Subclinical Atherosclerotic Disease Research Articles

Law Enforcement Officers Have an Increased Prevalence of Subclinical Cardiovascular Disease That Is Not Explained by Traditional Risk Factors.

The aim of the study is to determine if law enforcement officers develop subclinical atherosclerotic cardiovascular disease (ASCVD) earlier than nonofficers and, if so, the extent to which conventional risk factors explain this difference. Methods: Estimated pulse wave velocity (ePWV) was the marker of subclinical ASCVD. EPWV, ASCVD risk factors, metabolic syndrome (MetS), and 10-year risk for ASCVD were compared among 408 law enforcement officers and a civilian cohort. Results: EPWV, 10-year ASCVD risk, and MetS prevalence increased significantly with age. All but the officers age 55 and older had higher ePWV cohort than the civilian cohort ( P < 0.001). Ten-year ASCVD risk explained the most variability of ePWV ( R2 = 0.49, P < 0.001). Conclusions: Officers develop subclinical ASCVD earlier than nonofficers. Conventional ASCVD risk factors only explain about half of this increase. Occupational factors may play a role in contributing to this increased ASCVD risk.

PCSK9 genetic variants and risk of vascular and non-vascular diseases in Chinese and UK populations.

Lowering low-density lipoprotein cholesterol (LDL-C) through PCSK9 inhibition represents a new therapeutic approach to preventing and treating cardiovascular disease (CVD). Phenome-wide analyses of PCSK9 genetic variants in large biobanks can help to identify unexpected effects of PCSK9 inhibition. In the prospective China Kadoorie Biobank, we constructed a genetic score using three variants at the PCSK9 locus associated with directly measured LDL-C [PCSK9 genetic score (PCSK9-GS)]. Logistic regression gave estimated odds ratios (ORs) for PCSK9-GS associations with CVD and non-CVD outcomes, scaled to 1 SD lower LDL-C. PCSK9-GS was associated with lower risks of carotid plaque [n = 8340 cases; OR = 0.61 (95% confidence interval: 0.45-0.83); P = 0.0015], major occlusive vascular events [n = 15 752; 0.80 (0.67-0.95); P = 0.011], and ischaemic stroke [n = 11 467; 0.80 (0.66-0.98); P = 0.029]. However, PCSK9-GS was also associated with higher risk of hospitalization with chronic obstructive pulmonary disease [COPD: n = 6836; 1.38 (1.08-1.76); P = 0.0089] and with even higher risk of fatal exacerbations amongst individuals with pre-existing COPD [n = 730; 3.61 (1.71-7.60); P = 7.3 × 10-4]. We also replicated associations for a PCSK9 variant, reported in UK Biobank, with increased risks of acute upper respiratory tract infection (URTI) [pooled OR after meta-analysis of 1.87 (1.38-2.54); P = 5.4 × 10-5] and self-reported asthma [pooled OR of 1.17 (1.04-1.30); P = 0.0071]. There was no association of a polygenic LDL-C score with COPD hospitalization, COPD exacerbation, or URTI. The LDL-C-lowering PCSK9 genetic variants are associated with lower risk of subclinical and clinical atherosclerotic vascular disease but higher risks of respiratory diseases. Pharmacovigilance studies may be required to monitor patients treated with therapeutic PCSK9 inhibitors for exacerbations of respiratory diseases or respiratory tract infections. Genetic analyses of over 100 000 participants of the China Kadoorie Biobank, mimicking the effect of new drugs intended to reduce cholesterol by targeting the PCSK9 protein, have identified potential severe effects of lower PCSK9 activity in patients with existing respiratory disease.PCSK9 genetic variants that are associated with lower cholesterol and reduced rates of cardiovascular disease are also associated with increased risk of a range of respiratory diseases, including asthma, upper respiratory tract infections, and hospitalization with chronic obstructive pulmonary disease (COPD).These genetic variants are not associated with whether or not individuals have COPD; instead, they are specifically associated with an increase in the chance of those who already have COPD being hospitalized and even dying, suggesting that careful monitoring of such patients should be considered during development of and treatment with anti-PCSK9 medication.

Evaluation of Cardiovascular Risk in Patients with Type 1 Diabetes: How Ankle Brachial Index Can Be Usefull?

Background: Patients with type 1 diabetes (T1D) face a significantly higher mortality risk compared to the general population, primarily due to elevated rates of cardiovascular disease (CVD). Detecting cardiovascular disease at its preclinical stage is essential for effective primary prevention in this relatively young population. This study aims to assess the link between steno-risk and subclinical atherosclerotic disease, as detected by the Ankle-Brachial Index (ABI), in T1D patients and determine the prevalence of these abnormalities among them. Methods: A cohort of 312 adults with T1D (151 males and 161 females, mean age 31 ± 12 years) was examined. Patients were categorized based on their ABI values (ABI &lt; 0.9 indicating peripheral arterial disease (PAD), ABI ≥ 1.3 indicating arterial calcification (AC), and ABI between 0.9 and 1.3 indicating normal ABI). The study analyzed the relationship between ABI anomalies and cardiovascular risk factors and their association with the steno-risk category. Results: Among the patients, 138 (44.2%) had a normal ABI, 112 (35.9%) had PAD, and 62 (19.9%) had AC. AC was more prevalent in men than in women (p = 0.006). A family history of stroke was common in both the PAD and AC groups (p = 0.042 and p = 0.046, respectively). Patients with AC were often older (36 ± 13 vs. 30 ± 12; P = .012), had a longer duration of diabetes (20 ± 11 vs. 14 ± 9; P &lt; 0.001), a higher prevalence of hypertension (25.8% vs. 14.5%, P = 0.05), and a higher prevalence of smoking (19.3% vs. 9.4%, P = 0.046). A higher number of subjects with AC were found in the Steno-Risk 10–20% and Steno-Risk ≥20% categories compared to the Steno-Risk &lt; 10% (37.5 vs. 15.5; 29 vs. 15.5, p = 0.0106, respectively). Conclusion: This study demonstrates that an ABI &gt; 1.30 is more common in older patients with type 1 diabetes and is associated with a longer duration of diabetes, male gender, smoking, hypertension, and a family history of stroke. Furthermore, an ABI &gt; 1.30, indicating arterial calcification, is significantly linked to moderate and high cardiovascular risk assessed by steno-risk in patients with type 1 diabetes. The ABI may serve as a straightforward tool for screening atherosclerosis in T1D.

Plasma levels of amyloid beta 1-40 are associated with ultrasonographic morphological characteristics related with carotid plaque vulnerability in individuals without cardiovascular disease

Abstract Background Amyloid-beta (1-40) (Αb40), a proinflammatory and pro-atherosclerotic peptide, is associated with concurrent subclinical atherosclerotic cardiovascular disease (ASCVD) and with major adverse cardiac events in both primary and secondary prevention settings conferring additive and reclassification value over traditional risk factors and risk scores. This evidence supports the hypothesis that Ab40 could be a biomarker of ASCVD. However, mechanistic data on the association of Αb40 with in vivo morphological characteristics of atherosclerosis related with plaque vulnerability are not available. Purpose To examine the association of Ab40 levels with characteristics of the carotid artery wall in the general population. Methods In the settings of the Athens Vascular registry, subjects without clinically overt ASCVD were consecutively recruited (n=301). Subclinical carotid atherosclerosis was assessed by ultrasonography and the images were subsequently analyzed using a dedicated software (AMS v3.03). The sum and maximal area of atherosclerotic plaques (PLQ) and the minimum echogenicity using grey scale median (GSM) of intima-media thickness (IMT, IMT_GSM) and atherosclerotic plaques (PLQ_GSM) were used as the main endpoints of the analysis. Αb40 was measured in plasma samples. Results Subjects with Ab40 levels in the highest tertile had higher prevalence of male sex, presence of carotid plaque atherosclerosis, higher sum and maximal PLQ are and lower GFR HDL-C levels and lower PLQ_GSM (p&amp;lt;0.05 for all). Ab40 in the highest vs. lower tertile was associated with higher sum and maximal plaque area (b-coefficient= 22.9 95% CI: 0.72, 45.1, p=0.43 and b-coefficient= 10.5 95% CI: 1.77, 19.3, p=0.019, for sum and maximal plaque area, respectively) after adjustment for traditional cardiovascular risk factors and GFR (core model). Moreover, Ab40 in the highest tertile was associated with decreased GSM of both IMT and PLQ in the carotid arteries (b-coefficient= -6.0 95% CI: -9.6, -2.36, p=0.001, for IMT and b-coefficient= -8.66 95% CI: -16.5, -0.79, p=0.31, for PLQ) after adjustment for the core model. Conclusion In individuals without clinically overt ASCVD, higher levels of Ab40 are associated with the larger atherosclerotic burden and with ultrasonographic characteristics related to higher plaque vulnerability. These findings suggest a mechanistic background for the established association of Ab40 with major adverse cardiovascular events.

Menopausal vasomotor symptoms and subclinical atherosclerotic cardiovascular disease

Abstract Background Menopausal vasomotor symptoms (VMS) have been associated with subclinical and manifest atherosclerotic cardiovascular disease (ASCVD) but the scientific basis is limited and VMS have not been studied in relation to image-detected coronary atherosclerosis. PURPOSE To assess, in peri- and postmenopausal women, associations between VMS and subclinical ASCVD detected through computed tomography angiography (CCTA), coronary artery calcium score (CACS) or carotid ultrasound, and if potentially determined associations are modified by menopausal hormone therapy (MHT) or regular physical activity (PA). Methods This cross-sectional population-based study was conducted on a subset of participants from the Swedish CArdioPulmonary BioImage Study (SCAPIS), including women 50-65 years of age. The women underwent comprehensive cardiovascular assessments and completed an extensive questionnaire, which included questions about current and previous menopause-related symptoms. VMS was assessed on a 4-point scale and analyzed in relation to subclinical ASCVD, detected via CCTA, CACS and carotid ultrasound using multivariate logistic regression analyses. Results Of 2995 women included, 14.2% reported severe VMS (n= 425), 18.1% moderate VMS (n=543), and 67.7% no or mild VMS (n=2027). Women with severe, but not those with moderate, VMS had higher prevalence of CCTA detected atherosclerosis (34.1% vs 27.8%, p&amp;lt;0.05), but not CACS &amp;gt;100 (5.8% vs 6.6% p &amp;gt;0.05) or any carotid plaque (47.6% vs 46.6%, p&amp;gt;0.05) than women with no or mild VMS. Using the same reference category, severe but not moderate VMS was significantly associated with CCTA-detected atherosclerosis, odds ratio (OR) before and after multivariable adjustment 1.36, 95% confidence interval (CI) 1.08 – 1.72 and 1.33, 95% CI 1.02 – 1.72, respectively. This association became stronger when requiring an over 5-year duration of severe VMS, multivariable adjusted OR 1.53, 95% CI 1.09 – 2.14. Additional adjustment for MHT strengthened the association (OR 1.64, 95% CI 1.16 – 2.32). No significant association with CACS &amp;gt;100 or with the presence of any carotid plaque was observed. Additional adjustment for PA did not change any associations. Conclusions Severe but not moderate VMS were significantly associated with CCTA detected atherosclerosis, independent of a broad range of cardiovascular risk factors. Further research is required to determine the eventual causality of this relationship.Figure 1.Forest plots

Abstract 15088: Presence and Severity of Subclinical Atherosclerotic Disease in the Primary Prevention of the Oncologic Population

Introduction: There is scarce evidence about endothelial dysfunction and damage in patients with a history of cancer in cardiovascular primary prevention and the impact in the development of Subclinical Atherosclerotic Disease (SCAD). Methods: A cross-sectional study was carried out on a registry of patients enrolled in primary prevention who had a Doppler ultrasound (DUS) screening for SCAD in the carotid and ileofemoral territory from 09/2020 to 04/2023. Inclusion criteria: 18 years old or older. Exclusion criteria: Previous cardiovascular and/or cerebrovascular event. History of cancer was defined as active or remitted cancer, excluding basal cell and squamous cell carcinoma. Population was divided in two, G1: non-oncologic group; G2 oncologic group. SCAD was defined as the presence of more than 1 atherosclerotic plaque in the carotid and/or ileofemoral territory. Univariate and bivariate analysis were done to establish population characteristics. Results: A total of 7920 patients were included: 7694 in G1 and 226 in G2 (97.15% vs 2.85%). G2 patients were older, mostly women and had higher prevalence of hypertension and dyslipidemia. Clinical characteristics and findings of the DUS are shown in Table1. A linear regression was done to assess the total plaque area compared to oncologic history, adjusted for age, sex, smoking history, dyslipidemia, obesity, sedentarism, diabetes, and hypertension. Results show that history of cancer is a predictor for SCAD (OR=1.43 [IC 95%: 1.1-1.9], p=0.021). Cancer also seems to be associated with a higher number of territories affected by SCAD (OR=1.63 [IC 95%: 1.2-2.1], 0.001) adjusted for age, sex, tobacco use, obesity, dyslipidemia, diabetes, sedentarism, and hypertension. Conclusions: Patients with history of cancer had more SCAD. Cancer behaved as a predisposing factor for increased plaque presence and area, adjusted for classic risk factors. This raises the need for more intensive control of SCAD in cancer patients.

Use of Coronary Artery Calcium Quantification and Distribution for Coronary Vascular Disease Risk Reclassification in a Primary Prevention Setting

In a large screening program of asymptomatic middle-aged individuals, we sought to assess the degree of risk reclassification provided by comparing multiethnic study on subclinical atherosclerosis coronary artery calcium scoring (CACS) versus atherosclerotic cardiovascular disease (ASCVD) and Reynolds risk score (RRS) score. All 5,324 consecutive patients (aged 57 ± 8years, 76% male) who underwent CACS screening at the Cleveland Clinic as part of a primary prevention executive health between March 16 and October 21 were included. The 10-year ASCVD, RRS, and multiethnic study on subclinical atherosclerosis CACS (MESA-CACS) risk scores were calculated and categorized as <1, 1 to 4.99, 5 to 9.99, and ≥10%. Compared with ASCVD, using MESA-CACS resulted in a downgraded risk in 1,667 subjects (31%), whereas 738 (14%) had an upgrade in risk (total of 45% reclassification). Similarly, compared with RRS, using MESA-CACS resulted in an upgraded risk in 797 (15%) and a downgrade in 1,380 (26%) subjects (total of 41% reclassification). However, by further dividing by the distribution of the coronary calcification, ASCVD overestimates the risk only for patients with coronary artery calcium (CAC) in 0 or 1 coronary artery only, whereas MESA-CACS overestimates if the CAC was noted in ≥2 arteries. Similarly, RRS only overestimates the risk for patients with 0 CAC, whereas it underestimates the risk for patients with any CAC. In conclusion, the use of MESA-CACS, along with CAC distribution in primary prevention clinics, results in differential and significant reclassification of traditional scores when calculating the 10-years coronary vascular disease risk. Overall, RRS underestimates and ASCVD overestimates the cardiovascular disease risk compared with MESA-CACS.

Coronary artery calcium scoring for cardiovascular risk assessment in patients with inflammatory bowel disease

Inflammatory bowel disease (IBD) is associated with higher incidence of atherosclerotic cardiovascular disease (ASCVD). Data investigating the role of coronary artery calcium (CAC) scoring in identifying subclinical atherosclerotic disease in IBD patients is scarce. Using data obtained from the CLARIFY registry, a prospective study of no-charge coronary artery calcium (CAC) testing at University Hospitals, we reviewed patients with ulcerative colitis (UC) or Crohn's disease (CD) who underwent CAC scoring from 2014 to 2020. We investigated the concordance between CAC risk and 10-year estimated ASCVD risk by AHA/ACC pooled cohort equation using pre-established thresholds for statin prescription (CAC≥100, 10-year ASCVD risk ≥7.5%). We additionally investigated the association between CAC, preventive therapy initiation and Major Adverse Cardiovascular Events (MACE). A total of 369 patients with IBD were included (174 UC, 195 CD), with median age of 60 years. The median CAC score was 14.9 with no significant difference between UC and CD (P=.76). Overall, 151 (41%) had CAC of 0, 108 (29%) had CAC 1-99, 61 (17%) had CAC 100 to 399, and 49 (13%) had CAC ≥400 with no difference in CAC distribution between CD and UC (P=.17). There was no difference in median CAC between IBD or age/sex-matched controls (P=.34). Approximately half of the patients (52%) with IBD had 10-year estimated ASCVD risk of 7.5% or higher. Among patients with ASCVD risk <7.5% (n=163), 29 (18%) had CAC≥100 and among patients with ASCVD risk ≥7.5% (n=178), 102 (57%) had CAC <100. There was no difference between CAC<100 vs CAC≥100 with respect to CRP, use of immunosuppressive or amino-salicylate therapy, IBD severity or complications. CAC score (AUROC 0.67 [0.56-0.78]), but not PCE ASCVD risk (AUROC 0.60 [0.48-0.73]), was predictive of MACE. The best cut-off for CAC score was 76 (sensitivity=60%, specificity=69%), and was associated with 4-fold increase in MACE (Hazard Ratio 4.0 [2.0-8.1], P < .001). Subclinical atherosclerosis, as evaluated by CAC scoring, is prevalent in patients with IBD, and is associated with cardiovascular events. Further studies are needed to understand underlying biological processes of increased atherosclerotic disease risk among adults with IBD.

Low adherence to the Mediterranean diet is associated with increased prevalence and number of atherosclerotic plaques in the ILERVAS cohort

Background and aimsCurrent research on the association between dietary patterns and subclinical atherosclerotic disease (SAD) is still limited, and published results are inconsistent and often consist of small population sizes. We aimed to evaluate the association between the Mediterranean diet (MDiet) and SAD in a large cohort of Mediterranean individuals. MethodsThis was a cross-sectional study that included 8116 subjects from the ILERVAS cohort. The presence of atherosclerotic plaques (AP) was assessed by ultrasound examination. Adherence to the MDiet was assessed using the 14-item Mediterranean Diet Adherence Score (MEDAS). Inclusion criteria were subjects with at least one cardiovascular risk factor. Exclusion criteria were a clinical history of diabetes, chronic kidney disease, or a prior cardiovascular event. Bivariable and multivariable models were performed. ResultsCompared with subjects without SAD, participants with SAD were older and had a higher frequency of smoking habit, hypertension, dyslipidemia, HbA1c and waist circumference. The adjusted multivariable analysis showed that a higher MEDAS was associated with a lower risk of AP (incidence rate ratios [IRR] 0.97, 95% CI [0.96–0.98]; p<0.001). Furthermore, moderate or high adherence to the MDiet was associated with a lower number of AP compared with a low MDiet adherence (IRR 0.90, 95% CI [0.87–0.94]; p<0.001). In both models, female sex was associated with a lower risk of AP. ConclusionsOur findings point to a potentially protective role of MDiet for SAD in a Mediterranean population with low-to-moderate cardiovascular risk. Further research is needed to establish a causal relationship between both variables.

Long-Term High Level of Insulin Resistance Is Associated With an Increased Prevalence of Coronary Artery Calcification: The CARDIA Study.

Background Coronary artery calcification (CAC) is a crucial indicator of subclinical atherosclerotic cardiovascular disease. The relationship between long-term insulin resistance (IR) trajectory and CAC has been explored in few studies. Therefore, this study aimed to investigate whether the long-term IR time series of young adults are associated with the incidence of CAC in midlife. Methods and Results In a cohort study comprising 2777 participants from the CARDIA (Coronary Artery Risk Development in Young Adults) study, the homeostasis model assessment for IR was used to measure IR levels, and group-based trajectory modeling was used to fit three 25-year homeostasis model assessments for IR trajectories. Logistic regression was used to estimate the association between the 3 homeostasis model assessments for IR trajectories and CAC events at year 25. The results showed that among 2777 participants (mean age, 50.10±3.58 years; 56.2% women; 46.4% Black), there were 780 incident CAC events after a 25-year follow-up. After full adjustment, the prevalence of CAC was higher in the moderate- (odds ratio [OR], 1.40 [1.10-1.76]) and the high-level homeostasis model assessments for IR trajectories (OR, 1.84 [1.21-2.78]) than in the low-level trajectory. This association was observed in obese individuals despite the negative interaction between IR and different types of obesity (all P interactions >0.05). Conclusions Our study revealed that young adults with a higher level of IR were more likely to develop CAC in middle age. Furthermore, this association persisted in obese individuals. These findings highlight the importance of identifying subclinical cardiovascular risk factors and implementing primary prevention measures.

Carotid Ultrasound Abnormalities of People Living With HIV in Kunming, China: Multiple Correspondence Analysis Approach to Identify Influencing Factors.

With the use of antiretroviral therapy (ART), the life expectancy of people living with HIV (PLWH) is gradually increasing, but subclinical atherosclerotic cardiovascular disease is becoming increasingly common in PLWH. We obtained data from 326 PLWH. Based on the results of carotid ultrasonography, we divided patients into normal and abnormal carotid ultrasound groups and performed the χ2 test and multiple correspondence analysis (MCA) to determine the influencing factors of abnormal carotid ultrasound. Among the 326 PLWH, the overall abnormality rate of carotid ultrasound was 31.9% (104/326). MCA showed that carotid ultrasound abnormalities were markedly more common in patients with age (non-youth), BMI ≥24.0kg/m2, hypertension, diabetes, hyperlipidemia, ART treatment ≥5years, and CD4+T lymphocyte count <200/μL. Carotid ultrasound is more likely to be abnormal when PLWH have higher age, BMI ≥24.0kg/m2, hypertension, diabetes, hyperlipidemia, a longer course of ART, and a low CD4+ T lymphocyte count.

Microvascular reactivity using laser Doppler measurement in type 2 diabetes with subclinical atherosclerosis

Microangiopathy should be noted in diabetes with subclinical vascular diseases. Little is known about whether various surrogate markers of systemic arterial trees exacerbate simultaneously in preclinical atherosclerosis. To clarify the association of skin microvascular reactivity with arterial stiffness is essential to elucidating early atherosclerotic changes. The post-occlusive reactive hyperemia of skin microcirculation was evaluated in 27 control and 65 type 2 diabetic subjects, including 31 microalbuminuria (MAU) and 34 normoalbuminuria (NAU) patients. The laser Doppler skin perfusion signals were transformed into three frequency intervals for the investigation of endothelial, neurogenic, and myogenic effects on basal and reactive flow motion changes. The analysis of spectral intensity and distribution provided insight into potential significance of microvascular regulation in subclinical atherosclerotic diseases. Systemic arterial stiffness was studied by the brachial ankle pulse wave velocity (baPWV). Following occlusive ischemia, the percent change of endothelial flow motion was lower in MAU than in NAU and control groups. The MAU group revealed a relative increase in myogenic activity and a decrease in endothelial activity in normalized spectra. The baPWV showed more significant associations with reactive endothelial change (r = - 0.48, P < 0.01) and normalized myogenic value (r = - 0.37, P < 0.05) than diabetes duration and HbA1c. By multivariate regression analysis, only endothelial vasomotor changes independently contributed to the decreased baPWV (OR 3.47, 95% CI 1.63-7.42, P < 0.05). Impaired microcirculatory control is associated with increased arterial stiffness in preclinical atherosclerosis. To identify the early manifestations is necessary for at-risk patients to prevent from further vascular damage.

Association of high-sensitivity troponin T with outcomes in asymptomatic non-severe aortic stenosis: a post-hoc substudy of the SEAS trial

High-sensitivity Troponin T (hsTnT), a biomarker of cardiomyocyte overload and injury, relates to aortic valve replacement (AVR) and mortality in severe aortic stenosis (AS). However, its prognostic value remains unknown in asymptomatic patients with AS. We aimed to investigate if an hsTnT level >14pg/mL (above upper limit of normal 99th percentile) is associated with echocardiographic AS-severity, subsequent AVR, ischaemic coronary events (ICE), and mortality in asymptomatic patients with non-severe AS. In this post-hoc sub-analysis of the multicentre, randomised, double-blind, placebo-controlled SEAS trial (ClinicalTrials.gov, NCT00092677), we included asymptomatic patients with mild to moderate-severe AS. We ascertained baseline and 1-year hsTnT concentrations and examined the association between baseline levels and the risk of the primary composite endpoint, defined as the first event of all-cause mortality, isolated AVR (without coronary artery bypass grafting (CABG)), or ICE. Multivariable regressions and competing risk analyses examined associations of hsTnT level >14pg/mL with clinical correlates and 5-year risk of the primary endpoint. Between January 6, 2003, and March 4, 2004, a total of 1873 patients were enrolled in the SEAS trial, and 1739 patients were included in this post-hoc sub-analysis. Patients had a mean (SD) age of 67.5 (9.7) years, 61.0% (1061) were men, 17.4% (302) had moderate-severe AS, and 26.0% (453) had hsTnT level >14pg/mL. The median hsTnT difference from baseline to 1-year was 0.8pg/mL (IQR,-0.4 to 2.3). In adjusted linear regression, log(hsTnT) did not correlate with echocardiographic AS severity (p=0.36). In multivariable Cox regression, a hsTnT level >14pg/mL vs. hsTnT ≤14pg/mL was associated with an increased risk of the primary composite endpoint (HR, 1.41; 95% CI, 1.18-1.70; p=0.0002). In a competing risk model of first of the individual components of the primary endpoint, a hsTnT level >14pg/mL was associated with ICE risk (HR 1.71; 95% CI, 1.23-2.38; p=0.0013), but not with isolated AVR (p=0.064) or all-cause mortality (p=0.49) as the first event. hsTnT level is within the reference range (≤14pg/mL) in 3 out of 4 non-ischaemic patients with asymptomatic mild-to-moderate AS and remains stable during a 1-year follow-up regardless of AS-severity. An hsTnT level >14pg/mL was mainly associated with subsequent ICE, which suggest that hsTnT concentration is primarily a risk marker of subclinical coronary atherosclerotic disease. Merck & Co., Inc., the Schering-Plough Corporation, the Interreg IVA program, Roche Diagnostics Ltd., and Gangstedfonden. Open access publication fee funding provided by prof. Olav W. Nielsen and Department of Cardiology, Bispebjerg University Hospital, Denmark.

Evaluación de enfermedad cardiovascular subclínica en pacientes con diabetes mellitus tipo 1

Introducción: pacientes con diabetes mellitus tipo 1 (DM1) poseen mayor riesgo de enfermedad cardiovascular (ECV). Existen estudios en los que se observó que en pacientes con DM1 la ECV aparece en edades más tempranas, comparado con la población general. La asociación de anomalías vasculares y aterosclerosis es muy frecuente en DM1, siendo la detección del engrosamiento de la íntima media carotidea un método útil para realizar el diagnóstico de enfermedad aterosclerótica subclínica.&#x0D; Objetivos: realizar detección precoz de ECV subclínica, conocer si existe correlación directa entre la DM1 y diversos factores de riesgo a fin de instaurar medidas terapéuticas tempranas.

Improved adherence to statins following pictorial intervention. Sub study of visualization of subclinical atherosclerotic disease for optimum cardiovascular prevention (VIPVIZA)

Abstract Introduction VIPVIZA is a prospective, randomised controlled trial with open label and masked evaluators, integrated in Västerbotten intervention programme (VIP), a population-based CVD screening and prevention programme examining 40,50,60-year-olds. In VIPVIZA subclinical atherosclerosis was identified by ultrasound and pictorial information about carotid plaque presence, carotid thickness and risk assessment was provided to participants and their physicians. After examination, participants were randomized to pictorial information (intervention) or as usual care (control). Previous studies from VIPVIZA have shown that the time to initiation of statins is lower and the proportion of statin users is higher in the intervention group. Purpose To study whether the pictorial risk information intervention made participants with pre intervention prescription of statins more adherent to statin treatment. Method During 2013–2016, 3532 participants in VIPVIZA were screened by carotid ultrasound examination, of which 46% had plaque, 546 had expedited prescriptions of statins (ATC codes: C10AAxx, C10B, C10BA, C10BX) prior to inclusion. Participants were followed from inclusion until 3-year follow-up examination. Adherence calculations were based on Swedish prescription drug registry (PDR). For adherence calculations we assumed that medication is used as prescribed. Dose change of same medication is considered, and number of days' supply is recalculated if a dispensing event contains a change of dose. The new dose comes into effect the day of dispensing a prescription with a dose change. For the follow-up period the number of days with potential use (based on supply) is divided by days from baseline examination until 3-year examination, yielding a value in the interval [0,1] where 0 is non adherent and 1 perfect adherence. Remaining supply of medication at the end of follow-up period is disregarded. Adherence was also dichotomised at 0.8. Results The average adherence to statins was higher in the intervention group for participants with carotid plaque, 0.844 vs 0.773, confidence interval 95% for mean difference (−0.125, −0.018), p=0.009. The intervention group with carotid plaque had the best adherence of all subgroups, but the difference in adherence within the intervention group (plaque vs no plaque) was non-significant. With respect to sex the difference in mean adherence between intervention and control for males was 0.826–0.795 while for females 0.815–0.742. With dichotomised adherence the increase in the intervention group is significant for females, p=0.027. See table 1. Conclusion Providing information about subclinical atherosclerosis increases adherence to statins, especially in participants with plaque and females. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swedish Research Council

Impact of cognitive ability in young adult age on risk of cardiovascular disease and presence of subclinical carotid plaques among men aged 60 years

Abstract Background A clear association between low cognitive ability in early adult life and increased risk of premature cardiovascular diseases (CVD) has been demonstrated [1]. However, the mechanisms for this relationship are not fully understood. Also, despite the evidence on low early cognitive ability being a risk factor for CVD, specific CVD prevention studies in this group has not been reported and low cognitive ability has not been mentioned in clinical guidelines for prevention of CVD. Purpose To clarify the interrelationships between early adult life cognitive ability and late middle-life health behaviors and the risk of CVD and presence of subclinical carotid plaque. Methods Register-data from psychological testing of men at age 18–19 years in the Swedish Enlistment Battery was used (n=1009), and early cognitive ability was calculated as the mean of four subtests on a scale from 1 to 9 (logical-inductive ability, verbal ability, visuospatial ability and technical understanding). A lifestyle index on a scale from 4 to 12, which was calculated as the sum of self-reported diet, physical activity, smoking and alcohol consumption, where each behavior was divided into 3 levels and the most health-promoting level was the highest level, as well as clinical CVD risk factors were collected at age 60 years within the VIPVIZA RCT (Västerbotten Intervention Program – Visualization of subclinical Atherosclerotic disease for optimum cardiovascular prevention) [2]. Risk of CVD was calculated as SCORE and presence of carotid plaques was identified, based on ultrasonography and defined according to Mannheim consensus [2]. Early cognitive ability's association to SCORE and presence of carotid plaques was assessed using linear and logistic regression, respectively. The linear regression was performed using restricted cubic splines to account for non-linearity. Results Early cognitive ability and the lifestyle index were normally distributed (mean 4.24, SD 1.12 and mean 9.95, SD 1.484, respectively). Mean of SCORE was 2.6%, SD 1.4. Carotid plaques were observed among 61%. A statistically significant negative association between early cognitive ability and SCORE was found (p=0.009, Figure 1). Higher early cognitive ability was also associated with a decreased risk for carotid plaques, with an odds ratio 0.86 for each increase of one point in cognitive ability (95% CI: 0.76–0.96, p=0.007). Conclusion Among men, higher cognitive ability at age 18–19 years is associated with lower risk of CVD and lower risk of having carotid plaque at age 60 years Additional modelling analyses are warranted to clarify the mediating and moderating roles of socioeconomic position, lifestyle and clinical CVD risk factors on the path between early cognitive ability and risk of CVD and subclinical atherosclerosis. This may guide development of tailored interventions to reduce the inequity in CVD due to cognitive ability. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Swedish Research CouncilRegion Västerbotten

Carotid intima media thickness (CIMT) in adults in the AWI-Gen Nairobi site study: Profiles and predictors

BackgroundCarotid intima media thickness (CIMT) is used as a marker of subclinical and asymptomatic atherosclerotic vascular disease. Increased CIMT is associated with future cerebrovascular and cardiovascular events. There is limited data on the profile and correlates of CIMT in Africa. The aim of this study was to describe the profile and correlates of CIMT in apparently normal younger-age adults in an urban setting in Kenya. MethodsThis study used population-based data collected from 2003 adults between the ages of 40 and 60 years in two slums of Nairobi as part of a genetic study. CIMT was measured using LOGIQ e (GE Healthcare, CT, USA) ultrasound on both left and right carotid arteries, whereby maximum, mean, and minimum values were recorded. Age- and sex-specific CIMT measurements were calculated and their association with basic sociodemographic, behavioral and body composition indicators were investigated. ResultsThe median (IQR) CIMT were 0.58 (0.51, 0.66) and 0.59 (0.53, 0.66) in men and women, respectively. About 16% of the study population had CIMT greater than 0.7mm, the cut off for higher CIMT. Nearly 60% had CIMT values ≥75th percentile. Age, current use of alcohol, systolic blood pressure, subcutaneous fat thickness, pulse rate and pulse pressure were found to be the main predictors of CIMT in our study population. ConclusionThis study provided population-based reference values and predictors for CIMT for an adult population living in urban poor settings in Kenya. Future studies need to consider biochemical and genetic predictors of CIMT in this population.

Increased serum IL-6 is predictive of long-term cardiovascular events in high-risk patients submitted to coronary angiography: an observational study

BackgroundInterleukin-6 (IL-6) is an inflammation-related cytokine associated with an elevated risk of cardiovascular events. In a previous study, we demonstrated that increased IL-6 was predictive of sub-clinical atherosclerotic coronary disease in intermediate-risk patients undergoing coronary angiography. In the present study, we investigated whether increased serum IL-6 is predictive of cardiovascular events in high-risk patients.MethodsIn this observational study, consecutive patients referred for elective coronary angiography due to stable chest pain/myocardial ischemia had IL-6 measured immediately before the procedure. Long-term follow-up was performed by phone call or e-mail, and their clinical registries were revised. The primary outcome was a composite of new myocardial infarction, new ischemic stroke, hospitalization due to heart failure, new coronary revascularization, cardiovascular death, and death due to all causes.ResultsFrom 141 patients submitted to coronary angiography and IL-6 analysis, 100 had complete follow-up data for a mean of 5.7 years. The median age was 61.1 years, 44% were men, and 61% had type-2 diabetes. The median overall time-to-event for the primary outcome was 297 weeks (95% confidence interval [CI] 266.95–327.16). A receiver operator characteristic curve defined the best cut-off value of baseline serum IL-6 (0.44 pg/mL) with sensitivity (84.37%) and specificity (38.24%) to define two groups. High (> 0.44 pg/mL) IL-6 levels were predictive of cardiovascular events. (p for interaction = 0.015) (hazard ratio = 2.81; 95% CI 1.38–5.72, p = 0.01). Subgroup analysis did not find interactions between patients with or without diabetes, obesity, or hypertension.ConclusionIn conclusion, an interleukin-6 level higher than 0.44 pg/mL, obtained just before elective coronary angiography, was associated with a poorer prognosis after a mean of 5,7-year. A pre-procedure IL-6 below 0.44 pg/mL, on the other hand, has a very good negative predictive value, suggesting a good prognosis, and may be useful to better indicate coronary angiography in high-risk patients..

Extreme lipoprotein(a) levels and sub-clinical atherosclerotic disease: A descriptive case-control study (the Lp(a)extravasc study)

Background and Aims : Lipoprotein(a) [Lp(a)] contributes to atherogenesis, reduces fibrinolysis leading to thrombogenesis and increases pro-inflammatory response. Extreme levels of Lp(a) are associated with an increased risk of cardiovascular mortality, coronary heart disease, peripheral artery disease and stroke in primary prevention. Whether extreme Lp(a) is associated with sub-clinical atherosclerotic cardiovascular disease (sASCVD) has not been described yet. The aim of this study was to assess sASCVD in patients with extreme Lp(a) levels in primary prevention.

Association of left ventricular diastolic function with coronary artery calcium score: A Project Baseline Health Study

BackgroundCoronary artery calcium (CAC) and left ventricular diastolic dysfunction (LVDD) are strong predictors of cardiovascular events and share common risk factors. However, their independent association remains unclear. MethodsIn the Project Baseline Health Study (PBHS), 2082 participants underwent cardiac-gated, non-contrast chest computed tomography (CT) and echocardiography. The association between left ventricular (LV) diastolic function and CAC was assessed using multidimensional network and multivariable-adjusted regression analyses. Multivariable analysis was conducted on continuous LV diastolic parameters and categorical classification of LVDD and adjusted for traditional cardiometabolic risk factors. LVDD was defined using reference limits from a low-risk reference group without established cardiovascular disease, cardiovascular risk factors or evidence of CAC, (n ​= ​560). We also classified LVDD using the American Society of Echocardiography recommendations. ResultsThe mean age of the participants was 51 ​± ​17 years with 56.6% female and 62.6% non-Hispanic White. Overall, 38.1% had hypertension; 13.7% had diabetes; and 39.9% had CAC >0. An intertwined network was observed between diastolic parameters, CAC score, age, LV mass index, and pulse pressure. In the multivariable-adjusted analysis, e’, E/e’, and LV mass index were independently associated with CAC after adjustment for traditional risk factors. For both e’ and E/e’, the effect size and statistical significance were higher across increasing CAC tertiles. Other independent correlates of e’ and E/e’ included age, female sex, Black race, height, weight, pulse pressure, hemoglobin A1C, and HDL cholesterol. The independent association with CAC was confirmed using categorical analysis of LVDD, which occurred in 554 participants (26.6%) using population-derived thresholds. ConclusionIn the PBHS study, the subclinical coronary atherosclerotic disease burden detected using CAC scoring was independently associated with diastolic function. Clinicaltrials.gov identifierNCT03154346.