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Munnur RK, Nerlekar N, Wong DTL. Imaging of coronary atherosclerosis in various susceptible groups. Cardiovasc Diagn Ther 2016; 6:382-95. [PMID: 27500095 DOI: 10.21037/cdt.2016.03.02] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Coronary artery disease (CAD) is the leading cause of death and disability worldwide. Atherosclerosis, which is the primary pathophysiologic mechanism for the development of plaque leading to CAD, is a multifactorial process resulting from a complex interplay between genetic susceptibility and various risk factors such as hypertension (HT), dyslipidaemia, diabetes mellitus (DM) and smoking. In addition, influences from other disease states such as chronic kidney disease (CKD), obesity and the metabolic syndrome as well as gender and ethnic diversity also contribute to the disease process. Insights from pathological observations and advances in cellular and molecular biology have helped us understand the process of plaque formation, progression and rupture leading to events. Several intravascular imaging techniques such as intravascular ultrasound (IVUS), Virtual histology IVUS (VH-IVUS) and optical coherence tomography (OCT) allow in vivo assessment of plaque burden, plaque morphology and response to therapy. In addition, non invasive assessment using coronary artery calcium (CAC) score allows risk stratification and plaque burden assessment whilst computed tomography coronary angiography (CTCA) allows evaluation of luminal stenosis, plaque characterisation and quantification. This review aims to summarise the results of invasive and non-invasive imaging studies of coronary atherosclerosis seen in various high-risk populations including DM, metabolic syndrome, obesity, CKD and, gender differences and ethnicity. Understanding the phenotype of plaques in various susceptible groups may allow potential development of personalised therapies.
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Affiliation(s)
- Ravi Kiran Munnur
- Monash Cardiovascular Research Centre/MonashHEART, Clayton, Victoria, Australia
| | - Nitesh Nerlekar
- Monash Cardiovascular Research Centre/MonashHEART, Clayton, Victoria, Australia
| | - Dennis T L Wong
- Monash Cardiovascular Research Centre/MonashHEART, Clayton, Victoria, Australia
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Strang AC, van Wijk DF, Mutsaerts HJMM, Stroes ESG, Nederveen AJ, Rotmans JI, Rabelink TJ, Box FMA. Guideline treatment results in regression of atherosclerosis in type 2 diabetes mellitus. Diab Vasc Dis Res 2015; 12:126-32. [PMID: 25589481 DOI: 10.1177/1479164114559511] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Efficacy of guideline cardiovascular disease prevention regimens may differ between patients with or without type II diabetes mellitus. We therefore compared change in carotid artery wall dimensions in type II diabetes mellitus and non-type II diabetes mellitus patients with a history of a major cardiovascular disease event, using magnetic resonance imaging. METHODS Thirty type II diabetes mellitus patients and 29 age- and sex-matched non-diabetes mellitus patients with a history of stroke or myocardial infarction and a carotid artery stenosis (15%-70%) were included. In all patients, treatment was according to cardiovascular risk management guidelines. At baseline and follow-up, carotid artery vessel wall dimensions were measured using 1.5 T magnetic resonance imaging. RESULTS After 2 years of follow-up, total wall volume of the carotid artery in type II diabetes mellitus patients decreased by 9.6% (p = 0.016). In contrast, stabilization rather than regression of carotid artery wall dimensions was observed in non-diabetes mellitus patients over a 2-year period. Body mass index was identified as a predictor of total wall volume decrease. CONCLUSIONS Guideline treatment arrests atherogenesis in non-diabetes mellitus patients and even decreases vessel wall dimensions in type II diabetes mellitus patients. Baseline body mass index predicts cardiovascular disease prevention efficacy expressed as decrease in total wall volume. These data emphasize the importance of optimal cardiovascular-prevention, particularly in diabetes patients with a high body mass index.
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Affiliation(s)
- Aart C Strang
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Diederik F van Wijk
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Erik S G Stroes
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Aart J Nederveen
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Joris I Rotmans
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ton J Rabelink
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - Frieke M A Box
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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Kwan AC, May HT, Cater G, Sibley CT, Rosen BD, Lima JAC, Rodriguez K, Lappe DL, Muhlestein JB, Anderson JL, Bluemke DA. Coronary artery plaque volume and obesity in patients with diabetes: the factor-64 study. Radiology 2014; 272:690-9. [PMID: 24754493 DOI: 10.1148/radiol.14140611] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To determine the relationship between coronary plaque detected with coronary computed tomographic (CT) angiography and clinical parameters and cardiovascular risk factors in asymptomatic patients with diabetes. MATERIALS AND METHODS All patients signed institutional review board-approved informed consent forms before enrollment. Two hundred twenty-four asymptomatic diabetic patients (121 men; mean patient age, 61.8 years; mean duration of diabetes, 10.4 years) underwent coronary CT angiography. Total coronary artery wall volume in all three vessels was measured by using semiautomated software. The coronary plaque volume index (PVI) was determined by dividing the wall volume by the coronary length. The relationship between the PVI and cardiovascular risk factors was determined with multivariable analysis. RESULTS The mean PVI (±standard deviation) was 11.2 mm(2) ± 2.7. The mean coronary artery calcium (CAC) score (determined with the Agatston method) was 382; 67% of total plaque was noncalcified. The PVI was related to age (standardized β = 0.32, P < .001), male sex (standardized β = 0.36, P < .001), body mass index (BMI) (standardized β = 0.26, P < .001), and duration of diabetes (standardized β = 0.14, P = .03). A greater percentage of soft plaque was present in younger individuals with a shorter disease duration (P = .02). The soft plaque percentage was directly related to BMI (P = .002). Patients with discrepancies between CAC score and PVI rank quartiles had a higher percentage of soft and fibrous plaque (18.7% ± 3.3 vs 17.4% ± 3.5 [P = .008] and 52.2% ± 7.2 vs 47.2% ± 8.8 [P < .0001], respectively). CONCLUSION In asymptomatic diabetic patients, BMI was the primary modifiable risk factor that was associated with total and soft coronary plaque as assessed with coronary CT angiography.
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Affiliation(s)
- Alan C Kwan
- From the Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, 10 Center Dr, Building 10/1C355, Bethesda, MD 20892 (A.C.K., G.C., C.T.S., K.R., D.A.B.); Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, Utah (H.T.M., D.L.L., J.B.M., J.L.A.); Cardiology Division, Department of Medicine, Johns Hopkins University, Baltimore, Md (B.D.R., J.A.C.L.); and Cardiology Division, University of Utah, Salt Lake City, Utah (D.L.L., J.B.M., J.L.A.)
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D'Ascenzo F, Agostoni P, Abbate A, Castagno D, Lipinski MJ, Vetrovec GW, Frati G, Presutti DG, Quadri G, Moretti C, Gaita F, Zoccai GB. Atherosclerotic coronary plaque regression and the risk of adverse cardiovascular events: A meta-regression of randomized clinical trials. Atherosclerosis 2013. [PMID: 23206978 DOI: 10.1016/j.atherosclerosis.2012.10.065] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Tani S, Matsumoto M, Nakamura Y, Nagao K, Hirayama A. Association of the low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio and body mass index with coronary plaque regression. Am J Cardiovasc Drugs 2012; 12:279-86. [PMID: 22747341 DOI: 10.1007/bf03261836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND The change (Δ) in the low-density lipoprotein cholesterol (LDL-C)/high-density lipoprotein cholesterol (HDL-C) ratio (ΔLDL-C/HDL-C) and obesity are known to play important roles in the progression of coronary atherosclerosis. We hypothesized that a reasonable predictive model of coronary plaque regression could be constructed using ΔLDL-C/HDL-C and the body mass index (BMI). OBJECTIVE The purpose of this study was to establish a predictive model of coronary plaque regression using ΔLDL-C/HDL-C and BMI. METHODS AND RESULTS A 6-month prospective observational study was conducted among 114 patients with coronary artery disease (CAD) who were treated with pravastatin. The plaque volume, as assessed using volumetric intravascular ultrasound, decreased significantly by 9.9% (p < 0.0001 vs baseline). In a multivariate regression analysis with traditional risk factors, ΔLDL-C/HDL-C (β: 0.473, p = 0.0001) and the baseline BMI (β: 0.249, p = 0.004) were identified as independent predictors of the Δplaque volume. The patients were divided using the 50th percentile of the baseline BMI and the 50th percentile of the ΔLDL-C/HDL-C ratio as cutoffs, and a model for predicting coronary atherosclerotic regression was prepared using a combination of the two variables. The Δplaque volumes were -18.3%, -14.1%, -4.8%, and -2.2% for the groups with ΔLDL-C/HDL-C ≤ -22.2% and a BMI ≤ 24.1 kg/m(2), ΔLDL-C/HDL-C ≤ -22.2% and ΔBMI >24.1 kg/m(2), ΔLDL-C/HDL-C > -22.2% and BMI ≤ 24.1 kg/m(2), and ΔLDL-C/HDL-C > -22.2% and BMI >24.1 kg/m(2), respectively (p = 0.003). CONCLUSION A predictive model for coronary plaque regression based on a combination of ΔLDL-C/HDL-C and the baseline BMI may be a useful clinical tool in patients with CAD.
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Tani S, Matsumoto M, Nakamura Y, Nagao K, Hirayama A. Association of the Low-Density Lipoprotein Cholesterol/High-Density Lipoprotein Cholesterol Ratio and Body Mass Index with Coronary Plaque Regression. Am J Cardiovasc Drugs 2012. [DOI: 10.2165/11632520-000000000-00000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Tani S, Nagao K, Anazawa T, Kawamata H, Furuya S, Takahashi H, Iida K, Matsumoto M, Washio T, Kumabe N, Hirayama A. Coronary Plaque Regression and Lifestyle Modification in Patients Treated With Pravastatin - Assessment Mainly by Daily Aerobic Exercise and an Increase in the Serum Level of High-Density Lipoprotein Cholesterol -. Circ J 2010; 74:954-61. [DOI: 10.1253/circj.cj-09-0705] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Shigemasa Tani
- Department of Cardiology, Nihon University Surugadai Hospital
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Ken Nagao
- Department of Cardiology, Nihon University Surugadai Hospital
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Takeo Anazawa
- Department of Cardiology, Nihon University Surugadai Hospital
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Hirofumi Kawamata
- Department of Cardiology, Nihon University Surugadai Hospital
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Shingo Furuya
- Department of Cardiology, Nihon University Surugadai Hospital
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Hiroshi Takahashi
- Department of Cardiology, Nihon University Surugadai Hospital
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Kiyoshi Iida
- Department of Cardiology, Nihon University Surugadai Hospital
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Michiaki Matsumoto
- Department of Cardiology, Nihon University Surugadai Hospital
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Takehiko Washio
- Department of Cardiology, Nihon University Surugadai Hospital
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Narimichi Kumabe
- Department of Cardiology, Nihon University Surugadai Hospital
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Atsushi Hirayama
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
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