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Liu M, Gao T, Jiang L, Li S, Shi B, Li F. Enhancing the biopharmaceutical attributes of atorvastatin calcium using polymeric and lipid-polymer hybrid nanoparticles: An approach for atherosclerosis treatment. Biomed Pharmacother 2023; 159:114261. [PMID: 36689837 DOI: 10.1016/j.biopha.2023.114261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 01/01/2023] [Accepted: 01/14/2023] [Indexed: 01/22/2023] Open
Abstract
Atherosclerosis is associated with inflammation in the arteries, a significant cause of heart attacks and strokes. Although statin therapy can reduce the chances of atherosclerotic plaque formation, they need to be administered in high doses due to low systemic bioavailability and encountered with side effects. To overcome these challenges, we developed nanoparticles using biocompatible and biodegradable lipids and polymers for improving systemic drug absorption and therapeutic response. The polymeric nanoparticles were prepared using PLGA and PVA, while hybrid nanoparticles were prepared using PLGA and Phospholipon 90 G. Both nanoparticles were systematically optimized by I-optimal response surface design. The optimum formulation composition exhibited particle size of less than 250 nm, polydispersity index of less than 0.3, entrapment efficiency of more than 70%, and sustained drug release up to 6 h. In vivo pharmacokinetic evaluation in rats indicated multi-fold improvement in the extent of drug absorption (Cmax and AUCtotal) for atorvastatin from the nanoparticles vis-à-vis the pure drug suspension. In vivo pharmacodynamic studies also indicated the excellent ability of nanoparticles to lower the elevated levels of lipids (total cholesterol, triglycerides, and low-density lipoproteins) and increase the level of high-density lipoproteins as compared to that of the pure drug suspension.
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Affiliation(s)
- Miao Liu
- Department of Cardiac Surgery, Henan Provincial Chest Hospital, Zhengzhou University, Zhengzhou City, Henan Province 450008, China.
| | - Tingchao Gao
- Department of Cardiac Surgery, Henan Provincial Chest Hospital, Zhengzhou University, Zhengzhou City, Henan Province 450008, China
| | - Lei Jiang
- Department of Cardiac Surgery, Henan Provincial Chest Hospital, Zhengzhou University, Zhengzhou City, Henan Province 450008, China
| | - Shunqi Li
- Department of Cardiac Surgery, Henan Provincial Chest Hospital, Zhengzhou University, Zhengzhou City, Henan Province 450008, China
| | - Bolun Shi
- Cardiosurgery Intensive Care Unit, Henan Provincial Chest Hospital, Zhengzhou University, Zhengzhou City, Henan Province 450008, China
| | - Fangxu Li
- Department of Cardiac Surgery, Henan Provincial Chest Hospital, Zhengzhou University, Zhengzhou City, Henan Province 450008, China
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Knauer K, Chaudry O, Uder M, Kohl M, Kemmler W, Bickelhaupt S, Engelke K. Effects of High-Intensity Resistance Training on Visceral Adipose Tissue and Abdominal Aortic Calcifications in Older Men with Osteosarcopenia - Results from the FrOST Study. Clin Interv Aging 2023; 18:71-80. [PMID: 36700164 PMCID: PMC9869795 DOI: 10.2147/cia.s388026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 12/06/2022] [Indexed: 01/20/2023] Open
Abstract
Purpose To evaluate the effect of a high-intensity resistance training (HIT-RT) on visceral adipose tissue (VAT) and abdominal aortic calcifications (AAC). Patients and Methods We conducted a post hoc analysis of the Franconian Osteopenia and Sarcopenia Trial (FrOST). 43 community-dwelling men with osteosarcopenia aged 72 years and older were randomly allocated to a supervised high-intensity resistance training (HIT-RT) twice weekly for 18 months (EG; n=21) and a non-training control group (CG; n=22). Non-contrast enhanced 2-point Dixon MRI scans covering mid L2 to mid L3 were acquired to measure VAT volume inside the abdominal cavity. Volume of AAC and hard plaques in renal arteries, truncus celiacus and superior mesenteric artery was measured by computed tomography (CT) scans covering mid T12 to mid L3. Intention-to-treat analysis with imputation for missing data was used to determine longitudinal changes in VAT and AAC volume. Correlations were used to determine associations between VAT and AAC. Results Significant reduction of VAT volume in the EG (-7.7%; p<0.001) combined with no change in the CG (-1.3%; p=0.46) resulted in a significant 6.4% between group effect (p=0.022). We observed a significant increase of AAC volume in EG (+10.3%; p<0.001) and CG (12.0%; p<0.001). AAC differences between groups were not significant (p=0.57). In vascular outlets increases in volume of the hard plaques were observed in both groups, however, not all of them were significant. There was no significant correlation between changes in VAT and AAC volumes. Conclusion The study confirmed a positive impact of HIT-RT on the metabolic and cardiovascular risk profile with respect to reduction of VAT volume. No positive exercise effect on AAC was observed. However, there was a further progression of AAC volume independent of group affiliation. Whether different exercise regimen may show a positive effect on AAC remains subject to further studies.
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Affiliation(s)
- Kira Knauer
- Institute of Radiology, Friedrich-Alexander-Universität Erlangen-Nürnberg and University Hospital Erlangen, Erlangen, 91054, Germany,Institute of Medical Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, 91052, Germany,Correspondence: Kira Knauer, Institute of Radiology, Friedrich-Alexander University of Erlangen-Nürnberg, University Hospital Erlangen, Maximiliansplatz 3, Erlangen, 91054, Germany, Tel +49 9131/85-36065, Email
| | - Oliver Chaudry
- Institute of Medical Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, 91052, Germany,Department of Medicine III, Friedrich-Alexander University of Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, 91054, Germany
| | - Michael Uder
- Institute of Radiology, Friedrich-Alexander-Universität Erlangen-Nürnberg and University Hospital Erlangen, Erlangen, 91054, Germany
| | - Matthias Kohl
- Faculty Medical and Life Sciences, University of Furtwangen, Villingen-Schwenningen, 78054, Germany
| | - Wolfgang Kemmler
- Institute of Radiology, Friedrich-Alexander-Universität Erlangen-Nürnberg and University Hospital Erlangen, Erlangen, 91054, Germany,Institute of Medical Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, 91052, Germany
| | - Sebastian Bickelhaupt
- Institute of Radiology, Friedrich-Alexander-Universität Erlangen-Nürnberg and University Hospital Erlangen, Erlangen, 91054, Germany
| | - Klaus Engelke
- Institute of Medical Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, 91052, Germany,Department of Medicine III, Friedrich-Alexander University of Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, 91054, Germany
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Lim EY, Cho AH. Dynamic Changes of Carotid Atherosclerosis and Their Relation with Stroke Recurrence in Patients with Stroke or Transient Ischemic Attack. Curr Neurovasc Res 2022; 19:303-310. [PMID: 35996235 DOI: 10.2174/1567202619666220822141804] [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: 06/15/2022] [Revised: 07/05/2022] [Accepted: 07/14/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to show dynamic changes in carotid and vertebral artery using carotid Doppler ultrasonography (DUS) through a long-term follow- up exam, and determine their associations with stroke recurrence. METHODS We consecutively enrolled stroke or transient ischemic attack (TIA) patients who had undergone DUS more than twice with intervals of three months or more. Stroke recurrence during follow-up was also investigated by reviewing medical records. Progress or regress of plaque was defined as more than 0.1 mm change from the initial scan with a semi-quantitative measurement. The development of new plaque was also regarded as plaque progress. Increased intima-media thickness and plaque presence were interpreted at the initial and follow-up scans. Factors related to progression or regression were analyzed. The relationship between plaque change and stroke recurrence was investigated. RESULTS A total of 201 patients were enrolled (186 ischemic stroke patients and 15 TIA patients). There were 61 (30.3%) females. Their mean age was 64.2 ± 9.9 years. During a follow-up of 35.0 ± 22.6 (mean ± SD) months, plaque progress was observed in 92 (45.8%) and plaque regress in 13 (6.5%). Stroke recurred in 18 patients. Plaque progression showed no significant association with age, risk factors, statin use, or subtype. After adjustment of age, sex, diabetes, and stroke subtype, multiple logistic regression showed a significant association of plaque progression with stroke recurrence (odds ratio: 3.8, 95% confidence interval: 1.1 to 13.1, p = 0.034). Patients with plaque regress were significantly younger than those without plaque regress (57.8 years vs. 64.6 years, p = 0.041). CONCLUSION Plaque progression occurred in 46% of stroke or TIA patients. Plaque progression was significantly associated with clinical stroke recurrence. Plaque regressed in 6.5% of patients. Patients with regression were younger than those without.
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Affiliation(s)
- Eun-Ye Lim
- Department of Neurology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - A-Hyun Cho
- Department of Neurology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Rueda-Gotor J, Genre F, Corrales A, Blanco R, Fuentevilla P, Portilla V, Expósito R, Mata C, Pina T, González-Juanatey C, Rodriguez-Rodriguez L, González-Gay MA. Detection of high cardiovascular risk patients with ankylosing spondylitis based on the assessment of abdominal aortic calcium as compared to carotid ultrasound. Arthritis Res Ther 2018; 20:195. [PMID: 30157925 PMCID: PMC6116452 DOI: 10.1186/s13075-018-1684-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 07/23/2018] [Indexed: 01/16/2023] Open
Abstract
Background This study aimed to determine whether, besides carotid ultrasound (US), a lateral lumbar spine radiography may also help identify ankylosing spondylitis (AS) patients at high risk of cardiovascular (CV) disease. Methods A set of 125 AS patients older than 35 years without a history of CV events, diabetes mellitus, or chronic kidney disease was recruited. Carotid US and lateral lumbar spine radiography were performed in all of them. The CV risk was calculated according to the total cholesterol systematic coronary risk evaluation (TC-SCORE) algorithm. Presence of carotid plaques was defined following the Mannheim Carotid Intima-media Thickness and Plaque Consensus. Abdominal aortic calcium (AAC) in a plain radiography was defined as calcific densities visible in an area parallel and anterior to the lumbar spine. Results Carotid US showed higher sensitivity than lateral lumbar spine radiography to detect high CV risk in the 54 patients with moderate TC-SCORE (61% versus 38.9%). Using carotid plaques as the gold standard test, a predictive model that included a TC-SCORE ≥ 5% or the presence of AAC in the lateral lumbar spine radiography in patients with both moderate and low CV risk (< 5%) according to the TC-SCORE yielded a sensitivity of 50.9% with a specificity of 95.7% to identify high/very high CV-risk AS patients. A positive correlation between AAC and carotid plaques was observed (r2 = 0.49, p < 0.001). Conclusions A lateral lumbar spine radiography is a useful tool to identify patients with AS at high risk of CV disease.
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Affiliation(s)
- Javier Rueda-Gotor
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Avenida de Valdecilla, s/n, 39008, Santander, Spain.
| | - Fernanda Genre
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Avenida de Valdecilla, s/n, 39008, Santander, Spain
| | - Alfonso Corrales
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Avenida de Valdecilla, s/n, 39008, Santander, Spain
| | - Ricardo Blanco
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Avenida de Valdecilla, s/n, 39008, Santander, Spain
| | - Patricia Fuentevilla
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Avenida de Valdecilla, s/n, 39008, Santander, Spain
| | - Virginia Portilla
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Avenida de Valdecilla, s/n, 39008, Santander, Spain
| | - Rosa Expósito
- Division of Rheumatology, Hospital Comarcal, Laredo, Cantabria, Spain
| | - Cristina Mata
- Division of Rheumatology, Hospital Comarcal, Laredo, Cantabria, Spain
| | - Trinitario Pina
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Avenida de Valdecilla, s/n, 39008, Santander, Spain
| | | | - Luis Rodriguez-Rodriguez
- Division of Rheumatology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IDISSC), Hospital Clínico San Carlos, Madrid, Spain
| | - Miguel A González-Gay
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Avenida de Valdecilla, s/n, 39008, Santander, Spain.,Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Sakellarios AI, Bizopoulos P, Papafaklis MI, Athanasiou L, Exarchos T, Bourantas CV, Naka KK, Patterson AJ, Young VEL, Gillard JH, Parodi O, Michalis LK, Fotiadis DI. Natural History of Carotid Atherosclerosis in Relation to the Hemodynamic Environment. Angiology 2016; 68:109-118. [PMID: 27081091 DOI: 10.1177/0003319716644138] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Carotid atherosclerosis may lead to devastating clinical outcomes such as stroke. Data on the value of local factors in predicting progression in carotid atherosclerosis are limited. Our aim was to investigate the association of local endothelial shear stress (ESS) and low-density lipoprotein (LDL) accumulation with the natural history of atherosclerotic disease using a series of 3 time points of human magnetic resonance data. Three-dimensional lumen/wall reconstruction was performed in 12 carotids, and blood flow and LDL mass transport modeling were performed. Our results showed that an increase in plaque thickness and a decrease in lumen size were associated with low ESS and high LDL accumulation in the arterial wall. Low ESS (odds ratio [OR]: 2.99; 95% confidence interval [CI]: 2.31-3.88; P < .001 vs higher ESS) and high LDL concentration (OR: 3.26; 95% CI: 2.44-4.36; P < .001 vs higher LDL concentration) were significantly associated with substantial local plaque growth. Low ESS and high LDL accumulation both presented a diagnostic accuracy of 67% for predicting plaque growth regions. Modeling of blood flow and LDL mass transport show promise in predicting progression of carotid atherosclerosis.
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Affiliation(s)
- Antonis I Sakellarios
- 1 Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science, University of Ioannina, Ioannina, Greece
| | - Paschalis Bizopoulos
- 1 Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science, University of Ioannina, Ioannina, Greece
| | - Michail I Papafaklis
- 2 Michailideion Cardiac Center, Medical School, University of Ioannina, Ioannina, Greece.,3 Second Department of Cardiology, Medical School, University of Ioannina, Ioannina, Greece.,4 Institute for Medical Science and Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Lambros Athanasiou
- 1 Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science, University of Ioannina, Ioannina, Greece.,4 Institute for Medical Science and Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA.,5 Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Themis Exarchos
- 1 Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science, University of Ioannina, Ioannina, Greece.,6 Department of Biomedical Research Institute, Institute of Molecular Biology and Biotechnology, FORTH, University Campus of Ioannina, Ioannina, Greece
| | - Christos V Bourantas
- 7 Department of Cardiovascular Sciences, University College London, London, United Kingdom
| | - Katerina K Naka
- 2 Michailideion Cardiac Center, Medical School, University of Ioannina, Ioannina, Greece.,3 Second Department of Cardiology, Medical School, University of Ioannina, Ioannina, Greece
| | - Andrew J Patterson
- 8 Department of Radiology, University of Cambridge, Cambridge, United Kingdom
| | - Victoria E L Young
- 8 Department of Radiology, University of Cambridge, Cambridge, United Kingdom
| | - Jonathan H Gillard
- 8 Department of Radiology, University of Cambridge, Cambridge, United Kingdom
| | - Oberdan Parodi
- 9 Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Lampros K Michalis
- 2 Michailideion Cardiac Center, Medical School, University of Ioannina, Ioannina, Greece.,3 Second Department of Cardiology, Medical School, University of Ioannina, Ioannina, Greece
| | - Dimitrios I Fotiadis
- 1 Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science, University of Ioannina, Ioannina, Greece.,6 Department of Biomedical Research Institute, Institute of Molecular Biology and Biotechnology, FORTH, University Campus of Ioannina, Ioannina, Greece
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Preclinical models of atherosclerosis. The future of Hybrid PET/MR technology for the early detection of vulnerable plaque. Expert Rev Mol Med 2016; 18:e6. [PMID: 27056676 DOI: 10.1017/erm.2016.5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cardiovascular diseases are the leading cause of death in developed countries. The aetiology is currently multifactorial, thus making them very difficult to prevent. Preclinical models of atherothrombotic diseases, including vulnerable plaque-associated complications, are now providing significant insights into pathologies like atherosclerosis, and in combination with the most recent advances in new non-invasive imaging technologies, they have become essential tools to evaluate new therapeutic strategies, with which can forecast and prevent plaque rupture. Positron emission tomography (PET)/computed tomography imaging is currently used for plaque visualisation in clinical and pre-clinical cardiovascular research, albeit with significant limitations. However, the combination of PET and magnetic resonance imaging (MRI) technologies is still the best option available today, as combined PET/MRI scans provide simultaneous data acquisition together with high quality anatomical information, sensitivity and lower radiation exposure for the patient. The coming years may represent a new era for the implementation of PET/MRI in clinical practice, but first, clinically efficient attenuation correction algorithms and research towards multimodal reagents and safety issues should be validated at the preclinical level.
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Medical Management of Serum Lipids and Coronary Heart Disease. Coron Artery Dis 2015. [DOI: 10.1007/978-1-4471-2828-1_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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8
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Nemoto M, Hoshina K, Takayama T, Miura S, Nakazawa T, Kato M, Shigematsu K, Miyata T, Watanabe T. Statins reduce extensive aortic atheromas in patients with abdominal aortic aneurysms. Ann Vasc Dis 2013; 6:711-7. [PMID: 24386020 DOI: 10.3400/avd.oa.13-00065] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 09/30/2013] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Statins have been used widely to reduce dyslipidemia and recently have been reported to have pleiotropic effects such as plaque reduction and stabilization. This study retrospectively evaluated the regression of extensive thoracic atheromas ("shaggy aorta") in abdominal aortic aneurysm (AAA) patients who underwent contrast-enhanced computed tomography (CECT) before and after statin administration. MATERIALS AND METHODS CECT was used to examine thoracic aortas of 29 patients (statin group; n = 22, non-statin group; n = 7) with extensive atheromas from the ostium of the left subclavian artery to that of the more proximal renal artery. Extensive thoracic atheroma was defined by: (1) thickness >5 mm, (2) involved circumference of thoracic aorta >50%, and (3) length >30 mm. The areas of atheroma (cm(2)) were measured before and after administration of statins, and the atheroma reduction ratio (ARR) was evaluated. RESULTS The area of atheroma decreased after administration of statins, and the ARR was significant (P <0.01). The ARR increased with all cases in non-statin group. No complications associated with extensive atheroma were observed during the follow-up period. CONCLUSION This pilot study indicates statins can reduce extensive thoracic atheromas and lower lipid concentrations.
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Affiliation(s)
- Masaru Nemoto
- Department of Vascular Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Katsuyuki Hoshina
- Department of Vascular Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Toshio Takayama
- Department of Cardiovascular Surgery, Morinomiya Hospital, Osaka, Osaka, Japan
| | - Sumio Miura
- Department of Cardiovascular Surgery, Mitsui Memorial Hospital, Tokyo, Japan
| | - Tatsu Nakazawa
- Department of Surgery, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Masaaki Kato
- Department of Cardiovascular Surgery, Morinomiya Hospital, Osaka, Osaka, Japan
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Tetsuro Miyata
- Department of Vascular Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Toshiaki Watanabe
- Department of Surgical Oncology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
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Echeverri D, Cabrales J. Statins and percutaneous coronary intervention: A complementary synergy. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2013; 25:112-22. [DOI: 10.1016/j.arteri.2012.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Accepted: 10/31/2012] [Indexed: 11/15/2022]
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10
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Mihai G, Varghese J, Kampfrath T, Gushchina L, Hafer L, Deiuliis J, Maiseyeu A, Simonetti OP, Lu B, Rajagopalan S. Aliskiren effect on plaque progression in established atherosclerosis using high resolution 3D MRI (ALPINE): a double-blind placebo-controlled trial. J Am Heart Assoc 2013; 2:e004879. [PMID: 23686372 PMCID: PMC3698800 DOI: 10.1161/jaha.112.004879] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background The renin–angiotensin system is well recognized as a mediator of pathophysiological events in atherosclerosis. The benefits of renin inhibition in atherosclerosis, especially when used in combination with angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs) are currently not known. We hypothesized that treatment with the renin inhibitor aliskiren in patients with established cardiovascular disease will prevent the progression of atherosclerosis as determined by high-resolution magnetic resonance imaging (MRI) measurements of arterial wall volume in the thoracic and abdominal aortas of high-risk patients with preexisting cardiovascular disease. Methods and Results This was a single-center, randomized, double-blind, placebo-controlled trial in patients with established cardiovascular disease. After a 2-week single-blind placebo phase, patients were randomized to receive either placebo (n=37, mean±SD age 64.5±8.9 years, 3 women) or 150 mg of aliskiren (n=34, mean±SD age 63.9±11.5 years, 9 women). Treatment dose was escalated to 300 mg at 2 weeks and maintained during the remainder of the study. Patients underwent dark-blood, 3-dimensional MRI assessment of atherosclerotic plaque in the thoracic and abdominal segments at baseline and on study completion or termination (up to 36 weeks of drug or matching placebo). Aliskiren use resulted in significant progression of aortic wall volume (normalized total wall volume 5.31±6.57 vs 0.15±4.39 mm3, P=0.03, and percentage wall volume 3.37±2.96% vs 0.97±2.02%, P=0.04) compared with placebo. In a subgroup analysis of subjects receiving ACEI/ARB therapy, atherosclerosis progression was observed only in the aliskiren group, not in the placebo group. Conclusions MRI quantification of atheroma plaque burden demonstrated that aliskiren use in patients with preexisting cardiovascular disease resulted in an unexpected increase in aortic atherosclerosis compared with placebo. Although preliminary, these results may have implications for the use of renin inhibition as a therapeutic strategy in patients with cardiovascular disease, especially in those receiving ACEI/ARB therapy. Clinical Trial Registration URL: http://ClinicalTrials.gov Unique identifier: NCT01417104.
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Affiliation(s)
- Georgeta Mihai
- Dorothy M. Davis Heart & Lung Research Institute and the Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH 43210, USA
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11
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Kwan AC, Cater G, Vargas J, Bluemke DA. Beyond Coronary Stenosis: Coronary Computed Tomographic Angiography for the Assessment of Atherosclerotic Plaque Burden. CURRENT CARDIOVASCULAR IMAGING REPORTS 2013; 6:89-101. [PMID: 23524381 PMCID: PMC3601491 DOI: 10.1007/s12410-012-9183-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Coronary computed tomographic angiography (CCTA) is emerging as a key non-invasive method for assessing cardiovascular risk by measurement of coronary stenosis and coronary artery calcium (CAC). New advancements in CCTA technology have led to the ability to directly identify and quantify the so-called "vulnerable" plaques that have features of positive remodeling and low density components. In addition, CCTA presents a new opportunity for noninvasive measurement of total coronary plaque burden that has not previously been available. The use of CCTA needs also to be balanced by its risks and, in particular, the associated radiation exposure. We review current uses of CCTA, CCTA's ability to measure plaque quantity and characteristics, and new developments in risk stratification and CCTA technology. CCTA represents a quickly developing field that will play a growing role in the non-invasive management of cardiovascular disease.
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Affiliation(s)
- Alan C Kwan
- Radiology and Imaging Sciences - National Institutes of Health Clinical Center, Bethesda, MD, USA
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12
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Ribichini F, Tomai F, Pesarini G, Zivelonghi C, Rognoni A, De Luca G, Boccuzzi G, Presbitero P, Ferrero V, Ghini AS, Marino P, Vassanelli C, Ribichini F, Ferrero V, Pesarini G, Dal Dosso S, Vassanelli C, Tanguay JF, Tomai F, Presbitero P, Minelli M, Marino P, Anselmi M, Abukarsh R, Cima A, Ferrara A, Ferrero V, Menegatti G, Molinari G, Pesarini G, Ribichini F, Sparta D, Altamura L, Aurigemma C, Beraldi M, Corvo P, De Luca L, De Persio G, Ghini AS, Pastori F, Pellanda J, Petrolini A, Skossyreva O, Tomai. Ospedale F, Ospedale S, Bosco G, Boccuzzi G, Colangelo S, Garbo R, Minelli M, Noussan P, Belli G, Presbitero P, Rossi M, Soregaroli D, Zavalloni D, De Luca G, Franchi E, Leverone M, Rognoni A, Brunelleschi S, Feola M, Trinita OS, Menegatti G, Noussan P, Giovanni OS, Zanolla L, Magnani C. Long-term clinical follow-up of the multicentre, randomized study to test immunosuppressive therapy with oral prednisone for the prevention of restenosis after percutaneous coronary interventions: Cortisone plus BMS or DES veRsus BMS alone to EliminAte Restenosis (CEREA-DES). Eur Heart J 2013; 34:1740-8. [DOI: 10.1093/eurheartj/eht079] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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13
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Abstract
BACKGROUND Screening for abdominal aortic aneurysm (AAA) in selected groups is now performed in England, the USA and Sweden. Patients with aneurysms over 55 mm in diameter are generally considered for elective surgical repair. Patients with aneurysm diameters below or equal to 55 mm (termed 'small AAAs') are managed with aneurysm surveillance as there is currently insufficient evidence to recommend surgery in these cases. As more patients are screened, there will be an increasing number of small AAAs identified. There is interest in pharmaceutical interventions (for example angiotensin converting enzyme (ACE) inhibitors, antibiotics, beta-blockers, statins) which could be given to such patients to delay or reverse aneurysm expansion and reduce the need for elective surgical repair. OBJECTIVES To assess the effects of medical treatment on the expansion rate of small abdominal aortic aneurysms. SEARCH METHODS The Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (May 2012) and CENTRAL (2012, Issue 5). Clinical trials databases were searched for details of ongoing or unpublished studies. The reference lists of articles retrieved by electronic searches were searched for additional citations. SELECTION CRITERIA We selected randomised trials in which patients with small AAAs allocated to medical treatment with the intention of retarding aneurysm expansion were compared to patients allocated to a placebo treatment, alternative medical treatment, a different regimen of the same drug or imaging surveillance alone. DATA COLLECTION AND ANALYSIS Two authors independently extracted the data and assessed the risk of bias in the trials. Meta-analyses were used when heterogeneity was considered low. The two primary outcomes were the mean difference (MD) in aneurysm diameter and the odds ratio (OR) calculated to compare the number of individuals referred to AAA surgery in each group over the trial period. MAIN RESULTS Seven trials involving 1558 participants were included in this review; 457 were involved in four trials of antibiotic medication, and 1101 were involved in three trials of beta-blocker medication. Five of the studies were rated at a high risk of bias.Individually, all of the included trials reported non-significant differences in AAA expansion rates between their intervention and control groups.The two major drug groups were then analysed separately. For AAA expansion it was only possible to combine two of the antibiotic trials in a meta-analysis. This demonstrated that roxithromycin had a small but significant protective effect (MD -0.86 mm; 95% confidence interval (CI) -1.57 to -0.14). When referral to AAA surgery was compared (including all four antibiotic trials in the meta-analysis), non-significantly fewer patients were referred in the intervention groups (OR 0.96; 95% CI 0.59 to 1.57) than the control groups. When only the trials reporting actual elective surgery were included in a subgroup analysis, the result remained statistically non-significant (OR 1.17; 95% CI 0.57 to 2.42).For the beta-blocker trials, when all were combined in a meta-analysis, there was a very small, non-significant protective effect for propranolol on AAA expansion (MD -0.08 mm; 95% CI -0.25 to 0.10), and non-significantly fewer patients were referred to AAA surgery in the propranolol group (OR 0.74; 95% CI 0.52 to 1.05). Bronchospasm and shortness of breath were the main adverse effects from the beta-blockers. In one trial the adverse effects were reportedly so severe that the trial was stopped early after two years. AUTHORS' CONCLUSIONS There is some limited evidence that antibiotic medication may have a slight protective effect in retarding the expansion rates of small AAAs. The quality of the evidence makes it unclear whether this translates into fewer referrals to AAA surgery, owing mainly to the small sample sizes of the studies.Antibiotics were generally well tolerated with minimal adverse effects. Propranolol was poorly tolerated by patients in all of the beta-blocker trials and demonstrated only minimal and non-significant protective effects. Further research on beta-blockers for AAA needs to consider the use of drugs other than propranolol.In general, there is surprisingly little high quality evidence on medical treatment for small AAAs, especially in relation to the use of newer beta-blockers, ACE inhibitors and statins.
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Affiliation(s)
- Guy Rughani
- The Medical School, The University of Edinburgh, Edinburgh, UK.
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14
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van Gils MJ, Vukadinovic D, van Dijk AC, Dippel DWJ, Niessen WJ, van der Lugt A. Carotid atherosclerotic plaque progression and change in plaque composition over time: a 5-year follow-up study using serial CT angiography. AJNR Am J Neuroradiol 2012; 33:1267-73. [PMID: 22345501 DOI: 10.3174/ajnr.a2970] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Serial in vivo imaging of atherosclerosis is important for understanding plaque progression and is potentially useful in predicting cardiovascular events and monitoring treatment efficacy. This prospective study aims to quantify temporal changes in carotid atherosclerotic plaque volume and plaque composition using MDCTA. MATERIALS AND METHODS In 109 patients with TIA or ischemic stroke, serial MDCTA of the carotid arteries was performed after 5.3 ± 0.7 years. The carotid bifurcation was semiautomatically registered for paired baseline follow-up datasets. Outer vessel wall and lumen boundaries were defined using semiautomated segmentation tools. Plaque component volumes were measured using HU thresholds. Annual changes in plaque volume and plaque component proportions were calculated. RESULTS One-hundred-ninety-three carotid arteries were analyzed. Plaque volume decreased in 31% and increased in 69% of vessels (range -5.6-10.1%/year). Overall, plaque volume increased 1.2% per year (95% CI, 0.8-1.6, P ≤ .001). Plaque composition changed significantly from BL (fibrous 66.4%, lipid 28.8%, calcifications 4.8%): fibrous tissue decreased by 1.5%, lipid decreased by 1.8%, and calcification increased by 3.3% (P < .001). Intraobserver reproducibility of all volume and proportion measurements was good (ICC 0.78-1.00) and interobserver reproducibility was moderate (ICC 0.76-0.99). CONCLUSIONS Changes in carotid plaque burden and plaque composition can be quantified by using serial MDCTA. Plaque burden development is a heterogeneous and slow process.
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Affiliation(s)
- M J van Gils
- Department of Radiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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15
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Xie G, Zaman MJS, Myint PK, Liang L, Zhao L, Wu Y. Factors associated with compliance to lipid-lowering treatment in China. Eur J Prev Cardiol 2012; 20:229-37. [PMID: 22345695 DOI: 10.1177/2047487312438847] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There are an estimated 200 million people in China with dyslipidaemia. We sought to explore factors that influence compliance to treatment of dyslipidaemia, using a multi-centre sample in China. METHODS Through review of medical notes and direct interviews at two points in time (2006 and 2007) of 2094 patients in 27 hospitals receiving lipid-lowering therapy since 2004, 1890 patients were recruited who had been on treatment for more than one year. Good compliance (GC) was defined as days taking lipid-lowering drugs/total days of follow-up ≥ 80%. Logistic regression models were used to assess factors associated with GC. RESULTS In patients with one, two and three years of treatment respectively, GC was greater in those with higher versus lower medical insurance cover - odds ratios 2.8 (95%CI 2.2-3.7), 2.0 (1.5-2.7), 4.3 (2.3-8.1); in patients in province-level versus county-level hospitals-2.0 (1.5-2.6), 2.9 (2.0-4.1), 4.6 (1.8-12.0); in patients treated by non-cardiology physicians compared to cardiologists -1.7 (1.1-2.5), 2.0 (1.3-3.0), 4.0 (1.5-10.3) and in patients using a statin versus other forms of medication for dyslipidaemia -1.7 (1.2-2.2), 1.7 (1.2-2.3), 4.4 (2.3-8.5). CONCLUSIONS Better medical insurance cover, care in a province-level hospital rather than county-level hospital, treatment by a non-cardiologist and use of a statin were associated with better compliance to lipid-lowering treatment.
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Affiliation(s)
- Gaoqiang Xie
- Peking University Clinical Research Institute, Beijing, China
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16
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Eandi M. Drug Therapy and Follow-Up. ATHEROSCLEROSIS DISEASE MANAGEMENT 2011:563-631. [DOI: 10.1007/978-1-4419-7222-4_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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17
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Nair PK, Mulukutla SR, Marroquin OC. Stents and statins: history, clinical outcomes and mechanisms. Expert Rev Cardiovasc Ther 2010; 8:1283-95. [PMID: 20828351 DOI: 10.1586/erc.10.113] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The 1980s witnessed the inception of both stents and 3-hydroxy-3-methyl-glutaryl-CoA reductase inhibitors (statins). While they evolved separately, it was soon realized that they each offered a unique and powerful mechanism for targeting the major offender in cardiovascular disease, namely atherosclerosis. Coincidentally, the first statin was approved by the US FDA in 1987, the same year that the coronary stent was conceived. Since that time, stents and statins have revolutionized the field of cardiovascular medicine and their paths have been intertwined. Several pivotal randomized clinical trials have established statins as an effective therapy for improving clinical outcomes after percutaneous coronary intervention (PCI) among patients presenting with stable coronary artery disease and acute coronary syndromes. In addition, chronic statin therapy and acute loading of statins prior to PCI has consistently been shown to limit periprocedural myocardial necrosis. The mechanism for improved clinical outcomes with statins has clearly been associated with statin-induced reductions in LDL. In addition, statins may also exert 'pleiotropic' effects, independent of LDL lowering, that might counteract the inflammatory and prothrombotic mileu created with PCI. This article provides a brief historical perspective of the evolution of the use of statins and stents in patients with coronary artery disease, an evaluation of the available clinical data supporting the use of statins in patients undergoing PCI across a wide spectrum of clinical scenarios, and a discussion of the potential mechanisms of the benefit of statins in these patients.
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Affiliation(s)
- Pradeep K Nair
- Center for Interventional Cardiology Research, Cardiovascular Institute, University of Pittsburgh Medical Center, 200 Lothrop Street, A-333 PUH, Pittsburgh, PA 15213, USA
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18
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Buhk JH, Finck-Wedel AK, Buchert R, Bannas P, Schnackenburg B, Beil FU, Adam G, Weber C. Screening for atherosclerotic plaques in the abdominal aorta in high-risk patients with multicontrast-weighted MRI: a prospective study at 3.0 and 1.5 tesla. Br J Radiol 2010; 84:883-9. [PMID: 21081571 DOI: 10.1259/bjr/16555263] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE This prospective study compares MRI of atherosclerotic plaque in the abdominal aorta at 3 T with that at 1.5 T in patients suffering from hereditary hyperlipidaemia, a major risk factor for atherosclerosis. METHODS MRI of the abdominal aorta at 1.5 and 3 T was performed in 21 patients (mean age 58 years). The study protocol consisted of proton density (PD), T(1), T(2) and fat-saturated T(2) weighted black blood images of the abdominal aorta in corresponding orientation. Two independent radiologists performed image rating. First, image quality was rated on a five-point scale. Second, atherosclerotic plaques were scored according to the modified American Heart Association (AHA) classification and analysed for field strength-related differences. Weighted κ statistics were calculated to assess interobserver agreement. RESULTS Interobserver agreement was substantial for nearly all categories. MRI at 3 T offered superior image quality in all contrast weightings, most significantly in T(1) and T(2) weighted techniques. Plaque burden in the study collective was unexpectedly moderate. The majority of plaques were classified as AHA III lesions; no lesions were classified above AHA V. There was no significant influence of the field strength regarding the AHA classification. CONCLUSION Abdominal aortal plaque screening is basically feasible at both field strengths, whereas the image quality is rated superior at 3 T. However, the role of the method in clinical practice remains uncertain, since substantial findings in the high-risk collective were scarce.
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Affiliation(s)
- J-H Buhk
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany.
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Narwal R, Akhlaghi F, Åsberg A, Hermann M, Rosenbaum SE. Development of a Population Pharmacokinetic Model for Atorvastatin Acid and Its Lactone Metabolite. Clin Pharmacokinet 2010; 49:693-702. [DOI: 10.2165/11535980-000000000-00000] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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20
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Mihai G, Chung YC, Merchant A, Simonetti OP, Rajagopalan S. T1-weighted-SPACE dark blood whole body magnetic resonance angiography (DB-WBMRA): initial experience. J Magn Reson Imaging 2010; 31:502-9. [PMID: 20099365 DOI: 10.1002/jmri.22049] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To evaluate the feasibility of the dark blood fast spin echo (FSE) T1-weighted-Sampling Perfection with Application of optimized Contrasts using different flip angle Evolution (T1w-SPACE) sequence in assessing whole body arterial wall information from the extracranial carotids to the popliteal artery. MATERIALS AND METHODS Twenty-eight subjects were subjected to noncontrast, dark blood whole body magnetic resonance angiography (DB-WBMRA) using a T1w-SPACE sequence optimized for each of the individual stations: carotid artery, thoracic aorta, abdominal aorta, and thigh/superficial femoral artery (SFA). Image quality/vessel wall visualization and the time required to image the four stations were evaluated. Two observers checked the reproducibility of vessel wall depiction by performing quantitative measurements in registered initial and repeat studies (six subjects) of vessel wall and lumen area at 17 locations along the arterial tree. RESULTS In 25 of the 28 scanned subjects, dark blood arterial images acquired in approximately 1 hour total imaging time allowed whole body arterial vessel wall visualization. Quantitative measurements showed high correlation between the initial and repeat studies for each of the observers as well as high interobserver reproducibility (r > 0.95; P < 0.01). CONCLUSION DB-WBMRA using T1w-SPACE is feasible and can be performed with a high degree of reliability.
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Affiliation(s)
- Georgeta Mihai
- Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA.
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21
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Raval M, Frank PG, Laury-Kleintop L, Yan G, Lanza-Jacoby S. Celecoxib combined with atorvastatin prevents progression of atherosclerosis. J Surg Res 2010; 163:e113-22. [PMID: 20538289 DOI: 10.1016/j.jss.2010.03.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Revised: 02/17/2010] [Accepted: 03/03/2010] [Indexed: 11/18/2022]
Abstract
BACKGROUND Increased expression of cyclooxygenase (COX-2) contributes to atherosclerosis. Recent studies suggest that COX-2 inhibitors prevent early plaque development but their effects on established lesions are less clear, while the statins promote plaque stability. The purpose of this study is to investigate whether administering a combination of a COX-2 inhibitor with a statin drug alters plaque progression in apo E-/- mice. MATERIALS AND METHODS Apo E-/- mice were fed a Western diet from 6 to 26 wk of age. At 26 wk, the Western diets supplemented with atorvastatin, celecoxib, or atorvastatin plus celecoxib were given for an additional 12 wk. RESULTS When the mice were 38 wk of age, the total area occupied by the atherosclerotic lesion was 53% less in the mice fed the combination of atorvastatin + celecoxib P ≤ 0.05) than that of the apo E-/- mice fed the Western diet alone, atorvastatin alone, or celecoxib alone. The decreased extent of atherosclerosis observed in the apo E-/- mice fed the combination of drugs was associated with reduced levels of prostaglandin (PG) E(2,) decreased protein expression of metalloproteinase (MMP)-9, macrophage chemotactic protein (MCP-1), and COX 2, and decreased staining for MMP-9, F4-80 (a marker for macrophages), and vascular cell adhesion molecule (VCAM). CONCLUSION This study indicates that using statins with a COX-2 inhibitor reduced the extent of atherosclerosis and inflammatory/cell adhesion molecule levels in the apo E-/- mouse model.
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Affiliation(s)
- Mihir Raval
- Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania 19017, USA
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22
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Hayashi K, Mani V, Nemade A, Aguiar S, Postley JE, Fuster V, Fayad ZA. Variations in atherosclerosis and remodeling patterns in aorta and carotids. J Cardiovasc Magn Reson 2010; 12:10. [PMID: 20205722 PMCID: PMC2848016 DOI: 10.1186/1532-429x-12-10] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Accepted: 03/05/2010] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Atherosclerosis is a progressive disease that causes vascular remodeling that can be positive or negative. The evolution of arterial wall thickening and changes in lumen size under current "standard of care" in different arterial beds is unclear. The purpose of this study was to examine arterial remodeling and progression/regression of atherosclerosis in aorta and carotid arteries of individuals at risk for atherosclerosis normalized over a 1-year period. METHODS In this study, 28 patients underwent at least 2 black-blood in vivo cardiovascular magnetic resonance (CMR) scans of aorta and carotids over a one-year period (Mean 17.8 +/- 7.5 months). Clinical risk profiles for atherosclerosis and medications were documented and patients were followed by their referring physicians under current "standard of care" guidelines. Carotid and aortic wall lumen areas were matched across the time-points from cross-sectional images. RESULTS The wall area increased by 8.67%, 10.64%, and 13.24% per year (carotid artery, thoracic aorta and abdominal aorta respectively, p < 0.001). The lumen area of the abdominal aorta increased by 4.97% per year (p = 0.002), but the carotid artery and thoracic aorta lumen areas did not change significantly. The use of statin therapy did not change the rate of increase of wall area of carotid artery, thoracic and abdominal aorta, but decreased the rate of change of lumen area of carotid artery (-3.08 +/- 11.34 vs. 0.19 +/- 12.91 p < 0.05). CONCLUSIONS Results of this study of multiple vascular beds indicated that different vascular locations exhibited varying progression of atherosclerosis and remodeling as monitored by CMR.
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Affiliation(s)
- Katsumi Hayashi
- Imaging Science Laboratories, Translational and Molecular imaging Institute, Department of Radiology, Mount Sinai School of Med, New York, NY, USA
| | - Venkatesh Mani
- Imaging Science Laboratories, Translational and Molecular imaging Institute, Department of Radiology, Mount Sinai School of Med, New York, NY, USA
| | - Ajay Nemade
- Imaging Science Laboratories, Translational and Molecular imaging Institute, Department of Radiology, Mount Sinai School of Med, New York, NY, USA
| | - Silvia Aguiar
- Imaging Science Laboratories, Translational and Molecular imaging Institute, Department of Radiology, Mount Sinai School of Med, New York, NY, USA
| | - John E Postley
- College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Valentin Fuster
- Department of Medicine, Mount Sinai School of Medicine, New York, NY, USA
| | - Zahi A Fayad
- Imaging Science Laboratories, Translational and Molecular imaging Institute, Department of Radiology, Mount Sinai School of Med, New York, NY, USA
- Department of Medicine, Mount Sinai School of Medicine, New York, NY, USA
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Statins in prevention of repeat revascularization after percutaneous coronary intervention--a meta-analysis of randomized clinical trials. Pharmacol Res 2009; 61:316-20. [PMID: 19922797 DOI: 10.1016/j.phrs.2009.11.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Revised: 11/10/2009] [Accepted: 11/10/2009] [Indexed: 11/22/2022]
Abstract
Recent prospective cohort studies have shown that patients discharged on statins after percutaneous coronary intervention (PCI) are at lower risks of repeat revascularization and mortality when compared to those not on statins after discharge. However, few randomized clinical trials among post-PCI patients confirmed these beneficial effects. It is needed to evaluate the effects of post-procedural statin therapy on individual clinical outcomes to facilitate the further investigation on identifying the underlying mechanism(s). A meta-analysis of randomized clinical trials was conducted to examine the effects of statin therapy initiated after coronary angioplasty on repeat revascularization, all-cause mortality and myocardial infarction (MI). From relevant reports on Medline (from inception to October 2009), six randomized clinical trials comprising 2979 patients were included. Relative risks were evaluated for pooled data via random effect models. Compared with controls, post-PCI statin therapy was associated with a significantly decreased risk of repeat revascularization (risk ratio (RR)=0.73, 95% confidence interval (CI), 0.55-0.98, p=0.04), nonsignificantly decreased risks of all-cause mortality (RR=0.88, 95% CI, 0.35-2.21, p=0.79), MI (RR=0.76, 95% CI, 0.49-1.18, p=0.23), and target lesion or target vessel revascularization (RR=0.58, 95% CI, 0.24-1.39, p=0.22). In conclusion, statin therapy after PCI can reduce the risk of repeat revascularization. Further investigation is needed to identify the underlying mechanism(s).
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