Asymptomatic Atherosclerosis Research Articles

Pain Management for Patients with Acute Myocardial Infraction: An Interventional Study for Nursing Staff

Background: Coronary artery disease is the most common type of heart disease. It encompasses a spectrum of clinical conditions ranging from asymptomatic atherosclerosis and stable or unstable angina to acute coronary syndrome caused by atheroma changes in the coronary arteries. It is one of the leading causes of death. Assessing risk factors for coronary artery disease and attaining the knowledge on how to deal with the symptoms’ pain is the first step in its prevention. Objective: To find out the effectiveness of an interventional program on Nurses’ knowledge and practices about pain management for patients with acute myocardial infraction at Coronary Care Units. Methodology: A pre-experiment design (one group pretest-posttest design) is applied has been done to obtain the study goals. A non- probability (purposive) sample was chosen to obtain representative and accurate data. From total (41) nurses working at CCU, (11) nurses were excluded from the educational program (five nurses for the pilot study, four nurses previously participated in pain management courses, and two nurse did not complete the program). The total number of nurses participating in the program of the study were (30) nurses. The sample had been taken in one group. The program is established and designed based on the preliminary assessment of nurses' knowledge and practices about pain management for patients with acute MI at CCU, and also on the information obtained from the related scientific literatures and previous studies. The program content is reviewed by a group of experts. Statistical Package for Social Sciences (SPSS, version 23) was used to analyze the study data. Results of the study: The study findings presented that there was a highly significant differences of the knowledge between pre-test and post-test score at p value (.000), and a high significant difference between pre-test and post-test practices at p value (.000) related to pain management. Conclusion: The results of this study showed that the interventional program was an effective educational method that enables the nurses to improve their knowledge and practices towards pain assessment and management. Keywords: Pain Management, Acute Myocardial Infraction, Interventional Study, Nursing Staff

High Prevalence of Asymptomatic Intracranial Atherosclerosis in Elder Women With Tubal Ligation: Result From a Community-Based Study in Shandong, China.

BackgroundIn addition to traditional cardiovascular risk factors, gender-specific factors may also contribute to intracranial atherosclerosis. This study aimed to comprehensively investigate the association between asymptomatic intracranial atherosclerosis (aICAS) and menstrual or reproductive history (MRH), namely, menstruation, pregnancy, childbirth, menopause, and contraception.MethodsParticipants in this study were selected from the Kongcun town aICAS study. MRH was collected through structured case report forms, in which menarche age, menstrual regularity, dysmenorrhea, number of pregnancies, number of childbirths, age of first pregnancy, breastfeeding, menopause, menopause age, and contraceptive methods were all involved. All characteristics were compared by chi-squared and nonparametric tests as applicable. Logistic regression model and sensitivity analysis were used to analyze the association between aICAS and MRH.ResultsA total of 1,052 female participants were involved in this study, of which 5.7% had moderate to severe aICAS. Tubal ligation was significantly associated with aICAS in univariate analysis [crude odds ratio (OR), 2.85; 95% CI, 1.22–6.62; P = 0.015]. This association was still significant among female participants over 60 years old after multivariate adjustment (adjusted OR, 4.36; 95% CI, 1.55–12.24; P = 0.005). Sensitivity analysis showed a similar result (adjusted OR, 3.76; 95% CI, 1.24–11.41; P = 0.020). Menopause lost significant association with aICAS after multivariate adjustment (adjusted OR, 1.68; 95% CI, 0.66–4.24; P = 0.275). No other MRH factors were found to be associated with aICAS.ConclusionTubal ligation may be associated with a higher prevalence of aICAS in Chinese elderly women. This provides a new perspective to study the epidemiological characteristics of ICAS.

Abstract TMP76: Association Of Adiposity With Intracranial Atherosclerosis

Introduction: Adiposity, as measured by Body Mass Index (BMI) and Waist-to-Hip Ratio (WHR), is associated with ischemic stroke. However, association with Intercranial Atherosclerosis has not been well-established in the United States. We assessed the hypothesis that adiposity is associated with asymptomatic intracranial atherosclerosis (ICAS). Methods: BMI was calculated as weight (kg)/height (m) 2 . The ratio of waist (umbilical level) to hip (maximum buttocks) circumference (WHR) was calculated as a measure of fat distribution. In the ARIC cohort, a stratified subset (N=1145) underwent 3D time-of-flight MR angiogram and 3D high-isotropic resolution black blood MRI. ICAS was graded according to the criteria established by the Warfarin-Aspirin Symptomatic Intracranial Disease trial. In this study, we evaluated the relationship between BMI as well as WHR, and significant asymptomatic ICAS, defined as ≥50% stenosis. Student t-tests were performed to test continuous variables, and X 2 test was used to compare categorical variables. Analysis of covariance (ANCOVA) was used for multivariate testing. Results: Among subjects who underwent vascular imaging, 1033 (90%) had <50% ICAS and 112 (10%) had ≥50% ICAS. At the time of assessment, those with ≥50% ICAS were older (age 79±5 vs. 76±5, p<0.001), and had higher systolic blood pressure or SBP (134±19 vs. 130±18, p=0.02), compared with those with <50% ICAS. The BMI was higher (29.1±6.7 vs. 28.1±5.2), although the difference was statistically borderline significant (p=0.06). The WHR was higher (0.95±0.07 vs. 0.93±0,08), the difference being statistically significant (p=0.01). The difference remained significant after adjustment for age and SBP (p=0.02). Conclusion: We report a significant association between WHR, a measure of central adiposity, and ≥50% ICAS. This may be one of the first reported associations between central adiposity and ICAS. These results emphasize the importance of adiposity distribution in addition to overall adiposity, as a risk factor for significant asymptomatic ICAS.

Risk Factors for Asymptomatic and Symptomatic Intracranial Atherosclerosis Determined by Magnetic Resonance Vessel Wall Imaging in Chinese Population: A Case-Control Study.

Background and PurposeThe association between risk factors and intracranial atherosclerosis disease (ICAD) determined by magnetic resonance (MR) vessel wall imaging in Chinese population has not been investigated. The aim of this study was to investigate the associations of conventional vascular risk factors with asymptomatic and symptomatic ICAD using MR vessel wall imaging in Chinese population.MethodsThe study population was recruited from two cohort studies of ICASMAP and CAMERA comprised 104 symptomatic ICAD subjects (57.1 ± 11.1 years; 35.6% females), 51 asymptomatic ICAD subjects (70.1 ± 8.4 years; 50.0% females) and 418 controls (58.0 ± 13.3 years; 61.0% females) defined as asymptomatic subjects without ICAD on MR vessel wall imaging. We compared the vascular risk factors between the three groups using a multivariate logistic regression analysis.ResultsCompared with controls, there was a significant positive association between age (OR: 1.07, 95% CI: 1.03–1.10, p < 0.001) and hypertension (OR: 3.03, 95% CI: 1.45–6.36, p = 0.003) and asymptomatic ICAD. There was a positive association of smoking (OR: 3.41, 95% CI: 1.57–7.42, p = 0.001), hypertension (OR: 7.43, 95% CI: 3.81–14.49, p < 0.001) and diabetes (OR: 3.54, 95% CI: 1.93–6.49, p < 0.001) and an inverse association of high-density lipoprotein (HDL) (p < 0.017) with symptomatic ICAD. Compared to asymptomatic ICAD, there was a significant inverse association of age (OR: 0.86, 95% CI: 0.81–0.92, p < 0.001) and HDL (p < 0.001) with symptomatic ICAD.ConclusionOld age and hypertension are associated with asymptomatic ICAD and smoking, hypertension, diabetes and lower HDL are associated with an increased risk of symptomatic ICAD in Chinese population.Clinical Trial RegistrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT03417063.

Risk for Subsequent SARS-CoV-2 Infection and Severe COVID-19 Among Community-Dwellers With Pre-Existing Cervicocephalic Atherosclerosis: A Population-Based Study.

Background:COVID-19 patients may develop atherosclerosis-related complications. Whether a proportion of these patients already had asymptomatic cervicocephalic atherosclerosis before SARS-CoV-2 infection is not known. This study assessed whether pre-existing cervicocephalic atherosclerosis increased the susceptibility to SARS-CoV-2 infection or resulted in more severe or fatal COVID-19.Methods:Individuals enrolled in the Atahualpa Project cohort who received head CT (for assessing carotid siphon calcifications) and B-mode ultrasounds (for measurement of the carotid intima-media thickness) prior to the pandemic were eligible for this study. Among this cohort, those who also received serological tests for detection of SARS-CoV-2 antibodies and clinical evaluations for assessment of COVID-19 severity were enrolled. Multivariate logistic regression and exposure-effect models were fitted to assess the association between pre-existing atherosclerosis biomarkers, and SARS-CoV-2 seropositivity and COVID-19 severity.Results:Overall, 154 of 519 study participants (30%) had evidence of cervicocephalic atherosclerosis. A total of 325 (63%) individuals became SARS-CoV-2 positive, and 65 (23.5%) of seropositive individuals had severe or fatal COVID-19. The risk of SARS-CoV-2 seropositive status did not differ across individuals with and without atherosclerosis biomarkers (P = .360). Likewise, seropositive individuals with pre-existing atherosclerosis were not more prone to develop severe or fatal COVID-19 than those without evidence of atherosclerosis (P = .274). Average estimated exposure effects of pre-existing cervicocephalic atherosclerosis versus no atherosclerosis over SARS-CoV-2 seropositivity and COVID-19 severity were not significant.Conclusions:Pre-existing cervicocephalic atherosclerosis does not increase the risk of acquiring SARS-CoV-2 infection nor the severity of COVID-19 among seropositive individuals.

Use of Coronary CT Angiography as a Screening Tool for Coronary Artery Disease in Asymptomatic Healthy Individuals or Patients

심장 돌연사 환자들은 종종 흉통 또는 운동성 호흡곤란 등의 전조증상이 나타나지 않기 때문에 잠재적인 무증상 관상동맥 질환을 조기에 발견하는 것이 매우 중요하다. 관상동맥 전산화단층촬영 혈관조영술은 방사선 노출로 인한 위험성 때문에 무증상 환자에서 스크리닝 검사로 정당화되지 못했었지만 최근에 전산화단층촬영 기술의 비약적인 발전으로 방사선량을 1 mSv 미만으로 최소화함으로써 무증상 환자의 관상동맥 질환 선별 검사의 유용성에 대한 많은 연구가 진행되어 왔다. 그러나, 여전히 무증상 정상인 또는 환자의 관상동맥 질환 선별 검사에 대한 관상동맥 전산화단층촬영 혈관조영술의 유용성에 대해서는 다양한 의견들이 있다. 이 종설에서는 무증상 정상인 또는 환자들에게 관상동맥 질환 선별 검사로 관상동맥 칼슘 점수와 관상동맥 전산화단층촬영 혈관조영술 유용성에 대해서 다양한 문헌고찰을 통해서 알아보았다. 관상동맥 전산화단층촬영 혈관조영술상 무증상 정상인의 2.6%에서 70% 이상의 유의한 관상동맥 협착이 발견되었고, 선별 목적의 관상동맥 전산화단층촬영 혈관조영술이 무증상 건강한 사람의 미래의 심혈관 질환 발생을 예측할 수 있다. 그러나 현재 미국국립보건원에서 진행하고 있는 SCOT-HEART 2 연구가 끝나면 관상동맥 전산화단층촬영 혈관조영술이 무증상 성인의 심혈관 예방에 선별 검사로 적절한지 결정을 내릴 수 있을 것으로 생각된다.

Pathophysiology and Role of Coronary CT Angiography in Stable Angina

관상동맥질환의 임상적인 개념은 지난 10년 동안 패러다임의 변화를 보여왔다. 관상동맥질환은 대부분 진행성 질환이며, 관상동맥질환 환자는 질병 진행의 어느 시점에서도 급성 관상동맥 증후군에 직면할 수 있다. 이러한 임상적 맥락에서 2019년 유럽심장학회 가이드라인에서는 조기 진단과 꾸준한 관리가 필요한 관상동맥질환의 임상적인 중요성을 반영하여 “만성 관상동맥증후군”이라는 용어의 사용을 발표하였다. 최근 관상동맥 전산화단층촬영 혈관조영술을 이용한 관상동맥질환의 평가는 많은 발전을 이루었고, 안정형 협심증 또는 만성 관상동맥증후군 환자에서 관상동맥 전산화단층촬영 혈관조영술의 임상적 유용성은 초기 무증상 관상동맥질환의 발견에서부터 죽상경화판의 특성 분석 및 관상동맥질환의 치료 전략 결정에 도움을 주는 역할까지 관상동맥질환의 다양한 단계에 걸쳐 입증되고 있다. 이 종설에서는 안정형 협심증 환자의 이해를 돕는 병태생리를 설명하고 이에 대한 관상동맥 전산화단층촬영의 임상적 적용과 역할에 대해 알아보고자 한다.

HIV indirectly accelerates coronary artery disease by promoting the effects of risk factors: longitudinal observational study

Our objective was to assess whether human immunodeficiency virus (HIV)-infection directly or indirectly promotes the progression of clinical characteristics of coronary artery disease (CAD). 300 African Americans with asymptomatic CAD (210 male; age: 48.0 ± 7.2 years; 226 HIV-infected) who underwent coronary CT angiography at two time points (mean follow-up: 4.0 ± 2.3 years) were randomly selected from 1429 participants of a prospective epidemiological study between May 2004 and August 2015. We calculated Agatston-scores, number of coronary plaques and segment stenosis score (SSS). Linear mixed models were used to assess the effects of HIV-infection, atherosclerotic cardiovascular disease (ASCVD) risk, years of cocaine use on CAD. There was no significant difference in annual progression rates between HIV-infected and—uninfected regarding Agatston-scores (10.8 ± 25.1/year vs. 7.2 ± 17.8/year, p = 0.17), the number of plaques (0.2 ± 0.3/year vs. 0.3 ± 0.5/year, p = 0.11) or SSS (0.5 ± 0.8/year vs. 0.5 ± 1.3/year, p = 0.96). Multivariately, HIV-infection was not associated with Agatston-scores (8.3, CI: [− 37.2–53.7], p = 0.72), the number of coronary plaques (− 0.1, CI: [− 0.5–0.4], p = 0.73) or SSS (− 0.1, CI: [− 1.0–0.8], p = 0.84). ASCVD risk scores and years of cocaine-use significantly increased all CAD outcomes among HIV-infected individuals, but not among HIV-uninfected. Importantly, none of the HIV-medications were associated with any of the CAD outcomes. HIV-infection is not directly associated with CAD and therefore HIV-infected are not destined to have worse CAD profiles. However, HIV-infection may indirectly promote CAD progression as risk factors may have a more prominent role in the acceleration of CAD in these patients.

Subclinical Vascular Damage: Current Insights and Future Potential.

The cardiovascular risk assessment must be carried out during all the different phases of life because the cardiovascular risk and the related prevention actions are dynamic and constantly evolving. As patients age, they change their exposure to various risk factors and accumulate comorbidities by changing their subjective cardiovascular risk, so it is necessary to undertake personalized early and preventive diagnostic actions. The main approach to asymptomatic vascular disease is based on primary prevention with the adoption of a healthy lifestyle. Indeed, lifestyle influences most of the traditional risk factors. In recent years, important differences between the sexes regarding cardiovascular risk factors have emerged and in particular, risk factors specific for female sex have been identified. Women are more likely to be categorized into lower risk categories for cardiovascular disease and, as a result, receive less lifestyle counseling than men, as well as less intensive prevention. This narrative review aims to analyze CVD risk prevention in asymptomatic atherosclerosis with a look at new emerging factors. In the end, we quickly analyzed the effects of the recent pandemic on lifestyle and cardiovascular risk and the potential negative effects in the long term.

Potential Association between Distal Deep Vein Thrombosis and Asymptomatic Atherosclerosis.

Background Several studies have previously reported an association between idiopathic proximal deep vein thrombosis (DVT) and atherosclerosis, but whether spontaneous distal DVT is associated with asymptomatic atherosclerosis is still unknown. Methods Ultrasonography of the carotid arteries was done for plaque detection and intima-media thickness (IMT) evaluation, and the ankle-brachial index (ABI) in 116 patients with spontaneous DVT and without symptomatic atherosclerosis. Fifty-seven patients (M/F 19/38, age range 54–78 years) had distal DVT and 59 (M/F 24/35, age range 51–73 years) had proximal DVT. A group of 57 (M/F 21/36, age range 64–70 years) matched subjects acted as controls. Results No significant difference was found in carotid plaques between patients with distal or proximal DVT versus controls ( p > 0.05 in all comparisons). Carotid IMT (mean ± SD) was significantly increased in patients with distal (1.00 ± 0.20 mm) and proximal (0.98 ± 0.16 mm) DVT versus controls (0.88 ± 0.15 mm, p <0.01 in both comparisons). An ABI £ 0.9 was found in 3/57 (5.3%) and 5/59 (8.5%) patients with distal and proximal DVT, respectively versus no controls with abnormal ABI. Conclusion Our results revealed that there may be an association between spontaneous distal DVT and asymptomatic atherosclerosis, and confirmed the known association between idiopathic proximal DVT and asymptomatic atherosclerosis. Larger studies are needed to confirm our results and to evaluate their clinical implications.

Анализ гиполипидемической терапии у больных артериальной гипертензией

Артериальная гипертензия (АГ) и нарушения липидного обмена являются одними из главных причин неблагоприятного сердечно-сосудистого прогноза, каждая из которых способствует развитию и прогрессированию заболеваний, связанных с атеросклерозом. У многих пациентов эти факторы риска присутствуют вместе. В статье на основании клинического случая обоснована необходимость назначения статинов больному с артериальной гипертензией. Приведены клинический случай наблюдения и лечения АГ у 47-летнего пациента с дислипидемией на разных временных этапах с последующим анализом современной информации о комбинации статинов и антигипертензивных средств — сартанов в процессе ведения пациентов высокого кардиоваскулярного риска. После нескольких лет эффективного антигипертензивного лечения артериальное давление больного стабилизировалось на целевых уровнях. Он бросил курить, нормализовал массу тела. Осталась асимптомная дислипидемия, которую он медикаментозно не контролировал. Во время предпоследнего визита у пациента был обнаружен неокклюзивный атеросклероз сосудов нижних конечностей, протекающий асимптомно. С учетом признаков сосудистого атеросклероза пациент попадает в группу высокого кардиоваскулярного риска. Ему нужно назначить интенсивную статинотерапию. В этом случае важно выбрать наиболее эффективный и безопасный препарат и соответствующую дозу. При просмотре клинического случая комбинированного лечения нашего пациента кандесартаном (Кантаб) и аторвастатином (Толевас) следует обратить внимание на два момента, спровоцировавшие развитие периферического атеросклероза. Во-первых, к нам обратился пациент молодого возраста с симптомами гипертонии, которые считались основными для постановки диагноза и выбора терапии. В результате он и получал достаточно эффективное антигипертензивное лечение. Сопутствующая дислипидемия имела субклинический характер, и пациент самостоятельно перестал принимать статины. Высокий общий холестерин считался только фактором риска. Во-вторых, в своих медицинских рекомендациях мы руководствовались критериями оценки степени кардиоваскулярного риска у больных с АГ (Приказ МЗ Украины от 24.05.2012 № 384) и поэтому не настаивали на некоторых этапах лечения интенсивной статинотерапии, как это рекомендуется европейскими и североамериканскими рекомендациями 2017 года.

Prevalence of Asymptomatic Silent Myocardial Ischemia among Type 2 Diabetes Mellitus Patients in Bangalore - A Hospital-Based Cross-Sectional Study

Background: Earlier diagnosis of asymptomatic coronary artery disease (CAD) in diabetics may prevent catastrophic cardiac events and hence warrants the need for detection of silent myocardial ischemia (SMI). Therefore, the study aimed to assess the role of treadmill test (TMT) in patients who were asymptomatic, to detect and estimate the occurrence of SMI (positive exercise TMT), and to find the association between presence of SMI and duration of diabetes mellitus (DM). Methodology: A cross-sectional study was undertaken among 162 DM cases (type 2) with a mean age of 55.32 ± 11.89 years, who had undergone a TMT without any CAD evidence clinically. All the subjects had normal 12 lead electrocardiography and underwent TMT. Results: Among 162 subjects, TMT was positive in 63 (38.9%) study subjects. TMT positivity for inducible ischemia in type 2 DM patients was associated with increasing age, higher body mass index (BMI), smoking, higher HbA1C, albuminuria, retinopathy, and atherosclerotic cardiovascular disease (ASCVD) risk score. Smoking, diabetic retinopathy, and urine albumin were associated with TMT significantly (P value &lt; 0.005). A significant linear increasing trend in proportion of TMT positive over HbA1c was observed. Mean height of TMT-positive subjects (159.2 ± 7.47 cm) was more than TMT-negative subjects (P &lt; 0.005). The mean BMI (29.69 ± 3.58 kg/m2) and triglycerides (173.87 ± 112.7 mg/dl) of TMT-positive subjects were more than TMT-negative subjects (P &lt; 0.005). Conclusion: CAD prevalence is greater in asymptomatic cases of type 2 DM in this geographic region. A significant linear increasing trend was observed in TMT positive over HbA1c. Hence, TMT can be incorporated in routine screening for SMI in patients suffering from diabetes.

Use of Computed Tomography Coronary Calcium Score for Coronary Artery Disease Risk Stratification During Liver Transplant Evaluation

End-stage liver disease (ESLD) is not considered a risk factor for atherosclerotic cardiovascular disease (ASCVD). However, lifestyle characteristics commonly associated with increased ASCVD risk are highly prevalent in ESLD. Emerging literature shows a high burden of asymptomatic coronary artery disease (CAD) in patients with ESLD and a high ASCVD risk in liver transplantation (LT) recipients. Coronary artery calcium score (CAC) is a noninvasive test providing reliable CAD risk stratification. We implemented an LT evaluation protocol with CAC playing a central role in triaging and determining the need for further CAD assessment. Here, we inform our results from this early experience. Patients with ESLD referred for LT evaluation were prospectively studied. We compared accuracy of CAC against that of CAD risk factors/scores, troponin I, dobutamine stress echocardiogram (DSE), and single-photon emission computed tomography (SPECT) to detect coronary stenosis ≥70 (CAD≥70) per left heart catheterization (LHC). Thirty-day post-LT cardiac outcomes were also analyzed. One hundred twenty-four of 148 (84%) patients underwent CAC, 106 (72%) DSE/SPECT, and 50 (34%) LHC. CAC≥400 was found in 35 (28%), 100 to 399 in 17 (14%), and <100 in 72 (58%). LHC identified CAD≥70% in 8 of 29 (28%), 2 of 9 (22%), and 0 of 4, respectively. Two acute coronary syndromes occurred after LT in a patient with CAC 811 (CAD<70%), and one with CAC 347 (CAD≥70%). No patients with CAC<100 presented with acute coronary syndrome after LT. When using CAD≥70% as primary endpoint of LT evaluation, CAC≥346 was the only test showing predictive usefulness (negative predictive value 100%). CAC is a promising tool to guide CAD risk stratification and need for LHC during LT evaluation. Patients with a CAC<100 can safely undergo LT without the need for LHC or cardiac stress testing, whereas a CAC<346 accurately rules out significant CAD stenosis (≥70%) on LHC, outperforming other CAD risk-stratification strategies.

Prescription of Lipid-Lowering and Antihypertensive Drugs Following Pictorial Information About Subclinical Atherosclerosis

Preventive drugs are often underused. Carotid intima-media thickness and carotid plaques are associated with cardiovascular disease (CVD), and their detection could possibly improve estimation of the likelihood of CVD and prescription of preventive drugs. To evaluate whether pictorial information on participants' asymptomatic atherosclerosis based on carotid ultrasonographic examinations to participants and their physicians had an effect on prescribing of lipid-lowering or antihypertensive drugs during the following 465 days. Visualization of Asymptomatic Atherosclerotic Disease for Optimum Cardiovascular Prevention is a pragmatic randomized clinical trial nested within the Västerbotten Intervention Program, a CVD screening and prevention program in Sweden with 60% to 70% participation rates and small social selection bias. A total of 4177 individuals aged 40, 50, or 60 years participating in the Västerbotten Intervention Program who had low to moderate risk of CVD were invited to enroll in this trial from April 29, 2013, to June 7, 2016. Prescriptions for all participants were monitored for 465 days after the intervention. Data analysis was conducted from December 6, 2019, to April 2, 2020. Participants and their family physicians were randomly assigned 1:1 to receive or not receive pictorial information from carotid ultrasonographic determination of vascular age, assessed as carotid intima-media thickness and the presence of carotid plaques, combined with a follow-up call to participants by nurses. Two outcome measures of prescriptions of antihypertensive and lipid-lowering drugs within 465 days after ultrasonography was performed. Data obtained through intention-to-treat analysis are presented as proportions of individuals with a prescription among those who had no baseline prescription for agents from these drug classes. Of the 4177 individuals invited to enroll, 3532 participants were randomized and included in the analysis; 1870 (52.9%) were women, 2278 (64.5%) were aged 60 years, 978 (27.7%) were 50 years, and 276 (7.8%) were 40 years. First prescriptions of lipid-lowering drugs were higher in the intervention group vs the control group among men (118 of 639 [18.5%] vs 38 of 692 [5.5%]; P < .001) and women (126 of 804 [15.5%] vs 38 of 817 [4.7%]; P < .001). There were no significant differences in the proportion with prescription of antihypertensive drugs in the intervention vs control groups after ultrasonography among men (58 of 482 [12.0%] vs 56 of 528 [10.6%]; P = .47) and women (60 of 612 [9.8%] vs 64 of 615 [10.4%]; P = .73). The findings of this trial demonstrate that provision of pictorial information on vascular age and carotid plaques based on the results of ultrasonographic examination increased physician prescription of lipid-lowering drugs but not antihypertensive drugs within the following 465 days. ClinicalTrials.gov Identifier: NCT01849575.

Monocytes / macrophages of patients with asymptomatic atherosclerosis are characterized by a reduced ability to form immune tolerance towards lipopolysaccharide

Background and Aims: Tolerance of the immune response is a phenomenon in which cells, under the influence of various microbial components, lose their susceptibility to subsequent similar influences; it is one of the most important mechanisms for the completion of the inflammatory phase of the innate immune response. We hypothesized that the ability of blood monocytes from patients with atherosclerosis to form innate immune tolerance may be altered.

The study of the relationship of mitochondrial mutations associated with asymptomatic atherosclerosis with respiration of cybrid lines.

Background and Aims: Atherosclerosis is associated with chronic inflammation. The exact mechanisms leading to chronic inflammation are not known, but there is a direct link between chronic inflammation and the state of mitochondria, which play a key role in cell metabolism. The fundamental problem existing in this field of research is to understand how and by what mechanism mitochondrial mutations associated with atherosclerosis affect the main functions of mitochondria. The goal of this study is to identify the relationship between atherosclerosis-associated mitochondrial mutations and the main functions of mitochonria in cybrid lines.

Review of cadmium exposure and smoking-independent effects on atherosclerotic cardiovascular disease in the general population.

Exposure to cadmium (Cd) via food and smoking is associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD). Blood and urine levels of Cd are established biomarkers of exposure. To review (1) the smoking-independent associations between Cd exposure and ASCVD, including the possible presence of a nonlinear dose-response relationship with Cd exposure and (2) the causal effects of Cd exposure on different stages of atherosclerosis. Narrative review. Cd confers increased risk of ASCVD and asymptomatic atherosclerosis in the carotid and coronary arteries above B-Cd >0.5 μg/L or U-Cd >0.5 μg/g creatinine, but it has not been shown below a threshold of these exposure levels. Adjustment for smoking does not exclude the possibility of residual confounding, but several studies in never-smoking cohorts have shown associations between Cd and ASCVD, and experimental studies have demonstrated pro-atherosclerotic effects of Cd. Cd accumulates in arterial walls and atherosclerotic plaques, reaching levels shown to have proatherosclerotic effects. Suggested early effects are increased subendothelial retention of atherogenic lipoproteins, which become oxidized, and endothelial dysfunction and damage with increased permeability for monocytes, which in the intima turn to macrophages and then to foam cells. Later, Cd may contribute to plaque rupture and erosion by endothelial apoptosis and degradation of the fibrous cap. Finally, by having prothrombotic and antifibrinolytic effects, the CVD risk may be further increased. There is strong evidence that Cd causes ASCVD above a suggested exposure level via mechanisms in early as well as the late stages of atherosclerotic disease.

Diagnostic accuracy of myocardial perfusion imaging in patients evaluated for kidney transplantation: a systematic review and meta-analysis

Abstract Funding Acknowledgements Type of funding sources: None. Background A high prevalence of asymptomatic coronary artery disease (CAD) is found in patients with end-stage renal disease evaluated for kidney transplantation. Purpose We aimed to assess the diagnostic accuracy of myocardial perfusion imaging (MPI) for CAD in this patients population. Methods We performed a systematic literature search and meta-analysis. We retrieved studies investigating the diagnostic accuracy of single-photon emission computed tomography (SPECT) and positron emission tomography (PET) compared to the standards invasive coronary angiography (ICA) and coronary computed tomography angiography (CCTA) in patients evaluated for kidney transplantation. Results Out of 1379 records, 9 MPI SPECT studies were included in the meta-analysis with a total of 822 patients. There were no studies available using PET with ICA or CCTA as reference. Pooled sensitivity of MPI SPECT for CAD was 0.66 (95%-CI 0.52-0.78), pooled specificity 0.72 (95%-CI 0.57-84) and the area under the curve (AUC) 0.74. Positive likelihood ratio (PLR) was 2.31 (95%-CI 1.57-3.39) and negative likelihood ratio (NLR) was 0.41 (95%-CI 0.25-0.68) with an overall diagnostic odds ratio (DOR) of 5.43 (95%-CI 2.87-10.28). Significant heterogeneity existed across included studies. Conclusions MPI SPECT had a moderate diagnostic accuracy in patients evaluated for kidney transplantation, with a high rate of false-negative findings.

New Diagnostic Algorithm to Asymptomatic Coronary Artery Disease in Patients with Lower Peripheral Artery Disease

We retrospectively examined 4255 patients who experienced coronary angiography between September 2015 and January 2020. Medicana International Ankara Hospital Ethics Committee accepted the study schedule [Numbered: 2017/1]. Of the patients, 400 patients underwent both coronary angiography and lower extremity angiography because of peripheral artery disease symptoms. The odds ratios of coronary artery disease according to risk factors have been examined. Angiographically, lower extremity arteries were divided into three groups.

Medium-long-term results of carotid stenting in asymptomic stenosis of the carotid arteries

The article describes the experience of carotid stenting use in asymptomatic cerebral atherosclerosis. The study included 147 patients with unilateral asymptomatic carotid artery disease. The evaluation of mid-longterm results of carotid stenting in patients with asymptomatic stenosis was carried out in comparison with the use of conservative treatment in this category of patients (“optimal drug treatment”). In the course of the work, no significant intergroup difference was revealed in the incidence of adverse outcomes (TIA/stroke, death from stroke,) within a year from the moment of surgical treatment or the beginning of complex correction of risk factors.