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Bai L, Kwong JC, Kaufman JS, Benmarhnia T, Chen C, van Donkelaar A, Martin RV, Kim J, Lu H, Burnett RT, Chen H. Effect modification by statin use status on the association between fine particulate matter (PM2.5) and cardiovascular mortality. Int J Epidemiol 2024; 53:dyae084. [PMID: 38961644 PMCID: PMC11222296 DOI: 10.1093/ije/dyae084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 06/19/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND Numerous studies have linked fine particulate matter (PM2.5) to increased cardiovascular mortality. Less is known how the PM2.5-cardiovascular mortality association varies by use of cardiovascular medications. This study sought to quantify effect modification by statin use status on the associations between long-term exposure to PM2.5 and mortality from any cardiovascular cause, coronary heart disease (CHD), and stroke. METHODS In this nested case-control study, we followed 1.2 million community-dwelling adults aged ≥66 years who lived in Ontario, Canada from 2000 through 2018. Cases were patients who died from the three causes. Each case was individually matched to up to 30 randomly selected controls using incidence density sampling. Conditional logistic regression models were used to estimate odds ratios (ORs) for the associations between PM2.5 and mortality. We evaluated the presence of effect modification considering both multiplicative (ratio of ORs) and additive scales (the relative excess risk due to interaction, RERI). RESULTS Exposure to PM2.5 increased the risks for cardiovascular, CHD, and stroke mortality. For all three causes of death, compared with statin users, stronger PM2.5-mortality associations were observed among non-users [e.g. for cardiovascular mortality corresponding to each interquartile range increase in PM2.5, OR = 1.042 (95% CI, 1.032-1.053) vs OR = 1.009 (95% CI, 0.996-1.022) in users, ratio of ORs = 1.033 (95% CI, 1.019-1.047), RERI = 0.039 (95% CI, 0.025-0.050)]. Among users, partially adherent users exhibited a higher risk of PM2.5-associated mortality than fully adherent users. CONCLUSIONS The associations of chronic exposure to PM2.5 with cardiovascular and CHD mortality were stronger among statin non-users compared to users.
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Affiliation(s)
- Li Bai
- Primary Care & Population Health Research Program, ICES, Toronto, ON, Canada
| | - Jeffrey C Kwong
- Primary Care & Population Health Research Program, ICES, Toronto, ON, Canada
- Public Health Ontario, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Jay S Kaufman
- Department of Epidemiology and Biostatistics, McGill University, Montreal, QC, Canada
| | - Tarik Benmarhnia
- Scripps Institution of Oceanography, University of California, San Diego, La Jolla, CA, USA
| | - Chen Chen
- Scripps Institution of Oceanography, University of California, San Diego, La Jolla, CA, USA
| | - Aaron van Donkelaar
- Department of Energy, Environment and Chemical Engineering, Washington University, St Louis, MO, USA
| | - Randall V Martin
- Department of Energy, Environment and Chemical Engineering, Washington University, St Louis, MO, USA
| | - JinHee Kim
- Public Health Ontario, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Hong Lu
- Primary Care & Population Health Research Program, ICES, Toronto, ON, Canada
| | - Richard T Burnett
- Population Studies Division, Environmental Health Science and Research Bureau, Health Canada, Ottawa, ON, Canada
| | - Hong Chen
- Primary Care & Population Health Research Program, ICES, Toronto, ON, Canada
- Public Health Ontario, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Population Studies Division, Environmental Health Science and Research Bureau, Health Canada, Ottawa, ON, Canada
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Columbo JA, Stone DH. Appropriateness of care: Asymptomatic carotid stenosis including transcarotid artery revascularization. Semin Vasc Surg 2024; 37:179-187. [PMID: 39151997 PMCID: PMC11330557 DOI: 10.1053/j.semvascsurg.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/14/2024] [Accepted: 03/27/2024] [Indexed: 08/19/2024]
Abstract
Carotid artery stenosis is one of the most common diagnoses treated by vascular specialists in the United States. The optimal management of carotid stenosis remains controversial, however, with notable variation surrounding diagnostic imaging modalities, longitudinal surveillance, medical therapies, and procedural interventions. Data from high-quality randomized controlled trials and observational studies form the foundation for current management paradigms and societal guidelines that inform clinical practice. Presently, a diagnosis of carotid disease is most often established with duplex ultrasound and supplemental cross-sectional imaging using computed tomography or magnetic resonance angiography as needed to provide additional anatomic information. All patients with documented occlusive disease should receive goal-directed medical therapy with antiplatelet agents and a lipid-reduction strategy, most commonly with a statin. Those with severe carotid stenosis and an acceptable life expectancy may be considered for carotid artery revascularization. The proceduralist should optimally consider a shared decision-making approach in which the tradeoffs of revascularization can be carefully considered with the patient to optimize informed therapeutic decision making. In current practice, three distinct procedure options exist to treat carotid artery stenosis, including carotid endarterectomy, transfemoral carotid artery stenting, and transcarotid artery revascularization. It should be noted that each procedure, although often used interchangeably in most clinical settings, carry technical nuances and outcome disparities. In this review, each of these topics are explored and various approaches are outlined surrounding the appropriate use of treatments for patients with asymptomatic carotid artery stenosis.
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Affiliation(s)
- Jesse A Columbo
- Geisel School of Medicine at Dartmouth, Hanover, NH; Section of Vascular Surgery, 3V, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03766; Veterans Affairs Medical Center, White River Junction, VT.
| | - David H Stone
- Geisel School of Medicine at Dartmouth, Hanover, NH; Section of Vascular Surgery, 3V, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03766; Veterans Affairs Medical Center, White River Junction, VT
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3
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Ye C, Schousboe JT, Morin SN, Lix LM, McCloskey EV, Johansson H, Harvey NC, Kanis JA, Leslie WD. FRAX predicts cardiovascular risk in women undergoing osteoporosis screening: the Manitoba bone mineral density registry. J Bone Miner Res 2024; 39:30-38. [PMID: 38630880 PMCID: PMC11207923 DOI: 10.1093/jbmr/zjad010] [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: 08/18/2023] [Revised: 10/31/2023] [Accepted: 11/14/2023] [Indexed: 04/19/2024]
Abstract
Osteoporosis and cardiovascular disease (CVD) are highly prevalent in older women, with increasing evidence for shared risk factors and pathogenesis. Although FRAX was developed for the assessment of fracture risk, we hypothesized that it might also provide information on CVD risk. To test the ability of the FRAX tool and FRAX-defined risk factors to predict incident CVD in women undergoing osteoporosis screening with DXA, we performed a retrospective prognostic cohort study which included women aged 50 yr or older with a baseline DXA scan in the Manitoba Bone Mineral Density Registry between March 31, 1999 and March 31, 2018. FRAX scores for major osteoporotic fracture (MOF) were calculated on all participants. Incident MOF and major adverse CV events (MACE; hospitalized acute myocardial infarction [AMI], hospitalized non-hemorrhagic cerebrovascular disease [CVA], or all-cause death) were ascertained from linkage to population-based healthcare data. The study population comprised 59 696 women (mean age 65.7 ± 9.4 yr). Over mean 8.7 yr of observation, 6021 (10.1%) had MOF, 12 277 women (20.6%) had MACE, 2274 (3.8%) had AMI, 2061 (3.5%) had CVA, and 10 253 (17.2%) died. MACE rates per 1000 person-years by FRAX risk categories low (10-yr predicted MOF <10%), moderate (10%-19.9%) and high (≥20%) were 13.5, 34.0, and 64.6, respectively. Although weaker than the association with incident MOF, increasing FRAX quintile was associated with increasing risk for MACE (all P-trend <.001), even after excluding prior CVD and adjusting for age. HR for MACE per SD increase in FRAX was 1.99 (95%CI, 1.96-2.02). All FRAX-defined risk factors (except parental hip fracture and lower BMI) were independently associated with higher non-death CV events. Although FRAX is intended for fracture risk prediction, it has predictive value for cardiovascular risk.
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Affiliation(s)
- Carrie Ye
- Division of Rheumatology, University of Alberta, Edmonton, AB T6G 2G3, Canada
| | - John T Schousboe
- Park Nicollet Clinic and HealthPartners Institute, Bloomington, MN 55425, United States
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN 55455, United States
| | - Suzanne N Morin
- Division of General Internal Medicine, Department of Medicine, McGill University, Montreal, QC, H3G 2M1, Canada
| | - Lisa M Lix
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, R3E 0T6, Canada
| | - Eugene V McCloskey
- MRC Versus Arthritis Centre for Integrated Research in Musculoskeletal Ageing, Mellanby Centre for Musculoskeletal Research,Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield. Sheffield, SYK, S10 2TN, United Kingdom
- Department of Oncology & Metabolism, MRC Versus Arthritis Centre for Integrated Research in Musculoskeletal Ageing, University of Sheffield, Sheffield, SYK, S10 2TN, United Kingdom
| | - Helena Johansson
- MRC Versus Arthritis Centre for Integrated Research in Musculoskeletal Ageing, Mellanby Centre for Musculoskeletal Research,Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield. Sheffield, SYK, S10 2TN, United Kingdom
- Faculty of Health Sciences, Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC 3000, Australia
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, Hampshire, SO16 6YD, United Kingdom
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, SO16 6YD, United Kingdom
| | - John A Kanis
- MRC Versus Arthritis Centre for Integrated Research in Musculoskeletal Ageing, Mellanby Centre for Musculoskeletal Research,Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield. Sheffield, SYK, S10 2TN, United Kingdom
- Faculty of Health Sciences, Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC 3000, Australia
| | - William D Leslie
- Department of Oncology & Metabolism, MRC Versus Arthritis Centre for Integrated Research in Musculoskeletal Ageing, University of Sheffield, Sheffield, SYK, S10 2TN, United Kingdom
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Eppler M, Singh N, Ding L, Magee G, Garg P. Discharge prescription patterns for antiplatelet and statin therapy following carotid endarterectomy: an analysis of the vascular quality initiative. BMJ Open 2023; 13:e071550. [PMID: 37491096 PMCID: PMC10373683 DOI: 10.1136/bmjopen-2022-071550] [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] [Indexed: 07/27/2023] Open
Abstract
OBJECTIVES Despite guidelines endorsing statin and single antiplatelet therapy (SAPT) therapy post-carotid endarterectomy (CEA), these medications may be either under or inappropriately prescribed. We determined rates of new statin prescriptions as well as change in antiplatelet therapy (APT) regimen at discharge. We identified characteristics associated with these occurrences. DESIGN We performed a retrospective Vascular Quality Initiative registry analysis of more than 125 000 patients who underwent CEA from 2013 to 2021. SETTING The Vascular Quality Initiative is a multicentre registry database including academic and community-based hospitals throughout the USA. PARTICIPANTS Patients age≥18 years undergoing CEA with available statin and APT data (preprocedure and postprocedure) were included. PRIMARY AND SECONDARY OUTCOME MEASURES We determined overall rates of statin and APT prescription at discharge. Multivariate logistic regression was used to determine clinical and demographic characteristics that were mostly associated with new statin prescription or changes in APT regimen at discharge. RESULTS Study participants were predominantly male (61%) and White (90%), with a mean age of 70.6±9.1. 13.1% of participants were not on statin therapy pre-CEA, and 48% of these individuals were newly prescribed one. Statin rates steadily increased throughout the study period: 36.2% in 2013 to 62% in 2021. A higher likelihood of new statin prescription was associated with non-race, diabetes, coronary heart disease, stroke, TIA and a non-elective indication. Older age, female gender, chronic obstructive pulmonary disease and prior carotid revascularisation were associated with a lower likelihood of new statin prescription. Nearly all participants were discharged on APT (63% SAPT and 37% dual antiplatelet therapy, DAPT). Among these individuals, 16% were discharged on a regimen that was different from the one on admission (11 947 (10.7%) of patients were upgraded to DAPT and 5813 (5.2%) were downgraded to SAPT). CONCLUSIONS Although statin use has substantially improved following CEA, more than half of individuals not on a statin preprocedure remained this way at discharge. In addition, DAPT at discharge was frequent, a quarter of whom were on SAPT preprocedure. Further efforts are needed to improve rates of new statin prescriptions, ensure appropriate APT intensity at discharge and determine how different discharge APT regimens impact outcomes.
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Affiliation(s)
- Michael Eppler
- Division of Cardiology, USC Keck School of Medicine, Los Angeles, California, USA
| | - Nikhil Singh
- Cardiology, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Li Ding
- Division of Cardiology, USC Keck School of Medicine, Los Angeles, California, USA
| | - Gregory Magee
- Division of Cardiology, USC Keck School of Medicine, Los Angeles, California, USA
| | - Parveen Garg
- Division of Cardiology, USC Keck School of Medicine, Los Angeles, California, USA
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5
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Robinson C, Chanchlani R, Gayowsky A, Brar S, Darling E, Demers C, Mondal T, Parekh R, Seow H, Batthish M. Cardiovascular outcomes in children with Kawasaki disease: a population-based cohort study. Pediatr Res 2023; 93:1267-1275. [PMID: 36380069 DOI: 10.1038/s41390-022-02391-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 10/05/2022] [Accepted: 10/26/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND The risk of cardiovascular events after Kawasaki disease (KD) remains uncertain. Our objective was to determine the risk of cardiovascular events and mortality after KD. METHODS Population-based retrospective cohort study using Ontario health administrative databases (0-18 years; 1995-2018). EXPOSURE pediatric KD hospitalizations. Each case was matched to 100 non-exposed controls. PRIMARY OUTCOME major adverse cardiac events (MACE; cardiovascular death, myocardial infarction, or stroke composite). SECONDARY OUTCOMES composite cardiovascular events and mortality. We determined incidence rates and adjusted hazard ratios (aHR) using multivariable Cox models. RESULTS Among 4597 KD survivors, 79 (1.7%) experienced MACE, 632 (13.8%) composite cardiovascular events, and 9 (0.2%) died during 11-year median follow-up. The most frequent cardiovascular events among KD survivors were ischemic heart disease (4.6 events/1000 person-years) and arrhythmias (4.5/1000 person-years). KD survivors were at increased risk of MACE between 0-1 and 5-10 years, and composite cardiovascular events at all time periods post-discharge. KD survivors had a lower mortality risk throughout follow-up (aHR 0.36, 95% CI 0.19-0.70). CONCLUSION KD survivors are at increased risk of post-discharge cardiovascular events but have a lower risk of death, which justifies enhanced cardiovascular disease surveillance in these patients. IMPACT Among 4597 Kawasaki disease (KD) survivors, 79 (1.7%) experienced major adverse cardiac events (MACE) and 632 (13.8%) had composite cardiovascular events during 11-year median follow-up. KD survivors had significantly higher risks of post-discharge MACE and cardiovascular events versus non-exposed children. Only nine KD survivors (0.2%) died during follow-up, and the risk of mortality was significantly lower among KD survivors versus non-exposed children. Childhood KD survivors should receive preventative counseling and cardiovascular surveillance, aiming to mitigate adult cardiovascular disease.
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Affiliation(s)
- Cal Robinson
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
- Division of Nephrology, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Rahul Chanchlani
- Division of Nephrology, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- ICES McMaster, Hamilton, ON, Canada
| | | | - Sandeep Brar
- Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, USA
| | - Elizabeth Darling
- McMaster Midwifery Research Centre, McMaster University, Hamilton, ON, Canada
| | - Catherine Demers
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Tapas Mondal
- Division of Cardiology, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Rulan Parekh
- Division of Nephrology, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Hsien Seow
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Michelle Batthish
- Division of Rheumatology, Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
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6
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Anjorin AC, Marcaccio CL, Rastogi V, Patel PB, Garg PK, Soden PA, McCallum JC, Schermerhorn ML. Statin therapy is associated with improved perioperative outcomes and long-term mortality following carotid revascularization in the Vascular Quality Initiative. J Vasc Surg 2023; 77:158-169.e8. [PMID: 36029973 PMCID: PMC9789183 DOI: 10.1016/j.jvs.2022.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/14/2022] [Accepted: 08/17/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Statin therapy is the standard of care for patients with carotid artery stenosis given its proven cardiovascular benefits. However, the impact of statin therapy on outcomes in patients undergoing carotid revascularization in the Vascular Quality Initiative has not yet been evaluated. Therefore, our aim was to investigate the association of statin therapy with outcomes following carotid endarterectomy (CEA), transfemoral carotid artery stenting (tfCAS), and transcarotid artery revascularization (TCAR). METHODS We identified all patients who underwent CEA, tfCAS, or TCAR in the Vascular Quality Initiative registry from January 2016 to September 2021. To compare outcomes, we stratified patients by procedure type and created 1:1 propensity score-matched cohorts of patients who received no preoperative statin therapy (within 36 hours of procedure) versus those who received preoperative statin therapy. Propensity scores incorporated demographic characteristics, comorbidities, carotid symptom status, preoperative medications, and physician and hospital procedural experience. The primary outcome was a composite end point of in-hospital stroke and/or death. As a secondary analysis, we performed repeat propensity score-matching by postoperative statin use (prescribed at discharge) and assessed 5-year mortality. Relative risks (RR) and hazard ratios (HR) were calculated using log binomial regression and Cox regression, respectively. RESULTS Among 97,835 CEA, 20,303 tfCAS, and 22,371 TCAR patients, 15%, 17%, and 10% of patients did not receive preoperative statin therapy, respectively. Compared with statin use, no statin use was associated with a higher risk of in-hospital stroke or death among 13,434 matched CEA patients (no statin, 1.7% vs statin, 1.4%; RR, 1.2; 95% confidence interval [CI], 1.02-1.5) and among 2707 matched tfCAS patients (4.8% vs 2.8%; RR, 1.7; 95% CI, 1.3-2.3). However, there was no difference for this outcome by statin use among 2089 matched TCAR patients (1.8% vs 1.6%; RR, 1.1; 95% CI, 0.7-1.8). At 5 years, no statin therapy at discharge was associated with higher 5-year mortality after CEA (15% vs 10%; HR, 1.8; 95% CI, 1.6-2) and tfCAS (18% vs 14%; HR, 1.5; 95% CI, 1.2-1.8), but there was no difference after TCAR (14% vs 11%; HR, 1.3; 95% CI, 0.9-1.8). CONCLUSIONS Compared with statin use, no statin use was associated with a higher risk of in-hospital stroke or death and 5-year mortality among CEA and tfCAS patients. Although there was no significant difference in outcomes among TCAR patients, this may in part be due to lower statistical power in this cohort. Overall, statin therapy is essential in the short- and long-term management of patients undergoing carotid revascularization. Our findings not only support current Society for Vascular Surgery recommendations for statin therapy in patients undergoing carotid revascularization, but they also highlight an important opportunity for quality improvement.
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Affiliation(s)
- Aderike C Anjorin
- Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Christina L Marcaccio
- Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Vinamr Rastogi
- Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Priya B Patel
- Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Parveen K Garg
- Division of Cardiology, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Peter A Soden
- Division of Vascular Surgery, Department of Surgery, Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI
| | - John C McCallum
- Division of Vascular and Endovascular Surgery, Los Angeles County Harbor-UCLA Medical Center, Torrance, CA
| | - Marc L Schermerhorn
- Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
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7
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Ryu JC, Bae JH, Ha SH, Kwon B, Song Y, Lee DH, Kim BJ, Kang DW, Kwon SU, Kim JS, Chang JY. Association between lipid profile changes and risk of in-stent restenosis in ischemic stroke patients with intracranial stenosis: A retrospective cohort study. PLoS One 2023; 18:e0284749. [PMID: 37163551 PMCID: PMC10171672 DOI: 10.1371/journal.pone.0284749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 04/05/2023] [Indexed: 05/12/2023] Open
Abstract
OBJECTIVE The risk of ischemic stroke with intracranial stenosis is associated with various serum lipid levels. However, the effects of changes in the lipid profile on the risk of in-stent restenosis have not been verified. Therefore, we investigated the association between the occurrence of in-stent restenosis at 12-month follow-up and changes in various lipid profiles. METHODS In this retrospective cohort study, we included ischemic stroke patients who had undergone intracranial stenting for symptomatic intracranial stenosis between February 2010 and May 2020. We collected data about serum low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC), and triglyceride (TG) levels, and calculated the TC/HDL-C and LDL-C/HDL-C ratios at baseline and after 12 months. We conducted multivariable logistic regression analyses to verify the association between various lipid profile changes and in-stent restenosis at 12 months. RESULTS Among the 100 patients included in the study (mean age, 60.8 ± 10.0 years; male: 80 [80.0%]), in-stent restenosis was found in 13 (13.0%) patients. The risk of in-stent restenosis of more than 50% was significantly decreased when TC/HDL-C ratio (odds ratio [OR] 0.22, [95% confidence interval (CI) 0.05-0.87]) and LDL-C/HDL-C ratio (OR 0.23, [95% CI 0.06-0.93]) decreased or when HDL-C levels (OR 0.10, [95% CI 0.02-0.63]) were increased at 12 months compared with baseline measurements. CONCLUSIONS Improvement of HDL-C levels, TC/HDL-C ratio, and LDL-C/HDL-C ratio were associated with decreased risk of in-stent restenosis at 12-month follow-up. Management and careful monitoring of various lipid profiles including HDL-C levels, TC/HDL-C ratio, and LDL-C/HDL-C ratio may be important to prevent in-stent restenosis in patients with intracranial stenting.
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Affiliation(s)
- Jae-Chan Ryu
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Han Bae
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Hee Ha
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Boseong Kwon
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yunsun Song
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Deok Hee Lee
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Bum Joon Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong-Wha Kang
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sun U Kwon
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong S Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jun Young Chang
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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8
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Wu Z, Li X, Wen Q, Tao B, Qiu B, Zhang Q, Wang J. Serum LDL-C/HDL-C ratio and the risk of carotid plaques: a longitudinal study. BMC Cardiovasc Disord 2022; 22:501. [PMID: 36434516 PMCID: PMC9700971 DOI: 10.1186/s12872-022-02942-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 11/08/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Dyslipidemia contributes to an increased risk of carotid atherosclerosis. However, the association between the ratio of low-density lipoprotein cholesterol (LDL-C) to high-density lipoprotein cholesterol (HDL-C) and carotid plaque formation has not been well documented. This study aims to assess the role of LDL-C/HDL-C in the risk of carotid plaque formation in a Chinese population. METHODS We followed 2,191 participants who attended the annual routine health examination. Cox proportional hazards regression, restricted cubic spline (RCS), and subgroup analysis were applied to evaluate the association between the LDL-C/HDL-C ratio and carotid plaques. The hazard ratio (HR) and 95% confidence interval (CI) were used to estimate the strength of the association. RESULTS Among 2,191 participants, 388 had incident carotid plaques detected, with a median follow-up time of 1.05 years. Compared with subjects younger than 45 years, those aged 45 to 59 years (HR: 2.00, 95% CI: 1.55-2.58) and over 60 years (HR: 3.36, 95% CI: 2.47-4.58) had an increased risk of carotid plaque formation. Males (HR: 1.26, 95% CI: 1.01-1.56), diabetes (HR: 1.46, 95% CI: 1.06-2.01) and a high LDL-C/HDL-C ratio (HR: 1.22, 95% CI: 1.07-1.38) were significantly linked with the occurrence of carotid plaques. After adjusting for potential confounding factors, we observed that a high LDL-C/HDL-C ratio promoted carotid plaque events (HR: 1.30, 95% CI: 1.12-1.50). The RCS analysis revealed a significant nonlinear association. The association was stronger among females (P-interaction < 0.05). CONCLUSION A high LDL-C/HDL-C ratio could accelerate the occurrence of carotid plaques. Older men with diabetes and dyslipidemia are the critical target population. Women may be more likely to benefit from lipid-lowering interventions and thus avoid carotid plaque formation.
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Affiliation(s)
- Zhuchao Wu
- grid.89957.3a0000 0000 9255 8984Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, 211166 Nanjing, China
| | - Xiaona Li
- grid.412676.00000 0004 1799 0784Department of Health Management Center, the First Affiliated Hospital of Nanjing Medical University, 210029 Nanjing, China ,grid.89957.3a0000 0000 9255 8984Department of Health Management, Center for Global Health, School of Public Health, Nanjing Medical University, 211166 Nanjing, China
| | - Qin Wen
- grid.89957.3a0000 0000 9255 8984Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, 211166 Nanjing, China
| | - Bilin Tao
- grid.89957.3a0000 0000 9255 8984Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, 211166 Nanjing, China
| | - Beibei Qiu
- grid.89957.3a0000 0000 9255 8984Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, 211166 Nanjing, China
| | - Qun Zhang
- grid.412676.00000 0004 1799 0784Department of Health Management Center, the First Affiliated Hospital of Nanjing Medical University, 210029 Nanjing, China ,grid.89957.3a0000 0000 9255 8984Department of Health Management, Center for Global Health, School of Public Health, Nanjing Medical University, 211166 Nanjing, China
| | - Jianming Wang
- grid.89957.3a0000 0000 9255 8984Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, 211166 Nanjing, China
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9
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Li S, He J, Zhang X, Cai Y, Liu J, Nie X, Shi L. Cardiovascular adverse events in chronic myeloid leukemia patients treated with nilotinib or imatinib: A systematic review, meta-analysis and integrative bioinformatics analysis. Front Cardiovasc Med 2022; 9:966182. [PMID: 36426222 PMCID: PMC9678945 DOI: 10.3389/fcvm.2022.966182] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 10/18/2022] [Indexed: 12/02/2023] Open
Abstract
OBJECTIVE The aim of this article is to assess the risk and potential mechanisms of cardiovascular adverse events in patients treated with nilotinib or imatinib by conducting a systematic review, meta-analysis and integrative bioinformatics analysis. MATERIALS AND METHODS Three databases were systematically searched for studies published from inception to May 29, 2022. Differential expression analysis and weighted gene coexpression network analysis (WGCNA) were performed to search for modules of genes most associated with cardiotoxicity. Protein-protein interaction (PPI) network analysis was then performed to identify hub genes for the cardiotoxicity of nilotinib. Molecular docking was used to analyze the effects of rosuvastatin and aspirin on these targets. RESULTS Patients treated with nilotinib as first-line treatment were associated with a higher risk of CAE (OR = 3.43 [95% CI 2.77-4.25]), CAD (OR = 5.30 [95% CI 3.85-7.29]), ACS (OR 2.7 [95% CI 1.60-4.54]), CVA (OR 5.76 [95% CI 2.84-11.28]), PAOD (OR 5.57 [95% CI 3.26-9.50]) and arrhythmia (OR 2.34 [1.17,4.67]) than those treated with imatinib, while no significant difference was found in the risk of HF (OR 1.40 [95% CI 0.42-4.69]) between the two groups. Patients who were treated with more than 600 mg daily dosage of nilotinib or followed up for more than 5 years had a higher risk of ACS and CVA. IL6, CXCL8, CCL2, SOD2, NFKBIA, and BIRC3 were identified as the top 6 hub genes in the magenta module (human cardiomyocyte samples) and were mainly enriched in the NOD-like receptor signaling pathway, IL-17 signaling pathway, TNF signaling pathway, lipid and atherosclerosis signaling pathway. TYROBP and CSF1R were identified as hub genes in the turquoise module (liver samples from Mus musculus). GSEA results showed that type II diabetes mellitus, B-cell receptor, apoptosis, insulin, natural killer cell mediated cytotoxicity,mTOR, chemokine, and T-cell receptor signaling pathways were related to the higher risk of atherosclerosis caused by nilotinib. Rosuvastatin can effectively bind to most of the hub targets and proteins enriched in the inflammatory pathways above. CONCLUSION CML patients who start with nilotinib have a higher risk of CAE than those with imatinib. Atherosclerosis caused by the inflammatory response and glycolipid metabolism disorder is the key mechanism of nilotinib cardiotoxicity. Rosuvastatin may be an effective treatment for the cardiotoxicity of nilotinib.
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Affiliation(s)
- Sicong Li
- School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Jinshan He
- Department of Cardiovascular, Peking University People’s Hospital, Beijing, China
| | - Xinyi Zhang
- School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Yuchun Cai
- School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Jian Liu
- Department of Cardiovascular, Peking University People’s Hospital, Beijing, China
| | - Xiaoyan Nie
- School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Luwen Shi
- School of Pharmaceutical Sciences, Peking University, Beijing, China
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10
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Association between Statin Use and Risk of Parkinson’s Disease: Evidence from 18 Observational Studies Comprising 3.7 Million Individuals. J Pers Med 2022; 12:jpm12050825. [PMID: 35629248 PMCID: PMC9145914 DOI: 10.3390/jpm12050825] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/11/2022] [Accepted: 05/16/2022] [Indexed: 11/16/2022] Open
Abstract
The potential impact of statins on the risk of Parkinson’s disease (PD) is still controversial; therefore, we conducted a comprehensive meta-analysis of observational studies to examine the effect of statin use on the risk of PD. We searched electronic databases, such as PubMed, EMBASE, Scopus, and Web of Science, for articles published between 1 January 2000 and 15 March 2022. Cohort studies which examined the association between statins and PD risk in the general population were also included. Two authors assessed the data and extracted all potential information for analysis. Random effects meta-analyses were performed to measure the risk ratio (RR) and 95% confidence intervals (CIs). Eighteen cohort studies including 3.7 million individuals with 31,153 PD participants were identified. In statin users, compared with non-users, the RR for PD was 0.79 (95% CI: 0.68–0.91). In a subgroup analysis of PD, this association was observed with medium and high quality, and the studies were adjusted for age, gender, and smoking status. When the data were stratified according to the duration of exposure, long-duration statin use was associated with a decreased risk of PD (RR = 0.49; 95% CI: 0.26–0.92). There was no significant decrease in the risk of PD in short-term statin users (RR = 0.94; 95% CI: 0.67–1.31). Moreover, no significant difference in the reduction in the risk of PD was observed between men (RR = 0.80; 95% CI: 0.75–0.86) and women (RR = 0.80; 95% CI: 0.75–0.86). Although our findings confirm a reduction in the PD risk associated with statin treatment and suggest that statins play a clinically favorable role, these findings should be interpreted with caution. Future randomized control trials with an ad hoc design are needed to confirm the potential utility of statins in reducing the risk of PD.
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11
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Benefits and drawbacks of statins and non-statin lipid lowering agents in carotid artery disease. Prog Cardiovasc Dis 2022; 73:41-47. [DOI: 10.1016/j.pcad.2022.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 05/15/2022] [Indexed: 11/18/2022]
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12
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Cheng X, Li Z, Yang M, Liu Y, Wang S, Huang M, Gao S, Yang R, Li L, Yu C. Association of HbA1c with carotid artery plaques in patients with coronary heart disease: a retrospective clinical study. Acta Cardiol 2022; 78:442-450. [PMID: 35356852 DOI: 10.1080/00015385.2022.2040822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND AND AIMS Haemoglobin A1c (HbA1c) levels have been shown to be related to carotid artery plaques. However, studies on the relationship between HbA1c levels and carotid artery plaques in patients with coronary heart disease (CHD) are limited and inconsistent. Our objective was to examine the correlation between HbA1c levels and carotid artery plaques in patients with CHD. METHODS The study comprised 9275 Chinese adults with CHD from January 1, 2014, to September 30, 2020. HbA1c levels were assessed, and colour Doppler ultrasound was used to evaluate the carotid artery, including plaque presence, intima-media thickness, and plaque echo properties, to investigate the association between HbA1c and carotid plaque. A logistic regression model was used to assess the association between carotid artery plaques, carotid plaque echogenicity, and HbA1c. RESULTS The HbA1c level of the plaque-present group was higher than that of the plaque-absent group [6.1 (5.6-7.2) vs. 5.8 (5.5-6.5), p < 0.001]. In multiple linear regression analysis, intima-media thickness was associated with HbA1c (p < 0.001). Logistic regression showed that a higher HbA1c level was associated with plaque incidence as well as hyperechoic and heterogeneous plaques (p < 0.001). These associations persist after adjusting for age, sex, blood pressure, lipid profiles, alcohol consumption, and tobacco exposure. CONCLUSION HbA1c levels are notably associated with carotid artery plaque incidence, intima-media thickness, and plaque echogenicity in patients with CHD. These findings show that different levels of HbA1c may be an indicator for carotid artery plaques and thus, should be observed in patients with CHD.
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Affiliation(s)
- Xufeng Cheng
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Zhu Li
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Mingjie Yang
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yijia Liu
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Shuo Wang
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Mengnan Huang
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Shan Gao
- Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Rongrong Yang
- School of Health Science and Engineering, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Lin Li
- Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Chunquan Yu
- Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
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13
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A hybrid deep learning paradigm for carotid plaque tissue characterization and its validation in multicenter cohorts using a supercomputer framework. Comput Biol Med 2021; 141:105131. [PMID: 34922173 DOI: 10.1016/j.compbiomed.2021.105131] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/20/2021] [Accepted: 12/09/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Early and automated detection of carotid plaques prevents strokes, which are the second leading cause of death worldwide according to the World Health Organization. Artificial intelligence (AI) offers automated solutions for plaque tissue characterization. Recently, solo deep learning (SDL) models have been used, but they do not take advantage of the tandem connectivity offered by AI's hybrid nature. Therefore, this study explores the use of hybrid deep learning (HDL) models in a multicenter framework, making this study the first of its kind. METHODS We hypothesize that HDL techniques perform better than SDL and transfer learning (TL) techniques. We propose two kinds of HDL frameworks: (i) the fusion of two SDLs (Inception with ResNet) or (ii) 10 other kinds of tandem models that fuse SDL with ML. The system Atheromatic™ 2.0HDL (AtheroPoint, CA, USA) was designed on an augmentation framework and three kinds of loss functions (cross-entropy, hinge, and mean-square-error) during training to determine the best optimization paradigm. These 11 combined HDL models were then benchmarked against one SDL model and five types of TL models; thus, this study considers a total of 17 AI models. RESULTS Among the 17 AI models, the best performing HDL system was that comprising CNN and decision tree (DT), as its accuracy and area-under-the-curve were 99.78 ± 1.05% and 0.99 (p<0.0001), respectively. These values are 6.4% and 3.2% better than those recorded for the SDL and TL models, respectively. We validated the performance of the HDL models with diagnostics odds ratio (DOR) and Cohen and Kappa statistics; here, HDL outperformed DL and TL by 23% and 7%, respectively. The online system ran in <2 s. CONCLUSION HDL is a fast, reliable, and effective tool for characterizing the carotid plaque for early stroke risk stratification.
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14
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Sanagala SS, Nicolaides A, Gupta SK, Koppula VK, Saba L, Agarwal S, Johri AM, Kalra MS, Suri JS. Ten Fast Transfer Learning Models for Carotid Ultrasound Plaque Tissue Characterization in Augmentation Framework Embedded with Heatmaps for Stroke Risk Stratification. Diagnostics (Basel) 2021; 11:2109. [PMID: 34829456 PMCID: PMC8622690 DOI: 10.3390/diagnostics11112109] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/03/2021] [Accepted: 11/09/2021] [Indexed: 12/24/2022] Open
Abstract
Background and Purpose: Only 1-2% of the internal carotid artery asymptomatic plaques are unstable as a result of >80% stenosis. Thus, unnecessary efforts can be saved if these plaques can be characterized and classified into symptomatic and asymptomatic using non-invasive B-mode ultrasound. Earlier plaque tissue characterization (PTC) methods were machine learning (ML)-based, which used hand-crafted features that yielded lower accuracy and unreliability. The proposed study shows the role of transfer learning (TL)-based deep learning models for PTC. Methods: As pertained weights were used in the supercomputer framework, we hypothesize that transfer learning (TL) provides improved performance compared with deep learning. We applied 11 kinds of artificial intelligence (AI) models, 10 of them were augmented and optimized using TL approaches-a class of Atheromatic™ 2.0 TL (AtheroPoint™, Roseville, CA, USA) that consisted of (i-ii) Visual Geometric Group-16, 19 (VGG16, 19); (iii) Inception V3 (IV3); (iv-v) DenseNet121, 169; (vi) XceptionNet; (vii) ResNet50; (viii) MobileNet; (ix) AlexNet; (x) SqueezeNet; and one DL-based (xi) SuriNet-derived from UNet. We benchmark 11 AI models against our earlier deep convolutional neural network (DCNN) model. Results: The best performing TL was MobileNet, with accuracy and area-under-the-curve (AUC) pairs of 96.10 ± 3% and 0.961 (p < 0.0001), respectively. In DL, DCNN was comparable to SuriNet, with an accuracy of 95.66% and 92.7 ± 5.66%, and an AUC of 0.956 (p < 0.0001) and 0.927 (p < 0.0001), respectively. We validated the performance of the AI architectures with established biomarkers such as greyscale median (GSM), fractal dimension (FD), higher-order spectra (HOS), and visual heatmaps. We benchmarked against previously developed Atheromatic™ 1.0 ML and showed an improvement of 12.9%. Conclusions: TL is a powerful AI tool for PTC into symptomatic and asymptomatic plaques.
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Affiliation(s)
- Skandha S. Sanagala
- CSE Department, CMR College of Engineering & Technology, Hyderabad 501401, TS, India; (S.S.S.); (V.K.K.)
- CSE Department, Bennett University, Greater Noida 203206, UP, India;
| | - Andrew Nicolaides
- Vascular Screening and Diagnostic Centre, University of Nicosia, Nicosia 1700, Cyprus;
| | - Suneet K. Gupta
- CSE Department, Bennett University, Greater Noida 203206, UP, India;
| | - Vijaya K. Koppula
- CSE Department, CMR College of Engineering & Technology, Hyderabad 501401, TS, India; (S.S.S.); (V.K.K.)
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), 10015 Cagliari, Italy;
| | | | - Amer M. Johri
- Division of Cardiology, Queen’s University, Kingston, ON K7L 3N6, Canada;
| | - Manudeep S. Kalra
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA;
| | - Jasjit S. Suri
- Stroke Diagnostic and Monitoring Division, AtheroPoint™ LLC, Roseville, CA 95661, USA
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15
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Puri R, Mehta V, Iyengar SS, Srivastava P, Yusuf J, Pradhan A, Pandian JD, Sharma VK, Renjen PN, Muruganathan A, Mugundhan K, Srinivasan AV, Shetty S, Narasingan SN, Nair DR, Bansal M, Prabhakar D, Varma M, Paliwal VK, Kapoor A, Mukhopadhyay S, Mehrotra R, Patanwala RM, Aggarwal R, Mahajan K, Kumar S, Bardoloi N, Pareek KK, Manoria PC, Pancholia AK, Nanda R, Wong ND, Duell PB. Management of Dyslipidaemia for the Prevention of Stroke: Clinical Practice Recommendations from the Lipid Association of India. Curr Vasc Pharmacol 2021; 20:134-155. [PMID: 34751121 DOI: 10.2174/1570161119666211109122231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/21/2021] [Accepted: 09/28/2021] [Indexed: 02/08/2023]
Abstract
Stroke is the second most common cause of death worldwide. The rates of stroke are increasing in less affluent countries predominantly because of a high prevalence of modifiable risk factors. The Lipid Association of India (LAI) has provided a risk stratification algorithm for patients with ischaemic stroke and recommended low density lipoprotein cholesterol (LDL-C) goals for those in a very high risk group and extreme risk group (category A) of <50 mg/dl (1.3 mmol/l) while the LDL-C goal for extreme risk group (category B) is ≤30 mg/dl (0.8 mmol/l). High intensity statins are the first-line lipid lowering therapy. Non-statin therapy like ezetimibe and proprotein convertase subtilisin kexin type 9 (PCSK9) inhibitors may be added as an adjunct to statins in patients who do not achieve LDL-C goals statins alone. In acute ischaemic stroke, high intensity statin therapy improves neurological and functional outcomes regardless of thrombolytic therapy. Although conflicting data exist regarding increased risk of intracerebral haemorrhage (ICH) with statin use, the overall benefit risk ratio favors long-term statin therapy necessitating detailed discussion with the patient. Patients who have statins withdrawn while being on prior statin therapy at the time of acute ischaemic stroke have worse functional outcomes and increased mortality. LAI recommends that statins be continued in such patients. In patients presenting with ICH, statins should not be started in the acute phase but should be continued in patients who are already taking statins. ICH patients, once stable, need risk stratification for atherosclerotic cardiovascular disease (ASCVD).
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Affiliation(s)
| | - Vimal Mehta
- Department of Cardiology, G. B. Pant Institute of Postgraduate Medical Education and Research, New Delhi. 0
| | - S S Iyengar
- Department of Cardiology, Manipal Hospital, Bangalore, Karnataka. India
| | - Padma Srivastava
- Department of Neurology, Neurosciences Centre, AIIMS, New Delhi. India
| | - Jamal Yusuf
- Department of Cardiology, G. B. Pant Institute of Postgraduate Medical Education and Research, New Delhi. India
| | - Akshaya Pradhan
- Department of Cardiology King George's Medical University, Lucknow, U.P. India
| | | | - Vijay K Sharma
- Yong Loo Lin School of Medicine, National University of Singapore and National University Hospital. Singapore
| | - P N Renjen
- Department of Neurology, Indraprastha Apollo Hospital, New Delhi. India
| | - A Muruganathan
- Consultant Internal Medicine, AG Hospital, Tirupur, Tamil Nadu. India
| | - K Mugundhan
- Department of Neurology, Govt, Stanley Medical College, Chennai. India
| | - A V Srinivasan
- Department of Neurology, The Tamil Nadu,Dr MGR Medical University. India
| | - Sadanand Shetty
- Department of Cardiology, K.J Somaiya Super Speciality Institute Sion (East), Mumbai. India
| | - S N Narasingan
- The Tamil Nadu Dr MGR Medical University and Managing Director, SNN Specialities Clinic, Chennai, Tamil Nadu. India
| | - Devaki R Nair
- Department of Lipidology and Chemical pathologist, Royal Free Hospital, London. United Kingdom
| | - Manish Bansal
- Department of Cardiology, Medanta Hospital, Gurugram, Haryana. India
| | - D Prabhakar
- Department of Cardiology, Apollo Hospitals, Chennai, Tamil Nadu. India
| | - Mukul Varma
- Department of Neurology, Indraprastha Apollo Hospital, New Delhi. India
| | | | | | - Saibal Mukhopadhyay
- Department of Cardiology, G. B. Pant Institute of Postgraduate Medical Education and Research, New Delhi. India
| | - Rahul Mehrotra
- Non-Invasive Cardiology, Max Super Speciality Hospital, Saket, New Delhi. India
| | | | - Rajeev Aggarwal
- Jaswant Rai Speciality Hospital, Meerut, Uttar Pradesh. India
| | - Kunal Mahajan
- Department of Cardiology, Indra Gandhi Govt. Medical College and Hospital, Shimla. India
| | - Soumitra Kumar
- Department of Cardiology, Vivekananda Institute of Medical Sciences, Kolkata. India
| | - Neil Bardoloi
- Cardiology, Excel Care Hospital, Guwahati, Assam. India
| | - K K Pareek
- Department of Medicine, S. N. Pareek Hospital, Dadabari, Kota, Rajasthan. India
| | - P C Manoria
- Heart and Critical Care Hospital, Bhopal, Madhya Pradesh. India
| | - A K Pancholia
- Medicine and Preventive Cardiology, Arihant Hospital and Research Center, Indore, Madhya Pradesh. India
| | - Rashmi Nanda
- Consultant Physician and Lipidologist, Cardiac Care Centre, South Extension, New Delhi and Professor and Director University of California Irvine School of Medicine, Irvine, CA. United States
| | - Nathan D Wong
- Heart Disease Prevention Program, Division of Cardiology, University of California Irvine. United States
| | - P Barton Duell
- Knight Cardiovascular Institute and Division of Endocrinology, Diabetes and Clinical Nutrition, Oregon Health and Science University, Portland, OR. United States
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16
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Bosco E, Hsueh L, McConeghy KW, Gravenstein S, Saade E. Major adverse cardiovascular event definitions used in observational analysis of administrative databases: a systematic review. BMC Med Res Methodol 2021; 21:241. [PMID: 34742250 PMCID: PMC8571870 DOI: 10.1186/s12874-021-01440-5] [Citation(s) in RCA: 127] [Impact Index Per Article: 42.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 10/12/2021] [Indexed: 12/28/2022] Open
Abstract
Background Major adverse cardiovascular events (MACE) are increasingly used as composite outcomes in randomized controlled trials (RCTs) and observational studies. However, it is unclear how observational studies most commonly define MACE in the literature when using administrative data. Methods We identified peer-reviewed articles published in MEDLINE and EMBASE between January 1, 2010 to October 9, 2020. Studies utilizing administrative data to assess the MACE composite outcome using International Classification of Diseases 9th or 10th Revision diagnosis codes were included. Reviews, abstracts, and studies not providing outcome code definitions were excluded. Data extracted included data source, timeframe, MACE components, code definitions, code positions, and outcome validation. Results A total of 920 articles were screened, 412 were retained for full-text review, and 58 were included. Only 8.6% (n = 5/58) matched the traditional three-point MACE RCT definition of acute myocardial infarction (AMI), stroke, or cardiovascular death. None matched four-point (+unstable angina) or five-point MACE (+unstable angina and heart failure). The most common MACE components were: AMI and stroke, 15.5% (n = 9/58); AMI, stroke, and all-cause death, 13.8% (n = 8/58); and AMI, stroke and cardiovascular death 8.6% (n = 5/58). Further, 67% (n = 39/58) did not validate outcomes or cite validation studies. Additionally, 70.7% (n = 41/58) did not report code positions of endpoints, 20.7% (n = 12/58) used the primary position, and 8.6% (n = 5/58) used any position. Conclusions Components of MACE endpoints and diagnostic codes used varied widely across observational studies. Variability in the MACE definitions used and information reported across observational studies prohibit the comparison, replication, and aggregation of findings. Studies should transparently report the administrative codes used and code positions, as well as utilize validated outcome definitions when possible. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-021-01440-5.
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Affiliation(s)
- Elliott Bosco
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Box G-S121-3, Providence, RI, 02912, USA. .,Center for Gerontology and Healthcare Research, Brown University School of Public Health, RI, Providence, USA.
| | - Leon Hsueh
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Kevin W McConeghy
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Box G-S121-3, Providence, RI, 02912, USA.,Center for Gerontology and Healthcare Research, Brown University School of Public Health, RI, Providence, USA.,Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, USA
| | - Stefan Gravenstein
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Box G-S121-3, Providence, RI, 02912, USA.,Center for Gerontology and Healthcare Research, Brown University School of Public Health, RI, Providence, USA.,Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA.,Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, USA
| | - Elie Saade
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,School of Medicine, Case Western Reserve University, Cleveland, OH, USA
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17
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Frasco PE, Aqel B, Alvord JM, Poterack KA, Bauer I, Mathur AK. Statin Therapy and the Incidence of Thromboembolism and Vascular Events Following Liver Transplantation. Liver Transpl 2021; 27:1432-1442. [PMID: 33964102 DOI: 10.1002/lt.26093] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 04/27/2021] [Accepted: 04/30/2021] [Indexed: 12/24/2022]
Abstract
Statin therapy may reduce the risk of venous thromboembolism (VTE), which may impact solid organ transplant outcomes. We evaluated the incidence of VTE and other complications after liver transplantation stratified by hyperlipidemia status and statin use using a retrospective cohort study approach. We reviewed all primary orthotopic liver transplantation (OLT) records from January 2014 to December 2019 from our center. Intraoperative deaths were excluded. Recipient, donor clinical and demographic data were collected. We developed risk-adjusted models to assess the effect of statin use on the occurrence of VTE, hepatic artery complications (HACs), graft failure, and death, accounting for clinical covariates and competing risks. A total of 672 OLT recipients were included in the analysis. Of this cohort, 11.9% (n = 80) received statin therapy. A total of 47 patients (7.0%) had VTE events. HACs occurred in 40 patients (6.0%). A total of 42 (6.1%) patients experienced graft loss, whereas 9.1% (n = 61) of the cohort died during the study interval. Eighty OLT recipients (29.8%) were treated with statins. In the statin treated group, 0% of patients had VTE versus 7.9% of those not on statins (P = 0.02). HACs were identified in 1.2% of the statin group and 6.8% of the nonstatin group. Untreated hyperlipidemia was associated with a 2.1-fold higher risk of HACs versus patients with no hyperlipidemia status (P = 0.05). Statin therapy was associated with significantly better risk-adjusted thromboembolic event-free survival (absence of VTE, cerebrovascular accident, myocardial infarction, HACs, and death); hazard ratio, 2.7; P = 0.01. These data indicate that statin therapy is correlated with a lower rate of VTE and HACs after liver transplantation.
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Affiliation(s)
- Peter E Frasco
- Department of Anesthesiology, Mayo Clinic Arizona, Phoenix, AZ
| | - Bashar Aqel
- Department of Anesthesiology, Mayo Clinic Arizona, Phoenix, AZ
| | - Jeremy M Alvord
- Department of Anesthesiology, Mayo Clinic Arizona, Phoenix, AZ
| | - Karl A Poterack
- Department of Anesthesiology, Mayo Clinic Arizona, Phoenix, AZ
| | - Isabel Bauer
- Department of Anesthesiology, Mayo Clinic Arizona, Phoenix, AZ
| | - Amit K Mathur
- Department of Anesthesiology, Mayo Clinic Arizona, Phoenix, AZ
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18
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Jain PK, Sharma N, Giannopoulos AA, Saba L, Nicolaides A, Suri JS. Hybrid deep learning segmentation models for atherosclerotic plaque in internal carotid artery B-mode ultrasound. Comput Biol Med 2021; 136:104721. [PMID: 34371320 DOI: 10.1016/j.compbiomed.2021.104721] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 12/18/2022]
Abstract
The automated and accurate carotid plaque segmentation in B-mode ultrasound (US) is an essential part of stroke risk stratification. Previous segmented methods used AtheroEdge™ 2.0 (AtheroPoint™, Roseville, CA) for the common carotid artery (CCA). This study focuses on automated plaque segmentation in the internal carotid artery (ICA) using solo deep learning (SDL) and hybrid deep learning (HDL) models. The methodology consists of a novel design of 10 types of SDL/HDL models (AtheroEdge™ 3.0 systems (AtheroPoint™, Roseville, CA) with a depth of four layers each. Five of the models use cross-entropy (CE)-loss, and the other five models use Dice similarity coefficient (DSC)-loss functions derived from UNet, UNet+, SegNet, SegNet-UNet, and SegNet-UNet+. The K10 protocol (Train:Test:90%:10%) was applied for all 10 models for training and predicting (segmenting) the plaque region, which was then quantified to compute the plaque area in mm2. Further, the data augmentation effect was analyzed. The database consisted of 970 ICA B-mode US scans taken from 99 moderate to high-risk patients. Using the difference area threshold of 10 mm2 between ground truth (GT) and artificial intelligence (AI), the area under the curve (AUC) values were 0.91, 0.911, 0.908, 0.905, and 0.898, all with a p-value of <0.001 (for CE-loss models) and 0.883, 0.889, 0.905, 0.889, and 0.907, all with a p-value of <0.001 (for DSC-loss models). The correlations between the AI-based plaque area and GT plaque area were 0.98, 0.96, 0.97, 0.98, and 0.97, all with a p-value of <0.001 (for CE-loss models) and 0.98, 0.98, 0.97, 0.98, and 0.98 (for DSC-loss models). Overall, the online system performs plaque segmentation in less than 1 s. We validate our hypothesis that HDL and SDL models demonstrate comparable performance. SegNet-UNet was the best-performing hybrid architecture.
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Affiliation(s)
| | | | | | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), Cagliari, Italy
| | - Andrew Nicolaides
- Vascular Screening and Diagnostic Centre, University of Nicosia, Nicosia, Cyprus
| | - Jasjit S Suri
- Stroke Diagnostic and Monitoring Division, AtheroPoint™, Roseville, CA, USA.
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Toth PP. Low-Density Lipoprotein Cholesterol Treatment Rates in High Risk Patients: More Disappointment Despite Ever More Refined Evidence-Based Guidelines. Am J Prev Cardiol 2021; 6:100186. [PMID: 34327506 PMCID: PMC8315491 DOI: 10.1016/j.ajpc.2021.100186] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 04/12/2021] [Accepted: 04/15/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Peter P Toth
- CGH Medical Center Sterling, Illinois 61081, Cicarrone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205
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20
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Saba L, Sanagala SS, Gupta SK, Koppula VK, Johri AM, Khanna NN, Mavrogeni S, Laird JR, Pareek G, Miner M, Sfikakis PP, Protogerou A, Misra DP, Agarwal V, Sharma AM, Viswanathan V, Rathore VS, Turk M, Kolluri R, Viskovic K, Cuadrado-Godia E, Kitas GD, Sharma N, Nicolaides A, Suri JS. Multimodality carotid plaque tissue characterization and classification in the artificial intelligence paradigm: a narrative review for stroke application. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1206. [PMID: 34430647 PMCID: PMC8350643 DOI: 10.21037/atm-20-7676] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 02/25/2021] [Indexed: 12/12/2022]
Abstract
Cardiovascular disease (CVD) is one of the leading causes of morbidity and mortality in the United States of America and globally. Carotid arterial plaque, a cause and also a marker of such CVD, can be detected by various non-invasive imaging modalities such as magnetic resonance imaging (MRI), computer tomography (CT), and ultrasound (US). Characterization and classification of carotid plaque-type in these imaging modalities, especially into symptomatic and asymptomatic plaque, helps in the planning of carotid endarterectomy or stenting. It can be challenging to characterize plaque components due to (I) partial volume effect in magnetic resonance imaging (MRI) or (II) varying Hausdorff values in plaque regions in CT, and (III) attenuation of echoes reflected by the plaque during US causing acoustic shadowing. Artificial intelligence (AI) methods have become an indispensable part of healthcare and their applications to the non-invasive imaging technologies such as MRI, CT, and the US. In this narrative review, three main types of AI models (machine learning, deep learning, and transfer learning) are analyzed when applied to MRI, CT, and the US. A link between carotid plaque characteristics and the risk of coronary artery disease is presented. With regard to characterization, we review tools and techniques that use AI models to distinguish carotid plaque types based on signal processing and feature strengths. We conclude that AI-based solutions offer an accurate and robust path for tissue characterization and classification for carotid artery plaque imaging in all three imaging modalities. Due to cost, user-friendliness, and clinical effectiveness, AI in the US has dominated the most.
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Affiliation(s)
- Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (AOU), Cagliari, Italy
| | - Skandha S Sanagala
- CSE Department, CMR College of Engineering & Technology, Hyderabad, India.,CSE Department, Bennett University, Greater Noida, UP, India
| | - Suneet K Gupta
- CSE Department, Bennett University, Greater Noida, UP, India
| | - Vijaya K Koppula
- CSE Department, CMR College of Engineering & Technology, Hyderabad, India
| | - Amer M Johri
- Department of Medicine, Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Narendra N Khanna
- Department of Cardiology, Indraprastha APOLLO Hospitals, New Delhi, India
| | - Sophie Mavrogeni
- Cardiology Clinic, Onassis Cardiac Surgery Center, Athens, Greece
| | - John R Laird
- Heart and Vascular Institute, Adventist Health St. Helena, St Helena, CA, USA
| | - Gyan Pareek
- Minimally Invasive Urology Institute, Brown University, Providence, Rhode Island, USA
| | - Martin Miner
- Men's Health Center, Miriam Hospital Providence, Rhode Island, USA
| | - Petros P Sfikakis
- Rheumatology Unit, National Kapodistrian University of Athens, Greece
| | - Athanasios Protogerou
- Department of Cardiovascular Prevention, National and Kapodistrian University of Athens, Athens, Greece
| | - Durga P Misra
- Department of Clinical Immunology and Rheumatology, SGPGIMS, Lucknow, India
| | - Vikas Agarwal
- Department of Clinical Immunology and Rheumatology, SGPGIMS, Lucknow, India
| | - Aditya M Sharma
- Division of Cardiovascular Medicine, University of Virginia, VA, USA
| | - Vijay Viswanathan
- MV Hospital for Diabetes & Professor M Viswanathan Diabetes Research Centre, Chennai, India
| | - Vijay S Rathore
- Nephrology Department, Kaiser Permanente, Sacramento, CA, USA
| | - Monika Turk
- The Hanse-Wissenschaftskolleg Institute for Advanced Study, Delmenhorst, Germany
| | | | | | | | - George D Kitas
- R & D Academic Affairs, Dudley Group NHS Foundation Trust, Dudley, UK
| | - Neeraj Sharma
- Department of Biomedical Engineering, IIT-BHU, Banaras, UP, India
| | - Andrew Nicolaides
- Vascular Screening and Diagnostic Centre, University of Nicosia, Nicosia, Cyprus
| | - Jasjit S Suri
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA, USA
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21
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Erkol A, Dalgıç Y, Yıldırım S, Turan B. Incidence and predictors of prolonged hemodynamic depression after carotid artery stenting: Yet another benefit of statins? Clin Neurol Neurosurg 2021; 207:106786. [PMID: 34198224 DOI: 10.1016/j.clineuro.2021.106786] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES We aimed to assess the incidence and predictors of prolonged hemodynamic depression (PHD) after carotid artery stenting (CAS). METHODS We retrospectively analyzed data from 216 CAS procedures performed in 207 patients (156 male; median and interquartile range (IQR) of age 68 (62-73) yr) between July 2012 and October 2020. PHD was defined as hypotension (systolic blood pressure ≤ 90 mmHg) and/or bradycardia (heart rate < 60 bpm) lasting >1 h. RESULTS The incidence of PHD was 25.9%. At multivariate analysis, asymptomatic lesions (OR: 2.43, 95% CI (1.16-5.06), p: 0.018), the stenosis proximity (<10 mm) to bifurcation (OR: 2.94, 95% CI (1.34-6.43), p: 0.007) and implantation of a Protege stent (OR: 2.93, 95% CI (1.14-7.53), p: 0.025) were independent risk factors, while statin usage (OR: 0.48, 95% CI (0.24-0.95), p: 0.036) was an independent protective factor for PHD after CAS. CONCLUSIONS Patients with asymptomatic lesions and stenosis close to the bifurcation are more prone to PHD. The type of the stent selected significantly influences the risk of PHD. Further prospective randomized studies are warranted to investigate the possible protective role of statins against PHD after CAS.
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Affiliation(s)
- Ayhan Erkol
- Department of Cardiology, University of Health Sciences, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey.
| | - Yalçın Dalgıç
- Department of Cardiology, University of Health Sciences, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Serhan Yıldırım
- Department of Neurology, University of Health Sciences, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Burak Turan
- Department of Cardiology, University of Health Sciences, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
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22
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Kim JS. Role of Blood Lipid Levels and Lipid-Lowering Therapy in Stroke Patients with Different Levels of Cerebral Artery Diseases: Reconsidering Recent Stroke Guidelines. J Stroke 2021; 23:149-161. [PMID: 34102752 PMCID: PMC8189863 DOI: 10.5853/jos.2021.01249] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 05/19/2021] [Indexed: 01/13/2023] Open
Abstract
Hyperlipidemia is an important risk factor for ischemic stroke; the Stroke Prevention by Aggressive Reduction in Cholesterol Level and Treat Stroke to Target studies have shown that statins are beneficial for patients with stroke and that a low target for low-density lipoprotein cholesterol (LDL-C) concentration may maximize this benefit. Based on these results, recent guidelines have emphasized the application of "high-intensity statins" and "low LDL-C target" strategies in patients with stroke. However, it should be kept in mind that the role of blood lipids as a risk factor and benefit of lipid-lowering therapy are different among patients with different levels of cerebral arterial diseases. Studies have suggested that hypolipidemia, but not hyperlipidemia, is a risk factor for small vessel diseases (SVDs) such as intracerebral hemorrhages, microbleeds, white matter hyperintensities, and perhaps, lacunar infarction. Although lipid-lowering agents might benefit certain patients with SVD, high-intensity statin and low LDL-C target strategies cannot be applied. In contrast, these strategies are important in patients with extracranial atherosclerosis, such as internal carotid disease, considering ample evidence of the benefits of lipid-lowering agents. Imaging studies have shown that statins stabilize vulnerable plaques in these patients. Although lipid-lowering agents are likely to benefit patients with intracranial atherosclerosis, the degree of their benefit and appropriate target LDL-C level for these patients remain unclear. More studies are needed to elucidate the appropriate lipid-modifying strategies in patients with stroke with different levels of cerebral artery disease.
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Affiliation(s)
- Jong S Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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23
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Kandimalla J, Hussain Z, Piriyawat P, Rodriguez G, Maud A, Khatri R, Cruz-Flores S, Vellipuram AR. Stroke Rates Following Surgical Versus Percutaneous Revascularization for Ischemic Heart Disease. Curr Cardiol Rep 2021; 23:45. [PMID: 33721116 DOI: 10.1007/s11886-021-01471-w] [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] [Accepted: 02/11/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Coronary revascularization is a commonly performed major procedure in the hospitals. Stroke is one of the dreaded complications after coronary revascularization procedures. The focus of this review is to understand the stroke risk in percutaneous cutaneous intervention (PCI) and coronary artery bypass grafting (CABG) procedures. RECENT FINDINGS Available data show that PCI offers less procedural stroke risk compared to CABG although the survival benefits of CABG are better in certain scenarios. Innovative advancements in techniques, pre-procedural optimum medical therapy (OMT), intraoperative neuro-monitoring, and multidisciplinary post procedural care are the few strategies in early detection and reduce stroke risk. Despite several innovations and strategies, it is evident that there is not enough data available to make concrete conclusions related to stroke risk after coronary revascularization, which warrants further investigation.
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Affiliation(s)
- Jithendhar Kandimalla
- Department of Neurology, Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, El Paso, TX, 79905, USA
| | - Zain Hussain
- Department of Neurology, Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, El Paso, TX, 79905, USA
| | - Paisith Piriyawat
- Department of Neurology, Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, El Paso, TX, 79905, USA
| | - Gustavo Rodriguez
- Department of Neurology, Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, El Paso, TX, 79905, USA
| | - Alberto Maud
- Department of Neurology, Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, El Paso, TX, 79905, USA
| | - Rakesh Khatri
- Department of Neurology, Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, El Paso, TX, 79905, USA
| | - Salvador Cruz-Flores
- Department of Neurology, Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, El Paso, TX, 79905, USA
| | - Anantha R Vellipuram
- Department of Neurology, Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, El Paso, TX, 79905, USA.
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24
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Jang SH, Kwon DH, Han MK, Park H, Sohn SI, Choi H, Hong JH. Impact of statin pretreatment on the complications of carotid stenting in asymptomatic patients: observational study. BMC Neurol 2021; 21:75. [PMID: 33588788 PMCID: PMC7883458 DOI: 10.1186/s12883-021-02104-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 02/02/2021] [Indexed: 11/10/2022] Open
Abstract
Background Carotid stenosis is a known risk factor for ischemic stroke, and carotid artery stenting is an effective preventive procedure. However, the stroke risk reduction for asymptomatic patients is small. Therefore, it is important to reduce the risk of complications, particularly in asymptomatic carotid stenosis. Statins are known to reduce the overall risk of periprocedural complications, although there is a lack of data focusing on asymptomatic patients. We aimed to investigate whether different doses of statin pretreatment can reduce periprocedural complications of carotid artery stenting (CAS) in patients with asymptomatic carotid artery stenosis. Methods Between July 2003 and June 2013, 276 consecutive patients received CAS for asymptomatic carotid stenosis. Periprocedural complications included the outcome of stroke, myocardial infarction, or death within 30 days of CAS. Statin pretreatment was categorized as no-statin (n = 87, 31.5%), standard-dose (< 40 mg, n = 139, 50.4%), and high-dose statin (≥40 mg, n = 50, 18.1%) according to the atorvastatin equivalent dose. The Cochran-Armitage (CA) trend test was performed to investigate the association of periprocedural complications with statin dose. Results The overall periprocedural complication rate was 3.3%. There was no significant difference in the risk of periprocedural complications between the three groups (no statin: n = 3 [3.4%]; standard-dose: n = 4 [2.9%]; high-dose n = 2 [4.0%] p = 0.923). The CA trend test did not demonstrate a trend in the proportion of periprocedural complications across increasing statin equivalent doses (p = 0.919). Conclusions Statin pretreatment before CAS showed neither absolute nor dose-dependent effects against periprocedural complications in asymptomatic patients undergoing CAS. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02104-z.
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Affiliation(s)
- Seong Hwa Jang
- Department of Neurology, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, 1095 Dalgubeol-daero, Dalseo-gu, Daegu, 42601, South Korea
| | - Doo Hyuk Kwon
- Department of Neurology, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, 1095 Dalgubeol-daero, Dalseo-gu, Daegu, 42601, South Korea
| | - Moon-Ku Han
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University School of Medicine, Seongnam, South Korea
| | - Hyungjong Park
- Department of Neurology, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, 1095 Dalgubeol-daero, Dalseo-gu, Daegu, 42601, South Korea
| | - Sung-Il Sohn
- Department of Neurology, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, 1095 Dalgubeol-daero, Dalseo-gu, Daegu, 42601, South Korea
| | - Huimahn Choi
- Department of Neurology and Neurosurgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Jeong-Ho Hong
- Department of Neurology, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, 1095 Dalgubeol-daero, Dalseo-gu, Daegu, 42601, South Korea.
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25
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Ultrasound-based internal carotid artery plaque characterization using deep learning paradigm on a supercomputer: a cardiovascular disease/stroke risk assessment system. Int J Cardiovasc Imaging 2021; 37:1511-1528. [DOI: 10.1007/s10554-020-02124-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 11/28/2020] [Indexed: 12/17/2022]
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26
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Skandha SS, Gupta SK, Saba L, Koppula VK, Johri AM, Khanna NN, Mavrogeni S, Laird JR, Pareek G, Miner M, Sfikakis PP, Protogerou A, Misra DP, Agarwal V, Sharma AM, Viswanathan V, Rathore VS, Turk M, Kolluri R, Viskovic K, Cuadrado-Godia E, Kitas GD, Nicolaides A, Suri JS. 3-D optimized classification and characterization artificial intelligence paradigm for cardiovascular/stroke risk stratification using carotid ultrasound-based delineated plaque: Atheromatic™ 2.0. Comput Biol Med 2020; 125:103958. [PMID: 32927257 DOI: 10.1016/j.compbiomed.2020.103958] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/02/2020] [Accepted: 08/03/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE Atherosclerotic plaque tissue rupture is one of the leading causes of strokes. Early carotid plaque monitoring can help reduce cardiovascular morbidity and mortality. Manual ultrasound plaque classification and characterization methods are time-consuming and can be imprecise due to significant variations in tissue characteristics. We report a novel artificial intelligence (AI)-based plaque tissue classification and characterization system. METHODS We hypothesize that symptomatic plaque is hypoechoic due to its large lipid core and minimal collagen, as well as its heterogeneous makeup. Meanwhile, asymptomatic plaque is hyperechoic due to its small lipid core, abundant collagen, and the fact that it is often calcified. We designed a computer-aided diagnosis (CADx) system consisting of three kinds of deep learning (DL) classification paradigms: Deep Convolutional Neural Network (DCNN), Visual Geometric Group-16 (VGG16), and transfer learning, (tCNN). DCNN was 3-D optimized by varying the number of CNN layers and data augmentation frameworks. The DL systems were benchmarked against four types of machine learning (ML) classification systems, and the CADx system was characterized using two novel strategies consisting of DL mean feature strength (MFS) and a bispectrum model using higher-order spectra. RESULTS After balancing symptomatic and asymptomatic plaque classes, a five-fold augmentation process was applied, yielding 1000 carotid scans in each class. Then, using a K10 protocol (trained to test the ratio of 90%-10%), tCNN and DCNN yielded accuracy (area under the curve (AUC)) pairs of 83.33%, 0.833 (p < 0.0001) and 95.66%, 0.956 (p < 0.0001), respectively. DCNN was superior to ML by 7.01%. As part of the characterization process, the MFS of the symptomatic plaque was found to be higher compared to the asymptomatic plaque by 17.5% (p < 0.0001). A similar pattern was seen in the bispectrum, which was higher for symptomatic plaque by 5.4% (p < 0.0001). It took <2 s to perform the online CADx process on a supercomputer. CONCLUSIONS The performance order of the three AI systems was DCNN > tCNN > ML. Bispectrum-based on higher-order spectra proved a powerful paradigm for plaque tissue characterization. Overall, the AI-based systems offer a powerful solution for plaque tissue classification and characterization.
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Affiliation(s)
- Sanagala S Skandha
- CSE Department, CMR College of Engineering & Technology, Hyderabad, India; CSE Department, Bennett University, Greater Noida, UP, India
| | - Suneet K Gupta
- CSE Department, Bennett University, Greater Noida, UP, India
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), Cagliari, Italy
| | - Vijaya K Koppula
- CSE Department, CMR College of Engineering & Technology, Hyderabad, India
| | - Amer M Johri
- Department of Medicine, Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Narendra N Khanna
- Department of Cardiology, Indraprastha APOLLO Hospitals, New Delhi, India
| | - Sophie Mavrogeni
- Cardiology Clinic, Onassis Cardiac Surgery Center, Athens, Greece
| | - John R Laird
- Heart and Vascular Institute, Adventist Health St. Helena, St Helena, CA, USA
| | - Gyan Pareek
- Minimally Invasive Urology Institute, Brown University, Providence, RI, USA
| | - Martin Miner
- Men's Health Center, Miriam Hospital Providence, RI, USA
| | - Petros P Sfikakis
- Rheumatology Unit, National Kapodistrian University of Athens, Greece
| | - Athanasios Protogerou
- Department of Cardiovascular Prevention, National and Kapodistrian Univ. of Athens, Greece
| | - Durga P Misra
- Dept. of Clinical Immunology and Rheumatology, SGPGIMS, Lucknow, India
| | - Vikas Agarwal
- Dept. of Clinical Immunology and Rheumatology, SGPGIMS, Lucknow, India
| | - Aditya M Sharma
- Division of Cardiovascular Medicine, University of Virginia, VA, USA
| | - Vijay Viswanathan
- MV Hospital for Diabetes & Professor M Viswanathan Diabetes Research Centre, Chennai, India
| | - Vijay S Rathore
- Nephrology Department, Kaiser Permanente, Sacramento, CA, USA
| | - Monika Turk
- The Hanse-Wissenschaftskolleg Institute for Advanced Study, Delmenhorst, Germany
| | | | | | | | - George D Kitas
- R & D Academic Affairs, Dudley Group NHS Foundation Trust, Dudley, UK
| | - Andrew Nicolaides
- Vascular Screening and Diagnostic Centre, University of Nicosia, Nicosia, Cyprus
| | - Jasjit S Suri
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA, USA.
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Cao D, Chandiramani R, Capodanno D, Berger JS, Levin MA, Hawn MT, Angiolillo DJ, Mehran R. Non-cardiac surgery in patients with coronary artery disease: risk evaluation and periprocedural management. Nat Rev Cardiol 2020; 18:37-57. [PMID: 32759962 DOI: 10.1038/s41569-020-0410-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/18/2020] [Indexed: 12/18/2022]
Abstract
Perioperative cardiovascular complications are important causes of morbidity and mortality associated with non-cardiac surgery, particularly in patients with coronary artery disease (CAD). Although preoperative cardiac risk assessment can facilitate the identification of vulnerable patients and implementation of adequate preventive measures, excessive evaluation might lead to undue resource utilization and surgical delay. Owing to conflicting data, there remains some uncertainty regarding the most beneficial perioperative strategy for patients with CAD. Antithrombotic agents are the cornerstone of secondary prevention of ischaemic events but substantially increase the risk of bleeding. Given that 5-25% of patients undergoing coronary stent implantation require non-cardiac surgery within 2 years, surgery is the most common reason for premature cessation of dual antiplatelet therapy. Perioperative management of antiplatelet therapy, which necessitates concomitant evaluation of the individual thrombotic and bleeding risks related to both clinical and procedural factors, poses a recurring dilemma in clinical practice. Current guidelines do not provide detailed recommendations on this topic, and the optimal approach in these patients is yet to be determined. This Review summarizes the current data guiding preoperative risk stratification as well as periprocedural management of patients with CAD undergoing non-cardiac surgery, including those treated with stents.
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Affiliation(s)
- Davide Cao
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rishi Chandiramani
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Davide Capodanno
- Division of Cardiology, C.A.S.T., P.O. "G. Rodolico", Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy
| | - Jeffrey S Berger
- Center for the Prevention of Cardiovascular Disease, New York University Langone Health, New York, NY, USA
| | - Matthew A Levin
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mary T Hawn
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Roxana Mehran
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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MicroRNAs as sentinels and protagonists of carotid artery thromboembolism. Clin Sci (Lond) 2020; 134:169-192. [PMID: 31971230 DOI: 10.1042/cs20190651] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 12/12/2019] [Accepted: 01/03/2020] [Indexed: 02/06/2023]
Abstract
Stroke is the leading cause of serious disability in the world and a large number of ischemic strokes are due to thromboembolism from unstable carotid artery atherosclerotic plaque. As it is difficult to predict plaque rupture and surgical treatment of asymptomatic disease carries a risk of stroke, carotid disease continues to present major challenges with regard to clinical decision-making and revascularization. There is therefore an imminent need to better understand the molecular mechanisms governing plaque instability and rupture, as this would allow for the development of biomarkers to identify at-risk asymptomatic carotid plaque prior to disease progression and stroke. Further, it would aid in creation of therapeutics to stabilize carotid plaque. MicroRNAs (miRNAs) have been implicated as key protagonists in various stages of atherosclerotic plaque initiation, development and rupture. Notably, they appear to play a crucial role in carotid artery thromboembolism. As the molecular pathways governing the role of miRNAs are being uncovered, we are learning that their involvement is complex, tissue- and stage-specific, and highly selective. Notably, miRNAs can be packaged and secreted in extracellular vesicles (EVs), where they participate in cell-cell communication. The measurement of EV-encapsulated miRNAs in the circulation may inform disease mechanisms occurring in the plaque itself, and therefore may serve as sentinels of unstable plaque as well as therapeutic targets.
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Xu R, Zhang T, Wan Y, Fan Z, Gao X. Prospective study of hemoglobin A1c and incident carotid artery plaque in Chinese adults without diabetes. Cardiovasc Diabetol 2019; 18:153. [PMID: 31727070 PMCID: PMC6857319 DOI: 10.1186/s12933-019-0963-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 11/05/2019] [Indexed: 12/16/2022] Open
Abstract
Background Diabetes has been reported to be associated with carotid artery plaque (CAP). However, it remains unclear whether hemoglobin A1c (HbA1c) level, a marker for long-term glycemic status, is associated with altered CAP risk in individuals with fasting blood glucose (FBG) concentrations below the current cutoff for diabetes. Methods Included were 16,863 Chinese adults (aged 18 years or more; 9855 men and 7008 women) with fasting blood glucose < 7.0 mmol/L at baseline (2013). Both HbA1c level and CAP (assessed via ultrasound B-mode imaging) were annually assessed during 2014–2018. All the participants were further classified into three groups based on baseline HbA1c level: ≤ 5.6%, 5.7–6.4%, and ≥ 6.5%. We used Cox proportional-hazards model to evaluate the association between HbA1c level and incident CAP, adjusting for a series of potential confounders. Results During 5 years of follow up, 3942 incident CAP cases were identified. Individuals with higher baseline HbA1c had higher future risk of CAP (p-trend < 0.001). In the full-adjusted model, each percent increase of HbA1c was associated with a 56% (HR = 1.56, 95% CI 1.37, 1.78) higher risk of CAP. Excluding participants with chronic inflammation, as assessed by high-sensitivity C-reactive protein and white blood cell, and those with FBG ≥ 5.6 mmol/L at baseline generated similar results. Conclusions Elevated HbA1c level was associated with high risk of developing CAP in Chinese adults without FBG defined diabetes.
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Affiliation(s)
- Renying Xu
- Department of Clinical Nutrition, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China.
| | - Ting Zhang
- Vascular Surgery Department, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yanping Wan
- Department of Clinical Nutrition, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Zhuping Fan
- Department of Digestion, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiang Gao
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, 16802, USA.
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Qiao L, Wang S, Jia Q, Bian J, Fan Y, Xu X. Clinical efficacy and safety of statin treatment after carotid artery stenting. ARTIFICIAL CELLS NANOMEDICINE AND BIOTECHNOLOGY 2019; 47:3110-3115. [PMID: 31352800 DOI: 10.1080/21691401.2019.1645149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Objective: The randomized controlled trail was carried out to investigate the influence of statin pre-treatment on clinical efficacy of carotid artery stenting (CAS). Methods: 160 eligible patients were randomly divided into statin group (n = 82) and control group (n = 78). The patients in statin group received 40 mg atorvastatin daily 7 days before operation. Major endpoints included transient ischemic attack (TIA), stroke, death, myocardial infarction (MI), and other cardiac adverse events within 30 days after CAS. Results: Preoperative baseline information was similar between the statin and control groups (p > 0.05 for all). Within 48 h after operation, the occurrence rate of CIN (3.66% vs 8.97%, p = .019) and new infarction (4.88% vs. 14.10%, p = .045) were significantly lower in statin group than in control group. 30 days after CAS, the incidences of TIA (12.20% vs. 26.92%, p = .018), ischemic stroke (6.10% vs. 16.67%, p = .034), and other cardiac complications (7.32% vs. 19.23%, p = .026) were also significantly lower in statin group, than in the control group. Multiple analysis demonstrated that statin use exerted protective effect against ischemic stroke (OR = 0.038, 95% CI = 0.003-0.543, p = .016) and other cardiac complications (OR = 0.208, 95%CI = 0.063-0.694, p = .011). Conclusion: Pre-treatment with statin is an effective and safe strategy to prevent from perioperative complications and to improve postoperative outcomes in patients undergoing CAS.
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Affiliation(s)
- Lingya Qiao
- a Department of Neurology, Tianjin Huanhu Hospital , Tianjin , China
| | - Shibo Wang
- b Department of Neurosurgery, Tianjin Huanhu Hospital , Tianjin , China
| | - Qiang Jia
- b Department of Neurosurgery, Tianjin Huanhu Hospital , Tianjin , China
| | - Ji Bian
- a Department of Neurology, Tianjin Huanhu Hospital , Tianjin , China
| | - Yimu Fan
- b Department of Neurosurgery, Tianjin Huanhu Hospital , Tianjin , China
| | - Xiaolin Xu
- a Department of Neurology, Tianjin Huanhu Hospital , Tianjin , China
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