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Ciccarone Articles

Ciccarone Center Research

Topic

Vascular Imaging

Landmark Article

Thoracic aortic calcification and coronary heart disease events: the multi-ethnic study of atherosclerosis (MESA).
By: Budoff MJ, Nasir K, Katz R, Takasu J, Carr JJ, Wong ND, Allison M, Lima JA, Detrano R, Blumenthal RS, Kronmal R.
The presence and extent of CAC is an independent predictor of CHD morbidity and mortality. Few studies have evaluated interactions or independent incremental risk for coronary and thoracic aortic calcification (TAC). The independent predictive value of TAC for CHD events is not well-established. This study used risk factor and computed tomography scan data from 6,807 participants in MESA. Using the same images for each participant, TAC and CAC were each computed using the Agatston method. Our study indicates that TAC is a significant predictor of future coronary events only in women, independent of CAC. On studies obtained for either cardiac or lung applications, determination of TAC may provide modest supplementary prognostic information in women with no extra cost or radiation.
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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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Adjunctive lipid lowering therapy in the era of surrogate endpoints.
By: Silverman MG, Blaha MJ, Blumenthal RS.
Statins have been shown to reduce cardiovascular events. However, despite widespread use of statin therapy, residual cardiovascular risk remains, and this has left clinicians searching for an effective adjunctive therapy to optimize lipid profiles and reduce risk further. Our article provides clinicians with a practical approach to making decisions regarding adjunctive therapy in the absence of clinical outcomes data. Three ongoing clinical outcomes trials evaluating niacin and ezetimibe in combination with a statin will provide more definitive evidence regarding the safety and efficacy of these agents as adjunctive therapy.
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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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Relation of aortic valve calcium detected by cardiac computed tomography to all-cause mortality.
By: Blaha MJ, Budoff MJ, Rivera JJ, Khan AN, Santos RD, Shaw LJ, Raggi P, Berman D, Rumberger JA, Blumenthal RS, Nasir K.
Aortic valve calcium (AVC) can be quantified on the same computed tomographic scan as CAC. Although CAC is an established predictor of cardiovascular events, limited evidence is available for an independent predictive value for AVC. We studied a cohort of 8,401 asymptomatic subjects (mean age 53 ± 10 years, 69% men), who were free of known coronary heart disease and were undergoing computed tomography for assessment of subclinical atherosclerosis. The patients were followed for a median of 5 years (range 1 to 7) for the occurrence of mortality from any cause. In conclusion, AVC was associated with increased all-cause mortality, independent of the traditional risk factors and the presence of CAC.
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Risk factor differences for aortic versus coronary calcified atherosclerosis: the multi-ethnic study of atherosclerosis.
By: Criqui MH, Kamineni A, Allison MA, Ix JH, Carr JJ, Cushman M, Detrano R, Post W, Wong ND.
The goal of this study was to compare and contrast CAC with abdominal aortic calcium (AAC) in terms of their associations with traditional and novel CVD risk factors. AAC showed stronger correlations with most CVD risk factors than did CAC. The predictive value of AAC compared with CAC for incident CVD events remains to be evaluated.
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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.
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Risk factor differences for aortic vs. coronary calcified atherosclerosis: MESA.
By: Criqui MH, Kamineni A, Allison MA, Ix JH, Carr JJ, Cushman M, Detrano R, Post W, Wong ND.

The goal of this study was to compare and contrast coronary artery calcium (CAC) with abdominal aortic calcium (AAC) in terms of their associations with traditional and novel cardiovascular disease (CVD) risk factors. AAC showed stronger correlations with most CVD risk factors than did CAC. The predictive value of AAC compared with CAC for incident CVD events remains to be evaluated.

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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.
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