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Nishimura Y, Khan M, Lee B, Arayangkool C, Zhang J, Palanisamy A, Banerjee D, Izutsu C. Defining optimal blood pressure control for pre-transplant end-stage renal disease patients: scoping review. Blood Press Monit 2023; 28:316-321. [PMID: 37910025 DOI: 10.1097/mbp.0000000000000668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
BACKGROUND Strict blood pressure control is essential to prevent cardiovascular disease and is associated with decreased mortality. However, in patients with end-stage renal disease awaiting renal transplantation, the level of optimal blood pressure control is not yet defined. METHODS Following the PRISMA Extension for Scoping Reviews, we searched MEDLINE and EMBASE for all peer-reviewed articles using keywords including 'end-stage renal disease', 'blood pressure', and 'pre-transplant' from their inception to 7 August 2022. RESULTS Seven observational studies, including one population-based study, were included in the review. Most studies investigated factors associated with post-transplant graft failure or mortality. There was considerable heterogeneity in defining optimal pre-transplant blood pressure measurement frequency among studies (average of three measurements vs. single measurement). One study suggested that low pre-transplant diastolic blood pressure (<50 mmHg) was associated with lower odds of delayed graft failure and mortality. Two studies noted that pre-transplant hypertension, or clinical criteria of hypertension that were present prior to transplant, was associated with post-transplant adverse outcomes. In contrast, one study noted that pre-transplant sustained hypotension with mean blood pressure <80 mmHg, was associated with a higher frequency of delayed graft failure. CONCLUSION This systematic review summarizes the current evidence regarding the relationship between pre-transplant blood pressure control and post-transplant outcomes in end-stage renal disease patients. While the results from the included studies are mixed, more stringent blood pressure control than currently practiced may be beneficial to decrease graft failure and mortality in this patient population.
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Affiliation(s)
- Yoshito Nishimura
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawaii, USA
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Chedid G, Malik A, Daher R, Welty FK. Higher exercise capacity, but not omega-3 fatty acid consumption, predicts lower coronary artery calcium scores in women and men with coronary artery disease. Atherosclerosis 2023; 384:117168. [PMID: 37541921 PMCID: PMC10749985 DOI: 10.1016/j.atherosclerosis.2023.06.074] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 06/11/2023] [Accepted: 06/13/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND AND AIMS Higher coronary artery calcium (CAC) scores are associated with increased cardiovascular (CVD) events and mortality. Exercise capacity is predictive of CVD events. Our aim was to examine the relationship between exercise capacity and CAC in women and men. METHODS CAC was measured in 203 men and 38 women with clinical coronary artery disease using multidetector coronary tomography. They were randomized to 3.36 g eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) daily or none for 30 months. Maximal exercise treadmill testing was performed at baseline with calculation of metabolic equivalents of task (METs) achieved as a measure of exercise capacity. RESULTS Despite similar ages at baseline (64.0 ± 6.7 vs 62.7 ± 7.8 years, respectively, p = 0.225), women had lower CAC scores compared to men: 106.7 Agatston units [AU] vs 535.3, respectively, p < 0.001, and at every age (p < 0.001). Female CAC scores did not equal those of men until women were 20 years older. Higher levels of METs were associated with lower CAC scores in both women and men. After multivariate adjustment, METs was the most important predictor of CAC score in women at baseline and 30 months (p = 0.001 and 0.029, respectively) whereas only age predicted in men (p = 0.019 and 0.004, respectively). Annual CAC progression was significantly greater in men compared to women (94.8 AU/year vs 38.0, respectively, p = 0.014). No difference was observed in CAC progression in the EPA + DHA group compared to control in either men or women. CONCLUSIONS The association of higher METs with lower CAC scores in both women and men supports recommending exercise to maximize cardiorespiratory fitness as this may minimize CAC scores and thus, potentially decrease risk for CVD events. This may be especially important for women since METs independently predicted baseline and 30 month CAC in women.
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Affiliation(s)
- Georges Chedid
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Abdulaziz Malik
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Ralph Daher
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Francine K Welty
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, United States.
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Welty FK, Hariri E, Asbeutah AA, Daher R, Amangurbanova M, Chedid G, Elajami TK, Alfaddagh A, Malik A. Regression of Coronary Fatty Plaque and Risk of Cardiac Events According to Blood Pressure Status: Data From a Randomized Trial of Eicosapentaenoic Acid and Docosahexaenoic Acid in Patients With Coronary Artery Disease. J Am Heart Assoc 2023; 12:e030071. [PMID: 37681568 PMCID: PMC10547278 DOI: 10.1161/jaha.123.030071] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/10/2023] [Indexed: 09/09/2023]
Abstract
Background Residual risk of cardiovascular events and plaque progression remains despite reduction in low-density lipoprotein cholesterol. Factors contributing to residual risk remain unclear. The authors examined the role of eicosapentaenoic acid and docosahexaenoic acid in coronary plaque regression and its predictors. Methods and Results A total of 240 patients with stable coronary artery disease were randomized to eicosapentaenoic acid plus docosahexaenoic acid (3.36 g/d) or none for 30 months. Patients were stratified by regression or progression of coronary fatty plaque measured by coronary computed tomographic angiography. Cardiac events were ascertained. The mean±SD age was 63.0±7.7 years, mean low-density lipoprotein cholesterol level was <2.07 mmol/L, and median triglyceride level was <1.38 mmol/L. Regressors had a 14.9% reduction in triglycerides that correlated with fatty plaque regression (r=0.135; P=0.036). Compared with regressors, progressors had higher cardiac events (5% vs 22.3%, respectively; P<0.001) and a 2.89-fold increased risk of cardiac events (95% CI, 1.1-8.0; P=0.034). Baseline non-high-density lipoprotein cholesterol level <2.59 mmol/L (100 mg/dL) and systolic blood pressure <125 mm Hg were significant independent predictors of fatty plaque regression. Normotensive patients taking eicosapentaenoic acid plus docosahexaenoic acid had regression of noncalcified coronary plaque that correlated with triglyceride reduction (r=0.35; P=0.034) and a significant decrease in neutrophil/lymphocyte ratio. In contrast, hypertensive patients had no change in noncalcified coronary plaque or neutrophil/lymphocyte ratio. Conclusions Triglyceride reduction, systolic blood pressure <125 mm Hg, and non-high-density lipoprotein cholesterol <2.59 mmol/L were associated with coronary plaque regression and reduced cardiac events. Normotensive patients had greater benefit than hypertensive patients potentially due to lower levels of inflammation. Future studies should examine the role of inflammation in plaque regression. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01624727.
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Affiliation(s)
- Francine K. Welty
- Division of CardiologyBeth Israel Deaconess Medical CenterBostonMAUSA
| | | | | | - Ralph Daher
- Gilbert and Rose‐Marie Chagoury School of MedicineLebanese American UniversityByblosLebanon
| | | | - Georges Chedid
- Gilbert and Rose‐Marie Chagoury School of MedicineLebanese American UniversityByblosLebanon
| | - Tarec K. Elajami
- Division of CardiologyBeth Israel Deaconess Medical CenterBostonMAUSA
| | | | - Abdulaziz Malik
- Division of CardiologyBeth Israel Deaconess Medical CenterBostonMAUSA
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Hara T, Kasahara Y, Nakagawa T. Pre-dialysis diastolic blood pressure and intradialytic hypotension in patients undergoing maintenance haemodialysis. J Nephrol 2022; 35:1419-1426. [PMID: 35247180 DOI: 10.1007/s40620-022-01292-2] [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: 12/18/2021] [Accepted: 02/17/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Intradialytic hypotension is a clinically relevant complication in haemodialysis patients. Pre-dialysis diastolic blood pressure is routinely measured. However, the association between pre-dialysis diastolic blood pressure and intradialytic hypotension is not well understood. METHODS Patient-level (N = 545) and haemodialysis session-level (N = 3261) data were collected; the exposure variable was pre-dialysis diastolic blood pressure. The primary outcome of interest was the development of intradialytic hypotension, defined as any nadir < 100 mmHg if the pre-dialysis systolic blood pressure was ≥ 160 mmHg, or any nadir < 90 mmHg if the pre-dialysis systolic blood pressure was < 160 mmHg. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated using mixed-effects logistic regression for the association between pre-dialysis diastolic blood pressure and intradialytic hypotension, after adjusting for potential confounders. RESULTS Intradialytic hypotension occurred in 14.4% of the sessions. All sessions were divided into five categories according to pre-dialysis diastolic blood pressure. The adjusted ORs for intradialytic hypotension were 2.72 (95% CI 1.64-4.51), 1.07 (95% CI 0.68-1.66), 1.68 (95% CI 1.08-2.62), and 1.81 (95% CI 1.05-3.14) in sessions with pre-dialysis diastolic blood pressure of < 60 mmHg, ≥ 60 to < 70 mmHg, ≥ 80 to < 90 mmHg, and ≥ 90 mmHg, respectively, compared with the reference pre-dialysis diastolic blood pressure of ≥ 70 to < 80 mmHg. Cubic spline analyses revealed a reverse J-shaped association between pre-dialysis diastolic blood pressure and intradialytic hypotension. CONCLUSIONS Low and high pre-dialysis diastolic blood pressure levels were associated with intradialytic hypotension. This may help identify patients at a high risk of developing intradialytic hypotension.
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Affiliation(s)
- Takashi Hara
- Department of Nephrology, Rakuwakai Otowa Hospital, 2 Otowa-Chinji-cho, Yamashina-ku, Kyoto, 607-8062, Japan.
| | - Yuto Kasahara
- Department of Nephrology, Rakuwakai Otowa Hospital, 2 Otowa-Chinji-cho, Yamashina-ku, Kyoto, 607-8062, Japan
| | - Takahiko Nakagawa
- Department of Nephrology, Rakuwakai Otowa Hospital, 2 Otowa-Chinji-cho, Yamashina-ku, Kyoto, 607-8062, Japan.,Department of Biochemistry, Shiga University of Medical Science, Shiga, Japan
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Analysis of Fibrotic Plaques in Angiographic Manifest Cardiac Allograft Vasculopathy in Long-term Heart Transplanted Patients Using Optical Coherence Tomography. Transplant Direct 2021; 8:e1266. [PMID: 34966839 PMCID: PMC8710340 DOI: 10.1097/txd.0000000000001266] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 10/24/2021] [Accepted: 10/26/2021] [Indexed: 12/02/2022] Open
Abstract
Supplemental Digital Content is available in the text. Background. The development and progression of cardiac allograft vasculopathy documented by coronary angiography (CAVangio) after heart transplantation (HTx) has prognostic relevance. Yet there are limited data regarding the role of concomitant intracoronary imaging in the presence CAVangio. In particular, atherosclerotic plaques might represent a potential target for prevention, but their impact on stenosis is understudied. Methods. We used high-resolution intracoronary optical coherence tomography (OCT) to quantify and compare findings of intimal hyperplasia (IH) and plaque morphologies in HTx patients (fibrotic plaque, lipid plaque, and calcified plaque). OCT findings were related to the presence of CAVangio as well as to the severity of stenosis. Results. We included 65 consecutive patients into analysis (66% with CAVangio, posttransplant interval 9.9 ± 7.6 y). Fibrotic, lipid, and calcified plaques were present in 41 (63.1%), 39 (60%), and 18 (27.7%) patients, respectively. In addition to IH, the presence of fibrotic, lipid, and calcified plaques was found to be associated with CAVangio. The prevalence of lipid plaque and quantitative measurements of fibrotic plaque increased with stenosis severity (lipid plaque, P < 0.001, maximal and mean fibrotic arc, P = 0.05 and P = 0.001, respectively). Receiver operating characteristic analysis showed that area under the curve of the fibrotic plaque parameter mean fibrotic arc (0.87, 95% confidence interval [0.76-0.99]; P = 0.002) was superior to area under the curve of intima parameters regarding CAVangio. The effect of mean fibrotic arc (r = 0.52, P < 0.001) was relevant regarding stenosis severity. Conclusions. After a longer posttransplant interval, CAV findings in OCT included a combination of IH and atherosclerotic plaques. In addition to IH, the presence of fibrotic, lipid, and calcified plaques is associated with CAVangio. Further studies are warranted to evaluate if the in vivo screening for plaque progress, particularly of fibrotic plaque, could improve individual secondary prevention and outcome in HTx patients.
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Song X, Wei Q, Zhao X, Hou D, Zhao H, Wang L, Zhang X, Zheng Z, Wu J. Association between Short-Term Blood Pressure Variability and Intracranial Atherosclerotic Plaque Vulnerability: A High-Resolution Magnetic Resonance Imaging Study. J Atheroscler Thromb 2021; 29:1383-1392. [PMID: 34707024 PMCID: PMC9444806 DOI: 10.5551/jat.63164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: short-term blood pressure variability (BPV) as a risk factor of atherosclerosis and cardiovascular events has been investigated. However, its association with atherosclerotic plaque vulnerability remains unknown. The objective of this study was to determine the association between short-term BPV and intracranial atherosclerotic plaque vulnerability.
Methods: this is a cross-sectional analysis of 267 ischemic stroke patients with symptomatic intracranial atherosclerosis (mean age, 65±12 years old; 60.3% male), which were prospectively recruited in a comprehensive stroke center. Systolic and diastolic BP SD, CV, and BP variability ratio (BPVR) from 24 hours, daytime, and nighttime were calculated from 24-h ambulatory blood pressure monitoring, intracranial atherosclerotic plaque burden and vulnerability were evaluated by high-resolution magnetic resonance vessel wall imaging. Logistic regression analysis was used to locate the correlation between short-term BPV and plaque vulnerability.
Results: a total of 36.3% subjects presented with intraplaque hemorrhage (IPH) in this study. Multivariate logistic regression suggested that nighttime diastolic BP CV and 24-h BPVR were associated with intracranial IPH independently after adjusted for cardiovascular risk factors, odds ratio (OR) and 95% confidence interval (CI) for per SD BPV changes were 1.418 (1.051, 1.914) and 0.731 (0.548, 0.976), respectively, and this association also independent of atherosclerosis burden and 24-h mean systolic BP level. Further subgroup analysis by age and hypertension history demonstrated that the statistical correlation could only establish in the elder, and subjects with hypertension.
Conclusion: nighttime diastolic BP CV and 24-h BPVR were associated with intracranial IPH independently, especially in the elderly and subjects with hypertension.
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Affiliation(s)
- Xiaowei Song
- Department of Neurology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University
| | - Qiao Wei
- Department of Neurology, The Second Hospital of Hebei Medical University
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine
| | - Duoduo Hou
- Department of Neurology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University
| | - Hongliang Zhao
- Department of Radiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University
| | - Lixue Wang
- Department of Radiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University
| | - Xiaofeng Zhang
- Department of Neurology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University
| | - Zhuozhao Zheng
- Department of Radiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University
| | - Jian Wu
- Department of Neurology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University
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Malik A, Ramadan A, Vemuri B, Siddiq W, Amangurbanova M, Ali A, Welty FK. ω-3 Ethyl ester results in better cognitive function at 12 and 30 months than control in cognitively healthy subjects with coronary artery disease: a secondary analysis of a randomized clinical trial. Am J Clin Nutr 2021; 113:1168-1176. [PMID: 33675344 PMCID: PMC8243604 DOI: 10.1093/ajcn/nqaa420] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 12/11/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Omega-3 (n-3) fatty acids have shown benefit in cognitively impaired subjects, but the effect on cognitively healthy older subjects is unclear. OBJECTIVES Our aim was to determine if long-term, high-dose ω-3 ethyl esters, EPA (20:5n-3) and DHA (22:6n-3), prevent deterioration of cognitive function in cognitively healthy older adults. METHODS A total of 285 subjects with stable coronary artery disease (CAD) on statin treatment were randomly assigned to 3.36 g EPA and DHA or none (control) for 30 mo. Cognitive function was assessed in all 285 subjects at baseline and in 268 and 250 subjects who returned at 12- and 30-mo follow-up, respectively, with neuropsychological testing as a prespecified secondary outcome. A completer's analysis, along with a sensitivity analysis carrying forward the last observation, was performed. RESULTS Over the 30-mo period, subjects randomly assigned to EPA and DHA had significantly better scores than control for verbal fluency, language, and memory (mean: 1.08; 95% CI: 0.25, 1.91; P = 0.011) and 2 tests of visual-motor coordination (mean: -2.95; 95% CI: -5.33, -0.57; P = 0.015 and mean: -9.44; 95% CI: -18.60, -0.30; P = 0.043, respectively). The better scores for EPA and DHA were due to an improvement at 12 mo compared with baseline in verbal fluency, language, and memory (P = 0.047) and 2 tests of visual-motor coordination (P = 0.033 and P < 0.001, respectively), whereas control had no change. Post hoc analyses indicated no difference by age, sex, or diabetes status. CONCLUSIONS Cognitively healthy older adults with stable CAD randomly assigned to high-dose EPA and DHA had improved cognitive function over a 30-mo period compared with control. These findings may be especially important for CAD patients because CAD is a risk factor for cognitive decline.This trial was registered at clinicaltrials.gov as NCT01624727.
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Affiliation(s)
- Abdulaziz Malik
- Division of Cardiovascular Medicine, Beth Israel Deaconess
Medical Center, Harvard Medical School, Boston, MA,
USA
| | - Amira Ramadan
- Division of Cardiovascular Medicine, Beth Israel Deaconess
Medical Center, Harvard Medical School, Boston, MA,
USA
| | - Bhavya Vemuri
- Division of Cardiovascular Medicine, Beth Israel Deaconess
Medical Center, Harvard Medical School, Boston, MA,
USA
| | - Wardah Siddiq
- Division of Cardiovascular Medicine, Beth Israel Deaconess
Medical Center, Harvard Medical School, Boston, MA,
USA
| | - Maral Amangurbanova
- Division of Cardiovascular Medicine, Beth Israel Deaconess
Medical Center, Harvard Medical School, Boston, MA,
USA
| | - Aamir Ali
- Division of Cardiovascular Medicine, Beth Israel Deaconess
Medical Center, Harvard Medical School, Boston, MA,
USA
| | - Francine K Welty
- Division of Cardiovascular Medicine, Beth Israel Deaconess
Medical Center, Harvard Medical School, Boston, MA,
USA
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Rojulpote C, Patil S, Gonuguntla K, Karambelkar P, Bravo PE, Seraj SM, Asadollahi S, Raynor WY, Bhattaru A, Borja AJ, Zhang V, Werner TJ, Gerke O, Høilund-Carlsen PF, Alavi A. NaF-PET/CT global assessment in detecting and quantifying subclinical cardiac atherosclerosis and its association with blood pressure in non-dyslipidemic individuals. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2020; 10:101-107. [PMID: 32685267 PMCID: PMC7364275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 06/02/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND We used 18F-sodium fluoride (NaF) to assess early atherosclerosis in the global heart in asymptomatic individuals with a coronary calcium score of zero and without a formal diagnosis of hypertension. We hypothesized that these individuals might present with subclinical atherosclerosis that correlates with systolic, diastolic and mean arterial pressure (SBP, DBP, and MAP). METHODS We identified 20 asymptomatic individuals (41.6 ± 13.8 years, 8 females) from the CAMONA trial with C-reactive protein ≥3 mg/L, no smoking history, diabetes (fasting blood glucose <126 mg/dl) and dyslipidemia per the Adult Treatment Panel III Guidelines: untreated LDL <160 mg/dL, total cholesterol <240 mg/dL, HDL >40 mg/dL. All underwent PET/CT imaging 90 minutes after NaF injection (2.2 Mbq/Kg). The global cardiac average SUVmean (aSUVmean) was calculated for each individual. Correlation coefficients and linear regression models were employed for statistical analysis. RESULTS Significant positive correlation was revealed between global cardiac NaF uptake and all blood pressures: SBP (r=0.44, P=0.05), DBP (r=0.64, P=0.002), and MAP (r=0.59, P=0.007). After adjusting for age and gender, DBP and MAP were independent predictors of higher global cardiac NaF uptake. CONCLUSION NaF-PET/CT for detecting and quantifying subclinical atherosclerosis in asymptomatic individuals revealed that cardiac NaF uptake correlated independently with DBP and MAP.
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Affiliation(s)
- Chaitanya Rojulpote
- Department of Radiology, University of PennsylvaniaPhiladelphia, Pennsylvania, United States
- Department of Internal Medicine, The Wright Center for Graduate Medical EducationScranton, Pennsylvania, United States
| | - Shivaraj Patil
- Department of Radiology, University of PennsylvaniaPhiladelphia, Pennsylvania, United States
- Department of Internal Medicine, University of ConnecticutFarmington, Connecticut, United States
| | - Karthik Gonuguntla
- Department of Radiology, University of PennsylvaniaPhiladelphia, Pennsylvania, United States
- Department of Internal Medicine, University of ConnecticutFarmington, Connecticut, United States
| | - Pranav Karambelkar
- Department of Internal Medicine, The Wright Center for Graduate Medical EducationScranton, Pennsylvania, United States
| | - Paco E Bravo
- Department of Radiology, University of PennsylvaniaPhiladelphia, Pennsylvania, United States
| | - Siavash M Seraj
- Department of Radiology, University of PennsylvaniaPhiladelphia, Pennsylvania, United States
| | - Shadi Asadollahi
- Department of Radiology, University of PennsylvaniaPhiladelphia, Pennsylvania, United States
| | - William Y Raynor
- Department of Radiology, University of PennsylvaniaPhiladelphia, Pennsylvania, United States
| | - Abhijit Bhattaru
- Department of Radiology, University of PennsylvaniaPhiladelphia, Pennsylvania, United States
| | - Austin J Borja
- Department of Radiology, University of PennsylvaniaPhiladelphia, Pennsylvania, United States
| | - Vincent Zhang
- Department of Radiology, University of PennsylvaniaPhiladelphia, Pennsylvania, United States
| | - Thomas J Werner
- Department of Radiology, University of PennsylvaniaPhiladelphia, Pennsylvania, United States
| | - Oke Gerke
- Department of Nuclear Medicine, Odense University HospitalOdense, Denmark
- Department of Clinical Research, University of Southern DenmarkOdense, Denmark
| | - Poul F Høilund-Carlsen
- Department of Nuclear Medicine, Odense University HospitalOdense, Denmark
- Department of Clinical Research, University of Southern DenmarkOdense, Denmark
| | - Abass Alavi
- Department of Radiology, University of PennsylvaniaPhiladelphia, Pennsylvania, United States
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Malik A, Kanduri JS, Asbeutah AAA, Khraishah H, Shen C, Welty FK. Exercise Capacity, Coronary Artery Fatty Plaque, Coronary Calcium Score, and Cardiovascular Events in Subjects With Stable Coronary Artery Disease. J Am Heart Assoc 2020; 9:e014919. [PMID: 32212910 PMCID: PMC7428649 DOI: 10.1161/jaha.119.014919] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Aerobic exercise capacity is inversely associated with cardiovascular and all‐cause mortality in men and women without coronary artery disease (CAD); however, a higher amount of vigorous exercise is associated with a J‐shaped relationship in CAD patients. Therefore, the optimal type and amount of exercise for CAD patients is unclear. Coronary artery calcification (CAC) is associated with increased cardiovascular disease (CVD) events and mortality. Fatty plaque is more likely to rupture and cause coronary events than other types. We examined the association between exercise capacity, fatty plaque, CAC score and CVD events in CAD patients. Methods and Results A total of 270 subjects with stable CAD were divided into tertiles based on metabolic equivalents of task (METs) calculated from exercise treadmill testing. Self‐reported exercise was obtained. Coronary computed tomographic angiography measured coronary plaque volume and CAC score. After adjustment, fatty plaque volume was not different among the 3 MET groups. For each 1 MET increase, CAC was 66.2 units lower (P=0.017). Those with CAC >400 and ≥8.2 METs had fewer CVD events over 30 months compared to <8.2 METs (P=0.037). Of moderate intensity exercisers (median, 240 min/wk; 78% walking only), 62.4% achieved ≥8.2 METs and lower CAC scores (P=0.07). Intensity and duration of exercise had no adverse impact on coronary plaque or CVD events. Conclusions Achieving ≥8.2 METs with moderate exercise intensity and volume as walking resulted in lower CAC scores and fewer CVD events. Therefore, vigorous exercise intensity and volume may not be needed for CAD patients to derive benefit. Registration URL: https://www.clinicaltrials.gov; Unique Identifier: NCT01624727.
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Affiliation(s)
- Abdulaziz Malik
- Division of Cardiovascular Medicine Department of Medicine Beth Israel Deaconess Medical Center Harvard Medical School Boston MA
| | - Jaya S Kanduri
- Department of Medicine Beth Israel Deaconess Medical Center Harvard Medical School Boston MA
| | - Abdul Aziz A Asbeutah
- Division of Cardiovascular Medicine Department of Medicine Beth Israel Deaconess Medical Center Harvard Medical School Boston MA
| | - Haitham Khraishah
- Department of Medicine Beth Israel Deaconess Medical Center Harvard Medical School Boston MA
| | - Changyu Shen
- Division of Cardiovascular Medicine Department of Medicine Beth Israel Deaconess Medical Center Harvard Medical School Boston MA
| | - Francine K Welty
- Division of Cardiovascular Medicine Department of Medicine Beth Israel Deaconess Medical Center Harvard Medical School Boston MA
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Fassaert LMM, Timmerman N, van Koeverden ID, Pasterkamp G, de Kleijn DPV, de Borst GJ. Preoperative hypertension is associated with atherosclerotic intraplaque hemorrhage in patients undergoing carotid endarterectomy. Atherosclerosis 2019; 290:214-221. [PMID: 31610883 DOI: 10.1016/j.atherosclerosis.2019.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 07/29/2019] [Accepted: 09/19/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIMS Both hypertension and atherosclerotic plaque characteristics such as intraplaque hemorrhage (IPH) are associated with cardiovascular events (CVE). It is unknown if hypertension is associated with IPH. Therefore, we studied if hypertension is associated with unstable atherosclerotic plaque characteristics in patients undergoing carotid endarterectomy (CEA). METHODS Prospectively collected data of CEA-patients (2002-2014) were retrospectively analyzed. Blood pressure (BP) was the mean of 3 preoperative measurements. Preoperative hypertension was defined as systolic BP ≥ 160 mmHg. Post-CEA, carotid atherosclerotic plaques were analyzed for the presence of calcifications, collagen, smooth muscle cells, macrophages, lipid core, IPH and microvessel density. Associations between BP (systolic and diastolic), patient characteristics and carotid plaque characteristics were assessed with univariate and multivariate analyses with correction for potential confounders. Results were replicated in a cohort of patients that underwent iliofemoral endarterectomy. RESULTS Within CEA-patients (n = 1684), 708 (42%) had preoperative hypertension. Increased systolic BP was associated with the presence of plaque calcifications (adjusted OR1.11 [95% CI 1.01-1.22], p = 0.03), macrophages (adjusted OR1.12 [1.04-1.21], p < 0.01), lipid core >10% of plaque area (adjusted OR1.15 [1.05-1.25], p < 0.01), IPH (adjusted OR1.12 [1.03-1.21], p = 0.01) and microvessels (adjusted beta 0.04 [0.00-0.08], p = 0.03). Increased diastolic BP was associated with macrophages (adjusted OR1.36 [1.17-1.58], p < 0.01), lipid core (adjusted OR1.29 [1.10-1.53], p < 0.01) and IPH (adjusted OR1.25 [1.07-1.46], p < 0.01) but not with microvessels nor plaque calcifications. Replication in an iliofemoral-cohort (n = 657) showed that increased diastolic BP was associated with the presence of macrophages (adjusted OR1.78 [1.13-2.91], p = 0.01), lipid core (adjusted OR1.45 [1.06-1.98], p = 0.02) and IPH (adjusted OR1.48 [1.14-1.93], p < 0.01). CONCLUSIONS Preoperative hypertension in severely atherosclerotic patients is associated with the presence of carotid plaque macrophages, lipid core and IPH. IPH, as a plaque marker for CVE, is associated with increased systolic and diastolic BP in both the CEA and iliofemoral population.
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Affiliation(s)
- Leonie M M Fassaert
- Department of Vascular Surgery, University Medical Centre Utrecht, University Utrecht, Utrecht, the Netherlands
| | - Nathalie Timmerman
- Department of Vascular Surgery, University Medical Centre Utrecht, University Utrecht, Utrecht, the Netherlands
| | - Ian D van Koeverden
- Department of Experimental Cardiology, University Medical Centre Utrecht, University Utrecht, Utrecht, the Netherlands
| | - Gerard Pasterkamp
- Laboratory of Clinical Chemistry and Hematology, University Medical Centre Utrecht, University Utrecht, Utrecht, the Netherlands
| | - Dominique P V de Kleijn
- Department of Vascular Surgery, University Medical Centre Utrecht, University Utrecht, Utrecht, the Netherlands
| | - Gert J de Borst
- Department of Vascular Surgery, University Medical Centre Utrecht, University Utrecht, Utrecht, the Netherlands.
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