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Villarín-Castro A, Rodríguez-Roca GC, Segura-Fragoso A, Alonso-Moreno FJ, Rojas-Martelo GA, Rodríguez-Padial L, Fernández-Conde JA, Lorenzo-Lozano MC, Menchén-Herreros A, Fernández-Martín J. [Vascular age in a sample of general population of the sanitary area of Toledo (Spain). RICARTO study]. Med Clin (Barc) 2021; 157:513-523. [PMID: 33183766 DOI: 10.1016/j.medcli.2020.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/07/2020] [Accepted: 08/11/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To know the vascular age (VA) of a sample of general population included in the RICARTO study. PATIENTS AND METHOD Epidemiological study of the general population aged ≥18 from the Health Area of Toledo, based on the health card database. VA was calculated from the absolute cardiovascular risk (CVR) estimated with the Framingham and SCORE equations (type2 diabetes increased CVR in SCORE 2-fold in men and 4-fold in women). Patients with cardiovascular or renal disease were excluded. An ANCOVA analysis was conducted to adjust and compare the mean of VA by age and sex. RESULTS 1,496 subjects (53.54% women) were analyzed. Mean (SD) age was 48.77 (14.89) years old and. Mean VA was 51.37 (19.13) with Framingham equation and 57.09 (17.63) years old with SCORE equation. VA was significantly higher in men, low education level, arterial hypertension, dyslipidemia, hypertriglyceridemia, diabetes mellitus, abdominal obesity, general obesity, smoking and in individuals with 5CVR factors vs none (P<.001 in all). Higher differences (Cohen's D >0.5) were found in non-diabetic vs diabetic people (1.58 Framingham; 2.44 SCORE), normotensive vs hypertensive subjects (1.64 Framingham; 1.19 SCORE), and non-dyslipidemia vs presence of dyslipidemia (0.95 Framingham; 0.66 SCORE). CONCLUSIONS VA of our sample is two and a half years older than chronological one with Framingham equation and more than eight years with SCORE equation. Control of CVR factors is the key to get a VA closer to real and to obtain a better cardiovascular health in the population.
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Affiliation(s)
| | | | - Antonio Segura-Fragoso
- Medicina Preventiva y Salud Pública. Asesor en Metodología de la Investigación de la Fundación de la Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Facultad de Ciencias de la Salud, Universidad de Castilla-La Mancha, Talavera de la Reina, Toledo, España
| | | | | | - Luis Rodríguez-Padial
- Servicio de Cardiología, Complejo Hospitalario Universitario de Toledo, Toledo, España
| | | | | | | | - Juan Fernández-Martín
- Medicina Preventiva y Salud Pública, Servicio de Investigación e Innovación, Dirección General de Asistencia Sanitaria, Servicio de Salud de Castilla-La Mancha (SESCAM), Toledo, España
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Ahmed AI, Han Y, Al Rifai M, Alnabelsi T, Nabi F, Chang SM, Chamsi-Pasha MA, Nasir K, Mahmarian JJ, Cainzos-Achirica M, Al-Mallah MH. Added prognostic value of plaque burden to computed tomography angiography and myocardial perfusion imaging. Atherosclerosis 2021; 334:9-16. [PMID: 34450557 DOI: 10.1016/j.atherosclerosis.2021.08.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/16/2021] [Accepted: 08/18/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND AIMS Cardiac computed tomographic angiography (CCTA) - derived measures of coronary artery disease (CAD) burden have been shown to independently predict incident cardiovascular events. We aimed to compare the added prognostic value of plaque burden to CCTA anatomic assessment and single photon emission computed tomography (SPECT) physiologic assessment in a cohort with high prevalence of risk factors undergoing both tests. METHODS Consecutive patients who underwent clinically indicated CCTA and SPECT myocardial imaging for suspected CAD were included. Stenosis severity and segment involvement score (SIS - number of segments with plaque irrespective of stenosis) were determined from CCTA, and presence of ischemia was determined from SPECT. Patients were followed for major adverse cardiovascular events (MACE, inclusive of all-cause death, non-fatal myocardial infarction, and percutaneous coronary intervention or coronary artery bypass grafting 90-days after imaging test.) RESULTS: A total of 956 patients were included (mean age 61.1 ± 14.2 years, 54% men, 89% hypertension, 81% diabetes, 84% dyslipidemia). Obstructive stenosis (left main ≥50%, all other coronary segments ≥70%) and ischemia were observed in a similar number of patients (14%). In multivariable Cox regression models, SIS significantly predicted outcomes and improved risk discrimination in models with CCTA obstructive stenosis (HR 1.15, p ≤ 0.001; Harrel's C 0.74, p = 0.008) and SPECT ischemia (HR 1.14, p < 0.001; Harrel's C 0.76, p = 0.019). CONCLUSIONS Our results suggest that in patients with suspected CAD and a high prevalence of risk-factors, plaque burden adds incremental prognostic value over established CCTA and SPECT measures to predict incident cardiovascular outcomes.
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Affiliation(s)
| | - Yushui Han
- Houston Methodist Debakey Heart & Vascular Center, Houston, TX, USA
| | | | - Talal Alnabelsi
- Houston Methodist Debakey Heart & Vascular Center, Houston, TX, USA
| | - Faisal Nabi
- Houston Methodist Debakey Heart & Vascular Center, Houston, TX, USA
| | - Su Min Chang
- Houston Methodist Debakey Heart & Vascular Center, Houston, TX, USA
| | | | - Khurram Nasir
- Houston Methodist Debakey Heart & Vascular Center, Houston, TX, USA
| | - John J Mahmarian
- Houston Methodist Debakey Heart & Vascular Center, Houston, TX, USA
| | | | - Mouaz H Al-Mallah
- Houston Methodist Debakey Heart & Vascular Center, Houston, TX, USA.
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Miki T, Miyauchi S, Miyoshi T, Yoshida M, Ichikawa K, Soh J, Nakamura K, Kiura K, Kanazawa S, Toyooka S, Ito H. Chemoradiation therapy for non-small cell lung cancer exacerbates thoracic aortic calcification determined by computed tomography. Heart Vessels 2020; 35:1401-1408. [PMID: 32335716 DOI: 10.1007/s00380-020-01611-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 04/17/2020] [Indexed: 11/29/2022]
Abstract
Preoperative chemoradiation therapy (CRT) has been considered as an effective treatment for non-small cell lung cancer. However, there is concern that CRT progresses atherosclerosis in cancer survivors. This study sought to determine if preoperative CRT exacerbated thoracic aortic calcification (TAC) detected by computed tomography (CT) in patients with lung cancer. Among 473 patients who underwent surgery for lung cancer at Okayama University Hospital between 2011 and 2015, 34 patients undergoing preoperative CRT and surgery (CRT group) and 33 matched patients undergoing initial surgery (non-CRT group) were analyzed and compared. The volume of TAC between the 2nd and 12th thoracic vertebrae was quantitatively measured by CT at baseline and 1-year follow-up. Patients in the CRT group (62 ± 7 years old, 74% male) received cisplatin chemotherapy with docetaxel or vinorelbine and radiation therapy (mean 47.3 ± 4.0 Gy). The percent change in TAC volume was significantly greater in the CRT compared with the non-CRT group (58.7%, 95% confidence interval [CI] 41.7-75.7% vs. 27.2%, 95% CI 9.9-44.4%; p = 0.01). Multivariate logistic regression analysis identified CRT as an independent factor associated with greater TAC progression (> the median value) (odds ratio 3.63, 95% CI 1.19-11.08; p = 0.02). In conclusion, preoperative CRT for lung cancer exacerbates TAC. Follow-up of such patients should thus include careful longitudinal assessment for cardiovascular disease.
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Affiliation(s)
- Takashi Miki
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Kitaku Shikata-cho, Okayama, 700-8558, Japan
| | - Shunsaku Miyauchi
- Department of General Thoracic, Breast, and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Toru Miyoshi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Kitaku Shikata-cho, Okayama, 700-8558, Japan.
| | - Masashi Yoshida
- Department of Chronic Kidney Disease and Cardiovascular Disease, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Keishi Ichikawa
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Kitaku Shikata-cho, Okayama, 700-8558, Japan
| | - Junichi Soh
- Department of General Thoracic, Breast, and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan.,Department of Surgery, Division of Thoracic Surgery, Kindai University Faculty of Medicine, Osaka-Samaya, Japan
| | - Kazufumi Nakamura
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Kitaku Shikata-cho, Okayama, 700-8558, Japan
| | - Katsuyuki Kiura
- Department of Allergy and Respiratory Medicine, Okayama University Hospital, Okayama, Japan
| | - Susumu Kanazawa
- Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Shinichi Toyooka
- Department of General Thoracic, Breast, and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Kitaku Shikata-cho, Okayama, 700-8558, Japan
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Al-Mallah MH. Unlocking the secrets of high-risk lipid rich plaque: Are we there? Atherosclerosis 2018; 275:382-383. [PMID: 29961600 DOI: 10.1016/j.atherosclerosis.2018.06.873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 06/20/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Mouaz H Al-Mallah
- Advanced Cardiac Imaging, King Abdulaziz Cardiac Center, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
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