Detecting Occult Coronary Disease in a High-Risk Asymptomatic Population

Blumenthal, Roger S.; Becker, Diane M.; Yanek, Lisa R.; Aversano, Thomas; Moy, Taryn F.; Král, B; Becker, Lewis C.

doi:10.1161/01.cir.0000048127.93169.88

Cited by 49 publications

(19 citation statements)

References 46 publications

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“…The cohort included 543 healthy non-coronary artery disease (CAD) siblings, aged 30 to 75 years. 23 The study was approved by the Johns Hopkins Medicine Institutional Review Board, and all participants gave written informed consent. Subjects underwent risk factor screening and measurement of plasma Lp(a) after a 12-hour overnight fast.…”

Section: Study Populationsmentioning

confidence: 99%

“…Blood pressure and blood lipids (total cholesterol, HDLC, triglycerides, and LDL cholesterol [LDLC]) were assessed as previously described. 23 LDLC was estimated using the Friedewald formula. Lipoprotein subclass assays were performed by LipoScience Inc (Raleigh, NC) using nuclear magnetic resonance spectroscopy (see Methods in the Data Supplement).…”

Section: Study Populationsmentioning

confidence: 99%

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SCARB1 Gene Variants Are Associated With the Phenotype of Combined High High-Density Lipoprotein Cholesterol and High Lipoprotein (a)

Yang

Sethi

Yanek

et al. 2016

Circ Cardiovasc Genet

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Section: Study Populationsmentioning

confidence: 99%

Section: Study Populationsmentioning

confidence: 99%

SCARB1 Gene Variants Are Associated With the Phenotype of Combined High High-Density Lipoprotein Cholesterol and High Lipoprotein (a)

Yang

Sethi

Yanek

et al. 2016

Circ Cardiovasc Genet

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“…5 We now recognize that prognostically important stress-induced perfusion defects reflect not only the hemodynamic effects of focal stenoses but also the effects of diffuse atherosclerosis 6,7 and vasomotor changes. 8,9 The dynamic vasomotor changes and abnormal endothelial function may not be visible on routine diagnostic coronary arteriography unless vasodilator stress is used. 9 Both the extent and severity of stressinduced perfusion defects contribute to the identification of the coronary event risk associated with plaque burden of the coronary tree.…”

Section: Evolving Paradigmmentioning

confidence: 99%

Monitoring effectiveness of medical therapy in 2006

Schwartz

Kudes

2006

Journal of Nuclear Cardiology

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The decade of the 1990s witnessed a paradigm shift in the use of nuclear cardiology beyond diagnostic applications to prognostic assessments that were incremental to those provided by clinical, exercise, electrocardiographic, and arteriographic data. [1][2][3] The value of radionuclide tomographic perfusion and function imaging as a gatekeeper for coronary arteriography to define revascularization options has been confirmed by a large study of its cost-effectiveness of routine compared with selective use of coronary arteriography by use of single photon emission computed tomography (SPECT) imaging with the Economics of Noninvasive Diagnosis (END) study. 4 A further paradigm shift has been the understanding of the past decade that the vast majority of myocardial infarctions occur in areas of the coronary artery associated with hemodynamically nonocclusive stenoses. 5 We now recognize that prognostically important stress-induced perfusion defects reflect not only the hemodynamic effects of focal stenoses but also the effects of diffuse atherosclerosis 6,7 and vasomotor changes. 8,9 The dynamic vasomotor changes and abnormal endothelial function may not be visible on routine diagnostic coronary arteriography unless vasodilator stress is used. 9 Both the extent and severity of stressinduced perfusion defects contribute to the identification of the coronary event risk associated with plaque burden of the coronary tree. For example, an extensive mild ischemic defect might equal or exceed the risk of a smaller, more severe stress-induced defect. 10 The mechanistic understanding that has resulted from these findings over the past decade has positioned nuclear cardiologists to address 2 further developments in the clinical application of the field to meet public health needs.The first development is the ability of radionuclide myocardial perfusion scintigraphy (MPS) to detect preclinical risk of coronary events in high-risk asymptomatic populations, as has been reviewed recently. 11 The high-risk asymptomatic populations studied to date with MPS include apparently healthy adult subjects with type 2 diabetes mellitus, 12 subjects with siblings or parents with coronary artery disease (CAD), 8,13,14 and subjects with multiple coronary risk factors. 14,15 These asymptomatic subjects tend to have mild perfusion defects related to predominantly mild stenoses and stress-inducible vasomotor changes. 8,9,13 Earlier observations with quantitative coronary arteriography correlated the number and severity of coronary risk factors with reduced stress-induced dilation or provocation of spasm. 16 Risk, rather than symptoms, is considered to drive the predictive accuracy of MPS.The second development is the ability to monitor changes in myocardial perfusion associated with therapeutic effects of lifestyle and medical therapy associated with the healing of the endothelium. Starting in 1994, Gould et al 17,18 first described short-term (90-day) and long-term (5-year) improvements in stress perfusion with lifestyle changes by positron emiss...

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“…This interest has been propagated in large part by the realization that our traditional approaches to risk assessment result in a substantial detection gap [13,14]. Furthermore, the current risk assessment methods, based on risk factor categories, fail to account for a sizeable amount of variation in outcome [10,13].…”

Section: Introductionmentioning

confidence: 99%

Epidemiologic guidance with coronary artery calcium scoring

Raggi

Shaw²

2008

Curr Cardiol Rep

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The importance of screening for subclinical coronary artery disease is reinforced by the detection gap existing between the currently used risk stratification tools and the persistently elevated rates of cardiovascular disease in Western countries. Medicare data clearly indicate the extremely high cost of caring for patients with end-stage diseases, and early detection may curb some of these expenses. Coronary artery calcium screening has become a widely used tool to estimate risk in a variety of categories in the general population and is discussed in this review.

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Detecting Occult Coronary Disease in a High-Risk Asymptomatic Population

Cited by 49 publications

References 46 publications

SCARB1 Gene Variants Are Associated With the Phenotype of Combined High High-Density Lipoprotein Cholesterol and High Lipoprotein (a)

SCARB1 Gene Variants Are Associated With the Phenotype of Combined High High-Density Lipoprotein Cholesterol and High Lipoprotein (a)

Monitoring effectiveness of medical therapy in 2006

Epidemiologic guidance with coronary artery calcium scoring

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