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Tang P, Wang Q, Ouyang H, Yang S, Hua P. The feasibility of early detecting coronary artery disease using deep learning-based algorithm based on electrocardiography. Aging (Albany NY) 2023; 15:3524-3537. [PMID: 37186897 PMCID: PMC10449295 DOI: 10.18632/aging.204688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 04/13/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Coronary Artery Disease (CAD) is a major cause of morbidity and mortality, yet it is frequently asymptomatic in the early stages and hence goes undetected. OBJECTIVE We aimed to develop a novel artificial intelligence-based approach for early detection of CAD patients based solely on electrocardiogram (ECG). METHODS This study included patients with suspected CAD who had standard 10-s resting 12-lead ECGs and coronary computed tomography angiography (cCTA) results within 4 weeks or less. The ECG and cCTA data from the same patient were matched based on their hospitalization or outpatient ID. All matched data pairs were then randomly divided into training, validation dataset for model development based on convolutional neural network (CNN) and test dataset for model evaluation. The accuracy (Acc), specificity (Spec), sensitivity (Sen), positive predictive value (PPV), negative predictive value (NPV) and area under the receiver operating characteristic curve (AUC) of the model were calculated by using the test dataset. RESULTS In the test dataset, the model for detecting CAD achieved an AUC of 0.75 (95% CI, 0.73 to 0.78) with an accuracy of 70.0%. Using the optimal cut-off point, the CAD detection model had sensitivity of 68.7%, specificity of 70.9%, positive predictive value (PPV) of 61.2%, and negative predictive value (NPV) of 77.2%. Our study demonstrates that a well-trained CNN model based solely on ECG could be considered an efficient, low-cost, and noninvasive method of assisting in CAD detection.
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Affiliation(s)
- Panli Tang
- Department of Cardiovascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Qi Wang
- Department of Cardiovascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Hua Ouyang
- Department of Cardiovascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Songran Yang
- The Biobank of Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Ping Hua
- Department of Cardiovascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
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Hashemi H, Malekifar P, Aghamirsalim M, Yekta A, Mahboubipour H, Khabazkhoob M. Prevalence and associated factors of corneal arcus in the geriatric population; Tehran geriatric eye study. BMC Ophthalmol 2022; 22:354. [PMID: 36045353 PMCID: PMC9429327 DOI: 10.1186/s12886-022-02578-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/26/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Purpose
To determine the age and sex-standardized prevalence of corneal arcus and its associated factors in a geriatric population.
Methods
This population-based cross-sectional study was conducted in 2019 in Tehran; the capital of Iran, using a multi-stage stratified random cluster sampling method. All participants underwent a detailed interview, blood pressure measurement, laboratory blood tests, and a complete ocular examination.
Results
Three thousand three hundred ten of 3791 invitees participated in the study (response rate: 87.31%). The mean age of the participants was 69.35 ± 7.62 years (60–97 years) and 1912 (57.76%) were female. Overall, the age and sex-standardized prevalence (95% CI) of corneal arcus was 44.28% (41.21–47.39). Based on the multiple logistic regression, the odds of corneal arcus were higher in men than in women (OR: 1.51; 95% CI: 1.14–2.00); in the age group ≥ 80 years compared to the age group 60–64 years (OR: 2.44; 95% CI: 1.68–3.53), and in retired people compared to employed individuals (OR: 2.05; 95% CI: 1.31–3.21).
Conclusion
The present study showed a high prevalence of corneal arcus in the geriatric population. Although various studies have reported a significant relationship between corneal arcus with blood lipid and glucose levels as well as blood pressure, these relationships were not found in the present study.
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Lin S, Li Z, Fu B, Chen S, Li X, Wang Y, Wang X, Lv B, Xu B, Song X, Zhang YJ, Cheng X, Huang W, Pu J, Zhang Q, Xia Y, Du B, Ji X, Zheng Z. Feasibility of using deep learning to detect coronary artery disease based on facial photo. Eur Heart J 2020; 41:4400-4411. [PMID: 32818267 DOI: 10.1093/eurheartj/ehaa640] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 03/07/2020] [Accepted: 07/22/2020] [Indexed: 12/22/2022] Open
Abstract
Abstract
Aims
Facial features were associated with increased risk of coronary artery disease (CAD). We developed and validated a deep learning algorithm for detecting CAD based on facial photos.
Methods and results
We conducted a multicentre cross-sectional study of patients undergoing coronary angiography or computed tomography angiography at nine Chinese sites to train and validate a deep convolutional neural network for the detection of CAD (at least one ≥50% stenosis) from patient facial photos. Between July 2017 and March 2019, 5796 patients from eight sites were consecutively enrolled and randomly divided into training (90%, n = 5216) and validation (10%, n = 580) groups for algorithm development. Between April 2019 and July 2019, 1013 patients from nine sites were enrolled in test group for algorithm test. Sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were calculated using radiologist diagnosis as the reference standard. Using an operating cut point with high sensitivity, the CAD detection algorithm had sensitivity of 0.80 and specificity of 0.54 in the test group; the AUC was 0.730 (95% confidence interval, 0.699–0.761). The AUC for the algorithm was higher than that for the Diamond–Forrester model (0.730 vs. 0.623, P < 0.001) and the CAD consortium clinical score (0.730 vs. 0.652, P < 0.001).
Conclusion
Our results suggested that a deep learning algorithm based on facial photos can assist in CAD detection in this Chinese cohort. This technique may hold promise for pre-test CAD probability assessment in outpatient clinics or CAD screening in community. Further studies to develop a clinical available tool are warranted.
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Affiliation(s)
- Shen Lin
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing 100037, People's Republic of China
| | - Zhigang Li
- Department of Automation, Tsinghua University, Main building, Haidian District, Beijing 100084, People's Republic of China
| | - Bowen Fu
- Department of Automation, Tsinghua University, Main building, Haidian District, Beijing 100084, People's Republic of China
| | - Sipeng Chen
- Department of Information Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing 100037, People's Republic of China
| | - Xi Li
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing 100037, People's Republic of China
| | - Yang Wang
- Medical Research & Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing 100037, People's Republic of China
| | - Xiaoyi Wang
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing 100037, People's Republic of China
| | - Bin Lv
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing 100037, People's Republic of China
- Department of Radiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing 100037, People's Republic of China
| | - Bo Xu
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing 100037, People's Republic of China
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing 100037, People's Republic of China
| | - Xiantao Song
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing 100029, People's Republic of China
| | - Yao-Jun Zhang
- Department of Cardiology, Xuzhou Third People's Hospital, Xuzhou Medical University, No. 131 Huancheng Road, Huaihai Economy District, Xuzhou 221000, People's Republic of China
| | - Xiang Cheng
- Department of Cardiology, Wuhan Union Hospital, No. 1277 Jiefang Avenue, Jianghan District, Wuhan 430022, Hubei, People's Republic of China
| | - Weijian Huang
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang Road, Ouhai District, Wenzhou 325000, People's Republic of China
| | - Jun Pu
- Department of Cardiology, RenJi Hospital, Shanghai JiaoTong University Medical College, No. 160 Pujian Road, Pudong New District, Shanghai 200120, People's Republic of China
| | - Qi Zhang
- Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, No. 150 Jimo Road, Pudong New District, Shanghai 200120, People's Republic of China
| | - Yunlong Xia
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, No. 222 Zhongshan Road, Xigang District, Dalian 116011, People's Republic of China
| | - Bai Du
- Department of Cardiology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, No.5 Beixiange Road, Xicheng District, Beijing 100053, People's Republic of China
| | - Xiangyang Ji
- Department of Automation, Tsinghua University, Main building, Haidian District, Beijing 100084, People's Republic of China
| | - Zhe Zheng
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing 100037, People's Republic of China
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing 100037, People's Republic of China
- National Health Commission Key Laboratory of Cardiovascular Regenerative Medicine, Fuwai Central-China Hospital, Central-China Branch of National Center for Cardiovascular Diseases, No.1 Fuwai Avenue, Zhengdong New District, Zhengzhou 451464, People's Republic of China
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Hanterdsith B. An Evaluation of the Arcus Corneae For Age Estimation. Acad Forensic Pathol 2020; 9:155-162. [PMID: 32110250 DOI: 10.1177/1925362119891708] [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: 07/08/2019] [Accepted: 11/11/2019] [Indexed: 11/16/2022]
Abstract
Although the arcus corneae (AC) has long been used as an age indicator for forensic purposes, its diagnostic value has not been evaluated. To evaluate the AC as a predictor of chronological age, the author has studied the correlation of AC with respect to age of the deceased. A cross-sectional study was conducted of 342 Thai corpses at the Maharat Nakhon Ratchasima Hospital, Thailand. AC was graded into three levels: no AC, incomplete ring, and complete ring. One-way analysis of variance, chi-square test, binomial logistic regression, sensitivity, specificity, predictive values, and likelihood ratios were used for analysis. The Cohen's kappa was used to determine the intraobserver and interobserver reliability. The prevalence of AC and the probability of complete AC were significant higher in corpses aged 60 years and above than in those under 60 years. Consequently, this study confirmed that the prevalence of AC was significantly correlated with the age of Thai individuals. If the complete AC is used as an indicator of age of 60 years and above, complete AC has high sensitivity (92.56%) but low specificity (72.85%), low positive predictive value (65.12%), but high negative predictive value (94.71%). For diagnostic value, the presence of AC can be used for age screening but not for absolute confirmation. The absence of AC indicates young age, incomplete AC indicates middle age, and complete AC indicates old age. The high intraobserver and interobserver reliability provides assurance of the value of AC as a means to estimate personal age.
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Abstract
Degeneration is the process of change occurring in cells, their parts or intracellular matter that happens due to external factors affecting the life of an organism and results in gradual disruption of normal condition of the tissue or the organ, and possibly complete loss of its functionality. Corneal degenerations may be caused by age-related physiological changes, associated with a certain systemic disease or local inflammations, or be the consequence of chronic toxic action of unhealthy environmental factors on the eye. Unlike dystrophies, corneal degenerations cannot be inherited and do not onset early. When corneal degenerations significantly affect visual acuity, the treatment should aim at alleviating the primary disease before inducing changes in the cornea. The existence of such pathology is important to remember and timely differentiate from acute inflammatory processes of various etiology that require immediate treatment. The right diagnosis is the key factor in choosing effective treatment strategy and thus achieving positive clinical results.
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Affiliation(s)
- S V Trufanov
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - E P Salovarova
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - L Yu Tekeeva
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
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Is Corneal Arcus Independently Associated With Incident Cardiovascular Disease in Asians? Am J Ophthalmol 2017; 183:99-106. [PMID: 28911992 DOI: 10.1016/j.ajo.2017.09.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 08/31/2017] [Accepted: 09/01/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE To examine the longitudinal relationship between baseline corneal arcus (CA) and incident cardiovascular disease (CVD) in ethnic Indian and Malay adults in Singapore. DESIGN Population-based cohort study. METHODS Indian and Malay adults aged 40-80 years were recruited for baseline and 6-year follow-up visits between 2004-2009 and 2010-2015, respectively (follow-up response rate 73.9%). CA was assessed by ophthalmologists using slit-lamp biomicroscopy. The main outcome was self-reported incident CVD, defined as new myocardial infarction, angina pectoris, or stroke, which developed between baseline and follow-up. Multivariable logistic regression models assessed independent associations between baseline CA and incident CVD, adjusting for traditional CVD risk factors including age, sex, serum cholesterol, hypertension, diabetes, and smoking. We further conducted sex-stratified analyses to identify possible effect modifications. RESULTS Of the total 3637 participants (overall mean [SD] age: 56 [9] years, 46% male) with available follow-up data, without history of CVD at baseline, 208 (5.7%) incident CVD cases were reported. Participants with CA were more likely to have incident CVD (7.5%) than those without (4.9%). After controlling for traditional CVD risk factors, CA was independently associated with incident CVD (odds ratio [95% confidence interval]: 1.52 [1.07-2.16]) in adjusted models. In sex-stratified models, associations between CA and incident CVD were seen in men (1.73 [1.12-2.67]) and not in women (1.05 [0.56-1.97]). CONCLUSIONS CA is associated with incident CVD, independent of serum lipids and traditional CVD risk factors, in ethnic Malay and Indian men. Our finding suggests that CA is an additional observable indicator of CVD in men.
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Brown M, Sacco DF. Put a (Limbal) Ring on It: Women Perceive Men's Limbal Rings as a Health Cue in Short-Term Mating Domains. PERSONALITY AND SOCIAL PSYCHOLOGY BULLETIN 2017; 44:80-91. [PMID: 28978250 DOI: 10.1177/0146167217733072] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Limbal rings are dark annuli encircling the iris that fluctuate in visibility based on health and age. Research also indicates their presence augments facial attractiveness. Given individuals' prioritization of health cues in short-term mates, those with limbal rings may be implicated as ideal short-term mates. Three studies tested whether limbal rings serve as veridical health cues, specifically the extent to which this cue enhances a person's value as a short-term mating partner. In Study 1, targets with limbal rings were rated as healthier, an effect that was stronger for female participants and male targets. In Study 2, temporally activated short-term mating motives led women to report a heightened preference for targets with limbal rings. In Study 3, women rated targets with limbal rings as more desirable short-term mates. Results provide evidence for limbal rings as veridical cues to health, particularly in relevant mating domains.
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Affiliation(s)
- Mitch Brown
- 1 The University of Southern Mississippi, Hattiesburg, USA
| | - Donald F Sacco
- 1 The University of Southern Mississippi, Hattiesburg, USA
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Christoffersen M, Tybjærg-Hansen A. Visible aging signs as risk markers for ischemic heart disease: Epidemiology, pathogenesis and clinical implications. Ageing Res Rev 2016; 25:24-41. [PMID: 26590331 DOI: 10.1016/j.arr.2015.11.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 10/30/2015] [Accepted: 11/09/2015] [Indexed: 12/20/2022]
Abstract
Association of common aging signs (i.e., male pattern baldness, hair graying, and facial wrinkles) as well as other age-related appearance factors (i.e., arcus corneae, xanthelasmata, and earlobe crease) with increased risk of ischemic heart disease was initially described in anecdotal reports from clinicians observing trends in the physical appearance of patients with ischemic heart disease. Following these early observations numerous epidemiological studies have reported these associations. Since the prevalences of both visible aging signs and ischemic heart disease have a strong correlation with increasing age, it has been extensively debated whether the observed associations could be entirely explained by a common association with age. Furthermore, the etiologies of the visible aging signs are rarely fully understood, and pathophysiological explanations for these associations remain controversial, and are mostly speculative. As a consequence of inconsistent findings and lack of mechanistic explanations for the observed associations with ischemic heart disease, consensus on the clinical importance of these visible aging signs has been lacking. The aim of this review is for each of the visible aging signs to (i) review the etiology, (ii) to discuss the current epidemiological evidence for an association with risk of ischemic heart disease, and (iii) to present possible pathophysiological explanations for these associations. Finally this review discusses the potential clinical implications of these findings.
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Hashemi H, Khabazkhoob M, Emamian MH, Shariati M, Fotouhi A. A population-based study of corneal arcus and its risk factors in Iran. Ophthalmic Epidemiol 2014; 21:339-44. [PMID: 25118951 DOI: 10.3109/09286586.2014.949782] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To determine the prevalence of corneal arcus, its risk factors, and its relationship to ocular and visual indices. METHODS In this cross-sectional study, 300 clusters were randomly selected from Shahroud in the north of Iran, using multistage sampling. A total of 20 people were invited to participate from each cluster. After enrollment, all optometric, biometric and ophthalmic exams were conducted on site. RESULTS Of 6311 people invited, 5190 (82.2%) participated in the study. The prevalence of corneal arcus was 23.3% (95% confidence interval, CI, 22.1-24.6), and 98.4% were bilateral cases. The prevalence of corneal arcus was higher in men (odds ratio, OR, 2.02, 95% CI 1.8-2.3, p < 0.001) and increased with age (OR 1.1/year, p < 0.001). In a multivariable-adjusted regression model, age (OR 1.1/year, p = 0.006), male sex (OR 1.30, p = 0.001), diabetes (OR 0.7, p < 0.001), smoking (OR 1.5, p = 0.003), outdoor activity (OR 1.4, p = 0.006), systolic blood pressure (OR 1.01, p = 0.012), and diastolic blood pressure (OR 0.99, p = 0.016) were significantly correlated with corneal arcus. Including biometric components in another model, corneal thickness (OR 0.99, p < 0.001), anterior chamber depth (OR 0.68, p < 0.001) and corneal radius of curvature (OR 1.59, p < 0.001) were significantly correlated with corneal arcus. CONCLUSION This study adds valuable information to the epidemiology of corneal arcus in Iran and the Middle East. In people aged over 60 years, nearly 50% of the study population had corneal arcus. Older age, male sex, smoking, and systolic hypertension were risk factors for corneal arcus. Corneal arcus was also associated with thin and flat corneas and shallow anterior chamber depth.
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Affiliation(s)
- Hassan Hashemi
- Noor Ophthalmology Research Center, Noor Eye Hospital , Tehran , Iran
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Aggarwal A, Aggarwal S, Sarkar PG, Sharma V. Predisposing factors to premature coronary artery disease in young (age ≤ 45 years) smokers: a single center retrospective case control study from India. J Cardiovasc Thorac Res 2014; 6:15-9. [PMID: 24753826 PMCID: PMC3992726 DOI: 10.5681/jcvtr.2014.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Accepted: 02/07/2014] [Indexed: 11/17/2022] Open
Abstract
Introduction:
The role of the conventional risk factors in premature coronary artery disease (CAD) after eliminating the confounding variability of
smoking has not been evaluated. This study was conducted to identify role of traditional risk factors in smokers with premature CAD.
Methods: The case records of patients presenting acutely with premature CAD during the period 2007-2010 were analyzed retrospectively.
Age, sex and smoking matched controls were selected from same time period. Data records were obtained for family history, alcohol,
waist size, blood pressure, hypertension, blood sugar, lipid profile and presence of cutaneous markers for both groups and analyzed
using statistical software.
Results: 234 smokers with CAD and 122 smokers without CAD were included in groups 1 and 2, respectively.
The patients in group 1 had significantly increased prevalence of hypertension, diabetes mellitus, metabolic syndrome, dyslipidemia
and central obesity. There was no difference in prevalence of family history of CAD, arcus juvenilis and baldness. We found statistically
significant association of hypertension, DM and metabolic syndrome in young smokers with premature acute CAD in Indian population as
compared to young smokers without CAD.
Conclusion: In young smokers, presence of hypertension, central obesity, diabetes mellitus and
metabolic syndrome identifies a subset at increased risk for future acute CAD requiring more rigorous follow up and treatment.
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Affiliation(s)
- Amitesh Aggarwal
- Department of Medicine, University College of Medical Sciences (University of Delhi) and GTB Hospital, Delhi, India
| | - Sourabh Aggarwal
- Department of Medicine, University College of Medical Sciences (University of Delhi) and GTB Hospital, Delhi, India
| | - Prattaya Guha Sarkar
- Department of Medicine, University College of Medical Sciences (University of Delhi) and GTB Hospital, Delhi, India
| | - Vishal Sharma
- Department of Medicine, University College of Medical Sciences (University of Delhi) and GTB Hospital, Delhi, India
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Foody JM. Familial hypercholesterolemia: an under-recognized but significant concern in cardiology practice. Clin Cardiol 2013; 37:119-25. [PMID: 24193792 DOI: 10.1002/clc.22223] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 09/08/2013] [Indexed: 01/14/2023] Open
Abstract
Familial hypercholesterolemia (FH) is a common disorder in which genetic mutations in at least 1 of several genes lead to significantly increased levels of lipoproteins, in particular, low-density lipoprotein cholesterol. Most commonly, mutations in the low-density lipoprotein receptor gene result in high plasma levels of apolipoprotein B-containing lipoproteins (eg, low-density lipoprotein and lipoprotein(a)). High plasma levels of lipoproteins increase the risk of cardiovascular events by as much as 20-fold if left untreated. A 2011 survey of cardiologists performed by the American College of Cardiology (ACC) suggests that there is a need for greater awareness of FH among cardiologists with regard to its prevalence and heritability, and of the risk of cardiovascular (CV) disease associated with the disorder, such as premature coronary heart disease. Given that many patients with FH may first present to CV specialists at the time of a major coronary event, it is critical that cardiologists have strategies to manage this high-risk subset of patients. This brief review responds to areas of need identified in the ACC survey and is intended to provide current information about FH and increase awareness about this disorder among cardiologists.
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Affiliation(s)
- JoAnne M Foody
- Cardiovascular Wellness Program, Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts
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Aggarwal A, Aggarwal S, Goel A, Sharma V, Dwivedi S. A retrospective case-control study of modifiable risk factors and cutaneous markers in Indian patients with young coronary artery disease. JRSM Cardiovasc Dis 2012; 1:10.1258_cvd.2012.012010. [PMID: 24175065 PMCID: PMC3738325 DOI: 10.1258/cvd.2012.012010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Indians have the highest risk rates for coronary artery disease (CAD) among all ethnic groups. There is a paucity of data on the risk factors and clinical markers associated with premature CAD. We aimed to determine whether young CAD is due to preventable lifestyle-related factors and cutaneous clinical markers are useful in identifying at-risk patients. DESIGN Single-centre retrospective study. SETTING Tertiary care center. PARTICIPANTS A total of 292 patients (age ≤40 years) who presented with acute CAD between January 2005 and June 2009 and 92 age, and gender-matched controls. MAJOR OUTCOME MEASURES Details of smoking, family history of premature CAD, waist size, blood sugar and lipid profile. Clinical evidence of arcus juvenilis, premature greying of hair and premature baldness sought. RESULTS Dyslipidaemia (91%), smoking (74.3%), low high-density lipoprotein cholesterol (HDL-C) (68.9%), central obesity (47.7%) and greying of hair (34.9%) were the most commonly associated factors. Compared with male patients, females had greater prevalence of dyslipidaemia, low HDL-C, central obesity, hypertension, diabetes and family history of premature CAD. The presence of cutaneous markers was significantly associated with premature CAD. CONCLUSIONS CAD in young Indian people is multifactorial; dyslipidaemia, low HDL-C, smoking, hypertension, central obesity and family history of premature CAD are the most common risk factors. Smoking in men and central obesity in women are the most prevalent factors. Clinicians should be highly suspicious of patients with presence of cutaneous markers, and they should be followed intensively for lifestyle modifications.
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Affiliation(s)
- Amitesh Aggarwal
- Division of Preventive Cardiology, Department of Medicine, University College of Medical Sciences and GTB Hospital, University of Delhi , Delhi , India
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