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Predictors of progression in atherosclerosis over 2 years in systemic lupus erythematosus.
By: Kiani AN, Post WS, Magder LS, Petri M.
Cardiovascular disease remains the major cause of death in systemic lupus erythematosus (SLE). We assessed the degree to which cardiovascular risk factors and disease activity were associated with 2-year changes in measures of subclinical atherosclerosis. Our data did not provide evidence of an association between measures of SLE disease activity (SLEDAI, anti-dsDNA, anti-phospholipid and treatment) and progression of subclinical atherosclerosis. Age and hypertension were associated with the progression of carotid IMT and plaque. Age, smoking and cholesterol were associated with progression of CAC.
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Hepatic steatosis, obesity, and the metabolic syndrome are independently and additively associated with increased systemic inflammation.
By: Ndumele CE, Nasir K, Conceiçao RD, Carvalho JA, Blumenthal RS, Santos RD.
The goal of this study was to assess the independent and collective associations of hepatic steatosis, obesity, and the metabolic syndrome with elevated hsCRP levels. We evaluated 2,388 individuals without clinical cardiovascular disease between December 2004 and December 2006. Hepatic steatosis was diagnosed by ultrasound, and the metabolic syndrome was defined using National Heart, Lung, and Blood Institute criteria. We concluded that hepatic steatosis, obesity, and the metabolic syndrome are independently and additively associated with increased odds of high hsCRP levels.
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Associations between C-reactive protein, coronary artery calcium, and cardiovascular events: implications for the JUPITER population from MESA, a population-based cohort study.
By: Blaha MJ, Budoff MJ, DeFilippis AP, Blankstein R, Rivera JJ, Agatston A, O’Leary DH, Lima J, Blumenthal RS, Nasir K.
The landmark Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER) trial showed that some patients with LDL-cholesterol (LDL-C) <130 mg/dL and high-sensitivity C-reactive protein (hsCRP) concentrations of >2 mg/L benefit from treatment with rosuvastatin, although the absolute rates of cardiovascular events were low. In a population eligible for JUPITER, we established whether coronary artery calcium (CAC) might further stratify risk; additionally we compared hsCRP with CAC for risk prediction across the range of low and high hsCRP values. CAC further stratifies risk in patients eligible for JUPITER, and could be used to target subgroups of patients who are expected to derive the most, and the least, absolute benefit from statin treatment. Focusing of treatment on the subset of individuals with normal LDL-C and at least moderate subclinical atherosclerosis should allow for more appropriate allocation of resources.
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Impact of subclinical atherosclerosis on cardiovascular disease events in individuals with metabolic syndrome and diabetes: The multi-ethnic study of atherosclerosis.
By: Malik S, Budoff MJ, Katz R, Blumenthal RS, Bertoni AG, Nasir K, Szklo M, Barr RG, Wong ND.
While metabolic syndrome and diabetes generally confer a greater cardiovascular disease (CVD) risk, recent evidence suggests that these individuals have a wide range of risk. We evaluated whether screening for CAC and carotid intimal medial thickness (CIMT) can improve CVD risk stratification over traditional risk factors (RFs) in people with metabolic syndrome and diabetes. We concluded that individuals with metabolic syndrome or diabetes have low risks for CHD when CAC or CIMT is not increased. Prediction of CHD and CVD events are improved by CAC more than by CIMT. Screening for CAC or CIMT can stratify risk in people with metabolic syndrome and diabetes and support the latest recommendations regarding CAC screening in those with diabetes.
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The association of bone density and calcified atherosclerosis is stronger in women without dyslipidemia: The multi-ethnic study of atherosclerosis.
By: Jensky NE, Hyder JA, Allison MA, Wong N, Aboyans V, Blumenthal RS, Schreiner P, Carr JJ, Wassel CL, Ix JH, Criqui MH.
We tested whether the association between bone mineral density (BMD) and CAC varies according to dyslipidemia in community-living individuals. The inverse association of BMD with CAC proved stronger in women without dyslipidemia. These data argue against the hypothesis that dyslipidemia is the key factor responsible for the inverse association of BMD with atherosclerosis.
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Impact of coronary computed tomographic angiography results on patient and physician behavior in a low-risk population.
By: McEvoy JW, Blaha MJ, Nasir K, Yoon YE, Choi EK, Cho IS, Chun EJ, Choi SI, Rivera JJ, Blumenthal RS, Chang HJ.
We studied asymptomatic patients from a large health-screening program. Our study population comprised 1,000 patients who underwent coronary CT angiography (CCTA) as part of a prior study and a matched control group of 1,000 patients who did not. We assessed medication use, secondary test referrals, revascularizations, and cardiovascular events at 90 days and 18 months. An abnormal screening CCTA result was predictive of increased aspirin and statin use at 90 days and 18 months, although medication use lessened over time. Screening CCTA was associated with increased invasive testing, without any difference in events at 18 months. Screening CCTA in asymptomatic adults should NOT be considered a justifiable test at this time.
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Predictors of coronary heart disease events among asymptomatic persons with low low-density lipoprotein cholesterol MESA (Multi-Ethnic Study of Atherosclerosis).
By: Blankstein R, Budoff MJ, Shaw LJ, Goff DC Jr, Polak JF, Lima J, Blumenthal RS, Nasir K.
Our aim was to identify risk factors for CHD events among asymptomatic persons with low (?130 mg/dl) LDL-C. Among persons with low LDL-C, older age, male sex, hypertension, diabetes, and low HDL-C are associated with adverse CHD events. Even after accounting for all such variables, the presence of CAC provided incremental prognostic value. These results may serve as a basis for deciding which patients with low LDL-C may be considered for more aggressive therapies. An elevated hsCRP was not predictive of events in this population of individuals with normal LDL-C.
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Sex differences in subclinical atherosclerosis by race/ethnicity in the multi-ethnic study of atherosclerosis.
By: Kim C, Diez-Roux AV, Nettleton JA, Polak JF, Post WS, Siscovick DS, Watson KE, Vahratian AM.
Sex differences in CVD mortality are more pronounced among non-Hispanic whites than other racial/ethnic groups, but it is unknown whether this variation is present in the earlier subclinical stages of disease. The authors examined racial/ethnic variation in sex differences in CAC and cIMT at baseline in 2000-2002 among participants (n = 6,726) in MESA using binomial and linear regression. Models adjusted for risk factors in several stages: age, traditional cardiovascular disease risk factors, behavioral risk factors, psychosocial factors, and adult socioeconomic position. In conclusion, coronary artery calcification is differentially patterned by sex across racial/ethnic groups.
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Calcium score reclassification: how should baseline risk be measured?
By: McEvoy JW, Nasir K, Blumenthal RS.
A coronary artery score measurement to reclassify persons to either a low or high risk category has implications for preventive therapy strategies for patients in the broad intermediate cardiac risk category that need to be tested in a prospective, randomized manner.
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The relationship of insulin resistance and extracoronary calcification in the multi-ethnic study of atherosclerosis.
By: Tison GH, Blaha MJ, Budoff MJ, Katz R, Rivera JJ, Bertoni AG, Wong ND, Blumenthal RS, Szklo M, Eng J, Tracy R, Nasir K.
We hypothesized that insulin resistance, measured by the homeostasis model assessment of insulin resistance (HOMA-IR), is independently associated with prevalent and incident extra-coronary calcification (ECC). We concluded that HOMA has a positive and graded association with ECC, but not independently of cardiovascular risk factors, particularly metabolic syndrome components.
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