scholarly journals CVD Risk Stratification in the PCSK9 Era: Is There a Role for LDL Subfractions?

Diseases ◽  
2018 ◽  
Vol 6 (2) ◽  
pp. 45 ◽  
Author(s):  
Christian Kjellmo ◽  
Anders Hovland ◽  
Knut Lappegård
Keyword(s):  
Risk Stratification ◽  
Cvd Risk ◽  
Ldl Subfractions

scholarly journals Cardiac risk stratification in patients with non-alcoholic fatty liver disease and cholelithiasis

2021 ◽  
Vol 5 (6) ◽  
pp. 377-384
Author(s):  
T.S. Krolevets ◽  
◽  
M.A. Livzan ◽  
N.A. Cherkashchenko ◽  
A.V. Gorbenko ◽  
...  
Keyword(s):  
Liver Disease ◽  
Risk Stratification ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Comparison Group ◽  
Fatal Outcome ◽  
Cardiac Risk ◽  
Cvd Risk ◽  
Alcoholic Fatty Liver ◽  
Alcoholic Fatty Liver Disease

Aim: to increase the efficacy of patient management, to assess the risk of developing cardiovascular diseases (CVD) with the fatal outcome for 10 years in patients with comorbid cholelithiasis (C) and non-alcoholic fatty liver disease (NAFLD). Patients and Methods: 183 patients with NAFLD participated in an open comparative study. The main group (n=88) consisted of subjects with comorbid NAFLD and C, of which 53 patients have a history of cholecystectomy (CE). The comparison group consisted of patients with NAFLD only (n=95). The risk of CVD with fatal outcome in the comorbid course of NAFLD and C was assessed according to the SCORE 2019 scale for regions with an increased risk. A scale of relative total CVD risk was used for people under 40 years of age. Results: the detection rate of CHD, is positively correlated with comorbid course of NAFLD and C (25% — in the main group, and 9.47% — in the comparison group, χ2=7.83, p<0,01, rs=0,207, R<0.01), and the correlation increases among people with CE (rs=0,258, R<0,01). In the comparison group, prediabetes was significantly more commonly detected (χ2=8.24, p<0.01, r s=-0.212, p<0,01). Patients after CE had a higher level of LDL cholesterol (rs=0.228, p≤0.01). Patients with NAFLD are characterized by hyperleptinemia and leptin resistance along with insulin resistance. Patients after CE have the highest level of leptin (p<0.001). Subjects with a comorbid course of NAFLD, C and CE in the history have a significantly higher risk of CVD with the fatal outcome for 10 years (43.4%) (χ2=9.4140, p<0,01). A correlation of mean level between CE and high CVD risk was revealed (r=-0,4341, p≤0.01). Conclusion: the factors causing the comorbid course of NAFLD and C are also concerning the CVD progression. Stratification of patients by CVD risk groups and metabolic status can become an indispensable tool in the clinicians’ arsenal. KEYWORDS: cardiovascular risk, non-alcoholic fatty liver disease, cholelithiasis, cholecystectomy. FOR CITATION: Krolevets T.S., Livzan M.A., Cherkashchenko N.A. et al. Cardiac risk stratification in patients with non-alcoholic fatty liver disease and cholelithiasis. Russian Medical Inquiry. 2021;5(6):377–384 (in Russ.). DOI: 10.32364/2587-6821-2021-5-6-377-384.

Abstract 588: Nuanced Antibody Responses to Apolipoprotein A-I in Patients With Cardiovascular Disease

2017 ◽  
Vol 37 (suppl_1) ◽  
Author(s):  
David M Henson ◽  
Vincent Venditto
Keyword(s):  
Cardiovascular Disease ◽  
Risk Stratification ◽  
Antibody Responses ◽  
Post Translational Modification ◽  
Serum Samples ◽  
Cvd Risk ◽  
Cholesterol Acyl Transferase ◽  
Lecithin Cholesterol Acyl Transferase ◽  
Apolipoprotein A ◽  
Risk Stratification Tool

Antibodies targeting apolipoprotein A-I (ApoA-I) have been identified in patients with cardiovascular disease (CVD). Anti-ApoA-I antibodies are thought to be markers of disease, but their exact role is unclear. We hypothesize that antibodies targeting ApoA-I are both protective and pathologic and unraveling the nuanced response to ApoA-I will provide insight into improved risk stratification of patients suffering from CVD. To test our hypothesis we screened serum samples by ELISA collected from patients with CVD to identify anti-ApoA-I antibody responses toward the full length protein along with immunogenic epitopes including the lecithin cholesterol acyl transferase (LCAT) domain and the C-terminal peptide of ApoA-I. These epitopes are of particular interest due to their propensity to undergo oxidative post-translational modification. Antibodies were affinity-purified toward ApoA-I, and their role in reverse cholesterol transport elucidated. Our data indicate that serum collected from patients with CVD enrolled in multiple clinical trials possess a highly nuanced immune response. We find that these antibody responses change over time in some patients who present with an AMI and antibodies correlate with outcomes. The mechanisms of these observed effects are currently under investigation. A full report on correlations between patient characteristic and antibody level will be presented. This work highlights the complexities of anti-ApoA-I antibodies in patients, which will guide development of a CVD risk stratification tool.

scholarly journals Myeloperoxidase: A Useful Biomarker for Cardiovascular Disease Risk Stratification?

2009 ◽  
Vol 55 (8) ◽  
pp. 1462-1470 ◽  
Author(s):  
Roger K Schindhelm ◽  
Leonard P van der Zwan ◽  
Tom Teerlink ◽  
Peter G Scheffer
Keyword(s):  
Oxidative Stress ◽  
Cardiovascular Disease ◽  
Clinical Practice ◽  
Risk Stratification ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Routine Clinical Practice ◽  
Assay Method ◽  
Cvd Risk ◽  
And Oxidative Stress

Abstract Background: Inflammation and oxidative stress are associated with atherosclerosis. Myeloperoxidase (MPO) is linked to both inflammation and oxidative stress by its location in leukocytes and its role in catalyzing the formation of oxidizing agents. Recent evidence suggests that MPO activity precipitates atherogenesis. Measurement of MPO in plasma may therefore contribute to cardiovascular disease (CVD) risk stratification. Content: Cross-sectional studies, case-control studies, and prospective-cohort studies investigating the relation between MPO and CVD have been evaluated. Differences in study populations, sample materials, sample handling, and assays were ascertained. Potential causal mechanisms linking MPO to accelerated atherosclerosis are discussed here. A majority of studies indicate that measurement of MPO in plasma was associated with improved CVD risk stratification above and beyond risk stratification results obtained with markers used in routine clinical practice. However, comparison of these epidemiological studies with regard to MPO and outcome is hampered because the reported MPO concentration depends on the assay method, sampling material, and preanalytical and analytical procedures. The link between MPO and CVD can, at least partly, be explained by MPO-dependent oxidation of LDL and HDL, subsequently leading to cholesterol accumulation in the arterial wall. Furthermore, MPO may reduce the bioavailability of nitric oxide, resulting in endothelial dysfunction. Finally, MPO destabilizes atherosclerotic plaques. Summary: Increasing evidence suggests that MPO is causally linked to atherosclerosis and its measurement may improve CVD risk estimation. Before MPO can be used in routine clinical practice, however, standardization of sampling and laboratory procedures is needed.

scholarly journals The Predictive Value of Carotid Ultrasonography With Cardiovascular Risk Factors—A “SPIDER” Promoting Atherosclerosis

2021 ◽  
Vol 8 ◽  
Author(s):  
Hongwei Li ◽  
Xiaolin Xu ◽  
Baoming Luo ◽  
Yuling Zhang
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Risk Stratification ◽  
Cardiovascular Risk Factors ◽  
Carotid Atherosclerosis ◽  
Clinical Use ◽  
Cvd Risk ◽  
Carotid Ultrasonography ◽  
Carotid Plaques

Insufficient recommendations do not support the clinical use of carotid ultrasonography for further risk stratification in moderate-to-high risk patients with cardiovascular disease (CVD). A literature review was performed to assess six aspects of the research progress and limitations of carotid ultrasonography and carotid atherosclerosis-related risk factors: (1) structures of the carotid intima and media; (2) plaques; (3) inflammation; (4) dynamics of carotid blood flow; (5) early detection and intervention; and (6) risk factors for CVD. Although carotid intima-media thickness and carotid plaques are well-acknowledged independent predictors of CVD risk, normative and cut-off values are difficult to define due to the heterogeneous measurements reported in previous studies. Plaque properties, including location, number, density, and size, become more important risk predictors for cardiovascular disease, but a better approach for clinical use needs to be further established. Three-dimensional ultrasound and contrast-enhanced ultrasound are promising for promoting risk stratification with more details on plaque morphology. Moreover, inflammatory diseases and biomarkers should be evaluated for a full assessment of the inflammatory burden for atherosclerosis. Carotid flow velocity is not only an indicator for stenosis but also a potential risk predictor. Carotid atherosclerosis should be detected and treated early, and additional clinical trials are needed to determine the efficacy of these measures in reducing CVD risk. Cardiovascular risk factors tend to affect carotid plaques, and early treat-to-target therapy might yield clinical benefits. Based on the aforementioned six aspects, we consider that these six important factors act like a “SPIDER” spinning the web of atherosclerosis; a timely comprehensive assessment and intervention may halt the progression to CVD. Carotid ultrasound results should be combined with other atherosclerotic factors, and a comprehensive risk assessment may help to guide cardiovascular prevention decisions.

scholarly journals ASCVD risk stratification modifies the effect of HbA1c on cardiovascular events among patients with type 2 diabetes mellitus with basic to moderate risk

2020 ◽  
Vol 8 (1) ◽  
pp. e000810 ◽  
Author(s):  
Hongmei Zhang ◽  
Li Qin ◽  
Chang-Sheng Sheng ◽  
Yixin Niu ◽  
Hongxia Gu ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Risk Stratification ◽  
Chinese Patients ◽  
Moderate Risk ◽  
Cvd Risk ◽  
Cox Regression Analysis ◽  
Ascvd Risk

ObjectiveTo investigate the association between hemoglobin A1c (HbA1c) 7.0%–8.0% and cardiovascular disease (CVD) risk among Chinese patients with type 2 diabetes mellitus (T2DM) with different baseline 10-year atherosclerotic CVD (ASCVD) risk stratification.Research design and methodsA prospective population-based cohort of 10 060 adults aged 40–70 years in Chongming District of Shanghai was established in 2011. These participants were followed up for 3.25 years and CVD information was recorded. We investigated this association between HbA1c categories and incident CVD stratified by the 10-year ASCVD risk using multiple Cox regression analysis among 1880 patients with T2DM without CVD history. CVD events were defined as cardiovascular death, non-fatal myocardial infarction or non-fatal stroke.ResultsThe corresponding incidence of CVD per 1000 person-years for the HbA1c≤6.5%, 6.6%–6.9%, 7.0%–8.0% and >8.0% groups were 12.5, 21.8, 22.9 and 28.9, respectively. The HbA1c>8.0% group was significantly associated with a higher CVD risk in patients with T2DM. The HbA1c 7.0%–8.0% group was significantly associated with a higher CVD risk in patients with T2DM with moderate baseline ASCVD risk (HR 2.48; 95% CI 1.15 to 5.32).ConclusionHbA1c of 7.0%–8.0% may result in a significantly higher CVD risk among patients with T2DM with moderate baseline ASCVD risk, which support the use of HbA1c combined with baseline ASCVD risk assessment to determine future glucose-lowering treatment decisions among patients with T2DM with basic to moderate risk.

scholarly journals Cardiovascular Disease Risk amongst African Black Patients with Rheumatoid Arthritis: The Need for Population Specific Stratification

2014 ◽  
Vol 2014 ◽  
pp. 1-10 ◽  
Author(s):  
Ahmed Solomon ◽  
Linda Tsang ◽  
Angela J. Woodiwiss ◽  
Aletta M. E. Millen ◽  
Gavin R. Norton ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Cardiovascular Disease ◽  
Risk Stratification ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Cvd Risk ◽  
Black Patients ◽  
African Black ◽  
Reported Data

Rheumatoid arthritis (RA) enhances the risk of cardiovascular disease to a similar extent as diabetes. Whereas atherogenesis remains poorly elucidated in RA, traditional and nontraditional risk factors associate similarly and additively with CVD in RA. Current recommendations on CVD risk stratification reportedly have important limitations. Further, reported data on CVD and its risk factors derive mostly from data obtained in the developed world. An earlier epidemiological health transition is intrinsic to persons living in rural areas and those undergoing urbanization. It is therefore conceivable that optimal CVD risk stratification differs amongst patients with RA from developing populations compared to those from developed populations. Herein, we briefly describe current CVD and its risk factor profiles in the African black population at large. Against this background, we review reported data on CVD risk and its potential stratification amongst African black compared to white patients with RA. Routinely assessed traditional and nontraditional CVD risk factors were consistently and independently related to atherosclerosis in African white but not black patients with RA. Circulating concentrations of novel CVD risk biomarkers including interleukin-6 and interleukin-5 adipokines were mostly similarly associated with both endothelial activation and atherosclerosis amongst African black and white RA patients.

scholarly journals Machine learning approaches improve risk stratification for secondary cardiovascular disease prevention in multiethnic patients

Open Heart ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. e001802
Author(s):  
Ashish Sarraju ◽  
Andrew Ward ◽  
Sukyung Chung ◽  
Jiang Li ◽  
David Scheinker ◽  
...  
Keyword(s):  
Machine Learning ◽  
Cardiovascular Disease ◽  
Risk Stratification ◽  
Secondary Prevention ◽  
Risk Score ◽  
Characteristic Curve ◽  
World Population ◽  
Learning Approaches ◽  
Cvd Risk ◽  
Improve Risk Stratification

ObjectivesIdentifying high-risk patients is crucial for effective cardiovascular disease (CVD) prevention. It is not known whether electronic health record (EHR)-based machine-learning (ML) models can improve CVD risk stratification compared with a secondary prevention risk score developed from randomised clinical trials (Thrombolysis in Myocardial Infarction Risk Score for Secondary Prevention, TRS 2°P).MethodsWe identified patients with CVD in a large health system, including atherosclerotic CVD (ASCVD), split into 80% training and 20% test sets. A rich set of EHR patient features was extracted. ML models were trained to estimate 5-year CVD event risk (random forests (RF), gradient-boosted machines (GBM), extreme gradient-boosted models (XGBoost), logistic regression with an L2 penalty and L1 penalty (Lasso)). ML models and TRS 2°P were evaluated by the area under the receiver operating characteristic curve (AUC).ResultsThe cohort included 32 192 patients (median age 74 years, with 46% female, 63% non-Hispanic white and 12% Asian patients and 23 475 patients with ASCVD). There were 4010 events over 5 years of follow-up. ML models demonstrated good overall performance; XGBoost demonstrated AUC 0.70 (95% CI 0.68 to 0.71) in the full CVD cohort and AUC 0.71 (95% CI 0.69 to 0.73) in patients with ASCVD, with comparable performance by GBM, RF and Lasso. TRS 2°P performed poorly in all CVD (AUC 0.51, 95% CI 0.50 to 0.53) and ASCVD (AUC 0.50, 95% CI 0.48 to 0.52) patients. ML identified nontraditional predictive variables including education level and primary care visits.ConclusionsIn a multiethnic real-world population, EHR-based ML approaches significantly improved CVD risk stratification for secondary prevention.

Exploratory analysis of large-scale lipidome in large cohorts: are we any closer of finding lipid-based markers suitable for CVD risk stratification and management?

2021 ◽  
Vol 1142 ◽  
pp. 189-200
Author(s):  
Sílvia O. Diaz ◽  
José Luis Sánchez-Quesada ◽  
Victor de Freitas ◽  
Adelino Leite-Moreira ◽  
António S. Barros ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Large Scale ◽  
Exploratory Analysis ◽  
Cvd Risk

Abstract P148: C-Reactive Protein (CRP) and the Prediction of Cardiovascular Death Among Mexican-Americans

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Lenny Lopez ◽  
Carmen A Peralta ◽  
Anne Lee ◽  
Allison Aiello ◽  
Mary N Haan
Keyword(s):  
Mortality Rate ◽  
Risk Stratification ◽  
Risk Prediction ◽  
Mexican Americans ◽  
Risk Category ◽  
C Reactive Protein ◽  
Cvd Risk ◽  
Reactive Protein ◽  
Net Reclassification Improvement ◽  
Framingham Risk

Background: Addition of C-reactive protein (CRP) improves risk stratification provided by traditional Framingham risk factors (FRFs) in some populations, but findings vary by gender and by race/ethnicity. Whether CRP levels can improve risk prediction of cardiovascular mortality (CVD) among elderly Hispanics is unknown. Hypothesis: CRP will add incremental CVD risk prediction in addition to FRFs. Methods: We evaluated whether addition of baseline CRP to the Framingham risk score can improve CVD risk stratification for CVD death among 1,422 participants (536 males, 886 females) from the Sacramento Area Latino Study on Aging (SALSA). SALSA is a well-characterized, NIH funded cohort study of Mexican Americans aged > 60 followed since 1998–1999. Death was ascertained by participant contacts, obituary reviews and cause of death from death certificates. We evaluated the association of CRP levels with CVD death using Cox proportional hazards models adjusting for FRFs stratified by gender. We calculated gender stratified net reclassification improvement (NRI) in models with and without CRP to predict 10-year CVD risks using the established FRFs categories (<5%, 5–10%, 10–20%, > 20%). Results: Mean baseline age was 70.7 and mean CRP level was 5.86 ng/ml. There were 167 CVD male deaths (mortality rate 39.2 per 1,000 person years) and174 among women (mortality rate 27.8 per 1,000 person years). Higher CRP levels were significantly associated with higher CVD mortality risk in men, HR of 1.29 (95% CI 1.11 – 1.50) but not women, HR 0.94 (95% CI 0.81 – 1.08) after adjustment for covariates. Addition of CRP was useful in reclassifying CVD death risk among men defined by FRF alone, and this was due to correct reclassification of those who did not experience CVD death from the highest risk group to a lower risk category. The majority of male participants (619/745=83%) were classified as having >20%risk in the model without CRP. Mortality rate for men initially classified as having > 20% risk was 37.9 per 1,000 person years. After addition of CRP, 6% were reclassified into an intermediate risk category (NRI 7.4%, p< 0.001) and their mortality rate was 10.3 per 1,000 person years. Overall, NRI for men was 4.2% (p=0.05). In contrast, addition of CRP among women was associated with increased misclassification to a higher risk category (NRI= − 13.4%, p=0.0001). Conclusion: A risk prediction model that includes CRP improves cardiovascular risk classification among elderly Mexican-American men but not women as defined by traditional FRFs.

Diabetes without Manifest Cardiovascular Disease: A Novel Approach in Risk Stratification and Treatment Selection

2020 ◽  
Vol 16 (8) ◽  
pp. 869-873 ◽  
Author(s):  
Emile Andari ◽  
Samir Arnaout ◽  
Sami T. Azar ◽  
Elie Chammas ◽  
Selim Jambart ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
High Risk ◽  
Risk Stratification ◽  
Vascular Complication ◽  
Cvd Risk ◽  
Risk Of Death ◽  
Asymptomatic Patients ◽  
Novel Approach ◽  
Risk Patients

Background: Cardiovascular disease (CVD), the main macro vascular complication of type 2 diabetes (T2D), increases the risk of death significantly in patients with T2D. Introduction: Most of the patients with T2D do not have obvious CVD symptoms. Due to the paucity of data, CVD screening in asymptomatic patients with T2D remains highly controversial. Methods: This has driven a panel of experts to establish a novel consensus on how to approach patients with T2D at high CVD risk. The panel formulated a stepwise algorithm by which patients with T2D undergo initial risk stratification into low, intermediate and high risk using the ASCVD calculator. In patients with intermediate risk, coronary artery calcium measurement is used to further stratify those patients into new low and high-risk categories. Results and Conclusion: The panel recommends using standard diabetes care in low risk patients and using SGLT2 inhibitors and GLP1 agonists with cardio protective effect, on top of standard care, in high risk individuals.

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