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Leiherer A, Muendlein A, Saely CH, Geiger K, Brandtner EM, Heinzle C, Gaenger S, Mink S, Laaksonen R, Fraunberger P, Drexel H. Coronary Event Risk Test (CERT) as a Risk Predictor for the 10-Year Clinical Outcome of Patients with Peripheral Artery Disease. J Clin Med 2023; 12:6151. [PMID: 37834795 PMCID: PMC10573503 DOI: 10.3390/jcm12196151] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/30/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
(1) Background: Ceramides are a new kind of lipid biomarker and have already been demonstrated to be valuable risk predictors in coronary patients. Patients with peripheral artery disease (PAD) are a population with a worse prognosis and higher mortality risk compared to coronary artery disease (CAD) patients. However, the value of ceramides for risk prediction in PAD patients is still vague, as addressed in the present study. (2)Methods: This observational study included 379 PAD patients. The primary endpoint was all-cause mortality at 10 years of follow-up. A set of ceramides was measured by LC-MS/MS and combined according to the Coronary Event Risk Test (CERT) score, which categorizes patients into one of four risk groups (low risk, moderate risk, high risk, very high risk). (3) Results: Kaplan-Meier survival curves revealed that the overall survival of patients decreased with the increasing risk predicted by the four CERT categories, advancing from low risk to very high risk. Cox regression analysis demonstrated that each one-category increase resulted in a 35% rise in overall mortality risk (HR = 1.35 [1.16-1.58]). Multivariable adjustment, including, among others, age, LDL-cholesterol, type 2 diabetes, and statin treatment before the baseline, did not abrogate this significant association (HR = 1.22 [1.04-1.43]). Moreover, we found that the beneficial effect of statin treatment is significantly stronger in patients with a higher risk, according to CERT. (4) Conclusions: We conclude that the ceramide-based risk score CERT is a strong predictor of the 10-year mortality risk in patients with PAD.
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Affiliation(s)
- Andreas Leiherer
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Academic Teaching Hospital Feldkirch, Carinagasse 47, A-6800 Feldkirch, Austria; (A.M.); (K.G.); (E.-M.B.); (S.G.); (H.D.)
- Private University of the Principality of Liechtenstein, FL-9495 Triesen, Liechtenstein; (S.M.); (P.F.)
- Medical Central Laboratories, A-6800 Feldkirch, Austria
| | - Axel Muendlein
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Academic Teaching Hospital Feldkirch, Carinagasse 47, A-6800 Feldkirch, Austria; (A.M.); (K.G.); (E.-M.B.); (S.G.); (H.D.)
- Private University of the Principality of Liechtenstein, FL-9495 Triesen, Liechtenstein; (S.M.); (P.F.)
| | - Christoph H. Saely
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Academic Teaching Hospital Feldkirch, Carinagasse 47, A-6800 Feldkirch, Austria; (A.M.); (K.G.); (E.-M.B.); (S.G.); (H.D.)
- Private University of the Principality of Liechtenstein, FL-9495 Triesen, Liechtenstein; (S.M.); (P.F.)
- Department of Internal Medicine III, Academic Teaching Hospital Feldkirch, A-6800 Feldkirch, Austria
| | - Kathrin Geiger
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Academic Teaching Hospital Feldkirch, Carinagasse 47, A-6800 Feldkirch, Austria; (A.M.); (K.G.); (E.-M.B.); (S.G.); (H.D.)
- Medical Central Laboratories, A-6800 Feldkirch, Austria
| | - Eva-Maria Brandtner
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Academic Teaching Hospital Feldkirch, Carinagasse 47, A-6800 Feldkirch, Austria; (A.M.); (K.G.); (E.-M.B.); (S.G.); (H.D.)
| | - Christine Heinzle
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Academic Teaching Hospital Feldkirch, Carinagasse 47, A-6800 Feldkirch, Austria; (A.M.); (K.G.); (E.-M.B.); (S.G.); (H.D.)
- Medical Central Laboratories, A-6800 Feldkirch, Austria
| | - Stella Gaenger
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Academic Teaching Hospital Feldkirch, Carinagasse 47, A-6800 Feldkirch, Austria; (A.M.); (K.G.); (E.-M.B.); (S.G.); (H.D.)
| | - Sylvia Mink
- Private University of the Principality of Liechtenstein, FL-9495 Triesen, Liechtenstein; (S.M.); (P.F.)
- Medical Central Laboratories, A-6800 Feldkirch, Austria
| | - Reijo Laaksonen
- Finnish Cardiovascular Research Center, University of Tampere, FI-33014 Tampere, Finland;
- Zora Biosciences, FI-02150 Espoo, Finland
| | - Peter Fraunberger
- Private University of the Principality of Liechtenstein, FL-9495 Triesen, Liechtenstein; (S.M.); (P.F.)
- Medical Central Laboratories, A-6800 Feldkirch, Austria
| | - Heinz Drexel
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Academic Teaching Hospital Feldkirch, Carinagasse 47, A-6800 Feldkirch, Austria; (A.M.); (K.G.); (E.-M.B.); (S.G.); (H.D.)
- Private University of the Principality of Liechtenstein, FL-9495 Triesen, Liechtenstein; (S.M.); (P.F.)
- Vorarlberger Landeskrankenhausbetriebsgesellschaft, Academic Teaching Hospital Feldkirch, A-6800 Feldkirch, Austria
- Drexel University College of Medicine, Philadelphia, PA 19129, USA
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Theofilatos K, Stojkovic S, Hasman M, van der Laan SW, Baig F, Barallobre-Barreiro J, Schmidt LE, Yin S, Yin X, Burnap S, Singh B, Popham J, Harkot O, Kampf S, Nackenhorst MC, Strassl A, Loewe C, Demyanets S, Neumayer C, Bilban M, Hengstenberg C, Huber K, Pasterkamp G, Wojta J, Mayr M. Proteomic Atlas of Atherosclerosis: The Contribution of Proteoglycans to Sex Differences, Plaque Phenotypes, and Outcomes. Circ Res 2023; 133:542-558. [PMID: 37646165 PMCID: PMC10498884 DOI: 10.1161/circresaha.123.322590] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 08/09/2023] [Accepted: 08/13/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Using proteomics, we aimed to reveal molecular types of human atherosclerotic lesions and study their associations with histology, imaging, and cardiovascular outcomes. METHODS Two hundred nineteen carotid endarterectomy samples were procured from 120 patients. A sequential protein extraction protocol was employed in conjunction with multiplexed, discovery proteomics. To focus on extracellular proteins, parallel reaction monitoring was employed for targeted proteomics. Proteomic signatures were integrated with bulk, single-cell, and spatial RNA-sequencing data, and validated in 200 patients from the Athero-Express Biobank study. RESULTS This extensive proteomics analysis identified plaque inflammation and calcification signatures, which were inversely correlated and validated using targeted proteomics. The inflammation signature was characterized by the presence of neutrophil-derived proteins, such as S100A8/9 (calprotectin) and myeloperoxidase, whereas the calcification signature included fetuin-A, osteopontin, and gamma-carboxylated proteins. The proteomics data also revealed sex differences in atherosclerosis, with large-aggregating proteoglycans versican and aggrecan being more abundant in females and exhibiting an inverse correlation with estradiol levels. The integration of RNA-sequencing data attributed the inflammation signature predominantly to neutrophils and macrophages, and the calcification and sex signatures to smooth muscle cells, except for certain plasma proteins that were not expressed but retained in plaques, such as fetuin-A. Dimensionality reduction and machine learning techniques were applied to identify 4 distinct plaque phenotypes based on proteomics data. A protein signature of 4 key proteins (calponin, protein C, serpin H1, and versican) predicted future cardiovascular mortality with an area under the curve of 75% and 67.5% in the discovery and validation cohort, respectively, surpassing the prognostic performance of imaging and histology. CONCLUSIONS Plaque proteomics redefined clinically relevant patient groups with distinct outcomes, identifying subgroups of male and female patients with elevated risk of future cardiovascular events.
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Affiliation(s)
- Konstantinos Theofilatos
- King’s British Heart Foundation Centre, Kings College London, United Kingdom (K.T., M.H., F.B., J.B.B., L.E.S., S.Y., X.Y., S.B., B.S., J.P., M.M.)
| | - Stefan Stojkovic
- Division of Cardiology, Department of Internal Medicine II (S.S., O.H., C.H., J.W., M.M.), Medical University of Vienna, Austria
| | - Maria Hasman
- King’s British Heart Foundation Centre, Kings College London, United Kingdom (K.T., M.H., F.B., J.B.B., L.E.S., S.Y., X.Y., S.B., B.S., J.P., M.M.)
| | - Sander W. van der Laan
- Central Diagnostics Laboratory, Division Laboratories, Pharmacy, and Biomedical Genetics, University Medical Center Utrecht, Utrecht University, the Netherlands (S.W.v.d.L., G.P.)
| | - Ferheen Baig
- King’s British Heart Foundation Centre, Kings College London, United Kingdom (K.T., M.H., F.B., J.B.B., L.E.S., S.Y., X.Y., S.B., B.S., J.P., M.M.)
| | - Javier Barallobre-Barreiro
- King’s British Heart Foundation Centre, Kings College London, United Kingdom (K.T., M.H., F.B., J.B.B., L.E.S., S.Y., X.Y., S.B., B.S., J.P., M.M.)
| | - Lukas Emanuel Schmidt
- King’s British Heart Foundation Centre, Kings College London, United Kingdom (K.T., M.H., F.B., J.B.B., L.E.S., S.Y., X.Y., S.B., B.S., J.P., M.M.)
| | - Siqi Yin
- King’s British Heart Foundation Centre, Kings College London, United Kingdom (K.T., M.H., F.B., J.B.B., L.E.S., S.Y., X.Y., S.B., B.S., J.P., M.M.)
| | - Xiaoke Yin
- King’s British Heart Foundation Centre, Kings College London, United Kingdom (K.T., M.H., F.B., J.B.B., L.E.S., S.Y., X.Y., S.B., B.S., J.P., M.M.)
| | - Sean Burnap
- King’s British Heart Foundation Centre, Kings College London, United Kingdom (K.T., M.H., F.B., J.B.B., L.E.S., S.Y., X.Y., S.B., B.S., J.P., M.M.)
| | - Bhawana Singh
- King’s British Heart Foundation Centre, Kings College London, United Kingdom (K.T., M.H., F.B., J.B.B., L.E.S., S.Y., X.Y., S.B., B.S., J.P., M.M.)
| | - Jude Popham
- King’s British Heart Foundation Centre, Kings College London, United Kingdom (K.T., M.H., F.B., J.B.B., L.E.S., S.Y., X.Y., S.B., B.S., J.P., M.M.)
| | - Olesya Harkot
- Division of Cardiology, Department of Internal Medicine II (S.S., O.H., C.H., J.W., M.M.), Medical University of Vienna, Austria
| | - Stephanie Kampf
- Division of Vascular Surgery, Department of Surgery (S.K., C.N.), Medical University of Vienna, Austria
| | | | - Andreas Strassl
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-Guided Therapy (A.S., C.L.), Medical University of Vienna, Austria
| | - Christian Loewe
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-Guided Therapy (A.S., C.L.), Medical University of Vienna, Austria
| | - Svitlana Demyanets
- Department of Laboratory Medicine (S.D.), Medical University of Vienna, Austria
| | - Christoph Neumayer
- Division of Vascular Surgery, Department of Surgery (S.K., C.N.), Medical University of Vienna, Austria
| | - Martin Bilban
- Core Facilities (M.B.), Medical University of Vienna, Austria
| | - Christian Hengstenberg
- Division of Cardiology, Department of Internal Medicine II (S.S., O.H., C.H., J.W., M.M.), Medical University of Vienna, Austria
| | - Kurt Huber
- Third Medical Department, Wilhelminenspital, and Sigmund Freud University, Medical Faculty, Vienna, Austria (K.H.)
| | - Gerard Pasterkamp
- Central Diagnostics Laboratory, Division Laboratories, Pharmacy, and Biomedical Genetics, University Medical Center Utrecht, Utrecht University, the Netherlands (S.W.v.d.L., G.P.)
| | - Johann Wojta
- Division of Cardiology, Department of Internal Medicine II (S.S., O.H., C.H., J.W., M.M.), Medical University of Vienna, Austria
- Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria (J.W.)
| | - Manuel Mayr
- King’s British Heart Foundation Centre, Kings College London, United Kingdom (K.T., M.H., F.B., J.B.B., L.E.S., S.Y., X.Y., S.B., B.S., J.P., M.M.)
- Division of Cardiology, Department of Internal Medicine II (S.S., O.H., C.H., J.W., M.M.), Medical University of Vienna, Austria
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Lempesis IG, Varrias D, Sagris M, Attaran RR, Altin ES, Bakoyiannis C, Palaiodimos L, Dalamaga M, Kokkinidis DG. Obesity and Peripheral Artery Disease: Current Evidence and Controversies. Curr Obes Rep 2023; 12:264-279. [PMID: 37243875 PMCID: PMC10220347 DOI: 10.1007/s13679-023-00510-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/09/2023] [Indexed: 05/29/2023]
Abstract
PURPOSE OF REVIEW Obesity is a significant public health problem and a major risk factor for the development and progression of atherosclerosis and its cardiovascular manifestations. Lower extremity peripheral artery disease (PAD) affects 3%-10% of the Western population and, if left untreated, can lead to devastating outcomes with both an increased risk of morbidity and mortality. Interestingly, the association between obesity and PAD remains debatable. Whereas it is well known that PAD and obesity frequently overlap in the same patients, many studies have demonstrated a negative association between obesity and PAD and a protective effect of obesity on disease development and progression, a phenomenon described as the "obesity paradox." Possible mechanisms for this paradox may include genetic background, as assessed by mendelian randomization studies, adipose tissue dysfunction, and body fat distribution rather than adiposity, while other factors, such as sex, ethnicity, sarcopenia in the elderly population, or aggressive treatment of co-existing metabolic conditions in individuals with obesity compared to those with normal weight, could have some impact as well. RECENT RINDINGS Few reviews and meta-analyses examining systematically the relationship between obesity and PAD exist. The impact of PAD development due to the presence of obesity remains largely controversial. However, the most current evidence, backed by a recent meta-analysis, suggests a potential protective role of a higher body mass index on PAD-related complications and mortality. In this review, we discuss the association between obesity and PAD development, progression, and management, and the potential pathophysiologic mechanisms linking the two diseases.
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Affiliation(s)
- Ioannis G Lempesis
- Department of Biologic Chemistry, School of Medicine, National and Kapodistrian, University of Athens, Mikras Asias 75, 115 27, Athens, Greece.
| | - Dimitrios Varrias
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Marios Sagris
- General Hospital of Nikaia, Piraeus, 184 54, Athens, Greece
| | - Robert R Attaran
- Section of Cardiovascular Medicine, Yale University/Yale New Haven Hospital, 06519, New Haven, CT, USA
| | - Elissa S Altin
- Section of Cardiovascular Medicine, Yale University/Yale New Haven Hospital, 06519, New Haven, CT, USA
| | - Christos Bakoyiannis
- Department of Surgery, Division of Vascular Surgery, Laikon General Hospital, National Kapodistrian University of Athens, 15772, Athens, Greece
| | - Leonidas Palaiodimos
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Maria Dalamaga
- Department of Biologic Chemistry, School of Medicine, National and Kapodistrian, University of Athens, Mikras Asias 75, 115 27, Athens, Greece
| | - Damianos G Kokkinidis
- Section of Cardiovascular Medicine, Yale University/Yale New Haven Hospital, 06519, New Haven, CT, USA
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4
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Characteristics of atherosclerosis in femoropopliteal artery and its clinical relevance. Atherosclerosis 2021; 335:31-40. [PMID: 34547588 DOI: 10.1016/j.atherosclerosis.2021.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/28/2021] [Accepted: 09/09/2021] [Indexed: 12/12/2022]
Abstract
Atherosclerosis is a systemic disease with different faces. Despite identical or similar pathogenetic mechanisms, atherosclerotic lesions and their clinical manifestations vary in different parts of the vascular system. Peripheral arterial disease (PAD) represents one of the most frequent clinical manifestations of atherosclerosis with predominant location in the superficial femoral artery (SFA). Morphological characteristics of atherosclerotic plaques in peripheral arteries differ from lesions in the coronary and carotid arteries. Plaques in SFA have more fibrotic components, less lipids and inflammatory cells, which makes them more stable and less prone to rupture. Factors that determine the different structure of plaques in SFA compared to coronary arteries include hemodynamic forces, vasa vasorum and calcification. Low shear stress in SFA in the adductor canal is one of the factors which determines frequent atherosclerotic lesions in this region. Lower lipid content and fewer inflammatory cells explain higher stability of SFA plaques. The specific structure of SFA plaques may require preventive and therapeutic measures, which to some extent differ from prevention of coronary atherosclerosis and may include inhibition of fibrotic proliferation in SFA plaques and calcification. Revascularization of PAD differs from procedures used in coronary arteries and requires specific technical expertise and devices.
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Galán-González J, Rico-Martín S, Calderón-García JF, Antón J, Ramírez-Moreno JM, Álvarez-Rodríguez LR, Sánchez Muñoz-Torrero JF. Location of recurrent cardiovascular events and anticardiolipin antibodies. Eur J Clin Invest 2021; 51:e13533. [PMID: 33666941 DOI: 10.1111/eci.13533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND The relationship between anticardiolipin (aCL) antibodies and cardiovascular events is uncertain and may vary according to arterial location. MATERIALS AND METHODS FRENA is an ongoing registry of stable outpatients with symptomatic coronary artery disease (CAD), cerebrovascular disease (CVD) or peripheral artery disease (PAD). The rate of subsequent ischaemic events was cross-referenced with the presence of aCL antibodies (any isotype, IgG or IgM). RESULTS As of June 2017, 1387 stable outpatients were recruited. Of these, 120 (8.7%) showed positive levels of aCL antibodies. Over an average follow-up of 18 months, 250 patients developed subsequent events: 101 myocardial infarction, 57 ischaemic stroke and 92 critical leg events. Patients with positive aCL antibodies had a higher risk of distal artery events (a composite of ischaemic stroke or critical leg events) than patients with undetectable or low levels (rate ratio: 1.66; 95% CI: 1.07-2.60). However, an association with central coronary events was not found. The multivariate Cox analysis after adjustment for relevant clinical covariates showed that positivity of aCL antibodies is an independent risk factor for distal events (hazard ratio: 1.60; 95% CI: 1.01-2.55; P < .05). CONCLUSIONS Positivity of aCL antibodies is associated with an increased risk of subsequent distal artery ischaemic events (cerebral or leg arteries) but not coronary artery events. Anticardiolipin antibodies appear to have a different relationship on the localisation of ischaemic events in patients with symptomatic artery disease.
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Affiliation(s)
| | - Sergio Rico-Martín
- Department of Nursing, Nursing and Occupational Therapy College, University of Extremadura, Cáceres, Spain
| | - Julián F Calderón-García
- Department of Nursing, Nursing and Occupational Therapy College, University of Extremadura, Cáceres, Spain
| | - Joaquín Antón
- Department of Internal Medicine, Hospital San Pedro Alcántara, Cáceres, Spain
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Sluiter TJ, van Buul JD, Huveneers S, Quax PHA, de Vries MR. Endothelial Barrier Function and Leukocyte Transmigration in Atherosclerosis. Biomedicines 2021; 9:328. [PMID: 33804952 PMCID: PMC8063931 DOI: 10.3390/biomedicines9040328] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/17/2021] [Accepted: 03/19/2021] [Indexed: 12/24/2022] Open
Abstract
The vascular endothelium is a highly specialized barrier that controls passage of fluids and migration of cells from the lumen into the vessel wall. Endothelial cells assist leukocytes to extravasate and despite the variety in the specific mechanisms utilized by different leukocytes to cross different vascular beds, there is a general principle of capture, rolling, slow rolling, arrest, crawling, and ultimately diapedesis via a paracellular or transcellular route. In atherosclerosis, the barrier function of the endothelium is impaired leading to uncontrolled leukocyte extravasation and vascular leakage. This is also observed in the neovessels that grow into the atherosclerotic plaque leading to intraplaque hemorrhage and plaque destabilization. This review focuses on the vascular endothelial barrier function and the interaction between endothelial cells and leukocytes during transmigration. We will discuss the role of endothelial dysfunction, transendothelial migration of leukocytes and plaque angiogenesis in atherosclerosis.
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Affiliation(s)
- Thijs J. Sluiter
- Department of Vascular Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (T.J.S.); (P.H.A.Q.)
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Jaap D. van Buul
- Sanquin Research and Landsteiner Laboratory, Leeuwenhoek Centre for Advanced Microscopy, Swammerdam Institute for Life Sciences, University of Amsterdam, 1066 CX Amsterdam, The Netherlands;
| | - Stephan Huveneers
- Department of Medical Biochemistry, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, Location AMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands;
| | - Paul H. A. Quax
- Department of Vascular Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (T.J.S.); (P.H.A.Q.)
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Margreet R. de Vries
- Department of Vascular Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (T.J.S.); (P.H.A.Q.)
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
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Zhu S, Wen C, Bai D, Gao M. Diagnostic efficacy of intravascular ultrasound combined with Gd 2O 3-EPL contrast agent for patients with atherosclerosis. Exp Ther Med 2020; 20:136. [PMID: 33082868 PMCID: PMC7557720 DOI: 10.3892/etm.2020.9265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 08/16/2019] [Indexed: 12/23/2022] Open
Abstract
Atherosclerosis is a cardiovascular disease that is pathologically associated with the growth of atherosclerotic plaques and vascular vulnerability. Intravascular ultrasound (IVUS) has been used to evaluate and treat cardiovascular diseases. Accumulating evidence has demonstrated that Gd2O3-doped nanoparticles contrast can be applied for the diagnosis of human diseases. In the present study, eplerenone (EPL), a mineralocorticoid receptor antagonist, was first doped with Gd2O3 nanoparticles (Gd2O3-EPL), following which its diagnostic efficacy for use in IVUS measurements (Gd2O3-EPL-IVUS) was evaluated for patients suspected with atherosclerosis. Gd2O3-EPL-IVUS presented with higher accuracy and sensitivity compared with IVUS in diagnosing 188 patients with suspected atherosclerosis. Gd2O3-EPL-IVUS exhibited stronger signals associated with plaque morphology compared with aloe IVUS for patients with atherosclerosis. In addition, Gd2O3-EPL-IVUS application resulted in clearer arterial plaque images compared with IVUS by binding mineralocorticoid receptors. Atherosclerosis was subsequently confirmed in all patients using computerized tomography-coronary angiography. Gd2O3-EPL-IVUS showed more accuracy in measuring vessel size, plaque burden and minimal lumen area compared with IVUS analysis alone. In conclusion, these outcomes suggest that Gd2O3-EPL-IVUS is a reliable tool for the evaluation of coronary lesions in patients with atherosclerosis.
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Affiliation(s)
- Shuangli Zhu
- Department of Ultrasonic Medicine, Beijing Royal Integrative Medicine Hospital, Beijing 102206, P.R. China
- Department of Ultrasonic Medicine, Peking University International Hospital, Beijing 102206, P.R. China
| | - Chaoyang Wen
- Department of Ultrasonic Medicine, Peking University International Hospital, Beijing 102206, P.R. China
| | - Dongxue Bai
- Department of Ultrasonic Medicine, Peking University International Hospital, Beijing 102206, P.R. China
| | - Meiying Gao
- Department of Ultrasonic Medicine, Peking University International Hospital, Beijing 102206, P.R. China
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Belkin N, Stoecker JB, Jackson BM, Damrauer SM, Glaser J, Kalapatapu V, Golden MA, Wang GJ. Effects of dual antiplatelet therapy on graft patency after lower extremity bypass. J Vasc Surg 2020; 73:930-939. [PMID: 32777321 DOI: 10.1016/j.jvs.2020.06.127] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 06/26/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Current guidelines recommend single-agent antiplatelet therapy for patients with symptomatic peripheral artery disease and consideration of dual antiplatelet therapy (DAPT) after surgical revascularization. The objective of this study was both to explore prescribing patterns of single antiplatelet therapy vs DAPT after lower extremity bypass surgery and to investigate the effects of antiplatelet therapy on bypass graft patency. METHODS A retrospective analysis of prospectively collected nonemergent infrainguinal lower extremity bypass operations entered in the national Vascular Quality Initiative (2003-2018) with captured long-term follow-up was performed. Patients discharged on aspirin monotherapy or DAPT were identified. Linear regression investigated temporal trends in antiplatelet use. Multivariable Cox regression investigated predictors of primary, primary assisted, and secondary patency. RESULTS Of the 13,020 patients investigated, 52.2% were discharged on aspirin monotherapy and 47.8% on DAPT. The proportion of patients discharged on DAPT increased from 10.6% in 2003 to 60.6% in 2018 (P < .001). The DAPT cohort was younger, had higher rates of medical (hypertension, diabetes, congestive heart failure, chronic obstructive pulmonary disease) and atherosclerotic (coronary artery disease, prior coronary artery bypass graft or percutaneous coronary intervention, prior lower extremity intervention) comorbidities, and had higher risk bypass procedures (more distal targets, prior inflow bypass procedure, prosthetic conduit use). Multivariable Cox regression analysis did not show any difference between the DAPT and aspirin cohorts in primary patency (hazard ratio [HR], 0.98; 95% confidence interval [CI], 0.88-1.10; P = .78), primary assisted patency (HR, 0.93; 95% CI, 0.80-1.07; P = .30), or secondary patency (HR, 0.88; 95% CI, 0.74-1.06; P = .18). On subgroup analysis based on bypass conduit, DAPT was found to have a protective effect on patency only in the prosthetic bypass cohort (primary patency: HR, 0.81 [95% CI, 0.66-1.00; P = .05]; primary assisted patency: HR, 0.74 [95% CI, 0.58-0.94; P = .01]; and secondary patency: HR, 0.60 [95% CI, 0.44-0.82; P < .001]). No patency differences were observed on adjusted subgroup analysis for the other bypass conduits. CONCLUSIONS A significant and increasing proportion of patients are discharged on DAPT after lower extremity bypass revascularization. These patients represent a higher risk cohort with more medical comorbidities and higher risk bypass features. After controlling for these differences, DAPT therapy had no beneficial effect on overall bypass graft patency or major adverse limb events. However, on subgroup analysis, DAPT was associated with improved bypass graft patency in patients receiving prosthetic bypass conduits. Further study is warranted to investigate optimal duration of DAPT therapy and its possible bleeding complications in prosthetic bypass patients.
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Affiliation(s)
- Nathan Belkin
- Division of Vascular Surgery and Endovascular Therapy, Hospital of the University of Pennsylvania, Philadelphia, Pa.
| | - Jordan B Stoecker
- Division of Vascular Surgery and Endovascular Therapy, Hospital of the University of Pennsylvania, Philadelphia, Pa
| | - Benjamin M Jackson
- Division of Vascular Surgery and Endovascular Therapy, Hospital of the University of Pennsylvania, Philadelphia, Pa
| | - Scott M Damrauer
- Division of Vascular Surgery and Endovascular Therapy, Hospital of the University of Pennsylvania, Philadelphia, Pa
| | - Julia Glaser
- Division of Vascular Surgery and Endovascular Therapy, Hospital of the University of Pennsylvania, Philadelphia, Pa
| | - Venkat Kalapatapu
- Division of Vascular Surgery and Endovascular Therapy, Hospital of the University of Pennsylvania, Philadelphia, Pa
| | - Michael A Golden
- Division of Vascular Surgery and Endovascular Therapy, Hospital of the University of Pennsylvania, Philadelphia, Pa
| | - Grace J Wang
- Division of Vascular Surgery and Endovascular Therapy, Hospital of the University of Pennsylvania, Philadelphia, Pa
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9
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Tsai S, Vega GL. Coronary and peripheral artery plaques: do differences in plaque characteristics translate to differences in lipid management? J Investig Med 2020; 68:1141-1151. [DOI: 10.1136/jim-2019-001252] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2020] [Indexed: 12/22/2022]
Abstract
Optimal medical management of patients with peripheral arterial disease (PAD) includes statin therapy, which has been shown to decrease the risk of major cardiovascular events. However, the relationship between low-density lipoprotein (LDL) lowering, PAD progression and limb outcomes remains controversial. Although prevention of coronary and cerebrovascular events is a priority, limb outcomes are still important determinants of quality of life and healthcare spending. This review will highlight differences between coronary artery disease (CAD) and PAD, and in particular, the more prevalent role of lipids and LDL cholesterol in CAD versus calcification in PAD. This difference may contribute to the differential impact of LDL cholesterol levels on coronary events and outcomes versus limb outcomes. Beyond LDL lowering, immune modulators have emerged as another agent to treat atherosclerosis in CAD, however similar data in PAD are lacking. Small studies have suggested that other lipids besides LDL cholesterol, such as triglycerides or small dense LDL, may have a greater impact on limb outcomes in patients with PAD. Although statin therapy is central in the management of patients with PAD, current understanding of the distinctions between PAD and CAD suggest that there may be other non-LDL targets for risk reduction that require further study.
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10
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Rothstein E, Aronow H, Hawkins BM, Young MN. Intravascular Imaging for Peripheral Vascular Disease and Endovascular Intervention. CURRENT CARDIOVASCULAR IMAGING REPORTS 2020. [DOI: 10.1007/s12410-020-9526-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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11
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Syed MBJ, Fletcher AJ, Forsythe RO, Kaczynski J, Newby DE, Dweck MR, van Beek EJR. Emerging techniques in atherosclerosis imaging. Br J Radiol 2019; 92:20180309. [PMID: 31502858 PMCID: PMC6849665 DOI: 10.1259/bjr.20180309] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 08/14/2019] [Accepted: 08/27/2019] [Indexed: 12/13/2022] Open
Abstract
Atherosclerosis is a chronic immunomodulated disease that affects multiple vascular beds and results in a significant worldwide disease burden. Conventional imaging modalities focus on the morphological features of atherosclerotic disease such as the degree of stenosis caused by a lesion. Modern CT, MR and positron emission tomography scanners have seen significant improvements in the rapidity of image acquisition and spatial resolution. This has increased the scope for the clinical application of these modalities. Multimodality imaging can improve cardiovascular risk prediction by informing on the constituency and metabolic processes within the vessel wall. Specific disease processes can be targeted using novel biological tracers and "smart" contrast agents. These approaches have the potential to inform clinicians of the metabolic state of atherosclerotic plaque. This review will provide an overview of current imaging techniques for the imaging of atherosclerosis and how various modalities can provide information that enhances the depiction of basic morphology.
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Affiliation(s)
- Maaz BJ Syed
- British Heart Foundation Centre of Cardiovascular Science
| | | | | | | | | | - Marc R Dweck
- British Heart Foundation Centre of Cardiovascular Science
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Beiswenger AC, Jo A, Harth K, Kumins NH, Shishehbor MH, Kashyap VS. A systematic review of the efficacy of aspirin monotherapy versus other antiplatelet therapy regimens in peripheral arterial disease. J Vasc Surg 2018; 67:1922-1932.e6. [DOI: 10.1016/j.jvs.2018.02.047] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 02/27/2018] [Indexed: 10/16/2022]
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