1
|
Dykun I, Clark D, Carlo J, Lincoff AM, Menon V, Nissen SE, Nicholls SJ, Puri R. Longitudinal High-Sensitivity C-Reactive Protein and Longer-Term Cardiovascular Outcomes in Optimally-Treated Patients With High-Risk Vascular Disease. Am J Cardiol 2022; 181:1-8. [PMID: 35970631 DOI: 10.1016/j.amjcard.2022.06.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/22/2022] [Accepted: 06/28/2022] [Indexed: 11/01/2022]
Abstract
The relation between serial high-sensitivity C-reactive protein (hsCRP) and long-term major cardiovascular events (MACEs; cardiovascular death, myocardial infarction, stroke, coronary revascularization, hospitalization for unstable angina) has not been explored in optimally-treated patients with atherosclerotic cardiovascular disease. We tested the hypothesis that longitudinal follow-up hsCRP (repeated measures over time) would associate with 30-month MACE rates. We performed a post hoc analysis of ACCELERATE (Assessment of Clinical Effects of Cholesteryl Ester Transfer Protein Inhibitor with Evacetrapib in Patients with High-Risk for Vascular Outcomes), involving optimally-treated patients with high-risk vascular disease, with available baseline and at least 1 follow-up hsCRP level. Using multivariable Cox proportional hazard models, we determined the association of longitudinal follow-up hsCRP with MACE at 30 months among 8,563 patients (aged 64.6 ± 9 years, 22% women). Patients with incident MACE (n = 961) had higher baseline hsCRP levels (1.77 vs 1.46 mg/L, p <0.0001 for patients with and without MACE, respectively) and showed an upward trajectory during follow-up, whereas median hsCRP levels remained <2 mg/L at all time points (1.83 vs 1.53 mg/L, 1.91 vs 1.53 mg/L, 1.76 vs 1.37 mg/L, at 3, 12, and 24 months, respectively). In a multivariable analysis, higher longitudinal hsCRP levels were independently associated with MACE (hazard ratio [95% confidence interval] per SD 1.19 [1.10 to 1.29], p <0.001), the majority of its individual components and all-cause death. Multivariable models containing longitudinal hsCRP provided improved predictive ability of MACE over baseline hsCRP. In the setting of established medical therapies, longitudinal follow-up hsCRP was independently associated with long-term MACE. In conclusion, these findings suggest that longitudinal hsCRP represents a novel approach of residual cardiovascular risk even when on-treatment hsCRP levels remain <2 mg/L.
Collapse
Affiliation(s)
- Iryna Dykun
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | - Donald Clark
- Department of Medicine, University of Mississippi Medical Center, Jackson, Missouri
| | - Julie Carlo
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - A Michael Lincoff
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Venu Menon
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Steven E Nissen
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Stephen J Nicholls
- Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
| |
Collapse
|
2
|
Dykun I, Bayturan O, Carlo J, Nissen SE, Kapadia SR, Tuzcu EM, Nicholls SJ, Puri R. HbA1c, Coronary atheroma progression and cardiovascular outcomes. Am J Prev Cardiol 2022; 9:100317. [PMID: 35112095 PMCID: PMC8790601 DOI: 10.1016/j.ajpc.2022.100317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/13/2022] [Accepted: 01/16/2022] [Indexed: 11/26/2022] Open
Abstract
Background and aims We tested the hypothesis that on-treatment HbA1c levels independently associate with coronary atheroma progression and major adverse cardiovascular events (MACE: death, myocardial infarction, cerebrovascular accident, coronary revascularization, or hospitalization for unstable angina) rates. Methods We performed a post-hoc pooled analysis of data from seven prospective, randomized trials involving serial coronary intravascular ultrasonography (IVUS). The percent atheroma volume (PAV) was calculated as the proportion of the entire vessel wall occupied by atherosclerotic plaque. Using multivariable mixed modeling, we determined the association of on-treatment HbA1c with annualized change in PAV. Cox proportional hazard models were used to assess the association of HbA1c with incidence of MACE. Results Among 3,312 patients (mean age 58.6±9years, 28.4%women) average on-treatment HbA1c was 6.2±1.1%. Overall, there was no net significant annualized change in PAV (0.12±0.19%, p = 0.52). In a fully adjusted multivariable analysis (following adjustment of age, sex, body mass index, systolic blood pressure, smoking, low- and high-density lipoprotein cholesterol, triglyceride levels, peripheral vascular disease, trial, region, and baseline PAV), higher on-treatment HbA1c levels were independently associated with annualized changes in PAV [beta-estimate (95% confidence interval): 0.13(0.08, 0.19), p < 0.001]. On-treatment HbA1c levels were independently associated with MACE [hazard ratio (95% confidence interval): 1.13(1.04, 1.23), p = 0.005]. Conclusions Independent of achieved cardiovascular risk factor control, greater HbA1c levels significantly associate with coronary atheroma progression rates and clinical outcomes. These results support the notion of a direct, specific effect of glycemic control upon coronary atheroma and atherosclerotic events, supporting the rationale of therapies designed to directly modulate it.
Collapse
|
3
|
Dykun I, Bayturan O, Carlo J, Nissen SE, Nicholls SJ, Puri R. HbA1c, coronary atheroma progression and cardiovascular events. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Hemoglobin A1c (HbA1c) reflects long-term glycemic control and is associated with an increased risk of cardiovascular events among diabetic and non-diabetic patients. The specific impact of HbA1c upon atheroma progression and incident cardiovascular events relative to the presence of other cardiovascular risk factors remains uncertain.
Purpose
We tested the hypothesis that on-treatment HbA1c levels independently associate with coronary atheroma progression measured with serial intravascular ultrasonography (IVUS) and major adverse cardiovascular events (MACE: death, myocardial infarction, cerebrovascular accident, coronary revascularization, or hospitalization for unstable angina) rates.
Methods
We performed a post-hoc pooled analysis of data from eight prospective, randomized trials involving serial coronary IVUS. HbA1c was measured at baseline and the average of the follow-up values was taken. The percent atheroma volume (PAV) was calculated as the proportion of the entire vessel wall occupied by atherosclerotic plaque, throughout the segment of interest. Using multivariable mixed modeling, we determined the association of HbA1c with annualized change in PAV. Cox proportional hazard models were used to assess the association of HbA1c with incidence of MACE.
Results
Among 2,791 patients, mean age was 58.9±9 years and 29.1% were women. Mean on-treatment low-density lipoprotein (LDL)-cholesterol was 80.2±33.7 mg/dl and median on-treatment triglycerides (TG) were 125.5 (94.7, 170.2) mg/dl. Mean baseline and follow-up HbA1c was 6.2±1.2% and 6.3±1.2%, respectively. Overall, there was no net significant annualized change in PAV (0.15±0.21, p=0.47). In a fully adjusted multivariable analysis (following adjustment of age, sex, body mass index (BMI), systolic blood pressure, smoking, LDL- and high-density lipoprotein cholesterol, TG levels, peripheral artery disease, trial, region, and baseline PAV), higher on-treatment HbA1c levels were independently associated with annualized changes in PAV [beta-estimate (95% confidence interval): 0.13 (0.07, 0.19), p<0.001]. On-treatment HbA1c levels were significantly and independently associated with incidence of MACE [hazard ratio (95% confidence interval): 1.17 (1.07, 1.28), p<0.001].
Conclusions
Independent of achieved cholesterol levels, vascular risk factors and BMI, greater HbA1c levels significantly associate with coronary atheroma progression and clinical outcomes. These results support the notion of a direct, specific effect of glycemic control upon the natural history of coronary atheroma and atherosclerotic events, supporting the rationale of therapies designed to directly modulate it.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Iryna Dykun was supported by the German Research Foundation
Collapse
Affiliation(s)
- I Dykun
- Cleveland Clinic, Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland, United States of America
| | - O Bayturan
- Celal Bayar University Faculty of Medicine, Department of Cardiology, Manisa, Turkey
| | - J Carlo
- Cleveland Clinic, Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland, United States of America
| | - S E Nissen
- Cleveland Clinic, Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland, United States of America
| | - S J Nicholls
- Monash University, Monash Cardiovascular Research Centre, Melbourne, Australia
| | - R Puri
- Cleveland Clinic, Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland, United States of America
| |
Collapse
|
4
|
Mazhar J, Figtree G, Vernon ST, Galougahi KK, Carlo J, Nissen SE, Nicholls SJ. Progression of coronary atherosclerosis in patients without standard modifiable risk factors. Am J Prev Cardiol 2020; 4:100116. [PMID: 34327476 PMCID: PMC8315424 DOI: 10.1016/j.ajpc.2020.100116] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/11/2020] [Accepted: 10/18/2020] [Indexed: 12/11/2022] Open
Abstract
Background and aims The outcome of patients with clinical coronary artery disease despite traditional risk factors is poorly understood. Methods Clinical characteristics and plaque burden on serial intravascular ultrasonography were compared in patients without (n = 165) and with (n = 492) standard modifiable risk factors after matching on age, sex and use of statins from a database of 5823 patients participating in clinical trials of anti-atherosclerotic therapies. Results Patients without standard modifiable risk factors had lower baseline systolic blood pressure (118 ± 12 vs. 129 ± 17 mmHg, p < 0.001), low-density lipoprotein cholesterol (87 ± 21 vs. 104 ± 34 mg/dl, p < 0.001), triglycerides [106 vs. 136 mg/dl, p < 0.001)] and C-reactive protein [1.5 vs. 2.1 mg/l, p = 0.001]. At baseline, patients without modifiable risk factors had a lower percent atheroma volume (35.7 ± 8.6 vs. 38 ± 8.8%, p = 0.004) and total atheroma volume (174.7 ± 80 vs. 190.9 ± 84 mm3, p = 0.03) and less images with calcification (22.2 vs. 26.5%, p = 0.025). The use of aspirin and statin prior to and during the trials was similar. The use of ACE inhibitors and beta blockers was lower in the no risk factor group prior to and during the trials. The change in percent atheroma volume (−0.2 ± 2.8 vs. −0.1 ± 3.6%, p = 0.71), total atheroma volume (−5.5 ± 23.4 vs. −3.8 ± 22.7 mm3, p = 0.42), and the percentage of patients demonstrating any degree of progression (50.9% vs 45.1%, p = 0.20) were similar in those without and with standard modifiable risk factors, respectively. Conclusion Patients who develop clinical coronary atherosclerosis without standard modifiable risk factors have similar rates of plaque progression to those with traditional risk factors. Outcome of patients with CAD despite no traditional risk factors is poorly understood. Serial intravascular ultrasound studies provide an opportunity to examine this. Patients without standard risk factors had lower plaque burden and calcification. Use of aspirin and statin was similar in patients with and without standard risk factors. Plaque progression was similar in those without and with standard risk factors.
Collapse
Affiliation(s)
- Jawad Mazhar
- Kolling Research Institute, University of Sydney, Sydney, Australia
| | - Gemma Figtree
- Kolling Research Institute, University of Sydney, Sydney, Australia
| | - Stephen T Vernon
- Kolling Research Institute, University of Sydney, Sydney, Australia
| | | | - Julie Carlo
- C5Research, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Australia
| | - Steven E Nissen
- C5Research, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Australia
| | - Stephen J Nicholls
- Monash Cardiovascular Research Centre, Victorian Heart Institute, Monash University, Australia
| |
Collapse
|
5
|
Bazarbashi N, Kapadia SR, Nicholls SJ, Carlo J, Gad MM, Kaur M, Karrthik A, Sammour YM, Diab M, Ahuja KR, Tuzcu EM, Nissen SE, Puri R. Oral Calcium Supplements Associate With Serial Coronary Calcification: Insights From Intravascular Ultrasound. JACC Cardiovasc Imaging 2020; 14:259-268. [PMID: 32828785 DOI: 10.1016/j.jcmg.2020.06.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 06/04/2020] [Accepted: 06/26/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES This study sought to evaluate and assess the extent of serial coronary artery calcification in response to oral calcium supplementation. BACKGROUND Oral calcium supplements are frequently used despite their cardiovascular safety remaining controversial. Their effects on serial coronary calcification are not well established. METHODS In a post hoc patient-level analysis of 9 prospective randomized trials using serial coronary intravascular ultrasound, changes in serial percentage of atheroma volume (PAV) and calcium indices (CaI) were compared in matched segments of patients coronary artery disease who were receiving concomitant calcium supplements (n = 447) and in those who did not receive supplements (n = 4,700) during an 18- to 24-month trial period. RESULTS Patients (mean age 58 ± 9 years; 73% were men; 43% received concomitant high-intensity statins) demonstrated overall annualized changes in PAV and CaI with a mean of -0.02 ± 1.9% (p = 0.44) and a median of 0.02 (interquartile range: 0.00 to 0.06) (p < 0.001) from baseline, respectively. Following propensity-weighted mixed modeling adjusting for treatment and a range of demographic, clinical, ultrasonic, and laboratory parameters (including but not limited to sex, race, baseline, and annualized change in PAV, baseline CaI, concomitant high-intensity statins, diabetes mellitus, renal function), there were no significant between-group differences in annualized changes in PAV (least-squares mean: 0.09; 95% confidence interval [CI]: -0.20 to 0.37 vs. 0.01; 95% CI: -0.27 to 0.29; p = 0.092) according to calcium supplement intake. Per a multivariable logistic regression model accounting for the range of covariates described, calcium supplementation independently associated with an increase in annualized CaI (odds ratio: 1.15; 95% CI: 1.05 to 1.26; p = 0.004). CONCLUSIONS Oral calcium supplementation may increase calcium deposition in the coronary vasculature independent of changes in atheroma volume. The impact of these changes on plaque stability and cardiovascular outcomes requires further investigation.
Collapse
Affiliation(s)
- Najdat Bazarbashi
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio; Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Stephen J Nicholls
- Department of Cardiology, MonashHeart, Monash University, Melbourne, Victoria, Australia
| | - Julie Carlo
- Cleveland Clinic Coordinating Center for Clinical Research, Cleveland Clinic, Ohio
| | - Mohamed M Gad
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Manpreet Kaur
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Antonette Karrthik
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Yasser M Sammour
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Mohamed Diab
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Keerat Rai Ahuja
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - E Murat Tuzcu
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Steven E Nissen
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio; Cleveland Clinic Coordinating Center for Clinical Research, Cleveland Clinic, Ohio
| | - Rishi Puri
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio; Cleveland Clinic Coordinating Center for Clinical Research, Cleveland Clinic, Ohio.
| |
Collapse
|
6
|
McDonald CM, Gordish-Dressman H, Henricson EK, Duong T, Joyce NC, Jhawar S, Leinonen M, Hsu F, Connolly AM, Cnaan A, Abresch RT, Dubrovsky A, Kornberg A, Ryan M, Webster R, Biggar W, McAdam L, Mah J, Kolski H, Vishwanathan V, Chidambaranathan S, Nevo Y, Gorni K, Carlo J, Tulinius M, Lotze T, Bertorini T, Day J, Karachunski P, Clemens P, Abdel-Hamid H, Teasley J, Kuntz N, Driscoll S, Bodensteiner J, Connolly A, Pestronk A, Abresch R, Henricson E, Joyce N, McDonald C, Cnaan A, Morgenroth L, Leshner R, Tesi-Rocha C, Thangarajh M, Duong T. Longitudinal pulmonary function testing outcome measures in Duchenne muscular dystrophy: Long-term natural history with and without glucocorticoids. Neuromuscul Disord 2018; 28:897-909. [DOI: 10.1016/j.nmd.2018.07.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 06/24/2018] [Accepted: 07/17/2018] [Indexed: 10/28/2022]
|
7
|
Kowolenko M, Carlo J, Gozzo JJ. Histologic identification of cellular differences that may contribute to the reduced immunogenicity of transplanted neonatal versus adult skin tissue. Int Arch Allergy Appl Immunol 1986; 80:274-7. [PMID: 3522435 DOI: 10.1159/000234065] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Neonatal epidermal sections obtained within 24 h after birth from C3H/He mice along with adult epidermis from the same strain were evaluated for the presence of epidermal dendritic cells (Langerhans cells) by three staining methods: immunofluorescence, gold sodium thiomalate and adenosine triphosphatase (ATPase) activity. The results obtained indicate that Langerhans cells are present in both groups of tissue, but lack Ia antigen expression in the neonate. This lack of Ia antigen expression may contribute to the superiority of neonatal donor skin for transplantation over that from adult donors in the murine allograft model.
Collapse
|
8
|
Askanas V, Engel WK, Kwan HH, Reddy NB, Husainy T, Carlo J, Siddique T, Schwartzman RJ, Hanna CJ. Autosomal dominant syndrome of lipid neuromyopathy with normal carnitine: successful treatment with long-chain fatty-acid-free diet. Neurology 1985; 35:66-72. [PMID: 3966003 DOI: 10.1212/wnl.35.1.66] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
A family (mother and two sons) have had lifelong muscle weakness and intolerance to fatty food. Histochemistry of muscle biopsies of all three patients demonstrated increased lipids in type I muscle fibers and type II muscle fiber atrophy and paucity. Electronmicroscopy of muscle revealed increased lipids, abnormal mitochondria, and increased lipofuscin granules. Electronmicroscopy of sural nerve showed inclusions in most of the Schwann cell cytoplasm, with lipid droplets, zebra bodies, lipofuscin granules, and abnormal mitochondria. Carnitine and CPT I and II levels were normal in serum and muscle. Treatment with long-chain fatty-acid-free diet resulted in remarkable clinical improvement and in decrease of lipid droplets in the muscle. This dietary program may be useful in other forms of lipid myopathy.
Collapse
|
9
|
|
10
|
Gammon WR, Merritt CC, Lewis DM, Sams WM, Wheeler CE, Carlo J. Leukocyte chemotaxis to the dermal-epidermal junction of human skin mediated by pemphigoid antibody and complement: mechanism of cell attachment in the in vitro leukocyte attachment method. J Invest Dermatol 1981; 76:514-22. [PMID: 7017015 DOI: 10.1111/1523-1747.ep12521246] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
|
11
|
DeVylder J, Carlo J, Stratigos GT. Early recognition and treatment of the traumatically transected parotid duct: report of case. J Oral Surg 1978; 36:43-4. [PMID: 271210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The immediate treatment of a transected parotid duct has been presented along with a brief review of the literature. The importance of exploration of wounds in the facial area cannot be overemphasized, as early repair of a severed duct is of utmost importance for establishing its patency.
Collapse
|