The impact of dose reduction on the quantification of coronary artery calcifications and risk categorization: A systematic review

This study is the first systematic review of risk factors for stroke in China and supports the importance of current public health initiatives to manage the risk factors appropriately to reduce risk of stroke in high risk patients. Additionally, this study has been co-authored by prominent Chinese and US physicians and researchers with expertise in cardiovascular disease, neurologic disorders, epidemiology, and real world data. While there have been several systematic reviews of real world associations of risk factors for coronary artery disease, none focus specifically on the population of China, where there is growing evidence that such risk factors are poorly treated or uncontrolled, especially in rural areas. Background To better understand the impact of traditional cardiovascular risk factors on risk of coronary artery disease (CAD) in China, a systematic review of all Chinese observational studies published in either English or Chinese in MEDLINE and EMBASE over the last 5 years was performed and the association between any of 5 traditional risk factors (ie, hypertension, diabetes, elevated lipid levels, obesity, and smoking) and the risk of CAD was studied. Methods and Results The study found a consistent relationship between lipid levels and CAD. Higher low-density lipoprotein cholesterol values were associated with greater risk of CAD, with an odds ratio as high as 3.31. Other factors found to be significant contributors to the risk of CAD included hypertension (crude odds ratio range of 1.40-5.11), diabetes (1.50-5.97), and smoking (1.37-5.19). An association between obesity and CAD in China was observed, but the evidence supporting this was considered weak due to the paucity of studies found as part of this review. Conclusions This review provides a systematic summary of CAD risk factors in China and demonstrates the important differences that exist in CAD risk factors between countries and regions. Approaches to reduce CAD globally must take into account the unique risk factors that drive CAD in each country and region as is demonstrated by these findings.

Download Full-text

The impact of SSRIs on mortality and cardiovascular events in patients with coronary artery disease and depression: systematic review and meta-analysis

Clinical Research in Cardiology ◽

10.1007/s00392-020-01697-8 ◽

2020 ◽

Cited By ~ 2

Author(s):

Nuno Fernandes ◽

Luísa Prada ◽

Mário Miguel Rosa ◽

Joaquim J. Ferreira ◽

João Costa ◽

...

Keyword(s):

Systematic Review ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Cardiovascular Events ◽

Meta Analysis ◽

Artery Disease ◽

The Impact

Download Full-text

PW235 Quantifying The Impact of Using Coronary Artery Calcium Score For Risk Categorization Instead of Framingham Score or European Heart Score In Lipid Lowering Algorithms

Global Heart ◽

10.1016/j.gheart.2014.03.2331 ◽

2014 ◽

Vol 9 (1) ◽

pp. e305

Author(s):

Hussain Isma'eel ◽

Mohamad Almedawar ◽

Bernard Harbieh ◽

Wissam Alajaji ◽

Laila Al-Shaar ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Calcium ◽

Coronary Artery Calcium Score ◽

Calcium Score ◽

Lipid Lowering ◽

Framingham Score ◽

Heart Score ◽

The Impact ◽

Risk Categorization

Download Full-text

Heart-centered positioning and tailored beam-shaping filtration for reduced radiation dose in coronary artery calcium imaging: a MESA study

10.1101/2021.07.18.21259666 ◽

2021 ◽

Author(s):

Brendan Colvert ◽

Marzia Rigolli ◽

Amanda Craine ◽

Michael Criqui ◽

Francisco Contijoch

Keyword(s):

Coronary Artery ◽

Radiation Dose ◽

Dose Reduction ◽

Coronary Artery Calcium ◽

Patient Positioning ◽

Beam Shaping ◽

Clinical Role ◽

Risk Reclassification ◽

Scoring Accuracy ◽

The Impact

Purpose: Cardiac CT has a clear clinical role in the evaluation of coronary artery disease and assessment of coronary artery calcium (CAC) but the use of ionizing radiation limits clinical use. Beam shaping 'bow-tie' filters determine the radiation dose and the effective scan field-of-view diameter (SFOV) by delivering higher X-ray fluence to a region centered at the isocenter. A method for positioning the heart near the isocenter could enable reduced SFOV imaging and reduce dose in cardiac scans. However, a predictive approach to center the heart, the extent to which heart centering can reduce the SFOV, and the associated dose reductions have not been assessed. The purpose of this study is to build a heart-centered patient positioning model, to test whether it reduces the SFOV required for accurate CAC scoring, and to quantify the associated reduction in radiation dose. Methods: The location of 38,184 calcium lesions (3,151 studies) in the Multi-Ethnic Study of Atherosclerosis (MESA) were utilized to build a predictive heart-centered positioning model and compare the impact of SFOV on CAC scoring accuracy in heart-centered and conventional body-centered scanning. Then, the positioning model was applied retrospectively to an independent, contemporary cohort of 118 individuals (81 with CAC>0) at our institution to validate the model's ability to maintain CAC accuracy while reducing the SFOV. In these patients, the reduction in dose associated with a reduced SFOV beam-shaping filter was quantified. Results: Heart centering reduced the SFOV diameter 25.7% relative to body centering while maintaining high CAC scoring accuracy (0.82% risk reclassification rate). In our validation cohort, imaging at this reduced SFOV with heart-centered positioning and tailored beam-shaping filtration led to a 26.9% median dose reduction (25-75th percentile: 21.6 to 29.8%) without any calcium risk reclassification. Conclusions: Heart-centered patient positioning enables a significant radiation dose reduction while maintaining CAC accuracy.

Download Full-text

Impact of Pharmacist-Driven Transitions of Care Interventions on Post-hospital Outcomes Among Patients With Coronary Artery Disease: A Systematic Review

Journal of Pharmacy Practice ◽

10.1177/08971900211064155 ◽

2021 ◽

pp. 089719002110641

Author(s):

Erin Weeda ◽

Rachael E. Gilbert ◽

Shelby J. Kolo ◽

Jason S. Haney ◽

Linh Tran Hazard ◽

...

Keyword(s):

Systematic Review ◽

Coronary Artery ◽

Secondary Prevention ◽

Hospital Readmission ◽

The United States ◽

Transitions Of Care ◽

Prevention Measures ◽

Post Discharge ◽

Hospital Outcomes ◽

The Impact

Background Transitions of care (ToC) aim to provide continuity while preventing loss of information that may result in poor outcomes such as hospital readmission. Readmissions not only burden patients, they also increase costs. Given the high prevalence of coronary artery diseases (CAD) in the United States (US), patients with CAD often make up a significant portion of hospital readmissions. Objective To conduct a systematic review evaluating the impact of pharmacist-driven ToC interventions on post-hospital outcomes for patients with CAD. Methods MEDLINE, Scopus, and CINAHL were searched from database inception through 03/2020 using key words for CAD and pharmacists. Studies were included if they: (1) identified adults with CAD at US hospitals, (2) evaluated pharmacist-driven ToC interventions, and (3) assessed post-discharge outcomes. Outcomes were summarized qualitatively. Results Of the 1612 citations identified, 11 met criteria for inclusion. Pharmacist-driven ToC interventions were multifaceted and frequently included medication reconciliation, medication counseling, post-discharge follow-up and initiatives to improve medication adherence. Hospital readmission and emergency room visits were numerically lower among patients receiving vs not receiving pharmacist-driven interventions, with statistically significant differences observed in 1 study. Secondary prevention measures and adherence tended to be more favorable in the pharmacist-driven intervention groups. Conclusion Eleven studies of multifaceted, ToC interventions led by pharmacists were identified. Readmissions were numerically lower and secondary prevention measures and adherence were more favorable among patients receiving pharmacist-driven interventions. However, sufficiently powered studies are still required to confirm these benefits.

Download Full-text

Aberrant DNA methylation and miRNAs in coronary artery diseases and stroke: a systematic review

Briefings in Functional Genomics ◽

10.1093/bfgp/elz043 ◽

2020 ◽

Vol 19 (4) ◽

pp. 259-285 ◽

Cited By ~ 1

Author(s):

Anu Radha Sharma ◽

Umakanth Shashikiran ◽

Abdul Razak UK ◽

Ranjan Shetty ◽

Kapaettu Satyamoorthy ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Dna Methylation ◽

Coronary Artery ◽

Network Analysis ◽

Target Prediction ◽

Altered Expression ◽

Artery Disease ◽

Aberrant Dna Methylation ◽

The Impact

Abstract Coronary artery disease (CAD) and ischemic stroke are the two most predominant forms of cardiovascular diseases (CVDs) caused by genetic, epigenetic and environmental risk factors. Although studies on the impact of ‘epigenetics’ in CVDs is not new, its effects are increasingly being realized as a key regulatory determinant that may drive predisposition, pathophysiology and therapeutic outcome. The most widely studied epigenetic risk factors are regulated by DNA methylation and miRNA expression. To keep pace with growing developments and discoveries, a comprehensive review was performed using Pubmed, Science Direct and Scopus databases to highlight the role of DNA methylation and miRNAs in CAD and stroke subjects. Network analysis was performed using ClueGO software and miRTargetLink database. We identified 32 studies of DNA methylation on CAD and stroke, of which, 6 studies showed differences in global DNA methylation, 10 studies reported the genome-wide difference in DNA methylation and 16 studies demonstrated altered DNA methylation at 14 candidate loci. The network analysis showed positive regulation of nitric oxide biosynthetic process, homocysteine metabolic process and negative regulation of lipid storage. About, 155 miRNAs were associated with CAD, stroke and related phenotypes in 83 studies. Interestingly, mir-223 hypomethylation and altered expression were associated with cerebral infarction and stroke. The target prediction for 18 common miRNAs between CAD and stroke showed strong interaction with SP3 and SP1 genes. This systematic review addresses the present knowledge on DNA methylation and miRNAs in CAD and stroke, whose abnormal regulation has been implicated in etiology or progression of the diseases.

Download Full-text