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Kong N, Sakhuja S, Colantonio LD, Levitan EB, Lloyd-Jones DM, Cushman M, Muntner P, Polonsky TS. Atherosclerotic cardiovascular disease events among adults with high predicted risk without established risk factors. Am J Prev Cardiol 2024; 17:100612. [PMID: 38125204 PMCID: PMC10730342 DOI: 10.1016/j.ajpc.2023.100612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 10/27/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
Objective Age is the strongest contributor to 10-year predicted atherosclerotic cardiovascular disease (ASCVD) risk. Some older adults have a predicted ASCVD risk ≥7.5 %, without established risk factors. We sought to compare ASCVD incidence among adults with predicted ASCVD risk ≥7.5 %, with and without established ASCVD risk factors, to adults with predicted risk <7.5 %. Methods We analyzed data from REasons for Geographic and Racial Differences in Stroke study participants, 45-79 years old, without ASCVD or diabetes, not taking statins and with low-density lipoprotein cholesterol 70-189 mg/dL. Participants were categorized into 3 groups based on their 10-year predicted ASCVD risk and presence of established risk factors: <7.5 %, ≥7.5 % with established risk factors and ≥7.5 % without established risk factors. Established risk factors included smoking, systolic blood pressure ≥130 mmHg or antihypertensive medication use, total cholesterol ≥200 mg/dL, or high-density lipoprotein cholesterol <50 mg/dL for women (<40 mg/dL for men). Participants were followed for ASCVD events. Results Among 11,115 participants, 911 incident ASCVD events occurred over a median of 11.1 years. ASCVD incidence rates were 3.6, 12.8, and 9.8 per 1,000 person-years for participants with predicted risk <7.5 %, predicted risk ≥7.5 % with established risk factors and predicted risk ≥7.5 % without established risk factors, respectively. Compared to adults with predicted risk <7.5 %, hazard ratios for incident ASCVD in participants with risk ≥7.5 % with and without established risk factors were 3.58 (95 %CI 3.03 - 4.21) and 2.72 (95 %CI 1.91-3.88), respectively. Conclusions Adults with a 10-year predicted ASCVD risk ≥7.5 % but without established risk factors had a high ASCVD incidence.
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Affiliation(s)
- Nathan Kong
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Swati Sakhuja
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Lisandro D. Colantonio
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Emily B. Levitan
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Donald M. Lloyd-Jones
- Feinberg School of Medicine, Department of Preventive Medicine, Northwestern University, Chicago, IL, United States
| | - Mary Cushman
- Department of Medicine, Larner College of Medicine, The University of Vermont, Burlington, VT, United States
| | - Paul Muntner
- Office of Science, Center for Disease Control and Prevention, Atlanta, GA, United States
| | - Tamar S. Polonsky
- Department of Medicine, University of Chicago, Chicago, IL, United States
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2
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Hunter E, Kelleher JD. Age Specific Models to Capture the Change in Risk Factor Contribution by Age to Short Term Primary Ischemic Stroke Risk. Front Neurol 2022; 13:803749. [PMID: 35250810 PMCID: PMC8891452 DOI: 10.3389/fneur.2022.803749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/27/2022] [Indexed: 11/13/2022] Open
Abstract
Age is one of the most important risk factors when it comes to stroke risk prediction. However, including age as a risk factor in a stroke prediction model can give rise to a number of difficulties. Age often dominates the risk score, and also not all risk factors contribute proportionally to stroke risk by age. In this study we investigate a number of common stroke risk factors, using Framingham heart study data from the NHLBI Biologic Specimen and Data Repository Information Coordinating Center to determine if they appear to contribute proportionally by age to a stroke risk score. As we find evidence that there is some non-proportionality by age, we then create a set of logistic regression risk models that each predict the 5 year stroke risk for a different age group. The age group models are shown to be better calibrated when compared to a model for all ages that includes age as a risk factor. This suggests that to get better predictions for stroke risk it may be necessary to consider alternative methods for including age in stroke risk prediction models that account for the non-proportionality of the other risk factors as age changes.
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Affiliation(s)
- Elizabeth Hunter
- PRECISE4Q Predictive Modelling in Stroke, Technological University Dublin, Dublin, Ireland
- *Correspondence: Elizabeth Hunter
| | - John D. Kelleher
- PRECISE4Q Predictive Modelling in Stroke, Technological University Dublin, Dublin, Ireland
- ADAPT Research Centre, Technological University Dublin, Dublin, Ireland
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3
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Nguyen QD, Odden MC, Peralta CA, Kim DH. Predicting Risk of Atherosclerotic Cardiovascular Disease Using Pooled Cohort Equations in Older Adults With Frailty, Multimorbidity, and Competing Risks. J Am Heart Assoc 2020; 9:e016003. [PMID: 32875939 PMCID: PMC7727000 DOI: 10.1161/jaha.119.016003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Assessment of atherosclerotic cardiovascular disease (ASCVD) risk is crucial for prevention and management, but the performance of the pooled cohort equations in older adults with frailty and multimorbidity is unknown. We evaluated the pooled cohort equations in these subgroups and the impact of competing risks. Methods and Results In 4249 community‐dwelling adults, aged ≥65 years, from the CHS (Cardiovascular Health Study), we calculated 10‐year risk of hard ASCVD. Frailty was determined using the Fried phenotype. Latent class analysis was used to identify individuals with multimorbidity patterns using chronic conditions. We assessed discrimination using the C‐statistic and calibration by comparing predicted ASCVD risks with estimated risk using cause‐specific and cumulative incidence models, by multimorbidity patterns and frailty status. A total of 917 (21.6%) participants had an ASCVD event, and 706 (16.6%) had a competing event of death. C‐statistic was 0.68 in men and 0.69 in women; calibration was good when compared with cause‐specific and cumulative incidence estimated risks (males, −0.1% and 3.3%; females, 0.6% and 1.4%). Latent class analysis identified 4 patterns: minimal disease, cardiometabolic, low cognition, musculoskeletal‐lung depression. In the cardiometabolic pattern, ASCVD risk was overpredicted compared with cumulative incidence risk in men (7.4%) and women (6.8%). Risk was underpredicted in men (−10.7%) and women (−8.2%) with frailty compared with cause‐specific risk. Miscalibration occurred mostly at high predicted risk ranges. Conclusions ASCVD prediction was good in this cohort of adults aged ≥65 years. Although calibration varied by multimorbidity patterns, frailty, and competing risks, miscalibration was mostly present at high predicted risk ranges and thus less likely to alter decision making for primary prevention therapy.
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Affiliation(s)
- Quoc Dinh Nguyen
- Division of Geriatrics Department of Medicine Centre Hospitalier de l'Université de Montréal Montreal Quebec Canada.,Centre de Recherche du Centre Hospitalier de l'Université de Montréal Montreal Quebec Canada.,Department of Epidemiology, Biostatistics, and Occupational Health McGill University Montreal Quebec Canada
| | - Michelle C Odden
- Department of Epidemiology and Population Health School of Medicine Stanford University Stanford CA
| | - Carmen A Peralta
- University of California, San Francisco CA.,Kidney Health Research Collaborative University of California, San Francisco CA.,Cricket Health, Inc San Francisco CA
| | - Dae Hyun Kim
- Hinda and Arthur Marcus Institute for Aging Research Hebrew SeniorLifeHarvard Medical School Boston MA
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4
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Jackson R, Kerr A, Wells S. 'Should we reconsider the role of age in treatment allocation for primary prevention of cardiovascular disease?' No, but we can improve risk communication metrics. Eur Heart J 2019; 38:1548-1552. [PMID: 27436864 DOI: 10.1093/eurheartj/ehw322] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 06/28/2016] [Indexed: 11/12/2022] Open
Affiliation(s)
- Rod Jackson
- Section of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical of Health Sciences, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Andrew Kerr
- Section of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical of Health Sciences, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.,Department of Cardiology, Middlemore Hospital, Otahuhu, Auckland 93311, New Zealand
| | - Sue Wells
- Section of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical of Health Sciences, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
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5
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van Bussel EF, Richard E, Busschers WB, Steyerberg EW, van Gool WA, Moll van Charante EP, Hoevenaar-Blom MP. A cardiovascular risk prediction model for older people: Development and validation in a primary care population. J Clin Hypertens (Greenwich) 2019; 21:1145-1152. [PMID: 31294917 PMCID: PMC6772108 DOI: 10.1111/jch.13617] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/18/2019] [Accepted: 05/03/2019] [Indexed: 12/01/2022]
Abstract
Cardiovascular risk prediction is mainly based on traditional risk factors that have been validated in middle‐aged populations. However, associations between these risk factors and cardiovascular disease (CVD) attenuate with increasing age. Therefore, for older people the authors developed and internally validated risk prediction models for fatal and non‐fatal CVD, (re)evaluated the predictive value of traditional and new factors, and assessed the impact of competing risks of non‐cardiovascular death. Post hoc analyses of 1811 persons aged 70‐78 year and free from CVD at baseline from the preDIVA study (Prevention of Dementia by Intensive Vascular care, 2006‐2015), a primary care‐based trial that included persons free from dementia and conditions likely to hinder successful long‐term follow‐up, were performed. In 2017‐2018, Cox‐regression analyses were performed for a model including seven traditional risk factors only, and a model to assess incremental predictive ability of the traditional and eleven new factors. Analyses were repeated accounting for competing risk of death, using Fine‐Gray models. During an average of 6.2 years of follow‐up, 277 CVD events occurred. Age, sex, smoking, and type 2 diabetes mellitus were traditional predictors for CVD, whereas total cholesterol, HDL‐cholesterol, and systolic blood pressure (SBP) were not. Of the eleven new factors, polypharmacy and apathy symptoms were predictors. Discrimination was moderate (concordance statistic 0.65). Accounting for competing risks resulted in slightly smaller predicted absolute risks. In conclusion, we found, SBP, HDL, and total cholesterol no longer predict CVD in older adults, whereas polypharmacy and apathy symptoms are two new relevant predictors. Building on the selected risk factors in this study may improve CVD prediction in older adults and facilitate targeting preventive interventions to those at high risk.
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Affiliation(s)
- Emma F van Bussel
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Edo Richard
- Department of Neurology, Donderds Centre for Brain, Behaviour and Cognition, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Wim B Busschers
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ewout W Steyerberg
- Department of Biomedical Data Sciences, LUMC, Leiden, The Netherlands.,Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | - Willem A van Gool
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Eric P Moll van Charante
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marieke P Hoevenaar-Blom
- Department of Neurology, Donderds Centre for Brain, Behaviour and Cognition, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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6
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Hughes MF, Lenighan YM, Godson C, Roche HM. Exploring Coronary Artery Disease GWAs Targets With Functional Links to Immunometabolism. Front Cardiovasc Med 2018; 5:148. [PMID: 30460244 PMCID: PMC6232936 DOI: 10.3389/fcvm.2018.00148] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 10/01/2018] [Indexed: 12/24/2022] Open
Abstract
Finding genetic variants that cause functional disruption or regulatory change among the many implicated GWAs variants remains a key challenge to translating the findings from GWAs to therapeutic treatments. Defining the causal mechanisms behind the variants require functional screening experiments that can be complex and costly. Prioritizing variants for functional characterization using techniques that capture important functional and regulatory elements can assist this. The genetic architecture of complex traits such as cardiovascular disease and type II diabetes comprise an enormously large number of variants of small effect contributing to heritability and spread throughout the genome. This makes it difficult to distinguish which variants or core genes are most relevant for prioritization and how they contribute to the regulatory networks that become dysregulated leading to disease. Despite these challenges, recent GWAs for CAD prioritized genes associated with lipid metabolism, coagulation and adhesion along with novel signals related to innate immunity, adipose tissue and, vascular function as important core drivers of risk. We focus on three examples of novel signals associated with CAD which affect risk through missense or UTR mutations indicating their potential for therapeutic modification. These variants play roles in adipose tissue function vascular function and innate immunity which form the cornerstones of immuno-metabolism. In addition we have explored the putative, but potentially important interactions between the environment, specifically food and nutrition, with respect to key processes.
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Affiliation(s)
- Maria F Hughes
- UCD Diabetes Complications Research Centre, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland.,Nutrigenomics Research Group, UCD Institute of Food and Health, School of Public Health Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.,Centre of Excellence for Public Health, Queen's University Belfast, Belfast, United Kingdom.,UCD Institute of Food and Health, School of Public Health Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Yvonne M Lenighan
- UCD Diabetes Complications Research Centre, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland.,UCD Institute of Food and Health, School of Public Health Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Catherine Godson
- UCD Diabetes Complications Research Centre, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - Helen M Roche
- UCD Diabetes Complications Research Centre, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland.,Nutrigenomics Research Group, UCD Institute of Food and Health, School of Public Health Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.,UCD Institute of Food and Health, School of Public Health Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
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7
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Leening MJG, Ikram MA. Primary prevention of cardiovascular disease: The past, present, and future of blood pressure- and cholesterol-lowering treatments. PLoS Med 2018; 15:e1002539. [PMID: 29558473 PMCID: PMC5860691 DOI: 10.1371/journal.pmed.1002539] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In a Perspective, M. Afran Ikram and Maarten Leening discuss the evolving approaches to determining cardiovascular risk.
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Affiliation(s)
- Maarten J. G. Leening
- Department of Epidemiology, Erasmus MC – University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Cardiology, Erasmus MC – University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - M. Arfan Ikram
- Department of Epidemiology, Erasmus MC – University Medical Center Rotterdam, Rotterdam, the Netherlands
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8
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Bos D, Leening MJG. Leveraging the coronary calcium scan beyond the coronary calcium score. Eur Radiol 2018; 28:3082-3087. [PMID: 29383526 PMCID: PMC5986828 DOI: 10.1007/s00330-017-5264-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 11/28/2017] [Accepted: 12/20/2017] [Indexed: 12/21/2022]
Abstract
Non-contrast cardiac computed tomography in order to obtain the coronary artery calcium score has become an established diagnostic procedure in the clinical setting, and is commonly employed in clinical and population-based research. This state-of-the-art review paper highlights the potential gain in information that can be obtained from the non-contrast coronary calcium scans without any necessary modifications to the scan protocol. This includes markers of cardio-metabolic health, such as the amount of epicardial fat and liver fat, but also markers of general health including bone density and lung density. Finally, this paper addresses the importance of incidental findings and of radiation exposure accompanying imaging with non-contrast cardiac computed tomography. Despite the fact that coronary calcium scan protocols have been optimized for the visualization of coronary calcification in terms image quality and radiation exposure, it is important for radiologists, cardiologists and medical specialists in the field of preventive medicine to acknowledge that numerous additional markers of cardio-metabolic health and general health can be readily identified on a coronary calcium scan. KEY POINTS • The coronary artery calcium score substantially increased the use of cardiac CT. • Cardio-metabolic and general health markers may be derived without changes to the scan protocol. • Those include epicardial fat, aortic valve calcifications, liver fat, bone density, and lung density. • Clinicians must be aware of this potential additional yield from non-contrast cardiac CT.
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Affiliation(s)
- Daniel Bos
- Department of Radiology and Nuclear Medicine, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands. .,Department of Epidemiology, Erasmus MC - University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands. .,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Maarten J G Leening
- Department of Epidemiology, Erasmus MC - University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Cardiology, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
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9
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Pavlović J, Greenland P, Deckers JW, Kavousi M, Hofman A, Ikram MA, Franco OH, Leening MJ. Assessing gaps in cholesterol treatment guidelines for primary prevention of cardiovascular disease based on available randomised clinical trial evidence: The Rotterdam Study. Eur J Prev Cardiol 2017; 25:420-431. [PMID: 29171772 PMCID: PMC5818030 DOI: 10.1177/2047487317743352] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The purpose of this study was to determine how American College of Cardiology/American Heart Association (ACC/AHA) 2013 and European Society of Cardiology 2016 guidelines for the primary prevention of atherosclerotic cardiovascular disease (CVD) compare in reflecting the totality of accrued randomised clinical trial evidence for statin treatment at population level. Methods From 1997–2008, 7279 participants aged 45–75 years, free of atherosclerotic cardiovascular disease, from the population-based Rotterdam Study were included. For each participant, we compared eligibility for each one of 11 randomised clinical trials on statin use in primary prevention of CVD, with recommendations on lipid-lowering therapy from the ACC/AHA and European Society of Cardiology (ESC) guidelines. Atherosclerotic cardiovascular disease incidence and cardiovascular disease mortality rates were calculated. Results The proportion of participants eligible for each trial ranged from 0.4% for ALLHAT-LLT to 30.8% for MEGA. The likelihood of being recommended for lipid-lowering treatment was lowest for those eligible for low-to-intermediate risk RCTs (HOPE-3, MEGA, and JUPITER), and highest for high-risk individuals with diabetes (MRC/BHF HPS, CARDS, and ASPEN) or elderly PROSPER. Eligibility for an increasing number of randomised clinical trials correlated with a greater likelihood of being recommended lipid-lowering treatment by either guideline (p < 0.001 for both guidelines). Conclusion Compared to RCTs done in high risk populations, randomised clinical trials targeting low-to-intermediate risk populations are less well-reflected in the ACC/AHA, and even less so in the ESC guideline recommendations. Importantly, the low-to-intermediate risk population targeted by HOPE-3, the most recent randomised clinical trial in this field, is not well-captured by the current European prevention guidelines and should be specifically considered in future iterations of the guidelines.
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Affiliation(s)
- Jelena Pavlović
- 1 Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, the Netherlands
| | - Philip Greenland
- 2 Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, USA
| | - Jaap W Deckers
- 3 Department of Cardiology, Erasmus MC - University Medical Center Rotterdam, the Netherlands
| | - Maryam Kavousi
- 1 Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, the Netherlands
| | - Albert Hofman
- 1 Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, the Netherlands.,4 Department of Epidemiology, Harvard T.H. Chan School of Public Health, USA
| | - M Arfan Ikram
- 1 Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, the Netherlands.,5 Department of Neurology, Erasmus MC - University Medical Center Rotterdam, the Netherlands.,6 Department of Radiology, Erasmus MC - University Medical Center Rotterdam, the Netherlands
| | - Oscar H Franco
- 1 Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, the Netherlands
| | - Maarten Jg Leening
- 1 Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, the Netherlands.,3 Department of Cardiology, Erasmus MC - University Medical Center Rotterdam, the Netherlands.,4 Department of Epidemiology, Harvard T.H. Chan School of Public Health, USA
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10
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Recio C, Maione F, Iqbal AJ, Mascolo N, De Feo V. The Potential Therapeutic Application of Peptides and Peptidomimetics in Cardiovascular Disease. Front Pharmacol 2017; 7:526. [PMID: 28111551 PMCID: PMC5216031 DOI: 10.3389/fphar.2016.00526] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 12/19/2016] [Indexed: 12/11/2022] Open
Abstract
Cardiovascular disease (CVD) remains a leading cause of mortality and morbidity worldwide. Numerous therapies are currently under investigation to improve pathological cardiovascular complications, but yet, there have been very few new medications approved for intervention/treatment. Therefore, new approaches to treat CVD are urgently required. Attempts to prevent vascular complications usually involve amelioration of contributing risk factors and underlying processes such as inflammation, obesity, hyperglycaemia, or hypercholesterolemia. Historically, the development of peptides as therapeutic agents has been avoided by the Pharmaceutical industry due to their low stability, size, rate of degradation, and poor delivery. However, more recently, resurgence has taken place in developing peptides and their mimetics for therapeutic intervention. As a result, increased attention has been placed upon using peptides that mimic the function of mediators involved in pathologic processes during vascular damage. This review will provide an overview on novel targets and experimental therapeutic approaches based on peptidomimetics for modulation in CVD. We aim to specifically examine apolipoprotein A-I (apoA-I) and apoE mimetic peptides and their role in cholesterol transport during atherosclerosis, suppressors of cytokine signaling (SOCS)1-derived peptides and annexin-A1 as potent inhibitors of inflammation, incretin mimetics and their function in glucose-insulin tolerance, among others. With improvements in technology and synthesis platforms the future looks promising for the development of novel peptides and mimetics for therapeutic use. However, within the area of CVD much more work is required to identify and improve our understanding of peptide structure, interaction, and function in order to select the best targets to take forward for treatment.
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Affiliation(s)
- Carlota Recio
- Sir William Dunn School of Pathology, University of Oxford Oxford, UK
| | - Francesco Maione
- Department of Pharmacy, University of Naples Federico II Naples, Italy
| | - Asif J Iqbal
- Sir William Dunn School of Pathology, University of Oxford Oxford, UK
| | - Nicola Mascolo
- Department of Pharmacy, University of Naples Federico II Naples, Italy
| | - Vincenzo De Feo
- Department of Pharmacy, University of Salerno Salerno, Italy
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