Extent Of Atherosclerosis Research Articles

English

BACKGROUND Evaluation of endothelial function in isolated coronary artery ectasia (ICAE) with flow-mediated dilation (FMD) is limited and use of flow mediated vasodilation as a surrogate marker for the extent of coronary atherosclerosis remains unknown. Thus, the following study was done to evaluate for endothelial dysfunction (ED) in subjects with ICAE by assessing the FMD in the brachial artery. METHODS This was an observational study, conducted at a referral hospital providing tertiary care in India between June 2017 and November 2018. Fifty patients with ICAE and fifty control patients with normal coronary arteries (NCA) on coronary angiogram, done by using a standard Seldinger technique via femoral route, were the subjects of the study. Brachial artery FMD was determined by using a highresolution ultrasound system (Samsung RS80A) using a linear transducer of a frequency of 7.5 Mega Hertz. RESULTS The groups had same baseline characteristics in terms of age, sex etc. (all P values > 0.05). However, values of serum uric acid and low-density lipoproteins were statistically significantly higher in ICAE subjects (P < 0.0001). Whereas, dilatation of brachial artery in response to shear stress was significantly lower in patients with ICAE subjects than in patients with normal coronaries. (8.85 ± 0.49 vs. 12.83 ± 0.45, P < 0.0001). Marki’s classification, type 1, type 2, type 3 and type 4 coronary artery ectasia (CAE) was present in 8 (16 %), 4 (8 %), 13 (26 %), and 25 (50 %), respectively. CONCLUSIONS Atherosclerosis may play a pivotal role in the genesis of ICAE. Hyperlipidaemia may have a specific role in the disease process. Further research is required to evaluate the exact molecular mechanisms involved in CAE. KEYWORDS Coronary Artery Disease, Ectasia, Endothelial Dysfunction, Hyperlipidaemia

Assessing Cardiovascular Risk by Using the Fat Attenuation Index in Coronary CT Angiography.

Coronary CT angiography (CCTA) has evolved into a first-line diagnostic test for the investigation of chest pain. Despite advances toward standardizing the reporting of CCTA through the Coronary Artery Disease Reporting and Data System (or CAD-RADS) tool, the prognostic value of CCTA in the earliest stages of atherosclerosis remains limited. Translational work on the bidirectional interplay between the coronary arteries and the perivascular adipose tissue (PVAT) has highlighted PVAT as an in vivo molecular sensor of coronary inflammation. Coronary inflammation is dynamically associated with phenotypic changes in its adjacent PVAT, which can now be detected as perivascular attenuation gradients at CCTA. These gradients are captured and quantified through the fat attenuation index (FAI), a CCTA-based biomarker of coronary inflammation. FAI carries significant prognostic value in both primary and secondary prevention (patients with and without established coronary artery disease) and offers a significant improvement in cardiac risk discrimination beyond traditional risk factors, such as coronary calcium, high-risk plaque features, or the extent of coronary atherosclerosis. Thanks to its dynamic nature, FAI may be used as a marker of disease activity, with observational studies further suggesting that it tracks the response to anti-inflammatory interventions. Finally, radiotranscriptomic studies have revealed complementary radiomic patterns of PVAT, which detect more permanent adverse fibrotic and vascular PVAT remodeling, further expanding the value of PVAT phenotyping as an important readout in modern CCTA analysis. © RSNA, 2021.

The Relationship Between Earlobe Creases and the Presence, Extent, and Severity of Coronary Artery Atherosclerosis: A Regional Population-Based Autopsy Study.

The association between earlobe crease(s) and coronary artery atherosclerosis has stimulated debate and controversy over the years. Most available published studies have been conducted on living patients. Although these studies offer valuable insight into such associations in patients who exhibit symptoms, no information is available from these studies on the prevalence of earlobe creases among an asymptomatic population. Postmortem studies offer the advantage of including individuals free of symptomatic cardiovascular disease, thus providing an inbuilt control group. The atherosclerotic pathological findings of 1298 individuals who underwent coronial postmortem examination at Wellington Regional Hospital, New Zealand, between 2006 and 2013 were retrospectively studied. Earlobe creases and atherosclerosis involving the coronary arteries were semiquantitatively appraised. The presence of an earlobe crease was found to be significantly associated with coronary artery atherosclerosis.

Association of Epicardial Fat Volume With the Extent of Coronary Atherosclerosis and Cardiovascular Adverse Events in Asymptomatic Patients With Diabetes.

Epicardial adipose tissue has a paracrine effect, enhancing coronary artery atherosclerotic plaque development. This study evaluated epicardial fat volume (EFV), adipokines, coronary atherosclerosis, and adverse cardiovascular events in a cohort of asymptomatic patients with type 2 diabetes mellitus (T2DM). Epicardial fat volume was calculated using data from computed tomography coronary angiograms. Adipokines and inflammatory cytokines were also assayed and correlated with EFV. Epicardial fat volume was also assessed as a predictor of coronary artery calcium (CAC) score, number of coronary artery plaques, and significant plaque (>50% luminal stenosis). Data from the EFV analysis were available for 221 (85.7%) participants. Median EFV was 97.4 cm3, mean body mass index was 28.1 kg/m2, and mean duration of T2DM was 13 years. Statistically significant, but weak, correlations were observed between several adipokines, inflammatory cytokines, and EFV. Epicardial fat volume was a significant univariate (P = .01), but not multivariate, predictor of the number of coronary plaques, but not of CAC score or significant plaque. After a mean follow-up of 22.8 months, 12 adverse cardiovascular events were reported, exclusively in participants with EFV >97.4 cm3. Epicardial fat volume has limited utility as a marker of coronary artery plaque in patients with T2DM and is weakly correlated with adipokine expression.

Association between C-reactive protein and carotid plaque in mild-to-moderate idiopathic pulmonary fibrosis.

An association between C-reactive protein (CRP) levels and carotid plaque has never been investigated in idiopathic pulmonary fibrosis (IPF). The aim of this study was to evaluate the extent of carotid atherosclerosis in mild-to-moderate IPF and to assess its relationship to serum CRP. This observational retrospective case-control study included 60 consecutive IPF patients (73.8 ± 6.6years, 45 males) and 60 matched controls, examined between Sep 2017 and Jan 2019. All patients underwent CRP assessment and a carotid Doppler ultrasonography. CRP levels were significantly higher in IPF patients than controls (0.2 ± 0.09mg/dl vs 0.09 ± 0.04mg/dl, p < 0.0001). A total of 46 plaques were detected, with higher prevalence in IPF patients than controls (38 vs 8, p < 0.0001). On univariate logistic regression the main variables independently associated with carotid plaque were: age (HR 1.09, 95% CI 1.03-1.16, p = 0.006), hypertension duration (HR 1.05, 95% CI 1.01-1.09, p = 0.01), diabetes duration (HR 1.09, 95% CI 1.01-1.18, p = 0.03), LDL-cholesterol (HR 1.07, 95% CI 1.04-1.10, p < 0.0001) and finally CRP levels (HR 1.73, 95% CI 0.59-5.00, p < 0.0001). Multivariate logistic regression analysis revealed that LDL-cholesterol (HR 1.05, 95% CI 1.01-1.08, p = 0.009) and CRP levels (HR 1.43, 95% CI 0.39-5.19, p < 0.0001) retained statistical significance. Common carotid artery-intima media thickness was significantly correlated with CRP levels in IPF patients (r = 0.86). SerumCRP might represent both an early marker and a potential therapeutic target for carotid atherosclerosis in mild-to-moderate IPF.

The Proinflammatory Soluble CD40 Ligand Is Associated with the Systemic Extent of Stable Atherosclerosis.

Background and objectives: Polyvascular atherosclerosis is frequent and associated with a high cardiovascular risk, although the mechanisms regulating the atherosclerosis extent to single or multiple arterial territories are still poorly understood. Inflammation regulates atherogenesis and soluble CD40 ligand (sCD40L) is an inflammatory mediator associated with the presence of single-territorial atherosclerosis. We assessed whether the sCD40L expression is associated with the atherosclerosis extent to single or multiple arterial territories and with the atherosclerosis severity in different territories. Materials and Methods: We prospectively enrolled 94 participants with no atherosclerosis (controls, n = 26); isolated coronary atherosclerosis (group 1, n = 20); coronary and lower extremity (LE) atherosclerosis (group 2, n = 18); coronary and carotid atherosclerosis (group 3, n = 12); and coronary, LE, and carotid atherosclerosis (group 4, n = 18). Serum sCD40L levels were quantified. Results: The sCD40L levels (ng/mL, mean (standard deviation)) were 4.0 (1.5), 5.6 (2.6), 7.2 (4.2), 5.9 (3.7), and 5.1 (2.4) in controls and groups 1 to 4, respectively (ANOVA p = 0.012). In nonrevascularized patients, the sCD40L levels were significantly higher in group 2 than in group 1 and were correlated with the number of LE diseased segments. Prior LE bypass surgery was associated with lower sCD40L levels. Coexistence of coronary and LE atherosclerosis was independently associated with the sCD40L levels. Conclusions: The sCD40L levels were increased in stable atherosclerosis, particularly in polyvascular coronary and LE atherosclerosis. The number of LE diseased segments and prior LE revascularization were associated with sCD40L expression. To our knowledge, these are novel data, which provide insights into the mechanisms underlying multi-territorial atherosclerosis expression. sCD40L may be a promising noninvasive tool for refining the stratification of the systemic atherosclerotic burden.

Vascular ultrasound for cardiovascular risk stratification in asymptomatic patients with type-2 diabetes

Cardiovascular diseases are among the main long-term complications of type-2 diabetes (T2D). Several tools have been proposed to estimate the cardiovascular (CV) risk in patients with T2D, but their prognostic value requires further investigation. We aimed to identify new independent vascular markers to predict CV events in patients with T2D, and their incremental value compared to the Swedish National Diabetes Register (NDR) risk score. A retrospective cohort study was conducted on 1332 asymptomatic patients with T2D, free from prior CV event, assessed for CV work-up, including 12-lead ECG, ankle-brachial index and carotid and femoral bifurcations ultrasound to detect plaque in any of the 4 territories (right and left carotid and femoral arteries). The extent of atherosclerosis was rated from 0 to 4 and recorded as atherosclerosis burden score (ABS). Patients were followed up to 5 years and the occurrence of CV events (cardiovascular death, stroke/transient ischemic attack, myocardial infarction, unstable angina and cardiac revascularisation) was recorded. A total of 82 patients (6.2%) experienced a cardiovascular event, including 34 (2.6%) with myocardial infarction, 18 (1.4%) with cardiac revascularisation and 17 (1.3%) with stroke. The independent determinants of these events were: male gender (HR = 1.81 [1.13–2.88], P = 0.013) and ABS ≥ 2 (HR = 1.98 [1.21–3.25], P = 0.007). The NDR risk score performed poorly to predict cardiovascular events (area under the curve = 0.56 [0.49–0.63], P = 0.11), whereas screening for atherosclerotic plaques provided significant incremental prognostic value over the NDR score (model χ 2 increase: +231%, P = 0.002). Duplex ultrasonography for atherosclerotic plaques improve the estimation of CV prognosis on top of clinical data. Because of its high availability and safety, it could be routinely used to stratify the cardiovascular risk and implement the guidelines-based interventions.

Grading and occurrence of coronary artery stenosis in different age groups-an autopsy based study

Cardiovascular diseases especially ischemic heart disease is the most frequent cause of sudden and unexpected death that constitute a considerable portion of the autopsies conducted in our country. The most common cause of sudden death all over the globe is of cardiovascular origin. The peculiarity of heart disease in Indian population compared to other parts of the globe is that its onset is 5–10 years earlier. Sudden deaths in younger age groups have become a major concern. The extent and severity of atherosclerosis with stenosis is the most frequent pathological lesion which develops to coronary artery disease. Coronary artery disease will soon emerge as the single largest disease accounting for nearly one-third of all deaths in India. Cases of sudden death, road traffic accidents, burns, poisoning and asphyxia brought to the mortuary of Sri Ramachandra Medical College and Research Institute, Chennai for postmortem examination during the period of September 2014 to September 2015, were studied in detail. Age group between 61–70 years had severe stenosis of 70–99% with 6 cases while age group of 31–40, 41–50, 51–60 years had severe stenosis of 70–99% with 3 cases each and confirmed by histopathological examination. Regular health checkup with cardiovascular screening must be recommended every 6 months from the age of 21 years to prevent the menace of cardiovascular diseases.

The Correlation of plasma fibrinogen and complexity of coronary lesions in patients with acute coronary syndrome

Elevated levels of inflammatory markers are linked to an increased rates of adverse events in patients with CAD. Fibrinogen is an indicator of pro-coagulant state and also a biomarker playing a role in inflammatory responses in variable degrees. It is suggested that a high circulating plasma fibrinogen is correlated to adverse outcome in patients with CAD. We aimed to investigate the relationship between fibrinogen levels and CAD severity, complexity assessed with SS in patients admitted for ACS. A total of 102 patients (63.1 ± 10.3 years, 65% men) with Acute coronary Syndrome, who underwent coronary angiography were enrolled. Laboratory data including fibrinogen were obtained before admission to Cath Lab for coronary angiography. Syntax scores of all patients were calculated from baseline CAG. Intermediate-high SXscore was significantly associated with older age, female gender, Diabetes Mlellitus, heart rate and inversely associated with BMI, current smoking, and LVEF.Patients with SXscore ≥ 23 had increased inflammatory bio-markers hence hs-CRP .The plasma levels of fibrinogen were higher in the patients with SXscore ≥ 23 than in the patients with SXscore ≤ 22 ( P < 0.001). In addition, it was determined that there was a correlation between fibrinogen and hs CRP levels in the whole study population ( P < 0.001).The number of diseased vessels was significantly higher in patients with intermediate-high Sxscore compared with the low SXscore so as chronic total occlusion, by this associated also to a higher Fibrinogen levels .The rate of patients who underwent stent implantation was higher in the SXscore ≤ 22 group. In conclusion, plasma fibrinogen levels are significantly associated with the extent and complexity of coronary atherosclerosis in patients with ACS. A higher fibrinogen level is an independent predictor of intermediate-high SXscore.

Prediction of Future Atherosclerosis From Young Adulthood

To compare the Pooled Cohort Equation (PCE) and Ideal Cardiovascular Health Score (ICHS) with a simpler cardiovascular risk score not requiring laboratory tests (the Fuster-BEWAT score, FBS) in predicting the presence and extent of subclinical atherosclerosis 13 years later.

Abstract 13418: Inter-relation of Parity and Coronary Artery Calcium With Cardiovascular Disease Events: The Multi-ethnic Study of Atherosclerosis

Introduction: Coronary artery calcium (CAC) is a measure of subclinical atherosclerosis and predicts cardiovascular disease (CVD) events. Greater parity, or number of live births, has been shown to relate to CVD. We examined whether the relation of parity to CVD events may depend on the presence and extent of subclinical atherosclerosis measured by CAC. Methods: We studied 3151 women free of CVD at baseline in the Multi-Ethnic Study of Atherosclerosis, a prospective study of CVD. Participants were stratified by parity categories of 0-1 (reference), 2-3, and ≥4 and by baseline CAC categories of 0, 1-99, and 100+. We compared the incidence of CVD (myocardial infarction, stroke, resuscitated cardiac arrest, and coronary heart disease deaths) per 1000 years based on parity across levels of CAC over 13 years. Cox regression determined the joint association of parity and CAC on the incidence of CVD. Results: Women with greater parity had a higher prevalence of any CAC and CAC≥100 (p&lt;0.01); among those with CAC, parity related to greater mean CAC scores (175, 184, and 284, respectively) (p&lt;0.01). Women with greater parity also had greater incident CVD (7.1%, 8.7%, and 11.3% for 0-1, 2-3, and ≥4 live births, respectively, p-trend =0.01) and extent of CAC directly related to the incidence of CVD within parity groups. However, the association of parity with CAC was attenuated after adjustment for age, race, income, smoking and other risk factors. Parity also directly related to the incidence of CVD within CAC categories ( Figure ); however, from Cox regression analyses, these relations were attenuated when adjusted for age, ethnicity and other risk factors. Conclusion: In unadjusted analyses, we show parity to be associated with the prevalence of any or significant CAC, extent of CAC among those with CAC&gt;0, as well as the incidence of CVD events, overall and according to the presence and extent of CAC. However, the association of parity with CVD risk was attenuated after adjustment for other factors.

Prognostic irrelevance of plaque vulnerability following plaque sealing in high-risk patients with type 2 diabetes: an optical coherence tomography study

BackgroundType 2 diabetes mellitus (T2DM) is associated with an increased cardiovascular risk related at least in part to a more vulnerable plaque phenotype. However, patients with T2DM exhibit also an increased risk following percutaneous coronary intervention (PCI). It is unknown if plaque vulnerability of a treated lesion influences cardiovascular outcomes in patients with T2DM. In this study, we aimed to assess the association of plaque morphology as determined by optical coherence tomography (OCT) with cardiovascular outcome following PCI in high-risk patients with T2DM.Methods81 patients with T2DM and OCT-guided PCI were recruited. Pre-interventional OCT and systematic follow-up of median 66.0 (IQR = 8.0) months were performed.ResultsDuring follow-up, 24 patients (29.6%) died. The clinical parameters age (HR 1.16 per year, 95% CI 1.07–1.26, p < 0.001), diabetic polyneuropathy (HR 3.58, 95% CI 1.44–8.93, p = 0.006) and insulin therapy (HR 3.25, 95% CI 1.21–8.70, p = 0.019) predicted mortality in T2DM patients independently. Among OCT parameters only calcium-volume-index (HR 1.71 per 1000°*mm, 95% CI 1.21–2.41, p = 0.002) and lesion length (HR 1.93 per 10 mm, 95% CI 1.02–3.67, p = 0.044) as parameters describing atherosclerosis extent were significant independent predictors of mortality. However, classical features of plaque vulnerability, such as thickness of the fibrous cap, the extent of the necrotic lipid core and the presence of macrophages had no significant predictive value (all p = ns).ConclusionClinical parameters including those describing diabetes severity as well as OCT-parameters characterizing atherosclerotic extent but not classical features of plaque vulnerability predict mortality in T2DM patients following PCI. These data suggest that PCI may provide effective plaque sealing resulting in limited importance of local target lesion vulnerability for future cardiovascular events in high-risk patients with T2DM.

Lipoprotein subfraction LDL-5 and the presence of coronary atherosclerosis

Abstract Background Coronary artery disease (CAD) has high mortality rates and is a frequent cause of death globally. Serum lipids play a pivotal role in the development of atherosclerosis, and elevated levels of total cholesterol, low density lipoprotein (LDL) cholesterol, and triglycerides are well known risk factors of cardiovascular disease (CVD). However, there are limitations in the ability to predict CVD risk, which has led to an increased clinical interest in identifying novel risk markers. With the advances in lipidomic technology, lipoprotein subfractions may provide additional information that is missing in today's evaluation of CVD risk. Lipoprotein subfractions differ in size and density, and recent studies suggest that high density of small LDL particles provide a greater risk for CVD. Purpose To investigate whether lipoprotein subfractions are associated with the presence and extent of coronary atherosclerosis. Methods Fasting serum samples from 60 participants with suspected stable CAD were collected before scheduled coronary angiography, and analysed by nuclear magnetic resonance (NMR). The presence and extent of atherosclerosis were quantified by the Gensini Score. Participants were classified into one of three Gensini groups based on severity (&amp;lt;20.5, normal; 20.6–30, non-significant CAD; &amp;gt;30.1, significant CAD). Results A three-way ANOVA, adjusted for statin-use and sex, revealed statistically significant differences (p&amp;lt;0.005) in LDL-5 particle number, LDL-5 triglycerides, and LDL-5 phospholipids between the Gensini groups. In addition, significant differences (p&amp;lt;0.005) were found in the ratios apolipoprotein A/apolipoprotein B and LDL cholesterol/HDL cholesterol between the Gensini groups. All significant variables, identified by the three-way ANOVA, displayed the highest levels in the Gensini group with significant CAD. Conclusion Despite no difference in the traditional clinical measurements (total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides), NMR-lipidomics revealed significant differences in LDL-5 between the Gensini groups. Interestingly, our results reveal that those with significant CAD have a higher density of small LDL subfractions. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Norwegian Health Association, The Liaison Committee for Education, Research and Innovation in Central Norway

Biomarcadores inflamatorios y extensión de aterosclerosis coronaria en pacientes con síndrome coronario agudo: Estudio observacional prospectivo en un hospital general universitario

ObjectiveTo determine whether there is a relationship between C - reactive protein and fibrinogen levels and the extent of atherosclerosis in acute coronary syndrome. MethodsA prospective observational study was conducted that include 873 patients with coronary syndrome treated in a hospital between the years 2016 and 2018. An analysis was made that included C - reactive protein and fibrinogen levels, metabolic markers, extent of coronary atherosclerosis. ResultsNo positive correlation was found between the C - reactive protein and fibrinogen levels and the metabolic markers, nor with one, two, or three vessel disease (P=.829; P=.810). ConclusionsAlthough blood C-Reactive Protein and fibrinogen levels are associated with the rate of cardiovascular events, this study was unable to demonstrate whether there is a relationship between these and the severity of the coronary atherosclerosis.

Incremental prognostic value of pericoronary adipose tissue attenuation on top of comprehensive CCTA assessment

Abstract Background Coronary computed tomography angiography (CCTA) derived parameters linked to severity and extent of atherosclerosis are associated with prognosis in patients with coronary artery disease (CAD). Furthermore, coronary inflammation, by determining pericoronary adipose tissue CT-attenuation (PCATa), can be assessed on CCTA as well and has been proposed as promising prognostic marker. Objective To assess the prognostic value of PCATa on top of traditional CCTA derived atherosclerotic parameters. Methods A total of 543 patients who underwent CCTA because of suspected CAD and in whom follow-up was obtained were included. CCTA assessment comprised; coronary artery calcium score (CACS), presence of obstructive CAD (≥50% stenosis) and high-risk plaques (HRP), total plaque volume (TPV), non-calcified plaque volume (NCPV), and PCATa. The endpoint was a composite of death and non-fatal myocardial infarction (MI). Optimal prognostic thresholds were determined for quantitative CCTA variables. Univariable Cox regression analyses were performed to determine clinical characteristics and CCTA variables associated with the endpoint, a subsequent multivariable Cox regression analysis that included variables associated with the endpoint was used to determine independent predictors of the endpoint. An additional Cox regression analysis was performed to test the incremental prognostic value of CCTA variables over clinical characteristics, significance of each sequentially added variable was tested using the likelihood ratio test. Results During a median follow-up time of 6.6 [interquartile range: 4.7–7.8] years, a total of 42 (20 MI/22 death) (8%) patients suffered an endpoint. CACS &amp;gt;83.2, obstructive CAD, HRP, TPV &amp;gt;269mm3, and NCPV &amp;gt;83mm3 were all associated with occurrence of the endpoint with unadujsted hazard ratio's (HR) of; 5.37, 5.70, 3.31, 7.76, and 6.77, respectively (p&amp;lt;0.001 for all). PCATa of the RCA above −74.4 Hounsfield units (HU) had a detrimental effect on prognosis (unadjusted HR: 1.99, p=0.037), while PCATa of the LAD nor Cx was associated with outcome (Log-rank p-value 0.255 and 0.218, respectively). PCATa of the RCA remained an independent predictor of death and MI when incorporated in a multivariable analysis inlcuding all CCTA variables and clincal chacteristics associated with the endpoint (adjusted HR: 2.11, p=0.024). Furthermore, adding PCATa of the RCA to a model that included clinical characteristics and all CCTA parameters led to an improvement of the prognostic value of the model (change in Chi-square = 4.45, p=0.035) (figure). Conclusion Coronary inflammation of the RCA determined by PCATa provides incremental prognostic value on top of traditional CCTA parameters linked to extent and severity of CAD. Figure 1. Cox regression analysis demonstrating the incremental prognostic value of sequentially added CCTA variables over clinical characteristics tested for significance using the likelihood ratio test. Funding Acknowledgement Type of funding source: None

Cardiovascular risk and missed opportunities for treatment in patients with type 2 diabetes presenting with very premature coronary artery disease

Abstract Background Type 2 diabetes mellitus (T2D) is a major cardiovascular risk factor (CVRF), and comprehensive risk factor management reduces the incidence of cardiovascular events. Purpose To assess 1) prevalence of T2D among patients presenting with newly diagnosed very premature coronary artery disease (CAD) and its impact on CVRFs and extent of atherosclerosis; 2) effectiveness of glucose and lipid control in T2D patients before presentation with CAD. Methods We studied patients with angiographically proven CAD with stenosis of ≥50% who presented at the age of ≤50 years for males and ≤55 years for females. Diabetes was defined as fasting plasma glucose ≥7 mmol/L, haemoglobin (Hb)A1C ≥6.5% or diagnosis or treatment of T2D before or at presentation with CAD. CVRFs were defined as dyslipidemia, hypertension, obesity, current smoking, and family history of premature cardiovascular disease (CVD). Values are reported as mean (±SD), median (interquartile range) or percentages. Results From 417 premature CAD patients, 112 (26.9%) had T2D at the time of presentation with CAD. In 27 (24.1%) patients, T2D was newly diagnosed at presentation with CAD. Age of diagnosis of T2D was 41.3 (±6.9) years old. Patients with T2D had higher prevalence of dyslipidemia (83.0% vs 63.3%, p&amp;lt;0.001), hypertension (65.2% vs 40.3%, p&amp;lt;0.001), and obesity (56.3% vs 34.8%, p&amp;lt;0.001), higher cumulative number of CVRFs per person (2.8 (±1.2) vs 2.0 (±1.2), p&amp;lt;0.001) and less favourable lipid profiles, with higher levels of triglycerides (3.3 (2.1–4.7) vs 2.3 (1.5–3.4) mmol/L, p=0.001) and lower HDL-cholesterol (0.9 (±0.3) vs 1.1 (±0.3) mmol/L). Prevalence of smoking (32.1% vs 24.9%, p=0.14) and family history of premature CVD (43.8% vs 39.7%, p=0.45), levels of LDL-cholesterol (3.7 (±1.4) vs 3.8 (±1.2) mmol/L, p=0.23) and lipoprotein(a) (206 (99–819) vs 200 (99–700) mg/L, p=0.57) were not significantly different between groups. T2D patients had a greater prevalence of 3-vessel disease (35.7% vs. 22.2%, p=0.006) and were less likely to receive revascularization (70.5% vs 83.9%, p=0.002). Prior to presentation with CAD, 31 (27.7%) of T2D patients received insulin, 42 (37.5%) received oral hypoglycemic drugs, and 12 (10.7%) received no pharmacological treatment for diabetes. Only 23 (27.1%) of them achieved HbA1C ≤7% at the time of presentation with CAD (Figure 1). Among all T2D patients, 35 (31.3%) received treatment with statins and 16 (14.3%) reached guideline-recommended lipid targets of LDL cholesterol ≤2 mmol/L and/or non-HDL cholesterol ≤2.6 mmol/L. Conclusion Among patients with very premature CAD, T2D was common, was previously unrecognized in up to one quarter, and was associated with a greater burden of CVRFs and more extensive CAD at presentation. Few patients with T2D achieved guideline-recommended lipid or glucose targets. These data point to the need for improvements in screening and comprehensive CVRF treatment of T2D in order to reduce the burden of premature CAD. Figure 1 Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Canadian Institutes of Health Research. St. Paul's Hospital Foundation and the Vancouver General Hospital Foundation

Development of a three-dimensional prognostic score for patients with symptomatic peripheral artery disease: PAD3D score

Abstract Background Peripheral artery disease (PAD) is a high-risk condition for cardiovascular Events, but no individual prognosis assessment exists. Objectives We aimed to establish an individual, clinically useful risk score based on the combined predictive value for mortality of (i) age, (ii) severity of PAD, and (iii) extent of atherosclerosis (PAD3D). Methods 1310 patients with symptomatic PAD underwent follow-up for a mean of 50±26 months. We randomly subdivided the cohort into test and validation cohort. All-cause and cardiovascular mortality were prospectively analysed for the t PAD3D score and in combination with classical risk factors (PADRF). Results For test and validation cohort (n=655), all-cause and cardiovascular mortality was precisely predicted (both p&amp;lt;0.001) by the PAD3D score (Fig. 1 A+B). The additional inclusion of classical risk factors did not increase discrimination (Fig 1 C+D) compared to PAD3D score, as AU-ROCs were similar for both scores at 12 and 24 months (Fig. 2). Thus, the addition of classical risk factors did not further improve the prognostic value. The PAD3D score provides a risk gradient of a 4.5-fold increase in all-cause and cardiovascular mortality. Conclusions We established a score for precise prediction of all-cause and cardiovascular mortality. The PAD3D score promises to allow for personalized goals in risk intervention. All-cause and cardiovascular mortality Funding Acknowledgement Type of funding source: None

Association of habitual alcohol consumption with carotid atherosclerotic lesions: results from the Corinthia study

Abstract Introduction Alcohol is implicated in the pathophysiology of cardiovascular diseases. However, it is also believed to play a cardioprotective role if consumed in appropriate amounts. Purpose To assess the association between alcohol consumption and carotid atherosclerosis. Methods In the setting of the cross-sectional Corinthia study, volunteers filled in questionnaires regarding drinking habits and were characterized as social drinkers (SD) or habitual alcohol consumers (HAC). Furthermore, they underwent carotid ultrasonography examination to evaluate the carotid intima-media thickness (cIMT). Thickness of cIMT&amp;gt;1.5 mm or protrusion &amp;gt;50% compared to adjacent segments was considered as atherosclerotic plaque. Results HAC consumers were usually male (HAC: 61.1%, SD: 24.9%, p&amp;lt;0.001), smokers (HAC: 33.3%, SD: 23.5%, p&amp;lt;0.001) and frequently had a history of hypertension (HAC: 72.8%, SD: 67.5%, p=0.02) when compared to SD (Table 1). However, no significant differences were noted regarding other risk factors of atherosclerosis (Table). Notably, HAC had a greater extent of carotid atherosclerosis as demonstrated by an increased cIMT (HAC: 1.03±0.45mm, SD: 0.96±0.39mm, p&amp;lt;0.001) and carotid plaque burden (HAC: 27.7%, SD: 21.3%, p=0.004). Importantly, when taking into account the number of alcoholic drinks (in wine glasses), alcohol consumption of more than 1 wine glass resulted in significantly higher values of cIMT (1 wine glass: 1.00±0.42mm, &amp;gt;1 wine glass: 1.06±0.45mm, p=0.04) (Figure 1A) and extensive amount of carotid plaques (1 wine glass: 22.7%, &amp;gt;1 wine glass: 30.4%, p=0.02) when compared to consumption of 1 wine glass (Figure 1B). Conclusion Habitual alcohol consumption of more than one wine glass is associated with a higher carotid atherosclerotic burden. Figure 1 Funding Acknowledgement Type of funding source: None

Association of gamma-glutamyl transferase with subclinical coronary atherosclerosis and cardiac outcomes in non-alcoholics

In an asymptomatic population, we determined the relationship between serum gamma-glutamyl transferase (GGT) and subclinical atherosclerosis, using coronary computed tomography angiography (CCTA). This was a retrospective observational cohort study which analyzed 5120 consecutive asymptomatic individuals with no prior history of coronary artery disease or significant alcohol intake who voluntarily underwent CCTA as part of a general health examination. All subjects were stratified into tertiles based on GGT levels. Degree and extent of subclinical coronary atherosclerosis were evaluated using CCTA. Cardiac events were a composite of all-cause death, myocardial infarction, unstable angina, and coronary revascularization. After adjustment for cardiovascular risk factors, there were no significant differences among GGT tertiles in terms of adjusted odds ratios for non-calcified and mixed plaques. The risk of any atherosclerotic and calcified plaques, significant stenosis, multi-vessel disease, and significant stenosis in the left main or proximal left anterior descending artery was higher in the third GGT tertile than in the first tertile (all p < 0.05). Over a median 5.4-year follow-up, the third GGT tertile had significant adjusted hazards ratios for cardiac events than did the first GGT tertile, even after stepwise adjustment for cardiovascular risk factors (all p < 0.01). In asymptomatic individuals, elevated GGT was independently associated with high-risk feature atherosclerosis and poorer cardiac outcomes.

Pulmonary emphysema and atherosclerosis: association or syndrome?

BackgroundAtherosclerosis is an inflammatory reaction of the vessel wall. Emphysema may induce systemic inflammation, part of which may be the development or progression of atherosclerosis. So, the relationship between emphysema and atherosclerosis, whether both are due to the same causative agent and pathogenesis or emphysema led to atherosclerosis, is still not clearly understood. So, the aim of this work is to study the relationship between carotid atherosclerosis versus pulmonary emphysema extent and airflow obstruction.ResultsCigarette smoking index was higher in patients than controls. According to FEV1%, patients were classified into: GOLD 1 (mild): FEV1 ≥ 80% predicted, GOLD 2 (moderate): 50% ≤ FEV1 < 80% predicted, GOLD 3 (severe):30% ≤ FEV1 < 50% predicted, and GOLD 4 (very severe): FEV1 < 30% predicted. There was a significant difference between the studied groups as regard to ABG parameters. Emphysema score showed a positive correlation with thrombus size, plaque size, and stenosis percent. Approximately 2/3 of patients had atherosclerotic changes and the other 1/3 had increased IMT. GOLD staging, also, correlated with thrombus size and stenosis percent. So, there was a strong positive correlation between both emphysema score and GOLD staging and carotid atherosclerosis.ConclusionThe relationship between emphysema and atherosclerosis is suggested to be the chronic inflammatory reaction (against the same risk factor) based on the positive correlation between carotid atherosclerosis versus emphysema score and GOLD staging. The inherence of emphysema and atherosclerosis may be considered a syndrome. If so, targeting the same pathogenic mechanism will be valuable for their control.