Extent Of Subclinical Atherosclerosis Research Articles

Extent of subclinical atherosclerosis on coronary computed tomography and impact of statins in patients with diabetes without known coronary artery disease: Results from CONFIRM registry

BackgroundAbsence of subclinical atherosclerosis is considered safe to defer statin therapy in general population. However, impact of statins on atherosclerotic cardiovascular disease in patients with diabetes stratified by coronary artery calcium (CAC) scores and extent of non-obstructive CAD on coronary computed tomography angiography (CCTA) has not been evaluated. MethodsCONFIRM (Coronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multi-center Registry) study enrolled consecutive adults 18 years of age between 2005 and 2009 who underwent 364-detector row CCTA for suspected CAD. The long-term registry includes data on 12,086 subjects who underwent CCTA at 17 centers in 9 countries. In this sub-study of CONFIRM registry, patients with diabetes mellitus (DM) and without diabetes mellitus with normal CCTA or non-obstructive plaque (<50 % diameter stenosis) for whom data on baseline statin use was available were included. CAC score was calculated using Agatston score. The magnitude of non-obstructive coronary artery disease on CCTA was quantified using segment involvement score (SIS). Primary outcome was major cardiovascular events (MACE) which included all-cause mortality, myocardial infarction, and target vessel re-vascularization. ResultsA total of 7247 patients (Mean age 56.8 years) with a median follow up of 5 years were included. For DM patients, baseline statin therapy significantly reduced MACE for patients with CAC ≥100 (HR: 0.24; 95 % CI 0.07–0.87; p = 0.03) and SIS≥3 (HR: 0.23; 95 % CI 0.06–0.83; p = 0.024) compared to those not on statin therapy. Among Diabetics with lower CAC (<100) and SIS (≤3) scores, MACE was similar in statin and non-statin groups. In contrast, among non-DM patients, MACE was similar in statin and no statin groups irrespective of baseline CAC (1–99 or ≥100) and SIS. ConclusionIn this large multicenter cohort of patients, the presence and extent of subclinical atherosclerosis as assessed by CAC and SIS identified patients most likely to derive benefit from statin therapy.

Subclinical Atherosclerosis in Young, Socioeconomically Vulnerable Hispanic and Non-Hispanic Black Adults

BackgroundNon-Hispanic Black persons are at greater risk of cardiovascular (CV) events than other racial/ethnic groups; however, their differential vulnerability to early subclinical atherosclerosis is poorly understood. ObjectivesThis work aims to study the impact of race/ethnicity on early subclinical atherosclerosis in young socioeconomically disadvantaged adults. MethodsBilateral carotid and femoral 3-dimensional vascular ultrasound examinations were performed on 436 adults (parents/caregivers and staff) with a mean age of 38.0 ± 11.1 years, 82.3% female, 66% self-reported as Hispanic, 34% self-reported as non-Hispanic Black, and no history of CV disease recruited in the FAMILIA (Family-Based Approach in a Minority Community Integrating Systems-Biology for Promotion of Health) trial from 15 Head Start preschools in Harlem (neighborhood in New York, New York, USA). The 10-year Framingham CV risk score was calculated, and the relationship between race/ethnicity and the presence and extent of subclinical atherosclerosis was analyzed with multivariable logistic and linear regression models. ResultsThe mean 10-year Framingham CV risk was 4.0%, with no differences by racial/ethnic category. The overall prevalence of subclinical atherosclerosis was significantly higher in the non-Hispanic Black (12.9%) than in the Hispanic subpopulation (6.6%). After adjusting for 10-year Framingham CV risk score, body mass index, fruit and vegetable consumption, physical activity, and employment status, non-Hispanic Black individuals were more likely than Hispanic individuals to have subclinical atherosclerosis (OR: 3.45; 95% CI: 1.44-8.29; P = 0.006) and multiterritorial disease (P = 0.026). ConclusionsAfter adjustment for classic CV risk, lifestyle, and socioeconomic factors, non-Hispanic Black younger adults seem more vulnerable to early subclinical atherosclerosis than their Hispanic peers, suggesting that the existence of emerging or undiscovered CV factors underlying the residual excess risk (Family-Based Approach in a Minority Community Integrating Systems-Biology for Promotion of Health [FAMILIA (Project 2)]; NCT02481401)

CD36 expression intensity on different subpopulations of circulating monocytes depending on the extent of subclinical atherosclerosis

It is known that chronic activation of innate immunity and persistent low-intensity inflammation play a crucial role in the initiation and progression of atherosclerosis. It was found that atherogenic lipoproteins can act as inducers of the inflammatory response through ligand-receptor interaction with pattern-recognizing receptors of immunocompetent cells, such as CD36 (SR-B2) and Toll-like receptors. It is suggested that expression of CD36 on circulating monocytes may represent the burden of systemic atherosclerosis and, therefore, act as its diagnostic marker. The aim of the present study was to assess the intensity of CD36 expression on circulating monocytes of different subpopulations in patients without established cardiovascular disease (CVD) depending on the extent of subclinical atherosclerosis of peripheral arteries. One hundred patients without established atherosclerotic CVD, 49 (49.0%) men and 51 (51.0%) women, were included in the study. Monoclonal antibody conjugates were used to phenotype monocyte subpopulations. The expression of CD36 on CD14++CD16- monocytes (classical monocytes), CD14+CD16+ monocytes (intermediate monocytes), CD14+CD16++ monocytes (non-classical monocytes) was determined by the average fluorescence intensity. There was a statistically significant decrease in CD36 expression intensity on classical and non-classical monocytes with increasing number of vascular basins affected by atherosclerosis. A statistically significant decrease in CD36 expression intensity on classical and non-classical monocytes was found in the patients with two vascular beds lesions in comparison with patients with a single vascular bed lesion upon pairwise comparisons.

Prevalence and Extent of Subclinical Atherosclerosis and Associated Cardiovascular Risk Factors in Adult Patients With Psoriatic Arthritis: A Systematic Review.

Psoriatic arthritis (PsA) is a chronic T cell-mediated inflammatory condition affecting a considerable proportion of psoriasis (PSO) patients and a small segment of the general population. Recent studies have shown that patients with PsA are prone to premature atherosclerosis and are at an increased risk of cardiovascular disease (CVD) events, but the extent and prevalence of this are unknown. Our objective was to evaluate the prevalence and extent of subclinical atherosclerosis by measuring the intima-media thickness (IMT) of arteries in adult patients with PsA, as well as identify cardiovascular (CV) risk factors associated with PsA. An extensive literature search was conducted using PubMed as our main database. The articles exploring the association between PsA and subclinical atherosclerosis were included. We also searched other databases like MEDLINE and PubMed Central (PMC). A total of 2,561 studies published between 2005-2021 were obtained by searching the databases, and after the screening process, a total of nine studies were included for review and an additional 22 studies for comparison and backup evidence. As for results, our review included a total of 542 patients with PsA from nine different studies. All the reviewed studies showed a significant association between subclinical atherosclerosis and PsA, as endothelial functions were found to be impaired in PsA patients as deduced by measuring the carotid intima-media thickness (CIMT). PsA patients exhibited greater IMT than healthy controls. Increased IMT independently correlated with parameters of disease activity and conventional risk factors of atherosclerosis. An increased prevalence of CV risk factors such as hypertension, diabetes, obesity, and metabolic syndrome was also found in PsA patients.

Glycated Hemoglobin and Subclinical Atherosclerosis in People Without Diabetes

BackgroundThe metabolic injury caused by protein glycation, monitored as the level of glycated hemoglobin (HbA1c), is not represented in most risk scores (i.e., Systematic Coronary Risk Estimation or atherosclerotic cardiovascular disease risk scale). ObjectivesThe purpose of this study was to assess the association between HbA1c and the extent of subclinical atherosclerosis (SA) and to better identify individuals at higher risk of extensive SA using HbA1c on top of key cardiovascular risk factors (CVRFs). MethodsA cohort of 3,973 middle-aged individuals from the PESA (Progression of Early Subclinical Atherosclerosis) study, with no history of cardiovascular disease and with HbA1c in the nondiabetic range, were assessed for the presence and extent of SA by 2-dimensional vascular ultrasound and noncontrast cardiac computed tomography. ResultsAfter adjusting for established CVRFs, HbA1c showed an association with the multiterritorial extent of SA (odds ratio: 1.05, 1.27, 1.27, 1.36, 1.80, 1.87, and 2.47 for HbA1c 4.9% to 5.0%, 5.1% to 5.2%, 5.3% to 5.4%, 5.5% to 5.6%, 5.7% to 5.8%, 5.9% to 6.0%, and 6.1% to 6.4%, respectively; reference HbA1c ≤4.8%; p < 0.001). The association was significant in all pre-diabetes groups and even below the pre-diabetes cut-off (HbA1c 5.5% to 5.6% odds ratio: 1.36 [95% confidence interval: 1.03 to 1.80]; p = 0.033). High HbA1c was associated with an increased risk of SA in low-risk individuals (p < 0.001), but not in moderate-risk individuals (p = 0.335). Relative risk estimations using Systematic Coronary Risk Estimation or atherosclerotic cardiovascular disease predictors confirmed that inclusion of HbA1c modified the risk of multiterritorial SA in most risk categories. ConclusionsRoutine use of HbA1c can identify asymptomatic individuals at higher risk of SA on top of traditional CVRFs. Lifestyle interventions and novel antidiabetic medications might be considered to reduce both HbA1c levels and SA in individuals without diabetes.

The Prevalence, Distribution, and Extent of Subclinical Atherosclerosis and Its Relation With Serum Uric Acid in Hypertension Population.

Background: Data are limited on the prevalence, distribution, and extent of subclinical atherosclerosis (SCA) in populations with primary hypertension and an in-depth evaluation is required to explore the impact of elevated serum uric acid (SUA) levels on the systemic extent of SCA.Methods: A total of 1,534 individuals with blood pressure-controlled primary hypertension registered from January 1, 2015 to May 31, 2018 were included. The systemic extent and risk factors of SCA in the carotid, coronary, thoracic, and renal territories were investigated by Doppler ultrasound and computed tomography.Results: SCA was present in 85.9% of patients. The proportion of focal, intermediate and generalized SCA was 17.9, 21.3, and 46.6%. Plaques were most common in the thoracic aorta (74%), followed by the coronary (55.3%), carotid (51.6%), and renal (45.8%) arteries, respectively. Participants were stratified into quartiles based on gender-specific SUA levels. Compared with patients in the first quartile, the Odds Ratio (OR) [95% confidence interval] for SCA in the second, third and fourth quartile were 1.647 (1.011–2.680), 3.013 (1.770–5.124), and 5.081 (3.203–10.496), respectively. Patients with elevated SUA levels at high 10-year Framingham risk had a higher likelihood of a more severe risk of SCA (95.8%). However, extensive SCA was also present in a substantial number of low 10-year-Framingham risk patients at the higher quartiles of SUA (53.8%).Conclusions: SCA was highly prevalent in the hypertension population and the thoracic aorta was the most frequently affected vascular site. Elevated SUA concentration was significantly associated with the prevalence and severity of SCA regardless of territories.

FUSTER-BEWAT SCORE VERSUS IDEAL CARDIOVASCULAR HEALTH SCORE TO PREDICT LEFT VENTRICULAR HYPERTROPHY: DATA FROM CHINA PEACE MILLIONS PERSONS PROJECT

Abstract Objective: The Fuster-BEWAT Score (FBS) has been recently developed for use in lifestyle-based cardiovascular disease prevention, presenting similar accuracy in predicting subclinical atherosclerosis with ideal cardiovascular health score (ICHS), but it is unclear whether these scores exhibit comparable predictive values for detection of left ventricular hypertrophy (LVH). We evaluated the effectiveness of ICHS and FBS in assessing the presence of LVH among Chinese population. Design and method: A total of 3,521 participants aged 35 to 75 years with echocardiography screening in Guangdong were enrolled in the China PEACE (Patient centered Evaluative Assessment of Cardiac Events) Millions Persons Project. Subjects were grouped into three categories according to the number of favorable ICHS or FBS: ideal, intermediate, and poor. Left ventricular mass index (LVMI) was assessed by left ventricular mass divided by body surface area. LVH was defined as LVMI &gt; = 115 g/m2 in male and LVMI &gt; = 95 g/m2 in female. Results: In this study, poor ICHS accounts for 14.3% of all participants, intermediate ICHS 78.2%, and ideal ICHS 7.6%; poor FBS accounts for 4.4% of all participants, intermediate FBS 65.4%, and ideal FBS 30.2%. With poor ICHS as references, those with intermediate and ideal ICHS showed substantially lower adjusted odds of having LVH (odds ratio (OR) [95% confidence interval (CI)]: 0.643 [0.417, 0.991] and 0.346 [0.219, 0.547], respectively, with a p-value for trend &lt; 0.001). Compared with participants with poor FBS, intermediate and ideal FBS were negatively associated with the likelihood of LVH (OR [95%CI]: 0.638 [0.512, 0.796] and 0.316 [0.211, 0.473], respectively, with a p-value for trend &lt; 0.001). The Receiver Operating Characteristic Curve (ROC) indicated identical discriminating accuracy of ICHS (Area Under Curve (AUC): 0.696) and FBS (AUC: 0.702) with DeLong's test p-value 0.172 in identifying LVH. Conclusions: Both ICHS and FBS predict the presence and extent of subclinical atherosclerosis with similar accuracy, highlighting the value of the FBS as a simpler and more affordable score for evaluating the risk of LVH.

Machine Learning Improves Cardiovascular Risk Definition for Young, Asymptomatic Individuals

BackgroundClinical practice guidelines recommend assessment of subclinical atherosclerosis using imaging techniques in individuals with intermediate atherosclerotic cardiovascular risk according to standard risk prediction tools. ObjectivesThe purpose of this study was to develop a machine-learning model based on routine, quantitative, and easily measured variables to predict the presence and extent of subclinical atherosclerosis (SA) in young, asymptomatic individuals. The risk of having SA estimated by this model could be used to refine risk estimation and optimize the use of imaging for risk assessment. MethodsThe Elastic Net (EN) model was built to predict SA extent, defined by a combined metric of the coronary artery calcification score and 2-dimensional vascular ultrasound. The performance of the model for the prediction of SA extension and progression was compared with traditional risk scores of cardiovascular disease (CVD). An external independent cohort was used for validation. ResultsEN-PESA (Progression of Early Subclinical Atherosclerosis) yielded a c-statistic of 0.88 for the prediction of generalized subclinical atherosclerosis. Moreover, EN-PESA was found to be a predictor of 3-year progression independent of the baseline extension of SA. EN-PESA assigned an intermediate to high cardiovascular risk to 40.1% (n = 1,411) of the PESA individuals, a significantly larger number than atherosclerotic CVD (n = 267) and SCORE (Systematic Coronary Risk Evaluation) (n = 507) risk scores. In total, 86.8% of the individuals with an increased risk based on EN-PESA presented signs of SA at baseline or a significant progression of SA over 3 years. ConclusionsThe EN-PESA model uses age, systolic blood pressure, and 10 commonly used blood/urine tests and dietary intake values to identify young, asymptomatic individuals with an increased risk of CVD based on their extension and progression of SA. These individuals are likely to benefit from imaging tests or pharmacological treatment. (Progression of Early Subclinical Atherosclerosis [PESA]; NCT01410318)

Extent and characteristics of carotid plaques and brain parenchymal loss in asymptomatic patients with no indication for revascularization.

Extent of subclinical atherosclerosis has been associated with brain parenchymal loss in community-dwelling aged subjects. Identification of patient-related and plaque-related markers could identify subjects at higher risk of brain atrophy, independent of cerebrovascular accidents. Aim of the study was to investigate the relation between extent and characteristics of carotid plaques and brain atrophy in asymptomatic patients with no indication for revascularization. Sixty-four patients (aged 69±8years, 45% females) with carotid stenosis <70% based on Doppler flow velocity were enrolled in the study. Potential causes of cerebral damage other than atherosclerosis, including history of atrial fibrillation, heart failure, previous cardiac or neurosurgery and neurological disorders were excluded. All subjects underwent carotid computed tomography angiography, contrast enhanced ultrasound for assessment of plaque neovascularization and brain magnetic resonance imaging for measuring brain volumes. On multivariate regression analysis, age and fibrocalcific plaques were independently associated with lower total brain volumes (β=-3.13 and β=-30.7, both p<0.05). Fibrocalcific plaques were also independently associated with lower gray matter (GM) volumes (β=-28.6, p=0.003). On the other hand, age and extent of carotid atherosclerosis were independent predictors of lower white matter (WM) volumes. WM and GM have different susceptibility to processes involved in parenchymal loss. Contrary to common belief, our results show that presence of fibrocalcific plaques is associated with brain atrophy.

Association of flow mediated vasodilation and burden of subclinical atherosclerosis by coronary CTA

Background and aimsEndothelial dysfunction and atherosclerosis are linked by multiple mechanisms. Brachial artery flow-mediated dilation (FMD) rate is used to evaluate endothelial function and has been independently associated with adverse cardiac outcomes. The relationship between brachial artery FMD rate and severity of subclinical atherosclerosis by coronary computed tomography angiography (CCTA) is not understood. We hypothesized that brachial FMD is inversely associated with burden of subclinical atherosclerosis measured by CCTA. MethodsThis is a retrospective study of 100 participants with intermediate cardiac risk and atypical symptoms to examine association between brachial artery FMD rate and surrogate markers of severity of subclinical atherosclerosis on CCTA. Multivariate linear regression analysis was used to understand the relationship between brachial artery FMD rate and markers of plaque burden on CCTA including coronary artery calcium (CAC) score, segment involvement score (SIS; total number of segments with any plaque), segment stenosis score (SSS, sum of maximal stenosis score per segment), and total plaque score (TPS, the sum of all segments plaque burden). Results52 participants (42%) were female. Mean age of the cohort was 59.3 ± 10.4 years. After adjusting for traditional risk factors, brachial artery FMD rate was inversely associated with higher CAC, TPS, SIS and SSS (p < 0.05 for all). FMD <4.5 predicted the presence of CAC >0 and ≤ 100 most effectively, with a sensitivity of 62.2% and a specificity of 66.7%, respectively (area under the curve (AUC) of 0.5729, p = 0.0302). FMD <2.7 predicted the presence of CAC >100 most effectively, with a sensitivity of 34% and a specificity of 83% respectively (AUC of 0.6226, p = 0.0095). ConclusionsBrachial FMD is independently associated with the presence and extent of subclinical atherosclerosis on CCTA. Our findings provide more detailed evidence that mechanistically, FMD, a surrogate marker of systemic endothelial dysfunction is a correlate of atherosclerotic burden, assessed by CCTA and CAC.

Usefulness of baseline statin therapy in non-obstructive coronary artery disease by coronary computed tomographic angiography: From the CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter) study.

BackgroundThe extent to which the presence and extent of subclinical atherosclerosis by coronary computed tomography angiography influences a potential mortality benefit of statin is unknown. We evaluated the relationship between statin therapy, mortality, and subclinical atherosclerosis.MethodsIn the CONFIRM study, patients with normal or non-obstructive plaque (<50% diameter stenosis) for whom data on baseline statin use was available were included. Coronary artery calcium (CAC) was quantified using the Agatston score. The extent of non-obstructive coronary atherosclerosis was quantified using the segment involvement score (SIS). 8,016 patients were followed for a median of 2.5 years with analysis of all-cause mortality and major adverse cardiac events (MACE) including all-cause mortality, myocardial infarction, unstable angina, target vessel revascularization, and coronary artery disease-related hospitalization.Results1.2% of patients experienced all-cause mortality. Patients not on baseline statin therapy had a stepwise increased risk of all-cause mortality by CAC (relative to CAC = 0; CAC 1–99: hazard ratio [HR] 1.65, CAC 100–299: HR 2.19, and CAC≥300: HR 2.98) or SIS (relative to SIS = 0; SIS 1: HR 1.62, SIS 2–3: 2.48 and SIS≥4: 2.95). Conversely, in patients on baseline statin therapy, there was no significant increase in mortality risk with increasing CAC (p value for interaction = 0.049) or SIS (p value for interaction = 0.007). The incidence of MACE was 2.1%. Similar to the all-cause mortality, the risk of MACE was increased with CAC or SIS strata in patient not on baseline statin therapy. However, this relation was not observed in patient on baseline statin therapy.ConclusionIn individuals with non-obstructive coronary artery disease, increased risk of adverse events occurs with increasing CAC or SIS who are not on baseline statin therapy. Statin therapy is associated with a mitigation of risk of cardiac events in the presence of increasing atherosclerosis, with no particular threshold of disease burden.

Predicting Subclinical Atherosclerosis in Low-Risk Individuals: Ideal Cardiovascular Health Score and Fuster-BEWAT Score

BackgroundThe ideal cardiovascular health score (ICHS) is recommended for use in primary prevention. Simpler tools not requiring laboratory tests, such as the Fuster-BEWAT (blood pressure [B], exercise [E], weight [W], alimentation [A], and tobacco [T]) score (FBS), are also available. ObjectivesThe purpose of this study was to compare the effectiveness of ICHS and FBS in predicting the presence and extent of subclinical atherosclerosis. MethodsA total of 3,983 participants 40 to 54 years of age were enrolled in the PESA (Progression of Early Subclinical Atherosclerosis) cohort. Subclinical atherosclerosis was measured in right and left carotids, abdominal aorta, right and left iliofemoral arteries, and coronary arteries. Subjects were classified as having poor, intermediate, or ideal cardiovascular health based on the number of favorable ICHS or FBS. ResultsWith poor ICHS and FBS as references, individuals with ideal ICHS and FBS showed lower adjusted odds of having atherosclerotic plaques (ICHS odds ratio [OR]: 0.41; 95% confidence interval [CI]: 0.31 to 0.55 vs. FBS OR: 0.49; 95% CI: 0.36 to 0.66), coronary artery calcium (CACS) ≥1 (CACS OR: 0.41; 95% CI: 0.28 to 0.60 vs. CACS OR: 0.53; 95% CI: 0.38 to 0.74), higher number of affected territories (OR: 0.32; 95% CI: 0.26 to 0.41 vs. OR: 0.39; 95% CI: 0.31 to 0.50), and higher CACS level (OR: 0.40; 95% CI: 0.28 to 0.58 vs. OR: 0.52; 95% CI: 0.38 to 0.72). Similar levels of significantly discriminating accuracy were found for ICHS and FBS with respect to the presence of plaques (C-statistic: 0.694; 95% CI: 0.678 to 0.711 vs. 0.692; 95% CI: 0.676 to 0.709, respectively) and for CACS ≥1 (C-statistic: 0.782; 95% CI: 0.765 to 0.800 vs. 0.780; 95% CI: 0.762 to 0.798, respectively). ConclusionsBoth scores predict the presence and extent of subclinical atherosclerosis with similar accuracy, highlighting the value of the FBS as a simpler and more affordable score for evaluating the risk of subclinical disease.

Association Between a Social-Business Eating Pattern and Early Asymptomatic Atherosclerosis

BackgroundThe importance of a healthy diet in relation to cardiovascular health promotion is widely recognized. Identifying specific dietary patterns related to early atherosclerosis would contribute greatly to inform effective primary prevention strategies. ObjectivesThis study sought to quantify the association between specific dietary patterns and presence and extent of subclinical atherosclerosis in a population of asymptomatic middle-aged adults. MethodsThe PESA (Progression of Early Subclinical Atherosclerosis) study enrolled 4,082 asymptomatic participants 40 to 54 years of age (mean age 45.8 years; 63% male) to evaluate the presence of subclinical atherosclerosis in multiple vascular territories. A fundamental objective of this cohort study was to evaluate the life-style–related determinants, including diet, on atherosclerosis onset and development. We conducted a cross-sectional analysis of baseline data, including detailed information on dietary habits obtained as part of the overall life-style and risk factor assessment, as well as a complete vascular imaging study that was performed blinded to the clinical information. ResultsMost PESA participants follow a Mediterranean (40% of participants) or a Western (41%) dietary pattern. A new pattern, identified among 19% of participants, was labeled as a social-business eating pattern, characterized by a high consumption of red meat, pre-made foods, snacks, alcohol, and sugar-sweetened beverages and frequent eating-out behavior. Participants following this pattern presented a significantly worse cardiovascular risk profile and, after adjustment for risk factors, increased odds of presenting subclinical atherosclerosis (odds ratio: 1.31; 95% confidence interval: 1.06 to 1.63) compared with participants following a Mediterranean diet. ConclusionsA new social-business eating pattern, characterized by high consumption of red and processed meat, alcohol, and sugar-sweetened beverages, and by frequent snacking and eating out as part of an overall unhealthy life-style, is associated with an increased prevalence, burden, and multisite presence of subclinical atherosclerosis. (Progression of Early Subclinical Atherosclerosis [PESA]; NCT01410318)

Association of Homocysteine Levels with Subclinical Coronary Atherosclerosis in Asymptomatic Subjects

This article is available from http://www.labmedonline.org 2016, Laboratory Medicine Online This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Background: Progression of atherosclerotic plaques is known to be correlated with elevated circulating homocysteine (Hcy). However, whether the level of Hcy is related with coronary atherosclerosis in the subclinical state is unclear. Therefore, we performed this study to investigate the relationship between blood Hcy levels and subclinical atherosclerosis in asymptomatic self-referred subjects. Methods: We retrospectively enrolled 2,968 self-referred asymptomatic subjects (1,374 men, 1,594 women) who had undergone both coronary CT angiography (CCTA) and coronary artery calcium scoring. The relationships between atherosclerosis, Hcy, and other clinical factors were assessed. Results: Higher levels of Hcy were related with age, male gender, body mass index (BMI), waist circumference, blood pressure, high density lipoprotein (HDL), triglyceride, blood glucose, HbA1c, hsCRP, and coronary artery calcium score (CACS). Coronary plaque was more frequently found in higher Hcy quartile groups (21.3%, 28.8%, 34.4%, and 34.3%, P 50%) was also more frequent in higher Hcy quartile groups (1.8%, 5.4%, 5.0%, and 6.6%, P 400) than the first quartile group. Conclusions: Blood Hcy levels were associated with an increased risk of the presence and extent of subclinical atherosclerosis in asymptomatic subjects.

To measure the extent of subclinical atherosclerosis in patients with systemic sclerosis, and to evaluate any potential vascular risk factors in these patients

To measure the extent of subclinical atherosclerosis in patients with systemic sclerosis, and to evaluate any potential vascular risk factors in these patients

Prevalence, Vascular Distribution, and Multiterritorial Extent of Subclinical Atherosclerosis in a Middle-Aged Cohort: The PESA (Progression of Early Subclinical Atherosclerosis) Study.

Data are limited on the presence, distribution, and extent of subclinical atherosclerosis in middle-aged populations. The PESA (Progression of Early Subclinical Atherosclerosis) study prospectively enrolled 4184 asymptomatic participants 40 to 54 years of age (mean age, 45.8 years; 63% male) to evaluate the systemic extent of atherosclerosis in the carotid, abdominal aortic, and iliofemoral territories by 2-/3-dimensional ultrasound and coronary artery calcification by computed tomography. The extent of subclinical atherosclerosis, defined as presence of plaque or coronary artery calcification ≥1, was classified as focal (1 site affected), intermediate (2-3 sites), or generalized (4-6 sites) after exploration of each vascular site (right/left carotids, aorta, right/left iliofemorals, and coronary arteries). Subclinical atherosclerosis was present in 63% of participants (71% of men, 48% of women). Intermediate and generalized atherosclerosis was identified in 41%. Plaques were most common in the iliofemorals (44%), followed by the carotids (31%) and aorta (25%), whereas coronary artery calcification was present in 18%. Among participants with low Framingham Heart Study (FHS) 10-year risk, subclinical disease was detected in 58%, with intermediate or generalized disease in 36%. When longer-term risk was assessed (30-year FHS), 83% of participants at high risk had atherosclerosis, with 66% classified as intermediate or generalized. Subclinical atherosclerosis was highly prevalent in this middle-aged cohort, with nearly half of the participants classified as having intermediate or generalized disease. Most participants at high FHS risk had subclinical disease; however, extensive atherosclerosis was also present in a substantial number of low-risk individuals, suggesting added value of imaging for diagnosis and prevention. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01410318.

Subclinical carotid atherosclerosis in patients with traditional cardiovascular risk factors

Purpose: Carotid atherosclerosis is a marker of cardiovascular disease burden and is associated with cardiovascular morbidity and mortality however its correlation with the traditional cardiovascular risk factors is sometimes doubted. Our aim was to study the relationship between the extent of carotid artery atherosclerosis and cardiovascular risk factors and assess the prevalence of subclinical atherosclerosis in asymptomatic middle-aged subjects. Methods: This cross-sectional study included 123 patients (mean age 56,4±7,1 years, 45% female) with no evidence of coronary artery disease and with ≥1 traditional cardiovascular risk factor. For each participant 10-year cardiovascular risk was estimated using SCORE (Systemic Coronary Risk Evaluation) chart. In cigarette smokers number of pack-years was calculated. The extent of subclinical atherosclerosis was evaluated through carotid artery ultrasound imaging by assessing carotid intima-media thickness (CIMT) and presence of atherosclerotic plaque. Results: CIMT was the highest in the carotid bifurcation (1,29±0,46 mm in men and 1,27±0,46 mm in women). The mean values of CIMT in the common carotid artery (CCA) were 0,82±0,15 mm in men and 0,79±0,13 mm in women, in the internal carotid artery - 0,88±0,42 mm and 0,77±0,27 mm, respectively. Carotid plaque was present in total of 48 (39%) participants (in 46% of males and in 31% of females). A logical relationship was observed between common carotid intima-media thickness (CCIMT) and risk category, calculated by SCORE chart. CCIMT was 0,93±0,14 mm in high-risk group, 0,82±0,13 mm in intermediate-risk group and 0,71±0,09 mm in low-risk group, p<0,0001. The differences for the occurrence of the carotid plaque in low (13%), intermediate (43%) and high (78%) risk groups were also significant (p<0,0001). Robust regression analysis was performed to evaluate the association between cardiovascular risk factors and carotid atherosclerosis. The analysis demonstrated that among the risk factors, age and smoking had a strongest influence on CCIMT. A one year increase in age resulted in 0,008 mm increase of CCIMT (95% CI: 0,006-0,011; p<0,0001), while the increase of smoking by 1 pack-year resulted in 0,004 mm increase of CCIMT (95% CI: 0,002-0,006; p<0,0001). Conclusions: In asymptomatic patients, the extent of subclinical atherosclerosis correlates with the total cardiovascular risk calculated by SCORE chart, while age and smoking are the strongest determinants of CCIMT. Atherosclerotic plaque is present in total of 39% of asymptomatic middle-aged subjects, and its prevalence in women is 31%.

Prevalence and extent of subclinical atherosclerosis in patients with psoriasis

Patients with psoriasis are prone to premature atherosclerosis and increased risk of cardiovascular disease events. However, the prevalence and extent of atherosclerosis in patients with psoriasis are unknown. A cross-sectional study. The prevalence and extent of coronary and carotid atherosclerosis were compared in 70 patients with psoriasis (46±9years, 71% male) without known cardiovascular disease or joint involvement and 51 age- and gender-matched healthy control subjects (45±7years, 71% male). Systemic inflammation was assessed by the level of high-sensitivity C-reactive protein (hs-CRP). Coronary atherosclerosis was determined by the coronary calcification score (CCS) measured by multi-detector computed tomography. Carotid atherosclerosis was assessed by high-resolution ultrasound-derived carotid intima-media thickness (cIMT). Patients with psoriasis had a higher prevalence of coronary atherosclerosis (CCS>0; 28.6% vs. 3.9%, P<0.01), and a higher degree of coronary atherosclerosis estimated by the mean CCS (67.4±349.2 vs. 0.5±3.0, P<0.05) compared with controls. Similarly, cIMT was significantly greater in patients with psoriasis than in control subjects (0.73±0.11mm vs. 0.67±0.08mm, P<0.01). Multiple logistic regression revealed that psoriasis [odd ratio (OR): 10.54, 95% confidence interval (CI) 1.89-58.67, P<0.01] and serum total cholesterol level (OR 2.10, 95% CI 1.01-4.37) were associated with the presence of coronary atherosclerosis (CCS>0). By contrast, only age was independently associated with increased cIMT. Amongst participants with no traditional cardiovascular disease risk factors, hs-CRP level was higher in patients with psoriasis than in controls. The present results demonstrate early-onset, diffuse arterial atherosclerosis in coronary and carotid arteries in patients with psoriasis, but not in age- and gender-matched control subjects. Low-grade inflammation could explain the presence of premature atherosclerosis in patients with psoriasis.

Napping and Less Disturbed Nighttime Sleep Associated with Reduced Carotid Intima-Media Thickness in Elderly Alzheimer Caregivers

This study tested the hypothesis that disturbed or very short or long sleep durations are associated with subclinical atherosclerosis, as measured by carotid intima-media thickness (CIMT), in a sample of community-dwelling elderly spousal caregivers. Participants were 126 spousal caregivers of a person with Alzheimer's disease who underwent in-home sleep assessment by wrist actigraphy for 72 consecutive hours. Carotid artery ultrasound, also conducted in participants' homes, was used to measure CIMT in millimeters. Linear regression models including covariates related to sleep and CVD indicated that a longer daytime sleep duration was associated with significantly reduced mean common CIMT (B=-0.04, p=0.02). Specifically, for every additional hour of sleep obtained during the day, mean common CIMT was reduced by 0.04mm. Conversely, greater night time wake after sleep onset (WASO) was associated with significantly increased mean common CIMT (B=0.04, p=0.05); for each additional hour of WASO, mean common CIMT increased by 0.04mm. When combinations of sleep parameters were examined, caregivers who slept <30 minutes during the day and had ≥1 hour of WASO throughout the night had significantly greater (B=0.06, p=0.04) mean common CIMT than caregivers who slept <30 minutes during the day and had <1 hour of WASO. These analyses suggest that shorter naps and more disturbed nighttime sleep are associated with increased CIMT. Interventions that enhance sleep quantity and reduce sleep disturbance may decrease the prevalence and extent of subclinical atherosclerosis in older caregivers. Longitudinal studies with objective sleep measures that examine the effects of napping and disturbed sleep on subclinical atherosclerosis are needed.

Subclinical atherosclerosis in northern and southern China: the Chinese paradox

BackgroundThe incidence of coronary heart disease (CHD) is higher in Northern than that in Southern China, however differences in traditional CHD risk factors do not fully explain this. No study has examined the differences in subclinical atherosclerosis that may help explain the differences in incidence. This study examined these differences in subclinical atherosclerosis using coronary computed tomography (CT) for calcification between the Northern and Southern China.MethodsWe selected a random sample of participants in a large multi-center ongoing epidemiologic study for coronary calcium scanning in one northern city (North) (Beijing, n = 49) and in two southern cities (South) (Shanghai, n = 50, and Guangzhou, n = 50). Participants from the three field centers (mean age 67 years) underwent coronary risk factor evaluation and cardiac CT scanning for coronary calcium measurement using the Multi-Ethnic Study of Atherosclerosis scanning protocol.ResultsAdjusted log-transformed coronary artery calcium score in North China (Beijing) was 3.1 ± 0.4 and in South China (Shanghai and Guangzhou) was 2.2 ± 0.3 (P = 0.04). Mean calcium score for the northern city of Beijing was three times higher than that of the southern city of Guangzhou (P = 0.01) and 2.5 times higher than for the southern city of Shanghai (P = 0.03).ConclusionsThe extent of subclinical atherosclerosis is significantly higher in the northern city of Beijing than that in the two southern cities of Guangzhou and Shanghai, even after adjusting for standard cardiac risk factors. This finding suggests that standard risk factors do not fully explain north south differences in clinical CHD incidence.