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Yang H, Ou W, Song X, Chen A. Causal association between blood metabolites and abdominal aortic calcification: A bidirectional Mendelian randomization study. Medicine (Baltimore) 2024; 103:e39451. [PMID: 39252291 PMCID: PMC11383265 DOI: 10.1097/md.0000000000039451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/11/2024] Open
Abstract
Previous studies have reported correlations between metabolic factors and abdominal aortic calcification (AAC). However, the causal relationship between blood metabolites and AAC remains to be fully explored. We employed bidirectional two-sample Mendelian randomization (MR) to investigate the potential causal relationships between 486 blood metabolites and AAC. The inverse variance weighted method was primarily utilized for MR analysis, and the MR-Egger, weighted median, and Robust Adjusted Profile Score methods were used for supplementary analysis. Sensitivity analyses were conducted using Radial MR, MR-PRESSO, Cochran Q test, MR-Egger intercept, and leave-one-out analysis to evaluate the heterogeneity and pleiotropy. Furthermore, the Steiger test and linkage disequilibrium score regression were used to assess genetic correlation and directionality. Multivariable MR analysis was performed to evaluate the direct effect of metabolites on AAC. Through rigorous screening, we identified 6 metabolites with presumed causal effects on AAC: 4-methyl-2-oxopentanoate (effect size [ES] 0.46, 95% confidence interval [CI]: 0.10-0.82), erythrose (ES -0.35, 95% CI: -0.59 to -0.11), 10-undecenoate (11:1n1) (ES 0.14, 95% CI: 0.03-0.25), 1-myristoylglycerophosphocholine (ES 0.31, 95% CI: 0.11-0.50), glycerol 2-phosphate (ES 0.20, 95% CI: 0.04-0.37), and the unidentified metabolite X-11469 (ES 0.19, 95% CI: 0.08-0.30). Multivariable MR analysis revealed that genetically predicted erythrose, 10-undecenoate, 1-myristoylglycerophosphocholine, and X-11469 could directly affect AAC independent of other metabolites. Reverse MR analysis revealed an alteration in 12 blood metabolites due to AAC, including caffeine, 1,7-dimethylurate, arachidonic acid, and 1-arachidonoylglycerophosphocholine. This study provides evidence supporting a causal relationship between metabolites and AAC. These findings help elucidate the underlying biological mechanisms of AAC and may offer insights into screening, prevention, and treatment approaches.
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Affiliation(s)
- Hongwei Yang
- Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
- Guangdong Provincial Key Laboratory of Shock and Microcirculation, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Wen Ou
- Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
- Guangdong Provincial Key Laboratory of Shock and Microcirculation, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Xudong Song
- Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
- Guangdong Provincial Key Laboratory of Shock and Microcirculation, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Aihua Chen
- Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
- Guangdong Provincial Key Laboratory of Shock and Microcirculation, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
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Behzadi P, Cuevas RA, Crane A, Wendling AA, Chu CC, Moorhead WJ, Wong R, Brown M, Tamakloe J, Suresh S, Salehi P, Jaffe IZ, Kuipers AL, Lukashova L, Verdelis K, St Hilaire C. Rapamycin increases murine lifespan but does not reduce mineral volume in the Matrix GLA Protein (MGP) knockout mouse model of medial arterial calcification. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.08.01.606196. [PMID: 39149364 PMCID: PMC11326142 DOI: 10.1101/2024.08.01.606196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
Peripheral artery disease (PAD) is the narrowing of the arteries that carry blood to the lower extremities. PAD has been traditionally associated with atherosclerosis. However, recent studies have found that medial arterial calcification (MAC) is the primary cause of chronic limb ischemia below the knee. MAC involves calcification of the elastin fibers surrounding smooth muscle cells (SMCs) in arteries. Matrix GLA Protein (MGP) binds circulating calcium and inhibits vascular calcification. Mgp -/- mice develop severe MAC and die within 8 weeks of birth due to aortic rupture or heart failure. We previously discovered a rare genetic disease Arterial Calcification due to Deficiency in CD73 (ACDC) in which patients present with extensive MAC in their lower extremity arteries. Using a patient-specific induced pluripotent stem cell model we found that rapamycin inhibited calcification. Here we investigated whether rapamycin could reduce MAC in vivo using Mgp -/- mice as a model. Mgp +/+ and Mgp -/- mice received 5mg/kg rapamycin or vehicle. Calcification content was assessed via microCT, and vascular morphology and extracellular matrix content assessed histologically. Immunostaining and western blot analysis were used to examine SMC phenotypes and cellular functions. Rapamycin prolonged Mgp -/- mice lifespan, decreased mineral density in the arteries, and increased smooth muscle actin protein levels, however, calcification volume, vessel morphology, SMC proliferation, and autophagy flux were all unchanged. These findings suggest that rapamycin's effects in the Mgp -/- mouse are independent of the vascular phenotype.
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Affiliation(s)
- Parya Behzadi
- Department of Medicine, Division of Cardiology, and the Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Rolando A Cuevas
- Department of Medicine, Division of Cardiology, and the Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Alex Crane
- Department of Medicine, Division of Cardiology, and the Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Andrew A Wendling
- Department of Medicine, Division of Cardiology, and the Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Claire C Chu
- Department of Medicine, Division of Cardiology, and the Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - William J Moorhead
- Department of Medicine, Division of Cardiology, and the Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ryan Wong
- Department of Medicine, Division of Cardiology, and the Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mark Brown
- Department of Medicine, Division of Cardiology, and the Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Joshua Tamakloe
- Department of Medicine, Division of Cardiology, and the Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Swathi Suresh
- Department of Medicine, Division of Cardiology, and the Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Payam Salehi
- CardioVascular Center, Vascular Surgery, Tufts Medical Center, 800 Washington Street, Boston, MA, 02111-1800, USA
| | - Iris Z Jaffe
- Molecular Cardiology Research Institute, Tufts Medical Center, 800 Washington Street, Boston, MA, 02111-1800, USA
| | - Allison L Kuipers
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lyudmila Lukashova
- Departments of Endodontics and Oral Biology, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Konstantinos Verdelis
- Departments of Endodontics and Oral Biology, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Cynthia St Hilaire
- Department of Medicine, Division of Cardiology, and the Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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3
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Lu KC, Hung KC, Liao MT, Shih LJ, Chao CT. Vascular Calcification Heterogeneity from Bench to Bedside: Implications for Manifestations, Pathogenesis, and Treatment Considerations. Aging Dis 2024:AD.2024.0289. [PMID: 38739930 DOI: 10.14336/ad.2024.0289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 04/20/2024] [Indexed: 05/16/2024] Open
Abstract
Vascular calcification (VC) is the ectopic deposition of calcium-containing apatite within vascular walls, exhibiting a high prevalence in older adults, and those with diabetes or chronic kidney disease. VC is a subclinical cardiovascular risk trait that increases mortality and functional deterioration. However, effective treatments for VC remain largely unavailable despite multiple attempts. Part of this therapeutic nihilism results from the failure to appreciate the diversity of VC as a pathological complex, with unforeseeable variations in morphology, risk associates, and anatomical and molecular pathogenesis, affecting clinical management strategies. VC should not be considered a homogeneous pathology because accumulating evidence refutes its conceptual and content uniformity. Here, we summarize the pathophysiological sources of VC heterogeneity from the intersecting pathways and networks of cellular, subcellular, and molecular crosstalk. Part of these pathological connections are synergistic or mutually antagonistic. We then introduce clinical implications related to the VC heterogeneity concept. Even within the same individual, a specific artery may exhibit the strongest tendency for calcification compared with other arteries. The prognostic value of VC may only be detectable with a detailed characterization of calcification morphology and features. VC heterogeneity is also evident, as VC risk factors vary between different arterial segments and layers. Therefore, diagnostic and screening strategies for VC may be improved based on VC heterogeneity, including the use of radiomics. Finally, pursuing a homogeneous treatment strategy is discouraged and we suggest a more rational approach by diversifying the treatment spectrum. This may greatly benefit subsequent efforts to identify effective VC therapeutics.
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Affiliation(s)
- Kuo-Cheng Lu
- Division of Nephrology, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Fu Jen Catholic University Hospital, School of Medicine, Fu Jen Catholic University, New Taipei, Taiwan
| | - Kuo-Chin Hung
- Division of Nephrology, Department of Internal Medicine, Min-Sheng General Hospital, Taoyuan, Taiwan
- Department of Pharmacy, Tajen University, Pingtung, Taiwan
| | - Min-Tser Liao
- Department of Pediatrics, Taoyuan Armed Forces General Hospital, Hsinchu Branch, Hsinchu, Taiwan
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Li-Jane Shih
- Department of Medical Laboratory, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan
- Graduate Institute of Medical Science, National Defense Medical Center, Taipei, Taiwan
| | - Chia-Ter Chao
- Division of Nephrology, Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Graduate Institute of Toxicology, National Taiwan University College of Medicine, Taipei, Taiwan
- Center of Faculty Development, National Taiwan University College of Medicine, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Min-Sheng General Hospital, Taoyuan, Taiwan
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Higo Y, Hisamatsu T, Nakagawa Y, Sawayama Y, Yano Y, Kadota A, Fujiyoshi A, Kadowaki S, Torii S, Kondo K, Watanabe Y, Ueshima H, Miura K. Association of Anthropometric and CT-Based Obesity Indices with Subclinical Atherosclerosis. J Atheroscler Thromb 2024; 31:48-60. [PMID: 37558497 PMCID: PMC10776301 DOI: 10.5551/jat.64096] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 06/07/2023] [Indexed: 08/11/2023] Open
Abstract
AIM Few studies have compared the strength in the associations of anthropometric and computed tomography (CT)-based obesity indices with coronary artery calcification (CAC), aortic artery calcification (AoAC), and aortic valve calcification (AVC). METHODS We assessed cross-sectcional associations of anthropometric and CT-based obesity indices with CAC, AoAC, and AVC. Anthropometric measures included body mass index (BMI), waist circumference, hip ircumference, waist-to-hip circumference ratio, and waist-to-height ratio in 931 men (mean age, 63.7 years) from a population-based cohort. CT images at the L4/5 level were obtained to calculate the areas of abdominal visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), total adipose tissue (TAT), VAT-to-SAT ratio (VSR), and VAT-to-TAT ratio (VTR). CAC, AoAC, and AVC were quantified using the Agatston score based on CT scanning. RESULTS CAC, AVC, and AoAC were present in 348 (62.6%), 173 (18.6%), and 769 (82.6%) participants, respectively. In multivariable models adjusting for age, lifestyle factors, and CT types (electron beam CT and multidetector row CT), anthropometric and CT-based obesity indices were positively associated with CAC (p<0.01). Conversely, VAT-to-SAT ratio and VAT-to-TAT ratio were positively associated with AoAC (p<0.01). Any obesity indices were not associated with AVC. CONCLUSIONS The strength of the associations of obesity indices with subclinical atherosclerosis varied according to the anatomically distinct atherosclerotic lesions, among men.
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Affiliation(s)
- Yosuke Higo
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Shiga, Japan
| | - Takashi Hisamatsu
- NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan
- Department of Public Health, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yoshihisa Nakagawa
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Shiga, Japan
| | - Yuichi Sawayama
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Okayama, Japan
| | - Yuichiro Yano
- NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan
| | - Aya Kadota
- NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan
- Department of Public Health, Shiga University of Medical Science, Shiga Japan
| | - Akira Fujiyoshi
- NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan
- Department of Hygiene, Wakayama Medical University, Wakayama, Japan
| | - Sayaka Kadowaki
- NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan
- Department of Pediatrics, Uji Tokushukai Hospital, Kyoto, Japan
| | - Sayuki Torii
- NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan
- Department of Public Health, Shiga University of Medical Science, Shiga Japan
| | - Keiko Kondo
- NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan
- Department of Public Health, Shiga University of Medical Science, Shiga Japan
| | - Yoshiyuki Watanabe
- Department of Radiology, Shiga University of Medical Science, Shiga, Japan
| | - Hirotsugu Ueshima
- NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan
- Department of Public Health, Shiga University of Medical Science, Shiga Japan
| | - Katsuyuki Miura
- NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan
- Department of Public Health, Shiga University of Medical Science, Shiga Japan
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Wang L, Li Q, Su B, Zhang E, Zhang S, Tu H, Zhang L, Wang C, Chen G. The estimated glomerular filtration rate was U-shaped associated with abdominal aortic calcification in US adults: findings from NHANES 2013-2014. Front Cardiovasc Med 2023; 10:1261021. [PMID: 38124889 PMCID: PMC10731032 DOI: 10.3389/fcvm.2023.1261021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023] Open
Abstract
Objectives The high incidence of abdominal aortic calcification (AAC) is well-documented in individuals with severe renal function decline. However, there is limited research on the historical relationship between estimated glomerular filtration rate (eGFR) and the risk of AAC occurrence in the general population undergoing routine medical examinations. The main objective of this study was to investigate the historical relationship between eGFR and AAC in the general population of the United States. Methods We performed a cross-sectional study using the National Health and Nutrition Examination Survey 2013-2014 database. Weighted multivariate linear regression models were used to estimate the associations of eGFR with AAC score. Smooth curve fitting and two-piecewise linear regression were employed to explore the potential non-linear relationship. Results A total of 2,978 participant (48.22% were male) aged 40-80 years were included in this study. The fully-adjusted model demonstrated a negative correlation between eGFR and AAC score (β = -0.015, 95% CI: -0.023 to -0.006). However, when applying the smooth curve fitting method, a U-shaped relationship was identified, and the inflection point was calculated at 76.43 ml/min/1.73 m2 using the two-piecewise linear regression model. Conclusions There was a U-shaped association between eGFR and AAC score in general US adults, with an inflection point at about 76.43 ml/min/1.73 m2.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Gangyi Chen
- Department of Nephrology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou City, Guangdong Province, China
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Sheng C, Huang W, Wang W, Lin G, Liao M, Yang P. The association of moderate-to-vigorous physical activity and sedentary behaviour with abdominal aortic calcification. J Transl Med 2023; 21:705. [PMID: 37814346 PMCID: PMC10563258 DOI: 10.1186/s12967-023-04566-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 09/22/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND AND AIMS The increasing prevalence of metabolic and cardiovascular diseases poses a significant challenge to global healthcare systems. Regular physical activity (PA) is recognized for its positive impact on cardiovascular risk factors. This study aimed to investigate the relationship between moderate-to-vigorous physical activity (MVPA), sedentary behavior (SB), and abdominal aortic calcification (AAC) using data from the National Health and Nutrition Examination Survey (NHANES). METHODS The study used data from NHANES participants aged 40 and above during the 2013-2014 cycle. AAC scores were assessed using the Kauppila scoring system, and MVPA and SB were self-reported. Sociodemographic variables were considered, and multivariable linear regression models were used to analyze associations between MVPA, SB, and AAC scores. Subgroup analyses were conducted based on age, sex, BMI, hypertension, and diabetes. RESULTS The study included 2843 participants. AAC prevalence was higher in older age groups, smokers, and those with diabetes or hypertension. Lower socioeconomic status was associated with higher AAC prevalence. Individuals engaged in any level of MVPA exhibited lower AAC rates compared to inactive individuals. Not engaging in occupational MVPA (β = 0.46, 95% confidence interval = 0.24‒0.67, p < .001) and prolonged SB (β = 0.28, 95% confidence interval = 0.04‒0.52, p = .023) were associated with higher AAC scores. However, no significant associations were found for transportation and leisure time MVPA. Subgroup analysis revealed age and hypertension as effect modifiers in the MVPA-AAC relationship. CONCLUSIONS This study highlights the potential benefits of engaging in occupational MVPA and reducing SB in mitigating AAC scores, particularly among older individuals and those with hypertension.
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Affiliation(s)
- Chang Sheng
- Department of Vascular Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Weihua Huang
- Department of Clinical Pharmacology, Hunan Key Laboratory of Pharmacogenetics, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Institute of Clinical Pharmacology, Hunan Key Laboratory of Pharmacogenetics Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, School of Pharmacy, Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Wei Wang
- Department of Vascular Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Guoqiang Lin
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China.
- Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - Mingmei Liao
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China.
- Xiangya Hospital, National Health Commission Key Laboratory of Nanobiological Technology, Central South University, Changsha, Hunan, China.
| | - Pu Yang
- Department of Vascular Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China.
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Hegner A, Wittek A, Derwich W, Huß A, Gámez AJ, Blase C. Using averaged models from 4D ultrasound strain imaging allows to significantly differentiate local wall strains in calcified regions of abdominal aortic aneurysms. Biomech Model Mechanobiol 2023; 22:1709-1727. [PMID: 37405538 PMCID: PMC10511614 DOI: 10.1007/s10237-023-01738-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 06/13/2023] [Indexed: 07/06/2023]
Abstract
Abdominal aortic aneurysms are a degenerative disease of the aorta associated with high mortality. To date, in vivo information to characterize the individual elastic properties of the aneurysm wall in terms of rupture risk is lacking. We have used time-resolved 3D ultrasound strain imaging to calculate spatially resolved in-plane strain distributions characterized by mean and local maximum strains, as well as indices of local variations in strains. Likewise, we here present a method to generate averaged models from multiple segmentations. Strains were then calculated for single segmentations and averaged models. After registration with aneurysm geometries based on CT-A imaging, local strains were divided into two groups with and without calcifications and compared. Geometry comparison from both imaging modalities showed good agreement with a root mean squared error of 1.22 ± 0.15 mm and Hausdorff Distance of 5.45 ± 1.56 mm (mean ± sd, respectively). Using averaged models, circumferential strains in areas with calcifications were 23.2 ± 11.7% (mean ± sd) smaller and significantly distinguishable at the 5% level from areas without calcifications. For single segmentations, this was possible only in 50% of cases. The areas without calcifications showed greater heterogeneity, larger maximum strains, and smaller strain ratios when computed by use of the averaged models. Using these averaged models, reliable conclusions can be made about the local elastic properties of individual aneurysm (and long-term observations of their change), rather than just group comparisons. This is an important prerequisite for clinical application and provides qualitatively new information about the change of an abdominal aortic aneurysm in the course of disease progression compared to the diameter criterion.
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Affiliation(s)
- Achim Hegner
- Personalized Biomedical Engineering Lab, Frankfurt University of Applied Sciences, Frankfurt am Main, Germany
- Department of Mechanical Engineering and Industrial Design, School of Engineering, University of Cadiz, Cadiz, Spain
| | - Andreas Wittek
- Personalized Biomedical Engineering Lab, Frankfurt University of Applied Sciences, Frankfurt am Main, Germany
| | - Wojciech Derwich
- Department of Vascular and Endovascular Surgery, Goethe University Hospital, Frankfurt am Main, Germany
| | - Armin Huß
- Personalized Biomedical Engineering Lab, Frankfurt University of Applied Sciences, Frankfurt am Main, Germany
| | - Antonio J. Gámez
- Department of Mechanical Engineering and Industrial Design, School of Engineering, University of Cadiz, Cadiz, Spain
| | - Christopher Blase
- Personalized Biomedical Engineering Lab, Frankfurt University of Applied Sciences, Frankfurt am Main, Germany
- Cell and Vascular Mechanics, Goethe University, Frankfurt am Main, Germany
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Sayanthan S, Allison MA, Budoff MJ, Rye KA, Ong KL. Relationship of fibroblast growth factor 21 with the prevalence and progression of vascular and valvular calcification: Multi-ethnic study of atherosclerosis. Int J Cardiol 2023; 370:388-395. [PMID: 36306948 DOI: 10.1016/j.ijcard.2022.10.145] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/10/2022] [Accepted: 10/19/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Elevated circulating levels of fibroblast growth factor 21 (FGF21) are associated with cardiovascular disease (CVD). Therefore, we investigated the relationship of plasma FGF21 with calcification at different vascular and valvular sites. METHODS A total of 5786 participants, free of clinically apparent CVD at baseline and with valid data on plasma FGF21 and calcification (Agatston score, volume and density) at coronary arteries, thoracic arteries, mitral and aortic valves, and aortic valve ring, were included in the analysis. Vascular calcification was measured at 2-3 follow-up visits. RESULTS At baseline, higher FGF21 levels were associated with prevalent descending thoracic aortic calcification (DTAC) (prevalence ratio = 1.06 [95% CI 1.01-1.11] per SD increase in log-transformed unit, P = 0.016). Among participants without prevalent calcification, higher FGF21 levels were associated with incident DTAC (relative risk [RR] = 1.13 [95% CI 1.04-1.22], P = 0.002). Among all participants, higher FGF21 levels were also associated with the progression of DTAC score and volume (RR = 1.07 [95% CI 1.03-1.12] and 1.08 [95% CI 1.03-1.12] respectively, both P < 0.01). No significant association of FGF21 was found for prevalence (prevalence ratio = 0.89-1.05), incidence (RR = 0.97-1.16) and progression of calcification (RR = 0.94-1.14) at the other sites. CONCLUSION Higher FGF21 levels were associated with the presence, incidence and progression of DTAC. However, the magnitude of this association was similar to those of the non-significant associations of FGF21 levels with calcifications at other sites. Further research is needed to assess the potential of FGF21 as a biomarker for vascular calcification.
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Affiliation(s)
- Shoban Sayanthan
- School of Biomedical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Matthew A Allison
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, United States
| | - Matthew J Budoff
- Department of Medicine, Lundquist Institute at Harbor-UCLA, Torrance, CA, United States
| | - Kerry-Anne Rye
- School of Biomedical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Kwok Leung Ong
- School of Biomedical Sciences, University of New South Wales, Sydney, NSW, Australia.
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Extra-coronary Calcification and Cardiovascular Events: What Do We Know and Where Are We Heading? Curr Atheroscler Rep 2022; 24:755-766. [PMID: 36040566 DOI: 10.1007/s11883-022-01051-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW The coronary artery calcium score is a guideline-endorsed aid for further risk stratification in the primary prevention of atherosclerotic cardiovascular disease. The non-contrast scan performed for detection of coronary artery calcium also gives an opportunity to visualize calcifications in the thoracic aorta and in the heart valves, at no additional cost or radiation exposure. The purpose of this review was to discuss the potential clinical value of measuring thoracic aortic calcification, aortic valve calcification, and mitral annulus calcification. RECENT FINDINGS After two decades of active research, all three calcifications have been extensively evaluated, across various cohorts. We discuss classic and recent studies, current knowledge gaps, and future directions in this space. The added value of these measurements has traditionally been considered modest at best, and they are not currently discussed in relevant primary prevention guidelines in North America and Europe. However, recent studies evaluating high thoracic calcification thresholds and younger populations have further enriched this space. Specifically, some studies suggest that detection of severe thoracic aortic calcification may be helpful in further risk assessment and that detection of aortic valve calcifications may have important prognostic implications in younger individuals. Although more research is needed, particularly in larger young-to-middle-aged cohorts, future guidelines might consider including these features as risk-enhancing factors.
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Togashi Y, Miyashita D, Tsuno T, Inoue R, Okuyama T, Kyohara M, Nishiyama K, Arai M, Kanematsu K, Kanataki S, Terauchi Y, Shirakawa J. Abdominal aortic calcification is associated with Fib-4 index and low body mass index in type 2 diabetes: a retrospective cross-sectional study. J Diabetes Investig 2022; 13:1861-1872. [PMID: 35818826 DOI: 10.1111/jdi.13883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/11/2022] [Accepted: 07/08/2022] [Indexed: 11/27/2022] Open
Abstract
AIMS This study aimed to clarify the nature of the relationship between the abdominal aortic calcification (AAC) grade and the presence of cardiovascular diseases and determine factors related to AAC grade in participants with type 2 diabetes (T2DM). METHODS This retrospective cross-sectional study enrolled 264 in participants with T2DM. The AAC score and length were measured using the lateral abdominal radiographs. Logistic regression models were used to assess the associations between AAC scores/lengths and the presence of coronary artery disease (CAD), cerebral infarction (CI), and peripheral artery disease (PAD). The correlation between AAC scores/lengths and other clinical factors were evaluated using linear regression models. RESULTS The AAC score was significantly correlated with prevalent CAD and CI independent of age and smoking but not with the prevalence of PAD. AAC length was not significantly correlated with the presence of CAD, CI, or PAD; however, the sample size was insufficient to conclude probably due to low prevalence. Both the AAC score and length were correlated inversely with body mass index (BMI) and, with the Fib-4 index >2.67; these correlations were significant after adjusting for cardiovascular risk factors and BMI, although AAC was not associated with ultrasonography-diagnosed fatty liver. There was a significant interaction between BMI and Fib-4 index; lower BMI and Fib-4 index >2.67 demonstrated a synergistic association with high AAC grade. CONCLUSIONS AAC score is associated with CAD and CI morbidity in participants with T2DM. Low BMI and Fib-4 index >2.67 can be valuable indicators of AAC in people with T2DM.
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Affiliation(s)
- Yu Togashi
- Laboratory of Diabetes and Metabolic Disorders, Institute for Molecular and Cellular Regulation (IMCR), Gunma University, Maebashi, 371-8510, Japan.,Department of Endocrinology and Metabolism, Graduate School of Medicine, Yokohama City University, 3-9 Fuku-ura Kanazawa-ku, Yokohama, City, 236-0004, Japan
| | - Daisuke Miyashita
- Department of Endocrinology and Metabolism, Graduate School of Medicine, Yokohama City University, 3-9 Fuku-ura Kanazawa-ku, Yokohama, City, 236-0004, Japan
| | - Takahiro Tsuno
- Laboratory of Diabetes and Metabolic Disorders, Institute for Molecular and Cellular Regulation (IMCR), Gunma University, Maebashi, 371-8510, Japan.,Department of Endocrinology and Metabolism, Graduate School of Medicine, Yokohama City University, 3-9 Fuku-ura Kanazawa-ku, Yokohama, City, 236-0004, Japan
| | - Ryota Inoue
- Laboratory of Diabetes and Metabolic Disorders, Institute for Molecular and Cellular Regulation (IMCR), Gunma University, Maebashi, 371-8510, Japan
| | - Tomoko Okuyama
- Department of Endocrinology and Metabolism, Graduate School of Medicine, Yokohama City University, 3-9 Fuku-ura Kanazawa-ku, Yokohama, City, 236-0004, Japan
| | - Mayu Kyohara
- Department of Endocrinology and Metabolism, Graduate School of Medicine, Yokohama City University, 3-9 Fuku-ura Kanazawa-ku, Yokohama, City, 236-0004, Japan
| | - Kuniyuki Nishiyama
- Laboratory of Diabetes and Metabolic Disorders, Institute for Molecular and Cellular Regulation (IMCR), Gunma University, Maebashi, 371-8510, Japan
| | - Masanori Arai
- Department of Endocrinology and Metabolism, Graduate School of Medicine, Yokohama City University, 3-9 Fuku-ura Kanazawa-ku, Yokohama, City, 236-0004, Japan
| | - Kenta Kanematsu
- Department of Endocrinology and Metabolism, Graduate School of Medicine, Yokohama City University, 3-9 Fuku-ura Kanazawa-ku, Yokohama, City, 236-0004, Japan
| | - Soichiro Kanataki
- Department of Endocrinology and Metabolism, Graduate School of Medicine, Yokohama City University, 3-9 Fuku-ura Kanazawa-ku, Yokohama, City, 236-0004, Japan
| | - Yasuo Terauchi
- Department of Endocrinology and Metabolism, Graduate School of Medicine, Yokohama City University, 3-9 Fuku-ura Kanazawa-ku, Yokohama, City, 236-0004, Japan
| | - Jun Shirakawa
- Laboratory of Diabetes and Metabolic Disorders, Institute for Molecular and Cellular Regulation (IMCR), Gunma University, Maebashi, 371-8510, Japan.,Department of Endocrinology and Metabolism, Graduate School of Medicine, Yokohama City University, 3-9 Fuku-ura Kanazawa-ku, Yokohama, City, 236-0004, Japan
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11
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Ogunmoroti O, Osibogun O, Ferraro RA, Ndunda PM, Larson NB, Decker PA, Bielinski SJ, Blumenthal RS, Budoff MJ, Michos ED. Hepatocyte growth factor is associated with greater risk of extracoronary calcification: results from the multiethnic study of atherosclerosis. Open Heart 2022; 9:e001971. [PMID: 35641100 PMCID: PMC9157354 DOI: 10.1136/openhrt-2022-001971] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 05/05/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Hepatocyte growth factor (HGF) is a biomarker with potential for use in the diagnosis, treatment and prognostication of cardiovascular disease (CVD). Elevated HGF is associated with calcification in the coronary arteries. However, knowledge is limited on the role HGF may play in extracoronary calcification (ECC). This study examined whether HGF is associated with ECC in the aortic valve (AVC), mitral annulus (MAC), ascending thoracic aorta and descending thoracic aortic (DTAC). METHODS At baseline, adults aged 45-84 years, free of CVD, in the Multi-Ethnic Study of Atherosclerosis had HGF and ECC measured by ELISA and cardiac CT scan, respectively. ECC measurements were repeated after an average of 2.4 years of follow-up. Prevalent ECC was defined as Agatston score >0 at baseline. Incident ECC was defined as Agatston score >0 at follow-up among participants with Agatston score=0 at baseline. We used Poisson and linear mixed-effects regression models to estimate the association between HGF and ECC, adjusted for sociodemographic and CVD risk factors. RESULTS Of 6648 participants, 53% were women. Mean (SD) age was 62 (10) years. Median (IQR) of HGF was 905 (757-1087) pg/mL. After adjustment for CVD risk factors, the highest HGF levels (tertile 3) were associated with greater prevalence and extent of AVC, MAC and DTAC at baseline compared with the lowest tertile (tertile 1). Additionally, the risk of incident AVC and MAC increased by 62% and 45%, respectively, in demographic-adjusted models. However, the associations were not statistically significant in fully adjusted models. The highest HGF levels were also associated with 10% and 13% increase in MAC and DTAC progression, respectively, even after adjustment for CVD risk factors. CONCLUSION Higher HGF levels were significantly associated with a greater risk of calcification at some extracoronary sites, suggesting an alternate biological pathway that could be targeted to reduce CVD risk.
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Affiliation(s)
- Oluseye Ogunmoroti
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Olatokunbo Osibogun
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Richard A Ferraro
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Paul M Ndunda
- Division of Cardiology, Louisiana State University Health, Shreveport, Louisiana, USA
| | - Nicholas B Larson
- Division of Clinical Trials and Biostatistics, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Paul A Decker
- Division of Clinical Trials and Biostatistics, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Suzette J Bielinski
- Division of Epidemiology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Roger S Blumenthal
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Matthew J Budoff
- Department of Medicine, Lundquist Institute at Harbor-UCLA, Torrance, California, USA
| | - Erin D Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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12
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Koskela A, Ducatman A, Schousboe JT, Nahhas RW, Khalil N. Perfluoroalkyl Substances and Abdominal Aortic Calcification. J Occup Environ Med 2022; 64:287-294. [PMID: 35001069 DOI: 10.1097/jom.0000000000002479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To evaluate if serum perfluoroalkylated substances (PFAS) were associated with abdominal aortic calcification (AAC). METHODS We used weighted logistic regression to investigate the gender-specific association between PFAS serum levels and AAC more than or equal to 6 from dual-energy X-ray absorptiometry (DXA) scans of the thoraco-lumbar spine from National Health and Nutrition Examination Survey 2013-2014 survey participants aged more than or equal to 40 years. RESULTS After adjusting for confounding, none of log-transformed perfluorooctanoic acid (PFOA), perfluorooctane sulfonate (PFOS), perfluorohexane sulfonic acid (PFHxS), or perfluorononanoic acid (PFNA) were significantly associated with AAC for either men or women (adjusted odds ratios [ORs] ranged from 0.80 to 1.33, P > 0.05 each). For PFOA and PFOS, the association was positive only in women (although the difference was not statistically significant in either case). CONCLUSION These findings do not provide general support for a relationship of PFAS exposure to AAC, although the results show a need for gender-specific consideration in a larger dataset.
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Affiliation(s)
- Antti Koskela
- Cancer Research and Translational Medicine Research Unit, Faculty of Medicine, University of Oulu, Finland (Dr Koskela); West Virginia University School of Public Health, Morgantown, West Virginia (Dr Ducatman); Park Nicollet Osteoporosis Center and Health Partners Institute and Division of Health Policy and Management, University of Minnesota, Minneapolis, Minnesota (Dr Schousboe); Department of Population and Public Health Sciences (Dr Nahhas, Dr Khalil); Department of Psychiatry (Dr Nahhas), Boonshoft School of Medicine, Wright State University, Dayton, Ohio
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13
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Summers RM, Elton DC, Lee S, Zhu Y, Liu J, Bagheri M, Sandfort V, Grayson PC, Mehta NN, Pinto PA, Linehan WM, Perez AA, Graffy PM, O'Connor SD, Pickhardt PJ. Atherosclerotic Plaque Burden on Abdominal CT: Automated Assessment With Deep Learning on Noncontrast and Contrast-enhanced Scans. Acad Radiol 2021; 28:1491-1499. [PMID: 32958429 DOI: 10.1016/j.acra.2020.08.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/06/2020] [Accepted: 08/17/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Abdominal aortic atherosclerotic plaque burden may have clinical significance but manual measurement is time-consuming and impractical. PURPOSE To perform external validation on an automated atherosclerotic plaque detector for noncontrast and postcontrast abdominal CT. MATERIALS AND METHODS The training data consisted of 114 noncontrast CT scans and 23 postcontrast CT urography scans. The testing data set consisted of 922 CT colonography (CTC) scans, and 1207 paired noncontrast and postcontrast CT scans from renal donors from a second institution. Reference standard data included manual plaque segmentations in the 137 training scans and manual plaque burden measurements in the 922 CTC scans. The total Agatston score and group (0-3) was determined using fully-automated deep learning software. Performance was assessed by measures of agreement, linear regression, and paired evaluations. RESULTS On CTC scans, automated Agatston scoring correlated highly with manual assessment (R2 = 0.94). On paired renal donor CT scans, automated Agatston scoring on postcontrast CT correlated highly with noncontrast CT (R2 = 0.95). When plaque burden was expressed as a group score, there was excellent agreement for both the CTC (weighted kappa 0.80 ± 0.01 [95% confidence interval: 0.78-0.83]) and renal donor (0.83 ± 0.02 [0.79-0.86]) assessments. CONCLUSION Fully automated detection, segmentation, and scoring of abdominal aortic atherosclerotic plaques on both pre- and post-contrast CT was validated and may have application for population-based studies.
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Affiliation(s)
- Ronald M Summers
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bldg. 10 Room 1C224D MSC 1182, Bethesda, MD 20892-1182.
| | - Daniel C Elton
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bldg. 10 Room 1C224D MSC 1182, Bethesda, MD 20892-1182
| | - Sungwon Lee
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bldg. 10 Room 1C224D MSC 1182, Bethesda, MD 20892-1182
| | - Yingying Zhu
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bldg. 10 Room 1C224D MSC 1182, Bethesda, MD 20892-1182
| | - Jiamin Liu
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bldg. 10 Room 1C224D MSC 1182, Bethesda, MD 20892-1182
| | - Mohammedhadi Bagheri
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bldg. 10 Room 1C224D MSC 1182, Bethesda, MD 20892-1182
| | - Veit Sandfort
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bldg. 10 Room 1C224D MSC 1182, Bethesda, MD 20892-1182
| | - Peter C Grayson
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland
| | - Nehal N Mehta
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Peter A Pinto
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - W Marston Linehan
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Alberto A Perez
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Peter M Graffy
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Stacy D O'Connor
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Perry J Pickhardt
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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14
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Kuiper LM, Ikram MK, Kavousi M, Vernooij MW, Ikram MA, Bos D. C-factor: a summary measure for systemic arterial calcifications. BMC Cardiovasc Disord 2021; 21:317. [PMID: 34187369 PMCID: PMC8243490 DOI: 10.1186/s12872-021-02126-y] [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] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/15/2021] [Indexed: 11/24/2022] Open
Abstract
Background Arterial calcification, the hallmark of arteriosclerosis, has a widespread distribution in the human body with only moderate correlation among sites. Hitherto, a single measure capturing the systemic burden of arterial calcification was lacking. In this paper, we propose the C-factor as an overall measure of calcification burden. Methods To quantify calcification in the coronary arteries, aortic arch, extra- and intracranial carotid arteries, and vertebrobasilar arteries, 2384 Rotterdam Study participants underwent cardiac and extra-cardiac non-enhanced CT. We performed principal component analyses on the calcification volumes of all twenty-six possible combinations of these vessel beds. Each analysis’ first principal component represents the C-factor. Subsequently, we determined the correlation between the C-factor derived from all vessel beds and the other C-factors with intraclass correlation coefficient (ICC) analyses. Finally, we examined the association of the C-factor and calcification in the separate vessel beds with cardiovascular, non-cardiovascular, and overall mortality using Cox–regression analyses. Results The ICCs ranged from 0.80 to 0.99. Larger calcification volumes and a higher C-factor were all individually associated with higher risk of cardiovascular, non-cardiovascular, and overall mortality. When included simultaneously in a model, the C-factor was still associated with all three mortality types (adjusted hazard ratio per standard deviation increase (HR) > 1.52), whereas associations of the separate vessel beds with mortality attenuated substantially (HR < 1.26). Conclusions The C-factor summarizes the systemic component of arterial calcification on an individual level and appears robust among different combinations of vessel beds. Importantly, when mutually adjusted, the C-factor retains its strength of association with mortality while the site-specific associations attenuate. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02126-y.
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Affiliation(s)
- Lieke M Kuiper
- Departments of Epidemiology, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - M Kamran Ikram
- Departments of Epidemiology, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Neurology, Erasmus MC, Rotterdam, The Netherlands
| | - Maryam Kavousi
- Departments of Epidemiology, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Meike W Vernooij
- Departments of Epidemiology, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - M Arfan Ikram
- Departments of Epidemiology, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Daniel Bos
- Departments of Epidemiology, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands. .,Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands.
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15
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Yao H, Sun Z, Zang G, Zhang L, Hou L, Shao C, Wang Z. Epidemiological Research Advances in Vascular Calcification in Diabetes. J Diabetes Res 2021; 2021:4461311. [PMID: 34631895 PMCID: PMC8500764 DOI: 10.1155/2021/4461311] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/27/2021] [Accepted: 09/11/2021] [Indexed: 12/29/2022] Open
Abstract
Vascular calcification is the transformation of arterial wall mesenchymal cells, particularly smooth muscle cells (SMCs), into osteoblast phenotypes by various pathological factors. Additionally, vascular transformation mediates the abnormal deposition of calcium salts in the vascular wall, such as intimal and media calcification. Various pathological types have been described, such as calcification and valve calcification. The incidence of vascular calcification in patients with diabetes is much higher than that in nondiabetic patients, representing a critical cause of cardiovascular events in patients with diabetes. Because basic research on the clinical transformation of vascular calcification has yet to be conducted, this study systematically expounds on the risk factors for vascular calcification, vascular bed differences, sex differences, ethnic differences, diagnosis, severity assessments, and treatments to facilitate the identification of a new entry point for basic research and subsequent clinical transformation regarding vascular calcification and corresponding clinical evaluation strategies.
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Affiliation(s)
- Haipeng Yao
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Zhen Sun
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Guangyao Zang
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Lili Zhang
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Lina Hou
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Chen Shao
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Zhongqun Wang
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
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16
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Mazziotti G, Tupputi U, Ferrante G, Guglielmi G. Abdominal Aortic Calcification as a Marker of Relationship Between Atherosclerosis and Skeletal Fragility. J Clin Densitom 2020; 23:539-542. [PMID: 32536435 DOI: 10.1016/j.jocd.2020.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 04/22/2020] [Accepted: 05/05/2020] [Indexed: 11/21/2022]
Abstract
There is a pathophysiological and clinical link between atherosclerosis and skeletal fragility. Abdominal aortic calcifications (AACs) can be considered as a marker of coexistent atherosclerotic disease and osteoporosis. Indeed, AACs have been associated with alterations in bone strength and severe AACs predicted vertebral fractures in post-menopausal women and older men, independent of densitometric diagnosis of osteoporosis. Although quantitative computed tomography is the gold standard for evaluation of AACs, dual-energy x-ray absorptiometry can be considered as a cost-effective tool to identify and quantify AACs in clinical practice. This article provides an update on diagnostic aspects and clinical relevance of AACs as predictor of fractures in patients at high cardiovascular risk.
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Affiliation(s)
- G Mazziotti
- Endocrinology, Diabetology and Andrology Unit, Osteoporosis and Metabolic Bone Diseases Section, Humanitas Clinical and Research Center, IRCCS, Rozzano (Milan), Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - U Tupputi
- Department of Radiology, University of Foggia, Foggia, Italy
| | - G Ferrante
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, IRCCS, Rozzano (Milan), Italy
| | - G Guglielmi
- Department of Radiology, University of Foggia, Foggia, Italy; Department of Clinical and Experimental Medicine, Foggia University School of Medicine, Foggia, Italy.
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17
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Hassan MO, Duarte R, Dickens C, Dix-Peek T, Naidoo S, Vachiat A, Grinter S, Manga P, Naicker S. APOL1 Genetic Variants Are Associated with Serum-Oxidized Low-Density Lipoprotein Levels and Subclinical Atherosclerosis in South African CKD Patients. Nephron Clin Pract 2020; 144:331-340. [PMID: 32526749 DOI: 10.1159/000507860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 04/13/2020] [Indexed: 02/15/2024] Open
Abstract
INTRODUCTION Apolipoprotein L1 (APOL1) plays an important role in cholesterol metabolism and attenuation of low-density lipoprotein (LDL) oxidation. While protecting against Trypanosoma brucei rhodesiense infection, APOL1 risk alleles confer greater risk for CKD and cardiovascular disease among patients of African descent. OBJECTIVES We investigated whether APOL1 risk variants are associated with atherosclerosis and oxidized LDL (OxLDL) levels among black South African CKD patients. METHODS A cross-sectional study of 120 adult CKD patients and 40 controls was undertaken. DNA samples of participants were genotyped for APOL1 G1 and G2 variants. High-sensitivity C-reactive protein, serum lipids, and OxLDL levels were measured, and carotid doppler ultrasonography was performed on all participants. RESULTS APOL1 alleles rs73885319, rs60910145, and rs71785313 had minor allele frequencies of 9.2, 8.8, and 17.5%, respectively, in the patients, and 8.8, 8.8, and 13.8%, respectively, in the controls. Of the 9 patients with 2 APOL1 risk alleles, 77.8% were compound G1/G2 heterozygotes and 22.2% were G2 homozygotes. Carriers of at least 1 APOL1 risk allele had a 3-fold increased risk of subclinical atherosclerosis (odds ratio 3.19; 95% confidence interval: 1.64-6.19; p = 0.01) compared to individuals with no risk alleles. Patients with 1 or 2 APOL1 risk alleles showed a significant increase in OxLDL levels when compared with those without the APOL1 risk allele. CONCLUSION These findings suggest an increased risk for atherosclerosis in carriers of a single APOL1 risk variant, and the presence of APOL1 risk variants was associated with increased serum OxLDL levels in black South African CKD patients.
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Affiliation(s)
- Muzamil Olamide Hassan
- Divisions of Nephrology, Department of Internal Medicine, University of the Witwatersrand, Johannesburg, South Africa,
| | - Raquel Duarte
- Internal Medicine Research Laboratory, Department of Internal Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Caroline Dickens
- Internal Medicine Research Laboratory, Department of Internal Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Therese Dix-Peek
- Internal Medicine Research Laboratory, Department of Internal Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Sagren Naidoo
- Divisions of Nephrology, Department of Internal Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Ahmed Vachiat
- Division of Cardiology, Department of Internal Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Sacha Grinter
- Division of Cardiology, Department of Internal Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Pravin Manga
- Division of Cardiology, Department of Internal Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Saraladevi Naicker
- Department of Internal Medicine, University of the Witwatersrand, Johannesburg, South Africa
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18
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Bartstra JW, Mali WPT, Spiering W, de Jong PA. Abdominal aortic calcification: from ancient friend to modern foe. Eur J Prev Cardiol 2020; 28:1386-1391. [PMID: 34647579 DOI: 10.1177/2047487320919895] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 03/27/2020] [Indexed: 01/16/2023]
Abstract
Background Abdominal aortic calcifications were already ubiquitous in ancient populations from all continents. Although nowadays generally considered as an innocent end stage of stabilised atherosclerotic plaques, increasing evidence suggests that arterial calcifications contribute to cardiovascular risk. In this review we address abdominal aortic calcification from an evolutionary perspective and review the literature on histology, prevalence, risk factors, clinical outcomes and pharmacological interventions of abdominal aortic calcification. Design The design of this study was based on a literature review. Methods Pubmed and Embase were systematically searched for articles on abdominal aortic calcification and its synonyms without language restrictions. Articles with data on histology, prevalence, risk factors clinical outcomes and/or pharmacological interventions were selected. Results Abdominal aortic calcification is highly prevalent in the general population and prevalence and extent increase with age. Prevalence and risk factors differ between males and females and different ethnicities. Risk factors include traditional cardiovascular risk factors and decreased bone mineral density. Abdominal aortic calcification is shown to contribute to arterial stiffness and is a strong predictor of cardiovascular events and mortality. Several therapies to inhibit arterial calcification have been developed and investigated in small clinical trials. Conclusions Abdominal aortic calcification is from all eras and increasingly acknowledged as an independent contributor to cardiovascular disease. Large studies with long follow-up must be carried out to show whether inhibition of abdominal aortic calcification will further reduce cardiovascular risk.
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Affiliation(s)
- Jonas W Bartstra
- Department of Radiology, University Medical Center Utrecht, the Netherlands
| | - Willem PThM Mali
- Department of Radiology, University Medical Center Utrecht, the Netherlands
| | - Wilko Spiering
- Department of Vascular Medicine, University Medical Center Utrecht, the Netherlands
| | - Pim A de Jong
- Department of Radiology, University Medical Center Utrecht, the Netherlands
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19
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Li S, Yin L, Li K, Hu B, Wang L, Wang Y, Li N, You K, Liu Y, Liu G, Xu S, Zhu L, Shao J, Hao X, Zhou J, Cheng X, Li W. Relationship of volumetric bone mineral density by quantitative computed tomography with abdominal aortic calcification. Bone 2020; 133:115226. [PMID: 31945472 DOI: 10.1016/j.bone.2020.115226] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 12/31/2019] [Accepted: 01/07/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE This multicenter study aimed to evaluate the association between volumetric bone mineral density (vBMD) and abdominal aortic calcification (AAC) in a Chinese population. METHODS Quantitative computed tomography (QCT) and Agatston score (AS) were used to measure vBMD and AAC, respectively, in 3457 participants during 2013-2017. The association between vBMD and AAC was assessed using multivariate regression analysis, adjusted for age, residence, education, body mass index, and other cardiovascular risk factors. RESULTS The mean age of women and men was 61.4 and 62.7 years, respectively. In total, 30.4% of women and 37.7% of men were found to have AAC. After full adjustment, higher vBMD was associated with lower AAC score (β, -0.095; 95% confidence interval [CI], -0.167 to -0.024; P = 0.0087) and lower AAC prevalence (odds ratio [OR], 0.873; 95% CI, 0.824 to 0.924; P < 0.0001) in men. Inverse trends were also observed in the association of vBMD quartile with AAC severity (lowest vs highest quartile; β = 0.235; 95% CI, 0.011 to 0.459; Ptrend < 0.0001) and AAC prevalence (lowest vs highest quartile; OR = 1.329; 95% CI, 1.087 to 1.625; Ptrend < 0.0001) in men. However, no significant result was obtained in women, except for the association between quartiles of vBMD and AAC score. CONCLUSIONS In our study, vBMD was inversely associated with AAC among men independent of age and shared risk factors. However, the association was not significant among women.
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Affiliation(s)
- Sidong Li
- Medical Research & Biometrics Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lu Yin
- Medical Research & Biometrics Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Kai Li
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Bo Hu
- Medical Research & Biometrics Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ling Wang
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Yang Wang
- Medical Research & Biometrics Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ning Li
- Qingshan Lake Community Healthcare Service, Nanchang, China
| | - Kai You
- Shunyi Center for Disease Control and Prevention, Beijing, China
| | - Yu Liu
- Shenyang No. 242 Hospital, Shenyang, China
| | - Guoqin Liu
- People's Hospital of Jingle County, Shanxi, China
| | - Shaoqi Xu
- Department of Radiology, Nanjing University of Chinese Medicine Affiliated Wujin Hospital of Traditional Chinese Medicine, Changzhou, China
| | - Lei Zhu
- Department of Radiology, The People's Hospital of Dayi County, Chengdu, China
| | - Jiman Shao
- Department of Radiology, The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Xiaoguang Hao
- Department of Radiology, Taiyuan Central Hospital, Taiyuan, China
| | - Jun Zhou
- Department of Radiology, The 4(th) People's Hospital of Shenyang, Shenyang, China
| | - Xiaoguang Cheng
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China.
| | - Wei Li
- Medical Research & Biometrics Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Espíldora-Hernández J, Díaz-Antonio T, Baena-Espinar J, Alonso-Calderón I, Rioja J, Alba-Conejo E, Valdivielso P, Sánchez-Chaparro MÁ. Subclinical Arteriosclerosis is Associated With Common Vascular Risk Factors in Long-Term Survivors of Testicular Cancer. J Clin Med 2020; 9:E971. [PMID: 32244483 PMCID: PMC7231146 DOI: 10.3390/jcm9040971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 03/27/2020] [Accepted: 03/30/2020] [Indexed: 12/02/2022] Open
Abstract
Cardiovascular disease risk is increased in survivors of testicular cancer because of exposure to treatment (chemotherapy and radiotherapy), as well as modification in lifestyle. Our aim was to assess the presence of subclinical arteriosclerosis in survivors of testicular cancer in comparison with a control group. This was a cross-sectional, observational, case-control study including 50 survivors of Germ Cell Tumor (GCT) (14 years of follow-up) and 53 age-matched controls with no cancer. We registered clinical data, cardiovascular risk factors, physical and Mediterranean questionnaires, intima-media thickness and plaque at carotid and femoral arteries by ultrasound, calcium score at the abdominal aorta, and liver steatosis by computed tomography, and applied analytical tests to quantify metabolic risk factors and inflammation markers. Patients showed a trend toward greater intima-media thickness (IMT) and plaques than controls, as well as a higher calcium score in the abdominal aorta. Remarkably, patients had higher waist circumference, insulin resistance (HOMA-IR), and liver steatosis, but lower physical activity and high-density lipoprotein (HDL) cholesterol than controls (all p < 0.05). In multivariate analyses, only common vascular risk factors were associated with subclinical arteriosclerosis. As a conclusion, in our study, a higher rate of subclinical arteriosclerosis in testicular cancer survivors was associated with classical metabolic risk factors and lifestyle, but not with exposure to chemotherapy.
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Affiliation(s)
| | | | - Javier Baena-Espinar
- Oncology Unit, Hospital Virgen de la Victoria, 29010 Málaga, Spain; (J.B.-E.); (E.A.-C.)
| | | | - José Rioja
- Lipid and Arteriosclerosis Laboratory, Department of Medicine and Dermatology, and Biomedical Institute for Research (IBIMA), Universidad de Málaga, 29010 Málaga, Spain;
| | - Emilio Alba-Conejo
- Oncology Unit, Hospital Virgen de la Victoria, 29010 Málaga, Spain; (J.B.-E.); (E.A.-C.)
| | - Pedro Valdivielso
- Internal Medicine Unit, Hospital Virgen de la Victoria, 29010 Málaga, Spain; (J.E.-H.); (M.-Á.S.-C.)
- Lipid and Arteriosclerosis Laboratory, Department of Medicine and Dermatology, and Biomedical Institute for Research (IBIMA), Universidad de Málaga, 29010 Málaga, Spain;
| | - Miguel-Ángel Sánchez-Chaparro
- Internal Medicine Unit, Hospital Virgen de la Victoria, 29010 Málaga, Spain; (J.E.-H.); (M.-Á.S.-C.)
- Lipid and Arteriosclerosis Laboratory, Department of Medicine and Dermatology, and Biomedical Institute for Research (IBIMA), Universidad de Málaga, 29010 Málaga, Spain;
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21
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Pedrosa JF, Ribeiro ALP, Santana PC, Araújo LF, Barreto SM. Relation of Thoracic Aortic and Coronary Artery Calcium to Cardiovascular Risk Factors (from The Brazilian Longitudinal Study of Adult Health [ELSA-Brazil]). Am J Cardiol 2019; 124:1655-1661. [PMID: 31590910 DOI: 10.1016/j.amjcard.2019.08.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/25/2019] [Accepted: 08/30/2019] [Indexed: 12/01/2022]
Abstract
Thoracic aortic calcium (TAC) and coronary artery calcium (CAC) are associated with an increased risk of cardiovascular disease (CVD) and death. However, risk factors associated with arterial calcium may vary across vascular beds. We verified whether TAC is associated with the same risk factors as is CAC in adults without established CVD. Cross-sectional analysis including 2,433 participants (aged 38 to 78 years) of ELSA-Brasil cohort in Minas Gerais, Brazil. Nonenhanced ECG-gated multislice computed tomography were performed to detect calcium in the thoracic aorta and the coronaries (2015 to 2016). Multivariate logistic regression evaluated the associations of both TAC and CAC with CVD risk factors (smoking, body mass index, physical activity, alcohol intake, family history of CVD, low-density lipoprotein- and high-density lipoprotein-cholesterol, HbA1c, blood pressure, antidiabetic, antihypertensive, and lipid lowering medications). Overall prevalence of TAC and CAC were 69% and 43%, respectively. CAC prevalence was lower among women (31%) than men (56%) (Adjusted odds ratio [OR] 0.30; 0.24 to 0.38). After adjustments, black individuals were less likely to have any CAC as compared with whites (OR 0.63; 0.47 to 0.86). Neither sex, nor race/skin color were statistically associated with TAC. Use of antidiabetic medications remained associated with CAC (OR 1.80; 1.23 to 2.631.01), but not with TAC. All other risk factors, except education, alcohol, physical activity and HbA1c, persisted statistically associated with both TAC and CAC in the final analysis, with small differences in the magnitudes of the ORs. In conclusion, the only disagreements seen in the risk factors associated with CAC and TAC were sex, race/skin color, and use of antidiabetic medications.
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Affiliation(s)
- Jesiana F Pedrosa
- Department of Anatomy and Imaging, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Antonio Luiz P Ribeiro
- Department of Internal Medicine, School of Medicine and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Priscila C Santana
- Department of Anatomy and Imaging, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Larissa F Araújo
- Department of Public Health, School of Medicine, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil
| | - Sandhi M Barreto
- Department of Social and Preventive Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
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22
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Anatomical References to Evaluate Thoracic Aorta Calcium by Computed Tomography. Curr Atheroscler Rep 2019; 21:51. [DOI: 10.1007/s11883-019-0811-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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23
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The association between liver fat and systemic calcified atherosclerosis. J Vasc Surg 2019; 71:204-211.e4. [PMID: 31153702 DOI: 10.1016/j.jvs.2019.03.044] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 03/07/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND The association of nonalcoholic fatty liver disease (NAFLD) with systemic calcified atherosclerosis, other than the coronary arteries, has not been clearly elucidated. We investigated the association between NAFLD and calcification in eight different vascular beds. METHODS In a community-based cohort with computed tomography scans for carotid artery, coronary artery, thoracic aorta, abdominal aorta, iliac artery, renal artery, celiac trunk, and superior mesenteric artery, the association between NAFLD and arterial calcification was evaluated with adjustment for age, sex, hypertension, dyslipidemia, diabetes, obesity, current smoking status, and family history of heart disease in the first-degree relatives. RESULTS In age- and sex-adjusted models, NAFLD was significantly associated with calcification in the coronary artery, carotid artery, thoracic aorta, celiac trunk, and superior mesenteric artery vascular beds (P < .05). However, adjustment for the traditional chronic venous disease risk factors attenuated the associations, except in the case of the thoracic aorta (odds ratio [OR], 1.38; 95% confidence interval [CI], 1.09-1.78) and celiac trunk (OR, 2.05; 95% CI, 1.16-3.65). In addition, NAFLD was independently associated with multiarterial calcification (four or more [OR, 1.33; 95% CI, 1.01-1.74], five or more [OR, 1.46; 95% CI, 1.09-1.97], and six or more [OR, 1.58; 95% CI, 1.09-2.30] of eight evaluated arterial segments). CONCLUSIONS The association between NAFLD and arterial calcification is mainly mediated by conventional risk factors. The independent association between NAFLD and calcification in the thoracic aorta and celiac trunk as well as in a larger number of vascular beds needs confirmation in future prospective studies in diverse populations.
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24
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Clark D, Cain LR, Blaha MJ, DeFilippis AP, Mentz RJ, Kamimura D, White WB, Butler KR, Robertson RM, Bhatnagar A, Butler J, Correa A, Benjamin EJ, Hall ME. Cigarette Smoking and Subclinical Peripheral Arterial Disease in Blacks of the Jackson Heart Study. J Am Heart Assoc 2019; 8:e010674. [PMID: 30672360 PMCID: PMC6405586 DOI: 10.1161/jaha.118.010674] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 11/27/2018] [Indexed: 12/04/2022]
Abstract
Background Prevalence of peripheral artery disease ( PAD ) is significantly higher among blacks as compared with non-Hispanic whites, but the role of cigarette smoking in PAD is understudied in blacks. We aimed to evaluate the relationship between cigarette smoking and PAD in blacks in the (JHS) Jackson Heart Study. Methods and Results JHS participants (n=5306) were classified by self-reported baseline smoking status into current, past (smoked at least 400 cigarettes/life), or never smokers. We examined multivariable logistic and robust linear regression models to estimate the associations between baseline smoking status, smoking intensity, and measures of subclinical PAD (ankle-brachial index [visit 1] and aortic calcium by computed tomography [visit 2]) to yield odds ratios and β-coefficients (estimated adjusted difference) to compare each smoking status with never smokers (reference group). There were 3579 (68%) never smokers, 986 (19%) past smokers, and 693 (13%) current smokers self-identified at baseline. After adjustment for covariates, current smokers had increased risk of ankle-brachial index <1 (odds ratio, 2.2, 95% CI, 1.5-3.3) and increased risk of abdominal aortic (odds ratio, 8.4, 95% CI, 5.8-12.0) and aortoiliac calcium (odds ratio, 9.6, 95% CI, 6.7-13.7). When stratifying by smoking intensity, those smoking more than 20 cigarettes daily (1 pack) had higher likelihood of subclinical PAD by all of these measures compared with lower-intensity use, suggesting a dose-dependent relationship. Conclusions In a large black cohort, cigarette smoking was associated with measures of subclinical PAD in a dose-dependent manner. These findings highlight the association between smoking and PAD in blacks and support further research exploring the impact of interventions on smoking cessation to reduce PAD in this population.
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Affiliation(s)
- Donald Clark
- Department of MedicineUniversity of Mississippi Medical CenterJacksonMS
| | - Loretta R. Cain
- Department of Data SciencesUniversity of Mississippi Medical CenterJacksonMS
| | - Michael J. Blaha
- Johns Hopkins Bloomberg School of Public HealthJohns Hopkins Ciccarone Center for Prevention of Heart DiseaseBaltimoreMD
| | | | - Robert J. Mentz
- Duke University Medical CenterDuke Clinical Research InstituteDurhamNC
| | - Daisuke Kamimura
- Department of MedicineUniversity of Mississippi Medical CenterJacksonMS
| | | | - Kenneth R. Butler
- Department of MedicineUniversity of Mississippi Medical CenterJacksonMS
| | - Rose M. Robertson
- Department of MedicineVanderbilt University Medical CenterNashvilleTN
| | - Aruni Bhatnagar
- Division of Cardiovascular MedicineUniversity of LouisvilleKY
| | - Javed Butler
- Department of MedicineUniversity of Mississippi Medical CenterJacksonMS
| | - Adolfo Correa
- Department of MedicineUniversity of Mississippi Medical CenterJacksonMS
| | - Emelia J. Benjamin
- Department of MedicineBoston University School of MedicineBostonMA
- Department of EpidemiologyBoston University School of Public Health
| | - Michael E. Hall
- Department of MedicineUniversity of Mississippi Medical CenterJacksonMS
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25
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Zhu J, Nelson K, Toth J, Muscat JE. Nicotine dependence as an independent risk factor for atherosclerosis in the National Lung Screening Trial. BMC Public Health 2019; 19:103. [PMID: 30669994 PMCID: PMC6343324 DOI: 10.1186/s12889-019-6419-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 01/09/2019] [Indexed: 12/21/2022] Open
Abstract
Background Atherosclerosis and COPD are systemic inflammatory diseases that share common risk factors including cigarette smoking. A high level of nicotine dependence is emerging as a recently identified risk factor for pulmonary impairment, chronic obstructive pulmonary disease and tobacco-related cancers. We hypothesized that nicotine dependence is associated with the risk of atherosclerosis in long-term cigarette smokers. Methods A nested case-control study was conducted within the National Lung Cancer Screening Trial- American College of Radiology Imaging Network. Cases were defined as having a new diagnosis of any type of atherosclerosis. Controls were matched on a 2:1 basis by age, sex, race, study center, smoking status, years of smoking, and frequency of smoking. Dependence was measured by the time to first cigarette after awakening (TTFC). Results The study included 166 cases and 286 controls. Compared to participants who smoked within 5 min after waking, the risk of atherosclerosis for participants who smoked an hour or more after waking was borderline non-significant (odds ratio = 0.49, 95% confidence intervals [CI] 0.23, 1.00). Findings were similar for men and women. For aortic atherosclerosis, the corresponding odds ratio was 0.24 (95% CI 0.08, 0.69). Hypertension was associated with an increased risk and body mass index was associated with a decreased risk of aortic atherosclerosis. The TTFC was unrelated to coronary atherosclerosis. Conclusions Compared to smoking immediately after waking, delaying an hour or more reduces the risk of aortic atherosclerosis even among long-term heavy smokers. Possible mechanisms that explain this association are intensity of smoking, inflammation and oxidative stress, and elevated lipid levels.
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Affiliation(s)
- Junjia Zhu
- Penn State College of Medicine, Department of Public Health Sciences, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA, 17033, USA
| | - Kevin Nelson
- Penn State College of Medicine, Department of Public Health Sciences, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA, 17033, USA
| | - Jennifer Toth
- Penn State Milton S. Hershey Medical Center, Department of Pulmonary Medicine, 500 University Drive, PO Box 850, Hershey, PA, 17033, USA
| | - Joshua E Muscat
- Penn State College of Medicine, Department of Public Health Sciences, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA, 17033, USA.
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O'Connor SD, Graffy PM, Zea R, Pickhardt PJ. Does Nonenhanced CT-based Quantification of Abdominal Aortic Calcification Outperform the Framingham Risk Score in Predicting Cardiovascular Events in Asymptomatic Adults? Radiology 2018; 290:108-115. [PMID: 30277443 DOI: 10.1148/radiol.2018180562] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Purpose To determine if abdominal aortic calcification (AAC) at CT predicts cardiovascular events independent of Framingham risk score (FRS). Materials and Methods For this retrospective study, electronic health records for 829 asymptomatic patients (mean age, 57.9 years; 451 women, 378 men) who underwent nonenhanced CT colonography screening between April 2004 and March 2005 were reviewed for subsequent cardiovascular events; mean follow-up interval was 11.2 years ± 2.8 (standard deviation). Institutional review board approval was obtained. CT-based AAC was retrospectively quantified as a modified Agatston score by using a semiautomated tool. Kaplan-Meier curves and Cox proportional hazards models were used for time-to-event analysis; receiver operating characteristic curves and net reclassification improvement compared predictive abilities of AAC and FRS. Results An index cardiovascular event occurred after CT in 156 (19%) of 829 patients (6.7 years ± 3.5, including heart attack in 39 [5%] and death in 79 [10%]). AAC was higher in the cardiovascular event cohort (mean AAC, 3478 vs 664; P < .001). AAC was a strong predictor of cardiovascular events at both univariable and multivariable Cox modeling, independent of FRS (P < .001). Kaplan-Meier plots showed better separation with AAC over FRS. The area under the receiver operating characteristic curve (AUC) was higher for AAC than FRS at all evaluated time points (eg, AUC of 0.82 vs 0.64 at 2 years; P = .014). By using a cutoff point of 200, AAC improved FRS risk categorization with net reclassification improvement of 35.4%. Conclusion CT-based abdominal aortic calcification was a strong predictor of future cardiovascular events, outperforming the Framingham risk score. This finding suggests a potential opportunistic role in abdominal nonenhanced CT scans performed for other clinical indications. © RSNA, 2018.
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Affiliation(s)
- Stacy D O'Connor
- From the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Peter M Graffy
- From the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Ryan Zea
- From the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Perry J Pickhardt
- From the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis
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Echouffo-Tcheugui JB, Allison M, Kalyani RR, Sims M, Bertoni AG, Golden SH. Abdominal Aortic Calcification Among Individuals With and Without Diabetes: The Jackson Heart Study. Diabetes Care 2017; 40. [PMID: 28626009 PMCID: PMC5521965 DOI: 10.2337/dc17-0720] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Justin B Echouffo-Tcheugui
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Matthew Allison
- Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA
| | - Rita R Kalyani
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Mario Sims
- Jackson Heart Study, Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Alain G Bertoni
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC
| | - Sherita H Golden
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD.,Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD
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28
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Onuma OK, Pencina K, Qazi S, Massaro JM, D'Agostino RB, Chuang ML, Fox CS, Hoffmann U, O'Donnell CJ. Relation of Risk Factors and Abdominal Aortic Calcium to Progression of Coronary Artery Calcium (from the Framingham Heart Study). Am J Cardiol 2017; 119:1584-1589. [PMID: 28442125 DOI: 10.1016/j.amjcard.2017.02.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 02/01/2017] [Accepted: 02/01/2017] [Indexed: 12/21/2022]
Abstract
Coronary artery calcium (CAC) and abdominal aortic calcium (AAC) on multidetector computed tomography (MDCT) permit assessment of the presence and burden of coronary and systemic atherosclerosis. Risk factors for progression of CAC and AAC and the association of AAC with CAC progression have not been well characterized in a community-dwelling cohort. We studied 1,959 asymptomatic participants from the Framingham Heart Study who underwent serial MDCT scans with a median interval of 6.1 years. Primary outcomes were (a) the incidence of CAC and AAC (CAC >0 and AAC >0 with baseline CAC = 0 and AAC = 0) and (b) absolute progression of CAC (CAC > baseline CAC and AAC > baseline AAC). Covariates were collected at adjacent cycle examinations and included age, gender, use of antihypertensive therapy, use of lipid-lowering therapy, cigarette smoking, and total and high-density lipoprotein cholesterol. Predictors for CAC and AAC progression included baseline CAC, baseline AAC, lipid-lowering therapy, diabetes, high-density lipoprotein cholesterol, BMI, and serum creatinine. Multivariable stepwise logistic and linear regression models were used to test the association of these risk factors with CAC and AAC. Those who developed incident CAC on follow-up scanning comprised 18.8% of 1,124 participants, and 84.9% of 780 participants, with detectable baseline CAC, had further progression. Baseline AAC was a predictor of both CAC incidence and progression, independent of other risk factors. In stepwise models, addition of baseline AAC slightly improved the area under the curve from 0.72 (0.68 to 0.76) to 0.74 (0.70 to 0.78). In conclusion, standard cardiovascular disease risk factors are associated with incidence and progression of CAC and AAC, and AAC augments CAC incidence and progression above cardiovascular disease risk factors.
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Affiliation(s)
- Oyere K Onuma
- The National Heart, Lung, and Blood Institute's the Framingham Heart Study, Framingham, Massachusetts; Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Karol Pencina
- Department of Mathematics, Boston University, Boston, Massachusetts
| | - Saadia Qazi
- The National Heart, Lung, and Blood Institute's the Framingham Heart Study, Framingham, Massachusetts; Cardiology Section, Department of Medicine, Boston Veteran's Administration Healthcare, Boston, Massachusetts
| | - Joseph M Massaro
- Department of Mathematics, Boston University, Boston, Massachusetts
| | | | - Michael L Chuang
- The National Heart, Lung, and Blood Institute's the Framingham Heart Study, Framingham, Massachusetts
| | - Caroline S Fox
- The National Heart, Lung, and Blood Institute's the Framingham Heart Study, Framingham, Massachusetts
| | - Udo Hoffmann
- The National Heart, Lung, and Blood Institute's the Framingham Heart Study, Framingham, Massachusetts; Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christopher J O'Donnell
- The National Heart, Lung, and Blood Institute's the Framingham Heart Study, Framingham, Massachusetts; Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Cardiology Section, Department of Medicine, Boston Veteran's Administration Healthcare, Boston, Massachusetts.
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Remigio-Baker RA, Allison MA, Forbang NI, Loomba R, Anderson CAM, Budoff M, Schwimmer JB, Blumenthal RS, Ouyang P, Criqui MH. Race/ethnic and sex disparities in the non-alcoholic fatty liver disease-abdominal aortic calcification association: The Multi-Ethnic Study of Atherosclerosis. Atherosclerosis 2017; 258:89-96. [PMID: 28235711 PMCID: PMC5502083 DOI: 10.1016/j.atherosclerosis.2016.11.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 11/03/2016] [Accepted: 11/16/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS This study investigated the associations of non-alcoholic fatty liver disease (NAFLD) and abdominal aortic calcification (AAC) volume and density, and whether these relationships vary by race/ethnicity and/or sex, information that are limited in current literature. METHODS We studied 1004 adults from the Multi-Ethnic Study of Atherosclerosis to assess the relationship between NAFLD (liver-to-spleen ratio <1) and the following measures of AAC: presence (volume score >0, using Poisson regression); change in volume score (increasing vs. no change, using Poisson regression); and morphology (volume and density score, where volume score >0, using linear regression); and interaction by race/ethnicity and sex. RESULTS Among Blacks, those with NAFLD had greater prevalence for AAC compared to Whites regardless of sex (Prevalence Ratio [PR] = 1.41, CI = 1.15-1.74, p-interaction = 0.02). Concurrent interaction by race/ethnicity and sex was found comparing Chinese and Blacks to Whites (p-interaction = 0.017 and 0.042, respectively) in the association between NAFLD and the prevalence of increasing AAC. Among women, this relationship was inverse among Chinese (PR = 0.59, CI = 0.28-1.27), and positive among Whites (PR = 1.34, CI = 1.02-1.76). This finding was reversed evaluating the men counterpart. Black men also had a positive association (PR = 1.86, CI = 1.29-2.70), which differed from the inverse relationship among White men, and was greater compared to Black women (PR = 1.45, CI = 1.09-1.94). NAFLD was unrelated to AAC morphology. CONCLUSIONS NAFLD was related to the presence of AAC, however, limited to Blacks. Significant concurrent interaction by race/ethnicity (Chinese and Blacks vs. Whites) and sex was found in the relationship between NAFLD and increasing AAC. These findings suggest disparities in the pathophysiologic pathways in which atherosclerosis develops.
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Affiliation(s)
- Rosemay A Remigio-Baker
- University of California, San Diego, Department of Family Medicine and Public Health, La Jolla, CA, USA.
| | - Matthew A Allison
- University of California, San Diego, Department of Family Medicine and Public Health, La Jolla, CA, USA
| | - Nketi I Forbang
- University of California, San Diego, Department of Family Medicine and Public Health, La Jolla, CA, USA
| | - Rohit Loomba
- University of California, San Diego, Department of Family Medicine and Public Health, La Jolla, CA, USA
| | - Cheryl A M Anderson
- University of California, San Diego, Department of Family Medicine and Public Health, La Jolla, CA, USA
| | - Matthew Budoff
- University of California, Los Angeles Medical Center, Los Angeles Biomedical Research Institute, Torrance, CA, USA
| | - Jeffrey B Schwimmer
- University of California, San Diego, Department of Pediatrics, La Jolla, CA, USA
| | - Roger S Blumenthal
- Johns Hopkins Medical Institute, Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
| | - Pamela Ouyang
- Johns Hopkins Medical Institute, Women's Cardiovascular Health Center, Baltimore, MD, USA
| | - Michael H Criqui
- University of California, San Diego, Department of Family Medicine and Public Health, La Jolla, CA, USA
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Abstract
PURPOSE OF REVIEW This review provides a brief synopsis of sexual dimorphism in atherosclerosis with an emphasis on genetic studies aimed to better understand the atherosclerotic process and clinical outcomes in women. Such studies are warranted because development of atherosclerosis, impact of several traditional risk factors, and burden of coronary heart disease (CHD) differ between women and men. RECENT FINDINGS While most candidate gene studies pool women and men and adjust for sex, some sex-specific studies provide evidence of association between candidate genes and prevalent and incident CHD in women. So far, most genome-wide association studies (GWAS) also failed to consider sex-specific associations. The few GWAS focused on women tended to have small sample sizes and insufficient power to reject the null hypothesis of no association even if associations exist. Few studies consider that sex can modify the effect of gene variants on CHD. Sufficiently large-scale genetic studies in women of different race/ethnic groups, taking into account possible gene-gene and gene-environment interactions as well as hormone-mediated epigenetic mechanisms, are needed. Using the same disease definition for women and men might not be appropriate. Accurate phenotyping and inclusion of relevant outcomes in women, together with targeting the entire spectrum of atherosclerosis, could help address the contribution of genes to sexual dimorphism in atherosclerosis. Discovered genetic loci should be taken forward for replication and functional studies to elucidate the plausible underlying biological mechanisms. A better understanding of the etiology of atherosclerosis in women would facilitate future prevention efforts and interventions.
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Affiliation(s)
- Maryam Kavousi
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Lawrence F Bielak
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA
| | - Patricia A Peyser
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA
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Lee SA, Lee MJ, Ryu GW, Jhee JH, Kim HW, Park S, Jung SY, Oh HJ, Park JT, Han SH, Kang SW, Yoo TH. Low serum intact parathyroid hormone level is an independent risk factor for overall mortality and major adverse cardiac and cerebrovascular events in incident dialysis patients. Osteoporos Int 2016; 27:2717-2726. [PMID: 27216997 DOI: 10.1007/s00198-016-3636-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 04/11/2016] [Indexed: 12/18/2022]
Abstract
UNLABELLED Abnormal bone dynamics is a major risk factor for cardiovascular disease in patients with chronic kidney disease. The level of serum intact parathyroid hormone (iPTH) is widely used as a bone dynamic marker. We investigated the effect of the mean level of serum iPTH on overall mortality and cardiovascular outcomes in incident dialysis patients. PURPOSE Chronic kidney disease-mineral bone disorder (CKD-MBD) is a major risk factor for cardiovascular disease (CVD) in patients with end-stage renal disease (ESRD). CKD-MBD is classified as low- or high-turnover bone disease according to the bone dynamics; both are related to vascular calcification in ESRD. To evaluate the prognostic value of abnormal serum parathyroid hormone (PTH) levels on ESRD patients, we investigated the effects of time-averaged serum intact PTH (TA-iPTH) levels on overall mortality and major adverse cardiac and cerebrovascular events (MACCEs) in incident dialysis patients. METHODS Four hundred thirteen patients who started dialysis between January 2009 and September 2013 at Yonsei University Health System were enrolled. The patients were divided into three groups according to TA-iPTH levels during the 12 months after the initiation of dialysis: group 1, <65 pg/ml; group 2, 65-300 pg/ml; and group 3, >300 pg/ml. Cox regression analyses were performed to determine the prognostic value of TA-iPTH for overall mortality and MACCEs. RESULTS The mean age of the patients was 57 ± 15 years, and 222 patients (54 %) were men. During the median follow-up of 40.8 ± 29.3 months, 49 patients (12 %) died, and MACCEs occurred in 55 patients (13 %). The multivariate Cox regression analyses demonstrated that a low TA-iPTH level was an independent risk factor for both overall mortality (group 2 as reference; group 1: hazard ratio (HR) = 2.06, 95 % confidence interval (CI) = 1.11-3.83, P = 0.023) and MACCEs (HR = 1.82, 95 % CI = 1.04-3.20, P = 0.036) in incident dialysis patients after adjustment for confounding factors. CONCLUSION Low serum TA-iPTH is a useful clinical marker of both overall mortality and MACCEs in patients undergoing incident dialysis, mediated by vascular calcification.
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Affiliation(s)
- Sul A Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Mi Jung Lee
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam-si, Korea
| | - Geun Woo Ryu
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Hyun Jhee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hyung Woo Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Seohyun Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Su-Young Jung
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hyung Jung Oh
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Tak Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Hyeok Han
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Shin-Wook Kang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Tae-Hyun Yoo
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
- Department of Internal Medicine, College of Medicine; Severance Biomedical Science Institute, Brain Korea 21 PLUS, Yonsei University, 134 Shinchon-Dong, Seodaemun-Gu, Seoul, 120-752, Korea.
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Criqui MH, Aboyans V, Allison MA, Denenberg JO, Forbang N, McDermott MM, Wassel CL, Wong ND. Peripheral Artery Disease and Aortic Disease. Glob Heart 2016; 11:313-326. [PMID: 27741978 PMCID: PMC5119538 DOI: 10.1016/j.gheart.2016.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 08/02/2016] [Accepted: 08/04/2016] [Indexed: 01/14/2023] Open
Abstract
We reviewed published MESA (Multi-Ethnic Study of Atherosclerosis) study articles concerning peripheral arterial disease, subclavian stenosis (SS), abdominal aortic calcium (AAC), and thoracic artery calcium (TAC). Important findings include, compared to non-Hispanic whites, lower ankle-brachial index (ABI) and more SS in African Americans, and higher ABI and less SS in Hispanic and Chinese Americans. Abnormal ABI and brachial pressure differences were associated with other subclinical cardiovascular disease (CVD) measures. Both very high and low ABI independently predicted increased CVD events. Looking at aortic measures, TAC and AAC were significantly associated with other subclinical CVD measures. Comparisons of AAC with coronary artery calcium (CAC) showed that both were less common in ethnic minority groups. However, although CAC was much more common in men than in women in multivariable analysis, this was not true of AAC. Also, when AAC and CAC were adjusted for each other in multivariable analysis, there was a stronger association for AAC than for CAC with CVD and total mortality.
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Affiliation(s)
- Michael H Criqui
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA; Department of Medicine, University of California, San Diego, La Jolla, CA, USA.
| | - Victor Aboyans
- Department of Cardiology, Dupuytren University Hospital, Limoges, France; Inserm 1094, Tropical Neuroepidemiology, University of Limoges, Limoges, France
| | - Matthew A Allison
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA
| | - Julie O Denenberg
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA
| | - Nketi Forbang
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA
| | - Mary M McDermott
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Christina L Wassel
- Department of Pathology and Laboratory Medicine, College of Medicine, University of Vermont, Colchester, VT, USA
| | - Nathan D Wong
- Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine, Irvine, CA, USA
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Katz R, Budoff MJ, O'Brien KD, Wong ND, Nasir K. The metabolic syndrome and diabetes mellitus as predictors of thoracic aortic calcification as detected by non-contrast computed tomography in the Multi-Ethnic Study of Atherosclerosis. Diabet Med 2016; 33:912-9. [PMID: 26341116 PMCID: PMC4779073 DOI: 10.1111/dme.12958] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/01/2015] [Indexed: 11/30/2022]
Abstract
AIMS The metabolic syndrome (MetS) is a clustering of low levels of HDL cholesterol, hyperglycaemia, high waist circumference, hypertension and elevated triglycerides, and is associated with cardiovascular disease. Calcified atherosclerotic plaque in the thoracic aorta (TAC), measured by non-contrast cardiac computed tomography (CT) scans, is a marker for atherosclerosis and relates to mortality. We sought to evaluate the independent association of MetS and TAC on cardiac CT scans. METHODS We examined the relation of the MetS, and each of its components, to the prevalence of TAC, measured from 2000 to 2002 in 6778 white, Chinese, African-American and Hispanic participants in the Multi-Ethnic Study of Atherosclerosis (MESA). RESULTS Adjusting for age, gender, race, smoking, LDL cholesterol and lipid-lowering medications, relative risks and 95% confidence intervals (CI) for a TAC score > 0 were: 1.19 (95% CI 1.11 to 1.28) for participants with MetS, 1.34 (95% CI 1.21 to 1.49) for those with diabetes and MetS, and 1.33 (95% CI 1.11, 1.58) for those with diabetes and no MetS compared with participants who were free of the MetS and diabetes. Associations were found for most of the components of the MetS with TAC. CONCLUSIONS We conclude that in adults without known heart disease, the MetS, most of its components and diabetes are associated with a higher prevalence of calcified atherosclerotic plaque in the thoracic arteries in a multi-ethnic population of men and women.
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Affiliation(s)
- R Katz
- Department of Statistics, University of Washington, Seattle, WA
| | - M J Budoff
- Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA
| | - K D O'Brien
- Department of Statistics, University of Washington, Seattle, WA
| | - N D Wong
- Heart Disease Prevention Program, University of California, Irvine, CA
| | - K Nasir
- Department of Medicine, University of Boston, Boston, MA, USA
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van den Bosch H, Westenberg J, Setz-Pels W, Kersten E, Tielbeek A, Duijm L, Post J, Teijink J, de Roos A. Prognostic value of cardiovascular MR imaging biomarkers on outcome in peripheral arterial disease: a 6-year follow-up pilot study. Int J Cardiovasc Imaging 2016; 32:1281-8. [PMID: 27209283 DOI: 10.1007/s10554-016-0908-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 04/15/2016] [Indexed: 11/25/2022]
Abstract
The objective of this pilot study was to explore the prognostic value of outcome of cardiovascular magnetic resonance (MR) imaging biomarkers in patients with symptomatic peripheral arterial disease (PAD) in comparison with traditional risk factors. Forty-two consecutive patients (mean age 64 ± 11 years, 22 men) referred for contrast-enhanced MR angiography (CE-MRA) were included. At baseline a comprehensive cardiovascular MRI examination was performed: CE-MRA of the infra-renal aorta and run-off vessels, carotid vessel wall imaging, cardiac cine imaging and aortic pulse wave velocity (PWV) assessment. Patients were categorized for outcome at 72 ± 5 months follow-up. One patient was lost to follow-up. Over 6 years, six patients had died (mortality rate 14.6 %), six patients (14.6 %) had experienced a cardiac event and three patients (7.3 %) a cerebral event. The mean MRA stenosis class (i.e., average stenosis severity visually scored over 27 standardized segments) was a significant independent predictor for all-cause mortality (beta 3.0 ± standard error 1.3, p = 0.02). Descending aorta PWV, age and diabetes mellitus were interrelated with stenosis severity but none of these were significant independent predictors. For cardiac morbidity, left ventricular ejection fraction (LVEF) and mean MRA stenosis class were associated, but only LVEF was a significant independent predictor (beta -0.14 ± 0.05, p = 0.005). Diabetes mellitus was a significant independent predictor for cerebral morbidity (beta 2.8 ± 1.3, p = 0.03). Significant independent predictors for outcome in PAD are mean MRA stenosis class for all-cause mortality, LVEF for cardiac morbidity and diabetes mellitus for cerebral morbidity.
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Affiliation(s)
| | - Jos Westenberg
- Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Wikke Setz-Pels
- Department of Radiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Erik Kersten
- Department of Radiology, Catharina Hospital, Eindhoven, The Netherlands
| | | | - Lucien Duijm
- Department of Radiology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Johannes Post
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Joep Teijink
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Albert de Roos
- Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands
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Xie JX, Shaw LJ. Arterial Calcification in Cardiovascular Risk Prediction: Should We Shift the Target for Screening Beyond the Coronaries? Circ Cardiovasc Imaging 2016; 8:CIRCIMAGING.115.004171. [PMID: 26659367 DOI: 10.1161/circimaging.115.004171] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Joe X Xie
- From the Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA
| | - Leslee J Shaw
- From the Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA.
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Churchill TW, Rasania SP, Rafeek H, Mulvey CK, Terembula K, Ferrari V, Jha S, Lilly SM, Eraso LH, Reilly MP, Qasim AN. Ascending and descending thoracic aorta calcification in type 2 diabetes mellitus. J Cardiovasc Comput Tomogr 2015; 9:373-81. [PMID: 26119363 DOI: 10.1016/j.jcct.2015.04.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 02/24/2015] [Accepted: 04/18/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Calcification of the thoracic aorta is a risk factor for cardiovascular disease and peripheral arterial disease but has not been well studied in diabetics. In addition, many studies consider aortic calcium as a single anatomic entity, whereas calcification of the ascending and descending portions of the thoracic aorta may represent separate phenotypes. We sought to characterize the prevalence of ascending and descending aortic calcium among diabetics and to assess their associations with cardiovascular risk factors, coronary artery calcium, and peripheral arterial disease. METHODS Within the Penn Diabetes Heart Study, a cross-sectional study of subjects with type 2 diabetes mellitus but without coronary or renal disease, we quantified Agatston scores of the ascending and descending thoracic aorta in 1739 subjects (63% male, 61% Caucasian). Multivariate logistic and Tobit regressions were used to assess associations with cardiovascular risk factors, coronary calcium, and peripheral arterial disease. RESULTS Of all subjects, 54% had thoracic aortic calcium; of these, 37% had calcium solely in the ascending thoracic aorta and 20% solely in the descending thoracic aorta. In multivariate regression, age, Caucasian race, systolic blood pressure, low-density lipoprotein cholesterol, smoking, and diabetes duration were independently associated with calcium of both the ascending and descending thoracic aorta (P < .001 for all). Ascending and descending aortic calcium were each independently associated with coronary calcium in multivariate regression, but only calcification of the descending thoracic aortic was associated with low ankle-brachial index. CONCLUSION Ascending and descending thoracic aortic calcium have similar associations with traditional cardiovascular risk factors in diabetics and are independently associated with coronary artery calcium. Only calcium in the descending aorta is associated with peripheral arterial disease. Delineation of both phenotypes may provide information about the individualized vascular disease and risk profile of patients with type 2 diabetes mellitus.
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Affiliation(s)
| | - Suraj P Rasania
- Department of Cardiovascular Medicine, Geisinger Medical Center, Danville, PA, USA
| | - Hashmi Rafeek
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Claire K Mulvey
- Division of Internal Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Karen Terembula
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Victor Ferrari
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Saurabh Jha
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Scott M Lilly
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Luis H Eraso
- Jefferson Vascular Center, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Muredach P Reilly
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Atif N Qasim
- Division of Cardiology, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA.
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Ong KL, Ding J, McClelland RL, Cheung BMY, Criqui MH, Barter PJ, Rye KA, Allison MA. Relationship of pericardial fat with lipoprotein distribution: The Multi-Ethnic study of atherosclerosis. Atherosclerosis 2015; 241:664-70. [PMID: 26117404 PMCID: PMC4510019 DOI: 10.1016/j.atherosclerosis.2015.06.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Revised: 05/19/2015] [Accepted: 06/09/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Pericardial fat and lipoprotein abnormalities contribute to increased risk of cardiovascular disease (CVD). We investigated the relationship between pericardial fat volume and lipoprotein distribution, and whether the association of pericardial fat volume with subclinical atherosclerosis and incident CVD events differs according to lipoprotein distribution. METHODS We analyzed data from 5407 participants from the Multi-Ethnic Study of Atherosclerosis who had measurements of pericardial fat volume, lipoprotein distribution, carotid intima-media thickness (IMT), and coronary artery calcium (CAC). All participants were free of clinically apparent CVD at baseline. Incident CVD was defined as any adjudicated CVD event. RESULTS After adjusting for demographic factors, traditional risk factors, and biomarkers of inflammation and hemostasis, a larger pericardial fat volume was associated with higher large VLDL particle (VLDL-P) concentration and small HDL particle (HDL-P) concentration, and smaller HDL-P size (regression coefficients = 0.585 nmol/L, 0.366 μmol/L, and -0.025 nm per SD increase in pericardial fat volume respectively, all P < 0.05). The association of pericardial fat volume with large VLDL-P concentration and HDL-P size, but not small HDL-P concentration, remained significant after further adjusting for each other as well as LDL cholesterol, HDL cholesterol, and triglycerides. The relationship of pericardial fat volume with incident CVD events, carotid IMT, and prevalence and severity of CAC did not differ by quartiles of large VLDL-P concentration, small HDL-P concentration, or HDL-P size (P for interaction>0.05). CONCLUSION Pericardial fat is associated with atherogenic lipoprotein abnormalities. However, its relationship with subclinical atherosclerosis and incident CVD events does not differ according to lipoprotein distribution.
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Affiliation(s)
- Kwok-Leung Ong
- Centre for Vascular Research, University of New South Wales, Sydney, NSW 2025, Australia.
| | - Jingzhong Ding
- Sticht Center on Aging, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Robyn L McClelland
- Department of Biostatistics, University of Washington, Seattle, WA, United States
| | | | - Michael H Criqui
- Department of Family and Preventive Medicine, University of California San Diego, La Jolla, CA, United States
| | - Philip J Barter
- Centre for Vascular Research, University of New South Wales, Sydney, NSW 2025, Australia; Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
| | - Kerry-Anne Rye
- Centre for Vascular Research, University of New South Wales, Sydney, NSW 2025, Australia; Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
| | - Matthew A Allison
- Department of Family and Preventive Medicine, University of California San Diego, La Jolla, CA, United States
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Gebreab SY, Riestra P, Khan RJ, Xu R, Musani SK, Tekola-Ayele F, Correa A, Wilson JG, Rotimi CN, Davis SK. Genetic ancestry is associated with measures of subclinical atherosclerosis in African Americans: the Jackson Heart Study. Arterioscler Thromb Vasc Biol 2015; 35:1271-8. [PMID: 25745061 PMCID: PMC4523273 DOI: 10.1161/atvbaha.114.304855] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 02/22/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To determine whether genetic ancestry was associated with subclinical atherosclerosis measures after adjustment for traditional cardiovascular disease risk factors, inflammatory marker, socioeconomic status, and psychosocial factors in a large admixed African American population. APPROACH AND RESULTS Participants were drawn from the Jackson Heart Study. Participant's percent of European ancestry (PEA) was estimated based on 1747 genetic markers using HAPMIX. Association of PEA with peripheral arterial disease and common carotid intima-media thickness were investigated among 2168 participants and with coronary artery calcification >0 and abdominal aortic calcification >0 among 1139 participants. The associations were evaluated using multivariable regression models. Our results showed that a 1 SD increase in PEA was associated with a lower peripheral arterial disease prevalence after adjusting for age and sex (prevalence ratio=0.90 [95% CI, 0.82-0.99]; P=0.036). Adjustments for traditional cardiovascular disease risk factors, socioeconomic status, and psychosocial factors attenuated this association (prevalence ratio=0.91 [0.82-1.00]; P=0.046). There was also a nonlinear association between PEA and coronary artery calcification and abdominal aortic calcification. The lowest PEA was associated with a lower coronary artery calcification (prevalence ratio=0.75 [0.58-0.96]; P=0.022) and a lower abdominal aortic calcification [prevalence ratio=0.80 [0.67-0.96]; P=0.016) compared with the reference group (10th-90th percentile) after adjusting for traditional cardiovascular disease risk factors, inflammatory marker, socioeconomic status, and psychosocial factors. However, we found no significant association between PEA and common carotid intima-media thickness. CONCLUSIONS Overall, our findings indicate that genetic ancestry was associated with subclinical atherosclerosis, suggesting unmeasured risk factors and interactions with genetic factors might contribute to the distribution of subclinical atherosclerosis among African Americans.
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Affiliation(s)
- Samson Y Gebreab
- From the National Human Genome Research Institute, Metabolic, Cardiovascular and Inflammatory Disease Genomics Branch, Bethesda, MD (S.Y.G., P.R., R.J.K., R.X., F.T.-A., C.N.R., S.K.D.); and Jackson Heart Study (S.K.M., A.C.), and Department of Physiology & Biophysics (J.G.W.), University of Mississippi Medical Center, Jackson.
| | - Pia Riestra
- From the National Human Genome Research Institute, Metabolic, Cardiovascular and Inflammatory Disease Genomics Branch, Bethesda, MD (S.Y.G., P.R., R.J.K., R.X., F.T.-A., C.N.R., S.K.D.); and Jackson Heart Study (S.K.M., A.C.), and Department of Physiology & Biophysics (J.G.W.), University of Mississippi Medical Center, Jackson
| | - Rumana J Khan
- From the National Human Genome Research Institute, Metabolic, Cardiovascular and Inflammatory Disease Genomics Branch, Bethesda, MD (S.Y.G., P.R., R.J.K., R.X., F.T.-A., C.N.R., S.K.D.); and Jackson Heart Study (S.K.M., A.C.), and Department of Physiology & Biophysics (J.G.W.), University of Mississippi Medical Center, Jackson
| | - Ruihua Xu
- From the National Human Genome Research Institute, Metabolic, Cardiovascular and Inflammatory Disease Genomics Branch, Bethesda, MD (S.Y.G., P.R., R.J.K., R.X., F.T.-A., C.N.R., S.K.D.); and Jackson Heart Study (S.K.M., A.C.), and Department of Physiology & Biophysics (J.G.W.), University of Mississippi Medical Center, Jackson
| | - Solomon K Musani
- From the National Human Genome Research Institute, Metabolic, Cardiovascular and Inflammatory Disease Genomics Branch, Bethesda, MD (S.Y.G., P.R., R.J.K., R.X., F.T.-A., C.N.R., S.K.D.); and Jackson Heart Study (S.K.M., A.C.), and Department of Physiology & Biophysics (J.G.W.), University of Mississippi Medical Center, Jackson
| | - Fasil Tekola-Ayele
- From the National Human Genome Research Institute, Metabolic, Cardiovascular and Inflammatory Disease Genomics Branch, Bethesda, MD (S.Y.G., P.R., R.J.K., R.X., F.T.-A., C.N.R., S.K.D.); and Jackson Heart Study (S.K.M., A.C.), and Department of Physiology & Biophysics (J.G.W.), University of Mississippi Medical Center, Jackson
| | - Adolfo Correa
- From the National Human Genome Research Institute, Metabolic, Cardiovascular and Inflammatory Disease Genomics Branch, Bethesda, MD (S.Y.G., P.R., R.J.K., R.X., F.T.-A., C.N.R., S.K.D.); and Jackson Heart Study (S.K.M., A.C.), and Department of Physiology & Biophysics (J.G.W.), University of Mississippi Medical Center, Jackson
| | - James G Wilson
- From the National Human Genome Research Institute, Metabolic, Cardiovascular and Inflammatory Disease Genomics Branch, Bethesda, MD (S.Y.G., P.R., R.J.K., R.X., F.T.-A., C.N.R., S.K.D.); and Jackson Heart Study (S.K.M., A.C.), and Department of Physiology & Biophysics (J.G.W.), University of Mississippi Medical Center, Jackson
| | - Charles N Rotimi
- From the National Human Genome Research Institute, Metabolic, Cardiovascular and Inflammatory Disease Genomics Branch, Bethesda, MD (S.Y.G., P.R., R.J.K., R.X., F.T.-A., C.N.R., S.K.D.); and Jackson Heart Study (S.K.M., A.C.), and Department of Physiology & Biophysics (J.G.W.), University of Mississippi Medical Center, Jackson
| | - Sharon K Davis
- From the National Human Genome Research Institute, Metabolic, Cardiovascular and Inflammatory Disease Genomics Branch, Bethesda, MD (S.Y.G., P.R., R.J.K., R.X., F.T.-A., C.N.R., S.K.D.); and Jackson Heart Study (S.K.M., A.C.), and Department of Physiology & Biophysics (J.G.W.), University of Mississippi Medical Center, Jackson
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Ong KL, McClelland RL, Rye KA, Cheung BMY, Post WS, Vaidya D, Criqui MH, Cushman M, Barter PJ, Allison MA. The relationship between insulin resistance and vascular calcification in coronary arteries, and the thoracic and abdominal aorta: the Multi-Ethnic Study of Atherosclerosis. Atherosclerosis 2014; 236:257-62. [PMID: 25108074 PMCID: PMC4170001 DOI: 10.1016/j.atherosclerosis.2014.07.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 07/15/2014] [Accepted: 07/16/2014] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Insulin resistance may be related to vascular calcification as both are associated with abdominal obesity. We investigated the association of insulin resistance with abdominal aortic calcium (AAC), coronary artery calcium (CAC) and thoracic aortic calcium (TAC), and whether it differs according to different levels of subcutaneous fat area (SFA) and visceral fat area (VFA) in a cross-sectional study design. METHODS We investigated 1632 participants without diabetes from the Multi-Ethnic Study of Atherosclerosis with valid data on homeostasis model assessment index (HOMA-IR), AAC, CAC, and TAC. Adipocytokines, SFA, and VFA were also determined. RESULTS HOMA-IR was associated with the presence of CAC, but not AAC and TAC, and the association remained significant after adjusting for traditional risk factors, adipocytokines, abdominal muscle mass, SFA, and VFA (prevalence ratio = 1.04 per one interquartile range [IQR] increase, P = 0.01). As the strength of the association of HOMA-IR with vascular calcification may differ by abdominal fat composition, subgroup analysis was performed among participants with different tertiles of SFA and VFA. Significant interactions between HOMA-IR with SFA and VFA separately were observed for the presence of TAC, but not AAC and CAC, even after adjusting for confounding factors. The association of HOMA-IR with TAC tended to be stronger in participants with more SFA and VFA. CONCLUSIONS Atherosclerotic calcification, especially in the coronary arteries, is related to insulin resistance. Further studies are needed to delineate the mechanisms by which visceral obesity can lead to vascular calcification.
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Affiliation(s)
- Kwok-Leung Ong
- Centre for Vascular Research, University of New South Wales, Sydney, NSW, Australia; Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.
| | - Robyn L McClelland
- Department of Biostatistics, University of Washington, Seattle, WA, United States
| | - Kerry-Anne Rye
- Centre for Vascular Research, University of New South Wales, Sydney, NSW, Australia; Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
| | | | - Wendy S Post
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Dhananjay Vaidya
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Michael H Criqui
- Department of Family and Preventive Medicine, University of California San Diego, La Jolla, CA, United States
| | - Mary Cushman
- Departments of Medicine and Pathology, University of Vermont, Burlington, VT, United States
| | - Philip J Barter
- Centre for Vascular Research, University of New South Wales, Sydney, NSW, Australia; Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
| | - Matthew A Allison
- Department of Family and Preventive Medicine, University of California San Diego, La Jolla, CA, United States.
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Chuang ML, Gona P, Oyama-Manabe N, Manders ES, Salton CJ, Hoffmann U, Manning WJ, O'Donnell CJ. Risk factor differences in calcified and noncalcified aortic plaque: the Framingham Heart Study. Arterioscler Thromb Vasc Biol 2014; 34:1580-6. [PMID: 24833796 DOI: 10.1161/atvbaha.114.303600] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective of this study was to determine the prevalence and risk factor (RF) correlates of aortic plaque (AP) detected by cardiovascular magnetic resonance (CMR), which mainly shows noncalcified plaques, and by noncontrast computed tomography (CT), which best depicts calcified plaques, in community-dwelling adults. APPROACH AND RESULTS A total of 1016 Framingham Heart Study Offspring cohort members (64 ± 9 years; 474 men) underwent CMR and CT of the aorta. Potential RFs for AP (age; sex; body mass index; blood pressure; low-density lipoprotein and high-density lipoprotein cholesterol; fasting glucose; C-reactive protein; prevalent hypertension, diabetes mellitus, smoking; use of antihypertensive, diabetes mellitus, or lipid-lowering drugs) were compared between participants, with zero versus nonzero AP by CMR and by CT. Candidate RFs attaining P<0.05 for difference with either imaging modality were entered into multivariable logistic regression models adjusting for age, sex, and other RFs. Odds ratios were calculated for modality-specific prevalence of AP. Associations between RFs and continuous measures of AP were assessed using Tobit regression. Prevalence of CMR and CT AP was 49% and 82%, respectively. AP burdens by CMR and CT were correlated, r=0.28, P<0.0001. Increasing age and smoking were associated with prevalent AP by both CMR and CT. Additionally, prevalent AP by CMR was associated with female sex and fasting glucose and prevalent AP by CT with hypertension treatment and adverse lipid profile. CONCLUSIONS AP by CMR and CT are both associated with smoking and increasing age, but other RFs differ between calcified and noncalcified AP. The relative predictive value of AP detected by CMR versus by CT for incident cardiovascular events remains to be determined.
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Affiliation(s)
- Michael L Chuang
- From the National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (M.L.C., P.G., E.S.M., C.J.O.); Department of Quantitative Health Sciences, Division of Biostatistics and Health Services Research, University of Massachusetts Medical School, Worcester (P.G.); Departments of Medicine (Cardiovascular Division) (N.O.-M., C.J.S., W.J.M.) and Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Medicine, Division of Cardiology (C.J.O.) and The Cardiac MR PET CT Program, Department of Radiology (U.H.), Massachusetts General Hospital, Boston; and Harvard Medical School, Boston, MA (U.H., W.J.M., C.J.O.)
| | - Philimon Gona
- From the National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (M.L.C., P.G., E.S.M., C.J.O.); Department of Quantitative Health Sciences, Division of Biostatistics and Health Services Research, University of Massachusetts Medical School, Worcester (P.G.); Departments of Medicine (Cardiovascular Division) (N.O.-M., C.J.S., W.J.M.) and Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Medicine, Division of Cardiology (C.J.O.) and The Cardiac MR PET CT Program, Department of Radiology (U.H.), Massachusetts General Hospital, Boston; and Harvard Medical School, Boston, MA (U.H., W.J.M., C.J.O.)
| | - Noriko Oyama-Manabe
- From the National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (M.L.C., P.G., E.S.M., C.J.O.); Department of Quantitative Health Sciences, Division of Biostatistics and Health Services Research, University of Massachusetts Medical School, Worcester (P.G.); Departments of Medicine (Cardiovascular Division) (N.O.-M., C.J.S., W.J.M.) and Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Medicine, Division of Cardiology (C.J.O.) and The Cardiac MR PET CT Program, Department of Radiology (U.H.), Massachusetts General Hospital, Boston; and Harvard Medical School, Boston, MA (U.H., W.J.M., C.J.O.)
| | - Emily S Manders
- From the National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (M.L.C., P.G., E.S.M., C.J.O.); Department of Quantitative Health Sciences, Division of Biostatistics and Health Services Research, University of Massachusetts Medical School, Worcester (P.G.); Departments of Medicine (Cardiovascular Division) (N.O.-M., C.J.S., W.J.M.) and Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Medicine, Division of Cardiology (C.J.O.) and The Cardiac MR PET CT Program, Department of Radiology (U.H.), Massachusetts General Hospital, Boston; and Harvard Medical School, Boston, MA (U.H., W.J.M., C.J.O.)
| | - Carol J Salton
- From the National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (M.L.C., P.G., E.S.M., C.J.O.); Department of Quantitative Health Sciences, Division of Biostatistics and Health Services Research, University of Massachusetts Medical School, Worcester (P.G.); Departments of Medicine (Cardiovascular Division) (N.O.-M., C.J.S., W.J.M.) and Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Medicine, Division of Cardiology (C.J.O.) and The Cardiac MR PET CT Program, Department of Radiology (U.H.), Massachusetts General Hospital, Boston; and Harvard Medical School, Boston, MA (U.H., W.J.M., C.J.O.)
| | - Udo Hoffmann
- From the National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (M.L.C., P.G., E.S.M., C.J.O.); Department of Quantitative Health Sciences, Division of Biostatistics and Health Services Research, University of Massachusetts Medical School, Worcester (P.G.); Departments of Medicine (Cardiovascular Division) (N.O.-M., C.J.S., W.J.M.) and Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Medicine, Division of Cardiology (C.J.O.) and The Cardiac MR PET CT Program, Department of Radiology (U.H.), Massachusetts General Hospital, Boston; and Harvard Medical School, Boston, MA (U.H., W.J.M., C.J.O.)
| | - Warren J Manning
- From the National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (M.L.C., P.G., E.S.M., C.J.O.); Department of Quantitative Health Sciences, Division of Biostatistics and Health Services Research, University of Massachusetts Medical School, Worcester (P.G.); Departments of Medicine (Cardiovascular Division) (N.O.-M., C.J.S., W.J.M.) and Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Medicine, Division of Cardiology (C.J.O.) and The Cardiac MR PET CT Program, Department of Radiology (U.H.), Massachusetts General Hospital, Boston; and Harvard Medical School, Boston, MA (U.H., W.J.M., C.J.O.)
| | - Christopher J O'Donnell
- From the National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (M.L.C., P.G., E.S.M., C.J.O.); Department of Quantitative Health Sciences, Division of Biostatistics and Health Services Research, University of Massachusetts Medical School, Worcester (P.G.); Departments of Medicine (Cardiovascular Division) (N.O.-M., C.J.S., W.J.M.) and Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Medicine, Division of Cardiology (C.J.O.) and The Cardiac MR PET CT Program, Department of Radiology (U.H.), Massachusetts General Hospital, Boston; and Harvard Medical School, Boston, MA (U.H., W.J.M., C.J.O.).
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Canepa M, Ameri P, AlGhatrif M, Pestelli G, Milaneschi Y, Strait JB, Giallauria F, Ghigliotti G, Brunelli C, Lakatta EG, Ferrucci L. Role of bone mineral density in the inverse relationship between body size and aortic calcification: results from the Baltimore Longitudinal Study of Aging. Atherosclerosis 2014; 235:169-75. [PMID: 24842457 DOI: 10.1016/j.atherosclerosis.2014.04.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 04/01/2014] [Accepted: 04/12/2014] [Indexed: 01/06/2023]
Abstract
OBJECTIVE There is a J-shaped relationship between body mass index (BMI) and cardiovascular outcomes in elderly patients (obesity paradox). Whether low BMI correlates with aortic calcification (AC) and whether this association is accounted for by bone demineralization is uncertain. METHODS Presence of AC was evaluated in 687 community-dwelling individuals (49% male, mean age 67 ± 13 years) using CT images of the thoracic, upper and lower abdominal aorta, and scored from 0 to 3 according to number of sites that showed any calcification. Whole-body bone mineral density (BMD) was evaluated by dual-energy X-ray absorptiometry. Predictors of AC were assessed by logistic regression, and the role of BMD using mediation analysis. RESULTS Age and cardiovascular risk factors were positively associated while both BMI (r = -0.11, p < 0.01) and BMD (r = -0.17, p < 0.0001) were negatively associated with AC severity. In multivariate models, lower BMI (OR 0.96, 95%CI 0.92-0.99, p = 0.01), older age, higher systolic blood pressure, use of lipid-lowering drugs and smoking were independent predictors of AC. A nonlinear relationship between BMI and AC was noticed (p = 0.03), with decreased AC severity among overweight participants. After adjusting for BMD, the coefficient relating BMI to AC was reduced by 14% and was no longer significant, whereas BMD remained negatively associated with AC (OR 0.82, 95%CI 0.069-0.96, p = 0.01), with a trend for a stronger relationship in older participants. CONCLUSION Low BMI is associated with increased AC, possibly through calcium mobilization from bone, resulting in low BMD. Prevention of weight loss and bone demineralization with aging may help reducing AC.
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Affiliation(s)
- Marco Canepa
- Longitudinal Studies Section, Translational Gerontology Branch, NIA/NIH, Baltimore, MD, USA; Laboratory of Cardiovascular Sciences, Human Cardiovascular Studies Unit, NIA/NIH, Baltimore, MD, USA; Department of Internal Medicine, University of Genova, Genova, Italy.
| | - Pietro Ameri
- Department of Internal Medicine, University of Genova, Genova, Italy
| | - Majd AlGhatrif
- Longitudinal Studies Section, Translational Gerontology Branch, NIA/NIH, Baltimore, MD, USA; Laboratory of Cardiovascular Sciences, Human Cardiovascular Studies Unit, NIA/NIH, Baltimore, MD, USA; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Gabriele Pestelli
- Department of Internal Medicine, University of Genova, Genova, Italy
| | - Yuri Milaneschi
- Longitudinal Studies Section, Translational Gerontology Branch, NIA/NIH, Baltimore, MD, USA; Department of Psychiatry, VU University Medical Center/GGZ inGeest, Amsterdam, The Netherlands
| | - James B Strait
- Laboratory of Cardiovascular Sciences, Human Cardiovascular Studies Unit, NIA/NIH, Baltimore, MD, USA
| | - Francesco Giallauria
- Longitudinal Studies Section, Translational Gerontology Branch, NIA/NIH, Baltimore, MD, USA
| | | | - Claudio Brunelli
- Department of Internal Medicine, University of Genova, Genova, Italy
| | - Edward G Lakatta
- Laboratory of Cardiovascular Sciences, Human Cardiovascular Studies Unit, NIA/NIH, Baltimore, MD, USA
| | - Luigi Ferrucci
- Longitudinal Studies Section, Translational Gerontology Branch, NIA/NIH, Baltimore, MD, USA
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Kuipers AL, Zmuda JM, Carr JJ, Terry JG, Patrick AL, Ge Y, Hightower RC, Bunker CH, Miljkovic I. Association of volumetric bone mineral density with abdominal aortic calcification in African ancestry men. Osteoporos Int 2014; 25:1063-9. [PMID: 23974859 PMCID: PMC3945719 DOI: 10.1007/s00198-013-2486-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 07/24/2013] [Indexed: 01/08/2023]
Abstract
SUMMARY We tested for association between cortical and trabecular volumetric bone mineral density (vBMD) with abdominal aortic calcification (AAC) prevalence in 278 Afro-Caribbean men. AAC was present in 68.3 % of the men. Greater cortical, but not trabecular, vBMD was associated with significantly decreased odds of AAC independent of traditional risk factors. INTRODUCTION The aim of this study is to assess the prevalence and correlates of AAC in a sample of 278 Afro-Caribbean men (mean age 56) and to test for a largely unexplored association between cortical and trabecular vBMD with AAC prevalence. METHODS Men were recruited consecutively as part of an ongoing prospective cohort study of body composition in men aged 40+. For this analysis, AAC was assessed by computed tomography of the abdomen from L3 to S1. Aortic calcium was scored using the Agatston method, and prevalence was defined as a score ≥10 to rule out false positives. Men also had BMD assessed using peripheral quantitative computed tomography at 4 % (trabecular vBMD) and 33 % (cortical vBMD) of the radius and tibia. RESULTS Abdominal aortic calcification was present in 68.3 % of the men. Significant independent predictors of AAC prevalence were increased age, increased BMI, hypertension, and current smoking. Age was the strongest predictor, with each SD (7.8 year) increase in age conferring 2.7 times increased odds of having AAC (P < 0.0001). A one SD greater cortical, but not trabecular, vBMD was associated with a significant decreased odds of AAC prevalence independent of other traditional risk factors (OR 0.65; 95 % CI 0.45-0.92). CONCLUSIONS Cortical vBMD is inversely associated with AAC presence. This finding suggests that there may be shared physiology between cortical bone compartment remodeling and vascular calcification.
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Affiliation(s)
- A L Kuipers
- Department of Epidemiology, University of Pittsburgh, 130 DeSoto St, A521 Crabtree Hall, Pittsburgh, PA, 15261, USA,
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Staimez LR, Weber MB, Narayan KMV, Oza-Frank R. A systematic review of overweight, obesity, and type 2 diabetes among Asian American subgroups. Curr Diabetes Rev 2013; 9:312-31. [PMID: 23590534 PMCID: PMC4465442 DOI: 10.2174/15733998113099990061] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 04/06/2013] [Accepted: 04/08/2013] [Indexed: 11/22/2022]
Abstract
This systematic review synthesizes data published between 1988 and 2009 on mean BMI and prevalence of overweight, obesity, and type 2 diabetes among Asian subgroups in the U.S. We conducted systematic searches in Pub- Med for peer-reviewed, English-language citations that reported mean BMI and percent overweight, obesity, and diabetes among South Asians/Asian Indians, Chinese, Filipinos, Koreans, and Vietnamese. We identified 647 database citations and 23 additional citations from hand-searching. After screening titles, abstracts, and full-text publications, 97 citations remained. None were published between 1988 and 1992, 28 between 1993 and 2003, and 69 between 2004 and 2009. Publications were identified for the following Asian subgroups: South Asian (n=8), Asian Indian (n=20), Chinese (n=44), Filipino (n=22), Korean (n= 8), and Vietnamese (n=3). The observed sample sizes ranged from 32 to 4245 subjects with mean ages from 24 to 78 years. Among samples of men and women, the lowest reported mean BMI was in South Asians (22.1 kg/m(2)), and the highest was in Filipinos (26.8 kg/m(2)). Estimates for overweight (12.8-46.7%) and obesity (2.1-59.0%) were variable. Among men and women, the highest rate of diabetes was reported in Asian Indians with BMI ≥ 30 kg/m(2) (32.9%, age and sex standardized). This review suggests heterogeneity among U.S. Asian populations in cardiometabolic risk factors, yet comparisons are limited due to variability in study populations, methods, and definitions used in published reports. Future efforts should adopt standardized methods to understand overweight, obesity and diabetes in this growing U.S. ethnic population.
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Affiliation(s)
- Lisa R Staimez
- Emory University, Laney Graduate School, Division of Biological and Biomedical Sciences, Nutrition and Health Sciences Program, Atlanta, GA, USA.
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Abstract
Cardiovascular disease (CVD) remains the leading cause of death among adults with diabetes, and CVD prevention remains a major challenge. Coronary artery calcium (CAC) score measured by electron beam tomography (EBT) or multi-slice detector computed tomography correlates closely with plaque burden and coronary angiography, and predicts coronary events independently of other risk factors. Further, progression of CAC over several years has been shown to predict increased mortality. Coronary calcification is an active process strongly associated with atherosclerotic plaque evolution and is an accepted surrogate endpoint in studies of patients with diabetes older than 30. In this review, recent findings regarding the mechanisms and implications of vascular calcification in diabetes will be discussed.
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Affiliation(s)
- Janet K Snell-Bergeon
- Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, 1775 Aurora Ct, Mail Stop A140, Aurora, CO 80045, USA.
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Kim ED, Kim JS, Kim SS, Jung JG, Yun SJ, Kim JY, Ryu JS. Association of abdominal aortic calcification with lifestyle and risk factors of cardiovascular disease. Korean J Fam Med 2013; 34:213-20. [PMID: 23730489 PMCID: PMC3667229 DOI: 10.4082/kjfm.2013.34.3.213] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Accepted: 02/28/2013] [Indexed: 12/13/2022] Open
Abstract
Background Abdominal aortic calcification (AAC) is a marker of subclinical atherosclerotic disease and an independent predictor of subsequent vascular morbidity and mortality. This study was conducted to investigate the association of AAC with lifestyle and risk factors of cardiovascular disease. Methods The results of the abdominal computed tomography of 380 patients who visited Chungnam National University Hospital for a health checkup from January 1, 2008 to December 31, 2009 were reviewed. A six-point scale was used in grading the overall severity of the calcification in three areas of the abdominal aorta, including the area superior to the renal artery, the upper-half area inferior to the renal artery, and the lower-half area inferior to the renal artery, in addition to the common iliac artery. The association of the AAC severity with the age, lifestyle factors, and risk factors of cardiovascular disease was analyzed via multiple linear regression analysis. Results In the male subjects, the age, presence of dyslipidemia and smoking were positively related to AAC, but exercising was negatively related to AAC (total R2 = 0.563). In the female subjects, the age and presence of diabetes mellitus, hypertension, and dyslipidemia were positively related to AAC, but exercising was negatively related to AAC (total R2 = 0.547). Conclusion AAC was related to both the male and female subjects' age, presence of dyslipidemia, and exercising, to smoking in the male subjects and to the presence of diabetes mellitus and hypertension in the female subjects.
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Affiliation(s)
- Eung-Du Kim
- Department of Family Medicine, Research Institute for Medical Sciences, Chungnam National University School of Medicine, Daejeon, Korea
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Thompson RC, Allam AH, Lombardi GP, Wann LS, Sutherland ML, Sutherland JD, Soliman MAT, Frohlich B, Mininberg DT, Monge JM, Vallodolid CM, Cox SL, Abd el-Maksoud G, Badr I, Miyamoto MI, el-Halim Nur el-Din A, Narula J, Finch CE, Thomas GS. Atherosclerosis across 4000 years of human history: the Horus study of four ancient populations. Lancet 2013; 381:1211-22. [PMID: 23489753 DOI: 10.1016/s0140-6736(13)60598-x] [Citation(s) in RCA: 214] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Atherosclerosis is thought to be a disease of modern human beings and related to contemporary lifestyles. However, its prevalence before the modern era is unknown. We aimed to evaluate preindustrial populations for atherosclerosis. METHODS We obtained whole body CT scans of 137 mummies from four different geographical regions or populations spanning more than 4000 years. Individuals from ancient Egypt, ancient Peru, the Ancestral Puebloans of southwest America, and the Unangan of the Aleutian Islands were imaged. Atherosclerosis was regarded as definite if a calcified plaque was seen in the wall of an artery and probable if calcifications were seen along the expected course of an artery. FINDINGS Probable or definite atherosclerosis was noted in 47 (34%) of 137 mummies and in all four geographical populations: 29 (38%) of 76 ancient Egyptians, 13 (25%) of 51 ancient Peruvians, two (40%) of five Ancestral Puebloans, and three (60%) of five Unangan hunter gatherers (p=NS). Atherosclerosis was present in the aorta in 28 (20%) mummies, iliac or femoral arteries in 25 (18%), popliteal or tibial arteries in 25 (18%), carotid arteries in 17 (12%), and coronary arteries in six (4%). Of the five vascular beds examined, atherosclerosis was present in one to two beds in 34 (25%) mummies, in three to four beds in 11 (8%), and in all five vascular beds in two (1%). Age at time of death was positively correlated with atherosclerosis (mean age at death was 43 [SD 10] years for mummies with atherosclerosis vs 32 [15] years for those without; p<0·0001) and with the number of arterial beds involved (mean age was 32 [SD 15] years for mummies with no atherosclerosis, 42 [10] years for those with atherosclerosis in one or two beds, and 44 [8] years for those with atherosclerosis in three to five beds; p<0·0001). INTERPRETATION Atherosclerosis was common in four preindustrial populations including preagricultural hunter-gatherers. Although commonly assumed to be a modern disease, the presence of atherosclerosis in premodern human beings raises the possibility of a more basic predisposition to the disease. FUNDING National Endowment for the Humanities, Paleocardiology Foundation, The National Bank of Egypt, Siemens, and St Luke's Hospital Foundation of Kansas City.
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Affiliation(s)
- Randall C Thompson
- Saint Luke's Mid America Heart Institute, and University of Missouri-Kansas City School of Medicine, Kansas City, MO 64111, USA.
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Pencak P, Czerwieńska B, Ficek R, Wyskida K, Kujawa-Szewieczek A, Olszanecka-Glinianowicz M, Więcek A, Chudek J. Calcification of coronary arteries and abdominal aorta in relation to traditional and novel risk factors of atherosclerosis in hemodialysis patients. BMC Nephrol 2013; 14:10. [PMID: 23317172 PMCID: PMC3556324 DOI: 10.1186/1471-2369-14-10] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 01/08/2013] [Indexed: 12/30/2022] Open
Abstract
Background Process of accelerated atherosclerosis specific for uremia increases cardiovascular risk in patients with chronic kidney disease (CKD) and may be influenced by the different structure of arteries. The study assesses the influence of traditional and novel risk factors on calcification of coronary arteries (CAC) and abdominal aorta (AAC) in hemodialysis patients (HD). Methods CAC and AAC were assessed by CT in 104 prevalent adult HD and 14 apparently healthy subjects with normal kidney function (control group). Mineral metabolism parameters, plasma levels of FGF-23, MGP, osteoprotegerin, osteopontin, fetuin-A, CRP, IL-6 and TNF-α were measured. Results CAC and AAC (calcification score ≥ 1) were found in 76 (73.1%) and 83 (79.8%) HD respectively, more frequent than in the control group. In 7 HD with AAC no CAC were detected. The frequency and severity of calcifications increased with age. Both CAC and AAC were more frequently detected in diabetics (OR = 17.37 and 13.00, respectively). CAC score was significantly greater in males. CAC and AAC scores were correlated significantly with pack-years of smoking and plasma osteoprotegrin levels. However the independent contribution of plasma osteoprotegerin levels was not confirmed in multiple regression analysis. Age (OR = 1.13) and hemodialysis vintage (OR = 1.14) were the independent risk factor favoring the occurrence of CAC; while age (OR = 1.20) was the only predictor of AAC occurrence in HD. Conclusions 1. AAC precedes the occurrence of CAC in HD patients. 2. The exposition to uremic milieu and systemic chronic microinflammation has more deteriorative effect on the CAC than the AAC.
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Affiliation(s)
- Przemysław Pencak
- Department of Radiology, Medical University Hospital SPSK-M, Katowice, Poland
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Chuang ML, Massaro JM, Levitzky YS, Fox CS, Manders ES, Hoffmann U, O'Donnell CJ. Prevalence and distribution of abdominal aortic calcium by gender and age group in a community-based cohort (from the Framingham Heart Study). Am J Cardiol 2012; 110:891-6. [PMID: 22727181 PMCID: PMC3432173 DOI: 10.1016/j.amjcard.2012.05.020] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 05/04/2012] [Accepted: 05/04/2012] [Indexed: 11/22/2022]
Abstract
Abdominal aortic calcium (AAC) is associated with incident cardiovascular disease. However, the age- and gender-related distribution of AAC in a community-dwelling population free of standard cardiovascular disease risk factors has not been described. A total of 3,285 participants (aged 50.2 ± 9.9 years) in the Framingham Heart Study Offspring and Third Generation cohorts underwent abdominal multidetector computed tomography from 1998 to 2005. The presence and amount of AAC was quantified (Agatston score) by an experienced reader using standardized criteria. A healthy referent subsample (n = 1,656, 803 men) free of hypertension, hyperlipidemia, diabetes, obesity, and smoking was identified, and participants were stratified by gender and age (<45, 45 to 54, 55 to 64, 65 to 74, and ≥75 years). The prevalence and burden of AAC increased monotonically and supra-linearly with age in both genders but was greater in men than in women in each age group. For those <45 years old, <16% of the referent subsample participants had any quantifiable AAC. However, for those >65 years old, nearly 90% of the referent participants had >0 AAC. Across the entire study sample, AAC prevalence and burden similarly increased with greater age. Defining the 90th percentile of the referent group AAC as "high," the prevalence of high AAC was 19% for each gender in the overall study sample. The AAC also increased across categories of 10-year coronary heart disease risk, as calculated using the Framingham Risk Score, in the entire study sample. We found AAC to be widely prevalent, with the burden of AAC associated with 10-year coronary risk, in a white, free-living adult cohort.
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Affiliation(s)
- Michael L. Chuang
- The National Heart, Lung and Blood Institute's Framingham Heart Study, Boston MA
| | - Joseph M. Massaro
- The National Heart, Lung and Blood Institute's Framingham Heart Study, Boston MA
- Boston University School of Public Health Department of Biostatistics, Boston MA
| | - Yamini S. Levitzky
- The National Heart, Lung and Blood Institute's Framingham Heart Study, Boston MA
| | - Caroline S. Fox
- The National Heart, Lung and Blood Institute's Framingham Heart Study, Boston MA
- Division of Endocrinology, Metabolism, and Diabetes, Brigham and Women's Hospital, Boston MA
- Harvard Medical School, Boston, MA, USA
| | - Emily S. Manders
- The National Heart, Lung and Blood Institute's Framingham Heart Study, Boston MA
| | - Udo Hoffmann
- The Cardiac MR PET CT Program and Department of Radiology, Boston, MA
- Harvard Medical School, Boston, MA, USA
| | - Christopher J. O'Donnell
- The National Heart, Lung and Blood Institute's Framingham Heart Study, Boston MA
- the Division of Cardiology, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA, USA
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50
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Murea M, Ma L, Freedman BI. Genetic and environmental factors associated with type 2 diabetes and diabetic vascular complications. Rev Diabet Stud 2012; 9:6-22. [PMID: 22972441 DOI: 10.1900/rds.2012.9.6] [Citation(s) in RCA: 216] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Faced with a global epidemic of type 2 diabetes (T2D), it is critical that researchers improve our understanding of the pathogenesis of T2D and related vascular complications. These findings may ultimately lead to novel treatment options for disease prevention or delaying progression. Two major paradigms jointly underlie the development of T2D and related coronary artery disease, diabetic nephropathy, and diabetic retinopathy. These paradigms include the genetic risk variants and behavioral/environmental factors. This article systematically reviews the literature supporting genetic determinants in the pathogenesis of T2D and diabetic vasculopathy, and the functional implications of these gene variants on the regulation of beta-cell function and glucose homeostasis. We update the discovery of diabetes and diabetic vasculopathy risk variants, and describe the genetic technologies that have uncovered them. Also, genomic linkage between obesity and T2D is discussed. There is a complementary role for behavioral and environmental factors modulating the genetic susceptibility and diabetes risk. Epidemiological and clinical data demonstrating the effects of behavioral and novel environmental exposures on disease expression are reviewed. Finally, a succinct overview of recent landmark clinical trials addressing glycemic control and its impact on rates of vascular complications is presented. It is expected that novel strategies to exploit the gene- and exposure-related underpinnings of T2D will soon result.
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Affiliation(s)
- Mariana Murea
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
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