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Kinoshita D, Suzuki K, Yuki H, Niida T, Fujimoto D, Minami Y, Dey D, Lee H, McNulty I, Ako J, Ferencik M, Kakuta T, Ye JC, Jang IK. Coronary plaque phenotype associated with positive remodeling. J Cardiovasc Comput Tomogr 2024; 18:401-407. [PMID: 38677958 DOI: 10.1016/j.jcct.2024.04.009] [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: 02/02/2024] [Revised: 04/04/2024] [Accepted: 04/19/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Positive remodeling is an integral part of the vascular adaptation process during the development of atherosclerosis, which can be detected by coronary computed tomography angiography (CTA). METHODS A total of 426 patients who underwent both coronary CTA and optical coherence tomography (OCT) were included. Four machine learning (ML) models, gradient boosting machine (GBM), random forest (RF), deep learning (DL), and support vector machine (SVM), were employed to detect specific plaque features. A total of 15 plaque features assessed by OCT were analyzed. The variable importance ranking was used to identify the features most closely associated with positive remodeling. RESULTS In the variable importance ranking, lipid index and maximal calcification arc were consistently ranked high across all four ML models. Lipid index and maximal calcification arc were correlated with positive remodeling, showing pronounced influence at the lower range and diminishing influence at the higher range. Patients with more plaques with positive remodeling throughout their entire coronary trees had higher low-density lipoprotein cholesterol levels and were associated with a higher incidence of cardiovascular events during 5-year follow-up (Hazard ratio 2.10 [1.26-3.48], P = 0.004). CONCLUSION Greater lipid accumulation and less calcium burden were important features associated with positive remodeling in the coronary arteries. The number of coronary plaques with positive remodeling was associated with a higher incidence of cardiovascular events.
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Affiliation(s)
- Daisuke Kinoshita
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Keishi Suzuki
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Haruhito Yuki
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Takayuki Niida
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Daichi Fujimoto
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Yoshiyasu Minami
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Hang Lee
- Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Iris McNulty
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Maros Ferencik
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA
| | - Tsunekazu Kakuta
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan.
| | - Jong Chul Ye
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea; Kim Jaechul Graduate School of Artificial Intelligence, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Ik-Kyung Jang
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Ren X, Wang X. Association of the low-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio and major adverse cardiac and cerebrovascular events in patients with coronary heart disease undergoing percutaneous coronary intervention: a cohort study. Curr Med Res Opin 2023; 39:1175-1181. [PMID: 37560911 DOI: 10.1080/03007995.2023.2246889] [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: 04/26/2023] [Revised: 07/28/2023] [Accepted: 08/08/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Although dyslipidemia increases the risk of coronary heart disease (CHD) and its adverse prognosis, the association between the ratio of low-density lipoprotein cholesterol (LDL-C) to high-density lipoprotein cholesterol (HDL-C) and major adverse cardiovascular and cerebrovascular events (MACCE) after percutaneous coronary intervention (PCI) in patients with CHD has not been adequately demonstrated. Therefore, the aim of this study was to assess the role of LDL-C/HDL-C in the risk of MACCE after PCI in patients with CHD. METHODS In this large cohort observational study, we enrolled 2226 patients with CHD treated with PCI. LDL-C/HDL-C was considered as an exposure variable and MACCE was considered as an outcome variable. Univariate and multivariate Logistic regression models and subgroup analyses were used to assess the relationship between LDL-C/HDL-C and the risk of MACCE. RESULTS A total of 2226 patients (mean age: 60.02 years; 68.00% male) were included in the analysis, and 373 patients suffered MACC. Patients who developed MACCE had higher levels of LDL-C/HDL-C compared to patients who did not develop MACCE [(2.79 ± 1.15) vs (2.64 ± 1.09), p = 0.023]. Univariate Logistic regression analysis showed a correlation between LDL-C/HDL-C and the risk of MACCE (OR: 1.121, 95% CI: 1.019-1.233, p = 0.019). Multivariate Logistic regression analysis showed that higher levels of LDL-C/HDL-C remained strongly associated with a higher risk of MACCE after stepwise adjustment for confounding variables [Model 4: T3 vs T1, OR: 1.455, 95% CI: 1.095-1.933, p = 0.010; per unit increase, OR: 1.158, 95% CI: 1.047-1.281, p = 0.004]. Further subgroup analysis showed that the association between LDL-C/HDL-C and MACCE risk remained in the subgroup ≤60 years, male, without diabetes, and with hypertension (p < 0.05). CONCLUSION Higher LDL-C/HDL-C was closely associated with a higher risk of MACCE after PCI in patients with CHD.
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Affiliation(s)
- Xiaomei Ren
- Department of Geriatrics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, P.R. China
| | - Xia Wang
- Department of Geriatrics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, P.R. China
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3
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The Association between Low Levels of Low Density Lipoprotein Cholesterol and Intracerebral Hemorrhage: Cause for Concern? J Clin Med 2022; 11:jcm11030536. [PMID: 35159988 PMCID: PMC8836670 DOI: 10.3390/jcm11030536] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 12/27/2021] [Accepted: 01/18/2022] [Indexed: 12/24/2022] Open
Abstract
Excessive levels of low-density lipoprotein cholesterol (LDL-C) in the blood are a known risk factor for atherosclerosis, and a common target of treatment for primary and secondary prevention of cerebrocardiovascular disease. As lipid lowering agents including statins, ezetimibe and anti-proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have shown good therapeutic results, the guidelines are constantly lowering the "optimal" LDL-C goals. However, old and new data point towards an association between low LDL-C and total cholesterol and intracerebral hemorrhage (ICH). In this review we aimed to shed light on this troubling association and identify the potential risk factors of such a potential adverse reaction. With respect to the data presented, we concluded that in patients with high risk of ICH, a cautious approach and individualized therapy strategy are advised when considering aggressive LDL reduction.
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van den Hoogen IJ, van Rosendael AR, Lin FY, Gianni U, Andreini D, Al-Mallah MH, Budoff MJ, Cademartiri F, Chinnaiyan K, Hyun Choi J, Conte E, Marques H, de Araújo Gonçalves P, Gottlieb I, Hadamitzky M, Leipsic J, Maffei E, Pontone G, Shin S, Kim YJ, Lee BK, Chun EJ, Sung JM, Lee SE, Berman DS, Virmani R, Samady H, Stone PH, Narula J, Chang HJ, Min JK, Shaw LJ, Bax JJ. Measurement of compensatory arterial remodelling over time with serial coronary computed tomography angiography and 3D metrics. Eur Heart J Cardiovasc Imaging 2021; 23:1336-1344. [PMID: 34468717 DOI: 10.1093/ehjci/jeab138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Indexed: 11/14/2022] Open
Abstract
AIMS The magnitude of alterations in which coronary arteries remodel and narrow over time is not well understood. We aimed to examine changes in coronary arterial remodelling and luminal narrowing by three-dimensional (3D) metrics from serial coronary computed tomography angiography (CCTA). METHODS AND RESULTS From a multicentre registry of patients with suspected coronary artery disease who underwent clinically indicated serial CCTA (median interscan interval = 3.3 years), we quantitatively measured coronary plaque, vessel, and lumen volumes on both scans. Primary outcome was the per-segment change in coronary vessel and lumen volume from a change in plaque volume, focusing on arterial remodelling. Multivariate generalized estimating equations including statins were calculated comparing associations between groups of baseline percent atheroma volume (PAV) and location within the coronary artery tree. From 1245 patients (mean age 61 ± 9 years, 39% women), a total of 5721 segments were analysed. For each 1.00 mm3 increase in plaque volume, the vessel volume increased by 0.71 mm3 [95% confidence interval (CI) 0.63 to 0.79 mm3, P < 0.001] with a corresponding reduction in lumen volume by 0.29 mm3 (95% CI -0.37 to -0.21 mm3, P < 0.001). Serial 3D arterial remodelling and luminal narrowing was similar in segments with low and high baseline PAV (P ≥ 0.496). No differences were observed between left main and non-left main segments, proximal and distal segments and side branch and non-side branch segments (P ≥ 0.281). CONCLUSIONS Over time, atherosclerotic coronary plaque reveals prominent outward arterial remodelling that co-occurs with modest luminal narrowing. These findings provide additional insight into the compensatory mechanisms involved in the progression of coronary atherosclerosis.
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Affiliation(s)
- Inge J van den Hoogen
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA.,Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Alexander R van Rosendael
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA.,Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Fay Y Lin
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Umberto Gianni
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA.,Department of Healthcare Policy and Research, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA
| | | | - Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Matthew J Budoff
- Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, CA, USA
| | | | | | | | | | - Hugo Marques
- UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa, Portugal
| | | | - Ilan Gottlieb
- Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil
| | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany
| | - Jonathon Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Erica Maffei
- Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy
| | | | - Sanghoon Shin
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Seoul, Korea
| | - Yong-Jin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Byoung Kwon Lee
- Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Ju Chun
- Seoul National University Bundang Hospital, Sungnam, South Korea
| | - Ji Min Sung
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.,Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Sang-Eun Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.,Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Daniel S Berman
- Department of Imaging and Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Renu Virmani
- Department of Pathology, CVPath Institute, Gaithersburg, MD, USA
| | - Habib Samady
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Peter H Stone
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jagat Narula
- Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, Zena and Michael A. Wiener Cardiovascular Institute, and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, New York, NY, USA
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.,Ontact Health, Inc, Seoul, South Korea
| | - James K Min
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Leslee J Shaw
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
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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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Ma C, Gurol ME, Huang Z, Lichtenstein AH, Wang X, Wang Y, Neumann S, Wu S, Gao X. Low-density lipoprotein cholesterol and risk of intracerebral hemorrhage: A prospective study. Neurology 2019; 93:e445-e457. [PMID: 31266905 PMCID: PMC6693427 DOI: 10.1212/wnl.0000000000007853] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 03/13/2019] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To prospectively examine the association between low-density lipoprotein (LDL) cholesterol (LDL-C) concentrations and intracerebral hemorrhage (ICH) risk. METHODS The current cohort study included 96,043 participants (mean age 51.3 years) who were free of stroke, myocardial infarction, and cancer at baseline (2006). Serum LDL-C concentrations were assessed in 2006, 2008, 2010, and 2012. Cumulative average LDL-C concentrations were calculated from all available LDL-C data during that period. Incident ICH was confirmed by review of medical records. RESULTS We identified 753 incident ICH cases during 9 years of follow-up. The ICH risk was similar among participants with LDL concentrations of 70 to 99 mg/dL and those with LDL-C concentrations ≥100 mg/dL. In contrast, participants with LDL-C concentrations <70 mg/dL had a significantly higher risk of developing ICH than those with LDL-C concentrations of 70 to 99 mg/dL; adjusted hazard ratios were 1.65 (95% confidence interval [CI] 1.32-2.05) for LDL-C concentrations of 50 to 69 mg/dL and 2.69 (95% CI 2.03-3.57) for LDL-C concentrations <50 mg/dL. CONCLUSIONS We observed a significant association between lower LDL-C and higher risk of ICH when LDL-C was <70 mg/dL, and the association became nonsignificant when LDL-C ≥70 mg/dL. These data can help determination of the ideal LDL range in patients who are at increased risk of both atherosclerotic disease and hemorrhagic stroke and guide planning of future lipid-lowering studies.
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Affiliation(s)
- Chaoran Ma
- From the Department of Nutritional Sciences (C.M.), Eberly College of Science (S.N.), and Department of Nutritional Sciences (X.G.), Pennsylvania State University, University Park; Hemorrhagic Stroke Research Program (M.E.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Departments of Cardiology (Z.H., S.W.) and Neurology (X.W., Y.W.), Kailuan General Hospital, Tangshan, China; and Jean Mayer USDA Human Nutrition Research Center on Aging (A.H.L.), Tufts University, Boston, MA
| | - M Edip Gurol
- From the Department of Nutritional Sciences (C.M.), Eberly College of Science (S.N.), and Department of Nutritional Sciences (X.G.), Pennsylvania State University, University Park; Hemorrhagic Stroke Research Program (M.E.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Departments of Cardiology (Z.H., S.W.) and Neurology (X.W., Y.W.), Kailuan General Hospital, Tangshan, China; and Jean Mayer USDA Human Nutrition Research Center on Aging (A.H.L.), Tufts University, Boston, MA
| | - Zhe Huang
- From the Department of Nutritional Sciences (C.M.), Eberly College of Science (S.N.), and Department of Nutritional Sciences (X.G.), Pennsylvania State University, University Park; Hemorrhagic Stroke Research Program (M.E.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Departments of Cardiology (Z.H., S.W.) and Neurology (X.W., Y.W.), Kailuan General Hospital, Tangshan, China; and Jean Mayer USDA Human Nutrition Research Center on Aging (A.H.L.), Tufts University, Boston, MA
| | - Alice H Lichtenstein
- From the Department of Nutritional Sciences (C.M.), Eberly College of Science (S.N.), and Department of Nutritional Sciences (X.G.), Pennsylvania State University, University Park; Hemorrhagic Stroke Research Program (M.E.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Departments of Cardiology (Z.H., S.W.) and Neurology (X.W., Y.W.), Kailuan General Hospital, Tangshan, China; and Jean Mayer USDA Human Nutrition Research Center on Aging (A.H.L.), Tufts University, Boston, MA
| | - Xiuyan Wang
- From the Department of Nutritional Sciences (C.M.), Eberly College of Science (S.N.), and Department of Nutritional Sciences (X.G.), Pennsylvania State University, University Park; Hemorrhagic Stroke Research Program (M.E.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Departments of Cardiology (Z.H., S.W.) and Neurology (X.W., Y.W.), Kailuan General Hospital, Tangshan, China; and Jean Mayer USDA Human Nutrition Research Center on Aging (A.H.L.), Tufts University, Boston, MA
| | - Yuzhen Wang
- From the Department of Nutritional Sciences (C.M.), Eberly College of Science (S.N.), and Department of Nutritional Sciences (X.G.), Pennsylvania State University, University Park; Hemorrhagic Stroke Research Program (M.E.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Departments of Cardiology (Z.H., S.W.) and Neurology (X.W., Y.W.), Kailuan General Hospital, Tangshan, China; and Jean Mayer USDA Human Nutrition Research Center on Aging (A.H.L.), Tufts University, Boston, MA
| | - Samantha Neumann
- From the Department of Nutritional Sciences (C.M.), Eberly College of Science (S.N.), and Department of Nutritional Sciences (X.G.), Pennsylvania State University, University Park; Hemorrhagic Stroke Research Program (M.E.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Departments of Cardiology (Z.H., S.W.) and Neurology (X.W., Y.W.), Kailuan General Hospital, Tangshan, China; and Jean Mayer USDA Human Nutrition Research Center on Aging (A.H.L.), Tufts University, Boston, MA
| | - Shouling Wu
- From the Department of Nutritional Sciences (C.M.), Eberly College of Science (S.N.), and Department of Nutritional Sciences (X.G.), Pennsylvania State University, University Park; Hemorrhagic Stroke Research Program (M.E.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Departments of Cardiology (Z.H., S.W.) and Neurology (X.W., Y.W.), Kailuan General Hospital, Tangshan, China; and Jean Mayer USDA Human Nutrition Research Center on Aging (A.H.L.), Tufts University, Boston, MA.
| | - Xiang Gao
- From the Department of Nutritional Sciences (C.M.), Eberly College of Science (S.N.), and Department of Nutritional Sciences (X.G.), Pennsylvania State University, University Park; Hemorrhagic Stroke Research Program (M.E.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Departments of Cardiology (Z.H., S.W.) and Neurology (X.W., Y.W.), Kailuan General Hospital, Tangshan, China; and Jean Mayer USDA Human Nutrition Research Center on Aging (A.H.L.), Tufts University, Boston, MA.
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Liu X, Sun C, Tian J, Liu X, Fang S, Xi X, Gu X, Sun Y, Tian J, Yu B. Shrinkage as a potential mechanism of recurrent clinical events in patients with a large vulnerable plaque. J Cardiovasc Med (Hagerstown) 2019; 20:518-524. [PMID: 30889077 DOI: 10.2459/jcm.0000000000000783] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS This study aimed to investigate the progression and vascular shrinkage of vulnerable plaque lesions with a plaque burden at least 70% among patients with coronary artery disease by optical coherence tomography (OCT) and intravascular ultrasound (IVUS). METHODS Fifty-six OCT-identified vulnerable plaques from 47 patients were included among coronary angiography-identified nonculprit/nontarget lesions. Serial IVUS images were used to assess plaque progression and vascular shrinkage. RESULTS Thirty-five small vulnerable plaques (plaque burden <70%, group A) and 21 large vulnerable plaques (plaque burden ≥70%, group B) were identified. The IVUS results at baseline show that mean plaque areas (P < 0.001) and the percentage atheroma volume (PAV) (P < 0.0001) were greater and the minimal lumen area (P < 0.0001) was smaller in group B. The absolute and relative changes in the PAV and mean plaque area from baseline to follow-up were not significantly different. However, the lesions exhibited vessel shrinkage [the mean external elastic membrane (EEM) area (P = 0.02) and mean lumen area (P = 0.03) were significantly smaller in group B] from baseline to follow-up. Patients in group B also exhibited clinical events (recurrent angina symptoms) during the follow-up period. Positive correlations were found between changes in the mean plaque area and the mean EEM area in large vulnerable plaques (r = 0.61, P < 0.0001) and between changes in the mean EEM area and the mean lumen area in large vulnerable plaques (r = 0.61, P < 0.0001). CONCLUSION Vulnerable plaque progression was not different between small and large vulnerable plaques. However, large vulnerable plaque lesions tended to exhibit vascular shrinkage, which is possible a cause of coronary artery lumen loss in patients with large vulnerable plaques.
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Affiliation(s)
- Xianglan Liu
- Department of Cardiology, the Second Affiliated Hospital of Harbin Medical University, Harbin.,The Key Laboratory of Myocardial Ischemia, Harbin Medical University, Ministry of Education, Heilongjiang Province
| | - Changbin Sun
- Department of Cardiology, the Second Affiliated Hospital of Harbin Medical University, Harbin.,The Key Laboratory of Myocardial Ischemia, Harbin Medical University, Ministry of Education, Heilongjiang Province
| | - Jiangtian Tian
- Department of Cardiology, the Second Affiliated Hospital of Harbin Medical University, Harbin.,The Key Laboratory of Myocardial Ischemia, Harbin Medical University, Ministry of Education, Heilongjiang Province
| | - Xinxin Liu
- Department of Cardiology, the Second Affiliated Hospital of Harbin Medical University, Harbin.,The Key Laboratory of Myocardial Ischemia, Harbin Medical University, Ministry of Education, Heilongjiang Province
| | - Shaohong Fang
- Department of Cardiology, the Second Affiliated Hospital of Harbin Medical University, Harbin.,The Key Laboratory of Myocardial Ischemia, Harbin Medical University, Ministry of Education, Heilongjiang Province
| | - Xiangwen Xi
- Department of Cardiology, the Second Affiliated Hospital of Harbin Medical University, Harbin.,The Key Laboratory of Myocardial Ischemia, Harbin Medical University, Ministry of Education, Heilongjiang Province
| | - Xia Gu
- The Key Laboratory of Myocardial Ischemia, Harbin Medical University, Ministry of Education, Heilongjiang Province.,Department of Cardiology, the Heilongjiang Provincial Hospital, Harbin, China
| | - Yong Sun
- Department of Cardiology, the Second Affiliated Hospital of Harbin Medical University, Harbin.,The Key Laboratory of Myocardial Ischemia, Harbin Medical University, Ministry of Education, Heilongjiang Province
| | - Jinwei Tian
- Department of Cardiology, the Second Affiliated Hospital of Harbin Medical University, Harbin.,The Key Laboratory of Myocardial Ischemia, Harbin Medical University, Ministry of Education, Heilongjiang Province
| | - Bo Yu
- Department of Cardiology, the Second Affiliated Hospital of Harbin Medical University, Harbin.,The Key Laboratory of Myocardial Ischemia, Harbin Medical University, Ministry of Education, Heilongjiang Province
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Correlation Studies and Literature Review of Medullary Artery Occlusion After Intracranial Vertebral Artery Stenting. World Neurosurg 2018; 122:665-670. [PMID: 30465957 DOI: 10.1016/j.wneu.2018.11.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 11/06/2018] [Accepted: 11/08/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Stenosis of the target intracranial vertebral artery is one of the major causes of posterior circulation ischemic stroke. The objective of this paper is to explore methods for reducing the occurrence of medullary artery occlusion after intracranial vertebral artery stenting. CASE DESCRIPTION The current research presents a retrospective analysis of 48 patients who received Gateway-Wingspan stent angioplasty to treat severe stenosis of the intracranial vertebral artery, evaluates the results of stenosis remission and perfusion improvement after stent angioplasty, and explores the causes of postoperative medullary artery occlusion. A total of 49 Wingspan stents were implanted in the 48 patients, with a surgical success rate of 100%. After stent implantation, the patients' rates of intracranial vertebral artery stenosis dropped from 75.9% ± 6.3% to 28.4% ± 5.1%. Transcranial Doppler or cranial computed tomography angiography 3 months after surgery showed that none of the patients suffered from in-stent restenosis. Within 24 hours after surgery, medullary perforating artery occlusion occurred in 2 patients, probably because atherosclerotic plaque in the stenotic area became less stable and displaced under the mechanical action of postoperative saccule and stent. As a result, the medullary artery was blocked. After drug and rehabilitation therapies, the patients' symptoms were alleviated. CONCLUSIONS Perforating artery occlusion after intracranial vertebral artery stenting can be prevented by strict assessment and preparation before surgery, correct choices of saccule and stent during operation, and other measures. However, large sample data are needed for verification.
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Decano JL, Aikawa M. Dynamic Macrophages: Understanding Mechanisms of Activation as Guide to Therapy for Atherosclerotic Vascular Disease. Front Cardiovasc Med 2018; 5:97. [PMID: 30123798 PMCID: PMC6086112 DOI: 10.3389/fcvm.2018.00097] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 07/02/2018] [Indexed: 12/13/2022] Open
Abstract
An emerging theory is that macrophages are heterogenous; an attribute that allows them to change behavior and execute specific functions in disease processes. This review aims to describe the current understanding on factors that govern their phenotypic changes, and provide insights for intervention beyond managing classical risk factors. Evidence suggests that metabolic reprogramming of macrophages triggers either a pro-inflammatory, anti-inflammatory or pro-resolving behavior. Dynamic changes in bioenergetics, metabolome or influence from bioactive lipids may promote resolution or aggravation of inflammation. Direct cell-to-cell interactions with other immune cells can also influence macrophage activation. Both paracrine signaling and intercellular molecular interactions either co-stimulate or co-inhibit activation of macrophages as well as their paired immune cell collaborator. More pathways of activation can even be uncovered by inspecting macrophages in the single cell level, since differential expression in key gene regulators can be screened in higher resolution compared to conventional averaged gene expression readouts. All these emerging macrophage activation mechanisms may be further explored and consolidated by using approaches in network biology. Integrating these insights can unravel novel and safer drug targets through better understanding of the pro-inflammatory activation circuitry.
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Affiliation(s)
- Julius L. Decano
- Center for Interdisciplinary Cardiovascular Sciences, Division of Cardiovascular Medicine, Department of Medicine, Brigham Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Masanori Aikawa
- Center for Interdisciplinary Cardiovascular Sciences, Division of Cardiovascular Medicine, Department of Medicine, Brigham Women's Hospital, Harvard Medical School, Boston, MA, United States
- Center for Excellence in Vascular Biology, Division of Cardiovascular Medicine, Department of Medicine, Brigham Women's Hospital, Harvard Medical School, Boston, MA, United States
- Channing Division of Network Medicine, Department of Medicine, Brigham Women's Hospital, Harvard Medical School, Boston, MA, United States
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Nakanishi R, Alani A, Matsumoto S, Li D, Fahmy M, Abraham J, Dailing C, Broersen A, Kitslaar PH, Nasir K, Min JK, Budoff MJ. Changes in Coronary Plaque Volume: Comparison of Serial Measurements on Intravascular Ultrasound and Coronary Computed Tomographic Angiography. Tex Heart Inst J 2018; 45:84-91. [PMID: 29844740 DOI: 10.14503/thij-15-5212] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Serial measurements of coronary plaque volume have been used to evaluate drug efficacy in atherosclerotic progression. However, the usefulness of computed tomography for this purpose is unknown. We investigated whether the change in total plaque volume on coronary computed tomographic angiography is associated with the change in segment plaque volume on intravascular ultrasound. We prospectively enrolled 11 consecutive patients (mean age, 56.3 ± 5 yr; 6 men) who were to undergo serial invasive coronary angiographic examinations with use of grayscale intravascular ultrasound and coronary computed tomography, performed <180 days apart at baseline and from 1 to 2 years later. Subjects underwent 186 serial measurements of total plaque volume on coronary computed tomography and 22 of segmental plaque volume on intravascular ultrasound. We used semiautomated software to examine percentage relationships and changes between total plaque and segmental plaque volumes. No significant correlations were found between percentages of total coronary and segment coronary plaque volume, nor between normalized coronary plaque volume. However, in the per-patient analysis, there were strong correlations between the imaging methods for changes in total coronary and segment coronary plaque volume (r=0.62; P=0.04), as well as normalized plaque volume (r=0.82; P=0.002). Per-patient change in plaque volume on coronary computed tomography is significantly associated with that on intravascular ultrasound. Computed tomographic angiography may be safer and more widely available than intravascular ultrasound for evaluating atherosclerotic progression in coronary arteries. Larger studies are warranted.
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11
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Di Mario C, Mattesini A, Waksman R. An amber signal lights up before the red: do not dismiss it. Eur Heart J 2018; 39:303-304. [PMID: 28591767 DOI: 10.1093/eurheartj/ehx292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Carlo Di Mario
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Alessio Mattesini
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Ron Waksman
- MedStar Washington Hospital Center, Washington, DC, USA
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12
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Kunutsor SK, Zaccardi F, Karppi J, Kurl S, Laukkanen JA. Is High Serum LDL/HDL Cholesterol Ratio an Emerging Risk Factor for Sudden Cardiac Death? Findings from the KIHD Study. J Atheroscler Thromb 2017; 24:600-608. [PMID: 27784848 PMCID: PMC5453685 DOI: 10.5551/jat.37184] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 09/09/2016] [Indexed: 12/31/2022] Open
Abstract
AIM Low-density lipoprotein cholesterol (LDL-c) and high-density lipoprotein cholesterol (HDL-c), which are components of total cholesterol, have each been suggested to be linked to the risk of sudden cardiac death (SCD). However, the relationship between LDL-c/HDL-c ratio and the risk of SCD has not been previously investigated. We aimed to assess the associations of LDL-c, HDL-c, and the ratio of LDL-c/HDL-c with the risk of SCD. METHODS Serum lipoprotein concentrations were assessed at baseline in the Finnish Kuopio Ischemic Heart Disease prospective cohort study of 2,616 men aged 42-61 years at recruitment. Hazard ratios (HRs) (95% confidence intervals [CI]) were assessed. RESULTS During a median follow-up of 23.0 years, a total of 228 SCDs occurred. There was no significant evidence of an association of LDL-c or HDL-c with the risk of SCD. In analyses adjusted for age, examination year, body mass index, systolic blood pressure, smoking, alcohol consumption, physical activity, years of education, diabetes, previous myocardial infarction, family history of coronary heart disease, and serum high sensitivity C-reactive protein, there was approximately a two-fold increase in the risk of SCD (HR 1.94, 95% CI 1.21-3.11; p=0.006), comparing the top (>4.22) versus bottom (≤2.30) quintile of serum LDL-c/HDL-c ratio. CONCLUSION In this middle-aged male population, LDL-c or HDL-c was not associated with the risk of SCD. However, a high serum LDL-c/HDL-c ratio was found to be independently associated with an increased risk of SCD. Further research is warranted to understand the mechanistic pathways underlying this association.
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Affiliation(s)
- Setor K Kunutsor
- School of Clinical Sciences, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Southmead Road, Bristol, UK
| | | | - Jouni Karppi
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Sudhir Kurl
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Jari A Laukkanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Department of Medicine, Central Finland Central Hospital, Jyväskylä, Finland
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Kashyap VS, Lakin RO, Campos P, Allemang M, Kim A, Sarac TP, Hausladen A, Stamler JS. The LargPAD Trial: Phase IIA evaluation of l-arginine infusion in patients with peripheral arterial disease. J Vasc Surg 2017; 66:187-194. [PMID: 28366306 DOI: 10.1016/j.jvs.2016.12.127] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 12/30/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Endothelial function is improved by l-arginine (l-arg) supplementation in preclinical and clinical studies of mildly diseased vasculature; however, endothelial function and responsiveness to l-arg in severely diseased arteries is not known. Our objective was to evaluate the acute effects of catheter-directed l-arg delivery in patients with chronic lower extremity ischemia secondary to peripheral arterial disease. METHODS The study enrolled 22 patients (45% male) with peripheral arterial disease (mean age, 62 years) requiring lower extremity angiography. Endothelium-dependent relaxation of patent but atherosclerotic superficial femoral arteries was measured using a combination of intravascular ultrasound (IVUS) imaging and a Doppler FloWire (Volcano Corporation, Rancho Cordova, Calif) during the infusion of incremental acetylcholine (10-6 to 10-4 molar concentration) doses. Patients received 50 mg (n = 3), 100 mg (n = 10), or 500 mg (n = 9) l-arg intra-arterially, followed by repeat endothelium-dependent relaxation measurement (limb volumetric flow). IVUS-derived virtual histology of the culprit vessel was also obtained. Endothelium-independent relaxation was measured using a nitroglycerin infusion. Levels of nitrogen oxides and arginine metabolites were measured by chemiluminescence and mass spectrometry, respectively. RESULTS Patients tolerated limb l-arg infusion well. Serum arginine and ornithine levels increased by 43.6% ± 13.0% and 23.2% ± 10.3%, respectively (P < .005), and serum nitrogen oxides increased by 85% (P < .0001) after l-arg infusion. Average vessel area increased by 6.8% ± 1.3% with l-arg infusion (acetylcholine 10-4; P < .0001). Limb volumetric flow increased in all patients and was greater with l-arg supplementation by 130.9 ± 17.6, 136.9 ± 18.6, and 172.1 ± 24.8 mL/min, respectively, for each cohort. Maximal effects were seen with l-arg at 100 mg (32.8%). Arterial smooth muscle responsiveness to nitroglycerin was intact in all vessels (endothelium-independent relaxation, 137% ± 28% volume flow increase). IVUS-derived virtual histology indicated plaque volume was 14 ± 1.3 mm3/cm, and plaque stratification revealed a predominantly fibrous morphology (46.4%; necrotic core, 28.4%; calcium, 17.4%; fibrolipid, 6.6%). Plaque morphology did not correlate with l-arg responsiveness. CONCLUSIONS Despite extensive atherosclerosis, endothelial function in diseased lower extremity human arteries can be enhanced by l-arg infusion secondary to increased nitric oxide bioactivity. Further studies of l-arg as a therapeutic modality in patients with endothelial dysfunction (ie, acute limb ischemia) are warranted.
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Affiliation(s)
- Vikram S Kashyap
- Division of Vascular Surgery and Endovascular Therapy, University Hospitals Case Medical Center, Cleveland, Ohio.
| | - Ryan O Lakin
- Division of Vascular Surgery and Endovascular Therapy, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Patricia Campos
- Division of Vascular Surgery and Endovascular Therapy, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Matthew Allemang
- Division of Vascular Surgery and Endovascular Therapy, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Ann Kim
- Division of Vascular Surgery and Endovascular Therapy, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Timur P Sarac
- Divison of Vascular Surgery, Yale School of Medicine, New Haven, Conn
| | - Alfred Hausladen
- Institute for Transformative Molecular Medicine, Case Western Reserve University and University Hospitals Case Medical Center, Cleveland, Ohio
| | - Jonathan S Stamler
- Institute for Transformative Molecular Medicine, Case Western Reserve University and University Hospitals Case Medical Center, Cleveland, Ohio
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Intensive statin therapy stabilizes C-reactive protein, but not chemokine in stable coronary artery disease treated with an everolimus-eluting stent. Coron Artery Dis 2017; 27:405-11. [PMID: 27105046 DOI: 10.1097/mca.0000000000000375] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Besides its potent plasma cholesterol-lowering activity, statin treatment has several other important effects, including lowering high-sensitive C-reactive protein (hs-CRP), levels, and stabilizing risk factors of atherosclerosis, thereby reducing the risk of cardiovascular events. Our aim in this study was to identify how intensive statin therapy can affect plasma levels of inflammatory markers over the long term. METHODS AND RESULTS We used a prospective, randomized, open blinded-endpoint design. A total of 30 patients with stable coronary artery disease treated with everolimus-eluting stent implantation were randomized to receive rosuvastatin 2.5 (standard therapy group) or 10 mg (intensive therapy group) for 12 months. Plasma levels of hs-CRP, pentraxin-3, monocyte chemoattractant protein-1, and CXC chemokine ligand 4 were measured after a percutaneous coronary intervention, at 1, 3, 6, 9, and 12 months. Levels of LDL cholesterol (LDL-C) and HDL cholesterol were also measured. We investigated short-term and long-term clinical outcomes. After 12 months of therapy, the intensive therapy group had lower levels of LDL-C than the standard therapy group. Plasma levels of hs-CRP largely fluctuated in the standard therapy group, whereas they were stable in the intensive therapy group during the follow-up period. There were no significant differences in serum pentraxin-3, monocyte chemoattractant protein-1, and CXC chemokine ligand 4 levels, or in the incidence of any clinical adverse events, between the standard and the intensive therapy groups. CONCLUSION Intensive rosuvastatin therapy stabilizes hs-CRP levels, but not chemokine levels, besides lowering LDL-C levels. Thus, this therapy may inhibit the progression of atherosclerosis by stably inhibiting the inflammatory cascade.
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Kunutsor SK, Kurl S, Khan H, Zaccardi F, Laukkanen JA. Associations of cardiovascular and all-cause mortality events with oxygen uptake at ventilatory threshold. Int J Cardiol 2017; 236:444-450. [PMID: 28209387 DOI: 10.1016/j.ijcard.2017.01.156] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 12/09/2016] [Accepted: 01/16/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Oxygen uptake (VO2) at ventilatory threshold (VT), is a cardiopulmonary exercise testing parameter which may be a proxy for peak VO2. We aimed to assess the associations of VO2 at VT with sudden cardiac death (SCD), fatal coronary heart disease (CHD) and cardiovascular disease (CVD), and all-cause mortality. METHODS AND RESULTS VO2 at VT was assessed during a submaximal exercise test using respiratory gas analyzers in the Kuopio Ischemic Heart Disease cohort of 1639 middle-aged men. Hazard ratios (HRs) (95% CIs) were assessed. During a median follow-up of 25.6years, 121 SCDs, 202 fatal CHDs, 312 fatal CVDs, and 703 all-cause mortality events occurred. VO2 at VT was correlated with peak VO2 (r=0.90) and linearly associated with each outcome. Comparing extreme quartiles of VO2 at VT, the HRs (95% CIs) for SCD, fatal CHD, fatal CVD, and all-cause mortality on adjustment for established risk factors were 0.37 (0.18-0.78), 0.32 (0.18-0.57), 0.45 (0.30-0.69), and 0.50 (0.38-0.64) respectively. The HRs were 1.02 (0.36-2.91), 1.43 (0.63-3.25), 1.46 (0.79-2.71), and 1.02 (0.69-1.51) respectively on further adjustment for peak VO2. Addition of VO2 at VT to a CVD mortality risk prediction model containing established risk factors significantly improved risk discrimination and reclassification at 25years. CONCLUSIONS There are linear and inverse associations of VO2 at VT with fatal cardiovascular and all-cause mortality events, which are dependent on peak VO2. Inclusion of VO2 at VT in the standard established risk factors panel significantly improves the prediction and classification of long-term CVD mortality risk.
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Affiliation(s)
- Setor K Kunutsor
- School of Clinical Sciences, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Southmead Road, Bristol, UK.
| | - Sudhir Kurl
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.
| | - Hassan Khan
- Emory University School of Medicine, Atlanta, GA, USA.
| | | | - Jari A Laukkanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Central Finland Central Hospital, Internal Medicine, Jyväskylä, Finland.
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16
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Effect of rosuvastatin on atherosclerotic plaque stability: An intravascular ultrasound elastography study. Atherosclerosis 2016; 248:27-35. [DOI: 10.1016/j.atherosclerosis.2016.02.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 02/04/2016] [Accepted: 02/23/2016] [Indexed: 11/21/2022]
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Significance of the percentage of cholesterol efflux capacity and total cholesterol efflux capacity in patients with or without coronary artery disease. Heart Vessels 2016; 32:30-38. [PMID: 27106918 DOI: 10.1007/s00380-016-0837-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 04/15/2016] [Indexed: 01/11/2023]
Abstract
We hypothesized that cholesterol efflux capacity is more useful than the lipid profile as a marker of the presence and the severity of coronary artery disease (CAD). Therefore, we investigated the associations between the presence and the severity of CAD and both the percentage of cholesterol efflux capacity and total cholesterol efflux capacity and the lipid profile including the high-density lipoprotein cholesterol (HDL-C) level in patients who underwent coronary computed tomography angiography (CTA). The subjects consisted of 204 patients who were clinically suspected to have CAD and underwent CTA. We isolated HDL from plasma by ultracentrifugation and measured the percentage of cholesterol efflux capacity using 3H-cholesterol-labeled J774 macrophage cells and calculated total cholesterol efflux capacity as follows: the percentage of cholesterol efflux capacity/100× HDL-C levels. While the percentage of cholesterol efflux capacity was not associated with the presence or the severity of CAD, total cholesterol efflux capacity and HDL-C in patients with CAD were significantly lower than those in patients without CAD. In addition, total cholesterol efflux capacity and HDL-C, but not the percentage of cholesterol efflux capacity, significantly decreased as the number of coronary arteries with significant stenosis increased. Total cholesterol efflux capacity was positively correlated with HDL-C, whereas the percentage of cholesterol efflux capacity showed only weak association. In a logistic regression analysis, the presence of CAD was independently associated with total cholesterol efflux capacity, in addition to age and gender. Finally, a receiver-operating characteristic curve analysis indicated that the areas under the curves for total cholesterol efflux capacity and HDL-C were similar. In conclusion, the percentage of cholesterol efflux capacity using the fixed amount of isolated HDL was not associated with CAD. On the other hand, the calculated total cholesterol efflux capacity that was dependent of HDL-C levels had a significant correlation with the presence of CAD.
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Tanaka LY, Araújo HA, Hironaka GK, Araujo TL, Takimura CK, Rodriguez AI, Casagrande AS, Gutierrez PS, Lemos-Neto PA, Laurindo FR. Peri/Epicellular Protein Disulfide Isomerase Sustains Vascular Lumen Caliber Through an Anticonstrictive Remodeling Effect. Hypertension 2016; 67:613-22. [DOI: 10.1161/hypertensionaha.115.06177] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 11/16/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Leonardo Y. Tanaka
- From the Vascular Biology Laboratory (L.Y.T., H.A.A., G.K.H., T.L.S.A., A.I.R., A.S.C., F.R.M.L.), Interventional Cardiology Unit (C.K.T., P.A.L.-N.), and Pathology Laboratory (P.S.G.), Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, Brazil
| | - Haniel A. Araújo
- From the Vascular Biology Laboratory (L.Y.T., H.A.A., G.K.H., T.L.S.A., A.I.R., A.S.C., F.R.M.L.), Interventional Cardiology Unit (C.K.T., P.A.L.-N.), and Pathology Laboratory (P.S.G.), Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, Brazil
| | - Gustavo K. Hironaka
- From the Vascular Biology Laboratory (L.Y.T., H.A.A., G.K.H., T.L.S.A., A.I.R., A.S.C., F.R.M.L.), Interventional Cardiology Unit (C.K.T., P.A.L.-N.), and Pathology Laboratory (P.S.G.), Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, Brazil
| | - Thaís L.S. Araujo
- From the Vascular Biology Laboratory (L.Y.T., H.A.A., G.K.H., T.L.S.A., A.I.R., A.S.C., F.R.M.L.), Interventional Cardiology Unit (C.K.T., P.A.L.-N.), and Pathology Laboratory (P.S.G.), Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, Brazil
| | - Celso K. Takimura
- From the Vascular Biology Laboratory (L.Y.T., H.A.A., G.K.H., T.L.S.A., A.I.R., A.S.C., F.R.M.L.), Interventional Cardiology Unit (C.K.T., P.A.L.-N.), and Pathology Laboratory (P.S.G.), Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, Brazil
| | - Andres I. Rodriguez
- From the Vascular Biology Laboratory (L.Y.T., H.A.A., G.K.H., T.L.S.A., A.I.R., A.S.C., F.R.M.L.), Interventional Cardiology Unit (C.K.T., P.A.L.-N.), and Pathology Laboratory (P.S.G.), Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, Brazil
| | - Annelise S. Casagrande
- From the Vascular Biology Laboratory (L.Y.T., H.A.A., G.K.H., T.L.S.A., A.I.R., A.S.C., F.R.M.L.), Interventional Cardiology Unit (C.K.T., P.A.L.-N.), and Pathology Laboratory (P.S.G.), Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, Brazil
| | - Paulo S. Gutierrez
- From the Vascular Biology Laboratory (L.Y.T., H.A.A., G.K.H., T.L.S.A., A.I.R., A.S.C., F.R.M.L.), Interventional Cardiology Unit (C.K.T., P.A.L.-N.), and Pathology Laboratory (P.S.G.), Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, Brazil
| | - Pedro Alves Lemos-Neto
- From the Vascular Biology Laboratory (L.Y.T., H.A.A., G.K.H., T.L.S.A., A.I.R., A.S.C., F.R.M.L.), Interventional Cardiology Unit (C.K.T., P.A.L.-N.), and Pathology Laboratory (P.S.G.), Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, Brazil
| | - Francisco R.M. Laurindo
- From the Vascular Biology Laboratory (L.Y.T., H.A.A., G.K.H., T.L.S.A., A.I.R., A.S.C., F.R.M.L.), Interventional Cardiology Unit (C.K.T., P.A.L.-N.), and Pathology Laboratory (P.S.G.), Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, Brazil
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Abdeldayem EH, Ibrahim AS, Ahmed AM, Genedi ES, Tantawy WH. Positive remodeling index by MSCT coronary angiography: A prognostic factor for early detection of plaque rupture and vulnerability. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2014.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Sullivan DR, Watts GF, Nicholls SJ, Barter P, Grenfell R, Chow CK, Tonkin A, Keech A. Clinical guidelines on hyperlipidaemia: recent developments, future challenges and the need for an Australian review. Heart Lung Circ 2015; 24:495-502. [PMID: 25676115 DOI: 10.1016/j.hlc.2014.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 12/03/2014] [Accepted: 12/08/2014] [Indexed: 12/11/2022]
Abstract
Large reductions in cardiovascular disease (CVD) mortality have been achieved over the last 50 years in developed countries. The health policies that have contributed so much to this success have largely been coordinated by means of expert guidelines for the management of the classic modifiable risk factors such as blood pressure, diabetes and blood lipids. National and international guidelines for lipid management have demonstrated a high degree of consistency between numerous sets of recommendations. It has been argued that some important components of the consensus that has been established over the past decade have been challenged by the latest guidelines of the American Heart Association - American College of Cardiologists (AHA-ACC). Clinicians can be reassured that continued reliance on extensive scientific evidence has reaffirmed the importance of lipid metabolism as a modifiable risk factor for atherosclerotic cardiovascular disease. On the other hand, the recent AHA-ACC guidelines suggest changes in the strategies by which metabolic risk factors may be modified. This small number of important changes should not be sensationalised because these differences usefully reflect the need for guidelines to evolve to accommodate different contexts and changing perspectives as well as emerging issues and new information for which clinical trial evidence is incomplete. This article will consider the recent policies and responses of national and supranational organisations on topics including components of CVD risk assessment, sources of CVD risk information and re-appraisal of lipid-lowering interventions. Timely review of Australian lipid management guidelines will require consideration of these issues because they are creating a new context within which new guidelines must evolve.
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Affiliation(s)
- D R Sullivan
- Department of Chemical Pathology, Royal Prince Alfred Hospital, Camperdown, NSW.
| | - G F Watts
- Department of Medicine, University of Western Australia, Perth, WA
| | - S J Nicholls
- South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, SA
| | - P Barter
- Centre for Vascular Research, University of NSW, Sydney NSW
| | - R Grenfell
- National Heart Foundation Director of Cardiovascular Health, Melbourne Vic
| | - C K Chow
- The George Institute for International Health, University of Sydney, Camperdown, Sydney NSW
| | - A Tonkin
- Cardiovascular Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic
| | - A Keech
- NHMRC Clinical Trials Centre, University of Sydney and Royal Prince Alfred Hospital, University of Sydney, NSW
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Yayan J. Association of traditional risk factors with coronary artery disease in nonagenarians: the primary role of hypertension. Clin Interv Aging 2014; 9:2003-12. [PMID: 25429212 PMCID: PMC4242066 DOI: 10.2147/cia.s74471] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Previous studies have shown different relationships between traditional cardiovascular risk factors for coronary artery disease (CAD) in very elderly people. Although new associations with CAD have been reported, there is also evidence of the possibility of new therapeutic strategies for the treatment or prevention of CAD. DESIGN This article retrospectively examines the possible association of traditional cardiovascular risk factors with CAD in very elderly people aged >90 years. This study represents the hypothesis that the elderly aged >90 years have a different cardiovascular profile with respect to CAD than patients <90 years old. METHODS Data on all patients aged >90 years who received a cardiac catheterization were collected from hospital charts from the Department of Internal Medicine, Saarland University Medical Center, Germany, within the study period of 2004-2013. The cardiovascular risk profiles were compared in patients aged >90 years with and without CAD after cardiac catheterization. RESULTS One hundred and six out of 67,976 (0.2%, mean age 91.6±1.8 years, 40 female [37.7%]; 95% confidence interval [CI]: 0.1-0.2), and out of a total of 114 of the very elderly patients, were found to have CAD. From the results of this study, the author could establish only a causal relationship between hypertension and CAD in very elderly people (P=0.005). At best, this is just an association with a higher risk of CAD in this age group. Several studies with similar outcomes are needed to establish causality. CONCLUSION This study could find no link between CAD and traditional risk factors, except for hypertension.
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Affiliation(s)
- Josef Yayan
- Department of Internal Medicine, Division of Pulmonary, Allergy and Sleep Medicine, Saarland University Medical Center, Homburg, Saarland, Germany
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Yayan J. Weak prediction power of the Framingham Risk Score for coronary artery disease in nonagenarians. PLoS One 2014; 9:e113044. [PMID: 25393521 PMCID: PMC4231135 DOI: 10.1371/journal.pone.0113044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 10/16/2014] [Indexed: 11/29/2022] Open
Abstract
Background Coronary artery disease (CAD) is caused by an acute myocardial infarction and is still feared as a life-threatening heart disease worldwide. In order to identify patients at high risk for CAD, previous studies have proposed various risk assessment scores for the prevention of CAD. The most commonly used risk assessment score for CAD worldwide is the Framingham Risk Score (FRS). The FRS is used for middle-aged people; hence, its appropriateness has not been demonstrated to predict the likelihood of CAD occurrence in very elderly people. This article examines the possible predictive value of FRS for CAD in very elderly people over 90 years of age. Methods Data on all patients over 90 years of age who received a cardiac catheter were collected from hospital charts from the Department of Internal Medicine, Saarland University Medical Center, and HELIOS Hospital Wuppertal, Witten/Herdecke University Medical Center, Germany, within a study period from 2004 to 2013. The FRSs and cardiovascular risk profiles of patients over 90 years of age with and without CAD after cardiac catheterization were compared. Results One hundred and seventy-five (91.15%, mean age 91.51±1.80 years, 74 females [42.29%]; 95% confidence interval [CI], 0.87–0.95) of a total 192 of the very elderly patients were found to have CAD. Based on the results of our study, the FRS seems to provide weak predictive ability for CAD in very elderly people (P = 0.3792). Conclusion We found weak prediction power of FRS for CAD in nonagenarians.
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Affiliation(s)
- Josef Yayan
- Department of Internal Medicine, Division of Pulmonary, Allergy, and Sleep Medicine, Saarland University Medical Center, Homburg/Saar, Germany
- * E-mail:
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Stegman B, Puri R, Cho L, Shao M, Ballantyne CM, Barter PJ, Chapman MJ, Erbel R, Libby P, Raichlen JS, Uno K, Kataoka Y, Nissen SE, Nicholls SJ. High-intensity statin therapy alters the natural history of diabetic coronary atherosclerosis: insights from SATURN. Diabetes Care 2014; 37:3114-20. [PMID: 25190674 DOI: 10.2337/dc14-1121] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Although statins can induce coronary atheroma regression, this benefit has yet to be demonstrated in diabetic individuals. We tested the hypothesis that high-intensity statin therapy may promote coronary atheroma regression in patients with diabetes. RESEARCH DESIGN AND METHODS The Study of Coronary Atheroma by Intravascular Ultrasound: Effect of Rosuvastatin Versus Atorvastatin (SATURN) used serial intravascular ultrasound measures of coronary atheroma volume in patients treated with rosuvastatin 40 mg or atorvastatin 80 mg for 24 months. This analysis compared changes in biochemistry and coronary percent atheroma volume (PAV) in patients with (n = 159) and without (n = 880) diabetes. RESULTS At baseline, patients with diabetes had lower LDL cholesterol (LDL-C) and HDL cholesterol (HDL-C) levels but higher triglyceride and CRP levels compared with patients without diabetes. At follow-up, diabetic patients had lower levels of LDL-C (61.0 ± 20.5 vs. 66.4 ± 22.9 mg/dL, P = 0.01) and HDL-C (46.3 ± 10.6 vs. 49.9 ± 12.0 mg/dL, P < 0.001) but higher levels of triglycerides (127.6 [98.8, 163.0] vs. 113.0 mg/dL [87.6, 151.9], P = 0.001) and CRP (1.4 [0.7, 3.3] vs. 1.0 [0.5, 2.1] mg/L, P = 0.001). Both patients with and without diabetes demonstrated regression of coronary atheroma as measured by change in PAV (-0.83 ± 0.13 vs. -1.15 ± 0.13%, P = 0.08). PAV regression was less in diabetic compared with nondiabetic patients when on-treatment LDL-C levels were >70 mg/dL (-0.31 ± 0.23 vs. -1.01 ± 0.21%, P = 0.03) but similar when LDL-C levels were ≤70 mg/dL (-1.09 ± 0.16 vs. -1.24 ± 0.16%, P = 0.50). CONCLUSIONS High-intensity statin therapy alters the progressive nature of diabetic coronary atherosclerosis, yielding regression of disease in diabetic and nondiabetic patients.
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Affiliation(s)
- Brian Stegman
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
| | - Rishi Puri
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH C5Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
| | - Leslie Cho
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
| | - Mingyuan Shao
- C5Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
| | - Christie M Ballantyne
- Section of Cardiovascular Research, Baylor College of Medicine, and the Methodist DeBakey Heart and Vascular Center, Houston, TX
| | - Phillip J Barter
- Centre for Vascular Research, University of New South Wales, Sydney, Australia
| | - M John Chapman
- INSERM Dyslipidaemia and Atherosclerosis Research Unit, Pitié-Salpètrière University Hospital, Paris, France
| | | | - Peter Libby
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA
| | | | - Kiyoko Uno
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
| | - Yu Kataoka
- South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, Australia
| | - Steven E Nissen
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH C5Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
| | - Stephen J Nicholls
- South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, Australia
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Shimizu T, Miura SI, Tanigawa H, Kuwano T, Zhang B, Uehara Y, Saku K. Rosuvastatin Activates ATP-Binding Cassette Transporter A1–Dependent Efflux Ex Vivo and Promotes Reverse Cholesterol Transport in Macrophage Cells in Mice Fed a High-Fat Diet. Arterioscler Thromb Vasc Biol 2014; 34:2246-53. [DOI: 10.1161/atvbaha.114.303715] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Tomohiko Shimizu
- From the Departments of Cardiology (T.S., S.M., H.T., T.K., Y.U., K.S.), Molecular Cardiovascular Therapeutics (S.M., Y.U., K.S.), Biochemistry (B.Z.), and Advanced Therapeutics for Cardiovascular Disease (H.T., K.S.), Fukuoka University School of Medicine, Fukuoka, Japan
| | - Shin-ichiro Miura
- From the Departments of Cardiology (T.S., S.M., H.T., T.K., Y.U., K.S.), Molecular Cardiovascular Therapeutics (S.M., Y.U., K.S.), Biochemistry (B.Z.), and Advanced Therapeutics for Cardiovascular Disease (H.T., K.S.), Fukuoka University School of Medicine, Fukuoka, Japan
| | - Hiroyuki Tanigawa
- From the Departments of Cardiology (T.S., S.M., H.T., T.K., Y.U., K.S.), Molecular Cardiovascular Therapeutics (S.M., Y.U., K.S.), Biochemistry (B.Z.), and Advanced Therapeutics for Cardiovascular Disease (H.T., K.S.), Fukuoka University School of Medicine, Fukuoka, Japan
| | - Takashi Kuwano
- From the Departments of Cardiology (T.S., S.M., H.T., T.K., Y.U., K.S.), Molecular Cardiovascular Therapeutics (S.M., Y.U., K.S.), Biochemistry (B.Z.), and Advanced Therapeutics for Cardiovascular Disease (H.T., K.S.), Fukuoka University School of Medicine, Fukuoka, Japan
| | - Bo Zhang
- From the Departments of Cardiology (T.S., S.M., H.T., T.K., Y.U., K.S.), Molecular Cardiovascular Therapeutics (S.M., Y.U., K.S.), Biochemistry (B.Z.), and Advanced Therapeutics for Cardiovascular Disease (H.T., K.S.), Fukuoka University School of Medicine, Fukuoka, Japan
| | - Yoshinari Uehara
- From the Departments of Cardiology (T.S., S.M., H.T., T.K., Y.U., K.S.), Molecular Cardiovascular Therapeutics (S.M., Y.U., K.S.), Biochemistry (B.Z.), and Advanced Therapeutics for Cardiovascular Disease (H.T., K.S.), Fukuoka University School of Medicine, Fukuoka, Japan
| | - Keijiro Saku
- From the Departments of Cardiology (T.S., S.M., H.T., T.K., Y.U., K.S.), Molecular Cardiovascular Therapeutics (S.M., Y.U., K.S.), Biochemistry (B.Z.), and Advanced Therapeutics for Cardiovascular Disease (H.T., K.S.), Fukuoka University School of Medicine, Fukuoka, Japan
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25
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Sun Z, Xu L. Computational fluid dynamics in coronary artery disease. Comput Med Imaging Graph 2014; 38:651-63. [PMID: 25262321 DOI: 10.1016/j.compmedimag.2014.09.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Revised: 08/22/2014] [Accepted: 09/03/2014] [Indexed: 01/01/2023]
Abstract
Computational fluid dynamics (CFD) is a widely used method in mechanical engineering to solve complex problems by analysing fluid flow, heat transfer, and associated phenomena by using computer simulations. In recent years, CFD has been increasingly used in biomedical research of coronary artery disease because of its high performance hardware and software. CFD techniques have been applied to study cardiovascular haemodynamics through simulation tools to predict the behaviour of circulatory blood flow in the human body. CFD simulation based on 3D luminal reconstructions can be used to analyse the local flow fields and flow profiling due to changes of coronary artery geometry, thus, identifying risk factors for development and progression of coronary artery disease. This review aims to provide an overview of the CFD applications in coronary artery disease, including biomechanics of atherosclerotic plaques, plaque progression and rupture; regional haemodynamics relative to plaque location and composition. A critical appraisal is given to a more recently developed application, fractional flow reserve based on CFD computation with regard to its diagnostic accuracy in the detection of haemodynamically significant coronary artery disease.
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Affiliation(s)
- Zhonghua Sun
- Discipline of Medical Imaging, Department of Imaging and Applied Physics, Curtin University, Perth, Western Australia 6845, Australia.
| | - Lei Xu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
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26
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Coronary CT angiography in the quantitative assessment of coronary plaques. BIOMED RESEARCH INTERNATIONAL 2014; 2014:346380. [PMID: 25162010 PMCID: PMC4138793 DOI: 10.1155/2014/346380] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 07/17/2014] [Indexed: 01/31/2023]
Abstract
Coronary computed tomography angiography (CCTA) has been recently evaluated for its ability to assess coronary plaque characteristics, including plaque composition. Identification of the relationship between plaque composition by CCTA and patient clinical presentations may provide insight into the pathophysiology of coronary artery plaque, thus assisting identification of vulnerable plaques which are associated with the development of acute coronary syndrome. CCTA-generated 3D visualizations allow evaluation of both coronary lesions and lumen changes, which are considered to enhance the diagnostic performance of CCTA. The purpose of this review is to discuss the recent developments that have occurred in the field of CCTA with regard to its diagnostic accuracy in the quantitative assessment of coronary plaques, with a focus on the characterization of plaque components and identification of vulnerable plaques.
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Jinnouchi H, Sakakura K, Wada H, Ishida K, Arao K, Kubo N, Sugawara Y, Funayama H, Ako J, Momomura SI. Effect of chronic statin treatment on vascular remodeling determined by intravascular ultrasound in patients with acute myocardial infarction. Am J Cardiol 2014; 113:924-9. [PMID: 24456817 DOI: 10.1016/j.amjcard.2013.11.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 11/23/2013] [Accepted: 11/23/2013] [Indexed: 12/13/2022]
Abstract
Early statin treatment of patients with acute coronary syndrome results in vascular changes and improved clinical outcomes. However, the influence of chronic statin treatment on the culprit vessel in acute coronary syndrome is not fully understood. The aim of this study was to investigate the morphologic features of the culprit vessel in acute myocardial infarction by comparing patients with and without chronic statin treatment. We enroled consecutive patients with AMI, who had hyperlipidemia and primary percutaneous coronary intervention guided by intravascular ultrasound within 24 hours of symptom onset. Of 155 patients, 73 patients were stratified to the chronic statin group and 82 to the nonstatin group. Intravascular ultrasound in both the groups showed that positive remodeling was significantly less frequent in the chronic statin group (46.6%) compared with the nonstatin group (70.7%; p = 0.001). Necrotic core area was significantly smaller in the chronic statin group (2.2 ± 1.3 mm(2)) compared with the nonstatin group (3.2 ± 2.1 mm(2); p <0.001). Multivariate logistic regression analysis revealed that chronic statin treatment was significantly associated with less positive remodeling (odds ratio 0.283, 95% confidence interval 0.111 to 0.723, p = 0.008). In conclusion, chronic statin treatment reduced positive remodeling in the culprit lesions of patients with acute myocardial infarction.
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28
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Tayeh O, Ettori F. Vascular access and angiographic lesion morphology in elective percutaneous coronary intervention. Egypt Heart J 2014. [DOI: 10.1016/j.ehj.2013.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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29
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Derosa G, Maffioli P. Effects of amlodipine plus atorvastatin association in hypertensive hypercholesterolemic patients. Expert Rev Cardiovasc Ther 2014; 8:835-43. [DOI: 10.1586/erc.10.51] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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30
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Riccioni G. Integrated control of hypertension, dyslipidemia and carotid atherosclerosis in the reduction of cardiovascular risk. Expert Rev Cardiovasc Ther 2014; 5:371-4. [PMID: 17489661 DOI: 10.1586/14779072.5.3.371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
Intracranial stenosis accounts for 8-10% of ischemic strokes in the USA. Treatment of intracranial stenosis with extracranial-to-intracranial bypass surgery was investigated as a therapy in the 1980s, but was shown to be no better than aspirin alone. The Warfarin vs Aspirin for Symptomatic Intracranial Disease study found a 12% per year risk of recurrent stroke for symptomatic lesions of 50% or higher, with the majority of strokes occurring in the first year. Warfarin was no better than aspirin in the prevention of recurrent stroke and had a higher risk of serious bleeding and death. Subgroup analysis showed that patients with the highest risk of recurrent stroke included those with 70% or more stenosis and/or recent symptoms and women. Angioplasty and stenting of intracranial stenosis have been undergoing rapid evolution in technology and are emerging as a promising therapy. Current treatment recommendations include antiplatelet agents, with consideration for angioplasty alone or angioplasty and stenting in cases refractory to medical therapy.
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Affiliation(s)
- Robert A Taylor
- Department of Radiology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242-1077, USA.
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32
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Heo JH, Brugaletta S, Garcia-Garcia HM, Gomez-Lara J, Ligthart JM, Witberg K, Magro M, Shin ES, Serruys PW. Reproducibility of intravascular ultrasound iMAP for radiofrequency data analysis: Implications for design of longitudinal studies. Catheter Cardiovasc Interv 2013; 83:E233-42. [DOI: 10.1002/ccd.23335] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 07/04/2011] [Accepted: 08/08/2011] [Indexed: 11/09/2022]
Affiliation(s)
- Jung Ho Heo
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Salvatore Brugaletta
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
- Thorax Institute, Department of cardiology, Hospital Clinic, Barcelona, Spain
| | - Hector M. Garcia-Garcia
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
- Thorax Institute, Department of cardiology, Hospital Clinic, Barcelona, Spain
- Cardialysis, Rotterdam BV, The Netherlands
| | - Josep Gomez-Lara
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Jurgen M.R. Ligthart
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Karen Witberg
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Michael Magro
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Eun-Seok Shin
- Division of Cardiology, Ulsan University Hospital, South Korea
| | - Patrick W. Serruys
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
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Rached FH, Santos RD. Validating the benefits of lipid modifying therapies upon atherosclerotic plaque by computed tomography angiography: should we trust our eyes? Commentary on the study of Zeb et al. Atherosclerosis 2013; 231:189-90. [PMID: 24267224 DOI: 10.1016/j.atherosclerosis.2013.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 09/19/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Fabiana H Rached
- Heart Institute (InCor)- University of Sao Paulo Medical School Hospital, Sao Paulo, Brazil
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Kashyap VS, Lakin RO, Feiten LE, Bishop PD, Sarac TP. In vivo assessment of endothelial function in human lower extremity arteries. J Vasc Surg 2013; 58:1259-66. [PMID: 23830159 DOI: 10.1016/j.jvs.2013.05.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 05/09/2013] [Accepted: 05/10/2013] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Endothelial function has been measured in preclinical studies in human brachial and coronary arteries but not in lower extremity arteries affected by atherosclerosis. We describe a novel, first-in-man evaluation of endothelial function of the superficial femoral arteries (SFAs) in patients with peripheral arterial disease (PAD). METHODS Enrolled were 25 patients with PAD requiring lower extremity angiography. Endothelial-dependent relaxation was measured using intravascular ultrasound (IVUS) imaging and a Doppler flow wire after the infusion of acetylcholine (Ach). IVUS-derived virtual histology of the same vessel was calculated. Endothelial-independent relaxation was measured with an infusion of nitroglycerin (200 μg). Levels of nitric oxide and serum nitric oxide metabolites were determined by laboratory analysis. RESULTS Patients (48% male; mean age, 62 years) had a history of hypertension (80%), coronary disease (36%), and diabetes (40%). The mean SFA diameter was 5.2 ± 1 mm (range, 3.2-6.9 mm). Patients tolerated Ach infusion with no adverse events. Endothelial-dependent relaxation increased over baseline for all patients with Ach infusion of 10(-6) to 10(-4). At Ach 10(-4), diameter (0.5%) and area (1.8%) changes in the diseased SFAs were modest and insignificant; however, average peak velocity of blood flow significantly increased 26%, 46%, and 63% with an Ach 10(-6) to 10(-4) infusion. Calculations of limb volumetric flow (68% at Ach 10(-4)) were significantly increased after Ach infusion. Lower extremity nitric oxide levels were slightly lower than systemic venous levels (P = .04). Nitroglycerin infusion indicated normal smooth muscle responsiveness (3% diameter, 9% area, and 116% velocity change over baseline). IVUS-virtual histology plaque stratification indicated predominantly fibrous morphology (46%; necrotic core, 29%; calcium, 18%). Atheroma burden was 14.9 ± 5.5 mm(3)/cm and did not correlate with endothelial responsiveness. CONCLUSIONS Endothelial function can be measured directly in human lower extremity arteries at the sites of vascular disease. Despite extensive atherosclerosis, endothelial function is still intact. These data support the application of regional endothelial-specific biologic therapies in patients with PAD.
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Affiliation(s)
- Vikram S Kashyap
- Division of Vascular Surgery and Endovascular Therapy, University Hospitals, Case Medical Center, Cleveland, Ohio.
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Chen YC, Bui AV, Diesch J, Manasseh R, Hausding C, Rivera J, Haviv I, Agrotis A, Htun NM, Jowett J, Hagemeyer CE, Hannan RD, Bobik A, Peter K. A novel mouse model of atherosclerotic plaque instability for drug testing and mechanistic/therapeutic discoveries using gene and microRNA expression profiling. Circ Res 2013; 113:252-65. [PMID: 23748430 DOI: 10.1161/circresaha.113.301562] [Citation(s) in RCA: 149] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
RATIONALE The high morbidity/mortality of atherosclerosis is typically precipitated by plaque rupture and consequent thrombosis. However, research on underlying mechanisms and therapeutic approaches is limited by the lack of animal models that reproduce plaque instability observed in humans. OBJECTIVE Development and use of a mouse model of plaque rupture that reflects the end stage of human atherosclerosis. METHODS AND RESULTS On the basis of flow measurements and computational fluid dynamics, we applied a tandem stenosis to the carotid artery of apolipoprotein E-deficient mice on high-fat diet. At 7 weeks postoperatively, we observed intraplaque hemorrhage in ≈50% of mice, as well as disruption of fibrous caps, intraluminal thrombosis, neovascularization, and further characteristics typically seen in human unstable plaques. Administration of atorvastatin was associated with plaque stabilization and downregulation of monocyte chemoattractant protein-1 and ubiquitin. Microarray profiling of mRNA and microRNA (miR) and, in particular, its combined analysis demonstrated major differences in the hierarchical clustering of genes and miRs among nonatherosclerotic arteries, stable, and unstable plaques and allows the identification of distinct genes/miRs, potentially representing novel therapeutic targets for plaque stabilization. The feasibility of the described animal model as a discovery tool was established in a pilot approach, identifying a disintegrin and metalloprotease with thrombospondin motifs 4 (ADAMTS4) and miR-322 as potential pathogenic factors of plaque instability in mice and validated in human plaques. CONCLUSIONS The newly described mouse model reflects human atherosclerotic plaque instability and represents a discovery tool toward the development and testing of therapeutic strategies aimed at preventing plaque rupture. Distinctly expressed genes and miRs can be linked to plaque instability.
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Affiliation(s)
- Yung-Chih Chen
- Baker IDI Heart & Diabetes Institute, Melbourne, Australia
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Puri R, Nissen SE, Ballantyne CM, Barter PJ, Chapman MJ, Erbel R, Libby P, Raichlen JS, St. John J, Wolski K, Uno K, Kataoka Y, Nicholls SJ. Factors underlying regression of coronary atheroma with potent statin therapy. Eur Heart J 2013; 34:1818-25. [DOI: 10.1093/eurheartj/eht084] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kwan AC, Cater G, Vargas J, Bluemke DA. Beyond Coronary Stenosis: Coronary Computed Tomographic Angiography for the Assessment of Atherosclerotic Plaque Burden. CURRENT CARDIOVASCULAR IMAGING REPORTS 2013; 6:89-101. [PMID: 23524381 PMCID: PMC3601491 DOI: 10.1007/s12410-012-9183-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Coronary computed tomographic angiography (CCTA) is emerging as a key non-invasive method for assessing cardiovascular risk by measurement of coronary stenosis and coronary artery calcium (CAC). New advancements in CCTA technology have led to the ability to directly identify and quantify the so-called "vulnerable" plaques that have features of positive remodeling and low density components. In addition, CCTA presents a new opportunity for noninvasive measurement of total coronary plaque burden that has not previously been available. The use of CCTA needs also to be balanced by its risks and, in particular, the associated radiation exposure. We review current uses of CCTA, CCTA's ability to measure plaque quantity and characteristics, and new developments in risk stratification and CCTA technology. CCTA represents a quickly developing field that will play a growing role in the non-invasive management of cardiovascular disease.
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Affiliation(s)
- Alan C Kwan
- Radiology and Imaging Sciences - National Institutes of Health Clinical Center, Bethesda, MD, USA
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Alexopoulos N, Melek BH, Arepalli CD, Hartlage GR, Chen Z, Kim S, Stillman AE, Raggi P. Effect of intensive versus moderate lipid-lowering therapy on epicardial adipose tissue in hyperlipidemic post-menopausal women: a substudy of the BELLES trial (Beyond Endorsed Lipid Lowering with EBT Scanning). J Am Coll Cardiol 2013; 61:1956-61. [PMID: 23500254 DOI: 10.1016/j.jacc.2012.12.051] [Citation(s) in RCA: 124] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 12/10/2012] [Accepted: 12/16/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVES This study sought to evaluate the effect of intensive and moderate statin therapy on epicardial adipose tissue (EAT). BACKGROUND EAT has been associated with coronary artery disease severity and outcome. It is currently unknown whether EAT volume changes over time when patients are exposed to statin therapy. METHODS Subanalysis of a randomized study of atorvastatin 80 mg/day versus pravastatin 40 mg/day for 1 year in a clinical trial designed to assess the progression of coronary artery calcium (CAC) in hyperlipidemic post-menopausal women. Patients underwent cardiac computed tomography scans at the start and end of the trial period. RESULTS Of 420 patients, 194 received atorvastatin and 226 pravastatin; the median low-density lipoprotein change was -53.3% and -28.3% with atorvastatin and pravastatin, respectively (p < 0.001). Baseline EAT correlated with age, body mass index, hypertension, diabetes mellitus, high-density lipoprotein, triglyceride levels, and CAC (p < 0.001). At the end of follow-up, EAT regressed more in the atorvastatin than in the pravastatin group (median, -3.38% vs. -0.83%, p = 0.025). The EAT percent change from baseline was significant in the atorvastatin, but not the pravastatin group (p < 0.001 and p = 0.2, respectively). There was no correlation between lipid lowering and EAT regression. CAC progressed significantly in both groups from baseline. CONCLUSIONS In hyperlipidemic post-menopausal women, statin therapy induced EAT regression, although intensive therapy was more effective than moderate-intensity therapy. This effect does not seem linked to low-density lipoprotein lowering and may be secondary to other actions of statins such as anti-inflammatory effects.
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Affiliation(s)
- Nikolaos Alexopoulos
- Division of Cardiology, Department of Medicine, Emory University, Atlanta, Georgia, USA
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Hwang DS, Shin ES, Kim SJ, Lee JH, Kim JM, Lee SG. Early differential changes in coronary plaque composition according to plaque stability following statin initiation in acute coronary syndrome: classification and analysis by intravascular ultrasound-virtual histology. Yonsei Med J 2013; 54:336-44. [PMID: 23364965 PMCID: PMC3575992 DOI: 10.3349/ymj.2013.54.2.336] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 07/02/2012] [Accepted: 07/04/2012] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The aim of this study was to demonstrate the early effects of statin treatment on plaque composition according to plaque stability on Intravascular Ultrasound- Virtual Histology at 6 months after a coronary event. Previous trials have demonstrated that lipid lowering therapy with statins decreases plaque volume and increases plaque echogenicity in patients with coronary artery disease. MATERIALS AND METHODS Fifty-four patients (54 lesions) with acute coronary syndrome were prospectively enrolled. We classified and analyzed the target plaques into two types according to plaque stability: thin-cap fibroatheroma (TCFA, n=14) and non-TCFA (n=40). The primary end point was change in percent necrotic core in the 10-mm subsegment with the most disease. RESULTS After 6 months of statin therapy, no change was demonstrated in the mean percentage of necrotic core (18.7±8.5% to 20.0±11.0%, p=0.38). There was a significant reduction in necrotic core percentage in patients with TCFA (21.3±7.2% to 14.4±8.9%, p=0.017), but not in patients with non-TCFA. Moreover, change in percent necrotic core was significantly correlated with change in high-sensitivity C-reactive protein levels (r=0.4, p=0.003). Changes in low-density lipoprotein cholesterol levels and lipid core percentage demonstrated no significant associations. CONCLUSION A clear reduction of lipid core was observed only for the TCFA plaque type, suggesting that changes in plaque composition following statin therapy might occur earlier in vulnerable plaque than in stable plaque; the effect may be related to the anti-inflammatory effects of statins.
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Affiliation(s)
- Dae Seong Hwang
- Department of Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Eun Seok Shin
- Department of Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Shin Jae Kim
- Department of Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jun Ho Lee
- Department of Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jong Min Kim
- Department of Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Sang-Gon Lee
- Department of Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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Singh M, Bedi US. Is Atherosclerosis Regression a Realistic Goal of Statin Therapy and What Does That Mean? Curr Atheroscler Rep 2012; 15:294. [DOI: 10.1007/s11883-012-0294-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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41
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Coronary CT angiography and high-risk plaque morphology. Cardiovasc Interv Ther 2012; 28:1-8. [PMID: 23108779 DOI: 10.1007/s12928-012-0140-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 10/01/2012] [Indexed: 02/07/2023]
Abstract
Computed tomography angiography (CTA) is commonly employed for exclusion of coronary artery disease and demonstration of the extent of coronary vascular involvement. It has been recently proposed that coronary artery plaques could be visualized noninvasively. This review article focused on the high risk plaque detected by CTA. Plaque characteristics of acute coronary syndrome (ACS) was compared to sable angina pectoris (SAP). The presence of positive remodeling (ACS 87 %, SAP 12 %, p < 0.0001), low attenuation plaque (LAP) (ACS 79 %, SAP 9 %, p < 0.0001), and spotty calcification (ACS 63 %, SAP 21 %, p = 0.0005) were significantly more frequent in the culprit ACS lesions. Furthermore, in asymptomatic patients, presence of positively remodeling and LAP portends a greater risk for development of acute coronary events (hazard ratio = 22.8, CI = 6.9-75.2, p < 0.001). Possibility of drug intervention to high risk plaque was also reported. Serial CTA assessment allows for evaluation of interval change in morphological plaque characteristics and can be employed for assessment of efficacy of therapeutic intervention. Use of statin results in substantial reduction in LAP volume (follow-up: 4.9 ± 7.8 versus baseline: 1.3 ± 2.3 mm(3), p = 0.02) forwards stabilization of plaques. Although not recommended currently as a population-based strategy, CT angiographic examination may help identify very high risk asymptomatic subjects.
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Han SH, Chung WJ, Kang WC, Lee K, Park YM, Shin MS, Ahn TH, Choi IS, Shin EK. Rosuvastatin combined with ramipril significantly reduced atheroma volume by anti-inflammatory mechanism: Comparative analysis with rosuvastatin alone by intravascular ultrasound. Int J Cardiol 2012; 158:217-24. [DOI: 10.1016/j.ijcard.2011.01.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Revised: 12/14/2010] [Accepted: 01/10/2011] [Indexed: 11/27/2022]
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Nozue T, Yamamoto S, Tohyama S, Fukui K, Umezawa S, Onishi Y, Kunishima T, Sato A, Nozato T, Miyake S, Takeyama Y, Morino Y, Yamauchi T, Muramatsu T, Hibi K, Terashima M, Michishita I. Comparison of arterial remodeling and changes in plaque composition between patients with progression versus regression of coronary atherosclerosis during statin therapy (from the TRUTH study). Am J Cardiol 2012; 109:1247-53. [PMID: 22325089 DOI: 10.1016/j.amjcard.2011.12.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Revised: 12/15/2011] [Accepted: 12/15/2011] [Indexed: 12/12/2022]
Abstract
Statin therapy produces regression of coronary artery plaques and reduces the incidence of coronary artery disease. However, not all patients show regression of coronary atherosclerosis after statin therapy. The purpose of the present study was to identify differences in clinical characteristics, serum lipid profiles, arterial remodeling, and plaque composition between patients with progression and those with regression of coronary atherosclerosis during statin therapy. The effects of 8-month statin therapy on coronary atherosclerosis were evaluated in the Treatment With Statin on Atheroma Regression Evaluated by Intravascular Ultrasound With Virtual Histology (TRUTH) study using intravascular ultrasound-virtual histology. One hundred nineteen patients were divided into 2 groups according to atheroma volume increase (progressors) or decrease (regressors) during an 8-month follow-up period. Fifty-one patients (43%) were categorized as progressors and the remaining 68 (57%) as regressors. External elastic membrane volume increased, although not significantly (0.8%, p = 0.34), and luminal volume decreased significantly (-5.3%, p = 0.0003) in progressors, while external elastic membrane volume decreased significantly (-3.2%, p <0.0001) and luminal volume increased (2.2%, p = 0.13) in regressors. The fibrous component increased significantly in progressors, while this component decreased in regressors. A strong positive correlation was observed between change in atheroma volume and change in fibrous volume (r = 0.812, p <0.0001). In conclusion, coronary arteries showed negative remodeling during statin-induced plaque regression. The difference in plaque composition between patients with progression and those with regression of coronary atherosclerosis during statin therapy arose from the difference in the change in fibrous component.
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Affiliation(s)
- Tsuyoshi Nozue
- Division of Cardiology, Department of Internal Medicine, Yokohama Sakae Kyosai Hospital, Japan.
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Kim JH, Jeong MH, Hong YJ, Lee KH, Kim IS, Choi YH, Lee MG, Park KH, Sim DS, Kim JH, Ahn Y, Cho JG, Park JC, Kang JC. Low density lipoprotein-cholesterol/high density lipoprotein-cholesterol ratio predicts plaque vulnerability in patients with stable angina. Korean Circ J 2012; 42:246-51. [PMID: 22563337 PMCID: PMC3341421 DOI: 10.4070/kcj.2012.42.4.246] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Revised: 10/04/2011] [Accepted: 10/11/2011] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The relationship between lipid profile and coronary plaque tissue characteristics in patients with stable angina pectoris (SAP) is unclear. The aim of this study was to evaluate the relationship between tissue characteristics and lipid profile and predictors of unstable plaques (UPs) in patients with SAP by virtual histology intravascular ultrasonography (VH-IVUS). SUBJECTS AND METHODS VH-IVUS was performed for target lesions in patients with SAP (61.7±9.2 years, 174 males, n=266) at the time of coronary angiography. UPs are characterized by thin-cap fibroatheroma, ruptured plaque, or remaining thrombus with VH-IVUS. RESULTS The present study showed that 34 SAP patients had UPs (61.6±9.2 years, 24 males, 12.8%). The percentage of plaque area in the minimum luminal area in high low density lipoprotein-cholesterol (LDL-C)/high density lipoprotein-cholesterol (HDL-C) ratio patients was significantly higher than in low LDL-C/HDL-C ratio patients (72.7±9.5% vs. 69.9±9.3%, p=0.035). An LDL-C/HDL-C ratio >2.0 was an independent predictor for UPs in SAP patients (odds ratio 5.252, 95% confidence interval 1.132-24.372, p=0.034). CONCLUSION An elevated LDL-C/HDL-C ratio is a positive predictor for coronary plaque vulnerability in patients with SAP.
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Affiliation(s)
- Jeong Hun Kim
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
- Department of Public Health, Chonnam National University Medical School, Gwangju, Korea
| | - Myung Ho Jeong
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
- Korea Cardiovascular Stent Research Institute of Chonnam National University, Gwangju, Korea
| | - Young Joon Hong
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Ki Hong Lee
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - In Soo Kim
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Yun Ha Choi
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Min Goo Lee
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Keun-Ho Park
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Doo Sun Sim
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Ju Han Kim
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Youngkeun Ahn
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Jeong Gwan Cho
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Jong Chun Park
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Jung Chaee Kang
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
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Zamani P, Ganz P, Libby P, Sutradhar SC, Rifai N, Nicholls SJ, Nissen SE, Kinlay S. Relationship of antihypertensive treatment to plasma markers of vascular inflammation and remodeling in the Comparison of Amlodipine versus Enalapril to Limit Occurrences of Thrombosis study. Am Heart J 2012; 163:735-40. [PMID: 22520542 DOI: 10.1016/j.ahj.2011.12.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 12/18/2011] [Indexed: 01/09/2023]
Abstract
BACKGROUND Antihypertensive agents lower the risk of cardiovascular events, but whether they affect pathways important in inflammation and plaque remodeling in atherosclerosis is uncertain. We assessed whether 2 commonly used antihypertensive agents affected plasma biomarkers reflecting specific inflammatory and remodeling processes over 2 years in the Comparison of Amlodipine versus Enalapril to Limit Occurrences of Thrombosis (CAMELOT) study. METHODS The study was a randomized controlled trial of 2 antihypertensives (amlodipine and enalapril) compared with placebo in patients with coronary artery disease and diastolic blood pressure less than 100 mm Hg. In 196 subjects who had baseline and 2-year intravascular coronary ultrasound examinations, we measured plasma interleukin 18, interleukin 1 receptor antagonist, matrix metalloproteinase 9, neopterin, and C-reactive protein. Results for both treatment groups were pooled and compared with placebo. RESULTS Antihypertensive treatment with either agent significantly lowered diastolic blood pressure (-4.7 vs placebo 1.3 mm Hg, P = .002) and progression of coronary atheroma (Δ percent atheroma volume 0.6 vs placebo 2.1, P = .031). Antihypertensive therapy did not affect plasma biomarkers of inflammation or plaque remodeling in the 135 subjects with baseline and 2-year biomarker samples. Progression in percent atheroma volume was significantly less in subjects taking statins at baseline (-2.5%, P = .0008). CONCLUSIONS In patients with coronary artery disease and well-controlled risk factors, antihypertensive therapy lowered blood pressure and progression of coronary atherosclerosis but did not affect plasma biomarkers of inflammation and remodeling. Antihypertensives may decrease atheroma progression by mechanisms other than those reflected by these plasma biomarkers.
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Nozue T, Yamamoto S, Tohyama S, Umezawa S, Kunishima T, Sato A, Miyake S, Takeyama Y, Morino Y, Yamauchi T, Muramatsu T, Hibi K, Sozu T, Terashima M, Michishita I. Statin treatment for coronary artery plaque composition based on intravascular ultrasound radiofrequency data analysis. Am Heart J 2012; 163:191-9.e1. [PMID: 22305836 DOI: 10.1016/j.ahj.2011.11.004] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Accepted: 11/07/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND Systemic therapy with statin has been shown to lower the risk of coronary events; however, the in vivo effects of statin therapy on plaque volume and composition are less understood. METHODS We conducted a prospective, open-labeled, randomized, multicenter study in 11 centers in Japan. A total of 164 patients were randomized to receive either 4 mg/d of pitavastatin (intensive lipid-lowering therapy) or 20 mg/d of pravastatin (moderate lipid-lowering therapy). Analyzable intravascular ultrasound data were obtained for 119 patients at baseline and at 8-month follow-up. The primary end point was the difference of volume changes in each of the 4 main plaque components (fibrosis, fibrofatty, calcium, and necrosis), assessed by virtual histology intravascular ultrasound, between the 2 groups. RESULTS The mean low-density lipoprotein cholesterol level at follow-up was significantly lower in the pitavastatin than in the pravastatin group (74 vs 95 mg/dL, P < .0001). During the 8-month follow-up period, statin therapy reduced the absolute and relative amount of fibrofatty component (pitavastatin: from 1.09 to 0.81 mm(3)/mm, P = .001; pravastatin: from 1.05 to 0.83 mm(3)/mm, P = .0008) and increased in the amount of calcium (pitavastatin: from 0.42 to 0.55 mm(3)/mm, P < .0001; pravastatin: from 0.44 to 0.55 mm(3)/mm, P = .005), whereas volume changes in both plaque components were not statistically different between the 2 groups. CONCLUSIONS Both pitavastatin and pravastatin altered coronary artery plaque composition by significantly decreasing the fibrofatty plaque component and increasing the calcified plaque component.
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Affiliation(s)
- Tsuyoshi Nozue
- Division of Cardiology, Department of Internal Medicine, Yokohama Sakae Kyosai Hospital, Japan.
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Hattori K, Ozaki Y, Ismail TF, Okumura M, Naruse H, Kan S, Ishikawa M, Kawai T, Ohta M, Kawai H, Hashimoto T, Takagi Y, Ishii J, Serruys PW, Narula J. Impact of Statin Therapy on Plaque Characteristics as Assessed by Serial OCT, Grayscale and Integrated Backscatter–IVUS. JACC Cardiovasc Imaging 2012; 5:169-77. [DOI: 10.1016/j.jcmg.2011.11.012] [Citation(s) in RCA: 146] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Revised: 10/18/2011] [Accepted: 11/27/2011] [Indexed: 12/29/2022]
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Taylor RA, Weigele JB, Kasner SE. Current management of symptomatic intracranial stenosis. Curr Atheroscler Rep 2011; 13:321-9. [PMID: 21597931 DOI: 10.1007/s11883-011-0183-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Intracranial arterial stenosis (IAS) is the cause of about 10% of all ischemic strokes in the United States, but may account for about 40% of strokes in some populations. After a stroke or transient ischemic attack due to IAS, patients face a 12% annual risk of recurrent stroke on medical therapy, with most strokes occurring in the first year. Warfarin is no better than aspirin in preventing recurrent strokes but poses a higher risk of serious bleeding and death. Groups with the highest risk of recurrent stroke are those with high-grade (≥ 70%) stenosis, those with recent symptom onset, those with symptoms precipitated by hemodynamic maneuvers, and women. Endovascular treatment of IAS is a rapidly evolving therapeutic option. Antiplatelet agents are currently recommended as the primary treatment for symptomatic IAS, with endovascular therapy reserved for appropriate high-risk cases refractory to medical therapy.
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Affiliation(s)
- Robert A Taylor
- Department of Neurology, University of Minnesota, Minneapolis, USA.
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Safety and efficacy of early aggressive versus cholesterol-driven lipid-lowering strategies in heart transplantation: A pilot, randomized, intravascular ultrasound study. J Heart Lung Transplant 2011; 30:1305-11. [DOI: 10.1016/j.healun.2011.07.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 06/23/2011] [Accepted: 07/01/2011] [Indexed: 11/19/2022] Open
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50
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von Birgelen C, Hartmann M. Beyond the lumen border: on the use of intravascular ultrasound in the left main coronary artery. EUROINTERVENTION 2011; 7:300-2. [PMID: 21729830 DOI: 10.4244/eijv7i3a52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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