scholarly journals Association Between Ambulatory Blood Pressure and Coronary Artery Calcification

Hypertension ◽  
2021 ◽  
Author(s):  
Yiyi Zhang ◽  
Joseph E. Schwartz ◽  
Byron C. Jaeger ◽  
Jaejin An ◽  
Brandon K. Bellows ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Coronary Artery ◽  
Coronary Artery Calcification ◽  
Subclinical Atherosclerosis ◽  
Agatston Score ◽  
Ambulatory Bp Monitoring ◽  
Heart Study ◽  
Artery Disease ◽  
Prevalence Ratios ◽  
Multivariable Adjustment

High blood pressure (BP) based on measurements obtained in the office setting has been associated with the presence and level of coronary artery calcification (CAC)—a measure of subclinical atherosclerosis. We studied the association between out-of-office BP and CAC among 557 participants who underwent 24-hour ambulatory BP monitoring at visit 1 in 2000–2004 and a computed tomography scan at visit 2 in 2005–2008 as part of the JHS (Jackson Heart Study)—a community-based cohort of African American adults. Mean awake, asleep, and 24-hour BP were calculated for each participant. Among participants included in this analysis, 279 (50%) had any CAC defined by an Agatston score >0. After multivariable adjustment including office systolic BP (SBP), the prevalence ratios for any CAC comparing the highest versus the lowest quartiles of SBP on ambulatory BP monitoring were 1.08 (95% CI, 0.84–1.39) for awake SBP, 1.32 (95% CI, 1.01–1.74) for asleep SBP, and 1.19 (95% CI, 0.91–1.55) for 24-hour SBP. After multivariable adjustment including office diastolic BP, the prevalence ratios for any CAC comparing the highest versus the lowest quartiles of awake, asleep, and 24-hour diastolic BP were 1.27 (95% CI, 1.02–1.59), 1.29 (95% CI, 1.02–1.64), and 1.25 (95% CI, 0.99–1.59), respectively. The current results suggest that higher asleep SBP and higher awake and asleep diastolic BP may be risk factors for subclinical atherosclerosis and underscore the potential role of ambulatory BP monitoring in identifying individuals at high risk for coronary artery disease.

scholarly journals Ambulatory Blood Pressure Phenotypes in Adults Taking Antihypertensive Medication with and without CKD

2020 ◽  
Vol 15 (4) ◽  
pp. 501-510 ◽  
Author(s):  
Stanford E. Mwasongwe ◽  
Rikki M. Tanner ◽  
Bharat Poudel ◽  
Daniel N. Pugliese ◽  
Bessie A. Young ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ambulatory Blood Pressure ◽  
Antihypertensive Medication ◽  
Prevalence Ratio ◽  
Uncontrolled Hypertension ◽  
Creatinine Ratio ◽  
Ambulatory Bp Monitoring ◽  
Heart Study ◽  
Black Patients ◽  
Multivariable Adjustment

Background and objectivesRecent guidelines recommend out-of-clinic BP measurements.Design, setting, participants, & measurementsWe compared the prevalence of BP phenotypes between 561 black patients, with and without CKD, taking antihypertensive medication who underwent ambulatory BP monitoring at baseline (between 2000 and 2004) in the Jackson Heart Study. CKD was defined as an albumin-to-creatinine ratio ≥30 mg/g or eGFR <60 ml/min per 1.73 m2. Sustained controlled BP was defined by BP at goal both inside and outside of the clinic and sustained uncontrolled BP as BP above goal both inside and outside of the clinic. Masked uncontrolled hypertension was defined by controlled clinic-measured BP with uncontrolled out-of-clinic BP.ResultsCKD was associated with a higher multivariable-adjusted prevalence ratio for uncontrolled versus controlled clinic BP (prevalence ratio, 1.44; 95% CI, 1.02 to 2.02) and sustained uncontrolled BP versus sustained controlled BP (prevalence ratio, 1.66; 95% CI, 1.16 to 2.36). There were no statistically significant differences in the prevalence of uncontrolled daytime or nighttime BP, nondipping BP, white-coat effect, and masked uncontrolled hypertension between participants with and without CKD after multivariable adjustment. After multivariable adjustment, reduced eGFR was associated with masked uncontrolled hypertension versus sustained controlled BP (prevalence ratio, 1.42; 95% CI, 1.00 to 2.00), whereas albuminuria was associated with uncontrolled clinic BP (prevalence ratio, 1.76; 95% CI, 1.20 to 2.60) and sustained uncontrolled BP versus sustained controlled BP (prevalence ratio, 2.02; 95% CI, 1.36 to 2.99).ConclusionsThe prevalence of BP phenotypes defined using ambulatory BP monitoring is high among adults with CKD taking antihypertensive medication.

Abstract 3490: Formal Comparison between absolute and relative cut points for Coronary Artery Calcification in At Intermediate Risk Community-Based Men and Women: The Framingham Heart Study

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Udo Hoffmann ◽  
Joseph M Massaro ◽  
Caroline S Fox ◽  
Emily Manders ◽  
Christopher J O’Donnell
Keyword(s):  
Coronary Artery ◽  
Framingham Heart Study ◽  
Coronary Artery Calcification ◽  
Agatston Score ◽  
Intermediate Risk ◽  
Community Based ◽  
Men And Women ◽  
Cut Points ◽  
Framingham Risk ◽  
Heart Study

Background: Coronary artery calcification (CAC) may improve risk stratification of individuals at intermediate Framingham Risk. We determined the agreement between absolute and relative cut points to identify subjects with elevated CAC in individuals at intermediate Framingham Risk. Methods : The amount of CAC was quantified in 3238 participants from the Framingham Heart Study (FHS) Offspring and Third Generation cohorts (48% women, mean age 53 years) free of cardiovascular disease who underwent ECG triggered cardiac MDCT. We included subjects at intermediate Framingham risk, defined as 6 –20% ten year event risk, (n = 1177) and subjects free of cardiovascular risk factors (n = 1586). Distribution of CAC according to absolute (Agatston Score [AS] > 400) and relative (90 th percentile stratified by age as derived from the healthy reference subset) cut-points were determined for men and women Results: Among men with intermediate FRS, 17.7% had CAC above the 90 th percentile of the healthy referent sample, whereas 14% had CAC > 400. Similar findings were observed in women: 11.5% had CAC above the 90 th percentile of the healthy referent sample, whereas 2% had CAC > 400. Among all individuals at intermediate FRS Only 10.8% of subjects above the 90 th percentile had an AS < 400. Conclusions: The fraction of subjects with elevated CAC as determined by an AS > 400 is lower than subjects above the 90 th percentile especially among women at intermediate FRS in the community-based FHS. Overall, the agreement between absolute and relative cut points to identify subjects with elevated CAC is poor in this population. Prospective outcomes studies are necessary to test the hypothesis that relative rather than absolute cutpoints of CAC should be used to further stratify subjects at intermediate risk.

Abstract 3126: Coronary Artery Calcification as a Predictor of Subsequent Coronary Artery Disease Events

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Tina Costacou ◽  
Trevor J Orchard
Keyword(s):  
Coronary Artery Disease ◽  
Type 1 Diabetes ◽  
Coronary Artery ◽  
Coronary Artery Calcification ◽  
Diabetes Duration ◽  
Glucose Disposal ◽  
Agatston Score ◽  
Cross Sectional ◽  
Artery Disease

Coronary artery calcification (CAC) as measured by electron beam computed tomography (EBCT) can be used as an indicator of atherosclerotic burden. We have previously reported a cross sectional association between the presence of CAC and history of clinical coronary artery disease (CAD) in type 1 diabetes. In this analysis, we assessed the ability of CAC to predict the incidence of CAD events. Participants from the Pittsburgh Epidemiology of Diabetes Complications Study of childhood onset type 1 diabetes who underwent an EBCT screening (1996–98) and were free of clinical CAD were selected for study (n=236). Mean age at EBCT screening was 36.6 years and diabetes duration 28 years. CAC was calculated using the Agatston score and was used both as a continuous variable (after log transformation) and as a categorical variable. CAD was defined as non-fatal MI (n=4), ischemic ECG changes (Minnesota codes 1.3, 4.1, 4.2, 4.3, 5.1, 5.2, 5.3, 7.1) (n=9), hospitalized unstable angina (n=1), new onset angina leading to revascularization (n=2) or fatal CAD (n=4). Glucose disposal rate (eGDR-insulin sensitivity) was estimated by a regression equation derived from hyperinsulinemic euglycemic clamp studies with terms for waist to hip ratio, HbA 1c , and hypertension. During a mean follow-up of 7.4 years, 20 (8.5%) individuals had an incident event. Individuals who had an event were older, with a greater diabetes duration, systolic blood pressure, HbA 1c , and WBC count, a lower eGDR (all p-values <0.05), and a higher CAC score (p<0.0001). Thus, approximately 24% of persons with CAC ≥200 had a subsequent CAD event compared to only 3% of those with a zero score. In multivariable Cox proportional hazard models with backward elimination, a CAC score greater than zero was a significant predictor of CAD incidence (HR=4.07, 95% CI=1.38–11.96). Other significant predictors comprised diabetes duration (HR=1.07, 95% CI=1.01–1.14) and HbA 1c (HR=1.39, 95% CI=1.10–1.76). The area under the ROC curve increased from 0.720 to 0.784 with the inclusion of CAC score. In this cohort of individuals with type 1 diabetes, CAC is a significant predictor of subsequent CAD status and adds to the prediction beyond standard risk factors. Thus, CAC may be used as a screening tool for CAD risk in type 1 diabetes.

Abstract P184: Is Home Blood Pressure More Strongly Associated with Coronary Artery Calcification Than Clinic Blood Pressure Measured Under an Appropriate Condition?

Circulation ◽  
2016 ◽  
Vol 133 (suppl_1) ◽  
Author(s):  
Atsushi Satoh ◽  
Hisatomi Arima ◽  
Atsushi Hozawa ◽  
Takashi Hisamatsu ◽  
Sayaka Kadowaki ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Coronary Artery ◽  
Coronary Artery Calcification ◽  
Home Blood Pressure ◽  
Agatston Score ◽  
Ideal Condition ◽  
Clinic Blood Pressure ◽  
Cross Sectional ◽  
Electrical Device ◽  
The Mean

Background / Objective: A number of studies have shown that home blood pressure (HBP) is more strongly associated with atherosclerotic diseases than clinic blood pressure (CBP). In previous studies, however, measurement of CBP under suboptimal conditions might have undermined the usefulness of CBP for prediction of atherosclerotic diseases. Therefore, we conducted a cross-sectional analysis to clarify whether HBP is more strongly associated with coronary artery calcification (CAC) than strictly measured CBP among a general population of Japanese men. Methods: From 2006 to 2008, we recruited 1094 male participants randomly selected from the residents in Kusatsu City, Shiga, Japan. CBP was measured twice consecutively by a trained physician using electrical device after 5 minutes of complete rest in a sitting position in a silent room. The participants were asked to measure HBP with an electrical device once in the morning during the consecutive 7 days. HBP was measured in seated position after 2 minutes of rest, within an hour after waking up, after urination and before breakfast. The mean of 2 measurements of CBP and the mean of 7 days of HBP were used in the analysis. CAC was assessed using computed tomography. Presence of CAC was defined as Agatston score >10. After exclusion of 175 participants with missing data on HBP, CBP, or CAC, a total of 919 people were included into the present analysis. We calculated multivariable-adjusted odds ratios (ORs) for presence of CAC per one standard deviation (SD) increase of CBP and HBP, then compared by adding interaction terms to the statistical model. ORs were adjusted for age, body mass index, history of cardiovascular diseases, smoking, ethanol consumption, blood sugar, serum total cholesterol, high density lipoprotein cholesterol, and use of medication (hypertension, dyslipidemia, and diabetes mellitus). Results: The mean systolic CBP (SD) and HBP (SD) were 136.8 (19.0) mmHg and 137.2 (18.5) mmHg, respectively. CBP and HBP were highly correlated (r = 0.74 P <0.001). The difference between CBP and HBP was not significant (P = 0.595). CAC was found in 454 (49.4%) participants. Multivariable-adjusted ORs (95% confidence interval) for presence of CAC were comparable between CBP (1.34 (1.14 - 1.58) per 1SD increase) and HBP (1.37 (1.16 - 1.62) per 1SD increase) (P heterogeneity = 0.819). When mean value of the first 2 days of HBP was used as a sensitivity analysis, we found almost the same results (P heterogeneity = 0.992). Similar results were also obtained for diastolic CBP and HBP (P heterogeneity = 0.968 for 7 days of HBP, 0.566 for 2 days of HBP). Conclusion: In conclusion, the association of CBP measured in an ideal condition with CAC was comparable with that of HBP.

Abstract P173: The Impact of Asleep Blood Pressure on the Prevalence of Masked Hypertension by Race/ethnicity: Analysis of Pooled Population- and Community-based Studies

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Yuichiro Yano ◽  
Bharat Poudel ◽  
Ligong Chen ◽  
Swati Sakhuja ◽  
Byron Jaeger ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Young Adults ◽  
Coronary Artery ◽  
Prevalence Ratio ◽  
Masked Hypertension ◽  
Community Based ◽  
Ambulatory Bp Monitoring ◽  
Heart Study ◽  
Race Ethnicity ◽  
The Impact

Introduction: Masked hypertension is defined as having hypertensive blood pressure (BP) outside of the office setting among adults with non-hypertensive BP when measured in the office. Some guidelines recommend defining out-of-office BP using awake measurements while other guidelines recommend using awake and asleep measurements. Hypothesis: We hypothesized that defining masked hypertension using the awake and asleep BP measurements would increase the prevalence of masked hypertension compared to using the awake period alone, and the magnitude of this difference would be greater among non-Hispanic blacks compared with non-Hispanic whites and Hispanics. Methods: We pooled previously collected data from 5 NHLBI-funded population- and community-based studies including the Jackson Heart Study, the Coronary Artery Risk Development in Young Adults Study (total participants: 2,866). All participants had office systolic BP (SBP)<140mmHg and diastolic BP (DBP)<90mmHg and underwent ambulatory BP monitoring (ABPM) for 24 hours. Hypertensive awake BP was defined as SBP ≥135mmHg or DBP ≥85mmHg while awake, hypertensive asleep BP as SBP ≥120mmHg or DBP ≥70mmHg while asleep and hypertensive 24-hour BP as SBP ≥130mmHg or DBP ≥80mmHg over the entire ABPM period. Results: The prevalence of masked hypertension increased from 29% to 43% when defined using awake, asleep, or 24-hour BP versus using awake BP alone (Table). This increase was larger in non-Hispanic blacks (31-54%) compared with non-Hispanic whites (28-37%) and Hispanics (17-26%). The adjusted prevalence ratio (95% confidence interval) for having masked hypertension for non-Hispanic blacks compared with Non-Hispanic whites was higher from 1.20(1.05,1.37) to 1.33(1.20,1.47) when defined using awake, asleep and 24-hour BP versus awake BP only. Conclusions: Including asleep BP to define masked hypertension increased the prevalence of masked hypertension to a larger extent among non-Hispanic blacks compared to non-Hispanic whites and Hispanics.

Incidence and predictors of aorta calcification in patients with systemic lupus erythematosus

Lupus ◽  
2019 ◽  
Vol 28 (3) ◽  
pp. 275-282 ◽  
Author(s):  
L Hu ◽  
Z Chen ◽  
Y Jin ◽  
B Jiang ◽  
X Wang ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Coronary Artery ◽  
Lupus Erythematosus ◽  
Coronary Artery Calcification ◽  
Activity Index ◽  
Subclinical Atherosclerosis ◽  
Agatston Score ◽  
Systemic Lupus ◽  
Sledai Score ◽  
Increased Risk

Objective Artery calcification, as subclinical atherosclerosis, is attracting attention. The aim of this study was to determine the prevalence and risk factors of artery calcification in patients with systemic lupus erythematosus. Methods 641 patients with systemic lupus erythematosus were enrolled in the study. Demographic, clinical, and laboratory characteristics were collected. Calcification score was quantified from the multi-detector computed tomography scan image using the Agatston Score method. Results The total incidence of artery calcification was 25.9% (166/641), of which the percentages of aorta calcium and coronary artery calcification were 23.1% (148/641) and 8.4% (54/641), respectively. In multivariate models, systemic lupus erythematosus patients with artery calcification had longer disease duration than patients without artery calcification ( p < 0.05). Presence of serositis (OR 2.559, 95%CI 1.414–4.632), pneumonia (OR 2.022, 95%CI 1.102–3.711) and Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score (OR 1.049, 95%CI 1.004–1.095) were independently associated with increased risk of aorta calcium, while the duration of corticosteroids use (OR 1.039, 95%CI 1.002–1.078) and cyclophosphamide therapy (OR 8.251, 95%CI 2.496–27.279) were independently associated with increased risk of coronary artery calcification in systemic lupus erythematosus patients. In systemic lupus erythematosus patients, aorta calcium was prone to occur at a younger age compared to coronary artery calcification, and aorta calcium score was positively correlated with age. Conclusions Systemic lupus erythematosus patients had a much earlier onset and higher incidences of aorta calcium than coronary artery calcification. Presence of serositis, pneumonia, and higher SLEDAI score may predict increased risk of aorta calcium.

scholarly journals Sugar-Sweetened Beverage Consumption and Calcified Atherosclerotic Plaques in the Coronary Arteries: The NHLBI Family Heart Study

Nutrients ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1775
Author(s):  
Yash R. Patel ◽  
Tasnim F. Imran ◽  
R. Curtis Ellison ◽  
Steven C. Hunt ◽  
John Jeffrey Carr ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Coronary Arteries ◽  
Subclinical Atherosclerosis ◽  
Agatston Score ◽  
Sugar Sweetened Beverage ◽  
Cut Points ◽  
Sweetened Beverage ◽  
Family Heart Study ◽  
Heart Study ◽  
Nhlbi Family Heart Study

Background: Sugar-sweetened beverage (SSB) intake is associated with higher risk of weight gain, diabetes, hypertension, cardiovascular disease, and cardiovascular mortality. However, the association of SSB with subclinical atherosclerosis in the general population is unknown. Objective: Our primary objective was to investigate the association between SSB intake and prevalence of atherosclerotic plaque in the coronary arteries in The National Heart, Lung, and Blood Institute (NHLBI) Family Heart Study. Methods: We studied 1991 participants of the NHLBI Family Heart Study without known coronary heart disease. Intake of SSB was assessed through a semi-quantitative food frequency questionnaire. Coronary artery calcium (CAC) was measured by cardiac Computed Tomography (CT) and prevalent CAC was defined as an Agatston score ≥100. We used generalized estimating equations to calculate adjusted prevalence ratios of CAC. A sensitivity analysis was also performed at different ranges of cut points for CAC. Results: Mean age and body mass index (BMI) were 55.0 years and 29.5 kg/m2, respectively, and 60% were female. In analysis adjusted for age, sex, BMI, smoking, alcohol use, physical activity, energy intake, and field center, higher SSB consumption was not associated with higher prevalence of CAC [prevalence ratio (95% confidence interval) of: 1.0 (reference), 1.36 (0.70–2.63), 1.69 (0.93–3.09), 1.21 (0.69–2.12), 1.05 (0.60–1.84), and 1.58 (0.85–2.94) for SSB consumption of almost never, 1–3/month, 1/week, 2–6/week, 1/day, and ≥2/day, respectively (p for linear trend 0.32)]. In a sensitivity analysis, there was no evidence of association between SSB and prevalent CAC when different CAC cut points of 0, 50, 150, 200, and 300 were used. Conclusions: These data do not provide evidence for an association between SSB consumption and prevalent CAC in adult men and women.

scholarly journals Diagnostic and prognostic value of coronary artery calcium score of zero: is it time for guidelines to change?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E Arbas Redondo ◽  
D Tebar Marquez ◽  
I.D Poveda Pinedo ◽  
R Dalmau Gonzalez-Gallarza ◽  
S.C Valbuena Lopez ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Coronary Artery Calcium ◽  
Cardiac Ct ◽  
Invasive Coronary Angiography ◽  
Agatston Score ◽  
Non Invasive ◽  
Artery Disease

Abstract Introduction Cardiac computed tomography (CT) use has progressively increased as the preferred initial test to rule out coronary artery disease (CAD) when clinical likelihood is low. Coronary artery calcium (CAC) detected by CT is a well-established marker for cardiovascular risk. However, it is not recommended for diagnosis of obstructive CAD. Absence of CAC, defined as an Agatston score of zero, has been associated to good prognosis despite underestimation of non-calcified plaques. Purpose To evaluate whether zero CAC score could help ruling out obstructive CAD in a safely manner. Methods Observational study based on a prospective database of patients (pts) referred to cardiac CT between 2017 and 2019. Pts with an Agatston score of zero were selected. Results We included 176 pts with zero CAC score and non-invasive coronary angiography performed. The median duration of follow-up was 23.9 months. Baseline characteristics of the population are shown in Table 1. In 117 pts (66.5%), cardiac CT was indicated as part of their chest pain evaluation. Mean age was 57.2 years old, 68.2% were women and only and 9.4% were active smokers. Normal coronary arteries were found in 173 pts (98.3%). Obstructive CAD, defined as ≥50% luminal diameter stenosis of a major vessel, was present in 1/176 (0.6%); while non-obstructive atherosclerotic plaques were found in 2 pts (1.1%). During follow-up, one patient died of out-of-hospital cardiac arrest. None either suffered from myocardial infarction or needed coronary revascularization. Conclusions In our cohort, a zero CAC score detected by cardiac CT rules out obstructive coronary artery disease in 98.3%, with only 1.7% of non-calcified atherosclerosis plaques and 0.6% of major adverse events. Although further research on this topic is needed, these results support the fact that non-invasive coronary angiography could be avoided in patients with low clinical likelihood of CAD and zero CAC score, facilitating the management of the increasing demand for coronary CT and reduction of radiation dose. Funding Acknowledgement Type of funding source: None

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