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Pechlaner R, Xu Q, Kiechl S. Reply: Vascular Age Is Not Only Atherosclerosis, it Is Also Arteriosclerosis. J Am Coll Cardiol 2020; 76:230-231. [PMID: 32646576 DOI: 10.1016/j.jacc.2020.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/10/2020] [Indexed: 11/26/2022]
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152
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Liu Y, Zhang Z, Xia B, Wang L, Zhang H, Zhu Y, Liu C, Song B. Relationship between the non-HDLc-to-HDLc ratio and carotid plaques in a high stroke risk population: a cross-sectional study in China. Lipids Health Dis 2020; 19:168. [PMID: 32660519 PMCID: PMC7359500 DOI: 10.1186/s12944-020-01344-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/06/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Evidence on the association between the non-high-density lipoprotein cholesterol (non-HDLc)-to-high-density lipoprotein cholesterol (HDLc) ratio (non-HDLc/HDLc) and carotid plaques is still limited. This study aims to assess the relationship between the non-HDLc/HDLc and carotid plaques in a population with a high risk of stroke. METHODS A cross-sectional study based on the community was conducted in Yangzhou, China. Residents (no younger than 40 years old) underwent questionnaire interviews, physical examinations, and laboratory testing during 2013-2014. The subjects with a high risk of stroke were further selected (at least three of eight risk factors including hypertension, atrial fibrillation, type 2 diabetes mellitus, dyslipidaemia, smoking, lack of exercise, overweight, and family history of stroke) or a transient ischaemic attack (TIA) or stroke history. Carotid ultrasonography was then performed on the high stroke risk participants. Carotid plaque was defined as a focal carotid intima-media thickness (cIMT) ≥1.5 cm or a discrete structure protruding into the arterial lumen at least 50% of the surrounding cIMT. Logistic regression was employed to evaluate the relationship between the non-HDLc/HDLc and carotid plaques. RESULTS Overall, 839 subjects with a high risk of stroke were ultimately included in the analysis, and carotid plaques were identified in 341 (40.6%) of them. Participants in the highest non-HDLc/HDLc tertile group presented a higher proportion of carotid plaques than did those in the other two groups. After adjustment for other confounders, each unit increase in the non-HDLc/HDLc was significantly associated with carotid plaques (OR 1.55, 95%CI 1.28-1.88). In the subgroup analysis, the non-HDLc/HDLc was positively and significantly associated with the presence of carotid plaques in most subgroups. Additionally, the non-HDLc/HDLc interacted significantly with three stratification variables, including sex (OR 1.31 for males vs. OR 2.37 for females, P interaction = 0.016), exercise (OR 1.18 for subjects without lack of exercise vs. OR 1.99 for subjects with lack of exercise, P interaction = 0.004) and heart diseases (OR 1.40 for subjects without heart diseases vs. OR 3.12 for subjects with heart diseases, P interaction = 0.033). CONCLUSION The non-HDLc/HDLc was positively associated with the presence of carotid plaques in a Chinese high stroke risk population. A prospective study or randomized clinical trial of lipid-lowering therapy in the Chinese population is needed to evaluate their causal relationship.
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Affiliation(s)
- Yan Liu
- Endocrine and Diabetes Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, 8 Huadian East Road, Nanjing, 210028 China
- Department of Endocrinology, Clinical Medical College, Yangzhou University, 98 Nantong West Road, Yangzhou, 225001 China
| | - Zhenwen Zhang
- Department of Endocrinology, Clinical Medical College, Yangzhou University, 98 Nantong West Road, Yangzhou, 225001 China
| | - Binlan Xia
- Department of Ultrasonography, Clinical Medical College, Yangzhou University, 98 Nantong West Road, Yangzhou, 225001 China
| | - Liping Wang
- Department of Biobank, Clinical Medical College, Yangzhou University, 98 Nantong West Road, Yangzhou, 225001 China
| | - Hengzhong Zhang
- Department of Center of Health Management, Clinical Medical College, Yangzhou University, 98 Nantong West Road, Yangzhou, 225001 China
| | - Yan Zhu
- Department of Endocrinology, Clinical Medical College, Yangzhou University, 98 Nantong West Road, Yangzhou, 225001 China
| | - Chao Liu
- Endocrine and Diabetes Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, 8 Huadian East Road, Nanjing, 210028 China
| | - Bin Song
- Department of Center of Health Management, Clinical Medical College, Yangzhou University, 98 Nantong West Road, Yangzhou, 225001 China
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153
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Prediabetes Is Independently Associated with Subclinical Carotid Atherosclerosis: An Observational Study in a Non-Urban Mediterranean Population. J Clin Med 2020; 9:jcm9072139. [PMID: 32645918 PMCID: PMC7408832 DOI: 10.3390/jcm9072139] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 06/29/2020] [Accepted: 07/06/2020] [Indexed: 12/14/2022] Open
Abstract
This was a prospective, observational study to compare the burden of subclinical atherosclerosis as measured by carotid ultrasonography in a cohort of subjects with prediabetes vs. subjects with normal glucose tolerance (NGT) from a non-urban Mediterranean population. Atherosclerosis was assessed through carotid intima-media thickness (c-IMT), the presence/absence of carotid plaques, and plaque number. Among 550 subjects included, 224 (40.7%) had prediabetes. The mean c-IMT and the prevalence of carotid plaque were significantly higher in the prediabetes group compared to the NGT group (0.72 vs. 0.67 mm, p < 0.001; and 37.9% vs. 19.6%; p < 0.001, respectively). Older age, male gender, and increased systolic blood pressure were positively correlated with c-IMT and were independent predictors of the presence of plaques. In contrast, prediabetes and low-density lipoprotein (LDL)-c were predictors of the presence of plaque (odds ratio [OR] = 1.64; 95% confidence interval [CI] = 1.05-2.57; p = 0.03 and OR = 1.01; 95% CI = 1.00-1.02; p = 0.006, respectively) together with tobacco exposure and the leukocyte count (OR = 1.77; 95% CI = 1.08-2.89; p = 0.023 and OR = 1.20; 95% CI = 1.05-1.38; p = 0.008, respectively). In a non-urban Mediterranean population, prediabetes was associated with established subclinical carotid atherosclerosis. These findings could have implications for the prevention and treatment of CV risk in these subjects before the first symptoms of cardiovascular disease appear.
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154
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Abstract
In 44 years of practicing stroke prevention, I have learned many lessons; in this article, I hope to impart some of them. Three areas of my research are discussed. Controlling resistant hypertension is markedly improved by physiologically individualized therapy based on renin/aldosterone phenotyping; this is particularly important in black patients. Measurement of carotid plaque burden strongly predicts cardiovascular risk and is useful for genetic research and for a process called treating arteries instead of risk factors. Doing so in high-risk patients with asymptomatic carotid stenosis was associated with a >80% reduction in the 2-year risk of stroke and myocardial infarction. It also permitted the identification of extremes of atherosclerosis that are useful for studying both the genetics and the biology of atherosclerosis. Patients with very high plaque burden despite low levels of risk factors have an unexplained phenotype; those with little or no plaque despite high levels of risk factors are protected. Patients with unexplained atherosclerosis have higher plasma levels of toxic metabolites produced by the intestinal microbiome largely from egg yolk, red meat, and protein, and those metabolites are renally excreted. This has important dietary implications for stroke prevention. Lowering of plasma total homocysteine with B vitamins significantly reduces the risk of stroke. That was not apparent in early studies because harm from cyanocobalamin among participants with renal failure obscured the benefit among those with good renal function. We should be using B vitamins to prevent stroke but should use methylcobalamin or oxocobalamin instead of cyanocobalamin.
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Affiliation(s)
- J. David Spence
- Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, ON, Canada
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155
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Adams A, Bojara W, Romanens M. The Determination of the Plaque Burden on the Carotid Artery With Ultrasound Significantly Improves the Risk Prediction in Middle-Aged Subjects Compared to PROCAM: An Outcome Study. Cardiol Res 2020; 11:233-238. [PMID: 32595808 PMCID: PMC7295556 DOI: 10.14740/cr1067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/24/2020] [Indexed: 12/16/2022] Open
Abstract
Background There are only few data about the predictive value of atherosclerosis imaging beyond traditional risk calculators in younger subjects. Methods We assessed cardiovascular risk prediction with the PROCAM (the Prospective Cardiovascular Munster Study) risk equation and with carotid plaque imaging (determination of total plaque area (TPA) and the maximum plaque thickness with ultrasound) in subjects without known cardiovascular diseases. The follow-up was generated during follow-up examinations as part of preventive medical examinations or by telephone calls. Results In 2,508 subjects aged 35 - 64 years (50 ± 8 years, 34% women), 132 (5.3%) cardiovascular events occurred (42 myocardial infarction, 17 bypass surgery, 31 stent implantation, 42 coronary artery disease defined by invasive angiography) during a mean follow-up period of 5.4 (1 - 12) years. TPA in combination with the maximum plaque thickness (type III - IV b plaques ) tended to be superior compared to TPA, and both plaque imaging methods were superior to PROCAM: area under the curve (AUC) 0.9 (95% confidence interval (CI): 0.91 - 0.89) vs. 0.89 (95% CI: 0.90 - 0.88), P = 0.2 vs. 0.82 (95% CI: 0.84 - 0.81), P = 0.001; positive predictive value (PPV) 27% (95% CI: 0.31 - 0.22) vs. 19% (95% CI: 0.22 - 0.16) vs.19% (95% CI: 0.27 - 0.13). Conclusions Amount of carotid plaque assessed by carotid plaque imaging significantly improves cardiovascular risk prediction beyond the PROCAM risk equation.
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Affiliation(s)
- Ansgar Adams
- B·A·D Gesundheitsvorsorge und Sicherheitstechnik GmbH Zentrum Koblenz, Koblenz, Germany
| | - Waldemar Bojara
- Medizinische Klinik Kardiologie Koblenz, Gemeinschaftsklinikum Kemperhof II, Koblenz, Germany
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156
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Spence JD. New Canadian guideline is wrong to say acetylsalicylic acid is only for patients with symptomatic vascular disease. CMAJ 2020; 192:E661. [PMID: 32540911 DOI: 10.1503/cmaj.75470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- J David Spence
- Professor of Neurology & Clinical Pharmacology, Western University; Director, Stroke Prevention & Atherosclerosis Research Centre, Robarts Research Institute, London, Ont
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157
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Gurunathan S, Shanmuganathan M, Hampson R, Khattar R, Senior R. Role of adjuvant carotid ultrasound in women undergoing stress echocardiography for the assessment of suspected coronary artery disease. Open Heart 2020; 7:e001188. [PMID: 32587105 PMCID: PMC7319702 DOI: 10.1136/openhrt-2019-001188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 03/10/2020] [Accepted: 04/29/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Due to the low prevalence of obstructive coronary artery disease (CAD) in women, stress testing has a relatively low predictive value for this. Additionally, conventional cardiovascular risk scores underestimate risk in women. This study sought to evaluate the role of atherosclerosis assessment using carotid ultrasound (CU) in women attending for stress echocardiography (SE). METHODS This was a prospective study in which consecutive women with recent-onset suspected angina, who were referred for clinically indicated SE, underwent CU. RESULTS 415 women (mean age 61±10 years, 29% diabetes mellitus, mean body mass index 28) attending for SE underwent CU. 47 women (11%) had inducible wall motion abnormalities, and carotid disease (CD) was present in 46% (carotid plaque in 41%, carotid intima-media thickness >75th percentile in 15%). Women with CD were older (65 vs 58 years, p<0.001), and more likely to have diabetes (41% vs 21%, p=0.001), hypertension (67% vs 36%, p<0.01) and a higher pretest probability of CAD (59% vs 41%, p<0.001). 40% of women classified as low Framingham risk were found to have evidence of CD.The positive predictive value of SE for flow-limiting CAD was 51%, but with the presence of carotid plaque, this was 71% (p<0.01). Carotid plaque (p=0.004) and ischaemia (p=0.01) were the only independent predictors of >70% angiographic stenosis. In women with ischaemia on SE and no carotid plaque, the negative predictive value for flow-limiting disease was 88%.During a follow-up of 1058±234 days, there were 15 events (defined as all-cause mortality, non-fatal myocardial infarction, heart failure admissions and late coronary revascularisation). Age (HR 1.07 (1.00-1.15), p=0.04), carotid plaque burden (HR 1.65 (1.36-2.00), p<0.001) and ischaemic burden (HR 1.41 (1.18-1.68), p<0.001) were associated with outcome. There was a stepwise increase in events/year from 0.3% when there were no ischaemia and atherosclerosis, 1.1% when there was atherosclerosis and no ischaemia, 2.2% when there was ischaemia and no atherosclerosis and 10% when there were both ischaemia and atherosclerosis (p<0.001). CONCLUSION CU significantly improves the accuracy of SE alone for identifying flow-limiting disease on coronary angiography, and improves risk stratification in women attending for SE, as well identifying a subset of women who may benefit from primary preventative measures.
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Affiliation(s)
- Sothinathan Gurunathan
- National Heart and Lung Institute, Imperial College London, London, UK
- Department of Cardiology, Northwick Park Hospital, Harrow, UK
| | - Mayooran Shanmuganathan
- National Heart and Lung Institute, Imperial College London, London, UK
- Department of Cardiology, Northwick Park Hospital, Harrow, UK
| | | | - Rajdeep Khattar
- National Heart and Lung Institute, Imperial College London, London, UK
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Roxy Senior
- National Heart and Lung Institute, Imperial College London, London, UK
- Department of Cardiology, Northwick Park Hospital, Harrow, UK
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
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158
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Affiliation(s)
- Mohammed N Meah
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
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159
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Doneen AL, Bale BF, Vigerust DJ, Leimgruber PP. Cardiovascular Prevention: Migrating From a Binary to a Ternary Classification. Front Cardiovasc Med 2020; 7:92. [PMID: 32528979 PMCID: PMC7256212 DOI: 10.3389/fcvm.2020.00092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 04/29/2020] [Indexed: 12/21/2022] Open
Abstract
Migrating from a binary approach to risk assessment to a ternary model of disease identification allows for individualized, optimal disease management. Redefining the disease/inflammatory approach has been proven to identify, stabilize, and regress atherosclerosis while adding understanding to the progression of vascular disease. Our previously published results show the beneficial effect of comprehensive, evidence-based management on subclinical atherosclerosis and vulnerable plaque. We argue that this approach does not mitigate the value of utilizing standard risk factor identification, but rather augments it for the benefit of the individual patient.
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Affiliation(s)
- Amy Lynn Doneen
- College of Medicine, Washington State University, Spokane, WA, United States
| | - Bradley Field Bale
- College of Medicine, Washington State University, Spokane, WA, United States
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160
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Negative Risk Markers for Cardiovascular Events in the Elderly. J Am Coll Cardiol 2020; 74:1-11. [PMID: 31272534 DOI: 10.1016/j.jacc.2019.04.049] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/11/2019] [Accepted: 04/15/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Cardiovascular risk increases dramatically with age, leading to nearly universal risk-based statin eligibility in the elderly population. To limit overtreatment, elderly individuals at truly low risk need to be identified. OBJECTIVES Discovering "negative" risk markers able to identify elderly individuals at low short-term risk for coronary heart disease and cardiovascular disease. METHODS In 5,805 BioImage participants (mean age 69 years; median follow-up 2.7 years), the authors evaluated 13 candidate markers: coronary artery calcium (CAC) = 0, CAC ≤10, no carotid plaque, no family history, normal ankle-brachial index, test result <25th percentile (carotid intima-media thickness, apolipoprotein B, galectin-3, high-sensitivity C-reactive protein, lipoprotein(a), N-terminal pro-B-type natriuretic peptide, and transferrin), and apolipoprotein A1 >75th percentile. Negative risk marker performance was compared using patient-specific diagnostic likelihood ratio (DLR) and binary net reclassification index (NRI). RESULTS CAC = 0 and CAC ≤10 were the strongest negative risk markers with mean DLRs of 0.20 and 0.20 for coronary heart disease (i.e., ≈80% lower risk than expected from traditional risk factor assessment) and 0.41 and 0.48 for cardiovascular disease, respectively, followed by galectin-3 <25th percentile (DLR 0.44 and 0.43, respectively) and absence of carotid plaque (DLR 0.39 and 0.65, respectively). Results obtained by other candidate markers were less impressive. Accurate downward risk reclassification across the Class I statin-eligibility threshold defined by the American College of Cardiology/American Heart Association was largest for CAC = 0 (NRI 0.23) and CAC ≤10 (NRI 0.28), followed by galectin-3 <25th percentile (NRI 0.14) and absence of carotid plaque (NRI 0.08). CONCLUSIONS Elderly individuals with CAC = 0, CAC ≤10, low galectin-3, or no carotid plaque had remarkable low cardiovascular risk, calling into question the appropriateness of a treat-all approach in the elderly population.
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161
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Ahmadi A, Argulian E, Leipsic J, Newby DE, Narula J. From Subclinical Atherosclerosis to Plaque Progression and Acute Coronary Events: JACC State-of-the-Art Review. J Am Coll Cardiol 2020; 74:1608-1617. [PMID: 31537271 DOI: 10.1016/j.jacc.2019.08.012] [Citation(s) in RCA: 192] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 07/30/2019] [Accepted: 08/01/2019] [Indexed: 12/30/2022]
Abstract
It has been believed that most acute coronary events result from the rupture of mildly stenotic plaques, based on studies in which angiographic information was available from many months to years before the event. However, serial studies in which angiographic data were available from the past as also within 1 to 3 months of myocardial infarction have clarified that nonobstructive lesions progressively enlarged relatively rapidly before the acute event occurred. Noninvasive computed tomography angiography imaging data have confirmed that lesions that did not progress voluminously over time rarely led to events, regardless of the extent of luminal stenosis or baseline high-risk plaque morphology. Therefore, plaque progression could be proposed as a necessary step between early, uncomplicated atherosclerosis and plaque rupture. On the other hand, it has been convincingly demonstrated that intensive lipid-lowering therapy (to a low-density lipoprotein cholesterol level of <70 mg/dl) halts plaque progression. Given the current ability to noninvasively detect the presence of early atherosclerosis, the importance of plaque progression in the pathogenesis of myocardial infarction, and the efficacy of maximum lipid-lowering therapy, it has been suggested that plaque progression is a modifiable step in the evolution of atherosclerotic plaque. A personalized approach based on the detection of early atherosclerosis can trigger the necessary treatment to prevent plaque progression and hence plaque instability. Therefore, this approach can redefine the traditional paradigm of primary and secondary prevention based on population-derived risk estimates and can potentially improve long-term outcomes.
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Affiliation(s)
- Amir Ahmadi
- Icahn School of Medicine at Mount Sinai Hospital, New York, New York; St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Edgar Argulian
- Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Jonathon Leipsic
- St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, Scotland
| | - Jagat Narula
- Icahn School of Medicine at Mount Sinai Hospital, New York, New York.
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162
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Kocyigit D, Gurses KM, Taydas O, Poker A, Ozer N, Hazirolan T, Tokgozoglu L. Role of femoral artery ultrasound imaging in cardiovascular event risk prediction in a primary prevention cohort at a medium-term follow-up. J Cardiol 2020; 75:537-543. [DOI: 10.1016/j.jjcc.2019.09.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 09/04/2019] [Accepted: 09/20/2019] [Indexed: 10/25/2022]
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163
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“Sound” Advice—Let's “Stress” the Importance of Prevention: Combining Carotid Ultrasound and Stress Echocardiography for Cardiovascular Risk Assessment. J Am Soc Echocardiogr 2020; 33:570-572. [DOI: 10.1016/j.echo.2020.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 03/05/2020] [Accepted: 03/05/2020] [Indexed: 02/03/2023]
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164
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Bierig SM, Arnold A, Einbinder LC, Armbrecht E, Burroughs T. Unrecognized Cardiovascular Abnormalities Detected Through a Community Cardiovascular Screening Program. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2020. [DOI: 10.1177/8756479320905836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Self-referral community cardiovascular screening programs (CCSPs) have a potential to reduce outcome events through early detection of disease. This study evaluated the characteristics of a population that could predict a positive test. Materials and Methods: Participants who completed a cardiovascular screening protocol were compared. The screening protocol included a blood pressure (BP), Doppler ankle brachial index (ABI) testing, a limited carotid sonogram, a limited aortic sonogram, electrocardiogram (ECG), and limited transthoracic echocardiogram (TTE). Results: Screenings were performed on 205 participants (58% female, 68 ± 9 years of age). Sixty-seven (34%) participants were abnormal in at least one of the following screening tests: ABI (2%), carotid sonogram (6%), aortic sonogram (3%), ECG (11%), and TTE (22%). Although 60.5% of the participants reported recent symptoms, there were no differences in normal or abnormal results of participants presenting with or without symptoms ( P = .06). Income was not a predictor of abnormal test results (odds ratio, 0.76; 95% confidence interval, 0.55–0.97; P = .19). Multivariate analysis demonstrated, when controlling for age greater than 75 years, that participants taking BP medication was the only variable that predicted a positive test result. Conclusion: One-third of patient results were abnormal, regardless of symptoms or lack thereof, suggestive of subclinical disease. Further large-scale studies would demonstrate the role of CCSPs in risk stratifying participants.
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Affiliation(s)
| | | | | | - Eric Armbrecht
- Saint Louis University Center for Outcomes Research, Salus Center, Saint Louis, MO, USA
| | - Thomas Burroughs
- Saint Louis University Center for Outcomes Research, Salus Center, Saint Louis, MO, USA
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165
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Almeida DM, Charles ST, Mogle J, Drewelies J, Aldwin CM, Spiro A, Gerstorf D. Charting adult development through (historically changing) daily stress processes. AMERICAN PSYCHOLOGIST 2020; 75:511-524. [PMID: 32378946 PMCID: PMC7213066 DOI: 10.1037/amp0000597] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
This article views adult development through the lens of daily life experiences and recent historical changes in these experiences. In particular, it examines whether theories that postulate general linear increases in well-being throughout adulthood still hold during times of less prosperity and more uncertainty. Descriptive analyses of the National Study of Daily Experiences chart show how stress in the daily lives of Americans may have changed from the 1990s (N = 1,499) to the 2010s (N = 782). Results revealed that adults in the 2010s reported experiencing stressors on 2% more days than in the 1990s, which translates to an additional week of stressors across a year. Participants in the 2010s also reported that stressors were more severe and posed more risks to future plans and finances and that they experienced more distress. These historical changes were particularly pronounced among middle-aged adults (e.g., proportion of stressor days increased by 19%, and perceived risks to finances and to future plans rose by 61% and 52%, respectively). As a consequence, age-related linear increases in well-being observed from young adulthood to midlife in the 1990s were no longer observed in the 2010s. If further studies continue to replicate our findings, traditional theories of adult well-being that were developed and empirically tested during times of relative economic prosperity may need to be reevaluated in light of the changes in middle adulthood currently observed in this historic period. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- David M Almeida
- Department of Human Development and Family Studies, Pennsylvania State University
| | - Susan T Charles
- Department of Psychological Science, University of California, Irvine
| | - Jacqueline Mogle
- Department of Human Development and Family Studies, Prevention Research Center, Pennsylvania State University
| | | | - Carolyn M Aldwin
- Department of Human Development and Family Sciences, Oregon State University
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Ershova AI, Balakhonova TV, Ivanova AA, Meshkov AN, Boytsov SA, Drapkina OM. The problem of cardiovascular risk stratification depending on the severity of carotid and femoral artery atherosclerosis. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2020. [DOI: 10.15829/1728-8800-2020-2441] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- A. I. Ershova
- National Medical Research Center for Therapy and Preventive Medicine
| | | | | | - A. N. Meshkov
- National Medical Research Center for Therapy and Preventive Medicine
| | | | - O. M. Drapkina
- National Medical Research Center for Therapy and Preventive Medicine
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167
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Pathophysiological and Genetic Aspects of Vascular Calcification. Cardiol Res Pract 2020; 2020:5169069. [PMID: 32411445 PMCID: PMC7201852 DOI: 10.1155/2020/5169069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 02/17/2020] [Accepted: 03/23/2020] [Indexed: 12/21/2022] Open
Abstract
Recent evidence suggests that vascular calcification is an independent cardiovascular risk factor (CRF) of morbidity and mortality. New studies point out the existence of a complex physiopathological mechanism that involves inflammation, oxidation, the release of chemical mediators, and genetic factors that promote the osteochondrogenic differentiation of vascular smooth muscle cells (VSMC). This review will evaluate the main mechanisms involved in the pathophysiology and genetics modulation of the process of vascular calcification. Objective. A systematic review of the pathophysiology factors involved in vascular calcification and its genetic influence was performed. Methods. A systematic review was conducted in the Medline and PubMed databases and were searched for studies concerning vascular calcification using the keywords and studies published until 2020/01 in English. Inclusion Criteria. Studies in vitro, animal models, and humans. These include cohort (both retrospective and prospective cohort studies), case-control, cross-sectional, and systematic reviews. Exclusion Criteria. Studies before 2003 of the existing literature.
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168
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Kozakova M, Palombo C. Imaging subclinical atherosclerosis in cardiovascular risk stratification. Eur J Prev Cardiol 2020; 28:247-249. [PMID: 33611429 DOI: 10.1177/2047487320916589] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Michaela Kozakova
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Carlo Palombo
- Department of Surgical, Medical Molecular Pathology and Critical Care Medicine, University of Pisa, Italy
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169
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Johnson M, Brook JR, Brook RD, Oiamo TH, Luginaah I, Peters PA, Spence JD. Traffic-Related Air Pollution and Carotid Plaque Burden in a Canadian City With Low-Level Ambient Pollution. J Am Heart Assoc 2020; 9:e013400. [PMID: 32237976 PMCID: PMC7428640 DOI: 10.1161/jaha.119.013400] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background The association between fine particulate matter and cardiovascular disease has been convincingly demonstrated. The role of traffic‐related air pollutants is less clear. To better understand the role of traffic‐related air pollutants in cardiovascular disease development, we examined associations between NO2, carotid atherosclerotic plaque, and cardiometabolic disorders associated with cardiovascular disease. Methods and Results Cross‐sectional analyses were conducted among 2227 patients (62.9±13.8 years; 49.5% women) from the Stroke Prevention and Atherosclerosis Research Centre (SPARC) in London, Ontario, Canada. Total carotid plaque area measured by ultrasound, cardiometabolic disorders, and residential locations were provided by SPARC medical records. Long‐term outdoor residential NO2 concentrations were generated by a land use regression model. Associations between NO2, total carotid plaque area, and cardiometabolic disorders were examined using multiple regression models adjusted for age, sex, smoking, and socioeconomic status. Mean NO2 was 5.4±1.6 ppb in London, Ontario. NO2 was associated with a significant increase in plaque (3.4 mm2 total carotid plaque area per 1 ppb NO2), exhibiting a linear dose‐response. NO2 was also positively associated with triglycerides, total cholesterol, and the ratio of low‐ to high‐density lipoprotein cholesterol (P<0.05). Diabetes mellitus mediated the relationship between NO2 and total carotid plaque area (P<0.05). Conclusions Our results demonstrate that even low levels of traffic‐related air pollutants are linked to atherosclerotic plaque burden, an association that may be partially attributable to pollution‐induced diabetes mellitus. Our findings suggest that reducing ambient concentrations in cities with NO2 below current standards would result in additional health benefits. Given the billions of people exposed to traffic emissions, our study supports the global public health significance of reducing air pollution.
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Affiliation(s)
- Markey Johnson
- Air Health Science Division Health Canada Ottawa Ontario Canada
| | - Jeffrey R Brook
- Dalla Lana School of Public Health and Department of Chemical Engineering and Applied Chemistry University of Toronto Ontario Canada
| | - Robert D Brook
- Department of Internal Medicine University of Michigan Ann Arbor MI
| | - Tor H Oiamo
- Department of Geography and Environmental Studies Ryerson University Toronto Ontario Canada
| | - Isaac Luginaah
- Department of Geography Western University London Ontario Canada
| | - Paul A Peters
- Department of Health Sciences Carleton University Ottawa Ontario Canada
| | - J David Spence
- Department of Neurology and Clinical Pharmacology Western University London Ontario Canada.,Stroke Prevention and Atherosclerosis Research Centre Robarts Research Institute Western University London Ontario Canada
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170
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Daghem M, Bing R, Fayad ZA, Dweck MR. Noninvasive Imaging to Assess Atherosclerotic Plaque Composition and Disease Activity: Coronary and Carotid Applications. JACC Cardiovasc Imaging 2020; 13:1055-1068. [PMID: 31422147 PMCID: PMC10661368 DOI: 10.1016/j.jcmg.2019.03.033] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 03/07/2019] [Accepted: 03/24/2019] [Indexed: 12/20/2022]
Abstract
Cardiovascular disease is one of the leading causes of mortality and morbidity worldwide. Atherosclerosis imaging has traditionally focused on detection of obstructive luminal stenoses or measurements of plaque burden. However, with advances in imaging technology it has now become possible to noninvasively interrogate plaque composition and disease activity, thereby differentiating stable from unstable patterns of disease and potentially improving risk stratification. This manuscript reviews multimodality imaging in this field, focusing on carotid and coronary atherosclerosis and how these novel techniques have the potential to complement current imaging assessments and improve clinical decision making.
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Affiliation(s)
- Marwa Daghem
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Rong Bing
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Zahi A Fayad
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
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171
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Sprynger M, Girbea A. Can we improve cardiovascular risk assessment with ultrasounds? Eur Heart J Cardiovasc Imaging 2020; 21:397-398. [DOI: 10.1093/ehjci/jeaa006] [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: 11/14/2022] Open
Affiliation(s)
- Muriel Sprynger
- Department of Cardiology, University Hospital of Liège, Boulevard de l'Hopital, B 4000 Liège, Belgium
| | - Alexandra Girbea
- Department of Cardiology, University Hospital of Liège, Boulevard de l'Hopital, B 4000 Liège, Belgium
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172
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Infante T, Del Viscovo L, De Rimini ML, Padula S, Caso P, Napoli C. Network Medicine: A Clinical Approach for Precision Medicine and Personalized Therapy in Coronary Heart Disease. J Atheroscler Thromb 2020; 27:279-302. [PMID: 31723086 PMCID: PMC7192819 DOI: 10.5551/jat.52407] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 09/24/2019] [Indexed: 12/13/2022] Open
Abstract
Early identification of coronary atherosclerotic pathogenic mechanisms is useful for predicting the risk of coronary heart disease (CHD) and future cardiac events. Epigenome changes may clarify a significant fraction of this "missing hereditability", thus offering novel potential biomarkers for prevention and care of CHD. The rapidly growing disciplines of systems biology and network science are now poised to meet the fields of precision medicine and personalized therapy. Network medicine integrates standard clinical recording and non-invasive, advanced cardiac imaging tools with epigenetics into deep learning for in-depth CHD molecular phenotyping. This approach could potentially explore developing novel drugs from natural compounds (i.e. polyphenols, folic acid) and repurposing current drugs, such as statins and metformin. Several clinical trials have exploited epigenetic tags and epigenetic sensitive drugs both in primary and secondary prevention. Due to their stability in plasma and easiness of detection, many ongoing clinical trials are focused on the evaluation of circulating miRNAs (e.g. miR-8059 and miR-320a) in blood, in association with imaging parameters such as coronary calcifications and stenosis degree detected by coronary computed tomography angiography (CCTA), or functional parameters provided by FFR/CT and PET/CT. Although epigenetic modifications have also been prioritized through network based approaches, the whole set of molecular interactions (interactome) in CHD is still under investigation for primary prevention strategies.
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Affiliation(s)
- Teresa Infante
- Department of Advanced Clinical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Luca Del Viscovo
- Department of Precision Medicine, Section of Diagnostic Imaging, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | | | - Sergio Padula
- Department of Cardiology, A.O.R.N. Dei Colli, Monaldi Hospital, Naples, Italy
| | - Pio Caso
- Department of Cardiology, A.O.R.N. Dei Colli, Monaldi Hospital, Naples, Italy
| | - Claudio Napoli
- Clinical Department of Internal Medicine and Specialistics, Department of Advanced Clinical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
- IRCCS SDN, Naples, Italy
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173
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Fernández-Cidón B, Candás-Estébanez B, Ribalta J, Rock E, Guardiola-Guionnet M, Amigó N, Padró-Miquel A, Alía-Ramos P, Pintó-Sala X. Precipitated sdLDL: An easy method to estimate LDL particle size. J Clin Lab Anal 2020; 34:e23282. [PMID: 32198796 PMCID: PMC7370712 DOI: 10.1002/jcla.23282] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 01/16/2020] [Accepted: 02/04/2020] [Indexed: 11/10/2022] Open
Abstract
Background LDL‐C lowering is the main measure in cardiovascular disease prevention but a residual risk of ischemic events still remains. Alterations of lipoproteins, specially, increase in small dense LDL (sdLDL) particles are related to this risk. Objective To investigate the potential use of sdLDL cholesterol concentration (sdLDL‐C) isolated by an easy precipitation method and to assess the impact of a set of clinical and biochemical variables determined by NMR on sdLDL concentration. Methods sdLDL‐C and NMR lipid profile were performed in 85 men samples. Association among them was evaluated using Pearson coefficients (rxy). A multivariate regression was performed to identify the influence of NMR variables on sdLDL‐C. Results A strong association between sdLDL‐C and LDLLDL‐P (rxy = 0.687) and with LDL‐Z (rxy = −0.603) was found. The multivariate regression explained a 56.8% in sdLDL‐C variation (P = 8.77.10‐12). BMI, ApoB, triglycerides, FFA, and LDL‐Z showed a significant contribution. The most important ones were ApoB and LDL‐Z; a 1nm increase (LDL‐Z) leads to decrease 126 nmol/L in sdLDL‐C. Conclusion The association between sdLDL‐C, LDL‐Z, and LDL‐P is clear. From a large number of variables, especially LDL‐Z and apoB influence on sdLDL‐C. Results show that the smaller the LDL size, the higher their cholesterol concentration. Therefore, sdLDL‐C determination by using this easy method would be useful to risk stratification and to uncover cardiovascular residual risk.
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Affiliation(s)
- Bárbara Fernández-Cidón
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain.,Department of Biochemistry, Molecular Biology and Biomedicine, Autonomous University of Barcelona (UAB), Barcelona, Spain
| | | | - Josep Ribalta
- Institut d'Investigació Sanitària Pere Virgili, Reus, Spain
| | - Edmond Rock
- French National Institute for Agricultural Research, Paris, France
| | | | - Núria Amigó
- Institut d'Investigació Sanitària Pere Virgili, Reus, Spain
| | | | - Pedro Alía-Ramos
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Xavier Pintó-Sala
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
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174
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Marin M, Bia D, Zócalo Y. Carotid and Femoral Atherosclerotic Plaques in Asymptomatic and Non-Treated Subjects: Cardiovascular Risk Factors, 10-Years Risk Scores, and Lipid Ratios´ Capability to Detect Plaque Presence, Burden, Fibro-Lipid Composition and Geometry. J Cardiovasc Dev Dis 2020; 7:E11. [PMID: 32204546 PMCID: PMC7151111 DOI: 10.3390/jcdd7010011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/16/2020] [Accepted: 03/17/2020] [Indexed: 12/24/2022] Open
Abstract
Carotid and/or femoral atherosclerotic plaques (AP) assessment through imaging studies is an interesting strategy for improving individual cardiovascular risk (CVR) stratification and cardiovascular disease (CVD) and/or events prediction. There is no consensus on who would benefit from image screening aimed at determining AP presence, burden, and characteristics. AIMS (1) to identify, in asymptomatic and non-treated subjects, demographic factors, anthropometric characteristics and cardiovascular risk factors (CRFs), individually or grouped (e.g., CVR equations, pro-atherogenic lipid ratios) associated with carotid and femoral AP presence, burden, geometry, and fibro-lipid content; (2) to identify cut-off values to be used when considering the variables as indicators of increased probability of AP presence, elevated atherosclerotic burden, and/or lipid content, in a selection scheme for subsequent image screening. METHODS CRFs exposure and clinical data were obtained (n = 581; n = 144 with AP; 47% females). Arterial (e.g., ultrasonography) and hemodynamic (central [cBP] and peripheral blood pressure; oscillometry/applanation tonometry) data were obtained. Carotid and femoral AP presence, burden (e.g., AP number, involved territories), geometric (area, width, height) and fibro-lipid content (semi-automatic, virtual histology analysis, grayscale analysis and color mapping) were assessed. Lipid profile was obtained. Lipid ratios (Total cholesterol/HDL-cholesterol, LDL-cholesterol/HDL-cholesterol, LogTryglicerides(TG)/HDL-cholesterol) and eight 10-years [y.]/CVR scores were quantified (e.g., Framingham Risk Scores [FRS] for CVD). RESULTS Age, 10-y./CVR and cBP showed the highest levels of association with AP presence and burden. Individually, classical CRFs and lipid ratios showed almost no association with AP presence. 10-y./CVR levels, age and cBP enabled detecting AP with large surfaces (˃p75th). Lipid ratios showed the largest association with AP fibro-lipid content. Ultrasound evaluation could be considered in asymptomatic and non-treated subjects aiming at population screening of AP (e.g., ˃ 45 y.; 10-y./FRS-CVD ˃ 5-8%); identifying subjects with high atherosclerotic burden (e.g., ˃50 y., 10-y./FRS-CVD ˃ 13-15%) and/or with plaques with high lipid content (e.g., LogTG/HDL ˃ 0.135).
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175
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Schinkel AFL, Bosch JG, Staub D, Adam D, Feinstein SB. Contrast-Enhanced Ultrasound to Assess Carotid Intraplaque Neovascularization. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:466-478. [PMID: 31791553 DOI: 10.1016/j.ultrasmedbio.2019.10.020] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/25/2019] [Accepted: 10/28/2019] [Indexed: 06/10/2023]
Abstract
Contrast-enhanced ultrasound (CEUS) is increasingly being used to identify patients with carotid plaques that are vulnerable to rupture, so-called vulnerable atherosclerotic plaques, by assessment of intraplaque neovascularization. A complete overview of the strengths and limitations of carotid CEUS is currently not available. The aim of this systematic review was to provide a complete overview of existing publications on the role of CEUS in assessment of carotid intraplaque neovascularization. The systematic review of the literature yielded 52 studies including a total of 4660 patients (mean age: 66 y, 71% male) who underwent CEUS for the assessment of intraplaque neovascularization. The majority of the patients (76%) were asymptomatic and had no history of transient ischemic attack (TIA) or stroke. The assessment of intraplaque neovascularization was mostly performed using a visual scoring system; several studies used time-intensity curves or dedicated quantification software to optimize analysis. In 17 studies CEUS was performed in patients before carotid surgery (endarterectomy), allowing a comparison of pre-operative CEUS findings with histologic analysis of the tissue sample that is removed from the carotid artery. In a total of 576 patients, the CEUS findings were compared with histopathological analysis of the plaque after surgery. In 16 of the 17 studies, contrast enhancement was found to correlate with the presence and degree of intraplaque neovascularization on histology. Plaques with a larger amount of contrast enhancement had significantly increased density of microvessels in the corresponding region on histology. In conclusion, CEUS is a readily available imaging modality for the assessment of patients with carotid atherosclerosis, providing information on atherosclerotic plaques, such as ulceration and intraplaque neovascularization, which may be clinically relevant. The ultimate clinical goal is the early identification of carotid atherosclerosis to start early preventive therapy and prevent clinical complications such as TIA and stroke.
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Affiliation(s)
- Arend F L Schinkel
- Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.
| | - Johan G Bosch
- Department of Biomedical Engineering, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Daniel Staub
- Division of Angiology, Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Dan Adam
- Biomedical Engineering, Israel Institute of Technology, Haifa, Israel
| | - Steven B Feinstein
- Section of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
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176
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Paraskevas KI, Sillesen HH, Rundek T, Mathiesen EB, Spence JD. Carotid Intima-Media Thickness Versus Carotid Plaque Burden for Predicting Cardiovascular Risk. Angiology 2020; 71:108-111. [PMID: 31569951 DOI: 10.1177/0003319719878582] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Kosmas I Paraskevas
- Department of General and Vascular Surgery, Central Clinic of Athens, Athens, Greece
| | - Henrik H Sillesen
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tatjana Rundek
- Department of Neurology, the Evelyn F. McKnight Brain Institute, Miller School of Medicine, University of Miami, FL, USA
| | - Ellisiv B Mathiesen
- Faculty of Health Sciences, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.,Department of Neurology, University of North Norway, Tromsø, Norway
| | - J David Spence
- Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, Ontario, Canada
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177
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Schreinlechner M, Noflatscher M, Reinstadler SJ, Sommer P, Lener D, Reiser E, Theurl M, Kirchmair R, Bauer A, Marschang P. Early onset of menopause is associated with increased peripheral atherosclerotic plaque volume and progression. Atherosclerosis 2020; 297:25-31. [PMID: 32062136 DOI: 10.1016/j.atherosclerosis.2020.01.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 01/10/2020] [Accepted: 01/29/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS Cardiovascular disease (CVD) is the leading cause of death in western countries. One risk factor unique to women is the menopausal status. The aim of this study was to analyse the influence of the onset of menopause (MP) on the extent and progression of atherosclerotic plaque volume (PV). METHODS Postmenopausal women with at least one cardiovascular risk factor (CVRF) but without established CVD were included. Quantification of PV was performed in peripheral arteries using a three - dimensional (3D) ultrasound (US) technique. Follow-up examination to assess PV progression was performed after 19 (±8) months. RESULTS 110 consecutive postmenopausal women (mean age 65.5) were included. Females with an earlier onset of MP (<45 years) had a significantly higher PV than those with an intermediate (45-52 years) or later onset of menopause (>52 years), irrespective of other CVRF (244 mm³ vs. 193 mm³ vs. 73 mm³, respectively, p = 0.023). In addition, women with an earlier onset of MP had a higher PV progression compared to women with an intermediate or late onset (40 mm³ vs. 35 mm³ vs. 8.5 mm³; p = 0.002, respectively). Moreover, these results were confirmed in multivariate regression, where only onset of MP (OR 0.88; 95%CI 0.81-0.96; p = 0.004) and age (OR 1.06; 95%CI 1.08-1.13; p = 0.025) were significant predictors for a higher atherosclerotic progression. CONCLUSIONS An earlier onset of MP was associated with an increase in atherosclerotic PV and accelerated progression, independent of other CVRF.
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Affiliation(s)
- Michael Schreinlechner
- Department of Internal Medicine III (Cardiology and Angiology), Medical University of Innsbruck, Anichstr. 35, A-6020, Innsbruck, Austria.
| | - Maria Noflatscher
- Department of Internal Medicine III (Cardiology and Angiology), Medical University of Innsbruck, Anichstr. 35, A-6020, Innsbruck, Austria
| | - Sebastian Johannes Reinstadler
- Department of Internal Medicine III (Cardiology and Angiology), Medical University of Innsbruck, Anichstr. 35, A-6020, Innsbruck, Austria
| | - Philip Sommer
- Department of Internal Medicine III (Cardiology and Angiology), Medical University of Innsbruck, Anichstr. 35, A-6020, Innsbruck, Austria
| | - Daniela Lener
- Department of Internal Medicine III (Cardiology and Angiology), Medical University of Innsbruck, Anichstr. 35, A-6020, Innsbruck, Austria
| | - Elisabeth Reiser
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University of Innsbruck, Anichstr. 35, A-6020, Innsbruck, Austria
| | - Markus Theurl
- Department of Internal Medicine III (Cardiology and Angiology), Medical University of Innsbruck, Anichstr. 35, A-6020, Innsbruck, Austria
| | - Rudolf Kirchmair
- Department of Internal Medicine III (Cardiology and Angiology), Medical University of Innsbruck, Anichstr. 35, A-6020, Innsbruck, Austria
| | - Axel Bauer
- Department of Internal Medicine III (Cardiology and Angiology), Medical University of Innsbruck, Anichstr. 35, A-6020, Innsbruck, Austria
| | - Peter Marschang
- Department of Internal Medicine III (Cardiology and Angiology), Medical University of Innsbruck, Anichstr. 35, A-6020, Innsbruck, Austria
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178
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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: 4802] [Impact Index Per Article: 1200.5] [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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179
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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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180
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Zeng X, Zhu H, Liu W, Zhong J, Luo J. Electrocardiogram-Based R Wave Pulse Wave Index for Assessment of Carotid Atherosclerosis. Med Sci Monit 2020; 26:e919606. [PMID: 31941880 PMCID: PMC6984354 DOI: 10.12659/msm.919606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Carotid atherosclerosis (CA) is a common disease in middle-aged and elderly people, which is closely related to cardiovascular and cerebrovascular disease. In this study, we investigated the benefits of the electrocardiogram (ECG)-based R wave pulse wave index (ERWVI) for the diagnosis of CA. MATERIAL AND METHODS According to CA examinations by color Doppler ultrasound, patients were assigned to positive and negative groups. The ECG R wave-Pulse wave transit time (ERWPTT) was obtained by synchronously collecting ECG signals (R wave in ECG) and the time variations in maximum finger pulse oxygen (DOP) on the ECG monitor. RESULTS ERPWI was positively correlated with sex, age, BMI, diastolic/systolic blood pressure, fasting blood glucose, uric acid, cholesterol and triglyceride levels, LDL-cholesterol, non-alcoholic fatty liver disease (NAFLD), creatinine, and homocysteine, and was negatively correlated with HDL-cholesterol (P<0.05). With the increase of ERPWI, the incidence of CA significantly increased to various degrees among the subgroups (P<0.05). The binary logistic regression model showed that ERPWI was an independent risk factor for atherosclerosis. The ROC curve showed that when ERPWI was above 0.505, the incidence of CA increased significantly. CONCLUSIONS There is a close relationship between ERPWI and CA. ERPWI is an independent risk factor for CA. ERPWI ≥0.505 can be used as a diagnostic threshold for CA and a reference index for the diagnosis of CA.
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Affiliation(s)
- XiangHui Zeng
- Department of Cardiology, Ganzhou Municipal Hospital, Ganzhou, Jiangxi, China (mainland)
| | - HengQing Zhu
- Department of Cardiology, Ganzhou Municipal Hospital, Ganzhou, Jiangxi, China (mainland)
| | - WeiBin Liu
- Department of Cardiology, Ganzhou Municipal Hospital, Ganzhou, Jiangxi, China (mainland)
| | - JiuDong Zhong
- Department of Physical Examination, Ganzhou Municipal Hospital, Ganzhou, Jiangxi, China (mainland)
| | - JianPing Luo
- Department of Cardiology, Ganzhou People's Hospital, Ganzhou, Jiangxi, China (mainland)
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181
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Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L, Chapman MJ, De Backer GG, Delgado V, Ference BA, Graham IM, Halliday A, Landmesser U, Mihaylova B, Pedersen TR, Riccardi G, Richter DJ, Sabatine MS, Taskinen MR, Tokgozoglu L, Wiklund O. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Atherosclerosis 2020; 290:140-205. [PMID: 31504418 DOI: 10.1016/j.atherosclerosis.2019.08.014] [Citation(s) in RCA: 550] [Impact Index Per Article: 137.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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182
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Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L, Chapman MJ, De Backer GG, Delgado V, Ference BA, Graham IM, Halliday A, Landmesser U, Mihaylova B, Pedersen TR, Riccardi G, Richter DJ, Sabatine MS, Taskinen MR, Tokgozoglu L, Wiklund O. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J 2020; 41:111-188. [PMID: 31504418 DOI: 10.1093/eurheartj/ehz455] [Citation(s) in RCA: 4278] [Impact Index Per Article: 1069.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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183
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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: 5298] [Impact Index Per Article: 1059.6] [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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184
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Jarauta E, Laclaustra M, Villa-Pobo R, Langarita R, Marco-Benedi V, Bea AM, León-Latre M, Casasnovas JA, Civeira F. Three Dimensional Carotid and Femoral Ultrasound is not Superior to Two Dimensional Ultrasound as a Predictor of Coronary Atherosclerosis Among Men With Intermediate Cardiovascular Risk. Eur J Vasc Endovasc Surg 2019; 59:129-136. [PMID: 31836509 DOI: 10.1016/j.ejvs.2019.07.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 07/22/2019] [Accepted: 07/25/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Current cardiovascular disease (CVD) risk stratification scales, drawn up from traditional risk factors, have important limitations. The detection of subclinical atherosclerosis, by a non-invasive technique such as peripheral arteries ultrasound (US) may improve cardiovascular risk (CVR) stratification, especially in intermediate risk population. Our aim was to compare the predictive power of atherosclerotic plaques detected in carotid and femoral arteries by 2-dimensional (2D) vs. 3-dimensional (3D) US for positive coronary artery calcium score (CACS), used as a proxy for CVD, in a middle-aged sample with intermediate 10-year CVR (7.5-20%). METHODS To detect atherosclerotic plaques by 2D vs. 3D US scan of carotid and femoral arteries and comparison of their association with CACS obtained by computed tomography (CT) of subjects with intermediate CVR belonging to the Aragon Workers' Health Study. RESULTS 120 men were included, with a 10.4% average 10 years CVR. Forty-one (34.2%) participants had CACS ≥ 1. 90 participants (75%) had at least one plaque detected by 2D scan while 85 participants (70.8%) had at least a plaque detected by 3D US. Conventional CVR estimates c-statistic for CACS was .590. Although the variables most predicted of CACS ≥ 1 were those measured by 3D US (total plaque volume and mean of plaque density, c-statistics: .743 and .750 respectively), their predictive capacity was not statistically significantly different from the number of territories with plaque, measured either by 2D and 3D US (c-statistics .728 to .740 respectively). CONCLUSION Subclinical atherosclerosis measured by 2D and 3D US were better predictors of CACS ≥ 1 than CVR estimated by conventional guidelines. In our sample, 3D US did not show any significant advantages with respect to 2D US for the prediction of coronary atherosclerosis.
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Affiliation(s)
- Estíbaliz Jarauta
- IIS Aragón, Hospital Universitario Miguel Servet, Zaragoza, Spain; CIBERCV, Universidad de Zaragoza, Zaragoza, Spain.
| | - Martin Laclaustra
- IIS Aragón, Hospital Universitario Miguel Servet, Zaragoza, Spain; CIBERCV, Universidad de Zaragoza, Zaragoza, Spain; Fundación ARAID, Zaragoza, Spain
| | - Rosa Villa-Pobo
- IIS Aragón, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Raquel Langarita
- IIS Aragón, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Victoria Marco-Benedi
- IIS Aragón, Hospital Universitario Miguel Servet, Zaragoza, Spain; CIBERCV, Universidad de Zaragoza, Zaragoza, Spain
| | - Ana M Bea
- IIS Aragón, Hospital Universitario Miguel Servet, Zaragoza, Spain; CIBERCV, Universidad de Zaragoza, Zaragoza, Spain
| | - Montse León-Latre
- IIS Aragón, Hospital Universitario Miguel Servet, Zaragoza, Spain; CIBERCV, Universidad de Zaragoza, Zaragoza, Spain
| | - Jose A Casasnovas
- IIS Aragón, Hospital Universitario Miguel Servet, Zaragoza, Spain; CIBERCV, Universidad de Zaragoza, Zaragoza, Spain
| | - Fernando Civeira
- IIS Aragón, Hospital Universitario Miguel Servet, Zaragoza, Spain; CIBERCV, Universidad de Zaragoza, Zaragoza, Spain
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185
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Carotid atherosclerosis markers and adverse cardiovascular events. Int J Cardiol 2019; 307:178. [PMID: 31757651 DOI: 10.1016/j.ijcard.2019.10.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 10/29/2019] [Indexed: 12/31/2022]
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186
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Garoff M, Ahlqvist J, Edin LT, Jensen S, Levring Jäghagen E, Petäjäniemi F, Wester P, Johansson E. Bilateral vessel-outlining carotid artery calcifications in panoramic radiographs: an independent risk marker for vascular events. BMC Cardiovasc Disord 2019; 19:225. [PMID: 31619183 PMCID: PMC6796463 DOI: 10.1186/s12872-019-1211-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 09/26/2019] [Indexed: 12/27/2022] Open
Abstract
Background In odontology, panoramic radiographs (PRs) are regularly performed. PRs depict the teeth and jaws as well as carotid artery calcifications (CACs). Patients with CACs on PRs have an increased risk of vascular events compared to healthy controls without CACs, but this association is often caused by more vascular events and risk factors at baseline. However, the risk of vascular events has only been analyzed based on the presence of CACs, and not their shape. Thus, this study determined if the shape of CACs in PRs affects the risk of future vascular events. Methods The study cohort included 117 consecutive patients with CACs in PRs and 121 age-matched controls without CACs. CAC shape in PRs was dichotomized into bilateral vessel-outlining CACs and other CAC shapes. Participants were followed prospectively for an endpoint of vascular events including myocardial infarction, stroke, and vascular death. Results Patients with bilateral vessel-outlining CACs had more previous vascular events than those with other CAC shapes and the healthy controls (p < 0.001, χ2). The mean follow-up duration was 9.5 years. The endpoint was reached in 83 people. Patients with bilateral vessel-outlining CACs had a higher annual risk of vascular events (7.0%) than those with other CAC shapes (4.4%) and the controls (2.6%) (p < 0.001). In multivariate analysis, bilateral vessel-outlining CACs (hazard ratio: 2.2, 95% confidence interval: 1.1–4.5) were independent risk markers for the endpoint. Conclusions Findings of bilateral vessel-outlining CACs in PRs are independent risk markers for future vascular events.
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Affiliation(s)
- Maria Garoff
- Department of Odontology/Oral and Maxillofacial Radiology, Umeå University, SE-901 87, Umeå, Sweden.
| | - Jan Ahlqvist
- Department of Odontology/Oral and Maxillofacial Radiology, Umeå University, SE-901 87, Umeå, Sweden
| | - Linda-Tereza Edin
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Sofia Jensen
- Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden
| | - Eva Levring Jäghagen
- Department of Odontology/Oral and Maxillofacial Radiology, Umeå University, SE-901 87, Umeå, Sweden
| | - Fredrik Petäjäniemi
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Per Wester
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.,Department of Clinical Sciences, Danderyd hospital, Stockholm, Sweden
| | - Elias Johansson
- Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden.,Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden
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187
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Sánchez E, Betriu À, Yeramian A, Fernández E, Purroy F, Sánchez-de-la-Torre M, Pamplona R, Miquel E, Kerkeni M, Hernández C, Simó R, Lecube A, Hernández M, Rius F, Polanco D, Barbé F, Torres G, Suárez G, Portero-Otin M, Jové M, Colàs-Campàs L, Benabdelhak I, Farràs C, Ortega M, Manuel Valdivielso J, Bermúdez-López M, Martínez-Alonso M. Skin Autofluorescence Measurement in Subclinical Atheromatous Disease: Results from the ILERVAS Project. J Atheroscler Thromb 2019; 26:879-889. [PMID: 30842389 PMCID: PMC6800392 DOI: 10.5551/jat.47498] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Aim: Advanced glycation end-products (AGEs) have been involved in the atherogenic process in the high-risk population. The goal of this study was to demonstrate that AGEs are related to subclinical atheromatous disease in subjects with low to moderate vascular risk. Methods: A cross-sectional study in which 2,568 non-diabetic subjects of both sexes without cardiovascular disease were included. Subcutaneous content of AGEs was assessed by skin autofluorescence (SAF) and subclinical atheromatous disease was measured by assessing the atheromatous plaque burden in carotid and femoral regions using ultrasonography. In addition, serum pentosidine, carboxymethyl-lysine (CML) and AGE receptors (RAGE) were assessed in a nested case-control study with 41 subjects without plaque and 41 individuals subjects with generalized disease. Results: Patients with atheromatous plaque had a higher SAF than those with no plaque (1.9 [1.7 to 2.3] vs. 1.8 [1.6 to 2.1] arbitrary units (AU), p % 0.001). The SAF correlated with the total number of affected regions (r = 0.171, p < 0.001), increasing progressively from 1.8 [1.6 to 2.1] AU in those without atheromatous disease to 2.3 [1.9 to 2.7] AU in patients with ≥ 8 plaques (p < 0.001). A correlation was also observed between SAF and the total plaque area (r = 0.113, p < 0.001). The area under the Receiver Operating Characteristic curve was 0.65 (0.61 to 0.68) for identifying male subjects with atheromatous disease. The multivariable logistic regression model showed a significant and independent association between SAF and the presence of atheromatous disease. However, no significant differences in serum pentosidine, CML, and RAGE were observed. Conclusions: Increased subcutaneous content of AGEs is associated with augmented atheromatous plaque burden. Our results suggest that SAF may provide clinically relevant information to the current strategies for the evaluation of cardiovascular risk, especially among the male population.
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Affiliation(s)
- Enric Sánchez
- Endocrinology and Nutrition Department. University Hospital Arnau de Vilanova. Obesity, Diabetes and Metabolism (ODIM) research group. IRBLleida. University of Lleida
| | - Àngels Betriu
- Unit for the Detection and Treatment of Atherothrombotic Diseases (UDETMA V&R). University Hospital Arnau de Vilanova. Vascular and Renal Translational Research Group. IRBLleida. University of Lleida
| | - Andree Yeramian
- Endocrinology and Nutrition Department. University Hospital Arnau de Vilanova. Obesity, Diabetes and Metabolism (ODIM) research group. IRBLleida. University of Lleida
| | - Elvira Fernández
- Unit for the Detection and Treatment of Atherothrombotic Diseases (UDETMA V&R). University Hospital Arnau de Vilanova. Vascular and Renal Translational Research Group. IRBLleida. University of Lleida
| | - Francesc Purroy
- Stroke Unit. University Hospital Arnau de Vilanova. Clinical Neurosciences Group. IRBLleida. University of Lleida
| | - Manuel Sánchez-de-la-Torre
- Respiratory Department. University Hospital Arnau de Vilanova-Santa Maria. Translational Research in Respiratory Medicine. IRBLleida. University of Lleida.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII)
| | - Reinald Pamplona
- Department of Experimental Medicine. IRBLleida. University of Lleida
| | - Eva Miquel
- Borges Blanques Primary Health Care Unit
| | - Mohsen Kerkeni
- Laboratory of Biochemistry, LR12ES05, Faculty of Medicine, University of Monastir
| | - Cristina Hernández
- Endocrinology and Nutrition Department, University Hospital Vall d'Hebron. Diabetes and Metabolism Research Unit, Vall d'Hebron Institut de Recerca (VHIR). Universitat Autònoma de Barcelona.,Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII)
| | - Rafael Simó
- Endocrinology and Nutrition Department, University Hospital Vall d'Hebron. Diabetes and Metabolism Research Unit, Vall d'Hebron Institut de Recerca (VHIR). Universitat Autònoma de Barcelona.,Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII)
| | - Albert Lecube
- Endocrinology and Nutrition Department. University Hospital Arnau de Vilanova. Obesity, Diabetes and Metabolism (ODIM) research group. IRBLleida. University of Lleida.,Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII)
| | | | | | - Marta Hernández
- Endocrinology and Nutrition Department. University Hospital Arnau de Vilanova. Obesity, Diabetes and Metabolism (ODIM) research group. IRBLleida. University of Lleida
| | - Ferran Rius
- Endocrinology and Nutrition Department. University Hospital Arnau de Vilanova. Obesity, Diabetes and Metabolism (ODIM) research group. IRBLleida. University of Lleida
| | - Dinora Polanco
- Respiratory Department. University Hospital Arnau de Vilanova-Santa Maria. Translational Research in Respiratory Medicine. IRBLleida. University of Lleida
| | - Ferran Barbé
- Respiratory Department. University Hospital Arnau de Vilanova-Santa Maria. Translational Research in Respiratory Medicine. IRBLleida. University of Lleida.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII)
| | - Gerard Torres
- Respiratory Department. University Hospital Arnau de Vilanova-Santa Maria. Translational Research in Respiratory Medicine. IRBLleida. University of Lleida.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII)
| | - Guillermo Suárez
- Respiratory Department. University Hospital Arnau de Vilanova-Santa Maria. Translational Research in Respiratory Medicine. IRBLleida. University of Lleida.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII)
| | | | - Mariona Jové
- Department of Experimental Medicine. IRBLleida. University of Lleida
| | - Laura Colàs-Campàs
- Stroke Unit. University Hospital Arnau de Vilanova. Clinical Neurosciences Group. IRBLleida. University of Lleida
| | - Ikram Benabdelhak
- Stroke Unit. University Hospital Arnau de Vilanova. Clinical Neurosciences Group. IRBLleida. University of Lleida
| | | | | | - José Manuel Valdivielso
- Unit for the Detection and Treatment of Atherothrombotic Diseases (UDETMA V&R). University Hospital Arnau de Vilanova. Vascular and Renal Translational Research Group. IRBLleida. University of Lleida
| | - Marcelino Bermúdez-López
- Unit for the Detection and Treatment of Atherothrombotic Diseases (UDETMA V&R). University Hospital Arnau de Vilanova. Vascular and Renal Translational Research Group. IRBLleida. University of Lleida
| | - Montse Martínez-Alonso
- Unit for the Detection and Treatment of Atherothrombotic Diseases (UDETMA V&R). University Hospital Arnau de Vilanova. Vascular and Renal Translational Research Group. IRBLleida. University of Lleida
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188
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Natarajan P, Jaiswal S, Kathiresan S. Clonal Hematopoiesis: Somatic Mutations in Blood Cells and Atherosclerosis. CIRCULATION-GENOMIC AND PRECISION MEDICINE 2019; 11:e001926. [PMID: 29987111 DOI: 10.1161/circgen.118.001926] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The most important prognostic factor for atherosclerotic cardiovascular disease is age, independent of all other recognized risk factors. Recently, exome sequence analyses showed that somatic mutations in blood cells, a process termed clonal hematopoiesis, are common and increase in prevalence with age, with at least 1 in 10 adults older than 70 years affected. Carriers of clonal hematopoiesis have been shown to be not only at heightened risk for hematologic malignancy but also at increased risk for atherosclerotic cardiovascular disease. Here, we review the prior literature of clonal selection and expansion of hematopoietic stem cells and the evidence supporting its causal association with atherosclerotic cardiovascular disease.
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Affiliation(s)
- Pradeep Natarajan
- Center for Genomic Medicine and Cardiovascular Research Center, Massachusetts General Hospital, Boston (P.N., S.K.). .,Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, MA (P.N., S.K.).,Department of Medicine, Harvard Medical School, Boston, MA (P.N., S.K.)
| | - Siddhartha Jaiswal
- Center for Genomic Medicine and Cardiovascular Research Center, Massachusetts General Hospital, Boston (P.N., S.K.).,Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, MA (P.N., S.K.).,Department of Medicine, Harvard Medical School, Boston, MA (P.N., S.K.)
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189
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Turco JV, Inal-Veith A, Fuster V. Reprint of: Cardiovascular Health Promotion: An Issue That Can No Longer Wait. J Am Coll Cardiol 2019; 72:2945-2950. [PMID: 30522629 DOI: 10.1016/j.jacc.2018.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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190
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Kobyakova OS, Kulikov ES, Malykh RD, Chernogoryuk GE, Deev IA, Starovoytova EA, Kirillova NA, Zagromova TA, Balaganskaya MA. Strategies for the prevention of chronic non-communicable diseases: a modern look at the problem. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2019. [DOI: 10.15829/1728-8800-2019-4-92-98] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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191
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192
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Buttros DDAB, Branco MT, Orsatti CL, Almeida-Filho BDS, Nahas-Neto J, Nahas EAP. High risk for cardiovascular disease in postmenopausal breast cancer survivors. Menopause 2019; 26:1024-1030. [PMID: 31453965 DOI: 10.1097/gme.0000000000001348] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Breast cancer patients have a higher mortality risk of cardiovascular disease (CVD) than women from the general population. CVD risk may increase significantly in postmenopausal women with early-stage breast cancer. The aim of this study was to evaluate risk factors for CVD in postmenopausal breast cancer survivors. METHODS In this cross-sectional study, 96 postmenopausal breast cancer survivors were compared with 192 postmenopausal women. The main group included women with amenorrhea >12 months, aged ≥45 years, with breast cancer, and without established CVD. The control group fulfilled the same criteria, but did not have breast cancer. Groups were matched by age, time since menopause, and body mass index, in a ratio of 1 case to 2 controls (1:2). Women with three or more of the following criteria were diagnosed with metabolic syndrome: waist circumference >88 cm; triglycerides ≥150 mg/dL; high-density lipoprotein cholesterol <50 mg/dL; blood pressure ≥130/85 mm Hg; and glucose ≥100 mg/dL. Immunoassays were used (enzyme-linked immunosorbent assay test) for measurement of plasma heat shock proteins (HSP) 60 and 70 concentrations. Atherosclerotic disease was determined by intima-media thickness (>1 mm) of the carotid arteries and/or the presence of atheromatous plaque assessed by carotid artery ultrasound (scanner duplex). RESULTS Breast cancer patients had higher HSP60 levels and lower HSP70 levels than controls (P < 0.05). Analysis showed that the odds of developing metabolic syndrome (odds ratio [OR] = 4.21, 95% CI, 2.28-7.76), atheromatous plaque (OR = 2.61, 95% CI, 1.19-5.72), diabetes (OR = 4.42; 95% CI, 1.86-10.49), hypertriglyceridemia (OR = 2.32, 95% CI, 1.33-4.0), and increased waist circumference (OR = 11.22, 95% CI, 4.0-31.65) was significantly higher in women treated for cancer than in women without breast cancer. CONCLUSIONS Postmenopausal breast cancer survivors had a stronger association with risk factors for cardiovascular disease than postmenopausal women without breast cancer.
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193
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Gupta R, Wood DA. Primary prevention of ischaemic heart disease: populations, individuals, and health professionals. Lancet 2019; 394:685-696. [PMID: 31448740 DOI: 10.1016/s0140-6736(19)31893-8] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 07/03/2019] [Accepted: 07/11/2019] [Indexed: 12/24/2022]
Abstract
Ischaemic heart disease has a multifactorial aetiology and can be prevented from developing in populations primordially, and in individuals at high risk by primary prevention. The primordial approach focuses on social determinants of health in populations: political, economic, and social factors, principally unplanned urbanisation, illiteracy, poverty, and working and living conditions. Implementation of the UN Sustainable Development Goals can lead to major improvements in cardiovascular health, and adequate health-care financing and universal health care are important for achieving these goals. Population-level interventions should focus on tobacco control, promotion of healthy foods (fruits, vegetables, legumes, and nuts), curbing unhealthy foods (saturated fats, trans fats, refined carbohydrates, excessive salt, and alcohol), promotion of physical activity in everyday living, and control of ambient and indoor pollution. At the individual level, identification of people at high multifactorial risk and guideline-driven management of hypertension, LDL cholesterol, and diabetes is required. Strategies to improve adherence to healthy lifestyles and drug therapies are essential and can be implemented at health system, health care, and patient levels with use of education, technology, and personalised approaches. Improving quality of medical education with a focus on ischaemic heart disease prevention for physicians, nurses, allied health workers, and the public is required.
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Affiliation(s)
- Rajeev Gupta
- Academic Research Development Unit, Rajasthan University of Health Sciences, Jaipur, Rajasthan, India; Department of Preventive Cardiology and Internal Medicine, Eternal Heart Care Centre and Research Institute, Jaipur, Rajasthan, India.
| | - David A Wood
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland; National Heart and Lung Institute, Imperial College, London, UK
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194
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Coronary calcium is not all we need: Carotid plaque burden measured by ultrasound is better. Atherosclerosis 2019; 287:179-180. [DOI: 10.1016/j.atherosclerosis.2019.04.214] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 03/28/2019] [Accepted: 04/10/2019] [Indexed: 01/08/2023]
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195
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Wagner J, Knaier R, Infanger D, Arbeev K, Briel M, Dieterle T, Hanssen H, Faude O, Roth R, Hinrichs T, Schmidt-Trucksäss A. Functional aging in health and heart failure: the COmPLETE Study. BMC Cardiovasc Disord 2019; 19:180. [PMID: 31362698 PMCID: PMC6664502 DOI: 10.1186/s12872-019-1164-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 07/18/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Cardiovascular (CV) diseases including heart failure are the leading causes of morbidity, with age being the primary risk factor. The combination of age-related organic functional impairment and reduced physical fitness can drastically impact an individual's healthspan. One's lifespan can potentially be prolonged by the preservation or improvement of physical fitness. However, it remains unclear as to which biomarkers are most suitable for distinguishing between healthy aging and the impaired organ function associated with heart failure. Therefore, a comprehensive assessment of the components of physical fitness and CV function will be performed to identify the most important factors contributing to aging in relation to both health and disease. METHODS This cross-sectional investigation will consist of two parts: COmPLETE-Health (C-Health) and COmPLETE-Heart (C-Heart). C-Health will examine the aging trajectories of physical fitness components and CV properties in a healthy population sample aged between 20 and 100 years (n = 490). Separately, C-Heart will assess the same markers in patients at different stages of chronic heart failure (n = 80). The primary outcome to determine the difference between C-Health and C-Heart will be cardiorespiratory fitness as measured by cardiopulmonary exercise testing on a bicycle ergometer. Secondary outcomes will include walking speed, balance, isometric strength, peak power, and handgrip strength. Physical activity as a behavioural component will be assessed objectively via accelerometry. Further, CV assessments will include pulse wave velocity; retinal, arterial, and venous diameters; brachial and retinal arterial endothelial function; carotid intima-media thickness; and systolic and diastolic function. The health distances for C-Health and C-Heart will be calculated using the methodology based on statistical (Mahalanobis) distance applied to measurements of quantitative biomarkers. DISCUSSION This research seeks to identify physical fitness and CV biomarkers that best resemble underlying CV risk with age. Further, it will examine which physical fitness markers are impaired most in heart failure. The presented integrative approach could define new recommendations for diagnostic guidance in aging. Ultimately, this study is expected to offer a better understanding of which functional characteristics should be specifically targeted in primary and secondary prevention to achieve an optimal healthspan.
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Affiliation(s)
- Jonathan Wagner
- Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052 Basel, Switzerland
| | - Raphael Knaier
- Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052 Basel, Switzerland
| | - Denis Infanger
- Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052 Basel, Switzerland
| | - Konstantin Arbeev
- Biodemography of Aging Research Unit (BARU), Social Science Research Institute, Duke University, Durham, NC 27705 USA
| | - Matthias Briel
- Department of Clinical Research, Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Spitalstrasse 12, 4056 Basel, Switzerland
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street, Hamilton, ONL8S4K1 Canada
| | - Thomas Dieterle
- University Clinic of Medicine, Cantonal Hospital Baselland, University of Basel, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Henner Hanssen
- Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052 Basel, Switzerland
| | - Oliver Faude
- Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052 Basel, Switzerland
| | - Ralf Roth
- Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052 Basel, Switzerland
| | - Timo Hinrichs
- Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052 Basel, Switzerland
| | - Arno Schmidt-Trucksäss
- Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052 Basel, Switzerland
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196
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Fuster JJ, Walsh K. Somatic Mutations and Clonal Hematopoiesis: Unexpected Potential New Drivers of Age-Related Cardiovascular Disease. Circ Res 2019; 122:523-532. [PMID: 29420212 DOI: 10.1161/circresaha.117.312115] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Increasing evidence shows that conventional cardiovascular risk factors are incompletely predictive of cardiovascular disease, particularly in elderly individuals, suggesting that there may still be unidentified causal risk factors. Although the accumulation of somatic DNA mutations is a hallmark of aging, its relevance in cardiovascular disease or other age-related conditions has been, with the exception of cancer, largely unexplored. Here, we review recent clinical and preclinical studies that have identified acquired mutations in hematopoietic stem cells and subsequent clonal hematopoiesis as a new cardiovascular risk factor and a potential major driver of atherosclerosis. Understanding the mechanisms underlying the connection between somatic mutation-driven clonal hematopoiesis and cardiovascular disease will be highly relevant in the context of personalized medicine, as it may provide key information for the design of diagnostic, preventive, or therapeutic strategies tailored to the effects of specific somatic mutations.
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Affiliation(s)
- José J Fuster
- From the Molecular Cardiology Unit, Whitaker Cardiovascular Institute, Boston University School of Medicine, MA.
| | - Kenneth Walsh
- From the Molecular Cardiology Unit, Whitaker Cardiovascular Institute, Boston University School of Medicine, MA.
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197
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Cattaneo M, Froio A, Gallino A. Cardiovascular Imaging and Theranostics in Cardiovascular Pharmacotherapy. Eur Cardiol 2019; 14:62-64. [PMID: 31131039 PMCID: PMC6523052 DOI: 10.15420/ecr.2019.6.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Imaging plays a pivotal role in the diagnostic and prognostic assessment of cardiovascular diseases. During the past two decades, there has been an expansion of the available imaging techniques, some of which are now part of routine clinical practice. Cardiovascular imaging of atherosclerosis is a useful instrument, and it can corroborate and expand pathophysiological evidence on cardiovascular disease, providing proof of concept for medical therapy and can predict its responsiveness, and it may be able to be used as surrogate endpoints for clinical trials. Theranostics is an emerging therapy that combines imaging and therapeutic functions, using imaging-based therapeutic delivery systems. Theranostics could partially overcome current imaging limitations and translate experimental evidence and large-scale trials assessing clinical endpoints, rationalising cardiovascular drug development and paving the way to personalised medicine. The medical community cannot overlook the use of cardiovascular imaging as a complementary and supportive adjunct to trials investigating clinical endpoints, which remain the mainstay for investigating the efficacy and safety of cardiovascular pharmacotherapy.
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Affiliation(s)
- Mattia Cattaneo
- Cardiovascular Research Unit, Ospedale Regionale di Bellinzona e Valli Bellinzona, Switzerland.,Department of Cardiovascular Intensive Care, Cardiocentro Ticino Lugano, Switzerland
| | - Alberto Froio
- Department of Surgery and Interdisciplinary Medicine, University of Milano-Bicocca Milan, Italy
| | - Augusto Gallino
- Cardiovascular Research Unit, Ospedale Regionale di Bellinzona e Valli Bellinzona, Switzerland.,University of Zurich Zurich, Switzerland
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198
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Sharma SK, Tomey MI, Teirstein PS, Kini AS, Reitman AB, Lee AC, Généreux P, Chambers JW, Grines CL, Himmelstein SI, Thompson CA, Meredith IT, Bhave A, Moses JW. North American Expert Review of Rotational Atherectomy. Circ Cardiovasc Interv 2019; 12:e007448. [DOI: 10.1161/circinterventions.118.007448] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Samin K. Sharma
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (S.K.S., M.I.T., A.S.K.)
| | - Matthew I. Tomey
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (S.K.S., M.I.T., A.S.K.)
| | - Paul S. Teirstein
- Scripps Prebys Cardiovascular Institute, Scripps Health, La Jolla, CA (P.S.T.)
| | - Annapoorna S. Kini
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (S.K.S., M.I.T., A.S.K.)
| | | | - Arthur C. Lee
- The Cardiac and Vascular Institute, Gainesville, FL (A.C.L.)
| | - Philippe Généreux
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.)
| | | | - Cindy L. Grines
- Department of Cardiology, Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY (C.L.G.)
| | | | - Craig A. Thompson
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine (C.A.T.)
| | | | - Aparna Bhave
- Boston Scientific Corporation, Natick, NA (A.B.)
| | - Jeffrey W. Moses
- Center for Interventional Vascular Therapies, Columbia University Medical Center, New York, NY (J.W.M.)
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199
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Ultrasound Tissue Characterization of Carotid Plaques Differs Between Patients with Type 1 Diabetes and Subjects without Diabetes. J Clin Med 2019; 8:jcm8040424. [PMID: 30925670 PMCID: PMC6518191 DOI: 10.3390/jcm8040424] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 03/22/2019] [Indexed: 01/13/2023] Open
Abstract
The aim of the study was to investigate ultrasound tissue characterization of carotid plaques in subjects with and without diabetes type 1 (T1D). B-mode carotid ultrasound was performed to assess the presence and type of plaque in a group of 340 subjects with and 304 without T1D, all of them without cardiovascular disease. One hundred and seven patients with T1D (49.5% women; age 54 ± 9.8 years) and 67 control subjects without diabetes who had at least one carotid plaque were included in the study. The proportion of subjects who had only echolucent plaques was reduced in the group of patients with T1D (48.6% vs. 73.1%). In contrast, the proportion with only echogenic (25.2% vs. 7.5%) and calcified plaques (9.4% vs. 1.5%) was increased compared with subjects without diabetes. Moreover, having at least one echogenic plaque was more frequent in T1D patients compared with subjects without diabetes (49.5% vs. 26.9% p = 0.005). In addition to diabetes (OR 2.28; p = 0.026), age (OR 1.06, p = 0.002) was the other variable associated with echogenic plaque existence in multiple regression analysis. Patients with T1D exhibit a differential pattern of carotid plaque type compared with subjects without diabetes, with an increased frequency of echogenic and extensively calcified plaques.
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200
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Noncontrast Chest Computed Tomographic Imaging of Obesity and the Metabolic Syndrome. J Thorac Imaging 2019; 34:116-125. [DOI: 10.1097/rti.0000000000000391] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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