Preclinical atherosclerosis and cardiovascular events: Do we have a consensus about the role of preclinical atherosclerosis in the prediction of cardiovascular events?

Poredoš, Pavel; Cífková, Renata; Maier, Jeanette Anne Marie; Nemcsik, János; Šabovič, Mišo; Jug, Borut; Ježovnik, Mateja K; Schernthaner, G.; Antignani, Pier Luigi; Catalano, M.; Fras, Zlatko; Höbaus, Clemens; Nicolaides, Andrew; Paraskevas, Kosmas I.; Reiner, Željko; Wohlfahrt, Peter; Poredoš, Peter; Blinc, Aleš

doi:10.1016/j.atherosclerosis.2022.03.030

Cited by 25 publications

(16 citation statements)

References 131 publications

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“…Interestingly, as opposed to diagnosed (self-reported) dyslipidemia, none of the traditional lipid markers (LDL-C, HDL-C, and triglycerides) alone predicted coronary calcifications in our study, which is a likely result of selection bias. Patients referred for calcium scanning as per guidelines [ 30 ] fall in the intermediate-risk category (i.e., 1-5% predicted 10-year cardiovascular mortality rate in our study) with comparable lipid profiles (as depicted by low to moderate lipid derangements and relatively narrow value ranges in our study population). The clinical goal for subclinical atherosclerosis detection is lipid-lowering therapy initiation in patients below lipid thresholds; in this context, our findings suggest lipid subfraction measurement may improve prediction of subclinical coronary atherosclerosis in intermediate-risk populations.…”

Section: Discussionmentioning

confidence: 56%

Association between Lipoprotein Subfractions, Hemostatic Potentials, and Coronary Atherosclerosis

2022

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Background. Dyslipidemias are associated with atherosclerotic plaque formation and a prothrombotic state, thus increasing the risk of both atherosclerotic vascular disease and atherothrombotic adverse events. We sought to explore the association between lipoprotein subfractions, overall hemostasis, and coronary calcifications in individuals at intermediate cardiovascular risk. Methods. Consecutive statin-naive individuals at intermediate cardiovascular risk referred for coronary artery calcium score (CACS) scanning were included. CACS was assessed using a 128-slice dual-source CT scanner. Traditional lipid profile, high-density lipoprotein (HDL) subfractions 2 and 3, and small dense low-density lipoproteins (sdLDL) were measured with commercially available assays. Overall hemostatic (OHP) and coagulation potentials (OCP) were measured spectrophotometrically, using fibrin aggregation curves after exposure to thrombin and recombinant tissue-type plasminogen activator, respectively. Overall fibrinolytic potential (OFP) was calculated as a difference between the two areas under curves. Results. We included 160 patients (median age 63 (interquartile range (IQR), 56-71 years, 52% women, and median CACS 8, IQR 0-173 Agatston units). HDL3 levels—but not sdLDL or hemostatic potentials—were significantly associated with CACS zero, even after adjusting for age, sex, arterial hypertension, dyslipidemia, diabetes, and smoking history (OR 0.980 (0.962-0.999), p = 0.034 ). HDL3 was also significantly associated with OCP ( r = − 0.232 , p adjusted for age and sex 0.037). Conclusions. In patients at intermediate cardiovascular risk, HDL3 is associated with both subclinical atherosclerosis and overall coagulation. Our findings are in line with studies reporting on an inverse relationship between HDL3 and atherosclerosis and provide one possible mechanistic explanation for the association between novel lipid biomarkers and coagulation derangements.

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Section: Discussionmentioning

confidence: 56%

Association between Lipoprotein Subfractions, Hemostatic Potentials, and Coronary Atherosclerosis

2022

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“…The present study has some limitations. Perhaps the most important one is the fact that until relatively recently there was a lack of IMT measurement standardization (method, mean/maximal thickness, carotid segment, including or excluding plaque) which could influence the predictive value in CHD risk estimation in different studies; therefore, this might also have an impact on the results of this meta-analysis [ 70 ]. In addition, according to the observational design of the included studies, we could not perform a comparative evaluation of the effects of bariatric surgery and medical treatment on IMT.…”

Section: Discussionmentioning

confidence: 99%

Effect of Bariatric Surgery on Intima Media Thickness: A Systematic Review and Meta-Analysis

Jamialahmadi

Reiner

Alidadi

et al. 2022

JCM

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Background: Obesity, and in particular extreme obesity, as a global health problem is an important risk factor for many diseases, including atherosclerotic cardiovascular disease (ACVD). Bariatric surgery might stop or slow atherogenesis by decreasing excessive weight in the early stages of atherogenesis, by suppressing low-grade systemic inflammation as well as by inhibiting oxidative stress and endothelial dysfunction. The aim of this meta-analysis was to provide an answer to whether bariatric surgery has a significant effect on intima-media thickness (IMT) which is a surrogate marker of early atherosclerosis and has a good correlation with atherosclerotic coronary heart disease. Methods: A systematic literature search in PubMed, Scopus, Embase, and Web of Science as well as grey literature was performed from inception to 1 July 2022. The meta-analysis was performed using Comprehensive Meta-Analysis (CMA) V3 software. Overall, the estimate of effect size was measured by a random effects meta-analysis. To account for the heterogeneity of studies regarding study design, characteristics of the populations, and treatment duration, a random-effects model (using the DerSimonian–Laird method) and the generic inverse variance weighting approach were used. To assess the existence of publication bias in the meta-analysis, the funnel plot, Begg’s rank correlation, and Egger’s weighted regression tests were used. Results: The meta-analysis of 30 trials, including 1488 subjects, demonstrated a significant decrease in IMT after bariatric surgery. The reduction in IMT was also robust in the leave-one-out sensitivity analysis. It must be stressed that the results of the random-effects meta-regression did not suggest any relationship between the changes in IMT and delta body mass index (BMI) or duration of follow-up after the bariatric surgery. However, the subgroup analyses showed a better IMT reduction after laparoscopic sleeve gastrectomy (LSG) when compared to Roux-en-Y gastric bypass (RYGB). Within a year, the IMT follow-up values showed a further improvement. Conclusions: Bariatric surgery significantly reduced IMT. Significant associations were found between the surgery type and IMT changes, as well as a significant effect of follow-up duration on the changes of IMT after bariatric surgery.

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“…The predictive value of carotid intima-media thickness for CAD is controversial [20]. Although some prospective studies have shown that it increases the predictive power of traditional risk prediction models [6, 21,22], others cannot con rm this [23].…”

Section: Discussionmentioning

confidence: 99%

Predictive value of noninvasive peripheral atherosclerosis measurement for coronary artery disease in patients with long T2DM duration

Chen

Wang

et al. 2022

Preprint

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Background Vascular ultrasound is a commonly used tool to predict the existence and severity of coronary artery disease (CAD) by detecting the atherosclerosis of peripheral arteries. However, most studies on atherosclerosis are based on the general population, and the predictive efficacy of carotid or femoral ultrasound in type 2 Diabetes mellitus (T2DM) and its correlation with CAD severity are less elucidated. This study aimed to compare the predictive value of carotid or femoral artery ultrasound for CAD in T2DM patients free from known CAD, and to assess the relationship with the severity of coronary artery stenosis. Methods Cross-sectional study in adults with a T2DM duration of at least 5 years and without established CAD. All participants underwent carotid and femoral ultrasound and underwent coronary angiography for the first time. The carotid plaque score (CPS) was calculated by the sum of the maximum thickness of plaques on three segments of the carotid arteries on both sides. The Gensini score was used to assess the severity of coronary stenosis, and patients were divided into no or mild group, moderate group and severe group according to the tertile of the score. Results Multiple regression analysis showed that carotid plaque score, femoral plaque and smoking were independently and positively correlated with CAD. Carotid plaque score yielded the highest area under the curve for detecting significant coronary disease (AUC = 0.7323). In contrast, the area under the curve of femoral artery plaque and carotid intima-media thickness was lower than 0.7, which was at a lower prediction level. In the no or mild, moderate and severe groups, the CPS value gradually increased, and the difference between the groups was statistically significant (p < 0.05). The positive rate of femoral artery plaque in patients with moderate and severe CAD was significantly higher than that in the no or mild group (p < 0.0001). Conclusion In patients with long T2DM duration, carotid plaque score has a higher ability to predict the occurrence and severity of CAD. However, femoral artery plaque has special value in predicting moderate to severe coronary artery disease in patients with long-term T2DM.

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Preclinical atherosclerosis and cardiovascular events: Do we have a consensus about the role of preclinical atherosclerosis in the prediction of cardiovascular events?

Cited by 25 publications

References 131 publications

Association between Lipoprotein Subfractions, Hemostatic Potentials, and Coronary Atherosclerosis

Association between Lipoprotein Subfractions, Hemostatic Potentials, and Coronary Atherosclerosis

Effect of Bariatric Surgery on Intima Media Thickness: A Systematic Review and Meta-Analysis

Predictive value of noninvasive peripheral atherosclerosis measurement for coronary artery disease in patients with long T2DM duration

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