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Ciccarone Articles

Ciccarone Center Research



Abdominal aortic calcium and multisite atherosclerosis: the Multiethnic Study of Atherosclerosis.
By: Wong ND, Lopez VA, Allison M, Detrano RC, Blumenthal RS, Folsom AR, Ouyang P, Criqui MH.

Abdominal aortic calcification (AAC) is a measure of subclinical CVD. Data are limited regarding its relation to other measures of atherosclerosis. Among 1,812 subjects within the population-based MESA, we examined the cross-sectional relation of AAC with CAC, ankle brachial index (ABI), and CIMT, as well as multiple measures of subclinical CVD. Our study found that AAC is associated with an increased likelihood of other vascular atherosclerosis and its additive prognostic value to these other measures is of further interest.

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Atherosclerosis imaging in multiple vascular beds—Enough heterogeneity to improve risk prediction?
By: Tison GH, Blaha MJ, Nasir K.

This editorial review looks at the incremental predictive value of finding above average amounts of subclinical atherosclerosis in vascular territories other than the coronary circulation and its potential effect on cardiovascular risk prediction.

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Lower extremity peripheral artery disease in the absence of traditional risk factors. The Multi-Ethnic Study of Atherosclerosis.
By: Aboyans V, McClelland RL, Allison MA, McDermott MM, Blumenthal RS, Macura K, Criqui MH.
Lower-extremity peripheral artery disease (LE-PAD) is strongly related to traditional risk factors (smoking, hypertension, dyslipidemia, diabetes). We hypothesized that the prevalence of LE-PAD in the absence of traditional CVD risk factors is not negligible, and that this condition would remain associated with subclinical atherosclerosis in other territories. In the absence of traditional CVD risk factors, LE-PAD is still fairly common and associated with coronary artery disease.
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Relationships of mitral annular calcification to cardiovascular risk factors: the Multi-Ethnic Study of Atherosclerosis (MESA).
By: Kanjanauthai S, Nasir K, Katz R, Rivera JJ, Takasu J, Blumenthal RS, Eng J, Budoff MJ.
The relationship between MAC, a fibrous, degenerative calcification of the mitral valve, and CVD risk factors is not well defined. Thus, we performed a cross-sectional study to determine which CVD risk factors are independently associated with MAC. We concluded that age, female gender, diabetes, and increased BMI were significantly associated with MAC. Prevalence of MAC was strongly associated with female gender and increasing age in all ethnicities.
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Relationship between common carotid intima-media thickness and thoracic aortic calcification: the Multi-Ethnic Study of Atherosclerosis.
By: Takasu J, Budoff MJ, Katz R, Rivera JJ, Shavelle DM, Probstfield JL, O’Leary D, Nasir K.
Mean maximum carotid intima-media thickness (CIMT) is associated with both coronary artery disease and cerebral thromboembolism. Thoracic aortic calcification (TAC) detected by computed tomography (CT) is also highly associated with vascular disease and cardiovascular risk. No previous study has examined the relationship between CIMT and TAC in a large patient cohort. We performed a cross-sectional study to determine whether, at baseline, there is a relationship between CIMT and CT-determined TAC score.
Our study demonstrates that TAC is associated with increasing severity of carotid atherosclerotic burden as measured by CIMT. The combined utility of these two noninvasive measures of subclinical atherosclerosis for CVD risk assessment needs to be determined in future studies.
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Thoracic aorta calcification detected by electron beam tomography predicts all-cause mortality.
By: Santos RD, Rumberger JA, Budoff MJ, Shaw LJ, Orakzai SH, Berman D, Raggi P, Blumenthal RS, Nasir K.
The presence of CAC is an independent marker of increased risk of CVD events and mortality. However, the predictive value of TAC, which can be additionally identified without further scanning during assessment of CAC, is unknown. We followed a cohort of 8401 asymptomatic individuals (mean age: 53+/-10 years, 69% men) undergoing cardiac risk factor evaluation and TAC and CAC testing with electron beam computed tomography. In conclusion, the presence of TAC was associated with all-cause mortality in our study; this relationship was independent of conventional CVD risk factors as well as the presence of CAC.
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Coronary atherosclerosis detected by coronary CT angiography in asymptomatic subjects with early chronic kidney disease.
By: Cho I, Min HS, Chun EJ, Park SK, Choi Y, Blumenthal RS, Rivera JJ, Nasir K, Kim YJ, Sohn DW, Oh BH, Park YB, Chang HJ.
The purpose of this study is to assess the independent association between early chronic kidney disease (CKD) with coronary atherosclerosis and the feasibility of risk stratification of coronary atherosclerosis according to The Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines using non-invasive coronary angiography. We enrolled asymptomatic subjects who underwent coronary CT angiography as part of a general health evaluation. Results show early CKD was an independent risk factor for coronary atherosclerosis, and the risk stratification for coronary atherosclerosis should be based on the presence of proteinuria rather than decreased eGFR within early CKD.
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Serum vitamin D, parathyroid hormone levels, and carotid atherosclerosis.
By: Reis JP, von Mühlen D, Michos ED, Miller ER 3rd, Appel LJ, Araneta MR, Barrett-Connor E.

In subgroup analyses, 1,25(OH)(2)D was inversely associated with internal carotid IMT among those with hypertension. These findings from a population-based cohort of older adults suggest a potential role for vitamin D in the development of subclinical atherosclerosis. Additional research is needed to determine whether vitamin D may influence the progression of atherosclerosis, including the effects of supplementation on the atherosclerotic process.

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Association of traditional cardiovascular risk factors with coronary plaque sub-types assessed by 64-slice computed tomography angiography in a large cohort of asymptomatic subjects.
By: Rivera JJ, Nasir K, Cox PR, Choi E, Yoon Y, Cho I, Chun EJ, Choi SI, Blumenthal RS, Chang HJ.
Age and gender are overall the strongest predictors of atherosclerosis as assessed by CCTA in this large asymptomatic Korean population and these two risk factors are not particularly associated with a specific coronary plaque sub-type. Smoking is a strong predictor of NCAP, which has been suggested by previous reports as a more vulnerable lesion. Whether a specific plaque sub-type is associated with a worse prognosis is yet to be determined by future prospective studies.
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