scholarly journals De-risking primary prevention: role of imaging

2021 ◽  
Vol 15 ◽  
pp. 175394472110512
Author(s):  
Ahmed M. Shafter ◽  
Kashif Shaikh ◽  
Amit Johanis ◽  
Matthew J. Budoff
Keyword(s):  
Cardiovascular Disease ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Screening Method ◽  
The United States ◽  
Cochrane Library ◽  
Common Disease ◽  
Atherosclerotic Cardiovascular Disease ◽  
Cvd Risk ◽  
Artery Disease

Atherosclerotic cardiovascular disease (ASCVD) is a common disease among the general population, and includes four major areas: (1) coronary heart disease (CHD), manifested by stable angina, unstable angina, myocardial infarction (MI), heart failure, and coronary death; (2) cerebrovascular disease, manifested by transient ischemia attack and stroke; (3) peripheral vascular disease, manifested by claudication and critical limb ischemia; and (4) aortic atherosclerosis and aortic aneurysm (thoracic and abdominal). CHD remains the leading cause of death for both men and women in the United States. So, it is imperative to identify people at risk of CHD and provide appropriate medical treatment or intervention to prevent serious complications and outcomes including sudden cardiac death. Coronary artery calcification (CAC) is a marker of subclinical coronary artery disease. Therefore, coronary artery calcium score is an important screening method for Coronary artery disease (CAD). In this article, we performed a comprehensive review of current literatures and studies assessing the prognostic value of CAC for future cardiovascular disease (CVD) events. We searched PubMed, MEDLINE, Google Scholar, and Cochrane library. We also reviewed the 2018 American College of Cardiology (ACC)/American Heart Association (AHA) guideline on the assessment of CVD risk. A CAC score of zero corresponds to very low CVD event rates (∼1% per year) and hence a potent negative risk marker. This has been referred to as the ‘power of zero’ and affords the lowest risk of any method of risk calculation. It is now indicated in the 2018 ACC/AHA Cholesterol guidelines to be used to avoid statins for 5–10 years after a score of zero, and then re-assess the patient.

Abstract 15214: Food Insecurity and Cardiovascular Disease in NHANES (National Health and Nutrition Examination Survey) 2011-2016

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
MONICA M DELSON ◽  
Janice F Bell ◽  
Tequila S Porter ◽  
Julie T Bidwell
Keyword(s):  
Heart Failure ◽  
Cardiovascular Disease ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Food Insecurity ◽  
National Health ◽  
The United States ◽  
Nutrition Examination Survey ◽  
Health And Nutrition ◽  
Artery Disease

Background: Adherence to a heart-healthy diet is foundational for the prevention, management, and treatment of cardiovascular disease (CVD). Despite the fact that adhering to dietary guidelines may be challenging in the context of food insecurity, little is known about the likelihood of food insecurity in persons with CVD. Hypothesis: We hypothesized that persons with CVD (hypertension, coronary artery disease, heart failure, or stroke) would have significantly higher odds of food insecurity. Methods: This was an analysis of data from the National Health and Nutrition Examination Survey (NHANES), a nationally representative, cross-sectional study of health in the United States. All adults aged 19 years or older with food insecurity data were included across 3 cycles of NHANES (2011-2016). Food insecurity was measured using the 10-item Food Security Scale. CVD diagnosis was measured by self-report. Risk for food insecurity by CVD diagnosis was examined using multivariable logistic regression models, incorporating NHANES sample and person weights, and controlling for common sociodemographic confounders (age, gender, race/ethnicity, education, marital status). Results: The sample consisted of 17,175 persons (weighted study N =229,247,659). Slightly more than half were male (51.9%), and most were non-Hispanic white (65.1%). Just under half (45.6%) were in early adulthood (19-44 years), 35.3% were in middle adulthood (45-64 years), and 18.6% were in late adulthood (≥65 years). One quarter (25.9%) were food insecure. Consistent with our hypothesis, diagnosis of any CVD (stroke, heart failure, coronary artery disease, or hypertension) was significantly associated with higher likelihood for food insecurity (stroke: OR=2.18; 95% CI 1.83-2.60; p<0.001; heart failure OR=1.94, 95% CI 1.46-2.57, p<0.001; coronary artery disease: OR=1.90, 95% CI 1.49-2.43, p<0.001; and hypertension: OR=1.25, 95% CI 1.10-1.42, p=0.001). Conclusions: Diagnoses of hypertension, stroke, coronary artery disease, and heart failure were all significantly associated with higher risk for food insecurity. Given the necessity of dietary modification in CVD, further efforts to study food insecurity in CVD alongside other social determinants of health are urgently needed.

Cardiovascular Prognosis in Drug-Resistant Hypertension Stratified by 24-Hour Ambulatory Blood Pressure: The JAMP Study

Hypertension ◽  
2021 ◽  
Author(s):  
Kazuomi Kario ◽  
Satoshi Hoshide ◽  
Keisuke Narita ◽  
Yukie Okawara ◽  
Hiroshi Kanegae ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Coronary Artery Disease ◽  
Risk Factor ◽  
Coronary Artery ◽  
Ambulatory Blood Pressure ◽  
Resistant Hypertension ◽  
Cardiovascular Events ◽  
Atherosclerotic Cardiovascular Disease ◽  
Artery Disease

Resistant hypertension is an important cardiovascular risk factor. This analysis of the JAMP study (Japan Ambulatory Blood Pressure Monitoring Prospective) data investigated the effects of uncontrolled resistant hypertension diagnosed using ambulatory blood pressure (BP) monitoring on the risk of heart failure (HF) and overall cardiovascular events. The JAMP study patients with hypertension and no HF history were included. They had true resistant hypertension (24-hour BP ≥130/80 mm Hg), pseudoresistant hypertension (24-hour BP <130/80 mm Hg), well-controlled nonresistant hypertension (24-hour BP <130/80 mm Hg), or uncontrolled nonresistant hypertension (24-hour BP ≥130/80 mm Hg). The primary end point was total cardiovascular events, including atherosclerotic cardiovascular disease (fatal/nonfatal stroke and fatal/nonfatal coronary artery disease), and HF. During 4.5±2.4 years of follow-up the overall incidence per 1000 person-years was 10.1 for total cardiovascular disease, 4.1 for stroke, 3.5 for coronary artery disease, and 2.6 for HF. The adjusted risk of total cardiovascular and HF events was significantly increased in patients with true resistant versus controlled nonresistant hypertension (hazard ratio, 1.66 [95% CI, 1.12–2.48]; P =0.012 and 2.24 [95% CI, 1.17–4.30]; P =0.015, respectively) and versus uncontrolled nonresistant hypertension (1.51 [1.03–2.20]; P =0.034 and 3.03 [1.58–5.83]; P <0.001, respectively). The findings were robust in a sensitivity analysis using a slightly different definition of resistant hypertension. True resistant hypertension diagnosed using ambulatory BP monitoring is a significant independent risk factor for cardiovascular disease events, especially for HF. This highlights the importance of diagnosing and effectively treating resistant hypertension. Registration: URL: https://www.umin.ac.jp/ctr ; Unique identifier: UMIN000020377.

Abstract 264: Utilizing Risk Scoring for Prescribing Statins to Hospitalized Patients to Primarily Prevent Coronary Artery Disease

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Muhammed Atere ◽  
William Lim ◽  
Vishnuveni Leelaruban ◽  
Bhavya Narala ◽  
Stephanie Herrera ◽  
...  
Keyword(s):  
United States ◽  
Cardiovascular Disease ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
High Risk ◽  
Disease Risk ◽  
The United States ◽  
Intermediate Risk ◽  
Peripheral Artery ◽  
Artery Disease

Background: Cardiovascular disease is the leading cause of mortality in the United States. Approximately 25% of total deaths in the United States are attributed to cardiovascular diseases. Modification of risk factors has been shown to reduce mortality and morbidity in people with coronary artery disease. Medications such as statins are well known for reducing risks and recent data has shown that statins are beneficial in the primary prevention of coronary artery disease. The purpose of this study is to assess whether statins are being prescribed on discharge to patients who are identified as intermediate to high risk using the ACC/AHA Pooled Cohort Equations. Methodology: We reviewed and analyzed the charts of hospitalized patient’s ages 40 to 79 years who were discharged under the service of Internal Medicine at Richmond University Medical Center from September 2018 to August 2019. Exclusion criteria included: patients that expired before discharge or were admitted to the intensive or coronary care units, pregnancy, previous diagnosis of coronary/peripheral artery disease or stroke, already on statins or lipid-lowering medications, allergic to statins, discharged on statins for coronary/peripheral artery disease or stroke, and patients with liver disease or elevated liver enzymes. We used the ACC/AHA Pooled Cohort Equations risk to calculate the 10-year coronary artery disease risk for each patient. Results: The 10-year risk is grouped as low risk (<5%), borderline risk (5% to 7.4%), intermediate risk (7.5% to 19.9%) and high risk (≥20%). Among 898 patients, 10% had intermediate and high risk that were not discharged with statins. Among the 10%, about 6.6% were intermediate risk and 3.4% were high risk. Conclusions: A significant number of intermediate and high-risk patients were discharged without statins, although a CT coronary calcium may be helpful in further classifying the risk in some of them. We believe that a lipid profile should be checked in all hospitalized patients 40 years and older in order to calculate their atherosclerosis cardiovascular disease risk score and to possibly initiate statins after discussing the benefits and side effects, particularly in the intermediate risk group. The continuation of statins would be followed up by their primary care physicians. We plan to liaise with the information technology department in our facility to provide a link to the risk calculator in the electronic medical record so that the risk can be calculated and statins initiated as necessary. We will conduct a follow up review to assess for effectiveness.

scholarly journals The Comparison Between Management Versus Percutaneous Coronary Intervention (PCI) Patients With Coronary Artery Disease (CAD)

2021 ◽  
Vol 03 (06) ◽  
pp. 189-194
Author(s):  
Yuldashev Soatboy Jiyanboyevich ◽  
◽  
Dr. Imran Aslam ◽  
Arslonova Rayxon Rajabboevna ◽  
◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Cause Of Death ◽  
Coronary Intervention ◽  
The United States ◽  
Myocardial Infraction ◽  
The Usa ◽  
Artery Disease ◽  
The One

This study is based on the comparison between management versus PCI in patients with CAD. The prevalence of the major forms of cardiovascular disease (CVDs), mostly coronary artery disease (CAD), has changed dramatically in recent years. Cardiovascular disorders are now the one of the major cause of death and disability in the world.1 In 2015, 17.7 million individuals died from cardiovascular disease (CVD), which is around 31% of all deaths worldwide; 7.4 million pass away from coronary artery disease (CAD), and 6.7 million expired from stroke. 2 CAD is also the major cause of death, count for 13.2% of all deaths globally.3 It is responsible for one-quarter of all deaths in the United States of America (USA). About 75 percent of people with CAD in European countries are between the ages of 27 and 34.4 CAD was accountable for 16% of all man deaths and 10% of all female deaths in the England.5 Sudden death and CAD have a close connection. According to post-mortem reports and death certificates, 62-85 percent of patients who expired outside of the clinic have a past of CAD.6 As per informations from the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2014, myocardial infraction affects 3.0% of the mature people in the USA (3.3 percent of males and 2.3 percent of females). An MI occurs every 40 seconds or so in the USA. In the USA, the mean age at 1st MI is 65.6 years for guys and 72.0 years for ladies.7 In this study the management and PCI are compared in patients with CVD.

scholarly journals The Correlation of Dyslipidemia with the Extent of Coronary Artery Disease in the Multiethnic Study of Atherosclerosis

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Moshrik Abd alamir ◽  
Michael Goyfman ◽  
Adib Chaus ◽  
Firas Dabbous ◽  
Leslie Tamura ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Statistical Significance ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Low Hdl ◽  
Artery Disease ◽  
Prevalence Ratios

Background.The extent of coronary artery calcium (CAC) improves cardiovascular disease (CVD) risk prediction. The association between common dyslipidemias (combined hyperlipidemia, simple hypercholesterolemia, metabolic Syndrome (MetS), isolated low high-density lipoprotein cholesterol, and isolated hypertriglyceridemia) compared with normolipidemia and the risk of multivessel CAC is underinvestigated.Objectives.To determine whether there is an association between common dyslipidemias compared with normolipidemia, and the extent of coronary artery involvement among MESA participants who were free of clinical cardiovascular disease at baseline.Methods.In a cross-sectional analysis, 4,917 MESA participants were classified into six groups defined by specific LDL-c, HDL-c, or triglyceride cutoff points. Multivessel CAC was defined as involvement of at least 2 coronary arteries. Multivariate Poisson regression analysis evaluated the association of each group with multivessel CAC after adjusting for CVD risk factors.Results.Unadjusted analysis showed that all groups except hypertriglyceridemia had statistically significant prevalence ratios of having multivessel CAC as compared to the normolipidemia group. The same groups maintained statistical significance prevalence ratios with multivariate analysis adjusting for other risk factors including Agatston CAC score [combined hyperlipidemia 1.41 (1.06–1.87), hypercholesterolemia 1.55 (1.26–1.92), MetS 1.28 (1.09–1.51), and low HDL-c 1.20 (1.02–1.40)].Conclusion.Combined hyperlipidemia, simple hypercholesterolemia, MetS, and low HDL-c were associated with multivessel coronary artery disease independent of CVD risk factors and CAC score. These findings may lay the groundwork for further analysis of the underlying mechanisms in the observed relationship, as well as for the development of clinical strategies for primary prevention.

scholarly journals Polygenic Scores to Assess Atherosclerotic Cardiovascular Disease Risk

2020 ◽  
Vol 126 (9) ◽  
pp. 1159-1177 ◽  
Author(s):  
Krishna G. Aragam ◽  
Pradeep Natarajan
Keyword(s):  
Cardiovascular Disease ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Clinical Utility ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Risk Scores ◽  
Atherosclerotic Cardiovascular Disease ◽  
Artery Disease ◽  
Atherosclerotic Cardiovascular Disease Risk

An individual’s susceptibility to atherosclerotic cardiovascular disease is influenced by numerous clinical and lifestyle factors, motivating the multifaceted approaches currently endorsed for primary and secondary cardiovascular disease prevention. With growing knowledge of the genetic basis of atherosclerotic cardiovascular disease—in particular, coronary artery disease—and its contribution to disease pathogenesis, there is increased interest in understanding the potential clinical utility of a genetic predictor that might further refine the assessment and management of atherosclerotic cardiovascular disease risk. Rapid scientific and technological advances have enabled widespread genotyping efforts and dynamic research in the field of coronary artery disease genetic risk prediction. In this review, we describe how genomic analyses of coronary artery disease have been leveraged to create polygenic risk scores. We then discuss evaluations of the clinical utility of these scores, pertinent mechanistic insights gleaned, and practical considerations relevant to the implementation of polygenic risk scores in the health care setting.

Coronary artery bypass grafting in women

2021 ◽  
pp. 405-410
Author(s):  
Jessica Yu Rove ◽  
Jennifer S. Lawton
Keyword(s):  
United States ◽  
Cardiovascular Disease ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
The United States ◽  
Bypass Grafting ◽  
Artery Disease ◽  
Developed World

Cardiovascular disease poses the greatest health threat to women in the developed world. Despite the fact that up until 2013 in the United States more women than men died annually of cardiovascular disease, women remain underdiagnosed and undertreated for cardiovascular disease. This chapter acknowledges perceived and actual differences in the manifestation of coronary artery disease between women and men. Further, it summarizes data on the modern performance and outcomes of coronary artery bypass surgery in women compared to men.

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