Evaluation of Cardiovascular Risk Factors in Patients With Familial Hypercholesterolemia From the North-eastern Area of Romania

Abstract Background. Familial hypercholesterolemia(FH) is one of the most frequent and important monogenic cholesterol pathologies. Traditional and nontraditional cardiovascular risk factors increase the prevalence of atherosclerotic cardiovascular disease(ASCVD) in this population. The aims of the study were: (a)to identify FH patients in the North-Eastern part of Romania and to analyze demographic, clinical and paraclinical data (b)to evaluate the risk of new cardiovascular events at follow-up in FH patients stratified by lipid-lowering agents.Methods. This first prospective study in the North-Eastern part of Romania was carried out between October 2017 and October 2019; out of 980 patients with dyslipidemia evaluated with the Dutch Lipid Network(DLCN) and Simon Broome(SM) scores, 61 patients with DLCN score above 3 and possible/probable FH (SM score) were included.Results. The 61 subjects with clinical diagnosis of FH (6.2% of all patients examined) recorded a mean age of 48.5±12.5 years, with more female patients than male patients. Hypertension was the main cardiovascular risk factor for both genders, followed by physical inactivity and obesity for the female group and active smoking for the male group. The measured DLCN score recorded: “possible” FH identified in 39.4%, “probable” FH in 45.9% and “definite” FH in 14.7%. As far as treatment was concerned, the effective lipid-lowering drugs were statin alone and statin in association with fenofibrate, which improved both the lipid profile values and the subclinical atherosclerosis markers (ankle-brachial index, carotid intima-media thickness and high-sensitivity C-reactive protein). New ASCVDs that emerged during the study were most commonly represented by coronary heart disease and stroke. At the same time, the new CV events were delayed in patients receiving the lipid-lowering drugs, without significant differences between them.Conclusions. In patients with suspected FH, the lipid-lowering agents during the follow-up delayed the new cardiovascular events, yet failed to reach the goals proposed by the guidelines.

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Evaluation Of Cardiovascular Risk Factors In Patients With Familial Hypercholesterolemia From The North-Eastern Area Of Romania

10.21203/rs.3.rs-61509/v5 ◽

2021 ◽

Author(s):

Cristiana-Elena Vlad ◽

Liliana Foia ◽

Laura Florea ◽

Irina-Iuliana Costache ◽

Andreea Covic ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Cardiovascular Events ◽

Lipid Lowering ◽

The North ◽

North Eastern ◽

Lipid Lowering Agents ◽

North Eastern Part

Abstract Background. Familial hypercholesterolemia(FH) is one of the most frequent and important monogenic cholesterol pathologies. Traditional and non-traditional cardiovascular risk factors increase the prevalence of atherosclerotic cardiovascular disease(ASCVD) in this population. The aims of the study were:(a) to identify FH patients in the North-Eastern part of Romania and to analyze demographic, clinical and paraclinical data (b) to evaluate the risk of new cardiovascular events at follow-up in FH patients stratified by lipid-lowering agents. Methods. This first prospective study in the North-Eastern part of Romania was carried out between October 2017 and October 2019; out of 980 patients with dyslipidemia evaluated with the Dutch Lipid Network(DLCN) and Simon Broome(SM) scores, 61 patients with DLCN score above 3 and possible/probable FH(SM score) were included.Results. 980 patients were examined and 61 (6.2%) were received the clinical diagnosis of FH. The mean age was 48.5±12.5 years, with more female patients than male patients (63.9% versus 36%). Hypertension was the main cardiovascular risk factor for both genders, followed by physical inactivity and obesity for the female group and active smoking for the male group. The measured DLCN score recorded: “possible” FH identified in 39.4%, “probable” FH in 45.9% and “definite” FH in 14.7%. The effective lipid-lowering drugs used were statin alone and statin in association with fenofibrate, which improved both the lipid profile values and the subclinical atherosclerosis markers (ankle-brachial index, carotid intima-media thickness and high-sensitivity C-reactive protein). New ASCVDs that emerged during the study were most commonly represented by coronary heart disease and stroke. At the same time, the new cardiovascular events were delayed in patients receiving the lipid-lowering drugs, without significant differences between them. Conclusions. In patients with suspected FH, the lipid-lowering agents during the follow-up period delayed the new cardiovascular events, yet failed to reach the goals proposed by the guidelines.

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Evaluation of Cardiovascular Risk Factors in Patients with Familial Hypercholesterolemia from the North-Eastern Area of Romania

10.21203/rs.3.rs-61509/v4 ◽

2020 ◽

Author(s):

Cristiana-Elena Vlad ◽

Liliana Foia ◽

Laura Florea ◽

Irina-Iuliana Costache ◽

Andreea Covic ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Cardiovascular Events ◽

Lipid Lowering ◽

The North ◽

North Eastern ◽

Lipid Lowering Agents ◽

North Eastern Part

Abstract Background. Familial hypercholesterolemia(FH) is one of the most frequent and important monogenic cholesterol pathologies. Traditional and non-traditional cardiovascular risk factors increase the prevalence of atherosclerotic cardiovascular disease(ASCVD) in this population. The aims of the study were:(a) to identify FH patients in the North-Eastern part of Romania and to analyze demographic, clinical and paraclinical data (b) to evaluate the risk of new cardiovascular events at follow-up in FH patients stratified by lipid-lowering agents.Methods. This first prospective study in the North-Eastern part of Romania was carried out between October 2017 and October 2019; out of 980 patients with dyslipidemia evaluated with the Dutch Lipid Network(DLCN) and Simon Broome(SM) scores, 61 patients with DLCN score above 3 and possible/probable FH(SM score) were included.Results. 980 patients were examined and 61 (6.2%) were received the clinical diagnosis of FH. The mean age was 48.5±12.5 years, with more female patients than male patients (63.9% versus 36%). Hypertension was the main cardiovascular risk factor for both genders, followed by physical inactivity and obesity for the female group and active smoking for the male group. The measured DLCN score recorded: “possible” FH identified in 39.4%, “probable” FH in 45.9% and “definite” FH in 14.7%. The effective lipid-lowering drugs used were statin alone and statin in association with fenofibrate, which improved both the lipid profile values and the subclinical atherosclerosis markers (ankle-brachial index, carotid intima-media thickness and high-sensitivity C-reactive protein). New ASCVDs that emerged during the study were most commonly represented by coronary heart disease and stroke. At the same time, the new CV events were delayed in patients receiving the lipid-lowering drugs, without significant differences between them.Conclusions. In patients with suspected FH, the lipid-lowering agents during the follow-up period delayed the new cardiovascular events, yet failed to reach the goals proposed by the guidelines.

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Evaluation of cardiovascular risk factors in patients with familial hypercholesterolemia from the North-Eastern area of Romania

Lipids in Health and Disease ◽

10.1186/s12944-020-01428-y ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Cristiana-Elena Vlad ◽

Liliana Foia ◽

Laura Florea ◽

Irina-Iuliana Costache ◽

Andreea Covic ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Cardiovascular Events ◽

Lipid Lowering ◽

The North ◽

North Eastern ◽

Lipid Lowering Agents ◽

North Eastern Part

Abstract Background Familial hypercholesterolemia(FH) is one of the most frequent and important monogenic cholesterol pathologies. Traditional and non-traditional cardiovascular risk factors increase the prevalence of atherosclerotic cardiovascular disease(ASCVD) in this population. The aims of the study were: (a) to identify FH patients in the North-Eastern part of Romania and to analyze demographic, clinical and paraclinical data (b) to evaluate the risk of new cardiovascular events at follow-up in FH patients stratified by lipid-lowering agents. Methods This first prospective study in the North-Eastern part of Romania was carried out between October 2017 and October 2019; out of 980 patients with dyslipidemia evaluated with the Dutch Lipid Network(DLCN) and Simon Broome(SM) scores, 61 patients with DLCN score above 3 and possible/probable FH(SM score) were included. Results Nine hundred-eighty patients were examined and 61 (6.2%) were received the clinical diagnosis of FH. The mean age was 48.5±12.5 years, with more female patients than male patients (63.9% versus 36%). Hypertension was the main cardiovascular risk factor for both genders, followed by physical inactivity and obesity for the female group and active smoking for the male group. The measured DLCN score recorded: “possible” FH identified in 39.4%, “probable” FH in 45.9% and “definite” FH in 14.7%. The effective lipid-lowering drugs used were statin alone and statin in association with fenofibrate, which improved both the lipid profile values and the subclinical atherosclerosis markers (ankle-brachial index, carotid intima-media thickness and high-sensitivity C-reactive protein). New ASCVDs that emerged during the study were most commonly represented by coronary heart disease and stroke. At the same time, the new cardiovascular events were delayed in patients receiving the lipid-lowering drugs, without significant differences between them. Conclusions In patients with suspected FH, the lipid-lowering agents during the follow-up period delayed the new cardiovascular events, yet failed to reach the goals proposed by the guidelines.

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Evaluation of Cardiovascular Risk Factors in Patients With Familial Hypercholesterolemia From the North-Eastern Area of Romania

10.21203/rs.3.rs-61509/v2 ◽

2020 ◽

Author(s):

Cristiana-Elena Vlad ◽

Liliana Foia ◽

Laura Florea ◽

Irina-Iuliana Costache ◽

Andreea Covic ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Familial Hypercholesterolemia ◽

Cardiovascular Events ◽

Lipid Lowering ◽

The North ◽

Increased Risk ◽

North Eastern ◽

North Eastern Part

Abstract Background. Familial hypercholesterolemia (FH) is one of the most frequent and important monogenic cholesterol pathologies. Traditional and nontraditional cardiovascular risk factors increase the prevalence of atherosclerotic cardiovascular disease (ASCVD) in this population. Objective. (a)To identify FH patients in the North-Eastern part of Romania and to analyze demographic, clinical and paraclinical data (b)to identify of new cardiovascular events in FH patients throughout the follow-up based on the administrated lipid lowering drugs.Methods. This first prospective study in the North-Eastern part of Romania was carried out between October 2017 and October 2019; out of 980 patients with dyslipidemia evaluated with the Dutch Lipid Network (DLCN) and Simon Broome (SM) scores, only 61 patients with DLCN score above 3 and possible/probable FH (SM score) were included.Results. The 61 FH subjects recorded a mean age of 48.5±12.5 years, with more female patients than male patients. Hypertension was the main cardiovascular risk factor for both sexes, followed by physical inactivity and obesity for the female FH group and active smoker for the male FH group. The measured DLCN score recorded: “possible” FH identified in 39.4%, “probable” FH in 45.9% and “definite” FH in 14.7%. After the administration of the lipid-lowering agents for 24 months, low-density cholesterol lipoprotein(LDL-C) levels and carotid intima-media thickness(cIMT) have decreased, while the ankle-brachial index(ABI) and high-density cholesterol lipoprotein(HDL-C) levels have increased. Also, the cIMT values over 0.9mm, total cholesterol(TC), triglyceride(TG), and high-sensitivity C-reactive protein(hsCRP) levels were associated with an increased risk of ASCVD. In addition, statins administrated in monotherapy have delayed de new cardiovascular events.Conclusions. To obtain a reduction of cardiovascular events, FH patients need cascade screening for early identification and a specific management with possible administration of monoclonal antibodies, despite the significant socio-economic barriers.

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Evaluation of Cardiovascular Risk Factors In Patients With Familial Hypercholesterolemia From The North-Eastern Area of Romania

10.21203/rs.3.rs-61509/v1 ◽

2020 ◽

Author(s):

Cristiana-Elena Vlad ◽

Liliana Foia ◽

Laura Florea ◽

Irina-Iuliana Costache ◽

Andreea Covic ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Familial Hypercholesterolemia ◽

Lipid Lowering ◽

High Dose ◽

The North ◽

Increased Risk ◽

North Eastern ◽

North Eastern Part

Abstract Background. Familial hypercholesterolemia (FH) is one of the most frequent and important monogenic cholesterol pathology. Traditional and nontraditional cardiovascular risk factors increase the prevalence of atherosclerotic cardiovascular disease (ASCVD) in this population. Objective. To establish the prevalence and the cardiovascular risk factors of FH population, to identify the ASCVD through the clinico-biological and imaging modifications during the 24-months follow-up.Methods. This first prospective study in the north-eastern part of Romania, carried out between October 2017-October 2019, out of 980 patients with dyslipidemia evaluated with the Dutch Lipid Network (DLCN) and Simone Broome (SM) scores, only 61 patients with DLCN score above 3 and FH possible/probably (SM score) were included.Results. The 61 FH subjects recorded a mean age of 48.46±12.53 years, with more women compared to men. Regarding the traditional cardiovascular risk factors, we identified that high blood pressure was the main factor in all patients, followed by sedentary lifestyle, obesity, smoker status, personal cardiovascular history and type 2 diabetes. The measured DLCN score recorded: “possible” FH identified in 39.4%, the “probable”FH in 45.9% and the “definite” FH in 14.7%. After the administration of the lipid-lowering agents for 24 months, TC and LDL-C levels, carotid intima-media thickness (cIMT) and ankle-brachial index (ABI) decreased and HDL-C levels increased, but without reaching the guideline goals. In addition, the high-dose of statin alone, the high-dose of statin with fenofibrate, subjects with „possible” FH, the normal values of cIMT and ABI, had a reduced time of ASCVD occurrence. Also, the high cIMT values, physical inactivity, high TC, TG and high-sensitivity C-reactive protein (hsCRP) levels were associated with an increased risk of ASCVD. Conclusions. To reduce cardiovascular risk, the FH patients need a cascade screening and a specific management. Even though it was the first observational study in the north-eastern part of Romania, further molecular genetics studies are needed to confirm the FH cases.

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Use of Cardiovascular Drugs for Primary and Secondary Prevention of Cardiovascular Disease Among Rural-Dwelling Older Chinese Adults

Frontiers in Pharmacology ◽

10.3389/fphar.2020.608136 ◽

2020 ◽

Vol 11 ◽

Author(s):

Lin Cong ◽

Yifei Ren ◽

Tingting Hou ◽

Xiaolei Han ◽

Yi Dong ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Older Adults ◽

Cardiovascular Risk ◽

Secondary Prevention ◽

Cardiovascular Risk Factors ◽

Lipid Lowering ◽

Hypoglycemic Agents ◽

Primary And Secondary Prevention ◽

Lipid Lowering Agents

Cardiovascular risk factors and related disorders are common among older adults, and use of various classes of cardiovascular (CV) drugs could reduce the risk of cardiovascular disease (CVD). However, data are sparse with regard to the use of CV drugs among rural-dwelling older adults in China. Therefore, this population-based study aimed to describe use of CV drugs among older adults living in the rural communities in China, while taking into account the use of CV drugs for primary and secondary prevention of CVDs. This study included 5,246 participants (age ≥65 years; 57.17% women; 40.68% illiteracy) in the baseline examination of the MIND-China study. In March-September 2018, data on health-related factors, CVDs (ischemic heart disease, atrial fibrillation, heart failure, and stroke), and CV drug use were collected via face-to-face survey, clinical examination, and laboratory tests. We classified CV drugs according to the Anatomical Therapeutic Chemical classification system for western medications and specific cardiovascular effects for the products of traditional Chinese medicine (TCM). We conducted descriptive analysis. The overall prevalence of major cardiovascular risk factors ranged from 14.30% in diabetes and 23.81% in dyslipidemia to 66.70% in hypertension, and CVDs affected 35.07% of all participants (36.28% in women vs. 33.47% in men, p = 0.035). In the total sample, calcium channel blockers (C08) were most commonly used (10.39%), followed by TCM products (7.64%), hypoglycemic agents (A10, 4.73%), renin-angiotensin system (RAS)-acting agents (C09, 4.61%), and lipid-lowering agents (C10, 4.17%). The proportions of CV drugs for primary prevention (i.e., use of CV drugs among people without CVD) were 3.14% for antithrombotic agents (mainly aspirin), 1.38% for lipid-lowering agents, and 3.11% for RAS-acting agents; the corresponding figures for secondary prevention (i.e., use of CV drugs among people with CVD) were 13.97%, 9.35%, and 7.39%. In conclusion, despite highly prevalent cardiovascular risk factors and CVDs, a fairly low proportion of the rural-dwelling older adults take CV medications for primary and secondary prevention. Notably, TCM products are among the most commonly used CV drugs. These results call for additional efforts to promote implementation of the evidence-based recommendations for prevention of CVDs in the primary care settings.

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Growth Differentiation Factor 15, Its 12-Month Relative Change, and Risk of Cardiovascular Events and Total Mortality in Patients with Stable Coronary Heart Disease: 10-Year Follow-up of the KAROLA Study

Clinical Chemistry ◽

10.1373/clinchem.2016.254755 ◽

2016 ◽

Vol 62 (7) ◽

pp. 982-992 ◽

Cited By ~ 17

Author(s):

Dhayana Dallmeier ◽

Hermann Brenner ◽

Ute Mons ◽

Wolfgang Rottbauer ◽

Wolfgang Koenig ◽

...

Keyword(s):

Risk Factors ◽

Coronary Heart Disease ◽

Heart Disease ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Cardiovascular Events ◽

Total Mortality ◽

Growth Differentiation Factor 15 ◽

Stable Coronary Heart Disease

Abstract BACKGROUND This study considered whether baseline concentrations and 12-month changes of growth differentiation factor 15 (GDF-15) are associated with subsequent cardiovascular events (CVEs) and total mortality in patients with stable coronary heart disease. METHODS Baseline GDF-15 serum concentrations were measured in 1073 participants in a cardiac rehabilitation program (median follow-up 10 years). GDF-15 associations with subsequent CVE and total mortality were evaluated by Cox-proportional hazards models adjusting for well-established cardiovascular risk factors (Model 2), plus N-terminal probrain natriuretic peptide, high-sensitivity (hs) CRP, and hs cardiac troponin T (Model 3). RESULTS In our study population [84.7% men, mean age 59 years, median baseline GDF-15 1232 ng/L (interquartile range, 916, 1674)] we observed 190 CVE and 162 deaths. Compared to participants with GDF-15 <1200 ng/L, increased risk for death was found in participants with GDF-15 ≥1200 and ≤1800 ng/L [hazard ratio (HR) 1.68 (95% CI, 1.08–2.62)] and with GDF-15 >1800 ng/L [HR 1.73 (1.02–2.94)], even in Model 3. The 12-month relative median change was −16.7%. As compared to participants with 12-month relative changes between −20% and 20%, GDF-15 increments >20% were associated with: a) an HR of 1.84 (1.04–3.26) for CVE in Model 2, but found nonsignificant in Model 3; (b) an HR of 2.26 (1.32–3.86) for death even in Model 3. CONCLUSIONS GDF-15 at baseline is independently associated with subsequent CVE and 10-year total mortality. Twelve-month relative changes remained associated with subsequent CVE when adjusting for well-established cardiovascular risk factors, and with total mortality even after further adjustment for established cardiac biomarkers.

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The Influence of Cardiovascular Risk Factors and Hypogonadism on Cardiac Outcomes in an Aging Population of Beta-Thalassemia Patients

Journal of Cardiovascular Development and Disease ◽

10.3390/jcdd9010003 ◽

2021 ◽

Vol 9 (1) ◽

pp. 3

Author(s):

Umberto Barbero ◽

Matteo Ajassa ◽

Carmen Maria Gaglioti ◽

Antonio Piga ◽

Giovanni Battista Ferrero ◽

...

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Cardiovascular Events ◽

Thalassemia Major ◽

Beta Thalassemia ◽

Risk Equation ◽

Modifying Factors

Beta-thalassemia major (β-TM) is a hereditary genetic disease worsened by many comorbidities due to transfusion-related iron despite chelation therapy. Since there has recently been an increase in life expectancy of patients to up to 50 years old, which influences the prevalence of these diseases and the time span for traditional cardiovascular risk factors to play their role, this study aims to evaluate their distribution and prevalence in a population of thalassemia major patients and their relationship with observed cardiovascular events and potential modifying factors. One hundred and fifty-nine β-TM patients with at least 15 years of follow-up were included in this study. The mean age was 40.9 ± 8.4 years; 28% had diabetes mellitus and 62% had hypogonadism. The cardiovascular risk assessed using algorithms (CUORE and Pooled Cohort Risk Equation—PCRE) was low, but 3.8% of patients had at least one episode of heart failure, 35.9% showed early signs of heart failure, 22% received a diagnosis of diastolic dysfunction, and 21.4% showed supraventricular arrhythmias. Hypogonadism was shown to be related to the occurrence of cardiovascular events. The chronic accumulation of iron in the heart and the specific metabolic profile, mainly observed in patients with hypogonadism, allows us to define β-TM as a condition with a high level of cardiovascular risk from many points of view (iron-related myopathy, atherosclerosis and arrhythmias), which requires better stratification tools and a specific follow-up program.

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Impact of Cardiovascular Risk Factors on the Occurrence of Cardiovascular Events in Antineutrophil Cytoplasmic Antibody (ANCA)-Associated Vasculitides

Journal of Clinical Medicine ◽

10.3390/jcm10112299 ◽

2021 ◽

Vol 10 (11) ◽

pp. 2299

Author(s):

Camille Roubille ◽

Soledad Henriquez ◽

Cédric Mercuzot ◽

Claire Duflos ◽

Bertrand Dunogue ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Cardiovascular Events ◽

Sedentary Lifestyle ◽

Smoking Status ◽

Immunosuppressive Agents ◽

Antineutrophil Cytoplasmic Antibody ◽

Management Program

Despite improvement in the prognosis of ANCA-associated vasculitides (AAVs), increased mortality, mainly from a cardiovascular origin, persists. We aimed to determine the role of cardiovascular risk factors (CVRFs) on the occurrence of major cardiovascular events (MACEs) in AAVs. Patients with AAVs were successively included in a prospective cohort study, which assessed CVRFs (defined by age >50 years in men and >60 years in women, personal history of cardiovascular disease, smoking status, obesity, diabetes, dyslipidemia, hypertension, and sedentary lifestyle), the use of glucocorticoids and immunosuppressive agents at baseline and during follow-up, and the occurrence of MACEs. One hundred and three patients were included, with a median follow-up time of 3.5 years. In the glucocorticoids and cyclophosphamide adjusted multivariate analysis, the occurrence of MACEs was associated with older age (p = 0.001, OR = 14.71, 95% CI (confidence interval) = 2.98–72.68), cardiovascular history (p = 0.007, OR (odds ratio) = 6.54, 95% CI = 1.66–25.71), sedentary lifestyle (p = 0.011, OR = 4.50, 95% CI = 1.42–14.29), hypertension (p = 0.017, OR = 5.04, 95% CI = 1.33–19.12), and dyslipidemia (p = 0.03, OR = 3.86, 95% CI = 1.14–13.09). The occurrence of MACEs was associated with the number of CVRFs (p < 0.001), but not with the use of glucocorticoids or cyclophosphamide (p = 0.733 and p = 0.339, respectively). The implementation of a screening and management program for modifiable CVRFs, particularly hypertension, sedentary lifestyle, and dyslipidemia, may be beneficial for AAV patients in order to reduce their cardiovascular risk.

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Prediction of Cerebrovascular and Cardiovascular Events in Patients With Subclinical Carotid Atherosclerosis

Journal of Investigative Medicine ◽

10.2310/jim.0b013e31816204ab ◽

2008 ◽

Vol 56 (1) ◽

pp. 32-40 ◽

Cited By ~ 16

Author(s):

Manfredi Rizzo ◽

Egle Corrado ◽

Giuseppe Coppola ◽

Ida Muratori ◽

Salvatore Novo

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Cardiovascular Events ◽

Chlamydia Pneumoniae ◽

Carotid Atherosclerosis ◽

Older Age ◽

Markers Of Inflammation ◽

Progression Of Atherosclerosis

BackgroundSeveral studies have suggested that inflammation and infection may be important for accelerated progression of atherosclerosis, but few data are available on subjects with early stages of atherosclerosis.Methods and ResultsWe included, in a prospective 5-year follow-up study, 150 patients with subclinical carotid atherosclerosis, evaluating at baseline all established traditional cardiovascular risk factors (eg, older age, male sex, obesity, hypertension, diabetes, smoking, family history of coronary artery disease, and dyslipidemia); 2 markers of inflammation, fibrinogen, and high-sensitivity C-reactive protein (CRP); and the seropositivity to Helicobacter pylori, Chlamydia pneumoniae, and cytomegalovirus. After follow-up, cardiovascular and cerebrovascular events were registered in the 19% of patients, and the increment in CRP levels (in quintiles) was significantly associated with ischemic stroke (P = 0.0253), acute myocardial infarction (P = 0.0055), cardiovascular or cerebrovascular death (P = 0.0145), and the presence of any event (P = 0.0064). Most traditional cardiovascular risk factors (eg, older age, hypertension, diabetes, and dyslipidemia) were significantly associated with the events but only in the unadjusted analysis; in fact, at logistic regression analysis, among all baseline variables, only elevated CRP levels showed a predictive role (odds ratio, 7.0; 95% confidence interval, 2.2-18.4; P = 0.0247).ConclusionsOur findings suggest that elevated CRP concentrations may significantly influence the occurrence of cerebrovascular and cardiovascular events in patients with baseline subclinical carotid atherosclerosis. Notably, null findings were obtained by viral and bacteria titers, suggesting a greater role of inflammation (and not of infection) in the progression of atherosclerosis in our cohort. However, further studies are needed to evaluate the therapeutic implications in this category of patients.

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