection. CAC of >400 also yielded the lowest projected RCT costs, at least $40 million lower than using risk estimations alone. CAC of >100 showed the second-best performance in most scenarios. CONCLUSIONS High CAC scores used as study entry criteria can improve the efficiency and feasibility of primary prevention RCTs evaluating the incremental efficacy of novel add-on therapies.
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Affiliation(s)
- Miguel Cainzos-Achirica
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA; Center for Outcomes Research, Houston Methodist, Houston, Texas, USA; Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
| | - Marcio Sommer Bittencourt
- Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, São Paulo, Brazil
| | - Albert D Osei
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Waqas Haque
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Deepak L Bhatt
- Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Roger S Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ron Blankstein
- Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Kausik K Ray
- Imperial Centre for Cardiovascular Disease Prevention, Department of Primary Care and Public Health, Imperial College London, London, England
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA; Center for Outcomes Research, Houston Methodist, Houston, Texas, USA; Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Warfarin Accelerates Aortic Calcification by Upregulating Senescence-Associated Secretory Phenotype Maker Expression. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2020; 2020:2043762. [PMID: 33149806 PMCID: PMC7603623 DOI: 10.1155/2020/2043762] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 07/20/2020] [Indexed: 01/07/2023]
Abstract
Warfarin, a vitamin K antagonist (VKA), is known to promote arterial calcification (AC). In the present study, we conducted a case-cohort study within the Multi-Ethnic Study of Atherosclerosis (MESA); 6655 participants were included. From MESA data, we found that AC was related to both age and vitamin K; furthermore, the score of AC increased with SASP marker including interlukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α) rising. Next, a total of 79 warfarin users in our center developed significantly more calcified coronary plaques as compared to non-VKA users. We investigated the role of warfarin in phosphate-induced AC in different ages by in vitro experimental study. Furthermore, dose-time-response of warfarin was positively correlated with AC score distribution and plasma levels of the SASP maker IL-6 among patients < 65 years, but not among patients ≥ 65 years. In addition, in vitro research suggested that warfarin treatment tended to deteriorate calcification in young VSMC at the early stage of calcification. Our results suggested that aging and warfarin-treatment were independently related to increased AC. Younger patients were more sensitive to warfarin-related AC than older patients, which was possibly due to accumulated warfarin-induced cellular senescence.
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73
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Efe SÇ, Özdemir Candan Ö, Gündoğan C, Öz A, Yüksel Y, Ayca B, Çermik TF. Value of C-reactive Protein/Albumin Ratio for Predicting Ischemia in Myocardial Perfusion Scintigraphy. Mol Imaging Radionucl Ther 2020; 29:112-117. [PMID: 33094574 PMCID: PMC7583749 DOI: 10.4274/mirt.galenos.2020.88261] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 08/12/2020] [Indexed: 12/01/2022] Open
Abstract
Objectives Several studies demonstrate the relationship between coronary artery disease and inflammatory parameters. Nevertheless, there is paucity of data regarding the role of high sensitivity (hs)-C-reactive protein (CRP) to albumin ratio (CAR) in patients with ischemia on gated single photon emission tomography (SPECT) myocardial perfusion imaging (MPI). This study was aimed at demonstrating the relationship between CAR and the occurrence of ischemia on gated SPECT MPI. Methods We retrospectively evaluated 2.048 referred patients for gated SPECT MPI from a cardiology outpatient clinic between October 2017 and June 2019. After applying exclusion criteria and measuring serum CRP and albumin levels, we included 126 patients in the study. We then classified subjects into different groups according to the absence or presence of ischemia on gated SPECT MPI. Results According to laboratory findings, hs-CRP and CAR were significantly higher in the ischemia group, while the serum albumin was significantly lower in ischemia group (p<0.05 for each). The independent predictors of presence of ischemia in multivariate analysis were hypertension and CAR (CAR; odds ratio: 5.720, 95% confidence interval: 2.697-12.133, p<0.001). The optimal value of CAR for presence of ischemia was 0.96 with 76% sensitivity and 71% specificity. Conclusion We found CAR values as a predictor for ischemia before MPI.
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Affiliation(s)
- Süleyman Çağan Efe
- Kartal Koşuyolu Cardiovascular Diseases Training and Research Hospital, Clinic of Cardiology, İstanbul, Turkey
| | - Özlem Özdemir Candan
- Kartal Koşuyolu Cardiovascular Diseases Training and Research Hospital, Clinic of Cardiology, İstanbul, Turkey
| | - Cihan Gündoğan
- İstanbul Training and Research Hospital, Clinic of Nuclear Medicine, İstanbul, Turkey
| | - Ahmet Öz
- İstanbul Training and Research Hospital, Clinic of Cardiology, İstanbul, Turkey
| | - Yasin Yüksel
- İstanbul Training and Research Hospital, Clinic of Cardiology, İstanbul, Turkey
| | - Burak Ayca
- İstanbul Training and Research Hospital, Clinic of Cardiology, İstanbul, Turkey
| | - Tevfik Fikret Çermik
- İstanbul Training and Research Hospital, Clinic of Nuclear Medicine, İstanbul, Turkey
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Fisher R, Vandehei A, Haller C, Boster J, Shipley B, Kaatz C, Harris J, Shin SR, Townsend L, Rouse J, Davis S, Aden J, Thomas D. Reporting the Presence of Coronary Artery Calcium in the Final Impression of Non-gated CT Chest Scans Increases the Appropriate Utilization of Statins. Cureus 2020; 12:e10579. [PMID: 33110715 PMCID: PMC7580491 DOI: 10.7759/cureus.10579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Coronary artery calcium (CAC) scoring based on gated non-contrast cardiac computed tomography (CT) is a validated risk marker of major adverse cardiovascular events (MACE). Reporting of CAC on non-gated CT chest (NGCT) scans and the impact on medical therapy is not well studied. Methods A retrospective cohort of 5,043 NGCT scans was reviewed for the presence of CAC. The radiology report was reviewed to determine whether CAC was mentioned in either the body of the report or the final impression. Electronic medical records (EMR) were abstracted for baseline demographics, cardiovascular (CV) risk factors, lipid-lowering agents, and aspirin (ASA) prior to and after NGCT. Results CAC was present in 63.0% of NGCT scans. Of these scans, CAC was mentioned in the body of the report in 81.6% of studies. Conversely, CAC was mentioned in the final impressions in only 15.1% of these scans. Amongst patients with CAC, initiation of a statin in treatment-naive patients was more common when CAC was mentioned in the final impression versus the body only (12.3% vs. 4.9%, p=0.001) despite the fact that baseline utilization of statins in this cohort was higher (71.1% vs. 64.1%, p=0.005). Initiation of a statin in treatment-naive patients had a trend towards significance when CAC was mentioned in the body of the report versus not reported (4.9% vs. 2.62%, p=0.142). Reporting of CAC in the final impression significantly increased the initiation of ASA in treatment-naive patients (9.52% vs. 4.33%, p=0.033). Reporting of CAC in either the final impression or the body of the report did not affect the initiation of non-statin lipid-lowering therapies in patients with CAC. Conclusion The inclusion of CAC in the final impression of NGCT radiology reports positively impacts the appropriate initiation of statin and aspirin therapy in treatment-naive patients. Universal adherence to a standardized reporting system for the presence of CAC on NGCT should be considered to improve the initiation of guideline-directed medical therapy.
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75
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Shaw LJ, Blankstein R, Chandrashekar Y. Forecasting Preventive Care Effectiveness With Imaging. JACC Cardiovasc Imaging 2020; 13:2065-2067. [DOI: 10.1016/j.jcmg.2020.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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76
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Zeitouni M, Sabouret P, Kerneis M, Silvain J, Collet JP, Bruckert E, Montalescot G. 2019 ESC/EAS Guidelines for management of dyslipidaemia: strengths and limitations. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2020; 7:324-333. [PMID: 32652000 DOI: 10.1093/ehjcvp/pvaa077] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/18/2020] [Accepted: 07/03/2020] [Indexed: 01/28/2023]
Abstract
In 2019, the European Society of Cardiology and European Atherosclerosis Society released a new guideline document with substantial changes regarding the assessment of cardiovascular risk and treatments. The update of high-risk criteria and categories led to a better detection and primary prevention of patients at risk of a first cardiovascular event. Nonetheless, additional efforts are needed for a better inclusion of risk modifiers, especially specific to women, to improve risk stratification and direct primary prevention. Eventually, we discuss how these new guidelines implement PCSK9 inhibitors for very high-risk individuals and the evidence supporting new low-density lipoprotein cholesterol goals below, such as 55 and 40 mg/dL.
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Affiliation(s)
- Michel Zeitouni
- Department of Cardiology, Institut de cardiologie (AP-HP), Sorbonne Université, ACTION Study Group, INSERM UMRS_1166, 47-83 bld de l'Hôpital, 75013 Paris, France
| | - Pierre Sabouret
- Department of Cardiology, Institut de cardiologie (AP-HP), Sorbonne Université, ACTION Study Group, INSERM UMRS_1166, 47-83 bld de l'Hôpital, 75013 Paris, France
| | - Mathieu Kerneis
- Department of Cardiology, Institut de cardiologie (AP-HP), Sorbonne Université, ACTION Study Group, INSERM UMRS_1166, 47-83 bld de l'Hôpital, 75013 Paris, France
| | - Johanne Silvain
- Department of Cardiology, Institut de cardiologie (AP-HP), Sorbonne Université, ACTION Study Group, INSERM UMRS_1166, 47-83 bld de l'Hôpital, 75013 Paris, France
| | - Jean-Philippe Collet
- Department of Cardiology, Institut de cardiologie (AP-HP), Sorbonne Université, ACTION Study Group, INSERM UMRS_1166, 47-83 bld de l'Hôpital, 75013 Paris, France
| | - Eric Bruckert
- Department of Endocrinology, Pitié-Salpêtrière Hospital and Sorbonne University, Cardio Metabolic Institute, 83 bld de l'Hôpital, 75013 Paris, France
| | - Gilles Montalescot
- Department of Cardiology, Institut de cardiologie (AP-HP), Sorbonne Université, ACTION Study Group, INSERM UMRS_1166, 47-83 bld de l'Hôpital, 75013 Paris, France
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77
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Elshazly MB, Abdellatif A, Dargham SR, Rifai MA, Quispe R, Cainzos-Achirica M, Martin SS, Yeboah J, Psaty BM, Post WS, Nasir K, Budoff MJ, Blumenthal RS, Blaha MJ, McEvoy JW. Role of Coronary Artery and Thoracic Aortic Calcium as Risk Modifiers to Guide Antihypertensive Therapy in Stage 1 Hypertension (From the Multiethnic Study of Atherosclerosis). Am J Cardiol 2020; 126:45-55. [PMID: 32359719 DOI: 10.1016/j.amjcard.2020.02.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 02/25/2020] [Accepted: 02/27/2020] [Indexed: 12/20/2022]
Abstract
The 2017 American blood pressure (BP) guidelines recommended a personalized risk-based approach to treatment in stage 1 hypertension. We sought to establish the utility of coronary artery or thoracic aortic calcium (CAC or TAC) as additional risk modifiers in this setting. We included 1859 Multiethnic Study of Atherosclerosis participants with stage 1 hypertension. We compared adjusted HR for the composite outcome of incident atherosclerotic cardiovascular disease or heart failure across predefined categories of either CAC or TAC (0, 1 to 100, or >100) in: (1) the full sample; (2) 4 high-risk subgroups recommended for pharmacotherapy to a BP goal <130/80 mm Hg, and (3) low-risk subgroup not eligible for pharmacotherapy. We also estimated the 10-year number-needed-to-treat (NNT10) to a systolic BP <130 mm Hg as extrapolated from meta-analyses. Mean age was 62.8 ± 9.4 years, 46% were female and there were 300 events over a median follow-up of 13.8 years. The absolute event rate was 4.1 to 10.8 per 1,000 person-years among high-risk participants with CAC = 0, but 28.4 among low-risk participants with CAC >100. CAC >100 was independently associated with a higher relative risk of events compared with CAC = 0 (e.g., adjusted HR [9.5 (1.8 to 18.7)] in the low-risk subgroup). NNT10 for CAC = 0 were 3 to 5 times higher than those for CAC >100 in all analyses. TAC was not a reliable risk modifier in our study. In conclusion, CAC, but not TAC, can further guide risk-based allocation of treatment in stage 1 hypertension and should be considered as a risk modifier in future guidelines.
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Affiliation(s)
| | | | | | - Mahmoud Al Rifai
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD, USA
| | - Renato Quispe
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD, USA
| | - Miguel Cainzos-Achirica
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD, USA
| | - Seth S Martin
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD, USA
| | - Joseph Yeboah
- Division of Cardiovascular Medicine, Wake Forest University, Winston-Salem, NC, USA
| | - Bruce M Psaty
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Wendy S Post
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD, USA
| | - Khurram Nasir
- Center for Outcomes Research, Houston Methodist, Houston, TX, USA
| | - Matthew J Budoff
- Division of Cardiology, Department of Medicine, Lundquist Institute at Harbor-UCLA, Torrance CA, USA
| | - Roger S Blumenthal
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD, USA
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD, USA
| | - John W McEvoy
- National Institute for Prevention and Cardiovascular Health, National University of Ireland, Ireland
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Tawakol A, Osborne MT, Wang Y, Hammed B, Tung B, Patrich T, Oberfeld B, Ishai A, Shin LM, Nahrendorf M, Warner ET, Wasfy J, Fayad ZA, Koenen K, Ridker PM, Pitman RK, Armstrong KA. Stress-Associated Neurobiological Pathway Linking Socioeconomic Disparities to Cardiovascular Disease. J Am Coll Cardiol 2020; 73:3243-3255. [PMID: 31248544 DOI: 10.1016/j.jacc.2019.04.042] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/11/2019] [Accepted: 04/10/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND Lower socioeconomic status (SES) associates with a higher risk of major adverse cardiac events (MACE) via mechanisms that are not well understood. OBJECTIVES Because psychosocial stress is more prevalent among those with low SES, this study tested the hypothesis that stress-associated neurobiological pathways involving up-regulated inflammation in part mediate the link between lower SES and MACE. METHODS A total of 509 individuals, median age 55 years (interquartile range: 45 to 66 years), underwent clinically indicated whole-body 18F-fluorodeoxyglucose positron emission tomography/computed tomography imaging and met pre-defined inclusion criteria, including absence of known cardiovascular disease or active cancer. Baseline hematopoietic tissue activity, arterial inflammation, and in a subset of 289, resting amygdalar metabolism (a measure of stress-associated neural activity) were quantified using validated 18F-fluorodeoxyglucose positron emission tomography/computed tomography methods. SES was captured by neighborhood SES factors (e.g., median household income and crime). MACE within 5 years of imaging was adjudicated. RESULTS Over a median 4.0 years, 40 individuals experienced MACE. Baseline income inversely associated with amygdalar activity (standardized β: -0.157 [95% confidence interval (CI): -0.266 to -0.041]; p = 0.007) and arterial inflammation (β: -0.10 [95% CI: -0.18 to -0.14]; p = 0.022). Further, income associated with subsequent MACE (standardized hazard ratio: 0.67 [95% CI: 0.47 to 0.96]; p = 0.029) after multivariable adjustments. Mediation analysis demonstrated that the path of: ↓ neighborhood income to ↑ amygdalar activity to ↑ bone marrow activity to ↑ arterial inflammation to ↑ MACE was significant (β: -0.01 [95% CI: -0.06 to -0.001]; p < 0.05). CONCLUSIONS Lower SES: 1) associates with higher amygdalar activity; and 2) independently predicts MACE via a serial pathway that includes higher amygdalar activity, bone marrow activity, and arterial inflammation. These findings illuminate a stress-associated neurobiological mechanism by which SES disparities may potentiate adverse health outcomes.
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Affiliation(s)
- Ahmed Tawakol
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
| | - Michael T Osborne
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ying Wang
- Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Department of Nuclear Medicine, the First Hospital of China Medical University, Heping District, Shenyang, China
| | - Basma Hammed
- Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Brian Tung
- Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Tomas Patrich
- Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Blake Oberfeld
- Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Amorina Ishai
- Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Lisa M Shin
- Department of Psychology, Tufts University, Medford, Massachusetts
| | - Matthias Nahrendorf
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Erica T Warner
- Clinical Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jason Wasfy
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Zahi A Fayad
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Karestan Koenen
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Paul M Ridker
- Cardiology Division, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Roger K Pitman
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Katrina A Armstrong
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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Raggi P, Bellasi A, Bushinsky D, Bover J, Rodriguez M, Ketteler M, Sinha S, Salcedo C, Gillotti K, Padgett C, Garg R, Gold A, Perelló J, Chertow GM. Slowing Progression of Cardiovascular Calcification With SNF472 in Patients on Hemodialysis. Circulation 2020; 141:728-739. [DOI: 10.1161/circulationaha.119.044195] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background:
The high cardiovascular morbidity and mortality in patients with end-stage kidney disease could be partially caused by extensive cardiovascular calcification. SNF472, intravenous myo-inositol hexaphosphate, selectively inhibits the formation and growth of hydroxyapatite.
Methods:
This double-blind, placebo-controlled phase 2b trial compared progression of coronary artery calcium volume score and other measurements of cardiovascular calcification by computed tomography scan during 52 weeks of treatment with SNF472 or placebo, in addition to standard therapy, in adult patients with end-stage kidney disease receiving hemodialysis. Patients were randomized 1:1:1 to SNF472 300 mg (n=92), SNF472 600 mg (n=91), or placebo (n=91) by infusion in the hemodialysis lines thrice weekly during hemodialysis sessions. The primary end point was change in log coronary artery calcium volume score from baseline to week 52. The primary efficacy analysis combined the SNF472 treatment groups and included all patients who received at least 1 dose of SNF472 or placebo and had an evaluable computed tomography scan after randomization.
Results:
The mean change in coronary artery calcium volume score was 11% (95% CI, 7–15) for the combined SNF472 dose group and 20% (95% CI, 14–26) for the placebo group (
P
=0.016). SNF472 compared with placebo attenuated progression of calcium volume score in the aortic valve (14% [95% CI, 5–24] versus 98% [95% CI, 77–123];
P
<0.001) but not in the thoracic aorta (23% [95% CI, 16–30] versus 28% [95% CI, 19–38];
P
=0.40). Death occurred in 7 patients (4%) who received SNF472 and 5 patients (6%) who received placebo. At least 1 treatment-emergent adverse event occurred in 86%, 92%, and 87% of patients treated with SNF472 300 mg, SNF472 600 mg, and placebo, respectively. Most adverse events were mild. Adverse events resulted in discontinuation of SNF472 300 mg, SNF472 600 mg, and placebo for 14%, 29%, and 20% of patients, respectively.
Conclusions:
Compared with placebo, SNF472 significantly attenuated the progression of coronary artery calcium and aortic valve calcification in patients with end-stage kidney disease receiving hemodialysis in addition to standard care. Future studies are needed to determine the effects of SNF472 on cardiovascular events.
Registration:
URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT02966028.
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Affiliation(s)
- Paolo Raggi
- Department of Medicine, Mazankowski Alberta Heart Institute and University of Alberta, Edmonton, Canada (P.R.)
| | - Antonio Bellasi
- Research, Innovation and Brand Reputation Unit, ASST Papa Giovanni XXIII, Bergamo, Italy (A.B.)
| | - David Bushinsky
- Department of Medicine, University of Rochester Medical Center, NY (D.B.)
| | - Jordi Bover
- Department of Nephrology, Fundació Puigvert and Universitat Autònoma, IIB Sant Pau, REDinREN, Barcelona, Spain (J.B.)
| | - Mariano Rodriguez
- Nephrology Unit, Hospital Universitario Reina Sofia, IMIBIC, REDinREN, Córdoba, Spain (M.R.)
| | - Markus Ketteler
- Department of General Internal Medicine and Nephrology, Robert-Bosch-Krankenhaus, Stuttgart, Germany (M.K.)
| | - Smeeta Sinha
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, UK (S.S.)
| | - Carolina Salcedo
- Research and Development, Sanifit Therapeutics, Palma, Spain (C.S., J.P.)
| | - Kristen Gillotti
- Research and Development, Sanifit Therapeutics, San Diego, CA (K.G., C.P. R.G., A.G.)
| | - Claire Padgett
- Research and Development, Sanifit Therapeutics, San Diego, CA (K.G., C.P. R.G., A.G.)
| | - Rekha Garg
- Research and Development, Sanifit Therapeutics, San Diego, CA (K.G., C.P. R.G., A.G.)
| | - Alex Gold
- Research and Development, Sanifit Therapeutics, San Diego, CA (K.G., C.P. R.G., A.G.)
- Department of Medicine, Stanford University, Palo Alto, CA (A.G., G.M.C.)
| | - Joan Perelló
- Research and Development, Sanifit Therapeutics, Palma, Spain (C.S., J.P.)
- University of the Balearic Islands, Palma, Spain (J.P.)
| | - Glenn M. Chertow
- Department of Medicine, Stanford University, Palo Alto, CA (A.G., G.M.C.)
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Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Shay CM, Spartano NL, Stokes A, Tirschwell DL, VanWagner LB, Tsao CW. Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. Circulation 2020; 141:e139-e596. [PMID: 31992061 DOI: 10.1161/cir.0000000000000757] [Citation(s) in RCA: 4927] [Impact Index Per Article: 1231.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports on the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2020 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, metrics to assess and monitor healthy diets, an enhanced focus on social determinants of health, a focus on the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors, implementation strategies, and implications of the American Heart Association's 2020 Impact Goals. RESULTS Each of the 26 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, healthcare administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Moreyra E, Moreyra C, Tibaldi MA, Crespo F, Arias V, Lepori AJ, Moreyra EA. Concordance and prevalence of subclinical atherosclerosis in different vascular territories. Vascular 2020; 28:285-294. [DOI: 10.1177/1708538119894178] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Subclinical atherosclerosis (SA) in the carotid, femoral, and coronary territories is a powerful predictor of cardiovascular (CV) events. Whether it is sufficient to assess SA in a single vascular territory in early-stage disease is uncertain. We aimed to determine the prevalence and concordance of SA in these vascular beds in asymptomatic patients without known CV disease. Methods We enrolled patients aged 35 to 75 years who were asymptomatic, without known CV disease, and had undergone carotid and femoral Doppler ultrasonography and calcium scoring. Those receiving statins were excluded. SA was defined as the presence of plaques in the carotid and/or femoral arteries or the presence of calcium in the coronary arteries (Agatston score >0). Results A total of 212 patients were identified with a mean age of 53 ± 7 years, of which 60% (128 patients) were men. The prevalence of SA was 62%. The distribution of SA between the three territories was similar, involving the carotid territory in 38% of cases, the femoral in 31%, and the coronaries in 37%. The concordance between the different vascular territories was weak, with a k index of 0.21 between the coronary and carotid territories, 0.27 between the coronary and femoral territories, and 0.34 between the carotid and femoral territories. Conclusions The prevalence of SA in asymptomatic patients without known CV disease is high. The concordance in the presence of SA between the three vascular territories is weak. Therefore, all three vascular beds need to be investigated.
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Luo F, Feng C, Zhuo C. C-Reactive Protein and All-Cause Mortality in Patients with Stable Coronary Artery Disease: A Secondary Analysis Based on a Retrospective Cohort Study. Med Sci Monit 2019; 25:9820-9828. [PMID: 31863701 PMCID: PMC6937905 DOI: 10.12659/msm.919584] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background The association between C-reactive protein (CRP) and all-cause mortality (ACM) in patients with stable coronary artery disease (CAD) is unclear. Therefore, the aim of the present study was to explore the correlation between CRP and ACM in stable CAD patients. Material/Methods This study was a secondary analysis. Between October 2014 and October 2017, 196 patients aged 43 to 98 years who had a first diagnosis of stable CAD were recruited into this study. We divided the patients into 4 groups (Quartile 1: 0.01–0.03 mg/dL; Quartile 2: 0.04–0.11 mg/dL; Quartile 3: 0.12–0.33 mg/dL; and Quartile 4: 0.34–9.20 mg/dL) according to the concentration of CRP. The indicator surveyed in this research was ACM. Results During a median follow-up of 783 days, ACM occurred in 18 patients, with a mortality rate of 9.18% (18/196). Univariate analysis showed that elevated CRP was closely related to ACM in stable CAD patients (P<0.005). After controlling for potential confounding factors by multivariate logistic regression analysis, this relationship still existed. Pearson correlation analysis showed that elevated CRP log10 transform was associated with LVEF (r=−0.1936, P=0.0067). Receiver operating characteristic (ROC) curve analysis showed that the optimal concentration of CRP for the diagnosis of ACM was 0.345, and the area under the curve (AUC) was 0.735. Conclusions Elevated CRP is associated with ACM in stable CAD patients, and the best diagnostic threshold is 0.345.
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Affiliation(s)
- Faxin Luo
- Emergency Department, The People's Hospital of Longhua, Shenzhen, Guangdong, China (mainland)
| | - Caiyun Feng
- The People's Hospital of Longhua, Shenzhen, Guangdong, China (mainland)
| | - Chaozhou Zhuo
- Emergency Department, The People's Hospital of Longhua, Shenzhen, Guangdong, China (mainland)
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83
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Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Das SR, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Jordan LC, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, O'Flaherty M, Pandey A, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Spartano NL, Stokes A, Tirschwell DL, Tsao CW, Turakhia MP, VanWagner LB, Wilkins JT, Wong SS, Virani SS. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation 2019; 139:e56-e528. [PMID: 30700139 DOI: 10.1161/cir.0000000000000659] [Citation(s) in RCA: 5401] [Impact Index Per Article: 1080.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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84
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Muacevic A, Adler JR. Incidence and Implication of Coronary Artery Calcium on Non-gated Chest Computed Tomography Scans: A Large Observational Cohort. Cureus 2019; 11:e6218. [PMID: 31890419 PMCID: PMC6929257 DOI: 10.7759/cureus.6218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Coronary artery calcification (CAC) scoring is typically performed utilizing non-contrast, electrocardiogram- (ECG) gated CT and offers an estimation of cardiovascular (CV) prognosis and risk stratification beyond previously established cardiac risk factors. Coronary calcification can also be assessed during non-gated chest CT, which is significant given the recent recommendations for lung cancer screening by low-dose CT. Methods We retrospectively reviewed 4,953 non-contrast chest CT scans in a single, closed referral tertiary military treatment facility over an 18-month period. Baseline CV outcomes to include myocardial infarction (MI), cerebral vascular accidents (CVA), revascularization with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG), death, or a composite of all major adverse cardiac events (MACE), and baseline CV risk factors were abstracted from an electronic medical record (EMR) review. Results CAC was seen in 3,119 (63%) patients while 1,834 (27%) were without CAC. All traditional CV risk factors were more commonly observed in patients with CAC. Unadjusted odds of composite MACE, death, MI, coronary revascularization, and CVA between presence and absence of CAC were as follows: 3.55 [95% confidence interval (CI): 2.60-4.86, p: <0.0001]; 2.98 (95% CI: 2.02-4.40, p: <0.0001); 24.42 (95% CI: 3.36-177.6, p: <0.0001); 5.64 (95% CI: 2.58-12.32, p: <0.0001); and 2.32 (95% CI: 1.19-4.50, p: 0.0104), respectively. However, after adjusting for baseline risk factors, CAC on non-gated CT was associated only with an increased observed rate of MI (aOR: 38.1, 95% CI: 4.57-318.2, p: <0.0001) and revascularization (aOR: 5.58, 95% CI: 2.22-14.0, p; 0.0003). Conclusions Findings of CAC on non-gated chest CT may help to recognize patients who are at increased risk of MI and revascularization. Given the expected increase in chest CT utilization among former smokers for lung cancer screening, observed CAC should be reported to ordering providers in order to identify patients at increased risk of these important outcomes.
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85
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Abstract
PURPOSE OF REVIEW In this review, we describe the mechanism behind coronary artery calcification formation and detection, as well as its implication in cardiovascular disease (CVD) risk stratification, intervention, and prognosis in asymptomatic individuals. RECENT FINDINGS Multiple cohort and population studies have shown that coronary artery calcium scoring is effective and reproducible in predicting the risk for cardiovascular disease. The updated 2018 ACC/AHA guideline has incorporated consideration of coronary artery calcification testing into cardiovascular disease risk stratification and therapy guidance. Coronary artery calcification's evidence-based role in detection, risk stratification, and ultimately its unique influence on therapeutic intervention and prognosis of cardiovascular disease in asymptomatic population is increasingly being recognized..
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86
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Grandhi GR, Mirbolouk M, Dardari ZA, Al-Mallah MH, Rumberger JA, Shaw LJ, Blankstein R, Miedema MD, Berman DS, Budoff MJ, Krumholz HM, Blaha MJ, Nasir K. Interplay of Coronary Artery Calcium and Risk Factors for Predicting CVD/CHD Mortality: The CAC Consortium. JACC Cardiovasc Imaging 2019; 13:1175-1186. [PMID: 31734198 DOI: 10.1016/j.jcmg.2019.08.024] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 07/25/2019] [Accepted: 08/23/2019] [Indexed: 01/18/2023]
Abstract
OBJECTIVES This study sought to evaluate the association and burden of coronary artery calcium (CAC) with long-term, cause-specific mortality across the spectrum of baseline risk. BACKGROUND Although CAC is a known predictor of short-term, all-cause mortality, data on long-term and cause-specific mortality are inadequate. METHODS The CAC Consortium cohort is a multicenter cohort of 66,636 participants without coronary heart disease (CHD) who underwent CAC testing. The following risk factors (RFs) were considered: 1) current cigarette smoking; 2) dyslipidemia; 3) diabetes mellitus; 4) hypertension; and 5) family history of CHD. RESULTS During the 12.5-years median follow-up, 3,158 (4.7%) deaths occurred; 32% were cardiovascular disease (CVD) deaths. Participants with CAC scores ≥400 had a significantly increased risk for CHD and CVD mortality (hazard ratio [HR]: 5.44; 95% confidence interval [CI]: 3.88 to 7.62; and HR: 4.15; 95% CI: 3.29 to 5.22, respectively) compared with CAC of 0. Participants with ≥3 RFs had a smaller increased risk for CHD and CVD mortality (HR: 2.09; 95% CI: 1.52 to 2.85; and HR: 1.84; 95% CI: 1.46 to 2.31, respectively) compared with those without RFs. Across RF strata, CAC added prognostic information. For example, participants without RFs but with CAC ≥400 had significantly higher all-cause, non-CVD, CVD, and CHD mortality rates compared with participants with ≥3 RFs and CAC of 0. CONCLUSIONS Across the spectrum of RF burden, a higher CAC score was strongly associated with long-term, all-cause mortality and a greater proportion of deaths due to CVD and CHD. Absence of CAC identified people with a low risk over 12 years of follow-up, with most deaths being non-CVD in nature, regardless of RF burden.
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Affiliation(s)
- Gowtham R Grandhi
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
| | - Mohammadhassan Mirbolouk
- The Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, Maryland
| | - Zeina A Dardari
- The Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, Maryland
| | - Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
| | | | | | - Ron Blankstein
- Cardiovascular Division and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Michael D Miedema
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Daniel S Berman
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California
| | - Matthew J Budoff
- Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, California
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut; Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut; Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - Michael J Blaha
- The Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, Maryland
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart & Vascular Center, and Center for Outcomes Research (COR) Houston Methodist, Houston, Texas.
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Précoma DB, Oliveira GMMD, Simão AF, Dutra OP, Coelho OR, Izar MCDO, Póvoa RMDS, Giuliano IDCB, Alencar Filho ACD, Machado CA, Scherr C, Fonseca FAH, Santos Filho RDD, Carvalho TD, Avezum Á, Esporcatte R, Nascimento BR, Brasil DDP, Soares GP, Villela PB, Ferreira RM, Martins WDA, Sposito AC, Halpern B, Saraiva JFK, Carvalho LSF, Tambascia MA, Coelho-Filho OR, Bertolami A, Correa Filho H, Xavier HT, Faria-Neto JR, Bertolami MC, Giraldez VZR, Brandão AA, Feitosa ADDM, Amodeo C, Souza DDSMD, Barbosa ECD, Malachias MVB, Souza WKSBD, Costa FAAD, Rivera IR, Pellanda LC, Silva MAMD, Achutti AC, Langowiski AR, Lantieri CJB, Scholz JR, Ismael SMC, Ayoub JCA, Scala LCN, Neves MF, Jardim PCBV, Fuchs SCPC, Jardim TDSV, Moriguchi EH, Schneider JC, Assad MHV, Kaiser SE, Lottenberg AM, Magnoni CD, Miname MH, Lara RS, Herdy AH, Araújo CGSD, Milani M, Silva MMFD, Stein R, Lucchese FA, Nobre F, Griz HB, Magalhães LBNC, Borba MHED, Pontes MRN, Mourilhe-Rocha R. Updated Cardiovascular Prevention Guideline of the Brazilian Society of Cardiology - 2019. Arq Bras Cardiol 2019; 113:787-891. [PMID: 31691761 PMCID: PMC7020870 DOI: 10.5935/abc.20190204] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Affiliation(s)
- Dalton Bertolim Précoma
- Pontifícia Universidade Católica do Paraná (PUC-PR), Curitiba, PR - Brazil
- Sociedade Hospitalar Angelina Caron, Campina Grande do Sul, PR - Brazil
| | | | | | | | | | | | | | | | | | | | | | | | - Raul Dias Dos Santos Filho
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP - Brazil
- Hospital Israelita Albert Einstein, São Paulo, SP - Brazil
| | - Tales de Carvalho
- Clínica Cardiosport de Prevenção e Reabilitação, Florianópolis, SC - Brazil
- Departamento de Ergometria e Reabilitação Cardiovascular da Sociedade Brazileira de Cardiologia (DERC/SBC), Rio de Janeiro, RJ - Brazil
- Universidade do Estado de Santa Catarina (UDESC), Florianópolis, SC - Brazil
| | - Álvaro Avezum
- Hospital Alemão Oswaldo Cruz, São Paulo, SP - Brazil
| | - Roberto Esporcatte
- Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ - Brazil
- Hospital Pró-Cardíaco, Rio de Janeiro, RJ - Brazil
| | - Bruno Ramos Nascimento
- Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG - Brazil
| | - David de Pádua Brasil
- Faculdade de Ciências Médicas de Minas Gerias (CMMG) da Fundação Educacional Lucas Machado (FELUMA), Belo Horizonte, MG - Brazil
- Hospital Universitário Ciências Médicas (HUCM), Belo Horizonte, MG - Brazil
- Universidade Federal de Lavas (UFLA), Lavras, MG - Brazil
| | - Gabriel Porto Soares
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brazil
- Universidade de Vassouras, Vassouras, RJ - Brazil
| | - Paolo Blanco Villela
- Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brazil
- Hospital Samaritano, Rio de Janeiro, RJ - Brazil
| | | | - Wolney de Andrade Martins
- Universidade Federal Fluminense (UFF), Niterói, RJ - Brazil
- Complexo Hospitalar de Niterói, Niterói, RJ - Brazil
| | - Andrei C Sposito
- Universidade Estadual de Campinas (UNICAMP), Campina, SP - Brazil
| | - Bruno Halpern
- Universidade de São Paulo (USP), São Paulo, SP - Brazil
| | | | | | | | | | | | | | | | | | | | - Viviane Zorzanelli Rocha Giraldez
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP - Brazil
| | | | | | - Celso Amodeo
- Universidade Federal de São Paulo (UNIFESP), São Paulo, SP - Brazil
| | | | | | | | | | | | | | - Lucia Campos Pellanda
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS - Brazil
- Fundação Universitária de cardiologia do RS (ICFUC), Porto Alegre, RS - Brazil
| | | | | | | | | | - Jaqueline Ribeiro Scholz
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP - Brazil
| | | | - José Carlos Aidar Ayoub
- Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP - Brazil
- Instituto de Moléstias Cardiovasculares, São José do Rio Preto, SP - Brazil
| | | | - Mario Fritsch Neves
- Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ - Brazil
| | | | | | | | | | - Jamil Cherem Schneider
- SOS Cardio, Florianópolis, SC - Brazil
- Universidade do Sul de SC (Unisul), Florianópolis, SC - Brazil
| | | | | | - Ana Maria Lottenberg
- Hospital Israelita Albert Einstein, São Paulo, SP - Brazil
- Laboratório de Lípides (LIM10), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, São Paulo, SP - Brazil
| | | | - Marcio Hiroshi Miname
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP - Brazil
| | - Roberta Soares Lara
- Instituto de Nutrição Roberta Lara, Itu, SP - Brazil
- Diadia Nutrição e Gastronomia, Itu, SP - Brazil
| | - Artur Haddad Herdy
- Instituto de Cardiologia de Santa Catarina, São José, SC - Brazil
- Clínica Cardiosport de Prevenção e Reabilitação, Florianópolis, SC - Brazil
| | | | | | | | - Ricardo Stein
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brazil
| | | | | | - Hermilo Borba Griz
- Hospital Santa Joana Recife, Recife, PE - Brazil
- Hospital Agamenon Magalhães, Recife, PE - Brazil
| | | | | | - Mauro Ricardo Nunes Pontes
- Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS - Brazil
- Hospital São Francisco, Porto Alegre, RS - Brazil
| | - Ricardo Mourilhe-Rocha
- Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ - Brazil
- Hospital Pró-Cardíaco, Rio de Janeiro, RJ - Brazil
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88
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Arps K, Rifai MA, Blaha MJ, Michos ED, Nasir K, Yeboah J, Budoff MJ, Blumenthal RS, Bittencourt MS, McEvoy JW. Usefulness of Coronary Artery Calcium to Identify Adults of Sufficiently High Risk for Atherothrombotic Cardiovascular Events to Consider Low-Dose Rivaroxaban Thromboprophylaxis (from MESA). Am J Cardiol 2019; 124:1198-1206. [PMID: 31416591 PMCID: PMC6755041 DOI: 10.1016/j.amjcard.2019.07.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 07/08/2019] [Accepted: 07/11/2019] [Indexed: 11/17/2022]
Abstract
Low-dose rivaroxaban was effective in secondary prevention of atherosclerotic cardiovascular disease (ASCVD) in the COMPASS trial. There is no established role, however, for oral anticoagulants in primary prevention. We evaluated whether coronary artery calcium (CAC) scoring identifies a high-risk primary prevention adult population who may benefit from low-dose rivaroxaban to prevent ASCVD events. We modeled expected outcomes of low-dose rivaroxaban in 5,196 Multiethnic Study of Atherosclerosis (MESA) cohort participants not already on antiplatelet or anticoagulant therapy. We applied relative risk ratios from COMPASS to absolute MESA event rates in order to estimate number needed to treat (NNT) to avoid a composite of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke, as well as number needed to harm (NNH) to cause 1 hospitalized bleed; with both NNT and NNH stratified by calculated ASCVD risk and by baseline CAC. MESA participants with CAC ≥300 had crude ASCVD event rate of 20 per 1000 patient-years, which is comparable to that observed in the COMPASS control-arm. CAC was independently associated with the composite ASCVD outcome (p <0.001 for trend). However, CAC was not independently associated with adjusted hazard ratio for hospitalized major bleeding. Predicted 5-year NNT (modeled from COMPASS) was 75 in persons with CAC 100-299 and 45 with CAC ≥300 despite NNH values of 252 and 98, respectively. In conclusion, CAC helps to distinguish estimated ASCVD benefit from estimated bleeding harm, thereby identifying very high-risk primary prevention adults without established cardiovascular disease who may derive net-benefit from low-dose rivaroxaban.
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Affiliation(s)
- Kelly Arps
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland
| | - Mahmoud Al Rifai
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland
| | - Erin D Michos
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland
| | - Khurram Nasir
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - Joseph Yeboah
- Department of Heart and Vascular Center of Excellence, Wake Forest Baptist Health, Winston Salem, North Carolina
| | - Matthew J Budoff
- Department of Medicine, Harbor UCLA Medical Center, Los Angeles, California
| | - Roger S Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland
| | - Marcio S Bittencourt
- Centro de Pesquisa Clínica e Epidemiológica da Universidade de São Paulo (USP), São Paulo, Brazil
| | - John W McEvoy
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland; National Institute for Preventive Cardiology and National University of Ireland, Galway, Ireland.
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89
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Mitchell JD, Fergestrom N, Gage BF, Paisley R, Moon P, Novak E, Cheezum M, Shaw LJ, Villines TC. Impact of Statins on Cardiovascular Outcomes Following Coronary Artery Calcium Scoring. J Am Coll Cardiol 2019; 72:3233-3242. [PMID: 30409567 DOI: 10.1016/j.jacc.2018.09.051] [Citation(s) in RCA: 187] [Impact Index Per Article: 37.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 09/23/2018] [Accepted: 09/25/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Compared with traditional risk factors, coronary artery calcium (CAC) scores improve prognostic accuracy for atherosclerotic cardiovascular disease (ASCVD) outcomes. However, the relative impact of statins on ASCVD outcomes stratified by CAC scores is unknown. OBJECTIVES The authors sought to determine whether CAC can identify patients most likely to benefit from statin treatment. METHODS The authors identified consecutive subjects without pre-existing ASCVD or malignancy who underwent CAC scoring from 2002 to 2009 at Walter Reed Army Medical Center. The primary outcome was first major adverse cardiovascular event (MACE), a composite of acute myocardial infarction, stroke, and cardiovascular death. The effect of statin therapy on outcomes was analyzed stratified by CAC presence and severity, after adjusting for baseline comorbidities with inverse probability of treatment weights based on propensity scores. RESULTS A total of 13,644 patients (mean age 50 years; 71% men) were followed for a median of 9.4 years. Comparing patients with and without statin exposure, statin therapy was associated with reduced risk of MACE in patients with CAC (adjusted subhazard ratio: 0.76; 95% confidence interval: 0.60 to 0.95; p = 0.015), but not in patients without CAC (adjusted subhazard ratio: 1.00; 95% confidence interval: 0.79 to 1.27; p = 0.99). The effect of statin use on MACE was significantly related to the severity of CAC (p < 0.0001 for interaction), with the number needed to treat to prevent 1 initial MACE outcome over 10 years ranging from 100 (CAC 1 to 100) to 12 (CAC >100). CONCLUSIONS In a largescale cohort without baseline ASCVD, the presence and severity of CAC identified patients most likely to benefit from statins for the primary prevention of cardiovascular diseases.
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Affiliation(s)
- Joshua D Mitchell
- Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri.
| | - Nicole Fergestrom
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Brian F Gage
- General Medical Sciences, Washington University School of Medicine, St. Louis, Missouri
| | - Robert Paisley
- General Internal Medicine Section, Baylor College of Medicine, Houston, Texas
| | - Patrick Moon
- Internal Medicine Service, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Eric Novak
- Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri
| | - Michael Cheezum
- Cardiology Service, Fort Belvoir Community Hospital, Fort Belvoir, Virginia
| | - Leslee J Shaw
- Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia. https://twitter.com/lesleejshaw
| | - Todd C Villines
- Cardiology Service, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland
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90
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Miname MH, Bittencourt MS, Moraes SR, Alves RI, Silva PR, Jannes CE, Pereira AC, Krieger JE, Nasir K, Santos RD. Coronary Artery Calcium and Cardiovascular Events in Patients With Familial Hypercholesterolemia Receiving Standard Lipid-Lowering Therapy. JACC Cardiovasc Imaging 2019; 12:1797-1804. [DOI: 10.1016/j.jcmg.2018.09.019] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 09/17/2018] [Accepted: 09/20/2018] [Indexed: 02/04/2023]
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91
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Association between walking time spent and high sensitivity C-reactive protein level among obese women. ENFERMERIA CLINICA 2019. [DOI: 10.1016/j.enfcli.2019.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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92
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Emaus MJ, Išgum I, van Velzen SGM, van den Bongard HJGD, Gernaat SAM, Lessmann N, Sattler MGA, Teske AJ, Penninkhof J, Meijer H, Pignol JP, Verkooijen HM. Bragatston study protocol: a multicentre cohort study on automated quantification of cardiovascular calcifications on radiotherapy planning CT scans for cardiovascular risk prediction in patients with breast cancer. BMJ Open 2019; 9:e028752. [PMID: 31352417 PMCID: PMC6661654 DOI: 10.1136/bmjopen-2018-028752] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Cardiovascular disease (CVD) is an important cause of death in breast cancer survivors. Some breast cancer treatments including anthracyclines, trastuzumab and radiotherapy can increase the risk of CVD, especially for patients with pre-existing CVD risk factors. Early identification of patients at increased CVD risk may allow switching to less cardiotoxic treatments, active surveillance or treatment of CVD risk factors. One of the strongest independent CVD risk factors is the presence and extent of coronary artery calcifications (CAC). In clinical practice, CAC are generally quantified on ECG-triggered cardiac CT scans. Patients with breast cancer treated with radiotherapy routinely undergo radiotherapy planning CT scans of the chest, and those scans could provide the opportunity to routinely assess CAC before a potentially cardiotoxic treatment. The Bragatston study aims to investigate the association between calcifications in the coronary arteries, aorta and heart valves (hereinafter called 'cardiovascular calcifications') measured automatically on planning CT scans of patients with breast cancer and CVD risk. METHODS AND ANALYSIS In a first step, we will optimise and validate a deep learning algorithm for automated quantification of cardiovascular calcifications on planning CT scans of patients with breast cancer. Then, in a multicentre cohort study (University Medical Center Utrecht, Utrecht, Erasmus MC Cancer Institute, Rotterdam and Radboudumc, Nijmegen, The Netherlands), the association between cardiovascular calcifications measured on planning CT scans of patients with breast cancer (n≈16 000) and incident (non-)fatal CVD events will be evaluated. To assess the added predictive value of these calcifications over traditional CVD risk factors and treatment characteristics, a case-cohort analysis will be performed among all cohort members diagnosed with a CVD event during follow-up (n≈200) and a random sample of the baseline cohort (n≈600). ETHICS AND DISSEMINATION The Institutional Review Boards of the participating hospitals decided that the Medical Research Involving Human Subjects Act does not apply. Findings will be published in peer-reviewed journals and presented at conferences. TRIAL REGISTRATION NUMBER NCT03206333.
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Affiliation(s)
- Marleen J Emaus
- Imaging Division, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ivana Išgum
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sanne G M van Velzen
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Sofie A M Gernaat
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nikolas Lessmann
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Margriet G A Sattler
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Arco J Teske
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Joan Penninkhof
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Hanneke Meijer
- Department of Radiation Oncology, Radboudumc, Nijmegen, The Netherlands
| | - Jean-Philippe Pignol
- Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Helena M Verkooijen
- Imaging Division, University Medical Center Utrecht, Utrecht, The Netherlands
- Utrecht University, Utrecht, The Netherlands
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93
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Watson M, Dardari Z, Kianoush S, Hall ME, DeFilippis AP, Keith RJ, Benjamin EJ, Rodriguez CJ, Bhatnagar A, Lima JA, Butler J, Blaha MJ, Rifai MA. Relation Between Cigarette Smoking and Heart Failure (from the Multiethnic Study of Atherosclerosis). Am J Cardiol 2019; 123:1972-1977. [PMID: 30967285 PMCID: PMC6529241 DOI: 10.1016/j.amjcard.2019.03.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/04/2019] [Accepted: 03/07/2019] [Indexed: 12/18/2022]
Abstract
We studied the association between cigarette smoking and incident heart failure (HF) in a racially diverse US cohort. We included 6,792 participants from the Multi-Ethnic Study of Atherosclerosis with information on cigarette smoking at baseline, characterized by status, intensity, burden, and time since quitting. Adjudicated outcomes included total incident HF cases and HF stratified by ejection fraction (EF) into HF with reduced EF (HFrEF; EF ≤ 40%) and preserved EF (HFpEF; EF ≥ 50%). We used Cox proportional hazards models adjusted for traditional cardiovascular risk factors and accounted for competing risk of each HF type. Mean age was 62 ± 10 years; 53% were women, 61% were nonwhite, and 13% were current smokers. A total of 279 incident HF cases occurred over a median follow-up of 12.2 years. The incidence rates of HFrEF and HFpEF were 2.2 and 1.9 cases per 1000 person-years, respectively. Current smoking was associated with higher risk of HF compared with never smoking (hazard ratio [HR], 2.05; 95% confidence interval [CI], 1.36 to 3.09); this was similar for HFrEF (HR, 2.58; 95% CI, 1.27 to 5.25) and HFpEF (HR, 2.51; 95% CI, 1.15 to 5.49). Former smoking was not significantly associated with HF (HR, 1.17; 95% CI, 0.88 to 1.56). Smoking intensity, burden, and time since quitting did not provide additional information for HF risk after accounting for smoking status.
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Affiliation(s)
- Megan Watson
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Zeina Dardari
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland
| | - Sina Kianoush
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland; Department of Medicine, Yale-Waterbury, Waterbury, Connecticut
| | - Michael E Hall
- Division of Cardiology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Andrew P DeFilippis
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland; Diabetes and Obesity Center, University of Louisville School of Medicine, Louisville, Kentucky; Division of Cardiology, University of Louisville School of Medicine, Louisville, Kentucky
| | - Rachel J Keith
- Diabetes and Obesity Center, University of Louisville School of Medicine, Louisville, Kentucky; Division of Cardiology, University of Louisville School of Medicine, Louisville, Kentucky
| | - Emelia J Benjamin
- Department of Medicine, Division of Cardiology, Boston University School of Medicine, Boston, Massachusetts; Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Carlos J Rodriguez
- Maya Angelou Center for Health Equity, Wake Forest University, Winston-Salem, North Carolina
| | - Aruni Bhatnagar
- Diabetes and Obesity Center, University of Louisville School of Medicine, Louisville, Kentucky; Division of Cardiology, University of Louisville School of Medicine, Louisville, Kentucky
| | - Joao A Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Michael J Blaha
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland
| | - Mahmoud Al Rifai
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland; Department of Medicine, University of Kansas School of Medicine, Wichita, Kansas.
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94
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Alashi A, Lang R, Seballos R, Feinleib S, Sukol R, Cho L, Schoenhagen P, Griffin BP, Flamm SD, Desai MY. Reclassification of coronary heart disease risk in a primary prevention setting: traditional risk factor assessment vs. coronary artery calcium scoring. Cardiovasc Diagn Ther 2019; 9:214-220. [PMID: 31275811 DOI: 10.21037/cdt.2019.04.05] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background In a primary prevention screening program of asymptomatic middle-aged subjects, we sought to assess the degree of risk-reclassification provided by traditional risk assessment vs. coronary artery calcification scoring (CACS). Methods A total of 1,806 consecutive asymptomatic subjects (age 55 years, 76% men), who underwent comprehensive screening in a primary prevention clinic between 3/2016 and 9/2017 were included. Standard risk factors, C-reactive protein (CRP) and CAC scoring were performed. % 10-year coronary heart disease (CHD) risk was calculated using Reynolds Risk Score (RRS), atherosclerotic cardiovascular disease (ASCVD) score and multiethnic study on subclinical atherosclerosis (MESA) CACS were calculated. % 10-year CHD risk for all scores was categorized as follows: <1%, 1-5%, 6-10% and >10%. Results Mean CRP, RRS, ASCVD and MESA-CACS were 2.1±4.2, 3.7±4, 4.9±6, 4.9±5; 54% had CAC of 0, while 21% had CAC >75th percentile. There was a significant, but modest correlation between MESA-CAC score and (I) RRS (r=0.62) and (II) ASCVD scores (r=0.65, both P<0.001). Compared to MESA-CAC, for RRS, (I) 188 (10%) patients had a downgrade in risk and (II) 538 (30%) patients had an upgrade in risk (40% reclassification of risk). Similarly, compared to MESA-CAC, for ASCVD score, (I) 412 (23%) patients had a downgrade in risk and (II) 329 (18%) patients had a downgrade in risk (41% reclassification of risk). Conclusions In a primary prevention screening program of asymptomatic middle-aged patients, RRS overestimates and ASCVHD underestimates 10-year CHD risk vs. MESA-CACS. Addition of CACS results in significant risk reclassification.
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Affiliation(s)
- Alaa Alashi
- Cardiovascular Imaging Laboratory, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Richard Lang
- Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Raul Seballos
- Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Roxanne Sukol
- Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Leslie Cho
- Cardiovascular Imaging Laboratory, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Paul Schoenhagen
- Cardiovascular Imaging Laboratory, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Primary Prevention, Cleveland Clinic, Cleveland, OH, USA
| | - Brian P Griffin
- Cardiovascular Imaging Laboratory, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Scott D Flamm
- Cardiovascular Imaging Laboratory, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Primary Prevention, Cleveland Clinic, Cleveland, OH, USA
| | - Milind Y Desai
- Cardiovascular Imaging Laboratory, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Primary Prevention, Cleveland Clinic, Cleveland, OH, USA
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95
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Carr JJ, Jacobs DR, Terry JG, Shay CM, Sidney S, Liu K, Schreiner PJ, Lewis CE, Shikany JM, Reis JP, Goff DC. Association of Coronary Artery Calcium in Adults Aged 32 to 46 Years With Incident Coronary Heart Disease and Death. JAMA Cardiol 2019; 2:391-399. [PMID: 28196265 DOI: 10.1001/jamacardio.2016.5493] [Citation(s) in RCA: 237] [Impact Index Per Article: 47.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Coronary artery calcium (CAC) is associated with coronary heart disease (CHD) and cardiovascular disease (CVD); however, prognostic data on CAC are limited in younger adults. Objective To determine if CAC in adults aged 32 to 46 years is associated with incident clinical CHD, CVD, and all-cause mortality during 12.5 years of follow-up. Design, Setting, and Participants The Coronary Artery Risk Development in Young Adults (CARDIA) Study is a prospective community-based study that recruited 5115 black and white participants aged 18 to 30 years from March 25, 1985, to June 7, 1986. The cohort has been under surveillance for 30 years, with CAC measured 15 (n = 3043), 20 (n = 3141), and 25 (n = 3189) years after recruitment. The mean follow-up period for incident events was 12.5 years, from the year 15 computed tomographic scan through August 31, 2014. Main Outcomes and Measures Incident CHD included fatal or nonfatal myocardial infarction, acute coronary syndrome without myocardial infarction, coronary revascularization, or CHD death. Incident CVD included CHD, stroke, heart failure, and peripheral arterial disease. Death included all causes. The probability of developing CAC by age 32 to 56 years was estimated using clinical risk factors measured 7 years apart between ages 18 and 38 years. Results At year 15 of the study among 3043 participants (mean [SD] age, 40.3 [3.6] years; 1383 men and 1660 women), 309 individuals (10.2%) had CAC, with a geometric mean Agatston score of 21.6 (interquartile range, 17.3-26.8). Participants were followed up for 12.5 years, with 57 incident CHD events and 108 incident CVD events observed. After adjusting for demographics, risk factors, and treatments, those with any CAC experienced a 5-fold increase in CHD events (hazard ratio [HR], 5.0; 95% CI, 2.8-8.7) and 3-fold increase in CVD events (HR, 3.0; 95% CI, 1.9-4.7). Within CAC score strata of 1-19, 20-99, and 100 or more, the HRs for CHD were 2.6 (95% CI, 1.0-5.7), 5.8 (95% CI, 2.6-12.1), and 9.8 (95% CI, 4.5-20.5), respectively. A CAC score of 100 or more had an incidence of 22.4 deaths per 100 participants (HR, 3.7; 95% CI, 1.5-10.0); of the 13 deaths in participants with a CAC score of 100 or more, 10 were adjudicated as CHD events. Risk factors for CVD in early adult life identified those above the median risk for developing CAC and, if applied, in a selective CAC screening strategy could reduce the number of people screened for CAC by 50% and the number imaged needed to find 1 person with CAC from 3.5 to 2.2. Conclusions and Relevance The presence of CAC among individuals aged between 32 and 46 years was associated with increased risk of fatal and nonfatal CHD during 12.5 years of follow-up. A CAC score of 100 or more was associated with early death. Adults younger than 50 years with any CAC, even with very low scores, identified on a computed tomographic scan are at elevated risk of clinical CHD, CVD, and death. Selective use of screening for CAC might be considered in individuals with risk factors in early adulthood to inform discussions about primary prevention.
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Affiliation(s)
- John Jeffrey Carr
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis
| | - James G Terry
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Christina M Shay
- Center for Health Metrics and Evaluation, American Heart Association, Dallas, Texas
| | - Stephen Sidney
- Division of Research, Kaiser Permanente, Oakland, California
| | - Kiang Liu
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Pamela J Schreiner
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis
| | - Cora E Lewis
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham
| | - James M Shikany
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham
| | - Jared P Reis
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - David C Goff
- Department of Epidemiology, Colorado School of Public Health, Aurora
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96
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Mitevska I, Srbinovska E, Stojanovska L, Antova E, Apostolopoulos V, Bosevski M. Single-Photon Emission Computed Tomography Myocardial Ischemia Detection in High-Risk Asymptomatic Patients: Correlation with Coronary Calcium Score and High-Sensitivity C-Reactive Protein. Indian J Nucl Med 2019; 34:99-106. [PMID: 31040520 PMCID: PMC6481199 DOI: 10.4103/ijnm.ijnm_152_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background The association between myocardial ischemia in high-risk patients with coronary calcium score (CCS) and high-sensitivity C-reactive protein (hs-CRP) is not well established. Aims We evaluated the correlation between hs-CRP, CCS, and myocardial ischemia in asymptomatic high-risk patients without known coronary artery disease (CAD). Materials and Methods We prospectively assessed 68 asymptomatic high-risk outpatients without known CAD. One-day rest-stress Tc-99m single-photon emission computed tomography (SPECT) myocardial perfusion imaging and multislice computed tomography were performed. Multivariate regression analysis was performed for the assessment of predictors of myocardial ischemia. Standard risk factors and hs-CRP values were analyzed. Results CCS >0 Agatston score was observed in 26 patients (46.4%). Seven patients had CCS between 10 and 99 AU, 8 patients between 100 and 400 AU, and 11 patients had CCS >400 AU. Mild ischemia was noted in 11 patients, moderate ischemia in 10 patients, and severe ischemia in 6 patients. Hs-CRP was >1 mg/L in 39 patients, of whom 8 patients had CCS >0, 13 patients had normal SPECT results, 6 patients had mild ischemia, and 12 patients had moderate and severe ischemia. Multivariate regression analysis showed independent predictors for increased CCS: low-density lipoprotein cholesterol (odds ratio [OR]: 2.891; P = 0.001); age >70 years (OR: 2.568; P = 0.001); and smoking (OR: 1.931; P = 0.001). We found hs-CRP to be an independent predictor of myocardial ischemia (OR: 4.145; 95% confidence interval: 1.398-7.471, P = 0.001). Conclusion hs-CRP was an independent predictor of myocardial ischemia. hs-CRP might improve the selection of high-risk asymptomatic patients for myocardial SPECT imaging.
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Affiliation(s)
- Irena Mitevska
- Department of Nuclear Cardiology, University Cardiology Clinic, Skopje, Macedonia
| | - Elizabeta Srbinovska
- Department of Nuclear Cardiology, University Cardiology Clinic, Skopje, Macedonia
| | - Lily Stojanovska
- Department of Nuclear Cardiology, Victoria University, Melbourne, Australia
| | - Emilija Antova
- Department of Nuclear Cardiology, Victoria University, Melbourne, Australia
| | | | - Marijan Bosevski
- Department of Nuclear Cardiology, University Cardiology Clinic, Skopje, Macedonia
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97
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Leigh A, McEvoy JW, Garg P, Carr JJ, Sandfort V, Oelsner EC, Budoff M, Herrington D, Yeboah J. Coronary Artery Calcium Scores and Atherosclerotic Cardiovascular Disease Risk Stratification in Smokers. JACC Cardiovasc Imaging 2019; 12:852-861. [PMID: 29454784 PMCID: PMC6085167 DOI: 10.1016/j.jcmg.2017.12.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 12/21/2017] [Accepted: 12/23/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This study assessed the utility of the pooled cohort equation (PCE) and/or coronary artery calcium (CAC) for atherosclerotic cardiovascular disease (ASCVD) risk assessment in smokers, especially those who were lung cancer screening eligible (LCSE). BACKGROUND The U.S. Preventive Services Task Force recommended and the Centers for Medicare & Medicaid Services currently pays for annual screening for lung cancer with low-dose computed tomography scans in a specified group of cigarette smokers. CAC can be obtained from these low-dose scans. The incremental utility of CAC for ASCVD risk stratification remains unclear in this high-risk group. METHODS Of 6,814 MESA (Multi-Ethnic Study of Atherosclerosis) participants, 3,356 (49.2% of total cohort) were smokers (2,476 former and 880 current), and 14.3% were LCSE. Kaplan-Meier, Cox proportional hazards, area under the curve, and net reclassification improvement (NRI) analyses were used to assess the association between PCE and/or CAC and incident ASCVD. Incident ASCVD was defined as coronary death, nonfatal myocardial infarction, or fatal or nonfatal stroke. RESULTS Smokers had a mean age of 62.1 years, 43.5% were female, and all had a mean of 23.0 pack-years of smoking. The LCSE sample had a mean age of 65.3 years, 39.1% were female, and all had a mean of 56.7 pack-years of smoking. After a mean of 11.1 years of follow-up 13.4% of all smokers and 20.8% of LCSE smokers had ASCVD events; 6.7% of all smokers and 14.2% of LCSE smokers with CAC = 0 had an ASCVD event during the follow-up. One SD increase in the PCE 10-year risk was associated with a 68% increase risk for ASCVD events in all smokers (hazard ratio: 1.68; 95% confidence interval: 1.57 to 1.80) and a 22% increase in risk for ASCVD events in the LCSE smokers (hazard ratio: 1.22; 95% confidence interval: 1.00 to 1.47). CAC was associated with increased ASCVD risk in all smokers and in LCSE smokers in all the Cox models. The C-statistic of the PCE for ASCVD was higher in all smokers compared with LCSE smokers (0.693 vs. 0.545). CAC significantly improved the C-statistics of the PCE in all smokers but not in LCSE smokers. The event and nonevent net reclassification improvements for all smokers and LCSE smokers were 0.018 and -0.126 versus 0.16 and -0.196, respectively. CONCLUSIONS In this well-characterized, multiethnic U.S. cohort, CAC was predictive of ASCVD in all smokers and in LCSE smokers but modestly improved discrimination over and beyond the PCE. However, 6.7% of all smokers and 14.2% of LCSE smokers with CAC = 0 had an ASCVD event during follow-up.
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Affiliation(s)
- Adam Leigh
- Heart and Vascular Center of Excellence, Wake Forest University School of Medicine, Winston Salem, North Carolina
| | - John W McEvoy
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Parveen Garg
- Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - J Jeffrey Carr
- Departments of Cardiology and Radiology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Veit Sandfort
- Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Elizabeth C Oelsner
- Departments of Medicine and Epidemiology, Columbia University, New York, New York
| | - Matthew Budoff
- Los Angeles Biomedical Research Institute at Harbor-University of California, Los Angeles, Torrance California
| | - David Herrington
- Heart and Vascular Center of Excellence, Wake Forest University School of Medicine, Winston Salem, North Carolina
| | - Joseph Yeboah
- Heart and Vascular Center of Excellence, Wake Forest University School of Medicine, Winston Salem, North Carolina.
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98
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Coronary calcium is all we need for risk assessment, yet we do not use it often enough. Atherosclerosis 2019; 282:167-168. [DOI: 10.1016/j.atherosclerosis.2019.01.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 01/11/2019] [Indexed: 11/18/2022]
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99
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Andrade RLM, Gigante DP, de Oliveira IO, Horta BL. C-Peptide and cardiovascular risk factors among young adults in a southern Brazilian cohort. BMC Endocr Disord 2018; 18:80. [PMID: 30400868 PMCID: PMC6218973 DOI: 10.1186/s12902-018-0308-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 10/17/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Proinsulin connecting peptide (C-Peptide) is a marker of the beta-cell function and has been considered a marker of insulin resistance whose evidence suggests were associated with cardiovascular mortality. Our study aims to evaluate the association of C-Peptide with metabolic cardiovascular risk factors among young adults followed since birth in southern Brazil. METHODS In 1982, maternity hospital in Pelotas, a southern Brazilian city, were visited daily and all births were identified. Live births whose family lived in the urban area of the city were identified, their mothers interviewed, and these subjects have been prospectively followed. Casual hyperglycemia patients were excluded from analysis. C-Peptide was assessed at 23 years, when transversely analyzed its association with cardiometabolic and hemodynamic risk factors, and longitudinally 30 years of age. RESULTS At age 23, 4297 individuals were evaluated, and C-Peptide was measured in 3.807. In a cross-sectional analysis at 23 years of age, C-Peptide was positively associated with waist circumference, body mass index, glycaemia, triglycerides, and C-reactive protein. The association with HDL cholesterol was negative. In the longitudinal analysis at 30 years, C-Peptide remained associated with BMI, waist circumference, glycated hemoglobin, triglycerides, and C-reactive protein, whereas the association was negative for HDL. CONCLUSION In the Pelotas birth cohort, the C-Peptide was associated with obesity indicators (waist circumference and BMI) cross-sectional (23 years) and longitudinal (30 years). We also observed cross-sectional and longitudinal associations of C-Peptide with cardiometabolic and inflammatory risk factors.
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Affiliation(s)
- Romildo Luiz Monteiro Andrade
- University Hospital Cassiano Antônio de Moraes (HUCAM) of the Federal, University of Espírito Santo (UFES), Vitória-ES, Brazil
- Post-Graduate Program in Epidemiology, Federal University of Pelotas (UFPel), Pelotas-RS, Brazil
- Vitória, Brazil
| | - Denise P. Gigante
- Post-Graduate Program in Epidemiology, Federal University of Pelotas (UFPel), Pelotas-RS, Brazil
| | | | - Bernardo Lessa Horta
- Post-Graduate Program in Epidemiology, Federal University of Pelotas (UFPel), Pelotas-RS, Brazil
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Coronary Artery Calcium: Recommendations for Risk Assessment in Cardiovascular Prevention Guidelines. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:89. [DOI: 10.1007/s11936-018-0685-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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