Atherosclerosis In Asymptomatic Individuals Research Articles

Association between smoking status and subclinical coronary atherosclerosis in asymptomatic individuals.

In this study, we sought to evaluate the association between smoking status and subclinical coronary atherosclerosis, as detected by coronary computed tomography angiography (CCTA), in asymptomatic individuals. We retrospectively analyzed 9,285 asymptomatic participants (mean age, 53.7±8.0 years; 6,017 [64.8%] male) with no history of coronary artery disease (CAD) who had undergone self-referred CCTA. Of these participants, 4,333 (46.7%) were considered never smokers, 2,885 (31.1%) former smokers, and 2,067 (22.3%) current smokers. We assessed the degree and characteristics of subclinical coronary atherosclerosis using CCTA, with obstructive CAD defined as a diameter stenosis of at least 50%. Compared with never-smokers, former smokers exhibited no significant differences in the probabilities of obstructive CAD, any coronary plaque, calcified plaque, or mixed plaque, as determined using adjusted odds ratios (aORs; p>0.05 for all). However, the risk of non-calcified plaque was significantly higher in former smokers (aOR, 1.34; 95% confidence interval [CI], 1.00 to 1.78; p=0.048). Current smokers had significantly higher rates of obstructive CAD (aOR, 1.46; 95% CI, 1.10 to 1.96; p=0.010), any coronary plaque (aOR, 1.41; 95% CI, 1.20 to 1.65; p<0.001), calcified plaque (aOR, 1.32; 95% CI, 1.13 to 1.55; p=0.001), non-calcified plaque (aOR, 1.72; 95% CI, 1.28 to 2.32; p<0.001), and mixed plaque (aOR, 2.00; 95% CI, 1.39 to 2.86; p<0.001) compared to never smokers. This cross-sectional study revealed a significant association between current smoking and subclinical coronary atherosclerosis, as detected on CCTA. Additionally, former smoking demonstrated an association with non-calcified plaque, indicating elevated cardiovascular risk.

Re-Evaluation of Cardiovascular Disease Risk and Primary Prevention Treatments with Coronary Artery Calcium Scoring in Primary Prevention Patients.

Objective: The coronary artery calcium score (CACS) is used as a screening tool to identify the presence/absence of subclinical atherosclerosis in asymptomatic individuals. We evaluated the risk categories and medical therapy of asymptomatic individuals with subclinical atherosclerosis (CACS > 0) and applied the atherosclerotic cardiovascular disease (ASCVD) score and Framingham risk score (FRS) to assess those at a high risk of subclinical atherosclerosis (CACS ≥ 400). Methods: We retrospectively enrolled 218 asymptomatic individuals (65.6% women, and mean age 67.5 ± 10.3 years) who had their CACS evaluated at the cardiovascular department of our hospital between 2016 and 2020. Results: Among the 218 participants, 24.3% were classified as low-risk according to the FRS, and 19.3% had no subclinical atherosclerosis. However, only 12.8% and 27.5% of the study population were taking statins and aspirin, respectively. Furthermore, although more than half of the individuals without subclinical atherosclerosis were in the intermediate- and high-risk groups according to the risk scores, there were no considerable differences in the rates of taking aspirin and statins between the groups. When patients in the very-high-risk group according to the CACS and low-intermediate-risk patients were compared, there was no considerable difference in the rates of risk subgroups and taking statins, whereas high-risk patients took statistically significantly more aspirin. Conclusions: In primary prevention screening, CACS can be used as a reliable marker of subclinical ASCVD and help physicians optimize and improve adherence to medical therapy, including aspirin and statins, particularly for high-risk individuals.

Depression and Subclinical Coronary Atherosclerosis in Adults Without Clinical Coronary Artery Disease.

The relationship between depression and subclinical coronary atherosclerosis in asymptomatic individuals is not clear. We evaluated this relationship in a Korean population. We analyzed 3920 individuals (mean age 54.7±7.9 years and 2603 men [66.4%]) with no history of coronary artery disease who voluntarily underwent coronary computed tomographic angiography and screening for depression using the Beck Depression Inventory as part of a general health examination. The degree and extent of subclinical coronary atherosclerosis were evaluated by coronary computed tomographic angiography, and ≥50% diameter stenosis was defined as significant. Participants were categorized into groups of those with or without depression using the Beck Depression Inventory scores ≥16 as a cutoff value. Of the study participants, 272 (6.9%) had a Beck Depression Inventory score of 16 or higher. After adjustment for cardiovascular risk factors, depression was not significantly associated with any coronary plaque (adjusted odds ratio [OR], 1.05 [95% CI, 0.78-1.41]; P=0.746), calcified plaque (OR, 0.95 [95% CI, 0.71-1.29]; P=0.758), noncalcified plaque (OR, 1.31 [95% CI, 0.79-2.17]; P=0.305), mixed plaque (OR, 1.16 [95% CI, 0.60-2.23]; P=0.659), or significant coronary artery stenosis (OR, 1.22 [95% CI, 0.73-2.03]; P=0.450). In the propensity score-matched population (n=1318) as well, none of the coronary artery disease measures of subclinical coronary atherosclerosis were statistically significantly associated with depression (all P>0.05). In this large cross-sectional study with asymptomatic individuals undergoing coronary computed tomographic angiography and Beck Depression Inventory evaluation, depression was not associated with an increased risk of subclinical coronary atherosclerosis.

Coronary artery calcium score is a predictive tool for cardiovascular events in an asymptomatic population

Abstract Background Recent research highlights the role of the coronary artery calcium score (CAC Score) in evaluating the severity of subclinical atherosclerosis in asymptomatic individuals without apparent cardiovascular disease (CVD). However, the influence of the CAC score on the prognosis of an asymptomatic population is not consensual. Objective Investigate the role of the CAC score as a predictive tool for the occurrence of cardiovascular events in an asymptomatic population without known CVD. Methods 1195 asymptomatic subjects (mean age 55.1±6.9 years, 73.8% male) selected from the prospective arm of the GENEMACOR study were followed up during 5.9±4.3 years. CAC score was performed by cardiac computed tomography and reported as Agatston units according to the Hoff Nomogram in low, moderate and high-risk categories. The bivariate analysis evaluated CV events in the three CAC score risk categories and in traditional risk factors (TRFs) individually. Multivariable Cox proportional hazard ratios (HR) with 95% confidence intervals (95% CI) assessed the variables independently associated with CV events occurrence. Kaplan-Meier estimated the survival in the CAC risk categories. Results None of the TRFs showed significant differences in the CV events percentages. As the CAC score category increases, the percentage of CV events rises (p&amp;lt;0.0001). After Cox regression analysis, the high CAC risk category remained a strong CV events predictor (HR=3.71; 95% CI 1.66-8.27; p=0.001), along with age and smoking (Table). At fifteen years of follow-up, 95.3%, 92.8%, and 84.3% survived in the low, moderate and high-risk categories, respectively (Long Rank test; p&amp;lt;0.0001). Conclusion The presence of coronary calcifications indicated a worse prognosis in our asymptomatic population. CAC score is an excellent predictive tool for the asymptomatic subjects with coronary atherosclerosis in progression and could help initiate preventive therapy.

Current Toolset in Predicting Acute Coronary Thrombotic Events: The “Vulnerable Plaque” in a “Vulnerable Patient” Concept

Despite major advances in pharmacotherapy and interventional procedures, coronary artery disease (CAD) remains a principal cause of morbidity and mortality worldwide. Invasive coronary imaging along with the computation of hemodynamic forces, primarily endothelial shear stress and plaque structural stress, have enabled a comprehensive identification of atherosclerotic plaque components, providing a unique insight into the understanding of plaque vulnerability and progression, which may help guide patient treatment. However, the invasive-only approach to CAD has failed to show high predictive value. Meanwhile, it is becoming increasingly evident that along with the "vulnerable plaque", the presence of a "vulnerable patient" state is also necessary to precipitate an acute coronary thrombotic event. Non-invasive imaging techniques have also evolved, providing new opportunities for the identification of high-risk plaques, the study of atherosclerosis in asymptomatic individuals, and general population screening. Additionally, risk stratification scores, circulating biomarkers, immunology, and genetics also complete the armamentarium of a broader "vulnerable plaque and patient" concept approach. In the current review article, the invasive and non-invasive modalities used for the detection of high-risk plaques in patients with CAD are summarized and critically appraised. The challenges of the vulnerable plaque concept are also discussed, highlighting the need to shift towards a more interdisciplinary approach that can identify the "vulnerable plaque" in a "vulnerable patient".

Analysis of Dynamic Association Between Diabetes Mellitus and Cardiovascular Disease

Diabetes mellitus (DM) is becoming more common because of the modern lifestyle. The two primary causes of mortality and disability among people are “diabetes mellitus (DM)” and “cardiovascular disease (CVD)”, which are linked closely. Diabetes mellitus is on the increase, it is quickly becoming one of the world’s most devastating and costly chronic diseases. Heart disease is the leading cause of mortality in diabetes and it has shown to have a significantly association with diabetes. Diabetic patients are more likely to have cardiovascular events due to the prevalence of CV diseases such as obesity, hypertension, and dyslipidemia. In addition, this study discusses the debated benefits of monitoring for subclinical atherosclerosis in asymptomatic individuals. Investigate on the connection between suboptimal glycemic management, and insulin resistance indicators, as possible variables connecting diabetes and cardiovascular disease is also done in this study. With this study it was reported that there is very little information is present on the early medication for treatment of the subclinical atherosclerosis in diabetics who are asymptomatic. The present study concluded that there is an urgent need for advanced research strategies to reduce the weight loss and overcome the obesity to reduce the prevalence of cardiovascular diseases.

Decreased low-density lipoprotein receptor-related protein 1 expression in pro-inflammatory monocytes is associated with subclinical atherosclerosis.

Subclinical atherosclerosis (SCA) occurs in asymptomatic individuals. Blood peripheral monocytes are involved in the development of atherosclerosis. Circulating monocytes acquire pro-inflammatory profiles, and they are involved in the early stages of atherosclerosis development. Low-density lipoprotein Receptor-related Protein 1 (LRP1) is expressed in monocytes, mainly in classical and intermediate subsets. Although LRP1 is highly expressed in macrophages and vascular smooth muscle cells (VSMCs) in atherosclerotic plaque formation, its expression in circulating monocytes has not been studied in SCA. The aim of this study was to characterize the LRP1 expression level in circulating monocytes of individuals with SCA and compared with individuals with low (LR) and intermediate (IR) risk of cardiovascular diseases, both without evidence of atherosclerotic lesions in carotid and coronary arteries. LRP1 and additional markers (CD11b, CD11c, and CD36) at cell surface of monocytes were analyzed by flow cytometry assays, whereas LRP1 and pro-inflammatory factors gene expressions were measured in isolated monocytes by quantitative RT-PCRs. Both LRP1 protein and LRP1 mRNA were significantly reduced in monocytes in SCA and IR respect to LR. Conversely, CD36, CD11b, and CD11c monocytic markers showed no significant changes between the different study groups. Finally, increased gene expressions of TNF-α and IL-1β were detected in monocytes of SCA, which were associated with decreased LRP1 expression at the cell surface in total monocytes. In summary, we propose that the decreased LRP1 expression at cell surface in total monocytes with pro-inflammatory profile is associated with the development of atherosclerosis in asymptomatic individuals.

Marital Status and Subclinical Coronary Atherosclerosis in Asymptomatic Individuals.

BackgroundData are limited on the association between marital status and subclinical coronary atherosclerosis. This study investigated the influence of marital status on subclinical coronary atherosclerosis detected by coronary computed tomographic angiography in an asymptomatic population.Methods and ResultsThis retrospective study analyzed 9288 asymptomatic individuals (mean age, 53.7±8.0 years; 6041 [65%] men) with no history of coronary artery disease who voluntarily underwent coronary computed tomographic angiography during a general health examination. Marital categories were married (n=8481) versus unmarried (n=807), comprising never married (n=195), divorced (n=183), separated (n=119), and widowed (n=310) individuals. The degree and extent of subclinical coronary atherosclerosis were evaluated by coronary computed tomographic angiography; ≥50% diameter stenosis was defined as significant. Logistic regression and propensity score matching analyses were used to determine the association between marital status and subclinical coronary atherosclerosis. After adjustment for cardiovascular risk factors, no significant differences were observed in the adjusted odds ratio (OR) of unmarried status for any coronary plaque (OR, 1.077; 95% CI, 0.899–1.291), calcified plaque (OR, 1.058; 95% CI, 0.881–1.271), noncalcified plaque (OR, 0.966; 95% CI, 0.691–1.351), mixed plaque (OR, 1.301; 95% CI, 0.884–1.917), and significant coronary artery stenosis (OR, 1.066; 95% CI, 0.771–1.474). Similarly, in the 2:1 propensity‐score matched population (n=2398), no statistically significant differences were observed for the OR of marital status for any subclinical coronary atherosclerosis (P>0.05 for all).ConclusionsIn this large cross‐sectional study, marital status was not associated with an increased risk of subclinical coronary atherosclerosis.

Prevention of Coronary Heart Disease: A Translational Clinical Challenge

Introduction: Atherosclerotic cardiovascular disease is a dysmetabolic medical condition resulting in the #1 cause of morbidity and mortality in the United States. Coronary Artery Calcium (CAC) CT non-invasively identifies atherosclerosis in asymptomatic individuals. This translational study tested the hypothesis that clinically overtcardiovascular disease can be prevented in asymptomatic individuals in a medical clinic. Methods: Two hundred and six asymptomatic adults requested a CAC scan to identify subclinical heart disease. Individuals with a positive CAC score > 1 (n = 125) were prescribed targeted medical therapy to reverse their atherosclerosis. The goal was to achieve an LDL Cholesterol (LDL-C) ≤ 60 mg/dl. One hundred and ten individuals reached this goal (67 male, 43 female) receiving 10 mg/d of rosuvastatin and 10 mg/d of ezetimibe plus a low cholesterol diet. Other fifteen individuals with positive CAC scores did not achieve this LDL-C goal. Results: In the group following medical therapy and achieving an LDL-C ≤ 60 mg/dl, no cardiovascular events were observed during a maximum observation period of 5 years (mean observation time = 3.6 years). Based on previously published CVD outcome data in individuals with similar CAC scores, 12.6 cardiovascular events were expected. Two of fifteen individuals with positive CAC scores not following medical therapy had a cardiovascular event. None of the 81 individuals with a zero score had a cardiovascular event during follow-up. No adverse effects of therapy occurred. Conclusion: In a medical clinic, adult population with positive CAC scores and an LDL-C ≤ 60 mg/dl, targeted medical therapy prevented overt cardiovascular disease. These results should encourage other physicians to aggressively treat atherosclerotic cardiovascular disease in their clinic populations.

Relationship between lipoprotein (a) and subclinical carotid atherosclerosis in asymptomatic individuals

BackgroundThis study aimed to evaluate the associations between Lipoprotein (a) ‒ Lp(a) levels and carotid Intima-Media Thickness (cIMT) and with carotid plaques in healthy subjects because of previous contradictory data. MethodsA total of 317 healthy normolipidemic subjects (20‒77 years old) were selected. The cIMT and atherosclerotic plaques were determined by B-mode ultrasonography. Mann-Whitney tests were performed to compare the groups according to Lp(a) levels and to explore the associations between Lp(a), carotid plaques, and cIMT, logistic and linear regression analyses were performed. ResultsStudied population (51% females, median age 43 years old) presented carotid plaques and cIMT ≥ 0.9 mm in 23% and 18% of the participants, respectively. The group with Lp(a) levels > 30 mg/dL presented significantly higher age and atherosclerotic plaques. Indeed, multivariate linear regression analysis showed a significant association between Lp(a), age, and race. On the other hand, logistic regression analysis demonstrated that the subjects with Lp(a) > 30 mg/dL have a significantly high risk of carotid plaques. ConclusionThe data from the present study indicate that Lp(a) levels above 30 mg/dL contribute to the development of carotid plaques even in apparently healthy participants.

Coronary Artery Calcium Score - A Reliable Indicator of Coronary Artery Disease?

Coronary artery disease (CAD) is caused by atheromatous blockage of coronary vessels leading to acute coronary events that usually occur when a plaque ruptures and a thrombus forms. CAD is a known cause of significant cardiovascular events, accounting for more than 50% of the deaths in western countries, and most of the patients with CAD remain asymptomatic. The coronary artery calcium (CAC) score has been created as a measure of coronary atherosclerosis. This article has compiled various studies that conclude the clinical relationship between coronary artery calcium and the development of cardiovascular (CV) events by using the CAC score as a reliable indicator of CAD. This article has reviewed the pathophysiology and risk factors of CAD, along with various methods of CAC scoring. It also underlined the reliability of CAC scoring for early detection of CAD in asymptomatic individuals. We emphasized the importance of age-dependent risk factor analysis combined with practical screening tools like CAC scoring for early diagnosis of CAD can help direct the treatment and prevent deaths in asymptomatic individuals.

Association between low skeletal muscle mass and subclinical coronary atherosclerosis in asymptomatic individuals evaluated by CT

To investigate the associations of skeletal muscle area and density with coronary atherosclerotic plaques and significant stenosis in asymptomatic adults. A total of 243 consecutive subjects who had voluntarily undergone abdominal unenhanced computed tomography (CT) and coronary CT angiography (CCTA) as part of a general health examination were investigated retrospectively. Skeletal muscle area index (SMI) and skeletal muscle density (SMD) was assessed using CT. Coronary atherosclerotic plaques and stenosis on CCTA were evaluated. The associations of low SMI and low SMD with coronary atherosclerotic plaques and significant stenosis were determined by logistic regression analysis. After adjustment for cardiovascular risk factors, there were significant associations of low SMI or low SMD with atherosclerotic plaque, total significant stenosis, and significant stenosis caused by calcified or mixed plaques (for all p<0.05). In addition, multivariate regression analysis also showed that low SMI was independently associated with calcified plaque (p=0.038) and non-calcified plaque (p=0.006), and individuals with low SMD were more likely to have mixed plaque (p=0.001). Assessment of the skeletal muscle on CT help to identify asymptomatic adults at risk for coronary atherosclerosis.

Lipoprotein(a) and subclinical coronary atherosclerosis in asymptomatic individuals

Background and aimsThere are limited data regarding the association between lipoprotein(a) (Lp[a]) and subclinical coronary atherosclerosis. This study investigated the association between Lp(a) and subclinical coronary atherosclerosis detected by coronary computed tomographic angiography (CCTA) in an asymptomatic population. MethodsWe retrospectively analyzed 7201 asymptomatic individuals (mean age 54.4 ± 7.9 years; 65.3% men with no prior history of coronary artery disease who voluntarily underwent CCTA as part of a general health examination). The degree and extent of subclinical coronary atherosclerosis were evaluated by CCTA. Study participants were stratified into quartiles according to their Lp(a) levels (<4.3, 4.3–8.9, 9.0–20.1, and ≥20.2 mg/dL). ResultsOf the study participants, any coronary plaque on CCTA was observed in 2557 (35.5%). Specifically, calcified, non-calcified, and mixed plaques were observed in 2411 (33.5%), 363 (5.0%) and 249 (3.5%) participants, respectively. After adjustment for the presence of cardiovascular risk factors, the fourth Lp(a) quartile was significantly associated with any coronary (odds ratio [OR] 1.212; 95% confidence interval [CI] 1.038–1.416), calcified (1.205, 95% CI 1.030–1.410), non-calcified (1.588, 95% CI 1.152–2.189), or mixed (1.674, 95% CI 1.172–2.391) plaque compared with the first Lp(a) quartile. In addition, 442 (6.1%) had significant coronary artery stenosis (≥50% diameter stenosis). The odds ratio for significant stenosis (1.537, 95% CI 1.153–2.048) was higher in the fourth quartile compared with the first quartile. ConclusionsIn this large cross-sectional study with asymptomatic individuals undergoing CCTA, higher Lp(a) level was associated with subclinical coronary atherosclerosis.

Frequency and Significance of Right Bundle Branch Block and Subclinical Coronary Atherosclerosis in Asymptomatic Individuals

Limited data exist regarding the association between right bundle branch block (RBBB) and subclinical coronary atherosclerosis. This study investigated the influence of RBBB on subclinical coronary atherosclerosis detected by coronary computed tomographic angiography (CCTA) in an asymptomatic population. We retrospectively analyzed 7,205 asymptomatic individuals (mean age 54.4 ± 7.9 years and 4,695 men [65.2%]) with no prior history of coronary artery disease who voluntarily underwent CCTA and 12-lead electrocardiographic evaluation as part of a general health examination. The degree and extent of subclinical coronary atherosclerosis were evaluated by CCTA, and ≥50% diameter stenosis was defined as significant. The association between RBBB and subclinical coronary atherosclerosis was determined by logistic regression and propensity score matching analyses. Of study participants, 116 (1.6%) had RBBB. After adjustment for cardiovascular risk factors, there were no statistically significant differences in the adjusted odds ratios of RBBB for any atherosclerotic plaque (0.87, 95% confidence interval [CI] 0.57 to 1.32), calcified plaque (0.78, 95% CI 0.51 to 1.19), noncalcified plaque (1.44, 95% CI 0.77 to 2.69), mixed plaque (1.12, 95% CI 0.52 to 2.39), and significant coronary artery stenosis (0.92, 95% CI 0.48 to 1.74). Similarly, in the 5: 1 propensity score-matched population (n=696), there were no statistically significant differences in the odds ratios for any subclinical coronary atherosclerosis between participants with and without RBBB (p for all >0.05). In conclusion, through this large cross-sectional study of asymptomatic individuals who underwent CCTA and electrocardiography evaluation, individuals with RBBB were not associated with an increased risk of subclinical coronary atherosclerosis compared with those without RBBB.

Multiethnic Genome-Wide Association Study of Subclinical Atherosclerosis in Individuals With Type 2 Diabetes.

Coronary artery calcification (CAC) and carotid artery intima-media thickness (cIMT) are measures of subclinical atherosclerosis in asymptomatic individuals and strong risk factors for cardiovascular disease. Type 2 diabetes (T2D) is an independent cardiovascular disease risk factor that accelerates atherosclerosis. We performed meta-analyses of genome-wide association studies in up to 2500 T2D individuals of European ancestry (EA) and 1590 T2D individuals of African ancestry with or without exclusion of prevalent cardiovascular disease, for CAC measured by cardiac computed tomography, and 3608 individuals of EA and 838 individuals of African ancestry with T2D for cIMT measured by ultrasonography within the CHARGE (Cohorts for Heart and Aging Research in Genomic Epidemiology) Consortium. We replicated 2 loci (rs9369640 and rs9349379 near PHACTR1 and rs10757278 near CDKN2B) for CAC and one locus for cIMT (rs7412 and rs445925 near APOE-APOC1) that were previously reported in the general EA populations. We identified one novel CAC locus (rs8000449 near CSNK1A1L/LINC00547/POSTN at 13q13.3) at P=2.0×10-8 in EA. No additional loci were identified with the meta-analyses of EA and African ancestry. The expression quantitative trait loci analysis with nearby expressed genes derived from arterial wall and metabolic tissues from the Genotype-Tissue Expression project pinpoints POSTN, encoding a matricellular protein involved in bone formation and bone matrix organization, as the potential candidate gene at this locus. In addition, we found significant associations (P<3.1×10-4) for 3 previously reported coronary artery disease loci for these subclinical atherosclerotic phenotypes (rs2891168 near CDKN2B-AS1 and rs11170820 near FLJ12825 for CAC, and rs7412 near APOE for cIMT). Our results provide potential biological mechanisms that could link CAC and cIMT to increased cardiovascular disease risk in individuals with T2D.

Homocysteine is not a risk factor for subclinical coronary atherosclerosis in asymptomatic individuals.

Homocysteine has been known as a risk factor for cardiovascular disease. This study sought to evaluate the influence of homocysteine on the risk of subclinical coronary atherosclerosis in asymptomatic individuals. We reviewed 3,186 asymptomatic individuals (mean age 53.8 ± 8.0 years, 2,202 men [69.1%]) with no prior history of coronary artery disease who voluntarily underwent coronary computed tomographic angiography (CCTA) and laboratory tests as part of a general health examination. The subjects were stratified into tertiles according to their homocysteine levels. The degree and extent of subclinical coronary atherosclerosis were assessed by CCTA. Logistic regression analysis was used to determine the association between homocysteine levels and subclinical coronary atherosclerosis. The prevalence of significant coronary artery stenosis, any atherosclerotic, calcified, mixed, and non-calcified plaques increased with homocysteine tertiles (all p < 0.05). However, after adjustment for cardiovascular risk factors, there were no statistically significant differences in the adjusted odds ratios (ORs) for any atherosclerotic plaque (OR 1.06; 95% CI [confidence interval] 0.85-1.32; p = 0.610), calcified plaques (OR 1.17; 95% CI 0.92-1.48; p = 0.199), non-calcified plaques (OR 0.80; 95% CI 0.61-1.04; p = 0.089), and mixed plaques (OR 1.42; 95% CI 0.96-2.11; p = 0.077) between the third and first homocysteine tertiles. In addition, the adjusted OR for significant coronary artery stenosis (OR 0.92; 95% CI 0.63-1.36; p = 0.687) did not differ between the first and third tertiles. In asymptomatic individuals, homocysteine is not associated with an increased risk of subclinical coronary atherosclerosis.

Can the 2019 AHA/ACC Cardiovascular Guidelines Be Improved?

The 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease for treatment of atherosclerosis in asymptomatic individuals is an advance over previously published recommendations. However, since all guidelines are based on a limited quantity of published studies and result from a consensus of experts in different fields of medicine, omissions and errors are inevitable. The present manuscript identifies four areas in these 2019 AHA/ACC guidelines that alternative approaches or changes would result in improved outcomes and reductions in atherosclerotic events. First, the goal for the reduction in the prevalence of cardiovascular disease should be total (100%) eradication of the disease. This is a feasible goal as the facilities and resources to accomplish this task are currently available. Second, guidelines should acknowledge that atherosclerosis is a reversible disease as has previously been documented by multiple studies. If reversible, then under the appropriate clinical circumstances, it is preventable. Third, the goal for LDL cholesterol reduction should be <50 mg/dl, if eradication of atherosclerosis is to be achieved. This goal is achievable and safe as suggested by published studies. Fourth, widespread use of the coronary artery calcium scan needs to be recommended so that early atherosclerosis can be reversed before a major cardiovascular event occurs. Treating all individuals at a specific risk category without regard for the presence of disease results in poor adherence to therapy and unnecessary side effects. Consideration of these four issues would improve the AHA/ACC guidelines and result in better patient care.

Serum uric acid level and subclinical coronary atherosclerosis in asymptomatic individuals: An observational cohort study

Background and aimsThere are limited data on the association between serum uric acid (SUA) level and subclinical coronary atherosclerosis. This study investigated the influence of SUA level on subclinical coronary atherosclerosis, as detected by coronary computed tomography angiography (CCTA), in an asymptomatic population. MethodsWe evaluated 6431 asymptomatic individuals (mean age 53.6 ± 7.6 years, 4691 men [72.9%]) with no prior history of coronary artery disease, who voluntarily underwent laboratory tests and CCTA as part of a general health examination. The participants were stratified into quartiles according to their SUA levels. Coronary atherosclerotic plaques (calcified, mixed, and non-calcified plaques) were assessed using CCTA. Logistic regression analysis was used to determine the association between SUA levels and subclinical coronary atherosclerosis. ResultsThe prevalence of any atherosclerotic, calcified, mixed, and non-calcified plaques increased with SUA quartiles (all p < 0.001). After adjustment for cardiovascular risk factors, there were no statistically significant differences in the adjusted odds ratios for calcified plaque (1.19; 95% CI 0.98–1.46; p = 0.080) and mixed plaque (1.25; 95% CI 0.94–1.67; p = 0.132) in the fourth SUA quartile compared to the first quartile. However, the adjusted odds ratios for any atherosclerotic plaque (1.39; 95% CI 1.16–1.68; p < 0.001) and non-calcified plaque (1.38; 95% CI 1.11–1.72; p = 0.004) were significantly higher in the fourth SUA quartile. ConclusionsIn asymptomatic individuals, high SUA level was an independent predictor of non-calcified plaques, suggesting an increased cardiovascular risk.

Predictors of Severe or Moderate Coronary Artery Disease in Asymptomatic Individuals with Extremely Low Coronary Calcium Scores.

PurposeTo evaluate predictors of severe or moderate coronary artery disease (CAD) in individuals with zero or very low (<10) coronary artery calcium (CAC) scores.Materials and MethodsThe 1175 asymptomatic persons with zero or very low (<10) CAC scores were analyzed for CAD stenosis using coronary computed tomography angiography. Moderate and severe CADs were defined as having more than 50% and more than 70% stenosis in any of the major coronary arteries, respectively. Age, gender, body mass index, hypertension, type II diabetes, dyslipidemia, lipid profile, creatinine, and smoking status were evaluated as predictors for moderate and severe CAD.ResultsIn the study population, moderate and severe CADs were found in 7.5% and 3.3%, respectively. Among evaluated risk factors, age [odds ratio (OR) 1.04, 95% confidence interval (CI) 1.02−1.07, p<0.001], current smoking status (OR 3.12, 95% CI 1.82−5.34, p<0.001), and CAC 1−9 (OR 1.80, 95% CI 1.08−3.00, p=0.024) were significantly associated with moderate CAD. Meanwhile, age (OR 1.05, 95% CI 1.02−1.08, p=0.003), low high density lipoprotein (HDL) (OR 0.96, 95% CI 0.93−0.99, p=0.003), and current smoking status (OR 2.34, 95% CI 1.14−5.30, p=0.022) were found to be significantly associated with severe CAD. Improvement of discrimination power for predicting severe CAD was observed when smoking and HDL cholesterol were serially added into the age model.ConclusionSmoking showed significant correlations with moderate or severe CAD, and low HDL cholesterol also proved to be a predictor of severe CAD in asymptomatic individuals with extremely low CAC scores.

Differential Impact of Chronic Kidney Disease on Coronary Calcification and Atherosclerosis in Asymptomatic Individuals with or without Diabetes: Analysis from a Coronary Computed Tomographic Angiography Registry

Aim: The aim of this study was to assess the combined effects of chronic kidney disease (CKD) and diabetes on the extent and developmental pattern of coronary artery disease (CAD). Methods: A total of 3,017 self-referred asymptomatic individuals without known CAD who underwent 64-channel dual-source coronary computed tomography angiography between 2006 and 2010 were enrolled. The patients were divided into six groups based on their diabetes status (nondiabetic or diabetic) and estimated glomerular filtration rate (eGFR) (eGFR > 90 mL/min/1.73 m², normal renal function; eGFR 60–89, mild CKD; or eGFR 30–59, moderate CKD). We compared the coronary artery calcium score (CACS), segment stenosis score (SSS), and ≥50% obstructive CAD among the groups. Results: In nondiabetics, whereas SSS and ≥50% obstructive CAD were not different as renal function deteriorated, after adjusting for cardiovascular risk factors, CACS showed a unique developmental pattern: no CACS increase until mild CKD, but abrupt increase from the stage of moderate CKD (moderate vs. normal renal function, adjusted OR 5.118, 95% CI 1.293–20.262, p = 0.020). In diabetics, patients from the stage of mild CKD were more likely to have ≥50% obstructive CAD (p = 0.004), higher CACS (p = 0.020), and SSS (p = 0.001) in multivariable analysis. Conclusions: The presence of CKD did not have a significant impact on the development of coronary atherosclerosis, but affected the progression of coronary calcification more markedly from the stage of moderate CKD in nondiabetics. However, in diabetics, the deterioration of renal function was significantly associated with the development of coronary atherosclerosis and calcification from the stage of mild CKD.