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Impact of abdominal aortic calcification on long-term cardiovascular outcomes in patients with chronic kidney disease. Atherosclerosis 2015; 243:349-55. [DOI: 10.1016/j.atherosclerosis.2015.10.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 10/06/2015] [Accepted: 10/08/2015] [Indexed: 12/18/2022]
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Lee DG, Han JH, Kwon KY, Kim JH, Han KH, Lee EJ. Association of 10-Year Atherosclerotic Cardiovascular Disease Risk Score with Carotid Intima-Media Thickness and Plaque. Korean J Fam Med 2015; 36:310-5. [PMID: 26634098 PMCID: PMC4666867 DOI: 10.4082/kjfm.2015.36.6.310] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 06/23/2015] [Accepted: 09/03/2015] [Indexed: 12/12/2022] Open
Abstract
Background The aim of this study was to determine the association between carotid intima-media thickness (IMT) and newly developed 10-year atherosclerotic cardiovascular disease (ASCVD) risk score. Methods Participants were 201 Korean adults who underwent carotid ultrasonography at the Health Promotion Center of the Eulji General Hospital. We obtained information about medical history and lifestyle, and conducted laboratory tests. Carotid IMT by B-mode ultrasonography was measured. Carotid injury was considered present when the maximum carotid IMT was ≥0.9 mm or when arteriosclerotic plaques were detected. The 10-year ASCVD risk score was calculated using the 2013 American College of Cardiology/American Heart Association guidelines. Results Men had higher 10-year ASCVD risk score than did women (mean±standard deviation: 7.15±6.04 vs. 2.53±3.67, respectively; P<0.001). Ten-year ASCVD risk was significantly correlated with right maximum carotid IMT (r=0.307), left maximum carotid IMT (r=0.230), right mean carotid IMT (r=0.322), and left mean carotid IMT (r=0.264). The group with high 10-year ASCVD risk were at even higher risk of carotid injury than were the group with low 10-year ASCVD risk (odds ratio, 2.201; 95% confidence interval, 1.162-4.1706; P=0.019). Only 10-year ASCVD risk score was significantly associated with carotid injury (odds ratio, 4.104; 95% confidence interval, 1.570-10.729). Variables that were not included in the 10-year ASCVD risk score were not significantly associated with carotid injury. Conclusion The findings of this study suggest that 10-year ASCVD risk score is associated with carotid injury.
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Affiliation(s)
- Dong-Goo Lee
- Department of the Family Medicine, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Jee-Hye Han
- Department of the Family Medicine, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Kil-Young Kwon
- Department of the Family Medicine, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Jung-Hwan Kim
- Department of the Family Medicine, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Kun-Hee Han
- Department of the Family Medicine, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Eun-Ji Lee
- Department of the Family Medicine, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea
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153
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Zingg S, Collet TH, Locatelli I, Nanchen D, Depairon M, Bovet P, Cornuz J, Rodondi N. Associations Between Cardiovascular Risk Factors, Inflammation, and Progression of Carotid Atherosclerosis Among Smokers. Nicotine Tob Res 2015; 18:1533-8. [PMID: 26574552 DOI: 10.1093/ntr/ntv255] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 11/03/2015] [Indexed: 11/14/2022]
Abstract
INTRODUCTION The high risk of cardiovascular events in smokers requires adequate control of other cardiovascular risk factors (CVRFs) to curtail atherosclerosis progression. However, it is unclear which CVRFs have the most influence on atherosclerosis progression in smokers. METHODS In 260 smokers aged 40-70 included in a smoking cessation trial, we analyzed the association between traditional CVRFs, high-sensitivity C-reactive protein (hs-CRP), smoking cessation and 3-year progression of carotid intima-media thickness (CIMT, assessed by repeated ultrasound measurements) in a longitudinal multivariate model. RESULTS Participants (mean age 52 years, 47% women) had a mean smoking duration of 32 years with a median daily consumption of 20 cigarettes. Baseline CIMT was 1185 μm (95% confidence interval [CI]: 1082-1287) and increased by 93 μm (95% CI: 25-161) and 108 μm (95% CI: 33-183) after 1 and 3 years, respectively. Age, male sex, daily cigarette consumption, systolic blood pressure (SBP), but neither low-density lipoprotein cholesterol nor hs-CRP, were independently associated with baseline CIMT (all P ≤ .05). Baseline SBP, but neither low-density lipoprotein cholesterol nor hs-CRP, was associated with 3-year atherosclerosis progression (P = .01 at 3 years). The higher the SBP at baseline, the steeper was the CIMT increase over 3-year follow-up. We found an increase of 26 μm per each 10-mmHg raise in SBP at 1 year and an increase of 39 μm per each 10 mmHg raise in SBP at 3 years. Due to insufficient statistical power, we could not exclude an effect of smoking abstinence on CIMT progression. CONCLUSION Control of blood pressure may be an important factor to limit atherosclerosis progression in smokers, besides support for smoking cessation. IMPLICATIONS Among 260 smokers aged 40-70 years with a mean smoking duration of 32 years, baseline SBP was associated with atherosclerosis progression over 3 years, as measured by CIMT (P = .01 at 3 years), independently of smoking variables and other CVRFs. The higher the SBP at baseline, the steeper was the CIMT increase over 3-year follow-up. Our findings emphasize the importance of focusing not only on smoking cessation among smokers, but to simultaneously control other CVRFs, particularly blood pressure, in order to prevent future cardiovascular disease.
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Affiliation(s)
- Sarah Zingg
- Department of Ambulatory Care and Community Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Tinh-Hai Collet
- Department of Ambulatory Care and Community Medicine, Lausanne University Hospital, Lausanne, Switzerland; Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
| | - Isabella Locatelli
- Department of Ambulatory Care and Community Medicine, Lausanne University Hospital, Lausanne, Switzerland; Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - David Nanchen
- Department of Ambulatory Care and Community Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Michèle Depairon
- Service of Angiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Pascal Bovet
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Jacques Cornuz
- Department of Ambulatory Care and Community Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Nicolas Rodondi
- Department of General Internal Medicine, Inselspital, University of Bern, Bern, Switzerland
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154
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Hemerich D, van der Laan SW, Tragante V, den Ruijter HM, de Borst GJ, Pasterkamp G, de Bakker PIW, Asselbergs FW. Impact of carotid atherosclerosis loci on cardiovascular events. Atherosclerosis 2015; 243:466-8. [PMID: 26520901 DOI: 10.1016/j.atherosclerosis.2015.10.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 09/21/2015] [Accepted: 10/12/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Genome-wide association studies (GWAS) have identified six single-nucleotide polymorphisms (SNPs) related to carotid intima media thickness (cIMT) or plaque. However, whether these loci relate to other vascular diseases and subsequent vascular events is unclear. METHODS AND RESULTS We tested six SNPs (rs4888378, rs11781551, rs445925, rs6601530, rs17398575 and rs1878406) for association with subclinical atherosclerotic measures (cIMT, plaque presence and ankle-brachial index), as well as ischemic stroke, abdominal aortic aneurysm, peripheral or coronary artery disease (CAD) in the Second Manifestations of ARTerial disease (SMART) cohort. Four SNPs were associated with cIMT and two with plaque (p < 0.05). One SNP was also significantly associated to CAD (rs1878406, OR = 1.24, 95% CI = 1.08-1.42, p = 2 × 10(-3)). A genetic risk score (GRS) based on the cIMT-related SNPs was associated to increased risk of cIMT itself (p = 1 × 10(-3)), but not to other secondary outcomes or vascular events during follow-up (p = 0.86). CONCLUSIONS In addition to replicating previously published associations for cIMT, we confirmed a nominally significant effect between the GRS and cIMT.
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Affiliation(s)
- Daiane Hemerich
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands; CAPES Foundation, Ministry of Education of Brazil, Brasília, Brazil.
| | - Sander W van der Laan
- Laboratory of Experimental Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Vinicius Tragante
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hester M den Ruijter
- Laboratory of Experimental Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
| | - Gert Jan de Borst
- Department of Vascular Surgery, Division of Surgical Specialties, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gerard Pasterkamp
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands; Laboratory of Clinical Chemistry and Hematology, Division Laboratories and Pharmacy, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Paul I W de Bakker
- Department of Medical Genetics, Center for Molecular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
| | - Folkert W Asselbergs
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands; Durrer Center for Cardiogenetic Research, ICIN-Netherlands Heart Institute, Utrecht, The Netherlands; Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, United Kingdom.
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155
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Nezu T, Hosomi N, Aoki S, Matsumoto M. Carotid Intima-Media Thickness for Atherosclerosis. J Atheroscler Thromb 2015; 23:18-31. [PMID: 26460381 DOI: 10.5551/jat.31989] [Citation(s) in RCA: 194] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The carotid intima-media thickness (IMT) is a widely used surrogate marker for atherosclerosis worldwide. The carotid IMT can be simply, noninvasively, and reproducibly measured through B-mode carotid ultrasound. The carotid IMT is also a strong predictor of future cerebral and cardiovascular events. In addition, regressions of increased carotid IMT by lipid-lowering and antihypertensive drugs have been reported. Despite the strong association between increased carotid IMT and cardiovascular disease, it remains unclear whether routine carotid IMT measurement is useful for the detection of subclinical atherosclerosis in clinical practice. Researches should consider other methodological aspects, such as the definition of carotid plaques, the choice of measurement sites on the common or internal carotid artery, and the assessment of maximum or minimum IMT. The detailed guidelines for measuring carotid IMT vary by county. Thus, the usefulness of the carotid IMT may be assessed in different countries taking racial differences into account. Other important parameters revealed by carotid ultrasound, such as artery stenosis and the characteristics and size of plaques, should also be considered. Physicians should comprehensively interpret the results of carotid ultrasonography. Therefore, carotid ultrasonography is an essential tool for assessing cardiovascular risk in clinical settings.
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Affiliation(s)
- Tomohisa Nezu
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences
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156
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Hong EG, Ohn JH, Lee SJ, Kwon HS, Kim SG, Kim DJ, Kim DS. Clinical implications of carotid artery intima media thickness assessment on cardiovascular risk stratification in hyperlipidemic Korean adults with diabetes: the ALTO study. BMC Cardiovasc Disord 2015; 15:114. [PMID: 26438201 PMCID: PMC4595332 DOI: 10.1186/s12872-015-0109-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 09/22/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The primary objective was to investigate prevalence of subclinical atherosclerosis in Korean individuals with diabetes and hyperlipidemia. Association of subclinical atherosclerosis with cardiovascular risk was assessed. METHODS Assessments of carotid artery intima media thickness (cIMT) and atheromatous plaque were done using B-mode ultrasonography. Subclinical atherosclerosis was diagnosed based on presence of plaque, and/or increased cIMT versus mean cIMT reference values for Korean healthy controls. Atherosclerosis risk factors were analyzed using United Kingdom Prospective Diabetes Study (UKPDS) risk engine and Framingham Risk Score. RESULTS In total, 355 patients were included; increased mean cIMT was observed in 15.3 % of patients, 69 % had >1 carotid artery plaque, and 72.7 % were diagnosed with subclinical atherosclerosis. In total, 60 % of subjects were taking statins, with low-density lipoprotein cholesterol level maintained ~80 mg/dL at enrollment. Carotid artery measures were well correlated with UKPDS and Framingham risk scores. Prevalence of subclinical atherosclerosis in the low risk group (<15 % 10-year UKPDS-predicted coronary heart disease risk) was 64.7 %; higher than predicted in previous studies. In multivariate analysis, advanced age was a significant risk factor for subclinical atherosclerosis in men and women, while increased waist circumference and longer diabetes duration were independent predictors only in women. CONCLUSION Subclinical atherosclerosis is more prevalent among individuals with both diabetes and hyperlipidemia than in diabetic patients without additional cardiovascular risk factors. As conventional risk engines, based on modifiable risk factors may underestimate cardiovascular risk, early non-invasive carotid artery imaging screening may be warranted for patients with diabetes and hyperlipidemia, especially if they are elderly, have central obesity or have long duration of diabetes. TRIAL REGISTRATION www.clinicaltrials.gov NCT01264263.
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Affiliation(s)
- Eun-Gyoung Hong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea.
| | - Jung Hun Ohn
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea.
| | - Seong Jin Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea.
| | - Hyuk Sang Kwon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, Seoul, Korea.
| | - Sin Gon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea.
| | - Dong Jun Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inje University College of Medicine, Goyang, Korea.
| | - Dong Sun Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hanyang University Hospital, 222-1 Wangsimni-ro, Seoul, Seongdong-gu, 133-792, Korea.
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157
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Lee JJ, Woodard GA, Gianaros PJ, Barinas-Mitchell E, Tepper PG, Conroy MB. Ectopic adiposity is associated with autonomic risk factors and subclinical cardiovascular disease in young adults. Obesity (Silver Spring) 2015; 23:2030-6. [PMID: 26333626 PMCID: PMC4587338 DOI: 10.1002/oby.21138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 03/31/2015] [Accepted: 04/02/2015] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To examine the relationship between ectopic adiposity and markers of cardiometabolic risk, autonomic control, and subclinical cardiovascular disease (CVD). METHODS Cross-sectional analyses were performed in 324 subjects with overweight and obesity. Single-slice CT images were analyzed to calculate thigh muscle attenuation (MA), a measure of ectopic adiposity. Autonomic control was assessed using low-frequency to respiratory-frequency heart rate variability (LFa/RFa ratio). Carotid intima-media thickness (IMT) was a marker of subclinical CVD. RESULTS Among overweight participants, those with low MA had lower HDL-c, higher LFa/RFa ratio, and subcutaneous thigh fat compared to high MA individuals despite no difference in visceral fat or insulin resistance. Significant associations were not observed in the class I obese group. In the class II obese group, those with high MA had higher triglycerides and insulin levels, yet there was no difference in visceral fat compared to the low MA group. Mean IMT was significantly higher in the low MA compared to the high MA overweight group (0.63 mm vs. 0.58 mm, P = 0.04) but was similar between the low and high MA class II obese groups. CONCLUSIONS Excess ectopic adiposity in muscle tissue is associated with metabolic and autonomic risk factors and subclinical CVD, most notably in overweight individuals, independent of insulin resistance and visceral abdominal fat.
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Affiliation(s)
- Jane J Lee
- Department of Medicine, University of California, San Francisco, California, USA
| | - Genevieve A Woodard
- Department of Radiology, University of California, San Francisco, California, USA
| | - Peter J Gianaros
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Ping G Tepper
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Molly B Conroy
- Department of Medicine, University of California, San Francisco, California, USA
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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158
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Abstract
The Rotterdam Study is a prospective cohort study ongoing since 1990 in the city of Rotterdam in The Netherlands. The study targets cardiovascular, endocrine, hepatic, neurological, ophthalmic, psychiatric, dermatological, otolaryngological, locomotor, and respiratory diseases. As of 2008, 14,926 subjects aged 45 years or over comprise the Rotterdam Study cohort. The findings of the Rotterdam Study have been presented in over 1200 research articles and reports (see www.erasmus-epidemiology.nl/rotterdamstudy ). This article gives the rationale of the study and its design. It also presents a summary of the major findings and an update of the objectives and methods.
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159
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Tison GH, Guo M, Blaha MJ, McClelland RL, Allison MA, Szklo M, Wong ND, Blumenthal RS, Budoff MJ, Nasir K. Multisite extracoronary calcification indicates increased risk of coronary heart disease and all-cause mortality: The Multi-Ethnic Study of Atherosclerosis. J Cardiovasc Comput Tomogr 2015; 9:406-14. [PMID: 26043963 PMCID: PMC4582663 DOI: 10.1016/j.jcct.2015.03.012] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Revised: 03/14/2015] [Accepted: 03/30/2015] [Indexed: 02/09/2023]
Abstract
BACKGROUND Cardiovascular calcification outside of the coronary tree, known as extracoronary calcification (ECC), is highly prevalent, often occurs concurrently in multiple sites, and yet its prognostic value is unclear. OBJECTIVE To determine whether multisite ECC is associated with coronary heart disease (CHD) events, CHD mortality, and all-cause mortality. METHODS We evaluated 5903 participants from the Multi-Ethnic Study of Atherosclerosis without diabetes who underwent CT imaging for calcification of the aortic valve, aortic root, mitral valve, and thoracic aorta. Participants were followed for 10.3 years. Multivariable adjusted hazard ratios estimated risk of outcomes for increasing numbers of ECC sites (0, 1, 2, 3, and 4), and receiver operator characteristic analysis assessed model discrimination. RESULTS Prevalence of any ECC was 45%; median age was 62 years. Compared with those without ECC, those with ECC in 4 sites had increased hazards of 4.5, 7.1 and 2.3 for CHD events, CHD mortality, and all-cause mortality, respectively, independent of traditional risk factors (TRF; all P ≤ .05), and had ≥2-fold increased hazards for outcomes independent of coronary artery calcification (CAC). Each additional site of ECC was positively associated with each outcome in a graded fashion. When added to TRF, ECC significantly increased the area under the receiver operator characteristic curve for all outcomes and modestly increased the area under the curve for mortality beyond TRF + CAC (0.799 to 0.802; P = .03). CONCLUSION Increasing multisite ECC has a graded association with higher CHD and mortality risk, contributing information beyond TRF. Multisite ECC incidentally identified on imaging can be used to improve individualized risk prediction.
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Affiliation(s)
- Geoffrey H. Tison
- University of California, San Francisco, Division of Cardiology, San Francisco; CA, USA
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Johns Hopkins Hospital; Baltimore, MD, USA
| | - Mengye Guo
- University of Washington, Department of Biostatistics; Seattle, Washington USA
| | - Michael J. Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Johns Hopkins Hospital; Baltimore, MD, USA
| | - Robyn L. McClelland
- University of Washington, Department of Biostatistics; Seattle, Washington USA
| | - Matthew A. Allison
- University of California, San Diego, Division of Preventive Medicine, Department of Family and Preventive Medicine; San Diego, CA, USA
| | - Moyses Szklo
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University; Baltimore, MD, USA
| | - Nathan D. Wong
- Division of Cardiology, University of California, Irvine; Irvine, CA, USA
| | - Roger S. Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Johns Hopkins Hospital; Baltimore, MD, USA
| | - Matthew J. Budoff
- Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA; Torrance, CA, USA
| | - Khurram Nasir
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Johns Hopkins Hospital; Baltimore, MD, USA
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160
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Boardman-Pretty F, Smith AJP, Cooper J, Palmen J, Folkersen L, Hamsten A, Catapano AL, Melander O, Price JF, Kumari M, Deanfield JE, Kivimäki M, Gertow K, Baragetti A, Norata GD, Humphries SE. Functional Analysis of a Carotid Intima-Media Thickness Locus Implicates BCAR1 and Suggests a Causal Variant. ACTA ACUST UNITED AC 2015; 8:696-706. [PMID: 26276885 DOI: 10.1161/circgenetics.115.001062] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 07/24/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Carotid intima-media thickness (IMT) is a marker of subclinical atherosclerosis that can predict cardiovascular disease events over traditional risk factors. This study examined the BCAR1-CFDP1-TMEM170A locus on chromosome 16, associated with carotid IMT and coronary artery disease in the IMT and IMT-Progression as Predictors of Vascular Events (IMPROVE) cohort, to identify the functional variant. METHODS AND RESULTS In analysis of the locus lead single nucleotide polymorphism (SNP; rs4888378, intronic in CFDP1) in Progressione della Lesione Intimale Carotidea (PLIC), the protective AA genotype was associated with slower IMT progression in women (P=0.04) but not in men. Meta-analysis of 5 cohort studies also supported a protective effect of the A allele on common carotid IMT in women only (women: β=-0.0047, P=1.63 × 10(-4); men: β=-0.0029, P=0.0678). Two hundred fourteen noncoding variants in strong linkage disequilibrium (r(2) ≥ 0.8) with rs4888378 were identified from 1000 Genome Project. ENCODE regulatory chromatin marks were used to create a shortlist of 6 possible regulatory variants. Electrophoretic mobility shift assays on the shortlist detected allele-specific protein binding to the lead SNP rs4888378; multiplexed competitor electrophoretic mobility shift assays implicated FOXA as the protein. Luciferase reporter assays on rs4888378 showed a significant 35% to 92% (P=0.0057; P=4.0 × 10(-22)) decrease in gene expression with the A allele. Expression quantitative trait loci analysis confirmed previously reported associations of rs4888378 with BCAR1 in vascular tissues. CONCLUSIONS Molecular studies suggest the lead SNP as a potentially causal SNP at the BCAR1-CFDP1-TMEM170A locus, and expression quantitative trait loci studies implicate BCAR1 as the causal gene. This variant showed stronger effects on common carotid IMT in women, raising questions about the mechanism of the causal SNP on atherosclerosis.
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Affiliation(s)
- Freya Boardman-Pretty
- From the Centre for Cardiovascular Genetics, Institute of Cardiovascular Sciences (F.B.-P., A.J.P.S., J.C., J.P., S.E.H.), National Centre for Cardiovascular Prevention and Outcomes Institute of Cardiovascular Science (J.E.D.), Department of Epidemiology and Public Health (M. Kumari, M. Kivimäki), University College London, London, United Kingdom; Department of Systems Biology, Center for Biological Sequence Analysis, Technical University of Denmark, Lyngby, Denmark (L.F.); Atherosclerosis Research Unit, Department of Medicine Solna, Karolinska Institutet, Center for Molecular Medicine, Karolinska University Hospital Solna, Stockholm, Sweden (L.F., A.H., K.G.); Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, University of Milan, Milan, Italy (A.L.C., A.B., G.D.N.); IRCCS Multimedica, Milan, Italy (A.L.C.); Department of Clinical Sciences, Lund University, Malmö, Sweden (O.M.); The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh Medical School, Edinburgh, United Kingdom (J.F.P.); Institute for Social and Economic Research, University of Essex, Colchester, United Kingdom (M. Kumari); and SISA Center for the Study of Atherosclerosis, Bassini Hospital, Cinisello Balsamo, Italy (G.D.N., A.B.)
| | - Andrew J P Smith
- From the Centre for Cardiovascular Genetics, Institute of Cardiovascular Sciences (F.B.-P., A.J.P.S., J.C., J.P., S.E.H.), National Centre for Cardiovascular Prevention and Outcomes Institute of Cardiovascular Science (J.E.D.), Department of Epidemiology and Public Health (M. Kumari, M. Kivimäki), University College London, London, United Kingdom; Department of Systems Biology, Center for Biological Sequence Analysis, Technical University of Denmark, Lyngby, Denmark (L.F.); Atherosclerosis Research Unit, Department of Medicine Solna, Karolinska Institutet, Center for Molecular Medicine, Karolinska University Hospital Solna, Stockholm, Sweden (L.F., A.H., K.G.); Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, University of Milan, Milan, Italy (A.L.C., A.B., G.D.N.); IRCCS Multimedica, Milan, Italy (A.L.C.); Department of Clinical Sciences, Lund University, Malmö, Sweden (O.M.); The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh Medical School, Edinburgh, United Kingdom (J.F.P.); Institute for Social and Economic Research, University of Essex, Colchester, United Kingdom (M. Kumari); and SISA Center for the Study of Atherosclerosis, Bassini Hospital, Cinisello Balsamo, Italy (G.D.N., A.B.)
| | - Jackie Cooper
- From the Centre for Cardiovascular Genetics, Institute of Cardiovascular Sciences (F.B.-P., A.J.P.S., J.C., J.P., S.E.H.), National Centre for Cardiovascular Prevention and Outcomes Institute of Cardiovascular Science (J.E.D.), Department of Epidemiology and Public Health (M. Kumari, M. Kivimäki), University College London, London, United Kingdom; Department of Systems Biology, Center for Biological Sequence Analysis, Technical University of Denmark, Lyngby, Denmark (L.F.); Atherosclerosis Research Unit, Department of Medicine Solna, Karolinska Institutet, Center for Molecular Medicine, Karolinska University Hospital Solna, Stockholm, Sweden (L.F., A.H., K.G.); Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, University of Milan, Milan, Italy (A.L.C., A.B., G.D.N.); IRCCS Multimedica, Milan, Italy (A.L.C.); Department of Clinical Sciences, Lund University, Malmö, Sweden (O.M.); The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh Medical School, Edinburgh, United Kingdom (J.F.P.); Institute for Social and Economic Research, University of Essex, Colchester, United Kingdom (M. Kumari); and SISA Center for the Study of Atherosclerosis, Bassini Hospital, Cinisello Balsamo, Italy (G.D.N., A.B.)
| | - Jutta Palmen
- From the Centre for Cardiovascular Genetics, Institute of Cardiovascular Sciences (F.B.-P., A.J.P.S., J.C., J.P., S.E.H.), National Centre for Cardiovascular Prevention and Outcomes Institute of Cardiovascular Science (J.E.D.), Department of Epidemiology and Public Health (M. Kumari, M. Kivimäki), University College London, London, United Kingdom; Department of Systems Biology, Center for Biological Sequence Analysis, Technical University of Denmark, Lyngby, Denmark (L.F.); Atherosclerosis Research Unit, Department of Medicine Solna, Karolinska Institutet, Center for Molecular Medicine, Karolinska University Hospital Solna, Stockholm, Sweden (L.F., A.H., K.G.); Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, University of Milan, Milan, Italy (A.L.C., A.B., G.D.N.); IRCCS Multimedica, Milan, Italy (A.L.C.); Department of Clinical Sciences, Lund University, Malmö, Sweden (O.M.); The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh Medical School, Edinburgh, United Kingdom (J.F.P.); Institute for Social and Economic Research, University of Essex, Colchester, United Kingdom (M. Kumari); and SISA Center for the Study of Atherosclerosis, Bassini Hospital, Cinisello Balsamo, Italy (G.D.N., A.B.)
| | - Lasse Folkersen
- From the Centre for Cardiovascular Genetics, Institute of Cardiovascular Sciences (F.B.-P., A.J.P.S., J.C., J.P., S.E.H.), National Centre for Cardiovascular Prevention and Outcomes Institute of Cardiovascular Science (J.E.D.), Department of Epidemiology and Public Health (M. Kumari, M. Kivimäki), University College London, London, United Kingdom; Department of Systems Biology, Center for Biological Sequence Analysis, Technical University of Denmark, Lyngby, Denmark (L.F.); Atherosclerosis Research Unit, Department of Medicine Solna, Karolinska Institutet, Center for Molecular Medicine, Karolinska University Hospital Solna, Stockholm, Sweden (L.F., A.H., K.G.); Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, University of Milan, Milan, Italy (A.L.C., A.B., G.D.N.); IRCCS Multimedica, Milan, Italy (A.L.C.); Department of Clinical Sciences, Lund University, Malmö, Sweden (O.M.); The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh Medical School, Edinburgh, United Kingdom (J.F.P.); Institute for Social and Economic Research, University of Essex, Colchester, United Kingdom (M. Kumari); and SISA Center for the Study of Atherosclerosis, Bassini Hospital, Cinisello Balsamo, Italy (G.D.N., A.B.)
| | - Anders Hamsten
- From the Centre for Cardiovascular Genetics, Institute of Cardiovascular Sciences (F.B.-P., A.J.P.S., J.C., J.P., S.E.H.), National Centre for Cardiovascular Prevention and Outcomes Institute of Cardiovascular Science (J.E.D.), Department of Epidemiology and Public Health (M. Kumari, M. Kivimäki), University College London, London, United Kingdom; Department of Systems Biology, Center for Biological Sequence Analysis, Technical University of Denmark, Lyngby, Denmark (L.F.); Atherosclerosis Research Unit, Department of Medicine Solna, Karolinska Institutet, Center for Molecular Medicine, Karolinska University Hospital Solna, Stockholm, Sweden (L.F., A.H., K.G.); Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, University of Milan, Milan, Italy (A.L.C., A.B., G.D.N.); IRCCS Multimedica, Milan, Italy (A.L.C.); Department of Clinical Sciences, Lund University, Malmö, Sweden (O.M.); The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh Medical School, Edinburgh, United Kingdom (J.F.P.); Institute for Social and Economic Research, University of Essex, Colchester, United Kingdom (M. Kumari); and SISA Center for the Study of Atherosclerosis, Bassini Hospital, Cinisello Balsamo, Italy (G.D.N., A.B.)
| | - Alberico L Catapano
- From the Centre for Cardiovascular Genetics, Institute of Cardiovascular Sciences (F.B.-P., A.J.P.S., J.C., J.P., S.E.H.), National Centre for Cardiovascular Prevention and Outcomes Institute of Cardiovascular Science (J.E.D.), Department of Epidemiology and Public Health (M. Kumari, M. Kivimäki), University College London, London, United Kingdom; Department of Systems Biology, Center for Biological Sequence Analysis, Technical University of Denmark, Lyngby, Denmark (L.F.); Atherosclerosis Research Unit, Department of Medicine Solna, Karolinska Institutet, Center for Molecular Medicine, Karolinska University Hospital Solna, Stockholm, Sweden (L.F., A.H., K.G.); Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, University of Milan, Milan, Italy (A.L.C., A.B., G.D.N.); IRCCS Multimedica, Milan, Italy (A.L.C.); Department of Clinical Sciences, Lund University, Malmö, Sweden (O.M.); The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh Medical School, Edinburgh, United Kingdom (J.F.P.); Institute for Social and Economic Research, University of Essex, Colchester, United Kingdom (M. Kumari); and SISA Center for the Study of Atherosclerosis, Bassini Hospital, Cinisello Balsamo, Italy (G.D.N., A.B.)
| | - Olle Melander
- From the Centre for Cardiovascular Genetics, Institute of Cardiovascular Sciences (F.B.-P., A.J.P.S., J.C., J.P., S.E.H.), National Centre for Cardiovascular Prevention and Outcomes Institute of Cardiovascular Science (J.E.D.), Department of Epidemiology and Public Health (M. Kumari, M. Kivimäki), University College London, London, United Kingdom; Department of Systems Biology, Center for Biological Sequence Analysis, Technical University of Denmark, Lyngby, Denmark (L.F.); Atherosclerosis Research Unit, Department of Medicine Solna, Karolinska Institutet, Center for Molecular Medicine, Karolinska University Hospital Solna, Stockholm, Sweden (L.F., A.H., K.G.); Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, University of Milan, Milan, Italy (A.L.C., A.B., G.D.N.); IRCCS Multimedica, Milan, Italy (A.L.C.); Department of Clinical Sciences, Lund University, Malmö, Sweden (O.M.); The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh Medical School, Edinburgh, United Kingdom (J.F.P.); Institute for Social and Economic Research, University of Essex, Colchester, United Kingdom (M. Kumari); and SISA Center for the Study of Atherosclerosis, Bassini Hospital, Cinisello Balsamo, Italy (G.D.N., A.B.)
| | - Jacqueline F Price
- From the Centre for Cardiovascular Genetics, Institute of Cardiovascular Sciences (F.B.-P., A.J.P.S., J.C., J.P., S.E.H.), National Centre for Cardiovascular Prevention and Outcomes Institute of Cardiovascular Science (J.E.D.), Department of Epidemiology and Public Health (M. Kumari, M. Kivimäki), University College London, London, United Kingdom; Department of Systems Biology, Center for Biological Sequence Analysis, Technical University of Denmark, Lyngby, Denmark (L.F.); Atherosclerosis Research Unit, Department of Medicine Solna, Karolinska Institutet, Center for Molecular Medicine, Karolinska University Hospital Solna, Stockholm, Sweden (L.F., A.H., K.G.); Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, University of Milan, Milan, Italy (A.L.C., A.B., G.D.N.); IRCCS Multimedica, Milan, Italy (A.L.C.); Department of Clinical Sciences, Lund University, Malmö, Sweden (O.M.); The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh Medical School, Edinburgh, United Kingdom (J.F.P.); Institute for Social and Economic Research, University of Essex, Colchester, United Kingdom (M. Kumari); and SISA Center for the Study of Atherosclerosis, Bassini Hospital, Cinisello Balsamo, Italy (G.D.N., A.B.)
| | - Meena Kumari
- From the Centre for Cardiovascular Genetics, Institute of Cardiovascular Sciences (F.B.-P., A.J.P.S., J.C., J.P., S.E.H.), National Centre for Cardiovascular Prevention and Outcomes Institute of Cardiovascular Science (J.E.D.), Department of Epidemiology and Public Health (M. Kumari, M. Kivimäki), University College London, London, United Kingdom; Department of Systems Biology, Center for Biological Sequence Analysis, Technical University of Denmark, Lyngby, Denmark (L.F.); Atherosclerosis Research Unit, Department of Medicine Solna, Karolinska Institutet, Center for Molecular Medicine, Karolinska University Hospital Solna, Stockholm, Sweden (L.F., A.H., K.G.); Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, University of Milan, Milan, Italy (A.L.C., A.B., G.D.N.); IRCCS Multimedica, Milan, Italy (A.L.C.); Department of Clinical Sciences, Lund University, Malmö, Sweden (O.M.); The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh Medical School, Edinburgh, United Kingdom (J.F.P.); Institute for Social and Economic Research, University of Essex, Colchester, United Kingdom (M. Kumari); and SISA Center for the Study of Atherosclerosis, Bassini Hospital, Cinisello Balsamo, Italy (G.D.N., A.B.)
| | - John E Deanfield
- From the Centre for Cardiovascular Genetics, Institute of Cardiovascular Sciences (F.B.-P., A.J.P.S., J.C., J.P., S.E.H.), National Centre for Cardiovascular Prevention and Outcomes Institute of Cardiovascular Science (J.E.D.), Department of Epidemiology and Public Health (M. Kumari, M. Kivimäki), University College London, London, United Kingdom; Department of Systems Biology, Center for Biological Sequence Analysis, Technical University of Denmark, Lyngby, Denmark (L.F.); Atherosclerosis Research Unit, Department of Medicine Solna, Karolinska Institutet, Center for Molecular Medicine, Karolinska University Hospital Solna, Stockholm, Sweden (L.F., A.H., K.G.); Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, University of Milan, Milan, Italy (A.L.C., A.B., G.D.N.); IRCCS Multimedica, Milan, Italy (A.L.C.); Department of Clinical Sciences, Lund University, Malmö, Sweden (O.M.); The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh Medical School, Edinburgh, United Kingdom (J.F.P.); Institute for Social and Economic Research, University of Essex, Colchester, United Kingdom (M. Kumari); and SISA Center for the Study of Atherosclerosis, Bassini Hospital, Cinisello Balsamo, Italy (G.D.N., A.B.)
| | - Mika Kivimäki
- From the Centre for Cardiovascular Genetics, Institute of Cardiovascular Sciences (F.B.-P., A.J.P.S., J.C., J.P., S.E.H.), National Centre for Cardiovascular Prevention and Outcomes Institute of Cardiovascular Science (J.E.D.), Department of Epidemiology and Public Health (M. Kumari, M. Kivimäki), University College London, London, United Kingdom; Department of Systems Biology, Center for Biological Sequence Analysis, Technical University of Denmark, Lyngby, Denmark (L.F.); Atherosclerosis Research Unit, Department of Medicine Solna, Karolinska Institutet, Center for Molecular Medicine, Karolinska University Hospital Solna, Stockholm, Sweden (L.F., A.H., K.G.); Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, University of Milan, Milan, Italy (A.L.C., A.B., G.D.N.); IRCCS Multimedica, Milan, Italy (A.L.C.); Department of Clinical Sciences, Lund University, Malmö, Sweden (O.M.); The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh Medical School, Edinburgh, United Kingdom (J.F.P.); Institute for Social and Economic Research, University of Essex, Colchester, United Kingdom (M. Kumari); and SISA Center for the Study of Atherosclerosis, Bassini Hospital, Cinisello Balsamo, Italy (G.D.N., A.B.)
| | - Karl Gertow
- From the Centre for Cardiovascular Genetics, Institute of Cardiovascular Sciences (F.B.-P., A.J.P.S., J.C., J.P., S.E.H.), National Centre for Cardiovascular Prevention and Outcomes Institute of Cardiovascular Science (J.E.D.), Department of Epidemiology and Public Health (M. Kumari, M. Kivimäki), University College London, London, United Kingdom; Department of Systems Biology, Center for Biological Sequence Analysis, Technical University of Denmark, Lyngby, Denmark (L.F.); Atherosclerosis Research Unit, Department of Medicine Solna, Karolinska Institutet, Center for Molecular Medicine, Karolinska University Hospital Solna, Stockholm, Sweden (L.F., A.H., K.G.); Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, University of Milan, Milan, Italy (A.L.C., A.B., G.D.N.); IRCCS Multimedica, Milan, Italy (A.L.C.); Department of Clinical Sciences, Lund University, Malmö, Sweden (O.M.); The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh Medical School, Edinburgh, United Kingdom (J.F.P.); Institute for Social and Economic Research, University of Essex, Colchester, United Kingdom (M. Kumari); and SISA Center for the Study of Atherosclerosis, Bassini Hospital, Cinisello Balsamo, Italy (G.D.N., A.B.)
| | - Andrea Baragetti
- From the Centre for Cardiovascular Genetics, Institute of Cardiovascular Sciences (F.B.-P., A.J.P.S., J.C., J.P., S.E.H.), National Centre for Cardiovascular Prevention and Outcomes Institute of Cardiovascular Science (J.E.D.), Department of Epidemiology and Public Health (M. Kumari, M. Kivimäki), University College London, London, United Kingdom; Department of Systems Biology, Center for Biological Sequence Analysis, Technical University of Denmark, Lyngby, Denmark (L.F.); Atherosclerosis Research Unit, Department of Medicine Solna, Karolinska Institutet, Center for Molecular Medicine, Karolinska University Hospital Solna, Stockholm, Sweden (L.F., A.H., K.G.); Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, University of Milan, Milan, Italy (A.L.C., A.B., G.D.N.); IRCCS Multimedica, Milan, Italy (A.L.C.); Department of Clinical Sciences, Lund University, Malmö, Sweden (O.M.); The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh Medical School, Edinburgh, United Kingdom (J.F.P.); Institute for Social and Economic Research, University of Essex, Colchester, United Kingdom (M. Kumari); and SISA Center for the Study of Atherosclerosis, Bassini Hospital, Cinisello Balsamo, Italy (G.D.N., A.B.)
| | - Giuseppe Danilo Norata
- From the Centre for Cardiovascular Genetics, Institute of Cardiovascular Sciences (F.B.-P., A.J.P.S., J.C., J.P., S.E.H.), National Centre for Cardiovascular Prevention and Outcomes Institute of Cardiovascular Science (J.E.D.), Department of Epidemiology and Public Health (M. Kumari, M. Kivimäki), University College London, London, United Kingdom; Department of Systems Biology, Center for Biological Sequence Analysis, Technical University of Denmark, Lyngby, Denmark (L.F.); Atherosclerosis Research Unit, Department of Medicine Solna, Karolinska Institutet, Center for Molecular Medicine, Karolinska University Hospital Solna, Stockholm, Sweden (L.F., A.H., K.G.); Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, University of Milan, Milan, Italy (A.L.C., A.B., G.D.N.); IRCCS Multimedica, Milan, Italy (A.L.C.); Department of Clinical Sciences, Lund University, Malmö, Sweden (O.M.); The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh Medical School, Edinburgh, United Kingdom (J.F.P.); Institute for Social and Economic Research, University of Essex, Colchester, United Kingdom (M. Kumari); and SISA Center for the Study of Atherosclerosis, Bassini Hospital, Cinisello Balsamo, Italy (G.D.N., A.B.)
| | - Steve E Humphries
- From the Centre for Cardiovascular Genetics, Institute of Cardiovascular Sciences (F.B.-P., A.J.P.S., J.C., J.P., S.E.H.), National Centre for Cardiovascular Prevention and Outcomes Institute of Cardiovascular Science (J.E.D.), Department of Epidemiology and Public Health (M. Kumari, M. Kivimäki), University College London, London, United Kingdom; Department of Systems Biology, Center for Biological Sequence Analysis, Technical University of Denmark, Lyngby, Denmark (L.F.); Atherosclerosis Research Unit, Department of Medicine Solna, Karolinska Institutet, Center for Molecular Medicine, Karolinska University Hospital Solna, Stockholm, Sweden (L.F., A.H., K.G.); Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, University of Milan, Milan, Italy (A.L.C., A.B., G.D.N.); IRCCS Multimedica, Milan, Italy (A.L.C.); Department of Clinical Sciences, Lund University, Malmö, Sweden (O.M.); The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh Medical School, Edinburgh, United Kingdom (J.F.P.); Institute for Social and Economic Research, University of Essex, Colchester, United Kingdom (M. Kumari); and SISA Center for the Study of Atherosclerosis, Bassini Hospital, Cinisello Balsamo, Italy (G.D.N., A.B.)
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Weber LA, Cheezum MK, Reese JM, Lane AB, Haley RD, Lutz MW, Villines TC. Cardiovascular Imaging for the Primary Prevention of Atherosclerotic Cardiovascular Disease Events. CURRENT CARDIOVASCULAR IMAGING REPORTS 2015; 8:36. [PMID: 26301038 PMCID: PMC4534502 DOI: 10.1007/s12410-015-9351-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Traditional cardiovascular risk factors have well-known limitations for the accurate assessment of individual cardiovascular risk. Unlike risk factor-based scores which rely on probabilistic calculations derived from population-based studies, coronary artery calcium (CAC) scoring, and carotid ultrasound allow for the direct visualization and quantification of subclinical atherosclerosis with the potential for a more accurate, personalized risk assessment and treatment approach. Among strategies used to guide preventive management, CAC scoring has consistently and convincingly outperformed traditional risk factors for the prediction of adverse cardiovascular events. Moreover, several studies have demonstrated the potential of CAC testing to improve precision for the use of more intensive pharmacologic therapies, such as aspirin and statins, in patients most likely to derive benefit, as compared to atherosclerotic cardiovascular disease risk calculators. By comparison to CAC, the role of carotid ultrasound for the measurement of carotid intima-media thickness (CIMT) remains less well-elucidated but may be significantly improved with the inclusion of plaque screening and novel three-dimensional measurements of plaque volume and morphology. Despite significant evidence supporting the ability of non-invasive atherosclerosis imaging (particularly CAC) to guide preventive management, imaging remains an under-utilized strategy among current guidelines and clinical practice. Herein, we review evidence regarding CAC and carotid ultrasound for patient risk classification, with a comparison of these techniques to currently advocated traditional risk factor-based scores.
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Affiliation(s)
- Lauren A. Weber
- />Cardiology Service, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889 USA
| | - Michael K. Cheezum
- />Departments of Medicine and Radiology (Cardiovascular Division), Brigham and Women’s Hospital, Non-Invasive Cardiovascular Imaging Program, Boston, MA 02115 USA
| | - Jason M. Reese
- />Cardiology Service, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889 USA
| | - Alison B. Lane
- />Department of Medicine, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889 USA
| | - Ryan D. Haley
- />Department of Medicine, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889 USA
| | - Meredith W. Lutz
- />Department of Medicine, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889 USA
| | - Todd C. Villines
- />Cardiology Service, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889 USA
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162
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Shang X, Sanders KM, Scott D, Khan B, Hodge A, Khan N, English DR, Giles GG, Ebeling PR. Dietary α-Linolenic Acid and Total ω-3 Fatty Acids Are Inversely Associated with Abdominal Aortic Calcification in Older Women, but Not in Older Men. J Nutr 2015; 145:1778-86. [PMID: 26041673 DOI: 10.3945/jn.115.211789] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 05/15/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Associations of α-linolenic acid (ALA), eicosapentaenoic acid (EPA) plus decosahexaenoic acid (DHA), and total omega-3 (n-3) fatty acid (FA) intakes with abdominal aortic calcification (AAC) are not well understood. OBJECTIVE This study explored the associations between baseline and long-term changes in ω-3 FA consumption and AAC severity among community-dwelling older men and women. METHODS The present study used a subset of the Melbourne Collaborative Cohort Study in which participants were interviewed in 1990-1994 and again in 2010-2011. Dietary intake was evaluated at both baseline and follow-up with use of food-frequency questionnaires. AAC severity was assessed by both lateral thoraco-lumbar radiography and dual-energy X-ray absorptiometry (DXA) at follow-up. RESULTS A total of 312 participants aged 45-64 y old at baseline were followed for a duration of (mean ± SD) 18 ± 1 y. Baseline energy-adjusted ALA intake tended to be inversely associated with AAC severity by radiography [OR (95% CI) for tertile 3 vs. tertile 1: 0.49 (0.23, 1.02), P-trend: 0.06] and was inversely associated with AAC severity by DXA [OR (95% CI) for tertile 3 vs. tertile 1: 0.37 (0.16, 0.83)] in women, after adjustment for confounders. Women in the third tertile of total ω-3 FA intake had significantly lower AAC severity by radiography [OR (95% CI): 0.33 (0.16, 0.71)] and DXA [OR (95% CI): 0.27 (0.12, 0.62)] than those in the first tertile. Changes in tertile of ω-3 FA intake over 18 y were not found to be associated with AAC severity in either men or women. CONCLUSION The results of our study suggest that dietary ALA and total ω-3 FA intakes are both important predictors of the development of AAC in older women, but not in older men.
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Affiliation(s)
- Xianwen Shang
- Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne Medical School-Western Campus, Melbourne, Australia; Australian Institute for Musculoskeletal Science, Melbourne, Australia;
| | - Kerrie M Sanders
- Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne Medical School-Western Campus, Melbourne, Australia; Institute for Health and Ageing, Australian Catholic University, Melbourne, Australia
| | - David Scott
- Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne Medical School-Western Campus, Melbourne, Australia; Australian Institute for Musculoskeletal Science, Melbourne, Australia; Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Belal Khan
- Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne Medical School-Western Campus, Melbourne, Australia; Australian Institute for Musculoskeletal Science, Melbourne, Australia; Department of Medicine, Max Super Speciality Hospital, Patparganj, Delhi, India
| | - Allison Hodge
- Cancer Epidemiology Centre, The Cancer Council Victoria, Melbourne, Australia; and
| | - Nayab Khan
- Department of Radiology, Diwan Chand Satyapal Aggarwaal Diagnostic Imaging Research Centre, New Delhi, India
| | - Dallas R English
- Cancer Epidemiology Centre, The Cancer Council Victoria, Melbourne, Australia; and
| | - Graham G Giles
- Cancer Epidemiology Centre, The Cancer Council Victoria, Melbourne, Australia; and
| | - Peter R Ebeling
- Australian Institute for Musculoskeletal Science, Melbourne, Australia; Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
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163
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Zoet GA, Koster MPH, Velthuis BK, de Groot CJM, Maas AHEM, Fauser BCJM, Franx A, van Rijn BB. Determinants of future cardiovascular health in women with a history of preeclampsia. Maturitas 2015; 82:153-61. [PMID: 26255680 DOI: 10.1016/j.maturitas.2015.07.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 07/03/2015] [Accepted: 07/06/2015] [Indexed: 02/07/2023]
Abstract
Women who develop preeclampsia have an increased risk of cardiovascular disease (CVD) later in life. However, current guidelines on cardiovascular risk assessment and prevention are unclear on how and when to screen these women postpartum, and about the role of a positive history of preeclampsia in later-life CVD risk management. The aim of this review is to discuss the present knowledge on commonly used cardiovascular screening modalities available to women with a history of preeclampsia, and to discuss recent developments in early detection of CVD using cardiovascular imaging. Furthermore, we explore how female-specific risk factors may have additional value in cardiovascular screening, in particular in relatively young women, although their implementation in clinical practice is challenged by inconsistent results and lack of long-term outcome data. Non-invasive imaging techniques, e.g., coronary artery intima-media thickness (CIMT), can be helpful to detect subclinical atherosclerotic disease, and coronary artery calcium scoring (CACS) has shown to be effective in early detection of cardiovascular damage. However, while more short-term and long-term follow-up studies are becoming available, few studies have investigated women with a history of preeclampsia in the fourth and fifth decade of life, when early signs of premature CVD are most likely to become apparent. Further studies are needed to inform new and improved clinical practice guidelines, and provide long-term strategies to effectively prevent CVD, specifically targeted at women with a history of preeclampsia. Additionally, evaluation of feasibility, cost-effectiveness, and implementation of CVD screening and prevention initiatives targeted at former preeclampsia patients are needed.
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Affiliation(s)
- Gerbrand A Zoet
- Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, Lundlaan 6, PO Box 85090, 3508 AB Utrecht, The Netherlands.
| | - Maria P H Koster
- Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, Lundlaan 6, PO Box 85090, 3508 AB Utrecht, The Netherlands
| | - Birgitta K Velthuis
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Christianne J M de Groot
- Department of Obstetrics and Gynaecology, VU University Medical Center Amsterdam, de Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Angela H E M Maas
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Bart C J M Fauser
- Department of Reproductive Medicine & Gynaecology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Arie Franx
- Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, Lundlaan 6, PO Box 85090, 3508 AB Utrecht, The Netherlands
| | - Bas B van Rijn
- Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, Lundlaan 6, PO Box 85090, 3508 AB Utrecht, The Netherlands; Academic Unit of Human Development and Health, University of Southampton, Princess Anne Hospital, Coxford Road, Southampton SO16 5YA, United Kingdom
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Abstract
Evidence-based medicine requires us to use pharmacological agents that have been tested and that have been showed to reduce the disease in that particular group of affected patients. The choice of the efficacy endpoint is one of the most controversial issues in designing the trials. To reduce the high economic costs resulting by the large-scale trials design and implementation, the substitution of the primary endpoints with a surrogate one, is an optimal opportunity. Carotid intima-media thickness is considered an excellent predictor of cardiovascular events, and it is also seen as a perfect model of surrogate endpoint for pharmacological studies. However, the results from studies using it as a surrogate endpoints could lead to erroneous conclusions and could lead marketing of products with limited or doubt effectiveness on cardiovascular prevention. Studies showed that many interventions targeting the Carotid intima-media thickness not impact the final clinical endpoints of interest, whereas low-density lipoprotein cholesterol level is an excellent biomarker because it can predict the cardiovascular outcomes and interventions therapy can efficaciously reduce it.
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Loizou CP, Nicolaides A, Kyriacou E, Georghiou N, Griffin M, Pattichis CS. A Comparison of Ultrasound Intima-Media Thickness Measurements of the Left and Right Common Carotid Artery. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE 2015; 3:1900410. [PMID: 27170894 PMCID: PMC4848048 DOI: 10.1109/jtehm.2015.2450735] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 05/13/2015] [Accepted: 06/21/2015] [Indexed: 12/03/2022]
Abstract
The intima-media thickness (IMT) of the common carotid artery (CCA) is an established indicator of cardiovascular disease (CVD). There have been reports about the difference between the left and the right sides of the CCA IMT and their relation with CVD. In this paper, we propose an automated system based on image normalization, speckle reduction filtering, and snakes segmentation, for segmenting the CCA, perform IMT measurements, and provide the differences between the left and the right sides. The study was performed on 1104 longitudinal-section ultrasound images acquired from 568 men and 536 women out of which 125 had cardiovascular symptoms (CVD). A cardiovascular expert manually delineated the IMT for the normal and the CVD groups. The corresponding (normal versus CVD) IMT mean ± standard deviation values for the left and the right sides were 0.74 ± 0.24 versus 0.87 ± 0.24 mm and 0.70 ± 0.17 versus 0.80 ± 0.18 mm, respectively. The main findings of this paper can be summarized as follows: 1) there was no significant difference between the CCA left side IMT and the right side IMT. These findings suggest that the measurement of the CCA IMT on one side only is needed for the normal group (and this is in agreement with other studies); 2) there were statistical significant differences for the IMT measurements between the normal group and the CVD group for both the left and the right sides; 3) there was an increasing linear relationship of the left and the right IMT measurements with age for the normal group; and to a lesser extend for the CVD group; 4) no statistical significant differences were found between the manual and the automated IMT measurements for both sides; and 5) the best result for classification disease modeling, using support vector machines, to discriminate between the normal and the CVD groups was a 64%±3.5% correct classifications score when using both the left and the right IMT automated measurements. Further research is required for estimating differences and similarities between left and right intima media complex structure and morphology and their variability with texture features for differentiating between the normal and the CVD group.
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Affiliation(s)
| | - Andrew Nicolaides
- Cyprus Cardiovascular Disease Educational Research TrustNicosia2368Cyprus
| | - Efthyvoulos Kyriacou
- Department of Computer Science and EngineeringFrederick UniversityLimassol3080Cyprus
| | - Niki Georghiou
- Cyprus Cardiovascular Disease Educational Research TrustNicosia2368Cyprus
| | - Maura Griffin
- Cyprus Cardiovascular Disease Educational Research TrustNicosia2368Cyprus
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166
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Di Minno MND, Ambrosino P, Lupoli R, Di Minno A, Tasso M, Peluso R, Tremoli E. Cardiovascular risk markers in patients with psoriatic arthritis: A meta-analysis of literature studies. Ann Med 2015; 47:346-53. [PMID: 25953378 DOI: 10.3109/07853890.2015.1031822] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Several studies reported an increased cardiovascular (CV) morbidity and mortality in patients with psoriatic arthritis (PsA). We performed a meta-analysis on the impact of PsA on major markers of CV risk. METHODS Studies on the relationship between PsA and common carotid artery intima-media thickness (CCA-IMT), prevalence of carotid plaques, flow-mediated dilation (FMD), nitrate-mediated dilation (NMD), pulse wave velocity (PWV), augmentation index (AIx), and ankle-brachial index (ABI) were systematically searched in the PubMed, Web of Science, Scopus, and EMBASE databases. RESULTS Sixteen case-control studies (898 cases, 1,140 controls) were included. Compared to controls, PsA patients showed a higher CCA-IMT (MD 0.07 mm; 95% CI 0.04, 0.11; P < 0.0001), and a higher frequency of carotid plaques (OR 3.12; 95% CI 1.03, 9.39; P = 0.04). Moreover, a lower FMD was found in PsA subjects than in controls (MD -2.56%; 95% CI -4.17, -0.94; P = 0.002), with no differences in NMD (MD -0.40%; 95% CI -1.19, 0.39; P = 0.32). Because of the low number of studies, no meta- analytical evaluation was performed for PWV, AIx, and ABI. Despite heterogeneity among studies, PsA appears significantly associated with markers of subclinical atherosclerosis and CV risk. DISCUSSION These findings could help to establish more specific CV prevention strategies in this clinical setting.
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Affiliation(s)
- Matteo Nicola Dario Di Minno
- Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino , IRCCS, Milan , Italy
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167
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Li TC, Li CI, Liao LN, Liu CS, Yang CW, Lin CH, Hsiao JH, Hsiao CY, Lin WY, Wu FY, Lin CC. Associations of EDNRA and EDN1 polymorphisms with carotid intima media thickness through interactions with gender, regular exercise, and obesity in subjects in Taiwan: Taichung Community Health Study (TCHS). Biomedicine (Taipei) 2015; 5:8. [PMID: 26040574 PMCID: PMC4502041 DOI: 10.7603/s40681-015-0008-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 04/28/2015] [Indexed: 11/06/2022] Open
Abstract
The aim of this study was to evaluate the interacted association between EDNRA and EDN1 polymorphisms and gender, regular exercise, and obesity status on carotid intima media thickness (IMT) in community- dwelling subjects of the Taichung Community Health Study. Five single-nucleotide polymorphisms (SNPs rs1395821, rs1878406, rs5333, rs1800541, and rs5370) of the EDNRA and EDN1 gene were examined in 480 participants from 160 families. The IMT protocol involves scanning the common carotid arteries (CCAs), the carotid bifurcations (bulb), and the origins (first 1 cm) of the internal carotid arteries (ICAs). Generalized linear models with a generalized estimating equation were employed to consider the dependence among family members. After multivariate adjustment, the effects of interactions between EDNRA and EDN1 gene with gender, obesity, and exercise were observed. For gene-gender interaction on CCA IMT, the adjusted mean for men carrying the GA/GG genotype of EDNRASNP rs1878406 was 1.18 times higher than that for men carrying the AA genotype (95% CI: 1.01, 1.37). As for bulb and ICA IMT, the adjusted mean values for women carrying the AC/AA genotype of EDN1 rs5370 was lower than those carrying the CC genotype: 0.89, [0.82, 0.98]; and 0.90 [0.83, 0.99], respectively. We did observe significant effects of EDNRA SNPs rs1395821 and rs5333 in individuals who regularly exercised. A significantly lower adjusted mean in CCA IMT for non-obese individuals carrying EDNRA SNP rs5333 was observed (0.92 [0.86, 0.99]) compared with non-obese individuals carrying the AA genotype. This study first reported significant interactions of EDNRA and EDN1 polymorphisms with gender, regular exercise, and obesity on carotid IMT in Han Chinese participants.
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Affiliation(s)
- Tsai-Chung Li
- Graduate Institute of Biostatistics, College of Public Health, China Medical University, 404, Taichung, Taiwan,
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Clemente G, Mancini M, Giacco R, Tornatore A, Ragucci M, Riccardi G. Visceral adiposity and subclinical atherosclerosis in healthy young men. Int J Food Sci Nutr 2015; 66:466-70. [DOI: 10.3109/09637486.2015.1042845] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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169
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Baber U, Mehran R, Sartori S, Schoos MM, Sillesen H, Muntendam P, Garcia MJ, Gregson J, Pocock S, Falk E, Fuster V. Prevalence, impact, and predictive value of detecting subclinical coronary and carotid atherosclerosis in asymptomatic adults: the BioImage study. J Am Coll Cardiol 2015; 65:1065-74. [PMID: 25790876 DOI: 10.1016/j.jacc.2015.01.017] [Citation(s) in RCA: 327] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 01/06/2015] [Accepted: 01/11/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although recent studies suggest that measuring coronary artery calcification (CAC) may be superior to indirect atherosclerotic markers in predicting cardiac risk, there are limited data evaluating imaging-based biomarkers that directly quantify atherosclerosis in different vascular beds performed in a single cohort. OBJECTIVES The BioImage Study (A Clinical Study of Burden of Atherosclerotic Disease in an At-Risk Population) sought to identify imaging biomarkers that predict near-term (3-year) atherothrombotic events. METHODS The BioImage Study enrolled 5,808 asymptomatic U.S. adults (mean age: 69 years, 56.5% female) in a prospective cohort evaluating the role of vascular imaging on cardiovascular risk prediction. All patients were evaluated by CAC and novel 3-dimensional carotid ultrasound. Plaque areas from both carotid arteries were summed as the carotid plaque burden (cPB). The primary endpoint was the composite of major adverse cardiac events (MACE) (cardiovascular death, myocardial infarction, and ischemic stroke). A broader secondary MACE endpoint also included all-cause death, unstable angina, and coronary revascularization. RESULTS Over a median follow-up of 2.7 years, MACE occurred in 216 patients (4.2%), of which 82 (1.5%) were primary events. After adjustment for risk factors, and compared with individuals without any cPB, hazard ratios for MACE were 0.78 (95% confidence interval [CI]: 0.31 to 1.91), 1.45 (95% CI: 0.67 to 3.14), and 2.36 (95% CI: 1.13 to 4.92) with increasing cPB tertile, with similar results for CAC. Net reclassification significantly improved with either cPB (0.23) or CAC (0.25). MACE rates increased simultaneously with higher levels of both cPB and CAC. CONCLUSIONS Detection of subclinical carotid or coronary atherosclerosis improves risk predictions and reclassification compared with conventional risk factors, with comparable results for either modality. Cost-effective analyses are warranted to define the optimal roles of these complementary techniques. (BioImage Study: A Clinical Study of Burden of Atherosclerotic Disease in an At-Risk Population; NCT00738725).
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Affiliation(s)
- Usman Baber
- Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Roxana Mehran
- Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Samantha Sartori
- Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mikkel Malby Schoos
- Department of Vascular Surgery, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Henrik Sillesen
- Department of Vascular Surgery, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | | | - Mario J Garcia
- Division of Cardiology, Montefiore Medical Center, Bronx, New York
| | - John Gregson
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Stuart Pocock
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Erling Falk
- Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark
| | - Valentin Fuster
- Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York, New York.
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170
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Relationship between different cardiovascular risk scores and measures of subclinical atherosclerosis in an Indian population. Indian Heart J 2015; 67:332-40. [PMID: 26304565 DOI: 10.1016/j.ihj.2015.04.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Revised: 03/24/2015] [Accepted: 04/25/2015] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Relative accuracy of the various currently available cardiovascular (CV) risk assessment algorithms in Indian patients is not known. METHODS This study included 194 consecutive patients (mean age 49.6 ± 10.3 years, 84.5% males) attending a CV disease prevention clinic at a tertiary center in north India. Four risk assessment models [Framingham Risk score (RiskFRS), American College of Cardiology/American Heart Association pooled cohort equations (RiskACC/AHA), the 3rd iteration of Joint British Societies' risk calculator (RiskJBS) and the World Health Organization/International Society of Hypertension risk prediction charts (RiskWHO)] were applied. The estimated risk scores were correlated with carotid intima-media thickness (CIMT) and coronary calcium score (CCS) using nonparametric statistics (Chi-square test, Kruskal-Wallis test and Spearman rank correlation). RESULTS Overall, RiskACC/AHA and RiskWHO significantly underestimated CV risk as compared to RiskJBS and RiskFRS, with RiskJBS being the least likely to underestimate the risk (patients with coronary artery disease who were found to have ≥20% CV risk- 21.4% with RiskACC/AHA, 17.9% with RiskWHO, 41.4% with RiskFRS, and 58.6% with RiskJBS). Further, only RiskJBS and RiskFRS, but not RiskACC/AHA and RiskWHO, demonstrated consistent relationship with CIMT and CCS (Spearman rho 0.45 and 0.46 for RiskJBS and 0.39 and 0.36 for RiskFRS for CIMT and CCS respectively, all p values < 0.001). CONCLUSIONS The present study shows that in Indian subjects RiskJBS appears to provide the most accurate estimation of CV risk. It least underestimates the risk and has the best correlation with CIMT and CCS. However, large-scale prospective studies are needed to confirm these findings.
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171
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Carotid intima-media thickness and elastic properties of aortas in normotensive children of hypertensive parents. Hypertens Res 2015; 38:621-6. [DOI: 10.1038/hr.2015.49] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Revised: 12/07/2014] [Accepted: 02/20/2015] [Indexed: 01/19/2023]
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172
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Friedlander AH, El Saden SM, Hazboun RC, Chang TI, Wong WK, Garrett NR. Detection of carotid artery calcification on the panoramic images of post-menopausal females is significantly associated with severe abdominal aortic calcification: a risk indicator of future adverse vascular events. Dentomaxillofac Radiol 2015; 44:20150094. [PMID: 25945511 DOI: 10.1259/dmfr.20150094] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Outcome studies among post-menopausal females with calcified carotid artery plaque (CCAP) on their panoramic images have not been previously undertaken. We sought to compare the extent of abdominal aortic calcification (AAC) on lateral lumbar spine radiographs (LLSRs), among groups of females with (CCAP+) and without (CCAP-) carotid lesions on their panoramic images. "Severe" levels of AAC have previously been validated as a risk indicator of future adverse cardiovascular events. METHODS This cross-sectional case-control study included a "CCAP+ group" consisting of females more than 50 years of age having the carotid lesion diagnosed by their dentists and an atherogenic risk factor (age, body mass index, hypertension, diabetes and dyslipidaemia)-matched "CCAP- group". A physician radiologist, using the Framingham index, evaluated the LLSRs for the magnitude of AAC. Summary statistics for key variables were computed and conditional logistic regression techniques were considered. RESULTS Members of the CCAP+ group were significantly (p=0.038) more likely to demonstrate "severe" levels of AAC on their LLSRs than members of the CCAP group. CONCLUSIONS This is the first published study demonstrating that CCAP on panoramic images of post-menopausal females is significantly associated with "severe" levels of AACs on LLSRs independent of traditional risk factors. Given that these levels of AAC are a validated risk indicator of future myocardial infarction and stroke, dentists must evaluate the panoramic images of post-menopausal females for the presence of CCAP. Patients with carotid atheromas should be referred to their physicians for further evaluation given the systemic implications.
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Affiliation(s)
- A H Friedlander
- 1 Department of Graduate Medical Education, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,2 Department of Oral and Maxillofacial Surgery, School of Dentistry, University of California Los Angeles, Los Angeles, CA, USA
| | - S M El Saden
- 3 Imaging Service, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,4 Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - R C Hazboun
- 5 Dental Service, Oral and Maxillofacial Surgery Division, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - T I Chang
- 2 Department of Oral and Maxillofacial Surgery, School of Dentistry, University of California Los Angeles, Los Angeles, CA, USA.,5 Dental Service, Oral and Maxillofacial Surgery Division, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - W K Wong
- 6 Department of Biostatistics, School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - N R Garrett
- 7 Dean's Office, School of Dentistry, University of California Los Angeles, CA, USA
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Ghouri N, Purves D, Deans KA, Logan G, McConnachie A, Wilson J, Gill JMR, Sattar N. An investigation of two-dimensional ultrasound carotid plaque presence and intima media thickness in middle-aged South Asian and European men living in the United kingdom. PLoS One 2015; 10:e0123317. [PMID: 25884221 PMCID: PMC4401566 DOI: 10.1371/journal.pone.0123317] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 03/02/2015] [Indexed: 01/09/2023] Open
Abstract
Objectives Ultrasound studies of carotid intima media thickness (cIMT) and plaques are limited in South Asians, a group at elevated cardiovascular disease (CVD) risk. We determined whether South Asians have a difference in these ultrasound markers compared to Europeans living in the United Kingdom and whether measured risk factor(s) could account for any such differences. Methods One hundred South Asian men, aged 40 to 70 years and 100 European men of similar age and BMI, without diagnosed CVD or diabetes, underwent carotid ultrasound for measurement of cIMT and carotid plaque presence. Physical activity, cardiorespiratory fitness, anthropometry and blood pressure were assessed, fasted blood taken for measurement of cardiometabolic risk factors and demographic and lifestyle factors recorded. Results Age-adjusted mean (SD) cIMT was similar in South Asians and Europeans (0.64 (0.16) mm v 0.65 (0.12) mm, p = 0.64). Plaque was present in 48 South Asians and 37 Europeans and overall, there was no age-adjusted difference between South Asian and Europeans for plaque score(odds ratio 1.49, 95% CI, 0.86-2.80, p = 0.16), however, South Asians appeared to have more plaques at a younger age than Europeans; at age 40-50 years the odds of South Asians having plaques was 2.63 (95% CI, 1.16-5.93) times that for Europeans. Conclusions cIMT is similar between healthy South Asian and European men. Whilst there was no overall difference in plaque presence in South Asians, there is an indication of greater plaque prevalence at younger ages - an observation requiring further investigation. Prospective studies linking plaques to CVD outcomes in South Asians are needed to investigate whether these measures help improve CVD risk prediction.
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Affiliation(s)
- Nazim Ghouri
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8TA, United Kingdom
- * E-mail: (NG); (NS)
| | - David Purves
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, G12 8QA, United Kingdom
| | - Kevin A. Deans
- Department of Clinical Biochemistry, Aberdeen Royal Infirmary, Aberdeen, AB25 2ZN, United Kingdom
| | - Greig Logan
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8TA, United Kingdom
- Human Potential Centre, AUT University, Auckland, 1142, New Zealand
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, G12 8QA, United Kingdom
| | - John Wilson
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8TA, United Kingdom
| | - Jason M. R. Gill
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8TA, United Kingdom
| | - Naveed Sattar
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8TA, United Kingdom
- * E-mail: (NG); (NS)
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Rosvall M, Persson M, Östling G, Nilsson P, Melander O, Hedblad B, Engström G. Risk factors for the progression of carotid intima-media thickness over a 16-year follow-up period: The Malmö Diet and Cancer Study. Atherosclerosis 2015; 239:615-21. [DOI: 10.1016/j.atherosclerosis.2015.01.030] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 01/09/2015] [Accepted: 01/27/2015] [Indexed: 12/24/2022]
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175
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Metabolic syndrome showed significant relationship with carotid atherosclerosis. Heart Vessels 2015; 31:664-70. [PMID: 25810113 DOI: 10.1007/s00380-015-0668-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 03/20/2015] [Indexed: 10/23/2022]
Abstract
Metabolic syndrome (MetS) is associated with an increased risk of cardiovascular disease. We assessed the associations between MetS and the indicators of carotid atherosclerosis as assessed by ultrasonography taking into consideration of confounders in the general population. A total of 1281 subjects (856 males, 425 females) were included in the present study. The total plaque score and maximum intima-media thickness (IMT) of the carotid arteries were measured as indicators of atherosclerosis. Cardiovascular risk factors were several metabolic components, serum uric acid, serum C-reactive protein (CRP), and lifestyle factors. MetS was defined according to the criteria of the National Cholesterol Education Program. The prevalences of an elevated total plaque score (≥5) and elevated IMT (>1 mm) of the carotid arteries were significantly higher in subjects with MetS as compared to subjects without MetS. Furthermore, a trend was observed towards higher prevalences of these indicators of atherosclerosis as the number of components of MetS increased. Logistic regression analysis revealed a significant association between elevated plaque score and MetS even after adjustments for age, serum uric acid, serum CRP and lifestyle factors in the males. Among the indicators of atherosclerosis assessed by carotid ultrasonography, a significant independent association was observed between the total plaque score and MetS in males in the general population.
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176
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Alonso N, Traveset A, Rubinat E, Ortega E, Alcubierre N, Sanahuja J, Hernández M, Betriu A, Jurjo C, Fernández E, Mauricio D. Type 2 diabetes-associated carotid plaque burden is increased in patients with retinopathy compared to those without retinopathy. Cardiovasc Diabetol 2015; 14:33. [PMID: 25856787 PMCID: PMC4389661 DOI: 10.1186/s12933-015-0196-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 02/27/2015] [Indexed: 12/13/2022] Open
Abstract
Background Cardiovascular disease (CVD) is the leading cause of mortality among subjects with type 2 diabetes (T2D), and diabetic retinopathy (DR) has been associated with an increased risk for CVD. The present study was designed to test the concept that T2D patients with DR, but without previous cardiovascular (CV) events and with normal renal function, have an increased atherosclerotic burden compared with patients without DR. Methods A cross-sectional study was performed using patients with normal renal function (estimated glomerular filtration rate (eGFR) >60 ml/min) and without previous CV events. A total of 312 patients (men, 51%; mean age, 57 yrs; age range 40–75 yrs) were included in the study; 153 (49%) of the patients had DR. B-mode carotid ultrasound imaging was performed for all of the study subjects to measure the carotid intima-media thickness (cIMT) and carotid plaques in the common carotid artery (CCA), bifurcation and internal carotid artery (ICA). Results The percentage of carotid plaques in T2D patients with DR was higher than in T2D patients without DR (68% vs. 52.2%, p = 0.0045), and patients with DR had a higher prevalence of ≥2 carotid plaques (44.4% vs. 21.4%; p < 0.0001). No differences were observed in the cIMT measured at different carotid regions between the patients with or without DR. Using multivariate logistic regression (adjustment for major risk factors for atherosclerosis), DR was independently associated with mean-internal cIMT (p = 0.0176), with the presence of carotid plaques (p = 0.0366) and with carotid plaque burden (≥2 plaques; p < 0.0001). Conclusions The present study shows that DR in T2D patients without CVD and with normal renal function is associated with a higher atherosclerotic burden (presence and number of plaques) in the carotid arteries. These patients may be at a higher risk for future CV events; therefore, an ultrasound examination of the carotid arteries should be considered in patients with DR for more careful and individualised CV assessment and follow-up.
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Affiliation(s)
- Núria Alonso
- Department of Endocrinology and Nutrition, Health Sciences Research Institute and University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Alicia Traveset
- Department of Ophthalmology, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Esther Rubinat
- Department of Endocrinology and Nutrition, Hospital Universitari Arnau de Vilanova, Lleida, Spain.,Institut de Recerca Biomedica de Lleida, University of Lleida, Lleida, Spain
| | - Emilio Ortega
- Department of Endocrinology and Nutrition, Institut d'Investigacions Biomediques August Pi Suñer, CIBER de Diabetes y Enfermedades Metabólicas asociadas, Hospital Clinic, 08036, Barcelona, Spain
| | - Nuria Alcubierre
- Institut de Recerca Biomedica de Lleida, University of Lleida, Lleida, Spain
| | - Jordi Sanahuja
- Department of Neurology, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Marta Hernández
- Department of Endocrinology and Nutrition, Hospital Universitari Arnau de Vilanova, Lleida, Spain.,Unitat de Detecció i Tractament de Malalties Aterotrombòtiques, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Angels Betriu
- Unitat de Detecció i Tractament de Malalties Aterotrombòtiques, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Carmen Jurjo
- Department of Ophthalmology, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Elvira Fernández
- Unitat de Detecció i Tractament de Malalties Aterotrombòtiques, Hospital Universitari Arnau de Vilanova, Lleida, Spain.,Department of Nephrology, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Didac Mauricio
- Department of Endocrinology and Nutrition, Health Sciences Research Institute and University Hospital Germans Trias i Pujol, Badalona, Spain.
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Yerly P, Marquès-Vidal P, Owlya R, Eeckhout E, Kappenberger L, Darioli R, Depairon M. The Atherosclerosis Burden Score (ABS): a Convenient Ultrasound-Based Score of Peripheral Atherosclerosis for Coronary Artery Disease Prediction. J Cardiovasc Transl Res 2015; 8:138-47. [DOI: 10.1007/s12265-015-9617-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 02/23/2015] [Indexed: 12/30/2022]
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178
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Masley SC, Roetzheim R, Masley LV, McNamara T, Schocken DD. Emerging Risk Factors as Markers for Carotid Intima Media Thickness Scores. J Am Coll Nutr 2015; 34:100-7. [DOI: 10.1080/07315724.2014.916238] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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179
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Alahdab F, Wang AT, Elraiyah TA, Malgor RD, Rizvi AZ, Lane MA, Prokop LJ, Montori VM, Conte MS, Murad MH. A systematic review for the screening for peripheral arterial disease in asymptomatic patients. J Vasc Surg 2015; 61:42S-53S. [DOI: 10.1016/j.jvs.2014.12.008] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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180
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Catena C, Colussi G, Url-Michitsch M, Nait F, Sechi LA. Subclinical carotid artery disease and plasma homocysteine levels in patients with hypertension. ACTA ACUST UNITED AC 2015; 9:167-75. [PMID: 25660367 DOI: 10.1016/j.jash.2014.12.020] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 12/22/2014] [Accepted: 12/23/2014] [Indexed: 11/30/2022]
Abstract
Information on the association between homocysteine (Hcy) levels and subclinical carotid artery disease is limited. We investigated the relationship of plasma Hcy concentration with carotid artery plaques and intima-media thickness (IMT) in patients with hypertension. In 486 essential hypertensive patients who underwent ultrasound examination of the carotid arteries, we measured plasma levels of Hcy, vitamin B12, folate, and C-reactive protein. Plaques were detected in 34% of the study patients. Plasma Hcy levels were significantly greater in hypertensive patients with evidence of carotid plaques than patients without carotid plaques. Carotid IMT progressively increased across quartiles of plasma Hcy levels. Multivariate regression showed that carotid IMT was independently related with age, blood pressure, C-reactive protein, and Hcy levels. In a logistic regression, age, blood pressure, triglyceride, and Hcy independently predicted the presence of carotid plaques. Thus, elevated plasma Hcy levels are associated with asymptomatic carotid disease in hypertensive patients suggesting a role of Hcy in the development and progression of carotid atherosclerosis in these patients.
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Affiliation(s)
- Cristiana Catena
- Hypertension Unit, Internal Medicine, Department of Experimental and Clinical Medicine, University of Udine, Udine, Italy; Division of Cardiology, Medical University of Graz, Graz, Austria.
| | - GianLuca Colussi
- Hypertension Unit, Internal Medicine, Department of Experimental and Clinical Medicine, University of Udine, Udine, Italy
| | | | - Francesca Nait
- Hypertension Unit, Internal Medicine, Department of Experimental and Clinical Medicine, University of Udine, Udine, Italy
| | - Leonardo A Sechi
- Hypertension Unit, Internal Medicine, Department of Experimental and Clinical Medicine, University of Udine, Udine, Italy
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181
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Bonnick SL. Dual x-ray absorptiometry and measurement of bone. Rheumatology (Oxford) 2015. [DOI: 10.1016/b978-0-323-09138-1.00044-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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182
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Nishimura S, Nagasaki M, Okudaira S, Aoki J, Ohmori T, Ohkawa R, Nakamura K, Igarashi K, Yamashita H, Eto K, Uno K, Hayashi N, Kadowaki T, Komuro I, Yatomi Y, Nagai R. ENPP2 contributes to adipose tissue expansion and insulin resistance in diet-induced obesity. Diabetes 2014; 63:4154-64. [PMID: 24969110 DOI: 10.2337/db13-1694] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Body weight is tightly regulated by food intake and energy dissipation, and obesity is related to decreased energy expenditure (EE). Herein, we show that nucleotide pyrophosphatase/phosphodiesterase 2 (ENPP2, autotaxin) is an adipose-derived, secreted enzyme that controls adipose expansion, brown adipose tissue (BAT) function, and EE. In mice, Enpp2 was highly expressed in visceral white adipose tissue and BAT and is downregulated in hypertrophied adipocytes/adipose tissue. Enpp2(+/-) mice and adipocyte-specific Enpp2 knockout mice fed a high-fat diet showed smaller body weight gains and less insulin resistance than control mice fed the same diet. BAT was functionally more active and EE was increased in Enpp2-deficient mice. In humans, ENPP2 expression in subcutaneous fat and ENPP2 levels in serum were reduced in obese subjects. Taken together, our results establish ENPP2 as an adipose-derived, secreted enzyme that regulates adipose obesity and systemic metabolism. They also suggest ENPP2 could be a useful therapeutic target for the treatment of metabolic disease.
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Affiliation(s)
- Satoshi Nishimura
- Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan Translational Systems Biology and Medicine Initiative, University of Tokyo, Tokyo, Japan Research Division of Cell and Molecular Medicine, Center for Molecular Medicine, Jichi Medical University, Tochigi, Japan
| | - Mika Nagasaki
- Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan Computational Diagnostic Radiology and Preventive Medicine, University of Tokyo, Tokyo, Japan
| | - Shinichi Okudaira
- Department of Molecular and Cellular Biochemistry, Graduate School of Pharmaceutical Sciences, Tohoku University, Miygai, Japan
| | - Junken Aoki
- Department of Molecular and Cellular Biochemistry, Graduate School of Pharmaceutical Sciences, Tohoku University, Miygai, Japan
| | - Tsukasa Ohmori
- Research Division of Cell and Molecular Medicine, Center for Molecular Medicine, Jichi Medical University, Tochigi, Japan
| | - Ryunosuke Ohkawa
- Department of Clinical Laboratory, University of Tokyo Hospital, Tokyo, Japan
| | - Kazuhiro Nakamura
- Department of Clinical Laboratory, University of Tokyo Hospital, Tokyo, Japan
| | - Koji Igarashi
- Bioscience Division, Reagent Development Department, AIA Research Group, Tosoh Corporation, Kanagawa, Japan
| | - Hiroshi Yamashita
- Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan
| | - Koji Eto
- Center for iPS Cell Research and Application, Kyoto University, Kyoto, Japan
| | - Kansei Uno
- Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan Computational Diagnostic Radiology and Preventive Medicine, University of Tokyo, Tokyo, Japan
| | - Naoto Hayashi
- Computational Diagnostic Radiology and Preventive Medicine, University of Tokyo, Tokyo, Japan
| | - Takashi Kadowaki
- Translational Systems Biology and Medicine Initiative, University of Tokyo, Tokyo, Japan Department of Metabolic Diseases, University of Tokyo, Tokyo, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan
| | - Yutaka Yatomi
- Department of Clinical Laboratory, University of Tokyo Hospital, Tokyo, Japan
| | - Ryozo Nagai
- Research Division of Cell and Molecular Medicine, Center for Molecular Medicine, Jichi Medical University, Tochigi, Japan
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183
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Ambrosino P, Lupoli R, Di Minno A, Iervolino S, Peluso R, Di Minno MND. Markers of cardiovascular risk in patients with antiphospholipid syndrome: a meta-analysis of literature studies. Ann Med 2014; 46:693-702. [PMID: 25307359 DOI: 10.3109/07853890.2014.959559] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Several studies reported on the association between antiphospholipid syndrome (APS) and venous thrombosis. In contrast, little is known about cardiovascular (CV) risk in APS. We performed a meta-analysis on the impact of APS on major markers of CV risk. Studies on the relationship between APS and common carotid artery intima-media thickness (CCA-IMT), internal carotid artery IMT (ICA-IMT), carotid bifurcation IMT (BIF-IMT), prevalence of carotid plaques, flow-mediated dilation (FMD), nitrate-mediated dilation (NMD), and ankle-brachial index (ABI) were systematically searched in PubMed, Web of Science, Scopus, and EMBASE databases. Twenty case-control studies (668 cases, 678 controls) were included. Compared to controls, APS patients showed a higher CCA-IMT (mean difference [MD] 0.11 mm; 95% CI 0.07, 0.14), ICA-IMT (MD 0.08 mm; 95% CI 0.05, 0.11), BIF-IMT (MD 0.09 mm; 95% CI 0.06, 0.12) and a higher frequency of carotid plaques (OR 3.87; 95% CI 1.61, 9.31). Moreover, a lower FMD was found in APS subjects than in controls (MD -4.49%; 95% CI -6.20, -2.78), with no differences in NMD (MD -1.80%; 95% CI -4.01, 0.42). Finally, an increased prevalence of pathological ABI was found in APS patients compared to controls (OR 7.26; 95% CI 1.77, 29.71). Despite heterogeneity among studies, APS appears significantly associated with markers of subclinical atherosclerosis and CV risk. These findings can be useful to plan adequate prevention strategies and therapeutic approaches.
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Affiliation(s)
- Pasquale Ambrosino
- Department of Clinical Medicine and Surgery, Federico II University , Naples , Italy
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184
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Goetz M, Shah A, Goldberg J, Cheema F, Shallenberger L, Murrah NV, Bremner JD, Vaccarino V. Posttraumatic stress disorder, combat exposure, and carotid intima-media thickness in male twins. Am J Epidemiol 2014; 180:989-96. [PMID: 25301813 PMCID: PMC4224362 DOI: 10.1093/aje/kwu225] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Posttraumatic stress disorder (PTSD) is associated with an increased risk of ischemic heart disease, though the pathophysiologic mechanisms remain unclear. Carotid artery intima-media thickness (CIMT) is a measure of subclinical atherosclerosis. We examined whether PTSD and combat exposure were associated with CIMT in Vietnam War-era twins after controlling for shared genetic and childhood factors. Between 2002 and 2010, we studied 465 middle-aged twins from the Vietnam Era Twin Registry who were free from cardiovascular disease. PTSD was diagnosed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and CIMT was measured by ultrasound. Mixed-effects regression models were used to examine individual, between-pair, and within-pair associations. Approximately 13% of participants met the criteria for PTSD, and 45% served in the Vietnam Theater. PTSD was associated with 32.7 μm higher CIMT (95% confidence interval (CI): 0.9, 64.5) after adjustment for confounders. The average CIMT for the pair increased by 59.7 μm for each additional twin with PTSD (95% CI: 15.9, 104.2). We found no significant within-pair differences in CIMT when comparing PTSD-discordant co-twins. Results for combat exposure were similar, but its association with CIMT weakened after adjustment for PTSD (95% CI: 7.0, 45.3). Among Vietnam War-era veterans, combat exposure and PTSD are associated with CIMT, though the associations are largely mediated by shared childhood factors.
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Affiliation(s)
| | | | | | | | | | | | | | - Viola Vaccarino
- Correspondence to Dr. Viola Vaccarino, Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Room 3011, Atlanta, GA 30322 (e-mail: )
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185
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Severo MD, Leiria LF, Ledur PDS, Becker AD, Aguiar FM, Massierer D, Gus M, Schaan BD. Association between erectile dysfunction and echocardiographic variables of ventricular hypertrophy and diastolic function in hypertensive patients with type 2 diabetes mellitus: a cross-sectional study. J Diabetes 2014; 6:586-94. [PMID: 24460859 DOI: 10.1111/1753-0407.12133] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 01/18/2014] [Accepted: 01/21/2014] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND This study was conducted among individuals with diabetes and hypertension in order to assess the prevalence of erectile dysfunction (ED) and the association between ED and cardiovascular risk variables such as echocardiographic changes. METHODS We evaluated 114 men with type 2 diabetes mellitus and hypertension. ED was assessed by International Index of Erectile Function (IIEF-5) score. Clinical and laboratory variables were evaluated, including C-reactive protein (CRP), ambulatory blood pressure monitoring (ABPM), ankle brachial index (ABI) and transthoracic echocardiography. Comparisons between patients with ED (IIEF-5 < 22) and without ED (IIEF-5 ≥ 22) were performed. RESULTS Patients were 56.8 ± 5.7 years-old, systolic and diastolic blood pressure were 150.7 ± 19.5 mmHg and 85.4 ± 11.4 mmHg, respectively, and HbA1c was 8.0 ± 1.7%. The majority (74.6%) of patients had ED. Levels of CRP, ABPM values and ABI were similar between men with and without ED. Echocardiography variables related to cardiac chamber diameters, left ventricular hypertrophy and diastolic function were similar between groups, except there was a slight lower left ventricular ejection fraction in men with ED (64.9 ± 7.3 vs 68.1 ± 3.9%, P = 0.004). CONCLUSIONS In high cardiovascular risk hypertensive individuals with type 2 diabetes, ED is highly prevalent as expected, but its presence is associated with neither echocardiographic variables, nor other cardiovascular risk factors.
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186
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Di Minno G, Spadarella G, Cafaro G, Petitto M, Lupoli R, Di Minno A, de Gaetano G, Tremoli E. Systematic reviews and meta-analyses for more profitable strategies in peripheral artery disease. Ann Med 2014; 46:475-89. [PMID: 25045928 PMCID: PMC4245179 DOI: 10.3109/07853890.2014.932618] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
In the peripheral arteries, a thrombus superimposed on atherosclerosis contributes to the progression of peripheral artery disease (PAD), producing intermittent claudication (IC), ischemic necrosis, and, potentially, loss of the limb. PAD with IC is often undiagnosed and, in turn, undertreated. The low percentage of diagnosis (∼30%) in this setting of PAD is of particular concern because of the potential worsening of PAD (amputation) and the high risk of adverse vascular outcomes (vascular death, coronary artery disease, stroke). A Medline literature search of the highest-quality systematic reviews and meta-analyses of randomized controlled trials documents that, due to risk of bias, imprecision, and indirectness, the overall quality of the evidence concerning diagnostic tools and antithrombotic interventions in PAD is generally low. Areas of research emerge from the information collected. Appropriate treatments for PAD patients will only derive from ad-hoc studies. Innovative imaging techniques are needed to identify PAD subjects at the highest vascular risk. Whether IC unresponsive to physical exercise and smoking cessation identifies those with a heritable predisposition to more severe vascular events deserves to be addressed. Devising ways to improve prevention of vascular events in patients with PAD implies a co-ordinated approach in vascular medicine.
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Affiliation(s)
- Giovanni Di Minno
- Department of Clinical Mediine and Surgery, Università degli Studi di Napoli , Naples , Italy
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187
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Vedanthan R, Choi BG, Baber U, Narula J, Fuster V. Bioimaging and subclinical cardiovascular disease in low- and middle-income countries. J Cardiovasc Transl Res 2014; 7:701-10. [PMID: 25245465 PMCID: PMC4233173 DOI: 10.1007/s12265-014-9588-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 08/26/2014] [Indexed: 01/07/2023]
Abstract
Cardiovascular disease (CVD) is the leading cause of mortality worldwide and also exerts a significant economic burden, especially in low- and middle-income countries (LMICs). Detection of subclinical CVD, before an individual experiences a major event, may therefore offer the potential to prevent or delay morbidity and mortality, if combined with an appropriate care response. In this review, we discuss imaging technologies that can be used to detect subclinical atherosclerotic CVD (carotid ultrasound, coronary artery calcification) and nonatherosclerotic CVD (echocardiography). We review these imaging modalities, including aspects such as rationale, relevance, feasibility, utilization, and access in LMICs. The potential gains in detecting subclinical CVD may be substantial in LMICs, if earlier detection leads to earlier engagement with the health care system to prevent or delay cardiac events, morbidity, and premature mortality. Thus, dedicated studies examining the feasibility, utility, and cost-effectiveness of detecting subclinical CVD in LMICs are warranted.
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Affiliation(s)
- Rajesh Vedanthan
- Zena and Michael A. Wiener Cardiovascular Institute, and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health; Icahn School of Medicine at Mount Sinai; New York, NY, USA
| | - Brian G. Choi
- The GW Heart & Vascular Institute and Cheney Center for Cardiovascular Health; The George Washington University School of Medicine & Health Sciences; Washington, DC, USA
| | - Usman Baber
- Zena and Michael A. Wiener Cardiovascular Institute, and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health; Icahn School of Medicine at Mount Sinai; New York, NY, USA
| | - Jagat Narula
- Zena and Michael A. Wiener Cardiovascular Institute, and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health; Icahn School of Medicine at Mount Sinai; New York, NY, USA
| | - Valentin Fuster
- Zena and Michael A. Wiener Cardiovascular Institute, and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health; Icahn School of Medicine at Mount Sinai; New York, NY, USA
- Centro Nacional de Investigaciones Cardiovasculares; Madrid, Spain
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188
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Veronese E, Tarroni G, Visentin S, Cosmi E, Linguraru MG, Grisan E. Estimation of prenatal aorta intima-media thickness from ultrasound examination. Phys Med Biol 2014; 59:6355-71. [PMID: 25295390 DOI: 10.1088/0022-3727/59/21/6355] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Prenatal events such as intrauterine growth restriction and increased cardiovascular risk in later life have been shown to be associated with an increased intima-media thickness (aIMT) of the abdominal aorta in the fetus. In order to assess and manage atherosclerosis and cardiovascular disease risk in adults and children, in recent years the measurement of abdominal and carotid artery thickness has gained a growing appeal. Nevertheless, no computer aided method has been proposed for the analysis of prenatal vessels from ultrasound data, yet. To date, these measurements are being performed manually on ultrasound fetal images by skilled practitioners. The aim of the presented study is to introduce an automatic algorithm that identifies abdominal aorta and estimates its diameter and aIMT from routine third trimester ultrasonographic fetal data.The algorithm locates the aorta, then segments it and, by modeling the arterial wall longitudinal sections by means of a gaussian mixture, derives a set of measures of the aorta diameter (aDiam) and of the intima-media thickness (aIMT). After estimating the cardiac cycle, the mean diameter and the aIMT at the end-diastole phase are computed.Considering the aIMT value for each subject, the correlation between automatic and manual end-diastolic aIMT measurements is 0.91 in a range of values 0.44-1.10 mm, corresponding to both normal and pathological conditions. The automatic system yields a mean relative error of 19%, that is similar to the intra-observer variability (14%) and much lower that the inter-observer variability (42%).The correlation between manual and automatic measurements and the small error confirm the ability of the proposed system to reliably estimate aIMT values in prenatal ultrasound sequences, reducing measurement variability and suggesting that it can be used for an automatic assessment of aIMT.
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Affiliation(s)
- E Veronese
- Department of Information Engineering, University of Padova, Via Gradenigo 6/b,35100 Padova, Italy
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189
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A review of ultrasound common carotid artery image and video segmentation techniques. Med Biol Eng Comput 2014; 52:1073-93. [PMID: 25284219 DOI: 10.1007/s11517-014-1203-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Accepted: 09/22/2014] [Indexed: 10/24/2022]
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190
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Chronotropic response during treadmill exercise and subclinical carotid atherosclerosis after adjusting for the calibrated SCORE risk classification: a cross-sectional study. Heart Vessels 2014; 31:129-36. [DOI: 10.1007/s00380-014-0584-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 09/12/2014] [Indexed: 10/24/2022]
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191
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Associations of carotid artery plaque with lower urinary tract symptoms and erectile dysfunction. Int Urol Nephrol 2014; 46:2263-70. [DOI: 10.1007/s11255-014-0830-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 08/27/2014] [Indexed: 10/24/2022]
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192
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Kim ESH, Marycz DM, Archinal D, Gornik HL, Shishehbor MH, Bartholomew JR. Presence of external carotid artery plaque independently predicts mortality in patients without internal carotid artery atherosclerosis. Vasc Med 2014; 19:351-5. [DOI: 10.1177/1358863x14546159] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The presence of plaque in the external carotid artery (ECA) detected on carotid duplex ultrasound (CDU) is of unknown clinical significance and may not be reported in routine clinical practice. We hypothesize that ECA plaque in the absence of plaque in the other cervical vessels is a risk factor for increased all-cause mortality. Objectives: To determine the significance of ECA plaque on all-cause mortality in the absence of internal carotid artery (ICA) or common carotid artery (CCA) plaque. Methods: We queried the Non-Invasive Vascular Laboratory database for all CDUs performed between 1 January 2005 and 31 December 2005. All images were reviewed for the presence of plaque. Studies were included if plaque was absent in both the CCA and the ICA. Chart review was performed to obtain demographic and clinical information. All-cause mortality was determined using the Social Security Death Index. Results: A total of 500 patient studies met the inclusion criteria; 64 patients (12.8%) had plaque in one or both ECAs. There was no significant difference in age (mean 58.1 ± 14.8 years), race (82.5% white), or sex (64.4% male) between those with and without ECA plaque. There was a significant difference in all-cause mortality between patients with and without isolated ECA plaque after adjustment for age, sex, low-density lipoprotein cholesterol, smoking, hypertension, body mass index, and surgery within 30 days of CDU (adjusted hazard ratio 2.60, 95% CI 1.46–4.66, p<0.001). Conclusions: The presence of plaque isolated to the ECA is an independent predictor of all-cause mortality and may impart important prognostic information for patients referred for CDU.
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Affiliation(s)
- Esther SH Kim
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Devon Archinal
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Heather L Gornik
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mehdi H Shishehbor
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - John R Bartholomew
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
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193
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Gigante B, Leander K, Vikström M, Baldassarre D, Veglia F, Strawbridge RJ, McLeod O, Gertow K, Sennblad B, Shah S, Zabaneh D, Humphries SE, Kauhanen J, Rauramaa R, Smit AJ, Mannarino E, Giral P, Tremoli E, Hamsten A, Frostegård J, de Faire U. Low levels of IgM antibodies against phosphorylcholine are associated with fast carotid intima media thickness progression and cardiovascular risk in men. Atherosclerosis 2014; 236:394-9. [PMID: 25150937 DOI: 10.1016/j.atherosclerosis.2014.07.030] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 07/14/2014] [Accepted: 07/24/2014] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Low levels of IgM anti-phosphorylcholine (anti-PC) increase the risk of cardiovascular events (CVE). Here we investigate the association of low anti-PC with the progression of carotid intima media thickness (C-IMT) and incidence of CVE in a large cohort of individuals at high risk of CVE, the IMPROVE, a prospective multicenter European study. METHODS 3711 subjects (54-79 years) with at least three established cardiovascular risk factors were enrolled. Baseline serum levels of IgM anti-PC were measured by ELISA. Carotid ultrasound investigations were performed at baseline and after 15 and 30 months of follow-up. The risk of C-IMT progression and ischemic CVE associated with low anti-PC levels was tested by logistic regression and Cox regression analysis, respectively. Risk estimates were adjusted by center and conventional cardiovascular risk factors. RESULTS 3670 study participants were included in the present analysis and 213 CVE were recorded during a 3 year follow up. Anti-PC levels (U/ml) were classified into quartiles [Q1≤ 40, Q2 >40-≤64, Q3 >64-≤102, Q4 >102]. In men, low levels of anti-PC (Q1) were associated with the highest (>90th) percentile of the fastest C-IMT progression, i.e. the segment showing the fastest progression over 30 months in the whole carotid tree, with an OR of 1.41 (95%CI, 1.02-1.9) and with an increased risk of CVE with a multivariable adjusted HR of 1.85 (95%CI, 1.1-3.1). No significant associations were found in women. CONCLUSIONS Low anti-PC levels increase the risk of CVE in men. This effect may be partly mediated by a fast C-IMT progression.
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Affiliation(s)
- Bruna Gigante
- Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine (IMM), Stockholm, Sweden; Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
| | - Karin Leander
- Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine (IMM), Stockholm, Sweden
| | - Max Vikström
- Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine (IMM), Stockholm, Sweden
| | - Damiano Baldassarre
- Dipartimento di Scienze Farmacologiche e Biomolecolari, Università di Milano, Milan Italy; Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Fabrizio Veglia
- Dipartimento di Scienze Farmacologiche e Biomolecolari, Università di Milano, Milan Italy
| | | | - Olga McLeod
- Atherosclerosis Research Unit, Department of Medicine Solna, Sweden
| | - Karl Gertow
- Atherosclerosis Research Unit, Department of Medicine Solna, Sweden
| | - Bengt Sennblad
- Atherosclerosis Research Unit, Department of Medicine Solna, Sweden; Science for Life Laboratory, Karolinska Institutet, Stockholm, Sweden
| | - Sonia Shah
- University College London Genetics Institute, University College London, United Kingdom
| | - Delilah Zabaneh
- University College London Genetics Institute, University College London, United Kingdom
| | - Steve E Humphries
- Centre for Cardiovascular Genetics, University College London, United Kingdom
| | - Jussi Kauhanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Rainer Rauramaa
- Foundation for Research in Health, Exercise and Nutrition, Kuopio Research Institute of Exercise Medicine, Kuopio, Finland
| | - Andries J Smit
- Department of Medicine, University Medical Center Groningen, The Netherlands
| | - Elmo Mannarino
- Internal Medicine, Angiology and Arteriosclerosis Diseases, Department of Clinical and Experimental Medicine, University of Perugia, Perugia, Italy
| | - Philippe Giral
- Assistance Publique - Hopitaux de Paris, Service Endocrinologie-Metabolisme, Groupe Hôpitalier Pitie-Salpetriere, Unités de Prévention Cardiovasculaire, Paris, France
| | - Elena Tremoli
- Dipartimento di Scienze Farmacologiche e Biomolecolari, Università di Milano, Milan Italy; Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Anders Hamsten
- Atherosclerosis Research Unit, Department of Medicine Solna, Sweden
| | - Johan Frostegård
- Unity of Immunology and Chronic disease, IMM, Stockholm, Sweden; Unit of Acute Internal Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Ulf de Faire
- Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine (IMM), Stockholm, Sweden; Dept of Cardiology, Karolinska University Hospital, Stockholm, Sweden
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Naqvi TZ, Lee MS. Carotid intima-media thickness and plaque in cardiovascular risk assessment. JACC Cardiovasc Imaging 2014; 7:1025-38. [PMID: 25051948 DOI: 10.1016/j.jcmg.2013.11.014] [Citation(s) in RCA: 393] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 11/11/2013] [Accepted: 11/15/2013] [Indexed: 12/12/2022]
Abstract
Carotid intima-media thickness (CIMT) has been shown to predict cardiovascular (CV) risk in multiple large studies. Careful evaluation of CIMT studies reveals discrepancies in the comprehensiveness with which CIMT is assessed-the number of carotid segments evaluated (common carotid artery [CCA], internal carotid artery [ICA], or the carotid bulb), the type of measurements made (mean or maximum of single measurements, mean of the mean, or mean of the maximum for multiple measurements), the number of imaging angles used, whether plaques were included in the intima-media thickness (IMT) measurement, the report of adjusted or unadjusted models, risk association versus risk prediction, and the arbitrary cutoff points for CIMT and for plaque to predict risk. Measuring the far wall of the CCA was shown to be the least variable method for assessing IMT. However, meta-analyses suggest that CCA-IMT alone only minimally improves predictive power beyond traditional risk factors, whereas inclusion of the carotid bulb and ICA-IMT improves prediction of both cardiac risk and stroke risk. Carotid plaque appears to be a more powerful predictor of CV risk compared with CIMT alone. Quantitative measures of plaques such as plaque number, plaque thickness, plaque area, and 3-dimensional assessment of plaque volume appear to be progressively more sensitive in predicting CV risk than mere assessment of plaque presence. Limited data show that plaque characteristics including plaque vascularity may improve CV disease risk stratification further. IMT measurement at the CCA, carotid bulb, and ICA that allows inclusion of plaque in the IMT measurement or CCA-IMT measurement along with plaque assessment in all carotid segments is emerging as the focus of carotid artery ultrasound imaging for CV risk prediction.
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Affiliation(s)
- Tasneem Z Naqvi
- Echocardiography Laboratory, Mayo Clinic, Scottsdale, Arizona; Cardiac Noninvasive Laboratories, Keck School of Medicine, University of Southern California, Los Angeles, California.
| | - Ming-Sum Lee
- Cardiac Noninvasive Laboratories, Keck School of Medicine, University of Southern California, Los Angeles, California
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195
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Weir-McCall JR, Khan F, Lambert MA, Adamson CL, Gardner M, Gandy SJ, Ramkumar PG, Belch JJF, Struthers AD, Rauchhaus P, Morris AD, Houston JG. Common carotid intima media thickness and ankle-brachial pressure index correlate with local but not global atheroma burden: a cross sectional study using whole body magnetic resonance angiography. PLoS One 2014; 9:e99190. [PMID: 24933122 PMCID: PMC4059661 DOI: 10.1371/journal.pone.0099190] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 05/12/2014] [Indexed: 11/18/2022] Open
Abstract
Background Common carotid intima media thickness (CIMT) and ankle brachial pressure index (ABPI) are used as surrogate marker of atherosclerosis, and have been shown to correlate with arterial stiffness, however their correlation with global atherosclerotic burden has not been previously assessed. We compare CIMT and ABPI with atheroma burden as measured by whole body magnetic resonance angiography (WB-MRA). Methods 50 patients with symptomatic peripheral arterial disease were recruited. CIMT was measured using ultrasound while rest and exercise ABPI were performed. WB-MRA was performed in a 1.5T MRI scanner using 4 volume acquisitions with a divided dose of intravenous gadolinium gadoterate meglumine (Dotarem, Guerbet, FR). The WB-MRA data was divided into 31 anatomical arterial segments with each scored according to degree of luminal narrowing: 0 = normal, 1 = <50%, 2 = 50–70%, 3 = 70–99%, 4 = vessel occlusion. The segment scores were summed and from this a standardized atheroma score was calculated. Results The atherosclerotic burden was high with a standardised atheroma score of 39.5±11. Common CIMT showed a positive correlation with the whole body atheroma score (β 0.32, p = 0.045), however this was due to its strong correlation with the neck and thoracic segments (β 0.42 p = 0.01) with no correlation with the rest of the body. ABPI correlated with the whole body atheroma score (β −0.39, p = 0.012), which was due to a strong correlation with the ilio-femoral vessels with no correlation with the thoracic or neck vessels. On multiple linear regression, no correlation between CIMT and global atheroma burden was present (β 0.13 p = 0.45), while the correlation between ABPI and atheroma burden persisted (β −0.45 p = 0.005). Conclusion ABPI but not CIMT correlates with global atheroma burden as measured by whole body contrast enhanced magnetic resonance angiography in a population with symptomatic peripheral arterial disease. However this is primarily due to a strong correlation with ilio-femoral atheroma burden.
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Affiliation(s)
- Jonathan R. Weir-McCall
- Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, Dundee, United Kingdom
- NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom
- * E-mail:
| | - Faisel Khan
- Vascular & Inflammatory Diseases Research Unit, Medical Research Institute, University of Dundee, Dundee, United Kingdom
| | - Matthew A. Lambert
- Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, Dundee, United Kingdom
| | - Carly L. Adamson
- University of Dundee, Ninewells Hospital & Medical School, Dundee, United Kingdom
| | - Michael Gardner
- University of Dundee, Ninewells Hospital & Medical School, Dundee, United Kingdom
| | - Stephen J. Gandy
- NHS Tayside Medical Physics, Ninewells Hospital, Dundee, United Kingdom
| | | | - Jill J. F. Belch
- Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, Dundee, United Kingdom
| | - Allan D. Struthers
- Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, Dundee, United Kingdom
| | - Petra Rauchhaus
- Dundee epidemiological and biostatistics unit, University of Dundee, Dundee, United Kingdom
| | - Andrew D. Morris
- Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, Dundee, United Kingdom
| | - J. Graeme Houston
- Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, Dundee, United Kingdom
- NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, United Kingdom
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196
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Okello S, Millard A, Owori R, Asiimwe SB, Siedner MJ, Rwebembera J, Wilson LA, Moore CC, Annex BH. Prevalence of lower extremity peripheral artery disease among adult diabetes patients in southwestern Uganda. BMC Cardiovasc Disord 2014; 14:75. [PMID: 24913468 PMCID: PMC4057935 DOI: 10.1186/1471-2261-14-75] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 06/05/2014] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Peripheral artery disease (PAD) is a major complication of atherosclerosis. PAD can be diagnosed with low-cost diagnostic techniques and is associated with significant morbidity and mortality. While the major epidemiologic risk factors for PAD have been established in the western world, data from resource-poor countries are limited. We performed a cross-sectional study to determine the prevalence and correlates of PAD among patients with diabetes at Mbarara Referral Hospital in southwestern Uganda. METHODS We consecutively enrolled diabetes patients aged 50 years or greater presenting to the outpatient clinic. We collected blood for fasting lipid profile, HIV serology, and glycosylated hemoglobin, measured blood pressure and ankle brachial index, and administered the Edinburgh Claudication Questionnaire (ECQ). We also surveyed patients for other PAD risk factors. We used logistic regression to determine correlates of PAD. RESULTS We enrolled 229 diabetes patients. The median age of 60 years (IQR 55-66), and 146 (63.7%) were female. Fifty five patients (24%) had PAD (ABI of ≤ 0.9). Of these, 48 /55 (87.27%) had mild PAD (ABI 0.71-0.9) while 7/55 (12.73%) had moderate to severe PAD (ABI < 0.7). Amongst those with PAD, 24/55 (43.64%) reported claudication by the ECQ. Correlates of PAD included female sex (AOR 2.25, 95% CI 1.06 - 4.77, p = 0.034), current high blood pressure (AOR 2.59, 95% CI 1.25-5.33, p = 0.01), and being on a sulfonylurea-glibenclamide (AOR 3.47, 95% CI 1.55 - 7.76, p = 0.002). CONCLUSION PAD was common in diabetic patients in southwestern Uganda. Given its low cost and ease of measurement, ABI deserves further assessment as a screening tool for both PAD and long term cardiovascular risk amongst diabetics in this region.
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Affiliation(s)
- Samson Okello
- Department of Medicine, Mbarara University of Science and Technology, P,O Box 1410, Mbarara, Uganda.
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Yoon YM, Lee HS, Baek SH, Lee HL, Yeo M, Choi SY, Kim JS, Lee SH, Lee SS, Shin DI. Association between carotid intima-media thickness and Ankle-Brachial Index in patients with ischemic stroke. J Biomed Res 2014. [DOI: 10.12729/jbr.2014.15.2.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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198
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Ma H, Lin H, Hu Y, Li X, He W, Jin X, Gao J, Zhao N, Gao X. Serum levels of osteocalcin in relation to glucose metabolism and carotid atherosclerosis in Chinese middle-aged and elderly male adults: the Shanghai Changfeng Study. Eur J Intern Med 2014; 25:259-64. [PMID: 24521696 DOI: 10.1016/j.ejim.2014.01.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 12/27/2013] [Accepted: 01/22/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND The role of osteocalcin (OCN) in atherogenesis is unclear. We investigated the association between OCN and carotid atherosclerosis in Chinese middle-aged and elderly male adults and further determined whether OCN is independently associated with the carotid atherosclerosis in euglycemic subgroup. METHODS A total of 1077 male participants (mean age, 61.3 years) were enrolled from the Changfeng Study. A total of 638 subjects with normal glucose tolerance (NGT) were included in the subgroup analysis. A standard interview, anthropometric measurements and laboratory analyses were performed for each participant. Bilateral carotid intima-media thicknesses (CIMTs) were measured using ultrasonography, and the presence of carotid plaques was assessed. The circulating OCN was measured using electrochemiluminescence immunoassay. RESULTS OCN was 18.5 ± 7.5 ng/ml in this male population. Both impaired glucose regulation (IGR) and new diagnosed diabetes (NDD) groups had significantly lower OCN levels compared with the NGT group (17.7 ± 0.4 ng/ml, and 17.4 ± 0.6 ng/ml vs 19.2 ± 0.3 ng/ml, respectively). Multivariate linear stepwise regression analysis demonstrated that triglyceride (TG) (standardized β=-0.065, p=0.042) and fasting blood glucose (FBG) (standardized β=-0.063, p=0.034) were independently and inversely associated with serum OCN. In the NGT subgroup analysis, compared with subjects with OCN in the first quartile, subjects with OCN in the fourth quartile had decreased prevalence of carotid plaque. After adjusting for conventional CVD risk factors, male participants with OCN in the fourth quartile had a 0.57-fold decreased risk of carotid plaques relative to those in the lowest quartile. CONCLUSION These results suggest that OCN is independently associated with carotid atherosclerosis in male individuals with NGT and that OCN may be implicated in not only glucose metabolism but also atherosclerosis.
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Affiliation(s)
- Hui Ma
- Department of Endocrinology and Metabolism, Zhong Shan Hospital, Fudan University, Shanghai, China; Department of Geriatrics, Zhong Shan Hospital, Fudan University, Shanghai, China
| | - Huandong Lin
- Department of Endocrinology and Metabolism, Zhong Shan Hospital, Fudan University, Shanghai, China
| | - Yu Hu
- Department of Geriatrics, Zhong Shan Hospital, Fudan University, Shanghai, China
| | - Xiaoming Li
- Department of Endocrinology and Metabolism, Zhong Shan Hospital, Fudan University, Shanghai, China
| | - Wanyuan He
- Department of Ultrasonography, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xuejuan Jin
- Clinical Epidemiology Center, Zhong Shan Hospital, Fudan University, Shanghai, China
| | - Jian Gao
- Department of Clinical Nutrition, Zhong Shan Hospital, Fudan University, Shanghai, China
| | - Naiqing Zhao
- Department of Biostatistics, College of Public Health, Fudan University, Shanghai, China
| | - Xin Gao
- Department of Endocrinology and Metabolism, Zhong Shan Hospital, Fudan University, Shanghai, China.
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199
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Ma H, Lin H, Hu Y, Li X, He W, Jin X, Gao J, Zhao N, Gao X. Mean Platelet Volume in Relation to Carotid Atherosclerosis in Normotensive, Euglycemic, and Normolipidemic Chinese Middle-Aged and Elderly Adults. Angiology 2014; 65:512-8. [PMID: 24535639 DOI: 10.1177/0003319713520462] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
We investigated whether mean platelet volume (MPV) is independently associated with the carotid intima–media thickness (cIMT) in normotensive, euglycemic, and normolipidemic middle-aged and elderly adults. A total of 256 males and 398 females were enrolled from the Changfeng Study. Compared to male patients with MPV in the first quintile, male patients with MPV in the fifth quintile had greater cIMTs and higher prevalence of carotid plaque. After adjusting for conventional cardiovascular disease risk factors, male participants with MPV in the fifth quintile had a 1.669-fold increased risk of carotid plaques relative to those in the lowest quintiles. In female patients, the cIMTs and prevalence of carotid plaque were not significantly different among the groups. These results suggest that MPV is independently associated with carotid atherosclerosis in normotensive, euglycemic, and normolipidemic males. The MPV could be an easily measured marker of atherosclerosis for males.
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Affiliation(s)
- Hui Ma
- Department of Endocrinology and Metabolism, Zhong Shan Hospital, Fudan University, Shanghai, China
- Department of Geriatrics, Zhong Shan Hospital, Fudan University, Shanghai, China
| | - Huandong Lin
- Department of Endocrinology and Metabolism, Zhong Shan Hospital, Fudan University, Shanghai, China
| | - Yu Hu
- Department of Geriatrics, Zhong Shan Hospital, Fudan University, Shanghai, China
| | - Xiaoming Li
- Department of Endocrinology and Metabolism, Zhong Shan Hospital, Fudan University, Shanghai, China
| | - Wanyuan He
- Department of Ultrasonography, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xuejuan Jin
- Clinical Epidemiology Center, Zhong Shan Hospital, Fudan University, Shanghai, China
| | - Jian Gao
- Department of Clinical Nutrition, Zhong Shan Hospital, Fudan University, Shanghai, China
| | - Naiqing Zhao
- Department of Biostatistics, College of Public Health, Fudan University, Shanghai, China
| | - Xin Gao
- Department of Endocrinology and Metabolism, Zhong Shan Hospital, Fudan University, Shanghai, China
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200
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Nicoll R, Henein MY. The predictive value of arterial and valvular calcification for mortality and cardiovascular events. INTERNATIONAL JOURNAL OF CARDIOLOGY. HEART & VESSELS 2014; 3:1-5. [PMID: 29450162 PMCID: PMC5801264 DOI: 10.1016/j.ijchv.2014.02.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 02/01/2014] [Indexed: 11/16/2022]
Abstract
A review of the predictive ability of arterial and valvular calcification has shown an additive effect of calcification in more than 1 location in predicting mortality and coronary heart disease, with mitral annual calcification being a particularly strong predictor. In individual arteries and valves there is a clear association between calcification presence, extent and progression and future cardiovascular events and mortality in asymptomatic, symptomatic and high risk patients, although adjustment for calcification in other arterial beds generally renders associations non-significant. Furthermore, in acute coronary syndrome, culprit plaque is normally not calcified. This would tend to reduce the validity of calcification as a predictor and suggest that the association with cardiovascular events and mortality may not be causal. The association with stroke is less clear; carotid and intracranial artery calcification show little predictive ability, with symptomatic plaques tending to be uncalcified.
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Affiliation(s)
- Rachel Nicoll
- Department of Public Health and Clinical Medicine and Heart Centre, Umea University, Umea, Sweden.,Canterbury Christ Church University, Kent , UK
| | - Michael Y Henein
- Department of Public Health and Clinical Medicine and Heart Centre, Umea University, Umea, Sweden.,Canterbury Christ Church University, Kent , UK
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