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Puri R, Bansal M, Mehta V, Duell PB, Wong ND, Iyengar SS, Kalra D, Nair DR, Nanda NC, Narula J, Deedwania P, Yusuf J, Dalal JJ, Shetty S, Vijan VM, Agarwala R, Kumar S, Vijay K, Khan A, Wander GS, Manoria PC, Wangnoo SK, Mohan V, Joshi SR, Singh B, Kerkar P, Rajput R, Prabhakar D, Zargar AH, Saboo B, Kasliwal RR, Ray S, Bansal S, Rabbani MU, Chhabra ST, Chandra S, Bardoloi N, Kavalipati N, Sathyamurthy I, Mahajan K, Pradhan A, Khanna NN, Khadgawat R, Gupta P, Chag MC, Gupta A, Murugnathan A, Narasingan SN, Upadhyaya S, Mittal V, Melinkeri RP, Yadav M, Mubarak MR, Pareek KK, Dabla PK, Nanda R, Mohan JC. Lipid Association of India 2023 update on cardiovascular risk assessment and lipid management in Indian patients: Consensus statement IV. J Clin Lipidol 2024; 18:e351-e373. [PMID: 38485619 DOI: 10.1016/j.jacl.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/16/2024] [Accepted: 01/25/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVE In 2016, the Lipid Association of India (LAI) developed a cardiovascular risk assessment algorithm and defined low-density lipoprotein cholesterol (LDL-C) goals for prevention of atherosclerotic cardiovascular disease (ASCVD) in Indians. The recent refinements in the role of various risk factors and subclinical atherosclerosis in prediction of ASCVD risk necessitated updating the risk algorithm and treatment goals. METHODS The LAI core committee held twenty-one meetings and webinars from June 2022 to July 2023 with experts across India and critically reviewed the latest evidence regarding the strategies for ASCVD risk prediction and the benefits and modalities for intensive lipid lowering. Based on the expert consensus and extensive review of published data, consensus statement IV was commissioned. RESULTS The young age of onset and a more aggressive nature of ASCVD in Indians necessitates emphasis on lifetime ASCVD risk instead of the conventional 10-year risk. It also demands early institution of aggressive preventive measures to protect the young population prior to development of ASCVD events. Wide availability and low cost of statins in India enable implementation of effective LDL-C-lowering therapy in individuals at high risk of ASCVD. Subjects with any evidence of subclinical atherosclerosis are likely to benefit the most from early aggressive interventions. CONCLUSIONS This document presents the updated risk stratification and treatment algorithm and describes the rationale for each modification. The intent of these updated recommendations is to modernize management of dyslipidemia in Indian patients with the goal of reducing the epidemic of ASCVD among Indians in Asia and worldwide.
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Affiliation(s)
- Raman Puri
- Chair, FNLA, Sr. Consultant Cardiologist, Cardiac Care Centre, New Delhi, India (Dr Puri).
| | - Manish Bansal
- Co-Chair, Senior Director, Department of Cardiology, Medanta- The Medicity, Gurugram, Haryana, India (Dr Bansal)
| | - Vimal Mehta
- Co-Chair, Director-Professor, Department of Cardiology, G. B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India (Dr Mehta)
| | - P Barton Duell
- Co-Chair, FNLA, Professor of Medicine, Knight Cardiovascular Institute and Division of Endocrinology Diabetes and Clinical Nutrition, Oregon Health & Science University, Portland, OR, USA (Dr Duell)
| | - Nathan D Wong
- FNLA, Professor & Director Heart Disease Prevention program division of Cardiology, University of California, Irvine School of Medicine, USA (Dr Wong)
| | - S S Iyengar
- Sr. Consultant and Head, Department of Cardiology, Manipal Hospital, Bangalore, Karnataka, India (Dr Iyengar)
| | - Dinesh Kalra
- FNLA, Professor of Medicine, University of Louisville School of Medicine, USA (Dr Kalra)
| | - Devaki R Nair
- Sr. Consultant Department of Lipidology and Chemical pathologist, Royal Free Hospital, London, UK (Dr Nair)
| | - Navin C Nanda
- Professor of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, KY, USA (Dr Nanda)
| | - Jagat Narula
- Executive Vice President and Chief Academic Officer, UT Health, Houston, TX USA (Dr Narula)
| | - P Deedwania
- Professor of Medicine, University of California San Francisco, San Francisco, CA, USA (Dr Deedwania)
| | - Jamal Yusuf
- Director-Professor and Head, Department of Cardiology, G. B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India (Dr Yusuf)
| | - Jamshed J Dalal
- Sr. Consultant Cardiologist, Kokilaben Dhirubhai Ambani Hospital, Director-Centre for Cardiac Sciences, Mumbai, Maharashtra, India (Dr Dalal)
| | - Sadanand Shetty
- Head, Department of Cardiology, K. J. Somaiya Super Specialty Institute, Sion (East), Mumbai, Maharashtra, India (Dr Shetty)
| | - Vinod M Vijan
- Director, Vijan Hospital & Research Centre, Nashik, Uniqare Hospital, PCMC, Pune, India (Dr Vijan)
| | - Rajeev Agarwala
- Sr. Consultant Cardiologist, Jaswant Rai Specialty Hospital, Meerut, Uttar Pradesh, India (Dr Agarwala)
| | - Soumitra Kumar
- Professor and Head, Department of Cardiology, Vivekananda Institute of Medical Sciences, Kolkata, India (Dr Kumar)
| | - Kris Vijay
- FNLA, Professor of Medicine, Arizona Heart Foundation, University of Arizona, Phoenix, USA (Dr Vijay)
| | - Aziz Khan
- Sr. Consultant cardiologist, Crescent Hospital and Heart Centre, Nagpur, Maharashtra, India (Dr Khan)
| | - Gurpreet Singh Wander
- Professor of Cardiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India (Dr Wander)
| | - P C Manoria
- Director, Manoria Heart and critical Care Hospital, Bhopal, Madhya Pradesh, India (Dr Manoria)
| | - S K Wangnoo
- Sr. Consultant Endocrinology & Diabetologist, Indraprastha Apollo Hospitals, New Delhi, India (Dr Wangnoo)
| | - Viswanathan Mohan
- Director Madras Diabetic Research foundation and Chairman & chief Diabetology, Dr Mohan Diabetes Specialties Centre, Chennai, India (Dr Mohan)
| | - Shashank R Joshi
- Sr. Consultant Endocrinologist, Lilavati Hospital, Mumbai, Maharashtra, India (Dr Joshi)
| | - Balbir Singh
- Chairman - Cardiac Sciences, Max Hospital Saket, New Delhi, India (Dr Singh)
| | - Prafulla Kerkar
- Sr. Consultant Cardiologist, Asian Heart Institute and Research Centre, Mumbai, India (Dr Kerkar)
| | - Rajesh Rajput
- Professor & Head, Department of Endocrinology, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India (Dr Rajput)
| | - D Prabhakar
- Sr. Consultant, Department of Cardiology, Apollo Hospitals, Chennai, Tamil Nadu, India (Dr Prabhakar)
| | - Abdul Hamid Zargar
- Medical Director, Centre for Diabetes and Endocrine Care, National Highway, Gulshan Nagar, Srinagar, J&K, India (Dr Zargar)
| | - Banshi Saboo
- Chairman-Diacare- Diabetes Care, and Hormone Clinic, Ahmedabad, India (Dr Saboo)
| | - Ravi R Kasliwal
- Chairman, Division of Clinical & Preventive Cardiology, Medanta- The Medicity, Gurugram, Haryana, India (Dr Kasliwal)
| | - Saumitra Ray
- Director of Intervention Cardiology, AMRI (S), Kolkata, India (Dr Ray)
| | - Sandeep Bansal
- Professor and Head, Dept. of Cardiology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India (Dr Bansal)
| | - M U Rabbani
- Professor Dept. of Cardiology, J. N. Medical College, AMU, Aligarh, India (Dr Rabbani)
| | - Shibba Takkar Chhabra
- Professor Dept. of Cardiology, Dayanand Medical College and Hospital, Ludhiana, India (Dr Chhabra)
| | - Sarat Chandra
- Chief Cardiologist, TX Group of Hospitals, Banjara Hills, Hyderabad, India (Dr Chandra)
| | - Neil Bardoloi
- Managing Director and HOD, Cardiology, Excel Care Hospital, Guwahati, Assam, India (Dr Bardoloi)
| | - Narasaraju Kavalipati
- Director of Cardiology and Sr Interventional Cardiologist, Apollo Hospitals, Hyderabad, India (Dr Kavalipati)
| | - Immaneni Sathyamurthy
- Sr. Consultant Cardiologist, Apollo Hospital, Chennai, Tamil Nadu, India (Dr Sathyamurthy)
| | - Kunal Mahajan
- Director Dept. of Cardiology, Himachal Heart Institute, Mandi, Himachal Pradesh, India (Dr Mahajan)
| | - Akshya Pradhan
- Sr. Consultant, Department of Cardiology King George's Medical University, Lucknow, Uttar Pradesh, India (Dr Pradhan)
| | - N N Khanna
- Sr. Consultant, Department of Cardiology, Indraprastha Apollo Hospitals, New Delhi, India (Dr Khanna)
| | - Rajesh Khadgawat
- Professor, Department of Endocrinology and Metabolism, All India Institute of Medical Sciences (AIIMS), New Delhi, India (Dr Khadgawat)
| | - Preeti Gupta
- Associate Professor Dept. of Cardiology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India (Dr Gupta)
| | - Milan C Chag
- Sr. Consultant Cardiologist, Marengo CIMS Hospital, Ahmadabad, Gujarat, India (Dr Chag)
| | - Ashu Gupta
- Sr Consultant Cardiologist, Holy Heart Advanced Cardiac Care and Research Centre, Rohtak, Haryana, India (Dr Gupta)
| | - A Murugnathan
- Sr. Consultant Internal Medicine, AG Hospital, Tirupur, Tamil Nadu, India (Dr Murugnathan)
| | - S N Narasingan
- Former Adjunct Professor of Medicine, The Tamil Nadu Dr MGR Medical University & Managing Director, SNN Specialties Clinic, Chennai, India (Dr Narasingan)
| | - Sundeep Upadhyaya
- Sr. Consultant, Department of Rheumatology, Indraprastha Apollo Hospitals, New Delhi, India (Dr Upadhyaya)
| | - Vinod Mittal
- Sr. Consultant Diabetologist and Head, Centre for Diabetes & Metabolic disease Delhi Heart & Lung Institute, Delhi, India (Dr Mittal)
| | - Rashida Patanwala Melinkeri
- Sr. Consultant, Department of Internal Medicine, KEM Hospital and Sahyadri Hospitals, Pune, Maharashtra, India (Dr Melinkeri)
| | - Madhur Yadav
- Director- Professor of Medicine, Lady Harding Medical College, New Delhi, India (Dr Yadav)
| | - M Raseed Mubarak
- Sr. Consultant Cardiologist, Lanka Hospital, Colombo, Sri Lanka (Dr Mubarak)
| | - K K Pareek
- Head, Department of Medicine, S. N. Pareek Hospital, Dadabari, Kota, Rajasthan, India (Dr Pareek)
| | - Pradeep Kumar Dabla
- Professor of Biochemistry, G. B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India (Dr Dabla)
| | - Rashmi Nanda
- Managing Director, Ashakiran Family Wellness Clinic, Indrapuram, U.P, India (Dr Nanda)
| | - J C Mohan
- Sr. Consultant Cardiologist, Institute of Heart and Vascular Diseases, Jaipur Golden Hospital, New Delhi, India (Dr Mohan)
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Botto F, Obregon S, Forcada P, Di Leva A, Fischer Sohn G, Bang JH, Koretzky M, Baratta S, Kotliar C. Prevalence and Burden of Carotid and Femoral Atherosclerosis in Subjects Without Known Cardiovascular Disease in a Large Community Hospital in South-America. High Blood Press Cardiovasc Prev 2024; 31:177-187. [PMID: 38436891 DOI: 10.1007/s40292-024-00627-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 01/22/2024] [Indexed: 03/05/2024] Open
Abstract
INTRODUCTION Clinical guidelines recommend measurement of arterial (carotid and femoral) plaque burden by vascular ultrasound (VUS) as a risk modifier in individuals at low or moderate risk without known atherosclerotic cardiovascular disease (ASCVD). AIM To evaluate the prevalence of carotid and femoral plaques by age and sex, the burden of subclinical atherosclerosis (SA), and its association with classic CVRF in subjects over 30 years of age without ASCVD. METHODS We prospectively enrolled 5775 consecutive subjects referred for cardiovascular evaluation and determined the prevalence and burden of SA using 2D-VUS in carotid and femoral arteries. RESULTS Sixty-one percent were men with a mean age of 51.3 (SD 10.6) years. Overall, plaque prevalence was 51% in carotid arteries, 39.3% in femoral arteries, 62.4% in carotid or femoral arteries, and 37.6% in neither. The prevalence of plaques and SA burden showed an increasing trend with age, being higher in men than in women and starting before the age of 40, both in the carotid and femoral sites. There was also an increasing prevalence of plaques according to the number of CVRF, and interestingly we found a high prevalence of plaques in subjects with 0 or 1 classic CVRF. CONCLUSIONS We observed an increased prevalence and burden of carotid or femoral SA, higher in men, beginning before the fourth decade of life and increasing with age. Despite a significant association with classic CVRF, a significant number of subjects with low CVRF were diagnosed with SA.
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Affiliation(s)
- Fernando Botto
- Clinical Research Unit, Instituto Cardiovascular de Buenos Aires (ICBA), Av del Libertador 6302, Buenos Aires, Argentina.
- Hypertension and Vascular Ageing Unit, Hospital Universitario Austral, Pilar, Buenos Aires, Argentina.
| | - Sebastian Obregon
- Hypertension and Vascular Ageing Unit, Hospital Universitario Austral, Pilar, Buenos Aires, Argentina
| | - Pedro Forcada
- Hypertension and Vascular Ageing Unit, Hospital Universitario Austral, Pilar, Buenos Aires, Argentina
| | - Ana Di Leva
- Hypertension and Vascular Ageing Unit, Hospital Universitario Austral, Pilar, Buenos Aires, Argentina
| | - Gabriela Fischer Sohn
- Hypertension and Vascular Ageing Unit, Hospital Universitario Austral, Pilar, Buenos Aires, Argentina
| | - Joon-Ho Bang
- Hypertension and Vascular Ageing Unit, Hospital Universitario Austral, Pilar, Buenos Aires, Argentina
| | - Martin Koretzky
- Hypertension and Vascular Ageing Unit, Hospital Universitario Austral, Pilar, Buenos Aires, Argentina
| | - Sergio Baratta
- Hypertension and Vascular Ageing Unit, Hospital Universitario Austral, Pilar, Buenos Aires, Argentina
| | - Carol Kotliar
- Hypertension and Vascular Ageing Unit, Hospital Universitario Austral, Pilar, Buenos Aires, Argentina
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Chen D, Zhao Z, Liu P, Liu X, Wang X, Ren Q, Chang B. Adventitial Vasa Vasorum Neovascularization in Femoral Artery of Type 2 Diabetic Patients with Macroangiopathy Is Associated with Macrophages and Lymphocytes as well as the Occurrence of Cardiovascular Events. Thromb Haemost 2023; 123:989-998. [PMID: 37037199 DOI: 10.1055/s-0043-1768162] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
OBJECTIVES This study was conducted to assess the relationship between adventitial vasa vasorum neovascularization (VVn) in femoral artery of type 2 diabetic patients with macroangiopathy and the recruitment of macrophages and lymphocytes, and to relate the density of VVn to the occurrence of cardiovascular events. MATERIALS Femoral artery samples were obtained from amputation cases. A total of 55 type 2 diabetic patients with macroangiopathy, 15 autopsy cases with type 2 diabetes without atherosclerosis. METHODS Hematoxylin and eosin (H&E) staining to observe the histopathological features; Victoria blue staining to analyze the histological features; immunohistochemistry (CD34, CD68, CD20, and CD3) to determine the VVn density and the expression of macrophages, B lymphocytes, and T lymphocytes. RESULTS Type 2 diabetic patients with macroangiopathy showed a higher mean adventitial VVn density in femoral artery (48.40 ± 9.39 no./mm2) than patients with type 2 diabetes without atherosclerosis (19.75 ± 6.28 no./mm2) (p < 0.01). In addition, the VVn density was positively associated with the expression of CD68 macrophages (r = 0.62, p < 0.01) and CD20 B lymphocytes (r = 0.59, p < 0.01). Type 2 diabetic patients with high VVn density showed more adverse cardiovascular events (27/35 vs. 8/20 events, p = 0.006). In multivariable analysis adjusted for main risk factors for cardiovascular disease, VVn was still independently associated with adverse cardiovascular events (p = 0.01). CONCLUSION VVn density in type 2 diabetic patients with macroangiopathy is positively correlated with the adventitial immune-inflammatory cell numbers and the development of atherosclerotic lesions. Furthermore, VVn density is associated with adverse cardiovascular events.
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Affiliation(s)
- Dong Chen
- Department of Oncology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, People's Republic of China
| | - Zixi Zhao
- NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, People's Republic of China
| | - Peng Liu
- Department of Surgery, Binhai New Area Hospital of Traditional Chinese Medicine, Tianjin, People's Republic of China
| | - Xinbang Liu
- NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, People's Republic of China
| | - Xin Wang
- School of Laboratory Medicine, Hubei University of Chinese Medicine, Wuhan, People's Republic of China
| | - Qiuyue Ren
- Department of Endocrinology, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, People's Republic of China
| | - Bai Chang
- NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, People's Republic of China
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Genkel VV, Kuznetsova AS, Lebedev EV, Salashenko AO, Shaposhnik II. Prognostic Significance of Carotid and Lower Extremity Artery Stenosis in Patients With High and Very High Cardiovascular Risk. KARDIOLOGIIA 2023; 63:38-44. [PMID: 37815138 DOI: 10.18087/cardio.2023.9.n1949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 02/04/2022] [Indexed: 10/11/2023]
Abstract
Aim To study prognostic significance of the degree of stenosis of carotid and lower-extremity arteries (LEA) in patients at high and very high risk of cardiovascular complications (CVC).Material and methods The study included men and women aged 40-67 years at high and very high risk of CVC. Duplex ultrasound scanning of carotid arteries and LEA was performed for all patients. Laboratory tests included measurements of glucose, glycated hemoglobin, total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides, uric acid, creatinine with estimation of glomerular filtration rate (GFR) using the CKD-EPI Creatinine Equation formula, and high-sensitivity C-reactive protein (hsCRP). Composite endpoint was death from CVC, nonfatal myocardial infarction, nonfatal stroke, and coronary revascularization.Results The study included 214 patients from groups of high and very high risk of CVC. Median age of patients was 59.0 [53.2; 64.0] years. A very high risk was identified in 141 (65.8 %) patients and a high risk of CVC in 73 (34.1 %). Atherosclerotic plaques in at least one vascular bed were found in 191 (89.3 %) patients. Duration of the follow-up period was 32.0 [13.7; 49.1] months. Outcomes comprising the composite endpoint were observed in 36 (16.8 %) patients. Presence of carotid stenosis ≥35 % was not statistically significantly associated with the occurrence of outcomes comprising the composite endpoint (relative risk, RR: 1.22; 95 % confidence interval, CI: 0.56-2.66; p=0.607). In contrast, the presence of LEA stenosis ≥35 % was associated with a 2.51 times increased RR of CVC (95 % CI: 1.02-6.23; p=0.044).Conclusion In patients from the groups of high risk and very high risk of CVC, the presence of LEA stenosis ≥35 % predicted the development of severe CVC with a 69.4% sensitivity and a 61.8% specificity. The presence of LEA stenosis ≥35 %, but not of carotid arteries, was an independent predictor of severe CVC (RR, 2.51; 95 % CI: 1.02-6.23; p=0.044) after adjustments for sex, age, presence of arterial hypertension, diabetes mellitus, ischemic heart disease, obesity, smoking, LDL-C, GFR, and drug therapy.
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Affiliation(s)
- V V Genkel
- South Ural State Medical University, Chelyabinsk
| | | | - E V Lebedev
- South Ural State Medical University, Chelyabinsk
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Del Giorno R, Reveilhac M, Stauffer I, Berthoud M, Mazzolai L, Depairon M, Darioli R. A new score for improving cardiovascular risk prediction and prevention. Nutr Metab Cardiovasc Dis 2023; 33:1546-1555. [PMID: 37270305 DOI: 10.1016/j.numecd.2023.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 04/24/2023] [Accepted: 04/26/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND AND AIMS The ultrasonographic detection of subclinical atherosclerosis (scATS) at carotid and femoral vascular sites using the atherosclerosis burden score (ABS) improves the risk stratification for atherosclerotic cardiovascular disease beyond traditional cardiovascular (CV) risk factors. However, its predictive value should be further enhanced. We hypothesize that combining the ABS and the Framingham risk score (FHRS) to create a new score called the FHRABS will improve CV risk prediction and prevention. We aim to investigate if incorporating the ABS into the FHRS improved CV risk prediction in a primary prevention setting. METHODS AND RESULTS 1024 patients were included in this prospective observational cohort study. Carotid and femoral plaques were ultra-sonographic detected. Major incident cardiovascular events (MACEs) were collected. The receiver operating characteristic curve (ROC-AUC) and Youden's index (Ysi) were used to compare the incremental contributions of each marker to predict MACEs. After a median follow-up of 6.0 ± 3.3 years, 60 primary MACEs (5.8%) occurred. The ROC-AUC for MACEs prediction was significantly higher for the FHRABS (0.74, p < 0.024) and for the ABS (0.71, p < 0.013) compared to the FHRS alone (0.71, p < 0.46). Ysi or the FHRABS (42%, p < 0.001) and ABS (37%, p < 0.001) than for the FHRS (31%). Cox proportional-hazard models showed that the CV predictive performance of FHRS was significantly enhanced by the ABS (10.8 vs. 5.5, p < 0.001) and FHRABS (HR 23.30 vs. 5.50, p < 0.001). CONCLUSIONS FHRABS is a useful score for improving CV risk stratification and detecting patients at high risk of future MACEs. FHRABS offers a simple-to-use, and radiation-free score with which to detect scATS in order to promote personalized CV prevention.
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Affiliation(s)
- Rosaria Del Giorno
- Division of Angiology, Heart and Vessel Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.
| | - Maud Reveilhac
- Institute of Social Sciences, University of Lausanne, Lausanne, Switzerland.
| | - Iris Stauffer
- Division of Angiology, Heart and Vessel Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.
| | - Maud Berthoud
- Division of Angiology, Heart and Vessel Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.
| | - Lucia Mazzolai
- Division of Angiology, Heart and Vessel Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.
| | - Michèle Depairon
- Division of Angiology, Heart and Vessel Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.
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Bermúdez-López M, Martí-Antonio M, Castro-Boqué E, Bretones MDM, Farràs C, Gonzalez J, Pamplona R, Lecube A, Mauricio D, Cambray S, Valdivielso JM, Fernández E. Cumulative tobacco consumption has a dose-dependent effect on atheromatosis burden and improves severe atheromatosis prediction in asymptomatic middle-aged individuals: The ILERVAS study. Atherosclerosis 2023; 375:75-83. [PMID: 37276714 DOI: 10.1016/j.atherosclerosis.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 04/26/2023] [Accepted: 05/01/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND AND AIMS Sex-specific impact of cumulative tobacco consumption (CTC) on atheromatosis extension and total plaque area remains unknown. We aimed to determine the impact of CTC in atheromatosis localization and burden. METHODS We performed a cross-sectional analysis in 8330 asymptomatic middle-aged individuals. 12-territory vascular ultrasounds in carotid and femoral arteries were performed to detect atheromatous plaque presence and to measure total plaque area. Adjusted regressions and conditional predictions by smoking habit or CTC (stratified in terciles as low (≤13.53), medium (13.54-29.3), and high (>29.3 packs-year)) were calculated. Severe atheromatosis (SA, ≥3 territories with atheroma plaque) was predicted with the Systematic COronary Risk Evaluation 2 (SCORE2) model. The improvement of SA prediction after adding CTC was evaluated. RESULTS CTC was associated with an increased risk of atheromatosis, stronger in femoral than in carotid artery, but similar in both sexes. A dose-dependent effect of CTC on the number of territories with atheroma plaque and total plaque area was observed. Addition of CTC to the SCORE2 showed a higher sensitivity, accuracy, and negative predictive value in males, and a higher specificity and positive predictive value in females. In both sexes, the new SCORE2-CTC model showed a significant increase in AUC (males: 0.033, females: 0.038), and in the integrated discrimination index (males: 0.072; females: 0.058, p < 0.001). Age and CTC were the most important clinical predictors of SA in both sexes. CONCLUSIONS CTC shows a dose-dependent association with atheromatosis burden, impacts more strongly in femoral arteries, and improves SA prediction.
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Affiliation(s)
- Marcelino Bermúdez-López
- Grupo de Investigación Translacional vascular y Renal, IRBLleida, Red de Investigación Renal (RedInRen. ISCIII), Lleida, Spain.
| | - Manuel Martí-Antonio
- Grupo de Investigación Translacional vascular y Renal, IRBLleida, Red de Investigación Renal (RedInRen. ISCIII), Lleida, Spain
| | - Eva Castro-Boqué
- Grupo de Investigación Translacional vascular y Renal, IRBLleida, Red de Investigación Renal (RedInRen. ISCIII), Lleida, Spain
| | - María Del Mar Bretones
- Grupo de Investigación Translacional vascular y Renal, IRBLleida, Red de Investigación Renal (RedInRen. ISCIII), Lleida, Spain
| | - Cristina Farràs
- Centre d'Atenció Primària Cappont. Gerència Territorial de Lleida, Institut Català de la Salut, Barcelona, Spain; Research Support Unit Lleida, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gorina (IDIAPJGol), Barcelona, Spain
| | - Jessica Gonzalez
- Departament de Medicina Respiratòria, Hospital Universitari Arnau de Vilanova, Grup Recerca Translational Medicina Respiratòria, IRBLleida, Universitat de Lleida, Lleida, Spain; CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain
| | - Reinald Pamplona
- Departament de Medicina Experimental, IRBLleida, Universitat de Lleida, Lleida, Spain
| | - Albert Lecube
- Departament d'Endocrinologia i Nutrició, Hospital Universitari Arnau de Vilanova, Grup de Recerca Obesitat i Metabolisme (ODIM), IRBLleida, Universitat de Lleida, Lleida, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Dídac Mauricio
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Departament d'Endocrinologia i Nutrició, Hospital de la Santa Creu i Sant Pau, Institut de Recerca Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain; Faculty of Medicine, University of Vic & Central University of Vic, Vic, Spain
| | - Serafi Cambray
- Grupo de Investigación Translacional vascular y Renal, IRBLleida, Red de Investigación Renal (RedInRen. ISCIII), Lleida, Spain
| | - José Manuel Valdivielso
- Grupo de Investigación Translacional vascular y Renal, IRBLleida, Red de Investigación Renal (RedInRen. ISCIII), Lleida, Spain.
| | - Elvira Fernández
- Grupo de Investigación Translacional vascular y Renal, IRBLleida, Red de Investigación Renal (RedInRen. ISCIII), Lleida, Spain
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Parkkila K, Kesäniemi YA, Ukkola O. Comparing ultrasonographically assessed carotid and abdominal aorta plaques in cardiovascular disease risk estimation. BMC Cardiovasc Disord 2023; 23:245. [PMID: 37161438 PMCID: PMC10170739 DOI: 10.1186/s12872-023-03264-1] [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: 11/15/2022] [Accepted: 04/26/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Individual risk estimation is an essential part of cardiovascular (CV) disease prevention. Several imaging parameters have been studied for this purpose. Based on mounting evidence, international guidelines recommend the ultrasound assessment of carotid artery plaques to refine individual risk estimation. Previous studies have not compared carotid artery and abdominal aorta plaques in CV risk estimation. Our aim was to explore this matter in a prospective study setting. METHODS Participants were part of the Oulu Project Elucidating Risk of Atherosclerosis (OPERA) project. All participants (n = 1007, 50% males, aged 51.3 ± 6.0 years) were clinically examined in the beginning of 1990's and followed until the end 2014 for fatal and non-fatal CV events. RESULTS During a median follow-up of 22.5 (17.5-23.2) years, 246 (24%) participants suffered a CV event and 79 (32%) of those CV events were fatal. When compared to those without plaques, both carotid (hazard ratio, HR 2.854 [95% confidence interval, CI, 2.188-3.721, p < 0.001) and abdominal aorta plaques (HR 2.534 [1.503-4.274], p < 0.001) were major risk factors for CV events as an aggregate endpoint. These associations remained even after adjusting the multivariable models with age, sex, systolic blood pressure, smoking, diabetes, LDL cholesterol, and with previous CV events (coronary artery disease and stroke/transient ischemic attack). However, only carotid plaques were significant risk factors for fatal CV events: multivariable adjusted HR 2.563 (1.452-4.524), p = 0.001. Furthermore, reclassification and discrimination parameters were improved only when carotid plaques were added to a baseline risk model. Adding abdominal aorta plaques to the baseline risk model improved C-statistic from 0.718 (0.684-0.751) to 0.721 (0.688-0.754) whereas carotid plaques improved it to 0.743 (0.710-0.776). CONCLUSIONS Both carotid and abdominal aorta plaques are significant risk factors for CV events, but only carotid plaques provide prognostic information beyond traditional CV risk factors on fatal CV events. If one ultrasound parameter for plaque detection and CV risk estimation had to be chosen, carotid plaques may be preferred over abdominal aorta.
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Affiliation(s)
- Karri Parkkila
- Medical Research Center Oulu, Research Unit of Internal Medicine, Oulu University Hospital, University of Oulu, Oulu, Finland.
| | - Y Antero Kesäniemi
- Medical Research Center Oulu, Research Unit of Internal Medicine, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Olavi Ukkola
- Medical Research Center Oulu, Research Unit of Internal Medicine, Oulu University Hospital, University of Oulu, Oulu, Finland
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8
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Tomey MI, Camaj A, Kini AS, Sharma SK. Aortic Valvuloplasty and Large‐Bore Percutaneous Arterial Access. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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9
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New 3-Dimensional Volumetric Ultrasound Method for Accurate Quantification of Atherosclerotic Plaque Volume. JACC Cardiovasc Imaging 2022; 15:1124-1135. [PMID: 35680220 DOI: 10.1016/j.jcmg.2022.01.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 01/01/2022] [Accepted: 01/06/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Carotid and femoral plaque burden is a recognized biomarker of cardiovascular disease risk. A new electronic-sweep 3-dimensional (3D)-matrix transducer method can improve the functionality and image quality of vascular ultrasound atherosclerosis imaging. OBJECTIVES This study aimed to validate this method for plaque volume measurement in early and intermediate-advanced plaques in the carotid and femoral territories. METHODS Plaque volumes were measured ex vivo in pig carotid and femoral artery specimens by 3-dimensional vascular ultrasound (3DVUS) using a 3D-matrix (electronic-sweep) transducer and its associated 3D plaque quantification software, and were compared with gold-standard histology. To test the clinical feasibility and accuracy of the 3D-matrix transducer, an experiment was conducted in intermediate-high risk individuals with carotid and femoral atherosclerosis. The results were compared with those obtained using the previously validated mechanical-sweep 3D transducer and established 2-dimensional (2D)-based plaque quantification software. RESULTS In the ex vivo study, the authors assessed 19 atherosclerotic plaques (plaque volume, 0.76 µL-56.30 μL), finding strong agreement between measurements with the 3D-matrix transducer and the histological gold-standard (intraclass correlation coefficient [ICC]: 0.992; [95% CI: 0.978-0.997]). In the clinical analysis of 20 patients (mean age 74.6 ± 4.45 years; 40% men), the authors found 64 (36 carotid and 28 femoral) of 80 scanned territories with atherosclerosis (measured atherosclerotic volume, 10 μL-859 μL). There was strong agreement between measurements made from electronic-sweep and mechanical-sweep 3DVUS transducers (ICC: 0.997 [95% CI: 0.995-0.998]). Agreement was also high between plaque volumes estimated by the 2D and 3D plaque quantification software applications (ICC: 0.999 [95% CI: 0.998-0.999]). Analysis time was significantly shorter with the 3D plaque quantification software than with the 2D multislice approach with a mean time reduction of 46%. CONCLUSIONS 3DVUS using new matrix transducer technology, together with improved 3D plaque quantification software, simplifies the accurate volume measurement of early (small) and intermediate-advanced plaques located in carotid and femoral arteries.
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10
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Arterial Ultrasound Testing to Predict Atherosclerotic Cardiovascular Events. J Am Coll Cardiol 2022; 79:1969-1982. [PMID: 35589158 DOI: 10.1016/j.jacc.2022.03.352] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Studies have indicated that the presence and size of subclinical atherosclerotic plaques improve the prediction of atherosclerotic cardiovascular events (ASCVE) over and above that provided by conventional risk factors alone. However, the relative contribution of different ultrasonographic measurements and sites of measurements on the 10-year ASCVD risk is largely unknown. OBJECTIVES Our aims were to determine the relative performance of carotid intima-media thickness, plaque thickness, and plaque area in 10-year ASCVD prediction when added to conventional risk factors as well as whether the vascular territory of these measurements, carotid or common femoral bifurcation, and the number of bifurcations with plaque (NBP) influence prediction. METHODS We enrolled 985 adults (mean age: 58.1 ± 10.2 years) free of atherosclerotic cardiovascular disease. Conventional risk factors were recorded, and both carotid and common femoral bifurcations were scanned with ultrasonography. The primary endpoint was a composite of first-time fatal or nonfatal ASCVE. RESULTS Over a mean ± SD follow-up of 13.2 ± 3.7 years, ASCVE occurred in 154 (15.6%) participants. By adding different plaque measurements to conventional risk factors in a Cox model, net reclassification improvement was 10.4% with maximum intima-media thickness, 9.5% with carotid plaque thickness, and 14.2% with carotid plaque area. It increased to 16.1%, 16.6%, and 16.6% (P < 0.0001) by adding measurements from 4 bifurcations: NBP, total plaque thickness, and total plaque area, respectively. CONCLUSIONS NBP, total plaque thickness, or total plaque area from both the carotid and common femoral bifurcations provides a better prediction of future ASCVE than measurements from a single site. The results need to be validated in an independent cohort.
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11
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Unbiased plasma proteomics discovery of biomarkers for improved detection of subclinical atherosclerosis. EBioMedicine 2022; 76:103874. [PMID: 35152150 PMCID: PMC8844841 DOI: 10.1016/j.ebiom.2022.103874] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/14/2022] [Accepted: 01/25/2022] [Indexed: 01/21/2023] Open
Abstract
Background Imaging of subclinical atherosclerosis improves cardiovascular risk prediction on top of traditional risk factors. However, cardiovascular imaging is not universally available. This work aims to identify circulating proteins that could predict subclinical atherosclerosis. Methods Hypothesis-free proteomics was used to analyze plasma from 444 subjects from PESA cohort study (222 with extensive atherosclerosis on imaging, and 222 matched controls) at two timepoints (three years apart) for discovery, and from 350 subjects from AWHS cohort study (175 subjects with extensive atherosclerosis on imaging and 175 matched controls) for external validation. A selected three-protein panel was further validated by immunoturbidimetry in the AWHS population and in 2999 subjects from ILERVAS cohort study. Findings PIGR, IGHA2, APOA, HPT and HEP2 were associated with subclinical atherosclerosis independently from traditional risk factors at both timepoints in the discovery and validation cohorts. Multivariate analysis rendered a potential three-protein biomarker panel, including IGHA2, APOA and HPT. Immunoturbidimetry confirmed the independent associations of these three proteins with subclinical atherosclerosis in AWHS and ILERVAS. A machine-learning model with these three proteins was able to predict subclinical atherosclerosis in ILERVAS (AUC [95%CI]:0.73 [0.70–0.74], p < 1 × 10−99), and also in the subpopulation of individuals with low cardiovascular risk according to FHS 10-year score (0.71 [0.69–0.73], p < 1 × 10−69). Interpretation Plasma levels of IGHA2, APOA and HPT are associated with subclinical atherosclerosis independently of traditional risk factors and offers potential to predict this disease. The panel could improve primary prevention strategies in areas where imaging is not available.
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12
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Bermúdez-López M, Martínez-Alonso M, Castro-Boqué E, Betriu À, Cambray S, Farràs C, Barbé F, Pamplona R, Lecube A, Mauricio D, Purroy F, Valdivielso JM, Fernández E. Localización y carga de ateromatosis subclínica en población con un riesgo cardiovascular bajo-moderado: estudio ILERVAS. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.09.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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13
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Wang IC, Huang H, Chang WT, Huang CC. Wall shear stress mapping for human femoral artery based on ultrafast ultrasound vector Doppler estimations. Med Phys 2021; 48:6755-6764. [PMID: 34525217 DOI: 10.1002/mp.15230] [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: 03/24/2021] [Revised: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Wall shear stress (WSS), a type of friction exerted on the artery wall by flowing blood, is considered a crucial factor in atherosclerotic plaque development. Currently, achieving a reliable WSS mapping of an artery noninvasively by using existing imaging modalities is still challenging. In this study, a WSS mapping based on vector Doppler flow velocity estimation was proposed to measure the dynamic WSS on the human femoral artery. METHODS Because ultrafast ultrasound imaging was used here, flow-enhanced imaging was also performed to observe the moving blood flow condition. The performance of WSS mapping was verified using both straight (8 mm in diameter) and stenosis (70% of stenosis) phantoms under a pulsatile flow condition. A human study was conducted from five healthy volunteers. RESULTS Experimental results demonstrated that the WSS estimation was close to the standard value that was obtained from maximum velocity estimation in straight phantom experiments. In a stenosis phantom experiment, a low WSS region was observed at a site downstream of an obstruction, which is a high-risk area for plaque formation. Dynamic WSS mapping was accomplished in measurement in the femoral artery bifurcation. In measurements, the time-averaged WSS of the common femoral artery, superficial femoral artery, and deep femoral artery was 0.52± 0.19, 0.44 ± 0.21, and 0.29 ± 0.16 Pa, respectively, for the anterior wall and 0.29 ± 0.11, 0.54 ± 0.24, and 0.23 ± 0.10 Pa, respectively, for the posterior wall. CONCLUSIONS All results indicated that WSS mapping has the potential to be a useful tool for vessel duplex scanning in the future.
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Affiliation(s)
- I-Chieh Wang
- Department of Biomedical Engineering, National Cheng Kung University, Tainan City, Taiwan
| | - Hsin Huang
- Department of Biomedical Engineering, National Cheng Kung University, Tainan City, Taiwan
| | - Wei-Ting Chang
- Department of Cardiology, Chi-Mei Medical Center, Tainan City, Taiwan.,Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan City, Taiwan.,Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan City, Taiwan
| | - Chih-Chung Huang
- Department of Biomedical Engineering, National Cheng Kung University, Tainan City, Taiwan.,Medical Device Innovation Center, National Cheng Kung University, Tainan City, Taiwan
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14
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Korosoglou G, Maylar N. Looking to the femoral rather than the carotid bifurcation to predict obstructive coronary artery disease? Int J Cardiovasc Imaging 2021; 37:2975-2977. [PMID: 34313891 DOI: 10.1007/s10554-021-02361-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 07/17/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Grigorios Korosoglou
- Department of Cardiology, Vascular Medicine & Pneumology, GRN Hospital Weinheim, Weinheim, Germany.
- Cardiac Imaging Center Weinheim, Hector Foundation, Weinheim, Germany.
| | - Nasser Maylar
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Cardiology, Munster, Germany
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15
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Tsirimiagkou C, Karatzi K, Argyris A, Chalkidou F, Tzelefa V, Sfikakis PP, Yannakoulia M, Protogerou AD. Levels of dietary sodium intake: diverging associations with arterial stiffness and atheromatosis. Hellenic J Cardiol 2021; 62:439-446. [DOI: 10.1016/j.hjc.2021.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 12/18/2020] [Accepted: 02/12/2021] [Indexed: 02/07/2023] Open
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16
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Bermúdez-López M, Martínez-Alonso M, Castro-Boqué E, Betriu À, Cambray S, Farràs C, Barbé F, Pamplona R, Lecube A, Mauricio D, Purroy F, Valdivielso JM, Fernández E. Subclinical atheromatosis localization and burden in a low-to-moderate cardiovascular risk population: the ILERVAS study. ACTA ACUST UNITED AC 2020; 74:1042-1053. [PMID: 33162389 DOI: 10.1016/j.rec.2020.09.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 09/10/2020] [Indexed: 12/31/2022]
Abstract
INTRODUCTION AND OBJECTIVES There is a discrepancy between risk assessment based on cardiovascular risk factors (CVRF) and atheromatosis burden. The objective was to identify the prevalence of subclinical diseases with common risk factors, such as atheromatosis, occult kidney disease, prediabetes, and diabetes in a middle-aged population with low-to-moderate cardiovascular risk; to assess the vascular distribution, and severity of subclinical atheromatosis. METHODS Randomized, interventional, longitudinal clinical trial. The intervention consisted of vascular ultrasound examination in the carotid and femoral arteries assessing 12 territories, combined with clinical, anthropometric, lifestyle, and biochemical parameters. Inclusion criteria consisted of women (aged 50-70 years) and men (aged 45-65 years) with at least 1 CVRF. Exclusion criteria consisted of a clinical history of diabetes, chronic kidney disease, or a prior CV event. Here, baseline characteristics of the ILERVAS cohort are shown. RESULTS A total of 8330 middle-aged asymptomatic participants, 50.7% women, were enrolled. The presence of 1-2 CVRF was found in 74.8% and adherence to the Mediterranean diet was low in 52.8%. Several previously unknown chronic diseases were diagnosed, such as dyslipidemia (21.1%), hypertension (15.3%), kidney disease (15.4%), obesity (10.6%), and diabetes (2.3%). Subclinical atheromatosis was found in 71.4% of participants, localized in common femoral (54.5%), carotid bifurcation (41.1%) and internal carotid (22%). Intermediate atheromatosis (2-3 territories with atheroma plaque) was found in 32.6%, and generalized atheromatosis (>3 territories) in 19.7. Total plaque area was higher in men (0.97 cm2 vs 0.58 cm2, P<.001). Total plaque area was also higher in the femoral artery, and increased with the number of CVRF. CONCLUSIONS Subclinical atheromatosis was highly prevalent in a middle-aged population with low-to moderate cardiovascular risk, with 1 in 5 participants having generalized atheromatosis. ClinicalTrials.gov Identifier: NCT03228459.
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Affiliation(s)
- Marcelino Bermúdez-López
- Grupo Investigación Translacional Vascular y Renal, IRBLleida, Red de Investigación Renal (RedInRen-ISCIII), Lleida, Spain.
| | - Montse Martínez-Alonso
- Unitat de Bioestadística, IRBLleida, Departament de Ciències Mèdiques Bàsiques, Universitat de Lleida, Lleida, Spain
| | - Eva Castro-Boqué
- Grupo Investigación Translacional Vascular y Renal, IRBLleida, Red de Investigación Renal (RedInRen-ISCIII), Lleida, Spain
| | - Àngels Betriu
- Grupo Investigación Translacional Vascular y Renal, IRBLleida, Red de Investigación Renal (RedInRen-ISCIII), Lleida, Spain
| | - Serafí Cambray
- Grupo Investigación Translacional Vascular y Renal, IRBLleida, Red de Investigación Renal (RedInRen-ISCIII), Lleida, Spain
| | - Cristina Farràs
- Centre d'Atenció Primària Cappont, Gerència Territorial de Lleida; Institut Català de la Salut, Unitat de Suport a la Recerca Lleida, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Ferran Barbé
- Departament de Medicina Respiratòria, Hospital Universitari Arnau de Vilanova, Grup Recerca Translacional Medicina Respiratòria, IRBLleida, Universitat de Lleida, Lleida, Spain
| | - Reinald Pamplona
- Departament de Medicina Experimental, IRBLleida, Universitat de Lleida, Lleida, Spain
| | - Albert Lecube
- Departament d'Endocrinologia i Nutrició, Hospital Universitari Arnau de Vilanova, Grup de Recerca Obesitat i Metabolisme (ODIM), IRBLleida, Universitat de Lleida, Lleida, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Spain
| | - Dídac Mauricio
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Spain; Departament d'Endocrinologia i Nutrició, Hospital de la Santa Creu i Sant Pau, Institut de Recerca Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Francisco Purroy
- Unitat Ictus, Hospital Universitari Arnau de Vilanova, Grup Neurosciències Clíniques, IRBLleida, Universitat de Lleida, Lleida, Spain
| | - José Manuel Valdivielso
- Grupo Investigación Translacional Vascular y Renal, IRBLleida, Red de Investigación Renal (RedInRen-ISCIII), Lleida, Spain.
| | - Elvira Fernández
- Grupo Investigación Translacional Vascular y Renal, IRBLleida, Red de Investigación Renal (RedInRen-ISCIII), Lleida, Spain
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Kousios A, Kouis P, Hadjivasilis A, Panayiotou A. Cardiovascular Risk Assessment Using Ultrasonographic Surrogate Markers of Atherosclerosis and Arterial Stiffness in Patients With Chronic Renal Impairment: A Narrative Review of the Evidence and a Critical View of Their Utility in Clinical Practice. Can J Kidney Health Dis 2020; 7:2054358120954939. [PMID: 32963791 PMCID: PMC7488604 DOI: 10.1177/2054358120954939] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 07/23/2020] [Indexed: 01/20/2023] Open
Abstract
PURPOSE OF THE REVIEW Validated tools to improve cardiovascular disease (CVD) risk assessment and mortality in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) are lacking. Noninvasive measures of arteriosclerosis and subclinical atherosclerosis such as pulse wave velocity (PWV) and carotid intima-media thickness (cIMT), respectively, have emerged as promising risk stratification tools and potential modifiable biomarkers. Their wide use as surrogate markers in clinical research studies is based on the strong pathophysiological links with CVD. However, whether their effect as risk stratification or intervention targets is superior to established clinical approaches is uncertain. In this review, we examine the evidence on the utility of PWV, cIMT, and plaque assessment in routine practice and highlight unanswered questions from the clinician's perspective. SOURCES OF INFORMATION Electronic databases PubMed and Google Scholar were searched until February 2020. METHODS This narrative review is based on peer-reviewed meta-analyses, national and international societies' guidelines, and on focused critical review of recent original studies and landmark studies in the field. KEY FINDINGS Although patients with CKD are considered in the high-risk CVD groups, there is still need for tools to improve risk stratification and individualized management strategies within this group of patients. Carotid intima-media thickness is associated with all-cause mortality, CVD mortality, and events in CKD and hemodialysis cohorts. However, the evidence that measurement of cIMT has a clinically meaningful role over and above existing risk scores and management strategies is limited. Plaque assessment is a better predictor than cIMT in non-CKD populations and it has been incorporated in recent nonrenal-specific guidelines. In the CKD population, one large observational study provided evidence for a potential role of plaque assessment in CKD similar to the non-CKD studies; however, whether it improves prediction and outcomes in CKD is largely understudied. Pulse wave velocity as a marker of arterial stiffness has a strong pathophysiological link with CVD in CKD and numerous observational studies demonstrated associations with increased cardiovascular risk. However, PWV did not improve CVD reclassification of dialysis patients when added to common risk factors in a reanalysis of ESRD cohorts with available PWV data. Therapeutic strategies to regress PWV, independently from blood pressure reduction, have not been studied in well-conducted randomized trials. LIMITATIONS This study provides a comprehensive review based on extensive literature search and critical appraisal of included studies. Nevertheless, formal systematic literature review and quality assessment were not performed and the possibility of selection bias cannot be excluded. IMPLICATIONS Larger, prospective, randomized studies with homogeneous approach, designed to answer specific clinical questions and taking into consideration special characteristics of CKD and dialysis, are needed to study the potentially beneficial role of cIMT/plaque assessment and PWV in routine practice.
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Affiliation(s)
- Andreas Kousios
- West London Renal and Transplant Centre,
Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
- Cardiovascular Epidemiology and Genetics
Research Lab, Cyprus International Institute for Environmental and Public Health,
Cyprus University of Technology, Limassol, Cyprus
| | - Panayiotis Kouis
- Cardiovascular Epidemiology and Genetics
Research Lab, Cyprus International Institute for Environmental and Public Health,
Cyprus University of Technology, Limassol, Cyprus
- Respiratory Physiology Laboratory,
Medical School, University of Cyprus, Nicosia, Cyprus
| | - Alexandros Hadjivasilis
- Cardiovascular Epidemiology and Genetics
Research Lab, Cyprus International Institute for Environmental and Public Health,
Cyprus University of Technology, Limassol, Cyprus
| | - Andrie Panayiotou
- Cardiovascular Epidemiology and Genetics
Research Lab, Cyprus International Institute for Environmental and Public Health,
Cyprus University of Technology, Limassol, Cyprus
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18
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Grubic N, Colledanchise KN, Liblik K, Johri AM. The Role of Carotid and Femoral Plaque Burden in the Diagnosis of Coronary Artery Disease. Curr Cardiol Rep 2020; 22:121. [PMID: 32778953 DOI: 10.1007/s11886-020-01375-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE OF REVIEW With limitations of cardiovascular disease risk stratification by traditional risk factors, the role of noninvasive imaging techniques, such as vascular ultrasound, has emerged as a prominent utility for decision-making in coronary artery disease. A review of current guidelines and contemporary approaches for carotid and femoral plaque assessment is needed to better inform the diagnosis, management, and treatment of atherosclerosis in clinical practice. RECENT FINDINGS The recent consensus-based guidelines for carotid plaque assessment in coronary artery disease have been established, supported by some outcomes-based research. Currently, there is a gap of evidence on the use of femoral ultrasound to detect atherosclerosis, as well as predict adverse cardiovascular outcomes. The quantification and characterization of individualized plaque burden are important to stratify risk in asymptomatic or symptomatic atherosclerosis patients. Standardized quantification guidelines, supported by further outcomes-based research, are required to assess disease severity and progression.
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Affiliation(s)
- Nicholas Grubic
- Department of Medicine, Division of Cardiology, CINQ, Queen's University, 76 Stuart Street, FAPC 3, Kingston, ON, K7L 2V7, Canada.,Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Kayla N Colledanchise
- Department of Medicine, Division of Cardiology, CINQ, Queen's University, 76 Stuart Street, FAPC 3, Kingston, ON, K7L 2V7, Canada
| | - Kiera Liblik
- Department of Medicine, Division of Cardiology, CINQ, Queen's University, 76 Stuart Street, FAPC 3, Kingston, ON, K7L 2V7, Canada
| | - Amer M Johri
- Department of Medicine, Division of Cardiology, CINQ, Queen's University, 76 Stuart Street, FAPC 3, Kingston, ON, K7L 2V7, Canada.
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19
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Ecografía clínica en el riesgo cardiovascular. Rev Clin Esp 2020; 220:364-373. [DOI: 10.1016/j.rce.2019.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 11/09/2019] [Indexed: 11/16/2022]
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20
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Beltrán L, Rodilla E. Clinical ultrasonography in cardiovascular risk. Rev Clin Esp 2020. [DOI: 10.1016/j.rceng.2020.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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21
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Au JS, Yiu BYS, Yu ACH. Case Studies in Physiology: Visualization of blood recirculation in a femoral artery "trifurcation" using ultrasound vector flow imaging. J Appl Physiol (1985) 2019; 127:1809-1813. [PMID: 31580220 DOI: 10.1152/japplphysiol.00451.2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The femoral bifurcation is typically composed of a common femoral artery that bifurcates into the superficial (SFA) and deep (DFA) femoral arteries, with the lateral circumflex femoral artery (LCFA) branching distal to the origin of the DFA. We report a unique case of a 22-yr-old woman with a femoral "trifurcation," where the origin of the LCFA coincides with the origin of the DFA, resulting in a true three-way branching of the common femoral artery. We characterized the complex hemodynamics of the trifurcation region with ultrasound vector flow imaging at rest, and during 80 mmHg cuff compression of the calf to induce greater oscillatory blood flow. At rest, a clear trifurcation is observed with color Doppler imaging, while vector flow imaging further revealed a large area of flow circulation proximal to the LCFA and DFA. Cuff compression reduced SFA blood flow to 0 cm3/min, characterized by almost constant retrograde blood flow throughout diastole. When visualized with vector flow imaging, diastolic retrograde blood flow from the SFA appeared to reperfuse the DFA and LCFA during late systole, eliminating the retrograde flow component and providing a secondary source of anterograde blood flow to the thigh. In a rare case of a femoral trifurcation, we demonstrate blood recirculation patterns at rest, as well as collateral retrograde blood flow redistribution during lower limb compression. While it is unknown whether these trifurcation findings extend to typical bifurcations, it is evident that advanced methods of blood flow characterization are necessary to visualize and study complex vascular regions.NEW & NOTEWORTHY A femoral "trifurcation" is observed when the lateral circumflex femoral artery has an atypical proximal origin, branching at the same level as the superficial and deep femoral arteries. Ultrasound vector flow imaging at 750 fps was able to reveal substantial blood recirculation within the trifurcation at rest, as well as unique redistribution of blood flow between downstream branches during external cuff manipulation of retrograde flow, indicating novel ways in which diastolic blood flow is controlled.
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Affiliation(s)
- Jason S Au
- Schlegel Research Institute for Aging, University of Waterloo, Waterloo, Canada.,Department of Electrical and Computer Engineering, University of Waterloo, Waterloo, Canada
| | - Billy Y S Yiu
- Schlegel Research Institute for Aging, University of Waterloo, Waterloo, Canada.,Department of Electrical and Computer Engineering, University of Waterloo, Waterloo, Canada
| | - Alfred C H Yu
- Schlegel Research Institute for Aging, University of Waterloo, Waterloo, Canada.,Department of Electrical and Computer Engineering, University of Waterloo, Waterloo, Canada
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22
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Vouillarmet J, Marsot C, Maucort-Boulch D, Riche B, Helfre M, Grange C. Vascular Events and Carotid Atherosclerosis: A 5-Year Prospective Cohort Study in Patients with Type 2 Diabetes and a Contemporary Cardiovascular Prevention Treatment. J Diabetes Res 2019; 2019:9059761. [PMID: 31934592 PMCID: PMC6942832 DOI: 10.1155/2019/9059761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 12/04/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND AND AIMS European recommendations on cardiovascular prevention suggest that carotid atherosclerosis assessment by duplex ultrasonography could help in some cases to better assess CV risk. We investigated whether the presence of carotid atherosclerosis determined by duplex ultrasonography is associated with cardiovascular events in patients with type 2 diabetes and could therefore help to reclassify cardiovascular risk. METHODS Among 624 consecutive patients with type 2 diabetes and carotid atherosclerosis assessment by duplex ultrasonography between January and December 2012, 583 (93%) were included and followed up prospectively. The primary endpoint was the occurrence of cardiovascular events. The rate of new cardiovascular events was compared between patients with (n = 104) and those without (n = 479) prior cardiovascular events. RESULTS A total of new 104 cardiovascular events occurred in 72 patients (12.5%) during a mean ± SD follow-up period of 5.1 ± 1.6 years. At baseline, for 202 patients (34.6%), carotid evaluation was normal; 381 (65.4%) had a carotid atherosclerosis lesion. The presence of carotid atherosclerosis at baseline was not significantly associated with an increased risk of new cardiovascular events in both groups. The rate of new cardiovascular events was more than twice as high in patients with prior cardiovascular event than those without. CONCLUSION Systematic carotid atherosclerosis assessment by duplex ultrasonography in patients with type 2 diabetes and a contemporary cardiovascular prevention treatment does not offer additional information as to the risk of cardiovascular events. This trial is registered with ClinicalTrials.gov (ID: NCT02929355).
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Affiliation(s)
- Julien Vouillarmet
- Hospices Civils de Lyon, Department of Endocrinology, Diabetes and Nutrition, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France
| | - Charlotte Marsot
- Hospices Civils de Lyon, Department of Endocrinology, Diabetes and Nutrition, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France
| | - Delphine Maucort-Boulch
- Department of Biostatistics, Hospices Civil de Lyon, Lyon, France
- Université Lyon I, Villeurbanne, France
- CNRS, UMR 5558, Laboratoire Biostatistiques Sante, Pierre-Bénite, France
| | - Benjamin Riche
- Department of Biostatistics, Hospices Civil de Lyon, Lyon, France
- Université Lyon I, Villeurbanne, France
- CNRS, UMR 5558, Laboratoire Biostatistiques Sante, Pierre-Bénite, France
| | - Marjorie Helfre
- Hospices Civils de Lyon, Department of Vascular Medicine, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France
| | - Claire Grange
- Hospices Civils de Lyon, Department of Vascular Medicine, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France
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23
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Hsu S, Rifkin DE, Criqui MH, Suder NC, Garimella P, Ginsberg C, Marasco AM, McQuaide BJ, Barinas-Mitchell EJ, Allison MA, Wassel CL, Ix JH. Relationship of femoral artery ultrasound measures of atherosclerosis with chronic kidney disease. J Vasc Surg 2018; 67:1855-1863.e1. [PMID: 29276107 PMCID: PMC5970948 DOI: 10.1016/j.jvs.2017.09.048] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 09/28/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND Chronic kidney disease (CKD) is strongly associated with peripheral artery disease (PAD). Detection of subclinical PAD may allow early interventions for or prevention of PAD in persons with CKD. Whether the presence of atherosclerotic plaque and femoral intima-media thickness (IMT) are associated with kidney function is unknown. METHODS We performed a cross-sectional observational study of 1029 community-living adults. We measured superficial and common femoral artery IMT and atherosclerotic plaque presence by ultrasound. Estimated glomerular filtration rate (eGFR; continuous) and eGFR <60 mL/min/1.73 m2 (binary) were evaluated as outcomes. RESULTS Mean age was 70 ± 10 years, mean eGFR was 78 ± 17 mL/min/1.73 m2, and 156 (15%) individuals had eGFR <60 mL/min/1.73 m2; 260 (25%) had femoral artery plaque. In models adjusted for demographics and cardiovascular risk factors, individuals with femoral artery plaque had mean eGFR approximately 3.0 (95% confidence interval, -5.3 to -0.8) mL/min/1.73 m2 lower than those without plaque (P < .01). The presence of plaque was also associated with a 1.7-fold higher odds of eGFR <60 mL/min/1.73 m2 (95% confidence interval, 1.1-2.8; P < .02). Associations were similar in persons with normal ankle-brachial index. The directions of associations were similar for femoral IMT measures with eGFR and CKD but were rendered no longer statistically significant with adjustment for demographic variables and cardiovascular disease risk factors. CONCLUSIONS Femoral artery plaque is significantly associated with CKD prevalence in community-living individuals, even among those with normal ankle-brachial index. Femoral artery ultrasound may allow evaluation of relationships and risk factors linking PAD and kidney disease earlier in its course.
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Affiliation(s)
- Simon Hsu
- Division of Nephrology, Department of Medicine, University of California San Diego, La Jolla, Calif
| | - Dena E Rifkin
- Division of Nephrology, Department of Medicine, University of California San Diego, La Jolla, Calif; Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, Calif; Division of Preventive Medicine, Department of Family Medicine and Public Health, School of Medicine, University of California San Diego, La Jolla, Calif
| | - Michael H Criqui
- Division of Nephrology, Department of Medicine, University of California San Diego, La Jolla, Calif; Division of Preventive Medicine, Department of Family Medicine and Public Health, School of Medicine, University of California San Diego, La Jolla, Calif
| | - Natalie C Suder
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pa
| | - Pranav Garimella
- Division of Nephrology, Department of Medicine, University of California San Diego, La Jolla, Calif
| | - Charles Ginsberg
- Division of Nephrology, Department of Medicine, University of California San Diego, La Jolla, Calif
| | - Antoinette M Marasco
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pa
| | - Belinda J McQuaide
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pa
| | - Emma J Barinas-Mitchell
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pa
| | - Matthew A Allison
- Division of Preventive Medicine, Department of Family Medicine and Public Health, School of Medicine, University of California San Diego, La Jolla, Calif
| | - Christina L Wassel
- Department of Pathology and Laboratory Medicine, University of Vermont Larner College of Medicine, Burlington, Vt
| | - Joachim H Ix
- Division of Nephrology, Department of Medicine, University of California San Diego, La Jolla, Calif; Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, Calif; Division of Preventive Medicine, Department of Family Medicine and Public Health, School of Medicine, University of California San Diego, La Jolla, Calif.
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24
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Lucatelli P, Fagnani C, Tarnoki AD, Tarnoki DL, Sacconi B, Fejer B, Stazi MA, Salemi M, Cirelli C, d'Adamo A, Fanelli F, Catalano C, Maurovich-Horvat P, Jermendy AL, Jermendy G, Merkely B, Molnar AA, Pucci G, Schillaci G, Farina F, Meneghetti G, Baracchini C, Medda E. Genetic influence on femoral plaque and its relationship with carotid plaque: an international twin study. Int J Cardiovasc Imaging 2017; 34:531-541. [PMID: 29022127 DOI: 10.1007/s10554-017-1256-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 10/06/2017] [Indexed: 01/26/2023]
Abstract
To disentangle genetic and environmental influences on the development of femoral plaques using a population of adult twins. To evaluate the potential role of shared genetic and environmental factors in the co-occurrence of femoral and carotid plaques. The sample included 566 twins belonging to 164 monozygotic (MZ) and 119 dizygotic (DZ) twin pairs, who underwent peripheral arterial assessment by B-mode ultrasound in different centers. The variance in femoral plaques onset was due to genetic factors and the remaining 50% was explained by common (15%) and unique (35%) environmental factors. Findings on sidedness and number of femoral plaques indicated that also these traits were mainly under genetic control. No effect of common environment was found on plaques composition, and variability of this trait was explained by genetics (64%) and unique environment (36%). Covariation between the liabilities to carotid and femoral plaques was mainly attributed to shared genes (77%), with the remaining 23% explained by individual-specific environmental factors shared by the two districts. Inter-individual differences in plaque onset as well as in their number, sidedness and composition are mainly genetic in origin. The results on the cooccurrence of carotid and femoral plaque underline the genetic role in atherogenesis.
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Affiliation(s)
- Pierleone Lucatelli
- Vascular and Interventional Radiology Unit, Department of Radiology, Oncology and Anatomic Pathology, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy.
| | - Corrado Fagnani
- Centre for Behavioural Sciences and Mental Health, Istituto Superiore di Sanità, Rome, Italy
| | - Adam Domonkos Tarnoki
- Department of Radiology, Semmelweis University, Budapest, Hungary.,Hungarian Twin Registry, Budapest, Hungary
| | - David Laszlo Tarnoki
- Department of Radiology, Semmelweis University, Budapest, Hungary.,Hungarian Twin Registry, Budapest, Hungary
| | - Beatrice Sacconi
- Vascular and Interventional Radiology Unit, Department of Radiology, Oncology and Anatomic Pathology, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Bence Fejer
- Department of Radiology, Semmelweis University, Budapest, Hungary
| | - Maria Antonietta Stazi
- Centre for Behavioural Sciences and Mental Health, Istituto Superiore di Sanità, Rome, Italy
| | - Miriam Salemi
- Centre for Behavioural Sciences and Mental Health, Istituto Superiore di Sanità, Rome, Italy
| | - Carlo Cirelli
- Vascular and Interventional Radiology Unit, Department of Radiology, Oncology and Anatomic Pathology, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Alessandro d'Adamo
- Vascular and Endovascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Fabrizio Fanelli
- Vascular and Interventional Radiology Unit, Department of Radiology, Oncology and Anatomic Pathology, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Carlo Catalano
- Vascular and Interventional Radiology Unit, Department of Radiology, Oncology and Anatomic Pathology, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Pal Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Adam L Jermendy
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Gyorgy Jermendy
- 3rd Department of Internal Medicine, Bajcsy Zsilinszky Hospital, Budapest, Hungary
| | - Bela Merkely
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Andrea A Molnar
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Giacomo Pucci
- Unità di Medicina Interna, Ospedale 'S. Maria', Università di Perugia, Terni, Italy
| | - Giuseppe Schillaci
- Unità di Medicina Interna, Ospedale 'S. Maria', Università di Perugia, Terni, Italy
| | - Filippo Farina
- Department of Neurosciences, University of Padua School of Medicine, Padua, Italy
| | - Giorgio Meneghetti
- Department of Neurosciences, University of Padua School of Medicine, Padua, Italy
| | - Claudio Baracchini
- Department of Neurosciences, University of Padua School of Medicine, Padua, Italy
| | - Emanuela Medda
- Centre for Behavioural Sciences and Mental Health, Istituto Superiore di Sanità, Rome, Italy
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25
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Zhao X, Hippe DS, Li R, Canton GM, Sui B, Song Y, Li F, Xue Y, Sun J, Yamada K, Hatsukami TS, Xu D, Wang M, Yuan C. Prevalence and Characteristics of Carotid Artery High-Risk Atherosclerotic Plaques in Chinese Patients With Cerebrovascular Symptoms: A Chinese Atherosclerosis Risk Evaluation II Study. J Am Heart Assoc 2017; 6:JAHA.117.005831. [PMID: 28862936 PMCID: PMC5586432 DOI: 10.1161/jaha.117.005831] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Background Carotid atherosclerotic plaque rupture is an important source of ischemic stroke. However, the prevalence of high‐risk plaque (HRP) defined as plaques with luminal surface disruption, a lipid‐rich necrotic core occupying >40% of the wall, or intraplaque hemorrhage in Chinese population remains unclear. This study uses carotid magnetic resonance imaging (CMRI) to investigate HRP prevalence in carotid arteries of Chinese patients with cerebrovascular symptoms. Methods and Results Patients with cerebral ischemic symptoms in the anterior circulation within 2 weeks and carotid plaque determined by ultrasound were recruited and underwent CMRI. The HRP features were identified and compared between symptomatic and asymptomatic arteries. Receiver‐operating‐characteristic analysis was used to calculate area‐under‐the‐curve (AUC) of stenosis and maximum wall thickness for discriminating presence of HRP. In 1047 recruited subjects, HRP detected by CMRI was nearly 1.5 times more prevalent than severe stenosis (≥50%) in this cohort (28% versus 19%, P<0.0001). Approximately two thirds of HRPs were found in arteries with <50% stenosis. The prevalence of HRP in symptomatic carotid arteries was significantly higher than that of the contralateral asymptomatic carotid arteries (23.0% versus 16.4%, P=0.001). Maximum wall thickness was found to be a stronger discriminator than stenosis for HRP (AUC: 0.93 versus 0.81, P<0.0001). Conclusions There are significantly more high‐risk carotid plaques than carotid arteries with ≥50% stenosis in symptomatic Chinese patients. A substantial number of HRPs were found in arteries with lower grade stenosis and maximum wall thickness was a stronger indicator for HRP than luminal stenosis. Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT02017756.
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Affiliation(s)
- Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University, Beijing, China
| | - Daniel S Hippe
- Department of Radiology, University of Washington, Seattle, WA
| | - Rui Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University, Beijing, China
| | - Gador M Canton
- Department of Radiology, University of Washington, Seattle, WA
| | - Binbin Sui
- Department of Radiology, Beijing Tiantan Hospital, Beijing, China
| | - Yan Song
- Department of Radiology, Beijing Hospital, Beijing, China
| | - Feiyu Li
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Yunjing Xue
- Department of Radiology, Fujian Union Hospital, Fuzhou, China
| | - Jie Sun
- Department of Radiology, University of Washington, Seattle, WA
| | - Kiyofumi Yamada
- Department of Radiology, University of Washington, Seattle, WA
| | | | - Dongxiang Xu
- Department of Radiology, University of Washington, Seattle, WA
| | - Maoxue Wang
- Department of Radiology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Chun Yuan
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University, Beijing, China .,Department of Radiology, University of Washington, Seattle, WA
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26
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Wassel CL, Ellis AM, Suder NC, Barinas-Mitchell E, Rifkin DE, Forbang NI, Denenberg JO, Marasco AM, McQuaide BJ, Jenny NS, Allison MA, Ix JH, Criqui MH. Femoral Artery Atherosclerosis Is Associated With Physical Function Across the Spectrum of the Ankle-Brachial Index: The San Diego Population Study. J Am Heart Assoc 2017; 6:JAHA.117.005777. [PMID: 28729408 PMCID: PMC5586297 DOI: 10.1161/jaha.117.005777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The ankle‐brachial index (ABI) is inadequate to detect early‐stage atherosclerotic disease, when interventions to prevent functional decline may be the most effective. We determined associations of femoral artery atherosclerosis with physical functioning, across the spectrum of the ABI, and within the normal ABI range. Methods and Results In 2007–2011, 1103 multiethnic men and women participated in the San Diego Population Study, and completed all components of the summary performance score. Using Doppler ultrasound, superficial and common femoral intima media thickness and plaques were ascertained. Logistic regression was used to assess associations of femoral atherosclerosis with the summary performance score and its individual components. Models were adjusted for demographics, lifestyle factors, comorbidities, lipids, and kidney function. In adjusted models, among participants with a normal‐range ABI (1.00–1.30), the highest tertile of superficial intima media thickness was associated with lower odds of a perfect summary performance score of 12 (odds ratio=0.56 [0.36, 0.87], P=0.009), and lower odds of a 4‐m walk score of 4 (0.34 [0.16, 0.73], P=0.006) and chair rise score of 4 (0.56 [0.34, 0.94], P=0.03). Plaque presence (0.53 [0.29, 0.99], P=0.04) and greater total plaque burden (0.61 [0.43, 0.87], P=0.006) were associated with worse 4‐m walk performance in the normal‐range ABI group. Higher superficial intima media thickness was associated with lower summary performance score in all individuals (P=0.02). Conclusions Findings suggest that use of femoral artery atherosclerosis measures may be effective in individuals with a normal‐range ABI, especially, for example, those with diabetes mellitus or a family history of peripheral artery disease, when detection can lead to earlier intervention to prevent functional declines and improve quality of life.
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Affiliation(s)
- Christina L Wassel
- Department of Pathology and Laboratory Medicine, College of Medicine, University of Vermont, Burlington, VT
| | - Alicia M Ellis
- Department of Pathology and Laboratory Medicine, College of Medicine, University of Vermont, Burlington, VT
| | - Natalie C Suder
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA
| | - Emma Barinas-Mitchell
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA
| | - Dena E Rifkin
- Division of Preventive Medicine, Department of Family Medicine and Public Health, School of Medicine, University of California-San Diego, La Jolla, CA.,Division of Nephrology, Department of Medicine, School of Medicine, University of California-San Diego, La Jolla, CA
| | - Nketi I Forbang
- Division of Preventive Medicine, Department of Family Medicine and Public Health, School of Medicine, University of California-San Diego, La Jolla, CA
| | - Julie O Denenberg
- Division of Preventive Medicine, Department of Family Medicine and Public Health, School of Medicine, University of California-San Diego, La Jolla, CA
| | - Antoinette M Marasco
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA
| | - Belinda J McQuaide
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA
| | - Nancy S Jenny
- Department of Pathology and Laboratory Medicine, College of Medicine, University of Vermont, Burlington, VT
| | - Matthew A Allison
- Division of Preventive Medicine, Department of Family Medicine and Public Health, School of Medicine, University of California-San Diego, La Jolla, CA
| | - Joachim H Ix
- Division of Preventive Medicine, Department of Family Medicine and Public Health, School of Medicine, University of California-San Diego, La Jolla, CA.,Division of Nephrology, Department of Medicine, School of Medicine, University of California-San Diego, La Jolla, CA
| | - Michael H Criqui
- Division of Preventive Medicine, Department of Family Medicine and Public Health, School of Medicine, University of California-San Diego, La Jolla, CA
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27
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Subclinical Atherosclerosis Burden by 3D Ultrasound in Mid-Life. J Am Coll Cardiol 2017; 70:301-313. [DOI: 10.1016/j.jacc.2017.05.033] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 05/05/2017] [Accepted: 05/12/2017] [Indexed: 11/21/2022]
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28
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Lind C, Småbrekke B, Rinde LB, Hindberg K, Mathiesen EB, Johnsen SH, Arntzen KA, Njølstad I, Lijfering W, Brækkan SK, Hansen JB. Impact of Venous Thromboembolism on the Formation and Progression of Carotid Atherosclerosis: The Tromsø Study. TH OPEN 2017; 1:e66-e72. [PMID: 31249912 PMCID: PMC6524840 DOI: 10.1055/s-0037-1603983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Venous thromboembolism (VTE) is associated with increased risk of arterial cardiovascular diseases (CVD), and development of atherosclerosis secondary to VTE may be an intermediate between VTE and CVD. Therefore, we aimed to investigate whether incident VTE was associated with subsequent carotid atherosclerosis formation and progression in a population-based observational study. Subjects attending two or more ultrasound examinations of the right carotid artery, with measurement of total plaque area (TPA), in the Tromsø Study in 1994–1995, 2001–2002, and/or 2007–2008 were eligible. We identified 150 subjects diagnosed with first-lifetime VTE between the initial and follow-up visit, and randomly selected 600 age- and sex-matched subjects without VTE between the visits. Subjects with VTE and carotid plaque(s) at the first visit had 4.1 mm
2
(β: 4.13, 95% CI: −1.72 to 9.98) larger change in TPA between the first and second visit compared with subjects without VTE after adjustment for change in high-sensitivity C-reactive protein (hs-CRP) and traditional atherosclerotic risk factors. The association remained after restricting the analyses to VTE events diagnosed in the first half of the time interval between the carotid ultrasounds (β: 4.02, 95% CI: −3.66 to 11.70), supporting that the change in TPA occurred subsequent to the VTE. No association was found between VTE and novel carotid plaque formation. In conclusion, we found a possible association between VTE and atherosclerosis progression in those with already established carotid plaques, but not between VTE and novel plaque formation. The association between VTE and carotid plaque progression was not mediated by low-grade inflammation assessed by hs-CRP.
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Affiliation(s)
- Caroline Lind
- K.G. Jebsen Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway.,Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Birgit Småbrekke
- K.G. Jebsen Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Ludvig Balteskard Rinde
- K.G. Jebsen Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Kristian Hindberg
- K.G. Jebsen Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Ellisiv Bøgeberg Mathiesen
- K.G. Jebsen Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway.,Brain and Circulation Research Group, Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway.,Department of Neurology and Clinical Neurophysiology, University Hospital of North Norway, Tromsø, Norway
| | - Stein Harald Johnsen
- Brain and Circulation Research Group, Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway.,Department of Neurology and Clinical Neurophysiology, University Hospital of North Norway, Tromsø, Norway
| | - Kjell Arne Arntzen
- Brain and Circulation Research Group, Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway.,Department of Neurology and Clinical Neurophysiology, University Hospital of North Norway, Tromsø, Norway
| | - Inger Njølstad
- K.G. Jebsen Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway.,Epidemiology of Chronic Diseases Research Group, Department of Community Medicine, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Willem Lijfering
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sigrid Kufaas Brækkan
- K.G. Jebsen Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway.,Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - John-Bjarne Hansen
- K.G. Jebsen Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway.,Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
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29
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Usefulness of a systematic screening of carotid atherosclerosis in asymptomatic people with type 2 diabetes for cardiovascular risk reclassification. ANNALES D'ENDOCRINOLOGIE 2017; 78:14-19. [DOI: 10.1016/j.ando.2016.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 11/07/2016] [Accepted: 12/02/2016] [Indexed: 11/18/2022]
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30
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Tomey MI, Kini AS, Sharma SK, Kovacic JC. Aortic Valvuloplasty and Large-Bore Percutaneous Arterial Access. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Matthew I. Tomey
- The Zena and Michael A. Wiener Cardiovascular Institute, and The Marie-Josée and Henry R. Kravis Cardiovascular Health Center; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - Annapoorna S. Kini
- The Zena and Michael A. Wiener Cardiovascular Institute, and The Marie-Josée and Henry R. Kravis Cardiovascular Health Center; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - Samin K. Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, and The Marie-Josée and Henry R. Kravis Cardiovascular Health Center; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - Jason C. Kovacic
- The Zena and Michael A. Wiener Cardiovascular Institute, and The Marie-Josée and Henry R. Kravis Cardiovascular Health Center; Icahn School of Medicine at Mount Sinai; New York NY USA
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31
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Lucatelli P, Fagnani C, Tarnoki AD, Tarnoki DL, Stazi MA, Salemi M, Cirelli C, Sacconi B, d’Adamo A, Fanelli F, Catalano C, Pucci G, Schillaci G, Baracchini C, Medda E. Femoral Artery Ultrasound Examination. Angiology 2016; 68:257-265. [DOI: 10.1177/0003319716651777] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We compared intima–media thickness (IMT) and the prevalence of plaques in the common carotid artery (CCA) and common femoral artery (CFA) in apparently healthy participants. This multicenter study included 322 participants (59.9% female; age 20-78 years, mean 52.1 ± 15.3 years) who underwent Echo-color Doppler examination of the CCA and CFA bilaterally. Prevalence and composition of plaque were recorded. A significant ( P < .01) difference between mean CCA-IMT and mean CFA-IMT was detected (0.70 vs 0.73 mm). Plaque prevalence was significantly higher in the CFA compared to the CCA (40.7% vs 30.4%). Atherosclerotic plaques were found in both CFA and CCA in 46% of the cases, solely in CFA in 38%, and in CCA alone in 17%. The observed difference in plaque prevalence was even greater when only fibrolipid isolated plaques were considered (CFA 39.4% vs CCA 22.1%). In a healthy general population, atherosclerotic plaques were present in the CFA but not in the CCA in over one-third of the cases. Further studies must confirm whether ultrasonography of the CFA might be introduced in the screening protocols for cardiovascular risk assessment.
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Affiliation(s)
- Pierleone Lucatelli
- Department of Radiology, Oncology and Anatomic Pathology, Vascular and Interventional Radiology Unit, Policlinico Umberto I, “Sapienza” University of Rome, Rome, Italy
| | - Corrado Fagnani
- Genetic Epidemiology Unit, National Centre of Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy
| | | | - David Laszlo Tarnoki
- Department of Radiology and Oncotherapy, Semmelweis University, Budapest, Hungary
| | - Maria Antonietta Stazi
- Genetic Epidemiology Unit, National Centre of Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy
| | - Miriam Salemi
- Genetic Epidemiology Unit, National Centre of Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy
| | - Carlo Cirelli
- Department of Radiology, Oncology and Anatomic Pathology, Vascular and Interventional Radiology Unit, Policlinico Umberto I, “Sapienza” University of Rome, Rome, Italy
| | - Beatrice Sacconi
- Department of Radiology, Oncology and Anatomic Pathology, Vascular and Interventional Radiology Unit, Policlinico Umberto I, “Sapienza” University of Rome, Rome, Italy
| | - Alessandro d’Adamo
- Vascular and Endovascular Surgery Division, Department of Surgery “Paride Stefanini”, Policlinico Umberto I, “Sapienza” University of Rome, Italy
| | - Fabrizio Fanelli
- Department of Radiology, Oncology and Anatomic Pathology, Vascular and Interventional Radiology Unit, Policlinico Umberto I, “Sapienza” University of Rome, Rome, Italy
| | - Carlo Catalano
- Department of Radiology, Oncology and Anatomic Pathology, Vascular and Interventional Radiology Unit, Policlinico Umberto I, “Sapienza” University of Rome, Rome, Italy
| | - Giacomo Pucci
- Unità di Medicina Interna, Università di Perugia, Ospedale ‘S. Maria’, Terni, Italy
| | - Giuseppe Schillaci
- Unità di Medicina Interna, Università di Perugia, Ospedale ‘S. Maria’, Terni, Italy
| | - Claudio Baracchini
- Department of Neurosciences, University of Padua School of Medicine, Padua, Italy
| | - Emanuela Medda
- Genetic Epidemiology Unit, National Centre of Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy
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Li MF, Zhao CC, Li TT, Tu YF, Lu JX, Zhang R, Chen MY, Bao YQ, Li LX, Jia WP. The coexistence of carotid and lower extremity atherosclerosis further increases cardio-cerebrovascular risk in type 2 diabetes. Cardiovasc Diabetol 2016; 15:43. [PMID: 26944724 PMCID: PMC4779218 DOI: 10.1186/s12933-016-0360-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 02/25/2016] [Indexed: 12/27/2022] Open
Abstract
Background Both carotid and lower limb atherosclerosis are associated with increased cardiovascular and cerebrovascular risks. However, it is still unclear whether the concomitant presence of carotid and lower extremity atherosclerosis further increases the cardiovascular and cerebrovascular risks. Therefore, our aim is to investigate whether the coexistence of carotid and lower extremity atherosclerosis was associated with higher cardiovascular and cerebrovascular risks in patients with type 2 diabetes. Methods This cross-sectional study was performed in 2830 hospitalized patients with type 2 diabetes. Based on carotid and lower limb Doppler ultrasound results, the patients were divided into three groups including 711 subjects without atherosclerosis, 999 subjects with either carotid or lower limb atherosclerosis, and 1120 subjects with both carotid and lower limb atherosclerosis. And we compared the clinical characteristics and prevalence of both cardio-cerebrovascular events (CCBVEs) and self-reported cardio- cerebrovascular diseases (CCBVDs) among the three groups. Results After adjusting for age, sex, and duration of diabetes, there were significant increases in the prevalence of both CCBVEs (3.8 vs. 11.8 vs. 26.4 %, p < 0.001 for trend) and self-reported CCBVDs (6.9 vs. 19.9 vs. 36.5 %, p < 0.001 for trend) across the three groups (diabetics without atherosclerosis, diabetics with either carotid or lower limb atherosclerosis, and diabetics with both carotid and lower extremity atherosclerosis). A fully adjusted logistic regression analysis also revealed that compared with those without atherosclerosis, those with either carotid or lower limb atherosclerosis had higher risk of CCBVEs (OR 1.724, 95 % CI 1.001–2.966) and self-reported CCBVDs (OR 1.705, 95 % CI 1.115–2.605), and those with concomitant presence of carotid and lower extremity atherosclerosis had the highest risk of CCBVEs (OR 2.869, 95 % CI 1.660–4.960) and self-reported CCBVDs (2.147, 95 % CI 1.388–3.320)(p < 0.001 for trend in CCBVEs and p = 0.002 for trend in CCBVDs, respectively). Conclusions Either carotid or lower limb atherosclerosis was obviously related to increased cardio-cerebrovascular risk in type 2 diabetes. The concomitant presence of carotid and lower extremity atherosclerosis further increased cardio-cerebrovascular risk in patients with type 2 diabetes. The combined application of carotid and lower extremity ultrasonography may help identify type 2 diabetics with higher cardio-cerebrovascular risk.
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Affiliation(s)
- Mei-Fang Li
- Department of Endocrinology and Metabolism, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Diseases, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China. .,Department of Emergency, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China.
| | - Cui-Chun Zhao
- Department of VIP, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China.
| | - Ting-Ting Li
- Department of Endocrinology and Metabolism, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Diseases, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China.
| | - Yin-Fang Tu
- Department of Endocrinology and Metabolism, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Diseases, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China.
| | - Jun-Xi Lu
- Department of Endocrinology and Metabolism, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Diseases, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China.
| | - Rong Zhang
- Department of Endocrinology and Metabolism, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Diseases, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China.
| | - Ming-Yun Chen
- Department of Endocrinology and Metabolism, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Diseases, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China.
| | - Yu-Qian Bao
- Department of Endocrinology and Metabolism, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Diseases, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China.
| | - Lian-Xi Li
- Department of Endocrinology and Metabolism, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Diseases, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China.
| | - Wei-Ping Jia
- Department of Endocrinology and Metabolism, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Diseases, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China.
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Nicolaides A, Panayiotou AG. Screening for Atherosclerotic Cardiovascular Risk Using Ultrasound ∗. J Am Coll Cardiol 2016; 67:1275-7. [DOI: 10.1016/j.jacc.2016.01.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 01/11/2016] [Accepted: 01/13/2016] [Indexed: 10/22/2022]
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Bergström G, Börjesson M, Schmidt C. Self-efficacy regarding physical activity is superior to self-assessed activity level, in long-term prediction of cardiovascular events in middle-aged men. BMC Public Health 2015; 15:820. [PMID: 26303077 PMCID: PMC4548687 DOI: 10.1186/s12889-015-2140-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 08/11/2015] [Indexed: 01/22/2023] Open
Abstract
Background Self-efficacy has been determined to be a strong predictor of who will engage in physical activity. We aimed to evaluate the associations between self-efficacy to perform physical activity, self-reported leisure-time physical activity and cardiovascular events in a population-based cohort of middle-aged Swedish men with no previous cardiovascular disease, or treatment with cardiovascular drugs. Methods Analyses are based on 377 men randomly selected and stratified for weight and insulin sensitivity from a population sample of 58-year-old men (n = 1728) and who had answered a question about their competence to perform exercise (as an assessment of physical self-efficacy). The Saltin-Grimby Physical Activity Level Scale was used to assess self-reported levels of leisure-time physical activity. Cardiovascular events were recorded during 13-years of follow-up. Results The group with poor self-efficacy to perform physical activity had a significantly higher incidence of cardiovascular events compared with the group with good physical self-efficacy (32.1 % vs 17.1 %, p < 0.01). Multivariate analyses showed that poor physical self-efficacy was associated with an increased relative risk of 2.0 (95 % CI 1.2 to 3.0), of having a cardiovascular event during follow-up also after adjustments for co-variates such as waist to hip ratio, heart rate, fasting plasma glucose, serum triglycerides, systolic blood pressure, apoB/apoA-I ratio and leisure-time physical activity. Conclusion Self-efficacy to perform physical activity was strongly and independently associated with cardiovascular events and was superior to self-assessed physical activity in predicting cardiovascular events during 13-years of follow-up in a group of middle-aged men, without known CVD or treatment with cardiovascular drugs.
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Affiliation(s)
- Göran Bergström
- Wallenberg Laboratory for Cardiovascular Research, Institution of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy at University of Gothenburg, Göteborg, S-413 45, Sweden.
| | - Mats Börjesson
- Swedish School of Sports and Health Sciences and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.
| | - Caroline Schmidt
- Wallenberg Laboratory for Cardiovascular Research, Institution of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy at University of Gothenburg, Göteborg, S-413 45, Sweden.
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Baber U, Mehran R, Sartori S, Schoos MM, Sillesen H, Muntendam P, Garcia MJ, Gregson J, Pocock S, Falk E, Fuster V. Prevalence, impact, and predictive value of detecting subclinical coronary and carotid atherosclerosis in asymptomatic adults: the BioImage study. J Am Coll Cardiol 2015; 65:1065-74. [PMID: 25790876 DOI: 10.1016/j.jacc.2015.01.017] [Citation(s) in RCA: 327] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 01/06/2015] [Accepted: 01/11/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although recent studies suggest that measuring coronary artery calcification (CAC) may be superior to indirect atherosclerotic markers in predicting cardiac risk, there are limited data evaluating imaging-based biomarkers that directly quantify atherosclerosis in different vascular beds performed in a single cohort. OBJECTIVES The BioImage Study (A Clinical Study of Burden of Atherosclerotic Disease in an At-Risk Population) sought to identify imaging biomarkers that predict near-term (3-year) atherothrombotic events. METHODS The BioImage Study enrolled 5,808 asymptomatic U.S. adults (mean age: 69 years, 56.5% female) in a prospective cohort evaluating the role of vascular imaging on cardiovascular risk prediction. All patients were evaluated by CAC and novel 3-dimensional carotid ultrasound. Plaque areas from both carotid arteries were summed as the carotid plaque burden (cPB). The primary endpoint was the composite of major adverse cardiac events (MACE) (cardiovascular death, myocardial infarction, and ischemic stroke). A broader secondary MACE endpoint also included all-cause death, unstable angina, and coronary revascularization. RESULTS Over a median follow-up of 2.7 years, MACE occurred in 216 patients (4.2%), of which 82 (1.5%) were primary events. After adjustment for risk factors, and compared with individuals without any cPB, hazard ratios for MACE were 0.78 (95% confidence interval [CI]: 0.31 to 1.91), 1.45 (95% CI: 0.67 to 3.14), and 2.36 (95% CI: 1.13 to 4.92) with increasing cPB tertile, with similar results for CAC. Net reclassification significantly improved with either cPB (0.23) or CAC (0.25). MACE rates increased simultaneously with higher levels of both cPB and CAC. CONCLUSIONS Detection of subclinical carotid or coronary atherosclerosis improves risk predictions and reclassification compared with conventional risk factors, with comparable results for either modality. Cost-effective analyses are warranted to define the optimal roles of these complementary techniques. (BioImage Study: A Clinical Study of Burden of Atherosclerotic Disease in an At-Risk Population; NCT00738725).
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Affiliation(s)
- Usman Baber
- Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Roxana Mehran
- Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Samantha Sartori
- Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mikkel Malby Schoos
- Department of Vascular Surgery, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Henrik Sillesen
- Department of Vascular Surgery, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | | | - Mario J Garcia
- Division of Cardiology, Montefiore Medical Center, Bronx, New York
| | - John Gregson
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Stuart Pocock
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Erling Falk
- Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark
| | - Valentin Fuster
- Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York, New York.
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Yerly P, Marquès-Vidal P, Owlya R, Eeckhout E, Kappenberger L, Darioli R, Depairon M. The Atherosclerosis Burden Score (ABS): a Convenient Ultrasound-Based Score of Peripheral Atherosclerosis for Coronary Artery Disease Prediction. J Cardiovasc Transl Res 2015; 8:138-47. [DOI: 10.1007/s12265-015-9617-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 02/23/2015] [Indexed: 12/30/2022]
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Hillegass WB, Brott BC. Can femoral access bleeding outcomes be improved? Catheter Cardiovasc Interv 2015; 85:380-1. [PMID: 25684716 DOI: 10.1002/ccd.25808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 12/21/2014] [Indexed: 11/11/2022]
Affiliation(s)
- William B Hillegass
- Heart South Cardiovascular Group, Alabaster, Alabama; University of Alabama at Birmingham, Birmingham, Alabama
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Sanborn TA, Tomey MI, Mehran R, Généreux P, Witzenbichler B, Brener SJ, Kirtane AJ, McAndrew TC, Kornowski R, Dudek D, Nikolsky E, Stone GW. Femoral vascular closure device use, bivalirudin anticoagulation, and bleeding after primary angioplasty for STEMI: results from the HORIZONS-AMI trial. Catheter Cardiovasc Interv 2014; 85:371-9. [PMID: 25179260 DOI: 10.1002/ccd.25663] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 08/29/2014] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To assess the relationship of femoral vascular closure device (VCD) use to bleeding and ischemic events in patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) via different anticoagulation strategies. BACKGROUND It is unknown whether femoral VCD reduce major bleeding after primary PCI for STEMI using bivalirudin anticoagulation. METHODS We compared VCD-treated patients with propensity-matched controls in the HORIZONS-AMI trial with respect to net adverse clinical events (NACE), defined as the composite of major bleeding unrelated to coronary artery bypass graft surgery (CABG) and major adverse cardiac events (comprised of death, reinfarction, ischemia-driven target vessel revascularization, and stroke), at 30 days and 1 year. RESULTS Among 3,602 patients enrolled in HORIZONS-AMI, 2,948 underwent primary PCI via femoral arterial access and 896 (30%) received VCDs, of whom 642 were included in our model along with 642 propensity-matched controls. At 30 days, VCD-treated patients had significantly less NACE (6.7% vs. 10.8%, HR: 0.61, 95% CI: 0.42-0.89, P = 0.009), driven by a lower rate of non-CABG related major bleeding (5.0% vs. 8.1%, HR: 0.61, 95% CI: 0.39-0.94, P = 0.02). Bleeding reduction was maintained at one year and consistent in magnitude regardless of randomization to bivalirudin or unfractionated heparin plus a glycoprotein IIb/IIIa inhibitor (P for interaction = 0.84). CONCLUSION In patients undergoing transfemoral primary PCI for STEMI, VCD use was associated with significantly lower non-CABG major bleeding irrespective of anticoagulation strategy.
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Kim ESH, Marycz DM, Archinal D, Gornik HL, Shishehbor MH, Bartholomew JR. Presence of external carotid artery plaque independently predicts mortality in patients without internal carotid artery atherosclerosis. Vasc Med 2014; 19:351-5. [DOI: 10.1177/1358863x14546159] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The presence of plaque in the external carotid artery (ECA) detected on carotid duplex ultrasound (CDU) is of unknown clinical significance and may not be reported in routine clinical practice. We hypothesize that ECA plaque in the absence of plaque in the other cervical vessels is a risk factor for increased all-cause mortality. Objectives: To determine the significance of ECA plaque on all-cause mortality in the absence of internal carotid artery (ICA) or common carotid artery (CCA) plaque. Methods: We queried the Non-Invasive Vascular Laboratory database for all CDUs performed between 1 January 2005 and 31 December 2005. All images were reviewed for the presence of plaque. Studies were included if plaque was absent in both the CCA and the ICA. Chart review was performed to obtain demographic and clinical information. All-cause mortality was determined using the Social Security Death Index. Results: A total of 500 patient studies met the inclusion criteria; 64 patients (12.8%) had plaque in one or both ECAs. There was no significant difference in age (mean 58.1 ± 14.8 years), race (82.5% white), or sex (64.4% male) between those with and without ECA plaque. There was a significant difference in all-cause mortality between patients with and without isolated ECA plaque after adjustment for age, sex, low-density lipoprotein cholesterol, smoking, hypertension, body mass index, and surgery within 30 days of CDU (adjusted hazard ratio 2.60, 95% CI 1.46–4.66, p<0.001). Conclusions: The presence of plaque isolated to the ECA is an independent predictor of all-cause mortality and may impart important prognostic information for patients referred for CDU.
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Affiliation(s)
- Esther SH Kim
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Devon Archinal
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Heather L Gornik
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mehdi H Shishehbor
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - John R Bartholomew
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
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Wiberg B, Lind PM, Lind L. Serum levels of monobenzylphthalate (MBzP) is related to carotid atherosclerosis in the elderly. ENVIRONMENTAL RESEARCH 2014; 133:348-352. [PMID: 25036990 DOI: 10.1016/j.envres.2014.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 06/04/2014] [Accepted: 06/11/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND AND OBJECTIVE Background exposure to environmental contaminants has recently emerged as a new risk factor for cardiovascular disease in general and to atheroclerosis in particular. This cross-sectional study was performed to evaluate if serum concentrations of the phthalate metabolite monobenzylphthalate (MBzP) are related to atheroclerosis in the carotid arteries. METHODS In the population-based Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study (1003 subjects all aged 70) the prevalence of overt plaques and echogenicity (gray-scale median, GSM) of carotid artery plaques were recorded by ultrasound in both of the carotid arteries. The intima-media thickness (IMT) and echogenicity (IM-GSM) of the intima-media complex were also measured. The phthalate metabolite MBzP was analyzed in serum by a liquid chromatograph/tandem mass spectrometer. RESULTS The circulating level of the phthalate MBzP was related to intima-media thickness (IMT) when adjusting for gender, blood pressure, body mass index (BMI), waist circumference, HDL- and LDL-cholesterol, serum triglycerides, blood glucose and smoking (p=0.034). High levels of MBzP were also strongly associated with an echogenic IM-GSM and plaque GSM (p=0.0001 for both outcomes after adjustment) but not to plaque prevalence (p=0.42). CONCLUSION The phthalate metabolite MBzP was strongly related to the echogenicity of intima-media and plaques and also to IMT, independently of traditional CV risk factors. This suggests a role for the phthalate MBzP in the development of atherosclerosis.
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Affiliation(s)
- Bernice Wiberg
- Department of Public Health and Caring Sciences/Geriatrics, Uppsala University Hospital, SE-751 85 Uppsala, Sweden.
| | - P Monica Lind
- Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden
| | - Lars Lind
- Department of Medicine, Uppsala University, Uppsala, Sweden
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Hígado graso no alcohólico. Documento de posicionamiento de la Societat Catalana de Digestologia. GASTROENTEROLOGIA Y HEPATOLOGIA 2014; 37:372-83. [DOI: 10.1016/j.gastrohep.2014.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 03/03/2014] [Indexed: 12/13/2022]
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Buscemi S, Nicolucci A, Lucisano G, Galvano F, Grosso G, Belmonte S, Sprini D, Migliaccio S, Cianferotti L, Brandi ML, Rini GB. Habitual fish intake and clinically silent carotid atherosclerosis. Nutr J 2014; 13:2. [PMID: 24405571 PMCID: PMC3893519 DOI: 10.1186/1475-2891-13-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 01/07/2014] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Fish consumption is recommended as part of a healthy diet. However, there is a paucity of data concerning the relation between fish consumption and carotid atherosclerosis. We investigated the association between habitual fish consumption and asymptomatic carotid atherosclerosis, defined as the presence of plaques and/or increased intima-media thickness (≥ 0.90 mm), in non-diabetic participants. METHODS Nine hundred-sixty-one (range of age: 18-89 yrs; 37.1% males) adult participants without clinically known atherosclerotic disease were randomly recruited among the customers of a shopping mall in Palermo, Italy, and cross-sectionally investigated. Each participant answered a food frequency questionnaire and underwent high-resolution ultrasonographic evaluation of both carotid arteries. Routine laboratory blood measurements were obtained in a subsample of 507 participants. RESULTS Based on habitual fish consumption, participants were divided into three groups: non-consumers or consumers of less than 1 serving a week (24.0%), consumers of 1 serving a week (38.8%), and consumers of ≥ 2 servings a week (37.2%). Age-adjusted prevalence of carotid atherosclerosis (presence of plaques or intima media thickness ≥ 0.9 mm) was higher in the low fish consumption group (13.3%, 12.1% and 6.6%, respectively; P = 0.003). Multivariate analysis evidenced that carotid atherosclerosis was significantly associated with age (OR = 1.12; 95% CI = 1.09-1.14), hypertension on pharmacologic treatment (OR = 1.81; 95% CI = 1.16-2.82), and pulse pressure (OR = 1.03; 95% CI = 1.01-1.04), while consuming ≥2 servings of fish weekly was protective compared with the condition of consumption of <1 serving of fish weekly (OR = 0.46; 95% CI = 0.26-0.80). CONCLUSIONS High habitual fish consumption seems to be associated with less carotid atherosclerosis, though adequate interventional trials are necessary to confirm the role of fish consumption in prevention of cardiovascular disease.
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Affiliation(s)
- Silvio Buscemi
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS) - Laboratorio di Nutrizione Clinica, University of Palermo, Palermo, Italy.
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Carotid Atherosclerosis Predicts Future Myocardial Infarction But Not Venous Thromboembolism. Arterioscler Thromb Vasc Biol 2014; 34:226-30. [DOI: 10.1161/atvbaha.113.302162] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Li MF, Ren Y, Zhao CC, Zhang R, Li LX, Liu F, Lu JX, Tu YF, Zhao WJ, Bao YQ, Jia WP. Prevalence and clinical characteristics of lower limb atherosclerotic lesions in newly diagnosed patients with ketosis-onset diabetes: a cross-sectional study. Diabetol Metab Syndr 2014; 6:71. [PMID: 24926320 PMCID: PMC4054910 DOI: 10.1186/1758-5996-6-71] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 05/26/2014] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The clinical features of atherosclerotic lesions in ketosis-onset diabetes are largely absent. We aimed to compare the characteristics of lower limb atherosclerotic lesions among type 1, ketosis-onset and non-ketotic type 2 diabetes. METHODS A cross-sectional study was performed in newly diagnosed Chinese patients with diabetes, including 53 type 1 diabetics with positive islet-associated autoantibodies, 208 ketosis-onset diabetics without islet-associated autoantibodies, and 215 non-ketotic type 2 diabetics. Sixty-two subjects without diabetes were used as control. Femoral intima-media thickness (FIMT), lower limb atherosclerotic plaque and stenosis were evaluated and compared among the four groups based on ultrasonography. The risk factors associated with lower limb atherosclerotic plaque were evaluated via binary logistic regression in patients with diabetes. RESULTS After adjusting for age and sex, the prevalence of lower limb plaque in the patients with ketosis-onset diabetes (47.6%) was significantly higher than in the control subjects (25.8%, p = 0.013), and showed a higher trend compared with the patients with type 1 diabetes (39.6%, p = 0.072), but no difference was observed in comparison to the patients with non-ketotic type 2 diabetes (62.3%, p = 0.859). The mean FIMT in the ketosis-onset diabetics (0.73 ± 0.17 mm) was markedly greater than that in the control subjects (0.69 ± 0.13 mm, p = 0.045) after controlling for age and sex, but no significant differences were found between the ketosis-onset diabetics and the type 1 diabetics (0.71 ± 0.16 mm, p = 0.373), and the non-ketotic type 2 diabetics (0.80 ± 0.22 mm, p = 0.280), respectively. Age and FIMT were independent risk factors for the presence of lower limb plaque in both the ketosis-onset and non-ketotic type 2 diabetic patients, while sex and age in the type 1 diabetic patients. CONCLUSIONS The prevalence and risk of lower limb atherosclerotic plaque in the ketosis-onset diabetes were remarkably higher than in the control subjects without diabetes. The features and risk factors of lower limb atherosclerotic lesions in the ketosis-onset diabetes resembled those in the non-ketotic type 2 diabetes, but different from those in the type 1 diabetes. Our findings provide further evidences to support the classification of ketosis-onset diabetes as a subtype of type 2 diabetes rather than idiopathic type 1 diabetes.
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Affiliation(s)
- Mei-Fang Li
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital; Shanghai Diabetes Institute; Shanghai Clinical Center for Diabetes; Shanghai key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai 200233, China
| | - Ying Ren
- Department of VIP, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 600 Yishan Road, Shanghai 200233, China
| | - Cui-Chun Zhao
- Department of VIP, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 600 Yishan Road, Shanghai 200233, China
| | - Rong Zhang
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital; Shanghai Diabetes Institute; Shanghai Clinical Center for Diabetes; Shanghai key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai 200233, China
| | - Lian-Xi Li
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital; Shanghai Diabetes Institute; Shanghai Clinical Center for Diabetes; Shanghai key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai 200233, China
| | - Fang Liu
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital; Shanghai Diabetes Institute; Shanghai Clinical Center for Diabetes; Shanghai key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai 200233, China
| | - Jun-Xi Lu
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital; Shanghai Diabetes Institute; Shanghai Clinical Center for Diabetes; Shanghai key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai 200233, China
| | - Yin-Fang Tu
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital; Shanghai Diabetes Institute; Shanghai Clinical Center for Diabetes; Shanghai key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai 200233, China
| | - Wei-Jing Zhao
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital; Shanghai Diabetes Institute; Shanghai Clinical Center for Diabetes; Shanghai key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai 200233, China
| | - Yu-Qian Bao
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital; Shanghai Diabetes Institute; Shanghai Clinical Center for Diabetes; Shanghai key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai 200233, China
| | - Wei-Ping Jia
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital; Shanghai Diabetes Institute; Shanghai Clinical Center for Diabetes; Shanghai key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai 200233, China
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Buscemi S, Mattina A, Rosafio G, Massenti FM, Galvano F, Grosso G, Amodio E, Barile AM, Maniaci V, Bonura A, Sprini D, Rini GB. Habitual street food intake and subclinical carotid atherosclerosis. Eat Weight Disord 2014; 19:363-70. [PMID: 24151145 DOI: 10.1007/s40519-013-0081-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Accepted: 10/07/2013] [Indexed: 11/26/2022] Open
Abstract
Street food (SF) is defined as out-of-home food consumption, and generally consists of energy-dense meals rich in saturated fats and poor in fibers, vitamins and antioxidants. Though SF consumption may have unfavorable metabolic and cardiovascular effects, its possible association with atherosclerosis has not been considered. The association between habitual SF consumption and asymptomatic carotid atherosclerosis, defined as the presence of plaques and/or increased intima-media thickness, was therefore investigated. One thousand thirty-five randomly selected adult participants without known diabetes and atherosclerotic cardiovascular diseases were cross-sectionally investigated in Palermo, Italy. Each participant answered a food frequency questionnaire and underwent high-resolution ultrasonographic evaluation of both carotid arteries. Laboratory blood measurements were obtained in a subsample of 541 participants. A score of SF consumption was obtained by categorizing each of ten SFs consumed more or less than once a month. Participants were divided into three classes based on the tertiles of SF score distribution. Age, gender distribution, body mass index (BMI), prevalence of hypertension and of clinically silent carotid atherosclerosis (I tertile 20.8 %, II tertile 19.7 %, III tertile 19.0 %; P = 0.85) were not significantly different among the three groups. Clinically silent carotid atherosclerosis was independently associated with age, gender and hypertension. The score of SF consumption was significantly correlated with BMI (r = 0.10; P = 0.04), uric acid (r = 0.16; P = 0.002) and high-density lipoproteins-cholesterol (r = -0.13; P = 0.009) blood concentrations. In conclusion, this study suggests that SF consumption is not associated with clinically silent carotid atherosclerosis. However, given the association of SF consumption with other cardiovascular risk factors, caution requires that this category of food should be limited in patients at high cardiovascular risk.
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Affiliation(s)
- Silvio Buscemi
- Laboratorio di Nutrizione Clinica, Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), P. Giaccone Policlinico, University of Palermo, Via del Vespro 129, 90127, Palermo, Italy,
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Sillesen H, Fuster V. Predicting coronary heart disease: from Framingham Risk Score to ultrasound bioimaging. ACTA ACUST UNITED AC 2013; 79:654-63. [PMID: 23239204 DOI: 10.1002/msj.21343] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Atherosclerosis is the leading cause of death and disabling disease. Whereas risk factors are well known and constitute therapeutic targets, they are not useful for prediction of risk of future myocardial infarction, stroke, or death. Therefore, methods to identify atherosclerosis itself have been tested and found useful (ie, coronary calcium detection by computed tomography scanning, reduction in ankle-brachial index, and ultrasound scanning of the carotid arteries). This review will focus on the latter technique. Detection of thickened carotid intima-media by ultrasound has been used in many large epidemiological studies, but although it has been found to be associated with increased risk of cardiovascular death, its clinical utility is limited. Detection of carotid plaque has, on the other hand, been found to be associated with a substantial risk of future events. Similarly, detection of plaque in the femoral arteries is associated with increased risk, and plaque in the femoral as well as carotid arteries predicts even higher risk. Furthermore, quantification of plaque size (plaque area), such as quantification of amount of coronary calcium on computed tomography scanning, improves predictability-the larger the plaques, the higher the risk. So far, studies using ultrasound all have been performed with 2-dimensional ultrasound imaging. Recently, 3-dimensional ultrasound imaging has been introduced, which allows for more accurate quantification of atherosclerosis. Small studies pioneering its use have indicated the utility of measuring changes in vessel-wall volume and plaque volume with respect to treatment effect. The High-Risk Plaque Initiative BioImage Study is currently investigating the predictive value of total carotid plaque volume with respect to prediction of future cardiovascular events.
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Affiliation(s)
- Henrik Sillesen
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
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Coll B, Betriu A, Feinstein SB, Valdivielso JM, Zamorano JL, Fernández E. Papel de la ecografía carotídea en la reclasificación del riesgo cardiovascular de sujetos de riesgo bajo-intermedio. Rev Esp Cardiol 2013. [DOI: 10.1016/j.recesp.2013.05.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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48
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Coll B, Betriu A, Feinstein SB, Valdivielso JM, Zamorano JL, Fernández E. The role of carotid ultrasound in assessing carotid atherosclerosis in individuals at low-to-intermediate cardiovascular risk. ACTA ACUST UNITED AC 2013; 66:929-34. [PMID: 24774105 DOI: 10.1016/j.rec.2013.05.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 06/05/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION AND OBJECTIVES Detection of carotid atherosclerosis might help to better identify individuals susceptible to cardiovascular events. We aimed to quantify the number of participants with carotid atherosclerosis and low-to-intermediate cardiovascular risk according to the traditional risk factor scoring, and therefore with an elevated risk of cardiovascular events. METHODS Cross-sectional, observational study performed during a cardiovascular screening program. From a total of 3778 volunteers, low-to-intermediate cardiovascular risk individuals (N=2354) were identified and studied. Physical examination, blood test, and carotid ultrasound followed standard procedures. Common, bulb, and internal carotid arteries were examined and common carotid intima-media thickness was measured. SCORE risk value was calculated for all participants. Univariate and multivariate statistical analysis was performed. RESULTS Mean age of participants was 58.9 (15) years, 43.8% were men, 23.7% had hypertension, and 20.5% had hypercholesterolemia. The mean SCORE value was 1.47 (1.4). Both carotid intima-media thickness and the prevalence of carotid plaques increased steadily and significantly (P<.005) as advanced decades of life were analyzed. Variables significantly related with the presence of carotid atherosclerosis were age, male sex, and systolic blood pressure. Interestingly, 592 (25.1%) individuals were reclassified to a higher risk due to the presence of carotid atherosclerosis. CONCLUSIONS There was a clear dissociation between cardiovascular risk scoring and the presence of atherosclerosis, because 1 of 4 study participants at low-to-intermediate cardiovascular risk had carotid atherosclerosis.
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Affiliation(s)
- Blai Coll
- UDETMA, Hospital Universitari Arnau de Vilanova, IRBLleida, Lleida, Spain
| | - Angels Betriu
- UDETMA, Hospital Universitari Arnau de Vilanova, IRBLleida, Lleida, Spain
| | - Steve B Feinstein
- Cardiology Department, Rush University Medical School, Chicago, Illinois, United States
| | - Jose M Valdivielso
- UDETMA, Hospital Universitari Arnau de Vilanova, IRBLleida, Lleida, Spain
| | - Jose L Zamorano
- Servicio de Cardiología, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - Elvira Fernández
- UDETMA, Hospital Universitari Arnau de Vilanova, IRBLleida, Lleida, Spain.
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Lind L. Flow-mediated vasodilation was found to be an independent predictor of changes in the carotid plaque status during a 5-year follow-up. J Atheroscler Thromb 2013; 21:161-8. [PMID: 24126123 DOI: 10.5551/jat.18572] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM It has previously been shown that flow-mediated vasodilation is a predictor of the progression of the intima-media thickness (IMT). In the present study, the degree of endothelium-dependent vasodilation in both resistance and conduit arteries was evaluated as a predictor of the IMT and plaque progression. METHODS In the population-based Prospective Study of the Vasculature in Uppsala Seniors(PIVUS) trial(1,016 subjects all 70 years of age), the invasive forearm technique using acetylcholine administered in the brachial artery (resistance artery, EDV) and the brachial artery ultrasound technique with measurement of flow-mediated dilatation (conduit artery, FMD) were evaluated. The IMT and number of carotid arteries with plaques (0, 1 or 2) were recorded using ultrasound at the baseline investigation and the follow-up visit conducted five years later. RESULTS A total of 760 subjects had valid measurements of the IMT and carotid artery plaques at both the investigations conducted at 70 and 75 years of age. Neither the FMD nor EDV significantly predicted the change in IMT over five years. However, the FMD, but not EDV, was associated with the change in carotid plaque burden during the follow-up period, independent of classical risk factors, such as gender, waist circumference, fasting blood glucose, systolic and diastolic blood pressure, HDL- and LDL-cholesterol, serum triglycerides, BMI and smoking (OR 0.81 for a 1 SD change in FMD, 95%CI 0.68 to 0.95, p=0.010). CONCLUSIONS The FMD was found to be a predictor of changes in the carotid plaque status, but not IMT, during the 5-year follow-up period, independent of classical cardiovascular risk factors.
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Affiliation(s)
- Lars Lind
- Department of Medical Sciences, University Hospital, Uppsala University
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50
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Association of dietary patterns with insulin resistance and clinically silent carotid atherosclerosis in apparently healthy people. Eur J Clin Nutr 2013; 67:1284-90. [DOI: 10.1038/ejcn.2013.172] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 07/27/2013] [Accepted: 08/13/2013] [Indexed: 01/22/2023]
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