Aortic plaque burden predicts vascular events in patients with cardiovascular disease: The EAST-NOGA study

Objective: To identify determinants associated with insulin resistance and to assess the association between insulin resistance and cardiovascular events, vascular interventions and mortality in people with type 1 diabetes at high risk of cardiovascular disease . Design: Prospective cohort study. Methods: 195 people with type 1 diabetes from the Secondary Manifestations of ARTerial disease (SMART) cohort were included. Insulin resistance was quantified by the estimated glucose disposal rate (eGDR) with higher eGDR levels indicating higher insulin sensitivity (i.e. lower eGDR levels indicating higher insulin resistance). Linear regression models were used to evaluate determinants associated with eGDR. The effect of eGDR on cardiovascular events, cardiovascular events or vascular interventions (combined endpoint) and on all-cause mortality was analysed using Cox proportional hazards models adjusted for confounders. Results: In 195 individuals (median follow-up 12.9 years, IQR 6.7-17.0), a total of 25 cardiovascular events, 26 vascular interventions and 27 deaths were observed. High eGDR as a marker for preserved insulin sensitivity was independently associated with a lower risk of cardiovascular events (HR 0.75; 95%CI 0.61-0.91), a lower risk of cardiovascular events and vascular interventions (HR 0.74; 95%CI 0.63-0.87), and a lower risk of all-cause mortality (HR 0.81; 95%CI 0.67-0.98). Conclusions: Insulin resistance as measured by eGDR is an additional risk factor for cardiovascular disease in individuals with type 1 diabetes. Modification of insulin resistance by lifestyle interventions or pharmacological treatment could be a viable therapeutic target to lower the risk of cardiovascular disease.

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Imaging Angiogenesis in Atherosclerosis in Large Arteries with 68Ga-NODAGA-RGD PET/CT: Relationship with Clinical Atherosclerotic Cardiovascular Disease

10.21203/rs.3.rs-508079/v1 ◽

2021 ◽

Author(s):

Matthieu DIETZ ◽

Christel H. Kamani ◽

Emmanuel Deshayes ◽

Vincent Dunet ◽

Periklis Mitsakis ◽

...

Keyword(s):

Cardiovascular Disease ◽

Blood Pool ◽

Tracer Uptake ◽

Plaque Burden ◽

Atherosclerotic Cardiovascular Disease ◽

Cerebrovascular Event ◽

Promising Target ◽

Pet Ct ◽

Tracer Accumulation ◽

Alpha V Beta 3

Abstract BackgroundIntegrin alpha-V-beta-3 (αvβ3) pathway is involved in intraplaque angiogenesis and inflammation and represents a promising target for molecular imaging in cardiovascular diseases such as atherosclerosis. The aim of this study was to assess the clinical correlates of arterial wall accumulation of 68Ga-NODAGA-RGD, a specific αvβ3 integrin ligand for PET. Materials and methodsThe data of 44 patients who underwent 68Ga-NODAGA-RGD PET/CT scans were retrospectively analyzed. Tracer accumulation in the vessel wall of major arteries was analyzed semi-quantitatively by blood-pool-corrected target-to-background ratios. Tracer uptake was compared with clinically documented atherosclerotic cardiovascular disease, cardiovascular risk factors and calcified plaque burden. Data were compared using the Mann-Whitney U test and Spearman correlation. Results68Ga-NODAGA-RGD arterial uptake was significantly higher in patients with previous clinically documented atherosclerotic cardiovascular disease (mean TBR 2.44 [2.03-2.55] vs. 1.81 [1.56-1.96], p = 0.001) and showed a significant correlation with prior cardiovascular or cerebrovascular event (r = 0.34, p = 0.024), BMI (r = 0.38, p = 0.01), plaque burden (r = 0.31, p = 0.04), and hypercholesterolemia (r= 0.31, p = 0.04).Conclusions68Ga-NODAGA-RGD holds promise as a non-invasive marker of disease activity in atherosclerosis, providing information about intraplaque angiogenesis.

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Aspirin Dose for Prevention of Cardiovascular Disease in Diabetics

Annals of Pharmacotherapy ◽

10.1345/aph.1c101 ◽

2003 ◽

Vol 37 (1) ◽

pp. 116-121 ◽

Cited By ~ 6

Author(s):

Sandra N Nowak ◽

Linda A Jaber

Keyword(s):

Cardiovascular Disease ◽

Aspirin Therapy ◽

Biomedical Literature ◽

Diabetic Patients ◽

Vascular Events ◽

Cardiovascular Protection ◽

Patients With Diabetes ◽

Relationship Of ◽

Key Terms ◽

Prevention Of Cardiovascular Disease

OBJECTIVE To determine whether a specific dose of aspirin can be recommended for prevention of cardiovascular disease in patients with diabetes. DATA SOURCE Biomedical literature was accessed through MEDLINE (1990–February 2002). Key terms included diabetes, cardiovascular protection, and aspirin. DATA SYNTHESIS Pharmacologic and clinical studies focusing on the dose–response relationship of aspirin therapy were reviewed. Evidence supports the benefit of low-dose aspirin therapy in reducing vascular events in secondary and primary prevention trials in various patient populations; however, some studies suggest larger doses of aspirin may be needed in certain patients. CONCLUSIONS Review of the evidence does not support a particular dose of aspirin for cardiovascular protection in diabetic patients. Clinical guidelines recommend aspirin therapy in the range of 81–325 mg/d. However, due to an increased prevalence of cardiovascular morbidity and disturbances in coagulation in diabetic patients, the dose of aspirin for prevention of cardiovascular disease in these individuals may be different from that in other populations and requires further evaluation.

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Type 2 diabetic patients with diabetic retinopathy without previous cardiovascular disease show an increased carotid plaque burden

Atherosclerosis ◽

10.1016/j.atherosclerosis.2014.05.725 ◽

2014 ◽

Vol 235 (2) ◽

pp. e243

Author(s):

N. Alonso ◽

A. Traveset ◽

E. Rubinat ◽

M.V. Arcidiacono ◽

E. Ortega ◽

...

Keyword(s):

Cardiovascular Disease ◽

Diabetic Retinopathy ◽

Carotid Plaque ◽

Plaque Burden ◽

Diabetic Patients ◽

Type 2 Diabetic Patients ◽

Type 2 Diabetic

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Abstract 501: Prevalence of Ascending Aorta Atherosclerosis as Detected by Echocardiography and Computed Tomography in Patients Referred for Atrial Fibrillation Ablation

Arteriosclerosis Thrombosis and Vascular Biology ◽

10.1161/atvb.37.suppl_1.501 ◽

2017 ◽

Vol 37 (suppl_1) ◽

Author(s):

Efstratios Koutroumpakis ◽

Benjamin Schwartz ◽

John Espey ◽

Elizabeth Rau ◽

David Steckman ◽

...

Keyword(s):

Computed Tomography ◽

Transthoracic Echocardiography ◽

Left Atrial ◽

Ascending Aorta ◽

Plaque Burden ◽

Aortic Atherosclerosis ◽

Predictive Values ◽

Af Ablation ◽

Aortic Plaque ◽

Af Recurrence

Introduction: The prevalence and significance of thoracic aorta atherosclerosis in AF patients has not been clearly defined in the literature. There are scant reports supporting an association of atherosclerotic aortic plaque burden with embolic phenomena and recurrence of AF post ablation. Two modalities of aortic atherosclerosis detection include computed tomography (CT) and echocardiography. Hypothesis: The prevalence of ascending aorta atherosclerosis in AF patients is high and CT performs better than transthoracic echocardiography in its detection. Methods: We investigated prevalence of ascending aorta atherosclerosis by CT and transthoracic echocardiography in 76 consecutive patients referred for AF ablation (67.1% males, 62.9 +/- 9.8 years old, 6.6% active smokers, 75% paroxysmal AF, 13.1% with LV ejection fraction (EF) <50%, 61.8% with hyperlipidemia, 55.8% with hypertension, 10.5% with diabetes, 2.6% with chronic kidney disease, and 1 patient with peripheral artery disease). The pre-ablation echocardiograms and cardiac CT scans, originally performed for left atrial mapping and evaluation of left atrial appendage thrombus, were reviewed in a blinded fashion for the presence of aortic atherosclerosis. Results: Out of 76 AF ablation patients, 27 (35.5%) had evidence of ascending aorta atherosclerosis by CT and 43 (56.6%) by echocardiography. Using CT as the gold standard, echocardiography had a sensitivity of 70.4% and a specificity of 51% in identification of ascending aorta atherosclerosis. Positive and negative predictive values were 44.2% and 75.8%, respectively. A total of 16 patients (21.1%) had AF recurrence post ablation, out of which 6 (37.5%) had evidence of aortic atherosclerosis on CT (vs 21/49 [42.9%] in the non-recurrence group). Conclusions: Ascending aorta atherosclerosis is common in patients referred for AF ablation. Transthoracic echocardiography likely overestimates its prevalence. Aortic atherosclerosis as detected by CT was not significantly associated with AF recurrence post ablation. More studies investigating clinical implications and best treatment approach to subclinical aortic therosclerosis in patients with AF are needed.

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3141Predicting life-expectancy without recurrent vascular events in patients with cardiovascular disease: the REACH-SMART model

European Heart Journal ◽

10.1093/eurheartj/ehy563.3141 ◽

2018 ◽

Vol 39 (suppl_1) ◽

Author(s):

J A N Dorresteijn ◽

L Kaasenbrood ◽

D L Bhatt ◽

P W F Wilson ◽

R B D'Agostino Sr ◽

...

Keyword(s):

Cardiovascular Disease ◽

Life Expectancy ◽

Vascular Events

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A Ketogenic Diet Is Protective Against Atherosclerosis in Apolipoprotein E Knockout Mice

Current Developments in Nutrition ◽

10.1093/cdn/nzaa040_087 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 87-87

Author(s):

Courtney Whalen ◽

Floyd Mattie ◽

Elisabeth Bach ◽

Teodoro Bottiglieri ◽

A Catharine Ross ◽

...

Keyword(s):

Ketogenic Diet ◽

Inflammatory Cytokines ◽

Graduate Program ◽

Colorimetric Assay ◽

Plaque Burden ◽

Cvd Risk ◽

Aortic Plaque ◽

Funding Sources ◽

Apolipoprotein E Knockout Mice ◽

Student’S T

Abstract Objectives A ketogenic diet (KD) positively impacts cardiovascular disease (CVD) risk factors yet its effect on atherosclerosis, the main cause of CVD, is elusive. We hypothesize that, when compared to a high-fat diet (HF), KD protects from atherosclerosis. Methods Seven-week-old male Apoe−/− mice, a model for human atherosclerosis, were fed ad libitum (%kcal) KD (81-fat, 1-carbohydrate, 18-protein; n = 4) or HF (40-fat, 42-carbohydrate, 18-protein; n = 5). After 4, 8 and 12 weeks, plasma was collected and used to (1) quantify beta-hydroxybutyrate levels (OH-But) by a colorimetric assay; or (2) assess systemic inflammation, a key feature associated with atherosclerosis, using a panel of inflammatory cytokines; or (3) explore diet-driven changes in levels of atherosclerosis-relevant metabolites using a targeted metabolomic approach by triple quadrupole mass spectrometry. At the endpoint, mice were euthanized and their perfusion-fixed aortas were subjected to 3-D analysis by magnetic resonance imaging to quantify the extent of atherosclerosis. Data were reconstructed using Matlab and segmented to obtain atherosclerotic plaque volumes using Avizo 9.0. Results The inflammatory cytokines were significantly (P < 0.05, Student's t-test) elevated in HF-mice compared to KD-mice after 12 weeks; MIP-1α, (25 ± 13 vs 13 ± 4 pg/mol), MCP-1 (165 ± 67 vs 69 ± 23 pg/mol), TNF-α(51 ± 17 vs 35 ± 5 pg/mol), and IL-1β (2 ± 2 vs 0.6 ± 0.1 pg/mol). OH-But levels were always significantly higher in KD-mice than in HF-mice, thus confirming the presence of ketosis in KD-mice. Significant changes in the plasma metabolome of KD-mice, when compared to HF-mice, were present for dimethylated arginines, gut-derived metabolites, certain bile acids, some acylcarnitines and ceramides, certain sphingolipids and cholesterol esters, and constituents of the major intracellular antioxidant glutathione. Lastly, aortic plaque burden was significantly decreased in KD mice (2.77 ± 1.02%) than in HF mice (13.94 ± 3.72%). Conclusions KD was associated with decreased inflammation, changes in several metabolic intermediates and an atheroprotective effect based on MRI analysis. Funding Sources Huck Institutes of the Life Sciences; Graduate Program in Nutritional Sciences.

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Leveraging a Landmark Trial of Primary Cardiovascular Disease Prevention in Human Immunodeficiency Virus: Introduction From the REPRIEVE Coprincipal Investigators

The Journal of Infectious Diseases ◽

10.1093/infdis/jiaa098 ◽

2020 ◽

Vol 222 (Supplement_1) ◽

pp. S1-S7 ◽

Cited By ~ 3

Author(s):

Steven K Grinspoon ◽

Pamela S Douglas ◽

Udo Hoffmann ◽

Heather J Ribaudo

Keyword(s):

Cardiovascular Disease ◽

Human Immunodeficiency Virus ◽

Disease Prevention ◽

Gender Diversity ◽

Coronary Plaque ◽

Cardiovascular Disease Prevention ◽

Population Characteristics ◽

Vascular Events ◽

Global Epidemic ◽

Immunodeficiency Virus

Abstract The Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE) is the largest study of cardiovascular disease in human immunodeficiency virus. Enrolling 7770 participants from 2015 to 2019 with sites across 5 continents, REPRIEVE will assess the effects of a statin as a cardiovascular disease prevention strategy in people with HIV (PWH) receiving antiretroviral therapy (ART). Although the primary purpose of REPRIEVE, and its substudy assessing coronary plaque, is to assess cardiovascular outcomes, the trial is a rich source of data on population characteristics and critical comorbidities in PWH, particularly across Global Burden of Disease (GBD) regions, reflective of the ethnic, racial, and gender diversity in this global epidemic. The purpose of this Supplement is to leverage the rich phenotyping in REPRIEVE, to provide data on detailed patterns of baseline ART and immune function by GBD region, reproductive aging among cisgender women, and data on the participation and clinical characteristics of transgender participants. We also leveraged REPRIEVE to assess critical comorbidities, including renal dysfunction, muscle function and frailty, and myocardial steatosis. REPRIEVE is a remarkable collaboration between funders, trial networks, clinical research sites, clinical and data coordinating centers, and willing participants who devoted their time to make the trial possible.

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Lipoprotein(a) and Cardiovascular Disease in Ethnic Chinese: The Chin-Shan Community Cardiovascular Cohort Study

Clinical Chemistry ◽

10.1373/clinchem.2007.090969 ◽

2008 ◽

Vol 54 (2) ◽

pp. 285-291 ◽

Cited By ~ 19

Author(s):

Kuo-Liong Chien ◽

Hsiu-Ching Hsu ◽

Ta-Chen Su ◽

Fung-Chang Sung ◽

Ming-Fong Chen ◽

...

Keyword(s):

Cardiovascular Disease ◽

Cohort Study ◽

Chinese Adults ◽

Vascular Events ◽

Community Based ◽

Lipoprotein A ◽

Ethnic Chinese ◽

Total Death ◽

Age Range

Abstract Background: Little is known about lipoprotein(a) [Lp(a)] as a predictor of vascular events among ethnic Chinese. We prospectively investigated the association of Lp(a) with cardiovascular disease and all-cause death in a community-based cohort. Methods: We conducted a community-based prospective cohort study of 3484 participants (53% women; age range, 35–97 years) who had complete lipid measurements and were free of a cardiovascular disease history at the time of recruitment. Over a median follow-up of 13.8-years, we documented 210 cases of stroke, 122 cases of coronary heart disease (CHD), and 781 deaths. Results: The incidences for each event increased appreciably with Lp(a) quartile for stroke and all-cause death, but not for CHD. Baseline Lp(a) concentration by quartile was not significantly associated with stroke, all-cause death, and CHD in multivariate analyses. The multivariate relative risk was significant for stroke at the 90th and 95th percentiles and for total death at the 95th and 99th percentiles. Conclusions: Our findings suggest a threshold relationship with little gradient of risk across lower Lp(a) values for stroke and all-cause death in Chinese adults.

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Relative Risk of Cardiovascular Disease after Treatment for Aggressive Non-Hodgkin’s Lymphoma.

Blood ◽

10.1182/blood.v106.11.2831.2831 ◽

2005 ◽

Vol 106 (11) ◽

pp. 2831-2831

Author(s):

E. C. Moser ◽

E. M. Noordijk ◽

F. E. van Leeuwen ◽

S. le Cessie ◽

J. W. Baars ◽

...

Keyword(s):

Heart Failure ◽

Cardiovascular Disease ◽

Chronic Heart Failure ◽

Hodgkin Lymphoma ◽

Risk Model ◽

Salvage Treatment ◽

Excess Risk ◽

Vascular Events ◽

Increased Risk

Abstract Cardiovascular complications after therapy for Hodgkin lymphoma have been related to radiotherapy on the mediastinum, but have only incidentally been studied in NHL. As cardiovascular disease occurs commonly in the normal population, it is important to realize that risk factors as age, hypertension and life-style (diet and smoking) may be more outspoken in patients with NHL, who are generally older than patients with Hodgkin lymphoma. Moreover, although most patients with aggressive NHL will initially receive only chemotherapy, many will be treated with more than one therapy modality, incorporating stem cell transplantation or radiotherapy, because of early failure or relapses. Therefore, risk estimation of cardiovascular disease in NHL patients requires comparison to population-based rates. Here, we evaluated whether patients with aggressive NHL treated in 4 EORTC trials between 1980–1999 have an increased excess cardiovascular risk, compared to Dutch population rates. Relative risks (RR) and absolute excessive risks (AER per 1000 person-years) of cardiovascular disease were determined in 476 (Dutch and Belgian) patients and compared to incidence rates from the Continuous Morbidity Registry Nijmegen. Analyses were restricted to those patients treated with at least 6 cycles of doxorubicin-based chemotherapy and with a minimal follow-up time of 0.5 years. Only serious late events requiring daily medication and/or clinical interventions were recorded. Cumulative incidences of cardiovascular disease were estimated in the competing risk model by Gray with death by any cause as competing event. The overall cumulative incidence of cardiovascular disease was 12% at 5 and 22% at 10 years. At a median follow-up of 8.4 years, 66 cases of chronic heart failure (RR 5.4, 95% CI 4.1–6.9, AER 20.8), 17 myocardial infarctions (RR 1.2; 0.8–1.8, AER 0.8), 12 strokes (RR 1.8; 1.1–2.4, AER 1.5) and 9 other large vessel occlusions were registered. The large vascular events including strokes occurred in 16/21 patients after radiotherapy given in the same area. Pre-existent hypertension, NHL at young age (<55 years) and (any) salvage treatment increased risk of cardiovascular disease. Excess risk for myocardial infarction or stroke after radiotherapy on respectively the mediastinum or neck depended on cumulative radiation dose and was only seen after more than 40 Gy. Excess risk for chronic heart failure was registerd in both non-irradiated (RR 4.4) and irradiated patients, with an extremely high RR of 32 (13.7–57.0) if >40 Gy had been given. In conclusion, NHL patients treated with doxorubicin-based chemotherapy, especially those who are young, have hypertension, or received salvage treatment or radiotherapy above 40 Gy, are at high risk of cardiovascular disease and need lifelong monitoring in this regard.

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