In This Section      
 

Ciccarone Articles

Ciccarone Center Research

Journal

Journal of the American College of Cardiology

Landmark Articles

Impaired fasting glucose and the risk of incident diabetes mellitus and cardiovascular events in an adult population: MESA (Multi-Ethnic Study of Atherosclerosis).
By: Yeboah J, Bertoni AG, Herrington DM, Post WS, Burke GL.
The purpose of the study was to assess the cardiovascular risk of impaired fasting glucose (IFG). The associations between IFG, incident type 2 diabetes mellitus (T2DM), and CV events remains unclear. The MESA study included participants who were 45 to 84 years or age and free of clinical CV disease at baseline. Having IFG was not independently associated with an increased short-term risk for incident CV events. These data reiterate the importance of intervention for persons with IFG to reduce their incidence of T2DM.
Read on Pubmed
Localized calcific constrictive pericarditis masquerading as a basal aneurysm.
By: Blaha MJ, Panjrath G, Chacko M, Schulman SP.
Read on Pubmed
“Actually, it is more of a guideline than a rule.”
By: Blumenthal RS, Hasan RK.
This editorial discusses the challenges of designing a randomized controlled trial of coronary calcium scanning to improve risk prediction. It also emphasizes the theme of the iconic movie “Ghostbusters.”
Read on Pubmed
Coronary artery calcium progression: an important clinical measurement? A review of published reports.
By: McEvoy JW, Blaha MJ, Defilippis AP, Budoff MJ, Nasir K, Blumenthal RS, Jones SR.
Baseline CAC accurately identifies coronary atherosclerosis and improves prediction of future cardiac events. However, whether knowledge of progression of CAC scores over time further improves risk prediction is unclear. We conducted a comprehensive review of published reports on CAC progression and found that CAC progression correlates with worsening atherosclerosis and may facilitate prediction of future cardiac events. These findings support the notion that slowing CAC progression with therapeutic interventions might provide prognostic benefit. However, despite promising early data, such interventions (most notably with statin therapy) have not been shown to slow the progression of CAC in any randomized controlled trial to date, outside of post hoc subgroup analyses. Thus, routine quantification of CAC progression cannot currently be recommended in clinical practice.
Read on Pubmed
Coronary artery calcium progression — an important clinical measurement? (State of the Art Paper)
By: McEvoy JW, Blaha M, DeFilippis A, Budoff M, Nasir K, Blumenthal RS, Jones SR.

Baseline coronary artery calcification (CAC) accurately identifies coronary atherosclerosis and might improve prediction of future cardiac events. Serial assessment of CAC scores has been proposed for monitoring atherosclerosis progression and for assessing the effectiveness of medical therapies aimed at reducing cardiac risk. However, whether knowledge of progression of CAC scores over time further improves risk prediction is unclear. Several trials relating medical therapies to CAC progression have been performed without any formal guidelines on the definition of CAC progression and how it is best quantified. We conducted a comprehensive review of published reports on CAC progression. Increased CAC progression is associated with many known cardiac risk factors. We found that CAC progression correlates with worsening atherosclerosis and may facilitate prediction of future cardiac events. These findings support the notion that slowing CAC progression with therapeutic interventions might provide prognostic benefit. However, despite promising early data, such interventions (most notably with statin therapy) have not been shown to slow the progression of CAC in any randomized controlled trial to date, outside of post hoc subgroup analyses. Thus, routine quantification of CAC progression cannot currently be recommended in clinical practice. First, standards of how CAC progression should be defined and assessed need to be developed. In addition, there remains a need for further studies analyzing the effect of other cardiac therapies on CAC progression and cardiac outcomes.

Read on Pubmed
Noninvasive visualization of coronary artery endothelial function in healthy subjects and in patients with coronary artery disease.
By: Hays AG, Hirsch GA, Kelle S, Gerstenblith G, Weiss RG, Stuber M.
The goal was to test 2 hypotheses: first, that coronary endothelial function can be measured non-invasively and abnormal function detected using clinical 3.0-T magnetic resonance imaging (MRI); and second, that the extent of local CAD, in a given patient, is related to the degree of local abnormal coronary endothelial function. We concluded that endothelial-dependent coronary artery dilation and increased blood flow in healthy subjects, and their absence in CAD patients, can now be directly visualized and quantified non-invasively. Local coronary endothelial function differs between severely and mildly diseased arteries in a given CAD patient. This novel, safe method may offer new insights regarding the importance of local coronary endothelial function and improved risk stratification in patients at risk for and with known CAD.
Read on Pubmed
The ankle-brachial index and incident cardiovascular events in the MESA (Multi-Ethnic Study of Atherosclerosis).
By: Criqui MH, McClelland RL, McDermott MM, Allison MA, Blumenthal RS, Aboyans V, Ix JH, Burke GL, Liu K, Shea S.
Abnormal ABIs, both low and high, are associated with elevated CVD risk. However, it is unknown whether this association is consistent across different ethnic groups, and whether it is independent of both newer biomarkers and other measures of subclinical atherosclerotic CVD. In this study, both a low and a high ABI were associated with elevated CVD risk in persons free of known CVD, independent of standard and novel risk factors, and independent of other measures of subclinical CVD. Further research should address the cost-effectiveness of measuring the ABI in targeted population groups.
Read on Pubmed
elective use of coronary artery calcium screening: worth the cost?
By: Blumenthal RS, Hwang CW, Nasir K
Of all tests available for risk stratification, coronary artery calcium (CAC) superiorly divides patients into 2 clear subgroups of high and low future CHD risk, compared to carotid IMT testing. The results of the EISNER study alleviate the fear that such a strategy will inevitably lead to high downstream costs. The EISNER study provides further evidence for the urgency of a randomized trial that compares the current traditional risk factors-based approach with one supplemented by subclinical atherosclerotic screening to determine whether this approach can save lives in a manner that is at least moderately cost effective. This study does show that screening costs will beget more costs; testing produces more than the upfront cost of a procedure. In this regard, we applaud the recent efforts of the National Heart, Lung, and Blood Institute to initiate a dialogue on how to assess the societal utility of such screening tests and look forward to the outcome of these discussions.
Read on Pubmed
Association of combinations of lipid parameters with carotid intima-media thickness and coronary artery calcium in MESA.
By: . Paramsothy P, Knopp RH, Bertoni AG, Blumenthal RS, Wasserman BA, Tsai MY, Wong ND, Heckbert SR.
The purpose of this study was to determine the association of combinations of lipid parameters with subclinical atherosclerosis.  Carotid intima-media thickness (CIMT) and coronary artery calcium (CAC) are significantly associated with incident cardiovascular disease (CVD). The association between common dyslipidemias (combined hyperlipidemia, [simple] hypercholesterolemia, dyslipidemia of metabolic syndrome, isolated low high-density lipoprotein cholesterol, and isolated hypertriglyceridemia) compared with normolipemia, and CIMT and CAC has not been previously examined.
 
Among 4,792 participants, only those with combined hyperlipidemia and hypercholesterolemia demonstrated both increased common CIMT (combined hyperlipidemia 0.048 mm thicker, 95% confidence interval [CI]: 0.016 to 0.080 mm; hypercholesterolemia 0.048 mm thicker, 95% CI: 0.029 to 0.067 mm) and internal CIMT (combined hyperlipidemia 0.120 mm thicker, 95% CI: 0.032 to 0.208 mm; and hypercholesterolemia 0.161 mm thicker, 95% CI: 0.098 to 0.223 mm) as well as increased risk for prevalent CAC (combined hyperlipidemia relative risk: 1.22, 95% CI: 1.08 to 1.38; hypercholesterolemia relative risk: 1.22, 95% CI: 1.11 to 1.34) compared with normolipemia. The interactions between lipid parameters and race, sex, or high-sensitivity C-reactive protein were not significant for any outcomes.
Read on Pubmed
Cumulative exposure to ionizing radiation from diagnostic and therapeutic cardiac imaging procedures: a population-based analysis.
By: Chen J, Einstein AJ, Fazel R, Krumholz HM, Wang Y, Ross JS, Ting HH, Shah ND, Nasir K, Nallamothu BK.
Cardiac imaging procedures frequently expose patients to ionizing radiation, but their contribution to effective doses of radiation in the general population is unknown.
Read on Pubmed