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Ciccarone Articles

Ciccarone Center Research

Year

2012

Landmark Articles

Utility of coronary artery calcium scoring in the evaluation of patients with chest pain.
By: Tota-Maharaj R, McEvoy JW, Blaha MJ, Silverman MG, Nasir K, Blumenthal RS.
Although further research is needed, carefully selected patients presenting to the emergency department with a normal electrocardiogram, normal cardiac biomarkers, and no CAC may be considered for early discharge without further testing.
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Role of nonenhanced multidetector CT coronary artery calcium testing in asymptomatic and symptomatic individuals.
By: Nasir K, Clouse M.

Arteriosclerotic cardiovascular disease is the leading cause of death in the United States, with coronary artery disease (CAD) accounting for half of all cardiovascular disease deaths. Current risk assessment approaches for coronary heart disease, such as the Framingham risk score, substantially misclassify intermediate- to long-term risk for the occurrence of CAD in asymptomatic individuals. A screening modality such as a simple non-contrast-enhanced, or noncontrast, computed tomographic (CT) detection of coronary artery calcium (CAC) improves the ability to accurately predict risk in vulnerable groups and adds information above and beyond global risk assessment as shown by the recent Multi-Ethnic Study of Atherosclerosis. In addition, absence of CAC is associated with a very low risk of future CAD and as a result can be used to identify a group among which further testing and pharmacotherapies can be avoided. The Expert Consensus Document by the American College of Cardiology Foundation and the American Heart Association now recommends screening individuals at intermediate risk but did not find enough evidence to recommend CAC testing and further stratification of those in the low- or high-risk categories for CAD. In addition, emerging guidelines have suggested that absence of CAC can act as a "gatekeeper" for further testing among low- and intermediate-risk patients presenting with chest pain. This review of the current literature outlines the role of CAC testing in both asymptomatic and symptomatic individuals.

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Utility of coronary artery calcium scoring in the evaluation of patients with chest pain.
By: Tota-Maharaj R, McEvoy JW, Blaha MJ, Silverman MG, Nasir K, Blumenthal RS.
Although further research is needed, carefully selected patients presenting to the emergency department with chest pain and with a normal electrocardiogram, normal cardiac biomarkers, and CAC = 0 may be considered for early discharge without further testing.
Read on Pubmed
Endogenous sex hormone changes in postmenopausal women in the diabetes prevention program.
By: Kim C, Kong S, Laughlin GA, Golden SH, Mather KJ, Nan B, Edelstein SL, Randolph JF Jr, Labrie F, Buschur E, Barrett-Connor E.
Among postmenopausal glucose-intolerant women not using estrogen, intensive lifestyle modification increased SHBG levels and lower DHEA levels. These changes are associated with lower glucose independent of adiposity and insulin. Metformin effects upon endogenous sex hormones are not significant.
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Association of SRB1 variants with subclinical atherosclerosis and incident cardiovascular disease: The Multi-Ethnic Study of Atherosclerosis.
By: Manichaikul A, Naj AC, Herrington D, Post W, Rich SS, Rodriguez A.

We previously reported a statistically significant association of SCARB1 intronic single nucleotide polymorphism (SNP) rs10846744 with common carotid intimal-medial artery thickness in each of the 4 Multi-Ethnic Study of Atherosclerosis racial/ethnic groups (white, Chinese, black, and Hispanic). The SCARB1 SNP, rs10846744, exerts a major effect on subclinical atherosclerosis and incident cardiovascular disease in humans.

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Lipoprotein(a) particle concentration and lipoprotein(a) cholesterol assays yield discordant classification of patients defining four physiologically discrete groups.
By: Konerman M, Kulkarni K, Toth PP, Jones SR.

There is little known about the relative predictive value of different lipoprotein(a) [Lp(a)] assays in clinical use, although each has been shown to predict similar incremental risk over conventional clinical and lipid risk factors. Thus, we examined the classification behavior of two commonly used Lp(a) assays and their associations with other lipid parameters. Serum lipid and Lp(a) concentrations were measured in 144 primary and secondary prevention patients. Lp(a) cholesterol [Lp(a)-C] was measured with the Vertical Auto Profile (upper limit of normal, 10 mg/dL). Lp(a) particle concentrations [Lp(a)-P] were measured with an isoform-independent molar assay (upper limit of normal, 70 nmol/L). The subjects were divided into the following four groups on the basis of their Lp(a)-C and Lp(a)-P levels: normal Lp(a)-P and Lp(a)-C; high Lp(a)-P and normal Lp(a)-C; normal Lp(a)-P and high Lp(a)-C; and high Lp(a)-P and Lp(a)-C. The proportion of subjects with values above the upper limit of normal was similar with both assays (P = .15). However, the Lp(a)-C and Lp(a)-P assays discordantly classified 23% of the study's subjects. In addition, the four Lp(a)-defined groups displayed differences in their relationships with other lipoproteins. The two groups with elevated Lp(a)-C showed significant associations with higher high-density lipoprotein cholesterol, apolipoprotein AI, and high-density lipoprotein cholesterol/apolipoprotein AI ratios. Triglycerides were also noted to be above normal in discordant and normal within concordant Lp(a) groups. Finally, the amount of cholesterol per Lp(a) particle [Lp(a)-C/Lp(a)-P] varied widely across the four groups. These findings suggest that the four Lp(a)-defined groups are physiologically discrete. Further investigation is warranted to assess which parameters among Lp(a)-P, Lp(a)-C, and Lp(a)-C/Lp(a)-P can be used to more accurately characterize Lp(a)-associated cardiovascular risk.

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Herpes simplex virus type 2 (HSV-2) as a coronary atherosclerosis risk factor in HIV-infected men: Multicenter AIDS Cohort Study.
By: Hechter RC, Budoff M, Hodis HN, Rinaldo CR, Jenkins FJ, Jacobson LP, Kingsley LA, Taiwo B, Post WS, Margolick JB, Detels R.

We assessed associations of herpes simplex virus types 1 and 2 (HSV-1 and -2), cytomegalovirus (CMV), and human herpesvirus 8 (HHV-8) infection with subclinical coronary atherosclerosis in 291 HIV-infected men in the Multicenter AIDS Cohort Study. Coronary artery calcium (CAC) was measured by non-contrast coronary CT imaging. Markers for herpesviruses infection were measured in frozen specimens collected 10-12 years prior to case identification. Multivariable logistic regression models and ordinal logistic regression models were performed. HSV-2 seropositivity was associated with coronary atherosclerosis (adjusted odds ratio [AOR]=4.12, 95% confidence interval [CI]=1.58-10.85) after adjustment for age, race/ethnicity, cardiovascular risk factors, and HIV infection related factors. Infection with a greater number of herpesviruses was associated with elevated CAC levels (AOR=1.58, 95% CI=1.06-2.36). Our findings suggest HSV-2 may be a risk factor for subclinical coronary atherosclerosis in HIV-infected men. Infection with multiple herpesviruses may contribute to the increased burden of atherosclerosis.

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Association of sex hormones and sex hormone-binding globulin with depressive symptoms in postmenopausal women: the Multi-ethnic Study of Atherosclerosis.
By: Colangelo LA, Craft LL, Ouyang P, Liu K, Schreiner PJ, Michos ED, Gapstur SM.
In early postmenopausal women, sex hormones were associated with incident depressive symptoms.
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Rhinotillexis: a possible heuristic to reduce inappropriate noninvasive cardiac imaging?
By: McEvoy JW, Blaha MJ, Blumenthal RS.
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Computed tomography scans in the evaluation of fatty liver disease in a population based study: the multi-ethnic study of atherosclerosis.
By: Zeb I, Li D, Nasir K, Katz R, Larijani VN, Budoff MJ.

Fatty liver disease is a common clinical entity in hepatology practice. This study evaluates the prevalence and reproducibility of computed tomography (CT) measures for diagnosis of fatty liver and compares commonly used CT criteria for the diagnosis of liver fat. Fatty liver can be reliably diagnosed using nonenhanced CT scans.

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