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Luo RF, Wang JH, Hu LJ, Fu QA, Zhang SY, Jiang L. Applications of machine learning in familial hypercholesterolemia. Front Cardiovasc Med 2023; 10:1237258. [PMID: 37823179 PMCID: PMC10562581 DOI: 10.3389/fcvm.2023.1237258] [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: 06/09/2023] [Accepted: 09/11/2023] [Indexed: 10/13/2023] Open
Abstract
Familial hypercholesterolemia (FH) is a common hereditary cholesterol metabolic disease that usually leads to an increase in the level of low-density lipoprotein cholesterol in plasma and an increase in the risk of cardiovascular disease. The lack of disease screening and diagnosis often results in FH patients being unable to receive early intervention and treatment, which may mean early occurrence of cardiovascular disease. Thus, more requirements for FH identification and management have been proposed. Recently, machine learning (ML) has made great progress in the field of medicine, including many innovative applications in cardiovascular medicine. In this review, we discussed how ML can be used for FH screening, diagnosis and risk assessment based on different data sources, such as electronic health records, plasma lipid profiles and corneal radian images. In the future, research aimed at developing ML models with better performance and accuracy will continue to overcome the limitations of ML, provide better prediction, diagnosis and management tools for FH, and ultimately achieve the goal of early diagnosis and treatment of FH.
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Affiliation(s)
- Ren-Fei Luo
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jing-Hui Wang
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang, China
- Department of Clinical Medicine, Nanchang University Queen Mary School, Nanchang, China
| | - Li-Juan Hu
- Department of Nursing, Nanchang Medical College, Nanchang, China
| | - Qing-An Fu
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Si-Yi Zhang
- Department of Clinical Medicine, Nanchang University Queen Mary School, Nanchang, China
| | - Long Jiang
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang, China
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Computational intelligence in eye disease diagnosis: a comparative study. Med Biol Eng Comput 2023; 61:593-615. [PMID: 36595155 DOI: 10.1007/s11517-022-02737-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 12/09/2022] [Indexed: 01/04/2023]
Abstract
In recent years, eye disorders are an important health issue among older people. Generally, individuals with eye diseases are unaware of the gradual growth of symptoms. Therefore, routine eye examinations are required for early diagnosis. Usually, eye disorders are identified by an ophthalmologist via a slit-lamp investigation. Slit-lamp interpretations are inadequate due to the differences in the analytical skills of the ophthalmologist, inconsistency in eye disorder analysis, and record maintenance issues. Therefore, digital images of an eye and computational intelligence (CI)-based approaches are preferred as assistive methods for eye disease diagnosis. A comparative study of CI-based decision support models for eye disorder diagnosis is presented in this paper. The CI-based decision support systems used for eye abnormalities diagnosis were grouped as anterior and retinal eye abnormalities diagnostic systems, and numerous algorithms used for diagnosing the eye abnormalities were also briefed. Various eye imaging modalities, pre-processing methods such as reflection removal, contrast enhancement, region of interest segmentation methods, and public eye image databases used for CI-based eye disease diagnosis system development were also discussed in this paper. In this comparative study, the reliability of various CI-based systems used for anterior eye and retinal disorder diagnosis was compared based on the precision, sensitivity, and specificity in eye disease diagnosis. The outcomes of the comparative analysis indicate that the CI-based anterior and retinal disease diagnosis systems attained significant prediction accuracy. Hence, these CI-based diagnosis systems can be used in clinics to reduce the burden on physicians, minimize fatigue-related misdetection, and take precise clinical decisions.
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Hashemi H, Malekifar P, Aghamirsalim M, Yekta A, Mahboubipour H, Khabazkhoob M. Prevalence and associated factors of corneal arcus in the geriatric population; Tehran geriatric eye study. BMC Ophthalmol 2022; 22:354. [PMID: 36045353 PMCID: PMC9429327 DOI: 10.1186/s12886-022-02578-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/26/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Purpose
To determine the age and sex-standardized prevalence of corneal arcus and its associated factors in a geriatric population.
Methods
This population-based cross-sectional study was conducted in 2019 in Tehran; the capital of Iran, using a multi-stage stratified random cluster sampling method. All participants underwent a detailed interview, blood pressure measurement, laboratory blood tests, and a complete ocular examination.
Results
Three thousand three hundred ten of 3791 invitees participated in the study (response rate: 87.31%). The mean age of the participants was 69.35 ± 7.62 years (60–97 years) and 1912 (57.76%) were female. Overall, the age and sex-standardized prevalence (95% CI) of corneal arcus was 44.28% (41.21–47.39). Based on the multiple logistic regression, the odds of corneal arcus were higher in men than in women (OR: 1.51; 95% CI: 1.14–2.00); in the age group ≥ 80 years compared to the age group 60–64 years (OR: 2.44; 95% CI: 1.68–3.53), and in retired people compared to employed individuals (OR: 2.05; 95% CI: 1.31–3.21).
Conclusion
The present study showed a high prevalence of corneal arcus in the geriatric population. Although various studies have reported a significant relationship between corneal arcus with blood lipid and glucose levels as well as blood pressure, these relationships were not found in the present study.
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Crafa A, Condorelli RA, Cannarella R, Aversa A, Calogero AE, La Vignera S. Physical Examination for Endocrine Diseases: Does It Still Play a Role? J Clin Med 2022; 11:jcm11092598. [PMID: 35566722 PMCID: PMC9102568 DOI: 10.3390/jcm11092598] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 05/01/2022] [Accepted: 05/03/2022] [Indexed: 02/01/2023] Open
Abstract
A physical examination represents a fundamental step in diagnosing diseases. Due to the role that hormones play in the regulation of numerous biological processes in various organs and systems, endocrine diseases cause a variety of clinical manifestations that can be easily identified with a careful physical examination and can guide the clinician to specific diagnoses. Furthermore, the presence of specific clinical signs in various endocrine-metabolic diseases can predict the risk of developing comorbidities and serious adverse events. In this article, we present some of the main clinical signs of endocrine-metabolic diseases and the risk of comorbidities, summarizing the pathogenetic mechanisms that lead to their formation. The aim is to highlight how the identification of these specific signs can reduce the number of dynamic tests and the costs necessary to reach the diagnosis and allow the early identification of any complications associated with these diseases, improving the clinical management of affected patients.
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Affiliation(s)
- Andrea Crafa
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (A.C.); (R.A.C.); (R.C.); (A.E.C.)
| | - Rosita A. Condorelli
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (A.C.); (R.A.C.); (R.C.); (A.E.C.)
| | - Rossella Cannarella
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (A.C.); (R.A.C.); (R.C.); (A.E.C.)
| | - Antonio Aversa
- Department of Experimental and Clinical Medicine, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy;
| | - Aldo E. Calogero
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (A.C.); (R.A.C.); (R.C.); (A.E.C.)
| | - Sandro La Vignera
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (A.C.); (R.A.C.); (R.C.); (A.E.C.)
- Correspondence: ; Fax: +39-95-3781180
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Wasielica-Poslednik J, Hampel U, Ries L, Faysal R, Schulz A, Prochaska JH, Wild PS, Schmidtmann I, Münzel T, Beutel ME, Lackner KJ, Pfeiffer N, Schuster AK. Prevalence of corneal arcus and associated factors in a German population-Results from the Gutenberg Health Study. PLoS One 2021; 16:e0255893. [PMID: 34547023 PMCID: PMC8454945 DOI: 10.1371/journal.pone.0255893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 07/26/2021] [Indexed: 11/19/2022] Open
Abstract
Purpose We aimed to determine the prevalence of corneal arcus and to identify associated factors in the general population of Germany. Methods The Gutenberg Health Study (GHS) is a population-based cohort study in Germany, which includes an ophthalmological assessment. Refraction, distance-corrected visual acuity, non-contact tonometry and anterior segment imaging were performed for the five-year follow-up examination. Anterior segment photographs were graded for the presence of corneal arcus. Prevalence estimates were computed, and multivariable logistic regression analysis was applied to determine associated factors for corneal arcus including sex, age, spherical equivalent, central corneal thickness, intraocular pressure (IOP), socio-economic status, smoking, BMI, systolic and diastolic arterial blood pressure, HbA1c, HDL-C, LDL-C, triglyceride, and lipid modifying agents. Results A total of 9,850 right and 9,745 left eyes of 9,858 subjects (59.2±10.8 years), 49.0% females were included in this cross-sectional analysis. 21.1% of men (95%-CI: 20.0%– 22.3%) had a corneal arcus in at least one eye, and 16.9% (95%-CI: 15.9%– 18.0%) of women. In multivariable analyses, the presence of corneal arcus was associated with male gender (OR = 0.54 for female, p<0.0001), higher age (OR = 2.54 per decade, p<0.0001), smoking (OR = 1.59, p<0.0001), hyperopia (OR = 1.05 per diopter, p<0.0001), thinner cornea (OR = 0.994 per μm, p<0.0001), higher IOP (OR = 1.02, p = 0.039), higher HDL-C-level (OR = 2.13, p<0.0001), higher LDL-C-level (OR = 1.21, p<0.0001), and intake of lipid modifying agents (OR = 1.26, p = 0.0001). Arcus was not associated with socio-economic status, BMI, arterial blood pressure, and HbA1c. Conclusions Corneal arcus is a frequent alteration of the cornea in Germany and is associated with ocular parameters and systemic parameters of dyslipidemia.
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Affiliation(s)
- Joanna Wasielica-Poslednik
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg- University Mainz, Mainz, Germany
- * E-mail:
| | - Ulrike Hampel
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg- University Mainz, Mainz, Germany
| | - Lisa Ries
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg- University Mainz, Mainz, Germany
| | - Ruah Faysal
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg- University Mainz, Mainz, Germany
| | - Andreas Schulz
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Jürgen H. Prochaska
- Department of Cardiology–Cardiology I, University Medical Center Mainz, Mainz, Germany
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Philipp S. Wild
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Rhine-Main, Mainz, Germany
| | - Irene Schmidtmann
- Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Thomas Münzel
- Department of Cardiology–Cardiology I, University Medical Center Mainz, Mainz, Germany
| | - Manfred E. Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Karl J. Lackner
- DZHK (German Center for Cardiovascular Research), Partner Site Rhine-Main, Mainz, Germany
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Mainz, Mainz, Germany
| | - Norbert Pfeiffer
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg- University Mainz, Mainz, Germany
| | - Alexander K. Schuster
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg- University Mainz, Mainz, Germany
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Comparison of Subjective and Objective Methods of Corneoscleral Limbus Identification from Anterior Segment Optical Coherence Tomography Images. Optom Vis Sci 2021; 98:127-136. [PMID: 33534377 DOI: 10.1097/opx.0000000000001637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
SIGNIFICANCE This study evaluates the reliability and validity of an automatic method of the external and internal limbal points identification from anterior segment optical coherence tomography (OCT) images in comparison with manual delineation. PURPOSE The purpose of this work was to evaluate the repeatability and precision of a previously proposed automatic method of external and internal limbal points identification and to compare them with the manual delineation by experienced clinicians in terms of limbus diameter. METHODS Optical coherence tomography tomograms obtained for 12 healthy volunteers without a history of eye diseases were analyzed. Fifteen OCT tomograms were captured for each patient. For all the images, the external and internal limbal points were determined using both the automatic and manual methods. The external and internal limbus diameters were used as the comparative parameter between the methods under consideration. The statistical analysis included mean, standard deviation, the Passing-Bablok regression, and the Pearson correlation coefficient. RESULTS A strong linear dependence between the automatic and manual methods was identified. While compared with the subjective estimates from clinicians, the automatic technique overestimated the external limbus diameter (bias equals 0.21 mm for optometrist and 0.23 mm for ophthalmologist) and slightly underestimated the internal limbus diameter (bias equals 0.13 mm for optometrist and 0.04 mm for ophthalmologist). The automatic method showed significantly better repeatability than the manual method in the case of external limbal points identification and comparably high repeatability for internal limbal points recognition. CONCLUSIONS Because of high precision and excellent repeatability, the automatic method of limbal points identification may be successfully used for estimation of the dynamic changes in the geometry of the anterior segment of the eye, where the large number of captured OCT images needs to be processed automatically with high precision.
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Hanterdsith B. An Evaluation of the Arcus Corneae For Age Estimation. Acad Forensic Pathol 2020; 9:155-162. [PMID: 32110250 DOI: 10.1177/1925362119891708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 11/11/2019] [Indexed: 11/16/2022]
Abstract
Although the arcus corneae (AC) has long been used as an age indicator for forensic purposes, its diagnostic value has not been evaluated. To evaluate the AC as a predictor of chronological age, the author has studied the correlation of AC with respect to age of the deceased. A cross-sectional study was conducted of 342 Thai corpses at the Maharat Nakhon Ratchasima Hospital, Thailand. AC was graded into three levels: no AC, incomplete ring, and complete ring. One-way analysis of variance, chi-square test, binomial logistic regression, sensitivity, specificity, predictive values, and likelihood ratios were used for analysis. The Cohen's kappa was used to determine the intraobserver and interobserver reliability. The prevalence of AC and the probability of complete AC were significant higher in corpses aged 60 years and above than in those under 60 years. Consequently, this study confirmed that the prevalence of AC was significantly correlated with the age of Thai individuals. If the complete AC is used as an indicator of age of 60 years and above, complete AC has high sensitivity (92.56%) but low specificity (72.85%), low positive predictive value (65.12%), but high negative predictive value (94.71%). For diagnostic value, the presence of AC can be used for age screening but not for absolute confirmation. The absence of AC indicates young age, incomplete AC indicates middle age, and complete AC indicates old age. The high intraobserver and interobserver reliability provides assurance of the value of AC as a means to estimate personal age.
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Abstract
Primary biliary cholangitis (PBC) is a chronic, cholestatic, autoimmune disease with a variable progressive course. PBC can cause debilitating symptoms including fatigue and pruritus and, if left untreated, is associated with a high risk of cirrhosis and related complications, liver failure, and death. Recent changes to the PBC landscape include a name change, updated guidelines for diagnosis and treatment as well as new treatment options that have recently become available. Practicing clinicians face many unanswered questions when managing PBC. To assist these healthcare providers in managing patients with PBC, the American College of Gastroenterology (ACG) Institute for Clinical Research & Education, in collaboration with the Chronic Liver Disease Foundation (CLDF), organized a panel of experts to evaluate and summarize the most current and relevant peer-reviewed literature regarding PBC. This, combined with the extensive experience and clinical expertise of this expert panel, led to the formation of this clinical guidance on the diagnosis and management of PBC.
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S V MK, R G. Computer-Aided Diagnosis of Anterior Segment Eye Abnormalities using Visible Wavelength Image Analysis Based Machine Learning. J Med Syst 2018; 42:128. [PMID: 29860586 DOI: 10.1007/s10916-018-0980-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 05/18/2018] [Indexed: 11/26/2022]
Abstract
Eye disease is a major health problem among the elderly people. Cataract and corneal arcus are the major abnormalities that exist in the anterior segment eye region of aged people. Hence, computer-aided diagnosis of anterior segment eye abnormalities will be helpful for mass screening and grading in ophthalmology. In this paper, we propose a multiclass computer-aided diagnosis (CAD) system using visible wavelength (VW) eye images to diagnose anterior segment eye abnormalities. In the proposed method, the input VW eye images are pre-processed for specular reflection removal and the iris circle region is segmented using a circular Hough Transform (CHT)-based approach. The first-order statistical features and wavelet-based features are extracted from the segmented iris circle and used for classification. The Support Vector Machine (SVM) by Sequential Minimal Optimization (SMO) algorithm was used for the classification. In experiments, we used 228 VW eye images that belong to three different classes of anterior segment eye abnormalities. The proposed method achieved a predictive accuracy of 96.96% with 97% sensitivity and 99% specificity. The experimental results show that the proposed method has significant potential for use in clinical applications.
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Affiliation(s)
- Mahesh Kumar S V
- Department of Electronics and Communication Engineering, Pondicherry Engineering College, Puducherry, India.
| | - Gunasundari R
- Department of Electronics and Communication Engineering, Pondicherry Engineering College, Puducherry, India
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Is Corneal Arcus Independently Associated With Incident Cardiovascular Disease in Asians? Am J Ophthalmol 2017; 183:99-106. [PMID: 28911992 DOI: 10.1016/j.ajo.2017.09.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 08/31/2017] [Accepted: 09/01/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE To examine the longitudinal relationship between baseline corneal arcus (CA) and incident cardiovascular disease (CVD) in ethnic Indian and Malay adults in Singapore. DESIGN Population-based cohort study. METHODS Indian and Malay adults aged 40-80 years were recruited for baseline and 6-year follow-up visits between 2004-2009 and 2010-2015, respectively (follow-up response rate 73.9%). CA was assessed by ophthalmologists using slit-lamp biomicroscopy. The main outcome was self-reported incident CVD, defined as new myocardial infarction, angina pectoris, or stroke, which developed between baseline and follow-up. Multivariable logistic regression models assessed independent associations between baseline CA and incident CVD, adjusting for traditional CVD risk factors including age, sex, serum cholesterol, hypertension, diabetes, and smoking. We further conducted sex-stratified analyses to identify possible effect modifications. RESULTS Of the total 3637 participants (overall mean [SD] age: 56 [9] years, 46% male) with available follow-up data, without history of CVD at baseline, 208 (5.7%) incident CVD cases were reported. Participants with CA were more likely to have incident CVD (7.5%) than those without (4.9%). After controlling for traditional CVD risk factors, CA was independently associated with incident CVD (odds ratio [95% confidence interval]: 1.52 [1.07-2.16]) in adjusted models. In sex-stratified models, associations between CA and incident CVD were seen in men (1.73 [1.12-2.67]) and not in women (1.05 [0.56-1.97]). CONCLUSIONS CA is associated with incident CVD, independent of serum lipids and traditional CVD risk factors, in ethnic Malay and Indian men. Our finding suggests that CA is an additional observable indicator of CVD in men.
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Christoffersen M, Tybjærg-Hansen A. Visible aging signs as risk markers for ischemic heart disease: Epidemiology, pathogenesis and clinical implications. Ageing Res Rev 2016; 25:24-41. [PMID: 26590331 DOI: 10.1016/j.arr.2015.11.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 10/30/2015] [Accepted: 11/09/2015] [Indexed: 12/20/2022]
Abstract
Association of common aging signs (i.e., male pattern baldness, hair graying, and facial wrinkles) as well as other age-related appearance factors (i.e., arcus corneae, xanthelasmata, and earlobe crease) with increased risk of ischemic heart disease was initially described in anecdotal reports from clinicians observing trends in the physical appearance of patients with ischemic heart disease. Following these early observations numerous epidemiological studies have reported these associations. Since the prevalences of both visible aging signs and ischemic heart disease have a strong correlation with increasing age, it has been extensively debated whether the observed associations could be entirely explained by a common association with age. Furthermore, the etiologies of the visible aging signs are rarely fully understood, and pathophysiological explanations for these associations remain controversial, and are mostly speculative. As a consequence of inconsistent findings and lack of mechanistic explanations for the observed associations with ischemic heart disease, consensus on the clinical importance of these visible aging signs has been lacking. The aim of this review is for each of the visible aging signs to (i) review the etiology, (ii) to discuss the current epidemiological evidence for an association with risk of ischemic heart disease, and (iii) to present possible pathophysiological explanations for these associations. Finally this review discusses the potential clinical implications of these findings.
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12
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Ogura M, Hori M, Harada-Shiba M. Association Between Cholesterol Efflux Capacity and Atherosclerotic Cardiovascular Disease in Patients With Familial Hypercholesterolemia. Arterioscler Thromb Vasc Biol 2015; 36:181-8. [PMID: 26543100 DOI: 10.1161/atvbaha.115.306665] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 10/19/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Patients with familial hypercholesterolemia (FH) are at high risk for premature atherosclerotic cardiovascular disease (ASCVD), especially because of long-term exposure to high low-density lipoprotein cholesterol levels. It has been reported that low-density lipoprotein-lowering therapy delays the onset of ASCVD. However, it still remains difficult to prevent it. Therefore, novel biomarkers and therapeutic targets are necessary to evaluate and prevent atherosclerosis in FH. The aim of this study was to investigate associations of cholesterol efflux capacity with the presence of ASCVD and clinical features in patients with heterozygous FH. APPROACH AND RESULTS We measured cholesterol efflux capacity in 227 patients with heterozygous FH under pharmaceutical treatment. Seventy-six (33.5%) of them were known to have ASCVD. In a logistic-regression analysis adjusted for risk factors, increased efflux capacity was associated with decreased risk of ASCVD even after the addition of high-density lipoprotein cholesterol level as a covariate (odds ratio per 1-SD increase, 0.95; 95% confidence interval, 0.90-0.99; P<0.05). Decreased cholesterol efflux capacity was associated with the presence of corneal arcus after adjusting for age and sex. In addition, inverse relationships between cholesterol efflux capacity and Achilles tendon thickness, as well as carotid intima-media thickness, were observed after adjustment for age, sex, and traditional cardiovascular risk factors. CONCLUSIONS Cholesterol efflux capacity was independently and inversely associated with the presence of ASCVD in heterozygous FH. In view of residual risks after treatment with statins, cholesterol efflux capacity might be a novel biomarker and a therapeutic target for preventing atherosclerosis in patients with FH.
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Affiliation(s)
- Masatsune Ogura
- From the Department of Molecular Innovation in Lipidology, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan.
| | - Mika Hori
- From the Department of Molecular Innovation in Lipidology, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
| | - Mariko Harada-Shiba
- From the Department of Molecular Innovation in Lipidology, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
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El-Sayyad HIH, Elmansi AA, Bakr EHM. Hypercholesterolemia-induced ocular disorder: Ameliorating role of phytotherapy. Nutrition 2015; 31:1307-16. [PMID: 26429651 DOI: 10.1016/j.nut.2015.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 05/07/2015] [Accepted: 05/10/2015] [Indexed: 01/03/2023]
Abstract
The ocular region is a complex structure that allows conscious light perception and vision. It is of ecto-mesodermal origin. Cholesterol and polyunsaturated fatty acids are involved in retinal cell function; however, hypercholesterolemia and diabetes impair its function. Retinal damage, neovascularization, and cataracts are the main complications of cholesterol overload. Dietary supplementation of selected plant products can lead to the scavenging of free reactive oxygen species, thereby protecting the ocular regions from the damage of hypercholesterolemia. This review illustrates the dramatic effects of increased cholesterol levels on the ocular regions. The effect of phytotherapy is discussed in relation to the different regions of the eye, including the retina, cornea, and lens.
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Affiliation(s)
- Hassan I H El-Sayyad
- Faculty of Science, Department of Zoology, Mansoura University, Mansoura, Egypt.
| | - Ahmed A Elmansi
- Faculty of Science, Department of Zoology, Mansoura University, Mansoura, Egypt
| | - Eman H M Bakr
- Faculty of Science, Department of Zoology, Mansoura University, Mansoura, Egypt
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Hashemi H, Khabazkhoob M, Emamian MH, Shariati M, Fotouhi A. A population-based study of corneal arcus and its risk factors in Iran. Ophthalmic Epidemiol 2014; 21:339-44. [PMID: 25118951 DOI: 10.3109/09286586.2014.949782] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To determine the prevalence of corneal arcus, its risk factors, and its relationship to ocular and visual indices. METHODS In this cross-sectional study, 300 clusters were randomly selected from Shahroud in the north of Iran, using multistage sampling. A total of 20 people were invited to participate from each cluster. After enrollment, all optometric, biometric and ophthalmic exams were conducted on site. RESULTS Of 6311 people invited, 5190 (82.2%) participated in the study. The prevalence of corneal arcus was 23.3% (95% confidence interval, CI, 22.1-24.6), and 98.4% were bilateral cases. The prevalence of corneal arcus was higher in men (odds ratio, OR, 2.02, 95% CI 1.8-2.3, p < 0.001) and increased with age (OR 1.1/year, p < 0.001). In a multivariable-adjusted regression model, age (OR 1.1/year, p = 0.006), male sex (OR 1.30, p = 0.001), diabetes (OR 0.7, p < 0.001), smoking (OR 1.5, p = 0.003), outdoor activity (OR 1.4, p = 0.006), systolic blood pressure (OR 1.01, p = 0.012), and diastolic blood pressure (OR 0.99, p = 0.016) were significantly correlated with corneal arcus. Including biometric components in another model, corneal thickness (OR 0.99, p < 0.001), anterior chamber depth (OR 0.68, p < 0.001) and corneal radius of curvature (OR 1.59, p < 0.001) were significantly correlated with corneal arcus. CONCLUSION This study adds valuable information to the epidemiology of corneal arcus in Iran and the Middle East. In people aged over 60 years, nearly 50% of the study population had corneal arcus. Older age, male sex, smoking, and systolic hypertension were risk factors for corneal arcus. Corneal arcus was also associated with thin and flat corneas and shallow anterior chamber depth.
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Affiliation(s)
- Hassan Hashemi
- Noor Ophthalmology Research Center, Noor Eye Hospital , Tehran , Iran
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Gribble MO, Around Him DM. Ethics and Community Involvement in Syntheses Concerning American Indian, Alaska Native, or Native Hawaiian Health: A Systematic Review. AJOB Empir Bioeth 2014; 5:1-24. [PMID: 25089283 DOI: 10.1080/21507716.2013.848956] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The objective of the research was to review reporting of ethical concerns and community involvement in peer-reviewed systematic reviews or meta-analyses concerning American Indian, Alaska Native, or Native Hawaiian (AI/AN/NH) health. METHODS Text words and indexed vocabulary terms were used to query PubMed, Embase, Cochrane Library, and the Native Health Database for systematic reviews or meta-analyses concerning AI/AN/NH health published in peer-reviewed journals, followed by a search through reference lists. Each article was abstracted by two independent reviewers; results were discussed until consensus was reached. RESULTS We identified 107 papers published from 1986-2012 that were primarily about AI/AN/NH health or presented findings separately for AI/AN/NH communities. Two reported seeking indigenous reviewer feedback; none reported seeking input from tribes and communities. Approximately 7% reported on institutional review board (IRB) approval of included studies, 5% reported on tribal approval, and 4% referenced the sovereignty of AI/AN tribes. Approximately 63% used evidence from more than one AI/AN/NH population study, and 28% discussed potential benefits to communities from the synthesis research. CONCLUSIONS Reporting of ethics and community involvement are not prominent. Systematic reviews and meta-analyses making community-level inferences may pose risks to communities. Future systematic reviews and meta-analyses should consider ethical and participatory dimensions of research.
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Affiliation(s)
- Matthew O Gribble
- Department of Preventive Medicine, University of Southern California Keck School of Medicine
| | - Deana M Around Him
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health
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Christoffersen M, Frikke-Schmidt R, Schnohr P, Jensen GB, Nordestgaard BG, Tybjærg-Hansen A. Visible Age-Related Signs and Risk of Ischemic Heart Disease in the General Population. Circulation 2014; 129:990-8. [DOI: 10.1161/circulationaha.113.001696] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Cardiovascular disease is 1 of the most common age-related diseases, and also 1 of the most common causes of death in the general population. We tested the hypothesis that visible age-related signs associate with risk of ischemic heart disease (IHD), myocardial infarction (MI), and death in the general population, independent of chronological age.
Methods and Results—
10,885 individuals aged 20 to 93 years free of IHD were followed from 1976 through 1978 until June 2011 with 100% complete follow-up. During these 35 years of follow-up, 3401 participants developed IHD and 1708 developed MI. Presence of frontoparietal baldness, crown top baldness, earlobe crease, and xanthelasmata was associated with increased risk of IHD or MI after multifactorial adjustment for chronological age and well-known cardiovascular risk factors. The risk of IHD and MI increased stepwise with increasing number of age-related signs with multifactorially adjusted hazard ratios up to 1.40 (95% confidence interval, 1.20–1.62) for IHD and 1.57 (1.28–1.93) for MI, in individuals with 3 to 4 versus no age-related signs at baseline (
P
for trend <0.001). In all age groups in both women and men, absolute 10-year risk of IHD and MI increased with increasing number of visible age-related signs.
Conclusions—
Male pattern baldness, earlobe crease, and xanthelasmata—alone or in combination—associate with increased risk of ischemic heart disease and myocardial infarction independent of chronological age and other well-known cardiovascular risk factors. This is the first prospective study to show that looking old for your age is a marker of poor cardiovascular health.
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Affiliation(s)
- Mette Christoffersen
- From the Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark (M.C., R.F.-S.,A.T.-H.); The Copenhagen City Heart Study, Frederiksberg Hospital, Copenhagen, Denmark (P.S., G.B.J., B.G.N., A.T.-H.); the Department of Cardiology, Hvidovre Hospital, Hvidovre, Denmark (G.B.J.); Department of Clinical Biochemistry, Herlev Hospital, Copenhagen, Denmark (B.G.N.); and Copenhagen University Hospitals and Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark (M.C., R.F
| | - Ruth Frikke-Schmidt
- From the Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark (M.C., R.F.-S.,A.T.-H.); The Copenhagen City Heart Study, Frederiksberg Hospital, Copenhagen, Denmark (P.S., G.B.J., B.G.N., A.T.-H.); the Department of Cardiology, Hvidovre Hospital, Hvidovre, Denmark (G.B.J.); Department of Clinical Biochemistry, Herlev Hospital, Copenhagen, Denmark (B.G.N.); and Copenhagen University Hospitals and Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark (M.C., R.F
| | - Peter Schnohr
- From the Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark (M.C., R.F.-S.,A.T.-H.); The Copenhagen City Heart Study, Frederiksberg Hospital, Copenhagen, Denmark (P.S., G.B.J., B.G.N., A.T.-H.); the Department of Cardiology, Hvidovre Hospital, Hvidovre, Denmark (G.B.J.); Department of Clinical Biochemistry, Herlev Hospital, Copenhagen, Denmark (B.G.N.); and Copenhagen University Hospitals and Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark (M.C., R.F
| | - Gorm B. Jensen
- From the Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark (M.C., R.F.-S.,A.T.-H.); The Copenhagen City Heart Study, Frederiksberg Hospital, Copenhagen, Denmark (P.S., G.B.J., B.G.N., A.T.-H.); the Department of Cardiology, Hvidovre Hospital, Hvidovre, Denmark (G.B.J.); Department of Clinical Biochemistry, Herlev Hospital, Copenhagen, Denmark (B.G.N.); and Copenhagen University Hospitals and Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark (M.C., R.F
| | - Børge G. Nordestgaard
- From the Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark (M.C., R.F.-S.,A.T.-H.); The Copenhagen City Heart Study, Frederiksberg Hospital, Copenhagen, Denmark (P.S., G.B.J., B.G.N., A.T.-H.); the Department of Cardiology, Hvidovre Hospital, Hvidovre, Denmark (G.B.J.); Department of Clinical Biochemistry, Herlev Hospital, Copenhagen, Denmark (B.G.N.); and Copenhagen University Hospitals and Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark (M.C., R.F
| | - Anne Tybjærg-Hansen
- From the Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark (M.C., R.F.-S.,A.T.-H.); The Copenhagen City Heart Study, Frederiksberg Hospital, Copenhagen, Denmark (P.S., G.B.J., B.G.N., A.T.-H.); the Department of Cardiology, Hvidovre Hospital, Hvidovre, Denmark (G.B.J.); Department of Clinical Biochemistry, Herlev Hospital, Copenhagen, Denmark (B.G.N.); and Copenhagen University Hospitals and Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark (M.C., R.F
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Macchiaiolo M, Buonuomo PS, Valente P, Rana I, Lepri FR, Gonfiantini MV, Bartuli A. Corneal arcus as first sign of familial hypercholesterolemia. J Pediatr 2014; 164:670. [PMID: 24314439 DOI: 10.1016/j.jpeds.2013.10.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 10/21/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Marina Macchiaiolo
- Rare Diseases and Medical Genetics, Bambino Gesù Children's Hospital, Rome, Italy
| | | | - Paola Valente
- Pediatric Ophthalmology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Ippolita Rana
- General Pediatrics and Infectious Diseases, Bambino Gesù Children's Hospital, Rome, Italy
| | | | | | - Andrea Bartuli
- Rare Diseases and Medical Genetics, Bambino Gesù Children's Hospital, Rome, Italy
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Heterozygous familial hypercholesterolemia in Hong Kong Chinese. Study of 252 cases. Int J Cardiol 2013; 167:762-7. [DOI: 10.1016/j.ijcard.2012.03.048] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 03/03/2012] [Indexed: 01/30/2023]
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Brenes JA. White rings: arcus lipoides. Am J Med 2013; 126:112-3. [PMID: 23331436 DOI: 10.1016/j.amjmed.2012.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 10/04/2012] [Accepted: 10/04/2012] [Indexed: 11/17/2022]
Affiliation(s)
- Jorge A Brenes
- Department of Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA.
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Garcia-Rios A, Perez-Martinez P, Mata P, Fuentes F, Lopez-Miranda J, Alonso R, Caballero J, Mata N, Perez-Jimenez F, Ordovas JM. Polymorphism at the TRIB1 gene modulates plasma lipid levels: insight from the Spanish familial hypercholesterolemia cohort study. Nutr Metab Cardiovasc Dis 2011; 21:957-963. [PMID: 20692138 DOI: 10.1016/j.numecd.2010.04.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Revised: 03/31/2010] [Accepted: 04/02/2010] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND AIMS rs17321515 SNP has been associated with variation in LDL-C, high density lipoprotein cholesterol and triglycerides concentrations. This effect has never been studied in patients with severe hypercholesterolemia. Therefore, our aims were to assess the association of the rs17321515 (TRIB1) SNP with plasma lipids concentrations and anthropometric variables and to explore the interaction between this SNP and some classic risk factors in patients with familial hypercholesterolemia (FH). METHODS AND RESULTS rs17321515 SNP was genotyped in 531 subjects with genetic diagnosis of FH. Homozygous A/A had significantly higher waist circumference compared with G/G subjects (P = 0.006) and carriers of the minor allele G (P = 0.039). Interestingly, smokers homozygous for the A allele displayed higher plasma triglycerides concentrations (P = 0.029), higher VLDL-C levels (P = 0.023) and higher TC/HDL-C ratio (P = 0.035) than carriers of the minor allele G. In addition, homozygous A/A with the presence of arcus cornealis displayed lower plasma ApoA-I levels (P = 0.024) and higher TC/HDL-C ratio (P = 0.046) than carriers of the minor allele G. CONCLUSIONS Smoking status and presence of arcus cornealis modulate the effect of rs17321515 (TRIB1) polymorphism on plasma lipids levels in patients with FH. These results could explain the differences in the susceptibility to coronary heart disease in these patients.
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Affiliation(s)
- A Garcia-Rios
- Reina Sofia University Hospital, Instituto Maimonides de Investigacion Biomedica de Cordoba-IMIBIC, 14004 Cordoba, University of Cordoba, CIBER Fisiopatologia de la Obesidad y Nutricion, Spain
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Ang M, Wong W, Park J, Wu R, Lavanya R, Zheng Y, Cajucom-Uy H, Tai ES, Wong TY. Corneal arcus is a sign of cardiovascular disease, even in low-risk persons. Am J Ophthalmol 2011; 152:864-71.e1. [PMID: 21742308 DOI: 10.1016/j.ajo.2011.04.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Revised: 04/02/2011] [Accepted: 04/06/2011] [Indexed: 11/28/2022]
Abstract
PURPOSE To examine the association of corneal arcus to cardiovascular disease (CVD) in an adult, ethnic Indian population. DESIGN Population-based cross-sectional study. METHODS Population-based study of ethnic South Asian Indians 40 to 80 years of age in Singapore from June 2007 through March 2009. We obtained a 75.5% response rate (3397/4497). All participants underwent standardized interview and systemic and ocular examinations, followed by nonfasting blood sampling. Corneal arcus was detected using a standardized slit-lamp examination. The main outcome measure was CVD, defined from a self-reported history of previous myocardial infarction, angina, or stroke. RESULTS Corneal arcus, found in 1701 (50.1%) of 3397 participants, was associated with older age (odds ratio [OR], 3.07; 95% CI, 2.78 to 3.40; P < .001), male gender (OR, 2.17; 95% CI, 1.81 to 2.62; P < .001), higher levels of total cholesterol (OR, 1.14; 95% CI, 1.05 to 1.24; P = .002), hypertension (OR, 1.14; 95% CI, 1.05 to 1.24; P = .013), and cigarette smoking (OR, 1.59; 95% CI, 1.25 to 2.03; P < .001). Corneal arcus was associated with CVD (OR, 1.31; 95% CI, 1.02 to 1.7; P = .0038) independent of the above-named cardiovascular risk factors. Participants with low-risk Framingham scores were more likely to be associated with CVD if they had corneal arcus (men: OR, 2.02; 95% CI, 1.20 to 3.40; P = .008; women: OR, 2.78; 95% CI, 1.36 to 3.01; P < .001). Corneal arcus was associated with CVD independent of the Framingham score (men: Akaike information criterion, 1524.39 for Framingham Score and corneal arcus vs 1527.38 for Framingham Score alone; women: 1000.14 vs 1003.54, respectively). CONCLUSIONS Corneal arcus is associated with CVD, independent of risk factors in ethnic Indian adults, even in those at low risk for vascular disease.
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Affiliation(s)
- Marcus Ang
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
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Christoffersen M, Frikke-Schmidt R, Schnohr P, Jensen GB, Nordestgaard BG, Tybjærg-Hansen A. Xanthelasmata, arcus corneae, and ischaemic vascular disease and death in general population: prospective cohort study. BMJ 2011; 343:d5497. [PMID: 21920887 PMCID: PMC3174271 DOI: 10.1136/bmj.d5497] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To test the hypothesis that xanthelasmata and arcus corneae, individually and combined, predict risk of ischaemic vascular disease and death in the general population. DESIGN Prospective population based cohort study. SETTING The Copenhagen City Heart Study. PARTICIPANTS 12,745 people aged 20-93 years free of ischaemic vascular disease at baseline and followed from 1976-8 until May 2009 with 100% complete follow-up. MAIN OUTCOME MEASURES Hazard ratios for myocardial infarction, ischaemic heart disease, ischaemic stroke, ischaemic cerebrovascular disease, and death; odds ratios for severe atherosclerosis. RESULTS 563 (4.4%) of participants had xanthelasmata and 3159 (24.8%) had arcus corneae at baseline. During 33 years' follow-up (mean 22 years), 1872 developed myocardial infarction, 3699 developed ischaemic heart disease, 1498 developed ischaemic stroke, 1815 developed ischaemic cerebrovascular disease, and 8507 died. Multifactorially adjusted hazard/odds ratios for people with versus those without xanthelasmata were 1.48 (95% confidence interval 1.23 to 1.79) for myocardial infarction, 1.39 (1.20 to 1.60) for ischaemic heart disease, 0.94 (0.73 to 1.21) for ischaemic stroke, 0.91 (0.72 to 1.15) for ischaemic cerebrovascular disease, 1.69 (1.03 to 2.79) for severe atherosclerosis, and 1.14 (1.04 to 1.26) for death. The corresponding hazard/odds ratios for people with versus those without arcus corneae were non-significant. In people with versus those without both xanthelasmata and arcus corneae, hazard/odds ratios were 1.47 (1.09 to 1.99) for myocardial infarction, 1.56 (1.25 to 1.94) for ischaemic heart disease, 0.87 (0.57 to 1.31) for ischaemic stroke, 0.86 (0.58 to 1.26) for ischaemic cerebrovascular disease, 2.75 (0.75 to 10.1) for severe atherosclerosis, and 1.09 (0.93 to 1.28) for death. In all age groups in both women and men, absolute 10 year risk of myocardial infarction, ischaemic heart disease, and death increased in the presence of xanthelasmata. The highest absolute 10 year risks of ischaemic heart disease of 53% and 41% were found in men aged 70-79 years with and without xanthelasmata. Corresponding values in women were 35% and 27%. CONCLUSION Xanthelasmata predict risk of myocardial infarction, ischaemic heart disease, severe atherosclerosis, and death in the general population, independently of well known cardiovascular risk factors, including plasma cholesterol and triglyceride concentrations. In contrast, arcus corneae is not an important independent predictor of risk.
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Affiliation(s)
- Mette Christoffersen
- Department of Clinical Biochemistry, Rigshospitalet, DK-2100 Copenhagen, Denmark
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Cardiovascular risk factors, inflammation, and corneal arcus: the singapore malay eye study. Am J Ophthalmol 2010; 150:581-587.e1. [PMID: 20630492 DOI: 10.1016/j.ajo.2010.04.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2009] [Revised: 04/22/2010] [Accepted: 04/27/2010] [Indexed: 11/23/2022]
Abstract
PURPOSE To examine the relationship of corneal arcus with cardiovascular risk factors and inflammation in Malay adults living in Singapore. DESIGN Population-based cross-sectional study. METHODS A total of 3280 Malays aged 40-80 years (out of 4168 eligible participants; 78.7% response rate) had a standardized interview, systemic and ocular examinations, and laboratory investigations, including measurement of C-reactive protein (CRP), chronic kidney disease, and peripheral artery disease. Corneal arcus was defined from anterior segment images taken with a slit-lamp camera. RESULTS Corneal arcus was seen in 2345 out of 3260 participants who had anterior segment images (73.2%). After adjustment for age, gender, total cholesterol, serum glucose, and current smoking, many cardiovascular risk factors significantly associated with corneal arcus, including male gender (odds ratio [OR] 1.65, 95% confidence interval [CI] 1.27-2.03), older age (per 10 years, OR 4.49, 95% CI 3.91-5.15), higher body mass index (per kg/m(2), OR 1.02, 95% CI 1.00-1.04), higher levels of CRP (per 10 mg/L, OR 1.36, 95% CI 1.13-1.64), total cholesterol (per mmol/L, OR 1.21, 95% CI 1.11-1.32), low-density lipoprotein cholesterol (per mmol/L, OR 1.94, 95% CI 1.38-2.74), presence of peripheral artery disease (OR 3.85, 95% CI 1.29-11.5), chronic kidney disease (OR 1.14, 95% CI 1.03-1.38), and current smoking (OR 1.29, 95% CI 1.02-1.69). CONCLUSIONS This study confirms known associations of traditional cardiovascular risk factors with corneal arcus in an Asian population. Additionally, corneal arcus may be associated with systemic inflammatory markers, peripheral artery disease, and chronic kidney disease.
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Dwivedi S, Jhamb R. Cutaneous markers of coronary artery disease. World J Cardiol 2010; 2:262-9. [PMID: 21160602 PMCID: PMC2998827 DOI: 10.4330/wjc.v2.i9.262] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Revised: 08/20/2010] [Accepted: 08/27/2010] [Indexed: 02/06/2023] Open
Abstract
Coronary artery disease (CAD) is rapidly increasing in prevalence across the world and particularly in south Asians at a relatively younger age. As atherosclerosis starts in early childhood, the process of risk evaluation must start quite early. The present review addresses the issue of cutaneous markers associated with atherosclerosis, and the strengths and weaknesses of the markers in identifying early coronary atherosclerosis. A diligent search for such clinical markers, namely xanthelasma, xanthoma, arcus juvenilis, acanthosis nigricans, skin tags, ear lobe crease, nicotine stains, premature graying in smokers, hyperpigmented hands in betel quid sellers, central obesity, and signs of peripheral vascular disease may prove to be a rewarding exercise in identifying asymptomatic CAD in high risk individuals.
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Affiliation(s)
- Shridhar Dwivedi
- Shridhar Dwivedi, Rajat Jhamb, Department of Medicine/Preventive Cardiology, University College of Medical Sciences, University of Delhi and G.T.B. Hospital, Delhi 110095, India
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Affiliation(s)
- Scott A Read
- Contact Lens and Visual Optics Laboratory, School of Optometry, Queensland University of Technology, Brisbane, Queensland, Australia.
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Zech LA, Hoeg JM. Correlating corneal arcus with atherosclerosis in familial hypercholesterolemia. Lipids Health Dis 2008; 7:7. [PMID: 18331643 PMCID: PMC2279133 DOI: 10.1186/1476-511x-7-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2007] [Accepted: 03/10/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A relationship between corneal arcus and atherosclerosis has long been suspected but is controversial. The homozygous familial hypercholesterolemia patients in this study present a unique opportunity to assess this issue. They have both advanced atherosclerosis and corneal arcus. METHODS This is a cross-sectional study of 17 patients homozygous for familial hypercholesterolemia presenting to the Clinical Center of the National Institutes of Health. Plasma lipoproteins, circumferential extent of arcus, thoracic aorta and coronary calcific atherosclerosis score, and Achilles tendon width were measured at the National Institutes of Health. RESULTS Patients with corneal arcus had higher scores for calcific atherosclerosis (mean 2865 compared to 412), cholesterol-year score (mean 11830 mg-yr/dl compared to 5707 mg-yr/dl), and Achilles tendon width (mean 2.54 cm compared to 1.41 cm) than those without. Corneal arcus and Achilles tendon width were strongly correlated and predictive of each other. Although corneal arcus was correlated with calcific atherosclerosis (r = 0.67; p = 0.004), it was not as highly correlated as was the Achilles tendon width (r = 0.855; p < 0.001). CONCLUSION Corneal arcus reflects widespread tissue lipid deposition and is correlated with both calcific atherosclerosis and xanthomatosis in these patients. Patients with more severe arcus tend to have more severe calcific atherosclerosis. Corneal arcus is not as good an indicator of calcific atherosclerosis as Achilles tendon thickness, but its presence suggests increased atherosclerosis in these hypercholesterolemic patients.
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Affiliation(s)
- Loren A Zech
- Molecular Disease Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Building 10/Room 7N115, 10 Center Drive MSC 1666, Bethesda, MD 20892, USA
- College of Medicine, University of Illinois at Urbana-Champaign, 190 Medical Sciences Building, 506 South Mathews Ave, Urbana, IL 61801, USA
| | - Jeffery M Hoeg
- Molecular Disease Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Building 10/Room 7N115, 10 Center Drive MSC 1666, Bethesda, MD 20892, USA
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