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López-Candales A, Sawalha K. Improving diagnostic assessments in the ever-changing landscape of atherosclerosis. J Cardiovasc Med (Hagerstown) 2023; 24:221-229. [PMID: 36952387 DOI: 10.2459/jcm.0000000000001451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
As our understanding of atherosclerotic vascular injury continues to evolve, so should our diagnostic approaches. Emerging data have recently challenged our basic understanding in linking ischemia to its adverse outcomes as well as the need for invasive testing for both diagnosis and treatment. The advent of coronary computed tomography in providing improved visualization of coronary arteries has led to the identification of both subclinical atherosclerosis and high-risk coronary lesions. Recognition of asymptomatic coronary artery disease (CAD) with objective localization of subclinical coronary atherosclerosis improves atherosclerotic cardiovascular risk assessment and allows healthcare providers to take effective primary prevention measures. Therefore, reshaping the diagnostic landscape in proposing new testing modalities would be highly dependent on local resource availability and the reading expertise of each clinical practice and medical institution. The main objective of this Review is to propose a potentially new diagnostic approach of simply using noninvasive stress testing or coronary angiography in the routine assessment of CAD.
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Affiliation(s)
| | - Khalid Sawalha
- Nutrition and Metabolism Fellowship, University of Missouri-Kansas City, Kansas City, Missouri, USA
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Keyes E, Grinnell M, Jacoby D, Vazquez T, Diaz D, Werth VP, Williams KJ. Assessment and management of the heightened risk for atherosclerotic cardiovascular events in patients with lupus erythematosus or dermatomyositis. Int J Womens Dermatol 2021; 7:560-575. [PMID: 35024413 PMCID: PMC8721062 DOI: 10.1016/j.ijwd.2021.08.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/27/2021] [Accepted: 08/31/2021] [Indexed: 01/05/2023] Open
Abstract
For patients with lupus erythematosus (LE) or dermatomyositis (DM), there is an urgent need to address a heightened risk of clinical events, chiefly heart attacks and strokes, caused by atherosclerotic cardiovascular disease (ASCVD). Patients with LE or DM frequently exhibit high levels of conventional risk factors for ASCVD events, particularly dyslipoproteinemia and hypertension; an amplified burden of atherosclerotic plaques; and increased age- and sex-adjusted rates of ASCVD events compared with the general population. The rate of ASCVD events exceeds what would be expected from conventional risk factors, suggesting that disease-specific autoimmune processes exacerbate specific, known pathogenic steps in atherosclerosis. Importantly, despite their heightened risk, patients with LE or DM are often undertreated for known causative agents and exacerbators of ASCVD. Herein, we propose an approach to assess and manage the heightened risk of ASCVD events in patients with LE or DM. Our approach is modeled in large part on established approaches to patients with diabetes mellitus or stage 3 or 4 chronic kidney disease, which are well-studied conditions that also show heightened risk for ASCVD events and have been explicitly incorporated into standard clinical guidelines for ASCVD. Based on the available evidence, we conclude that patients with LE or DM require earlier and more aggressive screening and management of ASCVD. We suggest that physicians consider implementing multipliers of conventional risk calculators to trigger earlier initiation of lifestyle modifications and medical therapies in primary prevention of ASCVD events, employ vascular imaging to quantify the burden of subclinical plaques, and treat to lower lipid targets using statins and newer therapies, such as PCSK9 inhibitors, that decrease ASCVD events in nonautoimmune cohorts. More clinical vigilance is needed regarding surveillance, prevention, risk modification, and treatment of dyslipidemias, hypertension, and smoking in patients with LE or DM. All of these goals are achievable.
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Affiliation(s)
- Emily Keyes
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Corporal Michael J. Crescenz VAMC, Philadelphia, Pennsylvania
| | - Madison Grinnell
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Corporal Michael J. Crescenz VAMC, Philadelphia, Pennsylvania
| | - Douglas Jacoby
- Cardiovascular Division, Department of Medicine, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Thomas Vazquez
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Corporal Michael J. Crescenz VAMC, Philadelphia, Pennsylvania
| | - DeAnna Diaz
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Corporal Michael J. Crescenz VAMC, Philadelphia, Pennsylvania
| | - Victoria P. Werth
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Corporal Michael J. Crescenz VAMC, Philadelphia, Pennsylvania
| | - Kevin Jon Williams
- Department of Cardiovascular Sciences, Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
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Jiang W, Chen M, Huang J, Shang Y, Qin C, Ruan Z, Li S, Wang R, Li P, Huang Y, Liu J, Xu L. Proteinuria is independently associated with carotid atherosclerosis: a multicentric study. BMC Cardiovasc Disord 2021; 21:554. [PMID: 34798829 PMCID: PMC8603343 DOI: 10.1186/s12872-021-02367-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 10/29/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND AIMS Atherosclerosis is a vital cause of cardiovascular diseases. The correlation between proteinuria and atherosclerosis, however, has not been confirmed. This study aimed to assess whether there is a relationship between proteinuria and atherosclerosis. METHODS From January 2016 to September 2020, 13,545 asymptomatic subjects from four centres in southern China underwent dipstick proteinuria testing and carotid atherosclerosis examination. Data on demography and past medical history were collected, and laboratory examinations were performed. The samples consisted of 7405 subjects (4875 males and 2530 females), excluding subjects failing to reach predefined standards and containing enough information. A multivariate logistic regression model was used to adjust the influence of traditional risk factors for atherosclerosis on the results. RESULTS Compared with proteinuria-negative subjects, proteinuria-positive subjects had a higher prevalence rate of carotid atherosclerosis. The differences were statistically significant (22.6% vs. 26.7%, χ2 = 10.03, p = 0.002). After adjusting for common risk factors for atherosclerosis, age, sex, BMI, blood lipids, blood pressure, renal function, hypertensive disease, diabetes mellitus and hyperlipidaemia, proteinuria was an independent risk factor for atherosclerosis (OR = 1.191, 95% CI 1.015-1.398, p = 0.033). The Hosmer-Lemeshow test was used to test the risk prediction model of atherosclerosis, and the results showed that the model has high goodness of fit and strong independent variable prediction ability. CONCLUSIONS Proteinuria is independently related to carotid atherosclerosis. With the increase in proteinuria level, the risk of carotid atherosclerotic plaque increases. For patients with positive proteinuria, further examination of atherosclerosis should not be ignored.
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Affiliation(s)
- Wencai Jiang
- Department of Cardiology, Chengdu Second People's Hospital, Chengdu, China
- The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
- Department of Geratic Cardiology, General Hospital of the Southern Theatre Command, Guangzhou, China
| | - Meixiang Chen
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Jianyu Huang
- Department of Geratic Cardiology, General Hospital of the Southern Theatre Command, Guangzhou, China
| | - Yu Shang
- The People's Hospital of Wenchuan, Wenchuan, China
| | - Changyu Qin
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Zheng Ruan
- The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Shuang Li
- School of Automation, Guangdong University of Technology, Guangzhou, China
| | - Ruixin Wang
- The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Pengfei Li
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yuekang Huang
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Jianxiong Liu
- Department of Cardiology, Chengdu Second People's Hospital, Chengdu, China.
| | - Lin Xu
- The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China.
- Department of Geratic Cardiology, General Hospital of the Southern Theatre Command, Guangzhou, China.
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.
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Razavi AC, Bazzano LA, He J, Krousel-Wood M, Chen J, Fernandez C, Whelton SP, Kelly TN. Early Contributors to Healthy Arterial Aging Versus Premature Atherosclerosis in Young Adults: The Bogalusa Heart Study. J Am Heart Assoc 2021; 10:e020774. [PMID: 34096330 PMCID: PMC8477892 DOI: 10.1161/jaha.121.020774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background Early identification of healthy arterial aging versus premature atherosclerosis is important for optimal atherosclerotic cardiovascular disease risk stratification and prevention. We sought to identify predictors for the long‐term absence of carotid plaque among young adults. Methods and Results We included 508 participants from the Bogalusa Heart Study without clinical atherosclerotic cardiovascular disease who were free of carotid plaque at baseline (2001–2002) and underwent ultrasound imaging at follow‐up (2013–2016). Modified Poisson regression estimated the persistent absence of plaque over 12.8 years. Participants were on average age 36.2 years at baseline, 64% were women, and 29% were Black. Although nearly all participants (97%) had a 10‐year atherosclerotic cardiovascular disease risk <7.5%, there were 162 people (32%) who developed premature atherosclerosis. Aside from younger age (risk ratio [RR], 1.21; 95% CI, 1.07–1.36, per 10 years) and a total cholesterol/high‐density lipoprotein cholesterol ratio <3.5 (RR, 1.15; 95% CI, 1.01–1.30), normal values of traditional risk factors did not predict long‐term absence of plaque. Independent from traditional markers including glomerular filtration rate, serum calcium‐phosphate product (RR, 1.07; 95% CI, 1.01–1.14, per 1‐SD lower), phosphate (RR, 1.15; 95% CI, 1.03–1.29, per 1 mg/dL lower), and dietary sodium <2300 mg/day (RR, 1.20; 95% CI, 1.02–1.41) were significantly associated with the non‐development of plaque. Conclusions Nearly one third of young adults with a low burden of traditional risk factors developed premature atherosclerosis. Beyond younger age and an ideal lipoprotein profile, lower calcium‐phosphate homeostasis and low sodium intake were associated with long‐term absence of carotid plaque. These results suggest that dietary and intrinsic minerals are early contributors to the development of arterial aging phenotypes.
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Affiliation(s)
- Alexander C Razavi
- Department of Medicine Tulane University School of Medicine New Orleans LA.,Department of Epidemiology Tulane University, School of Public Health and Tropical Medicine New Orleans LA
| | - Lydia A Bazzano
- Department of Medicine Tulane University School of Medicine New Orleans LA.,Department of Epidemiology Tulane University, School of Public Health and Tropical Medicine New Orleans LA
| | - Jiang He
- Department of Medicine Tulane University School of Medicine New Orleans LA.,Department of Epidemiology Tulane University, School of Public Health and Tropical Medicine New Orleans LA
| | - Marie Krousel-Wood
- Department of Medicine Tulane University School of Medicine New Orleans LA.,Department of Epidemiology Tulane University, School of Public Health and Tropical Medicine New Orleans LA
| | - Jing Chen
- Department of Medicine Tulane University School of Medicine New Orleans LA.,Department of Epidemiology Tulane University, School of Public Health and Tropical Medicine New Orleans LA
| | - Camilo Fernandez
- Department of Medicine Tulane University School of Medicine New Orleans LA.,Department of Epidemiology Tulane University, School of Public Health and Tropical Medicine New Orleans LA
| | - Seamus P Whelton
- The Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins University School of Medicine Baltimore MD
| | - Tanika N Kelly
- Department of Medicine Tulane University School of Medicine New Orleans LA.,Department of Epidemiology Tulane University, School of Public Health and Tropical Medicine New Orleans LA
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Vermiglio E, Bortoletto E, Brunelli M, Sipala S, De Leo D. Sudden death in a 39-year-old woman due to three-vessel coronary artery disease: A case report and literature review. MEDICINE, SCIENCE, AND THE LAW 2021; 61:150-154. [PMID: 33591868 DOI: 10.1177/0025802420929210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Coronary atherosclerosis may be underestimated in previously asymptomatic and apparently healthy young people, although it has been reported in various epidemiological studies. Between 7% and 21% of sudden cardiac deaths in previously asymptomatic people aged <45 years are due to three-vessel coronary artery disease. So, clinical services need to vigilant for this condition. We report a single case of sudden death in a young woman who was affected by three-vessel coronary artery disease. This 39-year-old woman attended an emergency department for non-specific chest pain. After a brief observation period, in the absence of signs of an acute myocardial event, she self-discharged. However, she died suddenly the next day. The subsequent autopsy did not show significant pathological findings, although macroscopic examination of the heart revealed critical three-vessel coronary artery disease. Standard histological examination confirmed an atheromatous plaque obstructing >75% of the lumen of the anterior descending artery, complicated by haemorrhagic phenomena, with diffuse calcified and sub-totally occluded atherosclerotic plaques in the other vascular sections, without ischaemic signs of the cardiomyocytes or fibrosis. When young people present with chest pain, they must be carefully evaluated. Risks need to be clearly explained, particularly when self-discharge is requested.
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Affiliation(s)
- Elisa Vermiglio
- Department of Diagnostics and Public Health - Legal Medicine and Forensic Pathology Unit, University of Verona, Italy
| | - Elena Bortoletto
- Department of Diagnostics and Public Health - Legal Medicine and Forensic Pathology Unit, University of Verona, Italy
| | - Matteo Brunelli
- Department of Diagnostics and Public Health - Unit of Pathology, University of Verona, Italy
| | - Stefania Sipala
- Department of Diagnostics and Public Health - Legal Medicine and Forensic Pathology Unit, University of Verona, Italy
| | - Domenico De Leo
- Department of Diagnostics and Public Health - Legal Medicine and Forensic Pathology Unit, University of Verona, Italy
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Prunicki M, Cauwenberghs N, Ataam JA, Movassagh H, Kim JB, Kuznetsova T, Wu JC, Maecker H, Haddad F, Nadeau K. Immune biomarkers link air pollution exposure to blood pressure in adolescents. Environ Health 2020; 19:108. [PMID: 33066786 PMCID: PMC7566149 DOI: 10.1186/s12940-020-00662-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 10/01/2020] [Indexed: 05/08/2023]
Abstract
BACKGROUND Childhood exposure to air pollution contributes to cardiovascular disease in adulthood. Immune and oxidative stress disturbances might mediate the effects of air pollution on the cardiovascular system, but the underlying mechanisms are poorly understood in adolescents. Therefore, we aimed to identify immune biomarkers linking air pollution exposure and blood pressure levels in adolescents. METHODS We randomly recruited 100 adolescents (mean age, 16 years) from Fresno, California. Using central-site data, spatial-temporal modeling, and distance weighting exposures to the participant's home, we estimated average pollutant levels [particulate matter (PM), polyaromatic hydrocarbons (PAH), ozone (O3), carbon monoxide (CO) and nitrogen oxides (NOx)]. We collected blood samples and vital signs on health visits. Using proteomic platforms, we quantitated markers of inflammation, oxidative stress, coagulation, and endothelial function. Immune cellular characterization was performed via mass cytometry (CyTOF). We investigated associations between pollutant levels, cytokines, immune cell types, and blood pressure (BP) using partial least squares (PLS) and linear regression, while adjusting for important confounders. RESULTS Using PLS, biomarkers explaining most of the variance in air pollution exposure included markers of oxidative stress (GDF-15 and myeloperoxidase), acute inflammation (C-reactive protein), hemostasis (ADAMTS, D-dimer) and immune cell types such as monocytes. Most of these biomarkers were independently associated with the air pollution levels in fully adjusted regression models. In CyTOF analyses, monocytes were enriched in participants with the highest versus the lowest PM2.5 exposure. In both PLS and linear regression, diastolic BP was independently associated with PM2.5, NO, NO2, CO and PAH456 pollution levels (P ≤ 0.009). Moreover, monocyte levels were independently related to both air pollution and diastolic BP levels (P ≤ 0.010). In in vitro cell assays, plasma of participants with high PM2.5 exposure induced endothelial dysfunction as evaluated by eNOS and ICAM-1 expression and tube formation. CONCLUSIONS For the first time in adolescents, we found that ambient air pollution levels were associated with oxidative stress, acute inflammation, altered hemostasis, endothelial dysfunction, monocyte enrichment and diastolic blood pressure. Our findings provide new insights on pollution-related immunological and cardiovascular disturbances and advocate preventative measures of air pollution exposure.
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Affiliation(s)
- Mary Prunicki
- Sean N Parker Center for Allergy and Asthma Research, Stanford University, Stanford, USA
| | - Nicholas Cauwenberghs
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Jennifer Arthur Ataam
- Research and Innovation Unit, INSERM U999, DHU TORINO, Paris Sud University, Marie Lannelongue Hospital, Le Plessis Robinson, France
- Institute for Immunity, Transplantation, and Infection, Stanford University, Stanford, USA
| | - Hesam Movassagh
- Sean N Parker Center for Allergy and Asthma Research, Stanford University, Stanford, USA
| | - Juyong Brian Kim
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, USA
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, USA
| | - Tatiana Kuznetsova
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Joseph C. Wu
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, USA
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, USA
| | - Holden Maecker
- Institute for Immunity, Transplantation, and Infection, Stanford University, Stanford, USA
| | - Francois Haddad
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, USA
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, USA
| | - Kari Nadeau
- Sean N Parker Center for Allergy and Asthma Research, Stanford University, Stanford, USA
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