Surrogate Markers for Cardiovascular Disease

Mancini, G.B. John; Dahlöf, Björn; Díez, Javier

doi:10.1161/01.cir.0000133443.77237.2f

Cited by 186 publications

(149 citation statements)

References 168 publications

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“…We found, for the first time, that in hypercholesterolemic subjects the C allele was independently associated with reduced carotid IMT, an established surrogate of atherosclerosis [24], after adjusting for traditional cardiovascular risk factors. The model explained an 8.3% reduction in carotid IMT in CC homozygous compared with the remaining genotypes.…”

Section: Discussionmentioning

confidence: 73%

Protective effect of the G-765C COX-2 polymorphism on subclinical atherosclerosis and inflammatory markers in asymptomatic subjects with cardiovascular risk factors

Orbe

Beloqui

Rodríguez

et al. 2006

Clinica Chimica Acta

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Background: Cyclooxygenase (COX)-2, a key regulatory enzyme in prostanoid synthesis, plays an important role in inflammatory processes. The À765G > C COX-2 polymorphism has been associated with lower promoter activity in vitro and reduced levels of C-reactive protein (CRP) in atherosclerotic carriers of the C allele. However, its pathophysiological relevance in vivo has not been fully elucidated. Methods and results:We assessed the À 765G > C polymorphism and COX-2 expression in 220 asymptomatic subjects free of cardiovascular disease, in relation to global vascular risk, carotid intima-media thickness (IMT), and inflammatory markers (fibrinogen, Creactive protein [CRP], von Willebrand factor [vWF] and interleukin-6 [IL-6]). Genotype frequencies were: CC (7.7%), CG (34.5%), GG (57.7%). Among hypercholesterolemic subjects (n = 140), C allele carriers had lower COX-2 expression ( p < 0.05), reduced carotid IMT ( p < 0.01) and diminished levels of inflammatory markers CRP, vWF and IL-6 ( p < 0.05), as compared to GG homozygous subjects. The association between carotid IMT and COX-2 polymorphism remained significant after adjusting for cardiovascular risk factors and inflammatory markers ( p = 0.008). Conclusions: In asymptomatic hypercholesterolemic subjects the C allele of À 765G > C COX-2 polymorphism was associated with lower COX-2 expression, and reduced subclinical atherosclerosis and systemic inflammation compared with GG homozygous, thus conferring atherosclerosis protection in this cardiovascular risk population. D

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Section: Discussionmentioning

confidence: 73%

Protective effect of the G-765C COX-2 polymorphism on subclinical atherosclerosis and inflammatory markers in asymptomatic subjects with cardiovascular risk factors

Orbe

Beloqui

Rodríguez

et al. 2006

Clinica Chimica Acta

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“…In the hypertensive population, ECG and echo LVH regression has been associated with a significant reduction in both fatal and non-fatal cardiovascular events. 5,6 In a recent review, Mancini et al 7 emphasized, 'We now have the ultimate documentation for both ECG LVH and echo LVH that reversal has an independent prognostic value, independent of therapy and blood pressure'. 7 This view was endorsed again by Schillaci et al 8 Nevertheless, detection of LVH in CAD remains a challenge.…”

Section: Introductionmentioning

confidence: 99%

“…5,6 In a recent review, Mancini et al 7 emphasized, 'We now have the ultimate documentation for both ECG LVH and echo LVH that reversal has an independent prognostic value, independent of therapy and blood pressure'. 7 This view was endorsed again by Schillaci et al 8 Nevertheless, detection of LVH in CAD remains a challenge. While echo is a reliable method for detecting anatomic LVH, it is less widely available especially in the non US countries and obviously requires technical expertize.…”

Section: Introductionmentioning

confidence: 99%

The electrocardiogram is an unreliable method of identifying left ventricular hypertrophy in stable, treated angina patients

Ang

Struthers

2008

J Hum Hypertens

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In coronary artery disease (CAD), a potentially reversible factor leading to cardiac death is left ventricular hypertrophy (LVH). While the electrocardiogram (ECG) is a widely available way to diagnose LVH, its sensitivity and specificity has never been assessed in this particular patient group where added ischaemic changes on ECG might complicate things. Furthermore, there are at least 11 different ECG criteria proposed to identify LVH. We sought to determine how many cases of echocardiography (echo) LVH would be missed if all of these different ECG criteria were applied in a group of stable, treated angina patients. A total of 241 consecutive patients with angiographically confirmed CAD were prospectively recruited and 11 ECG criteria were assessed on each subject and compared with the presence or absence of LVH on echo. Individual sensitivity, specificity, positive predictive value and negative predictive value were calculated for each ECG LVH criteria. The prevalence of echo LVH in the entire CAD population was 43%. All the proposed ECG criteria were poor at identifying echo LVH. The Cornell product yielded the highest rate of change value but still missed up to 80% of the echo LVH cases. We conclude that in a group of stable, treated angina patients, ECG is an unreliable method of identifying LVH. As LVH is very common in this patient population, screening by means of echo might be indicated. This will enable intensified efforts to ensure LVH regression, which is associated with reduction in both cardiovascular morbidity and mortality.

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“…Past studies documented that an exaggerated rise in SBP is associated with failure to reduce total peripheral resistance and impaired endothelial vasodilator function 6. An exaggerated exercise SBP response is also associated with other established cardiovascular risk factors, such as insulin resistance, hypercholesterolemia, and carotid atherosclerosis 7, 8, 9. Arterial stiffening has also been proposed as a potential mechanism for an elevated exercise SBP response observed during both peak10 and submaximal exercise intensities 11…”

mentioning

confidence: 99%

Association of Thoracic Aorta Calcium Score With Exercise Blood Pressure Response and Clinical Outcomes in Elderly Individuals: Differential Impact of Aorta Calcification Compared With Coronary Artery Calcification

Cho

Chang

Cho

et al. 2016

JAHA

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BackgroundThe structure of the aorta is considered to influence exercise systolic blood pressure (SBP) response, which, in turn, might impact upon adverse outcomes. The current study sought to investigate the relationship of aortic calcification and exercise SBP with adverse outcomes among elderly individuals.Methods and ResultsWe retrospectively reviewed 702 elderly individuals (>65 years of age) without obstructive coronary artery disease (CAD; luminal stenosis <50%) who underwent coronary computed tomography (CT) and exercise treadmill testing. ΔSBP stage2 and ΔSBP peak were defined as the difference in systolic blood pressure (SBP) between rest and stage 2 or peak exercise, respectively. Thoracic aortic calcium score (TACS) and coronary artery calcium score (CACS) were measured using CT scanning procedures. The primary endpoints were defined as all‐cause death, admission for heart failure, obstructive CAD requiring coronary intervention, and stroke. In multivariable models, ΔSBP stage2 and ΔSBP peak were positively related with log(TACS+1), even after adjusting for various clinical variables, baseline SBP, and CACS (P<0.001). During a median follow‐up period of 65 months, there were 59 events (8.4%). In a multivariate Cox regression model, independent predictors for all events were age (hazard ratio [HR], 1.12; 95% CI, 1.05–1.19; P<0.001), dyslipidemia (HR, 1.96; 95% CI, 1.14–3.37; P=0.015), and the 4th quartile of TACS (HR, 1.24; 95% CI, 1.03–1.49; P=0.024). Among individual events, the 4th quartile of TACS was the only independent predictor for stroke (HR, 2.15; 95% CI, 1.09–5.13; P=0.044), whereas CACS ≥400 mm3 was an independent predictor for obstructive CAD requiring intervention (HR, 7.04; 95% CI, 1.58–31.36; P=0.010).ConclusionsAortic calcification was related to SBP response during exercise and was an independent predictor for outcomes, especially stroke, regardless of resting SBP or CACS.

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Surrogate Markers for Cardiovascular Disease

Cited by 186 publications

References 168 publications

Protective effect of the G-765C COX-2 polymorphism on subclinical atherosclerosis and inflammatory markers in asymptomatic subjects with cardiovascular risk factors

Protective effect of the G-765C COX-2 polymorphism on subclinical atherosclerosis and inflammatory markers in asymptomatic subjects with cardiovascular risk factors

The electrocardiogram is an unreliable method of identifying left ventricular hypertrophy in stable, treated angina patients

Association of Thoracic Aorta Calcium Score With Exercise Blood Pressure Response and Clinical Outcomes in Elderly Individuals: Differential Impact of Aorta Calcification Compared With Coronary Artery Calcification

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