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Solanki AJ, Kamrava M, Posadas EM, Freedland SJ, Ballas L, Sandler HM, Bairey Merz CN, Atkins KM, Nikolova AP. A practical guide for assessing and managing cardiovascular risk during androgen-deprivation therapy in patients with prostate cancer. Cancer 2024; 130:1916-1929. [PMID: 38529566 DOI: 10.1002/cncr.35285] [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: 12/14/2023] [Revised: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 03/27/2024]
Abstract
Prostate cancer is the most common malignancy among men worldwide, and androgen-deprivation therapy (ADT) is a mainstay of treatment. There are observational data demonstrating an increased risk of cardiovascular events in patients who receive ADT, particularly those who have an elevated baseline cardiovascular risk. Because, for most patients with prostate cancer, death is predominantly from noncancer-related causes, cardiovascular disease and its risk factors should be optimized during cancer treatment. This review provides an overview of the landscape of ADT treatment and serves as a guide for appropriate cardiovascular screening and risk-mitigation strategies. The authors emphasize the importance of shared communication between the multidisciplinary cancer team and primary care to improve baseline cardiovascular screening and treatment of modifiable risk factors within this higher risk population.
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Affiliation(s)
- Aum J Solanki
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Mitchell Kamrava
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Edwin M Posadas
- Department of Medicine, Division of Hematology Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Stephen J Freedland
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Leslie Ballas
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Howard M Sandler
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - C Noel Bairey Merz
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Katelyn M Atkins
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Andriana P Nikolova
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Somani S, Balla S, Peng AW, Dudum R, Jain S, Nasir K, Maron DJ, Hernandez-Boussard T, Rodriguez F. Contemporary attitudes and beliefs on coronary artery calcium from social media using artificial intelligence. NPJ Digit Med 2024; 7:83. [PMID: 38555387 PMCID: PMC10981728 DOI: 10.1038/s41746-024-01077-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 03/07/2024] [Indexed: 04/02/2024] Open
Abstract
Coronary artery calcium (CAC) is a powerful tool to refine atherosclerotic cardiovascular disease (ASCVD) risk assessment. Despite its growing interest, contemporary public attitudes around CAC are not well-described in literature and have important implications for shared decision-making around cardiovascular prevention. We used an artificial intelligence (AI) pipeline consisting of a semi-supervised natural language processing model and unsupervised machine learning techniques to analyze 5,606 CAC-related discussions on Reddit. A total of 91 discussion topics were identified and were classified into 14 overarching thematic groups. These included the strong impact of CAC on therapeutic decision-making, ongoing non-evidence-based use of CAC testing, and the patient perceived downsides of CAC testing (e.g., radiation risk). Sentiment analysis also revealed that most discussions had a neutral (49.5%) or negative (48.4%) sentiment. The results of this study demonstrate the potential of an AI-based approach to analyze large, publicly available social media data to generate insights into public perceptions about CAC, which may help guide strategies to improve shared decision-making around ASCVD management and public health interventions.
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Affiliation(s)
- Sulaiman Somani
- Department of Medicine, Stanford University, Stanford, CA, USA
- Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Sujana Balla
- Department of Medicine, University of California, San Francisco-Fresno, Fresno, CA, USA
| | - Allison W Peng
- Department of Medicine, Stanford University, Stanford, CA, USA
- Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Ramzi Dudum
- Cardiovascular Institute, Stanford University, Stanford, CA, USA
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA, USA
| | - Sneha Jain
- Cardiovascular Institute, Stanford University, Stanford, CA, USA
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA, USA
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - David J Maron
- Cardiovascular Institute, Stanford University, Stanford, CA, USA
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA, USA
- Stanford Prevention Research Center, Palo Alto, CA, USA
| | | | - Fatima Rodriguez
- Cardiovascular Institute, Stanford University, Stanford, CA, USA.
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA, USA.
- Center for Digital Health, Stanford University, CA, USA.
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Martin SS, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Barone Gibbs B, Beaton AZ, Boehme AK, Commodore-Mensah Y, Currie ME, Elkind MSV, Evenson KR, Generoso G, Heard DG, Hiremath S, Johansen MC, Kalani R, Kazi DS, Ko D, Liu J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Perman SM, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Tsao CW, Urbut SM, Van Spall HGC, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Palaniappan LP. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation 2024; 149:e347-e913. [PMID: 38264914 DOI: 10.1161/cir.0000000000001209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Marzlin N, Chapel A, Adefisoye J, Garg K, Zlochiver V, Walczak S, Plautz D, Peterson M, Muthukumar L, Harland DR, Jain R, Port S, Galazka P. Differences and Disparities Among Self-Referred and Physician-Referred Populations Undergoing Coronary Artery Calcium Scanning. Circ Cardiovasc Imaging 2024; 17:e015712. [PMID: 38377241 DOI: 10.1161/circimaging.123.015712] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 01/12/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Coronary artery calcium computed tomography (CAC) is an important tool for identifying subclinical atherosclerosis and cardiovascular risk stratification. Despite robust evidence and inclusion in current guidelines, CAC is considered investigational by some US insurance carriers and requires out-of-pocket expenses. CAC can be obtained via self-referral (SR) or physician referral (PR). We aimed to examine differences in patient, socioeconomic, and CAC characteristics between referral groups. METHODS We evaluated demographic, medical history, and CAC results of consecutive patients with a CAC completed at one of multiple Wisconsin sites from March 1, 2019, to June 30, 2021. We separated patients into SR and PR groups. Through census data, we analyzed socioeconomic variables at the block level including race and ethnicity, median income, average household size, and high school completion in the areas where patients resided at the time of CAC. RESULTS The final analysis included 19 726 patients: 13 835 (70.1%) PR and 5891 (29.9%) SR. Most patients in both groups were White (95.2% versus 95.1%), with the Black/African American population representing 2.7% (SR) and 2.3% (PR). The PR group had a higher prevalence of cardiovascular risk factors. SR patients were more likely to have a score of 0 (41.2% versus 38.1%; P<0.001); PR patients had a higher prevalence of CAC >300 (16.8% versus 14.8%; P<0.001). SR patients were more likely to be women (55.1% versus 48.9%; P<0.001) and were found to live in higher income areas (19.5% versus 16.4%; P<0.001). Patients from low-income areas comprised the smallest proportion in both groups (7.5%). CONCLUSIONS Patients who obtain out-of-pocket CAC live predominantly in medium- and high-income areas, and patients from lower income locations are less likely to obtain CAC despite having more cardiovascular disease risk factors. Consideration should be made from a policy perspective to promote health equity and improve utilization of CAC testing among underrepresented groups.
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Affiliation(s)
- Nathan Marzlin
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI (N.M, A.C, J.A, S.W., D.P, M.P, L.M., D.H., R.J., S.P., P.G.)
| | - Andrew Chapel
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI (N.M, A.C, J.A, S.W., D.P, M.P, L.M., D.H., R.J., S.P., P.G.)
| | - James Adefisoye
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI (N.M, A.C, J.A, S.W., D.P, M.P, L.M., D.H., R.J., S.P., P.G.)
| | - Kritika Garg
- Academic Affairs, Cardiovascular Research, Aurora Sinai/Aurora St. Luke's Medical Center, Milwaukee, WI (K.G., V.Z.)
| | - Viviana Zlochiver
- Academic Affairs, Cardiovascular Research, Aurora Sinai/Aurora St. Luke's Medical Center, Milwaukee, WI (K.G., V.Z.)
| | - Sara Walczak
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI (N.M, A.C, J.A, S.W., D.P, M.P, L.M., D.H., R.J., S.P., P.G.)
| | - Doreen Plautz
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI (N.M, A.C, J.A, S.W., D.P, M.P, L.M., D.H., R.J., S.P., P.G.)
| | - Michael Peterson
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI (N.M, A.C, J.A, S.W., D.P, M.P, L.M., D.H., R.J., S.P., P.G.)
| | - Lakshmi Muthukumar
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI (N.M, A.C, J.A, S.W., D.P, M.P, L.M., D.H., R.J., S.P., P.G.)
| | - Daniel R Harland
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI (N.M, A.C, J.A, S.W., D.P, M.P, L.M., D.H., R.J., S.P., P.G.)
| | - Renuka Jain
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI (N.M, A.C, J.A, S.W., D.P, M.P, L.M., D.H., R.J., S.P., P.G.)
| | - Steven Port
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI (N.M, A.C, J.A, S.W., D.P, M.P, L.M., D.H., R.J., S.P., P.G.)
| | - Patrycja Galazka
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI (N.M, A.C, J.A, S.W., D.P, M.P, L.M., D.H., R.J., S.P., P.G.)
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Behr C, Koffijberg H, IJzerman M, Kauczor HU, Revel MP, Silva M, von Stackelberg O, van Til J, Vliegenthart R. Willingness to participate in combination screening for lung cancer, chronic obstructive pulmonary disease and cardiovascular disease in four European countries. Eur Radiol 2023:10.1007/s00330-023-10474-w. [PMID: 38060003 DOI: 10.1007/s00330-023-10474-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 10/04/2023] [Accepted: 10/22/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVES Lung cancer screening (LCS), using low-dose computed tomography (LDCT), can be more efficient by simultaneously screening for chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD), the Big-3 diseases. This study aimed to determine the willingness to participate in (combinations of) Big-3 screening in four European countries and the relative importance of amendable participation barriers. METHODS An online cross-sectional survey aimed at (former) smokers aged 50-75 years elicited the willingness of individuals to participate in Big-3 screening and used analytical hierarchy processing (AHP) to determine the importance of participation barriers. RESULTS Respondents were from France (n = 391), Germany (n = 338), Italy (n = 399), and the Netherlands (n = 342), and consisted of 51.2% men. The willingness to participate in screening was marginally influenced by the diseases screened for (maximum difference of 3.1%, for Big-3 screening (73.4%) vs. lung cancer and COPD screening (70.3%)) and by country (maximum difference of 3.7%, between France (68.5%) and the Netherlands (72.3%)). The largest effect on willingness to participate was personal perceived risk of lung cancer. The most important barriers were the missed cases during screening (weight 0.19) and frequency of screening (weight 0.14), while diseases screened for (weight 0.11) ranked low. CONCLUSIONS The difference in willingness to participate in LCS showed marginal increase with inclusion of more diseases and limited variation between countries. A marginal increase in participation might result in a marginal additional benefit of Big-3 screening. The amendable participation barriers are similar to previous studies, and the new criterion, diseases screened for, is relatively unimportant. CLINICAL RELEVANCE STATEMENT Adding diseases to combination screening modestly improves participation, driven by personal perceived risk. These findings guide program design and campaigns for lung cancer and Big-3 screening. Benefits of Big-3 screening lie in long-term health and economic impact, not participation increase. KEY POINTS • It is unknown whether or how combination screening might affect participation. • The addition of chronic obstructive pulmonary disease and cardiovascular disease to lung cancer screening resulted in a marginal increase in willingness to participate. • The primary determinant influencing individuals' engagement in such programs is their personal perceived risk of the disease.
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Affiliation(s)
- Carina Behr
- Health Technology and Services Research, Faculty of Behavioural and Management Science, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, The Netherlands
| | - Hendrik Koffijberg
- Health Technology and Services Research, Faculty of Behavioural and Management Science, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, The Netherlands
| | - Maarten IJzerman
- Health Technology and Services Research, Faculty of Behavioural and Management Science, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, The Netherlands
- Cancer Health Services Research, Centre for Health Policy, Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Melbourne, VIC, 3010, Australia
- Erasmus School of Health Policy & Management, Rotterdam, The Netherlands
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
- Translational Lung Research Center, Member of the German Lung Research Center, Heidelberg, Germany
| | - Marie-Pierre Revel
- Service de radiologie, Université de Paris, Assistance Publique des hôpitaux de Paris, Hôpital Cochin, 85 boulevard Saint-Germain, 75006, Paris, France
- Inserm U1016, Institut Cochin, 22 rue Méchain, 75014, Paris, France
| | - Mario Silva
- Scienze Radiologiche, Department of Medicine and Surgery (DiMeC), University of Parma, Pad. Barbieri, Ospedale Universitario di Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Oyunbileg von Stackelberg
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
- Translational Lung Research Center, Member of the German Lung Research Center, Heidelberg, Germany
| | - Janine van Til
- Health Technology and Services Research, Faculty of Behavioural and Management Science, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, The Netherlands
| | - Rozemarijn Vliegenthart
- Department of Radiology, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
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Oude Wolcherink MJ, Behr CM, Pouwels XGLV, Doggen CJM, Koffijberg H. Health Economic Research Assessing the Value of Early Detection of Cardiovascular Disease: A Systematic Review. PHARMACOECONOMICS 2023; 41:1183-1203. [PMID: 37328633 PMCID: PMC10492754 DOI: 10.1007/s40273-023-01287-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/22/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Cardiovascular disease (CVD) is the most prominent cause of death worldwide and has a major impact on healthcare budgets. While early detection strategies may reduce the overall CVD burden through earlier treatment, it is unclear which strategies are (most) efficient. AIM This systematic review reports on the cost effectiveness of recent early detection strategies for CVD in adult populations at risk. METHODS PubMed and Scopus were searched to identify scientific articles published between January 2016 and May 2022. The first reviewer screened all articles, a second reviewer independently assessed a random 10% sample of the articles for validation. Discrepancies were solved through discussion, involving a third reviewer if necessary. All costs were converted to 2021 euros. Reporting quality of all studies was assessed using the CHEERS 2022 checklist. RESULTS In total, 49 out of 5552 articles were included for data extraction and assessment of reporting quality, reporting on 48 unique early detection strategies. Early detection of atrial fibrillation in asymptomatic patients was most frequently studied (n = 15) followed by abdominal aortic aneurysm (n = 8), hypertension (n = 7) and predicted 10-year CVD risk (n = 5). Overall, 43 strategies (87.8%) were reported as cost effective and 11 (22.5%) CVD-related strategies reported cost reductions. Reporting quality ranged between 25 and 86%. CONCLUSIONS Current evidence suggests that early CVD detection strategies are predominantly cost effective and may reduce CVD-related costs compared with no early detection. However, the lack of standardisation complicates the comparison of cost-effectiveness outcomes between studies. Real-world cost effectiveness of early CVD detection strategies will depend on the target country and local context. REGISTRATION OF SYSTEMATIC REVIEW CRD42022321585 in International Prospective Registry of Ongoing Systematic Reviews (PROSPERO) submitted at 10 May 2022.
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Affiliation(s)
- Martijn J Oude Wolcherink
- Health Technology and Services Research, Techmed Centre, University of Twente, Enschede, The Netherlands
| | - Carina M Behr
- Health Technology and Services Research, Techmed Centre, University of Twente, Enschede, The Netherlands
| | - Xavier G L V Pouwels
- Health Technology and Services Research, Techmed Centre, University of Twente, Enschede, The Netherlands
| | - Carine J M Doggen
- Health Technology and Services Research, Techmed Centre, University of Twente, Enschede, The Netherlands
| | - Hendrik Koffijberg
- Health Technology and Services Research, Techmed Centre, University of Twente, Enschede, The Netherlands.
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Won KB, Choi SY, Chun EJ, Park SH, Sung J, Jung HO, Chang HJ. Assessment of Normal Systolic Blood Pressure Maintenance with the Risk of Coronary Artery Calcification Progression in Asymptomatic Metabolically Healthy Korean Adults with Normal Weight, Overweight, and Obesity. J Clin Med 2023; 12:jcm12113770. [PMID: 37297965 DOI: 10.3390/jcm12113770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/27/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
Metabolically healthy obesity (MHO) is known to have a close association with subclinical coronary atherosclerosis. Despite recent data on the benefit of intensive systolic blood pressure (SBP) control in diverse clinical conditions, little is known regarding the association of normal SBP maintenance (SBPmaintain) with coronary artery calcification (CAC) progression in MHO. This study included 2724 asymptomatic adults (48.8 ± 7.8 years; 77.9% men) who had no metabolic abnormalities except overweight and obesity. Participants with normal weight (44.2%), overweight (31.6%), and obesity (24.2%) were divided into two groups: normal SBPmaintain (follow-up SBP < 120 mm Hg) and ≥elevated SBPmaintain (follow-up SBP ≥ 120 mm Hg). CAC progression was defined using the SQRT method, a difference of ≥2.5 between the square root (√) of the baseline and follow-up coronary artery calcium score. During a mean follow-up of 3.4 years, the proportion of normal SBPmaintain (76.2%, 65.2%, and 59.1%) and the incidence of CAC progression (15.0%, 21.3%, and 23.5%) was different in participants with normal weight, overweight, and obesity (all p < 0.05, respectively). The incidence of CAC progression was lower in the normal SBPmaintain group than in the ≥elevated SBPmaintain group in only participants with obesity (20.8% vs. 27.4%, p = 0.048). In multiple logistic models, compared to participants with normal weight, those with obesity had a higher risk of CAC progression. Normal SBPmaintain was independently associated with the decreased risk of CAC progression in participants with obesity. MHO had a significant association with CAC progression. Normal SBPmaintain reduced the risk of CAC progression in asymptomatic adults with MHO.
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Affiliation(s)
- Ki-Bum Won
- Division of Cardiology, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang 10326, Republic of Korea
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul 03722, Republic of Korea
| | - Su-Yeon Choi
- Division of Cardiology, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul 06236, Republic of Korea
| | - Eun Ju Chun
- Division of Radiology, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea
| | - Sung Hak Park
- Division of Radiology, Gangnam Heartscan Clinic, Seoul 06168, Republic of Korea
| | - Jidong Sung
- Division of Cardiology, Heart Stroke & Vascular Institute, Samsung Medical Center, Seoul 06351, Republic of Korea
| | - Hae Ok Jung
- Division of Cardiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul 03722, Republic of Korea
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Behr CM, Oude Wolcherink MJ, IJzerman MJ, Vliegenthart R, Koffijberg H. Population-Based Screening Using Low-Dose Chest Computed Tomography: A Systematic Review of Health Economic Evaluations. PHARMACOECONOMICS 2023; 41:395-411. [PMID: 36670332 PMCID: PMC10020316 DOI: 10.1007/s40273-022-01238-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/27/2022] [Indexed: 05/10/2023]
Abstract
BACKGROUND Chest low-dose computed tomography (LDCT) is a promising technology for population-based screening because it is non-invasive, relatively inexpensive, associated with low radiation and highly sensitive to lung cancer. To improve the cost-effectiveness of lung cancer screening, simultaneous screening for other diseases could be considered. This systematic review was conducted to analyse studies that published evidence on the cost-effectiveness of chest LDCT screening programs for different diseases. METHODS Scopus and PubMed were searched for English publications (1 January 2011-22 July 2022) using search terms related to screening, computed tomography and cost-effectiveness. An additional search specifically searched for the cost-effectiveness of screening for lung cancer, chronic obstructive pulmonary disease or cardiovascular disease. Included publications should present a full health economic evaluation of population screening with chest LDCT. The extracted data included the disease screened for, model type, country context of screening, inclusion of comorbidities or incidental findings, incremental costs, incremental effects and the resulting cost-effectiveness ratio amongst others. Reporting quality was assessed using the 2022 Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. RESULTS The search yielded 1799 unique papers, of which 43 were included. Most papers focused on lung cancer screening (n = 40), and three were on coronary calcium scoring. Microsimulation was the most commonly applied modelling type (n = 16), followed by life table analysis (n = 10) and Markov cohort models (n = 10). Studies reflected the healthcare context of the US (n = 15), Canada (n = 4), the UK (n = 3) and 13 other countries. The reported incremental cost-effectiveness ratio ranged from US$10,000 to US$90,000/quality-adjusted life year (QALY) for lung cancer screening compared to no screening and was US$15,900/QALY-US$45,300/QALY for coronary calcium scoring compared to no screening. DISCUSSION Almost all health economic evaluations of LDCT screening focused on lung cancer. Literature regarding the health economic benefits of simultaneous LDCT screening for multiple diseases is absent. Most studies suggest LDCT screening is cost-effective for current and former smokers aged 55-74 with a minimum of 30 pack-years of smoking history. Consequently, more evidence on LDCT is needed to support further cost-effectiveness analyses. Preferably evidence on simultaneous screening for multiple diseases is needed, but alternatively, on single-disease screening. REGISTRATION OF SYSTEMATIC REVIEW Prospective Register of Ongoing Systematic Reviews registration CRD42021290228 can be accessed https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=290228 .
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Affiliation(s)
- Carina M Behr
- Health Technology and Services Research, University of Twente, Enschede, The Netherlands
| | | | - Maarten J IJzerman
- Health Technology and Services Research, University of Twente, Enschede, The Netherlands
- Cancer Health Services Research, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Erasmus School of Health Policy and Managament, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Rozemarijn Vliegenthart
- Department of Radiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Hendrik Koffijberg
- Health Technology and Services Research, University of Twente, Enschede, The Netherlands.
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Venkataraman P, Neil AL, Mitchell GK, Stanton T, Nicholls S, Tonkin AM, Watts GF, Marwick TH. The cost-effectiveness of coronary calcium score-guided statin therapy initiation for Australians with family histories of premature coronary artery disease. Med J Aust 2023; 218:216-222. [PMID: 36841547 DOI: 10.5694/mja2.51860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 02/27/2023]
Abstract
OBJECTIVES To compare the cost-effectiveness of coronary artery calcium (CAC) score-guided statin therapy criteria and American College of Cardiology/American Heart Association (ACC/AHA) guidelines (10-year pooled cohort equation [PCE] risk ≥ 7.5%) with selection according to Australian guidelines (5-year absolute cardiovascular disease risk [ACVDR] ≥ 10%), for people with family histories of premature coronary artery disease. STUDY DESIGN, SETTING Markov microsimulation state transition model based on data from the Coronary Artery calcium score: Use to Guide management of Hereditary Coronary Artery Disease (CAUGHT-CAD) trial and transition probabilities derived from published statin prescribing and adherence outcomes and clinical data. PARTICIPANTS 1083 people with family histories of premature coronary artery disease but no symptomatic cardiovascular disease. MAIN OUTCOME MEASURES Relative cost-effectiveness over fifteen years, from the perspective of the Australian health care system, compared with usual care (Australian guidelines), assessed as incremental cost-effectiveness ratios (ICERs), with a notional willingness-to-pay threshold of $50 000 per quality-adjusted life-year (QALY) gained. RESULTS Applying the Australian guidelines, 77 people were eligible for statin therapy (7.1%); with ACVDR 5-year risk ≥ 2% and CAC score > 0, 496 people (46%); with ACVDR 5-year risk ≥ 2% and CAC score ≥ 100, 155 people (14%); and with the ACC/AHA guidelines, 256 people (24%). The ICERs for CAC-guided selection were $33 108 (CAC ≥ 100) and $53 028 per QALY gained (CAC > 0); the ACC/AHA guidelines approach (ICER, $909 241 per QALY gained) was not cost-effective. CAC score-guided selection (CAC ≥ 100) was cost-effective for people with 5-year ACVDR of at least 5%. CONCLUSION Expanding the number of people at low to intermediate CVD risk eligible for statin therapy should selectively target people with subclinical atherosclerosis identified by CAC screening. This approach can be more cost-effective than simply lowering treatment eligibility thresholds.
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Affiliation(s)
| | - Amanda L Neil
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, TAS
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10
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Tasdighi E, Blaha MJ. Coronary calcium scoring for guiding lipid-lowering therapy is cost-effective: time to remove barriers to its use. Med J Aust 2023; 218:214-215. [PMID: 36811155 PMCID: PMC10265314 DOI: 10.5694/mja2.51861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 01/25/2023] [Accepted: 01/25/2023] [Indexed: 02/24/2023]
Affiliation(s)
- Erfan Tasdighi
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, United States of America
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, United States of America
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11
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Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Beaton AZ, Boehme AK, Buxton AE, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Fugar S, Generoso G, Heard DG, Hiremath S, Ho JE, Kalani R, Kazi DS, Ko D, Levine DA, Liu J, Ma J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Virani SS, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association. Circulation 2023; 147:e93-e621. [PMID: 36695182 DOI: 10.1161/cir.0000000000001123] [Citation(s) in RCA: 1048] [Impact Index Per Article: 1048.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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12
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Mujwara D, Henno G, Vernon ST, Peng S, Di Domenico P, Schroeder B, Busby GB, Figtree GA, Bottà G. Integrating a Polygenic Risk Score for Coronary Artery Disease as a Risk-Enhancing Factor in the Pooled Cohort Equation: A Cost-Effectiveness Analysis Study. J Am Heart Assoc 2022; 11:e025236. [PMID: 35699184 PMCID: PMC9238642 DOI: 10.1161/jaha.121.025236] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Cardiovascular diseases are the leading cause of death in the United States, yet a significant proportion of adults at high risk remain undetected by standard screening practices. Polygenic risk score for coronary artery disease (CAD‐PRS) improves precision in determining the 10‐year risk of atherosclerotic cardiovascular disease but health benefits and health care costs associated with CAD‐PRS are unknown. We examined the cost‐effectiveness of including CAD‐PRS as a risk‐enhancing factor in the pooled cohort equation (PCE)—the standard of care for determining the risk of atherosclerotic cardiovascular disease—versus PCE alone. Methods and Results We applied a Markov model on a cohort of 40‐year‐old individuals with borderline or intermediate 10‐year risk (5% to <20%) for atherosclerotic cardiovascular disease to identify those in the top quintile of the CAD‐PRS distribution who are at high risk and eligible for statin prevention therapy. Health outcomes examined included coronary artery disease (CAD; ie, myocardial infarction) and ischemic stroke. The model projected medical costs (2019 US$) of screening for CAD, statin prevention therapy, treatment, and monitoring patients living with CAD or ischemic stroke and quality‐adjusted life‐years for PCE+CAD‐PRS versus PCE alone. Deterministic and probabilistic sensitivity analyses and scenario analyses were performed to examine uncertainty in parameter inputs. PCE+CAD‐PRS was dominant compared with PCE alone in the 5‐ and 10‐year time horizons. We found that, respectively, PCE+CAD‐PRS had 0.003 and 0.011 higher mean quality‐adjusted life‐years and $40 and $181 lower mean costs per person screened, with 29 and 50 fewer events of CAD and ischemic stroke in a cohort of 10 000 individuals compared with PCE alone. The risk of developing CAD, the effectiveness of statin prevention therapy, and the cost of treating CAD had the largest impact on the cost per quality‐adjusted life‐year gained. However, this cost remained below the $50 000 willingness‐to‐pay threshold except when the annual risk of developing CAD was <0.006 in the 5‐year time horizon. Results from Monte Carlo simulation indicated that PCE+CAD‐PRS would be cost‐effective. with the probability of 94% and 99% at $50 000 willingness‐to‐pay threshold in the 5‐ and 10‐year time horizon, respectively. Conclusions Implementing CAD‐PRS as a risk‐enhancing factor in the PCE to determine the risk of atherosclerotic cardiovascular disease reduced the mean cost per individual, improved quality‐adjusted life‐years, and averted future events of CAD and ischemic stroke when compared with PCE alone.
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Affiliation(s)
| | | | - Stephen T. Vernon
- Kolling InstituteRoyal North Shore HospitalSydneyNSWAustralia
- Charles Perkins CentreUniversity of SydneyNSWAustralia
- Department of CardiologyRoyal North Shore HospitalSydneyNSWAustralia
| | | | | | | | | | - Gemma A Figtree
- Kolling InstituteRoyal North Shore HospitalSydneyNSWAustralia
- Charles Perkins CentreUniversity of SydneyNSWAustralia
- Department of CardiologyRoyal North Shore HospitalSydneyNSWAustralia
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13
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Won K, Park H, Heo R, Lee BK, Lin FY, Hadamitzky M, Kim Y, Sung JM, Conte E, Andreini D, Pontone G, Budoff MJ, Gottlieb I, Chun EJ, Cademartiri F, Maffei E, Marques H, Gonçalves PDA, Leipsic JA, Lee S, Shin S, Choi JH, Virmani R, Samady H, Chinnaiyan K, Berman DS, Narula J, Bax JJ, Min JK, Chang H. Longitudinal quantitative assessment of coronary atherosclerosis related to normal systolic blood pressure maintenance in the absence of established cardiovascular disease. Clin Cardiol 2022; 45:873-881. [PMID: 35673995 PMCID: PMC9346967 DOI: 10.1002/clc.23870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/24/2022] [Accepted: 05/27/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Atherosclerosis-related adverse events are commonly observed even in conditions with low cardiovascular (CV) risk. Longitudinal data regarding the association of normal systolic blood pressure maintenance (SBPmaintain ) with coronary plaque volume changes (PVC) has been limited in adults without traditional CV disease. HYPOTHESIS Normal SBPmaintain is important to attenuate coronary atherosclerosis progression in adults without baseline CV disease. METHODS We analyzed 95 adults (56.7 ± 8.5 years; 40.0% men) without baseline CV disease who underwent serial coronary computed tomographic angiography with mean 3.5 years of follow-up. All participants were divided into two groups of normal SBPmaintain (follow-up SBP < 120 mm Hg) and ≥elevated SBPmaintain (follow-up SBP ≥ 120 mm Hg). Annualized PVC was defined as PVC divided by the interscan period. RESULTS Compared to participants with normal SBPmaintain , those with ≥elevated SBPmaintain had higher annualized total PVC (mm3 /year) (0.0 [0.0-2.2] vs. 4.1 [0.0-13.0]; p < .001). Baseline total plaque volume (β = .10) and the levels of SBPmaintain (β = .23) and follow-up high-density lipoprotein cholesterol (β = -0.28) were associated with annualized total PVC (all p < .05). The optimal cutoff of SBPmaintain for predicting plaque progression was 118.5 mm Hg (sensitivity: 78.2%, specificity: 62.5%; area under curve: 0.700; 95% confidence interval [CI]: 0.59-0.81; p < .05). SBPmaintain ≥ 118.5 mm Hg (odds ratio [OR]: 4.03; 95% CI: 1.51-10.75) and baseline total plaque volume (OR: 1.03; 95% CI: 1.01-1.06) independently influenced coronary plaque progression (all p < .05). CONCLUSION Normal SBPmaintain is substantial to attenuate coronary atherosclerosis progression in conditions without established CV disease.
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Affiliation(s)
- Ki‐Bum Won
- Department of Cardiology, Dongguk University Ilsan HospitalDongguk University College of MedicineGoyangSouth Korea,Department of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of MedicineYonsei University Health SystemSeoulSouth Korea,Yonsei‐Cedars‐Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of MedicineYonsei University Health SystemSeoulSouth Korea
| | - Hyung‐Bok Park
- Yonsei‐Cedars‐Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of MedicineYonsei University Health SystemSeoulSouth Korea,Department of CardiologyCatholic Kwandong University International St. Mary's HospitalIncheonSouth Korea
| | - Ran Heo
- Yonsei‐Cedars‐Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of MedicineYonsei University Health SystemSeoulSouth Korea,Department of Cardiology, Hanyang University Seoul HospitalHanyang University College of MedicineSeoulSouth Korea
| | - Byoung Kwon Lee
- Department of Cardiology, Gangnam Severance HospitalYonsei University College of MedicineSeoulKorea
| | - Fay Y. Lin
- Department of RadiologyNew York‐Presbyterian Hospital and Weill Cornell MedicineNew YorkNew YorkUSA
| | - Martin Hadamitzky
- Department of Radiology and Nuclear MedicineGerman Heart Center MunichMunichGermany
| | - Yong‐Jin Kim
- Division of Cardiology, Seoul National University College of Medicine, Cardiovascular CenterSeoul National University HospitalSeoulSouth Korea
| | - Ji Min Sung
- Department of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of MedicineYonsei University Health SystemSeoulSouth Korea,Yonsei‐Cedars‐Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of MedicineYonsei University Health SystemSeoulSouth Korea
| | | | | | | | - Matthew J. Budoff
- Department of MedicineLundquist Institute at Harbor UCLA Medical CenterTorranceCaliforniaUSA
| | - Ilan Gottlieb
- Department of RadiologyCasa de Saude São JoseRio de JaneiroBrazil
| | - Eun Ju Chun
- Seoul National University Bundang HospitalSungnamSouth Korea
| | | | - Erica Maffei
- Department of RadiologyArea Vasta 1/ASUR MarcheUrbinoItaly
| | - Hugo Marques
- UNICA, Unit of Cardiovascular Imaging, Hospital da LuzLisboaPortugal
| | - Pedro de Araújo Gonçalves
- UNICA, Unit of Cardiovascular Imaging, Hospital da LuzLisboaPortugal,Nova Medical SchoolLisbonPortugal
| | - Jonathon A. Leipsic
- Department of Medicine and RadiologyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Sang‐Eun Lee
- Yonsei‐Cedars‐Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of MedicineYonsei University Health SystemSeoulSouth Korea,Department of CardiologyEwha Womans University Seoul HospitalSeoulKorea
| | - Sanghoon Shin
- Yonsei‐Cedars‐Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of MedicineYonsei University Health SystemSeoulSouth Korea,Department of CardiologyEwha Womans University Seoul HospitalSeoulKorea
| | - Jung Hyun Choi
- Department of CardiologyPusan University HospitalBusanSouth Korea
| | - Renu Virmani
- Department of PathologyCVPath InstituteGaithersburgMarylandUSA
| | - Habib Samady
- Department of CardiologyEmory University School of MedicineAtlantaGeorgiaUSA
| | | | - Daniel S. Berman
- Department of Imaging and MedicineCedars Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Jagat Narula
- Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, Zena and Michael A. Wiener Cardiovascular Institute, and Marie‐Josée and Henry R. Kravis Center for Cardiovascular HealthNew YorkNew YorkUSA
| | - Jeroen J. Bax
- Department of CardiologyLeiden University Medical CenterLeidenThe Netherlands
| | - James K. Min
- Department of RadiologyNew York‐Presbyterian Hospital and Weill Cornell MedicineNew YorkNew YorkUSA
| | - Hyuk‐Jae Chang
- Department of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of MedicineYonsei University Health SystemSeoulSouth Korea,Yonsei‐Cedars‐Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of MedicineYonsei University Health SystemSeoulSouth Korea
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14
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Nassar M, Nso N, Emmanuel K, Alshamam M, Munira MS, Misra A. Coronary Artery Calcium Score directed risk stratification of patients with Type-2 diabetes mellitus. Diabetes Metab Syndr 2022; 16:102503. [PMID: 35653928 DOI: 10.1016/j.dsx.2022.102503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 05/07/2022] [Accepted: 05/10/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND AIMS This study aimed to review the available data on the role of coronary artery calcium (CAC) scoring as the preferred adjunct modality to improve risk prediction and reduce the incidence of major adverse cardiac events and mortality in T2DM patients. METHODS We reviewed the findings of 21 studies. RESULTS This study revealed that the CAC scoring system could enhance cardiovascular disease (CVD) risk stratification and positively affect the medical management of patients with T2DM. CONCLUSION A CAC scoring approach is necessary to reduce the incidence and prevalence of preventable CVD events in patients with type 2 diabetes.
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Affiliation(s)
- Mahmoud Nassar
- Department of Medicine, Icahn School of Medicine at Mount Sinai, NYC Health + Hospitals/Queens, NY, USA.
| | - Nso Nso
- Department of Medicine, Icahn School of Medicine at Mount Sinai, NYC Health + Hospitals/Queens, NY, USA.
| | - Kelechi Emmanuel
- Department of Medicine, University of Pittsburgh Medical Center Pinnacle, PA, USA.
| | - Mohsen Alshamam
- Department of Medicine, Icahn School of Medicine at Mount Sinai, NYC Health + Hospitals/Queens, NY, USA.
| | - Most Sirajum Munira
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, NYC Health + Hospitals/Queens, NY, USA.
| | - Anoop Misra
- Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, National Diabetes, Obesity and Cholesterol Foundation (N-DOC), Diabetes Foundation (India) (DFI), India.
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15
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Haq A, Miedema MD. Coronary Artery Calcium for Risk Assessment in Young Adults. Curr Atheroscler Rep 2022; 24:337-342. [PMID: 35274228 DOI: 10.1007/s11883-022-01010-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW To review the prognostic significance and clinical utility of coronary artery calcium (CAC) for risk assessment for atherosclerotic cardiovascular disease (ASCVD) in younger adults. RECENT FINDINGS Data from over 3000 young adults (mean age of 40.3 ± 3.6 followed for 12.5 years) in the CARDIA registry found that in an asymptomatic, community representative sample, there was a low prevalence of CAC (~ 10%) but those with CAC had an exponential increase in CAC over time and significantly higher rates of ASCVD events. Alternatively, data from the CAC consortium analyzed 22,346 asymptomatic individuals undergoing CAC for clinical indications (mean age 43.5 ± 4.5 years, followed for 13 ± 4 years) and found a much higher prevalence of CAC at 34% with rates of coronary heart disease mortality that varied significantly according to CAC. In younger adults, CAC provides clear prognostic value and can be considered in select individuals with uncertainties about their ASCVD risk or the benefit of preventive therapies.
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Affiliation(s)
- Ayman Haq
- The Nolan Family Center for Cardiovascular Health, Minneapolis Heart Institute Foundation, 920 East 28th Street, Suite 420, Minneapolis, MN, 55414, USA
| | - Michael D Miedema
- The Nolan Family Center for Cardiovascular Health, Minneapolis Heart Institute Foundation, 920 East 28th Street, Suite 420, Minneapolis, MN, 55414, USA.
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16
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Saydam CD. Subclinical cardiovascular disease and utility of coronary artery calcium score. IJC HEART & VASCULATURE 2021; 37:100909. [PMID: 34825047 PMCID: PMC8604741 DOI: 10.1016/j.ijcha.2021.100909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 10/14/2021] [Accepted: 10/25/2021] [Indexed: 11/21/2022]
Abstract
ASCVD are the leading causes of mortality and morbidity among Globe. Evaluation of patients' comprehensive and personalized risk provides risk management strategies and preventive interventions to achieve gain for patients. Framingham Risk Score (FRS) and Systemic Coronary Risk Evaluation Score (SCORE) are two well studied risk scoring models, however, can miss some (20-35%) of future cardiovascular events. To obtain more accurate risk assessment recalibrating risk models through utilizing novel risk markers have been studied in last 3 decades and both ESC and AHA recommends assessing Family History, hs-CRP, CACS, ABI, and CIMT. Subclinical Cardiovascular Disease (SCVD) has been conceptually developed for investigating gradually progressing asymptomatic development of atherosclerosis and among these novel risk markers it has been well established by literature that CACS having highest improvement in risk assessment. This review study mainly selectively discussing studies with CACS measurement. A CACS = 0 can down-stratify risk of patients otherwise treated or treatment eligible before test and can reduce unnecessary interventions and cost, whereas CACS ≥ 100 is equivalent to statin treatment threshold of ≥ 7.5% risk level otherwise statin ineligible before test. Since inflammation, insulin resistance, oxidative stress, dyslipidemia and ongoing endothelial damage due to hypertension could lead to CAC, ASCVD linked with comorbidities. Recent cohort studies have shown a CACS 100-300 as a sign of increased cancer risk. Physical activity, dietary factors, cigarette use, alcohol consumption, metabolic health, family history of CHD, aging, exposures of neighborhood environment and non-cardiovascular comorbidities can determine CACs changes.
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17
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Won KB, Han D, Choi SY, Chun EJ, Park SH, Han HW, Sung J, Jung HO, Chang HJ. Association between blood pressure classification defined by the 2017 ACC/AHA guidelines and coronary artery calcification progression in an asymptomatic adult population. EUROPEAN HEART JOURNAL OPEN 2021; 1:oeab009. [PMID: 35919095 PMCID: PMC9242050 DOI: 10.1093/ehjopen/oeab009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/15/2021] [Indexed: 11/13/2022]
Abstract
Aims Coronary artery calcium score (CACS) is widely used for cardiovascular risk stratification in asymptomatic population. We assessed the association of new blood pressure (BP) classification using the 2017 American College of Cardiology/American Heart Association guidelines with coronary artery calcification (CAC) progression according to age in asymptomatic adults. Methods and results Overall, 10 839 asymptomatic Korean adults (23.4% aged ≤45 years) who underwent at least two CACS evaluations for health check-up were enrolled. Participants were categorized by age (≤45 and >45 years) and BP [normal (<120/<80 mmHg, untreated), elevated (120-129/<80 mmHg, untreated), Stage 1 hypertension (untreated BP 130-139/80-89 mmHg) or Stage 2 hypertension (BP ≥140/≥90 mmHg or anti-hypertensive use)] groups. CAC progression was defined as a difference of ≥2.5 between the square root (√) of the baseline and follow-up CACS. During a mean 3.3-year follow-up, the incidence of CAC progression was 13.5% and 36.3% in individuals aged ≤45 and >45 years, respectively. After adjustment for age, sex, diabetes, dyslipidaemia, obesity, current smoking, and baseline CACS, hazard ratios (95% confidence interval) for CAC progression in elevated BP, Stage 1 hypertension, and Stage 2 hypertension compared to normal BP were 1.43 (0.96-2.14) (P = 0.077), 1.64 (1.20-2.23) (P = 0.002), and 2.38 (1.82-3.12) (P < 0.001) in the ≤45 years group and 1.11 (0.95-1.30) (P = 0.179), 1.17 (1.04-1.32) (P = 0.009), and 1.52 (1.39-1.66) (P < 0.001) in the >45 years group, respectively. Conclusion Newly defined Stage 1 hypertension is independently associated with CAC progression in asymptomatic adults regardless of age.
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Affiliation(s)
- Ki-Bum Won
- Division of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
| | - Donghee Han
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
- Department of Imaging and Medicine, Cedars-Sinai Medical Centre, Los Angeles, CA, USA
| | - Su-Yeon Choi
- Division of Cardiology, Healthcare System Gangnam Centre, Seoul National University Hospital, Seoul, South Korea
| | - Eun Ju Chun
- Division of Radiology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Sung Hak Park
- Division of Radiology, Gangnam Heartscan Clinic, Seoul, South Korea
| | - Hae-Won Han
- Department of Internal Medicine, Gangnam Heartscan Clinic, Seoul, South Korea
| | - Jidong Sung
- Division of Cardiology, Heart Stroke & Vascular Institute, Samsung Medical Centre, Seoul, South Korea
| | - Hae Ok Jung
- Division of Cardiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
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18
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Yeboah J. Coronary Artery Calcium Score as a Decision Aid May Be Cost-Effective. JACC Cardiovasc Imaging 2021; 14:1218-1220. [PMID: 33454251 DOI: 10.1016/j.jcmg.2020.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 11/18/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Joseph Yeboah
- Heart and Vascular Center of Excellence, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
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