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Diederichsen ACP, Mejldal A, Søgaard R, Hallas J, Lambrechtsen J, Steffensen FH, Frost L, Egstrup K, Busk M, Urbonaviciene G, Karon M, Rasmussen LM, Lindholt JS. User-defined outcomes of the Danish cardiovascular screening (DANCAVAS) trial: A post hoc analyses of a population-based, randomised controlled trial. PLoS Med 2024; 21:e1004403. [PMID: 38739644 PMCID: PMC11132442 DOI: 10.1371/journal.pmed.1004403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 05/28/2024] [Accepted: 04/12/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND The Danish cardiovascular screening (DANCAVAS) trial, a nationwide trial designed to investigate the impact of cardiovascular screening in men, did not decrease all-cause mortality, an outcome decided by the investigators. However, the target group may have varied preferences. In this study, we aimed to evaluate whether men aged 65 to 74 years requested a CT-based cardiovascular screening examination and to assess its impact on outcomes determined by their preferences. METHODS AND FINDINGS This is a post hoc study of the randomised DANCAVAS trial. All men 65 to 74 years of age residing in specific areas of Denmark were randomised (1:2) to invitation-to-screening (16,736 men, of which 10,471 underwent screening) or usual-care (29,790 men). The examination included among others a non-contrast CT scan (to assess the coronary artery calcium score and aortic aneurysms). Positive findings prompted preventive treatment with atorvastatin, aspirin, and surveillance/surgical evaluation. The usual-care group remained unaware of the trial and the assignments. The user-defined outcome was based on patient preferences and determined through a survey sent in January 2023 to a random sample of 9,095 men from the target group, with a 68.0% response rate (6,182 respondents). Safety outcomes included severe bleeding and mortality within 30 days after cardiovascular surgery. Analyses were performed on an intention-to-screen basis. Prevention of stroke and myocardial infarction was the primary motivation for participating in the screening examination. After a median follow-up of 6.4 years, 1,800 of 16,736 men (10.8%) in the invited-to-screening group and 3,420 of 29,790 (11.5%) in the usual-care group experienced an event (hazard ratio (HR), 0.93 (95% confidence interval (CI), 0.88 to 0.98; p = 0.010); number needed to invite at 6 years, 148 (95% CI, 80 to 986)). A total of 324 men (1.9%) in the invited-to-screening group and 491 (1.7%) in the usual-care group had an intracranial bleeding (HR, 1.17; 95% CI, 1.02 to 1.35; p = 0.029). Additionally, 994 (5.9%) in the invited-to-screening group and 1,722 (5.8%) in the usual-care group experienced severe gastrointestinal bleeding (HR, 1.02; 95% CI, 0.95 to 1.11; p = 0.583). No differences were found in mortality after cardiovascular surgery. The primary limitation of the study is that exclusive enrolment of men aged 65 to 74 renders the findings non-generalisable to women or men of other age groups. CONCLUSION In this comprehensive population-based cardiovascular screening and intervention program, we observed a reduction in the user-defined outcome, stroke and myocardial infarction, but entail a small increased risk of intracranial bleeding. TRIAL REGISTRATION ISRCTN Registry number, ISRCTN12157806 https://www.isrctn.com/ISRCTN12157806.
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Affiliation(s)
| | - Anna Mejldal
- Open Patient Data Explorative Network, Department of Clinical Research, Odense University Hospital, Odense, Denmark
| | - Rikke Søgaard
- Elite Research Centre for Individualised Medicine, Odense University Hospital, Odense, Denmark
| | - Jesper Hallas
- Department of Clinical Pharmacology, University of Southern Denmark, Odense, Denmark
| | | | | | - Lars Frost
- Department of Cardiology, Regional Hospital Central Jutland, Silkeborg, Denmark
| | - Kenneth Egstrup
- Department of Cardiology, Svendborg Hospital, Svendborg, Denmark
| | - Martin Busk
- Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark
| | | | - Marek Karon
- Department of Medicine, Nykøbing Falster Hospital, Nykøbing Falster, Denmark
| | - Lars Melholt Rasmussen
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Jes Sanddal Lindholt
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
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Qvist I, Rasmussen B, Frost L, Lindholt JS, Søgaard R, Lorentzen V. Danish men's experiences of cardiovascular screening and their views on preventive cardiovascular medication: A qualitative explorative nurse study. JOURNAL OF VASCULAR NURSING 2023; 41:195-202. [PMID: 38072572 DOI: 10.1016/j.jvn.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 06/29/2023] [Accepted: 06/29/2023] [Indexed: 12/18/2023]
Abstract
OBJECTIVES This study explored Danish men's experience of participating in a screening program for cardiovascular disease (CVD) and their perceptions of preventive medication for CVD before and after participation in the screening program. METHODS An exploratory phenomenological-hermeneutical study. Fifteen men from a cardiovascular screening program for men aged 65-74 years participated. Semi-structured interviews were conducted before screening and one year later (2015-2017). The interviews were transcribed verbatim and analysed using Kvale and Brinkmann's approach to data analysis. RESULTS Two main themes were identified: (i) seeking confirmation and control of health: familiarity with CVD; understanding the screening program; confirmation of health; perception of preventive medication, and (ii) sense of own health and prevention: experiences with the screening program; accept or denial of diagnosis and preventive medication. CONCLUSION A minority of the men understood the nature of the diseases for which they were being examined. The invitation for screening and the outcome of the examinations must be communicated more skilfully. The health providers need to engage early in treatment after the screening and provide an individualised plan that addresses patients concerns and knowledge based on their needs.
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Affiliation(s)
- Ina Qvist
- Department of Cardiology, Diagnostic Centre, Silkeborg Regional Hospital, Regional Hospital Central Jutland, Silkeborg, Denmark; The Centre for Nursing Research, Viborg, Denmark; Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Bodil Rasmussen
- School of Nursing and Midwifery, Deakin University, Geelong, Vic., Australia; Centre for Quality and Patient Safety Research - Western Health Partnership, St Albans, Vic., Australia; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Faculty of Health Sciences, University of Southern Denmark and Steno Diabetes Center, Odense, Denmark
| | - Lars Frost
- Department of Cardiology, Diagnostic Centre, Silkeborg Regional Hospital, Regional Hospital Central Jutland, Silkeborg, Denmark; Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jes S Lindholt
- Department of Vascular Surgery, Viborg Regional Hospital, Viborg, Denmark; Centre of Individualised Medicine in Arterial Diseases, Department of Cardiothoracic and Vascular Department T, Odense University Hospital, Odense, Denmark
| | - Rikke Søgaard
- Health Economics, CFK - Public Health and Quality Improvement, Central Denmark Region, Aarhus, Denmark; Health Economics, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Vibeke Lorentzen
- The Centre for Nursing Research, Viborg, Denmark; School of Nursing and Midwifery, Deakin University, Geelong, Vic., Australia; VIA University College, Viborg, Denmark; Institute of Public health, Section of Nursing, Aarhus University, Aarhus, Denmark
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Hasific S, Oevrehus KA, Lindholt JS, Mejldal A, Dey D, Dahl JS, Frandsen NE, Auscher S, Lambrechtsen J, Hosbond S, Alan D, Urbonaviciene G, Becker S, Rasmussen LM, Diederichsen AP. Effects of Vitamin K2 and D Supplementation on Coronary Artery Disease in Men: A RCT. JACC. ADVANCES 2023; 2:100643. [PMID: 38938724 PMCID: PMC11198368 DOI: 10.1016/j.jacadv.2023.100643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/14/2023] [Accepted: 08/10/2023] [Indexed: 06/29/2024]
Abstract
Background Extent and progression of coronary artery calcification (CAC) are strong predictors of myocardial infarction and mortality. Objectives This study aims to investigate if vitamin K2 and D supplementation can reduce CAC progression. Methods A total of 389 participants were randomized to supplementation with vitamin K2 (720 μg/day) and D (25 μg/day) vs placebo in a multicenter double-blinded randomized controlled trial. The primary endpoint (progression of aortic valve calcification) has been reported. This study reports CAC progression in participants with no ischemic heart disease. CT scans were performed at baseline, 12, and 24 months. ΔCAC and coronary plaque volume were evaluated in the entire group and in 2 subgroups. A safety endpoint was the composite of myocardial infarction, coronary revascularization, and all-cause mortality. Results In total, 304 participants (male, mean age 71 years) were identified. The intervention and placebo group both increased in mean CAC scores from baseline to 24-month follow-up (Δ203 vs Δ254 AU, P = 0.089). In patients with CAC scores ≥400 AU, CAC progression was lower by intervention (Δ288 vs Δ380 AU, P = 0.047). Plaque analyses showed no significant difference in progression of noncalcified plaque volume (Δ-6 vs Δ46 mm3, P = 0.172). Safety events were fewer in participants receiving supplementation (1.9% vs 6.7%, P = 0.048). Conclusions Patients with no prior ischemic heart disease randomized to vitamin K2 and D supplementation had no significant reduction in mean CAC progression over a 2-year follow-up compared to placebo. Although the primary endpoint is neutral, differential responses to supplementation in those with CAC scores ≥400 AU and in safety endpoints are hypothesis-generating for future studies.
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Affiliation(s)
- Selma Hasific
- Department of Cardiology, University Hospital, Odense, Denmark
| | | | - Jes S. Lindholt
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
| | - Anna Mejldal
- Department of Clinical Research, OPEN, University of Southern Denmark, Odense, Denmark
| | - Damini Dey
- Cedars-Sinai Medical Center, Biomedical Imaging Research Institute, Los Angeles, USA
| | - Jordi S. Dahl
- Department of Cardiology, University Hospital, Odense, Denmark
| | | | - Søren Auscher
- Department of Cardiology, OUH Svendborg Hospital, Svendborg, Denmark
| | - Jess Lambrechtsen
- Department of Cardiology, OUH Svendborg Hospital, Svendborg, Denmark
| | - Susanne Hosbond
- Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark
| | - Dilek Alan
- Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark
| | | | - Søren Becker
- Department of Cardiology, Regional Hospital Central Jutland, Silkeborg, Denmark
| | - Lars M. Rasmussen
- Department of Clinical Biochemistry, Odense University Hospital, Odense, Denmark
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Larsson J, Auscher S, Shamoun A, Pararajasingam G, Heinsen LJ, Andersen TR, Lindholt JS, Diederichsen ACP, Lambrechtsen J, Egstrup K. Insulin resistance is associated with high-risk coronary artery plaque composition in asymptomatic men between 65 and 75 years and no diabetes: A DANCAVAS cross-sectional sub-study. Atherosclerosis 2023; 385:117328. [PMID: 38390826 DOI: 10.1016/j.atherosclerosis.2023.117328] [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: 03/05/2023] [Revised: 09/29/2023] [Accepted: 10/03/2023] [Indexed: 02/24/2024]
Abstract
BACKGROUND AND AIMS Insulin resistance (IR) and pre-diabetes are associated with an increased risk of cardiovascular disease (CVD). We aimed to investigate vulnerable plaque composition in relation to IR and pre-diabetes in asymptomatic non-diabetic men. METHODS All participants underwent a contrast-enhanced coronary computed tomography angiography (CCTA) to evaluate coronary artery plaque burden and plaque composition (necrotic core, dense calcium, fibrotic and fibrous-fatty volume). Homeostasis model assessment of IR (HOMA-IR) was used, and participants were stratified into tertiles. Participants underwent a standard oral glucose tolerance test (OGTT) and were categorized into 2 groups (normal glucose tolerance (NGT) or pre-diabetes). A multivariable linear regression model was used to evaluate the association between vulnerable plaque composition and IR or glycemic group. RESULTS Four-hundred-and-fifty non-diabetic men without known CAD were included. The mean age was 70 ± 3 years. Participants in the higher HOMA-IR tertile (H-IR) had higher median necrotic plaque volume compared to the lower HOMA-IR tertile (L-IR) (18.2 vs. 11.0 mm3, p = 0.02). H-IR tertile (β 0.37 [95% CI 0.10-0.65], p = 0.008), pack-years (β 0.07 [95% CI 0.007-0.14], p = 0.03) and total atheroma volume (TAV) (β 0.47 [95% CI 0.36-0.57], p < 0.001) remained associated with necrotic plaque volume in the multivariable linear regression model. CONCLUSIONS IR was associated with necrotic plaque volume in asymptomatic men without diabetes. Thus, even in asymptomatic men without diabetes, IR seems to have an incremental effect on necrotic plaque volume and vulnerable plaque composition.
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Affiliation(s)
- Johanna Larsson
- Cardiovascular Research Unit, Odense University Hospital Svendborg, Baagøes Allé 15, 5700, Svendborg, Denmark.
| | - Søren Auscher
- Department of Cardiology, Odense University Hospital Svendborg, Baagøes Allé 15, 5700, Svendborg, Denmark
| | - André Shamoun
- Cardiovascular Research Unit, Odense University Hospital Svendborg, Baagøes Allé 15, 5700, Svendborg, Denmark
| | - Gokulan Pararajasingam
- Cardiovascular Research Unit, Odense University Hospital Svendborg, Baagøes Allé 15, 5700, Svendborg, Denmark
| | - Laurits Juhl Heinsen
- Cardiovascular Research Unit, Odense University Hospital Svendborg, Baagøes Allé 15, 5700, Svendborg, Denmark
| | - Thomas Rueskov Andersen
- Cardiovascular Research Unit, Odense University Hospital Svendborg, Baagøes Allé 15, 5700, Svendborg, Denmark
| | - Jes Sanddal Lindholt
- Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital Odense, J.B. Winsløws Vej 4, 5000, Odense, Denmark
| | | | - Jess Lambrechtsen
- Department of Cardiology, Odense University Hospital Svendborg, Baagøes Allé 15, 5700, Svendborg, Denmark
| | - Kenneth Egstrup
- Cardiovascular Research Unit, Odense University Hospital Svendborg, Baagøes Allé 15, 5700, Svendborg, Denmark
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Koutny F, Aigner E, Datz C, Gensluckner S, Maieron A, Mega A, Iglseder B, Langthaler P, Frey V, Paulweber B, Trinka E, Wernly B. Prevalence of Subclinical Cardiovascular Disease in Patients with Non-Alcoholic-Fatty Liver Disease: Analysis of the Paracelsus 10.000 Cohort Study. Med Princ Pract 2023; 32:000533909. [PMID: 37678174 PMCID: PMC10659702 DOI: 10.1159/000533909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 08/31/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND In patients with non-alcoholic fatty liver disease (NAFLD) cardiovascular diseases are more often the cause of death than the liver disease itself. However, the prevalence of atherosclerotic manifestations in individuals with NAFLD is still uncertain. This study aimed to explore the association between NAFLD and coronary artery calcification (CAC) in a Central European population. METHODS A total of 1,743 participants from the Paracelsus 10,000 study were included. The participants underwent CAC scoring and were assessed for fatty liver index (FLI), fibrosing non-alcoholic steatohepatitis Index (FNI) and fibrosis-4 index (FIB-4 score), which are indicators for steatosis and fibrosis. Multivariable logistic regression models were calculated. RESULTS Results revealed an association between liver steatosis/fibrosis and CAC. A FLI > 60 was associated with higher odds of NAFLD (OR 3.38, 95% CI: 2.61-4.39, p < 0.01) and increased prevalence of CAC-Score >300 compared to FLI <30 (9% vs. 3%, p < 0.01), even after adjusting for traditional cardiometabolic risk factors. While the crude odds ratios of the FIB-4 scores ≥ 1.3 and FNI score were significantly associated with increased odds of CAC, they became non-significant after adjusting for age, sex, and MetS. CONCLUSION This study reveals a significant association between NAFLD and CAC. The findings suggest that assessing liver fat and fibrosis could enhance assessment of cardiovascular risk, but further research is needed to determine whether hepatic fat plays an independent role in the development of atherosclerosis and whether targeting liver steatosis can mitigate vascular risk.
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Affiliation(s)
- Florian Koutny
- Department of Internal Medicine 2, Gastroenterology and Hepatology and Rheumatology, Karl Landsteiner University of Health Sciences, University Hospital of St. Pölten, Saint Pölten, Austria
| | - Elmar Aigner
- First Department of Medicine, University Clinic Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Christian Datz
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University, Salzburg, Austria
| | - Sophie Gensluckner
- First Department of Medicine, University Clinic Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Andreas Maieron
- Department of Internal Medicine 2, Gastroenterology and Hepatology and Rheumatology, Karl Landsteiner University of Health Sciences, University Hospital of St. Pölten, Saint Pölten, Austria
| | - Andrea Mega
- Gastroenterology Department, Bolzano Regional Hospital, Bolzano, Italy
| | - Bernhard Iglseder
- Department of Geriatric Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Patrick Langthaler
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University and Centre for Cognitive Neuroscience, Salzburg, Austria
- Department of Artificial Intelligence and Human Interfaces, Paris Lodron University of Salzburg, Salzburg, Austria
- Team Biostatistics and Big Medical Data, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Vanessa Frey
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University and Centre for Cognitive Neuroscience, Salzburg, Austria
- Spinal Cord Injury and Tissue Regeneration Center, PMU, Salzburg, Austria
- Neuroscience Institute, Christian Doppler University Hospital, Paracelsus Medical University and Centre for Cognitive Neuroscience, Salzburg, Austria
| | - Bernhard Paulweber
- First Department of Medicine, University Clinic Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Eugen Trinka
- Gastroenterology Department, Bolzano Regional Hospital, Bolzano, Italy
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University and Centre for Cognitive Neuroscience, Salzburg, Austria
- Spinal Cord Injury and Tissue Regeneration Center, PMU, Salzburg, Austria
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT – University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
- Karl Landsteiner Institute of Neurorehabilitation and Space Neurology, Salzburg, Austria
| | - Bernhard Wernly
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University, Salzburg, Austria
- Center for Public Health and Healthcare Research, Paracelsus Medical University of Salzburg, Salzburg, Austria
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Whitmore K, Zhou Z, Chapman N, Huynh Q, Magnussen CG, Sharman JE, Marwick TH. Impact of Patient Visualization of Cardiovascular Images on Modification of Cardiovascular Risk Factors: Systematic Review and Meta-Analysis. JACC Cardiovasc Imaging 2023; 16:1069-1081. [PMID: 37227327 DOI: 10.1016/j.jcmg.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/23/2023] [Accepted: 03/14/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND It is unclear whether detection and patient visualization of cardiovascular (CV) images using computed tomography to assess coronary artery calcium or carotid ultrasound (CU) to identify plaque and intima-medial thickness merely prompts prescription of lipid-lowering therapy or whether it motivates lifestyle change among patients. OBJECTIVES This systematic review and meta-analysis sought to investigate whether patient visualization of CV images (computed tomography or CU) has a beneficial impact on improving overall absolute CV risk as well as lipid and nonlipid CV risk factors in asymptomatic individuals. METHODS The key words "CV imaging," "CV risk," "asymptomatic persons," "no known or diagnosed CV disease," and "atherosclerotic plaque" were searched in PubMed, Cochrane, and Embase in November 2021. Randomized trials that assessed the role of CV imaging in reducing CV risk in asymptomatic persons with no known CV disease were eligible for study inclusion. The primary outcome was a change in 10-year Framingham risk score from the trial commencement to the end of the follow-up following patient visualization of CV images. RESULTS Six randomized controlled trials (7,083 participants) were included; 4 studies used coronary artery calcium and 2 used CU to detect subclinical atherosclerosis. All studies used image visualization in the intervention group to communicate CV risk. Imaging-guidance was associated with a 0.91% improvement in 10-year Framingham risk score (95% CI: 0.24%-1.58%; P = 0.01). Significant reductions in low-density-lipoprotein, total cholesterol, and systolic blood pressure were observed (all P < 0.05). CONCLUSIONS Patient visualization of CV imaging is associated with overall CV risk reduction and improvement of individual risk factors: cholesterol and systolic blood pressure.
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Affiliation(s)
- Kristyn Whitmore
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Zhen Zhou
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Niamh Chapman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Quan Huynh
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Costan G Magnussen
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland; Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - James E Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Thomas H Marwick
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.
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Meng Z, Zhang S, Li W, Wang Y, Wang M, Liu X, Liu CL, Liao S, Liu T, Yang C, Lindholt JS, Rasmussen LM, Obel LM, Stubbe J, Diederichsen AC, Sun Y, Chen Y, Yu PB, Libby P, Shi GP, Guo J. Cationic proteins from eosinophils bind bone morphogenetic protein receptors promoting vascular calcification and atherogenesis. Eur Heart J 2023; 44:2763-2783. [PMID: 37279475 PMCID: PMC10393071 DOI: 10.1093/eurheartj/ehad262] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 02/28/2023] [Accepted: 04/17/2023] [Indexed: 06/08/2023] Open
Abstract
AIMS Blood eosinophil count and eosinophil cationic protein (ECP) concentration are risk factors of cardiovascular diseases. This study tested whether and how eosinophils and ECP contribute to vascular calcification and atherogenesis. METHODS AND RESULTS Immunostaining revealed eosinophil accumulation in human and mouse atherosclerotic lesions. Eosinophil deficiency in ΔdblGATA mice slowed atherogenesis with increased lesion smooth muscle cell (SMC) content and reduced calcification. This protection in ΔdblGATA mice was muted when mice received donor eosinophils from wild-type (WT), Il4-/-, and Il13-/- mice or mouse eosinophil-associated-ribonuclease-1 (mEar1), a murine homologue of ECP. Eosinophils or mEar1 but not interleukin (IL) 4 or IL13 increased the calcification of SMC from WT mice but not those from Runt-related transcription factor-2 (Runx2) knockout mice. Immunoblot analyses showed that eosinophils and mEar1 activated Smad-1/5/8 but did not affect Smad-2/3 activation or expression of bone morphogenetic protein receptors (BMPR-1A/1B/2) or transforming growth factor (TGF)-β receptors (TGFBR1/2) in SMC from WT and Runx2 knockout mice. Immunoprecipitation showed that mEar1 formed immune complexes with BMPR-1A/1B but not TGFBR1/2. Immunofluorescence double-staining, ligand binding, and Scatchard plot analysis demonstrated that mEar1 bound to BMPR-1A and BMPR-1B with similar affinity. Likewise, human ECP and eosinophil-derived neurotoxin (EDN) also bound to BMPR-1A/1B on human vascular SMC and promoted SMC osteogenic differentiation. In a cohort of 5864 men from the Danish Cardiovascular Screening trial and its subpopulation of 394 participants, blood eosinophil counts and ECP levels correlated with the calcification scores of different arterial segments from coronary arteries to iliac arteries. CONCLUSION Eosinophils release cationic proteins that can promote SMC calcification and atherogenesis using the BMPR-1A/1B-Smad-1/5/8-Runx2 signalling pathway.
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Affiliation(s)
- Zhaojie Meng
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, 77 Avenue Louis Pasteur, NRB-7, Boston, MA 02115, USA
| | - Shuya Zhang
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, 77 Avenue Louis Pasteur, NRB-7, Boston, MA 02115, USA
- Hainan Provincial Key Laboratory for Tropical Cardiovascular Diseases Research & Key Laboratory of Emergency and Trauma of Ministry of Education, Institute of Cardiovascular Research of the First Affiliated Hospital, Hainan Medical University, Haikou 571199, Hainan, China
| | - Wei Li
- College of Chinese Medicinal Materials, Jilin Agricultural University, Changchun 130118, Jilin, China
| | - Yunzhe Wang
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, 77 Avenue Louis Pasteur, NRB-7, Boston, MA 02115, USA
- Department of Cardiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Minjie Wang
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, 77 Avenue Louis Pasteur, NRB-7, Boston, MA 02115, USA
| | - Xin Liu
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, 77 Avenue Louis Pasteur, NRB-7, Boston, MA 02115, USA
| | - Cong-Lin Liu
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, 77 Avenue Louis Pasteur, NRB-7, Boston, MA 02115, USA
- Department of Cardiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Sha Liao
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, 77 Avenue Louis Pasteur, NRB-7, Boston, MA 02115, USA
| | - Tianxiao Liu
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, 77 Avenue Louis Pasteur, NRB-7, Boston, MA 02115, USA
| | - Chongzhe Yang
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, 77 Avenue Louis Pasteur, NRB-7, Boston, MA 02115, USA
- Department of Geriatrics, National Key Clinical Specialty, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou 510000, Guangdong, China
| | - Jes S Lindholt
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
- Elite Research Centre of Individualized Treatment for Arterial Disease, University Hospital, Odense, Denmark
| | - Lars M Rasmussen
- Elite Research Centre of Individualized Treatment for Arterial Disease, University Hospital, Odense, Denmark
- Department of Clinical Biochemistry, Odense University Hospital, Odense, Denmark
| | - Lasse M Obel
- Elite Research Centre of Individualized Treatment for Arterial Disease, University Hospital, Odense, Denmark
- Department of Clinical Biochemistry, Odense University Hospital, Odense, Denmark
| | - Jane Stubbe
- Cardiovascular and Renal Research unit, Institute for Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Axel C Diederichsen
- Elite Research Centre of Individualized Treatment for Arterial Disease, University Hospital, Odense, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Yong Sun
- Department of Pathology, The University of Alabama at Birmingham, Birmingham, AL 35294, USA
- Birmingham VA Medical Center, Research Department, Birmingham, AL 35294, USA
| | - Yabing Chen
- Department of Pathology, The University of Alabama at Birmingham, Birmingham, AL 35294, USA
- Birmingham VA Medical Center, Research Department, Birmingham, AL 35294, USA
| | - Paul B Yu
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, 77 Avenue Louis Pasteur, NRB-7, Boston, MA 02115, USA
| | - Peter Libby
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, 77 Avenue Louis Pasteur, NRB-7, Boston, MA 02115, USA
| | - Guo-Ping Shi
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, 77 Avenue Louis Pasteur, NRB-7, Boston, MA 02115, USA
| | - Junli Guo
- Hainan Provincial Key Laboratory for Tropical Cardiovascular Diseases Research & Key Laboratory of Emergency and Trauma of Ministry of Education, Institute of Cardiovascular Research of the First Affiliated Hospital, Hainan Medical University, Haikou 571199, Hainan, China
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8
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Søgaard R, Diederichsen A, Lindholt J. The impact of population screening for cardiovascular disease on quality of life. EUROPEAN HEART JOURNAL OPEN 2023; 3:oead055. [PMID: 37293138 PMCID: PMC10246813 DOI: 10.1093/ehjopen/oead055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/09/2023] [Accepted: 05/22/2023] [Indexed: 06/10/2023]
Abstract
Aims To examine the impact of population screening-generated events on quality of life: invitation, positive test result, initiation of preventive medication, enrolment in follow-up at the surgical department, and preventive surgical repair. Methods and results A difference-in-difference design based on data collected alongside two randomized controlled trials where general population men were randomized to screening for cardiovascular disease or to no screening. Repeated measurements of health-related quality of life (HRQoL) were conducted up to 3 years after inclusion using all relevant scales of the EuroQol instrument: the anxiety/depression dimension, the EuroQol 5-dimension profile index (using Danish preference weights), and the visual analogue scale for global health. We compare the mean change scores from before to after events for groups experiencing vs. not experiencing the events. Propensity score matching is additionally used to provide both unmatched and matched results. Invitees reported to be marginally better off than non-invitees on all scales of the EuroQol. For events of receiving the test result, initiating preventive medication, being enrolled in surveillance, and undergoing surgical repair, we observed no impact on overall HRQoL but a minor impact of being enrolled in surveillance on emotional distress, which did not persist after matching. Conclusion The often-claimed detrimental consequences of screening to HRQoL could not be generally confirmed. Amongst the screening events assessed, only two possible consequences were revealed: a reassurance effect after a negative screening test and a minor negative impact to emotional distress of being enrolled in surveillance that did not spill over to overall HRQoL.
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Affiliation(s)
| | - Axel Diederichsen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
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9
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Larsen KL, Kavaliunaite E, Rasmussen LM, Hallas J, Diederichsen A, Steffensen FH, Busk M, Frost L, Urbonaviciene G, Lambrechtsen J, Egstrup K, Lindholt JS. The association between diabetes and abdominal aortic aneurysms in men: results of two Danish screening studies, a systematic review, and a meta-analysis of population-based screening studies. BMC Cardiovasc Disord 2023; 23:139. [PMID: 36927295 PMCID: PMC10022183 DOI: 10.1186/s12872-023-03160-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 03/01/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND A paradoxical protective effect of diabetes on the development and progression of abdominal aortic aneurysms (AAA) has been known for years. This study aimed to investigate whether the protective role of diabetes on AAAs has evolved over the years. METHODS A cross-sectional study, a systematic review and meta-analysis. This study was based on two large, population-based, randomised screening trials of men aged 65-74; VIVA (2008-2011) and DANCAVAS (2014-2018), including measurement of the abdominal aorta by ultrasound or CT, respectively. Analyses were performed using multiple logistic regressions to estimate the odds ratios (ORs) for AAAs in men with diabetes compared to those not having diabetes. Moreover, a systematic review and meta-analysis of population-based screening studies of AAAs to visualise a potential change of the association between diabetes and AAAs. Studies reporting only on women or Asian populations were excluded. RESULTS In VIVA, the prevalence of AAA was 3.3%, crude OR for AAA in men with diabetes 1.04 (95% confidence interval, CI, 0.80-1.34), and adjusted OR 0.64 (CI 0.48-0.84). In DANCAVAS, the prevalence of AAA was 4.2%, crude OR 1.44 (CI 1.11-1.87), and adjusted OR 0.78 (CI 0.59-1.04). Twenty-three studies were identified for the meta-analysis (N = 224 766). The overall crude OR was 0.90 (CI 0.77-1.05) before 2000 and 1.16 (CI 1.03-1.30) after 1999. The overall adjusted OR was 0.63 (CI 0.59-0.69) before 2000 and 0.69 (CI 0.57-0.84) after 1999. CONCLUSION Both the crude and adjusted OR showed a statistically non-significant trend towards an increased risk of AAA by the presence of diabetes. If this represents an actual trend, it could be due to a change in the diabetes population. TRIAL REGISTRATION DANCAVAS: Current Controlled Trials: ISRCTN12157806. VIVA: ClinicalTrials.gov NCT00662480.
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Affiliation(s)
- Katrine Lawaetz Larsen
- grid.7143.10000 0004 0512 5013Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark
- grid.7143.10000 0004 0512 5013The Danish Diabetes Academy, Odense University Hospital, Kløvervænget 6, 5000 Odense C, Denmark
| | - Egle Kavaliunaite
- grid.7143.10000 0004 0512 5013Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark
| | - Lars Melholt Rasmussen
- grid.7143.10000 0004 0512 5013Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark
| | - Jesper Hallas
- grid.7143.10000 0004 0512 5013Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark
- grid.10825.3e0000 0001 0728 0170Clinical Pharmacology and Pharmacy, University of Southern Denmark, J.B. Winsløws Vej 19, 5000 Odense C, Denmark
| | - Axel Diederichsen
- grid.7143.10000 0004 0512 5013Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark
| | - Flemming Hald Steffensen
- grid.459623.f0000 0004 0587 0347Department of Cardiology, Lillebaelt Hospital, Beriderbakken 4, 7100 Vejle, Denmark
| | - Martin Busk
- grid.459623.f0000 0004 0587 0347Department of Cardiology, Lillebaelt Hospital, Beriderbakken 4, 7100 Vejle, Denmark
| | - Lars Frost
- Department of Cardiology, Diagnostic Centre, Regional Hospital Silkeborg, Falkevej 1A, 8600 Silkeborg, Denmark
| | - Grazina Urbonaviciene
- Department of Cardiology, Diagnostic Centre, Regional Hospital Silkeborg, Falkevej 1A, 8600 Silkeborg, Denmark
| | - Jess Lambrechtsen
- grid.7143.10000 0004 0512 5013Department of Cardiology, Odense University Hospital Svendborg, Baagøes Àlle 15, 5700 Svendborg, Denmark
| | - Kenneth Egstrup
- grid.7143.10000 0004 0512 5013Department of Cardiology, Odense University Hospital Svendborg, Baagøes Àlle 15, 5700 Svendborg, Denmark
| | - Jes Sanddal Lindholt
- grid.7143.10000 0004 0512 5013Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark
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Protocol for a Systematic Review and Individual Participant Data Meta-Analysis of Randomized Trials of Screening for Atrial Fibrillation to Prevent Stroke. Thromb Haemost 2023; 123:366-376. [PMID: 36863334 PMCID: PMC9981276 DOI: 10.1055/s-0042-1760257] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
INTRODUCTION Atrial fibrillation (AF) is a common cause of stroke. Timely diagnosis of AF and treatment with oral anticoagulation (OAC) can prevent up to two-thirds of AF-related strokes. Ambulatory electrocardiographic (ECG) monitoring can identify undiagnosed AF in at-risk individuals, but the impact of population-based ECG screening on stroke is uncertain, as ongoing and published randomized controlled trials (RCTs) have generally been underpowered for stroke. METHODS AND ANALYSIS The AF-SCREEN Collaboration, with support from AFFECT-EU, have begun a systematic review and individual participant data meta-analysis of RCTs evaluating ECG screening for AF. The primary outcome is stroke. Secondary outcomes include AF detection, OAC prescription, hospitalization, mortality, and bleeding.After developing a common data dictionary, anonymized data will be collated from individual trials into a central database. We will assess risk of bias using the Cochrane Collaboration tool, and overall quality of evidence with the Grading of Recommendations Assessment, Development and Evaluation approach.We will pool data using random effects models. Prespecified subgroup and multilevel meta-regression analyses will explore heterogeneity. We will perform prespecified trial sequential meta-analyses of published trials to determine when the optimal information size has been reached, and account for unpublished trials using the SAMURAI approach. IMPACT AND DISSEMINATION Individual participant data meta-analysis will generate adequate power to assess the risks and benefits of AF screening. Meta-regression will permit exploration of the specific patient, screening methodology, and health system factors that influence outcomes. TRIAL REGISTRATION NUMBER PROSPERO CRD42022310308.
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Høgh A, Lindholt JS, Søgaard R, Refsgaard J, Svenstrup D, Moeslund NJ, Bredsgaard M, Dahl M. Protocol for a cohort study to evaluate the effectiveness and cost-effectiveness of general population screening for cardiovascular disease: the Viborg Screening Programme (VISP). BMJ Open 2023; 13:e063335. [PMID: 36854592 PMCID: PMC9980325 DOI: 10.1136/bmjopen-2022-063335] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
INTRODUCTION The prevalence of cardiovascular disease (CVD) is increasing. Furthermore, asymptomatic individuals may not receive timely preventive initiatives to minimise the risk of further CVD events. Paradoxically, 80% of CVD events are preventable by early detection, followed by prophylactic initiatives. Consequently, we introduced the population-based Viborg Screening Programme (VISP) for subclinical and manifest CVD, focusing on commonly occurring, mainly asymptomatic conditions, followed by prophylactic initiatives.The aim of the VISP was to evaluate the health benefits, harms and cost-effectiveness of the VISP from a healthcare sector perspective. Furthermore, we explored the participants' perspectives. METHODS AND ANALYSIS From August 2014 and currently ongoing, approximately 1100 men and women from the Viborg municipality, Denmark, are annually invited to screening for abdominal aortic aneurysm, peripheral arterial disease, carotid plaque, hypertension, diabetes mellitus and cardiac arrhythmia on their 67th birthday. A population from the surrounding municipalities without access to the VISP acts as a control. The VISP invitees and the controls are followed on the individual level by nationwide registries. The primary outcome is all-cause mortality, while costs, hospitalisations and deaths from CVD are the secondary endpoints.Interim evaluations of effectiveness and cost-effectiveness are planned every 5 years using propensity score matching followed by a Cox proportional hazards regression analysis by the 'intention-to-treat' principle. Furthermore, censoring-adjusted incremental costs, life-years and quality-adjusted life-years are estimated. Finally, the participants' perspectives are explored by semistructured face-to-face interviews, with participant selection representing participants with both negative and positive screening results. ETHICS AND DISSEMINATION The VISP is not an interventional trial. Therefore, approval from a regional scientific ethical committee is not needed. Data collection from national registries was approved by the Regional Data Protection Agency (record no. 1-16-02-232-15). We ensure patient and public involvement in evaluating the acceptability of VISP by adopting an interviewing approach in the study. TRIAL REGISTRATION NUMBER NCT03395509.
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Affiliation(s)
- Annette Høgh
- Vascular Research Unit, Department of Vascualr Surgery, Viborg Regional Hospital, Viborg, Denmark
- Institute for Clinical Medicine, Aarhus Universitet Health, Aarhus, Denmark
| | - Jes Sanddal Lindholt
- Institute for Clinical Medicine, Aarhus Universitet Health, Aarhus, Denmark
- Department of Cardiothoracic and Vascular Surgery, Odense Universitetshospital, Odense, Denmark
| | - Rikke Søgaard
- Demartment of Public Health and Department of Clinical Medicine, Aarhus Universitet, Aarhus, Denmark
- Department of Clinical Medicine, University of Southern Denmark, Odense, Denmark
| | - Jens Refsgaard
- Department of Cardiology, Viborg Regional Hospital, Viborg, Denmark
| | - Dorte Svenstrup
- Department of Cardiology, Viborg Regional Hospital, Viborg, Denmark
| | | | - Mette Bredsgaard
- The Health Centre of Viborg Municipality, Municipality of Viborg, Viborg, Denmark
| | - Marie Dahl
- Institute for Clinical Medicine, Aarhus Universitet Health, Aarhus, Denmark
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12
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Major Global Coronary Artery Calcium Guidelines. JACC. CARDIOVASCULAR IMAGING 2023; 16:98-117. [PMID: 36599573 DOI: 10.1016/j.jcmg.2022.06.018] [Citation(s) in RCA: 39] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/14/2022] [Accepted: 06/22/2022] [Indexed: 01/07/2023]
Abstract
This review summarizes the framework behind global guidelines of coronary artery calcium (CAC) in atherosclerotic cardiovascular disease risk assessment, for applications in both the clinical setting and preventive therapy. By comparing similarities and differences in recommendations, this review identifies most notable common features for the application of CAC presented by different cardiovascular societies across the world. Guidelines included from North America are as follows: 1) the 2019 American College of Cardiology/American Heart Association Guideline on the Primary Prevention of Cardiovascular Disease; and 2) the 2021 Canadian Cardiovascular Society Guidelines for the Management of Dyslipidemia for Prevention of Adult Cardiovascular Disease. The authors also included European guidelines: 1) the 2019 European Society for Cardiology/European Atherosclerosis Society Guidelines for the Management of Dyslipidemias; and 2) the 2016 National Institute for Health and Care Excellence Clinical Guidelines. In this comparison, the authors also discuss: 1) the Cardiac Society of Australia and New Zealand Guidelines on CAC; 2) the Chinese Society of Cardiology Guidelines; and 3) the Japanese Atherosclerosis Society Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases. Last, they include statements made by specialty societies including the National Lipid Association, Society of Cardiovascular Computed Tomography, and U.S. Preventive Services Task Force. Utilizing an in-depth review of clinical evidence, these guidelines emphasize the importance of CAC in the primary and secondary prevention of atherosclerotic cardiovascular disease. International guidelines all empower a dynamic clinician-patient relationship and advocate for individualized discussions regarding disease management and pharmacotherapy treatment. Some differences in precise coronary artery calcium score intervals, risk cut points, treatment thresholds, and stratifiers of specific patient subgroups do exist. However, international guidelines employ more similarities than differences from both a clinical and functional perspective. Understanding the parallels among international coronary artery calcium guidelines is essential for clinicians to correctly adjudicate personalized statin and aspirin therapy and further medical management.
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13
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Lindholt JS, Søgaard R, Rasmussen LM, Mejldal A, Lambrechtsen J, Steffensen FH, Frost L, Egstrup K, Urbonaviciene G, Busk M, Diederichsen ACP. Five-Year Outcomes of the Danish Cardiovascular Screening (DANCAVAS) Trial. N Engl J Med 2022; 387:1385-1394. [PMID: 36027560 DOI: 10.1056/nejmoa2208681] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Limited data suggest a benefit of population-based screening for cardiovascular disease with respect to the risk of death. METHODS We performed a population-based, parallel-group, randomized, controlled trial involving men 65 to 74 years of age living in 15 Danish municipalities. The participants were randomly assigned in a 1:2 ratio to undergo screening (the invited group) or not to undergo screening (the control group) for subclinical cardiovascular disease. Randomization was based on computer-generated random numbers and stratified according to municipality. Only the control group was unaware of the trial-group assignments. Screening included noncontrast electrocardiography-gated computed tomography to determine the coronary-artery calcium score and to detect aneurysms and atrial fibrillation, ankle-brachial blood-pressure measurements to detect peripheral artery disease and hypertension, and a blood sample to detect diabetes mellitus and hypercholesterolemia. The primary outcome was death from any cause. RESULTS A total of 46,611 participants underwent randomization. After exclusion of 85 men who had died or emigrated before being invited to undergo screening, there were 16,736 men in the invited group and 29,790 men in the control group; 10,471 of the men in the invited group underwent screening (62.6%). In intention-to-treat analyses, after a median follow-up of 5.6 years, 2106 men (12.6%) in the invited group and 3915 men (13.1%) in the control group had died (hazard ratio, 0.95; 95% confidence interval [CI], 0.90 to 1.00; P = 0.06). The hazard ratio for stroke in the invited group, as compared with the control group, was 0.93 (95% CI, 0.86 to 0.99); for myocardial infarction, 0.91 (95% CI, 0.81 to 1.03); for aortic dissection, 0.95 (95% CI, 0.61 to 1.49); and for aortic rupture, 0.81 (95% CI, 0.49 to 1.35). There were no significant between-group differences in safety outcomes. CONCLUSIONS After more than 5 years, the invitation to undergo comprehensive cardiovascular screening did not significantly reduce the incidence of death from any cause among men 65 to 74 years of age. (Funded by the Southern Region of Denmark and others; DANCAVAS ISRCTN Registry number, ISRCTN12157806.).
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Affiliation(s)
- Jes S Lindholt
- From the Departments of Cardiac, Thoracic, and Vascular Surgery (J.S.L., R.S.), Clinical Biochemistry and Pharmacology (L.M.R.), and Cardiology (A.C.P.D.), Elite Research Center for Individualized Medicine in Arterial Diseases, and the Open Patient Data Explorative Network (A.M.), Odense University Hospital, Clinical Institute, University of Southern Denmark (R.S.), Odense, the Department of Cardiology, Odense University Hospital, Svendborg (J.L., K.E.), the Department of Cardiology, Lillebaelt Hospital, Vejle (F.H.S., M.B.), and the Department of Cardiology, Diagnostic Center, Regional Hospital Silkeborg, Silkeborg (L.F., G.U.) - all in Denmark
| | - Rikke Søgaard
- From the Departments of Cardiac, Thoracic, and Vascular Surgery (J.S.L., R.S.), Clinical Biochemistry and Pharmacology (L.M.R.), and Cardiology (A.C.P.D.), Elite Research Center for Individualized Medicine in Arterial Diseases, and the Open Patient Data Explorative Network (A.M.), Odense University Hospital, Clinical Institute, University of Southern Denmark (R.S.), Odense, the Department of Cardiology, Odense University Hospital, Svendborg (J.L., K.E.), the Department of Cardiology, Lillebaelt Hospital, Vejle (F.H.S., M.B.), and the Department of Cardiology, Diagnostic Center, Regional Hospital Silkeborg, Silkeborg (L.F., G.U.) - all in Denmark
| | - Lars M Rasmussen
- From the Departments of Cardiac, Thoracic, and Vascular Surgery (J.S.L., R.S.), Clinical Biochemistry and Pharmacology (L.M.R.), and Cardiology (A.C.P.D.), Elite Research Center for Individualized Medicine in Arterial Diseases, and the Open Patient Data Explorative Network (A.M.), Odense University Hospital, Clinical Institute, University of Southern Denmark (R.S.), Odense, the Department of Cardiology, Odense University Hospital, Svendborg (J.L., K.E.), the Department of Cardiology, Lillebaelt Hospital, Vejle (F.H.S., M.B.), and the Department of Cardiology, Diagnostic Center, Regional Hospital Silkeborg, Silkeborg (L.F., G.U.) - all in Denmark
| | - Anne Mejldal
- From the Departments of Cardiac, Thoracic, and Vascular Surgery (J.S.L., R.S.), Clinical Biochemistry and Pharmacology (L.M.R.), and Cardiology (A.C.P.D.), Elite Research Center for Individualized Medicine in Arterial Diseases, and the Open Patient Data Explorative Network (A.M.), Odense University Hospital, Clinical Institute, University of Southern Denmark (R.S.), Odense, the Department of Cardiology, Odense University Hospital, Svendborg (J.L., K.E.), the Department of Cardiology, Lillebaelt Hospital, Vejle (F.H.S., M.B.), and the Department of Cardiology, Diagnostic Center, Regional Hospital Silkeborg, Silkeborg (L.F., G.U.) - all in Denmark
| | - Jess Lambrechtsen
- From the Departments of Cardiac, Thoracic, and Vascular Surgery (J.S.L., R.S.), Clinical Biochemistry and Pharmacology (L.M.R.), and Cardiology (A.C.P.D.), Elite Research Center for Individualized Medicine in Arterial Diseases, and the Open Patient Data Explorative Network (A.M.), Odense University Hospital, Clinical Institute, University of Southern Denmark (R.S.), Odense, the Department of Cardiology, Odense University Hospital, Svendborg (J.L., K.E.), the Department of Cardiology, Lillebaelt Hospital, Vejle (F.H.S., M.B.), and the Department of Cardiology, Diagnostic Center, Regional Hospital Silkeborg, Silkeborg (L.F., G.U.) - all in Denmark
| | - Flemming H Steffensen
- From the Departments of Cardiac, Thoracic, and Vascular Surgery (J.S.L., R.S.), Clinical Biochemistry and Pharmacology (L.M.R.), and Cardiology (A.C.P.D.), Elite Research Center for Individualized Medicine in Arterial Diseases, and the Open Patient Data Explorative Network (A.M.), Odense University Hospital, Clinical Institute, University of Southern Denmark (R.S.), Odense, the Department of Cardiology, Odense University Hospital, Svendborg (J.L., K.E.), the Department of Cardiology, Lillebaelt Hospital, Vejle (F.H.S., M.B.), and the Department of Cardiology, Diagnostic Center, Regional Hospital Silkeborg, Silkeborg (L.F., G.U.) - all in Denmark
| | - Lars Frost
- From the Departments of Cardiac, Thoracic, and Vascular Surgery (J.S.L., R.S.), Clinical Biochemistry and Pharmacology (L.M.R.), and Cardiology (A.C.P.D.), Elite Research Center for Individualized Medicine in Arterial Diseases, and the Open Patient Data Explorative Network (A.M.), Odense University Hospital, Clinical Institute, University of Southern Denmark (R.S.), Odense, the Department of Cardiology, Odense University Hospital, Svendborg (J.L., K.E.), the Department of Cardiology, Lillebaelt Hospital, Vejle (F.H.S., M.B.), and the Department of Cardiology, Diagnostic Center, Regional Hospital Silkeborg, Silkeborg (L.F., G.U.) - all in Denmark
| | - Kenneth Egstrup
- From the Departments of Cardiac, Thoracic, and Vascular Surgery (J.S.L., R.S.), Clinical Biochemistry and Pharmacology (L.M.R.), and Cardiology (A.C.P.D.), Elite Research Center for Individualized Medicine in Arterial Diseases, and the Open Patient Data Explorative Network (A.M.), Odense University Hospital, Clinical Institute, University of Southern Denmark (R.S.), Odense, the Department of Cardiology, Odense University Hospital, Svendborg (J.L., K.E.), the Department of Cardiology, Lillebaelt Hospital, Vejle (F.H.S., M.B.), and the Department of Cardiology, Diagnostic Center, Regional Hospital Silkeborg, Silkeborg (L.F., G.U.) - all in Denmark
| | - Grazina Urbonaviciene
- From the Departments of Cardiac, Thoracic, and Vascular Surgery (J.S.L., R.S.), Clinical Biochemistry and Pharmacology (L.M.R.), and Cardiology (A.C.P.D.), Elite Research Center for Individualized Medicine in Arterial Diseases, and the Open Patient Data Explorative Network (A.M.), Odense University Hospital, Clinical Institute, University of Southern Denmark (R.S.), Odense, the Department of Cardiology, Odense University Hospital, Svendborg (J.L., K.E.), the Department of Cardiology, Lillebaelt Hospital, Vejle (F.H.S., M.B.), and the Department of Cardiology, Diagnostic Center, Regional Hospital Silkeborg, Silkeborg (L.F., G.U.) - all in Denmark
| | - Martin Busk
- From the Departments of Cardiac, Thoracic, and Vascular Surgery (J.S.L., R.S.), Clinical Biochemistry and Pharmacology (L.M.R.), and Cardiology (A.C.P.D.), Elite Research Center for Individualized Medicine in Arterial Diseases, and the Open Patient Data Explorative Network (A.M.), Odense University Hospital, Clinical Institute, University of Southern Denmark (R.S.), Odense, the Department of Cardiology, Odense University Hospital, Svendborg (J.L., K.E.), the Department of Cardiology, Lillebaelt Hospital, Vejle (F.H.S., M.B.), and the Department of Cardiology, Diagnostic Center, Regional Hospital Silkeborg, Silkeborg (L.F., G.U.) - all in Denmark
| | - Axel Cosmus Pyndt Diederichsen
- From the Departments of Cardiac, Thoracic, and Vascular Surgery (J.S.L., R.S.), Clinical Biochemistry and Pharmacology (L.M.R.), and Cardiology (A.C.P.D.), Elite Research Center for Individualized Medicine in Arterial Diseases, and the Open Patient Data Explorative Network (A.M.), Odense University Hospital, Clinical Institute, University of Southern Denmark (R.S.), Odense, the Department of Cardiology, Odense University Hospital, Svendborg (J.L., K.E.), the Department of Cardiology, Lillebaelt Hospital, Vejle (F.H.S., M.B.), and the Department of Cardiology, Diagnostic Center, Regional Hospital Silkeborg, Silkeborg (L.F., G.U.) - all in Denmark
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Affiliation(s)
- Mark A Hlatky
- Stanford University, School of Medicine, Encina Commons, Room 200, 615 Crothers Way, Stanford, CA 94305-6006, USA
| | - Philip Greenland
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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15
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Søgaard R, Diederichsen ACP, Rasmussen LM, Lambrechtsen J, Steffensen FH, Frost L, Egstrup K, Urbonaviciene G, Busk M, Lindholt JS. Cost effectiveness of population screening versus no screening for cardiovascular disease: the Danish Cardiovascular Screening trial (DANCAVAS). Eur Heart J 2022; 43:4392-4402. [PMID: 36029019 DOI: 10.1093/eurheartj/ehac488] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/08/2022] [Accepted: 08/25/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Rikke Søgaard
- Elite Research Centre of Individualized Medicine in Arterial Disease (CIMA), Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Axel Cosmus Pyndt Diederichsen
- Department of Cardiology, Elite Research Centre of Individualized Medicine in Arterial Disease (CIMA), Odense University Hospital, Odense, Denmark
| | - Lars M Rasmussen
- Department of Clinical Biochemistry and Pharmacology, Elite Research Centre of Individualized Medicine in Arterial Disease (CIMA), Odense University Hospital, Odense, Denmark
| | - Jess Lambrechtsen
- Department of Cardiology, Odense University Hospital, Svendborg, Denmark
| | | | - Lars Frost
- Department of Cardiology, Diagnostic Centre, Regional Hospital Silkeborg, Silkeborg, Denmark
| | - Kenneth Egstrup
- Department of Cardiology, Odense University Hospital, Svendborg, Denmark
| | - Grazina Urbonaviciene
- Department of Cardiology, Diagnostic Centre, Regional Hospital Silkeborg, Silkeborg, Denmark
| | - Martin Busk
- Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark
| | - Jes S Lindholt
- Department of Cardiothoracic and Vascular Surgery, Elite Research Centre of Individualized Medicine in Arterial Disease (CIMA), Odense University Hospital, Odense, Denmark
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16
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Gonçalves-Teixeira P, Costa T, Fragoso I, Ferreira D, Brandão M, Leite-Moreira A, Sampaio F, Ribeiro J, Fontes-Carvalho R. Screening, Diagnosis and Management of Atrial Fibrillation in Cancer Patients: Current Evidence and Future Perspectives. Arq Bras Cardiol 2022; 119:328-341. [PMID: 35946695 PMCID: PMC9363048 DOI: 10.36660/abc.20201362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 05/12/2021] [Indexed: 11/18/2022] Open
Abstract
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in the general population, carrying a high morbimortality burden, and this also holds true in cancer patients. The association between AF and cancer goes even further, with some studies suggesting that AF can be a marker of occult cancer. There is, however, a remarkable paucity of data concerning specific challenges of AF management in cancer patients. AF prompt recognition and management in this special population can lessen the arrhythmia-related morbidity and have an important prognostic benefit. This review will focus on current AF diagnosis and management challenges in cancer patients, with special emphasis on AF screening strategies and devices, and anticoagulation therapy with non-vitamin K antagonist oral anti-coagulants (NOACs) for thromboembolic prevention in these patients. Some insights concerning future perspectives for AF prevention, diagnosis, and treatment in this special population will also be addressed.
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Affiliation(s)
- Pedro Gonçalves-Teixeira
- Departamento de Cardiologia, Vila Nova de Gaia Hospital Center, Gaia - Portugal.,Departamento de Fisiologia, Faculdade de Medicina, Universidade do Porto, Porto - Portugal.,Clínica Cardio-Oncológica, Centro Hospitalar Vila Nova de Gaia, Gaia - Portugal
| | - Telma Costa
- Clínica Cardio-Oncológica, Centro Hospitalar Vila Nova de Gaia, Gaia - Portugal.,Departamento de Oncologia, Centro Hospitalar Vila Nova de Gaia, Gaia - Portugal
| | - Isabel Fragoso
- Unidade de Atenção Primária à Saúde Aracetti, Arazede - Portugal
| | - Diogo Ferreira
- Departamento de Cardiologia, Vila Nova de Gaia Hospital Center, Gaia - Portugal.,Departamento de Fisiologia, Faculdade de Medicina, Universidade do Porto, Porto - Portugal
| | - Mariana Brandão
- Departamento de Cardiologia, Vila Nova de Gaia Hospital Center, Gaia - Portugal
| | - Adelino Leite-Moreira
- Departamento de Fisiologia, Faculdade de Medicina, Universidade do Porto, Porto - Portugal.,Departamento de Cirurgia Cardiotorácica, Hospital Universitário São João, Porto - Portugal.,Unidade de Pesquisa Cardiovascular (UnIC), Faculdade de Medicina, Universidade do Porto, Porto - Portugal
| | - Francisco Sampaio
- Departamento de Cardiologia, Vila Nova de Gaia Hospital Center, Gaia - Portugal.,Departamento de Fisiologia, Faculdade de Medicina, Universidade do Porto, Porto - Portugal
| | - José Ribeiro
- Departamento de Cardiologia, Vila Nova de Gaia Hospital Center, Gaia - Portugal.,Clínica Cardio-Oncológica, Centro Hospitalar Vila Nova de Gaia, Gaia - Portugal
| | - Ricardo Fontes-Carvalho
- Departamento de Cardiologia, Vila Nova de Gaia Hospital Center, Gaia - Portugal.,Departamento de Fisiologia, Faculdade de Medicina, Universidade do Porto, Porto - Portugal
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Diederichsen AC, Lindholt JS, Möller S, Øvrehus KA, Auscher S, Lambrechtsen J, Hosbond SE, Alan DH, Urbonaviciene G, Becker SW, Fredgart MH, Hasific S, Folkestad L, Gerke O, Rasmussen LM, Møller JE, Mickley H, Dahl JS. Vitamin K2 and D in Patients With Aortic Valve Calcification: A Randomized Double-Blinded Clinical Trial. Circulation 2022; 145:1387-1397. [PMID: 35465686 PMCID: PMC9047644 DOI: 10.1161/circulationaha.121.057008] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 02/09/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Menaquinone-7 (MK-7), also known as vitamin K2, is a cofactor for the carboxylation of proteins involved in the inhibition of arterial calcification and has been suggested to reduce the progression rate of aortic valve calcification (AVC) in patients with aortic stenosis. METHODS In a randomized, double-blind, multicenter trial, men from the community with an AVC score >300 arbitrary units (AU) on cardiac noncontrast computer tomography were randomized to daily treatment with tablet 720 µg MK-7 plus 25 µg vitamin D or matching placebo for 24 months. The primary outcome was the change in AVC score. Selected secondary outcomes included change in aortic valve area and peak aortic jet velocity on echocardiography, heart valve surgery, change in aortic and coronary artery calcification, and change in dp-ucMGP (dephosphorylated-undercarboxylated matrix Gla-protein). Safety outcomes included all-cause death and cardiovascular events. RESULTS From February 1, 2018, to March 21, 2019, 365 men were randomized. Mean age was 71.0 (±4.4) years. The mean (95% CI) increase in AVC score was 275 AU (95% CI, 225-326 AU) and 292 AU (95% CI, 246-338 AU) in the intervention and placebo groups, respectively. The mean difference on AVC progression was 17 AU (95% CI, -86 to 53 AU; P=0.64). The mean change in aortic valve area was 0.02 cm2 (95% CI, -0.09 to 0.12 cm2; P=0.78) and in peak aortic jet velocity was 0.04 m/s (95% CI, -0.11 to 0.02 m/s; P=0.21). The progression in aortic and coronary artery calcification score was not significantly different between patients treated with MK-7 plus vitamin D and patients receiving placebo. There was no difference in the rate of heart valve surgery (1 versus 2 patients; P=0.99), all-cause death (1 versus 4 patients; P=0.37), or cardiovascular events (10 versus 10 patients; P=0.99). Compared with patients in the placebo arm, a significant reduction in dp-ucMGP was observed with MK-7 plus vitamin D (-212 pmol/L versus 45 pmol/L; P<0.001). CONCLUSIONS In elderly men with an AVC score >300 AU, 2 years MK-7 plus vitamin D supplementation did not influence AVC progression. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03243890.
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Affiliation(s)
- Axel C.P. Diederichsen
- Department of Cardiology (A.C.P.D., K.A.Ø., M.H.F., S.H.‚ H.M., J.S.D.), Odense University Hospital, Denmark
| | - Jes S. Lindholt
- Department of Cardiothoracic and Vascular Surgery (J.S.L.), Odense University Hospital, Denmark
| | - Sören Möller
- Open Patient Data Explorative Network (S.M.), Odense University Hospital, Denmark
| | - Kristian A. Øvrehus
- Department of Cardiology (A.C.P.D., K.A.Ø., M.H.F., S.H.‚ H.M., J.S.D.), Odense University Hospital, Denmark
| | - Søren Auscher
- Department of Cardiology, Svendborg Hospital, Denmark (S.A., J.L.)
| | | | - Susanne E. Hosbond
- Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (S.E.H.‚ D.H.A.)
| | - Dilek H. Alan
- Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (S.E.H.‚ D.H.A.)
| | - Grazina Urbonaviciene
- Department of Cardiology, Regional Hospital Central Jutland, Silkeborg, Denmark (G.U., S.W.B.)
| | - Søren W. Becker
- Department of Cardiology, Regional Hospital Central Jutland, Silkeborg, Denmark (G.U., S.W.B.)
| | - Maise H. Fredgart
- Department of Cardiology (A.C.P.D., K.A.Ø., M.H.F., S.H.‚ H.M., J.S.D.), Odense University Hospital, Denmark
| | - Selma Hasific
- Department of Cardiology (A.C.P.D., K.A.Ø., M.H.F., S.H.‚ H.M., J.S.D.), Odense University Hospital, Denmark
| | - Lars Folkestad
- Department of Endocrinology (L.F.), Odense University Hospital, Denmark
| | - Oke Gerke
- Department of Nuclear Medicine (O.G.), Odense University Hospital, Denmark
| | - Lars Melholt Rasmussen
- Department of Clinical Biochemistry and Pharmacology (L.M.R.), Odense University Hospital, Denmark
| | - Jacob E. Møller
- Department of Cardiology, Copenhagen University Hospital, Denmark (J.E.M.)
| | - Hans Mickley
- Department of Cardiology (A.C.P.D., K.A.Ø., M.H.F., S.H.‚ H.M., J.S.D.), Odense University Hospital, Denmark
| | - Jordi S. Dahl
- Department of Cardiology (A.C.P.D., K.A.Ø., M.H.F., S.H.‚ H.M., J.S.D.), Odense University Hospital, Denmark
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18
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Fredgart MH, Lindholt JS, Brandes A, Steffensen FH, Frost L, Lambrechtsen J, Karon M, Busk M, Urbonaviciene G, Egstrup K, Khurrami L, Gerke O, Diederichsen ACP. Association of Left Atrial Size Measured by Non-Contrast Computed Tomography with Cardiovascular Risk Factors—The Danish Cardiovascular Screening Trial (DANCAVAS). Diagnostics (Basel) 2022; 12:diagnostics12020244. [PMID: 35204336 PMCID: PMC8871467 DOI: 10.3390/diagnostics12020244] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 01/18/2022] [Indexed: 02/06/2023] Open
Abstract
Left atrium (LA) size is associated with adverse cardiovascular events. The purpose of this study was to investigate the association of LA enlargement measured by non-contrast CT (NCCT) with traditional cardiovascular risk factors. Individuals aged 60–75 years from the population-based multicentre Danish Cardiovascular Screening (DANCAVAS) trial were included in this cross-sectional study. The LA was manually traced on the NCCT scans, and the largest cross-section area was indexed to body surface area. All traditional risk factors were recorded, and a subgroup received an echocardiographic examination. We enrolled 14,987 individuals. Participants with known cardiovascular disease or lacking measurements of LA size or body surface area were excluded, resulting in 10,902 men for the main analysis and 616 women for a sensitivity analysis. Adjusted multivariable analysis showed a significantly increased indexed LA size by increasing age and pulse pressure, while smoking, HbA1c, and total cholesterol were associated with decreased indexed LA size. The findings were confirmed in a supplementary analysis including left ventricle ejection fraction and mass. In this population-based cohort of elderly men, an association was found between age and pulse pressure and increasing LA size. Surprisingly, smoking, HbA1c, and total cholesterol were associated with a decrease in LA size. This indicates that the pathophysiology behind atrial cardiomyopathy is not only reflected by enlargement, but also shrinking.
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Affiliation(s)
- Maise Høigaard Fredgart
- Department of Cardiology, Odense University Hospital, 5000 Odense, Denmark; (M.H.F.); (A.B.); (L.K.)
- Odense Patient Data Explorative Network (OPEN), Odense University Hospital, 5000 Odense, Denmark
| | - Jes Sanddal Lindholt
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, 5000 Odense, Denmark;
- Cardiovascular Centre of Excellence (CAVAC), Odense University Hospital, 5000 Odense, Denmark
- Elitary Research Centre of Individualised Medicine in Arterial Disease, Odense University Hospital, 5000 Odense, Denmark
| | - Axel Brandes
- Department of Cardiology, Odense University Hospital, 5000 Odense, Denmark; (M.H.F.); (A.B.); (L.K.)
| | | | - Lars Frost
- Department of Cardiology, Regional Hospital Central Jutland, 8600 Silkeborg, Denmark; (L.F.); (G.U.)
| | - Jess Lambrechtsen
- Department of Cardiology, Svendborg Hospital, 5700 Svendborg, Denmark; (J.L.); (K.E.)
| | - Marek Karon
- Department of Medicine, Nykøbing Falster Hospital, 4800 Nykøbing Falster, Denmark;
| | - Martin Busk
- Department of Cardiology, Hospital Lillebælt, 7100 Vejle, Denmark; (F.H.S.); (M.B.)
| | - Grazina Urbonaviciene
- Department of Cardiology, Regional Hospital Central Jutland, 8600 Silkeborg, Denmark; (L.F.); (G.U.)
| | - Kenneth Egstrup
- Department of Cardiology, Svendborg Hospital, 5700 Svendborg, Denmark; (J.L.); (K.E.)
| | - Lida Khurrami
- Department of Cardiology, Odense University Hospital, 5000 Odense, Denmark; (M.H.F.); (A.B.); (L.K.)
| | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, 5000 Odense, Denmark;
| | - Axel Cosmus Pyndt Diederichsen
- Department of Cardiology, Odense University Hospital, 5000 Odense, Denmark; (M.H.F.); (A.B.); (L.K.)
- Elitary Research Centre of Individualised Medicine in Arterial Disease, Odense University Hospital, 5000 Odense, Denmark
- Correspondence:
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19
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Diederichsen A, Lindholt JS, Møller JE, Gerke O, Rasmussen LM, Dahl JS. Sex Differences in Factors Associated With Progression of Aortic Valve Calcification in the General Population. Circ Cardiovasc Imaging 2022; 15:e013165. [PMID: 34983195 DOI: 10.1161/circimaging.121.013165] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Guidelines recommend measurement of the aortic valve calcification (AVC) score to help differentiate between severe and nonsevere aortic stenosis, but a paucity exists in data about AVC in the general population. The aim of this study was to describe the natural history of AVC progression in the general population and to identify potential sex differences in factors associated with this progression rate. METHODS Noncontrast cardiac computed tomography was performed in 1298 randomly selected women and men aged 65 to 74 years who participated in the DANCAVAS trial (Danish Cardiovascular Screening). Participants were invited to attend a reexamination after 4 years. The AVC score was measured at the computed tomography, and AVC progression (ΔAVC) was defined as the difference between AVC scores at baseline and follow-up. Multivariable regression analyses were performed to identify factors associated with ΔAVC. RESULTS Among the 1298 invited citizens, 823 accepted to participate in the follow-up examination. The mean age at follow-up was 73 years. Men had significantly higher AVC scores at baseline (median AVC score 13 Agatston Units [AU; interquartile range, 0-94 AU] versus 1 AU [interquartile range, 0-22 AU], P<0.001) and a higher ΔAVC (median 26 AU [interquartile range, 0-101 AU] versus 4 AU [interquartile range, 0-37 AU], P<0.001) than women. In the fully adjusted model, the most important factor associated with ΔAVC was the baseline AVC score. However, hypertension was associated with ΔAVC in women (incidence rate ratios, 1.58 [95% CI, 1.06-2.34], P=0.024) but not in men, whereas dyslipidemia was associated with ΔAVC in men (incidence rate ratio: 1.66 [95% CI, 1.18-2.34], P=0.004) but not in women. CONCLUSIONS The magnitude of the AVC score was the most important marker of AVC progression. However, sex differences were significant; hence, dyslipidemia was associated with AVC progression only among men; hypertension with AVC progression only among women. Registration: URL: https://www.isrctn.com; Unique identifier: ISRCTN12157806.
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Affiliation(s)
- Axel Diederichsen
- Department of Cardiology (A.D., J.E.M., J.S.D.), and Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Denmark
| | - Jes Sanddal Lindholt
- Department of Thoracic and Vascular Surgery (J.S.L.), and Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Denmark
| | - Jacob Eifer Møller
- Department of Cardiology (A.D., J.E.M., J.S.D.), and Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Denmark.,Department of Cardiology, Rigshospitalet - Copenhagen, Denmark (J.E.M.)
| | - Oke Gerke
- Department of Nuclear Medicine (O.G., L.M.R.), and Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Denmark
| | - Lars Melholt Rasmussen
- Department of Nuclear Medicine (O.G., L.M.R.), and Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Denmark
| | - Jordi S Dahl
- Department of Cardiology (A.D., J.E.M., J.S.D.), and Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Denmark
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20
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Rasmussen JH, Fredgart MH, Lindholt JS, Johansen JB, Sandgaard N, Yousef AH, Hasific S, Sønderskov P, Steffensen FH, Frost L, Lambrechtsen J, Karon M, Busk M, Urbonaviciene G, Egstrup K, Diederichsen ACP. Mitral Annulus Calcification and Cardiac Conduction Disturbances: a DANCAVAS Sub-study. J Cardiovasc Imaging 2022; 30:62-75. [PMID: 35086172 PMCID: PMC8792721 DOI: 10.4250/jcvi.2021.0110] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/25/2021] [Accepted: 09/27/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Due to its location very close to the bundle of His, mitral annulus calcification (MAC) might be associated with the development of atrioventricular (AV) conduction disturbances. This study assessed the association between MAC and AV conduction disturbances identified by cardiac implantable electronic device (CIED) use and electrocardiographic parameters. The association between MAC and traditional cardiovascular risk factors was also assessed. METHODS This cross-sectional study analyzed 14,771 participants, predominantly men aged 60–75 years, from the population-based Danish Cardiovascular Screening trial. Traditional cardiovascular risk factors were obtained. Using cardiac non-contrast computed tomography imaging, MAC scores were measured using the Agatston method and divided into absent versus present and score categories. CIED implantation data were obtained from the Danish Pacemaker and Implantable Cardioverter Defibrillator Register. A 12-lead electrocardiogram was available for 2,107 participants. Associations between MAC scores and AV conduction disturbances were assessed using multivariate regression analyses. RESULTS MAC was present in 22.4% of the study subjects. Participants with pacemakers for an AV conduction disturbance had significantly higher MAC scores (odds ratio [OR], 1.11; 95% confidence interval [CI], 1.01–1.23) than participants without a CIED, whereas participants with a CIED for other reasons did not. Prolonged QRS-interval was significantly associated with the presence of MAC (OR, 1.45; 95% CI, 1.04–2.04), whereas prolonged PQ-interval was not. Female sex and most traditional cardiovascular risk factors were significantly associated with high MAC scores. CONCLUSIONS MAC was associated with AV conduction disturbances, which could improve our understanding of the development of AV conduction disturbances.
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Affiliation(s)
- Jeppe Holm Rasmussen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | | | - Jes Sanddal Lindholt
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
| | | | - Niels Sandgaard
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Selma Hasific
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | | | - Lars Frost
- Department of Cardiology, Regional Hospital Central Jutland, Silkeborg, Denmark
| | | | - Marek Karon
- Department of Medicine, Nykoebing Falster Hospital, Nykoebing Falster, Denmark
| | - Martin Busk
- Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark
| | | | - Kenneth Egstrup
- Department of Cardiology, Svendborg Hospital, Svendborg, Denmark
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21
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Nonparametric percentile curve estimation for a nonnegative marker with excessive zeros. MethodsX 2022; 9:101757. [PMID: 35782723 PMCID: PMC9241054 DOI: 10.1016/j.mex.2022.101757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/09/2022] [Indexed: 11/23/2022] Open
Abstract
Norm curves for the head circumference, height, and weight of newborns and infants are widely known examples of percentile curves over age, and early accounts date back 50 years. The advent of the Agatston score for coronary calcification based on coronary computed tomography in 1990 heralded the era of a new marker in preventive medicine, in addition to well-known cardiovascular risk factors. A peculiarity of the nonnegative Agatston score in populations that are free of coronary artery disease is the overexpression of zeros. In a case study, we have demonstrated a nonparametric approach for percentile curve estimation using markers such as the Agatston score. This method is based on lowess smoothing of marker-positive scores on age, and the resulting percentile curves are subsequently transposed according to the estimated proportions of zeros. The approach does not involve any parametric assumptions, is robust against outliers, and fulfills the noncrossing property for percentile curves. A simulation study using samples of N=1,000, 2,000, 5,000, and 10,000 subjects illuminates the closeness of the estimated 50th, 75th, and 90th percentile curves to the respective true curves, assuming an exponentially distributed marker and a proportion of zero scores that increase with age.The method is applicable to highly skewed data and exemplified here with subgroup data of the referenced procedure. The consistency and general performance of the method is shown by means of simulation. The method is an explicit, transferable, and reproducible procedure that is applicable to a wide spectrum of markers and scores across various scientific disciplines, far beyond cardiovascular medicine.
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22
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Andersen LAC, Palstrøm NB, Diederichsen A, Lindholt JS, Rasmussen LM, Beck HC. Determining Plasma Protein Variation Parameters as a Prerequisite for Biomarker Studies-A TMT-Based LC-MSMS Proteome Investigation. Proteomes 2021; 9:proteomes9040047. [PMID: 34941812 PMCID: PMC8707687 DOI: 10.3390/proteomes9040047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/24/2021] [Accepted: 11/26/2021] [Indexed: 12/03/2022] Open
Abstract
Specific plasma proteins serve as valuable markers for various diseases and are in many cases routinely measured in clinical laboratories by fully automated systems. For safe diagnostics and monitoring using these markers, it is important to ensure an analytical quality in line with clinical needs. For this purpose, information on the analytical and the biological variation of the measured plasma protein, also in the context of the discovery and validation of novel, disease protein biomarkers, is important, particularly in relation to for sample size calculations in clinical studies. Nevertheless, information on the biological variation of the majority of medium-to-high abundant plasma proteins is largely absent. In this study, we hypothesized that it is possible to generate data on inter-individual biological variation in combination with analytical variation of several hundred abundant plasma proteins, by applying LC-MS/MS in combination with relative quantification using isobaric tagging (10-plex TMT-labeling) to plasma samples. Using this analytical proteomic approach, we analyzed 42 plasma samples prepared in doublets, and estimated the technical, inter-individual biological, and total variation of 265 of the most abundant proteins present in human plasma thereby creating the prerequisites for power analysis and sample size determination in future clinical proteomics studies. Our results demonstrated that only five samples per group may provide sufficient statistical power for most of the analyzed proteins if relative changes in abundances >1.5-fold are expected. Seventeen of the measured proteins are present in the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) Biological Variation Database, and demonstrated remarkably similar biological CV’s to the corresponding CV’s listed in the EFLM database suggesting that the generated proteomic determined variation knowledge is useful for large-scale determination of plasma protein variations.
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Affiliation(s)
| | - Nicolai Bjødstrup Palstrøm
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, DK-5000 Odense, Denmark; (N.B.P.); (L.M.R.)
- Center for Clinical Proteomics (CCP), Odense University Hospital, DK-5000 Odense, Denmark
| | - Axel Diederichsen
- Center for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, DK-5000 Odense, Denmark; (A.D.); (J.S.L.)
- Department of Cardiology, Odense University Hospital, DK-5000 Odense, Denmark
| | - Jes Sanddal Lindholt
- Center for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, DK-5000 Odense, Denmark; (A.D.); (J.S.L.)
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, DK-5000 Odense, Denmark
| | - Lars Melholt Rasmussen
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, DK-5000 Odense, Denmark; (N.B.P.); (L.M.R.)
- Center for Clinical Proteomics (CCP), Odense University Hospital, DK-5000 Odense, Denmark
- Center for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, DK-5000 Odense, Denmark; (A.D.); (J.S.L.)
| | - Hans Christian Beck
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, DK-5000 Odense, Denmark; (N.B.P.); (L.M.R.)
- Center for Clinical Proteomics (CCP), Odense University Hospital, DK-5000 Odense, Denmark
- Center for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, DK-5000 Odense, Denmark; (A.D.); (J.S.L.)
- Correspondence: ; Tel.: +45-29-647-470
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23
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Khurrami L, Møller JE, Lindholt JS, Urbonaviciene G, Steffensen FH, Lambrechtsen J, Karon M, Frost L, Busk M, Egstrup K, Fredgart MH, Diederichsen ACP. Cross-sectional study of aortic valve calcification and cardiovascular risk factors in older Danish men. Heart 2021; 107:1536-1543. [PMID: 34376488 DOI: 10.1136/heartjnl-2021-319023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 06/27/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Aortic valve calcification (AVC) and coronary artery calcification (CAC) are predictors of cardiovascular disease (CVD), presumably sharing risk factors. Our objectives were to determine the prevalence and extent of AVC in a large population of men aged 60-74 years and to assess the association between AVC and cardiovascular risk factors including CAC and biomarkers. METHODS Participants from the DANish CArdioVAscular Screening and intervention trial (DANCAVAS) with AVC and CAC scores and without previous valve replacement were included in the study. Calcification scores were calculated on non-contrast CT scans. Cardiovascular risk factors were self-reported, measured or both, and further explored using descriptive and regression analysis for AVC association. RESULTS 14 073 men aged 60-74 years were included. The AVC scores ranged from 0 to 9067 AU, with a median AVC of 6 AU (IQR 0-82). In 8156 individuals (58.0%), the AVC score was >0 and 215 (1.5%) had an AVC score ≥1200. In the regression analysis, all cardiovascular risk factors were associated with AVC; however, after inclusion of CAC ≥400, only age (ratio of expected counts (REC) 1.07 (95% CI 1.06 to 1.09)), hypertension (REC 1.24 (95% CI 1.09 to 1.41)), obesity (REC 1.34 (95% CI 1.20 to 1.50)), known CVD (REC 1.16 (95% CI 1.03 to 1.31)) and serum phosphate (REC 2.25 (95% CI 1.66 to 3.10) remained significantly associated, while smoking, diabetes, hyperlipidaemia, estimated glomerular filtration rate and serum calcium were not. CONCLUSIONS AVC was prevalent in the general population of men aged 60-74 years and was significantly associated with all modifiable cardiovascular risk factors, but only selectively after adjustment for CAC ≥400 AU. TRIAL REGISTRATION NUMBER NCT03946410 and ISRCTN12157806.
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Affiliation(s)
- Lida Khurrami
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Jacob Eifer Møller
- Department of Cardiology, Odense University Hospital, Odense, Denmark.,Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Jes Sanddal Lindholt
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark.,Cardiovascular Centre of Excellence (CAVAC), Odense, Denmark.,University of Southern Denmark, Odense, Denmark
| | | | | | - Jess Lambrechtsen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Marek Karon
- Department of Medicine, Nykøbing Falster Hospital, Region Zealand, Denmark
| | - Lars Frost
- Department of Cardiology, Regional Hospital of Central Jutland, Silkeborg, Denmark
| | - Martin Busk
- Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark
| | - Kenneth Egstrup
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Axel Cosmus Pyndt Diederichsen
- Department of Cardiology, Odense University Hospital, Odense, Denmark.,Cardiovascular Centre of Excellence (CAVAC), Odense, Denmark.,University of Southern Denmark, Odense, Denmark
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24
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Obel LM, Diederichsen AC, Steffensen FH, Frost L, Lambrechtsen J, Busk M, Urbonaviciene G, Egstrup K, Karon M, Rasmussen LM, Gerke O, Bovling AS, Lindholt JS. Population-Based Risk Factors for Ascending, Arch, Descending, and Abdominal Aortic Dilations for 60-74-Year-Old Individuals. J Am Coll Cardiol 2021; 78:201-211. [PMID: 34266574 DOI: 10.1016/j.jacc.2021.04.094] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 04/26/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Aortic dilations (ectasias and aneurysms) may occur on any segment of the aorta. Pathogenesis varies between locations, suggesting that etiology and risk factors may differ. Despite this discrepancy, guidelines recommend screening of the whole aorta if 1 segmental dilation is discovered. OBJECTIVES The purpose of this study was to determine the most dominant predictors for dilations at the ascending, arch, descending, and abdominal part of the aorta, and to establish comprehensive risk factor profiles for each aortic segment. METHODS Individuals aged 60-74 years were randomly selected to participate in DANCAVAS I+II (Danish Cardiovascular Multicenter Screening Trials). Participants underwent cardiovascular risk assessments, including blood samples, blood pressure readings, medical records, and noncontrast computed tomography scans. Adjusted odds ratios for potential risk factors of dilations were estimated by multivariate logistic analyses. RESULTS The study population consisted of 14,989 participants (14,235 men, 754 women) with an average age of 68 ± 4 years. The highest adjusted odd ratios for having any aortic dilation were observed when coexisting aortic dilations were present. Other noteworthy predictors included coexisting iliac dilations, hypertension, increasing body surface area, male sex, familial disposition, and atrial fibrillation, which were present in various combinations for the different aortic parts. Smoking and acute myocardial infarction were inversely associated with ascending and abdominal dilations. Diabetes was a shared protective factor. CONCLUSIONS Risk factors differ for aortic dilations between locations. The most dominant predictor for having a dilation at any aortic segment is the presence of an aortic dilation elsewhere. This supports current guidelines when recommending a full screening of the aorta if a focal aortic dilation is discovered.
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Affiliation(s)
- Lasse M Obel
- Elitary Research Centre CIMA, Odense University Hospital, Odense, Denmark; Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Axel C Diederichsen
- Elitary Research Centre CIMA, Odense University Hospital, Odense, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Lars Frost
- Department of Cardiology, Diagnostic Centre, Regional Hospital Silkeborg, Silkeborg, Denmark
| | - Jess Lambrechtsen
- Department of Cardiology, Odense University Hospital, Svendborg, Denmark
| | - Martin Busk
- Department of Cardiology, Vejle Hospital, Vejle, Denmark
| | - Grazina Urbonaviciene
- Department of Cardiology, Diagnostic Centre, Regional Hospital Silkeborg, Silkeborg, Denmark
| | - Kenneth Egstrup
- Department of Cardiology, Odense University Hospital, Svendborg, Denmark
| | - Marek Karon
- Department of Medicine, Nykoebing Falster Hospital, Nykoebing Falster, Denmark
| | - Lars M Rasmussen
- Elitary Research Centre CIMA, Odense University Hospital, Odense, Denmark; Department of Clinical Biochemistry, Odense University Hospital, Odense, Denmark
| | - Oke Gerke
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
| | - Anders S Bovling
- Elitary Research Centre CIMA, Odense University Hospital, Odense, Denmark; Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jes S Lindholt
- Elitary Research Centre CIMA, Odense University Hospital, Odense, Denmark; Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
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Gerke O, Lindholt JS, Abdo BH, Lambrechtsen J, Frost L, Steffensen FH, Karon M, Egstrup K, Urbonaviciene G, Busk M, Mickley H, Diederichsen ACP. Prevalence and extent of coronary artery calcification in the middle-aged and elderly population. Eur J Prev Cardiol 2021; 28:2048-2055. [PMID: 34179988 DOI: 10.1093/eurjpc/zwab111] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/11/2021] [Accepted: 06/09/2021] [Indexed: 01/21/2023]
Abstract
AIMS Coronary artery calcification (CAC) measured on cardiac computed tomography (CT) is an important risk marker for cardiovascular disease (CVD) and has been included in the prevention guidelines. The aim of this study was to describe CAC score reference values in the middle-aged and elderly population and to develop a freely available CAC calculator. METHODS AND RESULTS All participants from two population-based cardiac CT screening cohorts (DanRisk and DANCAVAS) were included. The CAC score was measured as a part of a screening session. Positive CAC scores were log-transformed and non-parametrically regressed on age for each gender, and percentile curves were transposed according to proportions of zero CAC scores. Men had higher CAC scores than women, and the prevalence and extend of CAC increased steadily with age. An online CAC calculator was developed, http://flscripts.dk/cacscore. After entering sex, age, and CAC score, the CAC score percentile and the coronary age are depicted including a figure with the specific CAC score and 25%, 50%, 75%, and 90% percentiles. The specific CAC score can be compared to the entire background population or only those without prior CVD. CONCLUSION This study provides modern population-based reference values of CAC scores in men and woman and a freely accessible online CAC calculator. Physicians and patients are very familiar with blood pressure and lipids, but unfamiliar with CAC scores. Using the calculator makes it easy to see if a CAC value is low, moderate, or high, when a physician in the future communicate and discusses a CAC score with a patient.
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Affiliation(s)
- Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Winsløwparken 19, 5000 Odense C, Denmark
| | - Jes S Lindholt
- Department of Clinical Research, University of Southern Denmark, Winsløwparken 19, 5000 Odense C, Denmark.,Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense, Denmark.,Centre of Individualized Medicine in Arterial Disease (CIMA), Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense, Denmark
| | - Barzan H Abdo
- Department of Clinical Research, University of Southern Denmark, Winsløwparken 19, 5000 Odense C, Denmark
| | - Jess Lambrechtsen
- Department of Cardiology, Svendborg Hospital, Baagøes Àlle 15 5700 Svendborg, Denmark
| | - Lars Frost
- Department of Cardiology, Diagnostic Centre, Regional Hospital Central Jutland, Falkevej 1, 8600 Silkeborg, Denmark
| | | | - Marek Karon
- Department of Medicine, Nykøbing Falster Hospital, Hospitalsvej, 4800 Nykøbing Falster, Denmark
| | - Kenneth Egstrup
- Department of Cardiology, Svendborg Hospital, Baagøes Àlle 15 5700 Svendborg, Denmark
| | - Grazina Urbonaviciene
- Department of Cardiology, Diagnostic Centre, Regional Hospital Central Jutland, Falkevej 1, 8600 Silkeborg, Denmark
| | - Martin Busk
- Department of Cardiology, Lillebaelt Hospital, Beriderbakken 4, 7100 Vejle, Denmark
| | - Hans Mickley
- Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense, Denmark
| | - Axel C P Diederichsen
- Department of Clinical Research, University of Southern Denmark, Winsløwparken 19, 5000 Odense C, Denmark.,Centre of Individualized Medicine in Arterial Disease (CIMA), Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense, Denmark.,Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense, Denmark.,Odense Patient data Explorative Network (OPEN), Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense, Denmark
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26
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Orringer CE, Blaha MJ, Blankstein R, Budoff MJ, Goldberg RB, Gill EA, Maki KC, Mehta L, Jacobson TA. The National Lipid Association scientific statement on coronary artery calcium scoring to guide preventive strategies for ASCVD risk reduction. J Clin Lipidol 2021; 15:33-60. [PMID: 33419719 DOI: 10.1016/j.jacl.2020.12.005] [Citation(s) in RCA: 112] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 12/07/2020] [Indexed: 12/21/2022]
Abstract
An Expert Panel of the National Lipid Association reviewed the evidence related to the use of coronary artery calcium (CAC) scoring in clinical practice for adults seen for primary prevention of atherosclerotic cardiovascular disease. Recommendations for optimal use of this test in adults of various races/ethnicities, ages and multiple domains of primary prevention, including those with a 10-year ASCVD risk <20%, those with diabetes or the metabolic syndrome, and those with severe hypercholesterolemia were provided. Recommendations were also made on optimal timing for repeat calcium scoring after an initial test, use of CAC scoring in those taking statins, and its role in informing the clinician patient discussion on the benefit of aspirin and anti-hypertensive drug therapy. Finally, a vision is provided for the future of coronary calcium scoring.
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Affiliation(s)
- Carl E Orringer
- University of Miami, Miller School of Medicine, Cardiovascular Division.
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease
| | - Ron Blankstein
- Brigham and Women's Hospital, Harvard Medical School, Cardiovascular Division
| | | | - Ronald B Goldberg
- Diabetes Research Institute, University of Miami Miller School of Medicine
| | - Edward A Gill
- University of Colorado School of Medicine, Anschutz Campus
| | - Kevin C Maki
- Department of Applied Health Science, School of Public Health, and Midwest Biomedical Research, Indiana University
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Clark CE, Warren FC, Boddy K, McDonagh STJ, Moore SF, Goddard J, Reed N, Turner M, Alzamora MT, Ramos Blanes R, Chuang SY, Criqui M, Dahl M, Engström G, Erbel R, Espeland M, Ferrucci L, Guerchet M, Hattersley A, Lahoz C, McClelland RL, McDermott MM, Price J, Stoffers HE, Wang JG, Westerink J, White J, Cloutier L, Taylor RS, Shore AC, McManus RJ, Aboyans V, Campbell JL. Associations Between Systolic Interarm Differences in Blood Pressure and Cardiovascular Disease Outcomes and Mortality: Individual Participant Data Meta-Analysis, Development and Validation of a Prognostic Algorithm: The INTERPRESS-IPD Collaboration. Hypertension 2020; 77:650-661. [PMID: 33342236 PMCID: PMC7803446 DOI: 10.1161/hypertensionaha.120.15997] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Systolic interarm differences in blood pressure have been associated with all-cause mortality and cardiovascular disease. We undertook individual participant data meta-analyses to (1) quantify independent associations of systolic interarm difference with mortality and cardiovascular events; (2) develop and validate prognostic models incorporating interarm difference, and (3) determine whether interarm difference remains associated with risk after adjustment for common cardiovascular risk scores. We searched for studies recording bilateral blood pressure and outcomes, established agreements with collaborating authors, and created a single international dataset: the Inter-arm Blood Pressure Difference - Individual Participant Data (INTERPRESS-IPD) Collaboration. Data were merged from 24 studies (53 827 participants). Systolic interarm difference was associated with all-cause and cardiovascular mortality: continuous hazard ratios 1.05 (95% CI, 1.02-1.08) and 1.06 (95% CI, 1.02-1.11), respectively, per 5 mm Hg systolic interarm difference. Hazard ratios for all-cause mortality increased with interarm difference magnitude from a ≥5 mm Hg threshold (hazard ratio, 1.07 [95% CI, 1.01-1.14]). Systolic interarm differences per 5 mm Hg were associated with cardiovascular events in people without preexisting disease, after adjustment for Atherosclerotic Cardiovascular Disease (hazard ratio, 1.04 [95% CI, 1.00-1.08]), Framingham (hazard ratio, 1.04 [95% CI, 1.01-1.08]), or QRISK cardiovascular disease risk algorithm version 2 (QRISK2) (hazard ratio, 1.12 [95% CI, 1.06-1.18]) cardiovascular risk scores. Our findings confirm that systolic interarm difference is associated with increased all-cause mortality, cardiovascular mortality, and cardiovascular events. Blood pressure should be measured in both arms during cardiovascular assessment. A systolic interarm difference of 10 mm Hg is proposed as the upper limit of normal. Registration: URL: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42015031227.
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Affiliation(s)
- Christopher E Clark
- From the Primary Care Research Group, Institute of Health Services Research (C.E.C., F.C.W., S.T.J.M., S.F.M., R.S.T., J.L.C.), University of Exeter Medical School, College of Medicine & Health, Devon, England
| | - Fiona C Warren
- From the Primary Care Research Group, Institute of Health Services Research (C.E.C., F.C.W., S.T.J.M., S.F.M., R.S.T., J.L.C.), University of Exeter Medical School, College of Medicine & Health, Devon, England
| | - Kate Boddy
- Patient and Public Involvement Team, PenCLAHRC (K.B., J.G., N.R., M.T.), University of Exeter Medical School, College of Medicine & Health, Devon, England
| | - Sinead T J McDonagh
- From the Primary Care Research Group, Institute of Health Services Research (C.E.C., F.C.W., S.T.J.M., S.F.M., R.S.T., J.L.C.), University of Exeter Medical School, College of Medicine & Health, Devon, England
| | - Sarah F Moore
- From the Primary Care Research Group, Institute of Health Services Research (C.E.C., F.C.W., S.T.J.M., S.F.M., R.S.T., J.L.C.), University of Exeter Medical School, College of Medicine & Health, Devon, England
| | - John Goddard
- Patient and Public Involvement Team, PenCLAHRC (K.B., J.G., N.R., M.T.), University of Exeter Medical School, College of Medicine & Health, Devon, England
| | - Nigel Reed
- Patient and Public Involvement Team, PenCLAHRC (K.B., J.G., N.R., M.T.), University of Exeter Medical School, College of Medicine & Health, Devon, England
| | - Malcolm Turner
- Patient and Public Involvement Team, PenCLAHRC (K.B., J.G., N.R., M.T.), University of Exeter Medical School, College of Medicine & Health, Devon, England
| | - Maria Teresa Alzamora
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Mataró, Spain (M.T.A.)
| | - Rafel Ramos Blanes
- Unitat de Suport a la Recerca Girona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Institut d'Investigació Biomèdica de Girona (IdIBGi), Department of Medical Sciences, School of Medicine, University of Girona, Spain (R.R.B.)
| | - Shao-Yuan Chuang
- Institute of Population Health Sciences, National Health Research Institutes (NHRI), Taiwan, R.O.C (S.-Y.C.)
| | - Michael Criqui
- Department of Family Medicine and Public Health, University of California, San Diego, School of Medicine, La Jolla (M.C.)
| | - Marie Dahl
- Vascular Research Unit, Department of Vascular Surgery, Viborg Regional Hospital, Heibergs Allé 4, 8800 Viborg, Denmark (M.D.).,Department of Clinical Medicine, Aarhus University, Denmark (M.D.)
| | - Gunnar Engström
- Department of Clinical Science in Malmö, Lund University, Sweden (G.E.)
| | - Raimund Erbel
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Germany (R.E.)
| | | | | | - Maëlenn Guerchet
- INSERM U1094 & IRD, Tropical Neuroepidemiology, Institut d'Epidémiologie et de Neurologie Tropicale (IENT), Faculté de Médecine de l'Université de Limoges, Limoges Cedex, France (M.G., V.A.)
| | - Andrew Hattersley
- Institute of Biomedical and Clinical Science (A.H.), University of Exeter Medical School, College of Medicine & Health, Devon, England
| | - Carlos Lahoz
- Lípid and Vascular Risk Unit, Internal Medicine Service, Carlos III, La Paz Hospital, Madrid, Spain (C.L.)
| | | | - Mary M McDermott
- Northwestern University Feinberg School of Medicine, Chicago, IL (M.M.M.)
| | - Jackie Price
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Scotland (J.P.)
| | - Henri E Stoffers
- Department of Family Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, the Netherlands (H.E.S.)
| | - Ji-Guang Wang
- Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (J.-G.W.)
| | - Jan Westerink
- Department of Vascular Medicine, University Medical Center Utrecht, the Netherlands (J. Westerink)
| | - James White
- DECIPHer, Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Wales (J. White)
| | - Lyne Cloutier
- Département des Sciences Infirmières, Université du Québec à Trois-Rivières, Canada (L.C.)
| | - Rod S Taylor
- From the Primary Care Research Group, Institute of Health Services Research (C.E.C., F.C.W., S.T.J.M., S.F.M., R.S.T., J.L.C.), University of Exeter Medical School, College of Medicine & Health, Devon, England.,MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Scotland (R.S.T.)
| | - Angela C Shore
- NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter College of Medicine & Health, England (A.C.S.)
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, England (R.J.M.)
| | - Victor Aboyans
- Department of Cardiology, Dupuytren University Hospital, and Inserm 1094, Tropical Neuroepidemiology, Limoges, France (V.A.)
| | - John L Campbell
- From the Primary Care Research Group, Institute of Health Services Research (C.E.C., F.C.W., S.T.J.M., S.F.M., R.S.T., J.L.C.), University of Exeter Medical School, College of Medicine & Health, Devon, England
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28
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Eosinophils improve cardiac function after myocardial infarction. Nat Commun 2020; 11:6396. [PMID: 33328477 PMCID: PMC7745020 DOI: 10.1038/s41467-020-19297-5] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 10/07/2020] [Indexed: 02/06/2023] Open
Abstract
Clinical studies reveal changes in blood eosinophil counts and eosinophil cationic proteins that may serve as risk factors for human coronary heart diseases. Here we report an increase of blood or heart eosinophil counts in humans and mice after myocardial infarction (MI), mostly in the infarct region. Genetic or inducible depletion of eosinophils exacerbates cardiac dysfunction, cell death, and fibrosis post-MI, with concurrent acute increase of heart and chronic increase of splenic neutrophils and monocytes. Mechanistic studies reveal roles of eosinophil IL4 and cationic protein mEar1 in blocking H2O2- and hypoxia-induced mouse and human cardiomyocyte death, TGF-β-induced cardiac fibroblast Smad2/3 activation, and TNF-α-induced neutrophil adhesion on the heart endothelial cell monolayer. In vitro-cultured eosinophils from WT mice or recombinant mEar1 protein, but not eosinophils from IL4-deficient mice, effectively correct exacerbated cardiac dysfunctions in eosinophil-deficient ∆dblGATA mice. This study establishes a cardioprotective role of eosinophils in post-MI hearts. Blood eosinophil (EOS) counts may serve as risk factors for human coronary heart diseases. Here the authors show that increased circulating and myocardial EOS after myocardial infarction play a cardioprotective role by reducing cardiomyocyte death, cardiac fibroblast activation and fibrosis, and endothelium activation-mediated inflammatory cell accumulation.
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29
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Lambrechtsen J, Mayntz SK, Engdam KB, Egstrup K, Nielsen J, Steffensen FH, Frohn LM, Brandt J, Ketzel M, Pyndt Diederichsen AC, Lindholt JS. Relation between Accumulated Air Pollution Exposure and Sub-Clinical Cardiovascular Disease in 33,723 Danish 60-74-Year-Old Males from the Background Population (AIR-CARD): A Method Article. Cardiology 2020; 146:19-26. [PMID: 33238279 DOI: 10.1159/000511128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/17/2020] [Indexed: 11/19/2022]
Abstract
Cardiovascular disease is one of the main causes of death and disability in the Western world, and there is increasing evidence that air pollution is a risk factor for developing sub-clinical cardiovascular diseases. Previous studies have shown a correlation between cardiovascular disease and short-term exposure to elevated air pollution levels. However, the literature on the impact of long-term effect of air pollution is limited. We have a unique opportunity to evaluate this correlation. The DEHM/UBM/AirGIS model system calculates air pollution in a high temporal and spatial resolution and traces air pollution retrospectively to year 1979. The model calculates accumulated exposure using annual exposure from PM2.5 in relation to home and work addresses and takes into account working hours and holidays. We link the results from this model system to a population-based cardiovascular screening cohort of 33,723 individuals in the age of 60-74 to assess the contribution of the specific accumulated air pollution to the presence of sub-clinical arteriosclerosis in the coronary vessels, abdominal aortic aneurysms, and peripheral arterial disease. This correlation will be further analyzed in relation to specific air pollutants. This study will introduce more precise data for a longer period of time and incorporate participant's home and work addresses.
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Affiliation(s)
- Jess Lambrechtsen
- Cardiovascular Research Unit, Odense University Hospital - Svendborg, Svendborg, Denmark,
| | - Stephan Krog Mayntz
- Cardiovascular Research Unit, Odense University Hospital - Svendborg, Svendborg, Denmark
| | | | - Kenneth Egstrup
- Cardiovascular Research Unit, Odense University Hospital - Svendborg, Svendborg, Denmark
| | - Jan Nielsen
- Department of Clinical Epidemiology, Odense University Hospital, Odense, Denmark
| | | | - Lise M Frohn
- Department of Environmental Science, Faculty of Technical Sciences, Aarhus University, Aarhus, Denmark
| | - Jørgen Brandt
- Department of Environmental Science, Faculty of Technical Sciences, Aarhus University, Aarhus, Denmark
| | - Matthias Ketzel
- Department of Environmental Science, Faculty of Technical Sciences, Aarhus University, Aarhus, Denmark
| | | | - Jes Sanddal Lindholt
- Department of Cardiothoracic and Vascular Surgery T, Odense University Hospital, Odense, Denmark
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30
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Hasific S, Øvrehus KA, Gerke O, Hallas J, Busk M, Lambrechtsen J, Urbonaviciene G, Sand NPR, Nielsen JS, Diederichsen L, Pedersen KB, Carter-Storch R, Ilangkovan N, Mickley H, Rasmussen LM, Lindholt JS, Diederichsen A. Extent of arterial calcification by conventional vitamin K antagonist treatment. PLoS One 2020; 15:e0241450. [PMID: 33119722 PMCID: PMC7595268 DOI: 10.1371/journal.pone.0241450] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 10/14/2020] [Indexed: 12/18/2022] Open
Abstract
Background and aims Vitamin K antagonists (VKA) remain the most frequently prescribed oral anticoagulants worldwide despite the introduction of non-vitamin K antagonist oral anticoagulants (NOAC). VKA interfere with the regeneration of Vitamin K1 and K2, essential to the activation of coagulation factors and activation of matrix-Gla protein, a strong inhibitor of arterial calcifications. This study aimed to clarify whether VKA treatment was associated with the extent of coronary artery calcification (CAC) in a population with no prior cardiovascular disease (CVD). Methods We collected data on cardiovascular risk factors and CAC scores from cardiac CT scans performed as part of clinical examinations (n = 9,672) or research studies (n = 14,166) in the period 2007–2017. Data on use of anticoagulation were obtained from the Danish National Health Service Prescription Database. The association between duration of anticoagulation and categorized CAC score (0, 1–99, 100–399, ≥400) was investigated by ordered logistic regression adjusting for covariates. Results The final study population consisted of 17,254 participants with no prior CVD, of whom 1,748 and 1,144 had been treated with VKA or NOAC, respectively. A longer duration of VKA treatment was associated with higher CAC categories. For each year of VKA treatment, the odds of being in a higher CAC category increased (odds ratio (OR) = 1.032, 95%CI 1.009–1.057). In contrast, NOAC treatment duration was not associated with CAC category (OR = 1.002, 95%CI 0.935–1.074). There was no significant interaction between VKA treatment duration and age on CAC category. Conclusions Adjusted for cardiovascular risk factors, VKA treatment–contrary to NOAC—was associated to higher CAC category.
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Affiliation(s)
- Selma Hasific
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- * E-mail:
| | | | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
| | - Jesper Hallas
- Clinical Pharmacology and Pharmacy, University of Southern Denmark, Odense, Denmark
| | - Martin Busk
- Department of Cardiology, Little Belt Hospital Vejle, Vejle, Denmark
| | - Jess Lambrechtsen
- Department of Cardiology, Odense University Hospital Svendborg, Svendborg, Denmark
| | - Grazina Urbonaviciene
- Department of Cardiology, Regional Hospital Central Jutland Silkeborg, Silkeborg, Denmark
| | | | - Jens Steen Nielsen
- DD2, Steno Diabetes Centre Odense, Odense University Hospital, Odense, Denmark
- OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | | | | | - Rasmus Carter-Storch
- Department of Cardiology, Odense University Hospital Svendborg, Svendborg, Denmark
| | | | - Hans Mickley
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Jes Sandal Lindholt
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital,Odense, Denmark
| | - Axel Diederichsen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
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31
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Individual, expected diameters of the ascending aorta and prevalence of dilations in a study-population aged 60–74 years: a DANCAVAS substudy. Int J Cardiovasc Imaging 2020; 37:971-980. [DOI: 10.1007/s10554-020-02081-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 10/21/2020] [Indexed: 01/01/2023]
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32
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Saleh QW, Diederichsen ACP, Lindholt JS. Ascending Aortic Diameter after Dissection Does Not Reflect Size before Dissection. EJVES Vasc Forum 2020; 49:20-22. [PMID: 33089224 PMCID: PMC7567910 DOI: 10.1016/j.ejvsvf.2020.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 08/24/2020] [Accepted: 09/21/2020] [Indexed: 11/05/2022] Open
Abstract
Introduction Current guidelines for prophylactic resection of ascending aortic aneurysms are based on post-dissection aortic diameter. However, this may not reflect the diameter prior to dissection. Report Pre- and post-dissection aortic diameters were compared in 34 patients with available computerised tomography scans. The median time interval between these scans was 536 days (interquartile range 354 – 1237). Discussion There was a statistically significant difference in diameters from the sinotubular junction to the proximal abdominal aorta, the largest was in the ascending aorta with a mean of 7.6 mm (standard deviation 4.5). This suggests that the ascending aortic diameter is a poor predictor of dissection in most patients. Ascending aortic diameter expands due to acute dissection. Post-dissection aortic diameters probably overestimate pre-dissection diameters. Following ascending dissection, diameter expansion is not limited to aorta ascendens. In this sample, estimated pre-dissection ascending aortic diameters were below 60 mm in 91% of patients and below 50 mm in 85%.
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Affiliation(s)
- Qais W Saleh
- Department of Thoracic-, Cardiac- and Vascular Surgery, Odense University Hospital, Odense, Denmark.,Centre for Individualised Medicine in Arterial Diseases (CIMA), Odense University Hospital, Denmark.,Centre of Clinical Excellence in Southern Denmark (CAVAC), Odense University Hospital, Denmark
| | - Axel C P Diederichsen
- Centre for Individualised Medicine in Arterial Diseases (CIMA), Odense University Hospital, Denmark.,Centre of Clinical Excellence in Southern Denmark (CAVAC), Odense University Hospital, Denmark.,Department of Cardiology, Odense University Hospital, Denmark
| | - Jes S Lindholt
- Department of Thoracic-, Cardiac- and Vascular Surgery, Odense University Hospital, Odense, Denmark.,Centre for Individualised Medicine in Arterial Diseases (CIMA), Odense University Hospital, Denmark.,Centre of Clinical Excellence in Southern Denmark (CAVAC), Odense University Hospital, Denmark
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Khurrami L, Møller JE, Dahl JS, Carter-Storch R, Christensen NL, Pareek M, Lindholt JS, Diederichsen ACP. The association between aortic valve calcification, cardiovascular risk factors, and cardiac size and function in a general population. Int J Cardiovasc Imaging 2020; 37:711-722. [PMID: 32915345 DOI: 10.1007/s10554-020-02012-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 09/01/2020] [Indexed: 01/08/2023]
Abstract
To determine the presence and extent of aortic valve calcification (AVC) quantified by non-contrast cardiac computed tomography (NCCT), to determine the association between traditional cardiovascular risk factors and AVC score, and to evaluate the association between AVC and cardiac size and function assessed by echocardiography, in a general population aged 65-75 years. A random sample of 2060 individuals were invited to undergo NCCT through which their AVC score was assessed. Individuals with an AVC score ≥ 300 arbitrary units (AU) were invited for a transthoracic echocardiography together with age-matched controls. Descriptive statistics and multiple regression analyses were performed to identify risk factors associated with AVC and to describe associations between AVC score and echocardiographic findings. Of 2060 individuals invited 664 males and 636 females participated. Among those, 455 (68.5%) of males and 358 (56.3%) of females had AVC scores > 0 AU. The median AVC score was 6 AU (IQR 0-3064). Seventy-seven (11.6%) males and 20 (3.1%) females had an AVC score ≥ 300 AU. In a multiple regression analysis, age, sex, prior cardiovascular disease, smoking, and hypertension were associated with AVC score, while diabetes, hypercholesterolemia and kidney function were not. Individuals with AVC ≥ 300 AU had higher peak and mean aortic valve gradient, smaller indexed aortic valve area, greater left ventricular mass, and larger left atrial (LA) volume. In a random population sample of individuals aged 65-75 years, AVC was common and associated with most known cardiovascular risk factors. AVC ≥ 300 AU was associated with concentric remodeling and LA dilatation.
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Affiliation(s)
- Lida Khurrami
- Department of Cardiology, Odense University Hospital, Sdr. Boulevard 29, 5500, Odense C, Denmark.
| | - Jacob Eifer Møller
- Department of Cardiology, Odense University Hospital, Sdr. Boulevard 29, 5500, Odense C, Denmark
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Jordi Sanchez Dahl
- Department of Cardiology, Odense University Hospital, Sdr. Boulevard 29, 5500, Odense C, Denmark
| | - Rasmus Carter-Storch
- Department of Cardiology, Odense University Hospital, Sdr. Boulevard 29, 5500, Odense C, Denmark
| | | | - Manan Pareek
- Department of Internal Medicine, Yale New Haven Hospital, Yale University School of Medicine, New Haven, USA
| | - Jes Sanddal Lindholt
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
- Elitary Research Centre of Individualised Medicine in Arterial Disease (CIMA), Odense, Denmark
| | - Axel Cosmus Pyndt Diederichsen
- Department of Cardiology, Odense University Hospital, Sdr. Boulevard 29, 5500, Odense C, Denmark
- Elitary Research Centre of Individualised Medicine in Arterial Disease (CIMA), Odense, Denmark
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Vonder M, van der Aalst CM, de Koning HJ. Coronary artery calcium scoring in individuals at risk for coronary artery disease: current status and future perspectives. Br J Radiol 2020; 93:20190880. [PMID: 31999209 PMCID: PMC7465842 DOI: 10.1259/bjr.20190880] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 01/27/2020] [Indexed: 11/05/2022] Open
Abstract
The aim of this review is to provide clinicians with an overview of the role of coronary artery calcium (CAC) scoring across the spectrum ranging from asymptomatic individuals to chronic chest pain patients. We will briefly introduce the technical background of CAC scoring, summarize the major guidelines per type of patient at risk and discuss latest research with respect to CAC. Finally, the reader should be able to determine when CAC scoring is indicated or may be of added value.
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Affiliation(s)
- Marleen Vonder
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Carlijn M van der Aalst
- Department of Public Health, Erasmus MC – University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Harry J de Koning
- Department of Public Health, Erasmus MC – University Medical Center Rotterdam, Rotterdam, The Netherlands
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Abstract
An estimated 237 million people suffer from peripheral arterial disease (PAD), which is associated with high morbidity and mortality, and prevalence is still increasing. Currently, we do not have any randomized trials that compare screening to no screening specifically for PAD in the general population. Presently, PAD screening is not generally established. This systematic review gives an overview of relevant literature and guidelines. Screening usually focuses on ankle-brachial index (ABI)-measurement, which enables detection of asymptomatic and symptomatic PAD, but has limitations in diabetics. There are no sufficient data on PAD screening. Guideline recommendations are heterogeneous. While some advocate no screening until better data are available, most recommend selective screening despite insufficient data on morbidity and mortality reduction in consequence of screening. We support the only evidence-based screening strategy for PAD: combined screening for abdominal aortic aneurysm (AAA), PAD and arterial hypertension in men aged 65-74 according to the VIVA study. We additionally suggest a new simple three-step screening strategy for symptomatic PAD in all individuals aged 40 and older, who see a general practitioner: Asking one question ("Do you have pain or cramps in the legs during normal walking?") followed by physical examination (normal lower extremity pulse status?) in those, whose answer is "yes", and ABI measurement unless all pulses are normal.
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Affiliation(s)
- Arne G Kieback
- Medical University Department, Division of Angiology, Kantonsspital Aarau, Aargau, Switzerland
| | - Roman Gähwiler
- Medical University Department, Division of Angiology, Kantonsspital Aarau, Aargau, Switzerland
| | - Christoph Thalhammer
- Medical University Department, Division of Angiology, Kantonsspital Aarau, Aargau, Switzerland
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Abstract
Atrial fibrillation (AF) is a common and morbid arrhythmia. Stroke is a major hazard of AF and may be preventable with oral anticoagulation. Yet since AF is often asymptomatic, many individuals with AF may be unaware and do not receive treatment that could prevent a stroke. Screening for AF has gained substantial attention in recent years as several studies have demonstrated that screening is feasible. Advances in technology have enabled a variety of approaches to facilitate screening for AF using both medical-prescribed devices as well as consumer electronic devices capable of detecting AF. Yet controversy about the utility of AF screening remains owing to concerns about potential harms resulting from screening in the absence of randomized data demonstrating effectiveness of screening on outcomes such as stroke and bleeding. In this review, we summarize current literature, present technology, population-based screening considerations, and consensus guidelines addressing the role of AF screening in practice.
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Affiliation(s)
- Shaan Khurshid
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA
- Cardiology Division, Massachusetts General Hospital, Boston, MA
- Broad Institute of Harvard University and the Massachusetts Institute of Technology, Cambridge, MA
| | - Jeffrey S. Healey
- Population Health Research Institute, McMaster University, Hamilton, Ontario, CA
| | - William F. McIntyre
- Population Health Research Institute, McMaster University, Hamilton, Ontario, CA
| | - Steven A. Lubitz
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA
- Broad Institute of Harvard University and the Massachusetts Institute of Technology, Cambridge, MA
- Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, MA
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Kring C, Rasmussen LM, Lindholt JS, Diederichsen ACP, Vinholt PJ. Platelet aggregation is not altered among men with diabetes mellitus. Acta Diabetol 2020; 57:389-399. [PMID: 31679079 DOI: 10.1007/s00592-019-01438-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 10/18/2019] [Indexed: 12/22/2022]
Abstract
AIMS Platelets are pivotal in arterial thrombosis, and platelet hyperresponsiveness may contribute to the increased incidence of cardiovascular events in diabetes mellitus. Consequently, we hypothesized that increased in vitro platelet aggregation responses exist in men with diabetes mellitus. METHODS The Danish Cardiovascular Screening Trial (DANCAVAS) is a community-based cardiovascular screening trial including men aged 65-74 years. Platelet aggregation was tested using 96-well light transmission aggregometry with thrombin receptor-activating peptide (TRAP), adenosine diphosphate, collagen type 1, arachidonic acid and protease-activated receptor-4 in three concentrations. Further, cardiovascular risk factors and coronary artery calcification (CAC), estimated by CT scans and ankle-brachial index, were obtained. RESULTS Included were 720 men aged 65-74 years, 110 with diabetes mellitus. Overall, there was no difference in platelet aggregation among men with versus without diabetes mellitus when adjusting for or excluding platelet inhibitor treatment and men with established cardiovascular disease (CVD). This was true for all agonists, e.g., 10 µM TRAP-induced platelet aggregation of median 69% (IQR 53-75) versus 70% (IQR 60-76) in men with versus without diabetes mellitus. Platelet aggregation did not correlate with HbA1c or CAC. Men with diabetes mellitus displayed higher CAC, median 257 Agatston units (IQR 74-1141) versus median 111 Agatston units (IQR 6-420) in the remaining individuals, p < 0.0001. CONCLUSIONS Among outpatients with diabetes mellitus, but no CVD and no platelet inhibitor treatment, neither are platelets hyperresponsive in diabetes mellitus, nor is platelet aggregation associated with glycemic status or with the degree of coronary atherosclerosis. TRIAL REGISTRATION ISRCTN12157806.
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Affiliation(s)
- Christian Kring
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark.
- Centre of Individualized Medicine in Arterial Disease (CIMA), Odense, Denmark.
| | - Lars M Rasmussen
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark
- Centre of Individualized Medicine in Arterial Disease (CIMA), Odense, Denmark
| | - Jes S Lindholt
- Centre of Individualized Medicine in Arterial Disease (CIMA), Odense, Denmark
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
| | - Axel C P Diederichsen
- Centre of Individualized Medicine in Arterial Disease (CIMA), Odense, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Pernille J Vinholt
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark
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Lindholt JS, Diederichsen AC, Rasmussen LM, Frost L, Steffensen FH, Lambrechtsen J, Urbonaviciene G, Busk M, Egstrup K, Kristensen KL, Behr Andersen C, Søgaard R. Survival, Prevalence, Progression and Repair of Abdominal Aortic Aneurysms: Results from Three Randomised Controlled Screening Trials Over Three Decades. Clin Epidemiol 2020; 12:95-103. [PMID: 32158272 PMCID: PMC6986168 DOI: 10.2147/clep.s238502] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 01/10/2020] [Indexed: 11/26/2022] Open
Abstract
Aim The prevalence and mortality of abdominal aortic aneurysms (AAA) has been reported to decline. The aim of this study is to compare survival, prevalence, and repair rate of AAA in Denmark in the 1990s, the 2000s and the 2010s – and to examine any change in factors known to influence the prevalence. Methods Baseline status and up to 5-year outcomes of 34,079 general population men aged 65–74 were obtained from three RCTs; the Viborg study (1994–1998, n=4,860), the Viborg Vascular (VIVA) trial (2008–2011, n=18,748), and the Danish Cardiovascular (DANCAVAS) trial (2015–2018, n=10,471). After the millennium (VIVA and DANCAVAS) men with AAA were further offered low dose aspirin and statins. Follow-up data were not available for the DANCAVAS trial yet. Results Across the three decades, the AAA prevalence was 3.8% (Reference), 3.3% (p<0.001) and 4.2% (p=0.882), the proportion of smokers were 62%, 42% and 34% (p<0.001) amongst men with AAA, but AAA risk associations with smoking increased during the decades suggesting increased tobacco consumption of smokers. In addition, the proportions of attenders with ischemic heart disease or stroke increased significantly. The aneurysmal progression rate in the 1990s was 2.90 vs 2.98 mm/year in the 2000s (p=0.91). The need for preventive AAA repair increased insignificantly in the 2000s (Age adj. HR= 1.29, 95% C.I.: 0.95; 1.71, p=0.10), and mortality of men with screen-detected AAA was lower in the 2000s compared to the 1990s (Age-adj. HR= 0.28, 95% C.I.: 0.22; 0.36, p<0.001). Conclusion The Danish prevalence of AAA today compares to the nineties. Unchanged aneurysmal progression rates combined with improved survival of men at risk of AAA leave them in longer time to develop an AAA, be diagnosed and to need later aneurysmal repair or experience rupture. Clinical Trial Registrations Viborg study: No possibility of registration in the nineties. VIVA: NCT00662480, URL: https://clinicaltrials.gov/show/NCT00662480, DANCAVAS: ISRCTN12157806, URL: http://www.isrctn.com/ISRCTN12157806.
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Affiliation(s)
- Jes S Lindholt
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark.,Elitary Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense, Denmark.,Department of Vascular Surgery, Viborg Hospital, Viborg, Denmark
| | - Axel C Diederichsen
- Elitary Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense, Denmark.,Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Lars M Rasmussen
- Elitary Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense, Denmark.,Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Lars Frost
- Department of Cardiology, Diagnostic Centre, Regional Hospital Silkeborg, Silkeborg, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | | | - Grazina Urbonaviciene
- Department of Cardiology, Diagnostic Centre, Regional Hospital Silkeborg, Silkeborg, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Martin Busk
- Department of Cardiology, University Hospital Odense Svendborg, Svendborg, Denmark
| | | | - Katrine L Kristensen
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark.,Elitary Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense, Denmark.,Department of Vascular Surgery, Viborg Hospital, Viborg, Denmark
| | | | - Rikke Søgaard
- Department of Public Health and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Prediction of Subclinical Coronary Artery Disease With Breast Arterial Calcification and Low Bone Mass in Asymptomatic Women. JACC Cardiovasc Imaging 2019; 12:1202-1211. [DOI: 10.1016/j.jcmg.2018.07.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 06/11/2018] [Accepted: 07/05/2018] [Indexed: 11/23/2022]
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40
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Hansen TB, Lindholt JS, Diederichsen A, Søgaard R. Do Non-participants at Screening have a Different Threshold for an Acceptable Benefit-Harm Ratio than Participants? Results of a Discrete Choice Experiment. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2019; 12:491-501. [PMID: 31165400 DOI: 10.1007/s40271-019-00364-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE The objective of the study was to investigate non-participants' preferences for cardiovascular disease screening programme characteristics and whether non-participation can be rationally explained by differences in preferences, decision-making styles and informational needs between non-participants and participants. METHODS We conducted a discrete choice experiment at three screening sites between June and December 2017 among 371 male non-participants and 830 male participants who were asked to trade different levels of five key programme characteristics (chance of health benefit, risk of overtreatment, risk of later regret, screening duration and screening location). Data were analysed using a multinomial mixed-logit model. Health benefit was used as a payment vehicle for estimation of marginal substitution rates. RESULTS Non-participants were willing to accept that 0.127 (95% confidence interval 0.103-0.154) fewer lives would be saved to avoid overtreatment of one individual, whilst participants were willing to accept 0.085 (95% confidence interval 0.077-0.094) fewer lives saved. This translates into non-participants valuing health benefits 7.9 times higher than overtreatment. The corresponding value of participants is 11.8. Similarly, non-participants had higher requirements than participants for advanced technology and a quicker screening duration. With regard to their participation decision, 64% of the non-participants felt certain about their choice compared with 89% among participants. CONCLUSIONS This study shows that non-participants have different preferences than participants at screening as they express relatively more concern about overtreatment and have higher requirements for a high-tech screening programme. Non-participants also report to be more uncertain about their participation decision and more often seek additional information to the standard information provided in the invitation letter. Further studies on informational needs and effective communication strategies are warranted to ensure that non-participation is a fully informed choice.
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Affiliation(s)
- Tina Birgitte Hansen
- Department of Cardiology, Zealand University Hospital, Sygehusvej 10, 4000, Roskilde, Denmark. .,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
| | - Jes Sanddal Lindholt
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark.,Elitary Research Unit of Personalized Medicine in Arterial Disease (CIMA), Odense University Hospital, Odense, Denmark
| | - Axel Diederichsen
- Elitary Research Unit of Personalized Medicine in Arterial Disease (CIMA), Odense University Hospital, Odense, Denmark.,Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Rikke Søgaard
- Department of Public Health, Aarhus University, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Lindholt JS, Rasmussen LM, Søgaard R, Lambrechtsen J, Steffensen FH, Frost L, Egstrup K, Urbonaviciene G, Busk M, Olsen MH, Hallas J, Diederichsen AC. Baseline findings of the population-based, randomized, multifaceted Danish cardiovascular screening trial (DANCAVAS) of men aged 65–74 years. Br J Surg 2019; 106:862-871. [DOI: 10.1002/bjs.11135] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 12/17/2018] [Accepted: 01/21/2019] [Indexed: 12/24/2022]
Abstract
Abstract
Background
The challenge of managing age-related diseases is increasing; routine checks by the general practitioner do not reduce cardiovascular mortality. The aim here was to reduce cardiovascular mortality by advanced population-based cardiovascular screening. The present article reports the organization of the study, the acceptability of the screening offer, and the relevance of multifaceted screening for prevention and management of cardiovascular disease.
Methods
Danish men aged 65–74 years were invited randomly (1 : 2) to a cardiovascular screening examination using low-dose non-contrast CT, ankle and brachial BP measurements, and blood tests.
Results
In all, 16 768 of 47 322 men aged 65–74 years were invited and 10 471 attended (uptake 62·4 per cent). Of these, 3481 (33·2 per cent) had a coronary artery calcium score above 400 units. Thoracic aortic aneurysm was diagnosed in the ascending aorta (diameter 45 mm or greater) in 468 men (4·5 per cent), in the arch (at least 40 mm) in 48 (0·5 per cent) and in the descending aorta (35 mm or more) in 233 (2·2 per cent). Abdominal aortic aneurysm (at least 30 mm) and iliac aneurysm (20 mm or greater) were diagnosed in 533 (5·1 per cent) and 239 (2·3 per cent) men respectively. Peripheral artery disease was diagnosed in 1147 men (11·0 per cent), potentially uncontrolled hypertension (at least 160/100 mmHg) in 835 (8·0 per cent), previously unknown atrial fibrillation confirmed by ECG in 50 (0·5 per cent), previously unknown diabetes mellitus in 180 (1·7 per cent) and isolated severe hyperlipidaemia in 48 men (0·5 per cent).
In all, 4387 men (41·9 per cent), excluding those with potentially uncontrolled hypertension, were referred for additional cardiovascular prevention. Of these, 3712 (35·5 per cent of all screened men, but 84·6 per cent of those referred) consented and were started on medication.
Conclusion
Multifaceted cardiovascular screening is feasible and may optimize cardiovascular disease prevention in men aged 65–74 years. Uptake is lower than in aortic aneurysm screening.
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Affiliation(s)
- J S Lindholt
- Elitary Research Centre of Individualized Medicine in Arterial Disease (CIMA), Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
| | - L M Rasmussen
- Elitary Research Centre of Individualized Medicine in Arterial Disease (CIMA), Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - R Søgaard
- Department of Public Health and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - J Lambrechtsen
- Department of Cardiology, Odense University Hospital, Svendborg, Denmark
| | - F H Steffensen
- Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark
| | - L Frost
- Department of Cardiology, Diagnostic Centre, Regional Hospital Silkeborg, Silkeborg, Denmark
| | - K Egstrup
- Department of Cardiology, Odense University Hospital, Svendborg, Denmark
| | - G Urbonaviciene
- Department of Cardiology, Diagnostic Centre, Regional Hospital Silkeborg, Silkeborg, Denmark
| | - M Busk
- Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark
| | - M H Olsen
- CIMA, University of Southern Denmark, Odense, Denmark
- Department of Internal Medicine, Holbaek Hospital, Holbaek, Denmark
| | - J Hallas
- Institute of Pharmacology, University of Southern Denmark, Odense, Denmark
| | - A C Diederichsen
- Elitary Research Centre of Individualized Medicine in Arterial Disease (CIMA), Department of Cardiology, Odense University Hospital, Odense, Denmark
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Kvist LM, Vinter N, Urbonaviciene G, Lindholt JS, Diederichsen ACP, Frost L. Diagnostic accuracies of screening for atrial fibrillation by cardiac nurses versus radiographers. Open Heart 2019; 6:e000942. [PMID: 30997131 PMCID: PMC6443120 DOI: 10.1136/openhrt-2018-000942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/11/2018] [Accepted: 02/03/2019] [Indexed: 11/18/2022] Open
Abstract
Aim We examined the diagnostic accuracy of single-lead ECG as assessed by radiographers and 12-lead ECG as assessed by cardiac nurses for the diagnosis of atrial fibrillation (AF). Methods Based on the Danish Cardiovascular Screening Trial, we conducted a population-based, cross-sectional study of 1338 randomly selected Danish men aged 65–74 years with no exclusion criteria. The participants were screened with single-lead ECG during a CT scan assessed by radiographers and 12-lead ECG assessed by cardiac nurses. The diagnostic accuracy was evaluated compared with that produced by a 12-lead ECG assessed by two consenting cardiologists. Results The study identified 68 participants with ongoing AF, of whom 60 had self-reported AF and 8 had AF detected in the screening. Single-lead ECG assessed for AF by radiographers had a sensitivity of 60.3% (95% CI 47.7 to 72.0), specificity of 97.2% (95% CI 96.2 to 98.1), positive predictive value (PPV) of 53.9% (95% CI 42.1 to 65.5) and negative predictive value (NPV) of 97.9% (95% CI 96.9 to 98.6). 12-lead ECG assessed by cardiac nurses had a sensitivity of 97.1% (95% CI 89.8 to 99.6), specificity of 100% (95% CI 99.7 to 100), PPV of 100% (95% CI 94.6 to 100) and NPV of 99.8% (95% CI 99.4 to 100). Conclusions Single-lead ECG assessed by radiographers had a moderate sensitivity and PPV but a very high specificity and NPV. Using radiographers may be acceptable for opportunistic screening, in particular if radiographers are thoroughly trained. Thus, 12-lead ECG assessed by cardiac nurses is a potential diagnostic method for the detection of AF.
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Affiliation(s)
| | - Nicklas Vinter
- Diagnostic Centre, Regionshospitalet Silkeborg, Silkeborg, Denmark.,Department of Clinical Medicine, Aarhus Universitet, Aarhus, Denmark
| | - Grazina Urbonaviciene
- Diagnostic Centre, Regionshospitalet Silkeborg, Silkeborg, Denmark.,Department of Clinical Medicine, Aarhus Universitet, Aarhus, Denmark
| | - Jes Sanddal Lindholt
- Department of Cardiothoracic and Vascular Surgery, Elitary Research Centre of Individualized Medicine in Arterial Diseases (CIMA), Odense Universitetshospital, Odense, Denmark
| | | | - Lars Frost
- Department of Medicine, Silkeborg Regional Hospital and Cardiovascular Research Centre Viborg and Silkeborg Hospital and Institute of Clinical Medicine, Aarhus University Hospital Denmark, Silkeborg, Denmark
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Krogsbøll LT, Jørgensen KJ, Gøtzsche PC. General health checks in adults for reducing morbidity and mortality from disease. Cochrane Database Syst Rev 2019; 1:CD009009. [PMID: 30699470 PMCID: PMC6353639 DOI: 10.1002/14651858.cd009009.pub3] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND General health checks are common elements of health care in some countries. They aim to detect disease and risk factors for disease with the purpose of reducing morbidity and mortality. Most of the commonly used individual screening tests offered in general health checks have been incompletely studied. Also, screening leads to increased use of diagnostic and therapeutic interventions, which can be harmful as well as beneficial. It is therefore important to assess whether general health checks do more good than harm. This is the first update of the review published in 2012. OBJECTIVES To quantify the benefits and harms of general health checks. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, two other databases and two trials registers on 31 January 2018. Two review authors independently screened titles and abstracts, assessed papers for eligibility and read reference lists. One review author used citation tracking (Web of Knowledge) and asked trial authors about additional studies. SELECTION CRITERIA We included randomised trials comparing health checks with no health checks in adults unselected for disease or risk factors. We did not include geriatric trials. We defined health checks as screening for more than one disease or risk factor in more than one organ system. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risk of bias in the trials. We contacted trial authors for additional outcomes or trial details when necessary. When possible, we analysed the results with a random-effects model meta-analysis; otherwise, we did a narrative synthesis. MAIN RESULTS We included 17 trials, 15 of which reported outcome data (251,891 participants). Risk of bias was generally low for our primary outcomes. Health checks have little or no effect on total mortality (risk ratio (RR) 1.00, 95% confidence interval (CI) 0.97 to 1.03; 11 trials; 233,298 participants and 21,535 deaths; high-certainty evidence, I2 = 0%), or cancer mortality (RR 1.01, 95% CI 0.92 to 1.12; 8 trials; 139,290 participants and 3663 deaths; high-certainty evidence, I2 = 33%), and probably have little or no effect on cardiovascular mortality (RR 1.05, 95% CI 0.94 to 1.16; 9 trials; 170,227 participants and 6237 deaths; moderate-certainty evidence; I2 = 65%). Health checks have little or no effect on fatal and non-fatal ischaemic heart disease (RR 0.98, 95% CI 0.94 to 1.03; 4 trials; 164,881 persons, 10,325 events; high-certainty evidence; I2 = 11%), and probably have little or no effect on fatal and non-fatal stroke (RR 1.05 95% CI 0.95 to 1.17; 3 trials; 107,421 persons, 4543 events; moderate-certainty evidence, I2 = 53%). AUTHORS' CONCLUSIONS General health checks are unlikely to be beneficial.
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Affiliation(s)
- Lasse T Krogsbøll
- RigshospitaletNordic Cochrane CentreBlegdamsvej 9, 7811CopenhagenDenmark2100
| | | | - Peter C Gøtzsche
- RigshospitaletNordic Cochrane CentreBlegdamsvej 9, 7811CopenhagenDenmark2100
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Chen Q, Li L, Chen Q, Lin X, Li Y, Huang K, Yao C. Critical appraisal of international guidelines for the screening and treatment of asymptomatic peripheral artery disease: a systematic review. BMC Cardiovasc Disord 2019; 19:17. [PMID: 30646843 PMCID: PMC6332557 DOI: 10.1186/s12872-018-0960-8] [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] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 11/20/2018] [Indexed: 12/24/2022] Open
Abstract
Background Peripheral artery disease (PAD) is often asymptomatic but increases the risk of developing cardiovascular events. Due to the uncertainties regarding the quality of related guidelines and a lack of clear-cut evidence, we performed a systematic review and critical appraisal of these guidelines to evaluate their consistency of the recommendations in asymptomatic PAD population. Methods Guidelines in English between January 1st, 2000 to December 31th, 2017 were screened in databases including Medline via PubMed, EMBASE, the G-I-N International Guideline Library, the National Guidelines Clearinghouse, the Canadian Medication Association Infobase and the National Library for Health. Those guidelines containing recommendations on screening and treatment for asymptomatic PAD were included, and three reviewers evaluated the quality of the guidelines using Appraisal of Guidelines Research and Evaluation (AGREE) II instrument. Related recommendations were then fully extracted and compared by two reviewers. Results Fourteen guidelines were included finally and the AGREE scores ranged from 39 to 73%. Most of included guidelines scored low in Rigor of development and Editorial independence, and only two guidelines (ACCF/AHA, AHA/ACC) reached the standard on Conflict of Interest from Institute of Medicine (IOM). Eight guidelines recommended screening at different strength while the others found insufficient evidence or were against screening. Conflicting recommendations on treatment were found in the target value of the lipid lowering and antiplatelet therapy. The treatment policies in three guidelines (BWG, CEVF, ESC) appeared more aggressive, but they had low transparency between guideline developer and industry or did not reach the standard of IOM. Conclusions Current guidelines on asymptomatic PAD varied in the methodological quality and fell short of the standard in the rigor of development and editorial independence. Conflicting recommendations were found both on the screening and treatment. More effort is needed to provide clear-cut evidences with high quality and transparency among guideline developer and industry. Electronic supplementary material The online version of this article (10.1186/s12872-018-0960-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Qinchang Chen
- Department of Vascular Surgery, the First Affiliated Hospital, Sun Yat-sen University, No.58 Zhongshan Road 2, Guangzhou, China
| | - Lingling Li
- Department of Vascular Surgery, the First Affiliated Hospital, Sun Yat-sen University, No.58 Zhongshan Road 2, Guangzhou, China
| | - Qingui Chen
- Medical Intensive Care Unit, the First Affiliated Hospital, Sun Yat-sen University, No.58 Zhongshan Road 2, Guangzhou, China
| | - Xixia Lin
- Department of Vascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No.33, Yingfeng Road, Guangzhou, China
| | - Yonghui Li
- Department of Vascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No.33, Yingfeng Road, Guangzhou, China
| | - Kai Huang
- Department of Vascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No.33, Yingfeng Road, Guangzhou, China.
| | - Chen Yao
- Department of Vascular Surgery, the First Affiliated Hospital, Sun Yat-sen University, No.58 Zhongshan Road 2, Guangzhou, China.
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Individual preferences on the balancing of good and harm of cardiovascular disease screening. Heart 2019; 105:761-767. [DOI: 10.1136/heartjnl-2018-314103] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 12/04/2018] [Accepted: 12/10/2018] [Indexed: 01/19/2023] Open
Abstract
ObjectiveTransition towards value-based healthcare requires insight into what makes value to the individual. The aim was to elicit individual preferences for cardiovascular disease screening with respect to the difficult balancing of good and harm as well as mode of delivery.MethodsA discrete choice experiment was conducted as a cross-sectional survey among 1231 male screening participants at three Danish hospitals between June and December 2017. Participants chose between hypothetical screening programmes characterised by varying levels of mortality risk reduction, avoidance of overtreatment, avoidance of regretting participation, screening duration and location. A multinomial mixed logit model was used to model the preferences and the willingness to trade mortality risk reduction for improvements on other characteristics.ResultsRespondents expressed preferences for improvements on all programme characteristics. They were willing to give up 0.09 (95% CI 0.08 to 0.09) lives saved per 1000 screened to avoid one individual being over treated. Similarly, respondents were willing to give up 1.22 (95% CI 0.90 to 1.55) or 5.21 (95% CI 4.78 to 5.67) lives saved per 1000 screened to upgrade the location from general practice to a hospital or to a high-tech hospital, respectively. Subgroup analysis revealed important preference heterogeneity with respect to smoking status, level of health literacy and self-perceived risk of cardiovascular disease.ConclusionsIndividuals are able to express clear preferences about what makes value to them. Not only health benefit but also time with health professionals and access to specialised facilities were important. This information could guide the optimal programme design in search of value-based healthcare.
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Lindholt JS, Frandsen NE, Fredgart MH, Øvrehus KA, Dahl JS, Møller JE, Folkestad L, Urbonaviciene G, Becker SW, Lambrechtsen J, Auscher S, Hosbond S, Alan DH, Rasmussen LM, Gerke O, Mickley H, Diederichsen A. Effects of menaquinone-7 supplementation in patients with aortic valve calcification: study protocol for a randomised controlled trial. BMJ Open 2018; 8:e022019. [PMID: 30139903 PMCID: PMC6112404 DOI: 10.1136/bmjopen-2018-022019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Aortic stenosis is a common heart valve disease, and due to the growing elderly population, the prevalence is increasing. The disease is progressive with increasing calcification of the valve cusps. A few attempts with medical preventive treatment have failed; thus, presently, the only effective treatment of aortic stenosis is surgery. This study will examine the effect of menaquinone-7 (MK-7) supplementation on progression of aortic valve calcification (AVC). We hypothesise that MK-7 supplementation will slow down the calcification process. METHODS AND ANALYSIS In this multicenter and double-blinded, placebo-controlled study, 400 men aged 65-74 years with substantial AVC are randomised (1:1) to treatment with MK-7 (720 µg/day) supplemented by the recommended daily dose of vitamin D (25 µg/day) or placebo treatment (no active treatment) for 2 years. Exclusion criteria are treatment with vitamin K antagonist or coagulation disorders. To evaluate AVC score, a non-contrast CT scan is performed at baseline and repeated after 12 and 24 months of follow-up. Primary outcome is difference in AVC score from baseline to follow-up at 2 years. Intention-to-treat principle is used for all analyses. ETHICS AND DISSEMINATION There are no reported adverse effects associated with the use of MK-7. The protocol is approved by the Regional Scientific Ethical Committee for Southern Denmark (S-20170059) and the Data Protection Agency (17/19010). It is conducted in accordance with the Declaration of Helsinki. Positive as well as negative findings will be reported. TRIAL REGISTRATION NUMBER NCT03243890.
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Affiliation(s)
- Jes Sanddal Lindholt
- Department of Cardiothoracic and Vascular Surgery, Odense Universitetshospital, Odense, Denmark
- Centre for Individualized Medicine in Arterial Diseases, Odense Universitetshospital, Odense, Denmark
| | | | | | | | | | | | - Lars Folkestad
- Department of Endocrinology, Odense Universitetshospital, Odense, Denmark
| | | | | | - Jess Lambrechtsen
- Department of Cardiology, Svendborg Sygehus, Svendborg, Syddanmark, Denmark
| | - Søren Auscher
- Department of Cardiology, Svendborg Sygehus, Svendborg, Syddanmark, Denmark
| | | | | | - Lars Melholt Rasmussen
- Centre for Individualized Medicine in Arterial Diseases, Odense Universitetshospital, Odense, Denmark
- Department of Clinical Biochemistry and Pharmacology, Odense Universitetshospital, Odense, Denmark
| | - Oke Gerke
- Department of Nuclear Medicine, Odense Universitetshospital, Odense C, Denmark
| | - Hans Mickley
- Department of Cardiology, Odense Universitetshospital, Odense, Denmark
| | - Axel Diederichsen
- Centre for Individualized Medicine in Arterial Diseases, Odense Universitetshospital, Odense, Denmark
- Department of Cardiology, Odense Universitetshospital, Odense, Denmark
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Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, Davidson KW, Doubeni CA, Epling JW, Kemper AR, Kubik M, Landefeld CS, Mangione CM, Silverstein M, Simon MA, Tseng CW, Wong JB. Screening for Peripheral Artery Disease and Cardiovascular Disease Risk Assessment With the Ankle-Brachial Index: US Preventive Services Task Force Recommendation Statement. JAMA 2018; 320:177-183. [PMID: 29998344 DOI: 10.1001/jama.2018.8357] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
IMPORTANCE Peripheral artery disease (PAD) is a manifestation of atherosclerosis in the lower limbs. It can impair walking and, in severe cases, can lead to tissue loss, infection, and amputation. In addition to morbidity directly caused by PAD, patients with PAD are at increased risk for cardiovascular disease (CVD) events, because atherosclerosis is a systemic disease that also causes coronary and cerebrovascular events. OBJECTIVE To update the 2013 US Preventive Services Task Force (USPSTF) recommendation on screening for PAD and CVD risk with the ankle-brachial index (ABI). EVIDENCE REVIEW The USPSTF reviewed the evidence on whether screening for PAD with the ABI in generally asymptomatic adults reduces morbidity or mortality from PAD or CVD. The current review expanded on the previous review to include individuals with diabetes and interventions that include supervised exercise and physical therapy intended to improve outcomes in the lower limbs. FINDINGS The USPSTF found few data on the accuracy of the ABI for identifying asymptomatic persons who can benefit from treatment of PAD or CVD. There are few studies addressing the benefits of treating screen-detected patients with PAD; 2 good-quality studies showed no benefit of using the ABI to manage daily aspirin therapy in unselected populations, and 2 studies showed no benefit from exercise therapy. No studies addressed the harms of screening, although the potential exists for overdiagnosis, labeling, and opportunity costs. Studies that addressed the harms of treatment showed nonsignificant results. Therefore, the USPSTF concludes that the current evidence is insufficient and that the balance of benefits and harms of screening for PAD with the ABI in asymptomatic adults cannot be determined. CONCLUSIONS AND RECOMMENDATION The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for PAD and CVD risk with the ABI in asymptomatic adults. (I statement).
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Affiliation(s)
| | | | - Alex H Krist
- Fairfax Family Practice Residency, Fairfax, Virginia
- Virginia Commonwealth University, Richmond
| | - Douglas K Owens
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California
- Stanford University, Stanford, California
| | | | | | | | | | | | | | | | | | | | | | | | - Chien-Wen Tseng
- University of Hawaii, Honolulu
- Pacific Health Research and Education Institute, Honolulu, Hawaii
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Guirguis-Blake JM, Evans CV, Redmond N, Lin JS. Screening for Peripheral Artery Disease Using the Ankle-Brachial Index: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2018; 320:184-196. [PMID: 29998343 DOI: 10.1001/jama.2018.4250] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
IMPORTANCE Peripheral artery disease (PAD) is associated with a high risk for cardiovascular events and poor ambulatory function, even in the absence of symptoms. Screening for PAD with the ankle-brachial index (ABI) may identify patients in need of treatment to improve health outcomes. OBJECTIVE To systematically review evidence for the US Preventive Services Task Force on PAD screening with the ABI, the diagnostic accuracy of the test, and the benefits and harms of treatment of screen-detected PAD. DATA SOURCES MEDLINE, PubMed, and the Cochrane Central Register of Controlled Trials for relevant English-language studies published between January 2012 and May 2, 2017. Surveillance continued through February 7, 2018. STUDY SELECTION Studies of unselected or generally asymptomatic adults with no known cardiovascular disease. DATA EXTRACTION AND SYNTHESIS Independent critical appraisal and data abstraction by 2 reviewers. MAIN OUTCOMES AND MEASURES Cardiovascular morbidity; PAD morbidity; mortality; health-related quality of life; diagnostic accuracy; and serious adverse events. RESULTS Five studies (N = 5864 participants) were included that examined the indirect evidence for the benefits and harms of screening and treatment of screen-detected PAD. No population-based screening trials evaluated the direct benefits or harms of PAD screening with the ABI alone. A single diagnostic accuracy study of the ABI compared with magnetic resonance angiography gold-standard imaging (n = 306) found low sensitivity (7%-34%) and high specificity (96%-100%) in a screening population. Two adequately powered trials (n = 4626) in asymptomatic populations with and without diabetes with a variably defined low ABI (≤0.95 or ≤0.99) showed no statistically significant effect of aspirin (100 mg daily) for composite CVD outcomes (adjusted hazard ratio [HR], 1.00 [95% CI, 0.81-1.23] and HR, 0.98 [95% CI, 0.76-1.26]). One trial (n = 3350) demonstrated no statistically significant increase in major bleeding events with the use of aspirin (adjusted HR, 1.71 [95% CI, 0.99- 2.97]) and no statistically significant increase in major gastrointestinal bleeding (relative risk, 1.13 [95% CI, 0.44-2.91]). Two exercise trials (n = 932) in screen-relevant populations reported no differences in quality of life, Walking Impairment Questionnaire walking distance, or symptoms at 12 and 52 weeks; no harms were reported. CONCLUSIONS AND RELEVANCE There was no direct evidence and limited indirect evidence on the benefits of PAD screening with the ABI in unselected or asymptomatic populations. Available studies suggest low sensitivity and lack of beneficial effect on health outcomes, but these studies have important limitations.
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Affiliation(s)
- Janelle M Guirguis-Blake
- Department of Family Medicine, University of Washington, Tacoma
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Corinne V Evans
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Nadia Redmond
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Jennifer S Lin
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
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Measurement of left atrial volume by 2D and 3D non-contrast computed tomography compared with cardiac magnetic resonance imaging. J Cardiovasc Comput Tomogr 2018; 12:316-319. [DOI: 10.1016/j.jcct.2018.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 04/03/2018] [Indexed: 11/24/2022]
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Yndigegn T, Hofmann R, Jernberg T, Gale CP. Registry-based randomised clinical trial: efficient evaluation of generic pharmacotherapies in the contemporary era. Heart 2018; 104:1562-1567. [PMID: 29666176 DOI: 10.1136/heartjnl-2017-312322] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/22/2018] [Accepted: 03/26/2018] [Indexed: 12/22/2022] Open
Abstract
Randomised clinical trials are the gold standard for testing the effectiveness of clinical interventions. However, increasing complexity and associated costs may limit their application in the investigation of key cardiovascular knowledge gaps such as the re-evaluation of generic pharmacotherapies. The registry-based randomised clinical trial (RRCT) leverages data sampling from nationwide quality registries to facilitate high participant inclusion rates at comparably low costs and, therefore, may offer a mechanism by which such clinical questions may be answered. To date, a number of studies have been conducted using such trial designs, but uncritical use of the RRCT design may lead to erroneous conclusions. The current review provides insights into the strengths and weaknesses of the RRCT, as well as provides an exploratory example of how a trial may be designed to test the long-term effectiveness of beta blockers in patients with myocardial infarction who have preserved left ventricular systolic function.
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Affiliation(s)
- Troels Yndigegn
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | - Robin Hofmann
- Department of Clinical Science and Education, Division of Cardiology, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Tomas Jernberg
- Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Chris P Gale
- Clinical and Population Sciences Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
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