Presence Of Subclinical Coronary Atherosclerosis Research Articles

Subclinical coronary atherosclerosis, detected by computer tomography with coronary calcium score, and the occurrence of major cardiovascular events at 5 years of follow-up in a cohort of patients with systemic sclerosis

BackgroundSpreading data describe cardiovascular disease (CVD) as a growing cause of hospitalization in systemic sclerosis (SSc) patients. Although interstitial lung disease and pulmonary arterial hypertension (PAH) remain the principal causes of mortality, the presence of CVD has been shown to further increase mortality in SSc patients. Few and contrasting data are available on cardiovascular impairment, particularly of subclinical coronary arteries disease, in SSc patients. The aims of this study were: 1) to determine the demographic, clinical, and cardiovascular differences between the groups of SSc patients with and without subclinical coronary atherosclerosis (SCA) assessed by coronary calcium score; 2) to verify the performance of cardiovascular risk scores in SSc for detection of SCA major cardiovascular events (MCVE); 3) to evaluate the risk factors associated to MCVE in 5 years of follow-up in this study group of patients. MethodsSixty-seven SSc patients were enrolled in this study. SCA was assessed using quantification of coronary calcium score by computerized tomography, reported as Agatson. Evaluation of common cardiovascular risk scores, carotid plaques by Doppler ultrasonography, the history of peripheral artery disease (PAD), lipid profiles, and clinical and laboratiristic characteristics of SSc were assessed at baseline visits for each patient. Factors associated with the presence of SCA were assessed by multivariate logistic analysis. A five years prospective study was performed for the evaluation of MCVE occurrence and its possible predictors. ResultsThe prevalence of SCA was 42% (Agatston scores of 266.04 ± 455.9 units) in our group of SSc patients. Patients with SCA were principally older (p = 0.0001) and had higher rates of CENP-B antibodies (57% vs 26%; p = 0.009), pulmonary arterial hypertension (PAH) (25% vs 3%; p = 0.008), dysphagia (86% vs 61%; p = 0.027), and users of statins (36% vs 8%; p = 0.004), carotid plaque (82% vs 13%; p = 0.0001), PAD (79% vs 18%; p = 0.0001), and metabolic syndrome (25% vs 0%; p = 0.002) than patients without SCA. Metabolic syndrome (OR: 8.2, p = 0.0001), presence of a PAD (OR: 5.98, p = 0.031), and carotid plaque (OR: 5.49, p = 0.010) were the main factors associated with SCA in SSc patients, by multivariate regression analysis. MCVE occurred in 7 patients. By multivariate COX regression analysis unique predictor of MCVE in 5 years of follow-up in our SSc patients was the presence of PAH (HR: 10.33, p = 0.009). Of note, the contemporary presence of PAH and SCA (defined as "not pure" pattern of PAH) was observed in 71% of patients with the occurrence of MCVE ConclusionThis study evidenced the high presence of the new “not pure” pattern of PAH, which could worsen the outcome in SSc in a medium-term (5 years) observation period. Furthermore, our data confirmed a higher cardiovascular impairment in SSc due to the presence of both SCA, mainly associated with typical cardiovascular risk factors, and PAH, life-threatening complications of SSc, that is the principal cause of the occurrence of MCVE in our SSc patients. A careful assessment of cardiovascular involvement in SSc and a more aggressive therapeutic strategy for preventing CAD and treating PAH should be highly suggested to reduce MCVE in SSc patients.

Abstract 10531: Reactive Hyperemia Index and Coronary Plaque in Asymptomatic Adults - Insights From the Miami Heart Study at Baptist Health South Florida

Objective: We aimed to evaluate the associations between the reactive hyperemia index (RHI), a non-invasive estimate of endothelial function, and coronary artery plaque presence and features on coronary computed tomography angiography (CCTA); and whether these associations differ by sex. Methods: Data from Miami Heart Study, an ongoing, prospective US cohort of individuals free of clinical ASCVD. A total of 2,097 participants underwent assessment of both RHI using EndoPAT® (abnormal RHI defined as <1.67) and a CCTA scan. We computed the unadjusted prevalence of 4 plaque outcomes (any coronary plaque on CCTA, CAC score >0, maximal coronary stenosis ≥50%, and presence of ≥1 high-risk plaque features) among individuals with and without abnormal RHI; overall and by sex. Multivariable logistic regression models were used to investigate the association between RHI and the outcomes adjusting for confounders, overall and by sex. Results: Of the 2,097 participants, mean age was 53 years, 50% were women, and 15% had abnormal RHI. Mean age was 54±7 vs. 53±7 years for normal vs. abnormal RHI, respectively, and 17% men vs 13% women had abnormal RHI. In unadjusted analyses, abnormal RHI was not associated with a significant higher prevalence of any of the study outcomes ( Figure Panel A ; all P >0.05). Adjusting for sociodemographics, no statistically significant associations were observed between abnormal RHI and any of the coronary plaque features evaluated ( Panel B ). Similar observations were noted further adjusting for other risk factors. There was no evidence of interaction by sex in any of the associations (P for interaction: all >0.05). Conclusions: In the Miami Heart Study, abnormal RHI measured using EndoPAT was not associated with coronary plaque in either women nor men. Our findings suggest that this measurement may be suboptimal in the assessment of endothelial function, and not informative in predicting the presence of subclinical coronary atherosclerosis.

Abstract 11698: Family History of Atherosclerotic Cardiovascular Disease and Subclinical Coronary Atherosclerosis Among Asymptomatic Individuals: The Miami Heart Study at Baptist Health South Florida

Introduction: We sought to examine whether a positive family history of coronary heart disease and/or stroke (FamHx) is associated with presence of subclinical coronary atherosclerosis, as evaluated using CAC and CCTA, in asymptomatic individuals. We also evaluated whether these associations differ by FamHx type. Hypothesis: Coronary atherosclerotic plaque burden by CCTA and baseline CAC score will differ depending on the FamHx domain assessed. Methods: We included 2,359 asymptomatic participants free from known ASCVD from the Miami Heart Study, an ongoing, community-based, prospective cohort study where all participants underwent CAC, CCTA, and FHx assessment at baseline. Self-reported FamHx in first-degree relatives was evaluated using 5 definitions: any, premature, parental, sibling, and both parents and siblings. We used multivariable logistic regression models to estimate adjusted the associations between each FamHx definition, CAC>0, and presence of any coronary plaque on CCTA. Results: A total of 546 (23%) participants reported any FamHx (mean age 53.5 +/- 6.8 years, 54% female, 45% with CAC >0, and 50% with any coronary plaque). In analyses adjusted for sociodemographics, any FamHx was associated with CAC>0, and FamHx of both parents and siblings showed the strongest association with CAC>0 (OR 2.17; 95% CI 1.01, 4.67), followed by premature FamHx ( Table ). The associations for any and parental FamHx remained statistically significant after further adjusting for traditional risk factors, while the other definitions trended in the same direction, but the confidence intervals included the null value. Associations with any plaque on CCTA were weaker than for CAC>0, and none was statistically significant. Conclusion: FamHx, particularly a FamHx in both parents and siblings and premature FamHx, is associated with presence of CAC>0. The number of participants with several definitions of FHx was low, likely limiting statistical power.

Short Communication: Predictive Value of HIV-Related Versus Traditional Risk Factors for Coronary Atherosclerosis in People Aging with HIV.

Cardiovascular disease (CVD) is an important cause of morbidity in people living with HIV (PLWH). We compared the predictive value of HIV-related and traditional CVD risk factors to assess which factors best predict the presence of subclinical coronary atherosclerosis in PLWH. This is a cross-sectional study in PLWH over 50 years of age who performed computed tomography coronary artery calcium (CAC) scoring between 2009 and 2019 at Chelsea and Westminster Hospital. The following outcomes were analyzed: CAC = 0 (no calcification), CAC >0 (any calcification), CAC >100 (moderate calcification), and CAC >400 (severe calcification). Univariate and multivariate logistic regression analyses were performed to assess predictors of coronary calcification. A total of 744 patients were included (mean age 56 ± 5.7 years, 94.8% male, 84% white). A CAC >0 was found in 392 (52.7%), CAC >100 in 90 (12.1%), and CAC >400 in 42 (5.6%) subjects. CAC >100 was strongly associated with hypertension [odds ratio, OR: 2.91, (95% confidence interval: 1.93-4.36), p < .001], dyslipidemia [2.71 (1.81-4.06), p < .001], and diabetes [2.53 (1.29-4.96), p = .01]. Regarding HIV-specific factors, a significant association was found with exposure (>6 years) to protease inhibitors [1.67 (1.06-2.61), p = .05], whereas exposure to tenofovir (>8 years) was negatively associated with CAC >100 [0.54 (0.30-0.98), p = .05]. Despite the high prevalence of hypertension (45.4%) only 21.5% were on antihypertensives, whereas only 29.2% of eligible candidates were receiving lipid-lowering drugs for primary prevention of CVD. Traditional cardiometabolic risk factors remain the strongest predictors of coronary atherosclerosis in PLWH as in the general population. These results underscore the importance of optimizing treatment of hypertension and promoting primary prevention strategies that may be underused in PLWH.

Prediction of subclinical coronary atherosclerosis in patients with high and very high cardiovascular risk

Abstract Funding Acknowledgements Type of funding sources: None. Background Coronary atherosclerosis has a long subclinical period. It’s early detection may offer a possibility of timely initiation of preventive interventions Purpose To develop a diagnostic rule for detection of patients (pts) with high probability of subclinical atherosclerosis among those with high or very high cardiovascular (CV) risk. Methods This cross-sectional study enrolled 52 pts (32 men [62%]), aged 40 to 65 years [mean age 54.6 ± 8.0]) with high or very high CV risk (5-9 and ≥10% by The Systematic Coronary Risk Estimation Scale [SCORE], respectively). All participants underwent cardiac computed tomography (CT) angiography and calcium scoring. Traditional risk factors (RFs) (family history of premature CVD, smoking, overweight/obesity and abdominal obesity, hypertension, type 2 diabetes mellitus, lipids parameters (total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides) and lipids-related markers (apolipoprotein A1, apolipoprotein B, ApoB/ApoA1 ratio), biomarkers of inflammation (high-sensitivity C-reactive protein [hs CRP], fibrinogen), indicator carbohydrate metabolism (glucose), ankle-brachial index, stress-test, carotid plaques according to ultrasound were evaluated in all pts. Psychological RFs were evaluated using Hospital Anxiety and Depression Scale and DS-14 for type D personality. Results All pts were divided into 2 groups according to the CT angiography results: pts in the main group (n = 21) had any non-obstructive lesions or calcium score &amp;gt;0, pts in the control group (n = 31) had intact coronary arteries. The groups did not differ in age or gender. 26 multiple linear logistic models for any subclinical atherosclerosis were developed based on obtained diagnostic features. Taking into account R-square = 0.344 (p = 0.0008), the best fitting model was follows: subclinical coronary atherosclerosis= -1.576 + 0.234 x SCORE ≥5% + 0.541 x hs CRP &amp;gt;2 g/l + 0.015 x heart rate (bpm) + 0.311 family history of premature CVD. The developed algorithm had sensitivity of 63% and specificity of 80%. Conclusions The created diagnostic model diagnostic model suggests the presence of subclinical coronary atherosclerosis in patients with high / very high CV risk with a high degree of probability. This easy-to-use method can be used in routine clinical practice to improve risk stratification and management choices in high-risk pts.

Potential role of high sensitivity cardiac troponin T in subclinical coronary atherosclerosis in systemic lupus erythematosus patients

Aim of the workTo determine the role of high sensitivity cardiac troponin T (HS cTnT) in subclinical coronary atherosclerosis in SLE patients at an apparent low risk for CVD according to traditional risk factors. Patients and methodsThe presence of subclinical coronary atherosclerosis was assessed by non-contract coronary computerized tomography and calcium score was measured using Agatston score in 30 SLE patients asymptomatic for CVD and 30 age and sex matched apparently healthy controls. SLE disease activity index (SLEDAI) was assessed. Serum HScTnT concentration was measured using enzyme-linked immunosorbent assay (ELISA). ResultsThe mean age of the patients was 33 ± 5.7 years, disease duration of 33.7 ± 22 months and mean SLEDAI 8.1 ± 5.02. The mean HS cTnT level was 12.8 ± 11.3 ng/L (1–36 ng/L). Their Framingham score was 4.8 ± 3.1 (1–12). Framingham score was low in both SLE patients (range 1–12%) and controls (1–9%) (p = 0.12). 11 (36.7%) patients, but none of the controls, had coronary artery calcification (CAC). Serum HScTnT concentration was detectable (>3 ng/L) in 16 (53.3%) patients and 2 (6.7%) control (p < 0.001). Interestingly, it was detectable in all patients with CAC, but in only 26.3% of patients without (p < 0.001). HScTnT significantly correlated with Agatston (r = 0.63, p = 0.04), with erythrocyte sedimentation rate (r = −0.65, p = 0.03), and with C-reactive protein (r = 0.76, p = 0.03) in SLE patients with CAC. ConclusionSerum HScTnT level is high and associated with CAC in SLE patients who are at an apparently low risk for CVD according to the Framingham risk score. HS cTnT may be a useful biomarker for SLE-associated subclinical atherosclerosis.

Prediction of Subclinical Coronary Atherosclerosis in Patients with High and Very High Cardiovascular Risk

Objective To develop a diagnostic rule for detection of patients (pts) with high probability of subclinical atherosclerosis among those with high or very high cardiovascular (CV) risk.Materials and Methods This cross-sectional study enrolled 52 pts (32 men [62 %]), aged 40 to 65 years [mean age 54.6±8.0]) with high or very high CV risk (5-9 and ≥10 % by The Systematic Coronary Risk Estimation Scale [SCORE], respectively). All participants underwent cardiac computed tomography (CT) angiography and calcium scoring. Traditional risk factors (RFs) (family history of premature CVD, smoking, overweight / obesity and abdominal obesity, hypertension, type 2 diabetes mellitus, lipids parameters (total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides) and lipids-related markers (apolipoprotein A1, apolipoprotein B, ApoB / ApoA1 ratio), biomarkers of inflammation (high-sensitivity C-reactive protein [hs CRP], fibrinogen), indicator carbohydrate metabolism (glucose), ankle-brachial index, stress-test, carotid plaques according to ultrasound were evaluated in all pts. Psychological RFs were evaluated using Hospital Anxiety and Depression Scale and DS-14 for type D personality.Results All pts were divided into 2 groups according to the CT angiography results: pts in the main group (n=21) had any non-obstructive lesions or calcium score &gt;0, pts in the control group (n=31) had intact coronary arteries. The groups did not differ in age or gender. 26 multiple linear logistic models for any subclinical atherosclerosis were developed based on obtained diagnostic features. Taking into account R-square = 0.344 (p=0.0008), the best fitting model was follows: subclinical coronary atherosclerosis= -1.576 + 0.234 x SCORE ≥5 % + 0.541 x hs CRP &gt;2 g / l +0.015 x heart rate (bpm) +0.311 family history of premature CVD. The developed algorithm had sensitivity of 63 % and specificity of 80 %.Conclusion The created diagnostic model diagnostic model suggests the presence of subclinical coronary atherosclerosis in patients with high / very high CV risk with a high degree of probability. This easy-to-use method can be used in routine clinical practice to improve risk stratification and management choices in high-risk pts.

Independent role of low-density lipoprotein cholesterol in subclinical coronary atherosclerosis in the absence of traditional cardiovascular risk factors.

Individuals without traditional cardiovascular risk factors (CVRFs) still experience adverse events in clinical practice. This study evaluated the predictors of subclinical coronary atherosclerosis in individuals without traditional CVRFs. A total of 1250 (52.8 ± 6.5 years, 46.9% male) asymptomatic individuals without CVRFs who underwent coronary computed tomographic angiography for a general health examination were analysed. The following were considered as traditional CVRFs: systolic/diastolic blood pressure ≥140/90 mmHg; fasting glucose ≥126 mg/dL; total cholesterol ≥240 mg/dL; low-density lipoprotein cholesterol (LDL-C) ≥160 mg/dL; high-density lipoprotein cholesterol <40 mg/dL; body mass index ≥25.0 kg/m2; current smoking status; and previous medical history of hypertension, diabetes, and dyslipidaemia. Subclinical atherosclerosis, defined as the presence of any coronary plaque, was present in 20.6% cases; the incidences of non-calcified, calcified, and mixed plaque were 9.6%, 12.6%, and 2.6%, respectively. Multivariate regression analysis showed that LDL-C level [odds ratio (OR): 1.008; 95% confidence interval (CI): 1.001-1.015], together with age (OR: 1.101; 95% CI: 1.075-1.128) and male sex (OR: 5.574; 95% CI: 3.310-9.388), was associated with the presence of subclinical atherosclerosis (All P < 0.05). LDL-C level was significantly associated with an increased risk of calcified plaques rather than non-calcified or mixed plaques. LDL-C, even at levels currently considered within normal range, is independently associated with the presence of subclinical coronary atherosclerosis in individuals without traditional CVRFs. Our results suggest that a stricter control of LDL-C levels may be necessary for primary prevention in individuals who are conventionally considered healthy.

High prevalence of coronary artery calcification in Saudi patients with normal myocardial perfusion.

BACKGROUNDNormal single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) has a high negative predictive value for ischemic heart disease. Thus, the presence of subclinical coronary atherosclerosis detected by coronary artery calcification (CAC) score in patients who have undergone SPECT MPI is unknown.OBJECTIVESDetermine the prevalence of coronary artery calcification (CAC) in patients with normal SPECT MPI and examine the association of CAC with conventional coronary artery disease (CAD) risk factors.DESIGNCross-sectional analytical study using medical records from February 2010 to April 2016.SETTINGSSingle tertiary-care center.PATIENTS AND METHODSWe studied patients referred from the outpatient clinical services for clinically indicated noninvasive CAD diagnosis with MPI SPECT. CAC scoring was subsequently performed within 3 months after a normal MPI. We excluded patients with chest pain or decompensated heart failure or patients with a history of CAD. The study population was divided into three groups: patients with a CAC score of 0, a CAC score from 1 to 300, and a CAC score more than 300. The groups were analyzed by age and other demographic and clinical characteristics.MAIN OUTCOME MEASURE(S)Prevalence of CAC in patients with normal MPI.RESULTSThe prevalence of CAC was 55% (n=114) in 207 patients with a mean (SD) age of 57.1 (10.4) years. Twelve percent had severe coronary atherosclerosis (CAC score >300). All patients had a normal MPI SPECT. CAC scores were 0 for 93 patients (45%), 1 to 300 for 89 (43%), and more than 300 for 24 (12%). There was a strong association between CAC score and age (P<.0001), male sex (P<.0001), and diabetes mellitus (P=.042), but no association between CAC score and hypertension (P=.153), family history of CAD (P=.23), obesity (P=.31), hypercholesterolemia (P=.071), or smoking (P=.308).CONCLUSIONSThe prevalence of CAC is high in this study population of patients with normal SPECT MPI. Age, male sex and diabetes were risk factors associated with CAC.LIMITATIONSSingle center and small study population.

Evaluation of lipoprotein-associated phosholipase A2 and plaque burden/composition in young adults.

The total burden of subclinical coronary atherosclerosis is significant in young adults. Serum lipoprotein-associated phospholipase A2 (Lp-PLA2) is an established predictor of morbidity and mortality because of cardiovascular disease. The aim of the present investigation was to evaluate the relationship between subclinical coronary atherosclerosis and serum Lp-PLA2 concentrations in a population of young adults. A total of 261 individuals younger than 45 years of age who had undergone coronary computed tomography angiography were evaluated. The study group included 101 patients in whom coronary computed tomography angiography detected subclinical coronary atherosclerosis; the control group included 160 sex-matched and age-matched healthy control patients. Serum Lp-PLA2 levels were increased significantly in the study group patients compared with the control patients (15.42±11.88 vs. 8.06±4.32 ng/ml, P<0.001). Furthermore, a positive correlation was identified between the Lp-PLA2 levels and the total number of plaques and diseased arteries (r=0.495, P<0.001, and r=0.621, P<0.001, respectively). The presence of mixed plaque composition was also correlated with the Lp-PLA2 levels (r=0.657, P<0.001). Multivariate regression analysis identified four independently significant predictors of subclinical coronary atherosclerosis: high-sensitivity C-reactive protein levels, tobacco use, uric acid levels, and serum Lp-PLA2 levels. The presence of subclinical coronary atherosclerosis is associated independently with Lp-PLA2, and it has potential utility as a novel indicator of cardiovascular disease risk in the young adult population.

Association between hemoglobin A1c variability and subclinical coronary atherosclerosis in subjects with type 2 diabetes

AimsWe examined the association between hemoglobin A1c (HbA1c) variability and subclinical coronary atherosclerosis in subjects with type 2 diabetes. MethodsWe used the multidetector coronary computed tomography data collected from subjects with type 2 diabetes who did not have a history of cardiovascular disease or angina symptoms. HbA1c measurements preceding the date of cardiac imaging were retrospectively collected, and intraindividual SD (HbA1c-SD), CV and adjusted SD of HbA1c measurements were calculated. Subclinical coronary atherosclerosis was defined as calcium score >400 without any cardiac symptoms. ResultsA total of 595 subjects were categorized according to the median value of each HbA1c variability indicators. The prevalence of subclinical coronary atherosclerosis was higher in higher HbA1c variability group compared with lower HbA1c variability group. Multivariable logistic regression analysis showed that higher HbA1c-SD and -CV were associated with the presence of subclinical coronary atherosclerosis, independent of mean HbA1c level in subjects with diabetes duration ≤10years (OR [95% CI]; HbA1c-SD, 2.894 [1.105–7.584]; HbA1c-CV, 2.540 [1.022–6.316]). ConclusionsLong-term stabilization of blood glucose level might be important in preventing subclinical coronary atherosclerosis in subjects with earlier period of type 2 diabetes.

Association of a favorable cardiovascular health profile with the presence of coronary artery calcification.

To examine the association between the American Heart Association's 7 metrics of ideal cardiovascular health (ICH) and the presence of subclinical coronary atherosclerosis as assessed by coronary artery calcification (CAC) using electron-beam computed tomography. This study is a cross-sectional analysis of data obtained on 3121 male and female patients evaluated at the Cooper Clinic in Dallas, Texas, between 1997 and 2007. We included men aged ≥45 and women aged ≥55 without known cardiovascular disease and for whom information on all ICH metrics and a CAC score were available. Patients were grouped into 3 categories according to their number of ICH metrics: favorable (4-7 ICH metrics), intermediate (3 metrics), and unfavorable (0-2 metrics). Patients with favorable ICH profiles had a lower prevalence and severity of subclinical atherosclerosis than those with unfavorable or intermediate ICH profiles as estimated by CAC. This inverse association of CAC with ICH metrics was evident whether the presence of coronary calcium was defined as CAC score>0, CAC score>100, or CAC score>400. Patients with favorable ICH profiles had odds of coronary calcium (CAC>0) less than half of those for patients with unfavorable profiles (odds ratio 0.41; 95% confidence interval, 0.34-0.50) and patients with intermediate ICH profiles had odds of detectable CAC 32% lower (odds ratio 0.68; 95% confidence interval, 0.57-0.82). A statistically significant association was found between a favorable level of ICH metrics and less or absent subclinical atherosclerosis as measured by CAC underscoring the importance of primordial prevention.

Increased soluble vascular adhesion molecule-1 concentration is associated with impaired coronary flow reserve in cardiac syndrome X

It is well known that both atherosclerosis initiated by endothelial dysfunction due to inflammatory cascade and coronary flow reserve (CFR) are useful in the functional or risk assessment of coronary microcirculation. The aim of this study is to elucidate the association between early atherosclerotic inflammatory markers and CFR using transthoracic echocardiography (TTE) in subjects with cardiac syndrome X. A total of 135 individuals (mean age 56 ± 9 years, 79 males and 56 females) with angina or angina-like chest pain and a normal coronary angiogram were enrolled. The early inflammatory biomarkers related to atherosclerosis, namely soluble vascular adhesion molecule-1 (sVCAM-1), interleukin-6 (IL-6), monocyte chemoattractant protein-1 (MCP-1), and lipoprotein-associated phospholipase A2 (Lp-PLA2), were compared with analyzed CFR, using TTE and adenosine or dipyridamole, measured within 2 weeks after coronary angiography. There was an inverse correlation between sVCAM-1 and CFR (r = -0.225, P = 0.014). In the two groups divided by a CFR of 2.0, sVCAM-1 was significantly higher in the group with CFR <2.0 than in the group with CFR ≥2.0 (n = 21: 757 ± 323 ng/ml, vs n = 114: 628 ± 146 ng/ml, P = 0.007). In multivariate analysis, sVCAM-1 was an independent factor related to a CFR <2.0 (odds ratio 1.003, 95 % confidence interval 1.001-1.006, P = 0.023). Our results showed that sVCAM-1 levels were inversely associated with CFR using TTE in cardiac syndrome X. Further studies are warranted to validate whether increased sVCAM-1 concentration, as an inflammatory modulator, is reflected in the presence of subclinical coronary atherosclerosis.

Carotid doppler ultrasonography as a surrogate for coronary CT angiography to exclude subclinical coronary atherosclerosis in asymptomatic patients with a negative coronary calcium score

To evaluate the diagnostic accuracy of carotid Doppler ultrasonography (CDU) to predict the presence of subclinical coronary atherosclerosis in asymptomatic subjects with a zero coronary calcium score. Retrospective study of CDU and coronary CT angiography (CTA) findings in 118 asymptomatic subjects with a zero calcium score. CDU was considered abnormal when carotid intima-media thickness was >75 percentile or was ≥ 1 mm, or in presence of carotid plaque(s). We analyzed the diagnostic accuracy of CDU to predict the presence of non-calcified coronary plaque in comparison with coronary CTA. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of abnormal CDU to identify the presence of non-calcified coronary plaque on coronary CTA were 82.4% [(14/17); 95% confidence interval (CI), 56.6%-96.2%], 53.5% [(54/101); 95% CI, 43.3%-63.5%], 23.0% [(14/61); 95% CI, 13.1%-35.6%], and 94.7% [(54/57); 95% CI, 85.4%-98.9%], respectively. Although CDU has a low PPV for identifying the presence of non-calcified plaque on coronary CTA, its NPV is high to exclude subclinical coronary atherosclerosis in asymptomatic subjects with a zero calcium score.

The relation between coronary artery calcification in asymptomatic subjects and both traditional risk factors and living in the city centre: a DanRisk substudy

To evaluate the association between the risk factor for living in the city centre as a surrogate for air pollution and the presence of coronary artery calcification (CAC) in a population of asymptomatic Danish subjects. A random sample of 1825 men and women of either 50 or 60 years of age were invited to take part in a screening project designed to assess risk factors for cardiovascular disease (CVD). Noncontrast cardiac computed tomography was performed on all subjects, and their Agatston scores were calculated to evaluate the presence of subclinical coronary atherosclerosis. The relationship between CAC and several demographic and clinical parameters was evaluated using multivariate logistic regression. A total of 1225 individuals participated in the study, of whom 250 (20%) were living in the centres of major Danish cities. Gender and age showed the greatest association with the presence of CAC: the odds ratio (OR) for men compared with women was 3.2 [95% confidence interval (CI) 2.5-4.2; P < 0.0001], and the OR for subjects aged 60 versus those aged 50 years was 2.2 (95% CI 1.7-2.8; P < 0.0001). Other variables independently associated with the presence of CAC were diabetes and smoking with ORs of 2.0 (95% CI 1.1-3.5; P = 0.03) and 1.9 (95% CI 1.4-2.5, P < 0.0001), respectively. The adjusted OR for subjects living in city centres compared to those living outside was 1.8 (95% CI 1.3-2.4; P = 0.0003). Both conventional risk factors for CVD and living in a city centre are independently associated with the presence of CAC in asymptomatic middle-aged subjects.

Formas graves de retinopatia predizem aterosclerose subclínica em indivíduos com diabetes tipo 1

In patients with type 2 diabetes, the presence of retinopathy is associated with increased cardiovascular disease, regardless of known risk factors for vascular disease. To investigate the association of diabetic retinopathy (DR) and its grades with the presence of subclinical coronary atherosclerosis in patients with type 1 diabetes. A cross-sectional study was conducted with 150 type 1 diabetes individuals asymptomatic for coronary artery disease. They underwent clinical evaluation for microvascular complications and for the presence of coronary artery calcification (CAC). Severe forms of DR (severe non-proliferative DR and proliferative DR) were associated with CAC (OR: 3.98 95% CI 1.13-13.9, p = 0.03), regardless of known risk factors for cardiovascular disease (age, A1C, hypertension, dyslipidemia and male gender). Patients with severe forms of DR are at risk for the presence of coronary artery disease regardless of traditional cardiovascular risk factors.

The Role of the Framingham Risk Score to Predict the Presence of Subclinical Coronary Atherosclerosis in Patients with HIV Infection

The Role of the Framingham Risk Score to Predict the Presence of Subclinical Coronary Atherosclerosis in Patients with HIV Infection

Cardiovascular Disease

Cardiovascular disease is the leading cause of death among men and women in the United States. Silent myocardial ischemia, defined as documentation of ischemia in the absence of angina or anginal equivalents, affects up to 4 million Americans and carries a poor prognosis. The assessment of the presence of subclinical coronary atherosclerosis affords an opportunity to identify patients who may be at risk for coronary artery disease over the long term. In addition to traditional risk factors (such as lipid parameters, diabetes, hypertension, smoking, and age), a variety of novel factors (such as lipoprotein[a], homocysteine, and C-reactive protein) may enhance assessment of risk in specific populations. Risk modification should be aimed at achieving recommended levels of lipids and blood pressure, reducing obesity, facilitating optimal management of diabetes and the metabolic syndrome, and encouraging smoking cessation and physical activity. Clinicians should be knowledgeable regarding the application of national guidelines for the reduction of cardiovascular risk so as to maximize the prospects for both the primary and secondary prevention of coronary artery disease and associated adverse outcomes.

The impact of body mass index and familial history of diabetes on the presence of subclinical coronary atherosclerosis

The impact of body mass index and familial history of diabetes on the presence of subclinical coronary atherosclerosis