scholarly journals Coronary Calcification and Male Gender Predict Significant Stenosis in Symptomatic Patients in Northern and Southern Europe and the USA: A Euro-CCAD Study

2018 ◽  
Vol 13 ◽  
Author(s):  
Ying Zhao ◽  
Rachel Nicoll ◽  
Axel Diederichsen ◽  
Hans Mickley ◽  
Kristian Ovrehus ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery ◽  
Coronary Calcification ◽  
Ct Scanning ◽  
Fold Increase ◽  
Male Gender ◽  
Northern Europe ◽  
Southern Europe ◽  
Significant Stenosis ◽  
The Usa

Background and Aims: Significant stenosis is the principal cause of stable angina but its predictors and their variation by geographical region are unclear.Methods and Results: From the European Calcific Coronary Artery Disease (Euro-CCAD) cohort, we retrospectively investigated 5515 symptomatic patients from northern Europe (Denmark, France, Germany), southern Europe (Italy, Spain) and USA. All had conventional cardiovascular risk factor assessment, angiography and CT scanning for coronary artery calcium (CAC) scoring. There were differences in the patient characteristics between the groups, with the USA patients being younger and having more diet and lifestyle-related risk factors, although hypertension may have been better controlled than in Europe. USA patients had a two-fold increase in prevalence of significant stenosis and a three-fold increase in median CAC score. In all three groups, the log CAC score proved to be the strongest predictor of >50% stenosis followed by male gender. In the USA group, there were no additional independently predictive risk factors, although in northern Europe obesity, hypertension, smoking and hypercholesterolaemia remained predictive, with all risk factors other than hypertension proving to be predictive in the southern Europe group. Without the CAC score as a variable, male gender followed by diabetes were the most important predictors in all three regions, with hypertension also proving predictive in northern Europe.Conclusion:  In symptomatic patients, the CAC score and male gender were the two most important predictors of significant stenosis in symptomatic patients in northern and southern Europe and the USA.

scholarly journals Coronary artery calcium, HIV and inflammation in Uganda compared with the USA

Open Heart ◽  
2019 ◽  
Vol 6 (1) ◽  
pp. e001046 ◽  
Author(s):  
Ben Alencherry ◽  
Geoffrey Erem ◽  
Grace Mirembe ◽  
Isaac Ssinabulya ◽  
Chun-Ho Yun ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery ◽  
Antiretroviral Therapy ◽  
Coronary Artery Calcium ◽  
Density Lipoprotein ◽  
Sub Saharan Africa ◽  
Intercellular Adhesion Molecule ◽  
People Living With Hiv ◽  
Cross Sectional ◽  
The Usa

ObjectivesTo compare the prevalence of detectable coronary artery calcium (CAC) among higher risk, older people living with HIV (PLWH) and uninfected persons in Uganda versus the USA, and second to explore associations of CAC with HIV-specific variables and biomarkers of inflammation.MethodsThis cross-sectional study of 430 total subjects compared 100 PLWH on antiretroviral therapy and 100 age-matched and sex-matched HIV-uninfected controls in Uganda with 167 PLWH on antiretroviral therapy and 63 uninfected controls in the USA. Multivariable logistic regression was used to examine associations with detectable CAC (CAC >0).ResultsCompared with US subjects, Ugandans were older (mean age 56 vs 52 years) and were more likely to have diabetes (36% vs 3%) and hypertension (85% vs 36%), but were less likely to be male (38% vs 74%) or smokers (4% vs 56%). After adjustment for HIV serostatus, age, sex and traditional risk factors, Ugandans had substantially lower odds of CAC >0 (adjusted OR 0.07 (95% CI 0.03 to 0.17), p<0.001). HIV was not associated with CAC >0 in either country (p>0.1). Among all PLWH, nadir CD4 count was associated with the presence of CAC, and among Ugandans soluble intercellular adhesion molecule (p=0.044), soluble CD163 (p=0.004) and oxidised low-density lipoprotein (p=0.043) were all associated with the presence of CAC.ConclusionsUgandans had a dramatically lower prevalence of any coronary calcification compared with US subjects. The role of HIV infection and inflammation as risk factors for subclinical coronary disease in sub-Saharan Africa merits further investigation.

scholarly journals A Clinical Study of Lipid Abnormalities and Angiographic Profile in Patients of Coronary Artery Disease on Statins Undergoing Coronary Angiography

2017 ◽  
Vol 02 (02) ◽  
pp. 011-018
Author(s):  
Raghu Galla ◽  
Ch. Susmitha ◽  
G. Indrani
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Total Cholesterol ◽  
Male Gender ◽  
Coronary Angiogram ◽  
Vessel Disease ◽  
Lv Dysfunction ◽  
Artery Disease ◽  
Lipid Abnormalities

AbstractBackground: The traditional risk factors of coronary artery disease (CAD) are Age, Genetic factors, Smoking, Hypertension, Diabetes and Dyslipidemia occurrence of each of which influence the presentations of the disease and its severity of the angiographic profile. With changing scenario of risk factor assessment due to global increase in CAD and starting the statins quite early for patients with risk factors without the CAD, we want to see the present status of lipids in patients undergoing coronary angiogram (CAG).Objective: We aim to evaluate the occurrence of various risk factors especially lipid abnormalities and correlate them with angiographic severity in patients presenting with CAD and undergoing CAGMethods: We evaluated 504 consecutive patients already on statins presenting with CAD and undergoing coronary angiogram between august 2015 to December 2016 at our center. We obtained the detailed clinical, biochemical and angiographic profile from the records and analyzed the occurrence of risk factors and correlated the lipid abnormalities and angiographic profile for any statistical significance using Minitab 17 software.Results: Of the total 504 patients 331 (65.6%) were males. 347 (68.8%) had Hypertension, 258 (51.1%) had DM, 370 (73.4%) had Dyslipidemia and 128 (25.3%) had LV dysfunction. 303 (60.1%) had abnormal coronary angiograms. Of these 148 (48.8%) had single vessel disease (SVD), 85 (28%) had double vessel disease (DVD), 70 (23.2%) had triple vessel disease (TVD). Abnormal CAG is significantly found in Males (p = 0.03), Hypertension (p = 0.00), DM (P = 0.01) and LV dysfunction (p = 0.00). Dyslipidemia had tendency for correlation with abnormal CAG but not statistically significant (p = 0.07). The levels of LDL, HDL and triglycerides didn't correlate with the angiographic abnormality. In patients with severe CAD i.e. TVD the determinants are age (p = 0.01), male sex ( p = 0.01), smoking (p = 0.02), HTN (p = 0.002), DM (p = 0.03), LV dysfunction (p = 0.006). Neither Dyslipidemia (p = 0.2) nor levels of Total cholesterol, HDL, LDL, TG determined the occurrence of TVD. Occurrence of DVD correlated significantly with age (p = 0.001), male gender (p = 0.002) and LV dysfunction (p = 0.02). In SVD Male gender (p = 0.003), HTN (p = 0.001), LV dysfunction (p = 0.00), TG (p = 0.03) had showed significant correlation. Occurrence of Dyslipidemia didn't show any correlation with the occurrence of SVD (p = 0.26) or DVD (p = 0.43). High levels of individual lipid components except TG in SVD didn't show any correlation in occurrence of DVD or SVD.Conclusion: In patients presenting with CAD on statins with abnormal CAG, age, male gender, HTN, DM and LV dysfunction of any severity are the determinants but not the occurrence of Dyslipidemia or the levels of Total cholesterol of LDL, HDL or TG. The occurrence of Dyslipidemia or levels of individual lipid component abnormalities except for high levels of TG in SVD didn't show any significant correlation with the occurrence of SVD, DVD or TVD.

scholarly journals Extensive coronary artery disease in a long-distance athlete: a case report

2020 ◽  
Author(s):  
Vasiliki Katsi ◽  
Stergios Soulaidopoulos ◽  
Constantina Aggeli ◽  
George Latsios ◽  
Dimitrios Tousoulis ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Case Report ◽  
Coronary Artery ◽  
Coronary Calcification ◽  
Distance Runner ◽  
Long Distance ◽  
Common Cause ◽  
Coronary Events ◽  
Artery Disease

Abstract Despite the established benefits of regular physical activity in cardiovascular disease prevention, coronary events in the context of atherosclerotic coronary artery disease have been found to be the most common cause of exercise-related sudden death. A paradoxical development of an increased coronary calcification burden is likely to be associated with endurance training even in the absence of any of the traditional cardiovascular risk factors. In this case report, we present a 50-year old, male, long-distance runner with excessive, subclinical myocardial ischemia.

scholarly journals Implications of Gender Difference in Coronary Calcification as Assessed by CT Coronary Angiography

2014 ◽  
Vol 8s4 ◽  
pp. CMC.S18764 ◽  
Author(s):  
Amgad N. Makaryus ◽  
Cristina Sison ◽  
Michelle Kohansieh ◽  
John N. Makaryus
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Coronary Arteries ◽  
Calcium Score ◽  
Coronary Calcification ◽  
Smoking History ◽  
Males And Females ◽  
Coronary Events

Background Arterial calcium as measured by 64-slice computed tomography coronary angiography (64-CT) is a reliable predictor of cardiovascular disease risk. Lipid-rich plaques with lower degrees of calcification may pose greater risk for adverse coronary events than more stabilized calcified plaques as a result of the increased risk of plaque rupture, migration, and subsequent acute coronary syndrome. We sought to examine coronary artery calcium scores as measured via 64-CT to assess the extent of calcification and plaque distribution in women compared to men. Methods A total of 138 patients referred for 64-CT were evaluated. Computerized tomographic angiography was performed using the GE LightSpeed VCT. Subgroup analysis comparing male and female data (including demographic data) was performed. All major coronary arteries were analyzed for coronary stenosis/plaque characterization as well as total vessel calcium (Agatston) score quantification. Patient demographics and coronary risk factors were recorded. Results A total of 552 coronary arteries were evaluated in 138 patients (85 men, 53 women). The average age for females was 64.4 ± 10.8 years and for males 60.0 ± 12.8 years. The only demographic/cardiovascular risk factor in which the difference between men and women was significant was smoking history, where 23.5% of men had a history of smoking while only 9.6% of females endorsed having a smoking history ( P < 0.044). On comparison of all total vessel calcium scores, males had a higher total mean calcium score than females in each individual vessel. The results were as follows for males versus females, respectively: left main total vessel calcium score 46.49 versus 16.71 ( P = 0.167); left anterior descending 265.21 versus 109.6 ( P < 0.003); left circumflex 130.5 versus 39.7 ( P < 0.004); and right coronary 213.5 versus 73.8 ( P < 0.01). The odds of having a total calcium score >100 (versus not) was 3.62 times greater in males relative to females, given that all the other cardiovascular risk factors are adjusted for (95% confidence interval: 1.37-9.54). On average, men had an average of 2.1 ± 1.5 epicardial vessels with a calcium score ≥11 compared to 1.3 ± 1.4 for women ( P < 0.005). Conclusion There are clear differences between males and females regarding total vessel calcium scores and therefore risk of future adverse coronary events. Males tended to have higher average calcium scores in each coronary artery than females with a greater tendency to have multiple vessel involvement. Using this information, more large-scale, randomized controlled studies should be performed to correlate differences in the extent of coronary calcification with the observed variance in clinical presentation during coronary events between males and females as a means to potentially establish gender-specific therapeutic regimens.

scholarly journals Patients presenting with acute coronary syndromes have unreported coronary artery calcium on historical CT imaging

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
C Bradley ◽  
A Aggarwal ◽  
K Goatman ◽  
G Jones ◽  
C Berry ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Coronary Artery ◽  
Cardiovascular Events ◽  
Electronic Patient Record ◽  
Coronary Calcification ◽  
Ct Imaging ◽  
Radiology Reports ◽  
Clinical Radiology ◽  
The Mean

Abstract Introduction Ischaemic heart disease (IHD) remains the leading cause of mortality globally1. The presence and extent of coronary artery calcification (CAC) is a strong predictor of cardiovascular events, and CAC scoring has been shown to be more predictive of cardiovascular events than other traditional risk assessment scores2. Incidental coronary calcification can be detected and quantified on non-gated CT chest scans covering the heart in the field of view3. This finding is typically not reported4 and hence an opportunity to optimise cardiovascular risk assessment and treatment is missed. Purpose We sought to investigate whether patients presenting to our centre with an acute coronary syndrome (ACS) event had historical CT imaging demonstrating coronary artery calcification. Methods We retrospectively reviewed case records for all patients referred to our centre for an invasive coronary angiogram following their first known admission with an ACS event. ACS were defined according to contemporary guidelines from the European Society of Cardiology. We reviewed a 3 month period prior to the COVID-19 pandemic (01/01/2019–31/03/2019). The national imaging database was interrogated to identify previous CT imaging that includes the heart in the field of view. The presence of coronary calcification was confirmed and quantified using an ordinal scoring method previously described3. The clinical radiology reports for the scans were reviewed to determine the frequency of CAC being reported. Demographic information was collected from our electronic patient record including the presence of risk factors for IHD. Prescribed medication prior to admission was also recorded using the on-admission medicines reconciliation documented in the electronic patient record. Results 385 patients with first presentation of ACS were identified. 75 (19%) had a prior non-gated CT chest imaging. The most common indication for CT was for investigation of possible malignancy. The mean interval from CT imaging to ACS admission was 36 months. CAC was present on 67 (89%) scans. The mean ordinal score was 4.04, corresponding to moderate CAC. The distribution of CAC by coronary artery revealed the majority of disease to involve the left anterior descending artery (Table 1). Only 12/67 (18%) of clinical radiology reports mentioned coronary calcification (Figure 1). Patients with CAC frequently had additional risk factors for IHD. Despite this only 42% were prescribed antiplatelet therapy, and only 45% prescribed a statin. Conclusions A significant proportion of ACS admissions have evidence of CAC on historical CT scans. This finding is often not reported and the majority of patients with demonstrated coronary artery disease are not prescribed appropriate preventative therapies. Systematic reporting of this finding may have a significant impact on the prevention of acute cardiovascular events. FUNDunding Acknowledgement Type of funding sources: None. Table 1

scholarly journals Relationship between cardiovascular risk factors and coronary calcification in a middle-aged Dutch population: the Imalife study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Xia ◽  
M Vonder ◽  
G Sidorenkov ◽  
M Den Dekker ◽  
M Oudkerk ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Coronary Artery ◽  
Cardiovascular Risk Factors ◽  
Coronary Artery Calcium ◽  
Coronary Calcification ◽  
Low Risk ◽  
Funding Source ◽  
Middle Aged ◽  
Score Risk

Abstract Background Systematic COronary Risk Evaluation (SCORE) has been proposed to assess the 10-year risk of fatal cardiovascular diseases, with distinction between low-risk and high-risk countries. Risk modifiers are recommended to further improve risk reclassification, for example the coronary artery calcium (CAC) score. CAC scoring can significantly improve risk prediction for coronary events based on outcome studies. The impact of CAC scoring on risk classification in a middle-aged cohort from a low-risk country in comparison to SCORE is unknown. Purpose To assess presence of coronary calcification and association with cardiovascular risk factors and related SCORE risk in a middle-aged population from a low risk country. Methods Coronary calcification and classical cardiovascular risk factors were analyzed in 4,083 Dutch participants aged 45–60 years (57.9% women) without a known history of coronary artery disease in the population-based ImaLife (Imaging in Lifelines) study. Individuals underwent non-contrast cardiac CT using third generation dual-source CT. Coronary artery calcium (CAC) scores were quantified using Agatston's method. Age- and sex- specific distributions of CAC categories (0, 1–99, 100–299, ≥300) and percentiles were assessed. Distribution of CAC categories was compared to SCORE risk categories (&lt;1%, ≥1% to 5%, and ≥5%) for low risk countries. Relationship between risk factors and CAC presence was evaluated by logistic regression models. Population attributable fractions (PAFs) of classical risk factors for CAC presence were estimated to investigate potential prevention strategy. Results CAC was present in 54.5% of men and in 26.5% of women. With increasing age, an increasing percentage had a positive CAC score, from 38.1% of men and 15.2% of women at age 45–49 years, to 66.9% of men and 36.6% of women at age 55–60. Mean SCORE was 1.3% (2.0% in men, 0.7% in women). In SCORE risk &lt;1%, 32.7% of men and 17.1% of women had CAC. In men with SCORE risk ≥5% (0.1% of women), 26.9% had no CAC. Overall PAF for presence of CAC of the classical risk factors was 18.5% in men and 31.4% in women. PAF was highest for hypertension (in men 8.0%, 95% CI 4.2–11.8%; in women 13.1%, 95% CI 7.9–18.2%) followed by hypercholesterolemia and obesity. Conclusion In this middle-aged Dutch cohort, slightly over half of men and a quarter of women had any CAC. With age there was an increase in CAC presence for both sexes. Only a minor proportion of CAC presence was attributable to classical risk factors. This provides further support that CAC scoring can impact risk classification in a middle-aged population of a low-risk country. Funding Acknowledgement Type of funding source: Other. Main funding source(s): The ImaLife study is supported by an institutional research grant from Siemens Healthineers and by the Ministry of Economic Affairs and Climate Policy by means of the PPP Allowance made available by the Top Sector Life Sciences & Health to stimulate public-private partnerships.

Abstract 4192: Unrecognized Myocardial Infarctions are Common in Cardiac Asymptomatic Subjects at High Vascular Risk

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Matthijs F Meijs ◽  
Michiel L Bots ◽  
Maarten J Cramer ◽  
Evert J Vonken ◽  
Birgitta K Velthuis ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
High Risk ◽  
Male Gender ◽  
History Of ◽  
Artery Disease ◽  
Asymptomatic Subjects ◽  
Q Wave

Unrecognized myocardial infarction (UMI), generally assessed by the presence of a Q-wave on the electrocardiogram, is commonly found. Furthermore, mortality associated with UMI appears to be similar as for recognized myocardial infarction. With delayed enhancement cardiac MRI (DE-CMR) both Q-wave and non-Q wave infarctions can be identified. The aim of this study was to investigate the prevalence and determinants of UMI in high risk subjects without symptomatic coronary artery disease using DE-CMR. A DE-CMR was performed in 502 subjects with clinically manifest non-coronary atherosclerotic disease or marked risk factors for atherosclerosis. As all subjects had no known history of coronary artery disease, subendocardial and transmural scar tissue on DE-CMR was considered an UMI. In all subjects information on atherosclerotic risk factors was collected. Multivariable logistic regression was used to study the relation of risk factors with UMI. DE-CMR was of sufficient image quality in 480 (95.6%) subjects. Interobserver agreement was excellent (weighted kappa = 95%). An UMI was present in 45 (9.4%) of all subjects, and in 38 (13.1%) of 291 men and in 7 (3.7%) of 189 women. The risk of UMI increased from 6.0% (95%CI 2.2 – 9.8%) in those with two risk factors up to 26.2% (95%CI 15.2 – 37.3%) in those with 4 or 5 risk factors (male gender, age above mean of 53 years, ever smoking, history of stroke, and history of aneurysm of the abdominal aorta (AAA)). In multivariable analysis the risk of UMI was related to male gender (OR 2.6 (95%CI 1.1– 6.3)), age (OR 1.0 (95%CI 1.0 –1.1) per year), ever smoking (OR 3.1 (95%CI 1.0 –9.0), history of stroke (OR 2.1 (95%CI 1.0 – 4.4)) and history of AAA (OR 2.3 (95%CI 0.9 –5.9)). In high risk cardiac asymptomatic subjects UMI is common. The risk of UMI increases with increasing presence of risk factors.

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