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Braun SK, Jorge DW, Pedron VF. Influence of Preprocedural Statin Usage on Primary Patency and Amputation in Patients Undergoing Lower Limb Peripheral Angioplasty. Ann Vasc Surg 2024; 106:213-226. [PMID: 38821472 DOI: 10.1016/j.avsg.2024.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 03/24/2024] [Accepted: 03/24/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND Peripheral arterial disease can progress to critical limb ischemia, which is associated with high amputation rates and requires revascularization. The endovascular approach has lower long-term patency because of restenosis due to neointimal hyperplasia. Statins are significantly advantageous for patients undergoing percutaneous interventions; however, only few studies have reported surgical improvements with statin therapy after endovascular treatment in such patients. This retrospective cohort study assessed the effects of preprocedural statins on lower limb arterial angioplasty outcomes by evaluating patency and amputation rates and comparing with those without statins. METHODS Patients who underwent percutaneous transluminal angioplasty of the lower limbs for critical ischemia of the lower limbs or for limiting claudication were included in this retrospective cohort study. Patients were categorized according to statin use prior to and during hospitalization. Patient demographics, lesion morphology, primary patency, and limb salvage rates were compared between these groups. Statistical analyses were performed using Kaplan-Meier and multivariate regression analysis. RESULTS A total of 178 patients undergoing endovascular intervention by critical ischemia or limiting claudication were included. Approximately 80% of the procedures were ballon angioplasty. Primary patency was 73% in 1 year and preprocedural statin usage was not associated with improved primary patency rates (P = 0.2798). After adjusting the amputation outcomes for pre-established variables, such as prehospitalization statin use, diabetes, procedure indication, disease location, Trans-Atlantic Inter-Society Consensus classification, and current smoking, there was no statistically significant difference associated with preprocedural statin use in primary patency (hazard ratio: 0.87 [0.33-2.29], P = 0.79) or amputation (hazard ratio: 0.70 [0.40-1.23], P = 0.22). CONCLUSIONS The use of preprocedural statin did not improve primary patency or amputation rates in patients undergoing peripheral angioplasty.
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Affiliation(s)
- Stela Karine Braun
- Universidade Federal de Santa Maria, Santa Maria, Rio Grande do Sul, Brazil; Surgery Department, Universidade Franciscana, Santa Maria, Rio Grande do Sul, Brazil.
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Li A, Yan J, Zhao Y, Yu Z, Tian S, Khan AH, Zhu Y, Wu A, Zhang C, Tian XL. Vascular Aging: Assessment and Intervention. Clin Interv Aging 2023; 18:1373-1395. [PMID: 37609042 PMCID: PMC10441648 DOI: 10.2147/cia.s423373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/06/2023] [Indexed: 08/24/2023] Open
Abstract
Vascular aging represents a collection of structural and functional changes in a blood vessel with advancing age, including increased stiffness, vascular wall remodeling, loss of angiogenic ability, and endothelium-dependent vasodilation dysfunction. These age-related alterations may occur earlier in those who are at risk for or have cardiovascular diseases, therefore, are defined as early or premature vascular aging. Vascular aging contributes independently to cardio-cerebral vascular diseases (CCVDs). Thus, early diagnosis and interventions targeting vascular aging are of paramount importance in the delay or prevention of CCVDs. Here, we review the direct assessment of vascular aging by examining parameters that reflect changes in structure, function, or their compliance with age including arterial wall thickness and lumen diameter, endothelium-dependent vasodilation, arterial stiffness as well as indirect assessment through pathological studies of biomarkers including endothelial progenitor cell, lymphocytic telomeres, advanced glycation end-products, and C-reactive protein. Further, we evaluate how different types of interventions including lifestyle mediation, such as caloric restriction and salt intake, and treatments for hypertension, diabetes, and hyperlipidemia affect age-related vascular changes. As a single parameter or intervention targets only a certain vascular physiological change, it is recommended to use multiple parameters to evaluate and design intervention approaches accordingly to prevent systemic vascular aging in clinical practices or population-based studies.
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Affiliation(s)
- Ao Li
- Queen Mary School, Nanchang University, Nanchang, Jiangxi, 330031, People’s Republic of China
- Aging and Vascular Diseases, Human Aging Research Institute (HARI) and School of Life Science, Nanchang University, and Jiangxi Key Laboratory of Human Aging, Nanchang, Jiangxi, 330031, People’s Republic of China
| | - Jinhua Yan
- Department of Geriatrics, Institute of Gerontology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Ya Zhao
- Aging and Vascular Diseases, Human Aging Research Institute (HARI) and School of Life Science, Nanchang University, and Jiangxi Key Laboratory of Human Aging, Nanchang, Jiangxi, 330031, People’s Republic of China
| | - Zhenping Yu
- Institute of Translational Medicine, School of Life Science, Nanchang University, and Jiangxi Key Laboratory of Human Aging, Nanchang, Jiangxi, 330031, People’s Republic of China
| | - Shane Tian
- Department of Biochemistry/Chemistry, Ohio State University, Columbus, OH, USA
| | - Abdul Haseeb Khan
- Aging and Vascular Diseases, Human Aging Research Institute (HARI) and School of Life Science, Nanchang University, and Jiangxi Key Laboratory of Human Aging, Nanchang, Jiangxi, 330031, People’s Republic of China
| | - Yuanzheng Zhu
- Aging and Vascular Diseases, Human Aging Research Institute (HARI) and School of Life Science, Nanchang University, and Jiangxi Key Laboratory of Human Aging, Nanchang, Jiangxi, 330031, People’s Republic of China
| | - Andong Wu
- Aging and Vascular Diseases, Human Aging Research Institute (HARI) and School of Life Science, Nanchang University, and Jiangxi Key Laboratory of Human Aging, Nanchang, Jiangxi, 330031, People’s Republic of China
| | - Cuntai Zhang
- Department of Geriatrics, Institute of Gerontology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Xiao-Li Tian
- Aging and Vascular Diseases, Human Aging Research Institute (HARI) and School of Life Science, Nanchang University, and Jiangxi Key Laboratory of Human Aging, Nanchang, Jiangxi, 330031, People’s Republic of China
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Kozakova M, Morizzo C, Jamagidze G, Della Latta D, Chiappino S, Chiappino D, Palombo C. Association between Low-Density Lipoprotein Cholesterol and Vascular Biomarkers in Primary Prevention. Biomedicines 2023; 11:1753. [PMID: 37371848 DOI: 10.3390/biomedicines11061753] [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: 05/18/2023] [Revised: 06/08/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
Several noninvasive vascular biomarkers have been proposed to improve risk stratification for atherothrombotic events. To identify biomarkers suitable for detecting intermediate-risk individuals who might benefit from lipid-lowering treatment in primary prevention, the present study tested the association of plasma LDL-cholesterol with coronary artery calcification (CAC) Agatston score, high carotid and femoral intima-media thickness (IMT), low carotid distensibility and high carotid-femoral pulse-wave velocity in 260 asymptomatic individuals at intermediate cardiovascular risk and without diabetes and lipid-lowering treatment. High or low vascular biomarkers were considered when their value was above the 95th or below the 5th percentile, respectively, of the distribution in the healthy or in the study population. LDL-cholesterol was independently associated with the CAC score = 0 (OR 0.67; 95%CI 0.48-0.92, p = 0.01), CAC score > 100 (1.59; 1.08-2.39, p = 0.01) and high common femoral artery (CFA) IMT (1.89; 1.19-3.06, p < 0.01), but not with other biomarkers. Our data confirm that in individuals at intermediate risk, lipid-lowering treatment can be avoided in the presence of a CAC score = 0, while it should be used with a CAC score > 100. CFA IMT could represent a useful biomarker for decisions regarding lipid-lowering treatment. However, sex- and age-specific reference values should be established in a large healthy population.
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Affiliation(s)
- Michaela Kozakova
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
- Esaote SpA, 16152 Genova, Italy
| | - Carmela Morizzo
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, School of Medicine, University of Pisa, 56126 Pisa, Italy
| | - Giuli Jamagidze
- Imaging Department, Fondazione Toscana G. Monasterio, 54100 Massa, Italy
| | - Daniele Della Latta
- Imaging Department, Fondazione Toscana G. Monasterio, 54100 Massa, Italy
- Bioengineering and Deep Health Units, Fondazione Toscana G. Monasterio, 54100 Massa, Italy
| | - Sara Chiappino
- Imaging Department, Fondazione Toscana G. Monasterio, 54100 Massa, Italy
| | - Dante Chiappino
- Imaging Department, Fondazione Toscana G. Monasterio, 54100 Massa, Italy
| | - Carlo Palombo
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, School of Medicine, University of Pisa, 56126 Pisa, Italy
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Effects of statin use on primary patency, mortality, and limb loss in patients undergoing lower-limb arterial angioplasty: a systematic review and meta-analysis. Int J Clin Pharm 2023; 45:17-25. [PMID: 36369412 DOI: 10.1007/s11096-022-01513-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/21/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUD Peripheral arterial disease can progress to critical limb ischemia, which requires revascularization. The endovascular approach is associated with a lower long-term patency due to restenosis resulting from neointimal hyperplasia. Statins offer significant advantages in patients undergoing percutaneous interventions. However, there are few studies on statin therapy associated with improved clinical outcomes after endovascular treatment in this patients. AIM This systematic review and meta-analysis examined the effects of statins (in comparison with no statin) on outcomes of lower-limb arterial angioplasty by evaluating patency, amputation and mortality. METHOD We searched MEDLINE, Academic Search Premier and CINAHL using a predetermined search strategy from inception to September 21, 2022. Study selection (first by title and abstract and then by full text) and data extraction was conducted by two independent reviewers. Risk of bias was assessed using the Newcastle-Ottawa Scale. According to data availability, we conducted meta-analysis using RevMan v.5.4. RESULTS The search identified 841 relevant articles and included 10 studies with 43,543 patients. Statin use in patients before undergoing lower-limb arterial angioplasty was associated with improved primary patency at 12 (12.57%, 95% confidence interval [CI] 6.86-18.28, p < 0.0001) and 24 months (7.19%, 95% CI 1.02-13.37, p = 0.02), decreased mortality in 39% at 12 months (relative risk (RR): 0.61, 95% CI 0.55-0.74, p < 0.00001) and decreased limb loss in 23% in the studied patients (RR: 0.77, 95% CI 0.65-0.91, p = 0.003). CONCLUSION Statin therapy before the procedure was associated with significantly improved patency and overall survival and decreased limb loss after lower-limb arterial angioplasty.
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Reiner Ž, Simental-Mendía LE, Ruscica M, Katsiki N, Banach M, Al Rasadi K, Jamialahmadi T, Sahebkar A. Pulse wave velocity as a measure of arterial stiffness in patients with familial hypercholesterolemia: a systematic review and meta-analysis. Arch Med Sci 2019; 15:1365-1374. [PMID: 31749863 PMCID: PMC6855171 DOI: 10.5114/aoms.2019.89450] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 06/22/2019] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION The aim of this meta-analysis was to establish whether vascular pulse wave velocity (PWV) as a measure of arterial stiffness is changed in patients with familial hypercholesterolemia (FH). MATERIAL AND METHODS Studies comparing PWV between patients with FH and controls were searched in PubMed-Medline, SCOPUS, Web of Science and Google Scholar databases (up to November 26, 2017). A meta-analysis was conducted using Comprehensive Meta-Analysis V2 software. A random-effects model (using the DerSimonian-Laird method) and the generic inverse variance method were used to compensate for the heterogeneity of studies concerning demographic characteristics and differences in the studies' design. RESULTS This meta-analysis of 8 studies involving 317 patients with FH and 244 non-FH individuals did not suggest a significantly altered PWV in FH patients versus controls (weighted mean difference (WMD): 0.17 m/s, 95% confidence interval (CI): -0.31, 0.65, p = 0.489; I 2 = 80.15%). The result was robust in the sensitivity analysis and its significance was not influenced after omitting each of the included studies from the meta-analysis. Subanalysis of 6 of these studies which had data on intima-media thickness (IMT) indicated an increased IMT in FH patients when compared with controls (WMD = 0.03 mm, 95% CI: 0.003, 0.06, p = 0.034; I 2 = 48.95%). However, the effect size was sensitive to some of the included studies. CONCLUSIONS This meta-analysis suggests that FH patients do not have significantly altered PWV when compared with normocholesterolemic individuals. However, a subanalysis of studies in which IMT was measured indicated that IMT is increased in FH patients compared with controls.
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Affiliation(s)
- Željko Reiner
- University Hospital Center Zagreb, Department of Internal Medicine, School of Medicine, University of Zagreb, Zagreb, Croatia
| | | | - Massimiliano Ruscica
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy
| | - Niki Katsiki
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece
| | - Maciej Banach
- Department of Hypertension, WAM University Hospital in Lodz, Medical University of Lodz, Lodz, Poland
- Polish Mother’s Memorial Hospital Research Institute (PMMHRI), Lodz, Poland
| | - Khalid Al Rasadi
- Department of Clinical Biochemistry, Sultan Qaboos University Hospital, Muscat, Oman
| | - Tannaz Jamialahmadi
- Halal Research Center of IRI, FDA, Tehran, Iran
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
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Zhu YC, Jiang XZ, Bai QK, Deng SH, Zhang Y, Zhang ZP, Jiang Q. Evaluating the Efficacy of Atorvastatin on Patients with Carotid Plaque by an Innovative Ultrasonography. J Stroke Cerebrovasc Dis 2018; 28:830-837. [PMID: 30563776 DOI: 10.1016/j.jstrokecerebrovasdis.2018.11.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 11/12/2018] [Accepted: 11/29/2018] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND The present study aimed to explore the efficacy of atorvastatin on patients with carotid plaque, applying superb microvascular imaging (SMI), and contrast-enhanced ultrasound (CEUS) for evaluating carotid intraplaque neovascularization. METHODS A total of 82 patients (82 carotid plaques) who were randomized into treatment group and control group underwent conventional ultrasound, CEUS, and SMI examinations. Patients in treatment group received a dose of 20 mg atorvastatin per day for 6 months while those in control group received placebo instead. Lipid parameters were assessed and intraplaque neovascularization were evaluated by CEUS and SMI before and 6 months after atorvastatin treatment. RESULTS No significant differences were found between the 2 groups at the study entry. Patients with atorvastatin treatment received marked improvement in total cholesterol, triglyceride, and LDL-cholesterol compared with those in control group (P < .001). In treatment group, SMI-detected intraplaque neovascularization reduced from 69.23% to 48.72% while CEUS-detected ones reduced from 76.92% to 69.23%. By contrast, the percentage of intraplaque neovascularization in control group did not change too much either by SMI (65.12%, 67.44%) or CEUS (74.41%, 74.41%). The consistency between CEUS and SMI was above .75 at all assessments (P < .001). CONCLUSIONS Atorvastatin treatment works for patients with carotid plaque by reducing LDL-cholesterol and improving plaque regression. Second, the consistency between SMI and CEUS in visualizing intraplaque neovascularization is good. That indicates a high possibility to identify carotid plaque instability by a safer and cheaper ultrasonography without contrast agent.
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Affiliation(s)
- Yi-Cheng Zhu
- Department of Ultrasound, Pudong New Area People's Hospital affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Xiao-Zhen Jiang
- Department of Internal Medicine, Pudong New Area People's Hospital affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Qing-Ke Bai
- Department of Neurology, Pudong New Area People's Hospital affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Shu-Hao Deng
- Department of Ultrasound, Pudong New Area People's Hospital affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Yuan Zhang
- Department of Ultrasound, Pudong New Area People's Hospital affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Zhi-Peng Zhang
- Department of Head and Neck Surgery, Pudong New Area People's Hospital affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Quan Jiang
- Department of Ultrasound, Pudong New Area People's Hospital affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China.
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Marume K, Takashio S, Nagai T, Tsujita K, Saito Y, Yoshikawa T, Anzai T. Effect of Statins on Mortality in Heart Failure With Preserved Ejection Fraction Without Coronary Artery Disease - Report From the JASPER Study. Circ J 2018; 83:357-367. [PMID: 30416189 DOI: 10.1253/circj.cj-18-0639] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Statins might be associated with improved survival in patients with heart failure with preserved ejection fraction (HFpEF). The effect of statins in HFpEF without coronary artery disease (CAD), however, remains unclear. Methods and Results: From the JASPER registry, a multicenter, observational, prospective cohort with Japanese patients aged ≥20 years requiring hospitalization with acute HF and LVEF ≥50%, 414 patients without CAD were selected for outcome analysis. Based on prescription of statins at admission, we divided patients into the statin group (n=81) or no statin group (n=333). We followed them for 25 months. The association between statin use and primary (all-cause mortality) and secondary (non-cardiac death, cardiac death, or rehospitalization for HF) endpoints was assessed in the entire cohort and in a propensity score-matched cohort. In the propensity score-matched cohort, 3-year mortality was lower in the statin group (HR, 0.21; 95% CI: 0.06-0.72; P=0.014). The statin group had a significantly lower incidence of non-cardiac death (P=0.028) and rehospitalization for HF (P<0.001), but not cardiac death (P=0.593). The beneficial effect of statins on mortality did not have any significant interaction with cholesterol level or HF severity. CONCLUSIONS Statin use has a beneficial effect on mortality in HFpEF without CAD. The present findings should be tested in an adequately powered randomized clinical trial.
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Affiliation(s)
- Kyohei Marume
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | - Seiji Takashio
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | - Toshiyuki Nagai
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine.,Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | - Yoshihiko Saito
- First Department of Internal Medicine, Nara Medical University
| | | | - Toshihisa Anzai
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine.,Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
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Canepa M, Artom N, Ameri P, Carbone F, Montecucco F, Ghigliotti G, Brunelli C, Dallegri F, Pende A, Pisciotta L. Short-term effect of rosuvastatin treatment on arterial stiffness in individuals with newly-diagnosed heterozygous familial hypercholesterolemia. Int J Cardiol 2017; 255:215-220. [PMID: 29290422 DOI: 10.1016/j.ijcard.2017.12.051] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 12/04/2017] [Accepted: 12/16/2017] [Indexed: 01/27/2023]
Affiliation(s)
- Marco Canepa
- Cardiovascular Unit, Department of Internal Medicine, Ospedale Policlinico San Martino, Genova, University of Genova, Largo Benzi 10, 16132 Genova, Italy
| | - Nathan Artom
- First Clinic of Internal Medicine, Department of Internal Medicine, Ospedale Policlinico San Martino, Genova, University of Genova, Largo Benzi 10, 16132 Genova, Italy
| | - Pietro Ameri
- Cardiovascular Unit, Department of Internal Medicine, Ospedale Policlinico San Martino, Genova, University of Genova, Largo Benzi 10, 16132 Genova, Italy
| | - Federico Carbone
- First Clinic of Internal Medicine, Department of Internal Medicine, Ospedale Policlinico San Martino, Genova, University of Genova, Largo Benzi 10, 16132 Genova, Italy
| | - Fabrizio Montecucco
- First Clinic of Internal Medicine, Department of Internal Medicine, Ospedale Policlinico San Martino, Genova, University of Genova, Largo Benzi 10, 16132 Genova, Italy
| | - Giorgio Ghigliotti
- Cardiovascular Unit, Department of Internal Medicine, Ospedale Policlinico San Martino, Genova, University of Genova, Largo Benzi 10, 16132 Genova, Italy
| | - Claudio Brunelli
- Cardiovascular Unit, Department of Internal Medicine, Ospedale Policlinico San Martino, Genova, University of Genova, Largo Benzi 10, 16132 Genova, Italy
| | - Franco Dallegri
- First Clinic of Internal Medicine, Department of Internal Medicine, Ospedale Policlinico San Martino, Genova, University of Genova, Largo Benzi 10, 16132 Genova, Italy
| | - Aldo Pende
- First Clinic of Internal Medicine, Department of Internal Medicine, Ospedale Policlinico San Martino, Genova, University of Genova, Largo Benzi 10, 16132 Genova, Italy
| | - Livia Pisciotta
- First Clinic of Internal Medicine, Department of Internal Medicine, Ospedale Policlinico San Martino, Genova, University of Genova, Largo Benzi 10, 16132 Genova, Italy.
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Castejon R, Castañeda A, Sollet A, Mellor-Pita S, Tutor-Ureta P, Jimenez-Ortiz C, Yebra-Bango M. Short-term atorvastatin therapy improves arterial stiffness of middle-aged systemic lupus erythematosus patients with pathological pulse wave velocity. Lupus 2016; 26:355-364. [PMID: 27510602 DOI: 10.1177/0961203316662719] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives Statins have been proposed as a potential treatment for systemic lupus erythematosus (SLE) due to their immunomodulatory properties, their role restoring endothelial function and preventing atherosclerosis. We evaluate the effect of a short period treatment with a low dose of atorvastatin and its withdrawal on early stage subclinical atherosclerosis. Methods Thirty-seven SLE females received 20 mg/day atorvastatin during eight weeks. At baseline, at the end of treatment and six months after atorvastatin withdrawal, disease activity, subclinical atherosclerosis -assessed by measuring carotid-femoral pulse wave velocity (PWV) - and quantification of circulating endothelial progenitor cells (EPC) - as a surrogate biological marker of subclinical atherosclerosis - were carried out. Results The group of SLE patients with baseline pathological arterial stiffness showed a significant decrease of PWV after atorvastatin therapy (8.43 ± 1.45 m/s vs 7.42 ± 1.06 m/s; p = 0.002) that is maintained six months after treatment finished. Only patients of the middle-aged group showed a nearly significant decrease in the PWV measured along the study (7.16 ± 1.23 m/s vs 6.76 ± 0.82 m/s; p = 0.05). Atorvastatin induced a significant decrease in the circulating EPC percentage (0.65 ± 0.67 vs 0.40 ± 0.31; p = 0.023) as well as a downward trend of disease activity that it is observed by a decrease in SLE disease activity index simultaneously with an increase in C3 complement and significant decrease in serum concentration of vascular endothelial grow factor (VEGF) and sVCAM-1. Conclusions Short-term atorvastatin therapy reduces arterial stiffness of SLE patients with baseline pathological PWV, who are mainly in the group of middle-aged patients. Further studies are needed to determine whether these patients would benefit from statin therapy in preventing cardiovascular events.
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Affiliation(s)
- R Castejon
- 1 Systemic Autoimmune Diseases Unit, Internal Medicine Service, IDIPHIM (University Hospital Puerta de Hierro Research Institute), Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - A Castañeda
- 1 Systemic Autoimmune Diseases Unit, Internal Medicine Service, IDIPHIM (University Hospital Puerta de Hierro Research Institute), Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - A Sollet
- 1 Systemic Autoimmune Diseases Unit, Internal Medicine Service, IDIPHIM (University Hospital Puerta de Hierro Research Institute), Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - S Mellor-Pita
- 1 Systemic Autoimmune Diseases Unit, Internal Medicine Service, IDIPHIM (University Hospital Puerta de Hierro Research Institute), Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - P Tutor-Ureta
- 1 Systemic Autoimmune Diseases Unit, Internal Medicine Service, IDIPHIM (University Hospital Puerta de Hierro Research Institute), Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - C Jimenez-Ortiz
- 2 Neurology Service, IDIPHIM (University Hospital Puerta de Hierro Research Institute), Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - M Yebra-Bango
- 1 Systemic Autoimmune Diseases Unit, Internal Medicine Service, IDIPHIM (University Hospital Puerta de Hierro Research Institute), Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
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Fukuta H, Goto T, Wakami K, Ohte N. The effect of statins on mortality in heart failure with preserved ejection fraction: a meta-analysis of propensity score analyses. Int J Cardiol 2016; 214:301-6. [DOI: 10.1016/j.ijcard.2016.03.186] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 03/21/2016] [Accepted: 03/22/2016] [Indexed: 10/22/2022]
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11
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Protopsaltis I, Foussas S, Angelidi A, Gritzapis A, Sergentanis TΝ, Matsagos S, Tzirogiannis K, Panoutsopoulos GI, Dimitriadis G, Raptis S, Melidonis A. Impact of ADMA, endothelial progenitor cells and traditional cardiovascular risk factors on pulse wave velocity among prediabetic individuals. Cardiovasc Diabetol 2012; 11:141. [PMID: 23153108 PMCID: PMC3527304 DOI: 10.1186/1475-2840-11-141] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 11/11/2012] [Indexed: 12/14/2022] Open
Abstract
Background Central arterial stiffness represents a well-established predictor of cardiovascular disease. Decreased circulating endothelial progenitor cells (EPCs), increased asymmetric dimethyl-arginine (ADMA) levels, traditional cardiovascular risk factors and insulin resistance have all been associated with increased arterial stiffness. The correlations of novel and traditional cardiovascular risk factors with central arterial stiffness in prediabetic individuals were investigated in the present study. Methods The study population consisted of 53 prediabetic individuals. Individuals were divided into groups of isolated impaired fasting glucose (IFG), isolated impaired glucose tolerance (IGT) and combined IGT-IFG. Age, sex, family history of diabetes, smoking history, body mass index (BMI), waist to hip ratio (WHR), waist circumference (WC), blood pressure, lipid profile, levels of high sensitive C-reactive protein (hsCRP), glomerular filtration rate (GFR), and history of antihypertensive or statin therapy were obtained from all participants. Insulin resistance was evaluated using the Homeostatic Model Assessment (HOMA-IR). Carotid -femoral pulse wave velocity was used as an index of arterial stiffness. Circulating EPC count and ADMA serum levels were also determined. Results Among studied individuals 30 (56.6%) subjects were diagnosed with isolated IFG, 9 (17%) with isolated IGT (17%) and 14 with combined IFG-IGT (26.4%). In univariate analysis age, mean blood pressure, fasting glucose, total cholesterol, LDL cholesterol, and ADMA levels positively correlated with pulse-wave velocity while exercise and GFR correlated negatively. EPC count did not correlate with PWV. In multivariate stepwise regression analysis PWV correlated independently and positively with LDL-Cholesterol (low density lipoprotein) and ADMA levels and negatively with exercise. Conclusions Elevated ADMA and LDL-C levels are strongly associated with increased arterial stiffness among pre-diabetic subjects. In contrast exercise inversely correlated with arterial stiffness.
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Affiliation(s)
- Ioannis Protopsaltis
- Diabetes Center, Tzanio General Hospital of Piraeus, Zanni and Afendouli 1, Piraeus 18537, Greece.
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Burgess JL, Kurzius-Spencer M, Gerkin RD, Fleming JL, Peate WF, Allison M. Risk factors for subclinical atherosclerosis in firefighters. J Occup Environ Med 2012; 54:328-35. [PMID: 22371058 DOI: 10.1097/jom.0b013e318243298c] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Heart disease is the leading cause of firefighter line-of-duty deaths. The study objectives were to identify early atherosclerotic disease through ultrasound measurement of carotid intima-media thickness (CIMT) and risk factors predicting increased CIMT and carotid plaque. METHODS Following ultrasound evaluation of 597 Phoenix and Tucson firefighters, logistic regression was used to identify risk factors for mean CIMT greater than 75th percentile and for carotid plaque. RESULTS Age, low-density lipoprotein cholesterol (LDL-C) of 100 mg/dL or more, and high-density lipoprotein cholesterol were significant independent predictors of increased CIMT. Age, hypertension, LDL-C, and plasma soluble P-selectin were significant predictors of carotid plaque. CONCLUSIONS This study supports an emphasis on traditional risk factors for atherosclerotic disease in firefighters, in particular maintaining LDL-C less than 100 mg/dL. Plasma soluble P-selectin may help identify firefighters at increased risk for carotid plaque.
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Affiliation(s)
- Jefferey L Burgess
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA.
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13
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Chan W, Dart AM. Vascular stiffness and aging in HIV. Sex Health 2012; 8:474-84. [PMID: 22127032 DOI: 10.1071/sh10160] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Accepted: 03/31/2011] [Indexed: 12/19/2022]
Abstract
Large artery stiffening is a biological index of vascular aging. Vascular aging and atherosclerosis are two closely linked processes that develop in parallel and in synergy, sharing common aetiological determinants. Vascular stiffening increases left ventricular work and can lead to diminished coronary perfusion, and may therefore contribute to the development of cardiovascular disease. There is emerging evidence that large artery stiffness and vascular aging are accelerated in HIV infection because of the high prevalence of cardiovascular risk factors among HIV-infected patients. Moreover, the biological effects of HIV and the metabolic perturbations associated with antiretroviral therapies appear to accelerate vascular stiffening in HIV-infected patients. Further studies evaluating the effects of general and targeted therapies and various combinations of antiretroviral therapies on measures of large artery stiffness are urgently needed.
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Affiliation(s)
- William Chan
- Department of Cardiovascular Medicine, the Alfred Hospital, Melbourne, Vic. 3004, Australia
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Statin therapy is associated with superior clinical outcomes after endovascular treatment of critical limb ischemia. J Vasc Surg 2012; 55:371-9; discussion 380. [DOI: 10.1016/j.jvs.2011.08.044] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Revised: 08/25/2011] [Accepted: 08/25/2011] [Indexed: 11/18/2022]
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15
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Wang F, Ye P, Luo L, Xiao W, Qi L, Bian S, Wu H, Sheng L, Xiao T, Xu R. Association of serum lipids with arterial stiffness in a population-based study in Beijing. Eur J Clin Invest 2011; 41:929-36. [PMID: 21314825 DOI: 10.1111/j.1365-2362.2011.02481.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Some cardiovascular risk factors such as age, hypertension and diabetes have been confirmed to be positively correlated with arterial stiffness. However, the relationship between serum lipids and arterial stiffness is incompletely understood. Recent studies have been far from conclusive and consistent data were not obtained. We investigated the relationship between serum lipids and pulse wave velocity (PWV) in community-dwelling individuals in Beijing, China. METHODS This was a population-based, cross-sectional sample of adults (n = 2375; 48·1% men; age range, 40-96 years) from two communities in Beijing. A questionnaire was used for the risk factors of arterial stiffness. Anthropometry, blood pressure and heart rate were measured. Values of fasting plasma glucose (FPG), serum total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and uric acid were measured. Carotid-femoral PWV (cfPWV) and carotid-radial PWV (crPWV) were assessed non-invasively. RESULTS Carotid-femoral pulse wave velocity was significantly positively related to TC (r = 0·221; P < 0·0001), LDL-C (r = 0·193; P < 0·0001) and inversely related to HDL-C (r = -0·240; P < 0·0001), but not with TG (r = 0·073; P = 0·6721). crPWV was inversely related to HDL-C (r = -0·272; P < 0·0001), but not with TC (r = 0·007; P = 0·4781), LDL-C (r = 0·021; P = 0·6393) or TG (r = 0·008; P = 0·2498). The multiple regression analysis showed that LDL-C was independently associated with cfPWV and that HDL-C was inversely associated with cfPWV and crPWV. TC and TG were not independently related to cfPWV and crPWV. CONCLUSIONS These data show the correlation between some of the parameters of serum lipids and arterial stiffness. LDL-C was independently associated with aortic stiffness, and HDL-C was independently inversely associated with aortic stiffness and peripheral stiffness.
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Affiliation(s)
- Fan Wang
- Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China
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16
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Relationship between plasma coenzyme Q10, asymmetric dimethylarginine and arterial stiffness in patients with phenotypic or genotypic familial hypercholesterolemia on long-term statin therapy. Atherosclerosis 2011; 218:188-93. [DOI: 10.1016/j.atherosclerosis.2011.04.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Revised: 04/18/2011] [Accepted: 04/18/2011] [Indexed: 11/23/2022]
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17
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Reed RM, Iacono A, DeFilippis A, Jones S, Eberlein M, Lechtzin N, Girgis RE. Statin therapy is associated with decreased pulmonary vascular pressures in severe COPD. COPD 2011; 8:96-102. [PMID: 21495837 DOI: 10.3109/15412555.2011.558545] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Pulmonary hypertension (PH) in COPD carries a poor prognosis. Statin therapy has been associated with numerous beneficial clinical effects in COPD, including a possible improvement in PH. We examined the association between statin use and pulmonary hemodynamics in a well-characterized cohort of patients undergoing evaluation for lung transplantation. METHODS We conducted a cross-sectional analysis of 112 subjects evaluated for lung transplant with a diagnosis of COPD. Clinical characteristics, pulmonary function, cardiac catheterization findings and medical comorbidities were compared between statins users and non-users. RESULTS Thirty-four (30%) subjects were receiving statin therapy. Statin users were older and had an increased prevalence of systemic hypertension and coronary artery disease (CAD). Mean pulmonary arterial pressure (mPAP) in the statin group was lower [26 ± 7 vs 29 ± 7 mmHg, p = 0.02], as was pulmonary artery wedge pressure (PAWP) [12 ± 5 vs. 15 ± 6 mmHg, p = 0.02]. Pulmonary vascular resistance did not differ between the groups. In multiple regression analysis, statin use was associated with a 4.2 mmHg (95% CI: 2 to 6.4, p = <0.001) lower PAWP and a 2.6 mmHg (95% CI: 0.3 to 4.9, p = 0.03) reduction in mPAP independent of PAWP. CONCLUSIONS In patients with severe COPD, statin use is associated with significantly lower PAWP and mPAP. These finding should be evaluated prospectively.
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Affiliation(s)
- Robert M Reed
- University of Maryland School of Medicine, Division of Pulmonary and Critical Care Medicine, Baltimore, Maryland 21201, USA.
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Steppan J, Barodka V, Berkowitz DE, Nyhan D. Vascular stiffness and increased pulse pressure in the aging cardiovascular system. Cardiol Res Pract 2011; 2011:263585. [PMID: 21845218 PMCID: PMC3154449 DOI: 10.4061/2011/263585] [Citation(s) in RCA: 132] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Revised: 03/24/2011] [Accepted: 06/08/2011] [Indexed: 01/09/2023] Open
Abstract
Aging leads to a multitude of changes in the cardiovascular system, including systolic hypertension, increased central vascular stiffness, and increased pulse pressure. In this paper we will review the effects of age-associated increased vascular stiffness on systolic blood pressure, pulse pressure, augmentation index, and cardiac workload. Additionally we will describe pulse wave velocity as a method to measure vascular stiffness and review the impact of increased vascular stiffness as an index of vascular health and as a predictor of adverse cardiovascular outcomes. Furthermore, we will discuss the underlying mechanisms and how these may be modified in order to change the outcomes. A thorough understanding of these concepts is of paramount importance and has therapeutic implications for the increasingly elderly population.
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Affiliation(s)
- Jochen Steppan
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA
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Ershova AI, Meshkov AN, Boytsov SA, Balakhonova TV. Modern ultrasound methods and atherosclerosis assessment in patients with familial hypercholesterolemia. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2011. [DOI: 10.15829/1728-8800-2011-3-113-122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Familial hypercholesterolemia (FHCH) is characterised by early atherosclerosis development and its fast progression. The prevalence of FHCH inRussiahas been increasing, therefore, it is important to evaluate the potential of various methods for atherosclerosis diagnostics. Arterial ultrasound is an informative, accessible, and safe method for evaluating atherosclerotic vascular changes. The modern ultrasound methods allow describing vascular wall status in detail, including qualitative and quantitative characteristics of its structure and function. At the same time, most ultrasound characteristics of arterial wall are used in research settings or are under development, and not implemented into clinical practice. The most promising parameters, applicable for clinical use in FHCH patients, simultaneously describe atherosclerosis severity and its localization, such as total plaque height, ankle-brachial index, and plaque number.
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Plana N, Ferré R, Merino J, Aragonès G, Girona J, Heras M, Masana L. Heterozygous Familial Hypercholesterolaemic Patients have Increased Arterial Stiffness, as Determined using the Augmentation Index. J Atheroscler Thromb 2011; 18:1110-6. [DOI: 10.5551/jat.9795] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Masoura C, Pitsavos C, Aznaouridis K, Skoumas I, Vlachopoulos C, Stefanadis C. Arterial endothelial function and wall thickness in familial hypercholesterolemia and familial combined hyperlipidemia and the effect of statins. A systematic review and meta-analysis. Atherosclerosis 2011; 214:129-38. [DOI: 10.1016/j.atherosclerosis.2010.10.008] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2010] [Revised: 09/23/2010] [Accepted: 10/08/2010] [Indexed: 11/17/2022]
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Abstract
Arterial walls stiffen with age. The most consistent and well-reported changes are luminal enlargement with wall thickening and a reduction of elastic properties at the level of large elastic arteries. Longstanding arterial pulsation in the central artery causes elastin fiber fatigue and fracture. Increased vascular calcification and endothelial dysfunction are also characteristic of arterial aging. These changes lead to increased pulse wave velocity, especially along central elastic arteries, and increases in systolic blood pressure and pulse pressure. Vascular aging is accelerated by coexisting cardiovascular risk factors, such as hypertension, metabolic syndrome and diabetes. Vascular aging is an independent risk factor for cardiovascular disease, from atherosclerosis to target organ damage, including coronary artery disease, stroke and heart failure. Various strategies, especially controlling hypertension, show benefit in preventing, delaying or attenuating vascular aging.
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Affiliation(s)
- Hae-Young Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Wen C, Zhang L, Wang Y, Cheng Z, Lin Q, Wang Z, Tang J. Sonographic Assessment of Atherosclerotic and Hypercholesterolemic Artery Using the Echo-Tracking Technique in an Animal Model. Vascular 2010; 18:178-84. [PMID: 20470690 DOI: 10.2310/6670.2010.00006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to ascertain the utility of sonography with the echo-tracking (ET) technique to assess vascular stiffness in rabbits with hypercholesterolemia and atherosclerosis. Grayscale sonography associated with the ET technique was used to measure the elastic modulus (Ep) of the aorta in cholesterol-fed rabbits (group T1, n = 44, for 4 weeks; group T2, n = 44, for 12 weeks) and normal control rabbits (group C1, n = 44; group C2, n = 44). The aortic Ep values and blood biochemical markers between groups were compared using analysis of covariance. Light and transmission electron microscopic evaluation were used to demonstrate atherosclerotic changes in the aorta. The Ep values of the aorta in group T1 and T2 rabbits were significantly higher than those of group C1 and C2 controls (88.74 ± 27.99 and 100.96 ± 24.81 vs 64.38 ± 20.23 and 72.35 ± 18.43, p = .124). Also, the Ep values of the aorta between group T1 and T2 rabbits were significantly different ( p = .033). Light and transmission electron microscopy confirmed morphologic typical changes of aortic atherosclerosis in groups T1 and T2. Grayscale sonography with the ET method could be used to evaluate tissue elastic changes in arterial walls associated with atherosclerosis and hypercholesterolemia.
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Affiliation(s)
- Chaoyang Wen
- *Principal investigators who contributed equally to this work. †Department of Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Lihai Zhang
- *Principal investigators who contributed equally to this work. †Department of Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Yuexiang Wang
- *Principal investigators who contributed equally to this work. †Department of Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Zhigang Cheng
- *Principal investigators who contributed equally to this work. †Department of Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Qian Lin
- *Principal investigators who contributed equally to this work. †Department of Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Zhili Wang
- *Principal investigators who contributed equally to this work. †Department of Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Jie Tang
- *Principal investigators who contributed equally to this work. †Department of Ultrasound, Chinese PLA General Hospital, Beijing, China
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Luc M, Polonsky T, Lammertin G, Spencer K. Automated Border Detection for Assessing the Mechanical Properties of the Carotid Arteries: Comparison with Carotid Intima–Media Thickness. J Am Soc Echocardiogr 2010; 23:567-72. [DOI: 10.1016/j.echo.2010.01.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2009] [Indexed: 12/01/2022]
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Riggio S, Mandraffino G, Sardo MA, Iudicello R, Camarda N, Imbalzano E, Alibrandi A, Saitta C, Carerj S, Arrigo T, Saitta A. Pulse wave velocity and augmentation index, but not intima-media thickness, are early indicators of vascular damage in hypercholesterolemic children. Eur J Clin Invest 2010; 40:250-7. [PMID: 20415700 DOI: 10.1111/j.1365-2362.2010.02260.x] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Arterial stiffness is an important determinant of cardiovascular risk. It is associated with several cardiovascular risk factors, including hypertension, diabetes and cigarette smoking. However, there are conflicting data about the relationship between arterial stiffness and hypercholesterolemia. Furthermore, augmentation index (AIx), a measure of systemic arterial stiffness, has not been previously investigated in hypercholesterolemic (HCh) children. Aim of our study was to evaluate local and systemic arterial stiffness as well as carotid intima-media thickness (IMT) in HCh children and also to investigate the relation between serum cholesterol levels and arterial stiffness. MATERIALS AND METHODS We determined lipid profile, body mass index, blood pressure, heart rate, carotid IMT and several arterial stiffness parameters, as beta-index, elastic modulus (E(p)), arterial compliance (AC), pulse wave velocity (PWV) and AIx, in 44 untreated HCh children (mean age 10.7 +/- 2.8 years; 18 with familial hypercholesterolemia, FH, and 26 with primary hypercholesterolemia, PHC) and 18 age- and sex-matched controls. HCh children never received any medication, including antihypertensive and lipid lowering drugs. RESULTS Respect to controls and to PHC, FH had significantly higher (P < 0.001) beta-index (5.22 +/- 1.13 vs. 3.13 +/- 0.74 and 3.60 +/- 1.02), PWV (4.72 +/- 0.72 m s(-1) vs. 3.66 +/- 0.55 m s(-1) and 4.10 +/- 0.67 m s(-1)), AIx (3.55 +/- 3.97% vs. -4.43 +/- 4.09% and 0.61 +/- 2.39%) and E(p) (64.4 +/- 19.6 kPa vs. 36.2 +/- 11.3 kPa and 42.9 +/- 13.1), whereas AC (1.25 +/- 0.48 mm(2) kPa(-1) vs. 1.9 +/- 0.43 mm(2) kPa(-1) and 1.62 +/- 0.43 mm(2) kPa(-1)) was lower (P < 0.001). There was no significant difference in carotid IMT and blood pressure values between the groups. The multiple regression analysis showed a significant association of arterial stiffness values with plasma cholesterol levels (P < 0.0001). CONCLUSION Our findings show that local and systemic arterial stiffness are increased in asymptomatic, normotensive HCh children, suggesting that HCh plays a key role in arterial mechanical impairment since the paediatric age.
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Affiliation(s)
- S Riggio
- Department of Internal Medicine and Medical Therapy, University of Messina, 8298123 Messina, Italy
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Goodwill AG, Frisbee SJ, Stapleton PA, James ME, Frisbee JC. Impact of chronic anticholesterol therapy on development of microvascular rarefaction in the metabolic syndrome. Microcirculation 2010; 16:667-84. [PMID: 19905967 DOI: 10.3109/10739680903133722] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The obese Zucker rat (OZR) model of the metabolic syndrome is partly characterized by moderate hypercholesterolemia, in addition to other contributing comorbidities. Previous results suggest that vascular dysfunction in OZR is associated with chronic reduction in vascular nitric-oxide (NO) bioavailability and chronic inflammation, both frequently associated with hypercholesterolemia. As such, we evaluated the impact of chronic cholesterol-reducing therapy on the development of impaired skeletal muscle arteriolar reactivity and microvessel density in OZR and its impact on chronic inflammation and NO bioavailability. MATERIALS AND METHODS Beginning at seven weeks of age, male OZR were treated with gemfibrozil, probucol, atorvastatin, or simvastatin (in chow) for 10 weeks. Subsequently, plasma and vascular samples were collected for biochemical/molecular analyses, while arteriolar reactivity and microvessel network structure were assessed by using established methodologies after 3, 6, and 10 weeks of drug therapy. RESULTS All interventions were equally effective at reducing total cholesterol, although only the statins also blunted the progressive reductions to vascular NO bioavailability, evidenced by greater maintenance of acetylcholine-induced dilator responses, an attenuation of adrenergic constrictor reactivity, and an improvement in agonist-induced NO production. Comparably, while minimal improvements to arteriolar wall mechanics were identified with any of the interventions, chronic statin treatment reduced the rate of microvessel rarefaction in OZR. Associated with these improvements was a striking statin-induced reduction in inflammation in OZR, such that numerous markers of inflammation were correlated with improved microvascular reactivity and density. However, using multivariate discriminant analyses, plasma RANTES (regulated on activation, normal T-cell expressed and secreted), interleukin-10, monocyte chemoattractant protein-1, and tumor necrosis factor alpha were determined to be the strongest contributors to differences between groups, although their relative importance varied with time. CONCLUSIONS While the positive impact of chronic statin treatment on vascular outcomes in the metabolic syndrome are independent of changes to total cholesterol, and are more strongly associated with improvements to vascular NO bioavailability and attenuated inflammation, these results provide both a spatial and temporal framework for targeted investigation into mechanistic determinants of vasculopathy in the metabolic syndrome.
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Affiliation(s)
- Adam G Goodwill
- Department of Physiology and Pharmacology, West Virginia University School ofMedicine, Morgantown, West Virginia, USA
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Grosor de la íntima-media carotídea en la hipercolesterolemia familiar heterocigótica: factores asociados y variación al año de tratamiento. Med Clin (Barc) 2009; 133:121-6. [DOI: 10.1016/j.medcli.2009.02.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2008] [Accepted: 02/12/2009] [Indexed: 11/24/2022]
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McNeal CJ, Wilson DP, Christou D, Bush RL, Shepherd LG, Santiago J, Wu GY. The use of surrogate vascular markers in youth at risk for premature cardiovascular disease. J Pediatr Endocrinol Metab 2009; 22:195-211. [PMID: 19492575 DOI: 10.1515/jpem.2009.22.3.195] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Premature cardiovascular disease (CVD) begins in youth--a crucial period when modification of the disease may have the greatest impact. Failure to diagnose preclinical CVD at this stage misses a major opportunity to prevent the long-term consequences of this disease. An array of surrogate vascular markers (SVMs) are now available that can determine the extent of preclinical vascular injury in the pediatric population. These SVMs include flow-mediated vasodilatation, carotid intima media thickness, arterial stiffness, and biomarkers including high sensitivity C-reactive protein, cell adhesion molecules and methylarginines. We believe that the use of these SVMs will help to develop a better understanding of early pathological vascular changes in youth, facilitate earlier diagnosis of preclinical atherosclerosis and provide an objective measure of the vascular effects of any therapeutic intervention aimed at risk factor modification. Ultimately, our future health will depend on carefully balancing the benefits of early diagnosis and treatment in high-risk youth with the long-term risk of CVD. The application of SVMs in the pediatric population will help us achieve this balance.
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Affiliation(s)
- C J McNeal
- Department of Pediatrics, Scott & White Memorial Hospital and the Texas A&M Health Science Center, Temple, TX 76508, USA.
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Herold V, Wellen J, Ziener CH, Weber T, Hiller KH, Nordbeck P, Rommel E, Haase A, Bauer WR, Jakob PM, Sarkar SK. In vivo comparison of atherosclerotic plaque progression with vessel wall strain and blood flow velocity in apoE(-/-) mice with MR microscopy at 17.6 T. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2009; 22:159-66. [PMID: 19153787 DOI: 10.1007/s10334-008-0160-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2008] [Revised: 11/14/2008] [Accepted: 11/25/2008] [Indexed: 01/02/2023]
Abstract
OBJECT At present, in vivo plaque characterization in mice by MRI is typically limited to the visualization of vascular lesions with no accompanying analysis of vessel wall function. The aim of this study was to analyze the influence of atherosclerotic plaque development on the morphological and mechanical characteristics of the aortic vessel wall in a pre-clinical murine model of atherosclerosis. MATERIALS AND METHODS Groups of apolipoprotein E-deficient (apoE(-/-)) and C57BL/6J control mice fed a high-fat diet were monitored over a 12-week time period by high-field MRI. Multi-Slice-Multi-Spin-Echo and Phase-Contrast MRI sequences were employed to track changes to aortic vessel wall area, blood flow velocity and distensibility. RESULTS After 6- and 12-weeks, significant changes in vessel wall area and circumferential strain were detected in the apoE(-/-) mice relative to the control animals. Blood flow velocity and intravascular lumen remained unchanged in both groups, findings that are in agreement with the theory of positive remodeling of the ascending aorta during plaque progression. CONCLUSION This study has demonstrated the application of high-field MRI for characterizing the temporal progression of morphological and mechanical changes to murine aortic vasculature associated with atherosclerotic lesion development.
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Affiliation(s)
- Volker Herold
- Julius-Maximilians-Universität Würzburg, Lehrstuhl für Experimentelle Physik 5, Am Hubland, Würzburg, Germany.
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Williams B, Lacy PS, Cruickshank JK, Collier D, Hughes AD, Stanton A, Thom S, Thurston H. Impact of Statin Therapy on Central Aortic Pressures and Hemodynamics. Circulation 2009; 119:53-61. [DOI: 10.1161/circulationaha.108.785915] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Statins reduce the risk of cardiovascular events in people with hypertension. This benefit could arise from a beneficial effect of statins on central aortic pressures and hemodynamics. The Conduit Artery Function Evaluation–Lipid-Lowering Arm (CAFE-LLA) study, an Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) substudy, investigated this hypothesis in a prospective placebo-controlled study of treated patients with hypertension.
Methods and Results—
CAFE-LLA recruited 891 patients randomized to atorvastatin 10 mg/d or placebo from 5 centers in the United Kingdom and Ireland. Radial artery applanation tonometry and pulse-wave analysis were used to derive central aortic pressures and hemodynamic indices at repeated visits over 3.5 years of follow-up. Atorvastatin lowered low-density lipoprotein cholesterol by 32.4 mg/dL (95% confidence interval [CI], 28.6 to 36.3) and total cholesterol by 35.1 mg/dL (95% confidence interval, 30.9 to 39.4) relative to placebo. Time-averaged brachial blood pressure was similar in CAFE-LLA patients randomized to atorvastatin or placebo (change in brachial systolic blood pressure, −0.1 mm Hg [95% CI, −1.8 to 1.6],
P
=0.9; change in brachial pulse pressure, −0.02 mm Hg [95% CI, −1.6 to 1.6],
P
=0.9). Atorvastatin did not influence central aortic pressures (change in aortic systolic blood pressure, −0.5 mm Hg [95% CI, −2.3 to 1.2],
P
=0.5; change in aortic pulse pressure, −0.4 mm Hg [95% CI, −1.9 to 1.0],
P
=0.6) and had no influence on augmentation index (change in augmentation index, −0.4%; 95% CI, −1.7 to 0.8;
P
=0.5) or heart rate (change in heart rate, 0.25 bpm; 95% CI, −1.3 to 1.8;
P
=0.7) compared with placebo. The effect of statin or placebo therapy was not modified by the blood pressure–lowering treatment strategy in the factorial design.
Conclusions—
Statin therapy sufficient to significantly reduce cardiovascular events in treated hypertensive patients in ASCOT did not influence central aortic blood pressure or hemodynamics in a large representative cohort of ASCOT patients in CAFE-LLA.
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Affiliation(s)
- Bryan Williams
- From the Department of Cardiovascular Sciences, University of Leicester, Leicester, UK (B.W., P.S.L., H.T.); University Department of Medicine, Manchester Royal Infirmary, Manchester, UK (J.K.C.); Barts and the London, Queen Mary’s School of Medicine, London, UK (D.C.); International Centre for Circulatory Health, Imperial College, London, UK (A.D.H., S.T.); and Beaumont Hospital and Royal College of Surgeons, Dublin, Ireland (A.S.)
| | - Peter S. Lacy
- From the Department of Cardiovascular Sciences, University of Leicester, Leicester, UK (B.W., P.S.L., H.T.); University Department of Medicine, Manchester Royal Infirmary, Manchester, UK (J.K.C.); Barts and the London, Queen Mary’s School of Medicine, London, UK (D.C.); International Centre for Circulatory Health, Imperial College, London, UK (A.D.H., S.T.); and Beaumont Hospital and Royal College of Surgeons, Dublin, Ireland (A.S.)
| | - J. Kennedy Cruickshank
- From the Department of Cardiovascular Sciences, University of Leicester, Leicester, UK (B.W., P.S.L., H.T.); University Department of Medicine, Manchester Royal Infirmary, Manchester, UK (J.K.C.); Barts and the London, Queen Mary’s School of Medicine, London, UK (D.C.); International Centre for Circulatory Health, Imperial College, London, UK (A.D.H., S.T.); and Beaumont Hospital and Royal College of Surgeons, Dublin, Ireland (A.S.)
| | - David Collier
- From the Department of Cardiovascular Sciences, University of Leicester, Leicester, UK (B.W., P.S.L., H.T.); University Department of Medicine, Manchester Royal Infirmary, Manchester, UK (J.K.C.); Barts and the London, Queen Mary’s School of Medicine, London, UK (D.C.); International Centre for Circulatory Health, Imperial College, London, UK (A.D.H., S.T.); and Beaumont Hospital and Royal College of Surgeons, Dublin, Ireland (A.S.)
| | - Alun D. Hughes
- From the Department of Cardiovascular Sciences, University of Leicester, Leicester, UK (B.W., P.S.L., H.T.); University Department of Medicine, Manchester Royal Infirmary, Manchester, UK (J.K.C.); Barts and the London, Queen Mary’s School of Medicine, London, UK (D.C.); International Centre for Circulatory Health, Imperial College, London, UK (A.D.H., S.T.); and Beaumont Hospital and Royal College of Surgeons, Dublin, Ireland (A.S.)
| | - Alice Stanton
- From the Department of Cardiovascular Sciences, University of Leicester, Leicester, UK (B.W., P.S.L., H.T.); University Department of Medicine, Manchester Royal Infirmary, Manchester, UK (J.K.C.); Barts and the London, Queen Mary’s School of Medicine, London, UK (D.C.); International Centre for Circulatory Health, Imperial College, London, UK (A.D.H., S.T.); and Beaumont Hospital and Royal College of Surgeons, Dublin, Ireland (A.S.)
| | - Simon Thom
- From the Department of Cardiovascular Sciences, University of Leicester, Leicester, UK (B.W., P.S.L., H.T.); University Department of Medicine, Manchester Royal Infirmary, Manchester, UK (J.K.C.); Barts and the London, Queen Mary’s School of Medicine, London, UK (D.C.); International Centre for Circulatory Health, Imperial College, London, UK (A.D.H., S.T.); and Beaumont Hospital and Royal College of Surgeons, Dublin, Ireland (A.S.)
| | - Herbert Thurston
- From the Department of Cardiovascular Sciences, University of Leicester, Leicester, UK (B.W., P.S.L., H.T.); University Department of Medicine, Manchester Royal Infirmary, Manchester, UK (J.K.C.); Barts and the London, Queen Mary’s School of Medicine, London, UK (D.C.); International Centre for Circulatory Health, Imperial College, London, UK (A.D.H., S.T.); and Beaumont Hospital and Royal College of Surgeons, Dublin, Ireland (A.S.)
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32
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Abstract
This article reviews the available evidence from observational studies concerning the effect of statin therapy in patients who have heart failure and a preserved ejection fraction (diastolic heart failure). Observational studies suggest that statin therapy is associated with lower mortality in patients who have diastolic heart failure. These results emphasize the need for a randomized study of the effect of statins in diastolic heart failure. Until the results of such studies are available, it is recommended to use statins in patients with diastolic heart failure who otherwise have an indication for statin therapy.
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33
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Lee JM, Wiesmann F, Shirodaria C, Leeson P, Petersen SE, Francis JM, Jackson CE, Robson MD, Neubauer S, Channon KM, Choudhury RP. Early changes in arterial structure and function following statin initiation: quantification by magnetic resonance imaging. Atherosclerosis 2008; 197:951-8. [PMID: 17977546 PMCID: PMC2292239 DOI: 10.1016/j.atherosclerosis.2007.09.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2007] [Revised: 08/22/2007] [Accepted: 09/04/2007] [Indexed: 12/28/2022]
Abstract
Effective LDL-cholesterol (LDL-C) reduction improves vascular function and can bring about regression of atherosclerosis. Alterations in endothelial function can occur rapidly, but changes in atherosclerosis are generally considered to occur more slowly. Vascular magnetic resonance imaging (MRI) is a powerful technique for accurate non-invasive assessment of central and peripheral arteries at multiple anatomical sites. We report the changes in atherosclerosis burden and arterial function in response to open label statin treatment, in 24 statin-naïve newly diagnosed stable coronary artery disease patients. Patients underwent MRI before, and 3 and 12 months after commencing treatment. Mean LDL-C fell by 37% to 70.8 mg/dL (P<0.01). The plaque index (normalised vessel wall area) showed reductions in the aorta (2.3%, P<0.05) and carotid (3.1%, P<0.05) arteries at 3 months. Early reductions in atherosclerosis of aorta and carotid observed at 3 months were significantly correlated with later change at 12 months (R(2)=0.50, P<0.001; R(2)=0.22, P<0.05, respectively). Improvements in aortic distensibility and brachial endothelial function that were apparent after 3 months treatment were sustained at the 12-month time point.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Robin P. Choudhury
- Department of Cardiovascular Medicine, University of Oxford, United Kingdom
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34
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Hamilton PK, Lockhart CJ, Quinn CE, McVeigh GE. Arterial stiffness: clinical relevance, measurement and treatment. Clin Sci (Lond) 2007; 113:157-70. [PMID: 17623012 DOI: 10.1042/cs20070080] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Most traditional cardiovascular risk factors alter the structure and/or function of arteries. An assessment of arterial wall integrity could therefore allow accurate prediction of cardiovascular risk in individuals. The term 'arterial stiffness' denotes alterations in the mechanical properties of arteries, and much effort has focused on how best to measure this. Pulse pressure, pulse wave velocity, pulse waveform analysis, localized assessment of blood vessel mechanics and other methods have all been used. We review the methodology underlying each of these measures, and present an evidence-based critique of their relative merits and limitations. An overview is also given of the drug therapies that may prove useful in the treatment of patients with altered arterial mechanics.
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Affiliation(s)
- Paul K Hamilton
- Department of Therapeutics and Pharmacology, Queen's University Belfast, Whitla Medical Building, Belfast, UK.
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35
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Anderson TJ. Arterial stiffness or endothelial dysfunction as a surrogate marker of vascular risk. Can J Cardiol 2007; 22 Suppl B:72B-80B. [PMID: 16498516 PMCID: PMC2780833 DOI: 10.1016/s0828-282x(06)70990-4] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The understanding of the pathophysiology of atherosclerosis has advanced greatly in the past decade. Cardiovascular risk factors increase the likelihood of an adverse event by having a detrimental effect on the blood vessel wall. Abnormal interactions among cholesterol, inflammatory mediators, platelets and the vascular wall lead to atherogenesis and cardiac events. In an effort to better understand this process, develop surrogate end points for clinical trials and, ultimately, better risk stratify individuals, a variety of measures of arterial function have been studied. These include measures of endothelial health and arterial compliance. The current paper reviews the various techniques available for the study of vascular health. While not yet routinely used for clinical care, these measurements provide important insights into the pathophysiology and treatment of atherosclerosis.
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Affiliation(s)
- Todd J Anderson
- Correspondence: Dr Todd J Anderson, Department of Cardiovascular Sciences, Foothills Hospital, 1403 – 29 Street Northwest, Calgary, Alberta T2N 2T9. Telephone 403-944-1033, fax 403-283-0744, e-mail
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36
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Tziomalos K, Athyros VG, Karagiannis A, Mikhailidis DP. Endothelial function, arterial stiffness and lipid lowering drugs. Expert Opin Ther Targets 2007; 11:1143-60. [PMID: 17845142 DOI: 10.1517/14728222.11.9.1143] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The endothelium is a dynamic organ that plays a pivotal role in cardiovascular homeostasis. Alteration in endothelial function precedes the development of atherosclerosis and contributes to its initiation, perpetuation and clinical manifestations. It has been suggested that the assessment of endothelial function could represent a barometer of vascular health that could be used to gauge cardiovascular risk. This review summarises the various methods used to assess endothelium-dependent vasodilatation and their potential prognostic implications. In addition, the techniques used to evaluate arterial stiffness are discussed. The latter is to some extent controlled by the endothelium and has been the subject of considerable research in recent years. This paper also discusses the effects of lipid lowering treatment on both endothelial function and arterial stiffness.
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Affiliation(s)
- Konstantinos Tziomalos
- University of London, Department of Clinical Biochemistry, Royal Free Hospital, Pond Street, London NW3 2QG, UK
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37
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Wadei HM, Amer H, Taler SJ, Cosio FG, Griffin MD, Grande JP, Larson TS, Schwab TR, Stegall MD, Textor SC. Diurnal blood pressure changes one year after kidney transplantation: relationship to allograft function, histology, and resistive index. J Am Soc Nephrol 2007; 18:1607-15. [PMID: 17409307 DOI: 10.1681/asn.2006111289] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Loss of circadian BP change has been linked to target organ damage and accelerated kidney function loss in hypertensive patients with and without chronic kidney disease. Ambulatory BP-derived data from 119 consecutive kidney transplant recipients who presented for the first annual evaluation were examined in relation to allograft function, histology, and ultrasound findings. A total of 101 (85%) patients were receiving antihypertensive medications (median 2), and 85 (71%) achieved target awake average systolic BP (SBP) of <135 mmHg. A day-night change in SBP by 10% or more (dippers) was detected in 29 (24%). Dipping status was associated with younger recipient age, lack of diabetes, low chronic vascular score, and low resistive index. Nondippers and reverse dippers had lower GFR compared with dippers (P = 0.04). For every 10% nocturnal drop in SBP, GFR increased by 4.6 ml/min per 1.73 m(2) (R = 0.3, P = 0.003). Nondippers and reverse dippers were equally common in recipients with normal histology and in those with pathologic findings on surveillance biopsy. On multivariate analysis, percentage of nocturnal fall in SBP and elevated resistive index independently correlated with GFR. This study indicates that lack of nocturnal fall in SBP is related to poor allograft function, high chronic vascular score, and high resistive index irrespective of allograft fibrosis. Further studies are needed to determine whether restoration of normal BP pattern will confer better allograft outcome.
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Affiliation(s)
- Hani M Wadei
- Department of Medicine, Division of Nephrology and Hypertension, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
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38
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Raitakari OT, Salo P, Ahotupa M. Carotid artery compliance in users of plant stanol ester margarine. Eur J Clin Nutr 2007; 62:218-24. [PMID: 17356559 DOI: 10.1038/sj.ejcn.1602705] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To investigate the effects of stanol ester margarine use in healthy subjects on arterial compliance, endothelial function and intima-media thickness. DESIGN Case-control study comparing regular stanol ester margarine users to non-users. SETTING Occupational health service clinic. SUBJECTS We recruited 50 cases and 50 controls (mean age 51+/-8, range 26-65 years). All subjects were non-smokers and the study groups were matched for age and sex. As cases, we invited subjects who had been using regularly (daily) plant stanol ester margarine for a period of 2 years or longer. Non-invasive ultrasound was used to measure carotid artery compliance, carotid intima-media thickness and brachial artery flow-mediated endothelial dependent vasodilatation. RESULTS The carotid artery compliance was non-significantly higher in cases compared with controls, 1.84+/-1.02 vs 1.58+/-0.76 %/10 mm Hg (P=0.13). The difference in compliance became statistically significant (P=0.04) when the unbalance between the groups in family history of coronary artery disease and years of education were taken into account. There was also a significant dose-response relationship between stanol margarine use and carotid compliance, longer use being associated with higher compliance. Serum lipoproteins, blood pressure, flow-mediated dilation and intima-media thickness values did not differ between cases and controls. CONCLUSION These data raise the possibility that regular stanol ester margarine use may be associated with beneficial changes in arterial compliance. Intervention studies are needed to test this hypothesis and to reveal possible mechanisms.
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Affiliation(s)
- O T Raitakari
- Department of Clinical Physiology, University of Turku, Turku, Finland.
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39
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Cheng HM, Ye ZX, Chiou KR, Lin SJ, Charng MJ. Vascular stiffness in familial hypercholesterolaemia is associated with C-reactive protein and cholesterol burden. Eur J Clin Invest 2007; 37:197-206. [PMID: 17359487 DOI: 10.1111/j.1365-2362.2007.01772.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Familial hypercholesterolaemia (FH) is characterized by very high serum cholesterol and premature coronary atherosclerosis. Arterial stiffness and atherosclerosis are two major underlying pathophysiologies of arterial disease that are predictive of future cardiovascular events. The aims of this study were to quantify atherosclerosis and arterial stiffness and to evaluate their relationship with high sensitive C-reactive protein (hs-CRP) and the level of exposure to high serum cholesterol in FH patients. MATERIALS AND METHODS We measured traditional risk factors, hs-CRP, intima-media thickness (IMT) of carotid artery, and brachial-ankle pulse wave velocity (baPWV) in 35 heterozygous FH subjects and 17 healthy control subjects. Cholesterol-year score (CYS) was calculated to estimate the lifetime cholesterol burden in FH subjects. RESULTS FH subjects had significantly elevated total cholesterol, low-density lipoprotein cholesterol, and carotid IMT compared with those without mutations. Among FH patients, the baPWV and carotid IMT were higher in cases with high cholesterol burden than those without. Similarly, the baPWV and carotid IMT were also higher in cases with elevated hs-CRP (> 1 mg L(-1)) than those without. Multiple linear regression analysis demonstrated CYS and hs-CRP were significant independent predictors of baPWV and IMT in FH patients. CONCLUSIONS Both high cholesterol burden and vascular inflammation are not only associated with atherosclerosis, but also contribute to the development of arterial stiffness in FH patients. Early detection of hypercholesterolaemia in FH patients is warranted to prevent the untoward pathophysiologies.
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Affiliation(s)
- H M Cheng
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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40
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Erez G, Leitersdorf E. The rationale for using HMG-CoA reductase inhibitors ('statins') in peripheral arterial disease. Eur J Vasc Endovasc Surg 2006; 33:192-201. [PMID: 17185010 DOI: 10.1016/j.ejvs.2006.11.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2006] [Accepted: 11/24/2006] [Indexed: 10/23/2022]
Abstract
UNLABELLED Atherosclerosis is a systemic process, and the leading cause of morbidity and mortality in the developed world. HMG-CoA reductase inhibitors ('statins') are potent lipid lowering drugs, which have been shown to reduce morbidity and mortality in patients with coronary atherosclerosis. OBJECTIVE To present the up-to-date data concerning statin use in the prevention and treatment of extra-coronary atherosclerosis. METHODS Clinical trials with statins in patients with extra-coronary atherosclerosis were searched for via PUBMED. FINDINGS AND CONCLUSIONS The different forms of peripheral arterial disease (e.g. cerberovascular disease, lower extremity peripheral arterial disease) are associated with significant cardiovascular morbidity and mortality, and hence constitute a coronary artery disease equivalent in terms of published practice guidelines. There is some evidence from small randomized controlled trials that statin therapy decreases cardiovascular morbidity and mortality in patients with peripheral arterial disease. The mechanism of action of statins may derive from their lipid lowering properties, or from other, pleiotropic effects. Further, larger randomized controlled studies with statins are needed to evaluate the efficacy of statin therapy in patients with stable peripheral arterial disease and in those undergoing vascular or endovascular surgery.
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Affiliation(s)
- G Erez
- Center for Research, Prevention and Treatment of Atherosclerosis, Department of Medicine B, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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41
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Abstract
Patients with peripheral vascular disease are less likely to receive optimal medical management than patients with coronary artery disease. However, early medical treatment is critical because it is profoundly beneficial and the benefits are maximized. Even in patients with advanced disease requiring invasive intervention, medical management has been proven to improve outcome, prolong the success of the intervention, improve functional capacity, and prolong life. The vascular surgeon should be knowledgeable enough to initiate basic medical therapy and to define for their patients the goals that need to be met to optimize their medical management. The vascular surgeon should be instrumental in assuring that the peripheral vascular patient receives medical therapy of the same standard as the patient with coronary disease. The major modifiable risk factors in the vascular patient are: smoking, high blood pressure, hyperlipidemia, physical inactivity, obesity, and diabetes. In addition, the use of beta blockers for patients with coronary disease and antiplatelet therapy as well as angiotensin-converting enzyme (ACE) inhibitors are recommended for all patients with peripheral vascular disease. Statins have favorable effects on multiple interrelated aspects of vascular biology important in atherosclerosis. In particular they have beneficial effects on inflammation, plaque stabilization, endothelial dysfunction, and thrombosis. Statins have also been shown to be beneficial in acute vascular events. Angiotensin-converting enzyme inhibitors have been shown to reduce cardiovascular morbidity and mortality in patients with peripheral arterial disease regardless of the presence or absence of hypertension. A number of the pleiotropic effects of statins are shared by ACE inhibitors. In summary, patients with known vascular disease should be treated aggressively with a combination of a HMG CoA reductase inhibitor, an angiotensin-converting enzyme inhibitor, an antiplatelet agent and a beta blocker if there is a history of coronary disease. They should also receive tight control of their blood pressure and blood sugar. Smokers should be encouraged to stop smoking and should be provided with pharmaceutical and emotional support by their physicians. All of these patients should have their body mass index as close to normal as possible and be on a therapeutic lifestyle diet. Regular aerobic exercise is also indicated. Patients with symptomatic claudication should be considered for cilostazol. Patients with multiple risk factors for vascular disease, but who do not have documented disease should also be on statin therapy. As more studies define the linear relationship between lower LDL-C levels and lowered risk of vascular events, indicating that the lower the LDL-C level, the lower the risk, experts are advocating more aggressive lipid-lowering therapy. In patients with peripheral arterial disease, some experts now advocate lowering the goal of LDL therapy to 70 mg/dL.
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Affiliation(s)
- Terry W Rice
- Division of Vascular Surgery and Endovascular Therapy, Houston, TX 77030, USA
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42
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Harloff A, Strecker C, Reinhard M, Kollum M, Handke M, Olschewski M, Weiller C, Hetzel A. Combined Measurement of Carotid Stiffness and Intima-Media Thickness Improves Prediction of Complex Aortic Plaques in Patients With Ischemic Stroke. Stroke 2006; 37:2708-12. [PMID: 17008632 DOI: 10.1161/01.str.0000244763.19013.dc] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE We hypothesized that for the prediction or exclusion of aortic thrombi or plaques >or=4 mm, the combination of intima-media thickness (IMT) and distensibility (DC) of the common carotid arteries would be superior to the measurement of IMT alone. METHODS We prospectively included 208 stroke patients (mean age, 60 years) undergoing transesophageal echocardiography for screening of aortic plaques. IMT and DC were determined by ultrasound, and DC was quantified by measuring blood pressure and the common carotid arteries diameter change on M-mode ultrasound during the cardiac cycle. RESULTS Negative predictive values of IMT <0.9 mm and DC >or=24x10(-3)/kPa for the exclusion of aortic atheroma >or=4 mm were similar (92.0% and 91.7%, respectively). However, negative predictive values increased to 98.2% and to 100.0% for the exclusion of aortic thrombi when both parameters were combined. Positive predictive values of IMT >or=0.9 mm and DC <24 were lower (46.3%, 41.1%; respectively), but they also increased in combination (54.3%). CONCLUSIONS Our findings suggest that IMT and DC represent different vessel wall properties and that measuring both parameters provides optimized characterization of carotid atherosclerosis. Combining IMT and DC increases the predictive power of carotid ultrasound, making transesophageal echocardiography dispensable for assessment of the aorta for those with normal carotid arteries and indispensable for those patients with carotid atherosclerosis.
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Affiliation(s)
- Andreas Harloff
- Department of Neurology and Clinical Neurophysiology, University of Freiburg, Freiburg, Germany.
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43
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Ito MK, Talbert RL, Tsimikas S. Statin-associated pleiotropy: possible beneficial effects beyond cholesterol reduction. Pharmacotherapy 2006; 26:85S-97S; discussion 98S-101S; quiz 106S-108S. [PMID: 16803418 DOI: 10.1592/phco.26.7part2.85s] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Because elevated serum cholesterol levels are strongly associated with coronary heart disease, cholesterol reduction by 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (or statins) has been assumed to be the predominant, if not the only, mechanism underlying the beneficial effects of these drugs in cardiovascular diseases. Subgroup analyses of large clinical trials, however, have suggested that the beneficial effects of statins may extend to mechanisms beyond cholesterol reduction. Indeed, recent experimental and clinical evidence indicates that some of the cholesterol-independent or "pleiotropic" effects of statins may be mediated through improving or restoring endothelial function, enhancing the stability of atherosclerotic plaques, and decreasing oxidative stress and vascular inflammation.
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Affiliation(s)
- Matthew K Ito
- University of California, San Diego School of Medicine, La Jolla, California, USA
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44
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Gortler D, Maloney S, Rutland R, Westvik T, Muto A, Kudo FA, Dardik A. Adjunctive pharmacologic use in carotid endarterectomy: a review. Vascular 2006; 14:93-102. [PMID: 16956478 DOI: 10.2310/6670.2006.00020] [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: 11/18/2022]
Abstract
Although carotid endarterectomy (CEA) is now widely accepted as the surgical therapy for carotid stenosis, the role of and indications and evidence for many pharmacologic agents that are used adjunctively in the perioperative setting have not been conclusively established. Aspirin (acetylsalicylic acid) is the pharmaceutical agent that has been studied most extensively in conjunction with CEA; other than aspirin and dextran, the use of many agents before, during, and after CEA has not been standardized. Prospective randomized trials are still needed to demonstrate efficacy, predict outcome, and determine the optimal use of these medications in their adjunctive use during CEA to improve patient care and obtain optimal surgical outcomes.
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Affiliation(s)
- David Gortler
- VA Connecticut Healthcare System, West Haven, CT, USA
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45
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Chen W, Srinivasan SR, Li S, Berenson GS. Different Effects of Atherogenic Lipoproteins and Blood Pressure on Arterial Structure and Function: The Bogalusa Heart Study. J Clin Hypertens (Greenwich) 2006; 8:323-9. [PMID: 16687940 PMCID: PMC8109451 DOI: 10.1111/j.1524-6175.2005.04875.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Differential impact of non-high-density lipoprotein cholesterol (total cholesterol minus high-density lipoprotein cholesterol) and blood pressure on arterial wall thickness and stiffness was examined in 900 black and white adults aged 24-43 years. Blacks compared with whites had greater values of pulse wave velocity (5.4 m/sec vs. 5.2 m/sec; p<0.01) and carotid artery intima-media thickness (0.83 mm vs. 0.80 mm; p<0.01). Non-high-density lipoprotein cholesterol was significantly associated with carotid intima-media thickness (standardized regression coefficient [b]=0.21; p<0.01), but not with pulse wave velocity (b=0.03; p=0.37), after adjusting for race, sex, age, body mass index, insulin, glucose, and smoking. Systolic blood pressure was associated significantly stronger with pulse wave velocity (b=0.36; p<0.01) than with carotid intima-media thickness (b=0.15; p<0.01). No race difference in these relationships was found. The results of this study indicate that atherogenic lipoproteins and blood pressure may play different roles in the development of arterial wall stiffness and atherosclerosis.
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Affiliation(s)
- Wei Chen
- From the Tulane Center for Cardiovascular Health and the Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | - Sathanur R. Srinivasan
- From the Tulane Center for Cardiovascular Health and the Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | - Shengxu Li
- From the Tulane Center for Cardiovascular Health and the Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | - Gerald S. Berenson
- From the Tulane Center for Cardiovascular Health and the Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
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46
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Fouchier SW, Rodenburg J, Defesche JC, Kastelein JJP. Management of hereditary dyslipidaemia; the paradigm of autosomal dominant hypercholesterolaemia. Eur J Hum Genet 2005; 13:1247-53. [PMID: 16189547 DOI: 10.1038/sj.ejhg.5201496] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Inherited, or autosomal dominant, hypercholesterolaemia, with an average global prevalence of one in 500 individuals, is one of the most frequent inherited metabolic disorders. The disorder is associated with a high risk for premature cardiovascular disease (CVD) and death as a consequence of accelerated atherosclerosis. Although the molecular genetic basis is largely elucidated and effective medical treatment, in the form of inhibitors of intracellular cholesterol synthesis, is available, the disorder is severely underdiagnosed and undertreated. On the other hand, with the well-understood aetiology, the accurate diagnosis, the availability of sensitive predictive makers and efficacious therapy, this disorder can serve as a model for disease management: from early presymptomatic diagnosis, accurate prognosis, optimal treatment and large-scale screening to population-based prevention of CVD.
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Affiliation(s)
- Sigrid W Fouchier
- Department of Vascular Medicine, Academic Medical Centre at the University of Amsterdam, Amsterdam, The Netherlands
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Inukai T, Yamamoto R, Suetsugu M, Matsumoto S, Wakabayashi S, Inukai Y, Matsutomo R, Takebayashi K, Aso Y. Small low-density lipoprotein and small low-density lipoprotein/total low-density lipoprotein are closely associated with intima-media thickness of the carotid artery in Type 2 diabetic patients. J Diabetes Complications 2005; 19:269-75. [PMID: 16112502 DOI: 10.1016/j.jdiacomp.2005.03.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2004] [Revised: 02/23/2005] [Accepted: 03/08/2005] [Indexed: 11/30/2022]
Abstract
BACKGROUND The intima-media thickness (IMT) of the carotid artery, as determined by ultrasonography, is useful for reflecting the extent of subclinical atherosclerosis. We investigated the relationship between IMT and the serum concentrations of small low-density lipoprotein (LDL) in diabetic patients. METHODS The study was conducted with 27 Type 2 diabetic patients (14 males and 13 females; mean age=62.6+/-8.3 years) and 12 age-matched healthy controls. The LDL subfraction was measured using a polyacrylamide gel electrophoresis method. Vascular endothelial growth factor (VEGF) and platelet-derived growth factor (PDGF) concentrations were measured by an enzyme immunoassay. The IMT was expressed as the maximum IMT (Max-IMT) and average IMT (Ave-IMT) of the carotid artery, measured by ultrasonography. RESULTS Both the IMT and the small LDL concentrations were significantly increased in the diabetic patients compared with the healthy participants. The IMTs were significantly correlated with small LDL concentration and small LDL/total LDL more than LDL concentrations by multivariate analysis. The IMTs were not significantly correlated with the serum VEGF or PDGF concentrations. The patients with a larger IMT had a significantly higher prevalence of hypertension or ischemic heart disease than did the patients with a normal IMT. CONCLUSIONS The increased small LDL concentrations and small LDL/total LDL, in addition to total LDL concentrations, in Type 2 diabetic patients are closely associated with increased IMT of the carotid artery.
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Affiliation(s)
- Toshihiko Inukai
- Department of Internal Medicine, Koshigaya Hospital, Dokkyo University School of Medicine, 2-1-50, Minami-Koshigaya, Koshigaya 343-8555, Japan.
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Fukuta H, Sane DC, Brucks S, Little WC. Statin therapy may be associated with lower mortality in patients with diastolic heart failure: a preliminary report. Circulation 2005; 112:357-63. [PMID: 16009792 DOI: 10.1161/circulationaha.104.519876] [Citation(s) in RCA: 209] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND No therapy has been shown to improve survival in heart failure (HF) with a normal ejection fraction (EF). There are plausible reasons to hypothesize that statins may be of benefit in HF with a normal EF. METHODS AND RESULTS We evaluated 137 patients with HF and an EF > or =0.50. The effect of treatment received at study entry on survival was determined. During a follow-up of 21+/-12 months, 20 deaths were observed. Treatment with an ACE inhibitor or receptor blocker, beta-blocker, or calcium blocker had no significant effect on survival. In contrast, treatment with a statin was associated with a substantial improvement in survival (relative risk of death [95% CI] 0.22 [0.07 to 0.64]; P=0.006). Patients receiving statins had higher baseline LDL cholesterol than those not receiving statins (153+/-45 versus 98+/-33 mg/dL, P<0.01). After statin therapy, LDL cholesterol levels fell to a similar level (101+/-32 mg/dL) as in patients not receiving statins (98+/-33 mg/dL). After adjustment for differences in baseline clinical variables between groups (hypertension, diabetes, coronary artery disease, and serum creatinine), statin therapy was associated with lower mortality (adjusted relative risk of death [95% CI] 0.20 [0.06 to 0.62]; P=0.005). Similarly, after propensity matching, statin therapy was associated with improved survival (log-rank 6.12; P=0.013) and a trend toward improved survival without cardiovascular hospitalization (log-rank 3.02; P=0.082). CONCLUSIONS Statin therapy may be associated with improved survival in patients with HF and a normal EF.
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Affiliation(s)
- Hidekatsu Fukuta
- Cardiology Section, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157-1045, USA
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Sankatsing RR, Fouchier SW, de Haan S, Hutten BA, de Groot E, Kastelein JJP, Stroes ESG. Hepatic and cardiovascular consequences of familial hypobetalipoproteinemia. Arterioscler Thromb Vasc Biol 2005; 25:1979-84. [PMID: 16002743 DOI: 10.1161/01.atv.0000176191.64314.07] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Individuals with familial hypobetalipoproteinemia (FHBL) have been reported to be prone to fatty liver disease (FLD). Conversely, the profound reduction of low-density lipoprotein (LDL) cholesterol in this disorder might decrease cardiovascular risk. In the present study, we assessed hepatic steatosis as well as noninvasive surrogate markers for cardiovascular disease (CVD) in subjects with FHBL and in matched controls. METHODS AND RESULTS Hepatic steatosis was assessed by abdominal ultrasonography. Carotid intima-media thickness (IMT) and distal common carotid arterial wall stiffness as surrogate markers for CVD risk were measured using high-resolution B-mode ultrasonography. Whereas transaminase levels were only modestly elevated, both prevalence (54% versus 29%; P=0.01) and severity of steatosis were significantly higher in FHBL individuals compared with controls. Despite similar IMT measurements, arterial stiffness was significantly lower in FHBL (P=0.04) compared with controls. Additionally, the increase in arterial stiffness as seen in the presence of traditional risk factors was attenuated, suggesting that very low levels of apoB-containing lipoproteins can negate the adverse effects of other risk factors on the vasculature. CONCLUSIONS FHBL is characterized by an increased prevalence and severity of fatty liver disease. The observed decreased level of arterial wall stiffness, most pronounced in the presence of nonlipid risk factors, is indicative of cardiovascular protection in these subjects.
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Affiliation(s)
- Raaj R Sankatsing
- Department of Vascular Medicine, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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Saliashvili G, Davis WW, Harris MT, Le NA, Brown WV. Simvastatin improved arterial compliance in high-risk patients. Vasc Endovascular Surg 2005; 38:519-23. [PMID: 15592632 DOI: 10.1177/153857440403800605] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Reduced arterial compliance is associated with arteriosclerosis. In some arteries, this is due in part to abnormal vascular tone, which can be altered by low-density lipoprotein (LDL) cholesterol reduction and statin therapy. We tested the effectiveness of statin therapy in improving arterial compliance in patients with manifest coronary disease (CAD) and/or diabetes. Simvastatin (40 mg/day) was administered to 10 patients with proven CAD for 4 months. As measured by air plethysmography, compliance of the arterial segments in the thigh improved in every patient after 2 months, increasing by 34% by the fourth month. Compliance at the calf was not affected. These results suggest that compliance in the thigh is controlled by smooth muscle tone. Compliance measurements in the thigh and calf may be a useful measurement in evaluating high-risk patients and monitoring cholesterol-lowering therapy.
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