Abstract 16627: Coronary Artery Calcium Scoring and Cardiovascular Events in Patients With Cancer: Analysis of CLARIFY Registry

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Sadeer Al-Kindi ◽  
Nour Tashtish ◽  
Avirup Guha ◽  
Imran Rashid ◽  
Miguel Cainzos Achirica ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Calcium ◽  
Cardiovascular Events ◽  
Coronary Revascularization ◽  
Major Adverse Cardiovascular Events ◽  
Cancer Type ◽  
Patients With Cancer ◽  
Shared Risk ◽  
Age And Sex

Introduction: Cardiovascular disease and cancer co-exist due to shared risk factors. The utility of coronary artery calcium (CAC) scoring in this population to predict cardiovascular events is not certain. Methods: We studied all patients enrolled in the CLARIFY registry of no-charge CAC (Clinicaltrials.gov NCT04075162) with diagnosis of any cancer. We followed patients for major adverse cardiovascular events (myocardial infarction, stroke, heart failure, coronary revascularization or mortality). Results: A total of 3,432 patients with cancer were identified. Mean age was 64±9 years, 1965 (57%) were women and 2937 (86%) were white. Overall distribution of CAC scores were as follows: CAC 0 in 35%, CAC 1-99 in 31%, CAC 100-399 in 20%, and CAC ≥ 400 in 15%. CAC distribution varied by cancer type (figure A). At a median follow-up of 663 [294-1086] days, 343 patients had MACE event. Compared with CAC 0, patients with CAC ≥ 400 had increased unadjusted risk of MACE (HR 2.57 [1.93-3.41], P<0.001), which was not attenuated after adjusting for age and sex (HR 2.09 [1.50-2.90], P<0.001). Conclusions: In this large cohort of patients with cancer, coronary artery atherosclerotic calcifications are common, vary by cancer type, and are associated with major adverse cardiovascular events, independently of age and sex. Further research should focus on utility of routine CAC for cardiovascular risk stratification in patients with cancer.

scholarly journals Impact of type 2 diabetes mellitus and blood glucose admission levels in patients with myocardial infarction with non obstructive coronary artery disease (MINOCA)

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Paolisso ◽  
F Donati ◽  
L Bergamaschi ◽  
S Toniolo ◽  
E.C D'Angelo ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Events ◽  
Independent Predictor ◽  
Major Adverse Cardiovascular Events ◽  
Coronary Syndrome ◽  
Type 2 Dm ◽  
All Cause Mortality ◽  
Age And Sex

Abstract Background Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a heterogeneous clinically entity and represents 5% to 10% of all patients with myocardial infarction (MI). Besides type 2 diabetes mellitus (DM), which is a common comorbidity in patients hospitalized for an acute coronary syndrome, high glucose levels (HGL) at admission are frequently observed in this context. The risk of major adverse cardiovascular events following acute coronary syndrome is increased in people with DM and HGL. However, evidence regarding diabetes and high glucose level among MINOCA patients is lacking. Purpose To examine the incidence of major adverse cardiovascular events (MACEs) in diabetic and non-diabetic MINOCA patients as well as according to HGL at presentation. Methods Among 1995 patients with acute MI admitted to our coronary care unit from 2016 to 2018, we enrolled 186 consecutive MINOCA patients according to the current ESC diagnostic criteria. HGL at admission was defined as serum glucose level above 180 mg/dl. All-cause mortality and a composite end-point of all-cause mortality and myocardial re-infarction were compared. The median follow-up time was 19.6±12.9 months. Results Diabetic MINOCA patients were older (mean age 75.5±9.6 vs 66.5±14.7; p=0.002) and with higher prevalence of hypertension (p=0.016). Conversely, there were no significant differences in gender, BMI, dyslipidemia and atrial fibrillation. Similarly, no significant differences were observed regarding clinical and ECG presentation, echocardiographic features and laboratory tests. The rates of death (30.8% vs 8.3%; p=0.013) and MACEs (22.2% vs 6.8%; p=0.025) were significantly higher in MINOCA-DM patients; conversely, no significant differences were observed for re-MI (p=0.58). At multivariate regression model adjusted for age and sex, type 2 DM was not an independent predictor of all cause deaths (p=0.36) and MACE (p=0.24). Patients with admission HGL had similar baseline characteristics, cardiovascular risk factors, clinical presentations, echocardiographic features and troponin values as compared to patients with no-HGL. HGL at admission was associated with higher incidence of all-cause-death (p&lt;0.001) and MACE (p=0.003) during follow-up compared to patients with no HGL; conversely, no significant differences were observed in the incidence of re-MI (p=0.7). Multivariate analysis adjusted for age and sex demonstrated that HGL was an independent predictor of death (HR 6.25; CI 1.64–23.85; p=0.007) and MACEs (HR 6.17; CI 1.79–21.23, p=0.004). Conclusion In MINOCA patients, HGL was an independent risk factor for both MACEs and death while type 2 DM was not correlated with these hard endpoints. As a consequence, HGL could have a still unexplored pathophysiological role in MINOCA. Properly powered randomized trials are warranted. Funding Acknowledgement Type of funding source: None

scholarly journals Long-term Predictions of Incident Coronary Artery Calcium to 85 Years of Age for Asymptomatic Individuals with and without Type 2 Diabetes

2021 ◽  
Author(s):  
Bart S. Ferket ◽  
M.G. Myriam Hunink ◽  
Umesh Masharani ◽  
Wendy Max ◽  
Joseph Yeboah ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Coronary Artery ◽  
Coronary Artery Calcium ◽  
Cardiovascular Events ◽  
Diabetes Treatment ◽  
The Impact

<b>Objective</b> <p>To examine the utility of repeated computed tomography (CT) coronary artery calcium (CAC) testing, we assessed risks of detectable CAC and its cardiovascular consequences in individuals with and without type 2 diabetes from ages 45 to 85 years.</p> <p><b>Research Design and Methods</b></p> <p>We included 5836 individuals (618 with type 2 diabetes, 2972 without baseline CAC) from the Multi-Ethnic Study of Atherosclerosis. Logistic and Cox regression evaluated the impact of type 2 diabetes, diabetes treatment duration and other predictors on prevalent and incident CAC. We used time-dependent Cox modeling of follow-up data (median 15.9 years) for two repeat CT exams and cardiovascular events to assess the association of CAC at follow-up CT with cardiovascular events.</p> <p><b>Results</b></p> <p>For 45-year-olds with type 2 diabetes, the likelihood of CAC at baseline was 23% versus 17% for those without. Median age at incident CAC was 52.2 versus 62.3 years for those with and without diabetes. Each 5 years of diabetes treatment increased the odds and hazard rate of CAC by 19% (95% confidence interval [CI] 8-33%) and 22% (95% CI 6-41%). Male gender, white ethnicity/race, hypertension, hypercholesterolemia, obesity, and low serum creatinine also increased CAC. CAC at follow-up CT independently increased coronary heart disease rates. </p> <p><b>Conclusions </b></p> <p>We estimated cumulative CAC incidence to age 85. Patients with type 2 diabetes develop CAC at a younger age than those without diabetes. Because incident CAC is associated with increased coronary heart disease risk, the value of periodic CAC-based risk assessment in type 2 diabetes should be evaluated.</p>

scholarly journals NADPH Oxidase Gene Polymorphism is Associated with Mortality and Cardiovascular Events in 7-Year Follow-Up

2020 ◽  
Vol 9 (5) ◽  
pp. 1475
Author(s):  
Milena Racis ◽  
Wojciech Sobiczewski ◽  
Anna Stanisławska-Sachadyn ◽  
Marcin Wirtwein ◽  
Elżbieta Bluj ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Nadph Oxidase ◽  
Cardiovascular Events ◽  
Coronary Atherosclerosis ◽  
Protective Factor ◽  
Major Adverse Cardiovascular Events ◽  
Oxidase Gene ◽  
Risk Of Death ◽  
Coronary Syndrome

The CYBA gene encodes the regulatory subunit of NADPH oxidase, which maintains the redox state within cells and in the blood vessels. That led us to investigate the course of coronary artery disease (CAD) with regards to CYBA polymorphisms. Thus, we recruited 1197 subjects with coronary atherosclerosis and observed them during 7-year follow-up. Three CYBA polymorphisms: c.214C>T (rs4673), c.-932G>A (rs9932581), and c.*24G>A (1049255) were studied for an association with death, major adverse cardiovascular events (MACE) and an elective percutaneous coronary intervention or coronary artery bypass grafting (PCI/CABG). We found an association between the CYBA c.214C>T polymorphism and two end points: death and PCI/CABG. CYBA c.214TT genotype was associated with a lower risk of death than C allele (9.5% vs. 21%, p < 0.05) and a higher risk of PCI/CABG than C allele (69.3% vs. 51.7%, p < 0.01). This suggests that the CYBA c.214TT genotype may be a protective factor against death OR = 0.47 (95%CI 0.28–0.82; p < 0.01), while also being a risk factor for an elective PCI/CABG OR = 2.36 (95%CI 1.15–4.82; p < 0.05). Thus, we hypothesize that among patients with coronary atherosclerosis, the CYBA c.214TT genotype contributes to atherosclerotic plaque stability by altering the course of CAD towards chronic coronary syndrome, thereby lowering the incidence of fatal CAD-related events.

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