I Want To...
I Want To...
Find Research Faculty
Enter the last name, specialty or keyword for your search below.
School of Medicine
I Want to...
Ciccarone Center Research
View by Topic
- Antiplatelet Therapy
- ASCVD (Atherosclerotic Cardiovascular Disease)
- Blood Pressure
- Cardiac CT
- Cardiovascular Risk Assessment
- Carotid Atherosclerosis
- Cerebrovascular Disease / Stroke / Cognitive Function
- Cholesterol / Lipids / Statins
- Cigarette Smoking
- Diabetes & Metabolic Syndrome
- Diet & Weight
- Disparities in Care
- Emotional Health
- Endothelial Function
- Erectile Dysfunction
- Exercise and Physical Fitness
- Family History of CVD
- Gender / Cardiovascular Disease in Women
- Heart Failure
- Heart Rate
- Markers of Thrombosis, Myocardial Injury, Wall Stress
- Mobile Health
- Nutrition, Vitamins, Supplements
- PVD – Peripheral Vascular Disease
- Quality of Care
- Renal Disease
- Rheumatoid Arthritis & Collagen Vascular Diseases
- Sleep Disorders
- Stem Cells
- Subclinical Atherosclerosis
- Vascular Imaging
- Vascular Stiffness
View by Journal
- American Heart Journal
- American Journal of Cardiology
- American Journal of Epidemiology
- American Journal of Hypertension
- Annals of Internal Medicine
- Arteriosclerosis, Thrombosis & Vascular Biology
- British Medical Journal
- Clinical Cardiology
- Diabetes Care
- European Heart Journal
- European Journal of Preventive Cardiology
- International Journal of Cardiology
- Journal of Hypertension
- Journal of the American College of Cardiology
- Journal of the American Heart Association
- Journal of the American Medical Association
- Mayo Clinic Proceedings
- New England Journal of Medicine
- PLoS One
View by Year
- Meet the Authors
Journal of the American College of Cardiology
- Read on Pubmed
Headed in the right direction but at risk for miscalculation: a critical appraisal of the 2013 ACC/AHA risk assessment guideline.Read on Pubmed
The newly released 2013 ACC/AHA Guideline for Assessing Cardiovascular Risk was a major advance over prior guidelines, but the new risk equations do not appear to lead to significantly better discrimination than older models. Since the same risk factors are incorporated, using the new risk estimators may lead to inaccurate assessment of atherosclerotic cardiovascular risk in certain groups of patients. There also is likely an overestimation of risk when applied to modern populations. Future guidelines could provide clearer direction on which individuals would benefit from additional testing for more personalized preventive therapies.
Baseline subclinical atherosclerosis burden and distribution are associated with frequency and mode of future coronary revascularization: multi-ethnic study of atherosclerosis.Read on Pubmed
There was a strong association between the baseline burden and regional distribution of CAC and the risk and type of future coronary revascularization among asymptomatic subjects.
High-sensitivity C-reactive protein and cardiovascular disease: A resolute belief or an elusive link?Read on Pubmed
Although high-sensitivity C-reactive protein (hsCRP) is involved in the immunologic process that triggers vascular remodeling and plaque deposition and is associated with increased cardiovascular disease (CVD) risk, definitive randomized evidence for its role as a causative factor in atherothrombosis is lacking. This article reviews four distinct points from the literature to better understand the current state and application of hsCRP in clinical practice, and we highlight recommendations from societies and important considerations when using hsCRP to guide treatment decisions in the primary prevention setting.
Mortality rates in smokers and nonsmokers in the presence or absence of coronary artery calcification.Read on Pubmed
The aim of this study was to further explore the interplay between smoking status, coronary artery calcium (CAC), and all-cause mortality. Smoking is a risk factor for death across the entire spectrum of subclinical coronary atherosclerosis. Smokers with any CAC had significantly higher mortality than smokers without CAC, a finding with implications for smokers undergoing lung cancer CT-based screening. However, the absence of CAC might not be as useful a "negative risk factor" in active smokers, because this group has mortality rates similar to nonsmokers with mild-to-moderate atherosclerosis.
Niacin and statin combination therapy for atherosclerosis regression and prevention of cardiovascular disease events: Reconciling the AIM-HIGH (Atherothrombosis Intervention in Metabolic Syndrome With Low HDL/High Triglycerides: Impact on Global HealRead on Pubmed
Despite substantial risk reductions targeting low-density lipoprotein cholesterol with statins, there remains significant residual risk as evidenced by incident and recurrent CVD events among statin-treated patients. Observational studies have shown that low levels of high-density lipoprotein cholesterol (HDL-C) are associated with increased CVD risk. It remains unclear whether strategies aimed at increasing HDL-C in addition to background statin therapy will further reduce risk.
Impaired fasting glucose and the risk of incident diabetes mellitus and cardiovascular events in an adult population: MESA (Multi-Ethnic Study of Atherosclerosis).
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.
“Actually, it is more of a guideline than a rule.”
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.”
Coronary artery calcium progression: an important clinical measurement? A review of published reports.
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.
Coronary artery calcium progression — an important clinical measurement? (State of the Art Paper)
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.
Noninvasive visualization of coronary artery endothelial function in healthy subjects and in patients with coronary artery disease.
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.
The ankle-brachial index and incident cardiovascular events in the MESA (Multi-Ethnic Study of Atherosclerosis).
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.
elective use of coronary artery calcium screening: worth the cost?
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.
Association of combinations of lipid parameters with carotid intima-media thickness and coronary artery calcium in MESA.
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.
Cumulative exposure to ionizing radiation from diagnostic and therapeutic cardiac imaging procedures: a population-based analysis.
Cardiac imaging procedures frequently expose patients to ionizing radiation, but their contribution to effective doses of radiation in the general population is unknown.