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Ciccarone Articles

Ciccarone Center Research

Year

2010

Landmark Articles

  • 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.
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  • It is important to note that the conclusion in the editorial that the Gottlieb et al. paper presents a “starkly contrasting picture” to a prior systematic review is based on a statistical error.Once again, Bayes’ theorem is critical. Although CAC = 0 may not definitively exclude important coronary artery disease (CAD) in patients referred for coronary angiography, there may be potential applications in lower-risk patients presenting with atypical chest pain features.
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  • In this observational study, we examined whether high baseline CACS were associated with the initiation as well continuation of new lipid-lowering medication (LLM), blood pressure-lowering medication (BPLM), and regular aspirin (ASA) use in a multi-ethnic population-based cohort. Findings indicate that CACS >400 was associated with a higher likelihood of initiation and continuation of LLM, BPLM, and ASA. The association was weaker for continuation than for initiation of these preventive therapies.
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  • We describe 6 risk algorithms (Framingham Risk Score for coronary heart disease events and for cardiovascular events, Adult Treatment Panel III, SCORE [Systematic Coronary Risk Evaluation] project, Reynolds Risk Score, ASSIGN [Assessing Cardiovascular Risk to Scottish Intercollegiate Guidelines Network/SIGN to Assign Preventative Treatment], and QRISK [QRESEARCH Cardiovascular Risk Algorithm]) for outcomes, population derived/validated, receiver-operating characteristic, variables included, and limitations. Areas of uncertainty include 10-year versus lifetime risk, prediction of CVD or coronary heart disease end points, nonlaboratory-based risk scores, age at which to start, race and sex differences, and whether a risk score should guide therapy. We believe that the best high-risk approach to CVD evaluation and prevention lies in routine testing for cardiovascular risk factors and risk score assessment. We recommend that health care providers discuss the global cardiovascular risk and lifetime cardiovascular risk score assessment with each patient.
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Zero coronary calcium and Bayes’ theorem.
By: Blaha MJ, Blumenthal RS, Nasir K.
It is important to note that the conclusion in the editorial that the Gottlieb et al. paper presents a “starkly contrasting picture” to a prior systematic review is based on a statistical error.Once again, Bayes’ theorem is critical. Although CAC = 0 may not definitively exclude important coronary artery disease (CAD) in patients referred for coronary angiography, there may be potential applications in lower-risk patients presenting with atypical chest pain features.
Read on Pubmed
What is the prognostic value of a zero calcium score? Ask Bayes!
By: McEvoy JW.
The role of calcium scoring (CS), if any, appears to be in the reclassification of asymptomatic patients at intermediate risk for CAD by traditional risk factor models. This has led to a Class IIb recommendation by the American Heart Association for the use of CS in these patients. Further research is ongoing to study the effect of such reclassification.
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Statistical modeling of Agatston score in multi-ethnic study of atherosclerosis (MESA).
By: Ma S, Liu A, Carr J, Post W, Kronmal R.
We show that, to fully describe the relationship between covariates and CAC development, the semiparametric model with nonproportional covariate effects is needed. In contrast, for the purpose of prediction, the parametric model with proportional covariate effects is sufficient. This study provides a statistical basis for describing the behaviors of CAC and insights into its biological mechanisms.
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Associations between genetic variants in the ACE, AGT, AGTR1 and AGTR2 genes and renal function in the multi-ethnic study of atherosclerosis.
By: Campbell CY, Fang BF, Guo X, Peralta CA, Psaty BM, Rich SS, Young JH, Coresh J, Kramer HJ, Rotter JI, Post WS.

These data suggest that genetic polymorphisms in the renin-angiotensin system are associated with renal phenotypes in the general population, but that many associations differ across racial/ethnic groups.

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Lipid disorders.
By: DeFilippis A, Blumenthal RS.
Use of nonsteroidal anti-inflammatory drugs in patients with cardiovascular disease: a cautionary tale.
By: Amer M, Bead VR, Bathon J, Blumenthal RS, Edwards DN.
Potentially, all nonsteroidal anti-inflammatory drugs (NSAIDs) possess a fair risk of adverse effects on gastrointestinal, cardiovascular, and renal systems. Until more evidence for safety via randomized trials is available, we recommend caution in prescribing COX-1 and 2 inhibitors for musculoskeletal disorders in patients with existing gastrointestinal or cardiovascular conditions.
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Preventing heart disease: Why our guidelines need to be modified.
By: Brooks GC, Blaha MJ, Blumenthal RS.

The authors comment on the need to change guidelines to prevent heart diseases among individuals in the U.S.

Relation of C-reactive protein to abdominal adiposity
By: Brooks GC, Blaha MJ, Blumenthal RS.
The association between high-sensitivity C-reactive protein (hsCRP) and abdominal adiposity persists when taking into account body mass index. Elevation of hsCRP might be reversible with weight loss and exercise. In conclusion, clinical measurements of abdominal adiposity readily provide data elucidating the systemic inflammatory state of patients and can help guide intensity of lifestyle modifications, thus leading to reduction of this inflammation.
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Abdominal adiposity in rheumatoid arthritis: Association with cardiometabolic risk factors and disease characteristics.
By: Giles JT, Allison M, Blumenthal RS, Post W, Gelber AC, Petri M, Tracy R, Szklo M, Bathon JM.
The distribution of abdominal fat differs significantly by rheumatoid arthritis (RA) status. Higher visceral fat area (VFA) in men with RA, and the more potent association of VFA with cardiometabolic risk factors in men and women with RA, may contribute to cardiovascular risk in RA populations.
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Atherosclerotic plaque composition among patients with stenotic coronary artery disease on noninvasive CT angiography.
By: Hamirani YS, Nasir K, Gopal A, Ahmadi N, Pal R, Flores F, Blumenthal RS, Budoff MJ.
Significant differences in plaque composition according to severity of CAD were observed in our study. Individuals with a higher likelihood of stenotic CAD were more likely to have higher underlying burden of exclusively calcified and mixed plaque. These findings should stimulate further investigations to assess the prognostic value of plaque according to their underlying composition.
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