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Ahn J, Lee YS, Lee W, Jeong B, Choi EK, Shin DG, Han SJ, Lim HE. Randomized Comparison of Progression of Atherosclerotic Plaques and Calcification of Coronary Artery in Atrial Fibrillation Patients Treated With Edoxaban Versus Warfarin (The REPRESENT-AF trial). Am J Cardiol 2024; 229:56-62. [PMID: 39122204 DOI: 10.1016/j.amjcard.2024.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 07/14/2024] [Accepted: 08/02/2024] [Indexed: 08/12/2024]
Abstract
Although the adverse effects of long-term use of vitamin K oral anticoagulant (OAC), warfarin, on the coronary vasculature are well-established, it remains unknown whether nonvitamin K oral anticoagulants play a role in the attenuation of plaque progression and coronary calcification. This study aimed to compare the changes in atherosclerotic plaques and calcification of the coronary arteries in patients with atrial fibrillation (AF) treated with edoxaban and warfarin. A total of 150 OAC-naïve patients with AF and atherosclerotic lesions on coronary computed tomography angiography (CCTA) were enrolled and randomly assigned to the edoxaban or warfarin treatment groups. All enrolled patients received rosuvastatin 10 mg and 119 patients completed the entire study protocol. A total of 12 months after the assigned OAC treatment, follow-up CCTA was performed and changes in plaque and calcium volumes of the coronary arteries were analyzed. The baseline characteristics of the 2 groups were well-balanced. The percentage of time in therapeutic range in the warfarin group was 61.1%. Compared with the baseline CCTA, there was a significant reduction in plaque volume after 12 months of OAC and rosuvastatin administration in both groups, and the extent of regression did not differ significantly between the groups. The increase in calcium volume was greater in the warfarin group than in the edoxaban group; however, the difference was not significant. In OAC-naïve patients with AF and atherosclerotic coronary lesions who were treated with moderate-intensity statin, edoxaban use did not have a positive effect on atherosclerotic plaques and coronary calcification compared with warfarin use over a 12-month follow-up period.
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Affiliation(s)
- Jinhee Ahn
- Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea; Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Yoon Seong Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Whal Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - BaRen Jeong
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eue-Keun Choi
- Division of Cardiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dong Geum Shin
- Division of Cardiology, Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea
| | - Sang-Jin Han
- Division of Cardiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang-si, Republic of Korea
| | - Hong Euy Lim
- Division of Cardiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang-si, Republic of Korea; Division of Cardiology, Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong-si, Gyeonggi-do, Republic of Korea.
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Szulc P, Lewis JR, Chapurlat R. Accelerated Bone Loss in Older Men With Severe Abdominal Aortic Calcification-the Prospective MINOS Study. J Clin Endocrinol Metab 2023; 109:e32-e39. [PMID: 37610245 DOI: 10.1210/clinem/dgad459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 06/30/2023] [Accepted: 08/07/2023] [Indexed: 08/24/2023]
Abstract
CONTEXT Data on the association between the severity of abdominal aortic calcification (AAC) and bone loss are discordant. OBJECTIVE Our aim was to assess the association between baseline AAC and prospectively assessed bone loss in older men. METHODS This prospective cohort study started in 1995 (MINOS). Men aged 50 to 85 years (n = 778) had AAC assessed on the lateral radiograph of the spine using Kauppila's semiquantitative score and was followed prospectively for 7.5 years. Bone mineral density (BMD) and bone mineral content (BMC) were measured by dual-energy x-ray absorptiometry every 18 months. Statistical analysis was performed using linear mixed models. RESULTS In comparison to men without AAC (AAC = 0), severe AAC (>6) was associated with more rapid bone loss at the total hip (-0.62 ± 0.06 vs -0.32 ± 0.04%/year; P < .001), trochanter, and distal forearm (-0.72 ± 0.06 vs -0.45 ± 0.03%/year; P < .001). The highest decile (AAC >10) was associated with more rapid bone loss at the femoral neck, whole body, and ultradistal radius (-0.86 ± 0.12 vs -0.34 ± 0.05%/year; P < .001). The results were similar for BMD and for BMC. The patterns were similar in sensitivity analyses (eg, after excluding men with abdominal obesity, after excluding current smokers, after excluding men with ischemic heart disease or with diabetes mellitus, after excluding men with abnormal concentrations of lipids, bioavailable 17β-estradiol or 25-hydroxycholecalciferol, after excluding men with glomerular filtration rate <60 mL/min). CONCLUSION Severe AAC is associated with faster bone loss in older men and may contribute to the higher fracture risk observed in this population.
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Affiliation(s)
- Pawel Szulc
- INSERM UMR 1033, University of Lyon, Hospices Civils de Lyon, 69437, Lyon, France
| | - Joshua R Lewis
- Institute for Nutrition Research, Edith Cowan University, Joondalup, Perth, WA 6027, Australia
- Medical School, the University of Western Australia, Perth, WA 6009, Australia
| | - Roland Chapurlat
- INSERM UMR 1033, University of Lyon, Hospices Civils de Lyon, 69437, Lyon, France
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Pampori A, Shekhar S, Kapadia SR. Implications of Renal Disease in Patients Undergoing Structural Interventions. Interv Cardiol Clin 2023; 12:539-554. [PMID: 37673498 DOI: 10.1016/j.iccl.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Percutaneous structural interventions have a major impact on the morbidity, mortality, and quality of life of patients by providing a lower-risk alternative to cardiac surgery. However, renal disease has a significant impact on outcomes of these interventions. This review explores the incidence, outcomes, pathophysiology, and preventative measures of acute kidney injury and chronic kidney disease on transcatheter aortic valve replacement, transcatheter mitral valve repair, and percutaneous balloon mitral valvuloplasty. Given the expanding indications for percutaneous structural interventions, further research is needed to identify ideal patients with chronic kidney disease or end-stage renal disease who would benefit from intervention.
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Affiliation(s)
- Adam Pampori
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA
| | - Shashank Shekhar
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA.
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O'Neill WC. Targeting Vascular Calcification in CKD: Time to Redraw the Map. KIDNEY360 2023; 4:e838-e840. [PMID: 37143190 PMCID: PMC10371366 DOI: 10.34067/kid.0000000000000137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 03/27/2023] [Indexed: 05/06/2023]
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O'Neill WC. Should vitamin K antagonists ever be used in ESRD? Semin Dial 2023; 36:83-85. [PMID: 36525969 DOI: 10.1111/sdi.13134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/09/2022] [Accepted: 11/27/2022] [Indexed: 12/23/2022]
Affiliation(s)
- W Charles O'Neill
- Renal Division, Emory University School of Medicine, Atlanta, Georgia, USA
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Kim TI, Guzman RJ. Medial artery calcification in peripheral artery disease. Front Cardiovasc Med 2023; 10:1093355. [PMID: 36776265 PMCID: PMC9909396 DOI: 10.3389/fcvm.2023.1093355] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/13/2023] [Indexed: 01/28/2023] Open
Abstract
Medial artery calcification (MAC) is a distinct, highly regulated process that is often identified in small and mid-sized arteries of the lower extremities. It is associated with advanced age, diabetes, and chronic kidney disease. MAC often occurs in conjunction with atherosclerotic occlusive disease in lower extremity arteries, and when seen together or in isolation, long-term limb outcomes are negatively affected. In patients with peripheral artery disease (PAD), the extent of MAC independently correlates with major amputation and mortality rates, and it predicts poor outcomes after endovascular interventions. It is associated with increased arterial stiffness and decreased pedal perfusion. New endovascular methods aimed at treating calcified lower-extremity lesions may improve our ability to treat patients with limb-threatening ischemia. Although recent developments have increased our understanding of the mechanisms contributing to MAC, further investigations are needed to understand the role of medial calcification in PAD, and to develop strategies aimed at improving patient outcomes.
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Affiliation(s)
- Tanner I. Kim
- Deparment of Surgery, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, United States
- The Queen’s Health Systems, Honolulu, HI, United States
| | - Raul J. Guzman
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT, United States
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Kida Y, Yamaguchi I. The vascular protective effect of matrix Gla protein during kidney injury. FRONTIERS IN MOLECULAR MEDICINE 2022; 2:970744. [PMID: 39086959 PMCID: PMC11285670 DOI: 10.3389/fmmed.2022.970744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 10/13/2022] [Indexed: 08/02/2024]
Abstract
Matrix Gla protein (MGP) is a small secreted protein and requires vitamin K dependent γ-carboxylation for its function. MGP has been identified as a local inhibitor of vascular calcification because MGP-deficient mice die due to severe arterial calcification and resulting arterial rupture. Clinical trials revealed that reduction in active MGP predicts poor prognosis in patients due to cardiovascular complications. However, recent studies showed that MGP controls angiogenesis during development. MGP-deficient mice demonstrated abnormal hypervascularization and arteriovenous malformations in kidneys and other organs. This abnormal angiogenesis is largely caused by excessive expression of vascular endothelial growth factor-A (VEGF-A) and VEGF receptor-2 (VEGFR2). However, only a few studies have investigated the roles of MGP in tissue injury. We observed mesangial cell proliferation and mild interstitial fibrosis in addition to increased capillaries in kidneys of MGP-null mice even without injury. We also created a mouse model with kidney injury and found that kidney damage greatly increases MGP expression in peritubular capillary endothelial cells and tubular epithelial cells. Finally, our study showed that impairment of MGP expression aggravates peritubular capillary rarefaction and accumulation of collagen-producing myofibroblasts following kidney injury. Peritubular capillary damage induces capillary loss as well as trans-differentiation of vascular pericytes into myofibroblasts. These results indicate that MGP has the vascular protective effect in the injured kidney. Clinical trials have already started to test the efficacy of MGP activation to repair vascular calcification in patients with chronic kidney diseases. In this "Hypothesis and Theory" article, we discuss possible mechanisms by which MGP protects against vascular damage during tissue injury based on our experimental results and previous results from other research groups.
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Affiliation(s)
- Yujiro Kida
- Center for Tissue and Cell Sciences, Seattle Children’s Research Institute, Seattle, WA, United States
- Department of Nephrology, Takashimadaira Chūō General Hospital, Tokyo, Japan
| | - Ikuyo Yamaguchi
- Center for Tissue and Cell Sciences, Seattle Children’s Research Institute, Seattle, WA, United States
- Division of Pediatric Nephrology and Hypertension, Department of Pediatrics, The University of Oklahoma Health Sciences Center, Oklahoma Children’s Hospital, OU Health, Oklahoma City, OK, United States
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Kosciuszek ND, Kalta D, Singh M, Savinova OV. Vitamin K antagonists and cardiovascular calcification: A systematic review and meta-analysis. Front Cardiovasc Med 2022; 9:938567. [PMID: 36061545 PMCID: PMC9437425 DOI: 10.3389/fcvm.2022.938567] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 07/22/2022] [Indexed: 12/02/2022] Open
Abstract
Background Many patients treated with Vitamin K antagonists (VKA) for anticoagulation have concomitant vascular or valvular calcification. This meta-analysis aimed to evaluate a hypothesis that vascular and valvular calcification is a side-effect of VKA treatment. Methods We conducted a systematic literature search to identify studies that reported vascular or valvular calcification in patients treated with VKA. The associations between VKA use and calcification were analyzed with random-effects inverse variance models and reported as odds ratios (OR) and 95% confidence intervals (95% CI). In addition, univariate meta-regression analyses were utilized to identify any effect moderators. Results Thirty-five studies were included (45,757 patients; 6,251 VKA users). The median follow-up was 2.3 years [interquartile range (IQR) of 1.2–4.0]; age 66.2 ± 3.6 years (mean ± SD); the majority of participants were males [77% (IQR: 72–95%)]. VKA use was associated with an increased OR for coronary artery calcification [1.21 (1.08, 1.36), p = 0.001], moderated by the duration of treatment [meta-regression coefficient B of 0.08 (0.03, 0.13), p = 0.0005]. Extra-coronary calcification affecting the aorta, carotid artery, breast artery, and arteries of lower extremities, was also increased in VKA treated patients [1.86 (1.43, 2.42), p < 0.00001] and moderated by the author-reported statistical adjustments of the effect estimates [B: −0.63 (−1.19, −0.08), p = 0.016]. The effect of VKA on the aortic valve calcification was significant [3.07 (1.90, 4.96), p < 0.00001]; however, these studies suffered from a high risk of publication bias. Conclusion Vascular and valvular calcification are potential side effects of VKA. The clinical significance of these side effects on cardiovascular outcomes deserves further investigation.
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Affiliation(s)
- Nina D. Kosciuszek
- New York Institute of Technology, College of Osteopathic Medicine, Academic Medicine Scholar Program, OldWestbury, NY, United States
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, United States
| | - Daniel Kalta
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, United States
| | - Mohnish Singh
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, United States
| | - Olga V. Savinova
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, United States
- *Correspondence: Olga V. Savinova
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Sousa M, Cruz G, Vilela S, Cardoso C, Bravo P, Santos JP, Santos C, Silva J. Hemorrhagic Versus Ischemic Risk in Patients with Atrial Fibrillation on Hemodialysis. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2022. [DOI: 10.36660/ijcs.20210252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Abstract
Uremic calciphylaxis is a rare disease that affects patients with chronic end-stage renal disease. It is a pathology of the microvessels of the dermis and hypodermis which are calcified and whose thrombosis leads to skin necrosis. Calciphylaxis lesions can be distal and axial. They lead to pain, infection and are associated with denutrition and in high mortality rate (40-80% at 1 year). This general review describes the clinical and para-clinical presentations of calciphylaxis. It summarizes the current knowledge on its pathogenesis and the therapeutical options that can be proposed to improve the management and attempt to reduce the mortality of patients with uremic calciphylaxis.
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Liu X, Feng S, Chen Z, Zhou Y, Yin K, Xue Z, Zhu W. Is the Risk of Diabetes Lower in Patients With Atrial Fibrillation Treated With Direct Oral Anticoagulant Compared to Warfarin? Front Cardiovasc Med 2022; 9:874795. [PMID: 35665262 PMCID: PMC9160370 DOI: 10.3389/fcvm.2022.874795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe use of anticoagulants is an established strategy to prevent stroke, embolism, and cardiovascular mortality in patients with atrial fibrillation (AF), but its role in the prevention of incident diabetes is unclear. We aimed to investigate this question by using participant data from cohort studies.MethodsWe conducted a meta-analysis of participants to investigate the impact of direct oral anticoagulants (DOACs) on the risk of new-onset diabetes in AF patients. The collection of related data was performed in the PubMed and EMBASE databases until December 2021, including studies associated with evaluating the correlation between DOACs and incident diabetes. The hazard ratios (HRs) and 95% confidence intervals (CIs) were adjusted by the random-effects model with an inverse variance method.ResultsTwo cohort studies with a total of 24,434 patients were included in this study (warfarin: n = 6,906; DOACs: n = 17,528). Compared with warfarin, the use of DOACs could reduce the incident diabetic risk in AF patients (HR = 0.75, 95%CI: 0.68–0.82). Investigations about the effects of three major classes of DOACs showed that the individual use of dabigatran (HR = 0.76, 95%CI: 0.64–0.90), rivaroxaban (HR = 0.74, 95%CI: 0.64–0.87), apixaban (HR = 0.74, 95%CI: 0.60–0.92) and the combined use of rivaroxaban and apixaban (HR = 0.74, 95%CI: 0.66–0.84) could reduce the risk of new-onset diabetes compared with warfarin. This risk reduction effect could be observed in both male and female groups (HR = 0.73, 95%CI: 0.64–0.84, P < 0.00001; HR = 0.82, 95%CI: 0.82–0.99, P = 0.04).ConclusionsTreatment with DOACs compared with warfarin reduced the risk of new-onset diabetes in both male and female patients with AF.
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Affiliation(s)
- Xuyang Liu
- Department of Cardiology, Jinggangshan University, Ji’an, China
| | - Shenghui Feng
- Queen Mary School, Medical Department, Nanchang University, Nanchang, China
| | - Zhuohui Chen
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yue Zhou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Kang Yin
- Department of Critical Care Medicine, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
- *Correspondence: Kang Yin,
| | - Zhengbiao Xue
- Department of Critical Care Medicine, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
- Zhengbiao Xue,
| | - Wengen Zhu
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Wengen Zhu, ;
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Bezabhe WM, Bereznicki LR, Radford J, Wimmer BC, Salahudeen MS, Bindoff I, Peterson GM. Comparing the renal outcomes in patients with atrial fibrillation receiving different oral anticoagulants. Expert Rev Clin Pharmacol 2022; 15:359-364. [PMID: 35452586 DOI: 10.1080/17512433.2022.2070151] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND We aimed to compare renal function changes in patients with atrial fibrillation (AF) prescribed different oral anticoagulants (OACs). RESEARCH DESIGN AND METHODS We performed a retrospective analysis of Australian national primary care data. A total of 12,562 patients with AF and initiated OAC between 1 Jan 2013 and 31 Dec 2017 were included. Inverse probability of treatment weighting was used for balancing baseline characteristics and the risks of decline in estimated glomerular filtration rate (eGFR) in patients prescribed each OAC were compared using Cox proportional hazards regression model. RESULTS Compared with warfarin, prescribing of direct-acting oral anticoagulants (DOACs) was associated with a lower risk of renal function decline per 1000 person-years: hazard ratio (HR) 0.75, 95% confidence interval (CI) 0.68-0.81, p<0.001 for ≥30% decline in eGFR; HR 0.28, 95% CI 0.20-0.41, p<0.001 for eGFR decline to ≤30 mL/min/1.73m2; and HR 0.45, 95% CI 0.35-0.58, p<0.001 for serum creatinine doubling. Compared with dabigatran, rivaroxaban use had a significantly lowered risk of decline in eGFR to ≤30 mL/min/1.73m2 (HR 0.29, 95% CI 0.13-0.66, p=0.003) and risk of doubling of serum creatinine (HR 0.62, 95% CI 0.40-0.95, p=0.030). CONCLUSIONS The risk of renal function decline appeared to be lower in patients prescribed DOACs versus warfarin.
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Affiliation(s)
- Woldesellassie M Bezabhe
- School of Pharmacy and Pharmacology, University of Tasmania, Private Bag 26, Hobart, Tasmania 7001, Australia
| | - Luke R Bereznicki
- School of Pharmacy and Pharmacology, University of Tasmania, Private Bag 26, Hobart, Tasmania 7001, Australia
| | - Jan Radford
- Launceston Clinical School, Tasmanian School of Medicine, University of Tasmania, 41 Frankland St, Launceston, Tasmania 7250, Australia
| | - Barbara C Wimmer
- School of Pharmacy and Pharmacology, University of Tasmania, Private Bag 26, Hobart, Tasmania 7001, Australia
| | - Mohammed S Salahudeen
- School of Pharmacy and Pharmacology, University of Tasmania, Private Bag 26, Hobart, Tasmania 7001, Australia
| | - Ivan Bindoff
- School of Pharmacy and Pharmacology, University of Tasmania, Private Bag 26, Hobart, Tasmania 7001, Australia
| | - Gregory M Peterson
- School of Pharmacy and Pharmacology, University of Tasmania, Private Bag 26, Hobart, Tasmania 7001, Australia
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Therapy of Pseudoxanthoma Elasticum: Current Knowledge and Future Perspectives. Biomedicines 2021; 9:biomedicines9121895. [PMID: 34944710 PMCID: PMC8698611 DOI: 10.3390/biomedicines9121895] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/05/2021] [Accepted: 12/07/2021] [Indexed: 12/24/2022] Open
Abstract
Pseudoxanthoma elasticum (PXE) is a rare, genetic, metabolic disease with an estimated prevalence of between 1 per 25,000 and 56,000. Its main hallmarks are characteristic skin lesions, development of choroidal neovascularization, and early-onset arterial calcification accompanied by a severe reduction in quality-of-life. Underlying the pathology are recessively transmitted pathogenic variants of the ABCC6 gene, which results in a deficiency of ABCC6 protein. This results in reduced levels of peripheral pyrophosphate, a strong inhibitor of peripheral calcification, but also dysregulation of blood lipids. Although various treatment options have emerged during the last 20 years, many are either already outdated or not yet ready to be applied generally. Clinical physicians often are left stranded while patients suffer from the consequences of outdated therapies, or feel unrecognized by their attending doctors who may feel uncertain about using new therapeutic approaches or not even know about them. In this review, we summarize the broad spectrum of treatment options for PXE, focusing on currently available clinical options, the latest research and development, and future perspectives.
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Aksoy A, Al Zaidi M, Repges E, Becher MU, Müller C, Oldenburg J, Zimmer S, Nickenig G, Tiyerili V. Vitamin K Epoxide Reductase Complex Subunit 1-Like 1 (VKORC1L1) Inhibition Induces a Proliferative and Pro-inflammatory Vascular Smooth Muscle Cell Phenotype. Front Cardiovasc Med 2021; 8:708946. [PMID: 34778390 PMCID: PMC8578699 DOI: 10.3389/fcvm.2021.708946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 10/05/2021] [Indexed: 01/07/2023] Open
Abstract
Background: Vitamin K antagonists (VKA) are known to promote adverse cardiovascular remodeling. Contrarily, vitamin K supplementation has been discussed to decelerate cardiovascular disease. The recently described VKOR-isoenzyme Vitamin K epoxide reductase complex subunit 1-like 1 (VKORC1L1) is involved in vitamin K maintenance and exerts antioxidant properties. In this study, we sought to investigate the role of VKORC1L1 in neointima formation and on vascular smooth muscle cell (VSMC) function. Methods and Results: Treatment of wild-type mice with Warfarin, a well-known VKA, increased maladaptive neointima formation after carotid artery injury. This was accompanied by reduced vascular mRNA expression of VKORC1L1. In vitro, Warfarin was found to reduce VKORC1L1 mRNA expression in VSMC. VKORC1L1-downregulation by siRNA promoted viability, migration and formation of reactive oxygen species. VKORC1L1 knockdown further increased expression of key markers of vascular inflammation (NFκB, IL-6). Additionally, downregulation of the endoplasmic reticulum (ER) membrane resident VKORC1L1 increased expression of the main ER Stress moderator, glucose-regulated protein 78 kDa (GRP78). Moreover, treatment with the ER Stress inducer tunicamycin promoted VKORC1L1, but not VKORC1 expression. Finally, we sought to investigate, if treatment with vitamin K can exert protective properties on VSMC. Thus, we examined effects of menaquinone-7 (MK7) on VSMC phenotype switch. MK7 treatment dose-dependently alleviated PDGF-induced proliferation and migration. In addition, we detected a reduction in expression of inflammatory and ER Stress markers. Conclusion: VKA treatment promotes neointima formation after carotid wire injury. In addition, VKA treatment reduces aortal VKORC1L1 mRNA expression. VKORC1L1 inhibition contributes to an adverse VSMC phenotype, while MK7 restores VSMC function. Thus, MK7 supplementation might be a feasible therapeutic option to modulate vitamin K- and VKORC1L1-mediated vasculoprotection.
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Affiliation(s)
- Adem Aksoy
- Department of Cardiology, Heart Centre, University of Bonn, Bonn, Germany
| | - Muntadher Al Zaidi
- Department of Cardiology, Heart Centre, University of Bonn, Bonn, Germany
| | - Elena Repges
- Department of Cardiology, Heart Centre, University of Bonn, Bonn, Germany
| | - Marc Ulrich Becher
- Department of Cardiology, Heart Centre, University of Bonn, Bonn, Germany
| | - Cornelius Müller
- Department of Cardiology, Heart Centre, University of Bonn, Bonn, Germany
| | - Johannes Oldenburg
- Institute of Experimental Haematology and Transfusion Medicine, University of Bonn, Bonn, Germany
| | - Sebastian Zimmer
- Department of Cardiology, Heart Centre, University of Bonn, Bonn, Germany
| | - Georg Nickenig
- Department of Cardiology, Heart Centre, University of Bonn, Bonn, Germany
| | - Vedat Tiyerili
- Department of Cardiology, Heart Centre, University of Bonn, Bonn, Germany
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Endothelial Contribution to Warfarin-Induced Arterial Media Calcification in Mice. Int J Mol Sci 2021; 22:ijms222111615. [PMID: 34769044 PMCID: PMC8583869 DOI: 10.3390/ijms222111615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 10/22/2021] [Accepted: 10/25/2021] [Indexed: 12/12/2022] Open
Abstract
Arterial media calcification (AMC) is predominantly regulated by vascular smooth muscle cells (VSMCs), which transdifferentiate into pro-calcifying cells. In contrast, there is little evidence for endothelial cells playing a role in the disease. The current study investigates cellular functioning and molecular pathways underlying AMC, respectively by, an ex vivo isometric organ bath set-up to explore the interaction between VSMCs and ECs and quantitative proteomics followed by functional pathway interpretation. AMC development, which was induced in mice by dietary warfarin administration, was proved by positive Von Kossa staining and a significantly increased calcium content in the aorta compared to that of control mice. The ex vivo organ bath set-up showed calcified aortic segments to be significantly more sensitive to phenylephrine induced contraction, compared to control segments. This, together with the fact that calcified segments as compared to control segments, showed a significantly smaller contraction in the absence of extracellular calcium, argues for a reduced basal NO production in the calcified segments. Moreover, proteomic data revealed a reduced eNOS activation to be part of the vascular calcification process. In summary, this study identifies a poor endothelial function, next to classic pro-calcifying stimuli, as a possible initiator of arterial calcification.
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Guo X, O'Neill WC, Vey B, Yang TC, Kim TJ, Ghassemi M, Pan I, Gichoya JW, Trivedi H, Banerjee I. SCU-Net: A deep learning method for segmentation and quantification of breast arterial calcifications on mammograms. Med Phys 2021; 48:5851-5861. [PMID: 34328661 DOI: 10.1002/mp.15017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 04/27/2021] [Accepted: 05/21/2021] [Indexed: 11/11/2022] Open
Abstract
PURPOSE Measurements of breast arterial calcifications (BAC) can offer a personalized, non-invasive approach to risk-stratify women for cardiovascular diseases such as heart attack and stroke. We aim to detect and segment breast arterial calcifications in mammograms accurately and suggest novel measurements to quantify detected BAC for future clinical applications. METHODS To separate BAC in mammograms, we propose a lightweight fine vessel segmentation method Simple Context U-Net (SCU-Net). Due to the large image size of mammograms, we adopt a patch-based way to train SCU-Net and obtain the final whole-image-size results by stitching patchwise results together. To further quantify calcifications, we test five quantitative metrics to inspect the progression of BAC for subjects: sum of mask probability metric ( P M ), sum of mask area metric ( A M ), sum of mask intensity metric ( S I M ), sum of mask area with threshold intensity metric T A M X , and sum of mask intensity with threshold X metric T S I M X . Finally, we demonstrate the ability of the metrics to longitudinally measure calcifications in a group of 26 subjects and evaluate our quantification metrics compared with calcified voxels and calcium mass on breast CT for 10 subjects. RESULTS Our segmentation results are compared with state-of-the-art network architectures based on recall, precision, accuracy, F1 score/Dice score, and Jaccard index evaluation metrics and achieve corresponding values of 0.789, 0.708, 0.997, 0.729, and 0.581 for whole-image-size results. The quantification results all show >95% correlation between quantification measures on predicted masks of SCU-Net as compared to the groundtruth and measurement of calcification on breast CT. For the calcification quantification measurement, our calcification volume (voxels) results yield R2 -correlation values of 0.834, 0.843, 0.832, 0.798, and 0.800 for the P M , A M , S I M , T A M 100 , T S I M 100 metrics, respectively; our calcium mass results yield comparable R2 -correlation values of 0.866, 0.873, 0.840, 0.774, and 0.798 for the same metrics. CONCLUSIONS Simple Context U-Net is a simple method to accurately segment arterial calcification retrospectively on routine mammograms. Quantification of the calcifications based on this segmentation in the retrospective cohort study has sufficient sensitivity to detect the normal progression over time and should be useful for future research and clinical applications.
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Affiliation(s)
- Xiaoyuan Guo
- Department of Computer Science, Emory University, Decatur, Georgia, USA
| | | | - Brianna Vey
- Department of Radiology and Imaging Sciences, Emory University, Decatur, Georgia, USA
| | | | - Thomas J Kim
- College of Computing, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Maryzeh Ghassemi
- Department of Computer Science/Medicine, Toronto University, Toronto, Canada
| | - Ian Pan
- Department of Internal Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Judy Wawira Gichoya
- Department of Radiology and Imaging Sciences, Emory University, Decatur, Georgia, USA.,Department of Biomedical Informatics, Emory University, Decatur, Georgia, USA
| | - Hari Trivedi
- Department of Radiology and Imaging Sciences, Emory University, Decatur, Georgia, USA.,Department of Biomedical Informatics, Emory University, Decatur, Georgia, USA
| | - Imon Banerjee
- Department of Radiology and Imaging Sciences, Emory University, Decatur, Georgia, USA.,Department of Biomedical Informatics, Emory University, Decatur, Georgia, USA
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Szulc P, Planckaert C, Foesser D, Patsch J, Chapurlat R. High Cardiovascular Risk in Older Men With Severe Peripheral Artery Calcification on High-Resolution Peripheral QCT Scans: The STRAMBO Study. Arterioscler Thromb Vasc Biol 2021; 41:1818-1829. [PMID: 33792348 DOI: 10.1161/atvbaha.120.315289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Pawel Szulc
- INSERM UMR 1033, University of Lyon, Hôpital Edouard Herriot, France (P.S., C.P., D.F., R.C.)
| | - Catherine Planckaert
- INSERM UMR 1033, University of Lyon, Hôpital Edouard Herriot, France (P.S., C.P., D.F., R.C.)
| | - Dominique Foesser
- INSERM UMR 1033, University of Lyon, Hôpital Edouard Herriot, France (P.S., C.P., D.F., R.C.)
| | - Janina Patsch
- Division of General and Paediatric Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Austria (J.P.)
| | - Roland Chapurlat
- INSERM UMR 1033, University of Lyon, Hôpital Edouard Herriot, France (P.S., C.P., D.F., R.C.)
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18
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van Gorp RH, Dijkgraaf I, Bröker V, Bauwens M, Leenders P, Jennen D, Dweck MR, Bucerius J, Briedé JJ, van Ryn J, Brandenburg V, Mottaghy F, Spronk HMH, Reutelingsperger CP, Schurgers LJ. Off-target effects of oral anticoagulants - vascular effects of vitamin K antagonist and non-vitamin K antagonist oral anticoagulant dabigatran etexilate. J Thromb Haemost 2021; 19:1348-1363. [PMID: 33687782 PMCID: PMC8252511 DOI: 10.1111/jth.15289] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Vitamin K antagonists (VKA) and non-vitamin K oral antagonist anticoagulants (NOAC) are used in the clinic to reduce risk of thrombosis. However, they also exhibit vascular off-target effects. The aim of this study is to compare VKA and NOAC on atherosclerosis progression and calcification in an experimental setup. MATERIAL AND METHODS Female Apoe-/- mice (age 12 weeks) were fed Western-type diet as control or supplemented with dabigatran etexilate or warfarin for 6 or 18 weeks. Vascular calcification was measured in whole aortic arches using µCT and [18 F]-NaF. Atherosclerotic burden was assessed by (immuno)histochemistry. Additionally, in vitro effects of warfarin, thrombin, and dabigatran on primary vascular smooth muscle cells (VSMC) were assessed. RESULTS Short-term treatment with warfarin promoted formation of atherosclerotic lesions with a pro-inflammatory phenotype, and more rapid plaque progression compared with control and dabigatran. In contrast, dabigatran significantly reduced plaque progression compared with control. Long-term warfarin treatment significantly increased both presence and activity of plaque calcification compared with control and dabigatran. Calcification induced by warfarin treatment was accompanied by increased presence of uncarboxylated matrix Gla protein. In vitro, both warfarin and thrombin significantly increased VSMC oxidative stress and extracellular vesicle release, which was prevented by dabigatran. CONCLUSION Warfarin aggravates atherosclerotic disease activity, increasing plaque inflammation, active calcification, and plaque progression. Dabigatran lacks undesired vascular side effects and reveals beneficial effects on atherosclerosis progression and calcification. The choice of anticoagulation impacts atherosclerotic disease by differential off target effect. Future clinical studies should test whether this beneficial effect also applies to patients.
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Affiliation(s)
- Rick H. van Gorp
- Department of BiochemistryCardiovascular Research Institute MaastrichtMaastricht UniversityMaastrichtThe Netherlands
- Nattopharma ASAOsloNorway
| | - Ingrid Dijkgraaf
- Department of BiochemistryCardiovascular Research Institute MaastrichtMaastricht UniversityMaastrichtThe Netherlands
| | - Vanessa Bröker
- Department of BiochemistryCardiovascular Research Institute MaastrichtMaastricht UniversityMaastrichtThe Netherlands
| | - Matthias Bauwens
- Department of Radiology and Nuclear MedicineMaastricht University Medical Center (MUMC+)MaastrichtThe Netherlands
| | - Peter Leenders
- Department of BiochemistryCardiovascular Research Institute MaastrichtMaastricht UniversityMaastrichtThe Netherlands
| | - Danyel Jennen
- Department of ToxicogenomicsGROW School of Oncology and Developmental BiologyMaastricht UniversityMaastrichtThe Netherlands
| | - Marc R. Dweck
- Centre for Cardiovascular ScienceUniversity of EdinburghEdinburghUK
| | - Jan Bucerius
- Department of Radiology and Nuclear MedicineMaastricht University Medical Center (MUMC+)MaastrichtThe Netherlands
| | - Jacco J. Briedé
- Department of ToxicogenomicsGROW School of Oncology and Developmental BiologyMaastricht UniversityMaastrichtThe Netherlands
| | - Joanne van Ryn
- Department of Cardiometabolic ResearchBoehringer IngelheimBiberachGermany
| | - Vincent Brandenburg
- Klinik Für Kardiologie und NephrologieRhein‐Maas Klinikum WürselenWürselenGermany
| | - Felix Mottaghy
- Department of Radiology and Nuclear MedicineMaastricht University Medical Center (MUMC+)MaastrichtThe Netherlands
- Department of Nuclear MedicineUniversity Hospital RWTH Aachen UniversityAachenGermany
| | - Henri M. H. Spronk
- Department of BiochemistryCardiovascular Research Institute MaastrichtMaastricht UniversityMaastrichtThe Netherlands
| | - Chris P. Reutelingsperger
- Department of BiochemistryCardiovascular Research Institute MaastrichtMaastricht UniversityMaastrichtThe Netherlands
| | - Leon J. Schurgers
- Department of BiochemistryCardiovascular Research Institute MaastrichtMaastricht UniversityMaastrichtThe Netherlands
- Institute of Experimental Medicine and Systems BiologyRWTH Aachen UniversityAachenGermany
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Arbustini E, Vengrenyuk Y, Narula J. On the Shades of Coronary Calcium and Plaque Instability. J Am Coll Cardiol 2021; 77:1612-1615. [PMID: 33795034 DOI: 10.1016/j.jacc.2021.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/04/2021] [Accepted: 02/05/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Eloisa Arbustini
- Transplant Research Area and Centre for Inherited Cardiovascular Diseases, Department of Medical Sciences and Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | | | - Jagat Narula
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Sørensen IMH, Saurbrey SAK, Hjortkjær HØ, Brainin P, Carlson N, Ballegaard ELF, Kamper AL, Christoffersen C, Feldt-Rasmussen B, Kofoed KF, Bro S. Regional distribution and severity of arterial calcification in patients with chronic kidney disease stages 1-5: a cross-sectional study of the Copenhagen chronic kidney disease cohort. BMC Nephrol 2020; 21:534. [PMID: 33297991 PMCID: PMC7726904 DOI: 10.1186/s12882-020-02192-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 11/29/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Patients with chronic kidney disease (CKD) and arterial calcification are considered at increased risk of adverse cardiovascular outcomes. However, the optimal site for measurement of arterial calcification has not been determined. The primary aim of this study was to examine the pattern of arterial calcification in different stages of CKD. METHODS This was an observational, cross-sectional study that included 580 individuals with CKD stages 1-5 (no dialysis) from the Copenhagen CKD Cohort. Calcification of the carotid, coronary and iliac arteries, thoracic and abdominal aorta was assessed using non-contrast multidetector computed tomography scans and quantified according to the Agatston method. Based on the distribution of Agatston scores in the selected arterial region, the subjects were divided into calcium score categories of 0 (no calcification), 1-100, 101-400 and > 400. RESULTS Participants with CKD stages 3-5 had the highest prevalence of calcification and the highest frequency of calcium scores > 400 in all arterial sites. Calcification in at least one arterial site was present in > 90% of patients with CKD stage 3. In all five CKD stages prevalence of calcification was greatest in both the thoracic and abdominal aorta, and in the iliac arteries. These arterial sites also showed the highest calcium scores. High calcium scores (> 400) in all five arterial regions were independently associated with prevalent cardiovascular disease. In multivariable analyses, after adjusting for cardiovascular risk factors, declining creatinine clearance was associated with increasing calcification of the coronary arteries (p = 0.012) and the thoracic aorta (p = 0.037) only. CONCLUSIONS Arterial calcification is highly prevalent throughout all five CKD stages and is most prominent in both the thoracic and abdominal aorta, and in the iliac arteries. Follow-up studies are needed to explore the potential of extracardiac calcification sites in prediction of cardiovascular events in the CKD population.
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Affiliation(s)
- Ida Maria Hjelm Sørensen
- Department of Nephrology, Rigshospitalet University Hospital, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.
| | | | - Henrik Øder Hjortkjær
- Department of Cardiology, Rigshospitalet University Hospital, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Philip Brainin
- Department of Cardiology, Herlev and Gentofte University Hospital, Niels Andersens Vej 65, Post 835, DK-2900, Copenhagen, Denmark
| | - Nicholas Carlson
- Department of Nephrology, Rigshospitalet University Hospital, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | | | - Anne-Lise Kamper
- Department of Nephrology, Rigshospitalet University Hospital, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Christina Christoffersen
- Department of Clinical Biochemistry, Rigshospitalet University Hospital, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Blegdamsvej 3B, DK-2200, Copenhagen, Denmark
| | - Bo Feldt-Rasmussen
- Department of Nephrology, Rigshospitalet University Hospital, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Klaus Fuglsang Kofoed
- Department of Cardiology, Rigshospitalet University Hospital, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Susanne Bro
- Department of Nephrology, Rigshospitalet University Hospital, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
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21
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Alappan HR, Vasanth P, Manzoor S, O'Neill WC. Vascular Calcification Slows But Does Not Regress After Kidney Transplantation. Kidney Int Rep 2020; 5:2212-2217. [PMID: 33305114 PMCID: PMC7710884 DOI: 10.1016/j.ekir.2020.09.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/17/2020] [Accepted: 09/22/2020] [Indexed: 02/06/2023] Open
Abstract
Introduction Medial arterial calcification is a common and progressive lesion in end-stage renal disease that is associated with poor cardiovascular outcomes. Whether this lesion can be arrested or reversed is unknown, and was examined retrospectively by measuring progression of breast arterial calcification before and after kidney transplantation. Methods Arterial calcification was measured on serial mammograms from patients with previous kidney transplantation and compared to measurements performed before transplantation or in patients on the active waitlist. Serum creatinine >2.0 mg/dl after transplantation or warfarin use were exclusions. Results Median (interquartile range) progression of arterial calcification was 12.9 mm/breast per year (5.9 to 32.6) in 34 patients before or awaiting transplantation compared to just 1.2 mm/breast per year (-0.54 to 5.1) in 34 patients after transplantation (P < 0.001). Slowing of progression was also seen in longitudinal analyses of patients with mammograms performed both before and after transplantation. Duration of end-stage renal disease before transplantation but not age, diabetes, baseline calcification, or serum chemistries correlated with progression after transplantation. Significant regression was not observed in any patient. Conclusion In this first quantitative study of the effect of kidney transplantation, medial arterial calcification appeared to slow to rates seen in patients with normal renal function, indicating that the effect of renal failure may be completely abrogated. Overall, however, there was no significant regression, suggesting that calcification is irreversible and emphasizing the importance of prevention. Duration of pretransplant end-stage renal disease but not baseline calcification was a determinant of progression, consistent with cumulative, permanent changes to arteries that promote calcification.
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Affiliation(s)
- Harish R Alappan
- Renal Division, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Payaswini Vasanth
- Renal Division, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Shumila Manzoor
- Renal Division, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - W Charles O'Neill
- Renal Division, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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22
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Zwakenberg SR, de Jong PA, Hendriks EJ, Westerink J, Spiering W, de Borst GJ, Cramer MJ, Bartstra JW, Doesburg T, Rutters F, van der Heijden AA, Schalkwijk C, Schurgers LJ, van der Schouw YT, Beulens JWJ. Intimal and medial calcification in relation to cardiovascular risk factors. PLoS One 2020; 15:e0235228. [PMID: 32658909 PMCID: PMC7357737 DOI: 10.1371/journal.pone.0235228] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 06/10/2020] [Indexed: 01/08/2023] Open
Abstract
Purpose To assess specific risk factors and biomarkers associated with intimal arterial calcification (IAC) and medial arterial calcification (MAC). Methods We conducted a cross-sectional study in patients with or at risk of vascular disease from the SMART study(n = 520) and the DCS cohort(n = 198). Non-contrast computed tomography scanning of the lower extremities was performed and calcification in the femoral and crural arteries was scored as absent, predominant IAC, predominant MAC or indistinguishable. Multinomial regression models were used to assess the associations between cardiovascular risk factors and calcification patterns. Biomarkers for inflammation, calcification and vitamin K status were measured in a subset of patients with IAC(n = 151) and MAC(n = 151). Results Femoral calcification was found in 77% of the participants, of whom 38% had IAC, 28% had MAC and 11% were scored as indistinguishable. The absolute agreement between the femoral and crural arteries was high(69%). Higher age, male sex, statin use and history of coronary artery disease were associated with higher prevalences of femoral IAC and MAC compared to absence of calcification. Smoking and low ankle-brachial-index (ABI) were associated with higher prevalence of IAC and high ABI was associated with less IAC. Compared to patients with IAC, patients with MAC more often had diabetes, have a high ABI and were less often smokers. Inactive Matrix-Gla Protein was associated with increased MAC prevalence, while osteonectin was associated with decreased risk of MAC, compared to IAC. Conclusions When femoral calcification is present, the majority of the patients have IAC or MAC throughout the lower extremity, which have different associated risk factor profiles.
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Affiliation(s)
- Sabine R. Zwakenberg
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Pim A. de Jong
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Eva J. Hendriks
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jan Westerink
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Wilko Spiering
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Gert J. de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Maarten J. Cramer
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jonas W. Bartstra
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Teddo Doesburg
- Department of Radiology, Westfries Gasthuis, Hoorn, The Netherlands
| | - Femke Rutters
- Department of Epidemiology & Biostatistics, Amsterdam Public Health research institute, Amsterdam UMC – Location VUmc, Amsterdam, The Netherlands
| | - Amber A. van der Heijden
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam UMC – Location VUmc, Amsterdam, The Netherlands
| | - Casper Schalkwijk
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Leon J. Schurgers
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastrich, The Netherlands
| | - Yvonne T. van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Joline W. J. Beulens
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Epidemiology & Biostatistics, Amsterdam Public Health research institute, Amsterdam UMC – Location VUmc, Amsterdam, The Netherlands
- * E-mail:
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23
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Turner ME, Holden RM. Risks of Vitamin K Antagonism: Mammograms as a Powerful Tool to Assess Calcification Progression. Arterioscler Thromb Vasc Biol 2020; 40:1022-1024. [PMID: 32320292 DOI: 10.1161/atvbaha.120.314117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Mandy E Turner
- From the Department of Biomedical and Molecular Science (M.E.T., R.M.H.), Queen's University, Kingston, ON, Canada
| | - Rachel M Holden
- From the Department of Biomedical and Molecular Science (M.E.T., R.M.H.), Queen's University, Kingston, ON, Canada.,Department of Medicine (R.M.H.), Queen's University, Kingston, ON, Canada
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