Coronary Atherosclerosis Plaque Research Articles

Associations between lipids and subclinical coronary atherosclerosis

Whether HIV modifies the relationship of serum lipids with coronary atherosclerosis and coronary plaque subtypes is uncertain. We examined the associations between traditional lipids and coronary atherosclerosis among HIV-infected (HIV+) and HIV-uninfected (HIV-) men. The Multicenter AIDS Cohort Study is an observational cohort with a total of 429 HIV+ and 303 HIV- men who had non-contrast cardiac computed tomography performed to measure coronary artery calcium and coronary computed tomography angiography to measure coronary stenosis, coronary plaque presence, and composition. We used multivariable adjusted prevalence ratios to examine the relationship between the SD difference in each lipid parameter and coronary atherosclerosis. Total cholesterol (TC)/HDL-cholesterol had the strongest associations with coronary atherosclerosis regardless of HIV status. Overall, lipid parameters were most strongly associated with the presence of mixed plaque, stenosis more than 50%, and coronary artery calcium for both HIV+ and HIV- men. HIV+ men had similar, but weaker associations, between lipid parameters and coronary atherosclerosis compared with HIV- men. The strongest association was between the TC/HDL-cholesterol and stenosis more than 50% for both HIV+ [prevalence ratios 1.25 per SD (95% confidence interval 1.07-1.43)] and HIV- men [prevalence ratios 1.46 per SD (95% confidence interval 1.08-1.85)]. The associations between lipids and coronary atherosclerosis tended to be weaker for HIV+ compared with HIV- men, although TC/HDL had the strongest association for both HIV+ and HIV- men. A weaker association between lipid levels and coronary atherosclerosis for HIV+ men may contribute to the decreased discrimination of cardiovascular disease risk observed in HIV+ individuals.

PDCD4 expression in coronary atherosclerosis rat models and its mechanism.

This study investigated the expression of programmed cell death protein 4 (PDCD4) in rat models of coronary atherosclerosis (AS) and analyzed its role and mechanism. A total of 80 Wistar rats were selected and divided into the control group (n=40) and research group (n=40) according to the principle of similar body weight, of which coronary AS models were established in rats in the research group. PDCD4 expression in coronary artery tissues was detected using western blotting, and the expression of interleukin-6 (IL-6) and IL-8 in the coronary artery tissues were measured by means of reverse transcription-polymerase chain reaction (RT-PCR). The apoptotic rate of coronary artery smooth muscle cells was determined via terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL). The relative expression of PDCD4 in coronary artery tissues in the research group was obviously higher than that in the control group, and the difference was statistically significant (t=6.121, P<0.01). In terms of the relative expression of messenger ribonucleic acid (mRNA) of IL-6 in the coronary artery tissues, the research group had a remarkably higher level than the control group, with a statistically significant difference (t=21.03, P<0.01). The difference in the relative expression of IL-8 mRNA between the research group and the control group was statistically significant, of which a much higher level was detected in the research group (t=19.96, P<0.01). The apoptotic rate of smooth muscle cells in the research group was increased notably compared with that in the control group, and the difference was statistically significant (t=5.985, P<0.01). PDCD4 may participate in the formation of coronary AS plaque, and its possible function in the process is to inhibit the proliferation of vascular smooth muscle cells and promote the upregulation of IL-6 and IL-8.

Assessment of the synergistic association of serum concentration of vitamin D, vitamin K and osteocalcin with coronary atherosclerosis in patients undergoing angiography

ObjectiveThe aim of this study was to assess the association between serum concentration of vitamin D, vitamin K, and osteocalcin with coronary atherosclerosis in patients undergoing angiography. DesignIn this case-control study, 138 people who referred to Bushehr Heart Center for routine examination participated. Demographic information of the participants was registered by using a standard questionnaire. Before undergoing the angiographic processes, venous blood samples were obtained via venipuncture from the antecubital vein into gel and clot activator tubes and stored at – 80 °C until the analysis. After the angiography process was over, the normal participants entered the control group and those with coronary atherosclerosis plaque placed in the case group. Finally, serum levels of vitamin K2 and Osteocalcin were measured in the samples, by using ELISA kits and the serum level of vitamin D was measured by using HPLC. Resultserum levels of vitamin D in the case group were significantly lower than in the control (p = 0.009) and, serum levels of osteocalcin in the case group were significantly higher than in the control (P = 0.019). There was no difference in K2 level between the two groups (P = 0.84). By separating the three factors like age, sex and T2DM in the two groups, a significant synergistic was found between the concentration of osteocalcin, vitamin D (just in <20 ng/ml) and coronary atherosclerosis (p = 0.025, p = 0.029 respectively). Further, an association was observed between vitamin D level and the severity of atherosclerosis (P = 0.041).). Conclusionthe results of this study suggest that the increase in the level of osteocalcin and the deficiency of vitamin D is significantly associated with coronary atherosclerosis but, not with vitamin k2. Moreover, serum vitamin D concentration is associated with severity of coronary atherosclerosis.

Takotsubo syndrome with pulmonary embolism: a case report and literature review

BackgroundTakotsubo syndrome (TTS) is an acute cardiac condition with reversible heart failure which is often triggered by psychological and physical stressful events. Although pulmonary embolism (PE) was reported as a trigger for TTS, the concurrence of TTS and PE has been rarely reported, let alone that triggered by PE. Here we describe a case of a postmenopausal female presenting with symptoms similar to myocardial ischemia, which may be caused by PE, and review the available literature that may help clinicians with their practice to similar situations since no published guidelines are available.Case presentationAn 86-year-old female was referred to the emergency department for unrelieved chest tightness, shortness of breath and back pain. Cardiac biomarkers were mildly elevated and electrocardiogram displayed pathologic Q-waves, ST-segment elevation and inverted T-waves. Unexpectedly, coronary angiography was in absence of obstructed coronary atherosclerosis or acute plaque rupture. Chest computed tomography illustrated multiple pulmonary emboli in bilateral pulmonary arteries. She had suffered from long-term right lower extremity pain and experienced a long railway journey with less activity. Both echocardiogram and cardiac magnetic resonance demonstrated regional hypokinesia of left ventricle. She received anticoagulant and diuretic therapies, three-month follow up after discharge revealed uneventful recovery without any pulmonary emboli or regional motion abnormalities, thus she was retrospectively diagnosed with TTS caused by PE.ConclusionTTS and PE are scarcely concurrent and PE can exert as a potential trigger for TTS. TTS is easily misdiagnosed, actively seeking possible risk factors of TTS is in favor of early diagnosis and timely intervention. TTS with PE is reversible, timely and effective treatments ensure the best possible outcome.

Clinical analysis of acute myocardial infarction in emergency normal coronary angiography

Objective To investigate the clinical symptoms and pathogeny of acute myocardial infarction(AMI) in emergency normal coronary angiography(CAG). Methods From October 2015 to October 2017, the clinical data of 207 AMI patients withemergency CAG in the First People's Hospital of Huainan were retrospectively analyzed, including 7 patients with normal CAG.The clinical symptoms and pathogeny of these patients were analyzed. Results Among the patients with AMI, the patients with normal CAG accounted for 3.38 %(7/207), the average age was (49.00±11.94)years old, 4 patients were men, 3 patients were smokers and 3 patients had hypertension.The results of laboratory examination were cTnI (7.81±4.32)μg/L, myoglobin (231.43±136.03)μg/L, CK-MB (15.3±4.63)μg/L.The pathogeny of these patients were one case with coronarospasm(14.29 %), one case with myocardial bridge(14.29%), two cases with intracoronary thrombolysis(28.57%), two cases with aortic dissection (28.57%), and one case with myocarditis(14.29%). In addition to aortic dissection in 1 case of death, 1 case was transferred outside, the rest of the patients discharged after hospitalization. Conclusion AMI mainly occurres because of vascular thrombosis caused by the unstable coronary atherosclerosis plaque rupture, but some patients with normal CAG can also occure AMI, it has different clinical characteristics and pathogenys.In practice it should be carefully identified in order to improve the cure rate and prognosis. Key words: Myocardial infarction; Coronary occlusion; Myocardial bridging; Autolysis of coronary artery thrombosis; Aortic aneurysm, thoracic; Coronary angiography; Emergency treatment

An automatic multi-class coronary atherosclerosis plaque detection and classification framework.

Detection of different classes of atherosclerotic plaques is important for early intervention of coronary artery diseases. However, previous methods focused either on the detection of a specific class of coronary plaques or on the distinction between plaques and normal arteries, neglecting the classification of different classes of plaques. Therefore, we proposed an automatic multi-class coronary atherosclerosis plaque detection and classification framework. Firstly, we retrieved the transverse cross sections along centerlines from the computed tomography angiography. Secondly, we extracted the region of interests based on coarse segmentation. Thirdly, we extracted a random radius symmetry (RRS) feature vector, which incorporates multiple descriptions into a random strategy and greatly augments the training data. Finally, we fed the RRS feature vector into the multi-class coronary plaque classifier. In experiments, we compared our proposed framework with other methods on the cross sections of Rotterdam Coronary Datasets, including 729 non-calcified plaques, 511 calcified plaques, and 546 mixed plaques. Our RRS with support vector machine outperforms the intensity feature vector and the random forest classifier, with the average precision of 92.6 ± 1.9% and average recall of 94.3 ± 2.1%. The proposed framework provides a computer-aided diagnostic method for multi-class plaque detection and classification. Graphical abstract Diagram of the proposed automatic multi-class coronary atherosclerosis plaque detection and classification framework. ᅟ.

Predict value of adiponectin for coronary atherosclerosis plaques according to computed tomography angiography in an asymptomatic population

BackgroundThe association between serum adiponectin levels and coronary atherosclerosis plaque characteristics in asymptomatic populations is unclear. ObjectivesTo examine the predictive value of serum adiponectin levels for coronary high risk plaques as detected by computed tomography angiography (CTA). MethodsThis was a cross-sectional study. All patients were divided into high risk plaque group and non high risk plaque group. The FRS was calculated for each patient. CTA was performed for each patient. Adiponectin levels were measured by flow fluorescence immunmicrobead assay (FFIA). Receiver-operating characteristic (ROC) curves and multivariate analysis was used to determine the predictive value of adiponectin for high risk plaques. ResultsThe high risk plaque group showed lower adiponectin levels than non high risk plaque group (median, 7.27 vs. 8.51 μg/ml, P = 0.003). The multivariate analysis showed that age (OR = 2.62, 95%CI: 1.51–4.56, P = 0.001), hyperlipidemia (OR = 1.89, 95%CI: 1.07–3.36, P = 0.029), high-density lipoprotein cholesterol (HDL-C) (OR = 0.46, 95%CI: 0.24–0.87, P = 0.02), the ratio of total cholesterol to high-density lipoproteincholesterol (TC/HDL-C) (OR = 0.69, 95%CI: 0.50–0.94, P = 0.02), apolipoprotein B (apoB) (OR = 3.08, 95%CI: 1.50–6.32, P = 0.002), and adiponectin (OR = 0.37, 95%CI: 0.19–0.74, P = 0.005) were independently associated with the presence of high risk plaques. AUC of the multivariate model for high-risk plaques was 0.728 (95%CI: 0.627–0.783). Sensitivity was 74.9%, specificity was 60.2%, the positive predictive value was 65.3%, and the negative predictive value was 70.6%. ConclusionsDecreased adiponectin levels were associated with the presence of high-risk plaques in asymptomatic populations at low to intermediate FRS. Adiponectin can play an important role in plaque screening before coronary CTA.

155 Higher igm anti oxidised ldl antibodies point to favourable plaque characteristics as determined by radio frequency intravascular ultrasound (rf-ivus) and near infrared spectroscopy (nirs) in the integrated imaging and biomarker study 3 (ibis-3)

BackgroundMalondialdehyde (MDA)-LDL is one of the main oxidation products involved in atherosclerosis pathogenesis. IgM antibodies against MDA-LDL have been generally regarded as protecting from atherosclerosis. In contrast, the role of...

Coronary Plaque Burden and Adverse Plaque Characteristics Are Increased in Healthy Relatives of Patients With Early Onset Coronary Artery Disease

ObjectivesThis study characterized and quantified subclinical atherosclerosis by coronary computed tomography angiography (CTA) in first-degree relatives of patients with early onset coronary artery disease (CAD). BackgroundA strong family history of CAD is an important risk factor for adverse cardiovascular events. Whether predisposed individuals suffer an increased burden of coronary atherosclerosis and adverse plaque features is not known. MethodsWe included 88 healthy middle-aged first-degree relatives from 59 families with early onset CAD. Participants were matched by age and sex with 88 control patients with atypical angina or nonanginal chest pain and no family history of CAD, referred for coronary CTA. A blinded analysis of plaque burden and composition was performed using semiautomated plaque quantification software. The relative differences between the median volumes or the odds ratios (OR) were compared between groups, using a mixed model. ResultsFirst-degree relatives had significantly more affected coronary segments than controls (0 segments: 30% vs. 49%, respectively; 1 to 2 segments: 27% vs. 32%, respectively; 3 to 4 segments: 18% vs. 6%, respectively; and ≥5 segments: 25% vs. 14%, respectively; p = 0.001). In a multivariate model, the relative differences of total plaque, total calcified plaque (CP), total noncalcified plaque (NCP), and total low-density NCP (LD-NCP) were 5.8 (95% confidence interval [CI]: 2.8 to 11.9), 2.6 (95% CI: 1.5 to 4.5), 5.8 (95% CI: 2.9 to 12.0), and 3.6 (95% CI: 2.1 to 6.1), respectively. The adjusted OR of any positive remodeling plaque or any LD-NCP plaque was 4.2 (95% CI: 1.2 to 14) and 4.2 (95% CI: 1.9 to 9.5), respectively. ConclusionsHealthy first-degree relatives of patients with early onset CAD have an increased coronary plaque burden compared with symptomatic patients. The plaques display characteristics associated with myocardial ischemia and adverse coronary events.

Establishment of a rat model with diet-induced coronary atherosclerosis.

Coronary atherosclerotic disease is a serious disease in humans, but no suitable animal model is available currently for further studies. We used apolipoprotein E gene knockout (ApoE KO) rats to induce hypercholesterolemia through a special high cholesterol/bile salt diet (Paigen diet), then analyzed aortic and coronary atherosclerosis lesions and the myocardial injury in order to establish a novel small animal model of coronary atherosclerosis. Plasma cholesterol of ApoE KO rats increased 7.6-fold compared with wild-type rats after 8 weeks on the Paigen diet. After 10 to 12 weeks of subsisting on the Paigen diet, ApoE KO rats developed mild aortic atherosclerosis with severe coronary atherosclerosis. Hematoxilyn and eosin staining showed that 11 out of 12 ApoE KO male rats had right coronary artery atherosclerosis, 7 of them were>70% occluded. Oil Red O (Lipid Stain), Mac2 immuno-staining and Masson’s trichrome staining demonstrated substantial amounts of lipid, macrophages and collagen fibers in coronary atherosclerosis plaques. In addition, ApoE KO male rats had severe myocardial focal lesions with cholesterol ester as the main component in the lesions. In conclusion, ApoE KO rats developed severe hypercholesterolemia, coronary atherosclerosis and myocardial cholesterol ester deposition after subsisting on the Paigen diet and can be used as a novel animal model for studies on cholesterol metabolism and coronary atherosclerotic disease.

Association between serum vitamin D levels and subclinical coronary atherosclerosis and plaque burden/composition in young adult population.

Evidence suggests that low 25-OH vitamin D 25(OH)D concentrations may increase the risk of several cardiovascular diseases such as hypertension, peripheral vascular disease, diabetes mellitus, obesity, myocardial infarction, heart failure and cardiovascular mortality. Recent studies suggested a possible relationship between vitamin D deficiency and increased carotid intima-media wall thickness and vascular calcification. We hypothesized that low 25(OH)D may be associated with coronary atherosclerosis and coronary plaque burden and composition, and investigated the relationship between serum vitamin D levels and coronary atherosclerosis, plaque burden or structure, in young adult patients by using dual-source 128x2 slice coronary computed tomography angiography (CCTA). We included 98 patients with coronary atherosclerosis and 110, age and gender matched, subjects with normal findings on CCTA examinations. Patients with subclinical atherosclerosis had significantly higher serum total cholesterol, triglycerides, hs-CRP, uric acid, HbA1c and creatinine levels and lower serum 25(OH)D levels in comparison with controls. There was no significant correlation between 25(OH)D and plaque morphology. There was also a positive relationship between 25(OH)D and plaque burden of coronary atherosclerosis. In multivariate analysis, coronary atherosclerosis was associated high hs-CRP (adjusted OR: 2.832), uric acid (adjusted OR: 3.671) and low 25(OH)D (adjusted OR: 0.689). Low levels of 25(OH)D were associated with coronary atherosclerosis and plaque burden, but there was no significant correlation between 25(OH)D and plaque morphology.

GW25-e1492 Association of Human Epicardial Adipose Tissue Volume and Inflammatory Cytokines with Coronary Atherosclerosis Plaque Vulnerability

GW25-e1492 Association of Human Epicardial Adipose Tissue Volume and Inflammatory Cytokines with Coronary Atherosclerosis Plaque Vulnerability

Prognostic utility of coronary computed tomographic angiography: a 5-year follow-up in type 2 diabetes patients with suspected coronary artery disease.

Objectives. To analyze the predictive value of coronary computed tomography angiography on acute coronary artery events in patients with type 2 diabetes. Methods. Coronary computed tomography angiography was performed in 250 type 2 diabetic patients. After a follow-up for 5 years, 145 patients were excluded as they did not have any coronary events. The remaining 95 patients were divided into study group and control group. According to their density and shape, the coronary artery plaques were classified into 3 types and 4 types, respectively. Results. There is no statistically significant difference in the degree of stenosis between two groups. The proportion of calcified plaques in the study group was lower than in the control group. The proportion of mixed-calcified plaques in the study group was higher than in the other. Type III plaques have a 76.2% sensitivity and negative predictive value was 64.5% for acute coronary events; type IV plaques have a sensitivity of 52.6% and positive predictive value of 63% for chronic coronary events. Conclusions. CCTA may be used as a non-invasive modality for evaluating and predicting vulnerable coronary atherosclerosis plaques in patients with type 2 diabetes.

Abstract 18980: Aortic Distensibility May Be Associated With the Characteristics of Coronary Atherosclerosis Plaque

Purpose: Aortic distensibility (AD) has been shown to be inversely proportional to disease severity and presence of cardiovascular risk factors. MDCT can simultaneously characterize coronary and thoracic aortic atherosclerotic plaque morphology by delineating between calcified, mixed, non-calcified lesions. This study aimed to access relation between the characteristics of coronary plaque and AD in cardiac MDCT. Methods: The study was a retrospective analysis of the findings in 69 patients who performed cardiac MDCT for evaluation of chest pain symptoms. The 69 subjects was performed 64 channel cardiac MDCT and Scan data were reconstructed at 20 phases between 0% and 95% of the R-R intervals with an increment of 5%. Pixel-based measurements of arterial dimensions were performed at 1 cross-section of the descending aorta in a transverse plane at the aortic valve level. End diastole area was measured at 95% of R-R interval and end systolic area was measured at 35% of R-R interval. Aortic distensibility was calculated as follows: AD= (end systolic area - end diastolic area)/ (end diastolic area х pulse pressure). Coronary plaques in cardiac MDCT were categorized as calcified, mixed, or non-calcified. Results: Descending AD were lower in patients with any coronary plaque, calcified or mixed plaque than those without (mixed: p&lt;0.001, calcified: p=0.041) but not with non-calcified coronary plaque (p=0.497). In multivariate logistic regression analysis, descending AD (p = 0.011, HR 6.446) is independently associated with mixed coronary plaque after adjustment of age, sex, body mass index. The cutoff value of descending AD for prediction of mixed plaque in cardiac MDCT was 1.6 X 10 -3 mmHg with 69.2% of sensitivity and 69.2% of specificity (Fig). Conculsions: Descending AD may be associated with the mixed or calcified plaque in by MDCT. Especially, Descending AD might be associated with mixed coronary plaque.

GW24-e1133 Effect of Yindan Xinnaotong capsule on serum IL-6 of patients suffering from unstable angina pectoris

ObjectivesUnstable angina pectoris (UAP) is a kind of common clinical type of coronary artery atherosclerosis heart disease. Due to the serious condition and great harm, the heart disease severely affects...

GW24-e2104 Epinephrine enhanced LPS-induced pro-inflammatory cytokines release by BMMCs: a cross-talking between catecholamine, circadian rhythm and inflammation

ObjectivesOccurring of acute coronary syndromes (ACSs) displayed circadian rhythms as well as the levels of catecholamines and pro-inflammatory cytokines in vivo. Such circadian rhythms were proved to exist also in...

Elevated serum bilirubin levels are inversely associated with coronary artery atherosclerosis

BackgroundInverse correlations of high serum bilirubin with metabolic and cardiovascular disease have been suggested. However, anti-atherogenic effects of bilirubin have not been well-established in terms of the presence of plaques and stenosis identified in coronary computed tomography (CT). MethodsA cross-sectional study was conducted on 2862 men who were free of cardiovascular disease and underwent coronary CT as part of a routine medical screening examination. Coronary stenotic lesions were considered to be incidences of coronary atherosclerosis, and stenosis was classified as stenosis <50% or ≥50%, according to degree of stenosis. ResultsThe prevalences of coronary atherosclerosis and stenosis ≥50% in subjects with elevated bilirubin levels (>1.2 mg/dL) were lower than those in subjects with normal bilirubin levels (≤1.2 mg/dL) (19.9% vs. 27.9%, p < 0.001, 8.5% vs. 10.3%, p = 0.044). Bilirubin was inversely associated with total plaques (odds ratio [OR] 0.59, 95% confidence interval [CI] 0.48–0.73 in the 4th quartile vs. 1st quartile) and calcified plaques (OR 0.60, 95% CI 0.49–0.75) in univariate analysis. After adjusting for traditional risk factors, it was found that coronary atherosclerosis (OR 0.73, 95% CI 0.56–0.94 in the 4th quartile vs. 1st quartile) and calcified plaque (OR 0.66, 95% CI 0.53–0.84) were inversely associated with the bilirubin grade in a dose-dependent manner. ConclusionsThe serum bilirubin level was inversely associated with coronary atherosclerosis and calcified plaques in a dose-dependent manner. These results suggested that serum bilirubin could be used as a protective biomarker of coronary artery disease.

Correlation of Coronary Atherosclerosis and Subclinical Plaque Phenotype of Carotid Artery

This study aimed to evaluate the correlation between coronary atherosclerosis and the phenotype of subclinical carotid artery plaque using 320-row computed tomography via an original single-injection protocol. A total of 122 patients with suspected coronary artery disease but free of transient ischemic attack and stroke underwent computed tomographic angiography of carotid and coronary artery simultaneously. The mean attenuation was measured at each artery. The plaques in either carotid or coronary were classified into noncalcified, calcified, and mixed. Coronary plaque was evaluated with plaque score. Logistic regression analysis was used to determine the predictive value of coronary plaque score to the phenotype of carotid plaque. The prevalence of each phenotype of carotid plaque in different coronary stenosis groups was also analyzed. The mean (SD) attenuation of carotid and coronary artery was 456.3 (81.7) Hounsfield units (HU), 466.0 (85.5) HU, 446.5 (84.1) HU, and 476.4 (90.0) HU, respectively. There was a significant correlation between the noncalcified coronary plaque score and noncalcified plaque in carotid artery (odds ratio [OR], 2.9; P < 0.05). The coronary calcified plaque scores were significantly correlated with carotid mixed (OR, 1.8; P < 0.05) and calcified plaque (OR, 2.0; P < 0.05). The noncalcified plaque of carotid artery was more frequent (72.5% vs 67%) in the nonsignificant coronary stenosis group. The subclinical carotid plaque phenotypes are significantly associated with coronary plaque score and defined grade of stenosis in patients with suspected coronary artery disease. Our tailored computed tomographic angiography protocol may have a positive impact on secondary prevention.

Aortic distensibility and its relationship to coronary and thoracic atherosclerosis plaque and morphology by MDCT: Insights from the ROMICAT Trial

BackgroundMulti-detector cardiac computed tomography (CT) allows for simultaneous assessment of aortic distensibility (AD), coronary atherosclerosis, and thoracic aortic atherosclerosis. ObjectivesWe sought to determine the relationship of AD to the presence and morphological features in coronary and thoracic atherosclerosis. MethodsIn 293 patients (53±12years, 63% male), retrospectively-gated MDCT were performed. We measured intraluminal aortic areas across 10 phases of the cardiac cycle (multiphase reformation 10% increments) at pre-defined locations to calculate the ascending, descending, and local AD (at locations of thoracic plaque). AD was calculated as maximum change in area/(minimum area×pulse pressure). Coronary and thoracic plaques were categorized as calcified, mixed, or non-calcified. ResultsAscending and descending AD were lower in patients with any coronary plaque, calcified or mixed plaque than those without (all p<0.0001) but not with non-calcified coronary plaque (p≥0.46). Per 1mm Hg−1 10−3 increase in ascending and descending AD, there was an 18–29% adjusted risk reduction for having any coronary, calcified plaque, or mixed coronary plaque (ascending AD only) (all p≤0.04). AD was not associated with non-calcified coronary plaque or when age was added to the models (all p>0.39). Local AD was lower at locations of calcified and mixed thoracic plaque when compared to non-calcified thoracic atherosclerosis (p<0.04). ConclusionsA stiffer, less distensible aorta is associated with coronary and thoracic atherosclerosis, particularly in the presence of calcified and mixed plaques, suggesting that the mechanism of atherosclerosis in small and large vessels is similar and influenced by advancing age.

Increased prevalence of subclinical coronary atherosclerosis detected by coronary computed tomography angiography in HIV-infected men

The degree of subclinical coronary atherosclerosis in HIV-infected patients is unknown. We investigated the degree of subclinical atherosclerosis and the relationship of traditional and nontraditional risk factors to early atherosclerotic disease using coronary computed tomography angiography. Seventy-eight HIV-infected men (age 46.5 +/- 6.5 years and duration of HIV 13.5 +/- 6.1 years, CD4 T lymphocytes 523 +/- 282; 81% undetectable viral load), and 32 HIV-negative men (age 45.4 +/- 7.2 years) with similar demographic and coronary artery disease (CAD) risk factors, without history or symptoms of CAD, were prospectively recruited. 64-slice multidetector row computed tomography coronary angiography was performed to determine prevalence of coronary atherosclerosis, coronary stenosis, and quantitative plaque burden. RESULTS HIV-infected men demonstrated higher prevalence of coronary atherosclerosis than non-HIV-infected men (59 vs. 34%; P = 0.02), higher coronary plaque volume [55.9 (0-207.7); median (IQR) vs. 0 (0-80.5) microl; P = 0.02], greater number of coronary segments with plaque [1 (0-3) vs. 0 (0-1) segments; P = 0.03], and higher prevalence of Agatston calcium score more than 0 (46 vs. 25%, P = 0.04), despite similar Framingham 10-year risk for myocardial infarction, family history of CAD, and smoking status. Among HIV-infected patients, Framingham score, total cholesterol, low-density lipoprotein, CD4/CD8 ratio, and monocyte chemoattractant protein 1 were significantly associated with plaque burden. Duration of HIV infection was significantly associated with plaque volume (P = 0.002) and segments with plaque (P = 0.0009) and these relationships remained significant after adjustment for age, traditional risk factors, or duration of antiretroviral therapy. A total of 6.5% (95% confidence interval 2-15%) of our study population demonstrated angiographic evidence of obstructive CAD (>70% luminal narrowing) as compared with 0% in controls. Young, asymptomatic, HIV-infected men with long-standing HIV disease demonstrate an increased prevalence and degree of coronary atherosclerosis compared with non-HIV-infected patients. Both traditional and nontraditional risk factors contribute to atherosclerotic disease in HIV-infected patients.